Blog Archives

20 Years of Data Show Poultry, Fish, Beef Have Remained Leading Sources of Food-Related Outbreaks

Between 1998 and 2008, poultry, fish and beef were consistently responsible for the greatest proportion of foodborne illness outbreaks, according to a new government analysis.

Experts at the Centers for Disease Control and Prevention reviewed the 13,405 food-related outbreaks reported during this time period, identifying 3,264 outbreaks that could be attributed to a specific food category. Fish and poultry remained responsible for the greatest share of these outbreaks over these 20 years — accounting for about 17 percent of outbreaks each — followed closely by beef, which was responsible for 14 percent of outbreaks.

Eggs, on the other hand, played an increasingly smaller role as outbreak sources – accounting for 6 percent of outbreaks in 1998-1999 and for just 2 percent in 2006-2008. This trend was largely due to a decrease in the amount of Salmonella outbreaks linked to eggs, according to the report authors.

Leafy greens became a more common outbreak source, responsible for 6 percent of outbreaks in 1998-1999 and 11 percent by 2008-2009. Dairy also grew as an outbreak source, rising from 4 percent in the beginning of the period studied to 6 percent by 2006-2008.

The researchers also looked at the leading pathogen-food combinations that caused outbreaks during the 20-year window, finding that histamine in fish was the most common outbreak source, followed by ciguatoxin in fish, Salmonella in poultry and norovirus in leafy vegetables.

“You see the same combinations of pathogens and foods repeatedly,” said Hannah Gould, epidemiologist in the Division of Foodborne, Waterborne, and Environmental Diseases at CDC’s National Center for Emerging and Zoonotic Infectious Diseases and lead author of the report. “It’s good to keep tracking that and now to have a method to continue to look at changes over time,” Gould commented in an interview with Food Safety News.

The authors note that the number of outbreaks linked to these commodities should not be confused with the number of illnesses caused by these foods, as outbreaks result in varying numbers of illnesses.

While poultry was responsible for the largest share of illnesses (17 percent) between 1998 and 2008, leafy greens were the next greatest cause of illness, accounting for 13 percent of the 67,752 illnesses attributed to an outbreak food source.

The pathogen/commodity pairs responsible for the most outbreak-related illnesses were norovirus and leafy vegetables, which led to 4,011 illnesses of the 67,752 linked to a designated commodity category.

The team also looked at food preparation, finding that restaurants and delis accounted for the vast majority (68 percent) of the places where outbreak-linked foods were prepared. Private homes were the next most common place of preparation, at 9 percent, followed by catering or banquet facilities (7 percent).

“That’s something interesting that we talk about here more than we usually do,” said Gould, referring to the location data, which CDC doesn’t often report in its reviews of foodborne illness data.

Outbreaks after 2008

What about outbreaks that have occurred since 2008? Have these trends continued or have they changed in the past few years?

“Leafy greens and norovirus continues to be a problem and norovirus has been the number one cause of outbreaks in our data for years and years and years and has remained that way,” said Gould.

Gould also led an analysis of foodborne illness outbreaks that occurred between 2009 and 2010 — published in January of this year — which found that during that period, beef, dairy, fish, and poultry were associated with the largest number of foodborne disease outbreaks.

That report also showed that unpasteurized dairy products are the leading cause of dairy-related outbreaks, accounting for 81 percent of the outbreaks linked to dairy during that time period. Gould said the 1998-2008 report shows that the incidence of raw dairy-related outbreaks has been growing over this time.

“Outbreaks caused by dairy went up as well, and that seems to be caused by an increasing number of outbreaks due to unpasteurized milk,” she said.

The data used for this report comes from CDC’s Foodborne Disease Outbreak Surveillance System, which was started by CDC in 1973 and went online in 1998. The authors chose 1998-2008 as their reporting period because the format of the database changed starting in 2008, when it became the National Outbreak Reporting System.

Although this new report may appear similar to one CDC released in January titled “Attribution of Foodborne Illnesses, Hospitalizations, and Deaths to Food Commodities by Using Outbreak Data, United States, 1998-2008,” the two are very different. The January report offers an estimation of total U.S. illnesses linked to various food sources. Though it is based on data from the Foodborne Disease Outbreak Surveillance System, the figures in that report are extrapolated based on national foodborne illness estimates, while this June report looked only at outbreaks reported to CDC.

The complete results of the 2998-2008 data analysis can be found in CDC’s Morbidity and Mortality Weekly Report.

Food Safety News

The 10 Worst U.S. Foodborne Illness Outbreaks of 2014

This year saw dozens of well-publicized foodborne illness outbreaks caused by everything from bean sprouts to cilantro to caramel apples. Food Safety News has compiled a list of the 10 most harmful U.S. outbreaks of 2014, in terms of both the number of people who died and the number sickened.

This list includes only foodborne illness outbreaks in which investigators determined both the pathogen involved and the food source, which eliminates a number of outbreaks from inclusion.

10. Chia seeds and powder contaminated with Salmonella, 83 sickened. One of the more eyebrow-raising outbreaks of the year was tied to sprouted chia seeds and powder sold in the U.S. and Canada. At least 52 people from Canada and 31 from the U.S. were found to be sickened. [News report]

9. Bean sprouts from Wonton Foods contaminated with Salmonella, 111 sickened. New England residents were hit hard by this recent Salmonella outbreak, in which at least 29 people were hospitalized. [CDC outbreak information]

8. Chicken dish at Food Safety Summit contaminated with Clostridium perfringens, 216 sickened. This outbreak was the perfect recipe for a snarky news headline: Hundreds of people sickened with a foodborne illness at none 0ther than one of the nation’s biggest food-safety conferences. The likely source was a chicken marsala dish served by the conference’s hired catering company. [News report]

7. Foster Farms chicken Salmonella outbreak, 634 total sickened, including 218 in 2014. Coming in at number two on our list of the worst outbreaks from 2013, the nationwide Salmonella outbreak from Foster Farms chicken continued into 2014, sickening another 218 people this year before finally being declared over in July. The outbreak spanned more than 17 months, making it one of the longest-running outbreaks in recent memory. [News report]

6. Wedding dish contaminated with Clostridium perfringens, more than 300 sickened. Contaminated gravy allegedly ruined a special day for more than 300 of the 750 attendees at a wedding in Missouri. Shortly after the wedding, guests began reporting cases of diarrhea and vomiting. [News report]

5. Mexican-grown cilantro contaminated with Cyclospora, 304 sickened. Following a massive outbreak last year involving Cyclospora-contaminated salads and cilantro grown in Mexico, Texans once again faced the brunt of a Cyclospora outbreak from Mexican cilantro this year. The bulk of the illnesses once again hit at the height of summer. [CDC outbreak information]

4. Raw milk contaminated with Campylobacter in Utah, 1 dead and 80 sickened. This outbreak was the subject of a state legislative inquiry in Utah after it contributed to the death of one immunocompromised man. While Utah state law requires that raw milk carry a warning about the potential to carry harmful pathogens, the milk in this outbreak did not. [News report]

3. Bean sprouts from Wholesome Soy Products contaminated with Listeria monocytogenes, 2 dead and 5 sickened. 2014 was a bad year for bean sprouts, which saw numerous outbreaks and even more recalls. The most deadly of the sprout outbreaks was linked to Wholesome Soy Products, where FDA investigators found several problems related to unsanitary conditions during inspections of their facilities earlier this year. [CDC outbreak information]

2. Dual Listeria outbreaks linked to Mexican-style cheese, 2 dead and 13 sickened in total. Mexican-style cheeses were linked to two deadly outbreaks this year. In one, a patient died and eight were sickened by cheese produced by Maryland-based Roos Foods. The other outbreak, linked to cheese produced by Florida-based Oasis Brands, killed one patient and sickened five. [News report for Roos Foods outbreak] [News report for Oasis Brands outbreak]

1. Caramel apples contaminated with Listeria monocytogenes, 5 dead and 29 sickened. The year’s most deadly outbreak was also its most recent to be announced and likely its most unexpected. While illnesses first appeared in mid-October, public health officials didn’t trace the outbreak back to store-bought, prepackaged caramel apples until mid-December. A complete list of brand names has yet to emerge, but so far we know that Carnival brand and Kitchen Cravings brand caramel apples are among those affected. [News report]

Food Safety News

The 10 Worst U.S. Foodborne Illness Outbreaks of 2014

This year saw dozens of well-publicized foodborne illness outbreaks caused by everything from bean sprouts to cilantro to caramel apples. Food Safety News has compiled a list of the 10 most harmful U.S. outbreaks of 2014, in terms of both the number of people who died and the number sickened.

This list includes only foodborne illness outbreaks in which investigators determined both the pathogen involved and the food source, which eliminates a number of outbreaks from inclusion.

10. Chia seeds and powder contaminated with Salmonella, 83 sickened. One of the more eyebrow-raising outbreaks of the year was tied to sprouted chia seeds and powder sold in the U.S. and Canada. At least 52 people from Canada and 31 from the U.S. were found to be sickened. [News report]

9. Bean sprouts from Wonton Foods contaminated with Salmonella, 111 sickened. New England residents were hit hard by this recent Salmonella outbreak, in which at least 29 people were hospitalized. [CDC outbreak information]

8. Chicken dish at Food Safety Summit contaminated with Clostridium perfringens, 216 sickened. This outbreak was the perfect recipe for a snarky news headline: Hundreds of people sickened with a foodborne illness at none 0ther than one of the nation’s biggest food-safety conferences. The likely source was a chicken marsala dish served by the conference’s hired catering company. [News report]

7. Foster Farms chicken Salmonella outbreak, 634 total sickened, including 218 in 2014. Coming in at number two on our list of the worst outbreaks from 2013, the nationwide Salmonella outbreak from Foster Farms chicken continued into 2014, sickening another 218 people this year before finally being declared over in July. The outbreak spanned more than 17 months, making it one of the longest-running outbreaks in recent memory. [News report]

6. Wedding dish contaminated with Clostridium perfringens, more than 300 sickened. Contaminated gravy allegedly ruined a special day for more than 300 of the 750 attendees at a wedding in Missouri. Shortly after the wedding, guests began reporting cases of diarrhea and vomiting. [News report]

5. Mexican-grown cilantro contaminated with Cyclospora, 304 sickened. Following a massive outbreak last year involving Cyclospora-contaminated salads and cilantro grown in Mexico, Texans once again faced the brunt of a Cyclospora outbreak from Mexican cilantro this year. The bulk of the illnesses once again hit at the height of summer. [CDC outbreak information]

4. Raw milk contaminated with Campylobacter in Utah, 1 dead and 80 sickened. This outbreak was the subject of a state legislative inquiry in Utah after it contributed to the death of one immunocompromised man. While Utah state law requires that raw milk carry a warning about the potential to carry harmful pathogens, the milk in this outbreak did not. [News report]

3. Bean sprouts from Wholesome Soy Products contaminated with Listeria monocytogenes, 2 dead and 5 sickened. 2014 was a bad year for bean sprouts, which saw numerous outbreaks and even more recalls. The most deadly of the sprout outbreaks was linked to Wholesome Soy Products, where FDA investigators found several problems related to unsanitary conditions during inspections of their facilities earlier this year. [CDC outbreak information]

2. Dual Listeria outbreaks linked to Mexican-style cheese, 2 dead and 13 sickened in total. Mexican-style cheeses were linked to two deadly outbreaks this year. In one, a patient died and eight were sickened by cheese produced by Maryland-based Roos Foods. The other outbreak, linked to cheese produced by Florida-based Oasis Brands, killed one patient and sickened five. [News report for Roos Foods outbreak] [News report for Oasis Brands outbreak]

1. Caramel apples contaminated with Listeria monocytogenes, 5 dead and 29 sickened. The year’s most deadly outbreak was also its most recent to be announced and likely its most unexpected. While illnesses first appeared in mid-October, public health officials didn’t trace the outbreak back to store-bought, prepackaged caramel apples until mid-December. A complete list of brand names has yet to emerge, but so far we know that Carnival brand and Kitchen Cravings brand caramel apples are among those affected. [News report]

Food Safety News

The 10 Worst U.S. Foodborne Illness Outbreaks of 2014

This year saw dozens of well-publicized foodborne illness outbreaks caused by everything from bean sprouts to cilantro to caramel apples. Food Safety News has compiled a list of the 10 most harmful U.S. outbreaks of 2014, in terms of both the number of people who died and the number sickened.

This list includes only foodborne illness outbreaks in which investigators determined both the pathogen involved and the food source, which eliminates a number of outbreaks from inclusion.

10. Chia seeds and powder contaminated with Salmonella, 83 sickened. One of the more eyebrow-raising outbreaks of the year was tied to sprouted chia seeds and powder sold in the U.S. and Canada. At least 52 people from Canada and 31 from the U.S. were found to be sickened. [News report]

9. Bean sprouts from Wonton Foods contaminated with Salmonella, 111 sickened. New England residents were hit hard by this recent Salmonella outbreak, in which at least 29 people were hospitalized. [CDC outbreak information]

8. Chicken dish at Food Safety Summit contaminated with Clostridium perfringens, 216 sickened. This outbreak was the perfect recipe for a snarky news headline: Hundreds of people sickened with a foodborne illness at none 0ther than one of the nation’s biggest food-safety conferences. The likely source was a chicken marsala dish served by the conference’s hired catering company. [News report]

7. Foster Farms chicken Salmonella outbreak, 634 total sickened, including 218 in 2014. Coming in at number two on our list of the worst outbreaks from 2013, the nationwide Salmonella outbreak from Foster Farms chicken continued into 2014, sickening another 218 people this year before finally being declared over in July. The outbreak spanned more than 17 months, making it one of the longest-running outbreaks in recent memory. [News report]

6. Wedding dish contaminated with Clostridium perfringens, more than 300 sickened. Contaminated gravy allegedly ruined a special day for more than 300 of the 750 attendees at a wedding in Missouri. Shortly after the wedding, guests began reporting cases of diarrhea and vomiting. [News report]

5. Mexican-grown cilantro contaminated with Cyclospora, 304 sickened. Following a massive outbreak last year involving Cyclospora-contaminated salads and cilantro grown in Mexico, Texans once again faced the brunt of a Cyclospora outbreak from Mexican cilantro this year. The bulk of the illnesses once again hit at the height of summer. [CDC outbreak information]

4. Raw milk contaminated with Campylobacter in Utah, 1 dead and 80 sickened. This outbreak was the subject of a state legislative inquiry in Utah after it contributed to the death of one immunocompromised man. While Utah state law requires that raw milk carry a warning about the potential to carry harmful pathogens, the milk in this outbreak did not. [News report]

3. Bean sprouts from Wholesome Soy Products contaminated with Listeria monocytogenes, 2 dead and 5 sickened. 2014 was a bad year for bean sprouts, which saw numerous outbreaks and even more recalls. The most deadly of the sprout outbreaks was linked to Wholesome Soy Products, where FDA investigators found several problems related to unsanitary conditions during inspections of their facilities earlier this year. [CDC outbreak information]

2. Dual Listeria outbreaks linked to Mexican-style cheese, 2 dead and 13 sickened in total. Mexican-style cheeses were linked to two deadly outbreaks this year. In one, a patient died and eight were sickened by cheese produced by Maryland-based Roos Foods. The other outbreak, linked to cheese produced by Florida-based Oasis Brands, killed one patient and sickened five. [News report for Roos Foods outbreak] [News report for Oasis Brands outbreak]

1. Caramel apples contaminated with Listeria monocytogenes, 5 dead and 29 sickened. The year’s most deadly outbreak was also its most recent to be announced and likely its most unexpected. While illnesses first appeared in mid-October, public health officials didn’t trace the outbreak back to store-bought, prepackaged caramel apples until mid-December. A complete list of brand names has yet to emerge, but so far we know that Carnival brand and Kitchen Cravings brand caramel apples are among those affected. [News report]

Food Safety News

Wisconsin Names Two Farms That Sourced Raw Milk Linked to Outbreaks

Wisconsin state officials have released the names of two farms that supplied raw milk linked to Campylobacter outbreaks of the past few years.

In September 2014, 38 people were sickened after attending a potluck meal for the Durand High School football team. According to the state Department of Health Services memo released Friday, a farm operated by Roland and Diana Reed of Arkansaw, WI, was the source of the unpasteurized milk served at the meal.

Officials also stated that milk from Schaal Dairy Farm was linked to 16 illnesses that occurred at North Cape Elementary School in Franksville, WI, in 2011.

The information was released following a public record request from the Milwaukee Journal Sentinel.

The newspaper reports that the health department plans to release their report on the Durand outbreak on Monday, following which the state’s Agriculture Department will decide whether to take enforcement action.

Food Safety News

Publisher’s Platform: Will Whole Genome Sequencing Solve More Outbreaks?

“No illnesses have been reported to date.”

How many times have we read a food recall notice posted on either the FDA or FSIS websites and written by the companies recalling the product who use that self-serving statement?  I would say most of the time.

In the past few months the CDC has reported three outbreaks – one Salmonella outbreak and two Listeria outbreaks that have used whole-genome sequencing to connect ill people to tainted product. Perhaps “No illnesses have been reported to date” is a statement of the past trumped by science.

So, what is the science?

State and CDC public health investigators have used the PulseNet system to identify cases of illness that were part of an outbreak for nearly two decades.  PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, receives from state laboratories DNA “fingerprints” of bacteria obtained through diagnostic testing using Pulsed-field Gel Electrophoresis (PFGE).

Multiple Locus Variable-number Tandem Repeat Analysis (MLVA) is another technique used by scientists to generate a DNA fingerprint for a bacterial isolate. Scientists usually perform MLVA after PFGE to find out more specific details about the type of bacteria that may be causing an outbreak.

Whole Genome Sequencing, is a newer, more highly discriminatory subtyping method, that has been used to define the following outbreaks:

Oasis Brands Inc., Cheese Recalls and Investigation of Human Listeriosis Cases – One person became ill in September 2013 and two persons became ill in June and August 2014. These three ill persons were reported from three states: New York (1), Tennessee (1), and Texas (1).  All ill persons were hospitalized. One death was reported in Tennessee. One illness was related to a pregnancy and was diagnosed in a newborn.

Wholesome Soy Products, Inc. Sprouts Recall and Investigation of Human Listeriosis Cases - Five people became ill from June through August 2014. These five ill people were reported from two states: Illinois (4) and Michigan (1).  All ill people were hospitalized. Two deaths were reported.

Multistate Outbreak of Salmonella Braenderup Infections Linked to Nut Butter Manufactured by nSpired Natural Foods, Inc. - A total of six persons infected with the outbreak strain of Salmonella Braenderup were reported from five states since January 1, 2014.  The number of ill persons identified in each state was as follows: Connecticut (1), Iowa (1), New Mexico (1), Tennessee (1), and Texas (2).

“No illnesses have been reported to date,” may well be a statement of the past.

Food Safety News

Three Food Safety Rules Grow Moldy at OIRA as Import-Related Outbreaks Continue

About 15 percent of all foods we consume are imported. Looking at some particular categories, the numbers are far more striking: imports make up 91 percent of our seafood, 60 percent of our fruits and vegetables, and 61 percent of our honey. Most of these imports come from developing countries that lack any effective health and safety regulation—like China, which has had a seemingly endless run of food safety scandals and yet supplies 50 percent of our apple juice, 80 percent of our tilapia, and 31 percent of our garlic.

Unsanitary practices in these countries are well-documented: Vietnamese farmers are known to send shrimp to America in tubs of ice made from bacteria-infested water; and Mexican laborers are often given filthy bathrooms and no place to wash their hands before gathering onions and grape tomatoes for export. Despite the obvious risks of adulteration and contamination, the resource-strapped Food and Drug Administration (FDA) inspected only 2 percent of food imports and just 0.4 percent of foreign food facilities in 2011. Import-related outbreaks—like the 81 people sickened by Mexican cucumbers just a couple months ago—have become even more frequent in recent years.

The foodborne pathogens that make it to our tables often prove deadly for children, the elderly, and those with compromised immune systems. In 2008, after undergoing chemotherapy and radiation, 67-year-old Raul Rivera was told by his oncologist that he would likely survive non-Hodgkin’s lymphoma. He celebrated by taking his family out for dinner, where they ate pico de gallo. It was later discovered that the jalapeños in the salsa were imported from a Mexican farm that had used Salmonella-tainted water for irrigation. Rivera died two weeks later, not of cancer but of salmonellosis.

In January 2011, President Obama signed the Food Safety Modernization Act (FSMA), a set of sweeping reforms that would be fleshed out in rules issued by the FDA. Two and a half years later, only two proposed rules have been released—one on produce safety standards, and the other on preventive controls for human food. The FDA has drafted three other proposed rules that could significantly improve the safety of imports, but they are currently languishing at the Office of Information and Regulatory Affairs (OIRA), an office inside the White House that is notorious for blocking, weakening, and delaying the rules that it reviews.

These three rules, described below, are already many months beyond their statutory deadlines, and OIRA has held them well past the 90-day limit established by Executive Order 12866. Whenever these rules finally emerge, we should be alert to the ways that OIRA may have undermined their effectiveness, just as it substantially weakened the FDA’s preventive-controls rule before it was released in February.

Foreign Supplier Verification Program (FSVP)

(Final rule was due by January 2012; Proposed rule now stuck at OIRA for a year and seven months)

This rule would hold food importers liable for verifying that their foreign suppliers have adequate measures in place to prevent adulteration and contamination. In other words, U.S. companies that buy food products made in overseas facilities would be responsible for inspecting those facilities, periodically testing their shipments, and evaluating the supplier’s written safety plans. Any company that imports food without having an adequate verification program in place would face penalties.

Americans continue to be sickened by contamination that this rule might have prevented. In recent months, at least 120 people have been infected with hepatitis A after eating “Townsend Farms Organic Anti-Oxidant Blend” of frozen fruit. Despite the pastoral image of an Oregon farm on the package, Townsend actually had many of the blend’s ingredients shipped in from foreign countries. The strain of hepatitis, commonly found in North Africa and the Middle East, suggests that the pomegranate seeds—processed in Turkey—are the likely culprit. With no supplier-verification rule in place, Townsend Farms had no obligation to ensure that the Turkish facility followed sanitary practices or had adequate employee-hygiene policies.

Accreditation of Third Parties to Conduct Food Safety Audits

(Final rule was due by July 2012; Proposed rule now stuck at OIRA for seven months)

This rule will describe the FDA’s “third-party certification” system for foreign food facilities. The general setup is reminiscent of those Russian nesting dolls: the FDA will recognize a number of accreditation bodies, which will then accredit certain third parties to be auditors—including private firms, individuals, and even foreign governments—and these auditors will then be hired by foreign facilities that wish to be “certified” as complying with U.S. standards. (See the diagram on page 13 of this report.)

In several ways, these third-party audits are central to the FDA’s new paradigm: (1) food from certified facilities will qualify for expedited entry into the United States, (2) the FDA may require certain “high risk” foods to be certified before importation, and (3) the FDA will use third-party audit reports to decide which facilities to inspect or which foods to test at the border.

The FSMA’s reliance on third-party auditors is deeply troubling because these companies have a shameful record of incompetence, inconsistency, and conflicts of interest with the facilities they audit. Case in point: a private auditor gave Colorado’s Jensen Farms a score of 96 out of 100 in 2011, right before the farm’s Listeria-contaminated cantaloupes sparked the deadliest foodborne outbreak in nearly a century, killing 33 people and sickening 147. The same kind of rubber stamps were given to egg, peanut, and ground-turkey facilities either before or immediately after they became the source of major outbreaks and recalls. 

In order for the third-party certification program to have any value, the FDA must issue a strict set of standards by which auditors should be judged, and exercise rigorous oversight of both accrediting bodies and auditors. Unfortunately, we have no way of knowing what the FDA has planned until the White House releases the rule from its grip.

Preventive Controls for Animal Feed (Including Pet Food)

(Final rule was due by July 2012; Proposed rule now stuck at OIRA for a year and a half)

This rule would require all facilities (domestic and foreign) that produce food or ingredients for animals to develop a written plan describing the steps they will take to identify and prevent contamination or adulteration. Under the FSVP (described above), importers would also be responsible for verifying that foreign suppliers of animal food comply with these requirements.

This rule would hopefully prevent at least some of the worst outbreaks resulting from imported pet foods. Each month the U.S. imports about $ 40 million worth of pet food, with 70 percent of it coming from China. In 2007, pet food ingredients from China containing melamine and cyanuric acid killed thousands of cats and dogs. And over the past two years, more than a thousand owners have seen their dogs become ill or die after eating Chinese-made jerky treats; the FDA has not yet been able to determine the cause of these reactions.

Contaminated pet food not only endangers pets, but also poses a serious threat to humans, who can be infected from contact with their pets or from handling the food, as several Salmonella outbreaks have demonstrated. The FDA has recently begun sampling domestic pet food for Salmonella—indeed, five brands of dry food were recalled earlier this week after a positive test result—but the same contamination in imported pet food is likely going completely undetected, as the White House continues to sit on this rule that could prevent it in the first place. 

When Can We Expect to See These Rules Released?

The Center for Food Safety (CFS) sued the FDA last August over these and other delays, and a judge ordered the parties to agree on a new timeline for rolling out the remaining rules. They were unable to settle on a joint plan, so they each submitted their own timelines. The agency refused to set specific dates, instead promising to release two of these proposed rules by this “summer” and the other one by this “fall,” all of them to be finalized within roughly two years from their proposal. Since the FDA had these proposals fully written when it submitted them to OIRA 7 to 19 months ago, the agency’s reason for insisting on a vague and protracted timeline probably has more to do with how long it expects the OIRA review process to take than with its own ability to get the rules out.

Last Friday, the judge concluded that the FDA’s loose timeframes were inadequate and that new enforceable deadlines were needed—a significant victory for the public. But in setting the new dates, she deferred substantially to the agency’s projected timeline, at least as it applied to these three rules: all FSMA regulations must be proposed by November 30, 2013 and finalized by June 30, 2015. The judge also refused to excuse the rules from review by OIRA, as the CFS had requested, “absent some indication that [OIRA] is using its authority to unduly delay” the rules. One is left wondering how such “undue delay” might be shown, if 19-month holdups are not enough.

In his confirmation hearing last week, President Obama’s nominee for OIRA Administrator, Dr. Howard Shelanski, emphasized that one of his highest priorities would be ensuring the “timeliness” of OIRA’s reviews. If confirmed, he can begin to make good on his promise by immediately letting these food safety rules see the light of day—well before the FDA runs up against the court-imposed deadlines—and imparting a much-needed sense of urgency to OIRA’s review of regulations that quite literally deal in issues of life and death.

This article originally appeared on the Center for Progressive Reform Blog June 21, 2013. It has been updated to include the new timeline set forth by a federal judge for releasing the outstanding FSMA -mandated rules.

Food Safety News

Our Ability to Cope With Foodborne Outbreaks Hasn’t Improved Much

(This article was initially published May 6, 2014, by The Conversation. Dr. Pennington is Emeritus Professor of Bacteriology at the University of Aberdeen.)

On May 7, 1964, a catering-size can of corned beef from Rosario, Argentina, was opened in a supermarket in central Aberdeen. Half the contents were put on a shelf behind the cold meat counter and the other half went into the window.

The weather was warm. The sun shone on the meat. Corned beef is cooked in the can and should be sterile. But it wasn’t. It had been contaminated after cooking when the can was cooled with untreated water from the River Parana.

Into this river, 66 tons of human feces and 250,000 gallons of urine were discharged every day from Rosario, where typhoid was common. The bacteria in the corned beef in the window grew vigorously.

Toll rising

The first person to fall ill developed symptoms on May 12. Making an initial diagnosis is not easy; it usually starts with a high fever, which can have many causes.

In Aberdeen, the first definitive diagnoses were made on May 20. By midnight, 12 were in the hospital, and, until June 13, daily hospitalizations never fell below double figures. The outbreak then fizzled out. At its end, 503 had been admitted to the hospital with typhoid, 403 with bacteriological confirmation.

Among those affected, there was a significant over-representation of women aged 15 to 25 living in the more prosperous west end of the city. The probable explanation is that a slimming regime incorporating cold meats and salad was popular at the time.

Nobody died from typhoid in the outbreak, thanks to antibiotics, so in that regard it was modern. Its media coverage, by TV, would be recognizable today, too. But some aspects of its management were conducted as though World War II was still in progress. The names and addresses of those admitted to the hospital were published in the local paper and the end of the outbreak was announced as the “all clear.”

Dr. Ian MacQueen, then Aberdeen’s medical officer of health, took control of the outbreak. Opinion in Aberdeen is still divided about how he handled it. Some say he saved the city, others say that his antics verged on the ridiculous.

I belong to the latter camp. MacQueen believed that dramatic statements of risk were necessary to prevent the spread of infection. Thus Aberdeen became, in his description, the “beleaguered city,” and beef cattle raisers in Paraguay, Kenya and Tanzania suffered economically as importing meat came to be seen as high risk in the initial panic about the source.

MacQueen recommended that nobody should paddle in the sea, and the main thoroughfare, Union Street, was sprayed with disinfectant. There was an obsession with “wave after wave of infections” occurring because of poor personal hygiene.

In truth, this was always very improbable. There was no person-to-person spread. All the infections were caused by eating contaminated corned beef or cold meats cut with the same slicer. New cases continued to appear not because the source of infection was still active but because the incubation period — the time between being infected and falling ill — was often long.

The modern picture

Could the kind of events that happened in Aberdeen 50 years ago be repeated? Cans of food are unlikely to be the source nowadays because canning practices are almost certainly better (even if, as we saw in the horse meat scandal, the label does not always accurately describe the contents). Typhoid is still common in countries whose drinking water is regularly contaminated with human feces – the 2004-2005 outbreak in Kinshasa affected 42,564 and killed 214.

But an even nastier organism caused the most recent big foodborne outbreak in Europe. Like the Aberdeen outbreak, it started in May and went on until the end of June, and, like Aberdeen, it also affected women much more commonly than men. But it happened in 2011 in Germany.

The organism was E.coli O104:H4, a brand-new bacterium that had evolved as a hybrid of two other disease-causing E.coli strains. More than 3,500 fell ill, 855 developed serious complications and 53 died.

Just as in Aberdeen, the organism was imported. It came on the surface of fenugreek seeds, which had left Egypt by boat on Nov. 24, 2009, and eventually arriving at an organic sprout producer near Hamburg on Feb. 10, 2011.

Seed sprouting is ideal for bacterial growth. But identifying the seed sprouts as the cause of the outbreak was difficult and slow because they were used as a salad garnish and many victims were not aware that they had eaten them. That women were more commonly ill pointed to salads, but photographs taken at meals were invaluable.

It was all very embarrassing for the German public health authorities, particularly when the Hamburg health minister mistakenly announced that the organism that had caused the outbreak had been found on Spanish cucumbers, causing serous economic damage to that industry. Shades of Dr. MacQueen!

Lessons from Hamburg

This mistake illustrated the limits of modern lab technology. We might now be in a position where we could genome-sequence E.coli 0104:H4 quickly, but because it was a new strain, the authorities initially confused it for the more prevalent E.coli 0157:H7. When they found this latter bug on the cucumbers, they thought they had found the culprit. New bugs will always make life difficult for scientists.

The German outbreak also pointed to another unavoidable issue: the Egyptians initially denied responsibility. Whatever your technological advances, politics is still likely to slow you down. One bright spot here, though, is that the Chinese are much more cooperative than they once were. This is vital given that the country’s size and relative concentration of people makes it quite a likely source for outbreaks.

Another important step forward has been global food safety standards. The worldwide adoption of the hazard analysis critical control points system – HACCP — originally developed by NASA to protect astronauts from food poisoning, makes it less likely that the world food supply could lead to a major epidemic — even if some countries are still more diligent than others.

Having said that, food poisoning is more common than a century ago (albeit not dysentry spreading from person-to-person or tuberculosis in milk). The Ministry of Health for England and Wales recorded 59 food poisoning incidents during the years 1931-1935, compared to more than 73,000 in 2012, itself a gross underestimate because most people with food poisoning don’t seek medical advice.

The number of sufferers from the UK’s number-one cause, Campylobacter, has been convincingly estimated at 500,000 people each year. To some extent this is down to better diagnosis, but probably not entirely. The realities of 21st century mass production of cheap meat are likely to have driven up infection, for example.

Above all else, the big lesson from Germany was that a major outbreak could still take us completely by surprise. With microbes evolving as they do, we can be certain it will happen again.

Food Safety News

Our Ability to Cope With Foodborne Outbreaks Hasn’t Improved Much

(This article was initially published May 6, 2014, by The Conversation. Dr. Pennington is Emeritus Professor of Bacteriology at the University of Aberdeen.)

On May 7, 1964, a catering-size can of corned beef from Rosario, Argentina, was opened in a supermarket in central Aberdeen. Half the contents were put on a shelf behind the cold meat counter and the other half went into the window.

The weather was warm. The sun shone on the meat. Corned beef is cooked in the can and should be sterile. But it wasn’t. It had been contaminated after cooking when the can was cooled with untreated water from the River Parana.

Into this river, 66 tons of human feces and 250,000 gallons of urine were discharged every day from Rosario, where typhoid was common. The bacteria in the corned beef in the window grew vigorously.

Toll rising

The first person to fall ill developed symptoms on May 12. Making an initial diagnosis is not easy; it usually starts with a high fever, which can have many causes.

In Aberdeen, the first definitive diagnoses were made on May 20. By midnight, 12 were in the hospital, and, until June 13, daily hospitalizations never fell below double figures. The outbreak then fizzled out. At its end, 503 had been admitted to the hospital with typhoid, 403 with bacteriological confirmation.

Among those affected, there was a significant over-representation of women aged 15 to 25 living in the more prosperous west end of the city. The probable explanation is that a slimming regime incorporating cold meats and salad was popular at the time.

Nobody died from typhoid in the outbreak, thanks to antibiotics, so in that regard it was modern. Its media coverage, by TV, would be recognizable today, too. But some aspects of its management were conducted as though World War II was still in progress. The names and addresses of those admitted to the hospital were published in the local paper and the end of the outbreak was announced as the “all clear.”

Dr. Ian MacQueen, then Aberdeen’s medical officer of health, took control of the outbreak. Opinion in Aberdeen is still divided about how he handled it. Some say he saved the city, others say that his antics verged on the ridiculous.

I belong to the latter camp. MacQueen believed that dramatic statements of risk were necessary to prevent the spread of infection. Thus Aberdeen became, in his description, the “beleaguered city,” and beef cattle raisers in Paraguay, Kenya and Tanzania suffered economically as importing meat came to be seen as high risk in the initial panic about the source.

MacQueen recommended that nobody should paddle in the sea, and the main thoroughfare, Union Street, was sprayed with disinfectant. There was an obsession with “wave after wave of infections” occurring because of poor personal hygiene.

In truth, this was always very improbable. There was no person-to-person spread. All the infections were caused by eating contaminated corned beef or cold meats cut with the same slicer. New cases continued to appear not because the source of infection was still active but because the incubation period — the time between being infected and falling ill — was often long.

The modern picture

Could the kind of events that happened in Aberdeen 50 years ago be repeated? Cans of food are unlikely to be the source nowadays because canning practices are almost certainly better (even if, as we saw in the horse meat scandal, the label does not always accurately describe the contents). Typhoid is still common in countries whose drinking water is regularly contaminated with human feces – the 2004-2005 outbreak in Kinshasa affected 42,564 and killed 214.

But an even nastier organism caused the most recent big foodborne outbreak in Europe. Like the Aberdeen outbreak, it started in May and went on until the end of June, and, like Aberdeen, it also affected women much more commonly than men. But it happened in 2011 in Germany.

The organism was E.coli O104:H4, a brand-new bacterium that had evolved as a hybrid of two other disease-causing E.coli strains. More than 3,500 fell ill, 855 developed serious complications and 53 died.

Just as in Aberdeen, the organism was imported. It came on the surface of fenugreek seeds, which had left Egypt by boat on Nov. 24, 2009, and eventually arriving at an organic sprout producer near Hamburg on Feb. 10, 2011.

Seed sprouting is ideal for bacterial growth. But identifying the seed sprouts as the cause of the outbreak was difficult and slow because they were used as a salad garnish and many victims were not aware that they had eaten them. That women were more commonly ill pointed to salads, but photographs taken at meals were invaluable.

It was all very embarrassing for the German public health authorities, particularly when the Hamburg health minister mistakenly announced that the organism that had caused the outbreak had been found on Spanish cucumbers, causing serous economic damage to that industry. Shades of Dr. MacQueen!

Lessons from Hamburg

This mistake illustrated the limits of modern lab technology. We might now be in a position where we could genome-sequence E.coli 0104:H4 quickly, but because it was a new strain, the authorities initially confused it for the more prevalent E.coli 0157:H7. When they found this latter bug on the cucumbers, they thought they had found the culprit. New bugs will always make life difficult for scientists.

The German outbreak also pointed to another unavoidable issue: the Egyptians initially denied responsibility. Whatever your technological advances, politics is still likely to slow you down. One bright spot here, though, is that the Chinese are much more cooperative than they once were. This is vital given that the country’s size and relative concentration of people makes it quite a likely source for outbreaks.

Another important step forward has been global food safety standards. The worldwide adoption of the hazard analysis critical control points system – HACCP — originally developed by NASA to protect astronauts from food poisoning, makes it less likely that the world food supply could lead to a major epidemic — even if some countries are still more diligent than others.

Having said that, food poisoning is more common than a century ago (albeit not dysentry spreading from person-to-person or tuberculosis in milk). The Ministry of Health for England and Wales recorded 59 food poisoning incidents during the years 1931-1935, compared to more than 73,000 in 2012, itself a gross underestimate because most people with food poisoning don’t seek medical advice.

The number of sufferers from the UK’s number-one cause, Campylobacter, has been convincingly estimated at 500,000 people each year. To some extent this is down to better diagnosis, but probably not entirely. The realities of 21st century mass production of cheap meat are likely to have driven up infection, for example.

Above all else, the big lesson from Germany was that a major outbreak could still take us completely by surprise. With microbes evolving as they do, we can be certain it will happen again.

Food Safety News

Report Details Causes of Salmonella Outbreaks at Two Arkansas Prisons

Problems with food preparation, hand-washing and food-safety training were cited as the cause of two large, multi-serotype Salmonella outbreaks at Arkansas prisons in August of 2012, according to a new study released in last week’s Morbidity and Mortality Weekly Report (MMWR).

Investigators from the Arkansas Department of Health and the U.S. Centers for Disease Control and Prevention report that 597 inmates incarcerated at Arkansas prisons were infected with eight serotypes of Salmonella during the outbreak.

Those eight strains of Salmonella revealed 15 pulsed-field gel electrophoresis (PFGE) patterns of the bacterium. This finding surpasses all previous reports for multiple-serotype outbreaks of Salmonella previously reported in prisons.

Case-control studies conducted at the prisons revealed that the Salmonella outbreak was statistically associated with chicken salad and other food items. Chicken salad was the likely cause of the outbreak at Prison A. Multiple food items, as well as person-to-person transmission, were the likely causes of the outbreak at Prison B.

Both prisons incorporated eggs produced at Prison B into the chicken salad dishes served at the institutions. Several food-handling errors, including leaving chicken salad at unsafe temperatures, could have contributed to the Salmonella outbreak. MMWR editors noted that inmates should receive food safety training before assignment to kitchen work.

The editors further state that sanitarians should regularly inspect prison kitchens, cafeterias, and agricultural facilities, and require them to maintain standards equivalent to those of commercial establishments in accordance with state or local guidelines.

A final recommendation that resulted from the outbreak findings is that health departments might consider enhancing collaborative surveillance with prison staff to improve control of foodborne outbreaks in prisons.

The entire study and its findings can be found on the MMWR website.

Food Safety News

Analysis: Easier Raw Milk Sales Could Double Illness Outbreaks in Maryland

Maryland’s Department of Legislative Services says that making raw milk sales legal through individual cow-share or herd-share schemes could increase sporadic or isolated cases of illnesses from unpasteurized milk from almost none today to 100-165 per year.

In addition, the independent fiscal and policy analysis of House Bill 3 predicts raw milk-borne outbreaks in the state would double, reaching two to four per year from the current one to two per year.

Maryland is the second state bordering raw milk-exporting Pennsylvania to be considering a cow- or herd-share bill during the current legislative session. West Virginia is the other.

Maryland’s “Consumer-Owned Livestock” bill, heard two weeks ago, has not moved since the independent fiscal and policy note was issued by legislative services. It says that HB 3 exempts the sale of raw milk and raw milk products from regulations governing production, processing, labeling and distribution if the final consumer has an ownership interest in the animal or herd that produced the raw milk.

No exemption would apply to restaurant, retail, commercial, wholesale or other sales of raw milk and raw milk products to subsequent buyers.

Making raw milk sales legal through cow-share or herd-share ownership agreements would cost the state at least $ 66,100 in fiscal year 2015, according to fiscal estimates. That amount would pay for an additional employee to respond to increased raw milk disease outbreaks and sporadic cases.

The Maryland Association of County Health Officers told legislative services that more outbreaks would raise local costs as well. Additional cases and more outbreaks would increase costs for state laboratory services.

Under current law, Maryland prohibits selling raw milk for human consumption unless it’s used for making farmstead cheese. Milk must now be sold to processors, who pasteurize it before it can be distributed and sold to consumers.

Like West Virginia, however, raw milk does reach consumers in Maryland from neighboring Pennsylvania, where the sale of unpasteurized milk is legal and where, from time to time, the state line is not a barrier to distribution.

Raw milk policy is one of the most divisive health issues the states face. The public is divided between the vast majority who accept pasteurization as a prudent defense against a host of pathogens and the small but vocal minority who insist raw milk is antimicrobial and more nutritious than pasteurized milk.

As a result, the states are divided. Thirty of them allow raw milk sales only from on the farm to restaurants and retail stores, while the other 20 ban it for all but the farm families which own and milk the cows.

The federal Centers for Disease Control and Prevention (CDC) in Atlanta reported 148 outbreaks of disease from 1998 to 2011, causing 2,384 illnesses, 284 hospitalizations and two deaths. CDC found states that permit sales of raw milk have a higher incidence of milk product-related illnesses than those that don’t.

For its part, Maryland’s legislative services figures that each sporadic or isolated case involves eight to 16 hours of investigative time, in addition to the time and cost to state Laboratories Administration.

It was on that basis, the fiscal note stated, that additional staff should be hired if raw milk policy is liberalized in Maryland. Investigations typically involve patient interviews and the examination and processing of evidence. The estimate provided to the legislature states that 100 samples of milk tested for pathogens cost the state $ 10,000.

The U.S. Food and Drug Administration (FDA) warns that raw milk can contain harmful bacteria that may cause illness and death. Pathogens included E. coli O157:H7, Salmonella, Listeria, Campylobacter and Brucella. Both FDA and CDC say the health risks of raw milk far outweigh any possible benefits that the beverage may provide.

If passed by the Maryland Legislature, HB 3 would make the state the 14th to permit on-the-farm sales of raw milk. If approved, raw milk is expected to sell on the farm through share arrangements for $ 7 to $ 8 per month based on current prices paid for the product through Pennsylvania sources.

Food Safety News

Norovirus Outbreaks Haunt Cruise Ships

CNN reports that hundreds of people aboard two cruise ships in the Caribbean fell ill due to norovirus, the latest instances in which the stomach bug has thwarted vacationers at sea.

The Centers for Disease Control and Prevention reported Friday that norovirus had hit more than 600 passengers and crew on Royal Caribbean’s Explorer of the Seas, making it one of the biggest such outbreaks on any cruise ship in the last two decades.

In addition, the Caribbean Princess, operated by Princess Cruises, cut short its own seven-day Caribbean itinerary on Friday.  Princess Cruises said that 178 passengers and 11 crew members aboard had been stricken with norovirus, with CDC staffers on board Friday to help sanitize that ship.

There have been nearly 200 confirmed norovirus outbreaks on cruise ships in the past 20 years.

According to the CDC, norovirus is the most common cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths. Norovirus is also the most common cause of foodborne-disease outbreaks in the United States.

Food Safety News

Tracking Down the Source of Outbreaks: It’s Complicated

Meet CORE, FDA’s team of food safety sleuths

With a globalizing food supply, brought to us by increasingly complex supply chains, foodborne illness outbreaks are notoriously tough to solve. These outbreaks often involve multiple states, dozens of illnesses, which are chronically underreported, they include patients who can’t remember what they ate for lunch last week, and, while they are often narrowed down to a list of possible culprits, nine times out of ten we will never know what food product was to blame.

The outbreaks we hear about – and that Food Safety News reports on – are usually the ones that were solved, meaning federal, state, and local health officials were able to put all the evidence together, pinpoint a food source, and alert the public with an outbreak announcement from the Centers for Disease Control and Prevention or maybe even a recall from the U.S. Food and Drug Administration. But an extraordinary amount of work goes into trying to crack these cases, whether the public hears about them or not.

That’s where FDA’s elite team of investigators comes in.  This cohort – formally known as the Coordinated Outbreak Response and Evaluation Network – has been working tirelessly on foodborne illness outbreaks since the initiative launched two years ago this month.

Designed for more rapid response, CORE brings together epidemiologists, microbiologists, veterinarians, and other experts, under the same roof at FDA, so they can work together more efficiently and focus solely on outbreaks.

In interviews, CORE staff often used terms like “more efficient,” “better structured,” “more effective,”  “faster, and “better organized,” to describe the shift to a consolidated team. But one of the biggest changes, according to FDA officials, is that CORE puts a fresh focus on learning from each incident and applying those lessons toward more preventive policies and practices.

Before CORE, FDA only had seven or eight people to do outbreak response within the Center for Food Safety and Applied Nutrition, according to microbiologist Elisa Eliot, a 24-year veteran of FDA who now works at CORE.

“We didn’t have people out there really evaluating information, looking for outbreaks, and working proactively working with CDC. Sometimes we’d get together in a work group, but it wasn’t an ongoing, continuing, day-to-day activity,” recalls Eliot. “We didn’t have the people power to look back and do al lot of the ‘lessons learned’ and come up with preventive, better practices. We were more in the response mode all the time.”

CORE, which now has a staff of more than 30 (including contractors), is divided into three parts to help ensure prevention is not lost in the shuffle: Signals and Surveillance, which works closely with CDC to identify any emerging outbreaks that might be linked to an FDA-regulated product, Response, which is comprised of separate teams that coordinate the response efforts on multiple foodborne illness outbreaks, and Post-Response, a team that is dedicated solely to gleaning what is learned from each outbreak and applying it.

Tip of the iceberg

In the past two years, CORE has been repeatedly tested with an onslaught of foodborne illness outbreaks, only a fraction of which ever made headlines.

“It’s seasonal for us, as outbreaks tend to be,” said Ashley Grant, an epidemiologist for the Signals team. “Right now we are in the peak of our season so we probably have about eight to ten on our plate at any given time in summer and spring months. As we get into the fall and winter, we probably have about five a week.”

Between August 2011 and the end of 2012, for example, the CORE Signals team evaluated 211 incidents, 63 of which were transferred to a response team. During that time frame, however, only 12 outbreaks were announced on the FDA website.

Of all the incidents CORE Signals tracked in that time, 144 were not referred to a response team. According to FDA, in 22 of those cases the vehicle turned out to not be an FDA-regulated product (remember meat, poultry, and processed eggs all fall under the jurisdiction of the U.S. Department of Agriculture). The agency said that in another 34 cases, “FDA response activities had already been initiated and completed,” which means the case might be handled outside of CORE by the enforcement branch or at the state-level. In the remaining 88 cases, the vehicle was not identified.

Staying on top of this is a lot of work, any way you look at it. CORE staff are known to work long hours and weekends when they’re assigned to an outbreak that’s particularly tricky – think Salmonella tuna scrape or pomegranate seeds recently blamed for a Hepatitis A outbreak. (links)

The slow-moving nature of foodborne illness reporting, which suffers from lag times, underreporting, and diminishing public health resources at the state and local level, adds another layer to an already complicated puzzle.

“Sometimes, the outbreak has concluded by the time we’re actually getting to the point where we have an idea of what the vehicle might have been,” said Jennifer Beal, an epidemiologist for the Signals team. “In that case, there’s nothing left for the response team to do.”

“Other times, the vehicle is never identified and that probably constitutes the bulk of the cases we don’t transfer,” added Beal. “But for any one of these things, we put in the same amount of effort to try to make that determination.”

For the bulk of incidents that are monitored, but not referred to a response team for further action, the team still pours “a lot of time and energy” into trying to figure out what the cause might have been. They save that information in case a similar situation arises so they might benefit from their previous legwork the next time around.

According to Gary Weber, a supervisory interdisciplinary specialist in animal science for CORE, each and every incident is “pushed as far as this team can take them to find out the linkages.”

“They don’t give up easily, that’s for sure,” said Weber.

Frustration

When meeting with CORE investigators, the passion they have for their work and public health is evident – and so is their frustration over the outbreaks that could not be explained, despite lengthy investigations.

For Roberta Hammond, a supervisory interdisciplinary scientist for CORE, the heart break comes from multiple ingredient outbreaks. Oftentimes, investigators can narrow the source to a salad mix or a restaurant chain, but they aren’t able to take it one step further, to figuring out which ingredient.

Even when they do figure out the vehicle in time, comingling, and lot mixing, especially for produce, can complicate things.

“Something with a short shelf life is more challenging because there may not be product to sample, or if you do manage to trace it back to the firm or farm of field, it’s not there,” said Pamela LeBlanc, a leader of one of the CORE response teams.

Stelios Viazis, a microbiologist for one of CORE’s response teams, agrees: “That’s the most frustrating.”

These frustrations are likely to grow as Americans increase their appetite for fresh foods from a variety of sources, both domestic and foreign, year round.

Food Safety News

Diagnosing Foodborne Illness Outbreaks

Foodborne illness outbreaks result when two or more persons develop similar symptoms of illness (gastroenteritis) after eating a common food, or become ill after consuming food from a common source. Such events occur relatively frequently and create various degrees of crises for the firms and victims involved.

While food can be contaminated with a chemical or physical agent, the vast majority of foodborne illness outbreaks are due to contamination by microbes. There are at least 200 of such foodborne pathogens, including bacteria, virus and parasites. Some are less common, such as Plesimonas shigelloides, and there are a handful of common ones, including Norovirus, Listeria monocytogenes, Salmonella spp. and E. coli O157:H7.

Foodborne illness outbreaks often require the intervention of the agencies tasked with public health protection. State and local health departments are usually the first to field reports and investigate. Federal agencies such as the Centers for Disease Control and Prevention, the Food and Drug Administration, the U.S. Department of Agriculture and other federal agencies will also respond as necessary upon notification. These agencies work together during large multi-state investigations to uncover the sources of product contamination with the intention of removing the contaminated products from commerce as soon as possible.

While federal authorities may become involved, most of the work is done by local sanitarians, epidemiologists, public health nurses and clinicians in county and state health departments, with only occasional assistance from the federal agencies.

Epidemiologic investigations seek to uncover the “time-place-person” factors associated with an outbreak, such as the vehicle (food or beverage), the source of contamination, the exposed population, the number of ill persons and their characteristics and associated timelines. Various entry points for contamination need to be identified and include farms, packinghouses, slaughterhouses, processors of all types, manufacturers, foodservices, institutions, and community events, just to name a few.

Sanitarians (inspectors) working in public health agencies (environmental health units) evaluate associated environmental health factors, wherever contamination is suspected in the supply chain with the purpose of identifying the source of the offending agent and cutting off its means of spread. Inspections may uncover a variety of factors such as a contaminated food source, contaminated water supply (such as in produce washing operations), time and temperature abuse (typically in foodservice), poor hygiene, ill workers, contaminated equipment, environmental contamination, cross-contamination or ineffective cooking or heating.

Public health professionals analyze the findings of the investigation and make decisions to notify the public, recall products, stop the sale of products and/or close affected businesses. Even though agencies rarely pursue administrative action against an operation causing an outbreak, the political fallout from such interventions is often intense, causing agencies to act judiciously. Unfortunately, such realities may result in outbreaks continuing for some time before an agency is legitimately able to take action. Some have questioned the timing of agencies when “going public” and argue that a standard method is needed in that decision-making process.

The process of identifying the causes of a foodborne illness outbreak currently rests heavily on the results of molecular or traditional microbial analysis coupled with statistical techniques. In the past, before health departments had the benefit of molecular genotyping (DNA analysis), outbreak investigations were not always as conclusive. With sophisticated tools such as pulsed-field gel electrophoresis now in hand, investigators are increasingly able to identify common links in cases and thus determine the sources of contamination, the implicated products and the exposed populations with increasing accuracy.

When analysis reveals patterns of genetically and clinically associated subtypes of known pathogens, agencies should recognize that an outbreak is occurring and take action, including notification of the public when called for.

A process data collection and analysis ensues whenever there are verifiable reports of outbreaks. This includes an environmental assessment of operations and facilities to pinpoint the most likely mechanisms for the propagation and spread of the pathogen.

Finding the suspect microorganism in either the incriminated food, the victims, or, ideally, in both, helps to confirm an outbreak, and this information also provides a framework for the environmental assessment of a facility. For example, when a strain of Salmonella is found in a specific food product, the sanitarian’s work is then simply to determine the source of food and the production methods for that item that allowed Salmonella to contaminate, grow and survive. By identifying the sources of foods and ingredients, storage conditions, food handling, preparation and service, it is possible for a sanitarian to determine the most likely causes of an outbreak. The sanitarian uses the guidance of the FDA Food Code to identify lapses in sanitation likely associated with the outbreak. The code specifies the hygienic standards, sanitation procedures and process controls necessary for the safe production of food, while deviations from the code indicate that operators may not be in control.

Compliance with the code itself provides a basis for determining the factors likely associated with an outbreak; however, the value of the findings may be limited by certain factors. Those limitations include that the investigation may occur some time after the outbreak is identified, the operation may not be producing the incriminated food at the time of inspection, or operators may sell, discard or destroy the food item of interest before the inspection can take place.

The inspection of an operation can provide convincing evidence for causation when both the pathogen and vehicle are known; however, associated factors may be less obvious when pathogens have not been confirmed, or when epidemiological evidence is lacking, e.g., specific foods lack a strong association with cases.

Public health agencies may identify a foodborne illness outbreak when a sharp increase in cases of gastroenteritis occurs in a population, or when investigators find patterns in the incidence of cases of reportable diseases such as E. coli O157:H7 linked in time. Outbreaks may be short-lived episodes where victims recover quickly with no sequelae, or such events may be protracted over several weeks and affect a large number of victims with severe symptoms. Large, persistent outbreaks tend to be well-documented. Numerous cases result in more data and investigators can make a more accurate analysis when there are better food histories and clinical reporting. In addition, extended timeframes often allow for in-depth facility inspections to take place. Such well-documented larger events lend themselves to theories of causation. When there are limited data on victims or products consumed, causation is less clear, but a successful environmental assessment can still reveal important clues and uncover probable causes of contamination that help to strengthen a hypothesis.

While investigators should investigate all reports of outbreaks, the lack of resources available to health departments often limits their efforts. Too often, investigators fail to uncover the cause and the mechanisms at work. This means prevention becomes less effective and repeat occurrences are more likely.

Environmental assessment techniques

When a particular food item is suspected, the sanitarian follows the flow of that food item through production from receipt of the ingredients through to service. If that item is not being produced, a similar recipe or food production process can be examined. When deemed appropriate, the sanitarian may also collect environmental samples, which includes surface swabs and food items.

Hazard Analysis Critical Control Point, or HACCP, is a system of preventive controls that identifies hazards and establishes steps of production where those hazards can be eliminated or reduced to safe levels. Since the HACCP process identifies categories of microbiological hazards in food (contamination, growth and/or survival), sanitarians can use HACCP as an investigative tool. Using HACCP principles, the key steps of production are identified and the investigator can determine if operators properly applied food code standards to the most hazardous production steps. Investigators can also use HACCP to better target microbial sampling.

When the pathogen is not confirmed, the symptomology of victims is important to the environmental assessment. Symptoms of nausea and diarrhea are common to many foodborne illness etiologies, but their frequency in victims, coupled with average incubation period and length of symptoms, can provide clues to specific pathogens. For example, bacterial infections such as salmonellosis, campylobacteriosis, vibriosis and shigellosis are usually accompanied by fever, whereas infections with E. coli O157:H7 and related serotypes cause bloody diarrhea as the predominant system. Intoxications caused by Staphylococcus aureus and the spore-forming bacteria Bacillus cereus and Clostridium perfringens produce a rapid onset of symptoms, with nausea and vomiting as the predominant symptoms, while Clostridium botulinum is unique for causing descending bilateral paralysis.

Different levels of the supply chain have different risks. For example, viral infections are often passed between ill workers and patrons in food service settings through the handling of ready-to-eat foods with bare hands, but this rarely occurs at the manufacturing level.

When the contamination with infectious organisms occurs farther up to food chain, for example at the manufacturing or processing level, factors are less likely to involve direct food handling mistakes and more likely to include contaminated equipment, cross-contamination and process failures. When the primary producer level is suspected as the point of exposure, especially when produce is involved, contaminated water supplies become very important.

The distinction between “infection” and “intoxication” is another important consideration, as factors that give rise to bacterial infections through food may be significantly different from those associated with the spore-forming or intoxicating microorganisms. Cross-contamination, a human carrier or a contaminated source of ingredients, are often associated with infectious disease, while time and temperature abuse is always necessary for intoxicating microorganisms to proliferate and/or produce toxins in foods.

Investigators suspect Norovirus as the cause of foodborne illness when clinical specimens do not reveal bacterial agents and victims experience a rapid onset of nausea and vomiting combined with low-grade fever. In light of a Norovirus outbreak, investigations often focus on hygienic standards and the presence of infected workers. Investigators using molecular assay techniques, such as RT/PCR (reverse transcription polymerase chain reaction), can often detect the virus in food handlers and occasionally in surface swabs of equipment and environment. In such viral GI outbreaks, a ready-to-eat food is usually involved.

Sometimes unique symptoms such as septicemia and infected lesions in persons consuming raw shellfish clearly point to the pathogen Vibrio vulnificus. Other unique symptomologies include hemolytic uremic syndrome associated with E. coli O157:H7, the previously mentioned descending bilateral paralysis of botulism and the temperature reversal phenomena in cases of Ciguatera (from ingestion of inshore marine finfish such as barracuda, mackerel and jacks). All of these etiologies, whether known or suspected, will influence how a sanitarian goes about an environmental assessment.

For example, the source of shellfish is always an important issue when vibriosis is identified. Sanitarians in such cases typically collect and analyze the required shellfish tags and may also collect receipts of shellfish deliveries. Infections with Vibrio vulnificus don’t usually result in outbreaks, but investigators should look into such illnesses due to the severity of symptoms, with mortality reaching up to 40 percent of affected cases. Vibrio infection is the direct result of exposure of at-risk consumers to seawater or shellfish harvested from areas where seawater temperatures and other environmental conditions favor the presence of the free-living marine bacteria. While Vibrio vulnificus is an opportunistic pathogen, poor handling of shellfish anywhere in the supply chain increases the likelihood of exposure.

In the case of Ciguatera intoxication, one or several victims may be involved in an outbreak scenario. Ciguatoxin is bio-accumulated in certain finfish and is heat stable, making cooking of no importance to prevention. Ciguatera symptoms involve both the digestive and neurological systems, with some victims experiencing temporary paralysis. As in vibriosis cases, the sanitarian is concerned about the source of the fish, but there is usually no connection between poor handling and cases, except perhaps for cross-contamination that can occur during preparation.

To be effective in the role of an environmental investigator, a sanitarian must be well-versed in several disciplines and have expert knowledge of the characteristics and routes of transmission of a wide host of foodborne illness etiologies.

Food Safety News

The 10 Biggest Foodborne Illness Outbreaks of 2013

Editor’s note: 2013 saw dozens of well-publicized foodborne illness outbreaks. While many of them were found to have sickened a handful of individuals, a few stood out as especially wide in scope. Food Safety News has compiled a list of 10 of the biggest U.S. outbreaks in 2013. Please note that the list only includes outbreaks associated with grocery products or restaurants, and therefore excludes outbreaks associated with large public gatherings or those that went unsolved. Also note that the actual number of outbreak cases is typically much higher than the quoted number due to many victims typically falling ill but never being reported.

10. E. coli O157:H7 from Glass Onion chicken salads, 33 sick. Trader Joe’s customers in four states fell ill after eating one of two pre-made salad products from Glass Onion Catering: the Field Fresh Chopped Salad with Grilled Chicken or the Mexicali Salad with Chili Lime Chicken. At least seven people were hospitalized, with two developing hemolytic uremic syndrome (HUS), a kidney disease associated with severe E. coli infections. [CDC outbreak information]

9. Salmonella from Hacienda Don Villo in Channahon, IL, 35 sick. Health investigators traced 35 Salmonella illnesses back to this Mexican restaurant in Grundy County, but they could never pinpoint the exact food source. At least one person was hospitalized, and one employee was among those who tested positive for Salmonella. [News report]

8. E. coli O121 from frozen Farm Rich foods, 35 sick. Prompting a large recall of frozen mini pizza slices, cheeseburgers and quesadillas, this outbreak sickened predominantly minors across 19 states. Of those confirmed ill, 82 percent were 21 years of age or younger. Nine were hospitalized. The company recalled all products created at one Georgia plant between June 2011 and March 2013. [CDC outbreak information]

7. Salmonella from imported cucumbers, 84 sick. Investigators eventually traced this outbreak of Salmonella Saintpaul back to cucumbers imported from Mexico. Of those confirmed ill, 17 were hospitalized. The importers were barred from bringing more products into the U.S. until they could prove the products were not contaminated. [CDC outbreak information]

6. E. coli O157:H7 from Federico’s Mexican Restaurant in Litchfield Park, AZ, 94 sick. Investigators have implicated lettuce served at the restaurant as the likely source of the E. coli, but no other restaurants in the area had cases connected to them. The lettuce may have been cross-contaminated from another food at the restaurant, or the restaurant may have received a highly contaminated batch. Two victims developed HUS as a result of their infections. [News report]

5. Salmonella from Foster Farms chicken, 134 sick. The first of two Foster Farms outbreaks in 2013 hit Washington and Oregon the hardest, but then spread out across 13 states. At least 33 people were hospitalized, their infections likely resulting from improper handling or undercooking of contaminated raw chicken. [CDC outbreak information]

4. Hepatitis A from Townsend Farms frozen organic berries, 162 sick. At least 71 people were hospitalized after eating an organic berry mix purchased at Costco stores in the Southwest. The exact source of the outbreak was eventually traced back to pomegranate seeds from Turkey which were contained within the mix. [CDC outbreak information]

3. Salmonella from dining at Firefly restaurant in Las Vegas, NV, 294 sick. Patrons of this popular Las Vegas tapas restaurant fell ill after dining within a five-day stretch in April. The owners ultimately closed up shop and re-opened the restaurant in a new location. [News report]

2. Salmonella from Foster Farms chicken, 416 sick. While this outbreak appears to be ongoing, hundreds of individuals have fallen ill over the course of the year in connection with raw chicken processed at Foster Farms facilities in California. At least 162 people have been hospitalized after likely mishandling or undercooking the raw chicken. [CDC outbreak information]

1. Cyclospora from salads and cilantro, 631 sick. The outbreak of this foodborne parasite also takes the title for most confusing, as it appeared to be two separate Cyclospora outbreaks working in tandem. One set of patients – predominantly from Iowa and Nebraska – clearly appeared to be connected to Olive Garden and Red Lobster restaurants (both owned by Darden Restaurants), while, just weeks later, patients in Texas began cropping up with no apparent connection to those restaurants. The Darden illnesses were tentatively traced to lettuce supplier Taylor Farms de Mexico, but no contamination could be found at the farms. Meanwhile, many of the Texas illnesses seemed to implicate fresh cilantro grown in Puebla, Mexico.

Food Safety News

Tracking Down the Source of Outbreaks: It’s Complicated

At an FDA lab in Denver, Microbiologist Melissa Nucci preps for testing peanut butter samples for Salmonella. Photo courtesy of FDA’s flickr.

With a globalized food supply brought to us by increasingly complex supply chains, foodborne illness outbreaks are notoriously tough to solve. These outbreaks often involve multiple states and dozens of illnesses, which are chronically underreported. They include patients who can’t remember what they ate for lunch last week, and, while food products are often narrowed down to a list of possible culprits, nine times out of 10 we will never know which one was to blame.

The outbreaks we hear about – and that Food Safety News reports on – are usually the ones that were solved, meaning federal, state, and local health officials were able to put all the evidence together, pinpoint a food source, and alert the public with an outbreak announcement from the federal Centers for Disease Control and Prevention or maybe even a recall from the U.S. Food and Drug Administration. But an extraordinary amount of work goes into trying to crack these cases, whether the public hears about them or not.

That’s where FDA’s elite team of investigators comes in. This cohort – formally known as the Coordinated Outbreak Response and Evaluation Network – has been working tirelessly on foodborne illness outbreaks since the initiative launched two years ago this month.

Designed for more rapid response, CORE brings together epidemiologists, microbiologists, veterinarians and other experts, all under the same roof at FDA so they can work together more efficiently and focus solely on outbreaks.

In interviews, CORE staff often use terms such as “more efficient,” “better structured,” “more effective,”  “faster” and “better organized” to describe the shift to a consolidated team. But one of the biggest changes, according to FDA officials, is that CORE puts a fresh focus on learning from each incident and applying those lessons toward more preventive policies and practices.

Before CORE, FDA only had seven or eight people to do outbreak response within the Center for Food Safety and Applied Nutrition, according to microbiologist Elisa Eliot, a 24-year veteran of FDA who now works at CORE.

“We didn’t have people out there really evaluating information, looking for outbreaks, and working proactively with CDC. Sometimes we’d get together in a work group, but it wasn’t an ongoing, continuing, day-to-day activity,” Eliot recalls. “We didn’t have the people power to look back and do a lot of the ‘lessons learned’ and come up with preventive, better practices. We were more in the response mode all the time.”

CORE, which now has a staff of more than 30 (including contractors), is divided into three parts to help ensure prevention is not lost in the shuffle: Signals and Surveillance, which works closely with CDC to identify any emerging outbreaks that might be linked to an FDA-regulated product; Response, which is comprised of separate teams that coordinate the response efforts on multiple foodborne illness outbreaks; and Post-Response, a team solely dedicated to gleaning what is learned from each outbreak and applying it.

Tip of the iceberg

In the past two years, CORE has been repeatedly tested with an onslaught of foodborne illness outbreaks, only a fraction of which ever made headlines.

“It’s seasonal for us, as outbreaks tend to be,” said Ashley Grant, an epidemiologist for the Signals team. “Right now, we are in the peak of our season, so we probably have about eight to 10 on our plate at any given time in summer and spring months. As we get into the fall and winter, we probably have about five a week.”

Between August 2011 and the end of 2012, for example, the CORE Signals team evaluated 211 incidents, 63 of which were transferred to a Response team. During that time frame, however, only 12 outbreaks were announced on the FDA Website.

Of all the incidents CORE Signals tracked during that time, 144 were not referred to a Response team. According to FDA, in 22 of those cases, the vehicle turned out not to be an FDA-regulated product (remember that meat, poultry and processed eggs fall under the jurisdiction of the U.S. Department of Agriculture). The agency said that in another 34 cases, “FDA response activities had already been initiated and completed,” which means the case might be handled outside of CORE by the enforcement branch or at the state level. In the remaining 88 cases, the vehicle was not identified.

Staying on top of all this is a lot of work. CORE staff are known to work long hours and weekends when they’re assigned to an outbreak that’s particularly tricky.

The slow-moving nature of foodborne illness reporting, which suffers from lag times, underreporting and diminishing public health resources at the state and local levels, adds another layer to an already complicated puzzle.

“Sometimes, the outbreak has concluded by the time we’re actually getting to the point where we have an idea of what the vehicle might have been,” said Jennifer Beal, an epidemiologist for the Signals team. “In that case, there’s nothing left for the response team to do.”

“Other times, the vehicle is never identified and that probably constitutes the bulk of the cases we don’t transfer [to the Response team],” she added. “But for any one of these things, we put in the same amount of effort to try to determine the vehicle.”

The team still pours a lot of time and energy into trying to figure out what the cause of a foodborne illness outbreak might have been. When they aren’t successful, they still save the information gathered in case a similar situation arises.

According to Gary Weber, a CORE supervisory interdisciplinary specialist in animal science, each and every incident is “pushed as far as this team can take them to find out the linkages.”

“They don’t give up easily, that’s for sure,” he added.

Frustration over the unexplained

CORE Network Team leaders from left: Jeffrey Brown (Signals and Surveillance Team), Carla Tuite (Response Team), Brett Podoski (Post-Response Team), Pamela LeBlanc (Response Team) and William Lanier (Response Team). Photo courtesy of FDA’s flickr.

When meeting with CORE investigators, the passion they have for their work and for public health is evident, but so is their frustration over the outbreaks that could not be explained, despite intense, lengthy investigations.

For Roberta Hammond, a CORE supervisory interdisciplinary scientist, it’s often the multiple-ingredient outbreaks that cause heartbreak — when investigators can narrow the source to a salad mix or a restaurant chain but are unable to take it one step further to figure out which ingredient.

Even when they do figure out the vehicle in time, comingling and lot mixing, especially for produce, can complicate things.

“Something with a short shelf life is more challenging because there may not be product to sample, or if you do manage to trace it back to the firm or farm or field, it’s not there,” said Pamela LeBlanc, a leader of one of the CORE Response teams.

Stelios Viazis, a microbiologist for one of CORE’s response teams, agrees: “That’s the most frustrating.”

These are increasingly factors in foodborne illness outbreaks as Americans increase their year-round appetite for fresh and even raw foods from a variety of sources, both domestic and foreign.

Looking back at tuna scrape

Most consumers have never heard of tuna scrape – it’s tuna meat that has been scraped or mechanically separated from the bone, resulting in a slurry of fish meat – but it is commonly used to make inexpensive sushi. This is a prime example of what foodborne illness investigators call a “stealth ingredient.”

Last year, when Salmonella Bareilly and Nchanga infections started cropping up in several states, investigators quickly honed in on sushi, but they were stumped by which ingredient was responsible.

The CORE team recalls spending “a lot of time doing an ingredient matrix.”

For a while, they thought it might be the hot sauce mixed into spicy tuna rolls, as many people sickened had reported eating them.

Investigators pursued the hot sauce, with no luck, and there were many other ingredients to look at: sesame seeds, seaweed paper, rice, mayo or another sauce mixed in with the tuna, or even spices that were added into the mix.

As they started investigating tuna scrape, CORE investigators realized there was no common language for invoicing the product – the scrape could be labeled any number of things. Making matters more difficult, many of the restaurants also used Cash and Carry or bought ingredients from sources with no receipts or paper trails. Plenty of businesses linked to the outbreak didn’t know where their tuna product came from.

“It wasn’t labeled,” recalls Dr. Kathy Gensheimer, the chief medical officer and director of CORE. “We had someone from the Bronx who just bought this stuff off the back of a pickup truck.”

When approached by FDA, many restaurant owners also insisted they only used fresh tuna, not the lower-quality frozen scrape – even when they did – adding yet another layer to the investigation.

It ended up taking CORE about a month – bringing nearly 30 extra people into an emergency operations center to work on traceback for three weeks – to definitively link the outbreak to the scrape. Officials had to sort through thousands of pages of documents and map out each complicated supply chain, which are really more like webs.

The traceback map from that investigation is a flow chart that looks “like a circuit board,” as FDA spokesman Doug Karas puts it.

That outbreak, which ultimately sickened 425 people in 28 states, showed that “with enough resources, you can get to the bottom of anything,” Gensheimer said.

“A month may sound like a horrendously long time for people getting sick,” she said, but FDA’s effort paid off in terms of public health. Once a recall was initiated, 58,000 pounds of the contaminated scrape was taken off the market.

“That would have made a lot of sushi rolls,” Gensheimer noted, adding that the product showed an unusually high level of contamination. “Just about every sample we were pulling yielded Slamonella Bareilly and Nchanga.”

If you assume a sushi roll contained a few ounces per roll of a very contaminated product, FDA’s work likely prevented thousands of diners from eating the Salmonella-ridden pink paste.

“I think you can multiply that 500 cases many, many, more times. I think we would have had thousands of cases nationwide, and even internationally, because of course this is a global trade,” Gensheimer said.

New focus on prevention

During a series of interviews with CORE officials, prevention was a common theme. Investigators repeatedly said one of the best parts about the way CORE is organized is that it dedicates a team to learning from outbreaks and following up on investigator’s recommendations.

“Now we really take the time for every single outbreak to figure out: Is there something we could have done better? Even if it’s not us – even if it’s a policy or a practice – that’s just never been done before,” explains Carla Tuite, a leader of one of CORE’s Response teams.

CORE’s Post-Response team kicks in right as the outbreak is winding down, regardless of the size or scale of the incident. If investigators ran into roadblocks – perhaps a trading partner wasn’t cooperating, for example – this team follows up on those problems.

“It’s the follow-through that takes place that has really made a big impact,” said Kari Irvin, a leader of a Response team. Irvin explained that Post-Response might include follow-up inspections or specific policy recommendations.

“If we think it’s a larger industry problem, we might work with an industry association,” said Katherine Vierk, who works on Post-Response for CORE.  “[The team] might discuss whether there needs to be additional guidance, or if this issue needs to be considered in an upcoming guidance document.”

Vierk said the Post-Response teams also reach out to the people working on rolling out and implementing the Food Safety Modernization Act, the country’s new food safety law.

If poor record-keeping was a particularly thorny issue during an investigation, it would be the Post-Response team’s job to give feedback to the FSMA rulemaking experts and tell them what would have been helpful.

Or, let’s say that the Response teams didn’t ask for the right records. If that were the case, the Post-Response team would try to figure out a way to improve their internal process.

According to Vierk, CORE is expecting to look more toward environmental assessments in the future.

“Getting out there to find out the true environmental antecedents, the true reasons why contamination occurred and then exploring ways to get that information back to industry so it doesn’t happen to them,” is a top priority, she said.

CORE points to Jensen Farms as a great example of translating knowledge into better practices. What was learned in that Listeria monocytogenes outbreak in late 2011 is now informing preventive practices at the farm level. For produce, FDA puts together PowerPoint presentations based on what CORE has learned from various outbreaks, and those are disseminated through extension agents in different states. That knowledge, according to Vierk, is helping growers learn from others’ mistakes.

Before CORE, such prevention efforts were made on an ad hoc basis as people would flag things, but now the agency has dedicated staff to do that work.

FDA is also able to prevent more illnesses because CORE gets involved with foodborne illness investigations more quickly now than in years past, giving the agency a better shot at removing contaminated product before it’s consumed.

Before CORE was launched, CDC would determine that there was a foodborne illness, and then, once they figured out it might be related to an FDA-regulated product such as cheese or lettuce, “they would literally toss it over like a volleyball net and FDA could then could pick up their piece and run with it,” explains Gensheimer, who oversees CORE at FDA.

“If you’re sitting there waiting for all that work to be done, the lettuce is long gone or the cheese has been eaten,” she said.

“We get involved earlier now,” she added. The Signals team now actively monitors consumer complaints, talks to states, and keeps an eye on PulseNet, CDC’s surveillance network.

“Instead of that volleyball-net mentality, we’re all engaged with the states really almost from the get-go. It’s a cobweb interface, it’s constant communication back and forth and hopefully getting us where we need to be more quickly,” Gensheimer said.

Cyclospora outbreak rolls on

Despite all the focus on improving foodborne illness outbreak response, FDA has come under fire recently for what many consider a painfully slow response to the ongoing Cyclospora outbreak.

At last count, 548 people in 19 states have fallen ill with the parasite. In an update issued this week, The FDA said, “we are moving quickly to learn as much as possible and prevent additional people from becoming ill.”

But food safety experts have questioned why federal officials have still not figured out which product caused all of these illnesses, or even if all the illnesses are related to one another. A few weeks ago, Iowa and Nebraska identified an unnamed salad mix as the source, but both FDA and CDC have continued to say they are pursuing multiple leads, insinuating that the conclusions drawn by those two states are just part of the picture.

FDA has since confirmed that the salad mix grown by Taylor Farms de Mexico and served at Olive Gardens and Red Lobsters in Iowa and Nebraska is indeed linked to the illnesses in those states, but the question is why haven’t federal officials been able to solve the larger outbreak?

David Steigman, an FDA spokesman, declined to answer questions about how many separate supply chains the agency might be investigating because the investigation is still ongoing.

“It is not yet clear whether the cases reported from other states are all part of the same outbreak,” Steigman said.

Larry Slutsker, director of CDC’s Division of Parasitic Diseases and Malaria, told Food Safety News that part of the problem is that the agency lacks the technology to quickly differentiate which Cyclospora infections are related.

“The ability to determine subtypes, also known as strain differentiation, of foodborne pathogens would be an invaluable tool in foodborne outbreaks like this,” he said. “Subtyping supplements epidemiologic and traceback information so we’re better able to tell how cases or clusters of cases may – or may not – be related to each other. Unfortunately, this process is much less well-developed for parasites when compared to bacteria such as Salmonella or E. coli.”

FDA said Monday the traceback process for the current Cyclospora outbreak is “labor-intensive and painstaking work” that involves thousands of documents. The agency said it has a 21-person team focused on the outbreak at headquarters, with another 10-person staff working in the field, but there are still no answers as the outbreak rolls toward its eighth week.

Food Safety News

CIFOR Helps Food Industry Plan for Outbreaks

WASHINGTON — The Council to Improve Foodborne Outbreak Response, a collaboration between government and the food industry, has created guidelines to assist retailers and restaurants in dealing with outbreaks resulting from foodborne illnesses.

The document outlines what establishments can do to prevent outbreaks from happening and suggests steps for handling affected products as well as communicating with suppliers, customers and employees should an outbreak occur.


CONNECT WITH SN ON TWITTER

Follow @SN_News for updates throughout the day.


“Food safety is core to our principles in the food retail industry, and critical to ensuring the efficacy of our businesses. The CIFOR Industry Guidelines demonstrate collaboration between industry and public health professionals to respond more efficiently to the health needs of consumers,” Food Marketing Institute President and CEO Leslie G. Sarasin said in a statement.

CIFOR consists of representatives from the U.S. Department of Agriculture’s Food Safety Inspection Service, the Food and Drug Administration and the Centers for Disease Control and Prevention; local and state government agencies; and members of the food industry.

Suggested Categories More from Supermarketnews

Supermarket News

Almost 600 Sick from Hepatitis A in Frozen Berries in 3 outbreaks

It’s enough to turn me off frozen berries – he says while experimenting with a batch of gluten-free crepes filled with previously frozen berries.

As the case count for Hepatitis A linked to Townsend Farms Organic Antioxidant Blend reaches 140, outbreaks in Northern Italy and Northern Europe have sickened 352 and 103 respectively. All linked to frozen mixed berries.

Is there a connection?

Maybe probably not, other thanhuman shit Hepatitis A is everywhere, vaccines work, people in various countries don’t wash their hands and global trade in the smallest of ingredients complicates outbreak investigations.

The Italians fingered mixed berries (redcurrant, blackberries, raspberries, blueberries) and a dealer that received consignments of berries from different countries (mix made in Italy, with raw material from Bulgaria, Canada, Poland, and Serbia).

The Nords fingered frozen strawberries as the likely cause but could not exclude other frozen berries. The origin of the berries is still being investigated.

On Wednesday, Swedish supermarket chain Ica announced it was removing all frozen strawberries and some frozen mixed berries from its shelves. The berries come from Morocco and Egypt.

The Americans fingered a common shipment of pomegranate seeds from a company in Turkey, Goknur Foodstuffs Import Export Trading, and will detain shipments of pomegranate seeds from Goknur arriving into the U.S. Those pomegranate seeds were used by Townsend Farms to make the Townsend Farms and Harris Teeter Organic Antioxidant Blends and by Scenic Fruit Company to make the Woodstock Frozen Organic Pomegranate Kernels.

The Italians say the genotype and the sequence of the Hepatitis A virus isolated in the Italian outbreak is different from the U.S. and Nordic outbreaks.

Keep on investigating, investigators.

And know thy suppliers.

Maybe I’ll go for the gluten-free buckwheat pancakes instead and cook the berries in the batter. But there’s still that cross-contamination factor in the kitchen.

This article originally appeared on BarfBlog July 4, 2013. It has been updated to reflect the number of illnesses linked to the Townsend Farms outbreak as of July 5.

Food Safety News