Tuesday, December 22, 2015

A Second Outbreak of E. coli Associated with Chipotle is Being Investigated

The FDA and CDC are investigating a second outbreak of a different Shiga toxin-producing Escherichia coli O26 (STEC O26) that is being linked to Chipotle Mexican Grill restaurants during December 2015. Based on DNA fingerprinting, this outbreak is different that a larger E. coli outbreak which occurred in November as was primarily located in the northwestern part of the country (53 people in 9 states).   To this point, 5 people have become infected in this second outbreak. 

Unfortunately, most of the corrective actions for system improvements probably came after this second outbreak occurred.  But a point many have made is that more should have been done sooner.  Delayed reaction, due in part to an underestimation of the event, allowed more issue to occur in the meantime.  This now looks bad in that more issues are popping up after the big proclamation of a company wide food safety enhancement.

An interesting point in the NY Time article below is that there has been difficulty in tracking because of record keeping.

FDA Outbreak News Release
FDA Investigates Multistate Outbreak of E. coli O26 Infections Linked to Chipotle Mexican Grill Restaurants

December 22, 2015
On this page:
The U.S. Food and Drug Administration along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating an outbreak of E. coli infections.
Update: December 22, 2015
  • The FDA, CDC, and state and local officials are investigating a second, more recent outbreak of a different, rare DNA fingerprint of Shiga toxin-producing Escherichia coli O26 (STEC O26) linked to Chipotle Mexican Grill restaurants.
  • The CDC reports that five people have been reported with the new variant of STEC O26 from a total of three states: Kansas (1), North Dakota (1), and Oklahoma (3).
  • The Kansas and North Dakota cases ate at the same restaurant in Kansas. The three separate Oklahoma cases all ate at the same Chipotle restaurant.
  • As of December 18, 2015, 53 people infected with the previously reported outbreak strain of STEC O26 have been reported from nine states: California (3), Illinois (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27).
  • The epidemiologic evidence available at this time suggests that a common meal item or ingredient served at Chipotle Mexican Grill restaurants in several states is a likely source of both outbreaks.
  • The investigations are still ongoing to determine what specific food is linked to illness. .

What is the Problem and What is Being Done About It?  

The FDA and the Centers for Disease Control and Prevention (CDC) along with state and local officials are investigating two separate outbreaks of E. coli O26 infections that have been linked to food served at Chipotle Mexican Grill restaurants in several states.
As of December 4, 2015, the CDC reports a total of 52 people infected with the outbreak strain of STEC O26 from a total of nine states: California (3), Illinois (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (1), and Washington (27). There have been 20 reported hospitalizations. There have been no reports of hemolytic uremic syndrome (HUS) and no deaths. Of the three most recent illnesses reported in November, only one ill person, whose illness started on November 10, reported eating at Chipotle Mexican Grill in the week before their illness began. The majority of these cases were reported from Oregon and Washington during October 2015.
Investigators are also using whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness. To date, whole genome sequencing has been performed on STEC O26 isolates from 21 ill people from California (2), Minnesota (2), New York (1), and Washington (16). All 21 isolates were highly related genetically to one another. This provides additional evidence that illnesses outside the Pacific Northwest, could be related to the illnesses in Washington .
Chipotle Mexican Grill closed 43 restaurants in Washington and Oregon in early November 2015 in response to the initial outbreak. All these restaurants reopened in November 2015. Chipotle Mexican Grill worked in close consultation and collaboration with health officials throughout the investigation to determine whether it was appropriate to reopen these restaurants. Chipotle reports disclaimer icon taking the following actions, among others, prior to opening:
  • Confirming that all microbial testing performed by the company did not yield E. coli (more than 2,500 tests of Chipotle's food, restaurant surfaces, and equipment all showed no E. coli)
  • Confirming that no employees in these restaurants were sickened from this incident
  • Expanded testing of fresh produce, raw meat, and dairy items prior to restocking restaurants
  • Implementing additional safety procedures, and audits, in all of its 2,000 restaurants to ensure that robust food safety standards are in place
  • Working closely with federal, state, and local government agencies to ensure that robust food safety standards are in place
  • Replacing all ingredients in the closed restaurants
  • Conducted additional deep cleaning and sanitization in all of its closed restaurants (will conduct deep cleaning and sanitization additionally in all restaurants nationwide)
The FDA, CDC, and state and local officials began investigating an outbreak of a different Shiga toxin-producing Escherichia coli O26 (STEC O26) linked to Chipotle Mexican Grill restaurants during December 2015. This outbreak has a rare DNA fingerprint, which is different from the larger, previously reported outbreak. It is not known at this time if these infections are related to the previously reported outbreak. Because it is not known if these infections are related to the previously reported outbreak of STEC O26 infections, these illnesses are not being included in the case count for that investigation. Interviews were conducted with five ill people, who all reported eating at Chipotle Mexican Grill restaurants. Whole genome sequencing is being used to see this strain is genetically related to the STEC O26 that caused the larger outbreak. This investigation is ongoing.
The FDA continues to work with Chipotle Mexican Grill restaurants as well as federal, state and local agencies to gather information about the supply chain(s). The FDA will continue to provide updates on the investigation as they become available.
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What are the Signs & Symptoms of E. coli O26?

  • People usually get sick from STEC (Shiga toxin-producing E. coli) 2-8 days (average of 3-4 days) after swallowing the organism (germ).
    • Most people infected with STEC develop diarrhea (often bloody) and abdominal cramps.
    • Most people recover within a week.
  • Some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS).
    • HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
    • Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination.
    • People who experience these symptoms should seek emergency medical care immediately.
  • STEC infection is usually diagnosed by testing of a stool sample for Shiga toxins.
    • Clinical laboratories are required in some states to send Shiga toxin-positive specimens from ill people to the state public health laboratory for identification of STEC and PulseNet testing.
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Who is at Risk?

People of any age can become infected. Very young children and the elderly are more likely than others to develop severe illness and HUS, but even healthy older children and young adults can become seriously ill. In this particular outbreak, the age range of ill patients is 1 - 67 years.

What Do Consumers Need To Do?

Consumers who have recently become ill after eating at a Chipotle should contact their health care provider.

Who Should be Contacted?

Contact your healthcare provider if you have diarrhea that lasts for more than 3 days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.
The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday

through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult the FDA website.
Additional Information
Foodsafety.gov: Food Poisoning - E. coli
CDC: CDC E. coli homepage

NY Times
Chipotle E. Coli Cases Rise, With 5 More Ill in Midwest

The Centers for Disease Control and Prevention said on Monday that five more people became sick after eating at two more Chipotle Mexican Grill restaurants, dealing a further blow to the price of the company’s shares.
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The C.D.C. said that five people who had eaten in two Chipotle restaurants in Kansas and Oklahoma grew ill after eating something contaminated with E. coli STEC O26. The agency has not yet determined which food is responsible for the outbreak.

“One of the challenges here has been that we have been able to identify the restaurants where people ate, but because of the way Chipotle does its record-keeping, we have been unable to figure out what food is in common across all those restaurants,” said Dr. Ian Williams, chief of the outbreak response and prevention branch of the C.D.C.
Chipotle Shuts Restaurants in Northwest After E. Coli OutbreakNOV. 2, 2015

The same bacteria has sickened 53 people in eight other states, nearly all of whom said they had eaten at a Chipotle. But Dr. Williams said the DNA of the bacteria appeared different in the latest outbreak than in the previous one.

He said both types of the same bacteria were rare — the C.D.C. has seen the E. coli involved in the earlier outbreak only three times previously.

Chipotle says it is working to put in place programs to monitor the safety of each of the 68 ingredients it uses, using methods like high-resolution testing and additional food-safety training for its employees. “With all these programs in place, we are confident that we can achieve a level of food-safety risk that is near zero,” Chris Arnold, a spokesman for Chipotle, wrote in an email.

Mr. Arnold said that Chipotle had expected to see additional cases of E. coli poisoning like those that came to light on Monday, and he noted that not all of the victims in the earlier outbreak had reported eating at a Chipotle.

The company’s shares dropped $19.07, to $522.01, after the new outbreak came to light. The stock is down 30 percent from its high of $757.77 in August.

The latest infection is the fifth linked to Chipotle since August, when more than 200 people were infected with norovirus after eating at one of its restaurants in Simi Valley, Calif., according to Food Safety News.

The same month, more than 60 people got sick with salmonella poisoning after eating in one of 22 Chipotle restaurants in Minnesota. Then in October, the first cases of E. coli poisoning began to surface in the Pacific Northwest.

All told, almost 500 people have been sickened after eating in a Chipotle in the last half of this year, according to Food Safety News.

Earlier this month, Steve Ells, Chipotle’s founder and chief executive, went on the “Today” show to apologize to the people who became sick most recently. “I’m sorry for the people who got sick. They’re having a tough time and I feel terrible about that,” Mr. Ells said in an interview.

Arun K. Jain, a professor of marketing research at the University at Buffalo, compared Chipotle’s woes to those of Volkswagen, which is grappling with a scandal over its manipulation of emissions devices in some 11 million of its diesel cars.

“It’s death by a thousand cuts,” Mr. Jain said. “One day after another day, you keep getting this negative news, and it begins to really damage brand equity.”

He said the latest outbreak could be particularly bruising to Chipotle because the company has been promoting its new food safety programs.

“Consumers will conclude that these people have not done anything in spite of what they’ve been saying, and that becomes a credibility issue,” he said. “For a company like Chipotle, which talks a lot about the integrity of its food, that’s seriously damaging.”

Bill Marler, a lawyer who represents more than 50 victims from the four previous Chipotle food poisoning outbreaks, said he was stunned that the company was having yet another problem with food safety. “To have this many people spread out across the United States getting sick all within a month and a half, all with the same strain and all after eating in a Chipotle, that’s perplexing,” Mr. Marler said.

He, too, has been critical of Chipotle’s public response to the scandal, although he said the steps the company is taking to improve food safety now seem to be good ones. “Even after watching their C.E.O. on T.V., I’m not sure they get it,” Mr. Marler said. “You really do have to have a culture of food safety from the top down.”

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