Blame the media: Crypto reporting in England

During August 2015, a boil water notice (BWN) was issued across parts of North West England following the detection of Cryptosporidium oocysts in the public water supply.

les_nessmanUsing prospective syndromic surveillance, we detected statistically significant increases in the presentation of cases of gastroenteritis and diarrhea to general practitioner services and related calls to the national health telephone advice service in those areas affected by the BWN.

In the affected areas, average in-hours general practitioner consultations for gastroenteritis increased by 24.8% (from 13.49 to 16.84) during the BWN period; average diarrhea consultations increased by 28.5% (from 8.33 to 10.71). Local public health investigations revealed no laboratory reported cases confirmed as being associated with the water supply. These findings suggest that the increases reported by syndromic surveillance of cases of gastroenteritis and diarrhea likely resulted from changes in healthcare seeking behaviour driven by the intense local and national media coverage of the potential health risks during the event.

 This study has further highlighted the potential for media-driven bias in syndromic surveillance, and the challenges in disentangling true increases in community infection from those driven by media reporting.

The potential impact of media reporting in syndromic surveillance: An example using a possible Cryptosporidium exposure in north west England, August to September 2015

Euro Surveill. 2016;21(41):pii=30368. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.41.30368

AJ Elliot, HE Hughes, J Astbury, G Nixon, K Brierley, R Vivancos, T Inns, V Decraene, K Platt, I Lake, SJ O’Brien, GE Smith

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22610

‘It depends and it’s complicated’ Schaffner on the 5-second rule

Friend of the barfblog.com shares his thoughts about the five-second rule, peer-reviewed research, and media attention. Thanks for doing this, Don.

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In March 2014 I got angry. I saw an article in the popular press indicating that researchers from Aston University in the United Kingdom had “proved the five second rule was real”  It was not the finding that made me angry as much as the science behind it. Or more properly the lack of science behind it.

don-schaffner-214x300We’ve been studying microbial cross-contamination in my lab for more than 15 years, and I have considered myself a quantitative food microbiologist for my entire career. Given those two observations, it’s only natural that I be interested in an article like this. But when I reached out to the University for more information I learned the research had not been peer-reviewed, and the best that they could offer was a PowerPoint presentation. A PowerPoint presentation is not science. Science proceeds through peer review. Like democracy it’s a terrible system, just the best one we have found so far.

After I got angry, I got busy.  And like any good professor by “got busy”, I mean that a graduate student got busy doing the actual  work of science.  I had a brand-new MS student starting in my lab, and she had funding from another source, but needed a research project. We worked together to design an appropriate series of studies that would advance our understanding of microbial cross-contamination while at the same time could generate a press release that might get a little bit of attention. Like any good scientists we built on the work of others. We acknowledged non-peer-reviewed work from other institutions that paved the way like high school student Jillian Clarke in Hans Blaschek’s lab at the University of Illinois. We also acknowledged the first peer-reviewed research from Paul Dawson’s lab at Clemson University.

Flash forward a couple of years, we submitted our article to one of the best journals out there that publishes food microbiology research, Applied and Environmental Microbiology and after peer review and appropriate revisions our article was accepted for publication.  I reached out to a colleague in the media relations department at Rutgers University, and we worked together to write a press release.

As you may have noticed, we have garnered extensive media attention with thousands of articles published around the world. The New York Times did a particularly nice piece interviewing me as well as my colleague Bill Hallman, and barfblog’s Doug Powell.  It has been a fun ride, but I’m looking forward to getting back to other things.  Just keeping up with the requests for interviews has been almost a full-time job, I have generally resisted the temptation to respond to commenters on the Internet, who complain about everything from the waste of grant funds (not the case, we used discretionary funds I raised myself), to suggestions that I studied the wrong thing.

But before we close the books on this one, I do want to respond to Aaron Carroll, a medical doctor who became interested in the topic when he co-authored a book on medical myths. Carroll insists that it’s not any of the factors we studied that are important, but rather how dirty the surface might be.  He is certainly correct in that the level of contamination, as well as the type of contamination are important (pro tip: coliforms don’t make us sick), but the degree to which those microbes transfer is also essential in determining risk. As I’ve said in many interviews, if there are no pathogens present on the surface, the risk is zero. The immune state of the person doing the eating also makes a difference. The risk for someone who is immunocompromised is higher than the risk someone who has a healthy immune system.

schaffner-facebook-apr_-14So as any listener to our food safety podcast will know, it turns out “it depends” and “it’s complicated.” The level of contamination, the type of contamination, the nature of the surface, the nature of the food, as well as the immune state of the person all matter in determining risk of eating food off the floor.

Longer contact times increase cross-contamination of Enterobacter aerogenes from surfaces to food

Applied and Environmental Microbiology; Appl. Environ. Microbiol. November 2016 vol. 82 no. 21 6490-6496

Robyn C. Miranda and Donald W. Schaffner

http://aem.asm.org/content/82/21/6490.abstract?etoc

Abstract

Bacterial cross-contamination from surfaces to food can contribute to foodborne disease. The cross-contamination rate of Enterobacter aerogenes on household surfaces was evaluated by using scenarios that differed by surface type, food type, contact time (<1, 5, 30, and 300 s), and inoculum matrix (tryptic soy broth or peptone buffer). The surfaces used were stainless steel, tile, wood, and carpet. The food types were watermelon, bread, bread with butter, and gummy candy. Surfaces (25 cm2) were spot inoculated with 1 ml of inoculum and allowed to dry for 5 h, yielding an approximate concentration of 107 CFU/surface. Foods (with a 16-cm2contact area) were dropped onto the surfaces from a height of 12.5 cm and left to rest as appropriate. Posttransfer, surfaces and foods were placed in sterile filter bags and homogenized or massaged, diluted, and plated on tryptic soy agar. The transfer rate was quantified as the log percent transfer from the surface to the food. Contact time, food, and surface type all had highly significant effects (P < 0.000001) on the log percent transfer of bacteria. The inoculum matrix (tryptic soy broth or peptone buffer) also had a significant effect on transfer (P = 0.013), and most interaction terms were significant. More bacteria transferred to watermelon (∼0.2 to 97%) than to any other food, while the least bacteria transferred to gummy candy (∼0.1 to 62%). Transfer of bacteria to bread (∼0.02 to 94%) was similar to transfer of bacteria to bread with butter (∼0.02 to 82%), and these transfer rates under a given set of conditions were more variable than with watermelon and gummy candy.

IMPORTANCE The popular notion of the “five-second rule” is that food dropped on the floor and left there for <5 s is “safe” because bacteria need time to transfer. The rule has been explored by a single study in the published literature and on at least two television shows. Results from two academic laboratories have been shared through press releases but remain unpublished. We explored this topic by using four different surfaces (stainless steel, ceramic tile, wood, and carpet), four different foods (watermelon, bread, bread with butter, and gummy candy), four different contact times (<1, 5, 30, and 300 s), and two bacterial preparation methods. Although we found that longer contact times result in more transfer, we also found that other factors, including the nature of the food and the surface, are of equal or greater importance. Some transfer takes place “instantaneously,” at times of <1 s, disproving the five-second rule.

Counting STECs in poop: Medium matters

The isolation and quantification of non-O157 Shiga toxin–producing Escherichia coli (STEC) from cattle feces are challenging. The primary objective of this study was to evaluate the performance of selected agar media in an attempt to identify an optimal medium for the detection and quantification of non-O157 STEC in cattle feces.

medium.messageComparison studies were performed using CHROMagar STEC, Possé differential agar (Possé), Possé modified by the reduction or addition of antimicrobials, STEC heart infusion washed blood agar with mitomycin C (SHIBAM), and SHIBAM modified by the addition of antimicrobials. Fourteen STEC strains, two each belonging to serogroups O26, O45, O103, O111, O121, O145, and O157, were used to test detection in inoculated fecal suspensions at concentrations of 102 or 103 CFU/g. One STEC strain from each of these seven serogroups was used to estimate the concentration of recovered STEC in feces inoculated at 103, 104, or 105 CFU/g. Significantly more suspensions (P < 0.05) were positive for STEC when plated on Possé containing reduced concentrations of novobiocin and potassium tellurite compared with SHIBAM, but not SHIBAM modified by containing these same antimicrobials at the same concentrations. Numerically, more suspensions were positive for STEC by using this same form of modified Possé compared with Possé, but this difference was not statistically significant. More suspensions were positive for STEC cultured on CHROMagar STEC compared with those on Possé (P < 0.05) and on modified Possé (P = 0.05). Most inoculated fecal suspensions below 104 CFU/g of feces were underestimated or not quantifiable for the concentration of STEC by using CHROMagar STEC or modified Possé.

These results suggest that CHROMagar STEC performs better than Possé or SHIBAM for detection of STEC in bovine feces, but adjustments in the concentrations of novobiocin and potassium tellurite in the latter two media result in significant improvements in their performance.

Comparison of agar media for detection and quantification of Shiga toxin–producing Escherichia coli in cattle feces

Journal of Food Protection®, Number 6, June 2016, pp. 896-1055, pp. 939-949(11)

Stromberg, Zachary R.; Lewis, Gentry L.; Moxley, Rodney A.

http://www.ingentaconnect.com/contentone/iafp/jfp/2016/00000079/00000006/art00006

Media not paying attention in Lebanon so police to begin raiding non-compliant restaurants

Minister Wael Abu Faour announced Wednesday a new strategy to refocus the media’s attention on his food safety campaign: raids.

media.scoopThe ministry will order a food shop or factory found to be selling contaminated food to stop. If they don’t, the ministry will ask security forces to hit them with raids and shut down their shops, Abu Faour explained.

The minister said his new plan comes as a result of a decline in the media’s attention to his campaign launched in November.

In the first couple weeks of the campaign, he had showered the media with praise, attributing their close coverage of the contaminated food scandal to the success in getting them to shape up.

Many newspapers used to reproduce the lists of food safety violators that Abu Faour had named during his televised press conferences, sometimes with front-page features. But in the past few weeks, media have dedicated less attention to the campaign.

And since media have stopped publishing the list of violators, blacklisted establishments have begun showing little interest in making sure their products meet standards, Abu Faour said.

Transparency? Hepatitis A outbreaks in Belize, UK schools

The Ministry of Health is working to contain a localized outbreak of Hepatitis A at a government school in Buena Vista, Cayo.

hepatitis.AAccording to reports, there was one case of the virus reported before Christmas, and since then at least 20 more cases

The outbreak in a public school has been kept under the radar by the Ministry of Health. When the media asked Ministry of Health C.E.O. Peter Allen about it, he was surprised by the fact that the news had gotten out. But, of course, he claims that the Ministry seems to have the situation under control.

“I don’t know why I am surprised that the media knows more about these things than I ever expect them to but indeed, we appear to have an outbreak of Hepatitis A in that particular school.”

The UK is a tad more forthcoming, noting that vaccinations are being offered to staff and children at a school in Portsmouth after a case of Hepatitis A was discovered.

A pupil at Isambard Brunel Junior School contracted the illness, which is often associated with foreign travel.

Public Health England (PHE) has recommended vaccinations for those who have been in close contact with the child, including a class at the school.

An ambulance can only move so fast: problems with partnership’s food safety educator study

Chapman’s right when he says I probably didn’t notice him the first year he worked in my lab: it was big, and I had people supervising people.

ben.doug.2.12But he stuck with it, ended up coaching girls hockey with me, bailed me out of jail, published lots of cool research, and now he’s his own prof at North Carolina State.

And he gets to make his own mistakes.

The recent work he and graduate student Nicole Arnold did with the food safety partnership thingies might have been good experience, but he got pressured into violating some basic research tenets: surveys, on their own, suck (they had limited cash), and press release before peer review is always a bad idea.

At least Chapman insisted all the raw data be made available.

The draconian consistency of partnership messages – cook, clean, chill, separate – while all valid, lead to a snake-oil salesman effect and ignore one of the biggest causes of foodborne illness that has been highlighted by both the U.S. Centers for Disease Control and the World Health Organization: food from unsafe sources.

What did consumers have to do with outbreaks involving peanut butter, pizza, pot pies, pet food, pepper and produce (washing don’t do much). That’s just the Ps.

Reciting prescriptive instructions like some fascist country line-dancing instructor benefits no one. Food safety is complex, and it takes effort.

The survey found that in today’s digital environment, most food safety education is done in person. According to the survey, 90 percent of the people that consider themselves food safety educators connect with consumers via face-to-face meetings and presentations. The next most-used channel is online, with 36 percent of educators using this method to connect with consumers.

But such a conclusion ignores the multiplier effect of messages, or the social amplification of risk: where did those messages originate and are they valid?

If anything the results argue for marketing microbial food safety at retail, where people can vote at the checkout aisle.

And education is the wrong word: people make risk-benefit decisions all the time. For those who care, food safety information should be provided using multiple media and messages; then people can decide for themselves.

At least Chapman stressed the need for medium and message evaluation, which is sorely lacking.

Food Safety Talk 66: The IAFP special with Dr. Freeze

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.
In this episode, Ben and Don were on location in Indianapolis at the International Association for Food Protection annual meeting and the show kicks off with Don’s discussion of his script and playbook for the IAFP meeting.
Don ate dinner at a place (Harry and Izzy’s) that is not St. Elmo’s Fire and the guys decided that Rob Lowe looks the same as he did in 1986. Ben discussed his rule of three drinks, and Don does not subscribe to the same rule – which led to some tiredness.
The guys were joined by Dr. Freeze who is not to be confused by Canada’s king of icees, Mr. Freeze. In discussing Ben’s new found obsession with the number 3 (like Jack White), Don shares 5ives, Merlin Mann’s list of fives (including #3 on the list of 5 guitarists who rock the three-note solo).
Don’s continued use of his IAFP playbook as a prop leads to a dissuasion of Dungeons and Dragon’s, Canadianisms and the renaming of IAFP as science prom (where Don and Ben may take their bromance to the next level).
Don alluded to the Florida Association for Food Protection’s requirement that Don dress up as a roach. A talk of accents let to a discussion of one of Ben’s current obsessions, FX’s Fargo with Martin Freeman.
The group recapped Indianapolis happenings including Food Safety Talk guest Bill Marler’s Ivan Parkin Lecture and the Oregonian’s Lynne Terry filing stories and tweeting from the meeting. The discussion went into some of the opportunities and challenges of having media actively attending sessions. The topic turned to non-traditional media, the 24 hour news cycle and clickbait lists including Buzzfeed. Don told a story about how a clip of him talking about food safety in China ended up on Al Jazeera.
An age old discussion about the media (and others) getting science wrong led to Ben talking about an anonymous Twitter feed called IAFP no context. The discussion went into the War of 1812 (also known as the one that Canada won).
In the After Dark the group talked about the Grateful Dead, handy folks and carpenters.

TV kitchen crimes more about ratings than risk

Rob Mancini, the best–looking food inspector in Canada, writes:

The use of media in relaying food safety information can be a powerful tool. Food safety reality shows seem to be the fad these days as consumers are increasingly becoming aware of what actually occurs behind the scenes in restaurants. Truthfully, the more disgusting a restaurant is the better the ratings.

Rob_Mancini_001That’s reality I discovered when we shot Kitchen Crimes in Canada.

A well run, clean and sanitary restaurant will not draw in the ratings, but cockroaches and over-the-top chefs (Gordon Ramseys) will, so take what you see with a grain of salt. Either way, it gets people talking about food safety, which is a good thing. The BBC will be airing a new series of Food Inspectors that will focus on restaurant inspections, complaints, foodborne outbreaks, and providing food safety information to the public.

Former food safety undersecretary calls BS on media coverage

Dr. Richard Raymond writes in MeatingPlace.com that when it comes to food safety, no wonder it is hard for the public to believe what they hear. Here are four public statements that fell short on honesty and accuracy:

• “Our nations’ food safety system is a hazard to public health.” — President Barack Obama shortly after his inauguration.

• “We are standing on the brink of a public health disaster.” — Congresswoman Slaughter in February, 2014, right after the FDA released its latest National Antibiotic Resistance Dan Aykroyd Plays Julia ChildMonitoring System’s (NARMS) report.

• When farmers use antibiotics, “they do so…under the care of a veterinarian.” — United States Farmers and Ranchers Alliance’s website (USFRA)

• “Salmonella is killed when food is cooked and handled properly. So, people becoming ill from antibiotic resistant foodborne bacteria and not being able to be treated in some manner, is rare if not almost non-existent.” — USFRA website

Number 1 was a good sound bite that played to the media and the change mongers, but totally failed to recognize a food safety system that may have flaws and shortcomings, but for the most part is doing a very good job with the tools given to FDA and USDA to enforce and regulate and it also ignores the dedication of our farmers and ranchers, scientists, trade organizations, packers and processors who toil every day, knowing their work is critical to your and my health.

This was just a shameful slap at tens of thousands of men and women who have chosen a less than glamorous profession, work in harsh conditions at times and try to do it right every day.

Number 2 totally ignored the fact that the latest NARMS report regarding samples of retail meat and poultry for pathogens and antibiotic resistance showed that the drugs of choice for treating foodborne illnesses caused by Salmonella and Campylobacter remain effective with no resistance seen.

It also showed significant declines in resistance in pathogens to flouroquinolones, a class of antibiotic used in human medicine but for all effects and purposes banned from use in animals by the FDA because earlier NARMS reports indicated a rapidly growing resistance that was problematical.

Numbers 3 and 4 mislead and attempt to say “no problem here with antibiotic use in animals.” Two simple facts shoot these quotes down, even as this organization tries to needle.tenderize.crspeak positively for those raising our food.

Simply put, there are a lot of antibiotics being administered in feed and water with zero DVM oversight and supervision. We all know that as a fact.

Salmonella is the number one cause of deaths from foodborne illnesses in this country, accounting for 29 percent of the total deaths. If you read the CDC annual reports you know that fact also. Tell the family members of the 452 persons who died in 2012 that those deaths were “non-existent.”

The Salmonella pathogen class also causes over 1 million illnesses per year in the United States. That fact cannot be waived off with a toss of a hand and a web page declaration, especially after the recent Foster Farms related outbreak that sickened over 500.
We have been making steady progress in making our meat and poultry safer, especially since the Jack in the Box E. coli O157:H7 outbreak that caused the entire industry to declare food safety a non-competitive arena.

Headline seekers and grabbers do not help the movement to continue to improve. Using logic, common sense and science as the movers and shakers will produce a safer food supply.

When the mango bites back

As a large-scale outbreak of Salmonella Braenderup appears to be forming in Canada and the U.S. from Mexican mangoes, New York Times reporter Gardiner Harris, who has written plenty about food safety over the years, has his own crappy experience with mangoes in India.

Harris writes he accepted a just picked mango from a stranger in New Delhi and that putting it directly into my mouth — skin and all — was stupid.

“But why did my first horrible case of traveler’s diarrhea in India have to result from a mango? I love mangoes, and India’s vast array of deliciously different mango varieties has been one of the great delights of moving here.

“You didn’t even wash it?” Dr. Paul Offit, chief of infectious diseases at Children’s Hospital of Philadelphia, asked me later.

“No.

“Even by your standards, that was really stupid,” Dr. Offit said.

“Indeed, my wife joined me for the first week of my stay here before returning temporarily to the United States, and within four days she became terribly ill. I freely dispensed what turned out to be terrible advice, suggesting in the early hours of her illness that she avoid taking one of the antibiotic pills that we had brought for just such an eventuality.

“My advice sprang from the mistaken belief that the good bacteria in her gut had a fighting chance against the bad bacteria. “Honey, taking an antibiotic is like carpet-bombing a battlefield,” I told her in confident tones. “You kill off all the good guys as well as the bad guys. Let’s see if the good guys rally first.

“They did not. As it turns out, the fight against toxic bacteria is largely waged by the body’s immune system, not the sweet-tempered millions found in a spoonful of yogurt.”

At least he admitted he was dumb. But how much dumb – or slanted – advice was spewed out in the pages of the N.Y. Times over the years?