More details from the Oregon E. coli O157:H7 raw milk outbreak.

Lynne Terry of The Oregonian writes the latest outbreak associated with raw milk has put a toddler and two young teens from the Portland metro area in the hospital with E. coli poisoning, two with kidney failure.

A fourth child -- also under 15 -- fell ill but was not hospitalized.

Officials from Oregon Public Health said Friday the children consumed raw milk from Foundation Farm, a family run operation in Wilsonville. At least seven other people who drank the farm's raw milk -- adults and children -- have developed either diarrhea or bloody diarrhea, a sign of E. coli O157:H7.

The outbreak could grow. Foundation Farm, which agreed to stop production, sold raw milk to 48 families in Multnomah, Clackamas and Washington counties through a herd-sharing program. By Friday afternoon, state epidemiologists had only interviewed about half of them.

Dr. Katrina Hedberg, state epidemiologist, said anyone with the farm's raw milk or products made from the milk should throw them out.

A total of 20 states nationwide ban the sale of raw milk and 13 restrict sales. Oregon allows retail distribution of raw goat's milk but not raw cow or sheep's milk, which can only be sold directly to consumers at farms with no more than two producing cows and a maximum of nine producing sheep.

Foundation Farm has four cows, three that are lactating. But the farm is not breaking the law because herd-sharing programs are not regulated, said Bruce Pokarney, spokesman for the Oregon Department of Agriculture.

"There is no sale going on technically," he said. "The people who have
shares of the herd own the cows. That milk is their milk. It's as if they are living on the farm."

The company is owned by Bradley Salyers, according to a filing with the Oregon Secretary of State. The company took down its website, and Salyers could not be reached Friday for comment.

"There are laws that prohibit the retail sale (of raw milk) because this is not a safe product," Hedberg said. "People think there is a controversy. There is no controversy. People routinely used to get sick from raw milk."

An updated table of raw milk related outbreaks is available at http://bites.ksu.edu/rawmilk.

Fresh Del Monte is ending its lawsuit against Oregon health officials who linked a salmonella outbreak to its Guatemalan cantaloupe.

In August, Coral Gables, Fla.-based Del Monte Fresh Produce NA Inc. said it would sue the Oregon Health Authority’s Public Health Division and the agency’s top scientist over how it handled the investigation of the February and March 2011 outbreak that sickened 20 people in the western U.S. and Pennsylvania and Maryland.

Lynne Terry of The Oregonian reported yesterday that Del Monte Fresh Produce said in a letter e-mailed to the state earlier this month that it would not act on its notice to sue William Keene and Oregon Public Health.

"Obviously, it's a relief for us that that's withdrawn so now we can focus on the job we're supposed to do which is to protect the public's health," said Dr. Katrina Hedberg, state epidemiologist. The tort claim filed last August had gobbled up time of state scientists and lawyers dealing with it, she said.

The claim was unprecedented. State epidemiologists investigate dozens of foodborne illness outbreaks every year and name the culprits to prevent more people from getting sick. No other company has ever filed a suit or threatened to sue Oregon over one of those investigations.

"There have been lots of outbreaks," Hedberg said. "Why some companies choose to work with public health and others want to fight it -- I can't answer that."

Del Monte Fresh Produce wouldn't either. A spokesman said the company "does not comment on ongoing or closed investigations."

The company's letter said the withdrawal marked "a show of good faith" in its discussions with Oregon Public Health over food safety. It asked for another meeting with Oregon's top food safety detectives.

The state agreed to a meeting in Portland.

"I'm not sure why they want it," Hedberg said. "We work with businesses and companies but that does not preclude us from notifying the general public if we find a food item that's been responsible for an outbreak or cluster of illnesses."

The saga dates to January 2011 when people started getting sick. In March, the company recalled nearly 60,000 whole cantaloupes imported from its facility in Guatemala. The recall notice, published on the Food and Drug Administration website, said the melons could be contaminated with Salmonella Panama, the strain involved in the outbreak.

In July, the FDA imposed an import alert, effectively banning the sale of the Guatemalan melons until the company demonstrated they were safe. Located in Coral Gables, Fla., Del Monte Fresh Produce is a major importer of cantaloupe. A third of its supply comes from Guatemala.

The company, which is not part of the Del Monte Foods conglomerate, responded to the alert by filing suit against the FDA. Then in August, it filed the tort claim against Keene and Oregon Public Health along with a separate ethics complaint against Keene.

The documents said Keene conducted a shoddy investigation. They said he never found salmonella in its cantaloupes but named the company anyway. Del Monte Fresh Produce also blamed Keene for the recall, saying he pushed the FDA to take action.

But Keene was not the only epidemiologist who concluded that Del Monte Fresh Produce was to blame in that outbreak. His peers in Washington state reached the same conclusion.

In September, the FDA lifted its import alert and Oregon's Government Ethics Commission dismissed the ethics claim against Keene.

At the time, Kirk Smith, epidemiology supervisor for the Minnesota Department of Health, told the Washington Post it’s rare for scientists investigating foodborne illness outbreaks to test the exact food suspected of carrying pathogens. By the time symptoms occur and a foodborne illness is reported and confirmed, the product in question has likely been consumed or has exceeded its shelf-life and been thrown away.

Instead, scientists, like detectives, interview victims, collect data, analyze patterns and match food “fingerprints” to determine the likely source of an outbreak.

“The majority of outbreaks, we don’t have the food to test,” Smith said. “Laboratory confirmation of the food should never be a requisite to implicating a food item as the vehicle of an outbreak.

Epidemiology is actually a much faster and more powerful tool than is laboratory confirmation.”

 In the first known outbreak of Escherichia coli O26 in a U.S. child care center, neither severe illness nor a secondary household transmission was reported, according to results presented during the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.

Data on duration of Shiga-toxin-producing E. coli serotype O26 shedding are limited, but shedding can be prolonged. However, the need for separation of infected children who have this apparently low-virulence infection remains uncertain, according to Mathieu Tourdjman, MD, MPH, CDC Epidemic Intelligence Service Officer with the Oregon Health Authority.

“The study raised more questions than it answered,” Tourdjman said during his presentation. “Child care exclusion policies vary across country. Most frequently, the policy states that children infected with O157 should be excluded until at least two consecutive stool samples are negative. Because limited data on O26 are available for O26 infection, no consensus exists on whether similar exclusion should occur.”

The outbreak of E. coli O26 occurred in an Oregon child care center in October 2010. Children who attended the child care facility were aged in range from 6 weeks to 12 years. They were separated by age into six different classrooms.

According to Tourdjman, infected staff and parents of infected children provided demographic and clinical information. Secondary transmission to household members was assessed by screening stool specimens for Shiga toxin using PCR. Positive isolates were isolated and serotyped. Cases in this particular outbreak were defined as laboratory-confirmed O26 infection among attendees or staff during October 2010.

Results of the study revealed a total of 10 cases of E. coli O26: nine children (median age: 1 year) and one staff member. Patients were in three different classrooms and not clustered. Four patients reported diarrhea, including one with bloody diarrhea, but none of the patients progressed to hemolytic uremic syndrome or required hospitalization.

The findings of the investigation also revealed that duration of shedding ranged from 12 to 46 days (median 25 days), and a lack of secondary transmission to household members.

Tourdjman M. #L1-389. Duration of Shedding and Secondary Transmission of Shiga-Toxin-Producing Escherichia coli O26 During an Outbreak in a Child Care Center:: Oregon, October 2010. Presented at: 51st ICAAC. Sept. 17-20, 2011. Chicago.

Del Monte Fresh Produce, a company that recalled its cantaloupes in March after health investigators in several states linked them to a Salmonella Panama outbreak, said yesterday that is plans to sue Oregon Health Authority and, Dr William Keene, one of the nation's most well-known disease outbreak investigators (right, exactly as shown), claiming that the company's products were wrongly singled out.

Lisa Schnirring of CIDRAP news at the University of Minnesota interviewed several public health types, who say the company's suit is unprecedented, and some worry that it may inhibit future foodborne illness investigations.

Lon Kightlinger, MPH, PhD, state epidemiologist with the South Dakota Department of Health, said some of his department's disease investigations have involved legal tug-of-wars. "Although we do have some worries of legal threats, that does not drive our investigation, but causes us to do a better job," he said.

In Iowa, laws require public health officials to treat the names of entities such as restaurants or companies the same as people, said Patricia Quinlisk, MD, MPH, medical director and state epidemiologist for the Iowa Department of Public Health.

She said that, before going public with names, health officials must discuss the issue with the state attorney general's office to make sure the action complies with a "necessary for public health" clause. "Thus something like this might have more scrutiny here than other places," she said, adding that she's never seen a legal threat like Del Monte's.

Tim Jones, MD, MPH, state epidemiologist for the Tennessee Department of Health, said he's been bullied and subjected to implied threats in the course of epidemiologic investigations. "I've never taken them seriously, and legally I've never been worried," he said.

Though Del Monte's legal threat could create an inhibitory effect, epidemiologists take pride in being able to respond to outbreaks faster and freer than federal agencies, which are often bound by legal restrictions, Jones said.

"Our job is to protect people."

Some measure of immunity is needed for investigators, Jones said. "If anyone in public health is nervous about getting sued, it could be dangerously inhibitory."