Public pools and E. coli - an MMWR report

With summer fast approaching, it is great when we come upon a report on microbiological safety as it related to a fun summer-related activity. There is this gem in May 16th’s MMWR: Microbiologic Contamination of Filter Concentrates from Public Pools. Basically, they looked at pool filters from public pools and found that in more than half the samples tested, E. coli was present. Now while this was unlikely the pathogenic type of E. coli, it was certainly the type that screams – “of fecal origin”. Now I guess we all sort-of-figured this poop-particle-in-shorts thing happens, but to see it in writing… The authors go on to suggest that people consider taking pre-swimming showers, but I guess that is not going to happen, especially considering that people look at the pool as a place to bath. But certainly, if someone has diarrhea, they need to stay out of the pool. And this might not be as easy with children who may be willing to forget their stomach is rolling in order to get into the pool on a hot summer day. So then secondly, if your public pool water is looking a little murky, it may be a good sign to keep your head above the water. Go chlorine, and as Cathy Cutter points out, pray for that dilution effect.

Microbiologic Contamination of Filter Concentrates from Public Pools as Evidence of the Need for Improved Swimmer Hygiene — Atlanta, Georgia, 2012
http://www.cdc.gov/media/mmwrnews/2013/0516.html
CDC
Division of News & Electronic Media
404-639-3286

A study of public pools found that feces are frequently introduced into pool water by swimmers. Water samples from pool filters were tested for Escherichia coli, a fecal indicator, which was detected in 93 (58 percent) of 161 samples. The tests cannot determine whether the E. coli represents risk to swimmers, but they do indicate that swimmers frequently introduced fecal material into pool water, which could lead to spreading germs to other swimmers. Swimmers can minimize fecal contamination and help keep germs out water by taking a pre-swim shower and not swimming when ill with diarrhea. Aquatics staff can kill germs in pools by maintaining disinfectant level and pH according to state and local public health standards, which are enforced by environmental health specialists (pool inspectors).

 

 

Risk Assessment of Listeria in Retail Delicantessens

FDA released the Draft Interagency Risk Assessment – Listeria monocytogenes in Retail Delicatessens Technical Report. (http://www.fda.gov/downloads/Food/FoodScienceResearch/RiskSafetyAssessment/UCM351328.pdf). The goal of this report is to further the understanding of the risk of Listeria monocytogenes that is associated with the retail deli case. Listeria monocytogenes can grow on meat and cheese items that are sold in retail deli establishments. As we know, Listeria can grow at refrigeration temperatures and deli meat products have been involved in past outbreak. Therefore it is important for retail establishments to understand how to best limit the risk of Listeria in their retail cases where there are products with exposure during handling and storage, such as cut luncheon meats.

FDA and USDA evaluated various practices in retail deli operations and came up with some best practices to mitigate the risk of Listeria.

While this is a beast of a report at 179 pages, there are some good takeaways. Here some of the highlights, in more common language. Below this, the conclusion from the report and the USDA news release are also included.

1. Start with products that have minimal Listeria risk. While selling products that have anti-Listeria agents helps, this is not always possible. But procuring items that have been produced in establishments with good Listeria control programs is important. It is also important to properly handle those products are handled from the time they are made through the time they are brought into the retail deli establishment. Even small amounts of Listeria introduced can have a huge impact over time.
2. Keep deli retail case temperatures low, certainly below 41 degree F. While Listeria can grow at refrigeration temperatures, it does grow slowly. So the lower below the temperature of 41F, the better.
3. Clean and sanitize the retail deli units regularly, especially the niches within the cooler….like the drain.
4. Prevent cross contamination from other sources. Clean the slicers and the utensils regularly. Ensure that employees are washing hands and wearing gloves.
5. Remember that items that do not allow the growth of Listeria can be sources of contamination. For example, most fresh produce items which does not support the growth of Listeria can still be the source of contamination for meat items that will support growth. So put controls in place for handling and storage of those types of items.
6. If pre-slicing, pre-slice on a clean slicer. ( I am not a fan of pre-slice meat, I prefer sliced to order).

 

Conclusions from the report.

 

This QRA represents the first large-scale effort to model L. monocytogenes cross contamination at retail. The risk assessment model contributes to our understanding of L. monocytogenes transmission, survival, and growth in the retail environment and was used to evaluate how retail practices may impact the predicted risk of listeriosis. The approach used was to evaluate the public health effect of various mitigations under six different baseline conditions that may characterize a retail deli and the RTE food its serves.

Salmonella Typhi Infected Food Employee Potentially Exposes Restaurant Patrons

This past week, a San Francisco foodservice worker diagnosed with Salmonella Typhi, had potentially exposed restaurant patrons to infection (news report below). Salmonella Typhi is the causative agent of typhoid fever (CDC Report below).

As required by the US Food Code, (http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm181242.htm#part2-2), employees must contact their manager before coming to work when they have the symptoms of diarrhea, vomiting or jaundice, or have been diagnosed with, or have been exposed to, one of following reportable agents:
    a) Norovirus,
    b) Hepatitis A virus,
    c) Shigella spp.,
    d) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, or
     e) Salmonella Typhi

 A question that often arises is why Salmonella Typhi is singled out from the other strains of Salmonella for reporting, especially since other strains of Salmonella are more likely to be involved in foodborne illness cases.

Salmonella Typhi, the causative agent for typhoid fever, is a strain that is only carried by humans and is spread through direct contact or through food handled by an infected person. Basically, the organism passes through the intestinal tract and then invades the bloodstream leading to multisystem infection. If not treated, it invades the liver, spleen, bone marrow, gall bladder and lymph nodes.  

The symptoms are related to the systematic infection that results. The primary symptoms of Typhoid fever are typified by high sustained fever of 103 to 104 degree F, which is related to the intensive infection. Symptoms also include stomach pains, headache, and a rash or rose color spots. Untreated, the disease can progress to delirium, intestinal hemorrhaging, and potentially death (approximately 20% mortality rate). 

In some cases, people can become carriers and will shed the organism. This was the case of Typhoid Mary, a Salmonella typhi- infected house cook who contaminated approximately 50 of the people served with illness (in the years from 1900 to about 1915).  

Salmonella Typhi infection is seldom seen in the United States, in fact, most infections occur when people travel overseas. However, health officials must pay special attention in order to prevent large scale outbreaks.

 

Intentional Contamination Attempt in a Retail Store

Fortunately, we rarely see cases of intentional contamination. But when they occur, we like to point them out as a learning opportunity.

In this case, a woman contaminated orange juice bottles with rubbing alcohol, snuck them into a Starbucks store by hiding those bottles in her purse, and then placed the two contaminated bottles into a store's refrigerated display case. Lukily, another customer saw this and alerted store employees who promptly removed the contaminated bottles.

The motive of the woman is not known at this time.

Police: Woman charged over poisoned juice at California Starbucks store

By Chelsea J. Carter, CNN
updated 9:12 PM EDT, Tue April 30, 2013http://www.cnn.com/2013/04/30/justice/california-starbucks-tainted-juice/

 CNN) -- A California woman who police say planted two bottles of tainted orange juice at a San Jose Starbucks has been charged with attempted murder, a police spokesman said Tuesday. 

Ramineh Behbehanian, 50, is accused of adding rubbing alcohol to the contents of the bottles and then placing them into a refrigerated display case, Police Sgt. Jason Dwyer told reporters.

Cucumbers linked to 73 becoming ill from Salmonella

UPDATE 5/8/13  CDC  - 81 people  infected from 18 states with 29% hospitalized.
http://www.cdc.gov/salmonella/saintpaul-04-13/index.html

CDC is reporting that 73 people have become ill from eating cucumbers contaminated with Salmonella. The cucumbers are from one Mexican producer, and that producer has been put on an import alert by FDA.

According to the CDC report (below): A total of 73 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 18 states. The number of ill persons identified in each state is as follows: Arizona (9), California (28), Colorado (1), Idaho (2), Illinois (3), Louisiana (1), Massachusetts (1), Maryland (1), Minnesota (8), Nevada (1), New Mexic0 (2), North Carolina (1), Ohio (1), Oregon (2), South Dakota (2), Texas (6), Virginia (2), and Wisconsin (2).

Multistate Outbreak of Salmonella Saintpaul Infections Linked to Imported Cucumbers

Posted April 25, 2013 12:30 PM ET http://www.cdc.gov/salmonella/saintpaul-04-13/index.html

Highlights
· Read the Advice to Consumers »
· A total of 73 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 18 states.
o 27% of ill persons have been hospitalized, and no deaths have been reported.
· State public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.
o Preliminary information indicates that consumption of imported cucumbers is the likely source of infection for the ill persons.
· On April 24, 2013, the U.S. Food and Drug Administration placed Daniel Cardenas Izabal and Miracle Greenhouse of Culiacán, Mexico on Import Alert .
o Cucumbers from these two firms will be denied admission into the United States unless the suppliers show that they are not contaminated with Salmonella.
· Currently, there is no evidence that contaminated cucumbers supplied by Daniel Cardenas Izabal and Miracle Greenhouse are still on the market.
o Due to the time it takes between when a person becomes ill and when the illness is reported, additional ill persons may be identified.
o Consumers and retailers should always follow safe produce handling recommendations . 
· CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods eaten with before becoming ill. 

Reporting the Risks of Foodborne Illness

This past week, two reports relating to the topic of food risk were issued resulting in a media frenzy. 

One of those reports was CDC’s annual Trends in Foodborne Illness in the United States 2012 (below). CDC analyzes data from FoodNet, a system that tracks foodborne illness in roughly 10 states, and then projects these numbers for the entire country. News stories that were issued, including this Time article (http://healthland.time.com/2013/04/22/cdc-food-safety-report-card/), point out that the rates of foodborne illness have largely remained unchanged.   

Salmonella still remains one of the most common causes of foodborne illness and the number of cases remained roughly the same.

The report indicated that there was an increase in the rate of Campylobacter infection I think it can be argued however, that this may be the result of increased testing for Campylobacter and that the methodology for testing has improved. Campylobacter has traditionally not been an easy organism to culture, so as methodologies have improved, one would guess that labs will find it more often. http://wwwnc.cdc.gov/eid/article/18/3/11-1266_article.htm.  

Raw poultry is a main source of Campylobacter, and while the industry is working to reduce levels on poultry, at this time there is no magic bullet for eliminating it from poultry at the processing level. So it comes down to the consumer controlling it through proper preparation (cooking it to the right temperature), as well as proper handling (preventing cross contamination of food items with the raw product).

Vibrio is another pathogenic organism that has seen an increase. The primary vehicle for Vibrio is raw oysters. There are not many cases reported, probably because there are not many people who eat raw oysters. If consumers ate raw oysters as much as they ate bagged leafy greens, the numbers for Vibrio infections would dwarf all others.

So have the numbers of foodborne illness changed? We know that there are foods that are risky (raw oysters), and that practices for handling and preparing food need to improve throughout the food chain from the farm to the table, but perhaps we can look for a sign from the businesses that aid victims of foodborne illness - the food illness lawyers. According to a posting by one of the preeminent firms from that group….business is down. http://www.marlerblog.com/legal-cases/foodborne-illness-rates-continue-to-fall-and-that-is-a-good-thing/

The other report that garnered media attention, Risky Meat: A CSPI Field Guide to Meat & Poultry Safety (http://cspinet.org/foodsafety/riskymeat.html), was issued by Center for Science in the Public Interest. I think the title of this should have been title….Meats that Pose a Risk for Those Who Fail to Properly Cook and Clean. The strength of the CSPI report is that it reminds us that raw meat has the potential to carry pathogenic bacteria. But the sound bite heard over and over in the media was that chicken and hamburger are high risk meats. Well, these meats are only risky if they are not properly handled and prepared.

While the meat and poultry industry works to reduce the levels of pathogenic microorganisms on raw meat products, those items still have the potential to carry pathogenic microorganisms. But the risk is for people who mishandle or improperly prepare them. CSPI did provide guidance on proper handling and preparation.

 

Winn Dixie Recalls Apple Juice Because of Patulin

Winn-Dixie, a southern supermarket chain is recalling organic apple juice because of patulin, a mycotoxin (toxic fungal metabolite). Patulin is produced by certain mold species, including Penicillium, Aspergillus and Byccochlamus and can be found in fruit, most often apples. FDA has a limit of 50 ug/L in apple juice. 

At high does, it can be acutely toxic, but at lower levels, there is concern it may be a carcinogen, although studies are inconclusive. It is controlled through the prevention of using rotten apples from being processed into products like apple juice. This is accomplished through good pre and post-harvest practices, and the removal of any moldy or rotten fruit prior to processing.


Winn-Dixie Issues Voluntary Recall On Winn-Dixie Organic 100% Apple Juice

http://www.fda.gov/Safety/Recalls/ucm347979.htm?source=govdelivery
FOR IMMEDIATE RELEASE -April 12, 2013 - Winn-Dixie today announced an immediate voluntary recall of 64 FL OZ Winn-Dixie Organic 100% Apple Juice. The product is being recalled as a precaution because it could have levels of “patulin” that exceeds FDA limits. Winn-Dixie has received no reports of any issues associated with Winn-Dixie Organic 100% Apple Juice consumption.

Patulin is a mycotoxin, a by-product of some molds that can grow in fruits and vegetables. The possibility of adverse health consequences resulting from this product is very remote. However, the FDA has determined that products made from concentrate with a patulin level of over 50 parts per billion are subject to a voluntary recall.

Out of an abundance of caution for customers, Winn-Dixie is immediately recalling “64 FL OZ Winn-Dixie Organic 100% Apple Juice from Concentrate with Added Ingredient.” The recall is companywide for Winn-Dixie stores in the states of Florida, Georgia, Alabama, Mississippi, and Louisiana.

Frozen Meals Recalled Due to Link to E.coli Outbreak

UPDATE May 31, 2013

CDC issused the final update on this outbreak.

http://www.cdc.gov/ecoli/2013/O121-03-13/

A total of 35 persons infected with the outbreak strain of Shiga toxin-producing Escherichia coli O121 (STEC O121) were reported from 19 states.

• 82% of ill persons were 21 years of age or younger.
• 31% of ill persons were hospitalized. Two ill persons developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

UPDATE April 4, 2013

Rich Foods expanded the recall of various heat treated, not fully cooked frozen food items.  The recall will encompass what appears to be 10 months of production.
http://www.fsis.usda.gov/News_&_Events/Recall_025_2013_Expanded/index.asp

Rich Foods is recalling close to 200,000 lbs of frozen chicken quesadilla and other frozen products due to a potential link to an outbreak of E.coli O121. In this outbreak, at least 24 people in 15 states have become ill. Product did test positive for the strain, per NY Department of Health.  According to CDC, 78% of those ill are 21 years old or less.  33% are hospitalized, and 1 has HUS (hemolytic uremic syndrome).

This product does have validated cooking instructions (bottom of page), so this product would not be considered a fully cooked product. However the company is recalling product.

The responsible E. coli strain, O121, produces a shiga toxin like the O157:H7 strain that is associated with ground meat, so infection with this organism can result in bloody diarrhea as well as kidney damage.

USDA Recall Notice
http://www.fsis.usda.gov/News_&_Events/Recall_025_2013_Release/index.asp

New York Firm Recalls Frozen Mini Quesadilla, Pizza, Cheese Steak and Other Snack Products Due To Possible E. Coli O121 Contamination 
Recall Release

CLASS I RECALL


FSIS-RC-025-2013

HEALTH RISK: HIGH


WASHINGTON, March 28, 2013 – Rich Products Corporation, a Buffalo, NY firm, is recalling approximately 196,222 pounds of frozen chicken quesadilla and various other heat treated, not fully cooked frozen mini meals and snack items because they may be contaminated with E. coli O121, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.

The following products are subject to FSIS recall: [View Labels (PDF Only)]

Food Fraud - Horse Meat, Seafood, Honey, etc

With the recent discovery of horse meat in beef sold in Europe, there is an increased awareness of food fraud, the illegal substitution of one food item for another for economic gain. In some cases, it is a straight substation, while in others, it is addition of a filler. In some cases, it may be removal. (Removal would be used when there is chemical that would otherwise render the product unusable such as the removing of antibiotics from honey).

 

While there are been minimal food safety risks to this point, it does raise concerns about traceability and even food defense. Certainly an exception to this was the melamine contamination of wheat gluten that was used in pet foods. In this case, the industrial chemical melamine was added to wheat gluten to increase the level of ‘detectable protein’.  

 

Last month an advocacy group reported that up to 1/3 of seafood sold in restaurants may be mislabeled. One interesting example was that the fish species Escolar was being labeled as white tuna. Problem is that Escolar is the Ex-lax of the seafood world and can result in explosive diarrhea when eaten in large quantities. 

 

Other products that are subject to food fraud include 

• Honey – one of the largest items to be subject to fraud. There is a worldwide network that supplies honey. Cheaper honey from China is often mixed in other countries to escape being labeled “From China”. Problems with Chineese honey – one is that it has been found to contain antibiotics. In other cases, it was diluted. http://www.theglobeandmail.com/technology/science/honey-laundering-the-sour-side-of-natures-golden-sweetener/article562759/  
• Juice Concentrate (Orange and apple)
• Olive Oil
• Milk
• Coffee
• Saffron

 

USP has a Food Fraud Database that links to numerous studies.

 

  

 

Food Fraud: Are Your Ingredients At Risk?

 Wed, 03/06/2013 - 2:17pm

 Lindsey Jahn, Associate Editor, Food Manufacturing

 

 Food fraud is on the rise across the globe, and it is impacting all forms of products — from milk and olive oil to seafood and beef. While some cases of food fraud are due to the efforts of unscrupulous processors, some honest food companies are unknowingly producing items containing fraudulent ingredients.

 

Europe’s meat industry has been in crisis mode since Ireland announced that at least one-third of frozen “beef” burgers produced in the country contained traces — or sometimes much more than traces — of horsemeat. Since then, horsemeat has been detected in many European meat products, from Ikea’s signature Swedish meatballs to prepared meals produced by Nestle.

  

So far, no horsemeat has been detected in the U.S. food supply. But the U.S. food industry is no stranger to other types of food fraud. The U.S. Pharmacopeial Convention (USP) maintains a Food Fraud Database which identifies cases of food fraud occurring in the U.S. The USP in January released its most recent update to the database, which added almost 800 new records of food fraud, increasing the total number of records published in the database by 60 percent.