Multistate Outbreak of Listeriosis Linked to Packaged Salads

Vegetables were produced at Springfield, Ohio Dole Processing Facility.

Epidemiologic and laboratory evidence available at this time indicates that packaged salads produced at the Dole processing facility in Springfield, Ohio and sold under various brand names are the likely source of this outbreak.

State and local health departments are interviewing ill people about the foods they may have eaten or other exposures in the month before their illness began. Of five ill people who were asked about packaged salad, all five (100%) reported eating a packaged salad. Two (100%) of two ill people who specified the brand of packaged salad eaten reported various varieties of Dole brand packaged salad.

Twelve people infected with the outbreak strain of Listeria have been reported from six states since July 5, 2015. The number of ill people reported from each state is as follows: Indiana (1), Massachusetts (1), Michigan (4), New Jersey (1), New York (4), and Pennsylvania (1). WGS has been performed on clinical isolates from all 12 ill people and has shown that the isolates are highly related genetically.

As part of a routine product-sampling program, the Ohio Department of Agriculture collected a Dole brand Field Greens packaged salad from a retail location and isolated Listeria. This packaged salad was produced at the Springfield, Ohio Dole processing facility. In January 2016, WGS showed that the Listeria isolate from the packaged salad was highly related genetically to isolates from ill people. 

This information linked the illnesses to Dole brand packaged salads produced at the Dole processing facility in Springfield, Ohio.

On January 21, 2016, Dole reported to CDC that it had stopped production at the processing facility in Springfield, Ohio. The company also reported that it is withdrawing packaged salads currently on the market that were produced at this facility. The withdrawal does not affect other Dole products.

CDC recommends that consumers do not eat, restaurants do not serve, and retailers do not sell packaged salads produced at the Dole processing facility in Springfield, Ohio. These packaged salads were sold under various brand names, including Dole, Fresh Selections, Simple Truth, Marketside, The Little Salad Bar, and President's Choice Organics. The packaged salads can be identified by the letter "A" at the beginning of the manufacturing code found on the package. At this time, there is no evidence to suggest that packaged salads produced at other Dole processing facilities in the United States are linked to illness.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them.Updates will be provided when more information is available.

Source: http://www.cdc.gov/listeria/outbreaks/bagged-salads-01-16/index.html

Ongoing outbreak of invasive listeriosis, Germany, 2012 to 2015

The source of the causative food vehicle has not been elucidated yet.

Listeriosis patient isolates in Germany have shown a new identical pulsed-field gel electrophoresis (PFGE) pattern since 2012 (n = 66). Almost all isolates (Listeria monocytogenes serotype 1/2a) belonged to cases living in southern Germany, indicating an outbreak with a so far unknown source. 

Case numbers in 2015 are high (n = 28). No outbreak cases outside Germany have been reported. 

Next generation sequencing revealed the unique cluster type CT1248 and confirmed the outbreak.

Investigations into the source are ongoing. Since November 2012, a previously not observed pulsed-field gel electrophoresis (PFGE) pattern in human isolates of invasive L. monocytogenes serotype1/2a has been detected in Germany with increasing frequency. Altogether 66 outbreak cases have been recorded, with 28 cases in 2015. Four cases were pregnancy-associated and six cases died in the course of the disease. Here we provide details of the ongoing outbreak.

Outbreak description: Since 2009, all German Listeria isolates submitted to the National Reference Centre (NRC) for Salmonella and other bacterial enterics at the Robert-Koch Institute (RKI) or to the Austrian-German binational reference laboratory (KL) for Listeria at the Austrian Agency for Health and Food Safety (AGES), have been tested with PFGE for clonal relationship. Submission of isolates is encouraged by public health authorities but is voluntary without legal obligation. 

Between November 2012 and November 2015, altogether 793 isolates from notified listeriosis cases were typed, which accounted for 45% of all cases in that period (n=1,765). In southern Germany, this proportion was higher (ca 60%) and since 2012, human isolates of L. monocytogenes serotype 1/2a with the NRC internal nomenclature of the AscI/Apa I pattern 13a/54 have been observed.

Regarding the source of the causative food vehicle, the results showed a heterogeneous picture. Until now, we have not observed cases with an epidemiological link to an institution (e.g. hospital infection). Preliminary results largely exclude fish and cheese products as a possible source but this has to be complemented by systematic screening of Listeria isolates collected from food. Based on sequencing results, a PCR protocol aiming to detect CT1248 was developed for screening of isolates and published on the KL website. 

Source:http://www.eurosurveillance.org/images/dynamic/EE/V20N50/art21336.pdf

CURSOS 2016

The five Biggest U.S. Foodborne Illness Outbreaks of 2015

Salmonella caused six out of ten larger outbreaks

5. Shigella from Mariscos San Juan, 194 sickened. The Santa Clara County Public Health Department reported on Nov. 9 that 194 people were sickened with Shigella. Nearly all of the cases reported that they ate at Mariscos San Juan restaurant on Oct. 16 or 17. [News Report]

4. Salmonella Typhimurium from Tarheel Q, 1 death and 280 sickened. Those who fell ill after eating at the Lexington, NC barbeque restaurant came from 16 North Carolina counties and five states. Laboratory testing indicated that the BBQ sample and a sample from a patient who became ill during the beginning of the outbreak were both positive for Salmonella. [News report]

3. Salmonella from the Boise Co-op, 290 sickened. Approximately 290 people were sickened with Salmonella linked to food purchased from the Boise Co-op deli after June 1, 2015. Preliminary test results showed Salmonella growth in raw turkey, tomatoes and onion. [News report]

2. Cyclospora from Mexcan-grown cilantro, 546 sickened.For the third year in a row, Cyclospora-contaminated cilantro grown in Mexico caused a massive outbreak. This year, there were 31 states affected but Texans bore the most with 179 illnesses. The bulk of the illnesses hit at the end of May and throughout June.[CDC outbreak information]

1. Salmonella Poona from Cucumbers, 4 deaths and 838 sickened. This enormous outbreak hospitalized 165 people and four deaths were reported in Arizona, California, Oklahoma and Texas. The outbreak hit California the hardest where 232 people were sickened, but 38 states were affected in total. Investigators identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections and there were two recalls of potentially contaminated cucumbers. The number of reported illnesses has declined substantially since the peak of illnesses in August and September, but it hasn’t returned to the number of reported illnesses expected each month (about five). [CDC outbreak information]


t is also interesting to mention the Listeria outbreak connected with Blue Bell Creameries. There were three deaths and 10 illnesses connected to the ice cream and reported as early as 2010. On April 20, 2015, Blue Bell recalled all of its products and began distributing its ice cream again at the end of August. Although the outbreak was fairly small and only one connected illness was reported in 2015, we thought it important to note on this list because of the unusual food product and the national coverage it sparked this year.

Source:http://www.cdc.gov/foodsafety/outbreaks/multistate-outbreaks/outbreaks-list.html

New E. coli O26 causing an extensive outbreak

What is the Problem and What is Being Done About It?  

The FDA, CDC, and state and local officials began investigating an outbreak of a different Shiga toxin-producing Escherichia coli O26 (STEC O26) linked to Chipotle Mexican Grill restaurants during December 2015. This outbreak has a rare DNA fingerprint, which is different from the larger, previously reported outbreak.

During the firs outbreak Chipotle Mexican Grill closed 43 restaurants in Washington and Oregon in early November 2015 in response to the initial outbreak. All these restaurants reopened in November 2015. Chipotle Mexican Grill worked in close consultation and collaboration with health officials throughout the investigation to determine whether it was appropriate to reopen these restaurants. Chipotle reports taking the following actions, among others, prior to opening:

Interviews were conducted with five ill people, who all reported eating at Chipotle Mexican Grill restaurants. Whole genome sequencing is being used to see this strain is genetically related to the STEC O26 that caused the larger outbreak. This investigation is ongoing.

The FDA continues to work with Chipotle Mexican Grill restaurants as well as federal, state and local agencies to gather information about the supply chain(s). The FDA will continue to provide updates on the investigation as they become available

The FDA and the Centers for Disease Control and Prevention (CDC) along with state and local officials are investigating two separate outbreaks of E. coli O26 infections that have been linked to food served at Chipotle Mexican Grill restaurants in several states.

Earlier in December 4, 2015, the CDC reports a total of 52 people infected with the outbreak strain of STEC O26 from a total of nine states: California (3), Illinois (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (1), and Washington (27).

There have been 20 reported hospitalizations. There have been no reports of hemolytic uremic syndrome (HUS) and no deaths. Of the three most recent illnesses reported in November, only one ill person, whose illness started on November 10, reported eating at Chipotle Mexican Grill in the week before their illness began. The majority of these cases were reported from Oregon and Washington during October 2015.

To date, whole genome sequencing has been performed on STEC O26 isolates from 21 ill people from California (2), Minnesota (2), New York (1), and Washington (16). All 21 isolates were highly related genetically to one another. On the contrary all microbial testing performed by the company did not yield E. coli (more than 2,500 tests of Chipotle's food, restaurant surfaces, and equipment all showed no E. coli).

Source: http://www.cdc.gov/ecoli/2015/o26-11-15/index.html

FSMA Update: Importing Food under the Foreign Supplier Verification Program

Potential hazards may include any biological, chemical or physical hazards related to the food which are reasonably likely to cause illness or injury

The FSVP rule first looks to the importer. An importer is the U.S. owner or consignee of a food offered for import into the U.S. If the importer is a food manufacturer otherwise subject to the preventive controls rules, no FSVP program is necessary because the hazard is identified and managed under their preventive controls processes. If the importer is not a U.S. manufacturer subject to the preventive controls rules and does not meet one of the other enumerated exceptions, the importer must create and implement an FSVP.An FSVP requires the importer to vouch for the foreign supplier of an article of food. The foreign supplier is generally the foreign entity that manufacturers and processes the food being exported to the United States. If a foreign food passes through an intermediary packer, holder or re-labeler, the original manufacturer is still deemed to be the foreign supplier.
  
An importer’s FSVP must be a written plan which provides for three separate processes: 1) an evaluation of the potential hazards of the imported food; 2) an evaluation of the performance of the particular foreign supplier; and 3) a plan for the performance of periodic and appropriate supplier verification activities.

Potential hazards may include any biological, chemical or physical hazards related to the food which are reasonably likely to cause illness or injury. If potential hazards are identified, the foreign supplier’s performance in controlling hazards must be evaluated.

Once a foreign supplier is initially evaluated and approved, the supplier’s performance must be verified on a regular basis. If the potential hazard could cause serious adverse health consequences or death, the minimum standard is that a verification audit must be conducted at least annually.

If an importer utilizes several foreign suppliers, a separate FSVP must be developed for each. If an importer obtains more than one food product from any foreign supplier, an FSVP analysis must be performed for each food product, although there may be some overlap making the process easier. The type and method of foreign supplier verification processes is flexible and may include on-site audits, sampling and testing, and/or reviews of the suppliers’ relevant food safety records.

The three processes referred to above in an FSVP may be conducted by the importer itself or the importer may rely upon other specified types of entities so long as the importer itself reviews and assesses the verification records, including the results of supplier verification activities.  

Source: https://www.registrarcorp.com/monitor/index.jsp?gclid=CjwKEAiAkb-zBRC2upezwuyguQ4SJADZG08vjZVo-jK6WgjoFDhRCHKpnEmp44u3irGSiRBszmHAOBoCV1Tw_wcB

WHO Releases First Global Estimates of Foodborne Disease

One in 10 sickened annually around the world each year

About one in every 10 people around the world are affected by foodborne disease each year. Of those 600 million people, 420,000 die as a result.
These numbers are the first global estimates — conservative ones — of foodborne illnesses and were calculated by the World Health Organization (WHO). The comprehensive report, published Thursday, Dec. 3, incorporated 31 foodborne hazards, including bacteria, viruses, parasites, toxins and chemicals.
Diarrheal diseases were responsible for most of the global burden, causing 550 million illnesses and 230,000 deaths, WHO reported. In addition, children younger than 5 years old carried 40 percent of the foodborne disease burden, despite representing only 9 percent of the global population.

31 Foodborne Hazards in WHO Global Estimates
Diarrheal Disease Agents	Campylobacter spp., Cryptosporidium spp., Entamoeba histolytica, Enteropathogenic E. coli (EPEC), Enterotoxigenic E. coli (ETEC), Giardia spp., Norovirus, Salmonella enterica (non-invasive infections) non-typhoidal, Shigella spp., Shiga toxin-producing E. coli (STEC), Vibrio cholerae
Invasive Infectious Disease Agents	Brucella spp., Hepatitis A virus, Listeria spp., Mycobacterium bovis, Salmonella enterica (invasive infections) non-typhoidal, Salmonella enterica Paratyphi A, Salmonella enterica Typhi
Helminths	Ascaris spp., Echinococcus multilocularis, Echinococcus granulosus, Clonorchis sinensis, Fasciola spp., Intestinal flukes, Opisthorchis spp., Paragonimus spp., Taenia solium, Toxoplasma gondii, Trichinella spp.
Chemicals	Aflatoxin, Cassava cyanide, Dioxin

Source: http://www.who.int/foodsafety/areas_work/foodborne-diseases/ferg/en/

Multistate Outbreak of Shiga toxin-producing Escherichia coli O26.

Chipotle Mexican Grill restaurants at several states is a likely source of this outbreak.

CDC is only reporting ill people that have been confirmed by PulseNet as being infected with the outbreak strain of Shiga toxin-producing Escherichia coli O26 (STEC O26). Forty-five people infected with the outbreak strain of STEC O26 have been reported from 6 states. The majority of illnesses have been reported from Washington and Oregon. The number of ill people reported from each state is as follows: California (2), Minnesota (2), New York (1), Ohio (1), Oregon (13), and Washington (26).

Among people for whom information is available, illnesses started on dates ranging from October 19, 2015 to November 8, 2015. Ill people range in age from 2 years to 94, with a median age of 22. Fifty-eight percent of ill people are female. Sixteen (36%) people reported being hospitalized. There have been no reports of hemolytic uremic syndrome and no deaths.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview them.

Investigation Update: CDC, the U.S. Food and Drug Administration, and public health officials in several states are investigating an outbreak of Shiga toxin-producing Escherichia coli O26 (STEC O26) infections.

The epidemiologic evidence available to investigators at this time suggests that a meal item or ingredient served at Chipotle Mexican Grill restaurants at several states is a likely source of this outbreak. The investigation has not identified what specific food is linked to illness. Chipotle Mexican Grill is assisting public health officials with understanding the distribution of food items served at locations where ill people ate and this work is ongoing.

State and local public health officials are interviewing ill people to obtain information about foods they might have eaten and other exposures in the week before their illness started. Forty-three (96%) of 45 people interviewed reported eating at a Chipotle Mexican Grill restaurant. The investigation is ongoing to identify common meal items or ingredients causing illness.

Investigators are also using whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness. To date, whole genome sequencing has been performed on STEC O26 isolates from 9 ill people in Washington and 1 ill person in Minnesota. All 10 isolates were highly related genetically to one another. This provides additional evidence that illnesses outside the Pacific Northwest are related to the illnesses in Oregon and Washington.

Source: http://www.cdc.gov/ecoli/2015/o26-11-15/index.html