Calif. death, 76 illnesses linked to ground turkey (AP)

WASHINGTON � The government is scrambling to find the source of a salmonella outbreak likely linked to ground turkey that has killed one and sickened dozens more.

Finding the source of an outbreak hasn't been easy; the government has been chasing the illnesses for months. The Agriculture Department, which oversees meat safety, said it is still investigating who produced the meat, and the department hasn't initiated a recall.

California state health officials said Tuesday that the one death was in Sacramento County. Seventy-six people in 26 states have been made sick from the same strain of the disease.

The illnesses date back to March, and the federal Centers for Disease Control and Prevention said Monday that cultures of ground turkey from four retail locations between March 7 and June 27 showed contamination with the same strain of salmonella, though those samples were not specifically linked to the illnesses. The agency said preliminary information showed that three of those samples have been linked to the same production establishment but it did not name the retailers or the manufacturers.

The silence from government officials may be attributed to USDA rules that make it harder to investigate and recall salmonella-tainted poultry. Because salmonella is common in poultry, it is not illegal for meat to be tainted with the pathogen. Officials must directly link the salmonella illnesses with a certain producer or establishment, which is difficult to do because people don't always remember what they ate or where they bought it.

In this case, it appears that officials haven't been able to prove the link between the samples of salmonella they found � even though they are the same strain � and the 77 people who were sickened. USDA's Food Safety and Inspection Service sent out an alert about the illnesses late last week telling consumers to properly cook their turkey, which can decrease the chances of salmonella poisoning. But the department has not given consumers any further warnings about the source of the tainted meat.

"Despite an extensive investigation by FSIS and CDC to date, there is little epidemiological information available at this time that conclusively links these illnesses to any specific product or establishment," FSIS spokesman Neil Gaffney said Tuesday. "Without specific enough data, it would not be appropriate to issue a recall notice." Gaffney said the agency was committed to finding the source of the outbreak and then take action to protect public health.

Art Caplan, a bioethicist at the University of Pennsylvania, said the government's handling of the outbreak raises ethical questions about why the public wasn't warned sooner.

"You've got to protect the public health. That's their first and primary value � not industry, not any other goal. They have to warn as quickly as they think there's reasonable evidence for concern," Caplan said.

He said uncertainty about the outbreak's source might explain the long silence, but he added, "The moral duty is to really get the word out as soon as you have evidence of a problem."

The illnesses are spread all over the country. The states with the highest number sickened were Michigan and Ohio, 10 illnesses each, while nine illnesses were reported in Texas. Illinois had seven, California six and Pennsylvania five.

The remaining states have between one and three reported illnesses linked to the outbreak, according to the CDC: Alabama, Arizona, Georgia, Iowa, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, Nevada, New York, Oklahoma, Oregon, South Dakota, Tennessee and Wisconsin.

A chart on the CDC's website shows cases have occurred every month since early March, with spikes in May and early June. The latest reported cases were in mid-July, although the CDC said some recent cases may not have been reported yet.

CDC spokeswoman Lola Russell said Tuesday it can take three to four weeks to confirm a single case. Identifying an outbreak can take considerably longer than that when cases of foodborne illness occur sporadically, in several states, as has happened in the current outbreak, she said.

Dr. Mark Dworkin, a public health expert at the University of Illinois at Chicago, said it's not surprising that the government alert came months after the first cases were identified.

Outbreaks of foodborne illnesses where "everybody came together at a church supper and ate the same food" are easier to identify than those involving people in many states, he said. "The problem we have is our food is contaminated too often. It's not acceptable that such a large percentage of ground turkey has got such a potentially deadly pathogen."

Ground turkey is considered safe to eat when the internal temperature reaches 165 degrees during cooking. For turkey patties or burgers, internal temperatures on each side should be measured. The government also advises refrigerating meat promptly and washing hands for at least 20 seconds before and after handling raw meat or poultry.

The CDC estimates that 50 million Americans each year get sick from food poisoning, including about 3,000 who die. Salmonella causes most of these cases and federal health officials say they've made virtually no progress against it.

The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight hours to 72 hours of eating a contaminated product. It can be life-threatening to some with weakened immune systems.

___

Tanner reported from Chicago. Associated Press writer Shaya Tayefe Mohajer in Los Angeles contributed to this report.

___

Online:

CDC info on salmonella in ground turkey: http://www.cdc.gov/salmonella/heidelberg/080111/index.html

___

Find Mary Clare Jalonick on Twitter at http://twitter.com/MCJalonick

Find Lindsey Tanner on Twitter at http://www.twitter.com/LindseyTanner

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APNewsbreak: Salmonella death found in Calif. (AP)

LOS ANGELES � State health officials say a California resident is the lone known death in a spate of salmonella poisonings across the country that appear to be linked to eating ground turkey meat.

California Department of Public Health spokesman Mike Sicilia said Tuesday that the death was one of two cases of the illness reported in Sacramento County.

Four other cases of salmonella have been found in California, one each in Los Angeles, San Francisco, Riverside and San Diego counties.

Seventy-six people in 26 states have been made sick from the same strain of the disease.

The federal Centers for Disease Control and Prevention said Monday that ground turkey from four retail locations between March 7 and June 27 showed salmonella contamination, though those samples are not specifically linked to the illnesses.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

Federal officials say one person has died from salmonella poisoning that appears to be linked to eating ground turkey, but the government is still investigating who produced the meat and has not initiated a recall.

Seventy-six people in 26 states have been made sick from the same strain of the disease. The CDC did not say where the person who died became sick and released no details about the death.

The illnesses date back to March, and the CDC said Monday that cultures of ground turkey from four retail locations between March 7 and June 27 showed salmonella contamination, though those are not specifically linked to the illnesses. The agency said preliminary information showed that three of those samples have been linked to the same production establishment but did not name the retailers or the manufacturers.

The Agriculture Department oversees meat safety and would be the agency to announce a recall. The department sent out an alert about the illnesses late last week telling consumers to properly cook their turkey, which can decrease the chances of salmonella poisoning. But the department has not given consumers any further warnings about the source of the tainted meat.

USDA's Food Safety and Inspection Service "has not linked these illnesses to a particular brand, product, or establishment, and therefore has not issued a recall," spokesman Brian Mabry said Tuesday. "We are continuing to investigate this situation."

The CDC said it and USDA were "vigorously working to identify the specific contaminated product or products that are causing illnesses and will update the public on the progress of this investigation as information becomes available."

Food safety advocate Bill Marler, an attorney who has represented victims of the nation's biggest food-borne illness outbreaks, said he believes the three positive samples should prompt a recall.

"Consumers have no idea what to do except not eat ground turkey," he said.

The illnesses are spread all over the country. The states with the highest number sickened were Michigan and Ohio, 10 illnesses each, while nine illnesses were reported in Texas. Illinois had seven, California six and Pennsylvania five.

The remaining states have between one and three reported illnesses linked to the outbreak, according to the CDC: Alabama, Arizona, Georgia, Iowa, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, Nevada, New York, Oklahoma, Oregon, South Dakota, Tennessee and Wisconsin.

A chart on the CDC's website shows cases have occurred every month since early March, with spikes in May and early June. The latest reported cases were in mid-July, although the CDC said some recent cases may not have been reported yet.

University of Pennsylvania bioethicist Art Caplan said the government's handling of the outbreak raises ethical questions about why the public wasn't warned sooner.

"You've got to protect the public health. That's their first and primary value � not industry, not any other goal. They have to warn as quickly as they think there's reasonable evidence for concern," Caplan said.

He said that uncertainty about the outbreak's source might explain the long silence, but added, "the moral duty is to really get the word out as soon as you have evidence of a problem."

CDC spokeswoman Lola Russell said Tuesday it can take three to four weeks to confirm one case. Identifying an outbreak can take considerably longer than that when cases of foodborne illness occur sporadically, in several states, as has happened in the current outbreak, she said.

Russell said the CDC isn't advising the public to avoid eating ground turkey, but does urge people to cook it properly.

Ground turkey is considered safe to eat when the internal temperature reaches 165 degrees. For turkey patties or burgers, internal temperatures on each side should be measured.

Other government advice:

_Refrigerate raw meat and poultry within two hours after purchase, one hour if temperatures in the house exceed 90 F.

_Refrigerate cooked meat and poultry within two hours after cooking.

_Wash hands with warm, soapy water for at least 20 seconds before and after handling raw meat and poultry.

The CDC estimates that 50 million Americans each year get sick from food poisoning, including about 3,000 who die. Salmonella causes most of these cases and federal health officials say they've made virtually no progress against it.

The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight hours to 72 hours of eating a contaminated product. It is life-threatening to some with weakened immune systems.

Salmonella infections may last about a week and often don't require treatment other than drinking plenty of water and other fluids. Sometimes antibiotics are used when the infection spreads from the intestines. The CDC says some salmonella bacteria have become drug-resistant because of antibiotics used to promote livestock growth.

One of the largest outbreaks last year involved salmonella-tainted eggs that may have sickened as many as 56,000. About 2,000 illnesses were reported, but CDC estimates that only a fraction of illnesses are reported in most outbreaks.

In April, Jennie-O Turkey Store, a division of Hormel, recalled almost 55,000 pounds of frozen, raw turkey burger products linked to an outbreak of a different strain of salmonella. The CDC said then that 12 people were sickened in 10 states.

___

AP Medical Writer Tanner reported from Chicago.

___

Online:

CDC info on salmonella in ground turkey: http://www.cdc.gov/salmonella/heidelberg/080111/index.html

___

Find Mary Clare Jalonick on Twitter at http://twitter.com/MCJalonick

Find Lindsey Tanner on Twitter at _http://www.twitter.com/LindseyTanner

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CDC: 1 death, 76 illnesses linked to ground turkey (AP)

WASHINGTON � Federal officials say one person has died from salmonella poisoning that appears to be linked to eating ground turkey, but the government so far has declined to say who produced the meat or initiate a recall.

Seventy-six people in 26 states have been made sick from the same strain of the disease, which the federal Centers for Disease Control and Prevention says is resistant to many commonly prescribed antibiotics. The CDC did not say where the person who died became sick and released no details about the death.

The illnesses date back to March, and the CDC said Monday that cultures of ground turkey from four retail locations between March 7 and June 27 showed salmonella contamination. The agency said preliminary information showed that three of the samples have been linked to the same production establishment but did not name the retailers or the manufacturers.

The Agriculture Department oversees meat safety and would be the agency to announce a recall. The department sent out an alert about the illnesses late last week telling consumers to properly cook their turkey, which can decrease the chances of salmonella poisoning. But the department has not given consumers any further warnings about the source of the tainted meat.

The USDA has not responded to requests for comment on why there has not been a recall. The CDC said it and the USDA were "vigorously working to identify the specific contaminated product or products that are causing illnesses and will update the public on the progress of this investigation as information becomes available."

Food safety advocate Bill Marler, an attorney who has represented victims of the nation's biggest food-borne illness outbreaks, said he believes the three positive samples should prompt a recall.

"Consumers have no idea what to do except not eat ground turkey," he said.

The illnesses are spread all over the country. The states with the highest number sickened were Michigan and Ohio, 10 illnesses each, while nine illnesses were reported in Texas. Illinois had seven, California six and Pennsylvania five.

The remaining states have between one and three reported illnesses linked to the outbreak, according to the CDC: Alabama, Arizona, Georgia, Iowa, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, Nevada, Oklahoma, Oregon, South Dakota, Tennessee and Wisconsin.

The CDC said 26 states were affected but only listed 25 states in which illnesses were reported in a news release issued Monday evening.

A chart on the CDC's website shows cases have occurred every month since early March, with spikes in May and early June. The latest reported cases were in mid-July, although the CDC said some recent cases may not have been reported yet.

University of Pennsylvania bioethicist Art Caplan said the government's handling of the outbreak raises ethical questions about why the public wasn't warned sooner.

"You've got to protect the public health. That's their first and primary value � not industry, not any other goal. They have to warn as quickly as they think there's reasonable evidence for concern," Caplan said.

He said that uncertainty about the outbreak's source might explain the long silence, but added, "the moral duty is to really get the word out as soon as you have evidence of a problem."

CDC spokeswoman Lola Russell said Tuesday it can take three to four weeks to confirm one case. Identifying an outbreak can take considerably longer than that when cases of foodborne illness occur sporadically, in several states, as has happened in the current outbreak, shel said.

Russell said the CDC isn't advising the public to avoid eating ground turkey, but does urge people to cook it properly.

Ground turkey is considered safe to eat when the internal temperature reaches 165 degrees. For turkey patties or burgers, internal temperatures on each side should be measured.

Other government advice:

_Refrigerate raw meat and poultry within two hours after purchase, one hour if temperatures in the house exceed 90 F.

_Refrigerate cooked meat and poultry within two hours after cooking.

_Wash hands with warm, soapy water for at least 20 seconds before and after handling raw meat and poultry.

The CDC estimates that 50 million Americans each year get sick from food poisoning, including about 3,000 who die. Salmonella causes most of these cases and federal health officials say they've made virtually no progress against it.

The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight hours to 72 hours of eating a contaminated product. It can be life-threatening, especially to those with weakened immune systems.

One of the largest outbreaks last year involved salmonella-tainted eggs that may have sickened as many as 56,000. About 2,000 illnesses were reported, but CDC estimates that only a fraction of illnesses are reported in most outbreaks.

___

AP Medical Writer Lindsey Tanner contributed to this story from Chicago.

___

Online:

CDC info on salmonella in ground turkey: http://www.cdc.gov/salmonella/heidelberg/080111/index.html

___

Find Mary Clare Jalonick on Twitter at http://twitter.com/MCJalonick

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Coverage with no copay extended to birth control (AP)

WASHINGTON � A half-century after the advent of the pill, the Obama administration on Monday ushered in a change in women's health care potentially as transformative: coverage of birth control as prevention, with no copays.

Services ranging from breast pumps for new mothers to counseling on domestic violence were also included in the broad expansion of women's preventive care under President Barack Obama's health care overhaul.

Since birth control is the most common drug prescribed to women, health plans should make sure it's readily available, said Health and Human Services Secretary Kathleen Sebelius. "Not doing it would be like not covering flu shots," she said.

Officials said the women's prevention package will be available Jan. 1, 2013, in most cases, resulting in a slight overall increase in premiums. Tens of millions of women are expected to benefit initially, a number that is likely to grow with time. At first, some plans may be exempt due to an arcane provision of the health care law known as the "grandfather" clause. But those plans could face pressure from their members to include the new coverage.

Earlier requirements under the health care law improved preventive coverage generally for people of both sexes.

Social and religious and religious conservatives objected to the birth control mandate, saying a conscience exception unveiled by the administration is insufficient.

Sebelius acted after a near-unanimous recommendation last month from a panel of experts at the prestigious Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at the University of California, Los Angeles, said that prevention of unintended pregnancies is essential for the psychological, emotional and physical health of women.

"Over a span of generations from grandmothers to granddaughters, we have come from birth control being a hope and a wish � and almost luck � to being recognized as a part of health care that improves women's health," said Cynthia Pearson of the National Women's Health Network, an advocacy group supporting the change.

Some public health experts predicted the change will promote the use of costlier long-acting contraceptives, such as hormonal implants. More reliable than the pill, they are gaining popularity in other economically advanced countries.

As recently as the 1990s, many health insurance plans didn't even cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives � with varying copays. Medicaid, the health care program for low-income people, also covers birth control.

A government study last summer found that birth control use is virtually universal in the United States. Still, about half of all pregnancies are unplanned. Many are among women using some form of contraception, and forgetting to take the pill is a major reason.

Preventing unwanted pregnancies is only one goal of the new requirement.

Contraception can help make a woman's next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Research links closely spaced births to a risk of such problems as prematurity, low birth weight, even autism. Other research has shown that even modest copays for medical care can discourage use.

In a nod to social and religious conservatives, the rules issued Monday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage. However, many conservatives are supporting legislation by Rep. Jeff Fortenberry, R-Neb., that would codify a range of exceptions to the new health care law on religious and conscience grounds.

"It's a step in the right direction, but it's not enough," said Jeanne Monahan, a policy expert for the conservative Family Research Council. As it now stands, the conscience clause offers only a "fig leaf" of protection, she added, because it may not cover all faith-based organizations.

Although the new women's preventive services will be free of any additional charge to patients, somebody will have to pay. The cost will be spread among other people with health insurance, resulting in slightly higher premiums. That may be offset to some degree with savings from diseases prevented, or pregnancies that are planned to minimize any potential ill effects to the mother and baby.

The administration did allow insurers some leeway in determining what they will cover. For example, health plans will be able to charge copays for branded drugs in cases where a generic version is just as effective and safe for the patient.

The requirement applies to all forms of birth control approved by the Food and Drug Administration. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.

Coverage with no copays for the morning-after pill is likely to become the most controversial part of the change. The FDA classifies Plan B and Ella as birth control, but some religious conservatives see the morning-after drugs as abortion drugs. The rules HHS issued Monday do not require coverage of RU-486 and other drugs to chemically induce an abortion.

Other preventive services covered include:

_At least one "well-woman" preventive care visit annually.

_Screening for diabetes during pregnancy.

_Screening for the virus that causes cervical cancer for women 30 and older.

_Annual HIV counseling and screening for sexually active women.

_Screening for and counseling about domestic violence.

_Annual counseling on sexually transmitted infections for sexually active women.

_Support for breast feeding mothers, including the cost of renting pumps.

Aside from the conscience clause, the only other major exemption is for so-called "grandfathered" plans, many of which are offered by large employers. With time, however, many currently grandfathered plans are likely to lose that designation as they make routine changes affecting their benefits. Consumers should check with their health insurance plan administrator.

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Insurers must cover birth control with no copays (AP)

WASHINGTON � Health insurance plans must cover birth control as preventive care for women, with no copays, the Obama administration said Monday in a decision with far-reaching implications for health care as well as social mores.

The requirement is part of a broad expansion of coverage for women's preventive care under President Barack Obama's health care law. Also to be covered without copays are breast pumps for nursing mothers, an annual "well-woman" physical, screening for the virus that causes cervical cancer and for diabetes during pregnancy, counseling on domestic violence, and other services.

"These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need," said Health and Human Services Secretary Kathleen Sebelius.

The new requirements will take effect Jan. 1, 2013, in most cases. Over time, they are expected to apply to most employer-based insurance plans, as well as coverage purchased individually.

Sebelius acted after a near-unanimous recommendation last month from a panel of experts convened by the prestigious Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at the University of California, Los Angeles, said that prevention of unintended pregnancies is essential for the psychological, emotional and physical health of women.

As recently as the 1990s, many health insurance plans didn't even cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives � with varying copays. Medicaid, the health care program for low-income people, also covers contraceptives.

Indeed, a government study last summer found that birth control use is virtually universal in the United States, according to a government study issued last summer. More than 90 million prescriptions for contraceptives were dispensed in 2009, according the market analysis firm INS health. Generic versions of the pill are available for as little as $9 a month. Still, about half of all pregnancies are unplanned. Many are among women using some form of contraception, and forgetting to take the pill is a major reason.

Preventing unwanted pregnancies is only one goal of the new requirement. Contraception can help make a woman's next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Research links closely spaced births to a risk of such problems as prematurity, low birth weight, even autism. Research has shown that even modest copays for medical care can discourage use.

In a nod to social and religious conservatives, the rules issued Monday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage. However, many conservatives are supporting legislation by Rep. Jeff Fortenberry, R-Neb., that would codify a range of exceptions to the new health care law on religious and conscience grounds.

Although the new women's preventive services will be free of any additional charge to patients, somebody will have to pay. The cost will be spread among other people with health insurance, resulting in slightly higher premiums. That may be offset to some degree with savings from diseases prevented, or pregnancies that are planned to minimize any potential ill effects to the mother and baby.

The administration did allow insurers some leeway in determining what they will cover. For example, health plans will be able to charge copays for branded drugs in cases where a generic version is just as effective and safe for the patient.

The requirement applies to all forms of birth control approved by the Food and Drug Administration. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.

Coverage with no copays for the morning-after pill is likely to become the most controversial part of the change. The FDA classifies Plan B and Ella as birth control, but some religious conservatives see the morning-after drugs as abortion drugs. The rules HHS issued Monday do not require coverage of RU-486 and other drugs to chemically induce an abortion.

Advocates say the majority of women will be covered once the requirement takes effect in 2013, although some insurance plans may opt to offer the benefit earlier. Aside from the religious conscience clause, there is one additional exception. Plans that are considered "grandfathered" under the law will not be affected, at least initially. Consumers should check with their health insurance plan administrator.

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Nigeria parents risk jail for skipping polio shots (AP)

KANO, Nigeria � Officials in northern Nigeria say parents who do not allow their children to be vaccinated against polio now risk jail time for defying a government order.

The Kano state government says parents who prevent their children from getting immunized during the four-day campaign will face prosecution.

The campaign is targeting about 6 million children in the state, which recently recorded new polio cases.

Polio is largely eradicated in most of the world, but the vaccine has been met with resistance in Nigeria's impoverished north.

One 45-year-old local politician told The Associated Press on Friday that he would not allow his three young children to be immunized, saying he is skeptical of the vaccine.

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