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illnesses in egg outbreak top 1,800
Posted on October 19, 2010 by Drew Falkenstein
Wright County Egg and Hillandale Farms eggs have caused over 1800 Salmonella
illnesses nationally, according to the CDC's latest update, released
today. Significantly, we have still not yet reached the end of the reporting
period for this outbreak, which the CDC notes specifically in the summary
below. Will confirmed illnesses in the outbreak top 2,000? How many
total illnesses are there in this outbreak (confirmed and unconfirmed)?
FYI: 38 x 1,800 is 68,400.
The updated summary from the CDC on the egg outbreak:
In July 2010, CDC identified a nationwide sustained increase in the
number of Salmonella Enteritidis isolates with PFGE pattern JEGX01.0004
uploaded to PulseNet, the national subtyping network made up of state
and local public health laboratories and federal food regulatory laboratories
that performs molecular surveillance of foodborne infections. This increase
began in May 2010 and is evident in the epidemic curve, or epi curve.
The number of reports increased substantially in July when the peak
of the outbreak appears to have occurred. From May 1 to October 15,
2010, 2010, a total of 3,182 illnesses were reported. However, some
cases from this period have not been reported yet, and some of these
cases may not be related to this outbreak. Based on the previous 5 years
of reports to PulseNet, we would expect approximately 1,369 total illnesses
during this same period. This means there are approximately 1,813 reported
illnesses that are likely to be associated with this outbreak. Many
states have reported increases of this pattern since May. Because of
the large number of expected cases during this period, standard methods
of molecular subtyping alone are not sufficient to determine which reported
cases might be outbreak-associated. CDC is currently evaluating advanced
molecular methodologies to see if they help distinguish between outbreak-related
cases and sporadic (or background) cases.
Ilnesses that occurred after September 12, 2010 might not yet be reported
due to the time it takes between when a person becomes ill and when
the illness is reported. This typically takes two to three weeks for
Salmonella, but can take up to six weeks. For more details, please see
the Salmonella Outbreak Investigations: Timeline for Reporting Cases.
Epidemiologic investigations conducted by public health officials in
11 states since April have identified 29 restaurants or event clusters
where more than one ill person with the outbreak strain has eaten. Data
from these investigations suggest that shell eggs are a likely source
of infections in many of these restaurants or event clusters. Wright
County Egg, in Galt, Iowa, was an egg supplier in 15 of these 29 restaurants
or event clusters; three are clusters that have been recently reported,
but occurred earlier in the outbreak. Traceback investigations have
been completed for several of these clusters. A formal traceback was
conducted by state partners in California, Colorado, and Minnesota,
in collaboration with FDA and CDC, to find a common source of shell
eggs. Wright County Egg in Iowa was found as the common source of the
shell eggs associated with three of the clusters. Through traceback
and FDA investigational findings, Hillandale Farms of Iowa, Inc., was
identified as another potential source of contaminated shell eggs contributing
to this outbreak. FDA has completed its on-site investigations at both
of these firms in Iowa. Evaluation of the investigational data, including
review of sampling results and records, continues in order to identify
potential sources of contamination, such as feed. FDA¡¯s inspectional
observations, in addition to sample results, indicate substantial potential
for Salmonella to have persisted in the environment and to have contaminated
eggs (see 483 Inspectional Observations on the Egg Recall).
a New Way to Clean the Greens
By WILLIAM NEUMAN
Published: October 14, 2010
The produce industry ? rocked by several major recalls in recent years
linked to outbreaks of salmonella, E. coli and other bacteria ? has
been searching for a better way to wash the lettuce, spinach and other
greens it bags and sells in grocery stores and to restaurants.
Now, the nation¡¯s leading producer of bagged salad greens, Fresh Express,
says that washing them in a mild acid solution accomplishes the task.
The company plans to announce on Friday that it is abandoning the standard
industry practice of washing leafy greens with chlorine and has begun
using the acid mixture, which it claims is many times more effective
in killing bacteria. The new wash solution, called FreshRinse, contains
organic acids commonly used in the food industry, including lactic acid,
a compound found in milk.
¡°We do believe it provides a much higher level of effectiveness versus
the chlorine sanitizers in use today,¡± said Mike Burness, vice president
of global quality and food safety at Chiquita Brands International,
which owns Fresh Express. ¡°This technology was developed to raise the
Mr. Burness said the breakthrough came when researchers at the company
combined lactic acid with another organic acid, peracetic acid. The
two together, he said, worked much better than either one separately
and also achieved markedly better results than chlorine.
He said that the company had already begun using the acid mixture, diluted
in water, to wash produce at one of its processing plants. He said the
company¡¯s four other plants would be converted to use the mixture by
early next year.
Scientists not involved in the Fresh Express project and industry executives
said that while they were not familiar with the company¡¯s research,
if its claims were borne out, the new wash mixture could be a significant
¡°The holy grail of fresh-cut produce is finding a wash step that¡¯s going
to be more effective than chlorine at reaching those bacteria that chlorine
can¡¯t quite reach,¡± said David Gombas, senior vice president of food
safety and technology at the United Fresh Produce Association, a trade
group. ¡°If they¡¯ve achieved that, that would be a significant advance
in ensuring the safety of fresh-cut vegetables.¡±
Fresh Express is a member of the produce association, but Mr. Gombas
said that he was not aware of the company¡¯s plans or the results of
The leafy greens industry was forced to confront its food safety shortfalls
after a deadly E. coli outbreak in 2006 caused by spinach produced at
a California farm. Since then, there have been numerous outbreaks and
recalls involving leafy greens. Earlier this year, romaine lettuce grown
in Arizona caused a major E. coli outbreak.
Fresh Express issued three separate recalls this year of packaged salad
greens after random testing found salmonella, E. coli and listeria in
bags of its products.
Fresh Express said that its new cleaning mixture was 750 times as effective
as chlorine in killing bacteria suspended in wash water. It is also
at least nine times as effective as chlorine in killing bacteria that
has become attached to the leaves of produce.
Mr. Burness said that lettuce and other greens were cut up in the company¡¯s
plants, washed in water containing the acid mixture, typically for 20
to 40 seconds, then rinsed, dried and bagged. He said another advantage
is that the acid wash did not bleach the greens, making them pale in
color, as chlorine can.
The company said that it planned to license the mixture for use by other
Fresh Express has not published its research, so food safety experts
said on Thursday that they were unable to adequately evaluate the company¡¯s
Fresh Express said that it had informed the F.D.A. about its use of
the acid wash mixture, but that it was not required to get approval
for the switch because the ingredients were already approved for use
in the food industry.
Health experts, farmers disagree over restricting
use of antibiotics in animals
By KAREN DILLON
Posted on Sun, Oct. 17, 2010
The Kansas City Star
For decades, factory farms have used antibiotics even in healthy animals
to promote faster growth and prevent disease that could sicken livestock
held in confined quarters.
The benefit: cheaper, more plentiful meat for consumers.
But a firestorm has erupted over a federal proposal recommending antibiotics
only when animals are actually sick. Medical and public health experts
in recent years said overuse and misuse of antibiotics posed a serious
public health threat by creating new strains of bacteria that are difficult
to treat ? both in animals and humans.
¡°Over time, we have created some monster bugs,¡± said Russ Kremer, a
Bonnots Mill, Mo., farmer who speaks nationally about the threat to
the food supply.
¡°It is truly harmful to everyone to feed antibiotics to animals just
for growth promotion and economic gain.¡±
The meat industry argues that the draft guidelines from the Food and
Drug Administration are premature because a clear link has not been
shown between antibiotics in livestock and health problems in humans.
¡°What FDA is doing, trying to restrict the use of antibiotics and require
additional veterinary oversight, goes beyond where the science, their
own science, has gone,¡± said Kelli Ludlum, congressional relations director
for the American Farm Bureau.
This summer the FDA issued draft guidelines, which recommend using antibiotics
only in acute medical situations and under the supervision of a veterinarian.
The guidelines are only recommendations but are a first step toward
possible regulations to limit the use of antibiotics in the United States.
Despite meat industry protests, the medical community is unhappy that
the FDA recommendations don¡¯t go far enough. They are weak and voluntary,
and after decades of study, the FDA should just issue regulations, the
medical industry said.
¡°These are guidelines, not regulations, which means no enforcement,¡±
said Gail R. Hansen, a veterinarian and senior officer of the Pew Charitable
Trusts, which has campaigned for new limits on farm antibiotics.
¡°We don¡¯t see that it is going to move things along very efficiently.¡±
Medical and public health experts said the antibiotic issue had been
studied here, in Canada, Europe and other countries for 40 years. The
European Union issued rules more than 10 years ago limiting the use
of antibiotics in livestock. Even more stringent rules were issued in
The FDA is expected to issue the final guidance possibly early next
year. An FDA spokeswoman said the agency wanted to move quickly to begin
phasing in its guideline principles, but first it is studying an overwhelming
number of comments the agency received from the public.
For many years doctors worried the overuse of antibiotics was creating
bacteria that had grown resistant to the antibiotics, which left people
vulnerable to the bacteria.
Ultimately, they feared, a super strain of bacteria could develop that
would be devastating to humans.
As a result, medical experts have conducted campaigns to prevent overprescribing
of antibiotics for patients. Now, many have turned their attention to
bacteria that could be developing on the farms for the same reason ?
overuse of antibiotics ? and then infecting humans.
Difficult-to-treat strains of E. coli and salmonella have evolved.
Most of the arguments over the FDA guidelines swirl around whether there
is enough scientific evidence to prove a link between farms and humans.
In a letter to Congress last spring, Centers for Disease Control and
Prevention Director Thomas R. Frieden wrote that there is ¡°compelling
evidence of a clear link between antibiotic use in animals and antibiotic
resistance in humans.¡±
Tom Chiller, a CDC medical director, laid out the evidence:
?Scientists have documented studies and data that show using antibiotics
in animals creates resistant bacteria.
?Studies also show that the resistant bacteria survive on meats consumers
?Scientists know people get disease from some of the same hardy strains
of bacteria that are found on farms.
¡°It is hard to do a study, document that antibody A, used in cow A,
caused infection Z in human Z,¡± Chiller said. ¡°But we know along the
continuum of all those lines that antibiotic-resistant bacteria from
animals is getting into the food supply.¡±
The best evidence for the link between animals and humans is a study
from Denmark, Chiller said.
In the study, a growth-promoting antibiotic was used in animals and
not humans. The animals developed resistant bacteria that went through
the meat supply and showed up causing human infection.
¡°We have worked for years with the meat industry,¡± Chiller said. ¡°We
need to continue to work together to figure out the right thing in this
But the meat industry remains highly skeptical of such studies, which
it said did not clearly identify animals as the source of antibiotic
resistance in humans.
Howard Hill, an Iowa veterinarian for Iowa Select Farms, said he did
not think antibiotic use in livestock production was the likely cause
for an increase in antibiotic resistance in humans. Producers said human
overuse of antibiotics may be to blame.
Hill also did not think antibiotics were being given excessively to
livestock and pigs that received scheduled low levels of antibiotics.
¡°A healthier pig results in better quality meat and safer meat,¡± Hill
Livestock producers criticized several aspects of the FDA recommendations.
For one, the guidelines require that a veterinarian oversee the use
of antibiotics. But there is a severe shortage of large-animal veterinarians,
and that must be recognized by the FDA before possible changes are made,
The guidance¡¯s language is vague, farmers said, and it¡¯s unknown how
much use of antibiotics would be allowed. They also don¡¯t account for
what could be a costly increase in meat prices, they said.
Matt Teagarden, industry relations director for the Kansas Livestock
Association, said the beef association has had guidelines for years
regarding the use of antibiotics in cattle and said most cattlemen fed
their animals in a ¡°judicious¡± way to prevent antibiotic resistance.
Seventy percent of antibacterial medication in the United States is
used in livestock production, according to the Union of Concerned Scientists.
But the meat industry said the number was lower and that the government
did not track that number.
The USDA is considering tracking it after being approached by several
members of Congress, including Rep. Louise Slaughter, a New York Democrat.
Slaughter has more than 100 cosponsors on a bill that would ban the
use of antibiotic in healthy animals.
Slaughter was disappointed when she saw the draft guidelines because
of the seriousness of the problem, said Vincent Morris, her spokesman.
She believed the FDA should have proposed regulations, which would be
tougher than guidelines.
¡°(The guideline) doesn¡¯t commit any farms to any change,¡± Morris said.
Kremer said farmers had an option.
Twenty years ago in Missouri, Kremer was a big promoter of antibiotic
livestock therapy and a president of the Missouri Pork Producers Association.
But that changed soon after he was gored in the leg by a hog. Strep
infection caused his leg to swell to twice its size, he said, and penicillin
It turned out Kremer¡¯s hog had been fed low doses of penicillin for
some time, causing a hardier strain of strep to develop, and the strep
was passed on to Kremer.
¡°That was enough to raise my awareness,¡± said Kremer, who now speaks
about the dangers of antibiotic resistance.
He started a cooperative of farmers that sells antibiotic-free meat
to places like Whole Foods markets and Chipotle restaurants and also
now to conventional grocery stores.
There¡¯s no doubt that the number of shops selling meat from animals
that have seldom or never been treated with antibacterial medications
But that number is low, Teagarden said.
¡°Some consumers place value on purchasing that animal that was never
treated with antibiotics,¡± Teagarden said. ¡°But obviously as we look
at the meat product, the majority of consumers don¡¯t have that as a
Read more: http://www.kansascity.com/2010/10/17/2322733/conflicts-over-antibiotics-in.html#ixzz132G6dmOY
Back to the Field
by Michelle Greenhalgh | Oct 19, 2010
On today's grocery shelves, it's commonplace for produce from all over
the world to be displayed side by side, regardless of the season. It's
not unusual, in fact it's expected, to see lettuce or tomatoes from
California in New England grocery stores even as the snow begins to
With produce traveling further
than ever before from its origin to grocers' shelves, how can anyone
track where each head of lettuce comes from?
Some producers are beginning
to do that by affixing new radio frequency identification (RFID) chips
to each produce container. The chips can be used to trace a specific
batch from the fields to its final destination on supermarket shelves.
The technology, widely regarded as an effective step toward better food
safety, is precise enough to track produce back to within a few feet
of where it was grown.
Once the system achieves
what the industry calls "whole-chain traceability," the use
of RFID-type technology should benefit food safety and and improve recall
systems, explained Dan Vache, vice president of Supply Chain Management
with the United Fresh Produce Association.
Vache said RFID tags enable
each step of the entire growth, harvest, processing and distribution
chain to be traced efficiently. In the event of a foodborne-illness
outbreak or some other issue, "whole chain traceability will limit
the scope of a recall, speed up the identification process all the way
back to the grower," minimizing the impact to consumers, Vache
Vache has years of supply
chain management experience having been involved in multiple industries
providing cold chain analytics with services to track and trace products
throughout the cold chain from harvest to the backend of retail stores
With RFID tags, he explained,
each so-called touch point in the supply chain should capture a minimum
of basic data including the date, time and location and ultimately environmental
conditions as a product is handled and passed along, from harvest to
Eventually, the technology
will become so sophisticated that "smart tags" will indicate
a product's shelf life, whether it is beyond its use date or whether
it may have been exposed to temperatures that could be damaging, Vache
told FSN in an email.
Producers like the Dole Food
Company have led the pack in using RFID in the fields that is controlled
by handheld, GPS-enabled readers to encode chips with the coordinates
of the produce being harvested for a particular bin. Dole uses the RFID
program throughout its farms in the Salinas Valley.
Other producers are also
using the technology, although it's not yet widespread.
Vache told FSN that "what
we do see is some use of RFID in tracking assets such as pallets"
or containers that are eventually reused; in that case the RFID tags
are recommissioned for multiple uses.
Once there is sufficient
infrastructure for data collection at more perishable food distribution
centers, "the use of RFID tags will gain traction" and more
producers will be able to handle the volume of data. At that point,
the cost per tag should also go down dramatically, Vache said.
RFID chips and tracking systems
can be used to track or trace any type of products, not just produce.
The chips help industry "gain insight into the total supply chain
and enhance supply chain efficiencies," Vache said. Already, RFID
is in play with many products, especially items such as high-end electronics
and other hardware items.
As for the future of produce
tracking systems? "When RFID reaches critical mass, there will
be a tremendous amount of data that when analyzed will take the industry
to the next level in process improvements and increased consumer confidence,"
Tester's Small-Farm Exemptions
by Helena Bottemiller | Oct 20, 2010
Congress may be on recess, but food safety politicking is in full swing.
A coalition backing the pending food safety bill sent an email to Senate
offices Tuesday, soliciting support for the upcoming cloture vote. The
email also asks for support in modifying the Tester amendment, a popular
provision that would exempt small farmers from certain regulations.
The note reminds Senate offices that Majority Leader Harry Reid (D-NV)
filed a cloture petition to bring the bill to the floor: "We anticipate
a vote on Wednesday, November 17. We urge your senator to support this
The undersigned organizations--which include the American Public Health
Association, Consumers Union, and The Pew Charitable Trusts--reiterate
their support for the bipartisan manager's package of amendments to
the FDA Food Safety Modernization Act.
The package does not include
the Tester amendment, or Sen. Dianne Feinstein's (D-CA) controversial
amendment to ban the chemical bisphenol A from certain food packaging.
"The package will strengthen protection of the nation's food supply
and provide key tools to the Food and Drug Administration (FDA) to help
prevent food contamination and to detect and attack foodborne disease
outbreaks quickly and effectively," reads the email.
"However, our organizations oppose the current draft of the Tester
amendment and are deeply concerned about its impact on the safety of
the food supply," the groups continue. "Certain provisions
of the amendment must be changed so that it does not weaken current
law and exempt large amounts of food--including high-risk foods--from
The alert includes a white paper that outlines the concerns of the coalition,
formally the Make Our Food Safe campaign.
According to Make Our Food Safe, "unintended consequences"
of the amendment could "pose serious danger to consumers."
"Problems with the amendment include, most importantly, the fact
that it does not consider the risk of microbiological contamination
and foodborne illness posed by a particular food in granting an exemption
from federal food safety regulation," reads the memo, which questions
the amendment's definition of local food and the $500,000 annual sales
"It is unclear if the $500,000 criterion is appropriate; we need
to know what percentage of sales of fresh produce, and of FDA-regulated
processed foods, firms of this size and smaller represent," says
the document. "Rather than setting a specific dollar amount in
the statute, the Tester amendment should, instead, direct FDA to conduct
an analysis of these two markets and determine an appropriate sales
volume criterion for any exemption or modified requirements."
Ferd Hoefner, policy director for the National Sustainable Agriculture
Coalition, a group fighting to have the amendment added to the bill
on the Senate floor, called the document "surprisingly inaccurate,"
but added that NSAC would not formally respond until later Wednesday.
UK: Duck egg
link to salmonella
An outbreak of salmonella in England and Northern Ireland, which has
affected more than 60 people and resulted in one death, is being linked
to duck eggs.
The outbreak is being investigated jointly by the Health Protection
Agency and the Food Standards Agency. Both agencies have warned consumers
about the need to thoroughly cook duck eggs.
Salmonella has been effectively eliminated from hen¡¯s eggs in the UK
since the introduction of the British Lion scheme in 1998. This has
been confirmed by a number of independent surveys.
A report from the Advisory Committee for the Microbiological Safety
of Food in 2001 acknowledged the success of the British Lion vaccination
programme in tackling salmonella in eggs and in 2004 the Food Standards
Agency found no salmonella inside 28,000 UK-produced eggs tested. In
2006 the status of UK egg production as among the safest in the world
was confirmed by a EU salmonella zoonoses survey.
Only this year figures released by Defra and the European Union showed
that the United Kingdom had done much better than other leading European
egg producing countries in eradicating salmonella from its laying flocks.
The Food Standards Agency now says it has issued warnings about duck
eggs to both consumers and caterers.
The warning follows an outbreak of salmonella typhimurium DT8. The agency
says that from 1 January 2010 to date, 63 cases of salmonella typhimurium
DT8 infection have been reported in the United Kingdom.
"Two cases are known to have resulted in people being hospitalised
and one death has been reported (although at present it is uncertain
whether the death is directly related to the salmonella infection),"
said the agency in a prepared statement.
"Evidence from investigations carried out by the HPA and FSA supports
a link between the consumption of duck eggs and this outbreak."
The FSA statement read, "Duck eggs may occasionally be contaminated
with salmonella both on their shells or, more rarely, internally. Duck
eggs should be cooked thoroughly until both the white and yolk are solid.
If you are cooking a dish containing duck eggs, make sure you cook it
until the food is steaming hot all the way through. Good hygiene practices
should be followed when handling and storing all eggs, such as washing
hands, utensils and preparation surfaces after handling or using eggs."
Dr Dilys Morgan, who is leading the investigation for the Health Protection
Agency, said that as soon as the agency first noticed an increase in
cases it started detailed investigations using food questionnaires and
interviews to find the common cause of illness in the people affected
and to identify the source of the outbreak.
The HPA conducted epidemiological and trace back investigations. Detailed
food histories were collected from 21 cases during July and August known
not to have travelled outside the UK. These revealed that 14 (67 per
cent) had eaten duck products; 11 duck eggs, two duck liver pate and
one duck meat.
The HPA found that the eggs came from a variety of sources - from local
small retailers, farms or at market places. Duck eggs contaminated with
the outbreak strain were collected from a patient¡¯s home and investigations
by the Food Standards Agency also revealed evidence of salmonella typhimurium
DT8 further up the duck egg supply chain.
"It became clear from our investigations that the increase was
related to the consumption of duck products, mainly eggs," said
Dr Morgan. "It is important that consumers and caterers are aware
that all eggs, including duck eggs, may occasionally be contaminated
with salmonella and follow advice provided by the Food Standards Agency
in order to reduce the risk of infection. Eggs should be cooked thoroughly
and good hygiene practices, such as washing hands, utensils and kitchen
surfaces should be followed after handling or using duck eggs."
The HPA put the number of confirmed cases at 66 rather than 63. "Of
the reported cases two are known to have been hospitalised, one of whom
has died. Cases are mainly adults with an average age of 46 years, and
most are men (61 per cent). Cases have been referred from Northern Ireland
and most regions in England, with predominance in the South East and
North West," said the HPA in a statement.
A similar outbreak of the same type of salmonella was recently recorded
in Ireland. This was also linked to duck eggs.
S.A. food firm
tied to deaths
By Don Finley - Express-News
Web Posted: 10/20/2010 10:15 PM CDT
State health officials Wednesday ordered a San Antonio produce company
to halt production and ordered a recall of all products shipped from
the plant since January after five people ? three of them in Bexar County
? died from a foodborne illness.
Over the past nine months, 10 people in Bexar, Travis and Hidalgo counties
were infected with the same strain of listeria, including the five who
died. Six of the 10 were conclusively linked to chopped celery sold
by Sangar Fresh Cut Produce at 1500 S. Zarzamora St., health officials
They said most of the listeriosis patients were elderly with serious
underlying health problems, and many were hospitalized before and during
the onset of their infection.
As of Wednesday night, health officials weren't releasing any further
information about the patients.
In a statement, Sangar President Kenneth Sanquist Jr. took issue with
¡°The state's claim that some of our produce now fails to meet health
standards directly contradicts independent testing that was conducted
on the same products,¡± the statement said. ¡°This independent testing
shows our produce to be absolutely safe, and we are aggressively fighting
the state's erroneous findings.¡±
Of the shutdown, Texas Department of State Health Services spokeswoman
Carrie Williams said: ¡°This is a rare action that we took. ... We closed
the plant, we ordered a recall, but we're not at the end. We're still
investigating the situation.¡±
The emergency order prohibits the plant from resuming operations without
The recalled products were cut produce in sealed packages, and were
not believed to have been sold in grocery stores, but rather used in
restaurants and institutions such as schools and hospitals.
It wasn't immediately known how the packages were labeled.
Inspectors found sanitation problems at the plant, including a condensation
leak above a food product area, soil on a preparation table and improper
hand washing by employees.
Officials said the bacteria found in the celery may have contaminated
other food processed at the plant.
Health officials were working with the company to contact customers
using sales lists. Those with any of the produce are advised to discard
it or return it to the company rather than cooking it.
In May, the Metropolitan Health District alerted area infectious disease
specialists that it was working with the state on seven listeriosis
cases, two of them fatal. The oldest victim at the time was 93.
No common source of infection was known then.
Listeriosis is caused by bacteria normally found in the soil, Listeria
monocytogenes. It not only can contaminate raw vegetables, but animals
can carry the infection without appearing ill, and people can get sick
from consuming their meat or milk. Processed food also can become contaminated.
Cooking or pasteurization kills the bacteria, but health officials recommend
against cooking products from the company.
Listeriosis symptoms can include fever, muscle aches, diarrhea and vomiting,
and usually occur three to 70 days after infection. Older people, pregnant
women, newborns and those with weakened immune systems are most at risk.
The long investigation was made more difficult by the fact most of the
victims were frail with poor memories or had died.
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