An excellent piece authored by Dennis G. Maki, MD. discussing food safety and seeking lessons learned in recent national Salmonella outbreaks was recently brought to my attention.  Dr. Maki’s piece from the March 2009 New England Journal of Medicine looked back over two outbreaks in particular, the 2008 Salmonella Saintpaul outbreak linked to peppers, and the 2009 Salmonella Typhimurium outbreak in PCA peanut butter products. 

Dr. Maki pointed to an important lesson from the Salmonella Saintpaul outbreak- the importance to both consumers and industry alike of good traceability:

Initial epidemiologic investigations by state health departments and the CDC suggested that contamination of tomatoes grown in the southwestern United States was the cause, although this was never proved microbiologically. Predictably, tomato consumption plummeted, and the industry lost an estimated $200 million. After several months of investigation, the outbreak strain was isolated from jalapeño and serrano peppers that had been grown on one Mexican farm.

With respect to the PCA outbreak, Dr. Maki focused on the well-publicized, yet still remarkable, alleged failures of the producer:

Investigations have revealed that salmonella had been isolated from the implicated company’s peanut butter or peanut paste in its internal quality-control sampling program on at least 12 occasions during the past year, but no action was taken to investigate the source of contamination, review sterilization procedures, or reclean the production machinery. The company is now under criminal investigation.

Both of these outbreaks involved staggering amounts of confirmed illnesses – over 1400 with the peppers, over 600 connected to peanut butter.  The article points out though, as we have here, that the total number of ill individuals was likely much larger. "It has been estimated that in large salmonella outbreaks, for every case identified by clinical culture, there are approximately 38 additional undetected cases — meaning that these two outbreaks may each have affected more than 20,000 persons."

The article did provide a number of recommendations aimed at stemming the tide of ongoing large scale illness outbreaks tied to commercial food.

A first step was the improved design and implementation of HACCP (Hazard Analysis, and Critical Control Point)  programs by food producers.   Dr. Maki also called for a nationwide expansion of FoodNet, a food safety surveillance program.  He also recommended speeding up the reaction time of the CDC’s PulseNet’s program.  This program finds genetic links between reported illnesses, and is key to identifying an implicated food product.  

Dr. Maki also called for improved monitoring by the FDA and USDA.  This step is long overdue, and has been called for here and by Mr. Marler

The article also called for an "international moratorium on the incorporation into animal feeds of growth-promoting antibiotics, which have been linked to greatly increased antimicrobial resistance in bacterial enteropathogens."

Dr. Maki’s plea concluded with a call for increased reliance of irradiation of food.  The article is an excellent overview of the challenges facing our food production and distribution system, and an insightful look at much needed improvements.