Food Poisoning, Foodborne Illness Information and Research : International Food Safety Network : BarfBlog

When Canadian bureaucrats send out a food safety press release for no apparent reason other than to remind Canadians of something it usually means there is an outbreak going on.

Once again, it’s raw sprouts, and it’s not like it’s sprout season or something (unlike the often terrible turkey food safety advice the surfaces at Thanksgiving).

Health Canada and the Canadian Food Inspection Agency are reminding Canadians that raw or undercooked sprouts should not be eaten by children, the elderly, pregnant women or those with weakened immune systems.

Sprouts, such as alfalfa and mung beans, are a popular choice for Canadians as a low-calorie, healthy ingredient for many meals. Onion, radish, mustard and broccoli sprouts, which are not to be confused with the actual plant or vegetable, are also common options.

These foods, however, may carry harmful bacteria such as Salmonella and E. coli O157:H7, which can lead to serious illness.

Fresh produce can sometimes be contaminated with harmful bacteria while in the field or during storage or handling. This is particularly a concern with sprouts. Many outbreaks of Salmonella and E. coli infections have been linked to contaminated sprouts. The largest recent outbreak in Canada was in the fall of 2005, when more than 648 cases of Salmonella were reported in Ontario.
 

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Dumb things to say when 37 people are sick and 1 dead, from the same restaurant: "I eat here regularly and I have never gotten sick. Everyone in the community eats there. It has a very good reputation."

Apparently the Globe and Mail newspaper thinks so too, and published an awesome online review of Ruby, the Chinese restaurant at the center of a Salmonella outbreak. Or it was available, according to a food writer at the rival National Post newspaper, until the restaurant was closed: “review now deleted.”

Howard Shapiro, Toronto's associate medical officer of health, said,

Despite having almost two days to clean the restaurant, the restaurant failed to "meet the requirements needed to be met to re-open.” The restaurant will remain closed until the next inspection takes place sometime this weekend.

The restaurant was shut down on Wednesday, after two health inspectors found that foods were not protected from contamination, raw meat wasn't kept at the correct temperature, and utensils and cooking surfaces were inadequately cleaned. There was also a cockroach infestation and Shapiro said the floor was "dirtier than we would find acceptable."
 

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Whenever a group says the public needs to be educated about food safety, biotechnology, trans fats, organics or anything else, that group has utterly failed to present a compelling case for their cause. Individuals can choose to educate themselves about all sorts of interesting things, but the idea of educating someone is doomed to failure. And it’s sorta arrogant to state that others need to be educated; to imply that if only you understood the world as I understand the world, we would agree and dissent would be minimized.


On the same day the U.S. Food and Drug Administration issued its Strategic Plan for Risk Communication, which outlines the agency’s efforts to disseminate more meaningful public health information and has lots of pretty words about “two-way communication through enhanced partnerships,” FDA said its “new web videos educate consumers about food and medical product safety.”

No evidence is provided that anyone found the videos educational. And the language in the headline is not consistent with ”two-way communication.” What’s with the dualities? Good and bad, heaven and hell? How about multiple communications with a variety of audiences, to use bureau-speak; and chew gum at the same time.

It’s important to tell people how information is developed and released. We updated the bites.ksu.edu information protocol last week. But actions speak louder than words.

One of the tenets of effective risk communication to inform, discuss and participate in give and take when it comes to information, rather than educate. I co-wrote a book about it, 1997’s Mad Cows and Mother’s Milk. And people learn through stories, not facts.

There is a dearth of scientific studies applying proven risk communication concepts to issues of microbial food safety. There is, however, an abundance of academic, industrial and government pronouncements on how to improve communications activities related to food safety, based on anecdotal evidence and almost always citing the need for “educated consumers” or “a better-educated public.”

Such proposals invoke a one-way, authoritarian model of communication; and exactly how this mythical consumer will become better educated remains a mystery. What is known is that the traditional approach of scientists clearly explaining the facts is “naive—and probably a recipe for failure. ... 
Too often, risk communicators are more concerned with educating the public, rather than first listening to them and then developing communication policies.”

Food Safety Education Month, whatever that is, ended yesterday. People are still eating this morning. I wonder if they got educated?

An honest Food Safety Education month would include food safety stories, tragic or otherwise, and a rigorous evaluation of what has worked, what hasn’t worked and what can be improved, rather than a checklist of ineffective and often inaccurate food safety instructions with the cumulative effect of blaming consumers. Telling people to wash their hands isn’t keeping the piss out of meals. 


 

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The number of E. coli cases believed to be linked to the PNE has climbed from 13 last week to 18, and the mother of one sick child is questioning health officials' response.

Coquitlam, B.C., mother Caroline Neitzel says her 14-month-old daughter, Jacklyn (right), was infected with E. coli after a visit to the annual Vancouver fair on Sept. 5.

Neitzel said her daughter touched a number of different animals at the petting farm. She said she did her best to wipe her daughter's hands with wet wipes during that visit.

Despite her efforts, Jacklyn became very ill. At first doctors thought the toddler had the flu. Jacklyn was sent home twice before being admitted to Royal Columbian Hospital, according to her family.

"By that time, her eyes were rolling into the back of her head. She was just so lethargic," Neitzel told CTV News on Friday.

The toddler spent four days in hospital. Neitzel said she thinks her daughter would have been diagnosed earlier if health officials had issued a public warning when a cluster of E. coli cases was discovered.

Anna Marie D'Angelo, a spokeswoman for Vancouver Coastal Health, said the public was not alerted because there was no risk at the time.

"We became aware of the situation three days after the PNE had closed. So there was no risk to any future people getting this E. coli," she said.

Health officials say an alert would not have changed how a patient was treated at the hospital.

The PNE says E. coli has never been a problem in the past at the petting farm and that the fair has stringent hygiene measures in place, including signs and staff directing visitors to hand-washing stations.
 

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With 64 kids now stricken with E. coli O157 related to visits at the Godstone farm in Surrey, the responses from the folks who run petting zoos could be a little more sympathetic, a little more reflective.

Instead, as reported by the Guardian tonight (tomorrow in the U.K.), Geoff Ford, who runs Docker Park farm in Lancashire, where children can feed pygmy goats (see 1999 Ontario Western Fair outbreak, below) by hand and stroke rabbits, said any ban would affect "children's environmental education” stating,

"It's going to get hyped up out of all proportion. It does away with children's environmental education. It's important that children realise what a chicken is, what a calf is – often they come here and ask 'is that a horse?'… We have run our farm for 20 years with no problems. But there is only so much you can do if people don't listen. The farm at the source of the outbreak in Surrey had big signs all over the place telling people to wash their hands, but some people don't give a damn."

The U.K. Department of Health responded today by announcing that the advisory committee on dangerous pathogens would be reviewing the current guidance on open farms and will advise on the need for additional precautions "in the light of the current outbreaks of E coli O157."

A Department of Health spokesman told the Telegraph,

“The risk of infection from E-coli O157 through petting farm animals can be prevented by following everyday good hand hygiene measures.”

All of these statements have serious problems.

• 64 kids sick with E. coli O157 is not hysteria, it sucks;

• anyone who says, “we have run our farm for 20 years with no problems” is unwilling to learn and a hazard to public health;

• telling people to wash their hands is insufficient – proper handwashing requires access to proper tools;

• even with proper tools, signs are not enough, as we showed with our recent handwashing compliance study at a university residence when everyone was barfing and awareness was high; and,

• the best handwashing may not be enough -- the E. coli O157:H7 that sickened 82 people in 2002 at the Lane County Fair in Oregon appears to have spread through the air inside the goat and sheep expo hall.

Scott Weese, a clinical studies professor at the University of Guelph (Canada) and colleagues reported in the July 2007 edition of Clinical Infectious Diseases that in a study of 36 petting zoos in Ontario between May and October of 2006, they observed infrequent hand washing, food sold and consumed near the animals, and children being allowed to drink bottles or suck on pacifiers in the petting area.

He observed similar failures yesterday.

So after 159 people, mainly children, were thought to be sickened with E. coli O157:H7 traced to a goat and a sheep at the 1999 Western Fair in London, Ontario, and eight years after all Canadian fairs were urged to adopt 46 recommendations to enhance petting zoo safety, many are still doing a lousy job.

Bill Marler has compiled a list of outbreaks related to petting zoos. We’ve previously reported at least 29 petting zoo related outbreaks in North America alone.

These petting zoo experiences raise questions: how best to motivate fair managers to provide petting zoos that are microbiologically safe? Should the urban public be allowed to interact with livestock at all? Should petting zoos be inspected, as restaurants are, and the results displayed?

If 64 sick kids is hysteria, conversation is useless and regulation required.
 

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That's one of the responses Brae Surgeoner, Doug and I received when we asked University of Guelph students how they got information that a norovirus outbreak was happening on campus a couple of years ago. The kids were getting information through non-official channels and rumours were high. A lesson that was learned from the outbreak was to communicate with the target audience (whether it be college students or folks in a long-term care facility) with mediums they are already comfortable with.

I got an email from a couple of folks at Guelph this morning saying that our recently published Journal of Environmental Health article where the above results and conclusions were shared is making the rounds on campus. Here are some of the highlights from the interview I did with Katie Mangan at the Chronicle of Higher Education.

"We couldn't follow students into the bathroom, because that leads to ethical problems," Mr. Chapman says. So the researchers focused on whether students were using a plastic bottle of hand-sanitizing gel placed at the entrance of a cafeteria that had been described to them as "ground zero" of the outbreak.

"What people do and what they say with regard to hand hygiene are two different things," Mr. Chapman reports.

He says health officials should aim their messages at specific audiences, such as students living in a particular residence hall. Instant messaging and other social-media tools should be used as well.

"It really hits home," he notes, "when their classmates start changing their IM names to something like Puking Veronica."

Gotta know how to reach the kids with health messages; make it relevant and compelling. Check out www.foodsafetyinfosheets to see how we attempt to do that.

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Food safety researcher and talk-show host Jon Stewart got it right back in 2002 when he said,

“If you think the 10 commandments being posted in a school is going to change behavior of children, then you think “Employees Must Wash Hands” is keeping the piss out of your happy meals. It's not.”

Instead, getting college students to wash hands, halt disease, requires giving them proper tools and spreading the word in ways that get attention: the path to poor hand sanitation is paved with good intentions, according to researchers from Kansas State and North Carolina State Universities.

As college campuses prepare for an expected increase in H1N1 flu this fall, the researchers said students' actions will speak louder than words.

"Many students say they routinely wash their hands," said Douglas Powell, an associate professor of food safety at Kansas State University. "But even in an outbreak situation, many students simply don't."

In February 2006, Powell and two colleagues — Ben Chapman, an assistant professor at North Carolina State University, and research assistant Brae Surgeoner — observed hand sanitation behavior during an outbreak. What was thought to have been norovirus sickened nearly 340 students at the University of Guelph in Canada.

Hand sanitation stations and informational posters were stationed at the entrance to a residence hall cafeteria, where the potential for cross-contamination was high. The researchers observed that even during a high-profile outbreak, students followed recommended hand hygiene procedures just 17 percent of the time. In a self-reported survey after the outbreak had subsided, 83 of 100 students surveyed said they always followed proper hand hygiene but estimated that less than half of their peers did the same.

The results appear in the September issue of the Journal of Environmental Health.

Powell said that in addition to providing the basic tools for hand washing – vigorous running water, soap and paper towels — college students, especially those living in residence halls, need a variety of messages and media continually encouraging them to practice good hand hygiene.

"Telling people to wash their hands or posting signs that say, 'Wash your hands' isn’t enough," said Ben Chapman, an assistant professor at North Carolina State University. "Public health officials need to be creative with their communication methods and messages."

Most students surveyed perceived at least one barrier to following recommended hand hygiene procedures. More than 90 percent cited the lack of soap, paper towels or hand sanitizer. Additional perceived barriers were the notion that hand washing causes irritation and dryness, along with just being lazy and forgetful about hand washing. Fewer than 7 percent said a lack of knowledge of the recommended hand hygiene procedures was a barrier.

"Providing more facts is not going to get students to wash their hands," Powell said. "Compelling messages using a variety of media – text messages, Facebook and traditional posters with surprising images — may increase hand washing rates and ultimately lead to fewer sick people."

University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they do and what they actually do
01.sep.09
Journal of Environmental Health Sept. issue 72(2): 24-28
Brae V. Surgeoner, MS, Benjamin J. Chapman, PhD, and Douglas A. Powell, PhD
http://www.neha.org/JEH/2009_abstracts.htm#University_Students%92_Hand_Hygiene_Practice_During_a_Gastrointestinal_Outbreak_in_Residence:_What_They_Say_They_DO_and_What_They_Actually_Do
Abstract
Published research on outbreaks of gastrointestinal illness has focused primarily on the results of epidemiological and clinical data collected postoutbreak; little research has been done on actual preventative practices during an outbreak. In this study, the authors observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak in a university residence in Ontario, Canada. Data on observed practices was compared to post-outbreak self-report surveys administered to students to examine their beliefs and perceptions about hand hygiene. Observed compliance with prescribed hand hygiene recommendations occurred 17.4% of the time. Despite knowledge of hand hygiene protocols and low compliance, 83.0% of students indicated that they practiced correct hand hygiene during the outbreak. To proactively prepare for future outbreaks, a current and thorough crisis communications and management strategy, targeted at a university student audience and supplemented with proper hand washing tools, should be enacted by residence administration.

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Amy is a French professor.  Her influence on me has been profound – and has even involved some language awareness stuff.

That’s why we have don’t eat poop shirts in French, Chinese and Spanish.

You’d figure that getting stuff translated into other languages would be a breeze, since I have an in with the department. But to do it in real-time is a bit messy. The first time I tried to upload a French infosheet, last week, I crashed the entire bites.ksu.edu site.

Damn you, France.

We’ve been messing around but are reasonably confident we’ve got the people and technology in place to at least translate food safety infosheets on a weekly basis. The Spanish food safety infosheets are available at http://bites.ksu.edu/infosheets-sp, and the French food safety infosheets are available at http://bites.ksu.edu/infosheets-fr.

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Linda Rivera (right, pic from Washington Post)  is the face of everything that is wrong with Food Safety Education month.

As The Washington Post reports this morning:

In Room 519 of Kindred Hospital, Linda Rivera can no longer speak.

Her mute state, punctuated only by groans, is the latest downturn in the swift collapse of her health that began in May when she curled up on her living room couch and nonchalantly ate several spoonfuls of the Nestlé cookie dough her family had been consuming for years. Federal health officials believe she is among 80 people in 31 states sickened by cookie dough contaminated with a deadly bacteria, E. coli O157:H7.

The impact of the infection has been especially severe for Rivera and nine other victims who developed a life-threatening complication known as hemolytic uremic syndrome. One, a 4-year-old girl from South Carolina, had a stroke and is partially paralyzed.

In a baffling waste of resources, groups like the International Food Information Council, have decided that food safety education month – that apparently starts today – is all about educating consumers with sanitized messages; that if consumers were only made aware they had a role to play in food safety, outbreaks related to contaminated peanut butter, produce and cookie dough would be reduced.

Whenever a group says the public needs to be educated – in this case about food safety -- that group has utterly failed to present a compelling case for their cause. 

I cringe, and remember a Lewis Lapham column I read in Harper’s magazine in the mid-1980s about how individuals can choose to educate themselves about all sorts of interesting things, but the idea of educating someone is doomed to failure. Oh, and it’s sorta arrogant to state that others need to be educated; to imply that if only you understood the world as I understand the world, we would agree and dissent would be minimized.


Given all the outbreaks – produce, pet food, peanut butter, that have nothing to do with consumers, any food safety information – not education -- campaign should include what the World Heath Organization has been advocating since 2002: source food from safe sources. An evaluation of message effectiveness should also be a bare minimum and rarely happens.

An honest Food Safety Education month would include food safety stories, tragic or otherwise, and a rigorous evaluation of what has worked, what hasn’t worked and what can be improved, rather than a checklist of ineffective and often inaccurate food safety instructions with the cumulative effect of blaming consumers. Telling people to wash their hands isn’t keeping the piss out of meals.

But judge for yourselves in what I am sure is a completely spontaneous and unscripted video from IFIC on why ordinary consumers feel they should be doing more.
 

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Early on in the Aug. 2008 outbreak of listeria that killed 22 Canadians, the manufacturer, Maple Leaf Foods, adopted the line that, listeria is everywhere.

CEO Micheal McCain said,

“All food plants and supermarkets have some amount of listeria.”

Yesterday, when Maple Leaf announced yet another recall of product – this time involving nine wiener products produced under the Hygrade, Shopsy's and Maple Leaf brands produced at its plant in Hamilton, Ontario – the listeria is everywhere line was … everywhere.

Randy Huffman of Maple Leaf said in the company blog yesterday,

“Listeria is a common bacteria – it can be in virtually 100% of refrigerated food plants. It also exists at low levels in one out of every 200 ready-to-eat food products and even higher levels in many other foods we eat …

“This creates a real dilemma for us. I have to be frank with you. Nothing we can do – nothing anyone can do – will completely eliminate Listeria from the food supply. Listeria is found in about 0.5% of ready-to-eat meat and poultry products based upon best estimates from the USDA. This percentage means that one out of every 200 packages is likely to be positive. I know consumers might prefer that this number was zero, and food safety professionals certainly strive for this goal.”

I thought you were Randy, but if you’d rather be frank, sure. And this is a Canadian recall, you may want to explain what USDA is.

Both Huffman and Mansel Griffiths, professor in the food science department at the University of Guelph, invoked the consumer-wants-zero-risk although I’ve seen no evidence to back up this straw-person argument. Griffiths said,
 
“There's no such thing as 100-per-cent safe foods, no matter what food we eat.”

No one asked for risk-free food; but consumers do expect that those in charge of whatever portion of the farm-to-fork food safety system take responsibility for their own actions. Me, I told the Toronto Star the risk is that the listeria contamination could have happened after processing, and people, especially kids, eat wieners out of the fridge without reheating.

Back to the issue: if listeria is everywhere, what should processors and retailers do about it?

• Warning labels. Pregnant women and other at-risk populations should be informed of listeria risks, using a variety of messages and a variety of media. The supermarket Publix places all of its deli-cut meats into a plastic bag that says:

“The Publix Deli is committed to the highest quality fresh cold cuts & cheeses


Therefore we recommend all cold cuts are best if used within three days of purchase


And all cheese items are best if used within four days of purchase”

• Make listeria testing data public.

• Market food safety efforts at retail.

Because listeria is everywhere.
 

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Chuck Dodd is dreamy – as a student, that is.

What teacher wouldn’t be proud when a student does a class assignment, and it eventually gets published in a peer-reviewed journal?

Chuck took my graduate course, Food Safety Risk Analysis, in the early part of 2008. For the final assignment, students are required to take a food safety risk issue of their choosing, and develop a risk analysis report for an audience, like a regulatory agency, integrating risk assessment, management and communication.

Chuck’s report – after editing and thoughtful comments from colleagues – was recently published in Foodborne Pathogens and Disease, entitled, Regulatory management and communication of risks associated with Eschericia coli O157:H7 in ground beef.

The Kansas State University press release that went out this morning says, in part,

What consumers may not be finding out about recalls and the inspection process, however, could make them doubt the effectiveness of what is actually a pretty good system to keep food safe, according to Kansas State University researchers.

Charles Dodd, K-State doctoral student in food science, Wamego, and Doug Powell, K-State associate professor of food safety, published a paper in the journal Foodborne Pathogens and Disease about how one government agency communicates risk about deadly bacteria like E. coli O157 in ground beef.

Publications, Web pages and recalls are all used in this risk communication.

Dodd said that although the Food Safety and Inspection Service generally does a good job of keeping meat safe, it's easy for consumers to think the opposite, particularly when a recall tells them that the food in the fridge or pantry may be dangerous. In their study, Dodd and Powell looked at what information consumers can take away from the Food Safety and Inspection Service's Web site, and suggest government agencies can more clearly communicate their role in keeping the food supply safe.

"We as Americans tend to expect more from regulatory agencies than we should, so we set ourselves up for disappointment," Dodd said. "Occasionally, regulatory agencies may create unrealistic expectations by the way they communicate with the public. The message of our paper is to say that the Food Safety and Inspection Service is doing a good job, considering the amount of resources it has. We are trying to open up dialogue about how its role could be communicated more effectively." …

Testing is just one tool that the Food Safety and Inspection Service uses. Its role is to monitor what other stakeholders are doing to keep food safe. "As a regulatory agency, the Food Safety and Inspection Service is monitoring food safety, not necessarily testing it themselves," Dodd said. "I think that's what a lot of us consumers misinterpret. We need to remember that regulatory agencies allocate, not assume, responsibility."

He got an A in the class. And he collects his own cow pies for sampling (left).

Dodd, C.C. and Powell, D.A. 2009. Regulatory management and communication of risks associated with Eschericia coli O157:H7 in ground beef. Foodborne Pathogens and Disease, 6(6): 743-747.

Abstract

Foodborne illness outbreaks and ground beef recalls associated with Escherichia coli O157:H7 have generated substantial consumer risk awareness. Although this risk has been assessed and managed according to federal regulation, communication strategies may hamper stakeholder perception of regulatory efforts in the face of continued E. coli O157:H7 outbreaks associated with ground beef. To mitigate the risk of E. coli O157:H7 contamination in ground beef, the beef industry employs preharvest and postharvest interventions, while the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) provides regulatory oversight. Policy makers must understand and clearly express that regulation allocates, not assumes, responsibility. The FSIS role may be poorly communicated, leading consumers, retailers, and others in the farm-to-fork food safety system to misrepresent risks and creating unrealistic expectations of regulatory responsibility. To improve this risk communication, revisions may be needed in FSIS-related documents, Web pages, peer-reviewed publications, and recall announcements.

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Beginning in Aug. 2008, an outbreak of listeriosis linked to Maple Leaf deli meats was identified in Canada; 22 people would eventually die and at least 53 sickened.

In addition to the already available myriad of reports and testimonials comes the 181-page final report of Sheila Weatherill (right, exactly as shown) who was appointed directly by the Canadian Prime Minister.

The Investigation identified four broad categories where improvements need to be made. There must be:

-  more focus on food safety among senior officials in both the public and private sectors;

-  better preparedness for dealing with a serious foodborne illness with more advance planning for an emergency response;

-  a greater sense of urgency if another foodborne emergency occurs; and,

-  clearer communications with the Canadian public about listeriosis and
other foodborne illnesses, especially at risk populations and health professionals.

zzzzzzzzzzzzzzzzzzzzzz

After in-depth analysis and advice from food safety and public health experts, the Weatherill made 57 recommendations for improvements to Canada's food safety system. The recommendations address:

-  the safety culture of food processing companies;
-  the design of food processing equipment;
-  government rules and requirements for food safety;
-  the need for food service providers to adopt food safety practices aimed at vulnerable populations; and
-  government's capacity to manage national foodborne illness emergencies.

zzzzzzzzzzzzzzzzzzzzzzzzzz

Weatherill had a five-person advisory committee of food safety types including Bruce Tompkin, Mansel Griffiths and Michael Doyle. The full report is included below, but is painfully slow to scroll through, so these comments are based on a cursory reading; more details to follow. I did however find that Weatherill recommended precautionary labeling – warning labels – for vulnerable populations like pregnant women and old people. That’s a start.

Who knew what when?
The report presents a timeline of the listeria outbreak, but offers little in the way of analysis. In the past the Canadian Food Inspection Agency has placed import holds on fresh produce based on epidemiological and test results conducted in the U.S. But in the listeria outbreak of 2008 (if that’s what it’s going to be called) somehow, epidemiology and positive test results from an opened package of Maple Leaf deli meat weren’t sufficient to trigger a public health warning; CFIA argued the dead-or-dying person could have contaminated the unopened package of deli-meat, so they waited until the same DNA fingerprint was found in an unopened package, another three days of inaction. So why the different standards of proof for foreign and domestic foods? What exactly is CFIA’s policy on going public? CFIA could just publish something, rather than risk a full public inquiry to get answers; CFIA bureaucrats could just be accountable to the folks that pay their salaries.

The report also talks about the need to educate Canadians about listeria and food safety. I prefer inform to the indoctrination of education, but don’t let government types do it. David Butler-Jones (below, left), Canada’s chief medical officer of health, told Canadians at the height of the listeria outbreak,

“There are the usual things we should always be doing, like washing hands, storing and cooking food properly, washing fruits and vegetables well, and avoiding unpasteurized milk and milk products…”

No idea what this has to do with listeria and ready-to-eat foods.

Also, why long-term care facilities were feeding cold-cuts to a vulnerable population is baffling – unless food safety really isn’t taken seriously by all kinds of groups (gasp).

Finally, contrary to the complete bullshit statements of various politicians and bureaucrats in the early days of the outbreak, the system did not work.

Robert Clarke, the assistant deputy minister of the Public Health Agency of Canada, said Aug. 22, 2008, that the government's actions in this case were quite rapid and an illustration of success.



“I'm glad we got hold of it early and now we'll take serious steps working with the feds to put it behind us."



It was a disaster I’m sure you’d want to put in the past.

The issues raised are not going anywhere. And Maple Leaf, why wait for more government reports? Put warning labels on your products, make listeria test results public, and market your food safety efforts directly to consumers.

listeria.cdn.final.report.jul.09.pdf

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The Canadian politicians investigating last year’s listeria outbreak that killed 22 were so frustrated by the lack of information from the Canadian Food Inspection Agency and the Public Health Agency of Canada they have demanded a full public inquiry.

The Globe and Mail reports this morning that a report to be released Thursday will conclude that the two-month parliamentary study was unable to gather enough evidence to get to the bottom of the outbreak. The call for a public inquiry represents a rebuke to the government's own investigation into the issue led by Sheila Weatherill, who will release a report this summer.

The committee report will also call for an overhaul of the Public Health Agency of Canada so that it becomes more of an independent health watchdog. The committee further recommends that inspection reports at food processing plants be released to the public.

And since CFIA and others are stonewalling, what with their “we went public when we had hard scientific proof” and epidemiology-is –for-wusses line, we’ve put together a timeline that should help the investigators in their, uh, investigation.


Chronology of testing events prior to the August 17, 2008 public alert of possible contamination of Maple Leaf Foods’ deli meats by L. monocytogenes

And it took the Public Health Agency of Canada until Aug. 23, 2008, before they made a definitive link and then Michael McCain of Maple Leaf Foods went on his award-winning rendition of remorse.




 

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The feds failed miserably during the Aug. 2008 outbreak of listeria that claimed 21 lives across Canada but the province of Ontario handled the outbreak well and that, "compared to other outbreaks, experts will say this went amazingly fast.”

I have no idea who these experts are that Ontario's Chief Medical Officer of Health, Dr. David Williams, said would endorse the response to the outbreak other than other bureaucrats and politicians who were quick to praise themselves in the early days of the outbreak. And while media accounts are focusing on the bureaucrat blame game, they’re giving the Williams report little more that a fawning glance.

The good news is that the report has a basic timeline of who knew what when, at least from the perspective of Ontario bureaucrats.  By Aug. 1, 2008, the Ontario “Public Health Division identifies 16 cases of listeriosis in the month of July: the majority were in elderly people who had been in a long-term care home or hospital.”

By Aug. 4, 2008, the Listeria Reference Lab confirms that three food samples from Toronto long-term care home – all opened 1 kg packages of meat cold cuts – are positive for Listeria.

Yet the first public warning didn’t happen until the early hours of Sunday, Aug. 17, 2008.

This is the bad news. Other questions are simply ignored in the report -- like what are long-term care facilities doing serving cold-cuts to the immunocompromised elderly? Should there be warning labels or additional information provided to others at risk, such as pregnant woman? Why aren’t listeria test results made public?

The report does say the medical officer of health for Canada was missing in action during the outbreak, and that the Canadian Food Inspection Agency hampered the overall investigation.
 

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Every time the U.S. Food and Drug Administration issues a public advisory about some food product, the armchair critics pounce.

This time it’s pistachios. On March 30, FDA issued a blanket warning for folks not to eat pistachios or products containing pistachios until further details emerged. The nut industry went … nuts. Perishable Pundit Jim Prevor did his bit about how regulators and others could be sure the contamination went back to the pistachio plant. Several journalists asked me about the economic burden of such a recall, especially since there were no confirmed illnesses. I told CBS Radio that if industry wanted an economically prudent plan, industry should keep Salmonella out of pistachios.

The other aspect is that, given the public and government scrutiny of FDA, there is probably something going on – something is not quite right at the farm or processing plant or wherever – for FDA to issue a blanket warning. FDA just doesn’t have all the details yet.

Here are some details:

Elizabeth Weise of USA Today is reporting this morning that Setton Pistachio, the company that recalled 2 million pounds of pistachios on Monday, had been receiving positive salmonella tests for as long as five months.

David Acheson, FDA associate commissioner, said,

"The question is, 'Did Setton Farms have an ongoing problem, and what did they do about it?' "

The FDA believes batches of pistachios that tested positive for salmonella were destroyed, not distributed. Setton Pistachio spokeswoman Fabia D'Arienzo could not confirm that.

Almond Princess Linda Harris, an expert on salmonella in nuts at the University of California-Davis, said,

"If I'm getting a positive (result) and a couple of months later another positive, and then another, I would think the appropriate response would be to say, 'This is not right. I've got to figure this out.' "

Kraft spokeswoman Susan Davison said Kraft sent an internal food-safety auditing team to Setton Farms’ Terra Bella plant on March 23 and,

"They saw the potential for cross-contamination" between raw and processed pistachios. “For example, often in companies different colored gloves are used for the raw area and the roasted area." However at the Setton plant, the same colored gloves were used in both areas.
 

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Last week I dusted off some old slides to talk with an industry group about best practices in food safety. I got bored of hearing myself say the same thing about 10 years ago, but sometimes, it’s best to stick to basics.

Risk analysis is composed of risk assessment, management and communication. Over the years I’ve studied dozens of outbreaks of foodborne illness and concluded that a producer, or processor, or retailer needs to be excellent at all three—assessment, management and communication – and if they fail at just one, they will suffer the economic and associated hardships.

There is no doubt that Michael McCain and Maple Leaf Foods has practiced excellent risk communication since being fingered as the source of a listeria outbreak in Canada that killed at least 20 and sickened 60. I’ve said so from the beginning. I’ve also said that

it is impossible to judge whether Maple Leaf was practicing good risk management and assessment because no one will come clean on who knew what when as the outbreak was developing.

But that hasn’t stopped Canadians from gushing in a blindly patriotic way about how McCain set the ‘gold standard’ for reputational and financial management.

Maybe, but communications alone is never enough, just like science alone is never enough. And precisely because no one – government or industry – has come clean on who knew what when, it’s not surprising to hear

the Canadian federal government has delayed for months the release of notes on conference calls

held at the height of last summer's deadly listeriosis outbreak — a lag some experts say breaks Ottawa's own information laws.

At issue is an Access to Information request by The Canadian Press to the Privy Council Office for “all transcripts and minutes” of the crucial exchanges last August and September.

The Odwalla 1996 outbreak of E. coli O157:H7 in unpasteurized juice was also textbook risk communication, but the company was eventually revealed to have cut corners and ignored warning signs. Will Maple Leaf undergo similar scrutiny?

Below is an except from my 1997 book, Mad Cows and Mother’s Milk, about the Odwalla outbreak.

Sometime in late September 1996, 16-month-old Anna Gimmestad of Denver has a glass of Smoothie juice manufactured by  Odwalla Inc. After her parents noticed bloody diarrhea, Anna was admitted to Children’s Hospital on Oct. 16.  On 8 November 1996 she died after going into cardiac and respiratory arrest.  Anna had severe kidney problems, related to hemolytic uremic syndrome and her heart had stopped several times in previous days.

The juice Anna — and 65 others who got sick — drank was contaminated with E. coli O157:H7, linked to fresh, unpasteurized apple cider used as a base in the juices manufactured by Odwalla.  Because they are unpasteurized, Odwalla’s drinks are shipped in cold storage and have only a two-week shelf life.  Odwalla was founded 16 years ago on the premise that fresh, natural fruit juices nourish the spirit.  And the bank balance: in fiscal 1996, Odwalla sales jumped 65 per cent to $60 million (U.S.).  Company chairman Greg Steltenpohl has told reporters that the company did not routinely test for E. coli because it was advised by industry experts that the acid level in the apple juice was sufficient to kill the bug.

Who these industry experts are remains a mystery.  Odwalla insists the experts were the U.S. Food and Drug Administration.  The FDA isn’t sure who was warned and when.   In addition to all the academic research and media coverage concerning VTEC cited above — even all of the stories involving VTEC surviving in acidic environments — Odwalla claims ignorance.

In terms of crisis management — and outbreaks of foodborne illness are increasingly contributing to the case study literature on crisis management — Odwalla responded appropriately.  Company officials responded in a timely and compassionate fashion, initiating a complete recall and co-operating with authorities after a link was first made on Oct. 30 between their juice and illness.  They issued timely and comprehensive press statements, and even opened a web site containing background information on both the company and E. coli O157:H7.  Upon learning of Anna’s death, Steltenpohl issued a statement which said, “On behalf of myself and the people at Odwalla, I want to say how deeply saddened and sorry we are to learn of the loss of this child.  Our hearts go out to the family and our primary concern at this moment is to see that we are doing everything we can to help them.”

For Odwalla, or any food firm to say it had no knowledge that E. coli O157 could survive in an acid environment is unacceptable.  When one of us called this $60-million-a-year-company with the great public relations, to ask why they didn’t know that E. coli O157 was a risk in cider, it took over a day to return the call.   That’s a long time in crisis-management time.  More galling was that the company spokeswoman said she had received my message, but that her phone mysteriously couldn’t call Canada that day.

Great public relations; lousy management.  What this outbreak, along with cyclospora in fresh fruit in the spring of 1996 and dozens of others, demonstrates is that, vigilance, from farm to fork, is a mandatory requirement in a global food system.  Risk assessment, management and communication must be interlinked to accommodate new scientific and public information.  And that includes those funky and natural fruit juices.

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The Maple Leaf makeover continued this week – a promotional video, settling all lawsuits for $27 million – yet some lingering questions remain. And neither Maple Leaf nor the Canadian Food Inspection Agency is rushing to answer the hard questions:

• who knew what when;

• why won’t Maple Leaf make their listeria test results public; and,



• what is Maple Leaf Food's advice to those folks vulnerable to listeria.



Rob Cribb of the Toronto Star reports today that thousands of pages of documents detailing the federal government's handling of this summer's listeria outbreak are being withheld.

The Star and the CBC are seeking the records, which include emails sent between officials with the Canadian Food Inspection Agency (CFIA), Maple Leaf Foods and the City of Toronto, through an access to information request.

The CFIA has imposed extensions of a year or more on top of the normal 30-day deadline for responding to such requests.

The joint investigation used the federal access to information law in the hope that a request would yield records showing what went wrong, when officials first knew of the outbreak's potential impact and how quickly the system kicked in to protect Canadians.

None of the records first requested four months ago have been released.

Repeated requests for an interview with Federal Agriculture Minister Gerry Ritz have been denied.

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I'm a self-described food safety nerd. I don't hide from this obsession, I embrace it.  But my fixation on everything food safety has led to much stress lately -- for the past 9 months my food safety spidey-sense has been heightened more than normal as Dani and I have been expecting a baby.

And he finally arrived last week.

Our little dude, Jack Neil Chapman, showed up Friday morning at 4:11am (Yes, the Neil part is named after the greatest Canadian singer/songwriter, Neil Young -- I'll fight anyone who disagrees, Ari Gold style, http://www.youtube.com/watch?v=QGVoLsDS3t8&e)

Throughout Dani's pregnancy I became the food police in our house -- no soft cheeses or cold deli meats made it to Dani's plate, most didn't even make it in the house. Everything (and I mean everything) has been temped during cooking. I read pretty well every paper I could on listeria, and Doug and I discussed the merits of broad food surveys and listeria growth in blue-veined cheese. It was a bit ridiculous, but I hear that first time parents sometimes can be obsessive.

During the recent Canadian listeria outbreaks I selfishly felt vindicated for keeping the products out of our house -- our view was that no matter what type of food safety system food processors had, we weren't taking the risk. Maple Leaf is a huge company that can afford lots of food safety controls, spoke about their commitment to food safety, and even used the food safety culture term Doug and I are so fond of. But 18 people have so far died from listeria in their products.

When I held Jack for the first time, about 30 seconds after he was born, I first thought "Wow, you're tiny and light, and you don't smell as manky as I had thought you would" and soon after I thought about the parents, people just like us, who have been recently affected by listeria.  The victims include at least one miscarriage and  six babies born prematurely in Quebec resulting from the consumption of soft cheeses. A 6-week old Manitoba infant born with a listeria, not linked to either Maple Leaf or Quebec soft cheeses outbreak, also died last week. Those are the ones we know about.

And then I realized that, although I thought I did a great job managing risks in our house, I and the rest of the food safety world have probably failed many out there who haven't reduced risks.  Not the individuals who made the choice to eat risky foods, but the parents who have never heard about listeria, the ones who ate risky foods without knowing that listeria is 20 times more likely to infect pregnant women or that listeria infections during preganancy are likely to cause miscarriages or stillbirth.   Who knows what effect our risk-reduction practices had on Dani's pregnancy. Maybe things would have been fine without being so strict, but we weren't interested in taking the chance.

I'm all about informed decisions around risk. I even think there is a place for raw milk consumption for adults.  But we had the info to make the decisions.  Info that came from a variety of places (for us it was primary resources, outbreak reports and review papers). Other parents rely on food safety professionals, like the health authorities, for info.

Last weekend was all about Jack, and I didn't get back into reading FSNet until yesterday morning (I'm getting quite good at holding him and reading emails at the same time) and I came across Canada’s Chief Public Health Officer, Dr. David Butler-Jones’ advice concerning listeria, including the below:
*Wash your hands. This will help avoid many kinds of infections. Wash your hands in warm soapy water before preparing food, afterwards, and again before eating.
*Read labels and follow cooking and storage instructions for all foods. Make sure to check the “best before” date.
*Freeze or consume leftovers within four days of cooking. Always reheat leftovers until steaming hot before eating.
*Keep refrigerators clean and at a temperature below 4 C, or 40 F. Listeria can grow in the fridge, but the colder it is, the slower it grows. Install a thermometer in your fridge to be sure.
Those tips apply to all of us, all the time, and not just during an outbreak.

There are so many holes in his list of advice, many have nothing to do with listeria, and I don't think there is evidence that supports many of his statements. Following the list of consumer blames, Butler-Jones did get into listeria with feel-good language: "For seniors, pregnant women, and those with weakened immune systems, or for those serving or caring for anyone in these groups, some extra precautions are very important as [various] foods pose some risk."  He ended his advice with "these steps form a simple approach to food safety."

The most important message missing from his list was: Don't eat this stuff unless you are cool with the risks.

I sent an email to Doug (the subject line was "what a f*ing joke"), saying where was Dr. Butler-Jones when the outbreak was announced a month ago.  Did it really take a month for his staff to wake up and get some info out there?  A question echoed in the upcoming Canadian Medical Association Journal which says that the Public Health Agency of Canada should be the primary source of information for the public during a crisis and that Canada's chief public health officer has not been the lead voice to inform the public.

So I guess my preachy message is along the lines of don't eat poop (especially baby poop, though Jack's hasn't started to smell yet).We need to do a better job of creating a dialogue around food safety risks with specific target audiences -- especially those at higher risk for foodborne illnesses.  And though the bureaucrats talk a lot, they need to be the real leaders in information -- and forget about the fuzzy language that will make the minister happy.  Tell people to stay away from the risky stuff.
 

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