Missouri Outbreak Mystery Solved

Romaine lettuce grown on an unnamed farm has been blamed for an outbreak of E. coli O157:H7 illnesses that sickened 60 people in 10 states between October 10th and December 4th. CDC believes that the outbreak is now over.

Missouri reported the largest number of illnesses (37), but outbreak cases also occurred in Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3) and Nebraska (1). Approximately two-thirds of the outbreak victims were hospitalized, and two people developed hemolytic uremic syndrome. Most of the illnesses occurred during the second half of October 2011.

The outbreak puzzled Missouri public health authorities for weeks. Illnesses appeared to be linked epidemiologically to salad bars located in supermarkets – mainly in the St. Louis area. Schnucks, the supermarket chain that appeared to be linked to the outbreak, acted quickly to remove any potentially offending produce items from its salad bars.

The Missouri Department of Health and Senior Services analyzed 55 food samples in connection with the St. Louis area outbreak cases, but was unable to find a single E. coli-positive sample. Patient interviews and a comparison of eating patterns with those of healthy individuals in Missouri and other affected states pointed to romaine lettuce as a probable source of the illnesses.

Traceback studies determined that the romaine lettuce served at all of the Schnucks stores came from a single lettuce processing facility via a single distributor. Lettuce from the same farm also was supplied to university campuses in Minnesota and Missouri during the time of the outbreak illnesses.

An investigation was carried out at the implicated farm (identified by CDC simply as “Farm A”), but preliminary findings did not point to a source for the contamination. The farm was not in production during the investigation.

CDC considers this outbreak to be over, and has not issued outbreak-specific advice to consumers.

Raw Milk Products Implicated In E. coli O157:H7 Illnesses

Raw milk products from Organic Pastures (Fresno County, CA) are the probable source of five California cases of E. coli O157:H7 according to the California Department of Food and Agriculture. All five children became infected with the same strain of E. coli O157:H7 between August and October; three of the children were hospitalized with hemolytic uremic syndrome.

The five children live in four different California counties – Contra Costa, Kings, Sacramento and San Diego. While E. coli O157:H7 has not been recovered from lab samples of the company’s raw milk, the only food exposure they have in common is raw milk from the Organic Pastures dairy.

The California Department of Public Health has ordered a statewide recall of all raw milk products from Organic Pastures, except for cheese that has been aged a minimum of 60 days – the aging process is supposed to allow time for pathogens to die. In addition, Organic Pastures has been placed under a quarantine order; until further notice, the company may not produce raw milk products – including raw butter, raw cream, raw colostrum and Qephor – for the retail market.

This is the second time that raw milk products from Organic Pastures have been implicated in an outbreak of E. coli O157:H7 illnesses. In 2006, six children became infected with the pathogen after consuming raw milk or raw colostrum produced by Organic Pastures. On that occasion, too, the pathogen was not recovered from milk samples; however, the epidemiological evidence linking the illness to raw milk and colostrum from the dairy was strong.

State food safety experts are carrying out a complete inspection of the Organic Pastures operations. The present quarantine will not be lifted until the facility has been found to meet all sanitation requirements under state law and until lab tests confirm that the dairy’s raw milk products are in compliance with regulatory standards.

Individuals who have consumed raw milk products from Organic Pastures and who develop symptoms of E. coli O157:H7 infections – including abdominal cramps and diarrhea which is often bloody – should seek immediate medical attention. Young children and the elderly who become infected with this pathogen are at risk of developing hemolytic uremic syndrome, a life-threatening complication that is associated with this pathogen.

Pine Nut Recall Expands; CDC Updates Outbreak Data

Forty-two people were infected with Salmonella Enteritidis after consuming contaminated Turkish pine nuts, according to CDC.

Illnesses have been reported by five states: Maryland (1), New Jersey (2), New York (27), Pennsylvania (8), and Virginia (4). Two people were hospitalized; the oldest victim was 94, and the youngest was less than one year old. None of the outbreak patients died.

An earlier report, issued by CDC on October 26th, included Arizona in the list of cases. But supplementary DNA profiling carried out by CDC determined that the Arizona case was unrelated to the Pine Nut outbreak, according to Dr. Robert Tauxe of CDC.

CDC reports that some of the outbreak victims consumed prepared dishes – such as homemade pesto, that contained raw pine nuts. Both Virginia and New York state agencies have recovered the outbreak strain of Salmonella Enteritidis from samples of pine nuts (purchased by outbreak victims from bulk bins at Wegmans supermarket stores), and homemade pesto made from bulk-purchased pine nuts. Wegmans recalled the implicated bulk pine nuts on October 26, 2011.

Salmonella contamination in Turkish pine nuts should not be a total surprise. In August of this year, Greece rejected two consignments of pine nuts from Turkey after samples from both consignments were found to containSalmonella (RASFF Notification #2011.BQS and 2011.BQM).

The Turkish pine nuts were imported into the USA by Sunrise Commodities (Englewood Cliffs, NJ) and distributed in bulk to various food vendors in Florida, New Jersey, New York and Canada. Sunrise recalled 4 lots – totally approximately 21,000 pounds – of pine nuts, after FDA confirmed the presence of Salmonella on the pine nuts. Testing is in progress to determine whether any of FDA’s isolates are a genetic match for the outbreak strain.

CDC offers the following advice to consumers:

Consumers should check their homes, including refrigerators and freezers, for Turkish pine nuts purchased from bulk bins at Wegmans stores between July 1, 2011 and October 18, 2011 and not eat them. Consumers should also not eat any foods prepared with the recalled product, including pesto, salads, and baked goods.
Restaurants and food service operators should not serve the recalled product.
Consumers, retailers, and others who have any of the recalled product should dispose of it in a closed plastic bag placed in a sealed trash can. This will prevent people or animals from eating it.
Persons who think they might have become ill from eating possibly contaminated recalled products should consult their health care providers. Infants, older adults, and persons with impaired immune systems are more likely than others to develop severe illness.

It’s very likely that additional recall notices will be posted in coming days, as the extent of the pine nut distribution is determined. Please refer to the Turkish Pine Nuts Recall Distribution List for more information on where the pine nuts were sold.