Effect Measure

Salmonella outbreak developments

The tomatoes-peppers-cilantro-? Salmonella story is starting to break, although which way is hard to say at this moment. Beginning about 3 pm yesterday afternoon newswire stories began to report that the FDA had found a single jalapeno pepper in a small distribution center in McAllen, Texas, contaminated with the same uncommon Salmonella serovar (S. stpaul) implicated in a large outbreak that has infected over 1200 people in 43 states. This is the first time any food item has turned up positive for this Salmonella strain in the 14 weeks federal and state authorities have been trying to nail down the source of the infection. So this is significant progress, although it is tempered by the fact that the comparison is no progress. At this point, however, we don’t know exactly what it means:

The pepper, which showed up at a south Texas distribution facility, originated in Mexico but could have been contaminated in a variety of places, the FDA said.

[snip]

The FDA said inspectors were in Mexico searching for a possible source of the contamination. It is not clear whether the small McAllen, Texas facility could be the source of the entire outbreak, which has sickened people in 43 states, Washington D.C. and Canada.

“This is primarily just a distribution point. Our understanding is they may do some sorting of the products there,” said Steve Solomon, deputy director of the Office of Regional Operations at FDA.

Mexican agriculture ministry spokesman Marco Antonio Sifuentes said Mexico was opening an investigation into the case. Mexico maintains the strain of bacteria that sickened people in the United States has never been found in Mexico. (Maggie Fox, Reuters)

As of 10 pm EDST last night all the major newswires had the story, but only Maggie Fox at Reuters had the key piece of information:

Acheson said the facility was targeted for testing after the FDA traced one cluster of illness. “We are working back from a population of patients who got sick in a single geographic area that ate in a single place,” he said.

“We asked where peppers linked to that cluster came from.”

So kudos to Maggie Fox (a consistently excellent health and science reporter). And thumbs down to cable network MSNBC, whose newsanchor Milissa Rehberger has been running “newsbreaks” all evening saying the Salmonella outbreak has finally been traced to “a single jalapeno pepper,” as if the contaminated pepper were responsible for the entire outbreak. Talk about really, really bad news writing, that’s some of the worst we’ve seen in a long time.

What do we know at this point? Not that much. This is a small distribution center and we don’t know where the pepper got the Salmonella. Maybe it was on the farm in Mexico or somewhere between the farm and the warehouse or in the warehouse itself. We don’t know if peppers are the only contaminated food item — for example, tomoatoes or cilantro or other kinds of peppers. We don’t know if other distribution facilities might also have contaminated food items. Most importantly we don’t know how the Salmonella got to 43 states. It’s not likely from this one small facility. The FDA acknowledges all these uncertainties. I suppose we should add one more caveat: at this point this could still be a laboratory error, that is, a contamination with the incriminated strain. I doubt it, but at this point nothing would surprise me. This has not been the smoothest outbreak investigation I’ve ever seen. Still, the stated link to a single cluster adds some weight to the finding.

Maybe by the time you read this we’ll know more. But I doubt it. So stay tuned as this unfolds. In slow motion.

Comments

  1. #1 Mike Haubrich, FCD
    July 22, 2008

    I say crush the pepper. Make it break. No mercy. Lock it up in the facilities at Guacamole Bay. (Gickmo, to people who know military-speak.)

  2. #2 g366
    July 22, 2008

    Seems to me the next steps would have to be: a) Determine the length of time the contaminated pepper had been at that facility. b) Determine what else passed through that facility at the same time. c) Obtain samples from each (b) and test. d) Test the points of origin of each item (the peppers and (c)), and if another country prohibits or interferes with testing, block incoming shipments from said country.

    The problem we’re up against here is the complexity of food distribution systems in a globalized economy. And for all of those who claim that globalization is inevitable, necessary, and good: bull s—. Humans survived, prospered, and enjoyed themselves plenty before it became policy, and will do so even moreso long after it’s over. Buy local, eat local, and hire local. This isn’t difficult.

    Just be glad it was “only” salmonella this time.

  3. #3 CLM
    July 22, 2008

    This reminds of the scene from Life of Brian when the Roman soldiers searched a room repeatedly and finally one soldier says: “Found this spoon, sir.”

    One would have hoped the FDA would have done a better job than a Roman version of the Keystone Kops.

    Me being the distrustful of the Bush administration type, me thinks the FDA is protecting some very large food distributors/producers.

  4. #4 Julie Stahlhut
    July 22, 2008

    I say crush the pepper. Make it break. No mercy. Lock it up in the facilities at Guacamole Bay. (Gickmo, to people who know military-speak.)

    I think they should water-sink the little bugger. Strap it into a colander, stem-down, and drench it with a hand-sprayer. Then show it a food processor and a bowl of salsa. That’ll make it talk!

  5. #5 Lea
    July 22, 2008

    Actually this is beginning to go the way of Outer Limits

    A science fiction show in the 50’s that was popular.

  6. #6 Path Forward
    July 22, 2008

    I say crush the pepper. Make it break. No mercy. Lock it up in the facilities at Guacamole Bay. (Gickmo, to people who know military-speak.) — Mike H.

    I think they should water-sink the little bugger. Strap it into a colander, stem-down, and drench it with a hand-sprayer. Then show it a food processor and a bowl of salsa. That’ll make it talk! — Julie S.

    Don’t you think we should have several months of debate first, to decide who should be the lead agency? DHS, DOD, USDA, HHS?

    Maybe it should depend on whether it is a mild pepper, a medium pepper, or a really hot pepper…

  7. #7 Epifreek
    July 24, 2008

    Kudos to the Minnesota Department of Health

    How Minnesota solved salmonella riddle
    State scientists were first to link jalapenos to the outbreak

    By Lauran Neergaard
    Associated Press

    Article Last Updated: 07/24/2008 09:55:58 AM CDT

    Jalapeno peppers

    WASHINGTON It was a hot lead for detectives on a cold case. People suddenly were getting salmonella at a Minnesota restaurant more than 1,000 miles from the center of the nation’s outbreak.

    Not my tomatoes, protested the manager. He’d switched his supply to government-cleared fresh tomatoes and even canned ones. But a lot of his menu items had a raw jalapeno garnish sprinkled on top, and that turned out to be a critical clue in the two-month salmonella mystery.

    On July 3, Minnesota e-mailed the feds. After tracing credit card receipts to find what the restaurant’s healthy customers didn’t eat there was good evidence that the jalapenos were sickening people. And officials had a diagram tracing the pepper shipments all the way back to three farms in Mexico.

    One of those farms shipped peppers through the same large warehouse in McAllen, Texas, where Food and Drug Administration inspectors weeks later would find a single contaminated Mexican-grown pepper being packed by a neighboring vendor.

    How could Minnesota pinpoint hot peppers just days after discovering a cluster of sick residents, when federal investigators had spent weeks fruitlessly chasing tomatoes?

    To be fair, “there was already some doubt about tomatoes causing this whole outbreak,” cautioned Kirk Smith, foodborne disease chief at the Minnesota Department of Health.

    And federal investigators say Minnesota’s information came just as they were getting hints from two Texas restaurant clusters that jalapenos might play a role.

    “Ours was the first that pointed specifically to jalapenos as an ingredient, not just the salsa,” Smith said.

    PROBLEMATIC PROBE?

    It’s too soon to know if the federal Centers for Disease Control and Prevention improperly blamed tomatoes in early June, based on reports from the first people to fall ill in New Mexico and Texas.

    “I don’t think we can find fault yet,” said University of Georgia food-safety expert Michael Doyle. “With tomatoes, if you looked at the initial case-control studies, they really came up high on the list.”

    The CDC didn’t comment Wednesday.

    At the FDA, food safety chief Dr. David Acheson told the Associated Press the system should be reviewed to see if it can be improved.

    “Did every part of this system work from one end to the other?” he asked. “I’m not saying it didn’t, but I think one has to question that.”

    Regardless, the way Minnesota unraveled its own cases speedily comparing the sick and the well and then racing to track food suppliers offers lessons for a public health system grappling with how to handle increasingly complex outbreaks from tainted produce.

    “We have got to put the appropriate perspective on this outbreak as to what went right and what went wrong so the kind of changes that are going to further foodborne disease (prevention) can be made,” said Michael Osterholm, a University of Minnesota infectious disease specialist and frequent adviser to the government.

    He fears the salmonella mystery may be the “swine flu of foodborne disease” and may make federal health officials more reluctant to issue consumer warnings in future outbreaks unless they’ve found the smoking gun, an actual tainted food.

    “That would be the worst legacy of this entire situation,” Osterholm said.

    MINNESOTA JOINS HUNT

    Reports of the salmonella strain sickening hundreds elsewhere in the country began dribbling in to Minnesota’s state health department June 23.

    Minnesota’s system is different from those of many states: Rather than county health departments initially checking outbreaks and reporting to headquarters, Smith’s state office handles investigations from the beginning. By Thursday, with six cases reported, he had epidemiologists interviewing the sick: What did you eat in the few days before getting ill? Where?

    By Sunday, two people had mentioned the same Twin Cities-area restaurant. Smith ordered that other patients be directly asked about that site. Monday morning, four more people identified it and by lunchtime, epidemiologist Erin Hedican was on the scene.

    She quickly found seven more ill: employees who ate their own meals at the restaurant and started getting sick after the first customers had. Good to know; that meant the workers weren’t the source.

    With the manager, Hedican combed ingredients. Any new items added lately? New suppliers? She requested invoices from shipments just before June 14, the first known meal date of one of the sick, and started the hard push to get credit card receipts so she could learn what people who didn’t fall ill had eaten.

    By Tuesday morning, a garnish made of diced jalapenos and red peppers was topping a list of possible suspects.

    “This is not like a sprig of parsley on the edge of your plate. This was sprinkled directly on almost every entree,” Smith said.

    Still, “a lot of people didn’t notice the jalapenos,” Smith said, while they were quick to mention tomatoes.

    “Recall, that’s what makes it tricky. That’s why I wonder about all those initial cases” in other states, he added.

    By Wednesday night, Smith’s team had interviewed 13 sick people and 28 others who had eaten at the restaurant on the same days but stayed well. The sick were 46 times as likely to have eaten the garnish. The next morning, he alerted CDC and FDA.

    THE BREAKTHROUGH

    Meanwhile, Ben Miller of the Minnesota Department of Agriculture, which regulates food suppliers, was pursuing those invoices. Miller knows traceback: He is credited with following contaminated lettuce blamed for a 2006 E. coli outbreak back to two suspect farms in California, before FDA singled out the culprit.

    This time around, Miller knew his colleagues down the hall were suspicious of that garnish. He doubted a red pepper connection; they’re used in far more restaurants than jalapenos.

    The Twin Cities supplier that delivered to the restaurant led him to a larger distributor, also local. Miller whittled down shipment dates to between June 5 and 9. That distributor had bought from two sources: a shipper in California and another in McAllen, Texas, who in turn got the peppers from three farms in Mexico. Miller later ruled out one farm by further narrowing shipping dates. Now he’s waiting to hear from FDA if his Texas link panned out.

    “A few phone calls and you can work it fairly quickly back to the grower,” Miller said.

    Federal officials had lots of questions for Minnesota as they matched that data with the clusters in Texas, the outbreak’s center.

    The Minnesota data “helped us begin to narrow this down,” Acheson said, though he wouldn’t call it the key cluster.

    But Smith’s team wasn’t done. By July 8, it had a big enough group 19 sick and 78 healthy customers to do a statistical comparison of multiple ingredients. The sick were 100 times as likely to have eaten a jalapeno as the well.

    The next day, July 9, the CDC issued its first consumer precaution, that people at high risk of salmonella should avoid fresh jalapenos.

    ‘Team Diarrhea’ helped state crack salmonella case
    Minnesota investigators used bloodhound-like sleuthing to ID the source of a mysterious salmonella outbreak: jalapeno peppers.

    By JOSEPHINE MARCOTTY and MAURA LERNER , Star Tribune staff writers

    In less than two weeks, Minnesota Department of Health investigators traced the source of a mysterious salmonella outbreak that had stumped federal health officials for two months and sickened more than 1,200 people in 43 states and Canada.

    The culprit: jalapeno peppers.

    Federal officials had focused on tomatoes as the source of the salmonella, causing restaurants and stores to pull tomatoes and severely hurting tomato farmers in suspect areas.

    While tomatoes haven’t been entirely cleared by federal authorities, attention has now turned to the peppers in what federal officials said was a major break in the case. A gee-whiz state lab, investigators dubbed “Team Diarrhea” and a unique approach to sleuthing illness contributed to the breakthrough.

    The outbreak and the government’s inability to find the source have exposed serious flaws in the U.S. food safety system, experts say.

    Minnesota health officials first learned of a salmonella outbreak in the state on June 23. By July 9, they were on the phone with their federal counterparts making it “crystal clear” it was not tomatoes but jalapenos that were the likely source, said Kirk Smith, head of foodborne diseases at the Health Department.

    Smith said that by mid-June, federal investigators already had begun to think tomatoes were not the sole culprit.

    Food and Drug Administration (FDA) officials still have not completely ruled out tomatoes. Data indicate jalapeno peppers caused some illnesses but not all, said FDA spokesman Mike Herndon in an e-mail interview.

    In Minnesota, the break came when 27 people who ate at the same Twin Cities restaurant fell ill from the exact rare salmonella strain in the national outbreak.

    On Monday, federal officials said they found the same strain on a jalapeno pepper in a giant produce warehouse in McAllen, Texas — the same warehouse identified by Minnesota investigators weeks ago.

    “What happened in Minnesota should be the norm,” said Mike Osterholm, University of Minnesota foodborne illness expert and an adviser to state and federal health agencies. “They did it quickly and they did it effectively and they were able to trace back what nobody else was able to trace back.”

    Suspicions about peppers

    Until mid-June, Minnesota was largely untouched by the salmonella outbreak that appeared in April in New Mexico and Texas. Salmonella is a bacterial infection that can cause stomach cramps, fever and diarrhea.

    Every week the cases mounted. Federal officials, suspecting tomatoes, warned against eating most kinds.

    But Minnesota had only two cases, both people who had traveled in other states.

    Then, suddenly, cases started rolling in. Clinics must report all salmonella cases to the Minnesota Health Department, which immediately identifies the strain from samples sent to its highly sophisticated laboratory in St. Paul. On June 23, technicians got two cases of the strain linked to the tomato outbreak — ironically named salmonella saintpaul. Then seven more cases emerged. “It was pretty obvious there was an outbreak,” Smith said.

    He called in what is known at the Health Department as “Team Diarrhea” — mostly University of Minnesota School of Public Health graduate students who extensively interview victims.

    By Sunday, June 29, two victims named the same Twin Cities restaurant, which Smith declined to identify. On Monday, the manager told an investigator he had dumped all suspect tomatoes weeks before.

    In short, it couldn’t be coming from the tomatoes. Then, by comparing what both sick and healthy customers ate, investigators determined the source was a jalapeno garnish.

    On June 30, Ben Miller, the state Agriculture Department’s “traceback coordinator,” began tracking the suspect peppers’ roots. Using restaurant invoices to find the wholesale supplier, he followed the trail to California and Texas distributors. He found the farms that grew the peppers in Mexico.

    On July 3, Smith gave the Centers for Disease Control and Prevention and the FDA information on Minnesota’s cases and Miller’s traceback. Smith called back on July 9 “so they could be crystal clear about the detail. The pepper [in Texas] was collected on the 11th.” Federal officials were also looking at outbreaks in two Texas restaurants linked to salsa that used jalapenos.

    Minnesota’s edge

    What made Minnesota’s search quicker?

    Smith said investigations are centralized at the state level. The CDC and the FDA rely on local health departments, usually at the county or city level, which can cause enormous logistical problems.

    Minnesota also has a lab that can immediately identify pathogens down to their DNA, and investigators who interview everyone infected by salmonella, an average of 700 cases per year.

    In other states, health officials often won’t follow a trail beyond state borders. Miller follows it wherever it leads.

    “There surely are going to be questions,” Osterholm said, about whether the tomato warnings “were warranted by the data.” In a recent interview he said, “this tomato-outbreak investigation has bordered on incompetence.” Other experts have been equally critical.

    Osterholm plans to testify before Congress next week that the national system should be modeled on Minnesota’s. Once Minnesota’s state epidemiologist, he was pivotal in building its system.

    FDA defends probe

    But Herndon, of the FDA, said the probe was “complex and difficult.” Perishable produce is usually gone before investigators arrive, he said.

    But a consumer advocate argues the FDA should have a better tracking system. “The FDA wasted a lot of time on tomatoes,” said Jean Halloran, director of food policy at Consumers Union, publisher of Consumer Reports. “If there was better traceability, they would have more quickly figured out that they were barking up the wrong tree.”

    At the same time, she said, the FDA was right to raise alarms about the tomatoes, even without absolute proof. “This is kind of the danger of doing science in public,” she said. “It’s not always like ‘CSI,’ where in one hour you finally get the solution. Sometimes you go down the wrong path for a while before you figure out you took the wrong turn awhile back.”

    marcotty@startribune.com 612-673-7394 mlerner@startribune.com 612-673-7384

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