Food fraud: Inside global bullshit about spices

A bowl of ice cream on a hot day in Shanghai gave American Mitchell Weinberg the worst bout of food poisoning he can recall. It also inspired the then-trade consultant to set up Inscatech — a global network of food spies.

In demand by multinational retailers and food producers, Inscatech and its agents scour supply chains around the world hunting for evidence of food industry fraud and malpractice. In the eight years since he founded the New York-based firm, Weinberg, 52, says China continues to be a key growth area for fraudsters as well as those developing technologies trying to counter them.

“Statistically we’re uncovering fraud about 70 percent of the time, but in China it’s very close to 100 percent,” he said. “It’s pervasive, it’s across food groups, and it’s anything you can possibly imagine.”

While adulteration has been a bugbear of consumers since prehistoric wine was first diluted with saltwater, scandals in China over the past decade — from melamine-laced baby formula, to rat-meat dressed as lamb — have seen the planet’s largest food-producing and consuming nation become a hotbed of corrupted, counterfeit, and contaminated food.

Weinberg’s company is developing molecular markers and genetic fingerprints to help authenticate natural products and sort genuine foodstuffs from the fakes. Another approach companies are pursuing uses digital technology to track and record the provenance of food from farm to plate.

“Consumers want to know where products are from,” said Shaun Rein, managing director of China Market Research Group, citing surveys the Shanghai-based consultancy conducted with consumers and supermarket operators.

Services that help companies mitigate the reputational risk that food-fraud poses is a “big growth area,” according to Rein. “It’s a great business opportunity,” he said. “It’s going to be important not just as a China play, but as a global play, because Chinese food companies are becoming part of the whole global supply chain.”

Some of the biggest food companies are backing technology that grew out of the anarchic world of crypto-currencies. It’s called blockchain, essentially a shared, cryptographically secure ledger of transactions.

Wal-Mart Stores Inc., the world’s largest retailer (and source off the terrible graphic, above, right), was one of the first to get on board, just completing a trial using blockchain technology to track pork in China, where it has more than 400 stores. The time taken to track the meat’s supply chain was cut from 26 hours to just seconds using blockchain, and the scope of the project is being widened to other products, said Frank Yiannas, Wal-Mart’s vice president for food safety, in an interview Thursday.

But will it be advertised at retail, or just some faith consumers will be forced to rely on.

Real transparency means reals data, shared publicly; it’s not a matter of faith.

Toxo: You don’t want it

Toxoplasmosis is a foodborne zoonosis transmitted by Toxoplasma gondii, a cosmopolitan protozoan that infects humans through exposure to different parasite stages, in particular by ingestion of tissue cysts or tachyzoites contained in meat, primary offal (viscera), and meat-derived products or ingestion of environmental sporulated oocysts in contaminated food or water.

The pig is an important species for infection: raw or undercooked pork consumption not subject to treatment able to inactivate the parasite represents a risk to consumers’ health. Broadening knowledge of transmission ways and prevalence concerning this important pathogen in swine, together with a thorough acquaintance with hazard management are key elements to avoid T. gondii spreading within the swine production chain.

This review aims to illustrate why toxoplasmosis should be regarded as a veterinary public health issue through a careful description of the parasite, routes of infection, and inactivation treatments, highlighting the main prevention lines from pig breeding to pork consumption.

Toxoplasma gongii, a foodborne pathogen in the swine production chain form a European perspective

Foodborne Pathogens and Disease, ahead of print, July 2017,  De Berardinis Alberto, Paludi Domenico, Pennisi Luca, and Vergara Alberto, https://doi.org/10.1089/fpd.2017.2305

http://online.liebertpub.com/doi/abs/10.1089/fpd.2017.2305

Cyclospora: Back to the future

During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

Cyclosporiasis in travellers returning to the United Kingdom from Mexico in Summer 2017: Lessons from the recent past to inform the future

Eurosurveillance, vol. 22, issue 32, 10 August 2017, DFP Marques, CL Alexander, RM Chalmers, R Elson, J Freedman, G Hawkins, J Lo, G Robinson, K Russell, A Smith-Palmer, H Kirkbride, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.32.30592

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22854

206 sick: CDC notes increase of Cyclospora cayetanensis infection, United Sates, Summer 2017

Another North American summer, another Cyclospra-induced shit-fest.

The U.S. Centers for Disease Control and Prevention (CDC), State and Local Health Departments, and the Food and Drug Administration (FDA) are investigating an increase in reported cases of cyclosporiasis. The purpose of this HAN Advisory is to notify public health departments and healthcare facilities and to provide guidance to healthcare providers of the increase in reported cases. Please disseminate this information to healthcare providers in hospitals and emergency rooms, to primary care providers, and to microbiology laboratories.

Healthcare providers should consider a diagnosis of cyclosporiasis in patients with prolonged or remitting-relapsing diarrheal illness. Testing for Cyclospora is not routinely done in most U.S. laboratories, even when stool is tested for parasites. Healthcare providers must specifically order testing for Cyclospora, whether testing is requested by ova and parasite (O&P) examination, by molecular methods, or by a gastrointestinal pathogen panel test. Cyclosporiasis is a nationally notifiable disease; healthcare providers should report suspect and confirmed cases of infection to public health authorities.

As of August 2, 2017, 206 cases of Cyclospora infections have been reported to CDC in persons who became infected in the United States and became ill on or after May 1, 2017. These cases have been reported from 27 states, most of which have reported relatively few cases. Eighteen cases reported hospitalization; no deaths have been reported. At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s).

The number of cases (206) reported in 2017, is higher than the number of cases reported by this date in 2016. As of August 3, 2016, 88 Cyclospora infections had been reported in persons who became infected in the United States and became ill on or after May 1, 2016.

Impossible Burger, regulatory gaps, and money. Always money

I want hamburgers temperature-verified to 160F.

Blood is a terrible indicator.

Stephanie Strom of the NY Times writes that one of the chief selling points of the Impossible Burger, a much ballyhooed plant-based burger patty, is its resemblance to meat, right down to the taste and beeflike “blood.”

Those qualities, from an ingredient produced by a genetically engineered yeast, have made the burger a darling among high-end restaurants like Momofuku Nishi in New York and Jardinière in San Francisco, and have attracted more than $250 million in investment for the company behind it, Impossible Foods.

Bill Gates is an investor.

That makes me want to run to my Mac.

The genetically engineered yeast thingy is just thrown in there to raise alarm.

My 1985 daily squash partner, Andy, was working on genetically engineered yeast for wine back in the day. Our bottling parties were legend.

Now, its secret sauce — soy leghemoglobin, a substance found in nature in the roots of soybean plants that the company makes in its laboratory — has raised regulatory questions.

Impossible Foods wants the Food and Drug Administration to confirm that the ingredient is safe to eat. But the agency has expressed concern that it has never been consumed by humans and may be an allergen, according to documents obtained under a Freedom of Information request by the ETC Group as well as other environmental and consumer organizations and shared with The New York Times.

“F.D.A. believes the arguments presented, individually and collectively, do not establish the safety of soy leghemoglobin for consumption,” agency officials wrote in a memo they prepared for a phone conversation with the company on Aug. 3, 2015, “nor do they point to a general recognition of safety.”

Impossible Foods can still sell its burger despite the F.D.A. findings, which did not conclude soy leghemoglobin was unsafe. The company plans to resubmit its petition to the agency.

Impossible Foods is finding out what happens when a fast-moving venture capital business runs headlong into the staid world of government regulation.

In the case of Impossible Foods, the debate centers on its use of soy leghemoglobin, which the company’s engineered yeast produces and forms an important ingredient behind the business.

The company was started in 2011 by Pat Brown, a chemist at Stanford University. His approach, involving genetics, microbiology and cutting-edge chemistry attracted venture capitalists also eager to find plant-and lab-based replacements for hamburgers and chicken wings.

Impossible Foods sought to woo top chefs with a splashy sales pitch about how the burger mimicked the aroma, attributes and taste of real beef. When soy leghemoglobin breaks down, it releases a protein known as heme, giving it that meatlike texture.

Within three years of its founding, Impossible Foods landed big-name investors like Khosla, Mr. Gates and the Hong Kong billionaire Li Ka-Shing. This month, Temasek Holdings, Singapore’s sovereign wealth fund, joined an investment round that added $75 million to the company’s coffers.

“I love V.C.s and particularly the ones that invested in us,” Mr. Brown said at a TechCrunch conference in May, referring to venture capital firms. “But it’s truly astonishing how little diligence they do in terms of the actual science that underlies some tech companies.”

The F.D.A.’s approval is not required for new ingredients. Companies can hire consultants to run tests, and they have no obligation to inform the agency of their findings, a process known as self-affirmation.

Impossible Foods adhered to that procedure, concluding in 2014 that soy leghemoglobin was safe. But it went further, seeking the regulator’s imprimatur.

“We respect the role the F.D.A. plays in ensuring the safety of our food supply, and we believe the public wants and deserves transparency and access to any information they need to decide for themselves whether any food they might eat is safe and wholesome,” Rachel Konrad, a spokeswoman for Impossible Foods, wrote in an email.

The F.D.A., however, wanted the company to show the ingredient was safe specifically for humans. It told Impossible Foods to establish the safety of the more than 40 other proteins that make up part of its soy leghemoglobin. F.D.A. officials said the company’s assessment of the potential for the ingredient to be an allergen was deficient.

“This product has been touted as the ‘secret sauce’ in the Impossible Burger,” said Jim Thomas, program director at the ETC Group, the Canadian environmental organization that started the Freedom of Information request. “Now we know that the F.D.A. had questions about it, but it was put on the market anyway.”

Ms. Konrad defended the burger, writing it “is entirely safe to eat” and “fully compliant with all F.D.A. regulations.” She said the company was “taking extra steps to provide additional data to the F.D.A. beyond what’s required.”

Impossible Foods, she said, has tested its ingredient on rats fed “well above” the amount of soy leghemoglobin in its burger. Ms. Konrad said the company’s expert panel had determined those tests also demonstrated the ingredient was safe, and that the company would thus resubmit its petition for F.D.A. confirmation this month.

This is a novel food, and makes Canada’s approach to regulation of food safety sane, for a while.

4 sick with campy linked to raw milk served at Royal Welsh Show

In 2013, at least 50 people, mainly children, became ill with E coli O157 at the Ekka, Queensland, Australia’s version of the state fair.

It starts again on Friday, and because organizers have done little except to encourage people to wash their hands, we won’t be going.

Handwashing is never enough.

Manure from ruminants is easily aerosolized in these environments, and I’ve been to many human-animal interaction events for research, and there is shit everywhere.

Although ostensibly designed to promote understanding of food production, these agricultural celebrations rarely discuss risk – until an outbreak happens.

The motto seems to be: It’d be better for us if you don’t understand.

Now, four people have been sickened with Campylobacter linked to unpasteurised or raw cow’s milk from Penlan y Môr farm near New Quay, Ceredigion and sold at the Royal Welsh Show.

Public Health Wales says the four cases all consumed or bought the milk at Aberystwyth Farmer’s Market after June 1.

But visitors to the Royal Welsh Show in Builth Wells may also have sampled or bought the milk which was available there on Wednesday, 26 July.

A table of animal-human-interaction outbreaks is available at http://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

Noro is serious shit: Hotel housing athletes in world-class fail

As the world seemingly lurches to World War III, I’m reminded it’s the little things that add up.

Especially compensating for little hands.

BBC Sport and CNN report that Botswana’s Isaac Makwala has withdrawn from the 400m final, “due to a medical condition on the instruction of the IAAF Medical Delegate (Rule 113).”

Public Health England says 30 athletes and support staff have been affected by sickness at the Tower Hotel in London.

The International Association of Athletics Federations said Makwala withdrew from Monday’s 200m heats “due to a medical condition on the instruction of the IAAF medical delegate.”

He admitted to vomiting before the heats, but said he was not tested.

“I could have run. I did my warm up well and I was ready to run. I feel ready to run today, tonight,” he said.

Several German and Canadian athletes staying at the Tower Hotel fell ill last week.

A further 30 Germans due to arrive on Tuesday will be moved to other hotels.

German triple jumper Neele Eckhardt collapsed but was well enough to compete on Saturday, and took part in Monday’s final.

The Ireland team, who are also staying at the hotel, have confirmed that one athlete – 400m hurdler Thomas Barr – has been affected.

The Tower Hotel said investigations conducted with environmental health officers and the IAAF had shown the hotel was “not the source of the illness”. That has also been confirmed by Public Health England.

Ireland’s Thomas Barr withdrew from the 400m semifinals, while German and Canadian athletes also staying at The Tower Hotel near Tower Bridge have reportedly been affected too.

In a statement to CNN, Dr Deborah Turbitt, Public Health England (PHE) London deputy director for health protection, said: “We have so far been made aware of approximately 30 people reporting illness and two of these cases have been confirmed as norovirus by laboratory testing.

“PHE has been working closely with British Athletics and the hotel to provide infection control advice to limit the spread of illness.”

Public Health England said most peopled made a full recovery from the illness — often caught through close contact with someone carrying the virus or by touching contaminated surfaces — within one or two days without treatment.

A spokesperson for The Tower Hotel told CNN it was “not the source of the illness,” and that “We have followed strict hygiene protocol, ensuring that those affected are not in contact with other guests and all public areas have been thoroughly sanitized.

Uh-huh.

Careful with that Italian water fountain: An entire orchestra is rushed to hospital

Norman Lebrecht of Slippedisc reports all 80 members of the European Spirit of Youth Orchestra were rushed to the Santa Chiara Emergency Room in Trento, Italy, suffering from dehydration after an outbreak of vomiting and diarrhea.

About 20 young musicians received prolonged treatment and two were detained in hospital overnight.

The problem was traced to a picturesque fountain in the small town of Belluno, where the orchestra had stopped for a drink of water. Officials say this was due to current repairs to the aqueduct.

The orchestra aims to continue its tour with conductor Igor Coretti-Kuret.

 

Going public fail 2-in-1 day: Tainted eggs were known about for months

I hate the phrase, food scare.

Hate is a strong word, but when it comes to food poisoning outbreaks that kill little kids and others, it’s not a scare, it’s real.

A scare implies former scream-queen Jamie-Lee Curtis flogging yoghurt that makes people poop.

That’s a food scare.

See how many times the N.Y. Times can use the word scare in its opening paragraphs:

The European Union on Monday notified the food safety authorities in Britain, France, Sweden and Switzerland to be on the lookout for contamination in eggs after a food scare in Belgium, Germany and the Netherlands.

Anna-Kaisa Itkonen, a European Commission spokeswoman, said, “We do not know if the eggs are contaminated or not, but because of these notifications, it’s now up to the national authorities to check.”

The scare over contaminated eggs, which began in Belgium, has led supermarkets there and in Germany and the Netherlands to clear shelves of the product as the crisis entered its third week.

The removal of eggs from shops was prompted by the discovery of the insecticide fipronil in some shipments. The contamination is thought to have been caused by the mixing of the insecticide with a cleaning agent used at chicken farms. The scare began July 19 when the government of Belgium said that fipronil had been found in eggs produced there.

Major supermarket chains in Belgium, including Delhaize and Colruyt, have stopped selling eggs from affected farms. In the Netherlands, one poultry producer declared bankruptcy on Friday as a result of the insecticide scare, according to an industry group.

 The Dutch consumer safety authority has published a guide on identifying the tainted eggs through a 10-digit serial number stamped on the shells. The country’s biggest supermarket chain, Albert Heijn, stopped selling many eggs last week, but the company said that eggs were back on sale as normal on Monday. In the Netherlands, an estimated nine million chickens from about 180 farms have been affected.

In Germany, the supermarket chain Aldi withdrew all eggs from sale after the authorities said that about three million eggs imported from the Netherlands had been affected. Since then, fipronil contamination has been found at four farms in the German state of Lower Saxony.

Fipronil is toxic in large quantities and can damage kidneys, liver and lymph glands. The Belgian and Dutch authorities are investigating how the contamination happened.

The Dutch poultry association said that farmers had no idea that cleaners were using the substance. Aalt den Herder, the group’s secretary, said the risk had been overstated.

“It was never an issue of human health, it was an issue of consumer confidence,” he said.

Yeah, except, as explained by the Irish Examiner:

Belgian authorities have now admitted they began investigating pesticide contamination in eggs in early June – several weeks before the public was made aware of a food safety scare affecting several European countries.

Kathy Brison, of the Belgian food safety agency, said on Sunday that a Belgian farm alerted authorities to a possible contamination in June, and they began investigating and alerted Belgian prosecutors.

German authorities are frustrated by the apparent delay in informing European neighbours.

German Agriculture Minister Christian Schmidt plans to speak to his Belgian counterpart about the issue on Monday.

And where would a risk communication failure be without the UK Food Standards Agency, who today reported, “We have no evidence that eggs laid in the UK are contaminated or that Fipronil has been used inappropriately in the UK. 85% of the eggs we consume in the UK are laid here.

“The number of eggs involved represents about 0.0001% of the eggs imported into the UK each year. Our risk assessment, based on all the information available, indicates that as part of a normal healthy diet this low level of potential exposure is unlikely to be a risk to public health and there is no need for consumers to be concerned. Our advice is that there is no need for people to change the way they consume or cook eggs or products containing eggs.”

Sounds good if they’re all getting “laid here.”

Once again:

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.

Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions.

There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

Going public fail: 14 sick with E. coli linked to raw milk in Virginia, 2016

The general public didn’t have access to the suspect food, so there was no point in unnecessarily alarming the public.

I’ve heard that paternalistic crap for 30 years now, and it never turns out well.

Coral Beach of Food Safety News reports that Virginia officials did not alert the general public to an E. coli outbreak in March 2016 that sickened at least 14 people — a dozen of them children.

This week, 17 months after the outbreak, public health officials expect to complete their report on the incident, according to a spokesman for the Virginia Department of Health. The implicated milk was from Golden Valley Guernseys (free samples delivered for $4) dairy, which sent a letter to members of its herd-share operation alerting them to the illnesses at the time.

Of the 14 confirmed E. coli victims, half had symptoms so severe that they required hospitalization. Three developed hemolytic uremic syndrome.

The state health department’s Rappahannock-Rapidan Health District office did not make a public announcement about the outbreak at the time because the general public did not have access to the milk, District Director Dr. Wade Kartchner told Food Safety News.

“Consideration was given to putting out a broad public notice, but the nature of the herd-share programs are such that we were confident that we would be able to effectively reach those who were truly at risk of illness,” Kartchner said. “… it is not quite the same situation as a restaurant outbreak where the public at large may be exposed.”

This is so wrong.

Others, even mere mortals, learn from outbreaks: How did this happen? How dangerous was the outbreak? And what kind of foods to avoid, like raw fucking milk.

In the absence of public announcements, it also makes it harder for mere scientists to make a case that a certain food may be risky.

Going public is the new normal for foodborne outbreaks, and some day, admin-types may catch up.

Facebook, tweets, calls to lawyers like Marler, going public is any agency’s best defense.

And it’s the right thing to do.

We’ve published about this before, and as I said at the time, I’ve had different versions of this paper running through my head for 25 years.

It started as a rebel-without-a-clue teenager, and led to questions about mad cow disease in 1995 (or earlier) when the UK government knew there were human victims but said nothing until March 1996.

Yet the job of public health, no matter how many political assholes, no matter how many impediments, and no matter how many dog bites you have to investigate, is to protect public health.

If people are barfing, it’s time to go public.

That doesn’t always happen.

Anyone can search barfblog.com under the phrase “going public” and find hundreds of incidents of people acting like shits.

But this is important shit, because credibility depends on transparency and trust and truthiness (at least in my idyllic world-view).

Public health is under siege.

The science is there, the outbreaks are there. Go public.

Or at least explain the process so the rest of us can understand.

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.

Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions.

There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.