Tracy StilesFoodborne

Disease Surveillance Laboratories

Massachusetts Department of Public Health

Listeria

Outbreak in MassachusettsOnly the third outbreak in 30 years where pasteurized milk was implicated in human infection with L.monocytogenes

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2008

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Home > Listeria, Outbreaks, Recalls, Whittier Farms Lawsuit > 16 Listeria Samples Found at the Whittier Farms Milk Processing Plant > January 18, 2008 | Posted By Pritzker | Ruohonen | Comments |

16 Listeria Samples Found at the Whittier Farms Milk Processing Plant

The Massachusetts Department of Public Health (MDPH) continues its investigation into the Listeria outbreak linked to contaminated Whittier Farms milk. According to the MDPH, additional samples of milk products and several environmental samples taken at the Whittier Farms milk processing plant have tested positive for Listeria monocytogenes.

The following is from a MDPH press release regarding this Listeria outbreak.

The processing plant, located in Shrewsbury, Massachusetts remains closed and will not re-open until cleared to do so by the MDPH Food Protection Program and U.S. Food and Drug Administration (FDA) Regional Milk Specialists.

Massachusetts public health officials also continue to work with other agencies, including U.S. Food and Drug Administration and the Massachusetts Department of Agricultural Resources to complete the investigation and review whether changes are needed in current state regulations or in the federally mandated inspection and testing processes for dairy farms and plants.

Summary of Listeria Positive Laboratory Tests

Sample Description Listeria Strain Coffee flavored milk Glass, Quart A* Coffee flavored milk Glass, Quart A* 1% Chocolate flavored milk Plastic, 8 oz. A* Chocolate flavored milk Plastic, 8 oz. A* Chocolate flavored milk Plastic, Pint A* Vanilla flavored milk Glass, Quart A* Strawberry flavored milk Plastic, 8 oz A* Skim milk Glass, Quart A* 1% Chocolate flavored milk Glass, Quart B** Coffee flavored milk Glass, Quart B** 1% milk Glass, Quart B** 2% milk Glass, Quart C** * Denotes Listeria strain consistent with outbreak strain ** Denotes Listeria strain not consistent with outbreak strain or known human cases Environmental Samples Description Listeria Strain Environmental Swab 1 Floor near homogenizer A* Environmental Swab 2 Drain in fill room D** Environmental Swab 3 Bottle washer washband E** Environmental Swab 4 Empty unwashed bottle F** * Denotes Listeria strain consistent with outbreak strain ** Denotes Listeria strain not consistent with outbreak strain or known human cases Trackbacks (0) Links to blogs that reference this article Trackback URL Comments (0) Read through and enter the discussion with the form at the end Post A Comment / Question Use this form to add a comment to this entry. Name:

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Listeria

Statistics Massachusetts

MA sees ~30 cases of Listeriosis each year

In 2007:23 isolates were received at SLI

Several isolates not received at lab19 different Asc I patterns

Total Database (MA)225 entries of Listeria190 different Asc I patterns

Listeria 2007 All MA

Dice (Opt:1.50%) (Tol 1.5%-1.5%) (H>0.0% S>0.0%) [0.0%-100.0%]PFGE-A

100

PFGE-AscI PFGE-ApaI

Patient 1Unique patternin MANo action taken

Patient 2Match to June Patient

Epi notifiedPost to Webboard

June 2007 October 2007

CDC Response:Isolates >120 days apartNo Cluster ID

November 2007

Both match by PFGE

Per CDC—No other matchesAppears to be local cluster

Where did it come from?November 2007

Family of one patient implicated unpasteurized ciderLBOH visited home Collected cider (which had been pasteurized)Also took a bottle of flavored milk

Family reported patient drinks this milk regularly

L. mono isolated from milkPFGE match to 4 patients

Did the milk contaminate the patient or did the patient contaminate the milk?

The Investigation begins…November 2007

MA FPP visited local dairy where milk was processedCollected 11 milk samples (raw and sealed flavored and non‐flavored)Also collected environmental swabsL. mono isolated from one flavored milk sample

Same flavor as from patient’s homePFGE match to all cases

MA Press Release 12/27/08

THE COMMONWEALTH OF MASSACHUSETTS EXEC UTIVE OFFICE OF HEALTH AND HUMAN SERVICES

DEPARTMENT OF PUBLIC HEALTH 250 WASH INGTON STREET, BOSTON, MA 02108-4619

DEVAL L. PATRICK GOVERNOR

TIMOTHY P. MURRAY LIEUTENANT GOVERNOR

JUDYANN BIGBY, M.D. SECRETARY

JOHN AUERBACH COMMISSIONER

FOR IMMEDIATE RELEASE: December 27, 2007

CONTACT: Donna Rheaume 617-624-5006

DPH ISSUES CONSUMER WARNING FOR MILK PRODUCTS SOLD AT WHITTIER FARMS IN SHREWSBURY

DPH Issues Consumer Warning for Milk Products Sold at Whittier Farms in Shrewsbury

Boston — The Department of Public Health (DPH) is issuing a warning to consumers not to drink any milk products from Whittier Farms in Shrewsbury because of listeria bacteria contamination.

InvestigationDecember 2007

Plant voluntarily recalled all products and ceased operationsMany conference calls held with Lab, Epidemiology, FPP, and DEP

Calls detailed lab reports to date, epi findings to date, and past inspections of the processing plantPlant was compliant with all regulationsPlant in good repairDairy owners in full cooperation with investigators

History of the plantFamily owned farm and processing plantRoutinely inspected by MDARCompliant with FDA IMS ProgramMilk comes from the families own cows

300 cow herdSupplemented with another dairy (also compliant with MDAR and IMS program)Milk is shipped from farm to plant via dedicated milk truck owned by the familyTruck sanitized routinely with “clean in place” procedure

Compliant with all regulations

Process ~3500lbs of milk 3 days/weekProduct is distributed to customers via home delivery and 2 retail stores at farm and plant

Bulk cream is distributed out of state for use in baked goods

InspectionFPP visited plant for a full environmental inspection

Cooperation with FDA and LBOHInspection occurred over multiple days

Collected more than 100 samples of milk and environmental swabsConducted review of all procedures, mandatory recording charts, inspection of facilities, and sanitizing process

Full Inspection Day 1

Focused on pasteurization charts and equipment April 1, 2007‐December 27, 2007

Observations included:tools used to measure and mix flavored syrups on raw side of plant stored open and exposed to airCondensation was observed on the ceiling in front of 2 raw mixing batching tanks

Dripping to create pooled water on floorOpen‐ended milk bypass piping stored on a wall adjacent to raw milk separator unit

Internal inspection showed sour odor and soil in gasket areaFloor mat in front of raw milk product pump showed residual milk and sour odor underneath

Day 2 of InspectionInspected piping and processing downstream of processor

Yellow‐brown deposit on internal surface of valveRough, raised weld on interior surface of pipe to storage tankRubber plug valve on a storage tank pitted in milk contact areaRaised inner weld on discharge pipe from pump supplying milk to filler machineFloors uneven and cracked in several areas in front of 2 pumps used to transfer pasteurized product to filling machineDeteriorating floor by floor drain in front of homogenizer

Day 3 of InspectionFPP intended to evaluate bottle washer

Found it to have been disassembled to initiate maintenance

Instead inspected the pasteurizer while bottle washer was reassembled

Continuous HTST milk pasteurizerHigh temperature short timeMilk is held at 161°F for 15 secAny flavorings are added post‐pasteurization

Milk is then pasteurized again

Equipment compliance testing is done every 90 daysAll pasteurization was found to be in compliance with PMO

Day 3 (Continued)Plant Inspection

Condensate observed on day 1 had been repairedClosed sanitary lubricant for milk contact surfaces was stored in an unclean containerCracked cement floor with mold on ceiling, upper walls, and plastic strip curtains in milk product cooler

Lower walls in cooler showed wearDeteriorating floor surface near floor drain next to a raw product tank

Several feet away from pump that is used to transfer pasteurizedproduct to the filler

Deteriorating floor  (raised and cracked) directly below glass bottle fillerPointed wooden stick on cap applicator

Used to unclog caps from cap chute on filler machine

Day 3 Plant Inspection (Continued)Mold formation on walls of bottle washer room

Possibly due to inadequate ventilation

In raw milk room, a hose was observed hanging on the wall

Uncapped, unprotected, crackedConnected to public water supplyUsed for sanitizing equipmentWater sample was collected from hose

Day 4 of InspectionMajority of swabbing and sampling occurred

Dairy had private lab swab duplicate areasObservations

Dripping water from ceilingObserved in raw milk storage areaObserved in filling area adjacent to fill milk valves

Plastic milk cases were soiledBottle washer had been reassembled

Conveyor “fingers” that move the bottles appeared unclean

Final Inspection DayBottle washer documentation was reviewed

No violations to sanitizer concentrations or recordingAdditional Observations

Bottle washer drains into pipe that terminates in the bottle filling roomMilk cases are cleaned by hand by the bottle washerNew glass bottles stored open in a trailer

Inside was damp with visible mold growth and evidence of rodent droppingsBottles are all washed prior to use

**UPDATE**

MDPH CONTINUES LISTERIA INVESTIGATION Whittier Farms Dairy Processing Plant remains closed while state and federal health officials

continue to investigate the source of contamination BOSTON – The Massachusetts Department of Public Health (MDPH) is continuing its public health investigation of listeria contamination in milk products from Whittier Farms Dairy. Whittier Farms operates a dairy farm in West Sutton, Massachusetts, as well as a dairy processing plant and retail outlets at the farm and in Shrewsbury, Massachusetts. A source of contamination at the processing plant has not yet been identified. Four cases of listeriosis infection have been identified by DPH. The cases occurred in June, October and two in November. The four cases involved three elderly individuals and a pregnant woman. Two elderly men have died as a result. DNA fingerprinting conducted by the State Laboratory Institute showed that the bacteria causing these infections came from a common source. Whittier Farms milk product samples collected from a patient’s home and from Whittier Farms showed listeria contamination. The DNA fingerprints of the listeria found in the milk samples and in the patients were the same. There have been no new cases of listeriosis confirmed as linked to this outbreak.

“State and federal regulatory health officials have initiated an environmental investigation at the facility that includes a thorough examination of the plant and its production equipment, as well as their pasteurization, packaging, cleaning and sanitization procedures. The state will also be conducting environmental and product testing for listeria before the dairy is allowed to begin operations again.” said Suzanne Condon, Director of MDPH’s Environmental Health Bureau.

Whittier Farms has voluntarily suspended operations and distribution until the source of contamination is identified and corrected. The company has contacted all known customers and distributors of its products and informed them about the situation. A public health advisory was released by MDPH on December 27 to warn non-home delivery customers who may have purchased products in retail outlets and retained them at home to discard these products immediately.

The Commonwealth of Massachusetts Executive Office of Health and Human Services

Department of Public Health 250 Washington Street, Boston, MA 02108-4619

DEVAL L. PATRICK

GOVERNOR

TIMOTHY P. MURRAY LIEUTENANT GOVERNOR

JUDYANN BIGBY, MD SECRETARY

JOHN AUERBACH COMMISSIONER

FOR IMMEDIATE RELEASE: January 2, 2008 FURTHER INFORMATION: Tom Lyons (617) 624-5275, or Donna Rheaume (617) 624-5006

MDPH Press ReleaseUpdate1/2/08

Results L.mono grew out of 8 milks and one environmental swab

Positive swab was taken from floor drain near a homogenizer unit

Close proximity to where raw milk equipment was cleanedInspection showed floor surface around the drain was pitted and had pooled water

PFGE matched all cases

An additional 4 milks and 2 swabs grew Listeria(L.mono and other species) that did not match cases by PFGE

Positive swabs from shield in bottle washer and fill room floor drain

Enumeration Results

State Lab ID number

Inspect or

numberSample

description

Type of contain

er Code/date

Date of initial

dilution

Most probable number,

organisms/ mL

08F028JH

4928

1% chocolate,

Whittier Farm

plastic, 8 oz 1/6/2008 1/11/2008 460

08F029JH

4929

chocolate milk,

Whittier Farm

plastic, pint 12/31/2007 1/11/2008 >1100

08F030JH

4930

vanilla milk,

Whittier Farm

glass, quart 12/31/2007 1/11/2008 >1100

08F034JH

4934chocolate

milkplastic,

8 oz 1/3/2008 1/11/2008 >1100

08F007JH

49061%

chocolatequart glass 12/31/2007 1/11/2008 >1100

08F017JH

4917 coffee milkquart glass 1/10/2008 1/11/2008 >1100

08F003JH

4902 1% milkquart glass 1/3/2008 1/11/2008 >1100

08F004JH

4903 2% milkquart glass 12/31/2007 1/11/2008 >1100

08F016JH

4916 skim**quart glass 1/10/2008 1/15/2008 46,000

08F017JH

4917 coffee milkquart glass 1/10/2008 1/15/2008 460,000

Dice (Opt:1.50% ) (Tol 1.5%-1.5%) (H>0.0% S>0.0%) [0.0%-100. 0% ]PFGE-AscI

100

50

PFGE-AscI

ENVIRONMENTAL SWABENVIRONMENTAL SWABENVIRONMENTAL SWAB--COOLER FANENVIRONMENTAL SWAB--CENTRAL COOLER FAN#2ENVIRONMENTAL SWAB-FLOOR DRAIN, RAW MILK TANK OF HTST PROCESSORENVIRONMENTAL SWAB-FLOOR DRAIN, RAW MILK TANK OF HTST PROCESSORENVIRONMENTAL SWABENVIRONMENTAL SWAB-FLOOR DRAIN, RAW MILK TANK OF HTST PROCESSORENVIRONMENTAL SWAB--BOTTLE WASHERENVIRONMENTAL SWAB--BOTTLE WASHERENVIRONMENTAL SWAB--POOLING WATER IN FRONT OF RAW TANK COFFEEENVIRONMENTAL SWAB--FILL ROOM FLOOR DRAINENVIRONMENTAL SWAB--FILL ROOM FLOOR DRAIN1% CHOCOLATECHOCOLATE MILKVANILLA MILKCHOCOLATE MILKENVIRONMENTAL SWAB--FLOORENVIRONMENTAL SWABSKIM MILKSKIM MILKSKIM MILKSKIM MILKSTRAWBERRY MILKSTRAWBERRY MILKSTRAWBERRY MILKSTRAWBERRY MILKSTRAWBERRY MILK1% CHOCOLATECOFFEE MILK2% MILK, QT. GLASS2% MILK, QT. GLASS1% MILKSTRAWBERRY MILK

MDPH Press ReleaseUpdate #31/17/08

THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

DEPARTMENT OF PUBLIC HEALTH 250 WASHINGTON STREET, BOSTON, MA 02108-4619

DEVAL L. PATRICK GOVERNOR

TIMOTHY P. MURRAY LIEUTENANT GOVERNOR

JUDYANN BIGBY, M.D. SECRETARY

JOHN AUERBACH COMMISSIONER

FOR IMMEDIATE RELEASE: January 17, 2008

CONTACT: Donna Rheaume 617-624-5006

** UPDATE NO. 3** STATE RELEASES WHITTIER FARMS LABORATORY SAMPLE RESULTS

Environmental and milk products test positive for Listeria. Milk processing plant will remain closed until cleared by health officials.

BOSTON — As part of its on-going investigation of a Listeria monocytogenes (Listeria) outbreak linked to contaminated milk, the Massachusetts Department of Public Health (MDPH) said today that additional samples of milk products and several environmental samples taken at the Whittier Farms milk processing plant have tested positive for Listeria.

The processing plant, located in Shrewsbury, Massachusetts remains closed and will not re-open until cleared to do so by the MDPH Food Protection Program and U.S. Food and Drug Administration (FDA) Regional Milk Specialists.

One environmental swab, one sample of skim milk and seven flavored milk samples tested positive for the same strain of Listeria found in four of the five cases linked to this outbreak. No sample was available to test in the fifth case linked to the outbreak — a 31 year-old pregnant woman from Middlesex County who drank Whittier milk products and was diagnosed with  

Corrective ActionLetter requesting corrective action was sent to the plant

Outlined all observed violationsFebruary 1, 2008 

Dairy announced publicly it would not reopen the processing plantAttributed to the financial burden of making necessary corrections

Epidemiology 4 lab confirmed cases June‐NovemberAge range 31‐87 years3 males, one female

June patient consumed skim milk from this dairy regularlyOctober patient had no obvious exposure to milk1 November patient regularly drank flavored milk from this dairy1 November patient was unable to be interviewed (numerous attempts were made) 

EpidemiologyEpidemiology Investigation identified one additional case in September

Pregnant woman presented with listeriosisL. mono was isolatedIsolate never sent to labPatient reported milk consumption from this dairy Epi‐linked not PFGE‐linked

Summary of CasesCases range June‐November5 cases3 adult deaths 1 late term miscarriage1 premature c‐section resulting in healthy baby

Laboratory Strengths MA PFGE Lab is Rock Solid!

Diligent in finding match even though it was >120 daysFollowed all protocols including epi notification, posting to webboardContinued to monitor for this strain

Great teamwork among all labs PFGE, Food, Dairy, Enteric, Reference LabsAll staff ready and willing to help out wherever needed

Laboratory Weaknesses MA Food Lab needed help

The “forgotten lab” in MassachusettsLab tested ~100 samples/year

Mainly extraneous materials, little pathogen testingProtocols had been alteredResults improperly documentedMore testing done for this outbreak than any of the previous years

After 1st set of samples, BT‐FERN staff was enlisted to assist (Assisted in the 100+ samples)Much potential for the future

Lessons Learned‐EpidemiologyWhat about case in September?

If it had been sent to lab, would we have identified the outbreak sooner?

MA will begin focusing on re‐education of the local labsMA Regulations now state all isolates of L.mono are to be forwarded to the state lab immediately (within 48 hours) MA Regulations are being updated to make all submissions required

Up to now, it is not mandatory Still difficulty in getting interviews from this population

Lessons learned‐InspectionSeveral distinct strains of Listeria were found in product samples and environmental samples

Suggests post‐pasteurization contamination can go undetectedFacility design likely contributed to intermittent post‐pasteurization contamination from equipment and environment

Equipment met FDA standards for time, temp, and flow for pasteurization

Is this enough to ensure a safe milk supply?Plant had no environmental monitoring program for L.monocytogenesNot required, but should it be?Often done at larger facilitiesSpecial concern for ready‐to‐eat foods with a longer shelf life

Listeria will multiply at refrigeration temperatures

Is a physical inspection of the plant part of routine inspections?

AcknowledgmentsMassachusetts Lab Staff

PFGE LabBT‐FERN Staff Media Room StaffReference Lab Staff

Massachusetts EpidemiologistsMassachusetts Food Protection ProgramMassachusetts DEPMassachusetts Hospital Labs

If they had not submitted the isolates we would never have foundthe outbreak!

Local Board of Health