FDA has issued a release stating that the E. coli outbreak is likely linked to romaine lettuce grown in California during the fall timeframe. The agency’s traceback investigation is in progress, and it is looking at shipping records and invoices in order to trace the romaine lettuce supply from places in which ill people have been exposed to where the product was grown. Thus far this information has been connected to romaine lettuce harvested in the Central Coast growing regions located in northern and central California. Locations outside of California have not been linked to this particular outbreak, and thus the FDA is not recommending that consumers or retailers avoid romaine lettuce that has been grown outside of these California regions. The agency has not found evidence of any outbreaks linked to romaine that was grown hydroponically or in a greenhouse.
“During this new stage of the investigation, it is vital that consumers and retailers have an easy way to identify romaine lettuce by both harvest date and harvest location. Labeling with this information on each bag of romaine or signage in stores where labels are not an option would easily differentiate for consumers romaine from unaffected growing regions.” – FDA
As a result, FDA stated that romaine lettuce entering the market will be labeled with a harvest location and date to help consumers distinguish unaffected growing regions.
–END UPDATE–
Just when we thought the E.coli O157:H7 outbreak involving romaine lettuce was over: Today CDC issued a Food Safety Alert informing consumers not to eat ANY romaine lettuce. Retailers and restaurants shouldn’t serve any either.
“Thirty-two people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 have been reported from 11 states.
Illnesses started on dates ranging from October 8, 2018 to October 31, 2018.
Thirteen people were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.” – CDC
The agency is urging against the consumption of romaine lettuce because they haven’t been able to identify a common grower, supplier, distributor or brand.
Could we be in for another widespread outbreak? Just last week during a panel discussion at the Food Safety Consortium, the FDA and CDC said that when the last outbreak occurred they knew it would get bad really quickly.
This year’s multistate outbreak of E.coli O157:H7 infections linked to romaine lettuce affected 210 people, killing five. Although the outbreak was officially declared over by the end of June, questions still remain as to the exact source. Given the widespread nature of the outbreak and the speed with which illnesses occurred, there are many lessons to be learned from the case.
During last week’s annual Food Safety Consortium, industry stakeholders from the FDA, CDC and produce associations gathered to discuss agency action upon learning of the outbreak and where there is room for improvement.
The investigation began in April 2018 when the New Jersey Department of Health contacted the CDC about a cluster of E.coli O157:H7 illnesses from people who said they ate salads at various locations of the same restaurant chain. Three days later, the agency was able to confirm eight O157 isolates from six states with the same patterns using PulseNet. And five days after that, the CDC posted a notice on its website about the investigation of 17 cases across seven states.
“We knew right away that this was going to get bad and that it would get bad quickly,” said Matthew Wise, deputy branch chief for outbreak response at the Outbreak Response and Prevention Branch of the CDC. “We saw illnesses ramp up quickly.” He added that the agency saw a lot of illness subclusters, all with romaine lettuce as the common ingredient.
The epidemiological evidence clearly indicated chopped romaine lettuce, and it appeared that all the affected romaine was coming from the Yuma, Arizona growing region, noted Stic Harris, director of the Coordinated Outbreak Response & Evaluation Network at FDA. But then things got even more confusing, as an Alaskan correctional facility was also investigating a cluster of cases. This allowed the agency to trace the source directly back to Harrison Farms as the sole supplier to the correctional facility. However, as the multi-agency investigation continued, they uncovered that the source was not just one farm. “There were three dozen farms in the Yuma region that supplied romaine lettuce,” said Harris, adding that we may never know which exact farm, and even if it was one farm, that was the source of the outbreak.
(left to Right) Stic Harris, FDA; Matt Wise, CDC; Dan Sutton, Pismo Oceano Vegetable Exchange; Scott Horsfall, California Leafy Green Products Handler Marketing Agreement
During June, July and August, the FDA sent a multidisciplinary team of 16-18 people to conduct an environmental assessment of the affected area. Upon taking 111 samples, they found 13 different Shiga toxin-producing E. coli strains, but only three matched the strain of the outbreak. Water from 14 locations, including discharge, reservoir and canal water, was also tested. The environmental assessment found pervasive contamination in the water. But here was the big problem, said Harris: “There was no smoking gun. We don’t know how the E.coli got into the water, and we don’t know how the water got onto the lettuce.” He added that additional research is needed, and that government and non-government work must continue to identify the source.
There are several challenges associated with the complexity of this type of produce outbreak, said Harris and Wise:
The production lot information disappears at the point of service
Having a commingled product hinders traceback
Records present a challenge because agencies try to look at each company and their individual records, and every company has their own way of doing things—this takes time
The breadth of the impacted area—trying to do an environmental assessment for that area was staggering work
People who eat lettuce eat it often
Many people don’t remember what type of lettuce they ate
The product has a short shelf life
Communication: The packaging isn’t transparent on where it’s grown
Scott Horsfall, CEO, California Leafy Green Products Handler Marketing Agreement, chimed in on the challenges posed by the complexity of the outbreak. “If you compare these numbers with the 2016 spinach outbreak…they’re very similar [in the] total number of illnesses [and] number of states involved. But in [the spinach outbreak], it led to a specific farm. What we saw this time was very different.”
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One of the large successes in dealing with the outbreak is that the agencies issued public warnings quickly, said Wise. The produce industry also came together to form the Leafy Greens Food Safety Task Force. In addition, FDA is expanding its sampling for the coming harvests, according to Harris. “I think that in terms of the speed of the environmental assessment, we need to be quicker with that. We apparently hadn’t done one in quite a long time at FDA,” he said.
Harris and Wise also stressed that for industry to work more effectively together, they need to work with the FDA and CDC before there is an outbreak.
“This outbreak was a frustrating experience for all of us,” said Horsfall. “We have to communicate more and better when we can. And as an industry, stop these outbreaks from happening.”
Just in time for Thanksgiving, consumers are worrying about whether the turkey they are buying for the holiday is contaminated with Salmonella. A multistate outbreak of drug-resistant Salmonella linked to raw turkey products has been going on for months, but now USDA is facing increasing pressure to name any associated turkey brands. According to the CDC, “a single, common supplier of raw turkey products or of live turkeys has not been identified.”
As of the agency’s last update (November 5), 164 people across 35 states have been infected with the outbreak stream of Salmonella Reading. 63 people have been hospitalized, and one death has been reported. Three people reported living in households where raw turkey pet food was given to pets.
Thus far the CDC isn’t advising retailers to stop sell raw turkey. It is stresses that consumers should follow the basic food safety steps to prevent Salmonella infections, including proper handwashing, cooking the turkey to the proper temperature (including reheating the meat), keeping food prep areas clean, proper thawing of turkey in the refrigerator and avoiding feeding pets raw food.
CDC states that if the information becomes available, it will provide notification related to the supplier(s) related to the outbreak.
This year Salmonella outbreaks hit chicken, shell eggs, ground beef, pre-cut melon, dried and frozen coconut, pasta salad, chicken salad, turkey, ground beef, raw sprouts and breakfast cereal. There were also significant Cyclospora infections linked to salads sold at McDonalds as well as vegetable trays. For the first time in 10 years, a Listeria outbreak was linked to an FSIS regulated product (deli ham); ground beef was affected by E. coli O26. And perhaps the most notable outbreak of the year was the E.coli O157:H7 outbreak linked to romaine lettuce from the Yuma growing region.
“It’s been quite a year for outbreaks,” said John Besser, Ph.D., deputy chief, enteric diseases laboratory branch, at CDC, referring to the pathogens that have plagued a variety of consumer products in 2018. “Out of this group, there are a lot of the things you’d expect, but also some brand new unexpected [products affected] like shredded coconut and Honey Smacks cereal.”
Despite the number of outbreaks that have hit the food industry in 2018, “this is a really exciting time to be in public health and food safety, because there are a lot of tools we can use to help make food safer,” said Besser. Most of the diseases that impact the food industry are preventable if their source can be identified, and using big data can have a tremendous impact on improving food safety.
Yesterday John Besser informed attendees at the 2018 Food Safety Consortium about CDC’s latest efforts in foodborne disease surveillance, which he defines as the
systematic collection, analysis and interpretation of health data. The agency is actively working to identify unrecognized gaps in the food supply chain and provide the industry with information it can use to make products safer. “The most important reason for detecting outbreaks is so we can identify the problem and fix it,” said Besser.
There are two ways that CDC detects outbreaks. The first is via the “citizen reporters” who are observant and alert the agency. (This is actually how E.coli O157 was discovered). The second is through pathogen-specific surveillance where CDC takes lab information and links cases that are geographically diverse. These cases are often widely dispersed and are the most effective way to find food production and distribution problems, and are often easier to address than local issues, according to Besser.
He went on to review the successes of PulseNet and the promise of whole genome sequencing (WGS) and metagenomics. The CDC’s PulseNet nationwide WGS implementation project is underway and will result in a “tsunami of data”, with the timeline as follows:
January 15, 2018: Listeria monocytogenes
October 15, 2018: Campylobacter jejuni/coli
January 15, 2019: Diarrheagenic E.coli (including STEC)
March 15, 2019: Salmonella enterica
Metagenomics will continue to play a large role in enabling unbiased sequencing of all nucleic acids in an environment. It will help to directly characterize sequences from samples, food and people (i.e., the gut), and could aid in pathogen discovery.
“I think within just a few years, it’s going to be the standard for tests,” said Besser. “My prediction is that you’ll be able to do this test in the production environment.”
The following Duncan Hines cake mixes were recalled by Conagra Brands over concerns of Salmonella. (Click to enlarge)
–UPDATE–
“FDA and the CDC informed Conagra Brands that a sample of Duncan Hines Classic White Cake Mix that contained Salmonella Agbeni matched the Salmonella collected from ill persons reported to the CDC. This was determined through Whole Genome Sequencing, a type of DNA analysis. The sample was collected by Oregon health officials. Based on this information, Conagra Brands is working with FDA to proactively conduct a voluntary recall of Duncan Hines cake mixes from the market. The FDA is conducting an inspection at the Conagra Brands-owned manufacturing facility that produced the cake mixes. The FDA is also collecting environmental and product samples.” – FDA, November 7, 2018
–END UPDATE–
After a retail sample tested positive for Salmonella, Duncan Hines issued a recall of four varieties of its cake mixes. The sample that tested positive for the pathogen was the Classic White cake mix, but out of an “abundance of caution”, the company recalled its Classic Butter Golden, Signature Confetti and Classic Yellow cake mixes that were manufactured during the same period of time.
“Several of the individuals reported consuming a cake mix at some point prior to becoming ill, and some may have also consumed these products raw and not baked. Consumers are reminded not to consume any raw batter. Cake mixes and batter can be made with ingredients such as eggs or flour which can carry risks of bacteria that are rendered harmless by baking, frying or boiling.” – Conagra Brands
The recalled products have a “Best If Used By Date” ranging from March 7 to March 13, 2019 and were distributed to U.S. retailers as well as exported internationally (on a limited basis). Consumers are advised to return the recalled products to the store in which they were purchased.
The meat industry has been on alert over the past few days, much of which has been due to Salmonella and Listeria concerns. The following are the Class I recalls that have hit:
JBS Tolleson, Inc. recalls 6,937,195 pounds of raw non-intact beef products over concerns of Salmonella Newport contamination. According to the CDC, there are currently 57 reported cases across 16 states. No deaths have been reported. A traceback investigation involving store receipts and shopper card numbers enabled FSIS to trace the reported illnesses to JBS “as the common supplier of the ground beef products”.
Johnston County Hams recalls more than 89,000 pounds of RTE deli loaf ham products over concerns of adulteration with Listeria monocytogenes. The CDC and other health agencies are monitoring the outbreak, which has thus far infected four people, and one death has been reported. Recalled products were produced between April 3, 2017 and October 2, 2018. Also connected to this event is the recall of Callie’s Charleston Biscuits, which may contain ham from Johnston County Ham.
Canteen/Convenco recalled more than 1700 pounds of RTE breaded chicken tenders with BBQ sauce and hot sauce. The products were misbranded, as they may contain milk, and this was not declared on the finished product label. Thus far there have been no reported cases of adverse reactions due to consuming the products.
Ukrop’s Homestyle Foods has recalled more than 18,200 pounds of RTE meat and poultry deli-sliced products over concerns of product adulteration with Listeria monocytogenes. The products were produced and packaged from September 14–October 3, 2018. No confirmed illnesses have been reported to date.
The number of illness cases linked to the E.Coli 0157:H7 outbreak has jumped to 98. Fourteen more people from eight states were added since Wednesday, and three more states have reported sick people: Mississippi, Tennessee and Wisconsin. The current number of states affected is 22, and hospitalizations have increased to 46. No deaths have been reported.
Now the CDC is advising consumers, restaurants and retailers to get rid of all romaine lettuce—not just chopped romaine, but also whole heads and hearts of romaine, and salads and salad mixes containing the variety—if they cannot confirm the source. “Information collected to date indicates that romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick,” the CDC states on its website.
The most current illness case count is 53, with illnesses reported in 16 states. There have been 31 hospitalizations thus far and no deaths, according to the CDC.
Rose Acre Farms has voluntarily recalled eggs from its farm in Hyde County, North Carolina following an investigation by FDA, CDC and other agencies involving Salmonella illnesses. FDA testing determined that eggs produced from this farm are connected to 22 cases of Salmonella Braenderup infections; the CDC is confirming illness information with state health departments.
The exact amount of eggs recalled totals 206,749,248.
The eggs are sold under several brand names, including Coburn Farms, Country Daybreak, Food Lion, Glenview, Great Value, Nelms, and Sunshine Farms, as well as restaurants.
FDA is advising restaurants and retailers that they should not sell or use any recalled shell eggs. In addition, they should take measures to avoid cross-contamination of the food processing environment and equipment by washing and sanitizing display cases and refrigerators regularly, washing and sanitizing cutting boards, surfaces and utensils, and washing hands with hot water and soap after any cleaning or sanitation process. Consumers are advised not to eat the recalled eggs.
Steer clear of romaine lettuce, urged Consumer Reports yesterday. An E.coli O157 outbreak in Canada traced to romaine lettuce has sickened 41 people in the country, according to the Public Health Agency of Canada. In the United States, a multi-state outbreak of Shiga toxin-producing E. coli O157:H7 has hit 13 states and infected at least 17 people. However, the CDC has not issued an alert, because it has not yet confirmed the source of the infection. The latest CDC media statement was issued on December 28, but Consumer Reports stated that the CDC confirmed “the strain of E. coli detected in the U.S. is ‘a virtual genetic match’ with the one that has caused illnesses in Canada.”
The Consumer Reports article also quotes the head of the CDC’s Outbreak Response Team, Matthew Wise, Ph.D., who said that the agency is examining romaine lettuce and other leafy greens and that the investigation in Canada gave the CDC a “good starting point.” He also said that the CDC’s investigation should be completed within the next two weeks.
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