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

The CDC's Morbidity and Mortality Weekly Report (MMWR) includes a report titled, "Norovirus Outbreak Associated with Ill Food-Service Workers --- Michigan, January--February 2006" this week.  In it, we learn that:

• On January 30, 2006, the Barry-Eaton District Health Department (BEDHD) in Michigan was notified of gastrointestinal illness in several members of two dining parties after a meal at an Eaton County restaurant on January 28.
  
• BEDHD began an investigation to identify the source and agent of infection
• Norovirus genogroup I (GI) was detected in stool specimens submitted by multiple patrons and employees.
  
• Several food-service workers had been ill during January 19--February 3, 2006, and that a line cook had vomited in the restaurant on January 28, possibly increasing environmental contamination and transmission of virus.
  
• At least 364 restaurant patrons became ill with norovirus during the outbreak. 
  

Norovirus is easily spread in restaurant settings.  This week's food safety infosheet from the International Food Safety Network (iFSN) focuses on norovirus, the symptoms of norovirus illness, and its source - poop.

Ediets.com provided some good tips on safer eating this morning in an article titled, "13 Foods That Could Kill".  The thirteen foods the column focuses on are:

Lettuce: because lettuce has been identified as the source of several E. coli and other foodborne illness outbreaks.  In 2006, Dole spinach was the source of a large E. coli outbreak, and lettuce was the source of outbreaks at Taco Bell and Taco John's restaurants.  Ediets.com states, "All raw fruits and vegetables can harbor disease-causing bacteria. Thoroughly wash any raw produce under cold running water before eating it. If appropriate, use a small scrub brush to remove any visible dirt. This is true even for organic fruits and vegetables."

Water: because contaminated water can harbor bacteria, viruses, and parasites, it is important to ensure your drinking water, as well as water in pools or at sprayparks, has been properly treated to eliminate the possibility of contamination.  According to Ediets.com, "The Environmental Protection Agency (EPA) recommends that private water supplies be tested at least once a year for: nitrates, total dissolved solids and coliform bacteria, the presence of which (although it is generally harmless) may indicate other contamination. You may need to test more frequently and for more potential contaminants if a problem is suspected."

Raw sprouts: Because sprout seeds can be contaminated with foodborne pathogens that cause food poisoning, raw sprouts should be avoided.  Raw sprouts have been associated with E. coli and Salmonella outbreaks.  Ediets encourages consumers to cook sprouts thoroughly to kill bacteria.

Unpasteurized juice, milk or cheese: Because unpasteurized juices and "raw" dairy products do not go through a "kill step" before they are served, bacteria, viruses, or parasites could be present in the products.  Several E. coli outbreaks have been traced to raw juices, including a 1996 E. coli outbreak traced to apple juice and subsequent Salmonella outbreaks traced to orange juice.  outbreaks have been traced back to raw milk, including E. coli outbreaks that resulted in children being hospitalized for kidney failure.  Edites.com states, "Make sure you always purchase the pasteurized versions of your favorite products. Pasteurization kills bacteria. When you go to a juice bar, make sure the juices being served are pasteurized. Unpasteurized products have been linked to salmonella, E. coli and Listeria -- all of which can lead to death."

Moldy peanuts:  Because moldy peanuts, wheat chereals, and corn can produce aflatoxins.  Ediets.com encourages people to check these products for any signs of discoloration or mold, as, "Alfatoxins have been found to cause liver cancer in animal species."

Raw or undercooked shellfish: Because shellfish, such as clams and oysters, can be contaminated with micro-organisms such as vibrio or viruses such as norovirus.  Raw oysters should be avoided.  Ediets.com states:  "Any animal protein consumed raw or undercooked has an increased potential for causing illness."

Swordfish, shark, king mackerel and tilefish: Because these fish have been associated with high levels of methyl mercury, which can cause brain damage in unborn and young children.  According to Ediets.com, "The Food and Drug Administration (FDA) and the EPA advise young children, women who are planning to become pregnant and pregnant or nursing women not to eat these fish."

Caesar salad: Because many recipes for Caesar salad dressing call for raw eggs, and eggs can carry Salmonella, Campylobacter jejuni, and other foodborne pathogens. Ediets.com encourages you to ask your server or host if Caesar salad dressing contains raw eggs because, "Many restaurant or homemade recipes call for raw eggs in Caesar salad."

Wild mushrooms: Because several species of mushrooms contain deadly poisons.  According to Ediets.com, "Portabella and shiitake lovers have no reason to worry. Just don’t go scavenging in your backyard. Only eat mushrooms you’ve purchased in the grocery store."

Raw, homemade cookie dough. Because, again, raw eggs can contain potentially deadly foodborne pathogens.  Ediets.com says, "We're not talking about the prepackaged kind that many of us prefer to nibble on straight from the tube or tub. We're talking about homemade batter that's made with eggs."

Rare hamburger. Because ground beef can be contaminated with E. coli, Salmonella, and other bacterial pathogens that cause food poisoning.  All ground beef products and hamburgers should be cooked to 160 degrees fahrenheit.  Ediets.com provides the advice to, "Always use a food thermometer to ensure you've cooked the beef to a safe temperature. Avoid any restaurant entrée labeled "tartare" – it's raw."

Turkey and stuffing. Because stuffing cooked inside a turkey or chicken has a reduced likelihood of reaching a hot enough temperature to kill Salmonella, Campylobacter, or other "bugs".  Ediets explains, "The bird cooks both from the outside and the inside. When you stuff the bird, it reduces the heat penetration. Your best bet is to cook the turkey and stuffing separately. If you do choose to cook them together, make sure the temperature reaches at least 180 degrees Fahrenheit in the innermost part of the thigh while the center of the stuffing inside the turkey reaches 165 degrees."

Shakes and eggs. Because, as pointed out earlier, raw eggs can carry Salmonella or Campylobacter jejuni.  Protein shakes can be made with p asteurized eggs, but unless they're pasteurized, avoid raw eggs.  Ediets warns, "Once again, you're putting yourself at risk for salmonella when you consume raw eggs. Also, beware of sunny side up or runny eggs. The rule of thumb is to cook the egg until both the yolk and the white are firm."

More about food poisoning can be learned at www.foodborneillness.com. 

In the category of both stupid and tragic, public security officials in central China's Hubei Province on Saturday confirmed that a mass food poisoning that killed six people last weekend was caused by misuse of a highly toxic rat poison known as "Dushuqiang".

The investigation found that around midday on Nov. 11, Chen Ruyan, a salvage station worker near the Qingshibei Pump Station of Qinghe Village, Ganjiachang Township of Gong'an County, was preparing lunch. In the process, Chen found the rice dough he was preparing for making tangyuan, a kind of rice dumplings, was quite watery and he decided to add more rice flour.
Unfortunately, he mistook rat poison that had been placed together with other condiments as flour and mixed it into the dough. Two elderly people collapsed and died about 20 minutes after having consumed the rice dumplings. Six others soon developed symptoms of poisoning and were rushed to hospital. Four later died while under care.

Chen, the cook, also died from poisoning.

The Roanoke Times reported that Virginia health officials are investigating two cases of botulism.  So far, the Virginia Department of Health investigation into the cases has shown that home-canned food was the source of the botulism.  As reported by the Times:

The cases, which surfaced last week, occurred in one household and are related to home-canned food not in wide or commercial circulation, said Robert Parker, the department's regional spokesman. He declined to say if either case was fatal.

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. Clostridium botulinum is the name of a group of bacteria commonly found in soil. The bacteria are anaerobic, gram-positive, spore-forming rods that produce a potent neurotoxin. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores that allow them to survive in a dormant state until exposed to conditions that can support their growth. The organism and its spores are widely distributed in nature. They occur in both cultivated and forest soils, bottom sediment of streams, lakes, and coastal waters, in the intestinal tracts of fish and mammals, and in the gills and viscera of crabs and other shellfish.

Foodborne botulism is a severe type of food poisoning caused by the ingestion of foods containing the potent neurotoxin formed during growth of the organism. The incidence of the disease is low, but the disease is of considerable concern because of its high mortality rate if not treated immediately and properly. Most of the 10 to 30 outbreaks that are reported annually in the United States are associated with inadequately processed, home-canned foods, but occasionally commercially produced foods are implicated as the source of outbreaks. Sausages, meat products, canned vegetables, and seafood products have been the most frequent vehicles for foodborne botulism.

Salon.com features an interesting article about Methicillin-resistant Staphylococcus aureus that focuses on the origins of MRSA and how it is spreading to humans.  Following is an excerpt from the article:

Recently, something about MRSA -- and its epidemiology -- has been changing in ways that suggest that those changes could be taking place among livestock. Traditionally considered a disease picked up in hospitals, MRSA is now being seen more and more often in the community. And it doesn't appear that the hospital-acquired strains have just left the hospital and gone feral. The community-acquired strains of MRSA are genetically different. They're new. And though there is as of yet no definitive proof identifying livestock as the source of the major new MRSA strains, there is a growing body of evidence that suggests animals are, at minimum, reservoirs for other new strains now infecting humans.

Those studies done to date in Europe and Canada on MRSA give some credence to the involvement of livestock in MRSA's mutation. Hospitals in the Netherlands, for example, have had fantastic success at controlling MRSA. They employ a "search and destroy" policy, using aggressive screening, strict infection-control procedures, and severe restrictions on the quantity of antibiotics dispensed. They have managed to keep MRSA rates far below those in the rest of Europe. Dutch rates are so low, in fact, that Dutch hospitals list a previous visit to a foreign hospital as an MRSA risk factor.

Read the full article here.