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Foundation Farm Raw Milk

July 29, 2014 admin

Outbreak: Foundation Farm Raw Milk
Product: Foundation Farm Raw Milk	Investigation Start Date: 04/10/2012
Location: Clackamas, Multnomah and Washington Counties, Oregon	Etiology: E. coli (STEC) O157:H7
Earliest known case onset date: 04/01/2012	Latest case onset date: 04/14/2012
Confirmed / Presumptive Case Counts: 11 / 5	Positive Samples (Food / Environmental): 2 / 13
Hospitalizations: 4	Deaths: 0

The Three Graces: Three Jersey herdshare milkcows await outside the milking station.
Investigators "lean in" to catch the sample slung by Dr. Keene. Note the ankle-deep "river" of mud, excrement, and urine in the milkcow's pasture captured in the photo just behind Dr. Keene. Pasture samples tested positive with matching strains of E. coli.
Dr. Bill Keene leans in for a closer look.
Dr. Keene kneels to swab the milking station which abutted the muddy paddock. Not surprisingly, the sample was positive for E. coli O157 which matched the human cases.
Milking jug hung to air-dry over "clean" milking station.
Swabbing the milking jug.
"Sterilized" containers used to hold raw milk sold to herdshare customers.
Muddy fields with a deluxe chicken “coop” in the background.
Another day in the life of a field epidemiologist.
Pig sty just underneath the milking area.
Resident turkey overseeing the epi investigation.
Milk jars from customer households – one of which tested positive for E. coli O157:H7.
Epidemic curve of the outbreak.

OUTBREAK SUMMARY:

This outbreak highlighted the persistent hazard of raw milk consumption, already well documented in the medical literature. Four of the 11 cases were hospitalized — some critically ill and all with hemolytic-uremic syndrome (HUS), subsequently shown to have been caused by E. coli O157:H7. Although most sales of raw … Continue Reading ››

e-coli-o157

Berry Stand Strawberries

July 29, 2014 admin

Outbreak: Berry Stand Strawberries
Product: Strawberries	Investigation Start Date: 08/03/2011
Location: Clackamas, Multnomah, Washington, Clatsop, & Yamhill Counties, Oregon	Etiology: E. coli (STEC) O157:H7
Earliest known case onset date: 07/01/2011	Latest case onset date: 07/29/2011
Confirmed / Presumptive Case Counts: 14 / 1	Positive Samples (Food / Environmental): 4 / 100
Hospitalizations: 6	Deaths: 2

Traceback: Dr. Tourdjman and team visit a local berry stand.
"Farm A": the initial visit to the strawberry farm suspected as the outbreak source.
Specimen collection: deer feces are observed over wide areas of the strawberry fields. Specimen collection begins.
Deer feces among strawberry plants was common at "farm A".
Deer are observed grazing the strawberry fields.
From farm to fork: Oregon deer have no discretion about where they defecate.
Dr. Keene gets into the weeds.
Some of the crew after a day of collecting feces.
Samples seized from cases.
Preparing to ship a few hundred fecal specimens to the lab.
Months after the outbreak, a household near the implicated farm tested positive for the same O157 strain. The case had not consumed strawberries from farm A, but deer were abundant in the yard of the case. The contents of the household vacuum bag produced the same O157 strain as the outbreak.
Though mounted in the museum, we did not harvest the deer as a result of the investigation: it came from a resale shop in Portland.
The actual museum artifact from the outbreak: a box of strawberries obtained from one of the stands.
Epi curve.

OUTBREAK SUMMARY:

This investigation implicated a novel vehicle—strawberries—as the cause of an outbreak of E. coli O157 infections. An association with locally produced strawberries quickly became apparent as cases were interviewed; but the fact that almost all had purchased them at roadside stands and farmer’s markets led to concern about potential … Continue Reading ››

Salmonella Braenderup

Milk Crates, Cartons, & Jugs

July 29, 2014 admin

Outbreak: Milk Crates, Cartons, & Jugs
Product: Milk Crates, Cartons, & Jugs	Investigation Start Date: 01/27/2010
Location: Roseburg, Oregon	Etiology: Salmonella Braenderup
Earliest known case onset date: 10/21/2009	Latest case onset date: 10/01/2010
Confirmed / Presumptive Case Counts: 25 / 0	Positive Samples (Food / Environmental): 15 / 500
Hospitalizations: 0	Deaths: 0

Epi curve and map of Salmonella Braenderup outbreak cases associated with milk cartons.
A variety of milk containers were produced by Umpqua; all of these were part of the Salmonella outbreak.
A huge volume of milk was produced and the facility kept impeccable records.
Epidemiologists swab floor drains in the milk processing facility.
Outdoor milk crate storage.
Epidemiologists swab ceiling vents as they search for clues about whether Salmonella is contaminating this milk product.
Umpqua milk in an Umpqua milk crate.
Crate washer machine located on the roof of the plant.
Epidemiologists track specimens in a log as they are collected.
Standing water on the roof is swabbed.
Epidemiologists swabbed in between crate crevices to get a good sample.
Milk crates had to slide through here during the dysfunctional decontamination process.
Dr. Keene takes a shot of an Umpqua Dairy truck as the investigation comes to a close.

OUTBREAK SUMMARY:

This outbreak illustrates the value of descriptive epidemiology and the virtue of epidemiologist persistence! Over a 12-month period during 2009–2010, a total of 25 infections by Salmonella Braenderup with matching PFGE patterns were reported—no more than 4 in any given month. After 3 scattered cases over 3 months, the … Continue Reading ››

Salmonella Rissen

Lian How White Pepper

July 29, 2014 admin

Outbreak: Lian How White Pepper
Product: White Pepper	Investigation Start Date: 03/02/2009
Location: Multi-state outbreak–OR, CA, NV, WA	Etiology: Salmonella Rissen
Earliest known case onset date: 11/01/2008	Latest case onset date: 05/27/2009
Confirmed / Presumptive Case Counts: 87 / 0	Positive Samples (Food): 33
Hospitalizations: 8	Deaths: 0

Tray of accoutrements for Phở (Vietnamese noodle soup) including a shaker of the infamous Lian How white pepper.
Bulk spice storage of Lian How products at a restaurant.
Recall notice for many Lian How products, including white and black ground pepper.
Lian How white and black pepper containers that yielded positive Salmonella cultures; they now live in the museum.
Up close shot of the contaminated Lian How ground white pepper.
An orange added to illustrate the actual size of a 5lb. container of ground pepper.
The epidemic curve for S. Rissen white pepper outbreak; note date of recall and slow dissipation of cases are products are slowly identified in use at restaurant.
A graph depicts the background rate of the most common Salmonella serotype (Enteritidis) and the extremely low background rate of Salmonella Rissen infections in the United States.
Though a rare serotype, Salmonella Rissen did trend upward in the United States two years before this outbreak began.
List of ingredients.
One case had Salmonella cultured from an amputated toe; a replica exists in the museum.

OUTBREAK SUMMARY:

Salmonella Rissen is a very rare serotype in the US. When Oregon, California, and Nevada all reported it within days of each other, it began a coordinated investigation between those states (later to be joined by Washington and Idaho). This outbreak focused FDA attention on the role spices may … Continue Reading ››

e-coli-o157

Bagged Spinach

July 29, 2014 admin

Outbreak: Bagged Spinach
Product: Spinach	Investigation Start Date: 09/08/2006
Location: Multi-State	Etiology: E. coli (STEC) O157:H7
Earliest known case onset date: 08/25/2006	Latest case onset date: 09/13/2006
Confirmed / Presumptive Case Counts: 5 / 0	Positive Samples (Food / Environmental / Water): 0 / 0 / 0
Hospitalizations: 98	Deaths: 3

Oregon, CDC, and Wisconsin share hypotheses via conference call about their locally emerging (but nationally connected) E. coli O157 clusters; Oregon is convinced of bagged spinach.
Contaminated spinach purchased just before the national product recall of these brands was initiated. Packaging with replica spinach are museum exhibits.
Contaminated spinach collected from the home of a case of E. coli O157:H7 infection from Douglas county, Oregon.
Contaminated spinach collected from the home of a case of E. coli O157:H7 infection from Malheur county, Oregon.
Spinach field in Salinas Valley, CA.
Out tending the spinach in the field.
Headlines in the news as the recall story breaks wide open.
A selection of newspaper clippings about the outbreak investigation.
A selection of newspaper clippings about the outbreak investigation.
A selection of newspaper clippings about the outbreak investigation.
A selection of newspaper clippings about the outbreak investigation.

OUTBREAK SUMMARY:

This outbreak highlighted Inter-state health department cooperation. Oregon epidemiologists identified that 4 out of 5 cases in Oregon consumed bagged spinach using their homegrown "Shotgun" hypothesis-generating questionnaire. Contact with WI and NM showed cases already underway with spinach showing signs of being the culprit. Contact with Utah allowed them … Continue Reading ››

Salmonella-Typhimurium

Protected: Rajneesh Bioterrorism

July 29, 2014 admin

Outbreak: #1984-001
Product: Restaurant salad bars	Investigation Start Date: 1985
Location: Wasco County, Oregon	Etiology: Salmonella Typhimurium
Earliest known case onset date: 9/9/1985	Latest case onset date: 10/10/1985
Confirmed / Presumptive Case Counts: 751 / 0	Positive Samples (Food / Environmental / Water): 0 / 0 / 0

Rajneesh Salmonellosis Grand Rounds (Part 1 of 2)

1984 Terror Attack investigation presentation by Tom Török, April 24, 2014
The 1984 Rajneesh salmonella outbreak was actually a bioterror attack that poisoned 751 individuals in The Dalles, Oregon. This is a two-part presentation on the Oregon Health Authority investigation of this outbreak.

Rajneesh Salmonellosis Grand Rounds (Part 2 of 2)

1984 Terror Attack investigation presentation by Michael Skeels, April 24, 2014
The 1984 Rajneesh salmonella outbreak was actually a bioterror attack that poisoned 751 individuals in The Dalles, Oregon. This is a two-part presentation on the Oregon Health Authority investigation of this outbreak.

1984 salmonellosis Rajneesh bioterror attack in The Dalles, Oregon.

1984 salmonellosis Rajneesh bioterror attack in The Dalles, Oregon

Details:
A leading group of followers of Bhagwan Shree Rajneesh (later known as Osho) had hoped to incapacitate the voting population of the city so that their own candidates would win the 1984 Wasco County elections. The incident was the first and single largest bio-terrorist attack in United States history. The attack is one of only two confirmed terrorist uses of biological weapons to harm humans since 1945. 751 people contracted salmonellosis as a result of the attack; 45 of them were hospitalized. There were no fatalities.	Although an initial investigation by the Oregon Public Health Division and the Centers for Disease Control did not rule out deliberate contamination, the agents and fact of contamination were only discovered a year later. On February 28, 1985, Congressman James H. Weaver gave a speech in the United States House of Representatives in which he "accused the Rajneeshees of sprinkling salmonella culture on salad bar ingredients in eight restaurants". At a press conference in September 1985, Rajneesh accused several of his followers of participation in this and other crimes, including an aborted plan in 1985 to assassinate a United States Attorney,	and he asked State and Federal authorities to investigate. Oregon Attorney General David B. Frohnmayer set up an Interagency Task Force, composed of Oregon State Police and the Federal Bureau of Investigation, and executed search warrants in Rajneeshpuram. A sample of bacteria matching the contaminant that had sickened the town residents was found in a Rajneeshpuram medical laboratory. Two leading Rajneeshpuram officials were convicted on charges of attempted murder and served 29 months of 20-year sentences in a minimum-security federal prison.

Salmonella Enteritidis

Paramount & Raw Almonds

July 29, 2014 admin

Outbreak: Paramount & Raw Almonds
Product: Paramount & Raw Almonds	Investigation Start Date: 02/23/2004
Location: Multi-state outbreak	Etiology: Salmonella Enteritidis
Earliest known case onset date: 02/01/2004	Latest case onset date: 04/17/04
Confirmed / Presumptive Case Counts: 7 / 0	Positive Samples (Food / Environmental / Water): 1 / Lots / 0
Hospitalizations: 7	Deaths: 0

"Kirkland Signature” almonds from Paramount nuts, as exhibited in the museum.
An almond’s journey from branch to palm: Step one, growing free on a tree.
An almond’s journey from branch to palm: Step two, shakedown.
An almond’s journey from branch to palm: Moving around the plant.
An almond’s journey from branch to palm: Moving around the production line.
An almond’s journey from branch to palm: Moving around the production line.
A palette of finished almonds, ready to make their trip to Costco.
Samples from almond production lines.
Almonds, anyone?
Epi curve for this outbreak.

OUTBREAK SUMMARY:

This investigation was rapidly solved by the use of Oregon's "Shotgun" hypothesis-generating questionnaire, a detailed food history interview tool that asks about over 400 different foods and places to eat. A single interviewer at the Oregon state health department used this standardized questionnaire to interview all 5 … Continue Reading ››

Salmonella Mbandaka

Hydro-Harvest alfalfa sprouts

July 29, 2014 admin

Outbreak: Hydro-Harvest alfalfa sprouts
Product: Alfalfa sprouts	Investigation Start Date: 02/01/1999
Location: Multi-State: OR, WA, ID.	Etiology: Salmonella Mbandaka
Earliest known case onset date: 01/09/1999	Latest case onset date: 06/12/1999
Confirmed / Presumptive Case Counts: 43 / 0	Positive Samples (Food / Environmental / Water) 12 / 0 / 0

Alfalfa seeds from a recalled lot, on exhibit in the museum.
Handful of contaminated alfalfa seeds.
Reclaimed packaging from recalled alfalfa sprouts on display in the museum.
Reclaimed packaging from recalled alfalfa sprouts on display in the museum.
Reclaimed packaging from recalled alfalfa sprouts on display in the museum.
Distribution of contaminated seeds that would later be sprouted into outbreak vehicles.
Epi curve

OUTBREAK SUMMARY:

The increasing popularity of sprouts as health foods was sharply followed by the epidemiologic discovery that sprouts are prone to transmitting foodborne pathogens like Salmonella. This was the largest "sproutbreak" of foodborne salmonellosis in Oregon since the multistate and multinational outbreak of Salmonella Newport infection in 1996, in which … Continue Reading ››

e-coli-o157

Cal-Farms Parsley

July 29, 2014 admin

Outbreak: Cal-Farms Parsley
Product: Parsley	Investigation Start Date: 10/20/2005
Location: Deschutes County, OR	Etiology: E. coli (STEC) O157:H7
Earliest known case onset date: 10/08/2005	Latest case onset date: 10/27/2005
Confirmed / Presumptive Case Counts: 3 / 61	Positive Samples (Environmental / Water) 10 / 2

Nearby livestock
Evidence of heavy deer presence
Parsley epi curve
Parsley-processing machinery
Parsley field at Cascade Pacific
Muddy Parsley field
Deer track.
Muddy boots
Parsley

OUTBREAK SUMMARY:

This 2005 McGrath's Fish House outbreak of E. coli O157:H7 infections was traced back to parsley from Cal-Farms. The journey to finding the source was interesting: 206 people interviewed, 64 ill people, extremely muddy field conditions, cattle near the flooded parsley fields, and even evidence of heavy deer presence.

• … Continue Reading ››