Michael Booth of the Denver Post published an excellent investigative piece Friday about a 2009 E. coli outbreak that appeared linked to lettuce at restaurants in six states, but was never made public. Excerpts below:

The FDA's decision to let the six-state E. coli probe go dormant, despite clear leads, is part of what some food safety experts call a worrisome "cone of silence" around leafy green produce problems in the United States. These experts say the FDA dropping promising outbreak clues blocks efforts to force better growing and packing methods.

And they say the federal government's tendency to avoid naming names — even when state officials know the producers and suppliers — robs consumers of vital information. In an October 2011 salmonella outbreak that sickened 68, federal agencies told journalists there was no public benefit in being more specific than problems at Mexican "Restaurant Chain A."

It was the Oklahoma health department that disclosed the chain where many victims had eaten was Taco Bell.

"As someone who is out in fields with farmers, it's really hard to get them excited about food safety if they never hear about other outbreaks," said Doug Powell, a Kansas State University food scientist who advocates for wider probes and public disclosure. "We have evidence that telling stories makes a difference."

"I will forever be mad that the FDA didn't pursue" the 2009 E. coli cases that included Colorado, said Kirk Smith, a veterinarian and supervisor of the foodborne disease investigation section of the Minnesota Department of Health.

"It was a smaller outbreak, but still, if you figure out what the food is, even after the fact, you can hopefully get back to where that food was produced and perhaps correct something so there's not a bigger outbreak in the future."

State health officials grow nervous every September with the crowds, heat and open-air food at the Colorado State Fair in Pueblo. When two cases of E. coli O157:H7 matched at the state lab, one from a Jefferson County child and another from a Pueblo County child, health investigators moved fast.

County reporting forms showed both sick kids had attended the state fair. State officials urged the counties to speed up questioning, trying to nail down where the kids ate and what foods they had in common.

As they waited for more answers, cases in Minnesota, Iowa and three other states loaded illness cases into a national network and matched the genetic fingerprint.
Cases in Minnesota and Iowa had eaten at the same Italian-style restaurant in Omaha, Nebraska, in early September. So had a North Carolina case. When Colorado got its deeper case histories back, it found both state victims had eaten at an Italian-style restaurant in Pueblo.

More questions zeroed in on house salads. Even when the victims hadn't ordered salad, they had nibbled from a family member's plate. Eight of 10 cases had eaten lettuce at a restaurant, according to a Colorado outbreak memo obtained through the open records act.

States sought the restaurants' suppliers. Colorado learned that the lettuce used in Pueblo came from a major produce supplier in the Salinas Valley of California, Tanimura & Antle.

The patients, meanwhile, made slow recoveries. Some were in the hospital for days. E. coli is particularly worrisome to food experts because it can cause severe gastroenteritis, pneumonia and kidney failure.

And then the FDA and CDC dropped the case.

Once state public health officials identify an out-of-state supplier, they rely on the federal government's powers to move across boundaries and push outbreak probes forward. But what Colorado and Minnesota officials heard was silence.
By mid-October, officials in those states asked the CDC and FDA for a status on the case. On Oct. 28, according to e-mail records released by Colorado, CDC epidemiologist Colin Schwensohn told the states "with no recent cases, this cluster is less of a priority."

Minnesota's Smith fired back the same afternoon, saying "I think it is a huge mistake for FDA to drop this." Smith's e-mail to the CDC and other investigators, which he acknowledged was a "rant," went on:

"If FDA won't fully engage and work backwards from 2 restaurants on a rock solid lead, then all of their claims about making things better are all so much talk."

Colorado officials took a more measured approach, but still protested. "Colorado and other states challenged this decision, but FDA did not change its position about pursuing the traceback further," according to a state memo.

Colorado epidemiologist Alicia Cronquist said in an interview, "We were extremely frustrated." The states got on a conference call and said a deeper probe would prevent future outbreaks, Cronquist said.

The FDA declined comment, beyond the limited information about the federal agencies' reasoning contained in e-mails at the time, which were released by Colorado in the open records request. Neither the FDA nor the CDC offered responses to specific questions about the 2009 outbreak, or to general questions about how investigations end.

"Consumers of food have a right to know, period. And as taxpayers, consumers have a right to know what public health officials know about those same food producers," said Seattle attorney Bill Marler, a litigator for outbreak victims. Marler's firm was briefly a co-counsel for one of the Colorado victims suing over the 2009 E coli illnesses.

Early e-mails in the 2009 outbreak identified the restaurants that consumers said they had in common. Colorado named the produce grower, Tanimura & Antle, in its wrap-up memo, but said the restaurants did not appear to be at fault. Tanimura & Antle did not return calls seeking comment.

KSU's Powell argues for more disclosure. At the least, he said, CDC policy should make it clear why they name some restaurants and producers, and not others. The CDC stuck with "Restaurant Chain A" for the October 2011 salmonella outbreak even though Oklahoma had disclosed half the victims had eaten at Taco Bell.

"If Taco Bell keeps making people sick with lettuce, I want to know it's Taco Bell," he said. "How bright are they in choosing their lettuce suppliers?"
Taco Bell did not return phone calls seeking comment.

Cronquist said Colorado tries to strike a balance. If the public is still at risk from food, companies are identified. But the state also needs compliance from various facilities while it investigates. Moreover, victim interviews can be skewed by early disclosure; if they have heard "Taco Bell" or "green onions," it can bias their answers.

Larry “Larry” Goodridge (right, exactly as shown) got it right when he said farmers bear primary responsibility for food safety and they shouldn’t rely on third-party audits, but should retroactively fail my risk analysis course for saying Colorado’s response to the listeria-in-cantaloupe outbreak that killed 36 people "was as close to perfect as we are going to see" and that "Our food supply is one of the safest in the world, if not the safest."

Goodridge, an associate professor of food microbiology at Colorado State University, did follow up by telling the Governor's Forum on Colorado Agriculture yesterday, “But if you were to ask that question of family members who had someone die, they would tell you our food supply is not safe." Lots of people would say the food supply is not safe. Maybe about 48 million of them. Best to keep meaningless rankings out of the equation.

He also said the state could improve by creating a team that activated within hours of an outbreak, and that the government should target spending on high-risk produce — in particular, by educating farmers who grow high-risk produce. More focus on food inspectors isn't likely to significantly improve the system. Larry urged farmers to focus on sanitary practices such as keeping equipment and storage areas clean. He also urged them to educate the public on ways to safely handle produce in the same manner as consumers are advised how to safely handle meat.

As usual, no details were provided on how best to do this so-called education, for farmers or consumers.

Farm Fresh Direct chief executive Jim Knutzon, said he expects the federal government will write more specific regulations for growing cantaloupe and other produce. Then third-party auditors — hired by farms to inspect their operations — will have to check for specific standards called for by the Food and Drug Administration.

As the number of illnesses and deaths linked to Colorado cantaloupe continues to climb, the state said it will promote stronger oversight of its cantaloupe industry helping farmers create a certified label potentially backed by safety training, auditing and lab testing for pathogens.

State Agriculture Commissioner John Salazar told the Denver Post the measures — now under discussion with farmers and agriculture experts — could help right the melon business after 28 deaths and one miscarriage from Jensen Farms cantaloupes.

Salazar acknowledged, though, that the state does not have new resources to fund such a certification program. A new system would rely on budget shifts or payments from the farms themselves, as other industries currently do.

• A "Colorado Proud" label, or even one specific to the Rocky Ford area, could be used by farmers who meet certain criteria.

• Standards to earn the label would include undergoing safety training created by Colorado State University, and proof of outside audits of how those safety practices are carried out.

• CSU extension facilities in southeastern Colorado are capable of lab testing; depending on the response time on results, farms could seek a pathogen-free lab test before harvest and possibly additional lab tests during the short cantaloupe shipping season.

Follow the poop to find the listeria.

I keep getting asked about confined animal feeding operations or CAFOs as the cause of the listeria-in-cantaloupe outbreak that has killed at least 18 and sickened 100.

I say, all animals poop.

The deer that caused E. coli O157:H7 outbreaks in Odwalla juice in 1996 that killed a 16-month-old child, or local Oregon strawberries in 2011 that killed one and sickened 14, had nothing to do with CAFOs.

Neither did the sheep in 1981, which were used to crapping on a cabbage field in Nova Scotia (that’s in Canada) and led to a listeria outbreak linked to coleslaw that sickened seven adults and led to 34 perinatal infections, according to a report on the outbreak published in 1983 in the New England Journal of Medicine (NEJM).

Lisa Schnirring of CIDRAP cites Dr. Lawrence (Larry) Goodridge, a food microbiologist in the department of animal sciences at Colorado State University in Fort Collins, as saying all potential sources of contamination are being considered, including irrigation water, soil, "biosolids," and contamination from animal incursions.

Goodridge said in the region of Colorado where cantaloupes are grown—though not necessarily at the farm implicated in the outbreak—sheep are often grazed on cantaloupe fields following harvest.

"If that practice was followed at Jensen Farms, then there is the possibility of sheep manure contaminating the cantaloupe with L monocytogenes," he said. A similar scenario occurred in Nova Scotia, Canada, in 1981 when a listeria outbreak caused by tainted cabbage was traced to the use of sheep manure as fertilizer, Goodridge added.

Goodridge said another puzzling aspect of the cantaloupe Listeria outbreak is that four different pulsed-field gel electrophoresis (PFGE) profiles have been identified, falling into two distinct serotypes, which could suggest multiple contamination events or a contamination event from multiple sources, such as different animals.