59 sickened: Hepatitis A associated with semidried tomatoes imported from Turkey, processed, served in France, 2010

In January 2010, two clusters of nontraveler-associated hepatitis A were reported in 3 districts of southwestern France.

Gallot et al. report in Emerging Infectious Disease that a single IB strain of hepatitis A virus (HAV) was isolated (FR-2010-LOUR, GenBank accession no. GU646039). We conducted an investigation to describe the outbreak, identify the vehicle of transmission and source of infection, and propose appropriate control measures.

Cases were identified through mandatory notification or through the National Reference Centre for HAV. A total of 59 cases were identified: 49 confirmed cases (resident of France and infected with the outbreak strain) and 10 probable cases (resident of southwestern France and with a locally acquired infection positive for HAV immunoglobulin M against HAV with onset during November 1, 2009–February 28, 2010). Twelve (20%) persons were secondary case-patients (symptom onset 2–6 weeks after contact with a case-patient).

Trace-back investigations identified a supplier in France that imported frozen semidried tomatoes from Turkey and supplied the 3 sandwich shop chains. In France, the frozen semidried tomatoes were defrosted and processed with oil and herbs before distribution. No heat treatment, disinfection, or washing was conducted after defrosting. The period of distribution of 1 batch matched the estimated period of contamination of nonsecondary cases. This batch was no longer available at the supplier or at the sandwich shops for virologic analysis or for recall.

Our results suggest that this nationwide hepatitis A outbreak was associated with eating 1 batch of semidried tomatoes imported from Turkey and processed in France. Infected food handlers are the most frequently documented source of contamination by HAV of food items, but food also can be contaminated by contact of products or machinery with contaminated water. Therefore, the tomatoes may have been contaminated during processing by the supplier in France, during production in Turkey, or during growing. Fecal contamination of foods that are not subsequently cooked is a potential source of HAV, and the virus remains infectious for long periods, even after freezing. Various fresh or frozen produce have been associated with hepatitis A outbreaks.

Recently, three other hepatitis A outbreaks were associated with eating semidried tomatoes: in Australia in May and November 2009 and in the Netherlands in 2010

Gratuitous (comfort) food porn shot of the day: tomato soup and grilled cheese

Sorenne eating lunch with dad, 11:00 a.m., Dec. 27, 2009.

It’s not always a food porn extravaganza around the Hubbell household. Sure, last night’s dinner was marinated and oven-grilled tuna steaks, with asparagus and roasted sweet potato fries, but with the snow sticking around, and Sorenne’s nose draining like a running faucet, sometimes it’s best to stick with basics.

Tomato soup made with milk in my Dad cup — because I have a daughter who goes to McMaster University in Hamilton, Ontario — along with a grilled cheese sandwich made with whole wheat bread, a drizzle of butter, lots of extra sharp cheddar, prepared in a frying pan, and served with a pickle and ketchup.

Australian hepatitis A outbreak still linked to semi-dried tomatoes

Hepatitis A is one of the few causes of foodborne illness that only cycles through humans – and their poop.

So any outbreak of hepatitis A means human sewage came into contact with the food (which then wasn’t cooked) or someone shedding the virus had a poop, failed to adequately wash their hands, and then prepared an uncooked food.

Either could be happening in this on-going outbreak of hepatitis A in Australia that has sickened about 130 people and appears to be linked to semi-dry tomatoes.

Victorian health authorities revealed a further 23 cases of the infectious disease diagnosed in the past week.

Victoria’s chief health officer Dr John Carnie said that so far this year there had been 200 notifications of hepatitis A, compared to 74 at the same time last year.

A study into the increase of cases indicates that more than two thirds of people that have become ill recalled eating semi-dried tomatoes, he said.

Local producers had promised the Department of Human Services they were doing their best to reduce the risk, while importers of the tomatoes had also been instructed to ensure appropriate quality control measures were in place, he said.

Bottled semi-dried tomatoes in supermarkets were pasteurised and considered safe along with any of the cooked product such as in pizzas or quiches.

The greatest risk would appear to be at restaurants and cafes, where semi-dried tomatoes are served in foods such as salads and sandwiches.

Don’t eat poop. Or at least cook it.

Clean the poop off hands before making semi-dried tomatoes — linked to spike in Australian hepatitis A cases

The Age, which is the primary newspaper in Melbourne, Australia, in the state of Victoria, reports that semi-dried tomatoes have been linked to several cases of hepatitis A.

Victoria’s chief health officer John Carnie issued a warning on Friday evening (Friday morning here since they’re about 14 hours ahead) advising people to avoid eating semi-dried tomatoes unless they are thoroughly cooked.

"People who may have semi-dried tomatoes at home should not eat them unless they are thoroughly cooked, such as in pizza and quiche. Restaurants and cafes should also follow this advice.”

The Department of Health and Human Services has received 12 hepatitis A notifications this week and several people infected have reported eating semi-dried tomatoes.

Greens and melons and tomatoes – oh my. Will new guidelines make produce safer?

Last Friday, U.S. regulatory types announced plans to increase testing of beef trim for E. coli O157:H7 and to strengthen safety protocols for fresh fruits and vegetables. The former got lots of attention, especially with a new Salmonella outbreak that has sickened dozens and is linked to ground beef; the latter, not so much.

Fresh fruits and vegetables are one of, if not the most, significant sources of foodborne illness today in the U.S. – and it’s been that way for over a decade. As consumers increase per capita consumption of fresh vegetables, methods of handling, processing, packaging and distributing produce locally and internationally are receiving more attention in terms of identifying and controlling microbiological, chemical and physical hazards.

That was essentially the prelude for FDA publishing its 1998 Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables. We took those guidelines, as well as others, and created an on-farm food safety program for all 220 growers producing tomatoes and cucumbers under the Ontario Greenhouse Vegetable Growers banner. And set up a credible verification system.

So why did regulators and industry make such a big deal about commodity-specific guidelines for tomatoes, melons and leafy greens that were published in the federal register last Friday – in 2009?

I looked at the 2009 CSGs and the 1998 FDA guidance document – and I can’t see much of a difference in the on-farm stuf. Maybe I’m slow on the uptake; maybe guidelines are meaningless without implementation and verification; maybe growers keep asking for government babysitters so when the next outbreak happens, they can say, but we followed FDA guidelines (good luck with that). One of the notices said the draft guidances were FDA’s first step toward setting enforceable standards for produce safety, so maybe it’s some lawmaking thing.

Tom Stenzel, president of the United Fresh Produce Association, said in a statement released July 31,

“Our industry has worked hard since 2004 to develop commodity-specific guidance documents in each of these areas, and now strongly supports FDA taking these efforts to a new level.”

2004? Why not 1998? And do the new and supposedly improved guidelines mean fewer sick people? No. Not unless an individual grower or groups of growers, or associations, take serious steps to implement and verify, something could have been done in 1998 and does not need government oversight. We did it – how hard can it be?

It’s not, and lots of growers do it on a daily basis. So maybe the talk from Washington was rightly shrugged off as no biggie.

But why did Health and Human Services Secretary Kathleen Sebelius, in making the announcement, choose to highlight the “vital role” consumers play in ensuring the safety of the fresh produce they eat and offer a laundry list of questionable food safety advice that would do little to reduce contamination of tomatoes, leafy greens and melons that happened in the field? Especially with all the caveats featured in the introduction to the tomato commodity-specific guide, included below.

This guidance is intended to assist domestic firms and foreign firms exporting tomatoes to the United States (U.S.) by recommending practices to minimize the microbial food safety hazards of their products throughout the entire tomato supply chain. It identifies some, but not all, of the preventive measures that these firms may take to minimize these food safety hazards. This guidance document is not intended to serve as an action plan for any specific operation but should be viewed as a start­ing point. We encourage each firm from the farm level through the retail or foodservice level to assess the recommendations in this guidance and tailor its food safety practices to its particular operations by developing its own food safety program based on an assessment of the potential hazards that may be associated with its operations.

In addition, effective management of food safety requires that responsibility be clearly established among the many parties involved in the production of fresh produce. There may be many different permutations of ownership and business arrangements during the growing, harvesting packing, processing, and distribution of fresh and fresh-cut tomatoes. For this reason, it is important to identify which responsibilities rest with which parties, and to ensure that these responsibilities are clearly defined. For example, growers commonly contract with third parties to harvest their crops. Also, it is important that growers clearly identify which party is responsible for each applicable provision of this guidance, such as providing adequate toilet and handwashing facilities and worker training. Approaches to addressing responsibilities include delegating them to individuals within the firm and formally addressing them in contractual agreements when third parties are involved. Each party should be aware of its responsibilities to ensure microbial food safety hazards for tomatoes are minimized at each stage of the supply chain.

The commodity specific guidelines are available for leafy greens, tomatoes and melons. Guidance, however, does not mean responsibility. That’s up to industry, and it begins on the farm.


Over 100 sickened with Hepatitis A linked to dried tomato product in Australia

A semi-dried tomato product mixed with garlic, herbs and oil has been linked to a spike in hepatitis A cases in at least three states, Australian health authorities say.

South Australian director of public health Kevin Buckett says there have been 26 cases in the state since March, more than 70 in Victoria and an increased number in Queensland.

The cases are thought to be linked to the tomato product, which is manufactured in both Victoria and Queensland and sold in various states by weight.

Queensland Health Deputy Director-General Aaron Groves says an investigation into the possible contamination of unpackaged, loosely purchased semi-dried tomatoes is underway.

Who should be in charge of food inspections?

The New York Times reported this morning on the California leafy greens industry’s hiring of government inspectors in lieu of government-imposed visits by inspectors.

The almond industry and the Florida tomato industry have also instituted their own safety measures that invited oversight by federal agencies when the government did not independently provide it.

“It’s an understandable response when the federal government has left a vacuum,” said Michael R. Taylor, a former officer in two federal food-safety agencies and now a professor at George Washington University. But, he added, “it’s not a substitute” for serious federal regulation.

Is it the government’s responsibility to ensure that food is safe to eat, or is it the responsibility of those producing, processing, and selling it? Both, of course, in addition to those choosing to consume it and feed it to their loved ones.

Then, what’s so great about government-imposed inspections as opposed to inspections the food industry asks for? After devastating outbreaks in each industry awakened them to their invested interest in food safety, these three have been vigilant about minimizing the microbial risks to their commodities. Would the feds do a better job?

According to the Washington Post, a report by Taylor and his colleagues at George Washington University School of Public Health and Health Services determined that federal regulation of the inspection system and others is necessary to provide cohesion (and presumably increase efficacy) among safety-assuring efforts. In the report the authors urged Congress to “create a single cohesive food safety network composed of local, state and federal agencies and accountable to the secretary of health and human services.”

Some coordination certainly might move the country toward reducing the number of people who get sick from the food they eat. But each link in the food supply chain must remain proactive in their role in assuring food is safe to consume—regardless of who’s the boss.


Traceability: I can’t draw but I can trace

Traceability is one of those food safety buzzwords that’s been around for awhile but doesn’t seem to mean much. Last year during the Salmonella in tomatoes/jalapenos outbreak, health types expressed severe frustration that many food vendors had little idea where their tomatoes were coming from. Same with the current peanut mess – why are companies still figuring out, two months after the initial recalls, that they have the PCA crap in their products.

A  report expected to be made public today by Daniel R. Levinson, the inspector general of the Department of Health and Human Services, found that most food manufacturers and distributors cannot identify the suppliers or recipients of their products despite federal rules that require them to do so.

The investigators contacted 220 food facilities to ask about their supplier records. But only 118 of these businesses were included in the study because the rest were not required under rules adopted by the F.D.A. in 2005 to maintain supplier and recipient records. Of those 118 firms, 70 failed to provide investigators with required information about suppliers or customers, with 6 of the companies failing to provide any information at all.

United Fresh Produce Association President and CEO Tom Stenzel was scheduled to tell the U.S. House Committee on Appropriations, Subcommittee on Agriculture today that,

“… we have a very good story to tell in produce traceability.”

However, one vendor told investigators that it kept no records of tomato purchases.

Tomatoes have repeatedly been implicated in nationwide food contamination scares, including one last year. Fifteen facilities told investigators they mixed raw products from more than 10 farms.

Peanut butter, spinach, tomato and Chinese toy sandwich

Jon Stewart was poking fun at critics of President Obama’s stimulus package on The Daily Show last night, and came up with this quip:

Funding for regulatory agencies? Please. Now if you’ll excuse me, I have a peanut butter, spinach, tomato and Chinese toy sandwich to finish.

The line comes about 3:23 into this video.

Facing a recall without superhero senses leaves some vulnerable to confusion

I don’t like fresh tomatoes. Generally, my careful avoidance of them is a fairly unique practice. At least, I thought so until I met Bret. We stand together in our quest for vegetables that don’t leak acid on the rest of the salad.

We were on our honeymoon when the outbreak of Salmonella Saintpaul in tomatoes and/or hot peppers hit the news. Many people joined our stance on tomatoes then… but it took me a while to realize it.

Since I wasn’t reading FSnet while we were gone, I had to hear the warnings put out on eating tomatoes like a regular consumer would. It was like my superhero senses were turned off.

At the time, I wasn’t in the habit of watching the news. And according to the results of a Rutgers Food Policy Institute (FPI) survey,

“The majority of respondents (66 percent) first heard about the advisory on television.”

Throughout our trip, we ate at cafes, buffets, and casual dining establishments. When we didn’t eat out, we stopped at Wal-Mart for cereal and sandwich supplies. None of those places showed signs of produce being recalled.

The survey found,

“A small minority (8 percent) first heard about it from restaurants and retailers.”

As it happened, some of the first news I received came from my step-dad’s mom, who understood the problem to be in tomatoes sold with the vine still attached.

Hearing through the tomato-vine was problematic, though. I later learned the CDC advised,

“…persons with increased risk of severe infections…should not eat raw Roma or red round tomatoes other than those sold attached to the vine or grown at home…”

Those two words, “other than”, were missed (or misunderstood) at some point in the chain of communication that ended with me.

Lead author of the Rutgers FPI report, Dr. Cara Cuite said in a press release,

“Our results suggest that consumers may have a hard time taking in many details about these types of food-borne problems.”

Almost half (48 percent) of people surveyed indicated they were not sure which types of tomatoes were under suspicion.

I was back at superhero headquarters (i.e. in front of my Mac) when Salmonella Saintpaul was found in a sample of jalapenos from Mexico, and again when the outbreak strain was isolated from a Mexican serrano pepper and the water used to irrigate it.

Most consumers weren’t so lucky. From the survey,

“The researchers found that while almost all respondents (93 percent) were aware that tomatoes were believed to [be] the source of the illness, only 68 percent were aware…that peppers were also associated with the outbreak.”

Dr. Cara Cuite commented in the press release,

“This research is especially timely in light of the growing number of recalls as a result of the Salmonella outbreak associated with peanut butter and peanut paste.”

How can consumers be better informed? One practice seen in both outbreaks that helped alleviate some confusion was the use of club membership or “loyalty card” information to contact customers who had recently bought recalled products.

What else can be done to clear things up? After all, regular consumers don’t have superhero senses.