Ben Chapman

About Ben Chapman

Dr. Ben Chapman is an associate professor and food safety extension specialist at North Carolina State University. As a teenager, a Saturday afternoon viewing of the classic cable movie, Outbreak, sparked his interest in pathogens and public health. With the goal of less foodborne illness, his group designs, implements, and evaluates food safety strategies, messages, and media from farm-to-fork. Through reality-based research, Chapman investigates behaviors and creates interventions aimed at amateur and professional food handlers, managers, and organizational decision-makers; the gate keepers of safe food. Ben co-hosts a biweekly podcast called Food Safety Talk and tries to further engage folks online through Instagram, Twitter, Facebook, YouTube and, maybe not surprisingly, Pinterest. Follow on Twitter @benjaminchapman.

Flour power: NEJM paper on 2016 outbreak

A couple of weeks ago Duncan Hines brand cake mixes were recalled because of Salmonella. Maybe it was the flour. Flour comes from dried wheat that’s milled and not heat treated (because it messes with the gluten). As the Salmonella dries out it gets hardier and survives for months (or longer).

In 2016 pathogenic E. coli (both O121 and O26 serogroups) was the culprit in another raw flour outbreak. The good folks involved with that investigation (Crowe and colleagues) published their findings this week in the New England Journal of Medicine.

The outbreak began in December 2015 and lasted through to September 2016. Fifty-six cases in 22 states were identified.

The biggest takeaway for me was this (such a great explanation of how an investigation works):

Open-ended telephone interviews then were conducted with 10 patients, all of whom stated that they baked frequently or regularly consumed home-baked foods. Five of the patients recalled baking during the week before illness onset, and 3 others reported thatthey might have baked during that period. Of the 5 case patients who remembered baking, 4 reported eating or tasting homemade batter or dough, 3 of whom used brand A flour. The fourth used either brand A or another brand. Two of the patients (a resident of Colorado and a resident of Washington) still had the bags of brand A flour that they had used in the week before illness onset.

Shortly thereafter, state investigators identified 3 ill children who had been exposed to raw flour at restaurants in Maryland, Virginia, and Texas. Restaurant staff had given them raw dough to play with while they waited for their food to be served.

Folks in the media or the hockey arena often ask how these outbreaks get solved. This is how – lots of interviewing, hypothesis generating and then a case-case or case-control analysis. It’s part detective work, part statistics and all science. Sometimes the interviews are messy but this one shows what happens when it works.

Trace-back investigation of the two bags of brand A flour collected from patients in Colorado andWashington revealed that the flour from Colorado was unbleached all-purpose flour manufactured on November 14, 2015, and the flour from Washington was bleached all-purpose flour manufactured on November 15, 2015. The two bags were produced in the same facility. The flour that was used in the raw dough given to the children exposed in the Maryland, Virginia, and Texas restaurants also was from this facility, as was flour from three additional bags collected from case patients residing in Arizona, Califor- nia, and Oklahoma.

Romaine again: leafy green linked to illnesses in Canada and US

I’m not really a salad fan. I know it’s not cool to admit that, but I love lots of other types veggies (so don’t email me about my nutrition)>

One of the salads I can handle (although it’s not my favorite) is Caesar – Romaine with a yogurt-based garlic, lemon and olive oil mixture with some asiago and bacon is doable.

Caesar and Romaine is off the menu right now after E. coli O157 has been linked to 18 cases in Canada and 32 cases in the U.S. 

Fascinating part of this one is (as PHAC states), 

Laboratory analysis indicates that the illnesses reported in this outbreak are genetically related to illnesses reported in a previous E. coli outbreak from December 2017 that affected consumers in both Canada and the U.S. This tells us that the same strain of E. coli is causing illness in Canada and the US as was seen in 2017 and it suggests there may be a reoccurring source of contamination. Investigators are using evidence collected in both outbreaks to help identify the possible cause of the contamination in these events.

CDC notes that this outbreak is not linked to the one that was traced to Yuma.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on E. coli bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS performed on E. coli bacteria from ill people in this outbreak showed that the strains were closely related genetically. This means that the ill people were more likely to share a common source of infection.

As of November 20, 2018, 32 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from October 8, 2018 to October 31, 2018. Ill people range in age from 7 to 84 years, with a median age of 24. Sixty-six percent of ill people are female. Of 26 people with information available, 13 (50%) were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after October 30, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli infection and when the illness is reported. This takes an average of two to three weeks.

Ongoing outbreak and reoccurring source makes a recall (and no Romaine consumption) a good idea for now.

Over 80 outbreaks linked to leafy greens since 1995 – is pretty good justification.

Norovirus is hard to get rid of, especially in a shelter

I’m still here, just like norovirus.

I can’t really imagine what it’s like to have your community and homes destroyed by fire. I really struggle to find the words or feelings to describe what residents of California are going through. Viewing the social media posts and videos of folks fleeing the flames is emotional.

A few years ago an outbreak linked to a Denver homeless shelter made it into the barfblog new and notable category. Forty folks who depended on the emergency food were affected by violent foodborne illness symptoms after eating donated turkey. Fourteen ambulances showed up and took those most affected to area hospitals.

Getting into a shelter or temporary housing because of the fires and then acquiring norovirus is a terrible situation.

Butte County Public Health Department says that over 140 individuals housed in a Camp Fire shelters likely have norovirus. 

Since the shelters opened to house Camp Fire evacuees, 145 people have been sick with vomiting and/or diarrhea. As of Wednesday evening, there were 41 people experiencing symptoms at the following shelters:

Neighborhood Church: 179 total evacuees at the shelter, 21 currently experiencing illness

Oroville Nazarene Church: 352 total evacuees at the shelter, 10 currently experiencing illness

Butte County Fairgrounds: 142 total evacuees at the shelter, 9 currently experiencing illness

East Avenue Church: 200 total evacuees at the shelter, 1 currently experiencing illness

The number of sick people is increasing every day. Twenty-five people have been to the hospital for medical support. Staff serving the shelters have also been sick.

Norovirus can quickly go through a food shelter with many people living in close quarters. Once the virus is there, it is hard to get rid of.

As one friend of the blog posted on social media, having norovirus and using a public bathroom to deal with the symptoms must be particularly degrading.

This one is weird, 21 boxes: Salmonella causes limited Cap’n Crunch cereal recall

I’ve seen a lot of recalls, this is the first time I remember seeing only 21 boxes distributed to five specific stores. I’d like to know the back story on this one (maybe some avid barfblog readers can help).

The Quaker Oats Company, a subsidiary of PepsiCo, Inc., today announced a voluntary recall of a small quantity of Cap’n Crunch’s Peanut Butter Crunch cereal due to the potential presence of Salmonella. While the potentially affected product only reached five specific Target stores and is limited to 21 boxes of one variety with two Best Before Dates, Quaker is initiating the voluntary recall to protect public health.

The recall was initiated as the result of a routine sampling program by the company, which revealed the finished product may contain bacteria.

The product being recalled was distributed in limited quantities only to the five Target stores listed below. This recall only includes 21 outstanding boxes purchased after Nov 5.

This is some Willy Wonka golden ticket type stuff. I wonder if this was a market withdrawal that happened, except all but 21 boxes were pulled before sales. On the shelf quick, than off the shelf. Except for 21.

 

Posting restaurant grades is a good thing; does it make food safer? It’s hard to tell

I’ve long been a fan of posting restaurant inspection scores, grades, happy faces, whatever. The philosophy I subscribe to is that the inspection work is done with public money and the public should have access to the results. Whether the info is posted on the door, or a website, it should be accessible.

For a while lots of folks have wondered whether the posting matters, public health wise. I want to believe it does, but I’m still not sure.

The biggest issue in real life experimentation and hypotheses is that there are lots of other factors that could lead to an outcome. And if the outcome you’re looking for is reduction in Salmonella illnesses, you likely can find it if you look. Like Melanie Firestone and Craig Hedberg did in their EID paper that was released this week.

But I’m not convinced that less Salmonella was a result posting grades alone. And I don’t think they are either, since Firestone and Hedberg  highlight the other factors in their limitations:

First, this was a quasiexperimental, ecologic study that represents an association and not a causal relationship. Second, the NYC restaurant letter grade program involved multiple changes to sanitation enforcement in addition to letter grade posting; changes included inspection frequency, greater risk for fines, improvements to online resources, and additional training opportunities.. As a result, we could not determine which factors contributed the most to the reduction in Salmonella infections.

It’s good stuff, we need more data on these things. Posting grades is good, and absolutely should be done. So is increasing consequences and oversight – but how much each factor matters is still unknown. And what about other pathogens like norovirus and pathogenic E. coli?

FDA warns of honey-filled pacifiers after links to 4 cases of infant botulism

Tragic stories around infant botulism have popped up over the past couple of years and, as a dad, reading them is like a gut-punch.

In 2011, infant Amanda Zakrzewski was diagnosed with infant botulism and had to undergo 9 days of antitoxin treatment in hospital. Amanda wouldn’t eat, her eyes glassed over and she wasn’t able to suckle due to the paralysis the botulinum outgrowth caused. The result was months of rehab.

Also in 2011, 16-week-old Logan Douglas was temporarily blinded and paralyzed from infant botulism. He fully recovered after six months, but at one point the illness was so severe that doctors had discussed turning off life support systems as the toxin was attacking his body.

Logan’s illness was linked to honey that his pacifier was dipped into.

Kinda like the four infants from Texas whom FDA says have acquired the terrible illness from pacifiers filled with honey.

The FDA is reminding parents and caregivers not to give honey to infants or children younger than one year of age. This includes pacifiers filled with or dipped in honey.

The FDA has received reports from the state of Texas that four infants have been hospitalized with botulism. All four infants had used pacifiers containing honey. These pacifiers were purchased in Mexico, but similar products also appear to be available in the U.S. through online retailers.

Lets get the food safety science right at Thanksgiving

I’ve written before that Thanksgiving is my favorite holiday. A mid-week day off (which often stretches to a whole week of food, football and hanging out) is the way to go.
My parents make their annual pilgrimage from Southern Ontario to take in the whole turkey week Black Friday festivities as well.
The week also provides a really great opportunity to take food safety pictures (right, exactly as shown) and talk food safety stuff. The yearly blitz of holiday interviews have started – and so has Dr. Bob, suburban Chicago columnist.
A valiant effort at tackling food safety in the holidays, Dr. Bob misses the mark with a few things:
He starts with,
Emergency rooms across the state and nation are gearing up for a busy week following the Thanksgiving holiday. Unfortunately, many family get-togethers will spread more misery than joy. And I am not speaking of those troublesome individuals that exist in all families that drive many of us to contemplate violent acts. Rather, I am alluding to seasonal foodborne illnesses, which will put a quick end to the Thanksgiving holiday for tens of thousands of families nationwide and several hundred here in our own state.
That’s a great lede – but show your work here Dr. Bob, tens of thousands of hospitalizations might be an over reach here – even if we evenly divide the estimated 128,000 hospitalizations a year we get to a weekly average of 2,500 – I don’t think there’s data to show that Thanksgiving is a 5x or 10x riskier time of the year.
More from the good doctor,
Foodborne illnesses fall into two general categories: intoxication and infection. Foodborne intoxication is caused by ingestion of foods that contain a toxin that may be naturally present in the food, introduced by contamination with poisonous chemicals, or produced by bacteria or fungi growing on foods. Toxins may also be present in some fish and shellfish that have consumed toxin-producing algae. Examples can include contamination with cleaning agents, pesticides and herbicides as well as heavy metals.
Uh, I’m a bit lost – are we talking food borne illness or other stuff now.
Here’s the best though,
It is a well-accepted fact that 100 percent of poultry products are contaminated with salmonella. You read right, 100 percent of the Thanksgiving turkeys carry salmonella. It is only the cooking to proper temperatures and the avoidance of cross contamination that stands between health and sickness.
Not quite, FSIS actually does a great job in reporting contamination levels of Salmonella in poultry, and shows that in turkey contamination is much lower (like only 1.7% positive in turkey). And campy is around the same.
I’m all for talking about food safety and risk reduction and using the holidays as a hook – but lets get the numbers right, avoid the fake news, and give people real risk information.

Food Safety Talk 169: Panel of Plonkers

The episode starts with a quick discussion of books the guys are planning on reading this week, and a book that arrived mysteriously at the offices of many other food safety folks (including Don and Ben). The food safety discussion goes to a story of a Chicago bus driver pooping on his bus and trying to clean it up with the contents of a coffee cup; Don and Ben chat about the pros and cons of this approach. The guys tackle the safety of storing breast milk, pickling eggs in miso, and what levels of contamination may have led the Romaine-linked E. coli O157 outbreak earlier this year. The show ends on raw flour, TTIs (not STIs) and raw chicken thingies.

You can download episode 169 here and at iTunes.

Show notes so you can follow along at home:

Happy birthday Sam, no, you can’t eat the batter

My youngest kid is 8 today. He’s the funniest, cutest and most charming of any of us.

And he knows it.

He pretty much gets away with everything. Last year during the annual parent/teacher conference his teacher told us, sure, he talks all the time, he distracts other kids, but how can you discipline him? ‘He’s Sam’.

Today, this budding mite hockey player has practice, donuts with his teammates and then we’e going home for pizza and cake.

As Dani was making the cake earlier today I checked to see whether it was Duncan Hines. Although we’ve long outlawed eating cookie dough and licking the mixing bowl in our house, I still didn’t want to use the stuff that was recalled yesterday after being linked to five cases of Salmonella Agbeni.

From FDA’s website:

The FDA is investigating the manufacturing facility that made recalled Duncan Hines cake mixes.

FDA and the CDC informed Conagra Brands that a sample of Duncan Hines Classic White Cake Mix that contained Salmonella Agbeni matched the Salmonella collected from ill persons reported to the CDC. This was determined through Whole Genome Sequencing, a type of DNA analysis.

Based on this information, Conagra Brands is working with FDA to proactively conduct a voluntary recall of Duncan Hines cake mixes from the market. The FDA is conducting an inspection at the Conagra Brands-owned manufacturing facility that produced the cake mixes. The FDA is also collecting environmental and product samples.

Recommendation:

Consumers should not bake with or eat the recalled product. Additionally, consumers should not eat uncooked batter, flour, or cake mix powder.

Salmonella in low moisture foods continues to be an issue. As the Salmonella dries out it gets hardier and survives for months (or longer). Flour (if that’s the source) comes from dried wheat that’s milled and not heat treated (because it messes with the gluten. Salmonella or E. coli from wheat fields can make it to cake batter fairly easily.