Thanksgiving is in the heart, or stomach: Clostridium perfringens outbreak associated with a catered lunch — North Carolina, November 2015

Yesterday, while picking Sorenne up from school I asked several of the attendees at our Thanksgiving feast in the park on Saturday, if there was any intestinal upset.

All clear.

doug-turkey-cater-nov-16I was especially concerned about C. perfringens, what with the prior cooking of the turkeys and the transporting to the park, and the outside temp of90F as we move into summer, but I would have heard by Sunday.

The U.S. Centers for Disease Control reports that in November 2015, the North Carolina Division of Public Health was notified by the Pitt County Health Department (PCHD) that approximately 40 persons who attended a catered company Thanksgiving lunch the previous day were ill with diarrhea and abdominal pain. The North Carolina Division of Public Health and PCHD worked together to investigate the source of illness and implement control measures.

Within hours of notification, investigators developed and distributed an online survey to all lunch attendees regarding symptoms and foods consumed and initiated a cohort study.

A case of illness was defined as abdominal pain or diarrhea in a lunch attendee with illness onset <24 hours after the event. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated for all menu items. Among 80 attendees, 58 (73%) completed the survey, including 44 respondents (76%) who reported illnesses meeting the case definition; among these, 41 (93%) reported diarrhea, and 40 (91%) reported abdominal pain. There were no hospitalizations. Symptom onset began a median of 13 hours after lunch (range = 1–22 hours). Risk for illness among persons who ate turkey or stuffing (38 of 44; 86%), which were plated and served together, was significantly higher than risk for illness among those who did not eat turkey or stuffing (six of 14; 43%) (RR = 2.02; 95% CI = 1.09–3.73).

PCHD collected stool specimens from ill persons and samples of leftover food from the company that hosted the lunch. Stool specimens were tested for norovirus and bacterial enteric pathogens at the North Carolina State Laboratory for Public Health. Based on reported symptoms and short interval between the lunch and symptom onset, a toxin was suspected as the cause of the outbreak; therefore, five stool specimens from ill persons and 20 food samples were submitted to CDC for Clostridium perfringens detection.

debbiedownerthanksgiving_postStools were tested for C. perfringens enterotoxin (CPE) using reversed passive latex agglutination. Stool culture and enumeration of C. perfringens colony forming units (CFU) were performed for five samples of foods implicated by the epidemiologic investigation (one stuffing sample and four turkey samples). Because meat is the most common source of C. perfringens outbreaks (1), one ham sample also was analyzed, although consumption of ham was not associated with an increased risk for illness. CPE was detected in all five stool specimens. C. perfringens containing the C. perfringens enterotoxin gene (cpe) was recovered from all five stool specimens and from all four turkey samples; one turkey sample contained >105 CFU/g. C. perfringens was not recovered from samples of other foods. No other pathogens were detected in stool specimens. Collectively, laboratory results met CDC guidelines for confirming C. perfringens as the outbreak source (3).

PCHD environmental health specialists interviewed the caterer about food handling and preparation practices. The North Carolina Food Code requires that all commercial caterers operate in a facility that has been inspected for compliance and permitted by the regulatory authority (4). The caterer had previously maintained a permitted facility, but reported having prepared the lunch food served at this event in an uninspected, residential kitchen. Turkeys were cooked approximately 10 hours before lunch, placed in warming pans, and plated in individual servings. Food was then delivered by automobile, which required multiple trips. After cooking and during transport, food sat either in warming pans or at ambient temperature for up to 8 hours. No temperature monitoring was conducted after cooking.

C. perfringens toxicoinfection (a foodborne illness caused by ingestion of toxin-producing bacteria) is often associated with consumption of meat that has been improperly prepared and handled (1,2). Because diagnostic testing is not widely available, C. perfringens can go undetected as a cause of foodborne illness outbreaks (2,3,5). Diagnostic testing to assist with outbreak source identification is useful to corroborate epidemiologic information, document disease prevalence, and guide prevention recommendations.

Epidemiologic, laboratory, and environmental evidence indicate that this outbreak was caused by consumption of turkey prepared by a commercial caterer operating in an unpermitted kitchen. Inadequate facilities, extended time between turkey preparation and consumption, and failure to monitor and control temperature before and during transport resulted in an anerobic environment conducive to C. perfringens spore germination and growth (6). Prompt local health department response, use of an online survey, and rapid collaboration between local, state, and federal public health agencies were instrumental in identifying the outbreak source quickly and preventing additional cases.

These findings confirm the need for commercial food preparers to adhere to existing food safety regulations (4), including use of permitted facilities and having a certified kitchen manager on staff. Caterers should be aware of the risks associated with improper storage of prepared food for long periods and the importance of temperature monitoring and regulation during food preparation and handling.

2016 Thanksgiving turkey extravaganza combining Canadian, American and whatever it is Australia celebrates in honor of the harvest

Thanksgiving has always been our favorite holiday, a celebration of the feast, but there’s no damn turkeys in Brisbane for Canadian Thanksgiving, and it’s too damn hot to be cooking for American Thanksgiving at the end of November.

history-of-white-people-in-americaThere are also practical considerations.

Whole turkeys have started showing up in Coles and Woolies – the Australian  duopoly — in the past two weeks at about $10/kg; in North America they’re about $2.00/kg, but I may be aging myself.

Five years ago, I specially sourced a whole turkey for Canadian Thanksgiving in early Oct., in Brisbane, and it was about $20/kg. Never again.

Thanksgiving (French: Action de grâce), or Thanksgiving Day (Jour de l’action de grâce) is an annual Canadian holiday, occurring on the second Monday in October, which celebrates the harvest and other blessings of the past year.

Thanksgiving has been officially celebrated as an annual holiday in Canada since November 6, 1879, when parliament passed a law designating a national day of thanksgiving, although the first Canadian Thanksgiving is thought by some to have occurred on Baffin Island in 1578 while some English dudes were looking for the Northwest Passage.

The first Thanksgiving Day after Canadian Confederation was observed as a civic holiday on April 5, 1872, to celebrate the recovery of the Prince of Wales (later King Edward VII) from a serious illness.

Bloddy Monarchs.

amy-turkey-citrus-16According to wikii, tthe event that Americans commonly call First Thanksgiving was celebrated by the Pilgrims after their first harvest in the New World in 1621.[4] This feast lasted three days, and—as accounted by attendee Edward Winslow[5]—it was attended by 90 Native Americans and 53 Pilgrims.[6]

On Sat. Nov. 19 – it was the best date to fit around hockey schedules while accommodating the Canadian feast and the 6-week American orgy of food and shopping that begins this coming Thurs – we gathered 40 of our Australian friends at a local park on the river, and had a feast.

The two 10kg turkeys were purchased on Tues., Nov.15.

They sat on the counter for 12 hours and then 3-4 days in the fridge.

Amy made butter tarts, a carrot salad and a citrus-based turkey the day before.

Saturday, I was on the ice at 6.am. and then came home (sore) to make my bird, a traditional Alton-Brown-based variety (I like his science).

I took Amy to the park at 11ish a.m., to stake out BBQ and table space. (Brisbane has fabulous parks, especially along the river, because they have a 500-year-flood every 50 years, so parks better than houses. These parks have the best bathrooms, sanitation and free BBQs than in any other city I’ve been in.)

By our 1 p.m. start time, I had two turkeys, a gluten-free and a regular dressing (because it wasn’t inside the bird), and the best gravy I’ve ever made.

When I delivered to the park, people had started assembling, kids were running around, the river breezes were cool as Brisbane moves into summer,

dpturkey-16As I had written to our guests in the invite, “Think of it as a giant pot-luck, but you better practice decent food safety – no raw egg dishes, including homemade mayo, aioli or sauces – or your dish is consigned to the bin and covered in bleach (because that’s how health inspectors roll).

“The deal is, we’ve invited a bunch of people, and we’ll do it at Tennyson Park so the kids can run around.

Amy and I along with the capable assistance of chef Alex will bring the tip-sensitive digital thermometer-verified safe turkey (and gravy, you can’t overcook a turkey, that’s what the gravy’s for). Two kinds of stuffing – one gluten-free, one regular, which will be cooked outside of the bird (food safety 101).

thanksgiving-nov-16I mangled the turkey Amy cooked Friday night, and once I had started carving into the one I cooked Saturday a.m., a hockey parent who knows his why around a bird kindly asked, ”Would you like me to take over?

“Yes.”

The other families bring something: rolls, mashed potatoes, salad, cooked carrots, green beans, apple pie, beverages, cutlery, whatever, as long as it is microbiologically safe. And wash your damn hands before everyone gets hepatitis A (we’re vaccinated, the rest are on your own; for a pre-meal vindication, I can explain how hep A is spread amongst humans).

Oh, and I’ve got a face for radio and a voice for print. But it was fun.

However, in the videobelow,  I was trying to say, “You may know me because I coach your kid in hockey,” not “hit your kid in hockey.

Editing.

We are thankful to have so many and great friends in Brisbane.

Love, Actually sucks (as a movie); Love is great in real life

I hate myself.

i-hate-myself-8Amy loves herself.

Maybe that’s why we get along.

High school was sorta traumatic, what with me killing a couple of friends in a car crash, doing jail time, and then going to university and hiding myself in my studies so that I eventually became a prof.

But I was always an asshole.

Over the years I’ve reconnected with some of those Brantford friends – facebook can be wonderful – and am grateful to learn what I never expected.

My high school friend Bob, who was always there for me, sent me a note the other day, saying, “And that’s why you are loved. If it helps I now cook all bbq with a thermometer-because of you-and the food is better; cross contaminated perhaps, but better tasting.

What an unexpected and kind thing to say.

Changing the world, one thermometer at a time (Chapman, I’m running out).

It’s really hard for me to accept love, for whatever reason.

But if I can coach hockey and be lineman for my first game, with people screaming at me, then maybe I can welcome some love too.

‘Barf-proof yourself like a food-safety ace’

Amy says she’s going to get me a hat that says, Ace.

Joe Dziemianowicz of the New York Daily News writes:

article-barf-1024He rarely eats in restaurants. When he dines at friends’ homes, he’s been known to peek into his hosts’ fridge and cupboards. “It’s an annoying habit,” he tells the Daily News.

Meet Doug Powell (right, exactly as shown, in 2005, dissenters to the left please) a former professor of food safety and publisher of barfblog.com, which is all about food-safety issues. There are plenty of them. Last year there were 626 food recalls in the U.S. and Canada. The Centers for Disease Control and Prevention estimate that food-borne pathogens sicken 48 million Americans — that’s one in six — hospitalize 128,000 and kill 3,000. Powell, who was raised in Canada, lived in the U.S. and now resides in Brisbane, Australia, has been there. He wrote about that in barfblog.  “More recalls are due to better detection and awareness,” he says. “The food is as dangerous as it’s always been, not more so.”

Between posting about recalls and E. coli outbreaks in the U.S. and beyond, Powell, 53, set the Daily News straight about everyday food-safety questions.

Now it’s okay to eat pork that’s rosy pink, right?

Nope. “Research has shown that color is a lousy indicator of whether meat is safe to eat,” says Powell. Same goes for requesting your chops or steaks “well done,” which is vague enough to put you in hurl’s way. “When I go to a restaurant and they ask me how I want my steak, I say, ‘140 degrees.’” He also carries a tip-sensitive digital thermometer in his backpack. He swears by one from Comark that’s around $16.

Raw sprouts are good for you, yes?

dp-chest-protectorMaybe not. “I never eat them,” says Powell. And that includes ones he could grow at home. Warm and humid conditions ideal for growing sprouts are an Eden for growing bacteria, like Salmonella, Listeria, and E. coli. In the past 20 years they’ve been connected to at least 30 outbreaks of foodborne illness (bring on your best shots, left, I got some new goalie equipment, 11 years later).

You should have two cutting boards in the kitchen — one for meat, the other for vegetables?

Powell uses one and “usually I use dish soap” to clean it. To sanitize, he uses a 10-to-one ratio of bleach to water.

(Nosestretcher alert: I already sent in the correction, which is somewhere between 250-400 parts water to I part bleach, or a tablespoon bleach per gallon of water.)

Is organically raised food safer than if it’s conventionally produced?

Nope. “Organic is a production standard and has nothing to do with microbial food safety,” says Powell. “Large or small, conventional or organic, safety is a function of individual farmers. They either know about microbial food safety risks and take steps to reduce or manage that risk, or they don’t.” Along the same line, “local” does not automatically mean safe, he adds.

Super-fresh sushi won’t make you sick will it?

“Raw fish houses an amazing microbiology profile that can make you sick,” he says. “It’s just not a good idea to eat it.”

Chapman says whenever someone calls him Ace, he responds with Ace of Spades, in a bad imitation of Lemmy’s voice.

Recommend using a thermometer? Hong Kong finds Salmonella in roast pork sample

The Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department announced October 12 that a sample of roast pork taken from a licensed restaurant was found to contain a pathogen, Salmonella. The CFS is following up on the case.

barfblog-stick-it-inA spokesman for the CFS said, “The CFS collected the above-mentioned sample at a restaurant with a general restaurant licence in Shatin for testing under its routine Food Surveillance Programme. The test result showed the presence of Salmonella in 25 grams of the sample, exceeding the standard of the Microbiological Guidelines for Food which states that Salmonella should not be detected in 25g of food,” a CFS spokesman said.

The spokesman said that the CFS had notified the food premises concerned of the unsatisfactory test result and instructed it to stop selling the affected food item immediately.

The CFS has also provided health education on food safety and hygiene to the person-in-charge and staff of the food premises, requested it to review and improve the food production process and carry out thorough cleaning and disinfection.

 

Thermometers and hockey

“Do you always bring that thing with you?”

coffs-hockey-team-16“Don’t you?”

The thing was my tip-sensitive digital thermometer which is always in my backpack, which is always on my back, and the occasion was the annual BBQ at the annual Coffs Harbour 3-on-3 hockey tournament.

With 120 guests to serve, I always arrive packin’.

The meat was safely-temperature-verified-grilled, no bare hand contact was achieved through either tongs or gloves, and cross-contamination was minimal (the parents all know what I do, and they knew I’d be watching).

Amy and I played sous chefs for a couple of hours, prepping onions, tomatoes, cucumbers and watermelon.

Coffs Harbour Big Banana 3-on-3 Skirmish, now in its sixth year, started as a two club match-up between Newcastle North Stars and Southern Stars from Brisbane with Coffs Harbour as the halfway meeting point for the 3-on-3 ice hockey weekend.

doug-ref-oct-16The tournament has grown each year to now include nine clubs represented by 26 teams from NSW, QLD and ACT. Some 175 players ranging in age from 5-to-16-years-old in five different age divisions played in 80 games.

I coached, acted as medic, refereed for the first time since completing that 14-hour training and was called upon to be the badass coach when kids got unruly around the pool and BBQ area.

Amy did scorekeeping, merchandizing, and overall hockey mom stuff, like getting Sorenne prepared.

So many other people contributed in similar ways.

Great kids, great parents, it’s our church, but without the god stuff. There’s singing and dancing, but not so much the hymns. More AC/DC.

 

Inevitability of reproduction – TV cooking show edition

In 2004, my laboratory reported (and by reported I mean published in a peer-reviewed journal) that, based on 60 hours of detailed viewing of television cooking shows, an unsafe food handling practice occurred about every four minutes, and that for every safe food handling practice observed, we observed 13 unsafe practices. The most common errors were inadequate hand washing and cross-contamination between raw and ready-to-eat foods.celebrity_chefs4

The abstract is below.

Once the paper was published, it made headlines around the globe.

And then it started getting replicated. Texas, Europe, a few other places, and now Massachusetts.

Compliance With Recommended Food Safety Practices in Television Cooking Shows

Nancy Cohen, Rita Olsen

Journal of Nutrition Education and Behavior, 2016 Aug 28. pii: S1499-4046(16)30715-1. doi: 10.1016/j.jneb.2016.08.002. [Epub ahead of print]

Objective

Examine compliance with recommended food safety practices in television cooking shows.

Methods

Using a tool based on the Massachusetts Food Establishment Inspection Report, raters examined 39 episodes from 10 television cooking shows.

Results

Chefs demonstrated conformance with good retail practices for proper use and storage of utensils in 78% of episodes; preventing contamination (62%), and fingernail care (82%). However, 50% to 88% of episodes were found to be out of compliance with other personal hygiene practices, proper use of gloves and barriers (85% to 100%), and maintaining proper time and temperature controls (93%). Over 90% failed to conform to recommendations regarding preventing contamination through wiping cloths and washing produce. In only 13% of episodes were food safety practices mentioned.

Conclusions and Implications

There appears to be little attention to food safety during most cooking shows. Celebrity and competing chefs have the opportunity to model and teach good food safety practices for millions of viewers.

 Mathiasen, L.A., Chapman, B.J., Lacroix, B.J. and Powell, D.A. 2004. Spot the mistake: Television cooking shows as a source of food safety information, Food Protection Trends 24(5): 328-334.

Consumers receive information on food preparation from a variety of sources. Numerous studies conducted over the past six years demonstrate that television is one of the primary sources for North Americans. This research reports on an examination and categorization of messages that television food and cooking programs provide to viewers about preparing food safely. During June 2002 and 2003, television food and cooking programs were recorded and reviewed, using a defined list of food safety practices based on criteria established by Food Safety Network researchers. Most surveyed programs were shown on Food Network Canada, a specialty cable channel. On average, 30 percent of the programs viewed were produced in Canada, with the remainder produced in the United States or United Kingdom. Sixty hours of content analysis revealed that the programs contained a total of 916 poor food-handling incidents. When negative food handling behaviors were compared to positive food handling behaviors, it was found that for each positive food handling behavior observed, 13 negative behaviors were observed. Common food safety errors included a lack of hand washing, cross-contamination and time-temperature violations. While television food and cooking programs are an entertainment source, there is an opportunity to improve their content so as to promote safe food handling.

The research has been published where? Forget thawing food in fridge, use water instead

In what could be yet another case of PR before publication, Science Nordic has issued a press release extolling the virtues of thawing meat in cold water rather than in the fridge. The PR does not address issues of cross-contamination, how a consumer would determine if the meat was actually thawed, and most important, fails to cite a peer-reviewed publication, other than saying, “based on the institute’s own experiments with freezing and thawing different kinds of foods.”

meat-thaw-waterIf it has been published, it’s standard to include a link to that research, otherwise, it’s a fluff piece.

But you decide.

Most people know that food should be frozen as quickly as possible, to retain quality and flavour. The same turns out to be true when it comes to thawing frozen food, too —quicker is better.

So says Susanne Ekstedt, a researcher at the Food and Bioscience unit of SP Technical Research Institute of Sweden in Gothenburg.

“This is something food scientists have known to be true for a long time now. But this knowledge is mostly confined to the food industry. Most people don’t seem to be aware of this,” Ekstedt said.

What often happens instead is that people thaw their meats slowly in the refrigerator. While keeping meat cold while thawing is important to limit bacterial growth, it’s possible to thaw food quickly in water. 

Ekstedt’s recommendation is based on the institute’s own experiments with freezing and thawing different kinds of foods. Their conclusion: The best way to thaw frozen meat or fish is to put it in cold water. You have to wrap the food in plastic, of course, to keep the water out of the food, but water will thaw food quickly and effectively.

The reason for this is simple: Water conducts heat better than air. And the faster food is thawed, the better it tastes.

One reason that freezing and thawing foods quickly preserves their quality has to do with ice crystal formation.

When anything, be it snow or food, stays slightly below the freezing point for a long time, it creates the perfect environment for large ice crystals to grow.

In food, the formation of these large ice crystals during freezing can do a great deal of damage to cells, reducing the food’s ability to hold in fluids after it is thawed.

muppets-chef-2The result? Dry meat and flaccid vegetables.

Clarence Birdseye, who is credited with being the founder of the modern frozen food industry in the United States, is said to have discovered this principle himself when he worked in Labrador and was taught by the native Inuits how to ice fish.

He discovered that fish he caught at -40 degrees C froze quickly and tasted quite fresh when thawed.  He went on to invent a series of techniques that allowed foods to be frozen quickly, preventing the formation of large ice crystals.

To this day, the food industry is well aware of the problems posed by ice crystal formation. In fact, it’s not uncommon to buy frozen vegetables with labels that advise consumers to thaw vegetables quickly.

Bjørg Egelandsdal is a professor at the Norwegian University of Life Sciences in Ås whose specialty is meat.

“There has never been any good scientific evidence behind the advice that food should be thawed in the refrigerator,” she says.

“Maybe the idea behind this advice is that refrigerator thawing is most hygienic. It is true that meat and other foodstuffs should be stored in the refrigerator if they are thawed, but it is definitely better to thaw food quickly in water if you are going to use it right away,” she said. 

Another potentially quick way to defrost food, the microwave, can be hard on meat, says Per Einar Granum, a microbiologist also at the Norwegian University of Life Sciences.

He says if you are going to use the meat in a casserole or stew, thawing it in a microwave can be acceptable, because the meat will later become tender as it cooks.

But if you plan to grill your meat, forget the microwave. Even if you use the “thaw” program, it is “a little too brutal for the meat,” he says.

17 sickened with Hepatitis E linked to undercooked pig-liver stuffing

Background – On 11 December 2013, 3 clustered cases of hepatitis E were reported on a coastal island in Brittany. Cases had consumed spit-roasted and stuffed piglet during a wedding meal. The raw stuffing was partly made from the piglet liver. Investigations were carried out to identify the source and vehicle of contamination, and evaluate the dispersion of the hepatitis E virus (HEV) in the environment.

spit-roast-pigMethods – A questionnaire was administered to 98 wedding participants who were asked to give a blood sample. Cases were identified by RT-PCR and anti-HEV serological tests. A retrospective cohort study was conducted among 38 blood sampled participants after the exclusion of participants with evidence of past HEV immunity. Relative risks (RR) with their 95% confidence intervals were calculated based on foods consumed at the wedding meal using univariate and multivariable Poisson regressions.

The human HEV strains were compared with the strains detected in the liquid manure sampled at the farm where the piglet was born and at the inlet of the island wastewater treatment plants.

Results – 17 cases, including 3 confirmed cases, were identified and 70.6% were asymptomatic. Acute HEV infection was independently associated with piglet stuffing consumption (RR=1.69 [1.04-2.73]). Human strains from the index cases, veterinary and environmental HEV strains were identical.

Discussion – The outbreak was attributable to the consumption of an undercooked pig liver-based stuffing. After infection, the cases have probably become a temporary reservoir for HEV, which was detected in the island’s untreated wastewater.

Hepatitis E outbreak associated with the consumption of a spit-roasted piglet, Brittany (France), 2013

Épidémie d’hépatite E associée à la consommation d’un porcelet grillé à la broche, Bretagne, 2013. Bull Epidémiol Hebd. 2016;(26-27):444-9

Y Guillois, F Abravanel, T Miura, N Pavio, V Vaillant, S Lhomme, et al.

http://invs.santepubliquefrance.fr/beh/2016/26-27/2016_26-27_3.html

16 sickened with trichinellosis in Belgium from imported wild boar meat

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses.

wild-boar-recipes-and-uses_homemediumIn November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients’ muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative.

The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.

Outbreak of Trichinellosis related to eating imported wild boar meat, Belgium, 2014

Eurosurveillance, Volume 21, Issue 37, 15 September 2016, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.37.30341

P Messiaen, A Forier, S Vanderschueren, C Theunissen, J Nijs, M Van Esbroeck, E Bottieau, K De Schrijver, IC Gyssens, R Cartuyvels, P Dorny, J van der Hilst, D Blockmans

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22581