For those counting – which seems like a bizarrely gruesome fetish – the final tally for the listeria-in-cantaloupe outbreak of 2011 is 146 persons sick from 28 states, including 30 dead and one miscarriage.

Far more important is – will the cantaloupe industry in Colorado and elsewhere become overtly proactive, seeking the best research on the causes, prevention, and how to translate guidelines into actual actions in the field – where contamination starts.

The U.S. Centers for Disease Control today issued its final report on the Multistate Outbreak of Listeriosis Linked to Whole Cantaloupes from Jensen Farms, Colorado—United States, 2011.

(Sidenote: In the E. coli O157:H7 outbreak linked to Romaine lettuce served at Schnucks, CDC spokeswoman Lola Russell told The Packer yesterday the agency leaves announcements regarding names of growers and distributors to the regulatory agencies – state health departments and the U.S. Food and Drug Administration. But it had no problem fingering Jensen Farms? Maybe because the Food and Drug Administration named Jensen Farms on Sept. 14 it was open season after that. Maybe CDC was trying to protect other cantaloupe growers. Maybe they’d like to protect other Romaine lettuce growers? Is there a written policy on when to finger a farm? Consistency in communications helps build trust.)

From the CDC cantaloupe report:

A total of 146 persons infected with any of the four outbreak-associated strains of Listeria monocytogenes were reported to CDC from 28 states.

Among persons for whom information was available, reported illness onset ranged from July 31, 2011 through October 27, 2011. Ages ranged from <1 to 96 years, with a median age of 77 years. Most ill persons were over 60 years old. Fifty-eight percent of ill persons were female. Among the 144 ill persons with available information on whether they were hospitalized, 142 (99%) were hospitalized.

Thirty deaths were reported: Colorado (8), Indiana (1), Kansas (3), Louisiana (2), Maryland (1), Missouri (3), Nebraska (1), New Mexico (5), New York (2), Oklahoma (1), Texas (2), and Wyoming (1). Among persons who died, ages ranged from 48 to 96 years, with a median age of 82.5 years. In addition, one woman pregnant at the time of illness had a miscarriage.

Seven of the illnesses were related to a pregnancy; three were diagnosed in newborns and four were diagnosed in pregnant women. One miscarriage was reported.

Alex Paul of the Albany Democrat-Herald reports the first confirmed victims of a February outbreak of Salmonella Panama that eventually affected 20 people in 10 states and was traced to cantaloupe that came from a single farm in Guatemala, was in Albany, Oregon.

“We found one person confirmed and two others presumed with a pretty rare form of salmonella,” said Jane Fleischbein of the Linn County Public Health Department.

Fleischbein said the public wasn’t notified because Costco immediately pulled the product from its shelves.

“It all depends on timing,” Fleischbein said. “Sometimes it takes a while to track down and by the time the source has been identified, the product has already been consumed or taken off the shelves.”

Fleischbein said her office gets news of at least one recall per week.

“If local public health departments sent a notice about every recall, we would be awfully busy,” Fleischbein said. “There are many recalls that go under the radar.”

The three in Albany were among six people statewide who became sick. The investigation concluded they had eaten cantaloupe served at a church supper.

The Aug/Sept. issue of Food Quality magazine contains a package of articles about lessons learned from this year’s E. coli O104 outbreak in Germany linked to raw sprouts grown from seeds produced in Egypt.

My own contribution was an attempt, at the editor’s request, to capture the uncertainty and vagaries that characterize outbreaks of food- or waterborne illness.

My friend Jim called on a Friday afternoon. Jim is a dairy farmer located on the edge of a town in Ontario, Canada, called Walkerton, and he said a lot of people were getting sick. The community knew there was a problem several days before health types went public.

On Sunday, May 21, 2000, at 1:30 p.m., the Grey Bruce Health Unit in Owen Sound, Ontario posted a notice on its website to hospitals and physicians to make them aware of a boil water advisory and inform them that a suspected agent in the increase of diarrheal cases was E. coli O157:H7.

There had been a marked increase in illness in the town of about 5,000 people, and many were already saying the water was suspect. But because the first public announcement was also the Sunday of the Victoria Day long weekend, it received scant media coverage.

It wasn’t until Monday evening that local television and radio began reporting illnesses, stating that at least 300 people in Walkerton were ill.

At 11 a.m. on Tuesday, May 23, the Walkerton hospital held a media conference jointly with the health unit to inform the public of the outbreak, to make people aware of the potential complications of the E. coli O157:H7 infection, and to warn them to take the necessary precautions. This generated a print report in the local paper the next day, which was picked up by the national wire service Tuesday evening, and subsequently appeared in papers across Canada on May 24.

These public outreach efforts were neither speedy nor sufficient. Ultimately, 2,300 people were sickened and seven died—in a town of 5,000. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry
(www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton).

The E. coli O157:H7 was thought to have originated on a farm owned by a veterinarian and his family at the edge of town, someone my friend Jim knew well, a cow-calf operation that was the poster farm for Environmental Farm Plans. Heavy rains washed cattle manure into a long abandoned well-head, which was apparently still connected to the municipal system. The brothers in charge of the municipal water system for Walkerton, who were found to have been adding chlorine based on smell rather than something minimally scientific like test strips, were criminally convicted.

But the government-mandated reports don’t capture the day-to-day drama and stress that people like my friend experienced. Jim and his family knew many of the sick and dead. This was a small community. News organizations from around the province descended on Walkerton for weeks. They had their own helicopters, but the worst was the medical helicopters flying patients with hemolytic uremic syndrome to the hospital in London. Every time Jim saw one of those, he wondered if it was someone he knew.

I’m not an epidemiologist, but as a scientist and journalist with 20 years of contacts, I usually find out when something is going on in the world of foodborne outbreaks.

The uncertainties in any outbreak are enormous, and the pressures to get it right when going public are tremendous.

The public health folks in Walkerton may have been slow by a couple of days while piecing together the puzzle; what happened in Germany this summer in the sprout-related outbreak of E. coli O104, a relative of O157, was a travesty.
Worse, bureaucrats seemed more concerned about the fate of farmers than that of citizens. By at least one count, 53 have died, and more than 4,200 have been sickened.

Raw sprouts are one of the few foods I won’t eat, and as many epidemiologists have pointed out, sprouts top the list of any investigation involving foodborne illness.

We at bites count at least 55 outbreaks related to raw sprouts beginning in the U.K. in 1988, sickening thousands.

The first consumer warning about sprouts was issued by the U.S. Centers for Disease Control and Prevention (CDC) in 1997. By July 9, 1999, the U.S. Food and Drug Administration (FDA) had advised all Americans to be aware of the risks associated with eating raw sprouts. Consumers were informed that the best way to control the risk was to not eat raw sprouts. The FDA stated that it would monitor the situation and take any further actions required to protect consumers.

At the time, several Canadian media accounts depicted the U.S. response as panic, quoting Health Canada officials as saying that, while perhaps some were at risk, sprouts were generally a low-risk product.

That attitude changed in late 2005, as I was flying back to reunite with a girl I had met in Kansas and 750 people in Ontario became sick from eating raw bean sprouts.

Unfortunately, what food safety types think passes for common knowledge—don’t eat raw sprouts—barely registers as public knowledge. It’s hard to compete against food porn.

Sprouts present a special food safety challenge because the way they are grown, with high moisture at high temperature, also happens to be an ideal environment for bacterial growth.

Because of continued outbreaks, the sprout industry, regulatory agencies, and the academic community in the U.S. pooled their efforts in the late 1990s to improve the safety of the product, implementing good manufacturing practices, establishing guidelines for safe sprout production, and beginning chemical disinfection of seeds prior to sprouting.

But are such guidelines being followed? And is anyone checking?

Doubtful.

This was demonstrated by two sprout-related outbreaks earlier this year linked to sandwiches served by Jimmy John’s, a chain of gourmet sandwich shops based in Champaign, Ill.

Sprouts served on Jimmy John’s sandwiches supplied by a farm called Tiny Greens sickened 140 people with Salmonella, primarily in Indiana. In January, Jimmy John’s owner Jimmy John Liautaud said his restaurants would replace alfalfa sprouts, effective immediately, with allegedly easier-to-clean clover sprouts. This was one week after a separate outbreak of Salmonella sickened eight people in the U.S. Northwest who had eaten at a Jimmy John’s that used clover sprouts.

If the head of a national franchise is that clueless about food safety, can we really expect more from others?

Sprout grower Bill Bagby, who owns Tiny Greens Sprout Farm, said in the context of the German outbreak that, for many like him, the nutritional benefits outweigh the risk:

“Sprouts are kind of a magical thing. That’s why I would advise people to only buy sprouts from someone who has a (food safety) program in place (that includes outside auditors). We did not have (independent auditors) for about one year, and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”

Independent auditors? Like the ones who said everything was cool, everything was OK, at Peanut Corporation of America (nine dead, 700 sick in 2008-09) and Wright County Egg (2,000 sick in 2010)?

Like the Walkerton E. coli O157:H7 outbreak in 2000, too many are using the filters of their politics to advance their own causes and saying too many dumb things in light of the sprout outbreak of 2011.

It’s really about biology and paying attention to food safety basics—no matter how much that interferes with personal politics.

The massive ground turkey recall that Cargill Inc. announced this week is raising questions about whether federal food safety regulators should have moved faster to limit a nationwide salmonella outbreak.

I told Mike Hughlett and David Shaffer of Minnesota Star Tribune that, "Part of the problem is the absence of clear guidelines about when to go public."

Doug Powell, a food safety expert at Kansas State University who felt that the recall process was slow with the ground turkey, said food regulators appeared to become more conservative after a big salmonella outbreak in 2008. The U.S. Food and Drug Administration first linked it to tomatoes, only to find out later that jalapeno peppers were the most likely cause. The tomato industry cried foul after it got crushed financially.

The recall that Minnetonka-based Cargill announced late Wednesday covers 36 million pounds of ground turkey, one of the biggest U.S. meat recalls. It's linked to a particularly virulent strain of salmonella that has infected 78 people in 26 states and led to one death.

The recall involves ground turkey produced as early as February, and the U.S. Department of Agriculture had indications going back to at least July 20 that the culprit might be a Cargill plant in Arkansas.

The timing of the recall highlights a dilemma for the nation's food regulators over when to go public with recall information. Go too late, and public health could suffer. Go too early and make a mistake, and a corporation or industry's reputation could unduly suffer.

In Sacramento County, Calif., where a woman older than 65 died in June from the latest outbreak, the county's health officer brought up another factor bedeviling food regulators these days: budget cutting.

Dr. Glennah Trochet said her department now responds more slowly to outbreaks, sometimes delaying investigations a week or two. Public health workers often aren't available to interview possible victims. She suspects other agencies face the same constraints. "If you want rapid response, you need to have the resources to do rapid response," Trochet said.

This is something I hear from public health types across the country; it’s almost amazing outbreaks get tracked down at all given the fiscal mess at the state and local levels.

The salmonella outbreak linked to Cargill ground turkey began in early March. Chris Braden, the Centers for Disease Control and Prevention's director of foodborne diseases, said on Thursday that it was a slowly building outbreak in the beginning.

After recognizing an "unusual clustering" of Salmonella Heidelberg cases, the CDC began investigating on May 23, Braden said. About the same time, routine surveillance by a federal food monitoring system found the same strain of Salmonella Heidelberg in ground turkey in stores.

The monitoring service found four positive samples, one each in April, May, June and July, Braden said. Those four samples were traced to Cargill's Arkansas plant, he said, though he didn't elaborate on when.

David Goldman, a public health administrator in the USDA's Food Safety and Inspection Service, told reporters that by July 20 or 21, the agency had traced back two cases from the salmonella outbreak to Cargill's Arkansas plant. A third traceback to the same plant was confirmed last week.

Late Friday, the USDA put out a public warning about salmonella dangers in ground turkey, without naming the suspected source. Recalls are often initiated when food regulators tell a company they suspect it's the source of an outbreak.