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.

Always use a thermometer: 244 sickened by shiga toxin-producing E. coli at US Marine training base

In Nov. 2017, over 200 U.S. Marines-in-training were sickened by shiga-toxin producing E. coli at Marine Corps Recruit Depot San Diego and Camp Pendleton.

That outbreak was blamed on undercooked beef prepared by a civilian contractor, according to the results of an investigation.

First rule of public health (substitute military or any other organization): make public health look good.

According to Healio, the outbreak occurred in October and November among newly enlisted men at Marine Corps Recruit Depot, San Diego, and Camp Pendleton, a nearby base where recruits conduct weapons and field training, according to Amelia A. Keaton, MD, MS, EIS officer in the CDC’s Outbreak Response and Prevention Branch.

The outbreak involved Shiga toxin-producing E coli (STEC) — a major cause of foodborne illness in the United States each year and the pathogen responsible for the current multistate outbreak of E. coli linked to romaine lettuce. In all, 244 male recruits are suspected of being sickened, including 15 who developed a life-threatening complication of STEC infections called hemolytic uremic syndrome (HUS). Among those who developed HUS, six were deemed critically ill but none died, Keaton told Infectious Disease News during the CDC’s annual EIS conference.

She said the outbreak presented several challenges for investigators and highlighted some unique risk factors among military trainees living in close quarters.

“Nobody on our team had a military background, so we first wanted to understand what their training environment is like,” Keaton said. “Do they have any unique exposures that people in the general public don’t have? We wanted to get a sense of what day-to-day life was like for these guys and what risk factors for infection they were exposed to.”

Keaton and colleagues interviewed 43 case patients and 135 healthy controls, plus Marine officers, food workers and staff. They observed food preparation practices and studied recruit sleeping quarters, bathroom facilities and cafeterias where meals were served to around 2,000 to 3,000 recruits at a time, Keaton said.

Although they were unable to directly test any meat, through interviews investigators found that ill recruits were 2.4 times likelier to report consuming undercooked beef than healthy controls. Moreover, Keaton said investigators directly observed beef being undercooked.

According to Keaton, most dining facilities on military bases are run by civilian contractors, including the facilities involved in this outbreak, which offered the same menu prepared by the same company. The Navy is in charge of inspecting such facilities once a month, she said.

“A lot of people reported eating meals that were visibly undercooked,” Keaton said. “When we observed food preparation, we saw that food workers were cooking a large number of hamburger patties and a large number of meals. Because such a large number of meals are being prepared, they’re only able to check foods intermittently with a meat thermometer. In some instances, we saw there were temperature abuses where they weren’t necessarily cooking to temperatures recommended by California state law.”

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.

The role of meat in foodborne disease

Meat has featured prominently as a source of foodborne disease and a public health concern. For about the past 20 years the risk management paradigm has dominated international thinking about food safety. Control through the supply chain is supported by risk management concepts, as the public health risk at the point of consumption becomes the accepted outcome-based measure.

Foodborne pathogens can be detected at several points in the supply chain and determining the source of where these pathogens arise and how they behave throughout meat production and processing are important parts of risk-based approaches. Recent improvements in molecular and genetic based technologies and data analysis for investigating source attribution and pathogen behaviour have enabled greater insights into how foodborne outbreaks occur and where controls can be implemented. These new approaches will improve our understanding of the role of meat in foodborne disease and are expected to have a significant impact on our understanding in the next few years.

The role of meat in foodborne disease: Is there a coming revolution in risk assessment and management?

Meat Science

Narelle Fega, Ian Jenson

https://doi.org/10.1016/j.meatsci.2018.04.018

https://www.sciencedirect.com/science/article/pii/S0309174018300731

A foodborne illness outbreak could cost a restaurant millions, study suggests

A single foodborne outbreak could cost a restaurant millions of dollars in lost revenue, fines, lawsuits, legal fees, insurance premium increases, inspection costs and staff retraining, a new study from researchers at the Johns Hopkins Bloomberg School of Public Health suggests.

The findings, which will be published online on Apr. 16 in the journal Public Health Reports, are based on computer simulations that suggest a foodborne illness outbreak can have large, reverberating consequences regardless of the size of the restaurant and outbreak. According to the model, a fast food restaurant could incur anywhere from $4,000 for a single outbreak in which 5 people get sick (when there is no loss in revenue and no lawsuits, legal fees, or fines are incurred) to $1.9 million for a single outbreak in which 250 people get sick (when restaurants loose revenue and incur lawsuits, legal fees, and fines).

Americans eat out approximately five times per week, according to the National Restaurant Association. The Centers for Disease Control and Prevention (CDC) estimates that approximately 48 million people get sick, 128,000 are hospitalized and 3,000 die each year due to food-related illnesses, which are often referred to as food poisoning.

For the study, the researchers developed a computational simulation model to represent a single outbreak of a particular pathogen occurring at a restaurant. The model broke down results for four restaurant types: fast food, fast casual, casual and fine dining under various parameters (e.g., outbreak size, pathogen, and scenarios).

The model estimated costs of 15 foodborne pathogens that caused outbreaks in restaurants from 2010 – 2015 as reported by the CDC. Examples of the pathogens incorporated in the model were listeria, norovirus, hepatitis A, E. coli and salmonella. The model ran several different scenarios to determine the impact level ranging from smaller outbreaks that may incur few costs (i.e., no lawsuits and legal fees or fines) to larger outbreaks that incur a high amount of lawsuits and legal fees.

“Many restaurants may not realize how much even just a single foodborne illness outbreak can cost them and affect their bottom line,” says Bruce Y. Lee, MD, MBA, executive director of the Global Obesity Prevention Center (GOPC) at the Bloomberg School. “Paying for and implementing proper infection control measures should be viewed as an investment to avoid these costs which can top a million dollars. Knowing these costs can help restaurants know how much to invest in such safety measures.”

The research team found that a single outbreak of listeria in fast food and casual style restaurants could cost upwards of $2.5 million in meals lost per illness, lawsuits, legal fees, fines and higher insurance premiums for a 250-person outbreak. When looking at the same circumstances for fine dining restaurants, $2.6 million in costs were incurred. The subsequent costs of outbreaks can be major setbacks for restaurants and are sometime irreversible. For example, Chi-Chi’s restaurant went bankrupt and closed their doors in the U.S. and Canada permanently due to a hepatitis A outbreak in 2003. In the past decade, several national restaurant chains have lost significant business due to food-illness outbreaks.

“Even a small outbreak involving five to 10 people can have large ramifications for a restaurant,” says Sarah M. Bartsch, research associate at the Global Obesity Prevention Center and lead author of the study. “Many prevention measures can be simple, like implement adequate food safety staff training for all restaurant employees and apply sufficient sick leave policies, and can potentially avoid substantial costs in the event of an outbreak.”

We’re all hosts on a viral planet: Trillions upon trillions of viruses fall from the sky each day

When a stoned Carl Sagan used to do his TV bit and talk about billions and billions of galaxies, I turned my world inward, to the trillions and trillions of viruses.

I tell daughter Sorenne, I don’t care which you focus on, but get one of them right.

According to Jim Robbins of the New York Times, high in the Sierra Nevada mountains of Spain, an international team of researchers set out four buckets to gather a shower of viruses falling from the sky.

Scientists have surmised there is a stream of viruses circling the planet, above the planet’s weather systems but below the level of airline travel. Very little is known about this realm, and that’s why the number of deposited viruses stunned the team in Spain. Each day, they calculated, some 800 million viruses cascade onto every square meter of the planet.

Most of the globe-trotting viruses are swept into the air by sea spray, and lesser numbers arrive in dust storms.

“Unimpeded by friction with the surface of the Earth, you can travel great distances, and so intercontinental travel is quite easy” for viruses, said Curtis Suttle, a marine virologist at the University of British Columbia. “It wouldn’t be unusual to find things swept up in Africa being deposited in North America.”

The study by Dr. Suttle and his colleagues, published earlier this year in the International Society of Microbial Ecology Journal, was the first to count the number of viruses falling onto the planet. The research, though, is not designed to study influenza or other illnesses, but to get a better sense of the “virosphere,” the world of viruses on the planet.

Generally it’s assumed these viruses originate on the planet and are swept upward, but some researchers theorize that viruses actually may originate in the atmosphere. (There is a small group of researchers who believe viruses may even have come here from outer space, an idea known as panspermia.)

Whatever the case, viruses are the most abundant entities on the planet by far. While Dr. Suttle’s team found hundreds of millions of viruses in a square meter, they counted tens of millions of bacteria in the same space.

Mostly thought of as infectious agents, viruses are much more than that. It’s hard to overstate the central role that viruses play in the world: They’re essential to everything from our immune system to our gut microbiome, to the ecosystems on land and sea, to climate regulation and the evolution of all species. Viruses contain a vast diverse array of unknown genes — and spread them to other species.

Last year, three experts called for a new initiative to better understand viral ecology, especially as the planet changes. “Viruses modulate the function and evolution of all living things,” wrote Matthew B. Sullivan of Ohio State, Joshua Weitz of Georgia Tech, and Steven W. Wilhelm of the University of Tennessee. “But to what extent remains a mystery.”

We’re all hosts on a viral planet.

I didn’t understand this until fourth-year university, and it was only then I became interested in learning.

Until then, I was bored.

Researchers recently identified an ancient virus that inserted itDNA into the genomes of four-limbed animals that were human ancestors. That snippet of genetic code, called ARC, is part of the nervous system of modern humans and plays a role in human consciousness — nerve communication, memory formation and higher-order thinking. Between 40 percent and 80 percent of the human genome may be linked to ancient viral invasions.

Viruses and their prey are also big players in the world’s ecosystems. Much research now is aimed at factoring their processes into our understanding of how the planet works.

“If you could weigh all the living material in the oceans, 95 percent of it is stuff is you can’t see, and they are responsible for supplying half the oxygen on the planet,” Dr. Suttle said.

In laboratory experiments, he has filtered viruses out of seawater but left their prey, bacteria. When that happens, plankton in the water stop growing. That’s because when preying viruses infect and take out one species of microbe — they are very specific predators — they liberate nutrients in them, such as nitrogen, that feed other species of bacteria. In the same way, an elk killed by a wolf becomes food for ravens, coyotes and other species. As plankton grow, they take in carbon dioxide and create oxygen.

One study estimated that viruses in the ocean cause a trillion trillion infections every second, destroying some 20 percent of all bacterial cells in the sea daily.

Viruses help keep ecosystems in balance by changing the composition of microbial communities. As toxic algae blooms spread in the ocean, for example, they are brought to heel by a virus that attacks the algae and causes it to explode and die, ending the outbreak in as little as a day.

While some viruses and other organisms have evolved together and have achieved a kind of balance, an invasive virus can cause rapid, widespread changes and even lead to extinction.

 

Risk is not low if cause is not known: 5, then 19, now 34 sick and 1 dead sick in E. coli outbreak linked to Edmonton restaurant

If the E. coli-romaine lettuce made it to an Alaskan prison, maybe it made it to an Edmonton restaurant.

Just asking.

According to the Toronto Star, one person has died and more than 30 people have fallen ill following an E. coli outbreak that Alberta Health Services has called “extremely complex” to investigate.

In a statement, AHS says it has expanded its investigation into the source of an outbreak of E. coli, beyond cases directly linked to an Edmonton restaurant late last month.

While 21 of these lab-confirmed cases are linked to Mama Nita’s Binalot restaurant in Edmonton, AHS no longer has public health concerns related to the restaurant.

The number of lab-confirmed cases of E. coli has increased to 34, including 11 patients who have needed hospital care, and one patient who has died likely due to E. coli infection.

“This outbreak is extremely complex, however AHS, in partnership with other provincial and federal agencies, is doing all we can to protect the health of Albertans,” said Dr. Chris Sikora, a medical officer of health in the Edmonton zone, in a statement. “The risk of illness remains very low.”

AHS has not yet identified the source of these cases, but believes they are linked to the initial outbreak.

The risk is not low if the cause is not known.

AHS has worked closely with the owners of Mama Nita’s Binalot since it was identified that a cluster of people with lab-confirmed E. coli ate at the restaurant. AHS says the owners have taken significant steps to manage this issue, including voluntarily closing until AHS was confident the restaurant could reopen without presenting a risk to the public.

The deli is not safer: Slicer cleaning and Listeria

The Centers for Disease Control and Prevention (CDC) estimates that 3,000 people die in the United States each year from foodborne illness, and Listeria monocytogenes causes the third highest number of deaths. Risk assessment data indicate that L. monocytogenes contamination of particularly delicatessen meats sliced at retail is a significant contributor to human listeriosis. Mechanical deli slicers are a major source of L. monocytogenes cross-contamination and growth.

In an attempt to prevent pathogen cross-contamination and growth, the U.S. Food and Drug Administration (FDA) created guidance to promote good slicer cleaning and inspection practices. The CDC’s Environmental Health Specialists Network conducted a study to learn more about retail deli practices concerning these prevention strategies. The present article includes data from this study on the frequency with which retail delis met the FDA recommendation that slicers should be inspected each time they are properly cleaned (defined as disassembling, cleaning, and sanitizing the slicer every 4 h).

Data from food worker interviews in 197 randomly selected delis indicate that only 26.9% of workers (n = 53) cleaned and inspected their slicers at this frequency. Chain delis and delis that serve more than 300 customers on their busiest day were more likely to have properly cleaned and inspected slicers. Data also were collected on the frequency with which delis met the FDA Food Code provision that slicers should be undamaged. Data from observations of 685 slicers in 298 delis indicate that only 37.9% of delis (n = 113) had slicers that were undamaged. Chain delis and delis that provide worker training were more likely to have slicers with no damage.

To improve slicer practices, food safety programs and the retail food industry may wish to focus on worker training and to focus interventions on independent and smaller delis, given that these delis were less likely to properly inspect their slicers and to have undamaged slicers.

Retail deli slicer inspection practices: An EHS-Net study, May 2018

LAUREN E. LIPCSEI,1* LAURA G. BROWN,1 E. RICKAMER HOOVER,1 BRENDA V. FAW,2 NICOLE HEDEEN,3 BAILEY MATIS,4DAVID NICHOLAS,5 and DANNY RIPLEY6

Journal of Food Protection, vol. 81 no. 5

https://doi.org/10.4315/0362-028X.JFP-17-407

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-407?code=fopr-site

Flour power: Raw is risky

When I was a kid, I had this multi-colored swim towel that stated Flower Power (right, not exactly as shown).

I should have known that if a 1960s slogan had been co-opted by towel manufacturers in the early 1970s, it was a sign of corporate greed rather than earth-tone sentiment.

For the past decade, raw flour has increasingly come under the food safety microscope.

Flour was suspect in a 2008 outbreak of Salmonella in New Zealand. In June, 2009, an outbreak of shiga-toxin producing E. coli (primarily O157:H7) in Nestle Toll House cookie dough sickened at least 77 people in 30 American states. Thirty-five people were hospitalized – from flour in the cookie dough.

Hemp seed flour sickened 15 Germans in 2010.

There was the U.S. General Mills outbreak of 2016 which sickened at least 56 people with the outbreak strain of E. coli O121 and O26, followed by a separate outbreak of E. coli O121 in Robin Hood flour in Canada in late 2016 going into 2017, that sickened at least 29.

It’s this latter outbreak that has journalist Jim Romahn’s attention.

Romahn writes the release of 759 pages of mostly e-mails indicates there was a massive effort involved in a recall of flour milled in Saskatoon that was contaminated with E. coli O121.

Twenty-two Canadians were identified as sickened by the flour, including one key case where the person consumed raw dough.

With hindsight, health officials were able to determine the first person sickened was Nov. 13, 2016. The others sickened and linked to the flour were between then and Feb. 26, 2017.

Robin Hood flour was identified as the source in March and on March 26 the Canadian Food Inspection Agency began a recall that eventually grew to scores of brand-name products across Canada and even an export shipment to Guyana.

The recall involved a number of major companies, such as Smucker Foods of Toronto and the Sobeys supermarket chain.

There were some unusual difficulties, including the challenge of contacting Mennonites who have no telephones.

The investigation and lab results eventually traced the source to flour milled at Ardent’s Saskatoon plant on Oct. 15, 16 and 17.

A high percentage of packages of flour milled on those dates turned up with E. coli O121.

But even then it’s not clear where the wheat originated.

Ardent Mills said it was probably spring wheat, but it could have also contained soft wheat, and that it probably was from the 2016 harvest, but might have had some wheat from the 2015 harvest.

That’s reflective of the amount of blending that happens both with the wheat used in milling and the flours that are blended into products for sale.

The documents were released under Access to Information at the request of a woman who spent time in a hospital in Medicine Hat, Alta.

 An Outbreak of Shiga Toxin–Producing Escherichia coli O121 Infections Associated with Flour – Canada, 2016–2017

MMWR Morb Mortal Wkly Rep 2017; 66: 705–706

Morton V, Cheng JM, Sharma D, Kearney A.