Outbreaks in Quebec, Twin Cities Traced to Chinese Raspberries

Frozen raspberries imported from China were the source of 615 confirmed cases of norovirus in Quebec between March and July of this year, and of 15 cases in Minnesota in August of 2016.

The Quebec outbreak included clients and staff at seven seniors’ residences, two daycare centers and one hotel in four separate administrative regions of the province, according to a spokesperson for Quebec’s Ministry of Health and Social Services (MSSS).

Confirmed cases were documented in Mauricie at 6 seniors’ residences, in Laurentides at a conference at a hotel, in Chaudieres-Appalaches at a daycare center, and in Capitale-Nationale at a daycare center and a seniors’ residence.

Of the 615 outbreak victims, 141 were employees of at least two of the seniors’ residences. Four were employees at one of the affected daycare centers. Citing privacy concerns, MSSS declined to provide any further details on the victims by gender, age or geographic location. However, extrapolation of data provided by the provincial health agency suggests about 250 of the outbreak victims were seniors, and 33 were children.

The Minnesota outbreak was linked to ice cream manufactured by Sebastian Joe’s, a Minneapolis-based company, according to a spokesperson from the Minnesota Department of Health (MNDOH). The company supplied the ice cream to multiple venues within the Minneapolis-St. Paul area.

Norovirus illnesses were linked to consumption of raspberry chocolate chip flavor ice cream consumed at two Sebastian Joe’s venues, one private gathering, and one area restaurant. Of the 15 confirmed cases, 10 were female. One person was hospitalized.

The ice cream contained frozen raspberries imported from China. Analyses conducted by the Food and Drug Administration confirmed the presence of norovirus matching the case specimens in samples of the raspberries.

The Twin Cities and Quebec outbreaks occurred more than six months apart and appear to have been independent of each other, though frozen raspberries from China were implicated in both. Taian Runko, the company identified by the FDA during its analytical sampling, was not involved in the Quebec outbreak, according to the CFIA.

Product recalls lacked transparency
The Canadian Food Inspection Agency (CFIA) issued 14 recall notices, from June 20 through Aug. 21 this year. The agency disseminated 11 of the recalls only to businesses in the food industry, with no public warning released. Recall notices dated Aug. 11, 16 and 21 were released to the public, and alluded to the existence of “…reported illnesses associated with the consumption…” of the recalled products.

From June 23 through Aug. 14, Quebec’s Ministry of Agriculture, Fisheries and Food (MAPAQ) issued a series of six public alerts and product recalls, which included numerous bakery products manufactured with the individually quick frozen (IQF) raspberries. Each of the MAPAQ alerts warned of “many” illnesses associated with the consumption of products containing the IQF raspberries.

The U.S. Food and Drug Administration carried out analytical sampling and laboratory analysis when advised of the Minnesota outbreak, according to an agency spokesperson. As a result of the FDA investigation, the agency added IQF raspberries from Taian Runko Industry International Trade Co. Ltd. to the Import Alert 99-35 “Detention Without Physical Examination” list (Red List) on May 2 this year. Sebastian Joe’s initiated a product withdrawal as a result of the 2016 Minnesota outbreak.

Canadian health agency never issued alert
The Public Health Agency of Canada (PHAC) never issued a public health alert in conjunction with the IQF-raspberry norovirus outbreak. A spokesperson for PHAC explained the agency’s silence was because of the outbreak having been confined to a single province.

In Quebec, the provincial health department responsible for investigating the 5-month outbreak did not issue any news releases or public health alerts either. According to a MSSS spokesperson, food recalls are the responsibility of MAPAQ and CFIA. The spokesperson added that MSSS worked in collaboration with MAPAQ and other federal authorities on the investigation.

The first public notice of the Quebec outbreak was contained in a public warning and recall notice issued by MAPAQ on June 23. The CFIA did not include a similar warning with its recall notices until Aug. 11.

No public health alerts were posted on the Minnesota Department of Health website regarding the norovirus illnesses or ice cream recall in that state.

What consumers should know about norovirus
Norovirus is the leading cause of outbreaks from contaminated food in the United States, according to the Centers for Disease Control and Prevention. It accounts for approximately about half of all foodborne illnesses in the country every year.

Symptoms of norovirus infection include nausea, vomiting, diarrhea and stomach pain. The symptoms usually develop within 12 to 24 hours after exposure to the virus and last one to three days days.

Although extremely unpleasant, most cases of Norovirus are self-limiting, and do not present a long-term health risk, according to the CDC. Nevertheless, seniors and young children are at heightened risk of severe dehydration if infected with the virus.

Most cases of norovirus illness in the population at large are shrugged off as so-called stomach flu. Victims are usually not seen by doctors, and the infections go unreported.

A national survey carried out in the United Kingdom in 2011 determined that only one in every 23 people with norovirus consulted a physician. Overall, for every 288 cases of norovirus occurring in the general population, only one was reported to national surveillance authorities.

Timeline for Quebec, Minnesota outbreaks
August 4-14, 2016: Norovirus illnesses associated with consumption of raspberry chocolate chip ice cream at four Minneapolis-St. Paul area venues.

March-May 2017: Three separate outbreak clusters involving six seniors’ residences, all of which were serviced by a single central kitchen.

May 2, 2017: Individually quick frozen (IQF) Red Raspberries from Taian Runko Industry International Trade Co. Ltd. in Taian, Shandong China, is added to the Red List of Import Alert 99-35, citing norovirus GII contamination.

May 31, 2017: CFIA is notified by Quebec authorities that norovirus outbreak clusters appear to be linked to raspberries, and initiates a food safety investigation.

June 2017: Two additional outbreak clusters occur, one at a daycare center and the other at a hotel.

June 20, 2017: CFIA issues first product recall notice for IQF raspberries imported from China.

June 23, 2017: MAPAQ issues first consumer alert and recall notice for IQF raspberries and some products containing the raspberries, reporting for the first time the existence of “many” illnesses associated with consumption of IQF raspberries.

July 2017: Two additional outbreak clusters are reported, one at a daycare center and the other at a seniors’ residence.

This story first appeared in Food Safety News and is reproduced here with permission.

Second Papaya Recall issued as Salmonella Outbreak Grows

One person dead, 35 hospitalized, 109 ill.

A second recall has been issued for Maradol papayas from Mexico as a result of the ongoing investigation into a Salmonella outbreak that has grown to 109 confirmed illnesses.

Agroson’s LLC (Bronx, NY) has recalled 2,483 boxes of Cavi brand Maradol Papayas, grown and packed by Carica de Campeche. The recalled papayas were supplied to wholesalers in New York, Connecticut and New Jersey from July 16 to 19, 2017.

The papayas were available for sale until July 31, 2017. Consumers can identify the papayas by PLU sticker, cavi MEXICO 4395.

According to the recall notice, Agroson’s has ceased importing papayas from Carica de Campeche.

The US Centers for Disease Control and Prevention (CDC) reported earlier today that the Salmonella outbreak linked to consumption of Maradol papayas imported from Mexico has more than doubled in size, and has spread to six additional states.

Most of the increase is due to the addition of cases from a second outbreak strain.

In addition to Salmonella Kiambu, CDC has confirmed a strain of Salmonella Thompson from a sample of papaya is genetically similar to Salmonella Thompson cultures recovered from patients. In all, Salmonella Kiambu has been found in 48 outbreak cases, and Salmonella Thompson in 61.

Confirmed outbreak cases have been reported from 16 states, including: Connecticut (4), Delaware (1), Iowa (2), Kentucky (2), Louisiana (1), Maryland (6), Massachusetts (3), Michigan (1), Minnesota (4), North Carolina (2), New Jersey (26), New York (36), Oklahoma (2), Pennsylvania (7), Virginia (11) and Wisconsin (1).

Texas, which was indicated to have reported a single outbreak cases in CDC’s initial announcement, has been removed from the list of affected states.

The first victim fell ill May 17th; the most illness developed on July 22nd. The youngest outbreak victim was less than one year old; the oldest was 95. Approximately two-thirds of the victims were female, and 68% were of Hispanic ethnicity.

The death was reported from New York City.

Initial investigtions identified Caribeña brand Maradol papayas as a source of the Salmonella Kiambu outbreak. On July 26th, Grande Produce (San Juan, Texas) issued a limited recall of papayas shipped to a Maryland distributor.

Traceback investigations carried out by the US Food and Drug Administration (FDA) have identified the Carica de Campeche farm (Campeche, Mexico) as the likely source of the outbreak. According to FDA, papayas from Carica de Campeche tested positive for Salmonella Agona, Salmonella Senftenberg, and Salmonella Gaminara in addition to the outbreak strains of Salmonella Kiambu and Salmonella Thompson.

As a result of its findings, FDA has added Carica de Campeche to Import Alert 99-35 (Detention without physical examination of fresh produce that appears to have been prepared, packed or held under insanitary conditions) and has removed the farm from the Green List of entities exempt from Import Alert 21-17 (Countrywide Detention Without Physical Examination of Papaya from Mexico).

Carica de Campeche was granted an exemption from this detention notice in 2015.

FDA has stepped up testing of papayas from other farms in Mexico to determine whether they may be contaminated. If Salmonella is found in papaya from a farm, that entity will be added to the Import Alert 99-35 detention list.

What CDC wants consumers to know:

CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas from Mexico until we learn more.

At this time, Caribeña brand papayas from Mexico have been identified as one brand linked to the outbreak.
- Consumers should not eat, restaurants should not serve, and retailers should not sell recalled papayas.
- Additional brands will be announced as the information becomes available.
Maradol papayas have a green skin that turns yellow as the fruit ripens.
A sticker on the Maradol papaya should say if the papaya is Caribeña brand and if it is from Mexico.
If you aren’t sure if the papaya you bought is a Maradol papaya from Mexico, you can ask the place of purchase. Restaurants and retailers can ask their supplier.
When in doubt, don’t eat, sell, or serve them and throw them out.
Wash and sanitize countertops as well as drawers or shelves in refrigerators where papayas were stored.

Contact a healthcare provider if you think you got sick from eating contaminated papaya.

Most people infected with Salmonella develop the following signs and symptoms 12-72 hours after being exposed to the bacteria:
- Diarrhea
- Fever
- Abdominal cramps

Salmonella Outbreak Exposes Flaw in FDA ‘Import Alert’ System

The Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the Maryland Department of Health (MDH) and other state and local agencies continue to investigate the outbreak of Salmonella Kiambu illnesses, which has sickened 47 people and has already claimed one life.

The CDC posted this photo with the outbreak notice, describing maradol papayas as large, oval fruits that weigh 3 or more pounds, with green skins that turn yellow when the fruit is ripe. The flesh inside the fruit is salmon-colored.” Photo courtesy of CDC

Based on sampling and analysis reported by MDH, the outbreak appears to be linked to consumption of Maradol papayas, imported from Mexico. On July 26, 2017, Grande Produce (San Juan, TX) recalled Caribeña brand Maradol papayas that were shipped to an unnamed Maryland distributor center between July 10 and July 19.

The introduction of Salmonella-contaminated papayas into the US retail market occurred despite the issuance in August 2011 of Import Alert 21-17, COUNTRYWIDE DETENTION WITHOUT PHYSICAL EXAMINATION OF PAPAYA FROM MEXICO.

What is an Import Alert?

An Import Alert informs “…FDA field staff and the public that the agency has enough evidence to allow for Detention Without Physical Examination (DWPE) of products that appear to be in violation of FDA laws and regulations.” It can be very narrow (apply to a single company or importer) or extremely broad, as in the case of Import Alert 21-17. The purpose of the Import Alert is to place the burden of proving product safety on the shoulders of the producer or importer. The first Import Alert was issued in 1974.

History of Import Alert 21-17

Mexican papayas were the source of a Salmonella Agona outbreak that sickened 106 people in 25 US states between January 1 and August 25, 2011. The outbreak was traced to several brands of papayas distributed in the USA and Canada by Agromod Produce, Inc.

During the investigation into the source of the outbreak, FDA analyzed 211 samples of Mexican papayas, finding Salmonella in 33 (15.6 percent) of them. The positive samples came from 28 different firms and nearly all the major papaya-growing regions of Mexico. In response to the extent of the contamination, FDA issued Import Alert 21-17 on August 25, 2011.

Are there any exceptions to the Import Alert?

FDA policy allows for exemptions to an Import Alert, if a company can provide evidence that their products are likely to remain in compliance with FDA laws and regulations. In the case of Import Alert 21-17, FDA considers Salmonella-negative test results from five consecutive shipments over a period of time to be evidence of probable compliance. Entities able to meet these criteria may apply for an exemption. If accepted, they are added to the Green List appended to the Import Alert.

How does the Green List Work?

At last count, FDA has granted 98 exemptions in the nearly six years during which the Import Alert has been in force. Once granted, exemptions remain in effect unless FDA receives evidence of lack of compliance, such as a result of a consumer complaint, a Salmonella-positive routine retail surveillance sample. There is no requirement for inspection of the exempt entity’s operations, for routine or periodic submission of lab test results, or for any other form or recertification. A Green-listed entity under Import Alert 21-17 has carte-blanche to ship papayas from Mexico into the USA.

What Happens to Detained Shipments under Import Alert 21-17?

Entities whose products are detained without physical examination may apply to have those products released by submitting evidence from a third-party laboratory that the product is not contaminated with Salmonella. Otherwise, the product either will be refused entry into the USA, or will be destroyed.

The action taken last week by Grande Produce represents the second time in recent years that Caribeña brand Mexican papayas have been recalled due to Salmonella contamination. The first recall took place in May 2012 after routine testing by Caribe Produce, LTD CO discovered Salmonella contamination.

A recent search of Texas Secretary of State corporate filings revealed Raul Cano to be both the registered agent for Caribe Produce and a Managing Member/Director of Grande Produce. Both companies currently share the same street address. According to a May 2017 article published in Texas Border Business, Grande Produce is owned jointly by Raul Cano and his brother, Juan Cano.

While the identity of the Mexican grower who supplied the recalled papayas has not been determined, Chiapas-based Finca Monte Verde identifies its US distributor to be Grande Produce and identifies Caribe Produce as its contact point in the USA. Finca Monte Verde is on the Import Alert 21-17 Green List and, therefore, is exempt from automatic detention.

There is no information on either the Finca Monte Verde or the Grande Produce websites to indicate whether or not Finca Monte Verde is the sole supplier of papayas to Grande Produce. While FDA is conducting a traceback investigation of the recalled Caribeña papayas, its investigators also are working with CDC and state agencies to determine whether other brands of papayas may be implicated in the Salmonella outbreak.

Although the investigating state and federal agencies have not yet determined the origin of the contaminated papayas, or the point in the tree-to-table distribution chain at which they may have become contaminated, one thing is certain. Either the papayas entered the USA under the aegis of a Green-Listed entity or the produce was admitted as a result of a third-party lab analysis certifying a Salmonella-negative result.

As food safety advocate Bill Marler pointed out in his recent opinion piece, ‘Why the US imports tainted food that can kill you,’ FDA’s ability to carry out proactive inspections of foreign growers and packers is severely limited by budget constraints, forcing the agency to rely on the good faith and probity of these entities and of their third-party testing laboratories to deliver a safe product to US consumers.

In this case, it seems the outcome was a large gap in the food safety border wall—maybe large enough to drive a refrigerated 18-wheeler through.

This article first appeared on Food Safety News and is reposted here with permission. Attorney Bill Marler is the publisher of Food Safety News.