with monocytogenes Listeria monocytogenesListeria Outbreak ...€¦ · Listeria...
25
Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Outbreak Associated with Listeria monocytogenes Outbreak Associated with Outbreak Associated with Sprouts Outbreak Associated with Sprouts Sprouts Sprouts Tracy Stiles Tracy Stiles Massachussetts Dept. of Public Health State Laboratory Foodborne Disease Surveillance Laboratories Unit Massachussetts Dept. of Public Health State Laboratory Foodborne Disease Surveillance Laboratories Unit Brian D. Sauders, Ph.D. New York State Dept. of Agriculture & Markets Brian D. Sauders, Ph.D. New York State Dept. of Agriculture & Markets Food Laboratory, Microbiology Section Food Laboratory, Microbiology Section
Transcript of with monocytogenes Listeria monocytogenesListeria Outbreak ...€¦ · Listeria...
List
eria
mon
ocyt
ogen
esLi
ster
iam
onoc
ytog
enes
List
eria
mon
ocyt
ogen
esO
utbr
eak
Ass
ocia
ted
with
List
eria
mon
ocyt
ogen
esO
utbr
eak
Ass
ocia
ted
with
Out
brea
k A
ssoc
iate
d w
ith
Spro
uts
Out
brea
k A
ssoc
iate
d w
ith
Spro
uts
Spro
uts
Spro
uts
Trac
y S
tiles
Trac
y S
tiles
Mas
sach
usse
tts D
ept.
of P
ublic
Hea
lth S
tate
Lab
orat
ory
Food
born
e D
isea
se S
urve
illan
ce L
abor
ator
ies
Uni
tM
assa
chus
setts
Dep
t. of
Pub
lic H
ealth
Sta
te L
abor
ator
yFo
odbo
rne
Dis
ease
Sur
veill
ance
Lab
orat
orie
s U
nit
Bria
n D
. Sau
ders
, Ph.
D.
New
Yor
k S
tate
Dep
t. of
Agr
icul
ture
& M
arke
tsB
rian
D. S
aude
rs, P
h.D
.N
ew Y
ork
Sta
te D
ept.
of A
gric
ultu
re &
Mar
kets
pg
Food
Lab
orat
ory,
Mic
robi
olog
y S
ectio
np
gFo
od L
abor
ator
y, M
icro
biol
ogy
Sec
tion
Ove
rvie
wO
verv
iew
Ove
rvie
wO
verv
iew
•Li
ster
iam
onoc
ytog
enes
•Li
ster
iam
onoc
ytog
enes
•Li
ster
ia m
onoc
ytog
enes
•Li
ster
ia m
onoc
ytog
enes
•Li
ster
iain
pro
duce
& s
prou
ts•
List
eria
in p
rodu
ce &
spr
outs
•O
utbr
eak
inve
stig
atio
n•
Out
brea
k in
vest
igat
ion
g
Sm
mar
g
Sm
mar
•Su
mm
ary
•Su
mm
ary
Hum
an L
iste
riosi
sH
uman
Lis
terio
sis
zC
linic
al s
pect
rum
–G
astro
ente
ritis
(dia
rrhe
a)–
Inva
sive
dis
ease
, thi
rd tr
imes
ter a
borti
ons
zB
urde
n of
hum
an d
isea
se (C
DC
Foo
dNet
)–
~250
0 es
timat
ed c
ases
in th
e U
S/y
ear
–~9
2% c
ases
are
hos
pita
lized
–~2
0-30
% m
orta
lity
(~50
0 de
aths
/yea
r)
Prim
arily
affe
cts
zPr
imar
ily a
ffect
s–
Per
sons
<1
y.o.
and
> 6
0 y.
o. o
r tho
se w
ith u
nder
lyin
g im
mun
o-co
mpr
omis
ed c
ondi
tions
–H
owev
erca
naf
fect
norm
ally
heal
thy
pers
ons
How
ever
, can
affe
ct n
orm
ally
hea
lthy
pers
ons
zD
istr
ibut
ion
of c
ases
–M
ost c
ase
repo
rts c
onsi
dere
d sp
orad
icos
tcas
eep
ots
cos
deed
spo
adc
–La
rge
outb
reak
s ha
ve o
ccur
red
List
eria
mon
ocyt
ogen
esLi
ster
ia m
onoc
ytog
enes
zC
onsi
dere
d “u
biqu
itous
” in
natu
re.
zL.
mon
ocyt
ogen
esca
n su
rviv
e in
stre
ssfu
l en
viro
nmen
ts;
9ve
ry a
cidi
c (p
H 2
.5)
9hi
gh s
alt (
10 to
15%
)g
()
9ex
trem
e te
mpe
ratu
res
(-0.
4 to
50°
C)
S99
%f
fdb
zS
ourc
e: 9
9% o
f cas
es a
re fo
odbo
rne.
9C
onta
min
atio
n is
ofte
n lin
ked
to p
roce
ssin
g pl
ants
, but
th
ero
leof
cont
amin
atio
nin
reta
iles
tabl
ishm
ents
and
inth
e ro
le o
f con
tam
inat
ion
in re
tail
esta
blis
hmen
ts a
nd in
co
nsum
er h
omes
is n
ot w
ell u
nder
stoo
d.
L. m
onoc
ytog
enes
Pre
vale
nce
L. m
onoc
ytog
enes
Pre
vale
nce
Non
-Foo
d P
roce
ssin
g E
nvir
onm
ents
:•
Pris
tine
envi
ronm
ents
:13%
(n=9
00)(
Sau
ders
2006
)P
ristin
e en
viro
nmen
ts: 1
.3%
(n90
0) (S
aude
rs, 2
006)
•U
rban
env
ironm
ents
: 7.3
% (n
=900
) (S
aude
rs, 2
006)
•R
umin
ant f
arm
s (N
ight
inga
le, 2
004)
(g
g)
–B
ovin
e fa
rms
with
list
erio
sis
case
s: 2
4.35
% (n
=616
)–
Bov
ine
farm
s w
ithou
t lis
terio
sis
case
s: 2
0.06
% (n
=643
)–
Sm
all r
umin
ant f
arm
s w
ith li
ster
iosi
s: 3
2.92
% (n
=322
) (
)–
Sm
all r
umin
ant f
arm
s w
ithou
t lis
terio
sis:
5.8
9% (n
=475
)
Food
/Foo
dP
roce
ssin
gE
nvir
onm
ents
Food
/Foo
d P
roce
ssin
g E
nvir
onm
ents
•R
aw fo
ods
•Fo
od p
roce
ssin
g en
viro
nmen
ts: f
rom
<0.
1% to
30%
or m
ore
pg
•R
eady
-To-
Eat
food
s: 0
.17
–4.
7 %
(Gom
bas
et a
l., 2
003)
Listeria
inPr
oduc
e–
Hum
anD
isea
seListeria
inPr
oduc
e–
Hum
anD
isea
seListeria
in P
rodu
ce
Hum
an D
isea
seListeria
in P
rodu
ce
Hum
an D
isea
se
•19
22-1
960:
Rep
orts
link
list
erio
sis
in a
nim
als
to c
onta
min
ated
•
1922
-196
0:R
epor
ts li
nk li
ster
iosi
s in
ani
mal
s to
con
tam
inat
ed
sila
ge, b
ut n
o lin
ks to
hum
an li
ster
iosi
s id
entif
ied.
1981
Rtt
ht1
8f4
1h
hd
ll
sila
ge, b
ut n
o lin
ks to
hum
an li
ster
iosi
s id
entif
ied.
1981
Rtt
ht1
8f4
1h
hd
ll
•19
81:R
epor
t tha
t 18
of 4
1 hu
man
s w
ho c
onsu
med
col
esla
w
that
con
tain
ed c
abba
ge c
onta
min
ated
with
L. m
onoc
ytog
enes
died
(Can
ada)
.
•19
81:R
epor
t tha
t 18
of 4
1 hu
man
s w
ho c
onsu
med
col
esla
w
that
con
tain
ed c
abba
ge c
onta
min
ated
with
L. m
onoc
ytog
enes
died
(Can
ada)
.
•19
88:F
ive
case
of l
iste
riosi
s lin
ked
to fr
ozen
bro
ccol
i and
lif
l(U
S)
•19
88:F
ive
case
of l
iste
riosi
s lin
ked
to fr
ozen
bro
ccol
i and
lif
l(U
S)
caul
iflow
er (U
S).
•19
89:O
neca
seof
liste
riosi
slin
ked
tosa
lted
mus
hroo
ms
caul
iflow
er (U
S).
•19
89:O
neca
seof
liste
riosi
slin
ked
tosa
lted
mus
hroo
ms
•19
89:O
ne c
ase
of li
ster
iosi
s lin
ked
to s
alte
d m
ushr
oom
s (F
inla
nd).
•19
89:O
ne c
ase
of li
ster
iosi
s lin
ked
to s
alte
d m
ushr
oom
s (F
inla
nd).
Occ
urre
nce
ofListeria
inPr
oduc
eO
ccur
renc
eofListeria
inPr
oduc
eO
ccur
renc
e of
Listeria
in P
rodu
ceO
ccur
renc
e of
Listeria
in P
rodu
ce•
2003
FD
A L
. mon
ocyt
ogen
esris
k as
sess
men
t ide
ntifi
ed
dfl
it
ii
tbk
•20
03 F
DA
L. m
onoc
ytog
enes
risk
asse
ssm
ent i
dent
ified
d
fli
ti
itb
kpr
oduc
e as
an
unco
mm
on c
ause
of l
iste
riosi
s ou
tbre
aks,
ho
wev
er it
not
ed th
at s
ome
hum
an c
ases
hav
e oc
curr
ed.
–V
eget
able
s: l
ow p
redi
cted
rela
tive-
risk
of c
ausi
ng li
ster
iosi
s in
the
prod
uce
as a
n un
com
mon
cau
se o
f lis
terio
sis
outb
reak
s,
how
ever
it n
oted
that
som
e hu
man
cas
es h
ave
occu
rred
.–
Veg
etab
les:
low
pre
dict
ed re
lativ
e-ris
k of
cau
sing
list
erio
sis
in th
e g
pg
US
on
a pe
r-se
rvin
g ba
sis,
slig
ht h
ighe
r ris
k on
a p
er-a
nnum
bas
is.
–E
stim
ated
that
med
ian
num
ber o
f cas
es o
f lis
terio
sis
from
veg
etab
les
in th
e U
S w
as le
ss th
an 1
cas
e pe
r yea
r.
gp
gU
S o
n a
per-
serv
ing
basi
s, s
light
hig
her r
isk
on a
per
-ann
um b
asis
.–
Est
imat
ed th
at m
edia
n nu
mbe
r of c
ases
of l
iste
riosi
s fro
m v
eget
able
s in
the
US
was
less
than
1 c
ase
per y
ear.
py
•Li
mite
d su
rvey
s in
US
hav
e in
dica
ted
the
prev
alen
ce o
f
L
ti
id
f3
50%
py
•Li
mite
d su
rvey
s in
US
hav
e in
dica
ted
the
prev
alen
ce o
f
L
ti
id
f3
50%
L. m
onoc
ytog
enes
in v
ario
us p
rodu
ce ra
nges
from
3-5
0%–
Pot
atoe
s, ra
dish
es, o
ther
root
cro
ps a
ppea
r to
have
hig
her
prev
alen
ces
of L
m (2
7-50
%)
L. m
onoc
ytog
enes
in v
ario
us p
rodu
ce ra
nges
from
3-5
0%–
Pot
atoe
s, ra
dish
es, o
ther
root
cro
ps a
ppea
r to
have
hig
her
prev
alen
ces
of L
m (2
7-50
%)
New
Yor
k S
tate
Dep
t. of
Agr
icul
ture
& M
arke
tsLi
ster
ia m
onoc
ytog
enes
regu
lato
ry s
cree
ning
test
s fo
r d
dt
ii
fd
(J20
08A
2009
)
Com
mod
ityN
umbe
rN
umbe
r w
ithLM
%LM
Com
mod
ityN
umbe
rN
umbe
r w
ithLM
%LM
prod
uce
or p
rodu
ce c
onta
inin
g fo
ods
(Jan
200
8-A
pr 2
009)
Com
mod
ity te
sted
Com
mod
ity
Cod
eN
umbe
r S
cree
ned
with
LM
P
rese
nt%
LM
P
ositi
veFr
esh
fruit/
juic
es27
05
00.
0%N
uts
&nu
tpro
duct
s*36
01
110
0.0%
Com
mod
ity te
sted
Com
mod
ity
Cod
eN
umbe
r S
cree
ned
with
LM
P
rese
nt%
LM
P
ositi
veFr
esh
fruit/
juic
es27
05
00.
0%N
uts
&nu
tpro
duct
s*36
01
110
0.0%
Nut
s &
nut
pro
duct
s36
01
110
0.0%
Fres
h ve
geta
bles
(spr
outs
)39
035
411
.4%
Drie
d/de
hyrd
ated
veg
etab
les
420
20
0.0%
Cur
ed a
nd p
roce
ssed
veg
eta b
430
50
0.0%
Al
id30
10
00%
Nut
s &
nut
pro
duct
s36
01
110
0.0%
Fres
h ve
geta
bles
(spr
outs
)39
035
411
.4%
Drie
d/de
hyrd
ated
veg
etab
les
420
20
0.0%
Cur
ed a
nd p
roce
ssed
veg
eta b
430
50
0.0%
Al
id30
10
00%
App
le c
ider
530
10
0.0%
Mul
tiple
food
com
bina
tions
San
dwic
hes/
sala
ds/d
ips
450
700
0.0%
App
le c
ider
530
10
0.0%
Mul
tiple
food
com
bina
tions
San
dwic
hes/
sala
ds/d
ips
450
700
0.0%
453
501
2.0%
459
20
0.0%
Tota
l17
16
3.5%
453
501
2.0%
459
20
0.0%
Tota
l17
16
3.5%
Not
e: A
pple
s, d
ried
fruit,
frui
t pro
duct
s, g
rape
s, ja
ms/
jelli
es, l
ettu
ce, m
aple
syr
up,
onio
ns, a
nd p
otat
oes
wer
e in
clud
ed in
the
sear
ch, b
ut n
one
wer
e te
sted
in th
e tim
e pe
riod
surv
eyed
.
Why
dow
eea
tspr
outs
?W
hydo
we
eats
prou
ts?
Why
do
we
eat s
prou
ts?
Why
do
we
eat s
prou
ts?
•A
ncie
nt C
hine
se p
hysi
cian
s re
cogn
ized
and
pre
scrib
ed
•A
ncie
nt C
hine
se p
hysi
cian
s re
cogn
ized
and
pre
scrib
ed
py
gp
spro
uts
for c
urin
g m
any
diso
rder
s ov
er 5
,000
yea
rs a
go.
•A
ccou
nts
ofsp
rout
ing
appe
arin
the
Bib
lein
the
Boo
kof
py
gp
spro
uts
for c
urin
g m
any
diso
rder
s ov
er 5
,000
yea
rs a
go.
•A
ccou
nts
ofsp
rout
ing
appe
arin
the
Bib
lein
the
Boo
kof
Acc
ount
s of
spr
outin
g ap
pear
in th
e B
ible
in th
e B
ook
of
Dan
iel.
•S
ailo
rsin
the
1700
sw
ere
riddl
edby
scur
vy(la
ckof
Acc
ount
s of
spr
outin
g ap
pear
in th
e B
ible
in th
e B
ook
of
Dan
iel.
•S
ailo
rsin
the
1700
sw
ere
riddl
edby
scur
vy(la
ckof
•S
ailo
rs in
the
1700
s w
ere
riddl
ed b
y sc
urvy
(lac
k of
V
itam
in C
) and
con
sum
ed li
mes
, lem
ons
and
varie
ties
of
spro
uts
(all
abun
dant
hol
ders
of V
itam
in C
), pl
us o
ther
fre
sh fr
uits
and
veg
etab
les
to p
rote
ct th
e sa
ilors
’ hea
lth.
•S
ailo
rs in
the
1700
s w
ere
riddl
ed b
y sc
urvy
(lac
k of
V
itam
in C
) and
con
sum
ed li
mes
, lem
ons
and
varie
ties
of
spro
uts
(all
abun
dant
hol
ders
of V
itam
in C
), pl
us o
ther
fre
sh fr
uits
and
veg
etab
les
to p
rote
ct th
e sa
ilors
’ hea
lth.
gp
•M
ore
rece
ntly
, spr
outs
hav
e be
en s
how
n to
be
rich
in
subs
tanc
esth
atpr
omot
ean
tioxi
dant
activ
ityan
dm
ay
gp
•M
ore
rece
ntly
, spr
outs
hav
e be
en s
how
n to
be
rich
in
subs
tanc
esth
atpr
omot
ean
tioxi
dant
activ
ityan
dm
aysu
bsta
nces
that
pro
mot
e an
tioxi
dant
act
ivity
and
may
of
fer c
ance
r pro
tect
ion.
subs
tanc
es th
at p
rom
ote
antio
xida
nt a
ctiv
ity a
nd m
ay
offe
r can
cer p
rote
ctio
n.
Clu
ster
Inve
stig
atio
nC
lust
erIn
vest
igat
ion
Clu
ster
Inve
stig
atio
n 20
0809
Clu
ster
Inve
stig
atio
n 20
0809
2008
-09
2008
-09
Puls
eNetListeria
data
(200
8)Pu
lseN
etListeria
data
(200
8)Pu
lseN
et Listeria
data
(200
8)Pu
lseN
et Listeria
data
(200
8)
SF
Sour
ce
Freq
uenc
y
Hum
an
522
Unk
now
n 21
Food
256
Food
25
6
Envi
ronm
enta
l 23
4
O10
33TO
TAL
1033
Sour
ce:
CD
C n
atio
nal P
ulse
Net
dat
a, N
orth
east
Reg
iona
l Wor
king
Gro
up P
roje
ct
Tim
elin
e of
eve
nts
Tim
elin
e of
eve
nts
Tim
elin
e of
eve
nts
Tim
elin
e of
eve
nts
•19
97-2
006
GX
6A16
0282
td
14ti
•19
97-2
006
GX
6A16
0282
td
14ti
–G
X6A
16.0
282
repo
rted
14 ti
mes
•M
arch
2008
-Mar
ch20
09
–G
X6A
16.0
282
repo
rted
14 ti
mes
•M
arch
2008
-Mar
ch20
09•
Mar
ch 2
008-
Mar
ch 2
009
–20
cas
es o
f lis
terio
sis
Idi
tii
hbl
AI
dA
IPFG
E
•M
arch
200
8-M
arch
200
9–
20 c
ases
of l
iste
riosi
sI
diti
ih
blA
Id
AIP
FGE
–In
dist
ingu
isha
ble
Asc
I and
Apa
I PFG
E
patte
rns
CA
(1)
MA
(6)
NY
(6)
NJ(
4)M
D(1
)
–In
dist
ingu
isha
ble
Asc
I and
Apa
I PFG
E
patte
rns
CA
(1)
MA
(6)
NY
(6)
NJ(
4)M
D(1
)–
CA
(1),
MA
(6),
NY
(6);
NJ(
4); M
D(1
); M
E(1
); N
H(1
)T
tt
ll
t
–C
A (1
), M
A(6
), N
Y(6
); N
J(4)
; MD
(1);
ME
(1);
NH
(1)
Tt
tl
lt
–Tw
o se
para
te te
mpo
ral c
lust
ers;
som
e ca
ses
not i
n ob
viou
s cl
uste
rs–
Two
sepa
rate
tem
pora
l clu
ster
s; s
ome
case
s no
t in
obvi
ous
clus
ters
Tem
pora
l Dis
trib
utio
n of
G
X6A
1602
82(1
9920
09)
Tem
pora
l Dis
trib
utio
n of
G
X6A
1602
82(1
9920
09)
GX
6A16
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2 (1
997-
2009
)G
X6A
16.0
282
(199
7-20
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68
7
8
46
4
54
2
1
22
3111111111111111111111111
2
1
0
1997-01-312001-10-312002-06-032002-08-212002-12-132004-02-122006-04-122008-04-112008-05-292008-06-162008-08-012008-08-082008-08-152008-08-282008-09-102008-09-162008-09-182008-10-072008-11-172008-11-202008-12-162009-01-132009-01-232009-03-062009-03-182009-03-262009-03-302009-03-312009-04-062009-04-162009-04-172009-04-212009-04-242009-04-272009-04-302009-05-19
UploadDate
Pat
ient
Dem
ogra
phic
sP
atie
ntD
emog
raph
ics
Pat
ient
Dem
ogra
phic
sP
atie
nt D
emog
raph
ics
•A
gera
nge:
2089
year
s•
Age
rang
e:20
89ye
ars
•A
ge ra
nge:
20–
89 y
ears
•A
ge ra
nge:
20–
89 y
ears
•65
% a
re fe
mal
e –
21%
wer
e pr
egna
nt a
t the
tim
e of
infe
ctio
n•
65%
are
fem
ale
–21
% w
ere
preg
nant
at t
he ti
me
of in
fect
ion
•A
lltw
enty
patie
nts
wer
eho
spita
lized
for
•A
lltw
enty
patie
nts
wer
eho
spita
lized
for
All
twen
ty p
atie
nts
wer
e ho
spita
lized
for
thei
r illn
esse
s.
All
twen
ty p
atie
nts
wer
e ho
spita
lized
for
thei
r illn
esse
s.
Link
toFo
odS
ampl
e?Li
nkto
Food
Sam
ple?
Link
to F
ood
Sam
ple?
Link
to F
ood
Sam
ple?
•O
nA
pril
620
09N
ewY
ork
Sta
teD
epar
tmen
tof
•O
nA
pril
620
09N
ewY
ork
Sta
teD
epar
tmen
tof
•O
n A
pril
6, 2
009,
New
Yor
k S
tate
Dep
artm
ent o
f A
gric
ultu
re a
nd M
arke
ts u
ploa
ded
an is
olat
e of
Li
ster
ia m
onoc
ytog
enes
from
alfa
lfa s
prou
ts th
at
•O
n A
pril
6, 2
009,
New
Yor
k S
tate
Dep
artm
ent o
f A
gric
ultu
re a
nd M
arke
ts u
ploa
ded
an is
olat
e of
Li
ster
ia m
onoc
ytog
enes
from
alfa
lfa s
prou
ts th
at
yg
pw
as in
dist
ingu
isha
ble
from
the
outb
reak
stra
in.
yg
pw
as in
dist
ingu
isha
ble
from
the
outb
reak
stra
in.
•Th
e is
olat
e w
as fr
om a
spr
out s
ampl
e th
at w
as
colle
cted
thro
ugh
rout
ine
surv
eilla
nce
from
a
•Th
e is
olat
e w
as fr
om a
spr
out s
ampl
e th
at w
as
colle
cted
thro
ugh
rout
ine
surv
eilla
nce
from
a
supe
rmar
ket d
istri
buto
r in
New
Yor
k an
d w
as
prod
uced
by
Pro
duce
r A in
Brid
gepo
rt, C
T.
supe
rmar
ket d
istri
buto
r in
New
Yor
k an
d w
as
prod
uced
by
Pro
duce
r A in
Brid
gepo
rt, C
T.
Patie
ntIn
terv
iew
sPa
tient
Inte
rvie
ws
Patie
nt In
terv
iew
sPa
tient
Inte
rvie
ws
•10
patie
nts
wer
ein
terv
iew
edw
ith•
10pa
tient
sw
ere
inte
rvie
wed
with
•10
pat
ient
s w
ere
inte
rvie
wed
with
qu
estio
ns re
gard
ing
spro
ut
i
•10
pat
ient
s w
ere
inte
rvie
wed
with
qu
estio
ns re
gard
ing
spro
ut
ico
nsum
ptio
n–
four
repo
rted
spro
ut c
onsu
mpt
ion
cons
umpt
ion
–fo
ur re
porte
d sp
rout
con
sum
ptio
np
pp
–th
ree
wer
e un
sure
of s
prou
t co
nsum
ptio
n
pp
p–
thre
e w
ere
unsu
re o
f spr
out
cons
umpt
ion
cons
umpt
ion
–th
ree
deni
ed a
ny s
prou
t con
sum
ptio
n.co
nsum
ptio
n–
thre
e de
nied
any
spr
out c
onsu
mpt
ion.
Inspection
Inspection
Inspection
Inspection
•In
vest
igat
ors
from
the
CT
Dep
artm
ent o
f A
gric
ultu
rean
dFD
Ain
spec
ted
the
grow
ing
firm
•In
vest
igat
ors
from
the
CT
Dep
artm
ent o
f A
gric
ultu
rean
dFD
Ain
spec
ted
the
grow
ing
firm
Agr
icul
ture
and
FD
A in
spec
ted
the
grow
ing
firm
•Th
eyco
llect
eden
viro
nmen
tals
ampl
esan
dfo
od
Agr
icul
ture
and
FD
A in
spec
ted
the
grow
ing
firm
•Th
eyco
llect
eden
viro
nmen
tals
ampl
esan
dfo
odTh
ey c
olle
cted
env
ironm
enta
l sam
ples
and
food
pr
oduc
ts fo
r tes
ting.
Thtb
kt
if
di
lflf
t
They
col
lect
ed e
nviro
nmen
tal s
ampl
es a
nd fo
od
prod
ucts
for t
estin
g.
Thtb
kt
if
di
lflf
t•
The
outb
reak
stra
in w
as fo
und
in a
lfalfa
spr
outs
, cl
over
spr
outs
, spr
out b
lend
s en
viro
nmen
tal
swab
s an
d m
ulti p
le e
nviro
nmen
tal l
ocat
ions
(e.g
.
•Th
e ou
tbre
ak s
train
was
foun
d in
alfa
lfa s
prou
ts,
clov
er s
prou
ts, s
prou
t ble
nds
envi
ronm
enta
l sw
abs
and
mul
ti ple
env
ironm
enta
l loc
atio
ns (e
.g.
p(
ga
grow
ing
trenc
h, s
pent
irrig
atio
n w
ater
, etc
) co
llect
ed in
the
plan
t.
p(
ga
grow
ing
trenc
h, s
pent
irrig
atio
n w
ater
, etc
) co
llect
ed in
the
plan
t.
•O
ne a
dditi
onal
follo
w-u
p sa
mpl
e by
NY
SD
AM
w
as a
lso
foun
d to
con
tain
the
outb
reak
stra
in.
•O
ne a
dditi
onal
follo
w-u
p sa
mpl
e by
NY
SD
AM
w
as a
lso
foun
d to
con
tain
the
outb
reak
stra
in.
Dic
e (O
pt:1
.50%
) (To
l 1.5
%-1
.5%
) (H
>0.0
% S
>0.0
%) [
0.0%
-100
.0%
]P
FGE
-Asc
I
100
98
96
PF
GE
-Asc
I
20.00
40.00
100.00
150.00
200.00
250.00
300.00
350.00
400.00
500.00
600.00
2000
1.00E4
5.00E4
PF
GE
-Apa
I
20.00
40.00
100.00
150.00
200.00
250.00
300.00
350.00
400.00
500.00
600.00
2000
1.00E4
5.00E4
Key
CT_
__02
0339
17
CT_
__02
0339
18
CT_
__02
0339
19
CT_
__02
0339
20
CT_
__02
0339
21
So
urce
Sta
CT
CT
CT
CT
CT
Sou
rceS
ite
Alfa
lfa S
prou
ts
Alfa
lfa S
prou
ts
Alfa
lfa S
prou
ts
Alfa
lfa S
prou
ts
Alfa
lfa S
prou
ts
Sou
rceT
ype
Food
Food
Food
Food
Food
CT_
__02
0339
31
CT_
__02
0339
33
MA_
__08
PF04
25
MA_
__08
PF11
82
MA_
__08
PF15
21
MA_
__08
PF17
49
MA_
__08
PF21
22
MA_
__09
PF02
97
NH
___2
0080
2727
8
CT
CT
MA
MA
NJ
CA
NJ
NJ
NH
Fact
ory
swab
Alfa
lfa S
prou
ts
BLO
OD
BLO
OD
(SU
BCU
LTU
RE)
BLO
OD
bloo
d
BLO
OD
Bloo
d
bloo
d
Envi
ronm
enta
l
Food
Hum
an
Hum
an
Hum
an
Hum
an
Hum
an
Hum
an
Hum
an
Hum
an, f
ood,
and
en
viro
nmen
tal
Hum
an, f
ood,
and
en
viro
nmen
tal
NY_
__BA
C08
0000
2720
NY_
__BA
C09
0000
1363
MA_
__08
PF19
52
FCF_
_507
437-
1
FCF_
_507
437-
3
FCF_
_507
437-
4
FCF_
_507
437-
7
FCF_
_507
438-
1
FCF_
_507
438-
5
NY
NY
MA
CT
CT
CT
CT
CT
CT
Amni
otic
flui
d
Bloo
d
Spen
t irr
iaga
tion
wat
er
Spen
t irr
iaga
tion
wat
er
Spen
t irr
iaga
tion
wat
er
Spen
t irr
iaga
tion
wat
er
Alfa
lfa s
prou
ts
Alfa
lfa s
prou
ts
Hum
an
Hum
an
Hum
an
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
l
Food
Food
Asc
I& A
paI
Pat
tern
sA
scI&
Apa
IP
atte
rns
FCF_
_507
439-
1
FCF_
_507
439-
7
FCF_
_507
442-
106
FCF_
_507
442-
11
FCF_
_507
442-
16
FCF_
_507
442-
2
FCF_
_507
442-
21
FCF_
_507
442-
57
FCF
5074
42-6
8
CT
CT
CT
CT
CT
CT
CT
CT
CT
Alfa
lfa s
prou
ts
Alfa
lfa s
prou
ts
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
lSw
ab
Food
Food
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
l
Envi
ronm
enta
lFC
F__5
0744
268
FCF_
_507
442-
93
FCF_
_507
443
FCF_
_507
443-
1b
FCF_
_524
837-
1
FCF_
_524
837-
4
FCF_
_524
838-
3
FCF_
_524
838-
7
FCF_
_524
839-
1
FCF
5248
392
CT
CT
CT
CT
CT
CT
CT
CT
CT
CT
Envi
ronm
enta
l Sw
ab
Envi
ronm
enta
l Sw
ab
alfa
lfa/c
love
r spr
outs
in l.
alfa
lfa/c
love
r spr
outs
in l.
Spic
y Sp
rout
Ble
nd
Spic
y Sp
rout
Ble
nd
Clo
ver S
prou
ts
Clo
ver S
prou
ts
Broc
cosp
rout
s
Broc
cosp
rout
s
Envi
ronm
enta
l
Envi
ronm
enta
l
Food
Food
Food
Food
Food
Food
Food
Food
FCF_
_524
839-
2
FCF_
_524
840-
10
FCF_
_524
840-
2
FCF_
_524
844
MA_
__08
PF11
25
MA_
__08
PF13
23
MA_
__09
PF00
62
MA_
__09
PF03
31
MA_
__09
PF03
45
CT
CT
CT
CT
MA
ME
MA
NJ
MA
Broc
cosp
rout
s
Broc
coSp
rout
Ble
nd
Broc
coSp
rout
Ble
nd
Cru
nchy
Spr
out B
lend
SPIN
AL F
LUID
BLO
OD
BLO
OD
Bloo
d
Bloo
d
Food
Food
Food
Food
Hum
an
Hum
an
Hum
an
Hum
an
Hum
an
MD
___M
DA0
8223
487
NY_
__BA
C09
0000
0221
NYA
G_0
9B02
865A
-1
NYA
G_0
9B02
866A
-6
NYA
G_N
YAG
09B0
232.
NYC
__ny
c08-
1006
4771
6
NYC
__ny
c09-
1007
5372
9
NY_
__BA
C08
0000
4932
MD
NY
NY
NY
CT
NY
NY
NY
Bloo
d
Alfa
lfa S
prou
ts
Clo
ver S
prou
ts
Alfa
lfa S
prou
ts
Bloo
d
Hum
an
Hum
an
Food
Food
Food
Hum
an
Hum
an
Hum
an
Reg
ulat
ory
Act
ion
Reg
ulat
ory
Act
ion
Reg
ulat
ory
Act
ion
Reg
ulat
ory
Act
ion
•O
nA
pril
920
09a
volu
ntar
yre
call
of•
On
Apr
il9
2009
avo
lunt
ary
reca
llof
•O
n A
pril
9, 2
009,
a v
olun
tary
reca
ll of
al
falfa
and
oth
er s
prou
t pro
duct
s w
as
issu
ed
•O
n A
pril
9, 2
009,
a v
olun
tary
reca
ll of
al
falfa
and
oth
er s
prou
t pro
duct
s w
as
issu
edis
sued
.is
sued
.
•S
prou
t pro
duct
ion
halte
d.•
Spr
out p
rodu
ctio
n ha
lted.
•O
n A
pril
23, 2
009,
list
of r
ecal
led
prod
ucts
w
asex
pand
ed•
On
Apr
il 23
, 200
9, li
st o
f rec
alle
d pr
oduc
ts
was
expa
nded
was
exp
ande
d.w
as e
xpan
ded.
Summary
Summary
Summary
Summary
•Th
is is
the
first
repo
rted
outb
reak
of h
uman
lis
terio
sis
from
spro
uts
•Th
is is
the
first
repo
rted
outb
reak
of h
uman
lis
terio
sis
from
spro
uts
liste
riosi
s fro
m s
prou
ts.
•In
this
inve
stig
atio
na
sing
lero
utin
e
liste
riosi
s fro
m s
prou
ts.
•In
this
inve
stig
atio
na
sing
lero
utin
e•
In th
is in
vest
igat
ion,
a s
ingl
e ro
utin
e su
revi
llanc
e sa
mpl
e he
lped
iden
tify
the
sour
ce
of th
e ou
tbre
ak
•In
this
inve
stig
atio
n, a
sin
gle
rout
ine
sure
villa
nce
sam
ple
help
ed id
entif
y th
e so
urce
of
the
outb
reak
•S
ome
indi
catio
n th
at fo
r Listeria
the
win
dow
for
lt
ih
ldb
lth
120
•S
ome
indi
catio
n th
at fo
r Listeria
the
win
dow
for
lt
ih
ldb
lth
120
clus
ter s
cann
ing
shou
ld b
e la
rger
than
120
da
ys.
clus
ter s
cann
ing
shou
ld b
e la
rger
than
120
da
ys.
Summary
Summary
Summary
Summary
•B
oth
heal
th d
epar
tmen
ts a
nd re
gula
tory
ag
enci
esca
nm
ake
sign
ifica
ntco
ntrib
utio
nsto
•B
oth
heal
th d
epar
tmen
ts a
nd re
gula
tory
ag
enci
esca
nm
ake
sign
ifica
ntco
ntrib
utio
nsto
agen
cies
can
mak
e si
gnifi
cant
con
tribu
tions
to
outb
reak
inve
stig
atio
ns.
agen
cies
can
mak
e si
gnifi
cant
con
tribu
tions
to
outb
reak
inve
stig
atio
ns.
•R
egul
ator
y ag
enci
es h
ave
resp
onsi
bilit
ies
and
reso
urce
s th
at a
llow
for;
•R
egul
ator
y ag
enci
es h
ave
resp
onsi
bilit
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and
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urce
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at a
llow
for;
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apid
trac
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ck o
f pro
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from
reta
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plie
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Ver
ifica
tion
proc
edur
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r ens
urin
g th
at re
calle
d fo
odha
sbe
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mov
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mst
ore
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ves
–R
apid
trac
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ck o
f pro
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from
reta
il to
sup
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Ver
ifica
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proc
edur
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r ens
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g th
at re
calle
d fo
odha
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mov
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mst
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ves
food
has
bee
n re
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om s
tore
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lves
–E
nhan
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labo
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urge
cap
acity
and
mat
rix
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iliar
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atho
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has
bee
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om s
tore
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lves
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nhan
ced
labo
rato
ry s
urge
cap
acity
and
mat
rix
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iliar
ity fo
r scr
eeni
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f foo
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ne p
atho
gens
Ano
ther
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ther
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ak?
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ther
spr
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Cha
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Cha
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arm
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08B
0080
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09B
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PF
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20.00
40.00
100.00
120.00
150.00
200.00
250.00
300.00
350.00
400.00
500.00
600.00
2000
1.00E4
5.00E4
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20.00
40.00
100.00
120.00
150.00
200.00
250.00
300.00
350.00
400.00
500.00
600.00
2000
1.00E4
5.00E4
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Mel
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Que
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Q
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&
Dis
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Dis
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