CDC Report - Attribution of Foodborne Illnesses, Hospitalizations, and Deaths

The CDC issued a report that attributes foodborne illness cases to different foods. Calculations, based on known cases over the period from1998 to 2008, are used to estimate the number of cases caused by each disease causing agent as well as to attribute to one of 17 food types.

There are some big assumptions that are made in the report that I feel limits what headlines will report. 1) It applies known outbreaks to apply to sporadic cases. Because of this, it underestimates the number of cases caused by organisms that have illnesses which tend to be more sporadic in nature, such as Campylobacter. 2) Along those same lines, mass distributed product where a single contamination event results in a large number of illnesses, such as in bagged produce, outweighs foods that may are considered high risk for contamination. 3) In the cases where mixed food caused an illness, the blame is put on the item commodity that they determined to have caused the biggest
proportion of illnesses, rather than the real risk. 4) Some organisms don't even show up, such as Taxoplasma spp.. even though that organism is claimed to be one of the major pathogens associated with meat....(although owning multiple cats is probably a bigger risk).

The headlines from some of the major news outlets give the impression that certain foods are risky.

Philly.com - U.S. Officials Pinpoint Common Sources of Foodborne Illnesses
Reuters - U.S. government report outlines foods most prone to pathogens
Time - Here’s What Foods Are Most Likely To Have E. Coli or Salmonella

 It is hard to get a real sense of real risk there is no calculation associated with the units consumed. Without this, many will jump on items that show to have a caused a higher percentage of the number of illnesses caused, but not the real risk.

My takeaways:

• Produce - Because of the way that produce is processed and distributed, a contamination event involving produce will impact many and thus gets seen as having a big impact in this report.  However, if we look at the number of units sold, produce is a much smaller risk than it appears to be in this report when compared to other commodities.  Not to say that there is not work that needs to be done, especially in preventing contamination events that can impact thousands of units.  However, people should not be discouraged from produce due to the potential for foodborne illness.
• Dairy - raw milk should be considered the highest risk dairy product, and on the further processed side, cheese accounts for many of the cases of Listeria recently seen.
• Mollusks - raw shellfish is a high risk item, especially when you consider the small number of people that eat raw shellfish (compared to produce)
• Poultry - because it has a natural association with Salmonella and Campylobacter, there have been outbreaks.  Looking at USDA monitoring records, while the levels of Salmonella in whole chicken are low, for ground poultry and parts, it is higher.  So while the industry is working to lessen the prevalence of these pathogens in poultry products, elimination is unlikely.
• Meat - ground meat is the primary source of STEC E.coli.  USDA testing indicates that about 0.5% of ground meat tested was positive. 
• As for pathogens, Salmonella is a pathogen that seems to find its way to the consumer via a number of different food products.  As for Campylobacter, it has a high prevalence on chicken, but we don't necessary see the cases; probably, because most cases are sporadic. In recent outbreaks, raw milk has been the culprit.

Has the number of foodborne illness cases dropped recently?  While that seems to be the case, it is hard to tell in this report.  And if policy decisions are going to be made on this report, even using weighting the data from the last five years, there may be some issues.  For example, our ability to determine the agent (detection of Campylobacter as an example) has improved dramatically in the last few yeas.  Additionally, issues that occurred 2 to 5 years ago may not be as big as an issue today  Granted it is difficult to trend when working with  minimal data.  However, considerations must be taken if these calculations are used to set policy.

CDC - Emerging Infectious Diseases

http://wwwnc.cdc.gov/eid/article/19/3/11-1866_article

Volume 19, Number 3—March 2013

Research

Attribution of Foodborne Illnesses, Hospitalizations, and Deaths to Food Commodities by using Outbreak Data, United States, 1998–2008

 

John A. Painter(http://wwwnc.cdc.gov/eid/article/19/3/11-1866_article#comment) , Robert M. Hoekstra, Tracy Ayers, Robert V. Tauxe, Christopher R. Braden, Frederick J. Angulo, and Patricia M. Griffin

Author affiliations: Author affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA

   

Abstract

 

Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998–2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne illness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.

Ohio Establishment Recalls Fully Cooked Beef Patties for Listeria

An Ohio establishment is recalling fully cooked beef patties after a further-processor had reported that product tested positive for Listeria.

This is the type of product that is purchased by a foodservice supplier/distributor (further-processor) that takes the cooked burger, puts it on a bun, and sells it to vending machines companies to in convenience stores.  The item would be considered a 'heat and serve' product.  Any Listeria contamination that gets onto the product would likely be consumed.  Further, if the product is held at refrigeration temperature, it would have the opportunity to grow.

The further processor in this case would have tested this product as part of their supplier control program / ingredient receiving protocol.


USDA Recall Notice
http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2015/recall-034-2015-release
Kenosha Beef International Recalls Beef Product Due to Possible Listeria Contamination
Class I Recall 034-2015
Health Risk: High Feb 19, 2015
En Español
Congressional and Public Affairs  Alexandra Tarrant  (202) 720-9113

WASHINGTON, Feb. 19, 2015 – Kenosha Beef International, a Columbus, Ohio, establishment, is recalling approximately 21,427 pounds of ready-to-eat beefsteak patty product that may be contaminated with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The fully cooked beefsteak patties were produced on Jan. 24, 2015. The following product is subject to recall:
35.3-lb. boxes of “Fully Cooked Black Angus Ground Beefsteak (chopped and formed)” with product number 87657 and “use thru” date of 01/24/16.

The product subject to recall bears the establishment number “EST. 10130” inside the USDA mark of inspection. This product was shipped to distributors in Illinois and North Carolina for further distribution to restaurants.

The problem was discovered by a customer of Kenosha Beef International. The customer, a further processor, tested a sample of product produced the same day as the recalled product, returning a positive result for Listeria monocytogenes. FSIS and the company have received no reports of illness due to consumption of these products.

2014 Salmonella Outbreak Linked to Maryland Cucumbers

In a 2014 outbreak of Salmonella, cucumbers were linked to the outbreak that has resulted in 275 cases of illness.  The cucumbers were traced back to a farm on the Eastern Shore of Maryland.  While environmental samples were negative, the CDC report states, "Records and interviews indicated that the farm applied poultry litter approximately 120 days before harvest, but it was not available for testing."  So there is no definitive answer was found on how the product may have become contaminated.
CDC MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a3.htm?s_cid=mm6406a3_e
Outbreak of Salmonella Newport Infections Linked to Cucumbers — United States, 2014
Weekly
February 20, 2015 / 64(06);144-147

Kristina M. Angelo, DO1,2, Alvina Chu, MHS3, Madhu Anand, MPH4, Thai-An Nguyen, MPH2, Lyndsay Bottichio, MPH2, Matthew Wise, PhD2, Ian Williams, PhD2, Sharon Seelman, MS, MBA5, Rebecca Bell, PhD5, Marianne Fatica, PhD5, Susan Lance, DVM, PhD5, Deanna Baldwin6, Kyle Shannon3, Hannah Lee, MPH3, Eija Trees, PhD2, Errol Strain, PhD5, Laura Gieraltowski, PhD2 (Author affiliations at end of text)

In August 2014, PulseNet, the national molecular subtyping network for foodborne disease surveillance, detected a multistate cluster of Salmonella enterica serotype Newport infections with an indistinguishable pulse-field gel electrophoresis (PFGE) pattern (XbaI PFGE pattern JJPX01.0061).* Outbreaks of illnesses associated with this PFGE pattern have previously been linked to consumption of tomatoes harvested from Virginia's Eastern Shore in the Delmarva region and have not been linked to cucumbers or other produce items (1). To identify the contaminated food and find the source of the contamination, CDC, state and local health and agriculture departments and laboratories, and the Food and Drug Administration (FDA) conducted epidemiologic, traceback, and laboratory investigations. A total of 275 patients in 29 states and the District of Columbia were identified, with illness onsets occurring during May 20–September 30, 2014. Whole genome sequencing (WGS), a highly discriminating subtyping method, was used to further characterize PFGE pattern JJPX01.0061 isolates. Epidemiologic, microbiologic, and product traceback evidence suggests that cucumbers were a source of Salmonella Newport infections in this outbreak. The epidemiologic link to a novel outbreak vehicle suggests an environmental reservoir for Salmonella in the Delmarva region that should be identified and mitigated to prevent future outbreaks.

What Wine Do You Serve with Roasted Raccoon?

A California grocery store was selling frozen raccoon, fur on, until they were visited by the LA Health Department.  A customer had spotted the frozen furry critter with tongue hanging out, and reported it.  The supermarket is said to have been selling frozen raccoons for years.

At 9.99/lb, a five pound raccoon, field dressed and frozen, will probably yield about  2lbs or so of meat.  In the end, pretty expensive, unless of course, you can 'fix' yourself a coon tail hat.

Is it legal?  Game animals have to be farm raised and slaughtered under inspection to be sold commercially.

So what type of wine would you serve....well, you came to the spot.  Denise Gardner, Wine Extension Extraordinaire, suggests a nice Beaujolais, a light bodied red with a fair amount of acidity.  This will pair nicely to the gaminess of the cooked varmint.  Not the nouveau style of the wine however.


CBS Los Angeles
http://losangeles.cbslocal.com/2015/02/10/la-health-department-takes-action-after-local-supermarket-sells-raccoons-as-food/
LA Health Officials Take Action After Local Supermarket Sells Raccoons As Food
February 10, 2015 11:11 PM

TEMPLE CITY (CBSLA.com) — The Health Department has taken action after a local supermarket’s frozen foods section featured an unusual item.

Inspectors from the LA County Health Department visited the Metro Supermarket in Temple City on Tuesday, after being informed that the market was selling raccoons as food.

Study - Bacterial Diversity in a City Environment - No Reason to Fear

A recent study looked at the human and bacterial diversity that exists on NYC subways.  The study, Geospatial Resolution of Human and Bacterial Diversity with City-Scale Metagenomics, (Afshinnekoo, et al. 2015) finds that the subway is teaming with a great diversity of microbes and the cells of humans.  Pathogenic organisms are found, but with no cases of reported illnesses in this area, it is surmised that this is just part of the normal urban microbial environment.   Bacterial species associated with the skin are present in higher proportions compared to bacterial species associated with the intestinal tract (poop bacteria).

Of course to read the headlines (NY Times, New Republic), it can be unsettling to some that so much 'contamination' present....whether it is human cells, bacteria, or viruses.  Heck, there are bacterial species that have not yet been determined.

But as this is life on earth.  It is not sterile.  We coexist with a lot of microorganisms.  For the most part, they are under control.  However, there are certain instances, when our immune system is off or we encounter a large dose of a given microorganism (such as when we temperature abuse our food), we get sick.  But encountering a diversity of microorganisms is important for our immune systems to develop.  So don't worry about the myriad of microorganisms on the subway, embrace the fact that that 'what doesn't kill me, makes me stronger".  And wash your hands before dinner.

A few passages from the study:

Measles Vaccination - Science versus Politicians

This past week, a number of political candidates have put their support behind parental choice when it comes to vaccination.  This goes against the science in order to secure political points in the name of 'freedom'.  

There are growing numbers of people who are avoiding giving their children vaccinations and this has led to measles cases in different parts of the country including California and New Jersey.
The unwillingness of some politicians to understand the science or to communicate the real risks should raise questions as to whether these individuals should be given leadership roles that can impact the overall wellbeing of the nation's citizenry.

This nice National Geographic piece (below) provides an overview of how we got to this point and the impact of having unvaccinated children.


National Geographic
http://news.nationalgeographic.com/news/2015/02/150206-measles-vaccine-disney-outbreak-polio-health-science-infocus/
The Anti-Vaccine Generation: How Movement Against Shots Got Its Start
Mistrust and misinformation give a shot in the arm to measles vaccine naysayers.

Laura Parker
National Geographic
Published February 6, 2015

You could call New Jersey Governor Chris Christie and Kentucky Senator Rand Paul members of the "vax generation."

Herbal Supplements Questioned: Fighting Bad Practices with Bad Science?

This past week, the NY Attorney General accused major retailers (Walmart, Target, Walgreens and GNC) of selling herbal supplements that do not contain the herbs claimed on the label and issued a cease-and-desist letter demanding they stop selling those products.

Testing of the supplements was conducted using DNA barcoding, a technique that uses specific DNA sequences  to look for markers that indicate a specific plant species.  This technique has had much success in determining  animal and plant material authenticity and inclusion of potential adulterants.

However, these techniques work best on material where the DNA is likely to be there intact.  As pointed out by the critics of this investigation, many of the herbal supplements sold are highly processed, and this processing may degrade the DNA to a point where it will not be detected.

In DNA barcoding of medicinal plant material for identification (Techen, etal 2014 Current Opinion in Biotechnology Volume 25, Pages 103–110):

The isolation of pure, high molecular weight DNA is critical for the successful application of molecular methods. This can be quite a challenge since in processed medicinal plant material the DNA is often highly degraded or the plant material contains high amounts of polysaccharides, polyphenols and other secondary metabolites, such as, alkaloids and flavonoids. Various commercial kits and modified traditional methods are available to yield in good quality DNA from raw and powdered medicinal plant material, herbarium specimens, capsules, tablets, or tinctures for downstream applications 

In  DNA barcoding as a new tool for food traceability (Galimberti et al. 2013, Food Research International Volume 50, Issue 1,  Pages 55–63):

DNA is normally more resistant to industrial processes than other molecules, such as proteins (Martinez et al., 2003), and DNA fingerprinting methods can be successfully used in identifying animal or plant materials, even when in small traces (Bottero and Dalmasso, 2011, Costa et al., 2010, Kesmen et al., 2007, Mane et al., 2009, Martin et al., 2009 and Soares et al., 2010). Nonetheless, food processing causes chemical and physical alterations, degradation and fragmentation being the most common effects (Bauer, Weller, Hammes, & Hertel, 2003). DNA integrity largely influences the effectiveness of molecular methodologies (Hellberg and Morrisey, 2011, Meusnier et al., 2008 and Pafundo et al., 2007). DNA barcoding can have two advantages if compared to DNA fingerprinting approaches: i) it requires the amplification of a short DNA fragment (hence there is a lower risk of fragmentation), and ii) it is based on mitochondrial or plastidial genome (more preserved during processing).

 

The supplement industry is not regulated as a food or drug, but has its own regulations.  These rules are lax compared to those for drugs in that these products do not need to have FDA approval before selling on the market, and those claims do not necessarily need to stand to the same standard as a drug.  FDA requires that the herbal supplements are safe and that the ingredients listed on the label be in the product.  There is however, still the question whether these products actually have  any significant impact on health.

From the National Institutes of Health website:

Dietary supplements are not required to be standardized in the United States. In fact, no legal or regulatory definition exists for standardization in the United States as it applies to botanical dietary supplements. Because of this, the term "standardization" may mean many different things. Some manufacturers use the term standardization incorrectly to refer to uniform manufacturing practices; following a recipe is not sufficient for a product to be called standardized. Therefore, the presence of the word "standardized" on a supplement label does not necessarily indicate product quality.

In 2007, the FDA issued Good Manufacturing Practices (GMPs) for dietary supplements, a set of requirements and expectations by which dietary supplements must be manufactured, prepared, and stored to ensure quality. Manufacturers are now expected to guarantee the identity, purity, strength, and composition of their dietary supplements. For example, the GMPs aim to prevent the inclusion of the wrong ingredients, the addition of too much or too little of a dietary ingredient, the possibility of contamination (by pesticides, heavy metals such as lead, bacteria, etc.), and the improper packaging and labeling of a product.

Like other dietary supplements, botanicals are not required by federal law to be tested for safety and effectiveness before they are marketed, so the amount of scientific evidence available for various botanical ingredients varies widely. Some botanicals have been evaluated in scientific studies. For example, research shows that St. John's wort may be useful for short-term treatment of mild to moderate depression. Other botanical dietary supplements need more study to determine their value.

The dietary supplement industry has estimated sales of $6 billion, part of a $13 billion dietary supplements industry.  This investigation, while questionable in terms of methodology, may trigger further investigation into whether or not the dietary supplement industry is following questionable practices.

CBS/APFebruary 8, 2015, 3:59 PM
http://www.cbsnews.com/news/herbal-supplements-industry-lashes-out-at-fraud-claims/
Herbal supplements industry lashes out at fraud claims

ALBANY, N.Y. - DNA barcoding has exposed some infamous cases of food fraud, like cheap catfish sold as pricey grouper and expensive "sheep's milk" cheese that was really made from cow's milk.

But can it tell if a pill touted as an energy-booster contains ginseng or is just a mix of rice powder and pine?

Some scientists say yes, while industry groups and some independent experts say DNA testing alone is inadequate for analyzing botanical products that have gone through a lot of processing from leaf to tablet.

More Raw Meat Pet Food Recalled

 J.J. Fuds of Indiana is recalling pet food which was frozen raw meat product due to the fact that Salmonella and Listeria was found in the product. No illnesses have been reported (for people or pets).

What do we expect....it's raw meat.

FDA Recall Notice
http://www.fda.gov/Safety/Recalls/ucm433312.htm
J.J. Fuds, Inc. Expands Recall of Pet Food Because of Possible Health Risk

Contact:  Consumer:  888-435-5873
 Media:  Karl Gottschlich  (888) 432-5873

FOR IMMEDIATE RELEASE – February 4, 2015 – Valparaiso, IN – J.J. Fuds in Valparaiso, IN is expanding their recall to include all lots and products of J.J. Fuds Chicken Tender Chunks, Beef Tender Chunks and Duckling Tender Chunks Pet Food because it has the potential to be contaminated with Listeria monocytogenes and or Salmonella, organisms which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women. Salmonella can affect animals eating the products and there is risk to humans from handling contaminated pet products, especially if they have not thoroughly washed their hands after having contact with the products or any surfaces exposed to these products.

Senator Suggests Regulations Requiring Handwashing Not Needed

A NC Senator thinks that it should not be the governments job to have regulations requiring handwashing in food service operations. 

There are some dumb regulations, but regulations such as this that set a minimum bar for food safety,  in this case, requiring food service employees to wash their hands, is.....good.  Why would someone pick such a poor example to fight overregulation...perhaps he is not a handwasher and this is the example that first comes to mind when he thinks about deregulation.  Wouldn't want to eat at his house.

For a good sound mocking, we have this Daily Show clip.
http://thedailyshow.cc.com/videos/yikssr/mr--unclean


Charlotte Observerhttp://www.charlotteobserver.com/2015/02/03/5491207/sen-tillis-maybe-restaurants-shouldnt.html#.VNJyck10x9A
Sen. Tillis: Maybe restaurants shouldn’t require hand-washing

Posted: Wednesday, Feb. 04, 2015

Congressional Republicans are challenging several health regulations, with one senator suggesting restaurants shouldn’t have to make their employees wash their hands after bathroom visits.

Such restaurants would have to prominently disclose their decision, and then would probably would go out of business, said newly elected GOP Sen. Thom Tillis of North Carolina. But they should have that choice, he said.