Food Poison Journal - Food poisoning outbreaks and litigation: surveillance and analysis

A new article from the Investor's Business Daily focuses on a drop in consumer confidence in the American food supply:

"There's a great interest by both the supplier community and retailers to identify and trace foods," said Jill Hollingsworth, FMI's group vice president of food safety programs. "Retailers want to know more about where foods come from. The old system is just not enough anymore."

A new system can't come soon enough. Only 66% of shoppers, the lowest since 1989, are confident that the food they buy at grocery stores is safe, according to a survey by the Arlington, Va.-based FMI, whose members represent three quarters of domestic grocery sales. That's down from 82% last year.

People are even less comfortable with restaurant food, with only 42% feeling safe about meals eaten away from home, the survey said. No fewer than 38% of consumers have stopped buying items, led by produce, meat and poultry, because of outbreaks and recalls in 2006, the association said.

And while consumers are feeling less confident in the safety of our food, the Dow Jones MarketWatch published a story on how we can do more to protect ourselves when shopping at supermarkets.  Tips include:

• At the grocery store, make sure to double bag meats, and keep using bags even in your cooler. The bags will help to prevent cross contamination by containing any juices that can leak from the thin plastic wrap. If you don't see plastic bags near the meats, head back to the produce section and snag a few.
  
• When it comes to fresh produce, choose products with less damage, bruising and punctures. The skin of produce such as apples and cucumbers provides a barrier to contamination, says Michelle Smith, a scientist with the FDA's food safety office
  
  "The worst kind of damage would be a wound that would allow pathogens into the interior," she says.
  
• When you get to the grocery store, look at its layout, and figure out how to make sure that you pick up meats and dairy last, recommends Sam Beattie, a food safety extension specialist at Iowa State University.
  
• Just as you wouldn't want the local market to store meats and produce together, it's important for you to use the separate bins in your refrigerator.

A food worker at a Jamba Juice restaurant recently tested positive for hepatitis A, and KCBS out of San Jose, California, reported that the same worker prepared smoothies at the National Gymnastics Championships in August.  According to the report:

The female worker, who is now recovering from her infection, used good hygiene and food safety practices while preparing the smoothies so the chance of anyone who had a smoothie at the championships or the concurrent trade show is remote, Alexiou said.

Smoothies prepared by the infected worker were distributed at the JumpSport booth at the trade show on August 16th and 17th.

There have been no reports of additional Hepatitis A infections since the initial announcement about Jamba Juice last week.

Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is transmitted by the “fecal – oral route,” generally from person-to-person, or via contaminated food or water. Outbreaks associated with food have been increasingly implicated as a significant source of Hepatitis A infection. Such “outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler.” (Francis & Maynard, 1983; CDC, 2007)

Food contaminated with the virus is a common vehicle transmitting Hepatitis A. The food preparer or cook is the individual most often contaminating the food.  He or she is generally not ill: the peak time of infectivity (i.e., when the most virus is present in the stool of an infectious individual) is during the 2 weeks before illness begins. Indeed, “viral gastroenteritis was reported as the most common food-borne illness in Minnesota from 1984 to 1991, predominantly associated with poor personal hygiene of infected food handlers.” (Jaykus, 1997)

In addition to infected food workers, fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A. (Fiore, 2004) In 1997, frozen strawberries were determined to be the source of a hepatitis A outbreak in five states. (Hutin, 1999) In 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant. (Wheeler, 2005)

This week's Food Safety Infosheet from the International Food Safety Network gives us some good information about Norovirus, a common foodborne illness:

More than 100 people reported getting sick after attending a conference at the Hilton Chicago hotel in July. Health officials say the kitchens at the hotel passed an inspection and hotel employees are cooperating with the ongoing investigation to identify the still, as yet, undetermined source. The department said there was no evidence of ongoing transmission of illness from the Hilton kitchens or anywhere else conventioneers may have eaten.

Usual symptoms of Norwalk virus infections include nausea, vomiting, diarrhea, and abdominal pain. Headache and low-grade fever may also accompany this disease. The disease is usually mild and brief. It will develop 24 to 48 hours after contaminated food or water is ingested and lasts for 24 to 60 hours. People infected with Norwalk Virus usually recover in 2 to 3 days without serious or long-term health effects.

A 1999 study suggests that Norwalk may cause more outbreaks of food-borne illness than all bacteria and parasites. It is estimated that nearly 65% of nonbacterial gastroenteritis in the United States is attributable to Norwalk and Norwalk-like viruses. Approximately 181,000 cases occur annually, with no known associated deaths.

Today's Altoona Mirror reported on a hearing yesterday regarding the Sheetz Salmonella outbreak of 2004.  At yesterday's hearing, a Blair County Judge dismissed eight defendants from the case, stating that Sheetz and the company who supplied Salmonella-contamianted tomatoes to Sheetz, Coronet Foods, had not provided enough proof to implicate one or more Coronet suppliers as the source of the contaminated tomatoes.

From the Mirror:

President Judge Jolene G. Kopriva said in an opinion that “it is impossible to track back and differentiate which particular supplier sold the one or many contaminated tomato[es].”

For the sake of consumer protection and safety, she called for better record keeping from the farm to the salad bar.

Sheetz Salmonella outbreak background

In early July 2004, the Pennsylvania Department of Health (PDOH) notified the Centers for Disease Control and Prevention (CDC) that an apparent foodborne outbreak was occurring and that cases of Salmonella javiana might be reported in other states. Active case finding was expanded to include nearby states. Ohio, Maryland, and West Virginia all reported an increase in Salmonella javiana cases.

On July 16, 2004 when the PDOH issued a Health Advisory, stating that an outbreak of Salmonella javiana with more than 70 reported cases had been associated with eating at Sheetz deli counters throughout the state. On July 30, 2004, the PDOH issued a new Health Update regarding the outbreak. Over 300 cases had been reported in Pennsylvania, and dozens more in adjoining states, and yet another related Health Update on August 6, 2004. By then, over 330 cases of Salmonella javiana had been recorded in Pennsylvania, and over 80 cases in neighboring states.

Ultimately, as many as 564 confirmed cases of salmonellosis associated with consumption of contaminated tomatoes were reported in five states: Pennsylvania, Maryland, Ohio, West Virginia, and Virginia. Seventy percent were associated with tomatoes in food prepared at Sheetz convenience stores, which received tomatoes from Coronet Foods of Wheeling, West Virginia. Five separate serotypes of Salmonella were eventually associated with the outbreak.

The Seattle Times reported today that 300 detainees being held at the Northwest Detention Center in Tacoma/Pierce County became ill with food poisoning Sunday night.  Some workers at the facility also fell ill with symptoms of food poisoning, including diarrhea and vomiting.  The Times' report on the outbreak included the following:

Tacoma-Pierce County Health Department officials said they were contacted Saturday night after about 180 detainees were treated for diarrhea, nausea and vomiting at the detention-center clinic.

They had been served three meals that day that included hamburger-potato casserole for lunch and beef sausage and coleslaw for dinner.

Most began showing symptoms late Saturday, Department of Homeland Security spokeswoman Lorie Dankers said, adding that detention-center staff, who sometimes eat there, also got ill.

Joby Winans, public health-information officer, said Tacoma-Pierce County health officials were at the detention center Sunday, Monday and again Tuesday to try to determine what made so many people sick.

The CDC estimates that 76 million foodborne illness, or food poisoning, cases occur in the United States every year, which means that one in four Americans contracts a foodborne illness annually after eating foods contaminated with such pathogens as E. coli O157:H7, Salmonella, Hepatitis A, Campylobacter, Shigella, Norovirus, and Listeria. Approximately 325,000 people are hospitalized with a diagnosis of food poisoning, and 5,000 die. The estimated costs in terms of medical expenses and lost wages or productivity are between $6.5 and $34.9 billion (Buzby and Roberts, 1997; Mead, et al., 1999).

While most foodborne illness cases go unreported to health departments, nearly 13.8 million food poisoning cases are caused by known agents: 30% by bacteria, 67% by viruses, and 3% parasites (Mead, et al., 1999).