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

Amy, Sorenne and I spent a long last weekend in San Francisco, where Amy conferenced, I had some meetings, but mainly just hung out with the kid (three pirates and a little girl, right).

The washrooms at the San Francisco airport featured the Dysan airblade, billed as the “fastest, most hygienic hand dryer.” Says so right on the machine. And it’s certified by NSF as “tested, certified, hygienic.” Says so right on the machine.

My bowels are in a state of flux when traveling so I had several opportunities to try out the newfangled machinery, that sounds like an airplane is taking off below your fingertips.

We have maintained, based on our reading of the available literature, that proper handwashing, entails:

• wet hands with water;
• use enough soap to build a good lather;
• scrub hands vigorously, creating friction and reaching all areas of the fingers and hands for at least 10 seconds to loosen pathogens on the fingers and hands;
• rinse hands with thorough amounts of water while continuing to rub hands; and,
• dry hands with paper towel.

Water temperature is not a critical factor -- water hot enough to kill dangerous bacteria and viruses would scald hands -- so use whatever is comfortable.

The friction from rubbing hands with paper towels helps remove additional bacteria and viruses.

I did a cursory search to find some data on the Dysan thingy, and found a study comparing paper towel, regular blow dryers, and a Dysan-type jet dryer that was published in 2008.

Those authors state:

“The jet air dryer showed that there were significant differences (although not as great as for the fingerpads) between the towels and both types of dryer. Again, the superior performance of the towels in reducing bacterial numbers was confirmed. As for the fingerpads, the jet air dryer performed better than the warm air dryer in not increasing mean bacterial count on the palms as much but this difference was not significant.

“Therefore, the manufacturer’s claim that the tested JAD is the “most hygienic hand dryer” is confirmed, especially for fingerpads and assuming that the term “hand dryer” refers to electric devices only because its performance in terms of the numbers of all types of bacteria remaining on the hands of users compared to paper towels was significantly worse. …

“It is well known to microbiologists that air movements encourage the dispersal and transmission of microorganisms and increase the chances of the contamination of materials or persons in any situation. This makes paper towels, where little air movement is generated, the most hygienic option tested in this respect followed by the warm air dryer and, lastly, the jet air dryer.”

The friction from rubbing with paper towel is particularly effective at reducing microbial populations; yet many of these public bathrooms have signs proclaiming that electric dryers of whatever kind are better, and save the trees. Oh, and I should hear from someone at Dysan or NSF – public claims need to be backed with public data.

Maybe I’ll just stay at home.
 

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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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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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The bites/barfblog French team of correspondent Albert Amgar and Manhattan (Kansas) translators Abby Herald and Amy Hubbell have provided news of the latest E. coli related recall from France, this time in Carrefour Discount Frozen Hamburger Patties (right).

Product recalled by: Carrefour

Department: Food and Drinks

Brand: Carrefour

Product: Lot Number/Serial Number: The aim of this recall is for lot number IE 565 EC with a “best by” date of August 5th, 2010.

Reason for recall: Discovery of contamination by the E.coli bacteria

Recommendation: Consumers having bought this product are asked not to consume it.

Place of recall: Consumers who have purchased the product are asked to bring it back to the store where they will be reimbursed.

Additional information: Carrefour states that they have received no consumer complaints. According to the distributer this bacteria is destroyed at a temperature of 65° C (149° F) and the hamburgers are of no risk if they have been thoroughly cooked. The products related to this recall have been removed from Carrefour, Carrefour Market and Champion stores.

Consumer Hotline: For more information, call the toll free hotline 0 805 90 80 70

Again, the recommended cooking temperature seems low, and it’s really risky to say there’s no-risk with any product. Cross-contamination in any food preparation area is a huge issue. That’s why everyone tries to get the pathogens out, rather than blaming the cook.
 

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Restaurant inspectors in Philadelphia have abandoned the "floors, walls, ceilings" focus and instead are phasing in a more scientific, "risk-based" approach that emphasizes food workers' knowledge and behavior - do they know how contamination is spread and how to prevent it? - and calls for more frequent inspections of eateries that pose greater risks.

Don Sapatkin of the Philadelphia Inquirer writes this morning that Philadelphia is playing catchup in adopting changes that most counties around here have already made, in some cases many years ago. Yet the city's new approach is expected to mean more inspections of the 12,621 establishments that sell or serve food - four times a year at institutional kitchens, for example - than most places.

Still, this region is hardly progressive compared to places like Toronto, which posts red, yellow or green signs in restaurants, or Los Angeles (A-B-Cs), or Denmark (smiley faces). No county in the Philadelphia region requires restaurants to post full inspection reports on location.

It's not clear that food is any safer when there is greater transparency or even more frequent inspections, "but it does get people to think about food safety," said Doug Powell, an associate professor of food safety at Kansas State University who operates barfblog.

Don Schaffner, a professor of food microbiology at Rutgers University, said inspections traditionally have focused as much on appearance as on cooking temperatures. And they often made little distinction between sushi bars that serve raw fish and drug stores that sell prepackaged food.

"What we've learned over time is, not everything is equal.”

Ben Chapman, a food-safety extension specialist at North Carolina State University and a contributor to barfblog said prevention is really about "the culture of the restaurant”

Meaning, says Powell,

"If two workers are from the same restaurant (and go to the bathroom) and (only) one washes his hands, I want one to say to the other: 'Dude, wash your hands.' "

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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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The newly anointed leaders of the U.S. Food and Drug Administration say in a scientific journal this week that,

“… one of the greatest challenges facing any public health agency is that of risk communication.”

Lots of public health types say that. If only there were better communication, everyone would get along.

Life is messier than that.

Communication is one of those cop-out words that people and bureaucrats routinely use but really don’t want to use; the complications are far too messy.

Because communication would involve the actual transmission of feelings, and the hurt, pain, joy and angst of whatever anyone went through.

So when Margaret A. Hamburg, M.D., and Joshua M. Sharfstein, M.D., the commissioner, and the principal deputy commissioner, of the Food and Drug Administration, Silver Spring, MD, wrote in the New England Journal of Medicine yesterday that,

“We all accept small risks in our daily lives, from the risk of falling in the shower and sustaining a head injury to the risk of having a car accident on the way to the grocery store. One reason we are rarely fearful of these risks is our perception that we have control over them. When it comes to food and drugs, even small risks can cause considerable fear and anxiety, especially when they seem to be out of our control. Yet all pharmaceuticals have some potential adverse effects, and many raw foods may harbor natural pathogens.”

I fell asleep.

The author’s continued,

“Transparency is a potent element of a successful strategy to enhance the work of the FDA and its credibility with the public. Whenever possible, the FDA should provide the data on which it bases its regulatory decisions and other guidance and explain its decision-making process to the public.”

Right. So please provide public, transparent guidelines for going public about outbreaks of foodborne illness.

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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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I started my Xmas shopping this morning. I got Amy a can opener, a corkscrew and some scissors. She was with me at Target when I bought them.

Having a two-week-old puts a different spin on things. Our neighbors invited us for a Christmas eve get-together, but Sorenne is sleeping, and that’s a good gift.

Maybe next year we’ll be surfing during the summer in Australia or New Zealand at Christmas. And if so, we’ll try not to swallow too much water.

Researchers at Oregon State University (OSU) and the Oregon Dept. of Environmental Quality have found that surfers unintentionally ingest 10 times more water than swimmers or divers, putting them at higher risk of contracting gastrointestinal (GI) illnesses when surfing in contaminated waters.

The study also suggests that because the water quality at Oregon beaches is significantly better than more popular surfing destinations, such as California, Hawaii, or Florida, the risk of GI illness is lower for people surfing the frigid waters of the Oregon coast.

How did stoner Jeff Spicoli from Fast Times at Ridgemont High grow up to be Harvey Milk?

 

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Aisha P. Salazar, a graduate student at Kansas State University, writes:

I love traveling and eating just about anything in sight. My only rule is that food can’t be too spicy. That’s why ‘Bizarre Foods with Andrew Zimmern’ is one of my favorite shows. I recently found an old episode where he was visiting Ecuador, my parent’s native country. I have been to Ecuador several times since birth, but I got to thinking Zimmern must either have an incredibly tolerant stomach and intestines, or he must spend a lot of time on the toilet and it’s never captured on camera. I say this because he eats the oddest foods all over the world, even at local stands along the road, with apparently no gastrointestinal effect.

The last time I visited Ecuador was about two years ago. I went to different towns and ate all the street food in sight—beef, pork, mote, rice, plantains. I actually drew the line at the cuy because they didn’t look fully cooked and were in the least sanitary locations of all the food, though I have eaten it in the past and it’s really good. I knew I shouldn’t have eaten everything because of the variable sanitation standards, but I ate…and I got sick. I got the worst case of food poisoning I had ever experienced (I’m talking both ends, doubled over in severe pain for two days, unable to stomach anything for an additional two or more days).

It seemed that Zimmern takes precautionary measures by not eating from local stands at all times, but even when I eat at friend’s houses or restaurants I can come up with a bad case of the runs. It made me wonder what he does to prepare himself to prevent a run-in with a toilet and what he would do if he were to get sick. I don’t see any of the cooks using thermometers and he often eats raw foods. So how does he do it and what is his perception of risk? I decided to e-mail him and ask. Hopefully he, or someone working with him, will get back to me. The show’s website states they will be devoting an hour long Halloween Special to the topic of culture and food. He’ll also have an online Q&A session on October 21st.

I often don’t heed the advice of my own field, eating everything from sushi to unpasteurized cheese to alfalfa sprouts. In fact, right before one spring break in college my professor had talked to us about the risk of eating raw oysters and acquiring food poisoning from Vibrio cholera. I, of course, went to New Orleans and ate raw oysters the moment I arrived. I survived unscathed yet, even after several incidents of food poisoning, I still take the risk.

But where does my own perception of risk associated with foods come from? How is it different from the next person’s? Is one influenced by old wise tales, cultural norms, or scientific facts, or even blessed with good genes? Or is it a matter of adjusting one’s intestines to certain pathogens? How tolerant is a native person to certain foods compared to a foreigner? Or does your vulnerability to foodborne illness relate to your perception of risk? (For vulnerabilities, see ‘Who is at risk?’  and ‘Food safety in pregnancy is not simple’ ). Doug Powell often talks about creating a culture of safe food; reducing the risk begins with changing behaviors and spreading knowledge. I recommend Zimmern include a warning statement in his shows, informing the public of dangers that can result from eating certain foods. It would benefit travelers and spread the culture of safe food.

This topic has been on my mind for a couple of years, and pretty much anytime I travel, yet I haven’t bothered researching it. Instead, I go on blindly eating the foods I love and hope I don’t die from them. This doesn’t mean I’m not careful when I or anybody in my family cooks, but I’ve noticed my own risks seem to be greater when I’m eating outside my own home. My friends can tell you how ironic it is that I’m studying food safety yet I always get food poisoning. I found it ironic that Zimmern is the international spokesman for Pepto-Bismol. If only Pepto and Mylanta knew how much I relied on them. Then again, I’m not sure I’d like to be the face of Mylanta. I’m probably better off changing my own food rules and reducing my chances of getting sick.

We all pick our own poisons.

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Young children should not keep hedgehogs as pets — or hamsters, baby chicks, lizards and turtles — because of risks for disease.

That’s according to the nation’s leading pediatricians group in a new report about dangers from exotic animals.

Besides evidence that they can carry dangerous and sometimes potentially deadly germs, exotic pets may be more prone than cats and dogs to bite, scratch or claw — putting children younger than 5 particularly at risk, the report says.

Young children are vulnerable because of developing immune systems plus they often put their hands in their mouths and are awkward at handling animals, the report says.

The report appears in the October edition of the American Academy of Pediatric’s medical journal, Pediatrics.

A spokesman for the International Hedgehog Association said there’s no reason to single out hedgehogs or other exotic pets.

‘‘Our recommendation is that no animal should be a pet for kids 5 and under,’’ said Z.G. Standing Bear. He runs a rescue operation near Pikes Peak, Colo. for abandoned hedgehogs, which became fad pets about 10 years ago.

Abstract

Exposure to animals can provide many benefits during the growth and development of children. However, there are potential risks associated with animal exposures, including exposure to nontraditional pets in the home and animals in public settings. Educational materials, regulations, and guidelines have been developed to minimize these risks. Pediatricians, veterinarians, and other health care professionals can provide advice on selection of appropriate pets as well as prevention of disease transmission from nontraditional pets and when children contact animals in public settings.
 

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Amy is 6 months pregnant: An outbreak of listeria in Canada which has killed one and sickened dozens, is exactly why she hasn’t eaten any cold cuts or smoked salmon for the past six months.

It has been thoroughly documented that many pregnant women are not aware of the risks associated with consuming refrigerated, ready-to-eat foods like cold cuts. Nor does the literary dancing from various Canadian spokesthingies inspire confidence.

About 3 a.m. Sunday, Aug. 17/08, the Canadian Food Inspection Agency (CFIA) and Maple Leaf Consumer Foods issued an advisory warning the public not to serve or consume Sure Slice brand Roast Beef and Corned Beef because these products may be contaminated with Listeria monocytogenes.

The press statement said,

“There have been no confirmed illnesses associated with the consumption of these products.”

Usually, CFIA press releases say there have been no illnesses associated with the product in question, if that is indeed the case. The “confirmed illness” was a wiggle phrase that Canadian media dutifully reported and then went back to sleep.

Then, about 4 a.m. Wednesday Aug. 20/08, another press release arrived from CFIA, this time announcing that Maple Leaf was voluntarily recalling everything from the suspect Toronto plant and that,

“… a number of the affected products … are part of a listeriosis outbreak investigation.”

About the same time, Maple Leaf Foods put out a press release stating,

“A small number of Sure Slice packaged meat products produced at the Company's Bartor Road, Toronto facility, predominantly for foodservice customers, have tested positive to contain low levels of listeria monocytogenes.”

Always good to get someone else to read stuff to catch grammatical errors, but there may not always be time.

And maybe it wasn’t that small of a contamination, because Wednesday afternoon, Ontario's Chief Medical Officer of Health advised the public that there is an outbreak of Listeriosis in the province.

“In July 2008, routine surveillance conducted by the Ministry detected a marked increase in cases of Listeriosis being reported by Ontario health units.

“As of yesterday, there have been 29 cases associated with the outbreak across 17 health units. Of these, 13 are confirmed cases, and the rest are probable and suspect cases which are under investigation by the local health units. Outbreak associated cases of Listeriosis have also been reported in British Columbia, Saskatchewan and Quebec. Ontario is working with the Public Health Agency of Canada and the other provinces in the investigation.”

Yet, as reported by Canwest News Service, health officials in Ontario would not confirm a link between the cases and the recall. Dr. Eleni Galanis with the B.C. Centre For Disease Control said officials in that province had interviewed the two confirmed cases and were satisfied there was sufficient evidence to show a link.

"First, they have the same strain as the outbreak strain that has been identified in Ontario and second they have been exposed to the foods that are under recall. It does seem that they are linked."

Galanis, who said B.C. is also reviewing three more suspected cases, said she was particularly concerned for people with compromised immune systems and pregnant women.

"In pregnant women it could result in still birth," she said.

Despite the words of Dr. Galanis, the story has spun into political nonsense, with the two major political parties throwing barbs at each other, and one University of Guelph type defending small agriculture by saying,

“That's not to say that a small butcher can't make mistakes, but at best, he's going to kill off a few of his neighbours. When you take that same mistake and you put it into a plant that serves millions, the risk is vastly expanded.”

Wow. There’s a whole bunch of sick people out there. That’s where the focus should be. And then, journos should ask, at what point did health authorities make an epidemiological link to Maple Leaf cold cuts? Would some illnesses have been prevented if the warning Sunday morning had been expanded? What is the process used to decide when to issue public warnings? How much evidence is enough?

Oh, and the CFIA advice if you are pregnant or have a weakened immune system?

“Although the risk of listeriosis associated with foods from deli counters, such as sliced packaged meat and poultry products, is relatively low, pregnant women and immunosuppressed persons may choose to avoid these foods.”

Here’s the advice from the U.S. Centers for Disease Control for persons at high risk, such as pregnant women and persons with weakened immune systems:

• Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
-Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.


• Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pastuerized milk.


• Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may be eaten.
-Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

The USDA risk assessment for listeria is ready-to-eat foods is available here

http://www.fsis.usda.gov/OPPDE/rdad/FRPubs/97-013F/ListeriaReport.pdf

and one from the World Health Organization is here

http://www.who.int/foodsafety/publications/micro/mra_listeria/en/index.html
 

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The U.S. Centers for Disease Control and Prevention report in the current issue of Morbidity and Mortality Weekly Report on Escherichia coli O157:H7 infections in children associated with raw milk and raw colostrum from cows -- California, 2006. Some highlights below:

On September 18, 2006, the California Department of Public Health (CDPH) was notified of two children hospitalized with hemolytic uremic syndrome (HUS). One of the patients had culture-confirmed Escherichia coli O157:H7 infection, and both patients had consumed raw (unpasteurized) cow milk in the week before illness onset. Four additional cases of E. coli O157:H7 infection in children who had consumed raw cow milk or raw cow colostrum produced by the same dairy were identified during the following 3 weeks. In California, intrastate sale of raw milk and raw colostrum is legal and regulated. This report summarizes the investigation of these cases by CDPH, the California Department of Food and Agriculture (CDFA), and four local health departments and subsequent actions to prevent illnesses. As a result of this and other outbreaks, California enacted legislation (AB 1735), which took effect January 1, 2008, setting a limit of 10 coliforms/mL for raw milk sold to consumers. Raw milk in several forms, including colostrum, remains a vehicle of serious enteric infections, even if the sale of raw milk is regulated.

Six cases were identified; four persons had culture-confirmed infections, one had a culture-confirmed infection and HUS, and one had HUS only. The median age of patients was 8 years (range: 6--18 years), and four of the patients (67%) were boys. The six cases identified during this investigation were geographically dispersed throughout California. All six patients reported bloody diarrhea; three (50%) were hospitalized. Illness onset occurred during September 6--24, 2006. Isolates from the five patients with culture-confirmed infections had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. The PFGE pattern was new to the PulseNet (the National Molecular Subtyping Network for Foodborne Disease) database and differed markedly from the pattern of the E. coli O157:H7 strain associated with a concurrent multistate outbreak linked to spinach consumption (1). Four of the five E. coli O157:H7 isolates were subtyped by multiple-locus variable-number tandem repeat analysis (MLVA) according to a protocol used by CDPH laboratory and were found to have closely related MLVA patterns (2).

Five of six patients reported they had consumed brand A raw dairy products in the week before their illness onset; the sixth patient denied drinking brand A raw milk, although his family routinely purchased it. Among the five patients who consumed brand A dairy products, two consumed raw whole milk, two consumed raw skim milk, and one consumed raw chocolate-flavored colostrum. Four of the five patients routinely drank raw milk from dairy A. One patient was exposed to brand A dairy product only once; he was served raw chocolate colostrum as a snack when visiting a friend. No other food item was commonly consumed by all six patients. No other illness was reported among household members who consumed brand A dairy products.

Using purchase information supplied by the patients' families, investigators determined that the patients consumed raw milk from lots produced at dairy A during September 3--13, 2006. Milk samples from these production dates were not available for testing. Fifty-six product samples from several lots with code dates of September 17, 2006, or later were retrieved from retails stores and dairy A and were tested for aerobic microflora, total coliform, fecal coliform, and E. coli O157:H7. The outbreak strain of E. coli O157:H7 was not found in any product samples. However, standard aerobic plate counts and coliform counts of collected samples with code dates of September 17 through October 9, 2006, were indicative of contamination. Colostrum samples had high standard plate counts and total coliform counts, and fecal coliform counts of 210--46,000 MPN/g. California standards limit standard plate counts for raw and pasteurized milk to 15,000 CFU/mL and total coliform counts for pasteurized milk to 10 coliform bacteria/mL. At the time of this outbreak, California did not have a coliform standard for milk sold raw to consumers. California also classifies colostrum as a dietary supplement, for which it has no microbiologic standards, rather than a milk product.

Raw milk from dairy A was the likely vehicle of transmission, but the exact mode of milk contamination in this outbreak was not determined.

Asymptomatic cows can harbor pathogens and cause human illness by shedding pathogens in untreated milk or milk products. These findings suggest that if raw milk had been subject to the same coliform standard as pasteurized milk in California, milk from dairy A might have been excluded from sale and this outbreak might have been averted.

From 1998 to May 2005, raw milk or raw milk products have been implicated in 45 foodborne illness outbreaks in the United States, accounting for more than 1,000 cases of illness (CDC, unpublished data, 2007). Because illnesses associated with raw milk continue to occur, additional efforts are needed to educate consumers and dairy farmers about illnesses associated with raw milk and raw colostrum. To reduce the risk for E. coli O157 and other infections, consumers should not drink raw milk or raw milk products.

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The N.Y. Times reports that mistletoe is not quite as hazardous as it is made out to be. The plant contains harmful chemicals like viscotoxins, which can cause gastrointestinal distress, a slowed heartbeat and other reactions.

But in studies of hundreds of cases of accidental ingestion over the years, there were no fatalities and only a handful of severe reactions. One study published in 1996 looked at 92 cases of mistletoe ingestion and found that only a small fraction of patients showed any symptoms. Eight of 10 people who consumed five or more berries had no symptoms, and 3 of the 11 people who consumed only leaves had upset stomachs.

Other studies have found similar effects, suggesting that while mistletoe can be toxic, its lethal reputation is not quite deserved.

But, like poop, don't eat it.

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I love being at Kansas State. Sure, it's a long way to the airport, and there is no ice hockey, but those are minor  inconveniences.

What I love best, other than the French professor wife, is the flexibility and independence that KState admin-types offer, while making one feel they are part of a bigger team.

It's sorta cool.

So after a year of finding my place and where I fit in this food safety force, I'm going to start offering two courses. 

Food safety reporting is offered through the department of Mass Communications and Journalism (MC 690 Section C).

Food Safety Reporting will provide students the opportunity to develop news, feature and opinion stories for a variety of media. Students will receive extensive feedback from several instructors and will have the opportunity to interact with food reporters at several national newspapers. Individual pieces will be published through the International Food Safety Network (foodsafety.ksu.edu) website, listserves and barfblog.com.

Dr. Powell has been working on and off as a journalist since 1987, when he was the editor-in-chief of the University of Guelph student newspaper, The Ontarian. He has, and continues, to write for prominent newspapers in Canada, U.S. and Australia, including the N.Y. Times, the Globe and Mail, the National Post, and the Sydney Morning Herald. He was the Canadian news correspondent for the journal, Science, from 1990-1993.

The other is, Topics in Pathobiology: Food Safety Risk Analysis

As Thomas Jefferson wrote, "I know no safe depository of the ultimate powers of society but the people themselves; and if we think them not enlightened enough to exercise their control with a wholesome discretion, the remedy is not to take it from them but to inform their discretion by education."

This course is open to PhD students (DM/P 995), Masters students (DM/P 895) and undergraduates (e-mail me).

Food Safety Risk Analysis is based on the principles of risk analysis – the interwoven roles of risk assessment, management and communication – and their application to food safety, agricultural biotechnology, and food policy development. This course will aid students in developing the ability to critically examine risk issues and various stakeholder perspectives leading to appropriate and beneficial policy development. 

A significant portion of the course will focus on the importance of thorough research and good communication skills, as well as the suitability of communication efforts. In addition, assignments are designed to help students increase their knowledge, understanding, and use of electronic resources. The emphasis on acquiring and critically evaluating electronic information will assist students in further developing lifelong learning skills. The course will be presented through in-class lectures, case study presentations, and Internet-based support material including text, audio and video through the extensive database underpinning the Food Safety Network web site (foodsafety.ksu.edu).

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There's a food safety feeding frenzy going on in the nation's media outlets. Not a week goes by when Ben or I (and I'm sure dozens of other food safety geeks) get a call from an earnest reporter who wants to dish the dirt on dangerous dining, or seep into the city's soiled food service underbelly, or test for toxins in takeout.

But there's always someone who will play along. Yesterday it was menus and movie theaters.

Not the food on the menu, but the actual menu as a source of dangerous microorganisms, Same with movie theater chairs.

South Carolina's Live 5 News --with Tracey Amick -- reported that they tested a single menu from a single outlet of chain restaurants.

"The menu from the Olive Garden had no bacteria...and the ones from Noisy Oyster, Applebees, and Waffle House had normal levels of normal staph...nothing to cause concern.

"But the TGI Friday's menu had 100 units of Bacillus Cereus which if ingested...could make you sick with diahrrea and vomiting."

Charlotte, N.C's WCNC -- with action reporter Jeff Sonier -- bought tickets at a half dozen Charlotte area movie theaters.

Then we took our hidden cameras inside, along with a black light to locate stains and other foreign material, and swabs to take samples. We sealed up everything we found in test tubes, and sent them off to a laboratory near Raleigh.

… most of the germs WCNC found in most of the movie theaters we tested probably won't make you sick. But there were some exceptions – such as the seatback sample of bacteria we swabbed from the Carolina Pavilion theater on South Boulevard. The laboratory identified it as bacillus cereus.

Don't eat the menu. And don't lick movie theater seats.

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North Carolina state epidemiologist Jeffrey Engel, MD, told the Greensboro News Record today that,

"Raw milk is a product of animals, and as such, is much more likely than apple cider to be contaminated with animal pathogens that can make people sick."

Except animals, especially deer, love to hang  out and crap in apple orchards,

Risk comparisons are risky in the absence of references.

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Two health advisories, a feature and charcoal. Just another Friday night for raw milk, which I told the Atlanta Journal-Constitution, is a trend embraced by an affluent, food-obsessed culture.

Pennsylvania Agriculture Secretary Dennis Wolff said this evening that consumers who purchased raw milk from the Amos B. King dairy farm in Blain, Perry County, any time after Aug. 21, should discard it immediately due to the risk of campylobacterosis contamination.

Later this evening, the California Department of Food and Agriculture issued an order to Organic Pastures Dairy Company to withdraw from retail distribution Grade A raw cream manufactured at their facility in Fresno, due to detection of Listeria monocytogenes bacteria and ordered the company to stop producing raw cream for the retail market.

Meanwhile, the North Carolina Board of Agriculture unanimously voted today to require unpasteurized milk sold as pet food to be dyed a charcoal-gray color and labeled as not for human consumption.

Good thing too. As John Kessler of the Atlanta Journal-Constitution reported today,  at least one Atlanta store has raw milk in its dairy case. Cabbagetown Market, a funky grocer, stocks it right next to artisanal cheese and pullet eggs. Owner Lisa Hanson says she has gotten the go-ahead from Georgia Department of Agriculture to sell the milk, as it is labeled "not for human consumption."
Tell that to Suzanne Welander of Atlanta, who drinks the milk she buys there. "I like it for the quality," she enthuses. "It's a really creamy product and I enjoy knowing how it was raised."

Douglas Powell of Kansas State University said,

"If adults want to do it, fine," shrugs Powell, who publishes barfblog, which deals with food safety issues. "But the evidence is fairly clear in terms of links to illnesses from raw milk, and the arguments [touting its health benefits] are largely disingenuous. … Don't expose your kids to your dietary weirdness."

A table of raw-milk related outbreaks is available at:
http://www.foodsafety.ksu.edu/en/article-details.php?a=1&c=1&sc=1&id=384

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Tomorrow marks the one-year anniversary of Florida's so-called doggy dining law, a three-year experiment allowing pooches on restaurant patios.



Watching dogs in restaurants, stores and trains as we tour France has made us wonder if indeed 60 million Frenchmen can't be wrong.




Yet the other night during dinner at a patio table next to us, a couple sat with their ‘tween son and a tiny doggy that they passed from person to person until the food came. The Yorkie was then expected to sit calmly under a chair while his family ate. Within minutes he started yelping when a large stray wandered by looking for handouts. Most of the diners good-naturedly ignored the dog, but our neighbors, clear dog lovers, juggled patting the big beast, feeding table scraps to their own puppy, keeping the two from scuffling (surely the tiny dog would win), and finishing their dinners. The management softly discouraged feeding scraps to the stray, but there was no real effort made to dissuade him from joining the families.
No one seemed bothered.




But poop happens. Having to engage in athletic contortions to avoid dog poop in the narrow streets of Nîmes, Marseilles or Toulouse makes us recognize that dogs without yards, grass-lined sidewalks, and pooper-scoopers, quickly make an otherwise lovely city unsanitary. One pioneering doggy-friendly restaurant in St. Petersburg, Florida discovered this when a canine guest had diarrhea during peak hours. The owner said, "Ultimately, we're here to serve people, not dogs," and reverted to the no-dogs-allowed camp.

As lawmakers in Oregon, Missouri, Washington, Florida, Chicago, Austin, Dallas-Fort Worth, New York City and San Diego have discovered, there are reasons why dogs and their companions should -- and should not -- be allowed to “have a brewski together, a hot dog together or whatever they want” as former governor Jeb Bush worded it a year ago in enacting Florida's legislation.
Florida appears to have considered the risks -- at least on paper. And although doggy dining may be convenient for a client, for the restaurant owner it’s not as simple.

Under the law, Florida cities are able to enact an ordinance allowing restaurants to apply for permission to open their patio doors to dogs, under the following conditions:
• food service employees must not touch, pet or handle dogs while serving food or beverages;
• food service employees must wash their hands promptly after touching, petting or handling dogs;
• patrons must be advised to wash their hands before eating and the restaurant must provide waterless hand sanitizer at each table;
• dogs must not come into contact with serving dishes, utensils and tableware or other items involved in food service (this is the only applicable law in France);
• dogs will not be allowed on chairs, tables or other furnishings.
• accidents involving dog waste must be cleaned immediately and the area must be sanitized;
• cats and other pets are not covered by the law; and,
• local governments can issue a fee to the restaurants for  permit.

While the benefits for a dog-loving nation may seem apparent, there are any number of risks: tripping, biting, dog fights, barking, allergies, and the transfer of dangerous microorganisms such as E. coli, salmonella and cryptosporidium, among others. If it's difficult to get employees to wash their hands after using the bathroom, what about after touching a dog? And do public health inspectors, who already investigate both dog bites and restaurants in many cities, really need more of both without extra help?

The transfer of pathogens from dogs to humans (and vice-versa) is well-documented -- but not on restaurant patios. The outbreaks of foodborne illness just aren't there. A pre-rehab Britney Spears changing her baby's diaper on a restaurant table likely poses a greater risk.

As pet owners, we would likely choose to frequent restaurants that allow our (exceedingly well-behaved) dogs on the terrace, as we have done in the past.



If we were restaurant owners, we would want to know we weren’t serving poop, whether it came with the bags of spinach, was ground up in the beef that wasn’t sufficiently cooked, or transmitted on our patio by a pet. Further, we'd want to know the dog -- and more importantly the owner -- before they came anywhere near our patio.

The evidence suggests that dogs can and should be allowed on restaurant patios -- but only at the discretion of restaurant staff and only if staff and owners follow the Florida protocol.

Amy Hubbell and Douglas Powell are with the International Food Safety Network at Kansas State University.

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