3 dead, 3 sick in UK hospital sandwich outbreak

I’ve told these Australian hospitals to stop serving raw sprouts and cold cuts to immunocompromised people.

They just call me crazy.

Three hospital patients in the UK have died in an outbreak of listeria linked to pre-packed sandwiches.

Public Health England (PHE) said the victims were among six patients affected in England and the deaths occurred in Manchester and Liverpool.

Two of the victims were at Manchester Royal Infirmary, with the other a patient at Aintree Hospital.

Sandwiches and salads from The Good Food Chain linked to the outbreak have been withdrawn and production ceased.

PHE said the products were withdrawn from hospitals when the links to the infections were first identified.

PHE said The Good Food Chain had been supplied with meat produced by North Country Cooked Meats which subsequently produced a positive test result for the outbreak strain of listeria.

This business and North Country Quality Foods, who it distributes through, have also voluntarily ceased production.

A spokesman for The Good Food Chain Ltd said the company’s production facility in Stone, Staffordshire, was “cross contaminated by an ingredient from one of its approved meat suppliers”.

5 dead, 22 sick: Multi-country outbreak of Listeria monocytogenes clonal complex 8 infections linked to consumption of cold-smoked fish products

The European Centre For Disease Prevention and Control reports a prolonged multi-country outbreak of 22 listeriosis cases caused by Listeria monocytogenes sequence type (ST) 1247, clonal complex (CC) 8 has been identified through whole genome sequencing (WGS) in five EU countries: Denmark (9 cases), Estonia (6), Finland (2), France (1) and Sweden (4). Five patients have died due to, or with, the disease. The first case had symptom onset in July 2014 in Estonia, and the most recent case occurred in Denmark in February 2019. Eight patients, out of twelve for whom a food consumption history was available, confirmed the consumption of cold-smoked fish products.

L. monocytogenes food isolates, matching the human outbreak strain by WGS, were detected at wholesale and retail level in four countries (i.e. France, Denmark, Italy and Sweden) from 13 batches of cold smoked or gravad salmon and from six batches of cold smoked trout products. Traceability information of the contaminated batches pointed to the Estonian processing Company A as the single common manufacturer of these fish products. The raw fish was received from suppliers in Norway and Finland. Environmental investigations and food testing at the Estonian processing plant showed the presence of L. monocytogenes that matched the outbreak strain in two samples on the processing line and in four batches of the final product.

The presence of L. monocytogenes matching the outbreak strain over several years in the fish products suggests the persistence of the microorganism at the Estonian company’s premises. Further investigation is needed to identify points of cross-contamination in the food processing plant. Control measures were implemented in Estonia, Denmark, France and Italy following the RASFF (Rapid Alert System for Food and Feed) notifications, but until the source of infection has been identified and controlled, new invasive listeriosis cases associated with this event may still occur.  

In general, pregnant women, the elderly and immunocompromised individuals are at increased risk of invasive listeriosis, which is associated with severe clinical course and potentially death. 

Raw sprouts: food safety types won’t eat ‘em

A woman from a U.S. magazine interviewed me this morning about the risks of raw sprouts.

I was sorta nervous because I’ve been out of the media game for a while, but she played to my weaknesses and complimented me by saying I was imminently quotable, so I obliged, even though yesterday I couldn’t remember my phone number (writing allows one to go check things, talking, not so much).

I lost track a couple of times during the interview but she was sympathetic and I would defer by saying, it’s all on the barfblog.com, when I couldn’t remember something.

I did however note that many food service thingies have started using pea sprouts as substitutes for raw alfalfa or mung bean sprouts.

Pea sprouts are not yet widely consumed but I did note, the Canadian Food Inspection Agency launched a recall of pea sprouts because of Listeria contamination back in April, a recall that was expanded in May.

No one has been identified as sick, but I’m sure it will happen.

Here’s a table of over 75 sprout-related outbreaks going back to 1973.

‘Contamination of wheat poses a foodborne illness risk’

Following up on Chapman’s coverage of the current outbreak of E. coli O26 in flour that has sickened at least 17 people, researchers have concluded that little information is available regarding microbial pathogens in wheat and wheat flour. Information about microbial pathogens in wheat is needed to develop effective methods to prevent foodborne illnesses caused by wheat products.

From 2012 to 2014, we conducted a baseline study to determine the prevalence and levels of pathogens in wheat samples taken before milling. A total of 5,176 wheat samples were tested for enterohemorrhagic Escherichia coli (EHEC), Salmonella spp., Listeria spp., and L. monocytogenes. Positive samples were assayed for most probable numbers (MPNs), and isolates were fingerprinted by pulsed-field gel electrophoresis (PFGE). The rate of detection of each pathogen tested was as follows: Salmonella was in 1.23% of the samples (average level of 0.110 MPN/g), EHECs occurred in 0.44% of the samples (0.039 MPN/g), and Listeria spp. occurred in 0.08% of samples (0.020 MPN/g), but L. monocytogenes was not detected.

The PFGE assessment found a high diversity for all organisms. All EHEC PFGE patterns (22 of 22) were unique, and 39 of 47 Salmonella patterns (83%) were unique. These results indicate a diverse background of naturally occurring organisms. These findings suggest that the microbial contamination is coming from diverse sources and provide no evidence in support of a specific pathogen load. Altogether, our surveillance study shows that contamination of wheat with pathogens is clearly evident and poses a foodborne illness risk.

Occurrence and levels of salmonella, enterohemorrhagic Escherichia coli, and listeria in raw wheat

June 2019

Journal of Food Protection vol. 82 no. 6 pp. 1022-1027

Samuel Myoda, Stefanie Gilbreth, Deann Akins-Leventhal, Seana Davidson, and Mansour Samadpour

https://doi.org/10.4315/0362-028X.JFP-18-345

https://jfoodprotection.org/doi/full/10.4315/0362-028X.JFP-18-345

Worry about it: 1 dead, 7 sick from Listeria linked to deli-sliced products: Is steaming hot the same as piping hot?

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?

The U.S. Centers for Disease Control reports a total of 8 people infected with the outbreak strain of Listeria monocytogenes have been reported from 4 states.

All 8 people have been hospitalized, and one death has been reported from Michigan.

Epidemiologic and laboratory evidence indicates that meats and cheeses sliced at deli counters might be contaminated with Listeria monocytogenes and could make people sick.

In interviews, ill people report eating different types and brands of products, including meats and cheeses, purchased from and sliced at deli counters in many different retail locations.

The outbreak strain has been identified in samples taken from meat sliced at a deli and from deli counters in multiple stores.

A single, common supplier of deli products has not been identified.

CDC is not advising that consumers avoid eating products prepared at delis, or that retailers stop selling deli-sliced products.

Retailers should clean and sanitize deli slicers.d

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.

People who are at higher risk for Listeria infection should avoid eating lunch meats, cold cuts, or other deli meats, unless they are heated to an internal temperature of 165°F or until steaming hot just before serving.

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.

You can take steps to prevent Listeria infection:

Don’t let juice from lunch meat and hot dog packages get on other foods, utensils, and food preparation surfaces.

Wash hands after handling deli meats, lunch meats, deli cheeses, and hot dogs.

Store opened packages of meat sliced at a local deli no longer than 3 to 5 days in the refrigerator.

Smell the glove: Americans don’t understand food date labels and surveys still suck

Note to journalists (if there are any left): Don’t reprint PR fluff like it’s news and don’t bury the lede.

“A good way to test your food is also a simple way: give it a sniff,” says Roni Neff, PhD. “If the date says ‘best by’ and it looks and smells okay, it’s probably okay to eat.”

Probably is not good enough, and smell is a lousy indicator of food safety.

A new survey examining U.S. consumer attitudes and behaviors related to food date labels found widespread confusion, leading to unnecessary discards, increased waste and food safety risks. The survey analysis was led by researchers at the Johns Hopkins Center for a Livable Future (CLF), which is based at the Johns Hopkins Bloomberg School of Public Health.

This study calls attention to the issue that much food may be discarded unnecessarily based on food safety concerns, though relatively few food items are likely to become unsafe before becoming unpalatable. Clear and consistent date label information is designed to help consumers understand when they should and should not worry.

Among survey participants, the research found that 84 percent discarded food near the package date” occasionally” and 37 percent reported that they “always” or “usually” discard food near the package date. Notably, participants between the ages of 18 to 34 were particularly likely to rely on label dates to discard food. More than half of participants incorrectly thought that date labeling was federally regulated or reported being unsure. In addition, the study found that those perceiving labels as reflecting safety and those who thought labels were federally regulated were more willing to discard food.

New voluntary industry standards for date labeling were recently adopted. Under this system, “Best if used by” labels denote dates after which quality may decline but the products may still be consumed, while “Use by” labels are restricted to the relatively few foods where safety is a concern and the food should be discarded after the date. Previously, all labels reflected quality and there was no safety label.

Neff and colleagues found that among labels assessed, “Best if used by” was most frequently perceived as communicating quality, while “use by” was one of the top two perceived as communicating safety. But many had different interpretations.

Lead author, Roni Neff, PhD, who directs the Food System Sustainability Program with the CLF and is an assistant professor with the Bloomberg School’s Department of Environmental Health and Engineering said, “The voluntary standard is an important step forward. Given the diverse interpretations, our study underlines the need for a concerted effort to communicate the meanings of the new labels. We are doing further work to understand how best to message about the terms.”

How best to message about the terms? Maybe use language properly.

Using an online survey tool, Neff and colleagues from Harvard University and the National Consumers League assessed the frequency of discards based on date labels by food type, interpretation of label language and knowledge of whether date labels are regulated by the federal government. The survey was conducted with a national sample of 1,029 adults ages 18 to 65 and older in April of 2016. Recognizing that labels are perceived differently on different foods, the questions covered nine food types including bagged spinach, deli meats and canned foods.

When consumers perceived a date label as an indication of food safety, they were more likely to discard the food by the provided date. In addition, participants were more likely to discard perishable foods based on labels than nonperishables.

But dates can be a lousy indicator: I’ve got deli meat in the fridge with a use by label about 2 weeks from now, yet once that package is opened, the stuff is good for 2-4 days. Publix gets it right.

Smell, like color, is a lousy indicator of food safety.

Listeria happens in lotsa folks, and not pretty

Listeria monocytogenes is a foodborne pathogen that disproportionally affects pregnant females, older adults, and immunocompromised individuals. Using U.S. Foodborne Diseases Active Surveillance Network (FoodNet) surveillance data, we examined listeriosis incidence rates and rate ratios (RRs) by age, sex, race/ethnicity, and pregnancy status across three periods from 2008 to 2016, as recent incidence trends in U.S. subgroups had not been evaluated. The invasive listeriosis annual incidence rate per 100,000 for 2008–2016 was 0.28 cases among the general population (excluding pregnant females), and 3.73 cases among pregnant females.

For adults ≥70 years, the annual incidence rate per 100,000 was 1.33 cases. No significant change in estimated listeriosis incidence was found over the 2008–2016 period, except for a small, but significantly lower pregnancy-associated rate in 2011–2013 when compared with 2008–2010. Among the nonpregnancy-associated cases, RRs increased with age from 0.43 (95% confidence interval: 0.25–0.73) for 0- to 14-year olds to 44.9 (33.5–60.0) for ≥85-year olds, compared with 15- to 44-year olds. Males had an incidence of 1.28 (1.12–1.45) times that of females. Compared with non-Hispanic whites, the incidence was 1.57 (1.18–1.20) times higher among non-Hispanic Asians, 1.49 (1.22–1.83) among non-Hispanic blacks, and 1.73 (1.15–2.62) among Hispanics. Among females of childbearing age, non-Hispanic Asian females had 2.72 (1.51–4.89) and Hispanic females 3.13 (2.12–4.89) times higher incidence than non-Hispanic whites. We observed a higher percentage of deaths among older patient groups compared with 15- to 44-year olds.

This study is the first characterizing higher RRs for listeriosis in the United States among non-Hispanic blacks and Asians compared with non-Hispanic whites. This information for public health risk managers may spur further research to understand if differences in listeriosis rates relate to differences in consumption patterns of foods with higher contamination levels, food handling practices, comorbidities, immunodeficiencies, health care access, or other factors.

Differences among incidence rates of invasive Listeriosis in the U.S. FoodNet population by age, sex, race/ethnicity, and pregnancy status, 2008–2016

Pohl, A. M., Pouillot, R., Bazaco, M. C., Wolpert, B. J., Healy, J. M., Bruce, B. B., . . . Doren, J. M. (2019).

doi:10.1089/fpd.2018.2548

https://www.liebertpub.com/doi/full/10.1089/fpd.2018.2548

3 sick: Another outbreak of listeriosis likely associated with prepackaged caramel apples

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

25.jan.19

CDC

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 

https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a5.htm

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.

When it starts to fall apart it really falls apart: McCain Foods closes California facility responsible for 2018’s largest food safety recall

On Oct. 14, 2018, McCain Foods initiated a creeping crawling outbreak of processing vegetables from its Colton Calif. plant that lasted six weeks.

Now that plant has been closed.

Early in Jan., 2019, Sam Bloch of New Food Economy wrote that the Colton facility produced commercial ingredients—the invisible mortar of the food system.

You might not know McCain, but you’ve probably eaten its food. The multi-billion-dollar foodservice corporation, based in Toronto, Ontario (that’s in Canada), manufactures frozen foods—primarily potatoes, but also fruits and vegetables, pizzas, juices, and various oven meals—in 53 plants around the world.

(Bloch writes that McCain brags that one in every four French fries eaten globally is McCain. Bloch could have done a little digging and found that the McCain family are an on-going soap-opera of Machiavellian proportions, in Canadian terms, rivalled only by the Seagram family who made their fortune running booze to the U.S. during U.S. Prohibition. Oh, and the McCain family also killed genetically-engineered Bt potatoes which would have offered some chemical relief to the steams and environment, especially in Eastern Canada, but that’s another story. Back to the veggies).

In October a number of grocery stores, from Whole Foods to Walmart, pulled thousands of branded salads, wraps and burritos, from their shelves, out of concern over roasted corn and onion ingredients that may have been contaminated with Salmonella and Listeria monocytogenes.

Combined, the McCain recalls will affect over 99 million pounds of food.

Now Bloch writes McCain has closed its Colton, California plant, which had processed the vegetables, including chopped onions, peppers, and roasted corn, and sold them as ingredients to commercial kitchens and food manufacturers all over the country. The recalls spread to what seemed like every aisle of the supermarket, from prepackaged salads at Whole Foods and Trader Joe’s to cheese dips and frozen Kashi grain bowls. The total amount of product affected exceeds 100 million pounds, making it the largest recall of 2018, and perhaps of recent memory.  

McCain announced the plant’s closure on January 11, which, according to a statement from the company, will result in layoffs for 100 employees. In an email to The New Food Economy, Andrea Davis, a McCain spokeswoman confirmed the recall influenced the decision to close the plant,but said there were other factors involved.

“The product mix produced at the Colton facility does not support the changing needs of our portfolio,” Davis wrote. “While the recent recall was one consideration, the decision to permanently close the facility was ultimately a business decision.”

It is not clear exactly when the plant will be closed, and McCain representatives could not be reached for further comment by press time.  

The facility in question had a history of food safety violations.

Of course they did.

Harvard Biz: How Wegmans became a leader in improving food safety

Notes from a podcast by Ray Goldberg of the Harvard Business School drawn from his case study, Wegmans and Listeria: Developing a Proactive Food Safety System for Produce

The agribusiness program Goldberg developed in 1955 continues to bring business leaders and policy makers from around the world together each year. Throughout his tenure, Ray has written over 100 articles and 24 books on the business of agriculture, including his very latest, Food Citizenship: Food System Advocates in an Era of Distrust.

He was interviewed by podcast host, Brian Kenny: Did you coin the term agribusiness?

Ray Goldberg: I did, together with John Davis. He was the Assistant Secretary of Agriculture under Eisenhower, and he became the first head of the (HBS) Agribusiness Program.

Brian Kenny: The case cites examples of foodborne illness outbreaks in the US. We’re coming on the heels of the recent romaine lettuce issue in the US, which has now occurred, I think, twice in the last few months.

Ray Goldberg: I can describe the romaine lettuce [event], because I talked to the produce manager this morning, and he tells me the cost to the industry was $100 million dollars.

The problem is that romaine lettuce itself, when cold temperatures occur, begins to blister, which make it more susceptible to listeria. When they tried to find the location of that listeria, it came from a dairy herd about 2,000 feet away from where that lettuce was grown. We have a rule that 1,200 feet is far enough, but they actually found listeria a mile away from where that lettuce was concerned, so he feels very strongly that they have to change the rules.

(They seem to be confusing Listeria with E.coli O157 in Romaine, but that’s Haaaaaaaaarvard.)

Brian Kenny: Which gets to another issue that the case raises, which is has the industry done well enough trying to regulate itself? What are some of the things the industry has tried to do?

Ray Goldberg: Under Danny Wegman’s leadership—he was the person in charge of food safety of the Food Marketing Institute that really looked at the whole industry—he got several members of the industry to sit down and create new rules with the FDA, the EPA, the USDA, and CDC, all of them saying we have to have better rules. Produce, as you know in the case, is the most valuable part of a supermarket but also the most susceptible to problems.

Brian Kenny: This gets a little bit to the topic of your book, Food System Advocates in an Era of Distrust. [What[ are the big ideas coming out of your book?

Ray Goldberg: The big ideas are two-fold, that the kind of men and women in the industry have changed from commodity handlers and bargaining as to how cheap they can buy something, or how expensive they can make something, to finally realizing that they have to be trusted. And because they have to be trusted, they have to start working together to create that trust. In addition to that, they realize that the private, public and not-for-profit sectors really need to work together. That’s why I tried to write a book to give people an inkling of the kind of men and women in this industry who really are the change-makers, who are changing it to a consumer-oriented, health-oriented, environmentally-oriented, economic development-oriented industry.