AJ found this on E. Coli Lettuce Outbreak

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E. COLI LETTUCE OUTBREAKS E. coli O157:H7 outbreaks associated with lettuce

or spinach, specifically the “pre-washed” and “ready-to-eat” varieties sold

under various brand and trade names, are by no means a new phenomenon. In

October 2003, 13 residents of a California retirement center were sickened and 2

died after eating E. coli-contaminated “pre-washed” spinach. In September 2003,

nearly 40 patrons of a California restaurant chain became ill after eating

salads prepared with bagged, “pre-washed” lettuce. In July 2002, over 50 young

women were stricken with E. coli at a dance camp after eating “pre-washed”

lettuce, leaving several hospitalized and one with life-long kidney damage. The

Center for Science in the Public Interest found that, of 225 food-poisoning

outbreaks from 1990 to 1998, nearly 20 percent (55 outbreaks) were linked to

fresh fruits, vegetables, or salads.

 

 

It is clear that the risks associated with E. coli O157:H7 and lettuce were well

known to Dole and the industry prior to the 2005 outbreak. For some time prior

to the outbreak, the FDA had been aggressively trying to get the industry to

address serious deficiencies that were creating a critical risk to consumers.

The response by Dole and many of its industry brethren was woefully inadequate.

In November 2005, the FDA elucidated its past efforts and present concerns in

its “Letter to California Firms that Grow, Pack, Process, or Ship Fresh and

Fresh-Cut Lettuce.” The letter begins:

This letter is intended to make you aware of the Food and Drug Administration's

(FDA's) serious concern with the continuing outbreaks of foodborne illness

associated with the consumption of fresh and fresh-cut lettuce and other leafy

greens.

The FDA goes on to identify 18 outbreaks of E. coli O157:H7 associated with

fresh or fresh-cut lettuce, resulting in 409 illnesses and two deaths since

1995. According to the FDA, completed traceback investigations in eight of the

outbreaks—the 2005 Dole outbreak included—were traced to Salinas, California.

The FDA further states that the industry’s role in preventing these illnesses is

crucial because “these products are commonly consumed in their raw state without

processing to reduce or eliminate pathogens.”

The FDA efforts to lead the lettuce industry to safer practices were nothing

new. In 1998, the FDA issued guidance to the industry entitled “Guide to

Minimize Microbial Food Safety Hazards for Fruits and Vegetables.” The guide is

specifically designed to assist growers and packers in the implementation of

safer manufacturing practices. On February 5, 2004, the FDA issued a letter to

the lettuce and tomato industries to “make them aware of [FDA’s] concerns

regarding continuing outbreaks associated with these two commodities and to

encourage the industries to review their practices.”

The 2005 Dole outbreak prompted even more industry-admonition by the FDA: “In

light of continuing outbreaks associated with fresh and fresh-cut lettuce and

other leafy greens, particularly from California, we are issuing this second

letter to reiterate our concerns and to strongly encourage firms in your

industry to review their current operations.” This November 2005 FDA letter

explicitly rejected industry excuses for not having taken prior action. Further,

the FDA cited to research linking some or all of the outbreaks to sewage

exposure, animal waste, and other contaminated water sources. The research

further indicated that industry practices, including irrigation and field

drainage methods, may have led directly to the contamination of the lettuce with

E. coli O157:H7. As a result the FDA stated that it considers “adulterated” any

ready to eat crops that have come in contact with flood waters. The FDA closed

by warning industry members that food produced under unsanitary

conditions is adulterated under §402(a)(4) of the Food, Drug, and Cosmetic Act,

and that enforcement actions would be considered.

THE DOLE OUTBREAK

“DOLE Classic Romaine is triple washed and ready-to-eat. As a result, it is not

necessary to wash the salad prior to eating.” From

http://www.dole.com/Products/Products_Detail.jsp?CatGroupID=4 & ID=79, Dole Food

webpage

On September 22, 2005 the Minnesota Department of Health (MDH) Public Health

Laboratory (PHL) received an E. coli O157:H7 isolate for confirmatory testing

and Pulse Field Gel Electrophoresis (PFGE) subtyping. PFGE results were reported

on September 26 and uploaded to PulseNet, a national database of PFGE patterns

or “fingerprints” maintained at the federal Centers for Disease Control and

Prevention (CDC). The pattern derived from digestion with the restriction

endonuclease Xba I was assigned Pattern number EXHX01.0238. The isolate was soon

tested with a second enzyme, Bln I, and the resulting pattern was assigned

pattern number EXHA26.1040. Prior to September 19, the Bln I pattern had not

been posted on PulseNet.

Isolates obtained from culture of stool submitted by two new ill patients were

received at the MDH PHL on September 23, 2005 and subtyped. PFGE results showed

that the two new isolates and the isolate received on September 22 were

indistinguishable by two enzymes. By September 29, 2005 isolates obtained from

seven more patients arrived at the MDH PHL for further analysis. Public health

investigators recognized that an E. coli O157:H7 outbreak was underway in

Minnesota.

While laboratory testing was performed, MDH epidemiologists conducted

preliminary interviews with patients who were laboratory confirmed with E. coli

O157:H7. On the morning of September 28 investigators had identified

pre-packaged lettuce produced by Dole Food Company, Inc. as the likely vehicle

of transmission for infection with E. coli O157:H7. A supplemental questionnaire

focusing on the type and brand of lettuce consumed and where it was purchased,

was developed and administered to case-patients previously interviewed and newly

identified cases. On September 29 Minnesota Department of Agriculture (MDA)

staff collected a bag of Dole lettuce at the home of a case patient and began

microbiologic testing for the presence of E. coli O157:H7.

On September 30 the MDH issued a press release advising the public that 11 cases

of E. coli O157:H7 had been identified in Minnesota residents who had eaten Dole

lettuce purchased from at least four different stores in the Twin Cities area.

See Attachment No. 2, Minnesota Department of Health News Release, September 30,

2005. Dr. Kirk Smith, an MDH foodborne disease specialist, advised consumers to

discard Dole pre-packaged lettuce mixes with the “Best if Used by 09/23/05”

date. Persons with symptoms of E. coli were told to contact the MDH and their

physician. Dr. Chris Braden at the Foodborne and Diarrheal Disease Branch at the

CDC announced that no other states were reporting outbreak associated cases.

Meanwhile MDA microbiologists continued to process lettuce specimens obtained

from households with cases of confirmed E. coli O157:H7. On Monday, October 3

the agency reported that sample number M-05-2310, Lot Number B250215B received

on September 30 had tested positive for E. coli O157:H7. The isolate obtained

from the sample was sent to the MDH for PFGE analysis. The resulting pattern was

indistinguishable to the pattern identified in case-patients. A second specimen,

M-05-2318, lot number unavailable, would also yield positive results. See

Attachment No. 3, Minnesota Department of Agriculture Laboratory Analysis Report

dated 10/20/2005.

News of the positive lettuce specimen prompted the Food and Drug Administration

(FDA) to issue a nationwide health alert regarding Dole pre-packaged salads on

October 2. See Attachment No. 4, FDA Issues Nationwide Health Alert on Dole

Pre-Packaged Salads. The FDA announcement reiterated warnings expressed in the

MDH press release and further described the Dole products associated with

illness, Classic Romaine, American Blend, and Greener Selection. Although cases

had only been identified in Minnesota, the product was noted to have been

distributed nationwide.

It would not be long before cases of E. coli O157:H7 in Wisconsin and Oregon

would be recognized. The Wisconsin case was a 12 year old female with E. coli

O157:H7 who had a history of eating Dole pre-packaged lettuce. PFGE subtyping

showed that her isolate was indistinguishable to the EXHX01.0238 pattern and one

band different on the second enzyme pattern. Despite the one band difference,

MDH molecular epidemiologists considered the girl to be part of the outbreak

concluding that the difference was not enough to preclude the case from being

considered outbreak related.

The Oregon case was indisputably associated with consumption of Dole

pre-packaged salad mix. A 60 year old Portland resident was hospitalized and

laboratory confirmed with E. coli O157:H7 on September 21, 2005. The patient had

experienced onset of symptoms on September 18, four days after purchasing and

consuming Dole brand “Classic Romaine” salad mix. Michael Roberson,

representative for Albertsons’, the grocery store of purchase, confirmed that

the chain’s Portland area distributing center had received Dole Greener

Selection and Dole Classic Romaine. See Attachment No. 5, email message from

Michael Roberson to William E. Keene, dated 10/6/2005. A portion of the salad

mix was still in the patient’s refrigerator. A photograph taken of the packaging

documents that Ms. Scheetz purchased Dole salad mix with a “Best if Used By”

date of 9/23/05, lot number was B250215B. See Attachment No. 6, email message

from Bill Keene to Dr. Melvin N. Kramer, dated 10/24/2005. PFGE subtyping

showed that the Oregon isolate was indistinguishable by two enzymes to other

ill Dole lettuce consumers in Minnesota.

Aware of the potential severity of an E. coli O157:H7 outbreak, the FDA and the

Food and Drug Branch at the California Department of Health Services initiated

an investigation at the Dole processing plant. Preliminary information indicated

that 22,321 cases of Dole pre-packaged lettuce with a “Best If Used By” date of

9/23/05 and a production code starting with “B250” were shipped from a single

Dole processing facility in central California to 34 states in early September.

Investigators estimated that since each case contained between 6 and 12 bags,

approximately 244,866 bags of lettuce had made it to market.

On October 11, 2005 the MDH counted 23 laboratory confirmed cases of E. coli

O157:H7 and seven epidemiologically linked cases. Illness onset dates ranged

from September 16 to September 30. Two cases had developed Hemolytic Uremic

Syndrome (HUS). Oregon and Wisconsin reported one case each. Case control study

data show a statistically significant association between illness and consuming

Dole pre-packaged lettuce with a matched odds ratio of 6.8, 95% confidence

interval, 1.4-31.9, and a p-value of 0.01.

 

 

 

 

 

 

Have you seen her all in gold?

Like a queen in days of old

She shoots her colors all around

Like a sunset going down

Have you seen a lady fairer?

 

 

 

 

 

 

 

 

 

Source: She's A Rainbow - Rolling Stones

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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[Guest guest]

i never knew that i was buying bagged salad when i was to tired to

cook after work. not anymore. good info

 

Bear

 

, Donnalilacflower

<thelilacflower wrote:

>

> E. COLI LETTUCE OUTBREAKS E. coli O157:H7 outbreaks associated

with lettuce or spinach, specifically the " pre-washed " and " ready-to-

eat " varieties sold under various brand and trade names, are by no

means a new phenomenon. In October 2003, 13 residents of a California

retirement center were sickened and 2 died after eating E. coli-

contaminated " pre-washed " spinach. In September 2003, nearly 40

patrons of a California restaurant chain became ill after eating

salads prepared with bagged, " pre-washed " lettuce. In July 2002, over

50 young women were stricken with E. coli at a dance camp after

eating " pre-washed " lettuce, leaving several hospitalized and one

with life-long kidney damage. The Center for Science in the Public

Interest found that, of 225 food-poisoning outbreaks from 1990 to

1998, nearly 20 percent (55 outbreaks) were linked to fresh fruits,

vegetables, or salads.