Anatomy of the peanut salmonella outbreak

That Wednesday morning, Claude Ivester left for work at 6:30, as he always did, driving five miles from his home in Dewy Rose to the county recycling plant in his maroon Nissan Sentra. On the seat beside him was his insulated lunch bag.

Ivester’s wife, Barbara, had packed his favorite foods: a Jimmy Dean sausage biscuit, half a turkey sandwich and peanut-butter crackers.

Ivester worked part time at the Elbert County recycling plant, a job he took after he retired as a granite sandblaster. He’d made a good life for himself and Barbara on 2 acres in the northeastern Georgia town marked solely by a post office on Ga. 17. There they’d raised five girls and settled in a double-wide plastered with family photos.

At 74, Ivester was a stickler for routine, and Dec. 3 he kept to his usual schedule: Lunch was followed by the afternoon snack he loved — peanut-butter crackers.

But shortly afterward, he buckled with stomach cramps. It felt like a knife was slicing through his belly.

When he called Barbara to come fetch him, she thought her husband had caught a virus. But something far more deadly crumpled Ivester: an all-American food turned unsuspected foe.

During the next two months, the mysterious illness that befell the Georgia man would occupy disease detectives in 46 states and at the nation’s pre-eminent public health organization in Atlanta.

It would sicken almost 700 people and, eventually, be linked to nine deaths.

Solving the mystery would expose the weaknesses of a regulatory system responsible for protecting the food Americans consume.

And lead to a culprit hidden in plain sight.

At home, Ivester collapsed, shivering, into a recliner. He vomited and went to the bathroom every five minutes. When he couldn’t get his pants down to use the toilet, Barbara realized Claude was delirious.

Desperate, she called their daughter Donna, who whisked her parents to the Elbert County Hospital. On the way, Ivester tried to open the door of the speeding car.

Doctors transferred him to Athens Regional Medical Center, where he was admitted to the intensive-care unit. His fever raged above 105 degrees. He lay atop an ice blanket and yet another covered him. The man Barbara had loved since she was 17 was in critical condition.

“Take care of him,” she begged. “He’s all I got.”

Tracking a killer

Ian Williams had never heard Claude Ivester’s name. But as the elderly man courted death, Williams pressed forward with an investigation into what might have sickened him.

An epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Williams, 44, found his work thrilling and rewarding. He was a food-borne disease expert and, like a police detective solving a crime, he loved unearthing clues.

He slept at night knowing his work kept fewer people from falling ill — or dying.

In early December, Williams huddled with colleagues in a CDC office on Clifton Road. They had identified two clusters of salmonella cases, the first signal of spreading disease.

The most common cause of food-borne illness, salmonella infection sickens up to 1.4 million Americans each year. The microscopic rod-shaped germ is most commonly associated with meat, poultry, eggs and raw milk — products from animals that are carriers of the bacteria. It can also be found on fruits and vegetables, and in ingredients made from them.

The key to destroying it is to wash raw foods thoroughly and cook other foods at high enough temperatures to kill the bug.

Once ingested, the germ grows rapidly in the intestines, though it can take many hours or a few days to manifest. Most people fight it off, but sometimes it can turn into an opportunistic killer, preying on the most vulnerable: the young, the old and the sick who have lost their strength to resist.

Ivester seemed a perfect victim.

His stool sample was sent to a lab in Anderson, S.C, which verified the presence of salmonella Typhimurium and reported the case to the Georgia Division of Public Health. It, in turn, notified the CDC.

The federal agency analyzes reported cases, breaking each down by the type of salmonella and its genetic fingerprint.

Then it uploads the information into a central database at PulseNet USA, located a few floors down from Williams’ office.

A network of 75 labs nationwide, including the health departments of each state, PulseNet matches DNA “fingerprints” of suspicious bacteria strains the way police match fingerprints of criminals.

Typhimurium is a common type of salmonella, but on Nov. 10, PulseNet detected a cluster of 13 genetically identical cases reported in 12 states. A second cluster of 27 cases in 14 states, including Georgia, emerged two weeks later.

The CDC had not encountered these DNA patterns before. The rarity suggested a common source of contamination for each cluster.

Where was the salmonella coming from, and who was responsible for unleashing it?

Williams’ team alerted the states to begin narrowing the investigation. First step: Interview the sickened.

What foods have you eaten? Spinach? Chicken? Peanut butter? Where do you buy your food? Have you been to a zoo? Do you have a pet at home?

In 14 years at the CDC, Williams had investigated all sorts of foods. Grunt work, he called it.

He displayed cans of Castleberry chili sauce, recalled for botulism, and Veggie Booty snacks, recalled for salmonella, like trophies of past victories in the war against food-borne diseases.

This time, he detected an overlap in the two clusters. They were occurring in the same places in the country at the same time and were increasing at about the same frequency.

Williams knew tracing the source of contamination would not be easy, given how labyrinthian global food distribution has become. Plus, a single food product these days may contain ingredients from multiple sources around the world.

For now, the experienced salmonella sleuth was stumped.

A family’s ordeal

In Athens, the Ivester family, too, faced an unknown. Barbara and her five daughters were shattered by the sudden and fierce rage of Claude’s illness.

What stripped Claude of his sunny self one morning and pushed him close to death by dusk?

Plastic tubing and intravenous needles pumped fluids and antibiotics into his veins. Blisters bubbled on his mouth. His ears, fingertips and tongue were blue, a sign of renal failure. He was in shock from sepsis, a state in which the body’s immune system goes into overdrive to battle bacterial infection.

“How are you feeling?” Barbara asked him.

No words came out of her husband, and by this she understood one thing: He was trying to tell her that he wasn’t going to make it.

In the waiting room, memories rushed through her head. The couple had met when Claude stopped by after her brother died in a trucking accident. She could not imagine life without him after a marriage of 49 years.

In a hospital bathroom, Barbara fell to her knees. “Please, God,” she cried. “You know I want him home.”

‘Helter skelter’

While the CDC’s salmonella sleuth stalked the source of a national disease outbreak, a one-woman cleaning crew at a peanut plant in southwest Georgia kept a journal of what she saw: Rats. Roaches. Mildew. Holes in walls and ceiling.

“And I don’t mean a leak here and a leak there. I mean it rained in there.”

Anne Bristow, 58, had worked at the Peanut Corporation of America in Blakely for only a couple of years, but she was disturbed by what she saw there — and heard.

Longtime employees talked about the ambitious outsider who bought the plant in 2001 to capitalize on an iconic industry in Georgia, America’s top producer of peanuts.

Stewart Parnell hailed from Lynchburg, Va., and had aspirations for his new acquisition. Workers wilted under pressure to produce.

“Under the old boss, we’d do 100,000 pounds [of nuts] a week and he’s happy,” said Bobby Mallard, 59, a production line supervisor with 17 years at the plant. “But Stewart ran a bigger operation. He preferred to get out 100,000 pounds a day.”

Parnell dispensed with filling small jars and cans, preferring 30-pound boxes that could be cranked out quickly. He added a granulation line, which produced small chopped nuts to be used as a topping or ingredient. And in 2004, the company heralded the introduction of its own peanut butter.

Producing larger volumes and more products, Peanut Corp. enticed food giants such as the Kellogg Co., Sara Lee and King Nut. Annual sales jumped 66 percent, from $15 million in 2005 to $25 million last year, according to business researchers Dun & Bradstreet.

The money flowed for Parnell. And in hindsight, employees said, greed trumped safety.

Parnell, Mallard said, “was all about more, more, more, more, more.”

Bristow’s job wasn’t to sanitize the machinery but to clean the rooms and stock the plant with latex gloves, hairnets, beard guards and hand sanitizer.

She often mopped up standing water, which could activate bacteria brought in on raw peanuts and their dust. That’s what ConAgra says happened in a 2006-07 outbreak that stemmed from its peanut butter plant in nearby Sylvester.

Typically, salmonella on raw peanuts is killed by roasting them at 350 degrees. But even after a private lab offered to help Peanut Corp. validate its “kill step,” the company failed to record the roaster’s temperature on a daily basis.

Parnell’s push for high-volume production dictated practices at the plant, employees said. If a machine was shut down for cleaning, it wasn’t making money.

“When you get a guy who wants 95 percent production and 5 percent cleaning, you’ve got a problem, and that’s what we had,” Mallard said. “We didn’t have enough time to clean.”

That required taking pipes apart, scraping, washing and sanitizing them with alcohol. It was a full day’s work followed by a weekend of drip dry and another half day to put it all back together.

Frank Hardrick, 40, an assistant manager who supervised seven workers on the peanut butter line, said the last time he remembered the butter machine being disassembled for cleaning was well over a year ago.

And the only time the plant was thoroughly sanitized, recalled Bristow, was before the anticipated annual inspections on behalf of Kellogg, by the American Institute of Baking.

“The place did look decent for the inspector,” she said. “We’d work hard to get it looking that way, but in a few weeks, things would go back to being a mess.”

Peanut Corp. produced millions of pounds of peanuts for American consumers this way, inside a plant that Mallard described as “helter skelter.”

Testing of the company’s products should have ensured they were bacteria-free before shipping. But that failsafe, too, appeared doomed by the company’s mode of operation.

If a lot tested positive for salmonella, Peanut Corp. routinely sent another sample from the same lot for retesting.

It’s not possible, however, to “retest away a positive result,” said Charles T. Deibel, president of Deibel Labs, one of at least two used by Peanut Corp. “If you tested 50 samples for a given lot and 49 of those were negative and one was positive,” Deibel said, “that one positive must trump the 49 negatives.”

Nonetheless, when paste manufactured on Sept. 26 — Lot No. 8278 — tested positive for salmonella, a second test was ordered. It was negative, and the paste was pumped into a 45,000-pound tanker truck for delivery.

Not only should the lot have been destroyed, Deibel said, but the line that produced the contaminated product should have been shut down and cleaned.

Long after Lot No. 8278 had reached its destination, investigators would find that the company never cleaned the equipment that spit out the poisoned paste.

A new hypothesis

On Dec. 8, the third day of Claude Ivester’s hospitalization, his wife learned the cause of his illness: salmonella.

It was a word Barbara had heard before — something that caused nausea and stomach cramps. Nothing too serious. Now, she knew otherwise.

Barbara suspected the turkey sandwich she bought for Claude at a grocery deli. Bewildered, she could not accept that she might lose her lifelong partner this way.

Williams, the CDC disease detective, was also suspicious of poultry.

He noticed that several people in Stark County, Ohio, had tested positive for the suspected outbreak strain of salmonella. They had eaten chicken at Stir Fry 88, a food-court restaurant, between mid-October and mid-November.

It was certainly a plausible explanation.

But in Minnesota, a state that had reported nine genetically identical salmonella cases, health officials were developing another hypothesis.

They were like beat cops walking the streets. They knew their communities better than the feds and were determined to crack open the case.

A turning point came in late December when they discovered that the state’s victims had eaten at three institutions — two nursing homes and one elementary school. They began examining menus and when they could see no connection, they zeroed in on snacks.

After scrutinizing purchase invoices, they dug out a common source. Sysco, a food distributor with a center in Fargo, N.D., had shipped tubs of King Nut creamy peanut butter to the school and the nursing homes.

Investigators turned their attention to the American staple.

Intrigued by the discoveries in Minnesota, Williams’ outbreak team in Atlanta delved into drawing the larger picture.

By 9 every morning, they gathered in an emergency operations center to assemble incoming data. At 10:30, they shared the information with their federal regulatory partners at the Food and Drug Administration and the Department of Agriculture’s Food Safety Inspection Service. Then, at noon, a conference call connected the CDC with its public health partners in all 50 states.

Williams could see that some of the same people sickened in Ohio after eating chicken in a food court had also eaten King Nut peanut butter, distributed to nearby Mount Union College.

The CDC announced it was merging the investigations of the two clusters of identical salmonella cases. The number of people possibly sickened by a single food source suddenly doubled to 388 in 42 states.

At work, Williams helped craft another questionnaire to identify other possible sources of infection.

At home, he opened his kitchen cupboards to see what peanut-butter foods his children were eating.

Taking no chances

In Minnesota, a woman was dead.

So was a man in Idaho. Two women in Virginia. Someone in North Carolina.

Hundreds were sickened nationwide, including Claude Ivester and five others in Georgia.

Like Ivester, Shirley Mae Almer had fallen ill suddenly. She died in Brainerd, Minn., just four days before Christmas. At 72, she had survived lung cancer and a brain tumor. She was being treated for a urinary tract infection at a nursing home, expecting to go home any day. Her son Jeff arrived from Minneapolis just in time to say goodbye.It was only after a second nursing-home resident died, though, that Almer learned the cause of his mother’s death: She was infected by salmonella.

Investigators quizzed the family about their mother’s eating habits. She relished peanut-butter toast.

On Jan. 9, the Minnesota Department of Agriculture confirmed the presence of salmonella Typhimurium in a 5-pound tub of King Nut peanut butter confiscated from a nursing home. Because it had been opened, the source of contamination was still unclear.

But federal inspectors were taking no chances.

They traced the manufacturer: Peanut Corporation of America. And descended on Blakely.

The smoking peanut

During the fall harvest, the air in Blakely smells like a freshly opened jar of peanut butter.

A 1954 monument on the courthouse square credits the legume with the county’s success and the betterment of global health. The place is thick with peanut fields, farms and firms.

One, Peanut Corporation of America, was now besieged by strangers.

Anne Bristow, the plant’s sanitation worker, saw them wearing blue coats and tags labeling them “visitors.” She watched a cherry-picker hoist them near the warehouse ceiling so they could peer inside equipment.

Who were they? she wondered. Nobody had said a word about any inspections.

In mid-January, FDA investigators spent two weeks inside. They took swab tests. They studied records of Peanut Corp.’s product testing.

The plant stopped production the Friday they arrived, and soon after began recalling its products. Employees continued to report to work, though they could sense something ominous. They punched out and headed home Jan. 16, their futures suddenly uncertain.

The same day, health investigators in Connecticut sealed Peanut Corp.’s fate.

Test results confirmed the presence of salmonella in a tub of King Nut peanut butter found on the shelves of City Line food distributors in West Haven. It was a genetic match to the outbreak strain.

Because the tub was unopened, investigators knew the contamination occurred at the time of production in Blakely.

It was the wow moment the CDC’s Ian Williams had long awaited. He focused on determining what other products might be poisoned.

As the nation awaited the inauguration of Barack Obama, Williams’ staff clocked more than 1,000 weekend hours analyzing the second round of food questionnaires returned by the states.

What kind of peanut butter did you eat? What about peanut-butter crackers?

Kellogg had already recalled Austin brand crackers, made with paste manufactured in Blakely — the kind Ivester had eaten.

That was a relief because Williams was getting a strong signal that the crackers were another source in the outbreak. His detective work was paying off. Other retailers followed Kellogg with recalls. Cookies, crackers, candy, ice-cream and pet food were pulled off shelves.

Peanut Corp. items joined Castleberry chili sauce and Veggie Booty in the ostracized club of foods that sat on the shelves at OutbreakNet.

Williams took heart knowing that maybe he had prevented more poisonings. He felt a familiar satisfaction, when the mystery of disease is no longer so.

In Blakely, television crews mushroomed, their satellite trucks parked in front of the plant on Ga. 62. Blakely’s source of pride, the peanut, was pulling the town down.

Even then, in the heat of the investigation, Peanut Corp.’s president seemed focused on profit. With production of butter, paste and ground peanuts shut down, Parnell pleaded with the FDA in a Jan. 19 e-mail to allow him to “at least … turn raw peanuts on our floor into money.” He also maintained the plant was without fault.

“We send hourly PB samples to an independent lab to test for salmonella during production of peanut butter and we have never found any salmonella at all,” he said in an e-mail to his employees.

But FDA investigators would conclude otherwise.

They were like police detectives finally arriving at a long-sought crime scene to find a smoking gun.

Not only had Peanut Corp. failed to ward off contamination, but the FDA found that the company had shipped tainted products 12 times in the past two years.

The agency’s six-page report described the plant’s unsanitary conditions and said Peanut Corp. had failed to document the cleaning of peanut paste lines after they produced salmonella-contaminated products.

Those who helped Parnell grow his peanut empire felt betrayed.

“Nasty — the way he did us,” said Bristow about her boss.

Appearing at a congressional hearing, Parnell invoked the 5th Amendment, refusing to answer questions posed by angry lawmakers. He is the subject of a criminal investigation, and his company, facing lawsuits by families of salmonella victims, filed for bankruptcy on Feb. 13.

Bristow counted her days at Peanut Corp.: two years, 11 months, three weeks. She wondered if she was branded, whether anyone would hire her knowing where she had worked.

Hidden time bombs

Claude Ivester came home to Dewy Rose after eight harrowing days in the hospital. He suffers from irritable bowel syndrome and consults a nephrologist for kidney problems. Barbara thinks her husband is not the same.

He couldn’t remember where she kept her flour tin even though it sat in the same spot on the kitchen counter for 22 years. Maybe the prolonged high fever did something to his head.

“Claude almost died. Some people did die. And they didn’t care,” Barbara said of Peanut Corp.’s owner and managers. “They need to serve time for what they’ve done.”

In Blakely, residents are trying to put the scandal in the past. They have planned a “Peanut Proud” festival for Saturday to quell the fear that gripped America about the safety of peanuts.

But with almost 3,000 diverse products recalled — the largest ever in the United States — and the list still growing, Americans are not likely to forget soon.

Nine deaths have been linked to the outbreak. Almost 700 people have fallen sick, but the actual number is much higher because only about 3 percent of salmonella cases are reported to the CDC.

Williams worries more people will become victims as they unknowingly reach for recalled foods with everlasting shelf lives.

Little time bombs ticking inside America’s kitchens.

Salmonella’s toll on Ivester will not be erased quickly either. He’s on a doctor-ordered high-protein diet to gain back his strength — and the 27 pounds he lost.

Peanut butter would be the perfect cure. But Ivester won’t allow it in his home. It would be like inviting a serial killer inside.

“I’ll eat anything to get better,” he said, “but I ain’t going to eat peanut butter.”

In early February, Ivester returned to his job at the Elbert County recycling plant. As always, before the sun was up, he climbed into his Nissan Sentra, carrying his lunch bag.

But where once he packed peanut-butter crackers, there were now coconut macaroons.

Staff writers Alison Young and Craig Schneider and news researchers Nisa Asokan and Sharon Gaus contributed to this article.

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GEORGIA’S ROLE IN THE OUTBREAK

The salmonella mystery began, and ended, in Georgia. In Atlanta, the Centers for Disease Control and Prevention helped lead the investigation. In Blakely, a peanut plant ended up being the source of the tainted products. And six Georgians fell ill in an outbreak linked to the deaths of nine and the sickening of almost 700 in 46 states.

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THE SCIENCE OF SALMONELLA INVESTIGATIONS

The CDC’s PulseNet and OutbreakNet teams collect, monitor and assess data on U.S. salmonella cases. The first step is to identify the type of bacteria by strain and genetic fingerprint.

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HOW WE GOT THE STORY

To understand how the salmonella outbreak was tracked by public health investigators, reporters Moni Basu and Michelle E. Shaw visited the PulseNet and OutbreakNet offices at Atlanta’s Centers for Disease Control and Prevention. They interviewed health department officials in six states, and examined the written communications between the CDC and the Georgia Division of Public Health, obtained through a Freedom of Information request.

They interviewed salmonella victim Claude Ivester and examined his medical records. They reviewed the Food and Drug Administration’s inspection of the Peanut Corporation of America’s Blakely plant and the congressional testimony of officials with private labs that tested Peanut Corp. products. They also read Peanut Corp. e-mails, including some written by company owner Stewart Parnell. He declined a request for an interview. “With the current circumstances [I] am unable to discuss any aspects of this issue,” he said.

In a January e-mail to his employees, Parnell ordered them not to speak with the media. The descriptions of the Peanut Corp. plant and the way it changed under Parnell’s ownership came from interviews with the few employees in Blakely who were willing to talk.