Month: January 2012

An Open Letter To The U.S. CDC

Last week, CDC released two “Final Update” reports on Salmonella outbreak investigations within a 48-hour period.

The first report, released on January 17th, summarized the results of an investigation into a 10-month long outbreak of Salmonella Typhimurium associated with exposure to clinical and teaching microbiology laboratories. The second report, released on January 19th, presented the results of an investigation into a 2-month long multi-state outbreak of Salmonella Enteritidis infections linked to a restaurant chain.

These two outbreaks had very little in common with each other; the outbreak settings were different, the scope and duration of the outbreaks were different, and the source of the infections was different. Nevertheless, the two outbreaks have one very important thing in common.

CDC, in conjunction with at least some of its public health partners at the state and local level, has chosen to withhold important information from the public.

What information has CDC withheld, and why should this information be released? Here is a list of questions that I sent to my media contact at CDC on January 18th, the day after the Salmonella Typhimurium outbreak report was released.

  1. Is there a specific reason why CDC is not specifying the identity of the commercial strain of Salmonella Typhimurium that is associated with this outbreak (by the ATCC or NCTC strain number – not the commercial supplier)? Can you provide me with the strain number ID?
  2. Does CDC have any hypothesis as to the trigger for this outbreak? Most of the commercial strains have been in use in various labs for many years. What may have happened to initiate the increase in cases? What determined the start date? With a baseline rate for the outbreak strain of 0 to 4 reports/week, how were the start and ending date established for this outbreak?
  3. Were the outbreak cases all tied to the same commercial source of the S. Typhimurium “Strain X”?
  4. Were the outbreak cases tied to the use of a specific format of the commercial source (for example, Bacti-discs or pre-filled inoculation loops)?
  5. Have any cases involving this same strain been reported to CDC since the last “outbreak” case on June 29, 2011? If so, how has CDC differentiated those cases from the outbreak cases (keeping in mind the baseline of 0-4 cases per week mentioned in the CDC report).
  6. Were the bulk of the cases linked to student labs or to clinical labs?

To these questions, I would now add, “Were the clinical lab cases tied mainly to in-hospital labs, or to free-standing commercial clinical labs? If the latter, was any single commercial lab chain disproportionately involved?”

When the Salmonella Enteritidis restaurant chain outbreak report hit the internet, I again contacted my CDC media liaison and asked, “Can you please explain why CDC has not revealed the name of the restaurant chain implicated in the above-mentioned outbreak? Even better, can you identify the chain by name?”

I realize that both outbreaks are “over” and that at least some of this information now is academic. Nevertheless, I question CDC’s actions in withholding information that could influence purchasing decisions on the part of consumers and of medical and lab professionals.

CDC reported on January 19th that Restaurant Chain A’s handling and cooking processes likely ruled out ground beef as a source of the Salmonella Enteritidis outbreak. This is favorable to the restaurant chain, and would give consumers comfort that the restaurants belonging to this fast food chain are following appropriate food-handling procedures – if only CDC had released the name of the chain.

As for the lab-related outbreak, if I was still running a microbiology lab, I would certainly want to know whether a specific packaging or format of commercially available control culture was more prone to contaminating the lab surroundings than others. I would opt to avoid this format, if I had the information and the choice. Likewise, as a medical doctor, I would opt to avoid a commercial clinical lab chain that was prone to in-lab contamination.

If either of these outbreaks had been traced to a specific packaged food, the offending food would have been named. There is no logical reason for restaurant-linked outbreaks to be handled differently. There is no logical reason for a lab-related outbreak to be handled differently.

I would appreciate receiving substantive answers to my questions.

Sincerely yours,

Phyllis Entis, MSc., SM(NRCM)
eFoodAlert

Recalls and Alerts: January 20, 2012

Here is today’s list of food safety recalls, product withdrawals, allergy alerts and miscellaneous compliance issues. The live links will take you directly to the official recall notices and company news releases that contain detailed information for each recall and alert.

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United States

  • Allergy Alert: Narala Bakery (Brooklyn, NY) recalls Fruit Cake (1.5-lb plastic package; uncoded), due to the presence of undeclared eggs. The recalled Fruit Cake was sold at various stores in Brooklyn and Queens.
  • Allergy Alert: JKS Wholesale SVCS Inc (Beltsville, MD) recalls Torta de Pan (16-oz pkgs; Date codes up to and including 02/15/12), due to the presence of undeclared milk. The recalled product was distributed to supermarkets and delis in Washington DC, Maryland, Virginia, New Jersey and New York.
  • Food Safety Recall: Rich Products Corporation expands its earlier recall to include Vanilla Flavored Pre-Soaked Sponge Cake Artificially Flavored (8″; Product Code 62938; Produced in Ocoyoacac, Mexico after July 10, 2011), due to possible contamination with small plastic fragments.
  • Food Safety Recall: Kradjian Imp Co (Glendale, CA) recalls Cedar Tree brand unripened Tresse Cheese and Cedar Tree brand unripened Shinglish cheese (16-oz pkgs; delivered before November 13, 2011), due to possible contamination with Listeria monocytogenes. The recalled cheeses were manufactured and recalled by Fromagerie Marie Kade (Quebec, Canada) and were distributed in Southern California, Northern California, Washington State, Minnesota, Nevada, Oklahoma, Texas, Tennessee,Arizona and Michigan to Mediterranean specialty markets.
  • Cosmetic Product Safety Recall: USA Far Ocean Group Inc. recalls Vagifresh Ball and Vagifresh Gel, marketed individually or under a mixed packaged named Female One, because the products contain undeclared benzocaine. In additional, FDA analysis found the presence of several bacterial species in these products, including: Staphylococcus lentus, S. sciuri, Bacillus lantus, Alloiococcus otitis, Aerococcus viridans, Aeromonas salmonicid, Gemella spp, and Leuconostoc spp. The recalled products were sold via herbal stores, beauty shops, drug stores, internet and mail order.
  • Personal Care Product Safety Recall: Perfect Image Solutions, LLC recalls all lots of Men’s Minoxidil 15% Azelaic 5% Hair regrowth topical, 60mL; Men’s Minoxidil 10% Azelaic 5% Hair regrowth topical, 60mL; Men’s Minoxidil 5% Azelaic 5% Hair regrowth topical, 60mL; Women’s Minoxidil 3% Azelaic 5% Hair regrowth topical, 60mL; and Hair regrowth shampoo enhanced with Ketoconazole and salicylic acid, 180mL, because FDA deems these products to be “unapproved new drugs” under the law.

Canada

  • Allergy Alert: Solly’s (Montreal, QC) recalls various cakes, knishes and homentashen (all lots), due to the presence of undeclared milk, eggs, soy, and/or sulfites.
  • Food Safety Recall: Pantry Shelf Food Corp recalls Pantry Shelf Sliced Water Chestnuts (2.84L; Codes 566 824 1; PRO: 2010 03 30 4500/01053) due to unspecified microbiological contamination.

Europe

  • Allergy Alert (Germany): ERUs Käsewerk Sangerhausen GmbH recalls ERUs cream cheese exquisito – Indian spices (80g tube; Best before 07/12/2012), due to the presence of undeclared mustard and celery.
  • Outbreak Alert (UK): UK health officials are investigating an unusual increase in cases of salmonellosis due to Salmonella Typhimurium DT 193 in England and Wales. This strain of Salmonella is most common in beef and pork, according to a BBC report, but is also found in unpasteurized milk, desserts and sandwiches.
  • Food Safety Alert (UK): The dining room used by lawyers at the Snaresbrook Crown Court in east London has been closed due to a suspected food contamination issue, according to the Redbridge Council (reported by BBC).
  • Outbreak Alert (UK): A ward at Raigmore Hospital (Inverness) has been closed and some elective surgery cancelled due to an outbreak of Clostridium difficile at the hospital. Seven cases have been confirmed so far in January.
  • Food Safety Notification (EU #2012.0109): Ethephon in red seedless grapes from Namibia; distributed to the United Kingdom.
  • Food Safety Notification (EU #2012.0110): Ethephon in red seedless grapes from Lebanon; distributed to the United Kingdom.
  • Food Safety Notification (EU #2012.0111): Aflatoxins in dried figs from Turkey; distributed to Germany.
  • Food Safety Notification (EU #2012.0112): Insect infestation in shelled roasted groundnuts from China, via Slovakia; distributed to the Czech Republic.

Asia, Africa and the Pacific Islands

  • Food Safety Update (China): Tests performed by the Jiangxi Province Center for Disease Control and Prevention and the Jiangxi Dairy Quality Supervision and Inspection Center have cleared Synutra’s nutritional products from responsibility for the death of an infant in that Jiangxi Province. Authorities found that samples of Synutra’s products obtained directly from the family of the dead infant and from the retail store where the products were purchased complied with national microbiological standards, while tests of residential well water from the family found elevated levels of coliforms and total bacterial count that exceed national water quality standards.
  • Pharmaceutical Product Safety Recall (Hong Kong): Bayer Healthcare Limited recalls Saridon Tablet (Batch #CM01474), due to a packaging error.

Australia and New Zealand

  • Food Safety Recall (Australia): Backa Australia recalls Chabi (300g, unpackaged; No date marking), due to Staphylococcus contamination. The recalled product was sold only in Queensland, and was available at Backa Australia retail outlet, and at the following Farmers Markets: Chandler, Ascot, Rocklea, Palm Beach, Nerang, Southport and Beenleigh.
  • Dietary Supplement Safety Alert (Australia): The Therapeutic Goods Administration advises consumers that the sale of AdvanceMen capsules is illegal in Australia, as it contains the undeclared prescription substance sulfoalidenafil, a derivative of sildenafil (the active ingredient in Viagra).

Some supermarket chains post recall notices on their web sites for the convenience of customers. To see whether a recalled food was carried by your favorite supermarket, follow the live link to the supermarket’s recall web site.

*The Kroger umbrella encompasses numerous supermarket, marketplace and convenience store chains, listed on the Kroger corporate home page.
**Includes Safeway, Vons, Pavilions, Dominick’s, Genuardi’s, Randalls, Tom Thumb, Carrs and Pak N’ Save.

Salmonella Outbreak Linked to Unnamed Restaurant Chain

A Mexican-style restaurant chain has been linked to an outbreak of Salmonella Enteritidis infections that affected 68 people in 10 US states between October 13th and December 1st, 2011. Thirty-one percent of the confirmed outbreak victims were hospitalized.

CDC has declined to identify the chain, which it refers to simply as Restaurant Chain A in its first – and final – report on this outbreak.

According to CDC, the outbreak affected consumers in Texas (43 confirmed reports), Oklahoma (16), Kansas (2), Iowa (1), Michigan (1), Missouri (1), Nebraska (1), New Mexico (1), Ohio (1) and Tennessee. Victims range in age from less than one year to 79 years old, with a median age of 25. Slightly more than one-half (54%) of the victims were female. There were no deaths.

An investigation carried out by CDC, FDA and state public health officials determined that eating at Restaurant Chain A (described as a Mexican-style fast food restaurant) was significantly associated with illness. Sixty-two percent (62%) of outbreak victims reported eating at the implicated chain in the week before becoming ill; only 17% of well people ate at that chain in the week before being interviewed.

Although no single food or ingredient was associated with the illnesses, 90% of outbreak victims reported eating lettuce, 94% ate ground beef, 77% ate cheese and 35% ate tomatoes. After reviewing the handling and cooking processes used by the restaurant chain, CDC concluded that ground beef was not the likely source of this outbreak.

For now, CDC has the following advice to share:

  • At this time, there is no specific advice to consumers.
  • Consumers are not warned to avoid any specific foods or restaurants.
  • If a food source is identified for this outbreak and if there is evidence of continued risk of infection, public health officials will advise the public and take the necessary steps to avoid risk of additional illnesses.
  • To facilitate successful traceback efforts and outbreak investigations, retail establishments should maintain detailed records of food suppliers and distributors.

Or, in a word, NOTHING!