Raw is risky: Ceviche source of V. cholera 01 in Minn

As we drove the five hours yesterday to Sawtell, NSW, for a week of (ice) hockey for Sorenne, and some R&R for me and Amy (mainly me), Amy was telling me about this one time, she went to Senegal (they speak French) in 2005, and the hosts offered her Tang but she didn’t want to drink it because she had been warned about the water.

Turns out there was an on-going cholera outbreak.

I was driving and thought, should I tell her that cholera is a member of the Vibrio genus?

I kept driving.

Today, while Sorenne is working it on the ice, I’m catching up and came across this report from friends at the Minnesota Department of Health (MDH) published by the U.S. Centers for Disease Control.

On August 20, 2016, the Minnesota Department of Health (MDH) was notified of a case of Vibrio cholerae infection. The isolate was identified as serogroup O1, serotype Inaba at MDH. CDC determined that the isolate was nontoxigenic. The patient was a previously healthy woman, aged 43 years, with history of gastric bypass surgery. On August 16, she experienced profuse watery diarrhea, vomiting, abdominal cramps, and headache. On August 18, she sought care and submitted the stool specimen that yielded the V. cholerae isolate. She reported no recent travel. However, she had consumed ceviche made with raw shrimp and raw oysters at restaurant A on August 14, 49 hours before illness onset. Her husband had a similar illness with a similar incubation period after eating the same foods at restaurant A.

On August 22, MDH sanitarians visited restaurant A and obtained tags and invoices for oyster and shrimp products; the oysters were a product of the United States, and the shrimp was a product of India. Sanitarians also gathered patron contact information and credit card receipts for August 12–14. Two additional patrons reported experiencing a gastrointestinal illness that met the case definition of three or more episodes of watery stool in a 24-hour period within 5 days of eating at restaurant A; one reported eating ceviche and oysters at restaurant A. Review of complaints to the MDH foodborne illness hotline revealed a previous complaint from two persons who reported experiencing watery diarrhea after eating raw shrimp ceviche (but no oysters) at restaurant A on August 2. These persons did not provide stool specimens, but their gastrointestinal illnesses met the case definition, resulting in a total of six cases, including one laboratory-confirmed case. No other V. cholerae O1 Inaba cases were reported in the United States during this outbreak.

The Minnesota Department of Agriculture facilitated sampling of shrimp at the distributor from the same lots served at restaurant A on August 14, and most likely during August 2–13, and sent them to the Food and Drug Administration for culture. Shrimp samples yielded V. cholerae non-O1, non-O139, but V. cholerae O1 was not isolated. In response to the outbreak results, restaurant A placed consumer warnings on their menus about the risks of consuming raw or undercooked food items and identified raw menu items for consumers. Restaurant A also focused on other actions that might facilitate reduction of V. cholerae, including appropriate freezing of food items, and allowing raw food items to soak in lime juice before being served, rather than serving the items immediately after adding lime juice (1,2).

V. cholera has over 150 serogroups and has been identified in a wide range of aquatic life, including seafood (3). Whereas multiple serogroups can cause vibriosis, only serogroups O1 and O139 that also contain the cholera toxin are classified as causes of cholera (4). Previous studies have documented the presence of nontoxigenic V. cholerae O1 from environmental and shrimp samples in India and Southeast Asia (5–7).

This outbreak of domestically acquired, nontoxigenic V. cholerae infections, likely from shrimp consumption, included the first V. cholerae O1 case identified in a nontraveler in Minnesota since active surveillance for Vibrio began in 1996. Since 1996, MDH has detected 26 V. cholerae infections, 21 (81%) of which were non-O1, non- O139, and five of which were O1. Among the four O1 type cases identified before the current outbreak, all patients had a recent travel history to Micronesia or India. This outbreak demonstrates the importance of investigating all seafood eaten by patients with vibriosis. In addition, investigators should include nontoxigenic V. cholerae as a possible etiology of domestic foodborne outbreaks, particularly when foods eaten include those from V. cholerae O1–endemic areas.

Notes from the field: Vibrio cholerae Serogroup O1, Serotype Inaba — Minnesota, August 2016


Victoria Hall, Carlota Medus, George Wahl, Alida Sorenson, Melanie Orth, Monica Santovenia, Erin Burdette, Kirk Smith



California mother faces jail time after trying to sell homemade food on Facebook

KTLA 5 reports that a Stockton woman faces an impending trial and potential jail time after she joined a social media community food group, and sold some of the meals she cooked, which county San Joaquin County officials say is against the law.

cevicheMariza Reulas was cited by San Joaquin County for selling an illegal substance, but it wasn’t a powder, a pill or a plant. It was her bowl of homemade ceviche, according to KTXL.

“It was just like unreal that they were saying you could face up to a year in jail,” said Reulas.

A few years ago Reulas joined a Facebook group called 209 Food Spot – a forum she says, where people from the Stockton area shared recipes, organized potlucks and occasionally sold what they cooked.

“Somebody would be like, ‘Oh I don’t have anything to trade you but I would love to buy a plate,’ like they’d be off of work,” Reulas said.

On December 3 of last year, someone contacted Reulas, asking for a plate of her Ceviche –- one of her signature dishes. That person was an undercover investigator from San Joaquin County, according to court documents, on a sting because the majority of 209 Food Spot members didn’t have permits to sell their food.

Reulas and a dozen others were cited for two misdemeanors for operating a food facility and engaging in business without a permit.

Reulas refused to plea down to three years of probation. Now the single mother of six is headed to trial and could end up in jail.

“I don’t write the laws, I enforce them. And the legislature has felt that this is a crime,” said San Joaquin County Deputy District Attorney Kelly McDaniel. She says selling any food not subject to health department inspection puts whoever eats it in real danger, not to mention it undercuts business owners who do get permits to make their food.

She says the 209 Food Spot Facebook group was sent a warning before charges were handed down.

Ceviche ain’t muffins and cookies. It’s raw fish alleged cleaned up with some acid from lemons and limes.


Does lime juice make raw seafood, ceviche, safe? Sorta

Queensland has fabulous limes.

They taste nothing like the American ones, and I buy them by the bucket.

I’m a late arrival to the virtues of limes – odd that I have Limey heritage – but now they are in everything: the gallons of fruity herbal tea I drink daily, water Tahitian-Limewith ice and lemon-lime-ginger bitters, lime butter for popcorn and seafood, you get the idea.

I have a Tahitian lime tree on my concrete balcony, with dreams of someday moving near the ocean and properly planting my tree.

A boy can dream.

The acid in limes has long been used to marinate or cook raw fish in ceviche. But does it really make seafood safe?

Prateek Mathurand and friend of barfblog, Don Schaffner, report in this month’s Journal of Food Protection that lime juice does reduce levels of Vibrio, but is not so effective against Salmonella. I’ll stick with lime and a mild heat treatment for any seafood. Raw is risky.

Effect of lime juice on Vibrio parahaemolyticus and Salmonella Enterica inactivation during the preparation of the raw fish dish ceviche

Journal of Food Protection, Number 6, June 2013, pp. 928-1108 , pp. 1027-1030(4)

Mathurand, Prateek; Schaffner, Donald W.


Ceviche is a raw fish dish common in Peru and other Latin American counties. The most characteristic feature of ceviche is the use of lime juice for marinating or “cooking” the raw fish. Confirmed cases of cholera in Peru, New Jersey, and Florida have been associated with ceviche. Although the effect of organic acids on pathogenic bacteria has been well characterized, few data exist on the effect of these acids in seafood systems. The objective of the study was to evaluate the effects of lime juice marination on pathogens likely to be present in ceviche. Tilapia (Oreochromis niloticus) fillet pieces were inoculated with Vibrio parahaemolyticus and Salmonella enterica (>7 log CFU/g) and fish.bbq.feb.13incubated at 25 and 4°C for 30 or 120 min in the presence of fresh lime juice at concentrations typical for the preparation of ceviche. Similar levels of cells were also inoculated into fresh lime juice without tilapia. Surviving cells were enumerated on selective (xylose lysine Tergitol 4 and thiosulfate-bile-citrate-sucrose) and nonselective (tryptic soy agar) media. V. parahaemolyticus levels were reduced to below detection limits (∼5-log reduction) under all conditions studied. Salmonella strains on tilapia were much more resistant to inactivation and were only slightly reduced (∼1- to 2-log reduction). Salmonella and V. parahaemolyticus inoculated directly into lime juice without tilapia were all reduced to below detection limits (∼5-log reduction). A typical ceviche recipe reduces V. parahaemolyticus risk significantly but is less effective for control of S. enterica.

Florida restaurant hires own food safety firm after failing April inspection

Many chain restaurants and supermarkets have their own food safety staff or hire third-party auditors to stay ahead of local inspectors, and limit the risk of making customers sick.

Wtsp TV reports that a month after a state inspector temporarily shut down the popular Ceviche restaurant in downtown St. Pete, the company says it is Cevichehiring an independent food safety inspection company to evaluate the chain’s kitchens.

Ceviche Tapas Bar & Restaurant was shut down for just about 24 hours in early April after the Florida Department of Business and Professional Regulation documented 15 violations, four considered high priority. Among the problems listed on the report were temperature violations of the pork and seafood; an employee not properly washing their hands; and roach activity, with 25 live roaches written up by the inspector found crawling around the kitchen.

As a result of the bad inspection and the loss of business that followed, the restaurant cleaned house, hiring a new management team. The company also enlisted the help of an independent food safety inspection company, which will begin inspecting each Ceviche location and assigning a letter grade, which will then be posted on the front door.

Is that a tapeworm you have or are you just happy to see me; ceviche, to eat or not

Gonzalo Erdozain asks, what to do when tired of writing a research paper? Cook, and then blog about it.

The cooking in this case is a misnomer – I prepared ceviche. It has different iterations with varied ingredients, but as a food safety nerd, the one constant element of concern (which makes it ceviche) is raw fish “cooked” with lime juice. Eating this dish a few years ago would have been easy, but with three years of food safety research and two years of vet school under my belt, I just know a bit too much about the risks involved. Yet, here I am, preparing it.

Besides the well-known possibility of a bacterial contamination, like Salmonella (as in a recent sushi outbreak), Listeria (of special concern for pregnant women and immunocompromised individuals), or Vibrio, I happened to recall a parasitology lecture about Diphyllobothrium latum, a.k.a. broad tapeworm (although not a true tapeworm, we will call it that to spare you the details as to what qualifies as a true tapeworm).

D. latum is becoming more common in developed countries due to the increasing popularity of dishes based around raw fish (e.g., ceviche, sushi, sashimi). Doing some research, I found a paper where the acidity of the lime lowered the Vibrio numbers down to a safe level, while another study found lime acidity to have no effect on Salmonella. Listeria seems to be less resistant to acidic condition when kept at 7º C, and since ceviche is refrigerated for two hours while the fish “cooks,” the risk of Listeria could be reduced (I would still never feed this to a pregnant woman or immunocompromised individual).

Regarding the tapeworm, I didn’t find anything specific about lime juice, but the FDA makes the following recommendation:

“Parasites (in the larval stage) consumed in uncooked, or undercooked, unfrozen seafood can present a human health hazard. Among parasites, the nematodes or roundworms (Anisakis spp., Pseudoterranova spp., Eustrongylides spp. and Gnathostoma spp.), cestodes or tapeworms (Diphyllobothrium spp.) and trematodes or flukes (Chlonorchis sinensis, Opisthorchis spp., Heterophyes spp., Metagonimus spp., Nanophyetes salminicola and Paragonimus spp.) are of most concern in seafood. Freezing and storing at -4°F (-20°C) or below for 7 days (total time), or freezing at -31°F (-35°C) or below until solid and storing at -31°F (-35°C) or below for 15 hours, or freezing at -31°F (-35°C) or below until solid and storing at -4°F (-20°C) or below for 24 hours is sufficient to kill parasites. FDA’s Food Code recommends these freezing conditions to retailers who provide fish intended for raw consumption.”

I used cod, and found no evidence of it ever being involved in a tapeworm infection; but it could be possible. And if I end up with a tapeworm, I will let you all know. As for my kitchen clean-up, I did the same as when I deal with any raw meat: clean and disinfect all surfaces and stuck all utensils in my dishwasher.