Box Lunches Prepared by Volunteers Responsible for Salmonella Outbreak, Nearly 50 Affected

A group of volunteers associated with a Buddhist Temple in Gainesville, FL prepared box lunches that were responsible for making nearly 50 people ill with Salmonella.

https://www.gainesville.com/news/20191111/health-inspectors-investigating-salmonella-nearly-50-felled-by-illness
Health inspectors investigating salmonella, nearly 50 felled by illness
By Emily Mavrakis
Posted Nov 11, 2019 at 2:50 PM

Stew Source of C. perfringens Outbreak at NC Church BBQ

Hundreds of attendees of a church BBQ in North Carolina were stricken with C. perfringens.  Tests indicate that it was the Brunswick stew.  This would indicate that the stew was not held at proper temperatures between the time it was made and the time it was served, allowing the C. perfringens to grow to high number.  Symptoms, including watery diarrhea and mild abdominal cramps occur about 16 hours after consumption of foods containing large numbers (>106 live vegetative cells or >106 spores) of enterotoxin-producing C. perfringens and will last 12 to 24 hours.

Cabarrus Health Alliance

https://www.cabarrushealth.org/CivicAlerts.aspx?AID=108
UPDATE: Poplar Tent Presbyterian Church BBQ
New Update
Update: November 16, 2018

Follow-up for VA Chili Cook-off Salmonella Outbreak

As a follow-up to a Salmonella Outbreak associated with a volunteer fire company's chili cook-off from a few weeks back, a suspect product has been identified - Crab Shack Clam Chowder.  The County Health Department says that there have been 180 cases reported so far.

To help the restaurant from taking a big hit, the Eastern Shore Health Department director proclaimed the restaurant was fine, and demonstrated that fact by making a stop at the eatery and having lunch.  He pointed out a fact we know well, that restaurants can run into problems when they do these temporary events.

10 WAVY.com
http://wavy.com/2017/10/24/officials-180-reports-of-illness-following-chincoteague-event/
Officials: 180 reports of illness following Chincoteague event

Jambalaya Outbreak - 2 Different Bacterial Pathogens Responsible - Indicates Two Separate Mishandling Issues

A second bacterial pathogen, Clostridium perfringens, has been identified as part of the large outbreak in Louisiana that has been linked to jambalaya served at a softball fundraising event.  Salmonella had already been isolated, but Clostridium perfrigens has now also been identified in patient stool samples.  As of Friday, 125 cases were confirmed with 37 hospitalized.  One death may also be linked.

While Salmonella effects are due to the infection is causes, Clostridium perfringes produces a toxin that causes the symptoms of diarrhea and abdominal cramps.  It usually occurs in less than a day and those symptoms will normally last for 24 hours. 

The issues of contamination will also be different.  Salmonella is not heat resistant, so either the foods are undercooked or it will contaminate foods after cooking through cross contamination.  Clostridium perfringens is a sporeforming pathogen, and its spores are heat resistant and thus can survive normal cooking conditions such as when making jambalaya.  The key to prevention is proper cooling after the product is cooked.  Basically, the spores survive cooking, but need warmer conditions for growth.  In fact, at optimal growth temperature of 109F to 117F, C. perfringens can multiple every 10 minutes or so.

So clearly, the were some issues when people were making jambalaya....and this can be the case when people are cooking large quantities of food.  For Salmonella to be an issue, the cooks either undercooked it, or they had sloppy procedures that allowed cross contamination.  For the second bacterial pathogen - after cooking (or under-cooking), they did not properly cool the food which provided conditions for C. perfrigens growth.  By regulation, foods such as this must be cooled from 135F to 70F within 2 hours, and from 70F to 41F within 4 hours.  These conditions were established for C. perfringens.  And if large quantities were made, cooling can be difficult.

WWL TV.com
http://www.wwltv.com/news/not-just-salmonella-second-bacteria-idd-in-mass-north-louisiana-illness/485166123
Not just salmonella: Second bacteria ID'd in mass North Louisiana illness
WWLTV 10:45 AM. CDT October 22, 2017

Jambalaya Served at Fundraising Event Source Of Large Salmonella Outbreak

In Louisiana, a salmonella outbreak affecting more than 100 people has been linked to jambalaya prepared for a high school fundraising event.

The News Star - Louisianana
http://www.thenewsstar.com/story/news/local/2017/10/18/possible-mass-food-poisoning-outbreak-caldwell-probed/778040001/
BREAKING: Jambalaya likely source of mass salmonella outbreak
Ashley Mott, amott@thenewsstar.com 

Published 5:33 p.m. CT Oct. 18, 2017 | Updated 12:47 p.m. CT Oct. 19, 2017

In Virginia, Chili Cook-off is Site for Salmonella Outbreak

In Virginia, a Volunteer Fire Company's Chili Cook-off is being blamed for dozens of people becoming ill from Salmonella.  The exact food source responsible for the Salmonella contamination has not yet been identified.

You always wonder about eating food at these events - 1) do these cooks, the people making the food, really understand food safety principles, have they been trained in any way, 2) are they implementing those principles - have they taken the necessary precautions to transport and prepare the food for an onsite event such as this, 3) do their normal kitchen handling and preparation procedures adapt in order to make the larger quantities needed for this event, and 4) is the food protected at the event from cross contamination.

While regulations do not require training for these events, training is available.  Penn State offers the Volunteer Food Safety - Cooking for Crowds training.

Virginia Pilot - Local News
https://pilotonline.com/news/local/salmonella-found-in-food-from-chincoteague-chili-and-chowder-cook/article_41d118d2-db5a-57e2-b2e4-2326f39cb161.html
Salmonella found in food from Chincoteague Chili and Chowder Cook-off
By Ryan Murphy
The Virginian-Pilot
Oct 10, 2017 Updated 10 hrs ago

Pork BBQ Prepared by Volunteer is the Source of Staph Enterotoxin at Florida Science Fair

In Florida, a college sponsored science fair was the site of a foodborne illness outbreak with 32 reported cases of Staphylococcus aureus intoxication. Most of the cases were children. The source of the contamination was pork BBQ which was made by a volunteer.

Probably in this case, one could see the pork BBQ being prepared the day before, partially cooled, pulled, and then cooled and stored. A few factors that could be problematic if not done properly: 1) not cooling product temperature down to refrigeration temperature within the recommended amount of time, 2) not storing the product at refrigeration temperature, some time between after it was cooked and when it was served at the event and 3) pulling the meat in unsanitary fashion such as not using gloves. The cooling could be made difficult if the amount of product is large, going beyond the capacity of the volunteer's system. Contamination of the meat after cooking could come from a number of sources, but one concern would be from the volunteers themselves, especially if they were not using gloves.

This is a reminder of the need for volunteer food safety training. Preparing and handling large quantities of food can be difficult especially for the size of this event.   

As for organizations sponsoring these types of events, in the case a college in Florida, they need to have rules in place for how food can be sourced.

News 4 Jax
http://www.news4jax.com/news/florida/columbia-county/lake-city/cause-of-science-fair-food-poisining-uncovered-it-was-the-pork
Cause of science fair food poisoning uncovered; it was the pork
Nearly 30 minors, some adults taken to hospital
By Scott Johnson - Reporter , News4Jax.com Staff
Posted: 11:29 AM, February 09, 2017Updated: 11:29 AM, February 09, 2017

C. perfrigens Identified as Cause of Thanksgiving Foodborne Illness Outbreak

Shortly after Thanksgiving, an outbreak of foodborne illness was reported in California that was linked to a Thanksgiving charity event.  There were 3 deaths and another 22 others who were ill.  The causative agent was found to be Clostridium perfringens, a sporeforming pathogen that can grow rapidly when food is temperature abused.

The actual food source of the bacteria was not found, however investigators "found most of the ill people ate turkey and mashed potatoes and they all ate around the same time. Some dishes served at the event, including cooked turkey, were brought to the site after they were prepared in private homes."

A similar scenario occurred in a 2015 outbreak linked to a Thanksgiving luncheon.  In this case, 40 became ill from food contaminated with Clostridium perfrigens.  In this case however, food was prepared by a caterer.

Clostridium perfrigens: 

• Is a gram positive sporeforming anaerobe.
• Is widely distributed in the environment, but can be found in the intestines of animals and humans (but in small numbers).
• Spores are heat resistant and can survive boiling temperatures.  (Dvalues at 100C can range from 0.31min to 17.5min),
• In heat-treated foods that are temperature abused, this organism can divide in as fast as every 10 minutes.  (The heat treatment eliminates any competitive flora.)  Common food sources include cooked meat foods such as stews and casseroles that are temperature abused.
• Symptoms are caused by ingestion of large numbers ( > 106) vegetative cells or >106 spores/g of food. Toxin production in the digestive tract (or in vitro) is associated with sporulation.  This usually occurs about 16 hours after ingestion.  As the organism numbers increase, it produces an enterotoxin, and this entertoxin is responsible for the illness
• The primary symptoms are cramping and diarrhea and usually dissipate within 24 hours.

The cooling procedures in the Food Code and Appendix B for USDA are established taking C. perfringens into account.

This event points out the risk of having volunteers prepare food in their own home.  In many cases, these people have not been trained in preparing large quantities of food and/or preparing food for events outside of their own home.  In the latter, food transportation can be an issue, especially in warmer areas like California.

CBS SF Bay Area News
http://sanfrancisco.cbslocal.com/2016/12/20/common-bacteria-caused-antioch-thanksgiving-dinner-deaths/
Common Bacteria Caused Antioch Thanksgiving Dinner Deaths
December 20, 2016 11:43 AM

ANTIOCH (CBS SF) — A common food-borne bacteria was responsible for three deaths and the illnesses suffered by 22 others following a Thanksgiving meal sponsored by a community church at Antioch’s American Legion auditorium, health officials announced Tuesday.

Thanksgiving Charity Event Results in Foodborne Illness Including 3 Deaths

An apparent foodborne illness outbreak related to a Thanksgiving charity event has impacted 17 people and caused 3 deaths and 1 hospitalization.  Many of these people were in the "high risk' category.  While the cause and the source have not yet been identified (although this may be similar), here is what is known:

• Food was prepared at the facility as well as brought from volunteers homes.  Food prepared at the facility included mashed potatoes, stuffing, gravy, heated up creame corn and green beans.  Items made at volunteer's homes included turkeys, hams, and sweet potatoes.
• Pies purchased from local stores.
• Death ranges: Teens to 70’s
• Says patients came from at least 3 facilities
• Symptoms – nausea, diarrhea, vomiting
• People who became ill got sick within 24-hours of consuming the food
• In California, non-profits can run this type of event for members and guests without a permit. 

In Pennsylvania, a soup kitchen  operation would also be exempt from requiring a license, but the American Legion where the foods was provided would probably have one.  If the food was being sold rather than given away as a charity event, then a license would probably be required.  The additional concern would be the products that were made at home.  A licenced facility would not be allowed to serve these types of foods (TCS) made at home.

Regardless, it is an important to train volunteers on food safety, such as Cooking for Crowds.  Cases like this are reminders of that.


East Bay Times
http://www.eastbaytimes.com/2016/11/29/antioch-elder-victims-of-suspected-food-borne-illness-came-from-separate-care-homes/
News
Antioch food-related deaths: More cases of sickened patrons
By Aaron Davis | aarondavis@bayareanewsgroup.com, Matthias Gafni | mgafni@bayareanewsgroup.com and Sam Richards | srichards@bayareanewsgroup.com
PUBLISHED: November 29, 2016 at 12:42 pm | UPDATED: November 29, 2016 at 8:46 pm

Botulism Outbreak in Ohio Linked to Home Canned Potatoes, Confirmed Cases Now 21

The source of the botulism outbreak at the Ohio church potluck is most likely the home canned potatoes used to make the potato salad.  In this outbreak, the number of confirmed cases of botulism poisoning is now 21.

While potatoes can be safely canned (if done according to the directions provided by the National Center for Home Food Preservation), it is important to use the right potatoes, the right size, and the use of a pressure canner.  While there has been no further information provided at this point related to the canning procedures used or issues seen on other containers processed that may be still in storage, potatoes can become an issue if not done correctly.  First, potatoes are low acid, so a pressure canner must be used.  Second, it is important the type and the size are correct to allow proper heat movement within the jar (convection heating).  If the size is too big or the potatoes break down during processing, the heating parameters within the jar will change, thus affecting the ability of heat to reach the cold spot of the jar. 

Another issue is the use of home canned foods for volunteer events.   Generally,  bringing home canned foods to volunteer events is discouraged.  In Penn State's Volunteer Food Safety Curriculum, Cooking for Crowds, it states in Chapter 4:

As a precaution, never accept any home-canned or home-preserved food [for volunteer events]. Life-threatening foodborne illness can occur from food that has been preserved incorrectly

 The same must be said for using canned foods as an ingredient in dishes that will be brought and served at group functions.  There are no regulations for these volunteer groups and their functions however and so it comes down to the individual groups to require training and to institute policies.

Getting home preservers to follow scientifically developed recipes is not an easy.   Cases like this are reminders that improper canning procedures can lead to deadly consequences.

CBS/AP
http://www.cbsnews.com/news/source-of-deadly-botulism-outbreak-in-ohio-identified/
Source of deadly botulism outbreak in Ohio identified

April 28, 2015, 9:46 AM

LANCASTER, Ohio -- Health officials say the likely source of the botulism outbreak that killed one person and sickened many others at an Ohio church potluck dinner was home-canned potatoes used in a potato salad.

Over 20 Cases of Botulism with one death from Food at Church Potluck

One death and 23cases of botulism are being reported after the individuals ate at a church potluck in Lancaster. Ohio.

Antitoxin has been administered to the victims, which can reduce severity of the illness. 

The food has not yet been identified.

Botulism is the disease caused when the toxin produced by Clostridium botulinum is ingested.   The toxin is produced by the organism as it grows in a food. Generally we do not see many cases of this deadly disease, but it can be a risk when certain foods are not properly prepared. 

• Improperly processed low acid canned foods like green beans that are not properly pressure canned and then those cans are stored on the shelf..  
• Heated foods likes soups and stews when those foods are not properly cooled or are stored at the elevated temperatures (not refrigerated).
• Vacuum packaged cooked foods that are not stored at the right temperature.

 Clostridium botulinum is a spore-forming organism, and these spores can survive normal cooking.  If conditions are right, then the spores germinate and the organism grows in the food.  Conditions include a notorious food, warm to high temperatures, non-acidic pH, and low oxygen level.

The toxin is a neurotoxin and stops vital functions including breathing.

 

Columbus Dispatch

http://www.dispatch.com/content/stories/local/2015/04/21/botulism-lancaster.html

Botulism death tied to Lancaster church potluck

 

Wednesday April 22, 2015 9:33 AM 

 

One person has died and at least 20 others were hospitalized as of late last night with suspected botulism that health officials are linking to a potluck on Sunday at a Lancaster church.

 

A Kansas Meals-on-Wheels Operation Involved in Norovirus Outbreak.

A report concluded that a Meals-on-Wheels operation in Kansas was responsible for at least 61 illnesses, although the exact source was not identified.

So someone working for the operation, whether a food preparation person or a delivery person, or even an upstream provider, had to have the illness or had been exposed to someone with the virus.

The clientele served by Meals-on-Wheels would be classified as high risk, so procedures must be in place to prevent employees or volunteers from working when sick, or have exposed to someone who is sick.

Chanute.com
http://www.chanute.com/news/article_86b43810-cdc3-11e4-a460-7f7fd0d80954.html?mode=jqm
Investigative report released in January norovirus outbreakPosted 14 hours ago

JOSHUA VAIL
Tribune reporter

The Kansas Department of Health and Environment Division of Public Health has released its investigative report on the January norovirus outbreak associated with Meals on Wheels.

The investigation concluded that the most likely source of the infection was the Meals on Wheels kitchen in Chanute, but enough data to pinpoint a more specific source could not be obtained.

California University Recalls Chocolate Bars

A university in California is recalling candy bars that were produced by a student group in less-than-sanitary conditions.

While the story does not indicate how the contamination event occurred, if one had to guess, it would be that the student group made the product without following good sanitation procedures.  Later, a wiser individual(s) realized this (and this person(s) was probably not involved when the product was initially made) and raised questions about sanitation and allergen control.  The group was not able to answer these questions, thus putting the University at risk.  Rather than waiting for people to get ill and for a scandal to erupt, the University took a proactive posture and recalled the product.

Does this situation apply outside a university setting? Absolutely.  Anytime some genius thinks that they can produce product for sale on the fly without going through the proper channels, laying out a food safety plan, etc. This could be a temporary side operation that someone wants to do in a processing facility or a foodservice operation, or a volunteer group that thinks it can easily raise money. 

Here at Penn State, the risk management group has a strict policy regarding  products being made and branded as Penn State.  For good reason.


 The Tribune
http://www.sanluisobispo.com/2014/10/04/3280284/cal-poly-recalls-6-of-its-chocolate.html
Cal Poly recalls some chocolate bars because of possible contamination

Candies may contain allergens or infectious material, spokesman says
By Nick Wilson
nwilson@thetribunenews.com
October 4, 2014

Cal Poly has voluntarily recalled six varieties of its chocolate candy bars, citing possible contaminations.

The bars may have been tainted with peanut, milk or soy allergens and possibly exposed to microbial contamination, which can include infectious materials such as bacteria, yeast, or mold, the university said.

Bean Day goes bad for dozens of patrons who become infected with Salmonella

About 50 people become ill from Salmonella after attending Bean Day, an annual fundraising event in Alabama.

A number of issues were identified in the county health department's inspection report:

• Soaking the beans in a plastic-lined horse trough covered with plywood, with a water hose running water through the trough (the ADPH did not know if or how the trough, which was located at the church, had been used prior to the dinner)
• Handling food without gloves;
• Turning off the heat source for the beans and disconnecting gas lines for burners without monitoring the temperature of the food;
• Transferring the beans in outside cooking pots to a smaller iron pot on wheels to take large quantities of the beans inside the church;
• Using one sterno can per 6-inch-deep chaffing pan to maintain the holding temperature of the beans;
• Re-using chaffing pans and adding new beans to existing beans throughout the serving time. Illness sweeps

While the soaking of the beans in a plastic-line horse trough seems like the worst violation, this may be overstating its true involvement - because one, it was not currently used to water horses but was located there at the church where the fundraiser occurred;  and two, that proper cooking would have eliminated the contamination.

But looking at the sum of errors, one could see a laxness in the use of food safety procedures, indicating there may be a additional factors that may have contributed to this outbreak. 


Health Dept.: Beans soaked in horse trough Dozens taken ill after annual event
By Jean Cole jean@athensnews-courier.com
The News Courier Sun Feb 02, 2014, 02:00 AM CST

— The final report on the Bean Day salmonella outbreak that left a dozen people hospitalized and scores of people ill last October may make some Limestone County residents cringe.

 A nine-page study issued by the Alabama Department of Public Health and obtained Friday by The News Courier reveals that uncooked beans for the annual fundraiser had been soaked in a plastic-lined horse trough covered with plywood before the event and that existing bean soup was topped off with new bean soup during the event.

Those are just some of the possible ways the beans became contaminated with salmonella senftenberg, according to the report. An estimated 250 to 300 people ate food prepared for the Oct. 4 dinner hosted by the Athens-Limestone Foundation for Aging and held at First Baptist Church Family Life Center in Athens. The menu included white beans with ham, onions, vinegar-based coleslaw, cornbread, soft drinks and a variety of homemade desserts.