Where's The (Contaminated) Beef?

The CDC, the Ohio Department of Health (ODH) and the Michigan Department of Community Health (MDCH) all posted update reports on the E. coli O157:H7 outbreak investigation today.

According to CDC's consolidated report, 35 cases have been confirmed in this outbreak as of June 27th – 17 in Michigan and 18 in Ohio. Nineteen of the victims have been hospitalized.

ODH reports that it is investigating an additional 5 possible cases of E. coli O157:H7 illnesses to determine whether any of them are related to this outbreak. Michigan advises that, as of noon today, it has confirmed a total of 20 outbreak cases. Twelve of those patients required hospitalization.

Michigan also reports that "over half" of the confirmed cases in that state either prepared or consumed hamburger meat purchased from Kroger. This begs the question of how the remaining victims became infected with the outbreak strain. Were they the recipients of secondary infection, perhaps as a result of caring for one of the primary victims? Or was meat contaminated by the outbreak strain also sold elsewhere than in Kroger supermarkets?

Since the initial recall announcement on June 25th, neither Kroger nor USDA has released any information on the source of the contaminated meat that was sold in Kroger stores in Michigan and Northern Ohio. Unless Kroger's record-keeping is seriously defective, it shouldn't take very long to identify its meat supplier.

Is Kroger's supplier dragging its feet on a possible recall?

Ground Beef Outbreak Update

Both Ohio and Michigan have posted updated information on the E. coli O157:H7 outbreak that has affected both states and led to the recall last week of ground beef by The Kroger Company. Neither the company nor USDA has yet revealed the source of the beef sold in the Kroger supermarkets in Michigan and Northern Ohio.

Michigan reports that, as of June 27th, 17 residents of the state have been infected with the outbreak strain of E. coli O157:H7. Ohio has confirmed 18 cases of E. coli O157:H7, and is investigating an additional four cases. According to the CDC's most recent update, posted on June 26th, 17 people have been hospitalized in Ohio and Michigan as a result of the E. coli O157:H7 outbreak, including one who experienced kidney failure.

A lawsuit has already been filed on behalf of one of the Ohio outbreak victims. According to Bill Marler, his client purchased ground beef from Kroger's on June 4th, and cooked and consumed it that same day. She began to feel ill on June 8th, was hospitalized on June 10th, and released on June 12th. While in hospital, she tested positive for E. coli O157:H7.

This outbreak is a reminder to always handle raw meat and poultry with care, and to cook meat thoroughly. Hamburgers and other ground meat dishes should be cooked until the internal temperature has reached at least 160ºF throughout. For information on how to safely navigate the summer barbecue season, read the USDA Fact Sheet, Barbecue and Food Safety.

Russia's Time Bomb

There's been a third food poisoning outbreak this month among school children in Siberia. In all three cases, the culprit has been Yersinia enterocolitica.

In the most recent outbreak, 11 children, between 3 and 6 years old, were hospitalized in Krasnoyarsk (eastern Siberia) with symptoms of yersiniosis. A few days before, 65 children from a summer camp in Solnechny also were hospitalized in Krasnoyarsk with similar symptoms. And an outbreak of yersiniosis in Shaktyor sent 21 children from a summer camp to hospital.

While authorities suspect contaminated cabbage salad to be the source of these outbreaks, Yersinia enterocolitica infections most often result from consuming contaminated water, raw or undercooked meats, raw milk, or improperly pasteurized milk.

Rospotreb­nadzora, described by the Moscow News Weekly as Russia's consumer rights agency, recently inspected 2,409 of the country's dairies. Fewer than 58% of the dairies were satisfactory; 19% needed immediate structural renovations, according to the Rospotreb­nadzora report.

The inspections uncovered instances of lack of temperature control during pasteurization and delivery, as well as evidence of unsanitary conditions. The problems were especially severe in Far-Eastern, Siberian, and Ural federal regions, where 12.5% of milk samples failed to meet sanitary standards.

These major lapses in the safety of dairy processing and products translate into frequent, large outbreaks of food poisoning. Last year, several hundred children in the Stavropol region (in southern Russia) were hospitalized in two food poisoning outbreaks that were traced to contaminated kefir, a fermented dairy product. Several dairies in the region had allowed employees suffering from dysentery to continue working, and had fallen short of sanitation requirements in other respects as well.

Gennadiy Onishchenko, Russia's chief sanitarian, has suggested that the dairy industry return to an older method for delivering fresh, clean milk to consumers. He is advocating that consumers be allowed to fill milk jugs directly from parked trucks that haul milk in large refrigerated vats. Pilot projects to test this approach in North Osetia and Krasnodar proved successful, according to Onishchenko.

It's unclear how this "Back to the Future" approach would solve the problems of poor sanitation and lack of pasteurization temperature control that were reported by Rospotreb­nadzora. I suspect that it would simply substitute a different set of control problems, shifting the onus to the Russian consumer to keep their milk jugs clean and to maintain correct storage temperatures.

Until Russia solves the structural and sanitation problems in its dairy industry, its people can expect a regular diet of news articles about yersiniosis, as well as other food poisoning outbreaks.

Tomato Illnesses Climb: 810 Lab-Confirmed Cases

CDC has reported another jump in the number of lab-confirmed illnesses caused by Salmonella Saintpaul. There are now 810 lab-confirmed cases in 36 states and the District of Columbia. In case anyone is keeping score, 75% of the 48 contiguous US states have now been hit by this outbreak.

Of greatest significance in this report is that the most recent victim became ill on June 15th. Contrary to previous statements by CDC, not all of the increased number of reported cases is due simply to clearing of lab backlogs. Some truly are new cases.

An Associated Press article, published today, implied that CDC and FDA are starting to have doubts as to the source of the Salmonella Saintpaul that has sickened so many people. FDA has completed testing on 1,700 samples so far, and has yet to find a single Salmonella Saintpaul in any of them.

Dr. Acheson of FDA now says that it is unlikely the source is a single farm. It might be a warehouse or packing house, instead. If so, this outbreak could be with us for a long time to come.

I'll repeat once more what I've been saying all along. The only "safe" tomatoes are grape tomatoes, cherry tomatoes and tomatoes still attached to the vine. These varieties are likely to have gone through different handling procedures than those undergone by large tomatoes packed in bulk.

FDA: Tomatoes In, Garbage Out

I've been checking the FDA web site several times a day for progress reports on the tomato trace-back investigation. Imagine my joy when I discovered, just a few minutes ago, that the FDA site had been updated with a new pdf document, Salmonella Contamination Response as of June 27, 2008.

I immediately downloaded the file, expecting it to contain an up-to-the-minute progress report – maybe even news as to the source of the Salmonella-contaminated tomatoes. To my chagrin, it was nothing more than a PR stunt.

This touted "update" is a combination text-and-cartoon description of the FDA's response to the tomato outbreak. The final stage in the investigation response?

FDA works with industry, states, foreign governments, and academia to prevent future outbreaks.

Who does the agency think it's kidding? The nation's consumers, as well as the produce industry and state and local health agencies, are looking for substantive answers – not PR stunts like this "update" or the FDA Commissioner's weekly so-called blog, "Andy's Take".

It's time for FDA to get its priorities straight and focus on the nation's food safety problems. If it does so, FDA's image problems will solve themselves.

Norovirus Notes

While public health attention has been focused on Salmonella Saintpaul in tomatoes and E. coli O157:H7 in ground beef, the ever-present norovirus has quietly been striking down restaurant patrons and cruise line passengers.

Last week, approximately 60 restaurant patrons and 40 employees of an Illinois golf club complained of nausea and other "flu-like symptoms" after eating, visiting or working in the dining area of the Arrowhead Golf Club. Specimens obtained from ill employees were found to contain norovirus. The dining area was closed for thorough cleaning and disinfection. It is expected to reopen this evening.

This past week, between 80 and 90 people attending a bible camp near Oakhurst, California were stricken with diarrhea and vomiting. No lab results are available, but local health officials are attributing the outbreak to norovirus.

Norovirus is well known for the outbreaks of gastroenteritis it has caused in the past on cruise ships. And 2008 has been no exception. Norovirus has been responsible for seven out of eight cruise ship outbreaks of gastroenteritis so far. A ninth outbreak is still under investigation.

One cruise line in particular – Holland America Line – seems to be particularly susceptible to norovirus outbreaks this year. Four of the norovirus outbreaks have involved Holland America ships: the Volendam, the Noordam, the Ryndam, and the Zaandam. A fifth Holland America ship, the Veendam, is the setting for the outbreak that is still under investigation.

Norovirus is a highly contagious pathogen, and can survive on surfaces such as hand rails and door knobs for days. Staying healthy in the midst of a shipboard outbreak is difficult, but possible. To avoid illness, it is essential to be scrupulous about frequent and careful hand-washing, especially before eating, drinking, brushing teeth or any other activities that might bring the hands in contact with the face.

Tomatoes and Ground Beef: Another Update

CDC has published further updates to the case totals for both the Salmonella Saintpaul and the E. coli O157:H7 outbreaks that are currently under investigation.

Salmonella Outbreak

As of 9pm yesterday evening, federal and state health agencies have confirmed a total of 756 cases of Salmonella Saintpaul infection linked to contaminated tomatoes. Ninety-five people have been hospitalized.

Texas is the hardest-hit state, with 330 cases; New Mexico is next, with 80. Thirty-four states and the District of Columbia have each reported at least one lab-confirmed infection with the outbreak strain.

E. coli O157:H7 Outbreak

The number of victims of the contaminated ground beef – recalled yesterday evening by Kroger – has risen to 33. Sixteen of the lab-confirmed cases were reported by Michigan; 17 are from Ohio. Seventeen of the patients have been hospitalized, one with kidney failure – a common manifestation of hemolytic uremic syndrome.

Ground Beef Update: June 26th

CDC posted an update yesterday evening on the federal and state investigations of the E. coli O157:H7 outbreak in Ohio and Michigan. According to CDC's most current information, there have been 32 lab-confirmed victims so far – 17 in Ohio and 15 in Michigan. All of the victims fell ill between May 30th and June 11th.

Fourteen people have been hospitalized so far – one with kidney failure associated with hemolytic uremic syndrome. No one has died.

The source of the outbreak has been traced to ground beef sold in Kroger supermarkets in Michigan and some parts of Ohio. Yesterday evening, Kroger announced a voluntary recall of the contaminated ground beef. The company is cooperating with USDA officials in their trace-back investigation.

Tomato Update: June 26th

The toll of tomato-linked Salmonella Saintpaul illnesses continues to increase as CDC and state health departments try to catch up on their backlog of cases. CDC reports a revised total of 707 lab-confirmed cases, as of 5pm on June 24th. This revision was posted late yesterday evening (June 25th). Seventy-six of the patients have been hospitalized.

The victims of this outbreak live in the following 34 states and the District of Columbia:

Arkansas (7 persons), Arizona (36), California (10), Colorado (5), Connecticut (4), Florida (1), Georgia (15), Idaho (3), Illinois (63), Indiana (11), Kansas (11), Kentucky (1), Maryland (25), Massachusetts (17), Michigan (4), Missouri (12), New Hampshire (1), Nevada (4), New Jersey (4), New Mexico (80), New York (18), North Carolina (5), Ohio (3), Oklahoma (17), Oregon (5), Pennsylvania (6), Rhode Island (3), Tennessee (6), Texas (293), Utah (2), Virginia (22), Vermont (1), Washington (5), Wisconsin (6), District of Columbia (1).

The only new information posted by FDA is that Nevada has been added to the list of "safe" growing areas. This is not surprising, considering that New Mexico's trace-back information – furnished to FDA and CDC weeks ago – pointed strongly to Mexico as the most likely source of the contaminated produce.

More Breaking News: Kroger's Recalls Ground Beef

In reaction to the confirmed detection of the outbreak strain of E. coli O157:H7 in a sample of ground beef sold by a Kroger store in Ohio, The Kroger Company has just announced a voluntary recall of "...all ground beef products that were sold between May 21 and June 8, 2008 at its stores throughout Michigan and in central and northern Ohio (Columbus and Toledo areas)."

In its press release, Kroger requests customers to check their freezers and to return unused ground beef to the store for a refund or replacement. None of the suspect ground beef is available for purchase at Kroger stores at this time.

The company is cooperating with USDA efforts to trace back the source of the contaminated meat. Customers with questions about the recall can contact Kroger toll-free at (800) 632-6900.

Breaking News: E. coli O157:H7 Outbreak Update

The Ohio Department of Health and the Ohio Department of Agriculture jointly announced today that the outbreak strain of E. coli O157:H7 has been identified in a sample of ground beef provided to state investigators by one of the outbreak victims. The sample had been purchased at the Kroger Marketplace in Gahanna, Ohio.

USDA is conducting a trace-back investigation to determine the source of the contaminated ground meat. Kroger's is cooperating with the government efforts.

Ohio is continuing its investigation into 19 cases of E. coli O157:H7 illnesses that are linked to the contaminated ground beef and also are linked to 15 cases in Michigan. According to CDC, all of the victims became infected in late May and early June.

If you have eaten cooked ground meat and have experienced any symptoms of E. coli O157:H7 infection, please contact your health care professional and your local public health office. This outbreak may extend beyond the states of Ohio and Michigan.

In Other News . . .

Food-borne illness doesn't take a holiday elsewhere, just because of an outbreak or two in the United States. Here's the recent news from around the world.

Hong Kong
I reported last weekend that the Centre for Health Protection (CHP) had ordered a restaurant in Wan Chai closed for cleaning and disinfection after 6 patrons had developed food poisoning as a result of dining at the restaurant on June 9th and 15th. This action was too late to save an additional 13 clients from a bout of food poisoning after eating at that restaurant on June 16th.

CHP is also investigating an outbreak of gastroenteritis reported by 10 people who dined on a yacht on June 21st. Three of the victims visited a hospital for treatment, while another three contacted private doctors.

Tay Ninh, Viet Nam
Twenty percent of the workforce of the Hoang Gia VMC Limited Company– roughly 1,000 people – succumbed to food poisoning after eating dinner at the shoe factory on Monday, June 23rd. Hundreds of the workers were hospitalized after complaining of stomach aches and vomiting. Some also suffered from low blood pressure. The province's Department of Health is looking into the incident.

Rostov-on-Don, Russia
An inquest has been initiated into a food poisoning outbreak that sickened 43 kindergarten children in the south of Russia. Seventeen of the children were hospitalized. Authorities suspect that either dairy products or cabbage salad trimmed with dill are the most probable sources of the food poisoning. Lab tests are underway.

Lake Garda, Italy
Salmonella is suspected as being responsible for the death of a 71-year old British tourist and the illness of 19 others who dined at the Grand Hotel at Gardone Riviera in northern Italy. The twenty tourists complained of severe vomiting, diarrhoea and dehydration several hours after their meal. The twenty were part of a British tour group of 300 people.

Health officials suspect that contaminated fish might have been responsible for the illnesses, but are waiting for the results of lab analyses. The hotel's kitchen has been closed while the investigation proceeds.

According to the BBC News report, this resort once was a favorite destination of Winston Churchill.

North Carolina, USA
North Carolina is experiencing a cluster of Salmonella cases, according to a report WSPA News Channel 7. Nine patrons of O'Dear's Country Diner in Marion, NC were infected by Salmonella after eating at the restaurant. Three were hospitalized.

Lab results aren't available yet, but local health inspectors have ruled out any link to the tomato outbreak, "...because the ones served at the restaurant were from an approved FDA source."

No comment!

E. coli O157:H7 Found In Ohio Ground Beef Sample

Health officials in Ohio and Michigan, along with representatives of USDA and CDC, continue to investigate an outbreak of E. coli O157:H7 that has sickened at least 15 people in Michigan and 19 in Ohio. Ten of the 15 Michigan victims have been hospitalized. The identical strain of E. coli O157:H7 is responsible for the illnesses in both states.

The Michigan Department of Community Health reported yesterday that more than half of the patients in that state purchased and consumed ground beef from Kroger Food Stores. Officials are continuing their interviews and trace-back activities. Until the investigation is complete, they caution that meat from other retail outlets might also be implicated in the outbreak.

Meanwhile, Ohio reported that it has isolated E. coli O157:H7 from a ground beef sample obtained from one of that state's outbreak victims. Further tests are underway to determine whether the isolate is genetically identical to the outbreak strain.

According to CDC, which has finally posted a progress report on this investigation, all of the victims became ill in late May and early June. Fourteen have been hospitalized so far – one with symptoms of hemolytic uremic syndrome (HUS). The victims are between 9 and 78 years old, and just over one-half are female.

Attorney and blogger Bill Marler reported this morning that he has been contacted by E. coli O157:H7 victims in other states who, he suspects, might be part of a broader outbreak. So far, CDC is silent on the prospect that this same outbreak strain might be present elsewhere in the country's meat supply. Let's hope that CDC and USDA investigators are doing some data back-checking.

Tomatoes: Troublesome Tracebacks

I have just finished reading a very informative interview of Dr. Michael T. Osterholm, published in Jim Prevor's Perishable Pundit. While I strongly encourage everyone to read the entire interview, I have quoted a few brief excerpts here.

"The whole system is flawed. The relationship between FDA and CDC is strained; it’s improved but still lacking. It’s not clear who is really in charge."

"We need someone that understands outbreaks, not just manages them. In this case, it appears that instead of experienced professionals, Outbreak Investigation Class 101 was doing the control study."

"FDA never talked about tracing back product from the control group. It was a near fatal flaw from the get-go, and if they don’t change their approach they will never find the source."

"We need a serious examination of how this outbreak was handled from the first instance of illness. By the time tomatoes were identified, it was the end of May and the vast majority of product was through the food system already."

"I owe it to the public health of this country to come forward with my knowledge and put on the record the dysfunction occurring at the federal level. A subsequent review by experts in food borne disease investigations would say this tomato outbreak investigation has bordered on incompetence."

"There should be a call for a formal investigation on what happened and why."

Prevor's article also quotes a spokesperson from the New Mexico Department of Health, who said, in part:

"With Lowe’s and Bashas, it was Mexico. With those two stores, we were able to go down the supply chain to determine the distributor. At that point it was really pointing to Mexico and we passed that information on to the FDA and CDC, but we really don’t have the ability to go into Mexico."

CDC updated its totals again last night (although it date-stamped the update 9:00am, June 24 2008). Nevada has been added to the list of states affected by the outbreak; 34 states and the District of Columbia have now reported a total of 652 lab-confirmed cases, according to CDC. Seventy-one people have been hospitalized.

If Dr. Osterholm's take on the situation is correct – and I have a great deal of respect for his opinion – the FDA and CDC have been largely ineffectual in their response to this outbreak. I applaud his courage in speaking out so strongly, and I join his call for a thorough – and professional – examination of how our federal health agencies have handled this outbreak investigation.

Tomatoes: Yesterday's CDC Report Already Out-Of-Date

Yesterday evening, CDC posted an update to the agency's tally of Salmonella Saintpaul outbreak victims. That report is already obsolete.

This evening, the New Jersey Department of Health and Senior Services reported a revised total of four lab-confirmed cases of Salmonella Saintpaul – up from the single case included in yesterday evening's CDC totals. This brings the number of lab-confirmed cases to at least 616.

New Jersey has begun to inspect wholesale produce processors and distributors, to verify that the tomatoes they are stocking have been obtained from one of the "safe" growing areas. These inspections, which are being conducted randomly, include a review of company record keeping and produce handling procedures.

Tomato Toll Rises; FDA Narrows Search

CDC reported additional cases of Salmonella Saintpaul yesterday evening. The number of lab-confirmed cases linked to raw tomatoes now stands at 613, in what the agency characterizes as an ongoing outbreak that has spread to 33 US states. As many as 69 of the victims have been hospitalized.

In a separate update, FDA added more Mexican states to its list of areas that have been cleared of involvement in the tomato outbreak. Tomato farms, packing houses and distribution facilities in three Mexican states – Jalisco, Coahuila and Sinaloa – and several Florida counties are now the focus of joint inspections by FDA and local authorities.

New Mexico, one of the hardest-hit states in this outbreak, announced on June 21st a state-wide embargo of tomatoes from those parts of Florida and Mexico that are still suspected of being the source of the Salmonella-contaminated produce. The embargo is a joint effort of the state's Department of Health and Environment Department, and is meant to ensure that only tomatoes from safe growing areas are being sold in New Mexico.

A reminder: Grape tomatoes, cherry tomatoes, and tomatoes still attached to their vine have been cleared of involvement in this outbreak regardless of the state or country where they were grown.

Cheese Manufacturer Expands Recall

On May 30th, Fresca Italia recalled a single production batch of its Burrata Italian-style fresh cheese after the California Dept. of Food & Agriculture detected Listeria monocytogenes in the product.

The cheese, which was sold in restaurants and retails stores in Southern California and the San Francisco Bay area, was labeled with the manufacturer's name “Caseificio Voglie di Latte” and an expiration date of 24/5/2008.

Tests carried out subsequently by FDA found Listeria monocytogenes in additional batches of Burrata. In consequence, Fresca Italia has expanded its recall to include all outstanding batches of “Caseificio Voglie di Latte” Burrata that are still in circulation – 1,757 pounds of cheese in all.

Consumers who purchased “Caseificio Voglie di Latte” Burrata with an expiry date of 24/5/2008, 31/5/2008 or 07/06/2008 should return the cheese to the store for a full refund.

Tomato Catch-Up

It's time for another update to the Salmonella Saintpaul outbreak scorecard.

According to CDC's latest report, posted June 20th, 552 people living in 32 states and the District of Columbia had been infected with the outbreak strain. Today, we can add 12 more lab-confirmed victims – all from the Commonwealth of Massachusetts – bringing the lab-confirmed total to 564 people in 33 states and DC.

The victims – seven females and five males ranging in age between 5 and 39 years – became infected between May 30th and June 8th. Two of the patients were hospitalized as a result of the severity of their symptoms.

FDA believes that it may be closing in on the origin of the contaminated tomatoes. Their painstaking trace-back process has led to certain parts of Florida and Mexico. The agency has sent its investigators to those areas, and is working jointly with both Mexican and Florida officials to inspect farms, packing houses and distribution centers that may be implicated in the outbreak.

But this type of investigation will not bear fruit quickly. In the meantime, FDA continues to recommend that consumers limit their consumption of tomatoes to those from "safe" growing regions, or to those varieties that have been cleared of suspicion – grape tomatoes, cherry tomatoes, or tomatoes still attached to their vine.

Complaining To – Not About – The FDA

It's very easy to find fault with FDA. And with good reason – the agency seems to be dancing with two left feet much of the time. The new FDA weekly on-line column, Andy's Take, said to be written by FDA Commissioner Andrew von Eschenbach, has not been well-received by the media, and even most Internet-savvy consumers are probably unaware of its existence.

The communications disconnect between FDA and US consumers is disturbing. The agency relies heavily on patterns of consumer complaints and illness reports to decide where and how to spend its inadequate budget. Most of the major recalls and investigations that we learn about in the media – melamine in pet food, Salmonella in tomatoes – began as consumer complaints reported to FDA or outbreak clusters identified by state health agencies and the CDC.

But, before a consumer can lodge a complaint with FDA, he or she must know who to call. Earlier this month, the agency posted two new pages on its web site to guide consumers through the complaint process.

Your Guide To Reporting Problems To FDA tells consumers how to navigate the government's regulatory system. It offers tips on how to report problems, which agency to call (if the product is not under FDA regulation), and which office within FDA handles the various products and problems. Much of the information is displayed in an easy-to-use table.

FDA 101: How to Use the Consumer Complaint System and MedWatch, as its name implies, is a primer on how to make a consumer complaint to FDA. It lists the types of problems FDA wants to learn about from consumers, talks about what happens when a complaint is received, and provides the telephone numbers for all of the FDA regional Complaint Coordinators.

I strongly urge all my US readers to bookmark these web pages – or download the pdf versions – and to use this complaint process to make FDA aware of any health or safety issue you encounter with a product that this agency regulates.

Food Poisoning Around The World-Resuming The Tour

While US consumers have been consulting ever-changing lists of "safe" sources for tomatoes, the rest of the world has been coping with its normal diet – and its usual variety of food-borne diseases.

New Zealand
Poultry lovers in this country are breathing more easily this month. Cases of Campylobacter infections have dropped by more than one-third in the past year. Cross-contamination of food preparation areas with raw poultry, or eating undercooked poultry, are the most common causes of Campylobacter infection. The reduction in reported illnesses suggests that poultry producers in New Zealand might be starting to get a handle on the level of Campylobacter in their flocks.

Hong Kong
The Centre for Health Protection (CHP) is investigating three separate clusters of reported food poisoning, two of them apparently involving the same restaurant. In total, 17 people have fallen ill. The Wan Chai district restaurant that was responsible for two illnesses on June 9th and four on June 15th has been ordered closed for cleaning and disinfection.

CHP is also looking into another food poisoning outbreak, which sickened 10 primary school children in Hong Kong's Southern District. The four boys and six girls complained of abdominal pain, vomiting, diarrhoea and fever after eating lunch at the school.

Seremban, Malaysia
Eighty students at a local school were taken to hospital in the latest of a series of boarding school-related food poisoning outbreaks in this country. Although two of the students were admitted to hospital, none are in any danger. The school's dining hall remains open, but "under supervision.

Eastern Samar, Philippines
Foul-smelling meat felled 200 participants at a fiesta in Hernani town, Eastern Samar last week. Roughly 70% of the victims were children. Approximately 60 of the villagers, who complained of dizziness, abdominal pain, loose bowel movement, vomiting and body weakness, were treated in hospital and released.

Tokyo, Japan
Clostridium perfringens was blamed by Tokyo health officials for an outbreak of food poisoning that sickened 95 attendees at a training workshop held at the Shinagawa Prince Hotel in Tokyo. The victims fell ill after eating a bento lunch, which was offered on June 12th to workshop participants.

Nigeria
This country takes food poisoning seriously. Fifteen people were arrested following a rash of food poisonings that sent 68 people to hospital and killed two of them. The victims fell ill after eating food served at a ceremony. Some of the 15 detained individuals have since been released.

Jaipur, India
Participants in a religious festival in Jaipur had reason to regret their attendance last week. More than 100 people – most of them children – suffered food poisoning; 90 were hospitalized, and three were reported to be in critical condition. District health authorities are blaming spoiled rice for the outbreak.

Siberia, Russia
Forty-six children who were attending a kindergarten camp have been hospitalized as a result of infection with Yersinia enterocolitica. This pathogen is usually associated with consuming undercooked meat, or cross-contamination during food preparation. The camp is being investigated for possible unsanitary conditions. Due to the relatively long incubation period associated with this infection, health authorities are braced for additional cases.

E. coli O157:H7 Rears Its Ugly Head

As if the health authorities in Michigan and Ohio didn't have enough on their plates, these states are also wrestling with an as-yet-unexplained outbreak of E. coli O157:H7 illnesses.

As of the 18th, the Michigan Department of Community Health (MDCH) had received reports of 29 cases of E. coli O157:H7 infections for the month of June. Ohio is investigating 16 cases, at least 10 of which are linked by genetic fingerprint to each other, and to the Michigan cases.

CDC, which has its hands full with the nationwide Salmonella Saintpaul outbreak, is assisting Michigan and Ohio in their investigations. While the source of the E. coli O157:H7 hasn't yet been identified, suspicion is falling on contaminated ground beef.

According to an article in the Detroit Free Press, a spokesman for MDCH has suggested a possible link between the illnesses and the recall on June 8th of more than 13,000 pounds of ground beef by Dutch Meats, Inc. of Trenton, NJ. But the meat covered by that recall supposedly was distributed only to restaurants and food service institutions in and around Trenton.

We don't yet know whether consumers in any states neighboring Ohio and Michigan have suffered an infection with the outbreak strain of E. coli O157:H7, nor do we know how close investigators are to identifying the source of the contamination. Are Michigan investigators just speculating on a link between the Dutch Meat recall and the current outbreak, or have they matched the microbes genetically?

And how did meat that was only distributed in New Jersey sicken at least 29 people in Michigan and 10 or more in Ohio? Or does Dutch Meat's contamination extend beyond the 13,000 pounds that were recalled earlier this month?

Tomato Outbreak Keeps On Growing

CDC is reporting 552 lab-confirmed cases of Salmonella Saintpaul illnesses linked to contaminated tomatoes. The outbreak now encompasses 32 states and the District of Columbia. At least 53 people have been hospitalized.

Based on CDC's estimate of 38 unreported cases for each lab-confirmed illness, almost 21,000 people have now been victimized by the contaminated tomatoes. The most recent victims began to experience symptoms of gastroenteritis on June 10th.

FDA investigators continue to plod through data, clearing tomatoes from one growing area at a time. The latest source to be added to the agency's "safe" list is the state of Illinois.

This outbreak began in mid-April, when the first victim fell ill, and has lasted for a full two months, which seems unusual for a perishable commodity. And there's no evidence that we've seen the end of the stream of illness reports.

Until there are no new cases added to the list of victims, please limit your purchases of tomatoes to grape tomatoes, cherry tomatoes, or tomatoes still attached to the vine. These are the only varieties that have not been implicated in the outbreak.

PETCO - Where The Pests Go

FDA has announced the seizure of animal food from a PETCO warehouse in Joliet, IL after finding "widespread and active rodent and bird infestation" at the company's distribution center on two inspections in a row. The seizure was carried out yesterday by U.S. Marshals acting under a District Court warrant.

The Joliet PETCO facility distributes products to the company's stores in 16 states – Alabama, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Missouri, Nebraska, Ohio, Oklahoma, Tennessee, Texas, and Wisconsin.

According to FDA's news release, the seized products were in permeable packages and were held under conditions that could have allowed them to become contaminated or could have affected their quality. No illnesses from these products have been reported to FDA, and the agency does not believe that products shipped from this warehouse are hazardous to animal or human health.

As a precaution, FDA recommends that people who handle any products that might have been stored or shipped from the Joliet warehouse should wash their hands carefully with soap and hot water afterwards. Surfaces that have come in contact with the products or their outer packaging also should be cleaned thoroughly with soap and hot water.

If you suspect that your pet has become ill after eating pet food that came from the PETCO Joliet facility, FDA would like to hear from you. In addition to contacting your veterinarian, please call the FDA consumer complaint coordinator for your state.

Tomato Update: June 19th Edition

CDC updated its Salmonella Saintpaul status report yesterday evening. According to their most recent tally, 383 people in 30 states and the District of Columbia are confirmed to have been infected with the outbreak strain of Salmonella. At least 48 people have been hospitalized.

But this tally is incomplete. On June 17th, the New Mexico Department of Health reported that it had confirmed 77 outbreak victims in that state. The latest CDC update only reports 70 confirmed cases in New Mexico. The additional 7 cases brings the total to 390 lab-confirmed victims.

Based on CDC's own multiplier of 38 victims for every lab-confirmed case, the estimated number of victims of the Salmonella-contaminated tomatoes has surpassed 14,800. And it will continue to climb as the labs play catch-up on fingerprinting suspect Salmonella isolates, and as state health departments review their records in search of additional previously-unidentified cases.

As for FDA's search for the source of the contaminated tomatoes, it still seems to be proceeding by elimination. Oklahoma has been added to the list of "safe" growing areas. The agency is apparently focusing on a cluster of nine cases that are linked to a specific restaurant or restaurant chain, but has given no further details of its investigation.

Until this outbreak has burned itself out, the safest bet is to eat only grape tomatoes, cherry tomatoes, or tomatoes that are sold still attached to the vine. As a further precaution, when in restaurants, stick to cherry tomatoes or grape tomatoes. Avoid eating sliced tomatoes or raw tomato-containing dishes such as salsa, guacamole and bruscetta.

Creating Killer Tomatoes

One of my readers recently posted this comment:

I am curious as to how or if salmonella invades a tomato. If it is only on the surface can it be washed off?

A lot of research effort, time, and money has been spent during the last decade in an attempt to answer these questions. Here is what we know.

• Tomatoes can become contaminated in the field, either from irrigation water, from contaminated soil, from infected field animals, from equipment that has not been properly sanitized or from infected field workers. Salmonella can survive in fallow (idle) soil for up to six weeks, which means that the contamination can be transferred between successive crops in the same field if the new crop is planted too soon after harvest.
• The contamination is typically on the surface of the tomato before harvest. Salmonella can stick to the skin of the tomato and even grow there. Whether and how much it grows will depend on the weather during the growing season – temperature and relative humidity.
• Salmonella that is present on the tomatoes when they are harvested may continue to grow during storage. Warm storage temperatures and high relative humidity encourage growth of the microbe.
• Salmonella can penetrate into the body of the tomato through tears or bruises in the skin or through the scar tissue formed when a tomato is detached from its stem. Salmonella may penetrate into the body during washing at the packing house – especially if the tomatoes are warmer than the washing water. Once inside the tomato, the Salmonella cannot be washed away.
• Salmonella that has attached to the skin of the tomato can be partially scrubbed away in running tap water. Dipping the tomatoes in water that contains diluted bleach is a way to kill most – but not necessarily all – of the Salmonella on the surface.

I extracted this information from the following research articles.

Barak, J.D. and A.S. Liang. 2008. Role of soil, crop debris, and a plant pathogen in Salmonella enterica contamination of tomato plants. PLoS ONE 3(2):e1657 [Full text available on-line].

Guo, X., et al. 2001. Survival of salmonellae on and in tomato plants from the time of inoculation at flowering and early stages of fruit development through fruit ripening. Applied and Environmental Microbiology 67(10):4760–4764 [Full text available on-line].

Ibarra-Sánchez, L.S., et al. 2004. Internalization of bacterial pathogens in tomatoes and their control by selected chemicals. Journal of Food Protection 67(7):1353–1358 [Abstract
available on-line].
Iturriaga, M.H., et al. 2007. Colonization of tomatoes by Salmonella Montevideo is affected
by relative humidity and storage temperature. Journal of Food Protection 70(1):30-34 [Abstract available on-line].

Zhuang, R.-Y., et al. 1995. Fate of Salmonella montevideo on and in raw tomatoes as affected by temperature and treatment with chlorine. Applied and Environmental Microbiology 61(6):2127–2131 [Full text available on-line].

Chai Concentrate Recalled: Botulism Risk

Tipu's Tiger Chai, Inc. has announced a voluntary recall of its Chai Concentrate, distributed to stores and coffee kiosks in western Montana, and to one café in Prescott, Arizona. The concentrate is used in stores to prepare chai beverages sold on-site. A limited quantity of product was also supplied directly to consumers in western Montana.

The recall covers half-gallon bottles of the concentrate, carrying dates from 09/23/09 through and including 05/22/10. While no illnesses have been reported, an audit of production records found that the pH of the chai concentrate was higher than required by FDA, and represented a risk that Clostridium botulinum might survive and grow in the product.

Consumers are urged to return the recalled concentrate to the place of purchase for a full refund.

Exploring Outdoor Markets In France: Cannes

Visiting France again this spring, we spent a few days in Cannes – arriving the last day of the film festival.

While exploring the center of town, we discovered that Cannes has several outdoor market areas. These markets, each of which fill a city block, are open six days a week. We spent a couple of hours browsing through one of the markets, just a block from the rue d'Antibes, Cannes' main shopping street.

The first market stall we encountered offered a variety of vegetables, including some luscious tomatoes that were still on the vine.

"La vendeuse" was proud of her selection of grapes, cherries and strawberries. We purchased some grapes and strawberries to take back to our room for a snack.

This customer examined the produce with great care before finally making her selection.

The market offered more than just fruits and vegetables. There was a varied selection of fresh fish and seafood.



These prawns looked especially nice.

Calamari was also an option.

And what French market would be complete without a cheese stall?

The market didn't have any flower stalls. But a short walk away, down by the marina, we stumbled across an enormous rose garden.

An ocean of roses.

An especially striking cluster in the midst of the sea of roses.

And the "pièce de résistance"

Exploring Outdoor Markets In France: Vaison-la-Romaine

One of the joys of visiting France is not knowing when or where one will stumble over an outdoor market. On our first visit to Paris, in May 2000, we were strolling along boulevard Raspail on the Left Bank. To our amazement, there was a flourishing outdoor food market – complete with produce and cheese, beef and pork, fish and fowl – right in the middle of the boulevard's park-like center island. Unfortunately, the only thing missing was our camera.

In September 2006, we treated ourselves to a few days in Provence at the end of a month-long car trip through central and eastern Europe. In Vaison-la-Romaine, one of our overnight stops, we lucked into the town's weekly market. This time, we had camera in hand.

Of course, no day in France is complete without bread. This was one of several boulangerie stalls.

Salad greens were also in abundance at this time of year.

There were many varieties of fish from which to choose.

Of course, no self-respecting French cook would be caught without a supply of fresh herbs.

Next stop: Cannes

Number of Tomato-Linked Salmonella Cases Surges

CDC has just released its latest update on the Salmonella Saintpaul outbreak – the first one since last Thursday. As of today, there are 277 lab-confirmed cases of Salmonella illness, and 43 hospitalizations.

The infected individuals live in 28 different states and in the District of Columbia. The most recent victim became ill on June 5th. The confirmed victims range in age from <1 to 88 years, and 46% are female.

CDC estimates that, under normal circumstances, only one case of Salmonella infection is reported to health authorities for every 38 cases that occur. This means that the 277 lab-confirmed cases may translate into more than 10,500 cases of illness from Salmonella-contaminated tomatoes.

CDC has not yet incorporated into its tally all of the cases reported by the various states. For example, CDC reports 4 lab-confirmed cases in Missouri, while the state's Department of Public Health reported on June 12th a total of 8 cases either confirmed or still under investigation.

Meanwhile, FDA does not appear to have made much additional progress in its search for the source of the contaminated produce. According to the latest update on the FDA website, the northern part of Baja California (Mexico) has been cleared by the agency. Other parts of Mexico and some growing areas in Florida, though, remain under suspicion.

If Federal agencies appear to be groping in the dark, it's because they are. In most outbreak investigations, including the 2006 bagged spinach incident, investigators usually have some label information to point the way – a country or state of origin, a production code, an expiry date, or a brand name.

This outbreak is different. Most tomatoes are sold in bulk and are difficult, if not impossible to trace back to their point of origin. We might never know where the contaminated tomatoes came from, how and where they were distributed, or what quantity was contaminated with Salmonella.

This outbreak might only peter out once the contaminated tomatoes get too old to be eaten.

Salmonella Around The World

With the flood of news on Salmonella-contaminated tomatoes in the United States, it's easy to forget that this pathogen can be found on every continent. There are at least three significant Salmonella outbreaks in progress and under investigation outside of the United States.

Adelaide, Australia
Salmonella has claimed the lives of two nursing home residents in this city, and has sickened 18 more. One of the survivors is still in hospital.

According to a June 13th article in The Daily Telegraph, the source of this outbreak has yet to be determined. Infection control procedures have been implemented in the nursing home, and no additional illnesses have occurred.

Sydney, Australia
The Daily Telegraph reports that five area beaches are now closed while investigators scramble to figure out how Salmonella Java has contaminated the playground sand at these beaches.

When I first reported this outbreak on May 18th, a total of 23 children had become infected with this unusual strain of Salmonella, which is usually found in reptiles. Three more children have fallen ill since then, bringing the total to 26. All of the children had become ill – according to their parents – after eating sand at the playgrounds.

Investigators are no closer to determining where the Salmonella Java is coming from. They have extended their investigation to the natural habitats in the area.

Tallinn, Estonia
Health authorities in Estonia are investigating an outbreak of Salmonella Enteritidis that sickened 85 children and 9 employees at a Tallinn kindergarten last month. Seventy-one of the cases have been lab-confirmed. Five of the children were hospitalized, but all have recovered.

The outbreak occurred between May 7th and May 13th. Based on preliminary epidemiological information, the probable source of the infections was a chicken soup that was served at the kindergarten on May 7th. Most of the illnesses began between May 8th and May 10th.

Investigators have sampled foods from the kindergarten kitchen and have also taken environmental samples. The lab analyses – including molecular fingerprinting of the Salmonella isolates – is still in progress.


As for the Salmonella Saintpaul outbreak in the United States, I am hoping to see another update on the CDC and FDA web sites today.

Martha Stewart: Cooking With Fire

One of my pet peeves is the lack of attention paid by most celebrity chefs to the details of safe food preparation. In February, I commented on the food safety shortcomings of a recipe published by Mark Bittman of the New York Times in his blog, "Bitten". Blogger Doug Powell of Kansas State University has raised similar alarms about the on-air practices of celebrity chefs – most recently in a June 6th blog article.

Last December, I took Martha Stewart to task in an open letter over her inattention to safe cooking procedures for raw poultry, and for her use of raw eggs in an eggnog recipe. I emailed a copy of the letter to Martha Stewart Living, and had no response.

But today I am pleased to report that my message appears to have made an impact at Martha Stewart Living. The July/August 2008 edition of "Everyday Food" has incorporated safe grilling instructions into its recipes for turkey burgers and for marinated chicken breasts.

Specifically, on page 14 of the magazine, the recipe for "tex-mex turkey burgers with zucchini salad" includes the following directions:

"Cover and grill until an instant-read thermometer inserted in center of a burger reads 155º, 4 to 5 minutes per side."

"Top burgers with cheese. Cover and continue to grill until cheese has melted and internal temperature reaches 165º, 2 to 4 minutes more."

A recipe for "buttermilk and herb marinated chicken" in the same issue of the magazine instructs readers to:

"Grill until an instant-read thermometer inserted in thickest part of chicken registers 165º, 5 to 8 minutes per side."

It's nice to know that someone at Martha Stewart Living is paying attention to food safety.

Two More States Affected By Salmonella Outbreak

We can add Maryland and North Carolina to the list of states that have confirmed at least one victim of the Salmonella Saintpaul outbreak. That brings the number of states to 26.

The Maryland Department of Health and Mental Hygiene has identified one case of Salmonella Saintpaul, and has confirmed that the microbe, which they isolated from a Baltimore patient, matches the molecular fingerprint of the outbreak strain.

The North Carolina Department of Health and Human Services also has reported a single case of salmonellosis that is linked to the tomato outbreak. The North Carolina victim became ill last month after traveling to Texas – one of the hardest-hit states.

In addition, the New York State Department of Health is now reporting two confirmed cases of Salmonella Saintpaul infection, an increase of one case since the last CDC investigation update of June 12th.

These new cases bring the total number of lab-confirmed victims of this outbreak to 232 as of this morning. Based on CDC estimates that, on average, only one case of Salmonella infection in 38 is ever reported, roughly 8,800 people have been infected by the outbreak strain of Salmonella Saintpaul so far.

And FDA is still trying to figure out where the contaminated tomatoes originated.

Today's Tomato News

We can add a 229th victim and a 24th state to the numbers posted yesterday evening by CDC. Today, the State of Kentucky reported its first lab-confirmed case of salmonellosis caused by the outbreak strain of Salmonella Saintpaul. Fifty percent of the contiguous 48 US states are now part of this outbreak.

FDA has updated its list of tomato-growing areas again today, adding Indiana, New Mexico and – ironically – Kentucky to the "safe" list. Thirty-seven US states, several Florida counties, Puerto Rico, and a half-dozen foreign countries have been cleared by FDA investigators. Mexico and parts of Florida are still under suspicion.

This protracted outbreak investigation is having an impact on tomato growers, regardless of where they are located. Canadian growers are noticing that their sales are shrinking as domestic consumers avoid tomatoes, even though Canada is neither the source nor a victim of this outbreak. Mexican producers complain that their markets are drying up as US consumers shy away from purchasing tomatoes – especially theirs. Mexico says that the FDA has unfairly targeted that country's growers.

Eventually, whether or not FDA tracks down its source, this outbreak will burn out. But there have now been 13 US outbreaks of Salmonella traced to raw tomatoes since 1990. What is to prevent future flare-ups? One possibility is a research project underway at the University of Guelph in Ontario, Canada.

According to a Canadian Press report, researchers at Guelph are working on a way to inoculate tomato plants with a combination of Salmonella-specific bacteriophage – a virus that attacks Salmonella – and a species of Enterobacter that is harmless to humans. The combination of Enterobacter and the bacteriophage has been tested successfully on mung beans. The next step will be to find out whether it will prevent Salmonella from multiplying in and on tomatoes.

But, even if the research is a success, it will take several years before the approach could be widely adopted. In the meantime, we must rely on more conventional methods – or home gardens – to produce safe tomatoes for our garnishes and salad bowls.

Organic Pastures, Happy Cows & E. coli O157:H7

When a large, multi-state food poisoning outbreak is in progress, it's easy for a second outbreak to go virtually unnoticed, especially when the same microbe – in this case E. coli O157:H7 – is responsible for both. That's what would have happened in 2006, except for the vigilance of California's health authorities and the technology of microbiological "fingerprinting".

On September 8, 2006, Wisconsin health authorities reported to CDC that they had identified a small cluster of E. coli O157:H7 illnesses – all due to the identical strain of the microbe. Within a week, Oregon and New Mexico were added to the list of affected states, and the source of the outbreaks had been traced to bagged spinach.

The 2006 spinach outbreak had begun. Ultimately, 199 people in 26 states would report an illness with the outbreak strain. Just over one-half (102) of the victims would be hospitalized, and 31 would develop kidney failure and other consequences of hemolytic uremic syndrome (HUS). Three people would die.

While the spinach outbreak was in full bloom, the California Department of Health Services received reports of five children who had been infected with E. coli O157:H7. Two of the children were hospitalized, one of them suffering from HUS. A sixth child was also hospitalized with HUS, but E. coli O157:H7 was not lab-confirmed.

The E. coli O157:H7 cultures obtained from the five lab-confirmed victims matched each other, but had a different molecular fingerprint from the microbe that was behind the spinach outbreak. When investigators questioned the victims and their parents, they quickly found a common link. All six children had consumed raw milk or (in one case) raw colostrum from Organic Pastures Dairy Co., California's largest producer of organic raw milk for retail sale.

The California Department of Food and Agriculture, on September 21st, ordered a state-wide recall of Organic Pastures' whole and skim raw milk, raw cream and raw colostrum, and barred the company from producing raw milk. The production quarantine was lifted on September 29th, but the company was still forbidden from bottling its milk and cream for retail sale.

The owner of Organic Pastures, Mark McAfee, has always denied that his dairy was responsible for the six illnesses. In a telephone interview reported by SignOnSanDiego.com at the time of the outbreak, McAfee claimed he had been told that some of the children had eaten spinach and undercooked hamburger. And he contended that one of those foods had made them ill – despite the lab evidence that the children were infected with a different strain of E. coli O157:H7 than the one responsible for the spinach outbreak.

But Mark McAfee is an honorable man, and we should believe him.
The Organic Pastures web site boasts that "In more than 32 million servings, and more than five years of intensive testing, not one single pathogen has been found or detected. Not one person has complained to the state of CA that they have become sickened by an OPDC product."

Yet victims of the 2006 outbreak specifically reported drinking Organic Pastures raw milk and raw colostrum. And California ordered a recall of Organic Pastures raw cream in 2007 after finding Listeria monocytogenes in a sample.

But Mark McAfee is an honorable man, and we should believe him.
After California lifted its quarantine order, McAfee celebrated his exoneration. In his opinion, without the State having found the outbreak strain in his milk, in his dairy environment, or in his cows, there was no evidence that Organic Pastures was responsible for the E. coli O157:H7 outbreak.

According to the CDC report released this week, however, the production lot that was linked to the outbreak was no longer available for testing. Also, non-outbreak strains of the microbe were recovered from the dairy herd.

But Mark McAfee is an honorable man, and we should believe him.
Organic Pastures claims that the total bacterial counts in its raw milk are consistently below the State's limit of 15,000 bacteria per milliliter – even during the period covered by the 2006 outbreak. The State lab, though, found numerous samples containing counts in excess of the 15,000 limit – several of them in excess of 1,000,000 per milliliter.

Organic Pastures implies that its products have been negative for E. coli O157:H7 since 2002; however, the pdf file accessed from the same web page shows that testing for the pathogen only began about one month before the start of the 2006 outbreak.

But Mark McAfee is an honorable man, and we should believe him.
FDA prohibits the interstate sale of raw milk for human consumption. Organic Pastures says on its web site that it does not ship raw milk to customers outside of California. McAfee has exploited a loophole in the FDA regulations, which treat raw colostrum as a “non-dairy dietary supplement." Organic Pastures' Superlite Colostrum, containing 95% raw milk and 5% raw colostrum, is shipped to customers nationwide.

But Mark McAfee is an honorable man, and we should believe him.

Or should we believe the families of five children who were sickened in the 2006 outbreak and who have filed lawsuits against Mark McAfee?

Tomato Outbreak Grows Like Topsy

The FDA and CDC haven't yet updated their web pages devoted to the Salmonella Saintpaul outbreak, but Associated Press is reporting that approximately 60 new cases have been added to the list of victims of the contaminated tomatoes, bringing the total to 228. Six more states – Florida, Georgia, Missouri, New York, Tennessee and Vermont – have been added to the 17 that had already reported at least one lab-confirmed case, bringing the number of affected states to 23.

CDC has acknowledged the increased number of cases on its "Questions and Answers" page, and estimates that – because only one Salmonella infection in 38 is usually reported to health authorities – more than 8,600 people may have already been sickened in this outbreak.

CDC also confirmed that the contaminated tomatoes may have claimed the life of one victim. As I reported two days ago, a cancer patient in Texas had been suffering from an infection with the outbreak strain at the time of his death.

Although FDA continues to exonerate some growing areas from involvement in this outbreak, the agency is still not much closer to determining the source of the contaminated tomatoes. Until they do, consumers would be wise to stick to those varieties that are not implicated in this outbreak: cherry tomatoes, grape tomatoes, and tomatoes that are still attached to the vine.

UK Seed Recall

The Food Standards Agency has alerted consumers to the recall of a batch of Khakshir seeds by Golden Saffron Ltd. due to Salmonella contamination. The 200-g packages of seeds are labeled with an expiry date of 12/2009.

Liquid Infant Milk Recalled In UK

The Food Standards Agency is advising consumers that SMA Nutrition has recalled a single batch of its "SMA Gold ready to use liquid infant milk" due to curdling.

The 1-litre containers are labeled with batch code 06033G and a best before date of 12 March 2009. No other liquid or powdered products or production batches are affected by this recall.

SMA announced the recall after receiving reports that the contents of some containers had curdled. Customers who purchased the recalled batch are asked to call the SMA toll-free Careline at 0800 089 0075.

Tomato FAQs

As of the most recent CDC update (June 9th), the tally of lab-confirmed Salmonella Saintpaul cases linked to raw tomatoes is holding steady at 167 victims. The youngest victim so far is one year old, and the oldest is 82. Roughly half (49%) are female. At least 23 people have been hospitalized.

FDA and state investigators continue to close in on the source of the contaminated tomatoes. Yesterday, FDA expanded its list of "safe" growing areas once again. Several counties in Florida are now deemed safe, as are the following states, territories and countries:

Alabama, Arkansas, California, Colorado, Delaware, Florida*, Georgia, Hawaii, Louisiana, Maine, Maryland, Minnesota, Mississippi, New Jersey, New York, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, West Virginia, Wisconsin, Belgium, Canada, Dominican Republic, Guatemala, Israel, Netherlands, Puerto Rico

*Jackson, Gadsden, Leon, Jefferson, Madison, Suwannee, Hamilton, Hillsborough, Polk, Manatee, Hardee, DeSoto, Sarasota, Highlands, Pasco, Sumter, Citrus, Hernando, and Charlotte counties

During the last few days, several people have asked me questions about this outbreak. Here are some FAQs.

How serious is Salmonella?
Most cases of Salmonella infection are relatively mild. Symptoms usually consist of stomach cramps, diarrhea and a low-grade fever. Young children, the elderly, and those with pre-existing illness are at greatest risk of serious consequences – usually resulting from dehydration. As many as 2% of victims might develop a secondary chronic syndrome, such as reactive arthritis or Reiter's Syndrome.

How can FDA say that some growing areas are "safe" without knowing who's at fault?
FDA proceeds by process of elimination. As more and more outbreak victims are identified and interviewed, a pattern develops. First, investigators were able to establish that raw tomatoes were the culprit. Next, they managed to limit the varieties of tomato that might be at fault. Now, as federal and state investigators contact food stores and restaurants frequented by the outbreak victims, they can gradually close in on a possible common source for the tomatoes. By naming the safe growing areas as they are identified, FDA probably hopes to reduce the negative impact of this outbreak on the tomato growers.

If the outbreak is spread over 17 states, why have so few people become ill?
CDC reports only lab-confirmed cases in its tally. Only a relatively small percentage of food-poisoning victims – typically, those most seriously affected – ever visit a doctor. And the illness only comes to the attention of state or federal health officials if the doctor thinks to submit a stool sample for lab tests.

A recent Canadian study determined that the actual number of cases of Salmonella illnesses in that country is between 13 and 37 times as high as the number of reported cases. If those statistics are applied to the current US tomato outbreak, the actual number of Salmonella victims could easily exceed 2,000 and might even surpass 6,000 people.

Has this happened before?
The first multi-state Salmonella outbreak linked to tomatoes took place in 1990. It was followed by a second outbreak in 1993. Both outbreaks were traced to a single tomato packing facility, located in South Carolina. Investigators concluded that the tomatoes were most likely contaminated at the packing shed, as a result of all of the tomatoes being dumped into a common water bath for washing. There have been several outbreaks since 1993 – at least a dozen in the last 10 years.

How do tomatoes become contaminated with Salmonella?
Contaminated irrigation water was blamed for two outbreaks, one in 2002 and the other in 2005. Both outbreaks were caused by the identical strain of Salmonella Newport, and were traced to the same Virginia grower. Investigators were able to find the outbreak strain in pond water that had been used to irrigate the tomato fields.

Salmonella can be spread by field animals; small animals may even carry Salmonella into hothouses where tomatoes are grown. Packing houses can also be the source of – or the means of spreading – Salmonella, as occurred in the 1990 and 1993 outbreaks. Other possibilities include the use of improperly composted manure, field workers tracking contaminated soil into a field on their boots, or inattention to proper sanitation and personal hygiene.

Is anything being done to prevent future outbreaks?
Before a problem can be solved, it must first be understood. After the 1990 and 1993 outbreaks had been traced to their common source, industry funded research that confirmed the ability of Salmonella to grow under tomato packing house conditions. That research was used to develop and implement a program designed to prevent the problems that led to those early outbreaks.

Since then, a large number of graduate students and post-doctoral fellows have cut their collective research teeth on understanding the mechanisms that allow Salmonella to contaminate – and adhere tightly to – tomatoes, and on how to prevent or eliminate the contamination. Also, FDA, USDA and state officials are working with tomato growers to eliminate the sources of contamination in the fields.

How can consumers protect themselves during this outbreak?
The safest approach is to avoid raw, tomato-based dishes – salsas, guacamole, diced or sliced tomatoes – in restaurants, and to limit tomato consumption to those varieties that have not been implicated in the outbreak investigation: cherry tomatoes, grape tomatoes, and tomatoes attached to the vine.

Consumers can also consult the "safe" list (above). Farmer's markets in these areas should be good sources – in season – of raw tomatoes.

Finally, CDC offers the following advice for handling raw tomatoes and other raw produce:

• Refrigerate within 2 hours or discard cut, peeled, or cooked tomatoes.
• Avoid purchasing bruised or damaged tomatoes and discard any that appear spoiled.
• Thoroughly wash all tomatoes under running water.
• Keep tomatoes that will be consumed raw separate from raw meats, raw seafood, and raw produce items.
• Wash cutting boards, dishes, utensils, and counter tops with hot water and soap when switching between types of food products.