According to the Food and Drug Administration (FDA), the product was recalled April 28 after the Michigan Department of Agriculture found Salmonella Montevideo in routine sampling. The FDA also found Salmonella Mbandaka in further sampling of the same brand of tahini and the strain matches the DNA fingerprint of a strain associated with a small multi-state cluster of salmonellosis cases.

The Minnesota Department of Health has confirmed that the infection in one of the Minnesota cases matches the Mbandaka outbreak strain and one matches the Montevideo strain. Neither child was hospitalized and both are recovering.

Samples of the tahini from the homes of the Minnesota cases have been collected and are being analyzed by the Minnesota Department of Agriculture Laboratory.

The Krinos brand tahini sesame paste was distributed nationwide through retail stores. It is sold in 1 lb. glass jars, 2 lb. glass jars and in 40 lb. plastic pails. The UPC codes for the products are 0-75013-28500-3 (1 lb. jar), 0-75013-28510-2 (2 lb. jar) and 0-75013-04018-3 (40 lb. pail). The recalled lots have a code stamped on the lid of EXP JAN 01 – 2014 up to and including EXP JUN 08 – 2014 and EXP OCT 16 – 2014 up to and including EXP MAR 15 – 2015.

More information on the recall can be found on the FDA website: http://www.fda.gov/Safety/Recalls/ucm351630.htm.

The Cumberland County Department of Public Health continues to investigate the outbreak of Salmonella infection reported this week at the Holiday Inn Bordeaux, 1707 Owen Drive.

As part of the ongoing investigation, the Health Department and the North Carolina Division of Public Health continue to ask individuals who consumed food or beverages at the Holiday Inn Bordeaux since May 1and then developed symptoms within three days of that visit to call the county Health Department at 910-433-3638.

Individuals in other North Carolina counties should contact their local public health departments.

The Holiday Inn Bordeaux serves food at two restaurants, the All American Sports Bar and Grill and the Café Bordeaux, and from their banquet kitchen.

The Health Department has also set up a “Salmonella Hotline” at 910-433-3824.

Cape Fear Valley Health System has a Care Link health education line staffed by registered nurses. Call at 615-LINK (5465) with questions about Salmonella infection.

The number of cases of salmonella has risen to 18 including four people who are in the hospital.

All of them ate at the Holiday Inn Bordeaux since May 1.

The Holiday Inn Bordeaux has two restaurants, the All American Sports Bar and Grill and the Café Bordeaux. There is also a banquet kitchen.

Mae Freeman says she has never felt so sick in her life. Last Wednesday, she ate at the Holiday Inn hotel, and a day later she felt terrible.

“At first, I thought I was coming down with something because I had chills, and then I was running a high temperature, and then all of a sudden I had this severe case of diarrhea and severe abdominal cramps,” said Freeman.

Freeman says her doctor told her she had salmonella poisoning.

The health department is asking anyone who developed symptoms after eating at the Holiday Inn Bordeaux to call them at (910) 433-3638. For additional information, a salmonella hotline has been set up at (910) 433-3824.

As of Monday, the Health Department had identified 16 individuals with signs and symptoms consistent with salmonella: nausea, vomiting and diarrhea. All share a common denominator — they ate at the same establishment, the Holiday Inn Bordeaux, within the same time frame, Tuesday, May 7 and Wednesday, May 8. The Holiday Inn Bordeaux has two restaurants, the All American Sports Bar and Grill and The Café Bordeaux. There is also a banquet kitchen.

The Health Department is asking anyone who developed symptoms after eating at the Holiday Inn Bordeaux on Tuesday, May 7 or Wednesday, May 8 to call the department at 910-433-3638. Also, for additional information you can call the “Salmonella Hotline” at 910-433-3824.

To stop the further spread of the illness, the Health Department advises that handwashing is the best control measure.  People need to make sure they are staying hydrated and should seek medical care from their private doctor, urgent care or emergency room if their nausea, vomiting and diarrhea symptoms don’t improve.

A total of 81 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 18 states. The number of ill persons identified in each state is as follows: Arizona (11), California (28), Colorado (1), Idaho (2), Illinois (3), Louisiana (1), Massachusetts (1), Maryland (1), Minnesota (9), Nevada (1), New Mexico (2), North Carolina (3), Ohio (3), Oregon (2), South Dakota (2), Texas (6), Virginia (3), and Wisconsin (2).  Since the last update, 8 new ill persons have been reported from Arizona (2), Minnesota (1), North Carolina (2), Ohio (2), and Virginia (1). This PFGE pattern has rarely been seen before in PulseNet and in the past typically caused 0-5 cases per year.

29% of ill persons have been hospitalized, and no deaths have been reported

Linh Nguyen, PhD, MPH, Epidemiologist

April 30, 2013

BACKGROUND

On April 26, 2013, the Southern Nevada Health District (SNHD), Office of Epidemiology (OOE) received reports of gastrointestinal illness from eight independent groups of patrons of Firefly on Paradise or the adjacent affiliated restaurant Dragonfly on Paradise (Firefly) located at 3900 Paradise Road, Las Vegas, NV 89109. All patrons from these groups ate at the restaurant during April 21-24, 2013. Ill patrons reported symptoms of diarrhea and/or vomiting after they consumed food from Firefly restaurant, and many sought medical care for their illness. In response to these illness reports, the SNHD initiated an investigation.

On April 26, 2013, the SNHD performed an investigative inspection and closed Firefly andDragonfly restaurants to minimize ongoing risk of illness. The SNHD OOE, Environmental Health (EH) and Southern Nevada Public Health Laboratory (SNPHL) have been collaborating on the investigation and response to this outbreak. The Nevada State Health Division was also apprised of the outbreak investigation.

METHODS

Epidemiology: OOE staff performed telephone interviews with ill patrons to obtain more information regarding symptoms, food history, and illnesses among restaurant patrons. The SNHD foodborne illness complaint database was searched to identify other complaints against the restaurant in the 30 days prior to these complaints.

On April 26, 2013, OOE and EH staff visited the restaurant. OOE staff interviewed restaurant management and other employees regarding their illnesses in the past two weeks, their current illness status, their knowledge of other recent illnesses in restaurant staff and patrons, whether the restaurant had a sick employee policy, and if there were other customer complaints of illness.

A case is defined as illness in a person who consumed food served by Firefly restaurant during April 21-26, 2013 and experienced diarrhea (defined as ≥ 3 bouts of loose stools) and/or ≥ 1 episodes of vomiting during a 72-hour period after eating.In order to perform a case-control study and do additional case-finding, OOE staff identified additional restaurant patrons who dined at Firefly during April 21-24, 2013 via contact information from OpenTable, an online restaurant reservation system.

Environmental Health: EH staff performed inspections of Firefly and Dragonfly restaurants on April 26, 2013 and an ongoing risk assessment for foodborne illness.

Laboratory: Ill restaurant guests and staff were requested to provide stool specimens for bacterial culture (Salmonella, Shigella, Campylobacter, Escherichia coli O157, Yersinia, and Vibrio), Shiga toxin-producing E. coli (STEC) testing, and norovirus RT-PCR testing.

Food specimens were collected for submission to the Nevada State Public Health Laboratory for pathogen testing.

RESULTS

Epidemiology: The epidemiologic curve to date is presented in the figure below, and shows the total of 86 identified ill persons who ate at Firefly during April 21-26, 2013.

A total of 40 employees worked the dinner shift at Firefly on April 26, 2013. Of these, 33 were interviewed including three employees who were identified as having been recently ill with gastrointestinal symptoms; these workers were asked to submit stool specimens.

The restaurant has a sick employee policy and employees may call-in sick when necessary.  There was one customer complaint of illness to the restaurant. Thirty-three patron phone numbers were obtained from the OpenTable online reservations.

Environmental Health: Firefly restaurant uses two adjacent permitted kitchens, Firefly on Paradise (SNHD Permit Number PR0013375) and Dragonfly on Paradise (SNHD Permit Number PR0015008), to prepare food for their customers. The inspection found that numerous conditions existed that could contribute to an outbreak of a foodborne disease and included:

Inadequate holding of food, inadequate cooling, improper handwashing, employee bare hand contact with ready to eat food, improper food storage practices, improper cleaning practices, and improper thawing of food.

The results of the inspection were 44 demerits for Firefly and 47 demerits for Dragonfly on Paradise. Both facilities were closed by SNHD for excessive demerits and for being associated with a large cluster of reports of illness (SNHD Regulations Governing the Sanitation of Food Establishments 8-304.11).

Thirty samples of various foods were collected during the inspection and submitted to the SNPHL for possible testing to determine which food item(s) could have been the source of the illness.

Inspections were also conducted on April 29, 2013 of the two other Firefly restaurant outlets located in Clark County. Firefly Westside located at 9560 W. Sahara, Las Vegas received 30 demerits, and Firefly on Eastern located at 11261 S. Eastern received 6 demerits.

Laboratory: Of the 14 stool specimens collected from ill restaurant patrons, seven were positive for Salmonella species, one was negative for Salmonella, and results of six samples are pending.

The SNPHL submitted eight food items collected from Firefly restaurant to the Nevada State Public Health Laboratory for analyses.

CONCLUSIONS

At least 86 patrons and 3 employees who consumed food and/or drinks at Firefly during April 21-25, 2013 may have contracted Salmonella infection.

FUTURE ACTIONS

1.  Firefly should rectify faulty food storage equipment and practices to ensure that food will be maintained at proper temperatures.

2.  The SNHD OOE staff will continue to collect information about customers who ate at Firefly during April 21-26, 2013 to establish illness occurrences among restaurant  patrons, and to conduct a case-control study to identify specific food item(s), if any, were associated with illness.

3.  The SNHD EH staff will continue to review Firefly’s food preparation methods to identify possible lapses in food safety procedures, and to require restaurant management to provide and implement a comprehensive food safety plan.

4.  The SNHD OOE staff will continue to monitor the foodborne illness database for additional complaints of illness to determine whether the outbreak is limited to this establishment or has spread to the general community.

5.  The SNPHL will perform pulsed field gel electrophoresis on the submitted specimens that were positive for Salmonella to determine if illnesses among patrons from the different groups were linked.

RECOMMENDATIONS

1.  Food-service workers who test positive for Salmonella must be excluded or restricted from work per the FDA Food Code, and will require approval from the SNHD to return to work.

2.  Restaurant employees should also be cautioned about how Salmonella is transmitted and be made aware of the heightened importance of hand hygiene through washing with soap and water. Information about salmonellosis can be found at the SNHD website http://www.southernnevadahealthdistrict.org/health-topics/salmonellosis.php

3.  Food service workers should also be educated to the ways to clean and sanitize food preparation surfaces. Types of acceptable sanitizer solutions for use in a food establishment are located at the SNHD website http://www.southernnevadahealthdistrict.org/ferl/sanitizer-fact-sheet.php

4.  The restaurants are advised to cook all potentially hazardous foods thoroughly. Menu items intended not to be cooked to the recommended temperatures should be noted on menus, with an appropriate warning to consumers about the potential health hazards of eating undercooked foods.

5.  All suspected cases of Salmonella infection related to this outbreak should be reported  to the health authority. Illness clusters (e.g. restaurants, schools, hotels) are reportable.

27% of ill persons have been hospitalized, and no deaths have been reported.

State public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.

Preliminary information indicates that consumption of imported cucumbers is the likely source of infection for the ill persons.

On April 24, 2013, the U.S. Food and Drug Administration placed Daniel Cardenas Izabal and Miracle Greenhouse of Culiacán, Mexico on Import Alert.

Cucumbers from these two firms will be denied admission into the United States unless the suppliers show that they are not contaminated with Salmonella.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

The product has been distributed in British Columbia, Alberta, Saskatchewan and Manitoba, and may have been distributed to other provinces.

Trophy Foods Inc., of Calgary, is recalling the affected product. The CFIA will monitor the effectiveness of the recall.

There have been no reports of anyone becoming ill from eating the nuts. Consumption of food contaminated with the bacteria Salmonella may cause salmonellosis, the CFIA said.

In young children, the elderly and people with weakened immune systems, salmonellosis may cause serious and sometimes deadly infections.

The affected product is sold in 454 gram packages, with UPC 0 59966 04848 9.

The packages show a best before date of 2014 NO 05.

The number of ill persons identified in each state was as follows: Arizona (1), Illinois (2), Iowa (1), Michigan (9), Pennsylvania (1), and Wisconsin (8).

50% of ill persons were hospitalized, and no deaths were reported.

Collaborative investigative efforts of state, local, and federal public health and regulatory agencies indicated that ground beef produced by Jouni Meats, Inc. and Gab Halal Foods were the likely sources of this outbreak.

On January 24, 2013, Jouni Meats, Inc. recalled approximately 500 pounds of ground beef products.

On January 25, 2013, Gab Halal Foods recalled approximately 550 pounds of ground beef products.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

“Our findings were that Temazcal was most likely the source of this salmonella outbreak,” Dr. Laurie Smithee, chief of acute disease for the Oklahoma State Health Department said.

This information came after Temazcal voluntarily closed March 4, when a routine investigation by the health department discovered the restaurant’s walk in-cooler was not working properly.

Smithee said the information is based on a statistical study done by the health department so there is an extremely small chance Temazcal is not the source of the outbreak.

“We know that all six cases were confirmed to have the identical salmonella organism through our case and controlled study,” she said.

The organism found was Salmonella Enteriditis.