CDC Report: Listeria Illnesses, Deaths, and Outbreaks — United States, 2009–2011

CDC just released a report detailing Listeria outbreaks in the United States, 2009-2011. In this time frame, ,1651 cases were reported nationally. 

In summary, Listeria monocytogenes is a foodborne pathogen that primarily impacts those in high risk groups – elderly, immunocompromised, and pregnant women. Listeria infection in these individuals leads to bacteremia (bacterial blood infection), meningitis, and death (mortality rate of 21%).

Soft cheeses and cheeses made from unpasteurized milk are the primary vehicles, although there have been cases related to produce (cut celery and cantaloupe). So for high risk groups, individuals in these high risk groups may want to forgo the soft cheeses, cheeses made from unpasteurized milk, and unpasteurized milk.

I think it is important to note what is not on list of responsible food items in this reporting period – deli meats. The meat industry has done a good job in reducing the risk associated with those ready-to-eat meat items. But work needs to continue with all refrigerated RTE items that can support the growth of Listeria. Recently, an interagency report on the risk of Listeria in Retail Delicatessens (http://pennstatefoodsafety.blogspot.com/2013/05/risk-assessment-of-listeria-in-retail.html) highlighted the practices retail stores can take to reduce the risk of Listeria contamination.


CDC MMWR Repot  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0604a1.htm?s_cid=mm62e0604a1_w

Vital Signs: Listeria Illnesses, Deaths, and Outbreaks — United States, 2009–2011

Early Release
June 4, 2013 / 62(Early Release);1-5

Abstract

Background: Older adults, pregnant women, and persons with immunocompromising conditions are at higher risk than others for invasive Listeria monocytogenes infection (listeriosis), a rare and preventable foodborne illness that can cause bacteremia, meningitis, fetal loss, and death.

Methods: This report summarizes data on 2009–2011 listeriosis cases and outbreaks reported to U.S. surveillance systems. The Listeria Initiative and PulseNet conduct nationwide surveillance to rapidly detect and respond to outbreaks, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, sentinel population–based surveillance to track incidence trends, and the Foodborne Disease Outbreak Surveillance System (FDOSS) receives reports of investigated outbreaks to track foods and settings associated with outbreaks.

Results: Nationwide, 1,651 cases of listeriosis occurring during 2009–2011 were reported. The case-fatality rate was 21%. Most cases occurred among adults aged ≥65 years (950 [58%]), and 14% (227) were pregnancy-associated. At least 74% of nonpregnant patients aged <65 years had an immunocompromising condition, most commonly immunosuppressive therapy or malignancy. The average annual incidence was 0.29 cases per 100,000 population. Compared with the overall population, incidence was markedly higher among adults aged ≥65 years (1.3; relative rate [RR]: 4.4) and pregnant women (3.0; RR: 10.1). Twelve reported outbreaks affected 224 patients in 38 states. Five outbreak investigations implicated soft cheeses made from pasteurized milk that were likely contaminated during cheese-making (four implicated Mexican-style cheese, and one implicated two other types of cheese). Two outbreaks were linked to raw produce.
Conclusions: Almost all listeriosis occurs in persons in higher-risk groups. Soft cheeses were prominent vehicles, but other foods also caused recent outbreaks. Prevention targeting higher-risk groups and control of Listeria monocytogenes contamination in foods implicated by outbreak investigations will have the greatest impact on reducing the burden of listeriosis.

Implications for Public Health Practice: Careful attention to food safety is especially important to protect vulnerable populations. Surveillance for foodborne infections like listeriosis identifies food safety gaps that can be addressed by industry, regulatory authorities, food preparers, and consumers.

Berry Mix Containing Pomegranate and Hepatitis A

Update - 6/7/13
There are now 79 cases of Hepatitis A linked to the organic frozen berrry and pomegranante mix.

From CDC

As of June 7, 2013, 79 people with acute hepatitis A infections that may be linked with consumption of a contaminated product have been reported by eight states: Arizona, California Colorado, Hawaii, Nevada, New Mexico, Utah, and Washington. These numbers are expected to change as the investigation continues. 

 

Based on epidemiologic investigation of 55 cases:

• 35 (64%) ill people are women
• Ages range from 2 – 84 years
• Illness onset dates range from 3/16/2013 – 6/1/2013
• 30 (55%) ill people have been hospitalized, and no deaths have been reported
• 40 (73%) of 55 ill people interviewed reported eating “Townsend Farms Organic Antioxidant Blend” frozen berry and pomegranate mix
• 40 persons reported purchasing this product from Costco markets; however,the product was also sold at Harris Teeter stores. No cases have been identified that bought the product at Harris Teeter at this time.

6/3/13
There have been approximately 30 people show have contracted Hepatitis A from an organic frozen berry mix sold by an Oregon company through Costco. 

The blend is produced from fresh fruit and is often used fresh by customers to make smoothies and other fruit drinks. Therefore, if Hepatitis A is present on the incoming ingredients, it will not be eliminated by processing (viruses will easily survive freezing), and then end up in product the consumer eats. It can take as long as 60 days before someone sees the symptoms.

The strain of Hepatitis A is found primarily in North Africa and the Middle East, and one of the ingredients, pomegranate seeds, is said to come from Turkey.

On the company’s website for Townsend Farms (http://www.townsendfarms.com/farms), this is what they have to say about their sourcing:

In addition to our beautiful acreage in the Columbia Gorge, Townsend Farms works with other family farms up and down the I-5 corridor, across the United States, and around the world. The Townsend family personally selects the farms we work with based on shared vision and goals, high standards of quality, a commitment to Good Agricultural Practices (G.A.P.) and sustainable farming methods.

 

Our globally-situated source farms are utilized to provide the freshest produce available no matter the growing season in the Pacific NW, enabling us to provide the best product possible year-round. Under the Townsend Farms umbrella, you can expect the same quality as the produce from our original farm. We confidently provide each source farm on every package of berries, frozen or fresh, private label or our own.

 Food safety is important for ingredients used in products that will be used in RTE (ready-to-eat) applications, This is especially difficult when those ingredients are purchased in international markets. If this company lives up to the promise posted on their website, they should have no problems working back to the source of the issue. Unfortunately, this is not the first time berries have been involved in outbreaks. Earlier this year, there was an outbreak in Europe (71) and another in Canada (8). The Canadian product contained pomegranate. So at this point, if a company is using pomegranate, it may be good to stop using it until the safety can be verified. As a consumer, I would forgo my pomegranate-containing smoothie.




Hepatitis A Outbreak Linked To Oregon Berry Farm

By MARY CLARE JALONICK 05/31/13 09:36 PM ET EDT  AP


http://www.huffingtonpost.com/2013/06/01/hepatitis-a-outbreak_n_3373103.html


WASHINGTON -- The Food and Drug Administration is investigating an outbreak of hepatitis A linked to a frozen organic berry mix sold by an Oregon company.

The FDA and the federal Centers for Disease Control and Prevention said Friday that 30 illnesses are linked to Townsend Farms Organic Anti-Oxidant Blend, which contains pomegranate seed mix. Illnesses were reported in Colorado, New Mexico, Nevada, Arizona and California.
 
Several of those who fell ill reported buying the berry mix at Costco, according to CDC. A Costco spokesman said Friday that the company has removed the product from stores and is attempting to contact members who purchased the product in recent months.

Hepatitis A is a contagious liver disease that can last from a few weeks to a several months. People often contract it when an infected food handler prepares food without appropriate hand hygiene. Food already contaminated with the virus can also cause outbreaks.

Warehouse supevisor faces 5 yrs in prison for falsifying food safety records

A warehouse supervisor may face up to 5 years in prison and a 250,000 fine for falsifying temperature records on an exported frozen chicken. That is a huge price to pay for a guy who probably did not benefit greatly from pushing the shipment before it was ready…..probably too much in a hurry or just didn’t care. Was it the lack of training, or did his managers put expectation in the wrong place – speed instead of safety? Clearly a lack of understanding on the impact of food safety deviations and the severity of punishment on falsifying documentation as related to international agreements.

Can you imagine having to tell your kids you won’t be coming home for 5 years because you will be spending time in the big house with a cell mate named Butch….all for failing to do the job correctly.



Man admits conspiracy in poultry exports to Russia from PascagoulaPublished: May 22, 2013
http://www.sunherald.com/2013/05/22/4683370/man-admits-conspiracy-in-poultry.html
2 other Jackson County men face trial

By ROBIN FITZGERALD — rfitzgerald@sunherald.com

GULFPORT -- An Ocean Springs man has admitted conspiring to violate a trade agreement with Russia by authorizing the export of poultry at higher temperatures than required.

Terry White, 38, was a warehouse supervisor for Gulf Coast Cold Storage in 2009 when he directed others to falsify blast-freezer records and restack loads of poultry to disguise portions considered too "hot" to load onto ships.

The business is a tenant at the Port of Pascagoula.

White accepted a plea agreement Tuesday to conspiracy to commit offenses against the United States. The maximum penalty is five years in prison and a $250,000 fine.

He avoided trial on four other charges with additional penalties of up to 18 years in prison and fines of $760,000.

Peanut butter facility reopens 8 months after Salmonella outreak

After being closed for 8 months due to a Salmonella outbreak in their peanut butter, the Sunland plant plans to reopen. The NM plant issued an extensive recall in September of 2012 ( http://pennstatefoodsafety.blogspot.com/2012/10/peanut-butter-recall-continues-to-expand.html) after 42 people in 20 states become ill (http://www.cdc.gov/salmonella/bredeney-09-12/index.html). The FDA prevented the plant from restarting after their investigation resulted in number of findings including 28 Salmonella-positive environmental samples (http://pennstatefoodsafety.blogspot.com/2012/11/fda-investigation-report-on-sunland.html). FDA kept the facility closed (http://pennstatefoodsafety.blogspot.com/2012/11/fda-prevents-sunland-foods-from.html) under new power granted by FSMA. In December, the facility and FDA reached a deal that provided conditions for the plant to reopen (http://news.yahoo.com/deal-reached-reopen-nm-peanut-butter-plant-214723148--finance.html) if the facility met the requirements of the consent decree with approval by the FDA.

So now 8 months later, the facility will begin making peanut butter for sale. I will stick with my brand that was not involved in an outbreak.



New Mexico plant shuttered for 8 months amid salmonella outbreak is making peanut butter againBy Associated Press,
http://www.washingtonpost.com/national/health-science/new-mexico-plant-shuttered-by-salmonella-outbreak-is-making-peanut-butter-again/2013/05/23/719863cc-c3c8-11e2-9642-a56177f1cdf7_story.html 

May 23, 2013 06:16 PM EDT

ALBUQUERQUE, N.M. — The eastern New Mexico peanut butter plant shuttered eight months ago after a salmonella outbreak is back in production, and company officials say their coveted natural and organic butters could be back on store shelves within a month.
Sunland Inc. Vice President Katalin Coburn says the company last week got the go-ahead from the Food and Drug Administration to restart peanut butter operations at its factory in Portales. It is currently in a test phase of production, she said.

“The restart of the plant is not as simple as turning on a switch,” Coburn said Thursday. “Hopefully we will be back in full production in the next few days.”

The Food and Drug Administration shut the plant in late September after its products were linked to 41 cases in 20 states. Most of those were linked to natural peanut butter the company made for Trader Joe’s.

Food safety violations found during inspection of food delivery trucks

In a recent sting operation, State Police working with PA Department of Ag inspectors stopped and inspected approximately 400 food trucks. Of these 10 were found to have food safety violations – 3 had unsafe temperatures and 7 had unsanitary cargo. 

Transporters of food are an important link in the food supply chain. Unfortunately, this is a link that can be more difficult to control, especially for smaller establishments. This is not the first time that food haulers have been found using poor food handling practices. The State of Indiana found similar issues with haulers in 2011.

 

This inspection demonstrates some of the unsafe practices that can be used by food transporters.

• Temperature control – with fuel prices high, there is a financial incentive for truckers to shut off their refrigeration units, turning them back on right before the delivery is made. In warm weather, this unacceptable practice can be especially troublesome.
• Hauling potentially hazardous chemicals in the same trailer as food – this can be an issue when those chemicals get onto the food packaging and/or on the food.
• Residual chemicals left in the trailer that may contaminate food. As trucks crisscross the country side, they may carry a number of items. It is important for trucks to be well cleaned before carrying food, and when hauling certain chemicals, those trucks should not be carrying food at all.
• Food left uncovered during transport. Foods must be wrapped to prevent contamination during loading, unloading, and transport. This also creates a situation where there is the possibility of intentional contamination.

FDA has written guidance for the sanitary transport of food. These as well as other safe food transporting practices can be found here. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/SanitationTransportation/ucm208199.htm

 

  

 

Pennsylvania State Police

News for Immediate Release

May 13, 2013

  

PA State Police Announce Operation Code R.E.D. Enforcement Results

  

Harrisburg – The Pennsylvania State Police today announced the results of Operation Code R.E.D. (Refrigerated Enforcement Detail) refrigerator food truck inspection enforcement effort held on April 23.  

  

Operation Code R.E.D. targeted commercial vehicles and large trucks transporting potentially hazardous foods.

 

“During Operation Code R.E.D., the Pennsylvania State Police and the Department of Agriculture worked together targeting food trucks to make certain that these trucks and our food are both safe,” said State Police Commissioner Frank Noonan.

 

Public pools and E. coli - an MMWR report

With summer fast approaching, it is great when we come upon a report on microbiological safety as it related to a fun summer-related activity. There is this gem in May 16th’s MMWR: Microbiologic Contamination of Filter Concentrates from Public Pools. Basically, they looked at pool filters from public pools and found that in more than half the samples tested, E. coli was present. Now while this was unlikely the pathogenic type of E. coli, it was certainly the type that screams – “of fecal origin”. Now I guess we all sort-of-figured this poop-particle-in-shorts thing happens, but to see it in writing… The authors go on to suggest that people consider taking pre-swimming showers, but I guess that is not going to happen, especially considering that people look at the pool as a place to bath. But certainly, if someone has diarrhea, they need to stay out of the pool. And this might not be as easy with children who may be willing to forget their stomach is rolling in order to get into the pool on a hot summer day. So then secondly, if your public pool water is looking a little murky, it may be a good sign to keep your head above the water. Go chlorine, and as Cathy Cutter points out, pray for that dilution effect.

Microbiologic Contamination of Filter Concentrates from Public Pools as Evidence of the Need for Improved Swimmer Hygiene — Atlanta, Georgia, 2012
http://www.cdc.gov/media/mmwrnews/2013/0516.html
CDC
Division of News & Electronic Media
404-639-3286

A study of public pools found that feces are frequently introduced into pool water by swimmers. Water samples from pool filters were tested for Escherichia coli, a fecal indicator, which was detected in 93 (58 percent) of 161 samples. The tests cannot determine whether the E. coli represents risk to swimmers, but they do indicate that swimmers frequently introduced fecal material into pool water, which could lead to spreading germs to other swimmers. Swimmers can minimize fecal contamination and help keep germs out water by taking a pre-swim shower and not swimming when ill with diarrhea. Aquatics staff can kill germs in pools by maintaining disinfectant level and pH according to state and local public health standards, which are enforced by environmental health specialists (pool inspectors).

 

 

Risk Assessment of Listeria in Retail Delicantessens

FDA released the Draft Interagency Risk Assessment – Listeria monocytogenes in Retail Delicatessens Technical Report. (http://www.fda.gov/downloads/Food/FoodScienceResearch/RiskSafetyAssessment/UCM351328.pdf). The goal of this report is to further the understanding of the risk of Listeria monocytogenes that is associated with the retail deli case. Listeria monocytogenes can grow on meat and cheese items that are sold in retail deli establishments. As we know, Listeria can grow at refrigeration temperatures and deli meat products have been involved in past outbreak. Therefore it is important for retail establishments to understand how to best limit the risk of Listeria in their retail cases where there are products with exposure during handling and storage, such as cut luncheon meats.

FDA and USDA evaluated various practices in retail deli operations and came up with some best practices to mitigate the risk of Listeria.

While this is a beast of a report at 179 pages, there are some good takeaways. Here some of the highlights, in more common language. Below this, the conclusion from the report and the USDA news release are also included.

1. Start with products that have minimal Listeria risk. While selling products that have anti-Listeria agents helps, this is not always possible. But procuring items that have been produced in establishments with good Listeria control programs is important. It is also important to properly handle those products are handled from the time they are made through the time they are brought into the retail deli establishment. Even small amounts of Listeria introduced can have a huge impact over time.
2. Keep deli retail case temperatures low, certainly below 41 degree F. While Listeria can grow at refrigeration temperatures, it does grow slowly. So the lower below the temperature of 41F, the better.
3. Clean and sanitize the retail deli units regularly, especially the niches within the cooler….like the drain.
4. Prevent cross contamination from other sources. Clean the slicers and the utensils regularly. Ensure that employees are washing hands and wearing gloves.
5. Remember that items that do not allow the growth of Listeria can be sources of contamination. For example, most fresh produce items which does not support the growth of Listeria can still be the source of contamination for meat items that will support growth. So put controls in place for handling and storage of those types of items.
6. If pre-slicing, pre-slice on a clean slicer. ( I am not a fan of pre-slice meat, I prefer sliced to order).

 

Conclusions from the report.

 

This QRA represents the first large-scale effort to model L. monocytogenes cross contamination at retail. The risk assessment model contributes to our understanding of L. monocytogenes transmission, survival, and growth in the retail environment and was used to evaluate how retail practices may impact the predicted risk of listeriosis. The approach used was to evaluate the public health effect of various mitigations under six different baseline conditions that may characterize a retail deli and the RTE food its serves.

Salmonella Typhi Infected Food Employee Potentially Exposes Restaurant Patrons

This past week, a San Francisco foodservice worker diagnosed with Salmonella Typhi, had potentially exposed restaurant patrons to infection (news report below). Salmonella Typhi is the causative agent of typhoid fever (CDC Report below).

As required by the US Food Code, (http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm181242.htm#part2-2), employees must contact their manager before coming to work when they have the symptoms of diarrhea, vomiting or jaundice, or have been diagnosed with, or have been exposed to, one of following reportable agents:
    a) Norovirus,
    b) Hepatitis A virus,
    c) Shigella spp.,
    d) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, or
     e) Salmonella Typhi

 A question that often arises is why Salmonella Typhi is singled out from the other strains of Salmonella for reporting, especially since other strains of Salmonella are more likely to be involved in foodborne illness cases.

Salmonella Typhi, the causative agent for typhoid fever, is a strain that is only carried by humans and is spread through direct contact or through food handled by an infected person. Basically, the organism passes through the intestinal tract and then invades the bloodstream leading to multisystem infection. If not treated, it invades the liver, spleen, bone marrow, gall bladder and lymph nodes.  

The symptoms are related to the systematic infection that results. The primary symptoms of Typhoid fever are typified by high sustained fever of 103 to 104 degree F, which is related to the intensive infection. Symptoms also include stomach pains, headache, and a rash or rose color spots. Untreated, the disease can progress to delirium, intestinal hemorrhaging, and potentially death (approximately 20% mortality rate). 

In some cases, people can become carriers and will shed the organism. This was the case of Typhoid Mary, a Salmonella typhi- infected house cook who contaminated approximately 50 of the people served with illness (in the years from 1900 to about 1915).  

Salmonella Typhi infection is seldom seen in the United States, in fact, most infections occur when people travel overseas. However, health officials must pay special attention in order to prevent large scale outbreaks.

 

Intentional Contamination Attempt in a Retail Store

Fortunately, we rarely see cases of intentional contamination. But when they occur, we like to point them out as a learning opportunity.

In this case, a woman contaminated orange juice bottles with rubbing alcohol, snuck them into a Starbucks store by hiding those bottles in her purse, and then placed the two contaminated bottles into a store's refrigerated display case. Lukily, another customer saw this and alerted store employees who promptly removed the contaminated bottles.

The motive of the woman is not known at this time.

Police: Woman charged over poisoned juice at California Starbucks store

By Chelsea J. Carter, CNN
updated 9:12 PM EDT, Tue April 30, 2013http://www.cnn.com/2013/04/30/justice/california-starbucks-tainted-juice/

 CNN) -- A California woman who police say planted two bottles of tainted orange juice at a San Jose Starbucks has been charged with attempted murder, a police spokesman said Tuesday. 

Ramineh Behbehanian, 50, is accused of adding rubbing alcohol to the contents of the bottles and then placing them into a refrigerated display case, Police Sgt. Jason Dwyer told reporters.