CDC MMWR Report - 2017 Legionella Outbreak Associated with Memphis Hotel Hot Tub

In the January 19th MMWR release, an investigative report into a 2017 Legionella outbreak associated with a hotel hot tub and pool.  While the outbreak came to light because of a few cases, many more were found through old-fashioned investigative work rather than sample analysis.

Initially 3 cases were identified, and this led them to the hot tub.  Through proceeding to survey past guest, 92 cases were identified, including nine laboratory-confirmed (urinary antigen positive) cases, 19 probable (self-reported pneumonia) cases, and 64 suspected (self-reported fever and ≥1 compatible symptom*) cases.  Of these, 70 had required medical care, and 16 people were hospitalized and there was one reported death.

Not the way to meet up with Elvis after going into a Memphis hotel hot tub, or any hotel water for that matter.  But how do you know?  In this case, "environmental health specialists conducted an assessment of the hotel aquatics facility and identified improper water treatment monitoring and low chlorine residuals (0 ppm; acceptable range = 1–3 ppm)."  "Laboratory testing of the aquatics facility water samples identified three Legionella polymerase chain reaction–positive samples from the pool, pool sand filter, and hot tub sand filter, and isolated Legionella pneumophila serogroup 1 from the hot tub sand filter."   Something to be said about that smell of chlorine when poolside.

CDC MMWR
https://www.cdc.gov/mmwr/volumes/67/wr/mm6702a5.htm?s_cid=mm6702a5_e
Notes from the Field: Legionellosis Outbreak Associated with a Hotel Aquatics Facility — Tennessee, 2017

FDA to Expedite Recall Postings by Eliminating the Need to Have Classification Status at Time of Posting

FDA released a statement on its plan to expedite the recall postings / alerts to consumer.  The plan to remove the need for the 'recall classification' at the time of posting.  Normally, "only recalls that have already been classified into one of three categories based on the severity of the hazard have been listed in the report".    And, these "recall classifications can sometimes take weeks – or even months when FDA needs to conduct a complex evaluation."

Wow, that was the hold up.  I bet most could probably predict what the classification is just by reading the notice.  For others, it probably doesn't even matter.  But for FDA, determining whether a recall is Class I, II or III can be a lengthy process.  "Such analysis can involve determining whether any diseases or injuries have already occurred, the likelihood that a hazard might occur, or whether vulnerable segments of the population, such as children, are more at risk"

Through some process improvement determination, "FDA has decided that the public would benefit by having recall information about FDA-regulated products as soon as possible, even though further evaluation remains to be done. Moving forward, FDA will include “not-yet-classified” recalls of human drugs, foods, and veterinary products in the weekly Enforcement Report, even while classification work is still ongoing."

FDA Voice
https://blogs.fda.gov/fdavoice/index.php/2018/01/fda-to-expedite-release-of-recall-information

FDA to Expedite Release of Recall Information
Posted on January 18, 2018 by FDA Voice

France - Investigation Deepens Regarding French Infant Milk Contaminated with Salmonella

Investigators are searching French dairy Lactalis for information related to Salmonella outbreak linked to their infant milk.  More than 12 million boxes have been recalled in 83 different countries.  "At least 37 babies are so far reported to have been affected in France, with one case reported in Spain and a further unconfirmed case in Greece."

Reports were also released that the French grocery stores still continued to sell the recalled product.
"This is a major dysfunction in the withdrawal and recall by the operators, who bear responsibility," Agriculture Minister Stephane Travert told reporters.

BBC News
http://www.bbc.com/news/world-europe-42715187
France's baby milk scare: Police search Lactalis sites
17 January 2018

CDC and FDA Hold Off from Implicating Romaine Lettuce in E. coli Outbreak

FDA and CDC did not pull the trigger on making a public notice to avoid romaine lettuce for involvement in an E. coli outbreak.   The Canadians were first to issue a public notice implicating Romaine lettuce on Dec 14th.  At this point, however, there were no additional cases of E. coli infection reported with the last case on December 12th being reported (and recognizing there is a delay from infection and reporting).

In the end, that call was right.  Even if it is found that romaine lettuce was the source, that contaminated product would had already been through the system (considering the short shelf-life of product).  A public notice would have been missed the target and resulted in needless waste.

However, what we did see was a lot of confusion on the part of various entities issuing reactionary notices.  FDA and CDC would have done better to put their findings out there earlier.  Outbreak investigations are not perfect, and while it would have been easier on their part to trash the leafy green industry, relaying the findings would have gone a long way to quieting the alarmists.

https://www.fda.gov/Food/RecallsOutbreaksEmergencies/SafetyAlertsAdvisories/ucm591989.htm
FDA Information about E. coli O157:H7 Outbreak Likely Linked to Leafy Greens
January 10, 2018

This Week in Mislabeled Product - Ending Jan 13, 2018

Juice Products May Contain Milk Protein - Hiland Dairy is announcing a voluntary recall of two products produced at the Omaha, Nebraska facility, over concerns the products may contain milk protein that could affect those individuals that have sensitivity to milk allergens.  Hiland Dairy initially learned of a potential issue during internal quality control testing at the Omaha facility.

Tofu Product Does Not Declare Soy on Label - Rico Brand of Salt Lake City, Utah is recalling Tofu Breakfast Burrito, because it may contain undeclared Soy [And tofu is fermented soy, so must realize that some consumers may not recognize that fact?].  The recall was initiated after it was discovered that the product “Tofu Breakfast Burrito” containing Soybean was distributed in packaging that did not reveal the presence of Soybean. Subsequent investigation indicates the problem was caused by a temporary breakdown in the company's packaging processes.

Supplier Mistakenly Labels Coconut Macaroons as Oatmeal Cookies -  Dollar General Corporation announced a voluntary recall of a lot of its 12-ounce packages of Clover Valley® Iced Oatmeal Cookies  over concerns of undeclared milk and tree nuts.  Dollar General initially learned of a potential issue based upon information received from a store level employee. The Company promptly contacted the product’s manufacturer who confirmed a production facility labeling error in which Clover Valley® Coconut Macaroons were inadvertently placed in Clover Valley® Iced Oatmeal Cookie packaging.

Hiland Dairy Announces Voluntary Recall Of Hiland Dairy Orange Juice And Tampico Citrus Punch
For Immediate Release
January 13, 2018

Frozen Novelty Recall Expanded and Revised

A recall of frozen orange cream bars initially posted on 1/5/18 has been expanded on 1/9/18 and then clarified on 1/11/18 to include all //product produced on one production line at one of the company's facility due to the potential for Listeria contamination. The recall now includes chocolate covered vanilla bars in addition to the orange cream bars, as well as raspberry cream bars sold in split cases.  The recall covers close to 30 different brands.

"The potential for contamination was noted after routine industry testing revealed the presence of Listeria monocytogenes in only a few ice cream bar samples of many tested. The expansion of the recall is out of precaution for consumer health and food safety after a few additional samples tested positive for the presence of Listeria monocytogenes. There is no evidence of any contamination prior to October 31, 2017, but the company has issued the recall back to January 1, 2017 through an abundance of caution and in full cooperation with the FDA."

The Recall Notice goes on to state:

"The company has suspended production and distribution of all products produced on this production line while it cooperates with the FDA to fully investigate the source of the problem."

Which would indicate that they do not yet know what the problem was...and being they don't know the source, the recall was expanded.

https://www.fda.gov/Safety/Recalls/ucm592326.htm
Fieldbrook Foods Corporation Clarifies Scope of its Voluntary Recall. Products Include Orange Cream
For Immediate Release
January 11, 2018

Sushi Recalled by Grocery Chain After Supplier has Potential Listeria Contamination Issues

Price Chopper, a northeast-based supermarket chain is recalling sushi product produced by AFC Franchise Corp due to the potential to be contaminated by Listeria.  There was no information on which item was involved, but being that two stores from different states had suspect product, it is more likely an ingredient issue than a store issue.

AFC franchises sushi bars that are often located in supermarkets.  AFC provides the know-how and materials to allow a franchisee to operate a sales space in a grocery store.  AFC had a recall early this past year for packages of edamame due to Listeria.

Many of the ingredients used in making sushi have the sufficient nutrients and are stored under conditions that allow the growth of Listeria.   Once the product is made and packaged in the store, there is always the risk of consumer mishandling, in this case, storing at elevated temperatures.  This would exacerbate the situation by allowing more growth.

WBNG.com
http://www.wbng.com/story/37228295/price-chopper-recalls-packaged-sushi-made-with-tuna
Price Chopper recalls packaged sushi made with tuna
By David Hermanovitch
Posted: Jan 09, 2018

New Trend - Drinking 'Raw Water'

There is a new trend...'raw water'...water that is unfiltered, untreated spring water. A article in the New York Times, Unfiltered Fervor: The Rush to Get Off the Water Grid discusses a Oregon operation, Live Water, is selling water for $14.99/bottle refill while a San Diego operation sells their version for $2.50/gallon.

"The quest for pure water is hardly new; people have been drinking from natural springs and collecting rainwater from time immemorial. The crusade against adding fluoride to public water began in the 1950s among Americans who saw danger in the protective measures that had been adopted over decades to protect the populace from disease and contamination.  But the off-grid water movement has become more than the fringe phenomenon it once was, with sophisticated marketing, cultural cachet, millions of dollars in funding and influential supporters from Silicon Valley."

One can also purchase water collection systems that capture moisture from the air.

From a safety perspective, without treating water, one opens themselves to increased risk to a host of  microbial pathogens including bacteria and parasites such as Giardia and Cryptosporidium, .  Beyond that, people across globe do not have access to clean water and would prefer avoid drinking 'raw' water.  The article below, from National Review, sums that up pretty well.

National Review
‘Raw Water’ Makes a Mockery of Human Suffering
Read more at: http://www.nationalreview.com/article/455235/raw-water-movement-mocks-human-suffering
by Jibran Khan January 8, 2018 1:05 PM

It’s a play-act of poverty that puts ‘slum tourism’ to shame. Every few months, there’s a new trend that promises life-changing health benefits — a spice, or a juice, or another mundane consumable, often with an Indian or East Asian name thrown in to make it seem ancient and exotic. We see these things, laugh, and move on with our lives. We live and let live.

Orange Cream Bars Recalled After Lot Tests Positive for Listeria

A NY firm is recalling 340 cases  of orange cream bars due to potential contamination with Listeria monocytogenes.  This comes after the company's routine testing revealed the presence of Listeria monocytogenes in another production lot that had been fully contained.

Unfortunately, in these cases where Listeria is found in product, the recall often is expanded unless the company can clearly demonstrate that Listeria control had been maintained over time with some plausible exception for the lot that tested positive.

FDA Recall Notice
https://www.fda.gov/Safety/Recalls/ucm591580.htm
Fieldbrook Foods Corporation, Announces a Voluntary Recall of Orange Cream Bars for Possible Health Risk
For Immediate Release
January 5, 2018