Cyclospora sucks: 1060 North Americans sickened in summer Fresh Express outbreak

The parasite, Cyclospora, continues to provide illness and intrigue.

Florida-based Southeastern Grocers has issued a voluntary recall for its “SE Grocers Naturally Better Organic Fresh Cut Basil” following the detection of Cyclospora.

The company says the product was delivered through all of its distribution centers and sold in all its stores, including Winn-Dixie, BI-LO, Fresco y Más and Harveys Supermarkets. The basil comes in a 0.5-ounce container with UPC code 6-07880-20230-4.

The latest recall follows a summer outbreak of Cyclospora in the U.S. linked to Fresh Express and private label brand salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage, and/or carrots.

690 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick weren reported from 13 states (Georgia, Illinois, Iowa, Kansas, Massachusetts, Minnesota, Missouri, Nebraska, North Dakota, Ohio, Pennsylvania, South Dakota, and Wisconsin).

Illnesses started on dates ranging from May 11, 2020 to July 20, 2020.

37 people were hospitalized. No deaths were reported.

Canadians in several provinces were also sickened.

As of November 4, 2020, 370 confirmed cases of Cyclospora illness were reported in the following provinces and territories: British Columbia (1), Ontario (255), Quebec (105), New Brunswick (1), Newfoundland and Labrador (6), and Nunavut (2). Individuals became sick between mid-May and late August 2020. Ten individuals were hospitalized. No deaths were reported.

Frank Yiannas, Deputy Commissioner for Food Policy and Response at the U.S. Food and Drug Administration said in Aug. that a new method developed and validated by the FDA to sample for Cyclospora in agricultural water was used for the first time in a field investigation.

This method was used in our current investigation and may be instrumental in our efforts to better understand the dispersion of the parasite in the environment, which could help prevent future outbreaks. The collective work by public health officials to get these new findings demonstrates a commitment to innovation and science in the service of public health and the importance of strong federal and state coordination on food safety work.

Even as our agencies continue to respond to the COVID-19 public health crisis, teams of experts from the FDA and the Centers for Disease Control and Prevention (CDC) have continued to respond to a threat of a different kind – a nationwide outbreak of Cyclospora illnesses. Cyclospora cayetanensis is a parasite that is so small it can only be seen with a microscope. It causes an intestinal illness called cyclosporiasis from the consumption of contaminated food, mainly fresh produce, or contaminated water.

Epidemiology linked the illnesses to bagged salad produced by Fresh Express. The number of reported cases of Cyclospora typically rises during May through August. Although CDC conducts surveillance for cyclosporiasis year-round, during the spring and summer months CDC conducts enhanced surveillance for cases of domestically acquired illness. In this outbreak, CDC has reported 690 cases across 13 states, with 37 hospitalizations and no deaths. Onsets of illness range from May 11, 2020 to July 20, 2020. Salads made by Fresh Express and containing iceberg lettuce, red cabbage, and carrots were identified as the food vehicle responsible for the outbreaks.

Traceback of cases with the strongest sources of information (shopper card info, etc.) revealed that bagged salad codes most likely to have resulted in illness contained iceberg lettuce from California and red cabbage from Florida. The FDA evaluated and investigated each of the ingredients in the bagged salads, identifying red cabbage from Florida and iceberg lettuce from California as those most likely in the bagged salads consumed by people who became ill. Traceback investigations are time-consuming work but are critical. In this instance, in the wake of traceback and collaboration with the retailers to recall product, FDA identified a noticeable decline in illnesses that matched the time period in which cabbage sourcing shifted from Florida to another area, providing a possible clue in the investigation.

Environmental sampling detected the presence of Cyclospora in the surface water of a canal near a farm suspected of being a source of the red cabbage. Two samples collected to the north and south of where the farm accessed canal water for seepage irrigation were found to be positive for Cyclospora cayetanensis. The farm that supplied red cabbage was no longer in production at the conclusion of the growing season, so it was not possible to sample product. Additionally, the farms growing iceberg lettuce in California were investigated and all of the samples collected in California were negative for Cyclospora.

Given the emerging nature of genetic typing methodologies for this parasite, the FDA has been unable to determine if the Cyclospora detected in the canal is a genetic match to the clinical cases, therefore, there is currently not enough evidence to conclusively determine the cause of this outbreak.

The FDA has pioneered ways to detect the parasite that have been employed in this outbreak investigation, developing and validating new methods to test for Cyclospora in produce and agricultural water. The first of these new methods was used in 2018 to confirm the presence of the parasite in a salad mix product tied to an outbreak that sickened hundreds of people.

In July 2019, the FDA made its second major advance in Cyclospora detection, completing studies that resulted in a novel, validated method to test agricultural water for the presence of the parasite. These new methods were developed by the Foodborne Parasitology Research Program that the FDA established in 2014 in our Center for Food Safety and Applied Nutrition, in part to break the cycle of recurring Cyclospora outbreaks.

Strong federal and state coordination on matters of public health are critical. In identifying clinical cases of Cyclospora, assisting in providing traceback records and completing investigations in processing facilities and growing fields, our state partners’ work has proven essential to this investigation. We continue to work to strengthen these vital public health partnerships and federal agencies continue to work together to advance additional tools needed to assist with these investigations. For example, CDC is piloting the use of a genotyping tool to help identify cases of parasitic illness that might be linked to a common source.

While we as public health agencies have gotten better at detecting foodborne illnesses due to Cyclospora, our ability to trace contaminated foods back to their source has lagged, and once again, our ability to trace has been a challenge in this investigation, due in part to the lack of modernized food traceability capabilities.

Moreover, the detection of the parasite in surface waters near where product was grown once again puts a spotlight on the importance of managing the quality of irrigation water used to grow ready to eat crops. We are working closely with our colleagues at the Florida Department of Agriculture and Consumer Services to investigate this issue further to prevent future occurrences.

These findings further emphasize the importance of industry’s role in ensuring that irrigation water is safe to be used on produce. Under the FDA’s recently released New Era of Smarter Food Safety Blueprint, we’ll continue to remain laser focused on prevention. In the coming months, we will be issuing a proposed rule that will aid in achieving our goal of enhancing traceability to greatly reduce the time it takes to identify the origin of a contaminated food or ingredient tied to a recall and/or outbreak.

In addition, we intend to release a proposed rule in late 2020 to revise certain agricultural water requirements in the Produce Safety Rule and to address practical implementation challenges while protecting public health. We also plan to advance detection techniques that will help us pinpoint sources of Cyclospora outbreaks and to continue our research around water treatments for this parasite.

In closing, we believe the entire fresh produce supply chain from farm to fork can do better and we look forward to continuing our work with our public health partners, growers, processors, distributors and retailers in our shared efforts to protect consumers. Together, we’ll make progress on our overarching goal to give consumers the confidence they deserve to have in the safety of fresh produce.

1 dead 7 sick: Salmonella outbreak linked to pig ear dog treats in Canada

11-year-old daughter Sorenne is training our pup, George. She knows how to use bits of dog treats as an incentive, and she knows to wash her hands after handing any dog or cat treat or food.

Why?

Because the heat treatment in many cases has not been scientifically verified to remove all pathogens. Cross-contamination with something else is also a possibility.

As of September 29, 2020, there were, according to Outbreak News Today and the Public Health Agency of Canada, eight confirmed cases of Salmonella Typhimurium illness in the following provinces: British Columbia (5), Alberta (2), and Yukon (1). Individuals became sick between late February and early August 2020. Three individuals have been hospitalized. In addition, one individual has died.

Based on the investigation findings to date, exposure to pig ear dog treats has been identified as a likely source of the outbreak. Some of the individuals who became sick reported feeding their dog Paws Up! and Western Family brands of pig ear dog treats before their illnesses occurred. These brands are sold at Canadian Tire and Save-On-Foods. The outbreak investigation is on-going and it is possible that additional products may be identified.

On September 29, 2020, the supplying company, Masters Best Friend, voluntarily issued a Notice of Stop Sale for Paws Up! and Western Family brands of pig ear dog treats. These products were sold nationally.

Although products are no longer available for purchase in stores, they may still be in consumer homes. Given this, do not feed your dog any Paws Up! or Western Family brand pig ear dog treats. Always wash your hands right after handling dog treats, and ensure that all areas the treats have come in contact with are properly cleaned and sanitized.

CDC reports 641 cases of Cyclospora linked to recalled salad mixes nationwide

Since the last case count update on July 9, 2020, the U.S. Centers for Disease Control reported 132 new laboratory-confirmed Cyclospora infections have been reported, including 16 from three new states: Georgia, Pennsylvania, and South Dakota.

As of  July 22, 2020, a total of 641 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 11 states: Georgia (1), Illinois (198), Iowa (195), Kansas (5), Minnesota (73), Missouri (57) Nebraska (55), North Dakota (6), Pennsylvania (2), South Dakota (13) and Wisconsin (36). The ill person from Georgia purchased and ate a bagged salad product while traveling in Missouri.

Illnesses started on dates ranging from May 11, 2020 to July 5, 2020. Ill people range in age from 10 to 92 years with a median age of 59 and 52% are female. Of 636 people with available information, 37 people (6%) have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.

This investigation is ongoing.

The CDC says that it is specifically examining salad ingredients (iceberg lettuce, carrots, red cabbage) for the purposes of its investigation. The affected products include salad mixes made by Fresh Express, Hy-Vee Inc., Little Salad Bar, Signature Farms, Marketside and Hy-Vee. The products were sold at ALDI, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart locations.

The products were manufactured in Streamwood, Illinois at a Fresh Express production facility.

“Cyclosporiasis is an intestinal infection caused by the Cyclospora parasite,” the CDC says. “A person may become infected after ingesting contaminated food or water. Common symptoms include severe abdominal pain, diarrhea, nausea and vomiting, body aches and fatigue. The infection is treated with antibiotics and most people respond quickly to treatment.”

Specifically, the CDC says the products with a Z178 code or lower and “Best by” date that runs through July 14, 2020 are the ones potentially affected by the contamination.

However, only Georgia, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania, South Dakota and Wisconsin have reported cases of Cyclospora related to eating the salad mix. According to the CDC, the dates of the illness range from May 11, 2020 to July 5, 2020, with 37 people hospitalized as of Friday. Patients are ages 10 to 92 years with a median age of 59 years as of Friday’s data. No related deaths have been reported. People can go 4 to 6 weeks before noticing any symptoms of Cyclospora, the CDC says.

Write down what you ate in the two weeks before you started to get sick.

Report your illness to the health department.

Assist public health investigators by answering questions about your illness.

The CDC issued its recall warnings June 19, and Giant Eagle issued a recall on its Fresh Express products on June 29.

On June 27, 2020, Fresh Express Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage, and/or carrots due to possible Cyclospora contamination.

The Public Health Agency of Canada is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces. Exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots, and red cabbage, has been identified as a likely source of the outbreak.

  • Epidemiologic and traceback evidence indicates that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.
  • CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix was contaminated and whether other products are a source of illnesses.
  • CDC will provide updates when more information is available.

Raw is risky: Yes, for dogs too

There’s a subset of pet guardians who feverishly believe raw food is the only food for dogs and cats and other pets because that’s all that was available in the wild.

As Hobbes noted in 1651, nature is “solitary, poor, nasty, brutish, and short.”

Dogs too.

The Canadian Food Inspection Agency announced last week that Carnivora Fresh Frozen Patties for Dogs and Cats may be contaminated with Escherichia coli O157 (E. coli) and there is risk of cross contamination and illness after handling.

Consumers should immediately stop using any of the affected pet food products and contact the retailer where they purchased the affected product for a full refund or exchange.

As of June 12, 2020, the company has been made aware of 4 reports of illnesses in Canada – in people.

Consumers are advised to always wash hands, surfaces and utensils thoroughly with soap and water after feeding, handling or cleaning up after pets. Clean surfaces that come into contact with pet food or ill pets.

One of daughter Sorenne’s daily tasks is to give stress-reducing wet food to our neurotic cat, and she absolutely knows to wash her hands after handling the food.

Scott Weese over at the Worms and Germs blog writes that while people were presumably not eating the pet food (I wouldn’t presume that), there is the potential for cross-contamination of human food when handling raw pet food, as well as potential for exposure to pathogens through things like contact with pet food bowls and pet feces.

The main concern with raw pet food tends to be Salmonella; however, E. coli O157 is another significant concern because of the  potential severity of disease. A death was reported in a UK a couple years ago from exposure to E. coli O157 from contaminated pet food.

While most dogs and cats that eat raw diets are fine, and most owners don’t get sick, it’s clear that feeding raw diet or raw animal-based treats (e.g. pig ears) is associated with risks to the pet and any human contacts. I’d rather people not feed raw diets to their pets, particularly when the pet or household members are very young, elderly, pregnant or have compromised immune systems. If none of those risk factors are present and someone wants to feed a raw diet, I’d still rather they didn’t, but there are some things that can reduce the risks, as outlined on the Worms & Germs infosheet on raw diets available on our Resources – Pets page.

Oh, and don’t go to the company’s website for accurate information about risk and risk mitigation. They bury some good prevention recommendations in a pile of often out-of-context dialogue to try to deflect any concerns and the typical raw diet misinformation. Some other raw pet food companies are up front about the risks and prevention measures – I have a lot more confidence in companies like that.

Good on ya, Dr. Weese.

Trust but verify: Food fraud is hidden in plain sight

John Keogh of Big News Network writes that the globalization of the food chain has resulted in increased complexity and diminished transparency and trust into how and where our foods are grown, harvested, processed and by whom.

But this homily – we knew our grower so it must be safer – has no basis in factor data.

It’s like washing produce: It might make you feel better, but microbiologically, it does shit.

While the extent of global food fraud is difficult to quantify, the Canadian Food Inspection Agency (CFIA) suggests food fraud affects 10 per cent of commercially sold food. Various academic and industry sources suggest that globally, food fraud ranges from US$10 billion to $49 billion. This is likely a conservative range considering estimates of fake Australian meats alone and sold worldwide are as high as AUD$4 billion, or more than US$2.5 billion.

If you add the sales of fake wines and alcohol, adulterated honey and spices, mislabelled fish and false claims of organic products, wild-caught fish or grain-fed

As social media amplifies recurring high-profile incidents of food fraud, trust in our global food supply chains remains a concern. For the foreseeable future, much of Canada’s food fraud remains hidden in plain sight, sitting right there on our grocery store shelves.

Toxo in Canadian deer hunters eating undercooked venison from Illinois

We conducted a recent investigation in Quebec, Canada, concerning Canadian deer hunters who went to the United States to hunt deer and returned with symptoms of fever, severe headache, myalgia, and articular pain of undetermined etiology. Further investigation identified that a group of 10 hunters from Quebec attended a hunting retreat in Illinois (USA) during November 22–December 4, 2018.

Six of the 10 hunters had similar symptoms and illness onset dates. Serologic tests indicated a recent toxoplasmosis infection for all symptomatic hunters, and the risk factor identified was consumption of undercooked deer meat. Among asymptomatic hunters, 2 were already immune to toxoplasmosis, 1 was not immune, and the immune status of 1 remains unknown. Outbreaks of acute toxoplasmosis infection are rare in North America, but physicians should be aware that such outbreaks could become more common.

Acute toxoplasmosis among Canadian deer hunters associated with consumption of undercooked deer meat hunted in the U.S.

Emerging Infectious Diseases, vol. 26, no. 2

Colette Gaulin , Danielle Ramsay, Karine Thivierge, Joanne Tataryn, Ariane Courville, Catherine Martin, Patricia Cunningham, Joane Désilets, Diane Morin, and Réjean Dion

https://wwwnc.cdc.gov/eid/article/26/2/19-1218_article?deliveryName=DM17555

Twelve in Ontario, Quebec sickened in Salmonella outbreak linked to sausages

People always thought I was a bit affected when I would do the cooking for an Australian sausage sizzle and whip out my tip=sensitive digital thermometer and test every sausage.

I would say, no kid is getting sick on my watch.

Canadian health types say an outbreak of Salmonella that sickened a dozen people in Ontario and Quebec has been linked to a brand of sausage.

The Public Health Agency of Canada says the outbreak appears to be ongoing, in spite of a recall of the affected sausages.

The agency says the source of the outbreak is Filicetti brand Italian Style mild, dry, cured sausage (which is supposed to be cooked, but apparently not so much)

Ten people in Ontario and two in Quebec have become sick.

7 sick with Listeria in Canada linked to Rosemount brand cooked diced chicken: 2 dead 22 sick in US possibly related

As of August 23 2019, there have been seven confirmed cases of Listeria monocytogenes illness in three Canadian provinces: British Columbia (1), Manitoba (1) and Ontario (5) linked to cooked Rosemount brand cooked diced chicken.

The Public Health Agency of Canada notes Rosemount cooked diced chicken was supplied to institutions (including cafeterias, hospitals and nursing homes) where many of the individuals who became sick resided, or visited, before becoming ill.

Individuals became sick between November 2017 and June 2019. Six individuals have been hospitalized. Individuals who became ill are between 51 and 97 years of age. The majority of cases (86%) are female.

The collaborative outbreak investigation was initiated because of an increase of Listeria illnesses that were reported in June 2019. Through the use of a laboratory method called whole genome sequencing, two Listeria illnesses from November 2017 were identified to have the same genetic strain as the illnesses that occurred between April and June 2019. It is possible that more recent illnesses may be reported in the outbreak because of the period of time it takes between when a person becomes ill and when the illness is reported to public health officials. In national Listeria monocytogenes outbreak investigations, the reporting time period is usually between four and six weeks.

The U.S. CDC is also investigating an outbreak  of Listeria illnesses occurring in several states. The type of Listeria identified in the U.S. is closely related genetically (by whole genome sequencing) to the Listeria making people sick in Canada. Canada and U.S. public health and food safety partners are collaborating on these ongoing Listeria investigations.

CDC is not recommending that consumers avoid any particular food at this time. Restaurants and retailers are not advised to avoid serving or selling any particular food. We will update our advice if a source is identified.

Latest Outbreak Information

At A Glance

Reported Cases: 24

States: 13

Hospitalizations: 22

Deaths: 2

24 people infected with the outbreak strain of Listeria monocytogeneshave been reported from 13 states.

Of 23 ill people with information available, 22 hospitalizations have been reported.

Two deaths have been reported.

Canada: Raw frozen chicken thingies outbreaks

We’ve done extensive work on this topic dating back to 2006 (search barfblog.com), but new tools, like whole genome sequencing, mean additional outbreaks have been identified. A summary paper of recent outbreaks has just been published. Abstract below:

Frozen raw breaded chicken products (FRBCP) have been identified as a risk factor for Salmonella infection in Canada. In 2017, Canada implemented whole genome sequencing (WGS) for clinical and non-clinical Salmonella isolates, which increased understanding of the relatedness of Salmonella isolates, resulting in an increased number of Salmonella outbreak investigations. A total of 18 outbreaks and 584 laboratory-confirmed cases have been associated with FRBCP or chicken since 2017. The introduction of WGS provided the evidence needed to support a new requirement to control the risk of Salmonella in FRBCP produced for retail sale.

Outbreak of salmonella illness associated with frozen raw breaded chicken products in Canada 2015-2019

22 August 2019

Epidemiology and Infection vol. 147

  1. K. Morton(a1)A. Kearney(a2)S. Coleman (a3)M. Viswanathan (a1)K. Chau (a4)A. Orr (a5)and A. Hexemer (a1) 

DOI: https://doi.org/10.1017/S0950268819001432

https://www.cambridge.org/core/journals/epidemiology-and-infection/article/outbreaks-of-salmonella-illness-associated-with-frozen-raw-breaded-chicken-products-in-canada-20152019/9F1E5C0D2BF560E540C47BA064E7F713

7 sick in Canada: Listeria infections linked to Rosemount brand cooked diced chicken

As of August 18, 2019, there have been 7 confirmed cases of Listeria monocytogenes linked to Rosemount brand cooked diced chicken in British Columbia (1), Manitoba (1) and Ontario (5). Individuals became sick between November 2017 and June 2019. Six individuals have been hospitalized. Individuals who became ill are between 51 and 97 years of age. The majority of cases (86%) are female.

The collaborative outbreak investigation was initiated because of an increase of Listeria illnesses that were reported in June 2019. Through the use of whole genome sequencing, two Listeria illnesses from November 2017 were identified to have the same genetic strain as the illnesses that occurred between April and June 2019.

It is possible that more recent illnesses may be reported in the outbreak because of the delay between when a person becomes ill and when the illness is reported to public health officials. In national Listeria monocytogenes outbreak investigations, the case reporting delay is usually between 4 and 6 weeks.

If you have Rosemount brand cooked diced chicken meat 13mm – ½” (#16305), packdate – 01/21/2019 in your food establishment, do not eat the product or serve it to others

Secure the product and any foods made with the product in a plastic bag, throw it out and wash your hands with soapy water.