Tag Archives: oregon health authority

Cold Stone

February 26, 2015 admin

Outbreak: Cold Stone Cake Batter Ice Cream
Product: Cake Batter Ice Cream	Investigation Start Date: 06/29/2005
Location: Multi-state	Etiology: Salmonella Typhimurium
Earliest known case onset date: 05/21/2005	Latest case onset date: 07/04/2005
Confirmed / Presumptive Case Counts: 25 / 0	Positive Samples (Food / Environmental): 2 / 0

Cold Stone Creamery in Seattle, Washington
Bill Keene and Chris Van Beneden outside a Cold Stone Creamery in Seattle, WA
Cold Stone Creamery in Seattle, Washington
Cold Stone Creamery – Seattle, WA: At a store, mix-in ingredients are combined with ice cream to create various customized sundaes and treats.
Melissa Plantega holding a box of cake mix at a Cold Stone Creamery store in Tigard, OR.
Illness onset dates of cases by state of residence: Twenty-five S. Typhimurium isolates of the outbreak PFGE subtype were identified in 10 states. Twenty-four cases in nine states reported consuming Cold Stone Creamery cake batter ice cream prior to onset of illness. The median age of cases was 13 years (range, 2 – 32 years), 58% were female, and illness onsets ranged from May 21 to July 4, 2005. The median incubation period was 4 days (range 1 – 7 days) and four cases were hospitalized.
Traceback results for cake mix used in cake batter ice cream: Tracebacks in Minnesota, Oregon, and Virginia implicated a single lot of cake mix produced on April 14, 2005. No manufacturing anomalies were identified for this lot. Forty-eight percent of this lot shipped to the nine states with cases; 52% shipped to 20 other states. Cake mix and ice cream samples tested by the United States Food and Drug Administration and individual states were negative; however, two cake mix samples were positive for S. Typhimurium of the outbreak PFGE subtype at the University of Georgia Center for Food Safety.
Selected Cold Stone Creamery ice cream flavors and ingredients: The cake batter ice cream recipe called for 2 lbs. of powdered Gold Medal Supermoist Yellow Cake Mix mixed with 2.5 gallons of sweet cream ice cream base. The sweet cream base was used in nearly all Cold Stone Creamery ice cream flavors; therefore, the investigation focused on cake mix.
Cold Stone Creamery – Tigard, OR: A Cold Stone Creamery store posted this sign on their walk-in cooler. Cold Stone Creamery voluntarily recalled cake batter ice cream on July 1, just two days after the outbreak was initially detected.
Gold Medal SuperMoist Yellow Cake Mix: Cake mix pictured here contained flour, spray-dried egg whites, and several low risk components. The implicated lot of cake mix contained two lots of spray-dried egg whites; a 50lb box of one lot was available for testing but was negative for Salmonella. Specific lots of flour used in the cake mix were not determined nor tested. Low levels of contamination could have gone undetected in either ingredient. The difficultly in recovering Salmonella from implicated ice cream and cake mix at several laboratories, and the relatively long incubation period for cases in this outbreak, also suggests low level contamination of the cake mix.
Cake batter mix ingredients.

OUTBREAK SUMMARY:

The vehicle for this outbreak was ice cream made with a contaminated cake mix ingredient. Four patients reported eating cake batter flavor ice cream from two separate outlets of Cold Stone Creamery.

e-coli-o157

Jack-in-the-Box Hamburgers

February 19, 2015 admin

Outbreak: Jack In The Box Hamburgers
Product: Hamburgers	Investigation Start Date: 01/12/1993
Location: Multi-State Outbreak	Etiology: E. coli O157
Earliest known case onset date: 11/18/1992	Latest case onset date: 02/21/1993
Confirmed / Presumptive Case Counts: 503 / 229	Positive Samples (Food / Environmental / Water): 0 / 0 / 0
Hospitalizations: 151	Deaths: 3

Grill with frozen hamburger patties adjacent.
"Do not use" on box of hamburger patties.
Hamburgers from one of the lots of Jack-in-the-Box burgers implicated in the O157 outbreak.
Under-cooked Jack In The Box hamburger.

OUTBREAK SUMMARY:

This was the largest outbreak of E. coli O157 infections ever documented in the United States, and it injected this pathogen—and threats to food safety in general—into popular consciousness.

acute and communicable disease prevention dr bill keene E. coli O157:H7 FOMES integrated food safety center of excellence international outbreak museum iom jack in the box hamburgers oregon health authority tribute

shigella

Protected: 2005-106 Spiritual Retreat Shigella

February 6, 2015 admin

Outbreak: Spiritual Retreat Shigella

Product: Never pinpointed Investigation Start Date: 7/28/2005

Location: Douglas County, OR Etiology: Shigella

Earliest known case onset date: 07/19/2005 Latest case onset date: 08/06/2005

Confirmed / Presumptive Case Counts: 262 / 18 Positive Samples (Food / Environmental / Water): 0 / 0 / 0

Large parking lot and camping area of the spiritual retreat.

Group meals were self-served 3 times each day in a converted barn.

Group meals were self-served 3 times each day in a converted barn.

This large collection of portable toilets and sinks were available to the 750+ campers.

Signage reminder attendees (and presumably food handlers) to wash their hands with soap.

Group meeting during the retreat.

Control measures included keeping sick attendees together in separate rooms while they got well.

Map of the countries involved in this outbreak.

This outbreak's Epi Curve.

OUTBREAK SUMMARY:

This outbreak of shigellosis is one the largest Oregon has ever seen with at least 280 cases identified (18 of which were lab-confirmed).

• Full outbreak questionnaire (PDF)

• Supplemental follow-up questionnaire (PDF)

DETAILS:

A local organic farm and meditation retreat center hosted its annual 16-day retreat … Continue Reading ››

acute and communicable disease prevention dr bill keene FOMES integrated food safety center of excellence international outbreak museum iom oregon health authority Shigella Spiritual Retreat Spiritual Retreat Shigella tribute

e-coli-o157

Venison Jerky

July 29, 2014 admin

Outbreak: Venison Jerky

Product: Venison Jerky Investigation Start Date: 11/20/1995

Location: Benton County, Oregon Etiology: E. coli (STEC) O157:H7

Earliest known case onset date: 11/13/1995 Latest case onset date: 11/20/1995

Confirmed / Presumptive Case Counts: 6 / 5 Positive Samples (Food / Environmental / Water): 2 / 2 / 0

Close-up of the food dehydrator used to make contaminated venison jerky.

Food dehydrators used to make venison jerky.

An epidemiologist swabs the band saw used to processed the deer in question; the band saw tested positive.

Dehydrated venison (jerky); this tested positive for E. coli O157.

Dr. Keene retrieving the field dressing from the deer that yielded the contaminated venison jerky; field dressing tested positive.

OUTBREAK SUMMARY:

At a time when ground beef was thought to be the source of all foodborne E. coli O157 infections, this was the first documentation of venison-associated E. coli O157:H7 outbreak. Epidemiologists showed that deer can be colonized by E. coli O157:H7 and ultimately be a source of human infections. … Continue Reading ››

acute and communicable disease prevention dr bill keene E. coli O157:H7 FOMES integrated food safety center of excellence international outbreak museum iom oregon health authority tribute Venison Deer Jerky

e-coli-o157

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 ››

acute and communicable disease prevention dr bill keene E. coli O157:H7 FOMES Foundation Farm Raw Milk integrated food safety center of excellence international outbreak museum iom oregon health authority tribute

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 ››

acute and communicable disease prevention Berry Stand Strawberries dr bill keene E. coli O157:H7 FOMES integrated food safety center of excellence international outbreak museum iom oregon health authority tribute

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 ››

& Jugs acute and communicable disease prevention Cartons dr bill keene FOMES integrated food safety center of excellence international outbreak museum iom Milk Crates oregon health authority Salmonella Braenderup tribute

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 ››

acute and communicable disease prevention dr bill keene FOMES integrated food safety center of excellence international outbreak museum iom Lian How White Pepper oregon health authority Salmonella Rissen tribute

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 ››

acute and communicable disease prevention Bagged Spinach dr bill keene E. coli O157:H7 FOMES integrated food safety center of excellence international outbreak museum iom oregon health authority tribute

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 ››

acute and communicable disease prevention dr bill keene FOMES integrated food safety center of excellence international outbreak museum iom oregon health authority Paramount & Raw Almonds Salmonella Enteritidis tribute

Posts navigation

1 2 Next →