Raw is risky: ‘Not aware this was remotely possible’ Father of toddlers critically sickened by E. coli linked to raw milk in Tenn.

I started the Food Safety Network (the original FSN) as an incoming graduate student in 1993 in the wake of the Jack-in-the-Box outbreak, combining my science and journalism learnings, and because a constant refrain I observed was, I never knew foodborne illness could be so serious.

That’s why I continue to do it as a form of community service (I haven’t been paid since 2016).

There are now at least 15 children sick with E. coli in Tennessee that has now been linked to consumption of raw milk from French Broad Farm.

According to Kristi L Nelson of Knox News, Jordan and Stephanie Schiding wanted to give their children every health advantage.

That’s the reason the Schidings, two months ago, signed up for a local cow-share program after they read about the health benefits of unpasteurized milk.

Instead, 18-month-old Genevieve and 3-year-old Anthony contracted an illness caused by E. coli bacteria and ended up with kidney failure in the pediatric intensive care unit at East Tennessee Children’s Hospital — two of 12 local children hospitalized with E. coli since the end of May.

Knox County Health Department staff told the Schidings the E. coli infection was likely linked to the consumption of raw milk from French Broad Farm. On Thursday, the health department lifted its directive that requested French Broad Farm temporarily cease operations. But health department Director Dr. Martha Buchanan reiterated that consuming raw milk is always risky and health officials recommend the public consume only pasteurized milk and dairy products.

Jordan Schiding said he and his wife knew there was “potential” for food poisoning from unpasteurized milk, which both adults drank with seemingly no serious effects, but “we were definitely not aware that anything like this was remotely possible.”

The Schiding children seem to have turned a corner, he said, with Anthony discharged Friday afternoon and Genevieve still hospitalized but out of intensive care.

But what started as a supposed stomach bug May 31 turned into a terrifying experience that traumatized both the children and their parents, who had to watch them suffer.

Schiding said the family brought Genevieve to the emergency room at Children’s Hospital May 31 after she became seriously dehydrated with diarrhea and vomiting. As she was being admitted, Anthony also began vomiting.

The hospital rehydrated the children and discharged them a few hours later. Schiding believes they were among the first children related to the current cluster of E. coli cases to come to Children’s Hospital.

Two days later, after both children continued to get sicker, the Schidings brought them back to the hospital. This time, hospital staff took a stool sample from Genevieve, which tested positive for E. coli, and then from Anthony, who also tested positive. Both children were admitted, and Knox County Health Department contacted the couple the next day, he said.

The Schidings knew little about E. coli; certain strains produce a toxin, Shiga, that can cause a chain of reactions in the body — hemolytic uremic syndrome — resulting in clots in the small blood vessels in the kidneys that cause kidney failure. The very young, the very old and people whose immune systems are already compromised are more susceptible to HUS.

Four children admitted to Children’s so far have had HUS, including Genevieve and Anthony. Though Anthony wasn’t quite as sick as his sister, both had surgery to implant central lines so they could get fluids, dialysis and blood transfusions, Schiding said. Anthony had three days of dialysis, Genevieve seven.

In addition, Anthony’s central lines became infected with staph, Schiding said, but the antibiotics typically prescribed to treat staph are too hard on the kidneys to give a child with HUS, so doctors had to use a less common medication, which has seemed to work.

“Obviously, we were freaked out a little bit,” Schiding said. “It seemed like he had started turning the corner” until he spiked a fever of 104.9 and tested positive for staph.

Schiding said his family no longer will consume raw milk.

Raw is risky: Netherlands study finds STEC and Campylobacter in dairy goats and dairy sheep, shows importance of pasteurization

Researchers with the Dutch National Institute for Public Health and the Environment (RIVM) and the Dutch Food and Consumer Product Safety Authority (NVWA) shows that two types of bacteria that can cause diarrhea in humans ( STEC and Campylobacter) are common in dairy goat farms and dairy sheep farms, according to a RIVM press release (computer translated).

According to Outbreak News Today, in the animal study, 181 dairy goat farms and 24 dairy sheep farms were examined. STEC (Shiga-toxin-producing E. coli) and Campylobacter was found on most. STEC appeared on virtually all the farms studied. Campylobacter has been demonstrated in one out of three goat farms (33 percent) and almost all sheep farms (96 percent). These bacteria have found much less among cattle farmers and family members.

Listeria was less common, at about 9 percent of the goat and about 17 percent of the sheep farms. The bacteria was not found in the people studied. People run the risk of becoming infected with the listeria bacteria by eating raw milk soft cheese. The study also looked at Salmonella and ESBL-producing bacteria. These were not very common on the farms surveyed.

The results show that pasteurization of milk and hygiene after visiting a dairy goat farm or dairy sheep farm is important to prevent disease.

The bacteria found are in the intestines of the animals and thus enter the manure. A small amount of manure can contaminate raw milk or raw milk cheese. Contamination can be prevented by drinking only pasteurized milk or using it in other foods. In addition, people at a farm can become infected if they have contact with the animals or their environment. Visitors can reduce the risk of illness by washing their hands after contact with the animals or their environment.

In unrelated but related news, Brandon Macz of the Monroe Monitor reports that St. John Creamery in Monroe, Washington, announced on Thursday it is voluntarily recalling raw goat milk that may be contaminated with Escherichia coli (E.coli) bacteria.

A June 14 news release states the recall was initiated after “the presence of toxin-producing E.coli in retail raw goal milk dated 6/17” was discovered during routine sampling by the Washington State Department of Agriculture.

Included in the recall are half-gallon and one-pint containers of raw goat milk marked best by June 17-21.

Raw is risky: Oysters suspected as jury awards couple $6.7 million in Tampa food poisoning

Jonathan Capriel of Tampa Bay reports a jury awarded a couple $6.7 million after they got sick from eating seafood at a Tampa restaurant. The verdict came in May, years after the husband’s illness led to a rare disorder that causes paralysis and nerve damage.

Angel Martinez and his wife Maria Elena Martinez had eaten 10 times earlier at Lobster Haven, 12807 W Hillsborough Ave., when they sat down Dec. 21, 2013, for their usual — two three-pound lobsters and a dozen Bluepoint oysters, according to court records.

The couple declined to comment for this story, as did Lobster Haven owner Daniel Hall.

Attorneys for the couple said the illness was likely caused by the oysters.

“You take a risk when eating raw oysters,” said Brandon Cathey, who represented the Martinezes. “It might get you sick, but you don’t expect it to cause lifelong nerve damage.”

A few hours after the meal, the couple experienced vomiting and diarrhea, according to court records.

Maria Elena Martinez recovered in a few days, but three weeks later, her husband had to be taken by ambulance to Pasco Regional Medical Center after he collapsed on the floor at his home, according to court records.

Doctors transferred him to Tampa General Hospital, where he spent seven days in the intensive care unit, according to court records. He was paralyzed from the waist down for several months and had to learn how to walk again, according to court records.

Martinez’s foodborne illness developed into Guillain-Barre Syndrome, a rare disorder that causes the immune system to attack one’s own body.

He has recovered from the most severe symptoms of the illness but will likely feel long term effects, said his attorney Brent Steinberg.

Lobster Haven admitted it served the couple seafood that poisoned them but denied that it caused Guillain-Barre Syndrome, blaming instead a lamb that Mr. Martinez slaughtered and ate days later.

Lobster Haven’s insurance company offered to settle the case for $20,000 in 2016, Cathey said, but by then Martinez’s medical bills had reached more than $325,000, according to court records.

The restaurant had liability insurance up to $1 million and the Martinez’ likely would have settled for that amount, Cathey said.

“Now this restaurant may go out of business,” he said, “because of the way his insurance company handled this.”

Raw is risky: Salmonella growth on sprouts and microgreens

Microgreens, like sprouts, are relatively fast-growing products and are generally consumed raw. Moreover, as observed for sprouts, microbial contamination from preharvest sources may also be present in the production of microgreens.

In this study, two Salmonella enterica serovars (Hartford and Cubana), applied at multiple inoculation levels, were evaluated for survival and growth on alfalfa sprouts and Swiss chard microgreens by using the most-probable-number (MPN) method. Various abiotic factors were also examined for their effects on Salmonella survival and growth on sprouts and microgreens. Community-level physiological profiles (CLPPs) of sprout/microgreen rhizospheres with different levels of S. enterica inoculation at different growth stages were characterized by use of Biolog EcoPlates. In the seed contamination group, the ability of S. enterica to grow on sprouting alfalfa seeds was affected by both seed storage time and inoculation level but not by serovar. However, the growth of S. enterica on Swiss chard microgreens was affected by serovar and inoculation level. Seed storage time had little effect on the average level of Salmonella populations in microgreens. In the irrigation water contamination group, the growth of Salmonella on both alfalfa sprouts and microgreens was largely affected by inoculation level. Surprisingly, the growth medium was found to play an important role in Salmonella survival and growth on microgreens. CLPP analysis showed significant changes in the microbial community metabolic diversity during sprouting for alfalfa sprouts, but few temporal changes were seen with microgreens. The data suggest that the change in rhizosphere bacterial functional diversity was dependent on the host but independent of Salmonella contamination.

Sprouts and microgreens are considered “functional foods,” i.e., foods containing health-promoting or disease-preventing properties in addition to normal nutritional values. However, the microbial risk associated with microgreens has not been well studied. This study evaluated Salmonella survival and growth on microgreens compared to those on sprouts, as well as other abiotic factors that could affect Salmonella survival and growth on microgreens. This work provides baseline data for risk assessment of microbial contamination of sprouts and microgreens. Understanding the risks of Salmonella contamination and its effects on rhizosphere microbial communities enables a better understanding of host-pathogen dynamics in sprouts and microgreens. The data also contribute to innovative preventive control strategies for Salmonella contamination of sprouts and microgreens.

Plant-microbe and abiotic factors influencing salmonella survival and growth on alfalfa sprouts and Swiss chard microgreens

16 February 2018

Applied and Environmental Microbiology, vol 84 no 9

Elizabeth ReedaChristina M. Ferreiraa, Rebecca BellaEric W. Browna and Jie Zhenga

doi:10.1128/AEM.02814-17

http://aem.asm.org/content/84/9/e02814-17.abstract?etoc

Raw is risky: Norovirus outbreak linked to raw oysters rises to 126 in BC

In a follow-up on the norovirus outbreak linked to the consumption of British Columbia raw oysters, The Public Health Agency of Canada has reported that a total of 126 cases of gastrointestinal illness linked to oyster consumption have been reported in three provinces: British Columbia (92), Alberta (9), and Ontario (25). No deaths have been reported.

Ensure oysters are fully cooked before consuming them. Lightly cooking oysters does not kill norovirus. Oysters need to be cooked to an internal temperature of 90° Celsius (194° Fahrenheit) for a minimum of 90 seconds in order to kill norovirus.

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.

Going public, Salmonella-in-French-cheese-style: Morbier and Mont d’Or cheese behind 10 deaths in France, 2015-16

In a country where reporting foodborne illness is deemed unpatriotic an investigation by France Inter radio revealed that at least 10 people died in the Franche-Comté region in the east of France linked to two cheeses made from unpasteurized milk  in late 2015 and early 2016.

The investigation produced a document which showed that in January 2016 national health authorities had discovered an unusually high number of salmonella contaminations in France that was centred on Franche-Comté.

Five cheese making companies in the region, between them making 60 different brands, were later identified as being at the source of the contaminations that began in November 2015 and continued until April the following year.

In a way that is truly French in its description, those who died in the outbreak were old people who were physically weak or who suffered from another illness.

Jean-Yves Mano, the president of the CLCV consumer association, said he was surprised that a product recall had not been ordered of products that might have been infected with salmonella.

“We do not understand why a general alert was not issued by state officials, or at least information given on what precautions to take,” he told France Inter.

The state food agency, the Direction générale de l’alimentation (DGAL), said there were two reasons why a recall was not ordered.

The first was that it would have allegedly been very difficult to identify which exact brand of the cheeses were contaminated because there were a total of 60 that were produced in the cheese-making firms where the outbreak originated.

The second was that by the time the authorities found out where the outbreak had come from, the contaminated cheeses had already been consumed and the new batches in the cheesemakers’ premises were not infected.

“It is perhaps due to these two factors that this contamination was not in the media, even though all the data was public nothing was hidden,” said Fany Molin of the DGAL food agency.

That’s French-bureau-speak.

Go public: Further illnesses may be prevented; others learn; citizens may not come with torches demanding change; and it’s the right thing to do.

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public. Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough. Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

Again, 11 sick: Blame the consumer Hong Kong edition

The Centre for Health Protection (CHP) of the Department of Health is today (January 19) investigating an outbreak of food poisoning affecting 11 persons, and reminded the public to maintain personal, food and environmental hygiene to prevent food-borne diseases.

The patients, comprising one man and 10 women aged 63 to 76, developed abdominal pain, nausea, vomiting, diarrhoea and fever about 12 to 26 hours after having lunch at a restaurant at Lau Fau Shan in Yuen Long on January 7.

Five of them sought medical attention, of whom one required hospitalisation but was discharged upon treatment. The stool specimen of that patient tested positive for Vibrio parahaemolyticus. All affected persons are now in stable condition.

Cilantro has a history of shits: Produce risk modelling in India

This study estimates illness (diarrhea) risks from fecal pathogens that can be transmitted via fecal-contaminated fresh produce. To do this, a quantitative microbial risk assessment (QMRA) framework was developed in National Capital Region, India based on bacterial indicator and pathogen data from fresh produce wash samples collected at local markets.

Produce wash samples were analyzed for fecal indicator bacteria (Escherichia coli, total Bacteroidales) and pathogens (Salmonella, Shiga-toxin producing E. coli (STEC), enterohemorrhagic E. coli (EHEC)). Based on the E. coli data and on literature values for Cryptosporidium and norovirus, the annual mean diarrhea risk posed by ingestion of fresh produce ranged from 18% in cucumbers to 59% in cilantro for E. coli O157:H7, and was <0.0001% for Cryptosporidium; for norovirus the risk was 11% for cucumbers and up to 46% for cilantro. The risks were drastically reduced, from 59% to 4% for E. coli O157:H7, and from 46% to 2% for norovirus for cilantro in post-harvest washing and disinfection scenario.

The present QMRA study revealed the potential hazards of eating raw produce and how post-harvest practices can reduce the risk of illness. The results may lead to better food safety surveillance systems and use of hygienic practices pre- and post-harvest.

Quantitative microbial risk assessment to estimate the risk of diarrheal diseases from fresh produce consumption in India

Food Microbiology, January 2018

Arti Kundu, Stefan Wuertz, Woutrina Smith

DOI: 10.1016/j.fm.2018.01.017 

http://www.x-mol.com/paper/530702

Eating sushi can be risky

I dry heaved when I read this…..

Michelle Robertson of SF Gate reports

A Fresno man with a daily sushi habit had a 5.5-foot tapeworm lodged in his intestines. He pulled it out himself, wrapped it around a cardboard toilet paper tube and carried the creature into Fresno’s Community Regional Medical Center.
Kenny Bahn was the lucky doc on shift at the time. He recounted his experience on a recent episode of the podcast “This Won’t Hurt A Bit.”
Bahn said the patient complained of “bloody diarrhea” and expressed a desire to get treated for tapeworms.
“I get asked this a lot,” the doctor said. “Truthfully, a lot of times I don’t think they have it.”
This man had it, which he proved to Bahn by opening a plastic grocery bag and pulling out the worm-wrapped toilet paper tube.
Bahn then asked some questions, starting with: “That came out of your bottom?”
“Yes.” 
According to the doctor’s retelling, the patient was using the restroom when he noticed what looked like a piece of intestine hanging out of his body.
Doctors in Taiwan extracted an 8-and-a-half foot tapeworm from a girl’s intestine and believe she contracted the parasite through raw, contaminated fish.
“He grabs it, and he pulls on it, and it keeps coming out,” Bahn recounted. He then picks the thing up, “looks at it, and what does it do? It starts moving.” (Note: At this point in the podcast, the hosts audibly gasp.)
That’s when the man realized he had a tapeworm stuck in his insides. He headed to the emergency room shortly thereafter, where Bahn treated him with an anthelmintic, a single-treatment deworming medication used on humans and dogs alike.
Bahn also took it upon himself to measure the specimen on the floor of the hospital. It stretched a whopping 5 feet, 6 inches — “my height,” noted the doctor.
Tapeworms can be contracted in a variety of ways, but Bahn said his patient hadn’t traveled out of the country or engaged in any out-of-the-ordinary behavior. The man also professed his love of sushi, specifically raw salmon sashimi, which he confessed to eating daily.
Fresno is located an ample 150 miles from coastline and is not exactly famed for its sushi. The Centers for Disease Control and Prevention warned last February that the rise in popularity of raw fish consumption has likely spurred a recent increase of tapeworm infections.