{"id":210,"date":"2014-07-29T11:29:19","date_gmt":"2014-07-29T11:29:19","guid":{"rendered":"http:\/\/209.151.87.121\/~fomes\/iom\/?p=210"},"modified":"2016-03-16T20:08:47","modified_gmt":"2016-03-16T20:08:47","slug":"milk-crates-cartons-jugs","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/salmonella-braenderup\/milk-crates-cartons-jugs\/","title":{"rendered":"Milk Crates, Cartons, &#038; Jugs"},"content":{"rendered":"\n<table id=\"tablepress-15\" class=\"tablepress tablepress-id-15\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Milk Crates, Cartons, &amp; Jugs<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Milk Crates, Cartons, &amp; Jugs<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 01\/27\/2010<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Roseburg, Oregon<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> <i>Salmonella<\/i> Braenderup<\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 10\/21\/2009<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 10\/01\/2010<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b> 25 \/ 0<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples (Food \/ Environmental):<\/b> 15 \/ 500<\/td>\n<\/tr>\n<tr class=\"row-10\">\n\t<td class=\"column-1\"><b>Hospitalizations:<\/b> 0<\/td>\n<\/tr>\n<tr class=\"row-11\">\n\t<td class=\"column-1\"><b>Death:<\/b> 0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-15 from cache -->\n<div id=\"metaslider-id-234\" style=\"width: 100%; margin: 0 auto;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-234 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Umpqua 2010-023\" data-width=\"400\">\n    <div id=\"metaslider_container_234\">\n        <div id=\"metaslider_234\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2102 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-04-01 19:13:26\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/Umpqua-Epi-Curve-and-Map-400x200.jpg\" height=\"200\" width=\"400\" alt=\"\" class=\"slider-234 slide-2102 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epi curve and map of Salmonella Braenderup outbreak cases associated with milk cartons.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2101 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-04-01 19:13:24\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/Umpqua-Variety-400x200.jpg\" height=\"200\" width=\"400\" alt=\"\" class=\"slider-234 slide-2101 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A variety of milk containers were produced by Umpqua; all of these were part of the Salmonella outbreak.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-357 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-31 16:23:37\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/0830_Umpqua-milk-in-storage-11589_211-e1425548056433-400x200.jpg\" height=\"200\" width=\"400\" alt=\"A huge volume of milk was produced and the facility kept impeccable records.\" class=\"slider-234 slide-357 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A huge volume of milk was produced and the facility kept impeccable records.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-239 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:42:37\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/Bill-Umpqua_7_08-2010-e1425547118224-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Epidemiologists swab floor drains in the milk processing facility.\" class=\"slider-234 slide-239 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epidemiologists swab floor drains in the milk processing facility.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1898 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-18 20:44:52\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/parsley-epi-curve-400x200.png\" height=\"200\" width=\"400\" alt=\"Parsley epi curve\" class=\"slider-234 slide-1898 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Parsley epi curve<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1807 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:51\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Umpqua-Dairy-18029-1024x768-e1425608194201-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Outdoor milk crate storage.\" class=\"slider-234 slide-1807 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Outdoor milk crate storage.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-237 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:42:34\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/Bill-Umpqua_2_08-2010-e1425547167445-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Epidemiologists swab ceiling vents as they search for clues about whether Salmonella is contaminating this milk product.\" class=\"slider-234 slide-237 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epidemiologists swab ceiling vents as they search for clues about whether Salmonella is contaminating this milk product.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1809 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:54\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Umpqua-Dairy-18076-1024x768-e1425608165573-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Umpqua milk in an Umpqua milk crate.\" class=\"slider-234 slide-1809 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Umpqua milk in an Umpqua milk crate.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-642 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-09-03 15:02:05\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/09\/Umpqua-Dairy-107547-1-e1425546386520-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Crate washer machine on the roof of the plant.\" class=\"slider-234 slide-642 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Crate washer machine on the roof of the plant.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1808 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:53\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Umpqua-Dairy-18032-1024x768-e1425608181655-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Epidemiologists track specimens in a log as they are collected.\" class=\"slider-234 slide-1808 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epidemiologists track specimens in a log as they are collected.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1816 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:04\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Umpqua-Dairy-KV-60734-1024x683-e1425608125104-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Standing water on the roof is swabbed.\" class=\"slider-234 slide-1816 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Standing water on the roof is swabbed.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1812 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:58\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Umpqua-Dairy-by-KV-8541-1024x683-e1425608148579-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Epidemiologists swabbed in between crate crevices to get a good sample.\" class=\"slider-234 slide-1812 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epidemiologists swabbed in between crate crevices to get a good sample.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1813 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:00\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Umpqua-Dairy-by-KV-8563-683x1024-e1425608142718-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Milk crates had to slide through here during the dysfunctional decontamination process.\" class=\"slider-234 slide-1813 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Milk crates had to slide through here during the dysfunctional decontamination process.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-236 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:42:33\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/Bill-Umpqua_1_08-2010-e1425547219144-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Dr. Keene takes a shot of an Umpqua Dairy truck as the investigation comes to a close.\" class=\"slider-234 slide-236 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Dr. Keene takes a shot of an Umpqua Dairy truck as the investigation comes to a close.<\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n\n<table id=\"tablepress-57\" class=\"tablepress tablepress-id-57\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Outbreak Summary:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">This outbreak illustrates the value of descriptive epidemiology and the virtue of epidemiologist persistence! Over a 12-month period during 2009\u20132010, a total of 25 infections by <i>Salmonella<\/i>  Braenderup with matching PFGE patterns were reported\u2014no more than 4 in any given month. After 3 scattered cases over 3 months, the investigation began with recognition of a 3-case cluster in a single Oregon county in January 2010. Extensive hypothesis-generating (\u201cshotgun\u201d) interviews were thereafter conducted as each case was recognized, but no obvious source emerged. In desperation, on July 26, 2010, Oregon\u2019s epidemiologists gathered to review the available information. The descriptive epidemiology proved pivotal. Person: although cases ranged in age from 1 to 88 years, there was a predilection for children: median case age was 13 years. Place: cases resided in 9 contiguous Oregon counties\u2014but none from the populous Portland metropolitan area. Time: the prolonged duration of the outbreak ruled out most perishable items. What food or other vehicle could jibe with this information?<br \/>\n<br \/>\nAt least 94% of cases affirmed consumption of milk\u2014though pasteurized and of different labels. But Umpqua brand milk was known to be distributed predominantly south of the Portland area, and no other plausible hypothesis survived the analysis of the assembled epidemiologists.<br \/>\n<br \/>\nExperts in the Oregon Department of Agriculture were able to confirm that the alternative milk brands reported by cases or served in the case children\u2019s schools were, in fact, produced by Umpqua. With the epidemiologists, they visited the production facility and confirmed that the pasteurization process was in order: records indicated that the milk was heated, stored, and packaged appropriately, with no apparent opportunity for post-pasteurization contamination. But culture of 132 environmental specimens obtained at the facility yielded <i>Salmonella<\/i>  Braenderup in five: one from a milk crate, three from sites on the crate\u2019s conveyor system, and one from a floor drain. The crate washer was situated on the roof of the facility, open to birds and perhaps other wildlife.<br \/>\n<br \/>\nThe investigation tendered a surprising conclusion: the milk itself was never contaminated. Rather, the bacteria were on the milk crates, occasionally finding their way onto individual cartons, and, from perhaps one in 10,000 cartons, into someone\u2019s mouth. This conclusion that the milk crates and cartons acted as fomites <b>(f\u014d\u2019 m\u012d t\u0113z)<\/b>\u2014objects that can transfer infectious microorganisms to humans\u2014explained the prolonged duration of the outbreak, the low attack rate, the case demographics, and the cases\u2019 exposure histories. Finding the cause allowed for remediation and resumption of business for Umpqua: after closing for a week to sanitize and to rebuild its crate system, the plant resumed production, and the outbreak ended.<br \/>\n<br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/milk-Q-2010-023.pdf\" target=\"_blank\">Outbreak questionnaire (PDF)<\/a><\/li><\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-57 from cache -->\n<p style=\"text-align: justify;\">\n<table id=\"tablepress-76\" class=\"tablepress tablepress-id-76\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Details:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">To read The Oregonian story by Lynn Terry about this outbreak, <strong><a href=\"http:\/\/www.oregonlive.com\/business\/index.ssf\/2010\/08\/umpqua_dairy_resumes_productio.html\" target=\"_blank\">click here.<\/a><\/strong><br \/>\n<br \/>\n<strong>INTRODUCTION:<\/strong><br \/>\n25 cases dribbled out from Oct 2009 to Oct 2010; eventually linked to product from Umpqua Dairy in Roseburg. Crate washer was contaminating milk crates and (in turn) the sealed containers (not the milk per se).<br \/>\n<br \/>\n<strong>A SURPRISING TWIST:<\/strong><br \/>\nUmpqua milk products produced at the Roseburg plant have been confirmed as this source of the 25-case, year-long outbreak.<br \/>\n<br \/>\nIn a surprising twist, however, it appears that the milk itself may NEVER have been contaminated. Rather, the weight of evidence suggested that the problem stemmed from external contamination of the milk cartons and jugs from an outdoor crate washer.<br \/>\n<br \/>\nIn other words, the containers were fomites, meaning that by most definitions this was not a \"foodborne\" outbreak. Milk crates used to move product around the plant and to distribute product to retailers around the state come back to the Roseburg plant, where they recycled up a conveyor line through an outdoor crate washer and thence were carried inside the plant where they were loaded with cartons of milk.<br \/>\n<br \/>\nAs the crates went through the washer, they were in effect being sprayed down with a solution of <i>Salmonella<\/i> Braenderup. Matching bacteria were recovered from the washer and multiple points downstream, including crates and external surfaces of sealed containers.<br \/>\n<br \/>\nThe plant was shut for 5 days while the crate washer was disassembled, cleaned, and rebuilt, and other parts of the plant were cleaned and sanitized. Crates were boiled. New sanitizer stations were added to reduce or eliminate the risk of external contamination of the crates when they are filled with product.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-76 from cache --><\/p>\n<p style=\"text-align: justify;\"><a href=\"https:\/\/www.outbreakmuseum.com\/mobile\/exhibits\/\"><strong>Back to Outbreak Exhibits<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back to Outbreak Exhibits<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[98,81,97,77,82,80,87,88,96,79,108,78],"class_list":["post-210","post","type-post","status-publish","format-standard","hentry","category-salmonella-braenderup","tag-jugs","tag-acute-and-communicable-disease-prevention","tag-cartons","tag-dr-bill-keene","tag-fomes","tag-integrated-food-safety-center-of-excellence","tag-international-outbreak-museum","tag-iom","tag-milk-crates","tag-oregon-health-authority","tag-salmonella-braenderup","tag-tribute"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/210","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/comments?post=210"}],"version-history":[{"count":10,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/210\/revisions"}],"predecessor-version":[{"id":2075,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/210\/revisions\/2075"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=210"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=210"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=210"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}