Food Safety Network

Fact Sheet: A Timeline of Fresh Juice Outbreaks

19.jun.00, A. Luedtke and D. Powell, Food Safety Risk Management and Communications Project, Food Safety Network

The following fact sheet contains all outbreaks related to fresh juices in North America and Australia. Fresh juices are those that have NOT received any heat (unpasteurized) or processing treatment after pressing.

1923: Salmonella typhimurium: Apple Cider

Twenty-four cases of typhoid fever were reported. The cause of illness was from apples that were rinsed in a stream contaminated with S. typhi (Parish, 2000).

Eighteen cases of typhoid fever were reported and one death occurred. The source of contamination was an asymptomatic restaurant worker who prepared the orange juice at a Cleveland, Ohio, US, hotel (Parish, 1997)

1974: Salmonella typhimurium: Apple Cider

In New Jersey, U.S.A., 300 people became ill after drinking apple cider that was made from grounder apples from an orchard that fertilized with manure. No deaths were reported (Anonymousa, 2000).

In Toronto, Canada, fourteen children became ill after drinking fresh apple juice and 13 developed bloody diarrhea and HUS (hemolytic uremic syndrome), with one case resulting in death. The source of contamination is unknown although it has been postulated that fecal contamination of the apples occurred (Parish, 2000). At that time, E. coli 0157:H7 had not been recognized as a human pathogen and was not until 1982. This is believed to be the index case for E. coli 0157:H7 in unpasteurized apple cider (Anonymousa, 2000).

October-November, 1991: E. coli 0157:H7: Apple Cider

In Fall River, Massachusetts, U.S.A., 23 people became ill from apple juice with 16 developing bloody diarrhea and 4 progressing to HUS (Anonymousa, 2000). No deaths were reported. A local farm sold their cider at a roadside stand and admitted to using dropped apples and inadequate washing systems.

An outbreak was recorded in 1992 (Anonymous, 1998) that occurred in India. The number of cases is unknown, as is the source of contamination. However, the probable cause was poor sanitation practices and facility design (Parish, 2000).

In Washington State, U.S.A., one individual was hospitalized after drinking home-made carrot juice (Anonymousa, 2000).

In Florida, U.S.A., a home-made watermelon drink caused illness in 18 people with no reported deaths (Anonymousa, 2000).

In Maine, U.S.A., an outbreak occurred from using dropped apples that were from trees near a cow pasture (Anonymousa, 2000). There were 213 cases of illness (Anonymousa, 1999) in people who drank the cider at a country fair. No deaths were reported.

May-June, 1995: Salmonella Serovars Hartford, Gaminara and Rubislaw: Orange Juice

In Orlando, Florida, U.S.A., cases of Salmonella infections were reported at a Walt Disney World theme park after people drank unpasteurized orange juice. There were 63 cases from 21 states (average age 10 years old) and 22% were hospitalized (Anonymousc, 2000). No deaths occurred. Salmonella of three different serotypes were found (Parish, 1998,Smith De Waal et al., 1999). Isolates of the three serovars from the patients, orange juice and processing environment demonstrated a link between the facility and the outbreak (Parish, 1997). Amphibians are suspected to be the source of contamination (Parish, 2000).

The largest outbreak of E. coli 0157:H7 in apple cider occurred in October of 1996. Odwalla Inc. located in Half Moon Bay, California produced a 16-ounce sample of juice that contained the organism. Sixty-six cases of illness were confirmed with 14 progressing to HUS and one death. Half of the victims were 5 years old or younger and the outbreak spanned 4 US states and one Canadian province. Odwalla’s production practices were thought to be the cause of the outbreak as they used low quality, partially decayed apples and it was not certain whether drops were used. As well, sanitation within the plant and of the equipment failed to meet safety standards (Clarke, 1996).

In New York, U.S.A., water used for rinsing came from a well that tested positive for coliforms (Anonymousa, 2000). There were 32 cases of illness reported with no deaths (Anonymousa, 1999).

In Connecticut, U.S.A., 14 cases of illness were reported with 3 people developing HUS (Anonymousa, 2000). Dropped apples were used by a small cider mill. No deaths were reported.

In Washington State, U.S.A., apple cider made at a church event was determined to cause illness in six people. It was reported that the apples had been washed in a chlorine solution however, the amount used was not specified. No deaths occurred (Anonymousa, 2000).

In Perth County, Ontario, Canada, 10 people became ill after drinking custom-pressed cider. The apples were from two farm families who used dropped apples. No deaths occurred (Anonymousb, 1999).

Unpasteurized frozen mamey puree imported to the U.S.A., caused 13 cases of typhoid fever. The fruit was consumed either directly or was used to make fruit drinks (Anonymousb, 2000). Mamey is a traditional fruit used in Caribbean drinks and is new to the US.

In Adelaide, Australia there were approximately 500 laboratory confirmed cases of Salmonella infection from fresh, chilled, unpasteurized orange juice (Anonymousb, 2000). No deaths occurred. The Knispel Fruit Juice Pty Ltd's orange juice called "Nippy's" was found to be the cause of the outbreak (Steene, 1999). Oranges from a fresh fruit packing house were the source of the contamination (Parish, 2000).

In the summer of 1999, 300 people became infected with Salmonella muenchen after drinking either frozen or fresh unpasteurized orange juice. The product was sold by the bottle and in bulk to restaurants, hotels and other food establishments. Thus, 15 US states were involved and 2 Canadian provinces. The juice was produced by Sun Orchard Inc. in Tempe, Arizona and was labeled under a number of different brand names (Sun Orchard, Aloha, Zupan, etc.) (Steinberg, 1999). One death occurred. The causative organism was isolated from samples of the packaged raw juice as well as from storage vats within the packaging facility. Three other Salmonella strains were also isolated from the product at the plant in Tempe, Arizona (Anonymousc, 1999). Imports of Mexican orange juice that contained melted ice is the suspected source of contamination (Anonymousd, 1999). This was the largest Salmonella outbreak associated with unpasteurized orange juice. In November, a second recall of raw orange juice from the same Arizona firm occurred when laboratory testing confirmed the presence of Salmonella in 5 lots of product. No illnesses were reported in that case (Anonymousb, 2000).

In Tulsa, Oklahoma, U.S.A., unpasteurized apple cider was found to be the vehicle for 5 cases of E. coli 0157:H7 illness (Anonymousb, 2000). No deaths occurred and the source of contamination was unknown.

Seventy-four confirmed cases of Salmonellosis were reported in 7 US states. No deaths occurred. California Day-Fresh Foods, who sells the unpasteurized juice as "Naked Juice" and "Ferraro's", was implicated in the outbreak. The source of contamination is unknown (Anonymousd. 2000).

Anonymous. 1998. Risk Assessment: Unpasteurized Fruit Juice/Cider. Health Canada.

Anonymousa. 1999. Safe Tables Our Priority: Technical Meetings on Juice Safety. [Online]. Available: http://stop-usa.org/news/priorcom/11999com.html [May 30, 2000].

Anonymousb. 1999. An Outbreak of Escherichia Coli 0157:H7 Infection Associated with Unpasteurized Non-Commercial, Custom-Pressed Apple Cider- Ontario, 1998. [Online] Available: http://www.hc-sc.gc.ca:80/hpb/lcdc/publicat/ccdr/99vol25/dr2513ea.html [June 7, 1999].

Anonymousc. 1999. Safetyalerts. Sun Orchard, Sysco, Aloha and Zupan Brand Orange Juice Recalled. [Online] Available: http://www.safetyalerts.com/recall/f/99/sunorch.htm [June 2, 2000].

Anonymousd. 1999. Salmonella muenchen: United States (Update). [August 6, 1999].

Anonymousa. 2000. Department of Health and Human Services: Food and Drug Administration. [Online] Available: http://vm.cfsan.fda.gov/~acrobat/fr98424b.pdf [May 30, 2000].

Anonymousb. 2000. NFPA: The Food Safety People. [Online]. Available: http://www.nfpa-food.org/pubpolicy/juice_timeline.htm [May 30, 2000].

Anonymousc. 2000. General Microbiology Overview. Department of Food Science, North Carolina State University Foodborne Outbreaks Traced to Fresh Produce. [Online]. Available: http://www.ces.ncsu.edu/depts/foodsci/ext/faculty/curtis/HACCP/gen-micro/tsld009.htm [May 30, 2000].

Anonymousd. 2000. Juice Recall. Associated Press. [April, 21, 2000].

Clarke, R. 1996. Report on USFDA meeting: Unpasteurized Apple Cider Contaminated with E. coli 0157:H7, "email to D. Powell", 8, January, 1996.

Parish, M. 1997. Public Health and Nonpasteurized Fruit Juice. Critical Reviews in Microbiology. 23(2):109-119.

Parish, M. 1998. Coliforms, E. coli and Salmonella Serovars Associated with a Citrus-Processing Facility Implicated in a Salmonellosis Outbreak. J. Food Prot. 61:280-284.

Parish, M. 2000. Relevancy of Salmonella and Pathogenic E. coli to Fruit Juices. [Unpublished paper].

Smith De Waal, C., Alderton, L., and Jacobson, M.F. 1999. Outbreak Alert! Closing the Gaps in Our Federal Food-Safety Net. Center for the Science in the Public Interest, Washington, D.C. pp. 14.

Steene, M. 1999. Nippy's Denies Liability. Australia News Network. [Online]. Available: http://www.theage.com.au/news/20000502/A35465-2000May1.html [June 2, 2000].

Steinberg, E. 1999. Outbreak of Salmonella Serotype Muenchen Infections Associated with Unpasteurized Orange Juice- United States and Canada, June 1999. [Online]. Available: http://www.cdc.gov/od/oc/media/mmwrnews/n990716.htm#mmwr2 [May 30, 2000].

Additional Sources of Information:

http://vm.cfsan.fda.gov/~lrd/1216fda.html http://vm.cfsan.fda.gov/~lrd/1217fda.html http://vm.cfsan.fda.gov/~mow/nacmcf.html

Duncan, T.G., Coull, J.A., Miller, E.R., and Bancroft, H. 1946. Outbreak of Typhoid Fever with Orange Juice as the Vehicle, Illustrating the Value of Immunization. Am. J. Pub. Health, 36, 34.

Centres for Disease Control. 1975. Salmonella typhimurium Outbreak Traced to a Commercial Apple Cider - New Jersey. Morbid. Mortal. Weekly Rep., 24,87.

Centres for Disease Control. 1997. Outbreaks of Escherichia coli 0157:H7 infection and Cryptosporidiosis Associated with Drinking Unpasteurized Apple Juice - Connecticut and New York, October 1996. Morbid. Mortal. Weekly Rep., 46,4.

Millard, P.S., Gensheimer, K.F., and Addiss, D.G. 1994. An Outbreak of Cryptosporidiosis From Fresh Pressed Cider. JAMA, 292, 1592.

Steele, B.T., Murphy, N., and Rance, C.P. 1982. An Outbreak of Hemolytic Uremic Syndrome Associated with the Ingestion of Fresh Apple Juice. J. Pediatr., 101, 963.

Besser, R.E., Lett, S.M., Weber, J.T., Doyle, M.P., Barrett, T. J., Wells, J.G., and Griffin, P.M. 1993. An Outbreak of Diarrhea and Hemolytic Uremic Syndrome from Escherichia coli 0157:H7 in Fresh Pressed Apple Cider. JAMA, 269, 2217.

Centers for Disease Control. 1995. Outbreak of Salmonella Hartford Infections Among Travellers to Orlando, Florida. EPI-AID Trip Rpt., 95-62.

Centers for Disease Control. 1996. Outbreak of Escherichia coli 0157:H7 Infections Associated with Drinking Unpasteurized Commercial Apple Juice- British Columbia, California, Colorado and Washington - October 1996. Morbid. Mortal. Weekly Rep., 45, 975.