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

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.

Tuskegee University, Tuskegee, Ala., $100,000. Researchers will translate nucleic acid and biosensensor-based pathogen detection methods developed in the laboratory to local producer communities and train minority students in applied food safety educatioin and extension.

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.

Best-selling author Jeff Benedict this year released Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat, which chronicles the history-making 1993 Jack in the Box outbreak that introduced the nation to a deadly foodborne pathogen: E. coli O157:H7.  The book follows victims, corporate executives, defense attorneys, and plaintiffs lawyers through the events of the outbreak and its aftermath as each works in his or her own way to make sense of an unprecedented situation. 

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

Today, the U.S. Food and Drug Administration (FDA), in collaboration with other federal partners including the Centers for Disease Control and Prevention (CDC) and the U.S. Department of 

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. 

It is the unfortunate reality that children are disproportionately affected by foodborne illness. According to data collected by the Centers for Disease Control and Prevention (CDC), nearly half of the reported foodborne illnesses occur in children, with the majority of these cases occurring in children under 15 years of age. There are several reasons why children are at a higher risk for infection. Specifically, children have underdeveloped immune systems lacking the capacity to fight off severe infections, they have smaller bodies thereby reducing the amount of foodborne pathogens necessary to sicken them, and they have little to no control over what they eat.

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.