Marler Blog - Providing commentary on food poisoning outbreaks & litigation

Eating fresh cheese at a fair in Kansas was the only recent exposure associated with illness. Of 101 persons who ate the cheese, 66 percent became ill, the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report said.  On October 26, 2007, a family health clinic nurse informed the Kansas Department of Health and Environment that Campylobacter jejuni had been isolated from two ill persons from different families who were members of a closed community in a rural Kansas county.  By Oct. 29, 17 additional members of the community had reported gastrointestinal illness. All 19 persons reported consuming fresh cheese on Oct. 20 that was made the same day at a community fair from unpasteurized milk obtained from a local dairy, the report said.

An investigation by the Kansas Department of Health and Environment and the local health department determined the source and extent of the outbreak. Eating fresh cheese at the fair was the only exposure associated with illness.  Although all samples of cheese tested negative for Campylobacter, results of the epidemiologic investigation found an association between illness and consumption of fresh cheese made from unpasteurized milk, the report added.

Unpasteurized milk and milk products should not be consumed, especially among populations at high risk of infection complications -- the young, pregnant, elderly and immunocompromised.

Our food supply seems so challenged, that it was hard to narrow it down to only 10.

1. Globalization: More international recalls and outbreaks due to expanding globalalization of the food supply and the challenges of oversight/infrastructure in developing countries. International challenges probably deserve a list of their own, but in the mean time, this wide umbrella includes the possibility of bioterrorism and/or “economic/chemical terrorism” (intentional adulterations with a profit motive, like melamine).

2. Local Food: Outbreaks linked to local food and/or farmer's markets. Community Supported Agriculture (CSA) groups and food co-ops need to demonstrate knowledge and practice of food safety, and be inspected. In addition to produce and meats/fish, prepared items are currently unsupervised in some, but not all locations.

3. Non-O157 STEC (Shiga Toxic producing E. coli) illnesses and outbreaks (both beef and produce): E. coli O157:H7 is listed as an adulterant, is tested for, and is still a terrible problem. E. coli strains that are non-O157 (but are equally as deadly) have not been evaluated or listed, and are not regularly tested for.

4. Animal to Human contamination: More contamination events involving the whole food chain (from animal feed to animals to humans). Whether it’s dioxin in Irish hogs or melamine in Chinese egg-laying hens, it’s clear that what goes into animals eventually goes into us. As the market for animals-as-food grows, so does the price to feed those animals and then the impetus to cut corners.

5. Having to do more with less: Public funding for food safety research, surveillance, and education is down, but the work load (and its importance) continues to grow.

6. 21st Century communication: In addition to improving communication between each other, food safety agencies need to improve communication with consumers. Outbreaks will move through the population with increasing speed, and agencies need to streamline their processes (and embrace social media like twitter and Facebook) in order to keep up.

7. Balancing food protection and environmental health: How to balance on-farm food safety practices with the protection of water quality, the prevention of soil erosion & dust, and the protection of wildlife and their habitats.

8. Zoonotic diseases: The rise of grain prices and starvation in other parts of the world will have many consequences, including the possibility that as people hunt wild animals for food, they may become exposed to new diseases, triggering a zoonotic virus jumping into humans. (A zoonotic virus is one that originates in animals and crosses to humans, like avian influenza.)

9. Consumers and food safety: How do consumers sort through the cacophony of information on food? What’s “safe”? What does “organic” mean anymore? How is it that “USDA inspected and passed” doesn’t guarantee pathogen-free meat? Who does the consumer believe/trust? Included in this category are the raw milk controversy, food irradiation, and even the new labeling laws like COOL (Country Of Origin Label). Will we get closer to farm to fork tracking of all fruits and vegetables this year?

10. Pet food ills: Pet food testing is increasing, so the level of contamination will become more apparent, and we should expect more recalls. Supervision of the pet food industry as a whole needs improvement, with clarity in ingredients and calorie counts.

Parts I, II, and III of this series provided a literature review and commentary on the history, technology, food safety, and food quality aspects relating to the use of ionizing radiation in fresh iceberg lettuce and spinach processing. To finish the analysis, a review of the literature on potential consumer and industry acceptance of food irradiation relative to its costs and benefits is presented. Two major and intertwined challenges might limit or delay the application of this processing method in the market place for fresh iceberg lettuce and spinach despite FDA’s approval: 1) consumer acceptance of the technology and 2) costs to the leafy green industry to implement the process. Given the gravity of the situation with outbreaks from fresh iceberg lettuce and spinach in recent years, it is imperative to examine carefully these challenges, and potential solutions including food irradiation.

Consumer Confidence and Acceptance

Consumer confidence in the lettuce and spinach industry

Fresh-cut (minimally processed) produce has grown to a $15 billion dollar per year industry in North America, and salad greens comprise a significant portion of that market, including iceberg lettuce and spinach (Palumbo et al, 2006). Likewise, a disproportionate number of the produce-related foodborne disease outbreaks have been linked to contaminated fresh-cut lettuce and spinach (Table, Part II). As a result, consumer confidence in this market has been shaken, which severely hurts the US economy, as well as the consumers who enjoy these products as fresh, healthy, and nutritious food sources.

For example, a survey conducted by the Food Marketing Institute of the US Grocery Shopper trends (2007) found that “safety concerns prompted 38 percent of consumers to stop purchasing certain foods in the past 12 months — up from 9 percent in 2006. Among those who stopped buying products, the items most often mentioned were spinach (71 percent), lettuce (16 percent), bagged salad (9 percent) and beef (8 percent). The survey was conducted in January 2007, when the outbreak linked to spinach was still in the news and illnesses associated with other foods were starting to make headlines.”

Based on these finding, one may ask: does food irradiation represent an opportunity to improve consumer confidence in the safety of fresh iceberg lettuce and spinach?

The answer would appear to be a resounding, “yes,” given the strong scientific evidence that irradiation is an effective and safe approach to reduce the levels of the most important foodborne pathogens in combination with other approaches such as GAPs and HACCP, as discussed in the earlier parts of this series. NASA has been irradiating astronauts' food successfully since the 1970s, but acceptance and availability of the technology for approved foods such as ground beef and poultry in the civilian market place has been limited despite the benefits recognized by the scientific and medical communities. A review of consumer surveys provides insight into some of the complex reasons that this technology has not been widely adapted in the US and other parts of the world.

Historical perspective on consumer acceptance of food irradiation

Prior to FDA’s new rule for fresh iceberg lettuce and spinach, food irradiation at similar medium-level doses was approved in the US for numerous applications including control of foodborne pathogens in other fresh and processed foods. A large body of literature exists on the issue of consumer acceptance of food irradiation, especially for beef and poultry products. Notably, many of these consumer surveys took place 10-20 years ago, and similar studies on perceptions relating to the use of ionizing irradiation in fresh lettuce and spinach processing have not appeared in the literature as of the time of writing this review.

Dr. Christine Bruhn at the University of California, Davis published many of the pioneering studies on consumer acceptance, and recently made this comment about consumer acceptance of food irradiation in a series on the new FDA rule published by Jim Prevor’s Perishable Pundit (2008):

“My work and that of other researchers over the last 20 years has found some people are ready to buy irradiated product right now….This group of consumers represents maybe 10 percent of the population. At the other side of the spectrum, 10 percent of consumers are appalled by irradiation. They believe it makes the product less safe and less nutritious and wouldn’t touch it with a 10-foot pole. The majority of the population is in the middle. They don’t know very much about irradiation, or how it would benefit them.”

Clearly, the target audience for education (pros and cons) about food irradiation and FDA’s new rule concerning fresh iceberg lettuce and spinach, should be the 80 percent “in the middle.”

DeRuiter and Dwyer (2002) published a review article on consumer acceptance of irradiated food. Although slightly older, Sapp (1995) also provides an excellent review of the literature on consumer acceptance in the book, “Food Irradiation: A Sourcebook.” Some research highlights and selected original papers from these reviews and other sources are summarized below.

• Most consumers know little about food irradiation (American Meat Institute, 1993; Bruhn, 2001)
• A survey conducted at FoodNet sites in 1998-1999, indicated that the primary reason consumers would not buy irradiated foods (meat, poultry) was due to insufficient information about the risks and benefits; the survey also showed 50% of those asked were willing to buy irradiated meat and poultry and among those, 25% were willing to pay a premium price (Frenzen et al, 2000)
• Numerous studies have shown that consumer acceptance increases after they are given educational information about food irradiation, and many consumers have reported that they would prefer irradiated over non-irradiated meats after given science-based information (Bord and O’Connor 1989; Bruhn and Schutz, 1989; Fox et al, 1998; Resurreccion et al, 1995 )
• The use of audio and/or visual materials on food irradiation such pamphlets, slide shows and videos shifts consumers toward a positive attitude on food irradiation (Bruhn et al, 1986b; Hashim et al, 1995; Pohlman et al, 1994)
• Labeling is important to consumers, and strongly influences their acceptance of food irradiation; in one survey, 80% of US consumers indicated they would buy products with the approved Radura label and a statement: “irradiated to destroy harmful bacteria (Bruhn 2001)
• Consumers have expressed more concern about foodborne illness than irradiation “safety” (Bruhn et al, 1986)
• In a survey of 250 dieticians employed in health care facilities, the responses were surprisingly receptive to irradiation (Giamalva et al, 1998)
• Surveys indicate that military consumers, in particular, may be amendable to irradiated food (DeRuiter and Dwyer, 2002; Pohlman et al, 1994)
• Consumer confidence depends on making food clean first, and then using irradiation to make it even safer (DeRuiter and Dwyer, 2002)
• Consumers indicate they trust information most from health professionals (Bruhn 2001; American Meat Institute 1998); but, also trust in government and industry are the important factors affecting acceptance of irradiation (Bord and O’Connor, 1990)
• An interesting and innovative educational campaign was launched in Florida to promote food irradiation (Bruhn 2001; Hunter 2001), that engaged the state and local county health department and multiple media outlets. They used billboards with pictures of mothers and children to draw a comparison between pasteurized milk and irradiation. The billboard read:

PUBLIC HEALTH NOTICE:
Pasteurization, Safer Milk.
Irradiation, Safer Meat.

Additionally, the state health officer (a physician) made a statement directed at consumers and retailers (restaurants, grocery stores): “I hope you will purchase irradiated chicken and ground beef as they become available. This combination will afford your family maximum protection against foodborne illness.”

The role of the Internet in acceptance of food irradiation

It is worth noting, that since many of these studies were conducted more than a decade ago, the potential influence of the Internet, including anti-irradiation activist websites, has not been factored into the consumer acceptance equation. An informal survey on the web during this review showed a preponderance of mostly non-science groups against food irradiation, and a relative paucity of recent web-based information from scientists, industry, and government about the potential benefits. It is also difficult to predict how increased consumer demand for “organic” and “natural” foods will affect acceptance of food irradiation of fresh produce such as lettuce and spinach. Irradiation of organic food is currently prohibited. There is an urgent need to conduct new studies in today’s marketplace including assessments of consumer attitudes toward irradiation of leafy greens and other produce. Additionally, it would be useful to examine consumer demand in different types of markets (e.g., chain restaurants, institutional settings such hospitals, long-term care facilities, and prisons).

Economic Costs and Commercial Viability

Similar to the literature review on consumer acceptance, most of the papers that address economic costs and potential benefits (from reduced outbreaks and recalls) relating to food irradiation are outdated, and not specific for fresh lettuce, spinach or other leafy greens. Nevertheless, there are common themes that can be applied today when weighing the costs and benefits of radiation to control foodborne pathogens and spoilage organisms in fresh iceberg lettuce and spinach.

The human costs

The type of costs that accrue for individuals and society due to foodborne diseases and recalls include but are not limited to:

• Physician and emergency department visits
• Hospitalization
• Outpatient medication
• Productivity loss
• Long-term complications (e.g., HUS)
• Premature death
• Loss to industry from recalls and highly publicized outbreaks
• Loss of consumer confidence and market share
• Liability (lawsuits) and increased insurance premiums

As previously discussed in Part II, Tauxe (2001) analyzed the potential benefit of irradiated meat and poultry and estimated that 900,000 cases of infection, 8,500 hospitalizations, over 6,000 catastrophic illnesses, and 350 deaths could have been prevented each year. Similarly, Morrison et al (1992) conducted a cost:benefit analysis for irradiation of poultry products, and concluded that the savings from decreased foodborne illness would be greater than the small increase in cost passed on to consumers. Although similar studies have not been conducted for lettuce and spinach-related illnesses, it is reasonable to assume that irradiation would also result in reduced human illnesses and associated costs.

The facility costs

There is no debate concerning whether or not irradiation is technically feasible for fresh iceberg lettuce and spinach. The technology has been shown to be safe and effective (see Parts I, II, and III). The major disincentive for implementing food irradiation processing in the leafy greens industry relates to economic feasibility.

The fresh iceberg lettuce and spinach industry faces unique challenges with this technology. First, there is a geographic challenge. The majority of fresh iceberg lettuce and spinach is grown and shipped from the west coast (mostly the Salinas Valley, California). This region does not currently have a facility to accommodate radiation of fresh produce at the dose approved by the FDA for foodborne pathogen control; therefore, it is necessary to either 1) build stand-alone or in-line unit(s) in the major lettuce/spinach production region or 2) ship the packaged products to irradiation facilities in other distant parts of the country. There is potentially less financial risk in utilizing an offsite location given the uncertainty of consumer demand (see below); however, shipping to an out-of-state irradiation facility increases costs, and adds another layer in the distribution system where contamination could be introduced, especially if there is an accidental failure in temperature (refrigeration) control.

Second, it may be necessary still to optimize the conditions for ionizing radiation processing for specific facilities and product types/sizes (including packaging) to maximize the food safety benefits and minimize the potential negative effects on food quality such as off odors; this is a relatively simple problem to address once a facility is in place.

Several excellent reviews of the costs associated with irradiation facilities are available, but they are outdated (Cleland et al, 2001; Frenzen et al, 2001; Hayes, 1995; Kunstadt, 2001a; Kunstad, 2001b; Morrison et al, 1992; Morrison, 1989).

There are three major components that factor into costs for industry (and that may be passed on to consumers):

• Capitol costs (hardware and land/property)
• Annual operating costs (type of product and radiation source/dose, personnel maintenance, tax/insurance, regulatory requirements)
• Annual throughputs

Cleland et al (2001) summarize the critical importance of annual throughput: “total cost per unit of product decreases as the throughput rate increases because the fixed costs (e.g., capitol amortization, utilities, maintenance) are then spread over a larger market of units.” In other words, the financial success (economic feasibility) of building an irradiation facility is closely associated with the demand for the product.

Thus, the uncertainty of the market place with regard to the number of consumers (including retailers) that will purchase fresh iceberg lettuce and spinach treated with radiation for food safety and quality is perhaps the greatest challenge in implementing FDA’s new rule.

Consumer Willingness to Pay

Although the actual number of potential customers remains unclear for irradiated fresh iceberg lettuce and spinach, numerous surveys have indicated that once consumers are educated about the food safety benefits of the process, most are willing to pay an increased price (Bruhn 2001; Frenzen et al, 2001; Hayes, 1995; Sapp 1995). Furthermore, published studies indicate that the increased cost per pound for meat and poultry products amounts to only a few cents. Although current numbers are not available in the literature for lettuce/spinach, Sadex Corporation estimated the increased cost for food irradiation at the medium dose level would be approximately 10 to 20 cents per pound using e-beam technology (personal communication). This seems like a small price to pay for increasing food safety, but as reviewed exhaustively in this series, many complex scientific, social, economic, and policy factors influence the decisions surrounding acceptance and use of food irradiation.

In the final part of this series (Part V), the pros and cons of FDA’s new rule will be summarized, and the potential “next steps for action” presented.

References

Last week I warned, “A safer food supply cannot wait.”   Here is yet another reason, according to news reports this morning, Mexico has now suspended meat imports from 30 processing plants in 14 states, including some of the nation's largest (and ones I have sued), on Wednesday and Friday, according to a list posted on the U.S. Department of Agriculture Web site.  USDA spokeswoman Amanda Eamich said in an e-mail that Mexico had discussions over the course of the last five business days with the agency regarding concerns about the general condition of meat products, sanitation issues and "possible pathogen findings."

Published reports, however, raised the possibility the move could reflect Mexico's objection to a recently enacted law that requires meat products to bear country-of-origin labels.   The country-of-origin labeling law (COOL) mandates the separation of foreign cattle and pigs in U.S. feedlots and packing plants. Foreign animals are also required to have more documentation about where they come from and, in the case of cattle, must have tags that indicate they are free of mad cow disease.

If our focus was in fact on food safety, domestically or with imports, COOL would be unnecessary and trade would not be interrupted.

The Kerman-based dairy that has been linked to bacterial illnesses and recalls, on Monday agreed to plead guilty to shipping misbranded food -- in this case, raw milk labeled for pet use that instead was consumed by people -- across state lines. According to the Fresno Bee - In a plea agreement filed Monday in U.S. District Court in Fresno, Organic Pastures agreed to, among other things:

1) Organic Pastures Dairy in Kerman is one of only two raw-milk producers in California, 2) Stop shipping unpasteurized raw milk across state lines, 3) Put a notice on its Web site within two weeks that it no longer will sell raw-milk products outside of California, 4) Notify, in writing, any out-of-state customers from the past year that the dairy no longer will offer raw milk or raw-milk products, and 5) Allow the federal Food and Drug Administration to, without prior notice, make inspections of the dairy.

Perhaps more disturbing are these comments by Mr. McAfee on the Complete Patient:

Let me be very clear....

I am not a pacifist and there is a tipping point at which activism and defense of the rights of my home, my food, my freedom and my family takes precidence over peaceful politically appropriate action with cameras and playing along while you get raped. . . .

Another Wounded Knee, Ruby Ridge or Waco could easily happen in America because of police abuse, massive unemployment, corruption, Wallstreet rip offs, denial of the right to food etc. . . .

I also believe that each and every mentally and emotionally stable free American should know how to shoot and shoot well and that those Americans that choose to do so should own a gun and appreciate its place in history and freedom. On of my fondest memories was visiting Switzerland in 1983 and seeing a youth with a machine gun on his back going to the shooting range on a moped. I thought to myself....no body will ever mess with his rights. Homes in Switzerland have huge machine SIG guns and everyone knows how to use them. There is little violence in that land and the crime rate is nill. Cops thoughtfully enter homes after asking politely and do not brandish weapons like Miami Vice. . . .

I shoot and own guns....but you will never see them displayed or used against cops or any person. Until the tipping point. At that point my life is then the value which must be laid down in the balance and it is worth giving in trade. . . . Remember, those that live by the sward can also die by it. If you raise a gun in anger expect to pay a dear price at some point.

Mark McAfee

I am trying to have a ski vacation with my family, but a good friend emailed me Noam Levey’s article – “FDA reform likely to take back seat in Obama plan” - I nearly fell off the chairlift.

"’This is an issue that will have to wait its turn,’ said Assistant Senate Majority Leader Richard J. Durbin, a Democrat from Illinois and longtime proponent of tougher food laws and a friend of President-elect Obama. Once again, bigger problems with higher profiles might shoulder aside food safety in the competition for resources.”

Senator Durbin, with all due respect, from someone who has briefed you and your staff on food safety issues, who has testified before congress, and who has supported you and the Democratic Party for years, hoping that once we threw the R’s out public health would be pushed to the front burner - let’s think this through a bit.

Poisoning people is not good for the economy.  It is bad for it.  Continuing to allow 76,000,000 of our citizens to be sickened each year (325,000 hospitalized and 5,000 deaths) costs our nation billions and billions each and every year, from the needless medical expenses, lost wages, lost productivity and lost lives.  On top of that the cost of outbreaks to business can also be steep, hundreds of millions were lost by the tomato and spinach industries because of bacterial contamination in those products.

Rethinking how our government helps protect (or not) our food supply and spending needed money on the CDC (we need more surveillance), FDA (we need more inspectors domestically and abroad) and the USDA and FSIS (they need a new focus), are cheap investments for the public (both individual and business) good. There is always an excuse for doing what is unnecessary.  However, with respect to food safety it is necessary.  the time is over for excuses, we voted for change and we deserve it.

While consumers can take certain steps to reduce melamine migration in their own kitchens, most incidental – as opposed to deliberate – addition of melamine to food probably takes place on the farm, in processing plants, and in food service kitchens.

Down On the Farm

Cyromazine is an EPA-approved pesticide, used to control insect populations on field crops destined both for human food and for animal feed. EPA has established residue limits for cyromazine in a variety of fruits, legumes and vegetables, including corn, lettuce, beans, mangoes and tomatoes.

The limits range from a low of 0.2 ppm in dried onion bulbs to as much as 10 ppm in cabbages and turnip greens for human consumption. Radish (roots or greens) and corn destined for animal feed must have no more than 0.5 ppm cyromazine.

Why should we care about cyromazine? Because plants and animals metabolize cyromazine – producing melamine as a result.

This metabolic process is well known to EPA and to the international regulatory community. Until recently, however, the possible accumulation of small amounts of melamine in plant or animal tissue was treated as insignificant.

The use of cyromazine – and other chemically related pesticides – on crops is not the only way in which melamine can enter our food supply on an industrial scale.

Sanitizer Insanity

It is an axiom of good food handling practice in processing plants and food service kitchens. Every surface, utensil, dish, cup, or pair of gloved hands that comes into direct contact with food must be sanitized periodically to avoid transferring bacteria or viruses onto the food.

This is a sound principle. Unfortunately, one of the sanitizers approved by EPA for food contact surfaces is the melamine derivative, trichloromelamine (TCM). When dissolved in water, TCM breaks down to release chlorine – an effective sanitizing agent – and melamine.

According to H&S Chemical Company, TCM is used in a number of different applications, including:

- "third sink" sanitizer in bars and restaurants
- hard surface disinfectant in food service areas
- sanitizer/disinfectant in the brewing industry
- by the US Army as a disinfectant for fruit and vegetable wash

Other "advantages" of TCM touted by Leedah, Inc., an Atlanta-based importer and distributor of chemicals, are:

- no need to rinse off
- safe for use in child care centers
- direct and indirect food-contact sanitizer
- non-toxic and biodegradable

JohnsonDiversey, offers TCM in pre-packaged pouches for the food service industry. BeerClean® sanitizer pouches are marketed for use as a final glassware rinse in bars. Sani-Sure® pouches are promoted as a "last tank" sanitizing rinse for dish ware and utensils.

The Bottom Line

Until the lethal twin melamine poisoning incidents of 2007 (pet food) and 2008 (adulterated milk), toxicology experts around the world considered melamine to be of minimal health concern. That attitude, clearly, is changing. And so must our tolerance of melamine traces on our tableware, on our utensils, and on food contact surfaces – and in our food!

To learn more about the recent melamine adulteration incident, as well as other food safety issues, please visit eFoodAlert.

Phyllis is the author of "Food Safety: Old Habits, New Perspectives" and "Food Microbiology - The Laboratory". She has been a food safety microbiologist for 35 years, and has worked both in government and industry.

Melamine-based plastic tableware, trays and utensils are very popular amongst families with young children, and in cafeterias and other food service establishments. They resist breakage, are dishwasher-safe, and come in a wide variety of patterns and colors. But with repeated use, the plastic dish-ware develops cracks and scratches. And it can "bleed" melamine into food.

Melamine migration into food from plastic tableware was documented more than 20 years ago. While migration takes place over the entire usable life of the plastic, it is enhanced as the tableware ages from repeated exposure to elevated temperatures, such as in a dishwasher or from hot beverages. Exposure to mild acids – fruit juices or tomato-based sauces, for example – also increase the risk of migration.

There are several things that consumers and food service establishments can do to minimize the potential for melamine migration.

• Discard tableware that is scratched, crazed, discolored or otherwise appears worn.
• Avoid using melamine tableware for acidic beverages, hot soups, or hot beverages – especially acidic hot beverages such as coffee.
• Never use abrasive cleansers or scouring pads when cleaning melamine tableware or utensils.

Parents of young children should consider alternative break-resistant tableware for their infants and toddlers. One option might be Corelle, a laminated glass tableware that is lightweight, heat-resistant and break-resistant.

Tableware, though, is not the only possible source of melamine in the home. A convenient cleaning sponge – the Mr. Clean® Magic Eraser® – is composed of melamine foam. The sponge is marketed as a "... powerful multi-purpose cleaning pad..." that can remove crayon marks from walls, encrusted dirt from counters and stove tops, and miscellaneous grime from wherever it may be found. But in doing so, it leaves behind minuscule amounts of melamine.

Given the tendency of children and pets to explore their world by tasting it, a Magic Eraser® is not the safest choice of cleaning pad for a family with young children.

Melamine has other applications; it is an effective flame-retardant, and a sound insulator, for example. Those uses, however, are unlikely to bring the chemical into direct contact with food.

A far greater risk is posed by the application of government-approved pesticides and sanitizers to crops and food processing equipment, which will be the subject of tomorrow's column.

To learn more about the recent melamine adulteration incident, as well as other food safety issues, please visit eFoodAlert.

Phyllis is the author of "Food Safety: Old Habits, New Perspectives" and "Food Microbiology - The Laboratory". She has been a food safety microbiologist for 35 years, and has worked both in government and industry.

Four inches of snow and Seattle stops cold.  Yesterday, three of us made it into the office.  Today, I'm going to play in the snow with my kids.  Happy Holidays.

Interfood Shareholding Company is recalling all lot codes of multiple varieties of the Wonderfarm brand of biscuits because they may be contaminated with Melamine.  The Wonderfarm biscuits are sold in 800g red metal tins. The four varieties being recalled are:

1. Wonderfarm "Successful" Assorted Biscuits (UPC:8935001262091)
2. Wonderfarm "Royal Flavour" Assorted Biscuits (UPC:8935001263098)
3. Wonderfarm "Lovely Melody" Assorted Biscuits (UPC: 8935001263296)
4. Wonderfarm "Daily Life" Assorted Biscuits (UPC: 8935001264200)

The manufacturer identified on the product is Interfood Shareholding Company in Vietnam.  The recall was initiated after the firm was advised that samples collected by the Minnesota Department of Agriculture of the Wonderfarm "Successful" Assorted biscuits, tested positive for melamine. Interfood Shareholding Company was identified as the manufacturer of the product. After being advised that "Royal Flavour", "Lovely Melody", and "Daily Life" also tested positive for melamine, the firm agreed to expand their recall to include those products as well.

A friend of mine sent me this tonight - too good not to share:

In a trial, a Southern small-town prosecuting attorney called his first witness, a grandmotherly, elderly woman to the stand. He approached her and asked, "Mrs. Jones, do you know me?"

She responded, "Why, yes, I do know you, Mr. Williams. I've known you since you were a young boy and frankly, you've been a big disappointment to me. You lie, you cheat on your wife, and you
manipulate people and talk about them behind their backs. You think you're a big shot when you haven't the brains to realize you never will amount to anything more than a two-bit paper pusher. Yes, I know you."

The lawyer was stunned! Not knowing what else to do, he pointed across the room and asked, "Mrs. Jones, do you know the defense attorney?"

She again replied, "Why, yes, I do. I've known Mr. Bradley since he was a youngster, too. He's lazy, bigoted, and he has a drinking problem. He can't build a normal relationship with anyone and his law practice is one of the worst in the entire state. Not to mention he cheated on his wife with three different women. One of them was your wife. Yes, I know him." The defense attorney almost died.

The judge asked both counselors to approach the bench and, in a very quiet voice, said:

"If either of you idiots asks her if she knows me, I'll send you to the electric chair."

ABSTRACT: A survey of bacteriological quality and the occurrence of Salmonella in raw bovine colostrum

01.Dec.08
Foodborne Pathogens and Disease, 5(6): 853-858
B.A. Houser, S.C. Donaldson, S.I. Kehoe, A.J. Heinrichs, B.M. Jayarao

In recent years, bovine colostrum has gained popularity as a human food because it is an excellent source of bioactive proteins, which have been claimed to inhibit viral and bacterial pathogens, improve gastrointestinal health, and enhance body condition. A study was conducted to determine bacteriological quality and occurrence of Salmonella in colostrum collected from dairy herds (n=55) in Pennsylvania. Colostrum samples were analyzed for standard plate count, preliminary incubation count, laboratory pasteurization count, Staphylococcus aureus, Streptococcus agalactiae, coagulase negative staphylococci, streptococci, coliforms, and non-coliforms. A standardized polymerase chain reaction assay was used for detection of Salmonella in colostrum. Salmonella were detected in 8 of 55 (15%) of colostrum samples. Streptococcus agalactiae (1000 colony-forming units [CFU]/mL) was detected in one colostrum sample. The mean standard plate count (977,539CFU/mL), preliminary incubation count (12,094,755CFU/mL), laboratory pasteurization count (615CFU/mL), Staphylococcus aureus (306CFU/mL), coagulase negative staphylococci (164,963CFU/mL), streptococci (256,722CFU/mL), coliforms (323,372CFU/mL), and non-coliforms (111,544CFU/mL) counts in colostrum were considerably higher than raw bulk tank milk counts reported previously from Pennsylvania. Analysis revealed that farm size did not influence the bacteriological quality of colostrum. Collection, handling, and storage of colostrum need to be addressed to improve bacteriological quality of colostrum intended not only for feeding calves but also for human consumption.

I'm getting flooded with the top ten food safety problems from 2008.  So, what are the top ten food safety challenges for 2009?

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According to the amusing Wikipedia entry on a favorite culinary cliché, the following foods are said to “taste like chicken”—alligator, fried spider, frog legs, green iguana, huhu beetle, mopane worms, opossum, rabbit, rattlesnake, turkey, and squirrel. And for longtime fans of the reality show Survivor, few have likely forgotten the episode where the contestant trap and roast a rat, the first bite of which elicited a more-than-predictable response.“Tastes like chicken!”

It is thus more than a little ironic that most commercial chicken sold in the United States today does not, in fact, taste like chicken. Indeed, it does not really taste like anything at all. One could say that such chicken tastes bland—that is, if one ignored the fact that the definition of bland is tasteless. Or we could just agree that chicken tastes tasteless.

There are a lot of reasons why chicken today has no taste, but the main one is because someone seems to have decided that chicken must be cheap. And for chicken to be cheap, each chicken must be cheap to raise, which is to say quick and easily-managed. Thus, for starters, you need to get rid of genetic diversity, which is what occurred in the 1950’s with the wide-scale commercial production of chickens. In a recently-published study by William Muir of Purdue University, it was found that more than 50% of the diversity of ancestral breeds has been lost. Add to this the fact of commercial chickens being fed a diet of “super-grow” chicken feed, which is typically 70% corn, 20% soy, and 10% other ingredients such as vitamins and minerals, and you have the perfect recipes for chickens that grow quickly but taste like nothing.

It need not be this way, however. And in France, it is not. There, chickens that have earned the designation “Label Rouge” are guaranteed to taste not just better than commercially-raised chickens, but to actually taste like chicken. The label started in the early sixties when French chicken farmers banded together in cooperatives to protect the traditional methods of raising chickens on small farms. To be entitled to the coveted red-sticker that is the Label Rouge, farmers must comply with a long list of strict requirements, including the raising of only slow-growing breeds suited for living outdoors, which is what the chickens do, roaming in the open air for their relatively long lives.

Label Rouge chickens live for a minimum of 81 days, twice as long as their industrial-raised counterparts. The use of slow-growing birds is to ensure good flavor and meat quality. Label Rouge birds grow to five pounds in twelve weeks, while fast-growing broilers reach five pounds in half the time. Most importantly though, Label Rouge chickens are subject to regular taste-testing as a condition of certification, and the taste must be “vividly distinguishable” from conventional poultry. It is for this reason, among others, that two out of every three whole birds sold in France carry the Label Rouge, even though the birds cost twice as much. And as if all that was not enough, the incidence of Salmonella in Label Rouge chickens is less than 3%, meaning that only Norway (with its zero-tolerance policy) produces a more pathogen-free bird.

So maybe next time you eat a bite of commercially-raised chicken in the United States, you should instead say “tastes like roasted rat.” That is, after you made sure that the chicken was cooked to a pathogen-killing 165 degrees so that the meat is not only tasteless, but really dry.

Denis W. Stearns is a Partner at Marler Clark LLP PS

The Trust for America’s Health (TFAH) has released its sixth annual report?Ready or not? Protecting the public’s health from diseases, disasters, and bioterrorism. The report contains state-by-state health preparedness scores for all 50 states and Washington, D.C. based on 10 key indicators to assess health emergency preparedness capabilities. Food safety is one of the main topics included in the report. The 2008 report finds that cuts in federal funding for state and local preparedness since 2005, coupled with the cuts states are making to their budgets in response to the economic crisis, are putting the progress toward improved public health preparedness at risk.

The economic crisis could result in a serious rollback of the progress we’ve made since Sept. 11, 2001, and Hurricane Katrina to better prepare the nation for emergencies,” said Jeff Levi, Executive Director of TFAH. “The 25% cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities.”

Some 2008 health emergencies included the Salmonella outbreak in jalapeno and Serrano peppers and the largest beef recall in history, which occurred in Feb. The report stated that America’s food safety system has not been fundamentally modernized in more than 100 years. In addition, the report showed that 20 states and D.C. did not meet or exceed the national average rate for being able to identify the pathogens responsible for foodborne disease outbreaks.

The report concluded with suggested food safety reforms to make the U.S. food safety system preventative, instead of reactive:

1. Unified and prevention-oriented statutory mandate and organizational structures.
2. Increased resources for research, standard-setting, inspection, enforcement, and education.
3. Risk-based resource allocation.

Well, the ladies at Obama Foodorama have one idea that (along with a few other things on their blog) makes me blush - "Bill Marler: The Best Hope For Rapid Change in The Obama Foodorama"

Honestly, I would be happy if President Obama and Secretary Vilsack simply read and implemented several of my ideas from - "Open Letter to a New Under Secretary for Food Safety - FSIS - The End of E. coli Conservatism."

We shall see.  Hat tip ladies.

OK, so I did my obligatory twelve days of Christmas list. 

So, what about the top ten food safety stories of 2008?  Or, the top ten food safety challenges of 2009?  Because I really need to get back to my legal work of suing wayward companies, I thought I would start off with a contest for the top ten for both 2008 stories and 2009 challenges.  The winners will get a fluffy microbe or a t-shirt from Giant Microbes (where I do all my holiday shopping).  Feel free to comment below or email me directly at bmarler@marlerclark.com.

HERE THEY ARE.

If you can't sleep here is something to read.  Bottom line is that Westland Hallmark was not a well run nor well regulated facility.  It literally shoved downer cows to their deaths (Video) and then fed them to the public, including kids in the school lunch program.

People infected with Salmonella usually recover without medical treatment in six to ten days. It may be several months, however, before their susceptibility to diarrhea and gastrointestinal distress fully resolve. “Although younger individuals usually face far higher infection rates from these pathogens, older adults are more likely to have more severe complications.” In addition, “the elderly are far more susceptible to death from Salmonella infections than the general population.”

A variety of other medical problems may derive from Salmonella infections in any given case. Within several months of infection, a certain percentage of ill individuals will develop an arthritic condition known as reactive arthritis, or “Reiter’s Syndrome,” which results from an immune response to the Salmonella bacteria in the body where the immune system attacks the cartilaginous tissues in the joints. The condition frequently resolves within several months, but it can become chronic, even permanent.

Reiter’s Syndrome, which includes, and is sometimes referred to as reactive arthritis, is an uncommon, but debilitating, possible result of a Salmonella infection. Reiter’s Syndrome is a disorder that causes at least two of three seemingly unrelated symptoms: “reactive” arthritis, eye irritation, and urinary tract infection. The reactive arthritis associated with Reiter’s develops when a person eats food that has been tainted with bacteria. Reactive arthritis is characterized by the inflammation of one or more joints, following an infection localized in another portion of the body, commonly the gastrointestinal tract. The symptoms of Reiter’s Syndrome usually occur between one and three weeks after the infection.

The three most common symptoms of Reiter’s Syndrome are arthritis, eye irritation, and urinary tract symptoms. The arthritis associated with Reiter’s Syndrome typically affects the knees, ankles, and feet, causing pain and swelling. Wrists, fingers and other joints can be affected, though with less frequency. Patients with Reiter’s Syndrome commonly develop inflammation where the tendon attaches to the bone, a condition called enthesopathy. Some patients with Reiter’s Syndrome also develop heel spurs, bony growths in the heel that cause chronic or long-lasting foot pain. Arthritis from Reiter’s Syndrome can also affect the joints of the back and cause spondylitis, inflammation of the vertebrae in the spinal column. The duration of reactive arthritis symptoms can vary greatly. Most of the literature suggests that the majority of patients recover within a year. The condition, can, however, be permanent. One study found nearly 50% of patients with postdysenteric reactive arthritis continued to have symptoms roughly one year after onset.

The involvement of the eye in Reiter’s Syndrome is most commonly manifested as conjunctivitis, inflammation of the mucous membrane that covers the eyeball, or uveitis, an inflammation of the inner eye. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision.

The third situs for Reiter’s Syndrome symptoms is the urogenital tract. This includes the prostate, urethra, and penis in men and the fallopian tubes, uterus, and vagina in women. Men may notice an increased need to urinate, a burning sensation when urinating, and a discharge from the penis. Some men also develop prostatitis. Symptoms of prostatitis include fever, chills, increased need to urinate, and a burning sensation when urinating.

1.  J. Buzby. “Older Adults at Risk of Complications from Microbial FoodBorne Illness,” Food Review, Vol. 25, Issue 2, pp. 30-35, at 32, Summer-Fall, 2002.

2.  For more information see www.healthlink.mcw.edu/article/926056398.html.

3.  “Postdysenteric Reactive Arthritis, A Clinical and Immunogenetic Study Following an Outbreak of Salmonellosis.” Inman, Johnston, Hodge, Falk and Helewa. Arthritis and Rheumatism, Vol.31, No. 11, November 1988.

Too much legal work to do in January to spend much time talking food safety, but I have several opportunities in February.

American Association for Justice Mid-Winter Conference

02.10.2009 - I will travel to the AAJ Mid-winter conference in New Orleans - my speech is part of the Litigation at Sunrise program.

National Meat Association (NMA) Meatxpo

02.22.2009 - I will travel to Las Vegas to take part in a round-table discussion on the FSIS.

GMA Food Claims & Litigation Conference

02.25.2009 - I will travel to Rancho Mirage to the conference, which is focused on Emerging Issues in Food-Related Litigation

It snowed overnight on the Island.  That is an inch of snow on my '51 Chevy. 

For the hundreds of my subscribers and the nearly 60,000 monthly viewers of www.marlerblog.com, you may find my request for Guest Bloggers to be a bit too much. However, given the volume of food poisonings, and the issues involving food safety policy and the law, I would appreciate the help and differing perspectives. Here are some recent Guest Bloggers, professor Catherine O’Neill on mercury in our fish and Alex Ferguson on melamine in our milk. If you have something to say, email me at bmarler@marlerclark.com. 

I would really like some guests from industry and the defense bar.  What about a bunch of ideas for the new adminstration?

Food Safety consumer groups are really weighing in on what the Obama Administration should be doing. The Institute of Medicine today stated that the Food and Drug Administration’s food safety system remains ill-equipped to meet emerging challenges, and the legal authority underlying all government inspection programs should be updated to emphasize prevention of foodborne illness. The IOM further suggested there would be benefits to creating a new focused food safety entity within the Department of Health and Human Services rather than continuing at FDA. Consumer Federation of America and the Center for Science in the Public Interest endorsed that action and today are urging President-Elect Barack Obama to act quickly to advance it.

The groups said that the President, within the first 100 days in office, should:

* Issue an executive order re-establishing the White House Food Safety Council to provide him an overall view of food safety needs, and direct the council to manage strategic coordination of all food safety efforts and create a long-term budget plan for food safety agencies.

* Direct the Food Safety Council to work with Congress to establish a commission made up of government officials, industry and consumer leaders, and food safety experts to develop a proposal to bring together the various federal food safety efforts into a single agency charged with protecting the public from food-related illnesses.

* Instruct the Secretary of Health and Human Services to combine under a single HHS official, program and budget responsibility for all HHS food safety activities. The official should be directly accountable to the Secretary and responsible for leading food safety activities at FDA, including setting preventive safety standards for all FDA-regulated foods and assuring FDA inspection activities are carried out effectively. The secretary should also direct this official to lead the effort to establish a Food Safety Administration within HHS, consisting of the food-related activities now undertaken by the FDA operating under a modernized food safety statute.

President Obama is going to have a "full plate."

The occurrence of bacterial infection is a function of several major variables: (1) the virulence of the bacterial pathogen, that is, its ability to cause severe disease; (2) how the pathogen is transmitted to the “host”—for example, whether it is airborne, foodborne, blood borne, etc.; and (3) host susceptibility—i.e. how well the host can defend itself against the bacterial pathogen. Increased susceptibility, in turn, may result from two different processes: a bigger infectious dose in a given case of disease may cause a more severe infection, and physical characteristics particular to an individual host may render him or her less able to limit the spread of infectious microorganisms from the intestinal tract to the bloodstream.

Morbidity and mortality in the elderly from infectious disease is far greater than in other populations. For instance, 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. Published studies attribute the elderly’s heightened risks, both of infection and mortality due to enteric infectious disease, 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.

Our Government (National Agricultural Library) does not think so, and I agree.  Click on the below, you may never find your way back out again.

I was traveling somewhere on a case last week when I was struck by the media focus on “Oprah's see-saw battle of the bulge.”  Hmmm, I thought… I have been practicing law for 20 years now – 15 of which have been food poisoning cases.  During that time, I have cut back on my marathon running (OK, exercise in general) and I work and travel a lot whacking “evil-doer” food manufacturers, and eating and drinking too much.  So, in empathy to Oprah, I am now launching a downward trend from 205 lbs - goal is 175lbs.  I cannot stop suing companies, working too much or traveling (unless companies want to stop poisoning their customers), but I can cut back on my consumption and dust off the running shoes.   I also made a deal with fellow blogger, Eddie of the Hapazard Gourment GIrls that she will stop smoking.  I will keep you all posted.

You might recall a blog post I did from January of 2008 where I discussed testing retail ground beef for Non-O157:H7 Pathogenic Shiga Toxin Producing E. coli (STEC). We have completed a portion of the first year’s tests and are in the process of compiling the data. We hope to publish the results in the next month.  (See Abstract)

Non-O157 STEC are capable of causing the same debilitating triad of diseases as E. coli O157:H7, including hemorrhagic colitis, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Infection with the non-O157 STEC can result in death in children, the elderly and the immunocompromised. According to the U.S. Centers for Disease Control and Prevention, the number of reported cases of illnesses caused by this group of pathogenic E. coli has been steadily increasing over the past several years. Despite this, Non-O157:H7 STEC is not considered an adulterant under current law in the U.S. That needs to change.

Non-O157:H7 STEC are also known to occur in imported beef from several trading partners, yet the U.S. Department of Agriculture Food Safety and Inspection Service (FSIS) has not required that imported beef be free of these pathogens. The Agency has also failed to devise steps to measure and control the presence of these pathogens in domestic beef production and the ground beef supply, at the slaughterhouse or the grocery store.

Days after Europe was well on the way recalling all the little piggies who went to market, today Rupari Food Services, a Deerfield Beach, Fl., establishment, is recalling approximately 41,020 pounds of fresh pork products that may be contaminated with dioxins, the U.S. Department of Agriculture's Food Safety and Inspection Service announced today.  FSIS was notified by the Food Safety Authority of Ireland (FSAI) that routine surveillance tests indicated the presence of dioxin in pork products that were sent to multiple importers of record in the United States. FSIS believes the probability of adverse health effects related to consumption of these pork products to be low, and concurs with the conclusions of a risk assessment conducted by FSAI.

The products subject to recall include: n 44-pound approximate weight boxes of "ROSDERRA MEATS, ROSCREA, Pork Loin Back Ribs, KEEP FROZEN." The shipping label bears the Irish establishment number "EST NO. 355."  The frozen pork products were produced in Ireland between Sept. 1 and Dec. 7, 2008, and were then exported to the United States. These products were sent to restaurants in California.

Ooops, before I could log out here is another:

Tommy Moloney's Inc., a Long Island City, NY., establishment, is recalling approximately 4,041 pounds of fresh pork products that may be contaminated with dioxins, the U.S. Department of Agriculture's Food Safety and Inspection Service announced today. FSIS was notified by the Food Safety Authority of Ireland (FSAI) that routine surveillance tests indicated the presence of dioxin in pork products that were sent to multiple importers of record in the United States. FSIS believes the probability of adverse health effects related to consumption of these pork products to be low, and concurs with the conclusions of a risk assessment conducted by FSAI.

8-ounce packages of "Tommy Moloney's Traditional Irish Breakfast Bacon, Made from imported Irish Pork." The label bears the establishment number "EST. 33789" inside the U.S. mark of inspection as well as a "sell by" date between "Dec. 15, 2008" and "Jan. 31, 2009."  The pork products were produced in Ireland between Sept. 1 and Dec. 7, 2008, and were then exported to the United States. These products were sent to retail stores in California, Connecticut, Florida, Massachusetts, New Jersey, New York, Massachusetts and Virginia.

Don't we have pigs from the US that are dioxin free?

Trust for America’s Health and the Robert Wood Johnson Foundation today released the sixth annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism Report, which finds that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection, and food safety.

According to the report, America’s food safety system has not been fundamentally modernized in more than 100 years.. Twenty states and D.C. did not meet or exceed the national average rate for being able to identify the pathogens responsible for foodborne disease outbreaks in their states.

The report also offers a series of recommendations for improving preparedness, including:

* Restoring Full Funding. At a minimum, federal, state, and local funding for public health emergency preparedness capabilities should be restored to FY 2005 levels.
* Strengthening Leadership and Accountability. The next administration must clarify the public health emergency preparedness roles and responsibilities at the U.S. Department of Health and Human Services and U.S. Department of Homeland Security.
* Enhancing Surge Capacity and the Public Health Workforce. Federal, state, and local governments and health care providers must better address altered standards of care, alternative care sites, legal concerns to protect community assistance and surge workforce issues.
* Modernizing Technology and Equipment. Communications and surveillance systems and laboratories need increased resources for modernization.
* Improving Community Engagement. Additional measures must be taken to engage communities in emergency planning and to improve protections for at-risk communities.
* Incorporating Preparedness into Health Care Reform and Creating an Emergency Health Benefit. This is needed to contain the spread of disease by providing care to the uninsured and underinsured Americans during major disasters and disease outbreaks.

In another great example how interconnected a “farm to fork” food chain can be, a friend of mine sent me this article from AP Ireland, “Oil-tainted feed causes Irish pork crisis.”

The beginning of this food crisis (as opposed to all the others that we read about daily) according to Irish Agriculture Department is that a feed supplier, Millstream, was using an inappropriate type of fuel oil in a burner that dried out-of-date bread, dough and confectionery that was turned into pig feed. Apparently, the vapors from the burning oil worked their way into the food, creating dioxin levels 80 to 200 times above legal limits. To the governments credit all little piggies are now off the market.  However, the financial impacts will be felt throughout the chain and into the Irish public’s wallet.

- Pig meat processors will cull 100,000 pigs suspected of dioxin poisoning and they are demanding euro1 billion ($1.25 billion) in emergency aid.

- Ireland's biggest pig meat processor, Rosderra Irish Meats Group Ltd., turned away its 850 employees at four plants Monday and told them to sign up for state unemployment benefits. Irish labor union SIPTU said 6,000 pork-industry workers may be impacted.

- The government now faces an uphill struggle to restore international confidence in an industry worth more than euro450 million ($570 million) annually, chiefly in exports to Europe and Asia.

- Russia, China, Japan, South Korea and Singapore all announced import bans Monday on Irish pork.

All from not paying attention to your inputs. Hmm, sounds much like the melamine crisis in China, and scores of other food supply failures that seem to hit us on a weekly if not daily basis.  In the United States we see similar failures when sellers of products, from hamburger to lettuce, seem oblivious to what, if any, safety measures growers/shippers/suppliers (how many ever actually visit the supply chain?) have put into place to prevent bacterial or viral contamination.  And, then all are surprised when people become ill and another recall is announced.

A few moments ago, this landed in my inbox:  Irish tests find dioxins in cattle as well as pork

However, no recall on beef - yet?

In the recent volume of AAP News is an article entitled, “advis[ing] families against giving children unpasteurized [raw] milk.” The article could not be clearer in its warning:

Raw or unpasteurized milk can transmit many serious infectious diseases to children. Furthermore, there are no documented health benefits associated with ingestion of unpasteurized milk or milk products. Therefore, the Academy advises that children should receive only pasteurized milk products.

Other Raw Milk Outbreaks:

California 2008 – Campylobacter

Vermont 2008 – E. coli O157:H7

Connecticut 2008 – E. coli O157:H7

Missouri 2008 – E. coli O157:H7

California 2006 – E. coli O157:H7

For those who want a bit more information on Raw Milk, see "The History of Raw Milk."  I would also urge you to review "Raw Milk Pros" and "Raw Milk Cons."

I just finished my presentation here at the ACI Conference giving an overview of the increase in 2007 and 2008 in recalls and outbreaks associated with hamburger and E. coli O157:H7 when I got an email of an article from Clinical Infectious Diseases from its November 15, 2008 publication on the 2006 Carrot Juice Botulism Outbreak tied to Bolthouse Farms.

For those that do not recall, in September 2006, three people living in Georgia developed food-borne botulism that was eventually traced to commercial carrot juice from a single bottle. Soon thereafter an additional case in Florida and two in Ontario, Canada surfaced. One of the 6 botulism patients died 90 days after illness onset. One year later, two others were still on ventilators. The remaining three were taken off ventilator support after 54, 90, and 129 days. Two survivors were at home, two were in rehabilitation facilities, and one was still hospitalized. All the patients had consumed carrot juice from the same manufacturer.

Now, here is the interesting part, according to Dr. Anandi N. Sheth at the Centers for Disease Control in Atlanta, Georgia and colleagues, an investigation eventually determined that inadequate refrigeration probably led to botulinum toxin production. As the investigators pointed out, the pasteurized carrot juice had no protection against the bacterium Clostridium botulinum other than refrigeration. "This investigation demonstrates that carrot juice and other processed foods with no natural barriers to C. botulinum germination require additional chemical or thermal barriers," the investigators wrote in the medical journal Clinical Infectious Diseases. Accordingly, they report, "In June 2007, the FDA modified its guidance for refrigerated low-acid juices to recommend adding a validated juice-treatment method, such as acidification or appropriate thermal treatment, to decrease the risk of C. botulinum contamination, should any breaches in refrigeration occur."

As part of its investigation into a rare infection that can be associated with infant formula, the New Mexico Department of Health is advising people on the safest way to prepare formula. The Department of Health is investigating two cases of Enterobacter sakazakii illness, a rare cause of bloodstream and central nervous system infections, in a female infant from Lea County and a male infant from Otero County. The male infant has died, and the female infant is hospitalized.

E. sakazakii can cause severe, invasive disease among infants and has been associated with powdered formula, according to the U.S. Centers for Disease Control and Prevention. There have been about 120 cases recorded across the world in all age groups, but infants are at particular risk. Some proportion of powdered formulas that have been tested have contained E. sakazakii or other bacteria that can cause disease.

The Department of Health is working with the CDC, the U.S. Food and Drug Administration and New Mexico Environment Department to try to determine what caused the babies to develop the infection. The Department of Health has interviewed families and conducted environmental and food testing. The Department expects test results to be available in about a week.

Testing at the Department of Health’s Scientific Laboratory in Albuquerque has determined that the two infants had different strains of the bacteria. Both babies did consume powdered formula in addition to other foods. In past investigations in other states, powdered infant formula contaminated with Enterobacter sakazakii has been associated with infant illnesses. However, that association was not documented in many of the cases investigated.