Frozen berries, how I used to love you, and now I cook you

Epidemiological investigations of outbreaks of hepatitis A virus (HAV) and norovirus (NoV) infections in the European Union/European Economic Area (EU/EEA) in the last five years have highlighted frozen berries as a vehicle of infection.

frozen.strawberry-300x225Given the increasing berry consumption in the EU over the last decades, we undertook a review of the existing evidence to assess the potential scale of threat associated with this product. We searched the literature and four restricted-access online platforms for outbreak/contamination events associated with consumption of frozen berries. We performed an evaluation of the sources to identify areas for improvement. The review revealed 32 independent events (i.e. outbreak, food contamination) in the period 1983–2013, of which 26 were reported after 2004. The identified pathogens were NoV, HAV and Shigella sonnei. NoV was the most common and implicated in 27 events with over 15,000 cases reported. A capture–recapture analysis was performed including three overlapping sources for the period 2005–2013.

The study estimated that the event-ascertainment was 62%. Consumption of frozen berries is associated with increasing reports of NoV and HAV outbreaks and contamination events, particularly after 2003. A review of the risks associated with this product is required to inform future prevention strategies.

Better integration of the available communication platforms and databases should be sought at EU/EEA level to improve monitoring, prevention and control of food-borne-related events.

Food-borne diseases associated with frozen berries consumption: A historical perspective, European Union, 1983 to 2013

Eurosurveillance, Volume 20, Issue 29, 23 July 2015

Tavoschi L, Severi E, Niskanen T, Boelaert F, Rizzi V, Liebana E, Gomes Dias J, Nichols G, Takkinen J, Coulombier D.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21193

Clear as mud: Australia hep A outbreak sparks labeling changes but isn’t food safety

Green and gold kangaroo labels will show consumers how much of their food contains local ingredients and whether it was made in Australia, but the changes have been criticised by a consumer advocate for not requiring the origin of non-local ingredients.

MadeInAus_729pxThe new labelling system, which is expected to make food slightly more expensive, followed demands for clearer information on the origin of food products following an outbreak of hepatitis A caused by frozen berries imported from China earlier this year. 

Prime Minister Tony Abbott and Agriculture Minister Barnaby Joyce unveiled the new food labels on Tuesday, saying some businesses would start using them on a voluntary basis before the end of the year.

“If a product has got the green and gold kangaroo triangle, it is made or processed in Australia,” Mr Abbott said. “If the product has the gold bar, the product is Australian.”

The gold bar will display the proportion of local ingredients used in the food product.

From next year, Australian manufacturers will be required to carry the labels, which, are the result of a four-month senate inquiry into country-of-origin food labelling laws. The review was called after 28 people were infected with hepatitis A from frozen berries imported from China in February.

Asked how the labels would help prevent similar future outbreaks, Mr Abbott was quick to distinguish the labels from food safety standards. “Different people might have different views about where you are most likely to be confident in the quality of your food. 

“But they are two separate issues. We are dealing with one. Obviously it is up to the various levels of government to deal with the other.”

Tom Godfrey, a spokesman for consumer group Choice, said manufacturers should make it clear where all their ingredients are sourced from “and take on board the option to list the main ingredients of their products”.

 

Kitchen worker with hepatitis A confirmed at Original Joe’s in Alberta

Alberta Health Services is warning patrons who ate at an Original Joe’s in Strathmore after confirming a kitchen worker has hepatitis A.

original.joesPatrons who consumed food at the restaurant and bar, located at #8, 100 Ranch Market between June 9 to 19, are eligible for a hepatitis A vaccine. Those who only consumed beverages don’t require the vaccine.

The agency has confirmed that one of the restaurant’s kitchen workers contracted the disease, likely while traveling.

Alberta Health says odds are low that the worker has spread the disease but because Hepatitis A can contaminate food, it’s issued a warning to restaurant patrons.

34 sickened: Proposed new Australian food labelling laws released following Hepatitis A outbreak

Food packaging would be stamped with pie or triangle graphs illustrating how much of the product is locally grown under a proposed overhaul of labelling laws.

aust.country.origin.labels.15A two-month consultation study into food labelling regulations has found food can be ‘Made in Australia’ without any Australian ingredients. It also concluded consumers find current laws “confusing and irrelevant” and business considered the existing requirements “burdensome”.

The government initiated the overhaul of food labelling laws in the wake of the contaminated frozen berries scandal in February.

The Department of Industry and Science says the common ‘Made in Australia from local and imported ingredients’ label is meaningless.  It wants to scrap a current accounting production test known as the Safe Harbour Defence, which allows a manufacturer to label their food as Australian made if half the “transformation” or processing has taken place in Australia.

Given the production test includes labour and transport it is often difficult to process a food in Australia made from imported ingredients below the 50 per cent “transformation” threshold, meaning the so-called protection is redundant.

“It appears burdensome for business, yet of little relevance for consumers,” the department’s paper says.

Under new labels being considered, a graphic would included for food partially made in Australia as well as text which would clearly explain what is done in Australia and the proportion of Australian ingredients.

There would be no graphic for imported foods but text would be required to state where the food was manufactured and the origin of ingredients.

Get vaccinated for hep A before an outbreak: Utah restaurant gets support from customers

Keeping with the Utah theme, Cedar City residents have been heading over to The Pizza Cart to support the restaurant, after a food handler working at the restaurant tested positive for Hepatitis A.

pizza.cartLarisa Banks of Cedar City started an event on Facebook for supporters of the The Pizza Cart to come out and enjoy the restaurant on Friday.

“They have the best pizza and a great atmosphere,” she said. “My husband and I are small business owners in town and it is really hard to see another local business get hurt by something that is really out of their control. We just wanted to show our support.”

Banks said she was offended by some of the comments she heard in town – and on Facebook – and wanted to bring more attention that The Pizza Cart is not to blame.

“The whole thing about this (Hepatitis A) case is that it could have literally happened to anyone,” she said. “Any restaurant in town that has people working for them and handling food, it could have happened to them. The Pizza Cart was super classy with their online news release, they have been up front and honest and they took responsibility for everything, so we should support them for it.”

The Pizza Cart owner Cindy Murray, said, “It is unknown how the employee contracted the virus. However, this employee is recovering and will not be returning to work until medically cleared. All of our other employees have received the Hepatitis A vaccination.”

Hepatitis A, frozen berries, and hockey

I’ve been playing, coaching, and even sometimes administering hockey – the ice kind – for almost 50 years.

wayne-gretzky-nseI’ve seen every kind of parent, and as I age, I just pay attention to the kids, and tell the parents, get away from my bench.

So it’s not surprising that my volunteer gig as a food safety helper at the kid’s school didn’t end well.

It was, however, like the time Chapman worked in a restaurant for a month, educational.

Australia has an on-going outbreak of hepatitis A that has sickened at least 34, linked to frozen imported berries.

Europe has had tens-of-thousands-sickened in a different outbreak, and why I now always boil my frozen berries.

When the Australian outbreak hit the news, the person who runs the tuck shop wrote in the school newsletter they “would never use frozen berries.”

This is a common conceit I hear from Brisbane-types, which is convenient living in a sub-tropical climate.

So I wrote to the tuck shop person thingy and said, your unequivocal declaration goes against 150 years of freezing technology, that not everyone lives in a sub-tropical climate (Ontario? Canada?) and that the berries could be safely handled if cooked.

She came back with some stuff about sustainability, and all I could see was every hockey parent who thought their kid was the next Wayne Gretzky.

I grew up with Gretzky.

Food Standards Australia New Zealand has completed a risk statement on hepatitis A virus and imported ready-to-eat (RTE) berries. This statement has been given to the Department of Agriculture which is the enforcement agency for imported food.

 FSANZ uses an internationally recognized approach when assessing food safety risks which involves looking at: 

the likelihood of a food safety issue occurring

the consequence of the food safety issue.

We also look at mitigating factors, e.g. is the product going to be cooked or practices and procedures that can mitigate risk further.

The risk statement concluded that, hepatitis A virus in RTE berries produced and handled under Good Agricultural Practices (GAP) and Good Hygienic Practices (GHP) is not a medium to high risk to public health.

doug.hockey.goalieEffective control strategies minimize contamination at the primary production and food processing points of the supply chain

Regulatory authorities across the world, including those where outbreaks linked to berries or other produce have occurred, agree that hepatitis A virus contamination is best managed through good quality agriculture and hygiene practices throughout the supply chain.

Guidance is widely available on the good agriculture practices and good hygienic practices that focuses on preventing fresh produce becoming contaminated with viruses such as hepatitis A virus. For example, controls over the quality of water and fertilizers used in the field, as well as the hygiene of workers throughout the supply chain.

While there have been outbreaks associated with hepatitis A in ready-to-eat berries, they are infrequent internationally and rare in Australia

Over the last 25 years, there have been six reported outbreaks of hepatitis A associated with eating ready-to-eat berries around the world. A few of these were in Europe (involving mixed berries and strawberries grown and packed in Europe) and one was in New Zealand (involving domestically grown raw blueberries).

While one of these outbreaks was very large, when taken in the context of the amount of berries sold and traded throughout the world and the amount of berries consumed, the frequency of outbreaks is extremely low.

Hepatitis A infection can be incapacitating but it is not usually life-threatening and long-term effects are rare

Not all people exposed to the hepatitis A virus actually get sick. People who become infected might never show any symptoms. Unlike other foodborne illness, it is rare for small children to present with any symptoms. Long-term effects of having the virus are extremely rare and full recovery usually occurs in a number of weeks.

Because of the difficulties in detecting hepatitis A virus in food, there is very little data on level of contamination of ready-to-eat berries, but the evidence that is available suggests it’s very low.

Data on hepatitis A virus contamination are limited, partly because it is very difficult to test for the virus in food. But the data that is available from testing following outbreaks and the incidence of outbreaks themselves suggest contamination is rare.

There are no internationally agreed criteria for testing of berry fruits for the presence of hepatitis A virus.

Testing for E. coli can be used as an indicator of hygienic production. However, the presence of E.coli does not necessarily mean a food is unsafe and it is not a reliable test for the presence or absence of hepatitis A virus.

Hepatitis A virus cannot reproduce (increase in numbers) in RTE berries

Unlike some microorganisms like bacteria, hepatitis A virus doesn’t grow in food, so levels won’t increase during processing, transport and storage.

Many of the foods considered medium to high risk are foods that are associated with the kinds of microorganisms that can quickly multiply in food. These microorganisms are common and known to be responsible for a high number of outbreaks.

What does this advice mean for importers of ready-to-eat berries?

The Department of Agriculture has issued an Imported Food Notice in response to FSANZ’s advice.

What this means is that from 19 May 2015 importers of berries from any country must be able to demonstrate the product has been sourced from a farm using good agricultural practices.

In addition, good hygienic practices must be evident throughout the supply chain.

If not, then the berries could be considered to pose a potential risk to human health.

FSANZ has previously examined the issue of hepatitis A virus in produce following an outbreak in semi-dried tomatoes in 2010. Following that assessment, FSANZ determined that routine testing for viruses in food is of limited use because:

the virus in contaminated food is usually present at such low levels the pathogen can’t be detected by available analytical methods

viruses can be unevenly distributed and a result can be negative but food can still be unsafe

a positive result can come from the presence of genomic material from inactive or non-infectious virus in the food, but this doesn’t mean the virus is active.

What’s happening with the recalled berries?

In February 2015 FSANZ provided preliminary advice to the Department of Agriculture on the frozen berries linked to the outbreak.   

 FSANZ advised the department that current epidemiological evidence and some uncertainty about food safety controls implemented by the supplier of the berries indicates the product is a medium risk to public health until further information becomes available.

 Patties Foods has told regulators about the company’s testing regime for the products in question including:

ground water testing on the field (for microorganisms, salt and chemicals) 

pesticide testing on the field

pesticide and micro testing in the factory (including for E.coli, Salmonella and Listeria)

heavy metal testing in the factory

Further tests including microbiological tests were conducted pre-shipment and post shipment (after the product arrived in Australia).

Patties has initiated a more stringent testing program and has commenced an extensive testing program for the presence of hepatitis A virus in affected product. 

What is being done to ensure all recalled product is off the shelves?

 In Australia, state and territory regulatory authorities are responsible for working with the manufacturer or producer to ensure stock is removed from shelves.

 Victorian authorities who are managing this recall are also conducting testing on affected product.

How do we know no other berry products are affected?

 Patties Foods has informed FSANZ that the factory involved in processing the berries does not supply products to any customers other than Patties.

Is it true that a hepatitis A outbreak is more serious than other foodborne illness?

No. Foodborne illness as a result of bacteria such as Listeria, Salmonella and Campylobacter can be deadly, particularly for vulnerable populations.

 There are an estimated 4.1 million cases of foodborne illness each year in Australia.

 The latest report on foodborne illness estimates that each year there are more than 31,000 hospitalisations due to foodborne illness and 86 deaths. 

 Four pathogens (norovirus, pathogenic Escherichia coli, Campylobacter and nontyphoidal Salmonella species) are responsible for 93 per cent of the cases where the pathogens were known. 

 emerson.day.5Up until the end of April, 2015 there have been 97 cases of hepatitis A this year  in Australia (including the 34 cases linked to RTE frozen berries). At the same time last year there were 105 cases. Nearly half of all cases of hepatitis A reported in Australia are usually from people returning from overseas travel.

And my new grandson turned six-days-old. Maybe he’ll be a hockey player, maybe a risk assessor, maybe something else.

Boil berries: Ireland reiterates advice

The Food Safety Authority of Ireland (FSAI) today reiterated its advice to consumers to boil all imported frozen berries for at least one minute prior to consumption. 

berries.boozeThe advice follows recent outbreaks of norovirus in Sweden and hepatitis A virus in Australia linked to the consumption of imported frozen berries, although there is no indication that batches of berries implicated have been imported into Ireland.

The outbreak in Sweden occurred in a nursing home in the beginning of May, causing 70 people to become ill with norovirus. Three deaths are reported to have been potentially linked to this outbreak. Microbiological analysis confirmed that imported frozen raspberries from Serbia were the source of this outbreak.  Contrary to national food safety advice in Sweden, the frozen imported raspberries were served uncooked in a dessert.  In Australia, imported frozen berries were linked to an outbreak of Hepatitis A virus which caused over 30 people to become ill during February and March of this year.

The advice to boil all imported frozen berries was first issued by the FSAI in 2013 during the investigation of an outbreak of hepatitis A virus in Ireland which was linked to imported frozen berries.  The advice was renewed in 2014 following related outbreaks in Europe.  The Irish outbreak turned out to be part of a multi-State outbreak, with over 1,000 cases reported in 12 EU countries.  Following a European-wide investigation the source of the outbreak was never confirmed, however batches of frozen berries from twelve food operators were linked to cases of illness in five of the countries affected.

Dr Lisa O’Connor, Chief Specialist in Food Science, FSAI states: “There remains an ongoing risk in the global imported frozen berry supply chain.  We therefore continue to recommend that imported frozen berries should be boiled for at least one minute before they are eaten.  This precautionary measure will destroy the virus if it is present and is particularly important when serving these foods to vulnerable people such as nursing home residents. While fresh berries have not been linked to these outbreaks, we remind consumers that – as with all other fruit and vegetables – they should always be washed thoroughly if they are being eaten uncooked.”

Uh-huh: Rules will be strict and strident for frozen berries imported into Australia after hep A outbreak

Australian bureaucrats apparently don’t know hepatitis A is only transmitted amongst humans – it does not go through animals.

FROZEN BERRIES RECALLBut to have the appearance of doing something, importers of frozen berries will have to prove their fruit comes from farms and factories with strict sanitation standards after 34 people were sickened with hep A in Australia this year.

The Federal Agriculture Department enacted new health regulations, with the threat of up to 10 years jail if importers do not comply.

The department will also begin testing berries for E. coli after the rash of food poisoning cases highlighted inadequate screening and lax product labelling rules.

Victoria’s Patties Foods recalled Nanna’s 1kg frozen mixed berries after people were diagnosed with hepatitis A after eating this brand, which was packed in China.

The source of the infection remains unknown but the only common element was all patients ate the same brand of berries. Tests on an unopened pack found traces of the virus.

Thirty companies import frozen berries from China.

The food safety watchdog says correctly handled berries do not pose a medium or high threat to health but the new rules require importers to follow good agricultural and hygienic practices throughout the supply chain.

These include no contact with fecal matter or animals, clean and sanitised equipment, the product stays frozen and clean water is used for growing and washing berries.

Before they can ship berries into Australia, importers will have to review suppliers and keep records of these assessments.

Five per cent of berry consignments will be tested for E.coli, which can be a sign of poor hygiene. Testing for hepatitis A can be difficult because levels of the virus in food may be too low to be detected.

Food Safety Talk 76: Get ‘em really hot

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University. Every two weeks or so, Ben and Don get together virtually and talk for about an hour.  They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.1431643647306

This episode starts with a discussion of Ben’s taste in music, and then quickly moves into documentaries. Ben recently watched Jodorowsky’s Dune, on Don’s recommendation.  This documentary has some ‘artful nudity’ that leads to a discussion of perverts on airplanes and the appropriateness of reading material such as Fifty Shades of Grey while crammed into an airplane seat.  The conversation naturally transitioned into a discussion of microphone stands and coffee. Ben notes that owning a Nespresso machine has changed his life; he ranks it among his top 10 life changing things (including his wife and children). The guys then discuss other pop-culture topics including Deflate-Gate and TV shows The Affair,Portlandia (which had an episode satirizing raw milk), and Garfunkel and Oates. Note that Portlandia is required viewing before attending IAFP 2015 in Portland this summer

Ben leads off the actual food safety talk by mentioning sprouts and the number of outbreaks associated with them.  The guys then discuss experiments to validate sprout cooking processes including charred bean sprouts.  Ben then brings up the idea of baking cookies in a car and a visit from Linda Harris (who now downloads and listens).  From there the talk turns to pathogen reduction validations for baking processes spurred by the Wegmans recall of baked fruit dessertslast summer, presumably because they contained peaches recalled for Listeria.

The FDA’s Reportable Food Registry, along with CDC whole genome sequencing of pathogens, is enabling more illnesses to be linked to products, as seen in Salmonella Braenderup linked to nut butter.  Ben predicts more businesses will have to issue recalls because of validation issues, and the investigations that accompany these recalls will isolate pathogens from within facilities that can be linked to other illnesses which have occurred over months and years prior.

The discussion then turns to the very bad blizzard that New Jersey never had.  Don discusses the similarities between the models for weather forecasting and models in food safety.   Both situations have consequences for over or under reacting; both present risk management and risk communication difficulties.

A tweet from The New Yorker made Don mad: Bill Marler may be all that stands between you and Salmonella.  This resulted in Don tweeting back to The New Yorker.  Ben mentioned it was probably just Betteridge’s Law of Headlines.   Bill Marler is probably not all that stands between you and Salmonella; as there are a few more people trying to do the right thing.  The guys then go on to discuss how Marler and Caroline Smith DeWaal, a lawyer with the Center for Science in the Public Interest, have become controversial but generally respected food safety personalities over the years.

Don recently was quoted in an article about the safety of various cuts of meat (and Barfblogged here).   Don and Ben were so happy Don was quoted correctly, they were able to ‘ding’ their podcast bell; a auditory high-five.

Pork has a reputation for being dangerous but decreases in the prevalence of Trichinella and Americans tendency to overcook pork have reduced the actual risk, so Ben wanted to discuss a recent MMWR Trichinellosis report.  Don mentions ‘The Batz Report’ which determined the top 10 pathogen-food combinations with the greatest burden in public health.  This led to a discussion of sample size, detection limits, consumption rates, and risk messaging, leading to the conclusion that cultural practices in food preparation adds complexity to the determination of risk.

Thunder Bay restaurant food handler has hepatitis A

There’s a lot of hep A in food handlers making the news. Regardless of whether the staff member is a superstar handwasher, or not so stellar, folks who are exposed will be lining up for shots somewhere. And the stigma associated with the business is hard to shake.

According to the Thunder Bay News Watch (that’s in Canada), Bight Restaurant and Bar is experiencing the hepatitis A rollercoaster.51h4OC-rlZL._SY300_

The Health Unit is investigating a case of hepatitis A in an employee of Bight Restaurant and Bar, located at 2210 Sleeping Giant Parkway, Unit 100, Marina Park.

Anyone who visited this restaurant between March 23 and April 12 may have been exposed to the hepatitis A virus.

Patrons who have previously completed the two-dose hepatitis A vaccine series or the three-dose Twinrix® series would be protected. Staff of the restaurant is being offered immunization. Although the vaccine is most effective if given within 14 days of exposure, the Health Unit will be offering a free vaccination clinic on Saturday, April 18 from 12:00 to 3:00pm at 999 Balmoral Street (corner of Balmoral and William Street) for those that visited the establishment between March 23 and April 12.