Not the headline Batz would have used: Which U.S. foods are most likely to get you sick

Friend of the Michael Batz, says there is a difference between “which foods are most likely to get you sick?” and “which foods cause the greatest burden in the U.S.?”

So he provided commentary on a story he helped create.

The story ran in Fortune, and claimed the U.S. economy will take a $15.5 billion dollar food safety hit through lost income, lost revenue, healthcare-related costs and some intangibles, like “pain and suffering,” according to the U.S. Department of Agriculture.

Research shows the most common foodborne pathogen is norovirus, which is the leading cause of gastroenteritis. The most deadly is listeria; though it is rare, with just 123 confirmed cases in 2013, 24 led to death. The most expensive is salmonella, which is quite common — 7,277 cases in 2013, but with a small fraction (127) resulting in death.

How worried should Americans be about the safety of the food supply? Which foods are most likely to get Americans sick? A deep dive into the data offers a look at where the risks lie.

To identify the most dangerous foods, the Emerging Pathogen Institute, a research institute at the University of Florida, compiled a greatest hits of dangerous pathogen/food pairings. Using a methodology that combined the likelihood of contracting an illness and the illness’s severity to calculate total disease burden, the group identified a Top Ten list of combinations.

Rank Food and Pathogen Cost Illnesses Hospitalizations Deaths
1 Poultry (campylobacter) $1,257m 608,231 6,091 55
2 Pork (toxoplasma) $1,219M 35,537 1,815 134
3 Deli meats (listeria) $1,086M 651 595 104
4 Poultry (salmonella) $712M 221,045 4,159 81
5 Dairy products (listeria) $724M 434 397 70
6 Complex Foods (salmonella) $630M 195,655 3,682 72
6 Complex foods (norovirus) $914M 2,494,222 6,696 68
8 Produce (salmonella) $548M 170,264 3,204 63
8 Beef (toxoplasma) $689M 20,086 1,026 76
10 Eggs (salmonella) $370M 115,003 2,164 42

 The top pairings don’t necessarily map to the major outbreaks of disease; only four of the top ten outbreaks in 2014 were from pairings on the list. J. Glenn Morris, director of the Emerging Pathogen Institute, told Fortune that, outbreaks are “a small fraction” of the total number of foodborne illnesses. In most cases, foodborne illnesses are limited to a small group of people, which makes it difficult for authorities to track.

cdc.fbi.illnessBatz explains the which-foods-cause-the-greatest-burden-in-the-U.S. is about everyone. It is the summary row in a table with 300 million lines, each row representing a different person. Each row could be considered something like individual risk.

(You think you’re a special snowflake? Nope, you’re just a row in the giant spreadsheet of life.)

Our individual risks differ so greatly. Unless you’re pregnant, you don’t need to worry about transmitting Listeria monocytogenes or Toxoplasma gondii to your fetus. Your risks go up when you’re immunocompromised, particularly for some bugs. The young and old face increased risks, though again, every disease is different. People of different ages and genders have different food consumption patterns, too.

And even then, that one row represents risks faced at every meal over the course of a year. Some foods have much higher risks per serving, yet we don’t eat them that often. We consume other foods with lower risks per serving in very high quantities. When you’re telling someone which foods are riskiest, which do you mean? It’s tricky.

Five or so years ago, my colleagues and I published the results of trying to just get at that summary row. Or to be more specific, we tried to say something about which pathogens, which foods, and which pathogen-food pairs cause the greatest public health impact. This kind of information is, I believe, important for getting a handle on the landscape of foodborne disease, to help guide our efforts to reduce the burden.

fbi.batz.pie.chart.nov.15The report had a punchy “top ten” type title and got some attention (for which I’m thankful). But the attention has always come with a price, and that price is that when work like this is written up, it’s almost always presented to readers as some version of which foods to avoid.

I get it, I really do. It’s natural to frame things to readers this way, to take research and make it personally relevant to them. But it kind of butchers the work, and can do as much to misinform as to educate.

So kudos to Tamar Haspal of Fortune for mostly getting it right in an article that presents risks at the broad, national level. Boo to whoever wrote the headline, which conflates population and individual risk and asks “which foods are most likely to make you sick?”

Translating research is always tricky, and I’m never quoted quite to my satisfaction (I can’t get none). In the article, I say we value mortality at $8.7 million per life lost because “there’s also a social welfare value to a life.” Well, that’s not quite right, and I’m doubtful I put it quite that way, and my economist friends are likely groaning at the phrasing, but it’s fine. It’s mostly right, anyway. You have to learn to turn the other cheek.

But other things I just can’t let go. Like the fact that, for the record, I hate pie charts.

PR 101: Campylobacter still present on 76% of UK birds, but heavy contamination is down! Steaming hot sucks

The results for the first quarter of testing, from July to September 2015, show a decrease in the number of birds with the highest level of contamination from the same months last year.

chickenpurseThese most heavily contaminated birds are the focus of the current target agreed by industry, which is equivalent to no more than 7% of chickens at retail having the highest levels of contamination. Research has shown that reducing the proportion of birds in this category will have the biggest positive impact on public health.

The new data shows 15% of chickens tested positive for the highest level of contamination, down from 22% in July to September 2014. Campylobacter was present on 76% of chicken samples, down from 83% in the same months of last year.

The results for the first quarter show:

15% of chickens tested positive for campylobacter within the highest band of contamination*

76% of chickens tested positive for the presence of campylobacter

0.3% of packaging tested positive at the highest band of contamination

6% of packaging tested positive for the presence of campylobacter

*More than 1,000 colony forming units per gram (cfu/g). These units indicate the degree of contamination on each sample.

In this first quarter, 1,032 samples of fresh whole chilled UK-produced chickens and packaging have been tested. The chickens were bought from large UK retail outlets and smaller independent stores and butchers. The new survey commenced sampling in July 2015.

The FSA has been testing chickens for campylobacter since February 2014 and publishing the results as part of its campaign to bring together the whole food chain to tackle the problem. Campylobacter is the most common cause of food poisoning in the UK, making an estimated 280,000 people ill every year.

As with the previous survey, the data shows variations between the retailers. Testing of chickens from Co-op and Waitrose show both retailers have made the most significant reductions in the proportion of the chickens they sell that are most highly-contaminated.

Steve Wearne, Director of Policy at the FSA said: ‘It is good to see that some retailers are getting to grips with campylobacter. However, we want to see all of them pulling together to achieve real and lasting reductions.

‘I am also pleased that we are starting to see retailers and processors being open with consumers about what they are doing to tackle the problem and about the impact their interventions are having on the chickens they are selling.’

But FSA continues to insist chicken is safe as long as consumers follow good kitchen practice:

chicken.thermCover and chill raw chicken: Cover raw chicken and store on the bottom shelf of the fridge so juices cannot drip on to other foods and contaminate them with food poisoning bacteria such as campylobacter;

Don’t wash raw chicken: Cooking will kill any bacteria present, including campylobacter, while washing chicken can spread germs by splashing;

Wash hands and used utensils:  Thoroughly wash and clean all utensils, chopping boards and surfaces used to prepare raw chicken. Wash hands thoroughly with soap and warm water, after handling raw chicken. This helps stop the spread of campylobacter by avoiding cross contamination.

Cook chicken thoroughly:  Make sure chicken is steaming hot all the way through before serving. Cut in to the thickest part of the meat and check that it is steaming hot with no pink meat and that the juices run clear.

Steaming hot sucks, especially for a science-based agency.


Cook with thermometers: Campy in UK supermarkets, oh and surveys suck

The Food Standards Agency is Thursday to publish the results of its latest UK supermarket survey, testing for the deadly bug Campylobacter in chickens on sale.

chicken.thermdsA study led by Professor Dan Rigby at The University of Manchester found that almost three-quarters of consumers still do not associate the pathogen – the most common cause of food poisoning – with the chickens that they buy.

Professor Rigby said: “Following the headlines – one year ago – about the amount of contaminated chicken on supermarket shelves, we surveyed 900 people and found that only 28% associated Campylobacter with poultry and most still significantly underestimated the rate of contamination of chickens for sale in the UK .

“These findings show there is still a huge amount of work to be done to reduce the problem of Campylobacter infection; a problem which costs the UK around £900m annually.”

“There is still a huge amount of work to be done to reduce the problem of Campylobacter infection; a problem which costs the UK around £900m annually -Professor Dan Rigby”

Other key findings include:

One third of people interviewed shortly after last year’s headlines said they could not recall the story.

Less than half [40%] said they would change their behaviour at all as a result of the news, most citing changes to the way they handled or cooked chicken.

Just over a third of the sample correctly identified the retailer which had just been revealed as having the highest contamination rate.

Retailers are failing to promote the food safety benefits of ‘roast in the bag’ chickens.

Public health types have better things to do: 8 sick from raw milk in Idaho

Idaho Public Health officials are investigating eight illnesses in southwest Idaho likely associated with drinking unpasteurized (raw) milk.

napoleon.raw.milkTo date, four Campylobacter and four E.coli O157:H7 cases have reported drinking raw milk produced by the Natural Farm Fresh Dairy of Kuna in the week prior to getting sick. The investigation is ongoing with Southwest and Central District Health departments, working in association with the Idaho State Department of Agriculture.

“If people have recently purchased raw milk from this dairy, we advise them not to drink it and to discard it,” says Dr. Leslie Tengelsen, State Public Health Veterinarian with the Idaho Department of Health and Welfare.

The Idaho State Department of Agriculture is working with Natural Farm Fresh Dairy to confirm if the raw milk from that facility was the source of the reported illnesses. The dairy is fully cooperating with the investigation and issued the following statement: “Natural Farm Fresh is committed to providing a safe and wholesome product to its customers. Effective immediately, we are voluntarily removing all raw milk products currently on the shelves in retail stores and we will discontinue further distribution of our raw milk until additional product testing is completed.”

Campy in raw organic milk in Calif.

The California Food and Drug Administration has ordered a state-wide recall of raw milk produced by milk Organic Pastures Dairy of Fresno.

colbert.raw.milkThat recall follows a quarantine order after Campylobacter was discovered in some of the company’s milk. The CDFA reported on Friday that no illnesses have been reported from people drinking the affected milk.

Under the recall order, Organic Pastures Dairy’s grade-A, raw milk with a code date of “OCT 24” on the containers must be pulled from store helves, and consumers are urged to dispose of any of this milk remaining in their refrigerators.

The bacteria was discovered during normal testing by the CDFA of the company’s milk, the agency reports.

It can happen: Surveillance artefacts

In 1991, 1999 and 2006, randomly selected individuals from the Danish Central Personal Register provided a serum sample. From individuals aged 30 years and above, 500 samples from each year were analysed for Campylobacter IgG, IgA and IgM antibodies using a direct ELISA method.

surveillanceWe applied a seroincidence calculator available from the European Centre for Disease Prevention and Control to perform a mathematical back-calculation to estimate the annual Campylobacter seroincidence in the Danish population. The estimated Campylobacter seroincidence did not differ significantly between the 1991, 1999 and 2006 studies although the reported number of culture-confirmed cases of Campylobacter infection increased 2.5 fold from 1993 to 1999 among individuals aged 30 years and above.

This suggests that Campylobacter was widely present in the Danish population before the increase in poultry-associated clinical Campylobacter infections observed from 1993 to 2001 among individuals of this age groups.

Was the increase in culture-confirmed Campylobacter infections in Denmark during the 1990s a surveillance artefact?

Euro Surveill. 2015;20(41):pii=30041

Emborg H-D, Teunis P, Simonsen J, Krogfelt KA, Jørgensen CS, Takkinen J, Mølbak Kåre

Campy up, E. coli O157 down: Foodborne diseases active surveillance network (FoodNet)

The U.S. Centers for Disease Control and Prevention Foodborne Diseases Active Surveillance Network, or FoodNet, has been tracking trends for infections transmitted commonly through food since 1996. provides a foundation for food safety policy and prevention efforts. It estimates the number of foodborne illnesses, monitors trends in incidence of specific foodborne illnesses over time, attributes illnesses to specific foods and settings, and disseminates this information.

“FoodNet has matured and transformed over 20 years, and continues to evolve as technologies change,” says Dr. Olga Henao, FoodNet Team Lead.

The Foodborne Diseases Active Surveillance Network, or FoodNet, has been tracking trends in foodborne infections since 1996.

FoodNet provides a foundation for food safety policy and prevention efforts by estimating the number of foodborne illnesses, monitoring trends of specific foodborne illnesses, conducting studies to understand the causes of these illnesses, and informing the public about its findings.

FoodNet began to collect information on two pathogen cases identified by CIDT in 2009 and expanded the collection to other pathogens in 2011.

FoodNet has conducted surveillance for laboratory-confirmed cases of infection in humans  caused by Campylobacter, Listeria, Salmonella, Shiga toxin-producing E. coli (STEC) O157,  Shigella, Vibrio, and Yersinia since 1996, Cryptosporidium and Cyclospora since 1997, and STEC non-O157 since 2000. FoodNet staff in state health departments contact clinical laboratories in the surveillance area to get reports of infections diagnosed in residents.

Special Studies

Although foodborne outbreaks are common, most foodborne infections are sporadic, meaning they are not related to an outbreak. We can only rarely determine how one person got an infection but, by studying a large number of people with the same type of infection, we can often determine risk factors for getting ill.

Major Contributions

FoodNet is the only U.S. system focused on obtaining comprehensive information about sporadic infections caused by pathogens transmitted commonly through food. The network’s contributions to food safety policy and illness prevention include:

Establishing reliable, active population-based surveillance to understand who gets sick and why;

Developing and implementing studies that determine risk and protective factors for foodborne infections;

Conducting population surveys and laboratory surveys that describe the features of gastrointestinal illnesses, medical care-seeking behavior, foods eaten, and laboratory practices; and

Improving our ability at the federal and state level to track and study foodborne illnesses and respond to new issues as they arise. 

About FoodNet

Surveillance in an area that includes 15% of the U.S. population (approximately 48 million people)

Collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service, and the Food and Drug Administration. (Image: U.S. map showing FoodNet sites.)

Principal foodborne disease component of CDC’s Emerging Infections Program

Provides the data necessary for measuring the progress in foodborne disease prevention.

Chicken and campy: Foodnet Canada 2011-2012

FoodNet Canada (formerly known as C-EnterNet) is a preventive, multi-partner sentinel site surveillance system, facilitated by the Public Health Agency of Canada, that identifies what food and other sources are causing illness in Canada.

chickenEach sentinel site is founded on a unique partnership with the local public health unit, private laboratories, and water and agri-food sectors, as well as the provincial and federal institutions responsible for public health, food safety, and water safety. The pilot sentinel site (ON site), comprised of the Region of Waterloo, Ontario, has approximately 525,000 residents, with a mix of urban and rural communities and innovation in public health and water conservation.

A second site (BC site) was officially established in the Fraser Health Authority, British Columbia in April of 2010. This BC site includes the communities of Burnaby, Abbotsford, and Chilliwack and has approximately 450,000 residents.

In the ON site, enhanced surveillance of human cases of enteric disease in the community is performed, as well as active surveillance of enteric pathogens in water, food (retail meat and produce) and on farms. In the BC site in 2010, enhanced human disease surveillance began, as did active surveillance of enteric pathogens (for retail produce only).

The following key findings are based on the surveillance data from 2011–2012 in the ON and BC sites:

  • A total of 1663 human cases of 11 bacterial, viral and parasitic diseases were reported within the ON and BC sites between 2011 and 2012. The three most frequently reported diseases (campylobacteriosis, salmonellosis and giardiasis) accounted for 82% of the cases.
  • Campylobacteriosis remained the most commonly reported enteric disease in both sentinel sites, with Campylobacter jejuni being the most common species associated with human campylobacteriosis. The majority of raw chicken samples tested were also contaminated with Campylobacter jejuni. Possible exposure factors included living on a farm or country property, contacting on-farm poultry, contacting household pets, contacting animal manure and consuming spoiled food. Overall, as found in the past, retail chicken meat was considered to be the most important vehicle of transmission for Campylobacter.

Distributions of patient age and gender among the human salmonellosis cases between 2011 and 2012 were similar to those observed historically in both the ON and BC sites. The most commonly reported serovars for human cases of salmonellosis were Enteritidis, Typhimurium, and Heidelberg. Phage type alignment continues to be observed among isolates from endemic human cases, chicken meat, and broiler chicken feces for both Salmonella Heidelberg and Salmonella Enteritidis. A slight decrease was observed in the rate in both sites (in 2011–2012 combined compared to 2010), which is comparable to the national trend observed during the same time period (2, 3, 7, 8). The prevalence of Salmonella on ground chicken was twice the level found on chicken breast. This may highlight the greater chance of product contamination during processing. Overall, possible salmonellosis exposure factors included contact with pet reptiles, retail poultry products, and broiler chicken manure (Table 4.6). The most important possible vehicle of transmission is considered to be retail poultry products.

• Verotoxigenic E. coli (O157:H7 and non-O157:H7 serotypes) infections continue to be primarily acquired domestically, as demonstrated by the low number of travel-related cases in 2011–2012. E. coli O157:H7 PFGE patterns in both human and non-human samples from 2011–2012 continued to show considerable diversity, as observed nationally and within the FoodNet Canada sites, in past years.

• As in previous years, the majority of Yersinia cases are domestically acquired. Among travel-related cases, the majority reported travel to Central or South America in 2011–2012. The incidence in domestically acquired cases was much higher in females than males. None of the swine manure samples in the ON site in 2011 were positive for pathogenic Yersinia (biotype 4, serotype O:3). • As in previous years, pathogenic strains of Listeria monocytogenes were recovered in 2011–2012 from samples of skinless chicken breasts, ground beef, ground chicken and ground turkey, as well as uncooked chicken nuggets. The scientific literature suggests that abattoirs and meat processing environments rather than farm animals may be an important source of L. monocytogenes (21). The retail meat data from many historical surveillance years indicate that pathogenic serotypes of L. monocytogenes are present on raw chicken, beef, and pork meat sold at retail, as well as in bagged leafy greens. Although, based on one PFGE enzyme, there was a match between a human case and a sample of uncooked chicken nuggets in 2011–2012, there were no matches between sources and sentinel site cases of listeriosis in 2011–2012 when both PFGE enzyme patterns were compared. Also, based on one enzyme, a few matches were identified between meat isolates (chicken and beef) and four of the top five PFGE patterns reported at the national level in humans (according to PulseNet Canada data). In 2012, fresh herbs were tested for L. monocytogenes though the pathogen was not detected.

• The majority of Shigella infections were travel-related, with Asia being the most frequently reported travel destination.

FoodNet Canada surveillance identified human pathogenic strains of norovirus on retail soft berries and fresh herbs in 2011–2012. Historically, pathogenic subtypes have also been found in food animal manure, as well as retail pork chops and leafy greens.

Frankenface.berry• Cryptosporidium was found in 2011–2012 on retail soft berries and in untreated surface water. Giardia was detected on retail soft berries and herbs, and water in the same period. Also, Cyclospora was found on soft berries. However, the viability of these pathogens was unable to be determined.

• Travel outside of Canada continued to add to the burden of enteric disease observed in Canada during 2011–2012, with 27% of the reported cases from both sites (combined) likely involving infections acquired abroad. Safe travel practices continue to be important considerations among Canadians.

• Enhanced, standardized laboratory testing across all FoodNet Canada surveillance components (human, retail, on-farm, and water) has allowed for the identification of patterns in subtype distributions among human cases and potential exposure sources over time. Continued surveillance and addition of more sentinel sites will help in refinement of the key findings and inform prevention and control measures for enteric diseases in Canada.


UK supermarket chicken price war ‘putting health at risk’

When I showed up in Australia and started shopping at my local stores – as you do without a car – I noticed the whole chickens were leaking all kinds of bacterial crap.

moneyI spoke with the manager and said, in the U.S., they have additional plastic bags in the meat section and antibacterial wipes.

He said, that’s a great idea, I’ll bring it up at our fortnightly food safety meeting.

The company decided not to do anything because the wipes would cost half-a-cent each.

Other customers I’ve chatted with say they grab a plastic bag from the produce section to further enclose their chicken.

UK professor, Chris Elliott, who led the official inquiry into the horsemeat scandal, says supermarkets are reluctant to bring in changes that could reduce potentially fatal infections from chicken because of the cost.

Food safety versus economics.

E. coli in Qatar

Escherichia coli O157:H7, non-O157 E. coli, and Campylobacter spp. are among the top-ranked pathogens that threaten the safety of food supply systems around the world.

qatar.camelThe associated risks and predisposing factors were investigated in a dynamic animal population using a repeat-cross-sectional study design.

Animal and environmental samples were collected from dairy and camel farms, chicken processing plants, and abattoirs and analyzed for the presence of these pathogens using a combination of bacterial enrichment and real-time PCR tests without culture confirmation. Data on putative risk factors were also collected and analyzed.

E. coli O157:H7 was detected by PCR at higher levels in sheep and camel feces than in cattle feces (odds ratios [OR], 6.8 and 21.1, respectively). Although the genes indicating E. coli O157:H7 were detected at a relatively higher rate (4.3%) in fecal samples from dairy cattle, they were less common in milk and udder swabs from the same animals (1 and 2%, respectively).

Among the food adulterants, E. coli O103 was more common in cattle fecal samples, whereas O26 was more common in sheep feces and O45 in camel feces compared with cattle (OR, 2.6 and 3.1, respectively). The occurrence of E. coli in the targeted populations differed by the type of sample and season of the year.

Campylobacter jejuni and Campylobacter coli were more common in sheep and camel feces than in cattle feces. Most of the survey and surveillance of E. coli focused on serogroup O157 as a potential foodborne hazard; however, based on the PCR results, non-O157 Shiga toxin–producing E. coli serotypes appeared to be more common, and efforts should be made to include them in food safety programs.

 Risk of Escherichia coli O157:H7, non-O157 shiga toxin–producing Escherichia coli, and Campylobacter spp. in food animals and their products in Qatar

Journal of Food Protection®, Number 10, October 2015, pp. 1776-1924, pp. 1812-1818(7)

Mohammed, Hussni O.; Stipetic, Korana; Salem, Ahmed; McDonough, Patrick; Chang, Yung Fu; Sultan, Ali