Food Safety News

The Food and Drug Administration sends warning letters to entities under its jurisdiction as part of its enforcement activities. Some letters are not posted for public view until weeks or months after they are sent. Business owners have 15 days to respond to FDA warning letters. Warning letters often are not issued until a company has been given months to years to correct problems.

F1 Foods Inc. D/B/A Flavor First Foods Inc.
West Bridgewater, MA

A food firm in Massachusetts is on notice from the U.S. Food and Drug Administration (FDA) for various federal violations and not maintaining the facility in a clean and sanitary condition. Issues cited include the presence of insects and rotting fruit.

In a March 14, 2024, warning letter, the FDA described a July 18 through Aug. 15, 2023, inspection of Flavor First Foods Inc.’s ready-to-eat (RTE) prepared foods processing facility in West Bridgewater, MA.

FDA investigators found serious violations of the Emergency Permit Control regulation, Acidified Foods regulation, Seafood Hazard Analysis and Critical Control Point (HACCP) regulation, and the Current Good Manufacturing Practice, Hazard Analysis, and Risk-Based Preventive Controls for Human Food regulation (CGMP & PC rule).

After the inspection, the FDA investigator issued a Form FDA-483, Inspectional Observations, listing deviations found at their facility.

Some of the significant violations are as follows:

Acidified Foods Violations:

1. The firm failed to provide the FDA, before packing any new product, information on the scheduled processes from a qualified person filed with FDA for their (redacted by the FDA) Marinara Sauce as required. Specifically, no scheduled processes are on file for (redacted by the FDA) Marinara Sauce in any size or container the firm produces and distributes.

2. The firm failed to have operators of processing and packaging systems under the operating supervision of a person who has attended and satisfactorily completed a school approved by the FDA for pH controls and critical factors in acidification, as required. Specifically, no one in their facility has attended a Better Process Controls course or any other approved FDA training in the manufacturing of acidified foods.

Seafood HACCP Violations:

The firm must implement the monitoring procedures and frequency that they have listed in their HACCP plan. However, the firm did not implement the monitoring procedures at the following critical control points listed in their HACCP plan for refrigerated, ready-to-eat, heat treated, clam chowder in reduced oxygen packaging:

1. The firm did not follow the monitoring procedure of continuous monitoring of the product temperature to ensure minimum internal temperature of (redacted by the FDA) at the Hot Fill CCP with a (redacted by the FDA) inspection of the continuous time and temperature recording chart before starting each batch. They are not continuously monitoring the time and temperature and do not use a continuous monitoring device for either their cooking kettle or their holding tank. They were observed using a stem thermometer to monitor the temperature of the clam chowder before filling. FDA recommends continuous temperature monitoring at the hot fill step to ensure the cooked soup is hot filled at or above (redacted by the FDA).

2. The firm did not follow the monitoring procedure of “maintain temp at (redacted by the FDA)” at the Cooking CCP to control pathogenic bacteria survival through cooking. On July 26, 2023, they were observed taking only a single temperature during the cooking step for a batch of clam chowder which was observed to be (redacted by the FDA); however, they did not continue to measure the temperature for a period of (redacted by the FDA) to ensure that the clam chowder stayed at (redacted by the FDA) to ensure pathogen reduction as required by their HACCP plan. Furthermore, the first several bags of finished clam chowder that were used to prime the bagging system were reintroduced back into the kettle and never reverified time/temperature requirement of a (redacted by the FDA) as required by their HACCP plan. FDA recommends monitoring of the cook step be conducted using a continuous temperature recording device installed where it measures the coldest temperature in the cook vessel and through visual observation at the start and end of each cook cycle for each batch.

3. The firm did not follow their monitoring procedure of monitoring the water bath for residual chlorine using a (redacted by the FDA) before the use of the water bath at the Cooling After Cooking CCP to control the hazard of post-production contamination. They did not implement this monitoring procedure. Additionally, during the inspection on July 26, 2023, finished sealed bags of clam chowder were observed being cooled in water which was recovered water from their ice machine condensate drainpipe that was untreated. The finished bags of clam chowder were cooled in this water for approximately (redacted by the FDA) before being transferred to separate vats of ice water which was made with (redacted by the FDA) water and ice but was not monitored with (redacted by the FDA) for residual chlorine as required by their HACCP Plan. In addition, the Cooling After Cooking CCP should include a critical limit that ensures residual chlorine is present in the cooler water.

Current Good Manufacturing Practice:

1. The firm did not take reasonable measures and precautions to ensure that all persons working in direct contact with food wash hands thoroughly (and sanitize if necessary to protect against contamination with undesirable microorganisms) in an adequate hand-washing facility before starting work, after each absence from the work station, and at any time when the hands may have become soiled or contaminated, as required. Specifically, on July 18, 2023, during the production and packaging of RTE marinara sauce in 24 oz. glass jars with a manufacturing date of July 18, 2023, the firm’s owner was observed not wearing gloves and 2 other employees were observed wearing soiled gloves while (redacted by the FDA) capping finished filled jars of RTE marinara sauce with several instances of both the owner and the employees observed touching the rim of the jar during the capping process. During this process the owner and the other employees were observed touching other pieces of non-food contact equipment and then going back to (redacted by the FDA) capping the jars. The owner and the employees were not observed washing or sanitizing hands before, during, or after touching nonfood contact surfaces where the hands may have become soiled or contaminated.

2. The firm did not maintain buildings, fixtures, and other physical facilities of their plant in a clean and sanitary condition and in repair adequate to prevent food from becoming adulterated, as required. Specifically,
    a. On July 18, 2023, rusted metal plates with black debris and a white substance were observed directly above exposed glass jars of marinara sauce that were in the process of being filled.
    b. On July 18, 2023, clutter was observed along the walls and floor wall junctures of the dry storage area including but not limited to the storage of old plastic totes, pallets, old equipment, maintenance supplies, puddles of old standing water.
    c. On July 26, 2023, the stem thermometer used to measure the temperature of their clam chowder was observed stored in a PVC pipe that was soiled with a brown substance. There was condensate dripping directly inside the pipe. Several rusty metal steam pipes with dripping condensate were located directly next to the stored thermometer. The investigator observed dripping condensate come into direct contact with the thermometer.
    d. The firm does not have a bathroom inside their facility. Employees must access the adjacent firm to use a bathroom. On July 26, 2023, this bathroom was noted with cobwebs, black dirt and the toilet fixtures and wash sinks were soiled and not clean. The floor of the bathroom had clutter and black dirt. The entrance to the bathroom was cluttered with old equipment, trash, and debris on the floor.

3. The firm did not take effective measures to exclude pests from the manufacturing, processing, packing, and holding areas to protect against the contamination of food on the premises by pests, as required. Specifically,
    a. On July 18, 2023, multiple flying insects were observed by the manufacturing, packaging, and holding areas.
    b. On July 26, 2023, (redacted by the FDA) bushels of apples with a total weight of (redacted by the FDA) pounds were stored on the production floor in a broken walk-in cooler where they package products. The apples were in various stages of quality including many that were bruised and rotting. Fruit flies and other flying insects were noted in the immediate area.

4. The firm did not clean non-food-contact surfaces of equipment in a manner and as frequently as necessary to protect against allergen cross-contact and against contamination of food, food-contact surfaces, and food-packaging materials, as required. Specifically,
    a. On July 18, 2023, during the packaging/capping of marinara sauce, metal caps that were being used to cap the jars were observed to be stored exposed, in an open soiled white container.
    b. On July 26, 2023, the firm and another employee were observed using a (redacted by the FDA) to (redacted by the FDA) the floor and the side surface of the kettle where the clam chowder batch (redacted by the FDA) was being actively cooked with the cover of that kettle in the partial upright position, exposing the clam chowder to aerosols from (redacted by the FDA). Overspray and mist from the (redacted by the FDA) was observed contacting the surface of the lid to the kettle.

5. The firm did not conduct all food manufacturing, processing, packing, and holding under such conditions and controls as are necessary to minimize the potential for the growth of microorganisms and contamination of food, as required by 21 CFR 117.80(c)(2). Specifically,
    a. On July 18, 2023, multiple (redacted by the FDA) sealed bags of acidified marinara sauce Lot (redacted by the FDA) were observed being (redacted by the FDA) in (redacted by the FDA) of untreated water which was recovered water from their ice machine drainpipe. This process is used for all their (redacted by the FDA)-sealed bagged products including the refrigerated RTE, Reduced Oxygen Packaged, (redacted by the FDA) Treated Not Shelf Stable Clam Chowder. These processes can lead to the product becoming contaminated as the bags being (redacted by the FDA) in the untreated (redacted by the FDA) water may have faulty seals allowing the (redacted by the FDA) water from the ice machine to enter the bags.
    b. On July 18, 2023, during the packaging of the jarred marinara sauce, the product transfer hose that was transferring the marinara sauce from the cooking kettle to the hot fill kettle was observed in direct contact with the floor.

6. The firm did not maintain the grounds around their plant in a condition adequate to protect against the contamination of food by properly storing equipment and removing litter and waste that may constitute an attractant, breeding place, or harborage for pests, as required. Specifically, outside of the facility, the FDA investigator observed overflowing dumpsters, an old camper with broken windows and broken open door, and other discarded equipment providing harborages for rodents, birds, and pests.

The full warning letter can be viewed here.

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Singapore held the fifth meeting of an international food safety network this past week.

The annual meeting of the International Heads of Food Agencies Forum (IHFAF) took place from April 16 to 20, under the theme “Food Safety for a Resilient and Sustainable World”.

Heads of food agencies from 17 countries and 22 organizations, including the World Health Organization (WHO), The U.N.’s Food and Agriculture Organization (FAO), and the Codex Alimentarius Commission, attended the event.

National perspectives
Dr. Hisham bin Saad Aljadhey, CEO of the Saudi Food and Drug Authority (SFDA), headed the agency’s delegation. Aljadhey chaired two sessions on the safety assessment, regulatory frameworks, and risk communication for novel foods.

Other sessions covered topics such as climate resilience and safe food, sustainability and food safety, as well as discussing the activities of IHFAF.

SFDA officials held meetings with the Chilean Food Safety and Quality Agency (ACHIPIA), the New Zealand Ministry for Primary Industries (MPI), and the German Federal Institute for Risk Assessment (BfR).

Posting on social media, Sandra Cuthbert, Food Standards Australia New Zealand (FSANZ) CEO, said food systems are interconnected and working together was important.

“Sharing information between agency heads across the globe helps us all, and I am grateful for the strong collaboration and openness of everyone who joined. With thanks to the Singapore Food Agency for hosting this years’ forum. I’m already looking forward to seeing everyone again next year in Chile,” she said.

Gail Carroll, director of regulatory affairs and compliance, and Wayne Anderson, director of food science and standards, represented the Food Safety Authority of Ireland (FSAI) at the forum, which was held in Ireland in 2023.

FSAI said IHFAF has been crucial in building its global network, learning from other countries, and sharing expertise and experience in ensuring swift and effective response to any potential emerging risks and threats to the food chain. 

BfR and SFA to cooperate
The Singapore Food Agency (SFA) and the German Federal Institute for Risk Assessment (BfR) signed a Joint Declaration of Intent (JDI) at the event to cooperate on emerging developments in food safety, research, and risk assessments.

“The topic of food safety is constantly growing and evolving. For us, this means that our research must also continuously expand and improve,” said Tanja Schwerdtle, vice president of the BfR.

Schwerdtle traveled to Singapore as part of the IHFAF meeting to sign the document with Tan Lee Kim, SFA’s director-general and deputy CEO.

“We are optimistic that this collaboration can help to strengthen food safety science and risk assessment in both countries,” said Tan Lee Kim.

A multi-year work plan was defined, which covers cooperation in various subject areas to close research and data gaps as well as exchanging knowledge.

BfR and SFA scientists also discussed the safety of alternative proteins, emerging environmental contaminants affecting the food supply, food contact materials, and genetically modified food.

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The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert for ground beef products from Greater Omaha Packing Co. Inc. that may be contaminated with E. coli O157:H7.

FSIS is issuing this public health alert to ensure that consumers are aware that these products should not be consumed. 

A recall was not requested because the products are no longer available for purchase.

The raw ground beef items were produced on March 28, 2024. The products have a “Use/Freeze by” date of April 22, 2024, and packaging date of “032824.” The list of products that are subject to the public health alert can be found here.

The products subject to the public health alert bear establishment number “EST. 960A” inside the USDA mark of inspection. These items were shipped to food service institutions and retail locations nationwide.                           

The problem was discovered by the establishment while conducting an inventory of product that was on hold because it was found positive for E. coli O157:H7. The company notified FSIS that they inadvertently used a portion of the contaminated beef to produce ground beef products that they subsequently shipped into commerce.

There have been no confirmed reports of illness due to consumption of these products. 

FSIS is concerned that some product may be in consumers’ and food service institutions’ freezers. Consumers who have purchased these products are urged not to consume them and food service institutions are urged not to serve these products. These products should be thrown away or returned to the place of purchase.

FSIS advises all consumers to safely prepare their raw meat products, including fresh and frozen, and only consume ground beef that has been cooked to a temperature of 160 F. The only way to confirm that ground beef is cooked to a temperature high enough to kill harmful bacteria is to use a food thermometer that measures internal temperature, https://www.fsis.usda.gov/safetempchart.

Consumers with questions about the public health alert can contact Gina Adami, Greater Omaha Packing Co. Inc. Representative, at 402-575-4702 or gadami@gmail.com.

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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Consumers these days are being warned about the health hazards of highly processed foods. The message is that the health-conscious consumer should buy more whole foods and process them minimally. However, not all whole foods are safe, either, and some should come with a warning label. 

One of the most common problems caused by some fresh, natural foods are skin issues. Dermatitis can result from sensitivity and allergy to any food, or it can result from a food containing a chemical that makes your skin more sensitive to the sun.

Citrus fruits are notorious for causing dermatitis when exposing skin to fruit juice and peel. This includes oranges, lemons, grapefruit, and especially limes and bergamot. In fact, there is a disease called Lime Disease, (which is not the same as Lyme disease), which is caused by the blistering effect of lime juice on the skin when exposing the skin to the sun. It’s also called Margarita Disease, named after the drink that includes lime.

If you don’t want your skin to peel, then you don’t want to peel the skin of a citrus fruit when you are in the sun. 

What does sunshine have to do with it? 
The sun emits powerful ultraviolet light, which causes chemical reactions to occur. Ultraviolet light is a small part of the light spectrum coming from the sun, but when these wavelengths of light hit certain chemicals, the light energy is absorbed and a chemical bond is broken. This starts a cascade of reactions among unstable chemicals, ultimately result in skin damage. 

This is why you don’t want to leave out in the sun any fabric or plastic or other materials that can decompose under UV radiation. UV breaks down materials. This is also why you don’t want your skin to have too much sun. 

Keep in mind that all terrestrial life on Earth has evolved to live with solar radiation, and can heal from the damaging effects of UV.  In fact, plants and animals have evolved to use UV light for many necessary functions. In humans, for example, we need UV irradiating our skin to make Vitamin D. 

It is as though sunshine is an essential nutrient. But like all nutrients, there can be too much of a good thing.  

Plants, of course, have lots of chemicals, called phytochemicals, with the prefix phyto- meaning plant. Some of these phytochemicals are beneficial, such as vitamins, and are extracted from plants for their uses in medicine, perfumes, foods, cosmetics, and other products. But some of these plant chemicals are toxic, and these toxic chemicals can be in the same plant as the beneficial chemicals. 

In this case, the dangerous chemical is a furanocoumarin, which is a class of chemical compounds that are activated by UV light. Psoralen is the parent of this class of chemicals. 

Psoralen makes sunburn much more severe. If psoralen is on, or in, the skin, UV light from the sun activates the psoralen, making it highly reactive. This causes the psoralen molecule to bond with DNA in skin cells, which causes these cells to die. Symptoms of psoralen burning the skin include redness of the skin, edema, and blisters. 

UV rays can penetrate deep into the epidermis, into the dermis, so any psoralen on the skin, or in the skin, can be activated by the sun to make blister-forming eruptions. For some people, this also causes the skin to change color when healing, and can cause allergic or hypersensitivity reactions in other parts of the body with repeated exposure. 

The medical term for this problem is phytophotodermatitis, a word that literally means plant-sun-skin inflammation. It is not an allergic condition, since it does not require prior exposure. The blistering develops after about 24 hours of exposure, and peaks at 48-72 hours. It can take weeks to heal.

Skin reactions like this are a problem in farmers, grocers, and people who work with psoralen-containing foods. Of course, homemakers who cook for their families handle these daily. 

Unfortunately, lots of common, otherwise healthy foods have psoralen. This includes parsley, parsnips, carrots, and celery. Figs are also a problem, which can even cause skin blistering from simply touching the leaves or sap. Cloves are also high in psoralen. And all citrus fruit is high in psoralen, especially limes and bergamot. Bergamot oil is added to lots of drinks and other foods for flavoring, making these other foods also high in psoralen.

To give you an idea of what psoralen can do, consider its use in medicine to treat psoriasis eczema, and some other skin lesions, in a process called PUVA. This type of therapy is called photochemotherapy. Patients are given a psoralen drug, called methoxsalen, which within a short time is circulated throughout the body and into the skin. This gets the skin highly sensitive to UV rays, especially UVA, which is one of the UV wavelengths that goes deeply into the skin when you are in the sun. The patient is irradiated for up to 10 minutes over a series of treatments, essentially burning away the bad skin.

PUVA has been used for decades, and herbal remedies for skin ailments have included psoralen-containing plants being applied to the skin. However, there are side effects of this therapy. 

According to WebMD, “Psoralens can make your skin more sensitive to sunlight. They can raise your risk of sunburn, cataracts, and skin cancer. And your skin might age faster…Don’t eat limes, carrots, celery, figs, parsley, or parsnips while you take oral psoralens. It could boost the amount of natural psoralen in your system and make your skin even more sensitive to the sun.”

This means you are at risk of photosensitivity from eating foods containing psoralen, or applying those foods to your skin. This can lead to burns, skin cancer, and eye damage. 

Unfortunately, avoiding these foods will not make you safe from photosensitizers that you are consuming in medications. Some medications can directly be activated by UV to attack your skin when in the sun, as with psoralen. But other medications can cause damage to the skin by impairing the healing process. 

According to the North Carolina Department of Health and Human Services, “Certain food/drugs do not mix with ultraviolet light. Anyone taking any medication should consult with a physician PRIOR to tanning. Note: This is not a complete list of drugs or foods.” It then lists a frightening amount of drugs, including the most commonly used, which all make people more sensitive to sunlight and causing burns. 

This long list includes: 

Antihistamines

Anticonvulsants

Antifungals

Anti-inflammatory

drugs (Ibuprofen, Ketoprofen, Naproxen, etc.)

Antiseptics

Anitbiotics

Anticholesterol Medications

Antidepressants

Antipsychotic Medications

Artificial Sweeteners

Blood Pressure Medications

Coal Tar Productions (Tegrin, Denorex)

Oral Contraceptives & estrogen

Major Tranquilizers

Oral Diabetes meds

Sulphur based meds

Diuretics (fluid Pills)

Some Antimalarials –

Fansidar (a sulfa drug)

Chloroquine

Some deodorants

(perfumes colognes)

Cosmetics

Some herbal Products

Some Sunscreens

Tattoos

And the list goes on…

It also includes some foods:

Carrots

Celery

Citrus Fruits

Clover

Coumarin

Dill

Eggs

Figs

Garlic

Ginko Biloba

Grass (wheat, barley)

Lady’s Thumb (tea)

Lime oil

Mustards

Onions

Parsley

Parsnips (vegetables)

Saint John’s Wort

Smartweed (tea)

Vanilla oil

It is interesting that skin cancer is the leading type of cancer, and so many of these chemicals affect the skin and can cause cancer when in the sun. It’s not just the sun that harms the skin; it’s medications people take that increase the harm to the skin from the sun. 

Medications causing photosensitivity may be a reason why the medical industry has been encouraging people to wear sunscreen when in the sun, to minimize UV exposure. However, the sunscreen must be able to block UVA, which many do not unless they say “full spectrum”. However, even sunscreen lotions contain skin sensitizers, as the list above mentions. Ironically, this means sunscreen can possibly cause sunburns and skin cancer. 

According to a recent academic review, Drug‐induced photosensitivity: culprit drugs, potential mechanisms and clinical consequences:

“Drug‐induced photosensitivity, the development of phototoxic or photoallergic reactions due to pharmaceuticals and subsequent exposure to ultraviolet or visible light, is an adverse effect of growing interest. This is illustrated by the broad spectrum of recent investigations on the topic, ranging from molecular mechanisms and culprit drugs through epidemiological as well as public health related issues to long‐term photoaging and potential photocarcinogenic consequences…In total, 393 different drugs or drug compounds are reported to have a photosensitizing potential, although the level of evidence regarding their ability to induce photosensitive reactions varies markedly among these agents. The pharmaceuticals of interest belong to a wide variety of drug classes. The epidemiological risk associated with the use of photosensitizers is difficult to assess due to under‐reporting and geographical differences. However, the widespread use of photosensitizing drugs combined with the potential photocarcinogenic effects reported for several agents has major implications for health and safety and suggests a need for further research on the long‐term effects.”

These drugs and foods are common. If you are taking NSAIDS, such as aspirin, ibuprofen, or naproxen, you can more easily burn in the sun. The same goes for taking antibiotics, or antihistamines, or high blood pressure medication. Add to that having citrus or figs or a healthy salad or juice made of celery, parsley, and carrots, and you will be even more sensitive to the sun. Peel an orange at the beach or in the sunny park, and let the sunshine activate all the psoralen, and get ready for a few days of burned, blistered, red, hot, and damaged skin. 

This may also be why tanning is such a significant cause of skin cancer. The UV from these tanning treatments will be more damaging if you are priming your skin with psoralen from your diet or medications.  

If you want to keep the sunshine in your life, but want to minimize the risk of phytophotodermatitis from food, and chemophotodermatitis from medication, keep in mind the following:

1. Limit sun exposure to avoid peak sun intensity from 10 a.m. to 2 p.m. But don’t avoid the sun altogether. A little sun is necessary for health, including mental health. (Season Affect Disorder is from lack of sun.)

2. Wear loose-fitting, natural-fiber clothing when you want to block the sun from your skin. 

3. If you use sunscreen, make sure all the ingredients are safe. Look each ingredient up to see if it increases photosensitivity. Amazingly, many sunscreens contain chemicals that make your skin sensitive to the sun. 

4. Keep in mind that all chemicals on your skin will be irradiated with UV from the sun. This includes all lotions, creams, perfumes, and cleansers. Nobody is studying the many UV by-products from solar radiation of these chemicals, which then can get absorbed into your skin. 

5. When going out in the sun, remember the photosensitizing medications you are taking, and take precautions. 

6. Avoid foods that contain psoralen if you have any skin issues. 

7. Be cautious of foods that contain “natural flavors” or other unnamed natural ingredient, which could contain bergamot oil, or some other photosensitizing agent. 

8. Avoid tanning in a salon if you are on medications or eat foods that contain psoralen. 

9. Wash your hands well with soap and warm, not hot, water after handling any foods that contain psoralen. 

10. When preparing a picnic for a nice, sunny day at the park or beach, avoid UV-activated foods. 

11. Avoid tight clothing. This interferes with lymphatic circulation in the skin, which is essential for healing. After time in the sun, make sure your skin has proper circulation to allow the drainage of toxic, UV-irradiation chemical products. 

12. Keep in mind that, while the first skin contact exposure to psoralen and UV may result in blistering without an immune response, further exposure to these substances after that initial response may result in allergic reactions when taking that substance internally. This means the orange that you peeled at the beach in the sun which gave you blisters may now be giving you a rash when you eat citrus foods. The immune system learns to attack foods that cause dermatitis, and can generalize the attack, resulting in allergies to related foods. 

13. The phytophotodermatitis effect is directly related to sun exposure time and intensity, and photochemical concentration. The longer you are in the sun and the more intense the rays, the worse the skin burn. And the more foods you eat that contain psoralen, the worse the burn. 

14. If you develop a skin problem within 48 hours of tanning or of being in the sun, then look for causes in your diet or medications. 

15. Finally, discuss the need to avoid the sun with your healthcare provider. You may need Vitamin D supplementation. Or you may be able to use a different medication or treatment that doesn’t have to take the sunshine out of your life.  

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Botulism—A Rare, But Deadly Disease

Botulism is a rare, life-threatening paralytic illness caused by neurotoxins produced by an anaerobic, gram-positive, spore-forming bacterium, Clostridium botulinum.[1] Unlike Clostridium perfringens, which requires the ingestion of large numbers of viable cells to cause symptoms, the symptoms of botulism are caused by the ingestion of highly toxic, soluble exotoxins produced by C. botulinum while growing in foods.[2] These rod-shaped bacteria grow best under anaerobic (or, low oxygen), low-salt, and low-acid conditions.[3] Bacterial growth is inhibited by refrigeration below 4° C., heating above 121° C, and high water-activity or acidity.[4] And although the toxin is destroyed by heating to 85° C. for at least five minutes, the spores formed by the bacteria are not inactivated unless the food is heated under high pressure to 121° C. for at least twenty minutes.[5] C. botulinum bacteria and spores are widely distributed in nature, because they are indigenous to soils and waters.[6] They occur in both cultivated and forest soils, bottom sediment of streams, lakes, and coastal waters, in the intestinal tracts of fish and mammals, and in the gills and viscera of crabs and other shellfish.[7]

The incidence of foodborne botulism is extremely low.[8] Nonetheless, the extreme danger posed by the bacteria has required that “intensive surveillance is maintained for botulism cases in the United States, and every case is treated as a public health emergency.”[9] This danger includes a mortality rate of up to 65% when victims are not treated immediately and properly.[10] Most of the botulism events[11] that are reported annually in the United States are associated with home-canned foods that have not been safely processed.[12] Occasionally, though, commercially-processed foods are implicated as the source of a botulism events, including sausages, beef stew, canned vegetables, and seafood products.[13]

Symptoms of Botulism

After their ingestion, botulinum neurotoxins are absorbed primarily in the duodenum and jejunum, pass into the bloodstream, and travel to synapses in the nervous system.[14] There, the neurotoxins cause flaccid paralysis by preventing the release of acetylcholine, a neurotransmitter, at neuromuscular junctions, thereby preventing motor-fiber stimulation.[15]The flaccid paralysis progresses symmetrically downward, usually beginning with the eyes and face before moving to the throat, chest, and extremities.[16] When the diaphragm and chest muscles become fully involved, respiration is inhibited and, unless the patient is ventilated, death from asphyxia results.[17]

Classic symptoms of botulism include nausea, vomiting, fatigue, dizziness, double vision, drooping eyelids, slurred speech, difficulty swallowing, dryness of skin, mouth, and throat, lack of fever, muscle weakness, and paralysis.[18] Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.[19] Throughout all such symptoms, the victims are fully alert and the results of sensory examination are normal.[20]

In foodborne botulism cases, symptoms usually begin anywhere between 12 and 72 hours after the ingestion of toxin-containing food.[21] Longer incubation periods—up to 10 days—are not unknown, however. The duration of the illness is from 1 to 10 (or more) days, depending on host-resistance, the amount of toxin ingested, and other factors.[22] Full recovery often takes from weeks to months.[23] And, as earlier indicated, mortality rate can be from 30% to 65%, with rates generally lower in European countries than in the United States.[24]

Detection and Treatment of Botulism

Although botulism can be diagnosed based on clinical symptoms, its differentiation from other diseases is often difficult—especially in the absence of other known persons affected by the condition.[25] Once suspected, the most direct and effective way to confirm the diagnosis of botulism in the laboratory is testing for the presence of the botulinum toxin in the serum, stool, or gastric secretions of the patient.[26] The food consumed by the patient can also be tested for the presence of toxins.[27] Currently, the most sensitive and widely used method for the detection of the toxins is the mouse neutralization test, which involves injecting serum into mice and looking for signs of botulism.[28] This test typically takes 48 hours, while the direct culturing of specimens takes 5-7 days.[29] Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.[30]

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood.[31] This can prevent patients from worsening, but recovery still takes many weeks.[32] The mainstay of therapy is supportive treatment in intensive care, and mechanical ventilation in case of respiratory failure, which is common.[33]

Long-Term and Permanent Injury

Although a minority of botulism patients eventually recover their pre-infection health, the majority do not. For those who fully recover, the greatest improvement in muscle strength occurs in the first three months after the acute phase of illness.[34] The outside limit for such improvement appears, however, to be one year.[35] Consequently, physical limitations that still exist beyond the one-year mark are more probably than not permanent. Recovery from acute botulism symptoms may also be followed by persistent psychological dysfunction that may require intervention.[36]

According to a recently-published study that tracked the long-term outcomes of 217 cases of botulism, a large majority of patients reported “significant health, functional, and psychosocial limitations that are likely the consequences of the illness.”[37] These limitations included: fatigue, weakness, dizziness, dry mouth, and difficulty lifting things. The victims also reported difficulty breathing caused by moderate exertions, such as walking or lifting heavy items. They were also more likely to have limitations in vigorous activities, like running or playing sports, climbing up three flights of stairs, or carrying groceries. Summarizing its finding, the study concluded that:

Even several years after acute illness, patients who had botulism were more likely than control subjects to experience fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and difficulty breathing caused by moderate exertion….In addition, patients…reported worse overall psycho-social status than did control subjects, with patients being significantly less likely to report feeling happy, calm and peaceful, or full of pep.[38]

There is, as a result, no question that the damaging effects of botulism are life-long.

References

[1] See J. Sobel, et al., Foodborne Botulism in the United States, 1990-2000, Emerging Infectious Diseases, Vol. 10, No. 9, at 1606 (Sept. 2004).

[2] James M. Jay, MODERN FOOD MICROBIOLOGY, 466 (6th Ed. 2000)

[3] Id. at 469-71; see also Sobel, supra note 2, at 1606.

[4] Sobel, supra note 2, at 1606.

[5] Id.

[6] Jay, supra note 3, at 467-69. See also, generally H. Houschild, Clostridium Botulinum, in FOODBORNE BACTERIAL PATHOGENS, at 112-89 (M. Doyle Ed. 1989)

[7] Jay, supra note 3, at 467-69.

[8] Sobel, supra note 2, at 1607-09; Jay, supra note 3, at 472-76.

[9] Sobel, supra note 2, at 1606-07 (also noting that the CDC maintains a 24-hour clinical consultation and emergency antitoxin release service).

[10] Jay, supra note 3, at 474.

[11] With botulism, the broader term “event” is used to encompass both outbreaks—i.e., two or more cases of botulism caused by a common-source, as well as individual (or sporadic) cases.

[12] Sobel, supra note 2, at 1610; Jay, supra note 3, at 474.

[13] Id.

[14] Thomas P. Bleck, Clostridium botulinum (Botulism), in MANDELL, DOUGLAS AND BENNETT’S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASE 2543, 2544 (5th ed. 2000).

[15] Id.; Sobel, supra note 2, at 1606.

[16] Bleck, supra note 15, at 2545; see also BOTULISM FACT SHEET, National Agricultural Bio-Security Center, Kansas State University, online at http://nabc.ksu.edu/content/factsheets/category/Botulism#f26

[17] Bleck, supra note 15, at 2545; Sobel, supra note 2, at 1606.

[18] Sobel, supra note 2, at 1606; Jay, supra note 3, at 474.

[19] Jay, supra note 3, at 476-77.

[20] Sobel, supra note 2, at 1606.

[21] Jay, supra note 3, at 474.

[22] Id.

[23] R. Shapiro, et al., Botulism in the United States: A Clinical and Epidemiologic Review, Ann. Intern. Med. 1998; 129:221-28.

[24] Jay, supra note 3, at 474.

[25] Bleck, supra note 15, at 2546 (noting that “botulism has a limited differential diagnosis”).

[26] Sobel, supra note 2, at 1607; see also FDA/CFSAN Bad Bug Book, Clostridium Botulinum, available at http://vm.cfsan.fda.gov/~mow/chap2.html

[27] Id.

[28] Bleck, supra note 15, at 2546. See also, e.g. MMWWR, supra note 1, at 2 (“CDC detected botulinum toxin Type A by mouse bioassay in the man’s serum sample”).

[29] Bad Bug Book, supra note at 25.

[30] Sobel, supra note 2, at 1606; Shapiro, supra note 23, at 223.

[31] Jay, supra note 3, at 474; Sobel, supra note 2, at 1606.

[32] Id.; Bleck, supra note 15, at 2546-67.

[33] Sobel, supra note 2, at 1606.

[34] Bleck, supra note 15, at 2547. See also P. Wilcox, et al., Recovery of Ventilatory and Upper Airway Muscles and Exercise Performance After Type-A Botulism, Chest, 98:620-26 (1990); J. Mann, et al., Patient Recovery From Type-A Botulism: Morbidity Assessment Following a Large Outbreak, Am. J. Public Health, 71 (3):266-69 (Mar. 1981).

[35] Id.

[36] Bleck, supra note 15, at 2547. See also F. Cohen, et al., Physical and Psychosocial Health Status 3 Years After Catastrophic Illness—Botulism, Issues Mental Health Nurs., 9:387098 (1988)

[37] S. Gottlieb, et al., Long-Term Outcomes of 217 Botulism Cases in the Republic of Georgia, Clin. Infectious Disease, 45: 174-80, at 180 (220&).

[38] Id. at 179.

The number of Salmonella cases in England has returned to pre-COVID-19 pandemic levels and 11 outbreaks were reported in 2022.

Salmonella Enteritidis went back to being the most frequently reported serovar and Salmonella Typhimurium infections also increased, said the UK Health Security Agency (UKHSA).

In 2022, there were 8,125 Salmonella cases in England, compared to 5,033 in 2021, 4,712 in 2020 and 8,398 in 2019.

Salmonella Enteritidis reports jumped from 747 in 2021 to 2,044 in 2022. Salmonella Typhimurium infections rose from 1,219 in 2021 to 1,731 in 2022. Salmonella Infantis was in third place with 310 reports, followed by Salmonella Newport, Mbandaka, Agona, and Virchow.

Data comes from the Second Generation Surveillance System (SGSS) and the Gastrointestinal Infections and Food Safety (One Health) (GIFSOH) division’s eFOSS (electronic foodborne and non-foodborne outbreak surveillance system).

The age group with the most laboratory reports was children younger than the age of 10. This category, accounted for 26 percent of lab reports. Patients were split equally between males and females.

London had the highest number of Salmonella lab reports with 1,631 and was the region with the highest rate with 18.4 reports per 100,000 population. The North East had the lowest number of Salmonella reports with 408 but the East Midlands had the lowest reporting rate at 11.5 per 100,000 population.

In 2022 across 30 countries in Europe and the European Economic Area (EEA), more than 66,700 Salmonella cases were recorded with 81 deaths. France, Germany and Spain reported more cases than England.

Outbreak details
Eleven outbreaks were recorded in England in 2022 with 591 patients and four were caused by Salmonella Typhimurium.

The largest affected 133 people in England with 26 hospitalized. This was caused by contaminated Ferrero Kinder chocolate. Another outbreak with 91 cases was linked to meat products. A ready meal contaminated with Salmonella Typhimurium sickened 24 people with two deaths. Five people fell ill after drinking raw milk at a farm.

Two Salmonella Infantis outbreaks were linked to chicken. The first affected 50 people and the second had 58 cases.

One person died and 10 were hospitalized in a Salmonella Mbandaka outbreak with 112 cases caused by chicken.

A Salmonella Gueuletapee outbreak with 47 patients was linked to kebab meat and a Salmonella Agona outbreak with 16 patients was caused by cucumbers.

Fresh coriander served at a restaurant sickened 33 people with four hospitalized because of Salmonella Java. The source of another Salmonella outbreak that affected 22 people was not found.

Some of these outbreaks also involved other countries. The Salmonella Typhimurium chocolate outbreak had 455 lab confirmed cases in 17 countries.

As of March 2024, the Salmonella Mbandaka outbreak had sickened at least 300 people in seven countries, including 173 in the UK. The outbreak strain was found in frozen chicken breast fillets produced in Ukraine.

The Salmonella Agona incident affected more than 100 people in three European countries. Cucumbers from Spain were the suspected source.

The UK was also involved in a Salmonella Virchow outbreak caused by chicken kebab meat and a Salmonella Senftenberg outbreak linked to cherry-like tomatoes.

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The FDA has asked Sammy’s Milk of Newport Beach, CA, to provide a warning against the use of its toddler formula as an infant formula.

The agency is concerned that the formula may not meet requirements for infant formula and may be unsafe and not provide sufficient nutrition when used as an infant formula.

The FDA’s concerns were provided to Sammy’s Milk in a meeting with agency officials this week that identified representations on the Sammy’s Milk website and social media platforms that could be interpreted to indicate the product is safe for infants to consume.

The company says its product is specifically formulated for children between the ages of 12 and 36 months, as clearly indicated on its packaging and website. The product at issue was only available online, and included lot code SD348, with a “Best by” date of August of 2025.

“It is crucial that users adhere to the recommended age range for the consumption of our product. Sammy’s Milk does not recommend the use of Goat Milk Toddler Formula for infants under 12 months of age. If you are feeding our product to an infant, we recommend that you stop doing so because the FDA has concerns that Goat Milk Toddler Formula does not meet all FDA requirements for infant formula and may be unsafe and not provide sufficient nutrition when used as an infant formula,” the company said in a statement posted by the FDA.

“For further inquiries or clarification regarding the appropriate use of Sammy’s Milk Goat Milk Toddler Formula, please contact our customer service team at info@sammysmilk.com.”

In 2016 the company recalled all lots of Sammy’s Milk Baby Food because of the possible presence of Cronobacter, a bacteria that can cause severe and sometimes fatal blood infections or meningitis in infants.

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Another brand of fresh, organic basil has been linked to an outbreak of Salmonella infections.

Melissa’s-brand organic basil sold in 2-ounce and 4-ounce packages at Dierberg’s stores in Illinois and Missouri between Feb. 10 through Feb. 20, has been added to a recall by Infinite Herbs, LLC, of Miami, FL.

The company already recalled Infinite Herbs-brand fresh organic basil sold at Trader Joe’s stores and Fruit Center Marketplace from Feb. 1 through April 6 in relation to the outbreak, which has sickened 12 people with one requiring hospitalization.

Although the basil is no longer for sale, the Centers for Disease Control and Prevention is asking people to watch for symptoms of Salmonella infection after eating fresh basil and seek medical treatment. Doctors should report such infections to public health officials to aid with the outbreak investigation.

“If you previously purchased recalled basil and then froze it, you should throw it away if it’s part of the recall or if you cannot tell if it’s part of the recall,” the Food and Drug Administration said in an outbreak update today.

The Infinite Herbs brand fresh basil was sold in Trader Joe’s stores in Alabama, Connecticut, Washington D.C., Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Maine, Michigan, Minnesota, Missouri, North Carolina, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Vermont and Wisconsin.

The outbreak investigation is ongoing to determine the source of contamination and whether additional products are linked to illnesses. 

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has eaten any fresh organic basil and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop severe illness and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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Shearer’s Foods, LLC of Massillon, OH is recalling Great Value Twist & Shout Strawberry Creme Sandwich Cookies because they may contain foreign material, specifically plastic.

According to the details posted online by the Food and Drugs Administration (FDA), the recall was initiated on March 21, 2024, and is ongoing.

The recalled products were distributed in Oklahoma.

Recalled product:

Great Value Twist & Shout Strawberry Creme Sandwich Cookies 

• Net WT 15.35 oz. box containing film-wrapped trays of stacked cookies. 12 boxes per case.
• Product Quantity: 112 cases, 1344 units
• Code Information: BEST IF USED BY: SEP 11 2024 CB03

Consumers should not use this product. Recalled products should be thrown out or returned to their place of purchase.

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Public health officials in Michigan are again warning against drinking unpasteurized, raw milk, this time because of the highly pathogenic avian influenza (HPAI) that has been found in dairy herds.

The virus has been found in dairy cattle in eight states, including Michigan. It has also been detected in wild mammals and birds as well as domestic chicken flocks. Millions of chickens have had to be destroyed because of the outbreak.

Two cases of infection from the virus have been confirmed in people in the United States and patients have been identified in other countries.

The Michigan health officials are reminding the public that pasteurization kills viruses such as HPAI, but it survives in raw milk.

“Now that HPAI is infecting both cows and birds, it’s important to make sure that you are consuming food that is safe, including ensuring that the milk products you eat or drink are pasteurized,” said Michigan’s Chief Medical Executive Dr. Natasha Bagdasarian.

“Anyone can get sick from drinking raw milk, but children under age 5, adults over age 65 and those with weakened immune systems are more at risk for getting sick.” 

Pasteurized milk is extremely safe and has undergone a heating process which kills disease-causing germs like Campylobacter, E. coli and Salmonella. People who consume raw (or unpasteurized) milk, cheeses and other dairy products like ice cream created from raw milk are at risk for a variety of illnesses. Only pasteurized milk is sold in stores and provided to children in school lunches in Michigan.

People can get ill from the same source and product of raw milk they drank previously – milk that someone consumes from the same farm over a duration of time may not always be safe. Raw milk can become contaminated in many ways. While good safety practices can reduce the chance of germs getting in raw milk, they cannot eliminate risk, according to the Michigan public health agency.

The U.S. Food and Drug Administration does not currently have concerns about the safety or availability of pasteurized milk products nationwide. Pasteurization has continually proven to inactivate bacteria and viruses, like influenza viruses, in milk and is required for any milk entering interstate commerce.

The Centers for Disease Control and Prevention recommends taking the following steps to reduce risk:

• Choose pasteurized milk and dairy products.
• Refrigerate milk, dairy products and other perishable food at 40 degrees F or colder.
• Throw away expired food, including milk and dairy products.

For more information, visit CDC.gov/foodsafety/rawmilk.

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The 11th Circuit Court Of Appeals was scheduled to hear that five-year habeas corpus motion from Stewart Parnell but pulled it back.

The second highest court in the land promises to re-assign the Stewart Parnell case shortly. 

The Atlanta-based court appears ready to wrap up the Habeas petitions from Stewart Parnell and his brother, Michael Parnell.  Both filed so-called Motion 2255 actions challenging their convictions and sentences for their roles in a deadly Salmonella outbreak from peanut butter products.

In the five years that the brothers have pursued federal Writs of Habeas Corpus, the procedure has yet not given them much encouragement. However, that may change as petitions for both men will likely be heard soon at the U.S. Court of Appeals for the 11th Circuit.

Stewart and Michael Parnell were convicted by a 2014 jury trial in Albany, GA. Both were associated with the now-defunct Peanut Corporation of America, which was found responsible for the 2008-09 multistate Salmonella outbreak that sickened hundreds and killed several.

For their multiple felony convictions, Steward Parnell was sentenced to 28 years in federal prison, and Michael Parnell was sentenced to 20 years.

The Parnells filed petitions for federal Writs of Habeas Corpus under 18 U.S.C. §2254, which is for those in federal custody. The Latin “habeas corpus” translates into “you have the body.” A petition for the writ claims someone is being detained against their constitutional rights. A Habeas Corpus petition claims the arrest, sentence, or trial violated constitutional law, making imprisonment unlawful.

Ineffective assistance of trial counsel is the most common issue cited in Habeas Corpus petitions, and both Parnell brothers have raised that claim.

Stewart was first to file on Sept. 6, 2019. His attorneys wrote: “Stewart Parnell owned the Peanut Corporation of America (“PCA”), a peanut processing plant in Blakely, Georgia – a small town in southwest Georgia 48 miles southwest of Albany.

“In 2014, Mr. Parnell was convicted of conspiracy, introducing adulterated and misbranded food into interstate commerce, interstate shipments fraud, wire fraud, and obstruction of justice from a salmonella outbreak tied to PCA. After an unsuccessful direct appeal, United States v. Parnell, 723 Fed. Appx. 745 (11th Cir. 2018), Mr. Parnell now shows that his trial counsel provided ineffective assistance by failing to move for a change of venue or to strike jurors for cause who knew about allegations of deaths resulting from the salmonella outbreak.”

Michael Parnell filed his Habeus Corpus petition about a month later.

After filing their petitions, the Parnells each scored a victory when the Magistrate Judge decided the issues raised were worthy of an evidentiary hearing. Magistrate Judge Thomas Q. Langstaff for the Middle District of Georgia presided over the hearings in late May 2021 in the same Albany, GA, courthouse where the Parnells were convicted.

Federal marshals delivered the Parnells to the evidentiary hearings, and they could trade witness and exhibit lists. But after it was over, Langstaff ruled against their petitions in his recommendation to the Middle District of Georgia, and the trial judge, W. Louis Sands, agreed.

The final denial by the Middle District of Georgia left an appeal to the 11th Circuit as the next option. Stewart Parnell’s petition arrived first and cleared one big obstacle by winning a motion “for a certificate of appealability.”

While “granted in part,” U.S. Circuit Judge Andrew L. Brasher has permitted Stewart Parnell to appeal on two critical issues:

1.) whether the distinct court erred in determining that Parnell could not establish a presumption of jury prejudice, based on adverse pretrial publicity, under Skilling v. United States; and

2.) whether a showing of presumed jury prejudice under Skilling operates to establish both prongs of an ineffective assistance of counsel claim based on the counsels’ failure to move for a change of venue.

With Rouse & Copeland in Savannah, GA, Amy Copeland is Stewart Parnell’s attorney for the Habeus Corpus petition. Her next deadline for filing the appellant’s brief is June 26, about two weeks from now.

Michael Parnell’s appeal to the 11th Circuit was filed on May 26. Two Virginia attorneys, Elliott M. Harding and William J. Dinkin, represent him.

Before taking his petition to the Atlanta court, Michael Parnell triumphed in getting his conviction record corrected by the Middle District. At the suggestion of his Bureau of Prisons (BOP) case manager, Parnell’s Introduction of Adulterated Food offenses was corrected to “Introduction of Misbranded Food.”

It was Nov. 10, 2008, when the CDC’s PulseNet staff first noted a small and highly dispersed multistate cluster of 13 Salmonella Typhimurium isolates with an unusual DNA fingerprint or pulsed-field gel electrophoresis (PFGE) pattern reported from 12 states. By  April 20, 2009, 714 people in  46 states were confirmed with the outbreak strain of Salmonella Typhimurium associated with the Peanut Corporation of America (PCA) facility in Blakely, GA. Nine deaths were a direct result of the outbreak, according to the Centers for Disease Control and Prevention.

Criminal charges related to the outbreak were filed in 2013 against five PCA managers and executives. Only the Parnell brothers remain in federal custody.
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Scientists in Europe have updated the knowledge around parasites in fish based on available surveillance data.

The European Food Safety Authority (EFSA) scientific opinion also evaluated methods for detecting and killing parasites in fish.

European data indicates that many species of farmed fish are free from parasites that can infect humans. These include Atlantic salmon, rainbow trout, gilthead seabream, turbot, meagre, Atlantic halibut, carp, and European catfish.  

However, Anisakis pegreffii, Anisakis simplex and Cryptocotyle lingua were found in European seabass, Atlantic bluefin tuna and/or cod, and Pseudamphistomum truncatum and Paracoenogonimus ovatus in tench, produced in open offshore cages or flow-through ponds or tanks.

Situation in Europe
Eleven foodborne outbreaks caused by Anisakis occured in the EU from 2010 to 2022. In 2020, there were two outbreaks, both reported by Spain, involving six people.

From 2010 to 2023, there were 544 reports of infected fishery products reported by 21 EU member states to the Rapid Alert System for Food and Feed (RASFF). Italy had the most with 274 reports. Origin of products mainly included Spain, Morocco, and France. Anisakis was the parasite reported in the majority of notifications.

Experts said it was almost certain that fish produced in closed recirculating aquaculture systems or flow-through facilities with filtered water intake and only fed heat-treated feed are free of parasites.

The offshore location of salmon farms may result in increased exposure of the fish to anisakids as they are situated close to marine mammals’ migration routes and habitats. Aquaculture that relies on the capture of juvenile wild fish for subsequent growing and fattening in captivity, as used for Atlantic bluefin tuna in Europe, also potentially facilitates exposure of fish to parasites.

Scientists said more data was needed to estimate the prevalence of parasites in selected fish species, farming systems, and production areas in Europe.

The European Commission had asked EFSA to update certain aspects of a 2010 scientific opinion on the risk assessment of parasites in fish products.

Currently, the relationship between survival of the larvae, after a given treatment, and their infection capacity in humans is unclear, and as stated in the past opinion, a precautionary principle is adopted, meaning all larvae should be dead, which gives a higher margin of safety.

Detecting and killing parasites
Ecological drivers of infection of fish with parasites include temperature, salinity and oceanographic conditions; the fishing ground; fish length and size and part of the fish that is infected. Climate change may have an impact because of rising water temperature. People are also consuming raw or undercooked foods more often.

Freezing and heating continue to be the most efficient methods to kill parasites in fishery products. High-pressure processing may be suitable for some products. Pulsed electric field is a promising technology although further development is needed but ultrasound treatments were not effective.

For freezing, this is a core temperature of −15 degrees C (5 degrees F) for at least 96 hours, −20 degrees C (-4 degrees F) for at least 24 hours or −35 degrees C (-31 degrees F) for at least 15 hours. Heat treatment is at least 60 degrees C (140 degrees F) for 1 minute.

Traditional dry salting processes of anchovies inactivated Anisakis. Studies on other traditional processes such as air-drying and double salting also suggest that anisakids are inactivated.

Advanced processing techniques for cutting, which include gutting and trimming operations could have a significant impact on ensuring parasite-free products for consumers.

Scientists said further work should focus on detection and inactivation methods. They also said a survey should be undertaken at the processing stage to address data gaps on the occurrence of zoonotic parasites in fish species commonly produced in open systems.

Experts are also working to see if any wild fish species from specific fishing areas pose a risk to public health due to zoonotic parasites.  

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The Food and Drug Administration continues using import alerts to enforce U.S. food safety regulations for food from foreign countries. The agency updates and modifies the alerts as needed.

Recent modifications to FDA’s import alerts, as posted by the agency, are listed below. 

Click here to go to the FDA page with links to details on specific alerts.

Click on table to enlarge. Use link above to go to FDA page with links to specific alerts.

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What is the Salmonella Bacteria?

Salmonella is a bacterium that causes one of the most common enteric (intestinal) infections in the United States – salmonellosis. The term Salmonella refers to a group or family of bacteria that variously cause illness in humans.Salmonella serotype typhimurium and Salmonella serotype enteritidis are the most common in the United States.

What is the Incidence of Salmonella Infections?

In 2009, over 40,000 cases of Salmonella (13.6 cases per 100,000 persons) were reported to the Centers for Disease Control and Prevention (CDC) by public health laboratories across the nation, representing a decrease of approximately 15% from the previous year, but a 4.2% increase since 1996. [1] Overall, the incidence of Salmonella in the United States has not significantly changed since 1996. Only a small proportion of all Salmonella infections are diagnosed and reported to health departments. It is estimated that for every reported case, there are approximately 38.6 undiagnosed infections. The CDC estimates that 1.4 million cases, 15,000 hospitalizations, and 400 deaths are caused by Salmonella infections in the U.S. every year.

Salmonella can be grouped into more than 2,400 serotypes. The two most common serotypes in the U.S. are S. Typhimurium and S. Enteritidis. S. Typhi, the serotype that causes typhoid fever, is uncommon in the U.S. But globally, typhoid fever continues to be a significant problem, with an estimated 12-33 million cases occurring annually. Moreover, outbreaks in developing countries have a high deathrate, especially when caused by strains of the bacterium that are resistant to antibiotic treatment.

Salmonella are found in the intestinal tract of wild and domesticated animals and humans. Some serotypes of Salmonella, such as S. Typhi and S. Paratyphi are only found in humans. For ease of discussion, it is generally useful to group Salmonellae into two broad categories: typhoidal, which includes S. Typhi and S. Paratyphi, and non-typhoidal, which includes all other serotypes.

What is the Prevalence of Salmonella in Food and Elsewhere?

Most Salmonella infections are caused by eating contaminated food, especially food from animal origins. One study found that 87% of all confirmed cases of Salmonella were foodborne, with 10 percent from person-to-person infection and 3% caused by pets. Food remains the most common vehicle for the spread of Salmonella, and eggs are the most common food implicated. Chicken is also a major cause of Salmonella.Beginning in 1998, the publisher of Consumer Reports magazine has conducted surveys and tested chicken at retail for Salmonella and Campylobacter. Its 2009 study found 14% of broiler chickens at grocery stores to contain Salmonella. A USDA Baseline Data Collection Program report done in 1994 documented Salmonella contamination on 20.0% of broiler-chicken carcasses. However, in 2009 the same USDA data collection survey showed the prevalence of Salmonella in broiler chickens at 7.5%. Additionally, turkey carries a lower risk with a prevalence of 1.66%.  

While Salmonella comes from animal feces, fruits and vegetables can become contaminated. A common source is raw sprouts, which have been the subject of at least 30 reported outbreaks of foodborne illnesses since 1996. The U.S. Department of Health and Human Services cautions against consuming raw sprouts under any circumstances: “Unlike other fresh produce, seeds and beans need warm and humid conditions to sprout and grow. These conditions are also ideal for the growth of bacteria, including Salmonella, Listeria, and E. coli.”

What are the Symptoms of Salmonella Infection?

Salmonella infections can have a broad range of illness, from no symptoms to severe illness. The most common clinical presentation is acute gastroenteritis. Symptoms include diarrhea, and abdominal cramps, often accompanied by fever of 100°F to 102°F (38°C to 39°C). Other symptoms may include bloody diarrhea, vomiting, headache and body aches. The incubation period, or the time from ingestion of the bacteria until the symptoms start, is generally 6 to 72 hours; however, there is evidence that in some situations the incubation can be longer than 10 days. People with salmonellosis usually recover without treatment within 3 to 7 days. Nonetheless, the bacteria will continue to be present in the intestinal tract and stool for weeks after recovery of symptoms—on average, 1 month in adults and longer in children. 

What are the Complications of Salmonella Infection?

In approximately 5% of non-typhoidal infections, patients develop bacteremia. In a small proportion of those cases, the bacteria can cause a focal infection, where it becomes localized in a tissue and causes an abscess, arthritis, endocarditis, or other severe illness. Infants, the elderly, and immune-compromised persons are at greater risk for bacteremia or invasive disease. Additionally, infection caused by antimicrobial-resistant non-typhoidal Salmonella serotypes appears to be more likely to cause bloodstream infections. 

Overall, approximately 20% of cases each year require hospitalization, 5% of cases have an invasive infection, and one-half of 1% die. Infections in infants and in people 65 years of age or older are much more likely to require hospitalization or result in death. There is some evidence that Salmonella infections increase the risk of developing digestive disorders, including irritable bowel syndrome.

Although most persons that become ill with diarrhea caused by Salmonella recover without any further problems, a small number of persons develop a complication often referred to as reactive arthritis. The terminology used to describe this type of complication has changed over time. The term “Reiter’s Syndrome” was used for many years but has now fallen into disfavor. The precise proportion of persons that develop reactive arthritis following a Salmonella infection is unknown, with estimates ranging from 2 to 15%. Symptoms of reactive arthritis include inflammation (swelling, redness, heat, and pain) of the joints, the genitourinary tract (reproductive and urinary organs), or the eyes.

More specifically, symptoms of reactive arthritis include pain and swelling in the knees, ankles, feet and heels. It may also affect wrists, fingers, other joints, or the lower back. Tendonitis (inflammation of the tendons) or enthesitis (inflammation where tendons attach to the bone) can occur. Other symptoms may include prostatitis, cervicitis, urethritis (inflammation of the prostate gland, cervix or urethra), conjunctivitis (inflammation of the membrane lining the eyelid) or uveitis (inflammation of the inner eye). Ulcers and skin rashes are less common. Symptoms can range from mild to severe.

One study showed that on average, symptoms developed 18 days after infection. A small proportion of those persons (15%) had sought medical care for their symptoms, and two thirds of persons with reactive arthritis were still experiencing symptoms 6 months later. Although most cases recover within a few months, some continue to experience complications for years. Treatment focuses on relieving the symptoms.

How to Diagnose a Salmonella Infections?

Salmonella bacteria can be detected in stool. In cases of bacteremia or invasive illness, the bacteria can also be detected in the blood, urine, or on rare occasions in tissues. The test consists of growing the bacteria in culture. A fecal, blood or other sample is placed in nutrient broth or on agar and incubated for 2-3 days. After that time, a trained microbiologist can identify the bacteria, if present, and confirm its identity by looking at biochemical reactions. Treatment with antibiotics before collecting a specimen for testing can affect bacterial growth in culture, and lead to a negative test result even when Salmonella causes the infection.

What is the Treatment for Salmonella Infection?

Salmonella infections usually resolve in 3 to 7 days, and many times require no treatment. Persons with severe diarrhea may require rehydration, often with intravenous fluids. Antimicrobial therapy (or treatment with antibiotics) is not recommended for uncomplicated gastroenteritis. In contrast, antibiotics are recommended for persons at increased risk of invasive disease, including infants younger than 3 months of age. 

What are the steps a person can take to prevent a Salmonella infection?

In general, safe cooking and preparation of food can kill existing Salmonella bacteria and prevent it from spreading. Additionally, safe choices at the grocery store can greatly reduce the risk of Salmonella. 

• Always wash your hands before you start preparing food.
• Cook poultry until it reaches an internal temperature of 165 ºF.
• Cook beef and pork until they reach 160ºF. High quality steaks (not needle or blade tenderized) can be safely cooked to 145ºF.
• Cook eggs until they reach 160ºF or until the yoke is solid. Pasteurized eggs are available in some grocery stores.
• Do not eat or drink foods containing raw eggs. Examples include homemade eggnog, hollandaise sauce, and undercooked French toast.
• Never drink raw (unpasteurized) milk. 
• Avoid using the microwave for cooking raw foods of animal origin. Microwave-cooked foods do not reach a uniform internal temperature, resulting in undercooked areas and survival of Salmonella.
• If you are served undercooked meat, poultry, or eggs in a restaurant don’t hesitate to send your food back to the kitchen for further cooking.
• Avoid cross-contamination. That means that you should never allow foods that will not be cooked (like salads) to encounter raw foods of animal origin (e.g., on dirty countertops, kitchen sinks, or cutting boards). Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw foods of animal origin.
• Wash hands with soap after handling reptiles, amphibians or birds, or after contact with pet feces. Infants and persons with compromised immune systems should have no direct or indirect contact with such pets.
• Reptiles, amphibians or birds, or any elements of their housing (such as water bowls) should never be allowed in the kitchen.
• Avoid eating in animal barns and wash your hands with soap and water after visiting petting zoos or farm settings.
• Always wash your hands after going to the bathroom. The hands of an infected person who did not wash his or her hands adequately after using the bathroom may also contaminate food. 

References

1. CDC, “Salmonella Annual Summary Tables 2009,” 2009, available online at

http://www.cdc.gov/ncezid/dfwed/PDFs/SalmonellaAnnualSummaryTables2009.pdf

2. CDC, “Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly through Food—10 States, 2008,” MORBIDITY AND MORTALITY WEEKLY REPORT, Vol. 58, No. 14, pp. 333-37 (April 10, 2009), online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a2.htm

3. Voetsch, Andrew, et al., “FoodNet Estimate of the Burden of Illness Caused By Non-Typhoidal Salmonella Infections in the United States,” CLINICAL INFECTIOUS DISEASES, Vol. 15, No. 38, Supplement 3, pp. S127-34 (April 15, 2004) available online at http://cid.oxfordjournals.org/content/38/Supplement_3/S127.long

4. American Academy of Pediatrics, “Salmonella infections,” RED BOOK: 2006 Report of the Committee on Infectious Diseases, edited by L. K. Pickering, pp. 581–584 (27th ed. 2006).

5. Miller, S. and Pegues, D., “Salmonella Species, Including Salmonella Typhi,” in Mandell, Douglas, and Bennett’s PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES, Sixth Edition, Chap. 220, pp. 2636-650 (2005). 

6. Behravesh, C.B., et al., “Salmonellosis,” in CONTROL OF COMMUNICABLE DISEASES MANUAL, 19th Edition, published by American Public Health Association, pp. 535-540. (Heymann, D, editor 2008).

7.  Medus, C, et al., “Salmonella Outbreaks in Restaurants in Minnesota, 1995 through 2003—Evaluation of the Role of Infected Foodworkers,” JOURNAL OF FOOD PROTECTION, Vol. 69, No. 8, pp. 1870-78 (Aug. 2006), article abstract and paid-access to full-text available online at http://www.ncbi.nlm.nih.gov/pubmed/16924912

8.  Jones, Timothy F., et al, “Salmonellosis Outcomes Differ Substantially By Serotype,” JOURNAL OF INFECTIOUS DISEASES, Vol. 198, No. 1, pp. 109-14 (July 1, 2008) at http://jid.oxfordjournals.org/content/198/1/109.full

9.  Varma, Jay K., et al., “Antimicrobial-Resistant Non-typhoidal Salmonella is Associated with Excess Bloodstream Infections and Hospitalizations, JOURNAL OF INFECTIOUS DISEASES, Vol. 191, No. 4,  pp. 554-61 (Feb. 15, 2005) available online at http://jid.oxfordjournals.org/content/191/4/554.long

10. Townes, John M., “Reactive Arthritis after Enteric Infections in the United States: The Problem of Definition,” CLINICAL INFECTIOUS DISEASES, Vol. 50, Issue 2, pp. 247-54 (2010) available online at http://cid.oxfordjournals.org/content/50/2/247.long

11. National Institute of Arthritis and Musculoskeletal and Skin Diseases, “Reactive Arthritis—Questions and Answers,” (online publication-date: April 2009), available at

http://www.niams.nih.gov/Health_Info/Reactive_Arthritis/default.asp#a (last accessed on July 20, 2011)

12. Townes, John M., et al., “Reactive Arthritis Following Culture-Confirmed Infections with Bacterial Enteric Pathogens in Minnesota and Oregon: A Population-based Study,” ANNALS OF RHEUMATIC DISEASE, Vol. 67, No. 12, pp. 1689-96 (Dec. 2008) article abstract at http://www.ncbi.nlm.nih.gov/pubmed/18272671

13.       CDC, SALMONELLA SURVEILLANCE: ANNUAL SUMMARY: 2005 (2007).  http://www.cdc.gov/ncidod/dbmd/phlisdata/salmtab/2005/SalmonellaIntroduction2005.pdf

14.       Tauxe, R, “Emerging Foodborne Diseases: An Evolving Public Health Challenge.,” EMERGING INFECTIOUS DISEASES, Vol. 3, No. 4, pp. 425-34 (1997) at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640074/pdf/9366593.pdf

15.       USDA Food Safety and Inspection Service (FSIS), NATIONWIDE BROILER CHICKEN MICROBIOLOGICAL BASELINE DATA COLLECTION PROGRAM, July 1994—July 1995, (April 1996), online at http://www.fsis.usda.gov/OPHS/baseline/broiler1.pdf

16.       USDA Food Safety and Inspection Service (FSIS), THE NATIONWIDE MICROBIOLOGICAL BASELINE DATA COLLECTION PROGRAM: YOUNG CHICKEN SURVEY, July 2007—June 2008, at http://www.fsis.usda.gov/PDF/Baseline_Data_Young_Chicken_2007-2008.pdf

17.       USDA Food Safety and Inspection Service (FSIS), THE NATIONWIDE MICROBIOLOGICAL BASELINE DATA COLLECTION PROGRAM: YOUNG TURKEY SURVEY, Aug. 2008—July 2009, at http://www.fsis.usda.gov/PDF/Baseline_Data_Young_Turkey_2008-2009.pdf

18.       Wallinga, D, “Antimicrobial Use in Animal Feed:  An Ecological and Public Health Problem,” MINNESOTA MEDICINE, Vol. 85, No. 10 pp. 12-16 (Oct. 2002).

19.       White, David, National Antimicrobial Resistance Monitoring System (NARMS), Meetings for Expert Reviews on the NARMS Program, June 23-24, 2005, Rockville, MD, TRANSCRIPT, http://www.fda.gov/AnimalVeterinary/SafetyHealth/AntimicrobialResistance/NationalAntimicrobialResistanceMonitoringSystem/ucm143994.htm

20.       Council for Agriculture, Science and Technology (CAST), “Foodborne Pathogens: Risks and Consequences: Task Force Report No.122,” pp. 1-87 (Sept. 1994) download at http://www.cast-science.org/publications/index.cfm/foodborne_pathogens_risks_and_consequences?show=product&productID=2852

21.       Buzby, Jean, et al., USDA Economic Research Service, “Bacterial Foodborne Disease—Medical Costs and Productivity Losses,” AER-741, August 1996, available online at http://www.ers.usda.gov/Publications/AER741/

22.       Buzby, Jean and Roberts, Tonya, “The Economics of Enteric Infections: Human Foodborne Disease Costs, GASTROENTEROLOGY, Vol. 136, No. 6, pp. 1851-62 (May 2009).

23.       “Outbreak of Salmonella serotype javiana infections—Orlando, Florida, June 2002,” MORBIDITY AND MORTALITY WEEKLY REPORT, Vol. 51, No. 31, pp. 683-4 (Aug.  9, 2002) at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5131a2.htm

24.       Kass, E. H., “A Brief Perspective on the Early History of American Infectious Disease Epidemiology,” Yale Journal of Biology & Medicine, vol. 60, No. 4, pp. 341-48 (1987) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2590246/pdf/yjbm00082-0043.pdf

25.       Patrick. ME, et al.  “Salmonella Enteritidis infections, United States, 1985–1999,” EMERGING INFECTIOUS DISEASES, Vol. 10, No. 1 (Jan. 2004), available online at http://www.cdc.gov/ncidod/EID/vol10no1/02-0572.htm.

26.       Buzby, Jean and Roberts, Tonya, “The Economics of Enteric Infections: Human Foodborne Disease Costs, GASTROENTEROLOGY,  Vol. 136, No. 6, pp. 1851-62 (May 2009).

27.       Consumers Union, “How Safe is that Chicken?” CONSUMER REPORTS (Jan. 2010), online at http://www.consumerreports.org/cro/magazine-archive/2010/january/food/chicken-safety/overview/chicken-safety-ov.htm

28.       USDA Food Safety and Inspection Service (FSIS), FACT SHEETS, “Egg Products Preparation,” April 2011, available online at http://www.fsis.usda.gov/Factsheets/Focus_On_Shell_Eggs/index.asp

29.       Foodsafety.gov, “Sprouts: What You Should Know,” online at http://www.foodsafety.gov/keep/types/fruits/sprouts.html (last visited February 17, 2012).

30.       CDC, INVESTIGATION ANNOUNCEMENT: MULTISTATE OUTBREAK OF HUMAN SALMONELLA HEIDELBERG INFECTIONS, Aug. 2011, available online at http://www.cdc.gov/salmonella/heidelberg/080111/

31.       CDC, SALMONELLA: PREVENTION, Sep. 2010, available online at http://www.cdc.gov/salmonella/general/prevention.html

32.       USDA Food Safety and Inspection Service (FSIS), FACT SHEETS, “Salmonella Questions and Answers,” May 2011, available online at http://www.fsis.usda.gov/factsheets/salmonella_questions_&_answers/

33. Illinois Department of Public Health, HEALTHBEAT, Salmonella, Jan. 2009, available online at http://www.idph.state.il.us/public/hb/hbsam.htm

Consumer Reports (CR) has found concerning discoveries regarding pesticide contamination in everyday fruits and vegetables in a newly released investigation. The report, representing CR’s most extensive analysis to date, examines the pervasive presence of harmful pesticides in our food supply, raising critical questions about food safety and regulatory oversight.

While the exact extent of the health risks posed by chronic pesticide exposure remains uncertain, evidence from various studies suggests a link between pesticides and increased risks of cancer, diabetes, cardiovascular disease, Parkinson’s disease, and other health problems. Particularly vulnerable populations, such as farmworkers and their families, face heightened risks, with exposure during pregnancy and childhood potentially leading to developmental and respiratory issues. Concerns also arise regarding the potential cumulative effects of long-term exposure, especially for individuals with chronic health conditions or living in areas with high toxin exposure.

Based on seven years of data from the Department of Agriculture, CR’s food safety experts examined 59 common fruits and vegetables. Pesticides posed significant risks in 20 percent of the items scrutinized. Among the offenders were household staples such as bell peppers, blueberries, green beans, potatoes and strawberries.

 A particularly alarming revelation concerned green beans, which showed residues of a pesticide banned from use on the vegetable for more than a decade in the U.S. This issue points to potential gaps in regulatory enforcement and oversight.

“While fruits and vegetables are integral to a balanced diet, our findings underscore the pressing need for enhanced vigilance and regulatory action,” remarked James E. Rogers, Ph.D, who oversees food safety initiatives at CR. “It’s evident that current measures are inadequate in safeguarding public health against the risks posed by pesticide contamination.”

CR’s analysis offers actionable insights for consumers seeking to mitigate pesticide exposure. By utilizing CR’s ratings, individuals can identify safer alternatives and prioritize organic produce when feasible. The report emphasizes the importance of informed decision-making, particularly for vulnerable populations such as children and pregnant women, who may be more impacted by pesticide residues.

CR is advocating for regulatory interventions to better address pesticide risks. Enhanced oversight of imported produce, particularly from regions with more lax pesticide regulations, is recommended to ensure the integrity of our food supply. CR is also calling for increased support for organic farming practices, citing their potential to reduce reliance on harmful pesticides and promote sustainable agricultural systems.

CR hopes the report serves as an alarm for policymakers, industry stakeholders, and consumers alike to prioritize food safety and environmental stewardship.

Click here for the full report.

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The Food and Drug Administration has identified a new outbreak of infections from E. coli O157:H7.

The agency announced the outbreak on April 17 and indicated that traceback efforts have begun. However, the FDA did not report the food or foods being traced.

The FDA had identified nine patients in the outbreak as of the announcement. The agency has not reported how old the patients are or where they live.

Investigation of a Salmonella Typhimurium outbreak continues with the patient count increasing. Since the announcement of the outbreak on April 10, the FDA has identified one more sick person, bringing the total to 12.

As with the new E. Coli outbreak, the FDA has not yet determined what food is the source of the Salmonella. The agency has begun traceback efforts but has not reported what food or foods are being traced.

No sampling or site inspections are underway in either of the outbreak investigations.

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According to the Danish food agency, there is still uncertainty among chefs and kitchen workers about the management of norovirus.

A Danish Veterinary and Food Administration (Fødevarestyrelsen) control and guidance campaign targeted restaurants, kitchens, and shops that supply ready-to-eat (RTE) food. Work involved 829 visits from June to November 2023.

The agency asked kitchen managers what steps they should take to prevent outbreaks. Some said they were unsure how far they could go concerning an employee’s illness and health.

Scale of issue
Norovirus is the most common cause of foodborne outbreaks in Denmark. The campaign focused on companies’ training of employees regarding personal hygiene, guidance on staff notification, and employer obligations to avoid contamination with foodborne viruses.

Danish officials said that if outbreaks are to be prevented and reduced, kitchen staff and company managers need to have the necessary knowledge to operate in a hygienically correct manner and in a way that minimizes the risk of food contamination with norovirus, as well as enabling them to act responsibly if an incident occurs, by informing management.

“Several kitchen managers have replied that they have not yet introduced procedures for handling norovirus and have not instructed employees in what to do if they are affected by norovirus,” said Lene Mølsted Jensen from the Danish Veterinary and Food Administration.

“Because a sick employee can be a danger to food safety, the kitchen manager can inquire about the symptoms if the employee reports being sick with an upset stomach, just as the employee also must inform the boss about an upset stomach.”

Results showed that all visited companies had sufficient procedures around personal hygiene, including the behavior of employees in connection with symptoms of norovirus, so no sanctions were applied.

However, the fact that there were 20 outbreaks with 790 cases in 2021 and 2022 points to a difference between these findings and the companies’ actions in daily operations. The Danish Veterinary and Food Administration said detecting issues with a single pre-announced inspection can be difficult.

Main control findings
On two occasions, inspectors found sites did not have the necessary facilities for employees to maintain a high level of personal hygiene. In both cases, there was a lack of handwashing facilities.

Over half of the questionnaire respondents were unaware that General Data Protection Regulation (GDPR) rules do not prevent them from asking about an employee’s possible symptoms.

Less than half of the participants knew about a guide from the Danish Veterinary and Food Administration with advice on avoiding infecting consumers with norovirus.

More than 60 percent of companies use the Danish Veterinary and Food Administration as their primary source of information when looking for advice in the event of a suspected incident. Other sources include industry organizations and consultants.

In 2019, 2020, and 2021, outbreaks resulting from infection with norovirus represented 37 percent, 17 percent, and 22 percent, respectively, of all registered foodborne outbreaks. The number of confirmed norovirus outbreaks increased to 14 in 2021 from six in 2020.

The Danish Veterinary and Food Administration repeated bits of a control campaign from 2020/2021. The initiative is part of efforts against foodborne viruses from January 2019 to December 2023, alongside the agency’s strategy and goal of fewer people getting sick from food.

Similar work in 2022 revealed kitchen staff and food companies lacked knowledge about how foodborne viruses such as norovirus are transmitted and how to avoid passing the infection on to customers and colleagues.

Norovirus can spread through sick people, contaminated surfaces, or contaminated food and water. A person usually develops symptoms 12 to 48 hours after being exposed. Most people with norovirus illness get better within 1 to 3 days, but they can still spread the virus for another few days. Kitchen workers should stay away from work for at least 48 hours after symptoms have passed.

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Fresh organic basil sold at Trader Joe’s stores is behind a multi-state outbreak of Salmonella Typhimurium infections.

The Centers for Disease Control and Prevention is investigating the outbreak with the Food and Drug Administration. As of this afternoon, a dozen people across seven states have been confirmed with the outbreak strain of Salmonella.

The implicated fresh basil is sold in 2.5-ounce clamshell packaging under the Infinite Herbs brand. It was distributed to Trader Joe’s stores in Alabama, Connecticut, Washington D.C., Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Maine, Michigan, Minnesota, Missouri, North Carolina, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Vermont and Wisconsin.

Public health officials are interviewing patients and so far found that seven of eight patients interviewed reported exposure to fresh organic basil from Trader Joe’s stores before becoming ill.

Traceback data collected by FDA determined that Infinite Herbs LLC, in Miami, FL, was the supplier of the 2.5-ounce packages of organic basil sold at Trader Joe’s stores.

Trader Joe’s has voluntarily removed all Infinite Herbs brand organic basil packed in 2.5-ounce clamshell packaging from their stores and this product should no longer be available for sale.

The outbreak investigation is ongoing to determine the source of contamination and whether additional products are linked to illnesses. 

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has eaten any fresh organic basil from Trader Joe’s stores and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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About 10 days ago, after a second human case of Highly Pathogenic Avian Flu was announced, the Centers For Disease Control And Prevention (CDC) reworked its markup on the issue, not the message.

Since it first struck a commercial poultry flock on U.S. soil in early 2022. avian flu has been a harsh master, affecting 85.8 million birds in 48 states.

The USDA claims to have the world’s most robust avian influenza surveillance program. The flu has also taken 9,253 wild birds in 50 jurisdictions.

Recently, the CDC has been using color cartoons to spread its message that “Infected poultry can spread bird flu to people. Human infections with bird flu viruses are rare but possible.”

The CDC’s “protective actions for people” include these suggestions:

+ Avoid direct contact with wild birds, observing them only from a distance.

+ Do not make any contact with any dead birds and report any sick or dead birds.

Take protective actions around other animals thought to have HSN1 bird flu.

+ Food is safe to eat as long as it is properly handled and cooked.

+ CDC has not imposed any travel restrictions resulting from the avian flu crisis

+ Seasonal flu vaccines will reduce the risk of illness from avian flu.

+ The two human avian flu cases were many months apart, a Colorado poultry worker and a Texas dairy farm employee.  Both recovered.

+ Local health officials are being advised to look out for additional cases.

USDA’s Animal and Plant Health Inspection Service confirmed the highly pathogenic avian influenza (HPAI) in a commercial flock in the United States on Feb. 8, 2022. 

Since then, APHIS has worked to identify and respond to detections and mitigate the virus’ impact on U.S. poultry production and trade. 

Detections are higher in the fall and spring because wild birds continue to spread the virus as they migrate to their seasonal homes. APHIS continues to work closely with the States.

To provide context on the overall size of the U.S. poultry flock, there are more than 368.2 million egg-laying chickens in the United States. In 2022, more than 9.5 billion broiler chickens and 208 million turkeys were processed in the United States, according to USDA data.

In meetings, CDC told state officials to ensure that their bird flu operational plans are up-to-date.

The latest human case of U.S. avian flu cases with these facts:

• A person in Texas tested positive for highly pathogenic avian influenza (HPAI) A(H5N1) virus (“H5N1 bird flu”). This is only the second case of H5N1 bird flu in the United States; the first was in a poultry worker in Colorado in 2022.
• This person in Texas worked with dairy cows presumably infected with H5N1 bird flu viruses.
• This is the first time this virus has been found in cows and would be the first instance of cow-to-human spread of bird flu. Infected dairy herds have been found in eight states since the first confirmation in Texas.
• CDC has sequenced the influenza virus genome from a patient in Texas and compared this with other sequenced H5N1 viruses. The virus obtained from this person is nearly identical to what has been found in cows and birds in Texas. There are no changes associated with resistance to antiviral medications, and the virus is closely related to two existing candidate vaccine viruses.
• There is no sign of person-to-person spread of this virus at this time.
• This is an emerging and rapidly evolving situation that CDC is following closely. The CDC believes this virus’s overall risk to the general public remains low.

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Part of a federal investigation into lead in certain cinnamon applesauce products has been shifted to a followup status.

The new approach by the Food and Drug Administration is designed to provide post-incident response action. The agency will continue surveillance activities as well as prevention and compliance activities, according to an update posted by the FDA on April 16.

The Centers for Disease Control and Prevention is continuing to monitor the outbreak of lead poisoning and most recently reported 519 children impacted in the outbreak. The outbreak stretches across 44 states. The FDA has collected 90 “adverse incident” reports in the outbreak. The two agencies use different reporting methods, so their numbers may overlap somewhat and should not be added together. The CDC continues to add patients to its count.

Also, there can be significant lagtime between consumption of the lead contaminated cinnamon applesauce and the detection of elevated blood levels of the heavy metal.

Three brands of cinnamon applesauces sold in pouches and marketed for children have been recalled. They are Wanabana, Schnucks and Weis. Only cinnamon applesauce products have been implicated.

The FDA was first notified about the lead in the applesauce in mid-September of 2023 by public health officials in North Carolina. On Oct. 28 the FDA discussed analytical findings of lead in cinnamon applesauce produced by Astrofoods in Ecuador with the producer. Also on Oct. 28 the FDA issued a warning to U.S. consumers.

It was eventually determined that the lead was from contaminated cinnamon purchased from a third-party supplier. The FDA has reported that the lead was likely added to the cinnamon to increase its weight and therefore its commercial value.

Other key dates in the investigation include:

• On Oct. 29, 2023, Wanabana LLC notified their customers about recall of the WanaBana Apple Cinnamon Fruit Puree products.
• On Oct.30, 2023, and through continued cooperation with the FDA, Wanabana LLC issued a press release regarding their voluntary recall of all WanaBana Apple Cinnamon Fruit Puree Pouches.
• On Nov. 2, 2023, after reviewing records provided by the firm as part of their initial recall, the FDA learned that other products (i.e., certain Schnucks and Weis cinnamon applesauce pouches) were implicated in the recall and required additional public notice.
• On Nov. 3, 2023, the FDA updated its safety alert to, among other things, include certain Schnucks and Weis cinnamon applesauce pouches.
• On Nov.5, 2023, the FDA held a call with the firm, Wanabana LLC. During the call, FDA staff discussed the investigation, requested additional information from the firm, and asked the firm to update their press release regarding their voluntary recall and to provide additional clarification regarding the scope of the recall of all apple cinnamon fruit puree products, which the firm verbally agreed to provide.
• On Nov. 6, 2023, Apple Cinnamon Fruit Puree products from Austrofoods were added to Import Alert 99-42.
• On Nov. 9, 2023, Wanabana LLC issued their expanded recall announcement to include information on recalled Schnucks and Weis cinnamon applesauce pouches, which also impacts markets outside of the United States. Customer information provided by Wanabana LLC shows that product was also distributed to Cuba and the United Arab Emirates.

About lead poisoning
Parents and caretakers should consult a healthcare provider and ask for blood tests if they suspect a child may have been exposed to the recalled cinnamon applesauce products. 

Short-term exposure to lead could result in the following symptoms: headache, abdominal pain/colic, vomiting, and anemia. 

Longer-term exposure could result in additional symptoms: irritability, lethargy, fatigue, muscle aches or muscle prickling/burning, constipation, difficulty concentrating/muscular weakness, tremors, and weight loss. 

Permanent consequences can lead to developmental delays and brain damage.

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