CDC expands on Texas warning about Brucella in raw milk

A month after Texas public health officials urged raw milk drinkers and their doctors to be on the lookout for symptoms of Brucella infection, the federal government weighed in with its own advice.

Anyone who drank unpasteurized, “raw” milk from the K-Bar Dairy in Paradise, TX, from June 1 through Aug. 7 is “at an increased risk for brucellosis and should receive appropriate post-exposure prophylaxis (PEP),” the Centers for Disease Control and Prevention recommended Wednesday.

The CDC echoed advice and warnings that the Texas Department of State Health Services (DSHS) posted Aug. 14.

“A person who drank raw milk from K-Bar Dairy in Paradise, Texas, has been hospitalized with brucellosis. Milk samples from the dairy have tested positive for a Brucella strain called RB51,” according to the CDC health advisory.

“Brucella strain RB51 is resistant to rifampin and penicillin. A combination of doxycycline and trimethoprim/sulfamethoxazole for 21 days is the recommended first-line PEP regimen for RB51 exposure.”

Complicating the situation is the fact that symptoms of Brucella infection can take five days to six months to develop. Consequently, anyone who consumed raw dairy products from the K-Bar Dairy from June 1 through Aug. 7 should monitor themselves for symptoms for the coming months.

Even if symptoms have not developed, the CDC recommends the post-exposure course of antibiotics for 21 days. There isn’t a serological test to detect RB51 infection. Blood culture is the diagnostic test recommended by the CDC for exposed symptomatic individuals.

Symptoms of brucellosis can include fever, sweats, malaise, anorexia, headache, fatigue, muscle and joint pain, and potentially more serious complications such as swelling of heart, liver, or spleen, and neurologic symptoms.

Sometimes symptoms continue for long periods of time. They can also be chronic or recurring. The confirmed patient in Texas had fever, muscle and joint pain, and fatigue before the diagnosis of brucellosis.

Diagnosis is often difficult because symptoms can come and go. Also, brucellosis is relatively uncommon, so some health care providers may not be familiar with its symptoms, according to the Texas health department’s Aug. 14 advisory.

“The DSHS is concerned that other people who consumed raw milk from K-Bar Dairy may also have been exposed to Brucella and became infected. Brucellosis may cause short-term and long-term disease,” according to the Texas advisory.

“… it is an uncommon infection and can present with a wide variety of non-specific symptoms and signs that can wax and wane over weeks or even months.”

The RB51 strain of Brucella is dangerous for medical staff and lab personnel in addition to patients, particularly because of its resistance to some antibiotics. Therefore, the CDC’s health advisory includes an extra warning for health care providers.

“When ordering blood cultures to diagnose brucellosis, please advise the laboratory that the blood culture may grow Brucella and that appropriate laboratory precautions should be observed,” the CDC recommended.

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Papaya Salmonella outbreak hits Hispanic population hard

The popularity of fresh papaya in some ethnic cuisine is resulting in a disproportionate number of Hispanics being infected in four ongoing Salmonella outbreaks.

With 235 laboratory confirmed infections as of this week, the Centers for Disease Control and Prevention reports the number of Hispanic victims in the individual outbreaks ranges from 50 percent to 91 percent. Two people have died, but their ethnicity has not been made public.

The CDC and Food and Drug Administration are tracking eight different varieties of Salmonella, all found in maradol papayas from Mexico and matched by laboratory testing to samples from the victims. As of Thursday the CDC split the victims into four outbreaks, based on four farms in Mexico that produced contaminated fruit.

Both FDA and CDC are warning against maradol papayas from the four farms in Mexico. The FDA is continuing its stepped up testing of papayas from Mexico, which it began after the initial outbreak was confirmed by the Maryland Department of Health in mid-July.

“CDC recommends that consumers not eat, restaurants not serve, and retailers not sell recalled Maradol papayas from Carica de Campeche, Rancho El Ganadero, El Zapotanito, or Productores y Exportadores de Carica Papaya de Tecomán y Costa Alegre farms in Mexico,” according to Thursday’s update.

“Several companies have recalled papayas from these farms: Grande Produce recalled Caribena brand maradol papayas. Agroson’s LLC recalled certain Cavi brand maradol papayas. Freshtex Produce LLC recalled Valery Brand maradol papayas. Bravo Produce Inc. recalled maradol papayas packed by Frutas Selectas de Tijuana, S. de RL de CV.”

Federal officials suggest that people who aren’t sure if papayas they have purchased are among those recalled should ask the retailers that sold the fruit. When in doubt, throw it out, the CDC recommends.

Specific details on the four ongoing Salmonella outbreaks traced to whole, fresh papayas from Mexico are available at the following links:

• Outbreak of Salmonella Thompson, Salmonella Kiambu, Salmonella Agona, and Salmonella Gaminara infections linked to papayas from Carica de Campeche farm in Mexico;
• Outbreak of Salmonella Newport and Salmonella Infantis Infections linked to papayas from Rancho El Ganadero farm in Colima, Mexico distributed by Caraveo Produce;
• Outbreak of Salmonella Urbana Infections linked to papayas from El Zapotanito farm in La Huerta, Mexico; and
• Outbreak of Salmonella Anatum Infections linked to papayas from Productores y Exportadores de Carica Papaya de Tecoman y Costa Alegre in Tijuana, Mexico imported by Bravo Produce Inc.

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CDC discovers fourth Salmonella outbreak linked to papayas

Federal and state officials are investigating another deadly Salmonella outbreak traced to papayas imported from Mexico, but they have not named retailers that sold the contaminated fruit.

At least 14 people across Arizona, California and Colorado have been confirmed with the outbreak strain of Salmonella Anatum, according to the Centers for Disease Control and Prevention. One person has died. At least five have required hospitalization.

A dozen of the victims live in California. At least four of them reported buying and eating papayas from the same retail chain before becoming ill. The Salmonella Anatum identified in lab samples collected from the victims match the strain of that type of Salmonella found by the Food and Drug Administration on papayas imported by Bravo Produce Inc. of San Isidro, CA. Bravo initiated a recall Sunday.

Neither the California retailer — which uses Bravo Produce as a supplier of papayas — nor any of the other retailers implicated in the other three ongoing outbreaks have been named by the FDA, which is overseeing papaya recalls by importers and distributors.

The FDA routinely cites laws regarding “confidential corporate information” as prohibiting the agency from revealing retailers that received recalled foods. In its advice regarding the current outbreaks and recalls, the FDA tells consumers on its website to ask retailers if they sold the suspect papayas.

Arguing that public health trumps corporate secrets, the Center for Science in the Public Interest (CSPI) asked FDA on Aug. 17 to provide the list of retailers that handled papayas linked to the ongoing outbreaks. The federal agency denied that request and CSPI filed an administrative appeal this past week under the framework of the Freedom of Information Act.

“The typical consumer isn’t going to recognize the brand of papaya they buy or the farm it was grown on, but they know where they bought it,” said CSPI chief regulatory affairs counsel Sarah Sorscher.

“The FDA is supposed to be helping Americans avoid foodborne illness. It could improve by consistently disclosing retailer names and locations, along with brand names, dates of sale, lot numbers, and other useful information when it communicates with the media or with the public about recalls.”

Relentless investigators
Together, the four papaya-related Salmonella outbreaks have sickened 215 people from the Atlantic to the Pacific. Illnesses have been reported in 26 states. Including the California death announced Monday, the outbreaks have killed two people.

The outbreak reported Monday actually began in December 2016, according to the CDC.

“This past spring, CDC investigated a multistate outbreak of Salmonella Anatum infections,” according to the Monday report.

“While the epidemiologic information indicated that papayas were the likely source of this outbreak at the time, investigators could not determine the specific source of contaminated papayas and the outbreak investigation ended after illnesses stopped.”

Whole genome sequencing (WGS) showed that all 14 victims were infected with the same strain of Salmonella Anatum bacteria, suggesting a common source of infection. That common denominator wasn’t confirmed until this month.

“FDA informed CDC that a sample from an imported papaya identified Salmonella Anatum on Sept. 4. …WGS showed that the isolate from the papaya and the isolates from the 14 people infected with Salmonella Anatum this past spring were closely related.”

The 14 confirmed victims had illness onset dates from Dec. 20, 2016, to April 8 this year. However, the CDC reported it is investigating at least six more cases of Salmonella Anatum infection to determine if they are also linked to the maradol papayas imported by Bravo Produce Inc.

As with the other three ongoing Salmonella outbreaks, the Salmonella Anatum outbreak has hit Hispanics particularly hard. Of 11 victims for whom ethnic information was available as of Monday, 10 of them were Hispanic. The CDC has theorized the disproportionate impact is because of the popularity of fresh papaya in Hispanic and Mexican cuisine.

Bravo Produce Inc. imported the papayas implicated in the Salmonella Anatum outbreak from a farm in Tijuana, Mexico. The farm, Productores y Exportadores de Carica Papaya de Tecomán y Costa Alegre, is the fourth specific growing operation identified by the FDA as having produced papayas contaminated with the outbreak strains of Salmonella.

Before Bravo received the fruit it went from the farm to a Mexican packing company, Frutas Selectas de Tijuana, S. de RL de CV. Bravo officials reported in their recall notice on Sunday that their recalled papayas have stickers with the Frutas Selectas name on them.

Advice to consumers, restaurants and retailers
State and federal public health officials recommend applying the golden rule of food safety regarding papayas on hand in homes and businesses — when in doubt, throw it out.

Additional recommendations from CDC include:

• If you have had whole, fresh papayas in your home or business, wash and sanitize countertops, cutting boards and utensils, as well as drawers or shelves in refrigerators where papayas were stored, with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or new paper towel.
• Wash your hands with running water and soap following the cleaning and sanitation process.

Anyone who has eaten fresh papaya recently and developed symptoms of Salmonella infection is urged to seek medical attention and tell their doctors about the possible exposure so the proper diagnostic tests can be performed.

Salmonella bacteria can cause diarrhea, vomiting, stomach pain and fever.

Symptoms usually begin between 12 to 36 hours after exposure, but they may begin as early as 6 hours or as late as 72 hours after exposure.

Symptoms can be mild or severe and commonly last for two to seven days. Salmonella can infect anyone, but young children, older adults and people with weakened immune systems are the most likely to have severe infections.

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USDA expands FoodKeeper App to include food recall alerts

Thanks to recent updates made by the U.S. Department of Agriculture, users of the FoodKeeper application can choose to receive automatic notifications for food safety recalls.

Since its launch in April 2015, FoodKeeper has reached about 150,000 downloads. Now, when the USDA’s Food Safety and Inspection Service (FSIS) and the Food and Drug Administration announce food recalls, users can select to receive alerts as they happen, once a day or weekly.

Accessible on Google Play and iTunes  stores, the recent update includes instruction videos on proper handling and storage of food, along with a list of food and beverage products that has expanded to over 500 product items, according to the USDA’s news release.

“This is a great way for the public to stay informed when food is recalled,” said Carmen Rottenberg, acting deputy under secretary for food safety. “The FoodKeeper app is a very handy and easy to use tool.”

Rottenberg said in the news release that she believes the app reflects the USDA’s commitment to provide consumers with information and knowledge that will help them make informed decisions.

FSIS partnered with Cornell University and the Food Marketing Institute to develop the FoodKeeper app as a tool to “help reduce food waste and improve public health by sharing storage methods that extend the shelf life of the foods and beverages in American homes,” according to the release.

The recent updates now inform users of specific storage timelines for the refrigerator, freezer and pantry. Advice is now available on more than 500 products, including dairy, eggs, meat, poultry, produce, seafood and various types of baby food.

Rottenburg said the updates to the FoodKeeper app should also help reduce foodborne illness across the nation: “We want to make sure the valuable recall information FSIS and FDA publish is available to as many Americans as possible. With the expansion of products covered in the apps database, this app is helpful to any type of consumer, and I encourage anyone who hasn’t already done so, to download and begin using the FoodKeeper app.”

Features of the FoodKeeper application include:

• Specific storage timelines for the refrigerator, freezer and pantry, depending on the nature of the product;
• Cooking tips and methods for various types of meat, poultry and seafood products;
• Notices for calendars on mobile or other devices on when products are nearing the end of their recommended storage date;
• Question forms for USDA’s “Ask Karen” which is USDA’s 24/7 virtual representative. It provides information about preventing foodborne illness, safe food handling and storage, and safe preparation of meat, poultry and egg products; and
• Submission form for items not included in the database for consideration in future updates.

The FoodKeeper app can also be accessed at http://ift.tt/2vQI2ZF if interested consumers do not have access to a smartphone.

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More papayas with Salmonella; Bravo Produce recalls fruit

Maradol papayas imported from Mexico by Bravo Produce Inc. have tested positive for Salmonella and are being recalled in relation to an ongoing outbreak traced to whole, fresh papayas grown on Mexican farms.

Bravo sent the papayas to retailers and wholesalers in California between Aug. 10 and Aug. 29, according to the recall notice posted Sunday on the Food and Drug Administration website. The federal agency notified the importer on Friday that some  fruit it had not yet distributed had tested positive for Salmonella bacteria.

The recalled fruit was grown by Productores y Exportadores de Carica Papaya de Tecomán y Costa Alegre SPR of RL and packed by Frutas Selectas de Tijuana, S. de RL de CV. It is the fourth Mexican farm identified in the FDA’s ongoing outbreak investigation.

Bravo is referring to the recall as “a preventive measure.” Papayas from the other three Mexican farms were contaminated with outbreak strains of Salmonella bacteria, according to the Centers for Disease Control and Prevention. As of Sunday evening, the CDC had not posted any information regarding the specific Salmonella bacteria detected in fruit imported by Bravo Produce, which is based in San Ysidro, CA.

The CDC and FDA have already warned consumers, restaurants and retailers not to eat, serve or sell maradol papayas from the other three farms: Carica de Campeche, Caraveo Produce and El Zapotanito farms in Mexico.

Papayas from those three farms have been directly linked to 201 people in 23 states who have been sickened with Salmonella infections in recent months. One outbreak victim has died and 65 had to be admitted to hospitals for treatment, according to the CDC’s most recent information, which was posted Sept. 1.

Bravo Produce reports the papayas it has recalled have stickers from the packing company, Frutas Selectas de Tijuana. The papayas are packed in boxes that also bear the packing company’s name.

The recalled papayas sold by Bravo Produce can be identified by the following product codes, which can be found on the side of the packing boxes:

1222335215
1222635220
1222335216
1223035223
1223335227
1223835233
1222235215
1222535220
1222235216
1222835223
1223435230
1222235216
1222935223
1222135214
1222935223
1222935223
1222135214
1222235216
1222935223
1223035223
1222935221
1223035223
1223835233

“All consignees of the product have been notified, via telephone and email, to remove and destroy the papayas that are on store shelves and other commercial places. Supervision for withdrawal effectiveness is already underway by FDA,” according to the recall notice.

Bravo Produce Inc. will take precautionary measures to ensure the safety of its imported products, according to the recall notice. It will send samples to a private laboratory authorized by FDA for the detection of Salmonella. The company says it is also cooperating with FDA in its investigation and will provide all possible assistance.

Consumers who may have bought papayas from Productores y Exportadores de Carica Papaya de Tecoman y Costa Alegre S.P.R. de R.L and with the packing label of Frutas Selectas de Tijuana, S. de R.L. of C.V. are advised not to consume them. The FDA and CDC urge people to dispose of them so that won’t accidentally be eaten by other people or animals.

Advice to consumers, restaurants and retailers
Additional recommendations from CDC include:

• If you have had whole, fresh papayas in your home or business, wash and sanitize countertops, cutting boards and utensils, as well as drawers or shelves in refrigeratorswhere papayas were stored, with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or new paper towel.
• Wash your hands with running water and soap following the cleaning and sanitation process.

Anyone who has eaten fresh papaya recently and developed symptoms of Salmonella infection is urged to seek medical attention and tell their doctors about the possible exposure so the proper diagnostic tests can be performed.

Salmonella bacteria can cause diarrhea, vomiting, stomach pain and fever.

Symptoms usually begin between 12 to 36 hours after exposure, but they may begin as early as 6 hours or as late as 72 hours after exposure.

Symptoms can be mild or severe and commonly last for two to seven days. Salmonella can infect anyone, but young children, older adults and people with weakened immune systems are the most likely to have severe infections.

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Ragazzo’s Italian Style Meatball Mix recalled for soy not listed as allergen

Michigan’s Northside Noodle Company, located in Iron Mountain, Friday recalled approximately 123 pounds of meatball products due to misbranding and undeclared allergens, according to the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS). The product contains soy, a known allergen, which is not declared on the product label.

The frozen pork and beef meatball mix items were produced on June 6, 2017, June 27, 2017, and Aug. 2, 2017. The recalled  products include:

• 1-lb. polystyrene foam packages containing “Ragazzo’s ITALIAN STYLE MEATBALL MIX,” with lot codes 2008, 2024 and 2044.

The products subject to recall bear establishment number “EST. M10062” inside the USDA mark of inspection. These items were shipped to a retail location in Michigan. The mistaken labeling was discovered during routine label verification checks.

There have been no confirmed reports of adverse reactions due to consumption of these products. Anyone concerned about an injury or illness should contact a healthcare provider.

Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase.

FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list will be posted on the FSIS website.

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FDA faces suit for failing to reveal retailers in papaya outbreak

The Center for Science in the Public Interest (CSPI) wants the Food and Drug Administration to release the names and locations of supermarkets and other retailers who sold papayas now subject to a nationwide recall because of a Salmonella outbreak.

But FDA won’t do it, even though another federal food safety agency routinely makes such retail lists freely available. That’s left CSPI with no other choice but to sue FDA in federal court under the Freedom of Infomation Act (FOIA).

In announcing the action, CSPI noted the Salmonella outbreak linked to maradol papayas imported from Mexico is ongoing. To date, the outbreak has infected 201 people in 23 states. It’s also resulted in one death and 65 hospitalizations.

CSPI filed its request for the list of retailers on Aug. 17. The FDA admitted this week it has 451 pages of documents that are responsive to CSPI’s request. But it is withholding them, citing exemptions for trade secrets, “confidential corporate information” among other things.

FDA tells consumers on its website to ask retailers if they sold the suspect papayas.

“The typical consumer isn’t going to recognize the brand of papaya they buy or the farm it was grown on, but they know where they bought it,” said CSPI chief regulatory affairs counsel Sarah Sorscher.

“The FDA is supposed to be helping Americans avoid foodborne illness. It could improve by consistently disclosing retailer names and locations, along with brand names, dates of sale, lot numbers, and other useful information when it communicates with the media or with the public about recalls.”

CSPI said FDA’s reluctance to disclose retailers who might have sold contaminated products is not new, but it is also not consistent. In May, the FDA disclosed the names of retailers that sold tuna, imported from Indonesia, that tested positive for Hepatitis A.

The Consumer Federation of America, Pew Charitable Trusts, CSPI, and other health groups wrote to FDA Commissioner Scott Gottlieb in August, explaining why lists of retailers of recalled food are not exempt from disclosure under FOIA.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) decided several years ago that it could share with the public the names and locations of retail outlets involved with recalled products. That change came at the behest of Dr. Richard Raymond, USDA’s under secretary for food safety during President George W. Bush’s tenure.

Richard Raymond

Raymond, who before moving to Washington D.C. was Nebraska’s chief medical officer, previously told Food Safety News that without the “name and town” recalls are not be effective.

“When I was asked to move to D.C. to head up FSIS as its politically appointed under secretary, I knew I wanted to change the mindset that would not allow FSIS to release ‘proprietary information,’ as (FSIS) referred to the excuse that prevented it from releasing helpful information, or ‘confidential, corporate information’ as FDA has labeled the bureaucracy they hide behind on this issue,” Raymond recalled recently.

“I went to D.C. in 2005. The revised rule was posted in the Federal Register in 2008. That is actually pretty fast for Washington, D.C., a city of 12 square miles surrounded on all sides by sanity, ” he continued.

“Naturally, the Grocery Manufacturers Association and the American Meat Institute were adamantly opposed to naming outlets possibly selling contaminated meat and poultry, along with many other associations and alliances, but common sense and sanity did actually prevail and now USDA does provide the stores’ names and locations.”

Almost a decade later, retail lists are now routinely attached by FSIS to recalls of meat, poultry, eggs and catfish.

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