Does your stomach hurt? Maybe it’s because of a lot of food poisoning

Foodborne infections represent a serious and increasing human health problem while at the same time the incidence and prevalence of colitis and the inflammatory bowel diseases (IBDs) are increasing. The origins of these life-threatening syndromes predominantly include environmental factors deduced from studies of genetic twins and other human populations. Pathogen infection has been postulated as a possible environmental trigger of chronic intestinal inflammation and colitis. The Salmonella bacterial pathogen, for example, is widespread throughout the environment and remains a leading cause of human foodborne illness and disease. Salmonella infection can occur by the ingestion of contaminated food products often resulting in acute but temporary intestinal discomfort and dysfunction.

Possible links between pathogen infections and chronic intestinal inflammation are under increased study. Bacterial infections have been associated with seasonal increases in hospital admissions diagnosing intestinal inflammation and the IBDs. We considered that common repeated infections such as may occur in human food poisoning by Salmonella might be involved in triggering chronic intestinal inflammation. Such infections could be relatively mild, causing few symptoms that go unreported and disappear without clinical intervention, making it possible that there is currently an underappreciation of the numbers of infections occurring among individuals over a life span. We investigated whether low-titer and nonlethal Salmonella infections, designed to model repeated episodes of human food poisoning, may lead to chronic intestinal inflammation and colitis. If so, such a mechanism might be responsible for triggering human inflammatory syndromes including colitis and IBDs.

We developed and characterized a model of human food poisoning in the mouse using recurrent low-dose and nonlethal gastrointestinal infections of a virulent Salmonella isolate. We observed that repeated exposure induced inflammation of intestinal tissues, especially the colon. Although the host effectively cleared the pathogen weeks before reinfection, inflammation and intestinal tissue damage progressively increased in severity with additional infections. In addition, after the cessation of additional infections, inflammation and tissue damage failed to subside and persisted for months throughout the duration of study. We have identified the disease mechanism to be an acquired deficiency of intestinal alkaline phosphatase (IAP), an enzyme produced by enterocytes of the duodenum of the small intestine. IAP dephosphorylates and detoxifies the lipopolysaccharide (LPS) endotoxin produced by commensal microbiota of the host. Salmonella infection induced endogenous neuraminidase (Neu) activity among enterocytes of the duodenum by a Toll-like receptor 4 (TLR4)–dependent mechanism. This elevation of Neu activity accelerated the molecular aging and turnover of IAP, causing IAP deficiency in the colon. IAP deficiency led to elevated levels of LPS-phosphate that provoked TLR4-dependent inflammation. IAP augmentation or neuraminidase inhibition using a marketed antiviral neuraminidase inhibitor were similarly effective at preventing the accumulation of LPS-phosphate and the onset of disease.

We have discovered an environmental and pathogenic origin of chronic intestinal inflammation using a model of recurrent human food poisoning. We further show that this disease can be prevented by either IAP augmentation or Neu inhibition, both of which may represent prophylactic and therapeutic approaches to human colitis and the IBDs.

Recurrent infection progressively disables host protection against intestinal inflammation

Science, vol. 358, issue 6370, Won Ho Yang, Douglas M. Heithoff, Peter V. Aziz, Markus Sperandio, Victor Nizet, Michael J. Maha, DOI: 10.1126/science.aao5610

http://science.sciencemag.org/content/358/6370/eaao5610

Yup, they get into produce seeds, especially sprouts: Salmonella and E. coli internalization

Vegetable seeds contaminated with bacterial pathogens have been linked to fresh-produce-associated outbreaks of gastrointestinal infections. This study was undertaken to observe the physiological behavior of Salmonella enterica and enterohemorrhagic Escherichia coli (EHEC) cells artificially internalized into vegetable seeds during the germination process.

Surface-decontaminated seeds of alfalfa, fenugreek, lettuce, and tomato were vacuum-infiltrated with four individual strains of Salmonella or EHEC. Contaminated seeds were germinated at 25°C for 9 days, and different sprout/seedling tissues were microbiologically analyzed every other day. The internalization of Salmonella and EHEC cells into vegetable seeds was confirmed by the absence of pathogens in seed-rinsing water and the presence of pathogens in seed homogenates after post-internalization seed surface decontamination.

Results show that 317 (62%) and 343 (67%) of the 512 collected sprout/seedling tissue samples were positive for Salmonella and EHEC, respectively. The average Salmonella populations were significantly larger (P < 0.05) than the EHEC populations. Significantly larger Salmonella populations were recovered from the cotyledon and seed coat tissues, followed by the root tissues, but the mean EHEC populations from all sampled tissue sections were statistically similar, except in pre-germinated seeds. Three Salmonella and two EHEC strains had significantly larger cell populations on sprout/seedling tissues than other strains used in the study.

Salmonella and EHEC populations from fenugreek and alfalfa tissues were significantly larger than those from tomato and lettuce tissues. The study showed the fate of internalized human pathogens on germinating vegetable seeds and sprout/seedling tissues and emphasized the importance of using pathogen-free seeds for sprout production.

Fate of Salmonella enterica and Enterohemorrhagic Escherichia coli cells artificially internalized into vegetable seeds during germination

Appl. Environ. Microbiol. January 2018 84:e01888-17; Accepted manuscript posted online 27 October 2017, doi:10.1128/AEM.01888-17

Da Liu, Yue Cui, Ronald Walcott and Jinru Chen

http://aem.asm.org/content/84/1/e01888-17.abstract?etoc

 

 

Two outbreaks? One outbreak? Two different products? Same product? Romaine?

I dunno.

I’m having trouble agreeing with the avoid-romaine-in-the-US statement from Consumer Reports. Maybe it’s the same outbreak; maybe it’s not (and CDC didn’t say a lot about whether Canadian and US cases even have the same pfge match). Could be same pathogen on different product.

Just not sure yet. And public health folks share more about uncertainty; PHAC, share any info you have on distribution of the romaine you think it is.

Go public. Share data with the people.

Audits and inspections are never enough: French inspectors missed Salmonella at baby milk plant

French food safety inspectors failed to detect salmonella contamination at a plant belonging to dairy giant Lactalis, three months before the company carried out a major recall of baby milk, a report said Wednesday.

Lactalis, one of the world’s largest producers of dairy products, discovered the bacteria at its factory in Craon, northwest France, during tests in August and November.

It did not however report the find to the authorities.

Officials from the food safety department carried out a routine inspection of the site in September and gave it a clean bill of health, the Canard Enchaine investigative weekly reported.

It was only three months later, after around 30 infants being fed Lactalis powdered milk fell sick, that the health ministry sounded the alarm.

Officials from the national anti-fraud bureau swooped on the site on December 2 and found the assembly line where liquid milk is transformed into formula to be contaminated.

Lactalis issued two major recalls covering all production from the site from February 15, blaming the contamination on renovation work.

The plant has been at a standstill since December 8.

Lactalis is under investigation over the affair.

It could face charges of causing involuntary injuries and endangering the lives of others.

Market food safety at retail so consumers can choose.

Audits and inspections are never enough: A critique to enhance food safety

30.aug.12

Food Control

D.A. Powell, S. Erdozain, C. Dodd, R. Costa, K. Morley, B.J. Chapman

http://www.sciencedirect.com/science/article/pii/S0956713512004409?v=s5

Internal and external food safety audits are conducted to assess the safety and quality of food including on-farm production, manufacturing practices, sanitation, and hygiene. Some auditors are direct stakeholders that are employed by food establishments to conduct internal audits, while other auditors may represent the interests of a second-party purchaser or a third-party auditing agency. Some buyers conduct their own audits or additional testing, while some buyers trust the results of third-party audits or inspections. Third-party auditors, however, use various food safety audit standards and most do not have a vested interest in the products being sold. Audits are conducted under a proprietary standard, while food safety inspections are generally conducted within a legal framework. There have been many foodborne illness outbreaks linked to food processors that have passed third-party audits and inspections, raising questions about the utility of both. Supporters argue third-party audits are a way to ensure food safety in an era of dwindling economic resources. Critics contend that while external audits and inspections can be a valuable tool to help ensure safe food, such activities represent only a snapshot in time. This paper identifies limitations of food safety inspections and audits and provides recommendations for strengthening the system, based on developing a strong food safety culture, including risk-based verification steps, throughout the food safety system.

Probably: Should the toilet seat be closed before flushing?

About 30 years ago, I learned to consistently put the toilet seat down after spraying most of my urine into the bowl.

A wife, four daughters, another wife, another daughter, put the damn seat down. I get it.

With the tradies doing renos and using the loo, I had to remind the boys, house full of females, close the lid.

But should people, regardless of gender, close the seat before flushing?

I have anecdotally noticed more media references of a recommendation to close the lid before flushing, so I asked Dr. Don.

That’s Don Schaffner of Rutgers University, podcaster with Chapman, and friend of the barfblog.

(He gets paid to look up this stuff, I don’t, I’m just curious.)

Don replied within hours to say that it looks like there is some pretty good science to show this is more than a theoretical risk.

The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet.

Microbial biogeography of public restroom surfaces

“On toilet surfaces, gut-associated taxa were more prevalent, suggesting fecal contamination of these surfaces.”

Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk.

Chapman even chipped with a couple of papers from Chuck Gerba.

My risk-based recommendation?

Maybe.

And be careful (At home, I pee sitting down to minimize the mess, and complaints. That’s minimize, not eliminate).

35 now sick, 9 hosiptalized in South Australian Salmonella outbreak; bakery reopens

Confirmed cases of salmonella, linked to a South Australian bakery, have climbed to 35 with more expected as tests continue.

SA Health says nine people, including two children, have been hospitalised after eating products from the Gawler South bakery, which has two outlets in Gawler, about 40km north of central Adelaide.

The link to the bakery was first revealed late last month.

“We’ve now seen cases in people aged two years to 70 years old and we are anticipating more cases as further test results come through,” SA Health’s director of public health Kevin Buckett said.

The source of the contamination had been linked to sandwiches, wraps, rolls and focaccias with chicken and other fillings.’’

In a statement posted on social media the bakery’s management said it was no longer cooking chicken on the premises and SA Health officials were happy with its food handling processes.

Management also apologised to anyone who had become sick. “We hope this apology is received to be genuine and in good faith,” the statement said.

According to the ABC, the bakery was also struck by a salmonella outbreak in October 2016 which affected eight people.

Going public: FDA leaves tainted foods on shelves too long, report finds

The U.S. Food and Drug Administration is not moving quickly enough to ensure that contaminated food is removed from store shelves, despite being given the necessary authority, federal investigators have concluded.

The inspector general of the Department of Health and Human Services examined 30 of 1,557 food recalls between 2012 and 2015. The investigators found that the F.D.A. did not always evaluate foodborne hazards in a timely manner or ensure that companies initiated recalls promptly, leaving consumers at risk.

Food companies took an average of 57 days to recall items after the F.D.A. was apprised of the potential hazards. One recall did not begin for 303 days, the investigators said.

“Each and every day is important, because every day the product remains on the shelf, consumers are potentially at risk for serious illness or death,’’ said George Nedder, an assistant regional inspector general at Health and Human Services and lead author of the new report.

The F.D.A. has jurisdiction over most of the food supply in the United States, including virtually all processed food. (The Department of Agriculture oversees meat and poultry, and handles recalls of those products.)

About 48 million Americans get sick from food-borne diseases each year, according to the agency. Of those, 128,000 are hospitalized and 3,000 die.

Food recalls are announced frequently, but the vast majority are voluntary. Sometimes a company comes forward to report contamination, adulteration or mislabeling to the F.D.A. Sometimes the agency approaches a manufacturer after learning of a hazard from a state agency or other source.

In the past few months, the F.D.A. has announced recalls of contaminated apple slices (with listeria), biscotti (undeclared nuts) and adobo sauce (salmonella), among other problems.

The report noted numerous failings, among them “deficiencies in F.D.A.’s oversight of recall initiation, monitoring of recalls,” and in collecting and tracking recall data. Investigators also found that the F.D.A. did always not evaluate health hazards in a timely manner.

Many of the problems detailed in the report were the subject of an unusual “early alert memorandum” from the inspector general’s office in June 2016, which warned that “consumers remained at risk of illness or death for several weeks after F.D.A. was aware of a potentially hazardous food in the supply chain.’’

The new report noted that it took the agency 165 days to start a recall of nut butters that may have been tainted with salmonella; 151 days to recall hazelnuts that also suspected of salmonella contamination; 82 days to recall frozen spinach suspected of high levels of cadmium; and 27 days to start a recall of cooked duck eggs carrying the bacteria that cause botulism.

F.D.A. Commissioner Scott Gottlieb said that the agency had taken to heart the inspector general’s earlier warning and had already started to address recall enforcement problems that have persisted for years.

Dr. Gottlieb said that most food recalls occur within four days of a problem being reported, an assertion that Mr. Nedder disputed.

“Delay is deeply concerning to me as well,” Gottlieb, a physician, said in an interview. “I think it’s working a lot better now.”

FDA will also release guidance in the first half of 2018 on what information it can release about where recalled food and diet supplements were sold. A coalition of safety advocates urged Gottlieb in August to release the names of the stores that sell recalled food items, which FDA has claimed is confidential business information. The Agriculture Department releases it, as do other agencies including the Consumer Product Safety Commission.

FDA Commissioner Scott Gottlieb, MD said in a statement (edited below) that, “One of our most important jobs at the U.S. Food and Drug Administration is ensuring the safety of the U.S. food supply. When we learn about a food in the marketplace that may be unsafe, we must act quickly to keep people from getting sick or being harmed. If foodborne illness has already occurred, we also must act quickly to keep more people from becoming ill. The re-issued, final version of the report by the Office of the Inspector General (OIG), which examined our food recall practices over the time period from Oct. 1, 2012 to May 4, 2015, raised some significant concerns for me. While the FDA has addressed many of the findings after the draft version was first released in 2016, we still have more work to do. I take these obligations very seriously. Making sure the FDA has effective recall practices in place, and that we take immediate action to address unsafe foods, are high priorities of mine. Our recall authorities – and how we deploy them – are a cornerstone of our vital, consumer protection mission. …

“Among other steps, the agency will issue guidance on recall communications in the first half of 2018. As one example of the new steps we’re considering, the FDA is examining in what situations it can help consumers get information about the stores and food service locations that may have sold or distributed a potentially unsafe, recalled food, and what company may have supplied the product. If we’re able to disclose this information, consumers would have an easier time knowing if they might have, or have been, exposed to a recalled product that could cause potential risks if it were consumed.”

Here’s some suggestions:

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public. Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough. Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

‘When the going gets weird, the weird turn pro’ To sate China’s appetite, African donkeys are stolen and skinned

An edited version of this fascinating Times story is below:

“This is the spot,” said Morris Njeru, gazing down at a tangled patch of farmland where he recently found the bloody corpses of David, Mukurino and Scratch — his last donkeys.

Mr. Njeru, 44, a market porter who depends on his animals to ferry goods around this city, had already lost five donkeys earlier in the year. In each case, the thieves slit the animals’ throats and skinned them from the neck down, leaving the meat to vultures and hyenas.

Four months later, all Mr. Njeru could find of the animals was a single hoof, which he pocketed as a memento.

Rachel Nuwer of the New York Times writes there are scant remains, too, of Mr. Njeru’s once comfortable life. Without his animals, his income plummeted from nearly $30 per day to less than $5. He can no longer afford payments on a loan for a small piece of property he rented, and he fears he will have to take his child from boarding school.

“My life has completely changed,” he said. “I was depending on these donkeys to feed my family.”

For Mr. Njeru and millions of others around the world, donkeys are the primary means to transport food, water, firewood, goods and people. In China, however, they have another purpose: the production of ejiao, a traditional medicine made from gelatin extracted from boiled donkey hides.

Ejiao was once prescribed primarily to supplement lost blood and balance yin and yang, but today it is sought for a range of ills, from delaying aging and increasing libido to treating side effects of chemotherapy and preventing infertility, miscarriage and menstrual irregularity in women.

While ejiao has been around for centuries, its modern popularity began to grow around 2010, when companies such as Dong-E-E-Jiao — the largest manufacturer in China — launched aggressive advertising campaigns. Fifteen years ago, ejiao sold for $9 per pound in China; now, it fetches around $400 per pound.

As demand increased, China’s donkey population — once the world’s largest — has fallen to fewer than six million from 11 million, and by some estimates possibly to as few as three million. Attempts to replenish the herds have proved challenging: Unlike cows or pigs, donkeys do not lend themselves to intensive breeding. Females produce just one foal per year and are prone to spontaneous abortions under stressful conditions.

So Chinese companies have begun buying donkey skins from developing nations. Out of a global population of 44 million, around 1.8 million donkeys are slaughtered per year to produce ejiao, according to a report published last year by the Donkey Sanctuary, a nonprofit based in the United Kingdom.

“There’s a huge appetite for ejiao in China that shows no signs of diminishing,” said Simon Pope, manager of rapid response and campaigns for the organization. “As a result, donkeys are being Hoovered out of communities that depend on them.”

In November, researchers at the Beijing Forestry University warned that China’s demand for ejiao may cause donkeys “to become the next pangolin.”

“In 2016, this business of donkeys erupted,” said Obassy Nguvillah, a police superintendent in Tanzania’s Monduli district, near the Kenyan border. “There were increasing numbers of cases of guys passing into the Maasai area, taking people’s donkeys and transporting them to the Chinese-owned processing plant.”

In Esilalei — a village located on a sprawling, drought-plagued savanna under Mr. Nguvillah’s watch — residents lost nearly 475 donkeys in a single year. While about 175 of the animals were recovered by tracking the thieves into the bush, police believe the remainder were sold to slaughterhouses. Unable to afford replacements, the former owners are still reeling.

Unlike Tanzania, Kenya’s donkey skin trade shows no signs of slowing. In 2016, prices for skins were fifty times higher than in 2014, while prices for live donkeys have nearly tripled, from about $60 to $165.

The country’s three abattoirs — all of which have Chinese owners or partners — reported processing just under 100,000 donkeys in two years, according to a government memo. Both skin and meat are exported to China, usually through Vietnam or Hong Kong.

Seventeen skin traders have also opened shop, mostly in Nairobi, and a fourth abattoir is rumored to be on the way. The abattoir owners insist that they are bettering the country by generating jobs and paying handsome prices for unneeded donkeys.

“This business has helped so many people,” said John Kariuki, director of Star Brilliant Donkey Export Abattoir in Naivasha. “Instead of having to sell cows and goats, Maasai pastoralists are selling donkeys to pay their children’s school fees.”

Goldox Donkey Slaughterhouse in Baringo County — the largest of Kenya’s abattoirs, claiming to process some 450 donkeys a day — also attempts to spread good will by providing free water to neighbors, and by paying school fees for four local children.

Waste disposal has become a significant issue. Last fall, Goldox began dumping donkey remains at a parcel of land it purchased in Chemogoch village, down the road from its slaughterhouse.

After residents living adjacent to the site complained, the company began burying the waste rather than leaving it in the open. But neighbors say the situation is still unacceptable, accusing the company of contaminating ground water and breeding disease.

 “Should we go into the cocaine business or the sale of elephant tusks just because it makes money?” asked Dr. Onyango

Salmonella in poultry is naturally occurring. But reducible. Here’s some evidence

My paper of the day is from a group USDA Food Safety and Inspection Service folks who used a massive outbreak as a baseline for a set of interventions.

Good stuff.

The paper, Intensified Sampling in Response to a Salmonella Heidelberg Outbreak Associated with Multiple Establishments Within a Single Poultry Corporation by Green and colleagues, published online today in Foodborne Pathogens and Disease shows that on-farm and processing interventions matter.

They don’t say it’s Foster Farms, but it’s uh, Foster Farms.

Salmonella percent positive declined from 19.7% to 5.3% during this timeframe as a result of regulatory and company efforts. The company noted that a multihurdle approach to reduce Salmonella in products was taken, including on-farm efforts such as environmental testing, depopulation of affected flocks, disinfection of affected houses, vaccination, and use of various interventions within the establishments over the course of several months.

Less Salmonella is not just about cooking and cross-contamination in the home or a restaurant. Reducing how much Salmonella is introduced into kitchens really matters.

Popular doesn’t mean safe

There’s lots of popular food places. They might even make great food. Doesn’t mean that they know how to do food safety.

According to Wales Online, a popular chippy (one of my favorite UK terms) received a zero on their hygiene rating. Zero isn’t good. Unless the scale is -1 to zero. But it isn’t in Wales. Environmental health folks rate businesses on a scale from zero-5. 

The Fryery, in Rumney , was ranked at number nine on hungryhouse’s list after the online food ordering platform unveiled the list as part of its annual Most Loved Takeaway awards in April. 

But an inspection on November 20 handed the shop a zero rating meaning “urgent improvement” is necessary.

The Cardiff takeaway, which is located in Newport Road, is run by Kash Amin.

Mr Amin, who started working at his family’s takeaway at the age of 11 in 1988, has continued working in and running takeaways ever since – including Victor’s in Newport . 

Mr Amin said he was unhappy with the process of food hygiene rating inspections and said he had now paid £150 to appeal the decision.

Here’s the rating, doesn’t say much about the specifics of what was wrong. I wish more jurisdictions, including Wales, posted the entire inspection. The summary leaves a lot to assumptions.