Some public health types have long argued there is no point in making outbreaks of foodborne illness public – through media disclosure, for example – when the outbreak has passed or the food is gone and there is no on-going threat to public health.

I disagree.

Even if the threat has passed, public discussion of foodborne outbreaks enhances awareness, holds operators accountable, and builds trust and credibility for the investigating outfit (usually the local health department).

Oh, and as I told Jonathon Sher of the London Free Press (that’s in Canada) people have a right to know about events where people got sick.

Sher reports this morning that Londoners were kept in the dark about a viral outbreak at the London Hunt and Country Club after at least 25 people were stricken with suspected norovirus after a Thanksgiving buffet Oct. 11 and at least four more became ill after attending an event for medical residents on the 13th.

Cathie Walker of the Middlesex-London Health Unit said,

“We were notified Oct. 14 by an attendee who was ill.”

Public health officials didn’t reported the outbreaks to the general public and instead relied on the Hunt Club, which had e-mailed a newsletter to its members about the incident, and the organizer of the event for medical residents.

Walker defends the lack of public notification, saying people who didn’t attend the events weren’t at risk and that the private club had taken over the task of notifying those who attended.

“Health Units are loathe to report it because it creates more work but there’s value to reporting and the public has a right to know,” said Doug Powell, an associate professor of food safety at Kansas State University.

In outbreaks such as these the cause is most often a food handler who is already sick, Powell said.

Barbara Kowalcyk, director of food safety for the U.S.-based Center for Foodborne Illness Research & Prevention said, “(A worker) would be the logical place to look.”

While kitchen staff worked at both events and some later reported be stricken with illness, it’s not clear if any of the diners attending both events — health investigators never asked to compare the lists, the Hunt Club says.

The health unit instead interviewed 29 ill people, some who responded to the Hunt Club email and others mentioned by the initial people interviewed. But health investigators didn’t speak to the roughly 370 other people who attended, Walker said.

That’s a significant oversight, said Kowalcyk, who is a statistician completing a doctorate in Environmental Health with a focus in Epidemiology.

“If they don’t even talk to people who weren’t sick, I don’t know how they can say they did an investigation,” she said.

If a sick worker was the source it’s possible he or she doesn’t know it and may be still infecting people, she said.

“(The public) may want to know that,” Kowalcyk said. “I’d think public health official would want that worker not to handle food.”
 

I didn’t even come up with that headline. Those science journal writers are developing a sense of humor.

Eriksen et al. write in Eurosurveillance today:

Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer.

The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyze possible associations between the food consumed and becoming ill. Food, environmental and stool samples were tested for common causative agents, including enterotoxigenic C. perfringens. The clinical presentation and the epidemiological findings were compatible with C. perfringens food poisoning and C. perfringens enterotoxin was detected in stool samples from two cases.

The case-control study found statistically significant associations between becoming ill and eating either a specific chicken or lamb dish prepared by the same food handler of the implicated catering company. A rapid outbreak investigation with preliminary real-time results and the successful collaboration between the agencies and the caterer led to timely identification and rectification of the failures in the food handling practices.

In the discussion, the authors write,

A blast chiller is normally used for cooling large quantities of food quickly by this particular caterer; however it was not being used appropriately at the time of the incident. Temperature control of foods during preparation, cooling, transportation and reheating was poor. Furthermore, the vans used for food transport had no refrigeration and these events took place in July. The evidence of insufficient hygiene, cooling and reheating at the catering company during transport and at both venues (according to environmental health department inspections) are in keeping with a toxin-related gastroenteritis outbreak, including C. perfringens.
 

"What does (Powell) know about the actions of London politicians and the relationship of the city and the health unit? Probably nothing."

That was London-lite Councilor Harold Usher responding to my criticism that if London (in Ontario, in Canada) politicians wanted restaurant inspection disclosure in the form of colored signs on doors like the medical officer of health recommended 40 months ago, it would have happened faster. Just like it did in Toronto, all those years ago.

Sir, I didn’t just send my comments in by stagecoach from Kansas, I am from Brantford (in Ontario, in Canada), and have sat through numerous city council meetings involving board of health issues as both a journalist and participant in Toronto, Port Colborne, Welland, Guelph, and closer to London, Ingersoll (all in Ontario, Canada).

Coun. Susan Eagle, one of two people on the 11-member board appointed by city council, said,

"I was keen to move faster than we did . . . I'm disappointed it's taken so long."

Jonathan Sher of the London Free Press wrote in Saturday’s edition that when London-lite restaurant inspections went online for the first time this week, so many diners logged on, the system slowed to a crawl.

Dr. Douglas Powell, associate professor of food safety at Kansas State University, said,

"I think it goes back to a lack of political will. London could have done this earlier if (politicians) wanted to. Is there anyone in London who will champion the rights of diners and people who buy (prepared) food?"

London Controller Gina Barber thinks Powell has a point -- while politicians support the use of coloured signs, no one made it a priority or directed staff to get the work done by a deadline.

The Free Press coverage caused a flood of diners to call the health unit, where officials promised they'd soon post inspection summaries on a long-planned website.

I also told the reporter, the best restaurants will embrace public disclosure and even promote their food safety excellence.

How to use the inspection website in London:

Access at http://inspection.healthunit.com or through the health unit’s main website, www.healthunit.com

Search for restaurants by region, by first letter or by keyword. Violations will be listed for each. 

Click on restaurant names for dates of inspection reports, then on each date for summaries of violations and action required.

 

Media outlets in New York and London-lite (the Ontario version) are clamoring for improvements in restaurant inspection disclosure.

The job is easier in New York, because, as reported by nyunews.com, the city’s Department of Health and Mental Hygiene announced that beginning in July of 2010, restaurants in NYC will be required to display their health inspection letter grade so that it is highly visible to customers.

While gaining support from a number of people who believe the system will promote cleanliness and limit foodborne illnesses, many believe the system will be an unnecessary burden on the restaurant community. The following are reactions from managers and employees of several local restaurants.

Randy Richmond of the London Free Press writes that posting restaurant inspection results online will weed out unhealthy operations and protect the public, several local eatery owners say.

It would be better, though, if London could afford more inspectors to ensure more frequent checks, added one owner.

In New York, managers such as Elias Bourakac of Bully's Deli said,

"I'm for it. The inspection goes through the Health Department. We passed it, we did very good. No problems, no violations."

Frank Berascha of Famous Famiglia said,

"We had almost 90 percent last year. Everything is perfect. I would have no worries."

In London-lite, the health unit is expected to announce Thursday that it will start posting inspection results online and that’s fine by restaurateurs contacted by The Free Press.

Vanessa Willis, co-owner of the Church Key said,

"I think that's exactly how it should be done. I think the community has the right to know what restaurants are working properly and what ones are not."

Felipe Gomes, owner of Aroma said conscientious eatery owners spend thousands of dollars on equipment, supplies and training to keep operations safe and healthy, and those who cut corners should be exposed, adding, "You are dealing with the health and safety of people."