Food Safety Partnership:
Epidemiology Update
April 6, 2009
Karen Everstine
Congratulations to Dr. Snyder!
Foodservice Consultants Society International
(Americas Division) presented him with its 2008-2009
Trendsetter Award last month
Etiologies of 2009 Outbreaks
Confirmed foodborne - 44 total*
Pathogen
Number (%)
Norovirus
E. coli O157
Salmonella
Scombroid
Suspected norovirus
Campylobacter
Clostridium perfringens
Ciguatera
Susp. bacterial toxin
20 (45%)
10 (23%)
5 (11%)
2 (5%)
3 (7%)
1 (2%)
1 (2%)
1 (2%)
1 (2%)
*Data are preliminary
2009 Outbreak Settings
Confirmed foodborne - 44 total*
Setting
Number (%)
Restaurant
Private event
Contaminated product
Daycare
Unlicensed caterer
Cruise
Unknown
28 (%)
5 (%)
7 (%)
1 (%)
1 (%)
1 (%)
1 (%)
*Data are preliminary
Number of Confirmed Foodborne Outbreaks Per Year,
Minnesota, 1995-2009
90
80
60
50
40
30
20
10
Hotline initiated
0
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Number of Outbreaks
70
Year
Summary outbreak stats
2000-2008 (2009 pending)
Total number of outbreaks
439
Number of documented cases
Lab-confirmed cases
Commercial food establishment
6329
1478
330 (75%)
Summary outbreak stats
2000-2008 - etiologies
Norovirus
224
Salmonella
52
Suspected norovirus
Suspected bacterial intoxications
E. coli O157
Clostridium perfringens
Scombroid
Unknown
Campylobacter
Bacillus cereus
Shigella
42
34
18
15
15
9
5
5
5
Summary outbreak stats
2000-2008 - etiologies
Hepatitis A
4
Staphylococcus aureus
3
Cryptosporidium
2
Amatoxin (mushroom poisoning)
1
Astrovirus
Cyclospora
Escolar
Enterotoxigenic E. coli
Listeria
Multiple bacterial pathogens
Vibrio
1
1
1
1
1
1
1
2000-2008 – contributing factors
(excluding norovirus outbreaks)
Unknown
84
Time/temp abuse
37
Multiple factors
12
Contaminated product (meat)
10
Cross-contamination
5
Inadequate cooking
5
Contaminated product (produce)
4
Fish poisoning
4
Infected foodworker
4
Others: contaminated processed foods, eggs, ill
attendee, poisonous mushrooms, raw milk
E. Coli O157 outbreak
(December 2009)
E. Coli O157 outbreak
(December 2009)
• 1st MN case December 2
• Pulsenet search found 13 cases
nationwide
• First few cases reported similar types
of restaurants (Olive Garden,
Applebee’s, Ruby Tuesday)
• Multiple cases reported consumption of
steaks at Applebee’s
E. Coli O157 outbreak
(December 2009)
• Most cases reported eating rare or
medium-rare steak at a restaurant
• 3 Minnesota cases ate ground beef and
did not eat steak
• Invoices requested from restaurants
traced back to the same source
Cases by State of Residence
E. Coli O157 outbreak
(December 2009)
•
•
•
•
5 Minnesota case (1 secondary)
3 cases lived in group homes
4 hospitalized and one died
3 Minnesota cases ate ground beef
Group Home ground
beef- 1 case
Grocery D ground beef
product eaten by our 2
cases
Distributor E
Multiple chain
restaurants where
cases reported
consuming steak
J&B Meats,
St. Michael, MN
Company C
Plant 1
Company C
Plant 2
Company B
(trim)
Company C
Plant 3
?
National Steak
and Poultry
(recall on 12/24)
PRODUCER A
Plant in CO
3 Cases: HI, FL, IN
Group Home ground
beef- 1 case
Grocery D ground beef
product eaten by our 2
cases
Distributor E
Multiple chain
restaurants where
cases reported
consuming steak
J&B Meats,
St. Michael, MN
Company C
Plant 1
Company C
Plant 2
Company B
(trim)
Company C
Plant 3
?
National Steak
and Poultry
(recall on 12/24)
PRODUCER A
Plant in CO
3 Cases: HI, FL, IN
Group Home ground
beef- 1 case
Grocery D ground beef
product eaten by our 2
cases
Distributor E
Multiple chain
restaurants where
cases reported
consuming steak
J&B Meats,
St. Michael, MN
Company C
Plant 1
Company C
Plant 2
Company B
(trim)
Company C
Plant 3
?
National Steak
and Poultry
(recall on 12/24)
PRODUCER A
Plant in CO
3 Cases: HI, FL, IN
Group Home ground
beef- 1 case
Grocery D ground beef
product eaten by our 2
cases
Distributor E
Multiple chain
restaurants where
cases reported
consuming steak
J&B Meats,
St. Michael, MN
Company C
Plant 1
Company C
Plant 2
Company B
(trim)
Company C
Plant 3
?
National Steak
and Poultry
(recall on 12/24)
PRODUCER A
Plant in CO
3 Cases: HI, FL, IN
E. Coli O157 outbreak
(December 2009)
• Company B, Inc. likely received trim
from Producer A
• Processed beef product from fatty trim
that used to be used for pet food or
cooking oil
• This product is added to “the majority”
of ground beef sold nationwide
See The New York Times 12/31/09 “Safety of Beef Processing Method is
Questioned”
E. Coli O157 outbreak
(December 2009)
• Fat is liquified and protein extracted in a
centrifuge
• Sent through pipes with ammonia gas to kill
pathogens
• Mashlike substance is compressed and
frozen into blocks or chips
• Allowed up to 15% by volume in school
lunch ground beef
• No labeling requirements
See The New York Times 12/31/09 “Safety of Beef Processing Method is
Questioned”
Other outbreaks linked to
mechanically-tenderized beef
In Mar. 2003 six people developed E. coli O157:H7 infections after consuming
steaks produced by Stampede Meat, Inc., of Chicago, Illinois. The steaks,
which were later recalled, had been blade-tenderized and injected with
marinade.
In Aug. 2004 patrons of a Colorado Applebee's restaurant became ill with E.
coli O157:H7 infections after eating beef products produced by Quantum
Foods of Bolingbrook, Ill. The firm recalled approximately 406,000 pounds of
frozen beef products for potential E. coli O157:H7 contamination.
In May 2007 Davis Creek Meats and Seafood of Kalamazoo Michigan recalled
nearly 130,000 pounds of beef products in 15 states because of possible E.
coli O157:H7 contamination. The recalled boxes of mechanically tenderized
steaks and ground beef were linked to E. coli O157:H7 illnesses.
In May 2007, an E. coli O157:H7 outbreak investigation by the Fresno County
Department of Community Health revealed that tenderized, cooked tri-tip sold
by The Grill at the Meat Market and served at several catered functions was
the source of the outbreak.
From: http://www.foodsafetynews.com/2010/01/fsis-should-require-labelingfor-tenderized-steaks/
Comments or questions?
Salmonella Montevideo
SMON19 outbreak
Minnesota outbreak timeline
• Aug. 17: Investigated 2 case cluster
– Collection: 5/26/2009 and 7/8/2009
– No common source identified
• Nov. 10: Investigated 3 case cluster
– Collection: 9/19/2009, 10/23/2009, and
10/28/2009
– No common source identified
Outbreak timeline
• Nov. 30: First contacted by CDC requesting
exposure information
– 106 isolates nationwide with collection dates
6/14/09 to 11/10/09 (4 in MN)
• Dec. 3: First multistate conference call
– Previous food matches: fish food, dog food,
crimped oats from petting zoo
– Suspect exposures: Hispanic grocery store (CA),
salsa (6/8 in OR), Wal-Mart shoppers
Outbreak timeline
• Dec. 15:
– Pork products (carnitas from Hispanic grocery
store, BBQ from SC hunting trip), spices/meat
seasoning, BBQ sauce
• Jan. 6:
– Spices collected from OR case all negative
– 51 shotguns completed; eggs, fish, bottled water
most common
– 3 new open-ended interviews by CDC;
prepackaged spicy Italian sausage variety pack
reported
Outbreak timeline
• Jan. 8: 3rd and 4th enzyme results
circulated
• Jan. 11:
– Multiple reports of cases consuming
Italian subs with prepackage variety meat
packs
• Salami, Capocollo, Bresaola, Prosciutto
• Purchased at warehouse stores (Sam’s,
CostCo)
Outbreak timeline
• Jan. 13:
– WA reported that 5/7 cases with Costco
records purchased same product
• Daniele Italian brand gourmet brand
– Hot calabrese, hot capocollo, pepper salame
• Correlation between purchase and onset dates
• Only item that >2 cases purchased
• Jan. 17: Case-control study initiated
Outbreak timeline
• Jan. 20:
– Salmonella identified in unopened product
• Sopresetta meat from another variety pack
– 10/14 with Costco records purchased Italian
gourmet variety pack
• Purchase dates: July 2 – Dec. 20
• Jan. 21:
– Preliminary case-control study results implicate
salami
– Salmonella identified in open container of pepper
collection from Daniele plant by BAX
Outbreak timeline
• Jan. 22
– Italian gourmet variety pack collect from IA
case positive for Salmonella by BAX
• All subsamples from 3 meats positive
– Notified that plant had been closed
• Jan. 25
– IA confirmed that food isolate matches
Outbreak timeline
• Jan. 26
– Initial positive product from other variety
pack confirmed as a match
– More suspicious colonies from pepper
samples collected at plant, but serotype
not confirmed