356 confirmed sick; Multistate outbreak of Salmonella infections linked to raw turkey products

During 2018–2019, CDC, local and state public health partners, the U.S. Department of Agriculture (USDA), and the Food and Drug Administration (FDA) investigated a multistate outbreak of 356 Salmonella Reading infections from 42 states and the District of Columbia (DC) linked to turkey. The outbreak strain was isolated from raw turkey products, raw turkey pet food, and live turkeys. In July 2018, CDC and USDA’s Food Safety and Inspection Service (FSIS) shared outbreak investigation results with representatives from the U.S. turkey industry, engaging with an industry group rather than a specific company for the first time during an outbreak, and CDC issued a public investigation notice. During the investigation, four recalls of turkey products were issued. Evidence suggested that the outbreak strain of Salmonella was widespread in the turkey industry, and therefore, interventions should target all parts of the supply chain, including slaughter and processing facilities and upstream farm sources.

In January 2018, through routine state surveillance, Minnesota Department of Health investigators identified four Salmonella Reading infections with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern, suggesting they likely shared a common source. One patient had consumed ground turkey, and two lived in the same household where pets in the home ate raw turkey pet food. Minnesota investigators also identified this same strain in one sample of retail ground turkey. This PFGE pattern is the most common subtype of Salmonella Reading; however, the Reading serotype is uncommon, not ranking in the 20 most common types of human Salmonella infections reported in the United States (1). In response to Minnesota’s investigation, PulseNet,* the national laboratory network for foodborne disease surveillance, was queried for additional Salmonella infections with this PFGE pattern. CDC began a multistate cluster investigation, collecting information on patient exposures from local and state health departments and information on food and pet food products from FDA and FSIS.

CDC defined a case as an infection with Salmonella Reading with the outbreak PFGE pattern with illness onset from during November 20, 2017–March 31, 2019. Patients were interviewed to collect information on consumption of turkey and other poultry foods, exposure to raw poultry pet food, and contact with live poultry.

Investigators from DC Health and the Iowa Department of Health identified two illness subclusters of cases in which attendees ate at a common event before becoming ill. The two events occurred in November 2018 and February 2019, and 152 persons became ill, including 51 whose clinical isolates matched the outbreak strain and 101 who had clinically compatible illness without culture confirmation of Salmonella infection. Investigators identified whole turkey and boneless roast turkey as the food items significantly associated with illness at these two events and found that turkey was not handled or prepared in accordance with FSIS guidelines and was not held at proper temperatures to prevent bacterial growth (2).

Overall, 356 outbreak cases from 42 states and DC were identified. Patients ranged in age from <1 to 101 years (median = 42 years), and 175 (52%) of 336 patients for whom information on sex was available were male. Among 300 patients with available information, 132 (44%) were hospitalized, and one died. Among 198 interviewed patients, 132 (67%) reported direct or indirect contact with turkey in the week before illness; 123 reported preparing or eating turkey products that were purchased raw (including whole turkey, turkey pieces, and ground turkey), four became sick after pets in their home ate raw ground turkey pet food, and five worked in a facility that raises or processes turkeys or lived with someone who worked in such a facility. No common type, brand, or source of turkey was identified.

During the investigation, the outbreak strain was identified in 178 samples of raw turkey products from 24 slaughter and 14 processing establishments in 21 states that were collected by FSIS as part of routine testing and in 120 retail turkey samples collected as part of the National Antimicrobial Resistance Monitoring System retail meat sampling program. These samples represented several brands and types of raw turkey products. The outbreak strain was also identified in 10 samples from live turkeys in several states.

Investigators from the Arizona State Public Health Laboratory and the Michigan Department of Agriculture and Rural Development identified the outbreak strain in two of three unopened ground turkey samples collected from two patient homes. These were the same brand of ground turkey but were produced in different facilities. Investigators from the Minnesota Department of Agriculture identified the outbreak strain in samples of two brands of raw turkey pet food that were served to pets in patients’ homes. No commercial connections or common source materials were identified among any of these facilities.

The two illness subclusters in this outbreak indicate improper handling and cooking of raw turkey products and highlight the need to reinforce consumer education. A 2017 study found that adherence to food safety practices among persons preparing turkey burgers was low but did improve after watching a USDA video on proper thermometer use (9). This same study also found very low adherence to CDC’s recommended steps for handwashing during food preparation and noted that approximately half of the participants contaminated other kitchen items, such as spice containers, by touching them while preparing turkey (9). These findings underscore the impact that food safety messaging can have on consumer behavior and the importance of proper food safety throughout the food preparation process. Consumers should always thaw turkeys safely (in the refrigerator in a container, in a leak-proof plastic bag in a sink of cold water, or in a microwave oven following the manufacturer’s instructions), avoid the spread of bacteria from raw turkey by keeping it separate from other foods and keeping food surfaces clean, and cook turkey to 165°F (74°C), measured on a food thermometer inserted into the thickest portions of the breast, thigh, and wing joint.† In addition to emphasizing the importance of food safety messaging, this outbreak reinforced the need for awareness of the recommendations against feeding pets a raw meat diet, which can lead to both human and animal illnesses (10). Finally, industries can take steps to provide consumer education through their marketing programs and on product packages. Consumers, public health agencies, and industry officials all play important roles in promoting and implementing Salmonella prevention and control strategies to prevent future illnesses.

British girl, 2, dies from E. coli after holiday in Turkey

A two-year-old British girl has died after contracting E.coli while on holiday in Turkey.

Allie Birchall came down with the severe illness after returning to the UK following a stay at a luxury resort east of the coastal city of Antayla.

Her family were forced to turn off Allie’s life support machine just two weeks after their holiday because of complications caused by the illness.

The family had travelled to Turkey with tour operator Jet2 Holidays on 12 July and said they had concerns about the hygeine of the Turkish resort.

Katie Dawson, Allie’s mother, said her daughter did not start getting ill until five days after getting back to their home in Atherton, Greater Manchester.

According to Ms Dawson, Allie began suffering with stomach cramps, diarrhoea, loss of appetite and lethargy before being admitted to Royal Bolton Hospital on July 30.

The hospital confirmed Allie had contracted Shiga-Toxin producing E.Coli (STEC), which later led to her developing deadly Haemolytic Uraemic Syndrome (HUS) – a life-threatening complication related to the poisoning.

Allie was moved to the Manchester Royal Infirmary and put in an induced coma on August 1.

An MRI scan was carried out, which revealed that she had sustained severe brain trauma and damage. Katie had to make the difficult decision to terminate Allie’s life support following the advice from doctors.

“While nothing will bring her back, we need to know what caused her illness and if anything could have been done to prevent it.

The family have now instructed specialist international serious injury lawyers, Irwin Mitchell, to investigate what happened.

Public Health England is also currently investigating the matter, and an inquest has been opened to examine the circumstances surrounding Allie’s death.

Not as simple as just cook it: Ground turkey linked to Salmonella illnesses prompt Butterball recall

I use a lot of ground turkey – it’s my preferred ground meat for tacos and homemade burgers and tomato sauce. I switched to turkey when my kids were younger (because I was so much more freaked out about STECs, it was one way to manage the risk).

A year ago we did some work with RTI for FSIS on ground turkey preparation and during our observations found that cross-contamination could be a particularly an issue (to spice bottles and other areas).

Yesterday Butterball recalled over 75k lbs of ground turkey products after being linked to a Salmonella Schwarzengrund outbreak investigation.

FSIS and public health partners, including the Centers for Disease Control and Prevention (CDC), the Wisconsin Department of Health Services and Wisconsin Department of Agriculture, Trade and Consumer Protection, have been investigating a multistate outbreak of Salmonella Schwarzengrund illnesses involving 5 case patients from 2 states. Wisconsin collected three intact Butterball brand ground turkey samples from a residence where 4 of the case patients live. The case patients and ground turkey Salmonella Schwarzengrund isolates are closely related, genetically.

Butterball, LLC, a Mount Olive, N.C. establishment, is recalling approximately 78,164 pounds of raw ground turkey products that may be contaminated with Salmonella Schwarzengrund, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The prepacked raw ground turkey was produced on July 7, 2018. The following products are subject to recall: [View Labels (PDF only)]

48-oz. plastic wrapped tray containing “BUTTERBALL everyday Fresh Ground Turkey WITH NATURAL FLAVORING (85% LEAN/15% FAT)” with sell or freeze by date of 7/26/18, lot code 8188, and UPC codes 22655-71555 or 22655-71557 represented on the label.
48-oz. plastic wrapped tray containing “BUTTERBALL everyday Fresh Ground Turkey WITH NATURAL FLAVORING (93% LEAN/7% FAT)” with sell or freeze by date of 7/26/18, lot code 8188 and UPC code 22655-71556 represented on the label.
16-oz. plastic wrapped tray containing “BUTTERBALL everyday Fresh Ground Turkey WITH NATURAL FLAVORING (85% LEAN/15% FAT)” with sell or freeze by date of 7/26/18, lot code 8188 and UPC code 22655-71546 represented on the label.
16-oz. plastic wrapped tray containing “BUTTERBALL everyday Fresh Ground Turkey WITH NATURAL FLAVORING (93% LEAN/7% FAT)” with sell or freeze by date of 7/26/18, lot code 8188 and UPC codes 22655-71547 or 22655-71561 represented on the label
48-oz. plastic wrapped tray containing “Kroger GROUND TURKEY FRESH 85% LEAN – 15% FAT” with sell or freeze by date of 7/26/18, lot code 8188, and UPC code 111141097993 represented on the label.
48-oz. plastic wrapped tray containing “FOOD LION 15% fat ground turkey with natural flavorings” with sell or freeze by date of 7/26/18, lot code 8188 and UPC code 3582609294 represented on the label.
The products subject to recall bear establishment number “EST. P-7345” inside the USDA mark of inspection. These items were shipped to institutional and retail locations nationwide.

Stick it in and use a thermometer

As Jimmy Buffett said on his 1978 Live album, sometimes I’m real sentimental, and sometimes I’m real trashy.

I can relate.

How many times can the UK Food Standards-thingy say cook poultry until piping hot, while Canada, the U.S. and now even Australia – apparently the most monarch-frenzied country in the world according to early-morning talk-fests – say, use a fucking thermometer.

Stick it in and use a fucking thermometer.

And now, research from the U.S. says that changes in lighting conditions to promote energy conservation may induce folks to eat undercooked turkey, please, pay homage to my late, great food safety pioneer Pete Snyder (and pardon my Minnesotan, but am married to one and she swears like a drunken sailor, after living with me for 13 years) and use a fucking thermometer.

Changes in Lighting Source Can Produce Inaccurate Assessment of Visual Poultry Doneness and Induce Consumers To Eat Undercooked Ground Turkey Patties

Journal of Food Protection, March 2019, Volume 82, Number 3, pages 528-534, https://doi.org/10.4315/0362-028X.JFP-18-392

Curtis Maughan, Edgar Chamber IV, et al

https://jfoodprotection.org/doi/full/10.4315/0362-028X.JFP-18-392

Undercooked poultry is a potential source of foodborne pathogens, such as Salmonella and Campylobacter. The best way to avoid eating undercooked poultry is to use a food thermometer during cooking. However, consumers who cook poultry often use visual appearance for determining doneness, which relies on extrinsic factors, including lighting conditions. Because the United States recently mandated changes in lighting to promote energy conservation, this study evaluated the effect of lighting sources on consumer perceptions of doneness and willingness to eat cooked poultry patties. Consumers (n = 104) evaluated validated photographs of turkey patties cooked to different end point temperatures (57 to 79°C) and rated the level of perceived doneness and willingness to eat each sample. Evaluations were conducted under different lighting sources: incandescent (60 W, soft white), halogen (43 W, soft white), compact fluorescent lamp (13 W, soft white), light-emitting diode (LED; 10.5 W, soft white), and daylight LED (14 W). Lighting changed perception of doneness and willingness to eat the patties, with some of the energy-efficient options, such as LED and halogen making samples appear more done than they actually were, increasing the willingness to eat undercooked samples. This poses a risk of consuming meat that could contain bacteria not killed by heat treatment. Recent changes in lighting regulations can affect lighting in homes that affects perceptions of poultry doneness, requiring that educators place extra emphasis on the message that properly using a meat thermometer is the only way to ensure meat is cooked to a safe end point temperature.

Just cook it doesn’t cut it: 2 dead 238 sick in outbreak of multidrug-resistant Salmonella linked to raw turkey

CDC and public health and regulatory officials in several states are investigating a multistate outbreak of multidrug-resistant Salmonella infections linked to raw turkey products. The U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) is monitoring the outbreak.

As of December 18, 2018, 216 people infected with the outbreak strain of Salmonella Reading have been reported from 38 states and the District of Columbia.

84 people have been hospitalized, and one death has been reported from California.

Epidemiologic and laboratory evidence indicates that raw turkey products from a variety of sources are contaminated with Salmonella Reading and are making people sick.

In interviews, ill people report eating different types and brands of turkey products purchased from many different locations. Three ill people lived in households where raw turkey pet food was fed to pets.

The outbreak strain has been identified in samples taken from raw turkey pet food, raw turkey products, and live turkeys.

On November 15, 2018, Jennie-O Turkey Store Sales in Barron, Wisconsin recalled approximately 91,388 pounds of raw ground turkey products.

On December 21, 2018, Jennie-O Turkey Store Sales, LLC, in Faribault, Minnesota recalled approximately 164,210 pounds of raw ground turkey products.

A single, common supplier of raw turkey products or of live turkeys has not been identified that could account for the whole outbreak.

The Public Health Agency of Canada has identified an additional 22 ill people infected with the same DNA fingerprint of Salmonella Reading bacteria in Canada.

337 sick: Academics to dine with students after food poisoning at Van university in Turkey’s east

Hurriyet Daily News writes the senate of Van Yüzüncü Yıl University in the eastern province of Van has decided that one academic will dine with students every day after dozens of students living in a dormitory suffered from food poisoning last week.

On Nov. 29, a total of 337 students were hospitalized following complaints such as nausea and high fever. A special commission was established to investigate the suspected poisoning and officials from the local health and provincial directorate of agriculture collected samples from the food and the water students consumed.

While the investigation is still ongoing the university’s governing body decided that each day one academic staff should eat together with the students.

“Academics and students will share the same meal and the table to ease concerns and possible provocations. We have to stand by our students when they have concerns,” Peyami Battal, the rector, said. Battal was the first academic to dine with the students following the senate’s decision.

Turkish military under spotlight as food poisoning and accidental deaths increase

Supplying a safe, nutritious, and increasing local food supply to any military outfit is a challenge.

I was privileged for a few years to provide my thoughts to U.S. military food safety types once or twice a year while at Kansas State University in Manhattan.

I made some lasting friendships, and deeply respect the challenges they faced.

Zulfikar Dogan of Ahval News writes that when the Turkish government issued a series of decrees reshaping the country’s institutions in the aftermath of the July 2016 coup attempt, none of the bodies it set its eye on were more significant than the Turkish Armed Forces.

The radical changes implemented in the military came under the spotlight last week when 21 commando trainees in the western province of Manisa were hospitalised with food poisoning. This followed mass outbreaks of food poisoning in May and June last year, again in training facilities in Manisa, where more than 1,000 soldiers became ill and one died.

Similar cases of mass food poisoning took place in other barracks across the country around the same time. Several government-linked catering companies have already lost their contracts, and the defence minister at the time, Nurettin Canikli, resolved to review catering tenders and introduce a new procurement procedure.

Now, spurred by this month’s poisonings, Özgür Özel, a member of parliament for the main opposition Republican People’s Party (CHP), directed a series of questions in the assembly to Defence Minister Hulusi Akar.

He asked whether the new procurement system described by Canikli last year had been put in place, and for information on the food supply at the Manisa barracks and on the companies involved in catering. He also demanded answers on the last date of inspection at the barracks and on the truth of claims that detachments tasked with checking food had been shut down.

But the ruling Justice and Development Party (AKP) rejected opposition proposals to create a special investigation commission and convene the Committee on National Defence in response to the cases of food poisoning.

After the cases of food poisoning, the Turkish Medical Association released a statement drawing attention to the vacuum left when the military medical institutions were turned over to the Ministry of Health. The association called for these institutions to be reopened and returned to the Turkish Armed Forces.

The Turkish Retired Non-Commissioned Officers Association gave its own statement on the matter, stressing that military doctors were soldiers as well as doctors and that the decrees had made the Turkish Armed Forces the only military in the world that did not have dedicated hospitals and doctors. The association also demanded to know whether private companies would be responsible for catering to Turkey’s troops in wartime.

The points Başbuğ and these associations raise are well illustrated by the response to the cases of mass food poisoning in May and June of last year. Since there was not adequate space in Health Ministry facilities to treat the thousands of poisoned troops, hundreds were forced to receive treatment on stretchers outside hospitals.

Similar scenes were replayed after the food poisoning this month. Handing military decision making to the civilian bureaucracy and dissolving military education and medical institutions has resulted in increased casualties.

Lets get the food safety science right at Thanksgiving

I’ve written before that Thanksgiving is my favorite holiday. A mid-week day off (which often stretches to a whole week of food, football and hanging out) is the way to go.
My parents make their annual pilgrimage from Southern Ontario to take in the whole turkey week Black Friday festivities as well.
The week also provides a really great opportunity to take food safety pictures (right, exactly as shown) and talk food safety stuff. The yearly blitz of holiday interviews have started – and so has Dr. Bob, suburban Chicago columnist.
A valiant effort at tackling food safety in the holidays, Dr. Bob misses the mark with a few things:
He starts with,
Emergency rooms across the state and nation are gearing up for a busy week following the Thanksgiving holiday. Unfortunately, many family get-togethers will spread more misery than joy. And I am not speaking of those troublesome individuals that exist in all families that drive many of us to contemplate violent acts. Rather, I am alluding to seasonal foodborne illnesses, which will put a quick end to the Thanksgiving holiday for tens of thousands of families nationwide and several hundred here in our own state.
That’s a great lede – but show your work here Dr. Bob, tens of thousands of hospitalizations might be an over reach here – even if we evenly divide the estimated 128,000 hospitalizations a year we get to a weekly average of 2,500 – I don’t think there’s data to show that Thanksgiving is a 5x or 10x riskier time of the year.
More from the good doctor,
Foodborne illnesses fall into two general categories: intoxication and infection. Foodborne intoxication is caused by ingestion of foods that contain a toxin that may be naturally present in the food, introduced by contamination with poisonous chemicals, or produced by bacteria or fungi growing on foods. Toxins may also be present in some fish and shellfish that have consumed toxin-producing algae. Examples can include contamination with cleaning agents, pesticides and herbicides as well as heavy metals.
Uh, I’m a bit lost – are we talking food borne illness or other stuff now.
Here’s the best though,
It is a well-accepted fact that 100 percent of poultry products are contaminated with salmonella. You read right, 100 percent of the Thanksgiving turkeys carry salmonella. It is only the cooking to proper temperatures and the avoidance of cross contamination that stands between health and sickness.
Not quite, FSIS actually does a great job in reporting contamination levels of Salmonella in poultry, and shows that in turkey contamination is much lower (like only 1.7% positive in turkey). And campy is around the same.
I’m all for talking about food safety and risk reduction and using the holidays as a hook – but lets get the numbers right, avoid the fake news, and give people real risk information.

1 dead, 163 sick from multidrug-resistant Salmonella infections linked to raw turkey products

In the run up to the beginning of the five-week orgy of food and shopping in the U.S. known as Thanksgiving, the U.S. Centers for Disease Control and public health and regulatory officials in several states are investigating a multistate outbreak of multidrug-resistant Salmonella infections linked to raw turkey products. The U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) is monitoring the outbreak.

Seventy-four more ill people from 26 states were added to this investigation since the last update on July 19, 2018.

As of November 5, 2018, 164 people infected with the outbreak strain of Salmonella Reading have been reported from 35 states.

63 people have been hospitalized, and one death has been reported from California.

Epidemiologic and laboratory evidence indicates that raw turkey products from a variety of sources are contaminated with Salmonella Reading and are making people sick.

In interviews, ill people report eating different types and brands of turkey products purchased from many different locations. Three ill people lived in households where raw turkey pet food was fed to pets.

The outbreak strain has been identified in samples taken from raw turkey pet food, raw turkey products, and live turkeys.

A single, common supplier of raw turkey products or of live turkeys has not been identified.

The outbreak strain of Salmonella Reading is present in live turkeys and in many types of raw turkey products, indicating it might be widespread in the turkey industry. CDC and USDA-FSIS have shared this information with representatives from the turkey industry and asked about steps that they may be taking to reduce Salmonella contamination.

Always handle raw turkey carefully and cook it thoroughly to prevent food poisoning. This outbreak is a reminder that raw turkey products can have germs that spread around food preparation areas and can make you sick.

CDC is not advising that consumers avoid eating properly cooked turkey products, or that retailers stop selling raw turkey products.

CDC advises consumers to follow these steps to help prevent Salmonella infection from raw turkey:

Wash your hands. Salmonella infections can spread from one person to another. Wash hands before and after preparing or eating food, after contact with animals, and after using the restroom or changing diapers.

Cook raw turkey thoroughly to kill harmful germs. Turkey breasts, whole turkeys, and ground poultry, including turkey burgers, casseroles, and sausage, should always be cooked to an internal temperature of 165°F to kill harmful germs. Leftovers should be reheated to 165°F. Use a food thermometer to check, and place it in the thickest part of the food.

Don’t spread germs from raw turkey around food preparation areas. Washing raw poultry before cooking is not recommended. Germs in raw poultry juices can spread to other areas and foods. Thoroughly wash hands, counters, cutting boards, and utensils with warm, soapy water after they touch raw turkey. Use a separate cutting board for raw turkey and other raw meats if possible.

Thaw turkey in the refrigerator, in a sink of cold water that is changed every 30 minutes, or in the microwave. Never thaw your turkey by leaving it out on the counter.

CDC does not recommend feeding raw diets to pets. Germs like Salmonella in raw pet food can make your pets sick. Your family also can get sick by handling the raw food or by taking care of your pet.

Food safety in food service: We’re on a mission from god

Now they’re citing my lab in Turkey.

OK, I had a bunch of qualified people, and I’m putting the band back together to write a book.

These Turkey folks don’t know shit.

Neither do lots of others.

The purpose of this study is to examine the food safety knowledge of foodservice staff in fast-food restaurants in a Turkish context. Data for this empirical investigation was gathered from a sample of full-time foodservice staff at the different fast-food restaurants in Ankara/Turkey. Respondents self-administered the questionnaires. The total number of 165 questionnaires was obtained in the research location. Results based on the descriptive statistics, staff works in fast food restaurants in Ankara are not knowledgeable on foodborne/food poisoning and the training rate is not at the satisfactory level. In addition, t-test result demonstrates that female respondents are more knowledgeable compared to males. This paper provides implications for managers in terms of minimising the negative effects of foodborne diseases and maximising the employees’ food safety knowledge in a service setting where the food industry is increasing. Theoretically, the current study by examining the food safety knowledge of restaurant staff and providing insights into the foodborne disease in a developing touristic destination lends further contribution to the related literature.

Assessing the food safety knowledge of fast-food restaurant staff in Ankara/Turkey: some strategies from managerial approach

Middle East Journal of Management, https://doi.org/10.1504/MEJM.2018.095583

Kerem Kaptangil, Mustafa Daskin

https://www.inderscienceonline.com/doi/abs/10.1504/MEJM.2018.095583