Salmonella Panama: Del Monte's Dilemma

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Cantaloupes grown in Guatemala have been blamed for a baker's dozen of Salmonella Panama illnesses, according to CDC and various state health authorities.

CDC, which released an updated tally yesterday (March 29th), reports that the 13 outbreak victims fell ill between February 5th and March 4th. Three of the 13 infected individuals were hospitalized.

In response to the outbreak, Del Monte Fresh Produce N.A. Inc. recalled cantaloupe melons (packaged three to a bag in mesh bags) that were distributed through warehouse stores in Alaska, California, Colorado, Idaho, Montana, Oregon, and Washington. The recalled melons all came from a single Del Monte Fresh Produce farm – the Asuncion Mita farm in Guatemala – and were sold in Costco stores in those seven states between March 10th and March 21st.

Based on information contained in the CDC report and obtained from health officials in the affected states, the 13 confirmed cases of Salmonella Panama infections are located in:

• Alaska.- No cases of Salmonella Panama have been reported.


• California.- Two confirmed cases. Based on the retail distribution list posted by the California Department of Public Health, the recalled melons were sold in Costco stores in Northern California.


• Colorado.- One confirmed case. The victim reported having eaten cantaloupe "from a warehouse store" prior to becoming ill.


• Idaho.- No cases have been confirmed. The Central District Health Department is investigating a cluster of approximately 40 people who fell ill after attending a March 12th wedding reception in the Boise area at which cantaloupe from Costco was served. Two of the ill individuals submitted stool samples, which are still undergoing lab tests for Salmonella and Norovirus. Two melons were obtained from Costco for testing, but the store could not confirm whether the melons were from an implicated lot. Neither melon yielded Salmonella.


• Maryland.- One confirmed case matching the outbreak strain. This victim reported having eaten cantaloupe in the week prior to becoming ill. The cantaloupe WAS NOT purchased at Costco.


• Montana.- No cases of Salmonella Panama have been reported.


• Oregon.- Five confirmed cases, among attendees at a church supper where cantaloupe purchased from Costco was served. An additional three attendees at the supper also were ill, but have not been lab-confirmed. One more person was infected with a very similar (but distinguishable) genetic variant of Salmonella Panama, and also reported having consumed melon from Costco.


• Washington.- Four confirmed cases, including one adult (male), and three children (2 boys and one girl). The adult victim is from Whatcom County; the children live in Thurston County (one boy) and King County (one boy and one girl).

According to Bill Keene, Oregon's No. 1 Disease Detective, Costco receives only about 6% of the cantaloupes grown on Del Monte's Asuncion Mita farm. The rest of the crop is shipped to numerous other wholesalers and retailers – most, but not all, of them in the USA. The farm comprises some 15 cantaloupe fields, which are planted and harvested in series to ensure a continuous supply of melons. The last of the 15 fields to be harvested has been shut down since early March.

I asked Bill Keene about the rationale behind the recall. He said that the situation presented quite a dilemma, both to public health officials and to Del Monte. By the time the outbreak was identified and a probable source determined – which happened rather quickly, thanks to the relative rarity of Salmonella Panama and the Oregon illness cluster – the implicated melons had passed their usable shelf life. There was no point in recalling fruit that was no longer edible.

Why, then, did Del Monte recall the cantaloupes that were sold in Costco stores in several states beginning on March 10th? According to Keene, it was unclear whether the outbreak was a "one-off" problem relating to a small quantity of melons from one portion of a single field or whether it was a continuing situation. Del Monte Fresh Produce, therefore, decided on the recall.

And why was the recall limited to cantaloupes shipped to Costco in seven states? Because, except for the Maryland case, all of the illnesses were clustered within that group of states and were linked to cantaloupes purchased from Costco stores. It did not seem logical to recall the entire remaining production from the Asuncion Mita farm for what appeared to be a limited contamination problem.

Was Del Monte's decision justified? So far, it looks as though the company, in consultation with public health officials, made a reasonable call. While it's too soon to say for sure, the outbreak appears to have burned out.

Nevertheless, consumers should remain wary of cantaloupes. Avoid purchasing or consuming melons with bruised or broken skin. Wash the cantaloupes before cutting them open, and store cut cantaloupe in the refrigerator to minimize the risk of bacterial growth.

Finally, if you think that you have become ill after eating cantaloupe – or any other food – seek medical advice and cooperate with your public health authorities. This includes providing stool or any other clinical samples on request. "It is the only way," says Tom Shanahan of the Idaho Department of Health and Welfare, " to confirm a link."

Guatemalan Cantaloupe Spreads Salmonella Panama

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The US Centers for Disease Control and Prevention (CDC), and the US Food and Drug Adminstration (FDA), report that cantaloupes grown in and shipped from the Asuncion Mita farm in Guatemala are responsible for at least 12 cases of gastroenteritis due to Salmonella Panama in four states. The Asuncion Mita farm is owned and operated by Del Monte Fresh Produce N.A., Inc. ("Del Monte").

According to CDC, confirmed cases of Salmonella Panama illness "... have been reported from Oregon (5 cases), Washington (4 cases), California (2 cases), and Maryland (1 case). Reported dates of illness onset range from February 5, 2011 to February 23, 2011. Ill persons range in age from less than 1 year old to 68 years old, with a median age of 12 years old. Sixty-six percent are male. Among ill persons, two have been hospitalized and no deaths have been reported." The agency warns that more illness might yet come to light.

Yesterday (March 22, 2011) Del Monte recalled 4,992 cartons of cantaloupes. The cartons each contained 4 plastic beige mesh sleeves sealed with a plastic orange handle with the Del Monte logo and the statement “3 count, Product of Guatemala.” The cantaloupes were identified with lot codes 02-15-24-10, 02-15-25-10, 02-15-26-10 and 02-15-28-10, and were available for sale between March 10th and March 21st.

The recalled cantaloupes were sold in Costco Warehouse stores in Alaska, California, Colorado, Idaho, Montana, Oregon, and Washington. Costco has posted a recall notice on its web site. Del Monte has put on hold production and distribution of cantaloupes from its Asuncion Mita farm.

An efficient trace-back system helped FDA and CDC determine the likely source of the illnesses. CDC described the process in the following way:

"Eleven of 12 ill persons reported eating cantaloupe in the week before illness. Ten of these 11 ill persons purchased cantaloupes before becoming ill at seven different locations of a national warehouse clubs. Information gathered with patient permission from membership card records helped determine that ill persons purchased cantaloupes sourced from a single farm. Product traceback information indicates these cantaloupes were harvested from single farm in Guatemala."

Notwithstanding CDC's confidence in the outcome of its investigations, one flagrant discrepancy begs for an explanation. The Del Monte recall notice says that the implicated cantaloupes were available for sale from March 10th to March 21st, inclusive. But the confirmed illness reported to CDC occurred from February 5th to February 23rd, 2011. This suggests to me that the contamination problem pre-dates by more than one month the shipping dates of the cantaloupes formally recalled by Del Monte.

I also wonder how the Maryland case fits into the epidemiological equation, when the implicated melons are said to have been distributed only in seven western US states.

Del Monte has experienced two prior instances of Salmonella contamination in its cantaloupes. In October 2010, the company recalled 81 cartons of cantaloupes grown in and shipped from Arizona. The cantaloupes, which "... had the potential to be contaminated with Salmonella ..." were distributed to wholesalers in the Detroit area. One year earlier, Raley's Family of Fine Stores recalled Del Monte cantaloupes from its Raley’s, Bel Air, Nob Hill Foods and Food Source stores in Nevada and Northern California between Oct. 5 and Oct. 16, 2009 after Salmonella was detected in a sample of the melons during routine testing. No confirmed illnesses were associated with either recall.

While the recall and the investigation continue, CDC offers the following advice to consumers and retailers:

• Consumer should not eat recalled cantaloupes and restaurant and food service operators should not serve them.


• Consumers who have cantaloupes in their homes can check with the place of purchase to determine if the fruit came from this company.


• Recalled cantaloupes should be disposed of in a closed plastic bag placed in a sealed trash can. This will prevent people or animals from eating them.


• Persons who think they might have become ill from eating possibly contaminated cantaloupes should consult their health care providers.


• Consumers and food preparers should wash their hands before and after handling any melon. Wash the surface of melons such as cantaloupes, and dry them with a clean cloth or paper towel before cutting.

Alternatively, consumers might switch to honeydew melons and watermelons for the duration.

Bravo Farms Outbreak Tally Grows To 33 Illnesses

E. coli O157:H7 recovered from several packages of cheese

Arizona, California and Colorado have confirmed additional cases of E. coli O157:H7 that are associated with the consumption of Bravo Farms Dutch Style Gouda cheese, according to an investigation update released late this afternoon by CDC.

As of November 10th, 33 cases of E. coli O157:H7 infections have been reported from the following states: Arizona (15), California (3), Colorado (10), New Mexico (3), and Nevada (2). Dates of illness onset range from October 16, 2010 through October 24, 2010. Patients range in age from 1 to 81 years and the median age is 14 years. There have been 15 reported hospitalizations, 1 case of hemolytic uremic syndrome (HUS), and no deaths.

Lawsuits have now been filed against Bravo Farms on behalf of two of the Arizona outbreak patients.

Lab testing has confirmed the presence of the outbreak strain of E. coli O157:H7 (PulseNet profile #EXHX01.2292/EXHA26.0621) in two opened packages of Bravo Farms Dutch Style Gouda Cheese purchased at Costco. The packages were obtained from two different outbreak patients. In addition, E. coli O157:H7 has been recovered from an intact package of the same cheese obtained from a Costco store. Two additional opened packages – obtained from two other patient's homes – also have yielded E. coli O157:H7 in the lab. Additional lab testing is in progress to confirm these results and determine the genetic profiles of the isolates.

Bravo Farms has recalled all of its Dutch Style Gouda Cheese identified by the Julian date code 0233 or lower. The cheese was packed in 1.5-pound and 8-ounce pieces and distributed primarily through Costco Warehouse stores in Arizona, Southern California, Colorado, Utah, Nevada and New Mexico. Some of the cheese also was sold in other retail stores in California.

FDA and the appropriate state agencies are working together to investigate the Bravo Farms operation and to identify the possible sources of the contamination. As part of the investigation, FDA has collected additional product samples for lab analysis.

CDC warns that illnesses which developed after October 22, 2010 might not yet be reported, as it typically takes two to three weeks to confirm and report an illness. It's quite possible, therefore, that some additional illnesses will be reported, especially as the implicated cheese was available for sampling and sale until November 1st.

CDC offers the following Advice to Consumers who may have sampled or purchased the implicated cheese:

"Based on current information, there is a link with the consumption of one of several cheeses offered for sampling and sale at the “cheese road show” that was held at Costco Warehouses between October 5 and November 1 in Arizona, California, Colorado, New Mexico and Nevada. This cheese is Bravo Farms Dutch Style Gouda Cheese (Costco Item 40654), manufactured by Bravo Farms of Traver CA.

Consumers who have any of this cheese should not eat it. Instead, they should return the cheese to the place of purchase or dispose of it in a closed plastic bag placed in a sealed trash can. This will prevent people or animals, including wild animals, from eating it."

I urge anyone who consumed Bravo Farms Dutch Style Gouda Cheese during the October 5 through November 1 time period, and who subsequently experienced symptoms of E. coli O157:H7 infection, to seek medical advice and also contact his or her local or state health agency. CDC describes the symptoms of E. coli O157:H7 infections as follows:

"Most people infected with E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps 2-8 days (3-4 days, on average) after swallowing the organism, but some illnesses last longer and are more severe. Infection is usually diagnosed by stool sample culture. While most people recover within a week, some develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur among persons of any age but is most common in children under 5 years old and the elderly. Signs and symptoms of hemolytic uremic syndrome may include: fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, decreased urination and swelling of the face, hands, feet, or entire body. Persons who experience these symptoms and believe they are at risk for HUS should seek emergency medical care immediately."

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Bravo Farms Recalls Cheese Implicated In Outbreak

All lot codes below 0233 included in recall

Bravo Farms (Traver, CA) has recalled its Dutch Style raw milk Gouda Cheese, because the cheese may be contaminated with E. coli O157:H7. All lot codes below 0233 are encompassed by the recall notice, which is dated November 7, 2010 and was posted today on Costco's web site.

The recalled cheese was distributed mainly through Costco in Southern California (one San Diego County store), Nevada, Arizona, Utah, Colorado and New Mexico in 1.5 lb pieces. The Gouda also was distributed through various (unnamed) retail stores within California in 8-ounce pieces.

Bravo Farms' Dutch Style Gouda cheese is implicated in a five-state outbreak of E. coli O157:H7 illnesses. FDA and the state of California have initiated an investigation at Bravo Farms.

Illnesses related to this outbreak have been reported in Arizona, California, Colorado, New Mexico and Nevada. A rare strain of E. coli O157:H7 – one that has never before been reported to CDC's PulseNet data base for foodborne pathogens – has been recovered from outbreak patients. The strain has been characterized by CDC as EXHX01.2292/EXHA26.0621, based on the "genetic fingerprint" method known as Pulsed Field Gel Electrophoresis.

An opened package of the implicated cheese that was purchased at Costco by one of the outbreak patients has been found to contain E. coli O157:H7. As of November 5th (the date of the most recent CDC report), it was not clear whether or not this strain was identical to the outbreak strain that had infected 25 outbreak victims.

The largest single cluster of outbreak cases was reported in Arizona. According to information provided by Carol Vack, a spokesperson for the Arizona Department of Health Services, eleven Arizona residents – five females and six males – have been confirmed to be part of the outbreak. The victims range in age from 2 years old to 78 years old. Six of the Arizona victims have been hospitalized. Arizona is continuing to investigate, and Ms. Vack warns that the number of cases can change daily.

A lawsuit against Bravo Farms already has been filed on behalf of one of the Arizona victims, Annette Sutfin of Maricopa County. According to the Complaint, on October 15th, Ms. Sutfin consumed a sample of the implicated cheese at a Costco Warehouse store in Phoenix. She began to develop symptoms of E. coli O157:H7 infection on October 18th and sought treatment at a hospital emergency room on October 21st. Ms. Sutfin was hospitalized on October 23rd, received treatment, and was discharged on October 25th. She continue to suffer from gastrointestinal symptoms throughout the balance of October and into November and is still recovering.

California has recorded just one outbreak case, a six-year old girl living in San Diego County. Colorado's eight cases are spread over three counties; New Mexico's three victims – a four-year old boy, a seven-year old girl and a 41-year old man – live in two different counties. Nevada has released no details about its two cases.

Both CDC and FDA expect to issue updates as more information becomes available.

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Rare E. coli Strain Behind Raw Milk Cheese Outbreak

Outbreak strain "...never been seen before in the PulseNet database."

A raw milk cheese manufactured by Bravo Farms (Traver, CA) is suspected to be the source of a five-state outbreak of E. coli O157:H7. The Dutch Style Gouda Cheese was among those offered for sampling and for sale in Costco stores in Arizona, California (San Diego), Colorado, Nevada and New Mexico – the same five states that have reported the illnesses. Twenty-five infections have been reported so far.

According to CDC, this particular outbreak strain is a rare one. It has never before been reported to the federal PulseNet database – the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

What do we know about this outbreak?

• 25 patients have been reported to be infected with this rare strain of E. coli O157:H7.
• At least 9 people have been hospitalized – one of them with suspected hemolytic uremic syndrome.
• The victims live in Arizona, California, Colorado, New Mexico and Nevada.
• The youngest victim is 2 years old, and the oldest is 81 years old.
• The earliest onset date in this outbreak was October 16th.
• There is a good likelihood that more cases will be reported, since the suspect food was on the market until at least November 1st.
• E. coli O157:H7 has been found in an opened package of Bravo Farms Dutch Style Gouda Cheese obtained from one of the 25 outbreak victims. The package was purchased at Costco.

What do we know about the outbreak victims?

Three of the affected states have released additional information that is not contained in the CDC report.

• The lone California victim is a six-year old girl who lives in San Diego County. San Diego was the only Costco location in the state that carried the implicated cheese.
• New Mexico's three victims include a 41-year-old man and 7-year-old girl from Bernalillo County and a 4-year-old boy from Valencia County.
• Colorado has received a total of eight illness reports from three counties: Douglas (4), Arapahoe (3) and Boulder (1). All eight were Costco shoppers, most of whom sampled cheese during a “Cheese Road Show” at Costco Oct. 14-17.

What is the status of the outbreak investigation?

Based on the results of patient interviews and on the finding of the outbreak strain in an opened sample of cheese that had been purchased at Costco by one of the 25 victims, attention has been focused on Bravo Farms Dutch Style Gouda Cheese. This raw milk cheese is a product of Bravo Farms, a cheese factory that is located in Traver, California. The company manufactures eight varieties of aged raw milk cheeses, all of which can be purchased on-line via the Bravo Farms web site. The company is cooperating with FDA and state investigators, but has not yet issued a formal public recall notice.

No doubt, FDA and California investigators already are on-site at Bravo Farms, carrying out an intensive investigation and sampling. Testing for E. coli O157:H7 will not be limited to the specific variety of cheese that is thought to be the source of this outbreak; it will extend to all eight varieties, and will include extensive environmental testing, too. The herd of dairy cattle that supplies milk to the cheese factory most likely also will be examined for the outbreak strain. The goal is to determine both the source and the extent of the problem.

What should consumers do?

Based on the information collected so far, the source of the outbreak appears to be limited to cheese that was sold or available for taste-testing between October 5th and November 1st at Costco locations in the five states from which cases have been reported. Costco has removed the product from its stores and is contacting customers who purchased the product, in order to alert them to the situation and ask them to return the product to their Costco location for refund.

Consumers who purchased Dutch Style Gouda Cheese directly from Bravo Farms during the October 5th through November 1st time period should contact the company for more information. While Bravo Farms has not issued a formal public recall notice, the company is cooperating with Costco's recall activities and says that it has contacted by telephone those who purchased the product.

Anyone who has consumed any one of the eight varieties of Bravo Farms raw milk cheese that was purchased on or after October 5th – especially the Dutch Style Gouda – and who begins to experience symptoms of gastroenteritis (stomach ache, diarrhea, nausea, etc.) may be infected with E. coli O157:H7, and should consult a doctor immediately.

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Italian Company Confirmed Source of French Salmonella Outbreak

Meat processor has USA connection

As reported yesterday by my Guest Blogger, more than 100 college and high school students in the Poitiers area (France) were infected with Salmonella as a result of eating contaminated hamburgers at their schools. The news release issued by the Vienne Préfecture did not identify the type of Salmonella or the origin of the contaminated meat.

Today, courtesy of my French Connections, Albert Amgar and Bernard Pichetto, I am able to provide the Alert issued by the Regional Health Agency of Rhône-Alpes, followed by my translation into English for those who do not read or understand French.

Message d’alerte

à l’attention des établissements
Contamination de steaks surgelés par Salmonella Typhimurium

L’ARS Rhône-Alpes vous informe de la contamination par Salmonella Typhimurium de steaks hachés surgelés fabriqués par l'établissement Inalca en Italie, et distribués en France par POMONA dans différents établissements de restauration collective et commerciale.

Malgré les mesures de retrait élargi conduites par POMONA ce week-end, des personnes ont pu consommer ce produit jusqu'au 29 octobre. Des foyers de toxi-infections alimentaires collectives ont notamment été identifiés en relation avec la consommation de ce produit la semaine passée.

Des établissements ont été identifiés par la Direction générale de l’alimentation (DGAL) parmi les destinataires des lots contaminés (DLUO 23/09/2011).

Dans ce contexte, nous appelons votre attention sur le risque d’apparition de toxi-infection alimentaire collective (Tiac). Les Tiac étant des maladies à déclaration obligatoire, nous vous rappelons la nécessité de les signaler sans délai à votre délégation territoriale de l’ARS.

Nous vous rappelons également l'importance de la mise en place de mesures d'hygiène pour la prévention de la transmission de ce pathogène dans votre établissement.

Nous restons à votre disposition pour toute information complémentaire.

Contacts
Agence régionale de santé Rhône-Alpes
Délégation territoriale départementale de l’Ain
4 Bd Voltaire
01000 BOURG EN BRESSE
Tél. : 04 74 32 80 76
FAX : 04 74 32 80 69‏

The translation:

Alert

Attention: Establishments

Contamination of frozen steak by Salmonella Typhimurium

ARS Rhône-Alpes is informing you that frozen ground steaks produced by Inalca in Italy are contaminated with Salmonella Typhimurium. The meat was distributed in France by POMONA to various catering and commercial food service establishments.

In spite of expanded recall measures conducted by POMONA this weekend, some individuals may have consumed the (contaminated) product even up until October 29th. Food poisoning outbreak clusters were linked last week to the consumption of this product in connection with certain establishments identified by the Food Directorate that were among the recipients of the contaminated lot (lot #DLUO 23/09/2011).

In this context, we draw your attention to the possibility of additional food poisoning outbreak clusters. As food-borne outbreaks are notifiable disease events, we remind you of the need to alert your Regional Health Agency to any incidents without delay. We also remind you of the importance of ensuring that appropriate sanitation and hygiene measures have been implemented to prevent the transmission of this pathogen in your establishment.

We remain at your disposal for any additional information.

Pomona is an importer and distributer of foodstuffs, and has been in business since 1912. The company supplies food service establishments, restaurants and caterers. While the company has, according to the Alert, been engaging in an expanded recall effort, there is no mention of the recall or the health alert on the Pomona web site.

And the US connection?

Inalca, the Italian meat processor that produced the frozen hamburger patties, is a JBS company. According to it's website, "Inalca JBS Spa produces and sells a complete range of vacuum-packed fresh and frozen beef products in a protective atmosphere, ready foods, canned meats and a wide range of by-products. Inalca manages the entire production chain. All plants use modern production technologies and innovative safety systems which allow the company to be at the cutting edge in control methods, production chain programmes and meat identification and labelling processes."

The US operations of JBS have had their own brushes with food-borne pathogens over the years. In 2009, the company's Greeley, Colorado meat processing facility recalled in excess of 41,000 pounds of beef products due to E. coli O157:H7 contamination. The contaminated meat was blamed for as many as 23 E. coli O157:H7 infections (17 confirmed by genetic profiling) in 9 US states. Twelve of the victims were hospitalized, two with hemolytic uremic syndrome.

A word about transparency

The level of transparency and communication of recalls in France is far below that of the United States, Canada, Denmark, Australia and many other developed countries. A recall of this significance – especially one that is associated with one or more disease outbreak clusters – would, in the United States, be posted on the USDA (meat or poultry) or FDA (other foods) web sites, and would be publicized in the media. As of today (November 6th), there is no mention of this Salmonella Typhimurium outbreak or the associated meat recall on the French Ministry of Health web sites.

It should not be left to bloggers to alert consumers to this important public health information.

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Raw Milk Cheese May Be Source of New E. coli O157:H7 Outbreak

Cheese manufacturer cooperating in FDA/CDC/California outbreak investigation

FDA, CDC and Costco Wholesale Corporation have warned consumers that Bravo Dutch Style Raw Milk Gouda Cheese may be linked to an outbreak of E. coli O157:H7 infections. As of November 4th, cases of E. coli O157:H7 illnesses – all due to a single strain of the pathogen – have been reported in Arizona (11), California (1), Colorado (8), New Mexico (3) and Nevada (2). Nine people have been hospitalized, and one person may be suffering from hemolytic uremic syndrome.

The suspect cheese (Costco Item #40654) was offered for sale and in cheese sampling events at Costco locations in all five states (although only in the San Diego area in California) that have reported E. coli O157:H7 illnesses. The cheese was available for purchase and for tasting at these locations between October 5th and November 1st.

When invited by eFoodAlert to comment on the report, Jonathan Van Ryn of Bravo Farms Cheese issued the following statement:

"Recently the FDA has issued a warning that our Dutch style Gouda in Costco may be related to a foodborne disease. They have isolated a small percentage of this Gouda that may be suspect. The Gouda went to Costco stores in San Diego and some Costco’s outside California. It went to no other stores. We have reviewed all of our documentation and are working with the government agencies to assist them in their investigation. We at Bravo Farms work diligently to abide by all local and national safety requirements and hope to resolve this as quickly and safely as possible. We are working closely with Costco to voluntarily recall all Dutch style Gouda out of Costco stores, and a phone call was made to everyone who purchased this variety. We will continue to update on any progress."

The link between Bravo Farms Dutch Style Gouda and the E. coli O157:H7 outbreak is still characterized as "preliminary" by the federal agencies. Nevertheless, consumers are being advised by Costco to return any remaining Bravo Farms Dutch Style Gouda to the store for a full refund. Costco has removed the cheese from its stores and has used its card purchase records to identify and notify affected consumers by telephone.

FDA and CDC have promised to update the public on the status of this outbreak investigation as more information becomes available.

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Five Dead In Texas Due To Listeria monocytogenes

Texas orders produce firm to close down

Ten Texas residents with serious underlying health problems have been infected with Listeria monocytogenes over the last eight months. Five of the victims are dead. All of the reported illnesses occurred in Bexar, Travis and Hidalgo counties.

Six of the ten illnesses were linked to the consumption of chopped celery from Sangar Fresh Cut Produce in San Antonio.

The Texas Department of State Health Services (DSHS) has ordered the company to stop processing food and to recall all products that it has shipped since January 2010. The order followed detection of Listeria monocytogenes in a sample of chopped celery and the finding by state health inspectors of several sanitary violations including:

• a condensation leak above a food product area,
• soil on a preparation table, and
• hand washing issues.

Unlike FDA, Texas law empowers DSHS to mandate a closure or a food product recall "...when conditions exist that pose an immediate and serious threat to human life or health."

The recalled products, which have not been listed in detail, comprise mainly cut fresh produce in sealed packages. The products were distributed to restaurants and institutions, including schools and hospitals, but are not believed to have been sold in grocery stores.

DSHS is continuing its investigation into the possible sources of contamination. It is also working to determine precisely where the recalled products were distributed. Customers of Sanger Fresh Cut Produce are advised to either discard or return any products still in their possession.

Sanger will remain closed until DSHS is satisfied that its operation no longer poses a health hazard and gives permission for the plant to reopen.

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Unscrambling The Egg Mess: The Latest Developments

CDC updates numbers; FDA "warns" Wright County Egg, gives green light to Hillandale

Two weeks ago, CDC told me that it planned – "by the end of the week"– to release an update to its report on the Salmonella Enteritidis outbreak investigation. Yesterday, they delivered.

From May 1st to October 15, 2010, CDC estimates that 1,813 illnesses are likely to be associated with the consumption of Salmonella Enteritidis-contaminated eggs from Wright County Egg (also known as Quality Egg LLC) and Hillandale Farms of Iowa.

CDC typically receives approximately 1,369 reports of illnesses due to this very common strain of Salmonella during the May 1st to October 15th timeframe (based on a five-year average). This year, the agency has received 3,182 reports. The estimate of 1,813 illnesses represents the difference between this year's reports and the five-year average.

This graph, taken from the CDC investigation report, profiles the outbreak on a week-by-week basis. The solid line represents the five-year average number of cases.

The outbreak numbers appear to tail off during the last four weeks, but this is not necessarily the case. As the graph explains, the area in grey represents a time period during which new illnesses may have occurred but have not yet been diagnosed and reported to CDC.

What can we deduce from this graph?

1. The outbreak did not start on May 1st. It likely began much earlier – perhaps in February/March. The number of cases per week appears to start tracking noticeably above the baseline average as early as the last week of January.
2. The outbreak peaked in June/July. CDC identified the outbreak in July, when it was already at its peak. The number of cases began to drop off in August, even before the first recall was initiated.
3. The outbreak did not end with the August recalls of eggs from Wright County Egg and Hillandale Farms. Even in mid-September, the number of reported cases continued to track well above the 5-year average baseline.

What has FDA been doing?

Hillandale Farms of Iowa:- FDA performed a follow-up inspection of Hillandale's West Union facility from October 13 to 15th, and has permitted Hillandale to resume the distribution of shell eggs, based on the following understanding:

• Hillandale's agreement to clean and disinfect houses 1 & 2 prior to repopulation;
• Hillandale's commitment to comply with the requirements of the Egg Safety Rule, including egg testing from houses with environmental Salmonella-positives;
• FDA's confirmation of the corrections to the problems noted in the agency's August 2010 inspection (see FDA-483 report)
• Consistent negative Salmonella Enteritidis test results from the environment and from eggs at houses 3, 5 and 7 in the West Union facility.
• Commitment not to ship table eggs from houses 4, 6, 8 & 9 until they go through four rounds of egg testing. These eggs will be held and shipped once all four rounds of testing are completed satisfactorily.
• Monthly environmental testing of houses 4, 6, 8 & 9 for the life of the current flock.

Wright County Egg (Quality Egg, LLC):- FDA issued a Warning Letter to Austin Decoster, the owner of Quality Egg LLC on October 15th, based on the agency's inspection report and its subsequent discussions with the Company. It's clear from the Warning Letter that FDA is not yet satisfied with Decoster's response to the agency's findings. After reciting a summary of the deviations noted in its FDA-483 report, FDA closed with the following statements:

This letter is not intended to be an all-inclusive list of violations at your facility. You are responsible for ensuring that your firm operates in compliance with the Act, the shell egg regulation, and the PHS Act. You also have a responsibility to use procedures to prevent further violations.

You should take prompt and aggressive actions to eliminate the Salmonella Enteritidis contamination and the observations described in this letter. Failure to take prompt corrective action may result in regulatory action being initiated by the Food and Drug Administration without further notice. These actions include, but are not limited to, seizure and/or injunction.

FDA is in receipt of your response dated October 5,2010, to the FDA-483 and additional information you submitted reflecting ongoing discussions with the agency of your corrective actions. We acknowledge your commitment to correcting the deviations and will verify your corrections via inspection.

As for the rest of the shell egg industry, FDA has begun its first round of "routine" inspections under the new Egg Safety Rule. I reported two weeks ago, that the first inspections were completed in Maine in late September. The focus then shifted back to the Midwest. FDA has not indicated any plans to release the results of these inspections – unless, of course, they result in recalls or warning letters.

Until FDA decides to release the results of its inspections, our household is sticking with Eggland's Best!

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Oklahoma Salmonella Source Still A Mystery

No break yet in the Canadian County outbreak investigation

State health officials can put a name to the strain of Salmonella that has sickened elementary school-aged children in Mustang, Oklahoma. But they have not yet been able to identify a common source for the pathogen.

As of yesterday, the Oklahoma State Department of Health have identified fourteen cases of gastroenteritis among Mustang children. Ten of the cases were lab-confirmed. The other four were identified through interviews of ill and non-ill children in the elementary school district.

The four children whose illnesses were not lab-confirmed reported having experienced gastroenteritis symptoms – including diarrhea, vomiting, cramps and fever – that lasted for several days, according to Laurence Burnsed, Director of the Communicable Disease Division. All fourteen children fell ill between September 2nd and September 11th.

In addition to the 14 school children, the outbreak strain – Salmonella Paratyphi B var. L(+) tartrate (+), formerly known as Salmonella Java – has been recovered from three adults in two other counties – Oklahoma County and Carter County. One of the three adults was hospitalized.

The same strain of Salmonella has been isolated from two people in Iowa, according to health officials from that state. There have been reports of a case in Nebraska. But the Nebraska case was an Iowa resident whose specimen was processed in a Nebraska lab, according to Leah Bucco-White, Public Information Officer for the Nebraska Department of Health and Human Services.

So far, no common element has been found that links the Iowa cases to the Oklahoma cases – or, for that matter, that links the 3 infected Oklahoma adults to the 14 school children in Mustang. And with the epidemiological trail growing increasingly cold, the chances of finding that link are dwindling.

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E. coli O157:H7 Outbreak In Greater Toronto Area

Five illnesses linked to halal meat from North York store

The Ontario Ministry of Health and Long-Term Care (OMH) is working with public health agencies in the Greater Toronto Area to investigate a cluster of five confirmed cases of E. coli O157:H7 illnesses, according to Andrew Morrison, OMH Media Relations Coordinator. At least some of the victims reported having consumed various cuts of halal meat purchased at the Kabul Farms retail store located at 40 Beverley Hills Drive in North York.

The Canadian Food Inspection Agency issued a Health Hazard Alert on September 1, 2010, warning the public not to consume meats purchased at the Kabul Farms store.

Mr. Morrison provided the following statement to eFoodAlert by email today:

"In addition to the information contained in the CFIA's health hazard alert issued on September 1, 2010, warning consumers about cuts of beef sold on August 6, 2010, the Ministry of Health and Long-Term Care would like to inform the public that there may be a health risk associated with consumption of meat products purchased from the operation referred in the CFIA health hazard alert between July 8 and August 6, 2010. If anyone has purchased the cuts of beef from the retail outlet identified by the CFIA within this time period, the Ministry advises to exercise caution and dispose of these cuts to avoid illness.

The Ministry is working with Toronto Public Health, York Region Community and Health Services Department Unit, Halton Region Health Department and the Regional Municipality of Peel Health Department to investigate a small cluster of 5 cases of E. coli O157:H7, some of whom have reported consuming different cuts of halal meat purchased at the retail operation specified in the CFIA's health hazard alert of September 1, 2010. At this time, the Ministry is investigating to determine if other retail locations may be affected.

On August 27, 2010, the Ministry was notified by the Ontario Public Health Laboratory (OPHL) of positive food samples for E. coli O157:H7 taken during an investigation in York Region.

On the same day, the Ministry was also notified by the OPHL of four other human cases with the same genetic fingerprint as the York Region case. The onset dates of E. coli infection in all five cases range from July 15, 2010 to August 10, 2010.

No additional cases beyond this initial cluster have been identified.

We remind people that safe food handling practices and preparation are the best way to prevent infection from E. coli."

Anyone in the Greater Toronto Area who has consumed halal meat and experienced symptoms of E. coli O157:H7 gastroenteritis – especially bloody diarrhea – should consult a doctor immediately.

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Hundreds Sickened In Egg-related Salmonella Outbreak

Shell egg recalls extend to more than a dozen brands supplied to retailers and food service operators nationwide

The US Centers for Disease Control and Prevention (CDC) has received more than four times the usual number of Salmonella Enteritidis reports from state health agencies in late June and early July – all due to a single strain (genetic profile ID JEGXX01.0004) that is typically associated with eggs.

Quite a few of the illnesses are associated with restaurant meals, and eggs have been identified as a likely source of the Salmonella infections. FDA's traceback investigations revealed Wright County Egg (Galt, IA) to be the source of the eggs in many cases.

On August 13th, Wright County Egg recalled more than a dozen brands of eggs packed between May 16 and August 13, 2010 (Julian dates ranging from 136 to 225) at three different packing plants. The recalled eggs were distributed to food wholesalers, distribution centers and food service companies in California, Illinois, Missouri, Colorado, Nebraska, Minnesota, Wisconsin and Iowa, and were redistributed nationwide.

NuCal Foods (Ripon, CA), a customer of Wright County Egg, has initiated its own recall of five additional products, packed under the Bayview, Mountain Dairy, Nulaid and Sun Valley brands. NuCal distributed these eggs to wholesalers and retailers in California and Nevada.

The Lund Egg Co. (Woodville, WI) has recalled some Glenview Farms eggs, which were sold by Sysco Corp and Jetro (Restaurant Depot). Some of these eggs were supplied to two western distribution centers of U.S. Foodservice, a restaurant and food service supplier.

CDC has not identified which states have reported Salmonella Enteritidis infections that are linked to this outbreak. The agency says that it is working with FDA, USDA and public health officials in "many states" to investigate the outbreak. Nor has CDC estimated how may people have been infected, beyond stating that it received approximately 200 reports per week in "late June and early July" instead of the more typical 50 reports per week.

Only four states have come forward with their own data so far:

• California has been hardest hit, with 266 confirmed cases, 43 of them in Los Angeles County)
• Minnesota has confirmed at least 7 cases, linked to two separate restaurant outbreaks
• Colorado experienced 28 cases of Salmonella Enteritidis infections in June and July (versus their usual 7 cases); some of the cases from a restaurant-associated outbreak (The Fort restaurant in Jefferson County)
• Southern Nevada has seen 30 cases of Salmonella Enteritidis infections since January – a four-fold increase

State and local officials in the following states also are investigating reported illnesses, according to FDA: Arizona, Connecticut, Massachusetts, Maryland, North Carolina, Nevada, Oregon, Pennsylvania, Tennessee and Texas.

Restaurant-associated outbreaks of Salmonella due to contaminated eggs are an old story. In 1985 – 25 years ago – patrons of three different restaurants were infected with Salmonella Enteritidis after eating scrambled eggs from a breakfast buffet display. All three restaurants had purchased their eggs from the same distributor. How did it happen? Here's the way I described the 1985 scenario in my book "Food Safety: Old Habits, New Perspectives."

"All three restaurants used grade A shell eggs to prepare their scrambled eggs. Employees cracked the eggs by hand – as many as 1,800 eggs at a time. The scrambled egg mixture sometimes sat at room temperature for as long as 6 hours before being cooked. And the cooks took pains not to overcook the eggs. Otherwise, they would dry out too much in the breakfast bar's warming tray. Indeed, several of the food poisoning victims at restaurant number 3 reported that the eggs appeared underdone."

The 1985 outbreaks were the first of many Salmonella Enteritidis outbreaks reported in North America, Europe and Asia. This particular strain of Salmonella is able to colonize the oviduct (the egg "canal") of hens and infect the yolk before the shell is formed. Washing or sanitizing the outside of the shell cannot eliminate Salmonella Enteritidis from a contaminated egg.

Ironically, the federal government's new Egg Safety Final Rule became effective for large producers on July 9, 2010. That program, the development of which was initiated under the Clinton Administration, had sat on a back burner for years. The preventative measures included in the Egg Safety Final Rule are intended to reduce – perhaps eventually eliminate – the incidence of Salmonella Enteritidis in shell eggs.

This is not a "pie in the sky" goal. Several European countries, including Scandinavian countries and the United Kingdom have achieved substantial reductions in the incidence of Salmonella-contaminated shell eggs. Most egg-related cases of salmonellosis in the UK now come from imported eggs.

It will be several years, if ever, before the US achieves a significant reduction in Salmonella Enteritidis contamination in eggs. Until then, the prudent consumer:

• Will cook eggs completely
• Will discard cracked or dirty eggs
• Will keep shell eggs refrigerated
• Will NOT taste raw cookie dough or raw cake batter
• Will NOT use raw shell eggs in cake frosting, sauces or salads (e.g., Caesar salad)
• Will NOT eat undercooked eggs, especially from restaurant breakfast bars or buffets

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Outbreaks and Alerts: July 27, 2010

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

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United States

• Anchorage, AK. July 26: The Anchorage Department of Health and Human Services reports an outbreak of acute gastroenteritis associated with consumption of undercooked fiddlehead ferns that were harvested in Canada. Fiddleheads contain a natural toxin that is inactivated by boiling for 10–15 minutes or steaming for 10–12 minutes.
• Baton Rouge, LA. July 26: Three hundred and twenty-four oil spill exposure-related cases have been reported to the Louisiana Department of Health and Hospitals to date, according to its eighth surveillance report released today. Two hundred and forty-one of those cases involved workers on oil rigs or workers involved in the oil spill clean-up efforts, while 83 were reported by the general public.
• Pennsylvania. July 27: A Pennsylvania dairy farm has agreed to abide by federal regulations that protect meat from illegal drug residues caused by the unapproved medication of cattle before slaughter, as part of a consent decree of permanent injunction obtained by the U.S. Food and Drug Administration. The dairy farm sold animals through local livestock auctions to slaughterhouses that ship beef products to customers in New Jersey, New York, Maine, and Michigan.

Canada

• Ottawa, ON. July 27: Health Canada is informing Canadians about the potential dangers of buying prescription drugs online from www.globalpharmacycanada.com. The company responsible for the website recently removed Canadian access to it, but Canadians may have purchased from this website in the past.

Asia, Africa and the Pacific Islands

• Ankara, Turkey. July 25: Food-safety control tests conducted last year by the Agriculture Ministry in line with EU food regulations shows 5.28 percent of the analyzed comestibles yielded 'unsatisfactory' results and 4.42 percent turned out to contain pesticide residues. The overall rate of unsatisfactory test results was 5 percent, lower than that of 2008.
• Nairobi, Kenya. July 26: Poisonous moonshine has killed at least 17 people and blinded a dozen more in the Nairobi slum of Kibera. The home-distilled drink may have contained traces of methanol.
• Rajasthan, India. July 26: At least 20 girls today fell sick, with 14 of them hospitalised, after consuming food, served by a non-governmental organization (NGO), during lunch break in a government school.
• New Delhi, India. July 28: In a bid to make them look garden fresh and ensure that they grow faster to reach markets, farmers are using chemicals such as the hormone oxytocin on their produce. Oxytocin is a mammalian hormone, which also acts as a neurotransmitter in brain. The hormone is used clinically to help begin or to continue labour, to control bleeding after delivery and to stimulate the secretion of breast milk. The hormone is being administered by injection into vegetables such as pumpkins, watermelons and cucumbers.

Australia and New Zealand

• New Zealand. July 28: The New Zealand Food Safety Authority reports that it has found residue of endosulfan – a banned chemical acutely toxic to humans at high levels – in cucumbers and bok choy. In addition, 10 of 23 samples contained levels of the fungicide chlorothalonil or the insecticide thiamethoxam over the allowable limit.

Salmonella Chester In Canada: The Outbreak Expands

And so have the recalls

The outbreak of Salmonella Chester infections that we first learned about from the British Columbia Centre for Disease Control (BC CDC) has spread to a second province.

The Public Health Agency of Canada is reporting a total of 18 confirmed cases of this relatively rare strain of Salmonella – 17 in British Columbia and one in Ontario. Most of the outbreak victims are more than 70 years old.

According to BC CDC, about half of the initial 10 reported victims needed hospitalization.

The Canadian outbreak is completely unrelated to the recent Salmonella Chester outbreak in the USA.

The illnesses have been linked to the consumption of Freybe headcheese, which was manufactured for Freybe Gourmet Foods Ltd. by G. Brandt Meat Packers of Mississauga, Ontario.

Headcheese is a deli product made from meat from the head of a pig, combined with gelatine and spices. It is not a cheese and contains no dairy ingredients.

Freybe and Brandt have recalled their headcheeses in response to this outbreak:

• Freybe has recalled all Freybe brand Head Cheese products sold up to and including July 14, 2010. The recalled head cheese was distributed in British Columbia, Alberta, Saskatchewan, Manitoba, northwest Ontario, Yukon, and may have been distributed nationally. Freybe reports that the recalled products were distributed to the Overwaitea Food Group (which includes Save-on-Foods, PriceSmart Foods, Urban Fare and Cooper’s Foods) and Thrifty Foods stores, as well as other smaller delis in Western Canada and the Yukon. As a precaution, Freybe also has suspended distribution of its Ham Suelze, the only other product manufactured for Freybe at Brandt's Mississauga plant.
• G. Brandt Meat Packers Ltd. has recalled all flavours of Brandt Headcheese products, bearing Establishment number 164 and purchased up to and including July 21, 2010. The Brandt Headcheese products were distributed nationally.

Consumers often will not be aware of the source of the headcheese they have purchased, because these products typically are sold by the slice at deli counters. Anyone who has eaten headcheese and subsequently experienced symptoms that are consistent with a Salmonella infection (fever, severe headache, vomiting, nausea, abdominal pain and/or diarrhoea) should seek immediate medical attention.


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Purdue Chef Ivan Petkov Teaches Recipe for Food Poisoning

Purdue University Clinical Chef Instructor needs to go back to school!

Ivan Petkov is a Clinical Chef Instructor in Purdue University's Department of Hospitality and Tourism Management. In addition to his teaching role, Petkov is responsible for "...production, recipes, and menu development in a full-service cafe and banquet operation as well as special event chef for Purdue University's President France Cordova."

Under the circumstances, University President Cordova should be thanking his lucky stars that he hasn't been poisoned by his chef!

Earlier today, Purdue issued a news release with the title "Chef offers safety, food preparation tips for outdoor cooking." Among the range of suggestions for preventing grill flare-ups, deep frying, and seasoning food, Chef Petkov served up the following food safety recommendation:

If meat has been out for two hours in the "danger zone" (between 39 degrees to 141 degrees Fahrenheit), microwave it for a minute and a half or grill it for two minutes to kill all the germs. As soon as it reaches a temperature of 165 degrees Fahrenheit, it should be safe to eat.

What's wrong with this picture?

1. Meat should NEVER be left out for any length of time in the "danger zone".
2. Cooking meat in a microwave is NOT a reliable way to kill bacteria. Just ask anyone who suffered from Salmonella food poisoning after eating a microwaved ConAgra pot pie in 2007!
3. Some bacteria, such as Staphylococcus aureus and Bacillus cereus produce heat-stable toxins. If food has been left out long enough for the toxins to form, no amount of reheating will make that food "safe to eat."

Shame on Ivan Petkov for spreading false and inaccurate food safety information.

And shame on Purdue University for not ensuring that its "Clinical Chef Instructor" is properly instructed in safe food handling!

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Recalled Marie Callender's Cheesy Chicken Still In Circulation

Oregon warns that Salmonella-contaminated entrées may still be in stores

Marie Callender Cheesy Chicken frozen entrées – recalled one week ago due to Salmonella contamination – are still being sold in some grocery stores in Oregon, according to Emilio DeBess of the Oregon Public Health Division. Oregon Department of Agriculture inspectors "... found the recalled product still available in a limited number of stores," DeBess said today.

The entrées have been linked to an outbreak of Salmonella Chester that has affected at least 30 people in 15 states between April 11th and May 29th. The youngest victim was less than one year old; the oldest was 88. Six people were hospitalized.

ConAgra, the manufacturer of the frozen entrées, has recalled all 13-ounce packages of Marie Callender's Cheesy Chicken & Rice and Marie Callender's White Meat Chicken and Broccoli over Rice Topped with Rich Cheddar Sauce. The entrées were distributed to at least 41 national, state-wide and local retail grocery chains.

One week into the "public" phase of this outbreak, here is where things stand.

Profile of outbreak victims

The thirty individuals who are confirmed to have been infected with the outbreak strain of Salmonella Chester are scattered from coast to coast, across 15 of the 48 contiguous states:

• California: 4 confirmed cases
• Colorado: 2 confirmed cases
• Georgia: 6 confirmed cases
• Illinois: 1 confirmed case
• Kentucky: 1 confirmed case; patient was age 65 or older and was hospitalized
• Massachusetts: 2 confirmed cases
• Minnesota: 2 confirmed cases; 1 child and 1 adult; both female; one person hospitalized
• Missouri: 1 confirmed case
• North Carolina: 1 confirmed case
• Oklahoma: 1 confirmed case
• Oregon: 2 confirmed cases; one person hospitalized
• South Carolina: 2 confirmed cases
• Tennessee: 1 confirmed case
• Utah: 1 confirmed case
• Virginia: 3 confirmed cases; 1 child and 2 adults; 2 females and 1 male; 2 people hospitalized

The smoking gun

The Minnesota Department of Agriculture found Salmonella Chester in an intact package of Marie Callender’s Cheesy Chicken and Rice, collected from the home of a person who was infected with the outbreak strain. The Salmonella that was recovered from the chicken was a genetic match for the outbreak strain. The link between the outbreak and Marie Callender's Cheesy Chicken and Rice is incontrovertible.

What next?

State health departments and CDC are continuing to watch for new cases of Salmonella Chester, and also are back-checking PulseNet records for any other cases that were reported before the outbreak was identified. CDC expects to update its investigation status report tomorrow (June 25th).

Salmonella Chester is reported infrequently in the United States. West Virginia, for example, has recorded just one case in the last 10 years; New Mexico and Wyoming haven't seen a Salmonella Chester since 2003. The relative rarity of this particular type of Salmonella will make it easier to spot any other cases that may be part of the Marie Callender outbreak.

In addition to watching for new illnesses, state labs are continuing to test packages of the recalled entrées in order to determine the extent of the contamination. Oregon Public Health officials are especially interested in examining packages of Cheesy Chicken & Rice with ‘best if used by’ dates from any time in August 2011. Any consumers who still have boxes containing those date codes are asked to contact the Oregon Foodborne Illness Prevention Program at 971-673-1111.

What's a consumer to do?

1. Check your freezer and discard or return all recalled packages of Marie Callender's frozen entrées.
2. Take a copy of current recall notices with you when shopping for groceries, especially when visiting a local or independent grocery store that might not be as watchful of recall notices.
3. Always handle frozen entrées – especially those that contain chicken – the same way you would treat raw foods. Cook frozen entrées according to package directions, and always use a meat thermometer. Poultry should be cooked to an internal temperature of 165ºF.
4. If you think that you have become ill as a result of having eaten a Marie Callender frozen meal, consult a doctor and inform your local or state health department.
5. Stay tuned to eFoodAlert for further updates.

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