30 dead, 139 sick from listeria in cantaloupe; a history of US food safety disasters

Before Al Gore invented the Internet in 1994, there was this thing called paper, which was useful for keeping records.

Those with a fetish in the macabre or statistics may care that the listeria-in-cantaloupe outbreak, which has now killed 30 and sickened 139, pales in comparison to past outbreaks.

Robert Tauxe, deputy director of the U.S. Centers for Disease Control and Prevention’s Division of Foodborne, Waterborne and Environmental Diseases told Elizabeth Weise of USA Today the deadliest documented foodborne illness outbreak in the United States was in the winter of 1924-1925, when typhoid in raw oysters from New York City killed approximately 150 people and sickened more than 1,500.

The second largest outbreak linked to food occurred in Boston in 1911. Then, streptococcus in raw, unpasteurized milk killed 48 people and sickened more than 2,000. The disease was described as "septic sore throat’ at the time, Tauxe says. Similar but smaller outbreaks like this one led to a national move to pasteurize milk in 1924 by the U.S. Public Health Service.

In 1922 in Portland, Ore., another outbreak of "septic sore throat" killed 22 people and sickened 487. That round of streptococcus was also linked to raw, unpasteurized milk.

And in 1919, an outbreak of botulism from olives put up in glass jars in California killed at least 15 people in three states. It resulted in a major change in how items were canned so that botulism would no longer be a problem.

But, Americans don’t want medical care like that practiced in 1919, nor should food production be rooted in some nostalgic past. Every death and illness from food is tragic, especially if preventable; what can be done to prevent this happening again? Telling consumers to wash cantaloupes in bleach is not a solution.

A table of cantaloupe-related outbreaks is available at http://bites.ksu.edu/cantaloupe-related-outbreaks.

US disease agency reaches abroad to stem outbreaks

Julie Steenhuysen of Reuters reports that when a patient in Uganda fell ill with Ebola virus last month, the advice of U.S. disease experts helped local officials contain its spread.

"You didn’t read about it in the papers because for the first time ever we identified a single case, not an outbreak," said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention.

The Atlanta-based CDC is expanding its involvement in cases of illness overseas, from helping track the source of the highly toxic E. coli outbreak in Germany to homing in on the cause of cholera in the aftermath of Haiti’s earthquake.

Frieden said during a tour of CDC headquarters in Atlanta that CDC has more than 50 staff members in outposts around the world, replicating a program it first implemented at home to teach state health authorities how to best contain outbreaks.

He was reluctant to criticize Germany’s handling of the recent E. coli outbreak, the deadliest ever recorded, which has sickened 4,000 people.

But Frieden said the United States recently had a small, three-state outbreak of the more common E. coli 0157:H7, part of a class of bacteria known as Shiga toxin-producing Escherichia coli, or STEC. The E. coli strain that caused the German outbreak was also in this class.

"There were just a tiny handful of cases, but because we do DNA fingerprinting, we knew they were linked and we very quickly identified hazelnuts as the source and had them pulled," Frieden said.

As a result, there were just eight cases in the United States. "That type of system is very important," Frieden said.

Driving in cars with girls and foodborne illness

I haven’t put on makeup, played video games or combed my hair while driving – because I never do any of those things – but I’ve done everything else in this pop survey released in May and discussed by my friend and his wife as they drove to Vermont and back.

According to the study:

• 72% eat food while driving.
• 35% have taken clothes off or put clothes on while driving.
• 29% have kissed others while driving and 15% have performed sexual acts while driving.
• 28% have sent text messages while driving.
• 23% say they’ve combed their hair while behind the wheel.
• 13% have put on makeup while driving.
• 12% have written or read e-mails while driving.
• 10% reported reading newspapers or magazines while driving.
• 5% confessed to having played video games.
• 5% say they have shaved while behind the wheel.

Yesterday the U.K.’s Daily Mail reported those who eat while driving could be at a greater risk of food poisoning.

Scientists testing swabs taken from a typical family car discovered Bacillus cereus and staphylococcus in the interior, including the steering wheel, gear stick and door handles.

Another pop science survey that is meaningless.

Dr Anthony Hilton, reader in microbiology at Aston University said,

“People would be horrified at the prospect of eating from a toilet seat however they ought to be aware that eating from a contaminated car dashboard may represent the same health hazards.”

Always a possibility. Another survey revealed 58 per cent of car owners had found food remains lying around the interior when cleaning out the car.

That doesn’t mean people eat it: hint, don’t eat the food lying around in a car.

Bryant will play for Lakers while barfing

Los Angeles Lakers star Kobe Bryant has a stomach illness but is expected to play against the Orlando Magic.

Lakers coach Phil Jackson said before Sunday’s game that Bryant would likely play despite being a little late to the game because of the illness.

It was unclear how Bryant contracted the illness, although Jackson speculated that the All-Star likely ate something that didn’t sit well.

Green Day postpones Australian gig; frontman Billie-Joe has foodborne illness

Rock band Green Day has postponed tpnight’s concert in Melbourne after lead singer Billie-Joe Armstrong came down with a case of suspected food poisoning.

A spokesthing for Frontier Touring Company said,

"Although Billie-Joe was determined to perform tonight it became apparent at 4.30pm (AEDT) today that he would be unable to take to the stage – particularly in light of the lengthy 2.5-3 hour show the band traditionally perform.”

The concert has been rescheduled to tomorrow night (December 16).

3 stricken with E. coli O157 in Washington State from raw milk; is that food safety hysteria?

Chapman wasn’t feeling particularly hysterical as he kept crapping himself while he was in Manhattan (Kansas) a couple of weeks ago and was then confirmed to be suffering from campylobacter.

I didn’t feel hysterical with my own case of the green apple splatters over the weekend while sitting in the backseat with Sorenne, as Amy drove the five hours to Lebannon, Missouri, for a Thanksgiving dinner with her father and family. I spent the six hours we were there in the bed or bathroom, along with the five hour drive home, topped off with an, uh, uncomfortable night.

Parents of children who have died from foodborne illness, like Mason Jones of the U.K., are not hysterical. I prefer to discuss the multiple food safety failures that led to the outbreak so that others can be prevented – fewer sick people, fewer grieving parents. That’s not hysterical.

And the three people who have been stricken with E. coli O157 linked to drinking raw, unpasteurized milk from the Dungeness Valley Creamery in Washington State, reported this afternoon by the Washington State Department of Health, probably don’t feel they are being hysterical.

No E. coli has been found in samples from the dairy’s current batch of milk, but during an investigation at the dairy, WSDA found the same bacteria that caused one of the illnesses.

That, according to would-be raw milk guru David Gumpert, would probably mean health types were being hysterical because they didn’t have better proof of causation.

While acknowledging in some sort of column-opinion piece released last week that there are tragic cases, Gumpert attempted to blow the lid off the foodborne-illness-sick-people-hype by saying the data are incomplete and then sets up the rhetorical strawperson thingy:

“So what’s behind the hysteria on foodborne illness? Clearly, part of it has to do with the dramatic cases being reported of individuals who have suffered serious long-term repercussions. … They are tragic.”

I wrote a book with a professor who liked to begin every other paragraph with, “Clearly …” Maybe with the perspective of hindsight things are clear, but when outbreaks are actually going on, things are confusing. I’m much more comfortable saying, “I don’t know, how can we find out more,” rather than, “Clearly.”

We didn’t write together again.

Gumpert also said in his piece last week, “But there’s another factor at work here as well: a drive to broadly expand the powers of the FDA.”

The government conspiracy angle.

Gumpert apparently has issues with the U.S. Food and Drug Administration, and says “if you examine the data on foodborne illness, you find a different sort of crisis—a crisis of credibility, based on ineffective and incomplete data gathering and investigation.”

It’s been that way for a long time, because of the uncertainties of investigating the incidence and causes of foodborne illness.

The FoodNet surveillance system was established within the U.S. Centers for Disease Control in 1995 to determine more precisely and to monitor better the burden of foodborne diseases and to determine the proportion of foodborne diseases which are attributable to specific foods and pathogens. Whatever criticisms and uncertainties exist, the establishment of FoodNet was revolutionary in better understanding the impact of foodborne illness.

For every known case of foodborne illness, there are 10 -300 other cases, depending on the severity of the bug.?????? Most foodborne illness is never detected. It’s almost never the last meal someone ate or whatever other mythologies are out there. A stool sample linked with some epidemiology or food testing is required to make associations with specific foods.

Foodborne illness is vastly underreported – it’s known as the burden of reporting foodborne illness, or the burden of illness pyramid (right), a model for understanding foodborne disease reporting. Someone has to get sick enough to go to a doctor, go to a doctor that is bright enough to order the right test, live in a State that has the known foodborne illnesses as a reportable disease, and then it gets registered by the feds. All of this happened for Chapman’s campylobacter.

FoodNet additionally conducts laboratory surveys, physician surveys, and population surveys to collect information about each of these steps.

The World Health Organization (WHO) estimated that up to 30 per cent of individuals in developed countries acquire illnesses from the food and water they consume each year. U.S., Canadian and Australian authorities support this estimate as accurate (Majowicz et al., 2006; Mead et al., 1999; OzFoodNet Working Group, 2003) through estimations from available data, active disease surveillance and adjustments for underreporting. WHO has identified five factors of food handling that contribute to these illnesses: improper cooking procedures; temperature abuse during storage; lack of hygiene and sanitation by food handlers; cross-contamination between raw and fresh ready to eat foods; and, acquiring food from unsafe sources.

Putative food safety legislative changes involving FDA set a minimal bar for food safety; it can be improved, but the best food producers and processors will go far beyond government standards, provide testing data and market food safety directly to consumers at retail – but only if the data exists to validate such claims.

Majowicz, S.E., McNab, W.B., Sockett, P., Henson, S., Dore, K., Edge, V.L., Buffett, M.C., Fazil, A., Read, S. McEwen, S., Stacey, D. and Wilson, J.B. (2006), “Burden and cost of gastroenteritis in a Canadian community”, Journal of Food Protection, Vol. 69, pp. 651-659. ??????

Mead, P.S., Slutsjer, L., Dietz, V., McCaig, L.F., Breeses, J.S., Shapiro, C., Griffin, P.M. and Tauxe, R.V. (1999), “Food-related illness and death in the United States”, Emerging Infectious Diseases, Vol. 5, pp. 607-625.

OzFoodNet Working Group. (2003), “Foodborne disease in Australia: Incidence, notifications and outbreaks: Annual report of the OzFoodNet Network, 2002”, Communicable Diseases Intelligence, Vol. 27, pp. 209-243.

For the love of God, take it back and next time use a thermometer

Restaurants are always faced with the problem of rapid staff turnover rates resulting in an on-going regime of constant training. Fair enough but are new staff being trained in food safety? In certain provinces only one staff in five on any given shift are required to have some sort of food safety training through a professional organization. Theoretically, on-site managers will have taken the course in the hopes of shedding some of that knowledge to their staff. The concern, however, is that some managers simply don’t care about food safety and information is not being relayed to front line service staff. That’s when typically the public, you, barf. It is one thing to train someone on the basics of food safety in a classroom setting but it is another thing to change ones’ behaviours and habits when dealing with issues on food safety. For instance, this is a picture of an undercooked chicken burger served to a customer during a lunch rush. The manager was more concerned about dealing with the influx of customers than paying attention to food safety, as a result the cooks followed suit and a raw burger was served. Managers have a responsibility to promote safe food practices and encourage staff to do the same. It apparently seems that attitudes and behaviours tend to change when something horrible happens, like a foodborne outbreak. It is time to be proactive and not reactive.

Where does foodborne illness happen–in the home, at foodservice, or elsewhere–and does it matter?

Casey Jacob did a nice job on this brief paper, responding to the suggestions of reviewers and, dare I say, developing as a writer.

Foodborne Pathogens and Disease published the abstract this evening, but not the full paper, by Jacob and Powell.

So here’s the abstract as a teaser.

Foodservice professionals, politicians, and the media are often cited making claims as to which locations most often expose consumers to foodborne pathogens. Many times, it is implied that most foodborne illnesses originate from food consumed where dishes are prepared to order, such as restaurants or in private homes. The manner in which the question is posed and answered frequently reveals a speculative bias that either favors homemade or foodservice meals as the most common source of foodborne pathogens. Many answers have little or no scientific grounding, while others use data compiled by passive surveillance systems. Current surveillance systems focus on the place where food is consumed rather than the point where food is contaminated. Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.

Guidelines for foodborne disease outbreak response

Proving there is a Council for everything, the Council to Improve Foodborne Outbreak Response released its Guidelines for Foodborne Disease Outbreak Response today.

The guidelines in this document are targeted to local, state and federal agencies and provide model practices used in foodborne disease outbreaks, including planning, detection, investigation, control and prevention. Local and state agencies vary in their approach to, experience with, and capacity to respond to foodborne disease outbreaks. The guidelines are intended to give all agencies a common foundation from which to work and to provide examples of the key activities that should occur during the response to outbreaks of foodborne disease. The guidelines were developed by a broad range of contributors from local, state and federal agencies with expertise in epidemiology, environmental health, laboratory science and communications. The document has gone through a public review and comment process.

The Guidelines document is not intended to replace current procedure manuals for responding to outbreaks. Instead, it is designed to be used as a reference document for comparison with existing procedures; to fill in gaps and update site-specific procedures; to provide models for new procedures where they do not exist; and to provide training to program staff. The document is available in electronic and hard-copy formats for state and local health departments.


CDC speaks: Surveillance for U.S. foodborne disease outbreaks, 2006

The U.S. Centers for Disease Control reports in tomorrow’s Morbidity and Mortality Weekly Report that foodborne illnesses are a major health burden in the United States . Most of these illnesses are preventable, and analysis of outbreaks helps identify control measures. Although most cases are sporadic, investigation of the portion that occur as part of recognized outbreaks can provide insights into the pathogens, food vehicles, and food-handling practices associated with foodborne infections.

In 2006, CDC reported 1,270 foodborne disease outbreaks (FBDOs) from all states and territories through the Foodborne Disease Outbreak Surveillance System (FBDSS), resulting in 27,634 cases of foodborne illness and 11 deaths. Among the 624 FBDOs with a confirmed etiology, norovirus was the most common cause, accounting for 54% of outbreaks and 11,879 cases, followed by Salmonella (18% of outbreaks and 3,252 cases). Among the 11 reported deaths, 10 were attributed to bacterial etiologies (six Escherichia coli O157:H7, two Listeria monocytogenes, one Salmonella serotype Enteritidis, and one Clostridium botulinum), and one was attributed to a chemical (mushroom toxin).

Among outbreaks caused by a single food vehicle, the most common food commodities to which outbreak-related cases were attributed were poultry (21%), leafy vegetables (17%), and fruits/nuts (16%). Public health professionals can use this information to 1) target control strategies for specific pathogens in particular foods along the farm-to-table continuum and 2) support good food-handling practices among restaurant workers and the public.