Food Poison Journal

Haifa Smoked Fish, Inc. Recall

Drew Falkenstein — Mon, 08 Feb 2010 06:57:16 -0800

The FDA has announced the recall of Haifa Smoked Fish brand vacuum packaged Whole Schmaltz Herring with the lot number 20, because the product was found to be uneviscerated. The risk to consumers is that, due to the errors in production, the fish may be contaminated with clostridium botulinum.

The lot being recalled is a product of Norway, individually vacuum-packed in clear plastic pouches with lot # 20 indicated on the label and distributed through various food retailers in the NY and NJ area.

The Whole Schmaltz Herring was sampled by a New York State Agriculture and Markets Food Inspector during a routine inspection. Subsequent analysis of the product by New York State Food Laboratory personnel confirmed that Whole Schmaltz Herring was not properly eviscerated prior to processing.

The sale of uneviscerated fish is prohibited under New York State Agriculture and Markets regulations because of Clostridium Botulinum spores are more likely to be concentrated in the viscera than any other portion of the fish. Uneviscerated fish has been linked to outbreaks of botulism poisoning.

Botulism is a serious and potentially fatal form of food poisoning, causes the following symptoms: general weakness, dizziness, double-vision and trouble with speaking or swallowing. Difficulty in breathing, weakness of other muscles, abdominal distension and constipation may also be common symptoms. People experiencing these problems should seek immediate medical attention.

Haifa Smoked Fish, Inc's troubled past

On November 13, 2009, The U.S. Department of Justice, on behalf of the U.S. Food and Drug Administration, filed a complaint for permanent injunction against seafood processor Haifa Smoked Fish Inc. of Jamaica, N.Y., and two of its top officers for violations of the Federal Food, Drug and Cosmetic Act.

The injunction was sought to prevent the company from further manufacture, distribution, and sale of its products. “This company has consistently failed to make corrections to improve the insanitary conditions under which it processes smoked fish products, despite frequent warnings to do so,” said Michael Chappell, the FDA’s acting associate commissioner for regulatory affairs. “The FDA will not tolerate food companies that fail to provide adequate safeguards to protect the public.”

The company processes and distributes brined, cold-smoked, and hot-smoked fish and fishery products. The violations documented by the FDA pose a public health hazard because, without adequate controls, products made by Haifa Smoked Fish could become contaminated with (L. mono) or other pathogens and could cause serious illnesses.

“The public must be able to trust that the food in their grocery stores is safe for them to eat,” said Benton J. Campbell, the United States Attorney for the Eastern District of New York. “We will continue to work with the FDA to ensure that companies that produce food under dangerous or insanitary conditions take corrective action to clean up their act.”

Since 2001, the FDA and the New York State Department of Agriculture and Markets (NYSDAM) have inspected the Haifa Smoked Fish facility on numerous occasions. The inspections revealed insanitary conditions that could lead to the contamination of the finished product with L. monoor other pathogenic microorganisms. The act refers to unsanitary conditions as insanitary.

FDA analyses of samples taken during the inspections revealed that food products and environmental surfaces, including food-contact surfaces, were contaminated with L. mono. The company also continually failed to comply with FDA’s Hazard Analysis and Critical Control Point (HACCP) regulations. HAACP regulations require that seafood processors identify all food safety hazards likely to occur for each kind of seafood product, and develop and implement adequate plans to prevent and control those hazards.

The FDA issued warning letters to Haifa Smoked Fish in 2001 and 2004. In response, company officers promised to correct the violations. Subsequent inspections, however, revealed that the company did not make the corrections.

The Silence of the Peppers: Why it matters

Drew Falkenstein — Sun, 07 Feb 2010 09:07:46 -0800

We are currently investigating the illnesses of 15 people potentially sickened by Salmonella-contaminated Salami. There is the possibility, as well, that other products are contaminated by Salmonella montevideo or other strains of salmonella, yet we know virtually nothing about the whereabouts of the pepper. We were contacted yesterday by a young woman from Washington sickened in late January 2010 . . . after the Daniele Inc recall of 1.2 million pounds of potentially contaminated salami. She bought the salami at Costco, but didn't consume it until after word of the outbreak and recall had been announced. She just didn't know that the outbreak was occuring.

Had more effort been put forth to make people aware of the outbreak and dangers associated with consuming the implicated product, this woman's illness may not have happened, and she would not now be in danger of losing her job because of missed work days due to illness. This outbreak is associated with a product--actually two products, pepper and salami--with very long shelf lives. In such a situation, where there is more than a slim possibility that contaminated product will stay in people's homes well past public announcement of an outbreak or recall, better effort and more resources need to be devoted to informing the public of the risks they face.

The Silence of the Pepper Continues

Drew Falkenstein — Sun, 07 Feb 2010 08:09:15 -0800

It is Sunday, February 7, 2010; fifteen full days since Daniele Inc announced a recall of its salami products; and almost as long since the companies and investigating health authorities involved have either suspected or known that the ultimate source of illness in this large, and possibly growing outbreak, is black pepper. But we, the food consuming public, continue to know nothing about the whereabouts of the contaminated pepper. Why the silence?

To recap: The CDC now counts 213 confirmed cases of Salmonella montevideo illnesses stretching from July 2009 to the present. The cases are scattered across the country; 42 states in total; and California, Washington, Illinois, and Massachussets are the hardest hit states, with 30, 15, 13, and 12 cases respectively. Daniele Inc has recalled 1.28 million pounds of potentially contaminated product. The Rhode Island health department announced on February 3 that it had detected the outbreak strain of Salmonella montevideo in pepper samples from two of Daniele Inc's pepper suppliers, Overseas Spice Company and Wholesome Spice. Neither company, nor any government agency involved in the investigation (including FSIS, CDC, and USDA) has announced whether other food companies have received any of the contaminated pepper, or even whether the contaminated pepper is sitting on store shelves. Nor has there been a recall of the contaminated pepper.

From a public health standpoint, the proper flow of information would dictate that the public be made aware of where the contaminated pepper is; alternatively, if the companies involved and the governmental agencies investigating the outbreak have information to suggest that there really is no ongoing risk to the public, we should know that too.

Most of the ire about the slow flow of information in this outbreak exists because of the potential that the outbreak is broader than simply contaminated salami. We know that it wasn't the meat that was contaminated; it was contaminated pepper that ultimately caused the meat to become contaminated. The pepper came from two companies who obviously had the same supplier of pepper. Those pepper companies, Wholesome and Overseas, likely have more than one customer, thus creating the risk that more than Daniele is in possession of, or has used, the contaminated pepper. And critically, there has been the suggestion, at least, that some people who are counted as outbreak cases (i.e. confirmed with the outbreak strain of Salmonella montevideo) did not even have any reported consumption of Daniele Inc salami in the days prior to their illnesses. If true, this means that there must be more products that are making people sick, and may still be on store shelves.

Some of the ire, though, exists because this is not an isolated instance of the slow flow of information in food outbreaks. Recall that the E. coli O157:H7 outbreak linked to beef products from National Steak and Poultry was announced on Christmas Eve--probably the worst time possible to announce an outbreak and recall because most consumers simply aren't paying attention to recalls at that point in time. Another example is the West Missouri Beef recall of 14,000 pounds of potentially contaminated boneless beef products. Apparently, the meat was distributed to Chicago-area wholesalers, yet neither FSIS nor the company itself has disclosed the retail locations that received the potentially contaminated products.

So the silence of the peppers continues. If there is an ongoing risk to the public, we should have the benefit of knowing that so that we can make an informed choice about what products to buy. If there is no ongoing risk to the public, we should have the benefit of knowing that information too.

CDC now counts 213 confirmed cases in Salami/Pepper Salmonella outbreak

Drew Falkenstein — Fri, 05 Feb 2010 16:26:07 -0800

The CDC has again revised its numbers in the Salmonella montevideo outbreak linked to Daniele Inc. salami and black pepper sold by Oversees Spices Company and Wholesome Spice. There are currently 213 cases nationwide, stretching from July 2009 to the present. California Washington, Illinois, and Massachussetts remain the hardest hit states, with 30, 15, 13, and 12 cases respectively.

This outbreak has been thought provoking to say the least. It highlights the need for better communication amongst public health agencies, and faster dissemination of crucial information to the public. See The slow flow of information about food outbreaks. It is also remarkable for its length, causing illnesses over at least a seven month period, and it remains to be seen whether the outbreak is even over. Rhode Island has detected Salmonella in the black pepper sold to Daniele Inc by Oversees and Wholesome, and we still have no word on whether the contaminated black pepper is in consumers homes, on store shelves, or in other food products around the country.

Marler Clark attorney discusses Salmonella Saintpaul outbreak linked to alfalfa sprouts

Suzanne Schreck — Fri, 05 Feb 2010 09:47:50 -0800

The massive Salmonella Saintpaul outbreak from February through April 2009 was featured in a story by WHAS 11 News in Louisville, Kentucky. Drew Falkenstein spoke with Channel 11's Adam Walser about the outbreak:

USA Today Reports Sweeping Changes in Beef Acquisition for School Lunches

Drew Falkenstein — Fri, 05 Feb 2010 07:33:24 -0800

Blake Morrison and Peter Eisler report in today's edition of the USA Today:

The U.S. Department of Agriculture announced sweeping steps Thursday to "assure the safety and quality of food" purchased for the National School Lunch Program.

The measures include tightening requirements on companies that supply ground beef to schools, testing the beef more often and more thoroughly, and improving communications within the USDA to "identify potential food safety issues" before children get sick.

The initiatives come in the wake of a USA TODAY investigation that revealed failures in government programs intended to protect students from food-borne illnesses. More than 31 million children participate in the school lunch program.

The newspaper found that McDonald's and other fast-food chains are far more rigorous than the government in checking for bacteria and dangerous pathogens in beef. USA TODAY also found that the government lacks ways to quickly alert schools when products have been recalled or implicated in safety investigations.

The measures outlined Thursday are intended to address each of those points, bringing the standards and testing protocols in line with those used by the most selective restaurants and retailers. "It's a big deal," food safety consultant David Theno said of the USDA measures. He said the moves will push companies to "play to a higher standard" if they want to continue to supply food to schools.

The USDA also pledged to review the safety records of its school lunch suppliers more carefully and bar companies that have had repeated problems with their commercial products.

Such a move could affect companies such as Beef Packers, a Fresno company that recalled 826,000 pounds of ground beef last summer because it contained a drug-resistant strain of salmonella. Public health officials warned consumers to discard products from the company, which had a history of salmonella problems, but USA TODAY found that the USDA paid Beef Packers hundreds of thousands of dollars for 450,000 pounds of ground beef made during the period covered by the commercial recall.

Revisited: Salmonella Saintpaul outbreak linked to Alfalfa Sprouts

Drew Falkenstein — Fri, 05 Feb 2010 06:44:32 -0800

From February through May of 2009, the CDC counted 235 confirmed victims of a Salmonella Saintpaul outbreak linked to alfalfa sprouts. Here is the distribution of confirmed cases in the outbreak:

Nebraska was the hardest hit state by far, with 111 confirmed illnesses, many of whom consumed alfalfa sprouts on sandwiches from Jimmy John's restaurants. South Dakota had the second most illnesses with 38.

Investigating health authorities ultimately determined that sprout seeds distributed by a major seed distribution company called Caudill Seed (Louisville , KY) had been contaminated with Salmonella.

The outbreak occurred in two phases. The first phase, causing illness primarily in the midwest, occurred in February and March 2009, and the contaminated sprouts were grown by CW Sprouts, an Omaha Nebraska company. The chlorine treatment methods used by CW Sprouts were inadequate to eliminate the bacteria from the contaminated seeds that Caudill Seed had distributed to CW.

The second phase of the outbreak occurred shortly after the first, causing Salmonella infection by genetically indistinguishable bacteria from the CW Sprouts phase of the outbreak. But CW Sprouts did not distribute to many of the states affected by the second phase. The sprouts implicated in the second phase had been grown by multiple sprout growers from seeds produced and sold by Caudill Seed. In fact, the seeds in both phases of this large outbreak came from the same lot (032) of Caudill's seeds.

Marler Clark represents nine people in this outbreak, mostly from the State of Nebraska. Three lawsuits have been filed.

FDA Releases Update on Salmonella, Black Pepper, Salami

David Babcock — Thu, 04 Feb 2010 13:26:04 -0800

The FDA posted an update on the outbreak of Salmonella Montevideo related to salami and black pepper today, February 4, 2010.

The update includes the newest CDC statistics on the outbreak: 207 people have been infected with a matching strain of Salmonella Montevideo in at least 42 states and the District of Columbia.

In addition, the FDA update contains a link to the analysis of the empidemiologic study that links these illnesses to salami produced by Daniele International Inc, as well as a link to the list of recalled products.

The FDA provided some detail about positive Salmonella testing in the black pepper incorporated in Daniele's product:

Recent samples of black pepper collected by the Rhode Island Department of Health at Daniele International Inc. tested positive for Salmonella. One sample from an open container matched the outbreak strain.

The FDA is apparently still trying to determine whether black pepper "poses a risk to consumers:"

The FDA is actively investigating the supply chain of the black pepper used in the manufacturing of the recalled meat products to see if it poses a risk to consumers...If FDA identifies a public health risk associated with black pepper, or any other product, the Agency will take the appropriate action necessary to protect the public's health.

Finally, the FDA closed by urging customers to make sure their homes were free of the recalled products, which have a shelf life of one year.

15 Washington Residents Sickened in Salami/Pepper Salmonella Outbreak

Drew Falkenstein — Thu, 04 Feb 2010 07:09:34 -0800

The CDC's February 2 update on the Salmonella outbreak linked to salami and black pepper indicates that Washington, with 15 victims, is among the hardest hit states in the outbreak. Only California and New York, with 30 and 16 victims respectively, have more sick residents. Here is a distribution map of illnesses linked to the outbreak:

The latest update on the outbreak:

Rhode Island Department of Health has confirmed that the black pepper used to manufacture Daniele Inc's salami products has tested postiive for Salmonella Montevideo, thus confirming that the pepper was the ultimate source of contamination in the outbreak. Rhode Island has also indicated that black pepper from two of Daniele Inc's spice suppliers (Wholesome Spices and Oversees Spice Company) has tested positive for the outbreak strain of salmonella. This means that Wholesome and Oversees must have purchased their black pepper from the same supplier.

This outbreak may not be over. Unfortunately, the FDA and CDC have been largely silent on the nature of the ongoing risk to the public. And Wholesome and Oversees have not yet heeded calls to tell the public whether they sold contaminated product to other companies, so we do not yet know whether other food producers have been using the contaminated product. In fact, it seems very likely that they did. There is some indication that certain outbreak victims had no exposure to salami whatsoever in the timeframe of their illnesses, yet they match the outbreak strain of Salmonella. The implication is that there is, in fact, another food that is, or was, making people sick.

Marler Clark Files Second Salmonella-tainted Black Pepper Salami Case

Bill Marler — Wed, 03 Feb 2010 19:31:13 -0800

A second victim of the nationwide outbreak of Salmonella linked to pepper in salami meats has come forward to file a lawsuit against Daniele International Inc., which produced the recalled salami, and against Wholesome Spice, which supplied the tainted pepper. The CDC reports that currently 207 are confirmed ill in 42 states, with the actual total likely much higher.

“The CDC is the first to say that only about 3% of Salmonella illnesses are ever culture-confirmed, so the real number of victims of this outbreak is in the thousands,” said the attorney for the victims, William Marler. “Most people with Salmonella never know they have it, and try to ‘tough it out’ as a stomach flu, but Salmonella can get ugly, and it is important to visit a health care professional if you have consumed the recalled product or are experiencing symptoms of Salmonella infection.”

Harold Hanks purchased Salami products made by Daniele at a Walmart in Osage Beach, Missouri. He fell ill within a day of consuming the products, with nausea and diarrhea that continued to worsen. After medications prescribed by his physician failed to give him any relief, Mr. Hanks went to the emergency room at his local hospital, where he was treated for severe dehydration and bacterial infection. Stool samples taken during his hospital visit returned positive for the Salmonella montevideo outbreak strain. He continues to recover from his illness. His lawsuit was filed by Marler Clark and by Kansas attorney Roger Nail of Goza and Honnold.

“Salmonella infections have changed — and taken — lives,” continued Marler. “Our clients from the terrible outbreak of Salmonella in Peanut Butter have just learned that their lawsuits will be settled and bills paid from a twelve million dollar insurance policy. I’m glad we were able to help these people — even after the Peanut Corporation of America declared bankruptcy — but the best insurance policy any company can have is exemplary food safety practices.”

The slow flow of information about food outbreaks

Drew Falkenstein — Wed, 03 Feb 2010 19:22:11 -0800

Today, the Rhode Island Department of health announced that the pepper that Daniele Inc used to produce its salami--now the subject of a major recall and outbreak--was contaminated, not the meat itself Pepper has been suspected as the source of this outbreak since at least January 23, 2010, if not before. A little frighteningly, Rhode Island also says that pepper from both of Daniele Inc's suppliers has tested positive for the outbreak strain (suggesting a common grower or shipper) of salmonella, and that a number of outbreak victims may not have eaten salami at all. What's the implication? That more than just Daniele Inc. has received contaminated black pepper. Is it in your home now?

The problem that this scenario brings to light is that the public is clearly not getting the information that it should . . . and in a timely fashion. As I posted earlier today, the suppliers of pepper to Daniele (Oversees Spice Company and Wholesome Spice) should publicly disclose the list of customers who bought, or may have bought, the contaminated pepper. After all, the fact that some of the people sickened with the outbreak strain of salmonella in this outbreak, and who did not have an exposure to salami, suggests that other food producers may in fact have received the contaminated pepper as well, and they may be producing and selling food that is contaminated. Maybe the FDA doesn't have enough information to establish just who that or those food producers are, but Oversees and Wholesome could certainly protect a lot of people by disclosing their customer list.

This problem--i.e. the stagnant flow of information in food outbreaks--is not all on food suppliers either. Timely information published in a manner that effectively passes the information to the consuming public is not a strong point of our government either. Bill Marler authored a highly insightful blog post several days ago about this problem. Asking "why the silence of the steaks and the perjury of the peppers," he stated as follows:

why do the US Government and US Business not believe in Capitalism? The one thing that makes capitalism – free markets – work is knowledge and transparency. If you know who poisoned you, you can stop buying food from them. However, here – especially here – the government and industry do everything they can to not tell us the facts. In both instances they put the information out on a holiday or a Friday night, so no one but a loser blogger would be paying attention. More importantly is the fact that they withhold information about the ultimate source of the contamination? Why not say whom the supplier of steaks and trim is? Why not let the public know who produced the peppers and where they are from?

As for steaks, the event that got Bill talking was the recall of 124 tons of tenderized beef products manufactured by National Steak and Poultry and sold to a variety of major restaurant chains throughout the country. The recall was announced by USDA's Food Safety and Inspection Service on . . . Christmas Eve. Other than a few lawyers and the CDC, who is paying attention to FSIS recall notices on Christmas Eve? Or the following day? Or really any day for the rest of the year? And for that matter, on New Year's day too? Virtually nobody, particularly not a very significant percentage of the food consuming public.

This kind of information should not come on Christmas Eve, Friday night, or any other time of the year clearly designed to lessen the flow of information to the public, thereby protecting the interests only of the business that manufactured or sold the contaminated product. Eddie Gehman Kohan said it much better on her blog, Obamafoodorama.com, posing the question "How is it possible that a blogger notifies the public of a new Class I (you could die) recall of 1,240,000 pounds of meat before USDA does?":

It's a grim situation when a private citizen is more on the ball than the federal agency that's supposed to be managing national food safety concerns (CDC's own e mail heads-up about the outbreak included no information, except that a product sold nationally was contaminated with Salmonella Montevideo).

If the answer to these valid questions is that notifying the public will encourage lawsuits, or make them easier to prove, the failure to do so is only going to allow outbreaks to happen. And that's when the lawyers come in.

More Salami/Pepper Salmonella News: Where is the contaminated pepper?

Drew Falkenstein — Wed, 03 Feb 2010 16:02:53 -0800

The Rhode Island Department of Health announced today that recent test results strongly suggest black pepper is the source of the Salmonella outbreak associated with Daniele Inc. salami. According to the CDC, the outbreak has sickened at least 207 people in 42 states.

Daniele purchased black pepper from two different distributors (Mincing Oversees Spice Company and Wholesome Spices) who buy imported black pepper. Samples of pepper from both distributors have tested positive for Salmonella. All other tests of employees and the facilities are negative at this time. These findings are consistent with Daniele Inc.’s history of no Salmonella findings by in-house testing and USDA periodic testing. No additional food items have been added to the recall list.

As part of the outbreak investigation, it was determined that both distributors who supplied black pepper to Daniele imported pepper from common sources.

“These recent findings show that black pepper used during the manufacturing process at Daniele was the likely source of this outbreak,” said Director of Health David R. Gifford, MD, MPH. “This outbreak only underscores the importance of closely monitoring food that is imported from other countries as they may not have the same food safety standards as we do.”

Adding even more concern to an already devastating outbreak, a spokesperson for the Rhode Island Department of Health indicates that some of the outbreak victims don't have a known exposure to salami. What does this mean? Bad news for the american consumer. If there are lots of people out there who have been sickened by a strain of Salmonella that genetically matches the strain on Daniele Inc salami, there is a high likelihood that plain old pepper, or pepper on foods other than salami, is making people ill too.

What needs to happen now is that both suppliers of black pepper to Daniele Inc.--Mincing Oversees Spice Co. and Wholesome Spice--need to tell the government and everybody else who they distributed potentially contaminated pepper to. Pepper is a product with a long shelf life, and is ubiquitous in every home. This makes it a particularly risky food when there is a possibility that it is contaminated.

Oversees Spice and Wholesome: do what's right. If your products and sales are traceable, as they should be, then tell the public where the potentially contaminated product went. You may be facing multiple lawsuits now, but there will be many more to come if this outbreak continues to grow.

Class I Beef Recall due to E. coli Contamination

Drew Falkenstein — Wed, 03 Feb 2010 06:42:29 -0800

West Missouri Beef, LLC has voluntarily recalled 14,000 pounds of boneless beef products due to potential contamination by E. coli O157:H7. USDA's Food Safety and Inspection Service (FSIS) announced the Class I recall in a press release last night. It is the third Class I recall this year, and the fifth since November, adding up to 1,636,000 pounds of beef products that have been recalled due to potential E. coli O157:H7 contamination in the last 3+ months.

What is a Class I recall?

A Class I recall, according to FDA definitions, should occur when "there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death." Class II and III recalls are appropriate only when there is a significantly lesser, or remote, risk of adverse health consequences, or when the health consequences are minor. Due to its lethal capacity, E. coli O157:H7 is a bacteria that always requires a Class I recall.

What is E. coli O157:H7?

Escherichia coli (E. coli) are members of a large group of bacterial germs that inhabit the intestinal tract of humans and other warm blooded animals (mammals, birds). Newborns have a sterile alimentary tract which within two days becomes colonized with E. coli.

More than 700 serotypes of E. coli have been identified. The different E. coli serotypes are distinguished by their “O” and “H” antigens on their bodies and flagella, respectively. The E. coli serotypes that are responsible for the numerous reports of contaminated foods and beverages are those that produce Shiga toxin (Stx), so called because the toxin is virtually identical to that produced by another bacteria known as Shigella dysenteria type 1 (that also causes bloody diarrhea and hemolytic uremic syndrome [HUS] in emerging countries like Bangladesh) (Griffin & Tauxe, 1991, p. 60, 73). The best known and most notorious Stx-producing E. coli is E. coli O157:H7. It is important to remember that most kinds of E. coli bacteria do not cause disease in humans, indeed, some are beneficial, and some cause infections other than gastrointestinal infections, such urinary tract infections. This section deals specifically with Stx-producing E. coli, including specifically E. coli O157:H7.

Shiga toxin is one of the most potent toxins known to man, so much so that the Centers for Disease Control and Prevention (CDC) lists it as a potential bioterrorist agent (CDC, n.d.). It seems likely that DNA from Shiga toxin-producing Shigella bacteria was transferred by a bacteriophage (a virus that infects bacteria) to otherwise harmless E. coli bacteria, thereby providing them with the genetic material to produce Shiga toxin.

Although E. coli O157:H7 is responsible for the majority of human illnesses attributed to E. coli, there are additional Stx-producing E. coli (e.g., E. coli O121:H19) that can also cause hemorrhagic colitis and post-diarrheal hemolytic uremic syndrome (D+HUS). HUS is a syndrome that is defined by the trilogy of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute kidney failure.

Stx-producing E. coli organisms have several characteristics that make them so dangerous. They are hardy organisms that can survive several weeks on surfaces such as counter tops, and up to a year in some materials like compost. They have a very low infectious dose meaning that only a relatively small number of bacteria, less than 50, are needed “to set-up housekeeping” in a victim’s intestinal tract and cause infection.

The Centers for Disease Control and Prevention (CDC) estimates that every year at least 2000 Americans are hospitalized, and about 60 die as a direct result of E. coli infections and its complications. A recent study estimated the annual cost of E. coli O157:H7 illnesses to be $405 million (in 2003 dollars) which included $370 million for premature deaths, $30 million for medical care, and $5 million for lost productivity (Frenzen, Drake, and Angulo, 2005).

What is Hemolytic Uremic Syndrome?

Post-diarrheal Hemolytic Uremic Syndrome (D+HUS) is a severe, life-threatening complication that occurs in about 10% of those infected with E. coli O157:H7 or other Shiga toxin (Stx) producing E. coli. D+HUS was first described in 1955, but was not known to be secondary to E. coli infections until 1982. It is now recognized as the most common cause of acute kidney failure in infants and young children. Adolescents and adults are also susceptible, as are the elderly who often succumb to the disease.

How did these otherwise harmless E. coli become such killers? It seems likely that DNA from a Shiga toxin producing bacterium known as Shigella dysenteriae type 1 was transferred by a bacteriophage (bacteria infected with a virus) to harmless E. coli bacteria, thereby providing them with the genes to produce one of the most potent toxins known to man. So potent, that the Department of Homeland Security lists it as a potential bioterrorist agent. Although E. coli O157:H7 are responsible for the majority of cases in America, there are many additional Stx producing E. coli that can cause D+ HUS.

The chain of events leading to HUS begins with ingestion of Stx producing E. coli (e.g., E. coli O157: H7) in contaminated food, beverages or through person to person transmission. These E. coli rapidly multiply in the intestines causing colitis (diarrhea), and tightly bind to cells that line the large intestine. This snug attachment facilitates absorption of the toxin into the circulation where it becomes attached to weak receptors on white blood cells (WBC) thus allowing the toxin to “ride piggyback” to the kidneys where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin. Organ injury is primarily a function of Gb3 receptor location and density. Receptors are probably heterogeneously distributed in the major body organs, and this may explain why some patients develop injury in other organs (e.g., brain, pancreas).

Once Stx attaches to receptors, it moves into the cell’s cytoplasm where it shuts down the cells’ protein machinery resulting in cellular injury and/or death. This cellular injury activates blood platelets and the coagulation cascade which results in the formation of clots in the very small vessels of the kidney resulting in acute kidney injury and failure. The red blood cells are hemolyized (destroyed) by Stx and/or damaged as they attempt to pass through partially obstructed microvessels. Blood platelets (required for normal blood clotting), are trapped in the tiny blood clots or are damaged and destroyed by the spleen.

1,636,000 Pounds of Beef Recalled since November due to E. coli O157:H7

Drew Falkenstein — Tue, 02 Feb 2010 20:03:22 -0800

The unfortunate trend for E. coli and beef in late 2009 and 2010 continues. This evening, West MissourI Beef, LLC, a Rockville, Missouri beef company, recalled 14,000 pounds of boneless beef products due to potential E. coli O157:H7 contamination. Today's recall brings the tally for recalled beef due to E. coli contamination to 1,636,000 pounds of beef products in the last three months.

On January 18, 2010, the USDA's food inspection branch (FSIS) announced the recall of 846,000 pounds of ground beef products produced by a California company called Huntington Meat Packing, Inc., due to potential contamination by E. coli O157:H7.

On January 11, 2010, Adams Farm Slaughterhouse, LLC., an Athol, Mass., stablishment, recalled approximately 2,574 pounds of beef products due to potential E. coli O157:H7 contamination. The recall occurred in the wake of an epidemiological investigation into the E. coli illness of at least one Massachusetts resident.

In November 2009, ground beef from a New York ground beef company called Fairbank Farms was recalled due to E. coli O157:H7 contamination. That outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS).

And on Christmas Eve 2009, National Steak and Poultry recalled at least 124 tons of mechanically tenderized beef products. The National Steak and Poultry outbreak caused at least 21 E. coli O157:H7 illness in 16 states, including nine hospitalizations and one case of HUS.

Together, the recalls and outbreaks linked to beef from Adams Farm, National Steak and Poultry, Fairbank Farms, and now West Missouri Beef have caused at least 48 illnesses nationally. At least 1,636,000 pounds of beef have been recalled in total in the five recalls. .

West Missouri Beef Recalls 14,000 pounds of Boneless Beef due to Potential E. coli Contamination

Drew Falkenstein — Tue, 02 Feb 2010 19:53:16 -0800

West Missouri Beef, LLC, a Rockville, Missouri establishment, is recalling approximately 14,000 pounds of fresh boneless beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The following products are subject to recall:

One combo bin containing approximately 2,000 pounds of fresh boneless beef identified as “75 1-M,” produced on October 26, 2009.

One combo bin containing approximately 2,000 pounds of fresh boneless beef identified as “90 3-D,” produced on November 25, 2009.

One combo bin containing approximately 2,000 pounds of fresh boneless beef identified as “90 5-D,” produced on November 27, 2009. Combo bins containing approximately 2,000 pounds of fresh boneless beef identified as “90 2-P,” “90 2-R” or “90 2-V,” produced on December 8, 2009.

One combo bin containing approximately 2,000 pounds of fresh boneless beef identified as “90 3-E,” produced on January 13, 2010. Each container is marked with the establishment number “EST. 5821” inside the USDA mark of inspection.

The fresh boneless beef products were distributed to wholesalers in the Chicago, Ill., area.

The problem was discovered by FSIS during a verification review performed at the establishment.

Latest Salmonella Infections Final Nail For Nature's Fare Restaurant

Colin Caywood — Tue, 02 Feb 2010 15:59:57 -0800

Considered a local institution in Cicero, New York since its opening in 1974, the Nature's Fare Restaurant announced today that it is closing for good. According to the Post-Standard, the restaurant, which cooked and prepared between 100 and 200 fresh, raw turkeys each day, was recently notified that it had been linked to the Salmonella infections of at least two Plainview county residents. And this is not the first time. Approximately 20 people in 2008, and another 7 people in 2009, had Salmonella infections that were linked to food prepared and served at the restaurant.

Interestingly, the owner says he will contact people in the restaurant business to see if they want to buy the site and operate it under a model that does not involve working with fresh, raw poultry.

Symptoms of Salmonella include diarrhea, abdominal cramps, fever, nausea, and vomiting. In mild cases, diarrhea may be non-bloody, occur several times per day, and not be very voluminous; in severe cases it may be frequent, bloody and mucoid, and of high volume.

Fever generally occurs in the 100°F to 102°F (38°C to 39°C) range. Vomiting is less common than diarrhea. Headaches, myalgias (muscle pain), and arthralgias (joint pain) are often reported as well. Whereas the diarrhea typically lasts 24 to 72 hours, patients often report fatigue and other nonspecific symptoms lasting 7 days or longer.

A good point about the Salmonella salami/pepper outbreak

Drew Falkenstein — Tue, 02 Feb 2010 07:15:58 -0800

In response to my AM's blog post about the true scope of the Salmonella salami/pepper outbreak, a reader states as follows:

Can't you read between the lines Drew. The contaminated pepper was sent to
food plants all over the country, to supermarkets, restaurants etc. Its
everywhere. The only safe products now may be from Daniele Inc..The RI dept
of health and FDA have both confirmed positive salmonella in unopened
pepper. The truth is too big for you to get your mind around. This is a
big huge mess and now could be a bigger cover up. Someone should inform
people of the truth...

Good point. Where else is the contaminated pepper? What do our national public health agencies know about the pepper product (other than that it's from Vietnam), and when do we get the benefit of having them disclose what they know? Is there any ongoing risk to consumer health? Is the pepper in our homes?

The True Scope of the Salami/Pepper Salmonella Outbreak

Drew Falkenstein — Tue, 02 Feb 2010 06:18:46 -0800

The CDC reported yesterday that there are 203 confirmed "cases" (i.e. victims who's stool sample has tested positive for the outbreak strain of bacteria) in the recent Salmonella outbreak linked to recalled salami (Daniele, Inc.) and the ingredient pepper (Wholesome Spice). The outbreak is truly nationwide, having sickened people in at least 42 states and the District of Columbia. But as in any outbreak situation, particularly one involving a relatively common product distributed over a wide geographic region over a seven month time frame, there are many more people ill across the country than the CDC's official count would suggest.

A leading study on the subject suggests that the number of actual victims in a given outbreak, as opposed to merely those with positive stool samples, is as much as 38 times the number of stool sample confirmed individuals. See Paul Mead et al. http://www.cdc.gov/ncidod/EID/vol5no5/mead.htm.

There are several reasons why. First, it is highly unlikely that, considering the widespread distribution and availability of the potentially contaminated products, only the salami and pepper consumed by official "cases" was contaminated with Salmonella. More likely is that many more of the individual packages of salami were contaminated. After all, Daniele Inc. has now recalled 1,257,000 pounds of Salami. The 203 confirmed victims in this outbreak have certainly not purchased, much less consumed, that much salami.

Second, as noted by Mead et al., underreporting of foodborne disease is common. See Mead Article at 607. “Surveillance of foodborne illness is complicated by several factors. The first is underreporting. Although foodborne illnesses can be severe or even fatal, milder cases are often not detected through routine surveillance.” It is frequently the case that only the more severe illnesses come to the attention of health department officials. The less severe illnesses in any given outbreak often require less medical treatment, and the possibility that the causative agent—e.g. Salmonella bacteria—will be identified decreases as well.

Many cases of foodborne illness are not reported because the ill person does not seek medical care, the health-care provider does not obtain a specimen for diagnosis, the laboratory does not perform the necessary diagnostic test, or the illness or laboratory findings are not communicated to public health officials.

See Mead Article at 609.

Additionally, the likelihood that secondary transmission of Salmonella-bacteria occurred must be considered. As stated in the Mead Article, “many pathogens transmitted through food are also spread through water or from person to person, thus obscuring the role of foodborne transmission.” See Mead Article at 607. In other words, it is common in outbreak situations for people who became infected by contaminated food to thereafter sicken co-workers or family members by unwitting transmission of a small amount of bacteria.

Finally, in this particular outbreak, it must also be considered that the CDC's official "case" count is only for Salmonella Montevideo, which is the only strain that the CDC has officially linked to the recalled, contaminated product. But the CDC has itself stated that testing by at least one State Health Department has detected the presence of other strains of Salmonella in or on the recalled product. It is difficult to accurately estimate the number of people who have suffered illness, confirmed by stool test or not, due to infection by a strain of Salmonella that has not even been made public.

These circumstances constellate to make it highly likely that the salami outbreak is much larger than just 203 sick people. As Mead states:

To calculate the total number of illnesses caused by each pathogen, it is necessary to account for underreporting, i.e., the difference between the number of reported cases and the number of cases that actually occur in the community. For Salmonella, a pathogen that typically causes nonbloody diarrhea, the degree of underreporting has been estimated at ~38 fold . . . [W]e used a factor of 38 for pathogens that cause primarily nonbloody diarrhea (e.g. Salmonella, Campylobacter).

See Mead Article at 607.

203 multiplied by 38 is a big number = 7,714.

Consumer Reports: Packaged Salad Can Contain High Levels of Bacteria

Bill Marler — Tue, 02 Feb 2010 03:08:15 -0800

Consumers Union Urges FDA to Set Performance Standards for Greens

YONKERS, N.Y., Feb. 2 /PRNewswire-USNewswire/ -- Consumer Reports' latest tests of packaged leafy greens found bacteria that are common indicators of poor sanitation and fecal contamination, in some cases, at rather high levels. The story appears in the March 2010 issue of Consumer Reports and is also available free online at www.ConsumerReports.org. Consumers Union today also issued a report urging the U.S. Food and Drug Administration (FDA) to set safety standards for greens, available online at www.ConsumersUnion.org. FDA food safety legislation pending in the Senate, and passed last summer by the House of Representatives, would require the FDA to create just such safety standards.

The tests, which were conducted with financial support from the Pew Health Group, assessed for several types of bacteria, including total coliforms and Enterocccous -- "indicator organisms" found in the human digestive tract and in the ambient environment that can signal inadequate sanitation and the potential for the presence of disease-causing organisms. While there are no existing federal standards for indicator bacteria in salad greens, there are standards for these bacteria in milk, beef, and drinking water. Several industry consultants suggest that an unacceptable level in leafy greens would be 10,000 or more colony forming units per gram (CFU/g).

Consumer Reports found that 39 percent of samples exceeded this level for total coliform, and 23 percent for Enterococcus. The tests did not find E. coli O157:H7, Listeria monocytogenes or Salmonella -- sometimes deadly pathogens which can be found in greens, although it was not expected given the small sample size. The goal was to investigate other markers of poor sanitation that should be used in the food safety management of produce.

"Although these 'indicator' bacteria generally do not make healthy people sick, the tests show not enough is being done to assure the safety or cleanliness of leafy greens," said Dr. Michael Hansen, senior scientist at Consumers Unions, nonprofit publisher of Consumer Reports. "Levels of bacteria varied widely, even among different samples of the same brand. More research and effort is needed within the industry to better protect the public. In the meantime, consumers should buy packages of greens that are as far from the use-by date as possible."

For its latest analysis, Consumer Reports had an outside lab test 208 containers of 16 brands of salad greens, sold in plastic clamshells or bags, bought last summer from stores in Connecticut, New Jersey, and New York. Among the findings:

39 percent of samples exceeded 10,000 CFUs (or another similar measure) per gram for total coliforms and 23 percent for Enteroccocus, the levels industry consultants deemed unacceptable.
2 percent of samples exceeded French and 5 percent Brazilian standards for fecal coliform bacteria.
Many packages containing spinach, and packages which were one to five days from their use-by date, had higher bacterial levels. Packages six to eight days from their use-by date generally fared better.
Whether the greens came in a clamshell or bag, included "baby" greens, or were organic made no difference in bacteria levels.
Brands for which there were more than four samples, including national brands Dole, Earthbound Farm Organic, and Fresh Express, plus regional and store brands, had at least one package with relatively high levels of total coliforms or Enteroccocus.

"The Senate should act immediately to pass pending FDA food safety reform legislation that requires the agency to set performance standards as well as develop safety standards for the growing or processing of fresh produce," said Hansen. "FDA should also formally declare that certain pathogenic bacteria -- such as E. coli O157:H7, Salmonella, and Listeria -- be considered adulterants when found in salad greens." The Senate bill, S. 510, the FDA Food Safety Modernization Act, was voted unanimously out of committee in November. The House passed similar legislation last July.

Until packaged salad becomes cleaner, consumers' best line of defense involves following these procedures in stores and kitchens:

Buy packages far from their use-by date.
Wash the greens even if the packages say "prewashed" or "triplewashed." Rinsing won't remove all bacteria but may remove residual soil.
Prevent cross contamination of greens by keeping them away from raw meat and poultry.

For more information, go to www.ConsumersUnion.org or www.ConsumerReports.org. The March issue of Consumer Reports goes on sale February 2, 2010 wherever magazines are sold.

Genetic Risk Factors for Post-Infectious Irritable Bowel Syndrome Following a Waterborne Outbreak of Gastroenteritis

Bill Marler — Tue, 02 Feb 2010 01:51:54 -0800

Abstrac: j.gastro.2009.12.049

Alexandra-Chloé Villani, Mathieu Lemire, Marroon Thabane, Alexandre Belisle, Geneviève Geneau, Amit X. Garg, William F. Clark, Paul Moayyedi, Stephen M. Collins, Denis Franchimont, John K. Marshall

Background & Aims:

Acute gastroenteritis is the strongest risk factor for irritable bowel syndrome (IBS). In May 2000, more than 2300 residents of Walkerton Ontario developed gastroenteritis from microbial contamination of the municipal water supply; a longitudinal study found that more than 36.2% of these developed IBS. We used this cohort to study genetic susceptibility to post-infectious (PI)-IBS.

Methods:

We screened 79 functional variants of genes with products involved in serotoninergic pathways, intestinal epithelial barrier function, and innate immunity and performed fine mapping in regions of interest. We compared data from Walkerton residents who developed gastroenteritis and reported PI-IBS 2–3 years after the outbreak (n=228, cases) with data from residents that developed gastroenteritis but did not develop PI-IBS (n=581, controls).

Results:

Four variants were associated with PI-IBS, although the association was not significant after correction for the total number of SNPs. Two were located in TLR9, which encodes a pattern recognition receptor (rs352139, P545P, p =0.0059 and rs5743836, -T1237C, p =0.0250; r2<0.14); 1 was in CDH1, which encodes a tight junction protein (rs16260, -C160A, p =0.0352); and 1 was in IL6, which encodes a cytokine (rs1800795, -G174C, p=0.0420). Denser mapping of these 3 regions revealed 1 novel association in IL6 (rs2069861, p =0.0069) and 14 associations that could be accounted for by linkage disequilibrium with the 4 original variants. The TLR9, IL6, and CDH1 variants all persisted as independent risk factors for PI-IBS when controlling for previously identified clinical risk factors.

Conclusion:

This is the first descriptive study to assess potential genetic determinants of PI-IBS. Genes that encode proteins involved in epithelial cell barrier function and the innate immune response to enteric bacteria are associated with the development of IBS following acute gastroenteritis.