{"id":2725,"date":"2019-01-14T18:47:53","date_gmt":"2019-01-14T18:47:53","guid":{"rendered":"http:\/\/www.outbreakmuseum.com\/mobile\/?p=2725"},"modified":"2019-01-16T20:42:19","modified_gmt":"2019-01-16T20:42:19","slug":"listeria-soft-cheese","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/listeria\/listeria-soft-cheese\/","title":{"rendered":"Listeria Soft Cheese"},"content":{"rendered":"\n<table id=\"tablepress-121\" class=\"tablepress tablepress-id-121\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Listeria Soft Cheese<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Soft Cheese<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 06\/27\/2013<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Multi-State<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> <em>Listeria monocytogenes<\/em><\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 5\/14\/2013<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 6\/16\/2013<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b> 5 \/ 0<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples (food \/ Environmental):<\/b> 18 \/ 1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-121 from cache -->\n\n\n<div id=\"metaslider-id-2734\" style=\"width: 100%; margin: 0 auto;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-2734 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Crave Listeria Cheese\" data-width=\"400\">\n    <div id=\"metaslider_container_2734\">\n        <div id=\"metaslider_2734\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2740 ms-image \" aria-roledescription=\"slide\" data-date=\"2019-01-14 19:08:11\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2019\/01\/2007list-distribution-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2734 slide-2740 msDefaultImage\" title=\"2007list-distribution\" \/><div class=\"caption-wrap\"><div class=\"caption\">Product Distribution Chain<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2744 ms-image \" aria-roledescription=\"slide\" data-date=\"2019-01-14 19:08:11\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2019\/01\/2007list-receipt-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2734 slide-2744 msDefaultImage\" title=\"2007list-receipt\" \/><div class=\"caption-wrap\"><div class=\"caption\">Recreation of grocery store receipt for Les Freres purchase<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2743 ms-image \" aria-roledescription=\"slide\" data-date=\"2019-01-14 19:08:11\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2019\/01\/2007list-PGFE-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2734 slide-2743 msDefaultImage\" title=\"2007list-PGFE\" \/><div class=\"caption-wrap\"><div class=\"caption\">PFGE Testing Results<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2742 ms-image \" aria-roledescription=\"slide\" data-date=\"2019-01-14 19:08:11\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2019\/01\/2007list-onset-chart-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2734 slide-2742 msDefaultImage\" title=\"2007list-onset-chart\" \/><div class=\"caption-wrap\"><div class=\"caption\">Cases by Week of Illness Onset<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2741 ms-image \" aria-roledescription=\"slide\" data-date=\"2019-01-14 19:08:11\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2019\/01\/2007list-map-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2734 slide-2741 msDefaultImage\" title=\"2007list-map\" \/><div class=\"caption-wrap\"><div class=\"caption\">Outbreak Case Distribution<\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n\n\n\n<table id=\"tablepress-122\" class=\"tablepress tablepress-id-122\">\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\">Five outbreak cases of listeriosis were identified in Minnesota, Indiana, Illinois, and Ohio. The use of the <a href=\"https:\/\/www.cdc.gov\/listeria\/surveillance\/listeria-initiative.html\" target=\"_\">CDC Listeria Initiative questionnaire<\/a> to identify a soft cheese signal, along with re-interviewing cases (or their proxies) and calling restaurants to get specific details on cheese brand and cheese type were critical in identifying the outbreak vehicle. Environmental isolates in the <a href=\"https:\/\/www.cdc.gov\/pulsenet\/index.html\" target=\"_\">PulseNet<\/a> national database that were collected from the Crave Brothers cheese production plant (and indistinguishable from outbreak case isolates) were also a key supporting clue. These clues led to the testing of Crave Brothers cheese samples and detection of the outbreak stain in this product.<br \/>\n<br \/>\nThis investigation resulted in perhaps the fastest identification of a commercially distributed food vehicle of a listeriosis outbreak; the cluster was detected in Minnesota on June 27 and public health interventions were implemented on July 3 (6 days later). This was a remarkable accomplishment, especially with only 5 cases to work with. The rapidity of the investigation can be attributed primarily to the urgency displayed by the lead investigator and the aggressive acquisition of details on brand and type of soft cheese consumed, in collaboration with epidemiologists in the other affected states.<br \/>\n<br \/>\nThe MN CoE has created a detailed case study about this investigation that can be used for training public health practitioners in outbreak investigation. Public Health students love it too!<br \/>\n<ul><br \/>\n \t<li>\u2022 <a href=\"http:\/\/mnfoodsafetycoe.umn.edu\/wp-content\/uploads\/2016\/09\/Listeria-Cheese-Outbreak-Case-Study.pdf\" target=\"_blank\"><strong>Outbreak Investigation Case Series\u2013Minnesota Integrated Food Safety Center of Excellence (PDF)<\/strong><\/a><\/li><br \/>\n \t<li>\u2022 <a href=\"https:\/\/www.cdc.gov\/listeria\/outbreaks\/cheese-07-13\/\" target=\"_blank\"><strong>CDC outbreak page<\/strong><\/a><\/li><br \/>\n<\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-122 from cache -->\n\n\n\n<table id=\"tablepress-124\" class=\"tablepress tablepress-id-124\">\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\"><em>A multi-state outbreak of listerosis associated with soft cheese from Crave Brothers.<\/em><br \/>\n<br \/>\n<b>Background<\/b><br \/>\nOn June 27, 2013, the Minnesota Department of Health (MDH) Public Health Laboratory (PHL) determined that two clinical <em>Listeria monocytogenes<\/em> (LM) isolates submitted through routine surveillance had indistinguishable PFGE patterns. A review of the national PulseNet database revealed three additional LM isolates with the outbreak PFGE pattern in Indiana, Illinois, and Ohio. A multi-state investigation was initiated.<br \/>\n<br \/>\n<b>Results<\/b><br \/>\nFive cases from three states were ultimately identified in this outbreak (Minnesota, 2; Indiana, 1; Illinois, 1; and Ohio, 1). In addition, subsequent whole genome sequencing efforts identified another likely case in Texas, but exposure information was not available. Four (80%) cases were female and the median age of the cases was 55 years (range, 31 to 67 years). All five cases were hospitalized and one died. <em>Listeria<\/em> Initiative case report forms were completed for all five cases and all five reported consuming a variety of soft cheeses. Potato salad was reported by both Minnesota cases; however, no other cases reported consuming it. Epidemiologists conducted a case-case comparison study to compare outbreak case food consumption rates against estimated background consumption rates using non-outbreak associated LM cases. LM cases with the outbreak PFGE pattern were significantly more likely than sporadic LM cases to have consumed any soft cheese (odds ratio, 16.8; 95% confidence interval, 1.2\u20138) and yogurt (odds ratio, 7.5; 95% confidence interval, 1.3\u20138). Review of the initial interviews revealed that cases reported different brands of yogurt, making this an unlikely source of illness.<br \/>\n<br \/>\nThe Minnesota cases were re-interviewed to get additional specific product details on the soft cheese exposures. The first Minnesota case reported consuming a cheese plate at a restaurant in North Dakota. The investigator called the restaurant which reported that the cheese plate included Crave Brothers Les Fr\u00e8res cheese. The Illinois case reported consuming Crave Brothers Les Fr\u00e8res cheese purchased from a grocery store. The Indiana case reported consuming a cheese plate at a restaurant, and a review for the restaurant menu indicated that Crave Brothers Les Fr\u00e8res was served on the cheese plate. The Ohio case was re-interviewed and also reported consuming a cheese plate at a restaurant which included Crave Brothers Petit Fr\u00e8re cheese. PulseNet identified non-human isolates in PulseNet with the outbreak PFGE pattern that had been collected from the Crave Brothers cheese production facility in 2010 and 2011.<br \/>\n<br \/>\nOn July 1, Crave Brothers cheese was collected for testing from two locations of the grocery chain where MN case #2 had purchased the product, and submitted to Minnesota Department of Agriculture (MDA) for LM testing. In addition, leftover blue cheese, Irish cheddar, parmesan cheese, and an unknown hard cheese were collected for testing from MN case #2\u2019s home. By July 3, Enzyme-linked Fluorescent Assay results indicated that a wedge of Crave Brothers Petite Fr\u00e8re with Truffles from one grocery store location in Minnesota, two wedges of Crave Brothers Les Fr\u00e8res from another location of the same grocery store chain in Minnesota, and a wedge of blue cheese collected from MN Case #2\u2019s home all tested positive for LM. A traceback of the Crave Brothers cheese consumed by the cases revealed that the cheeses had different distributors, which indicated that the source of the contamination was the Crave Brothers plant.<br \/>\nA press release was issued warning consumers not to eat Crave Brothers Les Fr\u00e8res, Petit Fr\u00e8re, and Petit Fr\u00e8re with truffles and Crave Brothers issued a voluntary nationwide recall of these cheeses.<br \/>\nThe spouse of the second Minnesota case called investigators to report that he thought they had purchased Crave Brothers Petit Fr\u00e8re. He did not have a receipt but had used a credit card to make the purchase. The investigator contacted the grocery store and gave them the credit card transaction numbers, the date of the transaction, and the dollar amount of the transaction. Using this information the store was able to reprint the original receipt with included Crave Brothers Petit Fr\u00e8re.<br \/>\n<br \/>\n<b>Conclusions<\/b><br \/>\nThis was a multi-state outbreak of LM infections associated with Crave Brothers cheese. The use of the <em>Listeria<\/em> initiative questionnaire along with re-interviewing cases (or their proxies) and calling restaurants to get specific details on cheese brand\/type were critical in identifying the outbreak vehicle.<br \/>\nEnvironmental isolates in the <a href=\"https:\/\/www.cdc.gov\/pulsenet\/index.html\" target=\"_\">PulseNet<\/a> national database that were collected from the Crave Brothers cheese production plant were also a key supporting clue. This investigation resulted in perhaps the fastest identification of a commercially distributed food vehicle of a listeriosis outbreak.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-124 from cache -->\n\n\n\n<p><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":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[134],"tags":[],"class_list":["post-2725","post","type-post","status-publish","format-standard","hentry","category-listeria"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2725","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=2725"}],"version-history":[{"count":7,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2725\/revisions"}],"predecessor-version":[{"id":2756,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2725\/revisions\/2756"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=2725"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=2725"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=2725"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}