5 dead, 197 sick from E. coli O157 linked to romaine lettuce

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The U.S. Centers for Disease Control reports there are now five people dead and 197 sick from E. coli O157:H7 linked to romaine lettuce.

  • 197 people infected with the outbreak strain of E. coli O157:H7 have been reported from 35 states.
  • 89 people (48%) have been hospitalized, including 26 people who have developed hemolytic uremic syndrome.
  • 5 deaths have been reported from Arkansas (1), California (1), Minnesota (2), and New York (1).
  • Illnesses started on dates ranging from March 13, 2018 to May 12, 2018.
  • Ill people range in age from 1 to 88 years, with a median age of 29.
  • Sixty-eight percent of ill people are female.

The Public Health Agency of Canada has identified people in several Canadian provinces infected with the same DNA fingerprint of E. coli O157:H7.

It takes two to three weeks between when a person becomes ill with E. coli and when the illness is reported to CDC. Most of the people who recently became ill ate romaine lettuce when lettuce from the Yuma, Arizona, growing region was likely still available in stores, restaurants, or in peoples’ homes. Some people who became sick did not report eating romaine lettuce, but had close contact with someone else who got sick from eating romaine lettuce.

According to the U.S. Food and Drug Administration, the last shipments of romaine lettuce from the Yuma growing region were harvested on April 16, 2018, and the harvest season is over. It is unlikely that any romaine lettuce from the Yuma growing region is still available in people’s homes, stores, or restaurants due to its 21-day shelf life.

The traceback investigation indicates that the illnesses associated with this outbreak cannot be explained by a single grower, harvester, processor, or distributor. While traceback continues, the FDA will focus on trying to identify factors that contributed to contamination of romaine across multiple supply chains.  The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching consumers. 

The FDA has identified Harrison Farms of Yuma, Arizona, as the grower and sole source of the whole-head romaine lettuce that sickened several people in an Alaskan correctional facility, but has not determined where in the supply chain the contamination occurred.

On May 31, 2018 the FDA released a blog with updated information on the traceback investigation (for additional information, visit FDA Update on Traceback Related to the E. coli O157:H7 Outbreak Linked to Romaine Lettuce).

A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

Using observation to evaluate training: Canadian High School edition

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A couple of old friends Shannon Majowicz and Ken Diplock and colleagues from Waterloo, (that’s in Canada) are doing good work looking at food safety stuff with high school students- evaluating training efficacy using observation. They published their work demonstrating some sustained food safety behaviors following a training program, this month in the Journal of Food Protection.

Kenneth J. Diplock, Joel A. Dubin, Scott T. Leatherdale, David Hammond, Andria Jones-Bitton, and Shannon E. Majowicz. 2018. Observation of High School Students’ Food Handling Behaviors: Do They Improve following a Food Safety Education Intervention?

Greenbank High School Birkdale Merseyside.

Journal of Food Protection: June 2018, Vol. 81, No. 6, pp. 917-925

Youth are a key audience for food safety education. They often engage in risky food handling behaviors, prepare food for others, and have limited experience and knowledge of safe food handling practices. Our goal was to investigate the effectiveness of an existing food handler training program for improving safe food handling behaviors among high school students in Ontario, Canada. However, because no schools agreed to provide control groups, we evaluated whether behaviors changed following delivery of the intervention program and whether changes were sustained over the school term. We measured 32 food safety behaviors, before the intervention and at 2-week and 3-month follow-up evaluations by in-person observations of students (n = 119) enrolled in grade 10 and 12 Food and Nutrition classes (n = 8) and who individually prepared recipes. We examined within-student changes in behaviors across the three time points, using mixed effects regression models to model trends in the total food handling score (of a possible 32 behaviors) and subscores for “clean” (17 behaviors), “separate” (14 behaviors), and “cook” (1 behavior), adjusting for student characteristics. At baseline, students (n = 108) averaged 49.1% (15.7 of 32 behaviors; standard deviation = 5.8) correct food handling behaviors, and only 5.5% (6) of the 108 students used a food thermometer to check the doneness of the chicken (the “cook” behavior). All four behavior score types increased significantly ∼2 weeks postintervention and remained unchanged ∼3 months later. Student characteristics (e.g., having taken a prior food handling course) were not significant predictors of the total number of correctly performed food handling behaviors or of the “clean” or “separate” behaviors, and frequency of cooking and self-described cooking ability were the only characteristics significantly associated with food thermometer use (i.e., “cook”). Despite the significant increase in correct behaviors, students continued to use risky practices postintervention, suggesting that the risk of foodborne disease remained.

Electrolyzed water: a pretty good review

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An old friend of the blog emailed today looking for some info for someone he was working with who wanted to know about whether electrolyzed water, on it’s own, was a good replacement for sanitizers.

I came across this 2016 review paper in Comprehensive Reviews in Food Science and Food Safety.

Electrolyzed Water as a Novel Sanitizer in the Food Industry: Current Trends and Future Perspectives

SME Rahman, Imran Khan, and Deog-Hwan Oh

Abstract:

Electrolyzed water (EW) has gained immense popularity over the last few decades as a novel broad-spectrum sanitizer. EW can be produced using tap water with table salt as the singular chemical additive. The application of EW is a sustainable and green concept and has several advantages over traditional cleaning systems including cost effectiveness, ease of application, effective disinfection, on-the-spot production, and safety for human beings and the environment. These features make it an appropriate sanitizing and cleaning system for use in high-risk settings such as in hospitals and other healthcare facilities as well as in food processing environments. EW also has the potential for use in educational building, offices, and entertainment venues. However, there have been a number of issues related to the use of EW in various sectors including limited knowledge on the sanitizing mechanism. AEW, in particular, has shown limited efficacy on utensils, food products, and surfaces owing to various factors, the most important of which include the type of surface, presence of organic matter, and type of tape water used. The present review article highlights recent developments and offers new perspectives related to the use of EW in various areas, with particular focus on the food industry.

Michigan’s hepatitis A problem is a public health cycle

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Next month I’ll be in Michigan talking food safety with Don at a live podcast recording as part of the Global Food Law Current Issues Conference.

Added to the list for our chat is a local issue, a massive hepatitis A outbreak. Tragically, according to USA Today, the outbreak has been linked to 27 deaths and hundreds of cases.

Wrapped up in this outbreak is the intersection of intravenous drug use; individuals in the homeless population; and, folks working in food service. Public health is complicated.

Most of those who have died in Michigan in this outbreak are 50 or older, Fielder said. And they died of liver failure, septic shock or other organ failure.

“Generally, it’s been people who are more sick or people who have less access to health care,” Fielder said. “You know, we’ve also seen a homeless component to this. We’re seeing this driven by a substance use disorder risk group.”

People who use illegal drugs account for about half of outbreak-related cases..

“It’s a very hard group to reach, and it’s a very hard group to get public health messaging to. There’s a lot of trust issues with government entities in general. So there’s a lot of outreach going out from local public health to … people they do trust in the community.”

As of Wednesday before Memorial Day, the hardest hit areas are Macomb County, north of Detroit, with 220 cases; Detroit itself with 170; elsewhere in Wayne County, where Detroit is located, with 144; and Oakland County, to the west of Macomb County where Pontiac is located, with 114 cases, according to the Michigan Department of Health & Human Services.

Part of the problem: As many as 35 restaurant workers in the Detroit area were found to have the virus and may have spread it unknowingly to diners. The virus is contagious weeks before a person begins to exhibit symptoms, which makes it extremely challenging for public health officials to manage.

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.

Thousands of Oregon food safety inspections still past due

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Our own Rob Mancini – most handsome man in food safety – was quoted in the Oregon Statesman Journal last week as saying, “In other jurisdictions high-risk facilities are typically inspected four times per year and low-risk facilities once per year.”

Yet according to Tracy Loew of the Statesman Journal, Oregon’s Food Safety Program remains in disarray, a year and a half after a state audit found it was so far behind on inspections of grocery stores, food processors and other licensees that public health could be at risk.

Although program officials touted an improvement in the inspection backlog just a few months ago, a newly discovered error in their tracking database has nearly wiped out the gain.

And officials can’t say whether the remaining improvement is due to completing more inspections or to adjustments they’ve made to inspection deadlines.

That means the state hasn’t checked whether hundreds of establishments are following rules to keep consumers safe — rules such as keeping deli food at correct temperatures, protecting products from pests like rats and cockroaches, keeping expired food off shelves and making sure employees wash their hands.

The Statesman Journal learned of the program’s failure after requesting a copy of the inspection database.

Stephanie Page, who oversaw the program, discovered the mistake in early March. She informed the Secretary of State’s Audits Division in early April.

“Unfortunately, the database coding error makes it very difficult for us to know for sure whether the improving trends that we were seeing were actually happening,” Page, who has since moved to another state agriculture program, wrote to auditors.

Food safety officials also discussed the mistake with the program’s Food Safety Advisory Committee, which is supposed to be open to the public.

But the committee has met in secret since the food safety audit was released in November 2016, leaving consumers out of the loop.

In a follow-up editorial, the Statesman Journal writes there are numerous explanations for the failures, but they all sound like excuses.

The takeaway remains the same for Oregonians: The state Department of Agriculture, which oversees the food safety program, cannot be both regulator and champion of those it manages.

That’s not quite true.

Safe food is a cornerstone of trade and policy.

What is true is the need for public accountability, so consumers can choose.

Ireland daycare closes over E. coli outbreak

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A community creche in Co Monaghan has been closed over an outbreak of shiga-toxin producing E.coli infection among children and staff.

Ballybay Community Creche was forced to close following the outbreak, to limit the spread of the infection. All children and staff members are due to be screened to see if they have picked up the infection.

My leafy green conundrum

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Caesar salad isn’t even the best salad.

It’s the kind of salad you expect at a sports team banquet or during lunch at an all-day meeting.

It’s a safe menu choice.

Except for the past month when foodborne illness outbreak investigators have focused on Romaine lettuce as the culprit of an outbreak of E. coli O157 linked to over 170 illnesses in 32 states.

E. coli O157 historically was once only associated with ground beef making it’s first appearance as what was thought to be a rare strain in 1982 after an outbreak was traced to McDonald’s. In 1993 over 500 illnesses and 4 deaths were linked to Jack-in-the-Box restaurants , an event that brought foodborne illness to the national stage. Fast forward 35+ years and the devastating pathogen has caused illnesses after being consumed in cookie dough, hazelnuts, alfalfa sprouts, soy nut butter, chicken salad – and a whole bunch of fresh produce including leafy greens.

The very type of food we should eat more of betrays us at a higher rate compared to other foods: Fresh produce is believed to be the source of almost half of all foodborne illnesses in the U.S.

Because it is consumed raw, anything that fresh fruit and vegetables come in contact with from the field to the home can really only increase risk. Washing and rinsing can remove at most 99% of what’s there. Microbiologically speaking, because there may be tens of thousands of cells on a leaf of Romaine, that’s not a whole lot. Often produce-related outbreaks are linked to poop getting into the food somewhere — wildlife on the farm; water used for irrigation or rinsing; soil and/or manure; or, the people who harvest, pack, handle and prepare it.

The problem with this outbreak is that the world of food safety sleuths have yet to figure it out. This one is particularly hard because the supply chain is a mess and  investigators are trying to piece together what the farms and packing facilities looked like, food safety-wise, retroactively. Partners in figuring out outbreaks, the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration have only been able to trace the problem to a specific geographic location – Romaine that was grown in the Yuma, AZ region.

Having a good sense of the supply chain for food, so outbreaks and incidents can be solved, is something that the industry has struggled with for decades. Even with the increased use of electronic records and the promise of blockchain, the data that gets recorded and shared relate to location and how food safety is managed from production to distribution to the grocery store still relies on people to input it.

Better traceability is often held up as a magic bullet but can’t really stop outbreaks from happening alone. Being able to trace a product is wholly reactive. While it is part of a good food safety culture even a good traceability program doesn’t wipe raw poop off of foods.

What keeps food safe is vigilance by the food industry, learning from past outbreaks and focusing on carrying out best practices daily. Lots of food companies talk about food safety. Implementing it daily is much harder. It takes a system throughout the entire company from the front-line staff all the way to the CEO that values food safety. Everyone needs to understand why food safety matters, what their role is and care about the folks who eat their products.

Where I grew up, there was a small tailgate farmers market Saturday mornings in the parking lot adjacent to the grocery store. I never really wondered whether the food sold there was safe. I didn’t think a whole lot about food safety and regulation until years later. I figured that if someone could sell it, they must know what they are doing, and I didn’t have to worry about it.

Food safety is all about trust, and I had lots of it.

I still do.

But over 75 outbreaks linked to leafy greens since 1995 is eroding that trust.

 

90 sick: Salmonella in Flanders

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At least 90 students in the west and east of Flanders have contracted Salmonella and have become ill. According to the Agency for Care and Health, at least thirty schools have already been affected by salmonella contamination.

The Federal Food Agency FAVV has closed the company that supplies meals to 120 schools as a precaution. On Thursday, at least fourteen students were taken to the hospital.

It is not certain whether the company is responsible for the contamination. FASFC has not found a cause at the supplier for the time being. Samples were taken that are examined in a laboratory. Next week, new tests will be conducted and the agency will decide whether the caterer may reopen.