E. coli Blog - Surveillance & analysis on e. coli news & outbreaks

The California Department of Public Health (CDPH) issued a letter on January 17, 2012 to Mark McAfee, CEO of Organic Pastures Dairy in Fresno, California, explaining the link between his company’s raw milk products and a cluster of E. coli O157:H7 infections in California children. The letter further detailed problems found at the facility, including the isolation of a matching strain of E. coli to the ill children.

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.”

Over at Outbreak Database, we have been keeping track of foodborne illness outbreaks – small and large – over the last 12 months.  Here are some of the more interesting E. coli Outbreaks:

Organic Pastures Unpasteurized, Raw Milk November 2011 – 5 Ill.  Raw milk products produced by Organic Pastures were recalled and quarantined by the state of California after five children were infected with the same strain of E. coli O157:H7 and drinking Organic Pastures raw milk. The children were residents of Contra Costa, Kings, Sacramento, and San Diego counties. The only common food exposure was the unpasteurized raw milk. Laboratory sampling failed to detect E. coli O157:H7. The recall was ordered strictly on the basis of the epidemiologic findings of the California Department of Public Health. Organic Pastures was implicated in an earlier outbreak of E. coli O157:H7, in 2006; the E. coli O157:H7 implicated in this outbreak was different than the strain implicated in 2006.

Cozy Vale Creamery Raw, Unpasteurized Milk Products November 2011 – 3 Ill.  Cozy Vale Creamery’s raw milk products were recalled due to their link to an outbreak of E. coli O157:H7 in Washington State that began in August. Cozy Vale Creamery’s whole and skim milk and cream were distributed through seven retail outlets in Pierce, Thurston and King counties. The recalled products had sell-by dates of December 6 or earlier. The Washington State Department of Agriculture discovered that locations in the milking parlor and processing areas were contaminated with the outbreak strain of E. coli O157:H7 bacteria. The milk products were sold at the farm store and at Marlene's Market in Tacoma, two Olympia Food Co-Op locations in Olympia, Olympia Local Foods in Tumwater, Yelm Co-op in Yelm, Mt. Community Co-op in Eatonville and Marlene's Market in Federal Way. Retail raw milk is legal to buy and sell in Washington State.

Multistate Schnucks Salad Bars, College Campuses Romaine Lettuce October 2011 – 60 Ill.  An outbreak of E. coli O157:H7 was first identified in the region around Saint Louis, Missouri. Cases were found in Saint Louis, Jefferson, Saint Charles, and Saint Clair counties and in the city of Saint Louis. The cases ranged in age from 1 to 94. At least six persons were hospitalized. Many of the cases had eaten items from salad bars prior to becoming ill. On October 28, Illinois state health officials revealed that they were investigating an illness that might be linked to the outbreak in Missouri. The link was not described. On October 31, health department officials acknowledged that Schnucks salad bars were a focus of the investigation, however other sources had not been excluded. Cases were identified in Minnesota and Missouri that were linked to college campuses. Additional cases were found in other states; the exposure location in these states was not described. Traceback analysis determined that a common lot of romaine lettuce, from a single farm, was used to supply the Schnucks' grocery stores and the college campuses. The lettuce was sold to Vaughn Foods, a distributor, that supplied lettuce to the university campus in Missouri, but records were not sufficient to confirm that this lot was sent to this university campus. Preliminary findings of investigation at farm did not identify the source of the contamination.

Jaquith Strawberry Farm Strawberries September 2011 – 15 Ill.  An outbreak of E. coli O157:H7 was linked to eating fresh strawberries produced by Jaquith Strawberry Farm, in Oregon. The farm sold berries to buyers who in turn distributed them to roadside stands and farmers' markets in Multnomah, Washington, Clackamas, Yamhill, and Clatsop counties. The berries were sold in unmarked containers and were last distributed on August 1. Confirmed cases included residents of Washington, Clatsop, and Multnomah counties. Strawberries had not previously been implicated in an E. coli O157:H7 outbreak in the U.S. Ten percent of the environmental samples collected at the Jaquith Strawberry Farm tested positive for E. coli O157:H7. Those samples included deer feces; deer were suspected to be the source of the contamination. The outbreak strain was found in samples from fields in three separate locations.

Tyson Fresh Meats Ground Beef September 2011 – 4 Ill.  An outbreak of E. coli O157:H7 was associated with eating ground beef in a private home in Butler County, Ohio. A consumer sample of leftover ground beef was tested and confirmed the presence of the outbreak strain of E. coli O157:H7. On September 27, Tyson Fresh Meats issued a voluntary recall of 131,300 pounds of ground beef. The recall involved beef sold as Kroger brands at Kroger Company supermarkets; Butcher's Beef at Food Lion supermarkets; and generic beef sold to Save-A-Lot, Spectrum Foods, Supervalu and the Defense Commissary Agency.

J & B Meats Ground Beef July 2011 – 2 Ill.  J & B Meats recalled ground beef after an investigation into two cases of E. coli O157:H7 linked the product to the illnesses. The beef had been sold to restaurants in the Cincinnati, Ohio, region.

McNees Meats and Wholesale LLC Ground Beef July 2011 – 9 Ill.  An outbreak of E. coli O157:NM was attributed to the consumption of ground beef produced by McNees Meats and Wholesale, LLC, of North Branch, Michigan. The implicated beef was sold to restaurants through a retail establishment owned by McNees Meats and Wholesale, LLC. Illnesses were reported from Genesee, Isabella, Lapeer, and Sanilac counties.

Jason's Deli Guacamole April 2011 – 11 Ill.  Patrons of Jason's Deli in Killeen, Texas, became ill with E. coli O157:H7 bacteria. The epidemiologic investigation revealed that guacamole made on April 13 was the most likely cause of the outbreak. The guacamole had been used as a sandwich spread for the California Club sandwich. The guacamole had likely become contaminated at the deli.

Palmyra Bologna Company Lebanon Bologna January 2011 – 21 Ill.  On March 23, the Centers for Disease Control announced that there was an investigation underway into an outbreak of E. coli O157:H7 that had been epidemiologically linked to the consumption of Lebanon bologna. The Palmyra Bologna Company, of Palmyra, Pennsylvania, issued a recall of the product on March 22. Lebanon bologna is a fermented, semi-dry, sausage. The suspect bologna was produced in December 2010, and had been shipped to five states.

The CDC reported today that 60 persons have been infected with the outbreak strain of E. coli O157:H7 in 10 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 (Schnucks) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached Schnucks locations.

Ill persons reported purchasing salads from salad bars at Schnucks between October 5 and October 24, 2011. A total of 9 locations of Schnucks 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. Romaine lettuce served on salad bars at all locations of Schnucks 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 Schnucks 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 Schnucks 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 Schnucks 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.

From the Seattle Weekly:

2011 began with a legislative effort to relax restrictions on raw milk sales, and is ending with a reminder of why so many scientists oppose such measures.

Although State Sen. Kevin Ranker's bill exempting small-scale dairies from raw milk regulations is languishing in committee - "it fizzled out pretty quickly," Democratic Caucus spokesperson Michael Althauser says - the state still has among the nation's most liberal raw milk laws. Washington is one of 10 states in which raw milk can be legally sold at grocery stores.

Tenino's Cozy Vale Creamery, now the subject of an E. coli-related recall, sold its products at seven co-ops and natural foods stores around the Puget Sound, including Marlene's Market in Federal Way. The Washington State Department of Agriculture last week initiated the recall after finding E. coli in the dairy's milking parlor and processing area. Three illnesses have been linked with the contamination.

The Cozy Vale outbreak was the fourth raw milk outbreak in Washington since 2005, and the eighth in the U.S. this year: In 2011, more than 100 people nationwide were seriously sickened by raw milk.

"Raw milk is one of those food products, like raw hamburger, that really is just inherently dangerous," says Seattle food safety attorney Bill Marler, whose name recently appeared on New York Times columnist Mark Bittman's list of reasons for food activists to be thankful. Marler has been contacted by two of the families affected by the Cozy Vale outbreak.

"These are not bellyaches," Marler says. "This is acute kidney failure. These are very sick kids."

According to Marler, the proximity of a cow's udder to fecal matter makes it impossible to eliminate the risk of E. coli. Food safety experts hail pasteurization as the obvious solution: In the years before pasteurization standards were widely adopted, milk was the source of one-quarter of traceable food and waterborne illnesses. Milk now accounts for fewer than one percent of such illnesses.

But eaters who are wary of big ag and government interference in the food system have made a totem of raw milk, which often represents the end stage of an experimentation process that starts with filtered water and organic vegetables. Many raw milk devotees loudly credit the drink with elevating their health and restoring their happiness.

"There's a level of passion I find to be almost religious in its fervor," Marler says. "When I put up something on my blog about listeria, I won't get any comments. But when I post something about raw milk, I'll get 10, 15, 20 comments, most of them nasty."

Whole Foods last year stopped selling raw milk products, citing a need to develop nationwide corporate standards for the category. But Marler says few small natural food grocers have publicly followed suit, perhaps because they fear a backlash from raw milk believers.

"(Hemolytic Uretic Syndrome) cases are millions of dollars," Marler says. "The co-ops that sold this milk have enormous risks."

The risks are heightened, Marler says, by the common practice of shelving raw milk alongside pasteurized milk. Although Cozy Vale's customers aren't claiming they were misled into purchasing raw milk, Marler says a buyer told him, "I couldn't tell the difference."

Washington law mandates a warning label on raw milk.

"Unfortunately, maybe we can read the label," Marler says. "But kids don't have a chance against what mom and dad put in the kitchen."

November 2011

According to a California State Department of Health release, raw milk products produced by Organic Pastures of Fresno County are the subject of a statewide recall and quarantine order.

Under the recall, all Organic Pastures raw dairy products with the exception of cheese aged a minimum of 60 days are to be pulled immediately from retail shelves and consumers are strongly urged to dispose of any products remaining in their refrigerators. Until further notice, Organic Pastures may not produce raw milk products for the retail market. The order also affects Organic Pastures raw butter, raw cream, raw colostrum, and a raw product labeled “Qephor.”

The quarantine order came following a notification from the California Department of Public Health of a cluster of five children who were infected, from August through October, with the same strain of E. coli O157:H7. These children are residents of Contra Costa, Kings, Sacramento, and San Diego counties. Interviews with the families indicate that the only common reported food exposure is unpasteurized (raw) milk from Organic Pastures dairy. Three of the five children were hospitalized with hemolytic uremic syndrome, a serious condition that may lead to kidney failure. There have been no deaths. Surveys indicate that only about three percent of the public report drinking raw milk in any given week so finding 100% of these children drank raw milk and the absence of other common foods or animal exposures indicates the Organic Pastures raw milk is the likely source of their infection.

While laboratory samples of Organic Pastures raw milk have not detected E. coli O157:H7 contamination, epidemiologic data collected by the California Department of Public Health link the illnesses with Organic Pastures raw milk.

September 2006

Raw milk produced by Organic Pastures of Fresno County is the subject of a statewide recall and quarantine order.

Under the recall, all Organic Pastures whole and skim raw milk is to be pulled immediately from retail shelves and consumers are strongly urged to dispose of any product remaining in their refrigerators. Until further notice, Organic Pastures may not produce raw milk for the retail market. The order also affects Organic Pastures raw cream and raw colostrum.

The quarantine order came following a report that raw milk caused bacterial illness in a 10-year old girl in San Bernardino County. An investigation by the California Department of Health Services detected two additional bacterial illnesses in children consuming raw milk, one a 7-year old Riverside County boy, and the other an 8-year old San Diego County girl.

Doctors treating the children have identified the bacteria as E. coli O157:H7. While laboratory samples of Organic Pastures raw milk have not detected E. coli O157:H7 contamination, epidemiologic data collected by the Department of Health Services points to a link with Organic Pastures raw milk. Additional laboratory samples of Organic Pastures raw milk are pending.

It is not believed there is any connection with the recent E. coli O157:H7 contamination in fresh spinach. Typing of lab samples from one of the children shows a different strain than the one found in the spinach outbreak.

Of the three afflicted children, one has been hospitalized and released. The other two remain hospitalized.

Five years apart, but eerily similar.  For a bit(e) of history:

FYI - Organic Pastures Dairy E. coli O157:H7 Raw Milk Product Outbreak 2006

And - Organic Pastures - "Where There is Smoke, There is Fire."