Salmonella Poisoning and Death by Peanut Butter

Hi everyone! I’m Sarah. 

& I’m Becca. Welcome back to Dietetics After Dark! How is it going?

It’s so nice out! I realized this morning while I was having my coffee… cat mom fail

Poop trigger warning

 Let’s dive right in so we can go enjoy it! 

When it comes to food contamination, there are three different types - chemical, physical, and biological. Some say allergenic contamination is a 4th type, but since that doesn’t apply to everyone or all food, I won’t get into it here.

So chemical contamination refers to anything that has been contaminated with a chemical substance, like bleach, or anything that naturally produces a chemical - like toxins in certain fish (Australian Institute of Food Safety, n.d.). For example, the ciguatera (CIG-GWA-TERA) toxin may be present in certain types of tropical or subtropical fish. It is produced in the organism and may accumulate if that fish consumes other fish with the same toxin. It is harmless to the fish themselves but can have pretty serious impacts on humans, affecting digestive, muscular and neurological systems. Symptoms include an itchy rash, tooth pain, cramps, diarrhea, and joint pain; and severe cases may be life threatening. Thankfully this type of fish toxicity is pretty rare, although its prevalence has gone up more recently as the global demand for seafood has increased. 

The fish that are often living with this toxin are barracuda, red snapper, sea bass, and some other species; but they are typically found in coral reefs or low-lying shore areas. So to prevent this type of toxicity, you could avoid eating reef fish, as well as the head, liver, intestines and eggs of these fish, since the concentration of the toxin is usually higher in those areas. One really unfortunate, yet fascinating thing, is that the ciguatoxin (GWA) can be found and spread through breast milk or semen. So it is possible to spread it without someone actually consuming the fish (National Organization for Rare Disorders, 2009).

Next up, physical contamination is when a foreign object, like hair, has contaminated the food during the production process. So it’s likely that everyone has a physical contamination story.

STORY: Dan and I went to Fran’s for a drink before a show at the Sony Centre (Harry Potter symphony). I had a Campari spritz with no ice. And as I had one of the last sips, I got a piece of glass in my mouth. But before I realized, I had swallowed it…...

And lastly, biological contamination, which we will be discussing in much greater detail today; it’s when food is contaminated by substances produced by living creatures. So this means humans, rodents, pests, or microorganisms, and it can include bacterial, viral, or parasitic contamination that can be transferred through saliva, blood, or feces. This type of contamination is the most common cause of foodborne illness globally (Australian Institute of Food Safety, n.d.).

The World Health Organization estimates that every year 600 million people, or 1 in 10 people, get sick from contaminated food. And about 420,000 people (so almost half a million) lose their lives each year because of it. Over 110 billion dollars USD (over $133 billion CAD) is lost annually due to medical expenses and productivity costs resulting from food contamination at a global level. Symptoms like diarrhea are the most common, and are normally pretty mild, but can become more serious with dehydration and a large loss of electrolytes (WHO, 2020).

I feel like since COVID-19, people have become increasingly interested in the pathology of bacterial, viral or parasitic infections; and links to things like zoonotic disease - which are when pathogens jump from an animal to a human.

Now there are a lot of different things that can cause biological contamination, and these are usually broken down into a few groups. So we have viruses and bacteria, which can live outside of one’s body; and parasites, which actually need a living host to survive; and lastly, there are prions, which I won’t be getting into here for the sake of time, but they are proteins that contain infectious agents, and include things like mad cow disease. Which we will definitely cover in an episode soon.

First off, we have viruses. Two of the most common types of foodborne viruses are norovirus and hepatitis A. Norovirus infections are characterized by abdominal pain, vomiting, and diarrhea, and are typically contracted through fruits and vegetables, shellfish, water or carriers. We talked about this one in a bit more detail in our Organic Food Fraud episode, but Norovirus is commonly referred to as the Cruise Ship Virus since it is known to spread incredibly fast on cruise ships - simply because of how contagious it is and the close quarters on ships. And as we know, it is spread through contaminated food; BUT that food is most commonly contaminated with human feces…

Hepatitis A on the other hand, is a longer-lasting virus that impacts the liver. It is often spread through undercooked or raw shellfish, other food and water that has been contaminated, or through food handlers when sanitation practices aren’t upheld. Symptoms include things like fatigue, fever, dark urine and jaundice; which can last from a few weeks to several months. Up to 15% of people will show no symptoms, but may carry the virus for up to 6 months. In Canada, the Hepatitis A vaccine is recommended to those over the age of 6 months; and you may also need it before you travel to another country, especially if that country has a higher prevalence of Hep A.

Now on to parasites, which are the most disgusting in my opinion. They are transmitted through food and water, and require a living host to survive. So they can be transmitted from human to human, animal to human, or vice versa. Heat does tend to kill most parasites, so usually it is transmitted through infected water. But it is also why raw or undercooked fish and meat can contain parasitic tapeworms.

One of the most common foodborne parasites is Giardia or Beaver Fever. And it received this nickname after drinking water in Banff, Alberta became contaminated from an infested beaver dam and a mass outbreak occurred, impacting locals and tourism in the area. So, it’s a microscopic parasite that is typically transmitted through feces, and depending on the amount of time it remains in the body, it may lead to weight loss, malnutrition and dehydration. It can also cause lactose intolerance in some people, which may extend beyond the amount of time that someone is infected with giardia (Delgado, 2018).

Rosie story (giardia, malnourished & pointy ears). 

Lastly, we have foodborne illness caused by bacteria. And there are a lot of these, so I will only name a few. And most of them have unique origins and treatments, but a lot of the symptoms may be similar, which can make it challenging to identify what type of food poisoning you might be experiencing without proper testing. The most common foodborne pathogens are E. coli, campylobacter and salmonella. Symptoms include nausea, vomiting, diarrea, fever and headache. E. coli is most commonly associated with unpasteurized milk and uncooked meats; Campylobacter is also associated with raw poultry, raw milk and infected drinking water. 

And Salmonella outbreaks are often the result of contaminated eggs, poultry, other animal products and fecal contamination. This can also include produce that has been contaminated with these things as well. In 2017, it was estimated that there were over 95 million cases and more than 50,000 deaths associated with salmonella. Symptoms can begin as early as 6 hours after consumption, or as late as a few weeks, which makes it incredibly difficult to pinpoint the cause. But infection can be determined through stool testing. I don’t know if you knew this, because I didn’t (or I forgot), but the bacteria Salmonella typhi is what causes typhoid infections. Which makes me think of Typhoid Mary, who we need to do an episode on. ____ Anyways, salmonella typically lasts 4-7 days without antibiotic treatment (WHO, 2020; Government of Canada, n.d.)

Thank you Becca for that amazing and eye opening introduction to food poisoning. I think people don’t realize just how serious it can be, especially for the very young or very old, but it’s a real life threatening illness - a set of illnesses - and we’re very lucky to have regulatory bodies that are designed to keep us safe. 

Alright, so let’s get into the story.  

Margie Parsons. Robert Moss. Minnie Borden. Betty Shelander. Nellie Napier. Hester Fields. Clifford Tousignant. Doris Flatgard. Shirley Aylmer. Bobby Hullet. These names belong to people that have never met each other, but have one major thing in common: They all enjoyed peanut butter or products containing peanut butter between late 2008 and early 2009 sourced from the Peanut Corporation of America that was contaminated with Salmonella Typhimurium and... it killed them. This mass poisoning was caused by extreme, intentional negligence by the business owners and is also considered a crime that could have easily been prevented. It sickened at least 714 Americans (but estimates run as high as 20,000), hospitalized 166 people, killed 9, led to the recall of 3913 products made by 361 companies. Let’s get into it! 

My main sources for this scandal were an article from the Journal of Critical Criminology by Paul Leighton entitled Mass Salmonella Poisoning by the Peanut Corporation of America: State-Corporate Crime Involving Food Safety, an article by Lyndsey Layton and Nick Miroff for the Washington Post entitled The Rise and Fall of a Peanut Empire, and documentation by the Center for Disease Control (CDC) which has an intense and kind of amazing process for tracking outbreaks and documented the entire process. 

Let’s time travel. It’s 1977 in rural Gorman, Texas, population 1,236, and Stuart Parnell and his father Hugh are running a small peanut business that supplies candy and ice cream makers when they decide to expand the business. They buy a small processing plant where they can roast and sell wholesale peanuts, peanut butter, and peanut paste. Thus, the Peanut Corporation of America, or the PCA, was born. At first, the business struggled, only making about $50,000 in sales in the first year. The Parnell’s worked hard and started selling their peanuts and peanut products to bakeries and snack manufacturers. After about five years in business, the Parnell’s had grown their annual sales to $12 million dollars, and by 1994, the small peanut plant in Gorman, TX had grown to reach $30 million in annual sales with over 95 employees. The Parnell family had achieved the American dream! Hugh, the patriarch, was ready to retire and so he sold the plant, while Stuart and his two younger brothers decided to stay on in consulting roles. 

But Stuart couldn’t keep his hands out of the peanut butter jar for long, and in 2004, he repurchased the Gorman peanut plant and partnered up with another struggling peanut plant in Blakely, Georgia. Within 3 years of partnering with that plant, the revenue had tripled and Stuart had added on another operating facility in Suffolk, Virginia. Then Stuart shut down the Gorman plant (which was his original) and opened up another plant in Plainview, Texas. Stuart was described as a “hands on” manager at all 3 facilities and, as a trained pilot himself, he would fly his plane between facilities so that he could be present on-site fairly frequently. From the outside, it seemed like whatever Stuart got involved in became a success. Was it his business savvy? Turns out, Stuart was an extremely... frugal man. He operated his businesses at the lowest possible cost, relying on the cheapest peanuts he could find, paying his employees minimum wage ($6.25/h), and operating bare-bones facilities that he kept in disrepair. 

Parnell would look for dire situations and then make his move - for example, someone who had old peanuts they needed to get rid of was a perfect supplier, a processing plant that someone was about to shut down was a perfect place for his next roasting site.

Conditions in the Plants 

Okay, let’s get into some of the testimonies about the PCA plants. So when I say the PCA plants, I’m talking about the three main ones that Stuart Parnell owned, especially the Plainview, TX and Blakely, GA plants.

 David Brooks was a buyer for a snack company and had been to the PCA processing plants three different times throughout the mid-1980s to inspect the plant. Each time, he opted not to purchase from the PCA plants due to the conditions. I’m going to read you a quote by David Brooks from the Washington Post article:

"It was just filthy. Dust was all over the beams, the braces of the building. The roofs leaked, the windows would be open, and birds would fly through the building. . . . It was just a time bomb waiting to go off, and everybody in the peanut industry in Georgia, Virginia and Texas -- they all knew."

That’s throughout the 1980s!!! 

A former employee, Victoria Brown, whose job was to sift through peanuts and remove any sticks and rocks, recalled that the plant was scorching hot and whenever it would rain, the roof would leak. 

Another former employee and whistleblower, Kenneth Kendrick, went on Good Morning America to discuss the Plainview facility that he had worked at. He claimed that the basement was flooded, had rats, and had a roof that would drip rain contaminated with bird poop (double gross) into the production facility. These accounts give us a snapshot of what the plant looked like in the years leading up to the outbreak, and would later be confirmed by Food Safety officials and testimonies in court. 

The worst part of all this? Parnell’s plants were providing peanut and peanut butter products primarily to the "institutional food" market which services vulnerable populations, such as schools, prisons and long-term care homes, to food manufacturers for use in cookies, snacks, ice cream, and dog treats, and to other low-end markets such as dollar stores. So those locations encompass a lot of vulnerable people with weaker immune systems, like children and seniors. 

So let’s talk about Salmonella and peanuts. Becca gave us a wonderful overview of Salmonella listeriosis earlier, and keep in mind that there are over 2,600 subtypes of Salmonella and the type we are specifically dealing with at the PCA plants is Salmonella typhirium. But what is it about peanuts and peanut butter that make such a great home for that sneaky salmonella? So peanuts grow in the ground, I don’t know if you’ve ever seen a peanut plant or even thought about what a peanut plant looks like, but they are attached to the roots of the plant! Very similar to a potato plant. 

And so if the irrigation water is contaminated with feces or manure has been used that hasn’t been fully conditioned, then there is the possibility for contamination. Also, if there are rodent droppings near the raw product, that could easily contaminate the peanuts as well. Usually, production processes involve a “kill step” that will heat the food to the required temperature and duration required to kill salmonella and other pathogens. For salmonella, that is 131 F for one hour, 140 F for a half-hour, or by heating it to 167 F for 10 minutes. Typically, the peanut roasting process would kill salmonella, but reports say that the peanut roaster at the Plainview plant was not calibrated properly - so this likely wasn’t happening consistently. Also, best food safety practices dictate that raw product and product that has been processed and undergone the “kill step” need to be segregated to avoid cross contamination, which the plant was also not doing. 

In a peanut processing plant, keeping salmonella to a minimum is extremely important because a low-acid, high-fat food like peanut butter makes a really nice, safe environment for salmonella to hang out in. Salmonella can survive up to 2 years in a jar of peanut butter, and it’s considered stable because it won’t grow in the absence of water. So it will be stable and not growing or changing, so visually or taste-wise, you likely won’t be able to detect it. The water activity of peanut butter (and water activity describes the amount of water available in a product to contribute to microbial growth) is typically 0.35 or less which is very low and doesn’t allow for the growth of pathogens. However, if you get water near your peanuts or peanut butter, you’ve got a problem! If there is water present in a peanut processing plant, perhaps from a leaky roof, the salmonella will be able to grow and also spread. Remember the testimonies about Stuart Parnell’s peanut processing plants? The rodent problems which means feces, leaky roof which means water, improper roasting techniques and storage conditions created a recipe for disaster. 

So what happens if Salmonella does get into the food system? When a patient goes to their doctor with symptoms of salmonella poisoning, the doctor will take a stool sample. If that sample tests positive for salmonella, they will “fingerprint” the DNA of that specific strain of salmonella and upload it to the CDCs PulseNet which compares different DNA fingerprints of bacteria to patients from all over Canada and the US so that they can recognize clusters of disease with the same fingerprint, so that they can track the origin of the products. If a common DNA fingerprint is found in multiple places, public health officials will call the victims and take detailed notes about everything they ate probably a 24h or 48h recall, and start to make connections. 

In early 2009, media reports of a salmonella outbreak related to peanut butter were starting to spread across the country, but the specific origin hadn’t been pinpointed yet. Back at his peanut processing plant in Texas, Stuart Parnell was starting to get worried. Public health authorities had linked the salmonella to a peanut butter container from King Nut peanut butter, which was supplied by the Peanut Corporation of America’s peanut plant - but I believe at this point they couldn’t confirm, because the jar had been opened. On January 7, 2009, Parnell emailed the vice president of King Nut and attached an article by MSNBC entitled “Salmonella outbreak spreads to 42 states” and alongside it he wrote “I’m sure it’s something we did”. The King Nut executive responded back “I’m recalling everything”, to which Parnell responded “Now my heart is really in my throat. I’m going to church tonight.” At this point, public health officials couldn’t officially trace the peanut butter back to Parnell’s plants because all of the cases had been caused by open jars of peanut butter and so the possibility of cross contamination was there. 

We know from the state of Parnell’s facilities that he was not doing his due diligence to ensure a safe facility, but Parnell had been operating his plants for years without an outbreak or without alarming local officials. This is the United States of America - there are checks and balances in place to prevent these things from happening. Is it possible that Parnell just… didn’t know what he was supposed to do? There is evidence that Parnell was aware of these major concerns as early as 2006, when inspectors from Nestle visited the Plainview plant for an inspection because they were looking for a new peanut supplier. Rumour has it that Parnell knew that Nestle was coming and actually took steps to disguise the severity of some of the major health concerns at the plant - but not well enough! The Nestle inspectors noted the weakness of the pest control program, the lack of any pathogen monitoring program, and had concerns for the handling of raw and processed peanuts in the common processing area. They also noted that there was potential for microbiological cross contamination due to the lack of physical isolation and proper airflow for the roasting process. The report also stated that none of these issues would require significant capital investment to resolve - so they were pretty cheap and easy fixes. 

Let’s revisit Kenneth Kendrick, the whistleblower that used to work at the Plainview plant. He started after the Nestle audit, and he told the NYT that the plant looked like “something out of the 1950s”. He said the machinery constantly broke down and that it was a daily challenge to get the plant running. He also stated that they used low grade peanuts which had often been in storage for years, which made it difficult to kill salmonella. An older, dryer peanuts needs less roasting time which means that salmonella may survive the shorter roasting process. Also, recording of basic information, like roasting time and temperature, was not done on a regular basis which is normally standard practice to have a log book of some sort. Honestly, I could go on and on about the witness accounts of the plant conditions, but the biggest complaint and red flag that Kendrick confirmed was that whenever it rained the roof would leak and workers apparently had repeatedly requested funds to repair the roof but received emails denying the request. Additionally, the basement would flood and they would just keep pumping water out instead of fixing the problem, so the basement always had standing water. Documents from the department of justice showed emails in which officials from PCA told employees to just “air hose the top of the storage containers because they were covered in dust and rat crap”. 

Okay so there were clearly some shady and disgusting things happening at the PCA plants. When I read those reportsm, I’m shocked that something didn’t happen sooner. But we haven’t even gotten to the worst part yet. While PCA had a duty to ensure food safety when selling it’s peanuts, the companies who buy the peanuts also have a duty to ensure safety and so many companies will ask for a COA or a confirmation of assessment to confirm the safety. In order to fulfill the COA requests, PCA would semi-regularly test for salmonella (not as regularly as they should have, but they were testing occasionally). 

Here’s what is supposed to happen if you get a batch of peanuts that test positive for salmonella: if the first test is positive, the batch is dead. You can do a second test for confirmation or to test a different part of the batch to maybe see the extent of the problem, but you have to destroy the batch so that it doesn’t end up being sold. This standard is to prevent companies from retesting the same batch until they get a negative because that would be shady. At the eventual congressional hearings, one lab owner testified that if you get one positive test and 49 negatives, that one positive test trumps the 49 negatives. If the PCA got a positive test for salmonella, they would retest the batch in different areas until they got a negative test result and then proceed to sell it. A government investigation would later find that PCA knowingly shipped out contaminated peanut products at least 12 times in a 2 year period between 2007-2009, and in 6 of those cases, they conducted the first positive test and then didn’t even bother testing again. PCA would also forge test results by taking multiple samples from “clean” batches and then submitting them for testing under different batch numbers. One email from PCA clearly stated that if a company wanted a COA, they would make one and that “the girl in TX was very good at white out”. 

The Fall Out

So let’s get into the fall out. From September 2008 to March 31, 2009, 714 confirmed cases of salmonella typhimurium related to PCA peanut butter were reported across 46 states and Canada. Some estimates put infections as high as 11,000-20,000. The unique DNA fingerprint was linked to an unopened jar of peanut butter in Connecticut that was genetically matched to peanuts from PCA. The victims ages ranged from <1 to 98 years old, although half of them were children. This connection caused the texas department of health to immediately shut down the plant and recall everything the plant had every produced, triggering the most extensive food recall in U.S. history at the time, involving more than 360 companies, and more than 3,900 different products manufactured using PCA peanuts, including products from major brands such as Kellog’s, Sara Lee, Little Debbie, Clif bars, and General Mills. This recall had significant impacts on public perception of food safety, trust in government regulation, and also financial impacts for the companies affected. Kellog’s losses alone were

 estimated to be $65 million—2 % of each years’ operating profit—for lost inventory, recall and disposal, plus an unknown amount in lost sales. 

But the companies were far from the only victims. 

Shirley Almer had owned and operated her family bowling alley in Minnesota, called “Wadena Lanes.” for most of her life. After she retired, she enjoyed gardening and bowling in her bowling league, bird-watching, and spending time with her five children and four grandchildren. In July of 2008, she was diagnosed with a cancerous brain tumor and was in the midst of battling cancer when she consumed a product containing peanut butter from the PCA plant and passed away. Her son, Jeff Almer, wrote “Lung cancer and a brain tumor didn’t kill my mother — Salmonella-contaminated peanut butter did.” She was 72. 

Minnie Borden loved Little Debbie’s Peanut Butter Cheese sandwich crackers. In the fall of 2008, Minnie began complaining of abdominal pains and noticed that her appetite was dwindling, but she continued to snack on her favorite Little Debbie snacks. Well into December, Minnie’s stomach pain became excruciating and she eventually called her daughter to take her to the hospital. She passed away shortly after.

Bobby Ray Hullett was raised in North Carolina. Bobby, better known as “Pete,” and his wife, Shirley, were married for 45 years. He had worked at the Southern Glove Mill for 30 years, and he suffered a work injury that left him with only one functioning hand. Despite this injury, Pete was a very hard worker. One of Pete’s favorite snacks was the Austin brand peanut butter crackers, and he would have between two and three packs a day. He passed away in his early 50s, the day before thanksgiving, with his family by his side. 

Robert Moss was raised in Louisiana. He was a World War II Navy vet and the owner of Moss Carpet and Flooring. After eating Austin-brand peanut butter crackers, Robert became very ill and passed away at the age of 83.

Betty Shelander was raised in Blowing Rock, NC. She was a lively woman who loved music. Just two days after Christmas of 2008, Betty began feeling nauseous. The next day Betty’s husband, Albert, went to check on her and found her dead at the age of 53, due to salmonella from her favourite peanut toffee flavour of Zone perfect bars. 

Clifford Tousignant was raised in Duluth, MN. An Army veteran and a family man, he was sickened after consuming peanut butter sandwiches made with Salmonella-contaminated peanut butter. He passed away at the age of 79. 

Nellie Napier was a survivor, she had raised six children on her own, managed diabetes and beat cancer. The grandmother of 13 and great-grandmother of 11 loved reading, doing puzzles, cheering for the Cleveland Indians. She passed away from salmonella at 80 years old. 

Hester Fields had temporarily moved into a rehab center after some eye surgeries. She was preparing to move back in with her daughter when she started to feel ill. It’s likely she got salmonella from the peanut butter crackers served at the hospital. She was 78.

Those are just some of the names and stories of the people who lost their lives to salmonella linked to the PCA outbreak, but there are many more who were ill or injured from the mass poisoning that could have so easily been prevented. 

So what happened to the Peanut Corporation of American and Stuart Parnell? The PCA was immediately shut down. The Department of Justice brought a 76 count indictment against four of the top PCA executives. Stuart was sentenced to 28 years in prison for his role in the nationwide salmonella outbreak, the largest sentence in a food safety case in history, while his brother Michael was sentenced to 20 years. Mary Wilkerson, a quality control officer at PCA, served a five-year prison sentence for obstruction of justice. Two PCA managers who agreed to plead guilty and testify at trial, Daniel Kilgore and Samuel Lightsey, served six- and three-year prison terms respectively.

So justice was served, although it is heartbreaking to know how easily all of this could have been prevented if these business owners hadn’t been so focused on cutting corners and saving money. So what happened in the aftermath of the PCA mass salmonella poisoning? 

After PCA shut down, the whitehouse subcommittee on oversight and investigations held a hearing and went through all the old emails and documents showing PCA had intentionally released contaminated product into the market, and congress ultimately passed the Food Safety Modernization Act (FSMA), which was a sweeping overhaul of food safety laws that hadn’t been updated since 1938. What I like about these complicated food safety or food transparency cases like the Horsemeat scandal is action that gets taken after major cracks in the system are identified. It sucks that changes could have happened sooner, but I’m happy changes were implemented. 

Let’s bring it home with some tips for minimizing your risk of salmonella! 

Wash hands after using the bathroom and changing diapers, and before handling or eating any food - especially, especially, especially if there is diarrhea.

Always wash hands after contact with farm animals, pets, animal feces, and animal environments.

Keep your food preparation areas clean 

Keep raw meat and poultry separate from produce and other foods when shopping for, storing, and preparing food.

Wash hands, cutting boards, countertops, cutlery, and utensils after handling uncooked poultry.

Wash raw fruits and vegetables before eating.

Avoid unpasteurized (raw) milk and foods made from unpasteurized milk

Do not eat raw or undercooked eggs - yes, that includes cookie dough, but I break that rule fairly regularly. 

Thoroughly cook raw meat and poultry to destroy the bacteria. Meat, poultry, and hamburgers should be cooked until they are no longer pink in the middle.

Defrost food in the refrigerator, in cold water, or in the microwave. 

Do not eat food in areas where animals are present.