The South Carolina Department of Health and Environmental Control (DHEC) is requesting heightened surveillance for persons presenting with symptoms consistent with Shiga toxin producing E. coli (i.e., enterohemorrhagic E. coli), including diarrhea that is often bloody, hemolytic uremic syndrome (HUS) in children or thrombocytopenia purpura in adults.

DHEC is investigating an outbreak of Shiga toxin-producing Escherichia coli (STEC) related to dining at a Spartanburg-area Mexican restaurant during the last week of April, 2012. Preliminary lab results indicate the E. coli serotype being O157:H7. Of the 3 cases interviewed thus far, two reported the infection has progressed to hemolytic uremic syndrome (HUS), a severe condition associated with STEC infection that can lead to kidney failure. Interviews with an additional 8 cases are in progress.

Yesterday, Cleveland Beansprouts Co., Cleveland, recalled alfalfa sprouts because of possible listeria contamination.  No lot codes or any other identifier are on the sprouts, which were distributed in Ohio, according to a company news release posted on the Food and Drug Administration’s website.

And a few months, a total of 29 persons infected with the outbreak strain of STEC O26 were reported from 11 states linked to sprouts.

• The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Iowa (5), Kansas (2), Michigan (10), Missouri (3), Ohio (3), Pennsylvania (1), Washington (1), Wisconsin (1), and West Virginia (1).
• Seven ill persons have been hospitalized.

6-year-old Ramsey King is one of three kindergarten students at Stanford Elementary recovering from suspected E. coli exposure. King is one of two children still at UK Hospital where doctors have already confirmed at least one of the cases as E. coli.

School officials insist Stanford Elementary followed all safety procedures, prompting health investigators to continue looking for the source of the problem.

Prior School Outbreaks:

Finley Elementary School E. coli Outbreak - Washington

Robeson Schools E. coli Outbreak - North Carolina

Prior Daycare/School Settings:

Kid’s Korner Daycare E. coli Outbreak - Missouri

Kindercare E. coli Outbreak - California

CCC Alternative Learning Daycare E. coli Outbreak - Texas

According to the Tennessee Department of Health, three juveniles, all of whom attend the same daycare facility in Newport, were diagnosed with E. coli symptoms.

The source of the bacteria is currently unknown, but managers of the facility are working with investigators, and the families of all children who attend the daycare have been contacted.

State health department officials have not closed the facility, but are continuing to investigate the situation.

There have been a few other Day Care E. coli O157:H7 Outbreaks some with severe consequences - hemolytic uremic syndrome (HUS):

• CCC Alternative Learning Daycare E. coli Outbreak - Texas

• Kid’s Korner Daycare E. coli Outbreak - Missouri

• Kindercare E. coli Outbreak - California

Illnesses in the ongoing E. coli O157:H7 outbreak in central Missouri rose to 15 on Friday, while information on the individual infections suggests they may come from multiple sources. Of the 15 cases, seven individuals have reported that they consumed raw milk products from a single dairy in Howard County. As a result, the dairy has been under investigation and has halted sales of its raw milk products. The E. coli infections in six of those seven raw milk drinkers have shown to match by their identifiable genetic pattern known as a pulsed-field gel electrophoresis (PFGE).

The infection of the seventh raw milk drinker, the newest addition to the total number ill, has a different PFGE pattern, though one that is very similar to the other six, according to epidemiologist Sarah Rainey at Missouri's Columbia-Boone County Health Department. Of the other eight illnesses, the ones who did not report consuming raw milk products, only one individual has a PFGE pattern matching the raw milk drinkers. The other seven infections vary genetically or have not returned a PFGE reading.

The newest case in the outbreak is a child under 18 from Boone County who was hospitalized from the infection but has since been released. A 2-year-old from Boone County has been hospitalized for more than two weeks after developing symptoms of hemolytic uremic syndrome (HUS), a kidney disease associated with severe E. coli infections.

As of December 4, 2011, 60 persons infected with the outbreak strain of E. coli O157:H7 have been reported from10 states. The number of ill persons identified in each state is as follows: Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3), Missouri (37), and Nebraska (1).

Among persons for whom information is available, illnesses began from October 10, 2011 to November 4, 2011. Ill persons ranged in age from 1 to 94 years, with a median age of 29 years old. Sixty-three percent were female. Among the 45 ill persons with available information, 30 (67%) were hospitalized, and 2 developed hemolytic uremic syndrome (HUS). No deaths have been reported.

Collaborative investigative efforts of state, local, and federal public health agencies indicate that romaine lettuce sold primarily at several locations of a single grocery store chain (Chain A) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached grocery store Chain A locations.

During October 10 to November 4, 2011, public health officials in several states and CDC conducted an epidemiologic study by comparing foods eaten by 22 ill and 82 well persons, including 45 well persons who shopped at grocery store Chain A during the week of October 17, 2011. Analysis of this study indicates that eating romaine lettuce was associated with illness. Ill persons (85%) were significantly more likely than well persons (46%) to report eating romaine lettuce in the week before illness. Ill persons (86%) were also significantly more likely than well persons (55%) to report shopping at grocery store Chain A. Among ill and well persons who shopped at grocery store Chain A, ill persons (89%) were significantly more likely than well persons (9%) to report eating a salad from the salad bar at grocery store Chain A. Several different types of lettuce were offered on the salad bar at grocery store Chain A. Of 18 ill persons who reported the type of lettuce eaten, 94% reported eating romaine lettuce. No other type of lettuce or other item offered on the salad bar was reported to be eaten by more than 55% of ill persons.

Ill persons reported purchasing salads from salad bars at grocery store Chain A between October 5 and October 24, 2011. A total of 9 locations of grocery store Chain A were identified where more than one ill person reported purchasing a salad from the salad bar in the week before becoming ill. This included 2 separate locations where 4 ill persons reported purchasing a salad at each location. For locations where more than one ill person reported purchasing a salad from the salad bar and the date of purchase was known, dates of purchase were all within 4 days of other ill persons purchasing a salad at that same location. Chain A fully cooperated with the investigation and voluntarily removed suspected food items from the salad bar on October 26, 2011, out of an abundance of caution. Romaine lettuce served on salad bars at all locations of grocery store Chain A had come from a single lettuce processing facility via a single distributor. This indicates that contamination of romaine lettuce likely occurred before the product reached grocery store Chain A locations.

The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of grocery store Chain A and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply the grocery store Chain A locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus. Preliminary findings of investigation at Farm A did not identify the source of the contamination. Farm A was no longer in production during the time of the investigation.

Oregon Public Health officials today report test results of samples taken from Foundation Farm cows, manure and surfaces as well as raw milk from a farm customer are positive for E. coli O157.

The samples came from leftover milk recovered from one household, rectal swabs from two of four cows, and multiple manure and other environmental samples collected at the farm.

“We continue to warn people to not drink the raw milk or any products made from the raw milk that came from this farm or any other source. Pasteurized milk is the only safe milk because it kills harmful bacteria such as E. coli O157,” said Oregon Public Health State Epidemiologist Katrina Hedberg, M.D., M.P.H.

Four children have been hospitalized. Three have hemolytic uremic syndrome, a type of kidney failure. The fourth child is waiting lab-confirmation. A total of five people, ages 1 to 14, have laboratory-confirmed cases of E. coli. Thirteen people have reported having diarrhea, but their cases have not been lab-confirmed. All drank raw milk from Foundation Farm.

Milk from Foundation Farm and raw cow’s milk in general cannot be sold in retail stores in Oregon. The dairy only distributed to 48 households that were part of a herd-share, in which people contract to take ownership of a portion of a herd or individual animals.

Besides the state, health officials in Clackamas, Washington and Multnomah counties and the Oregon Department of Agriculture are investigating these cases, including interviewing customers and family members of those infected.

E. coli O157 infections are characterized by diarrhea — sometimes bloody — and abdominal pain. Kidney failure and related complications may occur, especially among young children and the elderly. Symptoms usually develop within two to eight days of eating contaminated food. Antibiotics have not been shown to reduce the duration or severity of symptoms, and may increase the risk of kidney failure.

Three children with laboratory-confirmed infections have been hospitalized. A fourth child has lab-confirmed E. coli but has not been hospitalized. All of the children consumed raw unpasteurized milk obtained from Foundation Farm in Clackamas County. The farm has voluntarily ceased its milk distribution.

According to news reports over the last week, Missouri state health officials have confirmed nine cases of E. coli in Missouri.  Missouri Department of Health and Senior Services confirmed cases in Boone, Cooper, Howard, Camden and Jackson counties.

Health officials say a 2-year-old girl a 17-month-old child have developed symptoms of a condition that can cause kidney damage (Hemolytic Uremic Syndrome)

Investigators say consumption of raw dairy products is a "possible" factor in some (actually only four at this time) of the cases.

Raw Milk and Raw Milk Cheese Outbreaks since 2010 (Not including Missouri and Oregon:

Outbreaks 

- 24 raw dairy outbreaks with 309 illnesses, no deaths (22 fluid raw milk, 2 aged raw milk cheese) 

Recalls (no illnesses reported) 

- 14 raw dairy (7 fluid raw milk, 7 aged raw milk cheese)

For more information on the real risks of raw milk, see www.realrawmilkfacts.com.

Missouri public health officials announced Friday that E. coli-contaminated raw milk is the source of an E. coli outbreak that has resulted in 5 E. coli cases, 2 with HUS.  Anyone who has purchased raw milk should dispose of it immediately due to its potential to be contaminated with E. coli bacteria.

E. coli infection is a serious foodborne illness with symptoms including bloody diarrhea.  Individuals who become ill with E. coli – especially the very young and very old – can develop hemolytic uremic syndrome (HUS), which can cause kidney failure and central nervous system impairment.

Raw milk can be contaminated with E. coli during the milking process.  E. coli bacteria live in the intestines of cows and other ruminant animals, and are shed in their feces.  Pasteurization kills E. coli and other bacteria.

The Missouri E. coli outbreak is one of several raw milk-related E. coli outbreaks that have occurred over the last several years.  E. coli outbreaks in California, Connecticut, and other states have been traced to raw milk produced through both commercial milk producers and cow-share agreements.

The Marler Clark attorneys have represented several children and adults who became ill with E. coli infections or HUS after consuming raw milk in litigation against raw milk dairies and retailers who sold raw milk.  Read more about E. coli cases the law firm has been involved in and cases the Marler Clark attorneys have brought on behalf of Missouri E. coli outbreak victims on the Marler Clark Website.

E. coli are bacteria that can cause serious, sometimes fatal, infections in humans.  The Centers for Disease Control and Prevention (CDC) estimates that E. coli causes 2,000 hospitalizations in the United States each year.  Ten percent of E. coli victims develop hemolytic uremic syndrome (HUS), which can cause kidney failure, damage to the central nervous system, and ultimately death.

The Marler Clark E. coli lawyers have unmatched experience representing victims of E. coli and HUS.  We have represented hundreds of victims of E. coli outbreaks traced to foods such as hamburgers, spinach, raw milk, water, and food served at restaurants.  The Marler Clark E. coli lawyers are the only lawyers in the nation with a practice focused exclusively on plaintiff foodborne illness litigation.

Our E. coli lawyers have represented victims of notable E. coli outbreaks such as the 2006 Dole Spinach E. coli outbreak, the 2007 Cargill beef E. coli outbreak, and the landmark 1993 Jack in the Box E. coli outbreak. Contact us today to learn more about our services.

• AFG / Supervalu E. coli Outbreak - Minnesota
• AgVenture Farms Petting Zoo E. coli O157:H7 Outbreak Litigation - Florida
• Aunt Mid’s Lettuce E. coli outbreak -  Michigan, Illinois, and Ontario
• Bauer Meat E. coli Litigation - Georgia
• Baugher’s Apple Cider E. coli Outbreak - Maryland
• Big Fresno Fair E. coli Outbreak - California
• BJ’s Wholesale Club E. coli Litigation - New York and New Jersey
• Bravo Farms Gouda Cheese E. coli Outbreak - Southwestern US
• California Romaine Lettuce E. coli Outbreak - Washington State
• Camp Bournedale-South Shore Meats E. coli Outbreak - Rhode Island, Massachusetts
• Cargill E. coli Outbreak - Nationwide
• Carneco / Sam’s Club E. coli Outbreak - Wisconsin & Minnesota
• CCC Alternative Learning Daycare E. coli Outbreak - Texas
• China Buffet E. coli Outbreak - Minnesota
• ConAgra Ground Beef E. coli Outbreak - Nationwide
• Country Cottage Restaurant E coli O111 Outbreak - Oklahoma
• Cozy Valley Raw Milk E. coli Outbreak - Washington State
• Crossroads Farm Petting Zoo E. coli Outbreak - North Carolina
• Cuyahoga County E. coli and HUS outbreak - Ohio
• Dee Creek Farm E. coli Outbreak - Washington & Oregon
• Dole Lettuce E. coli Outbreak - Minnesota, Wisconsin, and Oregon
• Dole Spinach E. coli Outbreak - Nationwide
• Dungeness Valley Creamery E. coli Outbreak - Washington State
• Emmpak E. coli Outbreak - Wisconsin
• Excel E. coli Outbreak - Georgia
• Fairbank Farms E. coli Outbreak - New England
• Finley Elementary School E. coli Outbreak - Washington
• Flanders Provision Co. E. coli Outbreak - Colorado, Nationwide
• Forest Ranch Fire Department Fundraiser E. coli Outbreak - California
• Freshway Lettuce E. coli 0145 outbreak - Michigan, Ohio, New York, Tennessee, and Pennsylvania
• Fresno Meat Market E. coli Outbreak - California
• Gold Coast Produce E. coli Outbreak - California
• Golden Corral E. coli Outbreak - Nebraska
• Habaneros E. coli Outbreak - Missouri
• Herb Depot & Autumn Olives Farm Raw Milk E. coli Outbreak - Missouri
• Interstate Meat E. coli O157:H7 Outbreak - Oregon, Washington & Idaho
• Ixtapa Mexican Restaurant E. coli outbreak - Washington State
• Jack in the Box E. coli Outbreak - Western States
• JBS Swift E. coli Outbreak - Nationwide
• Jimmy John’s and Sprouts Extraordinaire E. coli Outbreak - Colorado
• Jimmy John’s Clover Sprouts E. coli O26 Outbreak - Multistate
• Karl Ehmer Meats E. coli Outbreak – New Jersey
• KFC E. coli Outbreak - Ohio
• Kid’s Korner Daycare E. coli Outbreak - Missouri
• Kindercare E. coli Outbreak - California
• King Garden Restaurant E. coli Outbreak - Ohio
• Lane County Fair E. coli Outbreak - Oregon
• National Steak and Poultry E. coli O157:H7 outbreak - nationwide
• Nebraska Beef E. coli Outbreak - Minnesota (2006)
• Nebraska Beef E. coli Outbreak - Nationwide (2008)
• Nestle Toll House Cookie Dough E. coli Outbreak - Nationwide
• Odwalla E. coli Outbreak - Western States
• Olive Garden E. coli Outbreak - Oregon
• Organic Pastures E. coli Outbreak - California
• Parsley E. coli Outbreak - Washington & Oregon
• Peninsula Village E. coli Outbreak - Tennessee
• PM Beef Holdings, Lunds & Byerly’s E. coli Outbreak - Minnesota
• Robeson Schools E. coli Outbreak - North Carolina
• Robinswood Pointe Senior Living Facility E. coli Outbreak - Washington
• Rochester Meat Company E. coli Outbreak - Wisconsin, California
• Rocky Mountain Natural Meats Bison E. coli Outbreak - Colorado, New York
• S & S Foods - Goshen Boy Scout Camp E. coli Outbreak - Virginia
• Sizzler E. coli Outbreak - Wisconsin
• Sodexho Spinach E. coli Outbreak - California
• Spokane Produce E. coli Outbreak - Washington, Oregon, Idaho
• Stop & Shop E. coli Case - New Hampshire
• Taco John’s E. coli Outbreak – Iowa and Minnesota
• Topps and Price Chopper E. coli Case - New York
• Topps Meats E. coli Outbreak - Nationwide
• United Food Group E. coli Outbreak - Western States
• Valley Meats E. coli Outbreak - Ohio, Illinois, Pennsylvania
• Wendy’s E. coli Outbreak - Oregon
• Wendy’s E. coli Outbreak - Utah
• White Water Water Park E. coli Outbreak - Georgia

The Missouri Department of Health and Senior Services (DHSS) is investigating an increase in cases of Shiga toxin-producing Escherichia coli (STEC) in Central Missouri during late March and early April, 2012. Five cases of E. coli O157:H7 have been identified during this time period. Two of the cases, a two-year old child and a seventeen-month old child, reportedly have developed hemolytic uremic syndrome (HUS), a severe, life-threatening condition that may result in permanent kidney damage in some of those who survive.

The investigation is ongoing and the source of the infections has not been identified.

DHSS recommends that any person who has signs or symptoms of STEC infection should seek medical care. Health care providers should determine if testing for STEC infection is warranted.

Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody), and vomiting. If there is fever, it usually is not very high. Most patients' symptoms improve within 5–7 days, but some patients go on to develop HUS, usually about a week after the diarrhea starts. The classic triad of findings in HUS is acute renal damage, microangiopathic hemolytic anemia, and thrombocytopenia.

Among 29 ill persons, illness onset dates ranged from December 25, 2011 to March 3, 2012. Ill persons range in age from 9 years to 57 years old, with a median age of 26 years. Eighty-nine percent of ill persons are female. Among the 29 ill persons, 7 (24%) were hospitalized. None have developed HUS, and no deaths have been reported.

• 10 lb. boxes of PRIME RIB BEEF PATTIES 8 oz, with product code 55317, and production code 11 NO 22

• 10 lb boxes of PRIME RIB BEEF PATTIES 71g, with product code 55391 and bearing a production code of 11 SE 01 or 12 JA 04

Imported products were produced by New Food Classics, CFIA Establishment 761 of Saskatoon, Ontario and were imported by Sysco Food Services to a distribution center in Blaine, Wash. for use by food service institutions.

FSIS has been unable to make contact with Sysco Food Services to discuss a recall of this product, so the agency is issuing a Public Health Alert to inform food service  operations and consumers. FSIS will continue to provide information as it becomes available, including information about any related recall.

During October 10 to November 4, 2011, public health officials in several states and CDC conducted an epidemiologic study by comparing foods eaten by 22 ill and 82 well persons, including 45 well persons who shopped at grocery store Chain A during the week of October 17, 2011. Analysis of this study indicated that eating romaine lettuce was associated with illness. Ill persons (85%) were significantly more likely than well persons (46%) to report eating romaine lettuce in the week before illness. Ill persons (86%) were also significantly more likely than well persons (55%) to report shopping at grocery store Chain A. Among ill and well persons who shopped at grocery store Chain A, ill persons (89%) were significantly more likely than well persons (9%) to report eating a salad from the salad bar at grocery store Chain A. Several different types of lettuce were offered on the salad bar at grocery store Chain A. Of 18 ill persons who reported the type of lettuce eaten, 94% reported eating romaine lettuce. No other type of lettuce or other item offered on the salad bar was reported to be eaten by more than 55% of ill persons.

The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of grocery store Chain A and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply the grocery store Chain A locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus.

The number of ill persons identified in each state is as follows: Alabama (1), Iowa (5), Missouri (3), Kansas (2), Michigan (9), Arkansas (1), Ohio (3), and Wisconsin (1).

Six ill persons have been hospitalized, and no deaths have been reported.

Results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John's restaurants is the likely cause of this outbreak.

Epidemiologic and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies have linked this outbreak to eating raw clover sprouts. Among the 11 ill persons with information available, 10 (91%) reported eating at a Jimmy John's sandwich restaurant in the 7 days preceding illness. Ill persons reported eating at 9 different locations of Jimmy John's restaurants in 4 states in the week before becoming ill. One location was identified where more than one ill person reported eating in the week before becoming ill. Among the 10 ill persons who reported eating at a Jimmy John's restaurant location, 8 (80%) reported eating a sandwich containing sprouts, and 9 (90%) reported eating a sandwich containing lettuce. Currently, no other common grocery stores or restaurants are associated with illnesses.

Between September 16, 2008, and October 4, 2008, Boulder County Public Health (BCPH) received a total of 19 confirmed and suspect cases of Shiga toxin producing E. coli (STEC) O157:NM. Of those cases, 14 were lab confirmed to have matching PFGE patterns, and the pattern was unlike any other reported outbreak. Because most of the cases in this outbreak became ill at a Boulder Jimmy John’s Restaurant, Boulder County Public Health lead the investigation into the outbreak. Ultimately, in addition to the 19 confirmed Boulder County cases, one case was identified in each of the following counties: Arapahoe, Broomfield, Jefferson and Weld. BCPH reported: “Of the cases not in Boulder County, 2 of 4 (50%) reported eating food from a Jimmy John’s restaurant—one at the sorority house and one at a Jimmy John’s restaurant located in Adams County, Colorado. All 17 cases (100%) in Boulder County reported eating food from Jimmy John’s restaurant located in Boulder.” Based on their detailed traceback investigation, investigators ultimately found that one company, Sprouts Extraordinaire, had supplied alfalfa sprouts to not only the Boulder Jimmy John’s, but also the Federal Height’s (Adams County) Jimmy John’s, as well as the Pita Pit in Greeley, Colorado, where another PFGE matched case had consumed sprouts two days before onset of illness.

The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Arkansas (1), and Wisconsin (1).

Two ill persons have been hospitalized, and no deaths have been reported.

Preliminary results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John's restaurants is the likely cause of this outbreak.

Jimmy John's sprouts have been linked to earlier E. coli and Salmonella outbreaks.

The California Department of Public Health (CDPH) issued a letter

The letter provides the results of an environmental investigation conducted on November 15 and 16, 2011. CDPH explains that:

This investigation was initiated because of a cluster of illnesses in five children from four counties throughout California infected with E. coli O157:H7 having an identical, uncommon PFGE pattern. Illness dates for these cases extends from August 25 through October 25, 2011….

The sickened children ranged in age from one to five years. Three of the children developed the potentially fatal complication of hemolytic uremic syndrome (HUS).

CDPH further explained that:

Epidemiological information indicated that the only common exposure all five had prior to illness onset was consumption of OPDC (Organid Pastures) raw milk…indicating a strong epidemiologic link between the raw milk exposure and illness.

The Food and Drug Branch, FDB, collected samples during the inspection of manure, colostrum, water, soil, and surfaces at the plant. 10 of those samples were positive for E. coli O157:H7. Two of the isolates matched the outbreak strain isolated from the five children. CDPH wrote that “the fact that E. coli O157:H7 identical to the outbreak strain was recovered from OPDC environment supports the probability that the OPDC raw milk that the case patients consumed was similarly contaminated leading to their illnesses.”

In another disturbing revelation, CDPH reported that samples of colostrum from the facility revealed shiga-toxin producing pathogens. The isolate of the shiga-toxin was so rare that California was unable to serotype at their laboratory, and has sent it to the CDC.

There were problems beyond the samples. The FDB inspection revealed deficiencies in the milk bottling room, milk storage rooms, bottle labeler room, kefir room, as well as milk storage silos. Some examples of deficiencies cited by FDB included:

Failure to maintain equipment in good repair and in sanitary conditions;

Failure to product products from potential contamination;

Failure to effectively exclude pests from the facility;

Failure to maintain milk storage areas in good repair and sanitary condition.

The letter concluded by informing Organic Pastures that it must “provide adequate documentation that the deficiencies noted in the inspection have been mitigated and systemic procedures have been implemented to prevent their reoccurrence.”