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FoodHACCP Newsletter
03/16 2015 ISSUE:643

Listeria Outbreak Prompts Kroger to Pull Blue Bell Products
Source :
By Carla Gillespie (Mar 15, 2015)
Kroger has pulled recalled Blue Bell products from its stores after they were linked to a Listeria outbreak that sickened five people at Via Christi hospital in Wichita. The company is also using its recall notification system to warn customers of the problem.
Kroger Blue Bell Listeria RecallBetween January 2014 and January 2015, five patients at Via Christi contracted listeriosis from contaminated Blue Bell ice cream they were served while hospitalized for unrelated illnesses.  Although the first case occurred during January 2014, the outbreak was not discovered until this month when health officials noticed that two people sickened with the rare outbreak strain had both been Via Christi patients.
Lab tests have shown that the rare Listeria strains cultured from the five patients at Via Christi are a match to those found in samples of Blue Bell ice cream made at the company’s facility in Brenham, Texas.
The company’s CEO says the problem was due to a problem with one of their machines and has since stopped production on that line and withdrawn affected products from the market.
The recalled products are: Chocolate Chip Country Cookie SKU # 196, Great Divide Bar SKU #108, Sour Pop Green Apple Bar SKU #221, Cotton Candy Bar SKU #216, Scoops SKU #117, Vanilla Stick Slices SKU #964, Almond Bars SKU #156, 6 pack Cotton Candy Bars SKU #245, 6 pack Sour Pop Green Apple Bars SKU #249, and 12 pack No Sugar Added Mooo Bars* SKU #343. Consumers who have any of these products in their freezers should not eat them.
Symptoms of a Listeria infection, which can take as long as 70 days to develop, include gastrointestinal problems followed by fever, severe headache, stiff neck, loss of balance and confusion.  Complications of listeriosis include seizures, spinal injury, Listeria meningitis, brain damage and death.

Blue Bell Ice Cream Listeria Outbreak; The Epidemiological, Labratory and Environmental Facts
Source :
By Drew Falkenstein (Mar 15, 2015)
•Four rare strains of Listeria monocytogenes in five patients in Kansas hospital with onset dates January 2014 to January 2015.
•Invoices link hospital purchases to Blue Bell Creameries in Brenham, Texas.
•Three strains of Listeria monocytogenes isolated from the ice cream samples linked by samples taken in South Carolina.
•Texas Department of State Health Services found Listeria monocytogenes on products made on same product line at Blue Bell’s facility.
According to the CDC and the Kansas Department of Health and Environment, five patients who were treated in a single hospital in Kansas were infected with one of four rare strains of Listeria monocytogenes. All five case patients are adults. Three deaths have been reported. Three of these strains, which are highly similar, have also been found in products manufactured at the Blue Bell Creameries production facility in Brenham, Texas. Illness onset dates range from January 2014 to January 2015.
Three strains of Listeria monocytogenes isolated from the ice cream samples had PFGE patterns that were indistinguishable from those of Listeria bacteria obtained from samples from four patients. Listeria monocytogenes isolates with four other PFGE patterns were also isolated from the ice cream samples. Invoices provided by the hospital to the Kansas Department of Health and Environment indicate that the Blue Bell brand ice cream Scoops used in the patients’ milkshakes came from Blue Bell Creamery’s facility in Texas. Whole genome sequencing of the Listeria monocytogenes isolates obtained from the ice cream is in progress.
FDA was notified that these three strains and four other rare strains of Listeria monocytogenes were found in samples of Blue Bell Creameries single serving Chocolate Chip Country Cookie Sandwich and the Great Divide Bar ice cream products collected by the South Carolina Department of Health & Environmental Control during routine product sampling at a South Carolina distribution center, on February 12, 2015. These products are manufactured at Blue Bell Creameries’ Brenham facility.
The Texas Department of State Health Services, subsequently, collected product samples from the Blue Bell Creameries Brenham facility. These samples yielded Listeria monocytogenes from the same products tested by South Carolina and a third single-serving ice cream product, Scoops, which is also made on the same production line.
According to the Kansas Department of Health and Environment, hospital records available for four patients show that all were served ice cream from Blue Bell Creameries’ prepackaged, single-serving products and milkshakes made from these products.

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May 21-22, 2015
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Cantaloupe Listeria Outbreak Settled; Finally

Source :
By Bill Marler (Mar 14, 2015)
After three years and six months, the civil litigation on behalf of sixty-six families of the injured and the dead has been resolved against all remaining defendants. The settlement was finalized late last week. The settlement amount is confidential and the parties agreed to the following statement:
“The matter was resolved by mutual agreement of the parties.”
According to the Centers for Disease Control and Prevention (CDC), at least 147 people in 28 states were identified as part of the Listeria outbreak traced to cantaloupes grown by Jensen Farms in August and September of 2011.  33 deaths and 1 miscarriage were officially attributed to this outbreak, though the total dead may be as high as 36.
Marler Clark represented the families of 46 victims of the 2011 Listeria outbreak linked to cantaloupe grown by Jensen Farms.  The law firm pursued compensation from Jensen Farms, the firms that audited the farm’s food safety practices, the companies that distributed the Listeria-contaminated cantaloupes and the retailers that sold the unsafe food.
Jensen Farms declared Chapter 11 Bankruptcy on May 25, 2012.  All Marler Clark clients’ claims with Jensen Farms were resolved through the bankruptcy proceedings; however, claims against other parties were finally resolved in the last weeks.  The Jensen brothers were criminally charged.
Marler Clark filed lawsuits on behalf of all 46 families.  Those lawsuits were brought against multiple defendants in courts in 12 states.  They were filed on behalf of the families of 29 people who died and 17 people who survived.
The total past medical expenses to date were in excess of $15,000,000.

WHO links food safety and nutrition
Source :
By New Delhi, (Mar 13, 2015)
Linking food safety and nutrition, the World Health Organisation on Friday said food and water borne diseases kill an estimated two million people across the world annually.
"Globally, every year, millions of people die of food contamination. Food borne illness is a serious cause of concern. Access to sufficient amounts of safe and nutritious food is key to sustaining life and promoting good health. Food safety, nutrition and food security are inextricably linked," said Asheena Khalakdia, the team leader for communicable diseases at WHO country office for India.
She said that from production to consumption, there were several potential areas of food contamination and safe and healthy food should be the prime focus.
"Food safety is a big issue so this year we have come up with a theme on food safety on the occasion of World Health Day on April 7, 2015," she said, during a technical session on the theme for the World Health Day.
The WHO experts enumerated five key points for safer food.
These include cleanliness, keeping the raw and cooked food separate from other foods, cooking thoroughly especially meat, poultry, eggs and seafood at 70 degrees Celsius, keeping food at safe temperatures, using safe water and raw materials.
"Food safety is a shared responsibility. It is important to work all along the food production chain - from farmers and manufacturers to vendors and consumers. We want these five keys for safer food to be made accessible to every consumer. All the stake holders should come forward on a joint platform to share this responsibility," she added.

Salmonella From Live Poultry Sickened 363 in 2014
Source :
By Carla Gillespie (Mar 12, 2015)
Salmonella from live poultry sickened 363 people in 2014. The illnesses were part of five clusters that occurred from February through October.
Many of those who became ill reported purchasing live poultry from the mail order hatchery, Mt. Healthy Hatcheries in Ohio, which was also linked to Salmonella outbreaks in 2012 and 2013.
The outbreak strains in the 2014 outbreak included Salmonella Infantis, Salmonella Newport, and Salmonella Hadar. Illnesses were reported from 43 states and Puerto Rico. When combined, the illnesses represent the largest live poultry-associated salmonellosis outbreak in the United States.
About 35 percent of those who were sickened 10 years old or younger. Thirty three percent of those sickened were hospitalized. About a quarter of those sickened reported keeping the live poultry in their homes rather than outside.
Hatcheries need to use Salmonella prevention and control programs to prevent outbreaks, according to USDA rules. In addition to working on Salmonella prevention, hatcheries also need to do a better job educating consumers about the Salmonella risks associated with maintaining live poultry flocks.

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Most fast-food places do well with food safety

Source :
By Sam Wood, (Mar 15, 2015)
When McDonald's debuted the slogan "You Deserve a Break Today" in 1971, it was tacked onto a commercial that barely mentioned food. As a team of singing workers cavorted with mops and brooms, they extolled a quality you don't ordinarily see mentioned in an ad for a fast-food chain: "At McDonald's, it's clean!"
McDonald's founder Ray Kroc was, by all accounts, obsessed with cleanliness. Chains such as Burger King, which followed in Kroc's wake, took up the same principles: Quality, Service, Cleanliness, and Value.
Levels of cleanliness - a key part of food safety - vary widely at the individual franchise level, according to city restaurant inspection reports.
McDonald's, the biggest of the burger behemoths, has about 75 outlets in Philadelphia. Burger King trails with about 20. Accordingly, McDonald's has had more opportunities to get things right - and wrong.
During 2014, McDonald's restaurants in the city were cited with an average of 2.3 violations considered food-borne illness risk factors. That was exactly average for the 5,000 or so eat-in restaurants in the city. Burger Kings were cited with an average of just 0.52.
Records at the two chains have seesawed from year to year: In 2013, Burger King franchises were cited 2.1 times, on average, compared with McDonald's 1.8. The year before, Burger Kings averaged 1.0 violation vs. McDonald's 1.6.
Neither company would comment on specifics of food-safety practices.
"McDonald's and our independent owner-operators" - representing 90 percent of the chain's restaurants - "share a commitment to food safety and the well-being of our customers and respective employees," spokeswoman Terri Hickey said in an e-mail, adding that "health department inspections are taken seriously, and when an issue is brought to light, action is taken to address it."
Burger King had a similar response.
Food-borne illness risk factors, the more serious of two categories of violations used by inspectors here and in most other jurisdictions, are practices or procedures that research has linked to an increased likelihood of disease transmission. There are hundreds of possibilities, from a sewage leak to employees' not washing their hands vigorously enough.
Most fast-food franchises do well on inspections. Several have records that any restaurateur would envy. The McDonald's at 2851 Grays Ferry Ave. hasn't been cited with a food-borne illness risk factor violation in more than two years. The Burger King at 2400 Castor Ave. has had only one since early 2011.
"In terms of fast food, there's not much they can do to screw it up," said Don Schaffner, a professor of microbiology at Rutgers University and president of the International Association for Food Protection. The complex processes that can trip up exotic places that make everything from scratch, for example, are missing from these eateries, which is part of how they produce food fast.
"Those restaurants do a pretty good job of engineering out the risk factors," said Schaffner, who also sits on McDonald's Food Safety Advisory Council. "I'd be more leery going to a fancy white-tablecloth place than a fast-food restaurant."
Partly, food-safety experts say, that is because big, publicly traded corporations - from McDonald's to ConAgra - are well aware of the damage a food-poisoning scandal can do to their brands, and they put a priority on preventing it.
Inspectors from the Philadelphia Department of Public Health attempt to visit every restaurant once a year. Inspections are a snapshot in time, with limited ability to prevent food-borne illness. Much of the job involves educating food workers, which health officials say is more effective than policing or stiff fines.
Establishments with problem histories also are visited more often, however; the city says a single violation for a food-borne illness risk factor usually calls for a repeat inspection.
"If you're top-notch, you're not going to have more than one risk factor violation per inspection," said Janice Buchanon, a former food inspector and now an executive with the Steritech Group Inc., a Charlotte, N.C., company that consults on food safety with supermarkets, restaurant chains, hotels, and food-processing facilities. Burger King, Buchanon said, is one of the company's clients.
In Philadelphia, a handful of McDonald's restaurants collected more than 10 food-borne illness risk factor violations apiece in 2014. The McDonald's at 6470 Torresdale Ave., in the city's Tacony section, racked up the greatest number: 19 in four visits by inspectors. On Jan. 8, 2014, for example, an inspector listed six food-borne illness risk factor violations, including insufficiently hot water in hand-washing sinks, and food held at temperatures not hot enough to prevent bacterial growth. There were an additional 11 violations in the less-serious category, such as dirty restrooms, for a total of 17 violations on that one visit.
A follow-up inspection Feb. 12 turned up eight violations in the more serious category, a few of them repeats, such as improper hand washing, sanitizing solution that was too weak, and a lack of knowledge about food-borne illnesses on the part of the person in charge - a potentially serious issue, because the most common disease picked up in restaurants is norovirus, which is spread by sick employees. Including less serious violations - dirty restrooms again - the total that time was 19.
A March 13 "compliance check" - not a full inspection - in response to a plumbing complaint found the issue had been fixed. But another inspection, on Oct. 16, found five food-borne illness risk-factor violations, plus four less serious problems, for a grand total of 44 for the year.
A follow-up Jan. 23 was starkly different: no violations in the top category and three minor ones (one of which was a lack of menu board nutrition labeling, which city ordinance requires, but which is not being enforced due to a conflict with new federal regulations).
Mark Grenon, co-owner of the Torresdale Avenue McDonald's, said the franchise got another clean inspection (not yet posted by the city, which holds reports for 30 days) on Feb. 23.
"This restaurant has passed the last two inspections and we are committed to operating a safe and clean experience for customers," Grenon said in an email.
"I have also revisited cleaning and health-safety procedures with my employees," he wrote, "to ensure compliance with health department regulations, and safeguard against something like this happening again."
His efforts seem to have paid off.

New Food Safety Protocols Published for Reusable Grocery Containers
Source :
By James Andrews (Mar 12, 2015)
Reusable plastic containers used to transport fruits and vegetables have proliferated across the grocery industry in recent years despite recent warnings from university research studies suggesting the containers may harbor and spread harmful pathogens over time.
Reusable_Produce_Container_406x250Responding to critics, the Reusable Packaging Association (RPA) has issued comprehensive, science-based protocols for the use of grocery containers for produce, while at the same time maintaining that no documented food safety issues have arisen related to their use.
The guidelines cover the best practices for washing and handling reusable plastic containers (RPCs), as well as outlines for regular microbiological testing. The protocols reportedly took more than a year to finalize and received input from stakeholders at companies such as Safeway, Walmart and Dole.
For growers, key food safety practices should include wrapping pallets of RPCs, transporting RPCs in covered trailers, and storing RPCs under cover, the RPA said. The association also asks retailers to handle and load RPC pallets like any other packaged commodity.
“Creating stable and wrapped loads also helps prevent cross-contamination during transit and at the RPC provider’s facilities,” RPA said.
The committee also developed protocols for adhesive labels that will not leave behind residues that could aid in potential cross-contamination.
For RPC producers, the protocols most importantly cover best practices for microbiological sanitation and testing, as well as adherence to Hazards Analysis and Critical Control Points (HACCP) standards for controlling potential contamination. RPA also recommends that RPC producers keep a trained employee on staff to ensure compliance with the HACCP program.
In the past few years, at least three studies out of universities in the U.S. and Canada have concluded that RPCs can become contaminated and potentially transmit harmful pathogens from one food product to another, even after they’ve been cleaned and sanitized.
Recent studies from the University of Guelph and the University of California – Davis both found inconsistencies and inadequacies in the cleaning and sanitization process of some RPC manufacturers, allowing them to leave behind fecal bacteria contamination. A study from the University of Arkansas published weeks ago found similar results.
The RPC industry maintains that there is no evidence that the containers have caused any incidents of foodborne illness or cross-contamination.
“Most RPC suppliers are already doing a thorough job of sanitizing and managing RPCs; however, they have different processes to achieve the end result,” said RPA Committee Chair Paul Pederson in a written statement. “Creating and documenting uniform best practices satisfies the need of users of reusables who need defined guidelines to share with members of their supply chains.”

Texas Salmonella Outbreak Grows to 78 Cases
Source :
By News Desk (Mar 12, 2015) least 78 people have now been sickened in a Salmonella outbreak affecting residents of northwestern Texas, according to various news reports.
A large portion of the patients are connected to the Ten in Texas steakhouse in Dalhart, TX, while more cases have sprung up in the communities of Bushland and Amarillo.
Food Safety News will update this story after confirming the exact number tied to Ten in Texas, which varies according to different news sources. We last reported on this outbreak when the case count reached 59 and a lawsuit was filed.
Health authorities have not been able to track down the exact source of the outbreak.
Ten in Texas voluntarily shut down for a short time last month for a thorough cleaning and sanitization process.

Food safety doesn’t happen in an office
Source :
By Ben Chapman (Mar 12, 2015)
About 15 years ago, I was a goofy grad student without a lot of ambition.
I had an interest in infectious diseases, genetics and how people talked about risk. Not necessarily in that order.
I found Doug and he set me up with a project working with a bunch of greenhouse tomato and cucumber producers.
His advice was watch everything, ask questions and write it down or you will forget it.
Being on farms and in processing plants I learned about the real challenges that folks encounter when they try to manage risks and ended up finding a passion for food safety. I saw food safety in action daily.
Over the past few weeks I’ve spent a bunch of time out of my office doing food safety stuff in the real world like working with chefs on HACCP plans, visiting storage facilities, providing risk communication messages for an outbreak.
But the most food safety fun I’ve had recently was talking to a friend’s Brownie troop about micobiology and handwashing. Grad students Natalie Seymour, Nicole Arnold and Katie Overbey did the heavy lifting, showed the girls what science is and were excellent scientist role models. I just showed up.
But I guess my handwashing prowess blew a mind or two (above, exactly as shown).

Report confirms safety of Europe’s food
Source :
By (Mar 12, 2015)
 Today’s report from the European Food Safety Authority confirms once again that Europe’s food supply is among the safest in the world.
Europeans today enjoy a plentiful supply of fresh fruits and vegetables all year round thanks to modern solutions that support productive, competitive and sustainable agriculture.
The report contains findings from tests carried out in 2013 on more than 80,000 samples – showing that overall 97.4% of these food products were within the maximum residue levels (MRLs) of pesticides permitted in the EU. For the EU-coordinated program covering 12 food commodities, the results showed even higher compliance: 99.1%. MRLs are a strict trading standard under which cut-off points are set well within acceptable safety levels.
More instances of pesticide residues exceeding the MRLs were found in food imported from countries outside the European Union (5.7%) than in samples originating from the EU and EEA (1.4%). The EFSA report concludes that the presence of residues found in food in 2013 was unlikely to have a long-term effect on the health of consumers.
“As an industry we are always working to improve on and learn from these results. That’s why we have set up a dedicated project on pesticide residue management that focuses on training and advisory programs. These help reduce residues by promoting Integrated Pest Management principles and good agricultural practices in the EU and also outside of the EU – for example, in Turkey,” concludes Jean-Charles Bocquet, Director General of the European Crop Protection Association (ECPA).
For more information on industry stewardship initiatives, visit www.hungry4change.euonal news

Study: Contaminated Food Causes 14 Percent of Norovirus Outbreaks Worldwide
Source :
By News Desk (Mar 11, 2015)
According to new work by researchers from the Netherlands, New Zealand and the U.S. Centers for Disease Control and Prevention (CDC), about 14 percent of all norovirus outbreaks are attributed to contaminated food.
Noroviruses are one of the leading causes of gastroenteritis worldwide. In the U.S., the virus causes 19-21 million illnesses, 56,000-71,000 hospitalizations and 570-800 deaths.
The most common symptoms of a norovirus infection are diarrhea, vomiting, nausea and stomach pain. Other symptoms can include fever, headache and body aches. Anyone can be infected with norovirus and get sick, but illnesses can be especially serious for young children and older adults.
Norovirus can be transmitted directly from person to person or indirectly through contaminated food, water and environments.
To estimate the proportion of illnesses transmitted through food globally, the researchers aggregated and analyzed data from norovirus outbreaks that occurred between 1999 and 2012 from three international surveillance systems and peer-reviewed literature.
Noroviruses are classified into at least six genogroups.
A previous study on norovirus outbreaks in the U.S. showed that GI.3, GI.6, GI.7, GII.3, GII.6, and GII.12 were the genotypes most often associated with foodborne outbreaks and that, of the outbreaks with a known transmission route, 16 percent were foodborne.
The new study, published in CDC’s Emerging Infectious Diseases journal, found that worldwide, foodborne transmission is attributed to 10 percent of all genotype GII.4 outbreaks, 27 percent of outbreaks caused by all other single genotypes, and 37 percent of outbreaks caused by mixtures of GII.4 and other noroviruses.
Determining the transmission route during an norovirus outbreak investigation is complicated because transmission can occur through multiple sources in a single outbreak. If a virus is first transmitted through food, it can continue person to person or through the environment, making it hard to trace the disease back to contaminated food.
The researchers suggest that genotyping can help with source attribution for norovirus outbreaks.
They wrote that with approximately “1 in 7 norovirus outbreaks being attributable to food, the foodborne transmission route represents a major target for intervention, particularly given the possibility of widespread exposures and the possibility of preventing not only primary but also secondary cases if contaminated foods are recalled from the market.”

National Kidney Month, Learn Hemolytic Uremic Syndrome Risks
Source :
By Carla Gillespie (Mar 11, 2015)
Hemolytic Uremic Syndrome (HUS) is a life-threatening complication of E. coli infections that causes kidney failure, primarily in young children. Because March is Kidney Month, it’s a good time to learn the risks and symptoms of HUS.
In the United States, HUS from E. coli infections is the most common cause of serious kidney injury in children and the most common cause of E. coli deaths.  About 7, 500 cases are diagnosed each year. And most E. coli infections in children are caused by contaminated food or drinks.
E. coli outbreaks have been linked to hamburger, mechanically tenderized steak, lettuce, spinach, sprouts, raw milk, raw cheese, unpasteurized apple cider, strawberries, hazelnuts, frozen pizza and other frozen food products and cookie dough. Symptoms of E.coli infection usually develop within a week of eating contaminated food and include abdominal cramping and diarrhea that can be watery or bloody.
If your child is experiencing these symptoms, see a doctor. It’s important to note that the Centers for Disease Control and Prevention (CDC) recommends that antibiotics should not be prescribed for E. coli infections. as they put patients at greater risk of developing HUS.
HUS causes damage and destruction of red blood cells. The damaged red blood cells clog the filtering system in the kidneys which may cause kidney failure. It can also cause seizure, stroke and coma.
Most children with HUS recover. But about 30 percent of them will experience long-term health effects including chronic kidney disease, hypertension (high blood pressure), and chronic neurologic damage.
In many cases the child is one of many who were sickened in an outbreak. Past outbreaks have been caused by beef (ground, frozen hamburger patties and mechanically tenderized steak), lettuce, spinach, sprouts, raw (unpasteurized) milk and cheese made from this, unpasteurized apple cider, strawberries, hazelnuts, frozen pizza and other frozen food products and cookie dough. In some outbreaks, a restaurant is linked to the illnesses, but the food source is not found. When this happens, the restaurant is legally responsible for the harm done by the food it served.

Why Everyone Should Care About Food Safety
Source :
By Matt Shipman (Mar 11, 2015)
(This post by Matt Shipman, first published here on March 10, is the first in a series on food safety drawing on published research and the expertise of North Carolina State University researchers. We’re posting this in advance of April 7, when the World Health Organization will celebrate World Health Day, which is focused this year on food safety.)
Food safety poses a global health problem. According to the World Health Organization, contaminated food can cause more than 200 diseases — and foodborne and waterborne diseases that cause diarrhea are estimated to kill 2 million people each year worldwide.
Food safety is not just someone else’s problem.
“Foodborne illnesses are a significant problem in the United States, with massive impacts on public health and the economy,” says Ben Chapman, a food safety expert and researcher at NC State. And the numbers back him up.
According to a 2012 report from researchers at the Emerging Pathogens Institute, Resources For the Future, and the U.S. Department of Agriculture’s Economic Research Service, foodborne illness is estimated to cost the U.S. more than $14 billion annually. (This estimate takes into account factors such as medical costs and productivity losses.)
And a 2011 report from the U.S. Centers for Disease Control and Prevention (CDC) reported an estimated 9.4 million episodes of foodborne illness each year in the U.S. from known pathogens. An additional 38.4 million cases are estimated to come from unspecified or unknown pathogens. In total, foodborne illnesses are thought to contribute to 48 million illnesses annually — resulting in more than 128,000 hospitalizations and 3,000 deaths.
It is, in short, a big deal. So what are these foodborne illnesses? And how much damage does each of them cause?
Campylobacter: Campylobacter is a genus of bacteria, many of which can cause an illness called campylobacteriosis in humans, with symptoms including diarrhea and abdominal pain. People can contract campylobacteriosis from undercooked chicken, from cross-contamination via raw chicken, or from drinking unpasteurized milk.
According to the 2012 paper, campylobacteriosis affects 845,000 people annually in the U.S., costing the nation an estimated $1.747 billion every year and leading to 8,463 hospitalizations.
 Listeria monocytogenes: This is a bacterium that causes listeriosis, which is characterized by fever, muscle aches, and sometimes by gastrointestinal problems such as diarrhea. Listeriosis can be contracted from an incredibly broad range of foods.
According to the 2012 study, listeriosis costs the U.S. $2.577 billion annually despite the fact that there are only 1,591 illnesses per year. But 1,455 of those illnesses require hospitalization — and 255 result in death.
Norovirus: Noroviruses are the most common cause of foodborne illness in the U.S., affecting an estimated 19-21 million people each year. Symptoms range from vomiting and diarrhea to fever and headache. Transmission comes from ingesting infected feces or vomit particles — for example, by touching a contaminated surface and then touching food or touching your mouth.
According to the 2012 study, noroviruses cost the U.S. $2 billion per year, with more than 14,000 hospitalizations and approximately 150 deaths annually. NC State is a leader in norovirus research and home to NoroCORE, the Norovirus Collaborative for Outreach, Research, and Education. NoroCORE pulls together norovirus research from 18 institutions, with funding from the U.S. Department of Agriculture.
What are researchers doing about this?
The four pathogens listed above are just a few of the rogue’s gallery of bacteria and viruses that can cause foodborne illness. But researchers are constantly learning more about these health risks.
“New technology and new research on pathogens, practices and prevention are improving our ability to identify and address foodborne illness,” Chapman says. “The field is really opening up. It’s an exciting time to be involved in food safety research.”
Between now and April 7, we’re planning to publish a series of posts on various aspects of food safety — what we know, what we don’t know, and what we’re working on. We also hope to offer insights to help folks lower the risk of contracting foodborne illnesses. We hope you’ll learn something new.
You can find all of our posts related to food safety here.
Batz, Michael B., Sandra Hoffmann, and J. Glenn Morris Jr. “Ranking the Disease Burden of 14 Pathogens in Food Sources in the United States Using Attribution Data from Outbreak Investigations and Expert Elicitation” Journal of Food Protection, Vol. 75, No. 7, 2012, Pages 1278–1291. doi:10.4315/0362-028X.JFP-11-418
Scallan, Elaine, et al. “Foodborne Illness Acquired in the United States—Major Pathogens” Emerging Infectious Diseases, Vol. 17, No. 1, 2011. doi:10.3201/eid1701.P11101

West Virginia Passes Raw Milk Herd-Share Bill
Source :
By News Desk (Mar 11, 2015)
State lawmakers in West Virginia have passed a bill allowing people to buy and sell raw milk through herd-share programs, according to the Bluefield Daily Telegraph.
Raw milk was previously not allowed for sale in the state.
Herd-share programs allow those who wish to drink raw milk to buy a membership in a club that grants them partial ownership of the herd on paper. Herd-share programs for raw milk are already legal in Virginia, Kentucky, Indiana and Alabama.
Retail sales will remain illegal in WV. Those who buy into a herd-share program will reportedly also have to sign a form stating that they acknowledge the health risks of drinking raw milk.
The bill states that doctors will also be required to inform health officials of any illnesses related to raw milk consumption.
Raw milk is milk that has not been pasteurized to eliminate potentially harmful pathogens such as E. coli, Campylobacter, and Salmonella. Health experts often warn against serving raw milk to children, the elderly, or anyone with a compromised immune system.

Lebanon’s Food Safety Scandal Won’t Go Away
Source :
By Lauren Rothman (Mar 11, 2015)
The richly varied cuisine of Lebanon offers a seemingly endless parade of delights, from cold, refreshing salads such as baba ghanoush and tabbouleh to crisp, freshly fried falafel doused in nutty tahini to oozy, honeyed baklava. Unfortunately, in cities from Beirut to Tripoli, such dishes often come with a totally unwanted side of gut-roiling food poisoning.
Last November, Lebanon was rocked by a national food safety scandal after the country’s Ministry of Public Health responded to a years-long increase in the incidences of foodborne illnesses by beginning a campaign of surprise inspections of restaurants, slaughterhouses, supermarkets, and farms. The results were worse than the agency expected, and it decided that a public shaming might be just the ticket to getting Lebanon’s food businesses to shape up or get out of the game. That month, Minister of Public Health Wael Abou Faour held a press conference to announce the names of more than 1,000 establishments whose food samples had tested positive for a host of unappetizing additions ranging from salmonella to straight-up traces of feces and raw sewage. The list included some of Lebanon’s most popular chains, such as luxury supermarkets Spinneys and TSC Mega, all the way down to its street carts and casual cafes.
“I hope we are laying the groundwork for the permanent procedures of food safety in this country,” Faour said at the time.
But contaminated and expired food continues to be served in Lebanese eateries at a rate that is uncomfortable—and potentially deadly—for diners there. Last month, a labneh maker in the north of the country was shut down for failing to pass safety inspections, and on Saturday, more than 15 students at the Abi Samra Technical School in Tripoli were hospitalized after eating cheese-filled kaak, or stuffed bread. The ministry of health tested samples of the cheese filling and found that it contained the bacteria staphylococcus aureus at levels 16 times higher than the maximum allowable amount, as well as traces of E. coli, which is found in fecal matter and typically makes its way into foods when the cook doesn’t wash his hands. According to Lebanon’s Daily Star, all 15 students were hospitalized, two with critical illnesses. The cafeteria, as well as the bakery that provided the kaak, have since been shuttered by the government.
Ambiguity appears to be the cause of Lebanon’s food safety woes. According to an article in the Middle East Eye, “there is no one defining food safety law in Lebanon, and when it comes to what is required, legally, of restaurants and supermarkets, it all gets a bit foggy.”
Faced with a lack of clear rules or governmental oversight, restaurant owners say, for years they’ve been self-regulating their food safety practices. Restaurants equipped with the right facilities and knowledge can effectively maintain the hygiene of the food they serve, but others aren’t so lucky, according to Walid Hayek, the head of the Syndicate of Owners of Restaurants, Cafes, Nightclubs, and Pastries in Lebanon. (Editor’s note: what a title!)
“There are three kinds of restaurants in this sector,” Hayek told the Middle East Eye. “Those who internally adopted food safety standards a long time ago, those with good intentions but that don’t have the know-how, then those who are just bad.”
In spite of the Ministry of Health’s public shaming of eateries last year, policy changes on food safety in Lebanon have yet to go into effect. After a delay, a draft of a new food safety law was accepted in January by the country’s parliament, but officials have yet to announce when the law might take affect. Additionally, some restaurant owners have complained that the new hygiene effort, which is being handled jointly by the Ministry of Public Health and the Ministries of Economy and Agriculture, is simply too confusing.
“It’s good what they’re doing but it would have been logical to have one part of the government dealing with us, not three or four agencies,” Mahmud—a third-generation restaurateur who refused to give his real name—told the Middle East Eye.

Hamburg Addresses Food Safety, Dietary Supplements in House Budget Hearing
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By Steve Myers (Mar 10, 2015)
In a March 4 House Appropriations Agriculture subcommittee hearing on the 2016 FDA budget, outgoing FDA commissioner Margaret Hamburg, M.D., defended her agency’s request for a significant increase in funding and touched upon issues such as food safety, GMO labeling and dietary supplement regulation.
Hamburg, who ends her six-year run as FDA Commissioner at the end of this month, talked mostly about food safety and FSMA, the Food Safety Modernization Act.  Of the agency’s largest ever budget request of $4.9 billion, which is $400 million more than the current year budget, nearly $150 million would go to food safety, up $109 million from current funding. Rep. Hal Rogers (R-KY), chairman of the full Appropriations committee, said he was concerned about the size of the overall budget request and the huge amount for FSMA would be “hard to swallow."
Rep. Robert Aderholt, chairman of the Agriculture subcommittee, said while FDA reportedly regulates 20 percent of each U.S. consumer dollar spent on products, “the size of FDA’s fiscal year 2016 request includes increases for budget authority that disregard the debt crisis facing our nation." He said FDA must prove the funds needed cannot come from base resources and must look for potential savings and efficiencies—no overlap with other agencies. “The subcommittee funding level will stay flat, at best," he warned.
While most committee members speaking during the hearing praised the work Hamburg has done, many asked for and sometimes demanded more.
There were questions about inspecting foreign food suppliers. “I am concerned about the obstacles created by the Chinese got to our inspection of foreign food and drug products," Rogers said, noting he would like to see an even playing field. “If domestic manufacturers are subjected to extensive regulations, so should foreign suppliers."
Hamburg noted there are eight FDA staff stationed in China, with five more pending. She said they use the FDA office there as a hub for inspections throughout the large country. “There are many manufacturers in China we want to know about," she said, referring to efforts to ensure Chinese suppliers meet quality standards. “Yet, it is much more costly to conduct inspections overseas. One effort that may help, she noted, is the potential sharing of inspection data amongst the big buyers of Chinese foods, such as the European Union, Brazil, Canada and Australia.
Dietary supplement regulation only came up when Rep. Nita Lowey (D-NY), ranking member of the full committee, brought up the New York Attorney General’s recent investigation of herbal supplements sold at major retailers in the state. The investigation—the testing for which has been challenged by herbal experts both in and out of the supplement industry—found many herbal extract supplements did not contain what was on the label and, in some cases, contained contaminants.
“I’m really concerned about what that means for those with allergies, who may not know that supplements they consume may be contaminated by other substances which could cause the individual great harm," Lowey said. She asked Hamburg if dietary supplements should be evaluated at a higher standard and how should labeling standards be improved to make sure that allergens are properly disclosed?
“Many Americans are surprised to learn that dietary supplements are not subject to the same premarket review and approval process that drugs are," Hamburg said, adding the agency does have responsibilities with respect to claims and oversight of GMPs (good manufacturing practices) and companies are required to report serious adverse event reports to FDA. “We do monitor dietary supplements, and we are sadly called to action, in terms of enforcement, periodically because of findings dietary supplements contain unapproved drugs, various kinds of contaminants or are making claims that are false or misleading."
Hamburg noted the regulatory challenge is heightened by the increase in supplements coming in from all over the world via complex supply chains. “It’s an area I think we are concerned about, and we continue to act within in the responsibilities we’ve been given for oversight of dietary supplements," she said. “Certainly when we hear of concerns, we respond."
Hamburg reported there are many reputable manufacturers in the supplement industry. “We want to work closely with industry and the responsible players in the industry to see how we can ensure a higher level of quality," she said. “But we do not have the authority for premarket review nor the resources." She suggested Congress could undertake a discussion on premarket review in light of some of its concerns. 
When Lowey asked if it would take an act of Congress to change the standards and expand FDA’ authority over dietary supplements, Hamburg said yes, but “it would b e a very large task for us."
Labeling of genetically modified organisms (GMOs) in foods was brought up by Rep. Sam Farr, ranking member of the subcommittee. “I think the public distrust is born out by all these local initiatives to require labeling of GMOs," he stated. “We have not had the scientific evidence to show that genetically modified does any kind of harm, yet people are…freaked out about it." He said despite recent failures of voter initiatives mandating GMO labeling of foods, it will eventually pass. He asked for statements or studies from FDA, because “there is a lot of confusion out there."
Unfortunately he also added a request for a statement from Hamburg on medical marijuana research, which she addressed, leaving the GMO question unanswered.
Farr suggested Congress might have fallen short in either setting FDA’s role or allocating money for the agency to meet its oversight obligations. “It seems that Congress, in our lawmaking, has given you … tons of authorities, but we never give you the money to carry it out," he said. “Maybe we’ve overstretched your role. Yet, if you polled the public, you are the most trusted part of the federal government."
Hamburg recognized FDA will never get everything it needs, but the big “ask" for FSMA implementation is required to undertake an historic transformation from a reactive system to a preventive system. She noted FSMA won wide support from stakeholders and saw bipartisan passage in Congress. “By strengthening food safety and reducing foodborne illness, we will save the healthcare system an estimated $78 billion a year," she noted. “This is a critical time for implementation… there is a terrific return on investment if we invest now."
See Hamburg’s submitted written testimony at the House website.
The Senate Appropriations Agriculture subcommittee will hold its own hearing on FDA’s 2016 budget request this Thursday, March 12, 10 am EDT. Hamburg will testify, along with FDA CFO Jay Tyler and Health Department Deputy Assistant Secretary Norris Cochran.

No Multistate Food Poisoning Outbreaks So Far in 2015, Six Year Record
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By Carla Gillespie (Mar 10, 2015)
It was 2009 the last time we made it this far into the year without a multistate food poisoning outbreak being announced by the Centers for Disease Control and Prevention (CDC). Of course, that doesn’t mean that one hasn’t happened or isn’t happening right now, it just means the CDC hasn’t told anyone about it.
FPBSalmonella-300x225The CDC publishes a list of “selected multistate food poisoning outbreaks” each year. The rest fly under the radar. For the last five years ,there have been about 10 announced multistate food poisoning outbreaks, with the first one occurring between January and March. Not April, like 2009’s first, a Salmonella outbreak associated with pistcahios.
The new year was still new when last year’s first outbreak was announced, a Salmonella outbreak linked to cashew cheese. That outbreak, which sickened 17 people in three states, was announced on Januray 3, 2014. Three people were hospitalized.
Although most of the illnesses occurred during November 2013, the last reported date of onset of illness was January 3. Fifteen of the cases were reported in California. Nevada and Wyoming each reported one case.
Fifty-three percent of case patients, who ranged in age from 2 years to 83 years old, were male. The median age was 27.
Contact a Salmonella LawyerPublic health investigators used pulsed field gel electrophoresis (PFGE) testing to obtain a DNA “fingerprint” of the outbreak strain. The tests determined that the outbreak strain of Salmonella Stanley had only been seen 20 times prior to the outbreak.
In 2013, the first multistate outbreak announced by the CDC was also a Salmonella outbreak. But this time the food was ground beef. That six-state outbreak sickened 22 people, hospitalizing seven.
Recalls were issued by Jouni Meats Inc. of Sterling Heights, MI and Gab Halal Foods of Troy, MI.  Wisconsin with eight cases and Michigan with nine were hardest hit by the outbreak. Case counts in other states were as follows: Arizona (1), Iowa (1), Illinois (2) and Pennsylvania (1).

The Evolution of Food Safety: Avoiding Costly Recalls
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By (Mar 10, 2015)
Increased attention to food safety
Picture the scene several years ago. In 2009, there were 56 separate food safety incidents recorded in the UK caused by contamination from foreign bodies, such as glass or metal shards, stones or bones, or fragments of plastics or rubber. This has since risen to 118 in 2013, with plastic, metal and glass contamination in 19, 12 and 10 incidents respectively. Interestingly, of the 118 recorded incidents, 62 originated from the UK, 35 from the European Union (EU) and 11 were imported. In the United States, there were 10 recorded incidents of extraneous material contamination in 2013, with 331,732 pounds of food recalled. The number of incidents significantly increased from 5 in 2009 however the amount of food recalled reduced from over one million pounds. These, combined with a number of other high profile food scares, have had consumers in both Europe and North America increasingly worried about the safety of the products at supermarkets.
In addition, several product recalls over the last few years, such as needles in airplane food in the US, and glass shards in sparkling wine in the UK, have all led to widespread media coverage, impacting on consumer perceptions about the safety of the food supply chain. Such attention has put the spotlight firmly on the quality control practices carried out by manufacturers to minimize the risk to consumers, uphold their trust in the food they eat and, in doing so, safeguard their brand.
For any brand involved in a safety incident, a product recall can be costly, especially when you factor in the time and effort spent initiating the recall, communicating it to customers and consumers, then working to rebuild their reputation in the eyes of both retailers and the general public. In addition, there are damages that have to be paid to customers left out of pocket, as well as the expense of lost and wasted product. It is no surprise, then, that manufacturers are keen to do all they can to avoid an incident.
To continually protect consumers against substandard products, food safety legislation and standards in both the US and the European Union (EU) have evolved. The International Featured Standards in France, Germany and other European economies, the British Retail Consortium (BRC) Global Standards in the UK, and the Food Safety Modernization Act in the US are all more stringent than ever before to combat food safety hazards, safeguard consumer wellbeing and reclaim public trust in the food supply chain. They are now becoming the blueprints for similar regulations in emerging markets, such as China, both to improve safety for local consumers and to facilitate exports to Europe and North America.
As a result of these stricter rules around the globe, food manufacturers have had to evolve their product inspection processes to ensure compliance with regulations and minimize the risk of a costly product recall. At the same time, increasing worldwide demand for food products and growing globalization of the market has meant that they have had to maintain high levels of quality control while boosting their manufacturing output and productivity.
Product inspection manufacturers have had to develop their technologies, such as x-ray inspection systems, innovating to meet these requirements from customers, with ever greater sensitivity and features to balance product safety and productivity. Incorporating fully integrated automatic rejection systems, for example, into x-ray technology has enabled manufacturers to significantly increase throughput rates on their line without compromising contaminant detection. The development and inclusion of advanced data management systems in product inspection machines has also resulted in more accurate analysis and monitoring, enabling food manufacturers to not only demonstrate due diligence in the event of an incident, but to identify potential sources of contamination to minimize the risk of it happening again in the future.
Where we stand today
Even with the developments in legislation, food product recalls remain a significant issue for manufacturers today. The number of recalls in the UK and US, due to physical contamination, has increased over the last five years. However, this is due in large part to increased awareness of food safety among consumers and retailers, as well as stricter regulations – including audits - raising the bar for food manufacturers.
The globalization of the food market has led to much longer supply chains, with raw ingredients sourced in one country, processed and packaged in another, ready for selling in a third or even a fourth nation. This means that brand owners have to ensure that their products and their manufacturing processes comply with the regulations in place in each of the markets they are operating in. For example, if food is sourced in the US, processed in the UK and sold in France, then the manufacturer will have to meet the requirements of the US Food Safety Modernization Act, the BRC Global Standards and the IFS.
As a result, in order to comply with so many food safety standards, manufacturers have to ensure that their production lines meet more than just high hygiene standards. They also need to have in place precision product inspection processes to identify any and all instances of physical contamination on the line to minimize the risk of sub-standard packs reaching consumers. Product inspection equipment, such as advanced x-ray systems has been a real help here to manufacturers, enabling them to automate their quality control procedures to inspect all of their packs for foreign bodies. The use of innovative, high-performance x-ray technology can really help manufacturers to safeguard against physical contamination and reduce the risk of food safety recalls, protecting their brand reputation.
A new generation of technologies to avoid the recall threat
The new more stringent regulations in place worldwide are pressuring manufacturers to achieve ever higher standards of food safety. The industry is now turning to equipment suppliers to provide them with technologies that uphold the highest levels of product quality, while maintaining optimum line speed and efficiency.
Installing product inspection technologies on production lines in accordance with the principles of Hazard Analysis and Critical Control Points (HACCP) is a key first step in minimizing the risk of contamination. Under this protocol, rather than just inspecting products at the end of the manufacturing process, advanced inspection systems must be installed at every location on the line identified as vulnerable to contamination, known as Critical Control Points (CCPs). Doing this can ensure that even minuscule foreign bodies are identified as early as possible, maximizing detection rates and preventing contaminants from fragmenting during processing to affect a greater number of products.
However, to keep up with burgeoning competition on the international stage, food manufacturers need to strike the right balance between product safety and line productivity, which increasingly means boosting line speeds. High throughput rates through the product inspection process can be easily achieved, though, by installing advanced x-ray inspection machines capable of precision contaminant detection at high speeds, as well as by automating the rejection process. Fully-integrated automatic rejection systems can ensure that all non-conforming packs can be removed without the need to stop or slow the production line, maximizing production uptime, while keeping the risk of a contamination incident to a minimum.
While the inclusion of inspection systems that follow HACCP principles has helped to significantly decrease the likelihood of contamination reaching consumers, it is imperative that manufacturers are prepared for a potential food safety incident involving their product. If a recall were to occur, they need to be able to manage both the recovery of non-conforming packs from retailers and consumers, as well as any investigation by the authorities, providing proof of their due diligence.
In such an event, being fully informed about the performance of the production line and the product inspection systems is vital to maintain continuous operation and to mitigate the negative impact on brand reputation. Modern x-ray systems feature data management systems fully incorporated into the machine, capable of recording and storing data about both conforming and non-conforming products on the line. This information can allow manufacturers to demonstrate that they have taken every feasible measure to prevent contamination to investigators, and to enable them to trace the source of safety issues. Advanced systems can also be connected to a larger network, enabling manufacturers to access data from multiple inspection machines, and at the same time, further facilitating their analysis of contamination trends. All of this can help manufacturers to keep up to speed with how their production processes are operating and help to demonstrate due diligence, should the worst happen.
Evolving with the food safety landscape
The international food market has undergone an immense transformation since 2009, with increased globalization of the supply chain, and the introduction of a raft of rigorous safety regulations worldwide. To continue to comply with legislation and retain access to lucrative overseas markets, while remaining competitive on the world stage, food manufacturers need to ensure that they have the most up-to-date product inspection systems installed on their lines to optimize contaminant detection without compromising on productivity.
Product inspection system specialists are constantly developing their technologies to stay ahead of changes in the food safety landscape and to meet customer requirements. Working with such specialists, food manufacturers can ensure that their product inspection processes are capable of evolving with the food market, maximizing safety and helping them to avoid a costly recall.
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Journal Dedicates Issue to Climate Change and Food Safety
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By News Desk (Mar 9, 2015) Research International has published a special issue dedicated to the impacts of climate change on food safety.
The collection of research examined issues such as pesticide use, parasite transmission, mycotoxin production on tomatoes, paralytic shellfish poisoning, Vibrio parahaemolyticus, and the relationship between flooding and leafy greens contamination.
The issue was edited by researchers at Wageningen University in the Netherlands and Ghent University in Belgium and includes several papers from the Veg-i-Trade research project financed by the European Union.
A preliminary study into toxic substances from fungi showed that there could be an increased risk of contamination of tomatoes at the end of the 21st century in Poland, but that increased temperatures in Spain will lower the risk of contamination there.
Another study showed that flooding in a lettuce field may result in increased concentrations of harmful bacteria that can be quickly broken down again by UV light.
And future climate scenarios could cause shellfish poisoning outbreaks to occur during earlier months of the year.
The editors state that these are the first studies of climate change and food safety, and they argue for support of expanded research.

Two Year Salmonella Outbreak Linked to Chicken
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By Drew Falkenstein (Mar 9, 2015)
In 2013 and 2014 local, state, and federal public health and agriculture agencies collaborated in a multistate outbreak of Salmonella Heidelberg. Investigators used PulseNet to identify patients who were considered outbreak associated cases. Epidemiologic, laboratory and traceback investigations indicated that consumption of Foster Farms brand chicken was the source of the outbreak. Seven strains of Salmonella Heidelberg were isolated in patients. Before this outbreak, four of these strains were rarely reported to PulseNet. The other three strains were more common, with several ill persons infected with each strain reported to the CDC monthly. The DNA fingerprints of the Salmonella Heidelberg bacteria associated with this outbreak include the strain that was also associated with a multistate outbreak of Salmonella Heidelberg linked to Foster Farms brand chicken processed at an establishment in Washington State during 2012-2013.
A total of 634 persons infected with the outbreak strains of Salmonella Heidelberg were reported from 29 states and Puerto Rico from March 1, 2013 to July 11, 2014. Most of the ill persons (77%) were reported from California. Among 528 persons for whom information was available, 200 (38%) were hospitalized. Fifteen percent of ill persons developed blood infections as a result of their illness. No deaths were reported.
In interviews, 74% of ill persons reported consuming chicken prepared at home in the week before becoming ill. Among those who had brand information, 187 (87%) of 175 ill persons reported they consumed Foster Farms brand or another brand likely produced by Foster Farms. Health departments in Washington and California collected leftover chicken from the homes of ill persons for laboratory testing. Salmonella was isolated in leftover chicken, in an unopened package of raw Foster Farms chicken, and in leftover rotisserie chicken.
During September 2013, USDA-FSIS conducted in-facility testing for Salmonella at four Foster Farms production establishments in California and Washington. Six of the seven outbreak strains of Salmonella Heidelberg were isolated from raw chicken samples collected from the three Foster Farms establishments in California. At that time FSIS threatened Foster Farms with removing inspectors because sanitary conditions at its three facilities were so poor that they posed a “serious ongoing threat to public health.”  FSIS officials had found a “high frequency of Salmonella Heidelberg positives and specifically a high frequency of one or more outbreak strains” in the three plants. The letters also cited “fecal material on carcasses” and “findings of poor sanitary dressing practices, insanitary food contact surfaces, insanitary non food contact surfaces and direct product contamination” at the plants. See Notices of Intended Enforcement: ONE[1], TWO[2] and THREE[3] that FSIS sent to Foster Farms.
On July 3, 2014 Foster Farms recalled an undetermined amount of chicken products due to contamination with Salmonella Heidelberg. The recall resulted from USDA-FSIS identifying one of the outbreak strains of Salmonella Heidelberg in an intact sample of Foster Farms brand chicken collected from the home of a person in California infected with the same strain. The chicken breasts were packaged with critical labeling information to associate the product with the establishment and a specific production date.
By July 31, 2014 the CDC declared the outbreak to be over as the number of reported infections had returned to the expected number for that time of year.[4]

2005 Central Florida State Fair E. coli Outbreak
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By Patti Waller (Mar 9, 2015)
PettingZooThe outbreak was first recognized after two separate HUS case reports were posted on the Florida Department of Health EpiCom on March 18 and March 21, 2005. The two cases (a 5-yr-old girl and a 7-yr-old boy) both reported having visited a fair with a petting zoo (Agventure) a few days prior to becoming ill. The two children visited the same fair and did not have any other risk factors in common. The fair (the Central Florida Fair) was held from March 3-13, 2005.
The Orange CHD epidemiology on-call nurse was also contacted on March 20 by one of their local hospital administrators who reported a cluster of pediatric HUS cases in her hospital. Interviews with the parents of the hospitalized children revealed that all had attended a petting zoo (Agventure) at the Central Florida Fair or at a new fair (the Florida Strawberry Festival, also held March 3-13) within three weeks prior to becoming ill. E. coli O157:H7 isolates from the initial cases were sent to the Bureau of Laboratory in Jacksonville for PFGE typing (i.e., to determine if there was a match for the genetic fingerprints of the bacteria involved).
A conference call was held with county health department epidemiology staff in central and south Florida to discuss the initial results of the investigation, and to launch intensified E. coli O157:H7 case finding activities. A questionnaire with an extensive list of questions about potential risk factors for E. coli O157:H7 infections (including questions about exposures to foods, water and animals) was developed.
A list of animal vendors exhibiting at the Central Florida Fair and the Florida Strawberry Festival was obtained from management of the two fairgrounds. The two fairs had only one vendor in common, an exhibitor of a farm animal petting zoo (Agventure). The owner of Agventure was contacted on March 24, and the animals (sheep, goats and cattle) were placed under a voluntary quarantine for the duration of the outbreak investigation.
In conversations with the Agventure owner it was also revealed that the same animals had been exhibited once before, at the Florida State Fair, held between February 10-21, 2005.
An environmental investigation was undertaken at the three fair grounds and the Agventure petting zoo farm. Soil samples and environmental swabs were obtained from the petting zoo exhibit areas of the fairs. One hundred sixty eight animals exhibited at the fair, including the 37 animals exhibited at the farm animal petting zoo were also cultured.
The initial case definition was broad. As the outbreak investigation progressed, the case definition was made more specific and defined outbreak related cases by time, place and person as follows:
1.Confirmed-persons who attended one of the three fairs by 3/13/05 and had a lab diagnosis of  coli O157:H7 within 10 days of fair attendance and/or had a lab diagnosis of HUS within 21days of fair attendance;
2.Suspect-persons who attended one of the three fairs and developed symptoms of  coli O157:H7 within 10 days of fair attendance and/or developed symptoms of HUS within 21 days of fair attendance and did not have an alternative diagnosis; and
3.Secondary-persons who developed symptoms of  coli O157:H7 and/or had a lab diagnosis of E. coli O157:H7 within 2-10 days of having close contact to a case or persons who developed symptoms of HUS and/or had a lab diagnosis of HUS within 21 days of having close contact to a case.
A total of 22 confirmed, 45 suspect and 6 secondary cases from 20 Florida counties were identified as victims of this outbreak. All but one culture-confirmed case had isolates with matching PFGE patterns. Most cases were infected at either the Central Florida Fair or the Florida Strawberry Festival (only 3 cases associated with the Florida State Fair). Twelve cases developed HUS. There were no fatalities.
E. coli O157:H7 with matching PFGE patterns were also recovered from the animal exhibit areas of the Central Florida Fair and the Florida Strawberry Festival. E. coli O157:H7 with matching PFGE patterns were also recovered from 6 animals from the Agventure petting zoo.
While some diseases show host species specificity, meaning that they can only occur in one animal species, many other diseases can be spread between different animal species, including humans and animals. These diseases are collectively known as zoonotic diseases. The term zoonoses, is derived from Greek zoon (animals) and noses (diseases) that literally mean diseases from animals.
Zoonotic diseases can be transmitted by a variety of routes. Some documented ways include direct and indirect contact with infected animals, airborne exposure to infective agents shed by animals, consumption of animal products, consumption of water that has been contaminated by animal fecal material, or exposure to insect vectors such as fleas or ticks.
Previously, the primary mode of transmission of zoonotic diseases at agricultural fairs, petting zoos, and farm visits was thought to be fecal-oral, that is, by ingestion of bacteria-laden feces via contaminated food or water, or transfer by hand to mouth following contact with contaminated surfaces or animals. Conclusions reached by investigators in several recent fair-associated outbreaks of E. coli O157:H7 suggest that ingestion or perhaps even inhalation of contaminated dust particles may also be how fair attendees become infected with the bacteria.
Summaries of Known Cases of Zoonotic Pathogen Outbreaks Associated with State and County Fairs, Petting Zoos, and Community Activities Involving Human-Animal Contact
Outbreak Case 1: County Fair – Wisconsin
MMWR Weekly (November, 1988) reported that in September, 1988, a human was fatally infected with swine influenza virus in Wisconsin. A subsequent investigation found that the victim, a woman, had attended a county fair and visited the display area of the pig barn. Statements from the veterinarians at the fair indicated that pigs in the display area were found to show an illness consistent with swine influenza. A preliminary investigation found that there was no outbreak of influenza-like illness observed in the surrounding areas. Three healthcare personnel treating the case patient also developed influenza-like illness with laboratory evidence of Swine Influenza Virus (SIV) infection (Wells et al., 1991). The editorial note contained in the MMWR Weekly report indicated that the case suggested direct transmission of influenza virus from pig to human host.
Outbreak Case 2: Farm Visitor Center – Leicestershire, United Kingdom
Shukla et al (1995) investigated an outbreak of seven cases of E. coli O157:H7 infection associated with a visit to a farm in Leicestershire, United Kingdom, during the summer of 1994. A joint study was conducted between environmental health officers and the local veterinary investigation center of the Ministry of Agriculture, Fisheries and Food. A questionnaire was sent to all cases. Samples were collected from the farm, and the associated facilities for food preparation and hygiene were also assessed. The investigation found that the common factor linking all the cases was a visit to a farm visitor center in the three weeks before the onset of the illnesses. The epidemiological data supported this link, as the strains of E. coli O157:H7 isolated from nine animals on the farm were indistinguishable from those isolated from the human samples. This report concluded that the most likely cause of this outbreak was direct human contact with animals. The probability of contracting disease was increased by poor hand washing facilities, and a lack of information provided to the visitors on the importance of maintaining personal hygiene.
Outbreak Case 3: Farm Visit – Wales
In April 1995, an outbreak of Cryptosporidiosis was reported among 43 children and four staff after visiting a rural farm (Evans and Gardner, 1996). Out of the 43 cases reported, 7 were confirmed by laboratory cultures. The investigation indicated that the highest likelihood of source of contamination was contact with calves.
Outbreak Case 4: Farm Visit – Dublin
Sayers et al (1996) reported a Cryptosporidium outbreak the summer of 1995, involving 13 children identified as cases. The children had been to a summer project and visited an open farm in Dublin, Ireland. The second part of this study also included a case control study of 52 out 55 people who had visited the open farm.
The researchers concluded that the outbreak was significantly associated with playing in the sand on a picnic area beside the stream where animals had access. This outbreak emphasizes the risk associated with children visiting open farms.
Outbreak Case 5: Farms – Cornwall and West Devon, United Kingdom
Milne et al (1999) investigated an E. coli O157:H7 outbreak associated with a farm in the United Kingdom during the period of June to July, 1997. A Vero cytotoxins producing Escherichia coli O157:H7 infection was observed in three children, one who lived on an open farm and two who visited the farm during school parties. Two of the three children developed HUS and one suffered from severe neurological impairment. Isolates collected from the three children and from all environmental samples were indistinguishable by molecular typing, providing evidence of the link between the human contact with the farm and the outbreak.
The farm was closed voluntarily for six weeks, while recommendations to reduce the risk of transmission were implemented. These recommendations included reassessing provisions made for general hygiene, including making sure adequate hand washing facilities were available; strict segregation of eating and drinking areas from the animal contact area; reinforcement of precautions to be taken by visitors; reassessment of the species type and age of animals kept in the touching barn; prohibition of visitor exposure to fecal contamination (e.g. manure heaps, etc.); elimination of visitor use of cattle trails unless devoid of fecal contamination; implementing a “no touch” policy in various parts of the farm trail, like the calf pen area; enhancing decontamination of the goat paddock by putting it out of use a few weeks before the visits and keeping the grass short; performing rigorous detergent cleaning in areas of public access and appropriate use of disinfectants; and prohibiting public asses to the milking parlors, and calving barns.
Outbreak Case 6: Zoo Water Fountain – Minnesota
In July 1997, the Minnesota Department of Health (MDH) reported an outbreak of Cryptosporidiosis among children who visited the Minnesota Zoo (MMWR Weekly, October, 1998). A total of 369 cases were reported, of which 73 were subsequently confirmed by means of laboratory cultures. The report by MDH indicated case onset of vomiting or diarrhea 3 to 15 days after exposure to the zoo fountain. However, the fountain was not confirmed as the source. Exclusion of people from the suspect water fountain was suggested to reduce the risk of contamination to the public.
Outbreak Case 7: Agricultural Fair – British Columbia
During August and September of 1998 the British Columbia Center for Disease Control sent all E. coli O157:H7 isolates to an outside laboratory for molecular sub-typing (BC Center for Disease Control, March, 1999). On September 17 it was reported that nine of the 69 referred isolates had a common genotype. Three individuals were hospitalized, though none developed hemolytic-uremic syndrome (HUS). Seven of the nine had onset of illness within ten days of visiting a large agricultural fair. Despite in-depth interviews, no common source of infection could be identified. No environmental investigation of the fair could be carried out; because by the time laboratory results were available the fair had closed.
Outbreak Case 8: County Fair – Puyallup, Washington
An outbreak of hemorrhagic colitis due to E. coli O157:H7 was identified among visitors to the Puyallup Fair in Puyallup, Washington, during September of 1998 (CDC Memorandum, March 1999). Two children were initially confirmed as being ill from E. coli O157:H7. The Communicable Disease State Epidemiologist at the Washington State Department of Health mentioned in a news release immediately after the detection of two confirmed cases at the Puyallup fair that health officials were looking for food borne exposure as well as possible contamination at the animal petting areas and on water rides (Kobayashi, 1998).
The CDC conducted an investigation, and concluded that out of 80 ill people reporting, there were three confirmed and five probable cases of E. coli O157:H7 illness. Of these eight cases, seven reported consuming hamburgers, though purchased from multiple vendors. The environmental investigation suggested that exposure could have resulted from consuming food without washing hands after petting the animals in the petting zoo. The internal temperature of the cooked hamburgers tested ranged between 155 to 195° F although a number of situations of potential cross contamination were observed among the food handlers.
The CDC memorandum stated that compelling circumstantial, but not conclusive, evidence was found that the outbreak was a result of consumption of contaminated hamburgers. The memorandum also recommended enforcing proper food handling practices among food vendors, installing a large number of hand washing facilities at the animal petting zoo, and also throughout the fair. It also recommended performing a hazard evaluation of all the food sold at the fair for potential risk of foodborne illnesses.
Outbreak Case 9: Farm – North Wales, London
Payne et al (2003) reported an outbreak of Vero toxin producing E. coli O157:H7 (VTEC O157:H7) causing gastroenteritis among people visiting an open farm in North Wales, London in June 1999. A case-control study was designed which included 16 primary case patients and 36 controls. The preliminary investigation indicated a significant association between attendance on the second day of the festival, eating ice cream or cotton candy and contact with cows or goats. Further multivariable analysis of the data indicated that the only the association of the illness with eating ice cream and cotton candy remained significant. The researchers suggested that foods on open farms should be eaten only in the dedicated clean areas, and sticky food should be avoided in such events.
Outbreak Case 10: County Fair – Washington County, New York
The New York State Department of Health investigated what is believed to be the largest outbreak of waterborne E. coli O157:H7 illness in United States history. The outbreak occurred at a fair in Washington County, New York, in August of 1999 (New York State Department of Health, March, 2000). A total of 781 persons were identified with suspected infections of E. coli O157:H7 and/or Campylobacter jejuni. Of these cases 127 persons were culture confirmed to be ill with E. coli O157:H7, 71 individuals were hospitalized, 14 persons exhibited hemolytic uremic syndrome (HUS), and 2 people died. A household telephone survey indicated that the number of people infected by either pathogen after visiting the Washington County Fair might be as high as 2,800. The environmental and site investigation indicated that unchlorinated water from a well serving the southwestern portion of the fairgrounds was contaminated with E. coli O157:H7 (DOH News, 1999). Samples of manure collected from a barn located 50 feet from the well and samples from the groundwater flow from the manure storage area located 80 feet from the well tested negative for E. coli O157:H7. However, samples from the septic system tested positive for E. coli O157:H7.
The shape of the epidemic curve suggested a point source outbreak with the peak of symptom onset occurring on September 1. Considering a typical incubation period of 2-4 days, this suggested that most exposures took place towards the end of the fair. This matched information provided by the patients, 88% of whom visited the fair in the final week. Consumption of only two food or beverage items, soda with ice or ice in any drink, was reported by a majority of the culture-confirmed case patients. MMWR Weekly (1999) reported that the pulsed-field gel electrophoresis testing by the Wadsworth center indicated that the DNA fingerprints of E. coli O157:H7 isolates from the well, the water distribution system, and most confirmed cases were similar.
The epidemiological investigation of this outbreak concluded that a significant relationship was associated with the incidence of the outbreak and the consumption of beverages purchased from vendors supplied with water from the unchlorinated well. MMWR Weekly (1999) reported that letters were sent to nursing homes, hospitals and schools to exclude the symptomatic personnel and also follow careful hygienic practices to prevent secondary transmission.
Outbreak Case 11: Agricultural Fair – Ontario, Canada
Warshawsky et al (2002) investigated an outbreak of E. coli O157:H7 associated with a large agricultural fair conducted between September 10 and 19, 1999, in Ontario, Canada. This study indicated that 7 cases of E. coli O157:H7 infections were associated with animal contact at the agricultural pavilion of the regional fair. Sub-typing revealed that five of the seven cases were extremely uncommon E. coli O157:H7 PT 27 while the remaining two were common E. coli O157:H7 PT 14. The E. coli O157:H7 PT 27 pattern matched with three samples from goats and one sample from sheep from the traveling petting zoo. The researchers further noted that the clustering of positive cases on the two weekends of the fair indicated that exposures could be a result of difficulty in manure disposal and environmental cleaning due to high volumes of visitors. The results from this case control study strongly suggested that the goats and sheep from the petting zoo were the source of the E. coli O157:H7. The detailed history from two primary sources indicated that the rails and the environment surrounding the petting zoo could also have been contaminated and could have acted as a source of transmission. The researchers recommended that standards should be outlined for adequate hand washing facilities, appropriate disposal of manure, proper cleaning environment surrounding the petting zoos, including the rails and floors.
Outbreak Case 12: Social Event in Cow Pasture – Petersburg, Illinois
An outbreak of E. coli bacteria was reported in Petersburg, Illinois inn 1999 (Nando Times, 1999). The outbreak took place among 1,800 people who attended a party called “Cornstalk” held in a cow pasture. State health officials reported that 202 individuals became ill, and that 20 were hospitalized. However, none of the reported illnesses were considered serious. The source of contamination was not found.
Outbreak Case 13: Petting Zoo – Snohomish County, Washington
A press release by the Snohomish Health District, Communicable Disease Control (June, 2000) reported five cases of bacterial diarrhea caused by E. coli O157:H7 in children in Snohomish County in May 2000. Three of the children visited a petting zoo several days before they became sick. The fourth child did not visit the petting zoo, but was found to live on another farm where cattle were raised (MMWR Weekly, April 2001) reported an investigation of the farm by Snohomish Health District (SHD) and Washington Department of Health revealed that the children were allowed to touch young poultry, rabbits and goats. Children brought their own lunches and ate approximately 50 feet from the penned animals. The study also indicated that the animal stool samples collected from the farm tested negative for E. coli O157:H7. The Health District believed that the three children visiting the petting zoo acquired the bacterial diarrhea due to a lack of adequate hand washing facilities available. MMWR weekly (April 2001) also reported that no signs were posted to instruct the visitors to wash their hands after touching the animals.
Outbreak Case 14: County Fair – Medina County, Ohio
Crump et al (2000) discussed county fairs as risk factors for E. coli O157:H7 infections. The researchers investigated a cluster of E. coli O157:H7 isolates observed in Medina County, Ohio, in August of 2000. In this case control study 43 culture confirmed E. coli O157:H7 cases were identified. The environmental investigation suggested that contamination of a section of the water distribution system supplying various vendors was most consistent with the localization of the pathogenic exposure. Water samples collected for this study did not indicate any coliforms. However, a Halloween event was arranged on the same fairgrounds where the Medina County Fair was held, during which five children developed E. coli O157:H7 infection. These children consumed water-based products during the party and showed the same PFGE pattern as that observed in the Medina County Fair outbreak. The researchers concluded that the county fair exposure was significantly associated with the E. coli O157:H7 outbreaks. The report recommended that guidelines be developed for safer interactions between animals, humans, and the environment. These recommendations could include improving public awareness of risk and prevention strategies, identifying high-risk animals, and controlling their contact with humans through identifying interaction activities and groups at greater risk.
Outbreak Case 15: Dairy Farm – Pennsylvania
Crump et al (2002) discussed an outbreak of E. coli O157:H7 among visitors to a dairy farm in Pennsylvania in September, 2000. A case control study among the visitors was conducted to identify the risk factors of infection, along with a household survey to determine the rates of diarrheal illness. The total number of confirmed or suspected E. coli O157:H7 cases were determined to be fifty-one. The median age among the patients was four. Eight of the cases developed hemolytic uremic syndrome (HUS). The environmental investigation indicated that 28 of 216 cattle (13%) on the farm were carrying E. coli O157:H7 that yielded an identical pattern when analyzed by pulsed field gel electrophoresis to that observed for the isolates of the patients. The organism was also recovered from various surfaces in public access areas of the farm.
MMWR Weekly (April 2001) reported that a case control study among the farm visitors was conducted jointly by the CDC, Pennsylvania Department of Health, and Montgomery County Health Department to identify the risk factors. A “confirmed case” was defined as diarrhea in a person within 10 days of visiting the farm on or after September 1, with either E. coli O157 isolated from stool or HUS. A “probable case” was defined as diarrhea in a person within 10 days of visiting the farm on or after September 1. A “control” was defined as a person visiting the farm after September 1 who did not develop diarrhea within 10 days of the visit. Fifty-one case patients and ninety two controls were interviewed for this case control study. The research concluded that this large outbreak of E. coli O157:H7 was most likely a result of contamination of both animal hides and the environment. This study also reported that the data showed hand washing as providing protection against transmission of the pathogen.
Outbreak 16: Petting Zoo – Worcester, Pennsylvania
An article published by WebMD Medical News on April 23, 2001 (Bloomquist, 2001), reported an outbreak of E. coli O157:H7 among visitors to the Merrymead Farm petting zoo in Worcester, Pennsylvania. In all, 16 children who had visited the zoo contracted E .coli, and it was suspected that another 45 people became ill from the bacteria. The report indicated that one week after visiting the zoo, one of the children came down with violent stomach cramps and was hospitalized. A few days later, and after being released from the hospital, the patient was diagnosed with kidney failure. It is believed that 26 cows on the farm were carrying the E. coli bacteria, and that exposure may have occurred as visitors rode in a wagon which was caked with mud and animal manure, or as they touched animals that may have been infected.
Outbreak 17: County Fair – Ozaukee County, Wisconsin
The Ozaukee County Public Health Department and Wisconsin Department of Health and Family Services (2001) investigated an outbreak of E. coli O157:H7 associated with animals at the Ozaukee County Fair in August, 2001. A total of 59 E. coli O157:H7 cases were identified in this outbreak, with 25 laboratory confirmed cases (25 “primary cases” and 34 probable cases). Bacteriological testing of water at the Ozaukee County fairgrounds and the Fireman’s park did not indicate presence of E. coli O157:H7, though 10 of the 36 samples collected from the Ozaukee County Property showed elevated levels of total coliforms. The environmental investigation focused primarily on testing water samples from the livestock buildings, livestock washing stations, runoffs from settling basin, grass filter strip, manure storage area, fishing pond, and streams. A total of 19 surface water samples, and 8 sediment samples, were collected from the pond and stream on the fairgrounds property. All tested negative for E. coli O157:H7. Public health officials attributed the outbreak to animal contact in the petting zoo at the county fair (Cole et al, 2001).
As a consequence of this outbreak, the Wisconsin Division of Public Health, Wisconsin Department of Agriculture, Trade and Consumer Protection, and the Dane County Division of Public Health developed a list of voluntary guidelines for animal exhibitions at Wisconsin. The general precautions for livestock on public displays included providing hand-washing stations at strategic places around livestock barns, and posting signs encouraging their use. Actions included developing and implementing manure collection, handling, and storage procedures. It was recommended that runoffs into places where water was pulled be avoided. A written policy should be developed on handling animal bites and should be discussed with the corresponding county fair health authorities. Visitors should be prohibited from being in contact with baby animals, including newborns, if an animal birthing display is available. The recommendations regarding the food and hygiene practices included keeping food and beverage service away from the livestock, providing adequate hand washing facilities, and encouraging their usage. The guidelines also recommended keeping of records of all the vendors, vendor locations, and schedule of events.
Outbreak Case 18: County Fair – Lorain County, Ohio
The Department of Health and Human Services, Public Health Services (CDC memorandum, February, 2002) reported that 23 cases of E. coli O157:H7 infection were identified associated with the attendance at the Lorain County Fair, Ohio, in September, 2001. A number of additional cases of diarrhea were identified as likely due to secondary transmission from primary cases. The memorandum strongly associated presence at the Cow Palace, Lorain County, with bacterial diarrhea. The environmental and site investigation indicated that visible manure was present on the ground in at least one area of the barn floor. Out of 54 environmental samples, 23 tested positive for Shiga toxin producing E. coli O157:H7. Samples from the doorways, rails, bleachers, and sawdust exhibited an identical fingerprint pattern when analyzed by PFGE. Environmental samples of water obtained by the Health Department in the week before and during the fair tested positive for total coliforms for two spigots.
The CDC memorandum clearly associated the Lorain County Fair with the E. coli O157:H7 outbreak in the county. The possible mechanisms proposed for disease transmission included contamination of human hands with residual cow manure and/or aerosolized dispersion of E. coli O157:H7 in the sawdust. The memorandum also hypothesized that the patients became contaminated at the cow palace and were subsequently infected while eating or drinking at the various vendors. The case control study of this memorandum did not support an alternative hypothesis, that the fairground water was related with the outbreak. This investigation strongly supported the previous incidences of E. coli O157:H7 outbreaks associated with the county fair attendance. This memorandum also stressed the need for collaborative efforts between various public agencies to develop clear guidelines for ensuring the disinfection of the temporary facilities housing the animals. The recommendations provided in this memorandum included considering the banning of large dusty events, and the development of guidelines for disinfecting surfaces in the Cow Palace prior to events or to replace sawdust with non particulate ground covering. They also suggested that the fairgrounds should be provided with adequate hand washing facilities with hand sanitizers. Measures should be provided to prevent intermixing of water.
Outbreak Case 19: County Fair – Wyandot County, Ohio
The Ohio Wyandot County Health Department received a report of an E. coli O157 outbreak in September, 2001 (CDC memorandum, February, 2002). A total of 92 cases were identified, including 27 laboratory-confirmed E. coli O157 infections. Two cases were diagnosed with hemolytic uremic syndrome. Eighty-eight cases reported attending Wyandot County Fair before becoming ill. The source of the outbreak was not fully identified; however, the most likely source was believed to be contact with infected cattle. Disinfecting areas that house cattle, removal of fecal contamination from contact surfaces, and exclusion of calves or cows from petting areas were recommended. Active surveillance at the fairgrounds during the local fair or at large gatherings, along with strengthening measures to prevent water contamination, was suggested.
Outbreak Case 20: Farm – Wellington, New Zealand
An outbreak of Cryptosporidiosis was linked to a two-day farm educational event in the Wellington region of New Zealand. The total number of cases is unknown, but 23 cases were laboratory-confirmed. The most likely route of infection was determined to be from an infected animal. The outbreak was discussed in a report released in 2001 (Stefanogiannis et al, 2001).
Outbreak Case 21: County Fair – Lane County, Oregon
A news release from the Oregon Department of Human Services (Oregon, 2002) reported on hemorrhagic colitis from the Lane County Fair held during August, 2002, in Oregon. The report indicated that 56 primary and 14 presumptive secondary cases were identified. This is believed to be the largest E. coli O157:H7 outbreak in Oregon history. Two-thirds (66%) of the confirmed cases were <6 years old, and 56 % were <19 years old.
Although not confirmed, health officials postulated that possible exposures leading to the outbreak occurred at animal enclosures, including the cattle tent, horse barn, and exposition halls that housed goats, sheep, rabbits, chickens, ducks, and guinea pigs. Investigators tried to trace the transmission path of the bacteria to develop a strategy to prevent the outbreak in the future. Capital Press, an agricultural magazine, discussed this event (September, 2002). The article mentioned that scientists discovered a virulent strain of bacteria on the pipes 15 feet above the goat pens in a fair exhibition hall, where about 75 people, including 12 children, were believed to be infected. A state epidemiologist from the Oregon Department of Human Services suggested that the microorganisms must have been present in the dirt and dust, and henceforth accumulated on the tops of the pipes 15 feet in the air.
Outbreak Case 22: Petting Zoo – Zutphen, The Netherlands
Heuvelink, et al (2002) reported that a young child developed a Shiga toxin 2 producing strain of Escherichia coli (STEC) O157 infection after visiting a petting zoo in Zutphen, The Netherlands. The STEC strains were isolated from the fecal samples from goats and sheep on the farm. Molecular sub-typing proved that the human and animal isolates were identical.
Outbreak Case 23: County Fair – Fort Bend County, Texas
In 2003 twenty-five people – fair visitors and animal exhibitors – became ill with E. coli O157:H7 after attending the Fort Bend County Fair in Rosenberg, Texas. There were four cases of Hemolytic Uremic Syndrome and one case of Thrombotic Thrombocytopenic Purpura. All seven laboratory-confirmed cases had an indistinguishable PFGE pattern which matched with ten isolates obtained from environmental samples taken at four animal husbandry sites. Case-patients ranged in age from 18 months to 67 years. Eighteen other environmental specimens were positive for E. coli O157:H7 but were determined by PFGE analyses to be different strains from the outbreak strain. Investigators concluded that both the rodeo and animal exhibit areas were heavily contaminated with E. coli O157:H7. There was no association between illness and food or beverage consumption (Reynolds et al, 2004; Durso et al, 2005).
Outbreak Case 24: State Fair – Raleigh, North Carolina E. coli Outbreak, North Carolina State Fair
In late October 2004, the North Carolina Department of Health and Human Services (NCDHHS) conducted an E. coli O157:H7 outbreak investigation among attendees at the 2004 State Fair. The health department received over 180 reports of illness; the majority of cases occurring in children five years old and younger. Fifteen children developed hemolytic uremic syndrome.
A preliminary report issued by the NCDHHS in December 2004 identified multiple risk factors for infection with E. coli O157:H7 among visitors to four animal exhibits. Direct contact with goats and sheep was strongly associated with illness. Ill children age three years or less were seven times more likely to have contact with manure than children who were not ill. Ill children were also five times more likely to fall or sit on the ground than children who were not ill.
Cultures from 33 ill fair attendees had the same PFGE patterns. Environmental samples obtained from four fairground areas grew E. coli O157:H7. Nineteen of thirty specimens obtained from a particular petting zoo grew E. coli O157:H7 and were a PFGE match to ill patients.

Parents Need to Know the Signs of an E. coli Infection
Source :
By Linda Larsen (Mar 9, 2015)
Parents are responsible for their children’s health. This can sometimes feel overwhelming, but with a little knowledge you can make sure your child gets the best possible care if he gets sick.
Food poisoning is quite common in the United States and around the world. One out of every six people in this country will contract food poisoning this year.
Most people think of these infections as the “24 hour flu” and most get better without medical treatment. But thousands get sick enough to be hospitalized, and thousands die from their infections. There are several different kinds of bacteria that cause these illnesses: Salmonella, Campylobacter, Listeria monocytogenes, and E. coli.
E. coli O157:H7 and other strains of E. coli can cause serious illness, especially in children. These bacteria live in the intestinal tracts of animals and people. Children can contract an E. coli infection by drinking contaminated water, swallowing polluted pool or lake water, eating foods contaminated with the bacteria, by touching an animal that is shedding the bacteria, and sometimes through person to person contact.
Unfortunately, there is no one particular food that carries these pathogenic bacteria; E. coli can be anywhere. In the past few years, E. coli outbreaks have been linked to ground beef, mechanically tenderized steak, lettuce, spinach, raw cookie dough, frozen pizza, raw milk, raw sprouts, and apples. These foods can be contaminated by animals, dirty irrigation water, improper handling, improper cooking, and cross-contamiantion.
An E. coli infection begins with abdominal cramps and diarrhea. The diarrhea will then become bloody and watery. Any diarrheal illness can be serious in a young child, since dehydration can occur easily in small bodies; any child with diarrhea should be taken to the doctor.
The bacteria multiply rapidly in the child’s intestine and cause inflammation and damage to the intestinal wall, causing bleeding. But the bacteria can then get into the bloodstream and produce toxins called Shiga toxins. Those toxins head for the kidneys and cause a potentially deadly complication, especially in children under the age of five, called hemolytic uremic syndrome (HUS). The toxins destroy red blood cells, which block tubes in the kidneys, causing kidney failure. Children with HUS can have seizures, strokes, heart attacks, and die.
If your child develops bloody diarrhea, see your doctor as soon as possible and ask for an E. coli test. A sample of feces will be tested for the bacteria. If it is positive, the doctor will know how to treat your child. The doctor will send the sample to public health officials for confirmation, since E. coli infections are a reportable condition, and others may be sick with the same bacterial strain. Genetic testing called pulsed field gel electrophoresis (PFGE) can determine the DNA fingerprint of the bacteria that made your child sick. Armed with this knowledge, public health officials can help stop an outbreak, and pinpoint the bacteria’s source, which is critical if a lawsuit is filed.
E. coli infections need specialized treatment. Antibiotics should never be given to a child with an E. coli infection, because that can increase the risk of HUS development.
If your child develops the symptoms of hemolytic uremic syndrome, immediate medical attention is necessary. Those symptoms include fatigue, paleness, fainting, weakness, lethargy, bruising, decreased urine output, blood in the urine, and swelling of the limbs. Hospitalization is usually necessary at this point. The child will be hydrated and may need plasma treatment, anti platelet agents, and steroids. Early treatment is the best course of action for recovery.
The whole point is not to panic or obsess about your child’s health; just be aware. Now that you have this information, you can best protect your child if she does contract an E. coli infection.
You can also help by making sure your child does not consume raw milk or raw milk products, unpasteurized cider, raw sprouts, or undercooked ground beef. Always wash produce before serving it, and pay attention to recalls and outbreak warnings. Observe food safety rules in the kitchen, guard against cross-contamination around raw meats, and refrigerate perishable foods immediately. Wash your hands before and during meal preparation and after using the bathroom or changing diapers. Keep your family healthy and well with these rules.

Hatching Season for Baby Birds Prompts Annual Salmonella Warnings
Source :
By News Desk (Mar 9, 2015) time of year has arrived for baby chicks and ducklings to hatch out into the world, bringing with them annual warnings to help protect against the risk of Salmonella infection.
Every year, multiple outbreaks of Salmonella from newborn birds are estimated to sicken thousands of Americans. In the past three years alone, more than 1,200 laboratory-confirmed cases of Salmonella have been linked to chicks and ducklings, with tens of thousands more estimated to have gone unreported.
And, each year, local and state health departments put out warnings with practical advice to minimize illnesses. Those cases tend to see a spike around springtime, when feed supply stores fill up with freshly hatched chicks for sale.
Young children and adults older than 65 are strongly advised to limit direct contact with birds and thoroughly wash their hands immediately after any contact. Children younger than 5 especially need to be monitored closely to make sure that they don’t kiss the birds or stick their fingers in their mouths after handling them.
“For people at higher risk for severe Salmonella infections, it’s best to use a philosophy of ‘look but don’t touch’ because all chickens or ducks, even healthy ones, can carry bacteria like Salmonella that can make people sick,” said Washington State Health Officer Dr. Kathy Lofy in a written warning to bird owners. “And of course, if you handle a chick or duckling, wash your hands immediately with soap and water.”
Salmonella is a potentially deadly bacteria that most often causes diarrhea, nausea, vomiting and stomach pains in those it infects. Children, older adults and immunocompromised individuals are the most susceptible to Salmonella.
The Washington State Department of Health has published a webpage recommending Salmonella safety tips for bird owners. The tips include:
•Always wash hands with soap and water after handling birds.
•Don’t get baby birds as pets for children younger than 5.
•Always supervise children while handling poultry.
•Keep live birds away from family living spaces.
The most recent national Salmonella outbreak from live birds sickened at least 363 people in 43 states, hospitalizing 33 percent of them. Cases began in May 2014 and continued to be reported

Internet Journal of Food Safety (Operated by FoodHACCP)
[2015] Current Issues

Vol 17.25-31
Combined Effect Of Disinfectant And Phage On The Survivality Of S. Typhimurium And Its Biofilm Phenotype
Mudit Chandra, Sunita Thakur, Satish S Chougule, Deepti Narang, Gurpreet Kaur and N S Sharma

Vol 17.21-24
Quality analysis of milk and milk products collected from Jalandhar, Punjab, India
Shalini Singh, Vinay Chandel, Pranav Soni

Vol 17.10-20
Functional and Nutraceutical Bread prepared by using Aqueous Garlic Extract
H.A.R. Suleria, N. Khalid, S. Sultan, A. Raza, A. Muhammad and M. Abbas

Vol 17.6-9
Microbiological Assessment of Street Foods of Gangtok And Nainital, Popular Hill Resorts of India
Niki Kharel, Uma Palni and Jyoti Prakash Tamang

Vol 17.1-5
Assessment of the Microbial Quality of Locally Produced Meat (Beef and Pork) in Bolgatanga Municipal of Ghana
Innocent Allan Anachinaba, Frederick Adzitey and Gabriel Ayum Teye

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