Thanksgiving is in the heart, or stomach: Clostridium perfringens outbreak associated with a catered lunch — North Carolina, November 2015

Yesterday, while picking Sorenne up from school I asked several of the attendees at our Thanksgiving feast in the park on Saturday, if there was any intestinal upset.

All clear.

doug-turkey-cater-nov-16I was especially concerned about C. perfringens, what with the prior cooking of the turkeys and the transporting to the park, and the outside temp of90F as we move into summer, but I would have heard by Sunday.

The U.S. Centers for Disease Control reports that in November 2015, the North Carolina Division of Public Health was notified by the Pitt County Health Department (PCHD) that approximately 40 persons who attended a catered company Thanksgiving lunch the previous day were ill with diarrhea and abdominal pain. The North Carolina Division of Public Health and PCHD worked together to investigate the source of illness and implement control measures.

Within hours of notification, investigators developed and distributed an online survey to all lunch attendees regarding symptoms and foods consumed and initiated a cohort study.

A case of illness was defined as abdominal pain or diarrhea in a lunch attendee with illness onset <24 hours after the event. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated for all menu items. Among 80 attendees, 58 (73%) completed the survey, including 44 respondents (76%) who reported illnesses meeting the case definition; among these, 41 (93%) reported diarrhea, and 40 (91%) reported abdominal pain. There were no hospitalizations. Symptom onset began a median of 13 hours after lunch (range = 1–22 hours). Risk for illness among persons who ate turkey or stuffing (38 of 44; 86%), which were plated and served together, was significantly higher than risk for illness among those who did not eat turkey or stuffing (six of 14; 43%) (RR = 2.02; 95% CI = 1.09–3.73).

PCHD collected stool specimens from ill persons and samples of leftover food from the company that hosted the lunch. Stool specimens were tested for norovirus and bacterial enteric pathogens at the North Carolina State Laboratory for Public Health. Based on reported symptoms and short interval between the lunch and symptom onset, a toxin was suspected as the cause of the outbreak; therefore, five stool specimens from ill persons and 20 food samples were submitted to CDC for Clostridium perfringens detection.

debbiedownerthanksgiving_postStools were tested for C. perfringens enterotoxin (CPE) using reversed passive latex agglutination. Stool culture and enumeration of C. perfringens colony forming units (CFU) were performed for five samples of foods implicated by the epidemiologic investigation (one stuffing sample and four turkey samples). Because meat is the most common source of C. perfringens outbreaks (1), one ham sample also was analyzed, although consumption of ham was not associated with an increased risk for illness. CPE was detected in all five stool specimens. C. perfringens containing the C. perfringens enterotoxin gene (cpe) was recovered from all five stool specimens and from all four turkey samples; one turkey sample contained >105 CFU/g. C. perfringens was not recovered from samples of other foods. No other pathogens were detected in stool specimens. Collectively, laboratory results met CDC guidelines for confirming C. perfringens as the outbreak source (3).

PCHD environmental health specialists interviewed the caterer about food handling and preparation practices. The North Carolina Food Code requires that all commercial caterers operate in a facility that has been inspected for compliance and permitted by the regulatory authority (4). The caterer had previously maintained a permitted facility, but reported having prepared the lunch food served at this event in an uninspected, residential kitchen. Turkeys were cooked approximately 10 hours before lunch, placed in warming pans, and plated in individual servings. Food was then delivered by automobile, which required multiple trips. After cooking and during transport, food sat either in warming pans or at ambient temperature for up to 8 hours. No temperature monitoring was conducted after cooking.

C. perfringens toxicoinfection (a foodborne illness caused by ingestion of toxin-producing bacteria) is often associated with consumption of meat that has been improperly prepared and handled (1,2). Because diagnostic testing is not widely available, C. perfringens can go undetected as a cause of foodborne illness outbreaks (2,3,5). Diagnostic testing to assist with outbreak source identification is useful to corroborate epidemiologic information, document disease prevalence, and guide prevention recommendations.

Epidemiologic, laboratory, and environmental evidence indicate that this outbreak was caused by consumption of turkey prepared by a commercial caterer operating in an unpermitted kitchen. Inadequate facilities, extended time between turkey preparation and consumption, and failure to monitor and control temperature before and during transport resulted in an anerobic environment conducive to C. perfringens spore germination and growth (6). Prompt local health department response, use of an online survey, and rapid collaboration between local, state, and federal public health agencies were instrumental in identifying the outbreak source quickly and preventing additional cases.

These findings confirm the need for commercial food preparers to adhere to existing food safety regulations (4), including use of permitted facilities and having a certified kitchen manager on staff. Caterers should be aware of the risks associated with improper storage of prepared food for long periods and the importance of temperature monitoring and regulation during food preparation and handling.

Get stuffed?

I wrote the below for NC State News.

As a Canadian in the U.S. I’ve fully embraced the holiday season that runs from Thanksgiving through December. I enjoy spending a day planning and shopping for an event-style meal, and then another day actually preparing and cooking it. I throw on some tunes (this year it will probably be Drake, for my Canadian roots, and the Avett Brothers as a nod to North Carolina) and with the help of the rest of the family I’ll roast a turkey, make mashed potatoes, green beans, squash, beets and a couple of other harvest vegetables.

And we’ll make a lot of stuffing.stuffing-header-825x464

Depending on your preference and food persuasion there are lots of different stuffing or dressing options.

A common question that pops up is whether it’s better to cook stuffing it in the bird to preserve moisture (and get flavored by the turkey juices) or prepare it as a separate dish. The concern is that if someone puts the stuffing in the turkey cavity it may become contaminated by the turkey juices and Salmonella and Campylobacter will migrate through the stuffing. Easier to recommend not messing with the cross-contamination instead of managing the risk. But what does the science say?

I’m a food safety nerd and take a science-based approached to my meals. Armed with a digital, tip-sensitive thermometer I’m happy to jam stuffing up inside of my poultry and use the probe to check the temperature. And I use 165 degrees Fahrenheit as a target for my bread-based stuffing.

There’s some history to that number; in 1958 Raymond Rogers and Millard Gunderson of the Campbell Soup Company published some work evaluating the safety of roasting frozen stuffed turkeys (a new product at the time). Using a known amount of Salmonella pullorum, nine turkeys and some then-fancy ceramic thermocouples, they found that they could get an 8-log (or 99.999999%) reduction when the deepest part of the stuffing hit 160 degrees Fahrenheit. They recommended 165 degrees to be conservative (and because some thermometers aren’t always very accurate).

From the manuscript (comments that still apply today): “The initial temperature and the size of the turkey influence considerably the time required to reach a lethal temperature in the stuffing. The lower the initial temperature of the turkey, the longer the roasting period required. Present recommended roasting procedures designating hours cooking time or which stipulate a thigh or breast temperature to be attained alone does not appear to be adequate bacteriologically.”

Inside the bird, outside the bird; meat or no meat: Use a thermometer.

For your holiday viewing, here’s a video devoted to minimizing risk from foodborne illness when cooking turkey. More food safety tips are available here.

2016 Thanksgiving turkey extravaganza combining Canadian, American and whatever it is Australia celebrates in honor of the harvest

Thanksgiving has always been our favorite holiday, a celebration of the feast, but there’s no damn turkeys in Brisbane for Canadian Thanksgiving, and it’s too damn hot to be cooking for American Thanksgiving at the end of November.

history-of-white-people-in-americaThere are also practical considerations.

Whole turkeys have started showing up in Coles and Woolies – the Australian  duopoly — in the past two weeks at about $10/kg; in North America they’re about $2.00/kg, but I may be aging myself.

Five years ago, I specially sourced a whole turkey for Canadian Thanksgiving in early Oct., in Brisbane, and it was about $20/kg. Never again.

Thanksgiving (French: Action de grâce), or Thanksgiving Day (Jour de l’action de grâce) is an annual Canadian holiday, occurring on the second Monday in October, which celebrates the harvest and other blessings of the past year.

Thanksgiving has been officially celebrated as an annual holiday in Canada since November 6, 1879, when parliament passed a law designating a national day of thanksgiving, although the first Canadian Thanksgiving is thought by some to have occurred on Baffin Island in 1578 while some English dudes were looking for the Northwest Passage.

The first Thanksgiving Day after Canadian Confederation was observed as a civic holiday on April 5, 1872, to celebrate the recovery of the Prince of Wales (later King Edward VII) from a serious illness.

Bloddy Monarchs.

amy-turkey-citrus-16According to wikii, tthe event that Americans commonly call First Thanksgiving was celebrated by the Pilgrims after their first harvest in the New World in 1621.[4] This feast lasted three days, and—as accounted by attendee Edward Winslow[5]—it was attended by 90 Native Americans and 53 Pilgrims.[6]

On Sat. Nov. 19 – it was the best date to fit around hockey schedules while accommodating the Canadian feast and the 6-week American orgy of food and shopping that begins this coming Thurs – we gathered 40 of our Australian friends at a local park on the river, and had a feast.

The two 10kg turkeys were purchased on Tues., Nov.15.

They sat on the counter for 12 hours and then 3-4 days in the fridge.

Amy made butter tarts, a carrot salad and a citrus-based turkey the day before.

Saturday, I was on the ice at 6.am. and then came home (sore) to make my bird, a traditional Alton-Brown-based variety (I like his science).

I took Amy to the park at 11ish a.m., to stake out BBQ and table space. (Brisbane has fabulous parks, especially along the river, because they have a 500-year-flood every 50 years, so parks better than houses. These parks have the best bathrooms, sanitation and free BBQs than in any other city I’ve been in.)

By our 1 p.m. start time, I had two turkeys, a gluten-free and a regular dressing (because it wasn’t inside the bird), and the best gravy I’ve ever made.

When I delivered to the park, people had started assembling, kids were running around, the river breezes were cool as Brisbane moves into summer,

dpturkey-16As I had written to our guests in the invite, “Think of it as a giant pot-luck, but you better practice decent food safety – no raw egg dishes, including homemade mayo, aioli or sauces – or your dish is consigned to the bin and covered in bleach (because that’s how health inspectors roll).

“The deal is, we’ve invited a bunch of people, and we’ll do it at Tennyson Park so the kids can run around.

Amy and I along with the capable assistance of chef Alex will bring the tip-sensitive digital thermometer-verified safe turkey (and gravy, you can’t overcook a turkey, that’s what the gravy’s for). Two kinds of stuffing – one gluten-free, one regular, which will be cooked outside of the bird (food safety 101).

thanksgiving-nov-16I mangled the turkey Amy cooked Friday night, and once I had started carving into the one I cooked Saturday a.m., a hockey parent who knows his why around a bird kindly asked, ”Would you like me to take over?

“Yes.”

The other families bring something: rolls, mashed potatoes, salad, cooked carrots, green beans, apple pie, beverages, cutlery, whatever, as long as it is microbiologically safe. And wash your damn hands before everyone gets hepatitis A (we’re vaccinated, the rest are on your own; for a pre-meal vindication, I can explain how hep A is spread amongst humans).

Oh, and I’ve got a face for radio and a voice for print. But it was fun.

However, in the videobelow,  I was trying to say, “You may know me because I coach your kid in hockey,” not “hit your kid in hockey.

Editing.

We are thankful to have so many and great friends in Brisbane.

Thanksgiving Australia style, 2015 edition

We’ve tried Thanksgiving a few times in Australia.

We did the Canadian one because it was earlier and not so hot, we did the U.S one. and it’s too hot, so after four years we found a model that may have worked.

amy.thanksgiving.nov.15Thanksgiving is our favorite holiday. No religion, just good food to celebrate the harvest. We have traditionally hosted friends, family and students to share the feast each year.

So this year we adapted to Australian weather, and had about 30 people – that includes a bunch of kids – to a park.

We have fabulous parks.

The kids had a great playground and an area for rollerblading, scooters, whatever, the breezes from the river were good, and we did it picnic style.

I cooked the turkey and duck the night before – to a microbiologically safe temperature as determined by a tip-sensitive digital thermometer — and then refrigerated overnight.

Saturday morning, I carved up the birds – and underestimated the popularity – and made a casserole-based stuffing. Amy made potato salad, our friends brought sides, it was a relaxing four hours.

The hockey parents talked hockey gossip, the neighbors talked town home gossip, I stayed out of the way and tried to make sure everyone was fed.

Safely.

kids.thanksgiving.nov.15They all said they had never had anything like stuffing, so that was sorta cool.

We took a hockey kid home for 24 hours so his Canadian dad could play baseball.

Cause that’s how we roll.

And look how happy Hubbell is (hard to see).

Then we played hockey Sunday am.

Lifehacker covers the science of Thanksgiving

Lots of folks like to say that food safety in the home is simple. It isn’t. There are a lot of variables and messages have historically been distilled down to a sanitized sound bite. Saying that managing food safety risks is simple isn’t good communication; isn’t true; and, does a disservice to the nerds who want to know more. The nerds that are increasingly populating the Internet as they ask bigger, deeper questions.

Friend of barfblog, and Food Safety Talk podcast co-host extraordinaire, Don Schaffner provides a microbiological catch-phrase that gets used on almost every episode of our show to combat the food-safety-is-simple mantra; when asked about whether something is safe, Don often answers with, ‘it depends’ and ‘it’s complicated’. And then engages around the uncertainties.IMG_4138

Beth Skwarecki of Life Hacker’s Vitals blog called last week to talk about Thanksgiving dinner, turkey preparation and food safety and provided the platform to get into the  ‘it depends’ and ‘it’s complicated’ discussion. Right down to time/temperature combinations equivalent to 165F when it comes to Salmonella destruction.

Here are some excerpts.

How Do You Tell When the Turkey Is Done?

With a thermometer, of course. The color of the meat or juices tells you nothing about doneness, as this guide explains: juices may run pink or clear depending on how stressed the animal was at the time of slaughter (which changes the pH of the meat). The color of the bone depends on the age of the bird at slaughter. And pink meat can depend on roasting conditions or, again, the age of the bird. It’s possible to have pink juices, meat, or bones even when the bird is cooked, or clear juices even when it’s not done yet.

So you’ve got your thermometer. What temperature are you targeting? Old advice was to cook the turkey to 180 degrees Fahrenheit, but that was a recommendation based partly on what texture people liked in their meat, Chapman says. The guidelines were later revised to recommend a minimum safe temperature, regardless of what the meat tastes like, and that temperature is 165. You can cook it hotter, if you like, but that won’t make it any safer.

There’s a way to bend this rule, though. The magic 165 is the temperature that kills Salmonella and friends instantly, but you can also kill the same bacteria by holding the meat at a lower temperature, for a longer time. For example, you can cook your turkey to just 150 degrees, as long as you ensure that it stays at 150 (or higher) for five minutes, something you can verify with a high-tech thermometer like an iGrill. This high-tech thermometer stays in your turkey while it cooks, and sends data to your smartphone. Compare its readings to these time-temperature charts for poultry to make sure your turkey is safe.

The whole piece can be found here.

Thanksgiving goofiness

My parents come from Ontario (that’s in Canada) every year to visit for Thanksgiving (or American Thanksgiving as it’s known to them). My mom likes to participate in the Black Friday shopping craziness; my dad likes to watch football. It’s just fun to have them around.

A couple of years ago my friend Matt Shipman and I put together some Thanksgiving meal videos – sorta our goofy take on food safety for the holidays. The content (unlike my hairline) is timeless.

And here are some food safety infosheets for the holidays.

Holiday meal food safety

Bathing birds is a food safety mess

Avoid foodborne illness during the holidays

 

Celebrity food porn, NBC style

A food safety type from the U.S. writes that the average viewer of these celebrity chefs are ignorant of safe food handling practices. They are blinded because of the celebrity status of these chefs.

 celebrity.chefsThis past Thanksgiving, I tuned into “Today” and watched celebrity chef Giada prepare ready to eat foods with her bare hands. But worse than that is that she had a bandaid on her finger. At the very least she could have used a finger cot. I emailed the “Food Network three times with no response.

Visit NBCNews.com for breaking news, world news, and news about the economy

30 sick after Thanksgiving at hotel in New Jersey

The Princeton Health Department received 30 reports between Thanksgiving and Tuesday of individuals experiencing gastrointestinal illnesses.

Nassau Inn.thanksgiving.dec.14All 30 people ate at the restaurant at the Nassau Inn on Thanksgiving or the day after the holiday, Princeton Health Officer Jeffrey Grosser said. Many of the people also ate at other restaurants during the time period.

The health department has increased its surveillance of retail food establishments because of the incidents, and the Nassau Inn was inspected yesterday.

Laboratory testing has not yet confirmed the cause of the illnesses yet, but Grosser said the Norovirus is suspected in most or all of reported cases because of the symptoms and the time frame for the onset of symptoms and the recovery. The Norovirus is the most common cause of gastrointestinal illness and is especially common during the winter months.

“All the phone calls we received were similar in terms of where people ate, when people became ill (Thursday and Friday) and when they started feeling better (Sunday and Monday),” Grosser said.

An inspection of the restaurant at the hotel only revealed minor issues that can easily be rectified. Grosser said the issues did not cause the illnesses. About 70 percent of all Norovirus outbreaks are spread by food workers.

’Tis the season for holiday illnesses (apparently)

There’s a perception that there are more outbreaks around the holidays because folks don’t know how to cook turkey. The epidemiology isn’t all that strong around amateur bird preparation and illnesses –  but there are a lot of parties and potluck/covered dish dinners this time of year.

And it’s also noro season. img_1787

According to Planet Princeton, over 30 people reported illnesses to health authorities after eating at the Nassau Inn over Thanksgiving – and it looks like norovirus.

The Princeton Health Department received 30 reports between Thanksgiving and Tuesday of individuals experiencing gastrointestinal illnesses.

All 30 people ate at the restaurant at the Nassau Inn on Thanksgiving or the day after the holiday, Princeton Health Officer Jeffrey Grosser said. Many of the people also ate at other restaurants during the time period.

Laboratory testing has not yet confirmed the cause of the illnesses yet, but Grosser said the Norovirus is suspected in most or all of reported cases because of the symptoms and the time frame for the onset of symptoms and the recovery. 

“All the phone calls we received were similar in terms of where people ate, when people became ill (Thursday and Friday) and when they started feeling better (Sunday and Monday),” Grosser said.

An inspection of the restaurant at the hotel only revealed minor issues that can easily be rectified. Grosser said the issues did not cause the illnesses. 

 

Thanksgiving in space

According to the food safety nerd historians (and every HACCP class) the world of food safety was revolutionized by a partnership between NASA and Pillsbury.

Jennifer Ross-Nazzal writes about the history in Societal Impact of Space Flight.

Concerned about safety, NASA engineers specified that the food could not crumble, thereby floating into instrument panels or contaminating the capsule’s atmosphere. to meet the outlined specifications, food technologists at Pillsbury developed a compressed food bar with an edible coating to prevent the food from breaking apart. in addition to processing food that would not damage the capsule’s electronics, the food also had to be safe for the astronauts to consume.

Thanksgivinginspac_3120060bAlmost immediately food scientists and microbiologists determined that the assurance of food safety was a problem. [Pillsbury microbiologist Howard] Bauman recalled that it was nearly impossible for companies to guarantee that the food manufactured for the astronauts was uncontaminated.

“We quickly found by using standard methods of quality control there was absolutely no way we could be assured there wouldn’t be a problem,” he said. To determine food safety for the flight crews, manufacturers had to test a large percentage of their finished products, which involved a great deal of expense and left little for the flights.

So HACCP was created.

Today, according to The Telegraph, American astronauts on the International Space Station are enjoying a risk-reduced and HACCP-inspired Thanksgiving meal including irradiated smoked turkey.

NASA Astronauts Terry Virts and Barry Wilmore cobbled together a festive feast by combining foods that are stocked on the station. 

The meal also includes candied yams, freeze-dried dressing, cranapple desert, mashed potatoes, green beans and mushrooms. 

Crew members get ‘bonus containers’ in which they are allowed to carry special items for specific holidays, like Thanksgiving or Christmas.

“The turkey they have available for Thanksgiving has been made shelf-stable by irradiation,” said Vickie Kloeris, ISS Food System Manager 

“So this product is ready to eat and they just warm it up and eat out of a packet with a fork.

Mine is still roasting.