Risk is not low if cause is not known: 5, then 19, now 34 sick and 1 dead sick in E. coli outbreak linked to Edmonton restaurant

If the E. coli-romaine lettuce made it to an Alaskan prison, maybe it made it to an Edmonton restaurant.

Just asking.

According to the Toronto Star, one person has died and more than 30 people have fallen ill following an E. coli outbreak that Alberta Health Services has called “extremely complex” to investigate.

In a statement, AHS says it has expanded its investigation into the source of an outbreak of E. coli, beyond cases directly linked to an Edmonton restaurant late last month.

While 21 of these lab-confirmed cases are linked to Mama Nita’s Binalot restaurant in Edmonton, AHS no longer has public health concerns related to the restaurant.

The number of lab-confirmed cases of E. coli has increased to 34, including 11 patients who have needed hospital care, and one patient who has died likely due to E. coli infection.

“This outbreak is extremely complex, however AHS, in partnership with other provincial and federal agencies, is doing all we can to protect the health of Albertans,” said Dr. Chris Sikora, a medical officer of health in the Edmonton zone, in a statement. “The risk of illness remains very low.”

AHS has not yet identified the source of these cases, but believes they are linked to the initial outbreak.

The risk is not low if the cause is not known.

AHS has worked closely with the owners of Mama Nita’s Binalot since it was identified that a cluster of people with lab-confirmed E. coli ate at the restaurant. AHS says the owners have taken significant steps to manage this issue, including voluntarily closing until AHS was confident the restaurant could reopen without presenting a risk to the public.

Flour power: Raw is risky

When I was a kid, I had this multi-colored swim towel that stated Flower Power (right, not exactly as shown).

I should have known that if a 1960s slogan had been co-opted by towel manufacturers in the early 1970s, it was a sign of corporate greed rather than earth-tone sentiment.

For the past decade, raw flour has increasingly come under the food safety microscope.

Flour was suspect in a 2008 outbreak of Salmonella in New Zealand. In June, 2009, an outbreak of shiga-toxin producing E. coli (primarily O157:H7) in Nestle Toll House cookie dough sickened at least 77 people in 30 American states. Thirty-five people were hospitalized – from flour in the cookie dough.

Hemp seed flour sickened 15 Germans in 2010.

There was the U.S. General Mills outbreak of 2016 which sickened at least 56 people with the outbreak strain of E. coli O121 and O26, followed by a separate outbreak of E. coli O121 in Robin Hood flour in Canada in late 2016 going into 2017, that sickened at least 29.

It’s this latter outbreak that has journalist Jim Romahn’s attention.

Romahn writes the release of 759 pages of mostly e-mails indicates there was a massive effort involved in a recall of flour milled in Saskatoon that was contaminated with E. coli O121.

Twenty-two Canadians were identified as sickened by the flour, including one key case where the person consumed raw dough.

With hindsight, health officials were able to determine the first person sickened was Nov. 13, 2016. The others sickened and linked to the flour were between then and Feb. 26, 2017.

Robin Hood flour was identified as the source in March and on March 26 the Canadian Food Inspection Agency began a recall that eventually grew to scores of brand-name products across Canada and even an export shipment to Guyana.

The recall involved a number of major companies, such as Smucker Foods of Toronto and the Sobeys supermarket chain.

There were some unusual difficulties, including the challenge of contacting Mennonites who have no telephones.

The investigation and lab results eventually traced the source to flour milled at Ardent’s Saskatoon plant on Oct. 15, 16 and 17.

A high percentage of packages of flour milled on those dates turned up with E. coli O121.

But even then it’s not clear where the wheat originated.

Ardent Mills said it was probably spring wheat, but it could have also contained soft wheat, and that it probably was from the 2016 harvest, but might have had some wheat from the 2015 harvest.

That’s reflective of the amount of blending that happens both with the wheat used in milling and the flours that are blended into products for sale.

The documents were released under Access to Information at the request of a woman who spent time in a hospital in Medicine Hat, Alta.

 An Outbreak of Shiga Toxin–Producing Escherichia coli O121 Infections Associated with Flour – Canada, 2016–2017

MMWR Morb Mortal Wkly Rep 2017; 66: 705–706

Morton V, Cheng JM, Sharma D, Kearney A.

Waiter, is that romaine from Yuma? At least 53 sick across 16 US states with outbreak strain of E. coli O157:H7 linked to lettuce

David Meyer of Fortune magazine reports the U.S.’s mysterious E. coli outbreak now has a likely culprit: romaine lettuce grown around Yuma, Arizona. And consumers are being given conflicting advice on what to do to protect themselves.

The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) said Wednesday that any consumers in the U.S. who have store-bought chopped romaine lettuce should throw it away. If they want to buy romaine lettuce from now on, they should first check with the store or restaurant that it wasn’t grown in the Yuma region, the agencies said.

However, Consumer Reports has gone a step further, advising people to avoid all romaine lettuce for the time being. Why? Because people may find it difficult to establish for sure that their lettuce does not come from the growing region that’s suspected to be the source.

Niraj Chokshi of the New York Times reported that CDC said in a statement, “If you do not know if the lettuce is romaine, do not eat it and throw it away,” the C.D.C..

The agency was first alerted to the outbreak by health officials in New Jersey, who had noticed an increase in E. coli cases in the state, said Dr. Laura Gieraltowski, an epidemiologist at the C.D.C. After some discussion, it became clear that many of those infected had eaten chopped romaine lettuce at restaurants before getting sick.

Concerned, the agency looked for related cases by checking PulseNet, a national network of laboratories that catalog samples of harmful bacteria from infected patients.

“When we looked back into our PulseNet system we saw that there were other cases in other states with the same DNA fingerprint,” Dr. Gieraltowski said.

The C.D.C. learned that the others infected by that particular strain, E. coli O157:H7, had also eaten chopped romaine lettuce at restaurants before getting sick, she said. It turned over the information to the Food and Drug Administration, which helped trace the outbreak to Yuma, Ariz.

To pinpoint the exact source, though, investigators would need samples of the tainted lettuce. But because of the short shelf life of lettuce and the time it takes for an outbreak to be identified, obtaining such a sample may prove difficult.

However, a cluster of eight illnesses in an Alaska prison may help pinpoint the source.

Dr. Joe McLaughlin, with the Epidemiology Section at the state Department of Health and Social Services, said health officials had responded last week to an outbreak of E. coli O157:H7 bacteria at the Anvil Mountain Correctional Center in Nome, Alaska.

None of the eight patients have died or been hospitalized, in cases which were noticed between April 5 and April 15. All ate “significantly higher” numbers of salads than other people at Anvil Mountain, however, and have shown the same symptoms.

“Our outbreak is the first one I know of that’s been associated nationally with the consumption of whole heads of lettuce rather than chopped lettuce,” McLaughlin said. “What this outbreak suggests is that the source of contamination may actually be at the farm rather than the actual processing of the lettuce.”

Duh.

CDC reports in its latest outbreak update  that information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.

At this time, no common grower, supplier, distributor, or brand has been identified.

Consumers anywhere in the United States who have store-bought chopped romaine lettuce at home, including salads and salad mixes containing chopped romaine lettuce, should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick. If you do not know if the lettuce is romaine, do not eat it and throw it away.

Before purchasing romaine lettuce at a grocery store or eating it at a restaurant, confirm with the store or restaurant that it is not chopped romaine lettuce from the Yuma, Arizona growing region. If you cannot confirm the source of the romaine lettuce, do not buy it or eat it.

Restaurants and retailers should ask their suppliers about the source of their chopped romaine lettuce.

Food Safety Talk 150: Rambunctious Ramble in the Jungle

The show opens with Ben recounting of his thoughts on Temple Grandin’s talk in North Carolina, and the Humboldt Broncos tragedy.  Don mentions his shout out on Do By Friday.  Ben starts off by the nominal food safety talk regarding sock microwaving and the Cold Pressure Council seal. Don counters with the NJ Panera outbreak which seems to be part of FDA outgoing multistate outbreak of E. coliO157:H7. Next up are blockchain and Canadian food recalls.  Listener feedback covers restaurant grading, killing lobsters, glitter, flour heating, milk spoilage, farmers market and recipe safety.

Episode 150 is available on iTunes and here.

Disease outbreak at Texas cat café leads to kitty quarantine, investigation

I was walking Ted the Wonder Dog the other morning — which I try to do every day but often fail because I’m human, dammit, and Ted would rather sleep beside me all day, and then party at 2 a.m. — and we passed the new cat café in Annerley, Brisbane.

I never had indoor cats until the townhouse rules in Brisbane forced us so. Same with the tiny dog. Now we have our own inner city million-dollar property (in Monopoly money) the cats go in and out, and the dog won’t shut-up.

Cuteness overload was supposed to be the number one item on the menu at San Antonio’s first cat cafe, but now the owner is facing an investigation from local authorities.

City of San Antonio Animal Care Services seized two cats last week and ordered the remaining 54 cats in the 1,000-square-foot San Antonio Cat Cafe to be quarantined from the public on Monday, according to WOAI.

“You are not going to get the sick cats better in that environment and unfortunately you are likely to spread those ailments to the other animals that are currently healthy,” Shannon Sims, the assistant director of Animal Care Services, told the station.

The ailments that he’s talking about allegedly include ringworm and FIP, a viral disease that tends to attack the cells of the intestinal wall and is usually fatal in domestic cats, according to WebMD. Animal Care Services spokeswoman Lisa Norwood told KENS that the investigation thus far had revealed that up to three dozen cats that did not have rabies shots and that sick cats were often mixed with healthy cats.

Leah Taylor, a former cafe employee, who is studying to become a veterinary technician, told KENS she filed a complaint against owner Casey Steuart with Animal Care Services after witnessing four cats die there during her four months on the job.

“A lot of the cat care wasn’t maintained,” Taylor told KENS. “There were animals that should have been on medicine. There were animals that needed to see a vet for medical attention that weren’t tended to. There was a lot of ringworm and upper respiratory, which is very contagious not only to people but also to other animals.”

Cas Moskwa, another former Cat Cafe employee, posted a series of photos on Facebook Sunday, detailing what she called “the reality of the cafe and the poor state it currently is in.” She claimed that Steuart waited for weeks at a time before taking sick cats there to a veterinarian and left at least one sick and dying cat, named Decoy, out in the public lounge during his last agonizing days.

Her post includes photos of cats with crusted eyes and allegations that Steuart brought in a cat infected with ringworm into the facility’s kitten coop, resulting in three different litters becoming infected. She said in a separate post that a cat she took home from the cafe was one of them that had been infected.

According to KSAT, though, Steuart disputes the reports from Moskwa and other former employees, blaming “a lack of communication and misinterpretations.” She specifically disputed the reports of ringworm, a skin infection that can be transmitted to humans, in the cafe.

She also told the San Antonio Express News that three cats did die at the cafe, but none from neglect. One, she said, was 17 years old.

35 in 11 states sick with E. coli from Romaine lettuce grown in Arizona

It’s time to end the leafy greens cone of silence.

Top view of romaine lettuce that has been sliced on a wood cutting board.

This time it has made people unnecessarily sick.

I wouldn’t touch their product.

But how would I know?

On Sept. 14, 2006, the U.S. Food and Drug Administration announced that an outbreak of E. coli O157: H7 had killed a 77-year-old woman and sickened 49 others. The FDA learned from the Centers for Disease Control and Wisconsin health officials that the outbreak may have been linked to the consumption of produce and identified bagged fresh spinach as a possible cause.

Eventually, four would die and at least 200 sickened.

One of the responses was to form the Leafy Greens Marketing Agreement (LGMA) which apparently overseas most of the leafy greens production in the U.S.

They are known primarily for self-aggrandizing press releases.

And lots of rumors about how they inhibit epidemiological investigations into outbreaks of foodborne illness linked to their products (search ‘cone of silence’ on barfblog.com for plenty of examples)

According to the U.S. Centers for Disease Control, since the last update on April 10, 2018, 18 more people from 9 states were added to this outbreak.

How many of those could have been prevented if CDC or State health types fingered chopped Romaine lettuce when rumors started circulating? Is the goal of LGMA really to forego epi and demand absolute proof before going public?

As of April 12, 2018, 35 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states. Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 29. Sixty-nine percent of ill people are female. Twenty-two ill people have been hospitalized, including three people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after March 27, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli and when the illness is reported. This takes an average of two to three weeks.

Epidemiologic evidence collected to date indicates that chopped romaine lettuce is the likely source of this outbreak. Twenty-six (93%) of 28 people interviewed reported consuming romaine lettuce in the week before their illness started. This percentage is significantly higher than results from a survey[787 KB] of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed. Most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. The restaurants reported using bagged, chopped romaine lettuce to make salads. At this time, ill people are not reporting whole heads or hearts of romaine.

Traceback investigations are ongoing to determine the source of chopped romaine lettuce supplied to restaurant locations where ill people ate. At this time, no common grower, supplier, distributor, or brand has been identified. However, preliminary information indicates that the chopped romaine lettuce was from the Yuma, Arizona growing region.

Information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.

Advice to Restaurants and Retailers:

  • Restaurants and retailers should not serve or sell any chopped romaine lettuce, including salads and salad mixes containing chopped romaine lettuce, from the Yuma, Arizona growing region.
  • Restaurants and retailers should ask their suppliers about the source of their chopped romaine lettuce.

That’s right, consumers, it’s up to you.

It should be up to the restaurant or retailer, who markets food safety at point-of-purchase.

And LGMA, which covers Yuma growing, should be forthcoming about risks, rather than blowing themselves in nonsensical tweets.

White Hart Inn implicated in a foodborne outbreak leaving 25 guests ill from a common gathering

The Food Standards Agency awarded the White Hart Inn a 1-star rating after a foodborne outbreak incident left 2 people hospitalized and others ill from a gathering.

Inspections are a snap shot in time, what did the previous inspections look like for this facility? Any trends identified?

When I was in the field, I had to contend with a severe lack of resources to conduct my work adequately, meaning that a high risk establishment that should have been inspected 4 -6 times within a given year may have seen 1 inspection.

What’s the point?

Staff accordingly, provide the necessary resources to conduct a proper health inspection and ensure management supports your endeavors. It’s about quality not quantity.

Richard Duggan of Essex Live reports:

He said they are still trying to work out what happened
A businessman who runs a country pub has spoken out after a number of his customers contracted a nasty sickness bug.
The White Hart Inn, in Swan Lane, Margaretting Tye, has recently been scrutinised by food hygiene inspectors after the majority of a party became ill following a meal on February 18.
Of the 33 guests who attended the meal, 25 became ill following the outing, with two having to go to hospital because their symptoms were so severe.
Owing to the number of individuals who became sick, Public Health England and Chelmsford Environmental Health launched an investigation.
Following the episode, the pub’s owner, Saran Duffy, has explained how the incident has affected the business and what plans are being put in place to address customers’ concerns.
“All I’m trying to do is run a business here and employ people,” he said.
“We had our food tested – it all passed with flying colours.

What food was tested? Was there remaining food from the day of the incident or new batch?

“In terms of food poisoning, we are not sure how that happened – I’m not saying anybody else is at fault.”
Mr Saran states that tests conducted as part of the inspection of the premises following the outbreak found the restaurant’s food was “safe”.
Statement from a Chelmsford City Council spokesperson following the sickness outbreak
“Chelmsford City Council and Public Health England (PHE) have been made aware that a number of people attending a celebratory meal at an Ingatestone pub suffered with symptoms common with infectious gastroenteritis, although this is yet to be confirmed.
“Chelmsford Environmental Health Officers have been working with PHE and the pub to provide hygiene and infection control advice to help stop the illness spreading.
“PHE has also advised the cases that are poorly what to do to aid recovery and prevent them spreading the germ to others.”
Michele Dawes, from Cranham, was a member of the party that visited the White Hart Inn and then became ill.
“I was ill for five days, really dreadful and some were hit harder than others,” she said.
“It was non-stop for eight hours at a time. Some people just had diarrhoea, some had sickness, some had both. A lot of people were both.
The White Hart Inn is in Margaretting, Ingatestone
“If you have seen that scene from Bridesmaids and there is three of us in our house.”
The large group met for lunch, but following the meal, many fell ill with stomach cramps, vomiting and diarrhoea over the following days.
It is believed that the customers suffered with symptoms common with infectious gastroenteritis, although this is yet to be confirmed through the investigation.
What is infectious gastroenteritis?
Gastroenteritis is the inflammation of the guy caused by a virus or bacteria and a type of highly-infectious virus that can be spread. The symptoms are usually connected with sickness and diarrhoea and similar to food poisoning.
The symptoms:
Sudden diarrhoea
Feeling sick (nausea)
Being sick (vomiting)
Stomach ache or cramps
A high temperature of 38C or above
They usually start a few hours or days after picking up a bug.
Michelle contacted the pub after becoming ill and it was later revealed that two staff members had become unwell around the same time.
“When you’re that ill the last thing you want to do is pick up the phone,” she added.
“Everyone is okay, thats the main thing, I took it very seriously.
“The pub has done everything they could to help, I want to stress that.
“It’s a lovely pub and they were lovely about it.”
Once news of the sickness had spread, it had a knock-on effect of the pub’s business.
An inspection of the pub by officers from the Food Standards Agency on February 20 resulted in the business being awarded a one star rating, which means major improvement is necessary.
How are the food hygiene ratings for businesses decided?
There are three categories which make up a food hygiene rating.
Each one is individually graded and adds to the overall score for a business.
Overall ratings can be scored from zero to five.
Below is the most recent food hygiene rating for The White Hart:
Area inspected by food safety officer
Standards found
Hygienic food handling
Hygienic handling of food including preparation, cooking, re-heating, cooling and storage
Improvement necessary
Cleanliness and condition of facilities and building
Cleanliness and condition of facilities and building (including having appropriate layout, ventilation, hand washing facilities and pest control) to enable good food hygiene
Generally satisfactory
Management of food safety
System or checks in place to ensure that food sold or served is safe to eat, evidence that staff know about food safety, and the food safety officer has confidence that standards will be maintained in future.
Major improvement necessary
The pub has been awarded a rating of one star which means major improvement is necessary.
Despite the decision, Mr Saran is confident that changes made in the wake of the scandal will result in a more satisfactory rating, but accepts that he cannot “hasten” the re-inspection.
“They could revisit on any day but we will be prepared for it,” he added.
“We should be able to recover our rating from one star, otherwise it’s going to be a very difficult summer for everyone.
“I can only put my hands up and say we are trying and have everything we can within the remit of the environment agency and we look forward to their next visit.”
The White Hart Inn currently has an average rating of 4.5 stars from customers who have left reviews on Trip Advisor.

Mulit-state E. coli outbreak, source not yet identified

Kaitlyn Naples of KPAX reports:

A case of E.coli has been linked to 17 cases of sickness reported in several states, including two in Connecticut.
Officials from the Centers for Disease Control said the illnesses are linked to an outbreak of a “Shiga toxin-producing E. coli O157:H7 infections.”
Officials from the CDC, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture’s Food Safety and Inspection Service are investigating the recent outbreak.
No specific food item, grocery store, or restaurant chain has been identified as a source of the infections, health officials said.
“Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 41. Among ill people, 65% are female,” officials said.
A statement was released from Dr. Matthew Cartter from Connecticut Department of Public Health, which said in part, “We are assisting the CDC in investigating a multi-state outbreak of E. coli O157:H7 infections. It is still early in the investigation and no specific source of the infection has been identified so far. Most people infected with E. coli will develop diarrhea, severe stomach cramps and vomiting within 3-4 days of swallowing the germ. People who develop symptoms of E. coli, should seek medical care, contact their local health department to report the illness, and try to track what foods were eaten and restaurants visited in the days prior to becoming ill.”
No deaths have been reported.

17 sick in 7 states with E. coli O157:H7: Source not yet identified

CDC, several states, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture’s Food Safety and Inspection Service are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections. The investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. CDC is not recommending that consumers avoid any particular food at this time. Restaurants and retailers are not advised to avoid serving or selling any particular food. CDC will provide more information as it becomes available.

As of April 9, 2018, 17 people infected with the outbreak strain of E. coli O157:H7 have been reported from 7 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 41. Among ill people, 65% are female. Six ill people have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.