On Salmonella, go with science or rapper who craves Honey Smacks?

Joshua Espinoza of Complex writes that Boosie Badazz is in disbelief over the 2018 Honey Smacks recall.

Just days after it was announced that the beloved cereal was linked to 73 salmonella outbreaks in 31 states, the Baton Rouge rapper went to social media demanding further proof of the reported contamination.

“I just got home and my kids told me some shit about Honey Smacks are no longer available. I don’t if this true, but I’m pissed. I need proof,” he said in an Instagram video. “I think somebody might be tryin’ to fuck with me […] They say it’s full of salmonella, they were sayin’ something—well I’m full of salmonella!”

Boosie’s love for Honey Smacks has been well documented over the years. There are a number of videos of the rapper doing nothing more than grubbing on the puffed wheat breakfast cereal.

“I need proof, man. Fuck that. They just can’t take them off the market,” he goes on in the video. “I need proof. Somebody DM proof. The scientists, somebody, DM me some proof.”

How badazz is it to eat a kid’s cereal?

60 sick: Multistate outbreak of Salmonella Adelaide infections linked to pre-cut melon

The U.S. Centers for Disease Control (CDC) reports on June 8, 2018, Caito Foods, LLC recalled fresh cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing one of these melons produced at the Caito Foods facility in Indianapolis, Indiana.

Recalled products were distributed to Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, and Ohio.

Recalled products were sold in clear, plastic clamshell containers at Costco, Jay C, Kroger, Payless, Owen’s, Sprouts, Trader Joe’s, Walgreens, Walmart, and Whole Foods/Amazon.

The investigation is ongoing to determine if products went to additional stores or states.

Do not eat recalled products. Check your fridge and freezer for them and throw them away or return them to the place of purchase for a refund.

If you don’t remember where you bought pre-cut melon, don’t eat it and throw it away.

Retailers should not sell or serve recalled pre-cut melon products distributed by Caito Foods Distribution, Gordon Food Service, and SpartanNash Distribution.

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating an outbreak of Salmonella Adelaide infections in five Midwestern states.

60 people infected with the outbreak strain have been reported.

31 people have been hospitalized, and no deaths have been reported.

Epidemiologic and preliminary traceback evidence indicates that pre-cut melon supplied by Caito Foods, LLC of Indianapolis, Indiana is a likely source of this multistate outbreak.

Most of the ill people reported eating pre-cut cantaloupe, watermelon, or a fruit salad mix with melon purchased from grocery stores.

Information collected from stores where ill people shopped indicates that Caito Foods, LLC supplied pre-cut melon to these stores.

Illnesses started on dates ranging from April 30, 2018, to May 28, 2018. Ill people range in age from less than 1 year to 97, with a median age of 67. Sixty-five percent are female. Out of 47 people with information available, 31 (66%) have been hospitalized. No deaths have been reported.

Illnesses that occurred after May 20, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks.

CDC will provide updates when more information is available.

A table of cantaloupe/rockmelon outbreaks is available at  http://www.barfblog.com/wp-content/uploads/2018/03/Cantaloupe-Related-Outbreaks-3-8-18.xlsx.

124 sick so far this year: Seriously stop cuddling your chicks, they’re Salmonella factories

I’ve said it many times before, and will say it again: Stop cuddling your chicks.

The backyard chicken kind.

The U.S. Centers for Disease Control (CDC) and multiple states are investigating several multistate outbreaks of Salmonella infections linked to contact with live poultry in backyard flocks.

Several different types of Salmonella bacteria have made people sick: Salmonella Seftenberg, Salmonella Montevideo, Salmonella Infantis, Salmonella Enteritidis, Salmonella Indiana, and Salmonella Litchfield.

As of June 1, 2018, 124 people infected with the outbreak strains of Salmonella have been reported from 36 states.

Illnesses started on dates ranging from February 2, 2018 to May 14, 2018.

21 ill people have been hospitalized, and no deaths have been reported.

31% of ill people are children younger than 5 years.

Epidemiologic, traceback, and laboratory findings link these outbreaks to contact with live poultry, such as chicks and ducklings, which come from multiple hatcheries.

In interviews, 55 (74%) of 74 ill people with information available reported contact with chicks or ducklings in the week before their illness started.

People reported obtaining chicks and ducklings from several sources, including feed supply stores, websites, hatcheries, and from relatives.

Seventy outbreaks of Salmonella infections have been linked to contact with backyard flocks since 2000[PDF – 887KB]. In 2017, CDC reported the largest number of illnesses ever recorded linked to backyard flocks.

People can get sick with Salmonella infections from touching live poultry or their environment. These birds can be carrying Salmonella bacteria but appear healthy and clean and show no signs of illness.

Follow these tips to stay healthy with your backyard flock:

Always wash hands thoroughly with soap and water right after touching live poultry or anything in their environment.

Don’t let children younger than 5 years handle or touch live poultry without adult supervision.

Set aside a pair of shoes to wear while taking care of your birds and keep those outside of your home.

Do not let live poultry inside the house, in bathrooms, or especially in areas where food or drink is prepared, served, or stored, such as kitchens or outdoor patios.

For a complete list of recommendations, visit the Healthy Pets, Healthy People website section on backyard poultry

And don’t sleep with your chicks.

Depression sucks: CDC doctor who vanished for months before being found in a river killed himself by drowning

I sometimes think of going for a walk into the river.

It’s close, it’s convenient, it has bull sharks, I wouldn’t last long.

Dr. Timothy Cunningham from his facebook photos

But then I get on with my day, in whatever fragmented version of myself that may be.

When you hear your psychiatrist phoning in a prescription and characterizes you (me) as suffering from severe depression, it sorta hits home.

It sucks for my family, and I’m sorry for that.

I’m going through a lot of death that happened almost 40 years ago, but trying to deal with it and move on.

It ain’t easy, and it ain’t easy on those around me.

A U.S. Center for Disease Control doctor who vanished in February drowned himself and was pulled from an Atlanta river about two months after going missing, authorities now believe.

The Fulton County Medical Examiner’s Office classified Dr. Timothy Cunningham‘s death as “suicide by drowning,” though it remains unclear how exactly he first entered the water.

Cunningham, a Harvard-educated epidemiologist with the U.S. Centers for Disease Control and Prevention, was last seen alive leaving work Feb. 12, after complaining that he felt ill.

On April 3 — after much fruitless searching and mystery, some of which spawned wild and since-debunked conspiracy theories — his body was pulled from the Chattahoochee River.

The chief medical examiner, Dr. Jan Gorniak, told The Atlanta Journal-Constitution that toxicology testing found marijuana in Cunningham’s system, but there were no other significant findings.

His body showed no other signs of trauma, according to authorities.

According to the autopsy report, Cunningham’s parents told police that he did have frequent mood swings but that he had never been officially diagnosed with depression or any other mental illness.

The scientist, 35, was a team leader in the U.S. Public Health Service Commissioned Corps. His career had been marked by accomplishments including co-authoring 28 publications, focusing on how health issues affect minorities. He also worked on numerous public health emergencies, including the Ebola outbreak and the Zika virus.

“Tim was always the golden boy,” a colleague at the CDC previously told PEOPLE.

In his position Cunningham prominently studied heath patterns related to race, gender and geography. For his work, the Atlanta Business Chronicle featured him last October as one of its “40-Under-40” rising stars in the region.

“He expressed a strong desire to improve the health of others,” journalist Tonya Layman, who interviewed Cunningham for his Chronicle profile, told PEOPLE. “I was really impressed with his intellect and his passion for the work he was doing.”

We’re all just people.

The produce problem: Ingredient analysis at restaurants in Cyclospora outbreaks

By Sept. 2017, the U.S. Centers for Disease Control reported that almost 1,000 people had laboratory-confirmed cases of cyclosporiasis for the year.

Another banner year for the parasite famously associated with Guatemalan raspberries in 1996.

During July 21–August 8, 2017, the Texas Department of State Health Services (DSHS) was notified of 20 cases of cyclosporiasis among persons who dined at a Mediterranean-style restaurant chain (chain A) in the Houston area. On August 10, 2017, DSHS requested assistance from CDC to support ongoing investigations by the City of Houston Health Department, Harris County Public Health, Fort Bend County Health and Human Services, and Brazoria County Health Department. The objectives of this investigation were to determine the source of the illnesses in the Houston area and to generate hypotheses about the source of the national increase in cyclosporiasis in 2017.

Chain A has four locations in the Houston area and a central kitchen where many dishes are prepared. A case-control study was performed using a menu-specific questionnaire focusing on items containing fresh produce. A confirmed case was defined as laboratory-confirmed Cyclospora infection and clinically compatible illness in a person who ate at any location of chain A during May 28–July 15, 2017. A probable case was defined as diarrhea and at least one additional sign or symptom compatible with cyclosporiasis (e.g., anorexia, abdominal cramping, bloating, myalgia, fatigue, vomiting, or low-grade fever) in a person within 2 weeks after dining at chain A during May 28–July 15, 2017. Controls were identified as either dining companions of case-patients who had no illness or patrons who dined at the same chain A location within 2 days of a case-patient visit and who had no illness. For controls identified by the latter method, contact information was obtained using commercially available databases used by local health agencies in Texas. Three controls per case-patient were recruited.

A total of 22 case-patients (16 confirmed and six probable) and 66 controls were enrolled in the study. Case-patients had a median age of 52 years (range = 29–79 years); 50% were female. Analysis compared menu items consumed by case-patients and controls, followed by ingredient-level analysis. The following ingredients were identified as being significantly associated with illness: green onions (matched odds ratio = 11.3; 95% confidence interval = 2.55–104.68), tomatoes (5.5; 1.2–51.7), red onions (4.7; 1.3–21.0), and cabbage (4.0; 1.1–15.9). When analysis was limited to the 16 confirmed case-patients and their corresponding 48 controls, only green onions remained significantly associated with illness (17.6; 2.5–775.7). Restaurant invoices from chain A were collected for all items identified during the epidemiologic investigation, but efforts to trace any food item to its source were inconclusive. Although the current study identified potential foods associated with illness in Texas, investigators were not able to identify the illness source or confirm whether the patients within the chain A subcluster had consumed a product reported by other ill persons in the United States.

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis. Since 2013, the United States has experienced annual increases in the incidence of cyclosporiasis incidence during the summer months, with some illnesses linked to imported produce (1–3). Molecular subtyping of Cyclospora is not currently available; therefore, identification of an ingredient associated with a particular illness subcluster might provide information about a source contributing to other cyclosporiasis illnesses. Previous U.S. outbreaks of cyclosporiasis have been linked to fresh produce, such as prepackaged salad mix, raspberries, and cilantro (3,4). Identification of a vehicle for Cyclospora is complicated by the short shelf life of fresh produce as well as the use of potential vehicles such as garnishes or mixtures with other items that could also harbor the parasite. Ingredient-level analysis within restaurant clusters and subclusters therefore remains critical in Cyclospora outbreak investigations.

Notes from the field: Cyclosporiasis cases associated with dining at a Mediterranean-style restaurant chain- Texas 2017

1.jun.18 CDC

Amelia A. Keaton, MD1,2; Noemi Borsay Hall, PhD2,3; Rebecca J. Chancey, MD2,4; Vivienne Heines, MPH3; Venessa Cantu, MPH3; Varsha Vakil, MPH5; Stephen Long, MD5; Kirstin Short, MPH5; Elya Franciscus, MPH6; Natasha Wahab, MPH6; Aisha Haynie, MD6; Laura Gieraltowski, PhD2; Anne Straily, DVM4

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a5.htm

5 dead, 197 sick from E. coli O157 linked to romaine lettuce

The U.S. Centers for Disease Control reports there are now five people dead and 197 sick from E. coli O157:H7 linked to romaine lettuce.

  • 197 people infected with the outbreak strain of E. coli O157:H7 have been reported from 35 states.
  • 89 people (48%) have been hospitalized, including 26 people who have developed hemolytic uremic syndrome.
  • 5 deaths have been reported from Arkansas (1), California (1), Minnesota (2), and New York (1).
  • Illnesses started on dates ranging from March 13, 2018 to May 12, 2018.
  • Ill people range in age from 1 to 88 years, with a median age of 29.
  • Sixty-eight percent of ill people are female.

The Public Health Agency of Canada has identified people in several Canadian provinces infected with the same DNA fingerprint of E. coli O157:H7.

It takes two to three weeks between when a person becomes ill with E. coli and when the illness is reported to CDC. Most of the people who recently became ill ate romaine lettuce when lettuce from the Yuma, Arizona, growing region was likely still available in stores, restaurants, or in peoples’ homes. Some people who became sick did not report eating romaine lettuce, but had close contact with someone else who got sick from eating romaine lettuce.

According to the U.S. Food and Drug Administration, the last shipments of romaine lettuce from the Yuma growing region were harvested on April 16, 2018, and the harvest season is over. It is unlikely that any romaine lettuce from the Yuma growing region is still available in people’s homes, stores, or restaurants due to its 21-day shelf life.

The traceback investigation indicates that the illnesses associated with this outbreak cannot be explained by a single grower, harvester, processor, or distributor. While traceback continues, the FDA will focus on trying to identify factors that contributed to contamination of romaine across multiple supply chains.  The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching consumers. 

The FDA has identified Harrison Farms of Yuma, Arizona, as the grower and sole source of the whole-head romaine lettuce that sickened several people in an Alaskan correctional facility, but has not determined where in the supply chain the contamination occurred.

On May 31, 2018 the FDA released a blog with updated information on the traceback investigation (for additional information, visit FDA Update on Traceback Related to the E. coli O157:H7 Outbreak Linked to Romaine Lettuce).

A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

Playing in water, is it making you barf?

The U.S. Centers for Disease Control reports that outbreaks associated with treated recreational water can be caused by pathogens or chemicals.

During 2000–2014, 493 outbreaks associated with treated recreational water caused at least 27,219 cases and eight deaths. Outbreaks caused by Cryptosporidium increased 25% per year during 2000–2006; however, no significant trend occurred after 2007. The number of outbreaks caused by Legionella increased 14% per year.

The aquatics sector, public health officials, bathers, and parents of young bathers can take steps to minimize risk for outbreaks. The halting of the increase in outbreaks caused by Cryptosporidium might be attributable to Healthy and Safe Swimming Week campaigns.

Outbreaks associated with treated recreational water — United States, 2000–2014

18.may.18

Centers for Disease Control and Prevention

Michele C. Hlavsa, MPH; Bryanna L. Cikesh, MPH; Virginia A. Roberts, MSPH; Amy M. Kahler, MS; Marissa Vigar, MPH; Elizabeth D. Hilborn, DVM; Timothy J. Wade, PhD; Dawn M. Roellig, PhD; Jennifer L. Murphy, PhD; Lihua Xiao, DVM, PhD; Kirsten M. Yates, MPH; Jasen M. Kunz, MPH; Matthew J. Arduino, DrPH; Sujan C. Reddy, MD; Kathleen E. Fullerton, MPH; Laura A. Cooley, MD; Michael J. Beach, PhD; Vincent R. Hill, PhD; Jonathan S. Yoder, MPH

https://www.cdc.gov/mmwr/volumes/67/wr/mm6719a3.htm

84 now sick with E. coli O157:H7 linked to romaine lettuce

According to the U.S. Centers for Disease Control, 31 more ill people from 10 states were added to this investigation since the last update on April 18, 2018.

Three more states have reported ill people: Colorado, Georgia, and South Dakota.

The most recent illness started on April 12, 2018. Illnesses that occurred in the last two to three weeks might not yet be reported because of the time between when a person becomes ill with E. coli and when the illness is reported to CDC.

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

The investigation has not identified a common grower, supplier, distributor, or brand of romaine lettuce.

Do not eat or buy romaine lettuce unless you can confirm it is not from the Yuma, Arizona, growing region.

Product labels often do not identify growing regions; so, do not eat or buy romaine lettuce if you do not know where it was grown.

This advice includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce. If you do not know if the lettuce in a salad mix is romaine, do not eat it.

Do not serve or sell any romaine lettuce from the Yuma, Arizona growing region. This includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce.

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

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing Escherichia coliO157:H7 (E. coli O157:H7) infections.

Eighty-four people infected with the outbreak strain of E. coli O157:H7 have been reported from 19 states.

Forty-two people have been hospitalized, including nine people who have developed a type of kidney failure called hemolytic uremic syndrome.

No deaths have been reported.

A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

105 sickened, 1 death linked to Salmonella Newport outbreak originating in beef from dairy cattle, 2016-17

Contaminated ground beef was the likely source of a protracted outbreak of 106 Salmonella Newport infections, 42 hospitalizations, and one death in 21 states during October 2016–July 2017. While no direct link was found, whole genome sequencing suggests dairy cows were the ultimate outbreak source.

Foodborne outbreak investigations could be enhanced by improvements in the traceability of cows from their originating farms or sale barns, through slaughter and processing establishments, to ground beef sold to consumers.

In January 2017, the U.S. Centers for Disease Control (CDC) identified a cluster of Salmonella enterica serotype Newport infections with isolates sharing an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern, JJPX01.0010 (pattern 10), through PulseNet, the national molecular subtyping network for foodborne disease surveillance. This report summarizes the investigation by CDC, state and local health and agriculture departments, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) and discusses the possible role of dairy cows as a reservoir for strains of Salmonella that persistently cause human illness. This investigation combined epidemiologic and whole genome sequencing (WGS) data to link the outbreak to contaminated ground beef; dairy cows were hypothesized to be the ultimate source of Salmonella contamination.

A case was defined as infection with Salmonella Newport with PFGE pattern 10 closely related to the outbreak strain by WGS, with bacterial isolation during October 1, 2016, through July 31, 2017. A total of 106 cases were identified in 21 states (Figure 1). Most illnesses ([72%]) were reported from southwestern states, including Arizona (30), California (25), New Mexico (14), and Texas (seven). Illness onset dates ranged from October 4, 2016, through July 19, 2017. Patients ranged in age from <1–88 years (median = 44 years), and 53 (50%) were female. Among 88 (83%) patients with known outcomes, 42 (48%) were hospitalized, and one died.

Initial interviews identified consumption of ground beef as a common exposure among patients. A focused questionnaire was developed to collect detailed information on ground beef exposure and to obtain shopper card information and receipts. Among 65 interviewed patients, 52 (80%) reported eating ground beef at home in the week before illness began. This percentage was significantly higher than the 2006–2007 FoodNet Population Survey, in which 40% of healthy persons reported eating ground beef at home in the week before they were interviewed (p<0.001) (1). Among the 52 patients who ate ground beef at home, 31 (60%) reported that they bought it or maybe bought it from multiple locations of two national grocery chains, and 21 (40%) reported that they bought ground beef from locations of 15 other grocery chains. Specific ground beef information was available for 35 patients. Among these, 15 (43%) purchased ground beef as chubs (rolls) of varying sizes (range = 2–10 lbs), 18 purchased it on a tray wrapped in plastic, and two purchased preformed hamburger patties. Twenty-nine patients reported that they bought fresh ground beef, four bought frozen ground beef, and four did not recall whether it was fresh or frozen when purchased. When asked about ground beef preparation, 12 (36%) of 33 patients reported that they definitely or possibly undercooked it.

Traceback Investigation

USDA-FSIS conducted traceback on ground beef purchased within 3 months of illness onset for 11 patients who provided shopper card records or receipts. Approximately 20 ground beef suppliers belonging to at least 10 corporations were identified; 10 of the 11 records traced back to five company A slaughter/processing establishments, seven of 11 traced back to five company B slaughter/processing establishments, and four of 11 traced back to two company C slaughter/processing establishments.

Product and Animal Testing

Opened, leftover samples of ground beef from three patients’ homes were collected for testing. All were purchased from one of two national grocery chains that had been identified by a majority of patients. One sample, collected from ground beef removed from its original packaging, yielded the outbreak strain. The other two samples did not yield Salmonella.

The outbreak strain was also isolated from four New Mexico dairy cattle. One was collected from a spontaneously aborted fetus in July 2016, and one was isolated from feces from a young calf in November 2016. The third isolate was identified by searching the USDA Animal and Plant Health Inspection Service National Veterinary Services Laboratory (USDA-APHIS NVSL) database for Salmonella Newport isolates collected from cattle in Arizona, California, Texas, New Mexico, and Wisconsin during January 2016–March 2017. Eighteen Salmonella Newport isolates were identified, including 13 from Texas, three from New Mexico, and two from Wisconsin. The only Salmonella Newport pattern 10 isolate identified was from a fecal sample from a New Mexico dairy cow collected during November 2016. The fourth isolate was from a USDA-FSIS routine cattle fecal sample collected at a Texas slaughter establishment in December 2016; USDA-FSIS determined the sample was from a dairy cow and identified the New Mexico farm of origin. Because of confidentiality practices, officials were not able to identify the farm or farms of origin for the dairy cows associated with the other three samples or whether the four dairy cows were associated with a single farm. None of the 11 patients with information for traceback ate ground beef produced at the Texas slaughter establishment.

Whole genome high-quality single nucleotide polymorphism (SNP) analysis* showed that 106 clinical isolates were closely related to each other genetically, to the four dairy cattle isolates, and to the leftover ground beef isolate (range = 0–12 SNP differences), suggesting that the Salmonella bacteria found in patients, ground beef, and dairy cattle all shared a common source. Thirty-nine additional clinical isolates with PFGE pattern 10 were determined to not be closely related and were excluded from the outbreak. No antibiotic resistance was detected among three clinical isolates tested by CDC’s National Antimicrobial Resistance Monitoring Laboratory.

Because the USDA-FSIS traceback investigation did not converge on a common production lot of ground beef or a single slaughter/processing establishment, and no ground beef in the original packaging yielded the outbreak strain, a recall of specific product was not requested. A public warning was not issued to consumers because specific, actionable information was not available (e.g., a specific brand or type of ground beef). Officials in New Mexico visited the dairy farm that was the source of the cow at the Texas establishment and noted no concerns about conditions or practices. However, this visit occurred late in the investigation, and conditions at the time of the visit might not have represented those present immediately before and during the outbreak. No samples from the environment or cows were collected during this visit.

Epidemiologic and laboratory evidence indicated that contaminated ground beef was the likely source of this protracted outbreak of Salmonella Newport infections. A significantly higher percentage of patients than expected ate ground beef at home, and a patient’s leftover ground beef yielded the outbreak strain. Dairy cows colonized or infected with the outbreak strain before slaughter are hypothesized to be the ultimate outbreak source. Most U.S. ground beef is produced from beef cattle; however, 18% is produced from dairy cows (2). Dairy cows are sold for beef production through sale barns or directly to slaughter establishments as they age or if their milk production is insufficient (2). Previous studies have demonstrated long-term persistence of Salmonella Newport in dairy herds (3,4), and a 1987 Salmonella Newport outbreak was linked to contaminated ground beef from slaughtered dairy cows (5). In the current outbreak, as has been observed in previous outbreaks, ground beef purchases traced back to numerous lots and slaughter/processing establishments (6). One possible explanation is that dairy cows carrying a high Salmonella load that overwhelmed antimicrobial interventions could have gone to multiple slaughter/processing establishments (7), resulting in contamination of multiple brands and lots of ground beef. This might explain the reason for failure to identify a single, specific source of contaminated ground beef.

This investigation identified the outbreak strain only in samples from dairy cattle from New Mexico. All four isolates from dairy cattle samples were closely related genetically by WGS to isolates from patients, providing further evidence of a connection between dairy cattle in New Mexico and the outbreak. The disproportionate geographic distribution of cases in the U.S. Southwest, including New Mexico, also suggests a possible regional outbreak source. Although limited in scope, the query of the USDA-APHIS NVSL data identified the outbreak strain only from one New Mexico dairy cow (isolate 3), and the sample collection date was consistent with the timing of illnesses in this outbreak. The overall prevalence and geographic distribution of the outbreak strain in cattle is not known, and it is possible that cattle in states other than New Mexico might have been infected or colonized with the outbreak strain.

This was a complex and challenging investigation for several reasons. First, the PFGE pattern in the outbreak was not uncommon in PulseNet, making it difficult to distinguish outbreak cases from sporadic illnesses associated with the same Salmonella Newport pattern. WGS analysis provided more discriminatory power to refine the outbreak case definition and excluded 39 cases of illness from the outbreak. However, sequencing is not currently performed in real time for Salmonella, thereby slowing the process of determining which cases were likely outbreak-associated. In addition, a direct pathway linking outbreak cases to dairy cows infected with the outbreak strain of Salmonella Newport could not be established. This is because product traceback did not converge on a single contaminated lot of ground beef, and investigators were unable to ascertain a link between the beef slaughter/processing establishments identified during traceback and the farms with dairy cows that yielded the outbreak strain. Tracing back ground beef purchased by patients to slaughter/processing establishments requires documentation such as receipts or shopper card records, and only 10% of patients had this information available. For this outbreak, tracing back cows at slaughter/processing establishments to the farm from which they originated was problematic because cows were not systematically tracked from farm to slaughter/processing establishments.

Four points along the “farm to fork” continuum provide opportunities to prevent consumers from becoming ill from contaminated ground beef. First, farms can implement good management practices for cattle health, including vaccination, biosecurity (e.g., controlling movement of persons and animals on farms, keeping a closed herd [so that no animals on the farm are purchased, loaned to other farms, or have contact with other animals], planning introduction of new animals and quarantining them, and performing microbiologic testing of animals), and cleaning and disinfection measures to decrease Salmonella burden in animals and the environments in which they reside, reducing the likelihood that Salmonella will enter beef slaughter/processing establishments (8). Second, slaughter/processing establishments are required to maintain Hazard Analysis and Critical Control Points systems to reduce Salmonella contamination as well as slaughter and sanitary dressing procedures to prevent carcass contamination (9). Third, although Salmonella is not considered an adulterant in not-ready-to eat (NRTE) meat products, USDA-FSIS likely will consider the product to be adulterated when NRTE meat products are associated with an outbreak (9). Finally, consumers are advised to cook ground beef to 160°F (71°C) as measured by a food thermometer to destroy any bacteria that might be present. Consumers are also advised to wash hands, utensils, and surfaces often; separate and not cross-contaminate foods; and refrigerate foods promptly and properly.

This investigation emphasizes the utility of WGS during outbreak investigations and identifies the need for improvements in traceability from the consumer to the farm. It also highlights the importance of continued evaluation of farm practices to help reduce persistent Salmonella contamination on farms, contamination of ground beef, and ultimately human illness.

Protracted outbreak of Salmonella Newport infections linked to ground beef: Possible role of Dairy Cows-21 states, 2016-2017

CDC

https://www.cdc.gov/mmwr/volumes/67/wr/mm6715a2.htm

Kis Robertson Hale, Food Safety and Inspection Service, U.S. Department of Agriculture; territorial, state, city, and county health departments and laboratories; Danya Alvarez, John Crandall, Hillary Berman-Watson, California Department of Public Health Microbial Diseases Laboratory.

 

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.