CDC MMWR - Foodborne Illness Outbreaks at Retail Food Establishments

In CDC MMWR, a report titled Foodborne Illness Outbreaks at Retail Food Establishments — National Environmental Assessment Reporting System, 25 State and Local Health Departments, 2017–2019 provides insight into outbreaks associated with retail food establishments.

The top four issues and most probable contributing factors (from Table 2 below):

• Norovirus (261 incidents) and the need to have a food health policy, and more importantly, to enforce that policy.  
• Salmonella (103 incidents)- Preventing cross contamination and cooking to correct temperature.
• Vibrio (39 incidents) - contaminated raw food eaten raw or undercooked
• Clostridium perfringens (36 incidents) - improper cooling or holding

Items from the report:

• During 2017–2019, a total of 800 foodborne illness outbreaks associated with 875 retail food establishments were reported to NEARS by 25 state and local health departments. 
• Among outbreaks with a confirmed or suspected agent (555 of 800 [69.4%]), the most common pathogens were norovirus and Salmonella, accounting for 47.0% and 18.6% of outbreaks, respectively.
• Of the 725 managers interviewed, most (91.7%) said their establishment had a policy requiring food workers to notify their manager when they were ill, and 66.0% also said these policies were written. 
• Only 23.0% said their policy listed all five illness symptoms workers needed to notify managers about (i.e., vomiting, diarrhea, jaundice, sore throat with fever, and lesion with pus). 

CDC provided this interpretation - "Norovirus was the most commonly identified cause of outbreaks reported to NEARS, and contamination of food by ill or infectious food workers contributed to approximately 40% of outbreaks with identified contributing factors. These findings are consistent with findings from other national outbreak data sets and highlight the role of ill workers in foodborne illness outbreaks. Although a majority of managers reported their establishment had an ill worker policy, often these policies were missing components intended to reduce foodborne illness risk. Contamination of food by ill or infectious food workers is an important cause of outbreaks; therefore, the content and enforcement of existing policies might need to be re-examined and refined."

"Only 16.1% (117 of 725) of establishments had policies that included the four recommendations of the FDA Food Code that were assessed. These recommendations were to have a policy that required workers to tell a manager when they are ill, a policy that specified all five symptoms workers need to tell a manager about, a policy that restricted or excluded ill or infectious workers from working, and a policy that specified all five symptoms requiring restriction or exclusion. Fewer than half (316 of 725 [43.6%]) of managers said their establishments provided paid sick leave to any workers."

The top five contributing factors to foodborne illness outbreaks were all contamination related (Box 2).

•  The most common contributing factor was other mode of contamination (excluding cross-contamination) by a worker who was suspected to have an infectious illness (104 [20.8%]). 
• Other sources of contamination included contaminated raw food (88 [17.6%]), bare-hand contact with ready-to-eat (RTE) food by a food worker suspected to have an infectious illness (72 [14.4%]), cross-contamination of ingredients (68 [13.6%]), and other unspecified source of contamination (62 [12.4%]) (Table 2). 
• Contributing factors associated with ill workers (i.e., bare-hand contact with RTE food, gloved-hand contact with RTE food, and other contamination by workers suspected of having an infectious illness) were identified in 205 (41.0%) outbreaks.
•  The most common proliferation contributing factor was improper or slow cooling of hot food (53 [10.6%]), and the most common survival contributing factor was insufficient time or temperature during cooking or heat processing (33 [6.6%]).

CDC - MMWR
https://www.cdc.gov/mmwr/volumes/72/ss/ss7206a1.htm
Foodborne Illness Outbreaks at Retail Food Establishments — National Environmental Assessment Reporting System, 25 State and Local Health Departments, 2017–2019
Surveillance Summaries / June 2, 2023 / 72(6);1–11
Erin D. Moritz, PhD1; Shideh Delrahim Ebrahim-Zadeh, MS1; Beth Wittry, MPH1; Meghan M. Holst, MSPH1; Bresa Daise, MPH1,2; Adria Zern, MPH3; Tonia Taylor4; Adam Kramer, ScD1; Laura G. Brown, PhD1 (VIEW AUTHOR AFFILIATIONS)

Neb Sprouting Facility Issued Warning Letter After Salmonella Outbreak

FDA issued a Warning Letter to Rhodes Legacy Inc DBA Sun Sprouts, a sprouting operation located in Omaha, Nebraska.  The inspection comes after sprouts were linked by epidemiological and traceback evidence to an outbreak of human infections with Salmonella Typhimurium.

The FDA "inspection revealed serious violations of the Standards for the Growing, Harvesting, Packing, and Holding of Produce for Human Consumption regulation (Produce Safety Regulation or PSR), Title 21, Code of Federal Regulations, Part 112 (21 CFR Part 112). Based on [the] inspectional findings, [FDA] determined that [the] sprout products are adulterated."

Primary inspectional findings:

• "Failed to meet the requirement to test spent sprout irrigation water from each production batch of sprouts for E. coli O157:H7 and Salmonella spp. or, if such testing is not practicable, test each production batch of sprouts at the in-process stage (i.e., while sprouts are still growing) for E. coli O157:H7 and Salmonella spp."
• "Did not test the spent sprout irrigation water (or sprouts) from each production batch of sprouts for Salmonella spp. using either (1) the method of analysis described in “Testing Methodologies for E. coli O157:H7 and Salmonella species in Spent Sprout Irrigation Water (or Sprouts),” Version 1, October 2015, FDA or (2) a scientifically valid method that is at least equivalent to this method of analysis in accuracy, precision, and sensitivity, as required by 21 CFR 112.153(a)"
• "Did not clean and sanitize food contact surfaces that you use to grow, harvest, pack, or hold sprouts before contact with sprouts or seeds or beans used to grow sprouts...investigators observed significant filth on the irrigation nozzles for your mister." 
• "Did not meet the requirement that at least one supervisor or responsible party for your farm must have successfully completed food safety training at least equivalent to that received under standardized curriculum"

https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/rhodes-legacy-inc-dba-sun-sprouts-651402-05102023
WARNING LETTER
Rhodes Legacy Inc DBA Sun Sprouts
MARCS-CMS 651402 — MAY 10, 2023

CDC MMWR - Salmonella Outbreak with Non-RTE Breaded Stuffed Chicken Products

Commercially produced non-RTE frozen breaded stuffed chicken products, such as chicken cordon bleu, have been a repeated source of Salmonella infection.  "During 1998–2022, 11 Salmonella outbreaks linked to these products were reported; 57% of samples per outbreak from patient homes and retail stores yielded Salmonella."

Although packing has cooking instructions, people continue to prepare them, or handle them as if they are fully cooked items.  The reason is that they appear to be cooked, which they are in order to set the coating, but not to the point where the chicken itself if cooked to eliminate Salmonella contamination.

CDC Morbidity and Mortality Weekly Report (MMWR)
https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a2.htm
Salmonella Associated with Not Ready-to-Eat Breaded, Stuffed Chicken Products — United States, 1998–2022
Weekly / May 5, 2023 / 72(18);484–487

Summary
What is already known about this topic?
Not ready-to-eat breaded, stuffed chicken products have repeatedly been a source of Salmonella outbreaks. On April 28, 2023, the U.S. Department of Agriculture proposed to declare Salmonella an adulterant in these products.

What is added by this report?
During 1998–2022, 11 Salmonella outbreaks linked to these products were reported; 57% of samples per outbreak from patient homes and retail stores yielded Salmonella. Outbreaks continue to occur, although a smaller percentage of patients reported cooking the product in a microwave after labeling changes.

What are the implications for public health practice?
Outbreaks have continued despite consumer-based interventions. Additional control measures for Salmonella contamination by manufacturers could reduce Salmonella-involved illnesses associated with these products.

Article on Salmonellosis in Infants Resulting in Increased Health Risks

An article in the journal Pediatrics titled "Epidemiology of Salmonellosis Among Infants in the United States: 1968–2015 " looks at nontyphoidal Salmonella infection in infants which results in high rates of hospitalization and death due to the increased risk of invasive infection.

The study did not provide information regarding the source of the contamination. 

 "These data do not provide information to assess sources of Salmonella or risk factors for invasive disease; demographic characteristics are described as risk indicators. Reported risk factors for infant salmonellosis include exposure to animals, exposure to a household member or attending day care with a child with recent diarrhea, international travel, riding in a shopping cart with raw meat or poultry, and other indoor and outdoor environmental exposures.15,–18 Use of infant formula and lack of breastfeeding are correlated risk markers.15,19,Salmonella has only rarely been identified in commercial formula.20,21 Breastfeeding might be protective because of immunity (eg, maternal antibodies from breastmilk) or to lack of exposure to bottles contaminated by household members."

Pediatrics

https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2021-056140/191251/Epidemiology-of-Salmonellosis-Among-Infants-in-the

ARTICLE| MAY 10 2023

Epidemiology of Salmonellosis Among Infants in the United States: 1968–2015 

Julie L. Self, PhD, MPH; Michael C. Judd, MPH; Jennifer Huang, MPH; Patricia I. Fields, PhD; Patricia M. Griffin, MD; Karen K. Wong, MD, MPH

Mislabeled Wing Sauce Results in Undeclared Soy Allergen

T.W. Garner Food Company is voluntarily recalling 50,688 bottles of 12 oz. Texas Pete® Buffalo Wing Sauce with best used by 120623T 065239 UPC 0 75500 10011 6 because some of the bottles may contain Texas Pete® Extra Mild Wing Sauce which contains soy.  The recall was initiated after a report was received from a direct customer that a bottle labeled as Texas Pete® Buffalo Wing Sauce was located instead of Texas Pete® Extra Mild Wing Sauce. The bottle of Texas Pete® Buffalo Wing Sauce was missing the allergen declaration of soy. Investigation indicates the problem was caused by applying the wrong label during a portion of the production run.

While the products look different, the labels are nearly identical.  This is where a properly implemented Allergen Preventive Control at the point of labeling is critical.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/tw-garner-food-company-issues-voluntary-recall-texas-peter-buffalo-wing-sauce-due-undeclared-soy
T.W. Garner Food Company Issues Voluntary Recall on Texas Pete® Buffalo Wing Sauce Due to Undeclared Soy
Summary
Company Announcement Date:  May 25, 2023
FDA Publish Date:  May 25, 2023
Product Type:  Food & Beverages
Reason for Announcement:  Undeclared Soy
Company Name:  T.W. Garner Food Company
Brand Name:  Texas Pete
Product Description:  Buffalo Wing Sauce

Bakery Snack Item Recalled After Mispackaging Issue Results in Undeclared Peanuts

Flowers Foods, Inc, headquartered in Thomasville, Ga., issued a recall for Tastykake® Chocolate Kandy Kakes due to undeclared peanuts.  The recall was initiated after the firm discovered that certain packages of Tastykake® Chocolate Kandy Kakes contained Tastykake® Peanut Butter Kandy Kakes. The ingredient statement for the Chocolate Kandy Kakes does not declare that peanuts are in the product. 

Flowers Foods Issues Voluntary Recall on Tastykake Chocolate Kandy Kakes Due to Undeclared Peanuts
https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/flowers-foods-issues-voluntary-recall-tastykake-chocolate-kandy-kakes-due-undeclared-peanuts
Summary
Company Announcement Date:  May 24, 2023
FDA Publish Date:  May 24, 2023
Product Type:  Food & Beverages
Reason for Announcement:  Undeclared peanuts
Company Name:  Flowers Foods
Brand Name:  TastyKake
Product Description:  Chocolate Kandy Kakes

Chocolate Almonds Recalled After Chocolate Supplier Fails to Notify Retailer of Change

Meijer, a Grand Rapids, Mich.-based retailer, in conjunction with its supplier, Lamontagne Chocolate Corp., is announcing a recall of Frederik’s Dark Chocolate Almonds and Meijer Express Go Cup Dark Chocolate Almonds because they may contain undeclared milk.  The products may contain an undeclared milk allergen due to a product specification change from the supplier, Lamontagne Chocolate Corp., which was not communicated to Meijer.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/meijer-issues-allergy-alert-undeclared-milk-frederiks-dark-chocolate-almonds-and-meijer-express-go
Meijer Issues Allergy Alert on Undeclared Milk in Frederik’s Dark Chocolate Almonds and Meijer Express Go Cup Dark Chocolate
Summary
Company Announcement Date:  May 23, 2023
FDA Publish Date:  May 23, 2023
Product Type:  Food & Beverages  Snack Food Item
Reason for Announcement:  Undeclared Milk
Company Name:  Meijer
Brand Name:  Meijer Express, Frederik's by Meijer
Product Description:  Dark Chocolate Almonds

NY Boutique Ice Cream Company Recalls Product Due to Undeclared Walnuts

Van Leeuwen Ice Cream of Brooklyn, NY is voluntarily recalling 4,096 frozen 14 oz pints of its French Ice Cream product "Brown Sugar Chunk” because it contains an undeclared allergen, walnuts.  The recall was voluntarily initiated after a customer complaint led to the discovery that the ice cream in this lot contains walnuts but was distributed in packaging that did not declare the presence of walnuts. The cause of the product labeling error is being investigated.

This appears to be an issue of the product filled into prelabeled cups.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/van-leeuwen-issues-voluntary-recall-undeclared-walnuts-its-brown-sugar-chunk-ice-cream-pints
Van Leeuwen Issues Voluntary Recall on Undeclared Walnuts in its Brown Sugar Chunk Ice Cream Pints
Summary
Company Announcement Date:  May 23, 2023
FDA Publish Date:  May 23, 2023
Product Type:  Food & Beverages  Ice Cream/Frozen Dairy
Reason for Announcement:  Undeclared walnuts
Company Name:  Van Leeuwen Ice Cream LLC
Brand Name:  Van Leeuwen
Product Description:  BROWN SUGAR CHUNK WITH COOKIE DOUGH & BROWNIES FRENCH ICE CREAM

FL Company Recalls Frozen Popsicles Due to Undeclared Allergens

DIBE LLC. of MIAMI, FL, is recalling its 6 ounces packages of "TETAS MIREYA SABOR NUTELLA, TODDY, FERRERO, GALLETA MARIA & GALLETA OREO " food popsicles because they may contain undeclared allergens:  The recall was initiated after it was discovered by an Florida Department of Agriculture and Consumer Services supervisor at one retail store called Pastelitos Chips in Orlando, Fl. that the soy, wheat, and walnut-containing products were distributed in packaging that did not reveal the presence of soy, wheat, and/or walnuts. Subsequent investigation indicates the problem was caused by a temporary breakdown in the company's production and packaging processes.

From the pictures, it appears that are some multi-ingredient components that were not broken down to identify the allergens.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/dibe-llc-issues-allergy-alert-undeclared-soy-walnuts-and-wheat-tetas-mireya-sabor-nutella-toddy
DIBE LLC Issues Allergy Alert on Undeclared Soy, Walnuts, and Wheat in “Tetas Mireya Sabor Nutella, Toddy, Ferrero, Galleta Maria & Galleta Oreo”
Summary
Company Announcement Date:  May 22, 2023
FDA Publish Date:  May 22, 2023
Product Type:   Food & Beverages  Snack Food Item
Reason for Announcement:  Undeclared Soy, Walnuts, and Wheat
Company Name:  DIBE LLC
Brand Name:  TETAS MIREYA
Product Description:  TETAS MIREYA SABOR NUTELLA, TODDY, FERRERO, GALLETA MARIA & GALLETA OREO