65 sick from E. coli in Romaine lettuce: Collective amnesia for leafy green growers and loads of manure

Maybe CNN is fake news.

When the foodbabe is billed as an expert on microbial contamination of leafy greens and ends up delivering a screed about antimicrobial overuse in livestock as the source of superbugs, I sorta wonder.

But some background.

In sentencing me to jail in 1982, the judge said I had a memory of convenience.

I said I had a memory of not much.

Still don’t.

Spinach and lettuce growers seem to have a memory of not much, given the produce industry’s revisions to the 2006 E. coli O157:H7 outbreak in spinach that killed four and sickened 200.

In October, 1996, a 16-month-old Denver girl drank Smoothie juice manufactured by Odwalla Inc. of Half Moon Bay, California. She died several weeks later; 64 others became ill in several western U.S. states and British Columbia after drinking the same juices, which contained unpasteurized apple cider — and E. coli O157:H7. Investigators believed that some of the apples used to make the cider might have been insufficiently washed after falling to the ground and coming into contact with deer feces.

Almost 10 years later, on Sept. 14, 2006, the U.S. Food and Drug Administration announced that an outbreak of E. coli O157: H7 had killed a 77-year-old woman and sickened 49 others (United States Food and Drug Administration, 2006). The FDA learned from the Centers for Disease Control and Wisconsin health officials that the outbreak may have been linked to the consumption of produce and identified bagged fresh spinach as a possible cause.

In the decade between these two watershed outbreaks, almost 500 outbreaks of foodborne illness involving fresh produce were documented, publicized and led to some changes within the industry, yet what author Malcolm Gladwell would call a tipping point — “a point at which a slow gradual change becomes irreversible and then proceeds with gathering pace” (http://en.wikipedia.org/wiki/Tipping_Point) — in public awareness about produce-associated risks did not happen until the spinach E. coli O157:H7 outbreak in the fall of 2006. At what point did sufficient evidence exist to compel the fresh produce industry to embrace the kind of change the sector has heralded since 2007? And at what point will future evidence be deemed sufficient to initiate change within an industry?

In 1996, following extensive public and political discussions about microbial food safety in meat, the focus shifted to fresh fruits and vegetables, following an outbreak of Cyclospora cayetanesis ultimately linked to Guatemalan raspberries that sickened 1,465 in 21 U.S. states and two Canadian provinces (U.S. Centers for Disease Control and Prevention, 1997), and subsequently Odwalla. That same year, Beuchat (1996) published a review on pathogenic microorganisms in fresh fruits and vegetables and identified numerous pathways of contamination.

By 1997, researchers at CDC were stating that pathogens could contaminate at any point along the fresh produce food chain — at the farm, processing plant, transportation vehicle, retail store or foodservice operation and the home — and that by understanding where potential problems existed, it was possible to develop strategies to reduce risks of contamination. Researchers also reported that the use of pathogen-free water for washing would minimize risk of contamination.

What was absent in this decade of outbreaks, letters from regulators, plans from industry associations and media accounts, was verification that farmers and others in the farm-to-fork food safety system were seriously internalizing the messages about risk, the numbers of sick people, and translating such information into front-line food safety behavioural change.

So why was spinach in 2006 the tipping point?

It shouldn’t have been.

But it lets industry apologists say, how the hell could we known?

Beginning Sept. 14 and continuing until Sept. 20, 2006, the U.S. Food and Drug Administration issued daily news releases that flatly advised consumers “not to eat fresh spinach or fresh spinach-containing products until further notice.”

The agency had never before issued such a broad warning about a commodity, said Robert Brackett, who in 2006 was director of FDA’s Center for Food Safety and Applied Nutritions. Brackett is now vice president and director of the Institute for Food Safety and Health at the Illinois Institute of Technology,

“In this particular case all we knew (was) that it was bagged leafy spinach, but we had no idea whose it was or where it was coming from.

“It was a very scary couple of days because we had all of these serious cases of hemolytic-uremic syndrome popping up and people getting sick, and it was so widespread across the country.”

The Centers for Disease Control and Prevention reported about half of those who were ill were hospitalized during the 2006 spinach E. coli outbreak.

“It was shocking how little confidence that FDA and consumers had in the produce industry at that moment,” said David Gombas, senior vice president of food safety and technology for the Washington, D.C.-based United Fresh Produce Association.

Given the history of outbreaks, the only thing shocking was that the industry continued to expect blind faith.

There were guidelines for growers in 2006, but not a way to make sure growers were following them, said Joe Pezzini, CEO of Ocean Mist Farms, Castroville, Calif.

Convenient.

And now another decade-plus has passed and once again, FDA issued a commodity-wide warning: don’t eat Romaine lettuce (Cos for my Australian friends).

The same huskers and buskers stepped out to make their case, with industry saying OK, maybe we need to be more than a mile away from 100,000 cattle head feedlots that crap into the same water canals used to irrigate leafy greens.

Denny Black, a Manitoba farmer, who grows more than 20,000 heads of Greenleaf and butterhead lettuce at his Neva Farms in Landmark, Man., using hydroponics, a mix of nutrients including calcium and  nitrogen combined with water. The plants, which take about eight weeks to mature from tiny seeds into full grown greens, are grown under artificial lights.

“I think people are looking for an alternative to field grown crops,” Black said.

His method, he claims, could mitigate some risk, since produce can be contaminated with E. coli through the soil, water, animals or improperly composted manure.

Fortunately, Claudia Narvaez, an associate professor in the food science department at the University of Manitoba said, “If the seeds for that lettuce are contaminated with a foodborne pathogen, you can’t, you won’t get rid of it even in a hydroponic production system.”

She added that Black’s controlled environment is only moderately safer compared to soil, depending on the source of the water and whether people follow proper safety procedures when handling the produce.

Keith Warriner of the University of Guelph told CBC he was “shocked” by advice the public got this week from Dr. Jennifer Russell, New Brunswick’s chief medical officer of health, after people got sick from E. coli in Ontario, Quebec and New Brunswick.

Russell advised people to throw away their romaine lettuce. But if they decided to consume the lettuce, she said, they should wash it under cool, running water.

Warriner said washing is too risky.

“We’ve known for years now that washing doesn’t cut it.”

Warriner also told CTV News that romaine lettuce is more susceptible to E. coli contamination partly because of how it’s grown, adding “In our own research, what we found is that E. coli likes romaine lettuce out of all the other lettuces we have.”

Warriner conducted a study that showed romaine lettuce extracts prompted E. coli out of a dormant state, which it can remain in for about a year in soil, and allowed it to flourish.

Romaine’s increased susceptibility comes down to several factors, he said.

The crop is mostly grown in Arizona and California, Warriner said, which is also cattle country. Irrigation water used on romaine fields can become tainted with bacteria from the animals. It doesn’t help that both states are quite hot and romaine lettuce already requires an abundance of water, he said.

But top prize goes to the self-proclaimed foodbabe, she who gets chemicals out of food and managed to secure an interview on CNN (she starts at about 40 seconds in; judge for yourselves).

(Update: the video appears to be removed by CNN, probably due to the Twitter backlash, but here’s the transcript)

I don’t want to give her anymore space for fear it will be associated with credibility: it’s not, that stuff is earned.

Meanwhile, the U.S. Food and Drug Administration says romaine lettuce is now safe to eat following the “purge” of product on the market, and will allow supplies to resume, after grower-shippers agreed to new labeling standards that will include where the lettuce is grown.

The agreement, negotiated by romaine grower-shippers, processors and industry associations, will be the new standard for romaine packed in the U.S. The standards follow an E. coli outbreak linked to 43 illnesses in the U.S. and 22 in Canada, as of Nov. 26.

 “A number of produce associations also have agreed to support this initiative and are recommending that all industry members throughout the supply chain follow this same labeling program,” according to the United Fresh Produce Association, in an e-mail alert to members Nov. 26 sent several hours before the FDA released a statement lifting the advisory that virtually banned romaine in the U.S.

According to the FDA statement, the new labels are voluntary, but its updated message to consumers suggests it’s against shippers’ interest to forego the label:

“Based on discussions with major producers and distributors, romaine lettuce entering the market will now be labeled with a harvest location and a harvest date,” according to the FDA. “Romaine lettuce entering the market can also be labeled as being hydroponically or greenhouse grown. If it does not have this information, you should not eat or use it.”

I like that. It’s what we used with Ontario Greenhouse Vegetable Growers back in 2000 – yes I’m that old – this is a voluntary food safety program, but we have a list of everyone who doesn’t participate and that list will be available to retailers.

Yet why didn’t growers do this for themselves, decades ago, instead of waiting for sick people?

The FDA is advising retailers to display signs about the origin of romaine products when they’re not individually packaged, such as bulk displays of unwrapped heads of romaine.

And kudos to Hansel ‘n Griddle, a small but popular breakfast/lunch chain in the Rutgers area.

In the interest of public health, they texted the following to their customers:

To Our Valued Customer,

Hansel ‘n Griddle has temporarily stopped serving romaine lettuce due to a CDC Food Safety Alert posted on Tuesday, November 20th, 2018 regarding a E. coli outbreak with its source being from romaine lettuce. 

From the CDC website: “The CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until we learn more about the outbreak… This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.”

Below are two links, one to the CDC website, and one to the FDA website, giving details on the E. coli outbreak and more information.

https://www.cdc.gov/ecoli/2018/o157h7-11-18/index.html

https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm626330.htm

 While the CDC has not issued any formal recalls yet, we want to be proactive when it comes to issues regarding food safety and our customers health.

In the meantime, all Hansel ‘n Griddle locations will be substituting romaine lettuce with:

  • Iceberg lettuce in all our salads and wraps
  • Green leaf lettuce on all our paninis, sandwiches and burgers

As always, baby spinach is available for a small upcharge, in place of one of the above lettuce options.

We apologize for any inconvinience this temporary situation may cause

If you have any questions, please feel free to reach out to us atinfo@hanselngriddle.com

Thank you for being a Hansel ‘n Griddle customer.

Best Regards,

The Hansel ‘n Griddle Team

FDA’s update on Romaine-linked outbreak investigation – it is California stuff

The normal folks who I hang out with at the hockey arena have already started asking when they can start eating Romaine again (who knew there were so many Caesar fans).

FDA’s answer to when is soon

Some places never stopped serving it. 

Earlier today I told Korin Miller at Yahoo the below:

If you happen to visit a restaurant that tries to claim its romaine is safe, it’s really best to avoid the food. “I would send it back,” Benjamin Chapman, an assistant professor and food safety extension specialist at North Carolina State University, tells Yahoo Lifestyle. “When the CDC comes out with a message that says ‘Don’t eat romaine lettuce,’ you should heed that advice,” he says. “Right now, we don’t have any indication that it’s romaine from any certain part of the country or a certain company. It’s a standing blanket statement.”

And now we’ve got more information (that’s how quickly this stuff moves).

FDA announced late today that they have narrowed their investigation to field grown Romaine from Central Coast growing regions of northern and central California.

All other lettuce is as safe as it was last week before the announcement.

FDA is taking things a step further, in a really positive way in concept – asking producers to label where it came from.

Based on discussions with producers and distributors, romaine lettuce entering the market will now be labeled with a harvest location and a harvest date or labeled as being hydroponically- or greenhouse-grown. If it does not have this information, you should not eat or use it.

There is no recommendation for consumers or retailers to avoid using romaine lettuce that is certain to have been harvested from areas outside of the Central Coast growing regions of northern and central California. For example, romaine lettuce harvested from areas that include, but are not limited to the desert growing region near Yuma, the California desert growing region near Imperial County and Riverside County, the state of Florida, and Mexico, does not appear to be related to the current outbreak. Additionally, there is no evidence hydroponically- and greenhouse-grown romaine is related to the current outbreak.

During this new stage of the investigation, it is vital that consumers and retailers have an easy way to identify romaine lettuce by both harvest date and harvest location. Labeling with this information on each bag of romaine or signage in stores where labels are not an option would easily differentiate for consumers romaine from unaffected growing regions.

CDC’s Romaine clapback

Maybe it’s Californian Romaine, maybe not, but there looks to be some contradiction between messages from FDA’s Scott Gottlieb and CDC’s Director, Robert Redfield.

Redfield announced this after Gottlieb’s tweets indicating that the source of illnesses is likely California.

CDC continues to investigate a multistate outbreak of E. coli O157 infections linked to romaine lettuce. We understand this outbreak is of concern to many Americans – especially with so many gathering for meals this Thanksgiving week. CDC’s disease detectives are working with federal regulatory partners to investigate and determine the source of contamination as quickly as possible. We will continue to provide more information as it becomes available. The good news is we were able to detect and identify the outbreak quickly through our disease surveillance system, which can prevent further illness.

However, until we know more, it’s crucial that Americans continue to follow the guidance that CDC issued. There are no exceptions – all romaine lettuce must be discarded, regardless of brand, type, or if it is in a mixture. We also continue to urge people to follow our tips to help prevent E. coli illness. In addition, we remind clinicians that antibiotics are not recommended for patients in whom E. coli O157 is suspected until diagnostic testing rules out this infection.

FDA’s Gottlieb says Romaine likely came from California (other regions might be off the hook)

Scott Gottlieb, FDA Commissioner took to the Twitter this morning while many were buying TVs and Himalayan salt lamps to talk about the Romaine-linked E. coli O157 outbreak.

I imagine there’s lots of pressure out there to lift the blanket statement from CDC to avoid all Romaine. Especially if the dates of harvest/transition from one location to another make it so it’s not likely that lettuce from certain regions would be linked to the outbreak.

Some sort of identification is great – because how would a consumer know what to ask about or how to figure out the source without it.

 

 

Going public (not): Leafy green cone of silence on Cyclospora in Romaine lettuce, 2013

Read this Packer story from 2013 for the convoluted hoops public health types are faced with while investigating foodborne illness outbreaks. And now the scientific report: same hoops, same dance, same unsatisfactory outcome for consumers who want to know what’s safe.

cone.of.silence.get.smartA regional, multistate investigation into a June–August 2013 cyclosporiasis outbreak was conducted in Nebraska, Iowa, and neighbouring states. Cases were confirmed on the basis of laboratory and clinical findings.

Of 227 cases in Iowa (n = 140) and Nebraska (n = 87) residents, 162 (71%) reported dining at chain A/B restaurants – 96% reported house salad consumption. A case-control study identified chain A/B house salad as the most likely vehicle. Traceback was conducted to ascertain production lot codes of bagged salad mix (iceberg and romaine lettuce, red cabbage, and carrots) served as house salad in implicated restaurants. A single production lot code of salad mix supplied by both a common producer and distributor was linked to the majority of confirmed cases in persons reporting regional chain A/B exposure.

The salad mix linked to illnesses contained imported romaine lettuce from two separate single-grower fields-of-origin and ≥1 additional field from another grower.

Regional investigation of a cyclosporiasis outbreak linked to imported romaine lettuce – Nebraska and Iowa, June–August 2013

Epidemiology and Infection / Volume 144 / Issue 09 / July 2016, pp 1807-1817Copyright © Cambridge University Press 2015  DOI: http://dx.doi.org/10.1017/S0950268815002484 (About DOI), Published online: 22 October 2015

F. Buss, M. V. Joshi, A. L. O’keefe, C. D. Allensworth, A. Garvey, K. Obbink, S. Mandernach And T. J. Safranek

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10346466&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

are.you.mental

Not much E. coli on Romaine at retail

A total of 720 whole, romaine lettuce heads were purchased from retail locations in the Upper Midwest and assessed for coliform and Escherichia coli contamination and for the presence of E. coli O157:H7.

Romaine-Lettuce-PhotosDuring a 16-month period (August 2010 through December 2011), coliform and E. coli counts were enumerated on Petrifilm, and the presence of E. coli O157:H7 and the virulence gene eae was evaluated by real-time PCR (qPCR). Over half (400 of 720) of the lettuce samples were processed with an immunomagnetic separation step before the qPCR assay. All retail lettuce samples were negative for E. coli O157:H7 when tested with the R.A.P.I.D. LT qPCR targeting a region of the O-antigen, and only two (0.28%) were positive for the eae gene when tested with LightCycler qPCR.

On Petrifilm, coliform counts of most lettuce samples (96.4%) were between <101 and 103 CFU/g, and E. coli counts for nearly all lettuce samples (98.2%) were <101 CFU/g. No seasonal trend in coliform and E. coli counts was observed throughout the examination period nor was a difference in coliform counts observed between packaged and nonpackaged lettuce heads.

These results contribute to the limited recorded data and understanding of microbial contamination of whole romaine lettuce heads purchased from retail locations, specifically revealing the absence of E. coli O157:H7 and low levels of contamination with coliforms and other E. coli strains.

 Occurrence of coliform and Escherichia coli contamination and absence of Escherichia coli O157:H7 on romaine lettuce from retail stores in the Upper Midwest

Journal of Food Protection®, Number 9, September 2015, pp. 1624-1769

Greve, Josephine D.; Zietlow, Mark S.; Miller, Kevin M.; Ellingson, Jay L. E.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000009/art00013

4 sick; another E. coli outbreak in New Brunswick

Two months after an E. coli O157:H7 outbreak that sickened up to 24 people was linked to Romaine lettuce served at a Jungle Jim’s restaurant in Miramichi, New Brunswick, another outbreak has sent two Fredericton teenagers to hospital and sickened at least another two people.

CBC reports Micaella Boer (right) and one of her young male friends are two of the four confirmed cases of E. coli O157:H7 in the city, according to Micaella’s mother, Victoria Boer.

"We absolutely have no idea" where it came from, said Victoria Boer. Health officials have been going through Micaella’s bank statements to try to figure out where she had been eating in the days leading up to her illness, she said.

Micaella is in quite a bit of pain and has been crying a lot, said Boer.

"There’s a lot of swelling, facial swelling. Her eyes are swollen, her feet are swollen, her belly’s swollen. So she’s just really having a rough time with that," she said.

"We just feel sick for her … just to watch your child in so much pain and she can’t move," said Boer. "And hearing the percentages and seeing her have blood transfusions — it’s a rough thing to go through as a parent."

Are the outbreaks linked? Don’t know. But Health Canada did reissue its woefully inaccurate safe handling of produce advice today, which usually means there’s an outbreak.

60 sick with E. coli O157 in 10 states: it was Romaine lettuce (grown in California?) served at Schnucks salad bars by Mr. Green

A day after Missouri health types announced the source of the Schnucks-salad-bar-related E. coli O157 outbreak may never be found, the feds announced they found a source.

The U.S. Centers for Disease Control (CDC) reported today that as of Dec. 4, 2011, 60 persons infected with the outbreak strain of E. coli serotype O157:H7 had been reported from 10 states.

Collaborative investigative efforts of state, local, and federal public health and regulatory agencies indicate that romaine lettuce is the likely source of illnesses in this outbreak, and contamination likely occurred before the product reached retail stores.

CDC called Schnucks Chain A, and the farm the lettuce was traced to Farm A, without saying in what state the lettuce originated. But one of the Missouri health types did, saying a grower in California was suspected of being connected but records were “insufficient to complete the picture.”

The public reporting of this outbreak reeks of the Leafy Greens Cone of Silence – that the most noticeable achievement since the California Leafy Greens Marketing Agreement was created in the wake of the 2006 E. coli O157-in-spinach mess is the containment cone of silence that has descended upon outbreaks involving leafy greens.

Things didn’t sound quite right back on Oct. 28, 2011, when St. Louis County health officials first publicly confirmed that the source of the E. coli O157 strain that had sickened 23 people was foodborne, but that the investigation was ongoing. Though retailers have not been asked to pull any food, Schnucks voluntarily replaced or removed some produce in salad bars and shelves, beginning Oct. 26, 2011.

"Once we heard that the health department had declared an outbreak, we took some proactive steps with our food safety team to switch products out that recent history told us could be potential sources," said Schnucks spokeswoman Lori Willis.

A Schnucks store, Culinaria in downtown St. Louis, put a sign up on empty shelves that read in part, "Due to a voluntary recall on pre-packed lettuce, we will not be able to produce these pre-made salads. Be assured quality is our main concern. All of the lettuce on the salad bar is fresh and not involved with the recall."

As a retailer, Schnucks drew my attention earlier this year when it announced it was expanding its so-called Peace of Mind initiative from pricing to quality assurance with a new website, www.peaceofmindquality.com, that emphasizes the chain’s dedication to quality and food safety. Unfortunately, quality and safety are seemingly used interchangeably on the website when they are actually two different concepts.

A table of leafy green related outbreaks is available at http://bites.ksu.edu/leafy-greens-related-outbreaks.

I’m not feeling peace of mind.

More from the CDC report:

As of December 4, 2011, 60 persons infected with the outbreak strain of E. coli O157:H7 have been reported from10 states. The number of ill persons identified in each state is as follows: Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3), Missouri (37), and Nebraska (1).

Among persons for whom information is available, illnesses began from October 10, 2011 to November 4, 2011. Ill persons ranged in age from 1 to 94 years, with a median age of 29 years old. Sixty-three percent were female. Among the 45 ill persons with available information, 30 (67%) were hospitalized, and 2 developed hemolytic uremic syndrome (HUS). No deaths have been reported.

Collaborative investigative efforts of state, local, and federal public health agencies indicate that romaine lettuce sold primarily at several locations of a single grocery store chain (Chain A) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached grocery store Chain A locations.

Ill persons reported purchasing salads from salad bars at grocery store Chain A between October 5 and October 24, 2011. A total of 9 locations of grocery store Chain A were identified where more than one ill person reported purchasing a salad from the salad bar in the week before becoming ill. This included 2 separate locations where 4 ill persons reported purchasing a salad at each location. For locations where more than one ill person reported purchasing a salad from the salad bar and the date of purchase was known, dates of purchase were all within 4 days of other ill persons purchasing a salad at that same location. Chain A fully cooperated with the investigation and voluntarily removed suspected food items from the salad bar on October 26, 2011, out of an abundance of caution. Romaine lettuce served on salad bars at all locations of grocery store Chain A had come from a single lettuce processing facility via a single distributor. This indicates that contamination of romaine lettuce likely occurred before the product reached grocery store Chain A locations.

The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of grocery store Chain A and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply the grocery store Chain A locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus. Preliminary findings of investigation at Farm A did not identify the source of the contamination. Farm A was no longer in production during the time of the investigation.