Insanitary Conditions In India Behind Sushi Salmonella Outbreak

The contaminated raw tuna that is responsible – as of May 2, 2012 – for at least 258 Salmonella illnesses in 24 states and the District of Columbia was produced under filthy conditions in a substandard food manufacturing plant in Kerala, India.

FDA inspected the Kerala facility where Moon Fishery (India) Pvt. Ltd. produced the contaminated “Tuna Scrape” that was exported to the USA and sold to restaurants and grocery stores through distributors in Illinois, New Jersey, New York Massachusetts, Georgia, North Carolina, Texas and Maryland. The inspection took several days (April 19th – 24th, 2012).

Earlier today, Marler Blog released the initial Inspectional Observations Report (known as the 483) from that FDA inspection. It doesn’t take an advanced degree in microbiology or a great deal of imagination to deduce the probable source of the Salmonella contamination after reading the following observation, reproduced in full from the report:

You are not monitoring the sanitation conditions and practices with sufficient frequency to assure conformance with Current Good Manufacturing Practices including safety of water that comes into contact with food or food contact surfaces, including water used to manufacture ice, condition and cleanliness of food contact surfaces, maintenance of hand washing, hand sanitizing, and toilet facilities, and protection of food, food packaging material, and food contact surfaces from adulteration.

A- You are not monitoring the safety of water as evidenced by:

1- Tanks used for storage of process waters have apparent visible debris, filth, and microbiological contamination. Sand and activated carbon filter units used in manufacturing of water are not sanitized, and ventilation for tanks is not filtered to protect against contamination. There is no laboratory analysis for water used in ice manufacturing at the … facility to show the water used to make ice is potable. Ice manufacturing lacks sanitary controls: ice manufacturing equipment at the Moon Fishery facility is located outside and is susceptible to adulteration from pests and the environment. Apparent bird feces were observed on the ice manufacturing equipment at Moon Fishery; insects and filth were observed in and on the equipment. Ice manufacturing equipment at your … facility is rusty and situated so that the ice can not be protected against adulteration, as the ice manufacturing process is constructed into the flooring of the ice facility. Tuna processed at your facility, which is consumed raw or cooked, comes in direct contact with water and ice.

B- You are not monitoring the condition or cleanliness of food contact surfaces as evidenced by:

1-Some of the floor and wall tiles in the tuna processing area are broken and cracked, not allowing for proper cleaning.

2- After cleaning, the ceiling directly above the in-process tuna line was observed to have visible product residue.

3-After cleaning, product residues and rust were observed on knives and utensil storage boxes. These knives are used to cut raw tuna.

C-You are not monitoring protection from adulterants as evidenced by:

1-Peeling paint was observed directly above the in-process tuna line.

D-You are not monitoring hand washing, hand sanitizing and toilet facilities as evidenced by:

1-There were no hand drying devices available in the employee rest rooms on the first floor.

In short, the place was a mess!

There has been a tremendous amount of focus over the years on China as a source of hazardous foods and food ingredients. There has been very little media attention paid to India, even though that densely populated country struggles with a chronic shortage of sewage treatment facilities, a limited supply of potable water, and frequent food poisoning outbreaks.

Last month (April 2012), FDA refused 223 shipments of foodstuffs and other products from China, and 222 shipments from India. Reasons for rejecting food products from India included Salmonella, pesticides and process adulteration.

FDA physically examines less than 2% of all imported food shipments under its jurisdiction. The agency can’t be expected to check every shipment – it hasn’t the money, the staff or the lab facilities to do so.

It’s time to put the burden of demonstrating the safety of imported foodstuffs onto the shoulders of the producers and importers.

Why I STILL Don’t Eat Sushi

Four years ago last month, I wrote an article titled “Why I Don’t Eat Sushi Or Sashimi” after ten patrons of a restaurant in Kisai, Japan were diagnosed with cholera contracted as a result of having eaten contaminated sashimi.

I was taken to task by a reader who pointed out that FDA and the European Union require that fish used for sushi and sashimi be frozen before consumption in order to kill parasites. “So while there might be issues in Japan and other places,” my reader opined, “the EU and USA are relatively safe places to eat sashimi and sushi.”

In response to this comment, I explained that freezing the fish does not provide any protection against food poisoning bacteria such as Salmonella, unsanitary handling practices, cross-contamination or poor temperature control.

I suggest that the 258 victims of this year’s Salmonella Bareilly/Salmonella Nchanga outbreak would agree that eating raw sushi may be a risky business – especially when the sushi contains Nakaochi Scrape.

Today’s update from CDC revealed that the Salmonella outbreak now covers 24 states, including California, where the importer of the contaminated tuna is located. Thirty-two out of 258 outbreak victims have been hospitalized.

Sushi Case Count Map As of May 2, 2012 (source CDC)

Victims of this outbreak range in age from 4 to 86 years (median age of 30). More than half (57%) of the confirmed case patients are female. Illness onset dates range between January 28th and April 20th.

The Epi curve (a bar chart showing illness onset dates) clearly indicates that additional cases are likely to be reported. The shaded area in this chart indicates the time frame within which additional cases may have developed, but have not yet been confirmed or reported to CDC.

Confirmed infections by date of illness onset as of May 2, 2012 (source CDC)

While this outbreak plays out, CDC continues to offer the following advice:

CDC’s Advice to Consumers

Do not eat the recalled frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. This product is tuna backmeat that is scraped from the bones of tuna and may be used to make sushi, particularly “spicy tuna” sushi.
If you purchase “spicy tuna” or other sushi, sashimi, ceviche, or similar dishes that might contain Nakaochi Scrape tuna product from a restaurant or grocery store, check with the establishment to make sure that it does not contain raw recalled product from Moon Marine USA Corporation. When in doubt, don’t eat it.
Persons who think they might have become ill from eating possibly contaminated raw Nakaochi Scrape tuna product should consult their healthcare providers.
Infants, older adults, pregnant women, and persons with impaired immune systems are more likely than others to develop severe illness and should not eat raw or partially cooked fish or shellfish. If you are unsure of your risk, ask your healthcare provider.

CDC’s Advice to Retailers and Establishments

Do not serve raw recalled frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. If you do not know the source of your raw scraped yellowfin tuna product, check with your supplier.

CDC and FDA have been close-mouthed, as usual, regarding the retail distribution of the Nakaochi Scrape tuna product that is behind this Salmonella outbreak. California, though, has published a list of restaurants and sushi bars that are known to have been supplied with the implicated tuna.

Two Salmonella Strains In Sushi Outbreak – 200 Ill

The outbreak of Salmonella illnesses traced to eating sushi containing contaminated raw yellowfin tuna known as Nakaochi scrape has grown to encompass 200 confirmed illnesses in 21 states and the District of Columbia. Vermont was the latest state to be added to the list.

There is no longer even the slightest shadow of a doubt that the scrape yellowfin – which resembles ground tuna – is the source of this outbreak. Both FDA and the state of Wisconsin have confirmed the Salmonella Bareilly outbreak strain in food samples.

Two days ago, Wisconsin’s Department of Agriculture Trade and Consumer Protection laboratory reported confirming the presence of the outbreak strain of Salmonella Bareilly in the recalled yellowfin tuna and in a spicy tuna roll made with the recalled tuna. The DNA fingerprinting of the Salmonella was carried out by the Wisconsin State Laboratory of Hygiene, located at the University of Wisconsin – Madison.

Earlier today, FDA chimed in with its own announcement. FDA labs reported finding the Salmonella Bareilly outbreak strain in a sample of Nakaochi scrape yellowfin tuna obtained from a distributor of the raw fish product. The same sample contained a strain of Salmonella Nchanga that was indistinguishable from bacteria isolated from an additional cluster of 10 infections in 5 states. FDA also recovered Salmonella Bareilly from a sample of Nakaochi scrape yellowfin tuna obtained from a different distributor.

As a result of FDA’s lab findings, CDC has expanded its definition of the outbreak to include both Salmonella Bareilly and Salmonella Nchanga.

The raw tuna product was imported from India. On April 19th, FDA’s New Delhi office initiated a seafood (HACCP) inspection of the manufacturer’s facility (Moon Fishery Pvt Ltd, Aroor, India). The agency was informed that April 12, 2012 was the last day of tuna processing at the firm due to the seasonal nationwide ban on tuna harvest from the Indian Ocean. FDA has promised to post the inspection results once the report has been finalized.

CDC advises retailers and establishments not to serve raw recalled frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. Establishments and retailers should check with their suppliers to confirm the source of the tuna product.

CDC offers the following Advice to Consumers

Do not eat the recalled frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. This product is tuna backmeat that is scraped from the bones of tuna and may be used to make sushi, particularly “spicy tuna” sushi.
If you purchase “spicy tuna” or other sushi, sashimi, ceviche, or similar dishes that might contain Nakaochi Scrape tuna product from a restaurant or grocery store, check with the establishment to make sure that it does not contain raw recalled product from Moon Marine USA Corporation. When in doubt, don’t eat it.
Persons who think they might have become ill from eating possibly contaminated raw Nakaochi Scrape tuna product should consult their healthcare providers.
Infants, older adults, pregnant women, and persons with impaired immune systems are more likely than others to develop severe illness and should not eat raw or partially cooked fish or shellfish. If you are unsure of your risk, ask your healthcare provider.