The 21-page case questionnaire used by the North Carolina Division of Public Health to crack an outbreak of E. coli helped investigators to quickly focus on the Kelley livestock building on the State Fair grounds.
They have concluded that the Kelley livestock building, a permanent round-roofed structure where sheep, goats and pigs were exhibited, was the source of the E. coli O157:H7 outbreak at the North Carolina State Fair, which attracted more than one million attendees during its Oct. 13-23 run.
State Epidemiologist Megan Davies said animal contact at the Kelley building was the likely cause of the E. coli infections suffered by 27 fairgoers. She did not name any specific breed as the source.
No other fair exhibits, foods, or activities were found responsible for the illnesses.
Two of the 27 victims of the state fair outbreak remained in the hospital Thursday.
The 2011 E. coli outbreak at the North Carolina State Fair is at least the third to occur in recent years. In 2004 the petting zoo was responsible for infecting 108 fairgoers with the pathogen. Two years later in 2006, three others were stricken with the O157:H7 strain from contamination thought to have occurred at the pita stand.
After its 2004 run, the state fair installed its first public hand-washing stands around the petting zoo and other animal exhibits. It also double-fenced bedding areas to help keep people out.
In its case questionnaire this year, North Carolina public health officials asked fairgoers to recall if they or their children touched sheep, goats or pigs; allowed animals to nuzzle, nibble, or lick them; or whether they stepped in or touched “manure or poop” during their visit to the Kelley livestock building.
Investigators also asked whether children going through the building were carrying toys or blankets, sucking their thumbs or Sippy cups, or riding in strollers.
North Carolina public health investigators interviewed 114 fairgoers, including the 27 who got sick.
The Children’s Barnyard, the Graham Building, the State Fair Ark, the Rabbit Barn, the Amazing Animals Petting Zoo, the Hog way Speedway, and the Gov. Kerr Scott building were other fair locations that investigators asked specific questions about.
In addition, they required victims to answer questions about the foods they ate. Foods checked out included hamburgers and cheeseburgers, barbeques, hot dogs, turkey legs, ham, sausage, game meat, raw vegetables, salads, finger foods like popcorn and peanuts, ice cream, cotton candy, candy and caramel apples. The investigators also asked about beverages, including fresh squeezed lemonade.
Steve Troxler, North Carolina’s Agricultural Commissioner since 2005, is ultimately responsible for the state fair. With the Kelley livestock building named as the source of the latest outbreak, Troxler is promising to put additional safeguards in place.
“Our goal is to put on the safest fair we can,” he said.
Troxler said visitors are not supposed to touch animals in the Kelley building, and it is cleaned and disinfected after each livestock event. He said it “is not a petting zoo.”
But the Kelley livestock building was suspected from the beginning of the outbreak when a Sampson County, NC family named it as the fair location they’d visited before becoming ill.
Troxler acknowledged visitors attend the fair based on a “certain amount of trust.”
“We certainly want to keep that trust with the public and be proactive in doing anything we can do,” the commissioner said.
That the Kelley livestock building was the source of the outbreak came as no surprise to Davies, the state epidemiologist. She noted that pathogenic E. coli bacteria are shed in the feces of ruminant animals such as cows, goats, and sheep.
An outbreak of E. coli O157:H7 in the St. Louis area now includes 30 confirmed cases, according to the Missouri Department of Health and Senior Services (DHSS).
And the investigation into the cause of the outbreak is no closer to finding where the E. coli O157:H7 is coming from.
Two of four E.coli cases involving residents of the Columbia/Boone County area 125 miles west of St. Louis are believed to be part of the larger outbreak, while two others are not. A fifth person with E. coli-like symptoms in Boone County tested negative for the bacteria.
The lead agency in the federal, state and local investigation into the cause of the St. Louis E. coli outbreak late Monday said it added “two new cases based on lab results from specimens submitted to the State Public Health Laboratory last week.”
DHSS said the two cases have the E coli fingerprint that has been observed in the outbreak. The St. Louis outbreak may have topped out with the two cases.
“There are no other specimens at the State Lab believed to be connected to the outbreak on which testing is pending,” DHSS said in its daily media update.
The Missouri State Lab also has tested 55 food samples, mostly from the salad bars at the popular St. Louis-based Schnucks grocery stores, where many who became ill reported dining before they became ill.
All food samples tested to date, however, were found negative E. coli O157:H7.
The St. Louis outbreak has been underway since late October, and sent at least 22 to hospitals for treatment and resulted in one case of hemolytic uremic syndrome (HUS).
Investigation into the St. Louis outbreak is being assisted by the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) and local health departments.
North Carolina is also continuing to investigate an E. coli O157:H7 outbreak with as many as 24 cases where some activity at the state fair is suspected as the source. The first illnesses in North Carolina were reported on about Oc.t 15.
Meanwhile, there is a new E. coli outbreak at the Arapahoe County Jail in Colorado. Six inmates have been confirmed as E. coli cases and 14 others have symptoms.
The jail has transferred an inmate to a nearby hospital for treatment of dehydration.Sheriff Grayson Robinson said jail personnel acted quickly to stem the spread of the outbreak among the jail population.
The jail’s Pod 3, the housing unit affected, is now isolated from the rest of the facility and the Tri-County Health Department has been brought in to assist.
Arapahoe County is part of the Denver metropolitan area.
Just across the river from the epicenter of a mysterious E. coli outbreak, Senator Dick Durbin (D-IL) warned that cuts to the U.S. Food and Drug Administration (FDA) budget would be a step backward for food safety.
FDA is currently seeking a budget to fund its stepped up role under the Food Safety Modernization Act, which became law last January.
In a speech before culinary students at Southwestern Illionis College in Granite City, Illinois on Friday, Sen. Durbin specifically blasted the spending cuts approved by the House of Representatives over the summer that would cut FDA’s budget by more than 10 percent.
“If these funding cuts are sustained, there will be terrible consequences for our nation’s food safety system and efforts to prevent millions of food-borne illnesses and thousands of deaths each year will be set back,” said Durbin, a long-time advocate for a revamped food safety system. “The House bill takes us back to where we were before this landmark legislation was passed by cutting the funding FDA needs to meet the requirements of the new law.”
“We need to improve our nation’s food safety system – -not dismantle it,” he added.
House and Senate staff worked over the weekend to reconcile the House and Senate agriculture appropriations bills. The Senate version would give FDA a $50 million increase over last year.
Durbin pointed to the ongoing outbreak in nearby St. Louis as an example of food safety challenges. “The outbreak in the St. Louis region is not an isolated incident–there have recently been similar outbreaks in North Carolina, Ohio, Michigan and New York.”
Over the weekend, Missouri health officials said more illnesses had been linked to the E. coli outbreak, bringing the total count to 28.
Of the confirmed cases in the region, two live in Illinois, according to Durbin’s office. Local public health authorities said last week that at least 19 of the confirmed cases required hospitalization, including one case of hemolytic uremic syndrome (HUS).
The source of the outbreak remains a mystery. Missouri health officials have so far tested 55 food samples and have not found any positive matches.
Twice over the weekend, the Missouri Department of Health and Senior Services (DHSS) upped its count of confirmed cases, increasing the tally by two for the current total of 28. A Boone County resident was added to the count on Saturday because of recent travel to the St. Louis area.
On Sunday, DHSS added the second case based on lab results from specimens submitted to the State Public Health Laboratory last week. The case also has the same E. coli fingerprint as observed in the outbreak.
With all those negative tests on food samples, the source of the St. Louis E. coli outbreak remains a mystery.
How deadly is this cantaloupe Listeria monocytogenes outbreak and when will it end?
Are there as many as 292 ill and 61 dead and could illnesses be reported through November 23, 2011?
As of November 1, 2011, the CDC has reported that a total of 139 persons infected with any of the four outbreak-associated strains of Listeria monocytogenes have been reported to CDC from 28 states. The number of infected persons identified in each state is as follows:
Alabama (1), Arkansas (1), California (2), Colorado (39), Idaho (2), Illinois (3), Indiana (3), Iowa (1), Kansas (10), Louisiana (2), Maryland (1), Missouri (6), Montana (1), Nebraska (6), Nevada (1), New Mexico (15), New York (2), North Dakota (2), Oklahoma (11), Oregon (1), Pennsylvania (1), South Dakota (1), Texas (18), Utah (1), Virginia (1), West Virginia (1), Wisconsin (2), and Wyoming (4).
Persons infected with the outbreak-associated strains of Listeria monocytogens, by date of the illness onset (Figure A) and date of the clinical specimen collection (Figure B), 2011
Among persons for whom information is available, reported illness onset ranges from July 31, 2011 through October 21, 2011. Ages range from <1 to 96 years, with a median age of 77 years. Most ill persons are over 60 years old. Fifty-seven percent of ill persons are female.
Twenty-nine deaths have been reported:
Colorado (8), Indiana (1), Kansas (3), Louisiana (2), Maryland (1), Missouri (2), Nebraska (1), New Mexico (5), New York (2), Oklahoma (1), Texas (2), and Wyoming (1).
Among persons who died, ages range from 48 to 96 years, with a median age of 81 years. In addition, one woman pregnant at the time of illness had a miscarriage.
Elaine Scallan, and others, reported earlier this year in “Foodborne Illness Acquired in the United States–Major Pathogens,” that if a Listeria monocytogenes illness (listeriosis) is diagnosed, it will likely be reported to health officials (See, Table 2 – multiplier for underreporting is 1.0 and for underdiagnosis 2.1). Therefore, there may be as many as 292 ill and 61 dead.
Jensen Farms recalled its whole cantaloupes (300,000 cases – six cantaloupes per case) on September 14 in response to the multi-state outbreak of Listeriosis. According to the FDA, the recalled cantaloupes were produced from the end of July to September 10, 2011.
If you assume that all Listeria monocytogenes-tainted cantaloupe were off store shelves and were not consumed by customers after September 14, 2011 (given past recalls and outbreaks, not a great assumption), illnesses may well still occur through November 23, 2011 given that Listeria monocytogenes has an incubation period (ingestion to onset) from three to 70 days.
Deadly Fruit – far deadlier and not over yet.
More than 21,000 pounds of pine nuts are being recalled after evidence of Salmonella contamination was found in samples from Sunrise Commodities, the distributor who sold them in bulk to food vendors in Florida, New Jersey, New York and Canada.
The Turkish pine nuts are implicated in an outbreak of Salmonella Enteritidis that has sickened at least 42 people across 5 states. No deaths have been reported, but 2 people have been hospitalized.
The expanded recall announcement, issued Friday afternoon, comes more than a week after a 5,000-pound recall of pine nuts sold in bulk bins and used in prepared foods at Wegmans Food Markets in New York, Pennsylvania, New Jersey, Maryland and Virginia between July 1 and Oct. 18.
In a news release, the U.S. Food and Drug Administration warned consumers not to eat the Turkish pine nuts distributed by Sunrise Commodities, which is based in Englewood Cliffs, NJ. The FDA said its tests confirmed Salmonella in samples collected from a Sunrise Commodities warehouse; additional testing is underway to determine if the Salmonella matches the outbreak strain.
Public health labs had already found the outbreak strain of Salmonella in multiple samples of pine nuts or in pesto made with the pine nuts collected from Wegmans stores and from patients’ homes.
The expanded recall includes four lots of pine nuts packed in 22-pound boxes with these markings:
– Warehouse Lot 27963 with the identifying code “PO#: 50165″
– Warehouse Lot 29628 with the identifying code “PO#: 50558″
– Warehouse Lot 27713 with the identifying code “PO#: 49595″
– Warehouse Lot 27427 with the identifying code “PO#: 50032″
The FDA said Sunrise Commodities alerted its customers on Thursday to the results of the product tests and epidemiologic investigation, and asked them to notify their subsequent customers of the recall.
One of those was Badia Spices, which said it had repacked the Sunrise Commodities pine nuts and sold them in retail stores in Florida, New York, Pennsylvania, Maryland and New Jersey between June and October.
In a separate news release, Badia Spices said it is recalling about 3,800 pounds of the following lots:
– (UPC) 033844 00068 – 1 oz Pine nuts in small plastic bags Lot # 84666
– (UPC) 033844 00733 – 2 oz Pine nuts in PET bottles Lot # 83184, 85442
For more information on that recall consumers may contact Badia Spices at 305-629-8000 from 8 a.m. to 4:30 p.m. EST Monday through Friday or via email: info@badiaspices.com.
Publix is recalling pine nuts supplied by Badia Spices. The recalled pine nuts were sold in 1-oz small plastic bags (Lot #84666) and 2-oz PET bottles (Lot #83184 and 85442).
Meanwhile, the Canadian Food Inspection Agency is warning the public not to eat certain David Roberts brand and Sysco brand pine nuts that may be contaminated with Salmonella. See the news release describing the products here.
The FDA said “additional recalls may take place.” Unlike the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS), which routinely publishes retail distribution lists, FDA officials generally recommend that consumers ask their retailers about recalled products.
“If consumers have Turkish pine nuts or products containing Turkish pine nuts and are not sure if the pine nuts are part of Sunrise Commodities’ recall,” the FDA advised in its news release, “then they should contact the store where the food item was purchased or throw the product away.”
Two of four confirmed cases of E. coli O157:H7 involving residents of Boone County, Missouri could be related to the St. Louis outbreak, the Columbia/Boone County Department of Public Health said Friday.
Columbia/Boone health officials say testing is not complete. In one case matching the outbreak strain, the person has not been to St. Louis lately, so the case technically does not meet the outbreak criteria established by the federal Centers for Disease Control (CDC).
In the other case, the Boone County resident recently returned from St. Louis, but those test results also are still underway.
After the Missouri Department of Health and Senior Services (DHSS) reported Thursday that three confirmed E. coli cases in Boone County were not connected to the St. Louis outbreak, further work confirmed a fourth case and turned up the possible connection to the outbreak 125 miles to the east.
Columbia/Boone County health officials have also sent a fifth specimen to the state health lab for confirmation, but those test results are still pending.
Home of the main campus of the University of Missouri, Columbia is midway across the state, putting it within easy reach of both St. Louis to the east and Kansas City to the west.The city/county health officials in the college town are urging anyone experiencing symptoms such as stomach cramps, diarrhea or nausea to seek medical attention.
Missouri health officials have not yet been able to identify the source of the E. coli bacteria that is making people in the state sick. The St. Louis outbreak involves at least 25 cases, including 19 that have required hospitalization. One case of hemolytic uremic syndrome (HUS), which threatens the kidneys, is also being treated.
