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.

Where's The (Contaminated) Beef?

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

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

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

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

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

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

Ground Beef Outbreak Update

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

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

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

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

Russia's Time Bomb

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

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

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

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

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

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

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

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

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

Tomato Illnesses Climb: 810 Lab-Confirmed Cases

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

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

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

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

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

FDA: Tomatoes In, Garbage Out

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

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

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

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

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

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

Norovirus Notes

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

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

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

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

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

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

Tomatoes and Ground Beef: Another Update

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

Salmonella Outbreak

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

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

E. coli O157:H7 Outbreak

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

Ground Beef Update: June 26th

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

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

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

Tomato Update: June 26th

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

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

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

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

More Breaking News: Kroger's Recalls Ground Beef

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

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

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

Breaking News: E. coli O157:H7 Outbreak Update

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

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

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

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

In Other News . . .

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

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

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

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

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

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

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

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

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

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

No comment!

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

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

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

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

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

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

Tomatoes: Troublesome Tracebacks

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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