Gippsland Sprout Co has, according to Food Standards Australia New Zealand, recalled Gippsland Sprout Co Mung Beans and Flowerdale Farm Mung Sprouts due to microbial contamination (E.coli). These products have been available for sale from Melbourne Wholesale Fruit and Vegetable Market (Footscray), small grocery stores (including Inverloch Foodworks ) and green grocers in Victoria.
No details on how this E. coli was detected, what kind of E. coli, or if anyone is sick.
Why bother editing; it’s all below in this letter from the current issue of Emerging Infectious Diseases, Identifying risk factors for shiga toxin–producing Escherichia coli by payment information.
During May and June 2011, a large outbreak of hemolytic uremic syndrome (HUS) and diarrhea caused by Shiga toxin–producing Escherichia coli (STEC) occurred, centered on northern Germany (1,2). Early on, salads and raw vegetables were suspected to be food vehicles (3). Also in May, the staff department of a local company informed the Health Protection Authority in Frankfurt in southwestern Germany about the rapidly increasing number of patients with bloody diarrhea and HUS among employees at 2 company office sites. Both sites were served by cafeterias run by the same caterer. Main dishes were prepared in the cafeterias’ kitchens and differed between the 2 .jpg)
sites. However, in both cafeterias various fresh foods from a salad bar and fruits, desserts, and daily asparagus dishes originated from the caterer’s main kitchen. The salad bar included 30 items. Suspecting that this outbreak was linked to the one in northern Germany, we conducted an outbreak investigation to confirm the epidemiologic link to focus epidemiologic and traceback investigations.
A face-to-face survey among hospitalized employees and by email among all other employees was conducted, which included personal details, symptoms, and information about general food eaten at the cafeterias. We defined outbreak cases as infections in employees of the company at 1 of the 2 sites who by May 23, 2011, were either hospitalized with bloody diarrhea or HUS or who self-reported onset of bloody diarrhea from May 8 through May 23. A total of 320 persons responded to the survey, and 285 (89%) of 320 of the responders stated they used the cafeterias; 60 employees fulfilled our case definition. Case-patients’ median age was 33 years (range 22–60 years); 36 (60%) of 60 were female. Thirty case-patients were hospitalized; HUS developed in 18 (30%) (Figure A1). Disease onsets occurred over 9 days. Beginning and magnitude of the outbreak were not different between cafeteria locations. Bacteriologic diagnostics for 11 patients yielded results that are compatible with the outbreak strain (4).
We used billing data from the cafeterias’ obligatory cashless payment system to ascertain risk factors for disease. A nested case–control study design was chosen, limited to a fraction of the cohort to obtain rapid risk estimates. Exposures included were purchases of any fruit, salad bar item, dessert, or asparagus dish in either cafeteria from May 2 through May 13. On the basis of customer identification numbers, the caterer provided billing information for persons with early cases (n = 23). Controls were randomly chosen persons from the caterer’s database whose disease status was checked against the survey information (n = 30) and who did not report symptoms of diarrhea (nonbloody), vomiting, or nausea during the same period. Univariable logistic regression was performed.
In univariable analysis, salad bar purchases were highly associated with illness (odds ratio 5.19; 95% CI 1.28–21.03), and desserts, fruit, and asparagus dishes were not (Table). Three (9%) of the case-patients remained unexposed to salad bar items according to the payment system data. The analysis of main courses purchased in 1 cafeteria revealed that no such meal had been consumed by >5 (22%) of 23 case-patients. Beginning May 23, the cafeterias were closed for 1 week, and salad sales were suspended for a longer period. There were no additional cases.
These results and the identification of the same rare serotype of O104:H4 renders this a satellite outbreak to the larger outbreak in northern Germany, which is the largest outbreak in terms of HUS ever described worldwide. Sprouts are believed to be the food vehicle (5). Sprouts available in the Frankfurt cafeteria salad bars were traced back to a producer of fenugreek sprouts, which appear to be the common source of primary cases in the entire outbreak (5). Sprout consumption could not be studied directly in Frankfurt because of the intense media attention on the sprout hypothesis once it had been announced. Also, it was thought that too much time had passed to successfully recall actually selected salad bar items consumed a few weeks previous.
Cafeteria billing information allowed for a rapid investigation while avoiding exposure misclassification attributable to ill-remembered food purchases (6). Using data sources independent of individual memory is quite useful. In previous studies, similar tools were successfully applied for the detection of outbreak vehicles. Credit card information was used during an investigation on STEC in beef sausages in Denmark (7), supermarket purchase records for STEC in Iceland (8), and grocery store loyalty card records for cyclosporiasis in Canada (9). Shopper card information was used in the United States in an outbreak of Salmonella enterica 
serovar Montevideo (10). However, billing information also could have introduced exposure misclassification, e.g., purchased food that was left uneaten or brought for colleagues. Analysis on ingredient level is often not possible. This study emphasizes the need for recall-independent investigation methods. In settings where such methods are available, they should be exploited early and relevant data saved from routine deletion.
Hendrik Wilking , Udo Götsch, Helma Meier, Detlef Thiele, Mona Askar, Manuel Dehnert, Christina Frank, Angelika Fruth, Gérard Krause, Rita Prager, Klaus Stark, Boris Böddinghaus, Oswald Bellinger, and René Gottschalk
Author affiliations: Robert Koch Institute, Berlin, Germany (H. Wilking, M. Askar, M. Dehnert, C. Frank, G. Krause, K. Stark); Health Protection Authority, Frankfurt am Main, Germany (U. Götsch, B. Böddinghaus, O. Bellinger, R. Gottschalk); Veterinary Service, Frankfurt am Main (H. Meier, D. Thiele); Robert Koch Institute, Wernigerode, Germany (A. Fruth, R. Prager)
Acknowledgment
We are grateful to the caterer, the employees, and the company management for their cooperation. We thank each member of the Robert Koch Institute HUS Investigation Team for their indispensable work and the coordinators of the German Postgraduate Training for Applied Epidemiology and the European Programme for Intervention Epidemiology Training for their help.
References
Frank C, Werber D, Cramer J, Askar M, Faber M, an der Heiden M, Epidemic profile of Shiga-toxin–producing Escherichia coli O104:H4 outbreak in Germany. N Engl J Med. 2011;365:1771–80. DOI PubMed
Wadl M, Rieck T, Nachtnebel M, Greutélaers B, An der Heiden M, Altmann D, Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin–producing Escherichia coli in Germany, May to June 2011. Euro Surveill. 2011;16:pii:19893.
Frank C, Faber M, Askar M, Bernard H, Fruth A, Gilsdorf A, Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011. Euro Surveill. 2011;16:pii:19878.
Bielaszewska M, Mellmann A, Zhang W, Köck R, Fruth A, Bauwens A, Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect Dis. 2011;11:671–6.PubMed
Buchholz U, Bernard H, Werber D, Böhmer MM, Remschmidt C, Wilking H, German outbreak of Escherichia coli O104:H4 associated with sprouts. N Engl J Med. 2011;365:1763–70. DOI PubMed
Decker MD, Booth AL, Dewey MJ, Fricker RS, Hutcheson RH, Schaffner W. Validity of food consumption histories in a foodborne outbreak investigation. Am J Epidemiol. 1986;124:859–63.PubMed
Ethelberg S, Smith B, Torpdahl M, Lisby M, Boel J, Jensen T, Outbreak of non-O157 Shiga toxin–producing Escherichia coli infection from consumption of beef sausage. Clin Infect Dis. 2009;48:e78–81. DOI PubMed
Sigmundsdottir G, Atladottir A, Hardardottir H, Gudmundsdottir E, Geirsdottir M, Briem H. STEC O157 outbreak in Iceland, September-October 2007. Euro Surveill. 2007;12(11):E071101.2.
Shah L, MacDougall L, Ellis A, Ong C, Shyng S, LeBlanc L. Challenges of investigating community outbreaks of cyclosporiasis, British Columbia, Canada. Emerg Infect Dis. 2009;15:1286–8. DOI PubMed
Centers for Disease Control and Prevention. Salmonella montevideo infections associated with salami products made with contaminated imported black and red pepper—United States, July 2009–April 2010. MMWR Morb Mortal Wkly Rep. 2010;59:1647–50.PubMed
Figure
Figure A1. Patients with Shiga toxin–producing Escherichia coli/hemolytic uremic syndrome (STEC/HUS) by onset of diarrhea and cafeteria visit (location A or B) during STEC/HUS outbreak at a company in Frankfurt, Germany,…
Table
Table. Univariable analysis of risk factors for bloody diarrhea among users of 2 cafeterias in Frankfurt, Germany, 2011
Suggested citation for this article: Wilking H, Götsch U, Meier H, Thiele D, Askar M, Dehnert M, et al. Identifying risk factors for Shiga toxin–producing Escherichia coli by payment information [letter]. Emerg Infect Dis [serial on the Internet] 2012 Jan [date cited]. http://dx.doi.org/10.3201/eid1801.111044
DOI: 10.3201/eid1801.111044
SA Sprouts is recalling all of its sprouts varieties from Foodlands, IGAs and Fruit and vegetables stores in South Australia due to microbial contamination (E. coli). Customers can return the sprouts to the place of purchase for a full refund or throw them away.
No one is sick that anyone knows of.
The recalled varieties include:
SA Sprouts – Alfalfa & Varieties
Alfalfa & Onion 125 grams
Alfalfa Sprouts 125 grams
Green Alfalfa Sprouts 125 grams
Alfa & Chinese Cabbage 125 grams
Alfalfa & Radish 125 grams
Alfalfa & Mustard 125 grams
Alfalfa Sprouts 200 grams
Alfalfa Sprouts Fresh Organic Sprouts 125 grams
SA Sprouts – Other
Snow Pea Sprouts in 125g packs
Mung Bean Sprouts in 125g packs
Salad Mix in 175g pack
A table of international sprout-related outbreaks is available at http://bites.ksu.edu/sprouts-associated-outbreaks.
People who write with exclamation marks or IN ALL CAPS are yelling. And trying to disguise their inability to write clear, compelling sentences.
So when Green Valley Food Corp. announced it was recalling 650 cases of “Let’s Grow Healthy Together!” Alfalfa Sprouts 5 oz. containers and proclaimed, “Till this present day there has been no 
related illnesses CONFIRMED because of this recall” I wondered, why are they yelling, and what does CONFIRMED mean.
And who says, till this present day? In Texas?
The company also wrote the Let’s Grow Healthy Together! sprouts were recalled “because the results showed to be contaminated with Salmonella, an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.”
The results weren’t contaminated; the sprouts were contaminated with salmonella.
A table of sprout-related outbreaks is available at http://bites.ksu.edu/sprouts-associated-outbreaks.
“Let’s Grow Healthy Together!” Alfalfa Sprouts 5 oz. containers were distributed in Texas via truck deliveries to all customers in Texas. All customers were retail chains and food distribution centers. If you are a customer affected by this recall you will be receiving a letter asking for the quantities you were shipped and their whereabouts. Please, respond as soon as possible.
A letter? Who uses the post office in a recall situation involving fresh and perishable produce?
The product is in a plastic container that measures 4-inch by 4-inch container that has a lid. The containers UPC number is 714722228818. The label has blue lettering that states “Let’s Grow Healthy Together!” Alfalfa Sprouts 5 oz. containers. The code date on the shipping box is an orange tag that will state the number,”3440210”. The “Let’s Grow Healthy Together!” Alfalfa Sprouts 5 oz. containers will have a white tag on the upper right hand side of the label with the date of 1/1/2012.
Public health folks in the city of Hamburg are being sued for €2.3 million (about $3 million USD) after their market was damaged during an outbreak of E. coli O1O4 which was later linked to fresh sprouts. Spanish company Frunet, lodged the claim and is seeking damages for sullying the country’s reputation.
In response to the suit, according to AFP, German health authorities are supporting their summer cucumber warning,
"The Office for Health and Consumer Protection rejects these claims since the warning about the company’s cucumbers was necessary and right," the health office said in a written statement.
Insisting it believed it had taken the right course of action in issuing a warning with the information it had at the time, it said: "Protecting health comes before economic interests of companies."
The European Union provided €227 million in compensation for European producers of cucumbers, tomatoes, lettuce, courgettes and sweet peppers, withdrawn from the market as a result of the disease.
This isn’t a unique lawsuit, earlier this year Del Monte sued the state of Oregon following an outbreak investigation linked to their products.
Paul Mead, of the oft-quoted Mead et al paper (76 million illnesses a year) was once cited as saying, "Food safety recalls are either too early or too late. If you’re right, it’s always too late. If you’re wrong, it’s always too early."
From July to Oct. 2010, 136 people in London and east England were sickened by Salmonella Java phage type 3b variant 9. Gobin et al., from the U.K. Health Protection Agency, report in Eurosurveillance today that most cases were female with a median age of 39.5 years and lived in London. Results of epidemiological investigations are compatible with salad vegetables as the potential source, but no common suppliers of salad were identified and no organisms were isolated from environmental and food samples.
S. Java is present in poultry flocks in the European Union and is the most common serovar reported in poultry in the Netherlands. Outbreaks of S. Java have been reported in the past, associated with salad vegetables, goat’s milk cheese, poultry, reptiles and tropical fish .jpg)
aquariums. S. Java is an uncommon cause of salmonellosis in the United Kingdom (UK), with 151, 112 and 130 cases reported in 2007, 2008 and 2009 respectively according to the national database.
In 2007, a multi-country outbreak of S. Java phage type (PT) 3b variant 9 (var9) involved cases in Denmark, Finland, the Netherlands, Norway, the UK and the U.S. Epidemiological evidence suggested an association with salad vegetables.
The results of the case–case study confirmed a significant association between symptomatic infection of S. Java PT 3b var9 and eating out at restaurants, eating pre-packaged mixed salad leaves at home, consumption of salad leaves from takeaway restaurants and eating any salad leaves either at home or purchased from commercial catering settings. Since salad is often used as a garnish in meals eaten in commercial catering settings, it is possible that the model underestimated the proportion of cases who consumed salad leaves away from home.
We cannot exclude the possibility that the study may have missed the right vehicle of the outbreak such as sprouted seeds which have been implicated in two recent outbreaks in Europe. It is likely that the consumption of smaller food items (seeds, sprouted seeds and herbs) in salads prepared by commercial caterers was not remembered or was not noticed by cases. None of the smaller salad items were found to be associated with cases during the hypothesis generation. It is possible that salad leaves were a confounding factor in this investigation and smaller, less memorable items should be considered in outbreaks where salad vegetables appear to be implicated.
Environmental investigations did not identify common suppliers of salad vegetables and the short shelf life of salad vegetables limited the ability to acquire any suspect foods for microbiological analysis.
The contamination of salad leaves and salad vegetables during their production and processing has been implicated in a number of geographically widespread outbreaks. High risk practices during production and processing include the use of contaminated water either to irrigate the crops, to apply pesticides or other dressings, or to wash the crop once harvested; the use of human or animal sewage as a crop fertilizer; and the transport of the harvested crop in a contaminated vehicle/storage system, e.g. trucks previously used for transporting waste. Crops growing in the field are also vulnerable to contamination from sources such as wild animals and birds
Gastrointestinal infection associated with salad vegetables may also be the result of cross-contamination from poultry, meat or meat products or contamination by the food handler during food preparation in the home or in catering establishments. A review of more than 2,000 general .jpg)
foodborne outbreaks from 1992 to 2006 undertaken by the HPA found that 4% of them were associated with prepared salads. The review found that most of the outbreaks linked to salads occurred in the catering sector and were associated with infected food handlers, cross-contamination and poor storage.
The increase in illness and outbreaks associated with the consumption of fresh ready to eat salad vegetables indicates the ongoing need to improve methods in the production and preparation of these foods to reduce the potential for contamination with Salmonella and other enteric pathogens.
The complete epidemiological write-up, with a full discussion of limitations, is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20023.
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Six months after 53 people were killed and over 4,000 sickened with E. coli O104 in raw sprouts, the European Food Safety Authority (EFSA) said today that producers of sprouted seeds should tighten safety measures along the production chain.
Duh.
Pathogenic bacteria such as Escherichia coli (E.coli) can contaminate the seeds intended for sprouting during production, storage and distribution through contaminated irrigation water and soil particles, in a statement on Tuesday.
The high temperatures and humidity needed for the germination and sprouting of seeds are also favorable conditions for bacteria to grow and spread, while consumption of raw or minimally 
processed sprouted seeds pose additional safety concerns, EFSA said.
Producers should ensure safe use of fertilizers and irrigation water, minimize contamination of seeds with soil during harvest and prevent mechanical damage of seeds, it said.
Producers should also make sure that seeds are transported, processed and stored under conditions minimizing the potential for microbial contamination.
They should remove damaged seeds and improve the ability to trace seed lots, it said.
People who forgot to mention they had eaten sprouts may have thrown disease trackers off the trail as they sought to trace the source of the deadly strain of E. coli that sickened more than 4,300 people and killed at least 50 in Europe this year, according to a study published in the New England Journal of Medicine.
While a definitive genetic link remains elusive, three separate lines of investigation point to sprouts as the means by which the deadly O1O4:H4 strain of the bacteria was spread, researchers led by Udo Buchholz at the Robert Koch Institute in Berlin, Germany’s disease-control agency.
Buchholz and colleagues wrote, “The one dish that frequently exposed guests to sprouts was the side salad, which contained tomatoes, cucumbers, three sorts of leaf salads, and sprouts. Sprouts .jpg)
may have been the ingredient that visitors recalled least in such a mixed salad.”
Buchholz and colleagues conducted three studies in parallel. The first involved asking patients hospitalized with E. coli infection about their recent food consumption, and comparing that with food eaten by uninfected people. It found that “the only significant variable was sprouts.”
The second study identified 10 groups of diners who ate at a restaurant in Luebeck between May 12 and 16. It found that among 115 people who had been served sprouts, 31 fell ill, compared with none of those who had not eaten sprouts.
The third investigation traced 41 clusters of infections to a producer in Lower Saxony, who grew sprouts from seeds that came from a “supplier X,” Buchholz and colleagues wrote, without identifying either the producer or the supplier. A European Commission task force said in July that the sprouts were probably grown from fenugreek seeds imported from Egypt in 2009. The researchers still don’t know whether the seeds were contaminated before, during or after export from Egypt.
In an accompanying editorial, Martin J. Blaser, M.D. from the Departments of Medicine and Microbiology, New York University, writes the chain of transmission appears to have begun in Egypt, with fecal contamination of fenugreek seeds by either humans or farm animals during storage or transportation, perhaps as long ago as 2009. The seeds then went to a European distributor and from there to farms in several countries. During sprout germination, bacteria multiplied and moved from farm to restaurants and consumers, as Buchholz et al. extensively .jpg)
detail in their study. The evidence for such a series of events is compelling, even though the organism was not identified at the earliest steps, since the trail often is cold in point-source outbreaks by the time investigators are able to conduct trace-back investigations.
German outbreak of Escherichia coli O104:H4 associated with sprouts
26.oct.11
The New England Journal of Medicine
Udo Buchholz, M.D., M.P.H., Helen Bernard, M.D., Dirk Werber, D.V.M., Merle M. Böhmer, Cornelius Remschmidt, M.D., Hendrik Wilking, D.V.M., Yvonne Deleré, M.D., Matthias an der Heiden, Ph.D., Cornelia Adlhoch, D.V.M., Johannes Dreesman, Ph.D., Joachim Ehlers, D.V.M., Steen Ethelberg, Ph.D., Mirko Faber, M.D., Christina Frank, Ph.D., Gerd Fricke, Ph.D., Matthias Greiner, D.V.M., Ph.D., Michael Höhle, Ph.D., Sofie Ivarsson, M.Sc., Uwe Jark, D.V.M., Markus Kirchner, M.D., M.P.H., Judith Koch, M.D., Gérard Krause, M.D., Ph.D., Petra Luber, Ph.D., Bettina Rosner, Ph.D., M.P.H., Klaus Stark, M.D., Ph.D., and Michael Kühne, D.V.M., Ph.D.
http://www.nejm.org/doi/full/10.1056/NEJMoa1106482?query=featured_home
Human infection with Shiga-toxin–producing Escherichia coli is a major cause of postdiarrheal hemolytic–uremic syndrome. This life-threatening disorder, which is characterized by acute renal failure, hemolytic anemia, and thrombocytopenia, typically affects children under the age of 5 years. Shiga-toxin–producing E. coli O157 is the serogroup that is most frequently isolated from patients with the hemolytic–uremic syndrome worldwide.1
In May 2011, a large outbreak of the hemolytic–uremic syndrome associated with the rare E. coliserotype O104:H4 occurred in Germany.2-5 The main epidemiologic features were that the peak of the epidemic was reached on May 21 and May 224,5 and that the vast majority of case subjects either resided or had traveled in northern Germany. Almost all patients from other European countries or from North America had recently returned from northern Germany.2,6,7 Of the affected case subjects, 90% were adults, and more than two thirds of case subjects with the hemolytic–uremic syndrome were female.4
Early studies in Hamburg suggested that infections were probably community-acquired and were not related to food consumption in a particular restaurant. A first case–control study that was conducted on May 23 and 24 suggested that raw food items, such as tomatoes, cucumbers, or leaf salad,3 were the source of infection. The consumption of sprouts, which was previously implicated in outbreaks of Shiga-toxin–producing E. coli in the United States8 and Japan,9 was mentioned by only 25% of case subjects in exploratory interviews, so consumption of sprouts was not tested analytically.
This report describes the investigations that were conducted by the federal agencies under the auspices of the German Ministry of Health and the Ministry of Food, Agriculture, and Consumer Protection, as well as by the respective state agencies, to identify the vehicle of infection of this international outbreak.
Maybe something was lost in translation, but Prof. Christian Gerloff, Head of Neurology at the Hamburg-Eppendorf University Hospital (UKE), told the annual congress of the German Society for Neurology in Wiesbade on Sept. 28, 2011, that despite their life-threatening infection, most E. coli O104-in-raw-sprouts patients have recovered well from the summer’s epidemic.
The professor described how the wave of illness, caused by contaminated bean sprouts, was new territory for neurology. The neurology department had to help "in the crisis management of an 
epidemic for the first time."
According to the Robert Koch Institute, almost 3,500 EHEC cases were registered in Germany between May and July 2011. 50 patients, who were infected with the aggressive intestinal germ, .jpeg)
died of the disease.
Gerloff stated that, of the around 100 patients who were treated for the most intense course of the disease, only three are still displaying symptoms, such as paralysis or lalopathy. He explained that everyone else has recovered very well.
In each case, the illness began with diarrhea. However, every third patient was also hit by a life-threatening kidney failure –hemolytic-uremic syndrome (HUS). In addition, every sixth patient developed acute neurological disorders; in some cases seizures, in other cases epileptic fits, said Gerloff. "Patients fell into a coma within a few days."
Gerloff also reported that some EHEC cases resulted in neurological disorders without HUS. As such, the disorders do not always relate to the kidney failure.
