Walnuts suspected but not confirmed as E. coli source

The Montreal Gazette is reporting tonight that public health authorities are still trying to pin down the source of an E. coli O157:H7 outbreak that has claimed the life of one Quebecer, caused severe kidney complications in another, and sickened 11 others in Canada.

Not much new, other than a few quotes from some of the players.

Adel Boulos, vice-president at Amira Enterprises Inc. said Thursday none of the walnut samples — collected from the individuals who got sick, from stores and from the food importer’s warehouse, adding, "We have decided to do the recall even though none of the walnuts have tested positive. The investigation is going on and we are co-operating fully with the government to make sure that nobody gets sick."

Nathalie Levesque, a provincial Health Department official, said, "The Canadian Food Inspection Agency has serious doubts as to whether the infections are related to walnuts, but it’s the most probable source.”

Read into that what you like. If this was a homegrown product, CFIA would not be saying anything public, based on their past track record (see Maple Leaf). But when it’s imported, CFIA tends to rediscover the basics of epidemiology. Or maybe I’m wrong. If CFIA publically disclosed how, when and why they inform the public about potential food risks, and was consistent, perhaps there would be some confidence in the system.

Alice D’Anjou, a Canadian Food Inspection Agency spokeswoman said, “We got to trace these nuts right back to their source. We’re still trying to identify where the contamination happened, where the problem is, and how to fix it.”

In an advisory issued on Monday, the agency declared that "at this time, the outbreak investigation indicates that several individuals have reported consuming raw shelled walnuts.

The recalled walnuts, all imported by Amira from California, include products sold under the brand names Merit Selection and Tia. The walnuts were sold pre-packaged as well as in bulk bins.

Glacial government: CFIA still implementing recommendations from 2008 listeria outbreak

On Aug. 17, 2008, the Canadian Food Inspection Agency (CFIA) and Maple Leaf Foods, Inc. finally got around to telling Canadians they should avoid serving or consuming certain brands of deli meat as the products could be contaminated with L. monocytogenes. In the end, 23 deaths and 57 cases of listeriosis were linked to contaminated cold-cuts made by Maple Leaf.

In July 2009, investigator Sheila Weatherill who was appointed directly by the Canadian Prime Minister, issued a 181-page final report about the listeria crapfest, with 57 recommendations grouped into four broad categories:

– more focus on food safety among senior officials in both the public and private sectors;

– better preparedness for dealing with a serious foodborne illness with more advance planning for an emergency response;

– a greater sense of urgency if another foodborne emergency occurs; and,

– clearer communications with the Canadian public about listeriosis and
other foodborne illnesses, especially at risk populations and health professionals.


On Oct. 21, 2010, CFIA issued a couple of public reports, responding to the Weatherill report, all this over two-years after people starting barfing and dying from Maple Leaf meats. Buried within the bureaucratese are a few nuggets that show Canadian food safety types are trying to say the right thing – but really don’t get it.

Most of the media coverage focused on meat inspection protocols and complaints by the union of too few inspectors. There’s this big debate about who needs to do what and whether the federally-mandated Compliance Verification System (CVS), which sets out the procedures to be used by inspectors to verify the design and implementation of a plant’s food safety plan, is any good.

However, within the Oct. 2010 food safety progress report, the feds are apparently trying to come up with guidance on when to go public about food safety risks.

Health Canada is developing a federal guidance document on the weight of evidence needed to take action to protect consumers during foodborne illness outbreak investigations. The weight of evidence takes into consideration the microbiological information gathered through food sample testing and human illness reports, as well as the information collected from the follow-up investigation at food processing plants. Federal, provincial and territorial partners have been consulted on the draft guidance document. Health Canada also shared the document with selected international counterparts in June 2010. Once finalized, the document will be used by Health Canada, CFIA and PHAC during outbreak investigations.”

I look forward to the public availability of such a document, 14 years after the feds were criticized for the erroneous implication of California strawberries rather than Guatemalan raspberries as the source of a 1996 North America-wide cyclospora outbreak.

The Weatherill Report makes a number of recommendations to improve communication between government and the public on food safety and foodborne illness. The Government has taken steps to improve how and when it communicates with Canadians in general and with at-risk populations and key stakeholders, specifically. These steps take into consideration how it communicates food safety information in periods when there is no outbreak as well as during a national foodborne illness event.

In February 2010, the Government of Canada launched an online Food Safety Portal that offers a one-stop source for information about food safety and foodborne illness (www.foodsafety.gc.ca). The food safety and foodborne illness information initiatives developed by CFIA, PHAC and Health Canada and described in this report can now be found on the Portal.

To raise awareness of the Food Safety Portal, CFIA sent out a social media news release that encourages individuals to share information about the Portal online by using social media book-marking and tagging options, thus ensuring the broadest possible outreach.

CFIA has also been using social media tools, such as Twitter, to reach a wider audience on food safety issues and recalls. The Agency has gained over 400 followers on Twitter, including representatives from the media, health organizations, consumer groups and cooking/food allergy bloggers. In addition, CFIA has developed a recall widget to automate further distribution of notices. Food safety stakeholders have been invited to embed the CFIA widget on their websites, blogs, or social media pages to display live content from CFIA on food recalls.

The Consumer Centre section of the CFIA website has also been redesigned to clearly explain the roles that consumers, government and industry play in food safety, and to provide more information on important food safety issues. In addition, CFIA is participating in six food-related events between May 2010 and March 2011 to promote the Food Safety Portal and raise awareness of safe food handling practices and recall procedures.

And it goes on and on.

Creating a new web site doesn’t mean anyone reads it. And using social media is of no use if the messages still suck. People dying from deli meat is not a food handling concern.

PHAC has developed a risk communications strategy that will guide how the Agency communicates to Canadians during a national foodborne illness outbreak. PHAC has begun to implement various components of the strategy so that it can communicate to the public, key stakeholders, and targeted at-risk populations (older adults, pregnant women and those with weakened immune systems) more effectively. The strategy uses a variety of traditional and innovative formats, such as media events, web- and audio-casts, the Food Safety Portal, and stakeholder briefings. PHAC also collaborates with Health Canada to ensure that PHAC’s information for Canadians during a national outbreak is consistent with the food safety information that Health Canada provides.

There’s more but it’s tortuous. No evaluation of effectiveness, no indication that fewer people are barfing, no evidence that dieticians at care facilities won’t keep giving out cold deli meats to at-risk populations, no evidence that medical types at place like the Toronto Hospital for Sick Kids won’t keep dispensening stupid advice about listeria risks to pregnant women.

And for all the bureaucratese, no mention was made by anybody about Weatherill’s recommendation for precautionary labeling – warning labels – for listeria-vulnerable populations like pregnant women and old folks.

There must have been hundreds of fully salaried government types at all the meetings and in the report prep and website building and travel.
Maple Leaf or any other processor, government can continue to dither, you’re the ones losing customers and profits.

Make listeria testing results publicly available, and put warning labels or some sort of information available on the package. And stop saying deli meat is a consumer handling problem.

Waiting for government is like waiting for Godot.

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."

The politics of produce and going public

There are now 97 people sick with salmonella in 28 Illinois counties, all related to eating at a bunch of different Subway restaurants.

A bunch of the food handlers at different Subway outlets have tested positive for salmonella, but that’s probably because they’re snacking on the same ingredients the customers get in their sandwiches.

When the outbreak was first identified, Subway pulled its lettuce, green peppers, red onions and tomatoes from restaurants and brought in new supplies. A prudent produce move.

But now the Packer reports that investigators are saying fresh produce is just a “possible” source of the salmonella outbreak.

Although federal, state and local health agencies have not named fresh vegetables as the definitive source, Melaney Arnold, an Illinois Department of Public Health spokeswoman, has said the investigation was leaning toward produce as the culprit. On June 23, Arnold characterized produce only as a possible source.

A poem for public health

I’m surprised whenever an outbreak of foodborne illness is picked up in the U.S., except the most egregious violations of sanitation and safety, where large numbers of people are sickened.

Those investigations with people scattered across states, like the current E. coli O145 outbreak that has sickened over 50, are a testament to the skill, dedication of training of public and environmental health types.

Yet across the U.S., public health is taking budgetary hits as the trickle down of housing and financial collapse makes its way to the local level — states and counties are looking everywhere to balance the books.

A public health type penned and posted the following poem at http://randomleaves.blogspot.com/.

FIRST THEY VOTED to eliminate child care inspections
And I didn’t speak up because I didn’t have children

THEN THEY VOTED to stop inspecting food service establishments
And I didn’t speak up because another agency did those inspections

THEN THEY VOTED to get rid of nursing home and hospital inspectors
And I didn’t speak up because I worked in the OSTDS program

THEN THEY VOTED to abolish Environmental Health
And there was no one left to speak up


Maple Leaf makes lemon-scented food safety pledge

Maple Leaf Foods, the folks who made deli-meats that killed 23 Canadians in 2008, issued a public food safety pledge yesterday.

Fearless and empathetic leader Michael McCain, speaking on behalf of the 23,500 employees of Maple Leaf Foods, said

“We have spent the last 18 months seeking the advice of the best experts in the world (and in many cases hiring them), examined every one of our previous practices, made significant improvements in all areas of food safety – testing, training and sanitization – and worked with industry and government to raise the bar.”

Maybe. But you’ve retained the worst public relations advisors and it’s going to take a lot of lemons to cleanse the stench on this pledge. Below are all the components of the frat-boy type pledge (thank you sir, may I have another) exactly as it appeared, even though it’s far too wordy, with some editorial comments from me.

*We commit to becoming a global leader in food safety. Our Chief Food Safety Officer will lead the implementation of best practices in sanitation, testing, technologies, product formulations and manufacturing, and has the authority to stop production at any plant where he believes there may be a risk to food safety.”

Awesome. Will those test results be made public?

*We commit to building a strong culture of food safety, with high performance teams, through continuous training, education and communicating results. Our people are encouraged and expected to act on any food safety concern they may have to improve our food safety practices."

Communicating results, like making listeria test results public?

Public availability of food safety testing data underpins efforts to convince a skeptical public that a product is microbiologically safe.

Yes, testing has limitations, just like restaurant inspections, but the goal should be to figure out how best to make that information available – rather than saying people can’t have it or handle it.

On Dec. 31, 2009, Beef Products Inc. took a fairly public hit when the N.Y. Times questioned the efficacy of the company’s use of ammonia as an antimicrobial treatment for ground beef.

BPI founder and chairman Eldon Roth announced in February at the National Meat Association’s annual conference that the company will post on its Web site 100 per cent of its results from the processor’s testing for E. coli O157:H7 and salmonella.

"We’re going to be 100 percent transparent," Roth told Meatingplace in an interview following the announcement. … We’re not promising to be perfect, but I will promise that we will be better.”

That’s how it’s done.

*We commit to following the highest standard of testing and analysis to identify potential risk. Any test that raises food safety concerns will result in immediate quarantine, with no products leaving the plant until the Company (why is this capitalized? Is Maple Leaf its own nation-state? — dp) and government regulatory authorities are confident that the food is safe."

Test and hold. Sorta standard.

*We commit to setting and meeting high standards and measuring our performance against the Global Food Safety Initiative standards through independent audits which will also allow us to continuously improve."

Rather than relying on some auditor waltzing through the plant now and then, why not be able to prove how ab fab Maple Leaf is at this food safety thing. Borrow a page from Cargill (and activists around the world) and install your own video cameras to have data to support food safety pledges.

In April 2009, Cargill Beef announced it had implemented a third-party video-auditing system that would operate 24 hours a day at its U.S. beef plants to enhance the company’s animal welfare protection systems. All of Cargill’s U.S. plants were expected to have the program in place by the end of 2009.

In Feb. 2010, Cargill announced its expanded remote video auditing program will monitor food-safety procedures within its 10 beef-harvest facilities in North America.

Mike Siemens, Cargill leader of animal welfare and husbandry, said,

“The early results with our animal welfare program have been terrific and we’re excited to get all the facilities up-and-running on the program. Cargill has been able to use the RVA technology to help increase an already superior compliance rate at its plants to an even higher level. In addition to the positive results on compliance rates, we have observed healthy competition among plants on performance scores, as well as a general theme of collaboration among plants on how to attack specific operational challenges. The ability to share data and video easily is extremely valuable.”

Angie Siemens, Cargill technical services vice president for food safety and quality, said,

“We’re working to eliminate the opportunity for cross-contamination. We want to have the right steps at the beginning of our process to enhance the efficacy of our intervention technologies later in the process. The major objective of the video auditing application is to design a ground-breaking program that can further reduce the E. coli and Salmonella contamination.”

*We commit to openly sharing our knowledge with industry, government and consumers, so we can learn from them and they can learn from us, in pursuit of better food safety at every step of preparation."

Your knowledge isn’t required. Data would be more meaningful. So would warning labels of some sort, especially for at-risk populations. Florida-based supermarket Publix places all of its deli-cut meats into a plastic bag that says:??

“The Publix Deli is committed to the highest quality fresh cold cuts & cheeses.
Therefore we recommend all cold cuts are best if used within three days of purchase.
And all cheese items are best if used within four days of purchase.”

*We commit to placing public interest and consumers first, by behaving in the most responsible and transparent way possible if there is ever a breach in our food safety system.”

Is that why Maple Leaf and the Canadian Food Inspection Agency set aside epidemiology and waited for confirmatory testing in an unopened package before issuing any public warning, even though local health units had already established a link with Maple Leaf products?

Maple Leaf seems to be suffering from a common affliction that strikes many institutions in decline – they believe their own PR. Actions speak so much louder than words. From the beginning in Aug. 2008, Maple Leaf should have:

• come clean on who knew what when regarding listeria testing;

• made listeria test results public;

• provided warning labels on deli meats for at-risk populations, like pregnant women and all those old people that unnecessarily died; and,

• marketed food safety efforts at retail so consumers can choose.

Restaurant inspection results now available on-line for London-lite

As of 10 a.m. EST today, residents of London-lite (Ontario) can access the results of restaurant inspections back to June 2009 on-line at http://inspection.healthunit.com

Two weeks ago, London Free Press reporter Jonathan Sher ran a piece noting that local health types had promised a public disclosure system similar to Toronto’s red, yellow, green 16 months ago. The health unit had gotten busy and key personnel had departed, all reasonable explanations.

On Feb 11/10, Sher ran another piece, which disclosed that London diners unknowingly ate at places last year where inspectors found horrors from flies to feces.

Health inspectors shut down seven restaurants last year in London for stomach-turning reasons including:

* Egg noodles bound for diners were picked at first by flies that descended on an open container on a kitchen floor.

* A ventilation hood dripped grease on the food beneath.

* A restaurant with no hot water still made food — just with no place for kitchen staff to wash their hands.

* Mouse-like feces found on plates, shelves, behind the stove, on kitchen floors and behind a walk-in freezer.

* Uncovered food found on a food-encrusted floor in a walk-in fridge.

* Rags dirty from raw and cooked foods left on cutting boards.

* A restaurant with many health violations, even though a staffer had just completed the health unit’s food handling course.

If this were Toronto, red signs would have warned diners the places had been closed for something more serious than a holiday or renovation.

I told Sher there’s no doubt signs and other methods of public disclosure drive restaurants to be more careful, and that,

"They up their game . . . they don’t want the publicity.”

Today, The Middlesex-London Health Unit has launched a new, online resource for information on city restaurants.

Amazing how fast these things move with a little publicity.

The best restaurants flaunt, rather than fear, inspection disclosure

Media outlets in New York and London-lite (the Ontario version) are clamoring for improvements in restaurant inspection disclosure.

The job is easier in New York, because, as reported by nyunews.com, the city’s Department of Health and Mental Hygiene announced that beginning in July of 2010, restaurants in NYC will be required to display their health inspection letter grade so that it is highly visible to customers.

While gaining support from a number of people who believe the system will promote cleanliness and limit foodborne illnesses, many believe the system will be an unnecessary burden on the restaurant community. The following are reactions from managers and employees of several local restaurants.

Randy Richmond of the London Free Press writes that posting restaurant inspection results online will weed out unhealthy operations and protect the public, several local eatery owners say.

It would be better, though, if London could afford more inspectors to ensure more frequent checks, added one owner.

In New York, managers such as Elias Bourakac of Bully’s Deli said,

"I’m for it. The inspection goes through the Health Department. We passed it, we did very good. No problems, no violations."

Frank Berascha of Famous Famiglia said,

"We had almost 90 percent last year. Everything is perfect. I would have no worries."

In London-lite, the health unit is expected to announce Thursday that it will start posting inspection results online and that’s fine by restaurateurs contacted by The Free Press.

Vanessa Willis, co-owner of the Church Key said,

"I think that’s exactly how it should be done. I think the community has the right to know what restaurants are working properly and what ones are not."

Felipe Gomes, owner of Aroma said conscientious eatery owners spend thousands of dollars on equipment, supplies and training to keep operations safe and healthy, and those who cut corners should be exposed, adding, "You are dealing with the health and safety of people."

5 years later, Canada releases illness data; trends for Salmonella, Campylobacter, verotoxigenic E. coli and Shigella

The Public Health Agency of Canada, which was created to streamline various public health duties like providing meaningful data on foodborne illness and provide leadership on public health issues (totally useless during the 2008 listeria in deli meats outbreak that killed 22) has gotten around to releasing so-called integrated surveillance data for selected enteric diseases in Canada.

This report focuses on the years 2000 to 2004. The pathogens described are Salmonella, Campylobacter, verotoxigenic Escherichia coli and Shigella. From 2000 to 2004, a general decline in reported rates of all four pathogens was observed in all except a few provinces. When looking at more long-term trends from 1995 to 2004, a similar decline was seen in nationally reported rates for all four pathogens. S. Typhimurium was the most frequently reported Salmonella serovar during the five-year period described, followed by S. Heidelberg and S. Enteritidis. C. jejuni remained the most prevalent Campylobacter species reported between 2000 and 2004. E. coli O157 comprised the majority of verotoxigenic E.coli isolates over these five years. Shigella sonnei was the most frequently reported Shigella species.

Hospitalizations, deaths, outbreaks and case clusters, as well as unusual isolation sites and travel-acquired infections are also explored in this report. Pathogenic E. coli was associated with the highest hospitalization rates over the five-year period, although Salmonella infections resulted in the largest number of deaths overall. Data on outbreaks and case clusters is limited to those reported to the National Enteric Surveillance Program (NESP) and the National Microbiology Laboratory (NML).

Which means, not much. The data is exceedingly limited, and why it took at least 5 years to report is baffling. Canadians can comfortably go back to sleep.

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.