31 sickened by E. coli O55 in Dorset: 3 years later, health-types’ report remains a secret

In Dec. 2014, an outbreak of E. coli O55 was identified in Dorset, U.K. with at least 31 sickened. Public Health England (PHE) and local environmental health officials investigated and found nothing, other than cats were also being affected.

Tara Russell of Bournemouth Echo reports again this week that a review into the outbreak in Dorset was carried out, health chiefs have insisted – but the report is not available to the public.

Public Health England (PHE) says the public can only request to see the report detailing exactly what happened when 31 people contracted the O55 strain between July 2014 and November 2015 through a Freedom of Information request.

Families including some whose children have been left with lifelong health complications say they did not know the review existed and have branded it ‘disappointing and disgusting’ they have been kept in the dark.

The Daily Echo has lodged an official FOI request on behalf of the affected families and will receive a response in July.

Nurse Jessica Archer, who today suffers crippling head pains, fatigue and depression while her nephew Isaac Mortlock (right) endures severe seizures, must be peg fed every night and will need a kidney transplant as a result of the outbreak, said: “Without the Daily Echo we wouldn’t even know this report even existed and we are very interested to see it and we have the right to know. The families affected have so many unanswered questions and have to live with the effects of this outbreak forever but yet again we feel Public Health England are trying to sweep it under the carpet and hope that it will just go away.

“It is disappointing and disgusting this report has not already been made public let alone having to wait and wait still. We feel there have been a series of failures and this is the latest.”

The news comes after Jessica last month called for PHE to be held to account telling how her and her five-year-old nephew’s Isaac Mortlock’s lives have changed irreversibly, and accused the organisation of ‘a cover up.’

In response, PHE told the Daily Echo it carries out ‘routine outbreak reviews once investigations have ended’, adding it is ‘a learning organisation and reflects on outbreaks to identify lessons learnt and to continually improve our response.’

However at the time, the organisation refused to tell the Daily Echo exactly which lessons were learned.

It was only following a further request from this newspaper, PHE said a report was compiled however it has not been available to the public.

A spokesman said: “This report was not intended for external publication – it’s not standard procedure to publish outbreak reports externally due to patient confidentiality – however if interested parties would like to request a copy they can do this via our Freedom of Information portal.”

That’s bullshit.

Outbreak investigations are routinely published while ensuring patient confidentiality.

Families say it is the latest in a string of ‘failures’ by Public Health England.

A spokesman from PHE added: “As with all outbreaks, PHE Health Protection Team ensured throughout their investigation that those affected were kept informed of any information that was uncovered at that time.”

That’s also bullshit.

And why UK health types feature prominently in our paper on when to go public for the benefit of public health.

Three years seems a bit long.

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

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

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

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions.

Information provision on its own is not enough. Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

Going public: Why FDA doesn’t share retail outlet information (but should) edition

Earlier this month Doug and I had a paper published in the Journal of Environmental Health about the need for public health folks (especially at the local and state levels) who are dealing with an outbreak to have a plan on when to go public. The plan should include what info the release; how they release it; and, what triggers release.

There are a bunch of great folks in these agencies who are often understaffed, overworked and dealing with political pressures – but often don’t look to the risk communication world for tips on this stuff.

Caitlin Dewey at the Washington Post wrote about why FDA doesn’t practice sharing outlets/retailers where recalled products are sold, even those linked to illnesses.

The FDA does not specify, however, which stores, centers or schools — because that would violate its interpretation of an obscure trade secret rule.

This interpretation differs from that of other agencies in the federal food safety system, an overlapping and often illogical network of regulatory fiefdoms. The system, which is responsible for keeping food free of bacteria and other pathogens, frequently has to weigh the very real interests of private food companies against potential risks to the public. In the case of releasing retailer lists during major outbreaks, the FDA has historically sided with business, ruling that such lists constitute “confidential commercial information” and thus should not be available for public consumption.

Critics say that the agency’s unwillingness to share this information poses a clear danger to public health, particularly in cases like the current E. coli outbreak, where parents may not know if their child consumed the recalled product. According to the Centers for Disease Control and Prevention, 14 of the 16 people who have fallen ill were children.

It could also prove relevant in incidents like last year’s multistate hepatitis A outbreak, which was traced to frozen strawberries imported from Egypt and sold at several Tropical Smoothie Cafes. The FDA did not specifically reveal which locations, however — a measure that some experts say would have gotten the news to ill consumers faster. That’s important in the case of an illness like hepatitis A, which can be treated with a vaccine for a limited period after exposure.

Doug and I argue that public health agencies (like FDA) should be in the business of sharing the info they have, the info they don’t have and all the uncertainties. This includes distribution data. There are lots of ways that folks get food safety and recall information. Sometimes it’s directly from their retailer of choice; or maybe it comes from a local media source. Or someone shared something on Facebook.

Bill Hallman and colleagues at Rutgers conducted a survey of consumers and their self-reported behaviors following 2008’s Salmonella saintpaul in tomatoes, er, peppers outbreak and found that lots of people (81%) say they they share recall info when they see it. 38% believe that the food they purchase is less likely to be recalled than their neighbors. And less than 60% report checking their fridges and pantries for the food.

Releasing retailer/distribution information might increase the chance individuals will say to themselves ‘I’ve bought some soynut butter recently, and I got it at that grocery store’ and they go check.

But I could just be optimistic.

A food safety Facebook friend posted a couple of days ago about a Listeria monocytogenes-linked recall. It was so important to him that he posted the info twice once on Feb 17 and again March 11, ‘I want to again stress that you should check any production codes immediately and if you have any of these products, either throw them away or return them to your grocery store. I just checked my cheese stash and had the pepperjack slices that are included.’

But, like Hallman and colleagues found, while he shared the info, he wasn’t motivated to actually go to his fridge to look for it the first time he posted. Maybe the distribution information would have triggered a behavioral response.

Going public: have a plan

‘Food safety recalls are always either too early or too late. If you’re right, it’s always too late. If you’re wrong, it’s always too early.’
That’s what Paul Mead was quoted as saying in response to when to go public with outbreak information over a decade ago. 
During foodborne illness outbreaks and incidents information is evolving – what people know, and when the share it can impact public health, and buyer decisions. Go public too late and stuff remains on the market. Go public too early risks making a wrong decision
Doug, Sol Erdozian and I wrote a paper a while back that finally got published this week in the Journal of Environmental Health where we look at the going public situation. There’s no magic answer; just have a plan and a set of criteria to look at when making the decision of what to share when. Talk about uncertainty. And don’t make it up on the fly.
Here’s NC State’s press release about our paper:

There’s an ongoing debate among public health officials about how quickly they should notify the public about foodborne illness outbreaks, and how much information should be shared. Is it better to tell people as early as possible, or could that create panic that is counterproductive?

Food safety researchers are now calling on public health agencies to develop clear guidelines on when to inform the public about foodborne illness outbreaks – something which is often handled on an ad hoc basis at the local, state and federal levels.

To learn more about how health agencies are currently addressing these questions, researchers evaluated 11 case studies of large outbreaks, dating back to 1996.

Not only is there no clear consensus on how to respond, they discovered, but there is no system in place to help officials decide when to tell the public about a foodborne illness outbreak.

“We found that pressure from social media, or from companies, has sometimes influenced when health officials release information, which is problematic,” says Ben Chapman, lead author of a paper on the work and an associate professor of agricultural and human sciences at North Carolina State University.

“Officials need to have clearly defined processes for determining when information should be made public, and those processes don’t appear to exist right now,” Chapman says.

Instead, researchers found that public health agencies – from the federal Centers for Disease Control and Prevention to state and local agencies – make decisions about sharing information on a case-by-case basis.

“There are advantages and risks to both sharing and withholding information,” Chapman says.

Sharing information early in an outbreak can allow consumers to make informed decisions about their food choices that limit risk. But there can also be a lot of uncertainty about that information.

“For example, officials may be investigating a particular restaurant or type of food, but the investigation could ultimately find that the culprit was actually a different source altogether,” Chapman says.

By the same token, withholding information until there is less uncertainty may increase public health risks because the source of the illness may remain accessible to unwitting consumers.

“The best case is to share what you know, and what you don’t know, in an open and transparent way,” Chapman says. “Talking about uncertainty may be uncomfortable for officials, but they need to have a plan for how to do so.”

The paper, “Going Public: Early Disclosure of Food Risks for the Benefit of Public Health,” is published in the Journal of Environmental Health. The paper was co-authored by Maria Sol Erdozaim, a former undergraduate at Kansas State University, and Douglas Powell of Powell Food Safety.

-shipman-

Note to Editors: The study abstract follows.

“Going Public: Early Disclosure of Food Risks for the Benefit of Public Health”

Authors: Benjamin Chapman, North Carolina State University; Maria Sol Erdozaim, Kansas State University; Douglas Powell, Powell Food Safety

Published: March 2017, Journal of Environmental Health

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

Going public: The new normal for foodborne outbreaks

I’ve had different versions of this paper running through my head for 25 years.

It started as a rebel-without-a-clue teenager, and led to questions about mad cow disease in 1995 (or earlier) when the UK government knew there were human victims but said nothing until March 1996.

My father – the inspiration for the cooking show paper – has asked me a couple times over the years regarding the engineering/automotive sector, when they knew something was wrong; what should we do? But like so many other sectors, it gets brushed aside.

There’s money involved.

My local hockey club can’t figure out how to go public, so it’s no wonder that public health agencies can’t figure it out either.

Yet the job of public health, no matter how many political assholes, no matter how many impediments, and no matter how many dog bites you have to investigate, is to protect public health.

If people are barfing, it’s time to go public.

That doesn’t always (rarely) happen.

Anyone can search barfblog.com under the phrase “going public” and find hundreds of incidents of people acting like shits.

But this is important shit, because credibility depends on transparency and trust and truthiness (at least in my idyllic world-view).

Public health is under siege.

The science is there, the outbreaks are there. Go public.

Or at least explain the process so mere mortals can understand.

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

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

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

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.

Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

 

Going public (not): E. coli outbreak at Chicago restaurant sickened over 100 in June

In June, 2016, people started getting sick after dining at Carbon Live Fire Mexican Grill at 300 W. 26th St., Chicago.

carbon-live-mexican-grillBy July 1, at least 25 people were sick with Shiga-toxin producing E. coli, and the restaurant closed.

Five months later, and cilantro has been fingered as the source.

By the end of the outbreak, 68 people were sickened, 22 of whom were hospitalized. All have since been treated and released.

According to a report from the department of health, cilantro was identified as “food vehicle” that likely caused the outbreak. 

All prepared food was disposed, food handling practices were reviewed, and all staff who handle food were tested at least twice for the bacteria,” according to a release from Healthy Chicago, an initiative of the Chicago Department of Health, said at the time the outbreak was reported. 

Carbón withdrew from the Taste of Chicago so that it could turn “its full attention to addressing the issues at its Bridgeport location,” health officials said.

The owners also closed their second location at 810 N. Marshfield “out of an abundance of caution.” That location reopened July 9, health officials said. 

Two lawsuits stemming from the outbreak were filed against the restaurant, one seeking more than $90,000 in damages.

That’s the PR version.

The team at Marler’s Seattle law firm had previously filed a Freedom of Information Act request and found more than 100 people were sickened and that 16 of 40 food-handling employees of Carbón Live Fire Mexican Grill tested positive for E. coli soon after the restaurant’s two locations voluntarily closed for cleaning July 1.

Lab tests confirmed 69 people were sickened during the outbreak, with another 37 probable cases. Of the sick people, 22 had symptoms so severe that they required hospitalization. Illness onset dates ranged from June 3 to July 23.

Cilantro is the suspected source of the E. coli based on percentages of sick people who ate menu items made with the fresh produce item. Inspectors collected 12 food items, including cilantro, but none of the food returned positive results for E. coli bacteria. The cilantro was sourced from Illinois and Mexico, according to traceback information provided to the health department.

“Lettuce was associated with illness in both multivariable models but was consumed by only 44 percent of cases,” according to the health department report.

“In comparison, cilantro was consumed by 87 percent of cases, and either cilantro or salsa fresca (which included cilantro) were consumed by 95 percent of cases.”

The report references “several critical violations” observed during a July 1 inspection, such as improper temperatures for several food items including red and green salsas, tequila lime sauce, raw fish, guacamole and cheese. Inspectors also noted improper hand hygiene practices among food handlers.

Outbreak at San Antonio Housing Authority event leads to hospitalization

‘The people was wonderful. The food was wonderful,’ James Hamilton said, ‘when I first ate it.’

Sounds like most outbreaks.

According to KSAT12 an event for individuals supported by the San Antonio Housing Authority is being linked to a bunch of illnesses.

Hamilton said it did not take long for the food to make him ill.photo

“I started walking down the hallway to my apartment and I didn’t make it,” he said. “I got very sick before I even made it inside the door.”

The gala was held Friday at the Freeman Coliseum and the menu was a traditional holiday mix. Less than 48 hours later, Hamilton said he was in the hospital.

The housing authority would not disclose who prepared and provided the food.

The whole situation has left a bad taste in Hamilton’s mouth. “Getting food poisoning is one thing,” he said, “but them not telling the public that it happened is another thing altogether.”

Yep, that sucks. Businesses that make people sick don’t deserve to be protected. Share what you know. And what you don’t.

Going public: FDA not liable for $15 million in damages sought by tomato grower for food safety warning error

I remember. I was in Quebec City with a pregnant Amy when all this went down. Doing hour-long iradio interviews where midnight callers asked about aliens and Salmonella.

tomato

Michael Booth of the National Law Journal reports the U.S. Food and Drug Administration cannot be held liable for financial damages suffered by farmers when it issues emergency, but erroneous, food safety warnings, the U.S. Court of Appeals for the Fourth Circuit has ruled.

In its Dec. 2 ruling, the Fourth Circuit refused to allow a South Carolina tomato farmer to seek more than $15 million in damages from the federal government under the Federal Tort Claims Act after the FDA issued a warning that an outbreak of Salmonella Saintpaul was caused by contaminated tomatoes, when it was later determined that the outbreak was caused by contaminated peppers imported from Mexico.

A South Carolina tomato farm, Seaside Farm on St. Helena Island, sued the federal government, claiming that the incorrect warnings issued by the FDA, beginning in May 2008 and later corrected, cost it $15,036,294 in revenue. The Fourth Circuit agreed with a trial court that the FDA was acting within its authority to issue emergency food safety warnings based on preliminary information in order to protect public health.

“We refuse to place FDA between a rock and a hard place,” wrote Judge J. Harvie Wilkinson for the panel, sitting in Richmond.

“One the one hand, if FDA issued a contamination warning that was even arguably overbroad, premature, or of anything less than perfect accuracy, injured companies would plague the agency with lawsuits,” he said.

“On the other hand, delay in issuing a contamination warning would lead to massive tort liability with respect to consumers who suffer serious or even fatal consequences that a timely warning might have averted,” Wilkinson said.

Judges Paul Niemeyer and Dennis Shedd joined in the Dec. 2 ruling.

The medical crisis arose on May 22, 2008, when the New Mexico Department of Health notified the Centers for Disease Control and Prevention (CDC) that a number of residents had been diagnosed as having Salmonella Saintpaul, a strain that causes fever, diarrhea, nausea and, if left untreated, death. Soon after, similar reports came in from Texas.

The CDC determined that a “strong statistical” analysis determined that the illnesses were caused by people eating raw tomatoes. By June 1 of that year, CDC was investigating 87 illnesses in nine states.

tomato-irradiationThe FDA then issued a warning to consumers in New Mexico and Texas. By June 6, 2008, however, reported cases grew to 145 incidents in 16 states. In New Jersey, three people were reported to have been diagnosed with the illness. On June 7, the FDA issued a blanket nationwide warning telling consumers that they should be wary of eating raw tomatoes. (New Jersey tomatoes were not implicated, since they do not ripen until later in the season.)

The warning listed a number of countries and states, including South Carolina, that were not included and were not implicated, but those states were not listed in media reports. Eventually, 1,220 people were diagnosed as having Salmonella Saintpaul.

Raw tomatoes were not the cause of the illnesses, however. The contamination was traced to imported jalapeño and serrano peppers imported from Mexico.

Seaside Farm, which had just harvested a large crop of tomatoes, sued in May 2011. The farm claimed the erroneous FDA warning about tomatoes cost it $15 million-plus damages in revenue. 

Pinto defense: We meet all standards, after 1 dead and six sickened at Perth childcare

In the Aussie form of see, hear and speak no evil, evidence has emerged that a child has died following an outbreak of gastro at a lower North Shore (Perth) childcare centre.

see-no-evilSix children at Little Zak’s Academy in Artarmon — aged between 11 months and four years — developed high fevers and vomiting over the past week caused by rotavirus gastroenteritis, health authorities have confirmed.

But a seventh child died, with the causes so far unknown, although the death is not being directly attributed to the outbreak.

Northern Sydney Public Health Unit director Dr Michael Staff said four of the sick children had to be admitted to hospital.

“Tragically, another child who also attends the centre died in hospital on October 23, but at this stage it appears unrelated to the gastroenteritis outbreak,” he said.

He said they were working with specialist paediatricians to understand the cause of the child’s death.

Parents were tonight in shock over the news of the death.

pintoexplodingAn email from the local health district informing them of what had happened was only sent through this afternoon.

Michael Kendall, father to five-year-old Charlotte, said that he was “furious” and would not be bringing his child back to the child care centre.

He said the centre should have been shut down during the outbreak — and that he only just found out about what had happened.

“It’s the most disgusting thing I’ve ever heard in my life, I only found about it 15 minutes ago, I just heard that a child has died.

“If I knew my child wouldn’t have been here.

“I used to run a big centre down at the snow and our first priority was to take care of people especially kids, once you have an outbreak you’re supposed to tell the parents and shut the premises down.”

A spokesman for the centre said Public Health Unit advice was that “the outbreak appears to be under control and it is safe for children to continue to attend the Centre.”

Little Zak’s said in a statement, “Please be assured our Artarmon Centre is fully accredited and compliant with all health and regulatory requirements, and we endeavour at all times to operate to the highest standards of care and hygiene. As confirmed by the Northern Sydney Local Health District, we will continue to work closely with its Public Health Unit to ensure these high standards are maintained.”

Pinto defense.

 

Going public: The hepatitis A case that wasn’t

When there is a chance to protect public health you gotta go public with all the info you have, when you have it. Sometimes new information arises that changes things and makes it look like officials got it wrong – when they didn’t.

Last week, according to The Chronicle, a food handler tested positive for hep A – and it turned out to be a false positive.flat1000x1000075f

A reported case of Hepatitis A at the Chehalis Shop’n Kart last week has been ruled a false positive by county health officials, meaning a worker in the store’s bakery was not infected and baked goods they handled were not contaminated.

An initial press release from the Lewis County Public Health and Social Services last week said a bakery worker tested positive for the virus, which causes an acute liver infection.

But a release issued Friday said this test was a false positive, meaning there was never an infection or risk to customers.

Shop’n Kart owner Darris McDaniel said the containment procedure cost his store thousands of dollars in product they threw away, while also damaging its reputation.

“In the future, if anything would happen again, we would ask for another test right away, because this sent up a lot of bad signals for our business when in fact it wasn’t true,” he said. “We did take the proper steps and acted very quickly.”

Does that going public default apply to the leafy greens cone of silence? Arizona restaurant sued over Salmonella outbreak

Alejandro Barahona and Ken Alltucker of AZ Central report a Phoenix resident filed a lawsuit against Texas-based Pappas Restaurants Inc. that claims she contracted salmonella last month after eating at the chain’s Phoenix restaurant.

lsThe Maricopa County Department of Public Health confirmed there was an investigation of a salmonella outbreak at Pappadeaux Seafood Kitchen of Phoenix.

The outbreak is over and the county health department is closing its investigation, said Jeanene Fowler, a department spokeswoman.

Because final paperwork that details the outbreak has not been completed, Fowler said, county officials could not confirm the number of people who became ill after eating at the popular seafood restaurant, at 11051 N. Black Canyon Highway.

A manager at Pappadeaux in Phoenix said he could not discuss the outbreak, referring Republic inquiries to the chain’s headquarters in Houston. Officials at the chain’s headquarters did not respond to phone messages and email questions about the county’s investigation or the lawsuit.

Pappas Restaurants has not yet answered the lawsuit, which was filed last Friday at U.S. District Court in Phoenix.

The lawsuit states that on Aug. 14, Phoenix resident Shaina Robinson ate shrimp, tilapia and crab cakes at Pappadeaux Seafood Kitchen of Phoenix. The lawsuit states that two days later, Robinson became “violently ill” with stomach illness. Four days later, she sought treatment at a Scottsdale hospital.

She spent five days at the hospital and tested positive for a strain of salmonella, according to the lawsuit.

She missed two weeks of work and “incurred significant medical bills as a direct and proximate cause of her salmonella infection contracted at Pappadeaux Seafood Resturant,” the lawsuit states.

Robinson is seeking restitution for irreparable emotional distress, medical expenses, bodily injuries, suffering and permanent impairment, among other claims.

The county health department often does not publicly announce restaurants tied to an outbreak unless officials believe it can help prevent people from becoming sick, Fowler said.

spongebob-oil-colbert-may3-10She said part of the issue is timing. County health and environmental services inspectors must confirm that an outbreak is ongoing and public disclosure could prevent people from getting sick. Inspectors also must verify an outbreak is tied to a specific restaurant and not a supplier that delivered tainted food to different establishments.

“We don’t wanted to put (restaurants) out of business for something that may have nothing to do with the business,” Fowler said. “We are trying to take that into account.”

But Fowler said that completed reports, whether it’s a routine inspection or investigation of a foodborne illness, are available for public inspection.

“We get hundreds and hundreds of these each year,” Fowler said, referring to foodborne-illness complaints.

Attorney Ryan Osterholm said he believes county health officials should aggressively notify the public during outbreaks.

“The public deserves to know,” Osterholm said. “There should be transparency in anything unless there is a compelling reason not to. … The baseline should be transparency.”