Salmonella Saintpaul: One Diagram = 1,000 Words

It's finally starting to make more sense!

FDA published an updated flowchart of its trace-back/trace-forward investigation this afternoon. And just as I predicted, the separate – and apparently unrelated – findings of a contaminated jalapeño pepper in Colorado and one at a small importer/distributor in McAllen, Texas have converged onto a common link.

The trace-back diagram has clarified another inconsistency. Reports published yesterday stated that the jalapeño pepper from McAllen was traced to a different part of Mexico than the farm where contaminated irrigation water and contaminated serrano peppers were found. In fact, while the two sets of contaminated peppers were from different farms, both farms are located in the same state – Tamaulipas.

Here's how the puzzle fits together so far:

• Grower "A" – located somewhere in Tamaulipas – shipped jalapeño peppers via an intermediary to a packing house in Nuevo Leon, Mexico.
• The Nuevo Leon packing house shipped the jalapeño peppers to Agricola Zaragoza in McAllen, Texas, where FDA encountered its first positive sample.
  
  
• Grower "B" – located somewhere in Tamaulipas – shipped serrano peppers to the same packing house in Nuevo Leon, both directly and via at least three different distributor/re-packer/broker operations.
• FDA detected the outbreak strain of Salmonella Saintpaul in irrigation water and on serrano peppers at Grower "B".

How did the outbreak strain find its way onto two different varieties of peppers, each grown at a different farm? There are two possible explanations.

• The farms might be in close enough proximity to each other that they are both using the same contaminated irrigation water.
• The peppers might have become cross-contaminated at the Nuevo Leon packing house.

I'm betting on common irrigation water.

There are still some missing pieces to the puzzle.

• FDA hasn't indicated whether the harvest schedule for the serrano or jalapeño peppers matches the time frame of the outbreak.
• FDA has not ruled out the involvement of tomatoes in the early part of the outbreak. Indeed, there is one farm in the area that produces all three items – tomatoes, jalapeños and serranos.

The next several days should bring more developments as additional lab results become available, and FDA continues its field investigations.

Salmonella Saintpaul Investigation: Breakthrough Recap

As I posted yesterday evening, FDA has detected the outbreak strain of Salmonella Saintpaul in irrigation water and on serrano peppers from a Mexican farm. The farm, which distributed some of its output through Agricola Zaragoza in McAllen Texas, is located in the state of Tamaulipas, Mexico. Its business address is in Nuevo Leon, Mexico.

Agricola Zaragoza was the site of FDA's initial isolation of Salmonella Saintpaul from a sample of jalapeño pepper. That pepper was produced on a farm located in a different part of Mexico.

In addition to FDA's findings, the state of Colorado detected the outbreak strain from a sample of left-over jalapeño peppers obtained from one of the outbreak victims. That person had purchased the peppers at a local Wal-Mart.

Dr. David Acheson of FDA testified yesterday afternoon before the House Agriculture Subcommittee on Horticulture and Organic Agriculture. His scheduled appearance came just two hours after the agency's investigators confirmed their detection of the outbreak strain at the Tamaulipas farm.

Dr. Acheson told the Committee members that the contaminated jalapeño and serrano peppers had "common distribution points". When asked about the initial focus on tomatoes, he indicated that they have not been ruled out as having played a part in the early portion of the outbreak. FDA has identified at least one farm where all three produce items are grown.

As the outbreak winds down, the number of new cases added to CDC's daily update has dropped dramatically. As of 9pm (EDT) on July 29th, CDC has identified 1,319 lab-confirmed cases of Salmonella Saintpaul, distributed through 43 states, the District of Columbia and Canada.

FDA has amended its consumer advisory, and is now recommended that consumers avoid consuming raw jalapeño peppers and raw serrano peppers imported from Mexico.

California Company Recalls Cilantro

The Canadian Food Inspection Agency is advising consumers that NewStar Fresh Foods of Salinas, California has recalled fresh cilantro after it was found to contain Salmonella. The company initiated its recall after Michigan's Department of Agriculture detected Salmonella as part of its routine sampling program.

The contaminated cilantro was sold in 1-pound food-service packages in British Columbia, Manitoba and Alberta and in the following US states: Michigan, Illinois, Iowa, Wisconsin, Oklahoma, Washington, New York, Oregon, Ohio, Louisiana, Tennessee, Arkansas, North Carolina, Kentucky, New Mexico, Alabama, California, Texas, Georgia, Utah, Mississippi, Arizona, and Florida.

The one-pound clear plastic bags are labeled with Product Lot ID # 11B056404 and either an expired best-if-used by dates of July 26th and 27th or a Julian code of 192 or 193, and are sold under the brand names NewStar, Ready Set Serve, and Cross Valley Farms.

According to the recall notice, there have been no illnesses associated with this product, and the strain isolated from the cilantro is not Salmonella Saintpaul. But there is an on-going unexplained Salmonella outbreak in British Columbia, and one has to wonder if there is any link. The recalled cilantro was packaged on June 3rd and 4th, and the BC outbreak has been running for about two months.

Newstar has several growing operations in California, Mexico and Arizona. The cilantro is grown near Mexicali, Mexico.

Ironically, NewStar claims to have "...the strongest food safety program in the industry." The Company has adopted, according to its website, the most recent "Good Agricultural Practices" guidelines, and boasts of adhering to "...clearly defined Good Manufacturing Practices (GMPs), Standard Sanitation Operating Practices (SSOPs), Standard Operating Procedures (SOPs), and Traceback / Recall."

Customers should return the recalled cilantro to the place of purchase for a refund. For any questions about the recall, contact the company at 1-831-758-7810.

Timberwolf Organics Recalls Some Pet Foods

Thanks to Jan on the Doodle Discussion Forum for flagging this item.

Timberwolf Organics voluntarily recalled two of its dog food formulas, produced on three different dates on June 3rd, after receiving some consumer complaints.

The recall covers these three items:

• Bison with 'best by date' of 12 Feb 2009
• Ocean Blue with 'best by date' of 20 Feb 2009
• Ocean Blue with best by date' of 8 March 2009

The company has given the following explanation for this recall:

The reported symptoms include dogs refusing to eat, diarrhea or vomiting. While the problem is inconsistent (not every dog eating food from those dates/bag show the symptoms and not every bag), to err on the side of caution have decided to pull the formulas produced with the above dates. Initial testing has come back negative for problems and further testing is pending results.

Customers who have purchased any of the recalled items are invited to return them to the place of purchase for refund or exchange.

A tip of the hat to Timberwolf Organics for acting responsibly to protect its customers.

Jalapeños, Serranos, And ...?

Dr. David Acheson of FDA was testifying before a congressional committee this afternoon. Usually, these hearing can be pretty boring, but today – according to the Wall Street Journal – was different.

Jane Zhang of the Journal reported this afternoon that FDA has found the outbreak strain of Salmonella Saintpaul "...on serrano peppers..." There were few details in the Journal's story, but Associated Press has filled in some important gaps.

The outbreak strain was found by FDA in irrigation water and on serrano peppers from a farm in Nuevo Leon, Mexico. This farm is located in a different part of Mexico from the farm that produced the contaminated jalapeño pepper found at Agricola Zaragoza in McAllen, Texas.

Then there's the tomato connection. Did the farm in Nuevo Leon – or a different farm that also used the same water source for irrigation – also grow tomatoes? Or was New Mexico's tomato connection a false lead? Nuevo Leon was added to FDA's "safe tomato growing area" list (which has now disappeared from the FDA web site) more than a month ago.

Now that FDA has located an environmental source of Salmonella Saintpaul and tied it to contaminated produce, it will likely focus on the following outstanding questions and investigations:

• How many farms use the same source of irrigation water? Each of these farms will have to be checked for contamination, and produce from these farms traced forward to their ultimate destination. Additional recalls might be necessary.
• How did the irrigation water become contaminated? The source of the contamination will need to be addressed in order to avoid a repetition of the contamination on future crops.
• How did the Salmonella Saintpaul transfer from serrano peppers grown in Nuevo Leon to jalapeño peppers grown in a different part of the country? The distribution chains of both items will be scrutinized to look for any cross-over points. The McAllen, Texas finding was a secondary contamination. An employee of Agricola Zaragoza might have been infected with Salmonella Saintpaul and transferred the microbe to the jalapeño pepper while handling produce at the warehouse. The positive result might even have been a lab error.

Another important issue to be addressed is decontamination, both of the irrigation water and of the fields. Once the source of the Salmonella Saintpaul is found and eliminated, Mexican authorities – with assistance from FDA – will need to decontaminate the irrigation water before it can be used again. And the fields must lie fallow for several weeks – Salmonella can survive up to six weeks in soil – to avoid contamination of future crops.

FDA is maintaining its advice, for now, that consumers avoid Mexican-grown raw jalapeño and raw serrano peppers. US-grown peppers are safe to eat.

Salmonella Outbreak In Western Canada

The southern mainland region of British Columbia – including the Vancouver metropolitan area – recently has experienced an unusual number of cases of Salmonella illness during the last two months.

According to the BC Centre for Disease Control, more than 60 confirmed cases of Salmonella Enteritidis have been reported in the last two months, compared to just 39 infections due to this strain through all of 2007. Most, though not all, of the cases have occurred in the southern part of the province.

Salmonella Enteritidis has been linked, in the past, to contaminated meat, poultry, eggs and produce. Provincial epidemiologists have been working – unsuccessfully, so far – to identify a specific source of this outbreak.

E. coli O157:H7 Flare-Up

He's baaaack!

Bill Marler reported this morning that six people in the Dayton, Ohio area have been infected by E. coli O157:H7 in the last two weeks. The cases, apparently are linked to ground beef purchased from three local-area markets.

Two of the victims purchased their meat from the Dorothy Lane Market location on Washington Square. Dorothy Lane has recalled all ground beef labeled with "sell by" dates between June 9th and July 29th.

Dorothy Lane procured its meat from the same Nebraska Beef plant that was implicated in last month's seven-state outbreak of E. coli O157:H7. There's no information as yet whether the same strain of E. coli O157:H7 is responsible for this current rash of illnesses.

There are still some loose ends dangling from the earlier outbreak, most notably in Georgia. While the meat that infected at least eight people in Colquitt County originally came from Nebraska Beef and was contaminated with the outbreak strain of E. coli O157:H7, the Georgia meat was not part of the 5.3 million pound Nebraska Beef recall. Nor was the Georgia meat recalled subsequently.

The Georgia illness cluster arose in late June, putting it in the same date range as the meat recalled by Dorothy Lane. Might the Georgia and Dayton clusters be linked? We should have a better idea in the next week or two.

Salmonella Saintpaul: Triangulating A Source

In a major break in the hunt for America's Least Wanted (Salmonella Saintpaul, that is), the Colorado Department of Public Health and Environment (CDPHE) has announced the recovery of the outbreak strain from a jalapeño pepper.

The pepper was purchased at a Wal-Mart store in Montezuma County on June 24th by a victim of the multi-state Salmonella outbreak, who began to experience symptoms of salmonellosis on July 4th.

This second isolation of Salmonella Saintpaul from a jalapeño pepper – the first definitively tied to a victim of the outbreak – will be a major boost to FDA's attempts to find the source of the contaminant.

I hope that FDA hasn't cast aside the original New Mexico case control studies that pointed to Mexican tomatoes. The state's health department determined that there appeared to be a correlation between Salmonella Saintpaul illnesses and tomatoes purchased from Wal-Mart, Lowe's and Basha's food markets. Wal-Mart's tomatoes originated in Florida and Mexico; Lowe's and Basha's purchased their tomatoes exclusively from Mexico.

There are now three separate directional arrows, all of which should be pointing to a common source for FDA to follow in its investigations:

• The New Mexico case control study pointing to tomatoes from Mexico
• The finding by FDA of a Salmonella Saintpaul-contaminated jalapeño pepper imported from Mexico by a McAllen, TX importer/distributor
• The detection of Salmonella Saintpaul in a jalapeño pepper purchased from Wal-Mart by an outbreak victim in Colorado.

CDC reported yesterday afternoon a total of 1,304 lab-confirmed cases. The most recent estimated onset date is July 13th. With the outbreak continuing to slow, there will be very few new opportunities to find additional clues to the origin of the contaminant. Let's hope these three directional arrows lead FDA to the source.

Water Woes: Asia and Africa

The good news, according to a recent World Health Organization report, is that the number of people worldwide with no access to a protected drinking water source has fallen below one billion for the first time. The bad news is that 2.5 billion people – most of them in Asia and Africa – lack access to decent sanitation facilities. And nearly 1.2 billion people still have no alternative than to defecate in the open.

In light of these sad statistics, it's no wonder that a new or expanded cholera outbreak – or some other water-borne disease – is reported in Asia or Africa almost daily. Here are some examples:

Jaipur India. Three people die – including an eight-year old girl – and 115 people suffer from diarrhea after drinking contaminated water. The drinking water supply became contaminated by drain water as a result of pipeline corrosion.

Chandigarh, India. An outbreak of diarrhea, including approximately 20 confirmed cases of cholera is growing. Authorities have been sampling foods and water in a desperate effort to find the source of the outbreak, which has now sickened at least 400 people.

Ho Chi Minh City, Vietnam. Students in residence at Vietnam National University have been complaining about the quality of their water. Water for the student residence is pumped from wells and held in large storage tanks. Often, the tanks are adjacent to toilet facilities. The water usually is dirty, and is heavily contaminated with alum. Students use this water for washing, cooking and drinking.

Kitgum District, Uganda. Hepatitis E Virus, which has infected 4,000 people in the last five years in this northern Uganda district and has claimed 67 lives, has been linked to water drawn from springs, boreholes and shallow wells – often located near latrines. Tests carried out on water samples from these sources detected fecal coliform bacteria – an indication that the water has been contaminated with human or animal waste. UNICEF is asking for assistance to disinfect the water sources, most of which serve IDP (Internally Displaced Persons) camps in the district.

Anchau, Nigeria. Drought has dried up 90% of the water sources in this village and its surrounding areas. The water that remains is badly polluted due, at least in part, to a poor drainage system. Cholera, ever the opportunist, has taken hold in this area and has killed a dozen people so far.

Guinea Bissau. The situation in this west African nation is just the opposite from the Nigerian crisis. Flooding caused by heavy rains has washed fecal material into the country's wells and reservoirs. The resulting cholera outbreak has spread to many areas of the country that were previous thought to be safe. So far, 611 have contracted the disease – more than half of them in July. Fourteen people have died. The World Health Organization and UNICEF are doing what they can to help stem the spread of the disease. But there is, at present, not enough chlorine in the country to decontaminate the water supply.

Myanmar. The pleasant surprise in this deluge of bad news is the Ayeyarwaddy Delta region of Myanmar – hard hit by Cyclone Nargis in early May – where cholera has not broken out. While there have been scattered cases of diarrheal disease, the outbreak predicted by so many people (including eFoodAlert) never materialized. This outcome, while unexpected, is in line with the results of a study reported recently in Journal of Hospital Infection, and commented on in the July issue of Microbe, a monthly publication of the American Society for Microbiology. The study's authors pointed out that neither the 2004 tsunami nor hurricane Katrina were followed by severe outbreaks of communicable diseases.

WHO and other international organizations face major challenges in bringing improved sanitation facilities and safe drinking water to people living in the underdeveloped regions of the world. But these outbreaks, and all the others that are yet to come, highlight the importance of this international effort. We can never eradicate cholera – it's too well entrenched. But we can reduce its ability to spread by bringing basic sanitation and hygiene to people who need them desperately.

Listeria monocytogenes Prompts Smoked Salmon Recall

Vita Food Products, Inc., based in Chicago, has recalled packages of Vita Nova Salmon, due to a concern that the product may be contaminated with Listeria monocytogenes.

The packages of smoked salmon, which bear a code date on the left end flap of 11/16/08 198, were sold in Kroger stores in the Houston, TX area on or after July 22nd. In addition, 192 packages may have been sold – or are still available for sale – in stores in the Avenol, NJ area.

While there have been no customer complaints received by the company and no known illnesses associated with the recalled product, Listeria monocytogenes is not a microbe to be treated lightly. It grows in conditions of minimal oxygen and at refrigerator temperatures. It has been responsible for miscarriages. In susceptible individuals – the very young, the elderly, the immunocompromised – it can cause serious illness, even death.

If you have purchased a recalled package of Vita Nova Salmon, please return it to the store for a refund, or contact the manufacturer, toll-free, at 1-800-989-8482.

Lobster Lovers Beware: Toxic Tomalley

All lobster lovers, and even lobster first-timers, recognize the tomalley – the green stuff inside the crustacean. Some people enjoy eating it, while others – myself included – find its appearance rather off-putting. Now I have a socially-acceptable reason for scraping off the tomalley.

The state health departments in Massachusetts and Rhode Island have posted warnings about toxic tomalley. According to the Rhode Island Department of Health, the state of Maine has found that toxins produced during a "red tide" are concentrated in the tomalley. Eating tomalley from a lobster that was feeding in a red tide area could result in paralytic shellfish poisoning.

The tomalley is a lobster's liver. It acts as a filter, removing toxins – natural and man-made – that would otherwise poison the crustacean. Those toxins, including PCB's, are concentrated in the tomalley.

None of the toxin accumulates in the lobster meat, which remains safe even during a red tide event. So enjoy that lobster. But don't be shy about discarding the tomalley.

eFoodAlert World Tour: Outings and Outbreaks

As usual, we're visiting Asia and Africa this week, but with a side trip to the Caribbean. This tour will stick strictly to food-related news; we'll conserve water for another day.

Hong Kong
The Centre for Food Protection can always be counted on to report at least one restaurant-associated outbreak in time for our tour. Thirteen people suffered from abdominal pain, nausea, vomiting and diarrhoea after eating at a restaurant in Mong Kok on July 20th. As usual, the agency is "investigating" the outbreak, but no further details are available.

Separately, a 10-month old girl was confirmed to be suffering from E. coli O157:H7, and has been admitted to hospital. There is no indication of the possible source of the infection, but the girl's brother and grandmother had experienced, and recovered from, bouts of diarrhea before the toddler fell sick.

Notwithstanding the regular flow of illness outbreaks from Hong Kong, the Centre for Food Safety reported on July 23rd that 99.8% of food samples surveyed in May and June met safety standards. Only 19 out of 10,200 samples failed – some for microbiological reasons, and other for excessive levels of pesticides or other chemicals. A separate survey of 345 street snack samples found only three that did not meet standards – all due to non-permitted coloring agents.

Vietnam
From Hong Kong, it's a relatively short hop to Vietnam, which has had more than its share of food poisoning outbreaks so far this year. According to the country's health ministry, the months of January through June saw 4,718 people develop food poisoning – an increase of more than 50% over the same period last year. While the number of outbreaks – 106 nationwide – was down about 12% from last year, the average outbreak was larger than the year before. And the number of deaths also increased substantially – 43 in the first half of 2008 versus 28 in the same period last year.

India
Three migrant laborers in Banur complained of nausea and stomachache after eating eating a meal on Tuesday. One of the men died and another is still in critical condition in hospital. The third worker recovered. The illnesses are being blamed on an unspecified "food poisoning" according to local police officials.

South Africa
The pearl in the oyster at this year's Pick n Pay Knysna Oyster Festival apparently was microbial. Approximately 200 people who attended the festival came down with typical symptoms of food poisoning – nausea, vomiting, diarrhea, fever, aching muscles – after eating oysters during the two-week event. Some of the victims were admitted to hospital, but everyone appears to have recovered.

The victims had eaten at different restaurants, and oysters appear to be the only common link. Health authorities have not yet determined the microbe behind the misery.

Egypt
There's nothing like a bout of food poisoning to cast a pall over a holiday trip. More than 90 members of a tour group fell ill at the Movenpick Hotel in Taba, Egypt while on a two-week holiday. The victims suffered severe diarrhea. Several members of the group became so badly dehydrated that they required IV drip hydration therapy. A couple from Hemel Hempstead in the UK, along with 30 other members of their tour group, has decided to sue their tour operator, First Choice Holidays.

Trinidad
Police trainees in St. James, Trinidad and Tobago discovered that training for the police force carries its own risks. A meal consisting of rice, peas and chicken caused 82 trainees to experience stomach aches and diarrhea last Wednesday. The food had been prepared by a woman police officer, who had been awarded a contract to supply meals at the training school. None of the victims were hospitalized, but several have been granted sick leave.

Russia
Thirty-one children in Svobodny, in Russia's far east have been hospitalized with symptoms of acute gastroenteritis, according to Itar-Tass. The students had eaten at the railway station café in Svobodny before falling ill. An epidemiological investigation subsequently identified an additional ten children and one adult who experienced similar symptoms. The exact cause of the gastroenteritis has not yet been identified, but lab tests are in progress.

As the sun sets on this week's world tour, eFoodAlert wishes everyone "Safe Eating".

Salmonella Saintpaul: Weekend Update

CDC released its latest statistics on Friday evening, and the data continue to point to the end of the road for this marathon Salmonella outbreak.

As of 9pm (EDT) on July 24th, 1,294 people in 43 US states, the District of Columbia, and at least two Canadian provinces have been infected with the identical outbreak strain of Salmonella Saintpaul. Thirty-one of the victims became ill in the month of July, the most recent victim having falling sick on July 10th. At least 242 people have been hospitalized; two people infected with the outbreak strain have died.

FDA has been pursuing its investigation of the contaminated jalapeño pepper sample found at a McAllen, Texas importer/distributor, Agricola Zaragosa. The agency has confirmed that the pepper was Mexican grown. According to FDA, the importer was not the source of the Salmonella.

Jalapeño peppers and serrano peppers grown in the United States are safe to eat, according to FDA – if you can determine reliably their country of origin. Tomatoes that are available now in retail stores also are safe, regardless of their variety or country of origin. All of the tomatoes available today were harvested and shipped from areas that were not harvesting at the time of the outbreak.

While this outbreak soon will be declared over – whether or not the mysteries surrounding its origin are ever solved – careful consumers should pay attention to the following advice, posted daily on the CDC's Salmonella Saintpaul outbreak web page:

Consumers everywhere are advised to follow the general food safety guidelines below:

• Refrigerate within 2 hours or discard cut, peeled, or cooked produce items
• Avoid purchasing bruised or damaged produce items, and discard any that appear spoiled.
• Thoroughly wash all produce items under running water.
• Keep produce items 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.

Listeria Stages A European Comeback

Listeria monocytogenes, an old friend which appears to have taken a nap in North America, has been staging a comeback in Europe.

Dr. Véronique Goulet sounded the alarm in an article published this past week in the "Bulletin épidémiologique hebdomadaire" (Weekly Epidemiological Bulletin). The English abstract of the article reads:

From 1987 through 2001, the incidence of listeriosis in France declined spectacularly, then stabilised until 2005 to around 3.5 cases/million inhabitants. This trend changed suddenly in 2006 with an incidence increase of 4.6 cases/million inhabitants, which continued until 2007 to reach 5.0 cases/million inhabitants. This increase has occurred mainly among persons >60 years of age and immunosuppressive patients, regardless of their age. No increase has occurred in pregnancy-associated cases. Most geographical districts are involved, and seasonal variation is similar than before 2006. The increase of incidence is not linked to the emergence of particular strains at the origin of clusters, and the increase occurred in both sporadic and cluster-associated cases. In nine other European countries, an increase of listeriosis has also been observed during the period 2000-2006, with similar characteristics as in France (occurring in subjects >60 years, with no geographical and temporal clustering, and no emergence of any particular strain). In France, as in other European countries, the cause of this increase remains unknown. Different hypotheses contributing to explain this increase are discussed here.

Dr. Goulet published a similar report – covering data through 2006 – in Emerging Infectious Diseases in May of this year. Last week's report, which includes data gathered in 2007, simply confirmed her previous observations.

According to an article published in Le Monde this past week, Dr. Goulet has proposed a few possible explanations for the sharp increase in incidence of Listeria monocytogenes infections:

1. Reduced salt levels in many processed foods in response to government attempts to reduce the salt intake of the population;
2. Increased popularity of raw foods, such as sushi; or
3. Extended shelf-life of many refrigerated foods, which would allow low levels of Listeria monocytogenes to multiply.

Modified atmosphere packaging – replacing all or part of the oxygen in a sealed package with another gas – is an effective way to extend the shelf life of many perishable products. The technology is very successful at suppressing spoilage bacteria, most of which grow only in the presence of oxygen. But food-borne pathogens grow even in the absence of oxygen. Some of them – including Listeria monocytogenes – prefer an oxygen-poor environment.

USDA researchers have been studying the effect of modified atmosphere packaging of produce on bacterial survival and virulence. They found that bacteria grown under modified atmosphere became better able to survive stomach acid. The phenomenon was especially noticeable when packages of produce were held at "abusive" storage temperatures (room temperature or warmer).

Recently, the UK Food Standards Authority recommended that vacuum packaged foods and foods packed under modified atmosphere be limited to a 10-day shelf life. The regulators issued this guideline in order to minimize the risk that Clostridium botulinum might grow in the packaged products. But the 10-day limit should also reduce the risk of Listeria monocytogenes, which grows even more happily at refrigerator temperatures than C. botulinum.

The French have initiated a new survey this year to determine the level of Listeria monocytogenes contamination in various ready-to-eat foods. Dr. Goulet hopes that the results of this survey will help to explain the increased incidence of listeriosis in Europe. And point to a strategy to reverse the trend of the past few years.

If Western Europe is experiencing a large increase in listeriosis, can the United States and Canada be far behind? A quick look at a CDC surveillance chart shows that the incidence of Listeria monocytogenes reported to FoodNet dropped nearly in half between 1996 and 2002, then rose by almost 50%, and has remained in a fairly stable range since then. In 2007, the reported incidence of lab-confirmed cases in the United States was 2.7 per million population – a bit more than half the 2007 incidence in France. It's anybody's guess what will happen in 2008.

What can consumers do to reduce the risk of contracting an infection with Listeria monocytogenes? Here are some suggestions:

1. Buy unwrapped, unwashed produce.
2. Avoid buying packaged ready-to-eat food that is nearing its "sell by" date.

And pay attention to the next recall announcement.

Australia's Nursing Home Ills

Australia's nursing home residents have suffered several outbreaks of food-borne disease recently. Dr. Steve Corbett, public health director for the Sydney West Area Health Service told News.com (a News Corporation outlet) that five nursing homes have experienced gastroenteritis outbreaks so far this month. And that's just in west Sydney.

According to Dr. Corbett, Clostridium perfringens is suspected in two of the outbreaks – four residents in those two locations tested positive for the microbe. The cause of the remaining outbreaks is still under investigation.

This is not the first time that C. perfringens has been implicated in an Australian nursing home outbreak. Just last month, 80 residents of the Endeavour Nursing Home in New South Wales were stricken with gastroenteritis after eating food that was contaminated with this pathogen. Ten residents died, although some of those deaths might not have been outbreak-related.

Nursing home residents – usually elderly and often frail – are easy prey for bacteria and viruses that cause gastroenteritis. One of the most common culprits is Norovirus, a highly contagious and very rugged virus that often is carried into the nursing home by visitors. Norovirus outbreaks are unpredictable and difficult to prevent.

But there is no excuse for outbreaks of Clostridium perfringens. This microbe is easily controlled by correct food-handling procedures, especially proper attention to cooking, holding and serving temperatures.

C. perfringens is a spore-forming bacterium. When a food that contains C. perfringens spores is cooked, the spores are shocked into germinating. This is not a problem, if the food is cooled promptly to ≤45ºF (≤7ºC). Otherwise, the germinating spores begin to grow and, within just a few hours, can multiply to the millions per gram of food.

When food that contains this high level of C. perfringens is eaten, the microbe makes a home for itself in the intestines, and produces a toxin. Within 24 hours of having eaten the contaminated food, the victim begins to experience severe stomach cramps and diarrhea, lasting for a day or two.

In most people, C. perfringens symptoms are self-limiting and, while unpleasant, are not life-threatening. The very young and the elderly, though, are very susceptible to dehydration caused by severe diarrhea. In rare cases, the dehydration can be severe enough to be fatal.

Outbreaks due to C. perfringens, such as the ones that took place recently in Australia, are an indication that food preparers and food handlers have not been trained properly. Especially in institutions that cater to the elderly, formal training in safe food preparation and serving practices should be mandatory. And kitchen and dining hall facilities should be inspected regularly to ensure that the staff is following correct procedures.

Institutions have a responsibility to provide a clean and safe environment for their residents. The nursing homes that experienced C. perfringens outbreaks fell short, and their residents paid the price.

Water Woes: Bottled Water Recalled In Ireland

The Food Safety Authority of Ireland advised consumers last week that "Pure Spring Natural Still Water" was being recalled by the producer, after E. coli – an indicator of fecal contamination – was found in the water.

The affected batches carry Best Before dates of December 2008 and December 2009, and were sold in the following sizes:

Retail size: 500ml, 1L, 2L & 5L
Water Cooler: 19L

Consumers are advised to avoid drinking this water.

Salmonella Saintpaul: Updating the Stats

The outbreak clearly is winding down, but new cases still trickle in. As of 9pm (EDT) on July 23rd, CDC has amassed a total of 1,284 lab-confirmed cases of Salmonella Saintpaul infections. Only seven states – Alaska, Hawaii, Delaware, North Dakota, South Dakota, Nebraska and Wyoming – have avoided involvement in this produce-related outbreak.

Twenty-six of the victims became ill between July 1st and July 7th, the most recent onset date reported. Two deaths are blamed – at least in part – on the outbreak, and 239 people have been hospitalized.

FDA reported this week that it has detected the outbreak strain of Salmonella Saintpaul in a jalapeño pepper sample obtained from Agricola Zaragosa, a small importer/distributor based in McAllen, Texas. The contaminated pepper was grown in Mexico, but FDA was quick to say that the shipment might have been contaminated after it left the farm.

The agency, with the cooperation of the importer, is tracing the source of the jalapeño, and its entire passage through the distribution chain. Agricola Zaragosa has recalled all jalapeño peppers shipped from its facility since June 30th.

As a result of the Salmonella Saintpaul finding, FDA modified its warning to consumers this week. The government now is advising that all consumers avoid consuming "...raw jalapeno peppers or foods made from raw jalapeno peppers...," essentially the same advice given in this blog when peppers first were identified as a possible source of the outbreak.

As David Acheson of FDA pointed out in a telephone news conference on July 21st, the contaminated jalapeño pepper is just one piece of the investigation puzzle – albeit an important one. There is still a strong connection between consumption of raw tomatoes and illness, especially in the earlier phases of the outbreak. Eighty-six percent (86%) of victims in the first case control studies reported having eaten raw tomatoes, compared to a much lower percentage of healthy control individuals who were questioned by investigators.

With luck, tracing the contaminated shipment of jalapeño peppers back through the distribution chain will enable FDA to identify the hands that held the smoking gun.

Water Woes In The "Developed" World

Living in a "developed" country, it's easy to be complacent about water. Turn on the faucet, and there's an endless supply of fresh, cold, safe water. At least, there used to be.

Severe droughts have struck portions of Australia, Europe, and the United States. Water levels in the Murray-Darling River, source of water for 40% of Australia's farming industry, are at a record low. Barcelona was forced, this spring, to import shiploads of water from France. In 2007, Governor Perdue of Georgia declared a water emergency; this year, it was the turn of California's Governor Schwarzenegger to announce that the state was experiencing a drought.

At the other extreme, too much water brings its own set of problems, as residents of New Orleans can attest. It's not unusual, during heavy storms, for runoff from Toronto's combined sewage and storm drain system to overflow into Lake Ontario, causing bacterial levels to rise beyong safe levels. Ottawa, from time to time, spills sewage into its namesake river, resulting in the closure of beaches downstream. Both of these cities are wrestling with an aging sewage and storm drain system that was not designed to handle today's population density.

Municipal and County agencies in the United States also are struggling with water infrastructure challenges. "Boil water" advisories have been issued for eight different Kansas water districts so far this year. Earlier this week, the Snohomish Public Utility District in Washington State advised some of its residents to boil their drinking water after the system lost pressure due to a pump failure. And residents of Alamosa, Colorado won't soon forget the outbreak of Salmonella that resulted from contamination of their drinking water supply earlier this year.

Increasingly, we are making demands on our water and sewage infrastructure that are beyond its capacity to supply. If we don't take steps to conserve what we can – and update what we must – we'll find ourselves wrestling in the near future with the same issues of contaminated water that confront the populations of Africa and Asia today.

Contaminated Oysters – New Zealand

The New Zealand Food Safety Authority is advising consumers that several batches of Clevedon Coast Oysters may be contaminated with a "...micro organism that may cause vomiting or diarrhoea." The specific contaminant has not been identified.

The producer, Pakihi Marine Farms Ltd., has issued a recall of all potentially contaminated batches. The recalled shellfish – described as "½ Shell Oysters, Pottled Oysters" – were distributed throughout New Zealand and internationally.

The following batch numbers are included in the recall:

2230697 - 2210780
4240687 - 4110780
9060780 - 9080780

Oyster lovers should be on the look-out for products bearing the name "Clevedon Coast Oysters" and fitting the above description. Under no circumstances should these oysters be consumed.

The New Zealand Herald reports that the oysters – thought to be contaminated with norovirus – are responsible for 73 illnesses. While the investigation is still in progress, the medical officer of health expressed the opinion that the most likely sources of the contamination were, "...raw human sewage in the seawater before harvesting, possibly from sewerage pipes, a septic tank or a discharge from a passing boat."

Beef Recall – E. coli O157:H7

Beef Packers, Inc. of Fresno, CA is recalling approximately 1,560 pounds of beef cheek products after the company's own testing program detected E. coli O157:H7 in a sample of the product.

The beef cheeks, which were intended for further processing, are packed in 30-pound boxes, labeled with Est. No. 354, a "packed on" date of 07/02/08, and the description "CARGILL MEAT SOLUTIONS CORPORATION, BEEF CHEEK MEAT: SM BX."

This meat recall is not in any way linked to Nebraska Beef or to the 7-state E. coli O157:H7 illness outbreak. There are no known illnesses associated with the beef cheek products described in today's recall notice.

Given the "Cargill Meat" name on the boxes, though, it would not be surprising to learn of a separate recall by Cargill in the near future.

E. coli O157:H7 Infections Linked to Raw Milk – Again

You can't keep a bad bug down!

No sooner does one E. coli O157:H7 outbreak (Nebraska Beef) wind down, than another one begins.

Barfblog and Bill Marler carried reports this morning of an outbreak of E. coli O157:H7 in Connecticut. Yesterday evening, Marler also mentioned a separate – and we hope isolated – incident of E. coli O157:H7 in Missouri. Both the Missouri and the Connecticut cases appear to be linked to consumption of raw milk.

According to an article in this morning's Hartford Courant, four people have been diagnosed with E. coli. All four drank unpasteurized milk supplied by Town Farm Dairy of Simsbury, CT. The milk was bottled on three separate dates, as indicated by "sell-by" dates of June 24, July 4 and July 16 on the containers.

Town Farm Dairy is a non-profit business, which is owned and operated by Friends of Town Farm Dairy. Until July 1st, the organization employed farmers to assist in Town Farm's day-to-day operation. When the farmers left, members of the "Friends" board and volunteers took over the milking and farming operation.

The Connecticut outbreak is just one in a long and ever-expanding list of illnesses associated with drinking raw milk or consuming food – cheese, for example – made from unpasteurized milk. Raw milk contaminated with Salmonella, Listeria monocytogenes, Campylobacter or E. coli O157:H7 has caused serious illness to – AND HAS KILLED – the very young, the elderly, pregnant women (and the babies they carried), and immuno-compromised individuals. All in the name of "healthy eating."

Ironically, one of the favorite arguments of raw milk advocates is that pasteurization destroys the enzymes that keep milk safe from bacteria. How, then, can these people explain the steady stream of outbreaks and infections traced unequivocally back to the consumption of unpasteurized milk? They can't!

The retail sale of raw milk for human consumption is legal in a number of states. Elsewhere, dairy farmers and their customers circumvent the law by adopting "cow share" programs. A customer buys a share of a cow from a farmer and, in theory, is entitled to a proportional share of the milk from that cow. In practice, the customer receives a share of pooled milk from however many producing dairy cows comprise the cow share herd. Some of the reported raw milk outbreaks have been traced back to cow share programs.

In an era of mega farms and multinational food processors, the psychological appeal of drinking locally produced, unpasteurized milk is understandable. But understandable behavior isn't necessarily safe behavior. Consumers who are drawn to the idea of drinking unpasteurized milk should examine the risks carefully before taking that first sip.

Caveat vorador – let the consumer beware – should be the raw milk watchword.

Salmonella Saintpaul: 50-Million Dollar Microbe

As of 9pm (EDT) July 20th, CDC has recognized 1,251 lab-confirmed cases of Salmonella Saintpaul across 43 states, the District of Columbia and Canada. At least 228 people have been hospitalized during this marathon, and two deaths may be at least partly attributable to the outbreak strain. Four of the infected Canadians traveled in the United States prior to becoming ill; the fifth case is still under investigation.

Based on the onset date profile graph posted by CDC, this outbreak shows every sign of winding down. And late yesterday afternoon, FDA announced the first isolation of the outbreak strain of Salmonella Saintpaul from a sample of produce – a jalapeño pepper imported from Mexico by Agricola Zaragoza, an importer/distributor based in McAllen, Texas. Zaragoza has recalled all of the jalapeño peppers shipped to its customers since June 30th.

Now that CDC and FDA are moving into the "mopping up" phase of this outbreak, we can start to tally what Salmonella Saintpaul has cost the US economy. We can – very conservatively – calculate the cost based on the actual number of lab-confirmed cases. We can also determine an estimated cost by extrapolating the lab-confirmed cases to include cases that were never reported to CDC. First, though, we need to determine a cost per case.

Cost Per Case
Fortunately, a group of Canadian researchers studied the cost of gastroenteritis in Hamilton, Ontario (a mid-sized Canadian city with a well-respected teaching hospital). The study, which appeared in Journal of Food Protection in 2006, produced an estimated cost of CDN$1,089 per case. That figure included treatment costs, lost wages, and other concrete costs; it did not take into account "intangible" costs.

The Canadian estimate is more than two years old, but it is the best available. Medical costs, transportation costs and wages all have risen since then; however, we'll be conservative and use the Canadian data without adjusting for inflation. As the Canadian and US currencies are – essentially – at par, we can ignore any minor currency differences.

Cost of Lab-Confirmed Cases
At a cost per case of $1089, the 1,251 lab-confirmed cases tallied by CDC to date have cost the US economy approximately $1.36 million.

Cost of Estimated Number of Total Cases
The 1,251 lab-confirmed cases of Salmonella Saintpaul are only the tip of the outbreak iceberg. CDC estimates that there are 38 cases of Salmonella infection for every case that CDC hears about. That would put the actual size of the Salmonella Saintpaul outbreak at 47,538 cases. On that basis, this one outbreak has cost almost $52 million so far.

These calculations do not include the costs incurred by the US tomato growers, who have been devastated by this outbreak. Nor do they include the investigation costs incurred by FDA, CDC and state agencies.

Annual Cost of Food-borne Disease to US Economy
While on the subject, we also can estimate the annual cost of food-borne diseases. The most recent estimate – published in 1999 and long overdue for an update – is 76 million cases of food-borne disease each year. This translates – based on our cost/case estimate of $1,089 – to an annual cost to the US economy of more than $82.7 billion dollars.

To put these numbers into perspective, the entire FDA budget for the current year – including foods, drugs, and devices – is just $2.1 billion dollars. That's less than 3% of the annual cost of the food-borne diseases that FDA (and to some extent USDA) is mandated to prevent!

It's time to rethink the US strategy for attaining a safe food supply. The present system is a patchwork quilt of overlapping jurisdictions. It has been outgrown by rapid changes in the domestic food production and food processing industries, and by an exponential increase in food imports.

I propose that the next President form an independent Food Safety Commission. The Commission should be non-political (as opposed to by-partisan), and should receive testimony, briefs and proposals from industry, academia, consumers and regulators. The mandate should include:

1. Determine a current estimate of food-borne disease in the United States;
2. Recommend improvements to the current methods for reporting illnesses and detecting incipient outbreaks;
3. Review the present US food safety regulatory structure and compare its effectiveness with food safety regulatory structures adopted by other countries; and
   
4. Propose a new US food safety regulatory structure designed to respond more effectively to the current state of the US domestic and imported food supply.

It is vital that such a Commission be headed by an individual who does not owe loyalty to industry, regulators, or lobbying organizations. An individual who has no political axe to grind. An individual whose primary goal is to do whatever it takes to improve the safety of the country's food supply.

Bill Marler, are you listening?

Jalapeño Peppers Recalled

FDA has just announced the recall of jalapeño peppers imported and distributed by Agricola Zaragoza, Inc. of McAllen, Texas, after the peppers were found to be contaminated by the strain of Salmonella Saintpaul that has been blamed for sickening at least 1,251 people in 43 states since May of this year.

Agricola Zaragoza has recalled all jalapeño peppers shipped since June 30th. The recalled peppers, which were packed in bulk in 35lb. plastic crates and in 50lb. bags, were shipped to customers in Georgia and Texas.

Today's announcement is the first real break in the case, but I'm reminded of Winston Churchill's statement on the occasion of the Battle of El Alamein during World War II:

"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

The recalled produce was distributed to two states only. There must have been other shipments of contaminated peppers or tomatoes that found their way to New Mexico, Arizona, Illinois, and other states that reported large numbers of lab-confirmed Salmonella Saintpaul infections.

FDA still needs to trace back the shipment of jalapeño peppers to its source, and inspect every link in the distribution chain. And it needs to trace forward to their ultimate destinations every other shipment of produce – peppers, tomatoes, avocados – that passed through the hands of Agricola Zaragoza since the start of the outbreak.

But at least we've reached the end of the beginning.

Finding Salmonella Saintpaul: Answers Dribble Out

One of the questions I raised in my last post has been answered – thanks to an item from Associated Press that Bill Marler just pointed me to.

The Salmonella Saintpaul that FDA found in a jalapeño pepper sample taken from a McAllen, Texas distributor is a genetic match to the outbreak strain that has sickened at least 1,251 people.

Let's hope that more answers are forthcoming soon.

Finding Salmonella Saintpaul: A Break In The Case?

According to Jane Zhang of the Wall Street Journal, FDA has uncovered a jalapeño pepper that is contaminated with Salmonella Saintpaul. The pepper, which was Mexican-grown, was found during FDA's inspection of a small produce distributor in McAllen, Texas.

Before we declare this mystery solved, there are several questions remaining to be answered:

1. Is the Salmonella Saintpaul that was found on the jalapeño pepper identical to the outbreak strain?
2. Where did the contamination originate – on the farm in Mexico, at the produce distributor, or somewhere in between?
3. Is there any connection between the contaminated jalapeño and tomatoes?
4. Does the distribution pattern of the jalapeño peppers correlate with the geographic distribution pattern of lab-confirmed outbreak cases?
5. What other produce does the McAllen distributor handle, and is there any chance that these other produce items might become contaminated through cross-contamination at the distributor?
6. Are any of these peppers still available for sale in retail stores?
7. Are any of these peppers still in the food service distribution network or in restaurant kitchens?

Perhaps we'll get some answers when CDC and FDA get around to posting their web page updates later today.

Avocados And Peppers From Mexico Recalled

Last Thursday, Texas and North Carolina announced that they had detected Salmonella in samples of Hass avocados, serrano peppers and jalapeño peppers imported from Mexico. The strain of Salmonella found in these produce items is not – according to the state departments of health – linked to the massive Salmonella Saintpaul outbreak.

Today, FDA reported the extent of the recall. Grande Produce, the importer, has recalled serrano peppers and jalapeño peppers shipped between May 17th and July 17th, and avocados identified with lot number HUE08160090889.

The recalled produce was distributed in 16 states: Texas, Delaware, North Carolina, Georgia, Oklahoma, Iowa, Minnesota, Illinois, Florida, Indiana, Maryland, New York, Mississippi, Arkansas, Kansas, and Kentucky. Those who wonder whether these avocados and peppers might be implicated in the Salmonella Saintpaul outbreak should note that New Mexico – the hardest hit state per capita – did not receive any of the recalled items.

Anyone who lives in one of the states identified in the FDA recall notice and who has purchased Hass avocados, serrano peppers or jalapeño peppers should check with their retailer to determine the origin of the produce. Consumers with questions can also contact Grande Produce by telephone at (956) 843-8575.

Hepatitis A: Aftermath Of An Alert

Last week, the Iowa Department of Public Health issued a Hepatitis A Virus exposure alert to patrons of Whitey's Bar and Billiards in Burlington, after an employee of the restaurant was diagnosed with hepatitis A. Anyone who had eaten salad bar items or consumed drinks containing ice or lemon slices was urged to arrange for an injection of hepatitis A vaccine or immunoglobulin.

By July 19th, Whitey's had disinfected the premises and reopened. A Public Health spokesperson interviewed by The Hawk Eye, a local newspaper, advised the public that the restaurant was safe. And no restaurant patrons have shown symptoms of hepatitis A infection (which has an incubation period as long as six weeks) as yet.

An outbreak of hepatitis A appears to have been prevented. The restaurant was cleaned and disinfected and has reopened for business. No harm, no foul? No way!

Business at Whitey's was down by almost 90% immediately after the restaurant reopened, and is recovering very slowly – to about 50% of its pre-hepatitis level. The restaurant, which used to serve more than 100 customers on a Wednesday night, received only 12 customers last Wednesday.

The total cost of running Whiteys, including paying its 25 employees, is approximately $17,000/week, according to the restaurant's owner. In an effort to encourage its customers to return, Whitey's handed out "...a couple thousand dollars worth..." of restaurant coupons worth $3 each to everyone who obtained a hepatitis A vaccine at the County's special clinics.

Let's tally the combined cost – both to the restaurant's owners and to the public – of this non-outbreak of hepatitis.

• Whitey's operating cost for one week with little or no revenue: $17,000
• Value of incentive coupons handed out to restaurant patrons: $2,000
• Cost of precautionary vaccinations (~650 patrons x $30/injection): $19,500

These numbers, which total $38,500, do not include the inconvenience to restaurant patrons, who had to take time out from their schedules to receive precautionary injections. Nor do they take into account Whitey's on-going loss of business – and loss of reputation.

Many people have pointed out that food service-associated hepatitis alerts and outbreaks could be avoided by insisting that all food handlers be vaccinated against hepatitis A virus. Now, only two jurisdictions in the United States mandate this – St. Louis County, Missouri and Clark County, Nevada. But CDC has concluded, based on a study published in 2001, that this approach is not cost-effective, either to restaurant owners or to society in general.

Is CDC correct? It would be interesting to compare the cost and frequency of hepatitis A alerts and restaurant-associated outbreaks in St. Louis and Clark counties against other counties with similar demographics. Perhaps a follow-up study is called for.

Are you listening, CDC?

Government of Canada Plays With Fire

In the 1990's, USDA decided to shift much of the responsibility for regulating the day-to-day food safety activities of the meat industry onto the shoulders of individual meat processors. "Voluntary compliance" became the strategy and HACCP the rallying cry.

In the wake of the USDA's "MegaReg" came the MegaRecall:

• Hudson Foods (1997):
  25 million pounds
• ConAgra Beef Company (2002):
  19 million pounds
• Topps Meat Company (2007):
  21.7 million pounds
• Nebraska Beef Ltd. (2008):
  5.3 million pounds

Also in the 1990's, the government of Ontario (Canada) decided to trim its budget by shifting the responsibility for monitoring drinking water quality onto the various municipalities. In the name of economy, the Ontario government closed labs and required each town and city in the province to use private labs to test their drinking water. Provincial inspections of drinking water systems were reduced, and "voluntary compliance" ruled.

In 2000, the town of Walkerton, Ontario experienced a massive outbreak of E. coli O157:H7 as a result of contamination of its drinking water supply. More than 1,300 people became ill. Six of the victims died. A judicial inquiry into the outbreak uncovered evidence of negligence, incompetence, falsification of records, and a complete lack of oversight on the part of the Province of Ontario.

Now the Canadian government has decided to take another chance on "voluntary compliance". According to an article written by John Cotter of The Canadian Press, a confidential deal has been reached between the Canadian Food Inspection Agency and the Canadian meat packing industry to shift much of the burden of inspection onto the shoulders of the individual meat companies.

Under this agreement, government inspectors would "...check paper work and conduct inspections to ensure that companies are complying with the rules," essentially auditing each plant's internal inspections, much as USDA does under HACCP. And we know how well that has worked. Not surprisingly, a spokesman for the Canadian Cattlemen's Association expressed satisfaction with the arrangement.

The deal between the industry and the CFIA was struck last fall, and has remained under wraps until now. The new arrangement is expected to take effect before the end of this year.

It is outrageous that a policy change of this magnitude was negotiated in secret between a regulated industry and its regulator. Neither the Canadian public, nor its representatives in Parliament, have had the opportunity to question this agreement or to comment on a decision that will materially affect the microbiological safety of the country's meat supply.

It's time for the Parliamentary Opposition to raise a ruckus.

Salmonella Saintpaul Update: CDC July 18th Report

The number of new cases associated with this massive outbreak continues to fall, even as CDC added a 43rd state – Montana – to the list of those experiencing at least one case of Salmonella Saintpaul.

CDC now recognizes a total of 1,237 lab-confirmed cases in this outbreak, which has now lasted almost three months. More than half (641) of the victims fell ill since June 1st; at least 228 needed hospitalization as a result of the severity of their symptoms.

The confirmation of a case in Montana does not indicate that contaminated produce was distributed in that state. The Montana victim had traveled outside the state prior to becoming ill.

A fifth Canadian illness has also been linked to this outbreak. That case is under investigation. Chances are, though, that it will also be traced to recent travel in the United States.

On July 17th, Texas and North Carolina announced recalls of Hass avocados, jalapeño peppers and serrano peppers – all imported from Mexico – after detecting Salmonella in samples of the produce. The strain isolated by Texas is not Salmonella Saintpaul; North Carolina is still awaiting definitive lab results.

Nebraska Beef Outbreak: And Utah Makes Seven

CDC announced this evening that a seventh state – Utah – has been added to those reporting at least one lab-confirmed case of E. coli O157:H7 in the outbreak linked to contaminated beef supplied by Nebraska Beef.

The agency now reports a total of 49 cases: Georgia (4), Indiana (1), Kentucky (1), Michigan (20), New York (1), Ohio (21), and Utah (1). The most recent victim became ill on July 1st. Twenty-seven people have been hospitalized, and at least one is suffering from hemolytic uremic syndrome (HUS).

The wide distribution of the contaminated meat probably means that other previously unexplained cases of E. coli O157:H7 may eventually be tied to this outbreak. Certainly, the recognized number of cases in Georgia is likely to rise as CDC completes its evaluation of the Colquitt County data. And the number of recognized HUS victims will also increase as CDC continues to fold the Georgia data into the totals.

There has been no official word from USDA on the progress of the Nebraska Beef and Kroger recalls. The agency has neither confirmed nor denied an earlier report that contaminated meat found at the Barbecue Pit restaurant in Georgia was not on Nebraska Beef's July 3rd list of recalled items. Nor has the recall been expanded further.

Perhaps USDA and Nebraska Beef are hoping that all of the contaminated meat has been discarded – or consumed.

eFoodAlert World Tour: Misery Loves Company

Our tour this week begins and ends in Australia, which has been playing host to World Youth Day, a week-long international convention of Roman Catholic youths. Large gatherings often attract unwanted visitors, and this one has been no exception.

Australia
On July 16th, health authorities told of scattered cases of influenza and gastroenteritis among the pilgrims. By the next day, there were 22 cases of gastroenteritis among the attendees. According to today's report, 23 more attendees were suffering from gastroenteritis.

These number are not large, given the thousands of young people who have gathered for this convention. But they are a useful reminder that one need not be traveling in an underdeveloped country to become exposed to food-borne or water-borne pathogens.

Hong Kong
A regular stop on our tour, Hong Kong has reported another series of incidents of food poisoning linked to restaurant meals. Five groups of victims – 21 people in all – became ill after eating at a Yau Ma Tei restaurant between July 11th and July 14th. And 10 people required treatment for symptoms of gastroenteritis after dining at a restaurant in Sha Tin on July 15th and 16th. One of the Sha Tin victims remains hospitalized in stable condition.

Russia
An outbreak of yersiniosis in Krasnoyarsk has continued to grow. Two more kindergarten-age children have been added to the list, which now totals 141 victims – most of them young children. Twenty-two children and two adults remain in hospital for treatment.

Elsewhere in Russia – in Tatarstan – smoked or dried fish has been fingered as the source of at least 6, and possibly 7, cases of botulism. The fish was either prepared in the home, or purchased from unlicensed stalls.

Philippines
Forty-eight students taking part in a school lunch program began to feel ill on July 10th, minutes after eating a meal that consisted of munggo, bananas, malunggay, sardines and rice. The students became dizzy, complained of stomachaches, and later vomited. Samples of food from the meal were submitted to a government lab for analysis, but no specific source of the food poisoning has been determined.

One week after this incident, four people became ill after eating sardines – one of the items on the menu in the student outbreak. The individuals began to complain of dizziness and stomachaches and also experienced vomiting about two hours after eating the sardines.

Australia
The country is dealing with the aftermath of two outbreaks of gastroenteritis in a nursing home west of Sydney last month that sickened 80 residents and claimed 10 lives. According to the New South Wales communicable diseases director, investigators found evidence of Clostridium perfringens toxin in samples from the nursing home. This toxin usually forms when cooked food is allowed to stand for a few hours at room temperature.

Salmonella Statements – And Produce Recall

It's official. FDA released the following statement yesterday:

"After a lengthy investigation, the FDA has determined that fresh tomatoes now available in the domestic market are not associated with the current outbreak. As a result, the agency is removing its June 7 warning against eating certain types of red raw tomatoes."

Does this mean that tomatoes were not the source of the outbreak? No. It simply means that – since tomatoes are perishable – any contaminated tomatoes have long since disappeared from retail produce counters.

The investigation now focuses on raw jalapeño peppers and raw serrano peppers. FDA's warnings to "susceptible individuals" to avoid consuming these items remains in force. Given the magnitude of the outbreak and the large number of hospitalized victims (224 at last count), all consumers would be wise to avoid these items until the warning is lifted.

One by-product of FDA's intensive pepper probe is a recall – announced yesterday by the Texas Department of State Health Services – of Hass avocados, serrano peppers and jalapeño peppers imported from Mexico by Grande Produce, after Texas and North Carolina detected Salmonella in samples of the produce. Other varieties of avocados are not affected.

The Texas state lab found a non-outbreak strain of Salmonella in samples of jalapeño and serrano peppers. North Carolina isolated Salmonella from avocados and jalapeño peppers. The strain of Salmonella detected by the North Carolina lab is still being identified.

Texas, North Carolina and the FDA are working with the importer to trace shipments of these contaminated items, and to try to trace their source. Grande Produce is contacting their customers to advise them of the recall.

The recall notice does not list food stores, restaurants or food service outlets that have purchased the contaminated avocados or peppers.

Salmonella Saintpaul Outbreak: A Glimmer Of Hope

It looks as though my crude Outbreak Profile was pointing in the right direction two days ago. CDC posted a "date of onset" curve for the first time this evening, and the shape of the curve seems to show that the outbreak has passed its peak.

This does not mean that there won't be a further increase in the tally of cases. Nor, according to the update that appeared today on the FDA website has the warning against consuming certain types of tomatoes been canceled.

CDC reports that, as of 9pm (EDT) yesterday, there are now 1,220 lab-confirmed cases of Salmonella Saintpaul infection. The number of cases for which certain important details – including the date of onset – are known has risen from 828 (as of the July 16th report) to 1,167. The number of cases with an onset date in June or July has risen correspondingly, from 372 to 625.

The winding down of this outbreak is a mixed blessing. Of course, no one wants to see even one more person fall ill with a Salmonella infection. But entering this phase of an epidemic without having identified the source of the contamination makes it very likely that the culprit will never be known.

Why is this important? Because history – and outbreaks – have a nasty habit of repeating themselves when left unsolved. Malt-o-Meal can attest to that. So can the tomato grower on Virginia's eastern shore, whose tomatoes were the source of two Salmonella outbreaks – two years apart.

In the absence of a solution to this microbiological mystery, we probably have not seen the last of this strain of Salmonella Saintpaul.