One person has died and 12 have been hospitalized in a Listeriosis outbreak linked to Dole packaged salads. Officials from CDC announced today they have been investigating the six-state outbreak since September 2015. “Epidemiologic and laboratory evidence available to date indicate that packaged salads produced at the Dole processing facility in Springfield, Ohio, and sold under various brand names are the likely source of this outbreak,” according to the Jan. 22 investigation announcement from the Centers for Disease Control and Prevention. The CDC announcement came a day after the Public Health Agency of Canada reported that seven people have been hospitalized in a Listeria outbreak affecting five provinces. The agency believes there is a link with the U.S. outbreak, but is awaiting final lab results, according to media reports. The Canadian health agency said there were three cases in Ontario and one each in Quebec, New Brunswick, Prince Edward Island, and Newfoundland and Labrador. Most of them were women with an average age of 81. They became sick between September 2015 and early January and one of them died. It has not been determined if Listeria contributed to the death. Dole Food Co. issued a voluntary market withdrawal of packaged salads from 23 states and three Canadian provinces a few hours after the CDC announcement. “Retailers and consumers who have any remaining product with an ‘A’ code should not consume it, and are urged to discard it,” according to the withdrawal notice on the Food and Drug Administration website. “Retailer and consumer questions about the voluntary withdrawal should be directed to the Dole Food Co. Consumer Response Center at 800-356-3111.” Dole Fresh Vegetables’ customer service representatives have been contacting retailers and are in the process of confirming that the withdrawn product has been removed from the supply chain, company officials said in the withdrawal notice. Dole Food Co. officials reported to the CDC Jan. 21 that they had stopped production at the processing facility in Springfield, Ohio. The company also reported that it is withdrawing packaged salads currently on the market that were produced at this facility. “CDC recommends that consumers do not eat, restaurants do not serve, and retailers do not sell packaged salads produced at the Dole processing facility in Springfield, Ohio,” the outbreak announcement states. The packaged salads can be identified by the letter ‘A’ at the beginning of the manufacturing code found on the package. The packaged salads and leafy greens were sold under various brand names, including:

Dole;

Fresh Selections;

Simple Truth;

Marketside;

The Little Salad Bar; and

President’s Choice.

The number of ill people reported from each state is as follows: Indiana 1, Massachusetts 1, Michigan 4, New Jersey 1, New York 4, and Pennsylvania 1. Lab tests performed on clinical isolates from all 12 ill people have shown that the isolates are highly related genetically. Listeria specimens were collected from July 5, 2015, to Dec. 23, 2015. Ill people range in age from 3 years to 83, and the median age is 66. Of five ill people who were asked about packaged salad, all five reported eating a packaged salad. Two of two ill people who specified the brand of packaged salad eaten reported various varieties of Dole Food Co. brand packaged salad. Investigators linked the outbreak to the Dole salads after a routine product sampling by the Ohio Department of Agriculture returned positive results for Listeria in a Dole brand Field Greens packaged salad from a retail location. Additional tests showed that the Listeria isolate from the packaged salad was highly related genetically to isolates from ill people. Although one person has died and all 12 confirmed sick people required hospitalization, Dole issued a “market withdrawal” rather than a “recall” of its salads. Federal law defines a “market withdrawal” as “a firm’s removal or correction of a distributed product which involves a minor violation that would not be subject to legal action by the FDA or which involves no violation.” The federal definition for a Class 1 recall is “a situation in which there is a reasonable probability that the use of, or exposure to, a violative product will cause serious adverse health consequences or death.” Dole distributed the salads to retailers in:

Alabama

Connecticut

Florida

Georgia

Illinois

Indiana

Kentucky

Louisiana

Michigan

Massachusetts

Maryland

Minnesota

Missouri

Mississippi

North Carolina

New Jersey

New York

Ohio

Pennsylvania

South Carolina

Tennessee

Virginia

Wisconsin

Ontario

New Brunswick

Quebec

The Michigan Department of Health and Human Services is warning consumers who have eaten Dole bagged salads and become ill after eating them to seek medical attention. “Listeria can cause a serious, life-threatening illness. Symptoms of listeriosis include high fever, severe headache, neck stiffness, muscle aches, and nausea, sometimes diarrhea or other gastrointestinal symptoms,” according to a news release from the Michigan department. “The disease primarily affects pregnant women, newborn babies, older adults and adults with weakened immune systems. The incubation period is typically between two and three weeks, but can be as long as 70 days. People experiencing these symptoms and who may have consumed this packaged salad product should seek immediate medical attention.” (To sign up for a free subscription to Food Safety News, click here.)