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.

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?
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?
Were the outbreak cases all tied to the same commercial source of the S. Typhimurium “Strain X”?
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)?
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).
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

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!

FDA Finds Salmonella Enteritidis in Sparboe Farms Poultry House

FDA detected Salmonella Enteritidis in the environment of more than one poultry house at Sparboe Farms’ Litchfield, MN egg producing operation during the agency’s inspection of the farm.

After being informed of the Salmonella-positive results, the company initiated testing of eggs from those poultry houses. None of the eggs were positive for Salmonella.

Sparboe Farms – according to the company’s website – is the fifth largest producer and marketer of shell eggs in the USA, serving retail, wholesale and foodservice customers in 26 states.

The company maintains seven egg production and grading facilities in three states – Minnesota, Iowa and Colorado.

Late last week (November 17th and 18th), FDA posted the results of its inspections of the seven facilities. The inspections, which were carried out between April and July, 2011 revealed a number of deficiencies at one or more of the locations, including:

Inaccuracies and inadequacies in the company’s written Salmonella Enteritidis Prevention Plan,
Failure to conduct required environmental testing for Salmonella Enteritidis,
Failure to use approved methods for conducting environmental sampling and Salmonella testing,
Inadequate procedures for preventing cross-contamination between poultry houses,
Failure to prevent stray animals – including stray poultry from entering the poultry houses; and
Deficiencies in rodent control and/or insect control.

FDA issued a comprehensive Warning Letter to Sparboe Farms Owner Beth Sparboe Schnell on November 16th, detailing all of the “serious violations” observed during inspection of the various egg facilities. It was in the Warning Letter that FDA revealed the Salmonella-positive findings.

Last Friday evening (November 18th), ABC’s 20/20 aired a report on Sparboe, including an undercover video from Mercy for Animals, alleging animal cruelty and insanitary conditions in the company’s poultry houses.

Shortly after the ABC report aired, two major Sparboe customers – McDonald’s and Target – announced that they would no longer purchase eggs from Sparboe, and Target removed Sparboe eggs from its stores.

Although Sparboe Farms was relatively unaffected by last year’s massive Salmonella Enteritidis outbreak and egg recall, eFoodAlert received a number of reports from consumers who believed that they had become ill after consuming Target’s Market Pantry eggs – supplied to Target by Sparboe Farms. Consumers identified eggs from several Sparboe facilities, including the Litchfield, Minnesota location. At the time, there was never enough evidence to convince FDA or CDC to identify Sparboe-produced eggs as part of the problem.

Sparboe has acknowledged finding Salmonella in environmental samples, stating:

Salmonella is found everywhere from chicken barns and hog farms to your own kitchen counter and even on vegetables we buy from the store so naturally we expect to test positive for Salmonella on occasion in the environment. As part of the Egg Safety Rule, and Sparboe’s Salmonella Prevention Program, swabs are taken in the barn environment and tested for Salmonella. Since July 2010, when the rule went into effect, Sparboe has taken more than 3000 swabs and have found some environmental positives.

The rule states that when we find an environmental positive, we are to do additional testing inside the eggs. During testing, eggs from positive barns are not sold unless pasteurized. To date, Sparboe has never found Salmonella inside a hen or an egg.

The company adds that it was doing Salmonella testing long before the Egg Safety Rule was enacted in July of last year, and that it remains in compliance with the rule. “The warning letter,” Sparboe explains, “contained 34 corrective actions. Many cannot be resolved until FDA audits our farm again. The remaining open objections include 5 paperwork items, 7 relating to how we count and record mice, and 7 relating to our testing protocol, which was changed immediately upon notification.”

Strange definition of compliance!