Food Poisoning Lawyer & Attorney : Marler Clark : Food Poison Blog

Claudia Sanders Dinner House in Shelbyville, KY proves again that sometimes its the really popular places that can be the most dangerous for eating and drinking.

After making more than 100 people god-awfully sick with Staphylococcus bacteria on Easter Sunday, the southern landmark is going to re-open for weekend business, beginning tonight with the lounge.

Scott Harvey at WAVE 3, the NBC affiliate in Louisville, spent today (3/28/08) with Health Department officials finding out more than most people probably want to know about staph infection.  In the WAVE 3 report, he says:

Preliminary tests released by state health officials show the Staphylococcus bacteria or Staph Infection caused the problems. But they still don't know what the source was.

"The Health Department felt that we got some bad ham," said (Dinner House Manager) Riley. "But again, we are still waiting on the report so I will be glad to get it in black and white."

Dr. Matt Zahn, Medical Director for the Metro Public Health Departments, says the bacteria is common. "If you look at every person in Louisville, or around the country, about one in three of us at any one period of time will have this staph bacteria on our system."

Harvey also learns its not the bacteria, but the toxin it produces, that makes people so sick.  Check out the whole story here.

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KVUE-TV News in Austin, Texas is reporting that one child has died and five other people are ill all due to a shiga toxin.   Since an initial report on the illnesses issued late last week by the Texas Department of Health Services, concern about the shiga toxin has become very serious.

As reported by KVUE Reporter Erin Ochoa,  most of the cases are found in Bastrop County, located in southeast Texas.  Ochoa reports that:

It was about nine days ago when 18-month-old Michael Rick became ill. Michael's mother, Sylvia Rick, says he was hospitalized and treated and is improving.She believes he may have been one of six people recently diagnosed with a serious diarrheal illness caused by a shiga toxin."He got sick about a week ago," Rick said. "He had some really bad diarrhea, was throwing up not too much, just a little bit and it just progressively got worse."

Shiga toxins are usually foodborne, but health officials are still trying to figure out the exact source of the bacteria. Symptoms usually appear one to nine days after exposure, and include severe or bloody diarrhea and abdominal cramps.

"The bacteria that can produce this shiga toxin typically live in the intestines of animals, so the origin is usually going to be related to fecal matter from animal waste," said Doug McBride, spokesperson for the Texas Department of State Health Services.He says there are anywhere from 100 to 200 cases of illnesses due to the shiga toxin each year in Texas, but it's rarely fatal.

According to the state health department, six cases have already been reported:-- Four in Bastrop County-- One in Fayette County-- One in Lee County.

Three of the cases were children. One of those children died."What's unusual about this is to have six cases within a few days and in a relatively small geographical area," McBride said.Health official are awaiting the results of lab tests to identify a specific bacteria. They're asking anyone who has any of these symptoms to seek medical care.

The KVUE-TV story can be found here.

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This week's food safety infosheet (pdf) from the International Food Safety Network focuses on what we learned this week - that ground beef is once again the source of a multi-state E. coli outbreak.  At least five people in Wisconsin and one California resident became ill with E. coli infections after consuming meat produced by Rochester Meats of Michigan.  According to the Food Safety and Inspection Service's recall announcement from last weekend:

The problem was discovered through an investigation initiated by the Wisconsin Department of Health and Family Services and the California Department of Public Health into five illnesses in Wisconsin and one illness in California. Anyone concerned about an illness should contact a physician.

The ground beef products subject to recall were produced on Oct. 30, 2007, and Nov. 6, 2007. The products subject to recall were shipped to distributors nationwide for further distribution to restaurants and food service institutions. These products were not available for purchase by consumers in retail establishments.

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The outbreak investigation into the Listeria outbreak traced to the consumption of Whittier Farms milk products revealed contamination in several areas of the milk plant, according to reports from the Boston Herald and the Metro West Daily News. 

The Massachusetts Department of Public Health announced today:

More than 100 environmental and milk samples were taken from the processing plant as part of the investigation. A total of twelve milk samples and four environmental samples tested positive for varying strains of Listeria contamination (see summary below).

The findings do not pinpoint where the contamination of the milk occurred, but they do suggest that Listeria bacteria colonized somewhere in the processing plant and that the bacteria entered the milk products at some point during the production process. Records indicate that the plant’s equipment met federal standards for time, temperature and flow for effective pasteurization, however, pasteurization at the processing plant will be further examined.

The presence of Listeria in the physical plant of the facility is consistent with contamination occurring during post-pasteurizing processing and bottling. One theory under consideration by health officials is that cleaning activities at the plant may have unintentionally caused contamination of the processing equipment allowing bacteria to enter the finished milk products. Three of the four positive environmental tests for Listeria were collected from sections of the plant that are considered part of the post-pasteurization areas of the facility.

Listeria is the common name for the pathogenic or disease-causing bacterium known as Listeria monocytogenes. It is a foodborne illness that when ingested causes an infection known as listeriosis (Cossart & Bierne, 2001). Approximately 2,500 illnesses and 500 deaths are attributed to listeriosis in the United States annually (CDC, 2005).

Listeria is ubiquitous in the environment, and can be isolated from wild and domestic animals, birds, insects, soil, wastewater, and vegetation. The bacterium easily comes into contact with farm animals as it has been found to be present in grazing areas, stale water, and poorly prepared animal feed. In addition to being present in the environment, Listeria can live in the intestines of humans, animals and birds for long periods of time without causing infection. Because Listeria is present in nearly every environment - including in some food processing facilities - numerous opportunities for contamination exist during the food production process (Cossart & Bierne, 2001).

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Public health officials in South Dakota have confirmed 22 cases of Salmonella Newport that is similar to a strain of Salmonella Newport that has been identified as causing illness among residents of four other states.  An outbreak investigation is under way to determine whether victims of the outbreak ate the same food, but so far investigators have not been able to pinpoint the source of the outbreak. 

Genetic "fingerprinting" of the Salmonella strain isolated from victims' stool has helped public health agencies in the five states and at the Centers for Disease Control and Prevention (CDC) in their investigation.  The process of obtaining the DNA fingerprint is called Pulse Field Gel Electrophoresis, or PFGE. This technique is used to separate the DNA of the bacterial isolate into its component parts. It operates by causing alternating electric fields to run the DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments — or “fingerprints” — in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of E. coli O157:H7 as well as strains of listeria and campylobacter, and other pathogenic bacteria.  The PFGE pattern of the bacteria can then be compared and matched up to the PFGE pattern of the strain of infected persons who consumed the contaminated product. When PFGE patterns match, they, along with solid epidemiological work, are proof that the contaminated product was the source of a person's illness.

The Rapid City Journal reported on the outbreak today:

So far, health officials have confirmed 22 cases of a specific strain of the bacterial-borne intestinal disorder in the four states. All of South Dakota's 11 cases -- nine adults and two children -- were in the Black Hills area. Six of the 11 victims were hospitalized, five at Rapid City Regional Hospital.

"Everybody's recovering," state epidemiologist Lon Kightlinger of the South Dakota Department of Health in Pierre said Monday. "But since we've had so many of these cases hospitalized, which is fairly unusual, it leads me to believe it is a fairly potent strain."

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The Bellingham Herald reported today on a Campylobacter jejuni outbreak that has been traced to the consumption of raw milk purchased from a Whatcom County, Washington, dairy. 

In December, the Whatcom County Health Department issued a warning to consumers that Campylobacter had been isolated from a sample of milk produced at the Pleasant Valley Dairy in Ferndale.  The Seattle Post-Intelligencer reported:

The bacteria were found in a routine testing sample taken Dec. 11, the department said.

Local health departments are reviewing Campylobacter illness reports that may be related to the milk, the news release said. Symptoms of the illness usually occur two to five days after ingestion and generally last for seven to 10 days.

The milk was sold in half-gallon plastic containers at the Pleasant Valley farm store and at Barganica, Community Food Co-op and Terra Organica in Bellingham; Skagit Valley Co-op in Mount Vernon; Arlington Health, Petosa's, Manna Mills, Tru Health and Bob's Corn Patch in Snohomish County; and Spuds in Seattle, the news release said.

Now, health officials are saying that at least five people became ill with Campylobacteriosis, the illness caused by the ingestion of Campylobacter bacteria, after drinking raw milk produced by the Pleasant Valley Dairy.  According to the story in the Herald:

Four Whatcom County residents and one Skagit County resident tested positive for the same campylobacter jejuni strain that was found in a routine sample of raw milk from Pleasant Valley Dairy. The dairy pulled that batch of milk from the shelves and has resumed its distribution of raw milk.

The dairy has changed its testing procedures to reduce the risk of releasing contaminated milk, the health department said.

Outbreaks traced to the consumption of raw milk are not all that uncommon.  The International Food Safety Network has posted a list of outbreaks on its website.

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The Boston Globe reported today on the death of an 87-year-old man who passed away after suffering a Listeria infection he contracted from drinking milk supplied by the Whittier Farms Dairy.  Stephen Smith, the story's author, wrote about this most recent death and about the illness of a pregnant woman and her baby:

The 87-year-old man fell ill in November and died Thursday, said Donna Rheaume, spokeswoman for the state department of public health.

The number of people sickened by listeria bacteria also rose to five after health officials linked a 31-year-old woman's listeriosis, diagnosed in September, to products from the diary.

The infection was detected while the woman was in the hospital to deliver a baby, and "both mother and child are doing well," Rheaume said.

Elderly populations and pregnant women are the most vulnerable populations to Listeriosis, the illness caused by the ingestion of Listeria monocytogenes bacteria. 

Certain groups of individuals are at great risk for listeriosis. These are pregnant women (and their unborn children) and immunocompromised persons (e.g., transplant recipients). Among infants, listeriosis occurs when the infection is transmitted from the mother, either through the placenta or during the birthing process. These host factors, along with the amount of bacteria ingested and the virulence of the strain, determine the risk of disease.

Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body Listeria bacteria can travel through the blood stream, but are often found inside cells (they are "intracellular" pathogens). Listeria can co-opt the cell's machinery to its own advantage by manipulating the host cell genes, and then move directly from cell-to-cell, avoiding many of the host's defense mechanisms5. The bacteria also produce toxins that damages cells.

For unknown reasons, in immune-deficient hosts Listeria invades and grows best in the central nervous system, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus is most heavily infected, leading to spontaneous abortion, stillbirths, or sepsis in infancy.

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Public health officials in Massachusetts have confirmed that a listeriosis outbreak was caused by the consumption of milk purchased from Whittier Farms.  They used Pulsed Field Gel Electrophoresis (PFGE) to obtain the "genetic fingerprint" of the strain of Listeria that was isolated from case-patients and milk provided by the dairy for testing. 

PFGE is a technique used to separate the DNA of a bacterial isolate into its component parts. It operates by causing alternating electric fields to run the bacteria's DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments — or “fingerprints” — in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of Listeria, E. coli O157:H7, and and other pathogenic bacteria.

PFGE patterns of bacteria isolated from products can be compared and matched to PFGE patterns of bacteria isolated from people suffering illness after consuming contaminated products. When PFGE patterns of bacteria isolated from foods and human samples match, they, along with solid epidemiological work, provide proof that the contaminated product was the source of a person's illness.

The Boston Globe reported on the outbreak investigation today:

"The pattern is very unique," said Dr. Alfred DeMaria, the state's director of communicable disease control. "It means there's an outbreak here. There's no question there's an outbreak. And it implies that the dairy is the common source."

It is exceedingly rare, disease investigators said, to discover that cases of listeria are caused by germs with identical genetic profiles. Instead, each infection tends to be the result of a slightly different form of the bacterium.

In 19 other cases in 2007 in Massachusetts, each infection was caused by a germ with a distinctive fingerprint. Similarly, there were no genetic matches among 99 listeriosis cases in the previous five years.

That, specialists said, is why it was so telling that the samples from the dairy, the patient's refrigerator, and the four patients all matched.

According to the article, the investigation is now focusing on the packaging process as the potential source of contamination. 

More information on the outbreak investigation is available on the MDH website. 

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The Milford Daily News reported that two people died after drinking milk produced by Whittier Farms in Shrewsbury, Massachusetts.  According to the story, the Massachusetts Department of Public Health issued a warning to consumers not to drink milk produced by the dairy because it might be contaminated with Listeria monocytogenes. 

Whittier Farms distributes most of its milk to homes in the greater Worcester/Shrewsbury area under the brands Whittier, Schultz, Balance Rock, Spring Brook, and Maple. The dairy has ceased production until health officials are able to determine where the contamination occurred.

According to the Milford Daily News:

Four cases of listeriosis infection have been identified by DPH, according to a statement released by the state department late this afternoon. The cases occurred in June, October and two in November. The four cases involved three elderly residents and a pregnant woman from Worcester county. Two of the people have died. They have not been identified.

DNA fingerprinting conducted by the State Laboratory Institute showed that the bacteria causing these infections came from a common source. Samples collected showed product contamination.

Pregnant women are about 20 times more likely than other healthy adults to get listeriosis. About one-third of listeriosis cases happen during pregnancy. The incidence of listeriosis in the newborn is 8.6 per 100,000 live births. There is no routine screening test for susceptibility to listeriosis during pregnancy, as there is for rubella and some other congenital infections. Newborns, rather than the pregnant women themselves, suffer the serious effects of infection in pregnancy. Persons with weakened immune systems due to treatment, particularly transplant recipients10 and persons on treatment for lymphoma, but also other cancer victims, are at significantly increased risk for Listeria infection.

• Persons with AIDS suffer listeriosis 65-145 times more frequently than the general population.
• Persons who take glucocorticosteroid medications (also called cortisone) are also at increased risk. The most common medication prescribed in this class is prednisone. The threshold above which prednisone begins to have a significant effect on the immune system is 20 mg per day for 5 days.
• The elderly and certain debilitated patients (such as those on dialysis or alcoholics) are at minor increased risk for listeriosis.

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The U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) issued a public health alert today after a joint investigation by state public health officials and the Centers for Disease Control and Prevention identified ground beef as the source of a multi-drug-resistant strain of Salmonella.  At least 38 people in Arizona, California, Hawaii, Nevada, and New Mexico became ill with Salmonella Newport infections after consuming the ground beef between September 19 and November 5, 2007.

FSIS stated in its public health alert:

This alert is being issued after an exhaustive and continuing investigation whereby FSIS could not identify specific establishments, lots and products that would be subject to a recall. FSIS has no reason to believe that these products are still available for sale in commerce.

Consumers that may have purchased these fresh ground beef products between Sept. 19 and Nov. 5, 2007, and stored them in the freezer should look for and discard or destroy these products if they find them. . . .

This particular strain of Salmonella is resistant to many commonly prescribed drugs, which can increase the risk of hospitalization or possible treatment failure in infected individuals.

Antimicrobial Resistance in Salmonella Bacteria

Antimicrobial resistance in bacteria is an emerging and increasing threat to human health. Physicians should be aware that antimicrobial resistance is increasing in foodborne pathogens and that patients who are prescribed antibiotics are at increased risk for acquiring antimicrobial resistant foodborne infections. In addition, “[i]increased frequency of treatment failures for acute illiness and increased severity of infection may be manifested by prolonged duration of illness, increased frequency of bloodstream infections, increased hospitalization or increased mortality.”

The use of antimicrobial agents in the feed of food animals is estimated by the FDA to be over 100 million pounds per year. Estimates range from 36% to 70% of all antibiotics produced in the United Sates are used in a food animal feed or in prophylactic treatment to prevent animal disease. The use of antibiotics is thought to promote growth and to prevent disease in beef, pork, and poultry production as well as on fish farms and some fruit and vegetable farms.

According to the National Antimicrobial Resistance Monitoring System (NARMS), Campylobacter has been recovered from 47% of chicken breasts tested in recent studies. In the same NARMS studies, five mulit-drug resistant strains of Salmonella Newport were recovered from ground beef, ground turkey and pork chops. According to the report, “[a]ntimicrobial resistance among these foodborne bacteria is not uncommon and often associated with the use of antimicrobial agents in food animals.” Ceftriaxone-resistant Salmonella has also been reported (Fey et al., 2000). The emergence of multidrug-resistant Salmonella typhimurium in the United States is another example of a drug-resistant bacteria spreading from animals to humans (Glynn et al., 1998).

The use of antibiotics in feed for food animals, on animals prophylactically to prevent disease, and the use of antibiotics in humans unnecessarily must be reduced. European countries have reduced the use of antibiotics in animal feed and have seen a corresponding reduction in antibiotic-resistant illnesses in humans.

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Public health officials in North Carolina have not been able to identify the foodborne pathogen that sickened at least 76 people who attended a Force Protection Industries plant dedication in Roxboro.  The cause of the food poisoning outbreak has thus far been narrowed down to pork loin and/or pasta vegetable salad, according to an article in the Roxboro Courier. 

When interviewed, David Bergmire-Sweat of the Epidemiology Section of the N.C. Division of Public Health noted that improper holding temperatures for food can contribute to the growth of bacteria.  As reported by the Courier:

“Cold foods should be held at 45 degrees or below and hot foods should be cooked to the proper temperature or reheated to 165 degrees and then maintained at 135 degrees or above,” officials emphasized.

The Force Protection function was held on Friday, Nov. 30, at the former Collins & Aikman Corp. Elm Plant, which FP has refitted for production of the company’s Cheetah bomb-resistant armored vehicle.

Approximately 400 people attended the dedication ceremony, and the health department reported that 76 of the 335 people contacted, after health officials began investigating on Dec. 4, reported suffering from symptoms such as abdominal cramping, diarrhea and chills.

Improper food handling and holding temperatures have contributed to the spread of pathogens in several other outbreak-situations.

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Over three dozen people in Arizona, California, Idaho, and Nevada have become ill with a strain of Salmonella since early October, according to reports in the Tucson Citizen and Arizona Republic.  Public health officials from the four states are investigating the source of the outbreak, and presently believe the source to be a food item. 

The Tucson Citizen reported on the outbreak:

Though salmonella outbreaks are not unusual, authorities are trying to identify a common source. A store chain, but likely not a restaurant, may have distributed a food product that hospitalized a dozen people — seven from Arizona — said Shoana Anderson, an infectious disease epidemiologist in Phoenix.

Arizona had 14 cases in all, California 18, Nevada three and Idaho one, Anderson and food-borne disease epidemiologist Joli Weiss said. The illnesses were reported between between Oct. 4 and Nov. 9 and all involved the same strain of the disease.

According to the Centers for Disease Control and Prevention, most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts 4 – 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and people with impaired immune systems are more likely than others to develop severe illness. In severe infection, Salmonella spreads from the intestines to the bloodstream and then to other body sites, and death can occur if the person is not treated promptly with antibiotics.

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The CDC's Morbidity and Mortality Weekly Report (MMWR) includes a report titled, "Norovirus Outbreak Associated with Ill Food-Service Workers --- Michigan, January--February 2006" this week.  In it, we learn that:

• On January 30, 2006, the Barry-Eaton District Health Department (BEDHD) in Michigan was notified of gastrointestinal illness in several members of two dining parties after a meal at an Eaton County restaurant on January 28.
  
• BEDHD began an investigation to identify the source and agent of infection
• Norovirus genogroup I (GI) was detected in stool specimens submitted by multiple patrons and employees.
  
• Several food-service workers had been ill during January 19--February 3, 2006, and that a line cook had vomited in the restaurant on January 28, possibly increasing environmental contamination and transmission of virus.
  
• At least 364 restaurant patrons became ill with norovirus during the outbreak. 
  

Norovirus is easily spread in restaurant settings.  This week's food safety infosheet from the International Food Safety Network (iFSN) focuses on norovirus, the symptoms of norovirus illness, and its source - poop.

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The LA Daily News reported that at least two LA-area restaurants have been identified as the source of norovirus outbreaks recently.  The Buca di Beppo restaurant located in the Valencia Town Center and the Marie Callender's restaurant located near Magic Mountain - both in Los Angeles County - were the source of food poisoning outbreaks that caused symptoms of vomiting, diarrhea, nausea, fever, and dehydration.  According to the Daily News, one employee who worked at both restaurants could have been the source of disease transmission. 

Ironically, this week's MMWR, published by the Centers for Disease Control and Prevention, contains a report on norovirus outbreaks at Michigan restaurants in early 2006.  An editorial note in the MMWR contains the following:

Norovirus can be transmitted person-to-person (via the fecal-oral route) and spread through contaminated airborne droplets, food, water, environmental surfaces, and fomites (3). In the outbreak described in this report, at least 364 restaurant patrons became ill with gastroenteritis after dining at a restaurant where employees had reported to work while ill. In a norovirus outbreak, a vomiting incident is a major risk factor for norovirus illness and can double the attack rate (4). In this outbreak, vomiting by a line cook at the work station might have contributed to transmission. Because of the open physical layout of the restaurant, no barrier impeded airborne spread of the virus from the kitchen to the main dining area. Attack rates increased after this incident, and among employees who worked on January 28, a higher percentage of line cooks became ill compared with servers. In addition, other environmental contamination probably contributed to transmission. Low-level transmission was occurring in the week before January 28; seven patrons who dined at the restaurant during January 21--27 met the case definition. During January 21--February 3, exposure to virus likely occurred by contact with contaminated surfaces and objects.

Norovirus, as seen here, is particularly easy to spread and is frequently spread through modes of transmission other than food.

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At least 1,000 people were exposed to what is believed to be Norovirus at a Santa Cruz, California, hotel.  Santa Cruz County Public Health (SCCPH) has identified at least 80 people who were sickened as part of the outbreak.  SCCPH chief of public health Bob Kennedy commented on the outbreak that, "We strongly suspect it's the Norovirus, but we hope to have lab results back by Monday."

KTVU.com reported:

About 1,000 people may have been exposed at a Santa Cruz area hotel, which Kennedy declined to name, between Nov. 9 and Thursday. Public health is attempting to contact each person who may have been exposed, including hotel staff and guests.

Hotel workers are being monitored for symptoms and if they display signs of illness will be sent home until they are symptom free for 24 hours. The health department is also reviewing food-handling practices with workers and has supervised a thorough cleansing of the kitchen, bathrooms and dining areas.

Anyone who suspects they are suffering from the illness should contact their physician.

The Contra-Costa Times revealed the name of the hotel associated with the outbreak in an article published yesterday:

County health officials gave the restaurant [at Sanderlings resort] the OK to reopen around 8:45 p.m. Friday with the following conditions:

Facility and equipment cleaning and disinfection supervised and approved by Public Heath Department staff was completed.

Sanderlings' 71 staff members had been interviewed by the county.

The employees received food handling education.

Sanderlings management will screen employees returning to work for illness and they will not be allowed to work if they feel sick at all. The management will also keep a log on this screening, which the Public Health Department can inspect on an unannounced basis.

Usual symptoms of Norovirus infection include nausea, vomiting, diarrhea, and abdominal pain. Headache and low-grade fever may also accompany this disease. The disease is usually mild and brief. It will develop 24 to 48 hours after contaminated food or water is ingested and lasts for 24 to 60 hours. People infected with Norwalk Virus usually recover in 2 to 3 days without serious or long-term health effects.

A 1999 study suggests that Norovirus may cause more outbreaks of food-borne illness than all bacteria and parasites. It is estimated that nearly 65% of nonbacterial gastroenteritis in the United States is attributable to Noroviruses. Approximately 181,000 cases occur annually, with no known associated deaths.

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In the category of both stupid and tragic, public security officials in central China's Hubei Province on Saturday confirmed that a mass food poisoning that killed six people last weekend was caused by misuse of a highly toxic rat poison known as "Dushuqiang".

The investigation found that around midday on Nov. 11, Chen Ruyan, a salvage station worker near the Qingshibei Pump Station of Qinghe Village, Ganjiachang Township of Gong'an County, was preparing lunch. In the process, Chen found the rice dough he was preparing for making tangyuan, a kind of rice dumplings, was quite watery and he decided to add more rice flour.
Unfortunately, he mistook rat poison that had been placed together with other condiments as flour and mixed it into the dough. Two elderly people collapsed and died about 20 minutes after having consumed the rice dumplings. Six others soon developed symptoms of poisoning and were rushed to hospital. Four later died while under care.

Chen, the cook, also died from poisoning.

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Tortillas were pulled from school kitchens this week in Racine, Wisconsin, after students and teachers became ill.  Del Rey manufactured flour tortillas that are suspected of being the cause of an outbreak of food poisoning at three Racine Unified School District middle schools, and FDA officials stepped in to prevent the tortillas to be served again.

A Department of Public Instruction spokesperson spoke to the Journal Times, which reported on the story:

“In an effort to protect children from becoming ill, we are strongly encouraging all schools to refrain from serving the flour tortillas,” the DPI said in its release.

State health officials suspect Del Rey flour tortillas, the brand served at Starbuck, Mitchell and Gilmore middle schools, where more than 90 students suffered from symptoms like vomiting and stomach cramps.

The tortillas came in 12-ounce bags, 12 tortillas per package. The case linked to the illness contained 40 packages and was labeled Del Rey Flour Tortillas #6, according to a DPI statement.

A January 12, 2006 MMWR from the Centers for Disease Control and Prevention contained a report on previous school food poisoning from tortillas.

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This week's Morbidity and Mortality Weekly Report (MMWR), a publication from the Centers for Disease Control and Prevention, contains an outbreak report on a Salmonella Typhimurium outbreak associated with the consumption of raw milk and cheese produced at a Pennsylvania dairy beginning in February, 2007. 

According to the report, several people who consumed raw unpasteurized dairy products from the dairy became ill with Salmonellosis and the strain of Salmonella isolated from ill people's stool was indistinguishable from that isolated from a bulk dairy tank at the dairy.  In all, 29 cases of Salmonella were identified as part of the outbreak.

The Pennsylvania Department of Health findings regarding the Salmonella outbreak are summarized in the report:

A total of 29 cases were identified, with illness onset occurring in three temporal clusters during February 3--July 14, 2007 (Figure). The first cluster consisted of 15 cases with onsets of illness from February 3 to March 5. Raw-milk samples were collected February 20 from a dairy A bulk milk tank and February 28 from the home of an ill person. Both sets of samples yielded the outbreak strain of S. Typhimurium. On March 2, PDA ordered dairy A to stop raw-milk sales and advised the public not to consume raw-milk products from dairy A.

On March 19, PDA allowed dairy A to resume sales of raw milk after PDA conducted inspections and recorded two consecutive negative cultures from milk-tank samples. However, a second cluster of three cases was detected when the outbreak strain of S. Typhimurium was identified in another patient, whose diarrheal illness began on March 21 and who had consumed raw milk from dairy A after sales resumed. The two additional cases were identified in persons with onsets of illness on March 19 and March 22. The first of these occurred in one of six ill persons who primarily spoke Spanish and who told investigators they had not consumed raw milk. However, when reinterviewed in early April, three of these six persons reported consuming queso fresco (a type of soft cheese) they bought at a grocery store serving the local Hispanic community. PDA learned that the queso fresco had been made by an unlicensed producer who purchased approximately 20 gallons of raw milk weekly from dairy A. Sale of raw-milk cheeses aged <60 days is illegal in Pennsylvania. Subsequently, in April, PDA inspectors seized 18 unlabeled retail containers of queso fresco from the grocery store. The cheese tested positive for alkaline phosphatase, indicating the cheese was produced from unpasteurized milk (2). Bacterial cultures were negative for pathogens.

On March 27, PDA again ordered dairy A to halt raw-milk sales and suspended its raw-milk permit. No additional cases were noted until June--July 2007, when a third cluster of 11 PFGE-matched S. Typhimurium cases was detected through routine electronic laboratory reporting. Of these, 10 occurred among residents of three counties near dairy A. On July 19, PDA confirmed that dairy A had been distributing raw milk to the public despite its suspended permit; the date when illegal milk distribution began could not be determined. The outbreak strain of S. Typhimurium was isolated from dairy A raw milk collected from a bulk milk tank on July 19 and from the home of an ill person on July 20. PDA ordered dairy A to halt distribution of raw milk on July 20 and subsequently revoked the raw-milk permit for this dairy.

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According to Cargill and FSIS press releases: Cargill Meat Solutions said it is voluntarily recalling approximately 1,084,384 pounds of ground beef produced at its Wyalusing, Pa., Cargill Regional Beef facility because of the possible presence of E. coli O157:H7. The ground beef products subject to recall were produced at the Wyalusing plant between Oct. 8 and 11, 2007, and were distributed to retailers nationwide.  In addition to the below listed products, there are various weights and varieties of ground beef, ground chuck, and ground sirloin product that were distributed for further processing and repackaging and will not bear the same establishment number on the package.  Products subject to recall are:

Continue Reading...

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General Mills Operations, a Wellston, Ohio, establishment, is voluntarily recalling an undetermined amount of frozen meat pizza products because they may be contaminated with E. coli O157:H7 and may be linked to an outbreak of E. coli O157:H7 illnesses, the U.S. Department of Agriculture’s Food Safety and Inspection Service announced today.

The following products are subject to recall:

• 10.2-ounce packages of “Totino’s The Original Crisp Crust Party Pizza Pepperoni.”
• 10.2-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Classic Pepperoni.”
• 10.2-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Pepperoni Trio.”
• 10.7-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Combination Sausage & Pepperoni Pizza.”
• 10.5-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Three Meat Sausage, Canadian Style Bacon & Pepperoni Pizza.”
• 10.9-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Supreme Sausage & Pepperoni Pizza with Green Peppers & Onions.”
• 6.8-ounce packages of “JENO’S CRISP `N TASTY PIZZA, PEPPERONI.”
• 7.0-ounce packages of “JENO’S CRISP `N TASTY PIZZA, COMBINATION SAUSAGE AND PEPPERONI PIZZA.”
• 7.2-ounce packages of “JENO’S CRISP `N TASTY PIZZA, SUPREME SAUSAGE AND PEPPERONI WITH GREEN PEPPERS AND ONION PIZZA.”

Each package also bears the establishment number “EST. 7750” inside the USDA mark of inspection as well as a “best if used by” date on or before “02 APR 08 WS.” The company applies the “best if used by date” on the package based on a 155-day shelf life, however consumers are urged to look in their freezers for similar frozen pizza products and discard them if found. The frozen meat pizza products subject to recall were produced on or before Oct. 30 and were distributed to retail establishments nationwide. The recall affects approximately 414,000 cases of pizza products currently in stores and all similar pizza products in consumers’ freezers. It includes eight SKUs (stock keeping units or UPC codes) of Totino’s brand frozen pizza and three SKUs of Jeno’s brand frozen pizza with pepperoni topping, or incorporating pepperoni in combination with other toppings.

The problem was uncovered by state and federal authorities investigating 21 occurrences of E. coli-related illnesses in 10 states. Approximately half of the individuals who became ill were hospitalized as a result. The earliest case reported to state authorities occurred on July 20, and the latest case reported occurred on Oct. 10. Nine of the 21 people reported having eaten Totino’s or Jeno’s pizza with pepperoni topping at some point prior to becoming ill. Since July 1 of this year, Totino’s and Jeno’s have distributed more than 120 million pizzas nationwide.

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News Radio 1420 out of Lubbock, Texas, reported last week that Marissa Cisneros, a young victim of the botulism outbreak traced to Castleberry's chili products, may be returning to school soon. 

Last July, Castleberry's recalled canned meat products that were distributed nationwide, with the exception of Great Value chili products which were exported only to Canada, after two children in Texas and Indiana residents were confirmed ill with botulism after eating the company's canned chili products.  A public health investigation led to a recall of three types of meatless hotdog chili sauce, which was expanded to include all meatless products produced at the Castleberry Georgia plant that might still be in commerce.  The recall was further expanded to include products containing meat.  The USDA press release with pertinent information is found here.

As reported by Newsradio 1420's James Clark:

Cisneros and her older brother were the first cases of poisoning that led to a nationwide recall of Castleberry Chili and subsequently other Castleberry products. They ate contaminated Chili on June 28th. Her brother was hospitalized for about a month. But the young Ms. Cisneros was hospitalized clear up until mid September, which included time in Covenant and then later rehab in Dallas.

The botulism poisoned her diaphragm so she could not breathe. She was on a ventilator machine for well more than a month. She had to learn how to walk all over again. Needless to say the botulism could have killed her.

Classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk, and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after consuming contaminated food, but they can occur as early as 6 hours or as late as 10 days after consumption.

Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural junction. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, then moving to the throat, chest, and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhibited and unless the patient receives treatment in time, death from asphyxia results.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or using enemas.

While botulism has been known to cause death due to respiratory failure, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8%. The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves.

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Quiznos is back open for business after ten confirmed cases of salmonella shut it down. Officials were able to zero in on that particular Quiznos because the bacteria in each case matched. The state health department inspected the restaurant on Wednesday. Officials say the bacteria could have come from a contaminated product or possibly from an employee handling the food.

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E. coli hospitalizes four children in East Tennessee

The Associated Press  reported that four children in East Tennessee have been hospitalized in recent days for symptoms of food-borne E. coli bacteria. Jim McDonald, father of an ill 4-year-old boy and 1-year-old girl, told reporters he suspected his children became sick from eating tainted frozen hamburger patties that his family grilled on September 29th. He said the burgers were made by Cargill and purchased September 17th at a Sam's Club in Knoxville. Minneapolis-based Cargill has voluntarily recalled more than 840,000 pounds of patties sold by Sam's Club stores nationwide over concerns about E. coli infection. Tennessee health officials, however, have yet to make that connection to any sick children in Knox County. Three children remained hospitalized today while the fourth was discharged and is recovering.

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The ConAgra plant that produces the company's Banquet pot pies was closed yesterday among concerns of Salmonella contamination in Banquet chicken pot pies that had been manufactured in the plant.  The Associated Press reported on the closure today:

ConAgra Foods Inc. voluntarily stopped production Tuesday at the Missouri plant that makes its Banquet pot pies after health officials said the pies may be linked to 139 cases of salmonella in 30 states.

ConAgra officials believe the company's pies are safe if they're cooked properly, but the Omaha-based company told consumers Tuesday not to eat its pot pies until the government and company investigations are complete.

The U.S. Department of Agriculture also issued a health alert Tuesday afternoon to warn consumers about the link between the company's product and the salmonella cases.

The federal Centers for Disease Control and Prevention has been tracking reports of the salmonella cases since Wednesday. A CDC spokeswoman said the largest numbers of salmonella cases had been reported in Wisconsin, Pennsylvania and Missouri. 

The Centers for Disease Control and Prevention (CDC) issued a statement about the pot pie Salmonella outbreak, encouraging consumers to avoid any ConAgra-brand pot pies with a code of P-9, since they were produced in the same facility as the Banquet pot pies.

At this time, CDC recommends that people do not eat any Banquet pot pies or pot pies made by ConAgra Foods that have a printed code ending in “P9.” Other brands of pot pies made in the ConAgra Foods factory that makes Banquet brand pot pies and sold under other brand names may also be contaminated with Salmonella. These other pot pie boxes also have a printed code ending in “P9”. If you have any of these products at home, the safest thing to do is to discard them.

This information conflicts with what ConAgra has been telling the public, maintaining that if the pot pies are cooked properly they will be safe for human consumption.  The AP article stated included a few sentences on ConAgra's take on the outbreak:

[ConAgra spokeswoman Stephanie] Childs said ConAgra is confident in the safety of its chicken and turkey pot pies when all the cooking instructions on the package are followed. It is especially important to follow the directions when the pies are cooked in a microwave."

And on the International Food Safety Network's Barf Blog, Dr. Doug Powell wrote his family's experience with purchasing ConAgra-brand Banquet chicken pot pies and their attempt to get proper cooking information from ConAgra:

So Amy and I went to the local supermarket after dinner. We found the products in question, with the P-9 on the side, and on sale, 2-for-$1.

I called the number suggested by ConAgra (see above). After listening to a recorded message, I spoke with a human, who wanted to know my name, zip code, state, and when she got to address, I said, I just want to know how to properly cook these in the microwave, cause the press release says they're safe if cooked properly.

The human hung up.

Amy and I then examined the ingredient list, which included cooked chicken, and mechanically deboned chicken -- but did not specify whether the meat was coked or not. So maybe there is raw poultry in the pot pies, which could be a source of salmonella, or maybe it's all cooked but there was a failure in reaching 165F. Don't know at this point.

With the CDC reporting at least 139 cases of Salmonella epidemiologically linked to the ConAgra outbreak in 30 states - and that number growing - more information certainly will be available for Dr. Powell and others concerned about food safety very soon.

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Idaho health officials are warning that a Salmonella outbreak in southern Idaho has been ongoing since mid-September.  KTRV TV reported on the outbreak:

A number of Salmonella infections have been reported across southern Idaho since mid September.

Experts at the Idaho Health and Welfare Department believe they could be linked to undercooked chicken pot pies.

Residents are being warned to follow cooking instructions carefully -- since some frozen convenience foods are not pre-cooked.

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The CDC's publication, Morbidity and Mortality Weekly Report, contains a report on an outbreak of Salmonella Oranienburg that was determined to have originated from fruit salad served in health care facilities in the Northeastern United States and Canada in 2006.  While public health officials were unable to determine which fruit ingredient in the salads was the source of the outbreak, they did note the following:

Fruits such as cantaloupe and honeydew melon previously have been associated with salmonellosis outbreaks in the United States. During 1973--2003, a total of 11 cantaloupe-associated salmonellosis outbreaks were reported to CDC. Reported outbreaks were associated both with whole melons contaminated in growing fields and with precut melons. Cut fruit can be contaminated during processing when rind is removed and fruit is sliced. Furthermore, because the inner flesh of melons contains nutrients that can support microbial growth, improper refrigeration of cut fruit can cause bacteria proliferation.

The public health officials conducting the investigation into the Salmonella outbreak performed a case-control study, interviewing outbreak- and non-outbreak patients and found:

A case was defined as culture-confirmed S. Oranienburg infection with the outbreak strain and illness onset from June 15 to July 31. Forty-one cases of S. Oranienburg with the outbreak strain occurred in 10 U.S. states and one Canadian province: Massachusetts (12), New Hampshire (nine), New York (four), Pennsylvania (three), Vermont (three), Kentucky (two), Maine (two), Maryland (two), Connecticut (one), New Jersey (one), and Ontario, Canada (two). Date of illness onset ranged from June 15 to July 25 (Figure). The median age of patients was 59 years (range: 8 months--96 years); 31% of cases were in persons aged >70 years. Twenty-eight (68%) patients were female. Symptoms reported by patients included diarrhea (74%) (i.e., three or more loose stools in a 24-hour period), abdominal cramps (52%), fever (39%), vomiting (23%), and bloody diarrhea (16%). Seven (17%) patients were hospitalized as a result of their Salmonella infections. No deaths were reported.

Among the 41 cases, 30 (73%) occurred among persons who worked, stayed, or ate in a health-care facility during the 7 days preceding illness onset, including 10 already-hospitalized patients, 10 residents of a long-term--care facility, nine employees of health-care facilities, and one visitor who had eaten in a hospital cafeteria. The interviews with 33 of the 41 patients suggested that illness was associated with eating fruit salad in a health-care facility; 23 (70%) reported eating fresh fruit salad, 19 (83%) of whom had eaten fresh fruit salad in a health-care facility.

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The Centers for Disease Control and Prevention updated its reporting on the E. coli outbreak linked to Topps Meats yesterday. 28 cases of E. coli have been identified as part of the outbreak. According to CDC:

Health officials in several states who were investigating reports of E. coli O157 illnesses found that many ill persons had consumed the same brand of frozen ground beef patties. Ground beef patties recovered from patients' home were tested by state public health department and federal laboratories. Tests conducted by the New York State Wadsworth Center Laboratory and by a USDA-FSIS laboratory on opened and unopened packages of Topp's brand frozen ground beef patties yielded E. coli O157 isolates with several different “DNA fingerprint” patterns.

Investigators compared the “DNA fingerprints” patterns of E. coli O157 strains found in ground beef with “DNA fingerprints” patterns of E. coli O157 strains isolated from ill persons. As of 12 PM (ET) October 2, 2007, 28 cases of E. coli O157:H7 infection have been identified with PFGE patterns that match at least one of the patterns of E. coli strains found in Topp's brand frozen ground beef patties. Ill persons reside in 8 states [Connecticut (2), Florida (1), Indiana (1), Maine (1), New Jersey (6), New York (8), Ohio (1), and Pennsylvania (8)]. Seventeen (94%) of 18 patients with a detailed food history consumed ground beef. Three illnesses have confirmed associations with recalled products because the strain isolated from the person was also isolated from the meat in their home. The first reported illness began on July 5, 2007, and the last began on September11, 2007. Among fifteen ill persons for whom hospitalization status is known, ten (67%) patients were hospitalized. One patient developed a type of kidney failure called hemolytic-uremic syndrome (HUS). No deaths have been reported. Twelve (43%) patients are female. The ages of patients range from 3 to 77 years; 33% are between 15 and 24 years old (only 14% of the US population is in this age group).

DNA "fingerprints" or Pulsed Field Gel Electrophoresis patterns, are explained as follows:

When a sample is taken from either a piece of meat or poultry that is contaminated with a dangerous form of bacteria, such as E. coli O157:H7, listeria, or campylobacter, it can be cultured to obtain and identify the bacterial isolate. If a person consumes some of the contaminated meat or poultry, and becomes infected as a result, a stool sample can then be cultured to obtain and identify the bacterial isolate. These bacterial isolates are then broken down into their various component parts creating a DNA "fingerprint".

The process of obtaining the DNA fingerprint is called Pulse Field Gel Electrophoresis, or PFGE. This technique is used to separate the DNA of the bacterial isolate into its component parts. It operates by causing alternating electric fields to run the DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments — or “fingerprints” — in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of E. coli O157:H7 as well as strains of listeria and campylobacter, and other pathogenic bacteria.

The PFGE pattern of the bacteria can then be compared and matched up to the PFGE pattern of the strain of infected persons who consumed the contaminated product. When PFGE patterns match, they, along with solid epidemiological work, are proof that the contaminated product was the source of a person's illness.

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According to a press release by Topps:

Topps Meat Company LLC, located in Elizabeth, NJ, has voluntarily expanded its recall announced on September 25 to include 21.7 million pounds of ground beef products that may be contaminated with E. coli O157:H7. This represents all products produced by Topps with a "sell by date" or "best if used by date" that falls between September 25, 2007 and September 25, 2008. This information may be found on the back panel of the package. All recalled products will have a USDA establishment number of EST 9748, which is located on the back panel of the package and/or in the USDA legend.  For more information on past recalls and specific information about this recall, visit Marler Blog and E. coli Blog.

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At least seven children have been confirmed ill with E. coli O157:H7 infections, with another six illnesses awaiting confirmation from health officials in an E. coli outbreak among students of Galena Elementary School and their siblings.  In an article about the Floyd County E. coli outbreak that looked into whether the outbreak was part of an