Keeping the fair judges safe from botulism

One of the roles I inherited when I came to North Carolina is organizing the judges for annual home food preservation competition at the State Fair. The fair has a long history in scoring entries based on color, consistency, shapes and in some categories, taste.

According to the fair organizers we’re one of a handful of state fairs that allow judges to taste entries. It’s the part that has always made me nervous. I recruit the judges and it would be a tragic situation if someone got sick volunteering their time to evaluate canned goods. 9690269_orig

A couple of years ago, following a bot illness linked to watermelon jelly in British Columbia we decided to test the pH of some entries. Armed with blenders and pH meters my group opened a bunch of products and tested away. We found that a few exceeded 4.6 (the threshold that the NCHFP sets for safety in their recipes) and informed the competitors of the risks.

In subsequent years we increased the number of products we tested, and eliminated a category (sweet potato butter) due to safety concerns.

But the big turning point was the 2014 competition where we had a couple of judges taste a product that was supposed to be pickled, that wasn’t, and the pH was 6.1; a nice environment for bot toxin production.

It was a nervous week of waiting.

In consultation with the fair organizers, I decided to change the rules of the competition and require that competitors follow recipes in one of the three sources that have safety data behind them – the Ball Blue Book, So Easy to Preserve and the USDA guide to home canning.

It was a risk management decision. And it made some folks mad.

Jill Warren Lucas of Indy Week, a first time judge this year wrote a nice piece on her experiences and and the new rules,

Somewhere in my house, there is a photo of a much younger me, looking stunned to have won a red ribbon on my first try at the Indiana State Fair. I was bested only by my inspiration, the perennial winner Mrs. Imogene Orme.

Other hobbies have come and gone, but my obsessive passion for canning has stood the test of time. I’ve tested recipes for successful cookbooks and even published a few items of my own. And this year, I’ve met a new canning milestone: I served as a judge for home preservation entries at the North Carolina State Fair, which continues through Oct. 25.

I was the only newbie among 18 judges, some of whom have been participating for decades. After receiving directions from contest director Ben Chapman, associate professor and food safety extension specialist at North Carolina State University, we were sent off in pairs to pass judgment on blind entries in various categories.

During the next three hours, I tasted about 70 jams, jellies and juices. Even with small samplings, I soon approached a sugar-fueled state of delirium that my colleague expertly diagnosed as “jam drunk.” We both confessed relief when certain jars were determined to be outside of the scope of their category—for example, a lovely mashed-fruit jam erroneously entered as a whole-fruit preserve—and thus did not need to be sampled.

While a handful of entries were so exceptional we nominated them for Best of Show consideration, others were so mundane (or awful) that we actually presented no awards in a few categories.

The reason for this surprising lack of top-quality entries? Changing food safety standards.

Perhaps because I’m a careful canner, worrying about the safety of tasting entries never crossed my mind. But as Chapman soberly warned judges, concerns about just that led organizers to make controversial changes to this year’s contest.

According to Chapman, the North Carolina State Fair is one of only five across the country that tastes nearly all entries. The exception is low-acid foods, which, because of their inherent risk of instability, are judged on appearance only by a pair of food scientists, serving in this role for about 40 years. All other entries were first tested for safe pH levels and then brought to judges.

To further ensure our safety—and, more broadly, to foster standardized canning processes—all entrants had to cite one of three established sources as the basis of their recipe: the ubiquitous Ball Blue Book Guide to Preserving, USDA.gov guidelines or So Easy to Preserve, a publication of the University of Georgia’s National Center for Home Food Processing and Preservation. “We know that these documents have data behind the safety of their recipes,” Chapman explains.

Entrants also had to submit their entire recipe. Some longtime canners, like those who faithfully recreate recipes handed down through generations, balked at having to use a specified source. Many more took offense at having to provide their recipe. A few expressed anger at the lack of trust. Some feared that secret recipes would be revealed. While the updated rules were published in July, the backlash hit its peak in the weeks preceding the October 12th deadline to submit jars for judging. Organizers expected nearly 1,200 entries, but only received about 700.

Chapman says one irate individual, a longtime participant, even stated the intention to launch a boycott. University and fair officials have advised Chapman to not discuss specifics of what the individual said, but he confirmed that security issues became involved. There was even a brief scare at the fairgrounds when someone tried to enter the closed judging area, though it proved to be a false alarm.

Chapman spent much of his day comparing non-sourced entries to the three guides to determine if they were sufficiently similar to remain in contention. Most were found to have acceptable ratios of ingredients. If such vigilance seems like too much worry over canned fruit, remember 24 cases of botulism, including one death, have been reported in the U.S. this year.

“This happened last spring, right about the time we were talking about the rule changes,” Chapman says, adding there also was a troubling case in Ashe County. An experienced canner who ate spoiled carrots suffered severe symptoms for 11 days before her doctor identified the cause. “Botulism is the most toxic, naturally occurring substance we know of. It’s been used in terror attacks (not actually used but identified as a potential weapon -ben). One gram of botulism that is crystalized can kill a million people. It’s serious stuff.”

Previous tweaks to entry rules, likewise made in the name of food safety, also frustrated entrants. Chapman recalls “a similar uproar” a few years ago when participants were required to state how many minutes they processed any entry, an essential clue to knowing whether a jar’s contents had enough time to reach the temperature necessary to kill potential toxins. Unlike mold or other visible signs of spoilage, dangerous bacteria is not always so evident.

“We want to keep the tradition of tasting entries, but it’s my job to worry about this stuff,” Chapman says. “Most people understood the rationale. If some people decide that they can’t participate anymore, we’ll live with that.”

It’s not that simple and handwashing is never enough; trying to stay healthy around state fair animals? Simple–wash your hands

For many visitors to the Minnesota State Fair, wandering through the animal barns, listening to the indignant squeals of jostling pigs or watching a 1,500 pound cow unfurl its long tongue to snag an out-of-reach kernel of grain, is one of the fair’s great pleasures.

fair_46But even though the animals are bathed and brushed to perfection, they can carry germs that can make people sick.

The risk was made apparent earlier this month, when an E-coli outbreak that sickened 13 people was traced to a traveling petting zoo that appeared at several Minnesota county fairs and festivals. Seven people were hospitalized and two patients developed serious kidney complications.

Handwashing is never enough: a parent’s story about sickness at state fairs

Arinn Dixon Widmayer of Raleigh, North Carolina, writes in the Charlotte Observer:

As I sat in a darkened room in the middle of the night watching a nurse hook up a dialysis machine to my pale and shivering 7-year-old son, I wondered how in the world we ended up here.

It was October 2011, and my husband and I had been watching our son’s health all week. He stood motionless on the soccer field on Tuesday night, white handwash.UK.petting.zoo.09as a sheet, as the ball rolled by. By Thursday, he was nauseated and feverish. Our pediatrician told us to keep him hydrated, reduce the fever, that it was a bug and he’d get past it. By the weekend, he was eating little, sleeping most of the day.

This is a tale any parent can tell. We see it all the time – children with a virus, a cold, the flu. Parents worry, give them medicine, juice and too much TV, and in a few days they perk up and get back to their normal selves.

Except when they don’t.

During that weekend, the pediatrician thought maybe our son had eaten something that made him sick. She treated his symptoms and started running some tests for infection. It was at that visit I first heard a suggestion of salmonella, of listeria, of E. coli.

By Monday, he was in bad shape. I helped him to the bathroom that morning and hugged him while he sat there crying that his tummy hurt. Once I got him standing back up, I turned to flush the toilet and froze. It was full of blood. Only blood. Within three hours, an ER doctor was explaining test results. It was E. coli.

I closed my eyes, just relieved to have a name for this suffering, so I wasn’t looking at the doctor’s face when she uttered the words “double kidney failure.” handwashing.ekka.jpgAnd then I was in that dark room with the doctors and nurses and the dialysis machine. How did we get here?

Our son was infected with E. coli at the N.C. State Fair. Public health officials narrowed the site of his infection to the Kelley Building, one of the animal exhibit areas. It was a no-contact exhibit where the animals were fenced in. My family walked up and down the rows of pigs, sheep and goats. Our kids pointed and giggled at the jumping goats and fuzzy sheep. When we left the building, we stopped at the hand-washing station at the door and cleaned up. We did everything right. We avoided the petting zoo. We didn’t eat near the animals. We used the hand-washing stations when we left the exhibit and before we ate. None of us ever touched an animal. And our son still ended up enduring six dialysis treatments, four blood transfusions, 15 days in the hospital and a brush with death because of our decision to walk into that building.

Our son was just one of 27 people infected with E. coli at the State Fair in 2011. Add that to 108 people infected at the fair in 2004 and another three in 2006, and we end up with a serious public health issue. State health officials have recently made changes to the fair to reduce the risk of infection. They changed traffic patterns in the animal exhibits, increased the number of hand-washing stations, added signage warning fairgoers against touching animals and other measures.

Those are great steps toward protecting the public, but are they enough to protect fairgoers this year? I’m not advocating keeping animals and fairgoers separated by a glass wall, and I don’t pretend to know what else the fair can do to eliminate the risk of infection. But I do have to wonder whether large crowds and animals that carry deadly bacteria can coexist without the risk of E. coli? And at what point do those risks outweigh the benefits?

Handwashing is never enough. While some studies suggest inadequate handwashing facilities may have contributed to enteric disease outbreaks or washing hands was protective against illness, others suggest relevant infectious royal.petting.zooagents may be aerosolized and inhaled. Handwashing tool selection may also contribute to the success of hand hygiene as a preventive measure, as some outbreak investigations have reported alcohol-based hand sanitizer was not protective against illness, especially when hands are soiled.

All the refs can be found in our 2012 paper, a sorta secret petting zoo shopper, Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011.

I’m fine with animal interactions; but people, and organizers, should be a lot more careful than they thought. That’s what I told my 3-year-old’s daycare as they prepared for a chicken coop. I’m not sure people like that message.

Further, sanitizers have limited effectiveness, and in a petting zoo situation, so does handwashing; it’s only one component of an overall strategy to reduce risk. But it’s easy to say handwashing because that blames the patrons, not something else.

A table of petting zoo outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Same old same old: how to ensure guidelines are being followed; E. coli O157:H7 gastroenteritis associated with North Carolina State Fair, 2011

Notable finding: illness was associated with visit to a building in which sheep, goats, and pigs were housed for livestock competitions. Fair attendees were not intended to have physical contact with animals in the building; however, 25% of case-patients (three of 12) and 24% of control subjects (five of 21) who visited the building reported direct contact with animals.

The U.S. Centers for Disease Control and Prevention reports that on October 24, 2011, the North Carolina Division of Public Health (NCDPH) was notified of four Shiga toxin–producing Escherichia coli (STEC) infections among persons who had attended the 2011 North Carolina State Fair, held October 13–23 in Raleigh. Approximately 1 million visitors had attended the fair.

NCDPH conducted a case-control study to identify the source of transmission. A case was defined as laboratory evidence of STEC, hemolytic uremic syndrome (HUS), or acute bloody diarrhea with no other identified etiology in a person who attended the fair 1–10 days before illness onset. Active case finding was performed by using a network of hospital-based public health epidemiologists..

Passive surveillance was enhanced through notifications to public health officials, health-care providers, laboratory directors, and the public. Control subjects were recruited by contacting 11,000 randomly selected advanced ticket purchasers by e-mail with a request to participate in the investigation. Three control subjects were matched to each case by age (<18 years or ≥18 years) and date of fair attendance. A stool specimen was requested of all case-patients for laboratory confirmation of E. coli. Pulsed-field gel electrophoresis (PFGE) patterns were compared with known strains in the national PulseNet database. Case-patients’ exposures to food, animals, and fair activities were assessed by using a scripted questionnaire administered to case-patients and control subjects.

Twenty-five cases were identified with case-patients’ illness onsets during October 16–25; median age was 26 years (range: 1–77 years). Eight case-patients (32%) were hospitalized; four (16%) experienced HUS. Nineteen case-patients provided stool specimens, and 11 (44%) had laboratory confirmation of E. coli O157:H7 with matching PFGE patterns. This PFGE pattern is the eighth most common pattern in the PulseNet database and has been associated with previous foodborne outbreaks (CDC, unpublished data, 2011).

The only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions (matched odds ratio: 5.6; 95% confidence interval: 1.6–19.2). Fair attendees were not intended to have physical contact with animals in the building; however, 25% of case-patients (three of 12) and 24% of control subjects (five of 21) who visited the building reported direct contact with animals.

A previous STEC outbreak linked to a petting zoo at the 2004 North Carolina State Fair resulted in 187 illnesses, 15 of which were complicated by HUS (1). The 2004 outbreak led to the passage of Aedin’s Law in North Carolina, which created regulations for exhibitions housing animals intended for physical contact with the public. These regulations include requirements for permitting, education, and signage to inform the public of health and safety concerns, enhanced maintenance of animal facilities, transitional entrances and exits, and easily accessible hand-washing stations. The 2011 outbreak was associated with an animal exhibit not subject to Aedin’s Law. Preventive measures such as educational signs and hand-washing facilities were in place, based on national guidelines compiled in the 2011 Compendium of Measures to Prevent Disease Associated with Animals in Public Settings. As a result of this outbreak, a multiagency task force is being created in North Carolina to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.

A table of petting zoo/fair-related outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

27 ill; E. coli outbreak at NC fair linked to animal building

NBC17 reports state health officials have determined that the source of the E. coli O157:H7 outbreak came from the Kelley Building at the North Carolina State Fair.

The Kelley Building is one of the permanent buildings where sheep, goats, and pigs were housed and competed in livestock show.

NBC-17 was the first to report a direct link to goats at the State Fair and the E. coli outbreak. A family of six in Sampson County who was diagnosed with E. coli reported they visited the goats while attending the State Fair.

The N.C. Division of Public Health says 27 individuals were identified as having contracted E. coli after attending the State Fair in October.

State Epidemiologist Megan Davies said the illness is likely related to animal contact, however the study did not implicate any specific animal or breed. Health officials say no other exhibits, foods or activities were linked to the E. coli infections.

In 2004, 108 cases of E. coli were reported, all linked to the petting zoo at the State Fair. After the 2004 outbreak, Fair officials installed handwashing stations with sinks, soap and water around the petting zoo and near animal exhibits.

A table of petting zoo related outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

27 ill; E. coli outbreak at NC fair linked to animal building

NBC17 reports state health officials have determined that the source of the E. coli O157:H7 outbreak came from the Kelley Building at the North Carolina State Fair.

The Kelley Building is one of the permanent buildings where sheep, goats, and pigs were housed and competed in livestock show.

NBC-17 was the first to report a direct link to goats at the State Fair and the E. coli outbreak. A family of six in Sampson County who was diagnosed with E. coli reported they visited the goats while attending the State Fair.

The N.C. Division of Public Health says 27 individuals were identified as having contracted E. coli after attending the State Fair in October.

State Epidemiologist Megan Davies said the illness is likely related to animal contact, however the study did not implicate any specific animal or breed. Health officials say no other exhibits, foods or activities were linked to the E. coli infections.

In 2004, 108 cases of E. coli were reported, all linked to the petting zoo at the State Fair. After the 2004 outbreak, Fair officials installed handwashing stations with sinks, soap and water around the petting zoo and near animal exhibits.

A table of petting zoo related outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

Looking out for the farmers of the “safest food in the world”

This summer at the Kansas State Fair, I felt like I was getting a lot of strange looks. I tried to brush it off, telling myself that it was no crime to have never slopped a pig or stolen eggs from under a roosting a hen—I should still be welcome at the fair.

I was positive there were other non-farm girls there. Probably even some that grew up in the city; I, at least, shared a property line with a cow pasture. But people just kept staring.

I really got embarrassed when a representative from the Farm Bureau Federation started to laugh out loud and point at me.

When it finally donned on me that I was wearing my Don’t Eat Poop t-shirt that day, I turned to let him read the back: Wash Your Hands.

I explained that I worked for an organization that wants to turn the public’s attention to food safety.

He seemed to think that particular method was effective. “But do you make farmers look bad?” he asked while raising one eyebrow.

I told him we felt it was important that everyone does their part, from the farm to the fork.

He smiled, but I think he remained skeptical.

I raised my eyebrow today at a press release in which the director of congressional relations in the California Farm Bureau National Affairs and Research Division, Josh Rolph, was quoted as saying,

"Congress and the new administration will be sure to consider changes to the way the government oversees the safety of food production. We want to make sure that any changes don’t prove to be burdensome to farmers, who are growing the safest food supply in the world."

I wish I could meet this guy and stare strangely at him. If anyone’s going to claim to grow the safest food in the world, they’re going to have to take some pains to prove it.

“The nation’s farming community understands the need to improve food safety, Rolph said, but the farm-level impact to producers must be considered in any new food safety proposals.”

Salinas vegetable farmer Dirk Giannini referred to the surge in food safety action plans following the outbreak of E. coli from spinach in 2006, and explained that a frenzy of “non-scientific ideas” were putting farmers out.

"And don’t get me wrong,” said Giannini, “The farmers do not want to jeopardize anyone’s health or life—we have the safest food supply in the world. But the scientific-based decisions are the ones that we need to move forward."

Of course any actions to increase the safety of the food supply should be backed by scientific evidence, but public claims of safety should have the same foundation.

To the farmers who grow the food I appreciate every day: In your products and in your claims, Don’t Sell Poop.