I’m a doctor and I joined The Doctors to talk food safety

I don’t ask anyone to call me doctor; I find it a bit awkward and pretentious.

I guess the title matters to some folks. So much so that it’s the basis for a nationally syndicated talk show produced by another doctor, Dr. Phil. Today, an episode I taped with the good doctors about a month ago aired.

We talked oysters, sprouts, raw milk and undercooked beef for a few minutes. I got my plug in for using a thermometer (although I think I erroneously said meat instead of beef).

I tried not to look too goofy (not sure I accomplished that).

My face isn’t always washed out but I ended up doing the interview via Skype from my home office (with an antique Hespeler hockey stick in the background), in direct afternoon sunlight, instead of my planned location of a campus office. The locale change was due to the 5” of snow that hit Raleigh the day before. I wasn’t driving anywhere with the NC snow-excited drivers.

I’m also not the creator of Barf Blog. I just happen to host the barfblog collective. And contribute to it sometimes.

Oh well, can’t get it all right, but food safety made it into a couple of million homes this afternoon.

But there’s no way the segment was as impactful as the one previous to mine – it was about farting at the gym.

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.

 

Salmon sushi: 5.6′ tapeworm excreted by California man

Raw can be risky.

Including raw fish used to make sushi, especially if it is not frozen at sea.

Following up my chat with daughter Sorenne while strolling around Noumea, New Caledonia last week, a Fresno man with a daily sushi habit had a 5.5-foot tapeworm lodged in his intestines. He pulled it out himself, wrapped it around a cardboard toilet paper tube and carried the creature into Fresno’s Community Regional Medical Center.

Michelle Robertson, a San Francisco Gate staff writer, reports that Kenny Banh was the lucky doc on shift at the time. He recounted his experience on a recent episode of the podcast “This Won’t Hurt A Bit.”

Banh said the patient complained of “bloody diarrhea” and expressed a desire to get treated for tapeworms.

“I get asked this a lot,” the doctor said. “Truthfully, a lot of times I don’t think they have it.”

This man had it, which he proved to Banh by opening a plastic grocery bag and pulling out the worm-wrapped toilet paper tube.

Banh then asked some questions, starting with: “That came out of your bottom?”

“Yes.”

According to the doctor’s retelling, the patient was using the restroom when he noticed what looked like a piece of intestine hanging out of his body.

 “He grabs it, and he pulls on it, and it keeps coming out,” Banh recounted. He then picks the thing up, “looks at it, and what does it do? It starts moving.”

That’s when the man realized he had a tapeworm stuck in his insides. He headed to the emergency room shortly thereafter, where Banh treated him with an anthelmintic, a single-treatment deworming medication used on humans and dogs alike.

Banh also took it upon himself to measure the specimen on the floor of the hospital. It stretched a whopping 5 feet, 6 inches — “my height,” noted the doctor.

Tapeworms can be contracted in a variety of ways, but Banh said his patient hadn’t traveled out of the country or engaged in any out-of-the-ordinary behavior. The man also professed his love of sushi, specifically raw salmon sashimi, which he confessed to eating daily.

Fresno is located an ample 150 miles from coastline and is not exactly famed for its sushi. The Centers for Disease Control and Prevention warned last February that the rise in popularity of raw fish consumption has likely spurred

The story has attracted attention all over the world, as these things tend to do, says Peter Olson, a tapeworm expert and a researcher at the Natural History Museum’s life sciences department, who was quoted as telling The Guardian, “because they’re gross”. The worm, he says, was “almost certainly something called the broad fish tapeworm … salmon is one of the main ways you would pick it up, if you don’t cook the meat.” The life of the broad fish tapeworm involves more than one host. “A typical life cycle might include a bear that feeds on salmon, then defecates back into the river. The larvae would be passed into the environment and, in the case of an aquatic life cycle like this, it would be eaten by something like a copepod, a little crustacean. When that copepod is eaten by a fish, it would transform into a larval tapeworm and that’s what is being transmitted to a human in this case. That would go to the intestine and grow into this giant worm.”

(On one of our first dates, over 12 years ago – same age as barfblog.com — Amy tried to serve me grilled salmon. I whipped out my trusty tip-sensitive digital thermometer and noted a 98F reading, and said, no way. Cook it.)

The tapeworm is a monstrous and impressive creation. It has a segmented body, with male and female reproductive organs in each segment, so it is capable of self-fertilisation. It does not have a head as such – its “head” is only useful for holding on to its host’s gut, rather than for “eating” (it absorbs nutrients through its skin). In many cases, you would not know you were infected. You might spot bits of tapeworm segment in your stool – small, pale, rice-like bits – or experience stomach pain or vomiting.

Same-sex marriage and thermometers promoted in Australia: Welcome to the naught years

Australian politicians decided to be good politicians, not leaders – because pioneers get arrows in their back – and threw the issue of same-sex marriage to a public mail-in vote. The yes side won by a 2:1 margin, thereby undermining the foundation of Western society (or so some say).

I say, who cares, let same sex people enjoy the benefits and grief of marriage like the rest of us.

Australian food safety week is Nov. 11-18, 2017.

The organizers have been to my church, and the theme is not hockey, but, “Is it done yet? Use a thermometer for great food, cooked safely every time.”

Stick it in.

The theme last year was“Raw and risky.”

Uh-huh.

These PR thingies are increasingly meaningless.

Chapman is coming over in Jan. or so, once our renovations are done.

Bring another batch of thermometers, buddy.

If a group wants to promote thermometer use, give them away.

According to a self-reported bullshit survey, 70% of Australians don’t know that 75°C is the safe cooking temperature for high-risk foods such as hamburgers, sausages and poultry. 75% of Australians surveyed also reported that there wasn’t a meat thermometer in their household and only 44% of those with a thermometer reported using is over the previous month.

Check out our media release Australians clueless about safe cooking temperatures – Use a thermometer for great food, cooked safely every time.

Stick it in and get it safe

Our contractor warned us the house would like a missile site for a few weeks.

It does, after Canadian daughter 4-of-4 and her boyfriend moved in.

Aussie time.

What I do notice is the builders are always shouting out measurement in millimeters.

120-this, 280-that.

So why wouldn’t anyone expect the same precision in cooking and use a tip-sensitive digital thermometer instead of some food porn adjectives.

We expect bridges to stay up when we cross them, house to stay intact when they are reinforced with steel.

We should expect food to be safe when we cook it.

That requires data, not porn.

7 sick: Not just a UK problem: Outbreak of Campylobacter jejuni associated with consuming undercooked chicken liver mousse

The U.S. Centers for Disease Control reports that on July 13, 2016, Clark County (Washington) Public Health (CCPH) received a report of diarrheal illness in four of seven members of a single party who dined at a local restaurant on July 6, 2016. The report was received through an online/telephone system for reporting food service–associated illness complaints. Members of the five households in the party reported that their only shared exposure was the restaurant meal. CCPH ordered closure of the restaurant kitchen on July 13, 2016, and began an investigation to identify the source of diarrheal illness and implement additional control measures.

CCPH defined a probable case of restaurant-associated illness as diarrhea lasting >2 days in any restaurant guest or staff member with illness onset from July 1, 2016, to July 23, 2016. After Campylobacter jejuni was cultured from stool specimens submitted by three ill members of the dining party, a confirmed case was defined as culture evidence of C. jejuni infection in any restaurant guest or staff member with onset of diarrheal illness during the same period. Five cases (three confirmed and two probable) were identified, four in restaurant guests and one in a food worker; patient age ranged from 27–46 years; three patients were female.

CCPH conducted a case-control study involving 28 menu items, using 14 non-ill dining companions and restaurant staff members as controls. Consumption of two menu items, chicken liver mousse (odds ratio [OR] = 36.1, 95% confidence interval [CI] = 1.58–828.9), and grilled romaine hearts (OR = 18, 95% CI = 1.19–271.5) were associated with case status. Because of the higher odds ratio of chicken liver mousse and previous Campylobacter outbreaks associated with chicken livers (1,2), the investigation focused on the mousse.

During an inspection on July 15, the sous-chef solely responsible for preparing the chicken liver mousse demonstrated preparation to the CCPH food safety inspector, who observed that the sous-chef used the appearance of the livers alone to determine whether they were fully cooked. Final internal cook temperature of the largest liver measured by the inspector was <130°F (54°C), below the minimum 165°F (74°C) internal temperature deemed necessary by the Food and Drug Administration to eliminate food safety hazards (3). Because raw chicken parts are not required to be free of Campylobacter (4), and the bacteria might be present on the surface of 77% of retail chicken livers (5), CCPH immediately addressed undercooking of the livers.

One patient stool specimen isolate was available for typing by pulsed-field gel electrophoresis (PFGE). The PFGE pattern from this isolate was indistinguishable from those obtained from two chicken liver samples collected in a 2014 campylobacteriosis outbreak in Oregon (1). Chicken livers associated with both the 2014 outbreak and with this outbreak were supplied by the same company. Chicken livers from the lot served at the restaurant on the day of the implicated meal were no longer available; therefore, the U.S. Department of Agriculture could not pursue testing of chicken liver samples.

Among published C. jejuni outbreaks associated with undercooked chicken livers, this outbreak report is the second from the Pacific Northwest (1), and the first in the United States initially reported through an illness complaint system. Because CCPH does not actively investigate Campylobacter cases in persons aged >5 years, and because Campylobacter PFGE is not routinely conducted in Washington, this outbreak would have likely gone undetected if not for the illness complaint system, demonstrating the value of illness complaint investigations to identify outbreaks and mitigate public health risks.

Maybe not so slightly pink: Properly cooked pork chops may contain threat of Listeria and Salmonella for consumers

If you are eating leftover pork chops that have not been cooked well-done, you’re putting yourself at risk for Salmonella and Listeria exposure. While many individuals prefer to consume their pork medium, a new study published in Risk Analysis: An International Journal revealed that cooking pork chops to an acceptable temperature does not completely eliminate pathogens, providing these cells with the opportunity to multiply during storage and harm consumers.  

The study, “Impact of cooking procedures and storage practices at home on consumer exposure to Listeria monocytogenes and Salmonella due to the consumption of pork meat,” found that only pork loin chops cooked well-done in a static oven (the researchers also tested cooking on a gas stove top) completely eliminated the Listeria and Salmonella pathogens. Other levels of cooking, i.e. rare and medium, while satisfying the requirements of the product temperature being greater than or equal to 73.6 degrees Celsius and decreasing the pathogen levels, did leave behind a few surviving cells which were then given the opportunity to multiply during food storage before being consumed.  

It is generally believed that when meat is heat treated to 70 degrees Celsius for two minutes, a one million cell reduction of E. coli, Salmonella, and Listeria is achieved and thus the meat is free of pathogens and safe to eat. However, a report by the European Food Safety Authority revealed that more than 57 percent of Salmonella outbreaks in 2014 were in the household/kitchen, and 13 percent were associated with inadequate heat treatment. 

“The results of this study can be combined with dose response models and included in guidelines for consumers on practices to be followed to manage cooking of pork meat at home,” says Alessandra De Cesare, PhD, lead author and professor at the University of Bologna.  

In order to assess the pathogen levels in cooked pork, the researchers, from the University of Bologna, the Institute of Food Engineering for Development and the Istituto Zooprofilattico delle Venezie, tested 160 packs of loin chop. The samples were experimentally contaminated with 10 million cells of L. monocytogenes and Salmonella to assess the reduction in pathogens after cooking, in accordance with the Food Safety and Inspection Service (FSIS) and British Retail Consortium (BRC) specifications (ensuring a reduction of at least 100,000 and 1,000,000 cells, respectively). The samples were contaminated on the surface, to mimic contamination via slaughter and cutting.  

The samples were divided into groups to be cooked either on gas with a non-stick pan or in a static oven. In each setting, the pork chops were cooked to rare, medium, and well-done. For each cooking combination, 40 repetitions were performed for a total of 240 cooking tests.  

The researchers also interviewed 40 individuals between the ages of 20 and 60 to determine household consumer habits regarding doneness preferences. Prior published research was referenced to define meat storage practices and the probability that consumers store their leftovers at room temperature, in the refrigerator or discard them immediately. Growth rate data for the pathogens at each temperature were obtained using the software tool ComBase.  

The only cooking treatment able to completely inactivate the pathogens was oven well-done, which achieved a reduction between one and 10 million cells. Statistical analyses of the data showed significant differences related to level of cooking and cooking procedure. However, the researchers explained that factors such as moisture, water activity, fat levels, salts, carbohydrates, pH, and proteins can impact the cooking treatment and effectiveness and, as a consequence, on bacteria survival. These results emphasize the needs to consider the form of pork (such as whole muscle versus ground) being cooked, in addition to the final temperature necessary to inactivate pathogens.  

The results show that a reduction between one and 10 million of pathogen cells was reached when applying all of the tested cooking treatments, with product temperatures always reaching 73.6 degrees Celsius or greater. However, according to the simulation results using the obtained cell growth rates, the few surviving cells can multiply during storage in both the refrigerator and at room temperature, reaching concentrations dangerous for both vulnerable and regular consumers.  

After storing leftovers, there was a probability for the concentration of pathogens to reach 10 cells ranging between 0.031 and 0.059 for all combinations except oven well-done. Overall, the mean level of exposure to Listeria and Salmonella at the time of consumption was one cell for each gram of meat. The results obtained from this study can be implemented in guidelines for consumers on practices to follow in order to manage cooking pork meat at home.  

 

Everyone’s got a camera Arkansas, edition: Clinton students say school served them raw chicken

Color is still a lousy indicator of whether food is safe, but if Clinton High School wanted to make a case, they would provide internal temperature logs.

For two days a Clinton mother says her children sent her pictures of the food being served in the school cafeteria at lunch.  She says it appears to be undercooked chicken.

“I don’t want my child sick from food poisoning,” says Kathleen Page, mother of two teens at Clinton High School.

” It was so obviously raw,” says her son, Jonathan Carter, a junior at the school.  “You could see pink in it.  I’d cut it open with my fork and it’d be more red on the inside.”

Page called the school and was transferred to the cafeteria.  “I started to ask her questions and she told me it was none of my business and hung up.”

She also called the Health Department and they told her this wasn’t the first complaint they’d gotten about the school lunches.

Clinton School District Superintendent, Andrew Vining, released a statement regarding the issue.

“The Clinton School District strives to serve our students and staff a variety of meals that are healthy, nutritious, and appealing.  The photos that have been circulated do not appear that way.  This concerns us and we have taken steps to resolve the matter to ensure our students are provided with the best meals possible.

“There were also photos that were circulated regarding apparent raw pork; to clarify, no pork was served.

“The chicken fajita meat which was pictured was Tyson, fully cooked and prepackaged.  None of our staff or students have reported becoming ill after eating chicken from our cafeteria.  In the event someone does get sick, they need to notify my office and go to their doctor to see if symptoms were due to food-borne illness.

“We regret this has happened and we will continue to put the health of our students first in all things.”

Bad advice: Cook poultry thoroughly

 

The UK Food Standards Agency advises that poultry should be cooked thoroughly by ensuring it is steaming hot all the way through….NOPE. Use a thermometer and verify that the internal temperature has reached a minimum of 74C (165F). Stop guessing.

Following an article in The Mirror (9 September) which suggests that some people believe that raw chicken dishes are safe to eat, we are reiterating our advice not to eat raw chicken.
Raw chicken is not safe to eat – it could lead to food poisoning. Chicken should always be cooked thoroughly so that it is steaming hot all the way through before serving. To check, cut into the thickest part of the meat and ensure that it is steaming hot with no pink meat and that the juices run clear.
The article states that ‘if birds have been free range, kept in quality conditions, and processed in a clean environment, there’s not so much to worry about’; but this is not the case. All raw chicken is unsafe to eat, regardless of the conditions that the birds have been kept in.
Consuming raw chicken can lead to illness from campylobacter, salmonella and E coli. Symptoms include abdominal pain, diarrhoea, vomiting and fever. In some cases, these bugs can lead to serious conditions.

19 sickened: Temperatures matter; C. perfringens outbreak at a catered lunch Connecticut, 2016

The U.S. Centers for Disease Control reports in September 2016, the Connecticut Department of Public Health was notified of a cluster of gastrointestinal illnesses among persons who shared a catered lunch.

The Connecticut Department of Public Health worked with the local health department to investigate the outbreak and recommend control measures. Information about symptoms and foods eaten was gathered using an online survey. A case was defined as the onset of abdominal pain or diarrhea in a lunch attendee <24 hours after the lunch. Risk ratios (RRs), 95% confidence intervals (CIs), and Fisher’s exact p-values were calculated for all food and beverages consumed. Associations of food exposures with illness were considered statistically significant at p<0.05. Among approximately 50 attendees, 30 (60%) completed the survey; 19 (63%) respondents met the case definition. The majority of commonly reported symptoms included diarrhea (17 of 18), abdominal pain (15 of 16), and headache (7 of 15).

The median interval from lunch to illness onset was 5.3 hours (range = 0.4–15.5 hours) for any symptom and 7 hours (range = 2.5–13 hours) for diarrhea. Analysis of food exposures reported by 16 ill and 10 well respondents (four respondents did not provide food exposure information) found illness to be associated with the beef dish (RR = undefined; CI = 1.06–∞; p = 0.046) (Table). All 16 ill respondents reported eating the beef. Coffee was also associated with illness; however, all 13 coffee drinkers who became ill also ate the beef. Eating cake approached significance (p = 0.051); all 10 cake eaters who became ill also ate the beef.The caterer had begun preparing all dishes the day before the lunch. Meats were partially cooked and then marinated in the refrigerator overnight. In the morning, they were sautéed 2 hours before lunch. Inspection of the facility found the limited refrigerator space to be full of stacked containers that were completely filled with cooked food, disposable gloves that appeared to have been washed for reuse, and a porous wooden chopping block.

The caterer’s four food workers reported no recent illness. Stool specimens from the food workers and from four ill attendees all tested negative for norovirus, Campylobacter, Escherichia coli O157, Salmonella, and Shigella at the Connecticut State Public Health Laboratory. All eight specimens were sent to the Minnesota Department of Health Public Health Laboratory, where additional testing was available. Two specimens from food workers were positive for enterotoxigenic Escherichia coli by polymerase chain reaction, but no enterotoxigenic E. coli colonies were isolated. Seven specimens (four from food workers and three from attendees) were culture-positive for Clostridium perfringens, and specimens from all attendees contained C. perfringens enterotoxin. Pulsed-field gel electrophoresis of 29 C. perfringens isolates from the culture-positive specimens found no matches among attendee isolates, but demonstrated a single matching pattern between two food worker specimens. No leftover food items were available for testing.

C. perfringens, a gram-positive, rod-shaped bacterium, forms spores allowing survival at normal cooking temperatures and germination during slow cooling or storage at ambient temperature (1). Diarrhea and other gastrointestinal symptoms are caused by C. perfringens enterotoxin production in the intestines. Vomiting is rare and illness is usually self-limited, although type C strains can cause necrotizing enteritis (1).

Symptoms reported were consistent with C. perfringens infection, with a predominance of diarrhea, and median diarrhea onset time was at the lower end of the typical C. perfringens incubation period (6–24 hours) (1). C. perfringens enterotoxin detection in the stool of two or more ill persons confirms C. perfringens as the outbreak etiology (2). Both C. perfringens and enterotoxigenic E. coli can colonize asymptomatic persons (3,4), which might explain the presence of these pathogens in the stools of asymptomatic food workers. Pulsed-field gel electrophoresis did not identify the C. perfringens strain responsible for the outbreak, but findings add to the evidence for a wide variety of C. perfringens strains, not all producing C. perfringens enterotoxin (5).

C. perfringens outbreaks are typically associated with improper cooling or inadequate reheating of contaminated meats (1), which might have occurred with the beef dish. The restaurant was advised about the need for adequate refrigeration and best practices for cooling foods, including using stainless steel rather than plastic containers, avoiding filling containers to depths exceeding two inches, avoiding stacking containers, and ventilating hot food. Upon follow-up inspection, staff members discarded disposable gloves after one use, used only food-grade cutting boards, and maintained proper food temperatures for hot holding, cold holding, cooling, and reheating, as outlined in the Food and Drug Administration Food Code.

An estimated 1 million illnesses in the United States each year are attributable to C. perfringens, but fewer than 1,200 illnesses are reported annually with C. perfringens outbreaks (6). C. perfringens testing is not routine for foodborne outbreaks; even if testing is unavailable, C. perfringens should be considered when improper cooling, inadequate reheating, and improper temperature maintenance of meat are identified.