2020 – Understandably focused on COVID, we still had E. coli, Salmonella, Listeria and Cyclospora Outbreaks linked to food

Public health has understandably been focused in 2020 on the pandemic that has killed almost 350,000 of our fellow citizens.  However, in their “spare” time they, and their partners at the FDA and FSIS, have had more than a few food safety outbreaks to contend with.  Thank you for the work you do.  Here is a far better 2021.

E. coli – Sprouts

A total of 51 people infected with the outbreak strain of E. coli O103 were reported from 10 states.

Illnesses started on dates ranging from January 6, 2020, to March 15, 2020. Ill people ranged in age from 1 to 79 years, with a median age of 29 years. Fifty-five percent of ill people were female. Of 41 ill people with information available, 3 were hospitalized and no deaths were reported.

Epidemiologic, traceback, and laboratory evidence indicated that clover sprouts were the source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures they had in the week before their illness started. Eighteen (56%) of 32 people interviewed reported eating sprouts. This percentage is significantly higher than results from a survey of healthy people in which 8% reported eating sprouts in the week before they were interviewed.

Seventeen (63%) of 27 people interviewed reported eating sprouts at a Jimmy John’s restaurant. Jimmy John’s LLC reported that all of their restaurants stopped serving clover sprouts on February 24, 2020. Clover sprouts are no longer available at Jimmy John’s restaurants.

Additionally, FDA identified the outbreak strain of E. coli O103 in samples of Chicago Indoor Garden products that contain sprouts. On March 16, 2020, Chicago Indoor Garden recalled all products containing red clover sprouts.

FDA’s traceback investigation showed that a common seed lot was used to grow both the sprouts recalled by Chicago Indoor Garden and sprouts that were served at some Jimmy John’s locations. The same seed lot was also used to grow sprouts linked to an outbreak of the same strain of E. coli O103 infections in 2019.

E. coli – Unknown

As of December 16, 2020, a total of 32 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states.

Illnesses started on dates ranging from June 6, 2020, to October 25, 2020. Ill people ranged in age from 2 to 75 years, with a median age of 27 years, and 72% were female. Of 29 ill people with information available, 15 were hospitalized and 1 developed hemolytic uremic syndrome (HUS), a type of kidney failure. One death was reported from Michigan.

State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before they got sick. Ill people reported eating a variety of food items. Several ill people also reported eating at the same restaurant and had eaten multiple common food items. CDC analyzed the interview data and did not identify a specific food item as a potential source of the outbreak. FDA conducted traceback investigations for several of the food items served at the restaurant and did not find a common source in the distribution chain.

E. coli – Leafy Greens

As of December 18, 2020, a total of 40 people infected with the outbreak strain of E. coli O157:H7 were reported from 19 states.

Illnesses started on dates ranging from August 10, 2020, to October 31, 2020. Ill people ranged in age from 1 to 85 years, with a median age of 33 years, and 60% were female. Of 34 ill people with information available, 20 people were hospitalized and 4 people developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths were reported.

Epidemiologic and traceback evidence showed that leafy greens were the likely source of this outbreak. Investigators were unable to identify a specific type or brand of leafy greens because people in this outbreak reported eating a variety of leafy greens and because different leafy greens are often grown, harvested, and processed together.

State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before they got sick. Of the 23 ill people interviewed, 22 reported eating or maybe eating a variety of leafy greens, including spinach (16) and romaine lettuce (15).

FDA completed traceback investigations for several types of leafy greens ill people reported eating. Several farms of interest were identified, but no single ranch was a common source of the leafy greens.

FDA and state partners conducted inspections on farms of interest and collected environmental samples. FDA is analyzing the samples and continuing their investigations to identify the root cause of this outbreak.

E. coli – Leafy Greens

As of December 16, 2020, a total of 18 people infected with the outbreak strain of E. coli O157:H7 were reported from nine states.

Illnesses started on dates ranging from September 2, 2020, to November 6, 2020. Ill people ranged in age from 8 to 71 years, with a median age of 28 years, and 72% were female. Of 16 ill people with information available, 6 were hospitalized. No deaths were reported.

State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before they got sick. Of the 13 people interviewed, all reported eating or maybe eating various types of leafy greens, including romaine lettuce (9), spinach (9), and iceberg lettuce (7).

Laboratory testing identified the outbreak strain in a sample of Tanimura & Antle romaine lettuce in a single-head package, which was recalled on November 6, 2020. However, investigators were unable to determine if any ill people in this outbreak got sick from eating the recalled product. No one specifically reported eating Tanimura & Antle romaine lettuce, and some people got sick before the “packed on” dates for the recalled products.

FDA conducted traceback investigations and worked with state partners to conduct inspections at several farms. However, none of the findings identified a common source in the distribution chain or linked the farms to the outbreak.

Listeria – Deli Meat

As of November 30, 2020, a total of 11 people infected with the outbreak strain of Listeria monocytogenes have been reported from three states.

Listeria samples from ill people were collected from August 6, 2020, to October 30, 2020. Ill people range in age from 40 to 89 years, with a median age of 84 years, and 82% are female. All 11 ill people were hospitalized. One death has been reported from Florida.

Epidemiologic evidence shows that deli meat is a likely source of this outbreak.

State and local public health officials interviewed ill people about the foods they ate in the month before they became ill. Of the 10 people interviewed, all reported eating Italian-style deli meats, such as salami, mortadella, and prosciutto. They reported purchasing prepackaged deli meats and meats sliced at deli counters at various locations.

Investigators are working to identify a specific type of deli meat or a common supplier linked to the illnesses.

Listeria – Enoki Mushrooms

A total of 36 people infected with the outbreak strain of Listeria monocytogenes were reported from 17 states.

Listeria specimens from ill people were collected from November 23, 2016, to December 13, 2019. Ill people ranged in age from less than 1 to 96 years, with a median age of 67. Fifty-eight percent of ill people were female. Of 33 ill people with information available, 31 hospitalizations were reported. Four deaths were reported from California (2), Hawaii, and New Jersey. Six cases were pregnancy-associated, with two resulting in fetal loss.

Epidemiologic, traceback, and laboratory evidence showed that enoki mushrooms supplied by Green Co. LTD, located in the Republic of Korea, were the likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the month before they became ill. Twelve out of 22 (55%) reported eating mushrooms, including enoki, portobello, white, button, cremini, wood ear, maitake, and oyster.

FDA and state officials collected enoki mushrooms for testing. The Michigan Department of Agriculture and Rural Development collected enoki mushrooms from a grocery store where an ill person shopped and identified the outbreak strain in two samples. These mushrooms were labeled as “Product of Korea” and were distributed by Sun Hong Foods, Inc. On March 9, 2020, Sun Hong Foods, Inc. recalled enoki mushrooms. The California Department of Public Health collected enoki mushrooms from grocery stores and identified the outbreak strain in one sample. These mushrooms were labeled as “Product of Korea” and were distributed by Guan’s Mushroom Co. On March 23, 2020, Guan’s Mushroom Co. recalled enoki mushrooms. FDA collected samples of enoki mushrooms for testing at import from Green Co. LTD of the Republic of Korea. On April 6, 2020, results showed that two samples yielded the outbreak strain of Listeria monocytogenes. As a result, on April 7, 2020, FDA placed Green Co. LTD on Import Alert and H&C Foods Inc. recalled enoki mushrooms supplied by Green Co. LTD.

On March 18, 2020, the Korean Ministry of Food and Drug Safety published its investigation findings and steps it will take to prevent future illnesses. It found Listeria monocytogenes in enoki mushrooms produced by two firms in the Republic of Korea.

Salmonella – Wood Ear Mushrooms

A total of 55 people infected with the outbreak strain of Salmonella Stanley were reported from 12 states.

Illnesses started on dates ranging from January 21, 2020, to September 19, 2020. Ill people ranged in age from 2 to 74 years, with a median age of 28. Fifty-seven percent of ill people were female. Of 48 ill people with information available, 6 hospitalizations were reported. No deaths were reported.

Epidemiologic, laboratory, and traceback information showed that wood ear mushrooms distributed by Wismettac Asian Foods, Inc., were the likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 23 people with information, 22 (96%) reported eating ramen at a restaurant in the week before their illness started. Several people reported eating at the same ramen restaurants, showing they may have been part of illness clusters.

A foodborne illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. Investigating illness clusters can provide critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there.

Five illness clusters were identified at restaurants serving ramen in three states. Ten (91%) of the 11 ill people linked to restaurant clusters reported eating wood ear mushrooms or ramen containing wood ear mushrooms in the week before their illness started.

FDA and states conducted a traceback investigation from four of the restaurants with illness clusters to identify the source of the wood ear mushrooms eaten by ill people. Traceback determined that Wismettac Asian Foods, Inc., supplied wood ear mushrooms (dried fungus) to these restaurants.

On September 23, 2020, Wismettac Asian Foods recalled dried fungus due to possible Salmonella contamination. On October 1, 2020, the California Department of Public Health identified the outbreak strain of Salmonella Stanley in recalled dried fungus samples.

Salmonella – Peaches

A total of 101 people infected with the outbreak strain of Salmonella Enteritidis were reported from 17 states.

Illnesses started on dates ranging from June 29, 2020, to August 27, 2020. Ill people ranged in age from 1 to 92 years, with a median age of 43. Sixty-four percent of ill people were female. Of 90 ill people with available information, 28 hospitalizations were reported. No deaths were reported.

Epidemiologic and traceback evidence indicated that peaches packed or supplied by Prima Wawona or Wawona Packing Company were the likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 62 people with information, 50 (81%) reported eating fresh peaches in the week before their illness started. This percentage was significantly higher than results from a survey of healthy people in which 20% reported eating peaches in the week before they were interviewed. Of the 40 people who reported information on how the peaches were packaged, 25 (63%) reported buying loose peaches and the remaining 15 reported buying pre-bagged peaches.

The FDA and regulatory officials in several states collected records from grocery stores where ill people reported buying peaches. These records showed that loose and bagged peaches distributed by Wawona Packing Company, LLC, were sold at multiple grocery stores where ill people bought peaches.

On August 22, 2020, Prima Wawona recalled bagged and bulk, or loose, peaches that they supplied to retailers nationwide. See FDA’s notice for a list of recalled products. Recalled products are past their shelf life and should no longer be available in stores.

Salmonella – Onions

A total of 1,127 people infected with the outbreak strain of Salmonella Newport were reported from 48 states.

Illnesses started on dates ranging from June 19, 2020, to September 11, 2020. Ill people ranged in age from less than 1 to 102 years, with a median age of 41. Fifty-eight percent of ill people were female. Of 705 ill people with information available, 167 people were hospitalized. No deaths were reported.

Epidemiologic and traceback evidence showed that red onions from Thomson International Inc. were the likely source of this outbreak. Other onion types (such as white, yellow, or sweet yellow) were also likely to be contaminated because the onions were grown and harvested together.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Ninety-one percent of people reported eating onions or foods likely containing onions in the week before their illness started. Of the 208 people who were asked what types of onions they ate, 137 (66%) ate red onions, 130 (63%) ate white onions, and 110 (53%) ate yellow onions. Most ill people reported eating more than one type of onion.

FDA and states reviewed records where ill people purchased or ate onions and foods containing onions. This traceback investigation identified Thomson International Inc. as the likely source of red onions.

The Public Health Agency of Canada (PHAC) and The Canadian Food Inspection Agency (CFIA) also investigated an outbreak of Salmonella Newport infections in Canada that was related genetically by WGS to the U.S. outbreak. Their investigation identified red onions from Thomson International Inc. as the likely source of their outbreak.

On August 1, 2020, Thomson International Inc. recalled all red, yellow, white, and sweet yellow onions because they may be contaminated with Salmonella. Other companies also recalled onions or foods made with recalled onions.

Cyclospora – Salads

As of September 23, 2020, a total of 701 people with laboratory confirmed Cyclospora infections associated with this outbreak were reported from 14 states: GA, IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI. Exposures were reported in 13 states (IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI).

Illnesses started on dates ranging from May 11, 2020 to July 24, 2020. Ill people ranged in age from 11 to 92 years with a median age of 57; 51% were female. 38 (5%) people were hospitalized. No deaths were reported in this outbreak.

Epidemiologic evidence and product traceback indicated that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express was a likely source of this outbreak.

Fresh Express recalled Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contained iceberg lettuce, red cabbage, and/or carrots on June 27, 2020.

In interviews, ill people answered questions about the foods they ate and other exposures in the 2 weeks before they became ill. An illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there. In this bagged salad-associated cluster, there were several situations in which people reported purchasing the product from the same stores.

The FDA and regulatory officials in several states collected records to determine the source of the bagged salad that ill people ate in the affected areas. Product distribution information indicated that the Streamwood, Illinois Fresh Express production facility is the likely producer of the bagged salad mixes eaten by ill people.

Republished with permission from Bill Marler and Marler Clark. Copyright (c) Marler Clark LLP, PS. All rights reserved.