Texas proposes changes to salmonella warnings for handling reptiles

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ReptileChannel.com (another of my favorite reads) reports the Texas Department of State Health Services has proposed changes to the wording reptile retailers in Texas use on signs warning customers about salmonella. The deadline for the public to submit comments is Sunday, Nov. 21, 2010.

Current law requires all retail stores that sell reptiles to post warning signs and distribute written warnings about reptile-associated salmonellosis. The signs are to include recommendations for preventing the transmission of salmonella. The proposed changes, according to the department, allow for consistency with the Centers for Disease Control and Prevention recommendations.

If approved, the warning signs would have to include the following recommendations, at minimum.

• Persons should always wash their hands thoroughly with soap and running water after handling reptiles or reptile cages or after contact with reptile feces or the water from reptile containers or aquariums. Wash your hands before you touch your mouth.

• Persons at increased risk for infection or serious complications of salmonellosis, such as children younger than 5 years of age, the elderly, and persons whose immune systems have been weakened by pregnancy, disease (for example, cancer) or certain medical treatments (for example, chemotherapy) should avoid contact with reptiles and any items that have been in contact with reptiles.

• Reptiles should be kept out of households or facilities that include children younger than 5 years of age, the elderly, or persons whose immune systems have been weakened by pregnancy, disease (for example, cancer) or certain medical treatments (for example, chemotherapy). Families expecting a new child should remove any reptile from the home before the infant arrives.

• Reptiles should not be allowed to roam freely throughout the home or living area. Wash and disinfect surfaces that the reptile or its cage has contacted.


• Reptiles should be kept out of kitchens and other areas where food or drink is prepared or consumed. Kitchen sinks should not be used to bathe reptiles or to wash their dishes, cages or aquariums. If bathtubs are used for these purposes, they should be cleaned thoroughly and disinfected with bleach. Wear disposable gloves when washing the dishes, cages or aquariums.

The signs would also have to include a statement notifying customers that even though reptiles may not appear sick at the time of purchase, they may carry salmonella bacteria, which can make people sick.

The entire proposal is available at:

http://www.sos.state.tx.us/texreg/pdf/backview/1022/1022prop.pdf

Third-party audits: missing the forest for the trees

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Irwin Pronk of HACCP By Design, writes in this contributed piece:

Conducting food safety audits is hard work. It is a very difficult task requiring technical background, industry experience and people skills (especially in stressful environments).

There are a number of problems with third-party audits these days, and each in its own way undermines the effectiveness of audits as food safety tools.

One of the main dangers is that HACCP certifications can become mere “optics,” where the audit is not about reality, but about the “show” that was put on for the auditor for those two or three days. With the pressure of an audit, it is too easy for plant staff and management to forget that the goal of food safety programs is simply not the short-term one of passing the audit, but the ultimately more important one of producing safe food for the consumer. Easily said, but the reality of day-to-day operations in a food plant can make the result very different from the principle. For one thing, an audit must get past the enthusiastic descriptions of a few people and assess the food safety attitude, or culture, of the entire group. Any blame there might be for the thoroughness (or lack thereof) of audits obviously does not rest entirely with auditors, but must also be shouldered by Plant Managers and QA Managers who may feel it necessary to create these “shows” for the auditors without realising how putting on a “show” sends the plant the message that food safety is just a game. Perhaps that is why we see so little progress in reducing recalls and protecting the consumer.

Too often, auditors spend a disproportionate amount of time reviewing documents (procedures and records) and comparatively little time in the plant. A contact at one plant recently told me of a three-day audit where the auditor spent only three hours in the plant.

If some auditors spend too little time in the plant, others skew the results of their third-party audits by inflating scores, recording evaluations much higher than the plants deserve and giving the wrong impression of their performance. The difficulty for auditors is this: if the plant staff and management have been steadily making improvements, they naturally expect their score to rise; on the other hand, the standard also gets tougher every year, and so, even with all their improvements, they may not really deserve a higher score. The pressure on the auditor to “improve” the score can be considerable. It takes a strong person not to give in, but many do. Over time this inflation can result in some very strange scores. For example, there have been cases where a mediocre score for an audit is 92.5 percent, while a good score is 96.6 percent. What happened to the concept of the “average” being 65 percent? Sure, everyone wants to look good, but …

The most consistent complaints of auditors is that they are inconsistent and too often make “mountains out of mole-hills.” With the number of audits being required lately by retailers and other customers, and growing steadily, there is a shortage of knowledgeable, experienced auditors. To audit a food plant properly, the auditor should be technically capable and have working experience in that industry. How can an auditor from, say, the bakery industry audit a yoghurt plant, or meat person audit a winery? The Prerequisite Programs certainly form a common ground across industries, but a thorough understanding of the particular industry is necessary to apply the principles appropriately in the particular situation. But going beyond Prerequisite Programs to HACCP, it is much more difficult to determine whether Critical Control Points (CCPs) are appropriate, designed correctly, or managed effectively. For example, should the pH of a salad dressing be a CCP? What about the seal on a package of hotdogs, or the baking of a loaf of bread? Answering either yes or no requires a deep understanding of the technical issues in each industry. Too often, auditors are not qualified to audit plants in a particular industry, and plant staff and management need to be aware of this fact, and require of the Certification Body (auditing firm) that the auditors are qualified to assess their plant. Yes, you have the right to ask for the résumé of the auditor who is to come to your plant and refuse them if you do not feel they are qualified.

On top of this, with un-scored audits (where no numerical scores are recorded but Major and Minor non-conformances are identified and listed), it is not in the auditor’s best interests to point out non-conformances since they result in volumes of paperwork and perhaps even return visits to resolve Major non-conformances. As a result, an auditor may choose to downgrade Major non-conformances Minor, and Minors to Observations.

Not all the issues lie with auditors. Unrealistic expectations can make an audit unworkable. If an auditing firm is told, for example, that they only have one day to do an audit on a 600,000 ft2 facility, they have certain choices. They can refuse to do the audit, since it cannot be done adequately, or they can acquiesce and take the money. That can –and, for some, has– turned out to be an expensive $1,200 audit. Which leads to the fundamental problem that is, money is changing hands, and this can lead to undue emphasis on competing for business rather than ensuring quality. The plant is paying the auditing firm and even though the standard may be the same, each auditing firm enforces the requirements with varying degrees of rigour. Food plants can choose their auditing firm and too often choose based on which is the easiest.

So who is pointing fingers at whom? No one is guilt-free in the area. There is plenty of blame to go around, but we likewise we share equally the responsibility to change the system, to put the emphasis back where it belongs, on the ultimate goal of ensuring the safety of the food products being shipped from our plants, not racking up great audit scores. Hard as it is, we need to combine integrity with excellence, remembering that the short-term goal of good audit scores is only one piece in the larger picture of producing reliably, demonstrably safe food for our customers.

Irwin Pronk has worked with over 300 companies to implement food safety and quality assurance programs over the past 15 years. He has worked on all sections of the supply chain from agriculture through animal feed production, food processing, distribution and food service. He is a resource for many clients with in-plant facilitation of HACCP & GMP programs (SQF, ISO22000) and is an ISO22000 Lead Assessor. Irwin was a contributor to the Quality Auditor’s HACCP Handbook (ASQ). When it comes to management systems, he is a firm believer in the integration of risk management systems as well as using a behaviour-based approach. He was the winner of the OFPA’s Sanitarian of the Year award in 2005. Prior to consulting he worked with both Pillsbury Canada and Maple Leaf.

He lives in Fergus, which is near Guelph (that’s in Canada).
 

Some Calif. lettuce may contain salmonella

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State health officials warned consumers today not to eat certain Fresh Choice red leaf lettuce sold at three Southern California grocers, due to possible Salmonella contamination.

The lettuce was sold between Oct. 20 and Nov. 1 at Canton Food Co. in Los Angeles, Cardenas Market and Numero Uno Market locations throughout
Southern California, according to California Department of Public Health director Dr. Mark Horton.

Fresh Choice Marketing of Oxnard produced the lettuce and made it available in grocery stores as whole head lettuce without identifying labels, Horton said.

Cider strikes again; seven sick with E. coli O157 in MD

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In the fall of 1998, I accompanied one of my four daughters on a kindergarten trip to the farm. After petting the animals and touring the crops –I questioned the fresh manure on the strawberries –we were assured that all the food produced was natural.

We then returned for unpasteurized apple cider. The host served the cider in a coffee urn, heated, so my concern about it being unpasteurized was abated. I asked: "Did you serve the cider heated because you heard about other outbreaks and were concerned about liability?"

She responded, "No. The stuff starts to smell when it’s a few weeks old and heating removes the smell.”

??I repeat this story, again, because more people are once again sick with E. coli O157:H7 linked to unpasteurized cider.

The Maryland Department of Health and Mental Hygiene are conducting an investigation into a cluster of seven E. coli O157 infections.

There have been no deaths, although three of seven cases have resulted in hospitalization.

A potential association exists with the consumption of unpasteurized Baugher’s apple cider.

In response to the ongoing investigation, Baugher’s Orchard and Farm of Westminster, issued a voluntary recall of all its apple cider due to its potential contaminants. At this time, no other Baugher’s products are affected by the recall.
 

E. coli outbreak linked to Costco cheese samplers; 25 sick

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In 2004, I spent a week at a cottage with a couple of my children in Eastern Ontario near Sandbanks Provincial Park on Lake Ontario. Lovely spot.

One rainy day, we toured around and ended up at a cheese shop. They produced the cheese in the factory at the back, and had a charming market outlet that seemed to trap tourists like bees on sap.

Upon entering the store, a sign declared, “HACCP – A food safety program; Hazard Analysis Critical Control Pont.” Cool. I asked one of the staff what it meant. She said she didn’t know. ??But beside the HACCP proclamation was a sign that read, “Public bathroom is out of order; for your convenience there is a blue Johnny on the spot behind the building.”?

No handwashing facilities or sanitizer. I watched people go to the porta potty and then come into the cheese shop and do what people do at quaint cheese shops: stick their unwashed hands into shared samples of curds (that’s one of my daughters looking disgusted in the middle, right, not because of the practice, but because I have to take pictures and be a food safety geek everywhere we go). HACCP really doesn’t mean much unless there is a culture of food safety amongst the employees and everyone involved in making a product, like cheese or deli meat.??

These public sampling stations can be cross-contamination nightmares. But the best hygiene won’t prevent food safety foul-ups when the product itself is contaminated.

Multiple sources are reporting tonight that Arizona and four other states reported cases of E. coli O157 in cheese products sold in Costco stores in October.

Twenty-five cases of Escherichia coli were confirmed by officials, 11 in Arizona lone, according to a statement issued Thursday by the Arizona Department of Health Services.

The outbreak appears to have been associated with cheese available for purchase at Costco "Cheese Road Shows," and Costco was working with state officials to remove the tainted product from its stores.

Early data from health officials suggests that Dutch-style Gouda cheese is the culprit. Costco is cooperating with the investigation: they have removed all suspect products from shelves and are notifying customers who purchased cheese from the road show.

A U.S. Food and Drug Administration press release states:]

• Bravo Farms Dutch Style Gouda cheese, (Costco item 40654) offered for sale and in cheese sampling events at Costco Wholesale Corporation (Costco) locations is preliminarily linked with an outbreak of E.coli O157:H7 infections.

• Consumers who have any of this cheese should not eat it. They should return the cheese to the place of purchase or dispose of it in a closed plastic bag and place in a sealed trash can to prevent people or animals, including wild animals, from eating it.

• Most people infected with E. coli O157:H7 develop diarrhea and abdominal cramps, but some illnesses may last longer and can be more severe. While most people recover within a week, some may develop a severe infection. Rarely, as symptoms of diarrhea improve, a type of kidney failure called hemolytic uremic syndrome (HUS) can occur; this can happen at any age but is most common in children under 5 years old and in older adults. People with HUS should be hospitalized immediately, as their kidneys may stop working and they may be at risk for other serious health problems.

• As of Thursday, November 4, 2010, 25 persons infected with the outbreak strain of E. coli O157:H7have been reported from five states since mid-October. The number of ill persons identified in each state with this strain is as follows: AZ (11), CA (1), CO (8), NM (3) and NV (2). There have been 9 reported hospitalizations, 1 possible case of hemolytic uremic syndrome (HUS), and no deaths.

Costco may need to check its suppliers. Again.
 

Proper handwashing requires proper tools; no preaching without provisions

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A Toronto school had 250 students absent with flu-like symptoms earlier this week, believed to be norovirus-related. A school in Philipsburgh, PA, was closed today after 100 kids developed what was thought to be norovirus. And the tri-delts at the University of Michigan were barfing a couple of weeks ago because of, norovirus.

These stories all carry advice for students to wash their hands. But have any of these intrepid reporters gone to the school or sorority and checked out whether proper tools – running water, soap, paper towel – were available for proper handwashing? Too frequently, such tools are glaringly absent, especially in schools.
 

Sick in French salmonella outbreak tops 100

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Over 100 school kids (and a few adults) have been confirmed sick by salmonella in ground beef patties in Poitiers, France.

The source of original contamination has not been uncovered.

So far cases are limited to the Department of Vienne. Health authorities sent out a national alert but the school holidays hampered the investigation. It was an ER doctor in Poitiers who sent out the alert after seeing 8 patients arrive in the University Hospital with the same symptoms and from the same school. At that point they started a "regional cell of sanitary surveillance.” (Amy’s not sure on that translation).

Thanks to Albert Amgar for forwarding the story.
 

Salmonella in steak tartare in Netherlands sickens teenagers

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At what point does steak tartare earn the label, ‘ready-to-eat?’

Maybe it’s a Dutch thing.

Eurosurveillance reports today about the fourth food-borne outbreak in recent years linked to consumption of steak tartare and other raw beef products in the Netherlands. In 2006 to 2008, despite intensive monitoring and control programmes, Salmonella was still found in-store in raw meats (such as steak tartare and ossenworst) intended for direct consumption.

In the latest case, between October and December 2009, 23 cases of Salmonella Typhimurium (Dutch) phage type 132, each with an identical multiple-locus variable-number tandem-repeat analysis (MLVA) profile (02-20-08-11-212), were reported from across the Netherlands. A case–control study was conducted using the food-consumption component of responses to a routine population-based survey as a control group. The mean age of cases was 17 years (median: 10 years, range: 1–68). Sixteen cases were aged 16 years or under. Raw or undercooked beef products were identified as the probable source of infection. Consumers, in particular parents of young children, should be reminded of the potential danger of eating raw or undercooked meat.

The full report is available at:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19705
 

Campylobacter associated with chicken liver parfait, UK, June 2010

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I spent five summers in high school and university hammering nails and planks with a couple of Danish craftsmen. They taught me many things, including how to eat pate and beet sandwiches (lunch today, right), along with raw herring and vast quantities of aquavit.

Eurosurveillance reports this week on an outbreak of campylobacter associated with chicken liver parfait served in Scotland in June. Undercooking appears to be the culprit, probably because the cooks went with ‘piping hot’ rather than a thermometer. One web site says a chicken liver pate becomes a chicken liver parfait (French for perfect) when the cooked liver mixture is pushed through a sieve to remove any sinewy bits, resulting in a silkier, smoother and luscious liver parfait.

It’s on the Internet so it must be true. The full report follows.

In an outbreak of 24 cases of gastroenteritis among guests at a wedding reception, 13 cases had confirmed Campylobacter infection. In a cohort study, univariate analysis revealed a strong association with consumption of chicken liver parfait: risk ratio (RR): 30.08, 95% confidence interval (CI): 4.34-208.44, p<0.001, which remained after adjustment for potential confounders in a multivariable model: RR=27.8, 95% CI=3.9-199.7, p=0.001. These analyses strongly support the hypothesis that this outbreak was caused by the consumption of chicken liver parfait.

Background
Campylobacteriosis is an acute bacterial enteric disease, caused by infection with Campylobacter. Common symptoms include diarrhoea, abdominal pain, malaise, fever, nausea, and/or vomiting [1] and may persist for a week or even longer [2]. Onset is usually between two and five days after exposure, but may be up to 10 days. The infectious dose required to cause Campylobacter illness is estimated to be as low as 500 organisms [3]. Campylobacter infection continues to be the most commonly reported cause of foodborne illness in England and Wales, with 57,772 laboratory reports of Campylobacter cases received by the Health Protection Agency (HPA) in 2009 [4].

Despite the high incidence of this disease, the HPA received only 114 reports of foodborne Campylobacter outbreaks between 1992 and 2009, of which 25 (22%) were recorded as being linked to consumption of poultry liver dishes [5]. Chicken liver foods carry a high risk of Campylobacter infection as the bacteria can infect both the external and internal tissue of chicken livers [6], and may remain in chicken liver if insufficiently cooked [7]. The association between poultry liver dishes and outbreaks of Campylobacter infection has been illustrated by two recently published studies from Scotland [8,9].

On 5 July 2010, a suspected outbreak of campylobacteriosis was reported to the North East Health Protection Unit (HPU) by Environmental Health Officers from Northumberland County Council. Reports of illness were received from guests at a wedding held at a luxury hotel in Northumberland on 25 June 2010. One guest was hospitalised with Campylobacter infection following the event. In total, 13 guests who ate at the event submitted samples that tested positive for Campylobacter. The event consisted of a wedding breakfast (afternoon meal) and an evening buffet.

At the first Outbreak Control Team meeting on 7 July 2010, the decision was made to undertake an analytical study. Reports of illness were only received from guests who had attended the wedding breakfast, and accordingly the study was carried out on this group.

Method
Study design and cohort?
A retrospective cohort study was used. The cohort was defined as persons who had eaten the wedding breakfast at the luxury hotel on 25 June 2010 (n=67). Contact details for these 67 guests were obtained from the event organiser. The evening buffet was excluded because no cases were reported in guests attending only the evening buffet. All reported cases attended the wedding breakfast (three of them attended only the wedding breakfast).

Data collection
Of the 67 guests listed by the event organiser, 65 were posted a questionnaire with a covering letter and a stamped and addressed return envelope. The remaining two guests, resident outside the United Kingdom (UK), were sent an electronic copy of the covering letter and questionnaire via email in order to maintain the timeliness of the investigation. One week after the first posting, a follow-up letter was sent to those guests whose questionnaires were still to be received.

Case definition
Cases were defined as persons who attended the wedding at the hotel on 25 June 2010, who reported an illness with diarrhoea or vomiting, with or without other gastrointestinal symptoms, and with an onset of illness between 26 June 2010 and 5 July 2010. Guests with illness onset dates less than one day or greater than 10 days after the event were included as non-cases.

Response rate?
Of the 67 persons on the guest list, two were found to be infants who did not eat the wedding breakfast and were excluded from the study, giving a potential cohort size of 65. Completed questionnaires were received from 60 of 65 remaining guests (92%).

Questionnaire content?
The questionnaire contained questions regarding personal details, illness information, travel history, other illness in the household, food and drink consumed at the meal, in addition to other questions relating to the participant’s stay at the hotel. The menu for the wedding breakfast was obtained from the hotel; details from this menu were used to inform the content of the questionnaire.

Statistical analyses?
Data were double-entered using EpiData v3.1 (EpiData Association) and then verified and analysed using STATA 10.1 (StataCorp). The association between exposure variables and illness was examined using univariate, stratified methods (using Mantel-Haenszel risk ratios and the Woolf test for homogeneity) and multivariable methods (logistic and binary regression).

Results
Descriptive epidemiology
Of the 60 individuals included in the study, 24 fitted the case definition. Of these 24, 13 received laboratory confirmation of Campylobacter infection. Illness onset dates for cases ranged from 26 to 30 June 2010 (Figure 1). The incubation period ranged from one to five days (mean = 2.25 days). The symptoms experienced by cases are shown in Table 1; duration of symptoms ranged from 1 to 18 days. A mean duration of symptoms cannot be calculated as 13 of 24 cases were still experiencing symptoms when answering the questionnaire.

Analytical epidemiology
In a univariate analysis, the strength of association between the risk of becoming a case and 40 exposures was calculated. Of these, four exposures were significantly (p<0.05) associated with illness; these are shown in Table 2. From this univariate analysis, chicken liver parfait was the variable most strongly associated with illness, with a risk ratio (RR) of 30.08.

Of variables significantly associated with illness, chicken liver parfait, onion marmalade and the mixed leaf salad were served in the same set dish. Whilst cheesecake is positively associated with illness, it only explains 14 of the 24 cases, whereas chicken liver parfait explains 23 of the 24 cases.

To examine potential confounding and effect modification between variables, significant exposures (p<0.05) were stratified for exposure to chicken liver parfait and Mantel-Haenszel RRs calculated (Table 3). Consumption of chicken liver parfait strongly confounded each of these variables, and after stratification the association between these exposures and illness was no longer significant.

Multivariable analysis was conducted using logistic and binary regression models. The four variables significantly associated with illness in the univariate analysis were included in an initial logistic regression model. Variables were then removed in a stepwise fashion, in the order of the univariate p value, and a likelihood ratio (LR) test was conducted. As these models did not have significantly different log likelihoods (LR test p<0.05), the original model was used.

As the results of the multivariable model show (Table 4), when adjusting for other significant exposures, chicken liver parfait (RR= 27.8, 95% CI: 3.9-199.7) remained significantly associated with illness.

Microbiology
Due to the time between the event and notification of the outbreak (10 days), no samples of food from the wedding remained for microbiological analysis. However, environmental samples from the kitchen were taken. Based on results from these environmental samples, the general hygiene of the premises was determined to be satisfactory.

Discussion
These results show a very strong association between consumption of chicken liver parfait at the wedding breakfast and Campylobacter illness. The multivariable analysis of food items demonstrates that even after adjusting for confounding variables, guests who ate chicken liver parfait had a risk of illness that was 28 times greater than guests who did not eat this food.

An investigation by Environmental Health Officers identified concerns about the method used to prepare the chicken liver parfait for this event. Information from the hotel indicates that after mixing raw chicken livers with a red wine reduction and raw eggs, the parfait mixture was heated, using a bain marie (water bath), to a core temperature of 65°C and then immediately removed from the oven and cooled for 15 minutes. According to the UK Food Standards Agency advice, if liver is cooked at 65°C, it should be held at this temperature for at least ten minutes to ensure adequate cooking [10].

One of the most positive elements in the implementation of this study was the high response rate (92%) to the postal questionnaire. This may have been due to factors such as the prompt posting of the questionnaire after the wedding, the type of event concerned and the high proportion of guests reporting illness.

Other factors, such as the relatively short length of questionnaire, the inclusion of a personalised letter, first class postage, the inclusion of a stamped and addressed return envelope, and follow up contact of non-respondents, have all been previously associated with increasing response rates to postal questionnaires [11].

It is possible that the study was affected by an ascertainment bias, in that the suggestion that chicken liver parfait had caused the outbreak may have circulated among guests, biasing their responses in the questionnaire. However, the number of portions recorded as having been eaten in the questionnaires was similar to the hotel’s estimate of portions served, suggesting that the effect of this bias was inconsequential. Also, the case definition was such that guests reporting diarrhoea or vomiting, independent of other symptoms, were included as cases. This may have led to the misclassification of non-cases as cases, reducing the strength of observed associations.

The outbreak investigation was conducted in a timely fashion, which minimised recall bias in questionnaire responses and enabled prompt implementation of control measures. As a result of this outbreak investigation, the hotel, one of a group of six, reviewed their catering operations, removing certain high risk foods from their menus and implementing quarterly unannounced kitchen inspections.

Of the 25 foodborne Campylobacter outbreaks linked to chicken liver parfait/pâté reported to the HPA between 1992 and 2009, 17 were recorded to have been due to errors in food handling during preparation of the chicken liver dishes. These food handling errors included inadequate cooking of blended livers in a bain marie [5].

From 2007 to 2009, the proportion of foodborne Campylobacter outbreaks in England and Wales that were linked with chicken liver dishes increased significantly [12], indicating that the consumption of this food is a public health issue of escalating importance.

From the evidence available, it is likely that the cooking method used for the chicken liver parfait was insufficient to ensure that the food was free from Campylobacter bacteria. These findings demonstrate the importance of influencing catering practice with regard to the cooking of chicken livers, to reduce the risk of campylobacteriosis outbreaks.

References
Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington, DC: American Public Health Association; 2008: 94-8.
Butzler JP, Oosterom J. Campylobacter: pathogenicity and significance in foods. Int J Food Microbiol. 1991;12(1):1-8.
Robinson DA. Infective dose of Campylobacter jejuni in milk. BMJ (Clin Res Ed). 1981;282(6276):1584.
Health Protection Agency (HPA). Campylobacter infections per year in England and Wales, 1989-2009. London:HPA; [Accessed 1 Nov 2010]. Available from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Campylobacter/EpidemiologicalData/campyDataEw/
Little CL, Gormley FJ, Rawal N, Richardson JF. A recipe for disaster: Outbreaks of campylobacteriosis associated with poultry liver pâté in England and Wales. Epidemiol Infect. 2010;138(12):1691-4.
Baumgartner A, Grand M, Lininger M, Simmen A. Campylobacter contaminations of poultry liver – consequences for food handlers and consumers. Archiv Lebensmittelhyg. 1995;46:1-24
Whyte R, Hudson JA, Graham C. Campylobacter in chicken livers and their destruction by pan frying. Lett Appl Microbiol. 2006;43(6):591-5.
O’Leary MC, Harding O, Fisher L, Cowden J. A continuous common-source outbreak of campylobacteriosis associated with changes to the preparation of chicken liver pâté. Epidemiol Infect. 2009;137(3):383-8.
Forbes KJ, Gormley FJ, Dallas JF, Labovitiadi O, MacRae M, Owen RJ, et al. Campylobacter Immunity and Coinfection following a Large Outbreak in a Farming Community. J. Clin. Microbiol. 2009;47(1):111-16.
Food Standards Agency (FSA). Caterers warned on chicken livers. London:FSA. Accessed 28 Jul 2010. Available from: http://www.food.gov.uk/news/newsarchive/2010/jul/livers
Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, et al. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002;324(7347):1183.
Health Protection Agency (HPA). Food-borne outbreaks of Campylobacter (associated with poultry liver dishes) in England. Health Protection Report. 3(49); 11 Dec 2009. Available from: http://www.hpa.org.uk/hpr/archives/2009/news4909.htm

No restaurant grades for Pittsburgh diners

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What New York, LA, Toronto and hundreds of other cities have figured out is baffling the health folks in Pittsburgh.

The Pittsburgh Post-Gazette reports Allegheny County restaurants won’t be posting inspection scores or grades in their windows for the public to view any time soon.

Although County health department director Bruce Dixon and County Manager Jim Flynn were both on the subcommittee to design a restaurant inspection disclosure program, Flynn said he was "disappointed" and was "a little confused" with the plan, while Dixon added, "It needs to be more clear as to what the rules are."

This from two dudes on the committee, which also included six other health department administrators, three other board members and five representatives from the local restaurant industry.

That’s a lot of salaries sitting around a table to come up with … nothing.

Under the proposed system, food inspectors would score restaurants starting at 100 percent and subtracting points for food safety violations they uncover. Scores would be translated into a letter grade of A, B or C. Restaurants scoring below a C would be closed until violations were fixed.

Under the current system, inspectors record violations but do not issue an overall grade or score.
 

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