Foodborne illness in Denmark

I have a soft spot for the Danes. Spending five summers hammering nails with a couple of Danish homebuilders in Ontario taught me the value of being well-read and beer at morning coffee, lunch, and afternoon coffee. My friend John Kierkegaard would say, the beer is nice, but the work, it isn’t really so good.

quotes-1600-900-wallpaperWhen I went to Copenhagen for a scientific meeting, sure enough, there was beer at morning coffee.

The Technical University of Denmark reports that almost every other registered salmonella infection in Denmark in 2014 was brought back by Danes travelling overseas. Travel thus remains the largest cause of salmonella infections. An outbreak of salmonella from Danish eggs was also recorded in 2014, which is the first time in five years and illness was again attributed Danish chicken meat.

These are some of the findings presented in the annual report on the occurrence of diseases that can be transmitted from animals and food to humans. The report was prepared by the National Food Institute, Technical University of Denmark, in cooperation with Statens Serum Institut, the national institute of public health, and the Danish Veterinary and Food Administration.

In 2014 a total of 1,122 salmonella infections were reported among Danes, which is equivalent to 19.9 infected cases per 100,000 inhabitants. The figure is in line with the previous year when a historically low number of Danes was infected with salmonella.

In all, 48% became ill with salmonella after travelling overseas in 2014. Most of those who returned home with a travel-related infection had been to Thailand (17.5%), Turkey (15.4%) and Spain (6.4%).

Thus, foreign travel is still the largest cause of salmonella infections among Danes.

tasting-midtfyns-jule-stoutIn the annual source account which the National Food Institute calculates, salmonella infections were attributed Danish chicken meat for the first time since 2011. In total 2% of the infections were estimated to be attributed this source.

“For two decades Danish producers, authorities and researchers have successfully worked hard to make fresh chicken salmonella-free. It is not allowed to sell fresh meat from Danish chickens if the flock is positive for salmonella. There will always be a small risk that positive fresh meat goes under the surveillance radar and makes its way to store refrigerators. This is why it is important to continue to have a close monitoring,” Senior Academic Officer Birgitte Helwigh from the National Food Institute says.

The first salmonella outbreak from Danish eggs for five years has also been registered in 2014. “It has been five years since we last had a foodborne outbreak caused by Danish eggs. The outbreak was associated with an outbreak of acute salmonella illness in the flock, which is extremely rare. The results show how important it is that producers and authorities continue to focus on maintaining the low incidence of salmonella in the egg production,” says Birgitte Helwigh says.

Danish pork was the food source associated with the most infections among persons infected in Denmark. Overall 15% of the reported illness cases were attributed to Danish pork. There were three outbreaks where Danish pork was registered as the source of infection, which contributed 4.6% of the cases.

Approximately one fifth of all salmonella cases in Denmark were not attributed to a specific food source. The reason may be that the cases were caused by foods which were not included in the salmonella source account, e.g. fruit and vegetables, or other sources of infection such as contact with livestock and pets.

With 3,782 cases registered in 2014, campylobacter still causes the most cases of foodborne bacterial illnesses in Denmark. In 2014 a total of 92 listeria infections were registered, which is an increase of 84% compared to the year before. The increase is mainly due to an outbreak in “rullepølse” (a Danish cold cut ready-to-eat speciality) with 41 reported cases.

In 2014, a total of 60 foodborne disease outbreaks were registered compared with 74 outbreaks the year before. An outbreak is when several people become sick from the same food source. As in previous years, norovirus caused the most outbreaks (40%). These outbreaks usually take place in restaurants, where a total of 363 people were infected in 24 of the recorded outbreaks.

Leafy greens carry risks; at-home rinsing of pre-washed salad mix isn’t doing much

In the quest to get healthier, including losing weight and reducing my body fat percentage, I’ve been paying particular attention to my eating habits and eating a bunch more vegetables.

I’ve become increasingly fond of the convenience of pre-washed, bagged, fresh whatever. A staple of my weekly meals is 4oz of steak, a crumble of blue cheese, grilled mushrooms, sliced pear, a few walnuts all over a bed of 50/50 mix of pre-washed baby spinach and and mesclun mix.img86l

I just open the bag and throw it on the plate. Because there’s not much I can do, safety-wise, to it once it’s in my home. If there’s pathogenic E. coli, Listeria or Salmonella there (or others) I’m stuck with it. I’m following recommendations from a bunch of my food safety friends who reviewed the literature on cut, bagged, washed, ready-to-eat leafy greens from a few years ago. In the abstract, they write:

The panel concluded that leafy green salad in sealed bags labeled “washed” or “ready-to-eat” that are produced in a facility inspected by a regulatory authority and operated under cGMPs, does not need additional washing at the time of use unless specifically directed on the label.

Leafy green food safety risks need to be addressed before they get to me, all I can do by washing it again is increase the chance I cross-contaminate the salad precursor in my home. My purchasing choice is based in trust that growers, packers and processors know what they are doing, and do it. But at best, they can only remove 90% of what is there with a wash.

Last week some research was presented at the American Chemical Society National Meeting & Exposition, prior to peer-review, that states what lots of food safety folks have published over the past decade: washing leafy greens doesn’t result in a sterile salad and the bumpy leaves protect pathogens.


I talked to Korin Miller at Yahoo News about it,

Labels like “thoroughly washed” and “triple washed” make us feel comfortable chowing down on pre-washed baby spinach straight from the container. But researchers from the University of California, Riverside, say we might want to rethink that habit.

They discovered that the small peaks and valleys in baby spinach leaves can harbor bacteria — even during the washing process they often undergo in food-processing plants.

While the news is shocking to most people, “this is not a surprise to many of us in the food safety arena,” Mike Doyle, director of the Center for Food Safety at the University of Georgia, tells Yahoo Health.

Unfortunately, washing your pre-washed baby spinach before eating it doesn’t make a difference, says Benjamin Chapman, PhD, an assistant professor and food safety extension specialist at North Carolina State University.

“Rinsing isn’t going to do a whole heck of a lot for food safety,” Chapman tells Yahoo Health — it just may remove dirt or other physical objects that you can see. Cooking the spinach, however, will kill potentially harmful bacteria.

I don’t agree with this comment, ‘pre-washed baby spinach is typically treated using a bleach disinfectant’

But what about the whole “triple wash” label? Does that make pre-washed spinach safer? Chapman says there’s some confusion about what it means. Companies don’t triple wash spinach to disinfect it, he explains — they do it to reduce the likelihood of cross-contamination from one piece of spinach to another during the washing process.

The water is treated to reduce cross-contamination in the processing water; 2-log reduction, at the very best, is not an effective surface disinfectant.

Beware raw egg dishes: 160 sickened, Salmonella trial delayed in Canberra

A criminal trial over Canberra’s largest salmonella outbreak has been delayed until next year.

mayonnaise.raw.eggThe owners of the former Copa Brazilian restaurant had been scheduled to go before the ACT Magistrates Court on Thursday over the incident that left about 160 people with food poisoning in May 2013.

Under ACT food safety law, those who either knowingly or negligently sell unsafe food can face criminal prosecution.

The criminal case follows civil lawsuits against the restaurant, with an estimated $1 million, including costs, paid out to those struck down by salmonella.

An ACT Health investigation found a supplier in Victoria to be responsible for the bad eggs that had been used by the Dickson restaurant to make raw egg mayonnaise.

The mayonnaise was then served to diners in a potato salad.

Many patrons of the then newly-opened all-you-can-eat Brazilian barbecue were struck down with salmonella poisoning, and the Canberra Hospital’s emergency department reportedly had one of its busiest days on record.

In the aftermath, the restaurant issued an apology to those affected and removed all products containing raw egg from its menu to ensure the poisoning was not repeated.

It closed voluntarily, before reopening under the close watch of ACT Health authorities.

But the restaurant eventually closed its doors and left Dickson in June last year.

Vibrio in raw seafood a risk factor in China too

As the number sickened by Vibrio rises to 72 in western Canada, researchers report on dietary and medical risk factors for Vibrio parahaemolyticus (VP) infection in the coastal city Shenzhen in China. In April–October 2012, we conducted a case–control study in two hospitals in Shenzhen, China. Laboratory-confirmed VP cases (N = 83) were matched on age, sex, and other social factors to healthy controls (N = 249). Subjects were interviewed using a questionnaire on medical history; contact with seawater; clinical symptoms and outcome; travel history over the past week; and dietary history 3 days prior to onset. Laboratory tests were used to culture, serotype, and genotype VP strains. We used logistic regression to calculate the odds ratios for the association of VP infection with potential risk factors.

Results: In multivariate analysis, VP infection was associated with having pre-existing chronic disease (adjusted odds ratio [aOR], 6.0; 95% confidence interval [CI], 1.5–23.7), eating undercooked seafood (aOR, 8.0; 95% CI, 1.3–50.4), eating undercooked meat (aOR, 29.1; 95% CI, 3.0–278.2), eating food from a street food vendor (aOR, 7.6; 95% CI, 3.3–17.6), and eating vegetable salad (aOR, 12.1; 95% CI, 5.2–28.2).

Conclusions: Eating raw (undercooked) seafood and meat is an important source of VP infection among the study population. Cross-contamination of VP in other food (e.g., vegetables and undercooked meat) likely plays a more important role. Intervention should be taken to lower the risks of cross-contamination with undercooked seafood/meat, especially targeted at people with low income, transient workers, and people with medical risk factors.

Risk factors for Vibrio parahaemolyticus Infection in a southern coastal region of China

Foodborne Pathogens and Disease. Ahead of print. doi:10.1089/fpd.2015.1988.

Liao Yuxue, Li Yinghui, Wu Shuyu, Mou Jin, Xu Zengkang, Cui Rilin, Klena John D., Shi Xiaolu, Lu Yan, Qiu Yaqun, Lin Yiman, Xie Xu, Ma Hanwu, Li Zhongjie, Yu Hongjie, Varma Jay K., Ran Lu, Hu Qinghua, and Cheng Jinquan


Bad idea: Raw oysters in nursing homes

With at least 67 sick from Vibrio parahaemolyticus linked to raw oysters in Canada and a full recall being launched by the Canadian Food Inspection Agency, one has to wonder why raw oysters would be served in a nursing home.

oystersBut that’s what happened in France in 2012.

Researchers report that the presence of norovirus in shellfish is a public health concern in Europe. Here, we report the results of an investigation into a norovirus gastroenteritis outbreak following a festive lunch which affected 84 (57%) residents and staff members of a nursing home in January 2012 in France. Individuals who had eaten oysters had a significantly higher risk of developing symptoms in the following 2·5 days than those who had not, the risk increasing with the amount eaten [relative risk 2·2 (1·0–4·6) and 3·3 (1·6–6·6) for 3–4 and 5–12 oysters, respectively].

In healthy individuals during those days, 29 (32%) subsequently became ill, most of whom were staff members performing activities in close contact with residents. Genogroup II noroviruses were detected in fecal samples, in a sample of uneaten oysters and in oysters from the production area. Identifying a norovirus’s infectious dose may facilitate the health-related management of contaminated shellfish.

A norovirus oyster-related outbreak in a nursing home in France, January 2012

Epidemiology and Infection / Volume 143 / Issue 12 / September 2015, pp 2486-2493

Loury, F. S. Le Guyader, J. C. Le Saux, K. Ambert-Balay, P. Parrot and B. Hubert

Leafs are bumpy: Change in disinfecting spinach, salad greens could reduce illness

Cross contamination in commercial processing facilities that prepare spinach and other leafy greens for the market can make people sick. But researchers are reporting a new, easy-to-implement method that could eliminate or reduce such incidences.

howcleanisyoThe scientists will present their work at the 250th National Meeting & Exposition of the American Chemical Society (ACS).

Spinach or other leafy salad greens were responsible for 18 food-poisoning outbreaks over the last decade.

Greens are washed by commercial processes before they head to the grocery store. But these methods, which can include water and bleach rinses or irradiation, are not completely effective, says Nichola Kinsinger, Ph.D. She says scientists have estimated that 99 percent of food-borne illnesses from leafy greens can be traced back to disinfection issues. As a result, they have searched for and developed a different approach to attacking the bacteria, most notably E. coli, which is the cause of many outbreaks.

“Despite current disinfection rinsing, bacteria are surviving on the leaf and causing cross contamination, resulting in the numerous outbreaks we hear about in the media,” Kinsinger says. She is a postdoc in the lab of Sharon Walker, Ph.D., at the University of California, Riverside. “Pathogens can come from irrigation waters or from water used during processing, and they can adhere to spinach leaves. If these bacteria are not all killed in the disinfection process, they can continue to live, grow, spread and contaminate other surfaces within the facility and other leaves.”

Using a parallel-plate flow chamber system that Walker developed, the researchers tested the real-time attachment and detachment of bacteria to the outer layer of spinach leaves. At low bleach concentrations, the bacteria fell off the leaves, but remained alive. At the higher concentrations used commercially, however, all of the bacteria were killed. “This result was perplexing,” Walker says. “Our experiments were telling us that commercial bleach rinses should be much more effective than they are. But then we studied the leaf itself in more detail.”

A spinach leaf is not perfectly smooth, she notes. So, the team modeled how the bleach would move across the surface of a spinach leaf, taking its bumps and grooves into account. Surprisingly, the model revealed that the concentrations of bleach on leaves may not be consistent.

“We found that because of the topology of the spinach leaf, nearly 15 percent of the surface may ‘see’ a bleach concentration that is 1,000-times less than that of the rinse solution,” Kinsinger says. In some cases, that translated to a 90 percent bacterial survival in their tests—and a high risk for cross contamination.

To reduce that risk, the researchers are optimizing an inexpensive titanium dioxide (TiO2) photocatalyst that companies could add to the rinse water or use to coat equipment surfaces that come into contact with the leaves as they are processed. When TiO2 absorbs light, it produces a strong oxidant that kills bacteria.

The scientists now plan to conduct more studies on the photocatalyst, and they will look at a broader range of foods, engineered surfaces and pathogens.


67 sick: Raw oysters can suck and yes, I’ve temped oysters on the grill

Canadian health types are now investigating 67 Canadian cases of Vibrio parahaemolyticus infections in British Columbia and Alberta linked to raw shellfish. The majority of the illnesses have been linked to the eating of raw oysters.

oysters.grillThe risk to Canadians is low, and illnesses can be avoided if shellfish are cooked before being eaten.

In Canada, a total of 67 cases have been reported in British Columbia (48) and Alberta (19). One case has been hospitalized. No deaths have been reported. Individuals became sick between June 1 and August 7, 2015 and all reported consumption of raw shellfish, primarily oysters. The investigation is ongoing to determine the source and distribution of these products.

The following safe food practices will reduce your risk of getting sick from Vibrio and other foodborne illnesses.

-Do not eat raw shellfish.

-Cook shellfish thoroughly before eating, especially oysters. Shellfish should be cooked to a safe internal temperature of 74°C (165°F).

-Discard any shellfish that do not open when cooked.

-Eat shellfish right away after cooking and refrigerate leftovers.

-Always keep raw and cooked shellfish separate.

-Avoid eating oysters, or other seafood, when taking antacids as reduced stomach acid may favour the survival and growth of Vibrio species.

-Always wash your hands for 20 seconds with soap after using the bathroom.

-Avoid exposing open wounds or broken skin to warm salt or brackish water, or to raw shellfish. Wear protective clothing (like gloves) when handling raw shellfish.

-Wash your hands well with soap before handling any food. Be sure to wash your hands, cutting boards, counters, knives and other utensils after preparing raw foods.


Improving the safety of leafy greens: USDA

Food safety is a top priority for consumers, especially when it comes to the leafy greens in salads. Researchers at the University of Arizona have discovered natural methods to sanitize these vegetables using ingredients commonly found in the kitchen, such as oregano, cinnamon, and vinegar.

lettucePlant extracts, essential oils, and organic sanitizers have all proved effective in killing bacteria on leafy greens and extending their shelf life. When emulsified in the water used to wash these leaves, the approach compares to (and sometimes even works better than) bleach or hydrogen peroxide.

“Plant antimicrobials can be used by consumers at home,” said Sadhana Ravishankar, associate professor at the University of Arizona’s School of Animal and Comparative Biomedical Sciences. “Plant extracts and essential oils can be added in the wash water by themselves or combined with vinegar in the wash water for treatment.”

Benefits of using plant antimicrobials and organic sanitizers are that they are natural, environmentally friendly, and less energy intensive since they are effective at both room and cold temperatures. They also continue to kill bacteria during storage; their effectiveness is not reduced in the presence of organic matter; and they have added health benefits linked to a reduction in the occurrence of cancer, diabetes, and high cholesterol. The wash water containing plant compounds and organic sanitizers can also be recycled and reused without a loss in effectiveness.

“We have also researched a new way of applying plant antimicrobials to improve salad safety,” said Ravishankar. “We have incorporated plant essential oils into edible films that are added into salad bags and the vapors from the oils kill the bacteria in the salad bags during storage. Edible films are also plant-based sources such as apples, carrots, hibiscus, or spinach pulp.”

The project team has been using social media as an educational tool for the benefit of growers and other stakeholders.  The social media campaign includes YouTube videos, Facebook, and Twitter.

The outcomes of this project will benefit consumers by reducing and preventing contamination of the leafy greens by foodborne pathogens at the production and harvesting levels, providing a safer product in stores and on their tables.

Moving forward, Ravishankar and her team are testing combinations of plant antimicrobials and the effectiveness of them when the wash water is recycled.  USDA’s National Institute of Food and Agriculture (NIFA) is funding this new research, a four-year, $2,907,354 Organic Agriculture Research and Extension Initiative (OREI) grant.

OREI seeks to solve critical organic agriculture issues, priorities, or problems by integrating research, education, and extension activities. OREI-fund projects that will enhance the ability of producers and processors who have already adopted organic standards to grow and market their high quality organic agricultural products.

31 sick: Restaurants ordered to cook all oysters from B.C.

Vancouver Coastal Health has ordered restaurants to stop serving raw oysters from local waters in response to a rising tide of foodborne illness caused by vibrio parahaemolyticus, a bacteria that naturally occurs in shellfish.

BC.oystersAccording to an advisory issued Wednesday, 31 cases connected to raw oysters have been reported in B.C. so far this year, although the actual number is likely much higher because not all cases are reported.

Symptoms include diarrhea, cramps, vomiting and fever that can last up to a week.

VCH has ordered restaurants to cook all B.C. oysters and said only oysters from outside the province can be served raw. The order comes as the BC Centre for Disease Control issued a similar warning asking consumers to avoid eating locally harvested oysters raw.

“Normally we see between eight and 10 cases in (June and July),” said Marsha Taylor, an epidemiologist with the BCCDC. “So there has been a really notable increase this year.”

Sprouts recalled again

As Virginia sprout grower (not) Good Seed Inc., of Springfield, Va., announced its third recall because of Listeria monocytogenes, the Australian Food Safety Information Council issued a sprout summary, noting that in addition to overseas outbreaks, 125 were sickened with Salmonella in Western Australia in 205 and 15 in Victoria in 2006.

sprout.salad.aust.aug.15“Washing sprouts has been found to be not very effective as laboratory studies have shown that bacteria can be internalised in the sprouts, making it difficult wash off/sanitise, and bacteria can be protected in a biofilm on the sprout surface. People in the 4 vulnerable demographics (young children, people 70+, immune-compromised or pregnant) should not eat uncooked sprouts of any kind.

This is a picture of a salad served at an Australian institution full of immunocompromised people.

Guess they didn’t get the memo.

Good Seed in Virginia isn’t saying anything, although all three recalls came weeks after the fresh sprouts were packed and shipped. The most recent recall notice, dated Aug. 3, is for all sprouts Good Seed produced on or after June 22.

The Packer reports no illnesses have been linked to the sprouts, which were distributed to retailers in Virginia, Maryland and New Jersey.

However, a spokeswoman for the Virginia Department of Agriculture said in May that the Centers for Disease Control and Prevention confirmed some listeria infections among people in the distribution area match the genome type of the listeria monocytogenes confirmed on the Good Seed sprouts.