E. coli: Flour fights not such a good idea

In June, 2009, an outbreak of shiga-toxin producing E. coli (primarily O157:H7) in Nestle Toll House cookie dough sickened at least 77 people in 30 American states. Thirty-five people were hospitalized – from cookie dough.

The researchers could not conclusively implicate flour as the E. coli source, but it remains the prime suspect. They pointed out that a single purchase of contaminated flour might have been used to manufacture multiple lots and varieties of dough over a period of time as suggested by the use-by dates on the contaminated product.

The study authors concluded that “foods containing raw flour should be considered as possible vehicles of infection of future outbreaks of STEC.”

So it wasn’t much of a surprise when 56 people fell sick from with the outbreak strain of E. coli O121 from Dec. 2015 to Sept. 2016 were linked to raw General Mills flour.

The peer-reviewed summary of the outbreak investigation was published last week in The New England Journal of Medicine.

Abstract below:

In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin–producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer.

Methods

A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples.

Results

A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility.

Conclusions

This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.

Shiga toxin–producing E. coli infections associated with flour

N Engl J Med 2017; 377:2036-2043, November 23, 2017, DOI: 10.1056/NEJMoa1615910

Samuel J. Crowe, Ph.D., M.P.H., Lyndsay Bottichio, M.P.H., Lauren N. Shade, B.S., Brooke M. Whitney, Ph.D., Nereida Corral, M.P.H., Beth Melius, M.N., M.P.H., Katherine D. Arends, M.P.H., Danielle Donovan, M.S., Jolianne Stone, M.P.H., Krisandra Allen, M.P.H., Jessica Rosner, M.P.H., Jennifer Beal, M.P.H., Laura Whitlock, M.P.H., Anna Blackstock, Ph.D., June Wetherington, M.S., Lisa A. Newberry, Ph.D., Morgan N. Schroeder, M.P.H., Darlene Wagner, Ph.D., Eija Trees, D.V.M., Ph.D., Stelios Viazis, Ph.D., Matthew E. Wise, M.P.H., Ph.D., and Karen P. Neil, M.D., M.S.P.H.

http://www.nejm.org/doi/full/10.1056/NEJMoa1615910

Food Safety Talk 140: Dr. Linda is a Friend of Mine

In this episode Don and Ben are joined by Gordon Hayburn from Trophy Foods.  Gordon talks about his experiences in food safety, focusing on his time in the food industry, and his expertise in audits.

Episode 140 can be found here and on iTunes.

Show notes below so you can follow along at home.

Kansas veterinarian says the same food safety rules that apply to humans also apply to pets

When I got fired as a full professor from Kansas State University in 2013, my department chair actually kept a straight face as he said, if I didn’t show up on campus, he would have no choice, and that “I didn’t work well with others.”

Bureaucratic BS.

They wanted my salary, didn’t like what I said to cattle folks, and started a whole on-line thingy I had proposed after getting dumped.

Best and brightest get promoted.

There were several colleagues in the college of veterinary medicine I worked quite well with.

One was Kate KuKanich, associate professor of clinical sciences in Kansas State University’s College of Veterinary Medicine.

We hit the road and did handwashing studies in hospitals, co-supervized vet students who did cool investigative work on petting zoos, and she brought us duck eggs.

Kate made K-State’s Thanksgiving of PR, and full kudos for going through the process.

“Thanksgiving is a time when a lot of people think that giving tidbits of the food to pets it thoughtful. A small piece of turkey breast, which is low in fat and salt, is OK for a dog or cat in moderation. But, because we love our pets, we can often overdo it and ignore food safety rules that affect both our health and the health of our pets.”

Each year around Thanksgiving, KuKanich and colleagues at Kansas State University’s Small Animal Hospital treat multiple cats and dogs that have pancreatitis — an inflammation of the pancreas. The condition often manifests in pets that have eaten fatty human foods, such as meat trimmings and bacon, rather than their normal diet. Foods high in salt can be hazardous to pets with heart disease.

I thought it was drunks that got pancreatitis.

KuKanich advises pet owners to keep pets’ meals and treats as normal as possible during the holidays in order to avoid a recipe for disaster. She also said that the same food safety rules that apply to humans also apply to pets. These include:

  • Turkey and other meats must be cooked to 165 degrees Fahrenheit before dogs, cats and humans eat it. Raw and undercooked meats as well as their juices can contain germs that can cause serious illness in both people and animals.

“Sometimes people think that it’s OK to give a pet raw or undercooked meat because pets’ ancestors come from the wild,” KuKanich said. “Any raw meat, such as the gizzard of the turkey, can make our pets sick because they can be contaminated with bacteria. A meat thermometer is best way to know our meats are food safe and cooked to the proper temperature for everyone’s safety.”

  • Bones, such as a hambone, drumstick or rib, also can be dangerous because they can become lodged in the esophagus of dogs, requiring emergency endoscopy or surgical removal.
  • Pet owners should wash their hands in warm, sudsy water before and after feeding their pet. Pets’ food and water bowls and measuring cups used to dispense their food also should be cleaned regularly.

“Handwashing prior to cooking, eating and food storage is important to keep food and family members safe,” KuKanich said. “It also is a good idea to either avoid petting our furry friends during food prep and meals or to wash hands frequently so that we keep both the food and the pets safe.”

  • Juices from raw turkey and other meats will contaminate anything it touches in the kitchen, including counter space, utensils, other food and pet dishes.
  • Pets and people should not eat cooked and dairy-based food that has been sitting at room temperature for longer than 2 hours. Two hours is the longest food should sit at room temperature before it is refrigerated or frozen, according to a food safety specialist at Kansas State University Olathe.

Additionally, while sweets and deserts may affect our waistline, they can be hazardous to an animal.

Kate’s got the basics right.

Kansas State is fortunate to have her.

Our publications can be found on-line.

The vomit machine lives on; norovirus can aerosolize during vomit events

I’ve been lucky to be close to some excellent projects, some of the stuff and knowledge created through these projects ends up mattering to food safety nerds – especially those who are making risk management decisions. Former NC State student Grace Tung-Thompson’s PhD project on vomit spray and norovirus is one of the most impactful. The work was carried out as part of the USDA NIFA-funded NoroCORE project led by my friend Lee-Ann Jaykus.VOMIT-BLOG-HEADER-698x393

I’ve talked to lots of Environmental Health Specialists, retailers and food service food safety folks about what Grace and fellow graduate student Dominic Libera put together and many respond with a weird level of enthusiasm for the barf project.

Mainly because a real question they struggle with is how far will virus particles travel from an up-chuck event – knowing this, and then cleaning and sanitizing helps limit the scope of a potential outbreak.  Grace’s work was published in PLOS ONE a while ago, we used it as a centerpiece for a Conference for Food Protection issue on vomit clean up in 2016 (which, maybe, could be included in the oft rumored 2017 Food Code) and the Daily Beast  covered the work today.

A couple of years ago, PhD student Grace Tung Thompson demonstrated something incredibly gross: When a person vomits, little tiny bits of their throw-up end up airborne. You could ingest them just by breathing air in the same room. As if that weren’t disconcerting enough, if the person got sick from a virus, there could be enough viruses in the air to get you sick, too. Just try not to think about that the next time the person in the row behind you throws up on an airplane.
So how do you get rid of airborne viruses? “There is no known technology that will eliminate norovirus if it’s in the air,” Jaykus said, “and there really aren’t a lot of technologies—safe technologies—that even are likely to work.” Her research team recently experimented with misting antiviral compounds into spaces as an alternative to disinfecting surfaces individually, and it worked, but not completely. This technique, known as fogging, can only be used in spaces that can be cleared out and contained, like bathrooms, for example. “I think we need that technology, and that technology is really, really important, but how the heck we’re going to develop it? I’m at a loss for words.”

From an individual perspective, the best you can do is get yourself far away from a vomiting incident; Jaykus recommends at least 100 feet. If you were in the middle of a meal at a restaurant and someone at the next table threw up, you’d probably be wise to stop eating, and to wash yourself and your clothes when you are able.

From the perspective of a restaurant owner, the best course of action is to do a really, really good job of the cleanup. Commercial vomit and fecal matter cleanup kits are catching on with bigger companies in the foodservice industry, says Jaykus. They provide personal protection, including disposable coveralls and respirator masks, in addition to the material required to pick up and wipe down the mess.

Eating broken glass sucks; Trader Joe’s salad recalled

Friend of barfblog and mentor Tanya MacLaurin told me a story when I was in grad school that I still use when telling folks about physical hazards.

It goes sorta like this (or this is the version I remember):

Tanya was running food services at Kansas State and had a really big event with donors and university administrators. She came into the kitchen and saw her staff picking something out of a couple of hundred of salads that were prepped and ready to go our for service. Someone had broken a fluorescent light that was situated over the staging area and everyone was scrambling to pick out the glass.

A great risk manager, Tanya shut down the coverup operation.

Glass removal by eyesight isn’t a great critical control point.

In related news, a supplier of Trader Joe’s salads is recalling a whole bunch of prepared salads due to glass contamination.

Green Cuisine, a San Fernando, Calif. establishment, is recalling approximately 36,854 pounds of chicken and turkey salad products that may be contaminated with extraneous materials, specifically hard silica and glass fragments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ready-to-eat chicken and turkey salads were produced from Nov. 4 – 15, 2017. The following products are subject to recall:

* 10.5-oz. clear plastic individual serving packages containing “TRADER JOE’S White Meat Chicken Salad with celery, carrots and green onions” with a “Use By” date of November 10 – 21, 2017.

* 11.0-oz. clear plastic individual serving packages containing “TRADER JOE’S CURRIED WHITE CHICKEN DELI SALAD with toasted cashews, green onion and a bit of honey” with a “Use By” date of November 10 – 21, 2017.

* 10.25-oz. clear plastic individual serving packages containing “TRADER JOE’S TURKEY CRANBERRY APPLE SALAD TURKEY BREAST MEAT WITH SWEET DRIED CRANBERRIES, TANGY GREEN APPLES, PECANS AND SAGE” with a “Use By” date of November 10 – 21, 2017.

The products subject to recall bear establishment number “P-40299” inside the USDA mark of inspection. These items were shipped to retail locations in the following states: Arizona, California, Colorado, Idaho, Louisiana, New Mexico, Nevada, Oklahoma, Oregon, Texas, Utah and Washington.

‘Look where some people poo’ Global citizen’s Taylor Swift parody

Yasmine Gray of Billboard writes  Global Citizen — a social action platform dedicated to solving the world’s biggest problems — released a Taylor Swift parody video for a cause. Bringing attention to one of the most pressing issues in global development, the “Look What You Made Me Do” spoof draws attention to sanitation and toilet access.

Worldwide, 4.5 billion people lack access to safe and working toilets and sanitation, while 892 million people are forced to defecate outside in the open or into bodies of water. Poor sanitation is linked to the transmission of many deadly diseases, including cholera, diarrhea, dysentery, hepatitis A, typhoid, and polio, and 3.4 million people — mostly children — die from water-related diseases each year, with one in nine child deaths caused by diarrhea.

“Look Where Some People Poo” is the latest in a series of musical parodies Global Citizen has created to educate and inspire people around the world to take action. Past videos have included an Adele parody about calling Congress and a Bruno Mars parody concerning women’s rights.

Ahead of World Toilet Day (Nov. 19), the organization is asking supporters to sign a petition calling on the World Bank to commit to prioritizing basic sanitation.

 

 

What’s in your weed?

In Hawaii, one of the testing labs certified by the state to check the quality of medical marijuana said they found contamination in more than half of the samples from the black market.   

The lab, Steep Hill Hawaii, says over 50 percent of the black market product had contaminants that included mold, yeast, and pesticides. 

The lab says that doesn’t mean all homegrown products are bad, but patients should be aware of what’s in their medicine. 

“I personally was shocked to find out how much stuff was in black market cannabis that you would never expect. E. coli, which comes from fecal matter. Salmonella, which comes from raw egg and chicken. We found that on product we tested,” said Michael Covington, of Steep Hill Hawaii. 

In Canada, CannaDrinks may be all the rage in some parts of the world, but there are some serious health concerns surrounding new products being formulated.

Sure it sounds cool, to order some cannabis-infused drinks at the bar for you and your buddies. However, a leading food safety expert is warning that these cool drinks may be dangerous, and the public (apparently) needs to take note.

While a $245 million deal was penned between Constellation Brands and Canopy Growth last week, for a 10 percent stake of CP, Canada’s largest cannabis producer, to produce the new CannaDrinks, Rick Holley claims the drinks are problematic, “[Producers] could screw this all up if they don’t get into the mechanics of how to safely prepare and develop new food products,” he said, adding, “They could kill people!”

BNN reported that Constellation Brands told them via email that the company, “has a long-standing commitment to producing products with the highest quality standards and that comply with all regulations.”

According to Lawrence Goodridge, a McGill University food safety expert (Larry, you’re an expert), alcohol has the advantage of killing bacteria and toxins in sealed bottles or cans, whereas cannabis-infused products may not, “Because cannabis is a plant, there are certain concerns — like the possibility of pesticides used in production, or the type of fertilizer used, or the potential presence of heavy metals that could be toxic to humans,” said Goodridge, adding that, “Bacteria like e-coli or listeria that could be on the plant and that could make it onto the food, whether it is drinks or edibles, the risk is the same — but alcohol is special because we know that helps to kill some of those toxins.”

Also, Sikora et al. identified a case of Hepatitis A associated with cannabis use.

We identified a case of acute Hepatitis A virus (HAV) infection linked to cannabis use. The local Public Health department received report of a man in his mid-20s with a classic presentation of hepatitis – jaundice, abdominal pain, vomiting, general malaise, and dark urine – as well as elevated serum aminotransferase levels and a positive anti-HAV IgM. Upon questioning, he reported no contact with ill individuals, or travel outside his metropolitan area. His exclusive source of water was the local municipal supply. He reported consuming mainly pre-packaged lower risk foods from large chain-style supermarket stores and eating at several local restaurants. While administering the questionnaire, the investigator identified that the patient smoked cannabis. Upon request, the patient agreed to provide a sample of cannabis for testing purposes. A viral elution of fresh cannabis leaves was completed. The sequences derived from the patient’s serum sample and the eluate from the cannabis leaves were identical, but did not match any other HAV sub-genotype 1B sequences from Canadian isolates within the National Microbiology Laboratory database. Hepatitis A virus can survive >60 days when dried and kept at room temperature and low humidity; HAV can remain infectious in water at room temperature for 300 days. It cannot be concluded with certainty that the cannabis was the source of the hepatitis A; however, as other sources were excluded, or were of lesser probability, the association of cannabis with his disease acquisition remains strong.

 

Ready-to-eat meals may be popular but have risks

Eugene Boisvert of Au News writes that more than 40 per cent of ready-to-eat meals tested by South Australian health types contained an unsatisfactory level of bacteria, according to survey results published in the Eastern Health Authority’s annual report this month.

The SA Health survey said one of the tested meals contained 310 times the safe level of Bacillus cereus, and another had almost 13 times the safe level of E. coli, which comes from feces.

Out of 98 meals bought at local supermarkets and shops with a shelf life of 10 or more days, 42 had an unsatisfactory microorganism count.

Eastern Health Authority chief executive Michael Livori said more small businesses were trying to capitalise on the growing popularity of ready-to-eat meals without understanding the health risks involved.

“Most manufacturers who are normally in this business will (understand the risks) but there’s an increase in small businesses or retailers getting into this realm but not without risk,” Mr Livori said.

The SA Health survey and subsequent report, published in June, was sparked by Eastern Health Authority concerns about the standard of manufacturing processes of ready-to-eat meals.

The SA Health report recommended measures to prevent bacteria growing in ready-to-eat meals, including that they be heated to at least 90C for 10 minutes when being cooked.

Meanwhile, the Eastern Health Authority issued 10 businesses with prohibition orders in 2016/17, banning them from preparing, selling or transporting food until they cleaned up their act, compared with three in the previous two financial years.

Use a thermometer: 21 sickened: Campy in UK liver pate, again

Yorkshire Coast Radio reports Diversorium Ltd, the company which owns and operates the Downe Arms, a country inn hotel in Wykeham near Scarborough, has been fined £8,000 for two serious food hygiene related offences after an outbreak of Campylobacter food poisoning was traced back to contaminated chicken liver pate eaten at the hotel.

Following a prosecution by Scarborough Borough Council, Diversorium Ltd pleaded guilty at Scarborough Magistrates Court to two offences under the Food Safety and Hygiene (England) Regulations after 21 people fell ill following a Christmas party night on 17 December 2016 and a Christmas break package at the hotel during the same month. The court ruled that fines of £5,000 and £3000 respectively should be paid for the offences. The company was also ordered to pay the council £2170 in costs.

The council’s Environmental Health team received complaints from those affected by the food poisoning and during the subsequent investigation it was apparent that there were a number of issues which were not consistent with good hygiene practices and food safety management records were incomplete. In particular, the process for preparing the chicken liver pate had not been validated by appropriate temperature monitoring and recording, and food safety was not being managed effectively. The extensive investigation, carried out in conjunction with Public Health England, concluded that the pate was the most probable cause of the illness. The business was subsequently marked down to a food hygiene rating of 1 (major improvement necessary).

Hospitals should watch their litigation backside if growing their own produce with no safety talk

I’m not Debbie Downer, but I am Dougie Downer and never get invited to dinner.

This idea has risk written all over it.

Sarah Toy of USA Today writes that high atop the roof of a Boston hospital power plant in the middle of the city, you’ll find something unexpected: A 7,000-square-foot oasis with a lush carpet of green, rows upon rows of mesclun, kale, rainbow chard and a sea of plump green and red tomatoes.

Sounds good, has all the buzzwords except the one that I and anyone serving meals to immunocompromised people in hospitals should care about: microbiologically safe.

“There is an increasing trend in hospital farms,” said Stacia Clinton, the national program director for Health Care Without Harm’s Healthy Food in Health Care program, which advises hospitals on ways to provide sustainable and nutritious food. “There’s a greater demand now for people to know where their food is coming from, and hospitals are looking for ways to connect people to their food more directly.”

No mention of produce food safety.

If it’s growing on roofs, birds –Salmonella and Campylobacter factories – are crapping on the stuff, and washing does almost nothing.