Tumbling dice: Safety sacrificed for profits say former Blue Bell employees

Posted on September 14, 2015 by Douglas Powell

It’s a familiar tale.

Productivity may go down so safety corners are cut.

According to a feature in The Houston Chronicle, Benjamin Ofori sometimes watched a mush of strawberries and pecans flow into an ice cream tank even after his production line at Blue Bell had been scrubbed.

Low water pressure and temperature hampered Sabien Colvin’s cleanup efforts at the plant.

Another employee saw a steady drip, day after day, from a dirty air vent onto Fudge Bombstiks.

They say they all complained to supervisors.

Ofori also groused about a bypassed safety feature on his line. Later, that machine severed three of Colvin’s fingers.

In interviews with the Houston Chronicle, more than a dozen former employees of Blue Bell’s flagship Brenham plant described a company fighting to keep up with its growing customer base while sanitation and safety slipped. Cleanup workers regularly ran out of hot water, making machinery susceptible to pathogens and allergens. Reused packaging brought grime into the factory. Equipment went without safeguards for years, and several workers lost parts of one or more fingers.

The 14 employees have a combined 213 years of experience on the production lines. Their accounts are bolstered by the limited information reported by the Food and Drug Administration, including details about a contaminated machine that kept cranking out products even as a listeria crisis deepened. They’re also backed by an Occupational Safety and Health Administration investigation that blasted the company for failing to protect workers.

Blue Bell officials would not agree to an interview to discuss the ex-employees’ assessments of their operation. Spokesman Joe Robertson offered a one-paragraph response.

“We are a family at Blue Bell and we have always valued all of our employees and want them to feel safe and enjoy working here,” he said via email. “Our employees are our company’s greatest asset and many have spent their entire careers with us. Workplace safety, sanitation, and employee training remain our highest priorities as we continuously work to improve.”

Blue Bell attained a frozen empire with a story of idyllic country roots, old-fashioned values and quality ingredients.

But since 2010, tainted Blue Bell products sickened at least 13 people, including three who died after being hospitalized with other illnesses, according to the Centers for Disease Control and Prevention. Findings by the FDA and a private laboratory showed sanitation failures at Brenham extended to plants in Oklahoma and Alabama.

Nationwide, regulators and ice cream companies are rethinking long-held assumptions about cleaning and product testing.

The full story is a good read.

The trouble with meanings of risk, safety and security

Posted on August 18, 2015 by Douglas Powell

The concepts of risk, safety, and security have received substantial academic interest. Several assumptions exist about their nature and relation.

Besides academic use, the words risk, safety, and security are frequent in ordinary language, for example, in media reporting. In this article, we analyze the concepts of risk, safety, and security, and their relation, based on empirical observation of their actual everyday use.

The “behavioral profiles” of the nouns risk, safety, and security and the adjectives risky, safe, and secure are coded and compared regarding lexical and grammatical contexts.

The main findings are: (1) the three nouns risk, safety, and security, and the two adjectives safe and secure, have widespread use in different senses, which will make any attempt to define them in a single unified manner extremely difficult; (2) the relationship between the central risk terms is complex and only partially confirms the distinctions commonly made between the terms in specialized terminology; (3) whereas most attempts to define risk in specialized terminology have taken the term to have a quantitative meaning, nonquantitative meanings dominate in everyday language, and numerical meanings are rare; and (4) the three adjectives safe, secure, and risky are frequently used in comparative form. This speaks against interpretations that would take them as absolute, all-or-nothing concepts.

The Concepts of Risk, Safety, and Security: Applications in Everyday Language

Wiley Online Library, Risk Analysis, 18 AUG 2015

Max Boholm, Niklas Möller and Sven Ove Hansson

http://onlinelibrary.wiley.com/doi/10.1111/risa.12464/abstract;jsessionid=9D9F719E466B8B041E72C7163C374D8D.f04t01

E. coli in beach sand: It happens, but is it a risk?

Posted on July 22, 2015 by Douglas Powell

After surveying popular beaches in Hawaii, researchers from the University of Hawaii found that bacteria love the beach just as much as humans do. Turns out, the sand contained high levels of nasty bugs like E. coli.

The researchers discovered that warm, moist sand provides the ideal breeding ground for bacteria brought in by waste water run-off, sewage, or garbage dumped on the beach. “Beach sand needs to be considered carefully in assessing its impact on public health,” cautioned lead author Tao Yan, Ph.D. The side effect from your perfect afternoon in contaminated sand? Things like diarrhea, vomiting, rashes, and infections, the study authors warn.

But don’t freak out and cancel that trip to Cabo just yet, says Russ Kino, M.D., the medical director of the Emergency Department at Providence Saint John’s Health Center in Santa Monica, CA. “There’s nothing to worry about from walking or playing on the beach,” he says. “If you have an open wound on your legs or feet then there is a risk of infection, but just walking around the beach? Forget it. You’re safe.”

He doesn’t dispute that there are poop germs (and worse) on beaches, but he says that our built-in safety system—our skin—does a great job of keeping germs out. Even if you’re doing something a little more dirty, like letting your friends bury you in the sand, enjoying a picnic on the beach, or having a romantic (ahem) moment, you’re more likely to get sick from the activity than you are from the sand, according to Kino.

“Honestly, the biggest risk from the beach is a sunburn,” he says, adding that his number one tip for beach safety is to wear a hat and shirt with UPF protection and a good sunscreen, as melanoma is still the number one cancer killer of women under 35 years of age.

But what about listeria risks? FDA says fish consumption in large amount is the best food during pregnancy

Posted on January 26, 2015 by Douglas Powell

Daughter 2-of-5 is pregnant with my second grandson (I’m old).

What I’ve found through all these pregnancies is the enormous amount of conflicting advice provided to the moms-to-be.

It’s stressful enough being pregnant (not that I would know) without having Dr.-this-that giving bogus advice.

The Westside Story (whatever that is) writes that conflicting research works have been done on the nutritional benefits of consuming large amounts of fish during pregnancy and after that. Some studies have shown that fish is among the best foods that a pregnant and breastfeeding mom needs to take for the benefit of her baby and her own. However, some other studies raised questions about fish consumption, citing that some fish could actually have an adverse impact on the brain development of a baby. According to the latest research by the U.S. Food and Drug Administration (FDA), fish is good and eating large amounts of it is even better.

Good for brain development

What these stories lack is the potential Listeria risk in any refrigerated ready-to-eat foods like smoked salmon.

My kid’s got a biology degree and we’ve talked about this.

There’s a significant risk difference between refrigerated ready-to-eat foods and whole fish cooked to 145F as measured by a tip-sensitive digital thermometer.

Reported foodborne outbreaks due to fresh produce: US vs EU

Posted on January 17, 2015 by Douglas Powell

Consumption of fruit and vegetables is associated with a healthy lifestyle. Various international organizations, such as the World Health Organization, encourage the daily intake of at least 400 g of fruit and vegetables per day (excluding potatoes and other starchy tubers) for the prevention of chronic diseases, such as heart disease, cancer, diabetes, and obesity.

A large portion of this produce is consumed raw, and the number of foodborne outbreaks associated with these products has increased correspondingly. In this context, unpasteurized fruit juices and raw sprouts are also considered high-risk foods. The 2011 Escherichia coli O104:H4 outbreak from sprouted seeds in Germany gives a clear indication of the emerging relevance of the consumption of these products within food safety issues.

Globalization and growing international trade can also increase the risk, especially if produce comes from countries with lower safety standards. Nevertheless, nutrition educators and healthcare professionals believe that the benefits of eating fresh fruits and vegetables outweigh the risk of contracting a foodborne illness by consuming fresh produce.

The number of reported outbreaks (defined as the occurrence of two or more cases of similar illness resulting from the ingestion of a common food) reported both in the United States and European Union represents only a fraction of the actual number of outbreaks that occur.

Large outbreaks, outbreaks associated with food service and institutions, and outbreaks that have a longer duration or cause serious disease are more likely to be investigated and reported. Conversely, the data may not reflect what occurs in

sporadic cases. Moreover, there are differences in the sensitivity of the national or state systems in identifying and investigating foodborne outbreaks.

A wide spectrum of pathogens and food vehicles has been documented in produce-associated outbreaks. The occurrence of food-related infections due to fresh produce calls for better control interventions and the need for improved prevention strategies worldwide, since food can be contaminated at any point in the food chain, and interventions must be applied where appropriate at every step. Hence, the future success of global efforts to prevent produce-related outbreaks depends on the understanding of the key contributing factors and the maintenance of best practices to reduce and eliminate contamination.

Reported foodborne outbreaks due to fresh produce in the United States and European Union: trends and causes

Foodborne Pathogens and Disease. January 2015, 12(1): 32-38

Callejón Raquel M., Rodríguez-Naranjo M. Isabel, Ubeda Cristina, Hornedo-Ortega Ruth, Garcia-Parrilla M. Carmen, and Troncoso Ana M.

http://online.liebertpub.com/doi/abs/10.1089/fpd.2014.1821#utm_source=ETOC&utm_medium=email&utm_campaign=fpd

Abstract

The consumption of fruit and vegetables continues to rise in the United States and European Union due to healthy lifestyle recommendations. Meanwhile, the rate of foodborne illness caused by the consumption of these products remains high in both regions, representing a significant public health and financial issue. This study addresses the occurrence of reported foodborne outbreaks associated with fresh fruits and vegetables consumption in the United States and European Union during the period 2004–2012, where data are available. Special attention is paid to those pathogens responsible for these outbreaks, the mechanisms of contamination, and the fresh produce vehicles involved. Norovirus is shown to be responsible for most of the produce-related outbreaks, followed by Salmonella. Norovirus is mainly linked with the consumption of salad in the United States and of berries in the European Union, as demonstrated by the Multiple Correspondence Analysis (MCA). Salmonella was the leading cause of multistate produce outbreaks in the United States and was the pathogen involved in the majority of sprouts-associated outbreaks. As is reflected in the MCA, the pattern of fresh produce outbreaks differed in the United States and European Union by the type of microorganism and the food vehicle involved.

Infant botulism risks exist with all honey, pasteurized or not

Posted on November 12, 2014 by Ben Chapman

Tragic stories around infant botulism have popped up over the past couple of years and, as a dad, reading them is like a gut-punch.

In 2011, infant Amanda Zakrzewski was diagnosed with infant botulism and had to undergo 9 days of antitoxin treatment in hospital. Amanda wouldn’t eat, her eyes glassed over and she wasn’t able to suckle due to the paralysis the botulinum outgrowth caused. The result was months of rehab.

Also in 2011, 16-week-old Logan Douglas was temporarily blinded and paralyzed from infant botulism. He fully recovered after six months, but at one point the illness was so severe that doctors had discussed turning off life support systems as the toxin was attacking his body.

Related to infant botulism, ABC Research Laboratories blog has an interview with Chief Scientific Officer Gillian Dagan about food safety choices she makes as a food scientist. While I agree with most of what she says, she loses me at honey:

We all have fond memories of our grandparents when we were younger. Dr. Dagan remembers when her grandfather kept bees. She was fascinated by the bee hives and loved it when he would lift one of the trays and break off a piece of fresh honeycomb for her to enjoy on the spot. Now she knows better. As much as she loved that as a kid, she probably wouldn’t do that for her daughter. When she was younger she didn’t know that raw honey is a food at risk for botulism and should be pasteurized much like milk. Pasteurized honey is safe honey.

Sort of.

Clostridium botulinum spores, the stuff I’m guessing she’s worried about are tough to address in honey because they are heat-stable. Once the spores get into the digestive system of an infant, which hasn’t fully developed and has a gastric pH higher than 4.6, they can germinate and outgrow. The result is a cell that multiplies and secretes a toxin as a byproduct. The rub, for the honey industry is that consumption is a factor in almost all infant botulism cases. There is also some evidence that infant botulism may be a risk factor for SIDS.

And pasteurized vs. unpasteurized honey is no different when it comes to Clostridium botulinum spores.

According to the National Honey Board, recommended pasteurization treatments include flash pasteurization (170 °F for a few seconds) or heating at 145°F for 30 minutes.

Neither will do much to inactivate the spores. There’s really nice risk profile that the former NZ Food Safety Authority put together in 2006. The authors explicitly say: “Normal cooking temperatures would destroy vegetative cells, although these would not be expected to be present in honey in the first instance (because of the low water activity -ben). Commercially available honey may be pasteurised but this process is not sufficient to destroy the spores.”

I’m not sure if Dr. Dagan was worried about Salmonella that the industry standard wouldn’t do much for the stressed vegetative cells either (there’s a pretty good literature around low water activity and heat resistance , especially with a dry heat).

Honey is pasteurized for other reasons, but it really doesn’t do anything to reduce the risk of infant botulism. That’s why the industry and health authorities suggest that infants not be fed any honey, pasteurized or not, until after their first birthday.

Leicester diners placed at “unnecessary risk” says UK Food Standards Agency

Posted on November 5, 2014 by Douglas Powell

Leicester City Council has been criticized by the Food Standards Agency for the way it has let restaurant hygiene levels slip.

Concerns were raised over the lack of enforcement action taken against low-rated businesses and the backlog of uninspected restaurants in the city.

The Food Standards Agency (FSA) said the authority was putting diners at “unnecessary risk” after it was audited earlier this year.

A report released today by the agency’s chief executive Catherine Brown highlighted a number of concerns, nationwide, with regard to a lacklustre approach to food hygiene.

But Ms Brown drew particular attention to Leicester City Council in the eight-page document, saying its inspectors had failed on a number of points when dealing with food safety.

The report says: “An authority of particular concern to us at the moment is Leicester City Council, which the FSA has informed is in default of its statutory obligations under food law.

“This is as a result of ongoing and serious issues concerning levels of unrated premises, backlogs in inspecting premises, failing to inspect food manufacturing businesses prior to approval to operate and the level of enforcement activity undertaken in order to protect consumers.”

Dumped

Posted on September 26, 2014 by Ben Chapman

Ashley Chaifetz, a PhD student studying public policy at UNC-Chapel Hill writes,

Food safety and food quality are not the same, especially when you are in a dumpster searching for food to eat.

NPR’s The Salt covered Maximus Thaler, a “semi-professional dumpster diver with a moral purpose” and his organization, The Gleaners’ Kitchen.

“You look at the food and you smell the food … using your senses is really important,” Thaler says.

While vegetables may get mushy and cheeses might mold, it’s nothing that Thaler can’t cut off or cook up. He says the only thing that’s really risky is meat.

“I would never eat a rare steak out of the dumpster,” he says. “Don’t take the meat that’s obvious discolored,” he advises. Eggs, on the other hand, are fine, he says, as long as they don’t smell absurdly strong of sulfur.

“There are complex systemic reasons why there is so much food waste in this country, but at their core is the fact that most Americans have forgotten what good food is.” He argues that humans have evolved to know what good food is, and we don’t need the Food and Drug Administration or sell-by dates to tell us that.

The dates on food packages are certainly flawed but it isn’t because of the FDA. No federal agency regulates the dates on packaging, except for baby formula. Manufacturers and retailers add various kinds of dates to their foods—and use sell-by, best-by, or use-by to help consumers make choices about the quality, not safety, of the items.

Humans have no special ability to smell Salmonella, or E.coli, or any other pathogen that might be reason a grocery has tossed the food into the dumpster (and neither do dogs). Every item Thaler mentioned (vegetables, cheese, meat, and eggs) has been recalled due to pathogen contamination or foodborne illness risk within the last 5 years. Just because he hasn’t gotten sick does not mean the food is zero risk.

I agree with Thaler’s suggestion that more food is wasted than it should be—and certain grocery stores are better than others at donating their barely-damaged fruits and vegetables to food pantries and food banks.

It’s not that I think dumpster diving is intrinsically bad. It’s that the advocates often fail to adequately address certain issues, like food safety.

Raw and risky: do rewards outweigh risks?

Posted on August 31, 2014 by Douglas Powell

U.S. President Obama may want to think again about those burger outings he does.

Obama likes Five Guys Burgers and Fries, where, “kitchen rules include no timers in the kitchen (because good cooks know when food is done).”

Maybe use a tip-sensitive digital thermometer?

Misti Crane of The Columbus Dispatch writes that those who run kitchens commonly run afoul of food-safety sticklers when it comes time to eat.

Most chefs will likely tell you that a burger cooked to a safe temperature is a burger they would rather not order. And they probably aren’t pushing themselves away from the bar when an icy tray of fresh-shucked oysters arrives.

Food-safety experts shake their heads at such culinary daredevils, but the risk-takers shake their heads right back. Food is pleasure, they say, and rules can stand in the way.

“I like my meat running around the block,” said Columbus restaurateur Tasi Rigsby. “I eat everything. I ate sushi when I was pregnant.”

Mike Suclescy, who co-owns the Thurman Cafe, said most of the burger lovers who visit his German Village restaurant prefer theirs cooked below 160 degrees, the temperature at which E. coli bacteria are killed, according to U.S. Department of Agriculture guidelines.

Most people go for medium or medium-rare, he said.

“I don’t think a whole lot of people worry about it here at our place,” he said, adding that a 12-ounce Thurmanator takes a good eight minutes per side to cook to well-done.

Doug Powell, a former food-safety professor and publisher of the website barfblog.com, worries a lot about the safety of children and said he doesn’t take any food-safety risks when it comes to him or his daughters.

Many people who routinely eat raw shellfish or rare beef are quick to point out that they’ve never been harmed in a lifetime of dining.

“You could play the numbers game, and I hear these arguments all the time,” Powell said. “But if it happens to you, the numbers become irrelevant because the only number is one. These illnesses can cause lifelong damage.”

In the case of oysters, for instance, reported illnesses are relatively rare but can be deadly.

Last year in the United States, the federal Centers for Disease Control and Prevention recorded 12 outbreaks linked or possibly linked to oysters — 52 people were sickened, and three were hospitalized. The CDC database does not include individual illnesses or deaths linked to oysters, nor does it include those who are sickened and never seek medical care.

The CDC estimates that there are 3,000 food-related deaths per year in the United States and that 128,000 people are hospitalized.

“It’s up to the consumer, but they just have to be knowledgeable and be educated and understand that they are potentially at risk,” said Carol Zubovich, a specialist in the food-protection program at Columbus Public Health.

Restaurants that serve foods considered risky, including undercooked or raw meats, fish and shellfish, have the highest level of scrutiny by food inspectors, she said.

Rigsby said she’s especially selective about the meat, seafood and eggs she eats, and she and her husband, Kent Rigsby, are discriminating about whom they buy from and how they prepare their food.

The beef is all grass-fed, for instance. And the oysters are shipped in fresh from the East Coast and shucked to order. Neither of those things guarantees safety, experts caution, but it gives many people greater peace of mind.

Powell said he doesn’t buy the safe-sourcing argument.

“I know there’s a lot of food porn out there that says if you source it from the right place, it will be safer, but I don’t have any microbiological evidence of that,” he said. “I will not eat raw sprouts. I will not drink unpasteurized juice; and I generally cook my seafood, meat or protein. I wouldn’t touch raw dairy.”

Columbus Public Health’s Zubovich doesn’t go for potentially risky foods, either, and she mostly dines at home, she said. “Since getting into this line of work, I don’t eat out at a lot of restaurants.”

Sprouts still suck, even with social amplification

Posted on August 31, 2014 by Douglas Powell

I know lots about the social amplification of risk as promoted by Kasperson, et al., but I’m not sure the author a new paper examining that theory in Germany’s 2011 E. coli O104 outbreak involving sprouts does.

Lots of risk communication background, not much in the way of what to do. But, you can decide.

The social amplification of risk framework highlights the role which the news media play in risk communication by interacting with other agents in amplifying risk. However, the precise ways in which the media and other social agents actually amplify risks in public debates are unclear. In this article we draw on insights from the sociology of news to examine whether and to what extent social agents and news media amplify an emerging health risk. We use the debate about the Escherichia coli outbreak in Germany in 2011 to examine three issues: the amount of risk reporting by news media and social agents in their function as news sources; their evaluation of risk; and how they contribute to the escalation of risk, also known as ripple effects. In this article we draw on data from a content analysis of press releases from public health authorities and affected stakeholders and of news items in leading German news media. We found that the affected stakeholders were amplifying the risk to the greatest extent. We also found that there was a shift over time in the use of dominant frames. At the start of the debate the risk was framed as a public health issue and linked to medical-scientific progress. As the debate developed, more attention was given to political and economic consequences of the outbreak and the original health risk event was layered by other risk-related events.

Social agents and news media as risk amplifiers: a case study on the public debate about the E. coli outbreak in Germany 2011

Health, Risk & Society, August 20, 2014

Juliana Raupp

http://dx.doi.org/10.1080/13698575.2014.950203

We did our own take on the sprout-related literature a couple of years ago and concluded:

• raw sprouts are a well-documented source of foodborne illness;

• risk communication about raw sprouts has been inconsistent; and,

• continued outbreaks question effectiveness of risk management strategies and producer compliance.

We document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found at https://barfblog.com/wp-content/uploads/2014/08/Sprout-associated-outbreaks-8-1-14.xlsx.

Sprouts present a unique food safety challenge compared to other fresh produce, as the sprouting process provides optimal conditions for the growth and proliferation of pathogenic bacteria. The sprout industry, regulatory agencies, and the academic community have been collaborating to improve the microbiological safety of raw sprouts, including the implementation of Good Manufacturing Practices (GMP), establishing guidelines for safe sprout production, and chemical disinfection of seed prior to sprouting. However, guidelines and best practices are only as good as their implementation. The consumption of raw sprouts is considered high-risk, especially for young, elderly and immuno-compromised persons.

From November 2010 into 2011, an outbreak linked to raw sprouts in the U.S. and involving sandwich franchise Jimmy John’s sickened 140 people. This was the third sprout related outbreak involving this franchise, yet the owner of the Montana Jimmy John’s outlet, Dan Stevens, expressed confidence in his sprouts claiming that because the sprouts were locally grown they would not be contaminated. By the end of December 2010 a sprout supplier, Tiny Greens Farm, was implicated in the outbreak. Jimmy John’s owner, John Liautaud, responded by stating the sandwich chain would replace alfalfa sprouts with clover sprouts since they were allegedly easier to clean. However, a week earlier a separate outbreak had been identified in Washington and Oregon in which eight people were infected with Salmonella after eating sandwiches containing clover sprouts from a Jimmy John’s restaurant. This retailer was apparently not aware of the risks associated with sprouts, or even outbreaks associated with his franchisees.

In late December, 2011, less than one year after making the switch to clover sprouts, Jimmy John’s was linked to another sprout related outbreak, this time it was E.coli O26 in clover sprouts. In February 2012, sandwich franchise Jimmy John’s announced they were permanently removing raw clover sprouts from their menus. As of April 2012, the outbreak had affected 29 people across 11 states. Founder and chief executive, John Liautaud, attempted to appease upset customers through Facebook stating, “a lot of folks dig my sprouts, but I will only serve the best of the best. Sprouts were inconsistent and inconsistency does not equal the best.” He also informed them the franchise was testing snow pea shoots in a Campaign, Illinois store, although there is no mention regarding the “consistency” or safety of this choice.

Despite the frequent need for sprout-based risk communication, messaging with industry and public stakeholders has been limited in effectiveness. In spite of widespread media coverage of sprout-related outbreaks, improved production guidelines, and public health enforcement actions, awareness of risk remains low. Producers, food service and government agencies need to provide consistent, evidence-based messages and, more importantly, actions. Information regarding sprout-related risks and food safety concerns should be available and accurately presented to producers, retailers and consumers in a manner that relies on scientific data and clear communications.

Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A. 2012. Failures in sprouts-related risk communication. Food Control. 10.1016/j.foodcont.2012.08.022

http://www.sciencedirect.com/science/article/pii/S0956713512004707?v=s5

Abstract

Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been arecurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.

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