500 sick, 2 dead since 2011: FDA focusing on the papaya industry

Norman Sharpless and Frank Yiannas of the U.S. Food and Drug Administration write that fresh papayas are most often eaten raw, without cooking or processing to eliminate microbial hazards; and therefore, the way they are grown, harvested, packed, held, processed and distributed is crucial to minimizing the risk of contamination with human pathogens.

Since 2011, American consumers have been exposed to eight outbreaks caused by Salmonella serotypes linked to imported, fresh papaya. And, just this June we started an investigation into an outbreak of Salmonella Uganda illnesses tied to the consumption of whole, fresh papaya imported from Mexico. While the 2019 outbreak is ongoing, the first seven outbreaks accounted for almost 500 reported cases of illness, more than 100 hospitalizations, and two deaths.

This trend has to stop. The pattern of recurrent outbreaks we have observed since 2011, including the 2019 illnesses, have involved Salmonella infections traced back to, or are suspected of being associated with, papaya grown in Mexico. The recurring nature of these outbreaks is a clear indication that more must be done within all sectors of the papaya industry to protect its customers and to meet its legal obligations. This includes growers, importers and even retailers that can and must do more.

This is why today we have issued a letter calling on all sectors of the papaya industry to take actions to prevent these outbreaks in the future. We are urging growers, packers, shippers and retailers in the papaya industry to review their operations and make all necessary changes to strengthen public health safeguards.

Our letter calls on the papaya industry to assess the factors that make their crops vulnerable to contamination. If a foodborne pathogen is identified in the crop or growing environment, a root cause analysis should be performed to determine the likely source of contamination. Procedures and practices that minimize that contamination must be implemented.

We are strongly encouraging the papaya industry to examine the use and monitoring of water used to grow, spray (pesticides, fungicides), move, rinse or wax crops to identify and minimize risks from potential hazards. All sectors of the industry should adopt tools and practices needed to enhance traceability since papayas are a perishable commodity, to more rapidly facilitate the tracking of involved product to expedite its removal from commerce, prevent additional consumer exposures, and properly focus any recall actions.

And finally, they should fund and actively engage in food safety research to identify the potential sources and routes of contamination by microbial pathogens and develop data-driven and risk-based preventive controls.

In response to this most recent Salmonella Uganda outbreak, the FDA deployed an inspection team to the packing house and farm that was linked to the contaminated papayas via traceback and epidemiological evidence. The findings of those visits will be made public when their investigation is complete. We have also increased sampling and screening of papayas at the border. In addition, the FDA is actively collaborating with our counterparts in the Mexican government regarding this current outbreak through the agency’s Latin America Office to determine ways to further our collaborative prevention efforts.

The U.S. Federal Food, Drug, and Cosmetic Act prohibits food producers from introducing, or delivering for introduction, into interstate commerce adulterated foods (meaning foods that are potentially harmful to consumers). Additionally, there are new requirements under the FDA Food Safety Modernization Act (FSMA). The Produce Safety Rule under FSMA sets science- and risk-based minimum standards for domestic and foreign farms for the safe growing, harvesting, packing and holding of covered produce, which includes papayas. Another FSMA rule, the Foreign Supplier Verification Program (FSVP) makes importers responsible for verifying that the foods they bring into the U.S., including papayas, have been produced in a manner that meets applicable U.S. safety standards. 

I prefer mangoes.

Good year for Cyclospora bad year for humans: 205 sick linked to Mexican basil in latest outbreak

The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Cyclospora infections linked to fresh basil from Siga Logistics de RL de CV of Morelos, Mexico.

CDC is advising that consumers do not eat or serve any fresh basil from Siga Logistics de RL de CV of Morelos, Mexico. This investigation is ongoing and the advice will be updated when more information is available.

Consumers who have fresh basil from Siga Logistics de RL de CV of Morelos, Mexico, in their homes should not eat it. Throw the basil away, even if some has been eaten and no one has gotten sick.

Do not eat salads or other dishes that include fresh basil from Siga Logistics de RL de CV of Morelos, Mexico. This includes dishes garnished or prepared with fresh basil from Siga Logistics de RL de CV of Morelos, Mexico, such as salads or fresh pesto.

If you aren’t sure the fresh basil you bought is from Siga Logistics de RL de CV of Morelos, Mexico, you can ask the place of purchase. When in doubt, don’t eat the fresh basil. Throw it out.

Wash and sanitize places where fresh basil was stored: countertops and refrigerator drawers or shelves.

The FDA strongly advises importers, suppliers, and distributors, as well as restaurants, retailers, and other food service providers to not sell, serve or distribute fresh basil imported from Siga Logistics de RL de CV located in Morelos, Mexico. If you are uncertain of the source, do not sell, serve or distribute the fresh imported basil.

Two hundred and five people with laboratory-confirmed Cyclosporainfections and who reported eating fresh basil have been reported from 11 states; exposures occurred at restaurants in 5 states (Florida, Minnesota, New York, Ohio, and Wisconsin).

Illnesses started on dates ranging from June 10, 2019 to July 18, 2019.

Five people have been hospitalized. No deaths attributed to Cyclospora have been reported in this outbreak.

Epidemiologic evidence and early product distribution information indicate that fresh basil from Siga Logistics de RL de CV of Morelos, Mexico is a likely source of this outbreak.

2019 Outbreak of Cyclospora infections linked to fresh basil from Mexico

15.aug.19

CDC

https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2019/weekly/index.html

Outbreak investigation of Cyclospora illness linked to imported fresh basil, July 2019

16.aug.19

FDA

https://www.fda.gov/food/outbreaks-foodborne-illness/outbreak-investigation-cyclospora-illnesses-linked-imported-fresh-basil-july-2019

255 sick from same Salmonella in American beef and Mexican soft cheese

What is already known about this topic?

Decreased susceptibility to azithromycin is rare among Salmonella serotypes that cause human infections in the United States. If antibiotic treatment is indicated, azithromycin is recommended as an oral therapy.

What is added by this report?

During June 2018–March 2019, an outbreak caused by multidrug-resistant Salmonella Newport with decreased susceptibility to azithromycin led to 255 infections and 60 hospitalizations. Infections were linked to Mexican-style soft cheese obtained in Mexico and beef obtained in the United States.

What are the implications for public health practice?

Whole genome sequencing can be used in Salmonella outbreak investigations for rapid prediction of antimicrobial resistance and can link cases to each other and to possible sources of infection.

Outbreak of salmonella Newport infections with decreased susceptibility to azithromycin linked to beef obtained in the United States and soft cheese obtained in Mexico—United States 2018-2019

23.aug.19

CDC

https://www.cdc.gov/mmwr/volumes/68/wr/mm6833a1.htm?s_cid=mm6833a1_e&deliveryName=USCDC_921-DM7382

Frozen strawberry shipment from Mexico contained $12.7 million worth of meth

Joel Shannon of USA Today writes a commercial shipment of frozen strawberries coming from Mexico contained $12.7 million worth of methamphetamine, U.S. Customs and Border Protection announced Tuesday.

The alleged drug-smuggling operation was discovered at the cargo facility at the Pharr-Reynosa International Bridge in southern Texas on Feb. 16, a release says. Officers found 906 pounds of the drug concealed in a trailer, CBP says.

A 42-year-old man who is a Mexican citizen was arrested in connection with the seizure, according to the release.

An analysis of data from the southern border indicates the vast majority of narcotics enter through U.S. ports of entry

According to U.S. Customs and Border Protection statistics, 87 percent of methamphetamine seized along the border in the first 11 months of the 2018 fiscal year was caught trying to be smuggled in at legal crossing points.

UK Cyclospora shit fest

TTG reports a judge sitting at Manchester county court has ordered the disclosure of all documentary evidence relating to investigations carried out by Public Health England (PHE) surrounding cyclospora — a parasite spread by food contaminated with infected human faeces.

According to The Times, many customers claimed Tui did not tell them the Riviera Maya region of Mexico was subject to a public health warning due to cyclosporiasis before they booked.

This is in spite of 359 of the 440 British cases reported between June and October 2016 “involving travel to Mexico”, it is claimed.

Others customers allege they were handed a warning letter “only after their plane landed”.

440 sickened: Tui faces legal action from 400 people over Mexico sickness

TTG reports a  judge sitting at Manchester county court has ordered the disclosure of all documentary evidence relating to investigations carried out by Public Health England (PHE) surrounding cyclospora — a parasite spread by food contaminated with infected human faeces.

According to The Times, many customers claimed Tui did not tell them the Riviera Maya region of Mexico was subject to a public health warning due to cyclosporiasis before they booked.

This is in spite of 359 of the 440 British cases reported between June and October 2016 “involving travel to Mexico”, it is claimed.

Others customers allege they were handed a warning letter “only after their plane landed”.

Travel-related foodborne illness

A few years ago, my family and I embarked on a trip an all-inclusive resort in Mexico, a little get away from the hectic day to day musings in our lives. First day I decided to go for a jog  and was bitten by a wild dog travelling in a pack. I was shipped off to Cancun to start rabies postexposure prophylaxis. Second day, contracted norovirus. Third day almost left.

Colette Crampsey of the The Daily Record reports:

Reece Russell and John English both fell ill after eating at all-inclusive resorts in Cancun.
Two holidaymakers have told of their ordeals after being crippled by food poisoning bugs in Mexico.
Reece Russell, 28, was infected with salmonella, which led to inflammation around his heart.
And John English, 51, ended up in hospital with bacterial gastritis. He has been left with long-term health problems and has had to give up being a football coach.
Both men fell ill after travelling to all-inclusive resorts in Cancun.
Reece, from Dunfermline, went to the resort with his parents and sister in June.
He said: “About a week after I came home, I started falling very ill. I woke up at 1am with chest pains. In hospital, a blood test showed I had a high level of protein in my blood caused by possible heart attacks.”
Reece was diagnosed with myopericarditis –inflammation of the membrane and muscle around the heart. Tests showed salmonella was to blame.
He said: “The doctors implied that if I hadn’t gone to hospital when I did, it would have been significantly worse.” 
Engineer Reece, who stayed at the Bahia Principe, had to miss two weeks of work. He is seeking compensation from travel firm TUI.
John stayed at Moon Palace hotel with wife Janice and their two children in July.
After eating at a Brazilian restaurant, the Scottish Gas worker was violently sick and was whisked to hospital.
John said: “They told me my magnesium levels were very low. If that happens, your organs can shut down and you can die. It was quite frightening.”
The couple had to fork out £4000 for treatment and a further £1500 on John’s release the next day.
He said: “I’ve lost 2st and doctors have told me my blood pressure is through the roof. I could be on tablets for the rest of my life.
“I’m having to give up football coaching, which is very hard for me.”
A Thomas Cook spokesman said: “We are sorry to hear Mr English became ill. We advise customers to tell their rep or hotel staff immediately if they are unwell so they can get the right support.”
A spokesman for TUI said: “We will be contacting Mr Russell directly to review the matter.
“We regularly audit all of the hotels we feature in respect of health and safety, including hygiene.”

1 dead, over 200 sick: Salmonella Anatum infections linked to imported maradol papayas

This outbreak is one of four separate outbreaks currently under investigation that are linked to imported Maradol papayas from Mexico.

The Centers for Disease Control, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Anatum infections.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.

This past spring, CDC investigated a multistate outbreak of Salmonella Anatum infections. Fourteen people infected with the outbreak strain of Salmonella Anatum were reported from three states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS showed that isolates from people infected with Salmonella Anatum were closely related genetically. This close genetic relationship meant that people in this outbreak were more likely to share a common source of infection.

Illnesses started on dates ranging from December 20, 2016, to April 8, 2017. Ill people ranged in age from less than 1 year to 85, with a median age of 38. Ninety-two percent were female. Among 11 people with available information, 10 (91%) were of Hispanic ethnicity. Among those 11 people, 5 (45%) were hospitalized. One death was reported from California.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Seven (88%) of eight people interviewed reported eating papayas. This proportion was significantly higher than results from a survey of healthy Hispanic people in which 22% reported eating papayas in the week before they were interviewed. In addition, four of these seven people reported buying papayas from the same grocery store chain.

While the epidemiologic information indicated that papayas were the likely source of this outbreak at the time, investigators could not determine the specific source of contaminated papayas and the outbreak investigation ended after illnesses stopped.

FDA informed CDC that a sample from an imported papaya identified Salmonella Anatum on September 4, 2017. This sample came from a papaya from a grower in Mexico named Productores y Exportadores de Carica Papaya  de Tecomán y Costa Alegre in Tijuana, Mexico. WGS showed that the isolate from the papaya and the isolates from the 14 people infected with Salmonella Anatum this past spring were closely related. Bravo Produce Inc. was a supplier of Maradol papayas to the grocery store chain where four of seven ill people reported buying papayas. After receiving FDA’s recent Salmonella isolate from papayas, CDC reviewed the PulseNet database to look for matching DNA fingerprints in bacteria from people who got sick after the investigation closed in the spring of 2017. Six more ill people have been identified and CDC is investigating to determine if these more recent illnesses are also linked to Maradol papayas imported by Bravo Produce Inc.

On September 10, 2017, Bravo Produce Inc. recalled Maradol papayas packed by Frutas Selectas de Tijuana, S. de RL de CV. The grower of the recalled Maradol papayas is Productores y Exportadores de Carica Papaya de Tecoman y Costa Alegre in Tijuana, Mexico. The papayas were distributed to California from August 10 to August 29, 2017. The recalled papayas can be identified by the label on the fruit from the packing company, Frutas Selectas de Tijuana.

This investigation is ongoing. CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them. FDA continues testing papayas from Mexico to see if other papayas from other farms are contaminated with Salmonella. Investigations are ongoing to determine if additional consumer warnings are needed beyond the advice not to eat papayas from specific importers or farms. Updates will be provided when more information is available.

Cyclospora: Back to the future

During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

Cyclosporiasis in travellers returning to the United Kingdom from Mexico in Summer 2017: Lessons from the recent past to inform the future

Eurosurveillance, vol. 22, issue 32, 10 August 2017, DFP Marques, CL Alexander, RM Chalmers, R Elson, J Freedman, G Hawkins, J Lo, G Robinson, K Russell, A Smith-Palmer, H Kirkbride, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.32.30592

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22854

Food fraud: Mexican alcohol edition

To my four Canadian daughters: Pay attention.

Tourists to all-inclusive resorts in Mexico suspect they were given tainted alcohol.

Raquel Rutledge of the Milwaukee Journal Sentinel writes the scene at the swim-up bar at the Mexican resort where Abbey Conner was pulled listless from the pool in January was full of young tourists last month when an attorney hired by Conner’s family showed up.

It wasn’t surprising. It was a typical scene at an all-inclusive five-star resort where foreigners from both sides of the equator flock to escape their cold winters.

But as he watched, the attorney noticed something disturbing.

“They serve alcoholic drinks with alcohol of bad quality and in great amounts, mixing different types of drinks,” he wrote in his native Spanish.

That single paragraph, buried near the end of a four-page report summarizing how 20-year-old Conner drowned within a couple hours of arriving at the Iberostar Hotel & Resorts’ Paraiso del Mar, offers a possible lead in the investigation into her death.

And it could shed light on the circumstances surrounding numerous reports from others who have told the Milwaukee Journal Sentinel they experienced sickness, blackouts and injuries after drinking at Iberostar and other resorts around Cancun and Playa del Carmen in recent months.

A Pewaukee family traveled to an all-inclusive resort in Playa del Carmen in January. Their two college kids wound up unconscious, face down in the pool within two hours. Twenty-year-old Abbey died.

They told the Journal Sentinel they believe they were drugged or the alcohol may have been tainted. They questioned how they could fall into a stupor so quickly. And whether they had been targeted.