Update – Outbreak of E. coli Infections Linked to Romaine Lettuce

CDC, public health and regulatory officials in several states, Canada, and the FDA are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections. Read food safety alert.

As of December 6, 2018, 52 people infected with the outbreak strain of E. coli O157:H7 have been reported from 15 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from October 5, 2018 to November 18, 2018. Ill people range in age from 1 to 84 years, with a median age of 30. Sixty-nine percent of ill people are female. Of 45 people with information available, 19 (42%) have been hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after November 14, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coliinfection and when the illness is reported. This takes an average of two to three weeks.

Investigation of the Outbreak

Epidemiologic and traceback evidence indicates that romaine lettuce from the Central Coastal growing regions of northern and central California is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Twenty-four (83%) of 29 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey[PDF – 787 KB] of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people reported eating different types of romaine lettuce in several restaurants and at home.

Preliminary traceback information from the FDA indicates that ill people in this outbreak ate romaine lettuce harvested from the Central Coastal growing regions of northern and central California. The specific California counties FDA identified in the traceback investigation are Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, and Ventura. At this time, no common grower, supplier, distributor, or brand of romaine lettuce has been identified.

The FDA, along with CDC and state partners, is investigating farms and cooling facilities in California that were identified in traceback. CDC collected samples of water to test for E. coli O157:H7; these test results are pending.

This investigation is ongoing, and CDC will provide more information as it becomes available.

Tris Pharma Issues Voluntary Nationwide Recall of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL, Due to Potential Higher Concentrations of Ibuprofen

Tris Pharma, Inc. has voluntarily recalled three (3) lots of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL, to the retail level. The recalled lots of the product have been found to potentially have higher concentrations of ibuprofen. There is a remote possibility that infants, who may be more susceptible to a higher potency level of drug, and therefore may be more vulnerable to permanent NSAID-associated renal injury. Adverse effects that may be experienced are nausea, vomiting, epigastric pain, or more rarely, diarrhea. Tinnitus, headache and gastrointestinal bleeding are also possible adverse effects. To date, Tris Pharma, Inc. has not received any reports of adverse events related to the lots of product that are the subject of this recall. Read More

New and Invasive Tick Species in Virginia

In November of 2017, a tick species previously unknown to the US called Haemaphysalis longicornis, or the Asian longhorned tick, was discovered both on a sheep and in a pasture in New Jersey.  Since then, this new tick species has been found in eight additional states, including 17 counties and one city in Virginia.

The Asian longhorned tick is native to East Asia and has also been well described in New Zealand and Australia. In the tick’s native range, it has been known to cause Theileriosis disease in cattle, as well as a frequently fatal viral disease called “Severe Fever with Thrombocytopenia Syndrome” (or SFTS) in humans;  the SFTS virus resembles Heartland virus, a pathogen that may be found in Virginia’s environment. There is also some research from this tick’s native territory in Asia showing that the Asian longhorned tick might be capable of transmitting Lyme disease (from an Asian Borrelia species), as well as Human Anaplamsosis and Ehrlichiosis pathogens, and a Spotted fever Rickettsiosis.  However, more time will be needed to assess the tick’s ability to acquire and transmit these various pathogenic agents found in the United States.

An interesting feature of this tick and a major factor enabling its rapid spread, is the ability to reproduce asexually, a process known as parthenogenic reproduction. To date, no males of this species have been confirmed among the many thousands of females that have been discovered. This tick also boasts a broad host range and has been found on birds, rodents, terrestrial mammals, livestock, domestic pets, and even humans. Also, this species of tick has been found in both field and forested environments in Virginia and may be common in pasturelands where livestock might be found grazing. This is atypical of Virginia’s most common human-biting tick species, as they are more likely to be found in a forested environment.

For safety purposes, it is important to take precautionary measures to help reduce your risk of tick bites year round. Here are some steps you can take to avoid being bitten:

  • Use EPA registered repellents, such as permethrin, to treat your shoes, socks, pants, and shirts, and ALWAYS follow the product label for use.
  • Ticks typically start to climb onto people from the ground, or from low vegetation, so the use of repellents and protective clothing should also be from the ground, up. Tuck your pant legs into your socks and shirt into your pants when in forest or pasture environments.
  • Avoid any unnecessary walks in brushy or wooded environments, or grassy fields, especially when not using repellents.

For more information regarding ticks and tick-borne illnesses, visit our ‘Bugs’ and Human Health page on the Virginia Department of Health website under Environmental Epidemiology at http://www.vdh.virginia.gov/environmental-epidemiology/bugs-human-health

H. longicornis adult (left), nymph (center), and larva (right). (Photo credit: Manigandan Lejeune, Cornell Animal Health Diagnostic Center)

Food Safety Tips for a Happy Holiday Season

hot cocoa and cookiesWhether you are celebrating at home or dining out, there are simple steps you can take to keep you and your loved ones safe and healthy this holiday season.

Preparing a holiday meal at home? Prevent foodborne illness by washing hands and surfaces frequently, avoiding cross-contamination, cooking foods to proper temperatures, and refrigerating foods promptly. If you are cooking a holiday turkey, follow these four tips to take the guesswork out of preparation:

  1. Thawing: Thaw turkeys in the refrigerator, in a sink of cold water (changed every 30 minutes), or in a microwave. Frozen turkeys are safe indefinitely, but thawing turkeys must defrost at a safe temperature. Turkeys left out for more than two hours at room temperature can creep into the danger zone between 40°F and 140°F, where bacteria can grow rapidly.
  1. Handling: It’s flu season! Be sure to thoroughly wash your hands to prevent the spread of germs, using soap and clean running water for at least 20 seconds. This will help prevent the spread of bacteria from raw poultry, too. Don’t forget to also thoroughly wash utensils and work surfaces to protect your food and family!
  1. Stuffing: If you stuff the turkey, do so just before cooking. Bacteria can survive in stuffing that has not reached 165°F and possibly cause food poisoning, so use a food thermometer to make sure the stuffing’s center reaches this temperature. For optimum safety, cook your stuffing in a casserole dish for even cooking.
  1. Cooking: Set your oven to at least 325°F, and place the completely thawed turkey with the breast side up in a 2 to 2-1/2 inch deep roasting pan. Cooking times will vary depending on weight, so use a food thermometer inserted into the center of the stuffing and the thickest portions of the breast, thigh, and wing joint to make sure the bird has reached a safe internal temperature of 165°F. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat.

Dining out? Follow these four tips from CDC to prevent food poisoning:

  1. Check inspection s online for the restaurant you plan to go to. Restaurant inspection data for Virginia is available by health district here.
  2. Make sure that the restaurant is clean. If not, you may want to visit a different establishment.
  3. Check that your food is cooked thoroughly, and send back any undercooked food as it may contain harmful bacteria if not cooked adequately.
  4. Properly handle leftovers by refrigerating within 4 hours of eating. Eat leftovers within 3 to 4 days from purchase.

For more information, check out CDC’s blog for more Holiday Food Safety Tips and Food Safety Tips for Your Holiday Turkey.

FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely Linked to Romaine Lettuce Grown in California

Update: November 26, 2018

The FDA, along with CDC, state and local agencies, is investigating a multistate outbreak of E. coli O157:H7 illnesses likely linked to romaine lettuce grown in California this fall. The Public Health Agency of Canada (PHAC) and Canadian Food Inspection Agency are also coordinating with U.S. agencies as they investigate a similar outbreak in Canada.

The FDA has been conducting a traceback investigation, reviewing shipping records and invoices to trace the supply of romaine from the place where ill people were exposed to the place where that romaine was grown.

Preliminary traceback information indicates that ill people in several areas across the country were exposed to romaine lettuce harvested in California. Specifically, current evidence indicates this romaine was harvested in the Central Coast growing regions of northern and central California.

Romaine harvested from locations outside of the California regions identified by the traceback investigation does not appear to be related to the current outbreak. Read More>>

Get Your Flu Shot!

miss the fluBy now, you probably know that it is recommended that everyone 6 months of age or older receive a flu vaccination each year. While it’s best to get your flu shot as soon as it is available (sometimes as early as August)! Flu season usually peaks in January or February and continues through May. Getting a flu shot is not only the single best way to protect yourself from getting sick, it’s also the best way to prevent the spread of flu to others.

Help us make Virginia the healthiest state in the nation by getting a flu shot and encouraging your friends and family to get one as well.

It is important to get a flu shot even if you had one last year. Your immune protection from vaccination declines over time, so an annual vaccination is needed to get the best protection against the flu.

The flu is a serious disease, especially for certain age groups and people with certain chronic health conditions, such as:

  • Children younger than five, but especially younger than two years old
  • Adults 65 years of age or older
  • Women who are pregnant or just had a baby
  • People with chronic health conditions

Remember, a flu shot cannot cause illness.

To find out where to get a flu shot in your area, contact your local health department or use the vaccine finder. And visit our Miss The Flu page for more information on how to miss the flu, not your life!

Acute Flaccid Myelitis Virginia Update

Acute flaccid myelitis or “AFM” is a condition that affects the nervous system, specifically the spinal cord. Most patients have sudden onset of limb (arm and leg) weakness. AFM is thought to be caused by infections with different types of viruses. The infections most commonly mentioned with AFM include polio or West Nile virus and related infections. Most patients with AFM have a respiratory illness or fever before their limbs are affected. Other causes of AFM are still being explored and may include environmental toxins or genetic disorders. Learn More

CDC: Outbreak of E. coli Infections Linked to Romaine Lettuce

CDC, public health and regulatory officials in several states, Canada, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections linked to romaine lettuce. CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until they learn more about the outbreak. This investigation is ongoing and the advice will be updated as more information is available. Learn more

Be Food Safe This Holiday Season

food safety graphicFood safety is important for keeping your holiday gathering happy and healthy. However, food safety can be a challenge during the holiday season. Group gatherings may include more dishes than there is room for in the refrigerator or oven. Guest lists may also include those who are more vulnerable to illness, such as older people, young children, and pregnant women.

Follow these tips for a food-safe, happy holiday season:

Happy Handling

  • It’s flu season! Wash your hands well to prevent the spread of germs, using soap and clean running water for at least 20 seconds. This will help prevent the spread of bacteria from raw poultry, too.
  • Wash all fresh produce to reduce the potential for bacterial contamination.
  • Don’t forget to also wash utensils and work surfaces to protect your food and family!

Let’s Talk Turkey

Follow the tips in the infographic (right) to make sure your turkey is both delicious and safe to serve.

Cooking for a large group?

  • Prepare uncooked recipes before recipes that include raw meat. Also, store uncooked items out of the way while preparing meat dishes. These steps will help to reduce cross-contamination.
  • Cook to the proper temperature, and use a thermometer!
  • Remember the golden rule: Keep hot food hot and cold food cold! Use chafing dishes or crock pots and ice trays. Hot items should stay above 140 ˚F, and cold items should stay below 40 ˚F.
  • Discard perishable foods left out for 2 hours or more. Plan to refrigerate any leftovers within 2 hours of preparation.

Eating Out?

Follow these four tips from CDC to prevent food poisoning:

  1. Check inspections online for the restaurant you plan to go to. Restaurant inspection data for Virginia is available by health district here.
  2. Make sure that the restaurant is clean. If not, you may want to visit a different establishment.
  3. Check that your food is completely cooked. Send back any undercooked food, as it may contain harmful bacteria.
  4. Refrigerate leftovers within 4 hours of eating. Eat leftovers within 3 to 4 days from purchase.

View our My Meal Detective videos to learn how to prevent and report foodborne illness. For more information on general food safety, visit the VDH Food Safety page and:

CDC- Food Safety Tips for the Holidays and Tips for Your Holiday Turkey

FDA- Food Safety Tips for Healthy Holidays

FightBAC.org- Holiday Food Safety Resources (includes recipes and kids games and activities)

FoodSafety.gov- Thanksgiving and Winter Holidays

USDA- Seasonal Food Safety