Seventy-one Smith's stores throughout five Western states were told Thursday afternoon to remove and destroy hundreds of heads of iceberg lettuce after the company received an urgent recall notice due to possible salmonella contamination.

However, by early Friday afternoon the recall had been downgraded from "urgent" to "precautionary and voluntary," according to Smith's Food and Drug spokeswoman Marsha Gilford.

Lettuce from the central California produce company is not known to have had any salmonella contamination.

Smith's officials got the original, urgent — so-called Class 1 — recall around 4 p.m. Thursday, Gilford said. Workers at all 71 Smith's at stores in Utah, Idaho, Wyoming, Montana and northern Nevada began removing iceberg lettuce from shelves.

Friday, when it was clarified that the actual source of the salmonella was not a Growers Express lettuce field but a nearby one owned by another company, the recall was downgraded to Class 2: voluntary and precautionary.

Salmonella was apparently found in an Arizona field adjacent to the grower’s property.

None of the lettuce in the markets has tested positive for salmonella but the grower alerted retailers of the test results and sought a withdrawal of the product “out of an abundance of caution.”

“There’s no evidence of contamination on any product whatsoever,” Jamie Strachan, CEO of Salinas, Calif.-based Growers Express, told The Associated Press on Friday.

Still, The Kroger Co. and its affiliated grocery chain, Smith’s Food and Drug, decided to pull the product from 200 stores in at least seven states, including Virginia, West Virginia, North Carolina, Utah, Wyoming, Idaho and Nevada, Kroger spokesman Keith Dailey said.

Dailey called it a cautionary move prompted by a notice from the grower.

Strachan stressed that none of his company’s product has tested positive for salmonella, and that crops growing in the adjacent field south of Phoenix were destroyed. He would not say who owned the tainted property.

“They’re pulling the lettuce to be on the safe side, but there’s no official recall,” Utah Department of Agriculture and Food spokesman Larry Lewis said.

To notify customers, Smith's had put up signs in its produce departments, made automated phone calls to customers with Smith's discount card information and printed out warnings on those people's receipts, she said.

Cross-contamination has been identified by WHO and CDC as a risk-factor that could lead to foodborne illness. Some folks, me included, have suggested that we don't know a whole lot about cross-contamination (mechanisms for transfer and how often they happen). In a study a couple of years ago, we video recorded handling practices in food service kitchens, and saw quite a bit of cross-contamination. 

And most of it was indirect - where equipment or utensils (like sinks and knives) was an intermediate that facilitated transfer.

The newest food safety infosheet, a graphical one-page food safety-related story directed at food businesses, demonstrates some of the consequences of indirect cross-contamination.

Food Safety Infosheet Highlights:
- 75 ill with salmonellosis after eating at the Tenth Hole Tea Rooms in Southsea (U.K.)
- Salmonella found in pre-cooked pasta and dishcloths, staff tested positive
- Don't wash raw meats. Salmonella and other bugs can be sprayed up to 3 feet away by washing.

Click here to download the sheet.

A day after Missouri health types announced the source of the Schnucks-salad-bar-related E. coli O157 outbreak may never be found, the feds announced they found a source.

The U.S. Centers for Disease Control (CDC) reported today that as of Dec. 4, 2011, 60 persons infected with the outbreak strain of E. coli serotype O157:H7 had been reported from 10 states.

Collaborative investigative efforts of state, local, and federal public health and regulatory agencies indicate that romaine lettuce is the likely source of illnesses in this outbreak, and contamination likely occurred before the product reached retail stores.

CDC called Schnucks Chain A, and the farm the lettuce was traced to Farm A, without saying in what state the lettuce originated. But one of the Missouri health types did, saying a grower in California was suspected of being connected but records were “insufficient to complete the picture.”

The public reporting of this outbreak reeks of the Leafy Greens Cone of Silence – that the most noticeable achievement since the California Leafy Greens Marketing Agreement was created in the wake of the 2006 E. coli O157-in-spinach mess is the containment cone of silence that has descended upon outbreaks involving leafy greens.

Things didn’t sound quite right back on Oct. 28, 2011, when St. Louis County health officials first publicly confirmed that the source of the E. coli O157 strain that had sickened 23 people was foodborne, but that the investigation was ongoing. Though retailers have not been asked to pull any food, Schnucks voluntarily replaced or removed some produce in salad bars and shelves, beginning Oct. 26, 2011.

"Once we heard that the health department had declared an outbreak, we took some proactive steps with our food safety team to switch products out that recent history told us could be potential sources," said Schnucks spokeswoman Lori Willis.

A Schnucks store, Culinaria in downtown St. Louis, put a sign up on empty shelves that read in part, "Due to a voluntary recall on pre-packed lettuce, we will not be able to produce these pre-made salads. Be assured quality is our main concern. All of the lettuce on the salad bar is fresh and not involved with the recall."

As a retailer, Schnucks drew my attention earlier this year when it announced it was expanding its so-called Peace of Mind initiative from pricing to quality assurance with a new website, www.peaceofmindquality.com, that emphasizes the chain’s dedication to quality and food safety. Unfortunately, quality and safety are seemingly used interchangeably on the website when they are actually two different concepts.

A table of leafy green related outbreaks is available at http://bites.ksu.edu/leafy-greens-related-outbreaks.

I'm not feeling peace of mind.

More from the CDC report:

As of December 4, 2011, 60 persons infected with the outbreak strain of E. coli O157:H7 have been reported from10 states. The number of ill persons identified in each state is as follows: Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3), Missouri (37), and Nebraska (1).

Among persons for whom information is available, illnesses began from October 10, 2011 to November 4, 2011. Ill persons ranged in age from 1 to 94 years, with a median age of 29 years old. Sixty-three percent were female. Among the 45 ill persons with available information, 30 (67%) were hospitalized, and 2 developed hemolytic uremic syndrome (HUS). No deaths have been reported.

Collaborative investigative efforts of state, local, and federal public health agencies indicate that romaine lettuce sold primarily at several locations of a single grocery store chain (Chain A) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached grocery store Chain A locations.

Ill persons reported purchasing salads from salad bars at grocery store Chain A between October 5 and October 24, 2011. A total of 9 locations of grocery store Chain A were identified where more than one ill person reported purchasing a salad from the salad bar in the week before becoming ill. This included 2 separate locations where 4 ill persons reported purchasing a salad at each location. For locations where more than one ill person reported purchasing a salad from the salad bar and the date of purchase was known, dates of purchase were all within 4 days of other ill persons purchasing a salad at that same location. Chain A fully cooperated with the investigation and voluntarily removed suspected food items from the salad bar on October 26, 2011, out of an abundance of caution. Romaine lettuce served on salad bars at all locations of grocery store Chain A had come from a single lettuce processing facility via a single distributor. This indicates that contamination of romaine lettuce likely occurred before the product reached grocery store Chain A locations.

The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of grocery store Chain A and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply the grocery store Chain A locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus. Preliminary findings of investigation at Farm A did not identify the source of the contamination. Farm A was no longer in production during the time of the investigation.

From July to Oct. 2010, 136 people in London and east England were sickened by Salmonella Java phage type 3b variant 9. Gobin et al., from the U.K. Health Protection Agency, report in Eurosurveillance today that most cases were female with a median age of 39.5 years and lived in London. Results of epidemiological investigations are compatible with salad vegetables as the potential source, but no common suppliers of salad were identified and no organisms were isolated from environmental and food samples.

S. Java is present in poultry flocks in the European Union and is the most common serovar reported in poultry in the Netherlands. Outbreaks of S. Java have been reported in the past, associated with salad vegetables, goat’s milk cheese, poultry, reptiles and tropical fish aquariums. S. Java is an uncommon cause of salmonellosis in the United Kingdom (UK), with 151, 112 and 130 cases reported in 2007, 2008 and 2009 respectively according to the national database.

In 2007, a multi-country outbreak of S. Java phage type (PT) 3b variant 9 (var9) involved cases in Denmark, Finland, the Netherlands, Norway, the UK and the U.S. Epidemiological evidence suggested an association with salad vegetables.

The results of the case–case study confirmed a significant association between symptomatic infection of S. Java PT 3b var9 and eating out at restaurants, eating pre-packaged mixed salad leaves at home, consumption of salad leaves from takeaway restaurants and eating any salad leaves either at home or purchased from commercial catering settings. Since salad is often used as a garnish in meals eaten in commercial catering settings, it is possible that the model underestimated the proportion of cases who consumed salad leaves away from home.

We cannot exclude the possibility that the study may have missed the right vehicle of the outbreak such as sprouted seeds which have been implicated in two recent outbreaks in Europe. It is likely that the consumption of smaller food items (seeds, sprouted seeds and herbs) in salads prepared by commercial caterers was not remembered or was not noticed by cases. None of the smaller salad items were found to be associated with cases during the hypothesis generation. It is possible that salad leaves were a confounding factor in this investigation and smaller, less memorable items should be considered in outbreaks where salad vegetables appear to be implicated.

Environmental investigations did not identify common suppliers of salad vegetables and the short shelf life of salad vegetables limited the ability to acquire any suspect foods for microbiological analysis.

The contamination of salad leaves and salad vegetables during their production and processing has been implicated in a number of geographically widespread outbreaks. High risk practices during production and processing include the use of contaminated water either to irrigate the crops, to apply pesticides or other dressings, or to wash the crop once harvested; the use of human or animal sewage as a crop fertilizer; and the transport of the harvested crop in a contaminated vehicle/storage system, e.g. trucks previously used for transporting waste. Crops growing in the field are also vulnerable to contamination from sources such as wild animals and birds

Gastrointestinal infection associated with salad vegetables may also be the result of cross-contamination from poultry, meat or meat products or contamination by the food handler during food preparation in the home or in catering establishments. A review of more than 2,000 general foodborne outbreaks from 1992 to 2006 undertaken by the HPA found that 4% of them were associated with prepared salads. The review found that most of the outbreaks linked to salads occurred in the catering sector and were associated with infected food handlers, cross-contamination and poor storage.

The increase in illness and outbreaks associated with the consumption of fresh ready to eat salad vegetables indicates the ongoing need to improve methods in the production and preparation of these foods to reduce the potential for contamination with Salmonella and other enteric pathogens.

The complete epidemiological write-up, with a full discussion of limitations, is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20023.