Listeriosis Investigative Review
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Appendix B - Chronology of the Listeriosis Outbreak
The following chronology has been prepared based on the detailed review of information available to the investigative team from both testimony and documents.
The investigation identified key documents and testimony which have been used to validate each entry. Certain entries were drawn, and relied upon, from the chronologies prepared in the lessons learned reports of the Federal (CFIA/HC/PHAC) and Provincial (MOHLTC) departments and agencies involved with these events.
Acronyms
| AAFC | Agriculture and Agri-Food Canada |
| CEO | Chief Executive Officer |
| CFEZID | Centre for Foodborne, Environmental, Zoonotic and Infectious Disease (PHAC) |
| CFIA | Canadian Food Inspection Agency |
| CIOSC | Canadian Integrated Outbreak Surveillance Centre |
| CMOH | Chief Medical Officer of Health |
| CPHO | Chief Public Health Officer |
| CVS | Compliance Verification System |
| FIORP | Foodborne Illness Outbreak Response Protocol |
| P/T | Provincial/Territorial |
| HACCP | Hazard Analysis Critical Control Point |
| HC | Health Canada |
| LRS | Listeriosis Reference Service (HC) |
| HRA | Health Risk Assessment |
| iPHIS | Integrated Public Health Information System |
| MLF | Maple Leaf Foods |
| MOHLTC | Ministry of Health and Long-Term Care (Ontario) |
| NML | National Microbiology Laboratory (PHAC) |
| OFSR | Office of Food Safety and Recalls (CFIA) |
| OMAFRA | Ontario Ministry of Agriculture and Food and Rural Affairs |
| PHAC | Public Health Agency of Canada |
| PFGE | Pulsed Field Gel Electrophoresis |
| PHU | Public Health Unit |
| RTE | Ready-to-eat |
| TPH | Toronto Public Health |
| US | United States |
Pre-outbreak
Week of March 25, 2007
[1] Increase in positive Listeria test results, on line 7 from the MLF plant's environmental monitoring program.
Week of July 22
[2] Increase in positive Listeria test results, on line 8 from the MLF plant's environmental monitoring program.
Week of August 12
[3] Increase in positive Listeria test results, on line 8 from the MLF plant's environmental monitoring program.
Week of November 18
[4] Increase in positive Listeria test results, on lines 7 & 8 from the MLF plant's environmental monitoring program.
Friday, February 1, 2008
[5] Earliest production date of a sample that tested positive for L. monocytogenes of a product produced on line 7 at MLF Bartor Rd of MLF based on CFIA's post recall sampling.
Week of February 4
[6] Increase in the positive Listeria test results, on line 7 from MLF plant's environmental monitoring program.
Wednesday, April 2
[7] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
Thursday April 10
[8] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response tothe positive Listeria environmental program results.
Wednesday, April 16
[9] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
Week of May 19
[10] Increase in the positive Listeria test results, on line 7 & 8 from MLF plant's environmental monitoring program.
Wednesday, May 14
[11] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
Thursday, May 27
[12] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
Emergence of outbreak
Tuesday, June 3
[13] Earliest known onset of human illness related to listeriosis outbreak
Thursday, June 12
[14] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12
Tuesday, June 17
[15] First death linked to listeriosis from contaminated MLF products (diagnosed on June 10 and confirmed August 14).
Friday, June 20
[16] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Week of June 23
[17] Increase in the positive Listeria test results, from line 8 & 9 of the MLF plant's environmental monitoring program.
Tuesday, June 24
[18] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
Wednesday, June 25
[19] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Thursday, June 26
[20] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Friday, June 27
[21] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Saturday, June 28
[22] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Monday, June 30
[23] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Thursday, July 3
[24] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
[25] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
Saturday, July 5
[26] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Monday, July 7
[27] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Tuesday, July 8
[28] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Wednesday, July 9
[29] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Thursday, July 10
[30] As part of routine sampling, NML receives several human isolates of L. monocytogenes from the Ontario MOHLTC for DNA fingerprinting.
Saturday, July 12
[31] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Monday, July 14
[32] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Tuesday, July 15
[33] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Wednesday, July 16
[34] TPH begins investigating two cases of listeriosis in the same long-term care facility in Toronto. 11 food samples are collected and sent to TPH Labs. Samples were collected from prepared meals (retention samples) but were not linked to a manufacturer or production date.
[35] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Friday, July 18
[36] As part of routine sampling, NML testing identifies two human listeriosis samples received from MOHLTC that have matching DNA fingerprints.
[37] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Monday, July 21
[38] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
[39] MLF completes a Positive Recovery Corrective Action Report (CAR) for Bartor Rd in response to the positive Listeria environmental program results.
[40] The MOHLTC's Toronto Service Area Office receives a call from a Toronto long-term care facility on the evening of July 21st. The facility reports that it has two cases of listeriosis. One resident had died and the death is being investigated by the coroner's office; another resident was hospitalized. The Toronto Service Area Office forwards this information to MOHLTC.
Tuesday, July 22
[41] MOHLTC analyzes surveillance information from iPHIS and finds no listeriosis illnesses reported from long term care facilities.
[42] MOHLTC makes contact with TPH to follow up on reported cases of listeriosis in the long term care facility.
[43] MOHLTC (Lab) receives eleven food samples collected for testing by TPH from investigation launched July 16.
[44] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Wednesday, July 23
[45] MOHLTC (Lab) forwards eleven food samples received on July 22 to the LRS.
Thursday, July 24
[46] LRS receives the eleven food samples sent by MOHLTC.
Friday, July 25
[47] MOHLTC program staff detects an increase in the number of cases of listeriosis from iPHIS data.
[48] LRS begins analyzing the eleven samples.
[49] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Monday, July 28
[50] MOHLTC (Lab) reviews all cases of listeriosis from January 1 to July 28, 2008. MOHLTC staff contacts MOHLTC (Lab) and confirms 6 listeriosis cases (more than expected for July). MOHLTC continues investigating listeriosis cases (from July 25).
[51] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
[52] Halton Region Health Department sampled meats from unopened boxes that were used at the Burlington Hospital (ham, roast beef and turkey) and forwarded them to the Hamilton Public Health Lab for testing.
Tuesday, July 29
[53] MOHLTC notifies CFEZID of an increase in the number of listeriosis cases reported by Ontario health units. An alert, through CIOSC, is issued to all provincial, territorial and local health authorities across Canada regarding the increase in listeriosis cases. This represents the first knowledge nationally of the growing problem in Ontario.
Wednesday, July 30
[54] MOHLTC initiates conference call with PHAC, HC and 15 Ontario PHUs. Actions taken include: 1) MOHLTC asks public health units to ensure Listeria isolates are forwarded to MOHLTC (Lab) who will then submit human isolates to the NML and food isolates to LRS; 2) LRS continues to receive and analyze food samples and isolates; and 3) MOHLTC issues an Enhanced Surveillance Directive to all PHUs, requesting additional and timely reporting of listeriosis cases through iPHIS and that Listeria isolates be sent to the MOHLTC (Lab).
[55] NML informs MOHLTC that the results from the first available PFGE data for Ontario Listeria isolates collected prior to July 31st does not suggest a common source outbreak (clustering) as only 2 of the 13 human Listeria isolates have the same DNA fingerprint.
[56] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
Thursday, July 31
[57] MOHLTC continues to field calls from PHUs and assist with case management.
[58] MOHLTC forwards questionnaire and food sampling information sheets for use in prioritizing cases e.g. cold cuts, to PHUs to assist with epidemiological investigation for the listeriosis cases. MOHLTC also advises PHUs to collect food samples, providing guidance on how to do this.
[59] LRS takes note of the 3 positive results in the sampling from the 11 food samples that were received on July 24.
Friday, August 1
[60] MOHLTC continues to analyze iPHIS data and case files, and identifies 16 cases of listeriosis for the month of July. The norm for listeriosis cases in July is 5.
[61] LRS continues to receive samples from Ontario, including samples from Halton Region Health Department.
Saturday, August 2
[62] LRS receives the samples for testing from Halton Region Health Department. (See August 11 for positive results).
Monday, August 4
[63] LRS informs to MOHLTC via email that 3 of the 11 food samples collected July 21 from the Toronto long term care facility have tested positive for Listeria. The three positive results come from retention samples from foods prepared on July 13 and July 19.
Tuesday, August 5
[64] LRS confirms to MOHLTC via fax that 3 of the 11 food samples collected July 21 from the Toronto long term care facility have tested positive for Listeria.
[65] PHAC receives an update from MOHLTC indicating that 16 cases of listeriosis have been confirmed in Ontario during July 2008.
Wednesday, August 6
[66] TPH informs CFIA of the 3 positive food samples out of the 11 samples collected (see August 4).
Thursday, August 7
[67] OFSR initiates a food safety investigation to determine the extent and source of the potential food hazard. OFSR requests information from TPH and from LRS regarding sample collection practices and testing methodology for the positive samples collected by TPH.
[68] MLF informed by one of their distributors of an investigation in sliced meat production was underway by TPH. MLF contacted TPH to offer assistance. They were advised that no assistance was needed.
[69] OFSR received confirmation from TPH that MLF meats were used in the sandwiches that tested positive for L. monocytogenes made at the Toronto long term care facility.
[70] HC provides additional information to CFIA on the samples received from TPH including that samples were from previously-opened products retained and handled by nursing home staff as part of their daily retention protocols and therefore could not be considered aseptic and therefore relied upon as the basis for a HRA and product action.
Friday, August 8
[71] CFIA conducts a document review at MLF Bartor Rd to determine if the facility was following its food safety plan. No anomalies were noted.
[72] CFIA requests distribution records from MLF but is unable to obtain any because the MLF Sales Office was closed; MLF later informs the CFIA that the required information had already been provided separately to TPH on August 6, 2008.
[73] MLF provides CFIA with specific product information (name, product code, best before dates) for MLF product supplied to the Toronto long term care facility.
[74] CFIA confirms that positive product from the Toronto long term care facility originated at MLF Bartor Rd based on matching product information from a MLF distributor and MLF.
[75] CFIA collects and reviews records from a MLF distributor to identify the specific MLF Products served at the facility.
Week of August 11
[76] Increase in the positive Listeria test results, from line 7 & 8 of the MLF plant's environmental monitoring program.
Monday, August 11
[77] OFSR receives product distribution records from MLF with product codes and best before dates that were used to prepare meals at the Toronto long term care facility in July. Three largest distributors are immediately contacted but have no suspected product left in their possession. CFIA broadens search of suspect product to include other long term care facilities affiliated with the Toronto long term care facility that had the initial listeriosis cases to determine whether they have any unopened-package product on hand.
[78] MOHLTC (Lab) reports that two additional food samples, submitted by the Halton Region Health Department (the Burlington Hospital), test positive for Listeria.
Tuesday, August 12
[79] NML confirms that DNA fingerprinting patterns on human cases from Ontario match patterns identified in cases from other provinces, including Newfoundland & Labrador and Quebec. This represents the first suspicion that a national outbreak might be developing.
[80] Halton Region Health Department issues an advisory to its long-term care facilities.
[81] OFSR informed by MOHLTC that there may be additional cases in 3 other PHUs in Ontario (Peterborough, Simcoe, Etobicoke).
[82] CFIA locates and collects an unopened-package of suspected MLF product for testing from another long term care facility affiliated to the Toronto long term care facility that had the initial listeriosis cases. These unopened food samples are forwarded to the lab for testing. CFIA continues to search for samples in nursing homes and other clients of food distributors.
[83] OFSR is notified by Halton Regional Health Department of 2 additional listeriosis cases at the Burlington Hospital. Also 2 samples of MLF deli meats served at the hospital tested positive for L. monocytogenes. However it is reported that the two patients had not consumed the deli meats and the samples did not contain product code information. Since no scientific link can be established between the Toronto long term care facility and the Burlington Hospital cases, CFIA initiates a separate food safety investigation. CFIA informs MLF that an investigation has been launched.
[84] A MLF distributor informs OFSR based on an internal records review, suspect product associated with two lot codes, were provided to the Burlington Hospital during the time that listeriosis illnesses were reported.
[85] CFIA informs MLF that an investigation has been launched.
Wednesday, August 13
[86] MLF sends a letter to distributors informing them they are being investigated by the CFIA, and to place on hold any remaining inventory of "Sure Slice" Roast Beef, Corned Beef and Black Forest Ham. These "Sure Slice" brand products were sold only to institutions (hospitals, long term care facilities, restaurants, hotels, prisons)
[87] CFIA initiates a teleconference with PHAC, HC, MOHLTC and Ontario PHUs to review epidemiological information collected to date. Call participants are notified by MOHLTC that additional listeriosis cases had been reported to PHUs in Simcoe, Peterborough and Etobicoke. Investigations by those PHUs identified MLF brand as a possible source of the illness. Participants agreed to a large scale sampling plan to cover all "Sure Slice" brand products (with best before dates of August 1 to September 30) produced on two suspect MLF Bartor Rd production lines. This plan was agreed to by MOHLTC and initiated by PHUs.
[88] NML also notifies labs across Canada that DNA fingerprinting shows a clustering of human cases with a similar strain in more than one province.
[89] Teleconference concluded that further hazard and exposure information was required before HC could initiate a risk assessment and/or CFIA could initiate a recall procedure. No public notification or recall was deemed appropriate by any of the attending groups as the "Sure Slice" products were not sold to the general public and are not able to confirm a definitive link between the illnesses and specific product. Further investigation is still required.
[90] After a review of production and distribution records at MLF Bartor Rd, OFSR identified a possible link between the 5 positive samples - the products may all have originated from production lines 8 & 9 at the MLF Bartor Rd.
[91] PHAC learns that 5 samples of meat from open packages collected from institutions by local public health officials tested positive for outbreak strain of L.monocytogenes.
[92] Slicing dates of product from MLF that tested positive that was collected and analyzed during the week of August 12.
[93] MOHLTC makes a verbal request to PHUs reporting listeriosis cases to immediately start collecting closed samples of "Sure Slice" cold cuts and to submit them to the CFIA laboratory for analysis. PHUs respond immediately.
[94] Federal officials confirm there is a match in the L. monocytogenes strain in the product samples as well as the human samples identified in Ontario. DNA fingerprinting between the human cases and the food samples is still being conducted to find a definitive link.
[95] The LRS reports to MOHLTC regarding the PFGE results from food specimens collected as part of the epidemiological investigation. It indicates that PFGE patterns taken from open food samples from the Toronto long-term care home have matched PFGE patterns in two human cases, one from Toronto and one from Halton Regional Health Department. Both cases had been hospitalized at a Burlington Hospital prior to the onset of symptoms. Six other human cases have closely related PFGE patterns.
[96] It was also reported that a further 17 cases of Listeriosis were reported in July that were not clinically linked to the illnesses at Toronto long term care facility or at the Burlington Hospital, but the two of these illnesses that were PFGE typed matched the PFGE patterns of the original food samples taken from the Toronto long term care facility.
Thursday, August 14
[97] June 17, 2008 death confirmed as being linked to the MLF listeriosis outbreak.
[98] TPH asks its inspectors to contact all of their institutions to advise them to refrain from using MLF products, as per MLF's advisory to its customers/distributors on August 13.
[99] PHAC follows up with the Saskatchewan Ministry of Health regarding their cases in that province. A public health alert is drafted and a questionnaire put together to facilitate the standardization of inter-provincial data collection.
[100] MOHLTC holds a teleconference with affected PHUs to advise them of the laboratory results received and the ongoing listeriosis outbreak investigation. PHAC asks MOHLTC to send its hypothesis-generating questionnaire to other provinces.
[101] Halton Hills PHU notifies care homes not to consume cold cuts.
[102] CFIA regional staff in collaboration with MOHLTC and Ontario PHUs collect samples of MLF "Sure Slice" products from locations across Ontario over the next two days and submit them to the CFIA's Greater Toronto Area laboratory for analysis over the weekend.
[103] Conference calls led by CFIA continue with PHAC, HC, MOHLTC and PHUs to share information and update regarding the investigation at MLF Bartor Rd. Progress on the execution of the sampling plan to collect samples of "Sure Slice" products is discussed by CFIA. No public notification or recall was deemed appropriate by any of the attending groups.
Friday, August 15
[104] PHAC takes the lead coordinating role in the epidemiological investigation for the listeriosis outbreak, as per FIORP, since it had become apparent that the illnesses are distributed nationally.
[105] Conference calls lead by the CFIA continue with PHAC, HC, MOHLTC and Ontario PHUs to continue investigating the cause of the outbreak.
[106] PHAC issues an alert to all Public Health authorities in Canada to provide an update on the Ontario investigation and requests that health units collect information on consumption of RTE meats for cases that match the DNA fingerprint associated with the outbreak.
[107] MOHLTC instructs all PHUs to contact all hospitals, nursing homes, long-term care facilities and retirement homes in Ontario and instruct them to hold suspect product. (Notes no distribution lists are available at this time)
[108] CFIA continues to investigate the food sources and related information from the Burlington Hospital. They request and receive menu and deli meat information.
Saturday, August 16
[109] CFIA confirms a L. monocytogenes positive test result from an unopened package (see August 12) in a product produced at MLF Bartor Rd. The risk assessment determines that "Sure Slice" Roast Beef and Corned Beef meet the criteria for a "Health Risk I"
[110] CFIA contacts MLF to inform them the positive samples and that a Health Hazard Alert is being prepared for 2 specific product code of "Sure Slice" products.
Sunday, August 17
[111] At 2AM, CFIA issues a Health Hazard Alert warning the public not to consume "Sure Slice" Roast Beef and "Sure Slice" Corned Beef. CFIA states that no confirmed cases of listeriosis have been associated with the consumption of the recalled products. This is the first primary recall of MLF brand products. A primary recall indicates a recall of a product sold under the MLF name or one of its subsidiaries.
[112] At 3:30AM, MLF announces that it is voluntarily recalling two "Sure Slice" brand products sold in 1 kg packages.
[113] CMOH sends a notice alerting all Medical Officers of Health to the hazard and asks that their staff ensure that all products listed in the recall have been removed from their respective long-term care homes and hospitals.
Monday, August 18
[114] Epidemiological data from British Columbia identifies a potential link to the outbreak in Ontario.
[115] Conference calls led by CFIA continue with PHAC, HC, MOHLTC and PHUs to share information on MLF recall. PHAC chairs the epidemiological data portion of the call.
[116] MOHLTC issues a notice to food-recall contacts, directors of inspection and Medical Officers of Health in all PHUs. This notice provides updates on the CFIA Health Hazard Alert and requests assistance from PHUs to check the effectiveness of the food product recall at hospitals and other health care facilities.
[117] PHAC holds an inter-provincial teleconference. CFIA and MOHLTC are invited. CFIA advises that it may request assistance from PHUs to determine the presence of suspected products at local food establishments. CFIA also reports that it is monitoring the effectiveness of the recall in premises such as restaurants and deli counters.
Tuesday, August 19
[118] CFIA issues a Health Hazard Alert advising public not to consume or serve 23 other RTE deli meat products originating from MLF Bartor Rd. This is the second primary recall of MLF brand products.
[119] MLF was made aware by CFIA that two more tests on products produced at different times on the same lines had come back positive. MLF sends a letter to its customers informing them of its expanded recall to include all products produced on lines 8 and 9 from June 2nd.
[120] TPH surveillance alert sent to physicians and facilities.
[121] Conference calls initiated by the CFIA continue with PHAC, HC, MOHLTC and PHUs to share information. PHAC chairs the epidemiological data portion of the call.
[122] At 11am, CFIA reports two more positive results on MLF products from line 9 at MLF Bartor Rd collected August 14 and 15. Results were from product not included in August 17 recall. CFIA technical risk assessors request, from HC, a HRA for all "Sure Slice" meats from lines 8 & 9 in MLF Bartor Rd. Assessment determines that "Sure Slice" products produced in MLF Bartor Rd meet the criteria set by HC for a precautionary "Health Risk I" concern.
[123] PHAC updates its alert to provincial, territorial and local health authorities and requests that all provinces and territories review all cases of listeriosis from August 1, 2008.
[124] At 10:25PM, HC advises CFIA that all "Sure Slice" meat products in distribution present a risk to the public. HC indicates that PHAC has been consulting and is in agreement with this assessment.
[125] A HRA is done by HC. The assessment determines that "Sure Slice" products produced at MLF Bartor Rd met the criteria set by HC for a precautionary 'Health Risk I" concern.
Wednesday, August 20
[126] CFIA initiates verification checks to ensure recalled products have been removed at hospitals, long-term care homes and day cares.
[127] MLF suspends all production at MLF Bartor Rd and announces that it is voluntarily recalling 23 products.
[128] CFIA requires that MLF implement a hold and test protocol whereby no meat product produced at MLF Bartor Rd is made available to the consumer before test results are negative for L. monocytogenes.
[129] PHAC issues statement informing Canadians about the public health investigation.
[130] MOHLTC issues a listeriosis notice press release.
[131] CMOH advises the public, especially those at high risk for listeriosis, such as the elderly, pregnant women and those with weak immune systems, to make sure they avoid consuming the implicated products.
[132] CFIA inspectors sampled product from some lines prior to the end of the production run and took environmental swab samples of food contact surfaces in the plant (Note: All of the CFIA sampling results were negative.)
[133] Conference calls led by CFIA continue with PHAC, HC, MOHLTC and PHUs to share information on MLF recall. PHAC chairs the epidemiological data portion of the call.
Thursday, August 21
[134] CFIA receives lab results that indicate 18 "Sure Slice" product samples collected in Ontario have tested positive for Listeria. All samples testing positive for Listeria are on the current recall lists.
[135] CFIA issues an update to the previous day's warning to clarify best before dates on the 23 previously recalled products.
[136] TPH sends out a second surveillance alert sent to physicians and facilities.
[137] CMOH holds a press conference to update the media on the outbreak.
[138] PHAC requests all provinces and territories to review all cases of listeriosis from August 1, 2008.
[139] MOHLTC holds provincial teleconference with Ontario PHUs to provide updates on the outbreak. An update on the epidemiological investigation is provided and made available on the Public Health Ontario Portal.
[140] Conference calls led by CFIA continue with PHAC, HC, MOHLTC and PHUs to share information on MLF recall. PHAC chairs the epidemiological data portion of the call.
[141] Enhanced effectiveness checks are requested by CFIA officials. This includes 100% verification of removal of recalled product, with the assistance of local PHUs, at hospitals, nursing homes and independent grocery stores. Chain stores are checked via a normal verification process.
Friday, August 22
[142] PHAC, HC and CFIA hold a joint press conference in Ottawa to alert public about the food safety investigation and to answer questions from the media. (Attendees are senior executives of their departments.)
[143] CFIA and Royal Touch Foods issue a Health Hazard Alert regarding seven products sold under the Shopsy's brand that contain MLF deli meats that may be contaminated This is the first of the secondary recalls of MLF deli meats. (Secondary recall refers to recall of a product prepared by another company which contains Maple Leaf products as an ingredient.)
[144] PHAC activates its Emergency Operations Centre to Level 2 (Increased Vigilance).
[145] HC conducts a HRA, indicating that the additional products produced on lines 8 and 9 at MLF Bartor Rd (i.e., products recalled by MLF on August 19 other than "Sure Slice" products) constitute a 'Health Risk II'.
Saturday, August 23
PHAC Situation Report Update
| 21 Confirmed Cases | |||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 3 | 1 | 16 | 1 | ||||||||
[146] Minister of AAFC holds a press conference assisted by senior executives of PHAC, CFIA and HC (the first of a series of fifteen held by a Cabinet Minister) to announce that two out of three samples of recalled products test positive for the same outbreak strain of L. monocytogenes. The third sample is a slight variant. Results are shared with PHAC to compare with human samples.
[147] At 9:30PM, joint PHAC/CFIA news release indicates a confirmed link between the listeriosis outbreak strain and MLF Bartor Rd products. Lab results establish the link between products recalled by MLF Bartor Rd and the outbreak of listeriosis in four provinces. To date, 21 cases of listeriosis are confirmed, and the same strain has been detected in four people who have died. A further 30 cases remain under investigation.
[148] MLF CEO broadcasts a message to take responsibility following the determination that MLF Bartor Rd is the source of the outbreak. MLF also indicates that they will voluntarily expand their recall to include all 191 items produced at MLF Bartor Rd as a precaution. This is part of the third primary recall of MLF brand products.
[149] CFIA requests a HRA from HC on the entire production of MLF Bartor Rd and notifies MLF that assessment is being initiated as part of ongoing communication between the two parties.
[150] HC upgrades the HRA done on August 22, from "Health Risk II" to "Health Risk I" based on additional information from MLF Bartor Rd.
[151] Conference calls led by CFIA continue with PHAC, HC, MOHLTC and PHUs to share information on MLF recall. PHAC chairs the epidemiological data portion of the call.
Sunday, August 24
PHAC Situation Report Update
| 22 Confirmed Cases | |||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 3 | 1 | 17 | 1 | ||||||||
[152] CFIA issues an expanded Health Hazard Alert to cover all products produced at MLF Bartor Rd back to January 1st, 2008. This is the third primary recall of MLF brand products.
[153] MLF issues a press release confirming their voluntarily recall and expands it to include all 191 items produced at MLF Bartor Rd as a precaution. MLF emphasizes that there is no evidence of contamination beyond lines 8 and 9.
[154] Minister of Health holds a press conference assisted by senior executives from PHAC, CFIA and HC (the second of a series of fifteen by a Cabinet Minister) to respond to questions regarding outbreak and recall.
[155] HC conducts an HRA that determines and concludes that all products produced in MLF Bartor Rd meet the criteria for a "Health Risk I" concern.
[156] CFIA identifies that some MLF Bartor Rd product had been shipped to another MLF facility in Quebec (Est. 271B) and initiates a secondary food safety investigation at that facility.
[157] Conference calls led by CFIA continue with PHAC, HC, MOHLTC and PHUs to share information on MLF recall. PHAC chairs the epidemiological data portion of the call.
Monday, August 25
PHAC Situation Report Update
| 26 Confirmed Cases | 6 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 1 | 20 | 1 | 6 | |||||||
[158] Minister of AAFC, holds a press conference in which technical spokespeople from the CFIA, PHAC and HC respond to questions.
[159] CFIA and Lucerne Foods issue a Health Hazard Alert regarding 27 products sold under the Safeway and TakeAwayCafe brands that may contain contaminated MLF deli meats. This is the second secondary recall of MLF brand products.
[160] MOHLTC changes its reporting methodology to include all deaths among the listeriosis cases linked to the outbreak that had listeriosis as the underlying cause of death.
[161] PHAC hosts teleconference for: all provincial/territorial public health; environmental health officials; and federal food safety partners to discuss the investigation.
[162] A final conference call led by the CFIA with HC, PHAC, MOHLTC and PHUs to share information.
[163] CFIA continues with recall effectiveness checks to determine that all recalled product was removed from the marketplace. Approximately 29,000 checks were conducted between August 20th and September 14th.
[164] The CFIA receives a HRA from HC on MLF product produced at MLF Bartor Rd.
[165] MLF establishes an expert technical review panel to conduct a comprehensive investigation of food safety at MLF Bartor Rd with a mandate to determine root cause and likely source of contamination and to prepare for re-opening. Panel consisted of MLF people and three external experts in Listeria.
Tuesday, August 26
PHAC Situation Report Update
| 29 Confirmed Cases | 6 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 1 | 22 | 2 | 6 | |||||||
[166] CFIA issues two separate Health Hazard Alerts regarding products that may contain contaminated MLF deli meats:
- CFIA and Metro Ontario Inc issue an alert regarding 3 products sold under the Fresh 2 Go brand.
- CFIA and Atlantic Prepared Foods Limited issue an alert regarding 11 products sold under the Irving, Sub Delicious and Needs.
- This is the third secondary recall of MLF brand products.
[167] Minister of AAFC, holds a press conference in which technical spokespeople from the CFIA, PHAC and HC respond to questions.
[168] Minister of Health was interviewed by reporters at an event in Denver, Colorado regarding the listeriosis outbreak.
[169] TPH makes a verbal request to the CFIA to send a Toronto health inspector to accompany the CFIA audit team at the MLF facility (MLF Bartor Rd).
[170] PHAC hosts a teleconference with the CMOH and the CFIA to discuss the investigation and further public health actions, including testing guidelines for listeriosis.
[171] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA continue.
[172] CFIA requests a HRA from HC for products processed by other food processing establishments either using recalled MLF meat or meat products produced using the same equipment as that used in MLF Bartor Rd. Over the following days, CFIA and HC work to clarify the types of product to be assessed.
Wednesday, August 27
PHAC Situation Report Update
| 29 Confirmed Cases | 5 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 1 | 22 | 2 | 5 | |||||||
[173] CFIA issues two separate Health Hazard Alerts regarding products that may contain contaminated MLF deli meats:
- CFIA and Costco Wholesale Canada issue an alert regarding two products sold under the Kirkland Signature brands.
- CFIA and Sobeys Inc. issue an alert regarding six products sold in Sobeys' Foodland and IGA stores.
- This is the fourth secondary recall of MLF brand products.
[174] CPHO issues his first public statement on the outbreak.
[175] TPH makes a formal request to CFIA to send a Toronto health inspector to accompany CFIA audit team at MLF Bartor Rd. TPH is provided with a copy of MLF' action plan outlining steps necessary for the re-opening of the facility.
[176] Minister of AAFC, holds a press conference in which technical spokespeople from the CFIA, PHAC and HC respond to questions.
[177] CPHO participates in CTV National interview.
[178] The HC Listeria 'Its Your Health' document was slightly modified and re-posted.
[179] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA continue.
[180] PHAC hosts a teleconference with TPH and MOHLTC to discuss whether food handlers could have played a role in advancing the outbreak.
Thursday, August 28
PHAC Situation Report Update
| 29 Confirmed Cases | 8 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 1 | 22 | 2 | 8 | |||||||
[181] CFIA issues five separate Health Hazard Alerts and one expanded Health Hazard Alert regarding products that may contain contaminated MLF deli meats:
- CFIA and Sobeys Inc. has expanded their alert from August 27 to include two additional products.
- CFIA and White House Meats Inc. issue an alert regarding one product sold at White House Meats deli counters.
- CFIA and Delta Country Market issue an alert regarding three products sold at their deli counters.
- CFIA and Glen Fine Foods issue an alert regarding one product sold through vending machines in Ontario.
- CFIA and Loblaw Companies Limited issue an alert regarding 13 products sold at various Loblaws' stores in Ontario and Quebec.
- CFIA and Sobeys Inc issue an alert regarding 33 products sold at various Sobeys' stores across Canada.
- This is the fifth secondary recall of MLF brand products.
[182] Minister of AAFC, holds a press conference in which technical spokespeople from the CFIA, PHAC and HC respond to questions.
[183] CPHO grants Canada AM interview and video posted to PHAC website and YouTube.
[184] HC conducts and issues a HRA indicating that products processed by other establishments that contain recalled MLF meat meet the criteria for a "Health Risk I" concern.
[185] CFIA, HC and PHAC discuss MLF's environmental investigation, employee issues and food product testing associated with MLF Bartor Rd.
[186] MLF submits, to CFIA, a corrective action plan to mitigate deficiencies identified by the CFIA investigation team for review and approval.
[187] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA continue.
Friday August 29 to September 1
[188] PHAC issues public health notices daily to 123 newspapers across the country.
Friday, August 29
PHAC Situation Report Update
| 29 Confirmed Cases | 9 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 1 | 22 | 2 | 1 | 8 | ||||||
[189] CFIA issues five separate Health Hazard Alerts and one updated Health Hazard Alert regarding products that may contain contaminated MLF deli meats:
- CFIA and Metro-Richelieu Inc issue an alert regarding three products sold in certain Metro, Richelieu, Ami and Gem stores in Quebec.
- CFIA and Sobeys Inc issue an updated alert to clarify distribution information regarding the 33 products from the August 28 alert.
- CFIA and Metro Ontario Inc. issues an alert regarding one product sold at some A&P, Dominion, Loeb and The Barn Stores in Ontario.
- CFIA and Canada Safeway Limited issue an alert regarding five products sold at Safeway stores in Western Canada and Ontario.
- CFIA and Country Traditions Frozen Foods issue an alert regarding three products sold at Country Traditions, Taste of Country and Country Farm Supply stores in Ontario.
- CFIA and Co-op Atlantic issue an alert regarding seven products sold at Co-op Atlantic stores.
- This is the sixth secondary recall of MLF brand products.
[190] Minister of AAFC, holds a press conference to discuss the outbreak. Technical spokespeople from the CFIA, PHAC and HC respond to questions.
[191] The CFIA hosts a teleconference with PHAC, HC and PHUs and provides an update on the outbreak.
[192] NML has a teleconference with P/T and CMOH to finalize the cytogenes clinical laboratory testing guidelines and to discuss recommendations for testing at-risk populations and the general public. The results of this discussion are distributed amongst the community. The L. monocytogenes laboratory testing guidelines are posted on the PHAC website on the evening of August 29.
[193] PHAC prepares and distributes to provinces, territories and key partners an updated Brief Epidemiologic Report.
[194] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
Saturday, August 30
PHAC Situation Report Update
| 29 Confirmed Cases | 9 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 1 | 22 | 2 | 1 | 8 | ||||||
[195] PHAC posts an updated fact sheet on its website advising pregnant women how to protect themselves from listeriosis. PHAC also distributes this fact sheet to health care providers.
[196] CFIA and King Bean Wholesalers issue a Health Hazard Alert regarding four products under the King Bean brand that may contain contaminated MLF deli meats. This is the seventh secondary recall of MLF brand products.
[197] Minister of AAFC, holds a press conference to discuss the outbreak. Technical spokespeople from the CFIA, PHAC and HC respond to questions.
[198] CPHO grants an interview with the Toronto Star (which occurs on September 1).
[199] CFIA inspections staff and Meat Program specialists visit MLF Bartor Rd to initiate an in-depth review if the plant's standard operating procedures.
Sunday, August 31
PHAC Situation Report Update
| 33 Confirmed Cases | 11 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 24 | 2 | 1 | 1 | 9 | ||||
[200] Minister of AAFC, holds a press conference to discuss the outbreak. Technical spokespeople from the CFIA, PHAC and HC respond to questions.
Monday, September 1
PHAC Situation Report Update
| 38 Confirmed Cases | 12 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 10 | ||||
[201] Minister of AAFC, holds a press conference to discuss the outbreak. Technical spokespeople from the CFIA, PHAC and HC respond to questions.
[202] PHAC prepares and distributes to provinces, territories and key partners an updated Brief Epidemiologic Report.
Tuesday, September 2
PHAC Situation Report Update
| 38 Confirmed Cases | 12 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 10 | ||||
[203] Minister of AAFC, holds a press conference to discuss the listeriosis outbreak and investigation. CPHO and senior HC and CFIA staff participates in the press conference to provide updates and answer questions.
[204] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
[205] TPH joins the CFIA in-depth review team at MLF Bartor Rd.
[206] Conference call between CFIA and HC, to discuss the sampling proposals from MLF.
Wednesday, September 3
PHAC Situation Report Update
| 38 Confirmed Cases | 13 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 11 | ||||
[207] Prime Minister calls for an independent inquiry into the outbreak.
[208] The Ontario CMOH posts clinical guidelines for L.monocytogenes to health care providers on the MOHLTC website.
[209] Minister of AAFC, holds a press conference to discuss the listeriosis outbreak and investigation. CPHO and senior HC and CFIA staff participates in the press conference to provide updates and answer questions.
[210] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
[211] Conference call between CFIA and HC, to discuss the sampling proposals from MLF.
Thursday, September 4
PHAC Situation Report Update
| 38 Confirmed Cases | 13 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 11 | ||||
[212] PHAC posts an updated fact sheet on its website advising seniors how to protect themselves from listeriosis. PHAC also distributes this fact sheet to senior organizations and health care providers.
[213] Minister of AAFC, holds a press conference to discuss the outbreak. Technical spokespeople from the CFIA, PHAC and HC respond to questions.
[214] CFIA issues a Health Hazard Alert regarding one product sold at a Canex Retail Supermarket in Newfoundland and Labrador. This is the eighth and final secondary recall of MLF brand products.
[215] PHAC hosts a technical briefing with media on the surveillance systems used to detect and track Listeria and other foodborne pathogens.
[216] Teleconference with the CMOH and the CPHO. They discuss policy issues, consumer recommendations and public health advice.
[217] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
Friday, September 5
PHAC Situation Report Update
| 38 Confirmed Cases | 13 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 11 | ||||
[218] Prime Minister's office announces Prime Minister will meet with the Governor General to ask her to dissolve Parliament for an election call.
[219] CFIA issues an advisory to federally registered establishments processing RTE meats to ensure meat slicers are completely dismantled and cleaned, collect environmental samples to test for Listeria, and to review cleaning and disinfecting procedures with the CFIA inspector to ensure proper sanitation of the slicers.
[220] Minister of AAFC, holds a press conference to discuss the outbreak. Technical spokespeople from the CFIA, PHAC and HC respond to questions.
[221] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
[222] MOHLTC holds a provincial teleconference with the PHUs to provide updates on the outbreak.
- MOHLTC shares the results of food sample testing received from the CFIA. 116 sample results were received, 68 samples tested positive and 48 negative.
- TPH shares its findings from the inspections of the MLF Bartor Rd
[223] MLF announced that the Expert technical review panel concluded that the most likely source of Listeria contamination was deep inside the slicing machines on lines 8 and 9. Other environmental factors may also have contributed to the Listeria contamination.
[224] Expert technical review panel also recommended initiatives to improve the physical and operational systems and processes that contribute to food safety. MLF begins work immediately on these initiatives.
[225] MLF indicated that CFIA has provided an interim assessment which concurs with many of the findings of the expert technical review panel.
[226] Company submits 7 day start-up plan to CFIA.
[227] HC provides a sampling plan established to sample all of the recalled product from August 17, 19 and 24. Theses minimum sampling requirements are sent to CFIA, and then forwarded to Maple Leaf Foods.
Saturday, September 6
PHAC Situation Report Update
| 38 Confirmed Cases | 13 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 11 | ||||
[228] The Minister of AAFC, holds a press conference assisted by senior executives of PHAC, CFIA and HC (the last of a series of fifteen) to respond to questions.
[229] Prime Minister announces an investigation into the L. monocytogenes outbreak.
Monday, September 8
PHAC Situation Report Update
| 38 Confirmed Cases | 13 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 11 | ||||
[230] Federal Election called.
[231] PHAC posts an updated fact sheet on its website advising those with weakened immune systems about how to protect themselves from listeriosis. . PHAC also distributes this fact sheet to TB and HIV/AIDS distribution lists.
[232] PHAC's Emergency Operations Centre is de-activated to Level 1 (Normal Readiness)
[233] Teleconferences with P/Ts to discuss the epidemiology of the outbreak are reduced from daily to every other day.
[234] PHAC prepares and distributes to provinces, territories and key partners an updated Brief Epidemiologic Report.
[235] Anticipation of the resumption of production at MLF Bartor Road, the CFIA begins an in-depth review to assess the establishment's suitability for resumption of operations. Four corrective action requests are identified by the CFIA inspection team.
[236] CFIA meets with MLF to discuss disposal plan.
Tuesday, September 9
PHAC Situation Report Update
| 38 Confirmed Cases | 14 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 29 | 2 | 1 | 1 | 12 | ||||
[237] CFIA HQ distributes a memorandum regarding Task 1401 (Meat Slicing Equipment Sanitation) to CFIA field staff for immediate implementation. This CVS task was created to direct a survey targeted at all federally registered RTE meat establishments and required a verification activity to evaluate the effectiveness of an operator's HACCP system, focusing on sanitation in post-cook area.
[238] The CFIA issues a new compliance verification task procedure as a follow-up to the September 5th advisory to federally inspected plants that addresses:
- review of written sanitation program
- on-site review of the sanitation operations and
- on-site review of pre-operational sanitation.
Wednesday, September 10
PHAC Situation Report Update
| 42 Confirmed Cases | 15 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 33 | 2 | 1 | 1 | 13 | ||||
[239] OMAFRA forwards the CFIA advisory on cleaning and sanitation to all provincially licensed plants.
[240] MOHLTC hosts a provincial teleconference and advises PHUs about TPH's visits to the plant and informs them that a CFIA audit team is also present at the plant.
[241] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
Thursday, September 11
PHAC Situation Report Update
| 44 Confirmed Cases | 16 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 1 | 34 | 2 | 1 | 1 | 14 | |||
[242] CFIA informs MOHLTC that the effectiveness checks with respect to MLF in Ontario have been completed.
Friday, September 12
PHAC Situation Report Update
| 45 Confirmed Cases | 16 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 1 | 35 | 2 | 1 | 1 | 14 | |||
[243] MOHLTC holds a provincial teleconference with all PHUs to update them on the listeriosis outbreak.
[244] MOHLTC introduces and discusses institutional questionnaire. MOHLTC circulates an institutional questionnaire to all health units with outbreak-related cases that resided in a long-term care home, retirement home and/or hospital requesting feedback. The questionnaire is designed to solicit more comprehensive information on the outbreak.
[245] PHAC prepares and distributes to provinces, territories and key partners an updated Brief Epidemiologic Report.
Monday, September 15
[246] CFIA Headquarters distributes new directives to field staff re: Audit approach for RTE plants:
- Current Issue Task 1402 (Premises Sanitation)
For all federally registered RTE meat establishments to evaluate the effectiveness of an operator's HACCP system focusing on sanitation in post-cook area. - Current Issue Task 1403 (Sampling Program Survey)
A one-time CVS inspection and sampling task used to survey establishments in order to gather information regarding operator biological pathogen controls. - CVS inspection and sampling Tasks 3106 and 3107 (Risk-based Sampling in US-eligible Establishments)
[247] Daily conference calls hosted by PHAC with P/T colleagues, HC and CFIA to share information continue.
Tuesday, September 16
PHAC Situation Report Update
| 47 Confirmed Cases | 16 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 1 | 36 | 2 | 1 | 1 | 1 | 14 | ||
[248] MLF provides the CFIA's Ontario Area Office with a summary of its proposed action plan in anticipation of the restarting of operations at MLF Bartor Rd. The MLF document includes the results of the company-led investigation to identify the cause of the Listeria contamination.
MLF Bartor RD plant re-opens
Wednesday, September 17
PHAC Situation Report Update
| 47 Confirmed Cases | 17 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 1 | 36 | 2 | 1 | 1 | 1 | 14 | 1 | |
[249] MLF receives CFIA's approval to restart operations at the MLF Bartor Rd which were suspended on August 20th.
[250] MLF resumed limited production under the following conditions:
- Test and hold protocols to be in place for the first six weeks of operation.
- Re-testing and corrective action, if required, of all previously positive food contact surfaces.
- Submission in advance of Listeria sampling schedules to the CFIA responsible inspector.
- Environmental sites to be predetermined with CFIA input and production schedules to be supplied. Explicit directives from the CFIA on environmental Listeria sampling to be followed.
- All lab results for Listeria sampling, including immediate notification of positive results, must be provided to the CFIA.
- The release of all RTE products would require prior CFIA approval.
Thursday, September 18
PHAC Situation Report Update
| 47 Confirmed Cases | 17 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 4 | 2 | 1 | 1 | 36 | 2 | 1 | 1 | 1 | 14 | 1 | |
Friday, September 19
PHAC Situation Report Update
| 48 Confirmed Cases | 18 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 36 | 2 | 1 | 2 | 1 | 14 | 1 | |
[251] PHAC prepares and distributes to provinces, territories and key partners an updated Brief Epidemiologic Report.
Tuesday, September 23
PHAC Situation Report Update
| 48 Confirmed Cases | 18 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 36 | 2 | 1 | 2 | 1 | 14 | 1 | |
Wednesday, September 24
PHAC Situation Report Update
| 48 Confirmed Cases | 18 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 36 | 2 | 1 | 2 | 1 | 14 | 1 | |
[252] First set of CFIA environmental swabs negative. This sampling program continues on a daily basis.
Thursday, September 25
PHAC Situation Report Update
| 48 Confirmed Cases | 18 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 36 | 2 | 1 | 2 | 1 | 14 | 1 | |
Friday, September 26
PHAC Situation Report Update
| 49 Confirmed Cases | 19 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 36 | 3 | 1 | 2 | 1 | 14 | 1 | 1 |
Monday, September 29
PHAC Situation Report Update
| 49 Confirmed Cases | 19 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 36 | 3 | 1 | 2 | 1 | 14 | 1 | 1 |
Thursday, October 2
PHAC Situation Report Update
| 53 Confirmed Cases | 20 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 1 | 1 | 40 | 3 | 1 | 2 | 1 | 15 | 1 | 1 |
[253] Letter to company for product release for production dates of September 19 to 23 only.
Friday, October 3
[254] PHAC prepares and distributes to provinces, territories and key partners an updated Brief Epidemiologic Report.
Tuesday, October 7
[255] Positive test on food contact surface found for a sample taken October 1 (list spp). Further testing required of environmental sample to determine subspecies (i.e. if L. monocytogenes). Much communication regarding positive result. 4 products from line 7 and 8 test positive for L. monocytogenes from products from September 29 and 30.
Wednesday, October 8
[256] MLF and CFIA announce that four end product samples have tested positive for L. monocytogenes. None of the affected product had been released for sale. Increased L. monocytogenes testing continues in the facility.
[257] HC issues a precautionary "Health Risk I" assessment for product manufactured the week prior to the positive results. CFIA issues a Class 1 recall to distributors to ensure the product is not made available to consumers. A subsequent HRA conducted by HC determined that the product posed no health risk.
[258] MLF submits plan to sample detained product over the next 2 week period for legal purposes.
Friday, October 10
[259] Memorandum regarding current issue Task 1404 Operator Environmental and Product testing for Listeria distributed to CFIA field staff.
Friday, October 17
[260] CFIA approves the release of product produced between September 19 to 25 at the MLF Bartor Rd, except for product produced on line 7.
[261] Information posted on CFIA's website regarding the re-opening of MLF Bartor Rd.
[262] A HRA conducted by HC determined that the products manufactured on Line 7 at MLF Bartor Rd between September 19 and October 7 are suspect, and if distributed to the consumer, would be considered a "Health Risk I" situation.
Sunday, October 19
[263] Advice on Food Safety posted by CPHO.
Monday, October 20
[264] CFIA announced that MLF Bartor Rd products with satisfactory L. monocytogenes test results could be released for distribution. Test and hold protocols continue at MLF Bartor Rd as does enhanced inspection presence.
Tuesday, October 21
[265] Product starts to be shipped to customers, with exception of Line 7 production.
Wednesday, October 22
[266] MLF considers the crisis over.
[267] MLF begins distributing foods manufactured at its MLF Bartor Rd for public consumption.
Friday, November 14
[268] MOHLTC discontinues Enhanced Surveillance Directive for L. monocytogenes. that was distributed to PHUs.
Monday, December 8
[269] Ontario's CMOH declares the listeriosis outbreak over in Ontario.
Wednesday, December 17
[270] Disposal of 100% of the recalled product complete. 1.3 million kg of product was properly disposed of under supervision of CFIA and Ontario Ministry of Environment.
Thursday, December 18
[271] Three class action suits were settled for up to $27 million, subject to court approval.
January 1, 2009
[272] The latest expiry date found on the recalled products.
April 17, 2009
PHAC Situation Report Final Update
| 57 Confirmed Cases | 22 Deaths |
||||||||||
| BC | AB | SK | MB | ON | QC | NB | BC | AB | ON | QC | NB |
| 5 | 2 | 2 | 1 | 41 | 5 | 1 | 2 | 1 | 16 | 2 | 1 |
