Caramel Apples Linked to Listeria Outbreak, 5 Reported Deaths

Caramel Apples, commercially produced and prepackaged, are being linked to a Listeria outbreak that has caused 5 deaths and 21 hospitalizations in 10 states.

 While we have recently seen recalls related to Listeria being detected on apple slices, this is one of the first cases of a Listeria outbreak related to apples.  Considering that there are as many illnesses and deaths, this is the type of outbreak that will have a huge impact on fruit packers and processors.

At this point, there is little information on the circumstances, but certainly more will follow.

Melted caramel is liquid in the 125F to 150F range, so depending on how fast it cooled, Listeria could survive on the surface.  It also could be forced into the apple via the wooden stake.

At this point, it may be wise to avoid caramel apples.

Well here is a scenario….

 

• Apples that were probably washed, but in less-than-sanitary quality water contaminates the apple, and most importantly the calyx.  
• Apples were stored prior to adding caramel, providing a greater chance for biofilm formation at the calyx end.
• The stick, when shoved into the calyx of the apple, drags the inoculum into the center of the apple.
• The core, perhaps not having as low a pH compared to the cells in the pulp, may be more apt to support the growth of Listeria.
• Growth is further supported by the storage of those apples at room temperature..and that temperature may even be higher in that those apples were dipped in the warm caramel.
• If the processor used bulk storage apples, the conditions for supporting biofilm would probably be greater.
• Caramel apples can have a sell-by-date as long as one month, and this will provide more opportunity for growth, even if that growth is slow.

 

Potential Controls for Consideration:

• Using tree run fruit that is sorted for fresh sales.
• Sanitizing apples followed by proper drying.  Sanitizer concentration must be controlled.
•  Storage of fresh apples at refrigerated temperature in boxes with separators.
•  Pre-dip the sticks in an acid sanitizing solution.
•  Chilling apples after dipping in caramel,
•  Storage of the caramel apples at refrigeration temperature.
• Limit shelf-life of caramel apples.
•  Can the calyx of the apple be removed?

  

We will need to see what the conditions for processing these caramel apples were to get a better idea of what happened.

CDC Outbreak Notices

http://www.cdc.gov/listeria/outbreaks/caramel-apples-12-14/index.html

Multistate Outbreak of Listeriosis Linked to Commercially Produced, Prepackaged Caramel Apples

 

Posted December 19, 2014 9:30 AM ET

 

Highlights

• Read the Advice to Consumers and Retailers>>(http://www.cdc.gov/listeria/outbreaks/caramel-apples-12-14/advice-consumers.html)
• CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis) linked to commercially produced, prepackaged caramel apples. Listeria can cause a serious, life-threatening illness.
• The information CDC has at this time indicates that commercially produced, prepackaged caramel apples may be contaminated with Listeria and may be causing this outbreak.
• Out of an abundance of caution, CDC recommends that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.

As US Poultry Industry Braces for the Potential of Avian Flu, H5N2, People Not at Risk

Avian influenza has been found in wild birds on the US border.  USDA has not found it in in US poultry, but the strains H5N2 and H5N8 have been found in Canadian and European flocks.  While these strains are highly pathogenic to birds, they are not considered a risk to people.
 
Migratory birds such as ducks are a risk factor for spreading the virus to the US poultry population.  Once infected, the flock is often culled to eliminate further risk of spreading the virus.

Just this past year, the pork industry suffered the fate of the PED virus, or Porcine epidemic diarrhea virus.  PEDV causes severe diarrhea in pigs and has a high lethality in piglets, but poses no risk to other animals or humans.   PED and Influenza are different types of viruses. PED is from the Coronaviridae family of enveloped, positive-stranded RNA viruses.  Influenza is an Orthomyxovirus.

CIDRAP
H5N2, H5N8 avian flu viruses surface in US
Robert Roos | News Editor | CIDRAP News
http://www.cidrap.umn.edu/news-perspective/2014/12/h5n2-h5n8-avian-flu-viruses-surface-us
Dec 16, 2014

US authorities today reported finding wild birds in Washington state infected with two different highly pathogenic avian influenza (HPAI) viruses, H5N2 and H5N8, raising questions about possible connections with recent H5N2 outbreaks across the border in Canada and with an Asian H5N8 strain that is now hitting European poultry farms.

In reports to the World Organization for Animal Health (OIE), the US Department of Agriculture (USDA) said H5N2 was found in a wild pintail duck, while H5N8 was found in a captive wild gyrfalcon that was fed on hunter-killed birds. Both birds were in Whatcom County, Washington, which borders the Abbotsford area of British Columbia, the site of recent H5N2 outbreaks in poultry.

Catered Office Party Is the Site of Staph Aureus Intoxication

Approximately 60 people became ill after attending an office party in Florida.  About 25 were taken to the hospital.  The catered event served turkey, ham, stuffing and green bean to some 700 people.   The caterer was identified as Kitchen Divas, which from the website, appears to be a legitimate operation.

The illness appears to be Staphylococcus aureus intoxication, and one would guess the level of toxin formed in the food would be pretty high because of the short duration from the time the product was eaten to the point when people become ill, and the fact they had to cart people to the hospital.

If this is the case, it would mean that one of the foods served was drastically temperature abused.

It sucks when staff parties turn into 'staph' parties.  We highlighted a similar event within the past month in North Carolina where more than a dozen postal workers become ill.  Makes you reconsider attending your company's holiday party, doesn't it?


WKMG Local 6 Orlando
http://www.clickorlando.com/news/orange-county-fire-rescue-investigating-report-of-sick-people-in-office-building/30164136
Dozens sickened at office holiday party in Maitland
Officials say 30 taken to hospital for apparent food poisoning
Author: Shaun Chaiyabhat, Reporter, schaiyabhat@clickorlando.com
Michelle Dendy, ClickOrlando.com Web Editor, mdendy@clickorlando.com
Published On: Dec 10 2014 04:48:18 PM EST Updated On: Dec 12 2014 06:41:14 AM EST 

MAITLAND, Fla. -

Authorities are investigating what caused nearly 60 people to fall ill at a large holiday party in a Maitland office building Wednesday afternoon.

Orange County Fire Rescue, Seminole County Fire Rescue and Winter Park Fire Department were called to the office building at 2301 Lucien Way roughly two hours after the building-wide catered luncheon.

Report - Increased Outbreaks Associated with Raw Milk

In a survey looking at illness related to raw milk over a 5 year period, researchers concluded that the number of illnesses associated with raw milk has increased.  Basically, it is because more people are drinking raw milk.  There are now more states that allow for the sale of raw milk (currently 30).

There is a higher risk of foodborne illness from drinking raw milk.  If one chooses to drink raw milk, they should know that.

Emerging Infectious Disease
http://wwwnc.cdc.gov/eid/article/21/1/14-0447_article

Volume 21, Number 1—January 2015
Dispatch
Increased Outbreaks Associated with Nonpasteurized Milk, United States, 2007–2012

Conclusions

Within this 6-year period, the number of outbreaks associated with nonpasteurized milk increased. The number of outbreaks caused by Campylobacter spp. nearly doubled. The average number of outbreaks associated with nonpasteurized milk was 4-fold higher during this 6-year period (average 13.5 outbreaks/year) than that reported in a review of outbreaks during 1993–2006 (3.3 outbreaks/year) (4). This increase was concurrent with a decline in the number of states in which the sale of nonpasteurized milk was illegal, from 28 in 2004 to 20 in 2011 (7–9) and with an increase in the number of states allowing cow-share programs (from 5 in 2004 to 10 in 2008) (8,9). The decision to legalize the sale of nonpasteurized milk or allow limited access through cow-share programs may facilitate consumer access to nonpasteurized milk (5). The higher number of outbreaks in states in which the sale of nonpasteurized milk is legal has been reported elsewhere (4).

The legal status of nonpasteurized milk sales in 1 state can also lead to outbreaks in neighboring states. In a 2011 outbreak of Campylobacter spp. infections associated with nonpasteurized milk in North Carolina, where sales of this product were prohibited, milk was purchased from a buying club in South Carolina, where sales were legal. Another outbreak of Campylobacter spp. infection in 2012 implicated nonpasteurized milk from a farm in Pennsylvania, where sales are legal; cases from this outbreak were reported from Maryland, West Virginia, and New Jersey, all of which prohibit sale of raw milk (10). All patients residing outside Pennsylvania had traveled to Pennsylvania to purchase the milk (10).

Outbreaks associated with nonpasteurized milk continue to pose a public health challenge. Legalization of the sale of nonpasteurized milk in additional states would probably lead to more outbreaks and illnesses. This possibility is especially concerning for vulnerable populations, who are most susceptible to the pathogens commonly found in nonpasteurized milk (e.g., children, senior citizens, and persons with immune-compromising conditions). Public health officials should continue to educate legislators and consumers about the dangers associated with consuming nonpasteurized milk; additional information can be obtained at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html. In addition, federal and state regulators should enforce existing regulations to prevent distribution of nonpasteurized milk.

Report - Phthalates and IQ Levels in Children

A published study claims a link between lower IQ levels in children with higher levels of phthalates in their mothers during pregnancy.  But there have been other linkages to issues associated with development and reproductive health.  The chemical does not bioaccumulate in the body and does break down in the environment..

Phthalates are used in a large variety of products, from enteric coatings of pharmaceutical pills, gelling agents,  adhesives and glues, detergents, packaging, children's toys, modelling clay, waxes, paints, printing inks and coatings, pharmaceuticals, food products, and textiles. Phthalates are also frequently used in soft plastic fishing lures, sex toys, caulk, paint pigments, shower curtains, vinyl upholstery, adhesives, floor tiles, food containers and wrappers, and cleaning materials. Personal-care items containing phthalates include perfume, eye shadow, moisturizer, nail polish, liquid soap, and hair spray.  Items made of PVC and cosmetics may be the primary contributors.

 So it is easy to see that people are commonly exposed to phthalates.  In one study, CDC has found that people had the metabolites of multiple phthalates in their urine.

From the FDA webpage on the topic:

FDA reviewed the safety and toxicity data for phthalates, including the CDC data from 2001, as well as the CIR conclusions based on reviews in 1985 and 2002. While the CDC report noted elevated levels of phthalates excreted by women of child-bearing age, neither this report nor the other data reviewed by FDA established an association between the use of phthalates in cosmetic products and a health risk. Based on this information, FDA determined that there wasn’t a sound, scientific basis to support taking regulatory action against cosmetics containing phthalates.

Here is the link to the CDC website on the topic.

Like BPA, there is controversy around the real risk associated with phthalates.  And so what we can say is that where possible, we avoid risk.  This is not always easy because many of the items where phthalates are used, do not have regulations that require them on the label.  So on cosmetic items, especially fragrances, look for 'phthalate free'.  Use plastic with recycling codes 1, 2, and 5.  Throw out old plastic toys (pre-2010) or don't let little kids play with them (for you 'collectors').  Do not heat food in plastic containers.  Sex toys....won't go there.



Reuters
http://www.reuters.com/article/2014/12/10/us-health-pthalates-child-iq-idUSKBN0JO26620141210
Prenatal exposure to chemicals tied to lower IQ at age 7
By Kathryn Doyle

Wed Dec 10, 2014 2:20pm EST

(Reuters Health) - Children whose mothers were exposed to higher levels of phthalates, common chemicals in consumer products, in late pregnancy tend to score lower than other kids on intelligence tests at age seven, according to a new study.

Some soaps, nail polish, hairspray, shower curtains, raincoats, car interiors and dryer sheets contain phthalates, which are used as so-called plasticizers, or softening agents.

At present, the Food and Drug Administration does not have evidence that phthalates as used in cosmetics pose a safety risk, but six types of phthalates are currently banned from children’s toys, according to the U.S. Consumer Product Safety Commission.

Does BPA increase Blood Pressure? The BPA Controversy Continues

In the ongoing controversy on BPA, that chemical used in the lining of cans and in plastic containers, a Korean research team claims that BPA increases blood pressure. The American Chemistry Council (ACC) countered and said the study "inappropriately concerns and confuses consumers" in that the claim "is a gross overstatement of the findings, an incredible disservice to public health, and runs contrary to years of research by government scientists".

Huffington Post
http://www.huffingtonpost.com/2014/12/08/bpa-cans-blood-pressure_n_6290644.html
BPA In Cans Tied To Increased Blood Pressure
Reuters
Posted: 12/08/2014 4:31 pm EST Updated: 12/08/2014 5:59 pm EST
By Andrew M. Seaman

(Reuters Health) - People have small increases in blood pressure after drinking from cans lined with material that includes a common chemical, South Korean researchers say.

When can linings contained bisphenol A - more commonly known as BPA - systolic blood pressure (the top number) went up by about 5 millimeters of mercury (mm/Hg), researchers found.

"I would like to recommend consumers use fresh foods or glass bottled foods rather than canned foods," said Dr. Yun-Chul Hong, the study's senior researcher from the Seoul National University College of Medicine. "I also hope manufacturers develop and use healthy alternatives (instead) of BPA for inner lining of the can containers."

Increasing Demand for Organic Food Challenges Certifying Inspector Capacity

USDA estimates that the double digit growth in organic food will reach $35 Billion in sales this year.

According to a report in the WSJ,  this has created challenges for the inspectors who certify those farms as organic.  There are 81 accredited agencies who certify farms and according to the report:

40% of these 81 certifiers have been flagged by the USDA for conducting incomplete inspections; 16% of certifiers failed to cite organic farms’ potential use of banned pesticides and antibiotics; and 5% failed to prevent potential commingling of organic and nonorganic products

It is  not an easy task....farms must keep accurate records in order to show compliance with numerous restrictions.  And these records must be maintained over a number of years to demonstrate that the food can be called organic.

But for the consumer, they are willing to pay more than double for organic foods.




Wall Street Journal - Business
http://www.wsj.com/articles/organic-farming-boom-stretches-certification-system-1418147586?mod=WSJ_hpp_MIDDLENexttoWhatsNewsThird

Organic-Farming Boom Stretches Certification System
USDA Farms Out Inspections, but Thoroughness Is Questioned
By
Caelainn Barr Dec. 9, 2014 12:53 p.m. ET


The $35 billion organic-food industry has nearly tripled in size in the past decade, challenging the Agriculture Department’s ability to monitor the more than 25,000 farms and other organizations that sell organic crops and livestock.

Sliced Apple Product Recalled Due to Positive Listeria Test

Del Monte is recalling approximately 3000 units of packaged sliced apples after the Ohio Department of Health found Listeria in testing retail product.  No illnesses have been reported.  The product identified in the recall is past its expiration date.

While the risk of a Listeria outbreak from sliced apples may be considered low due to lack of an associated outbreak, there have been recalls of sliced apples due to Listeria.  One recall occurred at a Washington company in 2013 and also at a New Jersey company in 2012.  Listeria has been shown to grow on sliced apples when those apples are temperature abused, or when certain spoilage organisms grow and cause fruit rotting (Conway, eta. 2000).  So while the shelf-life on this product is relatively short (approximately 12 days), there theoretically can be an issue in certain situations.

 

Business Wire
http://www.businesswire.com/news/home/20141209006788/en/Del-Monte-Fresh-Produce-N.A.-Voluntarily-Recalls#.VIhiEE10yUk
Del Monte Fresh Produce N.A., Inc. Voluntarily Recalls Fresh Cut Fruit Containing Gala Red Apple in a Few States in North East US Because of Possible Health Risk

December 10, 2014 12:39 AM Eastern Standard Time

CORAL GABLES, Fla.--(BUSINESS WIRE)--Del Monte Fresh Produce N.A., Inc. (“Del Monte Fresh”) announced today the voluntary recall of fresh cut fruit containing Gala red apples grown in Pennsylvania. The affected product was distributed to a limited number of customers in a few States in North East US and is being recalled because these apples have the potential to be contaminated with Listeria monocytogenes, an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

E. coli O157:H7 Outbreak Linked to Cucumbers (Colorado, 2013)

A 2013 outbreak of  E. coli O157:H7, where 9 individuals were infected, appears to be linked to eating sandwiches containing cucumbers.  All ill patrons ate at different shops of the same restaurant chain which all used the same lot of cucumbers.

From the report:

Prior to this outbreak, there have been no documented E. coli O157:H7 outbreaks associated with cucumbers in the United States, per a literature search conducted by CDPHE and by searching for outbreaks on CDC’s Foodborne Outbreak Online Database (http://wwwn.cdc.gov/foodborneoutbreaks/), which captures foodborne outbreak reports generated by local and state health departments and the CDC from 1998 through 2012. An outbreak of E. coli O157:H7 associated with consumption of cucumber salad (consisting of cucumbers, hard-boiled egg, and vinaigrette dressing) affected school-age children from England who were visiting France in 2002 (5). The investigators hypothesized that the cucumbers became contaminated in the growing field. There is evidence that cucumbers can support the growth of E. coli O157:H7 based on a 1993 study by Abdul-Raouf et al (6). The researchers inoculated sliced cucumbers with E. coli O157:H7 and found that the bacteria load increased when storage temperatures were at 21 degrees Celcius (69.8 degrees Fahrenheit). Mukherjee et al conducted microbiological analyses of fresh cucumbers produced by organic and conventional farmers in Minnesota and were not able to isolate E. coli O157:H7 but did find that cucumbers are often contaminated with coliforms, an indicator of fecal contamination (7).

For this particular investigation, it is not clear how the cucumbers could have been contaminated. It is very unlikely that contamination occurred within the 3 implicated Jimmy John’s locations, as no major food handling violations were noted during the environmental assessments and no ill food handlers were discovered. It is more likely that the implicated stores received contaminated cucumbers. Our investigation found no evidence that would support that the cucumbers became contaminated at the Denver-based produce distributor (Colo-Pac Produce, Inc.) or during shipment to the implicated Jimmy John’s locations. 

But it is easy to see that cucumbers can be a source. They are on the ground when harvested, and if not washed sufficiently, that contamination can be transferred to the slice when cut.
  
  
 Marler Blog / Colorado Department of Public Health and Environment
http://www.marlerblog.com/files/2014/12/CDPHE-Final-Report-Dec.-4-2014.pdf-Adobe-Acrobat.pdf
 Outbreak #2013-00-006 - Escherichia coli O157:H7 Outbreak Associated with Cucumbers Consumed at a Sandwich Restaurant Chain – Colorado, October 2013

Summary
 CDPHE and several Denver metropolitan area public health departments investigated an outbreak of Escherichia coli O157:H7 (E. coli O157:H7) that occurred in October 2013. Nine cases were identified, including 1 probable case and 8 laboratory-confirmed cases with matching pulsed-field gel electrophoresis (PFGE) and multiple-locus variable number tandem repeat analysis (MLVA) patterns from E. coli O157:H7 isolated from stool. All 9 cases reported eating sandwiches at Denver-area Jimmy John’s locations in early October 2013. The outbreak investigation consisted of case finding and interviews, 2 separate case-control studies, environmental investigations, produce traceback, and laboratory testing. The results of this investigation indicate that consumption of Jimmy John’s sandwiches containing cucumbers imported from Mexico was the likely cause of the outbreak. To our knowledge, this is the first E. coli O157:H7 outbreak associated with cucumbers reported in the United States. Public health and food safety officials should be aware that cucumbers may be contaminated with E. coli O157:H7, which could cause sporadic E. coli O157:H7 infections as well as outbreaks. As of the date of this report, no other cases of E. coli O157:H7 with the PFGE pattern combination seen in this outbreak were reported in Colorado.