For some, microwaving fish in the employee lunch room is the ultimate work faux pas. But for one (likely mortified) employee of a seafood distribution plant in Maryland, it’s probably causing a mass poisoning with the homemade noodle dish they brought to share for lunch. The dish sickened 46 employees, spurring their employer to hastily release a statement assuring customers that it wasn’t the company’s food that caused the illnesses.
On October 21, first responders and paramedics arrived at the NAFCO Wholesale Fish Distribution Facility in Jessup, where dozens of employees had abruptly fallen ill about three hours after lunch. Helicopter footage of the event captured images of workers around picnic tables outside the plant, some doubled over and with their heads down.
Ultimately, 46 people were sickened, and at least 26 were treated at an area hospital with symptoms of food poisoning, according to The Baltimore Banner. They all recovered.
“NAFCO maintains the highest standards of food safety and regularly undergoes rigorous inspections by health authorities,” NAFCO said in a written statement. “Its products continue to be safely produced and consumed by customers nationwide, and there are no issues related to its supply chain.”
Enterotoxins
In an update on Tuesday, the Maryland Department of Health announced that testing found that Staphylococcus aureus was the cause of the illnesses. S. aureus is often thought of as a skin bacterium, but the pathogen can spread to food from unwashed hands, the Centers for Disease Control and Prevention notes. In food that isn’t thoroughly cooked or is held at warm temperatures (between 40° F and 140° F) conducive to bacterial growth, the germ can grow and produce toxins.
The 26 new cases represent a 50 percent increase in the case count from October 22, bringing the total to 75 cases. With the new cases, health officials also reported 12 more hospitalizations, including one new adult case of hemolytic uremic syndrome (HUS), a severe complication to an E. coli O157:H7 infection. Three more states are also newly affected: Michigan, New Mexico, and Washington.
In all, the outbreak now stands at 75 cases, including 22 hospitalizations and two cases of HUS, across 13 states. The number of deaths linked to the outbreak remains at one. The most recent illness onset for the cases identified so far is October 10.
The states with cases now include: Colorado (26 cases), Montana (13), Nebraska (11), New Mexico (5), Utah (5), Missouri (4), Wyoming (4), and Michigan (2), and one case each in Iowa, Kansas, Oregon, Washington, and Wisconsin.
The source of the outbreak has not yet been confirmed, but investigators have focused on the beef patties and slivered onions used on McDonald’s Quarter Pounders. McDonald’s immediately pulled the popular burger off the menu and paused distribution of the slivered onions from affected restaurants when the CDC announced the outbreak Tuesday. McDonald’s considered the affected areas to be Colorado, Kansas, Utah, and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma.
Onions recalled and destroyed
On Wednesday, one of McDonald’s onion suppliers, Taylor Farms, recalled peeled and diced yellow onion products. Taylor Farms told Bloomberg earlier this week that its testing had not turned up E. coli, but that it decided to issue the recall anyway.
Enlarge/ Mature morel mushrooms in a greenhouse at an agriculture garden in Zhenbeibu Town of Xixia District of Yinchuan, northwest China’s Ningxia Hui Autonomous Region.
True morel mushrooms are widely considered a prized delicacy, often pricey and surely safe to eat. But these spongey, earthy forest gems have a mysterious dark side—one that, on occasion, can turn deadly, highlighting just how little we know about morels and fungi generally.
On Thursday, Montana health officials published an outbreak analysis of poisonings linked to the honeycombed fungi in March and April of last year. The outbreak sickened 51 people who ate at the same restaurant, sending four to the emergency department. Three were hospitalized and two died. Though the health officials didn’t name the restaurant in their report, state and local health departments at the time identified it as Dave’s Sushi in Bozeman. The report is published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The outbreak coincided with the sushi restaurant introducing a new item: a “special sushi roll” that contained salmon and morel mushrooms. The morels were a new menu ingredient for Dave’s. They were served two ways: On April 8, the morels were served partially cooked, with a hot, boiled sauce poured over the raw mushrooms and left to marinate for 75 minutes; and on April 17, they were served uncooked and cold-marinated.
The mystery poison worked fast. Symptoms began, on average, about an hour after eating at the restaurant. And it was brutal. “Vomiting and diarrhea were reportedly profuse,” the health officials wrote, “and hospitalized patients had clinical evidence of dehydration. The two patients who died had chronic underlying medical conditions that might have affected their ability to tolerate massive fluid loss.”
Of the 51 sickened, 46 were restaurant patrons and five were employees. Among them, 45 (88 percent) recalled eating morels. While that’s a high percentage for such an outbreak investigation, certainly enough to make the morels the prime suspect, the health officials went further. With support from the CDC, they set up a matched case-control study, having people complete a detailed questionnaire with demographic information, food items they ate at the restaurant, and symptoms.
Mysterious poison
Forty-one of the poisoned people filled out the questionnaire, as did 22 control patrons who ate at the restaurant but did not report subsequent illness. The analysis indicated that the odds of recalling eating the special sushi roll were nearly 16 times higher among the poisoned patrons than among the controls. The odds of reporting any morel consumption were nearly 11 times higher than controls.
The detailed consumption data also allowed the health officials to model a dose response, which suggested that with each additional piece of the special roll a person recalled eating, their odds of sickness increased nearly threefold compared with people who reported eating none. Those who ate four or more pieces of the roll had odds nearly 22.5 times higher. A small analysis focusing on the five employees sickened, which was not included in the published study but was noted by the Food and Drug Administration, echoed the dose-response finding, indicating that sickness was linked with larger amounts of morel consumption.
When the officials broke down the analysis by people who ate at the restaurant on April 17, when the morels were served uncooked, and those who ate at the restaurant on April 8, when the mushrooms were slightly cooked, the cooking method seemed to matter. People who ate the uncooked rather than the slightly cooked mushrooms had much higher odds of sickness.
This all strongly points to the morels being responsible. At the time, the state and local health officials engaged the FDA, as well as the CDC, to help tackle the outbreak investigation. But the FDA reported that “samples of morel mushrooms collected from the restaurant were screened for pesticides, heavy metals, toxins, and pathogens. No significant findings were identified.” In addition, the state and local health officials noted that DNA sequencing identified the morels used by the restaurant as Morchella sextelata, a species of true morel. This rules out the possibility that the mushrooms were look-alike morels, called “false morels,” which are known to contain a toxin called gyromitrin.
The health officials and the FDA tracked down the distributor of the mushrooms, finding they were cultivated and imported fresh from China. Records indicated that 12 other locations in California also received batches of the mushrooms. Six of those facilities responded to inquiries from the California health department and the FDA, and all six reported no illnesses. They also all reported cooking the morels or at least thoroughly heating them.
