The U.S. Centers for Disease Control reports that since the last update on May 16, 2019, illnesses in an additional 227 people and 20 states have been added to this investigation. Four Salmonella serotypes have also been added.
A total of 279 people infected with the outbreak strains of Salmonella have been reported from 41 states.
40 (26%) people have been hospitalized and no deaths have been reported.
70 (30%) people are children younger than 5 years.
In interviews, 118 (77%) of 153 ill people reported contact with chicks or ducklings.
People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries.
One of the outbreak strains making people sick has been identified in samples collected from backyard poultry in Ohio.
People can get sick with Salmonella infections from touching backyard poultry or their environment. Backyard poultry can carry Salmonella bacteria but appear healthy and clean and show no signs of illness.
Follow these tips to stay healthy with your backyard flock:
Always wash your hands with soap and water right after touching backyard poultry 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.
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.
I used to write up the U.S. Centers of Disease Control with the enthusiasm of a teenage going on a date.
It was current, it was confident and it was cool.
Now, not so much.
Maybe it’s just me, but I’m tired of watching Salmonella and other foodborne illnesses flatline, even if a Senator brings a day-old bucket of KFC into a hearing to make some sort of metaphorical point.
I’ll say the same thing I say every year: the numbers aren’t changing because the interventions are in the wrong place.
When national organizations go agenst the World Health Organization and don’t mention on-farm food safety, then they’re missing the source.
According to Food Business News, illness was more prevalent in 2018, according to preliminary surveillance data from the Centers for Disease Control (C.D.C.) and Prevention. Incidents of Campylobacter, Salmonella and Cyclospora infections increased last year, according to FoodNet 2018 preliminary data released by the C.D.C. The increases were due, in part, to more infections being diagnosed using culture-independent diagnostic tests (C.I.D.T.s), but the C.D.C. noted the possibility that the number of infections actually is increasing.
Campylobacter infections were the commonly identified infection in FoodNet sites since 2013 with poultry being the major source of infection. More infections are being diagnosed, the C.D.C. said, because more laboratories use C.I.D.T.s to detect Campylobacterand other pathogens. C.I.D.T.s detect the presence of a specific genetic sequence of an organism. The tests produce results more rapidly because they do not require isolation and identification of living organisms.
Reducing Campylobacter infections will require more knowledge of how case patients are becoming infected, the C.D.C. said. The pathogen can contaminate raw chicken or poultry juices, and cross-contamination can impact hands, other foods or kitchen equipment.
“Focusing on interventions throughout the food production chain that reduce Campylobacter bacteria in chicken could lead to fewer illnesses in people,” the C.D.C. said. “Whole genome sequencing might help us figure out the contribution of various sources and help target interventions.”
Salmonella infections, the second most common infection, also appear to be increasing, according to the preliminary report. The most common Salmonella serotypes were Enteritidis, Newport and Typhimurium. Additionally, Enteritidis infections are not decreasing despite regulatory programs aimed at reducing Salmonella in poultry and eggs.
A new survey finds more than half of Americans (51 percent) use swimming pools as a communal bathtub– either swimming as a substitute for showering or using the pool to rinse off after exercise or yardwork. And, still, Americans knowingly make pools dirty despite nearly two-thirds (64 percent) of respondents saying pool chemicals do not eliminate the need to shower before swimming.
“When dirt, sweat, personal care products, and other things on our bodies react with chlorine, there is less chlorine available to kill germs,” said Dr. Chris Wiant, chair of the Water Quality & Health Council. “Rinsing off for just 1 minute removes most of the dirt, sweat, or anything else on your body.”
The survey revealed 40 percent of Americans admit they have peed in the pool as an adult. Peeing in the pool reacts with chlorine and reduces the amount of chlorine available to kill germs.
“The bottom line is: Don’t pee in the pool,” said Michele Hlavsa, chief of CDC’s Healthy Swimming program. “Swimming is a great way to be physically active and not peeing in the pool is a key healthy swimming step.”
I do not buy stuff from the deli-counter. I buy stuff that is pre-packaged and may contain antimicrobials, depending on what country you are in.
It’s all about the slicers, whether it’s the little ones at the deli counter or the huge industrial ones in food facilities – I’m looking at you Maple Leaf, source of 23 dead in 2008 in Canada – and how hard they are to properly clean.
Should deli meats be served in hospitals or aged care facilities where the immunocompromised abound?
This outbreak is a reminder that people at higher risk for severe Listeria infection should handle deli-sliced meats and cheeses carefully to prevent illness. Pregnant women and their newborns, adults age 65 and older, and people with weakened immune systems are more likely to get sick with listeriosis.
If you develop symptoms of a Listeria infection after eating deli-sliced products, contact a healthcare provider and tell them you ate deli-sliced products. This is especially important if you are pregnant, age 65 or older, or have a weakened immune system.
If you have eaten deli-sliced products and do not have any symptoms of a Listeria infection, most experts believe that tests or treatment are not needed, even for people who have a higher chance of Listeria infection.
Listeria bacteria can survive at very low temperatures and can spread easily to other foods and surfaces. Consumers should clean refrigerators, kitchen countertops, utensils, and other surfaces that touch deli-sliced products.
In 1999, I gave a talk to hundreds of farm leaders in Ottawa and told them that DNA fingerprinting – via PulseNet – would revolutionize foodborne illness outbreak investigations and that farmers better be prepared (the pic is from a 2003 awards ceremony where I was acknowledged for my outreach and extension efforts, the hair was fabulous).
Twenty years later and whole genome sequencing is even further piecing together disparate outbreaks.
Joanie Stiers of Farm Flavor writes that Michigan’s laboratory toolbox now includes whole-genome sequencing, allowing public health officials to stop the spread of foodborne illness faster than ever.
“With food now being distributed worldwide, illness can be spread from anywhere in the world,” says Ted Gatesy, laboratory manager of the microbiology section at Geagley Lab, which houses the whole-genome sequencing. “Using whole-genome sequencing, an illness can be tracked, for the most part, to the point in the food chain where it originated.
The U.S. Centers for Disease Control and Prevention and state health officials are investigating potential exposures to Brucella strain RB51 (RB51) in 19 states, connected to consuming raw (unpasteurized) milk from Miller’s Biodiversity Farm in Quarryville, Pennsylvania. One case of RB51 infection (brucellosis) has been confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking the milk from this farm. This type of Brucella is resistant to first-line drugs and can be difficult to diagnose because of limited testing options and the fact that early brucellosis symptoms are similar to those of more common illnesses like flu.
The New York case is the third known instance of an infection with RB51 associated with consuming raw milk or raw milk products produced in the United States. The other two human cases occurred in October 2017 in New Jersey and in August 2017 in Texas. Those cases reported drinking raw milk from an online retailer and a Texas farm, respectively. In addition to these three confirmed cases, hundreds of others were potentially exposed to RB51 during these three incidents.
RB51 is a live, weakened strain used in a vaccine to protect cows against a more severe form of Brucella infection that can cause abortions in cows and severe illness in people. On rare occasions, cows vaccinated with RB51 vaccine can shed the bacteria in their milk. People who drink raw milk from cows that are shedding RB51 can develop brucellosis.
People who consumed raw milk or raw milk products from this dairy farm since January 2016 may have been exposed and should talk to their doctor.
People who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis and should receive antibiotics to prevent an infection and symptoms, and should monitor their health for possible symptoms for six months. If symptoms develop, they should see their doctor immediately for testing.
Milk samples from Miller’s Biodiversity tested positive for RB51. A cow that tested positive for RB51 has been removed from the milking herd.
On December 1, 2017, PulseNet, the U.S. Centers for Disease Control’s molecular subtyping network for foodborne disease surveillance, identified a cluster of three Listeria monocytogenes clinical isolates with indistinguishable pulsed-field gel electrophoresis (PFGE) pattern combinations. These isolates were closely related to one another by whole-genome multilocus sequence typing within three allele differences (range = 0–3 alleles), indicating that the infections were likely from the same source.
CDC, the Food and Drug Administration (FDA), and state and local health departments initiated a multistate investigation. An outbreak case of listeriosis was defined as an infection with L. monocytogenes, with an isolate that was indistinguishable by PFGE and closely related by whole-genome multilocus sequence typing to the outbreak strain isolated during October–December 2017.
The cases corresponding to the three isolates were identified in Illinois, Iowa, and Michigan. Isolation dates ranged from October 15, 2017, to October 29, 2017. Patients ranged in age from 55 to 71 years (median = 69 years), and all three patients were male. All patients were hospitalized for listeriosis; no deaths were reported. PulseNet was queried routinely for new isolate matches during the investigation, and no additional cases were identified.
Interviews were conducted with all three patients or their surrogates using the standard Listeria Initiative questionnaire (1), which asks about a variety of foods consumed in the month preceding illness onset. Grocery store receipts were collected for the patient in Michigan. Review of reported exposures indicated that all three patients had consumed prepackaged caramel apples purchased from retail establishments in the month preceding illness onset. A case-case analysis was performed comparing exposure frequencies for all food items included in the Listeria Initiative questionnaire for the three outbreak-associated cases with exposure frequencies for 186 sporadic cases of listeriosis from the same states reported to CDC since 2006. Caramel apple consumption was significantly higher among patients included in the outbreak, compared with that among patients with sporadic illnesses (odds ratio = 21.7; 95% confidence interval = 2.3–infinity). None of the interviewed patients had leftover caramel apples in their home for testing.
State and local officials collected records at two of the three retail locations where caramel apples had been purchased. All three retailers sold the same brand of caramel apples (brand A). The product was packaged in a plastic clamshell containing three caramel apples, each on a stick. Caramel apples were seasonal products that were only available for a short period in the fall at two of the retail locations. However, the retail location where the Illinois patient purchased caramel apples had the product in stock at the time of the investigation. Eight packages of caramel apples were collected for testing by the Illinois Department of Public Health, but L. monocytogenes was not detected in any samples. It was not known whether the tested caramel apples were from the same lots as those consumed by the ill persons in this outbreak.
During an inspection at the caramel apple production facility, FDA reviewed records and practices and collected environmental samples for testing. No significant food safety concerns were observed. None of the environmental swabs yielded L. monocytogenes. Environmental swabs collected at a single whole apple supplier yielded L. monocytogenes, but it was not the outbreak strain. Traceback activities did not implicate a specific lot or supplier of whole apples used in brand A caramel apple production during the period of interest.
No additional outbreak-associated illnesses were identified during the investigation. In light of the limited shelf life of the product (reported by the production facility to be 15 days), it was unlikely that caramel apples consumed by ill persons in this outbreak would have still been available for purchase or in persons’ homes at the time of the investigation. Because there was no evidence to suggest an ongoing risk to the public, no public warning was issued by federal or state agencies.
Although the outbreak strain of L. monocytogenes was not isolated from caramel apples or their production environment, the epidemiologic evidence indicated that caramel apples were the suspected vehicle in this outbreak. All outbreak-associated ill persons consumed a specific brand of a relatively uncommon food product in the month before their illness onset, and all were infected with indistinguishable L. monocytogenes strains. Caramel apples were previously implicated in a large multistate outbreak of listeriosis during 2014–2015, caused by contamination of whole apples (2). Ready-to-eat food processors, including those that make caramel apples, could consider the introduction and persistence of L. monocytogenes in food production environments as a potential hazard and mitigate that risk through appropriate environmental monitoring and preventive controls (3). Further research into the control of L. monocytogenes in fresh produce, including fresh apples, might help identify prevention strategies to reduce or eliminate the pathogen in some ready-to-eat foods.
Notes from the field: Outbreak of listeriosis likely associated with prepackaged caramel apples
Jessica R. Marus, MPH1; Sally Bidol, MPH2; Shana M. Altman3; Oluwakemi Oni, MPH4; Nicole Parker-Strobe, MPH2; Mark Otto, MSPH5; Evelyn Pereira, MPH5; Annemarie Buchholz, PhD5; Jasmine Huffman1,6; Amanda R. Conrad, MPH1; Matthew E. Wise, PhD1
1Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 2Michigan Department of Health and Human Services; 3Illinois Department of Public Health; 4Iowa Department of Public Health; 5Food and Drug Administration, Silver Spring, Maryland; 6Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
Flour comes from dried wheat that’s milled and not heat treated (because it messes with the gluten). Because wheat is grown in nature, Salmonella or E. coli or other nasties can be present. As Salmonella dries out it gets hardier and survives for months (or longer).
In 1957, Duncan Hines and his wife, Clara, cut a cake at the Duncan Hines test kitchen in Ithaca, N.Y.
In Nov. 2018, the U.S. Food and Drug Administration investigated recalled Duncan Hines Cake Mixes potentially linked to seven Salmonella Agbeni illnesses.
On January 14, 2019, the Centers for Disease Control reported the outbreak appeared to be over. The FDA, CDC, public health and regulatory officials in several states worked together to investigate this multistate outbreak of Salmonella Agbeni infections.
The FDA recommends consumers to not bake with or eat the recalled product. Additionally, consumers should not eat uncooked batter, flour, or cake mix powder.
The FDA advised consumers not to bake with or eat any recalled cake mix. If already purchased, consumers should throw it away or return to the place of purchase for a refund.
Consumers should always practice safe food handling and preparation measures. It is recommended that they wash hands, utensils, and surfaces with hot, soapy water before and after handling food.
FDA offers these tips for safe food handling to keep you and your family healthy:
Do not eat any raw cake mix, batter, or any other raw dough or batter product that is supposed to be cooked or baked.
Wash hands, work surfaces, and utensils thoroughly after contact with flour and raw batter or dough products.
Keep raw foods separate from other foods while preparing them to prevent any contamination that may be present from spreading. Be aware that flour or cake mix may spread easily due to its powdery nature.