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

Salad Leaf Juice Enhances the Growth, Attachment, and Virulence of Salmonella

A study recently published in Applied and Environmental Microbiology shows that juices from leafy greens can enhance the growth, colonization, and virulence of Salmonella.  When chopping salad leaves, juices will be released from the cut surface.  The metabolites in these juices will enhance the growth of Salmonella as well as enhance its ability to form biofilms attaching to the leaf and bag surfaces.  There was even increased virulence.

While no one should avoid eating leafy greens, this study reinforces the need for good practices when growing, harvesting, processing and storing bagged chopped leafy greens.  Contamination on leafy greens is generally low, however, if improperly processed or handled, even a few inconsequential organisms can increase to the point where it becomes a problem.  For storage, bagged chopped salad should always be stored at refrigeration temperatures.

Reuters
http://www.reuters.com/article/us-health-salmonella-bagged-salads-idUSKBN13O2VM
Health News | Wed Nov 30, 2016 | 7:24am EST
Bagged salads may encourage Salmonella growth
By Carolyn Crist

FDA Report on Antibiotic Resistance of Bacterial Pathogens Indicates Improvement

The FDA released its 2014 National Antimicrobial Resistance Monitoring System (NARMS) report, which looks at antimicrobial resistance patterns in bacteria isolated from humans, retail meats, and animals at slaughter. Overall, the news is good, in that there have been decreases in bacterial pathogens with antibiotic resistance, or in other cases, the data has been steady, especially with regard to the medically important antibiotic types.

From the report:

• The prevalence of Salmonella in both retail chicken meat (9.1 percent) and retail ground turkey (5.5 percent) was at its lowest level since retail meat testing began in 2002. The prevalence of Campylobacter in retail chicken meat samples has gradually declined over time to 33 percent, the lowest level since testing began.
• Approximately 80 percent of human Salmonella isolates are not resistant to any of the tested antibiotics. This has remained relatively stable over the past ten years. Resistance for three critically-important drugs (ceftriaxone, azithromycin, and ciprofloxacin) in human non-typhoidal Salmonella isolates remained below 3 percent.
• Ceftriaxone, a third generation antibiotic used to treat infections where there is resistance to other antibiotics, has seen a continued decline in  resistance in non-typhoidal Salmonella with the exception of retail turkey meat isolates, where it rose slightly. In cattle, Salmonella isolates from carcasses collected at processing plants, ceftriaxone resistance reached its lowest level (7.6 percent) since 1999. In 2014, ceftriaxone resistance in human Salmonella Heidelberg isolates was 8.5 percent, down from a peak of 24 percent in 2010.   (But there have been some decreases in susceptibility in cattle and increases in resistance by strains of Campylobacter jejuni.)

FDA News Release
http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm529719.htm
FDA Releases 2014 NARMS Integrated Report; Finds Measurable Improvements in Antimicrobial Resistance Levels

November 18, 2016

GAO Finds FDA Technical Assistance Network (TAN) Response Times Slow

The US Government Accountability Office (GAO) found that FDA's Technical Assistance Network (TAN), a system for answering questions regarding FSMA regulations including the produce rule, has been slow in responding to questions.

From the report:

"We asked representatives from industry associations and other organizations we interviewed about their experiences submitting questions to the TAN. These representatives generally told us that wait times for answers from the TAN can be long, and some had not yet received answers to their questions. For example, representatives from one industry association told us it took 4 months to get an answer through the TAN."

While FDA is working on reducing the response times, there are questions that are not as easy to answer.  In some cases, the rule is still under development or the questions are more complex.

".....according to FDA officials, response times to TAN questions may be longer in some cases because agency guidance on the produce rule and other FSMA rules is still under development, and the agency does not want to provide information through the TAN that might conflict with the subsequent guidance. In addition, officials said that while simpler questions can often be addressed immediately by FDA staff that monitor the TAN, about 95 percent of the questions are more complex. These questions are forwarded to subject matter experts within the agency and, consequently, require more time for a response. According to FDA, median response time for questions forwarded to subject matter experts is 22 business days. FDA officials told us that if a question is still unaddressed after 30 days, FDA will send an automated message saying the agency is working on a response; a second automated message is sent after 60 days if the question is still unresolved."

These rules are new for many including the FDA, and many components of the rule have not yet been worked out for every permutation  So while delays in response times are completely understandable, I think that FDA officials and their surrogates need to acknowledge this when suggesting people go to the TAN for answers.  And considering that FDA technical support staff have a hard time answering these questions, this needs to be taken into account when inspectors are doing facility inspections.

GAO Release
http://www.gao.gov/products/GAO-17-98R
Food Safety:
FDA's Efforts to Evaluate and Respond to Business Concerns Regarding the Produce Rule
GAO-17-98R: Published: Nov 28, 2016. Publicly Released: Nov 28, 2016.

Three Recalls of Cooked Meat Products After Customers Complained of Undercooked Appearance

In the past few weeks, there have been three recalls of cooked meat products after customers/consumers complained that the product appeared to be undercooked.  The recalls were for firms located in OK, GA, and MO.  It is interesting in that these companies must have not been able to demonstrate that the suspect products had been properly cooked, and thus, they felt the need to do a recall.

Of course if the meat had not been fully cooked, there is the potential for pathogens such as Salmonella.


http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2016/recall-115-2016-release
National Steak and Poultry Recalls Food Service Ready-To-Eat Chicken That May Be Undercooked
Class I Recall115-2016
Health Risk: HighNov 23, 2016

Pumpkin Ice Cream Pies Recalled Because Peanut Ingredient Not Listed on Label

A Buffalo NY establishment, Anderson's Frozen Custard, is recalling Pumpkin Ice Cream pies because the product which contains peanuts did not list peanuts on the label.  So it was an undeclared allergen issue.

http://www.fda.gov/Safety/Recalls/ucm530645.htm
Anderson’s Frozen Custard issues Allergy Alert on Undeclared Peanuts in Pumpkin Ice Cream Pies
For Immediate Release
November 22, 2016

A 2015 Thanksgiving Luncheon Becomes Scene for C. perfringens Outbreak - A CDC Report

With Thanksgiving leftovers still in the fridge, it is a good time to review a 2015 outbreak that occurred during a Thanksgiving luncheon.  About 40 people who attended a catered company Thanksgiving lunch became ill with diarrhea and abdominal pain the following day (roughly 13 hours later).  C. perfrignes entrotoxin was found in the patient stool samples and C. perfrigens was isolated from the turkey as well as the patients.

According to the CDC report "The caterer had previously maintained a permitted facility, but reported having prepared the lunch food served at this event in an uninspected, residential kitchen. Turkeys were cooked approximately 10 hours before lunch, placed in warming pans, and plated in individual servings. Food was then delivered by automobile, which required multiple trips. After cooking and during transport, food sat either in warming pans or at ambient temperature for up to 8 hours. No temperature monitoring was conducted after cooking."

C. perfringens toxicoinfection is a foodborne illness caused by ingestion of toxin-producing bacteria where then the organism produces the toxin in the gut.  This type of foodborne illness is often associated with consumption of meat that has been improperly prepared and handled.

So store your leftover turkey at the proper temperatures (either below 40F or hot, above 140F).


Notes from the Field: Clostridium perfringens Gastroenteritis Outbreak Associated with a Catered Lunch — North Carolina, November 2015
Weekly / November 25, 2016 / 65(46);1300–1301

Sabra Hummus Recall Leads to Secondary Recalls

Greencore and Sky Chefs are recalling prepared sandwiches that were made with the recalled Sabra hummus.  Sandwiches were delivered to 7-Eleven stores in various markets including Pittsburgh, PA.

Taylor Farms is recalling various veggie trays and boxes that contain the Sabra humus.

FDA Recall Notice
http://www.fda.gov/Safety/Recalls/ucm530607.htm
National Recall by Sabra Dipping Company Leads to Secondary Recall of Deli Sandwich in Pittsburg (PA), Cleveland (OH) and Buffalo (NY) Markets
For Immediate Release
November 23, 2016

Sabra Hummus Recalled Due to Listeria Discovery in Processing Facility

Sabra of Colonial Heights, VA is recalling hummus products, about 50 SKUs in all, after finding Listeria monocytogenes in their facility.  The product being recalled is all product manufactured before November 8, 2016 (Coded “Best Before” date up through January 23, 2017).   The statement says that product had not tested positive, but there is probably a concern of where they found it in the facility.

With what appears to be a shelf-life of 75 days, there is probably over 2 months of production potentially in the marketplace or in consumer's refrigerators.  As a ready-to-eat product, there can be significant risk if the organism is present, so it is important to dispose of product.

According to the FDA investigation...."27 swabs of the processing environment that contained Listeria monocytogenes. Analysis by pulse-field gel electrophoresis (PFGE) revealed that one of the strains of Listeria monocytogenes found during the recent inspection matches a strain found in a retail product sample collected in 2015, indicating this strain of Listeria monocytogenes may be persistent in the production environment."

Sabra had another recall in 2015 when a positive product sample was found. Another company recalled hummus product in 2014.  Finding the same Listeria strain in the environment is a concern, and especially the large number of samples.
 
FDA Recall Noticehttp://www.fda.gov/Safety/Recalls/ucm529967.htm
Sabra Dipping Company Issues Voluntary Recall Of Certain Hummus Products Because Of Possible Health Risks
For Immediate Release
November 19, 2016