February 2011

photo22.JPGAfter giving my speech this afternoon at the 6th Annual Dubai Food Safety Conference, I was approached by a reporter or Gulf News about my thoughts that the doctor, a restaurant’s cook and a supervisor had been fined Dh10,000 each (about $2,750US), and ordered to jointly pay diyaa or blood money (money or some sort of compensation paid by an offender (usually a murderer) or his family group to the family or kin group of the victim) jointly in the amount of Dh200,000 (about $55,000US) to the parents of a five-year-old boy, Nathan D’Souza, and his seven-year-old sister Chelsea, who died of food poisoning in 2009.

The cook and the supervisor were convicted of violating the public health requirements of Dubai Municipality through unhygienic practices in preserving the food, which led to bacterial contamination. The doctor was convicted of providing negligent medical care to the children when they were admitted to hospital after eating a meal from the restaurant.

Screen shot 2011-02-28 at 10.14.21 AM.pngScreen shot 2011-02-28 at 10.14.10 AM.pngAccording to press reports, the deaths of these two children has been one of the latest in a series of high profile food poisoning incidences:

May 31, 2009: A four-year-old girl died of suspected food poisoning in Sharjah. The Indian family of four rushed to the hospital after series of vomiting.

November 4, 2008: Fourteen employees at a cement factory were hospitalized after consuming rotten food prepared at the factory kitchen in Ras Al Khaimah.

March 20, 2008: Six people fall ill after eating buffet food at a restaurant in Ibn Battuta Mall.

August 26, 2007: A 10-year-old girl died of food poisoning in Abu Dhabi

April 14, 2007: A three-year-old died of suspected food poisoning in Sharjah

It seemed like the people in the audience were engaged and focused.

UPDATE:  On Tuesday AM, I was in the audiance at the Dubai Food Safety Conference when suprisingly the head of Dubai Municipality’s food inspection section today said the deaths of two children in 2009 were not the result of food poisoning, despite a court ruling that held the chef, restaurant owner and a doctor accountable.  Ahmed Abdulrehman al Ali today said the tests that his unit performed showed no signs of food poisoning. He was speaking on the sidelines of the sixth Annual Dubai International Food Safety Conference, organised by the Municipality.

“By taking samples of the meal and the shared food with other family members, results did not show food poisoning. Neither did the lab or blood tests.  This is a very sad case and we heavily investigated the samples from the leftover food the kids ate, but found no amount of bacteria enough to cause death,” said the official, who did not wish to be named. “As the Municipality, we never said this was a food poisoning case. Investigation does not mean confirmation. The environment and food was cleared from our side. It was a suspected case based on assumption.”

All this should continue the discussion of this very sad case.

Three years after a Salmonella outbreak, first linked to United States Tomatoes and then Mexican Peppers, that sickened about 1,500 people and claimed two lives, U.S. epidemiologists have learned that speed is of the essence in identifying sources of food contamination and preventing further infection. However, in an editorial accompanying the paper in the February 23rd online issue of the New England Journal of Medicine points out, increased speed requires resources that cost money. Identifying sick people earlier would have given health officials a huge head start on getting to the source of the problem, said study lead author Dr. Casey Barton Behravesh, an epidemiologist with the U.S. Centers for Disease Control and Prevention.

Behravesh.png“One of the challenges is the lag time between when someone becomes ill and when that person is interviewed to ask about foods they ate in the week before the illness,” she said. “About half of the time, it can take up to 21 days as a median to interview ill people, and this lag can really make it hard not only to remember what food they ate but also for tracking people down.” In addition, she said, “investigating local clusters of illnesses, groups of people that ate at one restaurant in one state, can be aided by looking at menus or recipes to help us efficiently identify foods and even specific ingredients.” Behravesh said a collaboration of agencies and laboratories have established the “OutbreakNet Sentinel Sites, or OSS, are one of the key components that could have saved time in this (2008) outbreak.”

Correctly figuring out outbreaks earlier can prevent illnesses and save lives by getting the offending food product off the shelves faster and alerting consumers to safe food handling practices. As important is a faster response gives epidemiologists greater information to link a specific food and a specific manufacturer to an outbreak and recall. Cutting time between first illnesses can save millions in medical expenses, and being more accurate on the illness vector saves an industry from an undeserved black eye.

Congress should devote the resources necessary to prevent illnesses and prevent unnecessary business loss.

According to press reports, the City of Evanston said Merle’s BBQ Restaurant was the source of a recent food borne illness outbreak that caused 30 people to get sick. The Evanston restaurant was catering parent/teacher conferences at Haven Middle School on Feb. 16, and people reported falling ill shortly after. The Evanston Health Department investigated the incident and concluded that poor handling of the food was the likely cause of the outbreak.

“The outcome of the investigation revealed unsafe food handling and temperature storage at both Merle’s BBQ Restaurant and Haven Middle School and it is therefore unlikely that the exact cause of the outbreak will be determined,” said Evanston Health Director Evonda Thomas.

“Results of the test indicated Clostridium perfrigens as the causative agent,” the release said.

clostridium.jpgClostridium perfringens are bacteria that produce toxins harmful to humans. Clostridium perfringens and its toxins are found everywhere in the environment, but human infection is most likely to come from eating food with Clostridium perfringens in it. Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu.

The majority of outbreaks are associated with undercooked meats, often in large quantities of food prepared for a large group of people and left to sit out for long periods of time. Because of this, it is sometimes referred to as the “food service germ.” Meat products such as stews, casseroles, and gravy are the most common sources of illness from Clostridium perfringens. Most outbreaks come from food whose temperature is poorly controlled. If food is kept between 70 and 140 F, it is likely to grow Clostridium perfringens bacteria.

People generally experience symptoms of Clostridium perfringens infection 6 to 24 hours after consuming the bacteria or toxins. Clostridium perfringens toxins cause abdominal pain and stomach cramps, followed by diarrhea. Nausea is also a common symptom. Fever and vomiting are not normally symptoms of poisoning by Clostridium perfringens toxins.  Illness from Clostridium perferingens generally lasts around 24 hours, and is rarely fatal.

Checking in to the Burj Al Arab at 11:00 PM Friday after a flight from Seattle to Atlanta and Atlanta to Dubai, left me a few more hours to tweak by Power Point for my lunch time speech at the Dubai Food Safety Conference on Monday.

Screen shot 2011-02-01 at 3.41.47 PM.pngHopefully, the attendees will be paying attention to my speech and not wondering about their lunch?

Screen shot 2011-02-24 at 2.57.40 PM.pngMost state health departments encourage consumers to report food poisoning incidents to local health departments.  Food Safety News has provided links (see below) to pages on state health department or public health association Web sites where you can directly report a foodborne illness, or where you can obtain contact information to report your illness to your local public health agency. 

Food Safety News is considering ways to make it even easier for consumers to report illnesses quickly so foodborne illness outbreaks are stopped and restaurants and manufacturing problems are corrected.

Links below:

Continue Reading Find Your Health Department to Report Food Poisoning or Foodborne Illness

Screen shot 2011-02-24 at 12.50.28 PM.pngThe IAFP Foundation, through a contribution from Marler Clark, will fully support travel, hotel and registration expenses for up to four state or local health or state agricultural department employees to attend IAFP 2011.  Click here for the Awards criteria and Application form.  (Note: the application deadline for this award only is April 5, 2011.)

The International Association for Food Protection welcomes your nominations for our Association awards to be presented at IAFP 2011 in Milwaukee, Wisconsin. You do not have to be an IAFP Member to nominate a deserving professional or colleague for one of our food safety professional awards. Student Members of the International Association for Food Protection are also invited to submit their application for the Student Travel Scholarship award to attend the IAFP Annual Meeting.

The deadline for 2011 award nominations and student applications is March 1, 2011.  For Awards criteria and submission forms, click here.

Welcome to outbreakdatabase.com, a searchable database of illness outbreaks caused by one or more of the following

1. consumption of contaminated foods or beverages,

2. exposure to animals,

3. exposure to contaminated recreational water,

4. person-to-person contact with someone whose illness initiated from animal exposure or consumption of contaminated foods and beverages.

Screen shot 2011-02-23 at 4.05.05 AM.png

The Centers for Disease Control and Prevention (CDC) defines an outbreak as “two or more ill persons linked to a common source” and this serves as the basis of outbreakdatabase.com. To be included in outbreakdatabase.com, the outbreak must have supporting documentation from public health agencies, journal articles, media reports, etc. Names of stores, brands, restaurants, or other sources are listed if they have been publicly identified previously.

The database is a work in progress. It will continually be updated and revised. Significant effort has been made to ensure the data are accurate. We welcome contributions, corrections, comments, etc.

11206.jpgMichael T. Osterholm, Ph.D., M.P.H., (a.k.a., the god of food safety epidemiology) wrote today in the New England Journal of Medicine – “Foodborne Disease in 2011 — The Rest of the Story” today. Here are the highlights:

So will the Food Safety Modernization Act result in immediate improvements in food safety? The legislation brings long overdue modernization to the FDA’s food-safety activities. It gives the FDA broader authority to regulate food facilities, including authorization to inspect records related to food. It “requires each owner, operator, or agent in charge of a [nonexempt] food facility to identify and implement preventive controls to significantly minimize or prevent hazards that could affect food manufactured, processed, packed, or held by [that] facility.” It also requires the FDA “to issue guidance documents to reduce the risk from the most significant foodborne contaminants” and to “establish minimum standards for the safe production and harvesting of fruits and vegetables based on known safety risks.” It further requires the FDA “to allocate resources to inspect facilities and imported food according to the known safety risks of the facilities or food; and [to] establish a product tracing system to track and trace food that is in the United States or offered for import into the United States.” It gives the FDA authority to order a recall of a food when it is contaminated or implicated in an outbreak. Finally, it “requires U.S. importers to perform risk-based foreign supplier verification activities to verify that imported food is produced in compliance with applicable requirements related to hazard analysis and standards for produce safety and is not adulterated or misbranded.”

Although all these new forms of authority will substantially enhance the FDA’s ability to prevent foodborne disease and respond more effectively when an outbreak occurs, the new law has a major shortcoming: dollars. There was no appropriation approved by the Congress for the act or authorization in the bill for the FDA to assess fees on the companies that it inspects. The Congressional Budget Office estimated that implementing this legislation would require $1.4 billion between 2011 and 2015.5 Though the bill authorizes the FDA to collect fees when a facility requires reinspection and a recall fee for mandatory recalls, these fees are expected to provide minimal resources. In short, the actual effect of this important law will at best be extremely limited if Congress and the administration don’t appropriate and sign additional legislation providing the necessary funds to carry out its mandates. Recent reports in the media calling this act “historic legislation” must be tempered by the reality that without the necessary resources, requiring the FDA to carry out the law’s required activities will be like trying to get blood out of a rock. And in the end, food safety in the United States cannot be expected to improve in more than an incremental manner.

As Paul Harvey would have said, “That’s the rest of the story.”

I would simply say – “Show me the Money!”  This article (10.1056/NEJMp1010907) was published on February 23, 2011, at NEJM.org.

Full disclosure – Mike and I tend to email each other at hours between midnight and 4:00 AM; sometimes we do not agree on policy; and, his son worked for me for the Summer of 2009.  Also, we have talked about going fly fishing, but we have never connected.

If there ever was a reason (in addition to the risk of bio-terrorism) to apply more resources to national and state surveillance of bacterial outbreaks, the 2008 Salmonella outbreak that sickened 1500 people in 43 states, the District of Columbia, and Canada is one that I hear (from consumers and industry) most often. Now thanks to:

Casey Barton Behravesh, D.V.M., Dr.P.H., Rajal K. Mody, M.D., M.P.H., Jessica Jungk, M.P.H., Linda Gaul, Ph.D., M.P.H., John T. Redd, M.D., M.P.H., Sanny Chen, Ph.D., M.H.S., Shaun Cosgrove, B.A., Erin Hedican, M.P.H., David Sweat, M.P.H., Lina Chávez-Hauser, M.A., Sandra L. Snow, M.D., Heather Hanson, M.P.H., Thai-An Nguyen, M.P.H., Samir V. Sodha, M.D., M.P.H., Amy L. Boore, Ph.D., M.P.H., Elizabeth Russo, M.D., Matthew Mikoleit, M.A.S.C.P., Lisa Theobald, B.S., Peter Gerner-Smidt, M.D., D.M.S., Robert M. Hoekstra, Ph.D., Frederick J. Angulo, D.V.M., Ph.D., David L. Swerdlow, M.D., Robert V. Tauxe, M.D., M.P.H., Patricia M. Griffin, M.D., and Ian T. Williams, Ph.D. for the Salmonella Saintpaul Outbreak Investigation Team,

Screen shot 2011-02-23 at 3.09.56 PM.pngand, the New England Journal of Medicine, we have some answers:

The results of multiple investigations (in 2008) indicated that jalapeño peppers were the major vehicle for transmission, and serrano peppers were also a vehicle. These findings include epidemiologic associations between illness and consumption of hot peppers, the convergence of tracebacks to a single farm in Mexico that grew both types of peppers but not tomatoes, and isolation of the outbreak strain from agricultural water and serrano peppers collected on that farm.

Recall, however, that early in the outbreak, raw tomatoes were thought to be a vehicle because there was a strong association between illness and consumption of raw tomatoes. Tomatoes had been implicated in many Salmonella outbreaks. The initial finding that tomatoes were a source was supported by the observation that the number of new cases decreased shortly after the national tomato alert. The observed epidemiologic association with tomatoes may reflect collinearity between tomatoes and hot peppers, meaning that an association was identified because tomatoes were often eaten with hot peppers. It could also reflect amplified growth of salmonella in food items, such as salsa, containing both tomatoes and contaminated hot peppers. The decline in cases shortly after the nationwide tomato advisory could be explained if avoidance of raw tomatoes indirectly reduced exposure to contaminated hot peppers. The low frequency of reported hot-pepper consumption in the Texas survey could be due to unrecognized exposure to hot peppers as ingredients in other foods.

Bottom line, if you want to stop outbreaks earlier (less people sick – and less lawsuits) and get the right product identified as the culprit, put money into public health – PERIOD. Read the full article at (10.1056/NEJMoa1005741) was published on February 23, 2011, at NEJM.org.