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Hepatitis A Outbreak Associated Frozen Strawberries

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By Ryan Maus

A new outbreak of hepatitis A virus has been associated with frozen organic strawberries and sickened five people (with two hospitalizations) from the state of Washington. The strawberries were distributed to numerous retail locations across the country, sometimes comingled with other fruit products. This has led to numerous recalls of products with best by dates as far away as November 2024. The ongoing outbreak serves as a reminder of the hazard viruses can present for certain ingredients and the subsequent products (such as smoothies and juice) in which they are often used.

Outbreaks of hepatitis A are generally reported after epidemiological evidence points to a common food or water source. The virus replicates inside human host cells and is shed in human feces. The virus does not multiply in or on foods but can be transmitted by food and water contaminated with human fecal material. Several fecal-oral scenarios leading to an outbreak include contaminated irrigation or wash water, sick field workers during harvest, or ready-to eat products contaminated by sick food handlers. The current outbreak strain of hepatitis A virus is genetically identical to the hepatitis A strain found in fresh organic strawberries that caused an outbreak in 2022. Organic strawberries in both outbreaks were sourced from farms located in Baja California, Mexico.

Hepatitis A Foodborne Outbreaks (Source FDA and CDC)

YearProductVirusIllness
2023
2022
2019
2017
2016
2016
2013
Frozen Strawberries
Frozen Strawberries
Fresh Blackberries
Frozen Tuna
Frozen Strawberries
Raw Scallops
Pomegranate Seeds 		Hepatitis A
Hepatitis A
Hepatitis A
Hepatitis A
Hepatitis A
Hepatitis A
Hepatitis A		5 (currently)
18
20
Unknown
143
292
162

Berries contaminated with hepatitis A can also pose a hazard when processed into products such as fresh fruit smoothies or juice. A recent warning letter was issued to a juice manufacturer that used contaminated strawberries in the formulation of a high pressure processed (HPP) juice product. The manufacturer did not validate that the HPP treatment would produce the required minimum 5-log reduction to control the target pathogen (hepatitis A virus). Generally, cooking food until it’s at a
temperature of 190˚F in the middle for at least 1½ minutes or boiling food in water for at least 3 minutes inactivates the virus. However, if present, the virus is very hardy and can survive on food, in water, and on environmental surfaces for extended periods of time. Hepatitis A illness usually begins about 2-4 weeks after exposure causing symptoms of fever, low appetite, nausea, vomiting, diarrhea, muscle aches, and jaundice. The virus can clear on its own within a week or two.

However, in some instances, the infection can last up to 6 months and cause inflammation and damage to the liver. Although the virus cannot grow in the
environment, it is considered to be extremely stable under a wide range of environmental conditions, including freezing, heat, desiccation, and chemicals. Concentrations of disinfectants commonly used against pathogenic bacteria might not be effective. A vaccine for the virus has provided a reasonable control measure to prevent the spread of hepatitis A. Preventive measures generally include good food handler hygiene, supplier verification programs, use of potable water, thermal processing, and proper sanitation.

Regulatory Update: FDA Releases FY 2021 Pesticide Residue Monitoring Report

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The FDA published their annual Pesticide Residue Monitoring Program Report for Fiscal Year 2021 (FY 2021) on October 24, 2023.
The report summarizes findings from FDA testing of human and animal foods for approximately 750 different pesticides and selected industrial compounds from October 1, 2020, through September 30, 2021.


It is the legal responsibility of companies that produce and grow foods and manufacture products for food use sold in the U.S. to assure compliance with applicable Environmental Protection Agency (EPA) and FDA regulations.


The goal of the FDA’s pesticide residue monitoring program is to protect public health by assuring that pesticide tolerances, or maximum residue levels, set by the EPA are not exceeded in FDA-regulated foods shipped in interstate commerce and in foods imported into the U.S..

The FDA is responsible for enforcing pesticide tolerances. If the FDA finds that the amount of pesticide residue on a food is over the tolerance, or when a pesticide is found and there is no tolerance established, the FDA can take action. The findings of the 2021 monitoring program show that the levels of pesticide chemical residues measured by FDA in the U.S. food supply are generally in compliance with EPA pesticide tolerances.


Link: 2021 Report (PDF: 572 KB)


FDA selectively monitors a broad range of domestic and import commodities for residues of approximately 750 different pesticides and selected industrial compounds. FDA may also carry out focused sampling surveys for specific commodities or selected pesticides of special interest. In addition, FDA monitors the levels of pesticide chemical residues in foods prepared for consumption in its Total Diet Study (TDS), an ongoing program that monitors contaminants and nutrients in the average U.S. diet.

As with FY 2020, sample collection and analysis in FY 2021 was significantly impacted by the COVID-19 pandemic. Approximately 68% fewer human food samples and 78% fewer animal food samples were collected in FY 2021 compared with FY 2019, the most recent year not impacted by the global pandemic. Sample collection and analysis increased in FY 2022.

Overall Findings
Human Food Samples: 1,367 total samples (300 domestic food samples from 26 states and 1,067 imported food samples from 66 countries/economies).

  • 96.7% of domestic samples and 89.3% of imported samples were compliant with federal regulations (below EPA tolerances).
  • No pesticide chemical residues were detected in 35.0% of domestic samples and 44.5% of imported samples.


Animal Food Samples: 80 total samples (16 domestic food samples from 5 states and 64 imported samples
from 7 countries).

  • 100% of domestic samples and 98.4% of imported samples were compliant with federal
    regulations (below EPA tolerances).
  • No pesticide chemical residues were detected in 37.5% of domestic samples and 40.6% of
    imported samples.

Due to the low sample numbers, only limited conclusions can be drawn from the results. However, the violation rates for both human and animal food samples in FY 2021 were similar to recent years.

Warning Letter Highlights Necessary Controls for C. botulinum

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A warning letter was recently issued to a manufacturer of refrigerated ready-to-eat baby food products packaged in a reduced oxygen environment. The investigation that led to the warning letter was initiated because of a consumer complaint that involved a case of infant botulism. Infant botulism is caused by the presence of C. botulinum spores that temporarily colonize an infant’s large intestine and produce botulinum neurotoxin. However, spores are not a hazard for the majority of the population with developed guts. Instead, controlling C. botulinum spore germination, outgrowth, and toxin production in products that can support growth should be the focus of food manufacturers as highlighted by FDA in this warning letter.

In the warning letter, FDA cites that the manufacturer’s hazard analysis did not identify the potential for C. botulinum growth and/or toxin formation due to reduced oxygen packaging. This hazard should have been identified because C. botulinum is associated with the various product ingredients that are grown in the ground. This organism is an anaerobe that can grow in the reduced oxygen packaged product and pose a food safety risk because the product did not undergo a sporicidal treatment and the formulation did not control outgrowth and toxin formation.

Although the product was stored refrigerated, FDA indicated that refrigeration temperatures exceeded the levels necessary to prevent non-proteolytic C. botulinum strain outgrowth, considered to be <3°C. Likewise, the manufacturer did not utilize calibrated temperature probes that often indicated misleading monitored results. When temperature is the only control for C. botulinum, strict monitoring of that control is necessary throughout product storage.

Because temperature control throughout product storage, during transportation, and by the consumer may be hard to maintain, manufacturers will turn to other controls for C. botulinum. This can include a sporicidal heat treatment as outlined in 21 CFR Part 113 (Thermally Processed Low-Acid Foods Packaged In Hermetically Sealed Containers) or formulation and packaging controls that include:

• pH ≤4.6

• Water activity ≤0.935

• Aerobic packaging

• Preservatives such as nitrite, sorbic acid, phenolic antioxidants, polyphosphates, and ascorbates

A hurdle approach, or combination of controls, can also be used. In this case, no single control limits C. botulinum outgrowth. The combination of controls is commonly verified for effectiveness with a challenge study. Testing and handling of many bacterial toxins, like botulism toxin, requires sophisticated laboratory quality controls, including CDC / APHIS select agent accreditation. Deibel Laboratories has select agent approval and can conduct challenge studies to help verify that controls are effective to prevent C. botulinum outgrowth and toxin formation.

Failure to Develop a Foreign Supplier Verification Program -Top FDA Citation for Fiscal Year 2023

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According to FDA’s Data Dashboard, the most frequently cited violation by FDA investigators in fiscal year 2023 (ending September 30th) was the failure to develop an FSVP. This encompassed about 35% of all form 483 citations issued. Additionally, nine warning letters were published in the past month alone when food importers failed to correct FSVP violations cited during FDA investigations. According to FDA data, warning letters issued for FSVP violations in 2023 increased in number from the previous year. Forty-eight importers were placed on import alert and only two were removed. Normally, FDA investigators will determine if foreign food is imported during routine investigations. Manufacturers that import food and lack FSVP documentation will be cited for not following the FSVP rule if no exemptions apply.

Warning letters published this past month cited inaction on developing, maintaining, and following an FSVP as required by section 805 of the FD&C Act and 21 CFR 1.502(a) for any of the foods they import. Generally a written response to a warning letter is required within 15 working days of notification. If the matter is not adequately addressed, the FDA may take further action including an FDA product hold, detention, and Import Alerts (e.g. Import Alert # 99-41). Removal from an Import Alert is a lengthy process. The importer is required to submit information to the FDA that adequately demonstrates resolution of the conditions that gave rise to the FSVP violation and provide assurance that FSVP requirements will be met for future imports.

Final guidance is available from FDA to help importers comply with the FSVP rule. U.S. importers who have responsibility for fulfilling FSMA FSVP requirements for foreign suppliers that manufacture, process, pack, or hold food intended for human or animal consumption in the U.S. must use a qualified individual to develop and perform FSVP activities. These activities include determining known or reasonably
foreseeable hazards associated with each type of food, evaluating risks posed by the supplier’s performance, approving suppliers, conducting appropriate supplier verification activities, and verifying corrective actions that provide assurance the food’s hazards have been significantly minimized or prevented. Detailed records documenting these activities are also required.

A course specifically designed to train FSVP qualified individuals was developed by the Food Safety Preventive Controls Alliance (FSPCA) that provides a standardized curriculum recognized by the FDA. The course is offered by Deibel Laboratories.

Food Allergens – Understanding The Hazards

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Violations due to food allergen hazards are a major food safety concern globally. In a recent article in the Journal of Food Protection, FDA reviewed recalls associated with major food allergens (MFA) and gluten in FDA regulated foods from fiscal years 2013 to 2019. The review distilled information about the foods most frequently implicated in allergen recalls and the specific food allergens associated with recalled products. The root causes of the recalls that occurred over the time period studied were also examined.


During fiscal year 2013-2019, 1417 allergen related recalls were reported. Most of the recalls (97%) were classified as Class I (51%), posing a reasonable probability of serious adverse health consequences or death or Class II (46%), posing a remote probability of serious adverse health consequences or temporary/reversible adverse health consequences. Of the 1471 recalls, 1415 recalls were due to MFAs, 34 recalls were due to a gluten-free labeling violation, and 23 recalls involved other allergens. Milk was the most common allergen involved in MFA recalls (37.5%), followed by soy (22.5%) and tree nuts (21.6%). Almond, anchovy, and shrimp were the most common allergens recalled within the MFA groups of tree nuts, fish, and Crustacean shellfish, respectively. About 97% of MFA recalls involved one product category and among them, the category of ‘bakery products, dough, bakery mixes and icings’ ranked first (367 recalls), followed by the category of ‘chocolate and cocoa products’ (120 recalls).

The top five recalled food product categories – major food allergens implicated and number of recalls.

Product CategoriesMultiple MFACrustacean
Shellfish		EggFishMilkPeanutSoyTree NutWheatTotal
Bakery
Products,
dough, bakery
mixes, and
icings		8303318922337531387
Chocolate and
cocoa
products		2201042257203120
Multiple food
dinners,
gravies,
sauces, and
specialties		312158201101112110
Snack foods
(flour, meal, or
vegetable
base)		9031456116586
Ice cream and
related
products		12050820223272
Adapted from G. M. Sharma et.al. 2023.

The “mode of discovery” for allergen issues leading to a recall was also examined. These issues were most often detected by consumer and downstream customer complaints.

DiscoveredDescriptionNumbers of recalls % of total recalls
ComplaintIncludes complaint from consumer, downstream customer,
distributor, or others; did not involve allergic or other adverse
reactions		39227.7
FDAIncludes inspection or other means of discovery by FDA19313.6
FirmIncludes recalling firm, manufacturing firm, or responsible firm27919.7
Other governmentIncludes inspection, notification or other means of discovery by
State agencies, other federal agencies, or foreign government		21515.2
ReactionIncludes consumer adverse reaction associated with the
consumption of the product		1258.8
Unknownmode of discovery not identified based on available information to
FDA		21114.9
Adapted from G. M. Sharma et.al. 2023.

Nineteen different root cause categories were identified for the MFA recalls that occurred during the period studied. Overall, allergen labeling and packaging errors were the major sources of issues resulting in 64.6% (N = 914) of total MFA recalls.

Allergen cross-contact, defined as the unintentional incorporation of a food allergen into a food, resulted in 21.3% (N = 301) of total MFA recalls. Sources of unintended allergen presence in food products were related to processing or production such as a mix-up in rework, the use of a wrong ingredient that was not communicated on the product label (5.6% of total MFA recalls), or inadequate sanitation practices (7.1% of total MFA recalls).
1163 recalls out of 1415 MFA recalls were traced to a specific root cause. Considering all sources of
allergen issues, these were identified as the most common root causes:
◼ 662 recalls were traced to errors in labeling and packaging.
◼ 307 recalls were traced to raw or incoming ingredients.
◼ 194 recalls were traced to processing or production errors within the facility.

Root CauseExamples
No carry-through • MFA in sub-ingredient not declared on the final product
• MFA in an incidental additive not declared on final product
Wrong Package • Use of wrong primary or secondary package
• Mix-up of wrong package at supplier or manufacturer level
Wrong Label• Use of wrong label or one labels on the product is wrong
• Label mix-up at supplier or manufacturer level
Terminology• Ingredient is declared but its MFA source is not
Cross-contact• Sanitation issues
• Change-over or sequencing issues
Wrong ingredient• Use of wrong formulation or recipe
• Use of wrong sub-product in a composite product kit
Adapted from G. M. Sharma et.al. 2023.

Identification of allergen controls that could mitigate the source of allergen errors are listed below. Label controls (includes label content controls and label management controls) could have prevented 893 out of 1163 MFA recalls (76.8%), whereas allergen cross-contact controls and supply chain controls could have prevented 16.7% and 6.5% MFA recalls, respectively.

Allergen controlsSource of problemRoot causeNumber of recalls% of total recalls
Cross-contact controlsProcessing or productionIn process171.5
Other cross-contact796.8
Positive allergen test171.5
Rework161.4
Wrong ingredient655.6
Total cross-contact controls19416.7
Label content controls Labeling and packagingComputer error534.6
Foreign language121.0
Knowledge 342.9
No declaration 252.2
Not updated564.8
Partial declaration353.0
Terminology12110.4
Raw or incoming ingredientsNo carry-through23119.9
Total label content controls56748.8
Label management controlsLabeling and packagingWrong label16113.8
Wrong package16514.2
Total label management controls32628.0
Supply Chain ControlsRaw or incoming ingredientsIngredient mislabeled211.8
Other cross-contact221.9
Positive allergen test191.6
Wrong ingredient141.2
Total supply chain controls766.5
Total allergen controls1163100.0
Adapted from G. M. Sharma et.al., 2023.

Recent guidance documents listed below provide useful information for food allergen hazard assessments and associated controls.

CPG Sec 555.250 DRAFT: Major Food Allergen Labeling and Cross-contact | FDA

-Major Food Allergen Labeling and Cross-contact Draft Compliance Policy Guide (CPG)

Update to Draft Guidance for Industry: Hazard Analysis

-Chapter 11: Food Allergen Program

Source of information: FDA.gov

Retest Analysis: When Original Sample Results and Retest Results Don’t Correlate

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By Laurie Post, Ph.D.
When undesirable microorganisms are detected in a production lot, root cause analysis often includes testing additional samples from the affected lot or related lots of product. However, upon reanalysis, even when a larger sample size is used, the suspect organism cannot be detected in the retest analysis. Correlation differences between original and retest results can occur for several reasons:

  1. Distribution pattern of the microorganisms
  2. Lack of representative sampling
  3. Organism die-off
  4. Level of contamination and probabilities of detection

Distribution
The distribution pattern of microorganisms in a production lot affects the likelihood of detecting the organism in the product. For instance, distribution patterns can be Random or Non-Random.

Random Distribution: Microorganisms are distributed evenly throughout the entire lot. Microorganisms will likely be detected. This type of microbial distribution is not a factor of time since at any point in the sampling process there is an equal opportunity to detect the organism in question (Example A).


Non-random Distribution: Microorganisms are not distributed evenly throughout the entire lot. Microorganisms may not be detected by random sampling. This type of distribution is dependent on time since the microbial contamination is only represented at certain intervals in the production cycle without equal opportunity for detection (Examples B and C)

Example B shows a non-random distribution pattern of organisms that can be present at the startup of production. In this case, the food actually cleans the line, so that over time the contaminant is reduced to undetectable levels. If a retest sample of this lot of production is pulled from containers made later in the day, then the retest results will be negative for the target organism, even though the organism was present.

Example C is another example of non-random microbial distribution that can occur when condensate drips onto exposed product. Condensate began to drip sometime after startup and continues throughout the rest of the day, increasing toward shutdown. If retain samples taken at the beginning of the day were selected for retest analysis, the retest samples would likely be negative for the target organism even
though the organism was present in that lot of production.


Sampling
Microbiological analyses are only as good as the sampling procedure used to procure the sample. Every effort must be made to obtain a RANDOM SAMPLE. “Spot sampling” or taking a single sample will not yield a representative sample. FDA recommends taking 30 random 25g samples during the entire production run for Ready-to-Eat products that will be consumed without a process lethal to microbial pathogens. These include products such as cereals, confectionary products, cheese, dairy, spices – and many others (FDA Bacteriological Analytical Manual). For fluid and powdered products, most manufacturers employ mechanical or auto-samplers. For discrete products, samples are taken on a time production basis (i.e. one candy bar every half hour) and then the analytical unit (the actual amount tested) is made by compositing. Compositing must be performed carefully and thoughtfully, not only to ensure a representative sample, but also to avoid sample contamination.

Organism Die-off
Organisms contaminating a product may not survive at the same level for long periods of time. For example, Escherichia coli (E. coli) is not capable of long-term survival in an inhospitable matrix, such as chocolate, and will eventually die off. Levels may fall below the ability of an assay to detect the organism.


Levels of Contamination and Probability of Detection
The probability of finding a target organism in a retest sample is based on the probability of finding the target organism in the original sample. If 10 samples are collected for analysis and only one tests positive for a pathogen, the level of contamination is one in ten or 10%. Based on a standard statistical analysis, if there is a 10% chance of finding the target organism in the original sample, then the ability of finding the organism a second time by retest sampling is [10% X 10%] or [0.10 X 0.10 = 0.01] or one in a hundred. Similarly, if the level of contamination is 5%, the probability of finding the positive a second time is one in twenty-five and 1% is one in ten thousand. The short hand version of this is to simply square the level of
contamination, as shown here:

Level of Contamination- Probability of Finding the Target Organism in the Original Sample Probability of Finding the Target Organism in a
Retest Sample
One in two (50%)One in four (25%)
One in four (25%)One in sixteen (6.5%)
One in five (20%)One in twenty five (2.5%)
One in ten (10%)One in a hundred (1%)
One in a hundred (1%)One in ten thousand (0.01%)

There are many factors that can result in correlation differences between original and retest results. But, if a retest is desired, pull many random samples and request a retest as soon as possible.

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