Outbreaks and Alerts: November 16, 2010

A daily digest of international outbreaks, alerts and food safety news

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United States

• Arkansas City, KS. November 10th: At least 22 people who attended the Sacred Heart Turkey Dinner on the evening of November 8th have reported becoming ill with vomiting, diarrhea, abdominal pain and cramps. The outbreak is being investigated by the Kansas Department of Public Health (KDPH) and the City/Cowley County Health Department. Other than attendance at this dinner, no common link has been discovered. KDPH asks that everyone who attended the dinner or consumed food that was prepared for the event complete a survey questionnaire, whether or not they became ill. Data collected in this survey may help to determine the common link behind the outbreak.
• Olympia, WA. November 10th: Washington state has banned alcoholic energy drinks after nine dangerously drunk college students were hospitalized last month. FDA is reviewing the safety of these beverages.
• Atlanta, GA. November 12th: CDC reports that 37 cases of E. coli O157:H7 illnesses have now been linked to the consumption of Bravo Farms Dutch Style Raw Milk Gouda Cheese. Cases have been confirmed in Arizona (19), California (3), Colorado (10), New Mexico (3) and Nevada (2). Fifteen people have been hospitalized, and one patient is suffering from hemolytic uremic syndrome. There have been no deaths in this outbreak.
• Alden, MN. November 15th: Freeborne County Public Health and the Minnesota Department of Health are investigating a Norovirus outbreak that affected about 25% of the students at Alden Conger Elementary School last week. About 65 students were sick on Friday (Nov 12th) and 45 stayed at home on Monday.
• Austin, TX. November 15th: The Texas Department of State Health Services has issued an advisory against consuming blue catfish, channel catfish and smallmouth buffalo from Lake Worth in Tarrant County, after lab testing showed elevated levels of PCBs, aldrin and dieldrin in fish samples collected from the lake.

Canada

• Hamilton, ON. November 15th: The Clostridium difficile outbreak at St. Joseph's Healthcare has grown to 27 confirmed cases since the beginning of October. The outbreak has been linked to four deaths; 19 cases are currently active. The hospital has called in a special provincial infectious control team for assistance.
• Peterborough, ON. November 15th: Eleven people remain in isolation at Peterborough Regional Health Centre and one person has died in an combined outbreak of Clostridium difficile, methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci.

Europe

• Oslo, Norway. November 11th: Three small children from Oslo, Akershus and Østfold are in hospital with hemolytic uremic syndrome after developing an E. coli infection. It's not yet known whether the three cases are related.
• UK. November 12th: The Salmonella Bareilly outbreak has grown to 225 confirmed cases. Illnesses have been reported in Northern Ireland (3), Wales (5), Scotland (21) and England (196). The outbreak has been linked to consumption of raw or undercooked bean sprouts.
• Isle of Man. November 15th: Several cases of vomiting and diarrhea are suspected of being caused by an infection with Norovirus.
• Ireland. November 16th: Researchers have found that the virulent '027' strain of Clostridium difficile is prominent in Irish hospitals. There have been 1,419 cases reported in hospitals in Ireland so far this year.

Latin America and the Caribbean

• Port-au-Prince, Haiti. November 16th: Cholera has claimed 1,034 lives in Haiti and has sickened more than 14,500 people in less than one month. The United Nations forecasts that up to 200,000 Haitians may contract the highly contagious disease.

Outbreaks and Alerts: July 26, 2010

A daily digest of international outbreaks, alerts and food safety news

If you would like to receive automatic email alerts for all new articles posted on eFoodAlert, please click here or submit your request using the sidebar link. Please include "subscribe eFoodAlert" in the subject line.

United States

• Rush County, IN. July 19: The Rush County Health Department has confirmed three cases of E. coli infection. The outbreak, which has sent two children to hospital with hemolytic uremic syndrome, may be linked to attendance at the Rush County Fair.
• Jewell County, KS. July 23: Due to the presence of blue-green algae, the Kansas Department of Health and Environment (KDHE) is continuing to advise the public to avoid contact with water in Lovewell Reservoir in Jewell County.

Asia, Africa and the Pacific Islands

• Hong Kong. July 23: The Department of Health has drawn public attention to the risk of serious skin sensitive and allergic reactions in patients using topical products containing ketoprofen, a non-steroidal anti-inflammatory drug used in topical preparations.
• Hong Kong. July 23: The Department of Health has advised people who have been prescribed Chinese herb Rhizoma Atractylodis (蒼朮) by Tung Wah Hospital Clinical Centre for Teaching and Research in Chinese Medicine not to consume the herb as it was suspected to be contaminated with aconitum alkaloids.
• Pune, India. July 25: Speaker of the Maharashtra state assembly Dilip Walse-Patil has directed the state government to table a statement in the house over the alleged food poisoning' incident at a municipal school in Bopodi that is believed to have sickened 70 students.
• Hanoi, Vietnan. July 25: The Ha Noi People’s Committee, in co-ordination with the Ministry of Agriculture and Rural Development, plans to invest about VND2 trillion (US$104 million) in waste-water treatment plants along the Nhue-Day river. The money will also be used to dredge the riverbeds and upgrade the rivers’ dykes over the next five years. It will now be compulsory for new industrial parks in the city to have waste-water treatment facilities, while existing parks must begin treating their waste by the end of this year.
• Hong Kong. July 26: The Centre for Food Safety recently conducted two targeted food surveillance projects to assess the microbiological quality of ice-cream and Enterobacter sakazakii in powdered infant formula. No pathogens were found. Five samples of ice cream failed hygienic indicator tests.
• Yaounde, Cameroon. July 26: Cholera has killed 77 people in northern Cameroon since early June. There is concern that the outbreak may spread into Chad and Nigeria.
• Israel. July 26: The site where tradition holds Jesus was baptized is in danger of being declared off limits to pilgrims because of pollution in the Jordan River. Drought and diversion for irrigation have turned the lower Jordan River into a stagnant stream as it makes its way from the Sea of Galilee. The brook then swells with raw sewage as it passes Jericho. Israeli health officials are reportedly considering erecting signs warning: “Polluted Waters. Entry Forbidden.”
• Midnapore, India. July 26: More than 300 persons fell victims to food poisoning at a religious function in West Bengal's East Midnapore District. Fifteen of the victims have been admitted to hospital.

Australia and New Zealand

• West Australia. July 26: The deaths of two dolphins at the popular West Australian beach resort of Monkey Mia have prompted an investigation into whether recent sewage leaks at the resort are to blame.

Hemolytic Uremic Syndrome in France

Frozen ground beef recalled

February 21, 2009

The French Ministry of Health and Sports (Ministère de la Santé et des Sports) has issued a health alert in response to the diagnosis of a case of hemolytic uremic syndrome in a hospitalized child in the Paris area.

The child was infected with E. coli.

Epidemiological investigations have pointed authorities to a particular brand of frozen ground beef, and E. coli has been found in samples of the frozen meat. Further testing is underway to determine whether the strain in the meat matches the one recovered from the sick child.

Even though the genetic identity of the two isolates has not yet been confirmed, the manufacturer has recalled the following product at the request of the French authorities:

• Steaks hachés surgelés de la marque CERGEL, vendus par boite de 10 avec une date limite de consommation (DLUO) au 31/10/09 (CERGEL brand Frozen Ground Beef sold in boxes of 10 with an expiration date of 31/10/09)
  

Authorities are urging consumers to return packages of this product to the retailer for a refund.

USDA and the US meat industry: Are you taking notes?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It's Not Always The Raw Milk

I am not a booster of raw milk. As I have posted in the past (click on the "raw milk" topic to access those posts), drinking raw milk can be a very risky business. But I am the first to acknowledge that pasteurized milk – and dairy products made from pasteurized milk – can also be the source of food-borne disease.

This past week's issue of Eurosurveillance reports on an outbreak of hemolytic uremic syndrome (HUS) in Belgium that has been traced to ice cream made from pasteurized milk. Five children contracted HUS and seven other people suffered severe diarrhea. The ice cream was consumed at the farm where it was produced, and at two birthday parties.

Identical strains of E. coli O145 and E. coli O25 were isolated from the leftover ice cream, fecal samples from patients, fecal samples from calves and soiled straw from the farm. Investigators have determined that the milk used to produce the ice cream had been pasteurized correctly, and that none of the victims had come into direct contact with the farm animals.

The report concludes that the most likely cause of the outbreak was cross-contamination, perhaps as a result of a dairy worker having contact with the farm animals and then accidentally transferring the pathogens from the animals to the ice cream.

This outbreak underscores the need for constant vigilance and for attention to proper hygiene and sanitation in all food processing operations, regardless of size. It is also a reminder that pasteurization is just a preventative – not a panacea.

Would You Like Hormones With Your Hamburger?

Recently, I was reading a couple of research reports on a new E. coli O157:H7 cattle vaccine. The vaccine, which is meant to reduce the incidence of the microbe in feedlot cattle, has not yet been approved for use in the United States and has “investigational” status in Canada.

What caught my eye in these reports was the mention of the use of growth implants. These are pellets which are placed under the skin of the ear and slowly release growth hormones into the animal’s bloodstream. The hormones help the cattle “bulk up” more rapidly - just like athletes on anabolic steroids.

Growth promoting implants have been used by beef producers for more than 30 years. There are hundreds of articles in the scientific and technical literature touting the economic benefits of various growth-promoting hormones. I decided to check whether anyone had thought to investigate whether the use of these hormones might have an impact on the susceptibility of cattle to become colonized with E. coli O157:H7.

As far as I can tell, only one study has addressed this issue. A group of Canadian researchers systematically tested the effects of a growth promoting implant and the use of antibiotic feeding supplements on the presence or absence of E. coli O157 in cattle feces. In this study, some of the cattle (the control group) received neither hormones nor antibiotics; the others received a hormone implant, an antibiotic supplement, or both. At various times during the course of the 165-day experiment, feces from all of the cattle were tested for E. coli O157.

At no time during the entire study was E. coli O157 found in the feces of the “control” group - the cattle that received no hormones and no antibiotics. In contrast, more than half (54%) of the treated animals were positive for E. coli O157 at least once. The authors of the report (published in the Journal of Food Protection in November 2006) concluded that “...the high prevalence of E. coli O157 we observed may have been caused by the administration of growth-promoting agents...”

The authors went on to note that the differences between the treated and untreated cattle were not statistically significant. This was likely due, at least in part, to the small size of their experiment (only 80 animals in total). They went on to suggest that a larger study would allow more conclusive results to emerge. While we’re waiting, anyone for a hamburger?

It's About Time!

So far this year, 30 million pounds of ground beef have been recalled in the United States because of contamination with E. coli O157:H7. Most of this meat was recalled only AFTER it had been associated with outbreaks of gastroenteritis and hemolytic uremic syndrome.

"Test and Release" or "Test and Hold"

Until now, USDA has suggested that slaughterhouses and meat processors hold their products in-house until their micro test results are available. This is known as "Test and Hold". But many companies ship their meat before the results are in ("Test and Release"), and have to recall the product if the result shows that their meat contains E. coli O157:H7. Unfortunately, this means that the consumer sometimes becomes the guinea pig. Why not hold product until it has been cleared by the lab? The answer is $$$$$$$$$$. Warehousing a perishable product, even for a couple of days, is expensive.

On November 18th, USA Today reported that USDA is considering REQUIRING companies to move to a Test and Hold program. It's far from a complete answer to the problem of contaminated meat, but it would be a step in the right direction.