Marler Blog - Providing commentary on food poisoning outbreaks & litigation

The Center for Science in the Public Interest (CSPI) identified a total of 5,778 outbreaks of illness linked to specific foods, involving 168,898 individual illnesses that occurred between 1990 and 2006. An outbreak involves two or more ill people. The food categories most commonly linked to outbreaks were:

• Seafood: 1,140 outbreaks involving 11,809 cases of illness
• Produce: 768 outbreaks involving 35,060 cases of illness
• Poultry: 620 outbreaks involving 18,906 cases of illness
• Beef: 518 outbreaks involving 14,191 cases of illness
• Eggs: 351 outbreaks involving 11,143 cases of illness

This chart shows the relative rates of illnesses linked to outbreaks among the food categories when adjusted for consumption during the period of 1999 to 2006. Since Dairy is the lowest risk food category per serving consumed, we set its rate of illness as “1” in order to facilitate a comparison between categories.

Remember, CSPI is counting only those illnesses that are "officially" reported. The Centers for Disease Control and Prevention (CDC) estimates that 76 million foodborne illness cases occur in the United States every year. This amounts to one in four Americans becoming ill after eating foods contaminated with such pathogens as E. coli O157:H7, Salmonella, Hepatitis A, Campylobacter, Shigella, Norovirus, and Listeria. On an annual basis, approximately 325,000 people are hospitalized with a diagnosis of food poisoning, and 5,000 die

The Center for Science in the Public Interest recommends:

1. The Centers for Disease Control and Prevention (CDC) should continue to improve outbreak reporting and surveillance. The CDC has improved its reporting and surveillance system, but gaps still remain. For example, nearly half of all states do not follow national standards for tracking disease outbreaks. Those gaps are particularly troubling given the numerous recent large outbreaks. Improvements in state oversight and coordination and increased funding at state level would allow CDC to act more quickly and could reduce the sizes of foodborne illness outbreaks.

2. Congress should pass legislation to modernize food safety laws and increase funding, starting with FDA’s food safety program. While creating a unified, independent food- safety agency would be the best solution in the long run, the crisis in confidence in FDA’s ability to manage food safety problems creates an urgency for making improvements at that agency. Outbreaks occur, in part, because of inadequate regulatory authority, inadequate monitoring, and inadequate funding. Congress should separate food safety from drug approvals, by creating a new Food Safety Administration at the Department of Health and Human Services. A new Administrator would oversee the modernization of the food safety program, with an enhanced mission in the areas of prevention, inspection and enforcement and would help restore consumer confidence.

Today, seventeen months after the first reported illness and thirteen months after the recall, the CDC finally issues its final report on the 2007 Salmonella serotype I 4,5,12:i:-* infections. The CDC report summarizes the results of the investigation, which determined that 401 cases of salmonellosis occurred in 41 states during 2007, with 32% of ill persons hospitalized. In October 2007 the illnesses were finally associated with consumption of Banquet® brand frozen, not-ready-to-eat pot pies. Further investigation determined that 77% of patients who ate these pies cooked them in microwave ovens and that consumer confusion regarding microwaving instructions might have resulted in a failure to cook the product properly.

A voluntary recall was issued by the manufacturer (ConAgra Foods Inc., Omaha, Nebraska) on October 11, 2007, for all nine brands of pot pies produced at the implicated plant. The outbreak strain was isolated from 13 samples of unopened Banquet pot pies collected from the homes of patients. This outbreak highlights the need to cook not-ready-to-eat frozen foods thoroughly; these products should be clearly labeled as requiring complete cooking, and cooking instructions should be validated to account for variability in microwave wattage and common misconceptions among consumers regarding the nature of not-ready-to-eat foods.

Each year since, well since 2006 and 2007, I have given my readers a few safety tips of preparing safe food during the Holiday - specifically, Thanksgiving.  Honestly, I really do not have much to add to the links from 2006 and 2007 above, except to suggest that you add a small umbrella to each drink.

The family and I this year will once again partake in Thanksgiving on the beaches of Hawaii (don't be jealous, it is pouring rain).  This year our Thanksgiving is in homage to our new President.  By the way Mr. President, if you get bored dealing with our collapsing economy, global warming and terrorism, etc., feel free to read my post "Open Letter to a New Under Secretary for Food Safety - FSIS - The End of E. coli Conservatism."  Aloha.

I had a great meeting yesterday with ConAgra Foods. I met with a number of food safety employees and ConAgra’s Food Safety Board last time I visited Omaha a few months ago. According to its website and from what I can see, “ConAgra Foods has developed rigorous food-safety practices in all our facilities and manufacturing processes.” It goes on:

One example is our foodborne pathogen control program. Through equipment and process design, operating and sanitation procedures, and other measures, we ensure maximum protection against foodborne pathogens. Our state-of-the-art microbiological and chemistry testing laboratories further strengthen safety controls and research capabilities to address this key issue.

We also share our discoveries through publications and technical presentations; we have worked closely with the USDA and the FDA to provide scientific expertise, some of which has aided development of the food-safety regulations in place today.

The next Food Czar will need to work with industry to find the best practices to prevent foodborne illness outbreaks while at the same time keeping US companies price competitive.  Perhaps leading on food safety will be the way to gain market share?

In April 2007, Rick Perlstein penned a piece entitled “E. Coli Conservatism.”  His bottom line was the “Conservatism has been killing Americans. The recent food safety crisis is only one case study.”  Perhaps he is in part right.  However, whatever the political reasons for the “food safety crisis,” it has been long in coming and the system needs to be fixed.

E. coli is a powerful and deadly bacterium.  You cannot see it, taste it, or smell it. 250,000 E. coli bacteria will fit on the head of a pin.  Ten to 50 will kill your child or your grandmother.  Most likely due the expertise of Children’s Hospitals, and other top medical centers around the country, deaths at times are avoided, however, often not before Hemolytic Uremic Syndrome (HUS) nearly kills.  HUS, a complication from an E. coli infection, can cause severe damage to kidneys, intestines, liver and pancreas.  Falling into a coma and suffering further from cognitive impairment are all too common.

I have seen the inside of too many of those Intensive Care Units with families who are scared senseless as they watch their child or mother shutdown.  For 16 years, this has been my world.   When I was an undergraduate, I read Upton Sinclair’s, The Jungle.  That book took the American public on a tour of the contaminated underbelly of the meat industry and they were sickened.  It led to the Pure Food & Drug Act and the Federal Meat Inspection Act, versions of which are still in place today.

Until 1993, I thought—because of those laws—that the United States had a safe and secure food supply. But, then came the Jack-in-the-Box E. coli outbreak.  It killed four, and sickened hundreds, including many who were gravely ill with HUS and related complications.  Many of those victims became my clients.  Once again, there was a public outcry for safe meat.  The Food Safety & Inspection Service responded by creating and aggressively enforcing the Mandatory Risk Management System.  Based on research and practices of the U.S. Space Program, the risk management system established checkpoints at every phase of meat processing.

Although, the presence of some E. coli in hamburger was defined as an adulterant under the Federal Meat Inspection Act, I continued to sue “Big Meat” as most of my clients up to 2002 were children who were made sick by eating E. coli contaminated meat.  I recovered over $350 million during this period from the meat industry and the restaurants they supplied in verdicts and settlements on behalf of those clients.  In 2003 recalls of meat laced with E. coli began to decline.  After 24 million pounds of contaminated beef were recalled in 34 separate incidents in 2002, recalls dropped off to just over a million pounds a year for the next three years, and then to just 181,900 pounds in 2006.  The Centers of Disease Control and Prevention saw E. coli – related illnesses drop 48% between 2002 and 2006.

But then came Spring 2007.  E. coli, which begins its life in the hindgut of a cow, mounted a surge on its home court.  And, it came back with a vengeance.  Forty-four million pounds of beef have been recalled in 25 incidents.  All over the country, slaughterhouses, packing and distribution centers, retail outlets, and restaurants were once again testing positive for E. coli and people-mostly children-were getting seriously sick.  The American meat supply, which had again been touted as safest in the world, tumbled back into disarray.  But, why?

As with any unexplained mystery, theories abound.  Could it really just be meat industry complacency?  Did everyone respond to the good numbers in 2006 by taking a long nap?  Did meat processors slack off—consciously or unconsciously—and relax their testing procedures?  Did government regulators take a few years off?

Or could it be better reporting?  Doctors are more aware of E. coli now, and perhaps when patients present symptoms of food poisoning; tests are more likely to be ordered.  When the presence of E coli is found and reported, a recall is triggered.

There’s always global warming.  Seriously though – very smart people have posited that droughts in the southeast and southwest have launched more fecal dust into the air, which then finds its way into beef slaughtering plants.  It has also been suggested that the rainfall in other areas created muddy pens—an ideal environment for E. coli.

Why not blame high oil prices?  High prices have fueled the growth of ethanol plants.  These plants are often built next to feedlots, and a byproduct of the ethanol production process—distiller’s grains—is considered an excellent and cheap alternative to corn for cattle feed.  Unfortunately, research associates the use of distiller’s grains as feed with an increase in the incidence of E. coli in the hindguts of cattle.

Another controversial issue may affect the meat supply.  The New York Times reported that immigration officials began a crackdown at slaughterhouses across the country in the fall of 2006.  Experienced—albeit undocumented—workers have been cleared out and replaced with unskilled, inexperienced labor.

And then there’s Darwin.  Another theory holds that interventions have caused the wily E. coli microbes to adapt, selecting pathogens that are more resistant to detection or intervention.  E. coli back in our meat cannot be tolerated.  Summer has always been kind to the E. coli bug.  More than 5.6 million pounds of E. coli contaminated beef has been recalled so far in 2008, most supplied by Nebraska Beef Ltd., via the Kroger Grocery chain.  All of which was responsible for a multi-state outbreak of E. coli that again is filling up the ICU’s in Hospitals in the seven states.

What is being done?  Honestly, not much.  Congress has held some hearings, but the only new reform is that the names of retail stores that received meat and poultry involved in recalls with high health risk will be made public.  Good as far as it goes.

However, despite 76,000,000 American’s being sickened, 325,000 hospitalized and 5,000 deaths each year, food safety did not make it as a Presidential campaign issue.  Congress, Democrats and Republicans, have about run out its clock.  But E. coli is back in our meat and we better care.

Solutions?  Improve surveillance of bacterial and viral diseases. First responders - ER physicians and local doctors - need to be encouraged to test for pathogens and report findings directly to local and state health departments and the CDC promptly. Right now, for every person counted in an outbreak there are some 20 to 40 times those that are sick but never tested. The more we test, the quicker we know we have an outbreak and the quicker it can be stopped.

These same governmental departments, whether local, state or federal, need to learn to “play well together.” Turf battles need to take a back seat to stopping an outbreak and tracking it to its source. That means resources need to be provided and coordination encouraged so illnesses can be promptly stopped and the offending producer - not an entire industry - are brought to heal.

Require real training and certification of food handlers at restaurants and grocery stores. There also should be incentives for ill employees not to come to work when ill. We should impose fines and penalties on employers who do not cooperate.

Stiffen license requirements for large farm, retail and wholesale food outlets, so that nobody gets a license until they and their employees have shown they understand the hazards and how to avoid them.

Increase food inspections. While domestic production has continued to be a problem, imports pose an increasing risk, especially if terrorists were to get into the act. Points of export and entry are a logical place to step up monitoring. We need more inspectors - domestically and abroad - and we need to require that they receive the training in how to identify and control hazards.

Reorganize federal, state and local food safety agencies to increase cooperation and reduce wasteful overlap and conflicts. Reform federal, state and local agencies to make them more proactive, and less reactive. This too requires financial resources and accountability. We also need to modernize food safety statutes by replacing the existing collection of often conflicting laws and regulation with one uniform food safety law of the highest standard.

There are too few legal consequences for sickening or killing customers by selling contaminated food. We should impose stiff fines, and even prison sentences for violators, and even stiffer penalties for repeat violators.

We need to use our technology to make food more traceable so that when an outbreak occurs authorities can quickly identify the source and limit the spread of the contamination and stop the disruption to the economy. When I buy a book on line I can track it all the way to my mailbox.  We must be able to do the same with our food.

Promote university research to develop better technologies to make food safe and for testing foods for contamination. Provide tax breaks for companies that push food safety interventions and employee training. Greatly expand irradiation of raw hamburger and other high-risk products.

Improve consumer understanding of the risks of food-borne illness. Foster a popular campaign similar to Mothers Against Drunk Driving, which uses consumer power to promote a no-tolerance policy toward growers and companies that produce tainted food.

The time has come to act and not continue simply to react.  Consumers, Farmers, Suppliers, Manufacturers, Retailers, Regulators and Politicians need to work together to make our food supply safe, profitable and sustainable.  When a quarter of our population is sickened yearly by contaminated food, when thousands die, we do not have the “safest food supply in the world.  We should, must and can do better.

After two days of mediation in New York City, we were able to resolve several cases. However, a number were left unresolved. As readers recall, on August 31, 2007 a consumer complaint was filed with the USDA after a Florida resident fell ill after consuming a hamburger patty produced by Topps Meat Company (“Topps”) on July 12, 2007. The resident tested positive for E. coli O157:H7 on September 4, 2007. This was followed by similar reports of illnesses connected with Topps product in New York State and elsewhere in the following days. On or before September 8, 2007 the USDA had confirmed a sample from a Topps hamburger had tested positive for E. coli O157:H7. Additional illnesses continued to be reported.

Topps took no action to remove its products from the shelves until September 25, 2007. On that date, the USDA announced that Topps was recalling 332,000 pounds of ground beef due to contamination with E. coli O157:H7. The initial recall encompassed only products produced on June 22, July 12, and July 23, 2007. The New York Department of Health subsequently reported that an intact sample with a production date of June 21, 2007 had also tested positive for E. coli O157:H7. At the same time, a USDA Food Safety and Inspection Service (FSIS) conducted an inspection of Topps’s plant in Elizabeth, New Jersey.

The FSIS inspection of Topps’s plant and procedures at its Elizabeth, New Jersey facility on September 26, 2007 revealed alarming deficiencies in the firm’s safety programs. The problems began with the raw materials. Topps received boxed sub-primal products, which did not carry Certificates of Analysis (COA). Topps initially used these boxed sub-primal cuts only for non-ground product. But, Topps then mixed the trim, the left-overs after butchering, with the raw materials being used for its ground beef products. The trim was placed into the grinding operation without testing for E. coli O157:H7. This practice was in violation of federal regulations. See 9 CFR 417.5 (a) 1. The FSIS then concluded that this failure to ensure that product intended for grinding was free of E. coli O157:H7 called into question the “adequacy of the design and execution of your prerequisite program and HACCP [Hazard Analysis Critical Control Point] program.”

FSIS inspectors also found various sanitation deficiencies at the facility. During the pre-operational inspection FSIS personnel noted that “the patty making machine had gouges, cracks, and tears in the neoprene transfer belt used to move raw patties to packaging.” The inspectors also noted a history of prior non-conformance records relating directly to raw product residue on equipment surfaces. The FSIS concluded:

The recurring deficiencies of unsanitary equipment documented by USDA…provide evidence that [Topps] failed to re-evaluate the effectiveness of the sanitation SOPs [standard operating procedures].”

According to Canadian press reports, Romaine lettuce is the “prime suspect” in an E. coli outbreak in southwestern Ontario that has sickened at least 26 people, the Canadian Food Inspection Agency said Tuesday. The federal agency and health officials in the Niagara and Halton regions say preliminary tests suggest romaine lettuce is the likely source. There are 128 confirmed or probable cases of E. coli O157:H7 in the Niagara, Halton, Guelph and Waterloo regions. Laboratory testing has determined that cases in the four health units have the same DNA fingerprint.

“Romaine lettuce is the prime suspect,” said Rene Cardinal, an official with the CFIA.

The source of an unrelated outbreak of E. coli in North Bay, which left one child in critical condition and sickened up to 250 other people, has not been determined.

E. coli outbreaks in Halton, Niagara and Waterloo that have sickened hundreds have been linked by DNA tests showing they share the same rare genetic makeup. Public health officials are also investigating whether E. coli cases at the University of Guelph have the same DNA fingerprint. Of the cases linked in Ontario, 13 have been confirmed in the Niagara Region, three in Halton and two in Waterloo. Another 106 cases in Niagara and Halton are being investigated. In the United States, the genetic code recently showed up in five cases of the food-borne pathogen in Southern California, South Dakota and New Jersey.

Investigators from the Colorado Department of Health reported today that the outbreak of E. coli among eight children in the Evergreen area may be linked to elk droppings.  Specimens obtained from elk droppings in the mountain region have tested positive for the same strain of E. coli O157:H7 bacteria that was identified in the children, the Colorado Department of Public Health and Environment said.

The children who have been sickened are between 4 and 12 years old.  Of the eight cases, six are children in Jefferson County, one in Clear Creek County and one in Park County. The children's illness were reported sporadically throughout the summer and early fall, beginning in July and most recently in late October, the state health department said.  Most of the ill children had exposure to elk droppings while playing outdoors at parks or around their homes, Miller said.

Introduction

Part I and Part II of this series reviewed the historical background and technology of food irradiation, and the food safety implications relating to FDA’s recent approval of a new rule for use of ionizing irradiation as a processing step in fresh iceberg lettuce and spinach. This segment summarizes state-of-the art knowledge of the pros and cons (advantages and limitations) of using ionizing radiation to enhance the quality of fresh iceberg lettuce and spinach. The term “food quality” encompasses all of the objective and subjective factors that contribute to a food’s wholesomeness, nutritional value, and sensory attributes. Peri (2006) succinctly defined food quality as: “fitness for consumption,” in other words, “the requirements necessary to satisfy the needs and expectations of the consumer.”

Ionizing Radiation as a Food Preservation Technique

Irradiation is one of many food preservation techniques. As discussed in Part I, food irradiation is not new, but the application of this technology to fresh lettuce and spinach was only recently approved in the US. Before delving into the details of food quality in the context of food irradiation, it is worthwhile to consider the historical perspective of food preservation, and how food irradiation fits into this picture.

The quality of any fresh food deteriorates after harvest, in part, due to the action of spoilage organisms (e.g., bacteria, fungi). Spoilage leads to loss of nutrients and negative effects on the flavor and appearance of fresh food over time. The negative effects of deterioration could be avoided if consumers were able to prepare and eat foods almost immediately after the food leaves the farm. But, for most consumers this scenario is not practical on a year-around basis. The search for efficient and effective methods to preserve the safety, quality, and nutritional value of perishable foods during transportation and storage, while simultaneously maintaining the benefits of the original fresh product, has been an ongoing challenge across the ages of civilization.

The earliest examples of food preservation include cooking/boiling, cold storage (refrigeration/freezing), drying, and salting. To this day, these traditional methods remain a cornerstone in the prevention of food spoilage and waste, worldwide. Examples of more recent historical developments in food preservation include pasteurization and canning.

In the modern age, the food processing industry has addressed the unique food preservation challenges associated with fresh produce by introducing novel approaches such as the use of modified atmosphere packaging (MAP) and wash water disinfectants, especially for fresh-cut, minimally processed produce. Temperature control (refrigeration) continues to be the most important approach to preserving the quality and safety of fresh produce. Irradiation of fresh lettuce and spinach represents a new tool in the produce preservation toolbox. The following are examples of current approaches to achieve food quality preservation of fresh produce that may be used individually, or in combination, depending on the specific product.

• Refrigeration
• Freezing (spinach)
• Heat treatment – cooking and canning (spinach)
• Wash water sanitizers (e.g., sodium hypochlorite, hydrogen peroxide, chlorine dioxide, ozonated water, etc.)
• Modified atmosphere packaging (MAP), a procedure that packages fresh-cut lettuce/spinach in high CO2 and low O2 to control spoilage organisms
• Ionizing radiation