My daughter calls me flyslayer: I can’t stand flies, but are they a food service risk?

For decades, various food safety-types have debated the role of flies in the transmission of disease in food service settings, and more importantly, the significance.

Now that we live in an old distinguished house in Brisbane, and in every other place we’ve lived close to downtown (CBD) we know screens are an afterthought.

And maybe I’m an OK cook, because every time I start slicing and dicing, the flies converge, if the windows are open.

So we got central air installed – Brisbane breezes be damned – and keep the windows closed, yet I still go about my daily slaughter of about 50 flies.

Researchers at Penn State Eberly College of Science have found house flies carry salmonella, E. coli and even bacteria, which can lead to stomach ulcers and fatal sepsis.

The research, published in Scientific Reports, says flies may have been overlooked by public health officials as a source of disease outbreaks.

The paper found that flies legs transferred most of the microbial organisms from one surface to another, suggesting even a brief step onto food could leave behind bacteria.

Flies in urban areas were found to carry more bacteria than rural flies, with the scientists suggesting to avoid city parks for picnics and, instead, eating food in more rural locations.

The study suggests flies pick up the bacteria from faeces and decaying organic matter, which they use to nurture their young.

”People had some notion that there were pathogens that were carried by flies, but had no idea of the extent to which this is true and the extent to which they are transferred.” said Dr Donald Bryant, Professor of Biotechnology at Penn State University.

“We believe that this may show a mechanism for pathogen transmission that has been overlooked by public health officials.”

Less food poisoning associated with employee paid sick time?

I refer to parenting as hypocrisy disease.

And there’s been more than a few times when Amy has said to me, practice what you preach.

Like barfing and going to work.

People should not work when they are sick.

But in the world of food, people are going to lose their jobs if they don’t show up.

Hsuan et al. write in the American Journal of Preventative Medicine that:

Previous studies suggest an association between paid sick leave (PSL) and better population health, including fewer infectious and nosocomial gastrointestinal disease outbreaks. Yet few studies examine whether laws requiring employers to offer PSL demonstrate a similar association. This mixed-methods study examined whether laws requiring employers to provide PSL are associated with decreased foodborne illness rates, particularly laws that are more supportive of employees taking leave.

Methods:

The four earliest PSL laws were classified by whether they were more or less supportive of employees taking leave. Jurisdictions with PSL were matched to comparison jurisdictions by population size and density. Using difference-in-differences, monthly foodborne illness rates (2000-2014) in implementation and comparison jurisdictions before and after the laws were effective were compared, stratifying by how supportive the laws were of employees taking leave, and then by disease. The empirical analysis was conducted from 2015-2017.

Results:

Foodborne illness rates declined after implementation of the PSL law in jurisdictions with laws more supportive of employees taking leave, but increased in jurisdictions with laws that are less supportive. In adjusted analyses, PSL laws that were more supportive of employees taking sick leave were associated with an adjusted 22% decrease in foodborne illness rates (p=0.005). These results are driven by campylobacteriosis.

Conclusions:

Although the results suggest an association between more supportive PSL laws and decreased foodborne illness rates, they should be interpreted cautiously because the trend is driven by campylobacteriosis, which has low person-to-person transmission.

Association of paid sick leave laws with foodborne illness rates

Am J Prev Med. 2017 Sep 1. pii: S0749-3797(17)30359-8. doi: 10.1016/j.amepre.2017.06.029. [Epub ahead of print]

Hsuan C, Ryan-Ibarra S, DeBurgh K, Jacobson DM

https://www.ncbi.nlm.nih.gov/pubmed/28870665

With all the dirt and the grease and the gunk: Handwashing better than sanitizers in food service

Hands can be a vector for transmitting pathogenic microorganisms to foodstuffs and drinks, and to the mouths of susceptible hosts.

handwashing.loadsHand washing is the primary barrier to prevent transmission of enteric pathogens via cross-contamination from infected persons. Conventional hand washing involves the use of water, soap, and friction to remove dirt and microorganisms. The availability of hand sanitizing products for use when water and soap are unavailable has increased in recent years. The aim of this systematic review was to collate scientific information on the efficacy of hand sanitizers compared with washing hands with soap and water for the removal of foodborne pathogens from the hands of food handlers.

An extensive literature search was carried out using three electronic databases: Web of Science, Scopus, and PubMed. Twenty-eight scientific publications were ultimately included in the review. Analysis of this literature revealed various limitations in the scientific information owing to the absence of a standardized protocol for evaluating the efficacy of hand products and variation in experimental conditions. However, despite conflicting results, scientific evidence seems to support the historical skepticism about the use of waterless hand sanitizers in food preparation settings.

Water and soap appear to be more effective than waterless products for removal of soil and microorganisms from hands. Alcohol-based products achieve rapid and effective inactivation of various bacteria, but their efficacy is generally lower against nonenveloped viruses. The presence of food debris significantly affects the microbial inactivation rate of hand sanitizers.

Efficacy of instant hand sanitizers against foodborne pathogens compared with hand washing with soap and water in food preparation settings: A systematic review

Journal of Food Protection®, Number 6, June 2016, pp. 896-1055, pp. 1040-1054(15)

Foddai, Antonio C. G.; Grant, Irene R.; Dean, Moira

http://www.ingentaconnect.com/contentone/iafp/jfp/2016/00000079/00000006/art00020

Typhoid fever spread from asymptomatic restaurant worker in Colorado

On September 11, 2015, a single case of typhoid fever, caused by Salmonella Typhi infection, was reported to the Colorado Department of Public Health and Environment (CDPHE).

symptoms_of_typhoid_feverBecause the patient (patient A) had symptom onset September 2 and had traveled internationally for 4 days 60 days before symptom onset, the case initially was thought to be travel-associated* (1,2).

On October 1, a second case of S. Typhi infection was reported in patient B, with symptom onset September 20. Patient B reported no international travel or contact with ill persons or known carriers. Patients A and B resided approximately 6 miles (10 kilometers) apart and had no discernible epidemiologic connection. Family members of patients A and B tested negative for S. Typhi. CDPHE and the Weld County Department of Public Health and Environment (WCDPHE) investigated to 1) determine whether these cases represented a larger outbreak, 2) identify common exposure sources, and 3) stop transmission. Investigators determined that the typhoid fever in both patients and in a third patient (patient C) was associated with eating in the same restaurant during a 5-day period.

CDPHE defined a case of typhoid fever as clinically compatible illness with isolation of S. Typhi during July 1–October 15 and identification of an isolate with one of two pulsed-field gel electrophoresis (PFGE) outbreak patterns that differed by one band. A carrier was defined as a person who had contact with patients, reported no recent illness, and had S. Typhi with either of the PFGE outbreak patterns in an isolate from a rectal swab or stool specimen. Case finding included searching PulseNet for other isolates that might have been associated with the Colorado cases (3). On October 13, CDPHE issued a health alert notification to clinicians, local public health authorities, and laboratories to be vigilant for additional cases and to encourage reporting. During October 1–9, CDPHE and WCDPHE used the Salmonella National Hypothesis Generating Questionnaire (4), credit card receipts, food recall, shopper card records, and social media to identify potential exposures shared by patients A and B during the 60 days preceding symptom onset. Investigators found that the two patients had fresh produce purchases from the same grocery stores and had six common restaurant exposures.

On October 19, CDPHE was notified of a third Weld Country resident who had tested positive for S. Typhi infection. Patient C had symptom onset September 15 and reported no recent travel or relation to patient A or B. Patient C was interviewed using the Salmonella questionnaire, and credit card receipts were reviewed. Patient C did not shop at the same grocery stores as patients A or B, but all three patients had eaten at restaurant A during August 16–20, 2015. Patients A and C were hospitalized. Isolates from patients B and C had indistinguishable PFGE patterns (pattern 2), and the isolate from patient A had a 1-band difference (pattern 1), which met the PFGE outbreak definition.

s.typhi.symptomsCDPHE hypothesized that a chronic S. Typhi carrier might be working in food service at restaurant A, where food is prepared using fresh ingredients. Possible transmission routes were investigated through environmental assessments and staff interviews; food service staff members were asked to be tested for S. Typhi. Environmental assessments performed on October 27 found no deficiencies in hand hygiene or other food handling issues. Administrators from restaurant A provided a list of all current and former employees who worked in food handling during August 10–August 20, 2015. These more conservative dates were chosen because food might have been served as many as 4 days after preparation, and because of concerns regarding the accuracy of credit card statement dates.

On October 28, current restaurant employees were confidentially interviewed at a local clinic by CDPHE and WCDPHE regarding international travel, symptoms, and work tasks. Because bacterial shedding can be intermittent, employees were requested to collect rectal swab specimens from themselves on October 28 and November 3 for culture and PFGE testing of isolates. All employees were allotted paid time to be interviewed and provide specimens. By October 29, a total of 28 (100%) current employees had responded and provided one or more rectal swab specimens. On October 30, CDPHE was notified by the state health laboratory that S. Typhi had been isolated from one employee. The isolate’s PFGE pattern was indistinguishable from outbreak pattern 1, the pattern of patient A.

Interviews with the infected restaurant worker revealed travel to a country with endemic typhoid fever 15 years earlier, but no recent symptoms, and no contact with any ill persons. The worker was excluded from food service work, treated with azithromycin for 28 days, and monitored with stool testing until three consecutive specimens obtained ≥1 month apart were negative for S. Typhi (2). Restaurant A agreed to keep the worker’s job open and allow him to return to work once he was no longer a carrier.

Typhi infection is a nationally notifiable condition; in Colorado, reporting is required within 24 hours of case detection. Notable clinical symptoms of typhoid fever include insidious onset of fever, and headache, constipation, chills, myalgia, and malaise (1). Unlike other Salmonella species, S. Typhi does not commonly cause diarrhea, and vomiting typically is not severe (1).

Typhi infection is endemic in many low-income countries; an estimated 22 million cases and 200,000 deaths occur each year (2). In the United States, approximately 5,700 cases of typhoid fever are reported annually; the majority occur among travelers (1). In Colorado during 2009–2014, on average, six cases of confirmed typhoid fever were reported annually; all cases were associated with international travel or attributed to a household member or close contact with a carrier. Humans are the only reservoir for S. Typhi; disease is transmitted via the fecal-oral route, typically by contaminated food or water. Chronic carriage occurs in 2%–5% of cases (1,2), and shedding of S. Typhi in chronic carrier stools can be intermittent.

This investigation highlights the potential for chronic S. Typhi carriers to cause illness in other persons, even years after infection. When cases of typhoid fever not associated with travel are detected, rapid and thorough interviewing is essential. Social media posts and credit card receipts to detect common exposures can be useful. The high cooperation rate among workers at the restaurant, which is rare in foodborne outbreak investigations, was attributed to the restaurant’s support and accommodation, demonstrating the importance of collaboration among local public health, state public health, public health laboratories, patients, and industry for successful investigations.

Typhoid fever outbreak associated with an asymptomatic carrier at a restaurant ― Weld County, Colorado, 2015

MMWR Morb Mortal Wkly Rep 2016;65:606–607. June 2016, DOI: http://dx.doi.org/10.15585/mmwr.mm6523a4.

Jessica Hancok-Allen, Alicia B. Cronquist, JoRene Peden, Debra Adamson, Nereida Corral, Kerri Brown

http://www.cdc.gov/mmwr/volumes/65/wr/mm6523a4.htm?s_cid=mm6523a4_x

E. coli hitching a ride in healthy Japanese food handlers

The actual state of intestinal long-term colonization by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in healthy Japanese people remains unclear. Therefore, a total of 4,314 fecal samples were collected from 2,563 food handlers from January 2010 to December 2011.

tokyo-japan-shibuya-tokyu-food-show-depachika-600Approximately 0.1 g of each fecal sample was inoculated onto a MacConkey agar plate containing cefotaxime (1 μg/ml). The bacterial colonies that grew on each plate were checked for ESBL production by the double-disk synergy test, as recommended by the Clinical and Laboratory Standards Institute. The bacterial serotype, antimicrobial susceptibility, pulsotype, sequence type (ST), and ESBL genotype were checked, and the replicon types of plasmids harboring the ESBL gene were also determined after conjugation experiments.

ESBL producers were recovered from 70 (3.1%) of 2,230 participants who were checked only once. On the other hand, ESBL producers were isolated at least once from 52 (15.6%) of 333 participants who were checked more than twice, and 13 of the 52 participants carried ESBL producers for from more than 3 months to up to 2 years. Fluoroquinolone (FQ)-resistant E. coli strains harboring blaCTX-M were repeatedly recovered from 11 of the 13 carriers of blaCTX-M-harboring E. coli. A genetically related FQ-resistant E. coli O25b:H4-ST131 isolate harboring blaCTX-M-27 was recovered from 4 of the 13 carriers for more than 6 months. Three FQ-resistant E. coli O1:H6-ST648 isolates that harbored blaCTX-M-15 or blaCTX-M-14 were recovered from 3 carriers. Moreover, multiple CTX-M-14- or CTX-M-15-producing E. coli isolates with different serotypes were recovered from 2 respective carriers.

These findings predict a provable further spread of ESBL producers in both community and clinical settings.

Long-term colonization by blaCTX-M-harboring Escherichia coli in healthy Japanese people engaged in food handling

Applied and Environmental Microbiology; March 2016; vol. 82; no. 6; 1818-1827

Kunihiko Nakane, Kumiko Kawamura, Kensuke Goto and Yoshichika Arakawa

http://aem.asm.org/content/82/6/1818.abstract?etoc

Republican senator says restaurants should be able to opt-out of mandatory handwashing

As Republican presidential hopefuls like Rand Paul and Chris Christie fall over themselves to claim the live-free-or-die vote by saying vaccinations should be optional, North Carolina Senator Thom Tillis has gone further: laws requiring mandatory handwashing by food service employees are just regulatory burden.

handwashing.sep.12According to Daily Kos, Tillis made the declaration at the Bipartisan Policy Center, at the end of a question and answer with the audience. He was relaying a 2010 anecdote about his “bias when it comes to regulatory reform.”

“I was having a discussion with someone, and we were at a Starbucks in my district, and we were talking about certain regulations where I felt like ‘maybe you should allow businesses to opt out,’” he said, “as long as they indicate through proper disclosure, through advertising, through employment literature, or whatever else.”

Restaurants can just opt-out and let the free market take care of business after word spreads of unsanitary conditions.

“That’s the sort of mentality that we need to have to reduce the regulatory burden on this country,” he added. “We’re one of the most regulated nations in the history of the planet.”

Bipartisan Policy Center President Jason Grumet joked that he was “not sure” he would shake Sen. Tillis’ hand when the discussion was over, causing the lawmaker and members of the audience to laugh.

20 sickened at Subway: Colorado norovirus outbreak in BV serves as warning

Local health officials said they hope a norovirus outbreak in Buena Vista that left approximately 20 people ill in mid-November will serve as a reminder to area restaurants and food providers to be extra cautious.

norovirusThe Mountain Mail reports Chaffee County Public Health received complaints from five people saying they were ill after eating food from the Subway in Buena Vista, according to a restaurant inspection report.

Lab tests on samples from the five individuals all tested positive for norovirus.

Public Health estimates roughly 20 people, mostly students at Buena Vista High School, might have fallen ill in the outbreak.

An investigation by Chaffee County Environmental Health Manager Victor Crocco, who declined to name the restaurant, found that one employee reported feeling ill the day after the illness was originally reported.

Subway manager Brandon Alexander said he did not recall any of the employees being sick around the time of the outbreak.

Crocco’s investigation led him to conclude a sick employee, and not a larger food contamination, most likely caused the contamination.

Alexander said he doesn’t remember anything like this happening in his 8 years at the restaurant.

Training fail: Cheating the health card system in Vegas

When you go out to eat, what stands between you and food poisoning?

large_spaceyTonight, in a special Dirty Dining report, Contact 13 uncovers a loophole in the food safety system.

As Chief Investigator Darcy Spears learned, some of the people preparing your food may not be prepared to keep you safe.

“It was a wake-up call, especially for the employees,” said Mark Green when his restaurant, Kahunaville at TI, was on Dirty Dining in October.

“He was hired very new and so… he didn’t know,” said Vanessa Nguyen of Pho Bosa in another October Dirty Dining report.

And in September, Min Yoon of Kaizen Fusion Roll and Sushi said, “It’s incompetence.  I understand that.”

Week after week, that’s what we hear from restaurant owners and managers whose eateries are downgraded or closed for failing to protect public health.

But whether they’re featured on Dirty Dining or not, our investigation found local restaurants may be vulnerable to a loophole in the system.

Darcy Spears: Is this a system that’s ripe for fraud?
County Commissioner Chris Giunchigliani/Board of Health: It is a system that probably could be used fraudulently.

Contact 13 discovered it has.

The Health District certifies first-time restaurant workers in the form of a food handler safety training card.

“So that when they get to the workplace, they are ready and set to work,” explained SNHD Environmental Health Director Jackie Reszetar.

But at Wo Hing during the restaurant’s first inspection this month, they were nearly shut down due to unsafe food handling.

Darcy Spears: Did they have training from the Health District?  They have their food card, right?


Sam Lee/Wo Hing: Yeah, yeah.

Jonh Dang of Vietnamese bistro Nem Nuong says the training is flawed.

Jonh Dang: I fired a lot of people.


rainman.counting.cardsDarcy Spears: You had to fire like 20 people for defrauding the food card program?


Jonh: Yeah, they supposed to know what they doing.  You know?

The problem with the system is that there are no checks and balances. 

There’s nothing to prevent one person from stepping in and answering the test questions for another.

To get the card, you just need a test completion certificate, identification and $40.

Darcy Spears: What does that suggest to you?


Jackie Reszetar: That suggests that we have to have a better check system.

County Commissioner Chris Giunchigliani sits on the Board of Health, which oversees the Health District.

Darcy Spears: What safeguards are there in place right now to make sure that the person who goes on the computer is the person who goes to pick up the card and takes the picture?


Chris Giunchigliani: To my knowledge, I don’t know that they have that safeguard because they can do it from home, they can do it from a library.

The Health District issues more than 100-thousand food handler cards each year.

So how many instances of cheating have they documented?

“We don’t want the numbers out there,” Chua said.  “We don’t want anything out there because one person, one instance is too much.”

It was the waitress; 23 sick with Norovirus at Minn. Lion’s Club

A recently ill waitress was the likely source that caused about two dozen people to get sick after eating at a Nisswa Lion’s Club meeting, the Minnesota Department of Health (MDH) found.

brainerdThe March 24 Lion’s club meeting was held at the Nisswa Community Center, but was catered by Red, White and Blue Catering, which operates from the Nisswa American Legion.

An investigation by MDH showed that 23 people became ill with vomiting and diarrhea after the dinner meeting.

The symptoms of the illness lasted between seven to 115 hours for those affected, the department of health found. Other symptoms included cramps, fever and bloody stools.

Two people sought medical attention at a clinic and one was seen at an emergency room. No one was hospitalized.

Dan Bridge, owner of Red, White and Blue Catering, the waitress’ employer, said the incident is the first in the three decades he’s been operating the business.

“We try to do all we can to keep it from happening,” he said. “And it never does, except for this. It’s unfortunate. It just happened.”

Disappointed by the incident, Bridge says something like this “takes fun out of cooking.”

In MDH’s investigation, health officials determined that 23 people were sick, not the original six that first reported symptoms.

At the Lion’s club meeting, 35 people ate the buffet-style meal, which included pork chops, lettuce salad, potato salad, calico beans, rolls, butter and brownies.

But “no food item was significantly associated with illness,” the MDH said.

The waitress reported being sick with vomiting and diarrhea on March 19 and recovered on March 20.

She returned to work on March 21, where she plated salads and specials for the restaurant. On March 24, she prepared the salad for the Lion’s Club event.

The waitress tested positive for norovirus GII, the MHD said.

‘You just feel like you’re dying’ Food handlers cause 70% of norovirus outbreaks

Sunday has become hockey day.

It’s winter in Brisbane, and the locals are wearing parkas and Uggs as daytime temperatures struggle to climb above 80F.

doug.sorenne.hockey.apr.14On Sunday June 25, I was getting ready to take 5-year-old daughter Sorenne to weekly hockey practice when I promptly barfed after breakfast.

“But I’m the coach, I have to go.”

Amy the wife said, how can you preach that food workers shouldn’t show up to work sick when you won’t do it yourself?

She was right.

I stayed home.

The ice hockey world didn’t end (and I went and awesomely coached three hours of practice and games the next Sunday).

I realize the limitations when I, or the U.S Centers for Disease Control, tell the world, sick workers shouldn’t work. Economics and pride get in the way.

Liz Szabo writes in today’s USA Today that norovirus, the USA’s leading cause of foodborne illness, has become known as the “cruise ship virus” for causing mass outbreaks of food poisoning – and misery – on the high seas. Yet only about 1% of all reported norovirus outbreaks occur on cruise ships.

It might be more accurate to call it the “salad bar virus,” and not because customers are sneezing on the croutons.

But food handlers, such as cooks and waiters, cause about 70% of norovirus outbreaks related to contaminated food, mostly through touching “ready to eat” foods – such as sandwiches or raw fruit – with their bare hands, according to a new report from Centers for Disease Control and Prevention. More than 90% of contamination occurred during food preparation, and 75% of food involved in outbreaks was consumed raw.

Business practices in the food industry may contribute to the problem.

One in five restaurant workers admits having reported to work while sick with diarrhea and vomiting – the two main symptoms of norovirus – within the past year, the CDC says.

About 20 million Americans are sickened with norovirus every year, with a total of 48 million suffering food poisoning from all causes. The highly contagious family of viruses also causes up to 1.9 million doctor visits; 400,000 emergency room visits; up to 71,000 hospitalizations; and up to 800 deaths, mostly in young children or the elderly. Infections cost the country $777 million in health care costs.

norovirus-2Norovirus is wildly contagious.

As few as 18 viral particles can make people sick. In other words, a speck of viruses small enough to fit on the head of pin is potent enough to infect more than 1,000 people, according to the CDC report, released Tuesday. The virus can spread rapidly in close quarters, as well, such as dormitories, military barracks and nursing homes.

“Norovirus is one tough bug,” said CDC director Thomas Frieden.

Norovirus can make people violently ill so quickly that they don’t have time to reach a bathroom, says Doug Powell, a food safety expert in Brisbane, Australia, and author of barfblog.com. People who get sick in public often expose many others. Norovirus also can live on surfaces, such as countertops and serving utensils, for up to two weeks (I’m told it’s up to six weeks, which is why I always refer journalists to others more knowledgable about certain topics instead of talking out of my ass).

Norovirus is also the Terminator of germs — very tough to kill. Alcohol-based hand sanitizers don’t work very well, says Lee-Ann Jaykus, a professor of food science at North Carolina State University. That makes frequent handwashing important.

But even cooking may not kill noroviruses, which can survive the freezer and cooking temperatures above 140 degrees, the CDC says.

CDC recommends that restaurants offer paid sick leave and require food workers to stay home when sick, remaining out of work for at least 48 hours after symptoms cease. Restaurants should train their staffs well and have on-call workers who can fill in for sick co-workers. Lastly, restaurants should require food handlers to use disposable gloves and wash their hands frequently.

That may be easier said than done, says Powell, who notes that few restaurant workers today get paid sick leave. Many earn minimum wage and can’t afford to miss work. Others fear being fired if they call in sick.

Some restaurants are doing more than others, Jaykus says. “The large retailers are well-aware (of norovirus) and working very hard,” Jaykus says. “Smaller restaurants have, of course, fewer resources.”

The only good news about norovirus?

Scientists are working on a vaccine, although it’s in early stage.

And norovirus is less serious than other foodborne germs, such as salmonella, E. coli and listeria, all of which have led to recalls of fresh and frozen produce in recent years, Powell says. Although norovirus can sicken people for two to three days, it’s not usually fatal.

“You just feel like you’re dying,” Powell says.

The full CDC report is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0603a1.htm?s_cid=mm63e0603a1_e.

norovirus.prevention.fda.14