FSnet Aug. 1/08

BARFBLOG: Raw milk sickens infant; lawsuit filed

MISSOURI: E. coli lawsuit filed after infant gets sick

TEXAS: Officials investigating possible "Crypto" death

TEXAS: Crypto may be linked to child's death

Government of CANADA response to the outbreak of Salmonella Saintpaul in the United States

MEXICO criticizes U.S. salmonella findings

WASHINGTON: Salmonella probe likened to 'Keystone Kops'

COLORADO: Salmonella Saintpaul lawsuit filed against Wal-Mart

OREGON: Norovirus outbreak responsible for P.F. Chang's closure: More than 40 cases confirmed so far

TEXAS prison quarantined, hundreds sick with Norovirus: Hundreds ill Wynne Unit

CANADA: Health department closes Vineland Chinese restaurant

MINNESOTA: State models cited as ways to improve outbreak responses

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BARFBLOG: Raw milk sickens infant; lawsuit filed
31.jul.08
barfblog
Doug Powell
http://barfblog.foodsafety.ksu.edu/2008/08/articles/raw-milk/raw-milk-sickens-infant-lawsuit-filed/index.html
It's always the kids.
As a father with four daughters and a fifth on the way, I relate to the let's not make kids sick aspect of raw milk.
Proponents of raw milk say that is just so much statistical shit, and that hardly anyone gets sick from raw milk.
Except it is entirely preventable, and well-meaning people get sucked in by nutritional gobbledygook.
Like Angela Pedersen, who says her almost one-year-old Larry contracted E. coli O157:H7 from raw milk she bought at the Herb Depot and Organic Market in Monett, Miss.
"It was a living hell. I wouldn't wish that upon anyone. I don't know how many days I would look at my son and I didn't know if he was going to take another breath."
The family's now suing that business. Pedersen says back in April she went to the store to buy almond milk. She says she was then told about the benefits of raw milk.
"We were approached and told that the goat's milk would be a better alternative. It's healthier than breast milk and it would be wonderful for him. We agreed to try it," says Pedersen.
http://ozarksfirst.com/content/fulltext/?cid=42231
http://www.foodsafety.ksu.edu/articles/384/RawMilkOutbreakTable.pdf
http://barfblog.foodsafety.ksu.edu/2007/12/articles/raw-milk/raw-milk-sickens-the-unsuspecting-again/



 
MISSOURI: E. coli lawsuit filed after infant gets sick
31.jul.08
Ozarksfirst.com
Jennifer Denman
http://ozarksfirst.com/content/fulltext/?cid=42231
The Pedersen family is suing Soni Copeland and The Herb Depot and Organic Market in Monett. The family says their son got E.coli from some raw milk bought at that market.
KOLR/KSFX sat down with Angela Pedersen to hear what she had to say about the lawsuit. Angela didn't want us to show her son, who's still recovering from a long hospital stay. She says he just went through a battle for his life.
"It was a living hell. I wouldn't wish that upon anyone," says Pedersen.
It's hard for Pedersen to look back on the last few months. She almost lost her son Larry, who was not even a year old, to E-Coli.
"I don't know how many days I would look at my son and I didn't know if he was going to take another breath," says Pedersen.
Pedersen says Larry contracted the disease from raw milk she bought at the Herb Depot and Organic Market in Monett. The family's now suing that business. Pedersen says back in April she went to the store to buy almond milk. She says she was then told about the benefits of raw milk.
"We were approached and told that the goat's milk would be a better alternative. It's healthier than breast milk and it would be wonderful for him. We agreed to try it," says Pedersen.
Just days later, Pedersen says her son got very sick.
"It began with upset stomach, diarrhea and basically key thing and what all parents need to watch out for is blood in the stool," says Pedersen.
Larry was diagnosed with E.coli and quickly developed life-threatening complications. He did recover after 30 days, but the family says having kidney damage changes you for life.
"We are just grateful we've gotten through it and that we have our son, "says Pedersen.
He's healthy now, but lawyers for the family say what the market did was illegal. According to court documents, a retail shop in Missouri isn't allowed to sell raw milk. It can be sold from a dairy farm or delivered personally by the farmer.
The lawsuit accuses the Herb Depot of selling the raw milk and encouraging the Pedersen's to buy it. It also says the milk was contaminated with E.coli at the time it was sold.
KOLR/KSFX contacted the Herb Depot and spoke with Soni Copeland. Copeland says she would like to talk about the lawsuit, but has been advised by her lawyer not to.
Angela Pedersen says she understands there are many people who believe in drinking raw milk, but says from now on, she's sticking to what she knows and remaining thankful for what she has.
"Every day, every second, every time I look at my kids I am thankful." says Pederson.
The Missouri Attorney General's Office says it's also filing suit against the company for violating the law.
Many people still drink raw milk because when produced under humane and sanitary conditions, it contains natural enzymes, antibodies, as well as vitamins A and D.


 
TEXAS: Officials investigating possible "Crypto" death
31.jul.08
cbs11tv.com
Jay Gormley
http://cbs11tv.com/health/dallas.crypto.diagnosis.2.785119.html
Dallas -- Health officials believe the death of a 6-year-old North Texas girl could be linked to cryptosporidium. The parasite is found in human and animal fecese.
The girl died Tuesday after being hospitalized Monday. Her family says she tested positive for crypto after swimming in the Greenwood Hills Community Pool. However the Dallas County Medical Examiner has yet to release the official cause of death.
Since June 2008, the Dallas County Health and Human Services confirms there have been 41 cases of crypto.
"DCHHS is actively involved in the investigation of cases of diarrahal illnesses that may be associated with spray parks in Dallas County," said Zachary Thompson, DCHHS Director.
Also on Thursday, Frisco officials said they would close city pools so workers can treat the water.
Over the next two days, the YMCA of Metropolitan Dallas will also be closing down all 30 of its pools to treat them for crypto.
In Garland, the Surf and Swim Water Park will be closed while the water is being treated. The health department says a person who swam at the park tested positive for crypto. They are also closing down pools at daycare centers.
As of Thursday, Tarrant County officials report a total of 81 crypto cases so far this year. Sixty seven of those cases came from Burger's Lake.
In Lewisville, an ultra-violet light system is being used at some water park and pools. The system kills the crypto parasite using black light.
Health officials say crypto is resistant to normal levels of chlorine. However, it is not resistant to extreme levels of chlorine achieved by hyper-chlorination or "shocking" a pool.
Tarrant County Health officials offer these guidelines to prevent infection while swimming:
* Help protect yourself, your family and others in recreational swimming areas.
* Do not swim when you are ill with diarrhea or for two weeks after your diarrhea has stopped. Cryptosporidium is chlorine resistant.
* Do not swallow the water when you swim or wade in pool/lake/river water. Avoid getting water in your mouth.
* Practice good hygiene (i.e., shower before swimming).
* Please take children on bathroom breaks or check diapers often. Waiting to hear "I need to go," may mean that it is too late.
* Please change diapers in a bathroom or a diaper-changing area and not at poolside.
* Germs can be spread to surfaces and objects in and around the pool and cause illness.
* Please wash children thoroughly (especially in the diaper region) with soap and water before swimming.



 
TEXAS: Crypto may be linked to child's death
31.jul.08
My Fox Dallas-Fort Worth
http://www.myfoxdfw.com/myfox/pages/News/Detail?contentId=7110809&version=1&locale=EN-US&layoutCode=TSTY&pageId=3.2.1
A recent outbreak of cryptosporidium may be linked to a North Texas child's death this week, according to girl's family members. 6-year-old Rosemary Stagaman of Richardson died Tuesday morning, but the medical examiner is still waiting on toxicology tests to determine the exact cause of her death.
The girl was hospitalized at Medical City in Dallas with symptoms that resembled cryptospiridosis. It's not certain where she may have picked up the water-borne parasite.
Dallas County has confirmed 41 cases of the disease, while Tarrant County says it has 67 cases.
The outbreak began at Burger's Lake in Fort Worth, a spring-fed lake that's also a popular swimming attraction. Visitors reported nausea, vomiting and diarrhea in late June and early July. The CDC confirmed the cryptosporidium organism in the water on July 24.
Since then, several swimming pools and splash parks have been linked to the parasite, including the Cleburne Splash Station, Garland's Hawaiian Falls, and spray grounds at Mildred Dunn Park and Campbell Green Park in Dallas. All of the exposed facilities closed their doors and treated the water to destroy the organisms.
The scare prompted several local cities to hyper-chlorinate their pools to ward off any problems. Frisco is one of the latest to close its pools and splash parks for treatment. The Frisco facilities are slated to re-open on August 2.
The YMCA of Metro Dallas will also close its pools through Saturday for chlorination treatment.
Parents who plan to take their children swimming are urged to call their local facilities first to make sure they're open, since so many pools are conducting treatments.


 
Government of CANADA response to the outbreak of Salmonella Saintpaul in the United States
31.jul.08
Canadian Food Inspection Agency
http://www.inspection.gc.ca/english/corpaffr/newcom/2008/20080731e.shtml
Ottawa -- In keeping with the Government's commitment to food safety, the Canadian Food Inspection Agency (CFIA) is taking precautionary actions to prevent the implicated source of the Salmonella Saintpaul outbreak in the United States (U.S.) from entering Canada. Specifically, shipments of jalapeño and Serrano peppers from Mexico are being held by the CFIA pending laboratory results. Shipments found to be contaminated will not be allowed in the marketplace. The CFIA and the Public Health Agency of Canada (PHAC) will continue to monitor the situation closely.
This action is based on the U.S. Food and Drug Administration (FDA) recent advice to Americans to avoid eating raw jalapeño and raw Serrano peppers, and any foods that contain them, if they have been grown, harvested or packed in Mexico. These peppers have been associated with the current outbreak in many states. However, commercially canned, pickled, and cooked jalapeño and Serrano peppers are not associated with the current Salmonella Saintpaul outbreak. Jalapeño and Serrano peppers grown in Canada and the U.S. have not been connected with the current Salmonella Saintpaul outbreak in the U.S.
The Centers for Disease Control and Prevention (CDC) in the U.S. has found that many, but not all of the people who have become ill during the outbreak also reported eating jalapeño or Serrano peppers. The FDA and the CDC continue to update their respective websites to provide ongoing information about their investigation. Canadians travelling to the United States should be aware of U.S. advice to consumers regarding jalapeño and Serrano peppers.
The current situation in Canada remains unchanged from previous Government of Canada advisories issued on this topic. Public health officials are reporting five cases of Salmonella Saintpaul infection in Canada with the same strain of Salmonella infection associated with the outbreak in the United States. Four of the cases involve individuals who became ill upon return from travel to the U.S., suggesting they were infected during their trip. Cross border cases are expected given the size of the outbreak in the U.S., and the fact that many Canadians travel to the U.S. Officials with PHAC will continue to work with their colleagues in Canada and the U.S. to monitor the situation and assess further cases.
More information on the CDC's investigation is available at http://www.cdc.gov/salmonella/saintpaul/.
For more information, consumers and industry can call the CFIA at 1-800-442-2342 / TTY 1-800-465-7735 (8:00 a.m. to 8:00 p.m. Eastern time, Monday to Friday). People who believe they have experienced symptoms of illness are urged to contact their health care provider.
For information on Salmonella, visit the Food Facts webpage at http://www.inspection.gc.ca/english/fssa/concen/causee.shtml.
More information on the U.S. CDC's investigation is available at http://www.cdc.gov/salmonella/saintpaul/ or on the FDA's website at http://www.fda.gov/.
For information on receiving recalls by e-mail, or for other food safety facts, visit the Canadian Food Inspection Agency website at www.inspection.gc.ca.



 
MEXICO criticizes U.S. salmonella findings
31.jul.08
USA Today/Associated Press
http://www.usatoday.com/news/health/2008-07-31-mexico-salmonella_N.htm?csp=34
Mexico City -- Mexican agriculture officials were cited as saying Thursday that U.S. colleagues hunting for the source of a salmonella outbreak are rushing to a conclusion about finding the strain at a Mexican pepper farm.
The salmonella sample that one U.S. official called "a smoking gun" was taken from a water tank that had not been used for more than two months to irrigate crops, said the director of Mexico's Farm Food Quality Service, Enrique Sanchez.
Sanchez told a news conference on Thursday that the tank held rain water and suggested that roaming cattle or other factors could have recently contaminated the tank with the same strain of salmonella that has sickened 1,300 people in the United States since June.
Sanchez said the U.S. officials "totally lacked scientific evidence" to make those statements and said they had broken a confidentiality agreement by announcing findings before their investigation is complete.
"We're eating this same produce in Mexico and we haven't had any problems," Sanchez said.
He suggested the FDA officials had confused the source of the samples because the tainted water was found on a farm in the Tamaulipas state municipality of Hidalgo — not in Nuevo Leon as the FDA reported.
Miguel Angel Toscano of Mexico's Federal Commission for Protection against Health Risks said Mexican investigators also took samples from the soil, water and vegetables the FDA had tested and found salmonella in some of the samples taken in Tamaulipas. But he said more tests need to be done to determine the strain.
Previously, the FDA had traced a contaminated jalapeno pepper to another farm in Tamaulipas. Both farms shipped through a packing facility in Nuevo Leon, raising the possibility that contamination could have occurred there.



 
WASHINGTON: Salmonella probe likened to 'Keystone Kops'
31.jul.08
Los Angeles Times
Associated Press
http://www.latimes.com/business/la-fi-salmonella1-2008aug01,0,7950584.story?track=rss
WASHINGTON -- The government bungled the salmonella outbreak probe so badly, a House committee chairman said today, that federal investigators reminded him of Keystone Kops. A colleague hoped the maligned tomato can get its good name back.
The House Energy and Commerce Committee conducted its own investigation of the Food and Drug Administration's investigation of the salmonella scare. The outbreak has sickened more than 1,300 people this summer and set off a consumer scare that cost the produce industry more than $200 million.
One agency probably zeroed in on tomatoes too early, the committee concluded, while a second failed to tap industry expertise in trying to trace the source of the contamination.
To the chairman, Rep. John Dingell, D-Mich., the case reminded him of "a Keystone Kops situation." An investigation that should have taken hours or days instead has stretched on for weeks and months, he said.
Federal investigators are now focused on hot peppers from Mexico -- jalapenos and serranos. They still suspect that tainted tomatoes were involved at first, but they may never be able to prove it.
Holding up a bright red tomato, Rep. Bart Stupak, D-Mich., declared: "We want their good name back."
Officials from the Centers for Disease Control and Prevention and the FDA, which share responsibility for handling outbreaks of foodborne illnesses, found themselves on the defensive at the hearing.
Several lawmakers said the fact that no single agency is in charge may be part of the problem. The CDC is responsible for identifying the pathogen and the type of food that has been contaminated; the FDA is supposed to trace the outbreak to its source.
The FDA's food safety chief, Dr. David Acheson, said the agency plans to convene a panel of advisers to review the salmonella investigation. A faster system for tracing suspect produce might have allowed the FDA to clear tomatoes more rapidly, he said. While many major companies can trace their suppliers within hours, most smaller growers and shippers still rely on paper records.
The system "is what it is, and it worked," Acheson said. "It was just slow."
Lonnie King, head of the CDC's center for foodborne illnesses, said that his agency's statistical analysis of detailed interviews with people who got sick found a very strong link to tomatoes.
But Rep. Diana DeGette, D-Colo., pointed out that exhaustive questionnaires used in those interviews failed to ask whether patients had eaten freshly prepared salsa, which might have put investigators on the trail of peppers earlier on.



 
COLORADO: Salmonella Saintpaul lawsuit filed against Wal-Mart
31.jul.08
Marler Blog
Salmonella Lawyer
http://www.marlerblog.com/2008/07/articles/legal-cases/salmonella-saintpaul-lawsuit-filed-against-walmart/index.html
The first lawsuit stemming from the Salmonella outbreak that has sickened 1319 people, hospitalized 255 and caused the death of 2 in 43 states, the District of Columbia and Canada was filed today in the District Court of Montezuma County, Colorado. The complaint was filed on behalf of Delores, Colorado resident Brian Grubbs against Wal-Mart and an unknown supplier, referred to as "John Doe".
The lawsuit states that the Grubbs family purchased raw jalapeno peppers from the Wal-Mart Supercenter in Cortez, Colorado in late June, and that Mr. Grubbs ate them over the next week. He fell ill on July 3, experiencing nausea, vomiting, fever, chills, and diarrhea. Over the next several days, Mr. Grubbs' condition continued to worsen; he lost a great deal of weight, was severely dehydrated, and could not walk without assistance. His wife drove him to the Northern Navajo Medical Center in Shiprock, New Mexico, where he was treated for dehydration and decreased kidney and liver functions. Samples taken at the time later revealed that he was positive for salmonella Saintpaul.
"Consumers believe that retailers like Wal-Mart know the quality and safety of products they sell," said William Marler, the Grubbs' attorney. "Retailers benefit from that trust, and must be held accountable for the products they sell."
The Grubbs family still possessed some of the peppers that Mr. Grubbs had consumed, and provided them to authorities. Tests revealed that the peppers were tainted with salmonella Saintpaul, and provided one of the first reported physical links in the three-month-long search for the source of the outbreak.
Salmonellosis illnesses from the Saintpaul strain began showing up in Texas and New Mexico in late April, and in early June the CDC linked those illnesses to raw tomatoes and issued consumer warnings. Advisories were widened to include foods commonly consumed with tomatoes, such as peppers, cilantro, and onions, then narrowed to raw jalapeno and serrano peppers. On July 30, the FDA confirmed the presence of salmonella Saintpaul at a farm in Mexico, both in irrigation water and on produce. The investigation is continuing. (A full timeline of the outbreak can be found here.)
Salmonella is a bacterium that causes one of the most common intestinal illnesses in the US: salmonellosis infection. It can be present in uncooked or undercooked meat, poultry, eggs, or unpasturized dairy products, as well as other foods contaminated during harvest, production, or packaging. Symptoms can begin 6 to 72 hours from consumption, and include diarrhea, abdominal cramps, fever, nausea, and/or vomiting. In most victims, symptoms will lessen over a period of 10 days to 2 weeks, although it may take months for body functions to return to normal. In others, the infection can lead to more severe illnesses such as typhoid fever and bacteremia. There are many strains of the bacterium; salmonella Saintpaul is a fairly common serotype, but the specific subtype, or fingerprint, associated with this outbreak is very rare.



 
OREGON: Norovirus outbreak responsible for P.F. Chang's closure: More than 40 cases confirmed so far
31.jul.08
kptv.com
http://www.kptv.com/news/17056312/detail.html#-
http://barfblog.foodsafety.ksu.edu/2008/08/articles/norovirus/norovirus-sickens-31-customers-and-10-employees-at-pf-changs-in-oregon/index.html
Tigard, Oregon -- Washington County health officials said an outbreak of norovirus was responsible for dozens of customers and employees getting sick at a local P.F. Chang's restaurant.
The health department started getting calls July 24 from people who dined at the P.F. Chang's Chinese Bistro in Bridgeport Village.
The P.F. Chang's was still closed Thursday because of the illnesses.
After health department workers did some testing inside, they found out it was an outbreak of norovirus.
They've confirmed 41 cases so far – 31 customers and 10 employees -- but officials said they've been getting calls all day and that number could go up.
Norovirus is a highly contagious virus that quickly spreads on surfaces and between people.
Customers were confused at first as to where they had picked up the illness.
Craig and Nicole Baumer remember the wide array of dishes they tried with their friends on Saturday at P.F. Chang's. They felt fine until 24 hours later.
"Sunday night, I woke up in the middle of the night and just felt horrible," Craig Baumer said.
The Baumers thought it was a bug they picked up abroad.



 
TEXAS prison quarantined, hundreds sick with Norovirus: Hundreds ill Wynne Unit
31.jul.08
khou.com
Michelle Homer
http://www.khou.com/news/local/crime/stories/khou080731_mh_prison_virus.763bea.html
Huntsville, TX -- A Texas prison unit in Huntsville is on medical quarantine because of a widespread virus.
Hundreds of prisoners and several staff members at the Wynne Unit have been diagnosed with Norovirus.
"Some 440 offenders and 28 staff members have been affected by a confirmed Norovirus," said TDCJ spokesperson Michelle Lyons in a written statement.
Lyons said all weekend visitations have been cancelled at the main unit.
State and regional health authorities ordered the cancellations, according to Lyons.



 
CANADA: Health department closes Vineland Chinese restaurant
31.jul.08
St. Catherines Standard
Monique Beech
http://www.stcatharinesstandard.ca/ArticleDisplay.aspx?e=1138855
A Vineland, Onatrio, Chinese restaurant has been closed following a suspected food contamination outbreak that made at least 19 people ill.
China Express was closed last Friday by Niagara public health officials after a number of health violations were found at the takeout restaurant at 4630 Victoria Ave., near South Service Road.
China Express remained closed Thursday for "unsanitary conditions and improper food handling," read a notice posted at the restaurant. Public health inspectors continued to investigate the eatery, which recently changed ownership.
Nineteen people, believed to have eaten at the restaurant on or around July 24, fell ill with typical food poisoning symptoms, such as diarrhea, nausea and vomiting.
What exactly caused the outbreak is still being investigated, said Bjorn Christensen, director of environmental health with the Region's public health unit.
Officials have taken samples from the restaurant to a lab to try to isolate the organism that caused the illness, he said. The results are not yet available.



 
MINNESOTA: State models cited as ways to improve outbreak responses
31.jul.08
CIDRAP
Robert Roos
http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/jul3108outbreaks.html
Experts and industry leaders speaking at congressional hearings this week on the nationwide Salmonella outbreak said federal agencies should take cues from state programs if they want to improve the traceability of fresh produce and the success of foodborne disease outbreak investigations.
At a House subcommittee hearing yesterday, a Minnesota expert said investigations of multistate foodborne disease outbreaks are hindered by a lack of standardized techniques and approaches from state to state. The expert, Michael T. Osterholm, PhD, MPH, proposed that other states adopt a set of best practices like those used by the Minnesota Department of Health (MDH), which played a major role in linking the Salmonella cases to jalapeno peppers early in July.
Osterholm, who is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, also proposed the establishment of regional surveillance teams or a national surveillance team patterned after teams used by the MDH.
At a separate House subcommittee hearing today, tomato industry leaders from California and Florida said that programs in those states make it possible to quickly trace fresh tomatoes back from the retail level through the distribution chain to the grower.
The Food and Drug Administration (FDA) had a difficult time tracing the sources of tomatoes, which were the prime suspect in the huge outbreak for several weeks, until suspicion fell on jalapeno and Serrano peppers in early July. The FDA maintains that the main problem was that many businesses which handle tomatoes use paper instead of electronic records. In the early weeks of the outbreak, the agency published an often-revised list of growing areas that were considered safe, while warning consumers to avoid certain types of raw tomatoes from other areas.
The Salmonella outbreak included 1,319 cases in 43 states, Washington, DC, and Canada as of yesterday. The FDA began issuing advisories about raw jalapeno and Serrano peppers on Jul 9, and the warning about tomatoes, which was based on statistical associations in the absence of any findings of tomatoes contaminated with the outbreak strain, was canceled on Jul 17.
The FDA announced Jul 21 that a jalapeno pepper contaminated with the outbreak strain had been found at a tomato distributor in McAllen, Tex. Then on Jul 28, Colorado officials reported finding a jalapeno tainted with the outbreak strain in the home of a person who had the illness. Yesterday the FDA said that jalapeno was traced to a farm in Mexico and contaminated irrigation water and a tainted Serrano pepper had been found at another Mexican farm.
Lack of standardization
In written testimony presented to the House Agriculture Subcommittee on Horticulture and Organic Agriculture yesterday, Osterholm said epidemiologic investigations are carried out by many different jurisdictions, with no general agreement on best practices. His statement was co-written by Craig Hedberg, PhD, a foodborne disease expert with the University of Minnesota School of Public Health, and John Besser, PhD, clinical laboratory manager at the MDH.
"There are great differences in the ability of states to collect and analyze the basic information needed to resolve outbreaks, which places intrinsic limitations on the ability of CDC [Centers for Disease Control and Prevention] to investigate multistate outbreaks," Osterholm stated. "This in turn limits the ability of FDA or USDA [US Department of Agriculture] to pinpoint the sources of contamination and to break the chain of transmission."
Contributing to the lack of standardization is the fact that foodborne disease investigations are handled at different levels in different states, Osterholm reported. He said a survey reported last year showed that gastrointestinal disease surveillance was conducted by local agencies in about half of the states, was centralized in a state office in about a quarter of the states, and was handled by regional state offices in another 20%.
He explained that the role of CDC in multistate foodborne outbreak responses is to aggregate surveillance data on a national level and provide consultation and coordination; the agency does not have the authority to independently investigate an outbreak in a state, though it can respond to a state request.
In many foodborne disease outbreaks, the food vehicle is never found, Osterholm said. The prime reason many outbreak investigations fail is the long time lag between when people get sick and when the outbreak is recognized, he said. It can take 3 to 4 weeks for investigators to learn from DNA fingerprinting that they have a cluster of cases caused by the same strain of pathogen. When patients are interviewed, they have to try to recall what and where they ate as long as 5 to 6 weeks earlier.
Adding to the difficulty, Osterholm wrote, is that many public health agencies do not use a standardized questionnaire or collect detailed source information about food items when they interview case-patients. "Systematically collecting detailed exposure information during early interviews with cases is a critical need to improve the effectiveness of our surveillance and outbreak investigation efforts," he said.
Osterholm said a group called CIFOR—the Council to Improve Foodborne Outbreak Response—has developed guidelines that could help to standardize the response to outbreaks. The practices, many of which have been used successfully in Minnesota, include interviewing all patients when their cases are first reported, using a standardized form to collect detailed exposure information when recall is the greatest, and then to interview patients again after possible new sources are suggested during the investigation. "We believe these should be adopted as best practices, and that where resources limit the adoption of these practices, we must find a way to build the infrastructure of our public health system to make it possible," he stated.
A further key to successful outbreak investigation in Minnesota, Osterholm said, has been the use of a group of eight to ten public health students, known as Team Diarrhea, to interview patients. Since interviewing patients quickly is crucial, "we believe a series of regional Team Ds or a national Team D would go a long way to providing precisely the real-time support for outbreak investigations at the state and local levels that is so sorely needed," he said.
Osterholm's testimony dovetailed with comments at today's hearing by Kirk Smith, head of the MDH's foodborne disease unit. He summarized how the MDH investigated a cluster of Salmonella Saintpaul cases that surfaced in Minnesota in late June, leading to the identification of jalapeno peppers as the food vehicle.
The first S Saintpaul isolates were identified on Jun 23, and by Jun 30 several patients reported they had eaten at the same restaurant. On Jul 3 the MDH investigators were able to tell the CDC that the restaurant investigation pointed to jalapenos. In addition, the Minnesota Department of Agriculture was able to trace the jalapenos to a farm in Mexico.
One reason for the successful investigation was that foodborne disease probes in Minnesota are centralized at the state level, Smith said. That makes it possible to confirm and type Salmonella isolates, usually within 2 to 3 days, and to interview patients quickly, he explained.
Does Bioterrorism Act need updating?
Today's hearing, held by the House Energy and Commerce Subcommittee on Oversight and Investigations, focused on lessons learned from the Salmonella outbreak and response.
In an opening statement, Rep. Bart Stupak, D-Mich., the subcommittee chair, said the group would consider whether the Bioterrorism Act of 2002, which was designed in part to improve the traceability of food products, needs to be amended for that purpose.
The panel heard from tomato industry and state officials that Florida and California have programs that require traceability for tomatoes and work well.
Ed Beckman, president of California Tomato Farmers, based in Fresno, said his group recently conducted a trace-back demonstration for staff members of the subcommittee. He said it took only 35 minutes to trace a box of tomatoes to the grower.
"What we did was link the 'one step up and one step back' requirements of this (Bioterrorism) act at each level of the supply chain," he said.
Concerning FDA claims that it was difficult to trace tomatoes, Beckman said, "We can't help but ask specifically, where was the problem?"
The reply from David Acheson, MD, the FDA's associate commissioner for foods, was that many of the businesses that handle tomatoes had only paper records, which took time to sift through.
Acheson was asked whether the Bioterrorism Act "worked" in the case of this outbreak. "The Bioterrorism Act worked as written," he replied. "We rarely ran into a situation where people were not keeping records. It was many of the small producers, the small restaurants . . . they do not have electronic records; the vast majority of information we got was paper."
Parker Boothe, president of a tomato company in Manteca, California, and other industry representatives asserted that the FDA should set national safety and traceability requirements for tomatoes. He called the cost of the traceability system minimal, saying, "Any size firm, large or small, can do this."
Acheson told the panel that the FDA, in proposing its Food Protection Plan last fall, asked for 10 specific legislative authorities. Of those, "probably the one that's most important is the one that requires preventive controls [in food production and processing]. That's absolutely critical across the board," he said.
 


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Fsnet is supported at the Silver-plate Fork level by: The National Restaurant Association, Unilever, Sholl Group/Green Giant Fresh, Feedlot Health Management Services, McDonald's, and Syngenta Crop Protection Canada.


The Food Safety Network presents a unique opportunity to bring together all those associated with agriculture and food, to enhance the safety of the food supply. To provide financial support to the Food Safety Network, please visit http://www.foodsafety.ksu.edu/en/donations.php. For information on collaboration or fee-for-service opportunities, please contact Dr. Doug Powell: dpowell@ksu.edu

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For more information about the FSnet research program, please contact:
Dr. Douglas Powell
associate professor
dept. diagnostic medicine/pathobiology
Kansas State University
Manhattan, KS
66506
cell: 785-317-0560
fax: 785-532-4039
dpowell@ksu.edu
http://www.foodsafety.ksu.edu




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