It’s not a war: FDA arming itself with science to help prevent Cyclospora infections

Steven Musser Ph.D., Deputy Director for Scientific Operations, FDA’s Center for Food Safety and Applied Nutrition (CFSAN) and Alexandre da Silva, Ph.D., Lead Parasitologist at CFSAN’s Office of Applied Research and Safety Assessment, write that Cyclospora cayetanensis is so small that it can only be seen with a microscope. However, there is nothing small about the U.S. Food and Drug Administration’s work to help protect consumers from the foodborne illness that this parasite can cause.

Of course it’s small. So are the trillion of microorganisms inside each of us.

Cyclospora has been on the public radar since at least 1996.

Cyclosporiasis is an intestinal illness caused by consumption of foods, mainly fresh produce, that are contaminated with Cyclospora. The FDA has been working to help prevent contaminated product from reaching consumers, gathering the scientific knowledge that will help to better detect the parasite in food and the environment, and gathering data to better understand how food is contaminated by the parasite and help prevent contamination in the future. We’re also sharing what we know with stakeholders in the public and private sectors.

Because several past outbreaks have been associated with fresh herbs, the FDA has been conducting surveillance sampling of fresh cilantro, parsley and basil. A quarterly update on this food surveillance study was released today. As this effort continues, our goal is to collect enough samples to provide a precise estimate of the prevalence of contamination of Cyclospora in our food supply, enabling us to better understand our vulnerability to Cyclospora contamination.     

The FDA is also acting on what we already know about where Cyclospora is found and how contamination can be prevented.   

In 2019, 10% of the Cyclospora infections reported between May and August were linked to a multi-state outbreak associated with fresh imported basil that started in mid-June and was declared over in October. FDA increased its screening at the border of basil exported by the company tied to the outbreak before the company voluntarily recalled its product and ceased shipping while corrective measures were implemented.

The FDA is also tracking contamination in domestically-grown produce. The first confirmed evidence of Cyclospora in domestically grown produce was detected in 2018 in cilantro, a finding not associated with an outbreak of illnesses. As with bacterial pathogens, if the parasite is found on produce, the FDA follows up with inspections and sampling, working with the business to take the actions needed to protect public health.

The FDA has been reaching out to farmers to increase awareness of Cyclospora and actions that can be taken on the farm to reduce the likelihood of contamination. For example, ways to control sources of contamination include proper use, maintenance and cleaning of toilet and handwashing facilities. We created education and outreach materials for farmers, including the Cyclosporiasis and Fresh Produce Fact Sheet

In late 2014, the FDA’s Center for Food Safety and Applied Nutrition established a Foodborne Parasitology Research Program, and in collaboration with the CDC, has been sequencing the genomes of several different strains of C. cayetanensis, enabling the development of genetic typing methods. In 2016, we created a genome database named “CycloTrakr” to be used as a public repository of genomic data at the National Center for Biotechnology Information (NCBI). This is an important first step towards the goal of linking, in real-time, the genetic fingerprints of Cyclospora in contaminated food and sick people to pinpoint the source of the outbreaks.

The agency has also pioneered ways to detect the parasite, developing and validating new methods to test for Cyclospora in produce and water. The first of these new methods was used for the first time in 2018 to confirm the presence of the parasite in a salad mix product tied to an outbreak that sickened hundreds of people. 

In July 2019, the FDA made its second major advance in Cyclospora detection, completing studies that resulted in a novel, validated method to test agricultural water for the presence of the parasite. Water used on farms is a potential source of the contaminants that cause foodborne illnesses. Analysts from FDA laboratories are being trained in the use of this method for regulatory testing. 

Super sanitation cleaning: Caribbean Princess cruise ship turned back to US after more than 300 catch gastro bug

The Princess Cruises’ Caribbean Princess Ship left the U.S. on Feb 2 — and after more than a week at sea, was forced to turn back to the U.S. early when it was denied entry to the Caribbean.

The Caribbean Princess was set to have a 14-day trip around the Caribbean, but was forced to turn back to the U.S.

The cruise’s early return comes after it was denied entry to Trinidad and Tobago by the Government of Barbados due to the outbreak on board, according to a statement from the Ministry of Health.

Princess Cruises said in a statement to The Sun that the ship, which was on a 14-day cruise in the Caribbean, is now on its way back to the Port of Everglades in Fort Lauderdale.

The Caribbean Princess ship is scheduled to dock at 7 a.m. on Thursday, three days ahead of its previous Feb. 16 return.

A total of 299 passengers and 22 crew members of the 4,196 people on board got sick with a gastrointestinal bug, causing vomiting and diarrhea.

Princess Cruises said the cruise has “curtailed its voyage out of an abundance of caution due to guests reporting symptoms due to a mild gastrointestinal illness,” in a statement to The Sun.

The ship will undergo a “super sanitation cleaning” when it reaches the Florida port, according to a statement from the CDC.

WHO chimes in: Risk of Vibrio

There has been an increase in reported outbreaks and cases of foodborne disease attributed to pathogenic Vibrio species. As a result, there have been several instances where the presence of pathogenic Vibrio spp. in seafood has led to a disruption in international trade. The number of Vibrio species being recognized as potential human pathogens is increasing. The food safety concerns associated with these microorganisms have led to the need for microbiological risk assessment to support risk management decision making for their control.

V. parahaemolyticus is considered to be part of the autochthonous microflora in the estuarine and coastal environments in tropical to temperate zones. Food safety concerns have been particularly evident with V. parahaemolyticus. There have been a series of pandemic outbreaks of V. parahaemolyticus foodborne illnesses due to the consumption of seafood. In addition, outbreaks of V. parahaemolyticus have occurred in regions of the world where it was previously unreported. The vast majority of strains isolated from patients with clinical illness produce a thermostable direct haemolysin (TDH) encoded by the tdh gene. Clinical strains may also produce a TDH-related haemolysin (TRH) encoded by the trh gene. It has therefore been considered that those strains that possess the tdh and/or trh genes and produce TDH and/or TRH should be considered those most likely to be pathogenic. V. vulnificus can occasionally cause mild gastroenteritis in healthy individuals following consumption of raw bivalve molluscs. It can cause primary septicaemia in individuals with chronic pre-existing conditions, especially liver disease or alcoholism, diabetes, haemochromatosis and HIV/AIDS. This can be a serious, often fatal, disease with one of the highest fatality rates of any known foodborne bacterial pathogen.

The 41st Session of the Codex Committee on Food Hygiene (CCFH) requested FAO/WHO to convene an expert meeting to address a number of issues relating to V. parahaemolyticus and V. vulnificus including:

  • conduct validation of the predictive risk models developed by the United States of America based on FAO/WHO risk assessments, with a view to constructing more applicable models for wider use among member countries, including adjustments for strain virulence variations and ecological factors;
  • review the available information on testing methodology and recommend microbiological methods for Vibrio spp. used to monitor the levels of pathogenic Vibrio spp. in seafood and/or water; and,
  • conduct validation of growth rates and doubling times for V. parahaemolyticus and V. vulnificus in Crassostrea virginica (Eastern or American oyster) using strains isolated from different parts of the world and different bivalve molluscan species.

The requested expert meeting was held on 13-17 September 2010, and this report is the outcome of this meeting. Rather than undertaking a validation exercise, the meeting considered it more appropriate to undertake an evaluation of the existing risk calculators with a view to determining the context to which they are applicable and potential modifications that would need to be made to extend their application beyond that context. A simplified calculator tool could then be developed to answer other specific questions routinely. This would be dependent on the availability of the appropriate data and effort must be directed towards this.

The development of microbiological monitoring methods, particularly molecular methods for V. parahaemolyticus and V. vulnificus is evolving rapidly. This means the identification of any single method for the purposes of monitoring these pathogens is challenging and also of limited value as the method is likely to be surpassed within a few years. Therefore, rather than making any single recommendation, the meeting considered it more appropriate to indicate a few of the monitoring options available while the final decision on the method selected will depend to a great extent on the specific purpose of the monitoring activity, the cost, the speed with which results are required and the technical capacity of the laboratory.

The meeting considered that monitoring seawater for V. parahaemolyticus and V. vulnificus in bivalve growth and harvest areas has limited value in terms of predicting the presence of these pathogens in bivalves. A linear relationship between levels of the vibrios in seawater and bivalves was not found and whatever relationship does exist can vary between region, the Vibrio spp. etc. Also, the levels of Vibrio species of concern in seawater tend to be very low. This presents a further challenge as the method used would need to have an appropriate level of sensitivity for their detection. Nevertheless, this does not preclude the testing of seawater for these vibrios; for example, in certain situations testing can provide an understanding of the aquatic microflora in growing areas. Monitoring of seafood for these pathogenic vibrios was considered the most appropriate way to get insight into the xii levels of the pathogens in these commodities at the time of harvest. Monitoring on an ongoing basis could be expensive, so consideration could be given to undertaking a study over the course of a year and using this as a means to establish a relationship between total and pathogenic V. parahaemolyticus and V. vulnificus in the seafood and abiotic factors such as water temperature and salinity. Once such a relationship is established for the harvest area of interest measuring these abiotic factors may be a more cost-effective way of monitoring. The meeting undertook an evaluation exercise rather than attempting to validate the existing growth models. The experts considered the JEMRA growth model for V. vulnificus and the FDA growth model for V. parahaemolyticus were appropriate for estimating growth in the American oyster (Crassostrea virginica). The JEMRA growth model for V. vulnificus was appropriate for estimating growth in at least one other oyster species, Crassostrea ariakensis. The FDA model for V. parahaemolyticus was also appropriate for estimating growth in at least one other oyster species, Crassostrea gigas, but was not appropriate for predicting growth in the Sydney rock oyster (Saccostrea glomerata). There was some evidence that the V. parahaemolyticus models currently used over predict growth at higher temperatures (e.g. > 25 °C) in live oysters. This phenomenon requires further investigation. Growth model studies were primarily undertaken using natural populations of V. parahaemolyticus as these were considered to be the most representative. Data were limited and inconsistent with respect to the impact of the strain on growth rate although recent studies in live oysters suggest differences exist between populations possessing tdh/trh (pathogenic) versus total or non-pathogenic populations of V. parahaemolyticus. There was no data to evaluate the performance of the growth models in any other oyster species or other filter feeding shellfish or other seafood and as such its use in these products could not be supported. If the models are used there should be a clear understanding of the associated uncertainty. This indicated a data gap which needs to be addressed before the risk assessments could be expanded in a meaningful manner.

Risk assessment tools for vibrio parahaemolyticus and vibrio vulnificus associated with seafood, 2020

World Health Organization

https://apps.who.int/iris/bitstream/handle/10665/330867/9789240000186-eng.pdf?sequence=1&isAllowed=y

Storytelling is vital, so is content: Doctors on TikTok try to go viral

For decades, sex education in the classroom could be pretty cringey. For some adolescents, it meant a pitch for abstinence; others watched their teachers put condoms on bananas and attempt sketches of fallopian tubes that looked more like modern art.

Me and my veterinarian first wife had no qualms about explaining biological reality to our young daughters– no stork, no parthenogenesis, no saviour prince.

Emma Goldberg of New York Times writes that on TikTok – which my children are still trying to explain to me — sex ed is being flipped on its head. Teenagers who load the app might find guidance set to the pulsing beat of “Sex Talk” by Megan Thee Stallion.

A doctor, sporting scrubs and grinning into her camera, instructs them on how to respond if a condom breaks during sex: The pill Plan B can be 95 percent effective, the video explains.

The video is the work of Dr. Danielle Jones, a gynecologist in College Station, Tex., and so far has racked up over 11 million views. Comments range from effusive (“this slaps”) to eye-rolling (“thanks for the advice mom” and “ma’am, I’m 14 years old”).

 “My TikTok presence is like if you had a friend who just happens to be an OB/GYN,” Dr. Jones said. “It’s a good way to give information to people who need it and meet them where they are.”

Dr. Jones is one of many medical professionals working their way through the rapidly expanding territory of TikTok, the Chinese-owned short-form video app, to counter medical misinformation to a surging audience. The app has been downloaded 1.5 billion times as of November, according to SensorTower, with an audience that skews young; 40 percent of its users are ages 16 to 24.

That would be the food service audience. Guess I better get hip.

I’ve learned to text more. Seems like an entire generation missed e-mail.

Although medical professionals have long taken to social media to share healthy messages or promote their work, TikTok poses a new set of challenges, even for the internet adept. Popular posts on the app tend to be short, musical and humorous, complicating the task of physicians hoping to share nuanced lessons on health issues like vapingcoronavirusnutrition and things you shouldn’t dip in soy sauce. And some physicians who are using the platform to spread credible information have found themselves the targets of harassment.

Dr. Rose Marie Leslie, a family medicine resident physician at the University of Minnesota Medical School, said TikTok provided an enormous platform for medical public service announcements.

“It has this incredible viewership potential that goes beyond just your own following,” she said.

Dr. Leslie’s TikToks on vaping-associated lung diseases drew over 3 million views, and posts on the flu and HPV vaccines also reached broad audiences beyond her hospital.

Striking a chord on TikTok, Dr. Leslie said, means tailoring medical messaging to the app’s often goofy form. In one post, she advised viewers to burn calories by practicing a viral TikTok dance. She takes her cues from teen users, who often use the app to offer irreverent, even slapstick commentary on public health conversations. She noted one trend in which young TikTokers brainstormed creative ways to destroy your e-cigarette, like running it over with a car.

TikTok’s executives have welcomed the platform’s uses for medical professionals. “It’s been inspiring to see doctors and nurses take to TikTok in their scrubs to demystify the medical profession,” said Gregory Justice, TikTok’s head of content programming.

Earlier this month, Dr. Nicole Baldwin, a pediatrician in Cincinnati, posted a TikTok listing the diseases that are preventable with vaccines and countering the notion that vaccines cause autism.

Her accounts on TikTok, Twitter, Facebook and Yelp were flooded with threatening comments, including one that labeled her “Public Enemy #1” and another that read, “Dead doctors don’t lie.”

A team of volunteers that is helping Dr. Baldwin monitor her social media has banned more than 5,200 users from her Facebook in recent weeks.

Dr. Baldwin said she started out feeling enthusiastic about the opportunity TikTok provides to educate adolescents, but her experience with harassment gave her some pause.

 “There’s a fine line physicians are walking between trying to get a message out that will appeal to this younger generation without being inappropriate or unprofessional,” Dr. Baldwin said. “Because of the short content and musical aspect of TikTok, what adolescents are latching onto is not the professional persona we typically put out there.”

From the duh files: Corinthian Foods recalls fish nuggets mislabeled as chicken nuggets

Corinthian Trading, Inc./DBA Corinthian Foods is recalling 5 lb. retail bags of Uncooked Sweet Potato Crusted Alaska Pollack Nuggets 1 oz. with date code CF35319 due to mislabeling. The bag contains Chicken Nuggets instead of Fish Nuggets. The product is packaged in clear 5 lb. bags with a white label with black writing.

Product was distributed in the state of Michigan, and may reach consumers through retail stores.

All allergens are properly declared, and no illness have been reported.

The problem was discovered when cases were opened to put out for retail sale, and the label on the retail package did not match the label and description of the master case. Subsequent investigation indicates the problem was caused during the packaging process. The incorrect labels were applied to the product causing the product to be mislabeled.

Oh no, not the nuts: Listeria found in Superfood Smoothie Kits

From a company announcement (and stop with the super foods BS; food is food):

Blendtopia Products, LLC is voluntarily recalling 29,078 cases of 7 ounce frozen Blendtopia brand Superfood Smoothie Kits because of potential contamination with Listeria monocytogenes.

The smoothie blends affected include: Blendtopia brand “Glow”, “Detox”, “Energy”, “Immunity” and “Strength” Superfood Smoothie Kits. The impacted product is labeled as “Best By July 2021, Best By Oct 2021, and Best By Nov 2021”. Product was distributed nationwide and is sold at select retailers and through online sales.

The company discovered the issue through its quality control processes. The issue is believed to be isolated to a supplied ingredient. The products are being voluntarily recalled as a precaution, with the health and safety of consumers as top priority and in full cooperation with the FDA. There have been no reports of sickness or illness to date associated with any consumption of products related to this recall.

“Food safety is our highest priority, and we’re committed to assuring consumers can have full confidence in our products,” said Tiffany Taylor, founder of Blendtopia.

Uh huh.

Before Corona virus: Handwashing works, but requires proper tools (soap, vigorous waterflow and friction, paper towels)

The risk for a global transmission of flu‐type viruses is strengthened by the physical contact between humans and accelerated through individual mobility patterns. The Air Transportation System plays a critical role in such transmissions because it is responsible for fast and long‐range human travel, while its building components—the airports—are crowded, confined areas with usually poor hygiene.

Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) consider hand hygiene as the most efficient and cost‐effective way to limit disease propagation. Results from clinical studies reveal the effect of hand washing on individual transmissibility of infectious diseases. However, its potential as a mitigation strategy against the global risk for a pandemic has not been fully explored. Here, we use epidemiological modeling and data‐driven simulations to elucidate the role of individual engagement with hand hygiene inside airports in conjunction with human travel on the global spread of epidemics.

We find that, by increasing travelers engagement with hand hygiene at all airports, a potential pandemic can be inhibited by 24% to 69%. In addition, we identify 10 airports at the core of a cost‐optimal deployment of the hand‐washing mitigation strategy. Increasing hand‐washing rate at only those 10 influential locations, the risk of a pandemic could potentially drop by up to 37%. Our results provide evidence for the effectiveness of hand hygiene in airports on the global spread of infections that could shape the way public‐health policy is implemented with respect to the overall objective of mitigating potential population health crises.

Hand-hygiene mitigation strategies against global disease spreading through the air transportation network

Risk Analysis

Christos Nicolaides, Demetris Avraam, Luis Cueto‐Felgueroso, Marta C. González, Ruben Juanes

https://doi.org/10.1111/risa.13438

https://onlinelibrary.wiley.com/doi/full/10.1111/risa.13438#.XkIFeNVlfWw.twitter

No one here gets out alive: Doors’ food porn

I still get shivers when I listen to Robby Krieger’s solo on L.A. Woman or his pounding lead on Morrison Hotel.

December 1969, Los Angeles, California, USA — The Doors at the Morrison Hotel — Image by © Henry Diltz/CORBIS

I was a huge Doors’ fan when I was a teenager.

It’s a phase most of us embrace and then grow out of.

The Doors’ iconic album, Morrison Hotel, was released exactly 50 years ago, today, on February 9th, 1970.

On the eve of the album’s half-centennial anniversary, rock stars collided at West Hollywood’s Sunset Marquis Hotel where music lovers and legends fêted the 50th anniversary of Morrison Hotel.

Hosted by industry trailblazers John Varvatos and Timothy White and sponsored by Jack Daniels, the homecoming celebration paid homage to the record’s release 50 years ago with poolside performance helmed by The Doors’ guitarist and co-founder, Robby Krieger.

Robby Krieger and Tangiers Blues Band – (a NYC group who have shared the stage with artists such as Bruce Springsteen, Eddie Vedder, Brandi Carlisle, and many more) – along with an impressive roster of acclaimed musicians lent their respective talents to some of The Doors’ time-honored greatest hits. 

Everyone’ got a camera Red Rooster Australia edition

Nick Hall of Franchise Business reports fast food chain Red Rooster has made the drastic decision to shut two Perth outlets after leaked photos raised concerns over food safety.

Images posted on Facebook appear to show cooked chickens piled into the back of a Red Rooster delivery vehicle; unwrapped, unrefrigerated and in seemingly unsanitary condition.

Furthermore, reports suggest the chickens were being transported on day when the Perth sun was at its deadliest.

Social media users slammed the outlet for its unsanitary practices, with many questioning why the chickens were placed in the back of the car in the first place.

“To me this looks like a store has ran out of chicken and someone has transferred these from one store to another,” one user speculated.

In response to the alleged food safety breaches, Red Rooster quickly moved to close Forrestfield store, along with another in Waypoint also under the same franchisee’s direction.

In a statement, Red Rooster confirmed that the stores would remained closed until investigations were finalised.

“These stores will remain closed while detailed investigations are conducted, required actions are taken and we are satisfied that the operating standards of these locations meet the high expectations of our strict brand standards,” the brand said.

“We have alerted the relevant authorities and are working with them closely while our local staff on the ground undertake the investigation and actions required to meet our brand standards.”

Chipotle: The food safety gift that keeps on giving

In a previous life I was the scientific advisor for the Canadian Council of Grocery Distributors.

We would meet a couple of times a year, and I would provide my food safety thoughts on what was going on at retail, but what struck me was that the first three hours of every meeting were like a self-help therapy session.

These heads of food safety at major Canadian retailers would bemoan their diminishing status at the corporate level: No one cares about food safety until there’s an outbreak. Twenty years later, the song remains the same.

Alexis Morillo of Delish writes that Chipotle workers claim that food safety practices are at risk at the fast casual restaurant due to managerial procedures that cause workers to “cut corners.”

A total of 47 current and former Chipotle workers from New York City locations came forward about the malpractice in a report to Business Insider. This news follows recent allegations that the company has been violating child labor laws.

In the report obtained by Business Insider, workers outlined concerns about the way things are done behind the scenes at Chipotle. It said that many incentives like pay bonuses let other responsibilities like cleanliness audits and food safety fall to the wayside.

Workers said in the report that working at Chipotle is “highly pressurized environment” with goals that include “minimizing labor costs.”

It was also said that managers are often told in advance when a restaurant will be inspected for cleanliness so they can be prepared. Meanwhile, when an inspection isn’t taking place the cleanliness standard is much more laid back. In the past, people have questioned Chipotle’s safety standards because of the E. Coli outbreak a couple years back. The chain also has an interesting sick day policy, where there are on call nurses for workers to check if they’re actually sick.

Chipotle said in a statement to Delish that the company is committed to safe food and a safe work environment and that the pay bonuses actually incentivize workers to be even more precise when following company policies.

The song remains the same.