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

I started FSnet, the food safety news, shortly after the Jack-in-the-Box outbreak in Jan. 1993. Sure, Al Gore hadn’t invented the Internet yet, but those of us in universities had access, and I started distributing food safety stories.

It all seems sorta quaint now, what with Google alerts and blogs and RSS feeds, but my goal was straightforward: during the Jack-in-the-Box outbreak, a number of spokesthingies said, they didn’t know E. coli O157:H7 was a risk, they didn’t know that Washington State had raised its recommended final cooking temperature for ground beef, they didn’t know what was going on.

So FSnet was conceived and made widely available so that no one could legitimately say, they didn’t know.

Yet that’s exactly what federal bureaucrats in Canada said last night when questioned about the delay in warning those in southwestern Ontario that lettuce from Aunt Mid’s in Detroit, implicated in a large Michigan-based E. coli O57:H7 outbreak that has stricken at least 34, had made its way across the border.

And now at least two people in Ontario have tested positive for the same strain of E. coli O57:H7.

David Musyj, president and chief executive officer of the Windsor (Ontario) Regional Hospital, said last night that authorities in Michigan issued a public-health alert about the link to Aunt Mid’s iceberg on Friday, Sept. 26, 2008, but the Canadian Food Inspection Agency didn’t bother notifying Windsor health officials until Wednesday, Oct. 1, 2008.

"What happened between Sept. 26 and Oct. 1? Clearly there is a communication gap that occurred. I want an investigation to be launched into this to find out why there was a communication gap, whether it was our CFIA or whether it was the State of Michigan."

Dustin Pike, a spokesman for Agriculture Minister Gerry Ritz, said in an e-mail yesterday that the Public Health Agency of Canada notified the CFIA of the E. coli outbreak in Michigan potentially linked to the lettuce on Tuesday, and after determining that the product had been imported into Canada, the CFIA contacted Windsor health authorities the following morning. …

Davendra Sharma, a food-safety recall specialist at the CFIA, said the agency acted promptly when it heard of the outbreak to identify who in Canada purchased the product and to notify Windsor officials.

Again, I started FSnet all those years ago so bureaucrats and others couldn’t say, I didn’t know.

The Michigan outbreak was first publicly reported on Sept. 16, 2008. Lettuce was identified as the primary suspect on Friday, Sept. 26 2008. Why it took until Tuesday, Sept. 30, 2008 for someone at Health Canada, the Public Health Agency of Canada or the Canadian Food Inspection Agency to notice there was an outbreak next door in product that could be shipped to Canada is baffling.

Especially because of all the bureaucrats that read FSnet. According to tonight’s numbers, 27 people at PHAC, 149 people at Health Canada, and 316 people at CFIA receive FSnet. That’s almost 500 people, and no one noticed?

Tonight, test results have, unfortunately, revealed that two cases of E. coli O157:H7 in Chatham-Kent, Ontario, are of the same strain identified in 38 cases in the United States. All of the cases are thought to be linked to shredded iceberg lettuce distributed by Aunt Mid's Produce Company. This product is distributed in five pound industrial bags to institutions such as hospitals and long-term care homes, as well as restaurants in southwestern Ontario.

Musyj of the Windsor hospital captures the failings of CFIA when he says:

"Once something is thought of seriously enough to raise a red flag, then you better call everyone affected by the red flag. You can't wait for a death to happen to notify everyone."

Although that seems to have been the CFIA policy with listeria: with 20 dead and counting, it’s a bad policy.

CFIA, what is your policy on going public with information that can prevent illness? Is your primary priority to protect public health? If so, can you provide evidence to back such a claim? 

And how can any of you say you didn’t know?

Oh, and for those who see salvation in a single food inspection agency, as is often discussed in the U.S., please notice the dysfunctional mess that is CFIA.
 

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On the same day that congressional investigators cited shoddy oversight of produce processing operations, wholesale, bagged iceberg lettuce appears to be the culprit in the Michigan E. coli O157:H7 outbreak that has sickened at least 26 people.

“Some of the 26 Michigan cases consumed shredded or chopped iceberg lettuce in restaurants or institutions purchased from Aunt Mid’s Produce Company, a Detroit-based wholesale distributor; and other distributing outlets could be identified. Product trace back and additional tests results are still in progress.

“Our top priority at the Michigan Department of Community Health is to protect the public,” said Dr. Gregory Holzman, chief medical executive for MDCH. “We appreciate all of the assistance from Aunt Mid’s. They have been very helpful in this investigation. We want to ensure that the public’s health and well-being is protected. Even though the investigation is ongoing, available evidence is strongly pointing to iceberg lettuce.”

Wouldn’t it be nice if just one public health official in Canada had a similar statement – our top priority is to protect public health – during the listeria outbreak that has killed at least 18?

Although I do have some concerns about statements from Michigan State University physician Beth Alexander, who tonight said,

“We will continue to be as cautious as possible, until this issue is completely resolved.”

This is the same MSU physician Beth Alexander who said on Sept 16, 2008,

“Generally, the infection isn’t serious. It’s usually caused by food or water that has been contaminated with that bacteria.”

The eight MSU students who were hospitalized probably thought it was serious.

Further, a press release from MSU tonight said,

“The one food item typically associated with E. coli outbreaks is undercooked hamburger. Health officials advise all chefs to cook their hamburgers until the juice runs clear.”

I’m not sure what that has to do with lettuce. And color is a lousy indicator for judging whether meat is done or not – a digital, tip-sensitive thermometer is a must. Cooking until the juices run clear seems reckless rather than cautious.

Alexander also stressed that thorough hand washing remains the most effective way of fighting communicable diseases, and,
 
“Always wash your hands before preparing any foods. Make sure your countertops are clean and don’t do any food preparation if you are sick.”

Again, I’m not sure what this has to do with lettuce. Doesn’t instill a lot of confidence in the ability of MSU food service to provide safe food – no matter how much Spartan spirit they have. Maybe MSU should be examining their food procurement policies. If this is what a top-10 land grant university produces, maybe those rankings don’t mean too much.

A table of at least 28 previous North American outbreaks of shiga-toxin producing E. coli, like O157:H7, is available at:
 
http://foodsafety.ksu.edu/en/article-details.php?a=3&c=32&sc=419&id=903
 

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While Nebraska Beef was busy telling church ladies they didn’t know how to safely prepare food, and telling Americans, including 50 really sick ones, that their meat had never been linked with illness, the U.S. Department of Agriculture was busy telling Nebraska Beef they didn’t know shit.

Or at least how to reduce it in Nebraska Beef products.

USDA just announced that Nebraska Beef, Ltd., an Omaha, Neb., establishment is expanding its June 30 recall to include all beef manufacturing trimmings and other products intended for use in raw ground beef produced between May 16 and June 26, totaling approximately 5.3 million pounds, that may be contaminated with E. coli O157:H7.

“FSIS has concluded that the production practices employed by Nebraska Beef, Ltd. are insufficient to effectively control E. coli O157:H7 in their beef products that are intended for grinding. The products subject to recall may have been produced under insanitary conditions.”

That’s insane. Or unsane. And why thermometers and cleanliness are a must at retail, food service and the home, cause companies like Nebraska Beef would rather blame consumers than take care of their own shop.

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Andrew Schneider
 of the Seattle P-I, writes in a decent raw milk piece  this morning that consumers almost always link arms with government public health agencies banning the sale of food believed to contain dangerous pathogens. But that spirit appears to vaporize when the consumable is raw milk. Below are some excerpts:

“Although the number of cases nationwide is low, contaminated raw milk can contain a strain of E. coli that sometimes causes hemolytic uremic syndrome, a life-threatening complication that can cause kidney failure and death.

It took a 2005 outbreak of E. coli in raw milk that sickened 18 people in Washington and Oregon and put two children on life support to get all the players -- the dairy and raw milk communities, lawmakers, the state agriculture and health departments -- together to try to figure out what to do, Gordon said.

Last week, the owners of the dairy that sold the tainted milk, Michael and Anita Puckett, pleaded guilty in federal court in Seattle to the charge of distributing adulterated food.

Claudia Coles, food safety manager for the state Department of Agriculture, agreed that something had to done, that "in these outbreaks, it is almost always the children that become the victims."

The state's options for trying to control the sale of raw milk products were limited. In other states where it was banned completely, a black market flourished. So the question facing regulators is whether public health is better protected by regulating, testing, licensing and inspecting the raw milk or just by banning it so it goes underground with no oversight.

Doug Powell says he's not surprised that government health officials denounce the dangers of raw milk then turn around and license the sale of the same milk.

"In part, it's because of the almost evangelical way people talk about raw milk and that America is founded on consumer choice," said the associate professor of food safety at Kansas State University.

"The numbers of illnesses from outbreaks caused by unpasteurized milk are not that high. You could very easily make the cases that 'Wow, maybe tomatoes should be regulated a whole lot more than we do now because the numbers of cases of salmonella saintpaul are up to 550 now,' " said Powell, who is also scientific director for the International Food Safety Network.

"I don't care if people drink raw milk. What I'm particularly concerned about is them then imposing their choice on their kids, because they're the ones who get sick. People have the right to sell a product, but if it makes people sick, they have a right to sue."

Seattle food safety lawyer Bill Marler is up to his neck in many of those lawsuits. He grew up drinking raw milk on the farm "because that's what my dad wanted us to do," he said. He has tried injury suits stemming from most of Washington's raw milk outbreaks and is now handling similar cases in California and Missouri.

"The entire raw milk debate is so emotionally charged that there's no common ground at all," Marler said. "The reality is if you poison a little child by selling a product that could easily be pasteurized, you're going to have to deal with the legal issues surrounding that," he said.

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Seriously, I'm getting tired of using this picture. But I'm not running out of opportunities.

The Washington State Department of Health said today that  nine confirmed cases of E. coli infection found in Thurston and Pierce counties have been traced to romaine lettuce and a tenth case may be linked but was not tested.

Health Department spokesman Tim Church says five of the victims were hospitalized, but all have been released.

The U.S. Food and Drug Administration is tracing the source of the contaminated lettuce.



A table of known outbreaks of verotoxigenic E. coli -- including but not limited to E. coli O157:H7 -- associated with fresh spinach and lettuce is available at http://foodsafety.ksu.edu/en/article-details.php?a=3&c=32&sc=419&id=903.


UPDATE: The Department of Health says nine confirmed cases of E.coli infection found in north Thurston and south Pierce counties have been traced to bagged, commercial romaine lettuce.

Health officials say it's not the same type of lettuce you would buy in a grocery store.

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The families of the E. coli victims in the 2005 outbreak in Wales believe the public officials charged with protecting their families failed in their duty, but that butcher William Tudor “motivated by greed and profit bears the principal responsibility for the outbreak."

Bridgend County Council responded by saying it made a "reasonable" decision to allow William Tudor, the Butcher of Wales,  to use one vacuum-packing machine for both cooked and uncooked meat and that the rules on the issue were "unclear."

The BBC reports that Bridgend council do accept that there were deficiencies in the way its officers worked with the factory to introduce a hazard assessment plan, but it says that the government had intended the scheme to be introduced on a "softly softly" basis.

It also says that Mr Tudor's "undoubted attempts at deceit" gave their officers the impression that he was a "competent and informed food operator."

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Sharon Mills, 33, whose five-year-old son Mason Jones died in 2005 after contracting E. coli O157, told the public inquiry in Wales today that she was devastated when she learned he had the bug.

In her statement to the inquiry, Ms Mills said,

"When Mason was hallucinating he said to me, 'Mamma, I'm dying.' Mason had never been a child who had ever talked about death - his words therefore hit me for six. You could see it in Mason's eyes that when he said these words he meant what he was saying. That was the first time that I began to form a deep-rooted feeling that Mason could die. I tried to reassure him and talked about things like how many children he was going to have when he got older. I told him that the doctors and nurses were going to make him better. This night was the worst of my life. ...

"He was a beautiful child and I couldn't understand why this had happened. When Mason passed away I felt numb. I felt as if I were looking at someone else's child. I thought that it couldn't be Mason lying there. It was unreal. I felt that I was having a nightmare and that I couldn't wake up. I have felt like that ever since. Returning home without Mason felt as if my life had ended."

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Professor Hugh Pennington has become unstuck in time.

More like Bill Murray in Groundhog Day, than Billy Pilgrim.

In November 1996, over 400 fell ill and 21 were killed in Scotland by E. coli O157:H7 found in deli meats produced by family butchers John Barr & Son. The Butcher of Scotland, who had been in business for 28 years and who was previously awarded the title of Scottish Butcher of the Year, was using the same knives to handle raw and cooked meat. That's a food safety no-no.

In a 1997 inquiry, Prof. Pennington recommended, among other things, the physical separation, within premises and butcher shops, of raw and cooked meat products using separate counters, equipment and staff.

In the past two weeks, Prof. Pennington has heard in a new inquiry how John Tudor and Son, the Butcher of Wales, used the same machine to vacuum package both raw and cooked meats, leading to an E. coli O157:H7 outbreak beginning in Sept. 2005, which sickened some150 children in 44 schools in southern Wales and killed five-year-old Mason Jones.

How can the good professor awaken from this recurring national nightmare?

The inquiry into the 2005 outbreak, which began in Feb. 2008, is again chaired by Prof. Pennington and has again heard testimony highlighting gross managerial failures and shocking levels of complacency.

So far, the Butcher of Wales has been shown to have:

• encouraged staff suffering from stomach bugs and diarrhea to continue preparing meat for school dinners;
• known of cross-contamination between raw and cooked meats, but did nothing to prevent it;
• used the same packing in which raw meat had been delivered to subsequently store cooked product;
• operated a processing facility that contained a filthy meat slicer, cluttered and dirty chopping areas, and meat more than two years out of date piled in a freezer;
• a cleaning schedule at the factory that one expert called "a joke;"
• falsified crucial health and safety documents and lied about receiving hygiene awards; and,
• supplied schools with meat that was green, smelly and undercooked.

Professor Chris Griffith, head of the food research and consultancy unit at the University of Wales Institute, Cardiff, told the inquiry the culture at the premises was “dominated by saving money.”
This would explain why Tudor retained his contract to supply schools: because he was the cheapest.

So who allowed Tudor to operate under such conditions?

Government inspectors.

(This is why I get substantially nervous when any food producer, such as California lettuce and spinach growers, says they meet inspection standards.)

Prof. Pennington has heard that Tudor and Son was visited several times in the months leading up to the Sept. 2005 outbreak, that inspectors knew there was only one vac-pac machine being used for both cooked and raw meats but, despite Pennington's 1997 recommendation, inspectors decided the business did not pose "an imminent risk" to human health.

A retired senior Food Standards Agency official, who now works as a freelance food safety consultant, told the inquiry that the use of a single vac-pak for both raw and cooked meat was “like playing Russian Roulette."

The official also chided inspectors for failing to note deficiencies in Tudor's written food safety plan and stated, rather bluntly, "There was a failure in the series of inspections to identify poor hygiene and working practices and a failure to take action."

The inspectors also took on "face value" explanations offered by Tudor and his staff for various food safety failures.

Buyers with the school boards were equally eager to look the other way to save a pound. One supervisor told the inquiry, “You have to have faith in people. You don’t expect them to make up stories about meat.”

Except that inspection and regulatory regimes for meat were created in Southern France in the 12th century precisely because people do make up stories about meat. Europe has almost 1,000 years of regulatory experience with shoddy food suppliers;  that experience was not applied in southern Wales in 2005. As a result, 5-year-old Mason Jones died a painful and unnecessary death. Dozens of kids were hospitalized and will suffer life-long effects.

The official purpose of the inquiry is to provide recommendations designed to prevent a similar outbreak happening again.

As Prof. Pennington knows, that was supposed to happen in 1997.

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That's the conclusion from an extensive feature in Men's Health on last year's increase in E. coli O157:H7 in the U.S.

Author Tom Groneberg quotes several folks with their theories for the increase.

Richard Raymond, M.D., the USDA's undersecretary for food safety, says,

"The amount of product we test that's positive has gone up about 33 percent this year from the past 3 years. I don't think it's that the agency has fallen asleep at the switch. I don't think it's that the industry has gotten sloppy. I think it's the cows."

Specifically, Dr. Raymond cites high corn prices for prompting a switch to cheaper feeds for fattening cattle. "When you change their feed, their intestinal flora change."

T.G. Nagaraja, Ph.D., a professor of microbiology at Kansas State University and the leader of a team of researchers targeting ways to decrease levels of E. coli in cattle before they reach the slaughterhouse, says,

"We found that cattle consuming distiller's grains as 25 percent of their diet had about a twofold higher incidence of E. coli O157:H7. Our observation is preliminary, but we've done three studies that show a positive association between this feed and increased levels of O157."

David Smith, D.V.M., Ph.D., a professor of veterinary and biomedical science at the University of Nebraska, says,

"One factor associated with cattle shedding the E. coli organism is wet and muddy pen conditions. I suspect the slaughterhouses may have had cattle arrive this summer with a higher probability of shedding E. coli, or the cattle had it present on their hides, which led to greater opportunities for ground-beef contamination than during droughts."

Michael Doyle, Ph.D., director of the center for food safety at the University of Georgia and one of the world's leading authorities on E. coli and other foodborne pathogens, says,

"There is often an increase in bacterial contamination when experienced workers on the slaughter line are replaced with less-experienced workers, such as before and after holidays, and raids this year on illegal slaughterhouse workers by the INS led to replacement with less-experienced line workers."

Doug Powell, Ph.D., an associate professor of pathobiology and scientific director of the International Food Safety Network, says,

"You're not going to eliminate E. coli O157:H7. Down-line processors have to be operating under the assumption that they're going to get some E. coli just like we expect consumers to operate under the assumption that they're going to have some in their product, which is why we tell them to cook it."

So cook that burger. And stick that thermometer in it.

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The public inquiry into the 2005 E. coli outbreak in Wales began yesterday and already the evidence is shocking -- or, maybe, all too common.

Professor Chris Griffith, head of the food research and consultancy unit at the University of Wales Institute, Cardiff, was asked by South Wales Police to compile a report assessing the health risk posed by John Tudor and Son butchers.

Media Wales is reporting that,

E. coli butcher William Tudor encouraged staff suffering from stomach bugs and diarrhoea to continue preparing meat for school dinners.

He was also aware of cross contamination between raw and cooked meats, but did nothing to prevent it.

Some 150 schoolchildren were sickened in the outbreak and five-year-old Mason Jones died in October 2005.

Prof Griffith was quoted as telling the inquiry,

"Packaging in which raw meat had been delivered was subsequently used to store cooked product," and that a cleaning schedule at the factory was so bad it was "a joke."

Yesterday the inquiry was told that a routine inspection of John Tudor and Son in January 2005, by Bridgend Council environmental health officer Angela Coles, found that one vacuum-packing machine – referred to in the inquiry as a vac-packing machine – was being used to package raw and cooked meats – a potentially serious source of cross-contamination, and that there were no facilities for small equipment – such as knives – to be cleaned.

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