Tragic Thanksgiving outbreak linked to Clostridium perfringens 

It’s deja vu all over again. In November 2015 over 40 fell ill with Clostridium perfringens in my home state of North Carolina following a Thanksgiving community meal.

The caterer failed to keep the hot foods hot according to the investigation report in MMWR:

Turkeys were cooked approximately 10 hours before lunch, placed in warming pans, and plated in individual servings. Food was then delivered by automobile, which required multiple trips. After cooking and during transport, food sat either in warming pans or at ambient temperature for up to 8 hours. No temperature monitoring was conducted after cooking.

Today, according to the LA Times, perfringens has been linked to another Thanksgiving outbreak. This one was fatal.thanksgiving-dinner-1_0

Health officials say common foodborne bacteria caused an illness that left three people dead and sickened 22 others who attended a Thanksgiving dinner at an events hall in Antioch, Calif.

Officials identified the three people who died as 43-year-old Christopher Cappetti, 59-year-old Chooi Keng Cheah, and 69-year-old Jane Evans. All were residents of assisted living facilities in Antioch.

From a Contra Costa County press release:

A laboratory at the U.S. Centers for Disease Control & Prevention (CDC) confirmed the presence of the bacteria in stool samples taken from people sickened by food served at the Nov. 24 holiday celebration, held by a community church at Antioch’s American Legion auditorium.

“Our investigation was not able to determine exactly what people ate that made them sick. But after extensive interviews we found most of the ill people ate turkey and mashed potatoes and they all ate around the same time. Some dishes served at the event, including cooked turkey, were brought to the site after they were prepared in private homes,” said Dr. Marilyn Underwood, CCHS Environmental Health director.


Blame game erupts in tragic New Brunswick outbreak

There’s lots of talk about an organization creating and fostering a positive food safety culture, with much of the of focus being internal. Food safety goes beyond what the organization controls in day-to-day activities (like internal value systems, processes, training, support, and others).

A retailer doesn’t have a good food safety culture if it only places resources on their own staff and ignores suppliers’ actions and fails to communicate risks to consumers.image

Same thing goes for a place that rents space to others. Keeping the equipment up to standard is one thing, but if you truly value food safety you also need to check out who is using the space and gauge their ability to manage risks. And that’s not easy.

The consequence of just being a place that rents space and doesn’t work with the users is that if something bad happens (like 30 illnesses and a death) you’re all in it together.

Just ask the Nackawic Lions Club.

According to CTV news, the Lions Club, which supplied space for a local church function is trying to distance themselves from the outbreak.

The Lions Club kitchen in Nackawic, N.B. The club says it is not responsible for a dinner that left one woman dead and more than 30 people ill earlier this month.

Two different illness-causing bacteria were later found in food samples collected from the dinner, the province’s acting chief medical officer of health, Dr. Jennifer Russell, said in a statement.

Now, Brian Toole, the president of the Nackawic Lions Club, is trying to mend the club’s reputation. He says the church, not the Lions Club, provided the food that night, but people have mistakenly blamed the club for the unsafe meal.

“It was an unfortunate incident,” Toole said. “But the Lions Club and their food preparation, we had nothing to do with it.”

The Lions Club kitchen is inspected on a regular basis, and members have taken government-sponsored food safety courses. Now, they are also considering requiring groups renting the space to take the same precautions (uh, yeah, that’s what the good organizations do -ben).

Here are our conclusions on creating a good food safety culture from a 2011 Food Control paper (blaming others doesn’t really fit).

Individuals focusing on food safety risks within an organization with a good food safety culture:

– know the risks associated with the foods they handle and how those should be managed;

– dedicate resources to evaluating supplier practices;

– stay up-to-date on emerging food safety issues;

– foster a value system within the organization that focuses on avoiding illnesses;

-communicate compelling and relevant messages regarding risk-reduction activities and – empower others to put them into practice;

– promote effective food safety systems before an incident occurs;

– and, do not blame customers (including commercial buyers and end consumers) when illnesses are linked to their products.

New Brunswick community dinner linked to death and over 100 illnesses

When I was a kid my parents regularly took me to church dinners. Part of my family’s social schedule was the faith-based community events where folks got together over pancakes, spaghetti, shortcake and egg salad sandwiches. It never occurred to me that the organizers and food handlers weren’t professionals; they were the parents and grandparents of my friends.

And they happened to be making meals for a couple of hundred hungry community members.Screen Shot 2014-12-12 at 10.38.22 PM

I guess they meant well, but I have no idea whether the volunteers worried about food safety or did anything to keep me and the others sick. Or that community dinners had been a traditional setting for  foodborne pathogen outbreaks. According to CBC news, over 100 members of a New Brunswick (that’s in Canada) community fell ill following a community Christmas meal, and tragically an elderly woman died. 

Roughly 100 people attended the community supper on Dec. 5, where a traditional holiday meal of turkey, vegetables, gravy and pies was served.

Within a few hours of the supper, several people became sick. One woman died and 30 other people reported signs of gastrointestinal illness, diarrhea and abdominal pain. Bessie Scott has been identified as the woman who died, and on Friday family and friends filed into a funeral home in Nackawic to say goodbye.

Alex Hoffmann and his wife were among those who fell ill after eating the tainted food.

“At two o’clock we both woke up with terrible bellyache. And then I had to go that night three times …,” he said.

Dr. Jennifer Russell, the acting chief medical officer of health, said on Friday that public health officials have taken samples of the leftover food from the Christmas supper and are trying to determine the precise cause of the infections.

“But definitely the timeline of when those symptoms occurred was within 12 hours, so that is a pretty quick onset and so that in and of itself would tell us what kind of bacteria we are looking for,” Russell said.

“The most likely one that I discussed with Dr. Yves Leger [a local public health officer] is Clostridium perfringens.”

In 2011, the provincial government considered imposing food licensing and inspection requirements on not-for-profit events, such as church suppers.

But Madeleine Dubé, the health minister at the time, said the provincial government had received public feedback that “licensing and inspection requirements are too demanding for not-for-profit events.”

Environmental health specialists/health inspectors are the good guys, ensuring that organizers and volunteers have the right equipment in place and know what to do. Making turkey for hundreds is way different from making it for a family. A list of community dinner-linked outbreaks can be found here.


Ethiopian food vendor at Santa Fe festival thought to be source of illnesses

I’m in Providence for the International Association for Food Protection’s annual meeting. It’s sort of like Comicon for the food safety nerds. I left for the conference yesterday and missed out on my neighborhood’s yearly block party. Dani told me that there was a bunch of great side dishes and a 130lb pig that was slow cooked overnight. And not a lot of temperature control.

Festivals, community dinners and temporary events have had their share of outbreaks  (Taste of Chicago in 2007, Folklorama in 2010 and numerous fundraisers and community dinners). With community dinners there usually a bunch of well-meaning folks who may not always know or follow best practices.

Often at festivals and other events there are folks at booths who are not full-time food handlers, dealing with lineups, makeshift heat sources and poor access to handwashing facilities. Sometimes folks get sick as a result.

According The New Mexican, health officials are investigating a cluster of illnesses associated with eating at the Santa Fe International Folk Art Market.

Department of Health epidemiologist Joan Baumach said Thursday that the department has received reports of stomach illness from about 11 people, all of whom said they ate at the market. Baumach said Health Department staff are trying to determine if the illness was caused by a bacteria or virus while the Environment Department is trying to pinpoint the source.

Market organizers and several of those affected have said the sickness — the symptoms of which are diarrhea, stomach cramps and fever — is thought to have come from the Almaz Ethiopian Kitchen food booth.

“This booth was inspected,” said the market’s executive director, Charlene Cerny. “And [an employee] said he ate the thing that made people sick in the morning, so we are trying to figure out what happened. It’s really, sadly enough, a labor of love for the owner [Almaz Tesffimichal]. This is the only event she does all year.”

Frank Fiore, acting chief of the Environment Department Health Bureau, said all 23 of the booths that sold food or drinks at the market were inspected Saturday morning before the market opened.

A copy of the inspection report related to the Ethiopian Kitchen shows no violations. In fact, the sheet notes that the temperatures of the food at that time were all above 160 degrees Fahrenheit, the temperature at which, Fiore said, most pathogens die. The sheet did contain the note “test strips needed.”

Baumach said her staff is analyzing stool samples and conducting laboratory tests for things such as salmonella or e.coli. The results of those tests should be ready in a day or two, she said."

Charity pig roast connected to Salmonella outbreak, possibly

In the ongoing war between food businesses/events and epidemiologists, a battle over what caused 14 cases of salmonellosis in Devon (UK) has spilled into the BBC. A cluster of 14 Salmonella illnesses popped up back in April; 12 of the 14 attended and ate pork at charity hog roast. a fundraiser for the Hope Cove Life Boat. The even was put on to support the seaside village’s emergency rescue vehicle.

Graham Phillips, chairman of the lifeboat committee, said: "We are sympathetic to people that were ill but we are confident we took every step possible to make sure the catering met health regulations.

"We would not set out to cause harm to people and we have bent over backwards to help the HPA in its investigation."

The HPA started an investigation after a number of complaints of food poisoning from people who said they had eaten from the hog roast.
But the HPA said there was no food left over from the event available for testing.
It concluded: "It is not possible to confirm the source of the outbreak although the hog roast is the main link we identified between the cases."

A spokesman for South Hams District Council said the complaints had been "fully investigated" but it had decided there was not enough evidence to link the roast with the poisoning "beyond reasonable doubt."He said: "The key element for a successful prosecution would have been to confirm the strain of salmonella from the carcass of the roast pig, and then test victims to confirm it was of the same strain.

"However this was not possible because there was nothing left of the pig."
I can’t seem to find a report online with odds ratios but there often isn’t much food left to test in an outbreak. But we still trust the epidemiologists and the data they produce. Not many outbreaks would be solved if the strain had to be found in the food.

Lots of community dinners and charity events have been the source of a foodborne illnesses (here’s an infosheet). As Rob Tauxe said in an article about new trends in foodborne pathogens, have created some of the easily traced foodborne illness outbreaks:

The traditional foodborne outbreak scenario often follows a church supper, family picnic, wedding reception, or other social event. This scenario involves an acute and highly local outbreak, with a high inoculum dose and a high attack rate. The outbreak is typically immediately apparent to those in the local group, who promptly involve medical and public health authorities. The investigation identifies a food-handling error in a small kitchen that occurs shortly before consumption. The solution is also local.

Part of the local solution is having volunteer food handlers trained to look for risks and reduce them.