This is the CIDRAP summary of the latest CDC number crunching on microorganisms that lead to barfing.
The Centers for Disease Control and Prevention (CDC) late last week released a summary of foodborne illnesses in 2017 based on an annual analysis of data from the Foodborne Disease Outbreak Surveillance System, and norovirus was the most common pathogen reported, responsible for 46% of illnesses. Salmonella and Shiga toxin–producing Escherichia coli were also linked to a substantial number of outbreaks.
In 2017, the CDC tracked 841 foodborne outbreaks, which included 14,481 illnesses, 827 hospitalizations, 20 deaths, and 14 food product recalls. A single etiologic agent was confirmed in 395 outbreaks (47%), which are defined as two or more related cases.
Tainted seafood and poultry were tied with causing the most outbreaks, with mollusks (41 outbreaks), fish (37), and chicken (23) the specific food items most often implicated. The most outbreak-associated illnesses were from turkey (609 illnesses), fruits (521), and chicken (487), the CDC said.
California had the most outbreaks (107), followed by Ohio (69), and Washington state (67).
As in past years, restaurants with sit-down dining were the most commonly reported locations for food preparation associated with outbreaks (366).
My friend Tim Caulfield, a Canada Research Chair in Health Law and Policy at the University of Alberta, author of “Is Gwyneth Paltrow Wrong About Everything?: How the Famous Sell Us Elixirs of Health, Beauty & Happiness” (Beacon, 2015) and host of “A User’s Guide to Cheating Death” on Netflix (that’s a long bio) writes for NBC News, humans need water but the marketing of water as a detoxifying, energizing, health-enhancing, miracle beverage has become a lucrative business. Over the past few years the booming wellness industry (aka Big Wellness) has coopted this most basic of biological needs to sell products and promises of miraculous improved health. But is there any evidence to support the hydration hype?
Before I dump on the water business, let’s give a nod to the positives. There is growing recognition that sugary beverages are not a good choice, nutrition wise. Evidence suggests that consumption of sugary beverages, especially soft drinks, is associated with a range of health issues, including obesity and heart disease. As a result, there is a broad consensus among nutrition and public health experts about the value of limiting the consumption of these calorie-dense and relatively nutrition-free beverages.
So, in this context, the shift to water is a very good thing. But that doesn’t mean we have to buy what the “premium” water market is selling.
But before we get to the fancy packaging, we need to talk about volume. Do you actually need to drink eight glasses of water a day? In a word: Nope.
This strange and incredibly durable myth seems to have emerged from a misinterpretation of a 1945 US Food and Nutrition Board recommendation. That document suggested a “suitable allowance of water for adults is 2.5 litres daily” (i.e., roughly eight glasses a day). But what is almost always overlooked is that the recommendation — which was not based on a robust body of research — also noted “[m]ost of this quantity is in prepared foods.” In other words, you already get the bulk of your needed water from the food you eat.
In reality, there is no magical amount of water. We do need to stay appropriately hydrated, of course. And as our climate and activities change, so does the amount of water we lose through sweating etc. But our bodies are good at telling us how much and when we should drink. (Thanks, evolution.) And all liquids — coffee, tea, that weird fluid inside hotdogs — count toward your daily consumption of water. My body can’t tell if an H20 molecule came from a fresh-water spring on the side of a remote Himalayan mountain or from a cup of gas station java (which isn’t, despite conventional wisdom to the contrary, dehydrating).
But even if water is found in a lot of foods and beverages, pure bottled water is still better for us, right? Wrong again.
Yes, drinking plain water is almost always a better choice than some other, sugar-infused, beverage. But the water you drink doesn’t need to come out of a plastic, glass, or 24-karat gold (yes, that is a thing) bottle.
But bottled water tastes better, you say! Actually, blind taste tests have consistently found that to be untrue too. To cite just one example, only one-third of the participants in a Boston University study, were able to correctly identify tap water. One third thought it was bottled water and one third couldn’t tell the difference.
But bottled water tastes better, you say! Actually, blind taste tests have consistently found that to be untrue too.
And now we get to what is probably the biggest scam. Wellness wonks have been pushing absurd diets, supplements and potions for decades. Now that same thinking has come to water, with alkaline, hydrogen, gluten and GMO-free water brands hitting the supermarket and health food store shelves near you.
Nope, nope and — sigh — nope.
Alkaline water is part of the larger multimillion-dollar alkaline diet fad embraced by celebrities like New England Patriots quarterback Tom Brady. Proponents claim that humans can become too acidic and, as such, we need to consume foods and beverages that will lower the pH of our bodies. By doing so, we will improve our health and reduce the incidence of disease and cancer, the theory goes.
Problem two: You can’t change the pH of your body through food and beverages. So the entire premise is scientifically absurd. Your body tightly regulated the pH of your blood. It doesn’t need the help of overpriced bottled water.
Queen Elizabeth has a crafty way to avoid getting poisoned at the dinner table. A new documentary called Secrets of the Royal Kitchen explores the ins and outs of Buckingham Palace’s kitchens, including the lengths royal staffers go to keep Elizabeth safe. Here’s a quick look at all the interesting elements that go into a state banquet with the Queen.
During state banquets, Her Majesty’s staff are required to follow a serious protocol to keep her safe – and the lengths they go for her safety might surprise you.
A personal chef at the palace prepares the dishes for all of the guests. According to the New York Post, Elizabeth’s staff members then chose a random plate for her in an effort to prevent someone from poisoning her food.
The only way someone would be able to poison Queen Elizabeth is if they contaminated all of the dishes. This tactic has paid off so far, though we couldn’t imagine why someone would want to poison the Queen.
“After everything is plated up, a page chooses at random one of the plates to be served to her majesty,” Emily Andrews, a correspondent for the royals, shared. “So if anyone did want to poison the monarch they’d have to poison the whole lot.”
The documentary also revealed that banquet guests are required to follow some strict rules while dining with Elizabeth Queen.
This includes finishing their plates before Her Majesty is done eating. This is an old tradition that used to be more of an issue in the past as guests would race to finish their food. It is unclear if the palace requires visitors to follow this protocol or if they have gotten more flexible in recent years.
There are, of course, plenty of other traditions guests are required to follow whenever they are eating with the Queen.
For starters, nobody sits down until Elizabeth has been seated. You also cannot start eating until she has taken her first bite.
Elizabeth also has a personal menu that has been crafted to her liking. She schedules her meals three days in advance to give the palace chef plenty of time to gather ingredients.
When picking her dining options, Elizabeth crosses out dishes she doesn’t like. She also crosses out entire pages whenever she has a royal event that evening and will not be dining in the palace.
Eva Saiz of El Pais reports the owners of the food company responsible for the worst-ever listeriosis outbreak in Spain were arrested on Wednesday for manslaughter.
Since August, the outbreak has killed three people, caused seven miscarriages, and infected more than 200 people. The source of the bacterial infection was traced to a Seville-based company called Magrudis, which sold a contaminated pork loin product called carne mechada under the brand name La Mechá. Three more products produced by the company also tested positive for Listeria monocytogenes.
The owners of Magrudis, José Antonio Marín Pince and his two children Sandro and Mario, have been accused, to different degrees, of involuntary manslaughter, crimes against health and causing injury to a fetus.
“When the crisis broke, we reminded the business by email that one of their samples had been contaminated much earlier. Given that they did nothing, we passed on this information to the courts,” José Antonio Borrás, the owner of the Microal Group laboratory, told EL PAÍS.
The laboratory handed a report to the court in early September, and according to sources close to the investigation, the contents prompted Judge Pilar Ordóñez, who is overseeing the case, to take action on Tuesday.
Neither laboratories nor companies are legally obliged to warn the authorities if a product is found to test positive, but a company does have a duty to adopt measures to correct the problem. Investigators want to find out why the owners of Magrudis did not do this, and why, more importantly they hid the positive test results from health inspectors who visited the factory after the alert was raised. In public appearances, both Marín and his son Sandro claimed that the company had successfully passed all sanitary controls.
Traces of listeria were found in tests carried out on the Magrudis production line, including the oven carts used to transport the meat during the preparation process, and the larding needles used to inject the pork with fat before cooking. The crisis was complicated by the fact that the company’s products had been sold on to another firm and prepared for sale as an own-brand product in a supermarket chain without the proper labelling.
Food safety training is like psychotherapy: Sure, I understand the theory, the neural pathways, the addictive brain, but will that change my behavior (shurley not).
But there’s always hope – in place of well-designed studies that measure success, failure, and actual experiments with novel approaches. Most studies get tossed on the rhetorical pile of we-need-more-education crap.
Here’s the abstracts for two recent papers:
Effectiveness of food handler training and education interventions: A systematic review and analysis
Journal of Food Protection vol. 82 no. 10
Ian Young, Judy Greig, Barbara J. Wilhelm, and Lisa A. Waddell
Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings.
We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment.
We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; I2 = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases.
Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.
Gaps and common misconceptions in public’s food safety knowledge
Background: Incidence rates of some foodborne illnesses (FBIs) in BC still remain on the rise despite numerous initiatives to prevent FBIs. This rise over the years has been attributed to gaps in the public’s food-safety knowledge and practices. In order to decrease incidence rates and prevent future FBIs, efforts should be made to identify common misconceptions in the public’s food safety knowledge. With a focus on the Metro Vancouver population, common misconceptions in food safety were found and their knowledge level towards the misconceptions was analyzed.
Methods: An in-person survey was conducted in three locations in Metro Vancouver. The survey asked for demographics information, perceived food safety knowledge and food safety misconceptions. ANOVA and Independent Sample T-test were administered to analyze results.
Results: No statistically significant difference in food safety knowledge was found between groups by gender, age, and geographic region. The majority of participants rated their food safety knowledge as moderate but they demonstrated a poor knowledge level in food safety.
Conclusion: The public’s knowledge level should be improved to prevent further rises of FBIs. Initiatives involving the provincial Foodsafe certification program, secondary school curriculums and health authority websites can be utilized to educate the public.
The American Society for Microbiology says rubbing hands with ethanol-based sanitizers should provide a formidable defense against infection from flu viruses, which can thrive and spread in saliva and mucus. But findings published this week in mSphere challenge that notion — and suggest that there’s room for improvement in this approach to hand hygiene.
The influenza A virus (IAV) remains infectious in wet mucus from infected patients, even after being exposed to an ethanol-based disinfectant (EBD) for two full minutes, report researchers at Kyoto Profectural University of Medicine, in Japan. Fully deactivating the virus, they found, required nearly four minutes of exposure to the EBD.
The secret to the viral survival was the thick consistency of sputum, the researchers found. The substance’s thick hydrogel structure kept the ethanol from reaching and deactivating the IAV.
“The physical properties of mucus protect the virus from inactivation,” said physician and molecular gastroenterologist Ryohei Hirose, Ph.D, MD., who led the study with Takaaki Nakaya, PhD, an infectious disease researcher at the same school. “Until the mucus has completely dried, infectious IAV can remain on the hands and fingers, even after appropriate antiseptic hand rubbing.
The study suggests that a splash of hand sanitizer, quickly applied, isn’t sufficient to stop IAV. Health care providers should be particularly cautious: If they don’t adequately inactivate the virus between patients, they could enable its spread, Hirose said.
The researchers first studied the physical properties of mucus and found — as they predicted — that ethanol spreads more slowly through the viscous substance than it does through saline. Then, in a clinical component, they analyzed sputum that had been collected from IAV-infected patients and dabbed on human fingers. (The goal, said Hirose, was to simulate situations in which medical staff could transmit the virus.) After two minutes of exposure to EBD, the IAV virus remained active in the mucus on the fingertips. By four minutes, however, the virus had been deactivated.
Previous studies have suggested that ethanol-based disinfectants, or EBDs, are effective against IAV. The new work challenges those conclusions. Hirose suspects he knows why: Most studies on EBDs test the disinfectants on mucus that has already dried. When he and his colleagues repeated their experiments using fully dried mucus, they found that hand rubbing inactivated the virus within 30 seconds. In addition, the fingertip test used by Hirose and his colleagues may not exactly replicate the effects of hand rubbing, which through convection might be more effective at spreading the EBD. For flu prevention, both the Centers for Disease Control and Prevention and the World Health Organization recommend hand hygiene practices that include using EBDs for 15-30 seconds. That’s not enough rubbing to prevent IAV transmission, said Hirose. The study wasn’t all bad news: The researchers did identify a hand hygiene strategy that works, also sanctioned by the WHO and CDC. It’s simple: Wash hands, don’t just rub them. Washing hands with an antiseptic soap, they found, deactivated the virus within 30 seconds, regardless of whether the mucus remained wet or had dried.
Jess Davis of ABC News reports a frozen meringue was key to identifying and outbreak of Salmonella enteritidis (SE), a bacteria that until last year was not found in Australia, that sickened almost 200 people.
People first started getting sick in May 2018 and by July a cluster of cases had appeared in New South Wales. That was when health authorities started investigating.
“Health, through their investigations, were able to look at a number of isolates of Salmonella enteritidis that came from humans, who unfortunately had been ill, and use a technology called whole genome sequencing,” said NSW Food Authority CEO Lisa Szabo.
“So it’s a genetic-based technology that helps us join the dots, shall I say. And this was the first time they could see a group of people with the same whole genome sequence.”
Anyone with a confirmed case of SE was interviewed by investigators and asked for a detailed account of what they’d eaten — to try to find what the different cases had in common.
A few weeks after being interviewed, one of those people remembered they had a frozen meringue cake in their freezer, leftover from a birthday party, around the time they got sick.
Officers went to that person’s home, collected the cake and had it tested.
“We were able to isolate the Salmonella enteritidis and it had that same whole genome sequence. At the same time we could see who manufactured that cake,” Ms Szabo said.
“We could go back to the manufacturer, have a look at their environment, look at how they handle food and where they get their ingredients from, and that’s where we saw the connection to the egg farm.”
It wasn’t until September that the frozen meringue led investigators to a farm on the outskirts of Sydney, but by then the bacteria had slowly started spreading across the industry.
“Once we detected salmonella enteritidis on this particular farm, we then commenced another round of investigations … more from the biosecurity and then the farm side of trying to understand … [whether the] farm had other connections to other properties around the state” Ms Szabo said.
But how the bacteria made its way into Australian eggs in the first place is likely to remain a mystery.
One property in Victoria and 13 in NSW have been affected so far and more than half-a-million birds have been culled at a cost of $10 million.
The spread of SE has been blamed largely on the interconnected nature of the egg industry, with all the infected farms connected in some way.
Egg farmers often trade produce with each other, and equipment and workers also regularly move from farm to farm.
Veterinarian Rod Jenner said SE was difficult to contain because it could survive and multiply without a host and could live in the environment for up to two years.
“It can survive in dust and dirt, in vehicles, and can travel in the wind. Rodents, wild birds, that sort of thing, can carry it on their skin or in their bodies as well,” he said.
“So it has actually been demonstrated to travel vast distances and be contaminated, be deposited on other farms that have previously been free.”
A farmer’s worst nightmareBede Burke’s egg farm at Tamworth in NSW was the 11th property to be infected, with a notification it had tested positive to SE during a routine check just over three months ago.
“Your whole world crashes down around you, you know,” Mr Burke said.
“We just didn’t sleep for a week and that first seven or eight days was really traumatic. We had to learn how to both decontaminate and disinfect the premises.”
When the notification came through on the eve of the federal election, Mr Burke had to withhold his eggs from sale and was faced with the prospect of culling entire flocks.
“But then you’ve got heap of eggs on your premises, you can’t not stop packing eggs, we were still going to pack 90,000 eggs a day,” he said.
“It’s just stress beyond all belief and then start planning for the worst.”
But he was lucky the contamination was picked up early and while a swab of dirt and dust had tested positive, it hadn’t yet spread to his egg or birds.
There have been no confirmed cases of SE since June and the industry hopes that will be the end of it.
But the outbreak has raised serious questions about how biosecurity is managed. Despite the disease becoming a national problem, its enforcement and regulation is state-based.
Philip Szepe, who runs an egg farm at Kinglake in Victoria, tests for all strains of salmonella every three months.
But he’s concerned that not all farmers are as diligent and said biosecurity was too reliant on self-regulation.
“Government’s really good at responding to crisis. It’d be great if the Government had a bit more engagement with the industry around monitoring, surveillance and compliance,” he said.
Every year, studies about food handlers’ food safety knowledge, attitudes, and practices are published. Some results of these papers have been rather controversial, especially those related to food safety practices.
The two most common methods for evaluating food safety practices – self-assessment and observation – are generally treated as interchangeable, but they can have different meanings. The objective of this study was, therefore, to differentiate between the observed and self-reported food safety practices of food handlers, verifying the effect of different variables in these food safety indicators through structural equation modeling, and examining the relationship between cognitive factors and these practices.
A questionnaire with 37 questions was given to 183 food handlers to evaluate their food safety knowledge, attitudes, self-reported practices, and risk perceptions. For the observed assessment method of evaluating the food handlers’ practices (observed practices), a checklist was developed, and food handlers were observed during one workday.
Two models were developed based on the results of these two assessment methods. In the first model a significant positive effect of knowledge and a negative effect of risk perception on self-reported practices were observed. Food handlers with high risk-perception about their practices reported less adequate practices. Positive food safety attitudes acted as a moderator dampening the positive effect between knowledge and self-reported practices. In the second model a significant positive effect of knowledge on observed practices. Attitudes strengthened the positive effect between knowledge and observed practices.
A direct effect of attitude on observed practices was not observed. In conclusion, self-reported practices and observed practices are different and should be used and discussed properly.
The differences between observed and self-reported food safety practices: A study with food handlers using structural equation modeling 23 August 2019
The U.S. Centers for Disease Control reports in August 2018, two Oregon patients with diagnosed Salmonella infection were interviewed using a standard enteric illness questionnaire; both patients reported having eaten raw cake mix.
Standardized interview questionnaire data collected from 207 Oregon patients with salmonellosis in 2017 indicated a 5% rate of consumption of raw “cake mix or cornbread mix” (Oregon Health Authority, unpublished data, 2017). The binomial probability that both 2018 patients were exposed to raw cake mix by chance was determined to be 0.003, prompting the Oregon Health Authority (OHA) to collect and test the contents of 43 boxes of unopened cake mix of various brands from six retail locations. OHA sent samples to the Institute for Environmental Health Laboratories in Lake Forest Park, Washington, for pathogen testing. Salmonella Agbeni was isolated from an unopened box of white cake mix from manufacturer A, and whole genome sequencing (WGS) data describing the isolate were uploaded to the U.S. National Library of Medicine’s National Center for Biotechnology Information (NCBI) website (https://www.ncbi.nlm.nih.gov/pathogensexternal icon). OHA used the NCBI database to compare sequence data with the cake mix isolate (PNUSAS056022) and then consulted CDC’s System for Enteric Disease Response, Investigation, and Coordination (SEDRIC), a web-based, outbreak investigation tool designed for collaborative, multistate investigations of enteric disease outbreaks.* On October 19, OHA determined that clinical isolates from four patients from Maryland, Ohio, and Wisconsin, with specimen isolation dates ranging from June to September 2018, were genetically related to the Salmonella Agbeni isolate from the unopened box of white cake mix, within four single nucleotide polymorphisms (SNPs).
On October 22, 2018, OHA notified state public health counterparts in the three states of this finding and inquired about raw cake mix exposures among their patients. The Wisconsin patient reported having consumed an entire box of raw white cake mix over several days during the likely exposure period. In addition, WGS analysis indicated that this clinical isolate was closely related genetically (within one SNP) to the isolate cultured from the Oregon white cake mix. On October 25, CDC requested officials in Maryland, Ohio, and Wisconsin to interview patients using a questionnaire with specific questions about baking exposures.
On October 31, the Food and Drug Administration (FDA) initiated an investigation of manufacturer A with regard to the Salmonella-positive white cake mix. In addition to the investigation and document collection, FDA collected samples including an ingredient (flour), finished cake mix, and environmental samples. All collected samples tested negative for Salmonella. On November 5, a voluntary recall of manufacturer A’s classic white, classic butter golden, signature confetti, and classic yellow cake mixes was announced because they might be contaminated with Salmonella bacteria.
On January 14, 2019, CDC declared this outbreak, which totaled seven cases in five states,† to be over (1). This is the first time that OHA used WGS data on the publicly available NCBI website to detect a multistate outbreak associated with a widely distributed consumer product, which resulted in product action. WGS of food and environmental isolates and subsequent analysis on the NCBI and SEDRIC platforms are emerging as useful tools in identifying outbreaks associated with widely distributed products with long shelf lives and low background rates of consumption, such as raw cake mix. Detection of these outbreaks is typically difficult and relies mainly upon epidemiologic evidence from investigation of a larger number of cases (2–4). These efforts also highlight the value of collaboration between public health epidemiologists and laboratorians as well as the use of new technological tools for outbreak detection. During outbreak or cluster investigations, food and environmental samples should be collected as quickly as possible whenever practical, particularly when epidemiologic data suggest an association. WGS, in conjunction with the NCBI website and SEDRIC, can be used to identify genetically related isolates quickly.
US: Notes from the field: Multistate outbreak of salmonella Agbeni associated with consumption of raw cake mix – five states, 2018