On August 17, 2012, Protica Inc. of Whitehall, PA had undertaken a voluntary product withdrawal of four products including Body Choice "Protein Shots", Nutritional Resources "Protein Wave", ProBalance "Protein to Go French Vanilla Latte" and "Protein to Go Milk Chocolate Shake" because they have the potential to be contaminated with Clostridium botulinum.

Consumers are warned not to use the product even if it does not look or smell spoiled. Botulism, a potentially fatal form of food poisoning, can cause the following symptoms: general weakness, dizziness, double-vision and trouble with speaking or swallowing.

No illnesses have been confirmed to date.

The problem with the lots below were discovered when investigating the processing parameters for all manufactured products. The products withdrawn were distributed nationally through retail and direct mail and are limited to specific lots of the branded products.

On May 7, 2010, 42 residents and 12 staff members at a Louisiana state psychiatric hospital experienced vomiting, abdominal cramps, and diarrhea. Within 24 hours, three patients had died. The three fatalities occurred among patients aged 41–61 years who were receiving medications that had anti–intestinal motility side effects. For two of three decedents, the cause of death found on postmortem examination was necrotizing colitis. Investigation by the Louisiana Office of Public Health (OPH) and CDC found that eating chicken served at dinner on May 6 was associated with illness. The chicken was cooked approximately 24 hours before serving and not cooled in accordance with hospital guidelines. C. perfringens enterotoxin (CPE) was detected in 20 of 23 stool specimens from ill residents and staff members. Genetic testing of C. perfringens toxins isolated from chicken and stool specimens was carried out to determine which of the two strains responsible for C. perfringens foodborne illness was present. The specimens tested negative for the beta-toxin gene, excluding C. perfringens type C as the etiologic agent and implicating C. perfringens type A. This outbreak underscores the need for strict food preparation guidelines at psychiatric inpatient facilities and the potential risk for adverse outcomes among any patients with impaired intestinal motility caused by medications, disease, and extremes of age when exposed to C. perfringens enterotoxin.

Clostridium perfringens, the third most common cause of foodborne illness in the U.S., most often causes a self-limited, diarrheal disease lasting 12–24 hours. Fatalities are very rare, occurring in <0.03% of cases. Death usually is caused by dehydration and occurs among the very young, the very old, and persons debilitated by illness.

The full report is available from the U.S. Centers for Disease Control at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a1.htm?s_cid=mm6132a1_x.

What’s Yersinia doing in salad?

In 2011, an outbreak of illness caused by Yersinia enterocolitica O:9 in Norway was linked to ready-to-eat salad mix, an unusual vehicle for this pathogen.

MacDonald et al report in Emerging Infectious Diseases the outbreak illustrates the need to characterize isolates of this organism, and reinforces the need for international traceback mechanisms for fresh produce. Excerpts below.

Yersiniosis, a notifiable disease in Norway, is the fourth most common cause of acute bacterial enteritis registered by the Norwegian Surveillance System for Communicable Diseases. Approximately 30 domestic cases are reported annually (2010 incidence rate 0.5 cases/100,000 population). In Norway, >98% of cases of Yersinia enterocolitica infection are caused by serotype O:3, which is also the dominant serotype in Europe, Japan, and parts of North America. Infection by Y. enterocolitica is often associated with ingestion of pork because pigs commonly harbor the pathogenic serotypes O:3 and O:9. Recent foodborne outbreaks have been associated with pork products (2,3) and pasteurized milk.

A confirmed case-patient was defined as a person in Norway after January 1, 2011, who had laboratory-confirmed Y. enterocolitica O:9 infection that matched the MLVA profile of the outbreak strain. By May 5, the NRL had registered 21 outbreak case-patients (median age 37 years [range 10–63 years]), of whom 15 were female. Case-patients resided in 10 geographically dispersed municipalities throughout the country. Most case-patients became ill during February 7–March 20.

We traced the suspected salad mix to a single Norwegian company. Under the auspices of the Norwegian Food Safety Authority, we conducted an environmental investigation, including a traceback investigation and a review of production and cleaning procedures at the company. The suspected salad mix contained 4 salad green types: arugula, radicchio rosso, iceberg lettuce, and endive. These ingredients came, unprocessed, from 12 suppliers in 2 European countries. After delivery to the company in Norway, the greens were washed in 2 cold water baths, cut, and packaged. We found no indications of inadequate routines for ingredient control, hygiene, or sampling within Norway. We identified radicchio rosso, a leaf chicory, as the likely source of infection because it can be stored for several months and was the only ingredient included in the suspected salad mix that had delivery, production, and storage dates consistent with the outbreak period. The company in Norway traced the radicchio rosso to 1 of 3 possible growers in 1 European country but was not able to identify the source of contamination. The Norwegian company voluntarily withdrew all salad mixes containing radicchio rosso from the market. After withdrawal of the implicated ingredients, no new outbreak cases were reported.

Tests carried out by the U.K. Health Protection Agency (HPA) identified the toxin that causes botulism in a jar of Italian olives after an Oxfordshire resident was admitted to hospital with botulism poisoning. No further cases have been identified to date.

The Food Standards Agency (FSA) is now asking people who have bought jars of the implicated olives not to eat them and to contact their local authority environmental health food safety team to arrange collection of the product.

The implicated olives are “Olive Bella Di Cerignola” produced by ‘I Divini’. These are large green olives from the Puglia region of Italy and are packaged in brine in glass jars with a lot number of 161/11 and best before date of 10/06/2014. This type of olive is distributed under a number of different brand names but only the I DIVINI di Chicco Francesco brand is associated with this incident.

The HPA is working with the local authority environmental health department and the Food Standards Agency on the investigation. Botulism is rare in the UK – there have only been 33 recorded cases of food-borne botulism in England and Wales since 1989, with 27 of these linked to a single outbreak.

Investigations into the supply of these olives are focusing on delicatessen shops where this product could be on sale. Health professionals across the UK have been made aware of the case and advised to look out for people of all ages with possible symptoms.