From: Defibaugh-Chavez, Stephanie - FSIS Subject: Continued … · 2017-04-05 · Costco 9/1/2013 JF6X01.0045 San Mateo Foster Farm chicken tenderloins, frozen raw (Costco) ... unauthorized

file:///Z|/All%202014%20FOIA's/01%20-%2050/14-07/from%20OPHS/14-07/AG/2013%20Foster%20Farms.txt[12/6/2013 3:31:24 PM]

From: Defibaugh-Chavez, Stephanie - FSISSent: Tuesday, October 29, 2013 11:32 AMTo: Leskowsky, Robert - FSIS; - FSIS; Atkinson, Richard - FSIS; Pihkala, Nora - FSIS; Shaw, William - FSIS; Vetter, Danah - FSIS; Robertson, Kis - FSISCc: Kissler, Bonnie - FSIS; Green, Alice - FSIS; Dessai, Uday - FSISSubject: Continued Intensified Sampling Update

Importance: High

Just a quick update for continued intensified sampling (Phase 2) results for the 5 establishments currently being sampled:

Total Collected # Neg # Pos % Pos # In progress M33901-P33901 35 23 0 0.0 12 M6137-P6137 63 47 4 7.8 12 P33900-V33900 35 27 0 0.0 8 P6137A 63 44 4 8.3 15 P7632 63 47 1 2.1 15

There are 9 positive samples so far just for the continued (Phase 2) sampling at these establishments. There is not any subtyping information (serotype/PFGE) available yet, but unofficially I have heard that there are two Heidelbergs identified, and PFGE is still pending for these isolates. I am hoping to get that info in the next two days and will send an update as soon as I do.

Please share within your program areas as necessary.

-Stephanie

Stephanie Defibaugh-Chávez, Ph.D.MicrobiologistScience Staff, Office of Public Health ScienceFood Safety and Inspection ServiceUnited States Department of Agriculture202-690-6042 (office)202-641-5540 (Blackberry)202-690-6364 (fax)email: [email protected]

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From: - FSISSent: Tuesday, October 29, 2013 10:05 AMTo: Green, Alice - FSISSubject: RE: More Costco shopper records to request

The card number for , " " is incorrect as there is only 11 digits and Costco card numbers have 12.

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Compliance Investigator

USDA/FSIS/OIEA/CID

19110 Bothell Way NE, Suite #201

Bothell, WA 98011

Office:

Cell:

Fax: (425) 483-3492

fsis.usda.gov

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From: Green, Alice - FSIS Sent: Friday, October 25, 2013 1:28 PMTo: Atkinson, Richard - FSIS; - FSISCc: Khroustalev, Allison - FSISSubject: FW: More Costco shopper records to request

Please forgive me if I've missed any of these, but I didn't see them in the IR. Do these need to be requested from Costco?

Thank you!

Alice L. Green, MS, DVM

Public Health and Epidemiology Liaison

Office of Public Health Science | Food Safety and Inspection Service | U.S. Department of Agriculture

Butler Square West | 100 North 6th Street, Suite 420-C | Minneapolis, MN, 55403

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Tel: 612-659-8632 | Blackberry: 202-441-4752 | Cell: | Fax: 612-370-2070 | Email: [email protected] <mailto:[email protected]>

From: Peralta, Vi (CDPH-CID-DCDC-IDB) [mailto:[email protected]] Sent: Thursday, October 24, 2013 8:19 PMTo: Green, Alice - FSIS; Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC-IDB)Subject: More Costco shopper records to request

Hi Alice,

I've had a chance to go through all the records....whew! Thank you!

These are all the ones for which we don't have any records yet (the last two are new).

Talk to you tomorrow morning!

PulseNet ID

CDC ID

Onset Date

Cluster pattern

SourceCounty

Reported Chicken Exposures from Interview

Store1

Costco Shopper Card #

7/28/2013

JF6X01.0041

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San Diego

Foster Farms chicken livers (used as bait for fishing several time during week prior to illness onset) purchased from Stater Bros; Stater Bros brand chicken thighs; Sprouts natural chicken brand thighs

Costco

9/1/2013

JF6X01.0045

San Mateo

Foster Farm chicken tenderloins, frozen raw (Costco) consumed 8/26-8/28

Costco

8/29/2013

JF6X01.0022

San Diego

Costco/Kirkland thighs and maybe rotisserie chicken. Legs (Vons/Ralphs)

Costco

9/23/2013

JF6X01.0045

Santa Clara

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chicken bake 9/21/13 from Costco food court

Costco

and

9/14/2013

JF6X01.0258

Riverside

Maybe had Foster Farms breaded boneless skinless chicken, looks like strips (Costco). Maybe had pre-cooked rotisserie (Stater Bros)

Costco

9/11/2013

JF6X01.0258

San Francisco

Costco rotisserie chicken purchased and consumed 9/11/13

Costco

9/14/2013

JF6X01.0258

San Mateo

Buys Foster Farms chicken every week from Costco. Reports Foster Farms whole chicken, fresh raw, consumed 9/11/13. Foster Farms thighs, fresh raw, consumed within week before onset

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Costco

and

From: Green, Alice - FSIS [mailto:[email protected]] Sent: Thursday, October 24, 2013 1:06 PMTo: Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC-IDB)Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Allen, Latasha - Commissioned Corps - FSIS; Robertson, Kis - FSISSubject: shopper records

Hi Vi-

I believe I've covered all the records in your request. There might be some duplicates-I wanted to include all versions of shopper histories in case some are more complete than others.

Please let me know if I've omitted any of the ones you gently reminded us about. J

Thanks much,

Alice






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This electronic message contains information generated by the USDA solely for the intended recipients. Any unauthorized interception of this message or the use or disclosure of the information it contains may violate the law and subject the violator to civil or criminal penalties. If you believe you have received this message in error, please notify the sender and delete the email immediately.

From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 9:57 AMTo: Kissler, Bonnie - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Holt, Kristin - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

Thanks Bonnie!

Kis and SDC - We may need to mention this at OPHSLT, unless we have additional information from David.

Thanks much!

Uday

From: Kissler, Bonnie - FSIS Sent: Tuesday, October 29, 2013 10:55 AMTo: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Holt, Kristin - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

CDC is planning a web update this week (could be as early as tomorrow). If we decide to move forward with a recall, CDC will likely wait until after the recall before doing the web update.

Bonnie KisslerSenior EpidemiologistUSDA, FSIS, OPHS, AESc/o Centers for Disease Control and Prevention

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1600 Clifton Road, NE, MS A-38Building 24, Room 10203Atlanta, GA 30329Office: 404.639.5012Blackberry: 404.661.6640Fax: 404.718.2126Email: [email protected] <mailto:[email protected]>

From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 3:17 PMTo: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

Also here are summary points from SDC email from Friday:

About case-patient ( traceback and FSIS intensified sampling:

The specific product identified is a boneless skinless chicken thigh product. It was collected at P6137A but was produced from source materials that originated from P7632 (slaughtered on 9/9/2013). StephanieDC had suggested in her Friday’s email to consider recalling all chicken products (including parts and whole chicken!) produced from birds slaughtered on 9/9/2013 at P7632 . This was based on the fact that 11 total product –positives were produced from source materials that originated from P7632 (slaughtered on 9/9/2013 and includes a variety of parts and whole/rotisserie chicken.

Thanks much!

Uday

From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 8:57 AMTo: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

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HI David

Stephanie, Alice and Aphrodite are looking at the following two issues and here are our initial thoughts:

1) OIEA has established a compelling link in the Foster Farms illness outbreak investigation. Here are the details from

This revolves around The case patient shopper data and intensified sampling conducted at the three Foster farms facilities in California was utilized. The linkages are detailed below:

· tested for positive for PFGE 045, and the like sample collected on the same date, sample form ID number 100583269, as one of the pack dates is PFGE 045, which is the same PFGE pattern.

· The product purchased by the case patient and the like sample, Foster Farms boneless, skinless thighs, were slaughtered at P-7632 on 9/9/2013 and were processed/packed at P-6137A on 9/9/2013.

· There are other multiple sample positives for PFGE 45 at p-7632 and P-6137A on 9/9/2013, both parts and whole birds.

· SDC will look into this further….

2) P6137A PFGE pattern JF6X01.0122 (5/10 subs positive), additional 2 being tested for PFGEs; case patient has PFGE type 45

· Although:

o during the specpgm_02 Sept sampling there was a single positive with pattern .0122 from the same establishment

o the fact that mixed PFGE patterns can be found in the same sample

o There may be overwhelming indirect evidences..

o We cannot make a conclusive claim that there is a link between the patient and chicken samples recovered from the patients home

----------

o A close examination of the two band difference between 0122 and 45 shows that - these are distinctly different PFGE types (on the gel)

o We are awaiting the final results from the additional 2 PFGEs

o We are analyzing the hospitalization rate for the two PFGE types

o Etc.

Thanks much!

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Uday

Yes, I would say that these two patterns are significantly different.

Aphrodite DourisMicrobiologistOutbreaks Section, Eastern LaboratoryFood Safety and Inspection ServiceThe United States Department of AgricultureRussell Research Center950 College Station RoadAthens, GA [email protected]: (706) 546-2330 FAX:(706)546-3144

Privileged Communications: This transmission (and/or the documents accompanying it) may contain confidential information belonging to the sender. The information is intended only for the use of the individual or entity named in the distribution. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify us by telephone to arrange for the return of the documents.

_____________________________________________From: Dessai, Uday - FSIS Sent: Friday, October 25, 2013 2:22 PMTo: Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg similarity matrix

Thx much Alice and Douris.

2 bands different (~ 200 and ~ 80 region) as I see it on the picture.


Douris – does the ~ 200 region band constitute a real diffence ! ( I would imagin yes!)

Thanks

What remains to be done

<<6002696219 FF Invoice.pdf>> <<Originating Spreadsheet Special 102413.xlsx>> <<2013-10-22_Phase1-Heidelbergs.xlsx>>

Hello,

We have a compelling link in the Foster Farms illness outbreak investigation. This revolves around The case patient shopper data and intensified sampling conducted at the three Foster farms facilities in California was utilized. The linkages are detailed below:




I have attached invoice 6002696219 that shows the link in commerce between Foster Farms and the COSTCO store where the case patient purchased the product. I have also attached a spreadsheet titled “original Spreadsheet Special” that demonstrates the linkages between and the samples collected at Foster farms, and finally, I have attached the sample data spreadsheet that represents all samples collected at the three Foster farms facilities.

About the other CPs, are not as compelling:

Case patients – We could not make a connection between FSIS sampling dates for Est. 7632 & Est. 6137 for product comprising the load distributed to Costco, part of which may have been consumed by both case patients. Product from Est. 33900 was also included in the load to Costco.

Case patients – Product (Rotisserie Chicken) available on the purchase day consisted of seven Foster Farms invoices to Costco with several different slaughter and pack dates from Est. 7632, 6137, 6137A, and 33900. Positive test results, PFGE pattern 258, from FSIS sampling with slaughter dates of; 9/7, 9/9, 9/10, 9/11, and 9/17,

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taken at Est. 6137 and 6137A made up part of the product included on the invoices.

Case patient – OIEA is still waiting on California for membership card information.

Case patient - OIEA is still waiting on California for additional purchase dates.

Case patients – Product (Rotisserie Chicken) available on the day of purchase consisted of a single invoice from Foster Farms to Costco. Product represented on the invoice originated from Est. P-7632 and P-33900. Positive test results, PFGE pattern 258, from FSIS sampling with a slaughter date of 9/9 from Est. 7632 comprised part of the load.

The CCMS patient in NV:

OPHS spoke with complainant as did OIEA’s investigator. Review labs – CBC- WNL, Chemistry Profile – Elevated liver enzymes, Stool Sample negative for Salmonella, Shigella and Campy. He might give us some of the sample but not all of it. We are concerned about how we would do that.

Alice and SDC pl:

Isolate numbers

Types of parts, production/analysis dates and PFGEs

PFGE Types

P1

P2

P3

P4

P5

whole

Patient info

1?

NA

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NA

NA

NA

NA

NA

Product info

5 each (!)

OB/PFGE types

Note: Same or different PFGE types can be found in a given sample. And the prevalence of a PFGE type in the enriched medium, does not in any fashion or manner indicates absence of other PFGE types in the product.

From: Goldman, David - Commissioned Corps - FSIS


Sent: Friday, October 25, 2013 3:35 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSISSubject: Re: Positive chicken sample for S. Heidelberg patient

Good idea(s). We do need to figure this one out--I think I heard that FDA will sequence these strains. I would appreciate a separate discussion so that I understand how much we can learn about the genetic profile and phenotypic expression from this sequencing.

David P. Goldman, M.D., M.P.H.

Captain, USPHS

Assistant Administrator

Office of Public Health Science

Food Safety and Inspection Service

USDA

Room 341-E, Whitten Bldg.

1400 Independence Ave, SW

Washington, DC 20250

202-720-2644 (o)

202-690-2980 (f)

[email protected]

On Oct 25, 2013, at 1:34 PM, "Dessai, Uday - FSIS" <[email protected]> wrote:

Good point SDC Just a thought: Looks like there is a lot happening I Heidelberg genome.. For instance in the heidelbergs associated with this O/B, the virulence factors may be (just may be) up regulated for some reason... Alice and team: is it possible to tabulate rate of hospitalization for different PFGE types (if numbers are available!) Thx

From: Defibaugh-Chavez, Stephanie - FSIS Sent: Friday, October 25, 2013 01:18 PM

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To: Green, Alice - FSIS; Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient

Can we also follow-up with CDC to see if they included pattern 0041 in the cluster because of similarity to 0122? An alternative way of asking that is David’s original question of whether they would consider those two patterns the same strain. As Uday pointed out, sometimes lack of or additional bands in the lower molecular weight region (i.e. <100k bp) can be due to plasmid or just poor band resolution in that region. It would be nice to know how they would interpret this situation of finding these two specific patterns in connection with a leftover product and a case-patient clinical isolate.

Stephanie Defibaugh-Chávez, Ph.D.

Microbiologist

Science Staff, Office of Public Health Science


United States Department of Agriculture

202-690-6042 (office)

202-641-5540 (Blackberry)

202-690-6364 (fax)

email: [email protected]

Stay Connected with USDA:

<image001.png> <http://www.facebook.com/usda/> <image002.gif> <http://www.twitter.com/usda/> <image003.png> <http://www.youtube.com/usda/>

From: Green, Alice - FSIS Sent: Friday, October 25, 2013 1:13 PM To: Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS Cc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient

The health department picked up 3 packages of FF product. There were no other suspect products noted. I’ll seek guidance from OSEL on pattern similarity between patterns 41 and 122.

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From: Goldman, David - Commissioned Corps - FSIS Sent: Friday, October 25, 2013 11:46 AM To: Dessai, Uday - FSIS Cc: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: Re: Positive chicken sample for S. Heidelberg patient

Thanks for the latest on the PFGE similarity. I am confused about the leftover products--I just assumed that the health dept picked any "suspect" product (meaning something eaten by the case and so a possible exposure). Given that 2 of the samples were negative, what other possibility is there except that the positive product led to the illness? Is CA aware of other chicken exposures that might complicate the picture?

If need be, would CDC say that these 2 patterns are so close that they may represent the same pathogen in this instance?


Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]

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Thx Alice!

The Two bands (I would imagine in low molecular weight region!) may need to be considered a method artifact in this instance – given both are very close and part of the OB.

Cheers!

Uday

From: Green, Alice - FSIS Sent: Friday, October 25, 2013 12:26 PM To: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Defibaugh-Chavez, Stephanie - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient

Hi Uday—

You are correct! I do want to emphasize that both are outbreak strains, and pattern 122 and pattern 41 are 94.4% similar, differing in only two bands.

Alice






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From: Dessai, Uday - FSIS Sent: Friday, October 25, 2013 11:20 AM To: Goldman, David - Commissioned Corps - FSIS; Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient

Hi Alice

It is interesting that although we have pattern O122 in the product, we are not sure of the three products, which one was consumed by the patient!

So we have diffferent patterns between patient and product and we are not sure which product (1/3 positive) was consumed – right!

Thx!

From: Goldman, David - Commissioned Corps - FSIS Sent: Friday, October 25, 2013 12:11 PM To: Green, Alice - FSIS; Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: Re: Positive chicken sample for S. Heidelberg patient

Thanks Alice--just want to clarify; were all 5 subs pattern 122? If so, then are there more isolates to test? David Goldman, MD, MPH CAPT, USPHS Chief Medical Officer Assistant Administrator USDA-FSIS-OPHS 202-720-2644 -------------------------- Sent from my BlackBerry Wireless Handheld

From: Green, Alice - FSIS Sent: Friday, October 25, 2013 12:08 PM To: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS

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Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS; Goldman, David - Commissioned Corps - FSIS Subject: FW: Positive chicken sample for S. Heidelberg patient

FYI—

PFGE table for tested products is below.

is the appropriate lab contact ( Pictures have use-by date of 03-29-2014. Product is frozen Kirkland Signature boneless skinless chicken tenders (mis-stated as chicken breast in my previous email).

Thanks much,

Alice






From: Higa, Jeffrey (CDPH-CID-DCDC-IDB) [mailto:[email protected]] Sent: Friday, October 25, 2013 10:57 AM To: Green, Alice - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSIS; Allen, Latasha - Commissioned Corps - FSIS; [email protected]; [email protected]; [email protected]; [email protected]; [email protected] Cc: Needham, Michael (CDPH-DFDRS FDB); Hernandez, Michael (CDPH-DFDRS); Kennelly, Pat (CDPH-FDB); Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC); Gilliss, Debra (CDPH-CID-DCDC-IDB) Subject: Positive chicken sample for S. Heidelberg patient

Hello USDA and CDC colleagues,

On 10/9/2013, 3 open packages of Kirkland Signature Boneless, Skinless Chicken Tenderloins were

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collected from the home of S. Heidelberg pattern 0041 patient Our Food and Drug Lab tested chicken from all 3 packages. Chicken from one of packages was positive for Salmonella:

FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001

Kirkland Signature boneless, skinless Chicken tenderloins

P33901

negative for Salmonella

n/a

184100913-P002


P6137A

(best by 3/29/2014)

· positive for Salmonella group B

· 5 of 10 subs positive

· PFGE pattern JF6X01.0122

CA2__CA2F13M00985PP2A1

184100913-P003


P33901


n/a

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Attached are pictures of the package for the positive chicken sample. The chicken isolate was pattern 0122 and the patient had pattern 0041. Unfortunately, all 3 packages were open and the specific package the patient had chicken from prior to illness onset could not be determined.

FDB, please correct me if any of the information above is inaccurate.

-Jeff

Jeffrey Higa, MPH

California Department of Public Health

Infectious Diseases Branch

Disease Investigations Section

19300 S. Hamilton Ave., Suite 140

Gardena, CA 90248

310-217-6906

310-217-6911 (fax)

[email protected] <mailto:[email protected]>

NOTICE of CONFIDENTIALITY: This E-mail is the property of the California Department of Public Health and contains information that may be PRIVILEGED, CONFIDENTIAL or otherwise exempt from disclosure by applicable law. It is intended only for the person(s) to whom it is addressed. If you receive this communication in error, please do not retain or distribute it. Please notify the sender immediately by E-mail at the address shown above and delete the original message.

From: Kissler, Bonnie - FSISSent: Tuesday, October 29, 2013 9:55 AMTo: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Holt, Kristin - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

CDC is planning a web update this week (could be as early as tomorrow). If we decide to move forward with a recall, CDC will likely wait until after the recall before doing the web update.

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Bonnie KisslerSenior EpidemiologistUSDA, FSIS, OPHS, AESc/o Centers for Disease Control and Prevention1600 Clifton Road, NE, MS A-38Building 24, Room 10203Atlanta, GA 30329Office: 404.639.5012Blackberry: 404.661.6640Fax: 404.718.2126Email: [email protected] <mailto:[email protected]>





Thanks much!

Uday

From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 8:57 AMTo: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite -

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FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

HI David









· Although:





----------




o Etc.

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Thanks much!

Uday









Thanks



Hello,







Case patients – We could not make a connection between FSIS sampling dates for Est. 7632 & Est. 6137 for product comprising the load distributed to Costco, part of which may have been consumed by both case

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patients. Product from Est. 33900 was also included in the load to Costco.

Case patients – Product (Rotisserie Chicken) available on the purchase day consisted of seven Foster Farms invoices to Costco with several different slaughter and pack dates from Est. 7632, 6137, 6137A, and 33900. Positive test results, PFGE pattern 258, from FSIS sampling with slaughter dates of; 9/7, 9/9, 9/10, 9/11, and 9/17, taken at Est. 6137 and 6137A made up part of the product included on the invoices.






Alice and SDC pl:

Isolate numbers


PFGE Types

P1

P2

P3

P4

P5

whole

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Patient info

1?

NA

NA

NA

NA

NA

NA

Product info

5 each (!)

OB/PFGE types



From: Goldman, David - Commissioned Corps - FSIS Sent: Friday, October 25, 2013 3:35 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSISSubject: Re: Positive chicken sample for S. Heidelberg patient



Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]


Good point SDC Just a thought: Looks like there is a lot happening I Heidelberg genome.. For instance in the heidelbergs associated with this O/B, the virulence factors may be (just may be) up regulated for some reason... Alice and team: is it possible to tabulate rate of hospitalization for different PFGE types (if numbers are available!)

(b) (6)


Thx

From: Defibaugh-Chavez, Stephanie - FSIS Sent: Friday, October 25, 2013 01:18 PM To: Green, Alice - FSIS; Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient



Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





(b) (6)

(b) (6)












Captain, USPHS




USDA




(b) (6)

(b) (6)


202-720-2644 (o)

202-690-2980 (f)

[email protected]


Thx Alice!


Cheers!

Uday


Hi Uday—


Alice





(b) (6)




Hi Alice



Thx!



(b) (6)

(b) (6)

(b) (6)


From: Green, Alice - FSIS Sent: Friday, October 25, 2013 12:08 PM To: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS; Goldman, David - Commissioned Corps - FSIS Subject: FW: Positive chicken sample for S. Heidelberg patient

FYI—



Thanks much,

Alice







(b) (6)

(b) (6) (b) (6)(b) (6)

(b) (6)

(b) (6)



On 10/9/2013, 3 open packages of Kirkland Signature Boneless, Skinless Chicken Tenderloins were collected from the home of S. Heidelberg pattern 0041 patient ). Our Food and Drug Lab tested chicken from all 3 packages. Chicken from one of packages was positive for Salmonella:

FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


P6137A

(best by 3/29/2014)





184100913-P003


P33901


(b) (6)


n/a



-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)



From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 8:13 AMTo: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Green, Alice - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE


HI Alice

Thanks for following up on this request. Nice work…

Here are some additional thinks to consider..

· While the medial age is around 20, do the distributions for each PFGE type look any different (some weighted, skewed toward older or younger populations)

· Also, does the extent of hospitalization vary significantly by the product type

This info may be important from the pathogen view point (some level of age and/or product signal) as well as nature of the product (processing to handling and consumption).

If (and only if) there are any type of trends etc, we might be able to focus on additional sampling in that direction and may want to provide additional information/guidance to consumers etc.

Thx mch!

Uday

From: Dessai, Uday - FSIS Sent: Tuesday, October 29, 2013 8:33 AMTo: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Green, Alice - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: Re: Heidelberg Pct Hospitalized by PFGE

Yes, it has been difficult..However, I think product MPNs in the IIT will provide some insight into final product distributions..possibly!

From: Defibaugh-Chavez, Stephanie - FSIS Sent: Tuesday, October 29, 2013 08:25 AMTo: Dessai, Uday - FSIS; Robertson, Kis - FSIS; Green, Alice - FSIS Cc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS Subject: Re: Heidelberg Pct Hospitalized by PFGE

We have MPNs on the products we collected. Requesting MPNs on patient leftovers has never worked out because the


products are rarely stored in a manner that would make MPNs informative.

Stephanie -------------------------- Stephanie Defibaugh-Chavez, Ph.D. USDA-FSIS, Office of Public Health Science Science Division

Sent using BlackBerry

From: Dessai, Uday - FSIS Sent: Tuesday, October 29, 2013 08:16 AMTo: Robertson, Kis - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS Cc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS Subject: Re: Heidelberg Pct Hospitalized by PFGE

Ah, ha.. That is an important consideration!The illness rates at times may be impacted by the type of commodity, processing and handling etc..SDC and team - if/when implicated product is available, can we run some MPNs please..

Thx

From: Robertson, Kis - FSIS Sent: Tuesday, October 29, 2013 08:12 AMTo: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS Cc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS Subject: RE: Heidelberg Pct Hospitalized by PFGE

I like this discussion.

An important consideration is that a big chunk of the 258 patients were victimized by the rotisserie chicken. If the level of contamination on the rotisserie was lower than the level on raw products, the severity of illness could be also be lower.

Kis Robertson, DVM, MPH, DACVPM

Commander, U.S. Public Health Service

Acting Director

USDA/FSIS/OPHS/Applied Epidemiology Staff

Stop 3766, PP 3, 9-210B

1400 Independence Avenue, SW


Office Phone: (202) 772-9000


Blackberry phone: (202) 379-6648

Email: [email protected]

_____________________________________________From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 7:51 AMTo: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

On the dot SDC, I was also wondering about the same..

Alice, can you remind us if thediference is in the region below 80….

If it is, there must be a highly virulent mobile element/plasmid that is getting transfered within Heidelbeg populations under some sort of selection pressure..

We will need to look into this further (FDA collaboration…)

Thx

_____________________________________________From: Defibaugh-Chavez, Stephanie - FSISSent: Monday, October 28, 2013 6:51 PMTo: Green, Alice - FSIS; Dessai, Uday - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

I think it’s interesting that although 258 and 45 are highly similar in PFGE pattern, they appear to have vastly different hospitalization rates (almost double for 45). To me, this particular difference in hospitalization rates indicates the likelihood of some sort of plasmid that is making some of these strains more virulent than others.


Microbiologist




202-690-6042 (office)


202-690-6364 (fax)




<< OLE Object: Picture (Device Independent Bitmap) >> <http://www.facebook.com/usda> << OLE Object: Picture (Device Independent Bitmap) >> <http://www.twitter.com/usda> << OLE Object: Picture (Device Independent Bitmap) >> <http://www.youtube.com/usda>

_____________________________________________From: Green, Alice - FSISSent: Monday, October 28, 2013 6:08 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

Hi Uday—

Here is today’s update to the requested information.

Based on Aphrodite’s work last summer, patterns 258 and 45 are the most closely related in the cluster at 99% similar with one band differing. Patterns 122 and 672 are about 97% similar with one band difference. Pattern 22 is 90% or less similar to all other patterns.

California was keeping track of this information separately early on in the investigation. It is interesting to revisit now that the number of case-patients has increased. I am not detecting any clear patterns. Please let me know what you think. Thanks! J

Pattern % hospitalized (n) Median Age % Male 22 42% (21/50) 20 yrs (n=55) 45% 41 44% (14/32) 20 yrs (n=49) 43% 45 52% (28/54) 22 yrs (n=77) 54% 122 33% (8/24) 23 yrs (n=31) 52% 258 29% (22/76) 18 yrs (n=117) 56% 326 25% (4/16) 20 yrs (n=25) 50% 672 50% (1/2) 9 yrs (n=2) 50%

Alice






_____________________________________________From: Dessai, Uday - FSISSent: Monday, October 28, 2013 6:40 AMTo: Green, Alice - FSIS

(b) (6)


Cc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

This is very neat Alice J!

Although the lower numbers will be heavily influenced by the denominator, we may be able to divide these into atleast two categories based on % hospitalizations. (note: qualifying criteria could be something like we should have atleast 10 total illnesses to be counted in the categories)

1) 35% and below – 122, 258, 326

2) 35% and above – 22, 41, 45, 122, 672 (just 2 cases – does not qualify))

The next part will be to see if PFGEs in these categories have any commonality/similarity etc. If not all, atleast hose at the extreme ends of hospitalization..

Also, in your table, do if we add the columns for demographics (age, sensitive population etc.. if available, would that be useful to see..!)

Again, nice work Alice J!

_____________________________________________From: Green, Alice - FSISSent: Friday, October 25, 2013 2:41 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: Heidelberg Pct Hospitalized by PFGE

Pattern % hospitalized (n) 22 42% (21/50) 41 44% (14/32) 45 52% (28/54) 122 33% (8/24) 258 29% (22/75) 326 25% (4/16) 672 50% (1/2)






From: Dessai, Uday - FSIS

(b) (6)


Sent: Tuesday, October 29, 2013 7:33 AMTo: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Green, Alice - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: Re: Heidelberg Pct Hospitalized by PFGE

Yes, it has been difficult..However, I think product MPNs in the IIT will provide some insight into final product distributions..possibly!

From: Defibaugh-Chavez, Stephanie - FSIS Sent: Tuesday, October 29, 2013 08:25 AMTo: Dessai, Uday - FSIS; Robertson, Kis - FSIS; Green, Alice - FSIS Cc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS Subject: Re: Heidelberg Pct Hospitalized by PFGE

We have MPNs on the products we collected. Requesting MPNs on patient leftovers has never worked out because the products are rarely stored in a manner that would make MPNs informative.





Thx



An important consideration is that a big chunk of the 258 patients were victimized by the rotisserie chicken. If the


level of contamination on the rotisserie was lower than the level on raw products, the severity of illness could be also be lower.



Acting Director


Stop 3766, PP 3, 9-210B



Office Phone: (202) 772-9000








Thx





Microbiologist




202-690-6042 (office)


202-690-6364 (fax)

email: [email protected] <mailto:[email protected]>




Hi Uday—



California was keeping track of this information separately early on in the investigation. It is interesting to revisit now that the number of case-patients has increased. I am not detecting any clear patterns. Please let me know what you think. Thanks! :-)

Pattern % hospitalized (n) Median Age % Male 22 42% (21/50) 20 yrs (n=55) 45% 41 44% (14/32) 20 yrs (n=49) 43% 45 52% (28/54) 22 yrs (n=77) 54% 122 33% (8/24) 23 yrs (n=31) 52% 258 29% (22/76) 18 yrs (n=117) 56% 326 25% (4/16) 20 yrs (n=25) 50%


672 50% (1/2) 9 yrs (n=2) 50%

Alice






_____________________________________________From: Dessai, Uday - FSISSent: Monday, October 28, 2013 6:40 AMTo: Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

This is very neat Alice :-)!


1) 35% and below – 122, 258, 326




Again, nice work Alice :-)!


(b) (6)








From: Defibaugh-Chavez, Stephanie - FSISSent: Tuesday, October 29, 2013 7:26 AMTo: Dessai, Uday - FSIS; Robertson, Kis - FSIS; Green, Alice - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: Re: Heidelberg Pct Hospitalized by PFGE

We have MPNs on the products we collected. Requesting MPNs on patient leftovers has never worked out because the products are rarely stored in a manner that would make MPNs informative.





Thx

(b) (6)







Acting Director


Stop 3766, PP 3, 9-210B



Office Phone: (202) 772-9000








Thx





Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





Hi Uday—






Alice









1) 35% and below – 122, 258, 326





(b) (6)









From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 7:18 AMTo: Robertson, Kis - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Bennett, Patty - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: Re: Heidelberg Pct Hospitalized by PFGE

TeamI have included patty on this distribution. Thx



(b) (6)


Thx






Acting Director


Stop 3766, PP 3, 9-210B



Office Phone: (202) 772-9000








Thx





Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





Hi Uday—


Based on Aphrodite’s work last summer, patterns 258 and 45 are the most closely related in the cluster at 99% similar


with one band differing. Patterns 122 and 672 are about 97% similar with one band difference. Pattern 22 is 90% or less similar to all other patterns.



Alice









1) 35% and below – 122, 258, 326





(b) (6)









From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 7:17 AMTo: Robertson, Kis - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: Re: Heidelberg Pct Hospitalized by PFGE


Thx


(b) (6)






Acting Director


Stop 3766, PP 3, 9-210B



Office Phone: (202) 772-9000








Thx

_____________________________________________From: Defibaugh-Chavez, Stephanie - FSIS


Sent: Monday, October 28, 2013 6:51 PMTo: Green, Alice - FSIS; Dessai, Uday - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE



Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





Hi Uday—




Pattern % hospitalized (n) Median Age % Male 22 42% (21/50) 20 yrs (n=55) 45%


41 44% (14/32) 20 yrs (n=49) 43% 45 52% (28/54) 22 yrs (n=77) 54% 122 33% (8/24) 23 yrs (n=31) 52% 258 29% (22/76) 18 yrs (n=117) 56% 326 25% (4/16) 20 yrs (n=25) 50% 672 50% (1/2) 9 yrs (n=2) 50%

Alice









1) 35% and below – 122, 258, 326





_____________________________________________From: Green, Alice - FSIS

(b) (6)


Sent: Friday, October 25, 2013 2:41 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: Heidelberg Pct Hospitalized by PFGE







From: Robertson, Kis - FSISSent: Tuesday, October 29, 2013 7:12 AMTo: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSISCc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE



Kis Robertson, DVM, MPH, DACVPMCommander, U.S. Public Health ServiceActing DirectorUSDA/FSIS/OPHS/Applied Epidemiology StaffStop 3766, PP 3, 9-210B1400 Independence Avenue, SWWashington, DC 20250Office Phone: (202) 772-9000Blackberry phone: (202) 379-6648Email: [email protected]

_____________________________________________From: Dessai, Uday - FSIS

(b) (6)


Sent: Tuesday, October 29, 2013 7:51 AMTo: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

On the dot SDC, I was also wondering about the same..Alice, can you remind us if thediference is in the region below 80….If it is, there must be a highly virulent mobile element/plasmid that is getting transfered within Heidelbeg populations under some sort of selection pressure..


Thx

_____________________________________________From: Defibaugh-Chavez, Stephanie - FSIS Sent: Monday, October 28, 2013 6:51 PMTo: Green, Alice - FSIS; Dessai, Uday - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE



Stay Connected with USDA: << OLE Object: Picture (Device Independent Bitmap) >> <http://www.facebook.com/usda> << OLE Object: Picture (Device Independent Bitmap) >> <http://www.twitter.com/usda> << OLE Object: Picture (Device Independent Bitmap) >> <http://www.youtube.com/usda>

_____________________________________________From: Green, Alice - FSIS Sent: Monday, October 28, 2013 6:08 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE


Hi Uday—





Alice

Alice L. Green, MS, DVM Public Health and Epidemiology LiaisonOffice of Public Health Science | Food Safety and Inspection Service | U.S. Department of AgricultureButler Square West | 100 North 6th Street, Suite 420-C | Minneapolis, MN, 55403Tel: 612-659-8632 | Blackberry: 202-441-4752 | Cell: | Fax: 612-370-2070 | Email: [email protected]

_____________________________________________From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 6:40 AMTo: Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

This is very neat Alice :-)!Although the lower numbers will be heavily influenced by the denominator, we may be able to divide these into atleast two categories based on % hospitalizations. (note: qualifying criteria could be something like we should have atleast 10 total illnesses to be counted in the categories)1) 35% and below – 122, 258, 3262) 35% and above – 22, 41, 45, 122, 672 (just 2 cases – does not qualify))

The next part will be to see if PFGEs in these categories have any commonality/similarity etc. If not all, atleast hose at the extreme ends of hospitalization..Also, in your table, do if we add the columns for demographics (age, sensitive population etc.. if available, would that be useful to see..!)


(b) (6)


_____________________________________________From: Green, Alice - FSIS Sent: Friday, October 25, 2013 2:41 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: Heidelberg Pct Hospitalized by PFGE



From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 6:51 AMTo: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE

On the dot SDC, I was also wondering about the same..Alice, can you remind us if thediference is in the region below 80….If it is, there must be a highly virulent mobile element/plasmid that is getting transfered within Heidelbeg populations under some sort of selection pressure..


Thx

_____________________________________________From: Defibaugh-Chavez, Stephanie - FSIS

(b) (6)


Sent: Monday, October 28, 2013 6:51 PMTo: Green, Alice - FSIS; Dessai, Uday - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE



Stay Connected with USDA: << OLE Object: Picture (Device Independent Bitmap) >> <http://www.facebook.com/usda> << OLE Object: Picture (Device Independent Bitmap) >> <http://www.twitter.com/usda> << OLE Object: Picture (Device Independent Bitmap) >> <http://www.youtube.com/usda>


Hi Uday—






Alice








(b) (6)



From: Dessai, Uday - FSISSent: Tuesday, October 29, 2013 4:40 AMTo: Green, Alice - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

Thank you very very much Alice.

I could not make time yesterday to review the table carefully.

I am going to look at this later in the AM today.

Talk to you later.

Uday

From: Green, Alice - FSIS Sent: Monday, October 28, 2013 3:18 PMTo: Dessai, Uday - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

Uday--

Just wanted you to know that I will get you the additional information you requested before I leave today. Thanks! J

Alice

(b) (6)

(b) (6)

(b) (6)











Thanks much!

Uday

From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 8:57 AMTo: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSIS

(b) (6)

(b) (6)

(b) (6)


Cc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

HI David









· Although:





----------




(b) (6)

(b) (6)

(b) (6)

(b) (6)


o Etc.

Thanks much!

Uday









Thanks



Hello,







Case patients – We could not make a connection between FSIS sampling dates for Est. 7632 & Est.

(b) (6)

(b) (6)

(b) (6)

(b) (6)


6137 for product comprising the load distributed to Costco, part of which may have been consumed by both case patients. Product from Est. 33900 was also included in the load to Costco.







Alice and SDC pl:

Isolate numbers


PFGE Types

P1

P2

P3

P4

P5

whole

(b) (6)

(b) (6)

(b) (6)

(b) (6)


Patient info

1?

NA

NA

NA

NA

NA

NA

Product info

5 each (!)

OB/PFGE types






Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]


Good point SDC Just a thought: Looks like there is a lot happening I Heidelberg genome.. For instance in the heidelbergs associated with this O/B, the virulence factors may be (just may be) up regulated for some reason... Alice and team: is it possible to tabulate rate of hospitalization for different PFGE types (if numbers are available!)

(b) (6)


Thx




Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





(b) (6)

(b) (6)












Captain, USPHS




USDA




(b) (6)

(b) (6)


202-720-2644 (o)

202-690-2980 (f)

[email protected]


Thx Alice!


Cheers!

Uday


Hi Uday—


Alice




(b) (6)





Hi Alice



Thx!



(b) (6)

(b) (6)

(b) (6)



FYI—


is the appropriate lab contact Pictures have use-by date of 03-29-2014. Product is frozen Kirkland Signature boneless skinless chicken tenders (mis-stated as chicken breast in my previous email).

Thanks much,

Alice







(b) (6)

(b) (6) (b) (6)(b) (6)

(b) (6)

(b) (6)



On 10/9/2013, 3 open packages of Kirkland Signature Boneless, Skinless Chicken Tenderloins were collected from the home of S. Heidelberg pattern 0041 patient Our Food and Drug Lab tested chicken from all 3 packages. Chicken from one of packages was positive for Salmonella:

FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


P6137A

(best by 3/29/2014)





184100913-P003


P33901


(b) (6)


n/a



-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)



From: Defibaugh-Chavez, Stephanie - FSISSent: Monday, October 28, 2013 5:59 PMTo: Kissler, Bonnie - FSIS; Green, Alice - FSIS; Vetter, Danah - FSIS; Atkinson, Richard - FSISSubject: FYI...


Came across this today:http://fosterfarms.com/docs/Foster_Farms_Overview.pdf



From: Defibaugh-Chavez, Stephanie - FSISSent: Monday, October 28, 2013 5:51 PMTo: Green, Alice - FSIS; Dessai, Uday - FSISCc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg Pct Hospitalized by PFGE





Hi Uday—






Alice






(b) (6)





From: Gieraltowski, Laura (CDC/OID/NCEZID) [[email protected]]Sent: Monday, October 28, 2013 3:51 PMTo: Green, Alice - FSIS; Nakao, Jolene H. (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Schwensohn, Colin A. (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID)Subject: RE: NARMS chicken sample postive for S. Heidelberg

Alice –

I just talked to Jeff and he is going to follow-up with Vi. CDC is willing to try to interview these patients and it sounds like the local health department is willing to let us. We’ll let you know when we receive the patient contact information and if we’re able to reach any of them.

Thanks,

Laura

From: Green, Alice - FSIS [mailto:[email protected]] Sent: Monday, October 28, 2013 4:42 PMTo: Nakao, Jolene H. (CDC/OID/NCEZID); Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSIS

(b) (6)


Cc: Schwensohn, Colin A. (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID)Subject: RE: NARMS chicken sample postive for S. Heidelberg

A check-in question—has CA been in touch with CDC regarding possible assistance with several Alameda/Berkeley interviews of case-patients with recent illness onsets? This was mentioned to me as a possibility last week and I wanted to follow up.

Thanks much,

Alice






From: Nakao, Jolene H. (CDC/OID/NCEZID) [mailto:[email protected]] Sent: Monday, October 28, 2013 3:02 PMTo: Green, Alice - FSIS; Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: RE: NARMS chicken sample postive for S. Heidelberg

Yes! J

Apologies again, Alice. I need to put you on all of my list distribution emails.

Jolene

From: Green, Alice - FSIS [mailto:[email protected] <mailto:[email protected]> ] Sent: 28 October 2013 15:52To: Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS;

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Robertson, Kis - FSISCc: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: RE: NARMS chicken sample postive for S. Heidelberg

J That reminds me...does CDC have an updated linelist for this cluster?

Thanks much,

Alice






From: Gieraltowski, Laura (CDC/OID/NCEZID) [mailto:[email protected] <mailto:[email protected]> ] Sent: Monday, October 28, 2013 2:23 PMTo: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: Re: NARMS chicken sample postive for S. Heidelberg

Thanks, Alice. This isolate was uploaded to PulseNet today.

From: Green, Alice - FSIS [mailto:[email protected] <mailto:[email protected]> ] Sent: Monday, October 28, 2013 03:20 PM Eastern Standard TimeTo: Defibaugh-Chavez, Stephanie - FSIS <[email protected] <mailto:[email protected]> >; Kissler, Bonnie - FSIS <[email protected] <mailto:[email protected]> >; Robertson, Kis - FSIS <[email protected] <mailto:[email protected]> > Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID) Subject: FW: NARMS chicken sample postive for S. Heidelberg

FYI.

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From: Lofy, Kathy H (DOH) [mailto:[email protected] <mailto:[email protected]> ] Sent: Monday, October 28, 2013 1:22 PMTo: Green, Alice - FSISCc: Melius, Beth J (DOH); Stewart, Laurie K (DOH)Subject: NARMS chicken sample postive for S. Heidelberg

Hi Alice,

I want to let you know that routine meat testing in Washington for the NARMS program detected S. Heidelberg in a chicken sample. The label of this chicken sample is attached. It appears this chicken sample was processed at plant P-6137A (CA FF plant). The PulseNet PFGE pattern is not yet in our Washington database but I believe the pattern is XbaI JF6X01.0122. The isolate number is WA_19012.

Let us know if you need additional information.

Thanks

Kathy

Kathy Lofy, M.D.

Medical Epidemiologist

Washington State Department of Health

Office of Communicable Disease Epidemiology

Phone: 206-418-5500

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Public Health--Always Working for a Safer and Healthier Washington


From: Gieraltowski, Laura (CDC/OID/NCEZID) [[email protected]]Sent: Monday, October 28, 2013 3:50 PMTo: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Barton Behravesh, Casey (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Williams, Ian (CDC/OID/NCEZID)Cc: Kissler, Bonnie - FSIS; Green, Alice - FSISSubject: Foster Farms response on their website

FYI

http://www.fosterfarms.com/docs/Foster_Farms_Overview.pdf

Laura B. Gieraltowski, PhD, MPHLCDR, US Public Health ServiceDoctoral EpidemiologistOutbreak Response and Prevention Branch Division of Foodborne, Waterborne and Environmental Diseases

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention1600 Clifton Road, MS A-38Atlanta, GA 30329 Phone: (404)639-3868 Fax: (404)718-2126

From: Nakao, Jolene H. (CDC/OID/NCEZID) [[email protected]]Sent: Monday, October 28, 2013 3:02 PMTo: Green, Alice - FSIS; Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: RE: NARMS chicken sample postive for S. HeidelbergAttachments: CDC MLL S Heidelberg 2013 clusters_comprehensive, 10-28-13.xlsx


Yes! J

Apologies again, Alice. I need to put you on all of my list distribution emails.

Jolene

From: Green, Alice - FSIS [mailto:[email protected]] Sent: 28 October 2013 15:52To: Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: RE: NARMS chicken sample postive for S. Heidelberg

J That reminds me...does CDC have an updated linelist for this cluster?

Thanks much,

Alice






From: Gieraltowski, Laura (CDC/OID/NCEZID) [mailto:[email protected]] Sent: Monday, October 28, 2013 2:23 PMTo: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: Re: NARMS chicken sample postive for S. Heidelberg


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From: Green, Alice - FSIS [mailto:[email protected] <mailto:[email protected]> ] Sent: Monday, October 28, 2013 03:20 PM Eastern Standard TimeTo: Defibaugh-Chavez, Stephanie - FSIS <[email protected] <mailto:[email protected]> >; Kissler, Bonnie - FSIS <[email protected] <mailto:[email protected]> >; Robertson, Kis - FSIS <[email protected] <mailto:[email protected]> > Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID) Subject: FW: NARMS chicken sample postive for S. Heidelberg

FYI.






From: Lofy, Kathy H (DOH) [mailto:[email protected] <mailto:[email protected]> ] Sent: Monday, October 28, 2013 1:22 PMTo: Green, Alice - FSISCc: Melius, Beth J (DOH); Stewart, Laurie K (DOH)Subject: NARMS chicken sample postive for S. Heidelberg

Hi Alice,



Thanks

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Kathy

Kathy Lofy, M.D.




Phone: 206-418-5500



From: Dessai, Uday - FSISSent: Monday, October 28, 2013 2:47 PMTo: Green, Alice - FSISSubject: Re: Positive chicken sample for S. Heidelberg patient

Thx Alice..

From: Green, Alice - FSIS Sent: Monday, October 28, 2013 03:18 PMTo: Dessai, Uday - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient

Uday--

Just wanted you to know that I will get you the additional information you requested before I leave today. Thanks! J

Alice

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Thanks much!

Uday

From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 8:57 AMTo: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSIS

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Subject: RE: Positive chicken sample for S. Heidelberg patient

HI David









· Although:





----------




o Etc.

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(b) (6)

(b) (6)

(b) (6)


Thanks much!

Uday









Thanks



Hello,








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(b) (6)

(b) (6)

(b) (6)








Alice and SDC pl:

Isolate numbers


PFGE Types

P1

P2

P3

P4

P5

whole

Patient info

(b) (6)

(b) (6)

(b) (6)

(b) (6)


1?

NA

NA

NA

NA

NA

NA

Product info

5 each (!)

OB/PFGE types






Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]



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Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





(b) (6)

(b) (6)












Captain, USPHS




USDA




202-720-2644 (o)

(b) (6)

(b) (6)


202-690-2980 (f)

[email protected]


Thx Alice!


Cheers!

Uday


Hi Uday—


Alice





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Hi Alice



Thx!



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FYI—



Thanks much,

Alice








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(b) (6) (b) (6)

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On 10/9/2013, 3 open packages of Kirkland Signature Boneless, Skinless Chicken Tenderloins were collected from the home of S. Heidelberg pattern 0041 patient ). Our Food and Drug Lab tested chicken from all 3 packages. Chicken from one of packages was positive for Salmonella:

FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


P6137A

(best by 3/29/2014)





184100913-P003


P33901


n/a

(b)(6)




-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)



From: Gieraltowski, Laura (CDC/OID/NCEZID) [[email protected]]Sent: Monday, October 28, 2013 2:23 PMTo: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSISCc: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID)Subject: Re: NARMS chicken sample postive for S. Heidelberg



From: Green, Alice - FSIS [mailto:[email protected]] Sent: Monday, October 28, 2013 03:20 PM Eastern Standard TimeTo: Defibaugh-Chavez, Stephanie - FSIS <[email protected]>; Kissler, Bonnie - FSIS <[email protected]>; Robertson, Kis - FSIS <[email protected]> Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID) Subject: FW: NARMS chicken sample postive for S. Heidelberg

FYI.






From: Lofy, Kathy H (DOH) [mailto:[email protected]] Sent: Monday, October 28, 2013 1:22 PMTo: Green, Alice - FSISCc: Melius, Beth J (DOH); Stewart, Laurie K (DOH)Subject: NARMS chicken sample postive for S. Heidelberg

Hi Alice,



Thanks

(b) (6)


Kathy

Kathy Lofy, M.D.




Phone: 206-418-5500


This electronic message contains information generated by the USDA solely for the intended recipients. Any unauthorized interception of this message or the use or disclosure of the information it contains may violate the law and subject the violator to civil or criminal penalties. If you believe you have received this message in error, please notify the sender and delete the email immediately. From: Dessai, Uday - FSISSent: Monday, October 28, 2013 2:17 PMTo: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient




Thanks much!

Uday

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From: Dessai, Uday - FSIS Sent: Monday, October 28, 2013 8:57 AMTo: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: RE: Positive chicken sample for S. Heidelberg patient

HI David









· Although:





----------

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(b) (6)

(b) (6)

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o Etc.

Thanks much!

Uday




_____________________________________________


From: Dessai, Uday - FSIS Sent: Friday, October 25, 2013 2:22 PMTo: Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg similarity matrix




Thanks



Hello,





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(b) (6)











Alice and SDC pl:

Isolate numbers


PFGE Types

P1

P2

(b) (6)

(b) (6)

(b) (6)

(b) (6)

(b) (6)

(b) (6)


P3

P4

P5

whole

Patient info

1?

NA

NA

NA

NA

NA

NA

Product info

5 each (!)

OB/PFGE types






Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]


Good point SDC

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Just a thought: Looks like there is a lot happening I Heidelberg genome.. For instance in the heidelbergs associated with this O/B, the virulence factors may be (just may be) up regulated for some reason... Alice and team: is it possible to tabulate rate of hospitalization for different PFGE types (if numbers are available!) Thx




Microbiologist




202-690-6042 (office)


202-690-6364 (fax)




(b) (6)













Captain, USPHS




(b) (6)

(b) (6)

(b) (6)


USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]


Thx Alice!


Cheers!

Uday


Hi Uday—


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Alice







Hi Alice



Thx!


(b) (6)

(b) (6)

(b) (6)




FYI—



Thanks much,

Alice






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(b) (6) (b) (6)

(b) (6)





FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


P6137A

(best by 3/29/2014)




(b) (6)

(b)(6)



184100913-P003


P33901


n/a



-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)


NOTICE of CONFIDENTIALITY: This E-mail is the property of the California Department of Public Health and contains information that may be PRIVILEGED, CONFIDENTIAL or otherwise exempt from disclosure by applicable law. It is intended only for the person(s) to whom it is addressed. If you receive this communication in


error, please do not retain or distribute it. Please notify the sender immediately by E-mail at the address shown above and delete the original message.

From: Peralta, Vi (CDPH-CID-DCDC-IDB) [[email protected]]Sent: Monday, October 28, 2013 1:33 PMTo: Green, Alice - FSISCc: Higa, Jeffrey (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC)Subject: RE: One Costco shopper history, etc.

Hi Alice,

Yes, I finally have hot water again and it’s been glorious!

Thank you for the record. As for an update call, unfortunately Tuesday will not work for us as there is a conference that all 3 of us will be attending/participating in at various times of the day. We’ve got a few meetings on Wednesday as well. Thursday morning may work. Do you want to send us specific times on Wednesday and Thursday that you can do and maybe we can choose among those options?

Also, FYI, I spoke to my contact at Ralphs (part of the Kroger family) on Friday because one of our cases granted us written consent to obtain their records (however it was on our form and asked Ralphs to release the records to me) and the Ralphs representative said that Krogers is now very strict about releasing records. They indicated that since the chicken recall, Krogers is requiring that consent forms must be notarized and that they will not release records except under a court order or subpoena.

Vi

From: Green, Alice - FSIS [mailto:[email protected]] Sent: Monday, October 28, 2013 11:04 AMTo: Peralta, Vi (CDPH-CID-DCDC-IDB)Cc: Higa, Jeffrey (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC)Subject: One Costco shopper history, etc.

Hi Vi—

Good morning! I hope you have hot water at home.


I checked in with our investigators regarding the most recent outstanding shopper history list. Apparently this is the only one we’ve received and the others are still pending or need to be requested.

Would you guys like to try and schedule an update call for tomorrow or Wednesday? Also I am not sure the forms I sent last week really addressed your questions regarding Sam’s and Raley’s. Maybe we can chat a bit about that tomorrow too. When I responded to you last Wednesday, I was kind of muddled after the long Tuesday revolving around the MN Costco ground beef recall.

Thanks much,

Alice


From: Lofy, Kathy H (DOH) [[email protected]]Sent: Monday, October 28, 2013 1:22 PMTo: Green, Alice - FSISCc: Melius, Beth J (DOH); Stewart, Laurie K (DOH)Subject: NARMS chicken sample postive for S. HeidelbergAttachments: F13-486.JPG

Hi Alice,



Thanks

Kathy


Kathy Lofy, M.D.




Phone: 206-418-5500


From: - FSISSent: Monday, October 28, 2013 1:03 PMTo: Green, Alice - FSIS; Leskowsky, Robert - FSIS; Atkinson, Richard - FSISCc: Kissler, Bonnie - FSISSubject: RE:

Okay, will do

Compliance InvestigatorUSDA/FSIS/OIEA/CID19110 Bothell Way NE, Suite #201Bothell, WA 98011Office: Cell: Fax: (425) 483-3492

fsis.usda.gov


_____________________________________________From: Green, Alice - FSIS Sent: Monday, October 28, 2013 10:45 AMTo: Leskowsky, Robert - FSIS; - FSIS; Atkinson, Richard - FSISCc: Kissler, Bonnie - FSISSubject: CDC_067

Hi

Let me modify that last email. I've renamed the shopper history for . Can you please redact and

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upload it to the IR? I want to be sure you guys have the numbers you need.

Thank you,Alice

<< File: Safeway .xls >>


From: Kissler, Bonnie - FSISSent: Monday, October 28, 2013 12:08 PMTo: Robertson, Kis - FSIS; Allen, Latasha - Commissioned Corps - FSIS; Green, Alice - FSISSubject: FW: Foster Farms system wide strategy

FYI -- sorry if this is duplication.


From: Gomez, Thomas M. (CDC/OID/NCEZID) [mailto:[email protected]] Sent: Monday, October 28, 2013 12:49 PMTo: Gieraltowski, Laura (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Barton Behravesh, Casey (CDC/OID/NCEZID); Williams, Ian (CDC/OID/NCEZID); Tauxe, Robert V. (CDC/OID/NCEZID); Braden, Chris (CDC/OID/NCEZID); Liang, Arthur P. (CDC/OID/NCEZID); Kissler, Bonnie - FSIS; Basu, Pat - FSIS; [email protected]; Goldman, David - Commissioned Corps - FSIS; Annelli, Joseph F - APHIS; Rooney, Jane A - APHIS; McCluskey, Brian J - APHISCc: [email protected]: Foster Farms system wide strategy

All - FYI, the following was provided today by Dr. Richard Breitmeyer, Director, California Animal Health and Food Safety Laboratory System --

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Tom, this was in Friday's Meatingplace, an industry newsletter:

In an interview with Meatingplace, Dr. Robert O'Connor, Foster Farms senior vice president of technical services, detailed the changes the company is making at every level, from the breeder flocks through growout and processing.

* The company has vaccinated its breeder flocks at the pullet level since 2006, he said, but has switched to a vaccine that is more specific for Salmonella heidelberg, the strain that is responsible for the recent outbreak. He said that Dr. Charles Hofacre of the University of Georgia, who has published research on vaccination to control Salmonella in chickens, is serving as a consultant to the company.

* "Competitive exclusion" products are being used in both water and feed for both breeders and broilers to help fill their systems with benign microorganisms and crowd out potentially pathogenic bacteria.

* The company is requiring its supplier of replacement breeder pullets to certify that they are Salmonella-free. Foster has had this as a general rule for some years but is now putting the specification into contracts with the supplier, O'Connor said.

* Treatments are being used to try to reduce the prevalence of Salmonella and other microorganisms in the barns on the company-owned ranch on which broilers are raised to market weight, focusing on the litter that covers the floors of the structures.

"We are acidifying the bedding to make it less hospitable to the Salmonella organism," O'Connor said. The bedding is replaced after every third flock, he said. The birds' drinking water is also being treated with an acidifier to discourage bacterial growth, he added.

* In the processing plants, equipment, food contact surfaces, knives, workers' gear, and other places where contamination might occur are being subjected to "enhanced sanitization" and cleaned more frequently.

"We're putting a very heavy emphasis on operational sanitation," O'Connor said. He said the company aims to make the slaughter processing area of the plants "more like a ready-to-eat (product) environment" in terms of microbial status.

* The company is also implementing interventions to reduce microbial contamination of the carcasses as they move through processing.

"We are enhancing the sanitization of bird throughout the process," O'Connor said. "Where we have the opportunity to erect a hurdle, we are erecting a hurdle. We are enhancing sanitation across the board."

O'Connor said changes are being made in all five of the company's processing plants: three in California, one in Louisiana, and one in Washington.

"We are not going to stop at one plant," he said.

USDA's Food Safety & Inspection Service had threatened to withdraw its inspectors from the three California plants, effectively suspending their operations, unless changes were made.

##

_______________


Thomas M. Gomez DVM, MS

USDA, APHIS, Veterinary Services Liaison to CDC

One Health Coordination Office, USDA:APHIS:VS

1600 Clifton Road, NE Mailstop A-38

Building 24, room 10105

Atlanta, GA 30329

office: 404-639-3233

cell:

e-mail: [email protected]

From: Defibaugh-Chavez, Stephanie - FSISSent: Monday, October 28, 2013 10:56 AMTo: Atkinson, Richard - FSIS; Green, Alice - FSISCc: - FSIS; Leskowsky, Robert - FSISSubject: RE: Week of October 28, 2013

I’ll try to get an update to you on Phase 2 positives today so you guys know what we’ve got so far…-Stephanie



_____________________________________________From: Atkinson, Richard - FSIS Sent: Monday, October 28, 2013 11:19 AMTo: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSISCc: - FSIS; Leskowsky, Robert - FSISSubject: Week of October 28, 2013

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Hello,I will be out of the office this week. Robert Leskowsky will cover for me, and is still the lead for the FF illness outbreak. Any results from Phase Two FF sampling?Thank you.

Richard AtkinsonSupervisory InvestigatorCO, NM, WY, MT, ID, UT, NV, WA, AKUSDA, FSIS, OIEA, CIDDenver Sub-Region1 Denver Federal CenterBuilding 45, S-3Mail:P.O. Box 25387Denver, Colorado 80225-0387Office 303-236-9860Fax 303-236-9858Cell 303-618-5006

PREDECISIONAL NOT FOR COPY OR FURTHER DISTRIBUTIONThis electronic message contains information generated by theUSDA solely for the intended recipients. Any unauthorizedinterception of this message or the use or disclosure of theinformation it contains may violate the law and subject the violator tocivil or criminal penalties. If you believe you have received thismessage in error, please notify the sender and delete the emailimmediately.

From: Kissler, Bonnie - FSISSent: Monday, October 28, 2013 10:15 AMTo: FSIS - OPHS/HHSD; Fore, Sandra - FSISSubject: Investigations Team Daily 10/28/2013

In the Office (at meeting): LA, AG, TI, BK, KR, KS, PW

Out of Office Plans:

BK: 11/20/13-11/22/13

Investigations (active investigation; possible involvement of FSIS-regulated product):

* Multistate Salmonella Heidelberg cluster associated with chicken, FDIB# 2013-14 - Alice Green

* 349 case-patients from 20 states and PR (1-AK, 1-AR, 14-AZ, 257-CA, 6-CO, 1-CT, 4-FL, 3-ID, 1-KY, 3-MI,

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5-MO, 1-NC, 2-NM, 9-NV, 9-OR, 1-PR, 11-TX, 2-UT, 2-VA, 15-WA, 1-WI)

* Case definition: Person with Salmonella Heidelberg infection, with illness onset (or isolation, if onset date unknown) on 3/1/13 - present, and with isolate matching PFGE XbaI pattern JF6X01.0258, JF6X01.0045, JF6X01.0041, JF6X01.0672, JF6X01.0122, or JFX601.0326, or CA case-patient with PFGE pattern JF6X01.0022

* Onset dates: 3/2/13 - 10/7/13*

* Hospitalizations: 97/257 (38%)

* Deaths: 0

* Exposure: 134/190 (71%) consumed chicken prepared at home

* NARMS (clinical): Results available on 5 JF6X01.0258 clinical isolates (3-MDR; 2-pansusceptible); results available on 3 pattern JF6X01.0045 clinical isolates (2-MDR, 1-pansusceptible)

* NARMS (retail): 3 CA company A (establishment A1) retail chicken isolates from 2013 with PFGE patterns JF6X01.0258, JF6X01.0041, and JF6X01.0022 are MDR

* Leftover product: WA collected leftover chicken from 2 case-patients' homes for testing; results are negative for 1; 2nd WA leftover chicken product for which shopper card has been shared with OIEA is confirmed positive for Salmonella Heidelberg, PFGE is indistinguishable from case-patient's (JF6X01.0672). CA collected leftover chicken from 3 case-patients' homes for testing; results are negative. One product (from establishment A4 in Louisiana) was most likely consumed several weeks prior to illness onset. Leftover rotisserie chicken collected from CA case-patient tested positive for Salmonella Heidelberg with PFGE pattern JF6X01.0258.

* FSIS AMR results: 2 CA company A (establishments A2 and A3) ground chicken isolates from 2013 with PFGE pattern JF6X01.0258 are MDR; 2 CA company A (establishment A2) chicken parts isolates from 2012 with PFGE pattern JF6X01.0326 are pan-susceptible

* FSIS intensified testing: Ongoing data collection and summarization in progress

* CDC cluster code: 1306MLJF6-1

* PFGE patterns (ranking as of 6/30/13): JF6X01.0258 (not in top 10), JF6X01.0045 (ranked 9th), JF6X01.0041 (ranked 7th), JF6X01.0672 (new), JF6X01.0022 (ranked 1st), JF6X01.0122 (ranked 3rd), JFX601.0326 (ranked 6th)

* FIMS number: 20130703-01

* Recall: FSIS-RC-058-2013; recall expansion 10/17/13

Summary: Currently, there are 349 case-patients from 20 states and PR. PFGE patterns JF6X01.0258, JF6X01.0045, JF6X01.0041, JF6X01.0672, JF6X01.0022, JF6X01.0122, and JFX601.0326 have been combined by CDC as 1 cluster; 97 case-patients have been hospitalized; 134/190 (71%) consumed chicken prepared at home prior to illness onset. On 9/30/13, CA identified sub-clusters of 50 illnesses (36 lab confirmed) possibly linked to rotisserie chicken in San Mateo. Sampling at 4 Company A establishments completed on 9/23/13; 3 establishments were issued NOIEs on 10/7/13. FSIS issued a public health alert on 10/7/13. Leftover rotisserie chicken collected from CA case-patients tested positive for Salmonella Heidelberg with PFGE pattern JF6X01.0258. Costco's El Camino Real store in South San Francisco, CA recalled 9,043 units (approximately 39,755 lbs.)of rotisserie chicken products on 10/12/13. Retail product collected by CA tested positive for Salmonella Heidelberg with PFGE pattern JF6X01.0258, a recall expansion (14,093 units) based on these results was issued 10/17/13.

FSIS: Continue sampling at 5 Company A establishments; analyze sampling results; work with CDC and states to


gather epidemiologic and product information; traceback ongoing

* Tennessee University Chattanooga Salmonella Enteritidis and Campylobacter jejuni outbreak possibly associated with ground chicken product, FDIB# 2013-18 - Latasha Allen

* 25 (9 lab confirmed) case-patients

* Case definition: Pending

* Onset dates: 8/20/13 - 8/29/13

* Hospitalizations: 0

* Deaths: 0

* Exposure: 23 students and 2 staff members reported being ill after eating at the food service facilities on campus; 7 cases reported consumption of a stuffed pepper meal

* Product: Chicken dish was prepared with ground chicken; positive for SE and Campy with PFGE patterns matching outbreak strain

* CDC cluster code: N/A

* PFGE: JEGX01.0021 and JEGX01.0023 (Salmonella Enteritidis), both are common patterns; pattern for Campylobacter jejuni is DBRS16.0218

* MLVA: N/A

* FIMS number: 20130920-01

* Recall: N/A

Summary: There are 25 reported ill persons who were patrons of the food service facilities on the Tennessee University (UTC) campus in Chattanooga, TN. Epidemiologic information indicates that stuffed peppers containing ground chicken was served and consumed by 7 patrons to the cafeteria. 4/9 case-patients have been confirmed to be co-infected with Salmonella Enteritidis and Campylobacter jejuni; 3/9 case-patients are only infected with Salmonella Enteritidis; 2/9 case-patients are only infected with Campylobacter jejuni. Two PFGE patterns, JEGX01.0021 and JEGX01.0023, are from Salmonella Enteritidis isolates. The PFGE pattern for Campylobacter jejuni is DBRS16.0218. TN Health Department collected an intact chub chicken (ground chicken) sample from the cafeteria for testing and results are positive for Salmonella Enteritidis PFGE pattern JEGX01.0021 and Campylobacter jejuni PFGE pattern DBRS16.0218 and DBRS16.0008. Traceback information shows that the ground chicken chub tested was produced by Establishment B in Sedalia, MO. OIEA investigation determined that this product was distributed to UTC on 8/9/13 and 8/16/13 and used to prepare the stuffed peppers on 8/20/13. USDA (Buffalo Style Chicken Sausage) sample collected on 8/13/13 from Establishment C, in Woburn, MA tested positive for Salmonella Enteritidis with PFGE pattern JEGX01.0021, matching one of the outbreak patterns. USDA (ground chicken) sample collected on 8/7/13 from Establishment D, in Waco, TX tested positive for Campylobacter jejuni with PFGE pattern DBRS16.0008, matching one of the patterns seen in the positive intact product. Environmental assessment conducted by TN showed potential for cross-contamination.

OPHS: Work with state and CDC to gather additional detail epidemiologic information


* Minnesota E. coli O157:H7 illness associated with ground beef consumption, FDI# 2014-03 - Alice Green

* 1 case-patient

* Onset date: 9/29/13

* Hospitalization: 0

* Death: 0

* Exposure: Ground beef purchased from a wholesale chain on 9/6/13; product was 88/12 ground beef, as documented by the purchase receipt

* CDC cluster code: N/A

* PFGE: EXHX01.0074/EXHA26.0569, common

* MLVA: Pending

* FIMS number: N/A

* Recall: FSIS-RC-060-2013

Summary: There is one case-patient with illness onset 9/29/13. Tested leftover ground beef is positive for E. coli O157:H7 matching the outbreak strain. A Costco in Coon Rapids, MN issued a retail recall of 838 units 88% lean fresh ground beef products on 10/22/13. This illness has the same PFGE pattern combination as a multistate cluster for which CDC is currently gathering epi information.

OPHS: Work with CDC and state to gather additional epidemiologic information

Watches (following public health partner investigation; not sure if FSIS-regulated product is involved):

* Multistate Salmonella Typhimurium cluster possibly associated with beef, FDI# 2014-01 - Latasha Allen

* 28 case-patients in 8 states (8-CA, 3-ID, 1- IA, 1- MN, 2-NE, 1- NC, 7-OR, 5-UT)

* Case definition: Person with Salmonella Typhimurium infection with an onset date after 7/13/13 (or isolate date after 7/20/13 if onset date information is not available), and Isolate matching PFGE Xbal pattern JPXX01.2350

* Onset dates: 7/19/13- 10/7/13*

* Isolation dates: 7/22/13 - 10/10/13


* Deaths: 0


* Exposure: 2/8 (25%) report carne asada; 5/8 (63%) report beef, 2/5 (40%) report fresh killed whole cow from farm, 3/8 (38%) report exposure to farm animals

* Product/animal: 2 ground beef isolates from OH (8/13/13 and 8/20/13); 1 isolate from OR was stool from a dairy cow (9/6/13)

* CDC cluster code: 1310MLJPX-1

* PFGE: JPXX01.2350 (comprises 0.38%, 9348/91616)

* MLVA: N/A

* FIMS number: N/A

* Recall: N/A

Summary: There are 28 ill persons reported in 8 states possibly associated with the consumption of beef carne asada. 2/8 report carne asada, 5/8 case-patients report consumption of beef, 2/5 report fresh killed whole cow from farm, 3/8 farm animal exposure, 3/8 watermelon, and 3/8 banana. There are two ground beef isolates that tested positive for Salmonella. Preliminary epidemiologic information indicated that food items containing beef are possibly associated with the outbreak. OPHS has been in contact with CDC, who is following this cluster of illnesses, and additional epidemiologic information is pending.

OPHS: Work with CDC to gather additional epidemiologic information

* Ohio Salmonella I 4, [5],12:i-: cluster possibly associated with an Ohio restaurant, FDI# 2014-02 - Latasha Allen

* 27 case-patients (18 lab confirmed)

* Case definition: Pending

* Onset dates: 9/10/13 - 9/18/13


* Deaths: 0

* Exposure: Prime rib with au jus served at the restaurant (au jus is similar to gravy)

* Product: Prime rib sample tested positive for Salmonella, 2 samples taken from restaurant tested positive

* CDC cluster code: 1210OHJPX-1

* PFGE: JPXX01.0026

* MLVA: N/A

* FIMS number: N/A

* Recall: N/A

Summary: There are 18 lab confirmed case-patients who became ill after dining and consuming prime ribs at a Fulton


County, OH restaurant. The age range for case-patients is between 24 and 79 years. A leftover food sample (prime rib w/ au jus) collected from a case-patient's refrigerator tested positive for Salmonella matching the outbreak strain. Neither prime rib without au jus nor au jus without prime rib were available for testing alone and the two could not be separated in the data analysis as all prime rib is served with au jus poured on top. A case-control study conducted by the state using well meal companions as controls revealed the prime rib and the au jus were statistically significant for illness association.

OPHS: Work with state to gather additional epidemiologic information

*CDC last estimated onset date = 3 days before the isolation date


From: Elliott, Jerry - FSISSent: Monday, October 28, 2013 9:20 AMTo: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Atkinson, Richard - FSIS; Hori, David - FSIS; Leskowsky, Robert - FSISCc: Khroustalev, Allison - FSISSubject: RE: chicken salad - RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak

I am looping in the team from the Western Region to see if they are still looking at this info for non-FF related Sal.

Jerry L. Elliott DVMDirector - Compliance and Investigations DivisionUSDA, FSIS, OIEA, CID

Acting Director Import Inspection Management Division


USDA, FSIS, OFO, IIMD

1400 Independence Ave SW Rm 2149Washington DC 20250 Office [email protected] <mailto:[email protected]>

From: Green, Alice - FSIS Sent: Thursday, October 24, 2013 4:15 PMTo: Elliott, Jerry - FSIS; Defibaugh-Chavez, Stephanie - FSISSubject: FW: chicken salad - RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak

Jerry and Stephanie-

I know there's been some interest in non-Foster Farms follow-up. Please let me know how you'd like to proceed.

Thanks,

Alice






From: Bidol, Sally (DCH) [mailto:[email protected]] Sent: Thursday, October 24, 2013 2:14 PMTo: 'Gieraltowski, Laura (CDC/OID/NCEZID)'; Green, Alice - FSISCc: Barton Behravesh, Casey (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Arends, Katherine (DCH); Bohm, Susan (DCH)Subject: chicken salad - RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak

Hi Laura and Alice,

(b) (6)


The case household did not have any purchase receipts for the chicken salad but we have obtained the shopper card information from the household. This has been shared with our State Ag partners (MDARD). Is there anyone else within FSIS that should be looped in on this?

Regarding leftover product testing, the household did have some leftover chicken salad in the original deli container which is being collected for testing at our state lab. We'll share photos of the container once we get them. Our lab plans to set the sample up for testing on Monday, unless you feel that it needs to be tested over the weekend; please let us know your thoughts about the urgency of the testing.

Based on some preliminary followup by MDARD at the Kroger store, this outlet uses either of the following for its rotisserie chicken salad:

1) rotisserie chicken breast meat-savory fully cooked from Kroger distribution but originating from Good Heart Specialty Foods 11122 Nacogdoches Rd San Antonio Tx, 78217 USDA Plant P20481A

2) raw chicken from Kroger distribution that originates from Pilgrim's Pride, Greenly, Co 80634

--Sally

From: Gieraltowski, Laura (CDC/OID/NCEZID) [mailto:[email protected]] Sent: Wednesday, October 23, 2013 10:37 AMTo: Bidol, Sally (DCH); Nakao, Jolene H. (CDC/OID/NCEZID)Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Arends, Katherine (DCH); Bohm, Susan (DCH)Subject: RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak

Thanks, Sally.

I think you should go ahead and get the shopper card information and receipt now. We know that Kroger stores receive FF chicken. It might be useful for FSIS to have the shopper card in order to verify whether or not the MI Kroger stores use FF for their rotisserie.

Thanks!


Laura

Laura B. Gieraltowski, PhD, MPHLCDR, US Public Health ServiceDoctoral EpidemiologistOutbreak Response and Prevention Branch Division of Foodborne, Waterborne and Environmental Diseases


Centers for Disease Control and Prevention1600 Clifton Road, MS A-38Atlanta, GA 30329 Phone: (404)639-3868 Fax: (404)718-2126

From: Bidol, Sally (DCH) [mailto:[email protected]] Sent: Wednesday, October 23, 2013 10:33 AMTo: Nakao, Jolene H. (CDC/OID/NCEZID)Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Gieraltowski, Laura (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Arends, Katherine (DCH); Bohm, Susan (DCH)Subject: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak

Hi Jolene,

Wanted to give you a heads up that we have a new match to pattern JF6X01.0045:

MI_CL13-174980 (stool coll 10/8); 81 yo F with symptom onset 10/2/2013, hosp x 7D. She reported eating rotisserie chicken salad on 10/1 from a local Kroger store in the Detroit metro area. We've advised our State Ag partners.

If it should be determined that the store uses FF chicken for their rotisserie chicken, we can see whether the household has any purchase receipts or uses a Kroger shopper card. We're also checking to see if the patient may have any leftover chicken salad for possible testing at our lab.


Other thoughts or suggestions?

Thanks, --Sally

From: Nakao, Jolene H. (CDC/OID/NCEZID) [mailto:[email protected]] Sent: Thursday, October 17, 2013 10:54 AMTo: [email protected]; [email protected]; [email protected]; Rosen, Hilary (CDPH-CID-DCDC-IDB; Linda Gladden - AR; Stewart Matthews; [email protected]; Carmon Greene; Rashida Hassan; Selam Tecle; [email protected]; [email protected]; Cronquist, Alicia (CDC state.co.us); [email protected]; [email protected]; [email protected]; [email protected]; Hahn, Christine G. <ID> (CDC dhw.idaho.gov); [email protected]; Bohm, Susan (DCH); Bidol, Sally (DCH); Arends, Katherine (DCH); [email protected]; [email protected]; Rick Sowadsky; 'Chen, Lei'; Keene, Bill (CDC epilinks.com); Julie Hatch - OR; Borders,Julie (DSHS; Leos,Greg (DSHS; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Traci DeSalvo - WI; 'Justin R - DHS Kohl'; [email protected]; Martinek, Karen (CDC alaska.gov); [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]: Barton Behravesh, Casey (CDC/OID/NCEZID); Gieraltowski, Laura (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Robertson, Kis - FSIS ([email protected]); Allen, Latasha - Commissioned Corps - FSIS ([email protected])Subject: RE: conference call tomorrow, Thursday, October 17, 2013 at 1pm EST - Salmonella Heidelberg 1306MLJF6-1 outbreak

Colleagues,

The updated line list as of today is attached.

New cases: CA (9), AZ (1).

Jolene

From: Nakao, Jolene H. (CDC/OID/NCEZID) Sent: 16 October 2013 16:46To: '[email protected]'; '[email protected]'; '[email protected]'; 'Rosen, Hilary (CDPH-CID-DCDC-IDB'; 'Linda Gladden - AR'; 'Stewart Matthews'; '[email protected]'; 'Carmon Greene'; 'Rashida Hassan'; 'Selam Tecle'; '[email protected]'; '[email protected]'; Cronquist, Alicia (CDC state.co.us); '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; Hahn, Christine G. <ID> (CDC dhw.idaho.gov); '[email protected]'; 'Susan Bohm - MI'; 'Sally Bidol - MI'; 'Katie Arends - MI'; '[email protected]'; '[email protected]';


'Rick Sowadsky'; 'Chen, Lei'; Keene, Bill (CDC epilinks.com); 'Julie Hatch - OR'; 'Borders,Julie (DSHS'; 'Leos,Greg (DSHS'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; 'Traci DeSalvo - WI'; 'Justin R - DHS Kohl'; '[email protected]'; Martinek, Karen (CDC alaska.gov); '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'; '[email protected]'Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Gieraltowski, Laura (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Robertson, Kis - FSIS ([email protected]); Allen, Latasha - Commissioned Corps - FSIS ([email protected])Subject: conference call tomorrow, Thursday, October 17, 2013 at 1pm EST - Salmonella Heidelberg 1306MLJF6-1 outbreak

Dear colleagues,

We would like to invite you to a conference call tomorrow, Thursday, October 17, 2013 at 1pm EST to discuss updates in the Salmonella Heidelberg 1306MLJF6-1 outbreak investigation and to confirm case counts in each state. The conference call information is below.

Attached is the master line list updated as of yesterday. A total of 329 cases have been reported from 20 states and Puerto Rico, with the great majority (74%) in CA: AK (2), AR (1), AZ (13), CA (243), CO (4), CT (1), FL (4), ID (2), KY(1), MI (2), MO (5), NC (1), NM (2), NV (9), OR (9), PR (1), TX (9), UT (2), VA (2), WA (15), WI (1). Case-patients range in age from <1 - 93 (median: 18) and 48% are female. 40% have been hospitalized and no deaths have been reported.

Seven PFGE XbaI patterns are included in this cluster: JF6X01.0258, JF6X01.0045, JF6X01.0041, JF6X01.0122, JF6X01.0326, JF6X01.0672, JF6X01.0022.

The CDC web posting is available at:

http://www.cdc.gov/salmonella/heidelberg-10-13/index.html

Thank you very much for continuing to update us with epi information on your cases! This investigation is ongoing. As you know, FSIS sampled extensively in three of the Foster Farms plants of concern during the period Sept 9-Sept 27. FSIS is highly interested in any of the new cases that may have exposure information that overlaps with this period of intensified sampling. Please continue to collect shopper card numbers, receipts or left over products. This information is still very important to potentially link illnesses to specific lots and production times, and to support the investigation and future regulatory action as evidence allows.


Thank you and best regards,

Jolene

Conference line:

Passcode:

________________________________

Jolene Nakao, M.D., M.P.H. LCDR, US Public Health Service Epidemic Intelligence Service Officer Enteric Diseases Epidemiology Branch

Division of Foodborne, Waterborne and Environmental Diseases


U.S. Centers for Disease Control and Prevention

1600 Clifton Road, MS-A38

Atlanta, Georgia 30333 / USA

[email protected]

404-718-1151 (w)

(c)

404-718-2126 (f)

From: Dessai, Uday - FSISSent: Monday, October 28, 2013 7:57 AMTo: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSISCc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, Stephanie - FSIS

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Subject: RE: Positive chicken sample for S. Heidelberg patient

HI David









· Although:





----------




o Etc.

Thanks much!

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(b) (6)

(b) (6)

(b) (6)


Uday









Thanks



Hello,








(b) (6)

(b) (6)

(b) (6)

(b) (6)








Alice and SDC pl:

Isolate numbers


PFGE Types

P1

P2

P3

P4

P5

whole

Patient info

(b) (6)

(b) (6)

(b) (6)

(b) (6)


1?

NA

NA

NA

NA

NA

NA

Product info

5 each (!)

OB/PFGE types






Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]



(b) (6)





Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





(b) (6)

(b) (6)












Captain, USPHS




USDA




202-720-2644 (o)

(b) (6)

(b) (6)


202-690-2980 (f)

[email protected]


Thx Alice!


Cheers!

Uday


Hi Uday—


Alice




(b) (6)





Hi Alice



Thx!


Thanks Alice--just want to clarify; were all 5 subs pattern 122? If so, then are there more isolates to test? David Goldman, MD, MPH CAPT, USPHS Chief Medical Officer Assistant Administrator USDA-FSIS-OPHS 202-720-2644 --------------------------

(b) (6)

(b) (6)

(b) (6)


Sent from my BlackBerry Wireless Handheld


FYI—



Thanks much,

Alice







(b) (6)

(b) (6) (b) (6)

(b) (6)

(b) (6)




FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


P6137A

(best by 3/29/2014)





184100913-P003


P33901

(b) (6)



n/a



-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)



From: Dessai, Uday - FSISSent: Monday, October 28, 2013 6:40 AMTo: Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS


Subject: RE: Heidelberg Pct Hospitalized by PFGE

This is very neat Alice :-)!Although the lower numbers will be heavily influenced by the denominator, we may be able to divide these into atleast two categories based on % hospitalizations. (note: qualifying criteria could be something like we should have atleast 10 total illnesses to be counted in the categories)1) 35% and below - 122, 258, 3262) 35% and above - 22, 41, 45, 122, 672 (just 2 cases - does not qualify))






From: Higa, Jeffrey (CDPH-CID-DCDC-IDB) [[email protected]]Sent: Friday, October 25, 2013 4:47 PMTo: Green, Alice - FSISCc: Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC)Subject: Any possibility of recall this weekend?

Hi Alice,

(b) (6)


I hope you made it home and did not get stuck at the office.

Just one quick question…..after the flurry of activity this morning regarding the positive chicken sample from the San Jose patient’s home, is there any possibility of a recall this weekend?

Okay, two quick questions…..did Stephanie get a chance to talk with with Food and Drug Lab?

Thanks,

Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)



From: Dessai, Uday - FSISSent: Friday, October 25, 2013 4:07 PM

(b) (6)


To: Goldman, David - Commissioned Corps - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS; Cook, Victor - FSISSubject: Re: Positive chicken sample for S. Heidelberg patient

Hi DavidDouris, SDC, Alice and I have gone back and forth on this issue and I will send a summary of our discussion/situation. About geeting the PFGE types in question and sequencing - SDC will follow-up and provide you an update.

Cheers!

From: Goldman, David - Commissioned Corps - FSIS Sent: Friday, October 25, 2013 03:34 PMTo: Dessai, Uday - FSIS Cc: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: Re: Positive chicken sample for S. Heidelberg patient


David P. Goldman, M.D., M.P.H. Captain, USPHS Assistant AdministratorOffice of Public Health ScienceFood Safety and Inspection ServiceUSDA Room 341-E, Whitten Bldg. 1400 Independence Ave, SW Washington, DC 20250 202-720-2644 (o) 202-690-2980 (f) [email protected]



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Can we also follow-up with CDC to see if they included pattern 0041 in the cluster because of similarity to 0122? An alternative way of asking that is David's original question of whether they would consider those two patterns the same strain. As Uday pointed out, sometimes lack of or additional bands in the lower molecular weight region (i.e. <100k bp) can be due to plasmid or just poor band resolution in that region. It would be nice to know how they would interpret this situation of finding these two specific patterns in connection with a leftover product and a case-patient clinical isolate.


Microbiologist




202-690-6042 (office)


202-690-6364 (fax)





(b) (6)

(b) (6)


The health department picked up 3 packages of FF product. There were no other suspect products noted. I'll seek guidance from OSEL on pattern similarity between patterns 41 and 122.










Captain, USPHS




USDA




(b) (6)

(b) (6)


202-720-2644 (o)

202-690-2980 (f)

[email protected]


Thx Alice!

The Two bands (I would imagine in low molecular weight region!) may need to be considered a method artifact in this instance - given both are very close and part of the OB.

Cheers!

Uday


Hi Uday-


Alice




(b) (6)





Hi Alice


So we have diffferent patterns between patient and product and we are not sure which product (1/3 positive) was consumed - right!

Thx!


Thanks Alice--just want to clarify; were all 5 subs pattern 122? If so, then are there more isolates to test? David Goldman, MD, MPH CAPT, USPHS Chief Medical Officer Assistant Administrator USDA-FSIS-OPHS 202-720-2644 --------------------------

(b) (6)

(b) (6)

(b) (6)


Sent from my BlackBerry Wireless Handheld


FYI-



Thanks much,

Alice







(b) (6)

(b) (6) (b) (6)

(b) (6)

(b) (6)




FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


P6137A

(best by 3/29/2014)





184100913-P003


P33901

(b) (6)



n/a



-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906

310-217-6911 (fax)



From: - FSISSent: Friday, October 25, 2013 3:36 PMTo: Green, Alice - FSIS; Atkinson, Richard - FSISCc: Khroustalev, Allison - FSIS

(b) (6)


Subject: RE: More Costco shopper records to request

Alice, we have Costco shopping history already. The rest are new and we will need them.


USDA/FSIS/OIEA/CID


Bothell, WA 98011

Office:

Cell:

Fax: (425) 483-3492

fsis.usda.gov


From: Green, Alice - FSIS Sent: Friday, October 25, 2013 1:28 PMTo: Atkinson, Richard - FSIS; - FSISCc: Khroustalev, Allison - FSISSubject: FW: More Costco shopper records to request

Please forgive me if I've missed any of these, but I didn't see them in the IR. Do these need to be requested from Costco?

Thank you!


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From: Peralta, Vi (CDPH-CID-DCDC-IDB) [mailto:[email protected]] Sent: Thursday, October 24, 2013 8:19 PMTo: Green, Alice - FSIS; Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC-IDB)Subject: More Costco shopper records to request

Hi Alice,

I've had a chance to go through all the records....whew! Thank you!

These are all the ones for which we don't have any records yet (the last two are new).

Talk to you tomorrow morning!

PulseNet ID

CDC ID

Onset Date

Cluster pattern

SourceCounty

Reported Chicken Exposures from Interview

Store1

Costco Shopper Card #

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7/28/2013

JF6X01.0041

San Diego

Foster Farms chicken livers (used as bait for fishing several time during week prior to illness onset) purchased from Stater Bros; Stater Bros brand chicken thighs; Sprouts natural chicken brand thighs

Costco

9/1/2013

JF6X01.0045

San Mateo

Foster Farm chicken tenderloins, frozen raw (Costco) consumed 8/26-8/28

Costco

8/29/2013

JF6X01.0022

San Diego

Costco/Kirkland thighs and maybe rotisserie chicken. Legs (Vons/Ralphs)

Costco

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9/23/2013

JF6X01.0045

Santa Clara

chicken bake 9/21/13 from Costco food court

Costco

and

9/14/2013

JF6X01.0258

Riverside

Maybe had Foster Farms breaded boneless skinless chicken, looks like strips (Costco). Maybe had pre-cooked rotisserie (Stater Bros)

Costco

9/11/2013

JF6X01.0258

San Francisco

Costco rotisserie chicken purchased and consumed 9/11/13

Costco

9/14/2013

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JF6X01.0258

San Mateo

Buys Foster Farms chicken every week from Costco. Reports Foster Farms whole chicken, fresh raw, consumed 9/11/13. Foster Farms thighs, fresh raw, consumed within week before onset

Costco

and

From: Green, Alice - FSIS [mailto:[email protected]] Sent: Thursday, October 24, 2013 1:06 PMTo: Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC-IDB)Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Allen, Latasha - Commissioned Corps - FSIS; Robertson, Kis - FSISSubject: shopper records

Hi Vi-

I believe I've covered all the records in your request. There might be some duplicates-I wanted to include all versions of shopper histories in case some are more complete than others.

Please let me know if I've omitted any of the ones you gently reminded us about. J

Thanks much,

Alice





Tel: 612-659-8632 | Blackberry: 202-441-4752 | Cell: | Fax: 612-370-2070 | Email: (b) (6)

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From: Dessai, Uday - FSISSent: Friday, October 25, 2013 3:17 PMTo: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSISSubject: Re: Heidelberg similarity matrix

Excellent point and adds to our rationale..I do understand where SDC is coming from given our experience with this... Case.

From: Green, Alice - FSIS Sent: Friday, October 25, 2013 03:17 PMTo: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSIS; Dessai, Uday - FSIS Subject: RE: Heidelberg similarity matrix

Good catch. I goofed. Thanks!






From: Defibaugh-Chavez, Stephanie - FSIS Sent: Friday, October 25, 2013 2:15 PMTo: Green, Alice - FSIS; Douris, Aphrodite - FSIS; Dessai, Uday - FSISSubject: RE: Heidelberg similarity matrix

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Wait… I have that the pattern 0122 isolate has a slaughter date of 9/27 at P6137, but that the sample was collected at P6137A…


Microbiologist




202-690-6042 (office)


202-690-6364 (fax)



USDA In Facebook <http://www.facebook.com/usda/> USDA In Twitter <http://www.twitter.com/usda/> USDA In Youtube <http://www.youtube.com/usda/>

From: Green, Alice - FSIS Sent: Friday, October 25, 2013 3:11 PMTo: Douris, Aphrodite - FSIS; Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: RE: Heidelberg similarity matrix

Thanks Aphrodite. It looks like the product is Simple Truth Organic, boneless skinless chicken breast, slaughter date 9/9/13. The case-patient’s illness onset date is 9/12/13.







From: Douris, Aphrodite - FSIS Sent: Friday, October 25, 2013 2:02 PMTo: Dessai, Uday - FSIS; Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: RE: Heidelberg similarity matrix

Also, during the specpgm_02 Sept sampling we had a single positive with pattern .0122 and it is my understanding that this product tested is from the same establishment. Alice, is this correct?



From: Dessai, Uday - FSIS Sent: Friday, October 25, 2013 2:39 PMTo: Douris, Aphrodite - FSIS; Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: Re: Heidelberg similarity matrix

Yep, I agree..so, no point asking CDC to relook at this, right!In that case:I think our focus should be that:1) Finding Salmonella in the product is relatively a rare event2) Finding Heidelberg in the product is even more rare3) Hence it is sufficint that we have case and product positive for Heidelberg

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4) The fact that although the PFGE patterns are different, are part of the O/B and very closely related (about 95% similar) - strengthens our conclusion about the link. Note: in this case PFGe should be used as added informance in establishing the link

Team - is this a fair argument given the circumstances around this O/B!

Thx

From: Douris, Aphrodite - FSIS Sent: Friday, October 25, 2013 02:23 PMTo: Dessai, Uday - FSIS; Green, Alice - FSIS Cc: Defibaugh-Chavez, Stephanie - FSIS Subject: RE: Heidelberg similarity matrix


Aphrodite DourisMicrobiologistOutbreaks Section, Eastern LaboratoryFood Safety and Inspection ServiceThe United States Department of AgricultureRussell Research Center950 College Station RoadAthens, GA [email protected] <mailto:[email protected]> PHONE: (706) 546-2330 FAX:(706)546-3144


_____________________________________________From: Dessai, Uday - FSISSent: Friday, October 25, 2013 2:22 PMTo: Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSISSubject: RE: Heidelberg similarity matrix


Yep 2 bands different (~ 200 and ~ 80 region) as I see it on the picture.


Thanks


_____________________________________________From: Green, Alice - FSISSent: Friday, October 25, 2013 1:45 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSISSubject: Heidelberg similarity matrixImportance: High

This is the series of tables Aphrodite created in regards to this investigation back in July. Band comparisons for patterns 122 and 45 are on pages 4 and 5. The small bands appear to be low molecular weight.

<< File: Heidelberg matrix 072513.doc >>

Thanks,

Alice






From: Goldman, David - Commissioned Corps - FSISSent: Friday, October 25, 2013 2:35 PMTo: Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSISSubject: Re: Positive chicken sample for S. Heidelberg patient


David P. Goldman, M.D., M.P.H. Captain, USPHS Assistant AdministratorOffice of Public Health ScienceFood Safety and Inspection ServiceUSDA Room 341-E, Whitten Bldg. 1400 Independence Ave, SW Washington, DC 20250 202-720-2644 (o)

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202-690-2980 (f) [email protected]


Good point SDC Just a thought: Looks like there is a lot happening I Heidelberg genome.. For instance in the heidelbergs associated with this O/B, the virulence factors may be (just may be) up regulated for some reason... Alice and team: is it possible to tabulate rate of hospitalization for different PFGE types (if numbers are available!) Thx From: Defibaugh-Chavez, Stephanie - FSIS Sent: Friday, October 25, 2013 01:18 PM To: Green, Alice - FSIS; Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS Subject: RE: Positive chicken sample for S. Heidelberg patient



Microbiologist




202-690-6042 (office)


202-690-6364 (fax)


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Captain, USPHS




USDA




202-720-2644 (o)

202-690-2980 (f)

[email protected]


Thx Alice!


Cheers!

Uday


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Hi Uday—


Alice







Hi Alice



Thx!

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FYI—



Thanks much,

Alice



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FDLB Sample ID

Product

Establishment #

Result

PulseNet Isolate #

184100913-P001


P33901


n/a

184100913-P002


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P6137A

(best by 3/29/2014)





184100913-P003


P33901


n/a



-Jeff

Jeffrey Higa, MPH





Gardena, CA 90248

310-217-6906


310-217-6911 (fax)



From: Defibaugh-Chavez, Stephanie - FSISSent: Friday, October 25, 2013 2:15 PMTo: Green, Alice - FSIS; Douris, Aphrodite - FSIS; Dessai, Uday - FSISSubject: RE: Heidelberg similarity matrix

Wait… I have that the pattern 0122 isolate has a slaughter date of 9/27 at P6137, but that the sample was collected at P6137A…


Microbiologist




202-690-6042 (office)


202-690-6364 (fax)




From: Green, Alice - FSIS Sent: Friday, October 25, 2013 3:11 PMTo: Douris, Aphrodite - FSIS; Dessai, Uday - FSIS


Cc: Defibaugh-Chavez, Stephanie - FSISSubject: RE: Heidelberg similarity matrix











(b) (6)



Yep, I agree..so, no point asking CDC to relook at this, right!In that case:I think our focus should be that:1) Finding Salmonella in the product is relatively a rare event2) Finding Heidelberg in the product is even more rare3) Hence it is sufficint that we have case and product positive for Heidelberg4) The fact that although the PFGE patterns are different, are part of the O/B and very closely related (about 95% similar) - strengthens our conclusion about the link. Note: in this case PFGe should be used as added informance in establishing the link


Thx




Privileged Communications: This transmission (and/or the documents accompanying it) may contain confidential information belonging to the sender. The information is intended only for the use of the individual or entity named in the distribution. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received


this transmission in error, please notify us by telephone to arrange for the return of the documents.





Thanks




Thanks,

Alice






From: Defibaugh-Chavez, Stephanie - FSISSent: Friday, October 25, 2013 2:13 PMTo: Green, Alice - FSISSubject: RE: Heidelberg similarity matrix

(b) (6)


Remind me… product was 0122 and patient was 41?


Microbiologist




202-690-6042 (office)


202-690-6364 (fax)




From: Green, Alice - FSIS Sent: Friday, October 25, 2013 3:11 PMTo: Douris, Aphrodite - FSIS; Dessai, Uday - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: RE: Heidelberg similarity matrix






Tel: 612-659-8632 | Blackberry: 202-441-4752 | Cell: | Fax: 612-370-2070 | Email: (b) (6)








Yep, I agree..so, no point asking CDC to relook at this, right!In that case:I think our focus should be that:1) Finding Salmonella in the product is relatively a rare event2) Finding Heidelberg in the product is even more rare3) Hence it is sufficint that we have case and product positive for Heidelberg4) The fact that although the PFGE patterns are different, are part of the O/B and very closely related (about 95%


similar) - strengthens our conclusion about the link. Note: in this case PFGe should be used as added informance in establishing the link


Thx









Thanks





Thanks,

Alice






From: [email protected] on behalf of Meatingplace Editorial [[email protected]]Sent: Friday, October 25, 2013 2:04 PMTo: Green, Alice - FSISSubject: NewsMakers PM: Mexico bans Foster Farms poultry plants amid salmonella outbreak

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This afternoon's headlines from www.meatingplace.com

(b) (6)


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NEED TECHNICAL SUPPORT?Email [email protected] <http://www.marketingandtechnology.com/repository/corpGraphics/spacer.gif> <http://www.marketingandtechnology.com/repository/corpGraphics/spacer.gif> <http://www.marketingandtechnology.com/repository/corpGraphics/spacer.gif> <http://www.marketingandtechnology.com/repository/corpGraphics/spacer.gif> Copyright © 2013 Marketing & Technology Group, Inc. <http://www.marketingandtechnology.com/repository/corpGraphics/tagline_site13.gif> <http://www.marketingandtechnology.com/repository/corpGraphics/spacer.gif> <http://www.meatingplace.com/OpenRate.ashx?sentId=98599448> From: - FSISSent: Friday, October 25, 2013 2:09 PMTo: Green, Alice - FSISCc: Atkinson, Richard - FSISSubject: RE: Safeway shopper card records

Alice,

The only one that is new to me is . This is the first time I have seen that number. Can you convert this to a CDC number? I already have Safeway shopping histories for and they should be in the IR. I have Costco histories but not Safeway shopping histories for and have not seen them in the IR.

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USDA/FSIS/OIEA/CID


Bothell, WA 98011

Office:

Cell:

Fax: (425) 483-3492

fsis.usda.gov


From: Green, Alice - FSIS Sent: Friday, October 25, 2013 11:47 AMTo: Atkinson, Richard - FSIS; - FSIS; Elliott, Jerry - FSIS; Khroustalev, Allison - FSISSubject: FW: Safeway shopper card records

If you like I can change these to CDC pattern names and upload them to the IR (at least the ones that aren't already there).






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From: Peralta, Vi (CDPH-CID-DCDC-IDB) [mailto:[email protected]] Sent: Friday, October 25, 2013 1:44 PMTo: Green, Alice - FSISSubject: Safeway shopper card records

Hi Alice,

Since I've lost track of which Safeway records I have already sent, I am sending them all to you in this one email!

Vi

**********************************

Vi Peralta

Foodborne Epidemiologist




850 Marina Bay Parkway | Building P, 2nd Floor | Richmond, CA 94804

Phone: 510-620-3633 | Fax: 510-620-3425 | Email: [email protected]

CONFIDENTIALITY NOTICE WARNING: This transmission may contain confidential and proprietary information intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this transmission in error, any disclosure, copying, distribution, downloading, uploading or the taking of any action in reliance on the contents of this information is strictly prohibited, and you are requested to immediately notify the above sender.

From: Defibaugh-Chavez, Stephanie - FSISSent: Friday, October 25, 2013 2:07 PMTo: Dessai, Uday - FSIS; Douris, Aphrodite - FSIS; Green, Alice - FSISSubject: RE: Heidelberg similarity matrix

Uday,


I think the problem will be saying that the product is linked to illness. If the case-patient has one pattern, and the product has another, I think it will be an uphill battle trying to leverage some sort of regulatory action. The firm will claim that since the patterns are different (and considered significantly different) that it must have been something else that caused the illness. I don’t know that we would be able to dispute that legally speaking.

If the same pattern had been found, I think it would be a different story, but unless we can say these patterns are essentially the same (and justify it legally) then I don’t think we have anything here… Just my take on the situation.

-Stephanie


Microbiologist




202-690-6042 (office)


202-690-6364 (fax)








Thx










Thanks




Thanks,

Alice






From: Douris, Aphrodite - FSISSent: Friday, October 25, 2013 2:02 PMTo: Dessai, Uday - FSIS; Green, Alice - FSISCc: Defibaugh-Chavez, Stephanie - FSISSubject: RE: Heidelberg similarity matrix


Aphrodite DourisMicrobiologistOutbreaks Section, Eastern LaboratoryFood Safety and Inspection Service

(b) (6)


The United States Department of AgricultureRussell Research Center950 College Station RoadAthens, GA [email protected]: (706) 546-2330 FAX:(706)546-3144





Thx



Aphrodite DourisMicrobiologistOutbreaks Section, Eastern Laboratory


Food Safety and Inspection ServiceThe United States Department of AgricultureRussell Research Center950 College Station RoadAthens, GA [email protected] <mailto:[email protected]> PHONE: (706) 546-2330 FAX:(706)546-3144





Douris - does the ~ 200 region band constitute a real diffence ! ( I would imagin yes!)

Thanks




Thanks,

Alice







From: Peralta, Vi (CDPH-CID-DCDC-IDB) [[email protected]]Sent: Friday, October 25, 2013 1:44 PMTo: Green, Alice - FSISSubject: Safeway shopper card records Attachments: Safeway_pattern0022_CA005_M13X01887.xls; Safeway_pattern0022_CA08_M13X02218.xlsx; Safeway_pattern0022_CA012_M13X02445.xlsx; Safeway_pattern0022_CA025_M13X02989.xls; Safeway_pattern0045_CA012_M13X02584_daughter.xlsx; Safeway_pattern0045_CA017_M13X03242.xlsx; Safeway_pattern0045_CA020_M13X03447.xls; Safeway_pattern0258_CA017_M13X03485.xls; Safeway_pattern0258_CA019_M13X03917_card1.xls; Safeway_pattern0258_CA019_M13X03917_card2.xls

Hi Alice,

Since I’ve lost track of which Safeway records I have already sent, I am sending them all to you in this one email!

Vi

**********************************

Vi Peralta

Foodborne Epidemiologist




850 Marina Bay Parkway | Building P, 2nd Floor | Richmond, CA 94804

Phone: 510-620-3633 | Fax: 510-620-3425 | Email: [email protected] <mailto:[email protected]>

CONFIDENTIALITY NOTICE WARNING: This transmission may contain confidential and proprietary information intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this transmission in error, any disclosure, copying, distribution, downloading, uploading or the taking of any action in reliance on the contents of this information is strictly prohibited, and you are requested to immediately notify the above sender.

(b) (6)

Case Data (For Case No 2013-0702)

CONFIDENTIAL

1

CONFIDENTIAL

CCMS II Case Report For Case # 2013-0702 Page 1 of 12

10/30/2013 7:47:30AM

CONFIDENTIAL

1

Case OverviewCase In Charge Of OPHS

Case Status: Closed

Case Type: Illness

Alerts Were Sent To:

Reported Date: Monday, October 14, 2013

Entered By Agency: OFO - Alameda, CA (05)

Complainant State: NEVADA

Entered By:

Incident Date: 10/7/2013

Original Statement: The complainant bought 1 package (net weight 6.12 lbs.) of Foster Farms leg quarters on Monday,

Oct. 7, 2013, at approximately 0800 hours, from Food 4 Less on 8180 S. Las Vegas Blvd., Las

Vegas, Nevada. He said that, at approximately 1000 am on that same day, he cooked and

consumed some of the product. He said he went to sleep, and he woke up feeling muscle pains at

around 6pm or 7pm that day. He said he also experienced the following symptoms: headache, chills,

hot flashes, vomiting, and diarrhea. He said he also felt sluggish. He said he was experiencing these

symptoms until Friday, Oct. 11, when the diarrhea began to stop. He said he went to the hospital on

Sunday, October 13, for the pains he was still experiencing. He said the hospital wanted to take a

stool sample but that he already went to the bathroom before going to the hospital, so the hospital

took 2 blood samples (CBC,Chemistry) for diagnostics. He went to Valley Hospital Medical Center

on 620 Shadow Lane, Las Vegas, Nevada, 89106. The hospital gave him Cipro and Norco.

He indicated that the establishment number on the packaging is Est. P6137 with a use by/freeze by

date of October 9, 2013.

He said that he still has the product and packaging at his home. He is still currently experiencing

side pains on the right side of his body. He has not been able to eat. His headache comes and goes.

Complainant District: Alameda, CA (05)

Case Closing Reason: Wednesday, October 16, 2013 Not Investigated

Alleged incident appears isolated. Case will be archived and reevaluated should a similar

complaint be reported or additional information comes forward. Letter explaining disposition of

case will be sent to complainant. Plant will be informed of complaint by letter.

Tuesday, October 22, 2013 Not Investigated

Not Lab Confirmed, Not Isolated, Possibly Connected to a Recall or Investigation

Illness is not laboratory confirmed. This case may be associated with FSIS Recall # --- or a

current or recent outbreak investigation. Multiple complaints have been registered in CCMS as a

result of this recall or investigation, but the information provided in this case does not identify a

definitive relationship to other reported cases or investigations. The case will be archived and

reevaluated should additional information become available. No complainant address was

provided. Establishment (if identified) will be informed of complaint by letter.

Tuesday, October 29, 2013 Investigated, No Further Action Taken

Not Lab Confirmed, Not Isolated, Possibly Connected to a Recall or Investigation

Illness is not laboratory confirmed. This case may be associated with retail level recall 2013-058,

public health alert or a current or recent outbreak investigation. Multiple complaints have been

registered in CCMS as a result of this recall or investigation, but the information provided in this

case does not identify a definitive relationship to other reported cases or investigations. The case

will be archived and reevaluated should additional information become available. A letter

explaining the disposition of the case will be sent to complainant. Establishment will be informed

of complaint by letter.

Case Closing Remarks:

CONFIDENTIAL


10/30/2013 7:47:30AM

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CONFIDENTIAL

1

Nature of Complaints

Is Primary Complaint Type Medical Visit Hospitalized Life Threatening Complaint Description

Illness Yes No NoYes

Case Symptoms

Symptom Onset Time Comment

24-72 HoursDiarrhea

24-72 HoursDiarrhea - Blood In

8-24 HoursPain - Muscle

3-8 HoursNausea

8-24 HoursVomiting

CONFIDENTIAL


10/30/2013 7:47:30AM

CONFIDENTIAL

1

ProductsCountry of Origin

Product Brand

Product Date

Product Name

Species

Est. District Name

Processing Type

Purchase Date

Package

Case Status

Lot:

US

Foster Farms

10/9/2013 12:00:00AM

Leg quarters

Chicken

Alameda, CA (05)

Raw - Not Ground

10/7/2013 12:00:00AM

6.12 lbs. net weight

New

Est. Number Est. District Role Establishment Name Primary Intl.

06137 P 05 Processing Foster Poultry Farms Yes

06137 P 05 Unknown Foster Poultry Farms

CONFIDENTIAL


10/30/2013 7:47:30AM

CONFIDENTIAL

1

Similar Cases

Case # Reported On Case Type Status Compl. Dist. qi qk qik v Reason

10/14/2013 4:59:18PM Illness Closed Alameda, CA (05)Manually identified

2013-0703

9/6/2012 9:10:05AM Illness Closed Boulder, CO (15) 0.00 0.00 0.00 0.112012-0464

10/11/2013 2:02:56PM Illness Closed Raleigh, NC (80) 0.00 0.00 0.00 0.112013-0698

10/17/2013 10:06:13AM Illness Closed Alameda, CA (05) 0.00 0.00 0.03 0.112013-0714

10/9/2013 2:11:08PM Illness Active Alameda, CA (05) 0.00 0.00 0.03 0.112013-0684

10/8/2013 1:46:03PM Illness Active Alameda, CA (05) 0.00 0.00 0.03 0.112013-0672

7/24/2012 4:13:49PM Illness Closed Boulder, CO (15) 0.00 0.00 0.00 0.112012-0407

10/9/2013 9:11:05AM Illness Closed Boulder, CO (15) 0.00 0.00 0.00 0.112013-0680

10/9/2013 2:11:28PM Illness Closed Alameda, CA (05) 0.00 0.00 0.00 0.112013-0687

CONFIDENTIAL


10/30/2013 7:47:30AM

CONFIDENTIAL

1

Case TasksBrand: Foster Farms

Product Name: Leg quarters

Upload Document 10/14/13 10/14/13 Complete Standard

PriorityCurrent StatusInitiated OnTask Type Last

Activity

Instructions:



Activity

Instructions:



Activity

Instructions:

Search CCMS and/or PBIS 10/16/13 10/16/13 Complete Standard


Activity

Search CCMS and/or PBISInstructions:

Action For Task:

Created On: 10/16/2013 9:03:05AM

Created By:

Task has been marked as 'Complete'. There was no follow-up Task generated.

Action For Task:

Created On: 10/16/2013 9:03:05AM

Created By:

Task Completion Report: ''

CONFIDENTIAL


10/30/2013 7:47:30AM

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(b) (6)

CONFIDENTIAL

1

Note For Task:

Created On: 10/16/2013 9:02:58AM

Created By:

[10/16/2013 9:02:58 AM] Manual review of CCMS data by establishment number revealed similar complaint(s)

reported within the last year.

Manual review of PBIS/PHIS data within the last 6 months revealed noncompliance (s) that may suggest a

direct relationship between this complaint and practices in the identified plant.

ccmsTitle:

Submit Products to Lab 10/29/13 10/24/13 Cancelled Standard


Activity

Submit Products to Lab

1. You have access to CCMS to review the case information and input notes. Here’s the link in

case you do not have it: http://ccms.fsis.usda.gov/ccmsweb/MainPage.aspx . Please remember

when logging in that your username should be reflected as “fsisusda\blaw” and your password is

your network password (the one you would use to log into your computer). If you experience any

errors logging in, please take a screen shot and call or send me an email so that I may assist you.

2. To complete the task you will need to do the following: Make arrangements with the

complainant to visually verify the establishment and any lot numbers from the index package,

examine the index and like-coded product, if available, and obtain photographic evidence to include

establishment and package coding information. Pictures of the product and packaging have already

been uploaded to the case, but you will need to verify that this is the same product that you are

collecting for sampling. Collect (See FSIS Directive 7355.1 and MLG Chapter 10 for guidance on

sample seals and procedures.) the index sample and any like-coded product and send to:

ATTN: Laboratory Supervisor, FSIS OSEL

Russell Research Center, 950 College Station Rd, Athens, GA 30605.

3. The following forms will need to be completed for sample collection and submission.

a. FSIS Form 10,000-2: Domestic Laboratory Report (inspector generated). Please let me know if

you do not have this form and we can email a copy to you.

b. FSIS Form 8000-17: Evidence Receipt and Chain of Custody should be filled out and included

with samples.

c. AES CCMS Verification Report (attached) – this is form that we created to standardized the

information collected during these investigations. If OIEA uses a different form or method of

collecting this information, please just send us (or input the updates into CCMS tasks notes) and we

can transfer the information to the form and upload it to CCMS.

See the document section for the the verification report form.

Thanks

Instructions:

Action For Task:

Created On: 10/29/2013 2:15:31PM

Created By:

Task has been marked as 'Cancelled'

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1

Action For Task:

Created On: 10/29/2013 2:15:31PM

Created By:

Reason for cancellation: 'It was determined not to pursue the collection of the product from the consumer.'



Activity

Instructions:

Search CCMS and/or PBIS 10/16/13 10/16/13 Cancelled Standard


Activity

Search CCMS and/or PBISInstructions:

Action For Task:

Created On: 10/16/2013 8:57:37AM

Created By:

Task has been marked as 'Cancelled'

Action For Task:

Created On: 10/16/2013 8:57:37AM

Created By:

Reason for cancellation: 'task'

Investigate: Interview Complainant 10/24/13 10/23/13 Complete Standard


Activity

Investigate: Interview ComplainantInstructions:

Action For Task:

Created On: 10/24/2013 12:45:59PM

Created By:

Task has been marked as 'Complete'. There was no follow-up Task generated.

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Action For Task:

Created On: 10/24/2013 12:45:59PM

Created By:

Task Completion Report: ''

Note For Task:

Created On: 10/23/2013 2:23:12PM

Created By:

[10/23/2013 2:23:12 PM] Spoke with complainant -

Purchased chicken - no receipt information

Baked chicken - overcooked with potatoes

Felt nauseated about 6-8 hours later

Ate two more pieces with bread

Started vomiting and diarrhea 12-24 hours later

Went to the ER 5 days after symptoms started

Was given medication. No stool sample availble.

Blood, Chemistry and UA were taken

Went back to ER for recheck.

US of gallbladder, stool sample, UA and more blood work pending.

Complainant feels somewhat better but is not back to normal. Mostly has a loss of appetite.

Interview with complainantTitle:

Note For Task:

Created On: 10/24/2013 12:45:44PM

Created By:

[10/24/2013 12:45:44 PM] Spoke with this am.

Blookwork results:

Alk P 176 (40-115)

AST 48 (10-35)

ALT 51 (9-46)

U/A within normal limits

Stool sample negative for Salmonella, Shigella and Campylobacter

Will give us product but not the whole thing. Advised him to keep frozen, not handle the product and discuss

with the investigator how they can get some of the product.

He still feels naseated and just not right.

[10/29/2013 2:19:10 PM] Spoke to complainant again that evening. Is unwilling to give the product to the

investigator at this time as he may want to pursue litigation.

spoke with complainantTitle:



Activity

Instructions:

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Case Notes

Created By:

Created On: Wednesday, October 23, 2013

Modified By:

Modified On: Wednesday, October 23, 2013

Title: conversation

[10/23/2013 11:24:22 AM] bloodwork results

hematology 10/13/13

Procedure

WBC 3.5 (l)(3.8-10.8)

Chemistry- OK

urinalysis done on 15th - no stool sample

CDC with differential

CMP

Lipase

MICR(s)

US gallbladder

Sick on yesterday, pain behind left eye -cloudy vision

ach left thumb

Stomach - ADR, low appetite

Fatique

Gall bladder-US

[10/23/2013 2:16:23 PM] Stool sample collected on 10/18

Will try to get US,blood, urine and stool sample results today.

[10/23/2013 3:46:12 PM] There is no shopper card information.

Someone contacted the complainant to pick up the product.

He has raw product available.

He is going to the hospital tonight to get the lab results and says he will follow-up tomorrow.

Created By:

Created On: Tuesday, October 29, 2013

Modified By:

Modified On: Tuesday, October 29, 2013

Title: public health alert for Foster Farms raw product -

[10/29/2013 2:05:09 PM]

http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/current-recalls-and-alerts/!ut/p/a1/jY_BCoJAGISfxQdY9j

dF9CgLlpa7iGS2l1hMTdhWWa1DT5_SyUhy_tPAN_MzmOMccyWeTS2GplVCTp47F0jAMT0CEQv8AEJqBZlLtyYwZwTOM8AzJyBL2J

4QcKm1Mr8gH_7loxUPNjomcY15J4YbalTV4rx4aF2qAemyEFL2SKgrErLUQ49PmM87wRxv7EztXUQtYPY38GP0B1he1d2P-etQpWFt

GG85uhP2/?1dmy&current=true&urile=wcm%3apath%3a%2Ffsis-content%2Finternet%2Fmain%2Fnewsroom%2Fnews-releases-stat

ements-and-transcripts%2Fnews-release-archives-by-year%2Farchive%2F2013%2Fpha-100713

Created By:

Created On: Thursday, October 24, 2013

Modified By:

Modified On: Thursday, October 24, 2013

Title: notes from field investigator

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CONFIDENTIAL

1

[10/24/2013 9:10:35 AM] Good Afternoon xxxxxx

Below is a summary of information gathered for CCMS cases 2013-0702. I will be out of the office tomorrow and Friday, and will be

back in the office Monday otherwise. Please feel free to contact me via blackberry if you should have any questions in the meantime.

Thanks.

2013-0702—On 10/22/13 left a message with complainant. Will follow up on 10/23/13.

On 10/23/13 complainant indicated that he still has product and willing to share for sample collection. Not willing to provide all left over

product because he wants to have some left for evidence, etc. Confirmed onset date of 10/7/13 and was FF leg quarters from Food 4

Less. The complainant also indicated that he regulatory purchases, cooks and consumes poultry products daily. Prior to 10/7/13,

complainant indicated that the regularly purchases Pilgrims Pride “ready-to-cook” whole chicken and chicken breasts from Walmart.

These stores have no shoppercard numbers. Complainant could not provide specific dates which Walmart poultry products were

purchased on, however, indicated that the FF product was purchased on 10/7/13 at Food 4 Less located at 8180 Las Vegas Blvd., Las

Vegas, NV. The complainant had the following tests done: blood chemistry (no culture/sensitivity conducted) and stool sample. He will

be provided test results later today or tomorrow morning and will let me know results tomorrow for stool sample.

Created By:

Created On: Tuesday, October 29, 2013

Modified By:

Modified On: Tuesday, October 29, 2013

Title: OIEA summary 10/23/13

[10/29/2013 2:12:09 PM] Good Afternoon:

Below is a summary of information gathered for CCMS cases 2013-0702. I will be out of the office tomorrow and Friday, and will be

back in the office Monday otherwise. Please feel free to contact me via blackberry if you should have any questions in the meantime.

Thanks.

2013-0702—On 10/22/13 left a message with complainant. Will follow up on 10/23/13.

On 10/23/13 complainant indicated that he still has product and willing to share for sample collection. Not willing to provide all left over

product because he wants to have some left for evidence, etc. Confirmed onset date of 10/7/13 and was FF leg quarters from Food 4

Less. The complainant also indicated that he regulatory purchases, cooks and consumes poultry products daily. Prior to 10/7/13,

complainant indicated that the regularly purchases Pilgrims Pride “ready-to-cook” whole chicken and chicken breasts from Walmart.

These stores have no shoppercard numbers. Complainant could not provide specific dates which Walmart poultry products were

purchased on, however, indicated that the FF product was purchased on 10/7/13 at Food 4 Less located at 8180 Las Vegas Blvd., Las

Vegas, NV. The complainant had the following tests done: blood chemistry (no culture/sensitivity conducted) and stool sample. He will

be provided test results later today or tomorrow morning and will let me know results tomorrow for stool sample.

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Uploaded Documents

Added On Added By Document Name Document Title Size (KB)

10/14/2013 C:\Documents and

Settings\All Users\Application

Data\USDA\FSIS\CCMS2\\C

CMS2TMP_f9d55494_ffc1_42

0d_a99c_19232f9c068c.data

Leg quarters package, picture 3 594.75




CMS2TMP_98c05bc2_5957_

48f4_83ca_155297db7e78.da

ta

est. letter 2,174.30




CMS2TMP_c82809d7_7234_

406b_9349_56444c74002a.d

ata

verification form 516.98




CMS2TMP_22123e8b_e77c_

44f1_8faa_dbf90c713900.dat

a





CMS2TMP_ab73b5dd_f57e_4

c23_b59d_e15364e8968b.dat

a


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Washington, D.C. 20250

October 16, 2013 To: Foster Poultry Farms 1000 Davis St. Livingston, CA 95334 From: Consumer Complaint Monitoring System Food Safety and Inspection Service Please find enclosed a copy of a consumer complaint received by the U.S. Department of Agriculture, Food Safety and Inspection Service (FSIS). According to the consumer report, the complaint involves a product produced by your establishment. FSIS has entered the information into the Consumer Complaint Monitoring System - an electronic database designed to document and track all consumer complaints received by the agency. FSIS has determined that no further action is necessary at this time. However, your review of the enclosed report may indicate that unilateral actions on your part are needed. You do not need to reply to this communication. Sincerely, The CCMS Surveillance Team Applied Epidemiology Division Office of Public Health Science

Case Number: 2013-0702 Date Reported: 10/14/2013 Complainant Location: Las Vegas, NV Establishment: 06137 P Foster Poultry Farms Product Brand: Foster Farms Product Name: Leg quarters Package Size: 6.12 lbs. net weight Codes: Purchase Point: Food 4 Less Date: 10/7/2013 Primary Complaint: Illness Complainant Comment: The complainant bought 1 package (net weight 6.12 lbs.) of Foster Farms leg quarters on Monday, Oct. 7, 2013, at approximately 0800 hours, from Food 4 Less on 8180 S. Las Vegas Blvd., Las Vegas, Nevada. He said that, at approximately 1000 hours on that same day, he cooked and consumed some of the product. He said he went to sleep, and he woke up feeling muscle pains at around 6pm or 7pm that day. He said he also experienced the following symptoms: headache, chills, hot flashes, vomiting, and diarrhea. He said he also felt sluggish. He said he was experiencing these symptoms until Friday, Oct. 11, when the diarrhea began to stop. He said he went to the hospital on Sunday, October 13, for the pains he was still experiencing. He said the hospital wanted to take a stool sample but that he already went to the bathroom before going to the hospital, so the hospital took 2 blood samples for diagnostics. He went to Valley Hospital Medical Center on 620 Shadow Lane, Las Vegas, Nevada, 89106. The hospital gave him Cipro and Norco. He indicated that the establishment number on the packaging is Est. P6137 with a use by/freeze by date of October 9, 2013. He said that he still has the product and packaging at his home. He is still currently experiencing side pains on the right side of his body. He has not been able to eat. His headache comes and goes. Sampling Instructions: NOTICE: REPORT CONTAINS UNVERIFIED INFORMATION FURNISHED BY COMPLAINANT

0

1

2

3

4

5

Num

ber o

f Pat

ient

s

Illness Onset Date

Probable (n=14)Confirmed (n = 13)

San Mateo County (CA) Salmonella Infection Cluster Case-Patients by Illness Onset Date, September 2013 (N=27)

(as of 10/4/13)

Date of Illness Onset

Persons infected with the outbreak strains of Salmonella Heidelberg and by date of illness onset*

Number of persons

2013

*known and estimated onset date

0

1

2

3

4

5

6

2/22 3/1 3/8 3/15 3/22 3/29 4/5 4/12 4/19 4/26 5/3 5/10 5/17 5/24 5/31 6/7 6/14 6/21 6/28 7/5 7/12 7/19 7/26 8/2 8/9 8/16 8/23 8/30 9/6 9/13 9/20

JF6X01.0672JF6X01.0326JF6X01.0258JF6X01.0122JF6X01.0045JF6X01.0041JF6X01.0022

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Information reported may be incomplete and should be considered preliminary. It is subject to change as information is updated. More detailed information is available upon request. This information is to be considered confidential and is to be shared with colleagues on a strict need-to-know basis. Case-specific health information, proprietary information, and

establishment-specific information should be carefully reviewed before further dissemination.

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CCMS II EIAO Verification Report

CCMS Case Number Reporting Date Incident Date and Complaint Description

2013-0702

10/14/2013 Illness possibly associated with raw

10/07/2013 chicken product; Medical visit required. I

I

Please verify the following information when visiting with the consumer:

EST Number Establishment Name and Address

P6137 Foster Poultry Farms Livingston, CA 95334

Use/Sell By Date Product Name(s) and Description

10/09/2013 Foster Farms Leg Quarters

Lot Number Explanation of Product Date and Lotting

FSIS Processing Type (Select One)

l:l

1. What is the condition of the index product packaging? (e.g.,intact,non-intact,puncture holes, etc.)

2. What is the condition of the index product? (e.g., no abnormalities,off-color,off-odor,etc.)

3. Description of foreign object(s),if applicable.

Type

Shape

Color

Dimensions

4. Additional observations or notes:

5. Sampling submission instructions:

please collect and send to:

ATTN: Laboratory Supervisor, FSIS OSEL Russell Research Center, 950 College Station Rd, Athens, GA 30605.

NOTE: FSIS Forms 10,000-2: Domestic Laboratory Report (inspector generated) and 8000-17: Evidence Receipt and Chain of Custody should be filled out and included with samples. See FSIS Directive 7355.1 and MLG Chapter 10 for guidance on sample seals and procedures. 11

6. Insert pictures in the spaces provided. Pictures should contain at a minimum, packaging codes, the product and foreign objects against an object for size comparison (e.g. coin, ruler, etc.). Double click above the word "Image" to add files.

NOTE: The total file size for all pictures should be no greater than 2 MB or the system may time-out when attempting to upload the file. Please use a picture editing program such as Microsoft Office Picture Manager to compress the file sizes, if necessary. large files or extra pictures can be uploaded directly to the documents sections of the case.

Image 1 Image 2

I Reset Image 1

I I Reset Image 2 I

lmage3 lmage4

I Reset Image 3 I I Reset Image 4 I

NOTE: When completmg th1s form, please be as descnpt1ve as poss1ble m order to g1ve the reader a clear p1cture of what

you are relating in each response. Thank you.