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.

North American Cyclospora outbreaks

My aunt got sick from Cyclospora in some basil-based thingy in Florida, in 2005.

She was sick for weeks.

On June 12, 1996, Ontario’s chief medical officer, Dr. Richard Schabas, issued a public health advisory on the presumed link between consumption of California strawberries and an outbreak of diarrheal illness among some 40 people in the Metro Toronto area. The announcement followed a similar statement from the Department of Health and Human Services in Houston, Texas, who were investigating a cluster of 18 cases of Cyclospora illness among oil executives.

Dr. Schabas advised consumers to wash California berries “very carefully” before eating them, and recommended that people with compromised immune systems avoid them entirely. He also stated that Ontario strawberries, which were just beginning to be harvested, were safe for consumption. Almost immediately, people in Ontario stopped buying strawberries. Two supermarket chains took California berries off their shelves, in response to pressure from consumers. The market collapsed so thoroughly that newspapers reported truck drivers headed for Toronto with loads of berries being directed, by telephone, to other markets.

However, by June 20, 1996, discrepancies began to appear in the link between California strawberries and illness caused by the parasite, Cyclospora, even though the number of reported illnesses continued to increase across North America. Texas health officials strengthened their assertion that California strawberries were the cause of the outbreak, while scientists at the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) said there were not yet ready to identify a food vehicle for the outbreak. On June 27, 1996, the New York City Health Department became the first in North America to publicly state that raspberries were also suspected in the outbreak of Cyclospora.

By July 18, 1996, the CDC declared that raspberries from Guatemala — which had been sprayed with pesticides mixed with water that could have been contaminated with human sewage containing Cyclospora — were the likely source of the Cyclospora outbreak, which ultimately sickened about 1,000 people across North America. Guatemalan health authorities and producers have vigorously refuted the charges. The California Strawberry Commission estimates it lost $15 million to $20 million in reduced strawberry sales.

Cyclospora cayetanensis is a recently characterised coccidian parasite; the first known cases of infection in humans were diagnosed in 1977. Before 1996, only three outbreaks of Cyclospora infection had been reported in the United States. Cyclospora is normally associated with warm, Latin American countries with poor sanitation.

One reason for the large amount of uncertainty in the 1996 Cyclospora outbreak is the lack of effective testing procedures for this organism. To date, Cyclospora oocysts have not been found on any strawberries, raspberries or other fruit, either from North America or Guatemala. That does not mean that cyclospora was absent; it means the tests are unreliable and somewhat meaningless. FDA, CDC and others are developing standardized methods for such testing and are currently evaluating their sensitivity.

The initial, and subsequent, links between Cyclospora and strawberries or raspberries were therefore based on epidemiology, a statistical association between consumption of a particular food and the onset of disease. For example, the Toronto outbreak was first identified because some 35 guests attending a May 11, 1996 wedding reception developed the same severe, intestinal illness, seven to 10 days after the wedding, and subsequently tested positive for cyclospora. Based on interviews with those stricken, health authorities in Toronto and Texas concluded that California strawberries were the most likely source. However, attempts to remember exactly what one ate two weeks earlier is an extremely difficult task; and larger foods, like strawberries, are recalled more frequently than smaller foods, like raspberries. Ontario strawberries were never implicated in the outbreak.

Once epidemiology identifies a probable link, health officials have to decide whether it makes sense to warn the public. In retrospect, the decision seems straightforward, but there are several possibilities that must be weighed at the time. If the Ontario Ministry of Health decided to warn people that eating imported strawberries might be connected to Cyclospora infection, two outcomes were possible: if it turned out that strawberries are implicated, the ministry has made a smart decision, warning people against something that could hurt them; if strawberries were not implicated, then the ministry has made a bad decision with the result that strawberry growers and sellers will lose money and people will stop eating something that is good for them. If the ministry decides not to warn people, another two outcomes are possible: if strawberries were implicated, then the ministry has made a bad decision and people may get a parasitic infection they would have avoided had they been given the information (lawsuits usually follow); if strawberries were definitely not implicated then nothing happens, the industry does not suffer and the ministry does not get in trouble for not telling people. Research is currently being undertaken to develop more rigorous, scientifically-tested guidelines for informing the public of uncertain risks.

But in Sarnia (Ontario, Canada) they got a lot of sick people who attended the Big Sisters of Sarnia-Lambton Chef’s Challenge on May 12, 2010.

Michael T. Osterholm, PhD, who has a lot of titles and once called me at 5 a.m. to tell me I was an asshole (maybe not the exact words, but the sentiment) and chair of the Holstein Blue-Ribbon Panel on the Prevention of Foodborne Cyclospora Outbreaks writes that the 1996 cyclosporiasis outbreak in the United States and Canada associated with the late spring harvest of imported Guatemalan-produced raspberries was an early warning to public health officials and the produce industry that the international sourcing of produce means that infectious agents once thought of as only causing traveler’s diarrhea could now infect at home. The public health investigation of the 1996 outbreak couldn’t identify how, when, where, or why the berries became contaminated with Cyclospora cayetanensis.

The investigation results were published in the New England Journal of Medicine in 1997. I was asked to write an editorial to accompany the investigation report.2 In my editorial, I noted the unknowns surrounding the C. cayetanensis contamination. The 1997 spring harvest of Guatemalan raspberries was allowed to be imported into both the United States and Canada—and again, a large outbreak of cyclosporiasis occurred. As in the 1996 outbreak, no source for the contamination of berries was found. Later in 1997, the Food and Drug Administration (FDA) prohibited the importation of future spring harvests of Guatemalan raspberries until a cause for the contamination could be demonstrated and corrective actions taken. While the FDA did not permit the 1998 importation of the raspberries into the United States, the berries continued to be available in Canada. Outbreaks linked to raspberries occurred in Ontario in May 1998. When the U.S. Centers for Disease Control and Prevention (CDC)-led investigative team published its 1997 outbreak findings in the Annals of Internal Medicine, 3 I was again asked to write an accompanying editorial.4 As I had done in my previous editorial, I highlighted how little we know about the factors associated with the transmission Cyclospora on produce and how to prevent it.

Unfortunately, the state of the art for preventing foodborne, produce-associated cyclosporiasis had changed little since the 1996 outbreak despite the relatively frequent occurrence of such outbreaks.

Thirty-four years after that first Guatemalan raspberry-associated outbreak — and a year after produce-associated cyclosporiasis outbreaks that were linked to U.S.-grown produce — there has been a major leap in prevention, yet the outbreaks still happen.

 Foodborne outbreaks of cyclosporiasis have been reported in the United States since the mid-1990s and have been linked to various types of imported fresh produce, including raspberries, basil, snow peas, mesclun lettuce, and cilantro; no commercially frozen produce has been implicated to date. U.S. foodborne outbreaks of cyclosporiasis that occurred before 2000 were summarized previously, as were the major documented outbreaks in 2013 and 2014. Foodborne outbreaks during the 18-year period of 2000–2017 are summarized here.

The table provides information about 39 reported foodborne outbreaks of cyclosporiasis that occurred in the United States during 2000–2017; the total case count was 1,730. No outbreaks were reported in 2003, 2007, or 2010. Overall, a median of two outbreaks were reported per year, with a median of 19 cases per outbreak (range, 3 to 582 cases). Although the outbreaks occurred during 8 different months (December through July), the peak months were May, June, and July. As indicated in the table, a food vehicle of infection was identified (or suspected) for 17 of the 39 outbreaks.

Identifying the particular food item/ingredient that caused an outbreak of cyclosporiasis can be very challenging—for example, if fresh produce was served as a garnish or topping or if several types of produce were mixed together. CDC and other agencies are working to develop and validate molecular typing methods that could distinguish among different strains of the parasite Cyclospora cayetanensis that causes cyclosporiasis. In the future, such tools could help link cases of cyclosporiasis to each other and to particular types of produce, which could help public health officials investigate and prevent cases and outbreaks of Cyclospora infection.

Table: Summary of U.S. foodborne outbreaks of cyclosporiasis, 2000–2017
Year(s)* Month(s)* Jurisdiction(s)* No. of cases† Food vehicle and source, if identified‡
2000 May Georgia 19 Raspberries and/or blackberries (suspected)
2000 June Pennsylvania 54 Raspberries
2001 January–February Florida 39
2001 January New York City 3
2001–02 December–January Vermont 22 Raspberries (likely)
2002 April–May Massachusetts 8
2002 June New York 14
2004 February Texas 38
2004 February Illinois 57 Basil (likely)
2004 May Tennessee 12
2004 May–June Pennsylvania 96 Snow peas from Guatemala ⁂
2005 March–May Florida 582 ¶ Basil from Peru
2005 May South Carolina 6
2005 April Massachusetts 58
2005 May Massachusetts 16
2005 June Connecticut 30 Basil (suspected)
2006 June Minnesota 14
2006 June New York 20
2006 July Georgia 3
2008 March Wisconsin 4 Sugar snap peas (likely) ⁂
2008 July California 45 ¶ Raspberries and/or blackberries (likely)
2009 June District of Columbia 34
2011 June Florida 12
2011 July Georgia 88**
2012 June–July Texas 16
2013†† June Iowa, Nebraska, and neighboring states 162 Bagged salad mix from Mexico
2013†† June–July Texas 38 Cilantro from Mexico
2013 July Wisconsin 8 Berry salad (suspected)
2014 June Michigan 14
2014‡‡ June–July Texas 26 Cilantro from Mexico
2014 July South Carolina 13
2015 May–July Georgia, Texas, and Wisconsin 90 Cilantro from Mexico
2016 June–July Texas 6¶¶ Carrots or green cabbage (suspected)
2017 May Florida 6 Berries (suspected)
2017 May–July Texas 38*** Scallions (i.e., green onions)
2017 June Michigan 29
2017 June Tennessee 4†††
2017 June Connecticut 3
2017 July Florida 3‡‡‡

* The entries in the first three columns refer to the known or likely year(s), month(s), and jurisdiction(s) in which the exposure(s) to Cyclospora occurred.

† The case counts include laboratory-confirmed and probable cases of cyclosporiasis. By definition, each outbreak included at least two linked cases, at least one of which was laboratory confirmed.

‡ A food vehicle is specified only if a single ingredient or commodity was identified in an outbreak investigation.

¶ Cases that occurred in Canadian travelers to the United States were not included.

** An additional 10 probable cases were associated with this outbreak but were not counted in the table: nine of these cases were in residents of states in which cyclosporiasis was not a reportable condition, and the other case was in a patient whose state of residence was unknown.

†† For additional details, see summary information about the outbreak investigations in 2013. For the purposes of this table, the exposure month(s) and case counts are limited to those explicitly linked in the investigations to the food item specified in the last column.

‡‡ For additional perspective, see summary information about outbreak investigations in 2014. For the purposes of this table, the exposure months and the case count for the outbreak in Texas are limited to those explicitly linked in the investigations to the food item specified in the last column.

¶¶ An additional nine suspected cases were identified in persons associated with this outbreak but were not counted in the table because of reporting issues (e.g., insufficient case data).

*** An additional three probable cases were identified in persons associated with this outbreak but were not counted in the table because of reporting issues (e.g., insufficient case data).

††† An additional two probable cases were identified in persons associated with this outbreak but were not counted in the table because of reporting issues (e.g., insufficient case data).

‡‡‡ One additional probable case was identified in a person associated with this outbreak but was not counted in the table because of a reporting issue.

⁂ More information to help distinguish among types of peas can be found herepdf icon.

Table: Summary of U.S. foodborne outbreaks of cyclosporiasis, 2000–2017
Year(s)* Month(s)* Jurisdiction(s)* No. of cases† Food vehicle and source, if identified‡
2000 May Georgia 19 Raspberries and/or blackberries (suspected)
2000 June Pennsylvania 54 Raspberries
2001 January–February Florida 39
2001 January New York City 3
2001–02 December–January Vermont 22 Raspberries (likely)
2002 April–May Massachusetts 8
2002 June New York 14
2004 February Texas 38
2004 February Illinois 57 Basil (likely)
2004 May Tennessee 12
2004 May–June Pennsylvania 96 Snow peas from Guatemala ⁂
2005 March–May Florida 582 ¶ Basil from Peru
2005 May South Carolina 6
2005 April Massachusetts 58
2005 May Massachusetts 16
2005 June Connecticut 30 Basil (suspected)
2006 June Minnesota 14
2006 June New York 20
2006 July Georgia 3
2008 March Wisconsin 4 Sugar snap peas (likely) ⁂
2008 July California 45 ¶ Raspberries and/or blackberries (likely)
2009 June District of Columbia 34
2011 June Florida 12
2011 July Georgia 88**
2012 June–July Texas 16
2013†† June Iowa, Nebraska, and neighboring states 162 Bagged salad mix from Mexico
2013†† June–July Texas 38 Cilantro from Mexico
2013 July Wisconsin 8 Berry salad (suspected)
2014 June Michigan 14
2014‡‡ June–July Texas 26 Cilantro from Mexico
2014 July South Carolina 13
2015 May–July Georgia, Texas, and Wisconsin 90 Cilantro from Mexico
2016 June–July Texas 6¶¶ Carrots or green cabbage (suspected)
2017 May Florida 6 Berries (suspected)
2017 May–July Texas 38*** Scallions (i.e., green onions)
2017 June Michigan 29
2017 June Tennessee 4†††
2017 June Connecticut 3
2017 July Florida 3‡‡‡

By July 18, 1996, the CDC declared that raspberries from Guatemala — which had been sprayed with pesticides mixed with water that could have been contaminated with human sewage containing Cyclospora — were the likely source of the Cyclospora outbreak, which ultimately sickened about 1,000 people across North America. Guatemalan health authorities and producers have vigorously refuted the charges. The California Strawberry Commission estimates it lost $15 million to $20 million in reduced strawberry sales.

Cyclospora cayetanensis is a recently characterised coccidian parasite; the first known cases of infection in humans were diagnosed in 1977. Before 1996, only three outbreaks of Cyclospora infection had been reported in the United States. Cyclospora is normally associated with warm, Latin American countries with poor sanitation.

One reason for the large amount of uncertainty in the 1996 Cyclospora outbreak is the lack of effective testing procedures for this organism. To date, Cyclospora oocysts have not been found on any strawberries, raspberries or other fruit, either from North America or Guatemala. That does not mean that cyclospora was absent; it means the tests are unreliable and somewhat meaningless. FDA, CDC and others are developing standardized methods for such testing and are currently evaluating their sensitivity.

The initial, and subsequent, links between Cyclospora and strawberries or raspberries were therefore based on epidemiology, a statistical association between consumption of a particular food and the onset of disease. For example, the Toronto outbreak was first identified because some 35 guests attending a May 11, 1996 wedding reception developed the same severe, intestinal illness, seven to 10 days after the wedding, and subsequently tested positive for cyclospora. Based on interviews with those stricken, health authorities in Toronto and Texas concluded that California strawberries were the most likely source. However, attempts to remember exactly what one ate two weeks earlier is an extremely difficult task; and larger foods, like strawberries, are recalled more frequently than smaller foods, like raspberries. Ontario strawberries were never implicated in the outbreak.

Once epidemiology identifies a probable link, health officials have to decide whether it makes sense to warn the public. In retrospect, the decision seems straightforward, but there are several possibilities that must be weighed at the time. If the Ontario Ministry of Health decided to warn people that eating imported strawberries might be connected to Cyclospora infection, two outcomes were possible: if it turned out that strawberries are implicated, the ministry has made a smart decision, warning people against something that could hurt them; if strawberries were not implicated, then the ministry has made a bad decision with the result that strawberry growers and sellers will lose money and people will stop eating something that is good for them. If the ministry decides not to warn people, another two outcomes are possible: if strawberries were implicated, then the ministry has made a bad decision and people may get a parasitic infection they would have avoided had they been given the information (lawsuits usually follow); if strawberries were definitely not implicated then nothing happens, the industry does not suffer and the ministry does not get in trouble for not telling people. Research is currently being undertaken to develop more rigorous, scientifically-tested guidelines for informing the public of uncertain risks.

But in Sarnia (Ontario, Canada) they got a lot of sick people who attended the Big Sisters of Sarnia-Lambton Chef’s Challenge on May 12, 2010.

Michael T. Osterholm, PhD, who has a lot of titles and once called me at 5 a.m. to tell me I was an asshole (maybe not the exact words, but the sentiment) and chair of the Holstein Blue-Ribbon Panel on the Prevention of Foodborne Cyclospora Outbreaks writes that the 1996 cyclosporiasis outbreak in the United States and Canada associated with the late spring harvest of imported Guatemalan-produced raspberries was an early warning to public health officials and the produce industry that the international sourcing of produce means that infectious agents once thought of as only causing traveler’s diarrhea could now infect at home. The public health investigation of the 1996 outbreak couldn’t identify how, when, where, or why the berries became contaminated with Cyclospora cayetanensis.

The investigation results were published in the New England Journal of Medicine in 1997. I was asked to write an editorial to accompany the investigation report.2 In my editorial, I noted the unknowns surrounding the C. cayetanensis contamination. The 1997 spring harvest of Guatemalan raspberries was allowed to be imported into both the United States and Canada—and again, a large outbreak of cyclosporiasis occurred. As in the 1996 outbreak, no source for the contamination of berries was found. Later in 1997, the Food and Drug Administration (FDA) prohibited the importation of future spring harvests of Guatemalan raspberries until a cause for the contamination could be demonstrated and corrective actions taken. While the FDA did not permit the 1998 importation of the raspberries into the United States, the berries continued to be available in Canada. Outbreaks linked to raspberries occurred in Ontario in May 1998. When the U.S. Centers for Disease Control and Prevention (CDC)-led investigative team published its 1997 outbreak findings in the Annals of Internal Medicine, 3 I was again asked to write an accompanying editorial.4 As I had done in my previous editorial, I highlighted how little we know about the factors associated with the transmission Cyclospora on produce and how to prevent it.

Unfortunately, the state of the art for preventing foodborne, produce-associated cyclosporiasis had changed little since the 1996 outbreak despite the relatively frequent occurrence of such outbreaks.

Thirty-four years after that first Guatemalan raspberry-associated outbreak — and a year after produce-associated cyclosporiasis outbreaks that were linked to U.S.-grown produce — there has been a major leap in prevention, yet the outbreaks still happen.

Foodborne outbreaks of cyclosporiasis have been reported in the United States since the mid-1990s and have been linked to various types of imported fresh produce, including raspberries, basil, snow peas, mesclun lettuce, and cilantro; no commercially frozen produce has been implicated to date. U.S. foodborne outbreaks of cyclosporiasis that occurred before 2000 were summarized previously, as were the major documented outbreaks in 2013 and 2014. Foodborne outbreaks during the 18-year period of 2000–2017 are summarized here.

The table provides information about 39 reported foodborne outbreaks of cyclosporiasis that occurred in the United States during 2000–2017; the total case count was 1,730. No outbreaks were reported in 2003, 2007, or 2010. Overall, a median of two outbreaks were reported per year, with a median of 19 cases per outbreak (range, 3 to 582 cases). Although the outbreaks occurred during 8 different months (December through July), the peak months were May, June, and July. As indicated in the table, a food vehicle of infection was identified (or suspected) for 17 of the 39 outbreaks.

Identifying the particular food item/ingredient that caused an outbreak of cyclosporiasis can be very challenging—for example, if fresh produce was served as a garnish or topping or if several types of produce were mixed together. CDC and other agencies are working to develop and validate molecular typing methods that could distinguish among different strains of the parasite Cyclospora cayetanensis that causes cyclosporiasis. In the future, such tools could help link cases of cyclosporiasis to each other and to particular types of produce, which could help public health officials investigate and prevent cases and outbreaks of Cyclospora infection.

Table: Summary of U.S. foodborne outbreaks of cyclosporiasis, 2000–2017
Year(s)* Month(s)* Jurisdiction(s)* No. of cases† Food vehicle and source, if identified‡
2000 May Georgia 19 Raspberries and/or blackberries (suspected)
2000 June Pennsylvania 54 Raspberries
2001 January–February Florida 39
2001 January New York City 3
2001–02 December–January Vermont 22 Raspberries (likely)
2002 April–May Massachusetts 8
2002 June New York 14
2004 February Texas 38
2004 February Illinois 57 Basil (likely)
2004 May Tennessee 12
2004 May–June Pennsylvania 96 Snow peas from Guatemala ⁂
2005 March–May Florida 582 ¶ Basil from Peru
2005 May South Carolina 6
2005 April Massachusetts 58
2005 May Massachusetts 16
2005 June Connecticut 30 Basil (suspected)
2006 June Minnesota 14
2006 June New York 20
2006 July Georgia 3
2008 March Wisconsin 4 Sugar snap peas (likely) ⁂
2008 July California 45 ¶ Raspberries and/or blackberries (likely)
2009 June District of Columbia 34
2011 June Florida 12
2011 July Georgia 88**
2012 June–July Texas 16
2013†† June Iowa, Nebraska, and neighboring states 162 Bagged salad mix from Mexico
2013†† June–July Texas 38 Cilantro from Mexico
2013 July Wisconsin 8 Berry salad (suspected)
2014 June Michigan 14
2014‡‡ June–July Texas 26 Cilantro from Mexico
2014 July South Carolina 13
2015 May–July Georgia, Texas, and Wisconsin 90 Cilantro from Mexico
2016 June–July Texas 6¶¶ Carrots or green cabbage (suspected)
2017 May Florida 6 Berries (suspected)
2017 May–July Texas 38*** Scallions (i.e., green onions)
2017 June Michigan 29
2017 June Tennessee 4†††
2017 June Connecticut 3
2017 July Florida 3‡‡‡

Ontario parents speak out after 2-year-old’s E. coli linked death

I seemed to have missed this, which is inexcusable, volunteer or not, medical stuff for me or not, but here it is, a month later (and if I did publish it, shows where my brain is going).

Avis Favaro of CTV News reported in early May that it all started with a romaine salad.

Kristen and Brad Bell felt a little sick after eating the salad last October.

Their two-year-old son soon started to show more severe symptoms. Cooper Bell was vomiting. He developed diarrhea. Then his mother noticed the blood in his diaper.

“I had no idea [what] was happening,” Kristen Bell told CTV News from her home in Stirling, Ont.

“I thought ‘This is not normal.'”

An emergency room doctor thought Cooper might have contracted a bacterial infection. The family’s pediatrician agreed, saying the Bells should keep their son hydrated and bring him back in the morning.

Soon after the Bells returned home, they noticed some worrying changes in Cooper’s behavior.

“He wasn’t responding to me the same as he was earlier. It wasn’t long after that, that he had a seizure in Brad’s arms,” Kristen Bell said.

Seeing their son shaking uncontrollably with his eyes closed, the Bells called an ambulance. He spent a few hours in hospital in nearby Belleville, Ont., and was then airlifted to the Children’s Hospital of Eastern Ontario in Ottawa.

Doctors at CHEO diagnosed Cooper with kidney failure brought on by E. coli. He suffered cardiac arrest and died. The Bells believe it was the romaine lettuce that made Cooper sick, although they were unable to send the lettuce for testing to confirm their belief because it had been thrown out.

There were 29 illnesses and 10 hospitalizations reported across Canada during last fall’s E. coli outbreak, according to the Public Health Agency of Canada. It was one of three outbreaks in North America over the past year all of which were linked to romaine lettuce.

Keith Warriner, a food safety expert and professor at the University of Guelph in Ontario, said in an interview that the food industry has long been slow to improve its testing practices something that could improve overall food safety, but would mean extra costs for their operations.

“The industry itself has known for many years what it needs to do, but it’s just been reluctant to do it,” he said.

The Bells agree. They’re sharing their story of grief with the hope it will help hospital workers and other parents better understand the danger of E. coli, but also because they want to see changes at the food production level.

“E. coli shouldn’t be in our food,” Brad Bell said.

“The way that we’re growing food is dangerous, and something has to change.”

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.

529 now sick with Salmonella in Canada: Crisp & Delicious brand chicken breast nuggets recalled

Over a decade ago, when I went to Kansas State, me and Chapman and Phebus came up with a project to see how people cooked raw, frozen chicken thingies.

The American Meat Institute funded it.

Some of these chicken thingies are frozen raw, which means they have to be cooked in an oven and temperature verified with a tip-sensitive digital thermometer, and some of these thingies are pre-cooked, so can be thawed in a microwave.

Labelling has changed over the years, but it’s still necessary to know what you’re buying.

Some of the frozen raw products may appear to be pre-cooked or browned, but they should be handled and prepared with caution.

Through whole genome sequencing, health types in Canada had, by Nov. 2, 2018, identified 474 laboratory-confirmed cases of Salmonella linked to 14 national outbreaks involving raw chicken, including frozen raw breaded chicken products.

The Canadian Food Inspection Agency issued food recall warnings for ten products linked to some of these outbreak investigations.

Make that 11 products.

Sofina Foods Inc. is now recalling Crisp & Delicious brand Chicken Breast Nuggets from the marketplace due to possible Salmonella contamination.

As of January 25, 2019, there have been 529 laboratory-confirmed cases of Salmonella illness investigated as part of the illness outbreaks across the country: British Columbia (42), Alberta (81), Saskatchewan (18), Manitoba (25), Ontario (187), Quebec (111), New Brunswick (27), Nova Scotia (17), Prince Edward Island (5), Newfoundland and Labrador (12), Northwest Territories (1), Yukon (1), and Nunavut (2). There have been 90 individuals hospitalized as part of these outbreaks. Three individuals have died; however, Salmonella was not the cause of death for two of those individuals, and it was not determined whether Salmonella contributed to the cause of death for the third individual. Infections have occurred in Canadians of all ages and genders.

All active and future Salmonella outbreak investigations linked to raw chicken, including frozen raw breaded chicken products, and related food recall warnings will be listed in the next section of the public health notice to remind Canadians of the ongoing risk associated with these types of food products.

Active investigations

As of January 25, 2019, there is one active national Salmonella outbreak investigation linked to raw chicken including frozen raw breaded chicken products, coordinated by the Public Health Agency of Canada.

January 25, 2019 (NEW) – Salmonella Enteritidis

  • Currently, there are 54 cases of illness in ten provinces linked to this outbreak: British Columbia (4), Alberta (11), Saskatchewan (1), Manitoba (3), Ontario (20), Quebec (4), New Brunswick (2), Nova Scotia (5), Prince Edward Island (3) and Newfoundland and Labrador (1). None of the ill individuals have been hospitalized. No deaths have been reported. Frozen raw breaded chicken products have been identified as a source of this outbreak.

Product recall on January 25, 2019

  • Crisp & Delicious Chicken Breast Nuggets (1.6kg) with a best before date of July 19, 2019. UPC – 0 69299 11703 5. The product was distributed in British Columbia, Manitoba, Ontario, and Quebec, and may have been distributed in other provinces or territories

Self-reported and observed behavior of primary meal preparers and adolescents during preparation of frozen, uncooked, breaded chicken products
01.nov.09
British Food Journal, Vol 111, Issue 9, p 915-929
Sarah DeDonder, Casey J. Jacob, Brae V. Surgeoner, Benjamin Chapman, Randall Phebus, Douglas A. Powell
http://www.emeraldinsight.com/Insight/viewContentItem.do;jsessionid=6146E6AFABCC349C376B7E55A3866D4A?contentType=Article&contentId=1811820
Abstract:
Purpose – The purpose of the present study was to observe the preparation practices of both adult and young consumers using frozen, uncooked, breaded chicken products, which were previously involved in outbreaks linked to consumer mishandling. The study also sought to observe behaviors of adolescents as home food preparers. Finally, the study aimed to compare food handler behaviors with those prescribed on product labels.
Design/methodology/approach – The study sought, through video observation and self-report surveys, to determine if differences exist between consumers’ intent and actual behavior.
Findings – A survey study of consumer reactions to safe food-handling labels on raw meat and poultry products suggested that instructions for safe handling found on labels had only limited influence on consumer practices. The labels studied by these researchers were found on the packaging of chicken products examined in the current study alongside step-by-step cooking instructions. Observational techniques, as mentioned above, provide a different perception of consumer behaviors.
Originality/value – This paper finds areas that have not been studied in previous observational research and is an excellent addition to existing literature.

Is it BS? Restaurant issues an apology after customer finds a rat in their soup

I never liked Vancouver.

People in Brisbane, they think Canada ends at Banff and Vancouver is some idyllic Canadiana, but to me it’s junkie haven.

Never liked it.

And what kind of popular eatery would serve a rat in a customer’s soup?
Or have some bullshit where a customer would fake a ploy?

That’s the Vancouver I’m familiar with.

The customer posted a video of the rodent in their soup on Instagram.


The Vancouver Sun reports the customer posted the video on Instagram Thursday after they discovered the rodent in their soup at Crab Park Chowdery. The restaurant is well known for serving soups and clam chowder in a sourdough bread bowls. Its owner, Ashton Phillips, says he does not understand how the rodent got into the soup and that the restaurant follows strict health code regulations. He added that a female customer was the one who found the rat in her soup.

We are doing everything we can to figure out what happened. You have to lid soup. This is a food safety measure and we always take it. It’s just impossible that a rat got in there. We are baffled.”