It’s not OK to swim with diarrhea; safe swimming in Utah after cryptosporidiosis outbreak, 2008–2009, 5,700 sickened

It matters what’s done after people barf. Same if people have diarrhea – in a pool.

During the summer of 2007, almost 6,000 people in Utah started barfing from Cryptosporidium, transmitted via the barfblog fav, fecal-oral route

The U.S. Centers for Disease Control reports that of 1,506 interviewed patients with laboratory-confirmed cryptosporidiosis, 1,209 (80%) reported swimming in at least one of approximately 450 recreational water venues during their potential 14-day incubation period.

Cryptosporidium is extremely chlorine-tolerant, and secondary or supplemental disinfection with ultraviolet light or ozone can control but not prevent outbreaks. Because swimmers are the primary source of Cryptosporidium contamination, healthy swimming campaigns are needed to increase awareness and practice of healthy swimming behaviors, especially not swimming while ill with diarrhea (i.e., swimming while ill with diarrhea can lead to gross contamination of recreational water). Before the 2008 summer swimming season, Utah public health agencies launched a multimedia healthy swimming campaign. To assess knowledge of healthy swimming, a survey of Utah residents was conducted during July–September 2008. The results of that survey found that 96.1% of respondents correctly indicated that "it is not OK to swim if you have diarrhea."

In a separate national survey in 2009, 100% of Utah residents but only 78.4% of residents of other states correctly indicated that "not swimming while ill with diarrhea protects others from recreational water illnesses (RWIs)." No recreational water–associated outbreaks were detected in Utah during 2008–2011. The healthy swimming campaign, as part of a multipronged prevention effort, might have helped prevent recreational water–associated outbreaks of cryptosporidiosis in Utah.

Before the 2008 summer swimming season, Utah’s state and local public health agencies teamed with community partners to control recreational water–associated transmission of Cryptosporidium. For example, the Salt Lake Valley Health Department (SLVHD) collaborated with pool operators to establish fecal incident–response protocols and install secondary or supplement disinfection systems to inactivate Cryptosporidium at 75 treated recreational water venues.

SLVHD also collaborated with the Utah Department of Health and diagnostic laboratories to expedite reporting of cryptosporidiosis cases to public health authorities. To engage the public in prevention, SLVHD led efforts to disseminate healthy swimming messages via a website, two television advertisements, public service radio announcements, and posters at pools (e.g., "A Swimming Pool is Like a Community Bathtub"). In addition, targeted messages were disseminated to schools, competitive water sports teams, and licensed childcare facilities. SLVHD also conducted a press conference during Recreational Water Illness and Injury Prevention Week, which is held each year the week before the Memorial Day holiday.

The complete report is available at

Socializing for the holiday – food safety style

Michéle Samarya-Timm, a registered environmental health specialist with the Somerset County Department of Health in New Jersey (represent) writes:

Thanksgiving Day, as its name implies, is a time to give thanks. Many of us will travel far and wide to be with those who are important in our lives – you know – those whom we have been texting and Facebooking all year. In Thanksgivings past, socializing meant gathering with friends, family, loved ones and straggler students to share good food and good times. These days, being social around the holiday dinner table also takes on the meaning of regularly corresponding to all and sundry (a.k.a. our extended friends) about the food, the people, the football game, and the current goings on.

Modern technology and connectivity can be a wonderful thing for holiday fun.

Through sites like YouTube and Hulu, we can relive our favorite virtual Thanksgiving food safety moments –

“As God is my witness, I thought turkeys could fly.” (WKRP)

“I can’t cook a Thanksgiving dinner. All I can make is cold cereal and maybe toast.” (A Charlie Brown Thanksgiving)

“If I cook the stuffing inside the turkey, is there a chance I could kill my guests?” (The West Wing).

Ever consider that the same modern technology and connectivity can also function as an essential ingredient to safely feed ourselves and others. No one wants to relive Thanksgiving dinner ad nauseum. Surely we all have stories about Thanksgivings that didn’t quite go as planned…Why take a chance that this year will top them all?

With electronic media and the web, we have everything we need at our fingertips, through on-demand videos, online metasearches, and virtual recipe collections. This year, put your laptops and iPhones to good use and avoid kitchen and food safety disasters by expanding your social network to include a few essential friends.

Share info on your favorite food safety apps with your loved ones – both those next to you and those virtually connected. Along with forwarding tidbits about Uncle’s Bob’s latest joke, or debating the aesthetic value of melting marshmallow peeps on sweet potatoes, you can help assure that while Thanksgiving gatherings may wreak havoc on the nerves, digestive systems won’t be affected.

Selected web apps:
Ask Karen:
Butterball mobile site:
bites – Safe Food from Farm to Fork

Traditional phone:
Butterball Turkey Hotline: 1-800-288-8372
Reynolds Turkey Hotline: 1-800-745-4000
USDA Meat and Poultry Hotline: 1-800-535-4555
Doug Powell: deliberately unlisted ? 785-317-0560

Michéle Samarya-Timm is thankful for the many unnamed professionals who work to assure a safer food supply.

Food safety story time: researchers find stories can help improve food safety behavior

I never thought Chapman would finish — his degree, his fantasy football, and especially this paper.

We’ve been talking about food safety stories since at least 2002. I knew from research done in the 1990s about food and dieting and the power of exemplars – personal examples to get people’s attention. Chapman dug into the literature and found references going back decades.

The storytelling approach has underpinned much of what we’ve done over the past seven years, including food safety infosheets and the posts in Now we, along with our colleague Tanya MacLaurin of Guelph (who used to be at Kansas State, go figure) can say, see, these things work. And here’s how it’s done.

From the K-State press release this morning:

Food safety advice may fail because it’s too prescriptive — wash your hands, use a thermometer — and it often doesn’t include stories to make such information relevant. Researchers at North Carolina State University, Kansas State University and the University of Guelph have found that using short food safety stories with vibrant graphics can be a better training tool for food service workers.

A new paper by the researchers in the British Food Journal details the concept, creation and distribution of food safety infosheets, like those found at These single-page posters are created around a current food safety issue or outbreak, and are supplemented with graphics and information targeted at the food service industry. The infosheets are used to provide food safety risk-reduction information to generate behavior change and support a food safety culture.

"Food safety infosheets were designed with the goal of communicating risk reduction messages with the objective of changing behavior," said Ben Chapman, assistant professor in the department of 4-H youth development and family and consumer sciences at North Carolina State. "These infosheets differ from much of what is currently used in training, because we focus on the consequences of mishandling food by providing real examples taken from recent events."

A recent food safety infosheet detailed an outbreak of E. coli O157 linked to a festival in Winnipeg, Canada, that sickened 40. Another focused on food preparation and cooling for large crowds, sparked by an outbreak at a church turkey dinner in Kansas that sickened 159.

"Whether it’s a waitress, a line cook or the stock boy, people learn through stories," said Doug Powell, an associate professor of food safety at K-State. "We want to reach out to the last person who touched your food and make it safer."

Over the course of two years and using multiple methods, food safety infosheets transformed from a text-heavy memo to compelling, story-laden posters supported with contextual messages on what a food handler could do to reduce food safety risks, according to the researchers.

As part of the design phase of the infosheets, Chapman spent 185 hours working as a dishwasher in a local restaurant.

"We felt it was important to really immerse into the culture of a food handler, and get a better understanding of what types of conversations occurred and what the hierarchy was like," Chapman said. "The experience directed us to refocus our messages to be a bit edgier and include references to celebrity and music where possible."

Food safety infosheets at are created semi-weekly and are posted in restaurants, retail stores and on farms. They also are used in training throughout the world. Since September 2006 more than 150 food safety infosheets have been produced. They are available for download at no cost. The website has been recently redesigned, adding a search function, automatic e-mail alerts and RSS feeds. The new database is also sortable by pathogen, location and risk factor.

Citation and abstract:
Food safety infosheets: Design and refinement of a narrative-based training intervention
British Food Journal, Vol. 113 Iss: 2 (pre- print edition)
Benjamin Chapman, Tanya MacLaurin and Doug Powell

Purpose – Despite extensive investments in food handler training, research suggests that training programs are inconsistent, and rarely evaluated for efficacy. The generic prescriptive content and school-like delivery methods used in current food safety training may be a barrier to application. The purpose of this research was to develop a food safety communication tool, food safety infosheets, targeted specifically to foodservice food handlers utilizing popular media stories to illustrate the consequences of poor food handling.

Design/methodology/approach – Food safety infosheets were designed to be surprising, connect food handlers’ actions and consequences, and generate discussion through a verbal narrative framework. A Delphi-like exercise (n = 19), a posting pilot (n = 8) were carried out to assess the appropriateness of the concept of food safety infosheets. An intense participatory ethnographic study with an Ontario, Canada restaurant, and in-depth interviews with food service operators in Manhattan, Kansas, and Lansing, Michigan (n = 17) were conducted to gather qualitative data on the food service kitchen environment, including barriers to food safety practices, and the communication preferences of those who work in such kitchens.

Findings – The expert group, foodservice operators, and food handlers accepted food safety infosheets as an appropriate concept and valued storytelling as an effective communication strategy. Learning in the kitchen environment is largely hands-on and visual, and time pressure dictates practices. It is often difficult to attract and keep the attention of food handlers. Storytelling, celebrity and local outbreaks are of interest to the target audience.

Originality/value – This research provides a blueprint for the design and refinement of food safety communication tools targeted towards a specific audience. By utilizing multiple methodologies, this article provides a framework for other researchers to follow.

The secrets of a salmonella outbreak; over 100 sick

There are now over 100 sick with salmonella in France linked to hamburgers, primarily school kids, so as in the U.S., questions are being raised about food safety standards and procedures for products purchased by the school lunch program. After a USA Today expose last year, the U.S. asked microbiologist Gary Acuff to lead a panel to review and improve school lunch purchases.

My friend, Albert Amgar, wrote a particularly incisive blog post about the culture of food safety secrecy in France. Amy translated and excerpts follow:

The food poisoning outbreak caused by Salmonella in ground beef patties has raised many questions.

Of course, communication has been, as usual, opaque, but now the school cafeteria’s contract for the hamburgers is itself classified top secret, according to a Nov. 6 article by Emmanuel Coupaye of Centre, the newspaper for Vienne.

This journalist is asking questions: What are the established purchasing criteria for ground meat in the middle schools and high schools? After contamination, the question is disturbing.

Apart from the contamination of hamburgers with salmonella, "What is more upsetting is the National Education’s current difficulty in providing accurate information about the selection of products offered in school cafeterias. Since Thursday (November 4 – aa), we’ve been looking for an answer to a simple question: What are the selected criteria used in sourcing ground meat for Poitiers’ middle schools and high schools? Many parents as well as cattle farmers were surprised to learn that the meat for the hamburger patties was supplied by a foreign producer."

On Thursday, the manager of the high school, contacted by our editorial staff saw no problem with providing us a copy of the contract. We only had to come by the school yesterday morning (Friday, Nov. 5). Our goal was to know what are the established criteria for sourcing ground meat (French, EU or other) and the quality threshold (dairy breed, meat breed, meat with a seal of quality). But then, yesterday morning, after a night of reflection, the answer was no.

"I cannot give you this document," stated the school principal.

By late afternoon, the rector stated that he "did not have any information to add." Too bad the Ministry of Education’s website still boasts, under the catering section, its dual requirement "to maintain nutritional quality" and "better inform parents” (especially on issues related to food safety – aa).

In conclusion, the only thing left for us to do is to seize it through the Committee on Access to Administrative Documents!

I wish a lot of fun to those who would like to access these documents. Indeed, in France, transparency is often emphasized, but as pointed out in a recent book (Corinne Maier, Chao France, Flammarion, 2010) glasnost is not a French word. By comparison, the U.S. Congress passed a law on the freedom of information that requires the administration to establish clear standards to determine what documents can be classified as confidential, secret or top-secret, allowing citizens the right to challenge these classifications in court.

To be continued …

Going public with disease information: sooner the better

When to go public about health warnings – like potential outbreaks of foodborne disease – remains contentious. And no one is willing to come clean about it and say – this is when we go public and why. Or at least write it down. Bureaucrat 101 – write it down, have to do it; so don’t write it down.

I understand the flexibility public health types require to do their jobs effectively, but much of the public outrage surrounding various outbreaks – salmonella in tomatoes/jalapenos, 2008, listeria in Maple Leaf deli meats, 2008, the various leafy green recalls and outbreaks of 2010, and the delay in clamping down on Iowa eggs – can be traced to screw ups in going public.

It’s long been a tenet of risk communication that it is better to default to early public information rather than later. People can handle all kinds of information, especially when they are informed in an honest and forthright manner. In new research that seems directly applicable to going public about foodborne illness outbreaks, two mathematical biologists at the Georgia Institute of Technology and Marshall University in Huntington, West Virginia reported today that at the first sign of a disease pandemic, public health officials should begin strongly communicating about the extent of the outbreak and the steps that can be taken by the public to avoid infection

During outbreaks of serious infectious diseases, many individuals closely follow media reports and as a result, take precautions to protect themselves against the disease. These precautions may include staying home, getting vaccinated, avoiding crowds, using disinfectants, canceling travel plans and wearing face masks.

Known as "self-isolation," these precautions can significantly reduce the severity of an outbreak, according to mathematical modeling done by "The more forcefully the media provides information about pandemic infections and deaths, the more the total number of infections is reduced," said Howard Weiss, a professor in the Georgia Tech School of Mathematics. "Media coverage also reduces the maximum number of infections at any particular time, which is important for allocating the resources needed for treating infectious diseases."

The benefit of publicly reporting disease outbreaks seems obvious, and public health officials in the United States have a policy of regularly communicating with the news media about such incidents. But according to Weiss, not all world governments choose to communicate so well – and nobody had used rigorous mathematical techniques to study the impact of that communication before.

In a paper about the model submitted to a biostatistics journal and posted on the Physics arXiv blog, Mummert and Weiss describe testing their model with a hypothetical outbreak of Ebola Hemorrhagic Fever in Huntington – a college community of about 50,000 residents.

In their model, Mummert and Weiss did not look at such issues as the quality of news coverage, or what may happen if news reports turn out to be false or overstated. They also didn’t study the effect of individuals occasionally leaving their isolation to purchase food or medicine, for instance.

The paper cites the case of a false rumor spread across the Internet in 2003 about a restaurant worker in New York’s Chinatown who had supposedly died of the SARS infection. That rumor led to a decrease in travel to that area.

"In general, our advice to public health officials anywhere in the world is not to hold back," he added. "They should get out the news about infectious disease outbreaks loudly and quickly. It’s clear that vigorous media reporting can have a substantial effect on reducing the impact of an outbreak."

Two listeriosis cases investigated in Ontario

Ontario health officials are investigating two cases of listeriosis that appear to be linked to salami recalled from stores in Ontario and Quebec about three months ago.

The salami is sold by Siena Foods based in Toronto and was voluntarily recalled by the manufacturer on Dec. 21, 2009, the Canadian Food Inspection Agency said Wednesday. The best before date on the packaged meat is May 4, 2010.

Ontario health officials say they’ve been told two men became ill and are recovering at home. The officials wouldn’t say where the men live.

I understand the right to privacy, and the investigative angst regarding cases 3-months-old, but not releasing hometown information does little to jeopardize privacy and a lot to make sure others don’t come forward. And is this really the best various Canadian health bureaucrats can do in releasing timely information that may prevent others from barfing?

Canada: strive for mediocrity.

bites barfblog and food safety: information procedures

People often ask me, “Doug, how do you choose the information that goes in Do you have a basis for any of your food safety rants on barfblog? Why are you such a jerk?

People often ask Ben, “Why do you write so much about vomit?”

People often ask Amy, “Why are you with Doug?”

When we ran the food safety information centre back in Canada, we had detailed procedures for how to answer questions, what information was provided and why. We don’t answer questions so much anymore, but we do provide a lot of information so I figured we better clearly understand what we do and why. This is more for us and all the students that come through my lab than it is for you. Really, it’s me, not you. is a unique comprehensive resource for all those with a personal or professional interest in food safety. Dr. Powell of Kansas State University, and associates, search out credible, current, evidence-based information on food safety and make it accessible to domestic and international audiences through multiple media. Sources of food safety information include government regulatory agencies, international organizations such as the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), peer-reviewed scientific publications, academia, recognized experts in the field and other sources as appropriate.

Throughout all bites activities, the emphasis is on engaging people in dialogue about food-related risks, controls and benefits, from farm-to-fork. bites strives to provide reliable, relevant information in culturally and linguistically appropriate formats to assist people in identifying, understanding and mitigating the causes of foodborne illness.

The listserv is a free web-based mailing list where information about current and emerging food safety issues is provided, gathered from journalistic and scientific sources around the world and condensed into short items or stories that make up the daily postings. The listserv has been issued continuously since 1995 and is distributed daily via e-mail to thousands of individuals worldwide from academia, industry, government, the farm community, journalists and the public at large.

The listserv is designed to:

•    convey timely and current information for direction of research, diagnostic or investigative activities;
•    identify food risk trends and issues for risk management and communication activities; and
•    promote awareness of public concerns in scientific and regulatory circles.

The bites listserv functions as a food safety news aggregator, summarizing available information that can be can be useful for risk managers in proactively anticipating trends and reactively address issues. The bites editor, Dr. Powell, does not say whether a story is right or wrong or somewhere in between, but rather that a specific story is available today for public discussion. is where Drs. Powell, Chapman, Hubbell and assorted food safety friends offer evidence-based opinions on current food safety issues. Opinions must be evidence-based – with references – reliable, rapid and relevant. The barfblog authors edit each other – viciously.

Breaking food safety news items that eventually appear in bites or barfblog are often posted on Twitter for faster public notification.

Food safety infosheets are designed to influence food handler practices by utilizing four attributes culled from education, behavioral science and communication literature:

•    surprising and compelling messages;
•    putting actions and their consequence in context;
•    generating discussion within the target audiences’ environments; and
•    using verbal narrative, or storytelling, as a message delivery device.

Food safety infosheets are based on stories about outbreaks of foodborne illness sourced from the bites listserv. Four criteria are used to select the story: discussion of a foodborne illness outbreak; discussion of background knowledge of a pathogen (including symptoms, etiology and transmission); food handler control practices; and emerging food safety issues. Food safety infosheets also contain evidence-based prescriptive information to prevent or mitigate foodborne illness related to food handling. And now, available in French, Spanish and Portuguese.

bites bistro videos
A nod to the youtube generation, but we don’t really know what we’re doing.

The face of E. coli: Vancouver petting zoo edition

Although the Vancouver Coastal Health authority had identified a cluster of E. coli infections as early as last Thursday, no public health warning was issued, said spokeswoman Anna Marie D’Angelo.

All 13 cases that have presented so far are thought to be related to exposure to the the PNE petting zoo.

The Vancouver Sun reports that B.C.’s Medical Health Officer Dr. John Carsley, said,

“We were suspicious on Thursday when two cases were reported, then there were more on Friday. … “We wrestle very seriously with this issue of whether to do a public alert or not. It depends very much on the outbreak, and if there is a continued risk out there.”

The family of 14-month-old Jacklyn Simpson (above, right, photo from Vancouver Sun), who was stricken with the illness after visiting the petting zoo, believes that had they known about the outbreak, they might have been able to get help earlier.

That’s one of the reasons to issue public alerts – so additional illnesses can be prevented. E. coli O157 also spreads easily from person-to-person so public warnings may help reduce additional transmissions.

And it would be helpful if public health types would clearly articulate why they go public about foodborne illness outbreaks and when. Saying, "we wrestle with it,” does not enhance public confidence. Or prevent additional illnesses.

Duck and Cover: It’s Food Safety Education Month

Watching the pronouncements and proclamations for Food Safety Education month makes me think about kids in the 1950s getting educated about nuclear bombs: Duck, Cover and Roll.

In the film, below, substitute foodborne illness for atomic bomb, and substitute consumers have a role, for duck, cover and roll.

In a month of foodborne illness, the signal of impending doom is not an air raid siren, but more likely explosive diarrhea; you might even be out playing when it comes.

The advice in Duck and Cover is as useful in protecting against radiation as the advice from various government, industry and advocacy types is in preventing foodborne illness.

The failure that is Food Safety Education month

Linda Rivera (right, pic from Washington Post)  is the face of everything that is wrong with Food Safety Education month.

As The Washington Post reports this morning:

In Room 519 of Kindred Hospital, Linda Rivera can no longer speak.

Her mute state, punctuated only by groans, is the latest downturn in the swift collapse of her health that began in May when she curled up on her living room couch and nonchalantly ate several spoonfuls of the Nestlé cookie dough her family had been consuming for years. Federal health officials believe she is among 80 people in 31 states sickened by cookie dough contaminated with a deadly bacteria, E. coli O157:H7.

The impact of the infection has been especially severe for Rivera and nine other victims who developed a life-threatening complication known as hemolytic uremic syndrome. One, a 4-year-old girl from South Carolina, had a stroke and is partially paralyzed.

In a baffling waste of resources, groups like the International Food Information Council, have decided that food safety education month – that apparently starts today – is all about educating consumers with sanitized messages; that if consumers were only made aware they had a role to play in food safety, outbreaks related to contaminated peanut butter, produce and cookie dough would be reduced.

Whenever a group says the public needs to be educated – in this case about food safety — that group has utterly failed to present a compelling case for their cause. ??????I cringe, and remember a Lewis Lapham column I read in Harper’s magazine in the mid-1980s about how individuals can choose to educate themselves about all sorts of interesting things, but the idea of educating someone is doomed to failure. Oh, and it’s sorta arrogant to state that others need to be educated; to imply that if only you understood the world as I understand the world, we would agree and dissent would be minimized.???

Given all the outbreaks – produce, pet food, peanut butter, that have nothing to do with consumers, any food safety information – not education — campaign should include what the World Heath Organization has been advocating since 2002: source food from safe sources. An evaluation of message effectiveness should also be a bare minimum and rarely happens.

An honest Food Safety Education month would include food safety stories, tragic or otherwise, and a rigorous evaluation of what has worked, what hasn’t worked and what can be improved, rather than a checklist of ineffective and often inaccurate food safety instructions with the cumulative effect of blaming consumers. Telling people to wash their hands isn’t keeping the piss out of meals.

But judge for yourselves in what I am sure is a completely spontaneous and unscripted video from IFIC on why ordinary consumers feel they should be doing more.