Confused consumers: Canadians say E. coli in romaine outbreak is over; U.S. says it’s leafy greens

Outbreaks of foodborne illness are fraught with uncertainties.

It’s OK to admit, to do the best with the info available, and get on with things.

On January 10, 2018, the Public Health Agency of Canada reported that an outbreak of Shiga toxin-producing E. coli O157:H7 infections (STEC O157:H7) they had identified was linked to romaine lettuce appears to be over.

As of January 10, 2018, there were 42 cases of E. coli O157 illness reported in five eastern provinces. Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died.

In the United States, the Centers for Disease Control, several states, and the U.S. Food and Drug Administration continue to investigate a multistate outbreak of 24 STEC O157:H7 infections in 15 states. Since CDC’s initial media statement on December 28, seven more illnesses have been added to this investigation. The last reported illness started on December 12, 2017.

The likely source of the outbreak in the United States appears to be leafy greens, but officials have not specifically identified a type of leafy greens eaten by people who became ill.  Leafy greens typically have a short shelf life, and since the last illness started a month ago, it is likely that contaminated leafy greens linked to this outbreak are no longer available for sale. Canada identified romaine lettuce as the source of illnesses there, but the source of the romaine lettuce or where it became contaminated is unknown.

Whole genome sequencing (WGS) showed that the STEC O157:H7 strain from ill people in the United States is closely related genetically to the STEC O157:H7 strain from ill people in Canada. WGS data alone are not sufficient to prove a link; health officials rely on other sources of data, such as interviews from ill people, to support the WGS link. This investigation is ongoing. Because CDC has not identified a specific type of leafy greens linked to the U.S. infections, and because of the short shelf life of leafy greens, CDC is not recommending that U.S. residents avoid any particular food at this time.

In the United States, a total of 24 STEC O157:H7 infections have been reported. Among the 18 ill people for whom CDC has information, nine were hospitalized, including one person in California who died. Two people developed hemolytic uremic syndrome, a type of kidney failure.

The Public Health Agency of Canada identified romaine lettuce as the source of the outbreak in Canada. In the United States, the likely source of the outbreak appears to be leafy greens, but health officials have not identified a specific type of leafy greens that sick people ate in common.

State and local public health officials continue to interview sick people in the United States to determine what they ate in the week before their illness started. Of 13 people interviewed, all 13 reported eating leafy greens. Five (56%) of nine ill people specifically reported eating romaine lettuce. This percentage was not significantly higher than results from a survey of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed.  Based on this information, U.S. health officials concluded that ill people in this outbreak were not more likely than healthy people to have eaten romaine lettuce.  Ill people also reported eating different types and brands of romaine lettuce. Currently, no common supplier, distributor, or retailer of leafy greens has been identified as a possible source of the outbreak. CDC continues to work with regulatory partners in several states, at the U.S. Food and Drug Administration, and the Canadian Food Inspection Agency to identify the source.

Although the most recent illness started on December 12, there is a delay between when someone gets sick and when the illness is reported to CDC. For STEC O157:H7 infections, this period can be two to three weeks. Holidays can increase this delay. Because of these reporting delays, more time is needed before CDC can say the outbreak in the United Stated is over. This investigation is ongoing.

58 sick, 2 dead, possible link to romaine lettuce

Over the past seven weeks, 58 people in the U.S. and Canada have become ill and two have died from E. coli O157H7, linked by Canadians to romaine lettuce, probably grown in California, given the timing of illnesses.

On Dec. 11, 2017, the Public Health Agency of Canada did its public duty and notified Canadians that at least 21 people were sick with E. coli O157:H7 and the probable source was romaine lettuce.

A couple of retailers in Canada pulled all romaine lettuce from the shelves, but the others shrugged and said, not enough is known.

By Dec. 28, 2017, the Canadian numbers had jumped to 41 sick and one dead, and the U.S. Centers for Disease Control chimed in to say there were 17 sick in the U.S. with a similar strain but they wouldn’t say it was linked to romaine lettuce, with the Trumpesque language of “CDC is unable to recommend whether U.S. residents should avoid a particular food.”

Outbreaks are hard, but where’s the tipping point between protecting public health and protecting a commodity and all the growers, retailers, involved?

Everyone went off and enjoyed New Year’s, and then people woke up again on Jan. 2, 2018 (happy new year), to be told by the Toronto Star (that’s in Canada) that of the 17 U.S. cases, five people have been hospitalized, one of whom has died. Two have developed hemolytic uremic syndrome.

That’s 58 sick and two dead.

On Jan. 3, 2018, Trisha Calvo of Consumer Reports wrote the group’s food safety types advise “consumers stop eating romaine lettuce until the cause of the outbreak is identified and the offending product is removed from store shelves.”

“Even though we can’t say with 100 percent certainty that romaine lettuce is the cause of the E. coli outbreak in the U.S., a greater degree of caution is appropriate given that lettuce is almost always consumed raw,” says James Rogers, Ph.D., director of food safety and research at Consumer Reports.

“There is not enough epidemiologic evidence at this time to indicate a specific source of the illnesses in the United States,” says Brittany Behm, MPH, a CDC spokesperson. “Although some sick people reported eating romaine lettuce, preliminary data available at this time shows they were not more likely than healthy people to have eaten romaine, based on a CDC food consumption survey.” Health officials, Behm says, take action when there is clear and convincing information linking illness to a contaminated food.

“The FDA should follow the lead of the Canadian government and immediately warn the public about this risk,“ said Jean Halloran, Director of Food Policy Initiatives at Consumers Union, the policy and mobilization division of Consumer Reports.

“The available data strongly suggest that romaine lettuce is the source of the U.S. outbreak,” she says. “If so, and people aren’t warned, more may get sick.”

That got attention, and many media outlets chimed in.

barfblog.com’s Ben Chapman told Rachael Rettner of Live Science that, “[To] say ‘avoid romaine for now,’ I don’t know if I have enough information to agree with that statement,”  Benjamin Chapman, an associate professor and food safety specialist at North Carolina State University.

“Avoiding just romaine may or may not be enough,” because other lettuces or foods could also be affected, Chapman told Live Science. “It could be that there’s a different [food] source of this exact same pathogen,” he said.

Another possibility is that the E. coli strain causing illness in the United States is actually slightly different from the strain in Canada. “We could be looking at two different outbreaks at the same time,” Chapman said.

About four times a day I’ll get a tweet from the Leafy Green Marketing Agreement – the folks who set themselves up after the spinach outbreak of E. coli O157:H7 in 2006 that killed four and sickened 200 – blowing themselves about how great they are, and how their products are so safe.

If you want that kind of PR, then you have to take the hits as well.

LGMA never talks about an outbreak linked to leafy greens (publicly).

To me, they’ve succeeded best at lowering the leafy greens cone of silence and intimidating public health types into delaying reports of outbreaks.

But late on Jan. 4, 2018, LGMA finally made a public statement, below, with my comments.

A group of produce industry associations today issued the following statement to update consumers on a recent e.coli outbreak being investigated in Canada in the U.S.:

It’s E coli. You folks should be well-versed in that.

The U.S. Centers for Disease Control and Prevention has not identified what food likely caused this foodborne illness.  No public agency has contacted any Romaine lettuce grower, shipper or processor and requested that they either stop shipping or recall product already in the marketplace.

Defensive.

Even if this outbreak is actually confirmed to be caused by Romaine lettuce, it’s important to recognize this is a highly perishable product with a limited usable shelf life and it’s highly unlikely a specific affected lot would still be available for sale or in a home refrigerator with the last U.S. illness being reported on December 8th.

Carry on, it’s all gone.

Food safety remains a top priority of leafy greens farmers, shippers and processors and the industry has robust food safety programs in place that incorporate stringent government regulatory oversight.

The Pinto defense. Audits and inspections are never enough, and saying we have government oversight does nothing to build trust with the consuming public, as research shows.

Our leading produce industry associations have and will continue to cooperate fully with public health officials investigating this foodborne illness outbreak.

Play nice in the sandbox.

Anytime we see an outbreak of any foodborne illness, our hearts go out to the victims.

This is what you should have led with. Now it reads like a tack-on.

If the leafy green marketing folks want to be truly transparent, they will make actual inspection data public for mere mortals to review, they will market microbial food safety at retail, and stop stonewalling every time there is an outbreak linked to leafy greens.

I have lots of respect for individual farmers who make a go of it and produce the bounty of produce we enjoy.

I have no respect for self-serving associations with bad soundbites.

A table of leafy green related outbreaks is available at http://www.barfblog.com/wp-content/uploads/2018/01/lettuce-leafy-greens-outbreaks-table-_1-5-18.xlsx

12 stricken with E. coli O157 in UK burgers linked to Sainsbury’s

A supermarket’s own brand of beef burgers have been recalled in fears that customers might be struck down with the E.coli bug, just before Christmas.

Sainsbury’s issued an urgent product recall after customers apparently fell ill after eating the Aberdeen British Beef burgers.

Public Health England (PHE) has linked a dozen cases of E.coli to the range and Sainsbury’s have cleared the product from their shelves. All the people that fell ill have all recovered, PHE have said.

The bug has been linked to Sainsbury’s Taste the Difference ­Aberdeen Angus quarter-pounder burgers, 454g packets, which are sold in the frozen section.

The Food Standards Agency warned shoppers: “If you have bought any of the batches, do not eat them.”

Product: Taste the Difference 4 pack Aberdeen Angus British Beef Quarter Pounders (Frozen)

Pack size: 454g

Batches with ‘Best Before’ dates: July 2018, September 2018 and October 2018

Jazz is music in hell: Odwalla founder finds second life in Califia almond and plant-based beverages

Geoffrey Mohan of the LA Times writes that Greg Steltenpohl, 63, heads Califia Farms, an almond and plant-based beverage company he co-founded in 2010. With about $100 million in annual sales, the company is something of a redemption for the Stanford graduate, whose first lightning strike in the beverage business, Odwalla, started as a way to fund his avant-garde jazz band, and ended with a fatal food poisoning and recall that eventually left the company in the hands of Coca-Cola.

“Odwalla got started because I didn’t really have a plan. I was focused on music and just thought, ‘Hey, I can make some juice on the side, play music and all that.’”

The band’s eclectic mixtures of unpasteurized juice were far more popular than the band’s music and, by 1993, Steltenpohl and his partners took Odwalla public.

Accidental success met accidental fall in 1996, the year Odwalla hit its peak sales of $59 million. An E. coli outbreak traced to Odwalla’s raw apple juice sickened dozens and killed a child in Colorado. Federal criminal charges, fines, lawsuit settlements and a precipitous drop in sales left the company so short of cash it wound up controlled by new investors who eventually sold the brand to Coca-Cola.

Steltenpohl tried his hand at several other businesses before getting a call from Berne Evans, the head of Sun Pacific packing, who had helped pioneer easy-peeling mandarins — trademarked Cuties.

Steltenpohl blanches at the idea that he has some knack for catching food preference waves just as they crest — with Odwalla, then with almond milk, and now with a line of almond-based cold brew coffee drinks.

“It sounds like that,” he admitted with a laugh. “But you figure I’ve been doing it for 37 years. You could say I hit the waves, but there’s a lot of paddling in there.”

“It’s not always the important thing to be the first,” Steltenpohl said. “I think it’s more important to solve a number of other problems.… The way we talk about it is: something different, something better — that’s kind of the hurdle we have to pass internally. If we can’t answer to ourselves why is it different, why is it better, how does it move the bar higher, then why are we doing it?”

Too bad you didn’t apply that to juice business.

 In late Oct. 1996, an outbreak of Escherichia coli O157:H7 was traced to juice containing unpasteurized apple cider manufactured by Odwalla in the northwest U.S.Sixty-four people were sickened and a 16-month-old died from E. coli O157:H7. During subsequent grand jury testimony, it was revealed that while Odwalla had written contracts with suppliers to only provide apples picked from trees rather than drops – those that had fallen to the ground and would be more likely to be contaminated with feces, in this case, deer feces — the company never verified if suppliers were actually doing what they said they were doing. Earlier in 1996, Odwalla had sought to supply the U.S. Army with juice. An Aug. 6, 1996 letter from the Army to Odwalla stated, “we determined that your plant sanitation program does not adequately assure product wholesomeness for military consumers. This lack of assurance prevents approval of your establishment as a source of supply for the Armed Forces at this time.”

21 sick with E. coli O157 from Romaine lettuce in Canada: What says LGMA?

The Sponge-Bob leafy greens cone of silence has once again been deployed with 21 sick from E. coli O157 linked to Romaine lettuce.

The Public Health Agency of Canada made the announcement Monday night, so it’s time for another edition of spokesthingy fairytales. The statements in italics are from the Public Health Agency of Canada. The comments below are mine.

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada.

How do you know a Canadian is making a presentation at a scientific conference? They spend half the talk noting collaborations.

At this time, there are no product recalls associated with this outbreak. The outbreak investigation is ongoing, and this public health notice will be updated on a regular basis as the investigation evolves.

We’ll see.

The risk to Canadians is low.

If you have no product recalls, no real clues other than some lettuce, how can you say the risk is low?

However, Canadians are reminded to follow safe food handling practices for lettuce to avoid becoming ill.

Washing does almost nothing to improve the safety of leafy greens, other than to remove the snot from an appropriately heightened 5-year-old and make consumers feel better.

Most people with an E. coli infection will become ill for a few days and then recover fully.

Unless you’re part of the percentage that has life-long health issues from eating a salad.

Some E. coli infections can be life threatening, though this is rare.

But it really sucks when it happens.

Currently, there are 21 cases of E. coli O157 illness under investigation in three provinces: Quebec (3), New Brunswick (5), and Newfoundland and Labrador (13).

These are not prime lettuce growing areas in Canada, in November.

Individuals became sick in November 2017. Ten individuals have been hospitalized.

No deaths have been reported.

See, no biggie. But this was issued Dec. 11. 2017. So was it early November or late November. The difference is hugely significant when assessing the timeliness of the announcement.

The Canadian Food Inspection Agency is working with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to.
Which will be buried and vaguely released in some journal article a couple of years from now.
The following food safety tips for lettuce will help you reduce your risk of getting an E. coli infection.

  • Wash your hands thoroughly with warm water and soap for at least 20 seconds, before and after handling lettuce.

Water temperature doesn’t matter.

  • Discard outer leaves of fresh lettuce.
  • Wash your unpackaged lettuce under fresh, cool running water. There is no need to use anything other than water to wash lettuce. Washing it gently with water is as effective as using produce cleansers.

And neither are effective at removing pathogens.

  • Keep rinsing your lettuce until all of the dirt has been washed away.
  • Don’t soak lettuce in a sink full of water. It can become contaminated by bacteria in the sink.
  • Ready-to-eat lettuce products sold in sealed packages and labelled as washed, pre-washed or triple washed do not need to be washed again.
  • Use warm water and soap to thoroughly wash all utensils, countertops and cutting boards before and after handling lettuce to avoid cross-contamination.
  • Store lettuce in the refrigerator for up to seven days. Discard when leaves become wilted or brown.
  • Bagged, ready-to-eat, pre-washed lettuce products should also be refrigerated and used before the expiration date.

The Government of Canada is committed to food safety.

The Government of Canada is committed to creating a perception of commitment to food safety.

The Public Health Agency of Canada leads the human health investigation into an outbreak and is in regular contact with its federal and provincial partners to monitor the situation and to collaborate on steps to address the outbreak.

Thanks for the org-chart update.

This is nothing but crass industry-government-academia politico ass-covering.

At some point, the people barfing would probably appreciate something just a tad more human.

Sounds like Walkerton: More than 750,000 in NZ exposed to potentially unsafe drinking water

Same old, same old.

Tracy Watkins of Stuff writes complacency, inept officials – a Government inquiry paints a frightening picture of the state of New Zealand’s drinking water, with at least 750,000 of New Zealanders drinking from supplies that are “not demonstrably safe” – a figure described as likely to be a “significant underestimate.”

The inquiry was sparked by the 2016 Havelock North gastro outbreak, which has now been linked to four deaths, and calls for a major overhaul of water supplies, including mandatory treatment.

The Government has now written urgently to all mayors and district health boards asking to check the water they are supplying meets current standards after the inquiry revealed 20 per cent of water supplies were not up to standard.

That 20 per cent affects 759,000 people, of which 92,000 are at risk of bacterial infection, 681,000 of protozoal infection and 59,000 at risk from the long term effects of exposure to chemicals through their water supply.

But that figure was likely to understate the problem, as it did not include more than 600,000 people who drink water from self-suppliers or temporary suppliers, or tourists to places like Punakaiki on the West Coast, which is under a permanent “boil water” notice.

The inquiry found that complacency about the state of New Zealand’s drinking water was common, yet the evidence showed that in many cases it was safer to drink tap water overseas than here.

But its most damning findings related to the Ministry of Health, which it described as inept and negligent in its oversight of a system in which non-compliance with safe standards was high.

The risks for contamination of the water supplies were detailed by the inquiry including damaged pipes, a huge number of private and unknown bores, and the close proximity of sewerage to drinking water assets, a factor that caused surprise among overseas experts.

The second part of the inquiry looked at broader water quality issues.

It found that lessons from Havelock North appeared not to have been learned – compliance figures in the 2016-17 period were still “alarmingly low” and “do not appear to reflect any increased vigilance by suppliers in the aftermath of [that] outbreak”.

“The inquiry found the falling compliance levels with the bacteriological and chemical standards particularly concerning. The decrease in compliance with the bacteriological standards results from an increased number of transgressions, an increased number of supplies with ineffective, delayed or unknown remedial action following transgressions, and an increased number of supplies with inadequate monitoring.

“Twenty-seven supplies failed entirely to take any remedial action after a transgression. In the aftermath of the bacteriological outbreak in Havelock North, these failures to respond effectively to transgressions or to monitor adequately are surprising and unacceptable.”

E. coli: Flour fights not such a good idea

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 cookie dough.

The researchers could not conclusively implicate flour as the E. coli source, but it remains the prime suspect. They pointed out that a single purchase of contaminated flour might have been used to manufacture multiple lots and varieties of dough over a period of time as suggested by the use-by dates on the contaminated product.

The study authors concluded that “foods containing raw flour should be considered as possible vehicles of infection of future outbreaks of STEC.”

So it wasn’t much of a surprise when 56 people fell sick from with the outbreak strain of E. coli O121 from Dec. 2015 to Sept. 2016 were linked to raw General Mills flour.

The peer-reviewed summary of the outbreak investigation was published last week in The New England Journal of Medicine.

Abstract below:

In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin–producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer.

Methods

A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples.

Results

A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility.

Conclusions

This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.

Shiga toxin–producing E. coli infections associated with flour

N Engl J Med 2017; 377:2036-2043, November 23, 2017, DOI: 10.1056/NEJMoa1615910

Samuel J. Crowe, Ph.D., M.P.H., Lyndsay Bottichio, M.P.H., Lauren N. Shade, B.S., Brooke M. Whitney, Ph.D., Nereida Corral, M.P.H., Beth Melius, M.N., M.P.H., Katherine D. Arends, M.P.H., Danielle Donovan, M.S., Jolianne Stone, M.P.H., Krisandra Allen, M.P.H., Jessica Rosner, M.P.H., Jennifer Beal, M.P.H., Laura Whitlock, M.P.H., Anna Blackstock, Ph.D., June Wetherington, M.S., Lisa A. Newberry, Ph.D., Morgan N. Schroeder, M.P.H., Darlene Wagner, Ph.D., Eija Trees, D.V.M., Ph.D., Stelios Viazis, Ph.D., Matthew E. Wise, M.P.H., Ph.D., and Karen P. Neil, M.D., M.S.P.H.

http://www.nejm.org/doi/full/10.1056/NEJMoa1615910

Raw is risky and a drain on public health

A protracted outbreak of Escherichia coli O157:H7 infections was caused by consumption of unpasteurized (“raw”) milk sold at Oregon grocery stores. Although it never caused a noticeable increase in reported infections, the outbreak was recognized because of routine follow-up interviews.

Six of 16 Portland-area cases reported between December 1992 and April 1993 involved people who drank raw milk from dairy A. By pulsed-field gel electrophoresis (PFGE), E. coli O157:H7 isolates from these cases and from the dairy A herd were homologous (initially, 4 of 132 animals were E. coliO157:H7-positive).

Despite public warnings, new labeling requirements, and increased monitoring of dairy A, retail sales and dairy-associated infections continued until June 1994 (a total of 14 primary cases). Seven distinguishable PFGE patterns in 3 homology groups were identified among patient and dairy herd E. coli O157:H7 isolates. Without restrictions on distribution, E. coli O157:H7 outbreaks caused by raw milk consumption can continue indefinitely, with infections occurring intermittently and unpredictably.

A prolonged outbreak of Escherichia coli O157:H7 infections caused by commercially distributed raw milk

1.sep.2017

The Journal of Infectious Diseases

Keene et al.

https://academic.oup.com/jid/article/176/3/815/872141

2 sick with E. coli O157:H7 from Vermont’s Bread & Butter Farm

Vermont Livestock Slaughter and Processing, LLC, a Ferrisburg, Vt., establishment, is recalling approximately 133 pounds of ground beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ground beef was produced on July 24 and 25, 2017.  The following products are subject to recall:

* 1-lb. vacuum sealed packages containing “Bread & Butter Farm Ground Beef” with lot codes #072517BNB and #072417BNB.

The products subject to recall bear establishment number “EST. 9558” inside the USDA mark of inspection. These items were sold at Bread & Butter farm in Shelburne, Vt. (I could write a book about the BS in the pic, above; maybe I will).

On September 30, 2017, FSIS was notified of an investigation of E. coli O157:H7 illnesses. Working in conjunction with the Vermont Department of Health and the Centers for Disease Control and Prevention, FSIS determined the cooked beef burgers that were served at an event at Bread & Butter Farm was the probable source of the reported illnesses. Based on the epidemiological investigation, two case-patients were identified in Vermont with illness onset dates ranging from September 18, 2017, to September 23, 2017. Traceback information indicated that both case-patients consumed ground beef products at Bread & Butter Farm which was supplied by Vermont Livestock Slaughter & Processing. Vermont Livestock Slaughter and Processing, LLC is recalling the products out of an abundance of caution. FSIS continues to work with public health partners on this investigation and will provide updated information as it becomes available.