The Washington Post’s Dina ElBoghdady must not have had a busy social calendar this Summer weekend if she was stalking the pages of FoodNet for the latest in foodborne illness trends. Her story, “Food-borne illnesses not diminishing” which ran this morning on the Post’s website, I caught while sneaking a peak on my forbidden iPhone on a family camping trip. I will get to the trends in a second, but this line in the story also struck me:

the CDC released the data without reaching out to consumer groups and other key stakeholders who typically are notified in advance. Instead, the charts and graphs were quietly posted online Friday.

Can someone at the CDC explain the rationale for that?

On the numbers front, there are some things that you would think that the CDC would not want to release in the middle of the night:

Although Campylobacter, Listeria, Salmonella, Vibrio and Cryptosporidium are up, Shigella, E. coli O157:H7 and Yersinia are down that does not seem to justify a late Friday night posting on the CDC's website.  It will be interesting to watch the non-O157 E. coli trends over the next years.  Here are the numbers for this year:

Also, hemolytic uremic syndrome (HUS) was up in 2011 as compared to some earlier years.  Since this outcome can be caused by both E. coli O157:H7 and non E. coli O157 that might well be the reason.  Time will tell.

Overall, however, we (public health and food producers) are doing better that when I started doing foodborne illnesses cases in the 1993 Jack in the Box E. coli outbreak - that is a good thing.  Now we just need to implement the Food Safety Modernization Act (FSMA) and drive the numbers done farther.  I really think it is time I spent more time camping.

I admit this post is somewhat self-serving. But I am getting weary of so many lists (like this one) celebrating heroes of the food movement that leave out an entire category of professionals that deserve a little respect. They may not be as famous as Alice Waters but they are working just as hard, maybe even harder. So here, in no particular order, are ten lawyers doing critical work to improve how we eat.

1) Andrew Kimbrell, executive director of the Center for Food Safety and veteran warrior fighting Monsanto and GMOs.

2) Steve Gardner, director of litigation for Center for Science in the Public Interest, one of the few lawyers willing to sue the likes of McDonald’s over marketing to children.

3) Mark Gottlieb, executive director of the Public Health Advocacy Institute, which was working on legal solutions to the obesity epidemic before it became popular. (h/t also to senior staff attorney Cara Wilking)

4) Doug Blanke, founder and executive director of the Public Health Law Center, which provides legal analysis and technical assistance on a variety of issues, including healthy eating.

5) Samantha Graff, research director at ChangeLab Solutions (formerly Public Health Law and Policy), which provides legal analysis and technical assistance on childhood obesity.

6) Jonathan Lovvern, senior vice president for Animal Protection Litigation & Investigations at the Humane Society of the United States, which has long fought to improve the lives of farm animals.

7) Bill Marler, pioneer in food safety litigation through his law firm, Marler Clark, a tireless advocate for outbreak victims, and publisher of the indispensable Food Safety News.

8) Ellen Fried, adjunct professor of food policy at New York University’s Department of Nutrition, Food Studies, and Public Health and assistant attorney general for New York State.

9) Jennifer Pomeranz, director of legal initiatives for the Rudd Center for Food Policy and Obesity at Yale University, which does important research and advocacy.

10) Angela Campbell, professor of law at Georgetown University and long-time advocate fighting to stop predatory marketing to children.

Of course this list is not exhaustive and my apologies to those I’ve left out. The good news is the number of lawyers fighting against the food industry is growing. We sure need them, especially as the battles with Big Food get uglier, so let’s remember to acknowledge them for their hard work. Thank you.

Michele should have made the list 11 - and added herself.

Health Canada said Thursday that product tests by manufacturer Kimberly-Clark Professional Corporation detected bacteria that may pose health risks to people with weakened immune systems, especially those with cystic fibrosis.

The recalled Kleenex-brand Luxury Foam Hand Sanitizer is sold in 1 litre and 1.2 litre containers.The recalled Kleenex-brand Luxury Foam Hand Sanitizer is sold in 1 litre and 1.2 litre containers. (Courtesy Kimberly-Clark Professional Corporation )

The product is sold in 1 litre and 1.2 litre containers and is used in large dispensers in public areas and workplaces.

The bacteria in the tested samples were Burkholderia cepacia, which pose little risk to healthy people but can cause serious problems such as pneumonia and blood infections in people with weakened immune systems.

The recall affects about 430 containers that were distributed to retail stores and wholesalers across Canada.

Health Canada said companies or individuals who’ve bought the affected product should remove it from use.

Consumers with compromised immune systems should not use the affected Kleenex sanitizer or any sanitizing product that can't be identified from its dispenser, the regulator advised.

The affected products are:

Kleenex Luxury Foam Hand Sanitizer (Benzalkonium Chloride,0.1%), 1,000 ml manual cassette (used in manual dispensers) with Drug Identification Number: 02366045; lot number SA1229ANB.

Kleenex Luxury Foam Hand Sanitizer (Benzalkonium Chloride, 0.1%), 1,200 ml E-Cassette (used in electronic dispensers) with Drug Identification Number: 02366045; lot number SA1229ANA.

The daylong conference is coordinated by the Center for Produce Safety at UC Davis, a university-industry-government collaborative. Since its creation in 2007 in response to E. coli outbreaks in spinach, the center has played a unique role in providing science-based solutions to help safeguard the nation's fresh produce supply against foodborne diseases.

This year's symposium will include four sessions featuring presentations on new research findings in the areas of buffer zones between crops and animals; irrigation water quality; best practices for cultivation, harvest and farm management; and wash water and process control: Presentations will include:

"Reducing E. coli in irrigation water" - The project focuses on helping the produce industry identify risk-management practices and other remediation measures that reduce levels of generic E. coli in irrigation water supplies.

"Assessing postharvest Salmonella risks in pistachios" - The aim of this research was to identify points in postharvest handling of pistachios that may impact microbial safety. Those data were used to develop a risk-assessment model that can be used to enhance existing food safety risk-reduction strategies.

"Developing buffer zones between crops and sheep grazing" - Crop residues left in fields and orchards are an important source of food for livestock, however both domestic and wild animals represent a potential source of microbes that can cause foodborne diseases. This study focuses on how far - in time and geographic distance - grazing areas and crop plantings should be separated to prevent contamination from animal feces, soil, aerosols, wind, water or flies.

"Amphibians and reptiles as reservoirs of foodborne diseases" - Findings from this study will help the leafy greens produce industry determine if wild frogs, toads, lizards and snakes are potential carriers of E. coli 0157:H7 and Salmonella in California's Central Coast region and a farming region of southeastern Georgia. The results will be used to identify co-management strategies that promote produce food safety and environmental stewardship.

"Risk assessment for Salmonella in melons and related crops" - This study aims to determine how much Salmonella must be present in irrigation water to pose a risk of fruit contamination. This information is critical for determining food-safety standards for growing cantaloupe, honeydew, watermelon, and other melons, as well as cucumbers and squash.

The symposium will conclude with a panel discussion, moderated by Bryan Silberman of the Produce Marketing Association. Panel members will include Mike Taylor of the U.S. Food and Drug Administration, Mary Ellen Burris of Wegmans, Bill Schuler of Castellini Group of Companies and Stephen Patricio of Westside Produce.

In all, the symposium speakers and discussion-panel members represent approximately 24 universities, government agencies, private firms and industry organizations.

Register Now - http://www.foodseminarsinternational.com/Other-Discount-Marler.html

Overview

Bill Marler has been litigating foodborne illness cases for nearly two decades. The key to his success has been to find a quick, reliable method of distinguishing between legitimate food poisoning claims and suspect ones. In his experience, the food industry—from farmer to retailer to restaurant—tends to overemphasize the specious claim and undervalue the legitimate claim. It is an unfortunate situation that increases the likelihood that the industry will miss important opportunities to improve food safety.

By failing to improve food safety, the industry runs the risk of actually poisoning consumers and attracting expensive litigation that often results in public relations nightmares. Marler’s goal has been to bring forth only legitimate claims that have caused substantial personal damages and to force the food industry to think about the real costs of failing to ensure food safety.

Using case studies, this webinar will provide an overview of the various methods of proving a foodborne illness claim. The webinar will go over the obstacles companies face in prioritizing food safety. It will describe the legal basis of Strict Liability as well as the steps used to determine if a foodborne illness case fits into that legal definition. The important roles of epidemiology and Public Health and corporate and restaurant food safety will be covered. The webinar will also address what a food producer should do in an outbreak situation.

Who will benefit from this webinar

• All professionals in the food supply chain

• Educators and students concerned about food safety

• Educators and students interested in the law

• Government regulators

• Plantiff attorneys and defense attorneys

Presenter--William Marler, Managing Partner Marler Clark, The Food Safety Law Firm

William Marler began litigating food borne illness cases in 1993 by representing the seriously injured survivors of the landmark Jack in the Box E. coli O157:H7 outbreak. Since then, he has represented victims of every large foodborne illness outbreak in the United States and has secured over 600 million dollars for his clients in cases against food companies whose contaminated products have caused serious injury and death.

Bill Marler is a Technical Advisor to the National Environmental Health Association and, in 2010, was awarded the NSF Food Safety Leadership Award for Education. He has been repeatedly voted into Best Lawyers in America, has received the Public Justice Award from the Washington State Trial Lawyers Association and has been in the Bar Register of Preeminent Attorneys annually since 2002.

Marler is the publisher of the highly regarded online newspaper, Food Safety News. Additionally he maintains over 25 blogs and websites dedicated to the food safety and foodborne illness education, including his award-winning Marler Blog, which is read by over 1,000,000 people around the world each year.

Today, his firm, Marler Clark, The Food Safety Law Firm, is recognized as the nation's leading law firm representing victims of foodborne illness, and Mr. Marler is considered a major force in food safety policy in the United States. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety including testimony to the United States Congress Committee on Energy and Commerce.

The 2010 NARMS (National Antimicrobial Resistance Monitoring System) Report (FULL REPORT PDF) fell into my inbox today. According to the Report, for 2010, 5,280 retail meat samples were collected from 10 CDC FoodNet sites, including California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee and the Pennsylvania Department of Health. Each site collected samples from a randomized list of area grocery stores.

For 2010, some 35 Salmonella Serotypes were distributed among 400 Salmonella positive samples. Of the 400 Salmonella positive samples, 171 (42%) were in found in Chicken Breasts, 202 (50.5%) were found in Ground Turkey, 7 (1.8%) were found in Ground Beef and 20 (5%) were found in Pork Chops. Of note, 43.3% of Chicken Breasts and 33.7% of Ground Turkey were resistant to more than 3 antibiotics.

For 2010, 3 types of Campylobacter were distributed among the 518 Campylobacter positive samples. Of the 518 positive samples, 505 (97.5%) were found in Chicken Breasts and 13 (2.5%) were found in Ground Turkey. Because of the low incidence of Campylobacter in Ground Beef and Pork Chops, no tests were performed.

NARMS also tested for Escherichia coli (could include Shiga-toxin producing strains but not necessarily) by meat type.  Of the 460 positives, Chicken Breasts - 460 (77.6%), Ground Turkey - 369 (80.2%), Ground Beef - 269 (58.5%) and Pork Chops - 183 (39.8%).

So, what’s for dinner?

Last year we decided to fund yet another bacterial test on retail meat – this time chicken. All the chicken in the 100 chicken IEH Labs survey, which included whole fryers and packages of chicken parts, was collected and tested from March 1 to April 4 from Seattle area grocery stores. The chicken was purchased from Fred Meyer, Safeway, QFC, Whole Foods, Costco, Sam's Club, Albertsons, Thriftway, PCC Natural Markets and Ken's Market stores.

IEH Labs found S. aurea, or staph, in 42 percent of the samples overall and Campylobacter in 65 percent. The supermarket chicken was contaminated with other pathogens as well: 19 percent of the samples tested positive for Salmonella, one tested positive for Listeria, and 10 percent showed the presence of the methicillin-resistant S. aureus (MRSA). In an unusual finding, one of the chicken samples tested positive for E. coli 026, Shiga-toxin producing E. coli (STEC) bacteria more likely to be a contaminant of beef than poultry. Organic Chicken proved to be slightly less contaminated than nonorganic with 7 of the 13 (54%) testing positive for harmful bacteria.

Some comparisons to other studies:

Campylobacter - Our study: 65%. Miller WG, Mandrell RE. 2005. Prevalence of Campylobacter in the food and water supply: incidence, outbreaks, isolation and detection, p. 101-163. In J. Ketley and ME Konkel (ed), Campylobacter: Molecular and Cellular Biology. Horizon Bioscience, Norfolk, United Kingdom. 33-53% average; (3-98% range)

Staphylococcus aureus (“Staph” or S. aureus) and MRSA (Methicillan resistant Staph Aureus) - Our finding of 42% contamination with Staph is similar to recent findings (41% in chicken) by Price et. al published in the journal Clinical Infectious Diseases. Price and colleagues found that (26% of the chicken samples with Staph) were resistant to at least 3 classes of antibiotics. In our study, 10 (24%) of the samples with S. aureus were Methicillan resistant. The importance of findings of S. aureus and MRSA in raw poultry needs to be evaluated. Extracellular toxin production by large cell numbers of S. aureus causes foodborne illness; ingestion of the bacteria themselves does not. MRSA typically causes nosocomial infection, not foodborne illness. Since there is no recognized increase in staphylococcal enterotoxin production by MRSA, while this pathogen is of great clinical significance its antibiotic resistance has no influence on staphylococcal food poisoning. While resistance may enable the pathogen to persist in the food processing environment, most cases of foodbonre illness related to S. aureus are related to post-processing contamination by human contact, making the industrial relevance of MRSA among S. aureus strains questionable.

Salmonella - Our study 19%. In 1996 the USDA FSIS published the “Final Rule on Pathogen Reduction and Hazard Analysis and Critical Control Point (HACCP) Systems in an effort to reduce the prevalence of salmonella in meat. This rule requires that meat and poultry industries have a HACCP plan. Prior to passage of the Final Rule, the contamination rate in broiler chickens was 24%. After the Final Rule, the rate dropped to 11%. The rate has been increasing though and in 2005 the rate was 16%. (REF: D’oust JY, Maurer J. 2007. Salmonella species. p.187-236. In MP Doyle and LR Beuchat (ed), Food Microbiology Fundamentals and Frontiers, 3rd ed., ASM Press, Washington, DC.)

See our Full Survey in PDF and as Spreadsheet in PDF.

As the ABA said, “You may never look at a produce aisle the same way again once you’ve read Seattle lawyer Bill Marler’s exhaustive coverage of food safety violations. Marler tracks food poisoning cases with a single-minded fervor, offering a valuable resource to trial attorneys, food producers and anyone sitting down to dinner.”

Marler Blog has also made it into the Top Agricultural Blogs, Lexis Nexis Top 25 Law Blogs and Best Legal Blogs.

As we used to say to our kids at dinner - "happy fooding."

University of Arizona, Tucson, Ariz., $542,969. Researchers are collecting biofilms from the irrigation infrastructure throughout Yuma, Arizona, to test for the presence and levels of shiga toxin-producing Escherichia coli and Salmonella. Current intervention methods will be evaluated for their validity and a microbial risk assessment will be conducted.

Fort Valley State University, Fort Valley, Ga., $100,000. This project aims to improve processing operation methods in small and very small meat plants to enhance meat product safety.

University of Georgia, Athens, Ga., $535,725. This project will update and maintain the current National Center for Home Food Processing and Preservation website and conduct research on the safe and appropriate use of the home-style atmospheric steam canner for small batch canning.

University of Massachusetts, Amherst, Mass., $424,878. Through this partnership, university extension faculty and staff, county educators, local farm-to-preschool programs, early child care educators and local agricultural organizations in Massachusetts and New Hampshire will collaborate to identify and improve fresh produce safety knowledge and practices of staff, educators, and parent volunteers.

Michigan State University, East Lansing, Mich., $542,824. A team from Washington State University and Michigan State University will generate, validate and communicate process validation tools for low-moisture foods using innovative technologies such as fluid-based heating, radio frequency energy and low-energy X-ray.

Michigan State University, East Lansing, Mich., $543,000. This project conducted at Michigan State University, with Ohio State University, the University of Maryland and the Joint Institute for Food Safety and Nutrition, will develop standardized food safety education and training materials for the global food system.

Michigan State University, East Lansing, Mich., $1,809,934. This research and extension project will enhance the microbial safety and quality of ready-to-eat products by conducting research and training on the processing, packaging and retail distribution segment of the produce chain.

North Carolina State University, Raleigh., N.C., $541,621. This project conducted in collaboration with Alabama State University will identify and characterize the routes and mechanisms of transmission of campylobacter to turkeys.

Ohio State University, Columbus, Ohio, $1,864,665. Researchers and extension specialists will conduct research to better understand the impact of wildlife on the transmission of antimicrobial resistant organisms to food producing animals.

Oklahoma State University, Stillwater, Okla., $543,000. Researchers, extension faculty and industry are working together at Oklahoma State University and the University of Arkansas to develop and implement an Internet-based, stakeholder driven traceability and marketing system for agriculture commodities utilizing RFID technology and GS1 item-level labeling.

Pennsylvania State University, State College, Pa., $542,607. This collaborative project with Pennsylvania State University and Iowa State University will develop an updated and optimized Egg Quality Assurance Program (EQAP) that will significantly reduces Salmonella Enteritidis contamination of shell eggs.

Clemson University, Clemson, S.C., $542,999. Researchers and extension faculty at Clemson University will determine if and when alcohol-based hand rubs can be used to replace hand-washing in ten elementary schools in South Carolina as a way to slow the transmission of Human Norovirus.

Tennessee State University, Nashville, Tenn., $100,000. This project will determine the occurrence of antibiotic resistant Clostridium difficile in poultry and pork products and the farm environment and develop and distribute educational materials on improving management practices to limited resource poultry and pig producers.

University of Tennessee, Knoxville, Tenn., $542,977. This project will determine if modifications to educational interventions greatly impacts the overall effectiveness of food safety training or participant learning outcomes.

Texas Tech University, Lubbock, Texas, $540,326. Researchers will study Salmonella harborage in the lymph nodes of cattle in order to develop, test and disseminate practical solutions for control of Salmonella in beef cattle.

University of Wisconsin, Madison, Wisc., $541,313. Research and extension specialists at the University of Wisconsin-Madison and North Carolina State University will collaborate with academic colleagues, state and federal regulators, food processors and other stakeholders to fill the knowledge gap which exists in understanding the survival of shiga toxin-producing Escherichia coli in acidified canned foods.

What the Hell is Listeria and Listeriosis?

What is Listeria?

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

Approximately 2,500 cases of listeriosis are estimated to occur in the U.S. each year. About 200 in every 1000 cases result in death. Certain groups of individuals are at greater risk for listeriosis, including pregnant women (and their unborn children) and immunocompromised persons. Among infants, listeriosis occurs when the infection is transmitted from the mother, either through the placenta or during the birthing process. These host factors, along with the amount of bacteria ingested and the virulence of the strain, determine the risk of disease. Human cases of listeriosis are, for the most part, sporadic and treatable. Nonetheless, Listeria remains an important threat to public health, especially among those most susceptible to this disease.

What are the Symptoms of Listeria Infection?

It is thought that ingestion of as few as 1,000 cells of Listeria bacteria can result in illness. After ingestion of food contaminated with Listeria, incubation periods (from time of exposure to onset of illness) are in the range of one to eight weeks, averaging about 31 days. Five days to three weeks after ingestion, Listeria has access to all body areas and may involve the central nervous system, heart, eyes, or other locations.

A person with listeriosis usually has fever, muscle aches, and gastrointestinal symptoms such as nausea or diarrhea. If infection spreads to the nervous system, symptoms such as headache, stiff neck, loss of balance, confusion, obtundation (decreased consciousness) or convulsions can occur. With brain involvement, listeriosis may mimic a stroke. Infected pregnant women will ordinarily experience only a mild, flu-like illness; however, infection during pregnancy can lead to miscarriage, infection of the newborn or even stillbirth. Pregnant women are about 20 times more likely than other healthy adults to get listeriosis; about one-third of listeriosis cases happen during pregnancy. The incidence of listeriosis in the newborn is 8.6 cases per 100,000 live births. The perinatal and neonatal mortality rate (stillbirths and early infant deaths) from listeriosis is 80%.

Listeriosis is a serious infection caused by eating food contaminated with the bacterium called Listeria monocytogenes. Although there are other types of Listeria, most cases of listeriosis are caused by Listeria monocytogenes. Listeria is found in soil and water. Vegetables can become contaminated from the soil or from manure used as fertilizer. Animals can carry the bacterium without appearing ill and can contaminate foods of animal origin, such as meats and dairy products. Listeria has been found in a variety of raw foods, such as uncooked meats and unpasteurized (raw) milk or foods made from unpasteurized milk. Listeria is killed by pasteurization and cooking; however, in certain ready-to-eat foods, like hot dogs and cold cuts from the deli counter, contamination may occur after cooking but before packaging.

Adults can get listeriosis by eating food contaminated with Listeria, but babies can be born with listeriosis if their mothers eat contaminated food during pregnancy. The mode of transmission of Listeria to the fetus is either transplacental via the maternal blood stream or ascending from a colonized genital tract (Silver, 1998). Infections during pregnancy can cause premature delivery, miscarriage, stillbirth, or serious health problems for the newborn. Although healthy persons may consume contaminated foods without becoming ill, those at increased risk for infection can probably get listeriosis after eating food contaminated with even a few bacteria.

The Centers for Disease Control and Prevention (CDC), U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) and Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition established the Foodborne Diseases Active Surveillance Network (FoodNet) to monitor the effectiveness of food safety interventions in 1996. In a study of FoodNet laboratory-confirmed invasive cases (where infection is detected in blood, cerebrospinal fluid, amniotic fluid, placenta or products of conception), listeriosis decreased by 24% from 1996 through 2003; pregnancy-associated disease decreased by 37%; and cases among those ≥50 years old decreased by 23% (Voetsch et al., 2007). The highest incidence was reported among Hispanic persons from 1997 through 2001. Differences in incidence by age group and ethnicity may be explained by dietary preferences. More recently, FoodNet surveillance data revealed that the incidence of listeriosis in FoodNet active surveillance sites was 0.27 cases per 100,000 population in 2007, representing a decrease of 42% compared with 1996—1998 (CDC, 2009). The incidence did not change significantly in 2007 compared with 2004—2006 but remained higher than at its lowest point in 2002 (CDC, 2008).

Listeriosis-related mortality rates also decreased annually by 10.7% from 1990 through 1996 and by 4.3% from 1996 through 2005 (Bennion et al., 2008). Seasonal trends show a distinct peak in cases overall and in deaths from listeriosis from July through October. The most recent data suggest that about 2,500 illnesses and 500 deaths are attributed to listeriosis in the United States annually (CDC website, 2009). Neonatal infections are often severe, with a mortality rate of 25-50% (Bortolussi, 2008).

Treatment for Listeriosis

Invasive infections with Listeria can be treated with antibiotics. When infection occurs during pregnancy, antibiotics given promptly to the pregnant woman can often prevent infection of the fetus or newborn. Babies with listeriosis receive the same antibiotics as adults, although a combination of antibiotics is often used until physicians are certain of the diagnosis.

Who is most susceptible to Listeria monocytogenes infection?

Healthy adults and children occasionally get infected with Listeria, but they rarely become seriously ill. Several segments of the population are at increased risk and need to be informed so that proper precautions can be taken. The body’s defense against Listeria is called “cell-mediated immunity” because it depends on our cells (as opposed to our antibodies), especially lymphocytes called “T-cells.” Therefore, individuals whose cell-mediated immunity is suppressed are more susceptible to the devastating effects of listeriosis. Pregnant women naturally have a depressed cell-mediated immune system. In addition, the systems of fetuses and newborns are very immature and are extremely susceptible to these types of infections. Other adults, especially transplant recipients and lymphoma patients, are given necessary therapies with the specific intent of depressing T-cells, and these individuals become especially susceptible to Listeria as well.

Individuals at increased risk include (CDC website, 2009):

• Pregnant women: They are about 20 times more likely than other healthy adults to get listeriosis. About one-third of listeriosis cases happen during pregnancy.

• Newborns: Newborns rather than the pregnant women themselves suffer the serious effects of infection in pregnancy.

• Persons with weakened immune systems

• Persons with cancer, diabetes, or kidney disease

• Persons with AIDS: They are almost 300 times more likely to get listeriosis than people with normal immune systems.

• Persons who take glucocorticosteroid medications (such as cortisone)

• The elderly

How to prevent Listeriosis?

The CDC (CDC website, 2009) provides several recommendations to avoid infection with Listeria:

• Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.

• Wash raw vegetables thoroughly before eating.

• Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.

• Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.

• Wash hands, knives, and cutting boards after handling uncooked foods.

• Consume perishable and ready-to-eat foods as soon as possible.

Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above include:

• Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.

• Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.

• Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pasteurized milk.

• Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may be eaten.

• Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as “nova-style,” “lox,” “kippered,” “smoked,” or “jerky.” The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

References

Bennion JR, Sorvillo F, Wise ME, Krishna S, Mascola L. (2008). Decreasing listeriosis mortality in the United States, 1990-2005. Clin Infect Dis. 47(7):867-74.

Bortolussi R. (2008). Listeriosis: a primer. CMAJ. 179(8):795-7.

Bryan, FL. (1999). Procedures to Investigate Foodborne Illness Fifth Edition (p. 119). Des Moines, IA: International Association for Food Protection.

CDC. (2008). Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food—- 10 States, 2007. MMWR Morb Mortal Wkly Rep. 57(14);366-370.

CDC. (2009). Surveillance for foodborne disease outbreaks - United States, 2006. MMWR Morb Mortal Wkly Rep. 12;58(22):609-15.

CDC website. (2009). Listeriosis Information. Retrieved on November 1, 2009 from Centers for Disease Control and Prevention website, http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis.htm.

Cossart P, Bierne H. (2001). The use of host cell machinery in the pathogenesis of Listeria monocytogenes. Curr Opin Immunol (England). 13(1):96-103.

FDA/CFSAN. (2003). Foodborne Pathogenic Microorganisms and natural Toxins Handbook: The ‘Bad Bug Book.’ College park, MD: Center for Food Safety and Applied Nutrition, Food and Drug Administration. http://www.cfsan.fda.gov/~mow/chap6.html.

Gilbert DN, Moellering RC, Sande MA. (2001). The Sanford Guide to Antimicrobial Therapy 2001. Hyde Park, VT: Antimicrobial, Inc.

Heinitz ML, Johnson JM. (1998). The incidence of Listeria spp., Salmonella spp., and Clostridium botulinum in smoked fish and shellfish. J Food Prot. 61:318-23.

Jurado RL, Farley MM, Pereira E, Harvey RC, Schuchat A, Wenger JD, Stephens DS. (1993). Increased risk of meningitis and bacteremia due to Listeria monocytogenes in patients with human immunodeficiency virus infection. Clin Infect Dis. 17(2):224-7.

Loncarevic S, Tham W, Danielsson-Tham ML. (1996). Prevalence of Listeria monocytogenes and other Listeria spp. in smoked and ‘gravad’ fish. Acta Vet Scand. 37:13-18.

Mayo Clinic. (2009). Listeria infection (listeriosis). Retrieved November 1, 2009 from Mayo Clinic website: http://www.mayoclinic.com/health/listeria-infection/DS00963.

Pinner RW, Schuchat A, Swaminathan B, Hayes PS, Deaver KA, Weaver RE, Plikaytis BD, Reeves M, Broome CV, Wenger JD. (1992). Role of foods in sporadic listeriosis. II. Microbiologic and epidemiologic investigation. JAMA 267(15):2046-50.

Schuchat A, Deaver KA, Wenger JD, Plikaytis BD, Mascola L, Pinner RW, Reingold AL, Broome CV. (1992). Role of foods in sporadic listeriosis. I. Case-control study of dietary risk factors. JAMA. 267(15):2041-5.

Silver HM. (1998). Listeriosis during pregnancy. Obstet Gynecol Surv. 53:737-740.

Tappero JW, Schuchat A, Deaver KA, Mascola L, Wenger JD. (1995). Reduction in the incidence of human listeriosis in the United States. Effectiveness of prevention efforts. JAMA. 273(14):1118-22.

Voetsch AC, Angulo FJ, Jones TF, Moore MR, Nadon C, McCarthy P, Shiferaw B, Megginson MB, Hurd S, Anderson BJ, Cronquist A, Vugia DJ, Medus C, Segler S, Graves LM, Hoekstra RM, Griffin PM; Centers for Disease Control and Prevention Emerging Infections Program Foodborne Diseases Active Surveillance Network Working Group (2007). Reduction in the incidence of invasive listeriosis in foodborne diseases active surveillance network sites, 1996-2003. Clin Infect Dis. 15;44(4):513-20.

Weinberg, WG. (1996). No Germs Allowed: How to Avoid Infectious Diseases At Home and On the Road. Piscataway, NJ: Rutgers University Press.

The book has received rave reviews from news outlets like the New York Times, Associated Press and the Seattle Bar News and is recommend reading for anyone concerned about the state of the American food supply.  Now, at least six universities are finding value in the new book, too. Washington State University, Seattle University, Northeastern University, the New England School of Law, Brigham Young University-Idaho, and the Arkansas School of Law all plan to use the book in part of their curriculum for the 2011-2012 school year. 

All schools were given books as part of a donation drive performed by the book’s central figure, food safety attorney William Marler, and Benedict.  From courses in legal writing, journalism, and public affairs to nutrition and microbiology, each school is planning to utilize the donated books in a unique way.  In addition, the Deans of the following law schools, Yale University, Harvard Law School, Stanford University, Columbia University, University of Chicago, University of Michigan, University of Pennsylvania, University of California Berkeley, University of Virginia, Duke University, Northwestern University, Cornell University, University of Texas Austin, University of California Los Angeles, Vanderbilt University, University of Southern California, Washington University in St. Louis, George Washington University, University of Minnesota, Boston University, Indiana University, University of California Davis, University of Illinois, University of Notre Dame, Boston College, College of William and Mary , University of Iowa, Emory University, Fordham University, University of North Carolina Chapel Hill, University of Washington School of Law, Washington and Lee University School of Law, Ohio State University, University of Alabama School of Law, University of Georgia School of Law, University of Wisconsin Madison, Wake Forest University, Arizona State University, George Mason University, Brigham Young, University of California Hastings, University of Maryland , University of Utah, Tulane University, University of Colorado Boulder, University of Florida and American University, received copies of the book as well.

“Having conducted hundreds of interviews in the construction of this story, it wasn’t long before I came to realize the utter complexity of the Jack in the Box situation,” said Benedict. “The situation in Poisoned reveals the comprehensive nature of a foodborne illness outbreak. Corporate executives, public health officials, lawyers on both sides, and of course the victims all had a stake in the outcome, and in this book you really see that. I am pleased to see Poisoned serve as a teaching tool in so many fields.”

The book’s release comes in a year in which food safety has been a dominant issue. From the President’s signing of the Food Safety Modernization Act (FSMA) in January to the record E. coli outbreak in Europe that sickened thousands this spring and a recent 36 million pound ground turkey recall, food safety issues have rarely left the headlines.

“Having dealt with countless foodborne illness outbreaks and cases since Jack in the Box, the events of this year, primarily the enormous antibiotic-resistant European E. coli outbreak, have often reminded me the way things felt in 1993,” said Marler. “Frankly, this is worrisome, but I am glad the book could be so timely as it pertains to meaningful education.”

Bill Marler was a young attorney navigating uncharted legal waters when he represented children made seriously ill in the 1993 Jack in the Box E. coli outbreak. Today, his firm Marler Clark is considered to be the nation’s leading food safety law firm.  Marler works frequently with industry groups, academia, and government to improve food safety in the U.S. and around the world. Learn more at www.marlerblog.com

Jeff Benedict is a critically acclaimed investigative author who published his first book in 1997. He has since written many others including Without Reservation: How a Controversial Indian Tribe Rose to Power and Built the World’s Largest Casino and Little Pink House: A True Story of Defiance and Courage. Learn more at www.jeffbenedict.com

“I’m giving this book as a gift to food company CEOs and food safety department heads as a reminder that foodborne illness outbreaks are not only devastating for the people who suffer illness, but also for the companies involved,” said Marler.  “Jack in the Box learned a tough food safety lesson through a very unfortunate turn of events, and these CEOs have learned similar lessons.  I want to help make sure they’re not forgotten.”

Whereas the 1993 Jack in the Box outbreak introduced the public to E. coli O157:H7, this summer’s record Germany-based E. coli O104:H4 outbreak that sickened thousands and killed 50 has sparked conversation about whether the U.S. is prepared to prevent another major E. coli outbreak, possibly from an other, “non-O157” E. coli strain, from happening here.

Food industry leaders like BPI, Costco, Earthbound Farms, and Ready Pac have been testing their products for the presence of E. coli O157:H7 for years, and are now implementing procedures to test for non-O157:H7 strains of E. coli. 

  “I think these companies have gotten the message and are now putting customers first by putting food safety first,” added Marler. “Perhaps after reading Poisoned other food companies will look a little more closely at their own food safety procedures, as well as those of their partners in the supply chain.”

BILL MARLER is the nation’s foremost foodborne illness attorney and is a leading expert and advocate for improving food safety.   He speaks worldwide on food safety issues and works regularly with industry, government, and academia to improve food safety in the U.S. and around the world.  To speak with Mr. Marler contact Cody Moore at cmoore@marlerclark.com or call 206-407-2200.

Agriculture’s Food Safety Inspection Service (FSIS) and Animal and Plant Health Inspection Service (APHIS), released a new web-based tool called the Food Related Emergency Exercise Boxed set.

Better known as FREE-B, the online program is a collection of five scenarios 

that, according to FDA, “will help government regulators, public health organizations and the food industry test their readiness for food-related emergencies, such as a human health emergency caused by an unintentional contamination of produce with E. coli O157:H7.”

Each of the five scenarios contains a Facilitator’s Guide, a Lead Planner’s guide and a Situation Manual. The five scenarios are as follows: 

1. How Sweet It Is(n’t) - This scenario focuses attention on the regulatory traceback investigation that occurs after standard product testing shows that a food product contains excessive levels of a contaminant, as well as a recall of contaminated food.
2. Stealthy Situation - This exercise is a comprehensive scenario and highlights nuances encountered when a cluster of illness is associated with a foodservice establishment. The scenario includes the epidemiological investigation, identification of affected product through traceback procedures, implementation of a recall, and the role of regulatory agencies.
3. Wilted Woes - This scenario begins at the outset ofearly signal detection with clinical illness reports, and focuses on the epidemiological investigation process to identify the food vehicle when there is a human health emergency caused by an unintentional contamination of produce with E. coli O157:H7.
4. High Plains Harbinger - This scenario focuses on the investigation of animal disease caused by intentional infection of cattle with Foot and Mouth Disease (FMD) virus, highlighting the various animal agriculture agencies (Federal, state, local, territorial, and tribal) and their roles and responsibilities, as well as introducing the roles and responsibilities of law enforcement agencies during an animal health emergency.
5. Insider Addition - This scenario focuses attention on the intentional aspect of contamination of a raw meat product at the processor with a chemical agent. Various nontraditional organizations and expertise needed to investigate intentional contaminations and the establishment of collaborative processes and roles and responsibilities with the traditional public health and regulatory partners are highlighted.

Designed to help test and develop food emergency response plans, protocols and procedures, the FDA is hopeful that the five FREE-B scenarios will “help food and agriculture stakeholders and emergency preparedness planners collaborate better with each other, neighboring jurisdictions, the food industry and federal agencies during food emergencies.”

Deputy commissioner of the FDA Michael Taylor pointed out that “[b]eing prepared for any kind of emergency is critical to a rapid and effective response. FREE-B helps people think about their own responsibilities in a time of crisis and how to best work with others involved,” he added.

FDA’s target audience for the FREE-B tool includes state, local, tribal, and territorial regulatory and public health partners. The agency anticipates that the tool will benefit Departments of Health, Departments of Agriculture, Departments of Consumer/Environmental Protection Services, FDA Rapid Response Teams, Innovative Food, Defense Program Grant recipients, and Food Protection Task Force Grants recipients.

As FDA’s press release explains, by participating in the scenarios found in FREE-B, stakeholder will:

• Cultivate professional skills by learning how to work with dynamic, ad-hoc teams facing critical food emergency incidents that threaten the safety of the public.
• Assess readiness to effectively address a food contamination incident.
• Define roles and interactions with partners.
• Understand the purpose and objectives of federal, state, local and industry organizations and how each provides resources to address different aspects of food contamination scenarios.
• Take appropriate, timely and effective steps to remediate emergency situations that are caused by intentional or unintentional acts.

“It is critical for decision-makers involved in a food safety incident to appreciate the varied roles each must play to reduce foodborne illness, from data collection and analysis to traceback efforts to communicating with the public about how to protect themselves,” said Beth P. Bell, M.D., M.P.H., director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases. “FREE-B will give stakeholders such an opportunity.”

Those interested in learning more about FREE-B are being asked to sign up to receive more information from the Food Defense Oversight Team as it becomes available. 

By failing to improve food safety, the industry runs the risk of actually poisoning consumers and attracting expensive litigation that often results in public relations nightmares. My goal has been to bring forth only legitimate claims that have caused substantial personal damages and force the food industry to think about the real costs of food safety.

Download White Paper Here.

To address this public health concern, the U.S. Department of Agriculture (USDA) has already implemented several initiatives to promote food safety, particularly in schools and child care settings. However, Secretary of Agriculture, Tom Vilsack, made an important announcement last week about a new effort to make food safer for kids.

According to a press release issued by the Food and Nutrition Service (FNS) of USDA on April 14, 2011, Kansas State University will now be home to the Center of Excellence for Food Safety Research in Child Nutrition Programs, a research facility devoted solely to improving food safety for children.

Secretary Vilsack awarded the university a 2 year, $1.6 million grant in order to perform research on produce safety, examine existing school food safety programs, and develop education and training opportunities for school nutrition and child care employees. “Nothing is more important than the health and well-being of our nation's children and we must do everything we can to ensure that kids are being served safe, high quality meals,” said Vilsack.

FNS oversees the administration of 15 nutrition assistance programs, including the National School Lunch Program, School Breakfast Program, Summer Food Service, After School Snack Programs and the Child and Adult Care Feeding Programs. As the press release points out, “The National School Lunch Program is provided in over 101,000 public and non-profit private schools and residential child care institutions, serving over 31 million children each day.”   

The research performed at the Center will hopefully have a significant impact on the safety of child school nutrition programs across the U.S. and will reduce the number of foodborne illnesses that affect our most vulnerable population each year.

“Salmonella can be absolutely devastating for an elderly person”

“We typically see that children and the elderly suffer the most serious consequences in a Salmonella outbreak.” Said Marler, “However, there are many contributing factors that make an older person much more likely to contract a foodborne illness such as Salmonella.”

Death rates for infectious diarrheal disease alone are five times higher in people over 74 years of age than in the next highest group, children under four years of age, and fifteen times higher than the rates seen in younger adults. The elderly’s heightened risks, both of infection and mortality due to enteric infectious disease, are attributable to several factors: (1) the aging of the gastrointestinal tract (reduced gastric acidity/reduced gastric mobility); (2) a higher prevalence of underlying medical disorders (co-morbidity factors); and (3) malnutrition and a decline in the immune response that leaves the host less able to defend itself against infectious agents.

“Salmonella can be absolutely devastating for an elderly person,” said Marler. “It is vitally important for this age group to understand the effects, causes, symptoms, and prevention techniques associated with a Salmonella infection.”

Marler’s law firm Marler Clark, maintains numerous sites and blogs dedicated to educating and engaging consumers on the realities of foodborne illness and the importance of food safety. The site www.about-salmonella.com hosts general in-depth information about Salmonella including causes and symptoms as well as updated information about current outbreaks. Other sites cover complications associated with Salmonella such as Reactive Arthritis or Irritable Bowel Syndrome. He also offers downloadable materials such as The family guide to Salmonella designed to help people avoid an infection but also give steps to take if one suspects a Salmonella illness.

The authors of the study point out in the introduction that:

[a]ccording to the Centers for Disease Control and Prevention (CDC), the incidence of Salmonella (i.e., 16.2 cases per 100,000 population/year) was the least improved of all foodborne pathogens in terms of achieving national health objective targets for Healthy People 2010. Poultry remains an important vehicle of Salmonella transmission to humans, occurring mainly via contaminated meat.

That statistic, coupled with the fact that poultry is the fastest growing meat product within the U.S. organic market prompted scientists to undertake this study comparing the incidence of Salmonella in organic and conventional farming operations. The authors noted that “in consumers’ minds, organic foods appear to be a safer alternative to conventional poultry.” In performing this study, they wanted to determine whether that perception had any scientific basis.

Samples for the study were collected from one poultry company in North Carolina that maintains both USDA-certified organic and conventional broiler farms. In total, the team collected 700 samples (300 organic and 400 conventional) comprising of floor droppings, feed samples, and drinking water. After analyzing the samples, scientists found that:

[t]he overall prevalence of Salmonella across all farms, sample types, and age group was 4.3% (13/300) in organic broiler farms compared to 28.8% (115/400) in conventional broiler farms.

The study also revealed significant findings regarding anti-microbial resistant Salmonella. The authors reported:

The overall prevalence of individual and multidrug anti-microbial resistance was higher in Salmonella isolates from conventional broiler farms than in those from organic broiler farms. Multidrug resistance was more frequent in Salmonella isolates from conventional broiler farms (55.2%) compared with organic farms (41.6%).

Scientists concluded by stating the need for further study of the presence of Salmonella in multiple large-scale certified-organic farming operations; however, the study provides useful information for all consumers concerned about food safety.

This study evaluates the use of these surveillance systems by local health departments (LHDs) in the United States and their practices and policies for investigating complaints. Data for this study were collected through two Web-based surveys based on a representative sample of LHDs in the United States; 81% of LHDs use complaint-based surveillance. Of those that did not have a complaint system, 64% reported that the state health department or another agency ran their complaint system. Health departments collect a wide variety of information from callers through their complaint systems, including food intake history.

After analyzing outbreak detection rates and comparing them with public complaints of foodborne illnesses, the authors found a positive correlation.

Outbreak rates and complaint rates were found to be positively correlated, with a Pearson’s correlation coefficient of 0.38. Complaints were the most common outbreak detection mechanism reported by respondents, with a median of 69% of outbreaks during the previous year found through complaints. Complaint systems are commonly used in the United States.

So what does this study mean for the public?  If you suspect or are culture-confirmed through lab testing to be infected with a foodborne illness, don't wait--call your local health department immediately.  Health departments will only be made aware of a potential public health risk of a foodborne illness outbreak if the public makes them aware.

Here is the link to HEALTH DEPARTMENTS.

We thought we would add one more portal of information (it will likely be placed over at FSN) for consumers by listing all the websites we (my staff) could find on restaurant scores. 

It is still a work in progress, and I would love any feedback on places that have been missed.  It is clear some states, counties and cities are more interested in inspections and more willing to put the information on the web.

Happy eating - links below:

o   http://foodscores.state.al.us/%28S%28zdz522554dl5di45bwnivlec%29%29/Default.aspx

o   Jefferson County - http://www.jcdh.org//EH/FnL/FnL03.aspx

o   Montgomery County - http://www.adph.org/montgomery/Default.asp?id=1421

o   Mobile County - http://www.mobilecountyhealth.org/Default.asp?p=Restaurant

o   Montgomery County - http://www.adph.org/montgomery/Default.asp?id=1421

• Alaska

o   State - http://www.dec.state.ak.us/eh/fss/food_inspections.htm

o   Anchorage - http://hhs2.muni.org/fss/default.aspx

• Arizona

o   Maricopa County - http://www.maricopa.gov/envsvc/envwebapp/business_search.aspx?as_page_title=Food%20Establishments%20Search&as_type=Food

o   Cochise County - http://www.co.cochise.az.us/ccwebsite/FoodServiceSummary.asp?District=SierraVista

o   Pima County - http://www.pimahealth.org/restaurants/ratings/index.asp

o   Pinal County - http://www.pinalcountyaz.gov/Departments/EnvironmentalHealth/Pages/search.aspx

• Arkansas

o   Benton County - http://www.co.benton.ar.us/HealthDepartment/EnvironmentalHealth/FoodService.aspx (broken on 1/24)

• California

o   Alameda County - http://ehgis.acgov.org/dehpublic/dehpublic.jsp

o   Butte County – April 2008-2010 http://www.buttecounty.net/publichealth/environmental/inspection.asp

o   Butte County – April 2010-present http://www.buttecounty.net/publichealth/environmental/inspection.html

o   Contra Costa County - http://decadeonline.com/main.phtml?agency=ccc

o   Fresno County - http://www.fresnohealthinspections.com/ASP%20Pages/Main.asp

o   Kern County - http://www.decadeonline.com/main.phtml?agency=ker

o   Kings County - http://www.countyofkings.com/Health/ehs/reports.html

o   County of Lake - http://www.co.lake.ca.us/Government/Directory/Environmental_Health/Programs/foodsafety.htm

o   Los Angeles County - http://publichealth.lacounty.gov/rating/

o   Marin County - http://marin.ca.gegov.com/marin/search.cfm?CFID=7197915&CFTOKEN=30ae64951a3eda77-BF361A3E-D603-8E0E-71F9BB45DD1EDD3E

o   Mendocino County - http://www.co.mendocino.ca.us/hhsa/chs/eh/inspections.htm

o   Merced County - http://apps.co.merced.ca.us/PublicApplets/pages/FoodInspect/FoodInspect.aspx

o   Napa County - http://www.countyofnapa.org/FoodInspections/

o   Orange County - http://www.ochealthinfo.com/regulatory/downloads/reports.htm

o   Placer County - http://www.placer.ca.gov/Departments/hhs/env_health/Consumer%20Protection/Retail%20Food/FoodInspection/RestaurantDrillD.aspx

o   Plumas County - http://www.countyofplumas.com/BusinessDirectoryii.aspx

o   Riverside County - http://restaurantgrading.rivcoeh.org/

o   Sacramento County - http://www.foodinspect.saccounty.net/ASP%20Pages/InitiateSearch.asp

o   San Bernardino County - http://www.sbcounty.gov/dehs/restgrades/default.aspx

o   San Diego County - http://www2.sdcounty.ca.gov/ffis/

o   San Francisco County - http://dph-extranet2.sfdph.org:7777/pls/eeop_htmldb/f?p=132:1:1380247953112456

o   San Francisco City - http://sf.everyblock.com/restaurant-inspections/

o   San Joaquin County - http://decadeonline.com/main.phtml?agency=sjc

o   San Luis Obispo County - http://www.slocounty.ca.gov/health/RestInspSearch.htm

o   San Mateo County - http://www.co.sanmateo.ca.us/portal/site/health/menuitem.f44138fe5f6ec63d74452b31d17332a0/?vgnextoid=e33a0ed573960210VgnVCM1000001d37230aRCRD&vgnextchannel=3bab3a8126d60210VgnVCM1000001d37230aRCRD

o   Sana Barbara County - http://www.countyofsb.org/phd/environmentalhealth.aspx?id=26260

o   Santa Clara County - http://sccinspections.org/onlineinsp/

o   Santa Cruz - http://sccounty01.co.santa-cruz.ca.us/eh/consumer_protection/FoodFacilityViolations.pdf

o   Shasta County - http://www.co.shasta.ca.us/EHI/frmPubInspViol.aspx

o   Siskiyou County - http://www.co.siskiyou.ca.us/phs/envhealth/foodinsp/foodinsp.aspx

o   Solano County - http://www.co.solano.ca.us/depts/rm/food_facility/default.asp

o   Sonoma County - http://food.sonoma-county.org/foodsearch.htm

o   Stanislaus County - http://sbtapp1.co.stanislaus.ca.us/DERFoodFacilities/home.jsp

o   Sutter County - http://www.co.sutter.ca.us/apps/facilityinspection/

o   Tehama County - http://www.co.tehama.ca.us/index.php?option=com_docman&task=cat_view&gid=47&Itemid=76&phpMyAdmin=EnoGFkv%2Cc7dMRvqgsDQTPHxadm3&phpMyAdmin=dbe9156cbc4ca14cb7aebd15243fd0e1

o   Ventura County - http://www.decadeonline.com/main.phtml?agency=VEN

o   Yolo County - http://www.yolocounty.org/Index.aspx?page=118

• Colorado

o   Adams, Arapahoe and Douglas Counties - http://tri.co.gegov.com/tricounty/

o   Archuleta County - http://www.sjbhd.org/en/food-safety

o   Boulder County - http://www.bouldercounty.org/help/health/disease/pages/restaurantinspect.aspx

o   Denver City - http://www.denvergov.org/eh/tabid/435231/Default.aspx

o   El Paso County - http://elpaso2.co.gegov.com/el_paso/index.cfm

o   Fremont County - http://www.fremontco.com/building/restaurant/inspectionslist.shtml

o   Jefferson County - http://www.co.jefferson.co.us/amandaitoirf/ehfiDisclaimer.jsp (8/14/2006-present)

o   Jefferson County - http://www.co.jefferson.co.us/ehfiweb/ (Before 8/14/2006)

o  La Plata County - http://www.sjbhd.org/en/food-safety

o   Larimer County - http://www.larimer.org/health/food/index.asp

o   Mesa County - http://www.health.mesacounty.us/environment/foodinsp/index.asp

o   San Juan County - http://www.sjbhd.org/en/food-safety

o   Summit County - http://www.co.summit.co.us/ehealth/disclaimer.htm

o   Weld County - http://www.co.weld.co.us/apps/decade/

o   Logan, Morgan, Phillips, Sedgwick, Washington and Yuma Counties - http://www.nchd.org/

• Connecticut

o   East Shore District Health Department (Branford, East Haven and North Branford)  - http://www.esdhd.org/search.asp

o   Norwalk City - http://www.norwalkct.org/index.aspx?nid=723

o   Stamford City - http://www.cityofstamford.org/restaurantratings/

• Delaware

o   State - http://dhss.delaware.gov/dhss/dph/hsp/Default.aspx

• District of Columbia

o   City - http://washington.dc.gegov.com/webadmin/dhd_431/web/?a=Inspections

• Florida

o   State - http://www.myfloridaeh.com/ephdata/Food_Hygiene.html

• Georgia

o   State - http://health.state.ga.us/programs/envservices/inspections.asp

• Hawaii – none online
• Idaho

o   Benewah, Bonner, Bountary, Kootenai, Shoshone - http://www2.phd1.idaho.gov/Foodsearch/foodsearch.asp

o   Valley, Boise, Ada, Elmore - http://www.cdhd.idaho.gov/EH/food/fooddb_gui.cfm

o   Latah, Clearwater, Nez Perce, Lewis, Idaho - http://idahopublichealth.com/environment/food/map/

o   Adams, Washington, Payette, Gem, Canyon, Owyhee – http://www.publichealthidaho.com/food-service.asp

o   Camas, Blaine, Gooding, Lincoln, Jerome, Minidoka, Cassia, Twin Falls – http://www.phd5.idaho.gov/inspect/RestaurantSearch_Search.cfm

o   Lemhi, Custer, Clark, Fremont, Madison, Teton, Jefferson, Bonneville – not online

o   Butte, Bingham, Power, Bannock, Caribou, Oneida, Franklin, Bear Lake – not online

• Illinois

o   Eastside Health District Canteen Township, Centreville Township, East St. Louis Township and Stites Township- http://www.eshd.org/Portals/0/pdf/Restaurant%20Ratings%20120209.pdf

o   City of Evanston - http://www.cityofevanston.org/departments/health/reports/inspect.shtml

o   Fayette County - http://www.fayettehealthdept.org/foodscores.html

o   Lake County - http://lake.il.gegov.com/lake/

o   Lee County - https://public.cdpehs.com/ILENVPBL/ESTABLISHMENT/ShowESTABLISHMENTTablePage.aspx?ESTTST_CTY=773duOBtqQU%3d

o   Macon County - http://www.maconcountyhealth.org/RestaurantScores.aspx

o   Madison County - https://public.cdpehs.com/ILENVPBL/ESTABLISHMENT/ShowESTABLISHMENTTablePage.aspx?ESTTST_CTY=%2b%2fDlrHDHYEY%3d

o   Sangamon County - https://public.cdpehs.com/ILEnvPbl/ESTABLISHMENT/ShowESTABLISHMENTTablePage.aspx?ESTTST_CTY=sJRNEgWYzzs%3d

o   Mason County - http://www.masoncohealth.com/index_files/Page953.htm

o   McLean County - http://www.co.mclean.il.us/Health/ri.aspx

o   Pike County - http://www.pikecoilhealth.org/Services/restaurantinspectionscores.htm

o   St. Clair County - http://health.co.st-clair.il.us/Restaurant+Scores/

o   Whiteside County - http://www.whitesidehealth.org/

• Indiana

o   Adams County - http://www.co.adams.in.us/HealthDepartment/

o   Allen County - http://www.allencountyhealth.com/divisions/food/?ID=articles1226932205

o   Dearborn County - http://www.dearborncountyhealthdept.org/#inspections

o   Jackson County - https://sites.google.com/site/jacksoncountyhealthdepartment/food-inspections

o   Marion County - http://hhcwebfood.mchd.com/

o   Tippecanoe County - http://www.tippecanoe.in.gov/health/FoodInspectionDB/index.asp

o   Wabash County - http://foodservices.wabashcounty85.us/

• Iowa

o   State - http://www.dia.iowa.gov/food/controller.aspx?cmd=NavFromMenu&mode=search

• Kansas

o   State - http://www.ksda.gov/winwam/

• Kentucky

o   Fulton, Hickman, Carusle, Ballard, McCracken, Calloway -  http://www.purchasehealth.org/docs/Environmental_AddFollowups_xls.pdf

o   Union, Henderson, Webster, McLean, Daviess, Hancock, Ohio Counties - http://www.healthdepartment.org/county%20restaurant%20inspections.htm

o   Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Simpson, Warren Counties - http://www.barrenriverhealth.org/mx/hm.asp?id=RestaurantScores

o   Grayson, Hardin, LaRoue, Marion, Nelson, Washington County - http://www.ltdhd.ky.gov/Pages/Environmental2/Pages/Environmental/Food_Inspections_List.html

o   Boone, Kenton, Campbell, Grant Counties - http://www.nkyhealth.org/mx/hm.asp?id=foodscore

o   Mason, Robertson Counties - http://www.buffalotracehealth.com/foodinspections.htm

o   Christian County -  Can be found in the Kentucky New Era newspaper with subscription

o   Allen County - http://www.allencountyhealth.org/FoodServiceInspection.html

o   Monroe County - http://www.monroecohd.com/Foodinspection.html

o   Louisville City - http://www.louisvilleky.gov/Health/RestaurantInspectionScores.htm

o   Franklin County - http://www.fchd.org/Default.aspx?tabid=2279

o   Anderson County - http://achdonline.org/Environmental/FoodService/tabid/1886/Default.aspx

o   Woodford County - http://www.wchd.com/insp.htm

o   Jessamine County - http://www.myjchd.org/environmental/food-safety/

o   Madison County - http://www.madison-co-ky-health.org/environmentalinspection.html

o   Ashland-Boyd County - http://www.abchealthdepartment.com/content.asp?ContentId=541

• Louisiana – None Online
• Maine – None Online
• Maryland

o   Anne Arundel County - http://www.aahealth.org/envhlth_foodfacility.asp

• Massachusetts

o   Boston City - http://www.cityofboston.gov/isd/health/mfc/search.asp

• Michigan

o   Arenac, Clare, Gladwin, Isabella, Osceola, Rescommon Counties - http://www.cmdhd.org/

o   Baraga, Gogebic, Houghton, Keweenaw, Ontonagon Counties - http://www.wupdhd.org/?page_id=2221

o   Barry and Eaton Counties - http://fsea.barryeatonhealth.org/

o   Genesse County - http://www.gchd.us/Services/EnvironmentalHealth/FoodServiceInspection/

o   Kalamazoo County - http://www.swordsolutions.com/inspections/pgesearchrest.asp?Hit=DirectSearch&LastCty=30

o   Kent County - https://www.accesskent.com/RestaurantInspections/

o   Macomb Counties - http://www.macombcountymi.gov/publichealth/EH/FoodInspections.htm

o   Ottawa County - http://www.miottawa.org/HealthComm/Health/restaurant.htm

o   Wastenaw County - http://www.ewashtenaw.org/government/departments/environmental_health/food_safety/eh_restaurantreports.html

• Minnesota – None Online
• Mississippi

o   State - http://msdh.ms.gov/msdhsite/_static/43,1911,231,203.html

• Missouri

o   Adair County - http://adair.lphamo.org/Folders/environmental/restaurantinspections.html

o   Audrain City-County - http://www.acchu.org/

o   Benton County - http://benton.lphamo.org/inspections.htm

o   Butler County - http://www.butlercountyhealth.org/inspection_reports.html

o   Cape Girardeau County - http://cgcohealthdept.com/docs/eh_serv/index.cfm

o   Christian County - http://www.christiancountyhealth.com/food.html

o   Clay County (maybe, broken 2/22) - http://www.clayhealth.com/Default.aspx?ID=28b82ace-d608-45b9-877d-5acff23b8fce

o   Columbia County - http://www.gocolumbiamo.com/webapps/cfforms/health/health_inspections.cfm

o   Cooper County - http://www.coopercountypublichealth.com/docs/es/food_inspections.cfm

o   Henry County (Not updated recently) - http://henrycountyhealth.org/id19.html

o   Howell County - http://howellcountyhealthdept.com/restaurant.html

o   Independence City - http://www.indepmo.org/health/RestInsp.aspx

o   Jefferson County - http://www.jeffcohealth.org/foodinspections.aspx

o   Johnson County (not up yet, but looks like it will be in the future) - http://johnsoncountyhealth.org/index.php?option=com_content&view=article&id=136&Itemid=167

o   Lincoln County - http://www.lchdmo.org/oes/food.html

o   Macon County - http://www.maconcountyhealth.org/RestaurantScores.aspx

o   Mississippi County - http://misscohealth.com/inspection/index.html

o   Oregon County - http://oregoncountyhealthdepartment.com/ri.aspx

o   Phelps and Maries Counties - http://www.phelpscountyhealth.com/docs/ehs/pages/insp/insp_search.cfm

o   Polk County - http://www.polkcountyhealth.net/environmental/restaurants/

o   Pulaski County - http://www.pulaskicountyhealth.com/eph/foodinsp.html

o   Randolph County - http://randolphcountyhealth.org/docs/ehs/inspect/insp_search.cfm

o   Ripley County - http://www.ripleycountyhealth.com/index.php?page=24

o   St. Charles County - http://www.scchealth.org/docs/ph/ph_docs/RestInsp/search.cfm

o   St. Clair County - http://stclaircountyhealth.net/sanitation/index.html

o   St. Louis City - http://stlcin.missouri.org/pubhealth/restaurantratings/index.cfm

o   Ste. Genevieve County - http://stegencohealth.org/environmental-health/inspections

o   Taney County - http://www.taneycohealth.org/inspections.php

o   Texas County - http://www.texascountyhealth.org/Food%20Inspections.aspx

o   Warren County - http://www.warrencountyhealth.com/food_permits_inspections.html

• Montana

o   Missoula - http://www.co.missoula.mt.us/EnvHealth/Licest/Food/Inspections.htm

• Nebraska

o   Douglas County - http://www.douglascountyhealth.com/food-a-drink/food-facility-ratings

• Nevada

o   Las Vegas - http://www.lvrj.com/taste/restaurant-report-116720439.html

• New Hampshire

o   Manchester City - http://www.manchesternh.gov/website/Departments/Health/Inspections/tabid/735/Default.aspx

• New Jersey

o   Burlington County - http://www.co.burlington.nj.us/upload/Health/Images/Food_Safety_Information.pdf

o   Camden County - http://www.camdencounty.com/health/online-restaurant-inspections/introduction

o   Cumberland County - http://www.cshealth.org/Cumberland/

o   Gloucester County - http://www.co.gloucester.nj.us/rflistings/index.cfm

o   Montville Township - http://www.montvillenj.org/index.php?option=com_content&task=view&id=622&Itemid=242

o   Monmouth County (Region 1) - http://www.mcrhc.org/RI-main.html

o   Pequannock Township - http://www.peqtwp.org/Cit-e-Access/webpage.cfm?TID=60&TPID=7555

o   Rockaway Township - http://www.rockawaytownship.org/Restaurant%20Inspection%20List.pdf

o   Bernards, Bernardsville, Chester, Long Hill, Mendham, Peapack and Gladstone Borough and townships - http://www.bernardshealth.org/HomePages/FoodInspectionRatingsMain.htm

o   Rockaway Township - http://www.rockawaytownship.org/Restaurant%20Inspection%20List.pdf

o   Roxbury Township - http://www.roxburynj.us/index.aspx?nid=10#_Restaurants

o   Montville Township - http://www.montvillenj.org/index.php?option=com_content&task=view&id=622&Itemid=242

o   Bloomfield Township - http://www.bloomfieldtwpnj.com/health/environmental-health#InspResults

• New Mexico

o   Albuquerque City - http://falcon.cabq.gov/envhealth/search.asp

• New York

o   Albany County - http://www.albanycounty.com/departments/health/restaurantinspections/

o   Chemung County - http://www.chemungcountyhealth.org/index.asp?pageId=120

o   Columbia County - http://www.columbiacountyny.com/depts/health2/inspections.html

o   New York City - http://www.nyc.gov/html/doh/html/rii/index.shtml

o   Suffolk County - http://www.co.suffolk.ny.us/health/Restaurant/intro.html

• North Carolina

o   State - http://www.wral.com/5onyourside/restaurants/page/1001540/

• North Dakota

o   Grand Forks - http://grandforksgov.com/publichealth/documents/Sanitationscores.pdf

• Ohio

o   Canton City - http://www.cantonhealth.org/eh/?pg=268

o   Cincinnati City - http://www.cincinnati-oh.gov/noncms/health/inspection/

o   Cleveland City - http://www.clevelandhealth.org/Environment/FoodSafety/Inspection.html

o   Columbus City - http://www.decadeonline.com/main.phtml?agency=COL

o   Defiance County - http://www.defiancecohealth.org/Food%20Inspections.htm

o   Delaware County - http://www.delawarehealth.org/FPPS_FoodRetailEstb.htm

o   State (not being used widely yet) - http://www.ohioinspections.org/category.php

o   Franklin County - http://www.myfcph.org/foodinspections.php

o   Huron County - http://www.huroncohealth.com/environmental-programs/food-inspections.html

o   Mercer County - http://www.mccchd.org/index.php?option=com_content&view=article&id=101&Itemid=142

o   Dayton and Montgomery County - http://phdmc.net/apps/ir/

o   Pike County - http://www.pike-health.org/FoodServiceReports/

o   Stark County - http://www.starkhealth.org/rest_inspections/rest_search.htm

o   Van Wert County - http://www.vanwertcountyhealth.org/food-inspections.php

o   Williams County - http://www.williamscountyhealth.org/index.php?option=com_content&view=article&id=105&Itemid=170

o   Wood County - http://www.co.wood.oh.us/healthdepartment/inspection_results.htm

• Oklahoma

o   State - http://www.ok.gov/health/pub/wrapper/foodservice.html

• Oregon

o   Clackamas County - http://www.clackamas.us/foodinspection/ris.php

o   Clatsop County - http://www.co.clatsop.or.us/default.asp?pageid=648&deptid=10

o   Deschutes County - http://apps.deschutes.org/health/RestaurantInsp/index.cfm

o   Jackson County - http://www.co.jackson.or.us/page.asp?navid=712

o   Josephine County - http://www.co.josephine.or.us/Page.asp?NavID=1253

o   Marion County - http://apps.co.marion.or.us/RIS/

o   Multnomah County - http://web.multco.us/health/restaurant-inspections-lookup

o   Tillamook County - http://www.co.tillamook.or.us/gov/health/Environmental/Inspections.htm

o   Yamhill County - http://www.co.yamhill.or.us/ph/index.asp?sel=12

• Pennsylvania

o   State - http://www.agriculture.state.pa.us/portal/server.pt/gateway/PTARGS_0_2_24476_10297_0_43/AgWebsite/Page.aspx?name=Food-Safety-Inspection-Results&navid=31&parentnavid=0&pageid=50&navcol=true&

• Rhode Island

o   State - http://food.ri.digitalhealthdepartment.com/

• South Carolina

o   State - http://www.scdhec.gov/health/envhlth/food-safety/inspection-rating.asp

• South Dakota

o   Sioux Falls City - http://www.siouxfalls.org/Health/scoredisclaimer

• Tennessee

o   State (Temporarily Unavailable) - http://health.state.tn.us/GEH/restaurantinspections.htm/tennessee/

• Texas

o   Houston City - http://houston.tx.gegov.com/media/index.cfm

o   Williamson County - http://www.wcchd.org/Services/Food/RestaurantRatings.htm

o   Keller County - http://www.cityofkeller.com/index.aspx?page=806

o   Austin City - http://www.ci.austin.tx.us/health/restaurant/search.cfm

o   Angelina County - http://lufkindailynews.com/news/record/restaurant_inspections/

o   Kendall County - http://kendall.tx.gegov.com/kendall/

o   Dallas City - http://www.dallascityhall.com/code_compliance/restaurant_food_scores.html

o   San Angelo City - http://www.gosanangelo.com/data/RetailFoodInspections/

o   Tarrant County - https://publichealth.tarrantcounty.com/foodinspection/

o   Grayson County - http://www.co.grayson.tx.us/Health%20Department/ratings.pdf

o   Hunt County - http://www.huntcountyhealth.com/

o   Fort Worth - http://www.fortworthgov.org/applications/Health/

o   Brazos County - http://www.kbtx.com/restaurantreportcard

o   Waco/McLennan County - http://www.waco-texas.com/cms-healthdepartment/foodscores.aspx

o   San Antonio City - http://www.sanantonio.gov/health/Food-Establishment-Inspection.html

• Utah

o   Davis County - http://www.daviscountyutah.gov/health/environmental/inspections/search.cfm

o   Salt Lake County - https://public.cdpehs.com/UTEnvPbl/VW_EST_PUBLIC/ShowVW_EST_PUBLICTablePage.aspx

o   Utah County (Down for maintenance) - http://www.utahcountyonline.org/Dept2/Health/UCHD/inspections.html

o   Weber-Morgan Counties (only those under enforcement action) - http://www.webermorganhealth.org/enforcement_actions.php

• Vermont

o   State - http://healthvermont.gov/apps/restaurant_scores/RestaurantScores.aspx

• Virginia

o   State - http://www.healthspace.ca/vdh

• Washington

o   State - http://www.doh.wa.gov/ehp/food/restaurantinspections.html

• West Virginia

o   Berkeley County - http://www.bchealthdept.org/restaurant_inspections.html

o   Boone County - http://www.boonecountyhealthdepartment.org/restaurants.html

o   Cabell County - http://www.cabellhealth.org/restinspect.htm

o   Grant County - http://www.grantcountyhealthdepartment.com/Food%20Inspections.htm

o   Hampshire County (Under Construction) - http://www.hampshirecountyhealthdepartment.org/Food%20Inspections.htm

o   Jackson County (Does not appear to be in use) - http://www.jacksoncountyhealthdepartment.com/restaurant_inspections.htm

o   Jefferson County - http://jchealthdept.org/CriticalHome.html

o   Mid-Ohio Valley County - http://www.movhd.com/?page_id=299

o   Mineral County - http://mineralcountyhealthdepartment.com/Food%20Inspections.htm

o   Monongalia County - http://www.monchd.org/monongalia-county-health-department-food-inspections.html

o   Morgan County - http://morgancowvhd.org/EnvironmentalServices.aspx

o   Wayne County - http://www.waynehealthdept.org/

• Wisconsin

o   Appleton City - http://www.appleton.org/departments/page_8f42959588e3/?department=72b4610f58a7&subdepartment=0d8a94ae421f

o   Kenosha County - http://www.co.kenosha.wi.us/dhs/Divisions/Health/ServicesEnvironment/RestaurantInspectionReportSummaries.php

o   Lacrosse County - http://lacrossetribune.com/app/inspection/

o   Milwaukee City - http://itmdapps.ci.mil.wi.us/cehri/search.jsp

o   Racine City - http://www.cityofracine.org/City/Departments/Health/Dynamic.aspx?id=1084

• Wyoming

o   Laramie County - http://www.laramiecounty.com/_departments/_health/disclaimer_inspections.aspx

Related Posts

Lead author Mary E. Locking and her colleagues reviewed E. coli O157:H7 outbreaks in Scotland from 1999-2008.  The authors found that 11% of the cases in the outbreaks they reviewed were secondary.  It was also reported that factors that increased the likelihood of secondary transmission included  the "presence of siblings, young age of persons with primary or potential secondary cases, and waterborne compared with foodborne transmission in outbreaks."

Person-to-person transmission in E. coli O157:H7 outbreaks has been documented in the past.  These reports include:

• K. Ludwig, “Outbreak of Escherichia coli 0157:H7 Infection in a Large Family,” Eur. J. Clin. Microb. Infect. Dis. Vol. 16, at 238-41 (1997);
• P. Rowe, “Diarrhea in Close Contacts as a Risk Factor for Childhood Hemolytic Uremic Syndrome,” Epidem. Infect. 110:9-16 (1993).
• E. Belongia, et al., “Transmission of Escherichia coli 0157:H7 Infection in Minnesota Child-Care Facilities,” JAMA, at 887 (Feb. 17, 1993) (describing the inevitable spread of illness from primary to secondary cases).

Secondary cases have been recognized in the legal context as well.   Nearly a decade ago, MarlerClark took the claim of a young girl who was a secondary case in an outbreak to trial, and then up on appeal.   The Court upheld the girl's claim.  Almquist et al. v. Finley Sch. Dist., 57 P. 3d 1191 (Wash. App. 2002) Cert Denied 75 P.3d 968 (2003).