The face of E. coli: Vancouver petting zoo edition
Although the Vancouver Coastal Health authority had identified a cluster of E. coli infections as early as last Thursday, no public health warning was issued, said spokeswoman Anna Marie D’Angelo.
All 13 cases that have presented so far are thought to be related to exposure to the the PNE petting zoo.
The Vancouver Sun reports that B.C.’s Medical Health Officer Dr. John Carsley, said,
“We were suspicious on Thursday when two cases were reported, then there were more on Friday. … “We wrestle very seriously with this issue of whether to do a public alert or not. It depends very much on the outbreak, and if there is a continued risk out there.”
The family of 14-month-old Jacklyn Simpson (above, right, photo from Vancouver Sun), who was stricken with the illness after visiting the petting zoo, believes that had they known about the outbreak, they might have been able to get help earlier.
That’s one of the reasons to issue public alerts – so additional illnesses can be prevented. E. coli O157 also spreads easily from person-to-person so public warnings may help reduce additional transmissions.
And it would be helpful if public health types would clearly articulate why they go public about foodborne illness outbreaks and when. Saying, "we wrestle with it,” does not enhance public confidence. Or prevent additional illnesses.
Health dept: We balance public's need to know with needs of business; 20 sick with Hepatitis A in Illinois
KWQC is reporting that two workers at the Milan, Illinois, McDonald's tested positive for Hepatitis A but TV6 has learned one of those tests came back a month ago.
Even though the first case was confirmed back in mid-June, the Rock Island County Health Department didn't close the McDonald's until this past Wednesday. By then, another case had been confirmed.
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The health department now says it didn't respond back then because it didn't know back then. The health department says it didn't find out about the case on June 9th until July 10th, a month later.
By law, the health department should have been notified within 24 hours. At a press conference Saturday afternoon, health department staff said the system broke down.
Wendy Trute with the Health Department said,
"There's a network of providers and there's a whole list of people responsible for reporting infectious diseases or communicable diseases."
The Health Department also says in addition to the two confirmed cases at the Milan McDonalds, there are also confirmed hepatitis A cases involving other local businesses.
We then asked which businesses, Trute said,
"You know what? It's not our policy to name them, nor is it the policy of the state health department. However, I can assure you we have worked with them and they have taken all the necessary pre-cautions required of them."
As far as communicating details to the public, the Health Department says it tries to balance the public's need to know with the needs of any business that may be involved.
There are 20 confirmed Hepatitis A case in Rock Island and surrounding areas, with 11 people being hospitalized.
North Bay E. coli outbreak - see it all on youtube
The use of video is changing public perceptions of foodborne illness outbreaks. At least that’s what we hypothesized after the 2006 E. coli in spinach outbreak. But check it out for yourself. Next time, get the head of CFIA or FDA on camera, explaining the basis for going public.
As of Monday, Oct. 20, 2008, there were a total of 141 cases, of which 28 are lab confirmed for E. coli O157:H7, which includes cases being investigated by six other health units in Ontario. The case numbers are down because further information has shown that 18 people are not part of this outbreak.
Does that mean there were 18 people who were sick that were part of another outbreak?
At this time, all of the 141 cases are linked to one location - the Harvey’s Restaurant in North Bay.
Despite E. coli cases, Oklahoma restaurant kept serving customers; not so in North Bay
A Harvey’s restaurant in North Bay, Ontario, Canada, remains closed as the number of confirmed and suspected sick with E. coli O157:H7 climbed to 159 today.
The public health folks in North Bay must be going nuts, but they, along with the operators of Harvey’s, have put public health first and closed the restaurant until more is known.
Locust Grove, Oklahoma, was also hammered by an E. coli outbreak, E. coli O111, linked to dining at the Country Cottage restaurant in August.. One person died, 72 were hospitalized and 241 others got sick before the outbreak was contained.
Today it was revealed that State Health Department officials allowed the Country Cottage to stay open temporarily — even after confirming six of eight initial food poisoning victims had eaten its food, internal documents show. That decision may have resulted in additional people getting sick.
Health Department officials admitted last week there is no set threshold in such cases for closing a restaurant suspected of being the source of an outbreak.
There are no guidelines. Epidemiological investigations are full of uncertainty. So is most of what is known about foodborne illness. But after the Salmonella-in-tomatoes-jalapenos outbreak this summer, public health officials are seemingly reluctant to go public. Industry has attempted to take matters into their own hands – which they should have been doing anyway – and is increasingly challenging public health investigations with its own test results, and unfortunately overstating the value of their own tests.
Listeria in Maple Leaf deli meats, Salmonella in produce, E. coli in Ontario and Oklahoma. There are no guidelines on when to go public. Federal agencies like the U.S. Food and Drug Administration and the Canadian Food Inspection Agency must come clean with the public and industry and articulate the basis for public notification, or even restaurant closures, during outbreaks of foodborne illness. Until then local health units are left cleaning up the mess.
More of the same from Maple Leaf, CFIA
Maple Leaf Foods president and CEO Michael McCain said last night that “consistent with normal findings and practices” listeria continues to be found at the same facility that produced cold-cuts linked to at least 20 deaths and 50 illnesses in Canada.
“Listeriosis is an exceptionally rare illness,” he said, “but we are taking every precaution possible.”
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I’m sure the illness didn’t feel exceptionally rare to the sick and the dead.
Mr. McCain also reiterated that,
“Listeria exists in all food plants, all supermarkets and presumably in all kitchens,”
which is exactly why my pregnant wife and Ben’s pregnant wife didn’t go near Maple Leaf or any other cold cuts during their pregnancies. So I’m sure Mr. McCain will put as much energy and resources into advising vulnerable populations to stay away from Maple Leaf cold-cuts and other refrigerated ready-to-eat foods as he is into re-opening the Toronto plant.
And if Maple Leaf is now “behaving in the most conservative way possible,” what were they doing before the listeria outbreak became public knowledge on Aug. 20, 2008?
Confidential data obtained by the Toronto Star and CBC and reported last night revealed that two-thirds of Maple Leaf meat samples collected from Toronto hospitals and nursing homes tested positive for a virulent strain of listeria just before the country’s largest food recall.
The test results show a dramatically high percentage of bacteria-laced ham, corned beef, turkey, and roast beef was being served to hundreds of vulnerable hospital patients and seniors. Experts say it’s more contamination than they have seen and further evidence of a health risk that should have reached the public’s attention sooner.
“There shouldn’t be any positives,” says Rick Holley, a food safety expert at the University of Manitoba. “The reality is if you did a survey in the market, you might find one or two at most out of this sample that are positive ... And it is a particularly virulent strain of listeria. It’s one of the bad ones.” …
“I’d never seen anything like this,” said Dr. Vinita Dubey, Toronto’s associate medical officer of health. “The fact that so many came back positive shows how contaminated the source was.”
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So given the high level of contamination, what did the Canadian Food Inspection Agency do? Insist on more testing, because epidemiology is not enough to protect the health of Canadians.
In a conference call with members of the Canadian Food Inspection Agency on Aug. 14, Toronto officials told the agency they had enough evidence to make a connection and pressed the CFIA to warn the public about Maple Leaf products.
CFIA officials, however, said they needed to wait for one more set of test results from unopened meat packages.
While the CFIA had identified listeria bacteria at the Maple Leaf Foods meat processing plant in Toronto and even begun an investigation of the company by that time, the federal agency said it wanted definitive test results to see whether it was the same strain as the one responsible for the outbreak.
The CFIA declined a request for an interview with CBC News. The agency maintained that it requires hard scientific proof before it can recall food or issue warnings to the public.
Toronto Public Health said it had gathered plenty of evidence during July and August that linked Maple Leaf meat products to the outbreak, including:
* two deaths linked to listeriosis
* more cases being reported
* meat samples from sandwiches tested positive
* samples from opened meat packages were taken
During a 2005 outbreak of salmonella found in bean sprouts in Kingston, Ont., regional health officials didn't wait for definitive proof to issue their own recall.
"I think it's a less desirable approach, from the point of view of the people we serve, to say, 'We'll have to wait and have confirmation before we can intervene,'" said Dr. Ian Gemmill, the medical officer of health for the Kingston Area Health Unit.
The locals sound increasingly frustrated with CFIA. Until there is a clear policy on when to go public, expect more failures and frustration in the future.
Asked for the listeria test results leading up to the outbreak, the Maple Leaf spokesthingy said last week that, in the spirit of open and transparent co-operation and a genuine desire to improve the safety of refrigerated, ready-to-eat foods, the company would not release them publicly.
More listeria revelations: CFIA waited (at least) 5 days to issue advisory, policy on going public seems to suck
Toronto’s Globe and Mail newspaper reported Saturday that health officials in Ontario ordered hospitals and nursing homes to stop serving Maple Leaf meats five days before the public was told about a deadly source of food poisoning that has so far claimed 19 lives and left another 60 people seriously ill across Canada.
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The CFIA launched its investigation on Aug. 6, after officials at the Ontario Ministry of Health informed it that there was an outbreak of listeriosis in the province. Many local health officials were already grappling with a spike in listeriosis cases, but they did not become aware that the outbreak spanned several provinces until July 30, when they received a directive from the ministry, telling them to urgently report any new cases.
On Aug. 14, health officials in Ontario learned during a telephone conference call with the CFIA that the agency had some test results revealing that Maple Leaf deli meats contained the foodborne bacteria known as Listeria monocytogenes.
The CFIA waited until it had the DNA fingerprint evidence establishing a definitive link before it went public – on Aug. 19, 2008.
CFIA spokesman Garfield Balsom said,
“We had lab results indicating that there was positive listeria in a product and we would issue our normal recall based on that.”
So epidemiology doesn’t count? If CFIA really does not issue public advisories unless it has a positive result, that would explain the low number outbreaks linked to fresh fruits in vegetables in Canada. Who knows how many sick people there are, and how many illnesses and deaths could have been prevented in the current listeriosis outbreak.
A positive listeria sample would have triggered an immediate recall in the U.S. So what is the CFIA policy on going public – on issuing advisories that specific foods may pose an imminent danger to the health of Canadians. CFIA won’t say what their policy is, at least not publicly, but a policy that maligns epidemiology and relies excessively on positive test results – especially when those samples appear to be delivered by stagecoach – is restrictive and reckless.
As past of that accountability, I told the Toronto Star on Thursday that Canada does not need an inquiry and does not need more inspectors, rather,
"People need to do their jobs. The CFIA is accountable to Parliament through the minister of agriculture, so either the minister, or the Prime Minister's Office, should call the head of CFIA on the carpet and say, `You've had this internal report since 2005. Issue some clear guidelines on how to communicate during an outbreak of food-borne illness. Give clear instructions to inspectors and the industry on what is expected to ensure a safe food supply ... If you can't do that, I will find someone else who can – and not some political appointment, someone with a food safety background who will do what is necessary to protect the safety of the Canadian food supply and bolster the Canadian brand in international circles.'"
Such straight talk, especially when it comes to informing the public about health risks, is largely missing in Canada, experts agree.
So while the politicians and unionists pontificate, a columnist at the University of Calgary student paper got the most rightest:
"Canadians have entrusted one single agency, the CFIA, to protect the entire Canadian food supply-- we have placed all food security in one basket.
"If the CFIA did not exist, perhaps Canadians would be better off. … The current food inspection system has failed Canadians. Maybe it is time for a change."
As an aside, a columnist with the Ottawa Citizen who fancies himself as some sort of risk guru wrote Saturday that,
“Another clue lies in the number of listeriosis deaths in past years. According to Statistics Canada, there were five in 2000. In 2001, four. In 2002, seven. In 2003, three. In 2004, one. (Data for subsequent years were unavailable.) …
“The Globe also noted the Canadian regulatory standard is weaker than that of the United States, which allows no listeria content at all in ready-to-eat foods. But the Globe did not report that, according to the Centers for Disease Control, roughly 2,500 Americans become seriously ill with listeriosis each year and 500 die.
“Thus the listeriosis fatality rate is far smaller in Canada than the U.S. That, too, does not suggest a crisis.”
The columnist is comparing actual listeria cases in Canada with estimated cases in the U.S. And why no alarm that the most recent numbers in Canada are from 2004?
