Category Archives: Food Safety Policy

Another Cyclospora outbreak IDed in Minnesota

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The Minnesota Department of Health (MDH) is investigating an increase in Cyclospora infections within the last month. To date, state health officials have identified two outbreaks together involving at least three dozen Minnesotans.

One outbreak has been identified among people who ate at Sonora Grill in Minneapolis in mid-May. To date, 17 patrons have reported illness. The restaurant is fully cooperating with the investigation, and investigators say they do not have any indication that there is an ongoing risk to patrons.

To better identify the source of infection, MDH investigators want to speak with people who ate at Sonora Grill over the weekend of May 18-May 20, regardless of whether they became ill.

“Even if you have not been sick, your information can help us identify what may have caused these illnesses and prevent future illnesses,” said Trisha Robinson, an epidemiologist supervisor with MDH. “If you ate at Sonora Grill during that weekend of May 18-20, please contact the Minnesota Department of Health Waterborne Diseases Unit at 651-201-4891.”

Infection with Cyclospora, known as cyclosporiasis, is caused by the parasite Cyclospora and is spread through consumption of imported fresh produce; it is not spread person-to-person. Washing of imported produce, or routine chemical disinfection or sanitizing methods, are unlikely to kill Cyclospora. Symptoms typically include watery diarrhea, stomach cramps, nausea, loss of appetite and weight loss. People typically become ill about a week after exposure, but this period can range from 2-14 days. Diarrhea can last several weeks or longer if not treated.

A second outbreak has been linked to Del Monte vegetable trays purchased at Kwik Trip locations. To date, 20 cases have been identified among Minnesotans in this outbreak. Cases report purchasing the vegetable trays at various Kwik Trip locations around the state. Kwik Trip is cooperating with the investigation and voluntarily removed the vegetable trays from their shelves. Consumers should not eat the following products:

Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 6 oz.

Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 12 oz.

MDH investigators are working with the Minneapolis Health Department and the Minnesota Department of Agriculture (MDA) on the Sonora Grill outbreak and with MDA and other states on the Kwik Trip outbreak.

“We do not have any indication at this time that the two outbreaks are related,” Robinson said. “Besides these outbreak cases, there are other cases of cyclosporiasis that do not appear to be related to either of these outbreaks, which is not unexpected for this time of year. We typically see increases in Cyclospora infections from May through August.”

The global burden of crypto in children under 5

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The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden.

Methods

The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth.

Findings

In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone.

Interpretation

Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts.

Morbidity, mortality, and long-term consequences associated with diarrhoea from cryptosporidium infection in children younger than 5 years: A meta-analyses study

The Lancet Global Health, DOI: https://doi.org/10.1016/S2214-109X(18)30283-3

Ibrahim A Khalil, Christopher Troeger, Puja C Rao…

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30283-3/abstract#.WyQRPA3swGY.twitter

Funding

The Bill & Melinda Gates Foundation.

Depression sucks: CDC doctor who vanished for months before being found in a river killed himself by drowning

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I sometimes think of going for a walk into the river.

It’s close, it’s convenient, it has bull sharks, I wouldn’t last long.

Dr. Timothy Cunningham from his facebook photos

But then I get on with my day, in whatever fragmented version of myself that may be.

When you hear your psychiatrist phoning in a prescription and characterizes you (me) as suffering from severe depression, it sorta hits home.

It sucks for my family, and I’m sorry for that.

I’m going through a lot of death that happened almost 40 years ago, but trying to deal with it and move on.

It ain’t easy, and it ain’t easy on those around me.

A U.S. Center for Disease Control doctor who vanished in February drowned himself and was pulled from an Atlanta river about two months after going missing, authorities now believe.

The Fulton County Medical Examiner’s Office classified Dr. Timothy Cunningham‘s death as “suicide by drowning,” though it remains unclear how exactly he first entered the water.

Cunningham, a Harvard-educated epidemiologist with the U.S. Centers for Disease Control and Prevention, was last seen alive leaving work Feb. 12, after complaining that he felt ill.

On April 3 — after much fruitless searching and mystery, some of which spawned wild and since-debunked conspiracy theories — his body was pulled from the Chattahoochee River.

The chief medical examiner, Dr. Jan Gorniak, told The Atlanta Journal-Constitution that toxicology testing found marijuana in Cunningham’s system, but there were no other significant findings.

His body showed no other signs of trauma, according to authorities.

According to the autopsy report, Cunningham’s parents told police that he did have frequent mood swings but that he had never been officially diagnosed with depression or any other mental illness.

The scientist, 35, was a team leader in the U.S. Public Health Service Commissioned Corps. His career had been marked by accomplishments including co-authoring 28 publications, focusing on how health issues affect minorities. He also worked on numerous public health emergencies, including the Ebola outbreak and the Zika virus.

“Tim was always the golden boy,” a colleague at the CDC previously told PEOPLE.

In his position Cunningham prominently studied heath patterns related to race, gender and geography. For his work, the Atlanta Business Chronicle featured him last October as one of its “40-Under-40” rising stars in the region.

“He expressed a strong desire to improve the health of others,” journalist Tonya Layman, who interviewed Cunningham for his Chronicle profile, told PEOPLE. “I was really impressed with his intellect and his passion for the work he was doing.”

We’re all just people.

Bugs be passed around on leafy greens

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Several outbreaks of foodborne illness traced to leafy greens and culinary herbs have been hypothesized to involve cross-contamination during washing and processing. This study aimed to assess the redistribution of Salmonella Typhimurium LT2 during pilot-scale production of baby spinach and cilantro and redistribution of Escherichia coli O157:H7 during pilot-scale production of romaine lettuce.

Four inoculated surrogate: uninoculated product weight ratios (10:100, 5:100, 1:100, and 0.5:100) and three inoculation levels (103, 101, and 10−1 CFU/g) were used for the three commodities. For each of three trials per condition, 5-kg batches containing uninoculated product and spot-inoculated surrogate products at each ratio and inoculation level were washed for 90 s in a 3.6-m-long flume tank through which 890 L of sanitizer-free, filtered tap water was circulated. After washing and removing the inoculated surrogate products, washed product (∼23, 225-g samples per trial) was analyzed for presence or absence of Salmonella Typhimurium or E. coli O157:H7 by using the GeneQuence Assay.

For baby spinach, cilantro, and romaine lettuce, no significant differences (P > 0.05) in the percentage of positive samples were observed at the same inoculation level and inoculated: uninoculated weight ratio. For each pathogen product evaluated (triplicate trials), inoculation level had a significant impact on the percentage of positive samples after processing, with the percentage of positive samples decreasing, as the initial surrogate inoculation level decreased.

The weight ratio of contaminated: noncontaminated product plays an important role: positive samples ranged from 0% to 11.6% ± 2.05% and from 68.1% ± 33.6% to 100% among the four ratios at inoculation of 10−1 and 101 CFU/g, respectively.

To our knowledge, this study is the first to assess the redistribution of low levels of pathogens from incoming product to leafy greens during processing and should provide important data for microbial risk assessments and other types of food safety analyses related to fresh-cut leafy greens.

Transfer and redistribution of Salmonella typhimurium LT2 and Escherichia coli O157:H7 during pilot-scale processing of baby spinach, cilantro, and romaine lettuce

Journal of food Protection vol.81 no. 6 June 2018

HALEY S. SMOLINSKI,1 SIYI WANG,1 LIN REN,1 YUHUAN CHEN,2 BARBARA KOWALCYK,3 ELLEN THOMAS,3 JANE VAN DOREN,2 and ELLIOT T. RYSER1*

https://doi.org/10.4315/0362-028X.JFP-17-420

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-420

Money talks: Safety interventions in Dutch vegetable production

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Surveys still suck, but the results of this one generally correlate to what we have found doing 20 years of on-farm food safety with fresh produce growers.

Outbreaks and crisis drive grower food safety concerns, prevention is a hard sell, but we’ve shown it can be done.

Understanding growers’ preferences regarding interventions to improve the microbiological safety of their produce could help to design more effective strategies for the adoption of such food safety measures by growers.

The objective of this survey study was to obtain insights for the design of interventions that could stimulate growers to increase the frequency of irrigation water sampling and water testing to reduce possible microbiological contamination of their fresh produce.

The results showed that price intervention, referring to making the intervention less costly by reducing the price via discounts, is the most effective strategy to change growers’ intentions to increase their frequency of irrigation water testing. Moreover, a sense of urgency affects their intentions to increase the frequency of irrigation water testing.

The findings of this survey support the hypothesis that, to date, safety is not perceived as a quality control issue under normal circumstances, but safety becomes an overriding attribute in a food crisis.

Understanding preferences for interventions to reduce microbiological contamination in Dutch vegetable production

June 2018, Journal of Food Protection vol. 81 no. 6

A. P. M. VAN ASSELDONK,1*L. MALAGUTI,2M. L. H. BREUKERS,1 and H. J. van der FELS-KLERX2,3

https://doi.org/10.4315/0362-028X.JFP-17-106

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-106

Does chlorine make pathogens harder to detect in fresh produce?

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The microbiological safety of fresh produce is monitored almost exclusively by culture-based detection methods. However, bacterial foodborne pathogens are known to enter a viable-but-nonculturable (VBNC) state in response to environmental stresses such as chlorine, which is commonly used for fresh produce decontamination.

Here, complete VBNC induction of green fluorescent protein-tagged Listeria monocytogenes and Salmonella enterica serovar Thompson was achieved by exposure to 12 and 3 ppm chlorine, respectively. The pathogens were subjected to chlorine washing following incubation on spinach leaves. Culture data revealed that total viable L. monocytogenes and Salmonella Thompson populations became VBNC by 50 and 100 ppm chlorine, respectively, while enumeration by direct viable counting found that chlorine caused a <1-log reduction in viability. The pathogenicity of chlorine-induced VBNC L. monocytogenes and Salmonella Thompson was assessed by using Caenorhabditis elegans. Ingestion of VBNC pathogens by C. elegans resulted in a significant life span reduction (P = 0.0064 and P < 0.0001), and no significant difference between the life span reductions caused by the VBNC and culturable L. monocytogenes treatments was observed. L. monocytogenes was visualized beyond the nematode intestinal lumen, indicating resuscitation and cell invasion. These data emphasize the risk that VBNC food-borne pathogens could pose to public health should they continue to go undetected.

IMPORTANCE Many bacteria are known to enter a viable-but-nonculturable (VBNC) state in response to environmental stresses. VBNC cells cannot be detected by standard laboratory culture techniques, presenting a problem for the food industry, which uses these techniques to detect pathogen contaminants. This study found that chlorine, a sanitizer commonly used for fresh produce, induces a VBNC state in the foodborne pathogens Listeria monocytogenes and Salmonella enterica. It was also found that chlorine is ineffective at killing total populations of the pathogens. A life span reduction was observed in Caenorhabditis elegans that ingested these VBNC pathogens, with VBNC L. monocytogenes as infectious as its culturable counterpart. These data show that VBNC foodborne pathogens can both be generated and avoid detection by industrial practices while potentially retaining the ability to cause disease.

Viable-but-nonculturable listeria monocytogenes and Salmonella enterica serovar Thompson induced by chlorine stress remain infectious

17 April 2018

American Society for Microbiology, vol. 9 no. 2

Callum J. Highmorea, Jennifer C. Warnera*,  Steve D. Rothwellb, Sandra A. Wilksa, C. William Keevila

doi: 10.1128/mBio.00540-18

http://mbio.asm.org/content/9/2/e00540-18

The produce problem: Ingredient analysis at restaurants in Cyclospora outbreaks

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By Sept. 2017, the U.S. Centers for Disease Control reported that almost 1,000 people had laboratory-confirmed cases of cyclosporiasis for the year.

Another banner year for the parasite famously associated with Guatemalan raspberries in 1996.

During July 21–August 8, 2017, the Texas Department of State Health Services (DSHS) was notified of 20 cases of cyclosporiasis among persons who dined at a Mediterranean-style restaurant chain (chain A) in the Houston area. On August 10, 2017, DSHS requested assistance from CDC to support ongoing investigations by the City of Houston Health Department, Harris County Public Health, Fort Bend County Health and Human Services, and Brazoria County Health Department. The objectives of this investigation were to determine the source of the illnesses in the Houston area and to generate hypotheses about the source of the national increase in cyclosporiasis in 2017.

Chain A has four locations in the Houston area and a central kitchen where many dishes are prepared. A case-control study was performed using a menu-specific questionnaire focusing on items containing fresh produce. A confirmed case was defined as laboratory-confirmed Cyclospora infection and clinically compatible illness in a person who ate at any location of chain A during May 28–July 15, 2017. A probable case was defined as diarrhea and at least one additional sign or symptom compatible with cyclosporiasis (e.g., anorexia, abdominal cramping, bloating, myalgia, fatigue, vomiting, or low-grade fever) in a person within 2 weeks after dining at chain A during May 28–July 15, 2017. Controls were identified as either dining companions of case-patients who had no illness or patrons who dined at the same chain A location within 2 days of a case-patient visit and who had no illness. For controls identified by the latter method, contact information was obtained using commercially available databases used by local health agencies in Texas. Three controls per case-patient were recruited.

A total of 22 case-patients (16 confirmed and six probable) and 66 controls were enrolled in the study. Case-patients had a median age of 52 years (range = 29–79 years); 50% were female. Analysis compared menu items consumed by case-patients and controls, followed by ingredient-level analysis. The following ingredients were identified as being significantly associated with illness: green onions (matched odds ratio = 11.3; 95% confidence interval = 2.55–104.68), tomatoes (5.5; 1.2–51.7), red onions (4.7; 1.3–21.0), and cabbage (4.0; 1.1–15.9). When analysis was limited to the 16 confirmed case-patients and their corresponding 48 controls, only green onions remained significantly associated with illness (17.6; 2.5–775.7). Restaurant invoices from chain A were collected for all items identified during the epidemiologic investigation, but efforts to trace any food item to its source were inconclusive. Although the current study identified potential foods associated with illness in Texas, investigators were not able to identify the illness source or confirm whether the patients within the chain A subcluster had consumed a product reported by other ill persons in the United States.

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis. Since 2013, the United States has experienced annual increases in the incidence of cyclosporiasis incidence during the summer months, with some illnesses linked to imported produce (1–3). Molecular subtyping of Cyclospora is not currently available; therefore, identification of an ingredient associated with a particular illness subcluster might provide information about a source contributing to other cyclosporiasis illnesses. Previous U.S. outbreaks of cyclosporiasis have been linked to fresh produce, such as prepackaged salad mix, raspberries, and cilantro (3,4). Identification of a vehicle for Cyclospora is complicated by the short shelf life of fresh produce as well as the use of potential vehicles such as garnishes or mixtures with other items that could also harbor the parasite. Ingredient-level analysis within restaurant clusters and subclusters therefore remains critical in Cyclospora outbreak investigations.

Notes from the field: Cyclosporiasis cases associated with dining at a Mediterranean-style restaurant chain- Texas 2017

1.jun.18 CDC

Amelia A. Keaton, MD1,2; Noemi Borsay Hall, PhD2,3; Rebecca J. Chancey, MD2,4; Vivienne Heines, MPH3; Venessa Cantu, MPH3; Varsha Vakil, MPH5; Stephen Long, MD5; Kirstin Short, MPH5; Elya Franciscus, MPH6; Natasha Wahab, MPH6; Aisha Haynie, MD6; Laura Gieraltowski, PhD2; Anne Straily, DVM4

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a5.htm

It’s a bad day when your office is raided: Belgian food safety agency edition

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In July 2017 Belgian food safety authorities publicly released information about a pesticide, fipronil, found in eggs leading to millions of eggs recalled.

The announcement came a month after the government knew about it.

‘Food safety recalls are always either too early or too late. If you’re right, it’s always too late. If you’re wrong, it’s always too early.’

That’s what Paul Mead was quoted as saying in response to when to go public with outbreak information over a decade ago. 

During foodborne illness outbreaks and incidents information is evolving – what people know, and when the share it can impact public health, and buyer decisions. Go public too late and stuff remains on the market. Go public too early risks making a wrong decision.

Doug, Sol Erdozian and I wrote a paper in the Journal of Environmental Health where we look at how to go public with food safety info.

There’s no magic answer; just have a plan and a set of criteria to look at when making the decision of what to share when. Talk about uncertainty. And don’t make it up on the fly.

And be prepared for folks to look for what you knew, when you knew it, and what you did about it after.

Like what happened in Belgium today. According to Reuters, FASFC had a visit from government prosecutors.

Belgian prosecutors said on Tuesday they had raided the premises of the country’s food safety agency over an insecticide scandal in eggs that rattled European consumers last summer.

“The judicial investigation concerns the spreading of false information about the fipronil contamination in eggs in 2017,” prosecutors said in a statement, adding the investigation was ongoing.

Last summer, German authorities blamed their Belgian counterparts for not communicating sooner about a possible fipronil contamination. Belgium’s farm minister denied the accusations at the time.

A tale of two outbreaks: Farmers have to get ahead of the public conversation because they lose

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I don’t like counting outbreak tolls or square mileage affected – in the absence of meaningful information – because it seems like accounting, and I have an accountant to do that.

Numbers numb and go past the story: Stalin said, “One death is a tragedy; one million is a statistic.”

None of us wants to be a statistic.

Whether it’s E. coli in Romaine lettuce in the U.S. or Listeria in rockmelon in Australia, producer groups have failed the farmers they are supposed to represent.

Step up. It’s a long way to the top if you want to rock and roll.