Hepatitis A: Aftermath Of An Alert

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

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

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

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

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

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

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

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

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

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

Are you listening, CDC?

Government of Canada Plays With Fire

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

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

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

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

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

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

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

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

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

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

Salmonella Saintpaul Update: CDC July 18th Report

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

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

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

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

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

Nebraska Beef Outbreak: And Utah Makes Seven

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

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

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

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

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

eFoodAlert World Tour: Misery Loves Company

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

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

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

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

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

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

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

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

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

Salmonella Statements – And Produce Recall

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

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

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

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

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

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

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

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

Salmonella Saintpaul Outbreak: A Glimmer Of Hope

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

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

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

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

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

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

Food Poisoning: Names Behind The Numbers

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

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

eFoodAlert Outbreak Profile As Of July 16th CDC Report

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

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

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

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

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

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

CDC Acknowledges Georgia Affected by Nebraska Beef Outbreak

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

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

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

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

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

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

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

Hepatitis Warning in Burlington, Iowa

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Salmonella Saintpaul Outbreak: Running Out Of Steam?

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

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

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

Today's Outbreak Profile

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

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

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

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

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

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

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

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

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

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

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

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

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

Recalled Sandwiches May Contain Plastic Pieces

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

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

The recalled product can be identified as follows:

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

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

Salmonella Saintpaul: July 14th Update From CDC

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

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

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


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

Salmonella Saintpaul: Updated Canadian Advisory

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

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

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

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

Hong Kong Issues Consumer Alert On Smoked Salmon

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

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

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

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

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

Water Woes

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

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

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

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

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

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

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

Sarpy County: The Overlooked Outbreak

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

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

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

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

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

Warning: Salmonella-Contaminated Tuna Salad

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

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

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

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

E. coli O157:H7 Outbreak: CDC Update Overdue

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

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

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

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

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

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

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

Salmonella Saintpaul Outbreak: July 11th Update

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

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

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

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

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

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

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

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

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

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

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

Thai Basil Recalled - Salmonella

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

Consumers can identify the recalled packages as follows:

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

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

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

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

A Tale Of Two Outbreaks

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

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

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

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

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

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

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

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

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

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

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

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

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

Time For Another Nebraska Beef Recall Notice?

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

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

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

How much more contaminated meat has Nebraska Beef sold?

Salmonella Saintpaul: Pursuing Hypotheses

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

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

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

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

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

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

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

Salmonella Saintpaul Outbreak: July 10th CDC Update

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

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

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


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

Washington Company Recalls Nova Lox

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

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

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

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

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

Salmonella Saintpaul: One Hump Or Two?

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

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

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

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

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

This is what I found.

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

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

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

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

CDC Issues Warning On Jalapeno Peppers – And Explains Why

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

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

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

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

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

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

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

This outbreak is looking very much alive.

Salmonella Saintpaul Outbreak - Still On Fire or Winding Down?

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

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

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

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

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

E. coli O157:H7 and now Salmonella?

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

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

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

Nebraska Beef – How Many Victims?

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

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

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

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

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

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

Fish & Seafood Advisories: Texas and Maine

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

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

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


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

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

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

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

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

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

Food Poisoning Around The World: July 8th Edition

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

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

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

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

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

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

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

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

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

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

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


And thus ends another leg of our world tour.

Salmonella Saintpaul Outbreak Spreads Into Canada

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

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

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

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

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

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

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

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

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

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

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