Multistate foodborne outbreaks such as listeriosis linked to pre-packaged salads at the Dole processing plant in Springfield typically cause more deaths and more severe illnesses, this newspaper’s weeklong investigation revealed.
Interviews with experts also showed:
• Multistate outbreaks are more likely now because of how food is distributed;
• Reporting and tracking methods have improved in recent years, allowing companies and government agencies to identify outbreaks more quickly, potentially preventing more deaths; and
• Despite protocols and safeguards, eliminating foodborne illness is unlikely.
Ensuring food is safe is a complicated process that involves coordination between businesses, state and federal government agencies and consumers, said Fadi Aramouni, a professor of food science at Kansas State University. Companies like Dole have procedures and tools in place to prevent an outbreak, he said, but there’s no perfect solution.
“It’s a combination of everyone, even the consumer,” Aramouni said. “ I don’t think any of them will give you a 100-percent guarantee that the product will be perfectly safe to eat. There’s really no silver bullet other than in cooked products, the heating step.”
Dole voluntarily closed its Springfield production facility Jan. 21 after 12 illnesses, including one death, were linked to an outbreak of listeriosis in the U.S., according to information from the Centers for Disease Control and Prevention. On Thursday, the investigation expanded to include 15 U.S. cases in eight states.
The outbreak has also affected Canada, where the Public Health Agency of Canada has cited seven cases across five provinces. One death has also been reported, although it has not been determined if listeria contributed to the death, according to the Canadian government.
The U.S. cases were reported between July and Jan. 3, according to the CDC. The cases in Canada were reported between September and early this month.
Dole has closed its facility for two to four weeks while the U.S. Food and Drug Administration and CDC investigate.
Dole declined to comment for this story and directed this newspaper to its website.
Multistate foodborne illnesses rising
About 3 percent of foodborne outbreaks affect more than one state, but those are often more serious, causing 34 percent of hospitalizations and 56 percent of deaths compared to single-state outbreaks, according to the FDA.
Salmonella, E. Coli and listeria cause 91 percent of multistate outbreaks.
Much of the increase in multistate cases can be attributed to better reporting methods from the local level to the federal government, said David Rich, a professor of public administration and political science at Cedarville University.
The CDC said 34 outbreaks were reported between 1995 and 1999, then 79 outbreaks between 2005 and 2006. There were 120 outbreaks between 2010 and 2014.
Food distributors in general are also increasingly using vegetables and other products coming from sources not just in the U.S., but across the globe, Rich said.
“The supply has changed,” Rich said. “We’re no longer just getting lettuce from California and from Florida. We’re starting to see it from Mexico, Chile and further regions as we develop those agreements. Those internal controls you have on the growers are gone as soon as you do that.”
The total number of outbreaks overall, however, has declined over the past decade, according to the CDC. About 1,300 outbreaks were reported in 1998, compared to 866 in 2014, according to the CDC.
“Because of changes in food production and distribution methods, the ways foodborne disease can arise and spread is changing and the scope of outbreaks can be much larger than before,” according to information on the FDA’s website. “Multistate — and even multinational — occurrences are not uncommon.”
On the other end, many consumers assume pre-packaged salads and similar products are safe to eat without taking additional steps, and that’s not the case, Rich said.
“We need to do some due diligence as far as washing fresh fruit and vegetables before we consume those,” he said.
A collaborative process
Ensuring food is safe is a collaborative effort between businesses and local, state and federal governments, said Naila Khalil, an associate professor in the Center of Global Health at Wright State University. Listeria wasn’t associated with foodborne outbreaks just a few decades ago, she said, but has been in the spotlight more often as consumers have shifted to eating more fruits and vegetables.
One of the challenges with listeria is it can be found in numerous places, including soil, fertilizer, water, and even potentially on an employee’s clothing she said. It is also an unusual bacteria in that it can survive and grow in cold temperatures, making it tougher to eliminate.
Tracking how the food can become contaminated can be a lengthy and difficult process, Khalil said. Companies like Dole likely have a reliable grower who certifies they have procedures in place to prevent contamination, as well as additional steps during the shipping and packaging processes.
Checks inside the facility can include regularly cleaning equipment, monitoring for the bacteria, and ensuring staff is trained to prevent food from becoming contaminated. But with so many producers and steps along the way, it can be challenging to keep all of those controls perfect, Khalil said.
However, businesses and regulators have developed better methods to track and locate the source of outbreaks. In this case, the CDC used a technique called whole genome sequencing to link the outbreak to Springfield.
In that process, DNA fingerprints were pulled from samples of listeria from ill patients. Public health labs across the U.S. upload the DNA fingerprints to Pulsenet, and the CDC can then review data to see if something unusual or unexpected is happening, indicating a possible outbreak, said Kate Fowlie, a spokeswoman for the CDC.
“This sort of detective work and these advanced laboratory techniques weren’t available 15 to 20 years ago, so you’re seeing that our capability in recognizing and confirming these outbreaks and their origin has improved quite a lot,” Khalil said.
Inspection records reveal no violations
Dole’s Springfield processing facility had proper procedures in place to prevent contamination, according to inspection reports from the Ohio Department of Agriculture.
This newspaper reviewed ODA inspection reports from the facility from 2011 through last year after filing a public records request with the state agency. No compliance issues were noted in the ODA’s inspection reports for the last five years. The last inspection before last week’s voluntary closure occurred on Feb. 5, 2015.
State records show the ODA discovered listeria in packaged vegetables taken from Buehler’s Fresh Foods in Wooster in mid-November as part of the agency’s food surveillance program.
Listeria is usually not a serious threat to most healthy individuals, Kansas State’s Aramouni said. But it can be dangerous to elderly residents, those with weakened immune systems and pregnant women.
Typically, vegetables can become contaminated from the soil as well as equipment during the storage or packing process. There was more concern in the past about meat products becoming contaminated, but that has shifted as more consumers moved more frequently to vegetables, he said.
Meat is also usually heated, which can help kill the contaminants in most cases.
“Whenever you have a ready-to-eat product like a leafy vegetable that does not have a kill step as such, sometimes these organisms attach to the cell walls of a vegetable, and it’s hard to get rid of them,” Aramouni said.
Listeria has been linked to several multistate outbreaks in recent years. Of those, the most serious was tied to cantaloupes produced at a farm in Colorado. That 2011 case, the largest in U.S. history, was tied to 147 illnesses, 33 deaths and one miscarriage among residents of 28 states, according to information from the CDC.
Listeria outbreaks have also been linked to soft cheeses produced by Karoun Dairies and ice cream products at Blue Bell Creameries last year, as well as caramel apples and sprouts in recent years.
Effect on Dole, retailers unclear
Dole has provided updates in the case on its website, but has declined comment in the meantime.
It’s not clear what impact the outbreak will have on the company, said Frank Badillo, an adviser to several Fortune 500 companies and director of research at MacroSavvy, a market research firm. Because the products are distributed so widely, it could also impact grocers like Kroger, Meijer, Aldi and Walmart, which also carried pre-packaged salads from Dole under their store brands.
“It’s not just Dole that has something at stake here,” Badillo said. “It’s these retailers as well that are trying to build up these private label brands and now find that their private label brand image is at stake because of the performance of one of its suppliers.”
Shoppers increasingly spread information about products online, he said, so retailers and other firms need to be proactive to get the correct information out online. Many companies are still trying to figure out the best method to respond to their customers online, but can face the risk that false information gets spread quickly online, causing more damage.
“Many of them are still trying to figure out the best way to manage their brand in a social media world,” Badillo said.
There are proven methods to kill listeria, Aramouni said. The company and inspectors will likely have to go back weeks and review their process to find where the contamination may have occurred. Consumers can also take steps to keep food safe, including washing vegetables thoroughly and making sure products are stored at the right temperature.
“It is hard to control it 100 percent, but there are things that do work,” Aramouni said.
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