Canada's Listeria Outbreaks Tapering Off

With no new recalls to report, and both the cheese and deli meat outbreaks winding down, it's time for a brief update on the case tallies for these Made-in-Canada Listeria monocytogenes outbreaks.

The Public Health Agency of Canada released its latest update of illnesses and deaths related to the consumption of Listeria monocytogenes-contaminated meat produced by Maple Leaf Consumer Foods. As of mid-afternoon today, the key statistics are as follows:

• Total confirmed cases: 47
  
• Total suspected cases: 9
  
• Deaths where listeriosis was contributing cause: 16
  
• Deaths under investigation: 8
  

Confirmed cases in this outbreak have been reported in seven provinces: Ontario (36 cases, 14 deaths), British Columbia (4 cases, 1 death), Alberta (2 cases, 1 death), Saskatchewan (1 case), Manitoba (1 case), Quebec (2 cases), and New Brunswick (1 case). 

New Brunswick's lone victim of the national outbreak was an elderly woman who lived in a nursing home, and who died recently in hospital. The province received confirmation earlier today that the woman had become infected with the outbreak strain of Listeria monocytogenes. This death is still showing as a case under investigation in today's PHAC update.

Québec posted an update this morning on its cheese-linked Listeria monocytogenes outbreak. The province has confirmed 28 cases so far, including one death – an unidentified person  in his or her 70's. Twenty of the 28 victims were women – 9 of them pregnant. Four of the pregnant victims gave birth to infected babies. A fifth child, not included in the official totals, was still-born. All of the remaining victims were adults, aged 28 to 89 years.

The people most susceptible to serious illness as a result of Listeria monocytogenes infections are the elderly, the very young, people who are immune-deficient, and pregnant women. And these outbreaks were no exception. A disproportionate number of the reported victims were elderly, already in hospital, or were pregnant. 

These outbreaks are a sharp reminder that foods at elevated risk of Listeria monocytogenes contamination – soft cheeses, raw milk, ready-to-eat deli meats, and smoked fish – should not be on the menus of nursing homes or hospitals. Nor should pregnant women consume these foods. 

The consequences of infection are too severe.

Oklahoma: Closing The Books On An Outbreak

The Oklahoma State Department of Health reported today that the E. coli O111 outbreak that killed one person, sickened at least 314, and caused a popular buffet restaurant to close, is officially over. At least 72 of the outbreak victims were hospitalized; 17 of them required dialysis treatment.

No one has fallen ill since September 6th, according to the state. And that means we are now outside the expected maximum incubation period.

In a herculean effort to determine the source of the outbreak, OSDH, aided by CDC and local health officials, interviewed 1,843 people. The results of those interviews are still being collated and analyzed. But the odds that these interviews will yield a conclusive answer are vanishingly slender.

Today's report made no mention of the outbreak cluster associated with the a Church event catered by the Country Cottage restaurant. Implicitly, however, OSDH did not exclude this cluster. The report states:

"All known cases had association with the Country Cottage restaurant in Locust Grove, OK. The spread of E. coli O111 in this outbreak was directly related to the restaurant."

"Association" can include direct association (worked at or ate at the restaurant), indirect association (ate a meal at a venue catered by the restaurant), or secondary infection (became ill as a result of contact with an infected individual).

 

There is no indication when – or if – the restaurant will reopen. Nor do we know when – or if – OSDH will reveal the final results of their outbreak investigation.

PetSmart Poo-Poo's Pedigree® Problem

PetSmart is a retailer of Pedigree® dry dog foods, including one item that is part of this month's Mars Petcare recall. The company has posted a notice on its web site alerting customers to the Pedigree recall.

But the wording of the PetSmart recall notice downplays the seriousness of the risk to pet – and human – health. PetSmart makes the following statements (highlighted in red) in its recall announcement.

"There has been no confirmed link established between the recalled products and any human cases of salmonella"

This statement matches a statement contained in the FDA recall notice. But the FDA notice also makes it clear that Salmonella Schwarzengrund – the cause of the two human cases of salmonellosis that triggered the investigation and recall – was detected in Mars Petcare's Everson, PA production facility.

"Dogs cannot get sick from this particular strain of salmonella"

There is no scientific justification for this statement. PetSmart gives no reference or background information to support this totally unsubstantiated claim. Nor can we find anything in the scientific literature to support PetSmart's statement. 

It's true that no dog illnesses have been linked to this present group of recalled products. It's also true that no dog illnesses were traced to the large number of Salmonella Schwarzengrund-contaminated Mars Petcare products that were recalled in 2007 after a multi-state outbreak of salmonellosis was linked to the pet foods. 

But the outbreak strain of Salmonella Schwarzengrund was found in stools from several dogs during the investigation of the 2007 outbreak. And those dogs had eaten a pet food produced in the Salmonella Schwarzengrund-contaminated Pennsylvania facility. Any pet that carries a pathogen in its stool can transmit that pathogen to its human companion – as likely happened in several of the 2007 outbreak cases.

"We don't believe there is any cause for alarm."

This is the second time in less than a year that Mars Petcare's Everson facility has been the focus of a major recall after its products were linked to human cases of salmonellosis. Both times, the same serovar – Salmonella Schwarzengrund – was recovered from the victims and from the production plant environment. Mars Petcare was dilatory in announcing the recall (more than one month after it stopped production at the Everson facility). But, at least, Mars has urged customers to return or discard recalled products, and has given consumers an easy way to determine whether the product they had purchased was part of the recall.

It's hard enough to achieve a successful and complete product recall under the best of circumstances. Why is PetSmart making it more difficult by minimizing the urgency of thisrecall?

China's Food Safety Mindset: Has Anything Changed?

Two babies have died and at least 1,253 have been afflicted with kidney stones after being fed melamine-contaminated Sanlu brand powdered milk baby formula.

Sanlu Group has issued a public recall of 700 tonnes of baby milk formula produced before August 6, 2008. Chinese police, as part of a government investigation into how the melamine was introduced into milk sold to Sanlu, have questioned 78 people and detained 19 of them. China is conducting a nation-wide inspection of baby milk powder in response to the contamination crisis, and has promised to publicize the results. And the Chinese government has announced that the sick infants will benefit from an all-out treatment effort at government expense.

That's the good news. Here's the rest.

• Melamine was added deliberately to milk supplied to Sanlu Group, or to the milk powder, in an effort to boost the apparent protein content – just as was done in the case of wheat gluten that found its way last year into pet foods manufactured in the United States and Canada.
  
• Sanlu received complaints about the milk powder as early as March. Internally-conducted tests of the milk powder detected melamine in August. Yet the company remained silent.
  
• Sanlu informed its Board of Directors of the contamination problem on August 2nd. Fonterra (the New Zealand dairy cooperative that holds a 43% share of Sanlu) urged the company to initiate a public recall immediately. Sanlu declined to do so, opting instead for a trade-level recall.
  
• Sanlu's initial reaction when the story of sick infants first broke was to blame a "market pirate" for the poisoning. Only after the government investigation began did Sanlu change their story.
  
• A spokesman for the Gansu provincial health department stated that the department had investigated a hospital report about babies with kidney disease received on July 16th. All of the infants had been fed Sanlu baby milk powder formula. Gansu forwarded the report to the Ministry of Health, but no significant action was taken.
  

The Chinese government has been working for several months on a new food safety law. The most recent draft highlights the "social responsibility" of food producers and marketers. 

But it will take more than fine words in a government document to change the country's food safety mindset. It will take a major education and regulatory effort on the part of the Chinese government to bring the safety of the domestic food supply up to a reasonable standard.

Oklahoma E. coli O111 Investigation: Last Unturned Stone

State and federal health officials who are investigating the E. coli O111 outbreak that has sickened at least 291 people have almost run out of leads. The Oklahoma State Department of Health and the CDC have explored all the usual avenues of investigation, without success.

• Well water: No E. coli O111.
  
• Restaurant food samples: No E. coli O111.
  
• Restaurant food preparation/service surface swabs: No E. coli O111.
  
• Interview of victims and healthy restaurant patrons: No clear-cut indication of contamination source.
  
• Interview and testing of employees: No E. coli O111 found, although several employees reported being ill.
  

Investigators are in the process of turning over the last stone. A separate cluster of illnesses recently came to light, involving attendees at a Ladies' Tea held August 16th at the Bethany Free Will Baptist Church in Broken Arrow. The event was catered by the Country Cottage restaurant. At least 30 of the 250 participants complained of gastroenteritis. 

OSDH and CDC investigators are interviewing attendees of the Ladies' Tea in the hopes that this will help to reveal the source of the Country Cottage outbreak. Apparently, the range of food items served at the Tea was more limited that what was available at the restaurant during the August 15-17 weekend – the time frame when most of the outbreak victims ate at the Country Cottage.

It's not surprising that investigators are coming up with empty hands. Water, swab, and food samples were only taken several days after the weekend when the contamination is thought to have occurred. Persons who have suffered an infection with a gastrointestinal pathogen often will not continue to excrete the pathogen in their stools. And the nature of the restaurant's format – a large buffet – makes it very difficult for patrons to recall exactly what they did, or didn't eat.

Unless the Ladies' Tea produces a miracle, this outbreak will likely be added to the "cold case" list of unsolved epidemiological mysteries.

When Will Mars Petcare Come Clean With Pet Owners?

Pet owners woke up this morning to the news of yet another major recall of dry dog and cat food. The recalled items, which may be contaminated with Salmonella Schwarzengrund, were manufactured in the Everson, PA facility operated by Mars Petcare.

According to the recall notice, Mars claims to have initiated the recall as a "precautionary measure" after it was alerted to "... a possible link between dry pet food produced at the plant and two isolated cases of people infected with Salmonella Schwarzengrund."

Yesterday evening's recall is the most recent in a series of reports of Salmonella contamination and illness outbreaks associated with products from the Everson facility. Let's review the time line.

• September, 2007: CDC reports that pet food manufactured in a Mars Petcare plant located in Pennsylvania was linked to an 18-state outbreak of Salmonella Schwarzengrund. The outbreak began in January 2006, and dragged on until September 2007. The outbreak strain was recovered from the stools of two dogs living in the homes of outbreak victims, and in the environment of the production facility. It was also recovered from unopened bags of two brands of dog food produced in the Pennsylvania facility. Mars recalled selected bags of those two brands on August 21, 2007. Because the outbreak strain was not isolated from unopened bags of the brands that were purchased by outbreak victims, Mars got away with a very limited product recall.
  
• July 29, 2008: Mars Petcare shuts down its Everson, PA production facility after an isolate of Salmonella Schwarzengrund detected in the plant environment was a match for the strain that sickened two individuals.
  
• August 10, 2008: Mars Petcare announces a limited recall of Pedigree® Complete Nutrition Small Crunchy Bites (20 lb. bags) due to possible contamination with Salmonella (no mention of whether or not this also was Schwarzengrund). The company claimed that this was due to an "on hold" Salmonella-positive ingredient having been shipped in error to their Tracy, CA manufacturing facility. The recalled items were, according to Mars, sold only through Albertson stores in Las Vegas and Southern California.
  
• August 14, 2008: The California Department of Public Health advises consumers that the recalled pet food also was sold in Costco stores in California.
  
• September 12, 2008: Mars Petcare announces its product recall of all dog and cat foods manufactured in the Everson facility between February 18, 2008 and July 29, 2008.
  

Mars Petcare clearly is more protective of its profits than of its customers and their pets. The company recalled as little product as it could get away with in response to the 2007 outbreak. It failed to eliminate the source of contamination in its Everson facility. The company minimized the scope of its August 2008 Salmonella problem. And Mars Petcare delayed for more than a full month – from July 29th to September 12th – before announcing its most recent recall.

We don't yet know whether or not the same strain of Salmonella Schwarzengrund was the cause of both the 2006/2007 outbreak and this year's illnesses. But it would not be a surprise to find out that the same strain is behind both outbreaks.

Mars Petcare boasts that "[t]he love for dogs and cats is big business at Mars Petcare." It would appear that the company trades on their customer's love for dogs and cats to generate big business for Mars Petcare,  and for its parent company, Mars, Incorporated.

Got Campylobacter - Again!

The Pennsylvania State Health Secretary warned consumers yesterday that raw milk purchased from Hendricks Farm & Dairy (Telford, Montgomery County, PA) may be contaminated with Campylobacter and should be discarded. The dairy's raw milk permit has been suspended.

As we pointed out just two days ago, Campylobacter infections have been linked to consuming raw dairy products on numerous occasions. And this recall is just one more piece in the recurring pattern.

According to Health Secretary, Dr. Calvin B. Johnson, there have been seven confirmed cases of Campylobacter infection among raw milk consumers in seven unrelated households in Pennsylvania and a neighboring state. He did not name the other state.

Consumers may purchase raw milk legally in Pennsylvania from licensed, inspected dairies. As of August 13, 2008, 115 dairies were licensed by the state to sell raw dairy products. Licensed dairies must meet specific sanitary standards and microbiological testing requirements, including a total coliform limit of 10 per milliliter. These requirements clearly were not enough to prevent the contamination of raw milk at Hendricks Farm.

Anyone who has consumed raw milk or other raw dairy products from Hendricks Farm, and who has since experienced symptoms of gastroenteritis should seek immediate medical attention. Young children, especially, are at risk of severe dehydration from symptoms of gastroenteritis.

Ivanhoe Recalled Cheese List Corrected by CFIA

CFIA announced yesterday evening that its recall notices issued September 10th and 11th that identified Ivanhoe cheeses bearing code 3070 as being possibly contaminated with Listeria monocytogenes were in error. Those cheeses have been removed from the CFIA consolidated recall list.

Instead, the following Ivanhoe cheeses have been added to the list of recalled Ivanhoe cheeses:

• Great Canadian brand Shredded Marble Cheese, 400g, code 1089, UPC 0 68642 00211 0
  
• Great Canadian brand Shredded Marble Cheese, 200g, code 1089, UPC 0 68642 00201 1
  

The eFoodAlert posts mentioning the recall of Ivanhoe code 3070 cheeses have been removed from this site.

For more information, consumers should contact the Ivanhoe Consumer Hotline, toll-free, at 1-888-473-4269.

Pedigree Dog Food Recalled Due To Salmonella - Again

Mars Petcare US announced today that it was recalling all products manufactured at its Everson, PA facility between February 18, 2008 and July 29, 2008, after the same strain of Salmonella Schwarzengrund that sickened two pet owners was also detected in the Everson plant.

Mars was quick to add that none of the samples of pet food found in the consumers' homes were found to contain the Salmonella, and that the pets living in those homes had not become ill. Nevertheless, the company has ceased production in Everson until the source of the contamination can be found and removed. The company did not explain why it waited more than a month after stopping production before it initiated the product recall.

The list of recalled products is extensive, and can be found on the Mars Petcare News Release. The products were distributed through Giant Food and Stop & Shop stores, and may also have been distributed through other major food chains.

Please check the recall notices posted so far. We'll be adding to the list as more information becomes available.

"Meals on Wheels" Frozen Entrée Recalled

Private Recipes Limited (Brampton, ON) has recalled its Private Recipe brand Creamed Salmon with Mashed Potatoes & Glazed Carrots frozen meal, because of a risk that it may be contaminated with Listeria monocytogenes, according to an announcement this evening by CFIA.

The frozen entrée was supplied to "Meals on Wheels" and other charitable organizations for distribution in British Columbia, Ontario and New Brunswick. The recalled 370-gram entrée bears item number 12012 and a Best Before date of 2009 JN 06.

There have been no illness reports associated with this recall. 

Maple Leaf Listeria: Aftermath Of An Outbreak

As this tragic outbreak drags on, updates posted by provincial health authorities sometimes overtake the timeliness of the federal data. Such is the case today.

We are still waiting ( at 7:00 pm) for the Public Health Agency of Canada's daily update on the illness and death totals in the Maple Leaf outbreak. As of 4 pm yesterday (Sept. 11th), PHAC posted the following totals:

• Confirmed cases: 43 (34 in Ontario)
  
• Suspect cases: 19 
  
• Confirmed deaths attributed to the outbreak: 16 (14 in Ontario)
  
• Deaths under investigation: 5 
  

These numbers already are out of date. Ontario reported today that one of its suspect cases had been confirmed as part of the outbreak, raising the province's total to 35 confirmed cases. And Manitoba also reported today that its sole suspect case of listeriosis had been linked definitively to the outbreak.

It's far too easy to get caught up in the statistics, though, and to ignore the other ramifications of this national outbreak.

Impact on the lives of victims and their families. 

At least 16 – perhaps as many as 21 – families are mourning the untimely loss of a family member who did nothing more nefarious than eat deli meat processed and packaged at Maple Leaf's Bartor Road plant. Dozens of additional families have had their lives disrupted due to the illnesses suffered by outbreak victims who recovered.

Impact on Maple Leaf employees and shareholders.

The recall, alone, has cost the company approximately CDN$20 million. To this must be added the cost of lost business, and job layoffs. Probably, the company also will find itself spending a significant amount of money – either voluntarily or as a result of court proceedings – to compensate victims and their families. Maple Leaf is fortunate that Canada provides universal health care. And it's anyone's guess when – even whether – the Bartor Road facility will reopen.

Impact on the Canadian taxpayer.

Because Canada provides universal health care to its citizens and legal residents, the bulk of the medical costs incurred by outbreak victims will be borne by Canadian taxpayers. In addition, CFIA, PHAC and provincial health departments have had to carry the cost of the outbreak investigation and recall oversight.

Impact on the reputation of Canada's food safety system.

It's difficult to understate the impact of this outbreak on Canada's international food safety reputation. Canada's reputation already had been damaged by the slow, steady drip of reported BSE ("mad cow") findings. Now the country's processed meats also will be viewed askance. Mexico and China both halted the importation of Maple Leaf sausage casings after the outbreak was announced, even though the casings were produced at a different location from the contaminated deli meats. 

Impact on the meat industry.

As we reported previously, CFIA has advised all Canadian meat processors to disassemble, clean and sanitize their slicing equipment – a costly interruption of their normal production and cleaning cycles. Formax, Inc. has initiated a review of its recommended sanitation and operating instructions for its model S-180 slicer – the equipment that had harbored Listeria monocytogenes in Maple Leaf's Bartor road facility.

Impact on the just-announced Canadian elections.

The blame game began almost as soon as the outbreak was announced. At the federal level, the Liberal opposition party cast aspersions on the actions of the ruling Conservative Party. In Ontario, the opposition parties blamed the Liberal Party Premier Dalton McGuinty. Dr. Donald Low, Medical Director of the Ontario Public Health Laboratories, blames the lack of genetic typing facilities in the provincial lab for delays in recognizing the outbreak. The need to send isolates of Listeria monocytogenes from suspect meat and from patients to the national reference center (located in Winnipeg) for genetic fingerprinting cost several days.

Impact on the confidence of Canadians in the safety of the country's food supply.

This confidence has been badly shaken – by the Canada-wide Maple Leaf outbreak, the Ontario-wide recall of Ivanhoe cheeses, and the outbreaks of Salmonella and Listeria monocytogenes associated with cheeses in Québec.

Anyone for an "old-fashioned" Montreal Smoked Meat on rye?

China Recalls Melamine-Laced Baby Formula Powder

The Chinese government has ordered a recall of 700 tonnes (772 US tons) of Sanlu Bei Bei Infant Powder after one infant who was fed the milk powder died, and 50 others were hospitalized with kidney stones, according to an AP report carried by CBC. 

The recall is in sharp contrast to Sanlu's earlier protestations of innocence. The company claimed, at first, that a "market pirate" had sold sub-standard milk powder under the Sanlu name. Sanlu is 43% owned by Fonterra Cooperative Group, a New Zealand dairy company. To the best of Fonterra's knowledge, none of the contaminated milk powder was exported from China.

US manufacturers of infant formula do not use imported ingredients in their products. FDA, however, is concerned that some of the contaminated milk powder may be available for sale in Asian ethnic food stores. The agency is working with state health agencies across the country to alert the Asian community to the danger. 

This recall is the first major post-Olympic Games food poisoning scandal to hit China. It has dealt a serious blow to the PRC's attempt to present a new food safety face to the world. The Chinese government has reacted swiftly and strongly to the incident, and has promised "serious punishment" for the guilty party.

Got Campylobacter?

Campylobacter, year after year, is one of the two most common foodborne bacterial causes of gastroenteritis in the United States, with Salmonella being the other. No other species of bacteria – not E. coli O157:H7, not Listeria monocytogenes – even comes close.

Campylobacter, which can be carried in the intestines of birds and mammals, usually is spread through fecal contamination of food or water. Most human infections result from the drinking contaminated water, eating raw or undercooked contaminated meat or poultry, or consuming contaminated raw milk.

The World Health Organization has this to say about Campylobacter and raw milk:

"There are no proven intervention methods to reduce Campylobacter in cattle farms. Prevention of the contamination of raw milk on the farm is not consistently possible; therefore, consumption of raw milk should be avoided."

This statement on the part of WHO is reinforced regularly by the detection of Campylobacter in raw milk sold to retail consumers – in stores, where legal, or through cow-share programs – in the United States. And that message is further underscored by the periodic cases of Campylobacter gastroenteritis that are traced back to contaminated raw milk. Here are just a few recent examples.

• On December 17, 2007, the State of Washington warned consumers against consuming raw milk with a 12/20 "sell by" date from the Pleasant Valley Dairy, after detecting Campylobacter in a sample of the milk. The milk was linked to five cases of Campylobacter gastroenteritis.
  
• In April 2007, New York State issued a recall of raw milk from the Phil Stauderman farm after finding Campylobacter in the milk. There were no illnesses specifically associated with that recall.
  
• In April 2007, the Pennsylvania Department of Agriculture warned consumers about Campylobacter-contaminated raw milk from the Amos B. King dairy farm in that state.
  
• In August 2008, an outbreak of Campylobacter gastroenteritis that caused 15 people to fall sick, convinced Alexandre Family EcoDairy Farms, a northern California dairy, to end its raw milk program. One of the victims was hospitalized with Guillain-Barré syndrome, a form of paralysis that occasionally results from Campylobacter infections.
  

And today, the California Department of Food and Agriculture advised consumers that it had detected Campylobacter in Grade A raw cream from Organic Pastures of Fresno County. The contaminated cream, which bears a code date of Sep 12, is the subject of a statewide recall and quarantine.

This is not the first time that Organic Pastures has been the subject of a recall or regulatory action. The company's raw dairy products have been linked in the past to an outbreak of E. coli O157:H7, and have also been the subject of a recall due to Listeria monocytogenes. And the owner of Organic Pastures also has crossed swords with FDA for attempting to contravene the federal regulation against interstate transport of raw milk for retail sale.

As we've pointed out several times, consuming raw milk exposes individuals to an unnecessary risk of infection with Listeria monocytogenes, Salmonella, Campylobacter and E. coli O157:H7. Young children are especially susceptible to severe – sometimes life-threatening – illnesses when infected by one of these pathogens. 

Think before you drink.

Oklahoma E. coli Investigation Running Out Of Gas

Oklahoma's State Department of Health reported today that none of the food samples submitted for lab analysis yielded E. coli O111. 

While waiting for the lab results, investigators continued with their interviews yesterday, and now have spoken with more than 1,500 restaurant patrons. OSDH continues to beat the bushes in an effort to uncover additional people to interview, but the state is probably coming face-to-face with the law of diminishing returns.

The extensive series of interviews has turned up additional cases of E. coli O111 gastroenteritis. OSDH now says that at least 248 people fell victim to the outbreak – 202 adults and 46 children. Sixty-four people were hospitalized, and 16 of them required dialysis. Nine of the dialysis patients were children.

In an interview yesterday, the State Epidemiologist, Dr. Kristy Bradley, spoke for the first time of the possibility that a restaurant employee might have been a carrier of the outbreak strain. According to Dr. Bradley, the Country Cottage employed 58 food handlers. 

We suggested several days ago that a human carrier might be the source of the outbreak. OSDH has been very forthcoming in discussing the number of interviews it is conducting, and releasing the negative lab results obtained from environmental and equipment swabs, food samples and well water. But Dr. Bradley has said nothing at all about the Department's investigation – if any – of restaurant employees.

Have we missed something?

Creamy Soup and Cut-Rate Milk Power: A China Connection?

Campbell Soup Asia Limited, a Hong Kong-based company, has recalled two varieties of canned soup because of an unspecified off-smell, according to an announcement made by Hong Kong's Centre for Food Protection.

The recalled soup products are:

• Condensed Cream of Mushroom Soup (405g/14.3 oz)
  
• Condensed Creamy Chicken Mushroom Soup (410g/14.5 oz)
  

No production codes or lot numbers have been indicated. Consumers, merchants and anyone else in need of additional details should contact Campbell Soup Asia at: 3128 8022.

Separately, China's Xinhua News Agency reports that 14 babies have been hospitalized with kidney stones in Gansu province. All of the infants – none of them older than 11 months – had been fed Sanlu milk powder, described as a "cheap" brand in the news report. Sanlu Group is blaming the problem on "market pirates" and has sent its own investigators to the region to look into the problem.

Is this coincidence, or has some sub-standard milk powder found its way into those Campbell "creamy" soups?

Métro Richelieu Recalls Ham

Métro Richelieu (Montreal, QC) has recalled Merit Selection Delicatessen Cooked Extra Lean Ham, distributed to stores in 4.5-kilogram logs and carrying a "Best Before" date of OC 12, because the ham may be contaminated with Listeria monocytogenes.

The product was distributed to Métro, Richelieu, Ami and Extra stores in the province of Québec. It was sliced in the stores and sold at in-store deli counters between August 13th and September 10th.

This recall is completely unrelated to the Maple Leaf Listeria monocytogenes outbreak. It also is not related in any way to the Ivanhoe Cheese recall or the recalls of soft cheeses in Québec. No illnesses have been linked to Merit Ham. Nevertheless, any consumer who has eaten sliced ham that was purchased from in-store deli counters in any of the above-mentioned stores, and who has experienced symptoms of listeriosis, should seek medical assistance.

Consumers who have purchased this product should either discard it or return it to the store for a refund. For more information, contact Métro Richelieu's Customer Service department at 1-800-561-8429.

Iraq And Cholera: An Annual Event

The World Health Organization (WHO) has made it official. This year's cholera outbreak has begun in Iraq.

A year ago, the country suffered a major outbreak of cholera that sickened almost 4,700 people and claimed 24 lives. That outbreak took place mostly in the northern part of Iraq. But Vibrio cholerae, the water-borne microbe that is responsible for the bloody diarrhea that is the hallmark of cholera, has moved farther south this year.

The 2008 outbreak began officially on August 20th, when the first cases were lab-confirmed. By August 28th, 181 suspected cases – 7 confirmed – already had been reported from Baghdad and Misan Province. From Baghdad, the outbreak has traveled south to Babil Province, which has reported 116 suspected cases. As of September 10th, 21 of the suspected cases have been confirmed, and 10 people have died.

Last year's outbreak also began in mid-August. It was still raging in early October, having spread through 9 of the country's 18 provinces. Prior to 2007, the last cholera outbreak in Iraq that was large enough to attract the attention of the WHO took place in Basra during May 2003. In reporting on that outbreak, WHO commented that cases of cholera had occurred in Basra every year since 1989. It's our guess that there were outbreaks in 2004, 2005 and 2006 as well, but that these were not well reported – due, at least in part, to the ongoing conflict in many parts of the country.

As WHO points out in its report on the current outbreak, cholera outbreaks are facilitated by the lack of potable water, and an absence of infrastructure for hygienic disposal of sewage. More than five years after the United States, supported by the United Kingdom and the "Coalition of the Willing" invaded Iraq, "... the overall quality of water and sanitation remains very poor..." according to the WHO report.

Maybe next year?

Oklahoma E. coli O111: Interviews Uncover Additional Victims

Even when a food poisoning outbreak has been well publicized, some outbreak victims fall between the cracks. Oklahoma's intensive search for answers has uncovered 25 more cases of E. coli O111 gastroenteritis.

As of today, the Oklahoma State Department of Health reports that at least 231 people have been infected with E. coli O111 – including 185 adults and 43 children. At least 61 of the victims were hospitalized as a result of the severity of their symptoms; 16 required dialysis treatment. One person has died.

As part of their investigation into the source of the outbreak, the state submitted samples of well water, restaurant food, and environmental swabs of food preparation and serving surfaces for lab analysis. The water and swab samples did not uncover any traces of E. coli O111. Lab results on the food samples are not yet available.

Oklahoma investigators continue to ask everyone who ate at the Country Cottage restaurant during the period of August 15-17, and who has not yet been interviewed, to contact OSDH at 1-800-990-2769. 

Québec Listeria monocytogenes Outbreak: Cross-Contamination Concerns

In case anyone is wondering why the Québec Ministry of Agriculture's recall of cheeses seems to be never-ending, the Ministry of Health and Social Services (MSSS) made the reason clear in its press release yesterday. For readers of this blog who don't understand French, following is our translation of the key explanatory paragraph:

The Department of Public Health Protection recommends that the public not consume cheeses cut and purchased before September 7 at any one of the 300 retail points of sale reported by the Québec Ministry of Agriculture, Fisheries and Food (MAPAC). It is possible that these cheeses have been in contact with cheeses contaminated by the bacterium Listeria monocytogenes. The contamination may have occurred, for example, when someone neglected to disinfect a knife or working surface between cutting two cheeses, one of which was contaminated. This is referred to as cross-contamination. If you have purchased a cheese from one of the distribution points listed on the MAPAQ web site, it is recommended that these cheeses be discarded, along with any other food with which they may have come in contact, or which were handled using the same utensils. It is extremely important to wash with soapy water containing a small amount of bleach all kitchen utensils and containers that have been in contact with the cheeses (refrigerator shelves, cutting boards, knives, dishes, etc.)

Retailers, who are taking a financial hit from this massive recall, are complaining that the government is overreacting. Given, however, number of different brands and manufacturer listed in the MAPAQ recall notices, cross-contamination is a real possibility. 

Meanwhile, the size of the Québec outbreak continues to grow. The province now has confirmed 22 cases of listeriosis – 3 of them newborn infants – due to the cheese outbreak strain (up from 15 cases as of September 6), and one person infected with that strain has died. 

It's understandable that MAPAQ is taking extreme measures to contain the outbreak. Perhaps MAPAQ also should reexamine its recently announced plan to liberalize rules for production and sale of raw milk cheese in the province.

Québec Listeria Outbreak: Consolidated Recall List

UPDATED SEPTEMBER 10, 2008

The Québec Ministry of Agriculture (MAPAC) has announced ten cheese recalls due to the presence of Listeria monocytogenes since August 22nd. At least some of the recalled cheeses have been linked to the province's recently-revealed listeriosis outbreak.

As a convenience to consumers who are trying to wade through the multiple recall announcements, we have begun a consolidated list of MAPAC's cheese recalls. This list will be updated as new information becomes available.

All of the cheeses mentioned below are potentially contaminated with Listeria monocytogenes and SHOULD NOT be eaten. Consumers who have purchased any of the recalled cheeses should either discard them or return them to the store.

• IGA Marché au Vieux Beauport (771 ave Royale, Québec, QC). All cheeses cut in the store and sold in various sizes between September 2nd and September 8th. ADDED Sept. 10, 2008 
• Boulangerie Lesage (809 Harvey ouest, Alma, QC). Médard triple choco. Fram. brand chocolate cheesecake with best before dates earlier than September 20, 2008 and sold in 800-gram packages carrying the name Boulangerie Lesage or 250-gram unlabeled slices purchased from the service counter. 
• Au Petit Marché de Contrecoeur (6065, Marie-Victorin, Contrecoeur, QC). All cheese identified as Fromage Le 14 Arpents, sold in various sizes on or after August 29, 2008.
  
• Supermarché Saint-Hilaire (345, Raymond Dupuis, Saint-Hilaire, QC). Cheeses manufactured by Ferme du Domaine de la Rivière, and sold in various sizes on or after August 29, 2008, including: Le Rang des Iles, Le 14 Arpents, Le Petit Vieux, Le Gédéon, Le Médard, La Couventine, Le Cabrouet and Les Calles.
  
• Ferme du Domaine de la Rivière. Cheeses manufactured and sold in various sizes between July 12 and September 6, 2008, including: Le Rang des Iles, Le 14 Arpents, Le Petit Vieux, Le Gédéon, Le Médard, La Couventine, Le Cabrouet, and Les Calles.
  
• La Maison du Fromage (2888, Cosmodôme, Laval, QC). All cheeses cut and sold in various sizes on or after August 29, 2008. 
  
• Étal du Fromager (140, Bélanger, Saint-Jérôme, QC). All cheeses cut and sold in various sizes on or after August 25, 2008.
  
• Les Fromagiers de la Table Ronde (317 rte 158, Ste-Sophie, QC). Cheeses manufactured and sold – regardless of date – in various sizes either at the manufacturer or in certain retail stores (see consolidated list of retailers, below), and identified as Le Fleur de Lysé, Le Fou du Roi and Le Rassembleu.
  
• Aux Petits Délices GT (1191, rue Cartier, Québec, QC and 2500, chemin des Quatre-Bourgeois, Québec, QC). All cheeses cut and sold in various sizes on or after August 6, 2008.
  
• S. Bourassa (St. Sauveur) Ltée. (105, B. Guindon, Saint-Sauveur, QC). Tomme de Grosse-Ile brand cheeses of various sizes, packaged on August 15 and bearing a "best before" date of September 5, 2008.
  
• Octofruit Maître Gourmet (190, boul. Labelle, Sainte-Thérèse, QC). Mont Jacob brand cheeses of various sizes, packaged on August 14 and bearing a "best before" date of August 29, 2008.
  
• Aux Petits Délices (1191, rue Cartier, Québec, QC). Riopelle de l'Ile brand cheeses sold in various sizes between August 6 and August 11, 2008.
  

In addition to the above recall notices, MAPAC has posted a list of retail establishments where the recalled cheeses were sold. This list, which includes both food stores and restaurants, is being updated by MAPAC as new information becomes available.

Maple Leaf Listeria Outbreak: Slicing and Dicing

UPDATED SEPTEMBER 10, 2008

The number of confirmed illnesses and deaths in Canada's Listeria monocytogenes outbreak continues to creep up, even though the worst of the outbreak is probably over.

The Public Health Agency of Canada reported the following tallies, as of mid-afternoon, September 9th:

• Confirmed illnesses linked to the outbreak: 38
  
• Suspected cases linked to the outbreak: 20
  
• Deaths where listeriosis was an underlying or contributing factor: 14
  
• Deaths under investigation: 5
  

Twenty-nine of the confirmed cases and 12 of the deaths due in whole or in part to the outbreak strain of Listeria monocytogenes were reported by Ontario.

Not yet included in the federal totals are the newly reported deaths of a New Brunswick woman and a woman from British Columbia, both of whom were infected with Listeria monocytogenes. Lab tests are underway to determine whether these deaths are related to the Maple Leaf outbreak.

Maple Leaf announced last Friday that it had identified a probable source of the Listeria monocytogenes contamination in its meats. Intensive testing uncovered contamination inside the slicing machines on the #8 and #9 production lines. The same day, CFIA issued an advisory to all federally registered meat establishments, instructing operators to dismantle and check the interiors of their slicing equipment immediately,  "... and perform a systematic and thorough aggressive cleaning and sanitation procedure..."

Formax, Inc., the manufacturer of the slicing equipment, responded to the news by stating that nearly 300 units of this model (Formax S-180) are installed in processing plants around the world, and that this was the first occasion in 13 years that anyone had reported an incident. The S-180 appears to be an older model, and is no longer featured on the Formax web site. 

________________________

UPDATE: September 10th. Janie Gabbett of Meatingplace OnLine reported this morning that Formax has announced a review of its recommended sanitation protocols for the Model S-180 slicer. The Company's President and CEO, David Brown, told Meatingplace that both the equipment and the operating manuals are being reviewed. (Update ends)

________________________

Contamination deep within the slicing machine is consistent with a pattern of recurring contamination farther down the production/packaging line. If Maple Leaf was as assiduous as it claims to have been in its post-sanitation environmental swabbing program, the Company's quality assurance team should have noticed the disappearance and reappearance of Listeria monocytogenes on the line.

Testing cannot make a production line – or a product – microbiologically safe. All that testing can do is highlight potential problems and, if everything is working correctly, spur someone to ask the right questions.

Alaska Reports Campylobacter Outbreak

The Alaska Department of Health and Social Services reported today that the south-central part of the state – which includes Anchorage – has experienced an unusually large number of cases of Campylobacter enteritis since the beginning of July. 

Thirty-two people were diagnosed with Campylobacter in July and August of this year, compared to just 15 people during the same period last year. One person was hospitalized for observation.

Except for Salmonella, Campylobacter causes more cases of gastroenteritis annually in the United States than any other known bacterial pathogen. Individuals usually contract an infection by drinking raw milk, drinking or swimming in contaminated water, eating undercooked poultry, or eating food that has been cross-contaminated by contact with raw poultry or untreated water.

Most infections with Campylobacter are self-limiting, and disappear in a few days with no lingering aftereffects. But, in a small number of cases, the infection can trigger arthritis or – in approximately 0.1% of cases – a severe, acute neurological autoimmune disease known as Guillain-Barré syndrome.

As part of their investigation into the source of the outbreak, the state is asking any resident or visitor who has experienced a bout of bloody diarrhea since the beginning of July to contact the Section of Epidemiology at:  1-877-469-8067.

Oklahoma Still Searching for Source of E. coli O111

The Oklahoma State Department of Health has received the results of its environmental swab samples. The state found no trace of E. coli O111 on any of the food preparation and serving surfaces at the Country Cottage restaurant.

Under normal circumstances, this would be good news. But in the context of the state's outbreak investigation, thought not unexpected, it is a disappointment. 

Investigators had hoped that their swab samples might yield a clue to the source of the pathogen that has sickened 206 residents of the northeastern part of Oklahoma and has killed one man. 

Now they must pin their hopes for an answer to the mystery on lab results from food samples, and on the statistical analysis of information obtained during interviews with restaurant patrons. Those interviews are continuing, with the assistance of CDC staff members who have joined the investigation team.

The state has been conscientious about issuing daily reports on the status of its investigation into this outbreak. Those reports, however, have been strangely silent about any interviews conducted with restaurant employees, or any lab tests of employee stool samples. Why?

OSDH continues to ask anyone who ate at the Country Cottage restaurant between August 15 and August 23 – and especially during the period of August 15-17 – and who has not yet been interviewed, to please contact the Department of Health, toll-free at 1-800-990-2769.

Oklahoma E. coli Outbreak: A Weekend of Activity

Oklahoma's State Department of Health (OSDH) investigators are still scratching their heads over the source of the E. coli O111 strain that has sickened 206 people and killed one. They may not have the answer yet, but one must give them an "E" for Effort.

According to the update posted late this afternoon on the OSDH website, state investigators – and three staff members from the CDC – spent their weekend interviewing 310 additional patrons of the Country Cottage, the restaurant that is at the epicenter of this outbreak. So far, 1,300 people have been interviewed in an attempt to differentiate between the menu or buffet items eaten by outbreak victims, and food eaten by those who did not become sick.

OSDH has not mentioned the total number of cases since the September 3rd update. We can probably assume this means that the number of new cases has dried up and that the final tally will remain at 206 victims, including one death.

The weekend's interviews generated the names of another 300 or so restaurant patrons. These individuals will be contacted and interviewed. CDC staff members are assisting both in the interviews and in the epidemiological analysis of the information obtained from restaurant patrons. The state also is waiting for lab results to arrive for environmental swabs and food samples taken at the restaurant.

There has been no official indication whether any employees of the Country Cottage restaurant became ill, or whether the employees were asked to submit a stool specimen for lab testing. It would be usual, in this type of investigation, to make such a request of all restaurant staff. But cooperation with this sort of request is voluntary.

If luck is on the side of the investigation team, the lab results and interviews will provide some answers. Otherwise, the source of this outbreak will remain a mystery forever.

Cholera Makes A Comeback

Cholera is back (not that it ever really left) thanks to all the usual suspects: major flooding, military activities, overcrowding, shortage of health supplies and government indifference.

India

Even before the monsoonal floods hit, Delhi was writing the most recent chapter in its permanent almanac of cholera outbreaks. The city logged 450 cases of cholera in the first eight months of 2008. And the worst is still ahead. Indian officials warned yesterday that 2.1 million refugees are at risk of contracting cholera and other gastrointestinal diseases, with "large numbers" of people already complaining of stomach aches, fever and diarrhea. 

Villagers in Murshidabad, where the village wells haven't been operating for several months, have been drinking untreated water from the Banshlai River. The Vibrio cholerae-contaminated water has infected 70 villagers; eleven of them have been hospitalized in critical condition. Two children, aged 2 and 4 years, have died. The government has done nothing to repair or replace the wells.

Pakistan

Northwest Pakistan, near the Afghan border, is the scene of another cholera outbreak. Fighting between Pakistani government forces, and Taliban/al Qaeda forces has prompted 300,000 villagers to flee their homes and congregate in refugee camps. The International Committee of the Red Cross reported on Friday that cholera and other cases of watery diarrhea already have appeared among the refugees.

Zimbabwe

Residents of the town of Chitungwiza, near Harare, find themselves in the midst of a cholera outbreak that has killed 10 people so far. Nurses who work in the town's hospital are apparently on strike. They claim to be too hungry to work.  Chitungwiza now joins the ranks of several other Zimbabe towns that have all experienced recent outbreaks of cholera: Mabvuku, Tafara, Msasa Park and Letombo Park. The CEO of the Combined Harare Residents Association blames the Mugabe government for its total lack of response to the outbreak, and for the absence of clean water and sanitary sewage services.

Iraq

Cholera has reappeared in Iraq, this time in Babil province, south of Baghdad. At least 20 cases have been confirmed, according to the Iraqi government, and one person has died. Local officials in Babil, though, say that many more people are ill with cholera – as many as 300 – and that 10 have died. The ruling provincial council, complaining of the lack of action on the part of the national government, has taken its own steps. It has ordered the closure of all ice plants and many juice stands in an attempt to control the spread of the disease.

Myanmar

This is the dog that never barked. In spite of the massive flooding experience by residents in the low-lying Ayayerwaddy (Irrawaddy) Delta, cholera did not add to the devastation. Perhaps the Myanmar people were fortunate in the slow, heartless response of their government. 

By not amassing in the tens of thousands into overcrowded camps with few sanitary services and limited fresh water, the Myanmar people avoided the usual diseases of disaster that spread explosively in crowded, unclean environments. The fortunate outcome does not excuse the behavior of Myanmar's military regime, but perhaps the United Nations and international aid organizations should consider whether any lessons can be learned from this inadvertent experiment.

Maple Leaf Outbreak: Some Unanswered Questions

Yesterday, I called for a Walkerton-style Judicial Commission of Inquiry to investigate fully – and publicly – all aspects of the Canada-wide Listeria monocytogenes outbreak that has sickened at least 38 people and has killed 13 of them.

Yesterday, Doug Powell of Barfblog wrote: 

"Others are calling for a full-scale inquiry, like what happened after Walkerton and in Ontario after some dodgy meat slaughtering practices were uncovered (the Haines report). I participated in both inquiries. There is no need for another."

In the United States, each federal government department maintains an Office of Inspector General. The Inspector General has the power, on his or her own initiative, to audit any of the department's activities. The Inspector General's detailed audit reports are public information, often directly accessible over the Internet.

Canada is not this generous with its information. The independent investigation announced by Prime Minister Harper will not be a public inquiry, and there is no promise that the detailed report of this investigation will be made public. The investigator will report his or her findings to the Minister of Agriculture. Period.

In calling for a public inquiry, I am not suggesting that either Maple Leaf or the Canadian Food Inspection Agency set out deliberately to spread Listeria monocytogenes to hospitals, seniors' residences, nursing homes and other similar facilities across Canada. I am not proposing a witch hunt. But I think Canadians deserve some answers.

What do I think should be included in the scope of a Judicial Commission of Inquiry? Here are a few items:

• Why did Maple Leaf's food safety program not detect the contamination before the problem spiraled into an outbreak?
  
• Why did CFIA not respond to Maple Leaf's internal lab findings of Listeria monocytogenes in the Bartor Road facility environment, or was CFIA not privy to Maple Leaf's internal lab reports? 
  
• Why did the initial recall notice – dated August 17 and issued jointly by CFIA and Maple Leaf – say, disingenuously, that "[t]here have been no confirmed illnesses associated with the consumption of these products," when an outbreak investigation was already in progress and under investigation?
  
• Why are elderly and immune-compromised Canadians being fed high-risk prepared meats in the country's health care institutions?
  
• What can be done to prevent this from happening again?
  

This investigation must not only be carried out. It must be seen to be carried out, if Canadians are to regain – and retain – their confidence in the nation's food safety system.