Almost 5 years old now, Kendall Paciorek is right on track. She can walk, run, talk and say her ABCs. And while that normal progression of abilities common to many children her age might not seem all that impressive, to her mother and father Michelle Wakley-Paciorek and Dave Paciorek, it’s “a miracle.” Little Kendall was born three months premature on Sept. 21, 2011. Her early arrival was one result of a Listeria infection contracted from her mother who had eaten some contaminated cantaloupe the previous month. When she was born, the doctors warned her parents about all sorts of dire medical complications that she could develop: blindness, deafness, mental retardation, cerebral palsy, and others. The dire prognosis was offered even before the doctors ran blood tests and discovered something even more troubling: Both mother and daughter had listeriosis, a foodborne disease. They had suspected that Michelle had an infection of some sort, but didn’t know what it was until getting the results of the blood tests. “It was terrible,” said Michelle. “They didn’t even know why we were sick until the next day.”

The Listeria infections the mother and baby were suffering from were part of an outbreak traced to cantaloupes grown by Jensen Farms in Colorado in 2011.  According to the Centers for Disease Control and Prevention, at least 147 people in 28 states were confirmed as part of the outbreak. At least 33 deaths and one miscarriage were officially attributed to the outbreak. Kendall was one of three newborns diagnosed with Listeria infections during the outbreak. A week before she was born, the U.S. Food and Drug Administration announced a voluntary recall of the entire crop of fresh, whole cantaloupe from Jensen Farms. But the news about the Listeria outbreak linked to cantaloupes wasn’t widespread when Kendall was born because people were just beginning to get sick. It can take up to 70 days for symptoms to develop after exposure. Listeriosis is caused by Listeria, a type of bacteria that is commonly found in water, soil and feces. Raw vegetables and fruits can become contaminated with Listeria either through contact with soil or with animal manure that is used as fertilizer. Humans are infected when they consume foods or beverages that harbor the bacteria. Listeria, which can survive freezing and grow in refrigerated temperatures above 40 degrees, is responsible for around 1,600 illnesses and 260 deaths in the U.S. yearly, according to the CDC. Pregnant women and their unborn babies are especially vulnerable, with pregnant women 20 times more likely to develop listeriosis than the general population. Miscarriage or premature birth are two possible outcomes when a pregnant woman is infected with Listeria. In addition, a newborn babies who contract Listeria infections from their mothers might suffer a life-threatening infection in the days and weeks after birth. According to the American Pregnancy Association, 22 percent of Listeria infections in pregnant women result in stillbirth or miscarriage. Something just wasn’t right For Michelle and Dave, everything seemed to be going well, although for several weeks before Kendall’s birth, Michelle had been suffering flu-like symptoms, among them headaches, aching legs, sweats, chills and dry heaves. She attributed those symptoms to pregnancy, as did her doctor. The last thing on her mind was that she was sick because she had snacked on some cantaloupe. She said she had eaten cantaloupe multiple times, wanting to eat healthy food including fresh fruits and vegetables while she was pregnant. The day Kendall was born, Michelle and her then 4-year-old daughter Madison had gone to get pedicures, mainly as a pleasant diversion. While they were there, Michelle started having contractions. When she went to the hospital, she knew something was wrong. “The baby was coming,” she said. “I couldn’t believe I was in labor.” Later she found out that the contractions were as hard and painful as they were because the infection had advanced into her bloodstream. She said the baby reacted by pushing her way out in order to survive.

Kendall was immediately put into a neonatal incubator with tubes and machines attached to her on all sides. The tiny 3-pound, 11-ounce baby was fighting for her life. She stayed in the incubator for weeks during which time her parents couldn’t hold her. Michelle said she could only put a finger into the incubator to touch her. For a parent, it was agonizing in many ways. Several months later, Kendall was still on 24-hour watch and had to be fed through a tube in her stomach. She wasn’t thriving. “Every time she ate, she vomited,” said Michelle. Fortunately, the situation improved immensely when she was hooked up to an automatic drip feeder. “She could hold things down,” said Michelle, the relief in her voice still obvious four and a half years later. Just several days before her first Christmas, Kendall, who then weighed 7 pounds, was deemed to be strong enough to go home and sleep in her own crib. When Kendall was 6 months old, Michelle enrolled her in a First Steps program, which helped her with her feeding and small motor coordination. Two therapists came to the house to do the therapy. She continued in the program for 18 months. “It made all of the difference in the world,” Michelle said. “The early therapy was key to helping her thrive.” Just recently, Kendall attended a reunion of parents and their children who had been in the Newborn Infants Care Unit at St. Vincent’s Hospital in Indianapolis. “The nurses were amazed,” Michelle said. “She seems to be on track. We’re so lucky that she has overcome most of the odds.” And while they’re pleased with their daughter’s mental development, Michelle said they won’t know how far she has come until she starts school and faces some harder challenges. She’s small — very small for her age. She might have to go through a program of growth hormone shots based on her projected bone growth. “Right now, we are feeling very hopeful,” said Michelle. Yet she has this recurring question: “You look back,” she said “and think: All of this because of food?” Why cantaloupes? Bottomline, the sanitation practices at the Colorado farm’s processing unit were woefully lacking. According to the FDA report: “. . . several areas on both the washing and drying equipment appeared to be uncleanable and dirt and product buildup was visible on some areas of the equipment, even after it had been disassembled, cleaned and sanitized.” But there was something else that was even more troubling. The farm had removed its antimicrobial wash, which meant that melons could cross-contaminate the equipment and one another. In that way, an entire production line could spread the bacteria. In other words, just one contaminated melon could contaminate each and every melon that went after it. The melons were distributed to hundreds of supermarkets and retailers across the nation. For Michelle, there are no excuses for this disregard of sanitation and human health. “People doing things like this aren’t held accountable for their actions,” she said. “To save money, they’re are cutting corners. They don’t want to pay what it takes to keep the food they’re growing and selling to the public safe.” She said she’s hopeful that the stricter regulations under the Food Safety Modernization Act, which was signed into law in 2011, will help. But she also knows that the government can’t monitor everything. She worries that some pregnant moms, aren’t paying enough attention to the food they eat, some of which, if contaminated, can kill their babies. Her unequivocal advice to other parents comes down to this: “Be aware. Understand what kind of foods you shouldn’t eat when you’re pregnant. And know that what happened to our family could happen to you.“ Food safety ABCs for pregnant moms According to FDA’s “Food Safety for Moms-to-Be” website, pregnant women can become sick from foodborne illnesses, often referred to as food poisoning, when they eat or drink food or beverages that contain harmful microorganisms such as bacteria, parasites or viruses.

Pregnant women are especially vulnerable to foodborne illnesses because the immune system changes during pregnancy as a way to help the mother and unborn baby “get along with each other.” The unborn baby is vulnerable because its immune system has not developed enough to fight off harmful foodborne microorganisms. Symptoms can vary — stomach ache, vomiting, and/or diahrrea, fever, headache and body aches. Because the symptoms are often similar to the flu, many women assume they’ve caught a seasonal virus. In other cases, the mother doesn’t experience any symptoms at all, even though she’s been infected. Even so, she can pass the infection to her unborn child through the placenta. Symptoms usually appear in one to three days, although they can show up in as short a time as 20 minutes or as long a time as up to 10 weeks after eating or drinking contaminated food or water. Pregnant mothers experiencing these symptoms of food poisoning should contact their doctors. In general, the foodborne pathogens of most concern to pregnant women are Listeria and Salmonella, primarily because maternal infection can raise the risk of adverse pregnancy outcomes. However, other pathogens such as E. coli and Campylobacter are also of concern. What foods to avoid According to the Women’s Health Division of the U.S. Department of Veterans Affairs, pregnant women should avoid these foods:

• Unwashed fruits and vegetables;
• Raw sprouts;
• Unpasteurized milk also referred to as raw milk;
• Unpasteurized juice;
• Raw or undercooked meat, pates, poultry, eggs and seafood;
• Products containing raw unpasteurized eggs, which can include homemade mayonnaise, ice cream, egg nog, Caesar salad dressing, sauces, tiramisu, mousse and meringue;
• Eggs that aren’t fully cooked — runny without a firm yolk and egg white;
• Cheeses made with unpasteurized raw milk, which can include Feta, Brie, Camembert, blue-veined cheeses; queso blanco, queso fresco, panela;
• Hot dogs and lunch meat that haven’t been heated until they’re steaming hot;
• Uncooked smoked sea food, including salmon, trout, whitefish, cod, tuna and mackerel;
• Pre-stuffed poultry that has been purchased fresh and raw;
• Raw shellfish, including oysters, mussels, clams and scallops; and
• Salads made in retail locations, including as ham salad, chicken salad, tuna salad or seafood salad.

Mercury, a harmful metal found in high levels in some fish, especially larger and older fish, is particularly of concern. Because unborn and newborn babies are more sensitive to mercury than are adults, pregnant and breastfeeding mothers should avoid eating fish with high levels of it. Some of the fish with high concentrations of mercury are king mackerel, shark, swordfish and tile fish. Also to be avoided are raw fish found in foods such as sushi and sashimi. In addition, albacore or white tuna and tuna steaks have more more mercury than light tuna. Examples of fish with low levels of mercury are salmon, trout, sardines, pollock, catfish, cod, tilapia, and whitefish. The U.S. Department of Agriculture offers specific advice for mothers and pregnant women about which fish and seafood is safe on its website. About those cats Pregnant women, and even women contemplating pregnancy, need to take special care to protect themselves and their unborn babies from an infectious parasite known as Toxoplasma gondii (T. gondii). Because cats can spread this parasite through their feces, pregnant women are advised to have someone else change litter boxes, if possible. If not, then they should wear disposable gloves and wash their hands thoroughly with soap and water afterwards. Cats carry the parasite but do not show any symptoms of an infection. The parasite is also found in soil and outdoor places such as sandboxes. For this reason, it infects just about all cats that spend any time outdoors. They can become infected by eating small animals such as mice, or raw meat that’s infected. When this happens, the parasite is passed on through the feces. If a woman becomes pregnant while the parasite is still in her blood, it can pass through the placenta to her unborn child. In babies, toxoplasmosis, the disease caused by T. gondii, can cause hearing loss, intellectual disability, and blindness. Some children can develop brain or eye problems years after birth. According to the Centers for Disease Control and Prevention, toxoplasmosis infects 400 to 4,000 fetuses in the United States annually. Also, according to the CDC, it is considered to be a leading cause of death attributed to foodborne illness in the United States. More than 60 million men, women and children in the U.S. carry the Toxoplasma parasite, but very few have symptoms because their immune systems usually keeps the parasite from causing illness. However, CDC warns that women newly infected with Toxoplasma during pregnancy and anyone with a compromised immune system should be aware that toxoplasmosis can have severe consequences. Just to be safe, pregnant women who have cats that are allowed to go outdoors are advised to be tested. Medications are available that will clear up the infection. When it comes to food, the parasite can also be found in raw and undercooked meat; unwashed fruits and vegetables; and contaminated water. About half of the toxoplasmosis infections in the United States each year are acquired from food. Preventing foodborne illnesses Besides avoiding certain foods and being cautious about outdoor cats, pregnant women are also urged to follow basic food safety rules. Clean. Wash hands often with soap and warm water. Use clean dishes, spoons, knives and forks. Wash countertops and cutting boards with hot soapy water and clean up spills right away. Separate. Keep raw meat, fish and poultry away from other food that will not be cooked. Cook. Cook food to a safe minimum internal temperature. Check with a food thermometer. Chill. Refrigerate or freeze cooked foods within 2 hours, or 1 hour in hot weather. Don’t leave meat, fish, poultry or cooked food sitting out. Another word of advice: Keep cut greens that will be eaten raw — baby spinach and leaf lettuce, for example — at 40 degrees or lower. Additional food safety tips are available at FightBac.org. the organization also offers specific tips for safely consuming fresh produce. (To sign up for a free subscription to Food Safety News, click here.)