Public was never told: 4 dead, 30 sickened from Listeria in pasteurized chocolate milk in Ontario, Nov. 2015—June 2016

The Public Health Agency of Canada (PHAC) really sucks at this communication thing. They sucked during the 2008 Listeria outbreak linked to Maple Leaf cold cuts that killed 24 and sickened a further 33, they have always sucked when discussing numerous outbreaks of Cyclospra, and I guess they realized they suck so bad they didn’t even try during an outbreak spanning 2015-2016 linked to Listeria in milk.

Now, over three years since residents of Ontario (that’s in Canada) began reporting illnesses from Listeria in pasteurized chocolate milk produced at a dairy in Georgetown, Ontario, investigators have gotten around to saying just how many people got sick.

According to health-types writing in Emerging Infectious Disease, 11 case-patients had an onset date during November 14, 2015–February 14, 2016. Onset dates ranged from April 11 to June 20, 2016, for 21 case-patients in the second wave; the remaining 2 case-patients were outliers. Median age was 73 years (range <1 years–90 years). More than half of the case-patients were female (20/34, 59%). Hospitalizations occurred for 32 (94%) case-patients, and 4 deaths (12%) were reported.

In Ontario, local public health professionals complete the national invasive listeriosis questionnaire and collect food samples. We conducted a case–case analysis by using Ontario case-patients listed in the national listeriosis database as controls. We used a variety of methods to support hypothesis generation, including supplemental questionnaires, centralized interviewing, and reviewing purchase records collected through shoppers’ loyalty card programs. A meeting was also held with representatives from a grocery chain that was common for case-patients (retail chain A) for insights into possible sources.

PFGE and whole-genome sequencing were performed at the Public Health Ontario Laboratory, in accordance with PulseNet Canada protocols (Table). Food safety investigations, including targeted retail sampling, were conducted by the Canadian Food Inspection Agency and Ontario Ministry of Agriculture and Food and Rural Affairs. Laboratory analyses of food samples were conducted by the Canadian Food Inspection Agency and the Public Health Ontario Laboratory.

Several hypotheses were generated during the course of this outbreak. In the first wave, a concurrent listeriosis outbreak associated with leafy greens was ongoing in the United States and Canada. However, product testing did not establish a relationship between the 2 outbreaks. Cheddar cheese was also suspected, but a food safety investigation, including sampling at the manufacturer, did not support a link to this outbreak (6,7). Although leafy greens and cheddar cheese were ruled out, 1 commonality remained; shopping at retail chain A was reported frequently by case-patients.

A second wave began in April 2016 in which 10 of 17 case-patients reported consuming coleslaw. Six case-patients ate coleslaw from the same manufacturer, which supplied retail chain A and a fast food restaurant chain. However, the food safety investigation, including sampling at the manufacturer and supplier, did not support this hypothesis.

On May 24, 2016, L. monocytogenes isolated from expired bagged chocolate milk collected from the home of 1 case-patient was confirmed to have the outbreak strain PFGE pattern. Fluid milk in Canada is often sold in plastic bags. In this instance, the outer packaging, which is the only area that contains the brand name, was discarded. Thus, the brand name was uncertain, and efforts were undertaken to confirm the source of the chocolate milk. Because the proxy of the case-patient reported purchasing brand B milk, samples of brand B chocolate and white milk were collected from retail for testing. Brand B was the main brand of chocolate milk sold by retail chain A, and it is distributed only in Ontario.

Although the hypothesis-generating questionnaire used stipulated milk, with flavored milk as a prompt, chocolate milk was not specified, and as a result this type of milk might have been underreported. Exposure to pasteurized milk was reported by 60% of case-patients in the first wave compared with 76% of controls. Thus, milk was not originally pursued as a source. However, this new positive isolate led to re-interviewing of case-patients from the second wave and resulted in 9 (75%) of 12 case-patients reporting consuming brand B when asked specifically about chocolate milk.

On June 3, a retail sample of brand B chocolate milk was confirmed positive for L. monocytogenes. This finding led to a class I recall of 1 lot of brand B chocolate milk. On June 5, the recall was expanded to all lots of brand B chocolate milk processed at that facility because of the result of extensive retail sampling. Isolates from the original sample and 3 subsequent positive samples of chocolate milk matched the outbreak strain by PFGE and whole-genome sequencing. No white milk samples were positive for L. monocytogenes.

Environmental sampling at the manufacturer confirmed the presence of the outbreak strain within a post-pasteurization pump dedicated to chocolate milk and on nonfood contact surfaces. This post-process contamination of the chocolate milk line was believed to be the root cause of the outbreak. A harborage site might have been introduced by a specific maintenance event or poor equipment design. The equipment was subsequently replaced, and corrective measures were implemented to prevent reoccurrence. Chocolate milk production was resumed after vigorous testing for L. monocytogenes under regulatory oversight.


This outbreak lasted 7 months and resulted in 34 confirmed listeriosis case-patients. Discovering the cause of this listeriosis outbreak was challenging because pasteurized chocolate milk is a commonly consumed product. Although there have been previous outbreaks outside Canada caused by chocolate milk, pasteurized milk products are generally not expected to be the source. This outbreak highlights that even pasteurized products can be contaminated by and support the proliferation of L. monocytogenes when contamination is introduced post-pasteurization. The possibility of post-processing contamination indicates an ongoing need for regulatory oversight and robust quality assurance processes, which include routine sampling of the environment and finished products.

Brand B chocolate milk is a widely distributed product in Ontario, and contamination of this product could have resulted in >34 case-patients. It is possible that a lower number of case-patients were reported because chocolate milk may primarily be consumed by younger, healthier persons, in whom invasive listeriosis is less likely to develop. Another possible explanation is that the contamination in the milk appeared to be intermittent, with some samples testing positive while others tested negative. As such, careful attention should be given to equipment design and maintenance programs, as harborage sites could result in recurring contamination that goes undetected by routine monitoring. Targeted retail and environmental sampling was instrumental in identifiying the root cause in the facility and the breadth of potentially implicated products in the marketplace. Thus, this type of sampling should be considered during outbreak investigations.

Ultimately, the implicated product was determined on the basis of testing of food items obtained from the home of 1 case-patient. This finding highlights the necessity of obtaining a thorough food history and collecting and testing available samples of food that case-patients consumed during the incubation period. In Canada, where bagged milk is common, labeling of the inner and outer bags with the brand name would facilitate product identification by consumers. This recommendation could extend to other food products in North America (e.g., frozen hamburger patties) that have multiple layers of packaging.

That is a lucid, thought provoking summary of a complex foodborne outbreak, fraught with uncertainties.

When the Canadian Food Inspection Agency announced the recall on June 4, 2016, Chapman wrote it up for the blog, reminiscing about his childhood innocence in southern Ontario, and noted, as has become the pattern, that CFIA reports recalls, but it’s up to PHAC or provincial health ministries to identify the number of sick people. As far as I can tell, no public statement about illnesses was ever made, until now.

What the fuck do these people do, especially the communication hacks? Do they have a responsibility to the public? Why didn’t epidemiology count and a public warning issued rather than waiting for a positive sample in an unopened package, which has apparently become the Canadian standard for going public?

If that’s the standard, that sucks.

Listeria monocytogenes associated with pasteurized chocolate milk, Ontario, Canada

March 2019

Emerging Infectious Diseases vol. 25 no. 3

Heather Hanson , Yvonne Whitfield, Christina Lee, Tina Badiani, Carolyn Minielly, Jillian Fenik, Tony Makrostergios, Christine Kopko, Anna Majury, Elizabeth Hillyer, Lisa Fortuna, Anne Maki, Allana Murphy, Marina Lombos, Sandra Zittermann, Yang Yu, Kristin Hill, Adrienne Kong, Davendra Sharma, and Bryna Warshawsky

In an investigation of a listeriosis outbreak in Ontario, Canada, during November 2015–June 2016, Public Health Ontario identified pasteurized chocolate milk as the source. Because listeriosis outbreaks associated with pasteurized milk are rare in North America, these findings highlight that dairy products can be contaminated after pasteurization.

Georgetown, USC, now Vermont; students are barfing everywhere; no answer from Organic To Go

Susan Schoenfeld, the Vermont Health Department’s deputy epidemiologist, said state and UVM health officials were looking into the possibility that some of the students sickened by the virus got sick shortly after eating a meal at the University Marche, a dining center inside the school’s Living & Learning Center.

“Several of the students who had just eaten a meal at the dining hall became ill,” she said. “We’ve told the university we can’t rule out the possibility that food was related to the outbreak, in addition to person-to-person transmission.”

To date, about 60 students have reported becoming sick with gastroenteritis symptoms over the past few days, but the outbreak now appears to be in decline. Only four new cases of the illness were reported Thursday, according to a UVM memo to the campus community.

The memo also discussed the possible connection of the dining hall to the outbreak and said there was no way to confirm if food in the eatery caused anyone to become sick. The memo said it was possible someone who was sick possibly contaminated otherwise high-quality food.”

High quality? OK, so I’m sure the providers of food to UVM students are concerned about the things that make people barf, and wouldn’t be taken in by some trendy, local, natural thing, at least without asking basic questions about microbial food safety such as irrigation water quality, soil amendments and employee handwashing. 

But I asked the same questions of Organic To Go and have heard nothing.

Organic To Go gone from Georgetown

The Hoya reports that Georgetown University has ended its relationship with Organic To Go as the source of a norovirus outbreak that sickened at least 212 and was linked to Leo O’Donovan Hall continues to be investigated.

University spokesperson Julie Bataille said,

“When we reopened [O’Donovan Hall], we proactively agreed with the Department of Health to do so preparing our own Grab ‘n’ Go items as there was enough reason to suspect a potential link between those items and the virus on campus.”

The Hoya says that Organic To Go was introduced as an environmentally friendly choice and as part of the larger renovations to improve food options at the dining hall this fall.

Stephanie Sampiere, vice president of corporate communications at Organic To Go, said the company is no longer serving Georgetown, but maintained that Organic To Go could not have been the cause of the norovirus outbreak.

“All Organic To Go food is prepared in a central commissary kitchen, and the company served thousands of customers’ food prepared from the commissary kitchen that day and received absolutely no concern in regards to Organic To Go’s food.”

That’s the same Stephanie Sampiere who was quick off the mark when I published an entry about a possible link between norovirus outbreaks at Georgetown and the University of Southern California earlier this month, e-mailing me to remove the blog post.

I told her to post a comment, she persisted, so I added a line about how Organic To Go had stopped serving USC in Aug. 2008.

And I sent Stephanie another message:

“I added a note. But you’ve piqued my interest and I can’t find anything on your website.

So I’d like some information on the microbial standards for all fresh fruits and vegetables used by Organic-to-Go, where grab-and-go food is prepared and the training requirements for those assembling and serving food.

Stephanie wrote that she would try and track down that information.

I’m still waiting.

Food service is under tremendous pressure to go local, organic and sustainable, whatever those words mean. But the basics are the same: any supplier needs to substantively prove they are providing microbiologically safe product.

Is there a link between norovirus at Georgetown and USC?

As the number of norovirus illnesses reached 330 at the University of Southern California and 212 at Georgetown University in Washington, D.C., the Georgetown Voice reports both schools serve meals prepared by the Organic-to-Go food distributor, although Georgetown officials do not believe there is a connection. (Note: a PR person from Organic-to-Go says USC stopped serving what she calls grab-and-go food from Organic-to-Go in Aug. 2008 — dp)

Georgetown officials were also cited as saying today that:

* Georgetown cleaning crews and temporary contract crews have been working through the weekend to keep public areas clean.  Thousands of wipes and sixty hand sanitizer stations have been placed around campus.

* DC Department of Public Health is conducting an epidemiological study to determine the cause of the outbreak.  The results of the study should be released in the next few days.  Food samples from Leo’s have been tested.  The cause of the outbreak is still unknown, but the study should provide some insight.

* The University does not know when Leo’s employees will stop serving all food to students, but there are no plans to continue this practice indefinitely.

At USC, the Los Angeles County Department of Public Health confirmed norovirus was the source of the USC outbreak. Officials said restrooms and common areas of residence halls have been thoroughly cleaned in response to the outbreak and USC officials have provided sanitation measures to university-owned housing and fraternity and sorority row.

Here’s an old infosheet on norovirus, in Spanish.

Norovirus not just for Georgetown

Norovirus continues to work its porcelain magic.

After striking  175 Georgetown students – there was vomiting in the emergency waiting rooms and residence hallways, but at least they got Powerade – something that sure sounded like norovirus sickened 75 University of Southern California students.

The campus community was alerted early Saturday with a blast of e-mail and cell phone text messages and officials stressed that ill students should not attend Saturday evening’s football game between the USC Trojans and Oregon.

Several students and staff at a private school in Tulsa, Oklahoma, got sick during lunch on Friday and the health department suspects watermelon in a fruit salad based on what the individuals ate. The health department took samples, and will test them for foodborne illnesses.

And the Washoe District Health Department in Nevada is reminding people to use "effective handwashing procedures" following a rise of gastrointestinal illnesses.

Here’s another norovirus infosheet from the past.


Don’t eat poop (like those kids at Georgetown); proper handwashing and proper tools

I used to steal toilet paper.

As an undergraduate 25 years ago, and once my girlfriend showed me how to get at the theft-proof rolls in the university centre, the supplies of toilet paper in our household became one less student expense.

My hockey bag is still filled with those little soaps and shampoos from hotel rooms around the globe.

I was the kind of student — and apparently I’m not alone — University of Guelph administrators in Canada were worried about when they said that residence students should provide their own handwashing soap.

In 2005, the university switched to sanitizers instead of soap and paper towels in the residence washrooms because soap dispensers, paper towels and garbage cans went missing.

That was before a 2006 norovirus outbreak sickened over 150 students, primarily in one university residence.

The university subsequently returned soap and paper towels to all residences to help control the outbreak.

Students at Georgetown University are now being implored to wash their hands after a norovoirus outbreak linked to the school’s dining hall caused 175 students to vomit their way to the hospital. Said one university official, “Handwashing is going to be our mantra for a very long time around here.”

That’s great. A little late, but better than before. The U.S. Centers for Disease Control and Prevention estimates that up to 25 per cent of the 76 million annual cases of foodborne illness in the U.S. could be eliminated with proper handwashing.

That’s a lot fewer sick people.

But, as Jon Stewart quipped in 2002, “If you think the 10 commandments being posted in a school is going to change behavior of children, then you think ‘Employees Must Wash Hands’ is keeping the piss out of your happy meals. It’s not.”

So why don’t more people wash their hands?

While some practice a Howard Hughes-like paranoia, study after study shows that many are lazy when it comes to handwashing. The proclamations to practice proper handwashing, on restroom posters, in daycare facilities, in media scare stories, will always fail to register with those who are impervious to risk — that bad things happen to someone else, not me.

But as the Guelph example demonstrates, anything that can even slightly encourage proper handwashing and hygiene in general needs to be encouraged — and that means ready availability of soap, water and paper towels.

Once available, the facilities have to actually be used, whether in the workplace, the home, the university residence, or, the farm.

The steps in proper handwashing, as concluded from the preponderance of available evidence, are:

• wet hands with water;
• use enough soap to build a good lather;
• scrub hands vigorously, creating friction and reaching all areas of the fingers and hands for at least 10 seconds to loosen pathogens on the fingers and hands;
• rinse hands with thorough amounts of water while continuing to rub hands; and,
• dry hands with paper towel.

Water temperature is not a critical factor — water hot enough to kill dangerous bacteria and viruses would scald hands — so use whatever is comfortable.

The friction from rubbing hands with paper towels helps remove additional bacteria and viruses.
The next time you visit a bathroom that is missing soap, water or paper towels, let someone in charge know. And next time you see someone skip out on the suds in the bathroom, look at them and say, “Dude, wash your hands!”

Don’t eat poop.

175 sick with norovirus at Georgetown – but they’re getting Powerade

Todd A. Olson??????, vice president for student affairs at Georgetown University issued a statement this afternoon identifying norovirus as the cause of the recent gastrointestinal illnesses affecting Georgetown students and outlining a bunch of preventative measures. It was boring, and of course, didn’t say sorry for all the barfing.

However, the reporters at the Georgetown Voice offered a more entertaining presentation of the same information:

“Georgetown just sent out a message saying that the food poisoning is caused by the Norovirus, a contagious virus spread through oral and fecal contact. Georgetown is going to start a big cleaning regimen:

“Immediately, student residence halls are being cleaned with a specific focus on common areas and high contact surfaces such as bathrooms, doorknobs, and handrails. Common gathering areas including Yates Field House, McDonough Arena, the Leavey Center will also be cleaned, as well as bathrooms and high contact surfaces in academic and administrative buildings.

“It’s also spread by hand-to-hand contact. In June, a health inspection found that Leo’s had inadequate handwashing facilities for employees. According to the report, that problem was resolved. Georgetown says it’s going to continue normal operation, with a focus on cleaning. The message also encourages everyone to frequently wash their hands.

UPDATES: Todd Olson says the new number is 175 students. Only 3 in emergency room, 2 in student health center.
    Leo’s is open tonight.
    Any student who has missed class or assignment from being sick will be excused. Get in touch with your dean.
    Georgetown’s setting up a call center for parents. 1-800-208-5167. I guess it’s for calling to complain that your student is sick or could’ve been. For families with sick students: 202-444-3895
    Dr. Timpone is up saying everyone should wash their hands. Norovirus causes all kinds of miserable nausea, abdominal pain, diarrhea.
    People whose roommates have the virus and got splashed with vomit can easily get sick. Clean up! Use bleach.
    Degioia’s here! Timpone says don’t be upset if you get sick, the disease will pass in a few days. Just stay hydrated.
    I’m kind of surprised DeGioia’s here, considering how awful students were treated last night at that Grill.
    Question and answer time! Olson says he’s not familiar with the possible Leo’s handwashing connection. No word on whether you get to skip midterms, talk to your dean.
    Someone from Solidarity is asking about employees getting sick, good point. Todd says he doesn’t think any workers got sick.
    Todd says we’re getting lot of Powerade and hand sanitizers!
    Students who have vomit damage in their room  should call work management at 202-687-3432. I guess they’ll help now, unlike yesterday.
    People who have already been infected won’t catch it again.

Telling people to wash their hands is standard. Georgetown students, are there adequate supplies in the bathrooms – soap, water and paper towels – and were there adequate supplies before the outbreak?

Ever notice someone sick and working at Leo’s? That’s how norovirus often spreads, especially through a bunch of foods from one spot.

There are some tips on the infosheet below. Norovirus outbreaks like this are far too common.

Georgetown outbreak: Emergency so backed up there was ‘vomiting in the waiting room’

Molly Redden of the Georgetown Voice in Washington, D.C. does an excellent job going beyond the soundbites of talking health-heads to capture the impact of foodborne illness, in the case on a bunch of university students who dined at Leo O’Donovan Cafeteria or Leo’s.

At least 96 students were treated by the Georgetown University Hospital or the Student Health Center for gastroenteritis from Tuesday night and Wednesday. …

Neil McGroarty (NHS `12), arrived at the emergency room at around 10:30 p.m., only hours after eating a roast beef sandwich from Grab N’ Go. He said within hours of arriving at the Hospital, the emergency room was backed up to the point that students who weren’t receiving medical attention began vomiting in the waiting room.

“I know that some people in the waiting room had been there for three hours. There was a boy yelling ‘help me, help me!’ but there were no doctors,” Kathrin Verestoun (SFS `11), who accompanied her roommate to the emergency room, said. “They ran out of rooms and set up stretchers in the hall. Some people were so dehydrated that they couldn’t find their veins for IVs. They were just bleeding. [My roommate] bled all over her stretcher.” …

A Food Establishment Inspection Report obtained by the Voice through a Freedom of Information Act request reveals that in June, the D.C. Bureau of Community Hygiene determined that Leo’s’ handwashing facilities were not up to code, although this was “corrected on-site.” According to the report, sinks used for handwashing in the service area lacked handsoap. …

The actual number of students who have fallen ill may be far higher than reported. Interviews have revealed that many students who fell ill did not get medical help, like Katie O’Niell (COL `11), who began to vomit about three hours after eating a burrito at Leo’s.

“I didn’t feel like I could make it any further than from my bed to the bathroom,” she said.

Georgetown University dining hall closed; dozens of students barfing and crapping show up at Emergency last night

Amy and I went for lunch today in the student union. Nothing fancy, the salad fixin’s were reasonably priced, and the food selection was a lot better than when I was a student – way back in the old days, like on the Flintstones, with humans and dinosaurs playing together.

Any food service operation is vulnerable to foodborne illness, but the university ones have been popping up regularly of late – Guelph, Michigan State, and now, Georgetown in Washington, D.C.

Georgetown University closed its dining hall today after dozens of students went to the emergency room last night with symptoms of severe vomiting and diarrhea.

A call from an emergency room doctor at Georgetown University Hospital at about 12:30 a.m. today alerted campus officials that many students were being treated for symptoms that could indicate a foodborne illness, said university spokeswoman Julie Bataille.

She said officials are not sure yet of the number of students, but it could be dozens. About 5,000 students participate in the campus meal plan and eat at the Leo J. O’Donovan Dining Hall, which most students call Leo’s. The dining hall serves about 3,000 meals daily.

In an e-mail to the campus community today, Todd A. Olson, vice president for student affairs, announced that as a precaution the university had decided to close the dining hall and that breakfast would be served in a lounge on campus and that lunch and dinner would be served at the student center.

New food was delivered this morning, Bataille said, and health officials are now on campus taking samples and investigating the situation.