Outbreaks in the News this week (2/7/12)

There have been some interesting foodborne illness outbreaks in the news this week (Feb 7, 2012).  Here is a quick summary.

Clostridium perfrigens outbreak due to taco meat served at N.D. basketball game.  How it probably happened - the spore-forming organism survived the heat treatment and then grew in the taco meat when that cooked meat was not held at the proper temperature.  Temperature control of cooked food can be an issue  in venues like this.  Unfortunately, people are not willing to question servers when they receive meat products that are not hot.  People preparing and handling food may not have been trained.

http://www.ksfy.com/story/16689309/clostridium-perfringens-cause-of-pierre-outbreak

Watermelon the likely source for Salmonella outbreak – Over 35 people became ill (it occurred in England, so they became unwell) from eating ready-to-eat (pre-sliced) watermelon.  How it probably happened - during the watermelon slicing operation Salmonella was transferred from the outer surface to the interior surface.  This Salmonella could have originated on the raw fruit, and then been spread through the wash water.  If the sliced water melon was not refrigerated, Salmonella could grow on the more pH neutral fruit, making the situation worse.

http://www.telegraph.co.uk/news/uknews/9056645/One-person-dies-after-salmonella-outbreak-linked-to-watermelons.html

Update – Outbreak of Campylobacter from consumption of contaminated raw milk affects 43 people in 4 states.  The dairy has resumed sales. (That raw milk group is a dedicated bunch).

http://www.therecordherald.com/news/x962217783/Raw-milk-sales-resume-at-The-Family-Cow-in-Chambersburg

3 cruise ships disinfected after norovirus outbreak

http://www.washingtonpost.com/lifestyle/travel/ship-with-stomach-virus-outbreak-sets-sail-from-port-everglades-with-new-passengers/2012/02/06/gIQAc8aztQ_story.html?tid=pm_lifestyle_pop

Salmonella and Taco Bell - CDC to release or not to release

CDC released the final report on a multistate outbreak of Salmonella Enteritidis which was associated with eating food from a Mexican-style fast food restaurant chain, Restaurant Chain A.  This report, issued on January 19, 2011 (http://www.cdc.gov/salmonella/restaurant-enteriditis/011912/index.html) indicated that 68 individuals from 10 different states became ill from October, 2011 through November, 2011.

Much of the controversy now is that CDC or the FDA did not release the name of the restaurant which we now know is Taco Bell.  It is not agencies’ policy to release the name of establishments when it is determined that the release of this information will have no impact on other people becoming ill.  (http://abcnews.go.com/Blotter/hidden-outbreak-restaurants-stay-anonymous/story?id=15505386).  Having been to many food safety conferences over the years where CDC and FDA presented case study reports, I have seen that they never state the name of the company involved in the case being presented.

On one side, I can see the value in not releasing this name.  Often, the case is ongoing, so they need cooperation from the establishment.  Additionally, releasing this information can have a huge financial impact on the company.  We assume these investigations are air-tight, but that is absolutely the case.  We just need to look at how tomatoes were wrongly blamed in 2008 when peppers were actually the source. In that salsa outbreak, the tomato industry was devastated. (http://www.bloomberg.com/apps/news?pid=newsarchive&refer=columnist_skrzycki&sid=agA9XKef6P20).  In many investigations, the indictment of a food and associated producer is based on a statistical analysis without actual product testing, as was the case with Taco Bell.

On the other side, as a consumer, I want to know which establishments present a likely risk to me and my family.  The fact that an given establishment is involved indicated that they have a insufficient food safety system.  An added concern is the fact that there seems to be no clue as to the actual cause of the Salmonella contamination.  So, to what degree do we look at this company and question whether they have a potential condition under control?  In a statement, (http://blogs.ajc.com/business-beat/2012/02/02/taco-bell-salmonella-outbreak-remains-mystery/?cxntfid=blogs_business_beat) Taco Bell indicates that it is probably at the suppler level.  Is that giving you any confidence in the safety of their food?

Man treated for rabies after field dressing infected deer

A Pennsylvania man was treated for rabies after exposure from an infected deer he had shot and field dressed.
A few important points:
Hunters should avoid field dressing deer that look abnormal or that had acted abnormally (including hides with large or multiple lesions, internal organs with abscesses or that are foul smelling, or an animal that has exhibited unusual behavior, such as this case where the animal is growling.) In most all cases, the hunter should still take down the animal and then contact the Game Commission.
Always wear latex gloves when field dressing a deer, being sure to keep fluids from contracting your own skin.  (That includes refraining from spreading blood on your face as you pretend to be the Great Hunter.)
A little more on rabies from the CDC:

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes.

The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms
People usually get rabies from the bite of a rabid animal. It is also possible, but quite rare, that people may get rabies if infectious material from a rabid animal, such as saliva, gets directly into their eyes, nose, mouth, or a wound.
Scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material (such as brain tissue) from a rabid animal constitute non-bite exposures. Occasionally reports of non-bite exposure are such that postexposure prophylaxis is given.

Hunters risk run-in with rabieshttp://www.poconorecord.com/apps/pbcs.dll/article?AID=/20120203/NEWS/202030348/-1/NEWS01

Recall of cooked eggs due to Listeria postive test results

Recall of cooked eggs and products made from those eggs due to Listeria contamination. Eggs were sold by Michael Foods under the brand names Columbia Valley Farms, GFS, Glenview Farms, Papetti's, Silverbrook and Wholesome Farms. These were institutional sized pails sold to other companies to be used in further packaging or used in foodservice. They were not sold directly to consumers. There have been no associated illnesses.

According to a report by the Wall Street Journal (link below), “

"The recall was initiated after lab testing revealed that some of the eggs within the recalled lot dates may have been contaminated with Listeria monocytogenes. A recall of three lot dates was announced on Thursday, January 26. As a precautionary measure, the recall was expanded today to include additional lot dates. Michael Foods reached the decision to expand this recall after a thorough investigation which indicated a specific repair project that took place in the packaging room as the likely source of the contamination. The company has taken a number of corrective steps to address the issue and prevent recurrence"

Interesting to note was that work was done in the packaging room. This is a common issue – repair work either introduces Listeria, or releases it from some location where it has been in an inactive state, probably for some time. Whenever work is done, in a kitchen or a processing room, extra attention must be paid to cleaning and sanitizing the area where the work occurred. Additionally, heavy verification testing is recommended to ensure that an organism like Listeria is not present.

 Also, this is another case where positive results obtained through a third party testing laboratory, perhaps done on behalf of a customer, has triggered a recall that has affected a widening number of other customers.


FDA recall notices:
Michael Foods, Inc. is recalling specific lot dates of hard-cooked eggs in brine sold in 10- and 25-pound pails for institutional use that were produced at its Wakefield, Nebraska facility because the product has the potential to be contaminated with Listeria monocytogenes.
http://www.fda.gov/Safety/Recalls/ucm289920.htm
Allison’s Gourmet Kitchens Recalls Prepared Salads that Contain Hard Cooked Eggs - The recalled Prepared Salads that contain hard cooked eggs were distributed in Texas, Oklahoma, Alabama, Kansas, Illinois, Louisiana, Nebraska, South Carolina, North Carolina, Virginia, Pennsylvania, Florida, Tennessee and Missouri.
http://www.fda.gov/Safety/Recalls/ucm290212.htm

Wegmans Food Markets, Inc. is recalling hard-cooked eggs, as well as prepared foods that contain hard-cooked eggs, sold between January 23 and February 1, 2012 because the eggs have the potential to be contaminated with Listeria monocytogenes. …products sold in Wegmans prepared foods and deli departments….
http://www.fda.gov/Safety/Recalls/ucm290198.htm

Raw Milk and Campylobacter - Outbreak in PA

There are now close to 40 cases of Campylobacteriosis related to raw milk sold by a Pennsylvania dairy (Franklin County). Although the Campylobacter bacteria has been isolated from bottles of the milk, proponents march on in defense of raw milk – either denying it was the milk, or claiming their right to drink raw milk (read comment on the bottom of page by an advocate).

Campylobacter is a very serious illness. From the CDC (http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/):
Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.
I believe that people do have the right to drink raw milk, eat raw eggs, and eat raw oysters. But, people need to understand the real risk associated with these products AND society should not pick up the cost once they become sick, or perhaps even ensuring compliance of raw milk producers (that should be built into the cost of product).

Number of people with illnesses linked to raw milk rising in Pa., Md. W.Va.
Lab tests confirm bacteria's presence in raw milk from Chambersburg dairyFebruary 02, 2012|By JENNIFER FITCH | waynesboro@herald-mail.com
 http://articles.herald-mail.com/2012-02-02/news/31019695_1_raw-milk-unpasteurized-milk-dairy-farm

Revisiting Third Party Food Safety Audits

Once again third party audits take heat for an outbreak, in this case, the Listeria outbreak in Jenson Farms Cantaloupes.. In the USA Today, two viewpoints are presented. Both present valid points, but there is more that can be said. Third party food safety audits provide a snapshot evaluation of the food safety system of an organization and give an assessment of whether that facility is following that food safety system. One important limitation is that audits, as currently completed, are not as good at determining the validity of that system, in other words, how well that system is actually working to make safe food. An astute auditor can see signs that the plan is valid through results of pathogen testing, through the process parameters that are set up, but there are factors that limit this.

•  Auditors often cover a broad range of facilities and process types (even within the same commodity) and so it is difficult to have an in depth understanding of every process in every facility an auditor visits. They will not have the vast knowledge of a given pathogen as compared to a PhD who has studied that pathogen for years.
• Audits are often one day in duration, so there is little time to get into the nuts and bolts of the process. Audits will look at the broad systems that are in place and make sure they are being followed (such as GMP’s, supplier control, pest control, HACCP), but to look at the validity of a process can take days, especially when there is the lack of support documentation such as pathogen testing.
•  In most cases, auditors are not conducting microbiological analysis of the environment or of the finished product. They may look at results that are on file, but they themselves are not swabbing surfaces or pulling product from the end of the line and sending to a qualified laboratory. As was seen in the PCA case, a company may only show select results from a less reputable laboratory. So to what degree can an auditor, in a day or so, evaluate the laboratory being used, the methods that laboratory is using, and the sampling scheme used by the plant?
•  Auditors will count, in part, that the facility actually knows what it is doing. If a facility has been processing cantaloupes for years, it is easy to make the assumption they must have some clue of what they are doing. They can question why a change was made, in this case the change in process, but to make a call on the safety of that change is more difficult.
•  Companies being audited do want to pass the audit. Their business depends on it. When they hire an auditor, it is less likely they will put themselves in a position to fail….and that may mean hiring someone they know who will not put them through the ringer. Indeed, this a conflict of interest. But this practice of having the supplier pay for their own audit was started years ago by the purchasing companies requiring the audits. To get out of paying for audits of every supplier, they had the idea to make the supplier pay for the audit. Sure, the customer company provides a list of audit firms or auditors from which the supplier can choose, but still, the supplier still hires that person.

  

Because of these limitations associated with third party audits, they are not a guarantee of product safety. Rather, they are just a part of the entire food safety system that a company uses to ensure safe food. If a company uses the fact that they passed an audit as sole reason for why they believe their food is safe, then that company probably does not have true food safety systems in place. The goal of the audit for the food company is to assess their systems and provide feedback on where improvement is needed. Each aspect of the audit is there for a reason, so food companies need to embrace the intent of the requirement, not just to throw something in place to pass the audit.

  

While there has been a ratcheting up of requirements through GFSI (SQF and BRC) on both what is required in audits and what is required for someone to be a qualified auditor, some of these issues still exist. Even with government based inspection, there are similar shortcomings. Audits are an important part of our food safety system, whether internal, second party, third party , or government, but the responsibility for food safety ultimately falls on the company producing the food. Food companies must use these audits as guideposts for continual improvement. Employees, managers, and just as importantly, executive management must thoroughly understand their process and product. They must challenge themselves, with the help of auditors, to ensure their food safety system has addressed all possible food safety hazards.

  

by Martin Bucknavage 12/1/12

Venison and STEC E. coli

In this CDC report, high school students became infected with STEC E. coli from the mishandling / undercooking venison. Here, a group of students collected deer, processed them, and then prepared them as kebobs…..at school. 2 of them were hospitalized with STEC E.coli, (29 were ill, most were not E.coli related, rather some other type of illness). 

Studies have shown that deer do carry pathogenic E. coli. From the linked CDC report: “A study of white-tailed deer feces in Minnesota and Wisconsin found non-O157 STEC in 5% of samples (9). … Prevalence rates of E. coli O157 in deer have ranged from 0.25% to 2.4% (10–12). Previous outbreak investigations and case reports have linked E. coli O157 infections to deer (13–15).”
 
STEC E. coli is a very serious pathogen that can result in kidney failure and death. It is important for those processing, handling, and preparing venison to follow accepted practices of cooking, cleaning, chilling, and preventing cross contamination. In regard to cooking, wild game meat such as venison should be cooked o 165ºF.

Prevening Allergen Related Recalls Due to Mislabeling

The leading cause of recalls is allergens.  Case in point, 3 allergen-related recalls over the last two days due to mislabeling.  In two cases, the wrong preprinted label was placed on the food item, in the other, the wrong sauce mix packet added to the food package.

Prevention – making labeling a CCP – a critical control point to prevent a chemical hazard – allergens.  There are many companies that use multiple labels with varying allergens on each.  Having the additional attention that goes along with designating a process step as a CCP will require more thorough monitoring, verifying, and reporting.  For example, the label operator must sign-off on each pack or case of labels by reviewing the days production sheet as well as the formulation sheet in order to check for compliance with the label.  In addition, there would be verification of labels and formulation by QC and production supervisors, as well as daily sign-off by the HACCP coordinator.  All would be need to be trained in label review with an eye towards allergen identification.   I would argue that this step must be a CCP because based on industry history, hazards are not being prevented.  From a cost savings standpoint, although this added step will require operator time, it is cheaper than conducting a recall.

CDC lists Multistate Foodborne Outbreaks for 2011

CDC has updated their Multistate Foodborne Outbreak listing for 2011 (http://www.cdc.gov/outbreaknet/outbreaks.html). This is a nice reference page for reviewing major food outbreaks that have occurred over the past 6 years. (An outbreak, as defined by CDC is “When two or more people get the same illness from the same contaminated food or drink”)

 A few things to note:

• This does not include recalled products – products recalled due to only the presence of pathogens (pathogens were detected in the product, but there were no illnesses reported). There have been many recalls that have occurred due to positive analysis for a pathogen, especially now with the Reportable Registry (http://www.fda.gov/food/foodsafety/foodsafetyprograms/rfr/default.htm). And so it follows, it does not include recalls for allergens – the major cause for companies to conduct recalls.
• This list does not include single state outbreaks – so this list is manly large companies that produce products. This does not mean that smaller establishments do not have issues.
• A few items were actually not food, but rather pets (frogs and chicks/ducklings in 2011, and water frogs and frozen rodents, which are used to feed slithering pets, in 2010). One item was dog food, which we will count as food – you dog food eaters know who you are.
• There appears to be an increase in the number of entries each year on this listing. I don’t suspect things are getting worse, but rather detection and reporting are getting better.
• Of the 41 entries over the 6 year period where a cause can be found (dropping the pet related entries and the laboratory entry), fresh ground meat had 6 entries, alfalfa sprouts had 5, leafy greens had 5, and cantaloupe had 3.
• Salmonella related outbreaks accounted for roughly 2/3 of the entries. This is due to the wide prevalence of Salmonella in the enviornment.
• FDA regulated product entries accounted for 25 entries, USDA for 11, and I suspect that two of the outbreaks were from facilities that had both USDA and FDA oversight.
• Roughly 27 are what one would consider ready to eat (no required consumer cooking step). 14 entries were products would be considered products that required cooking, that if done sufficiently by the consumer, would have prevented illness (reasons why vary - cookie dough traditionally eaten raw, pot pies – poor cooking instructions, raw meat – no thermometer use).
• As a consumer, I avoid alfalfa sprouts, use a thermometer to cook my ground meat, really wash my cantaloupes, pray my chopped lettuce was not harvested from a farm located next to a cow barn, cook my cookie dough to have crunchy cookies, and refuse to buy my kids turtles, frogs, and snakes (that have to fed frozen rodents.) I have also ceased from eating dog food.

 Multistate Foodborne Outbreaks

 http://www.cdc.gov/outbreaknet/outbreaks.html

When two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne outbreak. Public health officials investigate outbreaks to control them, so more people do not get sick in the outbreak, and to learn how to prevent similar outbreaks from happening in the future.

CDC and partners ensure rapid and coordinated surveillance, detection, and response to multistate foodborne outbreaks.

Outbreaks by Year

 2011

 · Ground Beef - Salmonella Typhimurium

 · Romaine Lettuce - Escherichia coli O157:H7

 · Kosher Broiled Chicken Livers - Salmonella Heidelberg

 · Turkish Pine Nuts - Salmonella Enteritidis

 · Jensen Farms Cantaloupes - Listeria monocytogenes

 · Ground Turkey - Salmonella Heidelberg

 · Whole, Fresh Imported Papayas - Salmonella Agona

 · African Dwarf Frogs - Salmonella Typhimurium

 · Alfalfa and Spicy Sprouts – Salmonella Enteritidis

 · Travel to Germany - Shiga toxin-producing E. coli O104

 · Chicks and Ducklings - Salmonella Altona and Salmonella Johannesburg

 · Microbiology Laboratories - Salmonella Typhimurium

 · Turkey Burgers - Salmonella Hadar

 · Lebanon Bologna - Escherichia coli O157:H7

 · Del Monte Cantaloupe - Salmonella Panama

 · Hazelnuts - Escherichia coli O157:H7