Public was never told: 4 dead, 30 sickened from Listeria in pasteurized chocolate milk in Ontario, Nov. 2015—June 2016

The Public Health Agency of Canada (PHAC) really sucks at this communication thing. They sucked during the 2008 Listeria outbreak linked to Maple Leaf cold cuts that killed 24 and sickened a further 33, they have always sucked when discussing numerous outbreaks of Cyclospra, and I guess they realized they suck so bad they didn’t even try during an outbreak spanning 2015-2016 linked to Listeria in milk.

Now, over three years since residents of Ontario (that’s in Canada) began reporting illnesses from Listeria in pasteurized chocolate milk produced at a dairy in Georgetown, Ontario, investigators have gotten around to saying just how many people got sick.

According to health-types writing in Emerging Infectious Disease, 11 case-patients had an onset date during November 14, 2015–February 14, 2016. Onset dates ranged from April 11 to June 20, 2016, for 21 case-patients in the second wave; the remaining 2 case-patients were outliers. Median age was 73 years (range <1 years–90 years). More than half of the case-patients were female (20/34, 59%). Hospitalizations occurred for 32 (94%) case-patients, and 4 deaths (12%) were reported.

In Ontario, local public health professionals complete the national invasive listeriosis questionnaire and collect food samples. We conducted a case–case analysis by using Ontario case-patients listed in the national listeriosis database as controls. We used a variety of methods to support hypothesis generation, including supplemental questionnaires, centralized interviewing, and reviewing purchase records collected through shoppers’ loyalty card programs. A meeting was also held with representatives from a grocery chain that was common for case-patients (retail chain A) for insights into possible sources.

PFGE and whole-genome sequencing were performed at the Public Health Ontario Laboratory, in accordance with PulseNet Canada protocols (Table). Food safety investigations, including targeted retail sampling, were conducted by the Canadian Food Inspection Agency and Ontario Ministry of Agriculture and Food and Rural Affairs. Laboratory analyses of food samples were conducted by the Canadian Food Inspection Agency and the Public Health Ontario Laboratory.

Several hypotheses were generated during the course of this outbreak. In the first wave, a concurrent listeriosis outbreak associated with leafy greens was ongoing in the United States and Canada. However, product testing did not establish a relationship between the 2 outbreaks. Cheddar cheese was also suspected, but a food safety investigation, including sampling at the manufacturer, did not support a link to this outbreak (6,7). Although leafy greens and cheddar cheese were ruled out, 1 commonality remained; shopping at retail chain A was reported frequently by case-patients.

A second wave began in April 2016 in which 10 of 17 case-patients reported consuming coleslaw. Six case-patients ate coleslaw from the same manufacturer, which supplied retail chain A and a fast food restaurant chain. However, the food safety investigation, including sampling at the manufacturer and supplier, did not support this hypothesis.

On May 24, 2016, L. monocytogenes isolated from expired bagged chocolate milk collected from the home of 1 case-patient was confirmed to have the outbreak strain PFGE pattern. Fluid milk in Canada is often sold in plastic bags. In this instance, the outer packaging, which is the only area that contains the brand name, was discarded. Thus, the brand name was uncertain, and efforts were undertaken to confirm the source of the chocolate milk. Because the proxy of the case-patient reported purchasing brand B milk, samples of brand B chocolate and white milk were collected from retail for testing. Brand B was the main brand of chocolate milk sold by retail chain A, and it is distributed only in Ontario.

Although the hypothesis-generating questionnaire used stipulated milk, with flavored milk as a prompt, chocolate milk was not specified, and as a result this type of milk might have been underreported. Exposure to pasteurized milk was reported by 60% of case-patients in the first wave compared with 76% of controls. Thus, milk was not originally pursued as a source. However, this new positive isolate led to re-interviewing of case-patients from the second wave and resulted in 9 (75%) of 12 case-patients reporting consuming brand B when asked specifically about chocolate milk.

On June 3, a retail sample of brand B chocolate milk was confirmed positive for L. monocytogenes. This finding led to a class I recall of 1 lot of brand B chocolate milk. On June 5, the recall was expanded to all lots of brand B chocolate milk processed at that facility because of the result of extensive retail sampling. Isolates from the original sample and 3 subsequent positive samples of chocolate milk matched the outbreak strain by PFGE and whole-genome sequencing. No white milk samples were positive for L. monocytogenes.

Environmental sampling at the manufacturer confirmed the presence of the outbreak strain within a post-pasteurization pump dedicated to chocolate milk and on nonfood contact surfaces. This post-process contamination of the chocolate milk line was believed to be the root cause of the outbreak. A harborage site might have been introduced by a specific maintenance event or poor equipment design. The equipment was subsequently replaced, and corrective measures were implemented to prevent reoccurrence. Chocolate milk production was resumed after vigorous testing for L. monocytogenes under regulatory oversight.

Conclusions

This outbreak lasted 7 months and resulted in 34 confirmed listeriosis case-patients. Discovering the cause of this listeriosis outbreak was challenging because pasteurized chocolate milk is a commonly consumed product. Although there have been previous outbreaks outside Canada caused by chocolate milk, pasteurized milk products are generally not expected to be the source. This outbreak highlights that even pasteurized products can be contaminated by and support the proliferation of L. monocytogenes when contamination is introduced post-pasteurization. The possibility of post-processing contamination indicates an ongoing need for regulatory oversight and robust quality assurance processes, which include routine sampling of the environment and finished products.

Brand B chocolate milk is a widely distributed product in Ontario, and contamination of this product could have resulted in >34 case-patients. It is possible that a lower number of case-patients were reported because chocolate milk may primarily be consumed by younger, healthier persons, in whom invasive listeriosis is less likely to develop. Another possible explanation is that the contamination in the milk appeared to be intermittent, with some samples testing positive while others tested negative. As such, careful attention should be given to equipment design and maintenance programs, as harborage sites could result in recurring contamination that goes undetected by routine monitoring. Targeted retail and environmental sampling was instrumental in identifiying the root cause in the facility and the breadth of potentially implicated products in the marketplace. Thus, this type of sampling should be considered during outbreak investigations.

Ultimately, the implicated product was determined on the basis of testing of food items obtained from the home of 1 case-patient. This finding highlights the necessity of obtaining a thorough food history and collecting and testing available samples of food that case-patients consumed during the incubation period. In Canada, where bagged milk is common, labeling of the inner and outer bags with the brand name would facilitate product identification by consumers. This recommendation could extend to other food products in North America (e.g., frozen hamburger patties) that have multiple layers of packaging.

That is a lucid, thought provoking summary of a complex foodborne outbreak, fraught with uncertainties.

When the Canadian Food Inspection Agency announced the recall on June 4, 2016, Chapman wrote it up for the blog, reminiscing about his childhood innocence in southern Ontario, and noted, as has become the pattern, that CFIA reports recalls, but it’s up to PHAC or provincial health ministries to identify the number of sick people. As far as I can tell, no public statement about illnesses was ever made, until now.

What the fuck do these people do, especially the communication hacks? Do they have a responsibility to the public? Why didn’t epidemiology count and a public warning issued rather than waiting for a positive sample in an unopened package, which has apparently become the Canadian standard for going public?

If that’s the standard, that sucks.

Listeria monocytogenes associated with pasteurized chocolate milk, Ontario, Canada

March 2019

Emerging Infectious Diseases vol. 25 no. 3

Heather Hanson , Yvonne Whitfield, Christina Lee, Tina Badiani, Carolyn Minielly, Jillian Fenik, Tony Makrostergios, Christine Kopko, Anna Majury, Elizabeth Hillyer, Lisa Fortuna, Anne Maki, Allana Murphy, Marina Lombos, Sandra Zittermann, Yang Yu, Kristin Hill, Adrienne Kong, Davendra Sharma, and Bryna Warshawsky

https://wwwnc.cdc.gov/eid/article/25/3/18-0742_article

In an investigation of a listeriosis outbreak in Ontario, Canada, during November 2015–June 2016, Public Health Ontario identified pasteurized chocolate milk as the source. Because listeriosis outbreaks associated with pasteurized milk are rare in North America, these findings highlight that dairy products can be contaminated after pasteurization.

4 sickened: Outbreak of Listeria linked to pork products

The U.S. Centers for Disease Control reports that an outbreak of Listeria monocytogenes infections linked to pork products produced by Long Phung Food Products appears to be over.

On November 20, 2018, 165368 C. Corporation of Houston, Texas, doing business as Long Phung Food Products, recalled ready-to-eat pork products because they might have been contaminated with Listeria bacteria.

Do not eat, sell, or serve recalled products from Long Phung Food Products.

The full list of recalled ready-to-eat pork patty rolls is on the USDA-FSIS website.

Recalled products are labeled with establishment number “EST. 13561” inside the USDA mark of inspection.

Recalled pork patty rolls were produced on various dates from May 21, 2018, through November 16, 2018. These items were shipped to distributors and retail locations nationwide.

Recalled pork products should no longer be available in stores, but may still be in home freezers.

Wash and sanitize drawers or shelves in refrigerators and freezers where recalled pork products were stored. Follow these five steps to clean your refrigerator.

Retailers should clean and sanitize deli slicers and other areas where recalled pork products were prepared, stored, or served. Follow the manufacturer’s recommendations for sanitizer strength and application to ensure it is effective.

If you develop symptoms of a Listeria infection after eating recalled pork products, contact a healthcare provider and tell them you ate recalled pork products. This is especially important if you are pregnant, age 65 or older, or have a weakened immune system.

As of January 29, 2019, this outbreak appears to be over.

Four people infected with the outbreak strain of Listeria monocytogenes were reported from four states.

Listeria specimens from ill people were collected from July 1, 2017, to October 24, 2018.

Four people were hospitalized. No deaths were reported.

Epidemiologic and laboratory evidence indicated that pork products from 165368 C. Corporation, doing business as Long Phung Food Products, were the likely source of the outbreak.

Computer program aids food safety types with pathogen testing

Cornell University scientists have developed a computer program, Environmental Monitoring With an Agent-Based Model of Listeria (EnABLe), to simulate the most likely locations in a processing facility where the foodborne pathogen Listeria monocytogenes might be found. Food safety managers may then test those areas for the bacteria’s presence, adding an important tool to prevent food contamination and human exposure to the pathogen through tainted food.

The computer model, which is described in the Jan. 24 issue of Scientific Reports, has the potential to be modified for a wide range of microbes and locations.

“The goal is to build a decision-support tool for control of any pathogen in any complex environment,” said Renata Ivanek, associate professor in the Department of Population Medicine and Diagnostic Sciences and senior author of the paper. The study was funded by the Frozen Food Foundation through a grant to Martin Wiedmann, professor of food science, who is also a co-author of the paper.

The researchers, including first author Claire Zoellner, a postdoctoral research associate in Ivanek’s lab, want to eventually apply the framework to identifying contamination from pathogens that cause hospital-acquired infections in veterinary hospitals or E. coli bacteria in fruit and vegetable processing plants.

Food safety professionals at processing facilities keep regular schedules for pathogen testing. They rely on their own expertise and knowledge of the building to determine where to swab for samples.

“Whenever we have an environment that is complex, we always have to rely on expert opinion and general rules for this system, or this company, but what we’re trying to offer is a way to make this more quantitative and systematic by creating this digital reality,” Ivanek said.

For the system to work, Zoellner, Ivanek and colleagues entered all relevant data into the model – including historical perspectives, expert feedback, details of the equipment used and its cleaning schedule, the jobs people do, and materials and people who enter from outside the facility.

“A computer model like EnABLe connects those data to help answer questions related to changes in contamination risks, potential sources of contamination and approaches for risk mitigation and management,” Zoellner said.

“A single person could never keep track of all that information, but if we run this model on a computer, we can have in one iteration a distribution of Listeria across equipment after one week. And every time you run it, it will be different and collectively predict a range of possible outcomes,” Ivanek said.

The paper describes a model system that traces Listeria species on equipment and surfaces in a cold-smoked salmon facility. Simulations revealed contamination dynamics and risks for Listeria contamination on equipment surfaces. Furthermore, the insights gained from seeing patterns in the areas where Listeria is predicted can inform the design of food processing plants and Listeria-monitoring programs. In the future, the model will be applied to frozen food facilities.

Fresh peaches, nectarines and plums recalled in US because of Listeria

It’s not often that stone fruit – peaches, nectarines and plums are recalled for Listeria.

Jac. Vandenberg, Inc. of Yonkers, New York is doing just that.

The Fresh Peaches, Fresh Nectarines and Fresh Plums were distributed in Alabama, California, Georgia, Illinois, Kentucky, Maine, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, West Virginia and Virginia through small retail establishments and the following select retail stores:

Retail Stores States Product
ALDI Alabama, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia Nectarines, Peaches, Plums
Costco California Nectarines
Fairway Market New York Nectarines, Peaches
Hannaford Maine Peaches
Market Basket Massachusetts Nectarines, Peaches
Walmart Kentucky, Maryland, New Jersey, New York, Ohio, Pennsylvania, Virginia, West Virginia Nectarines (MD, NJ, NY, PA, VA, WV), Peaches (KY, NJ, NY, OH, PA, WV)

The peaches and nectarines are sold as a bulk retail produce item with PLU sticker (PLU# 4044, 3035, 4378) showing the country of origin of Chile. The peaches, nectarines and plums sold at ALDI are packaged in a 2-pound bag with the brand Rio Duero, EAN# 7804650090281, 7804650090298, 7804650090304. The nectarines sold at Costco are packaged in a 4-pound plastic clamshell with the brand Rio Duero, EAN# 7804650090212.

No illnesses have been reported to date in connection with this problem to date.

The recall was the result of a routine sampling program by the packing house which revealed that the finished products contained the bacteria. The company has ceased the distribution of the product as FDA and the company continue their investigation as to what caused the problem.

Machines are difficult to clean yet poop emoji soft-serve is all the rage in Tokyo

It was our most popular blog post for years.

Baskin Robbins decided to offer free soft serve ice cream to expectant mothers on May 21, 2008, in California, Chicago, New York, Nashville, and El Paso, Texas. It was apparently the beginning of a national roll-out of soft serve ice cream at Baskin Robbins.

I have no idea why they targeted expectant moms, or why they recruited a pregnant D-list celebrity like Tori Spelling as spokesthingy.

Problem is, soft serve ice cream is on the Australian list of foods pregnant women should avoid. Sanitation with the equipment appears to be an on-going problem.

In 2015, a year after a giant recall of Snoqualmie ice cream tied to Listeria, a third illness was blamed on the bug after it apparently lingered in a machine used to make milkshakes for hospital patients.

Yet in Japan, Poop emoji soft-serve is here to haunt your dreams.

A cafe in Tokyo’s fashionable Harajuku neighborhood is hawking soft-serve that looks like the poop emoji, complete with googly eyes and a toilet-shaped bowl.

Yummy.

13 sick: Some had eaten rakfish: — more affected by mysterious listeria outbreaks in eastern Norway

News Beezer reports that shortly before Christmas, the Norwegian Institute of Public Health announced that there had been six reports of a new outbreak of Listeriosis. Today it was known that this number has increased significantly and that the affected area is also larger than previously known

Typically, 1-2 patients with listeriosis are reported monthly. Four of the six patients reported in December come from Hedmark and Oppland. Now the infection has spread further and is increasing more and more.

A total of thirteen people have been reported with listeriosis. Most are located in the above circles, and Buskerud is now included in the list. It is common that they are older than 70 years and affect their general condition. The Norwegian Food Safety Authority works with the Norwegian Institute of Public Health, the Municipal Health Service and the Norwegian Veterinary Institute to determine if patients can share a common source of infection. So far, five patients have detected bacteria with a similar DNA profile.

FDA says wash those avocados

The avocado-based dip was the cause of an aggressive barfing incident that I’ve never been able to push aside, in the same way I wasn’t able to eat muffins for years after a barfing incident when I was a child.

I’m still amazed at the effects sight, sound and smell can have on food preferences.

It was about 33 years ago, and my ex-wife decided to make a batch of her self-proclaimed world-class guac.

We were driving to my relatives in Barrie, Ontario (that’s in Canada) and somewhere on highway 400, we pulled over and too much booze or guac or just being with me caused one of the most violent vomiting incidents I’ve witnessed.

The smell of the guacamole is forged in my memory.

The U.S. Food and Drug Administration has released two reports on its sampling of whole fresh avocados and hot peppers to determine how frequently harmful bacteria are found in each commodity.

For the whole fresh avocado sampling assignment, the FDA collected, tested and analyzed 1,615 domestic and imported avocado samples for Salmonella and Listeria monocytogenes. Of the 1,615 samples, 12 (0.74%) tested positive for Salmonella. As to the Listeria monocytogenes testing, the agency primarily tested the pulp of the avocado samples (as the pulp is the part of the fruit people eat), and some samples of the fruit’s skin. Of the 1,254 avocado pulp samples, 3 (far less than one percent) were positive for Listeria monocytogenes. Of the 361 avocado skin samples, 64 (17.73%) were positive for Listeria monocytogenes. FoodSafety.gov advises consumers to wash all produce before cutting into it or eating.  

Washing doesn’t do much, but with avocadoes it seems the exterior skins are loaded with Listeria, so the opportunities for cross-contamination are huge (think of how you prepare avocado).

CBS News concludes that one-in-five avocados tested positive for Listeria on the outside, so better wash those skins.

Washing won’t do much, but clean the damn cutting board and be the bug, think about where it would go.

Like my ex barfing.

Norway reports increase in listeriosis

Outbreak News Today reports that officials with the Norwegian Institute of Public Health report seeing an increase in listeriosis cases in December, prompting a warning for high-risk groups.

According to an official notice Friday (computer translated), six cases were reported this month when the country typically sees 1-2 cases a month.

Four of the six patients reported in December are from Hedmark and Oppland.

Health officials are working to identify if their is a common food source linked to the increase in cases.

Listeria is usually transmitted through food, especially long-life foods that are refrigerated and eaten without further heat treatment. Many of these food products are popular as Christmas foods and can be found on many Christmas parties.

Biofilms be good protection for bugs

In nature and man-made environments, microorganisms reside in mixed-species biofilms, in which the growth and metabolism of an organism are different from these behaviors in single-species biofilms. Pathogenic microorganisms may be protected against adverse treatments in mixed-species biofilms, leading to health risk for humans. Here, we developed two mixed five-species biofilms that included one or the other of the foodborne pathogens Listeria monocytogenes and Staphylococcus aureus.

The five species, including the pathogen, were isolated from a single food-processing environmental sample, thus mimicking the environmental community. In mature mixed five-species biofilms on stainless steel, the two pathogens remained at a constant level of ∼105 CFU/cm2. The mixed five-species biofilms as well as the pathogens in monospecies biofilms were exposed to biocides to determine any pathogen-protective effect of the mixed biofilm. Both pathogens and their associate microbial communities were reduced by peracetic acid treatments. S. aureus decreased by 4.6 log cycles in monospecies biofilms, but the pathogen was protected in the five-species biofilm and decreased by only 1.1 log cycles. Sessile cells of L. monocytogenes were affected to the same extent when in a monobiofilm or as a member of the mixed-species biofilm, decreasing by 3 log cycles when exposed to 0.0375% peracetic acid. When the pathogen was exchanged in each associated microbial community, S. aureus was eradicated, while there was no significant effect of the biocide on L. monocytogenes or the mixed community. This indicates that particular members or associations in the community offered the protective effect. Further studies are needed to clarify the mechanisms of biocide protection and to identify the species playing the protective role in microbial communities of biofilms.

IMPORTANCE This study demonstrates that foodborne pathogens can be established in mixed-species biofilms and that this can protect them from biocide action. The protection is not due to specific characteristics of the pathogen, here S. aureus and L. monocytogenes, but likely caused by specific members or associations in the mixed-species biofilm. Biocide treatment and resistance are a challenge for many industries, and biocide efficacy should be tested on microorganisms growing in biofilms, preferably mixed systems, mimicking the application environment.

Behavior of foodborne pathogens listeria monocytogenes and staphylococcus aureus in mixed-species biofilms exposed to biocides

Applied and Environmental Microbiology; DOI: 10.1128/AEM.02038-18

Virginie Oxaran, Karen Kiesbye Dittmann, et al

https://aem.asm.org/content/84/24/e02038-18?etoc=

Raw milk convention goerers got sick from raw milk

Katie Burns of JAVMA News writes, what could be more wholesome than chocolate milk from an Amish farm?

In November 2015, the International Raw Milk Symposium in Anaheim, California, brought in unpasteurized chocolate milk from an Amish farm in Pennsylvania. The sale of raw milk is legal in California and Pennsylvania, but the interstate sale of raw milk is illegal. Authorities embargoed the chocolate milk and sent a sample to the Food and Drug Administration—turning up Listeria.

An investigation by the Centers for Disease Control and Prevention and state health departments found that Listeria isolates from the milk seized at the symposium were related to isolates obtained from two people in 2014. One person in California had been hospitalized and the other, a cancer patient in Florida, had died.

The investigation revealed some of the risks of raw milk and some of the complexities of buyers’ clubs, which can be so secretive as to involve drop points and burner phones for temporary use. The AVMA supports laws requiring pasteurization of all milk, but unpasteurized milk has a devoted following despite the safety concerns and varying legality among states.