Listeria kills three in two years, source traced to Dutch cold meat factory

Three people have died and one woman has had a miscarriage after eating cold meat contaminated with listeria, the public health institute RIVM said last Friday.

top view of round slices of smoked pork loin ham in transparent plastic tray packaging isolated on white background

Dutch News reports all are thought to have become ill after eating meat products from the Offerman company over the past two years, the agency said. In total, at least 20 people have become ill after eating Offerman cold cuts. The company issued a health warning last Friday and Jumbo, which stocks 135 different products from Offerman, ordered an immediate recall. Aldi too has recalled its Offerman products, which were also widely sold to company canteens.

The source of the infection was traced by the RIVM and product safety board NVWA after an analysis of the different types of listeria infection this week. ‘It has only been recently possible to use this technique and without it, we would not have been able to identify the source,’ the RIVM said.

The factory where the bacteria originates is located in Aalsmeer and has been closed pending a thorough clean-up, the AD reported last Friday afternoon. According to broadcaster NOS the NVWA had ordered Offerman to take extra hygiene measures because there were suspicions that something was going wrong. ‘But this would appear not to have done the job,’ a NVWA spokesman told the broadcaster.

Listeria is particularly dangerous to the elderly and pregnant women and can cause miscarriages. Every year about 80 cases of listeria are reported to the RIVM.

‘Something is going on’ Salmonella Typhimurium infections in France jump from 50 to 2500 per year in a decade

(As usual, something may be lost in translation)

Salmonella contamination, found in cold cuts, mainly pork, exploded in 10 years in France, because of the progression of a new strain, called “monophasic typhimurium variant”.

(I particularly like the graphic, right, of the pregnant woman, with five bottles of wine in the fridge and a couple of beers).

On October 30th, lots of dry sausages contaminated with this salmonella were removed from supermarket shelves. Withdrawals and recalls have already taken place in the spring, on sausages that had sickened a dozen young children in the south of France. Dry sausages were also concerned.

Dr. François-Xavier Weill, director of the national center of reference for Salmonella, at the Institut Pasteur, at the origin of this discovery with his teams . It is here, in Paris, that the bacteria are identified, after analysis of the samples sent by the analysis laboratories. This is how the rise in food infections has been spotted.

“While it was detected that about 50 in 2007, we are at 2500 per year now,” says François-Xavier Weill. As a result, this bacterium, which causes gastroenteritis and fever, which can reach sepsis in the most fragile, has risen to the third position of salmonella, which gives the most poisoning. “We sounded the alarm, we said we’re paying attention, something is happening”. 

“Manufacturers must continue their work to limit the risks of the farm to the fork, explains Nathalie Jourdan-da Silva, doctor epidemiologist at Public Health France, agency that gave the alert in 2012 in one of its publications. But there is no risk zero, especially since this salmonella, identified in the swine industry, has since expanded to the beef sector. 

And the father of Amy’s French family was in Paris the other day, and he looked up and saw Charlie Watts, the drummer for the Rolling Stones, so this song is in honor of the time the Stones moved to southern France as tax exiles from the UK and recorded Exile on Main Street.

Listeria cases climb in Sweden, outbreak declared

Sweden’s Public Health Agency has declared a specific outbreak of Listeria during the final three months of 2013, with 41 sickened compared to 25 for the same period the year before.

“There was a clear increase, which led us to suspect that this was an outbreak and therefore we decided to investigate the matter immediately, says Viktor Dahl with the listeriaPublic Health Agency.

While previous Listeria outbreaks have largely been linked to smoked or pickled salmon, investigators suspect cold cuts in the latest increase.

Listeria brochures are never enough: frail wife ‘let down’ by NZ hospital

So much like Canada in 2008, and the U.S. in 1998. Listeria kills.

After two cold-cut deaths last year in New Zealand, a health spokesthingy says they “routinely hands out the brochures” and it no longer provides chilled pre- cooked meats to patients.

Do people really have to die before changes are implemented? Isn’t that why dieticians are in hospitals? Does anyone with a medical background know Patricia Hutchinson died of listeria poisoninganything about listeria?

It’s not like it’s something new.

Pay attention.

Marty Sharpe of the Dominion Post writes Patricia Hutchinson died in her husband’s arms after three weeks on life support while her frail body battled an aggressive foodborne infection.

She was one of two women who died from a listeria outbreak in Hawke’s Bay that was linked to contaminated cold meat.

Mrs Hutchinson’s death has resulted in an apology from Hawke’s Bay District Health Board, and a national review of how risks of the disease are explained to patients.

The 68-year-old great-grandmother was admitted to hospital on May 5 last year suffering symptoms similar to a stroke. It was later discovered she had contracted listeria. She died on June 5.

A year on, her husband, Robin Hutchinson, is ready to talk about events leading up to the death of his wife of 46 years, and how he believes she was let down by the DHB.

Mrs Hutchinson had type 2 diabetes, which she controlled through diet, and in 2011 was diagnosed with Crohn’s disease.

In February, a locum gastroenterologist at the hospital prescribed azathioprine – an immuno- suppressant, used to treat autoimmune diseases like Crohn’s, where someone’s immune system reacts against their own body.

After listeria was diagnosed, a Ministry of Health investigator spoke to Mr Hutchinson and gave him a brochure called “Avoiding Listeria.”

“Can you imagine how that made me feel?” he said. “In it, very clearly, it lists the people at serious risk of listeriosis and what they should avoid eating.

“Among those at risk are people with damaged immune systems. Had my wife or I been aware of this she would most certainly not have eaten those foods, listeriaincluding the ham at the hospital. She was extremely particular about her diet,” he said.

He wrote to the DHB a fortnight after Mrs Hutchinson’s death and asked for three things; an apology; an assurance that patients with a low immune system would be provided the listeria brochure; and a claim for payment towards funeral costs.

He met with DHB staff on July 20. In August, DHB chief executive Kevin Snee wrote to Mr Hutchinson: “We sincerely apologise that your wife was not informed of the increased risk of developing listeria when she saw Dr Mark Dell’Aglio, locum gastroenterologist, who prescribed azathioprine.”

She saw Dr Dell’Aglio in February. He returned to the US in March and had not been involved in the investigation, Dr Snee said.

The DHB declined to contribute toward funeral costs. ACC also refused to approve a claim as it “does not meet the criteria for a treatment injury”. That decision is to be reviewed in August.

Listeria and moms-to-be

Giving food safety – or any – advice to pregnant women is fraught with angst. And probably a lot of hypocrisy if you’re a dude.

I don’t want to freak anyone out, especially expectant mothers, but also have a responsibility to share accurate, evidence-based information if I know something about, say, food safety.

The certainties of youth left me long ago.

But certainties were on full display in an article distributed by the Australian Associated Press on April19, 2011, entitled, Pregnancy diet overkill.

Among the nosestretchers offered up by dietician and author Tara Diversi, quoted in the AAP story (I’ll put quotes from Tara or the story in italics, with a bullet, and my responses in something other than italics; and the comments at the bottom from NSW Food Authority will be in italics):

• "It’s not that you’re at higher risk (of food poisoning) being pregnant."

No. A Dec. 2007 review of listeria in pregnancy states,??“One of the most important changes during pregnancy is the down-regulation of the cellular immune system. Because the fetus is genetically different from the mother, the body treats it as a graft. To prevent the maternal immune system from rejecting the fetus, cell-mediated immunity must therefore be suppressed during pregnancy. This is favored by high levels of progesterone. However, reduced cell-mediated immune function leads to increased susceptibility of the woman and her fetus to infections by intracellular pathogens such as Listeria monocytogenes. That is why pregnant women are 20 times more at risk of contracting listeriosis than are other healthy adults. Pregnant women account for 30% of all cases of listeriosis and 60% of cases among persons 10 to 40 years of age.??“Typically, systemic infection occurs most frequently after ingestion of food contaminated with L monocytogenes. The bacteria cross the mucosal barrier of the intestine, probably aided by active endocytosis of organisms by epithelial cells. Once in the bloodstream, bacteria spread to different sites, but they have a particular affinity for the central nervous system or placenta. While circulating, the bacteria are internalized by macrophages and other plasma cells and are thereafter spread cell-to-cell through phagocytosis. As a result, antibodies, complement, and neutrophils become unable to protect the host.”

Pregnant women are about 20 times more likely than other healthy adults to get listeriosis. About a third of all reported cases in Illinois happen during pregnancy. Infection during pregnancy may result in spontaneous abortion during the second and third trimesters, or stillbirth.

The advice from the U.S. Centers for Disease Control is clear: Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated.

It has been documented that many pregnant women are not aware of the risks associated with consuming refrigerated, ready-to-eat foods like cold cuts.

Researchers reported in the Australian and New Zealand Journal of Health that in a survey of 586 women attending antenatal clinics in one private and two major public hospitals in New South Wales between April and November 2006, more than half received no information on preventing Listeria.

• But who would have thought the humble alfalfa sprout could be a cold-blooded killer in disguise?

Outbreaks of foodborne illness related to raw sprouts happen frequently. A table of North American raw sprout-related outbreaks is available at
http://bites.ksu.edu/sprout-associated-outbreaks-north-america

• Diversi says there hasn’t been a reported incident of poisoning from undercooked eggs since 1970s. "(Some of the advice) is weird. It’s not like we’re a Third World country," she says.

No. Hundreds of people have been sickened in Australia in the past five years from consuming undercooked eggs or dishes containing raw eggs, including 111 sick with salmonella from home-made aioli — a garlic mayonnaise that includes raw egg – at the Burger Barn in Albury, Australia last year. Other Australian outbreaks are available at these links.

http://barfblog.foodsafety.ksu.edu/blog/137965/07/12/25/raw-eggs-sicken-50-aussies

http://barfblog.foodsafety.ksu.edu/blog/139946/08/12/29/136-hospitalized-australian-bakery-fined-40000

http://barfblog.foodsafety.ksu.edu/blog/139553/08/02/17/tasmania-rest-australia-wake-raw-egg-risks

 http://barfblog.foodsafety.ksu.edu/blog/140014/09/02/08/raw-egg-hollandaise-sickens-20-upscale-retirement-home

• "It’s hard, because as a dietitian you don’t want to give blanket advice. But if I were pregnant myself I would eat poached eggs and I would eat from salad bars and I would eat lean meats because I know that they’re going to give me energy and the likelihood of getting food poisoning from it is relatively low. The trick is to limit the risks by buying your lunch from a reputable place with a high turnover.”

No. This sounds suspiciously like the terrible and libelous advice issued by the Motherisk team last year at Toronto’s Hospital for Sick Children, in which they stated,

“pregnant women need not avoid soft-ripened cheeses or deli meats, so long as they are consumed in moderation and obtained from reputable stores.”

I have no idea what a reputable source is. Certainly doesn’t have anything to do with microbiology.

Fortunately, the folks in Sydney at the New South Wales Food Authority comprehend some risk communication basics and fired out their response within a day. Excerpts below:

In its role as Australia’s first and only through-chain food regulatory agency the NSW Food Authority is responsible for providing consumers with safer food and clearer choices.

The Authority maintains a segment on its website dedicated to pregnancy and food safety.

It clearly states the best way to meet you and your baby’s nutritional needs is to eat a wide variety of nutritious foods.

These should include:
• bread, cereals, rice, pasta & noodles preferably wholegrain or wholemeal
• vegetables & legumes
• fruit
• milk, yoghurt, hard cheese preferably low fat
• meat, fish, poultry, cooked eggs & nuts.

The Authority provides information about how best to enjoy those foods safely, what foods to avoid during pregnancy and provides alternatives to foods identified as having a higher risk of containing certain bacteria that could be harmful to pregnant women and their unborn babies.

The Authority provides information on Listeria to pregnant women to allow them to make an informed food choice regarding the risk and how to minimise it. It is not to say that every piece of deli meat has Listeria on it, but some foods have a higher potential rate of contamination than others, and it is better to avoid them.

The risk of acquiring listeriosis is low. However the consequences for a pregnant woman contracting listeriosis are dire.

While the Authority may be accused of ‘being over the top’, we may also be accused of neglecting pregnant women if we did not provide this information so pregnant women could make informed choices in what they eat.

Over the last 5 years in Australia there have been between 4 and 14 cases of listeriosis diagnosed in pregnant women or their babies each year. These infections have resulted in the deaths of 8 foetuses or newborn babies.

Rates of listeriosis are increasing in Europe including France where they have increased over the last five years.

Listeriosis rates in France are twice that of Australia.

Listeria can target heart

This is sorta cool – unless you contract a subset of listeria and have heart problems.

Listeria is everywhere, as Michael McCain of Maple Leaf Foods likes to remind everyone, but Nancy Freitag, from the University of Illinois, Chicago, reports in the Journal of Medical Microbiology that some listeria strains had modified surface proteins that helped target the heart.

"A significant number – about 10% – of L. monocytogenes infections involve the heart. In these cases, death rate from cardiac illness is estimated to be up to 35%, yet very little is known about how these bacteria infect heart tissues."

Scientists in the United States discovered that mice infected with the strains had up to 15 times more bacteria in their hearts than those exposed to other forms of listeria.

The bug has an unusual ability to grow in low temperatures and can be found in a wide range of foods including soft cheeses, cold meat products, raw vegetables, fish, salads and unpasteurized milk.

Pregnant women are especially susceptible to listeria, which can cause them to miscarry.

Salmonella in headcheese leads to plant closure – 3 weeks later

Have Canadian officials resolved their federal-provincial-local turf issues involving food safety outbreaks with clear guidelines on when to issue public warnings and a clear commitment to place public health above corporate interests?

Doubtful.

The latest rolling recall involves products made by Toronto-based G. Brandt Meat Packers Ltd.

The British Columbia Centre for Disease Control got things rolling on July 14, 2010, when it confirmed 10 cases of Salmonella Chester in residents who consumed headcheese which had been purchased from various stores throughout the province from mid- to late June.

Headcheese is a deli product made from meat from the head of a pig, combined with gelatin and spices.

All anyone would say at the time was that B.C.’s Freybe Gourmet Foods Ltd. was voluntarily recalling the product, which was produced by a third-party manufacturer.

On July 22, 2010, the mystery manufacturer was indentified as the feds and Brandt announced there were now 18 people sick and people shouldn’t eat headcheese from Brandt.

On July 28, 2010, the Canadian Food Inspection Agency issued an alert advising Canadians not to eat Freybe brand Ham Suelze – Frebe being the same distributor of the salmonella headcheese – but no mention was made of who produced the mystery ham, and CFIA added there were no reported illnesses associated with the consumption of this product.

I’m guessing the Toronto Star made some phone calls, and on Saturday published a story reporting that G. Brandt Meat Packers Ltd. was closed for cleaning and that, “all Brandt cooked meat products bearing Establishment number 164 produced from May 30 up to and including July 30 are affected” and were potentially contaminated with either salmonella or listeria or both.

Later on July 31, CFIA published a huge list of recalled products all from the Brandt plant, and said the products may be contaminated with “foodborne pathogens” and insisted again that no one had gotten sick.

So later on July 31, 2010, the Public Health Agency of Canada issued its own release, stating,

“The Public Health Agency of Canada and the Canadian Food Inspection Agency (CFIA) is advising Canadians to avoid eating the cooked ready-to-eat meat products manufactured by G. Brandt Meat Products Ltd. listed in the CFIA recall notice.

The only illnesses associated to date with Brandt products have been caused by Salmonella Chester in Freybe brand headcheese.

Avoiding eating these products is especially important for Canadians at high risk of getting seriously ill from food-borne (sic, other agencies spell it foodborne) illness:
People 60 years and older.
Very young children.
People with weakened immune systems, such as those undergoing cancer treatment or who have HIV/AIDS or other chronic medical conditions.
Pregnant women, due to risk of harm to the fetus.

Besides terrible grammar, why hasn’t PHAC, or Health Canada, or CFIA said anything about the morons at Toronto’s Sick Kids’ Hospital who said that pregnant women could eat all the cold-cuts and ready-to-eat foods they want. This is wrong and dangerous.

A cluster of Samonella Chester was made publicly known by B.C. health types on July 14. It took until on or about July 30, 2010, for the feds to shut down the Toronto-based manufacturer. My guess is the plant had serious food safety issues. But that’s just a guess. The bureaucrats will never tell Canadians. And if they do, they’ll obfuscate, delay, patronize and pander.

Or just get it wrong.

Canadians can go back to sleep; Maple Leaf Foods is profitable again

Some American colleagues have said killing 22 customers with deli-meat would have led to a non-existent company. Not so in Canada, where $5.5 billion companies like Maple Leaf Foods can say with a straight face that listeria presented new challenges in the ready-to-eat food category.

Maple Leaf has been praised for its communication activities in the aftermath of the listeria outbreak last fall, but instead of taking a real leadership role they have fallen back on the tired and true – their stock went up, so everyone is happy.

Specifically, Maple Leaf has failed to provide point-of-sale warnings to at-risk populations like pregnant women and old folks, failed to publicly release listeria test data and failed to promote their food safety efforts at retail, to enhance the food safety culture back at the producer and processor level, and to build consumer confidence. A completely blown opportunity.

Well done: be aggressively mediocre. That’s how to get brownie points in Canada.

 

Marketing food safety: Maple Lodge Farms deli-meat edition

Maple Lodge Farms is often confused with Maple Leaf Foods, the latter of the listeria mess in Canada a year ago that killed 22 people.

In an effort to protect their brand, Maple Lodge has taken to marketing food safety. And I’m all for it.

These full-page advertisements are from a couple of Canadian magazines, the Sept. 2009 issue of Today’s Parent (right), and the Oct. 2009 issue of Canadian Living (below, left).

There’s far too many sick people, and far too much bureau-dancing around foodborne illness: The best food producers, processors, retailers and restaurants should go above and beyond minimal government and auditor standards and sell food safety solutions directly to the public. The best organizations will use their own people to demand ingredients from the best suppliers; use a mixture of encouragement and enforcement to foster a food safety culture; and use technology to be transparent — whether it’s live webcams in the facility or real-time test results on the website — to help restore the shattered trust with the buying public.

Those companies that promote food safety culture can market their activities, and then consumers have a way to choose at the check-out aisle, providing feedback to those companies that make food safety a public priority.

Maple Lodge isn’t so much promoting a food safety culture as a technological fix. But at least they’re out there. A case could be made that the tomatoes, lettuce and sprouts pictured in these sandwiches also pose a significant food safety risk. That’s why buyers have to source food from safe sources.
 

Maple Leaf says listeria happens; Carl says, stop whining

Michael McCain, president of Maple Leaf Foods, told a press conference yesterday that continuing to find listeria in the plant responsible for producing luncheon meats that have killed 26 and sickened 63 in Canada was no biggie.

“To suggest a shock at a positive environmental test is at best misguided and at worst fear mongering.”

As Toronto’s Globe and Mail reported this morning,

When the company’s deli meats were first linked to an outbreak of the food-borne disease known as listeriosis last August, it was a humble Mr. McCain who stood before television cameras and reporters and apologized.

Yesterday, by contrast, he defiantly reproached those who have criticized Canada’s food-safety watchdog, including the media, accusing them of undermining the public’s confidence in the system and of potentially jeopardizing thousands of jobs.

“There’s been a lot of criticism of the [Canadian Food Inspection Agency] in recent weeks,” he said. “While there’s likely lots of blame to go around, I personally see no balance in the reporting.” …

He said it is unrealistic for the public to have zero tolerance for the bacteria because it is everywhere in the environment.

“Frankly, if that was the tolerance level of Canadians, then Canadians would starve. They wouldn’t eat.”

Mr. McCain, this isn’t gotcha journalism and you’re not Sarah Palin. Yes, you have finally released some test results — four out of 3,850 product samples and one environmental sample out of 671 tested positive for listeria in product that was never released to the public – but you refuse to release results prior to public notification of the outbreak.

Yes, this is the most scrutinized plant in North America. Apparently more inspectors, even with listeria goggles, won’t make the listeria go away. The political opportunism being practiced by the inspector’s union and various parties falling over themselves to promise the hiring of more inspectors in the lead-up to Canada’s federal election on Tuesday is breathtakingly offensive to the sick and dead – I think I just threw up a bit in my mouth.

And yes, the risk is small — Mansel Griffiths, an adviser to Maple Leaf, said the tiny fraction of products that tested positive, 0.1 per cent, was in the range that would be found in deli meats for sale in Canada, ranging from 0.1 to .03 per cent – but I’m sure glad you’re not advising pregnant women, like my wife, who are 20 times more susceptible to infection with listeria – a bug that has a 20-30 per cent kill rate.

Now that Mr. McCain is a listeria expert, telling Canadians to get over it, listeria happens, I wonder why he never issued such a warning about the risk of listeria in his products before 26 were killed. Would he serve cold cuts to the elderly in nursing homes where many of the 20 confirmed deaths occurred? What would he recommend to one of his pregnant family members? That listeria happens?

In response to the initial coverage of Mr. McCain’s statements yesterday, Carl, a former USDA guru e-mailed me, stating,

“Ummm, maybe someone ought to point McCain to Nebraska’s series of webinars. It’ll take more than the webinars but it could be a start. Eliminating listeriae in plants has been done but it takes effort and diligence not just whining.”

Here’s the info for the latest listeria webinar from Nebraska.

Free Web Seminars on Controlling Listeria monocytogenes on Ready-to-Eat Meat and Poultry Products and in the RTE Processing Environment

The Listeria monocytogenes is a foodborne pathogen and is most often transmitted through ready-to-eat (RTE) foods products contaminated with this pathogen. People at most risk for illness and infection due to this pathogen are young, elderly and those will weakened immune systems such as the immuno-compromised.

The USDA-FSIS requires the Ready-to-Eat (RTE) meat and poultry processors to control Listeria monocytogenes in the environment and on their products. The web-seminar is designed to help small and very small RTE meat and poultry businesses to address Listeria in their RTE environment and ways to reduce the Listeria risk in their products. The web-seminar is designed to update you and provide you an opportunity to ask questions and get answers from the experts.

The University of Nebraska along with its collaborating partners, Colorado State University, Cornell University, Kansas State University and The Ohio State University is conducting a series of free web seminars to inform and educate the RTE meat and poultry processors on various aspects of controlling the organism in the RTE processing environment and on the product. This web seminar series is funded through a grant from the National Integrated Food Safety Initiative (Special Emphasis Grant No. 2005-511110-03278) of the CSREES, U.S. Department of Agriculture.
The next session is scheduled for Oct 15, 2008 from 11:00 AM to 12:00 PM (CST). Those interested can participate in these free web seminars by logging in at the following website:

http://connect.extension.iastate.edu/nebraska/ ??????

To receive notifications and presentation materials ahead of the web seminar, please register by sending an e-mail to Nina Murray at nmurray2@unl.edu with your name and e-mail. ??????

Topic:         L. monocytogenes Control Strategies: Quality Effects on RTE Meat Products ???Speaker:         Dr. Dennis Burson, University of Nebraska ??????

Dr. Dennis Burson is a Professor of meat science in the Department of Animal Science at the University of Nebraska, Lincoln. He also serves as the Extension meat specialist for the state of Nebraska and assists the meat, poultry and egg industry with outreach activities. He received his B.S. degree from University of Nebraska and his M.S. and Ph.D. degrees from Kansas State University.  His outreach focus is on improving quality, consistency and value of market animals, value addition and processing of meat products and food safety for meat and poultry processors. Dr. Burson has conducted numerous meat processing, harvesting and quality workshops in addition to food safety workshops including HACCP for the meat and poultry industry over the years and still is very active in the food safety outreach programs. He coordinates the four state consortium of Universities (UNL, KSU, SDSU, and Missouri) and holds several HACCP workshops within each of the states every year. He has taught several courses, including animal and carcass evaluation, principles of meat evaluation, grading and judging and advanced meat grading and evaluation. Dr. Burson is active in several professional organizations, including American Meat Science Association, Institute of Food Technologists and International Association for Food Protection among others. ??????

Topic:         Tracking Listeria in the RTE Meat and Poultry Processing Environment: DNA Based Methods ???Speaker:         Dr. Kendra Nightingale, Colorado State University ??????

Kendra Nightingale is originally from a small farming community in western Kansas.  Kendra received a B.S. degree in Agriculture from Kansas State University, where she participated in the undergraduate honors program.  Kendra also holds a M.S. degree from Kansas State University in Food Science, where her research evaluated the use of lactoferrin, a milk-derived protein, to decontaminate and extend the shelf-life of beef products.  Kendra Nightingale completed her Ph.D. at Cornell University in Food Science with a concentration in Food Microbiology and minors in Epidemiology and Microbiology.  Her Ph.D. work probed the molecular epidemiology, ecology, and evolution of the human foodborne and animal pathogen Listeria monocytogenes.  Kendra also completed her postdoctoral training in the Department of Food Science at Cornell University. Kendra joined the Department of Animal Sciences at Colorado State University as an Assistant Professor in 2006.