A former professor of food safety and the publisher of barfblog.com, Powell is passionate about food, has five daughters, and is an OK goaltender in pickup hockey. Download Doug’s CV here.
Dr. Douglas Powell
editor, barfblog.com
retired professor, food safety
3/289 Annerley Rd
Annerley, Queensland
4103
dpowell29@gmail.com
61478222221
I am based in Brisbane, Australia, 15 hours ahead of Eastern Standard Time
WATE reports a customer complaint sent a health inspector back to a Morristown restaurant six weeks after a routine inspection.
Golden Dragon, 3325 Andrew Johnson Highway, Morristown – Grade: 70
The Golden Dragon on Andrew Johnson Highway scored a 70 during the most recent inspection. The score was passing. The health department considers a grade below 70 is considered “unsanitary.”
Several of the violations marked off in the report could lead to foodborne illness if not corrected.
The inspector wrote he watched a worker carry dirty dishes from the dining room into the kitchen and start preparing food without washing his hands.
Another kitchen worker washed large containers of food in the utility sink with water and put them away without rinsing and sanitizing them.
Inside the kitchen raw frog legs were stored over banana pudding and raw fish was stored over broccoli. That is OK at home but raw food contains bacteria and placing raw food over ready to eat food raises the potential for cross-contamination.
The Baltic Times reports the Sigulda Regional Council turned to the State Police (VP) about the infection of four kindergarten children with salmonella, Sindija Brikmane, deputy head of the Public Relations Department of Sigulda Municipality, informed LETA.
Investigating the causes of the disease, the Center for Disease Prevention and Control (CDPC) has received information from a laboratory that four children from local kindergartens in Sigulda Region have been diagnosed with the salmonella bacterium.
The municipality has previously announced that if the responsible authorities confirm that the caterer is guilty of causing the disease, the municipality will immediately terminate the contract with SIA Baltic Restaurants Latvia.
The Sigulda Regional Council promises to continue to monitor the inspection services and inform the public and the parents of the children about the current situation and the results of the bacterial samples taken.
I don’t cover all the norovirus outbreaks because there are far too many: but I do cover the unique and unintentionally sardonic.
Bethany Whymark of the Eastern Daily Press reports a primary school where scores of children are believed to have been struck down with norovirus has declined to confirm or deny whether an outbreak took place.
Of course not. They’re British.
Parents at Norwich Primary Academy say an outbreak of the vomiting bug at the end of last week caused dozens of children to fall ill.
One parent claimed almost a quarter of the school’s 350 pupils were absent at the end of last week and questioned why the school had not been closed.
Norwich Primary Academy did not confirm or deny whether any cases of norovirus has been reported, saying it could not comment on individual cases, but added that it took pupil health seriously and followed all relevant health protection guidelines.
Uh-huh.
One parent, whose children are in year one and year three at Norwich Primary Academy, said a group social media chat for parents at the school has reportedly been awash with talk of children and other family members falling victim to sickness and diarrhea.
“It is speculation from the teachers at the moment,” she said.
“There were 18 children in a year one class out of 30 on Friday morning and 10 on Friday afternoon. The children are dropping like flies.”
In 2018, an outbreak of leptospirosis was identified among raspberry workers from a mixed‐berry farm in New South Wales, Australia. Initial testing had not revealed a cause, but eventually leptospirosis was detected via polymerase chain reaction (PCR). Further serological testing detected Leptospira borgpetersenii serovar Arborea, of which rodents are the predominant reservoir. Leptospirosis is rare in Australia, with outbreaks usually related to flooding. We conducted an investigation to identify risk factors for infection, to inform control measures.
Cases were detected through laboratory notifications, hospital‐based syndromic surveillance, awareness‐raising among farm employees and clinician alerts. Confirmed cases had a four‐fold rise in antibody titre or single titre ≥400 on microscopic agglutination test, and a positive IgM. Probable cases had a positive Leptospira PCR or IgM, and possible cases had a clinically compatible illness. We conducted a case–control study among raspberry workers on the farm and compared reported exposures between cases and seronegative controls. We assessed environmental risks on‐site and tested rodents for leptospirosis.
We identified 84 cases over a 5‐month period (50 confirmed, 19 probable and 15 possible). Compared with controls, cases were less likely to wear gloves and more recently employed. Cases also more commonly reported always having scratched hands, likely from the thorns on raspberry plants. We observed evidence of rodent activity around raspberry plants and three of thirteen trapped mice tested positive for Leptospira Arborea. Control measures included enhanced glove use, doxycycline prophylaxis and rodent control.
This is the largest known outbreak of leptospirosis in Australia. Workers were likely exposed through scratches inflicted during harvesting, which became contaminated with environmental leptospires from mice. Leptospirosis should be considered an occupational risk for raspberry workers, requiring protective measures. Chemoprophylaxis may assist in controlling outbreaks. PCR assists in the early diagnosis and detection of leptospirosis and should be included in surveillance case definitions.
Investigation and response to an outbreak of leptospirosis among raspberry workers in Australia, 2018
To date, disease doctors have identified 11 cases of E. coli 0157 among Minnesotans who were at the State Fair between Aug. 25 and Sept. 2. All of them fell ill between Aug. 29 and Sept. 6.
Ages of those sickened range from 2 to 43 years old. Six of the cases required the patient to be hospitalized, including one person developing hemolytic uremic syndrome, which the MDH says is a potentially fatal complication.
One person is still in a hospital being treated.
Investigators are working to determine the source of the outbreak, with evidence so far indicating that it most likely began with contact with livestock.
Most of the 11 patients visited the Miracle of Birth exhibit and made physical contact with calves, goats, sheep or piglets, but others suffering from the E. coli strain did not make direct contact with animals, leading the MDH to consider the possibility that those people made contact with contaminated surfaces.
“This serves as a strong reminder to always wash your hands after being around livestock and their enclosures,” the MDH says.
Fortunately, there is “little chance” of ongoing exposure to the strain since the fair has ended.
Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x.
Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos.
Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763).
Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.
More than 1.1 million people had already passed through the gates of the San Diego County Fair this summer by the time an E. coli outbreak forced the closure of all animal exhibits and rides.
News that a 2-year-old boy had died after picking up the particularly nasty infection, which was also contracted by three other children with animal contact at the fair, stirred alarm within the community. Many had already roamed the midway, stuffed themselves full of fair food and passed through the venue’s cavernous livestock barns en route to pig races, pony rides and the petting zoo.
Paul Sisson of The San Diego Union Tribune reports hundreds of emails and other documents obtained through Public Records Act requests show that, while the public health team was able to move quickly, more frequent county case reviews, a more modern medical records system and more prompt and accurate responses from families with infected children might have gotten the investigation started days earlier.
The decision to shut down the animal exhibits on June 29, records show, came after four days of a behind-the-scenes scramble by the county’s public health department. With one death already on the books, they decided to notify the public even though testing had not yet confirmed that all four of those first four cases had E. coli infections.
It quickly became clear those initial instincts were accurate. In the following weeks, an additional seven people, plus two more whose infections weren’t confirmed, came forward, including another young boy who nearly died after suffering severe complications that attacked his kidneys.
Records show that zeroing in on the fairgrounds was no simple task. Epidemiologists had to eliminate a broad range of possible locations, from restaurants to a busy daycare center, before they were able to zero in on the fairgrounds.
And there was plenty of other work that had to be done simultaneously. County records show that the department investigated 435 disease cases in June alone. Of those, there were 43 cases of shiga toxin-producing E. coli reported that month, forcing disease detectives to sift out the 11 eventually confirmed to be part of the outbreak.
Determining whether there are connections between cases requires interviews with each subject or their legal guardians. Depending on the type of pathogen involved, it’s a process that often relies on frail human memory to recall the finest possible details of possible exposure routes from foreign travel and foods consumed to places visited and close contact with others.
The investigative process doesn’t get started until the health department is notified, usually after a test result administered in a doctor’s office or hospital comes back positive.
Subjects often aren’t interviewed until weeks after they got infected because many infections have incubation periods measured in days or weeks and it usually takes time before individuals decide to seek medical attention and additional time for medical providers to make a diagnosis.
Often, those charged with reading these particularly fragile tea leaves learn to trust their instincts, and that was certainly the case with the fairgrounds outbreak.
Emails show that the county’s epidemiology team first began to suspect that it might have an outbreak on its hands on June 24, the day that 2-year-old Jedidiah King Cabezuela (right) was admitted to the intensive care unit at Rady Children’s Hospital with severe kidney problems.
While discussing his condition, an epidemiologist noted that the boy had visited the fair before he got sick. And, she said, the county had been notified just before Cabezuela’s death of another boy, this one 9 years old, who tested positive for the type of toxin produced by the E. coli strain causing so much difficulty for Cabezuela.
Though the 2-year-old and 9-year-old hadn’t eaten the same foods at the fair, and the older boy’s parents said he didn’t visit animal areas, the fact that both visited the same location was enough for the epidemiologist to suggest that the department “should at least keep an eye on” the 9-year-old, even though he never got sick enough to need hospitalization.
By Tuesday, June 25, the public health department received the news that Cabezuela died overnight, and that information pushed the team to begin a relentless search for similar shiga toxin-producing E. coli infections.
They quickly found a report of a 13-year-old girl who had a positive toxin test after visiting the fair on June 8. Her parents had told interviewers that she had contact with animals and had eaten fair food afterward without first washing her hands.
Another girl, this one age 11, had also had a positive test but her parents had not returned repeated calls for an interview. It would not become clear that she, too, had visited the fair and had contact with animals until her parents were finally reached on June 28, the same day that the county announced it would close all public animal exhibits.
Then there was the 9-year-old boy mentioned in that prescient June 24 email. His parents initially said that he had no animal contact at the fair, but in subsequent interviews those parents remembered that, yes, their son did visit the livestock barn when the family visited on June 13.
With three, then four cases all reporting food consumption and animal contact at the fairgrounds, food inspectors descended on five different food vendors who sold items that the kids reported eating and found no traces of E. coli contamination.
Food poisoning ruled out, officials concluded that the E. coli exposure was most likely down to animals and, with the cooperation of the fair board, shut down all public access to animal exhibits and rides on June 29. Testing never did pinpoint the exact source of contamination, though the fair’s petting zoo and pony rides were ruled out.
Once public health nurses do their phone interviews and build up as clear a picture as they can of the circumstances surrounding each individual case, epidemiologists can begin looking for patterns, keeping an eye out for clusters of patients in specific geographic areas or with other commonalities such as foreign travel or consumption of tainted food.
A timeline of the E. coli outbreak at the San Diego County Fair
May 31– San Diego County Fair opens
June 8 –11-year-old and 13-year-old girls visit fair
June 10 –13-year-old becomes ill
June 12 –11-year-old becomes ill after a second fair visit
June 13 – 9-year-old boy visits fair
June 15 – 2-year-old Jedidiah Cabezuela visits fair
June 16 – 9-year-old becomes ill
June 18 – Investigator call parents of 11-year-old, get no reply
June 19 – 13-year-old reports visiting animal areas at fair; Jedidiah becomes ill; county holds weekly analysis meeting
June 20 – Jedidiah admitted to Rady Children’s Hospital
June 21 – 4-year-old and 38-year-old who later test positive for E. coli infections visit fair
June 22 – Jedidiah diagnosed with severe E. coli infection; 6-year-old Ryan
Sadrabadi, 2-year-old Cristiano Lopez and his mother, Nicole Lopez, and another 2-year-old girl, visit the fair
June 23 – Family confirms Jedidiah visited fair’s animal exhibits; one-year-old girl later confirmed to have E. coli infection visits the fair
June 24 – Jedidiah dies from kidney failure; 9-year-old’s fair attendance confirmed, animal contact denied; County epidemiologist raises red flag about possible case cluster at fair; Nicole Lopez becomes ill, treated at Kaiser La Mesa
June 25 – County learns of Jedidiah’s death, begins exploring fair connections in depth
June 26 –Ryan, 2-year-old girl and 1-year-old become ill
June 28 – Family of 9-year-old revises statement, confirms visiting livestock barn; Family of 11-year-old confirms she visited sheep exhibit at fair; County announces E. coli cluster at Del Mar Fairgrounds; County inspects five food booths visited by first four cases, no E. coli found; Cristiano becomes ill
June 29 – County inspects all 160 food booths at fair, finds no E. coli contamination; All animal areas at the fair are closed; four-year-old becomes ill
June 30 – Ryan becomes ill diagnosed with E. coli infection
July 1 – 6-year-old’s case reported to county
July 2 – Cristiano admitted to Kaiser Permanente San Diego Medical Center with worsening symptoms, diagnosed with E. Coli infection
July 3 – 2-year-old girl and 4-year-old’s cases reported to county
July 4 – Fair closes with an attendance that exceeds 1.5 million; Cristiano’s infection reported to county; Cristiano transferred to Rady Children’s Hospital, undergoes dialysis for hemolytic uremic syndrome that attacks his kidneys
July 6 – 38-year-old becomes ill
July 9 – 38-year-old’s infection reported to county
July 10 – 30-year-old’s and 1-year-old’s infections reported to county
July 29 – Three families file claims against fair board, alleging they weren’t properly warned of E. coli risk
July 31 – Environmental and animal testing fail to reveal a clear source of outbreak, but exposure in fair’s livestock barn deemed “likely”
Best practices for planning events encouraging human-animal interactions
Zoonoses and Public Health
G. Erdozain , K. KuKanich , B. Chapman and D. Powell
Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.
In the spring of 2018, an E. coli O157 outbreak linked to romaine lettuce grown in the Yuma, Arizona area resulted in 210 reported illnesses from 36 states, 96 hospitalizations, 27 cases of hemolytic uremic syndrome (HUS) and five deaths.
The U.S. Food and Drug Administration has launched a new initiative with support from the Arizona Department of Agriculture, and in conjunction with the University of Arizona Cooperative Extension, the Wellton-Mohawk Irrigation and Drainage District (WMIDD), and members of the Yuma area leafy greens industry to better understand the ecology of human pathogens in the environment in the Yuma agricultural region. This initiative will be a multi-year study which will focus on how these pathogens survive, move and possibly contaminate produce prior to harvest.
While the FDA, the Arizona Department of Agriculture and other state partners conducted an environmental assessment from June through August 2018 that narrowed the scope of the outbreak, the specific origin, the environmental distribution and the potential reservoirs of the outbreak strain remain unknown.
Between 2009 and 2017, FDA and partners at CDC identified 28 foodborne STEC outbreaks with known or suspected links to leafy greens. Like a lot of fresh produce, leafy greens are often eaten raw without a kill-step, such as cooking, that could eliminate pathogens that may be present.
Sounds like Yuma growers could use a Box of Rain. Or maybe more knowledge of the microbial ripple effect. May death be groovy for you, long-time Grateful Dead collaborator and lyricist Robert Hunter, who passed on Tuesday, aged 78.
James Cain of The Mirror reports a factory has been ordered to stop making food after it put uncooked sausages into pre-packed sandwiches.
The Middlesbrough-based factory has been told by health authorities it risked causing a listeria outbreak.
Café Class Ltd has been served with a hygiene emergency prohibition order for food safety practices that posed an “immediate danger to human health”.
A court this week heard how the company extended the use-by dates of boiled eggs, cheddar cheese and streaky bacon, putting consumers’ health at risk.
The risk to the public was so severe that the Food Standards Agency (FSA) issued an immediate product recall on sandwiches, wraps and salads made by the company.
Listeria has been in the spotlight this year after six people died after getting listeria from prepackaged sandwiches and salads served in UK hospitals.
In the unrelated case the company, which traded with stores including Londis, Nisa and North East Convenience Stores, faced court as Middlesbrough Council sought an emergency hygiene order to prevent it from making food, reports the Local Demoracy Reporting service for Teesside Live .
Company directors Shahid Nawaz and Mohammed Haris Abdullah arrived at Teesside Magistrates’ Court yesterday to hear Middlesbrough Council lay out the case against their company.
Andrew Perriman, prosecuting for the council , told magistrates that Café Class, based in Riverside Park, was visited by environmental health officers on September 9.
The inspection was arranged “to assess compliance with a hygiene improvement notice served earlier in the year as a result of allergy management concerns”.
But Mr Perriman said the officers were shocked to discover the factory was routinely placing ingredients on their use-by date in sandwiches, wraps and salads which would then be labelled with a four-day use-by date.
“In respect of cooked ham aspect used in the final product, it is specified by the manufacturer to be used within three days once opened,” said Mr Perriman.
But the officers found that once opened, the ham had been placed in a plastic container on September 8 and labelled with a use-by date of September 11.
Mr Perriman said it could be argued that if September 8 is counted as day one, this actually meant the ham was being used for four days.
In any case, the factory would continue to use the ham as an ingredient right up until the final use-by day.
But Mr Perriman added: “It was then placed into a sandwich and given a further four-day use by date.
“Not only that, the packaging on the final product stated ‘once opened consume within 24 hours’.
He said this practice meant cooked ham with a use-by date of September 10 or 11 was actually being used in a product labelled with a use-by date of September 15 or 16.
“As a result, the three-day shelf life is exceeded by a further six days,” he said adding that this was “way past” safe limits.The company’s website says: “We here at Café Class carefully ensure that the standards of Food Agency are met at all times and any waste is disposed of appropriately.
“All our products are fully cooked but we do not send the food waste to landfill sites, thus helping the environment and fulfilling our responsibility towards the society.”
Dozens of people have been poisoned after consuming British eggs contaminated with salmonella, an investigation has found, despite recent government assurances that the risk had been virtually eliminated.
Andrew Wasley of The Guardian reports at least 45 consumers have fallen ill since January this year in a major disease outbreak health officials have traced back to contaminated eggs and poultry farms.
Despite outbreaks of this strain occurring for more than three years, the government has issued no public warnings about the safety of hens’ eggs. In 2017, the Food Standards Agency (FSA) told the public that it was safe for vulnerable people, including pregnant women and the elderly to eat raw, runny or soft-boiled eggs. At the time the head of the FSA said: “The risk of salmonella is now so low you needn’t worry.”
Internal records obtained by the Bureau of Investigative Journalism and the Guardian show that 25 egg-laying poultry flocks in the UK have tested positive for salmonella in 2019 so far, seven of them contaminated with the most serious strains of the bacteria. Two egg-packing factories – one that supplies leading supermarkets – have also been contaminated, records show.
Eggs produced by the infected poultry flocks were placed under restrictions, meaning they cannot be sold to the public and must be sent for processing to kill the bacteria or be disposed of – while birds from infected flocks were culled.
However, some contaminated eggs did reach the public, with PHE confirming that 45 people had become ill after eating eggs infected with salmonella since January. The exact route to the public is unclear.
The government records also reveal that in 2018, 28 flocks tested positive for salmonella, four of them with dangerous strains.
According to PHE a further 55 human cases prior to 2019 were also being linked to the outbreak.
The revelations come just two years after the Food Standards Agency (FSA) declared that almost all eggs produced in the UK were free of salmonella. A major health scare in the 1980s had led to warnings that vulnerable groups should not consume raw or lightly cooked eggs – or food containing them – because of the salmonella risk. The then junior health minister Edwina Currie sparked a public outcry after saying “most” British egg production was infected with salmonella.
But in 2017 the FSA lifted the advice, stating the presence of salmonella in eggs had been “dramatically reduced” and that “British Lion” eggs – which cover about 90% of UK egg production – were safe to eat.
Speaking at the time, the then FSA chair Heather Hancock said: “We are now saying if there is a British Lion egg, you’re safe to do that. The risk of salmonella is now so low you needn’t worry. And that’s true whether you’re a fit healthy adult, or whether you’re pregnant or elderly or young. It’s only people on strictly medically supervised diets who need to avoid those eggs.”
PHE stated that it had been investigating this strain of salmonella for three years, despite the FSA clearing eggs for consumption.
The British Retail Consortium said: “Food safety remains a top priority for UK retailers and all UK sourced eggs are produced to the Lion code of practice. Retailers will comprehensively investigate any safety issues in our food supply and will take swift action as necessary.”
Assif Majid of BBC News writes that Watchdog’s reporter was given no training on keeping delivery crates and vans clean.
The reporter witnessed spillages, but was told by senior drivers that there was no need to clear it up during the delivery round.
Asda says it has a “clean as you go” policy and staff get full training.
Both Asda employees and customers have contacted the consumer programme with allegations about the cleanliness of the store’s delivery crates.
One driver told the programme: “There’s no cleaning process in place. The crates are used over and over again, even after spillages. Most, if not all, are dirty, from food, and things like smashed eggs.”
Another driver told the programme they are so concerned about poor hygiene, they are worried about their own family eating food from the crates.
Asda said the findings were “isolated examples and the opinion of individual colleagues”.
It added: “The findings do not reflect the extensive policies and training they have in place, which are supported by independent third party audits.”
The supermarket also says Watchdog’s researcher did not receive the full role-specific training because he didn’t do enough shifts.
Chartered environmental health practitioner Barrie Trevena said: “Even if the food you’re putting in is wrapped, the packages then become contaminated and then when the customer handles the cans and the packages, then that’s going to contaminate their worktop and fridge.”
The company said it delivered almost half a million orders each week, using their totes more than 2.5 million times, and it was inaccurate and misleading to suggest that it did not have policies or training in place at a business level.
Golden Dragon, 3325 Andrew Johnson Highway, Morristown – Grade: 70
