The following is from a list of outbreak investigations being managed by FDA’s CORE Response Teams. The investigations are in a variety of stages, meaning that some outbreaks have limited information, and others may be near completion.
A public health advisory will be issued for outbreak investigations that have resulted in specific, actionable steps for consumers to take to protect themselves. Please direct your attention to those pages for the most up to date information on the investigation and for consumer protection information.
Outbreak investigations that do not result in specific, actionable steps for consumers may or may not conclusively identify a source or reveal any contributing factors. If a source and/or contributing factors are identified that could inform future prevention, the FDA commits to providing a summary of those findings.
Date Posted – 14 Jul 2021 Reference No – 1010 Pathogen – _E. coli_ O121 Product(s) Linked to Illnesses – Not Yet Identified Total Case Count – 15 Investigation Status – Active Outbreak Status – Ongoing
Health officials in New Brunswick are clamping down on restaurants serving beef tartare because the dish, considered by some a delicacy, violates the province’s food regulations.
Kevin Bissett of The Globe and Mail writes that over the past month, 11 restaurants have been given notice to stop serving raw or undercooked meat. The notice came as a surprise to chef Luc Doucet at the Black Rabbit restaurant in Moncton, N.B.
“I was blindsided,” he said in an interview Monday. “I got an email from health inspector that they needed a meeting and they showed up Thursday and served us a letter to cease all tartare operations and take it off the menu.”
The letter said current regulations don’t allow such foods to be served. “Our department was recently made aware that ground beef prepared as per the request of the customer and/or steak tartare is presently available at your food premises,” the letter stated. “This practice must cease immediately as it is in direct violation of the New Brunswick food regulation.”
Doucet said it appears officials were responding to a complaint, even though he’s never heard of anyone becoming sick from eating the dish (huh? – dp). He said he didn’t appreciate the way officials addressed the issue.
“It was not to ask us to provide our procedure for tartare or ground beef at the restaurant,” he said. “It was more, cease every dish that you have, and a lot of my restaurant friends have tartare on the menu.”
Of concern is that undercooked meat can contain pathogens that can make people sick. In a statement, the province said it’s working on establishing how such dishes can be served safely.
“These letters have not been issued as the result of people becoming ill from consuming these foods — instead, they are issued because of general food safety concerns, as eating raw or lightly cooked meats may increase the risk of food poisoning,” wrote Bruce Macfarlane, a spokesman for the Department of Health.
New Brunswick regulations include minimum cooking temperatures for meats such as beef, pork and poultry. The statement said for items like sushi and sous vide, policies are in place to support safe consumption.
Doucet said his beef tartare is composed of a quality cut of meat that is sliced in small cubes rather that ground up, and he said he has sampled tartare in restaurants across the country.
“Every time I go to Quebec, I have tartare in some form,” he said.
Harri Evans of Lancaster Live writes a toddler was left fighting for his life at a North West hospital and suffering kidney failure after eating seagull poo as he played in the garden.
Jaydon Pritchard, who is just 18 months old, is now doing much better after his ordeal, but is still “not out of the woods” according to his grandparents Arwel and Christine, who look after him along with his mother Tiffany at their home in Amlwch in Anglesey, off the north west coast of Wales.
Jaydon started to feel unwell in early April but was discharged by doctor after they thought he was suffering from a virus.
But Jaydon (below) continued to be sick and sleep lots and then his grandfather said they heard a “horrible noise coming from his cot”.
Mr Pritchard said: “He was having a fit, so we called for an ambulance straight away.
“He had another fit before the ambulance arrived and another three fits on the way to the hospital. It was like he was looking through you. He didn’t recognise anyone.
“There was a point where we really thought we were going to lose him. It was horrific.”
After being rushed to Ysbyty Gwynedd for the second time, a team from Alder Hey Children’s Hospital in Liverpool was sent to pick up Jaydon within a few hours – reports North Wales Live.
He was hooked up to a dialysis machine and received three blood transfusions during his 19-day stay at the children’s hospital.
Mr Pritchard said: “The doctors diagnosed him with kidney failure and told us that he had E. coli poisoning from having ingested the seagull faeces.
“We were fearing the worst at the time, seeing his little body hooked up to the dialysis machine and his face turned yellow.”
Between August and December 2020, the U.S. Food and Drug Administration (FDA) and multiple state and federal partners were involved in an outbreak investigation related to E. coli O157:H7 illnesses and the consumption of leafy greens. The outbreak, which caused 40 reported domestic illnesses, was linked via whole genome sequencing (WGS) and geography to outbreaks traced back to the California growing region associated with the consumption of leafy greens in 2019 and 2018. FDA, alongside state and federal partners, investigated the outbreak to identify potential contributing factors that may have led to leafy green contamination with E. coli O157:H7. The E. coli O157:H7 outbreak strain was identified in a cattle feces composite sample taken alongside a road approximately 1.3 miles upslope from a produce farm with multiple fields tied to the outbreaks by the traceback investigations. In addition, several potential contributing factors to the 2020 leafy greens outbreak were identified.
Isolates within this cluster of illnesses are part of a reoccurring strain of concern and are associated with outbreaks that have occurred in leafy greens each fall since 2017. The two most recent outbreaks associated with this strain were an outbreak in 2018 (linked to romaine lettuce from the Santa Maria growing region of California) and an outbreak in 2019 (linked to romaine lettuce from the Salinas growing region of California). Clinical isolates from cases in this 2020 outbreak appear more closely related to those from the 2019 outbreak than the 2018 outbreak. In addition, several specific food and environmental isolates that appear to be highly related to this 2020 outbreak include a fecal-soil composite sample collected by FDA in February 2020 from the Salinas growing region and two leafy green samples collected in 2019 by state partners as a part of the 2019 investigation that traced back to the Salinas growing region.
As part of this investigation, tracebacks of leafy greens consumed by ten ill individuals from eleven points of service were conducted. Although that traceback investigation was based on a relatively small number of the total cases, it was based on those cases which presented the strongest evidence via purchase card information, invoices, bills of lading, and electronic data. The traceback investigation identified the Salinas growing region of California as a geographical region of interest.
In light of this most recent finding, combined with previous outbreak investigation findings in the region, FDA has identified key trends regarding the issues of a reoccurring strain, a reoccurring region, and reoccurring issues around adjacent and nearby land use of primary importance in understanding the contamination of leafy greens by E. coli O157:H7 that occurred in 2020 and previous years.
FDA also recognizes the interconnection between people, animals, plants, and their shared environment when it comes to public health outcomes. As such, we strongly encourage collaboration among various groups in the broader agricultural community (i.e. livestock owners; leafy greens growers, state and federal government agencies, and academia) to address this issue. With this collaboration, the agricultural community, alongside academic and government partners, can work to identify and implement measures to prevent contamination of leafy greens. FDA recommends that these parties participate in efforts to understand and address the challenge of successful coexistence of various types of agricultural industries to ensure food safety and protect consumers against foodborne illnesses.
Frank Yiannas, Deputy Commissioner for Food Policy and Response – Food and Drug Administration said in a release that as part of our ongoing efforts to combat foodborne illness, today the U.S. Food and Drug Administration published a report on the investigation into the Fall 2020 outbreak of Shiga Toxin-Producing E. coli (STEC) O157:H7 illnesses linked to the consumption of leafy greens grown in the California Central Coast. The report describes findings from the investigation, as well as trends that are key to understanding leafy green outbreaks that are linked to the California Central Coast growing region, specifically encompassing the Salinas Valley and Santa Maria growing areas every fall since 2017.
We released our preliminary findings earlier this year that noted this investigation found the outbreak strain in a sample of cattle feces collected on a roadside about a mile upslope from a produce farm. This finding drew our attention once again to the role that cattle grazing on agricultural lands near leafy greens fields could have on increasing the risk of produce contamination, where contamination could be spread by water, wind or other means. In fact, the findings of foodborne illness outbreak investigations since 2013 suggest that a likely contributing factor for contamination of leafy greens has been the proximity of cattle. Cattle have been repeatedly demonstrated to be a persistent source of pathogenic E. coli, including E. coli O157:H7.
Considering this, we recommend that all growers be aware of and consider adjacent land use practices, especially as it relates to the presence of livestock, and the interface between farmland, rangeland and other agricultural areas, and conduct appropriate risk assessments and implement risk mitigation strategies, where appropriate. Increasing awareness around adjacent land use is one of the specific goals of the Leafy Greens Action Plan we released last March, which we’re also announcing is being updated today to include new activities for 2021.
During our analysis of outbreaks that have occurred each fall since 2017, we have determined there are three key trends in the contamination of leafy greens by E. coli O157:H7 in recent years: a reoccurring strain, reoccurring region and reoccurring issues with activities on adjacent land. The 2020 E. coli O157:H7 outbreak associated with leafy greens represents the latest in a repeated series of outbreaks associated with leafy greens that originated in the Central Coast of California (encompassing Salinas Valley and Santa Maria) growing region (that’s me and Frank and the woman who wants to divorce me in our Kansas kitchen, 10 years ago)
In the investigation, the FDA recommends that growers of leafy greens in the California Central Coast Growing Region consider this reoccurring E. coli strain a reasonably foreseeable hazard, and specifically of concern in the South Monterey County area of the Salinas Valley. It is important to note that farms covered by the Food Safety Modernization Act (FSMA) Produce Safety Rule are required to implement science and risk-based preventive measures in the rule, which includes practices that prevent the introduction of known or reasonably foreseeable hazards into or onto produce.
The FDA also recommends that the agricultural community in the California Central Coast growing region work to identify where this reoccurring strain of pathogenic E. coli is persisting and the likely routes of leafy green contamination with STEC. Specifically, we have outlined specific recommendations in our investigation report for growers in the California Central Coast leafy greens region. Those recommendations include participation in the California Longitudinal Study and the California Agricultural Neighbors workgroup. When pathogens are identified through microbiological surveys, pre-harvest or post-harvest testing, we recommend growers implement industry-led root cause analyses to determine how the contamination likely occurred and then implement appropriate prevention and verification measures.
In response, Tim York wrote in The Packer that on April 16 the California LGMA Board took decisive action to endorse pre-harvest testing guidance. The guidance recommends pre-harvest testing specifically when leafy greens are being farmed in proximity to animal operations.
It’s the intention of the board to include pre-harvest testing as part of the LGMA audit checklist so the government can verify that all LGMA members are in compliance.
This is the first time an entire commodity group will be required to conduct pre-harvest testing.
This is a big deal, but a necessary response to the recent U.S. Food and Drug Administration report on outbreaks associated with lettuce in 2020. The findings and regulatory language used by FDA in this report were nothing short of a warning shot that calls on our industry to do more to stop outbreaks.
And so, we must do more.
Updating LGMA’s required food safety practices is an involved process that seeks input from scientists, food safety experts and the public. No other entity is capable of making such widespread change as quickly as we can.<
Some weeks ago, in the first piece I wrote for The Packer as CEO of the California LGMA, I stressed the need for collaboration with the retail and foodservice buying community, noting that we must lean on each other to make needed improvements together. And now, I am asking for your help.
Updating LGMA’s required food safety practices is an involved process that seeks input from scientists, food safety experts and the public. No other entity is capable of making such widespread change as quickly as we can.
I guess someone published this again, since the Walkerton outbreak of E. coli O157 which killed seven and sickened over 2,000 k in a town of 5,000 happened in May 2000.
I know it’s not the best writing, but I tried, and it was 20 years ago. I severed on an expert (I hate that word) committee and we wrote our report.
We live near the publicaly funded Princess Alexandria hospital in Brisbane.
A helicopter flies over our house a couple of times a day bringing some victim from the outback or the coast.
The state of Queensland is really, really big.
It reminds me of my Walkerton-resident friend and what he went through in the aftermath of the E. coli O157 outbreak in drinking water.dying being flown to the medical center in London, Ontario (that’s in Canada, like Walkerton).
I think of Jim and the victims every time a chopper goes past.
The E. coli O157:H7 waterborne outbreak in Walkerton, Ont., Canada, in May 2000, presented a clear and present danger of risk to citizens who consumed that water — at least in retrospect. More challenging though, is to know when a risk is severe enough to warrant extraordinary communications and how best to compel citizens to comply with health advisories.
Risk theory, involving assessment, management and communication, is important to underpin discussions of how regulators, industry and citizensincorporate and act on information about risks — such as the hazards posed by E. coli O157:H7 in drinking water. Today it is well accepted that the three components of risk analysis cannot be separated and are, in fact, integrated, and that communication involves the multi-directional flow of information.
Evidence from recent water-borne disease outbreaks illustrates the importance of timeliness in health related warnings.
Timeliness of message delivery is dependent on how quickly a problem is identified, and how the message is delivered. The public can passively receive information on health related risks from the media or the utility, or actively seek out information from information sources such as the Internet, telephone hotlines or library services (Casman et al., 2000).
In determining when to go public with health advisories, health authoritiesreport that every outbreak of food- or water-borne illness must be examine dusing factors such as severity, potential impact and incubation time of the suspect pathogen. The health risk outcome of microbiological hazards to the public should be assessed, discussed and quantified among workers from diverse disciplines, including health officials, veterinarians, food processing experts, microbiologists, medical doctors, risk analysis experts, and consumer behavior experts.
Once sufficient evidence exists to issue a public health advisory, risk messages must be designed that accurately describe the risk to individuals and provide concrete steps that individuals can take to reduce the chances of risk exposure.
Further, the number of suspected or confirmed illnesses related to the particular outbreak should be included as a matter of course in any public communications. And once health advisories have been created, a variety ofmessage delivery techniques need to be employed, again depending on the severity of the hazard, the size of the impacted population and local circumstances.
For a severe and immediate hazard such as E. coli O157:H7 in drinking water, a mixture of low-to-high technology message delivery mechanisms should be employed, including door-to-door, the buddy system, the use of existing community networks such as Neighbourhood Watch, emergency hubsite information centers and even mobile megaphones, complimented by more broader mechanisms such as local media, posting information on a website, automated telephone messages, broadcast faxes, and electronic mail distribution.
However, the key to using any of these technologies effectively is to plan ahead and be prepared. Effective planning will establish which techniques are best for the size of the community and the existing infrastucture. No one technology can reach all members of the target audience, therefore combining delivery methods is essential.
The current state of risk management and communication research suggests that those responsible with food and water safety risk management must be actively seen to be reducing, mitigating or minimizing a particular risk. The components for managing the stigma associated with any food safety issue seem to involve all of the following factors:
effective and rapid surveillance systems;
effective communication about the nature of risk;
a credible, open and responsive regulatory system;
demonstrable efforts to reduce levels of uncertainty and risk; and,
evidence that actions match words.
This report has been concerned with the second point, the ability to effectively communicate about the nature of risk. E. coli O157:H7 is not regular E. coli. It is a highly virulent and dangerous pathogen that sickens tens of thousands annually in North America and kills hundreds. Each year since the 1993 Jack-in-the-Box outbreak has brought a high profile and deadly outbreak of E. coli O157:H7 from some corner of the developed world; outbreaks that receive significant media coverage and provide new insights; Australia in 1994 (involving the related E. coli O111); Scotland and Japan in 1996; a waterpark in Atlanta, Ga in 1998. While many Canadians may be unfamiliar with such outbreaks — media coverage in Canada is superficial at best, frequently focused on the hypothetical risks posed by various food-related technologies while ignoring the carnage associated with food and water-borne pathogens
Any local efforts must be supported by a national culture of awarenessregarding a risk such as E. coli O157:H7, which has been known to cause outbreaks and severe illness, and sometimes death, for almost 20 years. When compared to outbreaks and response in the U.S., it is observed that outbreaks, particularly of E. coli O157:H7 bring a sustained policy response from the highest levels of government, including the Office of the President. While there have been many private-sector initiatives in Canada to enhance the safety of the food supply, these efforts are rarely communicated or discussed by government, short of admonitions to “cook hamburger thoroughly.
Tyana Grundig, Greg Sadler and Asha Tomlinson report for CBC’s Marketplace (see below) that the last decade has seen recall after recall of tainted romaine lettuce coming into Canada from the United States. At least seven people have died, and hundreds have been sickened or hospitalized in both countries.
Toddler Lucas Parker was one of them.
In the fall of 2018, his parents, Nathan Parker and Karla Terry of Richmond, B.C., took Lucas and his siblings to Disneyland, their first trip outside Canada. But what they couldn’t know at the time was that a few bites of romaine salad Lucas ate one night at a small California roadside restaurant would change their lives forever.
Like most people who get sick from this strain of E. coli, Lucas, then two years old, didn’t show symptoms right away. When he started feeling unwell, the family headed out for the long drive home. By the time he was in a Canadian hospital, the E. coli had shut down one of his kidneys and led to two brain injuries. There are no current treatments for E. coli that can help alleviate infections or prevent complications.
Lucas can no longer walk, talk or see.
“Lucas was just a beaming ray of light … he was a caring person … a cheeky boy, a loving brother,” said his father, Nathan Parker. “I remember him in the hospital waking up out of a coma and looking around, just lost, not talking, not walking, not moving much. Such a brain injury that his brain was so swollen that there was no comfort, there was nothing. It was just hell.”
Bill Marler, an American lawyer and food-safety advocate who has been fighting for food safety for almost 30 years, represents Lucas and his parents. Marler has filed suit on behalf of the family against the restaurant where they ate, as well as the farm and suppliers of the lettuce; the case is currently in the discovery phase in a court system slowed down because of the COVID-19 pandemic.
Lucas, “is the most devastatingly injured human who has survived a food-borne illness outbreak — ever,” said Marler. “The fact that he survived at all and his parents care for him as gently and as caringly as they do is a testament to them.”
Australia is a hard country with massive droughts, massive rainfalls every 10 years (like now) and quite weird behavior.
Stories like the following appear daily. The weird ones.
Heath Parkes-Hupton of The Australian writes a mum accused of putting feces in her son’s cannula as he writhed in pain at a Sydney hospital was heard being asked by her sick child “why are you doing this to me”, a court has heard.
The boy’s mother is facing a special hearing at Downing Centre District Court for allegedly poisoning her then nine-year-old son through his cannula while he was a patient at The Children’s Hospital at Westmead in September 2014.
The woman, a mother of four who can’t be named, denies infecting the boy and has pleaded not guilty to using poison to endanger a life.
His blood culture later tested positive to the bacteria E. coli.
The mother’s barrister Pauline David told the court on Thursday there were a number of possibilities that could explain how the boy became infected.
Crown witness and nurse Lindie Brown, who was working at a unit manager at the ward where the boy was a patient, told the court he became “very unwell” during one of her shifts.
The court heard the boy had a temperature of 40C and began experiencing rigors – or shaking.
He was also complaining of pains in his back, stomach and head and asked for medicine to “take the pain away”, the court heard.
Ms Brown told the court she then heard the boy ask his mother “why she was doing this to him”.
He then said words to the effect of “you could have put something in my cannula when I was asleep”, Ms Brown said.
CBC’s Marketplace (that’s a TV show in Canada) notes that Canada has been hit by a number of romaine lettuce recalls. We set out to the U.S., where the majority of our leafy greens come from, to dig up why E. coli outbreaks continue to plague our food supply. We meet one B.C. family whose lives have been forever changed by a contaminated salad (thanks to Bill Marler for posting on this).
One of my best friends used to be a dairy farmer, and he would always say, I’m not eating at McDonald’s, could be one of my former cows.
Shiga toxin-producing Escherichia coli (STEC) are foodborne bacterial pathogens, with cattle a significant reservoir for human infection. This study evaluated environmental reservoirs, intermediate hosts and key pathways that could drive the presence of Top 7 STEC (O157:H7, O26, O45, O103, O111, O121 and O145) on pasture-based dairy herds, using molecular and culture-based methods.
A total of 235 composite environmental samples (including soil, bedding, pasture, stock drinking water, bird droppings and flies and faecal samples of dairy animals) were collected from two dairy farms, with four sampling events on each farm. Molecular detection revealed O26, O45, O103 and O121 as the most common O-serogroups, with the greatest occurrence in dairy animal faeces (> 91%), environments freshly contaminated with faeces (> 73%) and birds and flies (> 71%). STEC (79 isolates) were a minor population within the target O-serogroups in all sample types but were widespread in the farm environment in the summer samplings.
Phylogenetic analysis of whole genome sequence data targeting single nucleotide polymorphisms revealed the presence of several clonal strains on a farm; a single STEC clonal strain could be found in several sample types concurrently, indicating the existence of more than one possible route for transmission to dairy animals and a high rate of transmission of STEC between dairy animals and wildlife.
Overall, the findings improved the understanding of the ecology of the Top 7 STEC in open farm environments, which is required to develop on-farm intervention strategies controlling these zoonoses.
Investigation of on-farm transmission routes for contamination of dairy cows with top 7 Escherichia coli O-serogroups
Rapp & C. M. Ross & P. Maclean & V. M. Cave & G. Brightwell