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“Chicken Salad made with Rotisserie Chicken” from Costco has been connected with at least one case of E. coli O157:H7 in Washington. Consumers who purchased this product – item number 37719 – from any Washington Costco location should discard it.

The Department of Health, along with the Centers for Disease Control and Prevention (CDC) and other western states, are investigating E. coli illnesses from chicken salad purchased from various Costco stores in late October. Washington has confirmed one case of E. coli O157:H7 from King County, who became ill in late October. This confirmed case was not hospitalized.

“We take E. coli very seriously in Washington,” said State Epidemiologist Dr. Scott Lindquist, “and we are working with CDC and state partners to determine the source.”

Others states with confirmed E. coli cased linked to Costco chicken salad include Colorado, Montana, and Utah. In addition to CDC, the U.S. Food and Drug Administration and U.S. Department of Agriculture are working with Costco to determine the source of the contamination.

People who have eaten this product and feel ill should consult with their health care provider. If you have leftover product in your refrigerator or freezer do not eat it and discard the product. People usually get sick 2-8 days after getting E. coli. Only people who have symptoms should see a health care provider.

Most people infected with E. coli develop diarrhea – often bloody – and abdominal cramps. Most people recover within a week. Some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS).  HUS can occur in people of any age, but is most common in young children under five, older adults, and people with weakened immune systems. Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination. People who have these symptoms should seek emergency medical care immediately. Antibiotics and antidiarrheal medicines should not be given unless E. coli is ruled out, since they may increase the risk of HUS in people with E. coli infections.

An E. coli 0157:H7 outbreak that sickened nearly two dozen people and prompted a popular south-Reno restaurant to voluntarily close has been linked to a dessert food manufactured, sold, and distributed by Reno Provisions according to Health District officials.

“Our epidemiologists and environmental health staff have identified a dessert that was prepared by Reno Provisions,” said Washoe County District Health Officer Kevin Dick. “Several people who ate at the Twisted Fork restaurant had the dessert, as did some other people outside the Reno area who then developed the E. coli infection. That commonality led investigators to the dessert supplier, and to tests of food and equipment at Reno Provisions,” Dick added.

Now that positive test results have identified a specific E. coli source, the Health District’s investigation has shifted focus from the restaurant to the manufacturer. The Health District confirms that all of the remaining desserts associated with the E. coli contaminations have been disposed of.

Since mid-October twenty-one confirmed and probable cases of E. coli 0157:H7 have been reported in Washoe County.  “The complete cooperation and engagement in the investigation that we received from Twisted Fork, and their decision to voluntarily close, were significant factors in identifying the E. coli source,” said Dick.

On November 12, the CDC reported fifty ill people from Washington (31) and Oregon (19) from Shiga toxin-producing Escherichia coli O26 (STEC O26) infections. Fourteen people have been hospitalized in Washington (10) and Oregon (4) linked to Chipotle restaurants in Oregon and Washington.

Today the CDC reported that Public health officials in Washington, Oregon, and Minnesota announced that that are continuing the investigation of an outbreak of Shiga toxin-producing Escherichia coli O26 (STEC O26) infections. CDC and the U.S. Food and Drug Administration (FDA) are assisting with the investigation. As of November 17, 2015, 37 people infected with the outbreak strain of STEC O26 have been reported to CDC PulseNet from Washington (24) and Oregon (13). 13 of these people were hospitalized in Washington (9) and Oregon (4). Additional illnesses are under investigation by Washington and Oregon and will be reported if they are confirmed to be infected with the outbreak strain of STEC O26.

There have been no reported infections with the outbreak strain of STEC O26 in Washington or Oregon since the Chipotle Mexican Grill locations closed in the Pacific Northwest on October 30, 2015. A search of the PulseNet database identified one person in Minnesota infected with STEC O26 that has the same DNA fingerprint as ill people in Washington and Oregon. This ill person did not eat at a Chipotle Mexican Grill in the week before illness onset. Minnesota’s investigation is ongoing. The illness does not appear to be linked to Chipotle Mexican Grill locations in Washington and Oregon.

Washington and Oregon report that nearly all of the ill people ate at several locations of Chipotle Mexican Grill in those states before getting sick. The investigation is still ongoing to determine if the ill people ate a meal item or ingredient in common that was served at the Chipotle Mexican Grill locations. Chipotle Mexican Grill reopened its restaurants in Washington and in the Portland, Oregon area that had been closed in response to this investigation.

Fifty ill people have been reported from Washington (31) and Oregon (19). Fourteen people have been hospitalized in Washington (10) and Oregon (4). There have been no reports of hemolytic uremic syndrome (HUS) and no deaths.

Thirty-three isolates from ill people in Washington (22) and Oregon (11) have been uploaded to the CDC PulseNet database. All 33 people were infected with STEC O26 that has the same DNA fingerprint. Additionally, as reported on November 6, a search of the PulseNet database identified one person in Minnesota infected with STEC O26 that has the same DNA fingerprint. This ill person did not eat at a Chipotle Mexican Grill in the week before illness onset. Minnesota’s investigation is ongoing. The illness does not appear to be related to the outbreak in Washington and Oregon linked to Chipotle Mexican Grill locations in those states. Whole genome sequencing, an advanced laboratory technique, is being used to give investigators more information about the DNA fingerprint of the pathogen causing illnesses in Washington, Oregon, and Minnesota.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview them. Updates will be provided when more information is available.

The investigation is still ongoing to determine if the ill people ate a meal item or ingredient in common that was served at the Chipotle Mexican Grill locations. Several food items collected from Chipotle Mexican Grill locations in Washington and Oregon are being tested by FDA and Chipotle for the presence of bacteria. As of November 12, 2015, test results have not identified E. coli in any of the food items tested. Additional results are pending and will be reported once available.

The case count in the investigation of an outbreak of E. coli O26 illnesses related to Chipotle restaurants in Washington and Oregon includes 30 Washington residents and 19 Oregon residents.

Five Chipotle restaurants in Washington are associated with this outbreak: Hazel Dell, 7715 NE 5th Avenue, Suite 109, in Vancouver; 1404 Broadway Avenue and 4229 University Way NE in Seattle; 512 Ramsey Way 101 in Kent; and 1753 S. Burlington Blvd. in Burlington.

In Oregon 19 sick have been reported from Multnomah, Clackamas, Washington, Columbia, Linn and Lane counties. Four people have been hospitalized and they range in age from 11 to 74. Associated Chipotle Restaurants: Cascade Station (9687 NE Cascades Pkwy), Washington Square (9120 SW Hall Blvd), Lake Oswego (8 Centerpointe Dr), Tanasbourne (2048 NW Stucki Ave), Sunnyside (Clackamas Town Center) and Gresham (2065 NE Burnside Rd).

Public health officials in Washington, Oregon, and Minnesota are investigating an outbreak of Shiga toxin-producing Escherichia coli O26 (STEC O26) infections. CDC and the U.S. Food and Drug Administration are assisting with the investigation. As of November 6, 2015:

  • 41 ill people have been reported from Washington (28) and Oregon (13).
  • 14 people have been hospitalized in Washington (10) and Oregon (4).
  • There have been no reports of hemolytic uremic syndrome (HUS) and no deaths.

Laboratory testing is ongoing to determine the DNA fingerprint of the STEC O26 bacteria making people sick. These DNA fingerprints are uploaded to the CDC PulseNet database as they become available.

16 isolates from ill people in Washington (13) and Oregon (3) have been uploaded to the CDC PulseNet database. All 16 people were infected with STEC O26 that has the same DNA fingerprint. Laboratory testing is continuing.

A search of the PulseNet database identified one person in Minnesota infected with STEC O26 that has the same DNA fingerprint. This ill person did not eat at a Chipotle Mexican Grill in the week before illness onset. Minnesota’s investigation is ongoing. At this time, the illness does not appear to be related to the outbreak in Washington and Oregon.

Washington and Oregon report that most of the ill people ate at several locations of Chipotle Mexican Grill in those states before getting sick.

The investigation is ongoing to determine if the ill people ate a common meal item or ingredient that was served at the Chipotle Mexican Grill locations.

The investigation into an outbreak of E. coli O26 illnesses linked to Chipotle restaurants in Washington and Oregon is up to 29 reported Washington cases. The latest update includes a case in an additional county, Whatcom.

The Washington State Department of Health continues working closely with local, state, and federal partners on a disease investigation to learn the extent of the outbreak and possible sources of E. coli bacteria.

In Washington, residents of Clark (12), Cowlitz (3), Island (2), King (6), Skagit (5), and Whatcom (1) counties have been reported as outbreak cases. Nearly all of the 29 cases reported having been at Chipotle restaurants before getting sick. Eleven of the Washington residents were hospitalized. Cases range in age from 1-to-67.

There are five Washington restaurants associated with this outbreak: Hazel Dell, 7715 NE 5th Avenue, Suite 109, in Vancouver; 1404 Broadway Avenue and 4229 University Way NE in Seattle; 512 Ramsey Way 101 in Kent; and 1753 S. Burlington Blvd. in Burlington.

The Oregon Health Authority is reporting a total of 10 cases of Shiga toxin E. coli O26 linked to eating at Chipotle restaurants in the Portland Metro area, up from three cases that were first reported October 31.

Among the cases, three were hospitalized. People in Multnomah, Clackamas and Washington counties, as well as Columbia, Benton and Deschutes counties have reported symptoms.

Five locations in Oregon are involved, all of them in the Portland metro area: Cascade Station at 9687 N.E. Cascades Parkway; Washington Square at 9120 S.W. Hall Blvd.; Lake Oswego at 8 Centerpointe Dr.; Tanasbourne at 2048 N.W. Stucki Ave., and Sunnyside in the Clackamas Town Center.

Update: AP now reports that Washington and Oregon Health officials are investigating an E. coli outbreak linked to six Chipotle restaurants in Washington state and Oregon, health officials said Saturday. Three people in the Portland area and at least 19 people in Washington have become sick after eating at the Mexican food chain since October 14.

The Skagit Valley Herald reports that the Skagit County Department of Public Health announced Friday that it has closed Chipotle Mexican Grill in Burlington pending an investigation of several E. coli infections among recent diners.

Of five cases under investigation since October 15, four individuals were hospitalized, according to the health department news release. Results of specimens sent to the state health lab for analysis are expected early next week.

The Department of Public Health advised those who have had close contact with someone ill with symptoms of E. coli infection to see a doctor. Symptoms include diarrhea (often bloody), abdominal cramps, vomiting and nausea.

High Hill Ranch, located in the community of Camino in El Dorado County, has initiated a voluntary recall of its unpasteurized apple juice following notification from local health officials of suspected contamination with bacteria, likely Escherichia coli (E. coli.). El Dorado County health officials are warning consumers to not drink and dispose of any unpasteurized apple juice purchased from High Hill Ranch on or after October 6, 2015.

The El Dorado County Environmental Management and Public Health divisions were notified this week by the Sacramento County Department of Health and Human Services of at least seven (7) cases of E. coli illness among Sacramento County residents who consumed the unpasteurized apple juice from High Hill Ranch in mid-October. The apple juice was consumed at home or at High Hill Ranch. One person has been hospitalized and is expected to recover.

E. coli is caused by the Escherichia coli bacteria. People can get sick when they consume food or drink that is contaminated by the bacteria. Symptoms of E. coli illness typically include severe stomach cramps, diarrhea, vomiting and sometimes low-grade fever. The symptoms usually occur within 3-4 days after exposure, but can occur anywhere between 1 to 12 days after exposure.

Most people who get sick from E. coli recover within 5 to 7 days. Supportive care, such as making sure a person drinks plenty of liquids and gets rest are important for people with the illness. For severe cases, particularly in children, elderly people or those with underlying health problems, a health care provider should be consulted.

The El Dorado County Environmental Management Division, Public Health Division and California Department of Public Health are working closely with the management at High Hill Ranch to determine the source of the potential contamination. The High Hill Ranch Management has pulled the product from the shelves.

The 2015 Oxford County Fair that was held in mid-September will be remembered for the death of one child and the severe illness to another due to infections with E. coli O111. The common exposure to the two children was the same petting zoo.

The investigation is ongoing, but what has appeared thus far indicates a venue that followed few of the warnings and recommendations from decades of prior outbreaks that had sickened thousands. As more information comes out over the next week on what the Fair did and did not do to prevent these families’ tragedies, the fair should be judged from health official recommended since 2001.

“Reducing the Risk for Transmission of Enteric Pathogens at Petting Zoos, Open Farms, Animal Exhibits, and Other Venues Where the Public Has Contact With Farm Animals” – 2001 CDC Recommendations:

  • Information should be provided. Persons providing public access to farm animals should inform visitors about the risk for transmission of enteric pathogens from farm animals to humans, and strategies for prevention of such transmission. This should include public information and training of facility staff. Visitors should be made aware that certain farm animals pose greater risk for transmitting enteric infections to humans than others. Such animals include calves and other young ruminant animals, young poultry, and ill animals. When possible, information should be provided before the visit.
  • Venues should be designed to minimize risk. Farm animal contact is not appropriate at food service establishments and infant care settings, and special care should be taken with school-aged children. At venues where farm animal contact is desired, layout should provide a separate area where humans and animals interact and an area where animals are not allowed. Food and beverages should be prepared, served, and consumed only in animal-free areas. Animal petting should occur only in the interaction area to facilitate close supervision and coaching of visitors. Clear separation methods such as double barriers should be present to prevent contact with animals and their environment other than in the interaction area.
  • Hand washing facilities should be adequate. Hand washing stations should be available to both the animal-free area and the interaction area. Running water, soap, and disposable towels should be available so that visitors can wash their hands immediately after contact with the animals. Hand washing facilities should be accessible, sufficient for the maximum anticipated attendance, and configured for use by children and adults. Children aged <5 years should wash their hands with adult supervision. Staff training and posted signs should emphasize the need to wash hands after touching animals or their environment, before eating, and on leaving the interaction area. Communal basins do not constitute adequate hand washing facilities. Where running water is not available, hand sanitizers may be better than using nothing. However, CDC makes no recommendations about the use of hand sanitizers because of a lack of independently verified studies of efficacy in this setting.
  • Hand-mouth activities (e.g., eating and drinking, smoking, and carrying toys and pacifiers) should not be permitted in interaction areas.
  • Persons at high risk for serious infections should observe heightened precaution. Everyone should handle farm animals as if the animals are colonized with human enteric pathogens. However, children aged <5 years, the elderly, pregnant women, and immunocompromised persons (e.g., those with HIV/AIDS) are at higher risk for serious infections. Such persons should weigh the risks for contact with farm animals. If allowed to have contact, children aged <5 years should be supervised closely by adults, with precautions strictly enforced.

“Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2013” – National Association of State Public Health Veterinarians Animal Contact Compendium Committee 2013:

Venue operators should take the following steps:

  • Become familiar with and implement the recommendations in this compendium.
  • Consult with veterinarians, state and local agencies, and cooperative extension personnel on implementation of the recommendations.
  • Become knowledgeable about the risks for disease and injury associated with animals and be able to explain risk-reduction measures to staff members and visitors.
  • Be aware that direct contact with some animals is inappropriate in public settings, and this should be evaluated separately for different audiences.
  • Develop or obtain training and educational materials and train staff members.
  • Ensure that visitors receive educational messages before they enter the exhibit, including information that animals can cause injuries or carry organ- isms that can cause serious illness.
  • Provide information in a simple and easy-to-under- stand format that is age and language appropriate.
  • Provide information in multiple formats (e.g., signs, stickers, handouts, and verbal information) and languages.
  • Provide information to persons arranging school field trips or classroom exhibits so that they can educate participants and parents before the visit.

Venue staff members should take the following steps:

  • Become knowledgeable about the risks for dis- ease and injury associated with animals and be able to explain risk-reduction recommendations to visitors.
  • Ensure that visitors receive educational messages regarding risks and prevention measures.
  • Encourage compliance by the public with risk- reduction recommendations, especially compliance with hand-washing procedures as visitors exit animal areas.

Recommendations for nonanimal areas are as follows:

  • Do not permit animals, except for service animals, in nonanimal areas.
  • Store, prepare, serve, or consume food and beverages only in nonanimal areas.
  • Provide hand-washing facilities and display hand- washing signs where food or beverages are served.
  • Entrance transition areas should be designed to facilitate education.
  • Post signs or otherwise notify visitors that they are entering an animal area and that there are risks associated with animal contact.
  • Instruct visitors not to eat, drink, smoke, and place their hands in their mouth, or use bottles or pacifiers while in the animal area.
  • Establish storage or holding areas for strollers and related items (e.g., wagons and diaper bags).
  • Control visitor traffic to prevent overcrowding.
  • Exit transition areas should be designed to facilitate hand washing.
  • Post signs or otherwise instruct visitors to wash their hands when leaving the animal area.
  • Provide accessible hand-washing stations for all visitors, including children and persons with disabilities. Position venue staff members near exits to encourage compliance with proper hand washing.

Recommendations for animal areas are as follows:

  • Do not allow consumption of food and beverages in these areas.
  • Do not allow toys, pacifiers, spill-proof cups, baby bottles, strollers, or similar items to enter the area.
  • Prohibit smoking and other tobacco product use.
  • Supervise children closely to discourage hand-to- mouth activities (e.g., nail biting and thumb sucking), contact with manure, and contact with soiled bedding. Children should not be allowed to sit or play on the ground in animal areas. If hands become soiled, supervise hand washing immediately.
  • Ensure that regular animal feed and water are not accessible to the public.
  • Allow the public to feed animals only if contact with animals is controlled (e.g., with barriers).
  • Do not provide animal feed in containers that can be eaten by humans (e.g., ice cream cones) to decrease the risk of children eating food that has come into contact with animals.
  • Promptly remove manure and soiled animal bedding from these areas.
  • Assign trained staff members to encourage appropriate human-animal interactions, identify and reduce potential risks for patrons, and process reports of injuries and exposures.
  • Store animal waste and specific tools for waste removal (e.g., shovels and pitchforks) in designated areas that are restricted from public access.
  • Avoid transporting manure and soiled bedding through nonanimal areas or transition areas. If this is unavoidable, take precautions to prevent spillage.
  • Where feasible, disinfect the area (e.g., flooring and railings) at least once daily.
  • Provide adequate ventilation both for animals and humans.
  • Minimize the use of animal areas for public activities (e.g., weddings and dances).
  • If areas previously used for animals must be used for public events, they should be cleaned and disinfected, particularly if food and beverages are served.

A view from the Courtroom:

Under premises liability law, the entity or entities responsible for managing an animal exhibition have a duty of care to those it invites onto the premises. This duty includes the responsibility to adequately reduce risks the entity is or should be aware of. The duty also carries a responsibility to warn fairgoers of risks present at the exhibition.

The principles of negligence also revolve around the risks to fairgoers that animal exhibitors know of or reasonably should know of. To successfully bring a negligence claim, a sickened person would need to show that the actions of an animal exhibitor fell below a reasonable standard of care in the operation of the exhibit. Failing to implement the well-established recommendations of the CDC and NASPHV constitutes falling below that standard of care.

Both bases for liability on the part of animal exhibitors-premises liability and negligence-carry with them a burden of education on the part of the exhibitor. Because the law holds people to a standard of what they reasonably should know, ignorance of the risks involved is not an effective defense. The law thus provides no impetus to stray from the course of action that is best for both customers and exhibitors in the first place-recognizing the risk and taking steps to reduce it.