But what does gastro mean? Outbreak hits University of Queensland students

I don’t know what it is about Australians, whether it’s some pseudo-inherited British culture of hierarchy, or just dumbness, but lately, any outbreak of barfing and pooping is called a gastro outbreak.

As in gastroenteritis.

There are microbiology labs in Australia, so figure it out, and let people know.

Janelle Miles of The Courier Mail reports 20 students at two University of Queensland residential colleges have fallen ill with gastroenteritis in the middle of orientation week.

The students are residents of King’s College and Grace College at UQ’s St Lucia campus in Brisbane’s west.

They have been quarantined separated from other students to avoid the infection spreading.

Was it foodborne? Are there any epidemiologists in Australia? Is anyone investigating?

Improving food safety, one thermometer at a time

Sorenne and I were walking home from school yesterday, sweating in the heat and humidity, and were waiting at a light with a young woman who had just got off work at an early childcare place that Sorenne used to attend.

I started up a conversation — it’s a long light – and she told me she had finished university and was taking a gap year, so had to pay the bills and was working.

I asked her what she was planning to do and she matter-of-factly said, “A PhD in clinical psychology.”

“That’s cool, I’ve got a PhD.”

“Oh, what in?”

“Food science, or food safety.”

“I remember you now. You were the parent who was always temping things with a thermometer when we had sausage sizzles.”

“Yup.”

“That was cool.”

Thanks to the barfblog.com community who has wrote back after my personal post about depression and the like.

The little things make a big difference.

Chapman, I need more thermometers.

 

Singapore: y’know, don’t hurl the contents of your stomach in public

Another serial vomiter story, this time from Coconuts Singapore, but with the risk communication tagline, “y’know, don’t hurl the contents of your stomach in public.”

The residents at Pinnacle@Duxton’s Block 1C have a whole ‘other level of revolting (and downright strange) situation to handle — piles of vomit at random places at the car park and the common area, as many as three to four times a week. The case of the serial vomiter at the Tanjong Pagar estate has gotten so bad that even the town council had to step in a few months ago with posters that say, y’know, don’t hurl the contents of your stomach in public.

According to Channel NewsAsia, the Tanjong Pagar town council received a complaint last year about the recurring problem of vomiting at the common area of that one particular block.

“Town Council put up the poster as an educational tool to deter this anti-social behavior as well as to seek residents’ assistance to contact the Town Council if they know who had committed this act,” said the town council’s vice-chairman in a typical politically correct tone to CNA.

Lettuce grazers rejoice: Consumer Reports says it’s ok to eat romaine lettuce again

Actually, it was the U.S.  Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) who jointly declared an end to the E coli O157 outbreak after nearly two months of investigation. At least 66 people across the U.S and Canada became ill, 22 were hospitalized, and 2 died during November and December, all linked to consumption of romaine lettuce.

Consumer Reports went along for the ride.

What’s been missing is any response from the leafy greens marketing agency types.

Silence – the LGMA cone of silence — is golden, I guess.

CDC announced on January 25, 2018, that this outbreak appears to be over, because the last case became ill on December 12, 2017. This indicates that the food causing illness is no longer available in the marketplace or consumers’ homes.

Although this outbreak appears to be over, the FDA’s outbreak investigation team is continuing to work with federal, state and local partners to determine what leafy greens made people ill, what people ate, where they bought it, and identify the distribution chain — all with the goal of identifying any common food or points where the food might have become contaminated. To date, no common link has been identified.

Because whole genome sequencing showed that the E. coli O157:H7 strain that resulted in the U.S. illnesses was closely related genetically to the strain that caused illnesses in Canada, the FDA and CDC have been in contact with Canadian food safety authorities throughout this outbreak.

 

Going public: US FDA version

The purpose of this guidance is to assist and provide recommendations to industry and FDA staff regarding the use, content, and circumstances for issuance of public warnings and public notifications for firm-initiated or FDA-requested recalls under 21 CFR Part 7, Subpart C – Recalls (Including Product Corrections) – Guidance on Policy, Procedures, and Industry Responsibilities.

The guidance also discusses what information should be included in a public warning, as well as the parties responsible for issuing it.

It represents FDA’s current thinking on public warning and notification of recalls under 21 CFR Part 7. 1 This guidance has been prepared by the Office of Strategic Planning and Operational Policy (OSPOP), in the Office of Regulatory Affairs (ORA), in cooperation with the Center for Biologics Evaluation and Research (CBER), the Center for Drug Evaluation and Research (CDER), the Center for Devices and Radiological Health (CDRH), the Center for Veterinary Medicine (CVM), the Center for Tobacco Products (CTP), and the Center for Food Safety and Applied Nutrition (CFSAN) at the U.S. Food and Drug Administration.

This draft guidance, when finalized, will represent the current thinking of the Food and Drug Administration (FDA or Agency) on this topic. It does not establish any rights for any person and is not binding on FDA or the public. You can use an alternative approach if it satisfies the requirements of the applicable statutes and regulations. To discuss an alternative approach, contact the FDA staff responsible for this guidance as listed on the title page.

This guidance applies to voluntary recalls of products subject to FDA’s jurisdiction, including any food, drug, and device intended for human or animal use, any cosmetic and biologic intended for human use, any tobacco product intended for human use, and any item subject to a quarantine regulation under part 21 Part 1240. However, it does not apply to radiation emitting electronics which are governed by 21 CFR Part 1003 and 1004.

In general, FDA’s guidance documents do not establish legally enforceable responsibilities. Instead, guidances describe the Agency’s current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency guidances means that something is suggested or recommended, but not required.

Public warning and notification recalls under 21 CFR part 7, subpart C guidance for industry and FDA staff, 17 January 2018

FDA

https://www.fda.gov/downloads/Safety/Recalls/IndustryGuidance/UCM592851.pdf

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.

 

The only thing certain is more uncertainty: Europe tries new uncertainty approach

The European Food Safety Authority (EFSA) has developed a harmonised approach to assessing and taking account of uncertainties in food safety, and animal and plant health. This approach will boost the transparency of the resulting scientific advice and make it more robust for decision-making.

Maybe.

The EFSA Scientific Committee guidance on uncertainty in scientific assessments offers a diverse toolbox of scientific methods and technical tools for uncertainty analysis. It is sufficiently flexible to be implemented in such diverse areas as plant pests, microbiological hazards and chemical substances.

Prof Tony Hardy, Chair of the Scientific Committee said: “Since 2016, we have tested, refined and tailored our new approach to uncertainty analysis, benefiting from open consultations with EFSA’s partners and the wider public. Crucially, we learnt a great deal about how to apply the new approach by trialling it across all EFSA’s scientific areas of activity.

The approach is described in two separate documents: a short user-friendly (says who?) guidance with practical instructions and tips, and a supporting scientific opinion with all the detailed scientific reasoning and methods.

The long-term goal is that the new guidance on uncertainty will be an integral step in all EFSA’s scientific assessments.

Prof Hans Verhagen is head of EFSA’s department for risk assessment. He said: “The trial showed that in areas like plant health, an explicit uncertainty analysis is already being used, with positive feedback from risk managers who say this helps them with their decision-making. In other areas, where uncertainty analysis is not yet integrated in the assessment process, the testing phase has helped give a clearer idea how to develop tailored approaches.”

EFSA will implement the approach in two stages. In general scientific areas, the guidance will apply from autumn 2018 after the renewal of the Authority’s scientific panels.

In regulated products areas such as pesticides, food additives or food contact materials it will be phased in later on, in light of the experience gained in the ‘non-regulated’ areas.

In parallel, EFSA is developing practical guidance for communication specialists on how to communicate the results of uncertainty analysis to different target audiences, including the public. A public consultation will be held on a draft of the communication approach in 2018.

Others have been working on this for 40 years. When the goal is public health – so more people don’t barf – we already know it’s better to go public early and oftern.

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.

‘Something will always be somebody’s last meal’ Does it have to be today?

My favorite food safety fairytale is along the lines of, we’ve always produced food this way and no one has ever gotten sick.

Because bugs don’t change, food don’t change, people don’t change.

Raw oysters, the renowned aphrodhsiac, is especially prone to fairytale hyperbole.

Delayna Earley of the Island Packet in South Carolina, writes, who doesn’t love a good oyster roast?

“I’ve been doing this all my life and we’ve never had a case of anyone dying from eating an oyster,” Larry Toomer, owner of the Bluffton Oyster Co., said. “We know where our oysters came from because we harvest them, refrigerate them ourselves and then cook them shortly after.”

Toomer says that there is always a risk when consuming any raw food, but the oysters that are harvested off the coast of the Low country typically don’t have bacteria due cleansing nature of the tidal waters they grow in.

“Something will always be somebody’s last meal,” Toomer says. “If you’re immune system is not up to snuff you shouldn’t eat anything raw, whether that is an oyster, or burger or any other type of meat, but something is going to set you off if you’re already sick. But other than that, we shouldn’t worry too much.”

36 sick: Lactalis offers salmonella compensation, French government says probe continues

We’re in New Caledonia for Amy to do some French professoring stuff, with the Calgary-Carolina hockey game on in the background on a sports channel from France.

I went for a walk along the ocean this morning, sans Ted, which is the extent of my French.

While I’m surrounded by the beauty of this Pacific island, the Lactalis mess in France continues a downslide into parody (except for the sick kids and their families).

According to Reuters, France welcomed dairy group Lactalis’ pledge to compensate victims of a Salmonella contamination in its baby milk on Sunday, but said a judicial investigation to determine who was responsible would continue.

Lactalis Chief Executive Emmanuel Besnier told the weekly Journal du Dimanche his family company, one of the world’s biggest dairies, would “pay damages to every family which has suffered a prejudice.”

Is prejudice French for barfing?

Salmonella infections can be life-threatening and the families of three dozen children who have fallen sick in France as a result of the contaminated baby milk have announced a raft of lawsuits.

Besnier’s promise came two days after Lactalis widened a product recall to cover all infant formula made at its Craon plan, regardless of the manufacture date, in a bid to contain the fallout from a health scare that risks damaging France’s strategic agribusiness in overseas markets.

“Paying compensation is good, but money cannot buy everything,” government spokesman Benjamin Griveaux said in an interview on BFM TV.

The health scare intensified last week after France’s biggest retailers including Carrefour, Auchan and Leclerc admitted products recalled in December had still found their way onto shelves.

“It is the job of the investigation to determine where failings occurred and who is to blame,” Griveaux said, adding that “responsibilities were shared.”

Implementing the global recall will be challenging. Privately owned Lactalis, one of the world’s biggest dairies, exports its baby food products to 83 countries across Europe, Africa and Asia.

The recall involves some 12 million tins of baby milk.

“It’s not easy to evaluate the number of items that need to be returned because we don’t know what’s been consumed already,” Besnier said in a rare newspaper interview published on Sunday.

Friday’s recall was the third in a month and Lactalis has come under fire for its clumsy response. Besnier also told the French weekly that the company had acted as quickly and efficiently as possible and denied slowing the process to curb losses.

Besnier has also been criticized for failing to speak out publicly during the salmonella scare.

While his family are France’s 11th wealthiest, according to a 2017 ranking by Challenges magazine, the dairy tycoon has long shunned the public limelight and schmoozing with politicians.

His workers nickname him the “invisible man.”

“We’re a discreet business. In this region there is a mentality of ‘work first, speak later,” he said. But he acknowledged lessons had been learned during the past few weeks.

Lactalis has become an industry giant, with annual sales of 17 billion euros ($20.73 billion) and 18,900 employees across some 40 countries.


 

Confused consumers: Canadians say E. coli in romaine outbreak is over; U.S. says it’s leafy greens

Outbreaks of foodborne illness are fraught with uncertainties.

It’s OK to admit, to do the best with the info available, and get on with things.

On January 10, 2018, the Public Health Agency of Canada reported that an outbreak of Shiga toxin-producing E. coli O157:H7 infections (STEC O157:H7) they had identified was linked to romaine lettuce appears to be over.

As of January 10, 2018, there were 42 cases of E. coli O157 illness reported in five eastern provinces. Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died.

In the United States, the Centers for Disease Control, several states, and the U.S. Food and Drug Administration continue to investigate a multistate outbreak of 24 STEC O157:H7 infections in 15 states. Since CDC’s initial media statement on December 28, seven more illnesses have been added to this investigation. The last reported illness started on December 12, 2017.

The likely source of the outbreak in the United States appears to be leafy greens, but officials have not specifically identified a type of leafy greens eaten by people who became ill.  Leafy greens typically have a short shelf life, and since the last illness started a month ago, it is likely that contaminated leafy greens linked to this outbreak are no longer available for sale. Canada identified romaine lettuce as the source of illnesses there, but the source of the romaine lettuce or where it became contaminated is unknown.

Whole genome sequencing (WGS) showed that the STEC O157:H7 strain from ill people in the United States is closely related genetically to the STEC O157:H7 strain from ill people in Canada. WGS data alone are not sufficient to prove a link; health officials rely on other sources of data, such as interviews from ill people, to support the WGS link. This investigation is ongoing. Because CDC has not identified a specific type of leafy greens linked to the U.S. infections, and because of the short shelf life of leafy greens, CDC is not recommending that U.S. residents avoid any particular food at this time.

In the United States, a total of 24 STEC O157:H7 infections have been reported. Among the 18 ill people for whom CDC has information, nine were hospitalized, including one person in California who died. Two people developed hemolytic uremic syndrome, a type of kidney failure.

The Public Health Agency of Canada identified romaine lettuce as the source of the outbreak in Canada. In the United States, the likely source of the outbreak appears to be leafy greens, but health officials have not identified a specific type of leafy greens that sick people ate in common.

State and local public health officials continue to interview sick people in the United States to determine what they ate in the week before their illness started. Of 13 people interviewed, all 13 reported eating leafy greens. Five (56%) of nine ill people specifically reported eating romaine lettuce. This percentage was not significantly higher than results from a survey of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed.  Based on this information, U.S. health officials concluded that ill people in this outbreak were not more likely than healthy people to have eaten romaine lettuce.  Ill people also reported eating different types and brands of romaine lettuce. Currently, no common supplier, distributor, or retailer of leafy greens has been identified as a possible source of the outbreak. CDC continues to work with regulatory partners in several states, at the U.S. Food and Drug Administration, and the Canadian Food Inspection Agency to identify the source.

Although the most recent illness started on December 12, there is a delay between when someone gets sick and when the illness is reported to CDC. For STEC O157:H7 infections, this period can be two to three weeks. Holidays can increase this delay. Because of these reporting delays, more time is needed before CDC can say the outbreak in the United Stated is over. This investigation is ongoing.

58 sick, 2 dead, possible link to romaine lettuce

Over the past seven weeks, 58 people in the U.S. and Canada have become ill and two have died from E. coli O157H7, linked by Canadians to romaine lettuce, probably grown in California, given the timing of illnesses.

On Dec. 11, 2017, the Public Health Agency of Canada did its public duty and notified Canadians that at least 21 people were sick with E. coli O157:H7 and the probable source was romaine lettuce.

A couple of retailers in Canada pulled all romaine lettuce from the shelves, but the others shrugged and said, not enough is known.

By Dec. 28, 2017, the Canadian numbers had jumped to 41 sick and one dead, and the U.S. Centers for Disease Control chimed in to say there were 17 sick in the U.S. with a similar strain but they wouldn’t say it was linked to romaine lettuce, with the Trumpesque language of “CDC is unable to recommend whether U.S. residents should avoid a particular food.”

Outbreaks are hard, but where’s the tipping point between protecting public health and protecting a commodity and all the growers, retailers, involved?

Everyone went off and enjoyed New Year’s, and then people woke up again on Jan. 2, 2018 (happy new year), to be told by the Toronto Star (that’s in Canada) that of the 17 U.S. cases, five people have been hospitalized, one of whom has died. Two have developed hemolytic uremic syndrome.

That’s 58 sick and two dead.

On Jan. 3, 2018, Trisha Calvo of Consumer Reports wrote the group’s food safety types advise “consumers stop eating romaine lettuce until the cause of the outbreak is identified and the offending product is removed from store shelves.”

“Even though we can’t say with 100 percent certainty that romaine lettuce is the cause of the E. coli outbreak in the U.S., a greater degree of caution is appropriate given that lettuce is almost always consumed raw,” says James Rogers, Ph.D., director of food safety and research at Consumer Reports.

“There is not enough epidemiologic evidence at this time to indicate a specific source of the illnesses in the United States,” says Brittany Behm, MPH, a CDC spokesperson. “Although some sick people reported eating romaine lettuce, preliminary data available at this time shows they were not more likely than healthy people to have eaten romaine, based on a CDC food consumption survey.” Health officials, Behm says, take action when there is clear and convincing information linking illness to a contaminated food.

“The FDA should follow the lead of the Canadian government and immediately warn the public about this risk,“ said Jean Halloran, Director of Food Policy Initiatives at Consumers Union, the policy and mobilization division of Consumer Reports.

“The available data strongly suggest that romaine lettuce is the source of the U.S. outbreak,” she says. “If so, and people aren’t warned, more may get sick.”

That got attention, and many media outlets chimed in.

barfblog.com’s Ben Chapman told Rachael Rettner of Live Science that, “[To] say ‘avoid romaine for now,’ I don’t know if I have enough information to agree with that statement,”  Benjamin Chapman, an associate professor and food safety specialist at North Carolina State University.

“Avoiding just romaine may or may not be enough,” because other lettuces or foods could also be affected, Chapman told Live Science. “It could be that there’s a different [food] source of this exact same pathogen,” he said.

Another possibility is that the E. coli strain causing illness in the United States is actually slightly different from the strain in Canada. “We could be looking at two different outbreaks at the same time,” Chapman said.

About four times a day I’ll get a tweet from the Leafy Green Marketing Agreement – the folks who set themselves up after the spinach outbreak of E. coli O157:H7 in 2006 that killed four and sickened 200 – blowing themselves about how great they are, and how their products are so safe.

If you want that kind of PR, then you have to take the hits as well.

LGMA never talks about an outbreak linked to leafy greens (publicly).

To me, they’ve succeeded best at lowering the leafy greens cone of silence and intimidating public health types into delaying reports of outbreaks.

But late on Jan. 4, 2018, LGMA finally made a public statement, below, with my comments.

A group of produce industry associations today issued the following statement to update consumers on a recent e.coli outbreak being investigated in Canada in the U.S.:

It’s E coli. You folks should be well-versed in that.

The U.S. Centers for Disease Control and Prevention has not identified what food likely caused this foodborne illness.  No public agency has contacted any Romaine lettuce grower, shipper or processor and requested that they either stop shipping or recall product already in the marketplace.

Defensive.

Even if this outbreak is actually confirmed to be caused by Romaine lettuce, it’s important to recognize this is a highly perishable product with a limited usable shelf life and it’s highly unlikely a specific affected lot would still be available for sale or in a home refrigerator with the last U.S. illness being reported on December 8th.

Carry on, it’s all gone.

Food safety remains a top priority of leafy greens farmers, shippers and processors and the industry has robust food safety programs in place that incorporate stringent government regulatory oversight.

The Pinto defense. Audits and inspections are never enough, and saying we have government oversight does nothing to build trust with the consuming public, as research shows.

Our leading produce industry associations have and will continue to cooperate fully with public health officials investigating this foodborne illness outbreak.

Play nice in the sandbox.

Anytime we see an outbreak of any foodborne illness, our hearts go out to the victims.

This is what you should have led with. Now it reads like a tack-on.

If the leafy green marketing folks want to be truly transparent, they will make actual inspection data public for mere mortals to review, they will market microbial food safety at retail, and stop stonewalling every time there is an outbreak linked to leafy greens.

I have lots of respect for individual farmers who make a go of it and produce the bounty of produce we enjoy.

I have no respect for self-serving associations with bad soundbites.

A table of leafy green related outbreaks is available at http://www.barfblog.com/wp-content/uploads/2018/01/lettuce-leafy-greens-outbreaks-table-_1-5-18.xlsx