Tag Archives: MMWR

There was a lot of Salmonella in peppers in 2016; some of it led to 36 illnesses

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Last year someone I didn’t know called me about whether I had heard about people getting Salmonella from peppers. I hadn’t. It was around the same time there were a few recalls:

And that FDA had been sampling peppers for Salmonella.

I didn’t think much about it until this afternoon, when CDC published a report in MMWR about a multistate S. Anatum outbreak linked to imported hot peppers.

In June 2016, PulseNet identified a cluster of 16 Salmonella Anatum infections with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern from four states.* In April 2016, the same PFGE pattern had been uploaded to PulseNet from an isolate obtained from an Anaheim pepper, a mild to medium hot pepper. Hot peppers include many pepper varieties, such as Anaheim, jalapeño, poblano, and serrano, which can vary in heat level from mild to very hot depending on the variety and preparation. This rare PFGE pattern had been seen only 24 times previously in the PulseNet database, compared with common PFGE patterns for this serotype which have been seen in the database hundreds of times. Local and state health departments, CDC, and the Food and Drug Administration (FDA) investigated to determine the cause of the outbreak. Thirty-two patients in nine states were identified with illness onsets from May 6–July 9, 2016.

Local and state investigators visited restaurants where patients reported consuming peppers. They collected recipes for reported menu items, including salsa, and reviewed invoices to identify common ingredients. To identify the source of hot peppers, FDA conducted traceback (the process of tracing a food from point-of-service to its origin or manufacturer source) from three restaurants in Minnesota and Texas where patients reported eating. Two of the three restaurants received peppers from a consolidator/grower in Mexico (consolidator/grower B) (Figure 3), which exported Anaheim peppers to the United States in April 2016. Consolidators pool foods from different growers or growing locations; this designation is also used if some growers/growing locations are unknown.** The third restaurant received peppers from various firms in Mexico; however, this restaurant had received peppers from consolidator/grower B before this outbreak. Because of the complicated supply chain for peppers and the extensive mixing of peppers from different suppliers, repacking, and reselling of product, FDA was unable to identify a single source farm or point of contamination for peppers.

Too bad. Maybe this is what the call was about.

Keep food out of animal education events

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Next week I’m tagging along on a field trip with Jack’s first grade class. They’ve been studying the solar system and we’re headed to the planetarium to view the stars and learn about space missions.

No animal exhibits involved in this trip, but I’m sure those are in the future.

I plan on chaperoning any school trips the boys take to the farm, the fair or the petting zoo to help with the onsite risk management.070414.T.FF_.AGEDCENTER1

But, as today’s MMWR highlights, a lot of the disease risk stuff needs to be taken care of before with good planning and procedures.

Yeah, hand washing matters, but so does not letting kids bring lunch/snacks into a contaminated environment.

Or serving food directly in the barn to a 1,000 kids.

Or as Curran et al. say,  ‘These environments should be considered contaminated and should not be located in areas where food and beverages are served’
During April 20–June 1, 2015, 60 cases (25 confirmed and 35 probable) were identified (Figure). Eleven (18%) patients were hospitalized, and six (10%) developed hemolytic uremic syndrome. No deaths occurred. Forty primary cases were identified in 35 first-graders, three high school students, one parent, and one teacher who attended the event. Twenty secondary cases were identified in 14 siblings, four caretakers, and two cousins of attendees.

Food was served inside the barn to adolescents who set up and broke down the event on April 20 and April 24. During April 21–23 approximately 1,000 first-grade students attended the event, which included various activities related to farming. Crude attack rates were higher among those who assisted with setup on April 20 or breakdown on April 24 (three of 14 high school students; 21%) and among attendees on April 21 (22 of 254 students; 9%), than among attendees on April 22 (six of 377 students; 2%) and April 23 (seven of 436 students; 2%).

Animals, including cattle, had been exhibited in the barn during previous events. Before the dairy education event, tractors, scrapers, and leaf blowers were used to move manure to a bunker at the north end of the barn. Environmental samples collected in this area yielded E. coli O157:H7 PFGE patterns indistinguishable from the outbreak strains.

Although it might not be possible to completely disinfect barns and areas where animals have been kept, standard procedures for cleaning, disinfection, and facility design should be adopted to minimize the risk for exposure to pathogens (1). These environments should be considered contaminated and should not be located in areas where food and beverages are served. Hands should always be washed with soap and clean running water, and dried with clean towels immediately upon exiting areas containing animals or where animals have been kept previously, after removing soiled clothing or shoes, and before eating or drinking. Event organizers can refer to published recommendations for preventing disease associated with animals in public settings.

Here’s a set of guidelines we came up with for folks to use when choosing whether to take a trip to these animal events.

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MMWR Express app for iPhone and iPad now available

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My second favorite bathtime pastime is  MMWR, otherwise know as the U.S. Centers for Disease Control’s Morbidity and Mortality Weekly Report.

image_thumb[9]And now there’s an app for that.

MMWR Express, is now available for free download in the Apple App Store for both iPhone and iPad. This application provides fast access to the blue summary boxes in the MMWR Weekly. Summaries can be viewed by publication date or by searching for a specific subject (e.g., Salmonella). It is the first iPhone/iPad app to provide MMWR content.

MMWR publications have been in existence since 1952, and today MMWR remains CDC’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations. MMWR readership, which extends around the globe, predominantly consists of physicians, nurses, public health practitioners, epidemiologists and other scientists, researchers, educators, pharmacists, and laboratorians.

This application is one of an expanding collection of mobile applications from CDC. Development of applications for other mobile operating systems is under consideration. When online, MMWR Express can quickly check for new content, ensuring that users always have the most up-to-date information. Users also can share content with others via e-mail, text message, Facebook, or Twitter. The free application is available at https://itunes.apple.com/us/app/mmwr-express/id868245971?mt=8

Crayfish cross-contamination sickens four with Vibrio in Spokane

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Live or boiled crayfish is not anywhere near my list of food favorites. But if it’s yours, then keep raw and cooked foods separate, or people can barf.

CDC’s Morbidity and Mortality Weekly Report today contains a report of two people who were hospitalized on June 24, 2010, in Spokane, Washington with severe dehydration whose stool specimens yielded Vibrio mimicus.

“Investigators learned that both persons had consumed crayfish on June 20, 2010. The previous day, live crayfish obtained from an online seafood company had been boiled and served warm at a party. The chef reported that the boiled crayfish were served out of a cooler that had contained live crayfish, and the cooler had not been cleaned before being used to serve the cooked crayfish. After the party, the remaining crayfish were refrigerated overnight in different containers and served cold as leftovers the following evening on June 20.

“Questionnaires were administered to 21 (95%) of 22 persons who had attended either the party on June 19 or the meal of leftovers on June 20. A case was defined as an illness in any person who had attended the party or the meal and experienced acute, watery diarrhea during June 19–25. Four cases were identified. Consuming leftover crayfish was associated with illness. Of eight persons who consumed leftover crayfish, four (50%) became ill compared with zero of the 13 persons who did not consume leftover crayfish (relative risk = 14; Fisher’s exact test p value = 0.007). No other food items or environmental exposures were associated with illness. V. mimicus was isolated from cultures of stool specimens, and genes encoding cholera toxin were identified by polymerase chain reaction (PCR) in all three ill persons who submitted specimens."

Bad food safety reporting I. Would your home kitchen fail a food safety inspection? Mine would

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There has been a proliferation of terrible food safety reporting, especially nonsensical stories targeting the home as the overall number 1 super-duper source of foodborne illness.

The most recent round started with a study published in the U.S. Centers for Disease Control weekly report on Sept. 3, 2010, by the folks in Los Angeles who popularized letter grades for displaying the results of restaurant inspections. This time they used the same criteria to grade home kitchens, and concluded “at least one in seven home kitchens would flunk the kind of health inspection commonly administered to restaurants.”

So what? Based on the way the study was done, my kitchen would fail.

The problem with many of the results garnered from the L.A. study is that home kitchens where food is prepared for a few family members and friends are not restaurants where food is prepared daily for thousands of strangers: the risk is amplified, and so are the required precautions.

The results are based not on actual inspections, but  an Internet quiz taken by about 13,000 adults. So it’s the same self-reported nonsense, and only by people who surf the Intertubes, and could be bothered to take the quiz.

Direct video observation is a far more reliable indicator of human behavior in the kitchen, and yes, people make mistakes all the time, especially me.

But how those mistakes are defined can really mess up the results; food safety is not simple, so basing scores on answers to 45 questions could be erroneous and magnify the error rate.

I went through the survey and spotted some possibly problematic questions, depending on how the answers were scored and weighted (that information is apparently not available to mere mortals).

Q. I cook meat thoroughly until the juices are clear, not bloody.

I cook meat until it reaches the safe temperature endpoint as verified by a tip-sensitive digital thermometer. Color is a lousy indicator of meat food safety. Do I lose points?

Q. I defrost frozen foods by either storing them inside the refrigerator, under cold running water, using a microwave oven, or during the cooking process.

I would never defrost under cold running water because that is a microbial cross-contamination disaster and is not recommended by the federal government. Do I lose points?

Q. I check to make sure that there are no foreign objects such as glass, hair, etc., in my food.

I pay attention. I don’t specifically check for glass or hair using my special glass and hair goggles. Do I lose points?

Q. I thoroughly rinse my fruits and vegetables before cooking or eating them.

Depends. If it’s pre-washed bagged salad, I do not rewash because scientists have said the re-washing process is more likely to cross-contaminate the greens with whatever crap was previously in my sink. The paper is in Food Protection Trends and available here. Do I lose points?

Q. I always have soap and paper towels available for hand washing.

At home I use tea towels and go through a couple a day, ensuring they are routinely washed and cleaned. Do I lose points?

Q. I remove all jewelry from my hands and maintain my fingernails trimmed before I prepare foods.

No. I’m not a sandwich artist making subs for thousands. I’m preparing food for my family. Do I lose points?

The authors conclude, “Use of interactive, online learning tools such as the Food Safety Quiz can be used to promote home food safety in the community” but provide no evidence to support this claim, and state in the next sentence, “further research is needed to evaluate and improve the program content and to assess its effect on changing food handling and preparation practices in the home kitchen.”

The study was crap. Worse, blaming people is a lousy motivator for behavior change, if that was indeed the goal.

The Associated Press, and every other story about the study stated, “experts believe the bulk of food poisonings are unreported illnesses from food prepared at home.”

Experts believe foodborne illness has multiple causes from multiple sources. Casey Jacob and I tried to contribute to the public conversation about foodborne illness, where it happens and who’s to blame, with the appropriately titled paper, Where Does Foodborne Illness Happen—in the Home, at Foodservice, or Elsewhere—and Does It Matter? in the journal, Foodborne Pathogens and Disease. The paper has been published online ahead of print. We conclude, ??While some occurrences of foodborne illness result from unsafe practices during final preparation or serving at the site where food was consumed, others are consequences of receiving contaminated food from a supplier, or both. Data gathered on instances of contamination that lead to illness make greater contributions to the development of programs that reduce the risk of foodborne illnesses, than data or assumptions that describe locations where contaminated food is consumed. The abstract is below:

Foodservice professionals, politicians, and the media are often cited making claims as to which locations most often expose consumers to foodborne pathogens. Many times, it is implied that most foodborne illnesses originate from food consumed where dishes are prepared to order, such as restaurants or in private homes. The manner in which the question is posed and answered frequently reveals a speculative bias that either favors homemade or foodservice meals as the most common source of foodborne pathogens. Many answers have little or no scientific grounding, while others use data compiled by passive surveillance systems. Current surveillance systems focus on the place where food is consumed rather than the point where food is contaminated. Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.