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.

Two outbreaks? One outbreak? Two different products? Same product? Romaine?

I dunno.

I’m having trouble agreeing with the avoid-romaine-in-the-US statement from Consumer Reports. Maybe it’s the same outbreak; maybe it’s not (and CDC didn’t say a lot about whether Canadian and US cases even have the same pfge match). Could be same pathogen on different product.

Just not sure yet. And public health folks share more about uncertainty; PHAC, share any info you have on distribution of the romaine you think it is.

Go public. Share data with the people.

Canadian STEC/lettuce outbreak leads to a death

Every day I eat food that doesn’t kill me. Or hasn’t yet.

I get kinda emotional when I read about a death linked to food.

While billions of servings of food every year don’t lead to tragedy, when it does I take notice.

I’ve met folks who continue to suffer the life-long impacts of foodborne pathogens; people who have watched their loved ones in pain in a hospital bed and ultimately them.

All from food.

According to an updated statement from the Public Health Agency of Canada, 30 people across Canada are dealing with E. coli O157 linked to romaine lettuce.  There’s not a lot of details though.

Currently, there are 30 cases of E. coli O157 illness under investigation in five provinces: Ontario, (6), Quebec (5), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and December 2017. Twelve individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 4 and 80 years of age. The majority of cases (70%) are female.

Many individuals who became sick reported eating romaine lettuce before their illnesses occurred. 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.

No one should die as a result of food they ate.

Chili cook-off outbreak; we’ve been doing this for x years and no one has been ill

No one thinks their food is going to make anyone sick. After 15 years in food safety that’s what I’ve learned.

I’ve heard it from restaurants, processors, extension folks, event organizers. Whoever.

Turns out, that’s just wishful thinking.

If there’s an event, like say, a chili cook-off, and folks don’t know how pathogens get in food and grow, someone is probably gonna get sick.

Sorta like what happened last week in Chincoteague, Virginia.

According to Delaware.gov, Virginia regulators are looking into illnesses after a bunch of people got sick following a chili competition.

The Virginia Department of Health (VDH) began investigating a gastrointestinal disease outbreak shortly after a number of people who attended the event developed nausea, vomiting, diarrhea and fever. Illness in a Delaware resident who reportedly attended the event, may be linked.

VDH, reached out to neighboring states’ health departments, including the Delaware Division of Public Health, and asked for assistance in getting their residents to complete the survey, whether they became ill or not. The survey can be found at https://redcap.vdh.virginia.gov/redcap/surveys/?s=RPPDH7DWDF. VDH estimates 2,500 attendees from multiple states were present at the cook-off. The investigation is ongoing. Anyone with additional questions should call the Accomack County, Virginia Health Department at 757-302-4268.

Virginia Chipotle closed after reports of illness

According to multiple outlets, a Sterling VA, Chipotle restaurant has closed due to what looks like a foodborne illness outbreak. Folks are speculating that it might be norovirus. And by folks, I mean Chipotle.

Huffpo reports,

After voluntarily closing a restaurant in Sterling, Virginia, after multiple customers reported falling ill, Chipotle said it plans to reopen the burrito spot on Tuesday.

Eight customers who ate at the location between July 14 and 15 filed reports on the food safety crowdsourcing website iwaspoisoned.com, indicating they suffered symptoms like diarrhea, nausea and vomiting.

According to the reports, at least two customers have been hospitalized. 

“Norovirus does not come from our food supply, and it is safe to eat at Chipotle,” Jim Marsden, Chipotle’s executive director of food safety, said in an emailed statement. “We plan to reopen the restaurant today.”

“We take every report of illness seriously,” Marsden added. “In accordance with our established protocols, our team is working to ensure the safety of our customers and employees, including voluntarily closing the restaurant yesterday to conduct a complete sanitization.”

Uh, Jim, noro can come from the food supply. Yours and others’. It has even been linked to lettuce distribution. It certainly sounds like this is localized (like most noro is), but seems a bit early for certainty statements like this. Oh, and noro can definitely be foodborne. Sure, there’s likely a lot of person-to-person transmission out there but a couple of years ago my man Aron Hal of CDCl (and colleagues) looked at foodborne noro outbreaks in the U.S. They state that on average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death.

Safe is a promise.

From Business insider,

Here are some of the reports from iwaspoisoned.com related to the Sterling restaurant. All the reports were made from Sunday to Monday:

• Friday 7/14: Daughter and friends went to Chipotle Saturday 7/15: stomach pains and nausea started in morning Saturday 7/15: violently sick, puking, diarrhea, severe pain, overnight into Sunday. Friends ill as well with one friend also in ER. Sunday 7/16: Hospital visit for dehydration, nausea, pain Monday 7/17: severe pain, trauma pain This is the worst that I have ever seen. Severe food borne illnesses can cause long-term damage to the gastro-intestinal track. This was BAD!

• I ate a chicken bowl at 6ish and the rest at 11 pm Friday and then woke up Sunday morning with diarrhea and was nauseous

• Wife and I ate chicken bowls Friday night. Puking brains out Saturday night and Sunday.

• Ate salad bowl on Friday at 1230pm, became ill at 3pm on Saturday. Three up multiple times, had fever, dizziness, etc. Salad bowl with chicken, Pico, beans, medium salsa, corn

• My husband and I both had chicken around 7:00 on Friday, July 14th. Over 24 hours later, we both started vomiting. We are still experiencing symptoms as of Monday morning.
Chicken bowl – around 6 pm on 7.15.2017

• My husband and I shared a burrito bowl last night for dinner around 6:30 PM. It had rice, chicken, corn, pico, sour cream, cheese, medium salsa. At around midnight my husband woke up vomiting violently. Less than an hour later I began vomiting as well. We have since continued vomiting in addition to having diarrhea, stomach pains, dizziness upon standing, and low grade fevers. Chipotle was the only thing we both ate yesterday.

• My Son and I both had burrito bowls and became violently ill within hours of each other. He was visiting from college. Chipotle was the only food item we both ate that day. Violent stomach cramps, diarrhea, vomiting. Violently ill. Same exact symptoms Burrito bowl. Steak, rice, green peppers and onions, guacamole, cheese. Violently ill.

Full disclosure, I’ve been collaborating with the iwaspoisoned.com guy, Patrick Quade over the past couple of years through NoroCORE.

Shares plummeted more than 5 percent after the illnesses were reported.

There was a lot of Salmonella in peppers in 2016; some of it led to 36 illnesses

Last year someone I didn’t know called me about whether I had heard about people getting Salmonella from peppers. I hadn’t. It was around the same time there were a few recalls:

And that FDA had been sampling peppers for Salmonella.

I didn’t think much about it until this afternoon, when CDC published a report in MMWR about a multistate S. Anatum outbreak linked to imported hot peppers.

In June 2016, PulseNet identified a cluster of 16 Salmonella Anatum infections with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern from four states.* In April 2016, the same PFGE pattern had been uploaded to PulseNet from an isolate obtained from an Anaheim pepper, a mild to medium hot pepper. Hot peppers include many pepper varieties, such as Anaheim, jalapeño, poblano, and serrano, which can vary in heat level from mild to very hot depending on the variety and preparation. This rare PFGE pattern had been seen only 24 times previously in the PulseNet database, compared with common PFGE patterns for this serotype which have been seen in the database hundreds of times. Local and state health departments, CDC, and the Food and Drug Administration (FDA) investigated to determine the cause of the outbreak. Thirty-two patients in nine states were identified with illness onsets from May 6–July 9, 2016.

Local and state investigators visited restaurants where patients reported consuming peppers. They collected recipes for reported menu items, including salsa, and reviewed invoices to identify common ingredients. To identify the source of hot peppers, FDA conducted traceback (the process of tracing a food from point-of-service to its origin or manufacturer source) from three restaurants in Minnesota and Texas where patients reported eating. Two of the three restaurants received peppers from a consolidator/grower in Mexico (consolidator/grower B) (Figure 3), which exported Anaheim peppers to the United States in April 2016. Consolidators pool foods from different growers or growing locations; this designation is also used if some growers/growing locations are unknown.** The third restaurant received peppers from various firms in Mexico; however, this restaurant had received peppers from consolidator/grower B before this outbreak. Because of the complicated supply chain for peppers and the extensive mixing of peppers from different suppliers, repacking, and reselling of product, FDA was unable to identify a single source farm or point of contamination for peppers.

Too bad. Maybe this is what the call was about.

Bot cluster linked to California gas station

Botulism is no joke. The threat of bot toxins binding to nerve endings and blocking muscle contractions scares me.

A small bit of toxin means no more hockey, no catch with my kids and months of rehab. That’s why I find it so scary.

There’s usually less than a couple of hundred cases annually in the US. And not much foodborne. In the past week we’ve seen dried deer antler tea-linked to two illnesses – and now a California gas station looks to be the source of another outbreak, according to the Sacramento Bee.

Sacramento County Public Health officials are investigating a botulism outbreak after several people who ate prepared food from the Valley Oak Food and Fuel gas station in Walnut Grove contracted the possibly fatal form of food poisoning.

County Public Health Officer Dr. Olivia Kasirye said five cases are under investigation and the affected people are in serious condition at local hospitals. Four of the five confirmed they’d eaten prepared food from the gas station. Kasirye said the county wants to ensure that anyone who has eaten at the gas station since April 23 and is experiencing botulism symptoms receives immediate medical attention.

Unknown are the linked foods – and what the type toxin it is (because that may be a clue). I usually stick to candy bars and gum at gas stations.

Morimoto restaurant linked to Salmonella

My roommate Owen and I used to watch Iron Chef, the original dubbed version, while we ate late night Chinese food after going to the bar. I always liked the Morimoto the best. He was sort of the Bill Belichick of the show. He never smiled and always had his game face on. Serious about fancy food.

Fancy food ain’t safe food though; according to the Napa Valley Register Morimoto’s Napa joint has been linked to six cases of salmonellosis.

Several people reported getting sick with salmonella after eating at Morimoto Napa last month, according to Napa County Public Health.

There are at least six confirmed cases of salmonella-related food borne illnesses in customers who dined at the restaurant on Main Street between Oct. 10 and Oct. 12, said Dr. Karen Relucio, the county’s chief public health officer.

Relucio confirmed that the restaurant has been cooperative. During their investigation, she said, officials found that the restaurant was very clean and organized with strict operating procedures.

I ate at Morimoto’s Disney Springs restaurant earlier this year and there was a lot of sushi and sashimi on the menu. Maybe it’s the frozen kind.

Over 100 ill with noro at USC

Norovirus kind of sucks, unless you are a virologist. The perfect human pathogen (a term coined by my NoroCORE colleague and all-around good guy, Aron Hall) is shed at a crazy high rate of virus particles per gram of vomit or feces and sticks around in the environment for a long time. So outbreaks tend to persist and hit college campuses where lots of people live and eat together.

Like USC, where, according to LAist, a lot of students are sick.la-sp-usc-recruiting-update-20141021

The Los Angeles County Department of Public Health has confirmed that they are currently investigating a norovirus outbreak at the University of Southern California. A representative from the Department of Public Health told LAist that 103 cases have been reported since October 26, which is when the university reached out to the department about the situation. 

The university has asked students to remain home from classes or social events until they’ve been symptom free for at least 24 hours, according to a post on the USC Engemann Student Health Center website. This isn’t the first time the student body has been struck down by the virus—in 2008 hundreds of cases were reported in 2008, and there were a number of outbreaks around the L.A. area last year, as well.

Brae Surgeoner, Doug and I had a paper published in the Journal of Environmental Health about some research we conducted in the Winter of 2006. The study came about because a whole bunch of kids in the University of Guelph’s residence system started puking from an apparent norovirus outbreak. There were lots of handwashing signs up and we wanted to know whether they changed hygiene behavior (especially if kids were using the tools available when entering the cafeteria). Turns out that students weren’t doing as good of a job at hand hygiene as they reported to us.

Maybe IBM is good at some stuff: Grocery scanner data to speed investigations during early foodborne illness outbreaks

Foodborne illnesses, like salmonella, E. coli and norovirus infections, are a major public health concern affecting more than one out of six Americans each year, according to the Centers for Disease Control and Prevention (CDC)1. During a foodborne illness outbreak, rapidly identifying the contaminated food source is vital to minimizing illness, loss and impact on society.

ibm.nerdsToday, IBM Research – Almaden announced its scientists have discovered that analyzing retail-scanner data from grocery stores against maps of confirmed cases of foodborne illness can speed early investigations. In the study, researchers demonstrated that with as few as 10 medical-examination reports of foodborne illness they can narrow down the investigation to 12 suspected food products in just a few hours.

In the study, researchers created a data-analytics methodology to review spatio-temporal data, including geographic location and possible time of consumption, for hundreds of grocery product categories. Researchers also analyzed each product for its shelf life, geographic location of consumption and likelihood of harboring a particular pathogen – then mapped the information to the known location of illness outbreaks. The system then ranked all grocery products by likelihood of contamination in a list from which public health officials could test the top 12 suspected foods for contamination and alert the public accordingly.

A traditional investigation can take from weeks to months and the timing can significantly influence the economic and health impact of a disease outbreak. The typical process employs interviews and questionnaires to trace the contamination source. In 2011, an outbreak of E. coli in Europe took more than 60 days to identify the source, imported fenugreek seeds. By the time the investigation was completed, all the sprouts produced from the seeds had been consumed. Nearly 4,000 people became ill in 16 countries and more than 50 people died before public health officials could pinpoint the source, according to the European Food Safety Authority2.

“When there’s an outbreak of foodborne illness, the biggest challenge facing public health officials is the speed at which they can identify the contaminated food source and alert the public,” said Kun Hu, public health research scientist, IBM Research – Almaden in San Jose, Calif. “While traditional methods like interviews and surveys are still necessary, analyzing big data from retail grocery scanners can significantly narrow down the list of contaminants in hours for further lab testing. Our study shows that Big Data and analytics can profoundly reduce investigation time and human error and have a huge impact on public health.”

Already, the method in this study has been applied to an actual E.  coli  illness outbreak in Norway. With just 17 confirmed cases of infection, public health officials were able to use this methodology to analyze grocery-scanner data related to more than 2,600 possible food products and create a short-list of 10 possible contaminants. Further lab analysis pinpointed the source of contamination down to the batch and lot numbers of the specific product – sausage.