Risk

  • Posted: January 28th, 2012 - 11:20am by Doug Powell

    The UK Health Protection Agency is issuing a seasonal warning to pregnant women about the potential risk associated with close contact with animals that are giving birth.

    Pregnant women who come into close contact with sheep during lambing, for example, may risk their own health, and that of their unborn child, from infections that can occur in some ewes.

    Although the number of human pregnancies affected by contact with an infected animal is extremely small, it is important that pregnant women are aware of the potential risks and take appropriate precautions.

    It is also important to note that these risks are not only confined to the spring (when the majority of lambs are born), nor are the risks only associated with sheep: cows and goats that have recently given birth can also carry similar infections.

    To avoid the possible risk of infection, pregnant women are advised that they should:

    • not help to lamb ewes, or to provide assistance with a cow that is calving or a nanny goat that is kidding;
    • avoid contact with aborted or new-born lambs, calves or kids or with the afterbirth, birthing fluids or materials (eg bedding) contaminated by such birth products;
    • avoid handling (including washing) clothing, boots or any materials that may have come into contact with animals that have recently given birth, their young or afterbirths; and,
    • ensure partners attending lambing ewes or other animals giving birth take appropriate health and hygiene precautions, including the wearing of personal protective equipment and adequate washing to remove any potential contamination.

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  • Posted: January 10th, 2012 - 9:10pm by Doug Powell

    cantaloupe.salmonella.jpg

    There’s plenty of swarminess to go around in a new report by the U.S. House of Representatives Energy and Commerce Committee on the listeria-in-cantaloupe outbreak of 2011.

    That’s what happens when 30 (or 31) people are killed, 1 suffers a miscarriage and at least 146 are sickened from eating some fruit.

    The report concludes the outbreak could have been avoided if Jensen Farms of Colorado had maintained its facilities in accordance with existing guidance from the U.S. Food and Drug Administration (FDA), which is not mandatory.

    This is nothing new. FDA has been issuing guidance on how to produce safe produce since 1998 and, like spinach and leafy greens and tomatoes, cantaloupe growers now have to act like, oh, we didn’t know.

    Fortunately, the vast majority of cantaloupe growers do know how to produce safe product. But any commodity is only as good as its worst performer. Which is why verification matters, and once again, audits, as currently designed, aren’t up to the task.

    Not mentioned in the report is the devastating effect the outbreak had on individuals, families, other growers and the flaws in relying on others – in food safety they’re called auditors -- to check things out.

    Here’s what the various players told the Congressional investigators:

    FDA officials cited several deficiencies in Jensen Farms’ facility, which reflected a general lack of awareness of food safety principles and may have contributed to the outbreak, including:

    • condensation from cooling systems draining directly onto the floor;
    • poor drainage resulting in water pooling around the food processing equipment;
    • inappropriate food processing equipment which was difficult to clean (i.e., Listeria found on the felt roller brushes);
    • no antimicrobial solution, such as chlorine, in the water used to wash the cantaloupes; and,
    • no equipment to remove field heat from the cantaloupes before they were placed into cold storage.

    FDA emphasized to Committee staff that the processing equipment and the decision not to chlorinate the water used to wash the cantaloupes were two probable causes of the contamination.

    Primus Labs has audited Jensen Farms during the course of Jensen Farms’ relationship with Frontera Produce, beginning in 2003. Primus Labs hired a subcontractor, Bio Food Safety, Inc., to conduct its recent audits of Jensen Farms. On August 5, 2010, Jerry Walzel, the President of Bio Food Safety, audited the Jensen Farms packing facility and gave it a 95% grade - a “superior” rating, despite finding several major and minor deficiencies.

    One precaution that Jensen Farms took in 2010, which it dropped in 2011, was to use an antimicrobial solution, such as chlorine, in the cantaloupe wash water. The front page of the August 2010 audit stated, “[t]his facility packs fresh cantaloupes from their own fields into cartons. The melons are washed and then run through a hydro cooler which has chlorine added to the water. Once the product is dried and packed into cartons it is placed into coolers.” After the August 2010 audit was completed, one of the Jensen brothers informed Mr. Walzel that they were interested in improving their processes. According to Jensen Farms, in response to this inquiry, Mr. Walzel indicated that they should consider new equipment to replace the hydrocooler the farm used to process cantaloupe. Mr. Walzel stated that the hydrocooler, with its recirculating water, was a potential food safety “hotspot,” and advised them to consider alternate equipment. Based on his comments, and input from a local equipment broker, Jensen Farms purchased and retrofitted equipment previously used to process potatoes.

    The Jenson brothers stated that they changed from the hydrocooler to the new food processing equipment in an attempt to strengthen their food safety efforts.
    Jensen Farms stated that they contracted with Primus Labs to perform an audit in July 2011. Again, Primus Labs subcontracted with Bio Food Safety to conduct the audit. Mr. Walzel did not conduct this audit; a new auditor from Bio Food Safety, James Dilorio, conducted the audit on July 25, 2011, and, after spending approximately four hours inspecting the facility, gave Jensen Farms a 96% grade - again a “superior” rating. Despite this high rating, Mr. Dilorio identified several deficiencies, including three “major deficiencies”: (1) wood (which can house bacteria and cause splinters) covered the unloading and packing tables, (2) lack of hot water at hand washing stations, and (3) doors left open during operating hours, potentially allowing pests to enter the facility.

    Jensen Farms noted that it received a visit from a representative of Frontera Produce, its distributor, shortly before the 2011 audit. According to the Jensen brothers, this representative provided them with advice about preparing for the audit, but did not note any problems. Jensen Farms informed Committee staff that quality control representatives from various retailers have visited the farm as well. The Jensen brothers stated that based on these inspections and their prior food safety record, they had no concerns about their operations prior to the recent outbreak.

    Will Steele and Amy Gates, the CEO and executive vice president of Frontera Produce, told Committee staff that they had visited Jensen Farms to inspect its facilities and provide business advice and both were critical of the current standards for third-party audits and had concerns about inadequate standards.
    Ms. Gates indicated that there is “no industry standard for validation points” after an audit, while Mr. Steele stated that “this is the industry standard. I’ve always believed there’s got to be more validation points. This case clearly demonstrates that.”

    Robert Stovicek, president of Primus Labs told Committee staff that his company’s role is to conduct an impartial assessment of a client’s operations and provide its findings to the client. He stated that the audits are intended to assess whether the client’s operations are in compliance with current baseline industry standards—not to improve those standards or push a client towards best practices. Mr. Stovicek said that Primus Labs would “be a rogue element if they tried to pick winners and losers” by holding industry to higher standards. He also said that Primus Labs did not have the “expertise to determine which best practices should be pushed by the industry.”

    Jerry Walzel, the president of Bio Food Safety, told the Committee that – consistent with Primus Labs policy – the audits only deducted from the score if a method or technique was inconsistent with FDA regulations; they did not deduct from the score if FDA guidance was not being followed. … He stated that Bio Food Safety auditors were “roped in by regulation and Primus training,” and that “guidelines are opinions…. regulations are law.”

    Additionally, he noted, “we are not supposed to be opinionated on this, we are supposed to go by FDA’s regulations… FDA should have mandated that you cannot sell cantaloupes that have not been sanitized.”

    According to Frontera Produce, in response to the outbreak, many major retailers have already instituted end-product testing of cantaloupe to identify Listeria, Salmonella and other pathogens. Frontera Produce officials also informed Committee staff that retailers and industry groups are studying the possible implementation of additional checks at different critical control points in the supply chain, including risk-based assessments and sample testing. Primus Labs noted, and FDA confirmed, that buyers will immediately start requiring auditors to take environmental swabs while auditing food facilities.

    Democrats on the House Energy and Commerce Committee, including Rep. Diana DeGette of Denver, also asked the FDA to step up regulation of outside auditors, who they say bring numerous "conflicts of interest" to the food safety system. Excerpts from their letter are below:

    The investigation identified significant problems with the third-party inspection system used by growers and distributors to ensure the safety of fresh produce, This auditing system is often the first and only line of defense against a deadly foodborne disease outbreak. …

    Our investigation reveals some of the reasons why: the auditors' findings were not based on the practices of the best farms and failed to ensure that the producer met FDA guidance; the auditors missed or failed to prioritize important food safety deficiencies; the auditors lacked any regulatory authority and did not report identified problems to the FDA or other state or federal authorities; the auditors did not ensure that identified problems were resolved; and the auditors provided advance notice of site visits and spent only a short period of time on-site. It also became apparent in the investigation that the auditors had multiple conflicts of interest.

    The problems identified in the audits of Jensen Farms are similar to those that the Committee identified in food safety investigations in 2009 and 2010. In 2009, following the Salmonella outbreak in peanut butter products sold by the Peanut Corporation of America (PCA), a Committee investigation revealed that a private, for-profit auditing firm gave the company glowing reviews (step forward American Institute of Baking). The auditor, AlB, was selected by PCA, it was paid by PCA, and it reported to PCA. The auditor awarded a "superior" rating to the company’s plant. Six months after the audit, PCA's products killed nine people and sickened 691 people .

    In 2010, the Committee's investigation into an outbreak of Salmonella in eggs produced by Wright County Egg revealed the same problems with third-party audits. Following the outbreak, federal officials inspected Wright County Egg facilities and found serious violations of food safety standards, including barns infested with mice, chicken manure piled eight feet high, and uncaged hens tracking through excrement. There were very different results when Wright County Egg farms were inspected by AlB. AlB gave Wright County Egg an award two months before the outbreak, rating them "superior" and awarding the company a "recognition of achievement.”

    Weaknesses in third-party auditors represent a significant gap in the food safety system because the auditors are often the only entities to inspect a farm or facility. … Like it or not.our food safety system relies heavily on third party auditors to identify dangerous practices and prevent contaminated foods from reaching the market.

     

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  • Posted: January 7th, 2012 - 4:20am by Doug Powell

    When toxoplasma in pork ranked second in last year’s top 10 riskiest combinations of foods and disease-causing microorganisms at $1.2 billion a year, some wondered, what?

    Now the Brits have chirped in, saying much more needs to be known about Toxoplasma gondii in the country’s food and especially the impact on pregnant women.

    The UK Food Standards Agency’s (FSA) Advisory Committee of the Microbiological Safety of Food (ACMSF) is seeking stakeholder views on its draft report relating to toxoplasma in the food chain (available at http://www.food.gov.uk/multimedia/pdfs/consultation/criskprotoxoplasmafoodchain.pdf).

    According to the UK National Health Service (NHS), food sources include undercooked or raw meat, raw cured meat (including Parma ham, salami) and unpasteurised goat’s milk, and the infection can pass between humans from a pregnant woman to an unborn baby.

    Although toxoplasmosis usually only causes mild flu-like symptoms in adults, the ACMSF said it can be fatal to babies, and has been linked with associated jaundice, eye infections and seizures.

    The FSA’s scientific advisory committee was asked to consider whether current evidence indicates a food safety issue that needs to be addressed, what food sources could present a significant risk and identify further work needed on UK prevalence and foodborne sources of toxoplasmosis.

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  • Posted: October 24th, 2011 - 7:06pm by Doug Powell

     While America’s farmers of fresh produce try to figure out what is a good agricultural practice (GAP) and how best to limit animal incursions, the first dog gets a portrait in the midst of the presidential garden.

    Retailers expect farmers to have some control over deer crapping on strawberries or apples and killing people, so maybe it’s not a bright idea to promote pooches in the garden.

    I look forward to a full discussion of microbial food safety risks and fresh produce in Michelle Obama's upcoming book, Grown: How the White House Kitchen Garden Inspires Families, Schools, and Communities, announced today by the Crown Publishing Group. Beleaguered cantaloupe farmers may also appreciate some First guidance on allowable animal incursions.

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  • Posted: July 11th, 2011 - 8:15pm by Doug Powell

    “I got tired of talking about hypothetical risks.”

    That’s what I told Maclean’s and the Medical Post today in a brief story about genetically engineered foods.

    And I agreed with a spokesthingy who said, “To date, Health Canada has not identified health risks associated with GM foods that have been approved for sale in Canada.”

    As the journal Nature reported in 2009, “No one gets into research on genetically modified (GM) crops looking for a quiet life. Those who develop such crops face the wrath of anti-biotech activists who vandalize field trials and send hate mail… [Those] who suggest that biotech crops might have harmful environmental effects are learning to expect attacks of a different kind. These strikes are launched from within the scientific community and can sometimes be emotional and personal…”

    Dr. Douglas Powell, a professor in food safety at Kansas State University who sat on the Canadian Biotechnology Advisory Committee (CBAC) in the early 2000s,, said, “(CBAC) reviewed everything that was out there and there was nothing to show GMOs present a risk to health. In fact, Dr. Powell has since moved away from researching the subject because, he says, “I got tired of talking about hypothetical risks.”

    With at least 48 million suffering from foodborne illness each year in the U.S., I got plenty of work.
     

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  • Posted: May 2nd, 2011 - 8:23pm by Doug Powell

    This is gross.

    Infants as young as one month are being given either dietary botanical supplements or herbal teas.

    A study done for the University Hospitals Case Medical Center in Cleveland, Ohio and published in the June edition of Pediatrics, has found that nine per cent of infants in a major survey were given a wide variety of herbal supplements and tea. It is being raised as a concern because some supplements given to infants may be health risks.

    The purity and potency of such supplements and teas are not regulated in the same way as pharmaceuticals and may lead to adverse drug reactions and may contain heavy metals and other contaminants which could be harmful, says the study.

    In 2007 one brand of gripe water, used to soothe fussy babies, was recalled because it contained cryptosporidium, a parasite that can cause intestinal infections.

    The supplements and teas are sometimes preferred by parents because they can be obtained without medical prescriptions and have been shown to be effective for some conditions. Most are marketed as, and considered to be, more natural.

    Experts recommend that infants receive only human milk or infant formula for the first four to six months, with vitamins and medicine as needed.
     

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  • Posted: April 28th, 2011 - 7:32am by Doug Powell

    chicken.therm_.jpg

    If policy types are going to focus resources, it helps to know where to get the most bang for the regulatory dollar.

    Researchers at the University of Florida Emerging Pathogens Institute have attempted to identify the Top 10 riskiest combinations of foods and disease-causing microorganisms.

    The report, Ranking the Risks: The 10 Pathogen-Food Combinations with the Greatest Burden on Public Health, lists the number of illnesses, costs, and overall public health burden of specific microbes in particular types of food. The list includes:

    Campylobacter in poultry — costs $1.3 billion a year
    Toxoplasma in pork — costs $1.2 billion a year
    Listeria in deli meats — costs $1.1 billion a year
    Salmonella in poultry — costs $700 million a year
    Listeria in dairy products — costs $700 million a year
    Salmonella in complex foods — costs $600 million a year
    Norovirus in complex foods — costs $900 million a year
    Salmonella in produce — costs $500 million a year
    Toxoplasma in beef — costs $700 million a year
    Salmonella in eggs — costs $400 million a year


    “The number of hazards and scale of the food system make for a critical challenge for consumers and government alike,” said Michael Batz, lead author of the report and head of Food Safety Programs at the Emerging Pathogens Institute. “Government agencies must work together to effectively target their efforts. If we don’t identify which pairs of foods and microbes present the greatest burden, we’ll waste time and resources and put even more people at risk.”

    Of these, the new report concludes that five leading bugs—Campylobacter, Salmonella, Listeria monocytogenes, Toxoplasma gondii, and norovirus – result in $12.7 billion in annual economic loss - with the Top 10 pathogen-food combinations responsible for more than $8 billion. That burden includes the cost of medical care and lost productivity from employee sick days, as well as the expense of serious complications or chronic disabilities that result from the acute illness or sometimes strike after acute illness goes away.

    Douglas Archer, associate dean for research at the UF Institute of Food and Agricultural Sciences who reviewed the report, told The Gainesville Sun, "You can't inspect away foodborne illnesses.”

    Of course, a farming rep told the Sun, food producers have to be diligent in ensuring food safety, but the public also has to play a role.

    Frankie Hall, director of agricultural policy for the Florida Farm Bureau said, producers can do a good job only to have the person who takes the food home handle it improperly, adding, "There is responsibility for food safety when you get it back to the home.”

    J. Glenn Morris, the director of the Emerging Pathogens Institute at the University of Florida and one of the authors of the study told the Washington Post that policymakers at the USDA, which regulates meat, poultry and some egg products, and the FDA, which oversees the rest of the food supply, should consider the economic burden on society when deciding how to direct food safety resources, adding, “You can begin to use these more sophisticated analytic tools, which can serve as the basis of spending public dollars in terms of food safety.”

    The report, which was supported by a grant from the Robert Wood Johnson Foundation, includes the following key findings and recommendations for food safety officials:

    • Poultry contaminated with Camplylobacter bacteria topped the list, sickening more than 600,000 Americans at a cost of $1.3 billion per year. Salmonella in poultry also ranks in the Top 10, with $700 million due to costs of illness. Infections with these microorganisms can cause acute illness such as vomiting but also can lead to hospitalization or death. Campylobacter infection can also cause paralysis and other neuromuscular problems. The report questions whether new safety standards announced by the USDA for young chickens and turkeys are sufficient, and recommends evaluating and tightening these standards over time.

    • Salmonella is the leading disease-causing bug overall, causing more than $3 billion in disease burden annually. In addition to poultry, Salmonella-contaminated produce, eggs and multi-ingredient foods all rank in the Top 10. The report recommends that the FDA and USDA develop a joint Salmonella initiative that coordinates efforts in a number of foods.

    • Four combinations in the Top 10 – Listeria in deli meats and soft cheeses, and Toxoplasma in pork and beef – pose serious risks to pregnant women and developing fetuses, causing stillbirth or infants born with irreversible mental and physical disabilities. The report recommends that agencies strengthen prevention programs for these pathogens and improve education efforts aimed at pregnant women.

    • Norovirus is the most common foodborne pathogen and is largely associated with multi-ingredient items that can become contaminated, often by service-industry workers who handle food. The researchers recommend strengthening state and local food safety programs through increased funding, training and adoption by states of the most recent FDA Food Code.

    • The report lists E. coli O157:H7 as the sixth pathogen in overall burden, with the majority due to contaminated beef and produce. The report recommends federal agencies continue to target E. coli O157:H7, due to the particularly devastating injuries it causes in small children, including kidney failure, lifetime health complications, and death.

    The report is available at: http://www.epi.ufl.edu/sites/www.epi.ufl.edu/files/RankingTheRisksREPORT.pdf
     

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  • Posted: January 31st, 2011 - 11:54am by Doug Powell

    Focusing on the language needs of expectant mothers and enhancing food safety in hospitals could reduce cases of foodborne illness caused by listeria.

    Australian researchers report in the current Epidemiology and Infection that of 136 cases of listeriosis in Australia between Nov. 2001 and Dec. 2004, 40 per cent of cases with prior hospitalization were exposed to high-risk foods during hospitalization; consumption of camembert cheese was an additional risk factor.

    Of the 19 perinatal cases -- defined as illness in a pregnant woman, fetal loss, or illness in a baby aged less than 3 months with isolation of L. monocytogenes from at least one of the maternofetal pair -- living in a household where a language other than English (LOTE) was spoken was the primary risk factor associated with listeriosis.

    The numbers are small, but the researchers have identified a persistent problem – providing information is nice, but what if the target can’t read or understand (in this case) English?

    “The Food Standards Australia and New Zealand (FSANZ) website only provides a brochure on listeriosis and food in English. Languages used in State and Territory brochures vary widely with some only including English while others provide up to 14 languages other than English.

    “This study identified that listeriosis prevention messages need to be disseminated in multiple languages and primary-care practitioners should ensure that patients from households speaking a LOTE receive counselling on listeriosis prevention.”

    Which sounds nice, but since hospitals are serving high-risk foods to others at risk, maybe the medical community is a limited source of information. And just because a brochure is in another language doesn’t mean anyone will read it or act upon the information. That requires far more rigorous evaluation in terms of information needs, delivery, messages and accuracy. The morons at Toronto Sick Kids hospital told moms-to-be that cold-cuts and raw fish were OK (they're not).

    As the authors conclude,

    “The effectiveness of the implementation of the new food safety programs for food service to vulnerable persons should be carefully evaluated to ensure optimal protection of this group.”

    A national case-control study of risk factors for listeriosis in Australia
    30.apr.10
    Epidemiology and Infection (2011), 139: 437-445
    C.B. Dalton, T.D. Merritt, L.E. Unicomb, M.D. Kirk, R.J. Stafford, K. Lalor and the OzFoodNet Working Group
    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8013904
    Abstract
    Listeriosis is a foodborne disease associated with significant mortality. This study attempts to identify risk factors for sporadic listeriosis in Australia. Information on underlying illnesses was obtained from cases' treating doctors and other risk factors were elicited from the patient or a surrogate. We attempted to recruit two controls per case matched on age and primary underlying immune condition. Between November 2001 and December 2004 we recruited 136 cases and 97 controls. Of perinatal cases, living in a household where a language other than English was spoken was the main risk factor associated with listeriosis (OR 11·3, 95% CI 1·5–undefined). Of non-perinatal cases we identified the following risk factors for listeriosis: prior hospitalization (OR 4·3, 95% CI 1·0–18·3), use of gastric acid inhibitors (OR 9·4, 95% CI 2·4–37·4), and consumption of camembert (OR 4·7, 95% CI 1·1–20·6). Forty percent of cases with prior hospitalization were exposed to high-risk foods during hospitalization.

     

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  • Posted: January 21st, 2011 - 6:11am by Doug Powell

    It was a come-and-meet-a- real-live Canadian event when I first met Amy in Kansas in 2005, and when I first told her that sleeping with her dog was a microbiological risk.

    I also told her French food was overrated and she shouldn’t eat rare hamburgers.

    She asked me out on a date.

    In a study to be published in Emerging Infectious Diseases, veterinary scientists say sleeping with your pets increases the chances of contracting everything from parasites to the plague.

    Andrew Schneider of AOL News reports most U.S. households have pets, and more than half of those cats and dogs are allowed to sleep in their owner's beds.

    Personal note: our dogs do not sleep in the bed, but the cats do, primarily in the winter when it’s too cold to go outside; in the summer we are of no use and the cats can disappear for days.

    Drs. Bruno Chomel, a professor at the University of California, Davis, School of Veterinary Medicine, and Ben Sun, chief veterinarian for California's Department of Health, say they wanted to raise the attention of people, as sleeping with a pet is becoming quite common, and there are risks associated with it, even if it is not very frequent.

    The authors found that "the risk for transmission of zoonotic agents by close contact between pets and their owners through bed sharing, kissing or licking is real and has even been documented for life-threatening infections such as plague, internal parasites" and other serious diseases.

    This study and several others show that disease from cats is far more prevalent, and often more serious.

    The number of cats snuggling up with their owner is far greater, which may explain the larger number of people acquiring feline-spawned diseases, Chomel explained.

    Sharing our resting hours with our pets may be a source of psychological comfort, but because pets can bring a wide range of zoonotic pathogens into our environment, sharing is also associated with risks, the authors of the current study reported.

    • A 9-year-old boy from Arizona got the plague because he slept with his flea-infested cat.
    • A 48-year-old man and his wife repeatedly contracted MRSA (methicillin-resistant Staphylococcus aureus), which their physicians eventually attributed to their dog. The animal "routinely slept in their bed and frequently licked their face," the California experts reported.
    • A Japanese woman contacted meningitis after kissing her pet's face.
    • A study published last August in the journal Pediatrics tracked an outbreak of salmonella in 79 people between 2006 and 2008 that was caused by contaminated meat in dry cat and dog food.

    Half of the victims were children, who CDC investigators said "might also have played with the pet food and then put their hands -- or the food itself -- in their mouths."

     

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  • Posted: January 13th, 2011 - 4:19pm by Doug Powell

    Good to see my food safety friend Michael Brodsky keeping up the food safety fight back in my native Ontario (that’s in Canada).

    In 2005, an outbreak of salmonella in mung bean sprouts sickened 648 people across Ontario. Yet on Jan. 10, 2011, The Toronto Star, in keeping with all things groovy, ran an article entitled, The indoor garden's tiny shooting stars.

    Brodsky responded (and Jimmy John’s, pay attention):

    Nara Schoenberg’s article encouraged people to grow and eat sprouts. As an environmental microbiologist for more than 38 years, I caution against following this recommendation.

    In the U.S., since 1996, there have been at least 30 reported outbreaks of foodborne illness associated with different types of raw and lightly cooked sprouts. Most of these outbreaks were caused by Salmonella and E. coli infections. Recently, Tiny Greens Organic Farm of Urbana, Illinois, announced a recall of specific lots of Alfalfa Sprouts and Spicy Sprouts because they have the potential to be contaminated with Salmonella.

    The CDC and Health Canada recommend that children, the elderly, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean sprouts).
    Cook sprouts thoroughly to reduce the risk of illness. Cooking thoroughly kills the harmful bacteria.

    Request that raw sprouts not be added to your food. If you purchase a sandwich or salad at a restaurant or deli, check to make sure that raw sprouts have not been added. It is irresponsible to advocate an activity that could cause serious illness without including an adequate precautionary warning.

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