Based on numerous media interviews today, the take-home message will be, foodborne illness has declined by 23 per cent over 14 years.

Nope.

Instead, what the U.S. Centers for Disease Control has done is publish 18 papers today that provide a glimpse into the intricacies, problems and potential of foodborne illness surveillance. There are many caveats, there will be many criticisms, but the approach is consistent with a risk analysis approach to problems: this is what we know, these are the assumptions we made, this is what we think it means, let’s discuss how to make it better.

And bring evidence to the table.

The papers also highlight the complexities of food-pathogen interactions while reinforcing that food safety happens in lots of places in lots of ways, from farm-to-fork. The next time someone says food safety is simple, roll your eyes, walk away, respond with derision, whatever your preference.

But bring some data to the table. This issue of Clinical Infectious Disease will help with that.

Below are the urls for the 18 abstracts:

http://cid.oxfordjournals.org/content/54/suppl_5/S381.extract
http://cid.oxfordjournals.org/content/54/suppl_5/S385.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S396.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S405.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S411.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S421.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S424.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S432.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S440.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S446.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S453.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S458.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S464.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S472.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S480.abstract http://cid.oxfordjournals.org/content/54/suppl_5/S498.abstract

At this time of year it’s usually chicks and ducklings and Salmonella, but why not throw some turtles into the mix. Again.

I still regret cuddling up to my pet turtle, but what did I know?

The U.S. Centers for Disease Control reports a total of 66 persons infected with outbreak strains of Salmonella Sandiego, Salmonella Pomona, and Salmonella Poona have been reported from 16 states; 11 ill persons have been hospitalized, and no deaths have been reported; 55% of ill persons are children 10 years of age or younger.

Results of the epidemiologic and traceback investigations indicate exposure to turtles or their environments (e.g., water from a turtle habitat) is the cause of this outbreak.

Turtles with a shell length of less than 4 inches in size should not be purchased or given as gifts.

CDC is collaborating with public health officials in multiple states to investigate three overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). The first is an outbreak of human Salmonella Sandiego infections, the second is an outbreak of human Salmonella Pomona infections, and the third is an outbreak of human Salmonella Poona infections. These are rare types of Salmonella.

The Salmonella Sandiego and Salmonella Pomona outbreaks have similar geographic distributions, with cases occurring in the Northeast and Southwest. The Salmonella Poona outbreak has a slightly different geographic distribution, with cases occurring in the Midwest and Southwest. Public health investigators are using the PulseNet system to identify cases of illness that may be part of these outbreaks. In PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, DNA "fingerprints" of Salmonella bacteria are obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak.

Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human Salmonella infections. Small turtles, with a shell length of less than 4 inches, are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration (FDA) has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs are shed in their droppings and can easily contaminate their bodies and anything in areas where these animals live. Reptiles and amphibians that live in tanks or aquariums can contaminate the water with germs, which can spread to people.

I worry about this every time my daughter’s school brings in chicks and other animals. And I always make sure to ask if they are testing for salmonella and what kind of controls are in place. And I complain about parents parking in the handicapped spots. They think I’m crazy, but I’ll show them. Except no one wins with salmonella either.

The U.S. Centers for Disease Control is reporting that salmonella infections from contact with live poultry (chickens, ducks, turkeys, and geese) continue to be a public health problem.

In summer 2011, two clusters of human Salmonella infections were identified through PulseNet, a molecular subtyping network for foodborne disease surveillance. Standard outbreak and traceback investigations were conducted. From February 25 to October 10, 2011, a cluster of 68 cases caused by Salmonella serotype Altona and a cluster of 28 cases caused by Salmonella Johannesburg were identified in 24 states. Among persons infected, 32% of those with Salmonella Altona and 75% of those with Salmonella Johannesburg were aged ≤5 years. Forty-two of 57 (74%) Salmonella Altona patients and 17 of 24 (71%) of Salmonella Johannesburg patients had contact with live poultry in the week preceding illness. Most patients or their parents reported purchasing chicks or ducklings from multiple locations of an agricultural feed store chain that was supplied by a single mail-order hatchery. Live poultry were purchased for either backyard flocks or as pets.

Live poultry are commonly purchased from agricultural feed stores or directly from mail-order hatcheries; approximately 50 million chicks are sold annually in the United States. Since 1990, approximately 35 outbreaks of human Salmonella infections linked to contact with live poultry from mail-order hatcheries have been reported. These outbreaks highlight the ongoing risk for human Salmonella infections associated with live poultry contact, especially for young children.

In response to this ongoing public health problem, officials with local, state, and federal public and animal health agencies, the U.S. Department of Agriculture's National Poultry Improvement Plan (USDA-NPIP), the mail-order hatchery industry, and other partners have collaborated to develop and implement a comprehensive Salmonella control strategy. Mail-order hatcheries should comply with management and sanitation practices outlined in the USDA-NPIP Salmonellaguidelines and should avoid the shipment of hatched chicks between multiple hatcheries before shipping to customers. Educational materials warning customers of the risk for Salmonella infection from live poultry contact are available and should be distributed with all live poultry purchases.
 

(although imperfect)

Those words, in parentheses, are the most important in a paper by CDC-types about self-reported consumption of pink beef, and impair the conclusions.

Researchers from the U.S. Centers for Disease Control used FoodNet data from a 2006-2007 survey of 8,543 respondents to conclude 75.3% reported consuming some type of ground beef in the home, and of those respondents who ate ground beef patties in the home, 18.0% reported consuming pink ground beef.

That’s a high number, but is pink hamburger correlated with cooking temperatures of less than 165F? Not always.

For purposes of the paper, pink hamburger is equated to undercooked and therefore potentially dangerous hamburger, except for the acknowledgement that color is an “imperfect” indicator for the consumption of undercooked ground beef.

The authors do mention in the paper that “color is not a reliable indicator of ground beef doneness, and thermometer use was not assessed so self-reported consumption of pink ground beef may not truly represent consumption of undercooked beef.

A series of studies beginning in the 1990s and led by Melvin “Hunter” Hunt of Kansas State University concluded that color is a lousy indicator of whether hamburger has reached a microbiologically safe internal temperature of 160F with something like 30 per cent of burgers browning prematurely, based on levels of different forms of myoglobin within hamburger. The U.S. Department of Agriculture agrees, and has a thorough summary of the problems with color at http://www.fsis.usda.gov/factsheets/Color_of_Cooked_Ground_Beef/index.asp.

So why base a consumer study on color, which research concludes and U.S. and Canadian governments agree in the form of consumer advice, is unreliable? Guess it was easier.

The survey did further verify a long-standing observation that is apparently ignored by every local, state or federal agency that says rates of E. coli O157:H7 increase in summer months because more people barbeque: there’s no correlation with cooking. Instead, the correlation is with microbial loads in cattle, which increase in spring and summer.

“We noted a distinct lack of seasonality in the consumption of ground beef or pink ground beef patties in the home. This contrasts with the marked seasonality reported for E. coli O157:H7 infections in humans, which peaks in the summer months. These data suggest that factors other than seasonality in ground beef consumption, such as differences in food handling practices or increases in the amount of bacterial contamination on meat and other foods or environmental sources during warmer months, are responsible for the seasonal increase in E. coli O157:H7 infections. Shedding of E. coli O157:H7 by cattle peaks during the spring and summer months, corresponding to the period of the highest incidence of human infections. Others have suggested that fluctuations in E. coli O157:H7 prevalence in cattle may be linked to human infections. Our data support this hypothesis and suggest that further attention to pre-harvest food safety interventions may be warranted to decrease the numbers of organisms shed in cattle feces and, ultimately, decrease the number of human infections."

For those who think consumers need to be better educated to reduce incidence of foodborne illness, the survey found yet another link to trash such a notion.

“Although persons with higher education and income reported consuming pink ground beef patties in the home more often, this group consumed ground beef overall less frequently. These findings do not explain these patterns, but we speculate that the increased level of risky behavior among more highly educated and higher income respondents may be due to several factors. These persons may not prepare food at home as often as other groups and
therefore may be less practiced in appropriate safe food handling and cooking practices or they may prefer pink ground beef. Higher income persons have been shown both to have more confidence in the safety of the national food supply and to be more likely to use unsafe food practices than lower income persons. Persons that are more educated may also perceive themselves to be at less risk for foodborne illness and consequently be more likely to engage in risky behaviors. The increased willingness among this population to engage in unsafe food-related behaviors has been suggested to rise from more prevalent beliefs that they understand and can control food safety risks.”

Or, smart people can be dumb. Certainly applies to me (the dumb part).

The abstract of the paper is below.

Ground beef consumption patterns in the United States, FoodNet, 2006 through 2007
Journal of Food Protection®, Volume 75, Number 2, February 2012 , pp. 341-346(6)
Taylor, Ethel V.; Holt, Kristin G.; Mahon, Barbara E.; Ayers, Tracy; Norton, Dawn; Gould, L. Hannah
http://www.ingentaconnect.com/content/iafp/jfp/2012/00000075/00000002/art00016/
Infection resulting from foodborne pathogens, including Escherichia coli O157:H7, is often associated with consumption of raw or undercooked ground beef. However, little is known about the frequency of ground beef consumption in the general population. The objective of this study was to describe patterns of self-reported ground beef and pink ground beef consumption using data from the 2006 through 2007 FoodNet Population Survey. From 1 July 2006 until 30 June 2007, residents of 10 FoodNet sites were contacted by telephone and asked about foods consumed within the previous week. The survey included questions regarding consumption of ground beef patties both inside and outside the home, the consumption of pink ground beef patties and other types of ground beef inside the home, and consumption of ground beef outside the home. Of 8,543 survey respondents, 75.3% reported consuming some type of ground beef in the home. Of respondents who ate ground beef patties in the home, 18.0% reported consuming pink ground beef. Consumption of ground beef was reported most frequently among men, persons with incomes from $40,000 to $75,000 per year, and persons with a high school or college education. Ground beef consumption was least often reported in adults ≥65 years of age. Men and persons with a graduate level education most commonly reported eating pink ground beef in the home. Reported consumption of ground beef and pink ground beef did not differ by season. Ground beef is a frequently consumed food item in the United States, and rates of consumption of pink ground beef have changed little since previous studies. The high rate of consumption of beef that has not been cooked sufficiently to kill pathogens makes pasteurization of ground beef an important consideration, especially for those individuals at high risk of complications from foodborne illnesses such as hemolytic uremic syndrome.