By: James Peacock

            The year 2016 was a busy year in food poisoning, with outbreaks being linked to a wide variety of products. Common pathogens, including E. coli, Salmonella, and Listeria continued to cause outbreaks throughout the year, but there were also some more unique outbreaks, including those caused by Hepatitis A and Shigella. As the year comes to a close, here is a brief look some of largest and most important foodborne illness outbreaks during this year:

The Dole Listeria Outbreak

            Food poisoning in 2016 did not waste any time making headlines. On January 22, the CDC announced that they were investigating an outbreak of Listeria monocytogenes bacteria. This bacteria had been linked to pre-packaged salads produced by Dole. Illnesses linked to this investigation began as early as July 2015. All Dole salad produced at its Springfield, Ohio facility was recalled shortly thereafter, on January 27. This outbreak would continue to grow until March, when the CDC ended the investigation. There were 19 people sickened in the United States with Listeriosis as a result of this outbreak. These illnesses were spread out over 9 different states, mainly centering on the Northeastern portion of the United States. New York and Michigan were the hardest hit, with 6 and 4 cases of illness respectively. All cases of illness in this outbreak required hospitalization, and there was 1 death reported. Testing done by health officials in Canada revealed that Listeria illnesses in that country were genetically similar to the cases in the United States. The Dole outbreak impacted 5 different Canadian provinces and sickened another 14 people.

The Raw Meal Shake Outbreak

            Just a few weeks after the announcement of the Dole Listeria outbreak, there was another CDC investigation announced. This time the CDC was looking into the connection between a series of Salmonella Virchow Infections and Garden of Life brand RAW Meal Organic Shakes. On February 2, they announced that there were 11 people sickened in the outbreak. This number would go up to 33 by the end of the outbreak on April 21. These cases of food poisoning were spread across 23 different states, and hit all areas of the country. The recall associated with this outbreak actually came before the announcement, on January 29. There were no deaths linked to this outbreak, and 6 people needed to be hospitalized. The CDC warned consumers that these products have a very long shelf life, and could continue to cause illnesses even after the end of the outbreak investigation.

The Sweetwater Farms Outbreak

            In terms of causing major foodborne illness outbreaks, there was no bigger culprit this year than sprouts. Sprout-related outbreaks would sicken more than 70 people this year. The first outbreak to be connected to sprouts was the Sweetwater Farms outbreak. First announced on February 23, there would end up being 26 people sickened in this outbreak. The illness onset dates associated with this outbreak, like many of the outbreaks early in the year, spanned the end of 2015 and continued into 2016. Illnesses that would eventually be linked to this outbreak would begin as early as November 2015. These 26 cases of Salmonella poisoning would be spread out over 12 states, with clusters of impacted states springing up in the Northeast and Midwest. Kansas, where Sweetwater Farms is located, was the hardest hit with 5 cases of illness. This outbreak was caused by alfalfa sprouts specifically, and these sprouts as well as other varieties would cause another outbreak shortly after this one. Out of the 26 people sickened in this outbreak, eight of them required hospitalization, and there were no deaths reported

The Jack & the Green Sprouts Outbreak

            In fact, it would be just two short days later that another sprout-related outbreak would make headlines. On February 25th, the CDC announced that they were investigating another outbreak related to alfalfa sprouts. This outbreak, though, was caused by E.coli bacteria rather than Salmonella bacteria. This was also a much smaller outbreak, only sickening 11 people in two states. The state of Minnesota reported eight cases of illness and the state of Wisconsin reported three cases of illness. All cases of illness took place in 2016, with the earliest cases of illness occurring in mid-January. The investigation eventually led to the source of the outbreak, which was determined to be a farm in River Falls, Wisconsin called Jack and the Green Sprouts. Two of the people sickened in the outbreak required hospitalization because of their illness, and there were no reports of death or HUS.

The General Mills Outbreak

            After the first two sprouts-related outbreaks came one of the biggest outbreaks of the year. First announced on June 1st, the E. coli outbreak linked to General Mills flour would launch an investigation that lasted until the end of September and involved a series of recalls. There would eventually be 63 cases of illness connected to this outbreak, across 24 states. In what was truly a nationwide outbreak, all regions of the United States were impacted by these E. coli poisonings. Minnesota and Washington were hit the hardest in this outbreak, with 7 and 5 people sickened in each state respectively. After those two states there were quite a few states to report 4 cases of illness, including Colorado, Michigan, New York, and Wisconsin. The investigation was able to conclude early on that the source of the outbreak was flour produced at the General Mills facility in Kansas City, Missouri. These findings led to an immediate recall of various products made at the facility. At first, only a few products were impacted by the recall, but as the investigation continued the recall was updated several times to include more products and lot numbers. There was also a series of secondary recalls spawned by the initial flour recall. There were 17 hospitalizations because of this outbreak, but no deaths were reported. One person developed HUS, which is a rare and serious kidney syndrome, but recovered. The CDC was able to connect illnesses not only with consuming products made with the flour, but also to people using and eating raw dough. The CDC then sent out a reminder to thoroughly cook products made with flour and to avoid playing with raw dough.

The Hawaii Hepatitis Outbreak

            In one of the largest outbreaks of 2016, scallops imported from the Philippines caused an outbreak of Hepatitis A to occur on the Hawaiian Islands. The investigation began in mid-July, when the Hawaii Department of Health began to receive word that quite a few people were being diagnosed with Hepatitis A on the island of Oahu. They responded by launching an investigation and began to offer vaccines for the Hepatitis A virus at pharmacies on the island. Even still, the amount of illnesses caused by this outbreak would continue to rise well into mid-December, and would eventually reach 292. A case study run by the Hawaii Department of Health, plus other breakthroughs in the investigation led health officials to determine that Sea Port Bay scallops were the source of the outbreak. On August 15th, Health officials embargoed the imported scallops, most of which were still at the warehouse. Contaminated scallops had been distributed to restaurants in Oahu and Kauai, and many of these restaurants were promptly closed. The long incubation period associated with Hepatitis A, which usually begins to show symptoms between 15 and 50 days after infection, has contributed to the size of the outbreak as well as the length of time required to investigate it. The 292 people sickened in this outbreak had illness onset dates between June 12th and October 9th.  Seventy four people sickened in this outbreak have required hospitalization because of their illness.

The Sprouts Extraordinaire Outbreak

            Alfalfa sprouts would cause one more outbreak in 2016, and the last one was the biggest of the three. The CDC investigation for this outbreak ended in late September, and by then 36 people had been sickened with one of two strains of Salmonella bacteria. These 36 cases of illness took place in 9 different states. This outbreak was mainly centered in the Midwestern region of the United States. The two states hardest hit by this outbreak are Colorado and Kansas, who reported 17 and 9 cases of illness respectively. The investigation was able to link sprouts produced by Sprouts Extraordinaire to the outbreak after testing revealed that they were contaminated with Salmonella bacteria. After this, Sprouts Extraordinaire issued a recall for contaminated sprouts on August 5th. This outbreak was one of the few to feature two distinct strains of foodborne illness, as illnesses were caused by the Salmonella serotypes Reading and Abony. The illnesses linked to this outbreak had onset dates ranging from May 21st to September 10th. Seven people required hospitalization because of this outbreak and no deaths were reported.

The Live Poultry Outbreaks

            In the largest and most widespread outbreak investigation of the year, the CDC was able to link almost 900 illnesses to live poultry in backyard flocks.  This outbreak is actually 8 outbreaks linked together because of a common source. Each of the outbreaks were caused by Salmonella bacteria. There were seven different strains of Salmonella bacteria involved in this outbreak, including Enteritidis, Muenster, Hadar, Indiana, Mbandaka, Infantis, and Braenderup. Salmonella Infantis caused two of the Salmonella outbreaks. This huge outbreak impacted 48 states, leaving only Hawaii and New Mexico unscathed. There were many states who reported double digit numbers of cases, but the hardest-hit state was New York, which reported more than 100 cases of Salmonella poisoning as a result of these outbreaks. Outbreaks were producing illnesses for quite a while, with the earliest cases of illness coming in early January 2016. The last cases reported in relation to this outbreak had onset dates in late September. Almost 30% of all illnesses took place in children under the age of 5. There were more than 200 cases of illness that required hospitalization as a result of Salmonella poisoning, and three deaths were reported.

The Flint Shigella Outbreak

            Flint, Michigan has made headlines repeatedly for the amount of lead found in their water supply. Concurrent to the lead crisis was an outbreak of Shigella poisoning that sickened 177 people between March and October. All of these cases took place in two different Michigan counties, Saginaw and Genese. The outbreak was beginning to slow down in September, and in late October health officials declared an end to the investigation. the Shigella outbreak may have a connection to the lead crisis, as fear of contamination led to many residents of the area using baby wipes instead of thorough hand-washing. Because baby wipes do not kill all bacteria, this practice led to an environment ripe for the spread of foodborne illnesses. While Shigella outbreaks are not uncommon, and are usually over quickly, this outbreak lasted for many months and caused close to 200 cases of illness in a state that typically sees 300 to 400 Shigella bacterial infections each year. Because Sheila infections are fairly self-limiting, there was no report of any hospitalizations.

The Strawberry Hepatitis Outbreak

            The last major outbreak of the year was also caused by Hepatitis A. While the first hepatitis A outbreak was limited to Hawaii, this outbreak impacted the contiguous United States. By the end of this investigation 143 people would be infected with Hepatitis A in nine different states. The majority of these illnesses happened in Virginia, where the outbreak was first spotted. Smoothies from Tropical Smoothie Cafe were linked to rising hepatitis A incidence rates in September.  The investigation later revealed that frozen strawberries imported from Egypt were the source of the Hepatitis A infections. On August 8th, Tropical Smoothie Café reported that they had pulled any Egyptian frozen strawberries from their stores, and also switched to a new supplier. Despite reports that Egyptian strawberries were free of any Hepatitis, the FDA reported on October 30th that they had found Hepatitis A in multiple samples of frozen strawberries. These strawberries were then recalled by ICAPP, the company who had imported them to the United States. In addition to the many cases connected to Tropical Smoothie Cafe, there were 14 cases of illness that had no direct connection. There were 56 people hospitalized because of their illnesses, and no deaths were reported.

            As we approach the New Year, now is a great time to implement proper safety techniques when dealing with food items. Always make sure meats and seafood are thoroughly cooked to a proper internal temperature. Most meats require a temperature of 160 degrees Fahrenheit in order to eliminate any foodborne pathogens, and seafood requires an internal temperature of 145 degrees Fahrenheit. Products made with raw dairy, unpasteurized cider, or unpasteurized juices should be avoided. The thorough washing of hands also contributes heavily to limiting the spread of foodborne illnesses. All fruits and vegetables should be washed thoroughly before being consumed, or cooked thoroughly to limit pathogen exposure. By practicing these tips, as well as others, the number of foodborne outbreaks can be limited in 2017.