Mexican government dismisses as ‘premature’ CDC’s link of Salmonella outbreak to imported papayas

In a July 1, 2019 news release, El Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria de Mexico / The National Service of Health, Safety and Agri-Food Quality (Senasica) has described as “premature” CDC’s June 28, 2019 report of a link between Mexican papayas and a current outbreak of Salmonella Uganda illnesses.

Senasica points out that the outbreak strain has not been recovered from a papaya sample, nor has Salmonella Uganda been isolated from papayas in Mexico.

According to Senasica, until the outbreak strain has been found in a papaya sample, Mexico does not consider CDC’s findings to be conclusive.

The outbreak under investigation comprises 62 illnesses in eight US states: Connecticut (14), Florida (1), Massachusetts (5), New Jersey (12), New York (24), Pennsylvania (4), Rhode Island (1), Texas (1). Twenty-three people have been hospitalized.

Two people who lived in different households got sick in Connecticut after eating papayas purchased from the same grocery store location in the week before becoming ill.

According to CDC, epidemiological evidence, including interviews conducted with some of the outbreak victims, points to papayas as the source of the outbreak.

FDA is conducting a traceback investigation to establish the source of the papayas. Early product distribution information indicates that they were imported from Mexico.

Senasica’s official response to CDC’s report is reminiscent of the initial Mexican response to the 2011 outbreak of Salmonella Agona illnesses caused by contaminated papayas imported from Mexico.

Back then, Mexico vehemently denied responsibility for the outbreak, even after FDA found the outbreak strain in samples of the imported papayas.

What will it take for Senasica to acknowledge reality?

And, what will it take for FDA to impose a complete embargo on the importation of papayas from Mexico?

What consumers should do

  • If you have purchased a papaya grown in Mexico, throw it away.
  • Do not eat fruit salads or other mixes that include papayas from Mexico.
  • If you aren’t sure the papaya you bought is from Mexico, you can ask the place of purchase. When in doubt, don’t eat the papaya. Throw it out.
  • Wash and sanitize places where papayas were stored: countertops and refrigerator drawers or shelves. Follow these five steps to clean your refrigerator.

What restaurants and retailers should do

In the event that restaurants, retailers and/or other food service operators are found to have handled potentially contaminated food in their facilities, they should:

  • Contact their local health department and communicate to their customers regarding possible exposure to a pathogen.
  • Wash the inside walls and shelves of the refrigerator, cutting boards and countertops, and utensils that may have contacted contaminated foods; then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or paper towel that has not been previously used.
  • Wash and sanitize display cases and surfaces used to potentially store, serve, or prepare potentially contaminated foods.
  • Wash hands with warm water and soap following the cleaning and sanitation process.
  • Conduct regular frequent cleaning and sanitizing of cutting boards and utensils used in processing to help minimize the likelihood of cross-contamination.

Papayas from Mexico blamed for another Salmonella outbreak

For the sixth time in eight years, papayas grown in Mexico have been linked to an outbreak of Salmonella.

The US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) are warning consumers in Connecticut, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island to avoid eating any fresh papayas from Mexico until further notice.

No recall has been announced.

CDC reports 62 cases of Salmonella Uganda illnesses, including 23 hospitalizations, in eight states: Connecticut (14), Florida (1), Massachusetts (5), New Jersey (12), New York (24), Pennsylvania (4), Rhode Island (1), and Texas (1).

No deaths have been reported.

According to FDA, most people with salmonellosis develop diarrhea, fever, and abdominal cramps. More severe cases of salmonellosis may include a high fever, aches, headaches, lethargy, a rash, blood in the urine or stool, and in some cases may become fatal.

Children younger than five, the elderly, and people with weakened immune systems are more likely to have severe salmonellosis infections.

By the numbers

Epidemiological evidence gathered by CDC, and product distribution information obtained by FDA, point to papayas grown in Mexico and distributed in Connecticut, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island.

Just over one-half of the victims are female, and approximately two-thirds of those interviewed are of Hispanic ethnicity. Ages of outbreak victims range from one to 86 years.

Of those victims who were interviewed, 76% reported having eaten papaya in the week before becoming ill.

The Florida victim reported having traveled to Connecticut in the week before becoming ill. It is unknown at this time whether the Texas victim had traveled to one of the six states to which the papayas were shipped.

FDA has not yet identified a source or grower of the contaminated papayas.

History

This is the sixth in a series of Salmonella outbreaks linked to papayas grown in Mexico and imported into the USA in the last eight years.

In 2011, Mexican papayas contaminated with Salmonella Agona were the source of a 25-state outbreak that sickened 106 individuals, sending 10 of them to hospital.

In 2017, history repeated itself four-fold. A total of 251 individuals were infected with one of several different strains of Salmonella after eating Mexico-grown papayas. Seventy-eight of the outbreak victims were hospitalized and two people died.

If history is any guide, it is likely that the number of cases and hospitalizations in this outbreak will increase.

What should consumers do?

  • If you have purchased a papaya grown in Mexico, throw it away.
  • Do not eat fruit salads or other mixes that include papayas from Mexico.
  • If you aren’t sure the papaya you bought is from Mexico, you can ask the place of purchase. When in doubt, don’t eat the papaya. Throw it out.
  • Wash and sanitize places where papayas were stored: countertops and refrigerator drawers or shelves. Follow these five steps to clean your refrigerator.

What should restaurants and retailers do?

In the event that restaurants, retailers and/or other food service operators are found to have handled potentially contaminated food in their facilities, they should:

  • Contact their local health department and communicate to their customers regarding possible exposure to a pathogen.
  • Wash the inside walls and shelves of the refrigerator, cutting boards and countertops, and utensils that may have contacted contaminated foods; then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or paper towel that has not been previously used.
  • Wash and sanitize display cases and surfaces used to potentially store, serve, or prepare potentially contaminated foods.
  • Wash hands with warm water and soap following the cleaning and sanitation process.
  • Conduct regular frequent cleaning and sanitizing of cutting boards and utensils used in processing to help minimize the likelihood of cross-contamination.

 

 

Evanger’s pentobarbital recalls. A peek behind the curtain.

On February 3, 2017, Evanger’s Dog & Cat Food Co. announced a recall of specific production lots of its Hunk of Beef au Jus canned dog food after pentobarbital was confirmed in samples of the product.

One month later, the company expanded its recall to include every batch of Hunk of Beef, Braised Beef and Against the Grain Pulled Beef canned dog foods manufactured between December 2015 and January 2017.

FDA categorized the recalls as Class I.

A Class I recall represents “a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death.”

More than two years later, these Class I recalls are still listed as “Ongoing” by FDA.

A series of email exchanges between Evanger’s, its attorneys, its consultants and FDA staff, released in response to a Freedom of Information Act request, offer a glimpse into the prickly relationship between Evanger’s and FDA.

The story began on December 31, 2016 when Nikki Mael gave her five dogs a New Year’s Eve ‘treat’, consisting of most of the contents of a can of Evanger’s Hunk of Beef au Jus dog food. Within 15 minutes, the dogs began to behave oddly, exhibiting acute neurological symptoms. The pet owner rushed her dogs to an emergency veterinary clinic, where one of the dogs died.

Lab tests conducted on stomach contents retrieved during necropsy of the dead dog revealed the presence of a large amount of pentobarbital, a drug used to euthanize animals. The same drug was found in the residue of food remaining in the can from which the five dogs were fed.

FDA, alerted by the veterinarian, launched its investigation into the incident, including an inspection of Evanger’s production facilities that began on January 10, 2017.

According to a February 4th email from Evanger’s to FDA, the agency first advised Evanger’s of the results of the necropsy on January 27th.

Evanger’s management protested FDA’s handling of the incident. In a series of emails, the company questioned FDA’s determination that pentobarbital was an adulterant, and cautioned the agency not to put too much credence in consumer complaints.

The company’s outside consultant had this to say in an email addressed to Joel Sher, Vice-President of Evanger’s, dated February 4, 2017.

I am dismayed by CVM’s determination. Low levels of Pentobarbital have positive uses in treating seizures and insomnia, both in humans and animals. Those who made the decision are obviously unaware of FDA’s 1998 study that found Pentobarbital in almost 50% of the dry dog foods tested and made a determination at that time that residues of Pentobarbital were acceptable.

Evanger’s consultant made reference to a 1986 fraudulent complaint targeting Gerber’s baby food before summarized the company’s thoughts regarding consumer complaints in the following words, taken from an email dated February 17, 2017.

Complaints cannot be trusted! Once a complaint hits the press unscrupulous people will line up complaining hoping for a payout. Back in 1986 FDA did not have the Office of Criminal Investigations to conduct follow-ups at complainants to interrogate them to determine if their complaints were legitimate or not. Today FDA does have that ability and, perhaps, some of the complaints against Evanger’s and Against the Grain should be investigated further by FDA. I would really caution FDA about coming out with a press statement about receiving ‘many’ complaints against these products unless a comprehensive analysis of the complaint is done first.

In a March 3rd email, Evanger’s attorney expressed concern about FDA’s press releases, and asked the agency to give Evanger’s the opportunity to ‘address the issues’ prior to issuing a new public alert, as follows:

Please recall I represent Evanger’s. On its behalf, I’d like to request that the FDA communicate to and work with Evanger’s after the completion of any investigation or the discovery of any new information or questions so that, prior to any new press release from the FDA, Evanger’s is given the opportunity to address the issues. As I am sure you are aware, an FDA press release has significant impact in the market; this is obviously the FDA’s intended effect with the goal of protecting the public. This is indeed the goal the FDA and Evanger’s share.

Later in the same email, the attorney wrote,

It is for this reason that we ask that, Evanger’s be given the opportunity to address new questions, issues or concerns before the FDA issues an independent release. If this is not possible, I believe Evanger’s would be entitled to know why so as to preclude even the appearance of arbitrary or capricious action.

On June 29, 2017, FDA issued a formal Warning Letter to Evanger’s, listing the various violations of the Federal Food, Drug & Cosmetics Act documented during the agency’s January inspection of the company’s facilities. 

On July 9, 2017, a “concerned consumer” sent the following email to FDA.

Dear Mr. Lyons,

I am responding, to the letter that your office sent to Evanger’s Dog And Cat Food Company, dated June 29, 2019. The reason is the FDA has made false Allegations against Evanger’s in the following way: [redacted by FDA].

The anti seizure medication contained 30 mg of phenobarbital not 15 mg. The medication has since been recalled by a company called Truxton because of mislabeling. [redacted by FDA]

Again the FDA jumped the gun when Evanger’s got blamed for the dogs deaths.

[redacted by FDA]

5. The FDA came charging in like a bull, and the FDA failed to ask about the medical history of the dogs. The phenobarbital that you found came from a labor dispute between the meat supplier and its employee.

Before you make any more false and misleading information about Evanger’s, you need to check your facts. As you have caused thousands of dogs to lose a perfectly safe free meal. Please correct your letter and investigate the new facts in this case. Thank you [redacted by FDA]

Ps. Let me also make it clear I am just a concerned consumer writing this letter by myself.

In October 2017, the company and FDA were still in correspondence regarding the destruction of the recalled products. An October 18, 2017 email from FDA to Evanger’s attorney provides a window into some of the ongoing issues.

As you may know, FDA initiated an inspection at the Evanger’s Markham, IL facility on Tuesday, October 10, 2017 (and is still currently in progress). According to our investigators, the firm has approximately only [redacted by FDA] pallets of recalled product in their possession at this location. The amount of recalled product originally inventoried at the firm in February 2017 by FDA was approximately [redacted by FDA] pallets of product. The firm stated they are destroying the product by discarding approximately [redacted by FDA] at a time into their regular trash bin and covering the product in trash; the trash is then collected per their regularly scheduled pickup. The firm has not provided any documentation or evidence that the product was destroyed; however, Chelsea Sher stated on the second day of the inspection that some of the product has been disposed of at a landfill with documentation. Documentation of the landfill destruction has not been provided to the investigators either. According the investigators the firm is also not rendering the product unsalvageable when the product is thrown into the trash.

Relations between FDA and the companies it regulates can be difficult. Fortunately, not every recall situation is fraught with the controversy and confrontation that characterized the interaction between Evanger’s and FDA. 

A final note: All of the excerpts quoted above are ‘as written’ except for the indicated redactions by FDA. No attempt was made to abridge the content or correct any errors of fact, spelling or grammar.