19 sickened: Temperatures matter; C. perfringens outbreak at a catered lunch Connecticut, 2016

The U.S. Centers for Disease Control reports in September 2016, the Connecticut Department of Public Health was notified of a cluster of gastrointestinal illnesses among persons who shared a catered lunch.

The Connecticut Department of Public Health worked with the local health department to investigate the outbreak and recommend control measures. Information about symptoms and foods eaten was gathered using an online survey. A case was defined as the onset of abdominal pain or diarrhea in a lunch attendee <24 hours after the lunch. Risk ratios (RRs), 95% confidence intervals (CIs), and Fisher’s exact p-values were calculated for all food and beverages consumed. Associations of food exposures with illness were considered statistically significant at p<0.05. Among approximately 50 attendees, 30 (60%) completed the survey; 19 (63%) respondents met the case definition. The majority of commonly reported symptoms included diarrhea (17 of 18), abdominal pain (15 of 16), and headache (7 of 15).

The median interval from lunch to illness onset was 5.3 hours (range = 0.4–15.5 hours) for any symptom and 7 hours (range = 2.5–13 hours) for diarrhea. Analysis of food exposures reported by 16 ill and 10 well respondents (four respondents did not provide food exposure information) found illness to be associated with the beef dish (RR = undefined; CI = 1.06–∞; p = 0.046) (Table). All 16 ill respondents reported eating the beef. Coffee was also associated with illness; however, all 13 coffee drinkers who became ill also ate the beef. Eating cake approached significance (p = 0.051); all 10 cake eaters who became ill also ate the beef.The caterer had begun preparing all dishes the day before the lunch. Meats were partially cooked and then marinated in the refrigerator overnight. In the morning, they were sautéed 2 hours before lunch. Inspection of the facility found the limited refrigerator space to be full of stacked containers that were completely filled with cooked food, disposable gloves that appeared to have been washed for reuse, and a porous wooden chopping block.

The caterer’s four food workers reported no recent illness. Stool specimens from the food workers and from four ill attendees all tested negative for norovirus, Campylobacter, Escherichia coli O157, Salmonella, and Shigella at the Connecticut State Public Health Laboratory. All eight specimens were sent to the Minnesota Department of Health Public Health Laboratory, where additional testing was available. Two specimens from food workers were positive for enterotoxigenic Escherichia coli by polymerase chain reaction, but no enterotoxigenic E. coli colonies were isolated. Seven specimens (four from food workers and three from attendees) were culture-positive for Clostridium perfringens, and specimens from all attendees contained C. perfringens enterotoxin. Pulsed-field gel electrophoresis of 29 C. perfringens isolates from the culture-positive specimens found no matches among attendee isolates, but demonstrated a single matching pattern between two food worker specimens. No leftover food items were available for testing.

C. perfringens, a gram-positive, rod-shaped bacterium, forms spores allowing survival at normal cooking temperatures and germination during slow cooling or storage at ambient temperature (1). Diarrhea and other gastrointestinal symptoms are caused by C. perfringens enterotoxin production in the intestines. Vomiting is rare and illness is usually self-limited, although type C strains can cause necrotizing enteritis (1).

Symptoms reported were consistent with C. perfringens infection, with a predominance of diarrhea, and median diarrhea onset time was at the lower end of the typical C. perfringens incubation period (6–24 hours) (1). C. perfringens enterotoxin detection in the stool of two or more ill persons confirms C. perfringens as the outbreak etiology (2). Both C. perfringens and enterotoxigenic E. coli can colonize asymptomatic persons (3,4), which might explain the presence of these pathogens in the stools of asymptomatic food workers. Pulsed-field gel electrophoresis did not identify the C. perfringens strain responsible for the outbreak, but findings add to the evidence for a wide variety of C. perfringens strains, not all producing C. perfringens enterotoxin (5).

C. perfringens outbreaks are typically associated with improper cooling or inadequate reheating of contaminated meats (1), which might have occurred with the beef dish. The restaurant was advised about the need for adequate refrigeration and best practices for cooling foods, including using stainless steel rather than plastic containers, avoiding filling containers to depths exceeding two inches, avoiding stacking containers, and ventilating hot food. Upon follow-up inspection, staff members discarded disposable gloves after one use, used only food-grade cutting boards, and maintained proper food temperatures for hot holding, cold holding, cooling, and reheating, as outlined in the Food and Drug Administration Food Code.

An estimated 1 million illnesses in the United States each year are attributable to C. perfringens, but fewer than 1,200 illnesses are reported annually with C. perfringens outbreaks (6). C. perfringens testing is not routine for foodborne outbreaks; even if testing is unavailable, C. perfringens should be considered when improper cooling, inadequate reheating, and improper temperature maintenance of meat are identified.

Was it the celery? 74 sickened with E. coli O157:H7 associated with Jim-N-Jo’s Northland Katering, Minnesota:, July 2014

Bill Marler has kindly made public the final health report regarding the E. coli O157:H7 outbreak that sickened at least 74 people attending a July picnic for Elders of the Fond du Lac Band of Lake Superior Chippewa, in Minnesota.

CeleryOn July 17, 2014, a physician called the Minnesota Department of Health (MOH) to report that five individuals had been treated in the emergency department at Community Memorial Hospital in Cloquet for bloody diarrhea. All five cases had reported attending a picnic for Elders of the Fond du Lac Band of Lake Superior Chippewa on July 11that was catered by Jim-N-Jo’s Northland Katering. The caterer is licensed by the University of Minnesota (UMN) and operated out of a kitchen located at the Cloquet Forestry Center. MOH Environmental Health (EH), UMN EH, Fond du Lac Human Services, and MOH Tribal Relations were notified and an investigation was initiated.


Cases were identified through routine laboratory surveillance and interviews with event attendees identified through contact information provided by event hosts. A case was defined as an individual who attended an event catered by Jim-N-Jo’s Northland Katering and subsequently developed diarrhea (3 loose stools in a 24- hour period) that was either bloody or at least 3 days in duration, or an individual who had E. coli 0157:H7 isolated from a stool culture with a pulsed-field gel electrophoresis (PFGE) pattern indistinguishable from or within 3 bands of the main outbreak pattern by at least 1enzyme (Xbal or Bin i ). All Shiga toxin-producing E. coli cases reported to MOH are interviewed about potential exposures, including food consumption, as part of routine enteric disease surveillance. Event attendees identified through event hosts were interviewed about food consumption at the event and illness history.

Stool samples from consenting patrons and food workers were submitted to the MDH Public Health Laboratory (PHL} for bacterial and viral testing.

A UMN sanitarian visited the catering facility on July 18 to evaluate food preparation and handling procedures, interview employees, collect food invoices, and gather contact information and menus for catered events.

The Minnesota Department of Agriculture (MDA) conducted traceback investigations of food items of interest to determine the source and possible routes of contamination of those items. MDA also collected samples of suspected products from the caterer for E. coli 0157:H7 testing by the MDA Laboratory. All E. coli 0157:H7 isolates recovered from food were forwarded to the MOH PHL for PFGE subtyping.


A total of 199 individuals from seven catered events were interviewed. Of these, 74 (37%) reported recent gastrointestinal illness, including 57 (29%) who met the case definition. Seventeen individuals were excluded from analysis; 16 attendees reported i!!ness that did not met the case definition, and 1individual possibly represented a secondary infection to an ill household contact. The state of residence was reported as Minnesota for 48 cases, Wisconsin for 4, Alabama for 2, Illinois for 1, Indiana for 1, and Ohio for 1.

celeryThirty-seven (65%) of the cases were female; the median case age was 62 years (range, 4 to 85 years). All cases reported diarrhea, 55 {96%) cramps, 35 (61%) bloody stools, 21 (37%) vomiting, and 11(19%) fever. The median incubation for cases was 91 hours (range, 9 to 174 hours); the median duration of illness was 157 hours (range, 52 to 288 hours) for the 11cases who had recovered by the time of interview. Illness onset dates ranged from July 8 to July 23. Twenty-one {37%) cases sought medical care at a clinic, 18 (32%) were seen at an emergency department, and 9 (16%) were hospitalized. Hospitalizations ranged from 2 to 6 days. !’Jo cases were diagnosed with hemolytic uremic syndrome or died.

Twenty-seven laboratory-confirmed cases representing three different catered events were identified, including seven ill individuals who originally tested negative for Shiga toxin by Meridian lmmunoCard STAT! EHEC at a clinical laboratory. Multiple closely related Xbal and Bin i patterns were observed among attendees of each event. Nineteen (70%) isolates were indistinguishable by Xbal from the subtype designated EXHXOl.0238 by the Centers for Disease Control and Prevention (CDC) (Minnesota pattern designation MN1393), five (19%) isolates were designated as EXHXOl.0074 (Minnesota pattern designation WAl), and one isolate each was designated as EXHXOl.0696, EXHXOl.0344, and EXHXOl.0248. Each of these patterns was two or fewer bands different from the main pattern Xbal with the exception of EXHXOl.0344, which was four bands different from the main pattern and two bands different from WAl. By Bini, 20 (74%) isolates were designated as EXHA26.1045, 6 (22%) isolates were designated as EXHA26.0621, and 1isolate was designated as EXHA26.1577.

During the initial follow-up with the Fond du Lac Band, it was discovered that many of the attendees of the Elder Picnic also might have had attended a Veteran’s powwow held July 12-13 on the reservation. The food for this event was provided by several licensed operators, but did not include Jim-N-Jo’s Northland Katering. The powwow was ruled out as the source of illness because only two ill individuals reported only attending the Veteran’s powwow. All other attendees of the powwow also attended an event catered by Jim-N-Jo’s.

Jim-N-Jo’s catered at least 12 events from July 5 to July 17. Menus and contact information for attendees were available for six events. Illness that met the case definition was identified at four of these events (July 11, picnic on the Fond du Lac Reservation; July 12, wedding; July 14-16, 3-day conference for a private company; and July 16, focus group on the Fond du Lac Reservation), and an additional case was identified through routine surveillance that attended an event hosted by Carlton County on July 17 that was also catered by Jim-N-Jo’s.

Of the 199 individuals interviewed, 122 (61%) attended the picnic on July 11; among these, 43 (35%) cases were identified. One culture-confirmed case reported onset of illness on July 8 before attending the picnic and could not recall attending any other catered events. However, the case did report taking part in other activities sponsored by the tribe that may have been catered by Jim-N-Jo’s . The food served at the picnic inciuded hamburgers, hot dogs, brats, chicken breasts, buns, condiments,onion, lettuce, tomato, cheese slices, sauerkraut, baked beans, potato salad, fruit salad (watermelon, cantaloupe, pineapple, honeydew, and strawberries), corn, chips, cookies, and packaged beverages. In the univariate analysis including attendees of the picnic, consumption of potato salad (37 of 38 cases vs. 44 of 66 controls; odds ratio [OR], 18.5; 95% confidence interval [Cl], 2.4 to 143.9; p < 0.001) was associated with illness.

Twenty-two of the individuals interviewed attended the focus group on Ju!y 16; two (9%) met the case definition (both were culture-confirmed). Of these, one case also attended the Elder picnic and reported onset of illness before the focus group. The menu for the focus group included a build-your-own salad buffet with several types of cut leafy greens, chicken, numerous vegetable toppings, bread and butter, strawberries, cookies, and water. Fresh celery and onions were available as vegetable toppings.

The wedding on July 12 was attended by approximately 300 people. Only a partial list of wedding attendees was provided. Of the 20 people interviewed, 9 (45%) met the case definition (including 5 cases who were culture­ confirmed). The menu for the wedding included pulled pork sandwiches, buns, cheese, onions, fruit salad (watermelon, cantaloupe, pineapple, honeydew and strawberries), vegetable tray (carrots, celery, broccoli, and cauliflower), dill dip, ranch dip, cheesy potatoes, baked beans, corn, packaged beverages, and cupcakes not provided by the caterer. Among wedding guests, no food was statistically associated with illness. However, consumption of celery sticks (5 of 9 cases vs. 2 of 8 controls; OR, 3.75; 95% Cl, 0.5 to 29.8; p = 0.33), and cantaloupe (6 of 8 cases vs. 3 of 7 controls; OR, 4.0; 95% Cl, 0.4 to 35.8; p = 0.31) had elevated odds ratios. The original menu provided to MOH did not include chopped onions that were available as a sandwich garnish. Five of nine cases were re-inten1iewed about onion consumption; no cases reported consuming onions at the event.

Twelve of the 21 people who attended the 3-day conference (July 14-16) were interviewed; three cases were identified. Lunch was served each day (July 14: pulled pork sandwiches, cheese, onions, potato salad, fruit salad, and cookies; July 15: salad, wild rice, red potatoes, beef tips, grapes, bread, and cookies; and July 16: chicken wild rice soup, make-your-own sandwich buffet, cookies, and banana bread). The small number of cases and controls precluded a meaningful statistical analysis among conference attendees.

No list of attendees was provided for the meeting held on July 17. One case was identified through routine surveillance who attended the event. The case reported eating ham, turkey, sausage, lettuce, tomato, cucumber, potato salad, strawberries, and a cookie.

Raw celery and onions were the only food items served at all five events with identified cases. Three events (picnic, 3-day conference, and meeting) were served the same batch of potato salad that contained raw celery and onions. The celery was also served as part of a vegetable tray at the wedding and a chopped garnish on the salad bar for the focus group. Chopped onions were also available at all events. In the univariate analysis including all events, consumption of celery (46 of 52 cases vs. 55 of 95 controls; OR, 5.6; 95% Cl, 2.2 to 14.3; p <0.001) was significantly associated with illness, and onions (42 of 51 cases vs. 61of 90 controls; OR, 2.2; 95% Cl, 1.0 to 5.2; p = 0.08) approached a statistically significant association with illness. In a multivariate model, only consumption of celery (adjusted OR, 10.1;p = 0.004) was significantly associated with illness.

UMN sanitarians visited the catering kitchen on July 18. All five employees were interviewed. One employee reported onset of diarrhea on July 14 and recovery on July 16 and worked while ill during July 15-16. A stool specimen submitted by the employee was positive for E. coli 0157:H7 with the main outbreak PFGE pattern. The employee reported sampling or tasting food during preparation.

Ingredients and preparation procedures for menu items were reviewed. The sanitarian noted inconsistent glove use and issues with date marking. No improper practices or procedures were noted with regard to cooking, cooling, or cross-contamination. The ingredients for the potato salad that was served at the picnic, 3-day conference, and meeting were prepared over a 3 day period. On July 7, the potatoes were boiled and cooled; on

July 8, celery and onions were washed and cut; and on July 9, potatoes were peeled and cut, and potato salad ingredients (potatoes, celery, onions, hard boiled eggs, mayonnaise, mustard, dried dill, sugar, pickle juice, vinegar, salt, pepper, and commercially prepared potato salad) were assembled and mixed separately into four 5-gallon bins. The celery that was served at the wedding was cut into sticks on July 10, stored in water, and added to the vegetable tray on July 12. The celery that was served at the focus group was chopped sometime during July 7-15 and stored in water before the event.

On July 21, an MDA inspector picked up leftover food from the caterer that was served at the implicated events, including potato salad, strawberries, honeydew, pineapple, and cantaloupe . The potato salad was positive for E. coli O157:H7; all other food samples were negative. Multiple PFGE subtypes were isolated from the potato salad, including the two main patterns isolated from the cases and two other closely related patterns that were not found among the case isolates. Additionally, on July 28, leftover celery and onions from the same shipment as what had been served in the potato salad, at the wedding, and the focus group were collected from the caterer and tested. Both products were negative.

The caterer ordered all fresh produce from Upper Lakes Foods, Inc. The celery that was served at all of the events was received by the caterer on June 25 in a case of 24 heads. MDA worked with Pro*Act distributing and Mann Packing to identify the field in California where the celery was grown as Martignoni Ranch block Sc. The California Department of Public Health {CDPH) was notified of the outbreak and traceback investigation and was able to confirm that the field was owned by Costa Farms and harvested by Mann Packing. The field is adjacent to a defunct dairy operation north of Gonzales, California in the Salinas Valley. CDPH notified the California Food Emergency Response Team {CalFERT) which conducted an inspection of the field and collected five water and soil samples on August 13. No potential cross-contamination issues or positive environmental samples were detected. The inspectors reported that grazing cattle are occasionally present in the adjacent field, but were not in sight at the time of inspection.

Nationally, one additional E. coli O157:H7 case with an isolate that was indistinguishable by PFGE was identified in Indiana. The case reported onset of illness on July 2 and no travel to Minnesota. No connection was found to the Minnesota outbreak.


This was a foodborne outbreak of E. coli O157:H7 infections associated with multiple events catered by Jim-N­ Jo’s Katering. Cases were associated with five events that took place from July 11to July 17. Potato salad served at three events was found to be contaminated with E. coli 0157:H7 that was indistinguishable from case isolates by PFGE. Cases were also identified at two additional events that did not serve the potato salad, but served celery that was from the same shipment as the celery in the potato salad. Contaminated celery that was served in some form at all five events was the most likely vehicle of transmission. The source of contamination was not identified, but sampling in the field was limited. It is still plausible that celery could have become contaminated during production.

Workers’ ‘squalid’ catering unit in UAE closed after hundreds fall sick

The United Arab Emirates has made food safety a priority, and food service companies have apparently imported some Western-style BS explanations when people barf.

A spokesthingy for a labor camp operated by Abu Dhabi-based Al Jaber Group, told The National.

"The safety of our staff is our utmost priority. … In more than two decades of operation, and serving 150,000 meals a day all over the UAE, this is the first instance of food poisoning at any of our camps."

Not much consolation to the 236 workers who were diagnosed with food poisoning; the catering unit was found to be operating without a licence and under "squalid conditions."

Investigators from the Abu Dhabi Food Control Authority (ADFCA) have closed down the catering unit at the Habshan Labour Camp after 117 workers were taken to Madinat Zayed Hospital on Saturday and Sunday, and a further 119 were treated on site at the camp.

Inspectors found cockroaches inside the water dispensers and destroyed 675kg of cooked rice which was kept in "unsafe conditions for more than four hours", according to a statement released by ADFCA.

The inspection report stated the camp, which caters for 2,200 workers, was "violating all norms of hygiene and disregarding the health consequences for the labourers."

Cross-contamination – mixing meat, poultry and vegetables, both raw and uncooked, in the same freezer – was apparent, and food products did not have manufacturing details on them, so may have been expired, the report said.

Mohammed al Reyaysa, the director of communications at ADFCA, described the conditions as "shocking" and said "the people behind this disaster will not go unpunished."

Two weddings and an outbreak: Clostridium perfringens in London, July 2009

I didn’t even come up with that headline. Those science journal writers are developing a sense of humor.

Eriksen et al. write in Eurosurveillance today:

Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer.

The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyze possible associations between the food consumed and becoming ill. Food, environmental and stool samples were tested for common causative agents, including enterotoxigenic C. perfringens. The clinical presentation and the epidemiological findings were compatible with C. perfringens food poisoning and C. perfringens enterotoxin was detected in stool samples from two cases.

The case-control study found statistically significant associations between becoming ill and eating either a specific chicken or lamb dish prepared by the same food handler of the implicated catering company. A rapid outbreak investigation with preliminary real-time results and the successful collaboration between the agencies and the caterer led to timely identification and rectification of the failures in the food handling practices.

In the discussion, the authors write,

A blast chiller is normally used for cooling large quantities of food quickly by this particular caterer; however it was not being used appropriately at the time of the incident. Temperature control of foods during preparation, cooling, transportation and reheating was poor. Furthermore, the vans used for food transport had no refrigeration and these events took place in July. The evidence of insufficient hygiene, cooling and reheating at the catering company during transport and at both venues (according to environmental health department inspections) are in keeping with a toxin-related gastroenteritis outbreak, including C. perfringens.

Toronto restaurant fined maximum $20K for heavy cockroach problem

Oh Scarberia, suburb of Toronto, home to Mike Myers and some of the Barenaked Ladies. Why do your restaurants suck?

A takeout restaurant in Scarborough was fined $20,000 – the maximum penalty – after pleading guilty to four food-safety violations, including a "heavy" cockroach infestation.

The guilty plea last Friday by Chandra’s Takeout Restaurant and Catering, at 201 Markham Rd., related to problems that closed it Aug. 24 to Aug. 28. It has since reopened and passed full inspections on Aug. 28 and Nov. 6.

The restaurant was fined $5,000 for each of four infractions: not controlling a pest/insect infestation; failing to protect food from contamination; not having a certified food handler; and for obstructing Toronto Public Health’s red closure sign while the restaurant was shut down in August.