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South Africa Has the World’s Largest Listeria Outbreak According to WHO

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The Cause Unknown after a Year

South Africa is encountering the worst case of listeriosis ever reported, according to WHO (World Health Organization). Currently, there are 727 laboratory-confirmed cases with 67 death reported. The number of cases and the death toll increased significantly since last December when South Africa had 577 cases and 36 deaths.
South Africa Health Minister Aaron Motsoaledi said “When we view statistics of affected people, we note that of all the vulnerable groups, neonates [newborn babies within first 28 days of life] are the worst affected if we analyze it by age group from birth to 93 years. In this case, neonates alone account for close to 40 percent of the cases,” The minister continued: “Of note is that of all the neonates that get affected, 96 percent had an early-onset disease, that is, from birth to six days after birth. It is clear that these neonates are simply vulnerable due to their pregnant mothers. They are infected by their mothers at birth.”
According to WHO the most distressing element of this outbreak is that 40% of the dead are babies less than four weeks old, mostly infected from their mothers.
The infected people come from diverse socio-economic backgrounds, as determined by the use of both public and private hospitals.
The source of the infection is yet unknown. The long incubation period for the disease symptoms makes it difficult to identify the food source.  “Even if a food source is identified, we can expect to have cases reported for several weeks to come,” said Lindmeier (WHO media Officer). “This is making the investigation into the source of the outbreak particularly complex.”

Listeria Stains

In a press release South Africa Ministry of Health reported that from 1st of January 2017 to 3rd of January 2018, 337 isolates from the outbreak had been sequenced. Of them 73% were clinical isolates, 22% were food isolates, and 5% were environmental isolates.
The minister Motsoaledi said that “…out of the total of 727 laboratory confirmed cases which we know about, we are only able to trace 134 actual patients, which is only 18%. This means that we still have a long way to go in searching. Out of the 134 traced patients, 61 had passed on,”
He further said that 91% of the isolates were the ST6 type and are very closely related to each other, representing a single strain of Listeria monocytogenes.  The ST6 isolates were found in samples from all the 9 South Africa providences.  This supports the hypothesis that there is a single source of the food contamination.  It implies that it is a widely consumed food produced at a single facility. “Most likely a food product on the market or a series of food products produced in the same manufacturing environment,” says Dr. Lucia Anelich‚ a prominent South African food microbiologist and food safety expert.
The mortality rate of listeriosis is very high (20-30%) when compared to other food pathogens such as Salmonella and E. coli, with a mortality rate of 1-2%.
The isolated Listeria strain was not drug-resistant. Therefore, the deaths due to this outbreak were due to delays in diagnosis and treatment.

Potential Source of the Outbreak

Listeriosis most often results from foods such as unpasteurized (raw) milk and dairy products; soft cheese made with unpasteurized milk‚ such as feta‚ brie and camembert; refrigerated smoked seafood, ready-to-eat meats, raw vegetables, and pre-packed salads.
However, in this case, the minister of Health Motsoaledi said that a piece of chicken obtained from a patient’s home contained Listeria monocytogenes. The source of this chicken was traced back to the store and then to Soverein Foods slaughterhouse.
Whole Genome Sequencing was performed on the strains of Listeria monocytogenes isolated from the Soverein Foods environment and food samples. None of the isolates was the outbreak strain of ST6. Regardless, some of the obtained strains had the potential of causing the disease.
As a result of the data obtained from the slaughterhouse cannot be conclusively identified as the source of the outbreak. Regardless, the Department of Health closed the poultry slaughterhouse. The company was delisted from the Johannesburg stock exchange in November. Yet, since in the latest inspection found no Listeria, the plant was allowed to be reopened.   According to Reuters  Sovereign Foods head of production, Blaine van Rensburg, said: “Despite being declared clean and free of the Listeria bacterium, we are further strengthening steps to render products safer than they already are,”

Action Taken by Health Department

Since December 5, 2017, the Department of Health amended the list of notifiable diseases to include Listeriosis, requiring clinics to notify the government of any case of listeriosis.
The food industry was requested by the Director-General of the National Department of Health to formally submit details of Listeria -positive food items, environmental swabs and Listeria isolates to the authorities.
It is very troublesome that after a whole year the outbreak is still continuing without any resolution forthcoming.
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E. coli in Romaine Lettuce-Impact of No Recall and Potential Solution

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The E. coli Outbreak

Earlier we reported that an E. coli O157:H7 outbreak in the US was suspected of being related to an outbreak in Canada that had been linked to romaine lettuce.  From November 15 to December 17 illnesses in 13 states were reported. Five people have been hospitalized, two have developed hemolytic uremic syndrome (HUS), and one person died.
The Canadian Health Authorities reported on 41 cases of illnesses in 5 Eastern states (Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13)) attributed to E. coli O157:H7 in romaine lettuce. Seventeen individuals have been hospitalized. One individual died. 
As a result of their investigation, the Canadian Health authorities recommended the people in the Eastern provinces to refrain from eating romaine lettuce.
The CDC reported that the E. coli causing the illnesses in both countries was genetically closely related. This closeness implies that the illnesses are sharing a common source of infection. However, the CDC has not yet identified the source of the US infection.
In the U.S. there is no recall of romaine lettuce or a recommendation to stop its consumption. In a statement Brittany Behm, MPH, a CDC spokeswoman said in an email that “there is not enough epidemiologic or traceback evidence at this time to indicate a specific source of illnesses in the United States. Therefore, CDC cannot recommend that U.S. residents avoid a particular food.”   The CDC believes that the evidence collected to date does not have sufficient convincing information linking the lettuce to the illnesses. “We strive to be fast and right. … We wish we knew more and we’re working hard to get there. But we don’t have enough evidence yet,” said Wiliams, chief of the CDC’s Outbreak Response and Prevention Branch.  He also said that there was no guarantee that in the future, the CDC and FDA would be able to identify the exact source of the outbreak.    

Consumer Report Recommendation

The consumer Report magazine has taken an extreme step advising the public to stop the consumption of any romaine lettuce until there is a clarification of the situation.
“Even though we can’t say with 100 percent certainty that romaine lettuce is the cause of the E. coli outbreak in the U.S., a greater degree of caution is appropriate given that lettuce is almost always consumed raw,” said James Rogers, the Consumer Report’s director of food safety and research.
Jean Halloran, the director of food policy initiatives at Consumers Union, said:” Better to avoid romaine lettuce for now.”  “Given the size of the outbreak and the severity of the risk, which is worse for elderly people and children, the magazine felt it was the right decision,”.
Bill Marler, a Seattle-based attorney specializing in food safety cases noted that “Identifying the source of a foodborne illness outbreak can be a delicate balance between warning consumers of public health risks and unduly tainting industries or specific businesses without sufficient evidence.” However, he supports the Consumer Report decision to advise people not to consume romaine lettuce.
The consumer Report recommendation was intensely covered by the many TV outlets and in many of the papers.

“To Recall or Not” and Their Consequences

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued a recent report concluding that the current recall process used by the FDA can be too slow putting consumers at risk.  In response to the report, the FDA is planning to announce a new strategic plan in place to outline actions to improve the recall management. A faster process if clearly needed.
With the requirement to definitively decide the source of the outbreak, the investigation sometimes takes a very long time, and meanwhile, the products are being consumed, and people get ill.
The heavily publicized recommendation by the Consumer Report will certainly cause many good lettuces to be disposed of. Growers of perfectly health romaine lettuce will suffer. Currently, all romaine lettuce is presumed guilty of contamination.  A better system should be put in place to make the identification of contaminated produce easier.
On Jan. 6, the United Fresh Produce Association e-mailed members, stressing that the last U.S. case was reported Dec. 8; the last case in Canada was Dec. 12. “This fact makes it very unlikely — even if the outbreak is tied to romaine —that any affected product remains in marketing channels,” therefore in their opinion the outbreak is over.
However, Bill Marler wrote “I certainly understand that many romaine lettuce growers would like the CDC to call the “outbreak over” since lettuce is perishable. Since neither Canada nor the US has been able to confirm where the contamination occurred – on the farm, in processing, in transit – I think I agree with the Canadian and Consumer Reports approach – “When in doubt, throw it out.”

Is Blockchain the Solution

As reported earlier Blockchain is a decentralized, shared log of data maintained on a network of computers. It is an exciting new technology that can revolutionize food safety and offer much faster traceability of food products including produce.
According to Fortune magazine Viant and the World Wild Fund for Nature, using blockchain technology, provided a way to verify the fish journey from the ocean to the plate. The Tuna fish is tagged with a QR code (two-dimensional barcode) supplied by Viant. The fish is logged into the blockchain system, and its progress is monitored throughout the chain.
It is conceivable that in the future lettuce can be tagged with a QR barcode and be followed to the markets. As a result, any outbreak will be easier to trace back to the farm of origin.
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T. Marzetti Buttermilk biscuits sold across the US recalled due to Listeria concerns

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The FDA announced that T. Marzetti Company voluntarily recalled a variety of frozen biscuits due to the potential contamination with Listeria monocytogenes, as a precautionary measure.
 
Twenty-three frozen 12 or 20 count biscuits packs of T. Marzetti biscuit products are being recalled, including: Southern Home Old Fashioned Buttermilk Style Biscuits, Marshall’s and Shur Fine Old Fashioned Southern Style Biscuits, Shur Fine Old Fashioned, Buttermilk Biscuits, Valu Time, Food Club, SE Grocers, Lowes Foods, Laura Lynn, and Southern Home Southern Style Biscuits; Valu Time Buttermilk Style Biscuits, Food Lion Homestyle Buttermilk Biscuits, Food Club, SE Grocers, Piggly Wiggly, Lowes Foods, Premium Pick 5, Morning Fresh Farms, Laura Lynn, and Southern Home Buttermilk Biscuits, and Piggly Wiggly Homestyle Biscuits.
The products were distributed in the following states: Alabama, Florida, Georgia, Indiana, Kentucky, Louisiana, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. Food Safety News reports that Marshall’s Old Fashioned Southern Style Biscuits have also been recalled in California.
The frozen biscuits are not ready-to-eat products and need to be baked before consumption.  Typically the baking instructions call the baking of the product at 4000F for 20 minutes. The internal biscuit temperature should reach 2000F (930C) enough to kill the organism if present. However, since undercooking can occur, there might be a slight risk, and as a result, Marzetti had decided to recall the product.
Interestingly, this recall was intensely covered by the general media, including many TV stations and newspapers, disproportionate to the risk it poses.
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Lettuce E. coli Outbreak May be Spreading to the US from Canada

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The CDC (Centers for Disease Control and Prevention) says preliminary test results from an E. coli outbreak in the U.S. shows a common source of infection with an outbreak in Canada that was linked to romaine lettuce.
The CDC is investigating a multistate outbreak of Shiga toxin-producing E. coli o157:H7 infections (STEC O157:H7) in 13 states. Seventeen illnesses have been reported from California (3), Connecticut (2), Illinois (1), Indiana (1), Michigan (1), Nebraska (1), New Hampshire (2), New York (1), Ohio (1), Pennsylvania (1), Virginia (1), Vermont (1) and Washington (1). Illnesses started on dates from November 15 through December 8, 2017.
The Public Health Agency of Canada (PHAC) has established romaine lettuce as the source of the outbreak and advised consumers in affected areas to avoid romaine lettuce. However, the current CDC’s notice of Dec. 28 said a definite source had not been found, and it is “unable to recommend whether U.S. residents should avoid a particular food.”
In Canada, there are currently 41 cases of E. coli O157 illness under investigation in five eastern provinces: Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 3 and 85 years of age. The majority of cases (73%) are female.
Canadian retailer Sobeys, which has about 1,500 stores under numerous names, announced Dec. 22 it had pulled all romaine products from shelves as a cautionary measure. Media reports said the retailer pulled more than 300 romaine products.
The CDC is performing whole genome sequencing on samples of bacteria making people sick, from the U.S. cases to obtain information about the possible relationship between the US cases and the Canadian outbreak. The preliminary testing results “show the type of E. coli making people sick in both countries is closely related genetically, meaning the ill people are more likely to share a common source of infection.”
Illness onset dates in the U.S. range from Nov. 15 to Dec. 8. In Canada, the Public Health Agency of Canada reports illnesses started in November and ended in early December. The Canadian agency added one more case on Dec. 28, bringing the total to 41 illnesses from five eastern provinces. One person has died as a result of the E. coli outbreak, according to the agency.
In the U.S., state and local health officials are interviewing sick people to document what they consumed before the outbreak began. That process is ongoing, and interviews focus on all foods, not just romaine and other leafy greens, according to the CDC.
State and local authorities are interviewing sick people to see what they ate in the week before they became ill. Because a source of the US infections hasn’t been identified, the CDC said it is unable to recommend if US residents should avoid a particular food. “This investigation is ongoing, and more information will be released as it becomes available,” the CDC press release said.
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How can Blockchain Technology Help Improve Food Safety

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What Is Blockchain

The original blockchain was created by Bitcoin founder Satoshi Nakamoto to serve as the public ledger to record all Bitcoin transactions.
Blockchain – is a decentralized, shared log of data maintained on a network of computers, rather than a physical ledger. The primary purpose of blockchain is to record any transaction or movement of an asset. Therefore, it is a digital ledger of records that are organized in chunks of data called blocks.
The blocks are then linked with one another through a cryptographic (secure communications) validation. The linked blocks form an unbroken chain — a blockchain. It gives the network participants the ability to share ledger data. Each participant on the network can act as publisher and subscriber. Each participant can receive data and send data, and the data is synchronized throughout the network.
The main innovation of Blockchain is that it keeps all data in a sequence of “blocks,” which are spread over a computer network of nodes. It is impossible for any user to change or remove data because: (i) There is no central authority; (ii) because copies of the ledger are stored on every node. Whatever is put on the blockchain is cast in stone.
The main features of blockchain network include the ability of participants on each node to know where the products came from and how ownership changed over time. The blockchain provides a single place to determine the movement of goods.  No participant can change a transaction after it is recorded. The history of all the transactions (including reversal of error) is transparent to all users, and therefore the system is tamper-evident.
IBM has published an EBook detailing the technology. The blockchain built by IBM is called Hyperledger Fabric, and the company is trying to promote it to various industries. It is eagerly trying to sell subscriptions to blockchain related services and their integration with the cloud business.

Coalition of Companies are Using Blockchain

Fortune magazine reported that Walmart and a number of other food giants (Unilever, Dole, Nestlé,  Kroger, McCormick and Company, McLane Company, Driscoll’s, Tyson Foods, and Golden State Foods ) teamed up with IBM investigate how to utilize blockchain to improve the traceability of food and its ingredients.
According to Fortune magazine, Walmart ran a trial of blockchain utilization, in cooperation with IBM. In the first trial, they used blockchain to track the movement of pork in China.
In the second trial, they used blockchain to trace mangoes from Mexico. Tagged pallets of mangoes were traced through the blockchain. While manual tracing took almost a week, the software took a couple of seconds to show the results. In the event of a food pathogen outbreak, the difference between 6+ days and 2 seconds can be very significant.
Because of the success of these experiments, Walmart is now reaching out to other suppliers and retailers.

Examples of Use of Blockchain and its Benefits in Food Safety

Food manufacturers and suppliers like the idea of simple, automated tracking system of important information (temperature, delivery dates, safety certificates, etc.) available instantly.
Another use of Blockchain technology is to utilize sensors data in warehouses and transportation. It can serve as proof that the products were all along handled at the right temperature.

Examples of Potential Impact on Recalls of Contaminated Foods

Blockchain can allow companies to trace their products in case of a recall due to contaminated product, and remove it promptly from the shelves. The ability to pinpoint within minutes, where contaminated product might be, can revolutionize food safety.
Blockchain can allow tracing a contaminated papaya, for example, to a farm of origin and find the location of existing products on the market. Retailers can instantaneously remove these products from the shelves.
The Blockchain technology can play a major role in the investigation of foodborne illnesses.  For example, the outbreaks due to Salmonella in contaminated Maradol papayas imported from Mexico infected 251 people in 25 states. 79 of the infected people were hospitalized, and two deaths were reported. It took many months to identify the farms responsible for the outbreaks. If blockchain technology was in place and the origin of each papaya could be identified in seconds, the outbreak would have ended faster, with fewer victims.
Another example is the milk powder and buttermilk produced by Valley Milk Products (VMP) that presumably was contaminated with Salmonella.  The VMP recall resulted in a subsequent ripple effect of recalls affecting over 30 companies.  It included companies that bought products from VMP (first group), but also companies that used seasoning containing VMP products from the first group or products that were manufactured by a third party on lines where traces of the VMP were processed. If all parties involved were on a blockchain system, it could have taken less than a day to complete the recall saving most companies the trouble of going through the costly recalls.

Utilization in Food Fraud

In the Netherlands, Arc-net and PwC sign an agreement, using blockchain in the fight against food fraud. They are developing a supply chain authentication platform using blockchain in the cloud to allow food producers and retailers to assure the origin and authentication of their products.
 

Hurdles

Technology in early stages of development and faces some hurdles ranging from technological hurdles to legal, economic, and regulatory. All trials to date were on a very small scale. It must be adequately evaluated before any widespread adoption.
A technological hurdle is the cost of data storage in blockchain and the limited number of transactions per second.  However, this does not stop innovators from building on this promising solution.
A main challenge is how and who will be responsible for the governance of the technology. The regulatory framework for the technology is uncertain and unpredictable.  Will the technology be regulated by the authorities? Will they accept the technology?
The full benefit of blockchain will not be realized without widespread adoption by the industry. This is difficult due to the need to integrate blockchain into the industry’s countless number of information systems, lacking a common communication standard.
Despite these hurdles, the blockchain technology had made several baby steps and is turning into giant strides.

Summary

Blockchain is an exciting new technology that can revolutionize food safety. It can resolve many critical issues affecting food safety such as prevent unnecessary recalls, avoid cross-contamination, prevent foodborne illnesses, eliminate waste, simplify recalls, and save money. However, there are still some impediments that need to be overcome before widespread adaptation in food safety.  
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Multiple State Salmonella Outbreaks due to Papayas from Mexico is over: What have we Learn?

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According to reports by the CDC and the FDA, this summer outbreaks due to Salmonella-contaminated Maradol papayas imported from Mexico infected 251 people in 25 states. 79 of the infected people were hospitalized, and two deaths were reported.
The outbreak strains included: Salmonella Thompson (144), Kiambu (54), Anatum (20), Agona (12), Gaminara (7), Urbana (7), Newport & Infantis (4), and Senftenberg (3). Four brands of Maradol papayas were implicated:
  • Caribeña brand was distributed by Grande Produce between July 10 and 19.
  • Cavi distributed to wholesalers in New York, Connecticut, and New Jersey from July 16-19 and available to consumers until July 31. The product was distributed by distributed by Agroson’s.
  • Valery brand was distributed by Freshtex Produce, from July 10 to 13.
  • Fruta Selectas brand distributed by Bravo Produce to markets in the state of California between August 10 and 29.
Boarder testing of papayas by the FDA showed three additional positive samples linked to sick individuals. The papayas were from Caraveo Produce in Tecomán, Mexico, which tested positive for Salmonella Infantis and Newport. The Salmonella strains from this shipment have at least one PFGE (Pulsed-field gel electrophoresis) match to a sick person.  WGS (Whole Genome Sequencing) showed genetic relationship between the isolates from the papayas to ill individuals. The relationship between the papaya strains and the individuals can also indicate that previous shipments from Caraveo Produce were likely the cause of previous illnesses. Caraveo Produce identified the Rancho El Ganadero farm in Colima, Mexico as the supplier.
Currently the outbreak is over, and as a result, the final reports were published by the FDA and the CDC. Every few years there is a major outbreak related to imported produce. According to the CDC, in 2015 a major outbreak of Salmonella Poona in cucumbers imported from Mexico caused 907 infections in 40 states with 204 hospitalizations and six deaths. 
According to the CDC In 2011, there was another outbreak due to imported papayas from Mexico. It is important to note that since the last major outbreak, papayas from Mexico have been screened at the border by a third party laboratory. Only papayas that tested negative for Salmonella were allowed to enter the USA. Farms that have five consecutive shipments without Salmonella could be added to a “green” list. Farms with positive Salmonella, testing has been required to demonstrate that they have taken corrective action to prevent future contamination.
The new inspection regime worked for several years without any major infection due to Salmonella. However, the major outbreak this year may require some further thought about the current regulations.
With the implementation of the new FSMA produce rules it is hoped that both the domestic and imported produce will not cause such massive outbreaks.