Chipotle: Another gift that keeps on giving, $25 million criminal fine for food poisoning

Chipotle Mexican Grill Inc. will, according to Edvard Pettersson of Bloomberg, pay a $25 million criminal fine to resolve allegations by federal prosecutors that its food sickened more than 1,100 people across the U.S. from 2015 to 2018.

It’s the largest fine ever imposed in a food-safety case, according to a statement by the U.S. attorney’s office in Los Angeles.

The criminal charges pertain in part to norovirus outbreaks at Chipotle restaurants. The highly contagious virus can be transmitted by infected food workers handling ready-to-eat foods and their ingredients, according to the statement. It can cause severe symptoms, including diarrhea, vomiting and abdominal cramping.

“Chipotle failed to ensure that its employees both understood and complied with its food safety protocols, resulting in hundreds of customers across the country getting sick,” U.S. Attorney Nick Hanna said in the statement announcing the deferred-prosecution agreement.

The Newport Beach, California-based company said that, as part of the agreement, it will its strengthen its food-safety polices and practices.

“This settlement represents an acknowledgment of how seriously Chipotle takes food safety every day and is an opportunity to definitively turn the page on past events and focus on serving our customers real food made with real ingredients that they can enjoy with confidence,” Brian Niccol, chairman and chief executive officer of the company, said in a statement.

Prosecutors alleged that four norovirus outbreaks were caused by employees showing up to work sick, in violation of company policy, and by food products being stored at the wrong temperatures.

A fifth outbreak — which sickened about 647 people in July 2018 who dined at a Chipotle in Ohio — was from Clostridium perfringens, a bacterium found in raw meat and poultry that is one of the most common types of foodborne illness in the U.S. People who get ill from it usually recover in 24 hours and it’s not contagious.

Managers at the company’s restaurants failed on a number of occasions to notify Chipotle’s safety group at its headquarters when an employee had been vomiting at work, according to prosecutors. Instead, the safety analysts would find out only after contacting the restaurant because it had received a complaint from a sick customer. As a result, there were days of delay before the restaurants were sanitized.

Berries on boats: You’re breakin’ my heart

The U.S. Centers for Disease Control reports that from July to September 2019, cruise line X experienced sudden, unexplained outbreaks (>3% of the passenger population) of acute gastroenteritis (AGE) among passengers on 10 cruise ships sailing in Europe. The rapid onset of vomiting and diarrhea followed by recovery within 24 hours were consistent with norovirus infection. Investigations by the cruise line throughout the summer yielded no clear source of the outbreaks even after extensive food testing.

On September 18, 2019, CDC’s Vessel Sanitation Program (VSP) was notified of an outbreak of AGE on cruise ship A of cruise line X, sailing into U.S. jurisdiction (defined as passenger vessels carrying ≥13 passengers sailing to the United States from a foreign port) from Germany to New York City (1). By the end of the 19-day voyage on September 23, a total of 117 of 2,046 (5.7%) passengers and eight of 610 (1.3%) crew members met the case definition for AGE (three or more loose stools within a 24-hour period or more than normal for the patient, or vomiting plus one other sign or symptom including fever, diarrhea, bloody stool, myalgia, abdominal cramps, or headache).

Four stool specimens were collected and tested for norovirus at CDC’s National Calicivirus Laboratory; three tested positive for norovirus by quantitative reverse transcription–polymerase chain reaction (RT-PCR). No outbreak source was determined after a field investigation by a VSP team on September 22.

The following month, on October 7, CDC’s VSP was notified of two more outbreaks in U.S. jurisdiction. The first outbreak occurred on another ship (ship B) of cruise line X sailing to and from New York City along the eastern seaboard and affected 85 (3.9%) of 2,166 passengers and 10 (1.6%) of 612 crew members; the second outbreak occurred on ship A sailing from Montreal to New York City and affected 83 (3.7%) of 2,251 passengers and 10 (1.6%) of 610 crew members. VSP again conducted outbreak investigations on October 12 (ship B) and October 13 (ship A). Five stool specimens from ship B and two from ship A were collected for laboratory testing. During the field investigations, cruise line X’s public health officials reported to VSP that after reviewing food questionnaires completed by ill passengers on ship B, nearly 80% of completed questionnaires implicated a smoothie made from frozen fruits and berries. Because of the epidemiologic link and because berries have been implicated in past outbreaks (2,3), CDC requested assistance from the Food and Drug Administration (FDA) to collect frozen fruit and berry items from ship B for norovirus testing. Food item lot numbers from ship B matched those from the same frozen fruit and berry items on ship A.

Overall, nine of 11 stool samples from the three outbreak voyages on ships A and B tested positive for norovirus by quantitative RT-PCR at CDC; these included three of four from ship A’s first voyage, four of five from ship B, and two of two from ship A’s second voyage. The samples were typed as GII.2[P16]. FDA tested 16 frozen fruit and berry items, and three items tested positive for norovirus: raspberries (norovirus genogroup II), tropical fruit cocktail (norovirus genogroup I), and berry mix (norovirus genogroup I). Norovirus sequences from the stool samples and from raspberries were 97.5% similar. After removal of the fruit items, no further outbreaks were reported on cruise line X.

Upon further review of food provisioning, cruise line X determined that its food vendor had purchased several containers (nearly 22,000 pounds) of frozen raspberries of the same lot from a supplier in China beginning the end of June 2019. These raspberries had been supplied to the entire fleet of cruise line X. Both the epidemiologic and laboratory data implicated the raspberries as the cause of the outbreaks. As a result of these findings, on November 11, the World Health Organization issued a recall notice* for frozen raspberries traced back to China. This investigation highlights the importance of AGE surveillance at sea to prevent transmission of AGE illness through U.S. ports and to identify contaminated foods at sea that had not yet been implicated on land.

Notes from the field: Multiple cruise ship outbreaks of norovirus associated with frozen fruits and berries—United States, 2019, 24 April 2020

Morbidity and Mortality Weekly Report pg. 501-502

Jared R. Rispens, MD1,2; Amy Freeland, PhD2; Beth Wittry, MPH2; Adam Kramer, ScD2; Leslie Barclay, MPH3; Jan Vinjé, PhD3; Aimee Treffiletti, MPH2; Keisha Houston, DrPH2

https://www.cdc.gov/mmwr/volumes/69/wr/mm6916a3.htm?s_cid=mm6916a3_e&deliveryName=USCDC_921-DM26466

Herb Tarlek and Cindy Williams (not exactly as shown, below, offer their rendition.

The burden of norovirus

Up-to-date estimates of the burden of norovirus, a leading cause of acute gastroenteritis (AGE) in the United States, are needed to assess the potential value of norovirus vaccines in development. We aimed to estimate the rates, annual counts, and healthcare charges of norovirus-associated ambulatory clinic encounters, Emergency Department (ED) visits, hospitalizations, and deaths in the United States.

Methods

We analyzed administrative data on AGE outcomes from July 1, 2001 through June 30, 2015. Data were sourced from IBM® MarketScan® Commercial and Medicare Supplemental Databases (ambulatory clinic and ED visits), the Healthcare Utilization Project National Inpatient Sample (NIS; hospitalizations), and the National Center for Health Statistics multiple-cause-of-mortality (MCM) data (deaths). Outcome data (ambulatory clinic and ED visits, hospitalizations, or deaths) were summarized by month, age group, and setting. Healthcare charges were estimated based on insurance claims. Monthly counts of cause-unspecified gastroenteritis-associated outcomes were modeled as functions of cause-specified outcomes, and model residuals were analyzed to estimate norovirus-associated outcomes. Healthcare charges were estimated by applying average charges per cause-unspecified gastroenteritis encounter to the estimated number of norovirus encounters.

Results

We estimate 900 deaths (95% Confidence Interval [CI]: 650 – 1100), 110,000 hospitalizations (95%CI: 80,000 – 145,000), 470,000 ED visits (95% CI: 348,000 – 610,000), and 2.3 million ambulatory clinic encounters (95% CI: 1.7 – 2.9 million) annually due to norovirus, with an associated $430 – 740 million in healthcare charges.

Conclusions

Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have important public health impact.

The burden of norovirus in the United States, as estimated based on administrative data: Updates for medically attended illness and mortality, 2001-2015, 14 April 2020

Clinical Infectious Diseases

Rachel M Burke, PhD, MPH, Claire Mattison, MPH, Talia Pindyck, MD, MPH, Rebecca M Dahl, MPH, Jessica Rudd, MPH, Daoling Bi, MS, Aaron T Curns, MPH, Umesh Parashar, MBBS, MPH, Aron J Hall, DVM, MSPH

https://doi.org/10.1093/cid/ciaa438

https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa438/5820114

I love the berries but not the Hep A or noro

Foodborne enteric viruses, in particular HuNoV and HAV, are the most common cause of the berry-linked viral diseases, and outbreaks around the world, and have become an important concern for health authorities. Despite the increased importance of berry fruits as a vehicle for foodborne viruses, there is limited information concerning the fate of foodborne viruses in the berry supply chain from farm to consumer.

A comprehensive understanding of berry-associated viral outbreaks – with a focus on contamination sources, persistence, survival, and the effects of current postharvest and processing interventions and practices – is essential for the development of effective preventative strategies to reduce risk of illness.

The purpose of this paper is twofold; (i) to critically review the published literature on the current state of knowledge regarding berry-associated foodborne viral outbreaks and the efficiency of berry processing practices and (ii) to identify and prioritize research gaps regarding practical and effective mechanism to reduce viral contamination of berries.

The review found that fecally infected food handlers were the predominant source of preharvest and postharvest pathogenic viral contamination. Current industrial practices applied to fresh and frozen berries demonstrated limited efficacy for reducing the viral load. While maintaining best practice personal and environmental hygiene is a key intervention, the optimization of processing parameters (i.e., freezing, frozen storage, and washing) and/or development of alternative processing technologies to induce sufficient viral inactivation in berries along with retaining sensory and nutritional quality, is also an important direction for further research.

Outbreaks, occurrence, and control of norovirus and hepatitis A virus contamination in berries: a review, 03 February 2020

Critical Reviews in Food Science and Nutrition

Hayriye Bozkurt,Kim-Yen Phan-Thien,Floris van Ogtrop,Tina Bell &Robyn McConchie

https://doi.org/10.1080/10408398.2020.1719383

https://www.tandfonline.com/doi/abs/10.1080/10408398.2020.1719383?journalCode=bfsn20&mc_cid=4f462afa96&mc_eid=3d0743ebc0&

Bile acids open the door to Norovirus infection

Researchers at the Baylor College of Medicine report some people call it the ship cruise virus, but norovirus can be found in many other places. People can catch this very contagious virus from an infected person, contaminated food or water or by touching contaminated surfaces. The virus causes acute gastroenteritis – the stomach and/or the intestines get inflamed, and this leads to stomach pain, nausea, diarrhea and vomiting. Noroviruses are the leading cause of foodborne illness.

Teams of researchers around the world have been working for more than four decades to find a way to grow this virus in the lab. Success came in 2016 from the laboratory of Dr. Mary K. Estes at Baylor College of Medicine, where she and her colleagues grew, for the first time, noroviruses in laboratory cultures of human intestinal epithelial cells.

This work, published in Science, represents a major step forward in the study of human gastroenteritis viruses because it is allowing researchers to explore and develop procedures to prevent and treat infection and to better understand norovirus biology.

“In the Science paper, we showed that bile, a yellowish fluid produced by the liver that helps digest fats in the small intestine, was key to successfully culturing certain strains of norovirus in the lab,” said Victoria R. Tenge, graduate student of molecular virology and microbiology in the Estes’s lab. “The work discussed here (of which Tenge is co-first author) shows the results of our continuing investigations to identify the bile components that are involved in promoting norovirus infection.”

The researchers worked with human enteroids, a laboratory model of human intestinal cells that retains properties of the small intestine and is physiologically active.

“Mini-guts, as we call them, closely represent actual small intestine tissue, and, importantly, they support norovirus growth, allowing researchers to study how this virus causes disease,” said co-first author Dr. Umesh Karandikar, a research scientist in the Estes lab.

The researchers discovered that bile acids and ceramide in bile were necessary for viral infection.

 “Interestingly, we also discovered that bile acids stimulated the process of endocytosis in mini-guts, which was not previously appreciated. Endocytosis is a normal cellular process that cells use to acquire materials from their environment,” said corresponding author, Dr. Mary K. Estes, Cullen Foundation Endowed Professor Chair of Human and Molecular Virology at Baylor College of Medicine and emeritus founding director of the Texas Medical Center Digestive Diseases Center.

Their findings led the researchers to propose that as bile acids activate endocytosis, they create a stage that norovirus takes advantage of by riding along with it to enter the cells and subsequently replicate, causing disease.

 “This strategy works well for a food-borne virus,” said co-first author Dr. Kosuke Murakami, who was working in the Estes lab during most of this project. He is currently at the National Institute of Infectious Diseases in Tokyo. “As people ingest food, the body’s normal response is to secrete bile into the small intestine. Noroviruses contaminating food piggyback on this natural bodily response to invade cells in the small intestine, replicate and cause disease.”

The current study is published in Proceedings of the National Academy of Sciences.

Reverse zoonoses: It’s when people infect animals

We talk a lot about Norovirus because there are a lot of outbreaks and a lot of sick people.

Dogs too.

In July 2018, recombinant norovirus GII.Pe-GII.4 Sydney was detected in dogs who had diarrhea in a kennel and in children living on the same premises in Thailand. Whole-genome sequencing and phylogenetic analysis of 4 noroviruses from Thailand showed that the canine norovirus was closely related to human norovirus GII.Pe-GII.4 Sydney, suggesting human-to-canine transmission.

Human norovirus infection in dogs, Thailand

Emerging Infectious Diseases, vol. 26, no. 2

Kamonpan Charoenkul, Chanakarn Nasamran, Taveesak Janetanakit, Ratanaporn Tangwangvivat, Napawan Bunpapong, Supanat Boonyapisitsopa, Kamol Suwannakarn, Apiradee Theamboonler, Watchaporn Chuchaona, Yong Poovorawan, and Alongkorn Amonsin 

https://wwwnc.cdc.gov/eid/article/26/2/19-1151_article?deliveryName=DM17555

Norovirus outbreak leads to shellfish harvesting ban on stretch of Virginia river

WTVR reports health officials announced Saturday an extension of the ban on shellfish harvesting in the waters off Parrot Island in the Rappahannock River in Middlesex County.

The news comes after Virginia Department of Health officials banned the harvesting of oysters and clams in that stretch of the river on Dec. 27 following a Norovirus outbreak in Colorado linked to shellfish harvested from the area.

As a result, oysters harvested between Dec. 1, 2019 through Jan. 11, 2020 are being recalled.

The only oysters affected by the recall were shipped by Rappahanock River Oyster Company from lease numbers 18403, 18417, and 19260 in the Rappahanock River, according to the Virginia Department of Health. The company said the oysters were sold under the Emersum brand name.

Officials noted crabs and fin fish in the river are still safe to catch.

Raw is risky: 179 sick from oysters in France

Outbreak News Today reports that French health authorities (Santé publique France) say since December 2019, 179 compulsory declarations (DO) of collective food poisoning ( toxi-infection alimentaire collective-TIAC) ​​suspected of being linked to the consumption of raw shellfish, mainly oysters.

The reports come from the majority of regions in mainland France.

Seventy-seven percent of cases occurred since December 23, with the peak of patients being observed around December 25-27.

The symptoms, mainly diarrhea and vomiting, as well as the incubation times, are compatible with infections with norovirus or other enteric viruses. Stool tests performed to date by the National Reference Center for Gastroenteritis Viruses have confirmed the presence of norovirus and other enteric viruses.

The number of TIAC suspected of being linked to the consumption of raw shellfish is significantly higher than in previous years. Each year between 25 and 120 TIAC suspected of being linked to the consumption of shellfish are reported to Public Health France, of which between 4 and 30 occurred during the December-January periods.

The norovirus barf cycle

Jessica Grose of The New York Times writes that “two days before my 37th birthday, I received the following bone-chilling email from my daughter’s elementary school: “Dear Families, We wanted to inform you that we had an unusually high number of students across all grades suffering from symptoms of a stomach bug.”

One day before my 37th birthday, I had a parent-teacher conference in that building of horrors.

You know where this is going: I spent my birthday eve in the local E.R., getting fluids and the anti-nausea medication Zofran pumped into my veins. “You need to break the barf cycle,” the attending doctor said.

The ailment sweeping my kid’s school and my intestines was norovirus, a highly contagious stomach bug that causes nausea, vomiting and diarrhea. There are multiple strains of norovirus, so you can catch it more than once in a season — and it’s basically hanging around all winter, from November to April.

Norovirus can live on surfaces for days and, per the Centers for Disease Control and Prevention, people infected with norovirus shed billions of virus particles for two weeks or more; just a few particles can make other people sick. That’s why norovirus outbreaks have caused an elementary school in Seattle and 40 schools in Colorado to close briefly in recent weeks — officials wanted to stop the spread, and keeping sick kids away from each other and the building can help.

Norovirus outbreak at Lego event leaves more than 40 people suffering with sickness and diarrhea

The organisers of the Bristol Brick show say they are ‘devastated’ and an investigation has been launched by the city’s health authorities.

Nearly 4,000 people visited the Action Indoor Sports centre to celebrate Lego but after the event more than 40 attendees started experiencing sickness and diarrhoea.

One Lego fan, who wishes to remain anonymous, said he was not happy with the cleanliness of the venue.

He said: “The state of the place left a lot to be desired.”

“The food wasn’t great and over the weekend, the toilets weren’t well maintained, the basins didn’t work well and there was no hand sanitiser and that sort of thing.”

“At least 40 people that I know about have been affected.”