It is easy to make the assumption that rapid diagnostics, CIDT or Culture Independent Diagnostic Tests, would help in determining the cause of an outbreak, but this may not be the case. While rapid testing may help with the treatment of a patient by determining the type of organism that caused the illness, without isolating the organism through good old fashion culture methods, the investigation essentially stops there. To go beyond diagnosis of the illness to a point where the exact strain of the organism can be determined for matching purposes, isolation and cultural confirmation is needed.
An increasing number of tests completed by clinical laboratories are using CIDTs. In some cases where a positive is found, no further isolation was attempted, and in other cases, the lab was not able to isolate the organism. In the past, the isolated organisms would then be forwarded to the public health laboratories for further identification and characterization, including if an organism was antibiotic resistant. The organism could be subtyped and this information is used in determining if this illness/organism is part of a wider outbreak.
The inability to culture a CIDT positive sample may also indicate a false positive, especially where the type of CIDT used was an antigen based technology.
CDC MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6409a4.htm?s_cid=mm6409a4_e
Bacterial Enteric Infections Detected by Culture-Independent Diagnostic Tests — FoodNet, United States, 2012–2014
Weekly
March 13, 2015 / 64(09);252-257
Martha Iwamoto, MD1, Jennifer Y. Huang, MPH1, Alicia B. Cronquist, MPH2, Carlota Medus, PhD3, Sharon Hurd, MPH4, Shelley Zansky, PhD5, John Dunn, DVM6, Amy M. Woron, PhD6, Nadine Oosmanally, MSPH7, Patricia M. Griffin, MD1, John Besser, PhD1, Olga L. Henao, PhD1 (Author affiliations at end of text)
The increased availability and rapid adoption of culture-independent diagnostic tests (CIDTs) is moving clinical detection of bacterial enteric infections away from culture-based methods. These new tests do not yield isolates that are currently needed for further tests to distinguish among strains or subtypes of Salmonella, Campylobacter, Shiga toxin–producing Escherichia coli, and other organisms. Public health surveillance relies on this detailed characterization of isolates to monitor trends and rapidly detect outbreaks; consequently, the increased use of CIDTs makes prevention and control of these infections more difficult (1–3). During 2012–2013, the Foodborne Diseases Active Surveillance Network (FoodNet*) identified a total of 38,666 culture-confirmed cases and positive CIDT reports of Campylobacter, Salmonella, Shigella, Shiga toxin–producing E. coli, Vibrio, and Yersinia. Among the 5,614 positive CIDT reports, 2,595 (46%) were not confirmed by culture. In addition, a 2014 survey of clinical laboratories serving the FoodNet surveillance area indicated that use of CIDTs by the laboratories varied by pathogen; only CIDT methods were used most often for detection of Campylobacter (10%) and STEC (19%). Maintaining surveillance of bacterial enteric infections in this period of transition will require enhanced surveillance methods and strategies for obtaining bacterial isolates.
Thursday, March 12, 2015
Friday, March 6, 2015
Knowing Your Water Source - Ground Water Awareness Week
This coming week is Ground Water Awareness Week, and this is good time to understand where your water comes from, even if it is through a municipality, and what impact there would be for your product/process if there would be a water contamination event, such as brown water coming out of the spigots, bad test results, or an announcement of a boil advisory by the municipal provider.
There have been a number of outbreaks associated with drinking water, but the risk of contamination to a food establishment is dependent upon the types of processes run. So it is important to conduct a risk analysis, considering you water source, the types of contaminates that can be present, and the impact of your processes on those contaminates.
The types of contaminates in water can be found on the EPA website (US Environmental Protection Agency. Drinking water contaminants. http://www.epa.gov/safewater/contaminants/index.html).
General information on well water can be found on the CDC Websites:
There have been a number of outbreaks associated with drinking water, but the risk of contamination to a food establishment is dependent upon the types of processes run. So it is important to conduct a risk analysis, considering you water source, the types of contaminates that can be present, and the impact of your processes on those contaminates.
The types of contaminates in water can be found on the EPA website (US Environmental Protection Agency. Drinking water contaminants. http://www.epa.gov/safewater/contaminants/index.html).
General information on well water can be found on the CDC Websites:
- http://www.cdc.gov/healthywater/drinking/private/wells/index.html
- http://www.cdc.gov/healthywater/drinking/training-education.html#webtraining.
Wednesday, February 25, 2015
Recalls Due to Allergen Issues
There have been a number of recalls related to allergen issues over the past few weeks. It is interesting to see the reasons why these recalls occur.
WhiteWave Foods recalled cheddar crackers due to undeclared peanuts. The outer package is labeled as a cheddar sandwich cracker and the inner package contains the peanut butter sandwich crackers.
Packaging Error - wrong package
Old Home Kitchens is voluntarily recalling "Sock It To Me Crème Cake" under "the Bakery because they contain undeclared pecans. Kitchens discovered that product containing pecans was distributed in packaging that did not reveal the presence of pecans. No illnesses have been reported to date
Packaging Labeling Error - Allergen not declared.
Hummingbird Wholesale in Eugene Oregon is recalling 110 jars of Hummingbird Brand Organic Chocolate Hazelnut Butter that may contain undeclared milk. The recall was initiated after it was discovered that a supplier had changed the ingredients without notice to include milk.
Ingredient Supplier Error - supplier changed formulation
Chocolate By Design Inc. of Ronkonkoma, NY, is recalling its Milk Chocolate “Assorted Character Icing Pops”, “Christmas Icing Pops” and “Triple Heart Icing Pops” because they contain undeclared eggs. The recall was initiated after it was discovered during the current FDA inspection that the Milk Chocolate Icing Pops were distributed in packaging that did not reveal the presence of egg and the certified food colors.
Packaging Labeling Error - Allergen not declared
Update - Con Yeager Spice Company has previously issued a voluntary recall for multiple sized packages under multiple brand names of ground cumin and multiple seasoning blends (containing ground cumin) due to undeclared Peanut allergens in the ground cumin.
Ingredient Supplier Error - supplier poor allergen control
WhiteWave Foods recalled cheddar crackers due to undeclared peanuts. The outer package is labeled as a cheddar sandwich cracker and the inner package contains the peanut butter sandwich crackers.
Packaging Error - wrong package
Old Home Kitchens is voluntarily recalling "Sock It To Me Crème Cake" under "the Bakery because they contain undeclared pecans. Kitchens discovered that product containing pecans was distributed in packaging that did not reveal the presence of pecans. No illnesses have been reported to date
Packaging Labeling Error - Allergen not declared.
Hummingbird Wholesale in Eugene Oregon is recalling 110 jars of Hummingbird Brand Organic Chocolate Hazelnut Butter that may contain undeclared milk. The recall was initiated after it was discovered that a supplier had changed the ingredients without notice to include milk.
Ingredient Supplier Error - supplier changed formulation
Chocolate By Design Inc. of Ronkonkoma, NY, is recalling its Milk Chocolate “Assorted Character Icing Pops”, “Christmas Icing Pops” and “Triple Heart Icing Pops” because they contain undeclared eggs. The recall was initiated after it was discovered during the current FDA inspection that the Milk Chocolate Icing Pops were distributed in packaging that did not reveal the presence of egg and the certified food colors.
Packaging Labeling Error - Allergen not declared
Update - Con Yeager Spice Company has previously issued a voluntary recall for multiple sized packages under multiple brand names of ground cumin and multiple seasoning blends (containing ground cumin) due to undeclared Peanut allergens in the ground cumin.
Ingredient Supplier Error - supplier poor allergen control
Study - Wild Animal Poop Can Be a Source of E.coli Contamination
A recent study demonstrated that wild animal poop (aka scat) can serve as a source of E.coli O157:H7 for produce located in close proximity. In the study, rabbit poop inoculated with E.coli was placed ina romaine lettuce field, the field was irrigated ("foliar irrigation by using typical commercial farming practices for central coastal California"), the lettuce was tested, and 38 of the lettuce had E. coli. Some good news however, removing the out leaves of lettuce was effective at eliminating the contamination.
The Packer
http://www.thepacker.com/news/romaine-study-examines-wildlife-e-coli
Romaine study examines wildlife, E. coli
By Mike Hornick February 24, 2015 | 5:47 pm EST
Growers’ removal of wildlife feces from their fields has gained confirmation from a study that supplies new data about how much E. coli O157:H7 can be transferred to romaine from that source by foliar irrigation.
The joint study by Western Center for Food Safety and Food and Drug Administration researchers, published in the February Journal of Food Protection, also aims to provide insights for emerging food safety strategies.
The Packer
http://www.thepacker.com/news/romaine-study-examines-wildlife-e-coli
Romaine study examines wildlife, E. coli
By Mike Hornick February 24, 2015 | 5:47 pm EST
Growers’ removal of wildlife feces from their fields has gained confirmation from a study that supplies new data about how much E. coli O157:H7 can be transferred to romaine from that source by foliar irrigation.
The joint study by Western Center for Food Safety and Food and Drug Administration researchers, published in the February Journal of Food Protection, also aims to provide insights for emerging food safety strategies.
One Food Agency - Is Marginal Benefit Worth the Potential Costs?
Over the past few years, there has been a lot of talk involving one food agency, and with the recent Administration proposal, perhaps there is a little momentum...little being the key word. And much of the media seems to think it would be a good idea, and perhaps it is, but as pointed out in a commentary by Froma Harrop, (below) many of the arguments for one agency have little to do with food safety. I agree. The media sensationalism of outbreak events has given the general public a very skewed view of risk associated with food.
Now if combining into one agency would help to any great degree, perhaps, but at what cost. Pulling the primary facets of regulatory oversight out of two agencies and creating another is unlikely to be a cost saving proposition. Rather, and more likely, it would be more, much more. We only need to look at the health care overhaul to see that it is very difficult to add agencies without enormous cost escalations.
Columbus Dispatch
http://www.dispatch.com/content/stories/editorials/2015/02/25/1-in-debate-over-food-safety-system-lets-keep-it-honest.html
Froma Harrop commentary: In debate over food-safety system, let’s keep it honest
As things now stand, the U.S. Department of Agriculture oversees steaks, chicken thighs and eggs out of their shells. The Food and Drug Administration keeps an eye on salmon, apples and eggs in their shells.
Fifteen government entities now supervise food safety, including the Centers for Disease Control and Prevention, the Environmental Protection Agency and the National Oceanic and Atmospheric Administration (seafood).
President Barack Obama wants to consolidate all these food monitoring functions in a yet-to-be-created Food Safety Administration. Makes sense.
Now if combining into one agency would help to any great degree, perhaps, but at what cost. Pulling the primary facets of regulatory oversight out of two agencies and creating another is unlikely to be a cost saving proposition. Rather, and more likely, it would be more, much more. We only need to look at the health care overhaul to see that it is very difficult to add agencies without enormous cost escalations.
Columbus Dispatch
http://www.dispatch.com/content/stories/editorials/2015/02/25/1-in-debate-over-food-safety-system-lets-keep-it-honest.html
Froma Harrop commentary: In debate over food-safety system, let’s keep it honest
As things now stand, the U.S. Department of Agriculture oversees steaks, chicken thighs and eggs out of their shells. The Food and Drug Administration keeps an eye on salmon, apples and eggs in their shells.
Fifteen government entities now supervise food safety, including the Centers for Disease Control and Prevention, the Environmental Protection Agency and the National Oceanic and Atmospheric Administration (seafood).
President Barack Obama wants to consolidate all these food monitoring functions in a yet-to-be-created Food Safety Administration. Makes sense.
Tuesday, February 24, 2015
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:
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.
CDC - Emerging Infectious Diseases
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
(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.
Friday, February 20, 2015
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.
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.
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