Showing posts with label Foodborne illness. Show all posts
Showing posts with label Foodborne illness. Show all posts

Saturday, October 1, 2011

HCV-Listeria Outbreaks, Tainted wipes; Its Personal

Greetings folks, another wonderful weekend is upon us, time for relaxing and spending time with family. Most weekends you can find this blogger playing with my grandchild. I am one delighted grandma, that's an understatement.

The Good News
I am so excited that my daughter is about to give birth to my new grandchild, I could slap myself.

The Not So Good News
However, during this pregnancy my daughter has been screening her phone calls, why? I have no idea.

Well, it could be because she receives far too many unmanageable emotional phone calls from some woman who gave birth to her.

Just saying.

I can't help myself, each morning when I scan the health news for this blog, I frequently run across yet another recall or warning that my daughter needs to know about. Although I attempted to cut down the phone calls to listeria outbreaks only, its complicated. As any grandmother knows listeria can cause problems for both the mother and the baby. When a fetus is infected with listeria, it may be born prematurely or ... worse.

Pregnant women are more susceptible to it than non-pregnant healthy adults, and for certain vulnerable people, the illness could be fatal. Its become personal for me, not only is my daughter at risk but so are my friends with HCV, and friends who received a liver transplant. When it includes our friends and loved ones, it really hits home .

As reported at medpage the recent listeriosis outbreak from tainted cantaloupes shipped from July 29 to Sept. 10 to 25 states, sickened at least 72 individuals, killing 13 of them, according to the FDA and CDC. It s been reported that the outbreak was the most serious in over a decade.

Listeria can be potentially harmful for the elderly and individuals with the following medical problems; diabetes, immunocomprised adults , leukemia, kidney disease, hogkins disease, systemic lupus erythematosus, all our friends with AIDS, diseases of the liver, especially transplant recipients and my pregnant daughter.

The current public health advice to vulnerable groups on preventing listeria is to avoid the following:- Prepacked or delicatessen sliced meats- Soft cheeses - brie, camembert and chevre (goat's cheese)- Smoked fish- All kinds of pate including vegetable varieties- Pre-prepared cooked and chilled meals- Pre-prepared sandwiches- Unpasteurized milk, and now lets add cantaloupes to that list.

The Reality

From Medpage
CDC: 1,000 Food-Borne Disease Outbreaks in a Year
Matt McMillen-September 8, 2011

The latest numbers from the CDC show the U.S. had more than 1,000 outbreaks of food-borne disease in a single year.

The CDC study includes reports of illness from 2008, the most recent year that information is available.

The outbreaks caused 23,152 cases of illness, nearly 1,300 hospitalizations, and 22 deaths. But because most food-borne illnesses go unreported, the actual numbers are much higher. The CDC estimates that contaminated food causes as many as 48 million illnesses annually.
According to the CDC, a food-borne outbreak occurs when two or more cases of a similar illness are caused by a common food. An average of 24 such outbreaks were reported from each state or territory in 2008.

The total number of outbreaks was 10% less than the average number reported from 2003 to 2007. The number of outbreak-related illnesses in 2008 was also lower, by 5%.
Seventeen of the outbreaks crossed state lines, according to the CDC. Nine of those were caused by salmonella. Health officials identified the contaminated foods in six of those outbreaks: cantaloupe, cereal, ground turkey, ground white pepper, jalapeño and serrano peppers, and peanut butter.

Restaurant and deli food caused just over half of the 868 outbreaks that could be tied to a single location. Home cooking accounted for 15%...continue reading..

While I'm on my rant, those recalls on tainted wipes manufactured by Triads parent company H&P, really hit home. The recalls started around January of 2011, ending with the death of a child, which was reported this August, too much. The recall touched us all, and became personal for the millions of people infected with HCV.

The prep pads were packaged with pegasys in the U.S . and Pegintron outside the U.S. The wipes were contaminated with a rare bacteria, Bacillus cereus. As reported by MSNBC , there were eight reports of fatalities, 11 infections and nearly 250 other problems associated with the prep pads.

The Prep Pads and My Grandchild

For this grandma who often attends to my grandbabies boo-boo's, it should be noted that this spring I had those prep pads on hand, I still get chills. When my little angel ran a bit too fast and fell, because grandma tempted him with chocolate Ho Hos, me bad, I used good old soap and water to make it all better, not a prep pad.

To me it's evident that the dangers of using the tainted wipes to clean a wound on a child is low. My grandchild is healthy and has no underlying disease, however the risk is unacceptable. The loving parents of Harrison were not so fortunate.

The heartbreaking death of a child

January 2011
Parents blame toddler's death on tainted wipes

The parents of a 2-year-old Houston boy who died from a rare infection are suing makers of recalled alcohol prep products, claiming contaminated wipes and swabs transmitted bacteria that caused his fatal case of meningitis.

Sandra and Shanoop Kothari say their lively, dark-eyed toddler, Harrison, was recovering just fine from surgery to remove a benign cyst from near his brain and spinal cord last fall. But the day before he was set to be discharged after a week's stay, he developed a sudden and severe infection that worsened rapidly, causing multi-organ failure that led to Harrison’s death on Dec. 1, 2010.

Cultures showed he succumbed to acute bacterial meningitis caused by Bacillus cereus, bacteria typically found in rare food poisoning outbreaks, but not in hospital infections.

The wipes were contaminated with Bacillus cereus.
Continue Reading..

As reported by MSNBC in February 2011
"It also reported on a 55-year-old Tennessee man who contracted endomyocarditis, allegedly after using a Triad pad packaged with Genentech's peginterferon alfa-2a drug for hepatitis C. The man survived but required cardiac valve replacement surgery in December, the website indicated. He too has filed suit against Triad, with Genentech also named as a defendant".

Another Recall

Ground Beef In The News

Yesterday we heard of yet another recall on ground beef due to E. Coli.

From;The Food Poison Journal
Manning Beef, LLC, a Pico Rivera, Calif. establishment, is voluntarily recalling approximately 80,000 pounds of beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

This weekend published @ Forbes

The 5 deadliest food-borne illnesses & how to prevent them
Oct 2 2011

With Listeria suddenly all over today's headlines thanks to the deaths of 21 people sickened by eating contaminated cantaloupes (as of Sept. 28th), you're probably asking yourself why you've heard so little about this deadly food-borne bacteria, and how to protect yourself from it.

Sadly, though, Listeria is just one of many types of bacteria that have been sneaking their way into the food supply in recent years, triggering fears of an epidemic of food poisoning.

Here, the 5 deadliest types of food-borne bacteria and how to keep yourself and your family members safe....continue reading..

Those Ugly Bacterial Toxins

Food Poisoning-Who's Most At Risk?

Infants and the elderly are at greater risk for food poisoning.
Other risk factors include:Having a pre-existing medical condition, such as chronic kidney failure, liver disease, or diabetes

Taking antibiotic, antihistamine, or steroid medicines
Having sickle cell anemia and other problems with red blood cells
Weakened immune system, pregnant women and people over age 65 are most at risk
Traveling in an area where contamination is more likely

Common bacterial toxins include:
Usually bacteria and algae cause food poisoning, but poisonous plants and animals may also be the cause.

Common bacterial toxins include:

E. coli in undercooked hamburger, unpasteurized apple juice or cider, raw milk, contaminated water (or ice), vegetables fertilized by cow manure, or spread from person to person.

Symptoms- Escherichia coli (E. coli): hemorrhagic colitis (diarrhea with very little stool and large amounts of blood), occurring up to 3 days after eating contaminated food

E. coli

What is E. coli?

Escherichia coli (E. coli) are gram-negative bacteria that can survive in an environment with or without air (facultative anaerobes) and, depending on the environment, may or may not produce thin hair-like structures (flagella or pili) that allow the bacteria to move and to attach to human cells. These bacteria commonly live in the intestines of people and animals worldwide. There are many strains (over 700 serotypes) of E. coli. Most of the E. coli are normal inhabitants of the small intestine and colon and do not cause disease in the intestines (non-pathogenic).

Nevertheless, these non-pathogenic E. coli can cause disease if they spread outside of the intestines, for example, into the urinary tract (where they cause bladder or kidney infections), or into the blood stream (sepsis). Other E. coli strains (enterovirulent E. coli strains or EEC) cause "poisoning" or diarrhea even though they usually remain within the intestine by producing toxins or intestinal inflammation..more information.

Listeria monocytogenes (L. monocytogenes) in cole slaw, dairy products (mostly soft cheeses from outside the United States), and cold, processed meats

Symptoms-For healthy adults listeria is generally not a significant risk – exposure to it might cause mild flu-like symptoms or stomach problems. More serious infections generally cause serious gastrointestinal and flu-like symptoms, often with muscle ache and a stiff neck, or sometimes confusion and loss of balance. This can then lead to a meningitis-like inflammation around the brain or septicaemia. Listeria is generally treated with antibiotics, which need to be administered quickly in serious cases.


How can it be prevented?
Meats should be thoroughly cooked, and raw fruit and vegetables washed. Uncooked meat should be stored separately, and products containing unpasteurised milk avoided. Another key element is good kitchen hygiene, both keeping hands and equipment clean, and consuming even refrigerated leftovers within a few days.

Salmonella spp. in poultry, beef, eggs, or dairy products

From Medicine Net
Salmonella (S.) is the genus name for a large number (over 2,500) of types of bacteria. Each type is distinctly identifiable by its specific protein coating. The types are otherwise closely related. Salmonella bacteria are rod-shaped, flagellated, Gram stain-negative, and are known to cause disease in humans, animals, and birds (especially poultry) worldwide. The two major diseases caused by Salmonella spp. are gastroenteritis and typhoid fever (typhoid and paratyphoid fevers) in humans.


Potential direct sources of Salmonella are pets such as pet turtles, dogs, cats, most farm animals, and humans that are infected or are carriers of the organisms.

Symptons- Salmonellosis (gastroenteritis characterized by nausea, vomiting, and diarrhea) is the most common disease caused by the organisms. Abdominal cramping also may occur. Salmonellosis thus produces the symptoms that are commonly referred to as food poisoning. Although food poisoning is usually a mild disease, the nausea, vomiting, and diarrhea can lead to dehydration and even death (about 500 per year in the U.S.).

Salmonella Entering the Intestinal Tract

Shigella spp. from raw vegetables or cool, moist foods (such as potato and egg salads) that are handled after cooking

Symptoms- fever, chills, bloody diarrhea


What is shigellosis?
Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. The diarrhea is often bloody. Shigellosis usually resolves in 5 to 7 days. Persons with shigellosis in the United States rarely require hospitalization. A severe infection with high fever may be associated with seizures in children less than 2 years old. Some persons who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others.

What sort of germ is Shigella?
The Shigella germ is actually a family of bacteria that can cause diarrhea in humans. They are microscopic living creatures that pass from person to person. Shigella were discovered over 100 years ago by a Japanese scientist named Shiga, for whom they are named. There are several different kinds of Shigella bacteria: Shigella sonnei, also known as "Group D" Shigella, accounts for over two-thirds of shigellosis in the United States. Shigella flexneri, or "group B" Shigella, accounts for almost all the rest. Other types of Shigella are rare in this country, though they continue to be important causes of disease in the developing world. One type found in the developing world, Shigella dysenteriae type 1, can cause deadly epidemics...more information

Staphylococcus aureus (S. aureus) in salad dressing, ham, eggs, custard filled pastries, mayonnaise, and potato salad (usually from the hands of food handlers)

Staphylococcus aureus is a common bacterium found on the skin and in the noses of up to 25% of healthy people and animals. Staphylococcus aureus is important because it has the ability to make seven different toxins that are frequently responsible for food poisoning.


What is staphylococcal food poisoning?
Staphylococcal food poisoning is a gastrointestinal illness. It is caused by eating foods contaminated with toxins produced by Staphylococcus aureus . The most common way for food to be contaminated with Staphylococcus is through contact with food workers who carry the bacteria or through contaminated milk and cheeses. Staphylococcus is salt tolerant and can grow in salty foods like ham. As the germ multiplies in food, it produces toxins that can cause illness. Staphylococcal toxins are resistant to heat and cannot be destroyed by cooking. Foods at highest risk of contamination with Staphylococcus aureus and subsequent toxin production are those that are made by hand and require no cooking. Some examples of foods that have caused staphylococcal food poisoning are sliced meat, puddings, some pastries and sandwiches.

What are the symptoms of staphylococcal food poisoning?
Staphylococcal toxins are fast acting, sometimes causing illness in as little as 30 minutes. Symptoms usually develop within one to six hours after eating contaminated food. Patients typically experience several of the following: nausea, vomiting, stomach cramps, and diarrhea. The illness is usually mild and most patients recover after one to three days. In a small minority of patients the illness may be more severe.
Click here for more information

C. jejuni in raw milk and chicken
Symptoms- Symptoms of food poisoning from Campylobacter usually occur 2 to 5 days after a person eats contaminated food, but may take up to 10 days to appear. The most common symptom of a Campylobacter infection is diarrhea, which is often bloody. Typical symptoms include:Diarrhea: Diarrhea ranges from mild to severe and is often bloody Fever Nausea Vomiting Abdominal pain Headache Muscle pain

C. jejuni

Campylobacter jejuni is the most common cause of bacterial foodborne illness in the United States. Over 6,000 cases of Campylobacter infection were reported in 2009 alone, but many cases are not reported to public health authorities. A 2011 report from the CDC estimates that Campylobacter causes approximately 845,000 illnesses in the United States each year.
Campylobacter is found most often in food, particularly in chicken. Food is contaminated when it comes into contact with animal feces. Any raw poultry may contain Campylobacter, including organic and “free range” products. In fact, studies have found Campylobacter contamination on up to 88 percent of chicken carcasses. Despite the commonness of Campylobacter, however, infections are usually isolated events, and widespread outbreaks are rare.
Two age groups are most commonly affected by Campylobacter: children under 5 years of age and young adults aged 15-29...more information

C. botulinum in improperly home canned foods (in children under 1 year of age, mostly from honey but also from corn syrup)

Symptoms weakness, blurred vision, sensitivity to light, double vision, paralyzed eye nerves,difficulty speaking and swallowing, paralysis that spreads downward, respiratory failure, death.
Click here for more information

Clostridium perfringens(C. perfringens) in meat and poultry dishes and gravies, mostly foods that were cooked more than 24 hours before eating and were not reheated well enough.

Symptoms of C. perfringens- Persons infected with C. perfringens develop watery diarrhea and abdominal cramps within 6 to 24 hours (typically 8-12). The illness usually begins suddenly and lasts for less than 24 hours. Persons infected with C. perfringens usually do not have fever or vomiting. The illness is not passed from one person to another.

Clostridium perfringens

What is Clostridium perfringens?
Clostridium perfringens (C. perfringens) is a spore-forming gram-positive bacterium that is found in many environmental sources as well as in the intestines of humans and animals. C. perfringens is commonly found on raw meat and poultry. It can survive in conditions with very little or no oxygen. C. perfringens produces a toxin that causes illness.

How common is C. perfringens food poisoning?
C. perfringens is one of the most common causes of foodborne illness in the United States. It is estimated that it causes nearly a million cases of foodborne illness each year...more information

Cirrhosis and Vibrio vulnificus Infection
Vibrio vulnificus Infection: Vibrio vulnificus is an organism that lives in salt-water, particularly in the Southeast Atlantic and the waters of the Gulf of Mexico. However, infections have been reported from all coastal areas in the United States. This infection can be acquired by eating raw or poorly cooked seafood (raw oysters, sushi) or by going in sea water with open skin sores. In patients with cirrhosis this infection can be lethal. Patients with cirrhosis should not eat raw seafood and should abstain from going in the ocean if open sores are present.

Download a PDF of this fact sheet
The Risk of Eating Raw Oysters or Clams Brochure

Fish poisoning causes nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache.

Common types of fish poisoning include:
Scombroid poisoning from bacteria in dark meat fish (tuna, bonito, skipjack, mahi-mahi, mackerel) that are not refrigerated well

Specific types of fish poisoning can cause other signs and symptoms, such as:

Ciguatera poisoning in tropical fish (grouper, surgeonfish, snapper, barracuda, moray eel, shark) that have eaten toxic plankton

Symptoms;Ciguatera (caused by toxins in some fish, including grouper, snapper, mackerel, and barracuda): numbness or tingling around the mouth, feeling of loose teeth, impaired touch sensation of hot as cold and cold as hot, itching, muscle and joint pain, slow heart rate, low blood pressure

Puffer fish poisoning from the organs and flesh of puffer fish

Symptoms- Pufferfish poisoning: numbness or tingling around the mouth, trouble coordinating movement, difficulty swallowing, excess saliva, twitching, loss of ability to talk, convulsions, paralysis that spreads upward, respiratory failure, death

Poisoning from shellfish that feed on certain algae

Symptoms- Shellfish poisoning (caused by toxins in algae that are then eaten by shellfish): numbness or tingling around the mouth or in the arms and legs, trouble swallowing, difficulty speaking.

Mushroom Poisoning

Mushroom poisoning occurs from eating wild poisonous mushrooms, especially Amanita phalloides.

Symptoms -Mushroom poisoning: affects the liver, the neurological system (brain), or the gastrointestinal tract, including symptoms such as stomach upset, delirium (confusion), vision difficulties, heart muscle problems, kidney failure, death of liver tissue, and death if left untreated

CDC-Foodborne diseases in the United States

Data and Methodological Differences, 2011 and 1999

The 2011 estimates of illnesses, hospitalizations, and deaths from foodborne disease in the United States reflect improvements made since 1999 in data quality and methodology. Perhaps most importantly, these new estimates identify and rank the most important bacteria, viruses and parasites (“pathogens”) responsible for causing foodborne illness. Going forward, CDC will use the 2011 data to develop estimates of the proportion of illnesses that can be attributed to specific foods. These more specific estimates can further inform policy and regulatory priorities to prevent future illnesses.

The following table highlights the major differences in data and methodology between the new estimates and those published in 1999, and how they affect the estimates of illnesses, hospitalizations, and deaths from foodborne diseases in the United States.

1999 Estimate 2011 Estimates Effects of Differences
2011 estimate of acute gastroenteritis illnesses: more precise

Used 1996–1997 FoodNet Population Survey and data from US studies done before 1980 Used three most recent FoodNet surveys conducted in 2000–2001, 2002–2003, and 2006–2007

5 times larger = 2011 sample size (>48,000) compared with 1999 estimates. Larger sample size resulted in more precise data.

Stricter definition reduced rate of acute gastroenteritis.

Greater number of respondents excluded reduced rate of acute gastroenteritis.

Respondents reporting any vomiting included in definition of acute gastroenteritis Respondents reporting vomiting for <1 day or whose illness did not restrict activities excluded from definition of acute gastroenteritis.
25% = Proportion of respondents excluded from estimate of acute gastroenteritis because they reported cough or sore throat 38% = Proportion of respondents excluded from estimate of acute gastroenteritis because they reported cough or sore throat
0.79 = Rate of acute gastroenteritis per person per year 0.60 = Rate of acute gastroenteritis per person per year 211 million in 1999 reduced to 178.8 million in 2011 = Decline in the estimate of the total number of acute gastroenteritis illnesses

2011 estimate focused on foodborne illnesses acquired in the United States
Included international travel–related illnesses. Excluded international travel–related illnesses. Estimates were limited to foodborne illnesses that were domestically acquired, which reduced the number of foodborne illnesses in 2011 vs 1999.
2011 estimate showed decline in proportion of illnesses determined to be foodborne
40% = Proportion of norovirus illnesses estimated to be foodborne 26% = Proportion of norovirus illnesses estimated to be foodborne

Because norovirus causes a large number of illnesses, this reduction resulted in a big drop in the proportion of illnesses from all known gastroenteritis pathogens estimated to be foodborne, which in turn reduced the proportion of unspecified illnesses that were estimated to be foodborne.

76 million in 1999 to 47.8 million in 2011 = Decline in the overall estimate of foodborne illnesses (Also due to a lower estimate of acute gastroenteritis)

36% = Proportion of known gastroenteritis pathogens and the unspecified agents estimated to be foodborne 25% = Proportion of the known gastroenteritis pathogens and the unspecified agents estimated to be foodborne
2011 estimate of illnesses caused by known pathogens: more accurate
15% = Proportion of survey respondents with bloody diarrhea seeking medical care 35% = Proportion of survey respondents with bloody diarrhea seeking medical care Higher, more accurate estimate of medical care-seeking was used in multipliers to correct for under-diagnosis, resulting in lower illness estimates for known pathogens.
12% = Proportion of respondents with non-bloody diarrhea. 18% = Proportion of survey respondents with nonbloody diarrhea seeking medical care
2011 estimate used "adjustment” multipliers specific for each pathogen
Generic multipliers used to adjust for underreporting based on similarity of symptoms for known pathogens. Pathogen-specific multipliers used to adjust for under-reporting and under-diagnosis. Pathogen-specific multipliers resulted in more precise estimates.
2011 estimate modeled uncertainty for generation of estimates
Point estimates calculated without modeling of uncertainty. Modeled uncertainty for each estimate, resulting in credible intervals for each number. Credible intervals indicate a 90% probability that the actual numbers fall within the stated ranges.

The 10 riskiest foods in America

Leafy greens top the list of FDA-regulated foods that can make you ill

Source- MSNBC Published in 2009

  • U.S. consumers have been bombarded with reports of contaminated food in recent years, from salmonella in peanut butter and spinach to E. coli in cookie dough and ground beef. Individually, the outbreaks are alarming, but collectively, they represent what the consumers' group Center for Science in the Public Interest calls "a perfect storm of unsafe food." A new CSPI report finds that the top 10 riskiest foods regulated by the federal Food and Drug Administration accounted for nearly 40 percent of all foodborne outbreaks in the U.S. between 1990 and 2006, spawning nearly 50,000 illnesses with symptoms ranging from stomach cramps and diarrhea to kidney failure and death. Using data from the Centers for Disease Control and Prevention, researchers tracked more than 1,500 separate, definable outbreaks involving not only high-risk foods like meat and dairy, but staples of a healthy diet, such as fruits and vegetables. These outbreaks are only the tip of the iceberg of foodborne illness. For every case of salmonella poisoning reported, for instance, the CDC estimates that another 38 cases go unreported.

  • Leafy greens
    Image: salad

    Can salad really be bad for you?
    Although considered a healthy food, nutritious greens can also be coated in disease-causing germs. The Center for Science in the Public Interest identified 363 separate outbreaks linked to leafy greens, making them the No. 1 entry on the top 10 list of riskiest FDA-regulated foods. Salads and other food items containing leafy greens — iceberg lettuce, romaine lettuce, leaf lettuce, butter lettuce, baby leaf lettuce, escarole, endive, spring mix, spinach, cabbage, kale, arugula or chard — accounted for 24 percent of the outbreaks, which sickened at least 13,568 people. Another pathogen appearing frequently in leafy greens is norovirus, which was linked to 64 percent of the outbreaks in leafy greens. Salmonella was responsible for another 10 percent. Contamination may be present from production and processing or through improper handling, such as inadequate handwashing.


    Eggs, a popular high-protein breakfast food, have been linked to 352 outbreaks. The majority of illnesses from eggs are associated with salmonella, which sickened 11,163 people from 1990 to 2006. Salmonella lives in the intestinal tracts of animals and birds and is transmitted to humans when animal feces contaminate a food item of animal origin (such as eggs). Regulations implemented in the 1970s have reduced salmonellosis infections. However, salmonella enteritidis, the most prevalent type of salmonella in eggs today, infects the ovaries of otherwise healthy hens and contaminates the eggs before the shells are formed. New regulations issued in July 2009 require the adoption of controls aimed at minimizing salmonella enteriditis in egg production. While proper cooking should destroy most pathogens, serving eggs raw – or "runny" – or leaving egg dishes at improper holding temperatures (such as on a breakfast buffet) can allow the salmonella to multiply.

  • Tuna

    Image: tuna

    Many consumers are familiar with warnings about tuna and methylmercury, but the fish has also been implicated in 268 outbreaks and 2,341 reported cases of foodborne illness. Tuna has been linked to scombroid, the illness caused by scombrotoxin. Fresh fish decay quickly after being caught and, if stored improperly, begin to release natural toxins that are dangerous for humans. Adequate refrigeration and handling can slow this spoilage, but the toxin cannot be destroyed by cooking. Symptoms of scombroid poisoning can include skin flushing, headaches, abdominal cramps, nausea, diarrhea, palpitations and loss of vision. In addition to scombrotoxin, norovirus and salmonella can also be related to tuna consumption. More than 65 percent of outbreaks linked to tuna occurred in restaurants.

  • Oysters

    Image: Oysters

  • Contaminated oysters can ruin more than just a gourmet dinner. Oysters have been linked to 132 outbreaks, with 3,409 reported cases of illness. Not surprisingly, the majority of outbreaks from oysters occurred in restaurants. Illnesses from oysters occur primarily from two sources: norovirus and vibrio. Although norovirus in other foods is usually associated with improper handling, oysters actually can be harvested from waters contaminated with norovirus. When served raw or undercooked, those oysters can cause gastroenteritis, an inflammation of the stomach and small or large intestines. Vibrio, a type of bacterium in the same family as cholera, can cause a severe illness, particularly in those with a compromised immune system, characterized by fever and chills, septic shock and blistering skin lesions and can even be fatal.


    Image: potatoes

    Potatoes, often in the form of potato salad, were linked to 108 outbreaks, with 3,659 consumers reported to have been sickened by spuds since 1990. Salmonella is the most common pathogen, associated with nearly 30 percent of outbreaks, followed by E. coli at 6 percent. The presence of salmonella and E. coli in potato dishes could indicate cross-contamination from raw or cooked ingredients or possibly from raw meat or poultry during handling and preparation. Shigella and listeria also appear in outbreaks associated with potatoes. More than 40 percent of potato outbreaks were linked to foods prepared in restaurants and food establishments (including grocery stores and delis).


    Image: brie

    Cheese has been linked to 83 outbreaks involving 2,761 reported cases of illness since 1990, with salmonella the most common hazard. Cheese can become contaminated with pathogens during production or processing. Most cheeses are now made with pasteurized milk, lowering the risk of contamination. In August, California officials warned consumers about eating Latin American-style cheeses such as queso fresco or queso Oaxaca, which may be made by unlicensed manufacturers using unpasteurized milk that could contain harmful bacteria. Pregnant women should be particularly cautious about consumption of soft cheeses such as feta, brie, camembert, blue-veined and Mexican-style cheese, which can carry listeria. Listeriosis infection can lead to miscarriage. For the elderly, listeria can cause severe illnesses, with high rates of hospitalization and death

    Ice cream

    Image: Ice cream cone

    Whether served in a cone or in a cup, America's favorite frozen treat occasionally can carry a load of dangerous bacteria. Ice cream has been linked to 74 outbreaks involving 2,594 reported cases of illness from pathogens such as salmonella and staphylcoccus since 1990. Soft ice cream can be particularly hazardous to pregnant women. Listeria can survive on metal surfaces — such as the interior of soft ice cream machines — and may contaminate batch after batch of products.

    Image: Tomatoes

    Although tomatoes were wrongly implicated in a sweeping 2008 outbreak later linked to fresh jalapeno and Serrano peppers, they have caused at least 31 identified outbreaks and sickened 3,292 since 1990. The most common hazard associated with tomatoes is salmonella, which accounted for more than half of the reported outbreaks. Salmonella can enter tomato plants through the roots or flowers and can enter the tomato fruit through small cracks in the skin, the stem scar or the plant itself. Restaurants were responsible for 70 percent of all illnesses associated with tomatoes.


    Image: Sprouts

    Sprouts are a popular way to add crunch to salads and in Asian dishes. As the popularity of sprouts increases, however, so too does the potential for foodborne illnesses. Sprouts have been implicated in 31 outbreaks involving 2,022 reported cases of illness since 1990. The CDC and the FDA recommended in 1999 that people at high risk for complications from salmonella and E. coli — such as the elderly, young children, and those with compromised immune systems — not eat raw sprouts. The most likely source of sprout contamination is the seeds that are used to grow the sprouts. Seeds may become contaminated in the field or during storage, and the warm and humid conditions required to grow sprouts are ideal for the rapid growth of bacteria.

    • Berries
      Image: strawberries

      Strawberries, raspberries, blackberries and other berry products have caused 25 outbreaks and sickened 3,397 since 1990. In 1997, more than 2.6 million pounds of contaminated strawberries were recalled after thousands of students across several states reported illnesses from eating frozen strawberries in their school lunches. Hepatitis A was the culprit, and contamination may have occurred through an infected farm worker, according to the CSPI report. That same year, raspberries imported from Guatemala and Chile were implicated in a cyclospora outbreak across five states. The resulting infection is a parasitic illness of the intestines, which can cause severe diarrhea, dehydration and stomach cramps and requires treatment with antibiotics.

      — Center for Science in the Public Interest

    Friday, September 23, 2011

    FDA-Five more states had Listeria-tainted cantaloupes

    Five more states had Listeria-tainted cantaloupes, FDA says

    September 22, 2011
    By Keith Coffman

    DENVER (Reuters) - Listeria-tainted cantaloupes were shipped to five more states than was previously known, bringing to 22 the total number of states affected by an outbreak that killed eight people, the FDA said on Thursday.

    So far, a total of 55 people in 10 states have been infected from the tainted cantaloupe, with the highest number of patients seen in Colorado where the fruits were grown, said the Centers for Disease Control and Prevention.

    Not all the states that received shipments of the fruits appear to have seen infections.
    Officials have traced the outbreak to cantaloupe grown at Colorado-based Jensen Farms Inc and sold under the brand name Rocky Ford. The company has voluntarily recalled its cantaloupe shipped between July 29 and September 10, the Food and Drug Administration said in a statement.

    This is the deadliest U.S. outbreak since a number of salmonella infections killed nine people in 2008 and 2009, Russell said.

    The number of Listeria infections from the food-borne illness could easily rise, said Lola Russell, spokeswoman for the CDC.

    "We could see more because it can be in a person's system for up to two months before it presents itself," she told Reuters.

    The Food and Drug Administration last week identified 17 states affected by the outbreak.
    But on Thursday, the agency said 22 states were affected. The additional states were: Arkansas, California, Idaho, Ohio and Oklahoma, the FDA said.

    Listeria monocytogenes, the bacterial strain found in the tainted cantaloupe, thrives at low temperatures, the CDC said on its website.

    Infection can be particularly dangerous for elderly people, pregnant women and patients with weakened immune systems, health officials said.

    Russell said it is unusual for Listeria outbreaks to be linked to fresh produce, and often deli meats are the culprit. This is the first outbreak traced to cantaloupes, she said.
    Previous Listeria outbreaks linked to produce were traced to sprouts and celery.
    (Writing by Alex Dobuzinskis; Editing by Jerry Norton)

    Reuters Health
    (c) Copyright Thomson Reuters 2011. Check for restrictions at:

    Tuesday, August 30, 2011

    Mythbusters: Learn the Truth about Food Safety in Your Home

    Mythbusters: Learn the Truth about Food Safety in Your Home
    By Howard Seltzer, National Education Advisor, Center for Food Safety and Applied Nutrition, FDA

    It’s September, so it’s time for us to bust some myths.
    Beginning in the mid-90’s, National Food Safety Education Month has focused public attention on safe food handling and preparation. Since 2009, the U.S. Department of Agriculture, the Food and Drug Administration, and the Centers for Disease Control and Prevention, in cooperation with the non-profit Partnership for Food Safety Education, have marked the occasion by exposing myths about food safety that somehow keep cropping up.

    Food safety myths may not sound very serious. But they may cause food handling mistakes that can lead to food poisoning, severe illness, and even death. So it’s important to get the facts straight.

    Here are the myths — and the facts — for 2011:
    Myth: I eat a vegetarian diet, so I don't have to worry about food poisoning.
    Fact: Fruits and vegetables are an important part of a healthy diet. But justlike other foods they carry a risk of foodborne illness. Always rinse produce under running tap water, including fruits and vegetables with skins and rinds that are not eaten. Never use detergent or bleach to wash fresh fruits or vegetables as these products are not intended for consumption. Packaged fruits and vegetables labeled “ready-to-eat” or “washed” don’t need to be re-washed. Learn more tips at:

    Myth: Freezing foods kills harmful bacteria that can cause food poisoning (also called foodborne illness).
    Fact: Bacteria can survive freezing temperatures. Freezing food is not a method for making foods safe to eat. When food is thawed, bacteria can still be present and may begin to multiply. Cooking food to the proper internal temperature is the only way to kill harmful bacteria. Use a thermometer to measure the internal temperature of cooked foods. See the chart at:

    Myth: Locally grown, organic foods will never give me food poisoning.
    Fact: Any food from any source can become unsafe if it is not handled and stored properly. Consumers in their homes can take action to keep themselves and their families safe. That is why it is important to reduce your risk of food poisoning by practicing the four steps to food safety: Clean, Separate, Cook, and Chill. Learn more about these steps at:

    Myth: Plastic or glass cutting boards don't hold harmful bacteria on their surfaces like wooden cutting boards do.
    Fact: Regardless of the type of cutting board you use, it should be washed and sanitized after each use. Solid plastic, tempered glass, sealed granite, and hardwood cutting boards are dishwasher safe. However, wood laminates don’t hold up well in the dishwasher. Once cutting boards of any type become excessively worn or develop hard-to-clean grooves, they should be discarded.

    Mythbusters of past years can be found at

    Monday, August 15, 2011

    National Beef recalls 60,424 lbs ground beef for e.coli

    CHICAGO Mon Aug 15, 2011 5:30am BST

    CHICAGO (Reuters) - The U.S. Department of Agriculture said National Beef Packing Co has recalled about 60,424 pounds of ground beef products after inspection at an Ohio processing plant produced suspicions of contamination by e.coli 0157:H7 bacteria.

    USDA and the company, which is based is Dodge City, Kansas, have received no reports of illnesses associated with consumption of these products.

    The beef was shipped to distributors nationwide for further processing and distribution, USDA said in a statement.

    Winn-Dixie Stores, of Jacksonville, Florida, said it issued its own recall to customers tied to the National Beef recall, saying some of the beef affected was sold in its stores in Florida, Georgia, Alabama, Mississippi and Louisiana. The beef had "sell by" dates of July 31 to August12, it said.

    Colorado Sam's Club stores have also been contacting members who may have recently purchased beef included in the recall, Christi Davis Gallagher, a spokesperson for Sam's Club, told the Colorado Springs Gazette.

    The problem was discovered as a result of routine microbial testing conducted by the Ohio Department of Agriculture at a state-inspected facility that had purchased these products for further processing, USDA said.

    Each box and chub bears the establishment number "Est. 262" within the USDA mark of inspection. The products listed above may have been repackaged into consumer-size packages and sold under different retail brand names.

    E.coli O157:H7 is a potentially deadly bacterium that can cause diarrhea, dehydration and, in the most severe cases, kidney failure. Young children, seniors and people with weak immune systems are most susceptible to the bacteria, USDA said.

    Food experts advise consumers to only consume ground beef cooked to a temperature of 160 degrees, which is high enough to kill any harmful bacteria.

    (Editing by Peter Bohan)

    Monday, August 8, 2011

    Turkey recall raises U.S. food safety questions

    Turkey recall raises U.S. food safety questions

    By Lisa Baertlein
    LOS ANGELES Fri Aug 5, 2011 5:19pm EDT
    LOS ANGELES (Reuters) - U.S. food safety advocates are calling for changes to meat recall rules after regulators took months to warn the public about a Salmonella outbreak that has sickened nearly 80 people and caused one death.
    Cargill Inc, one of the largest U.S. meat producers, on Wednesday recalled roughly 36 million pounds of fresh and frozen ground turkey produced at its plant in Springdale, Arkansas, after investigators linked the meat to a person who became ill with antibiotic-resistant Salmonella Heidelberg.

    A government agency that tracks antibiotic-resistant pathogens found evidence of the contamination in Cargill ground turkey in early March, and the five-month lapse of time between that discovery and the recall has sparked a renewed debate about how the United States protects the public from tainted meat.

    And the company said on Friday that Salmonella Heidelberg was detected at the Springdale plant even earlier than that March discovery.

    Routine regulatory testing at the plant in June and July of 2010 found Salmonella Heidelberg on the surface of turkey before it was ground, Cargill spokesman Mike Martin said, but "no corrective action was required because of the low level found." Martin added that Salmonella Heidelberg is one of the most common of the 2,400-plus strains of Salmonella
    Cargill's turkey recall was the third-largest meat recall in U.S. history. More importantly, it is the biggest-ever Class I recall -- which the government defines as "a health hazard situation in which there is a reasonable probability that eating the food will cause health problems or death."
    "While determining the food source can be very challenging in an outbreak like this, I think the government unduly delayed in getting both information to the company and in issuing a public warning and recall," said Caroline Smith DeWaal, food safety director at the Center for Science in the Public Interest (CSPI), a consumer group.

    Routine sampling by the National Antimicrobial Resistance Monitoring System (NARMS) turned up the outbreak strain in four ground turkey samples purchased from four retail stores between March 7 and June 27. That information made its way to regulators, but it took several months for investigators to definitively link the contaminated meat to reports of human illness, which also began surfacing in March.

    Poultry and many other meats are regulated by the U.S. Department of Agriculture, which cannot move to recall a tainted product until a link to illness has been made.
    One of the few exceptions to that is the finding of the particularly lethal bug E. coli O157 in meat, which starts the recall process.

    Food safety attorney Bill Marler told Reuters that a "more logical approach" would be for USDA to adopt recall procedures like those used at the U.S. Food and Drug Administration.
    FDA regulates about 80 percent of the U.S. food supply, including lettuce and other produce. It can push companies to recall a food that tests positive for a disease-causing pathogen, even if no illness has been reported.

    Roughly 10 to 15 percent of ground turkey in the United States is contaminated with Salmonella, which has proved one of the toughest pathogens to contain in the country's food supply, experts said.

    DeWaal, of CSPI, has petitioned USDA to add Salmonella Heidelberg and three other antibiotic-resistant strains linked to prior outbreaks to its list of "adulterants," joining the deadly E. coli O157. That step would make selling food products that contain those pathogens illegal under federal law.

    Attorney Marler also has urged USDA to extend adulterant status to all Shiga toxin-producing E. coli strains other than 0157. Such a strain was implicated in two deadly outbreaks that killed more than 50 people and sickened more than 4,400 others in Europe and North America.
    "USDA should take action before people get sick, and require controls and testing for these pathogens before they reach consumers," DeWaal said.
    While there were suggestions of a link between ground turkey and Salmonella Heidelberg illness as early as May, investigators didn't catch a break until July, when they found an opened package of the meat in the home of a patient.

    Test results on July 29 confirmed the connection. USDA's Food Safety and Inspection Service issued a public alert and contacted Cargill.

    The July 29 public notice, which warned of "an association" between eating ground turkey products and Salmonella Heidelberg infection, did not name the meat producer.
    The Centers for Disease Control and Prevention also did not reveal the producer in its public announcement about the outbreak on August 1 -- even though preliminary information suggested that three of the four tainted samples found by NARMS came from the same production facility.

    "Clearly the government needs to decide on an approach for using information from NARMS when there is a clear public health benefit from doing it," DeWaal said.
    The Salmonella Heidelberg outbreak also has renewed calls for curbing the practice of feeding healthy animals low doses of antibiotics to speed growth.
    Salmonella Heidelberg cannot be treated with some common antibiotics, including ampicillin, tetracycline and streptomycin, which CDC said may explain higher hospitalization rates than what are seen in other Salmonella outbreaks.

    "This outbreak offers stark casualties from our collective failure to keep antibiotics out of animal feed," said Steven Roach, Public Health Program Director at Food Animal Concerns Trust and a member of the group Keep Antibiotics Working.
    (Editing by Gary Hill)

    Sunday, August 7, 2011

    Escherichia coli, detected in 94% of retail chicken meat samples in the Netherlands

    These findings suggest transmission of ESBL-producing E. coli from poultry to humans through the food chain. The extremely high prevalence of ESBL-producing bacteria in retail chicken meat is alarming and is probably not restricted to the Netherlands. This situation calls for perfect hygiene when handling poultry meat — and also for a ban on antibiotic use in food animals.

    ESBL-Producing Bacteria — From Chicken
    Extended-spectrum β-lactamase–producing Escherichia coli, detected in 94% of retail chicken meat samples in the Netherlands, is probably transmitted through the food chain to humans.

    Recent years have seen an alarming worldwide rise in the incidence of infections caused by multidrug-resistant gram-negative bacteria that produce extended-spectrum β-lactamases (ESBLs). Now, researchers in the Netherlands have used molecular methods to examine the relation among ESBL-producing bacteria in retail chicken meat, in poultry isolates from a prevalence survey, and in human patients.

    Ninety-eight fresh, raw chicken breasts bought in 12 stores in Utrecht in 2010 were sampled. ESBL-producing Escherichia coli was isolated from 92 (94%) of the samples (total, 163 isolates). Further analysis of 81 isolates from 42 samples revealed genes from six ESBL groups. Taken together, blaCTX-M-1 and blaTEM-52 — both considered "poultry associated" — accounted for 75% of these genes.

    A similar distribution (but lower frequency) of ESBL-producing bacteria was seen in a prevalence survey of poultry in the Netherlands in 2006. Ten percent of E. coli and Salmonella enterica isolates from poultry harbored ESBL genes, with blaCTX-M-1 and blaTEM-52 together accounting for 78% of these genes.

    ESBL-producing E. coli isolates from humans, submitted by 31 Dutch laboratories between February and April 2009, were also analyzed. Of these 409 isolates, 35% contained poultry-associated ESBL genes and 19% contained poultry-associated ESBL genes located on plasmids; again, blaCTX-M-1 and blaTEM-52 were the most prevalent (taken together, 86%).

    Comment: These findings suggest transmission of ESBL-producing E. coli from poultry to humans through the food chain. The extremely high prevalence of ESBL-producing bacteria in retail chicken meat is alarming and is probably not restricted to the Netherlands. This situation calls for perfect hygiene when handling poultry meat — and also for a ban on antibiotic use in food animals.

    Thomas Glück, MD
    Published in Journal Watch Infectious Diseases August 3, 2011

    Leverstein-van Hall MA et al. Dutch patients, retail chicken meat and poultry share the same ESBL genes, plasmids and strains. Clin Microbiol Infect 2011 Jun; 17:873.
    Medline abstract (Free)

    Tuesday, August 2, 2011

    CDC: 1 death, 76 illnesses linked to ground turkey

    CDC: 1 death, 76 illnesses linked to ground turkey
    By MARY CLARE JALONICK Associated Press

    WASHINGTON (AP) -- Federal officials say one person has died from salmonella poisoning that appears to be linked to eating ground turkey, but the government so far has declined to say who produced the meat or initiate a recall.

    Seventy-six people in 26 states have been made sick from the same strain of the disease, which the federal Centers for Disease Control and Prevention says is resistant to many commonly prescribed antibiotics. The CDC did not say where the person who died became sick and released no details about the death.

    The illnesses date back to March, and the CDC said Monday that cultures of ground turkey from four retail locations between March 7 and June 27 showed salmonella contamination. The agency said preliminary information showed that three of the samples have been linked to the same production establishment but did not name the retailers or the manufacturers.

    The Agriculture Department oversees meat safety and would be the agency to announce a recall. The department sent out an alert about the illnesses late last week telling consumers to properly cook their turkey, which can decrease the chances of salmonella poisoning. But the department has not given consumers any further warnings about the source of the tainted meat.
    The USDA has not responded to requests for comment on why there has not been a recall. The CDC said it and the USDA were "vigorously working to identify the specific contaminated product or products that are causing illnesses and will update the public on the progress of this investigation as information becomes available."

    Food safety advocate Bill Marler, an attorney who has represented victims of the nation's biggest food-borne illness outbreaks, said he believes the three positive samples should prompt a recall.

    "Consumers have no idea what to do except not eat ground turkey," he said.
    The illnesses are spread all over the country. The states with the highest number sickened were Michigan and Ohio, 10 illnesses each, while nine illnesses were reported in Texas. Illinois had seven, California six and Pennsylvania five.

    The remaining states have between one and three reported illnesses linked to the outbreak, according to the CDC: Alabama, Arizona, Georgia, Iowa, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, Nevada, Oklahoma, Oregon, South Dakota, Tennessee and Wisconsin.

    The CDC said 26 states were affected but only listed 25 states in which illnesses were reported in a news release issued Monday evening.

    A chart on the CDC's website shows cases have occurred every month since early March, with spikes in May and early June. The latest reported cases were in mid-July, although the CDC said some recent cases may not have been reported yet.
    University of Pennsylvania bioethicist Art Caplan said the government's handling of the outbreak raises ethical questions about why the public wasn't warned sooner.
    "You've got to protect the public health. That's their first and primary value - not industry, not any other goal. They have to warn as quickly as they think there's reasonable evidence for concern," Caplan said.

    He said that uncertainty about the outbreak's source might explain the long silence, but added, "the moral duty is to really get the word out as soon as you have evidence of a problem."
    CDC spokeswoman Lola Russell said Tuesday it can take three to four weeks to confirm one case. Identifying an outbreak can take considerably longer than that when cases of foodborne illness occur sporadically, in several states, as has happened in the current outbreak, shel said.
    Russell said the CDC isn't advising the public to avoid eating ground turkey, but does urge people to cook it properly.

    Ground turkey is considered safe to eat when the internal temperature reaches 165 degrees. For turkey patties or burgers, internal temperatures on each side should be measured.

    Other government advice:
    -Refrigerate raw meat and poultry within two hours after purchase, one hour if temperatures in the house exceed 90 F.
    -Refrigerate cooked meat and poultry within two hours after cooking.
    -Wash hands with warm, soapy water for at least 20 seconds before and after handling raw meat and poultry.

    The CDC estimates that 50 million Americans each year get sick from food poisoning, including about 3,000 who die. Salmonella causes most of these cases and federal health officials say they've made virtually no progress against it.
    The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight hours to 72 hours of eating a contaminated product. It can be life-threatening, especially to those with weakened immune systems.
    One of the largest outbreaks last year involved salmonella-tainted eggs that may have sickened as many as 56,000. About 2,000 illnesses were reported, but CDC estimates that only a fraction of illnesses are reported in most outbreaks.
    AP Medical Writer Lindsey Tanner contributed to this story from Chicago.
    CDC info on salmonella in ground turkey:
    Find Mary Clare Jalonick on Twitter at
    © 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Learn more about our Privacy Policy and Terms of Use.

    Saturday, May 7, 2011

    Listeria Risk For Patients With Underlying Medical Problems

    In the news today came this warning from the CDC;

     Sandwich lovers listen up!

    The Centers For Disease Control are issuing a warning, specifically for those age 50 and up. The CDC says you need to cook your sandwich meat before you eat it.

    Laurence Burnsed with the State Department of Health says, "Be sure to cook lunch meats and hot dogs to a hot steamy temperature of over 160 degrees before consuming them."

    Listeria can be potentially harmful for the elderly and individuals with the following medical problems; diabetes, immunocomprised adults , leukemia, AIDS, hogkins disease, systemic lupus erythematosus, liver disease, transplant recipients and pregnant women.

    Cancer Patients at Five-Fold Risk of Listeria Infection

    In 2010 research by the United Kingdom Health Protection Agency has shown that cancer patients have a five-fold increased risk of developing listeria than people with other underlying conditions - and those those with cancers of the blood have the greatest risk. These findings are published in the journal of Emerging Infectious Diseases.

    Listeriosis is a rare but serious foodborne illness caused by the bacterium Listeria monocytogenes. Some groups of people can be more seriously affected by this type of food poisoning than others. Pregnant women and their unborn or newborn babies are at most risk, as well as the elderly and those with conditions that affect their immune system.

    In addition to cancer, diseases of the liver, kidney and connective tissue (e.g. Lupus) as well as alcoholism, diabetes, high blood pressure and inflammation of the intestines (e.g. Crohn's disease) were also found to increase the risk of developing listeria.

    Those receiving cancer treatment or suffering from a variety of conditions, including diabetes, kidney or liver disease, should be offered appropriate health advice on how to avoid listeria. At present this is given passively and mainly to pregnant women, but clearly there are other groups of people who need to be advised on what they can do to protect their health.

    Listeria can cause serious illness or even death in those people who have serious underlying health conditions. Taking steps to avoid infection is a very important part of managing their health and these groups need to be made aware of how they should do this.

    The current public health advice to vulnerable groups on preventing listeria is to avoid the following:

    - Prepacked or delicatessen sliced meats
    - Soft cheeses - brie, camembert and chevre (goat's cheese)
    - Smoked fish
    - All kinds of pate including vegetable varieties
    - Pre-prepared cooked and chilled meals
    - Pre-prepared sandwiches
    - Unpasteurized milk

    Listeria monocytogenes
    Listeria monocytogenes is commonly found in soil, stream water, sewage, plants, and food  Listeria are known to be responsible for listeriosis, a rare but potentially lethal food-borne infection. The case fatality rate for those with a severe form of infection may approach 25%. (Salmonella, in comparison, has a mortality rate estimated at less than 1%[ Although Listeria has low infectivity, it is hardy and is able to grow in temperatures ranging from 4°C (39°F) (the temperature of a refrigerator), to 37°C (99°F), (the body's internal temperature). Listeriosis is a serious illness, and the disease may manifest as meningitis, or affect newborns due to its ability to penetrate the endothelial layer of the placenta  Vegetables can become contaminated from the soil, and animals can also be carriers. Listeria has been found in uncooked meats, uncooked vegetables, unpasteurized milk, foods made from unpasteurized milk, and processed foods.Pasteurization and sufficient cooking kill Listeria; however, contamination may occur after cooking and before packaging. For example, meat-processing plants producing ready-to-eat foods, such as hot dogs and deli meats, must follow extensive sanitation policies and procedures to prevent Listeria contamination.

    Thursday, February 24, 2011

    Foodborne Disease in 2011 — The Rest of the Story


    Foodborne Disease in 2011 — The Rest of the Story

    NEJM February 23, 2011 Topics: Drugs, Devices, and the FDA, Public Health
    Michael T. Osterholm, Ph.D., M.P.H.

    Recent media headlines might have you believe that our food supply is substantially more safe than it was a decade ago and about to get even safer. First, on December 15, 2010, the Centers for Disease Control and Prevention (CDC) announced a long-awaited reanalysis of the burden of foodborne illness in the United States and reported a substantial decrease in the estimated incidence of foodborne disease between 1999 and 2011. Then, on January 4, 2011, President Barack Obama signed into law the Food Safety Modernization Act, the first major legislation related to the food-safety authority of the Food and Drug Administration (FDA) since 1938. But as the late radio commentator Paul Harvey would say, “You know what the news is; in a minute, you’re going to hear . . . the rest of the story.”

    As the first set of headlines indicated, the CDC reported a substantial decrease in the estimated incidence of foodborne disease between 1999 and 2011. In 1999, Mead and colleagues published the first comprehensive estimates of foodborne disease in the United States.1 Scallan and colleagues, in two recent articles, detail new estimates of the burden of foodborne disease for 31 known2 and unspecified3 infectious agents. In 1999, it was estimated that annually, foodborne pathogens caused 76 million episodes of illness, 325,000 hospitalizations, and 5000 deaths. On the basis of these estimates, 27% of Americans could expect to have a foodborne illness each year, 115 per 100,000 population would be hospitalized, and almost 2 per 100,000 would die.
    The CDC now estimates that there are approximately 48 million foodborne illnesses, 128,000 hospitalizations, and 3000 deaths per year.

    That means that 15% of Americans can expect to have a foodborne illness annually and that 41 in 100,000 will be hospitalized and 1 in 100,000 will die. However, the authors have strongly cautioned that the 1999 estimates cannot be compared with the current ones for purposes of trend analysis, because different methods and underlying assumptions were used.

    Therefore, we cannot draw inferences from these CDC data about the relative safety of our food supply today, as compared with 12 years ago.

    More reliable trend data for disease incidence are available from the Foodborne Disease Active Surveillance Network (FoodNet) of the CDC’s Emerging Infections Program. FoodNet supports active, population-based surveillance in 10 states for all laboratory-confirmed infections with selected pathogens that are commonly transmitted through food.4 The system has been in place since 1996. It provides a relatively constant measuring stick of the incidence of foodborne disease across geographic areas and over time. Additional data that are collected by local and state health departments participating in FoodNet also help to define routes of exposure to various foodborne pathogens, in part by identifying the roles played by food not typically associated with outbreaks of foodborne disease and food preparation in the risk of disease. These data show that even with improvements made during the past decade, the burden of foodborne disease persists.

    According to a 2010 FoodNet report, which included preliminary data from 2009, rates of infection with shigella, yersinia, Shiga-toxin–producing Escherichia coli (STEC) O157, campylobacter, and listeria were at least 25% lower than they were a decade ago; the rate of infection with salmonella, a bellwether pathogen for foodborne-disease surveillance, was only 10% lower.
    Rates of vibrio infection were substantially higher in 2009 than in the period from 1996 through 1998.4 All these findings, however, must be interpreted with caution, since most of the decreases occurred between 1996 and 2000, and there has been little additional change since then. When the 2009 incidence of infections with the eight primary bacterial and parasitic pathogens is compared with their incidence in the period from 2006 through 2008, no significant change can be seen for six pathogens; only the infection rates with shigella and STEC O157 show significant decreases (see graph).
    In addition, recent studies have demonstrated a significant increase in the incidence of foodborne disease caused by emerging non-O157 STEC, suggesting that surveillance for O157 is no longer sufficient to determine the effect of foodborne STEC infections.

    Percent Change in the Incidence of Laboratory-Confirmed Bacterial and Parasitic Infections from 2006–2007 to 2009, According to Pathogen.

    On the basis of FoodNet data for the past 14 years, we must conclude that the improvements made in the late 1990s in the safety of our food supply are still having a positive effect. But we’ve made little additional progress in the past decade. Although the media and some food producers, processors, wholesalers, and retailers may conclude that the recent CDC estimates offer evidence of major improvements in food safety since 1999, data from active population-based surveillance offer a more nuanced and neutral picture. Moreover, in this issue of the Journal, Barton Behravesh et al. remind us that previously unrecognized vehicles for foodborne disease, such as jalapeño peppers, can cause large nationwide outbreaks. And outbreaks associated with raw produce are among the most difficult ones for public health officials to identify and control, since produce from a single farm may be distributed widely and consumed rapidly because it is perishable.

    So will the Food Safety Modernization Act result in immediate improvements in food safety? The legislation brings long overdue modernization to the FDA’s food-safety activities. It gives the FDA broader authority to regulate food facilities, including authorization to inspect records related to food. It “requires each owner, operator, or agent in charge of a [nonexempt] food facility to identify and implement preventive controls to significantly minimize or prevent hazards that could affect food manufactured, processed, packed, or held by [that] facility.” It also requires the FDA “to issue guidance documents to reduce the risk from the most significant foodborne contaminants” and to “establish minimum standards for the safe production and harvesting of fruits and vegetables based on known safety risks.” It further requires the FDA “to allocate resources to inspect facilities and imported food according to the known safety risks of the facilities or food; and [to] establish a product tracing system to track and trace food that is in the United States or offered for import into the United States.” It gives the FDA authority to order a recall of a food when it is contaminated or implicated in an outbreak.
    Finally, it “requires U.S. importers to perform risk-based foreign supplier verification activities to verify that imported food is produced in compliance with applicable requirements related to hazard analysis and standards for produce safety and is not adulterated or misbranded.”
    Although all these new forms of authority will substantially enhance the FDA’s ability to prevent foodborne disease and respond more effectively when an outbreak occurs, the new law has a major shortcoming: dollars. There was no appropriation approved by the Congress for the act or authorization in the bill for the FDA to assess fees on the companies that it inspects. The Congressional Budget Office estimated that implementing this legislation would require $1.4 billion between 2011 and 2015.5 Though the bill authorizes the FDA to collect fees when a facility requires reinspection and a recall fee for mandatory recalls, these fees are expected to provide minimal resources.
    In short, the actual effect of this important law will at best be extremely limited if Congress and the administration don’t appropriate and sign additional legislation providing the necessary funds to carry out its mandates. Recent reports in the media calling this act “historic legislation” must be tempered by the reality that without the necessary resources, requiring the FDA to carry out the law’s required activities will be like trying to get blood out of a rock. And in the end, food safety in the United States cannot be expected to improve in more than an incremental manner.

    As Paul Harvey would have said, “That’s the rest of the story.”
    This article (10.1056/NEJMp1010907) was published on February 23, 2011, at
    Disclosure forms provided by the author are available with the full text of this article at .

    Source Information
    From the Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis.
    Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis 1999;5:607-625CrossRef Web of Science Medline

    Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States — major pathogens. Emerg Infect Dis 2011;17:7-15Medline

    Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States — unspecified agents. Emerg Infect Dis 2011;17:16-22Medline

    Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food — 10 states, 2009. MMWR Morb Mortal Wkly Rep 2010;59:418-422Medline

    Congressional Budget Office. Senate File 510: Food Safety Modernization Act — as reported by the Senate Committee on Health, Education, Labor, and Pensions. August 12, 2010.