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.

US Cyclospora infections from salads rise, found in Canada

Chris Koger of The Packer reports that cases of Cyclospora infection linked to Fresh Express salads continue to rise, according to the Centers for Disease Control and Prevention, and Canada is reporting its first cases.

Lab-confirmed cases thought to be linked to iceberg lettucecarrots or red cabbage in garden salads were 509 in the U.S, as of July 9, according to the CDC. The Canadian Food Inspection Agency on July 8 reported 37 cases in Ontario, Quebec and Newfoundland and Labrador.

The salads, including private-label bagged garden salads, were processed at Fresh Express’ Streamwood, Ill., facility, according to the FDA.

Fresh Express has recalled salads from the plant containing the three ingredients under investigation, along with Aldi, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite and Walmart issuing recalls of private label salads.

The Canadian Food Inspection Agency reported on June 28 Fresh Express had recalled products in Canada. They were distributed nationwide by Crescent Multi-Foods, Federated Co-Operatives Ltd., Fresh Express and Walmart Canada Corp., according to the Canadian Agency.

An edited version of the latest CDC update is below:

On June 27, 2020, Fresh Express recalled 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.

509 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from 8 Midwestern states (Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Wisconsin).

Illnesses started on dates ranging from May 11, 2020 to July 1, 2020.

33 people have been hospitalized. No deaths have been reported.

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.

Since the last case count update on June 26, 2020, 303 new laboratory-confirmed Cyclospora infections have been reported.

As of July 8, 2020, a total of 509 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 8 states: Illinois (151), Iowa (160), Kansas (5), Minnesota (63), Missouri (46) Nebraska (48), North Dakota (6), and Wisconsin (30).

Illnesses started on dates ranging from May 11, 2020 to July 1, 2020. Ill people range in age from 11 to 92 years with a median age of 60 and 53% are female. Of 506 people with available information, 33 people (7%) 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.

Additionally, the Public Health Agency of Canada  is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces where 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.

Coronavirus and chicks: Risk remains

As coronavirus increases, many have taken to old timey ways of raising food.

Careful with that.

The U.S. Centers for Disease Control reports the outbreak strain of Salmonella Hadar has een reported from 28 states.

17 people (34% of those with information available) have been hospitalized and no deaths have been reported.

30% of ill people are children younger than 5 years of age.

Epidemiologic evidence shows that contact with backyard poultry (such as chicks and ducklings) is the likely source of this outbreak.

In interviews, 38 (86%) of 44 ill people reported contact with chicks and ducklings.

People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries.

Advice to Backyard Flock Owners

You can get sick with a Salmonella infection from touching backyard poultry or their environment. These birds can carry Salmonella bacteria even if they look healthy and clean and show no signs of illness. Follow these tips to stay healthy with your backyard flock:

Wash your hands.

Always wash your hands with soap and water right after touching backyard poultry, their eggs, or anything in the area where they live and roam.

Adults should supervise handwashing by young children.

Use hand sanitizer if soap and water are not readily available.

Be safe around poultry.

Don’t kiss backyard poultry or snuggle them and then touch your face or mouth.

Don’t let backyard poultry inside the house, especially in areas where food or drink is prepared, served, or stored.

Set aside a pair of shoes to wear while taking care of poultry and keep those shoes outside of the house.

Don’t eat or drink where poultry live or roam.

Stay outdoors when cleaning any equipment or materials used to raise or care for poultry, such as cages and containers for feed or water.

Supervise kids around poultry.

Always supervise children around poultry and while they wash their hands afterward.

Children younger than 5 years of age shouldn’t handle or touch chicks, ducklings, or other poultry. Young children are more likely to get sick from germs like Salmonella.

Handle eggs safely.

Collect eggs often. Eggs that sit in the nest can become dirty or break.

Throw away cracked eggs. Germs on the shell can more easily enter the egg though a cracked shell.

Eggs with dirt and debris can be cleaned carefully with fine sandpaper, a brush, or a cloth.

Don’t wash warm, fresh eggs because colder water can pull germs into the egg.

Refrigerate eggs after collection to maintain freshness and slow germ growth.

Cook eggs until both the yolk and white are firm. Egg dishes should be cooked to an internal temperature of 160°F (71°C) or hotter. Raw and undercooked eggs may contain Salmonella bacteria that can make you sick.

For a complete list of recommendations, visit the Healthy Pets, Healthy People website section on backyard poultry.

My friend, veterinarian, University of Guelph prot and OK hockey player writes in his Worms and Germs blog, Scott Weese I’m not anti-backyard chickens. I’m anti-“spending the weekend on the toilet” and anti-“seeing people hospitalized unnecessarily” and, I guess, just anti-Salmonella and anti-Campylobacter in general. I can’t see any redeeming qualities of those bacteria, at least in people.

Rates of FBI going nowhere

Is unconditional love a real thing? Is it possible to maximize an individual’s goals and relationships at the same time? Is microbial foodborne illness still a thing?

Unconditional is a subjective word that means different things to different people.

Rather than going for the safe middle in conflict resolution, I have a therapist who says, go for the jugular: have a great relationship and go after great goals (note: it helps if you tell your partner what you want in terms of the relationship and goals).

Microbial foodborne illness rates in the U.S. have been stagnant for 15 years. It’s a thing, but it’s not clear who cares.

The Washington Post stated back in the day, “Between 1998 and 2004, illnesses reported by CDC that were caused by E. Coli, listeria, campylobacter and a few other bacteria decreased by 25 to 30 percent, perhaps because of improvements in the handling of meat and eggs. Since about 2004, however, the rate of these illnesses has basically remained steady.”

There’s lots of new media toys out there, but it’s the high-tech version of signs that say, “Employees Must Wash Hands.” Reposting press releases – especially in the absence of critical analysis — is a waste of bandwidth and resources. And there is no evidence it results in fewer sick people.

Last week, the U.S. Centers for Disease Control reiterated the incidence of most infections transmitted commonly through food has not declined for many years.

Incidence of infections caused by Listeria, Salmonella, and Shigella remained unchanged, and those caused by all other pathogens reported to FoodNet increased during 2019. Infections caused by Salmonella serotype Enteritidis, did not decline; however, serotype Typhimurium infections continued to decline.

New strategies that target particular serotypes and more widespread implementation of known prevention measures are needed to reduce Salmonella illnesses. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Isolates are needed to subtype bacteria so that sources of illnesses can be determined.

I’ve been harping about the need for new messages and new media for 15 years – even did a road trip in 2009 with a number of talks stressing this point – with apparently little effect.

So maybe I’ll focus on relationships and being the best partner, father and person I can be.

Peace and love.

Preliminary incidence and trends of infections with pathogens transmitted commonly through food—foodborne diseases active surveillance network, 10 US sites, 2016-2019, 01 May 2020

Morbidity and Mortality Weekly Report pp.509-514

Danielle M. Tack, DVM1; Logan Ray, MPH1; Patricia M. Griffin, MD1; Paul R. Cieslak, MD2; John Dunn, DVM3; Tamara Rissman, MPH4; Rachel Jervis, MPH5; Sarah Lathrop, PhD6; Alison Muse, MPH7; Monique Duwell, MD8; Kirk Smith, DVM9; Melissa Tobin-D’Angelo, MD10; Duc J. Vugia, MD11; Joanna Zablotsky Kufel, PhD12; Beverly J. Wolpert, PhD13; Robert Tauxe, MD1; Daniel C. Payne, PhD1

https://www.cdc.gov/mmw/volumes/69/wr/mm6917a1.htm?s_cid=mm6917a1_w&deliveryName=USCDC_921-DM26943

Berries on boats: You’re breakin’ my heart

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

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

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

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

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

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

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

Morbidity and Mortality Weekly Report pg. 501-502

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

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

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

C. diff rates decline

Efforts to prevent Clostridioides difficile infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of C. difficile infection is unclear.

The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used case and census sampling weights to estimate the national burden of C. difficile infection, first recurrences, hospitalizations, and in-hospital deaths from 2011 through 2017. Health care–associated infections were defined as those with onset in a health care facility or associated with recent admission to a health care facility; all others were classified as community-associated infections. For trend analyses, we used weighted random-intercept models with negative binomial distribution and logistic-regression models to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types.

RESULTS

The number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011 (10,177 health care–associated and 5284 community-associated cases) and 15,512 in 2017 (7973 health care–associated and 7539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017. With accounting for NAAT use, the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of health care–associated C. difficileinfection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly.

CONCLUSIONS

The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care–associated infections. (Funded by the Centers for Disease Control and Prevention.)

Trends in US burden of clostridioides difficile infection and outcomes, 02 April 2020

New England Journal of Medicine

Alice Y. Guh, M.D., M.P.H., Yi Mu, Ph.D., Lisa G. Winston, M.D., Helen Johnston, M.P.H., Danyel Olson, M.S., M.P.H., Monica M. Farley, M.D., Lucy E. Wilson, M.D., Stacy M. Holzbauer, D.V.M., M.P.H., Erin C. Phipps, D.V.M., M.P.H., Ghinwa K. Dumyati, M.D., Zintars G. Beldavs, M.S., Marion A. Kainer, M.B., B.S., M.P.H., Maria Karlsson, Ph.D., Dale N. Gerding, M.D., and L. Clifford McDonald, M.D.

DOI: 10.1056/NEJMoa1910215

https://www.nejm.org/doi/10.1056/NEJMoa1910215

Four listeria deaths over three years traced to enoki mushrooms

Enoki mushrooms from South Korea have been recalled and investigators are linking them to a multi-year outbreak of Listeria monocytogenes that has killed four people.

The importer, Sun Hong Foods Inc., Montebello, Calif., recalled the mushrooms March 9 after Michigan Department of Agriculture and Rural Development officials found two samples of the mushrooms were positive for the listeria strain.

According to the Centers for Disease Control and Prevention, public health agencies are using the PulseNet system to identify illnesses linked to the outbreak, using “DNA fingerprinting” through whole genome sequencing. 

The agencies did not report when the deaths occurred. Patients in California, Hawaii and New Jersey died.

The cases traced to the mushrooms have a high rate of hospitalization, with 30 of the 36 patients identified requiring hospitalization, according to the Food and Drug Administration, which released a warning to consumers March 10 to not eat any enoki mushrooms from Sun Hong Foods.

Sun Hong Foods, Inc 1105 W Olympic Blvd, Montebello, CA 90640 is recalling All Cases Enoki Mushroom (Product of Korea) Net Wt 7.05/200g because it has the potential to be contaminated with Listeria monocytogenes, a bacterium which can cause life-threatening illness or death. Consumers are warned not to even if it does not look or smell spoiled.

CDC’s At A Glance concluded:

Reported Cases: 36

States: 17

Hospitalizations: 30

Deaths: 4

Recall: Yes

Outbreak investigation of Listeria monocytogenes: Hard-boiled eggs (December 2019)

Why did Listeria appear in hard-boiled eggs? Insufficient cooking? Cross-contamination? Dirty pails? This report doesn’t say.

The U.S. Food and Drug Administration, the U.S. Centers for Disease Control, CDC, and state and local partners investigated an outbreak of Listeria monocytogenes infections linked to hard-boiled eggs produced by Almark Foods’ Gainesville, Georgia facility. Almark Foods announced an initial voluntary recall of hard-boiled and peeled eggs in pails on December 20, 2019, and then on December 23, 2019 expanded the recall to include all hard-boiled eggs produced at the Gainesville, Georgia facility. All recalled products are now past their “best by” dates.

CDC has announced this outbreak is over. FDA’s investigational activities, including an inspection, are complete. At this time, the firm is no longer producing products at this facility.

Recommendation

Recalled products are now past their “best by” dates and should be thrown away.

FDA recommends that food processors, restaurants and retailers who received recalled products use extra vigilance in cleaning and sanitizing any surfaces that may have come in contact with these products, to reduce the risk of cross-contamination.

Case Counts

Total Illnesses: 8
Illnesses in 2019: 5
Hospitalizations: 5
Deaths: 1
Last illness isolation date: December 7, 2019
States with Cases: FL (1), ME (2), PA (1), SC (2), TX (2)
States with Cases in 2019: FL (1), ME (2), SC (2), TX (1)
Product Distribution*: Nationwide
*Distribution has been confirmed for states list, but at this time we believe the product was distributed nationwide. Updates will be provided as more information becomes available.

What Products are Recalled?

Recalled products include bulk product sold in pails, as well as products sold at retail. Companies who received recalled product from Almark Foods have initiated recalls of products containing these eggs. A list of all these recalls is available on the FDA website.

 

Lettuce is overrated: FDA’s leafy greens STEC action

I’ll say it again, as a comic in all seriousness: Lettuce is overrated.

My favorite salad is a Greek one with all those veggies and no lettuce.

The U.S. Food and Drug Administration announced last week that between 2009 and 2018, FDA and the Centers for Disease Control and Prevention (CDC) identified 40 foodborne outbreaks of Shiga toxin-producing E. coli (STEC) infections in the U.S. with a confirmed or suspected link to leafy greens.

Holy shit.

This is why The Tragically Hip were so great, and why they never appealed much beyond Canada.

I feel the same about academia.

And why Osterholm called me 15 years ago as a consultant for Fresh Express, and asked me how dare I the lettuce and skull picture, and I said because I can and it was fairly apt given there have been 40 outbreaks.

Holy shit (this is me echoing my John Oliver voice).

Coronavirus is just confirming: Go public, go often, go hard.

It’s the only way people will pay attention.

And as this story in the N.Y. Times points out, there have been spectacular public health failures by people who tell others, just shut the fuck up.

According to the FDA, it has an unwavering commitment to advancing the safety of fresh leafy greens. Leafy greens are among the most widely consumed vegetables and an important part of an overall healthy diet. While millions of servings are consumed safely every day, this produce commodity has been implicated too often in outbreaks of foodborne illness, and we believe that FDA, along with leafy greens sector stakeholders, can do more.

Between 2009 and 2018, FDA and Centers for Disease Control and Prevention (CDC) identified 40 foodborne outbreaks of Shiga toxin-producing E. coli (STEC) infections in the U.S. with a confirmed or suspected link to leafy greens. While most strains of E. coli are harmless, STEC can cause bloody diarrhea, anemia, blood-clotting problems, and kidney failure – conditions that are potentially life-threatening. The most common STEC, E. coli O157:H7, is the type most often associated with outbreaks.

Most leafy greens are grown outdoors, where they are exposed to soil, animals, and water, all of which can be a source of pathogen contamination. In addition, leafy greens are mostly consumed raw, without cooking or other processing steps to eliminate microbial hazards. The Produce Safety Rule under the FDA Food Safety Modernization Act (FSMA) sets science-based standards to help ensure that water, soil amendments (e.g., fertilizer or compost), food contact surfaces and other materials that touch produce during growing, harvesting, packing, and holding do not contribute to produce contamination. The Produce Safety Rule also addresses animal intrusion into fields and worker hygiene.

Due to the recurring nature of outbreaks associated with leafy greens, FDA has developed this commodity-specific action plan. What follows is an overview of the actions FDA plans to take in 2020 to advance work in three areas: (1) prevention, (2) response, and (3) addressing knowledge gaps.

Super sanitation cleaning: Caribbean Princess cruise ship turned back to US after more than 300 catch gastro bug

The Princess Cruises’ Caribbean Princess Ship left the U.S. on Feb 2 — and after more than a week at sea, was forced to turn back to the U.S. early when it was denied entry to the Caribbean.

The Caribbean Princess was set to have a 14-day trip around the Caribbean, but was forced to turn back to the U.S.

The cruise’s early return comes after it was denied entry to Trinidad and Tobago by the Government of Barbados due to the outbreak on board, according to a statement from the Ministry of Health.

Princess Cruises said in a statement to The Sun that the ship, which was on a 14-day cruise in the Caribbean, is now on its way back to the Port of Everglades in Fort Lauderdale.

The Caribbean Princess ship is scheduled to dock at 7 a.m. on Thursday, three days ahead of its previous Feb. 16 return.

A total of 299 passengers and 22 crew members of the 4,196 people on board got sick with a gastrointestinal bug, causing vomiting and diarrhea.

Princess Cruises said the cruise has “curtailed its voyage out of an abundance of caution due to guests reporting symptoms due to a mild gastrointestinal illness,” in a statement to The Sun.

The ship will undergo a “super sanitation cleaning” when it reaches the Florida port, according to a statement from the CDC.