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.

Food Poisoning: Names Behind The Numbers

CDC published its daily update on the Salmonella Saintpaul outbreak yesterday evening. As of 9pm (EDT) July 15th, the agency has received reports of 1,196 lab-confirmed victims of this outbreak. Two hundred twenty-four people have been hospitalized.

At least 372 of the victims began to experience symptoms of salmonellosis on or after June 1st – up from 357, the day before. After a very brief drop into single digits, the day-over-day increase in relatively recent cases is back into the teens.

eFoodAlert Outbreak Profile As Of July 16th CDC Report

Statistics can give some insight into the scope and duration of a disease outbreak. When the numbers are massaged appropriately, they can even give direction to investigators who are searching for the source of the outbreak.

But behind each number is a name, and behind each name is a victim. While we continue to monitor the "progress" of this current outbreak of salmonellosis, let's also remember a few of the many victims of food-borne disease.

• Alexander Thomas Donley (January 28, 1987-July 18, 1993).
  Victim of E. coli O157:H7 (Jack In The Box outbreak)
• Kevin Kowalcyk (died August 11, 2001; 2 years, 8 months, 1 day old).
  Victim of E. coli O157:H7 (sporadic case)
• Luz Romero (died in 1985 at age 83).
  Victim of Listeria monocytogenes (Jalisco cheese outbreak)
• Thomas Levins (died in 1985 at age 44).
  Victim of Salmonella (Jewel Dairy outbreak)
• Raul Rivera (died in 2008 at age 67).
  Cancer patient infected with Salmonella Saintpaul.

And yesterday evening Bill Marler gave a voice to some of the victims of the Nebraska Beef E. coli O157:H7 outbreak, when he wrote,

No surprise to the folks sitting in the ICU waiting room of the Archbold Hospital in Thomasville, Georgia who I met with today. Three women in ICU with families at their side – life should not hang in the balance at age 70 after going to a local restaurant you have visited for years. A teenager should not be at risk of kidney failure after eating a burger. An adult man should not loose weeks of works for eating out.

Let's never lose sight of the names behind the numbers.

CDC Acknowledges Georgia Affected by Nebraska Beef Outbreak

CDC finally got the word. In its E. coli O157:H7 outbreak update, released late this afternoon, the agency added Georgia to the list of states affected by the outbreak linked to beef and beef trimmings supplied by Nebraska Beef. That company recently recalled approximately 5.3 million pounds of beef in response to the outbreak.

The tally of victims, according to CDC, now stands at 45 people in six states: Georgia (1), Indiana (1), Kentucky (1), Michigan (20), New York (1), and Ohio (21). Twenty-three people have been hospitalized – one with hemolytic uremic syndrome.

But there are some discrepancies between the CDC report and information that has been released by Michigan and by the Southwest Georgia Public Health District 8-2.

CDC recognizes only 20 lab-confirmed cases in Michigan. As long as a week ago (July 9th), the Michigan Department of Community Health reported 22 lab-confirmed cases, of which 12 were hospitalized.

Even more glaring is the difference between CDC and county data in the Georgia outbreak cluster. CDC has acknowledged just one case from Georgia, whereas the Public Health District has reported 8 confirmed cases and 4 probable cases.

All of the Georgia cases are linked to the Barbecue Pit restaurant, which purchased meat – through a distributor – that originated with Nebraska Beef. A sample of ground beef obtained from the restaurant was found to be contaminated with the outbreak strain of E. coli O157:H7.

How many more states have experienced either sporadic cases – or clusters – of E. coli O157:H7 illness that are part of this same outbreak?

Hepatitis Warning in Burlington, Iowa

The Iowa Department of Public Health posted a warning to patrons of Whitey's Bar and Billiards in Burlington, IA after a food service employee of Whitey's was diagnosed with hepatitis A. The warning extends to all Whitey's customers who visited the restaurant between June 25th and July 13th, and who consumed any salad bar items or any drinks that contained ice or lemon slices.

Whitey's patrons who consumed any of these items between the dates of July 2 through and including July 13 should arrange to receive either Hepatitis A vaccine or immune globulin immediately. It is too late for those exposed before July 2 to obtain any benefit from an injection.

According to the state's news release, the Des Moines County Health Department will hold a walk-in clinic to administer Hepatitis A vaccine at the following location and times:

Des Moines County Health Department
522 North 3rd Street
Burlington, Iowa

• Wednesday, July 16 - 9 a.m. to 8 p.m.
• Thursday, July 17 - 9 a.m. to 8 p.m.
• Friday, July 18 - 9 a.m. to 6:30 p.m.

The vaccine and immune globulin injections are not 100% protective. Therefore, all of those who were potentially exposed to the infected food service worker – whether or not they receive a protective dose of vaccine or immune globulin – should be watchful for symptoms of hepatitis A, and also should be especially careful of their personal hygiene.

While infrequent, restaurant-associated warnings and outbreaks of hepatitis A pop up from time to time. This year has seen several, including:

• Chipotle Mexican Grill, La Mesa, CA: 22 cases
• International House of Pancakes, Albuquerque, NM: 4 cases
• Socialista, New York, NY: as many as 1,000 patrons warned
  

Whenever there is a significant outbreak of restaurant-associated hepatitis A – or a warning that involves a large number of restaurant patrons – the question of mandatory vaccination for food service workers is raised. Now, only two counties in the United States have this requirement on their books – St. Louis County, Missouri and Clark County, Nevada.

From an economic perspective, mandatory vaccination does not appear to make sense. A 2001 study carried out by CDC concluded that,

"Vaccinating restaurant employees is unlikely to be economical from either the restaurant owner or the societal perspective, even during hepatitis A epidemics."

As I reported in an earlier hepatitis post, roughly one-third of the US population already carries immunity to Hepatitis A virus, and CDC recommends that all children be vaccinated against Hepatitis A before their first birthday.

Economics isn't everything, though there's no point in mandating that someone who is already immune to the virus be vaccinated as a condition of employment.

But why not require all food service workers to demonstrate either proof of immunity to Hepatitis A or proof of vaccination before they are permitted to handle food or come into contact with restaurant patrons?

Salmonella Saintpaul Outbreak: Running Out Of Steam?

It's premature to draw any conclusions, but there's just a glimmering of hope that the Salmonella Saintpaul outbreak is starting to run out of steam.

CDC has just updated its statistics on this very frustrating outbreak. As of 9pm EDT yesterday, the agency has received reports of 1,167 lab-confirmed cases of salmonellosis caused by the outbreak strain. At least 220 of the victims required hospitalization.

Of the 1,167 cases, at least 357 individuals began to experience symptoms on or after June 1st. This is an increase of only 9 people over yesterday's report - the first single-digit increase since July 2nd.

Today's Outbreak Profile

If this outbreak truly is winding down, we have the perishable nature of produce to thank. There has been no further news from FDA on the progress of their broadened investigation into possible sources of the outbreak strain.

E. coli O157:H7 - Moultrie (Georgia) Still On My Mind

I know that bureaucratic millstones grind slowly, but this is getting ridiculous.

CDC has – at last – posted an update on what began as the Ohio/Michigan E. coli O157:H7 outbreak. CDC is reporting a total of 44 confirmed cases of E. coli O157:H7 in five states: Ohio, Michigan, Indiana, Kentucky and New York. Twenty-one of the victims needed hospitalization, including one patient who developed hemolytic uremic syndrome.

All of these cases are linked to beef and beef trimmings that have since been recalled by their producer – Nebraska Beef – and by The Kroger Company, through which much of the meat was sold as ground beef. According to USDA, none of the meat included in the recall is still available in stores; but consumers are advised to check their refrigerators and freezers and discard any ground that is included in the recall notices.

Someone, though, seems to have mislaid the state of Georgia. According to a communiqué released by the Southwest Georgia Public Health District 8-2, a cluster of 8 lab-confirmed and 4 probable E. coli O157:H7 cases in the Colquitt County have been linked by molecular fingerprinting to the Nebraska Beef outbreak.

All of the Georgia victims ate at the Barbecue Pit restaurant in Moultrie. USDA has confirmed the presence of the outbreak strain in a sample of ground beef obtained from the Barbecue Pit restaurant. The Barbecue Pit's management has confirmed that it purchased sirloin beef for grinding from a distributor that, in turn, purchased meat from Nebraska Beef.

Colquitt County, GA knows about this cluster – the local media carried regular updates on the story. USDA knows about this cluster – it confirmed the presence of the outbreak strain in the meat sample. Georgia's state laboratory knows about this cluster – it identified and fingerprinted the cultures obtained from the eight confirmed victims. So why doesn't CDC know about this cluster?

For the record, including the Georgia cluster, there are now 52 lab-confirmed cases of E. coli O157:H7 in six states: Ohio, Michigan, New York, Indiana, Kentucky and Georgia. Five of the victims – including four in Georgia – have developed hemolytic uremic syndrome.

USDA hasn't covered itself with glory either. According to WALB News in Albany (GA), the sirloin beef that was supplied to the Barbecue Pit "...shares the same dates as the beef in the Nebraska Beef recall, but the meat cut itself does not appear to be part of the recall." If this is so, why has USDA not insisted that Nebraska Beef expand its recall once again?

USDA announced last Friday that it will finally begin to release the names of retail stores that have received recalled meat and poultry products – "...generally within three to ten business days..." of issuing a recall notice. This new policy will take effect next month. Unfortunately, the agency will not release the names of restaurants, food service facilities or distribution centers who have been supplied with recalled meat and poultry items.

USDA's new policy is a small step in the right direction – putting additional information in the hands of consumers. But it will only be useful if the agency also can convince suppliers of contaminated products to recall them promptly.

I'm left wondering whether either USDA or CDC have the institutional mentality and dexterity to respond quickly and effectively to contain outbreaks of food-borne disease.

Recalled Sandwiches May Contain Plastic Pieces

USDA has advised consumers of a nation-wide recall of more than 199,000 pounds of prepared sandwiches issued by Nestlé Prepared Foods Company.

The "Lean Pockets Spinach Artichoke Chicken" sandwiches were recalled after the company received communications from consumers, who complained about pieces of plastic. Two injuries have been reported.

The recalled product can be identified as follows:

9-ounce boxes of "Lean Pockets Spinach Artichoke Chicken - 2 sandwiches." Printed on the side of each box is a "Best Before" date of "Nov 2009" followed by a package code beginning "8144 544616." Also printed on the side of the package is the establishment number "P7721A."

Consumers with questions about this recall, or who want to report a problem, can contact the Nestlé Consumer Services Center at (800) 350-5016.

Salmonella Saintpaul: July 14th Update From CDC

The Salmonella Saintpaul outbreak shows no signs of ending. According to today's report from CDC, the most recent victim became ill on July 4th - just 10 days ago.

CDC now acknowledges 1,148 lab-confirmed cases; 220 people have been hospitalized. Victims of the Salmonella outbreak have been reported in 42 states and the District of Columbia. In addition, four Canadians who traveled in the United States became ill with the outbreak strain shortly after returning home.

While many older cases continue to be reported, at least 348 of the 1,148 people became ill on or after June 1st. Since CDC still is not breaking down case numbers by onset date, I am continuing to chart the cases by report date. Here is today's Outbreak Profile chart:


As of today, there has been no further news from FDA on the progress of their lab and field investigations.

Salmonella Saintpaul: Updated Canadian Advisory

The Public Health Agency of Canada and the Canadian Food Inspection Agency issued a joint advisory to Canadian consumers on Friday about the current status of the US outbreak of Salmonella Saintpaul.

In addition to the almost 1,100 US residents of 42 states and the District of Columbia, the outbreak has affected four Canadians. According to Friday's news release, the two Albertans and two Ontario residents became ill after traveling in the United States.

The joint advisory reminded Canadians to be aware of the foods that are suspected of being the source of this massive outbreak of salmonellosis. US authorities have fingered jalapeño peppers, raw serrano peppers and certain varieties of raw tomatoes as the most likely suspects, but have not been able to isolated the outbreak strain from any sample of food tested so far.

Canadian consumers should feel relatively secure when shopping for produce at home. Canadian-grown produce has not been implicated in this outbreak.

Hong Kong Issues Consumer Alert On Smoked Salmon

Last week, Washington state smoked salmon producer Salmolux, Inc. recalled a single batch of its Nova Lox after the Florida Department of Agriculture and Consumer Services detected Listeria monocytogenes in a sample of the product.

The recalled product was sold in retail stores in Arizona, California, Nevada, Delaware, Florida, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, West Virginia, and Virginia – and in Hong Kong.

On Friday, the Hong Kong Centre for Food Safety warned people not to purchase or consume Wild Alaskan Smoked Salmon Nova Lox, Batch #01418. The agency also instructed retailers to remove the product from store shelves.

Listeria monocytogenes can produced serious – sometimes fatal – illness in susceptible individuals. The very young, the elderly, people with compromised immune systems, and pregnant women are especially at risk of complications from an infection with Listeria monocytogenes.

Customers who purchased the recalled product should discard it or return it to the store. Anyone who has eaten the recalled smoked salmon and who begins to experience symptoms of listeriosis should contact a medical practitioner.

Water Woes

Water – too much, too little, too dirty – has been in the news a lot in recent months. So it should be no surprise that the G8 nations were lobbied on the subject last week by Water Aid, an international charity.

According to a BBC news report, Water Aid informed the G8 summit that 40% of the world's population lacks basic sanitation infrastructure. The international community undertook at the beginning of the 21st century to cut in half, by 2015, the number of people who lack basic sanitation and toilet facilities. According to Water Aid, improvements in sub-Saharan Africa are so slow that it will only reach the targeted reduction by 2076.

Ethiopia is a poster child for sub-Saharan Africa's sanitation woes. As reported by BBC, the World Health Organization estimates that 64% of the country's population defecate in the open – an significant improvement since 1990, when more than 90% of the country's people did so. Raw sewage flows through the streets of some parts of Addis Ababa, the nation's capital. Some Ethiopians try to boil water before using it for washing or drinking, but the fuel needed to do so is both expensive and in short supply.

Vietnam is one of many countries struggling with contaminated water supplies. Recently, almost 1,600 factory workers fell sick with gastroenteritis after eating a meal in the factory canteen. The canteen kitchen drew water from an untreated and untested well. And factory workers were given drinking water that had not been boiled or otherwise purified.

Storms can also be the harbinger of water woes. A typhoon that hit the central Philippines last month was the trigger for an outbreak of diarrhea that killed at least 15 people and sickened dozens more. Storm runoff carried pathogenic bacteria into the region's drinking water supply.

Even the developed world is susceptible to water contamination issues. Cities in North America that boasted 50 or 60 years ago of modern storm run-off and sewage treatment systems now are wrestling with their aging infrastructure. An intense storm that hit Toronto last week resulted in a release of raw sewage into Lake Ontario that closed more than half of the city's 11 beaches. Residents in the east end of the city reported flooded basements and backed up sewage in their homes.

In this International Year of Sanitation, we would be wise to remember that clean water cannot be taken for granted anywhere in the world.

Sarpy County: The Overlooked Outbreak

Did anyone outside of the state of Nebraska notice the E. coli O157:H7 outbreak that occurred in Sarpy County in late March?

According to Michael O'Connor, staff writer for the Omaha World-Herald, at least 14 people were infected with E. coli O157:H7 after attending a private gathering at a local reception hall on March 26th. Four of the victims were hospitalized.

Dr. Tom Safranek, Nebraska's epidemiologist, was quoted in the article as saying that the outbreak was linked to roast beef that was prepared in a private home and served at the reception. USDA was trying to trace the source of the roast beef.

At the time O'Connor's article appeared, health investigators hadn't determined whether the beef was already contaminated at the time it was purchased, or whether it became contaminated during or after preparation. As far as I can tell, no follow-up reports have been published.

The Sarpy County outbreak occurred well before the start of the multi-state outbreak that is now in progress. But I'm left wondering whether there might be a connection. Has anyone thought to compare the genetic profile of the Sarpy outbreak strain with that of the Ohio/Michigan/Georgia outbreak strain of E. coli O157:H7?

Warning: Salmonella-Contaminated Tuna Salad

The Georgia Department of Agriculture has found Salmonella in a sample of “Deli Fresh” tuna salad manufactured by Allison’s Gourmet Kitchens of Moore, OK. The contamination was found during a routine sampling program, and no illnesses have been reported.

The tuna salad was sold in a 12-ounce packaged with the marking "USE BY 07/29/08 B1."

Georgia has notified the FDA of its finding. Ingle's – the store where the contaminated salad was purchased – has removed the product from its shelves. Department of Agriculture sanitarians will be checking other grocery stores in the state to make sure that the Salmonella-contaminated product has been removed from sale.

Consumers who have purchased this tuna salad should either discard it, or return it to the store for a refund. Anyone who has already eaten the contaminated product and begins to experience symptoms of salmonellosis – diarrhea, stomachache, low-grade fever, vomiting – should seek medical care.

E. coli O157:H7 Outbreak: CDC Update Overdue

It's been more than a week since CDC last provided consumers with an update on the E. coli O157:H7 outbreak that began in Michigan and Ohio and then spread to Georgia.

As of July 3rd – the date of CDC's last update – there were 41 confirmed cases of E. coli O157:H7 in Ohio and Michigan. Kroger's had recalled ground beef from stores in multiple states, and Nebraska Beef had just announced an expanded recall of 5.3 million pounds of beef and beef trimmings.

But that wasn't the end of the story. Here's what has happened since July 3rd.

• Ohio is investigating a total of 25 cases of E. coli O157:H7, 21 of them confirmed and definitely linked to the contaminated ground beef. The state health authorities consider the remaining 4 cases as probably linked to the outbreak.
• Michigan now has identified 22 cases of E. coli O157:H7 illnesses that are linked genetically to the outbreak, up from the 21 reported by CDC on July 3rd. Twelve of the Michigan cases required hospitalization.
• Georgia has announced that the E. coli O157:H7 restaurant-associated outbreak in the southwest part of that state is linked to the Ohio/Michigan outbreak. At least 8 people are confirmed to have become infected with the same strain of E. coli O157:H7 as the one that sickened as many as 47 people in Ohio and Michigan. The implicated restaurant purchased sirloin beef from a distributor, who had procured the meat from Nebraska Beef. A sample of the meat was tested by USDA and determined two days ago to be contaminated by the outbreak strain of E. coli O157:H7. The meat in question was not part of the 5.3 million pound recall, but was shipped by Nebraska Beef in the same time period as the recalled products.

And here is what hasn't happened since July 3rd.

• CDC has not updated its E. coli O157:H7 investigation web page, even though the link between the Georgia and the Ohio/Michigan cases has been confirmed microbiologically.
• USDA has not issued a news release to warn the public that the outbreak is no longer confined to Ohio and Michigan, or that whole cuts of meat supplied by Nebraska Beef – such as sirloin – might also be contaminated with E. coli O157:H7.
• Nebraska Beef has not expanded its recall to include meat from the Georgia outbreak in the list of recalled products.

What is everybody waiting for – an E. coli O157:H7 the size of the Salmonella Saintpaul outbreak?

Salmonella Saintpaul Outbreak: July 11th Update

CDC released its daily diet of Salmonella Saintpaul news yesterday evening. As of 9pm (EDT) on July 10th, there are 1090 lab-confirmed illnesses in 42 states, the District of Columbia and Canada; at least 210 people have been hospitalized, and one person has died.

According to the CDC report, 330 of the victims first experienced their symptoms on or after June 1st. The most recent reported onset date is now July 1st. Clearly, this outbreak is still very much alive.

Including the most recent CDC data, my Outbreak Profile Chart now looks like this.

CDC is recommending that consumers take the following precautions until this outbreak is over:

Until health officials know that the contaminated product or products are no longer on the market, persons with increased risk of severe infection, including infants, elderly persons, and those with impaired immune systems, should not eat raw jalapeño peppers or raw serrano peppers. They should also only eat raw tomatoes that are on the FDA safe list. Produce grown at home is not part of this warning. Other persons who are concerned and who want to reduce their risk of Salmonella infection can take similar precautions. Consumers should be aware that raw jalapeño peppers are often used in the fresh preparation of salsa, pico de gallo, and other dishes.

How did an outbreak that first appeared to be strongly linked to certain types of raw tomatoes end up jumping to raw jalapeño or serrano peppers? There are at least three possibilities.

1. A contaminated field may have first been planted with tomatoes, then – after the tomatoes were harvested – with peppers.
2. A contaminated irrigation pond might have been used to water both crops.
3. A packing house might have handled – and contaminated – both the tomatoes and the peppers.

It has also been suggested that this outbreak's "second wind" might be due to food-handlers who were infected during the earlier phase of the outbreak, are still carrying Salmonella Saintpaul, and are infecting food that they prepare and serve in restaurants. While theoretically possible, I am inclined to discount this hypothesis for two reasons:

• The number of cases in New Mexico – the hardest hit state on a per capita basis – has continued to increase. New Mexico, however, has not experienced even one restaurant-associated cluster of cases. And illnesses transmitted by food handlers would tend to result in restaurant-associated illness clusters.
• Illnesses transmitted by food handlers would not tend to be linked to a single specific food item, or even to a few items. These illnesses would be more likely to encompass the entire range of menu items offered in a restaurant.

FDA continues to proceed by process of elimination. Yesterday, the agency updated its list of "safe" growing areas to include the Mexican state of Coahuila. That leaves only the states of Jalisco and Sinaloa open to question. And a new section – Advice for Packers and Shippers of Fresh Produce – has been added to the agency's web site.

But FDA has not announced any new leads in its trace-back investigations. Nor, in the absence of a lucky break, is it likely to do so.

Thai Basil Recalled - Salmonella

Lucky Green Trading Inc. has recalled some packages of Thai Basil, which may be contaminated with Salmonella. The company announced the recall after random testing by FDA uncovered Salmonella in the finished product.

Consumers can identify the recalled packages as follows:

Thai Basil was distributed through retail stores and direct delivery to customers in Southern California, Arizona , and Nevada on June 30, 2008.

The product was shipped in 14 LB cardboard cartons with 12 individual packages weighting approx.1.2 LB each in clear, unmarked, plastic bags. The exterior cartons were labeled "16 DE SEPTIEMBRE S/N SANTA ROSA TAPACHULA NAYARIT, C.P. 63731" "Thai Basil" and also had an attached sticker with Airway Bill #027 1947 0861.

Consumers who have purchased any basil recently should contact the store and ask whether the basil they purchased was part of this recall.

Lucky Green Trading has suspended importation and distribution of the Thai Basil pending the outcome of FDA's investigation.

A Tale Of Two Outbreaks

"[T]he largest outbreak of Salmonella infections...since 1993."

"The outbreak was discovered in early April ... but the number of reported cases has been particularly high in May and June."

"[A]n unusually large outbreak of gastrointestinal illness caused by Salmonella..."

"The results of these investigations indicate that the outbreak may be caused by several types of food vehicles."

If these statements sound familiar, they shouldn't. The above quotes are excerpts from an article in this week's edition of Eurosurveillance, and the outbreak in question is in Denmark.

The Danish Salmonella outbreak actually began in February, but was discovered in April when genetic fingerprinting connected a number of isolates of Salmonella Typhimurium that had been submitted to the Statens Serum Institut for detailed phage and molecular typing.

I first reported on this outbreak a week ago, after CBC News carried an item on the story. At that time, There were 330 confirmed cases at that time, and the Danes were estimating that this probably represented less than 10% of the actual number of people infected.

As of July 7th, there are 366 lab-confirmed cases; the outbreak is on-going, but has not spilled over the border into any neighboring countries.

There are some interesting parallels between the Danish outbreak and the on-going Salmonella Saintpaul outbreak in the United States.

1. Both outbreaks are unusually large, and of an unusually long duration.
2. Both outbreaks are caused by a relatively uncommon strain of Salmonella.
3. Both outbreaks are essentially nation-wide, although the incidence varies in different regions.
4. In neither outbreak have the health authorities been able to pinpoint a source of the contamination.

There are also significant differences, both in the nature of the outbreaks and in the way in which each national health authority has disseminated information to the public.

1. CDC, to its credit, has been updating the public several days a week on the status of the oubreak. The Danish government, as far as I can tell, has not.
2. The Danes, to their credit, have presented their data in a format that shows clearly the onset profile of new cases. The CDC has not.
3. The per capita number of cases in the Danish outbreak is far higher than in the US outbreak – 67 cases/million in Denmark versus approximately 3.5 cases/million in the United States.
4. The US outbreak is suspected of a linkage to produce, which may or may not have been imported. The Danish outbreak is suspected of a linkage to one or more meat – most likely pork – products.

And one final similarity. There's a good chance that both outbreaks will die a natural death without either health authority having pinpointed the exact source of the contamination.

Time For Another Nebraska Beef Recall Notice?

WALB News in South Georgia is reporting that health authorities have confirmed finding E. coli O157:H7 in a sample of ground beef from the Barbecue Pit restaurant in Moultrie (Colquitt County). The restaurant ground the beef itself using sirloin supplied from Nebraska Beef.

Colquitt County has been the scene of an outbreak of E. coli O157:H7 that has sickened at least 8, and possibly as many as two dozen, people. The eight confirmed victims all were infected with the same strain of E. coli O157:H7 that has been found in the meat sample from the Barbecue Pit. This is also the same strain that is responsible for the recent Ohio/Michigan outbreak.

The meat from Nebraska Beef that has been implicated in the Georgia outbreak was not part of the 5.3 million pounds recalled by the company on July 3rd, although it falls into the same date range as the previously recalled meat.

How much more contaminated meat has Nebraska Beef sold?

Salmonella Saintpaul: Pursuing Hypotheses

I'm not the only one to wonder what CDC and FDA might be missing in their investigation of this large and complex outbreak. Jim Prevor (The Perishable Pundit) floated a couple of "outside the box" hypotheses in his column today.

Prevor suggested that one possible source of the second phase of this outbreak might be secondary infections transmitted by victims who are still carrying the outbreak strain. He suggests that some of these individuals might work in food service and – a la Typhoid Mary – could contaminate the food they are handling. This is an interesting theory, and one that has not been mentioned in any of the FDA/CDC media conference calls.

Prevor's second hypothesis – cross-contamination in the kitchen with Salmonella Saintpaul from raw chicken – is more far-fetched. While Salmonella Saintpaul has been reported in poultry in the past, it's unlikely that raw chicken, all carrying the outbreak strain, would account for the geographical distribution that has been documented by CDC and state health agencies.

I have just finished reading the transcript from yesterday's FDA/CDC media conference call, which is available for download from the FDA outbreak investigation web page. Here are some of the more intriguing (to me, at least) tidbits from that conference.

• Early on in the outbreak, there were no illness clusters. The first cases were scattered and not tied to dining out. More recently, many of the cases have occurred in clusters of victims who dined out together.
• While the highest density of cases are located in Texas and New Mexico – two states with large Hispanic populations – the case clusters are not linked to any one ethnic food type.
• The epidemiological data that fingered jalapeno peppers are not as compelling as the earlier data that pointed to raw tomatoes. Fewer than 50% of the victims included in the later study consumed jalapeño peppers; approximately 80% of victims reported having eaten raw tomatoes in the earlier case control study.

There are a number of possible explanations for the duration and profile of this outbreak, some of which – common distribution chain, common packing house, et cetera – were mentioned in the conference call. Here are some other avenues of investigation that I hope FDA is considering as the agency continues to pursue its detective work.

1. What is the growing/harvest sequence for tomatoes and peppers in the three Mexican states still under the microscope – Jalisco, Sinaloa and Coahuila? Does the timing of the harvest correlate with that of the outbreak?
2. Do any of the farms in those states grow both tomatoes and peppers?
3. Are there any common elements on these farms, such as fertilizer or irrigation water, that could link the tomato and pepper crops?
4. Do any of the farms grow tomatoes and then peppers in the same field? Salmonella is able to survive for up to six weeks in soil after harvest, and can contaminate successive crops if they are planted soon enough after each other.
   

Salmonella Saintpaul Outbreak: July 10th CDC Update

CDC has posted a new interim report on the Salmonella Saintpaul outbreak. As of 9pm (EDT) yesterday, a total of 1,065 cases of salmonellosis due to the outbreak strain have been lab-confirmed – at least 315 of them since June 1st. One death has been attributed to the outbreak, and 205 people have been hospitalized.

Mississippi was added to the honor roll of affected states today, bringing that total to 42. The District of Columbia has experienced one case, and four Canadians – three of whom are known to have travelled to the United States prior to their illness – have also been infected.

I have updated my Outbreak Profile chart to include today's new data.


The number of new cases with an onset date of June 1st or later was lower today, though still in double digits. It's too soon to say whether this is just a statistical blip or the beginning of a downturn in the number of recent new cases. The next few days may tell.

Washington Company Recalls Nova Lox

FDA advises that Salmolux Inc. of Federal Way, WA has recalled a single lot of its Wild Alaska Smoked Salmon Nova Lox after the Florida Department of Agriculture and Consumer Services found Listeria monocytogenes in the product.

The Florida testing was carried out as part of a routine retail-level sampling program. No illnesses have been associated with this product.

The recalled product – packing in a 3-ounce blue package and identified as lot #01418 – was sold in Von's retail stores in Arizona, California and Nevada, and in Food Lion stores in Delaware, Florida, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, West Virginia, and Virginia.

Listeria monocytogenes usually causes just a mild gastrointestinal or flu-like symptoms. But, an infection with this pathogen can cause serious illness – even death – in the very young, the elderly, people with compromised immune systems, and pregnant women.

Consumers who purchased the recalled lot of Nova Lox should return the package to the store for a full refund.

Salmonella Saintpaul: One Hump Or Two?

I was wondering the other day whether this outbreak was winding down or heating up. So I decided to poke around in the limited amount of data that CDC has provided in its outbreak updates since the beginning of June.

I am now firmly convinced that we are in the middle of a two-phase outbreak. The first phase, which probably peaked sometime in April/May, was likely due to tomatoes. The second phase, which is in progress right now, might very well be linked to jalapeño or serrano peppers in addition to tomatoes. Here's why.

1. The initial epidemiological investigations carried out by the state of New Mexico pointed very strongly to tomatoes sold in retail food markets as the source of the outbreak. Furthermore, two of the food market chains were selling only Mexican tomatoes at the time of the outbreak.

2. Epidemiological evidence from three recent large clusters of confirmed cases have pointed to jalapeño peppers. Among the current list of suspected foods, only jalapeño peppers were implicated in two of the clusters. No tomatoes were involved.

3. I have graphed all of the data reported by CDC. While CDC hasn't released information by date of onset, I was able to break down their data based on the number of new illnesses added to the total each day. I also analyzed separately the illnesses that were reported to have begun on or after June 1st.

This is what I found.

Series 1: Total number of accumulated cases as of each CDC update
Series 2: Number of new cases added to the total at each update
Series 3: Total number of accumulated cases with onset of June 1st or later
Series 4: Number of new cases with onset of June 1st or later at each update

Almost all of the new cases reported by CDC since the end of June had onset dates of June 1st or later. On June 30th, CDC reported that 173 people became ill between June 1st and June 20th – an average of just over 8 new illness per day. The number of new cases (with June 1st or later onset) jumped to 29 in the July 3rd report, and has stayed in double-digit territory ever since.

I am convinced that these data, if graphed correctly by date of onset, would show a clear two-phase outbreak pattern. But what would explain this behavior, and how could the outbreak strain jump from tomatoes to jalapeño peppers?

I'll suggest some possible answers to these questions in the next couple of days.

CDC Issues Warning On Jalapeno Peppers – And Explains Why

In its latest update on the Salmonella Saintpaul outbreak investigation, CDC has finally given consumers some insight into why the list of suspect foods has been expanded. Here is what they say:

"An initial epidemiologic investigation in New Mexico and Texas comparing foods eaten by persons who were ill in May to foods eaten by well persons identified consumption of raw tomatoes as strongly linked to illness. A similar but much larger, nationwide study comparing persons who were ill in June to well persons found that ill persons were more likely to have recently consumed raw tomatoes, fresh jalapeño peppers, and fresh cilantro. These items were commonly, though not always, consumed together, so that study could not determine which item(s) caused the illnesses.

Recently, many clusters of illnesses have been identified in several states among persons who ate at restaurants. Most clusters involve fewer than 5 ill persons. Three larger clusters have been intensively investigated. In one, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeño peppers. In the other two, illnesses were linked to an item containing fresh jalapeño peppers and no other of the suspect items. The accumulated data from all investigations indicate that jalapeño peppers caused some illnesses but that they do not explain all illnesses. Raw tomatoes, fresh serrano peppers, and fresh cilantro also remain under investigation."

Along with this explanation, CDC also has expanded its advice to consumers. Until the government is certain the contaminated food that is causing this outbreak is no longer on the market, infants, elderly, and immunocompromised individuals should avoid eating raw jalapeño peppers and raw serrano peppers, and should limit consumption of raw tomatoes to those included on the FDA safe list – updated earlier today to include tomatoes grown in Idaho and Rhode Island.

I would take CDC's recommendation two steps farther. I would extend the caution against raw peppers to all consumers – not just "...infants, elderly persons, and those with impaired immune systems." In addition, based on CDC's newly-released information, I would add fresh cilantro to the list of foods to be avoided.

At first glance, it appears unfortunate that the three large illness clusters have given such contradictory results. But this might be a blessing in disguise for investigators. If I were in their shoes, I would be looking for a common element in the production/distribution chain – one shared both by jalapeño peppers and by tomatoes. Contamination at a common point, such as a packing house or distribution facility, could explain the outbreak pattern.

As of 9pm (EDT) yesterday, 1,017 lab-confirmed cases of Salmonella Saintpaul have been attributed to this outbreak. At least 203 have been hospitalized. Three hundred of the victims (nearly 30% of the total) became symptomatic on or after June 1st – the most recent on June 26th.

This outbreak is looking very much alive.

Salmonella Saintpaul Outbreak - Still On Fire or Winding Down?

CDC reported yesterday evening that the Salmonella Saintpaul outbreak has infected at least 991 people – 275 or more of them between June 1st and June 25th. One hundred ninety-four people have been hospitalized and there has been one death attributed to the outbreak.

Forty-one states and the District of Columbia have now reported at least one lab-confirmed case. And four Canadians – two from Alberta and two from Ontario – have also been infected by the outbreak strain. The two Albertans became ill after returning from a business trip to Texas; one of the Ontario victims also had traveled to the United States before falling sick.

I have been looking back at the archived outbreak reports on the CDC website to try to determine whether or not this epidemic has peaked. Unfortunately, the data are not broken down by date of onset. CDC simply is reporting the total number of cases, and – beginning with the June 30th report – the number of cases with an onset date on or after June 1st.

Between June 30th and last evening's report, the total number of cases rose from 851 to 991 – an increase of 140 cases. The number of cases with an onset date in the month of June rose to from 173 to 275 – an increase of only 102 cases. Thus, older cases are still coming out of the closet.

But there is no way to tell, based on CDC's data presentation, how many of the 102 "newest" cases developed in early June, and how many are recent onset – that is, June 25th. CDC apparently has decided that this information should not be disseminated. Otherwise, those of us on the outside of this investigation might actually be able to figure out what's going on.

E. coli O157:H7 and now Salmonella?

Poor Colquitt County, Georgia! Not only does this southwest part of the state have to deal with the aftermath of an outbreak of E. coli O157:H7, but some cases of Salmonella have also been reported in the county.

According to a report in The Moultrie Observer, several cases of Salmonella illness have been found in southwest Georgia – a few of them in Colquitt County. These cases appear not to be linked to the national Salmonella Saintpaul outbreak. They have not yet been traced to a specific source or venue.

Could this be just coincidence, or is it possible that Nebraska Beef might have been supplying Salmonella in addition to E. coli O157:H7 in its meat?

Nebraska Beef – How Many Victims?

It's past time for CDC to update its E. coli O157:H7 outbreak investigation web page, which hasn't changed since July 3rd.

According to the Ohio Department of Health, that state now has confirmed 21 cases of the outbreak strain of E. coli O157:H7 – up from 20 confirmed cases as of July 3rd – and is investigating an additional four probable victims.

Of greater significance is new information that ties the E. coli O157:H7 outbreak in Colquitt County, GA even more closely than before to the Nebraska Beef recall and the Ohio/Michigan outbreak that spawned it.

The Southwest Georgia Public Health District reported earlier today that it had confirmed eight cases of E. coli O157:H7 illness, with four additional "probable cases" in the pipeline and several more possible cases under investigation. At least one of the victims was infected by the same strain that caused the Ohio/Michigan outbreak. A Moultrie, GA restaurant – The Barbecue Pit – is implicated in the outbreak and closed voluntarily on July 3rd to aid the investigation.

This evening, District Health Director Dr. Jacqueline Grant released newly-acquired information about the outbreak's origins. Management of The Barbecue Pit advised that they had changed meat suppliers prior to the outbreak. The new supplier had purchased meat from Nebraska Beef – recently identified as the source of E. coli O157:H7-contaminated meat that has sickened at least 42 people in Ohio and Michigan.

A USDA investigator met this morning with the restaurant management and the District Health officials. Will the next recall announcement be made by the distributor who supplied meat to The Barbecue Pit restaurant?

Fish & Seafood Advisories: Texas and Maine

The Texas Department of State Health Services is advising consumers to limit their consumption of spotted seatrout (also known as speckled trout) and catfish harvested from Galveston Bay, including Chocolate Bay, East Bay, West Bay, Trinity Bay and contiguous waters.

This advisory was issued as a result of a two-year study, which found elevated levels of dioxins and polychlorinated biphenyls (PCBs) in the two species of fish. This notice does not prohibit recreational fishing of these species.

Adults should consume no more than one 8-ounce meal of spotted seatrout or catfish from Galveston Bay a month. Women who are nursing, pregnant or who may become pregnant and children should not eat any fish covered by the advisory notice.


Three people from Washington County, Maine were hospitalized with symptoms of paralytic shellfish poisoning after eating contaminated mussels over the July 4th holiday weekend, according to a news release issued today by the Department of Health and Human Services.

The victims, all of whom are expected to recover fully, harvested the mussels from a rope dangling in the ocean off a pier, rather than from an approved bed. The area where the mussels were gathered had been closed for three weeks due to a red tide.

Maine health authorities advise that mussels and other shellfish can be consumed safely if the following precautions are taken:

1. Purchase shellfish from a certified shellfish dealer. Their operations undergo rigorous public health screening and auditing.

2. If harvesting for personal use, make sure the shellfish beds are not closed for red tide. Check the Department of Marine Resources’ website for the latest information on closed areas: http://www.maine.gov/dmr/rm/public_health/closures/pspclosures.htm

3. Do not consume clams or mussels floating in ocean waters. They are likely to have filtered much more algae-containing water than those from flats or beds, and therefore will usually have much higher concentrations of toxin.

Food Poisoning Around The World: July 8th Edition

Our virtual travel this week consists of four stops, and includes one very unusual outbreak – gastrointestinal anthrax.

Stockholm, Sweden
A two-year-old child died late last week after becoming infected with enterohemorrhagic E. coli. The child, who became ill just over a week ago, succumbed a few days after her symptoms appeared. Health officials do not yet know how the little girl contracted her infection.

The last fatality caused by this microbe in Sweden occurred in 2005. The country usually experiences approximately 100 cases of enterohemorrhagic E. coli infections by mid-year, and this year has been no exception. The pathogen can be transmitted by direct contact with infected animals – on farms or in petting zoos – by eating contaminated food, or by direct contact with the feces of an infected individual.

Masantol, Philippines
More than 100 participants at a "thanksgiving party" became ill last month after enjoying a spaghetti dinner. The victims complained of stomach aches, vomiting, nausea, and diarrhea the morning after attending the Sunday evening dinner. More than one-third of the people were treated in hospital and released. Health authorities did not name the microbe that caused this outbreak, but the symptoms are consistent either with Clostridium perfringens or Bacillus cereus.

Hong Kong
The Centre for Health Protection (CHP) reported two restaurant-food poisoning investigations. On June 30th, 13 people fell ill after eating lunch on a boat trip the day before. Three of the victims were admitted to hospital for treatment, while several others were treated by private doctors.

CHP announced an investigation into two additional food poisoning incidents on July 2nd. Twenty-five individuals complained of abdominal pain, diarrhoea, vomiting and fever after patronizing a Mong Kok hotel buffet on June 30th. In a separate incident, 13 people became ill with similar symptoms after consuming food purchased from a "food premises" in the Central district of Hong Kong. Several victims from both incidents sought treatment for their symptoms.

Separately, Hong Kong's Food & Environmental Hygiene Department (FEHD) lifted closure orders from two sushi restaurants (Itacho Sushi on Hennessy Road, Wan Chai, and Itamae Sushi on Hoi Yuen Road, Kwun Tong) that had been implicated in food poisoning incidents earlier in June. The restaurants were allowed to reopen after undertaking a thorough cleaning and disinfection, and upgrading their workflow procedures.

Finally, FEHD ordered a restaurant on Man Nin Street in Sai Kung to close for cleaning and disinfection after the outlet was found to be the source of two food poisoning incidents, involving 26 people in June and early July. The restaurant will remain closed until FEHD is satisfied that it has corrected its health and sanitation deficiencies.

Ha Giang Province, Viet Nam
Two people died, and more than 400 were sickened in this northern province after eating meat from anthrax-infected animals – the result of good intentions gone terribly wrong.

The owners of two cows, which had died of unknown causes, shared their meat with 90 families in Po Qua Hamlet on June 21st. All those who ate the meat complained of vomiting, stomachache and swollen legs. In addition to the two fatalities, three more victims are in critical condition.

Local authorities are working to contain the anthrax outbreak that has hit cattle in this district. And they have cautioned residents against eating meat from the infected animals.


And thus ends another leg of our world tour.

Salmonella Saintpaul Outbreak Spreads Into Canada

CDC has just released an update to the toll of Salmonella Saintpaul illnesses, and the number of Canadian cases has increased to four. Three of the Canadians became ill after returning home from a visit to the United States. The fourth case is still under investigation.

Meanwhile, the number of lab-confirmed cases in the United States continues to rise. As of 9pm (EDT) on July 6th, 971 people (including the four Canadians) have become infected with the outbreak strain of Salmonella since April 10th. At least 189 people have been hospitalized, and there has been one death attributed to the outbreak. More than 25% of the confirmed victims – 258 people – have become ill since the June 1st.

According to the CDC report, additional epidemiological investigations have led the goverment to broaden its search for the contaminated food that is the cause of this outbreak. In addition to tomatoes, CDC and FDA are now considering fresh hot chili peppers such as jalapeños, and fresh cilantro as possible suspects.

So far, neither FDA nor CDC have mentioned holding shipments of these produce items at the Mexico/US border for testing before allowing them into the country. Nor has the government expanded its warning to consumers to avoid eating cilantro or peppers.

E. coli O157:H7. The Outbreak Spreads??

According to WALB News (Channel 10) in Albany, GA, there are now eight lab-confirmed cases of E. coli O157:H7 in Colquitt County. At least some of those cases appear to be due to the same strain of the pathogen that has sickened more than 40 people in Ohio and Michigan and triggered the recall last week of 5.3 million pounds of beef.

The size of the Colquitt County outbreak will likely grow. Health authorities have tested more than two dozen patients for E. coli O157:H7 and are still awaiting results on many of those tests.

Seven of the eight confirmed victims report having eaten at the Barbecue Pit restaurant in Moultrie, GA. The restaurant closed on July 3rd, so that health authorities could carry out a thorough investigation.

Not all of the confirmed and suspected victims of this outbreak, however, reported eating hamburger at the Barbecue Pit. But there might have been an opportunity for cross-contamination in the restaurant's kitchen, or some of the sick individuals might have contracted the infection while caring for one of the initial victims.

It's becoming increasingly likely, if the WALB report is accurate, that some of the meat recalled by Nebraska Beef is the source of this outbreak. CDC, however, has not yet acknowledged a link between the Ohio/Michigan outbreak and the one in Colquitt County, GA. That might happen as early as this evening – if the agency finds the time to update its outbreak investigation web page, which it last did on July 3rd.

Meanwhile, I'm left wondering how many other sporadic cases and small-scale outbreaks of E. coli O157:H7 have been caused by contaminated meat shipped by Nebraska Beef since early May.

On The Cholera Trail

The only certainties in this world are death, taxes and cholera. Since my last report, there have been several new outbreaks of cholera and "acute diarrhea" in Africa and Asia.

Uganda (southeast)
Four districts fed by the Manafwa River in the southeast of Uganda experienced a cholera outbreak after heavy April rains flushed contaminated water from Bugobero into the Manafwa. Thirty-one people died, out of a total of at least 290 infected individuals, in the six weeks following the rains.

South Africa (KwaZulu-Natal)
Health officials implemented precautionary measures in late June at a shelter in the coastal area of KwaZulu-Natal after an unspecified number of people – including a one-month-old baby boy – began to experience diarrhea. Cholera is suspected, but hadn't been confirmed at the time of the report.

Kenya (Nyanza and Western provinces)
Several outbreaks of cholera have been reported in this region of Kenya since the beginning of 2008. At least 46 people died out of a total of 832 confirmed cases of cholera by early April. After a lull during which no new cases appeared, approximately 30 new cases were reported in the first half of June.

Vietnam (northern)
Cholera broke out again last month in three northern provinces of this Southeast Asian country. Nearly 60 cases of cholera have been confirmed, many of them from Chan Lac Village. Health officials warned villagers not to use water from the lake, after it was tested and found to contain Vibrio cholerae. The lake has since been disinfected. Vietnam has experienced some 500 confirmed cases of cholera so far this year.

Nepal (mid-western)
A remote village in the Jumla district of Nepal has been devastated by an outbreak of cholera, which claimed at least six lives – mostly children – and sickened more than 100 villagers. The village is accessible only on foot, and is a seven-hour trek from the district headquarters. But distances made no difference in this case. According to the Xinhua news agency, the health district had no medicines to distribute to the afflicted village.

Myanmar
There is still a de facto news blackout on the cholera situation in the cyclone-devastated regions of this country. On May 9th, a spokesperson for Medecins Sans Frontieres reported "many" cases of diarrhea, as well as outbreaks of cholera and malaria.

A resident of Bogalay village, in the cyclone-hit area, also reported cases of cholera and dysentery among survivors of the storm. But on May 18th, the Myanmar government denied the existence of any disease outbreaks, "...except usually occurring diseases..."

Unfortunately, the number of "usually occurring diseases" in Myanmar is probably high enough to mask the additional number of cases due to the cyclone's aftermath.

Food Safety And Good Corporate Citizenship

Bill Marler wrote yesterday evening:

"Frankly, I think the grocery stores - especially the big box types - need to take a more active role in seeing that plants like this perform - that is - they do not produce meat products contaminated with E. coli, Salmonella, Listeria, etc. Perhaps stores should be less concerned about sales and more concerned with safety."

Bill's statement reminded me of an experience I had back in the mid-1990's, when I was Research Director of QA Life Sciences, a company that developed and supplied rapid test systems to the food industry. One of our customers was a supermarket chain (not one of the Kroger's group of companies).

My contact at Company X was the QA Manager ("Q"), an old-timer who felt a responsibility for the safety of the foods his employer sold to consumers. He was especially concerned about the beef and trimmings that Company X was purchasing for grinding, and he decided to put pressure on the company's meat suppliers to clean up, or risk losing Company X's business.

Q adopted our rapid test, which produced simultaneous counts of total E. coli and E. coli O157 within 24 hours. He could then determine the "H7" part of the E. coli O157:H7 within an additional 24 hours. After receiving grudging corporate management support for his plan, Q contacted Company X's beef suppliers and proposed that they meet specific standards for total E. coli and for E. coli O157:H7.

Q was ahead of his time. USDA had recently (October 1994) named E. coli O157:H7 as an adulterant in ground beef, but not in beef destined for grinding. He met stiff resistance from several of the company's suppliers, especially for his E. coli O157:H7 proposal. Eventually, he was able to negotiate standards based on total E. coli and E. coli O157.

Why the resistance to completing the H7 portion of the test? Company X's suppliers did not want to know that their beef was contaminated with E. coli O157:H7. Were they advised of a positive E. coli O157:H7, they would have to act on the knowledge. But if the test was limited to E. coli O157, the beef suppliers could accept returned meat that failed Company X's standards and resell it to a less demanding customer.

Q told me on several occasions that his program was successful. The overall safety and cleanliness of Company X's ground beef was much improved.

The beef screening program stayed in force until Q retired. Company X dropped the program soon afterward.

E. coli O157:H7 and Moultrie, Georgia On My Mind

I suggested on July 2nd that the E. coli O157:H7 outbreak that triggered a recall by Nebraska Beef and The Kroger Company might extend beyond Ohio and Michigan – into Georgia, to be precise. It would appear that my hunch was correct.

On June 30th, the Southwest Georgia Public Health District reported that it was investigating the source of two confirmed cases of E. coli O157 in Colquitt County. An additional dozen suspect cases were also under investigation.

Earlier today, Bill Marler cited a report in the Moultrie Observer that six people were now confirmed to have been infected with E. coli O157:H7. Three more individuals – all suffering symptoms of hemolytic uremic syndrome – are also expected to be confirmed as victims of this outbreak.

Brenda Greene, the Deputy Director of the public health district told the Moultrie Observer that a "... specimen sample from one of the patients resulted in a match to the same strain of E. coli bacteria in disease outbreaks in Michigan and Ohio," and that CDC and state epidemiologists agreed "...ground beef may be a source..." of the Colquitt County outbreak.

All of the infected individuals ate at the Barbecue Pit, a Moultrie restaurant. The restaurant has closed to aid the investigation, which is proceeding over the holiday weekend.

This will likely send epidemiologists and public health officials in the other 47 states scurrying back through their records of unexplained E. coli O157:H7 cases from May and June. At least CDC won't have to figure out what food to blame for this outbreak.

Salmonella Saintpaul Outbreak Investigation A Shambles

Remember the Keystone Kops of silent movie fame? We're living a remake of those movies, with FDA and CDC staffers in the starring roles.

CNN is reporting that FDA plans to halt a whole range of produce items at the U.S.-Mexico border starting on Monday. The list of products includes cilantro, jalapeño peppers, Serrano peppers, scallions and bulb onions, according to the news report.

CNN quotes FORMER Health and Human Services Secretary Tommy Thompson as the source for this information. Thompson told CNN that the named produce items would be held at the border pending lab tests for Salmonella.

If CNN's information is accurate, this smells like a fishing expedition – a desperate attempt to appear to be dealing with the problem. To the best of my recollection, this type of shotgun approach is unprecedented.

I am incensed – as should the Mexican authorities and growers be incensed – that consumers and the industry are being treated in such a cavalier and condescending fashion. The public deserves to hear this news directly from the responsible authority – not from unnamed health officials (as in the Baltimore Sun article that I referred to yesterday) and certainly not from a former HSS secretary.

At this moment (3:30pm EDT), neither the FDA nor the CDC web site has been updated with the information carried in the CNN report. We are being treated like the proverbial mushroom – kept in the dark, and fed feces.

Twice "Bitten"

Back in February, I was introduced to a New York Times recipe blog – "Bitten" – which is written by Mark Bittman. Much to my dismay, Bittman was recommending a recipe for Fast Roast Chicken that made no provision for confirming that the chicken was completely cooked through.

I wrote an article about that recipe, and also posted a comment on Bittman's blog site to air my concern. I never heard from Bittman, nor did he post any clarification of his cooking instructions subsequent to my article.

I had a similar experience last December with some Martha Stewart poultry recipes. While I never had a direct reply from anyone in her organization, I was delighted to see that her more recent poultry recipes gave specific instructions on testing the internal temperature of poultry to verify that it has been cooked throughout.

But I must report that yesterday's "Bitten" Recipe of the Day – while it sounds delicious – contains potentially fatal flaws.

1. The recipe calls for cooking the chicken "...in the least hot part of grill until chicken looks close to done."
2. The recipe then suggest setting the incompletely cooked chicken aside, if desired "...for a couple of hours..."
3. Next, the chicken is to be cooked until crisp on the hot side of the grill "...turning chicken until it is brown and crisp all over, 5 to 10 minutes."
4. Finally, Bittman suggests that the chicken be served "...hot, warm or at room temperature..."

This is a potential recipe for at least three different types of food-borne illness – Salmonella, Staphylococcus aureus, and Clostridium perfringens. Here's how these three pathogens could take advantage of Bittman's recipe to leave a sour aftertaste to any Fourth of July backyard party.

Salmonella
It's no secret that between a quarter and a half (depending on which survey you believe) of all the poultry sold at retail in the United States and Canada is contaminated with Salmonella. Both the USDA and the Canadian Food Inspection Agency recommend that poultry be cooked throughout to an internal temperature of 165ºF. This is to ensure that any Salmonella present in the poultry has been killed.

It is very risky to cook a piece of poultry incompletely, then put it aside. Any Salmonella that survives the initial partial cooking can begin to recover and multiply in the incompletely cooked poultry. When the poultry is put back on the grill to "finish" the cooking, the internal temperature of the meat might not reach 165ºF. And serving the meat "warm" or at "room temperature" gives the surviving Salmonella a chance to multiply once again. Often, it takes only a few live cells to make someone ill.

Staphylococcus aureus
This food poisoning bacterium is found frequently on the people's hands and in their nostrils. Many strains of S. aureus produce a heat-stable toxin when they grow. If the microbe is transferred to the poultry while the food is being handled, the S. aureus will have a chance to begin multiplying during the time the partly-cooked chicken is set aside. Any toxin produced by the microbe will survive the final cooking on the hot part of the grill. Depending on how long the chicken is allowed to sit to one side while awaiting its final cooking, there could be enough toxin produced to make someone quite ill.

Clostridium perfringens
This microbe produces heat-resistant spores that can survive even a thorough cooking. Heat stimulates the spores to germinate, and the microbe can multiply while the food is set aside. If the final cooking is not sufficient to kill the bacteria that have multiplied but not yet produced spores, this microbe can grow to a population size that will produce illness.


Mark Bittman, it's time you thought through the possible consequences of some of your recipes.

Salmonella Saintpaul - Filling The Information Vacuum

In the absence of direct information from CDC and FDA as to what additional food items they are investigating, it's not surprising that the media are starting to search for other news sources on the Salmonella Saintpaul outbreak. And it's to be expected that leaks from "unnamed sources" have started to appear.

Both the Marler Blog and the BarfBlog have picked up on a report by Johnathan Rockoff in today's Baltimore Sun. In his article, Rockoff cites unnamed health officials as saying that new evidence is pointing to jalapeño peppers – a common ingredient in salsa – as the possible source of the outbreak that has sickened more than 900 people. Rockoff's sources acknowledge, however, that no samples of jalapeño peppers have tested positive yet for Salmonella Saintpaul.

CDC updated its status report on the outbreak again today, but made no comment on which additional foods are under the epidemiological microscope. As of 9pm (EDT) yesterday, 943 cases of infection with the outbreak strain of Salmonella have been lab-confirmed, including one Canadian who was infected when traveling in the United States.

At least 130 of the outbreak victims have needed hospital care. One elderly Texas man has died as a result of his infection. A second Texan – a cancer patient – also died after suffering an infection with the outbreak strain. But CDC and Texas health authorities do not know for certain whether the infection caused his death.

I've never been one to put much credence in anonymous news sources, so I'm not sure how much weight to give the Baltimore Sun article. I would have been more impressed had someone been prepared to go "on the record", the way Dr. Michael Osterholm did in his interview with The Perishable Pundit on June 24th.

Skyrocketing Ground Beef Recall To Mark July 4th

The initial Nebraska Beef recall of 531,707 pounds of beef and trimmings destined for ground beef was just a 10% down payment. Yesterday evening, the company expanded its recall to 5.3 million pounds, comprising "...all beef manufacturing trimmings and other products intended for use in raw ground beef produced between May 16 and June 26."

According to the FSIS recall announcement, the expansion was due to findings by FSIS that "...the production practices employed by Nebraska Beef, Ltd. are insufficient to effectively control E. coli O157:H7 in their beef products that are intended for grinding. The products subject to recall may have been produced under insanitary conditions."

The FSIS news release adds that the recalled meat was used for further processing into ground beef at other establishments. But the agency does not name those establishments, nor has it posted recall notices from companies other than Nebraska Beef and Kroger.

Yesterday evening, The Kroger Company expanded its own ground beef recall again (it had already done so on July 1st) to take into account the additional production dates included in the revised Nebraska Beef recall. The July 3rd Kroger recall has been posted on the FSIS site, although the agency never notified consumers of the July 1st recall.

Consumers nationwide who purchased ground beef from any store in the Kroger group of companies should read the recall notice carefully. This includes customers of Baker’s, City Market, Dillons, Fred Meyer, Fry’s, Gerbes, Hilander, King Soopers, Kroger stores, Kroger Mid-Atlantic, Owen’s, Pay Less, QFC, Ralphs, Scott’s, and Smith’s. Meat that is included in this recall notice should be returned to the store for a full refund.

Just two states, other than Ohio and Michigan, have posted information about this recall on their own web sites so far. The Arizona Department of Health Services has posted an alert to consumers in that state together with safe food handling guidelines. And the West Virginia Department of Agriculture has responded to the Kroger and Nebraska Beef recalls by expanding its sampling of retail ground beef for E. coli O157:H7.

CDC has updated its E. coli O157:H7 outbreak investigation web page to include a mention of the most recent recall notices. There are now 41 lab-confirmed cases of E. coli O157:H7 in Ohio and Michigan. Twenty-two of the victims have been hospitalized. Fortunately, there have been no deaths linked to this outbreak, although one victim is suffering from hemolytic uremic syndrome.

On this holiday weekend, CDC is reminding consumers to pay attention to safe food handling practices, including the following:

Wash hands with warm, soapy water for at least 20 seconds before and after handling raw meat and poultry. Wash cutting boards, dishes and utensils with hot, soapy water. Immediately clean spills.

Keep raw meat, fish and poultry away from other food that will not be cooked. Use separate cutting boards for raw meat, poultry and egg products and cooked foods.

Consumers should only eat ground beef or ground beef patties that have been cooked to a safe internal temperature of 160°F.

Color is NOT a reliable indicator that ground beef or ground beef patties have been cooked to a temperature high enough to kill harmful bacteria such as E. coli O157:H7.

The only way to be sure ground beef is cooked to a high enough temperature to kill harmful bacteria is to use a thermometer to measure the internal temperature.

Refrigerate raw meat and poultry within two hours after purchase or one hour if temperatures exceed 90°F. Refrigerate cooked meat and poultry within two hours after cooking.

If a restaurant serves you an under-cooked hamburger, send it back for more cooking. Ask for a new bun and a clean plate, too.

Never put cooked hamburgers or meat on the plate they were on before cooking. Wash the meat thermometer after use.

Salmonella Saintpaul Outbreak Keeps On Growing

Just as surely as the giant oil slick that spread over the ocean's surface following the Exxon Valdez disaster, the Salmonella Saintpaul outbreak continues to ooze, amoeba-like, across the contiguous 48 states. According to today's pre-Independence Day update from CDC, there are now 922 lab-confirmed cases in 40 states.

Especially worrisome for consumers, the produce industry, and regulators, the most recent illness onset date keeps shifting. It now is reported as June 25th. At least 210 people have been infected with the outbreak strain since June 1st, and 111 – or more – have been hospitalized.

The only states that have not, as yet, reported at least one confirmed case of Salmonella Saintpaul are: Alaska, Delaware, Hawaii, Mississippi, Montana, Nebraska, North Dakota, South Dakota, West Virginia, and Wyoming. The hardest-hit state, per capita, is New Mexico (>20 cases per million population), followed by Texas (10-19.9 cases/million), then Arizona, Oklahoma, Kansas, Illinois and Maryland (each with 5-9.9 cases/million).

CDC has revisited its initial case-control studies, and has reopened the possibility that some food or ingredient other than raw tomatoes might be at the bottom of this outbreak. And FDA has activated the Food Emergency Response Network, a group of volunteer laboratories last used in the melamine investigation, to augment its analytical lab capacity for an expanded investigation of possible food sources.

Both agencies insist that raw tomato is still the primary "food of interest". And they have not changed any of the recommendations issued to consumers. This can't be pleasing to tomato producers either in the United States or in Mexico, but it's hard to see how the federal government could rescind the tomato advisory in the absence of hard evidence pointing to a different culprit.

Nevertheless, one wishes that the feds could be a little more forthcoming with information on the scope of the expanded investigation. Are all potential salad ingredients – lettuce, spinach, carrots, and so forth – under suspicion now? Or is the focus on ingredients commonly added to dips, salsas, and other raw tomato-based condiments?

It would be nice to know into what we can dip our chips this Fourth of July weekend.

And In Other Salmonella News . . .

Denmark
The Danes are searching for the source of a Salmonella outbreak that has sickened 330 people so far. The country's Center for Prevention and Control of Infectious Diseases estimates that as many as 4,000 people might actually be affected.

With a population of fewer than 5.5 million people, this translates into a confirmed case rate of approximately 60 cases per million people. In comparison, the confirmed case rate in the current Salmonella Saintpaul outbreak in the United States is roughly 3 cases per million.

Investigators are interviewing patients, checking their refrigerators, and even accessing credit card records to determine what foods the patients purchased. Suspicion is falling on a domestic product – perhaps a meat product – since neighboring countries are unaffected by the outbreak.

Marion, North Carolina
The Salmonella outbreak presumptively linked to Marion's O'Dear's Country Diner has grown to 11 cases since my June 25th report. O'Dear's has closed twice voluntarily during the outbreak investigation for cleaning and disinfection at the request of local health authorities. The county health officials haven't said what Salmonella serotype is the culprit, nor have they identified a suspect food – except to say that it's probably not tomatoes, since the restaurant was serving tomatoes from a "safe" source.

Newton, Kansas
Salmonella Enteritidis is responsible for an outbreak that has sickened 19 people in three south-central Kansas counties. The Acapulco Restaurant in Newton, KS has been fingered as the probable source. The restaurant was inspected on June 17, 2008, and was cited for four critical violations, all of which were corrected immediately. The exact cause of the Salmonella infections remains a mystery.

Sliced Turkey Breast Recalled In UK

The UK Food Standards Agency is advising consumers that one production lot of sliced, cooked turkey breast is contaminated with Listeria monocytogenes and has been recalled by Co-operative Group.

The recalled product, which is sold in 125g packs, is labeled as "Co-operative Sliced Cooked Turkey Breast, and has a use-by date of 3 July 2008. Customers are asked to contact the company, toll-free, at 0800 0686 727 for a full refund.

Listeria monocytogenes causes mild illness in most people, but can produce serious illness – even death – in immuno-compromised individuals, the very young, the elderly, and pregnant women.

If you have purchased this product, please contact the manufacturer and follow their instructions. It is never wise to consume a recalled product.

USDA's Inadeqate Recall Alert System

With the United States in the midst of an outbreak of E. coli O157:H7 that has been traced to ground beef, and with the recall of more than 530,000 pounds of beef and beef trimmings from Nebraska Beef due to E. coli O157:H7 contamination, it's clear that our national recall alert system leaves a lot to be desired.

The initial recall that resulted from this outbreak was announced by The Kroger Company on June 25th. The Kroger recall, which was limited to ground beef sold in their Michigan and Ohio stores, was also posted on the USDA/FSIS recall notice list.

Next, on June 30th, Nebraska Beef Ltd. announced its recall of 531,707 pounds of beef after FSIS found E. coli O157:H7 in samples from two federally inspected establishments that had purchased meat from Nebraska Beef. That recall, too, was posted on the FSIS web site. But the company and the agency declined to identify the establishments to which Nebraska Beef had shipped the recalled meat.

Kroger's expanded its recall very substantially on July 1st as a result of the Nebraska Beef recall. And Giant Food Stores recalled one batch of preformed burger patties that same day, due to "E. coli" contamination. Both of these July 1st recalls were described by the companies as "Class I" recalls – a classification that, according to USDA and FDA, represents a high level of health risk.

Neither of these July 1st recalls has appeared on the FSIS recall web page. The government appears to be relying solely on the supermarkets to get this vital food safety information into the hands of customers. Coverage of the expanded Kroger recall has been very spotty. The initial New York Times news item, for example, made no mention of the extension of the recall beyond the borders of Ohio and Michigan. And media reports of the Giant Food Stores recall have been conspicuous by their absence.

As of 2:30pm (EDT) yesterday, Michigan has confirmed 21 genetically linked cases of E. coli O157:H7. More than half of the patients purchased or ate ground beef from Kroger's, but the state does not say whether it has been able to trace back the source of the pathogen in the other confirmed cases. Ohio has now confirmed 20 cases linked genetically to this outbreak, and is investigating four more.

No other states have linked cases to this outbreak – yet. Georgia, one of the states included in the expanded Kroger recall, is investigating an outbreak of E. coli O157:H7 in the southwest part of the state, but has not yet established a food link. CDC still considers the E. coli O157:H7 outbreak to be confined to Ohio and Michigan. Let's hope they are right.

But containing a food poisoning outbreak requires cooperation from all parties – not just to recall the contaminated food, but to make sure that the information reaches consumers in timely way. It's clear that FSIS, by neglecting to post the July 1st recall actions of Kroger and Giant, is not pulling its share of the load. What is the agency waiting for – a larger outbreak?

Revisiting Myanmar: Eyewitness Report, Part Two

Yesterday, I posted the first paragraphs of an eyewitness report that was written by a native of Myanmar now living in the United States. This courageous and compassionate person, who I refer to here as "U", traveled to Myanmar with two suitcases full of aid supplies and spent three weeks delivering assistance to villagers in the disaster area.

Here is the rest of U's trip report:

The Burmese government’s response to the storm has left a lot to be desired and can be described as neglect. Their reaction afterwards was even worse. The first to help those who had suffered, to clear roads and debris so that people who needed help could be reached, and to provide shelter for those in need, was not the government, but those living in the cyclone-hit regions who were fortunate enough to have something left to help others.

Many aid workers and experts with the experience, knowledge and skills necessary to help rebuild the lives of the victims and prevent the death toll from rising higher and higher were subject to bureaucratic delays or denied access altogether. The longer aid supplies and relief workers were kept waiting, the higher the chance that the death toll would continue to climb. While people were suffering and at risk of disease and death, the junta chose to give priority to the referendum it wished to see passed. While the world debated what to do about the situation, the government continued to value its own political goals over the needs of the victims.

While I was relieved to know that my own family was safe, I could not just stay in [deleted] while people were suffering in Burma. The government banned visas to many foreign aid workers who wanted to help the victims of the cyclone. Only Westerners with Burmese citizenship were allowed into the country. As a Burmese citizen, I was able to take that advantage and go back to Burma with two suitcases full of water purification tablets, other medical supplies and some donations from friends.

I spent three weeks in Burma and it was an unforgettable experience. Together with my neighbors, we went to seven villages and distributed about 1400 food bags/supplies to victims of the cyclone. We were not alone: in the absence of an organized relief effort by the government, many Burmese volunteers organized their own deliveries to the delta to help people who had not received any aid.

Life is slowly returning to normal in Rangoon. The streets, once filled with beautiful, green trees, today are littered with torn and twisted tree limbs, but most of the fallen trunks have been pushed to one side, so traffic is flowing. Some shops and offices are open again.

In the Irrawaddy delta, half a day's journey from Rangoon, life is far from normal. This is a desperately poor region where hundreds of thousands of people live in tiny settlements scattered amongst low-lying islands.

Instead of welcoming help and granting improved access to the Irrawaddy Delta area, the Burmese military government is still using red tape to obstruct some relief efforts. At each checkpoint on the way to delta areas, we encountered not only police, but also immigration officers searching out any foreigners who might be coming in with locals. Even Burmese citizens are being restricted by the security forces. At some checkpoints, the officials wanted us to leave our supplies with them for distribution. We refused, since we knew that, if we had done so, the supplies would not get to the victims, and might even end up on the black market. Then they asked if we wanted to distribute aid ourselves. We said yes, so they asked us to give them money.

I wanted to use my small video camera to make a record of our aid distribution to show my friends; in some places we were allowed to do so, but not in others, where we were requested not to take pictures. In [deleted] village, my video camera was taken by the check point officer. After talking with him for about 30 minutes, explaining it was just for my family to see, and after offering him money, he agreed to gave me back the camera—but without the tape.

On our way to [deleted village name], we saw dead buffalo and cows floating. There is still a bad smell swirling around. Villagers in that area said that there were still bloated bodies lying uncollected near their villages.

Cyclone victims from villages between Kunchangone in Rangoon Division and Irrawaddy's Dadaye Township are keeping a daily roadside vigil in the hope of receiving aid. Villagers continued to flock to the main highways because aid workers had not been able to access the more remote villages. The villagers go back to their villages in boats at the end of the day, after they have received food for their family from the aid workers. Their buffaloes and cows were killed by the storm, so it is very unlikely that they will be able to resume their routine jobs this year.

As for living conditions, they don’t even have enough plastic sheets to make roofs for their shacks. They are using coconut leaves for roofs. After distributing food supplies in [deleted village name], we came back in the heavy rain and saw many, many people crouched by the side of the road, holding their children in their arms and covering themselves with plastic sheets.

A week before I came back to [deleted], the Myanmar Jewish community hosted an interfaith prayer ceremony for the victims of the cyclone at the Rangoon Synagogue. Leaders from the Muslim, Christian, Buddhist, Bahai’ and Hindu communities were invited to attend. About 100 people assembled for the ceremony and it was beautiful to see all the different religions gather together for a common cause affecting all of our people, regardless of their individual faiths.

Wherever we went to distribute food bags, plastic shelters and clothing, I could see the faces of the cyclone victims light up. It was very rewarding to see smiles on the faces of people who had suffered so much. And in every cyclone-hit region I went to in Burma, I shared with the victims I met there that there are passionate people in the outside world who care about the Burmese people and whose hearts go out to them during this very difficult time.

CDC's E. coli O157:H7 Update

CDC has posted updated totals for the E. coli O157:H7 outbreak that, according to the agency, is still limited to Ohio and Michigan. As of 5pm (EDT) yesterday, CDC acknowledges 40 lab-confirmed cases of E. coli O157:H7 – 21 from Michigan and 19 from Ohio. Twenty-one people have been hospitalized, one of them with kidney failure.

All of the cases are linked by genetic fingerprinting to each other and to contaminated ground beef. The ground beef was prepared using beef and beef trim supplied by Nebraska Beef, Ltd. As a result, that company has recalled more than 530,000 pounds of potentially contaminated beef products.

While the cases of E. coli O157:H7 appear at this time to be confined to Ohio and Michigan, CDC and state health agencies are examining the possibility that the outbreak is more widespread. There is, for example, a current outbreak under investigation in Southwest Georgia.

The extent to which potentially contaminated meat was distributed nationally is becoming more clear. For example, Ralph's Supermarkets – part of the Kroger empire – has recalled ground beef sold in its Southern California stores. And there will probably be more recalls to come, as federal agencies, meat grinding establishments, and retailers continue to navigate back through their purchasing and distribution records.

If you have purchased ground beef, or pre-formed ground beef patties, please check the recall notices published by The Kroger Company (which includes Ralph's) and Giant Food Stores. Links to these notices can be found in my post of earlier today.

Kroger's Expands Ground Beef Recall To Other States

This morning's New York Times reports that Kroger has expanded its recall of ground beef products "...to include ground beef products in Styrofoam tray packages wrapped in clear cellophane or purchased from an in-store service counter from certain stores..." in Ohio and Michigan.

But the expanded recall goes much farther. According to information available on the Kroger web site, the company is now recalling ground beef sold in several of the supermarket chains that are part of the Kroger empire. Here is a complete list of stores, products and expiry dates that are included in the expanded recall:

Fred Meyer May 21-July 5
QFC May 21-July 5
Kroger stores May 21-July 3 *
(*except Kroger stores in Georgia, South Carolina, Alabama, and Knoxville, Tenn. and Kroger’s Mid-Atlantic division, which includes stores in North Carolina, Northeastern Tennessee, Virginia and West Virginia. Kroger stores in Georgia, South Carolina, Alabama and Knoxville, Tenn. are not involved in the recall of ground beef in Styrofoam trays or from in-store service counters.)

Kroger Mid-Atlantic May 19-June 6
Fry’s May 21-July 3
Ralphs May 21-July 3
Smith’s May 21-July 3
Baker’s May 17-June 4
King Soopers June 20-July 3
City Market June 20-July 3
Customers who shop at Hilander, Owen’s, Pay Less, and Scott’s should follow the “sell by” dates listed above for Kroger stores.

In addition to the ground beef described above, Kroger is recalling Private Selection Natural ground beef sold in 16 oz. packages that were in the self-service meat case. The “sell by” dates for this product is July 11 through July 21, 2008. The product was available at all Kroger stores (including Kroger Mid-Atlantic and stores in Georgia, South Carolina, Alabama and Knoxville, Tenn.) and Dillons, Fred Meyer, Baker’s, Smith’s and Fry’s.

This represents all of the recalled Nebraska Beef products that were supplied to Kroger. The following information, which is part of the recall notice, should also be of interest to Kroger customers:

Kroger has expanded the recall due to new information provided by the USDA. This information links product produced by Nebraska Beef to the illnesses. As a precaution, Kroger is removing all ground beef supplied by Nebraska Beef during the dates provided by the USDA.

The following items are not included in this recall: ground beef sold in sealed tubes in one, three or five-pound packages and frozen ground beef patties sold in the frozen food section of its stores.

Kroger has already begun notifying customers about this recall by placing signs in stores in meat departments. Kroger is also using its register receipt notification system that alerts customers about recalls of products they may have purchased.

Kroger has instructed every store involved in the recall to discard the ground beef products in question and thoroughly clean and sanitize all equipment used to prepare ground beef for sale.

Consumers who have questions about the recall may contact Kroger toll-free at (800) 632-6900.

This expanded recall reinforces my earlier suspicion that this E. coli O157:H7 outbreak may extend well beyond the borders of Ohio and Michigan. Stores in Georgia, South Carolina, Alabama and Knoxville, TN are mentioned specifically in the Kroger recall notice.

Coincidentally, public health investigators in Southwest Georgia are investigating an outbreak of E. coli O157:H7 in Moultrie (Colquitt County). Two instances of E. coli O157:H7 have been lab-confirmed, and an additional 12 cases are pending. At the moment, the investigation is focussing on patients who have either been hospitalized or treated as out-patients. While the source of this outbreak has not yet been established, Georgia is one of the states included in Kroger's expanded recall announcement.

Giant Food Stores, a regional supermarket chain headquartered in Pennsylvania and with stores in Maryland, New Jersey, New York, Ohio, Pennsylvania, Virginia and West Virginia, also has issued a recall notice. The chain is advising its customers that "Natures Promise 90% Ground Beef Patties" with a Use/Freeze by date of 7-11-08 "may be contaminated with E. coli bacteria." The patties were sold in Giant and Martin's supermarkets.

With the traditional July 4th barbecue festivities approaching, this recall is a reminder to handle raw meat carefully and to grill hamburgers until the meat has reached an internal temperature of 160ºF throughout. Color is not a good indicator of safety. USDA offers tips for safe handling and grilling of meats and poultry on its web site.

Tomato Pasting

The numbers continue to climb in the largest tomato-related Salmonella outbreak in US history. At last count – as of 9pm (EDT) last night – CDC has acknowledged 869 lab-confirmed cases of Salmonella Saintpaul infections in 36 states and the District of Columbia. At least 107 people have been hospitalized.

What's even more significant than the continuing increase in reported cases is the timing of new cases. CDC now tells us that, contrary to its previous reports, 179 of the victims – more than 20% of the lab-confirmed total – began to have symptoms of salmonellosis during the month of June. The newest patients became ill on June 20, two weeks after FDA alerted consumers, retailers and food service operators nation-wide to the outbreak.

On the subject of FDA, there has been no further substantive news on its trace-back investigations. None of the tomato samples tested so far have yielded the outbreak strain. We don't even know whether any Salmonella – outbreak strain or not – has turned up in the more than 1,700 samples FDA has examined.

Having cut my food safety teeth within a federal health agency (Canada's Health Protection Branch), I usually tend to give government investigators the benefit of the doubt. I know how complex and difficult it can be to trace the source of a microbiological contaminant. But I get the sense that FDA is floundering in its trace-back attempts.

I am especially disturbed by the latest statements out of CDC and FDA that cast doubt on their initial positive assertions as to the source of this outbreak. And I find Dr. Acheson's apparent surprise at the complexity of the raw tomato distribution system disingenuous, at best.

This is the thirteenth Salmonella outbreak that has been linked to contaminated tomatoes in the United States since 1990. Surely, FDA should know by now the details of the tomato distribution chain – or should know where to find that information pronto.

When all the dust finally settles on this enigmatic outbreak, I hope – and expect – to see a full Congressional inquiry into the handling of this investigation by FDA and CDC.

Nebraska Beef Recalls 531,707 Pounds of Meat

Nebraska Beef, Ltd. has recalled 531,707 pounds of ground beef components – beef and beef trimmings that are used to produce ground beef at specified fat levels. The Omaha company was identified as the source of contaminated ground beef sold by Kroger.

This investigation began as the result of an outbreak of E. coli O157:H7 in Michigan and Northern Ohio. That outbreak was traced to ground beef purchased in Kroger supermarkets in those two neighboring states. Kroger recalled the implicated ground beef on June 25th, after the outbreak strain was isolated from a package of meat that had been purchased by an outbreak victim.

This outbreak might extend well beyond the borders of Michigan and Ohio. According to the USDA/FSIS recall announcement, FSIS detected the outbreak strain of E. coli O157:H7 in samples taken from two federally inspected establishments that had purchased meat from Nebraska Beef.

The recall notice does not name those establishments. But a review of recent FSIS news releases might offer some clues. On May 22nd, FSIS alerted consumers to possible E. coli O157:H7 contamination of 808 pounds of ground beef produced by Tyson Fresh Meats, Inc. of Lexington, NE. And on June 8th, Dutch Meats, Inc. of Trenton, NJ recalled more than 13,000 pounds of ground beef due to E. coli O157:H7 contamination.

FSIS has not said whether the E. coli O157:H7 isolates that triggered these earlier recalls – both of which fall into the same time frame as the Ohio/Michigan outbreak – are related genetically to the outbreak strain. Even if these recalls are linked to the current investigation, there is still much more to come. Together, the Tyson and Dutch Meat recalls represent less than 3% of the more than 530,000 pounds of meat recalled last night by Nebraska Beef.

There has been at least one unexplained E. coli outbreak recently. Twenty children attending the Wonder World Preschool in Slayton, MN became ill between mid-May and early June. Twelve of the children were confirmed to have been infected with E. coli. And there might be other incidents that escaped media attention.

Let's hope that CDC will find the time to review its backlog of PulseNet reports on E. coli O157:H7 isolates to determine whether any of them are a genetic match to the Ohio/Michigan outbreak strain. I would not be surprised to learn that the outbreak is more extensive than previously reported – and that the distribution pattern of the Nebraska Beef products matches the geography of the outbreak.

Revisiting Myanmar: Eyewitness Report, Part One

We haven't been hearing much about Myanmar recently. Its tragedy has been replaced by other – more recent – news: the electoral sham in Zimbabwe, China's preparation for the 2008 Olympics, world food shortages, and escalating petroleum prices.

But lack of media attention doesn't equate to an absence of news – or mean that Myanmar's problems have disappeared in some magical way. The status quo is still very much in place.

The difficulties encountered by the United Nations, international aid organizations, and foreign governments who wanted to assist survivors of Cyclone Nargis have been reported in great detail. The military junta, which rules Myanmar, first denied needing outside help, then welcomed foreign aid supplies, but insisted on distributing the aid itself.

In spite of predictions of a public health disaster – published elsewhere as well as on this blog – major outbreaks of dysentery and cholera appear to have been averted. Or, any spike in illnesses following the Cyclone might have been masked by the normal level of diarrheal disease in that region.

But some of the credit for staving off sickness and starvation must go to the citizens of Myanmar who banded together – in the face of government disapproval and obstruction – to assemble and deliver aid to their compatriots in the Ayeyarwaddy Delta. These volunteers returned from their visits to the Delta with tales of homeless storm victims, rotten rice, and confiscated aid supplies.

The Myanmar government has denied all of the reports of mismanagement and malfeasance that have emanated from the cyclone-stricken area, saying in one article that "...the rumours are invented and spread by certain Western countries with negative attitude towards our country."

This statement, however, is belied by eyewitness reports from aid workers and others who have visited the Ayeyarwaddy Delta and seen the misery that remains. I have been corresponding with one such eyewitness, whom I shall call "U" – a Myanmar honorific, which is roughly equivalent to the Japanese "San".

U recently returned from a three-week visit to Myanmar. He has consented to sharing his observations with eFoodAlert readers. His report is dated 6/12/2008. I have deleted all references that might identify him or his family, some of whom still live in Myanmar. My deletions are shown in red.

On May 2, 2008, Cyclone Nargis hit Burma, first attacking the southern part of Irrawaddy Division, then passing through Rangoon (Yangon) and the delta areas. In its wake, the cyclone left 133,000 people dead or missing. According to the United Nations, 2.4 million people required emergency aid, but five weeks after the storm, there are still one million people who have yet to receive any help at all.

Fortunately for me, I was living in [deleted], working for [deleted]. My family in Rangoon was not so fortunate, and they had to endure several hours of intense rain and wind as the storm made its way across Burma. As it was, I was out of [deleted] at a conference, and I wasn’t even aware that a cyclone had hit Burma until the morning of May 4th, when I received many phone calls from my friends in the United States, all enquiring about my family. I was shocked to hear the news and it took me a while to absorb the fact that my family could be in danger.

Even in normal times, communications between the U.S. and Burma can be difficult, with email and telephone calls not easy to get through. This time, it took two days, until May 6th, with the help of the [deleted] Embassy and the [deleted] Embassy in Rangoon, I finally received the news that my family had survived and our house suffered only minor damage to the roof, but it had been quickly repaired. While many were equally fortunate, a great number more suffered far worse conditions and had nothing left but the clothes on their backs. Some did not even have that: the storm blew them off while they clung to trees for survival as the cyclone tore away their homes and their families.

This completes the introductory part of U's report. Please watch for the balance of the report, which will appear tomorrow.