A tale of two outbreaks: Farmers have to get ahead of the public conversation because they lose

I don’t like counting outbreak tolls or square mileage affected – in the absence of meaningful information – because it seems like accounting, and I have an accountant to do that.

Numbers numb and go past the story: Stalin said, “One death is a tragedy; one million is a statistic.”

None of us wants to be a statistic.

Whether it’s E. coli in Romaine lettuce in the U.S. or Listeria in rockmelon in Australia, producer groups have failed the farmers they are supposed to represent.

Step up. It’s a long way to the top if you want to rock and roll.

The pain of E. coli O157: Walkerton survivor ends his life

On Sunday, May 21, 2000, at 1:30 p.m., the Bruce Grey Owen Sound Health Unit in Ontario, Canada, posted a notice to hospitals and physicians on their web site to make them aware of a boil water advisory and that a suspected agent in the increase of diarrheal cases was E. coli O157:H7.

There had been a marked increase in illness in the town of about 5,000 people, and many were already saying the water was suspect. But the first public announcement was also the Sunday of the Victoria Day long weekend and received scant media coverage.

It wasn’t until Monday evening that local television and radio began reporting illnesses, stating that at least 300 people in Walkerton were ill.

At 11:00 a.m., on Tuesday May 23, the Walkerton hospital jointly held a media conference with the health unit to inform the public of outbreak, make the public aware of the potential complications of the E. coli O157:H7 infection, and to tell the public to take the necessary precautions. This generated a print report in the local paper the next day, which was picked up by the national wire service Tuesday evening, and subsequently appeared in papers across Canada on May 24.

Ultimately, 2,300 people in a town of 5,000 were sickened and seven died. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry.

Paul Hunter of the Toronto Star writes it was a glorious, sun-warmed afternoon after a long winter. Robbie Schnurr’s blinds were closed. He was finalizing his plans to die.

“Pretty much where I’m laying right now, where I’ve been for years,” he said, reflexively patting the bedsheet between him and the half-finished bottles of water kept within easy reach.

“What does a person do when they know they’re going to die within hours? I mean, do you walk over and look out the window? I can’t walk anyways. I guess you just wait for the time to pass and then you miss the hors d’oeuvres.”

It’s been 18 years since a deadly E. coli outbreak devastated the rural town of Walkerton, 150 kilometres northwest of Toronto. Seven people perished. A further 2,500, half the population, took ill. Most eventually got better. Schnurr never did.

Poisoned like the others, his health declined slowly and painfully until he lived in a sort of limbo: a prisoner in his own body, in his own bed, here in his 11th-floor Mississauga condo, a 71-year-old alone and feeling largely forgotten.

The former OPP officer and investigator with Ontario’s Office of the Fire Marshal was in constant pain from a degenerative nerve disease. Doctors, he said, told him he would continue to decline. There was no hope of improvement.

His legs had wasted away. Numbness in his fingers made it impossible for him to write or button a shirt; he opened bottles of painkillers with his mouth. He was losing sight in his right eye; the hearing in one ear was already gone. He’d leave his home only every two weeks, strapped on a gurney to be transported to the Queensway Health Centre for an intravenous immunoglobulin treatment. He went for the last time in late April.

On May 1, a doctor came to him.

In the company of his younger sister, Barbara Ribey, her husband, Norm, and two friends, Schnurr fulfilled his wish for a physician-assisted death.

“I just won’t live like this anymore,” he explained the day before that final moment. “There’s nothing to look forward to, there’s no goals in life. There’s nothing.”

Before he took ill, Schnurr said he “had the world by the ass.” He wanted people to know that. He also didn’t want forgotten what happened at Walkerton and how it cheated him, and others from his hometown, in life and left a heartbreaking legacy.

Schnurr said he also recently spoke to two old friends from the OPP who’d had no idea of what became of him.

He wanted everyone to know. So he invited the Star to his home to share his story and explain his decision.

Schnurr was, as it would have been described in another era, a man’s man, living like he was the lead in a 1970s action movie.

Mustachioed and handsome, he drove fast cars (the last a black Corvette), lived for long stretches on his 35-foot boat (where the parties were frequent) and had a closet full of Armani and Hugo Boss suits and silk ties. He owned a condo in Mexico and, befitting a Hollywood star, he always seemed to have a beautiful date on his arm.

“Women loved Robbie,” said Ribey.

Schnurr skied, he rollerbladed, he had a black belt in karate. As a teen, he played every sport he could. He excelled at hockey and was never afraid to drop the gloves. In baseball, a fastball in the low to mid-90s caught a scout’s eye, and he went off to pitch in the minors in North Carolina.

“I know I could have made the big leagues, but I didn’t know how long it would take,” he said. “And there was this girl that wanted me to get married. When I got home she handed me an application for the OPP.”

The policing job idea stuck, but the thought of marriage didn’t. Schnurr became a cadet at 19, was sworn in and got his gun at 21. He said he was shot twice and stabbed twice. He lost hearing in one ear because of target shooting practice. He investigated motorcycle gangs — “We didn’t get along real well, the bikers and I” — and major crimes.

He moved from Owen Sound to Kenora to Manaki before landing in Orillia in the early 1980s shortly before a train derailed in nearby Medonte. The fire marshal’s office was impressed with how he handled that case and suggested he apply. Schnurr said he beat out 800 other candidates for the job and was soon sent off to train with the FBI to become an expert in explosions.

In newspapers during the ’80s and ’90s, Schnurr was frequently quoted standing among the ashes at one fire or another. He figured he investigated some 2,000 fires. At one point, he helped profile and hunt down an arsonist who was terrorizing Toronto’s west end. On another case, the torching of a church, he received death threats.

Through his working life, sports remained important, as he coached youth baseball and organized instructional clinics around the province.

Though single at the end, he had married twice, had a daughter, Samantha, whom he adored and a grandson, Kaiden, born in January.

Tough as he was, through a twist of fate Schnurr was exiled from the world he embraced so enthusiastically.

“Now, I can’t even get down the goddamned hall,” he said. “To make a long story short, I was screwed.”

Schnurr didn’t even live in Walkerton when he encountered his kryptonite there. He’d gone to his hometown for his mother’s memorial in mid-May of 2000. When he returned to Mississauga, he realized he’d forgotten his suit jacket. With Victoria Day weekend coming, he decided to make a quick return trip to Walkerton to pick it up and see a couple of friends on the Friday before the holiday traffic got heavy.

“It was a really hot and muggy day and when I got there, I took a pitcher of water and chugalugged it,” he said.

That began a weekend of hell that lasted 18 years.

“I had blood coming out of both ends,” he said of the next 48 hours, spent feeling groggy and on the floor of his condo. “It was almost two days before I could get any help because I wasn’t strong enough.”

Walkerton’s water supply had been contaminated. A heavy rainstorm washed cow manure carrying a strain of E. coli O157:H7 into a vulnerable town well and, because of improper chlorination, the lethal bacteria was not destroyed.

The poison was passed on through tainted tap water and made thousands sick with severe gastrointestinal issues, including bloody diarrhea, in one of the worst public health disasters in Canadian history. A landmark, seven-year study of those who fell ill, released in 2008, determined there were legacy illnesses from the tragedy. Patients who had confirmed gastroenteritis had a 30 per cent higher risk of high blood pressure or kidney damage.

The study found that 22 children who became sick in 2000 had permanent kidney damage, but treatment had stopped that illness from getting worse.

Dr. William Clark, a kidney specialist at London Health Sciences Centre who led the study, looked again three years ago at the victims of Walkerton, and found that although “there is no doubt some people have had significant long-term problems” when compared with similar small towns, Walkerton is actually doing “somewhat better” when it comes to kidney and heart issues.

That, he suggests, could be related to a post-crisis medical screening program involving about 4,000 residents. It not only identified health issues related to the contamination, but also picked up ailments such as diabetes and hypertension, allowing physicians to get those patients on proper medication.

Clark said the kidney and heart issues of Walkerton residents have improved, but “there’s no doubt they’re on more medication” than comparable groups.

Schnurr had no idea others were also poisoned as he floundered on his condominium floor in 2000. He didn’t know why he was sick, even as an ambulance eventually took him, in blood-soaked clothes, to the hospital. He also wondered why all the medical staff took such keen interest in his Walkerton roots. Then, on one of the muted televisions at the hospital, he started to see familiar faces from his hometown.

“I’m going, ‘What’s going on?’ (A hospital worker) said to me, ‘You haven’t heard about the E. coli epidemic in Walkerton?’ Bang. It all came together.”

Schnurr returned to work until 2002, but he got progressively weaker. His retirement plan had been to take a lucrative position investigating insurance fraud in the U.S., or set up his own business. Instead, he struggled with balance, falling often, and forgot things. At 55, he could no longer work.

Schnurr said the bacterial infection destroyed his immune system and that led to his current neurological disorder. Press reports, years after the Walkerton disaster, chronicled Schnurr’s struggles as a lingering victim.

Doctors eventually diagnosed Schnurr with chronic inflammatory demyelinating polyneuropathy (CIDP), a neurological disorder that causes the body’s immune system to attack and destroy the myelin sheath that envelops nerves. It’s comparable to stripping the insulation off electrical wires. Symptoms include tingling in the feet and hands as well as progressive weakness in the legs and arms. For Schnurr, it also brought debilitating pain.

“Anything too hot or too cold on him would almost be like tinfoil on a tooth filling,” Ribey said.

CIDP, a rare disorder, typically follows an infection in the body that messes up the immune system. There is always a suspected trigger, but the exact cause can’t be pinned down.

Clark, the lead health investigator at Walkerton, said research hasn’t shown a good correlation between E. coli O157:H7 and CIDP.

“But I’m not excluding it because the reality is any inflammatory event may … contribute to the onset of an autoimmune disorder, which CIDP really is,” he said.

At first, Schnurr could “furniture walk” around his condo, using a cane and clutching at various items to keep his balance. But there were too many tumbles, too many sutures and too many broken bones. Five times, he ended up in the hospital. Once he fell into his television, pushing it through the drywall.

“When I could get out of bed, I’d go down into the living room and sit there and stare,” he said. “I wouldn’t even answer the phone.”`

When his legs got weaker, Schnurr would crawl around his home, sometimes till his knees bled. For the past decade, even that was too much.

“I would often hope and pray I would get some kind of something to make me well,” he said. “I know now that’s not going to happen and …”

The rest of that thought preoccupied his mind, he said, for almost 10 years. He wanted out of a life that hurt to live. Before assisted death became legal in Canada in 2016, he considered going to Switzerland, where it was available.

“I’m not afraid. I’m not scared. I’m almost looking … I am looking forward to it because I’ll be gone,” he said.

“I think most people, well, I know most people, they don’t want to die. They want to live, but life is no fun for me. I can’t go anywhere. I can’t do anything. My body is breaking down more and more. So I discussed it with doctors and family. They agreed with me. So here I am.”

Schnurr was resolute in his decision, approaching his own death with an almost clinical detachment — “There was never a tear,” Ribey said — as he wondered about timing and process. He said he cleaned up any debts and other paperwork so his sister wouldn’t be burdened. He got someone to throw away all his pills and he said goodbye to those who mattered.

“I’m rational. I’m in pain, but I’m always in pain,” he said. “I gave it a lot of thought. It’s not something you decide overnight.”

On his birthday on July 14, 2017, he posted on Facebook that it would be his last.

“Going back a month ago up till present, I was ticking the days off,” he said. “I just didn’t want to suffer anymore. The pain and suffering and lack of friends, you know. I’m basically here alone with the exception of the people that come in and clean.”

On the first day of May, in the afternoon, Ribey lay down next to her brother. It was time. A doctor administered three injections.

“I was lying beside him and holding his hand and he just put his head down on mine and said, ‘How’s my little sister?’ And that’s when I started to cry. Then I said something like, thank you for being such a kind brother and a good brother to me. I’m going to miss you … I told him I loved him.”

She said it was “very, very peaceful and very quick.”

For Schnurr, a man broken beyond repair, the pain stopped.

40 sick, 1 dead: Alberta meat retailers struggling on the E. coli chain gang

Supply chain? Blockchain? Chain gang?

In food safety, anyone is only as good as their weakest link.

The fall-out can be devastating.

Several businesses have been impacted, positively and negatively, by the current E. coli outbreak. CTV Edmonton’s Dan Grummett reports.

As the number of Alberta residents sickened by pork tainted with E. coli rises, many of the butcher shops caught up in the ensuing recall say their businesses’ reputations have been damaged.

Since the outbreak began in late March, 40 cases of E. coli infection have been confirmed; 12 people have been hospitalized and one person has died.

The outbreak began when several people who visited the same restaurant in Edmonton become ill. Alberta Health Services soon traced the illnesses to pork products distributed by The Meat Shop in Pine Haven, Alb.

Edmonton’s Real Deal Meats says her family-run business has had to throw away thousands of dollars worth of meat.

That prompted a recall that has since expanded to include raw and frozen meat, ground pork, sausages and more. The products have only been distributed in Alberta.

An Edmonton law firm has already begun a $15-million lawsuit against The Meat Shop, on behalf of those who have become ill. But more than half a dozen businesses whose names have been caught up in the recall say their reputations are taking a hit too.

Alicia Boisvert of Edmonton’s Real Deal Meats says her family-run business has had to throw away thousands of dollars worth of meat — much of it returned by customers.

“We have to remove all the packaging… before the truck picks it up,” she told CTV Edmonton. “And then we have to pay for that (removal). Obviously, we’re going to have to figure that out as well.”

Another business whose reputation has taken a hit in this outbreak is Mama Nita’s Filipino Cuisine in southeast Edmonton – the restaurant where the outbreak began.

A full 21 of the 40 lab-confirmed cases have been linked to Mama Nita’s. The restaurant is still open but would not speak to CTV Edmonton about how their business is doing.

The other 19 illnesses — including the one involving the patient who died — have been linked to pork sold by Pine Haven’s retail partners.

The names of each business have been listed on the Canadian Food Inspection Agency’s website, their store fronts splashed on the news even if they didn’t sell any contaminated pork.

Real Deal Meats’ Boisvert says, just being associated with an E. coli outbreak has led to many sleepless night for her and her family.

At K&K Foodliner — another food retailer caught up in the recall — business is slower. Even though Pine Haven pork is no longer sold at the store, general manager Kevin Krause says some customers are avoiding pork altogether.

“This is our first recall in 62 years,” he told CTV Edmonton. “Regardless if it’s Pine Haven’s fault, it’s still our reputation on the line as well.”

We don’t need no edumacation

For all the folks out there trying to educate consumers and others about food safety, forget it.

Stick with stories.

Pink Floyd figured that out in 1980, in what would become the soundtrack for my grade 12 (Stones’ Some Girls was the soundtrack for grade 10) and a weirdly accurate foretelling of my first marriage.

121 sick, 52 hospitalized, 14 with kidney failure and 1 death linked to Yuma romaine E. coli outbreak

I’m not sure in what universe, the-growing-area-has-stopped-harvesting is a useful explanation for an outbreak of foodborne illness that has sickened 121 and hospitalized almost 50 per cent.

And this picture from 12 years ago is still apt.

I’ll write a much more scathing indictment of the 10-year-experiment in self-fellatio practiced by the Leafy Greens Marketing Association in my upcoming book, Food Safety Fairy Tales.

For now, let it be known that according to the U.S. Centers for Disease Control, E. coli O157:H7 linked to romaine lettuce has sickened 121 people in 25 states.

52 people have been hospitalized, including 14 people who have developed hemolytic uremic syndrome.

One death was reported from California.

This investigation is ongoing, and CDC will provide updates when more information is available.

Bloody diarrhea is usually the clue: 5 sick in E. coli outbreak linked to Oklahoma daycare

The State Health Department confirms they are investigating several cases in children in the Moore area. The department says this is not related to the nationwide romaine lettuce E. coli outbreak but instead, the virus (it’s a bacterium) can be traced back to a Moore day care.

Neveah Bell is usually a very a happy and active baby. So earlier this month, it was obvious that something was very wrong. 

“She wouldn’t even lift up her head, she was not eating anything. She wouldn’t play with her toys. She just wanted to be held,” said Melissa Bell, Neveah’s grandmother and guardian.

The day before, Neveah came home sick from day care.

“She had some diarrhea that was pretty violent and had blood,” said Bell.

Neveah was admitted to the hospital.

Doctors eventually confirmed she had E. coli.

The State Health Department says they have identified five cases of E. coli that can be traced back to a Moore day care. But say that’s not all that unusual.

“Clusters of cases happen in group settings, especially in child care facilities that are interacting on a daily basis,” explained Laurence Burnsed and Epidemiologist with the Oklahoma Department of Health.

E. coli can be transmitted directly or through contamination of objects that children share. The Health Department says they are working with the day care to stop further spread. Symptoms include diarrhea, bloody stools and cramps and like in Neveah’s case, it can be very serious.

“This is a bacteria that if it gets into your blood stream or effects other organs, it can cause other complications. Some occurrences can result in death,” explained Burnsed.

After two weeks in the hospital, Neveah has fully recovered.  But her grandmother says it was a very scary time.

1 dead, 36 sick with E. coli O157:H7 in Canada, linked to pork from meat shop in central Alberta

Keith Gerein of the Edmonton Journal writes The Meat Shop at Pine Haven, located on a Hutterite colony southeast of Wetaskiwin, announced Wednesday it had temporarily shut down and issued a voluntary recall of a number of its raw and ready-to-eat pork products.

A full list of the recalled items, including ground pork, chops, sausages, bacon and salami, was available on the Canadian Food Inspection Agency website.

The products in question were sold or distributed by the shop between Feb. 19 and April 24, and included pork served by Mama Nita’s Binalot restaurant where the outbreak was first identified a month ago.

“This is our businesses, it’s our livelihood and the food safety of our products to consumers is the highest priority,” facility manager Tim Hofer said. “It’s a very difficult time for us, but we are doing the best we absolutely can to identify the problem, and once we have found it, to mitigate the risks. “

All 36 patients sickened by E. coli O157:H7 have been linked in one way or another to meat from the shop, said Dr. Jasmine Hasselback, medical officer of health, Edmonton zone, for Alberta Health Services.

Hasselback said tracing the bug’s origins proved to be complex and time-consuming, requiring nearly a month of detective work by public health officials.

The initial cluster of five infections was discovered in late March among patrons of the restaurant, but investigators were hampered by the fact the establishment used different meat suppliers. As well, it appeared not all of the infected patients had eaten pork.

“When you are looking at foods people ate at the restaurant, there actually wasn’t a consistent pattern at that time,” Hasselback said. “It wasn’t until we were able to start adding information regarding the individuals who were not linked to the restaurant that pork was able to come a little bit clearer.”

Of the 36 patients identified to date, 21 are believed to have acquired their infection at Mama Nita’s — including several staff. The remaining 15 cases, including the deceased patient, have no connection to the restaurant.

Hasselback said those additional cases gave public health staff more information to work with, but also more variables to consider.

She said investigations of food-borne outbreaks tend to rely on three major avenues of inquiry.

These include interviews with patients to explore what they have eaten and where they have travelled, and lab tests to link the cases of E. coli 0157:H7. As well, investigators gather samples of food that are possibly suspect and have those tested in a lab.

Hofer said his meat facility has supplied products to “dozens” of customers in the Edmonton area — including Mama Nita’s — though he didn’t have an exact number.

He said the business was informed last Wednesday of a potential connection to the outbreak. When managers learned swabs of certain products had tested positive, along with one swab of the facility itself, the operation was shut down.

“The first thing we did was a deep clean of the facility, from ceiling to everything, all scrubbed and sanitized,” Hofer said, adding that a thorough review of the facility’s procedures has begun.

The family-run business has been operation since 2004 and has never before had a contamination issue, he said.

Good luck with the lawyers, who have already filed a $15-million lawsuit against The Meat Shop.

The lawsuit is on behalf of people who suffered damages as a result of buying or consuming pork products that may have been contaminated with E. coli, the law firm of James H. Brown & Associates said.

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.

All the news just repeats itself: Leafy greens in public

In October, 1996, a 16-month-old Denver girl drank Smoothie juice manufactured by Odwalla Inc. of Half Moon Bay, California. She died several weeks later; 64 others became ill in several western U.S. states and British Columbia after drinking the same juices, which contained unpasteurized apple cider — and E. coli O157:H7. Investigators believed that some of the apples used to make the cider might have been insufficiently washed after falling to the ground and coming into contact with deer feces (Powell and Leiss, 1997) not that washing would do much.

Almost 10 years later, 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 (United States Food and Drug Administration, 2006). The outbreak ultimately killed four and sickened at least 200 across the U.S. This was documented-outbreak 29 linked to leafy greens, but also apparently the tipping point for growers to finally get religion about commodity-wide food safety, following the way of their farmer friends in California, 10 years later.

In the decade between these two watershed outbreaks, almost 500 outbreaks of foodborne illness involving fresh produce were documented, publicized and led to some changes within the industry, yet what author Malcolm Gladwell would call a tipping point — “a point at which a slow gradual change becomes irreversible and then proceeds with gathering pace” — in public awareness about produce-associated risks) did not happen until the spinach E. coli O157:H7 outbreak in the fall of 2006. At what point did sufficient evidence exist to compel the fresh produce industry to embrace the kind of change the sector has heralded since 2007? And at what point will future evidence be deemed sufficient to initiate change within an industry?

The 1993 outbreak of E. coli O157:H7 associated with undercooked hamburgers at the Jack-in-the-Box fast food chain propelled microbial food safety to the forefront of public awareness, at least in the U.S. (Powell and Leiss, 1997). In 1996, following extensive public and political discussions about microbial food safety in meat, the focus shifted to fresh fruits and vegetables, following an outbreak of Cyclospora cayetanesis ultimately linked to Guatemalan raspberries that sickened 1,465 in 21 U.S. states and two Canadian provinces (U.S. Centers for Disease Control and Prevention, 1997). That same year, Beuchat (1996) published a review on pathogenic microorganisms in fresh fruits and vegetables and identified numerous pathways of contamination.

By 1997, researchers at CDC were stating that pathogens could contaminate at any point along the fresh produce food chain — at the farm, processing plant, transportation vehicle, retail store or foodservice operation and the home — and that by understanding where potential problems existed, it was possible to develop strategies to reduce risks of contamination (Tauxe et al., 1997). Researchers also reported that the use of pathogen-free water for washing would minimize risk of contamination (Suslow, 1997; Beuchat, 1998).

Beuchat and Ryu (1997) reported in a review that sources of pathogenic microorganisms for produce included:

Preharvest

  • Feces
  • Soil
  • Irrigation water
  • Water used to apply fungicides, insecticides
  • Green or inadequately composted manure
  • Air (dust)
  • Wild and domestic animals (including fowl and reptiles)
  • Insects
  • Human handling

Postharvest

  • Feces
  • Human handling (workers, consumers)
  • Harvesting equipment
  • Transport containers (field to packing shed)
  • Wild and domestic animals (including fowl and reptiles)
  • Insects
  • Air (dust)
  • Wash and rinse water
  • Sorting, packing, cutting, and further processing equipment
  • Ice
  • Transport vehicles
  • Improper storage (temperature, physical environment)
  • Improper packaging (including new packaging technologies)
  • Cross-contamination (other foods in storage, preparation, and display areas)
  • Improper display temperature.

kFresh fruits and vegetables were identified as the source of several outbreaks of foodborne illness in the early 1990s, especially leafy greens (Table 1).

Date Product Pathogen Cases Setting/dish State
Apr-92 Lettuce S. enteriditis 12 Salad VT
Jan-93 Lettuce S. Heidelberg 18 Restaurant MN
Jul-93 Lettuce Norovirus 285 Restaurant IL
Aug-93 Salad E. coli O157:H7 53 Salad Bar WA
Jul-93 Salad E. coli O157:H7 10 Unknown WA
Sep-94 Salad E. coli O157:H7 26 School TX
Jul-95 Lettuce E. coli O153:H48 74 Lettuce MT
Sep-95 Lettuce E. coli O153:H47 30 Scout Camp ME
Sep-95 Salad E. coli O157:H7 20 Ceasar Salad ID
Oct-95 Lettuce E. coli O153:H46 11 Salad OH
May-96 Lettuce E. coli O157:H10 61 Mesclun Mix ML
Jun-96 Lettuce E. coli O153:H49 7 Mesclun Mix NY

Outbreaks of foodborne illness related to leafy greens, 1992-1996.

Dave Gombas told an International Association for Food Protection symposium on leafy green safety on Oct. 6, 2006 in Washington, D.C. that if growers did everything they were supposed to do — in the form of good agricultural practices — and it was verified, there may be fewer outbreaks. He then said government needs to spend a lot more on research.

Wow. The same person who has vacillated between the Produce Marketing Association and the U.S. Food and Drug Administration for the past couple of decades (all you critics who complain about folks jumping back-and-forth-and-back as part of a genetically-engineered conspiracy may want to look at the all-natural, all-good-for-ya produce sector) pronounced on grower verification in which nothing has been done.

Since we were on the same panel in Washington, in 2006, I asked Gombas, why is the industry calling for more investment in research about the alleged unknowns of microbial contamination of produce when the real issue seems to be on-farm delivery and verification? Hiding behind the unknown is easy, working on verifying what is being done is much harder.

More calls for research.

Nothing on human behavior in a fresh produce environment.

It’s just another case of saying the right things in public, but failing to acknowledge what happens on individual farms. Verification is tough. Auditing may not work, because many of these outbreaks happened on third -party audited operations. Putting growers in a classroom doesn’t work, and there’s no evidence that begging for government oversight yields a product that results in fewer sick people.

In 1999, several more outbreaks of Shiga-toxin producing E. coli (STEC) were linked to leafy greens (Table 2), and the U.S. group, the United Fresh Fruit and Vegetable Association, developed and published HACCP-based food safety guidelines for industry (United Fresh Fruit and Vegetable Association, 1999).

Date Product Pathogen Cases Setting/dish State
Feb-99 Lettuce E. coli O157:H9 65 Restaurant NE
Jun-99 Salad E. coli O111:H8 58 Texas Camp TX
Sep-99 Lettuce E. coli O157:H11 6 Iceberg WA
Oct-99 Lettuce E. coli O157:H7 40 Nursing Home PA
Oct-99 Lettuce E. coli O157:H7 47 Restaurant OH
Oct-99 Salad E. coli O157:H7 5 Restaurant OR

Table 2. 1999 U.S. outbreaks of STEC linked to leafy greens

By 2000, Rafferty and colleagues demonstrated that E. coli could spread on-farm in plant production cuttings from one contaminated source, magnifying an outbreak to a whole farm (Rafferty et al., 2000). A 2001 outbreak of Shigella flexneri (886 ill) in tomatoes further focused public and scientific attention onto fresh produce.

Solomon and colleagues (2002a) discovered that the transmission of E. coli O157:H7 to lettuce was possible through both spray and drip irrigation. They also found that the pathogen persisted on the plants for 20 days following application and submerging the lettuce in a solution of 200ppm chlorine did not eliminate all viable E.coli O157:H7 cells, suggesting that irrigation water of unknown microbial quality should be avoided in lettuce production (Solomon et al., 2002a). In a follow-up experiment, Solomon and colleagues (2002b) explored the transmission of E. coli O157:H7 from manure-contaminated soil and irrigation water to lettuce plants. The researchers recovered viable cells from the inner tissues of the lettuce plants and found that the cells migrated to internal locations in plant tissue and were thus protected from the action of sanitizing agents. These experiments demonstrated that E. coli O157:H7 could enter the lettuce plant through the root system and migrate throughout the edible portion of the plant (Solomon et al., 2002b). Such results were widely reported in general media.

During this time, several outbreaks of E. coli were again linked to lettuce and salad (Table 3).

Date Product Pathogen Cases Setting/dish State
Oct-00 Salad E. coli O157:H7 6 Deli IN
Nov-01 Lettuce E. coli O157:H7 20 Restaurant TX
Jul-02 Lettuce E. coli O157:H8 55 Bagged, Tossed WA
Nov-02 Lettuce E. coli O157:H7 13 Restaurant IL
Dec-02 Lettuce E. coli O157:H7 3 Restaurant MN

Table 3: Leafy green outbreaks of STEC, 2000 — 2002.

 In 2003, according to Mexican growers, the market impact of an outbreak of hepatitis A traced to exported green onions lasted up to 4 months while prices fell 72 per cent (Calvin et al., 2004). Roma tomatoes were identified as the source of a salmonellosis outbreak that resulted in over 560 cases in both Canada and the US (CDC 2005).

During 2003-2005, several additional outbreaks of E. coli O157:H7 were linked to fresh leafy greens, including one multi-state outbreak involving Dole bagged lettuce (Table 4). 

Date Product Pathogen Cases Setting/dish State
Sep-03 Lettuce E. coli O157:H7 51 Restaurant CA
Nov-03 Spinach E. coli O157:H7 16 Nursing Home CA
Nov-04 Lettuce E. coli O157:H7 6 Restaurant NJ
Sep-05 Lettuce E. coli O157:H7 11 Dole, bagged Multiple

Table 4: Leafy green STEC outbreaks, 2003 — 2005.

During 2005–2006, four large multistate outbreaks of Salmonella infections associated with eating raw tomatoes at restaurants occurred in the U.S., resulting in 459 culture-confirmed cases of salmonellosis in 21 states. Investigations determined that the tomatoes had been supplied to restaurants either whole or precut from tomato fields in Florida, Ohio, and Virginia (CDC, 2006).

Allwood and colleagues (2004) examined 40 items of fresh produce taken from a retail setting in the U.S. that had been preprocessed (including cut, shredded, chopped or peeled) at or before the point of purchase. They found fecal contamination indicators (E. coli, F-specific coliphages, and noroviruses) were present in 48 per cent of samples.

 Researchers in Minnesota conducted a small-scale comparative study of organic versus conventionally grown produce. They found that while all samples were virtually free of pathogens, E. coli was 19 times more prevalent on produce acquired from the organic farms (Mukherjee et al., 2004). They estimated that this was due to the common use of manure aged for less than a year. Use of cattle manure was found to be of higher risk as E. coli was found 2.4 times more often on farms using it than other animal manures (Mukherjee et al., 2004).

On Sept. 14, 2006, the U.S. Food and Drug Administration (2006) issued a public statement warning against the consumption of bagged fresh spinach.

“Given the severity of this illness and the seriousness of the outbreak,” stated Dr. Robert Brackett, Director of FDA’s Center for Food Safety and Applied Nutrition (CFSAN), “FDA believes that a warning to consumers is needed (United States Food and Drug Administration, 2006).”

That is no different from the sometimes conflicting messages coming from FDA today about the E. coli O157:H7 outbreak on lettuce that originated in Yuma, Arizona: these public health folks are figuring it out on the go.

Sean Rossman of USA Today reports today that in the current E. coli O157:H7 outbreak linked to Yuma lettuce, 70% of those who’ve gotten sick are female.

Similarly, when leafy greens were the culprit of an E. coli outbreak last year, 67% of those infected were women or girls. In 2016, females were 73% of those ill from an outbreak in alfalfa sprouts, notes the U.S. Centers for Disease Control and Prevention.

Here are some suggestions:

  • The first line of defense is the farm, not the consumer.
  • All ruminants — cows, sheep, goats, deer — can carry dangerous E. coli like the O157:H7 strain that sickened people in the spinach outbreak, as well as the Taco Bell and Taco Johns outbreaks ultimately traced to lettuce.
  • Any commodity is only as good as its worst grower.

We’ve had a few peer-reviewed thoughts on these topics:

Powell, D.A. and Chapman, B. 2007. Fresh threat: what’s lurking in your salad bowl?. Journal of the Science of Food and Agriculture. 87: 1799-1801.

Implementing On-Farm Food Safety Programs in Fruit and Vegetable Cultivation, Improving the Safety of Fresh Fruit and Vegetables

Luedtke, A., Chapman, B. and Powell, D.A. 2003. Implementation and analysis of an on-farm food safety program for the production of greenhouse vegetables. Journal of Food Protection. 66:485-489.

Powell, D.A., Bobadilla-Ruiz, M., Whitfield, A. Griffiths, M.G.. and Luedtke, A. 2002. Development, implementation and analysis of an on-farm food safety program for the production of greenhouse vegetables in Ontario, Canada. Journal of Food Protection. 65: 918- 923.

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