Effect Measure

We are getting the first hints of a potential foodborne vehicle for the multi-state salmonella outbreak that began in September. We’ve seen it before:

The source of the outbreak of Salmonella [t]yphimurium that has sickened at least 400 and may have contributed to one death has been identified in Minnesota as King Nut peanut butter. Peanut butter tainted with the genetic fingerprint matching the outbreak was tested by the Minnesota Health Department. The product is suspected as the source of the nation-wide illnesses, which began showing up in September 2008 and have been documented in 42 states.

“The signs started pointing to something like peanut butter with a longer shelf-life,” said foodborne illness attorney Bill Marler. “It started to look a lot like the pattern that emerged in the 2006 outbreak.”

Marler`s firm, food poisoning powerhouse Marler Clark, handled the cases of many of the compensated victims of the 2006 Peter Pan/Great Value outbreak, which was traced to a Georgia plant owned by ConAgra. (Press release from Marler’s firm via Reuters) [NB: Commenter Evan correctly points out Marler's judgment about the genetics of the salmonella found in the peanut butter is premature; the cases have been linked nationally but tests on the peanut butter sample are still underway]

Once again the first word comes from the excellent public health laboratory at the Minnesota Department of Health, before any word or confirmation from the vaunted CDC. Maybe the top brass there are too busy re-doing their resumes as the Obama era dawns. No one can say anything there until checking with the top. But in Minnesota they were hard at work and talking, with their 30 cases part of a 42 state nationwide outbreak that has so far sickened almost 400 and put 70 in the hospital. By taking food histories of the cases they discovered that many or most had eaten King Nut brand creamy peanut butter. They retrieved a sample in a nursing home with cases and discovered a genetic match for the outbreak strain in an institutional-sized (5 lb.) container. King Nut is an Ohio firm but is only the distributor of a product made by the Peanut Corporation of America (PCA) of Lynchburg, Virginia, with processing operations in Virginia, Georgia and Texas (CNN). While King Nut does not sell directly to consumers, only institutions, it isn’t known if PCA sells to other distributors with other brand names. King Nut is recalling all its creamy peanut butter immediately.

This is the second mass salmonella outbreak associated with a commercial peanut butter operation in recent years. The other was in Peter Pan peanut butter made in a ConAgra plant in Georgia. An informative comment by Moderator LL at ProMed notes that while peanut butter is not generally thought of as a vehicle for salmonella, there is at least one previous report (Australia, 1996) and that salmonella spp. seem to do fine in that environment, retaining viable organisms at 5 degrees C. for 24 weeks (6 months), although at usual (“room”) temperatures retention was less. There is also some evidence (cites in the ProMed comment) that pasteurization is not sufficient to eliminate salmonella if it is in the peanut butter. Peanut butter is a food that is in mass distribution, often to institutions like schools and nursing homes. Dramatic failures in high volume food production facilities like this are just one more symptom of a badly broken food protection system.

As a new administration prepares to move into the house, they will find it has been trashed by vandals. Time to bail out public health. Because it’s sinking.

Comments

  1. #1 Evan Henke
    January 11, 2009

    The Minnesota Department of Health stated late Friday that genetic fingerprinting results of the Salmonella they detected in the 5-lb. tub of peanut butter would be complete sometime on Monday. I don’t understand what authority Marler has to claim that the strain is indeed the outbreak strain per genetic fingerprint, especially since this post went up on the same day of the MN press release, 1/9/09. If MN had confirmed a matching genetic fingerprint on Friday, they would have noted that in their press release and CDC and FDA would have been releasing statements officially implicating this brand of peanut butter.

    I’m skeptical of anything Marler puts out, it doesn’t appear he has any appointment in any public health agency, and where he gets his information is a mystery. His information is not consistent with any statements out from the CDC, FDA, or even the Minnesota Department of Health.

  2. #2 revere
    January 11, 2009

    Evan: You are correct that the peanut butter has not yet been linked, just the cases. The MDH statement is:

    The Minnesota cases have the same genetic fingerprint as the cases in the national outbreak that has sickened almost 400 people in 42 states; however, laboratory results for the product sample have not yet been linked to this national outbreak. Additional laboratory results are expected early next week.(Minnesota Dept. of Public Health statement)

    While it is likely, given the high correlation with the cases and peanut butter consumption that this link will be confirmed, your clarification is quite in order. Thank you. Whatever the source of your skepticism about Marler, the linkage is highly plausible and is consistent with existing information in the sense that it does not contradict it. It is, however, premature and you are right to call attention to that fact.

  3. #3 david78209
    January 11, 2009

    I hope peanut butter in general doesn’t get ‘tarred by this brush’. I think it’s as close as we’ve come to a widely accepted form of legume protein eaten directly by people. It would be nice if we could get most of the world population to eat soybeans in some form for most of their protein, but I think feeding the world on PBJ’s is moving in the right direction.

  4. #4 Mike the Mad Biologist
    January 11, 2009

    The real shame in all of this is how slow the reporting at the national level is. If CVS can track what birthday cards I buy for my mother, then why can’t the CDC have quicker information transfer. Frustrating.

  5. #5 revere
    January 11, 2009

    Mike: Gerberding shut down release of information. I’m not sure CDC will ever get back to pre-Gerberding on that one. Once those controls are put in place they are hard to removed, I’m afraid. The nation’s loss.

  6. #6 Evan Henke
    January 12, 2009

    I’m not sure if Gerberding was just trying to block information from being released for the sake of blocking information.

    If national and/or state investigations can’t reveal a significant association between illnesses and a source, releasing information can only be harmful. Why release a warning about illnesses if you can’t advise the public how to avoid the illness? The natural response from the public would be to bombard public health officials with worrisome and alarmed phone calls, which would effectually distract them from solving the crisis at hand.

    It seems releasing a warning without being able to advise the public how to protect themselves is actually something Bush and his cronies would do, like issuing a “code orange” or “code red” terror warning.

  7. #7 revere
    January 12, 2009

    Evan: It’s not just this case. It’s a history going back years. MDH did it right and competently. Or do you think they didn’t?

  8. #8 Evan Henke
    January 12, 2009

    I admit to knowing very little about Gerberding’s legacy. I’m only just starting my education in Public Health.

    I think MDH did the right thing releasing a statement on their own without a joint statement from CDC, but I think the point I’m trying to make is that even Minnesota didn’t release a statement until after they had isolated Salmonella from a jar of King Nut. What led them to believe that King Nut might be harboring the Salmonella? They must have had some reason to test the jar, probably epidemiologic evidence, and who knows how long it took them to find a jar and test it after first suspecting King Nut.

    So until they could make a useful, science-based public health recommendation, they were as silent as the CDC.

  9. #9 revere
    January 12, 2009

    Evan: They looked at peanut butter because the food histories indicated that most or all of the cases had eaten peanut butter and the cases were the same fingerprint as the national outbreak. It has now been confirmed that the peanut butter sample has the same genetic finger print, as was the most plausible inference from the data.

    MDH was not “as silent” as CDC. As soon as MDH had data it made a statement. That is not what CDC did or has done. Their last update was on Friday. I do not believe they have made any further statements. They are more silent than MDH.

    Public health is about prevention of disease.

  10. #10 Evan Henke
    January 12, 2009

    revere: Perhaps I got off topic.

    I just think the reason it took so long for a statement to be made about this outbreak is bigger than Julie Gerberding ordering the CDC to be quiet until indisputable evidence links a vehicle to illness, if that is the case. I got carried away explaining my personal opinion of when it is appropriate to release a food advisory, which I think can add weeks to an investigation, and can also change depending on the context of the outbreak.

    To spare you from an excruciatingly long post, you can read about the larger problems of foodborne illness reporting and surveillance, if you wish, at CIDRAP.

    http://www.cidrapbusiness.net/cidrap/content/fs/food-disease/news/jul3108outbreaks.html

  11. #11 Bill Marler
    January 12, 2009

    Sorry, If this is being posted again – I kept getting error messages. Not only is the Epi strong on this case, but other labs have tested this peanut butter. (PFGE was confirmed this morning in Minnesota) In any event, there are more important issues too. Here is my take:

    Minnesota Department of Health announces late Friday that the have linked thirty illnesses ( and a death) to the consumption of King Nut Peanut Butter (and Parnell’s Pride?). There is nothing on the CDC website or other State Health Department sites naming names – yet. On Saturday King Nut and the FDA jointly release a recall notification, but King Nut blames the Peanut Corporation of America (PCA) for its problem. PCA’s lawyers write a press release that tries to deny as much as possible.

    So, what is next? Here are a few ideas (not in any particular order) that the companies involved and the government should do Monday morning:

    1. Make sure ALL product is promptly recalled;
    2. Do not destroy any documents;
    3. The companies should pay the medical bills and all related expenses of the innocent victims and their families;
    4. The companies should pay the cost of all related Health Department, CDC and FDA investigations;
    5. Provide all bacterial and viral testing of all recalled product and any other tested product (before and after recall);
    6. Release all inspection reports on the plants by any Governmental Entity or Third-party Auditor;
    7. Release all Salmonella safety precautions taken by either King Nut or Peanut Corporation of America – especially after the 2007 Salmonella Peanut Butter Outbreak;
    8. Provide the public with the Epidemiological investigation (with names redacted), so it is clear who knew what and when about the likely source of the outbreak; and,
    9. Show the public what is being done to prevent the next outbreak.

    Taking these steps will go a long way in convincing us that food safety and consumer confidence is of primary importance both to the companies and the government.

  12. #12 Evan Henke
    January 12, 2009

    I was just checking Marlerclark.com and it looks like his 1/9/09 report has been amended so as not to confuse readers about the match of genetic fingerprints, even if it is now after the fact, so props to Mr. Marler for that one.

    Also, lets be clear what “genetic fingerprinting” really means.

    Salmonella has ~3000 species within its genus. As I was trained, Salmonella typhimurium is not a genetic fingerprint, but one of many species of Salmonella. A genetic fingerprint as I understand it is a PFGE or Pulsed-field electrophoresis pattern, which is determined by digesting the genetic material of a species of Salmonella with selective restriction enzymes, running it through a pulse-field gel, and observing the pattern. This can differentiate one species into dozens if not more different subgroups. Marler was correct in asserting the peanut butter isolate was Salmonella typhimurium, but it’s “genetic fingerprint” was technically unknown at the time.

  13. #13 Evan Henke
    January 12, 2009

    Hello, Mr. Marler,

    Not coming from a law background, I am somewhat surprised to learn that persons who suffer from these illnesses are able to claim damages from companies who are unfortunate enough to sell contaminated product. Are there laws in place (tort?) that allow this or are these cases mostly settled out of court? Your other suggestions seem very appropriate.

    Evan Henke

  14. #14 Bill Marler
    January 12, 2009

    Mr. Henke – there are and were other labs – public and private – that were doing PFGE testing.

    Regarding whom is unfortunate, I would argue that the over 400 ill and 3 deaths are the unfortunate. Bacterial contamination in a ready to eat product like PB sold in institutions is an unacceptable risk. People who are actually sickened should be fairly compensated. It is fair to the sickened person and send a good message to industry to get feces out of our PB.

  15. #15 Bill Marler
    January 12, 2009

    I also added you folks as a link to http://www.marlerblog.com. Revere – thanks for the tech advice today – you should get a raise.

  16. #16 Marymary
    January 13, 2009

    @Evan: If I’m not mistaken, Marler-Clarke often argues strict liability (tort) in foodborne illness cases. This means, that the defendant(s) served, sold, or distributed the food, the plaintiff(s) became ill from said food–end of story, defandant(s) is/are liable. From Wikipedia: “Strict liability is a legal doctrine that makes a person responsible for the damage and loss caused by his/her acts and omissions regardless of culpability.” It may seem harsh, but foodborne illness from something like peanut butter is difficult for a consumer to avoid or detect and clearly harm has occurred. If strict liability does not apply, other tort doctrines such as negligence often do apply in foodborne illness situations.

    Also, settling a case out of court does not mean that there are no laws on the books to cover the situation. In order to file suit, the plaintiff’s attorneys must allege some harm under existing statutes and legal doctrines. Whether they will win the suit is different story. Cases are settled for a variety of reasons, but not usually, if ever, because there are no laws on the books to cover them. Since Mr. Marler is here and making comments himself, he can explain further, if he so chooses, that is. :)

  17. #17 Evan Henke
    January 13, 2009

    Thanks for that explanation, Mary. I understand much more now.

  18. #18 Bill Marler
    January 13, 2009

    Evan – well explained.

  19. #19 Katy
    January 14, 2009

    Does anyone know the exact strain of the salmonella? It says it is salmonella typhimurium, but do we have a specific strain number and letter code? My prof. is curious and assigned us to find out what it was, but most articles only post the genus and the species and not the strain code.
    Thanks,
    Katy

  20. #20 revere
    January 14, 2009

    Katy: The terminology seems to have changed since my day, but what I’ve seen is S. enterica serotype Typhimurium, nor further characterization. Anyone else have better info?

  21. #21 Evan Henke
    January 14, 2009

    S. typhimurium can be differentiated into subgroups based on the PFGE patterns, but nomenclature around the patterns is not uniform. State labs assign their own codes, while the CDC uses a much more complex codes for patterns (they must keep track of more strains on a national level than a state lab does). I’m not sure it gets more precise than just typhimurium at this point…I’ve not read anything about there being an already existing name for the strain and I don’t think CDC has released the pattern or the code they’ve given to the pattern. I could be wrong.

    So, regarding what Bill wrote, I am skeptical that private labs could confirm a match before a state lab. 1) They would not know which pattern is actually behind the national outbreak 2) They would not know what foods are suspect or 3) where to find them. Also, if a private lab DID confirm a match somehow, why didn’t the lab or the person who requested the PFGE release news of the match and be hailed as the new J. Craig Venter of national outbreaks by beating the feds to the culprit? Of course if the CDC released the pattern to the public prior then my skepticism is unwarranted, and I’m unsure of that.

  22. #22 Marymary
    January 17, 2009

    FYI: The recall is expanding. IIRC, after peanut butter recall from two years ago, the FDA was supposed to move peanut butter onto its list of high-risk foods and step up inspections at peanut butter plants. Does anyone know if the FDA actually did anything?