Always use a thermometer: 244 sickened by shiga toxin-producing E. coli at US Marine training base

In Nov. 2017, over 200 U.S. Marines-in-training were sickened by shiga-toxin producing E. coli at Marine Corps Recruit Depot San Diego and Camp Pendleton.

That outbreak was blamed on undercooked beef prepared by a civilian contractor, according to the results of an investigation.

First rule of public health (substitute military or any other organization): make public health look good.

According to Healio, the outbreak occurred in October and November among newly enlisted men at Marine Corps Recruit Depot, San Diego, and Camp Pendleton, a nearby base where recruits conduct weapons and field training, according to Amelia A. Keaton, MD, MS, EIS officer in the CDC’s Outbreak Response and Prevention Branch.

The outbreak involved Shiga toxin-producing E coli (STEC) — a major cause of foodborne illness in the United States each year and the pathogen responsible for the current multistate outbreak of E. coli linked to romaine lettuce. In all, 244 male recruits are suspected of being sickened, including 15 who developed a life-threatening complication of STEC infections called hemolytic uremic syndrome (HUS). Among those who developed HUS, six were deemed critically ill but none died, Keaton told Infectious Disease News during the CDC’s annual EIS conference.

She said the outbreak presented several challenges for investigators and highlighted some unique risk factors among military trainees living in close quarters.

“Nobody on our team had a military background, so we first wanted to understand what their training environment is like,” Keaton said. “Do they have any unique exposures that people in the general public don’t have? We wanted to get a sense of what day-to-day life was like for these guys and what risk factors for infection they were exposed to.”

Keaton and colleagues interviewed 43 case patients and 135 healthy controls, plus Marine officers, food workers and staff. They observed food preparation practices and studied recruit sleeping quarters, bathroom facilities and cafeterias where meals were served to around 2,000 to 3,000 recruits at a time, Keaton said.

Although they were unable to directly test any meat, through interviews investigators found that ill recruits were 2.4 times likelier to report consuming undercooked beef than healthy controls. Moreover, Keaton said investigators directly observed beef being undercooked.

According to Keaton, most dining facilities on military bases are run by civilian contractors, including the facilities involved in this outbreak, which offered the same menu prepared by the same company. The Navy is in charge of inspecting such facilities once a month, she said.

“A lot of people reported eating meals that were visibly undercooked,” Keaton said. “When we observed food preparation, we saw that food workers were cooking a large number of hamburger patties and a large number of meals. Because such a large number of meals are being prepared, they’re only able to check foods intermittently with a meat thermometer. In some instances, we saw there were temperature abuses where they weren’t necessarily cooking to temperatures recommended by California state law.”

Raw is risky: Norovirus outbreak linked to raw oysters rises to 126 in BC

In a follow-up on the norovirus outbreak linked to the consumption of British Columbia raw oysters, The Public Health Agency of Canada has reported that a total of 126 cases of gastrointestinal illness linked to oyster consumption have been reported in three provinces: British Columbia (92), Alberta (9), and Ontario (25). No deaths have been reported.

Ensure oysters are fully cooked before consuming them. Lightly cooking oysters does not kill norovirus. Oysters need to be cooked to an internal temperature of 90° Celsius (194° Fahrenheit) for a minimum of 90 seconds in order to kill norovirus.

30 sick from Salmonella linked to raw frozen chicken thingies in Canada

In an outbreak that begin May 2017 and continues, the Public Health Agency of Canada is reporting 30 cases of Salmonella Enteriditis between May 2017 and February 2018.

The news release came out last Thursday, two days, one day after the feds reminded Canadians on the importance of properly cooking such this.

Use a thermometer.

Currently, there are 30 cases of Salmonella Enteritidis illness in four provinces: Alberta (2), Ontario (17), Quebec (7), and New Brunswick (4). Four individuals have been hospitalized. Individuals became sick between May 2017 and February 2018. The average age of cases is 32 years, with ages ranging from 1 to 73 years. The majority of cases (57%) are male.

Based on the investigation findings to date, exposure to poultry, including frozen raw breaded chicken products has been identified as a source of illness. Several individuals who became ill reported consuming a mix of poultry and frozen raw breaded chicken products. The Canadian Food Inspection Agency is conducting a food safety investigation into a source of the outbreak. At this time, there is no food recall warning associated with this outbreak. The outbreak investigation is ongoing.

Frozen raw breaded chicken products may appear to be pre-cooked or browned but they contain raw chicken and should be handled and prepared no differently from other raw poultry products.

The safety of these products rests with the consumer who is expected to cook it, according to the directions on the package.

In 2015, industry voluntarily developed additional labelling on frozen raw breaded chicken products that included more prominent and consistent messaging, such as “raw,” “uncooked” or “must be cooked” as well as explicit instructions not to microwave the product and they voluntarily introduced adding cooking instructions on the inner-packaging bags.

Microwave cooking of frozen raw breaded poultry products including chicken nuggets, strips or burgers is not recommended because of uneven heating.

Use a digital food thermometer to verify that frozen raw breaded chicken products have reached at least 74°C (165°F). Insert the digital food thermometer through the side of the product, all the way to the middle. Oven-safe meat thermometers that are designed for testing whole poultry and roasts during cooking are not suitable for testing nuggets, strips or burgers.

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.