9/27
2004

ISSUE:
134

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California farmers stay step ahead of proposed FDA salmonella egg rule
September 24, 2004
Knight-Ridder Tribune
Reed Fujii, The Record, Stockton, Calif.
A proposed U.S. regulation to reduce consumers' exposure to salmonella-contaminated chicken eggs could, according to this story, cost U.S. producers $82 million, but it should have little effect in California, where most farmers already follow such practices.
The story says that the new rule, if implemented, would improve standards for chicks and young hens put to use as egg layers, impose new biosecurity measures, improve controls on pests that might carry salmonella, require cleaning and disinfection of farms where salmonella is detected, set standards for refrigeration of eggs, impose testing for the unwanted bacteria and require egg farms to appoint someone to oversee salmonella-control programs.
But farm officials in California were cited as saying that producers are already following a similar set of practices, the state Egg Quality Assurance Plan.
Debbie Murdock, manager of the California Egg Industry Association, was quoted as saying that, "Actually, we're pretty much doing everything they are asking us to do."
She withheld full judgment of the proposed FDA rules, however, noting that industry experts were still digesting all the details.

Allergen Labeling Not As Simple As It Seems - Begin Changes Now

Source of Article: http://www.prweb.com/

Food Consulting Company is advising food companies to prepare now to meet the January 1, 2006, mandatory compliance date for federally mandated allergen labeling. President Bush signed the Food Allergen and Consumer Protection Act of 2004, into law on August 2, 2004. This act amends the Federal Food Drug and Cosmetic Act and requires food manufacturers to identify, in plain, common language, the presence of any of the eight major food allergens (milk, egg, fish, Crustacean shellfish, tree nuts, wheat, peanuts, and soybeans) that are or might be present in any ingredient contained in a food product.

Del Mar, CA (PRWEB) September 22, 2004 -- Food Consulting Company is advising food companies to prepare now to meet the January 1, 2006, mandatory compliance date for federally mandated allergen labeling. President Bush signed the Food Allergen and Consumer Protection Act of 2004, into law on August 2, 2004. This act amends the Federal Food Drug and Cosmetic Act and requires food manufacturers to identify, in plain, common language, the presence of any of the eight major food allergens (milk, egg, fish, Crustacean shellfish, tree nuts, wheat, peanuts, and soybeans) that are or might be present in any ingredient contained in a food product.

Many food labels already bear voluntary allergen declarations according to Karen Duester, president of Food Consulting Company, but the information may not satisfy the new law. "For example," said Duester, "the 'plain, common language' requirement means that an ingredient such as sodium caseinate will have to be declared in the ingredient list as being derived from milk." Right now manufacturers often use chemical names to declare certain ingredients like sodium caseinate without declaring in 'plain, common language' their associations with a major allergen.

The law also requires that labels must declare if flavorings, colorings, and other additives are derived from or have been in contact with a major allergen at any time during the manufacturing process. Duester explained that existing ingredient labeling regulations have not called for this and so manufacturers do not routinely declare the incidental additives found in these ingredients even if they have been associated with a major allergen. "Now manufacturers will need to research ingredients to determine or rule out exposure to allergens."

"The distant compliance date might imply plenty of time," according to Duester, "but really it is just 15 months away." Savvy manufacturers have to allow time for research and they will want to have revised label content ready to be incorporated into new label plates and print runs when current label inventories expire, or when labels are updated to reflect formulation changes or label design changes -- all in order to gain economic savings.

The bill has other requirements including facility inspections and the publication of a final rule to define and permit use of the term gluten-free on food labels. Manufacturers can read the bill by searching Bill Number "S.741.ENR" at http://thomas.loc.gov . Concerned parties can keep up-to-date on the allergen regulation progress and other government changes affecting food labels by subscribing to INTOUCH, a free email newsletter available at http://www.foodlabels.com/newsletter.htm .

Food Consulting Company, based in Del Mar, CA, and the largest out-source provider assisting food companies in meeting FDA label requirements, offers a full range of food labeling services including product analysis (both database and laboratory), nutrition facts panels, ingredient statements, allergen information, full label compliance packages, shelf life evaluations, and final label reviews. Duester can be reached through the company web site at http://www.foodlabels.com, or by calling 800-793-2844.

Food safety training for Food Service to take place September 29

Source of Article: http://www.dodgeglobe.com/
A 3-hour food safety short course for food service employees and volunteer groups will be held on Wednesday afternoon, Sept. 29, from 1:30 to 4:30 p.m. at the Ford County Extension Office in Dodge City. This class will cover the basics of safe food handling, including an introduction to food safety, proper temperatures, personal hygiene and cleaning and sanitizing. Materials will come from the ServSafe program, and KDHE. All participants will leave with a proof of attendance certificate.

This course is intended for all types of food service personnel, both commercial and non-commercial. This includes: Educators/Students, Health care, Hotel/motel Food Service, Long Term Care, Restaurant/Supermarket Deli, School Food Service or anyone desiring food safety training.

This course is being conducted by K-State Research and Extension faculty and is sponsored by K-State Research and Extension.

Cost is $5.00 per person for class materials and refreshments. For a registration form please call the Extension Office. Pre-registrations are due today to the Ford County Extension Office.

School support necessary to protect children with life-threatening allergies, says Anaphylaxis Canada: Ontario government considering anaphylaxis legislation for schools
September 22, 2004
From a press release
Ottawa - A national organization for people with life-threatening allergies is calling on the Ontario government to pass legislation that will require schools to have consistent policies to help care for children with this dangerous condition. Ontario is the first province to be considering such legislation.
The request from Anaphylaxis Canada is tied to the first anniversary of the death of Sabrina Shannon, 13, who died from an anaphylactic reaction at her Pembroke, Ontario high school. She suffered from life-threatening allergies to peanuts, milk, and soy. On the day she died, Sabrina had eaten French fries in the cafeteria, which investigators believe may have been accidentally contaminated by one of the dangerous foods. Sabrina had been taught to carry life-saving medication (commonly known as an EpiPen(R)), but did not have it with her that day in the cafeteria. Reactions can progress rapidly; that's why people with severe allergies are advised to keep their EpiPens(R) close by.
"Should children and teenagers carry EpiPens(R) with them at all times?
Absolutely," says Laurie Harada, executive director of Anaphylaxis Canada. "But unfortunately, many of them don't, because they don't want to be seen as different."
Keeping children and teenagers with life-threatening allergies safe should be the joint responsibility of the child, his or her family, and the school, says Harada.
"Families can't do this alone. Life-threatening allergies are unforgiving there is no room for error. And kids are going to make mistakes."
Schools need policies
Many schools have allergy management policies in place that include identifying the children to staff and ensuring regular staff training in EpiPen(R) use. Sabrina's school had a policy, but staff have since added spot checks of children with life-threatening allergies to make sure they are carrying their EpiPens(R).
"Whether or not a school has a good policy often depends on the level of the principal's commitment and whether the parents are good communicators. Sometimes information given to the school is inaccurate or out-of-date," says Harada. "As a result, protection for these children is inconsistent - great in some schools, and sub-standard in others. We need consistent allergy management policies, approved by medical advisers, that can be used by all schools."
Legislation slated for Ontario
The Ontario government has been considering draft legislation entitled Bill 3 that would require schools to make anaphylaxis management policies a priority. Under the current draft of the Bill, schools would be required to establish emergency plans for students at risk, arrange annual training for staff, and provide information on anaphylaxis to the school community. Legislation to protect children with life-threatening allergies was part of the Ontario Liberals' campaign platform. Bill 3, An Act to Protect Anaphylactic Students, has already passed through the second reading in the House, which means that it has been approved in principle and is now being reviewed by Ontario government ministries (such as Health and Education) with a stake in the legislation.
Bill 3 is a private member's bill spearheaded by Liberal MPP Dave Levac, a former school principal. His experiences with anaphylaxis in the school system prompted the bill.
"The Ontario legislature will be reconvening shortly, and we urge the government to make Bill 3 a priority," says Harada. "No one needs to die from anaphylaxis, and this legislation can make a difference." Bill 3 would be the first legislation of its kind in Canada. Harada hopes that it will give the other provinces incentive to pass similar legislation.
For further information: Laurie Harada, Executive Director, Anaphylaxis
Canada, Cell: (647) 225-7984

Sweden beats salmonella
Source of Article: http://www.meatprocess.com/
21/09/2004 - The country with the lowest occurrence of salmonella in the world said this week it has aroused ¡®great interest¡¯ in the US for its methods to control this harmful pathogen.
The Salmonella bacteria is a major problem in most countries across the globe and can be carried in eggs, poultry and other meats, raw milk and chocolate.
The Swedish way to fight salmonella in poultry was recently introduced at an American food safety conference, arranged by International Association for Food Protection. Representatives from the US Department of Agriculture have been in Sweden to study the methods in detail.

"Sweden has practically managed to eliminate salmonella from its chicken breeding. Now, we want to find out how we in the US can use parts of the Swedish method to prevent salmonella" said Stan Bailey at USDA, reports the ¨ªresund Food Network.

In North America today, salmonella can be found in 10- 35 per cent of the chickens. So far, efforts to fight salmonella have been concentrated on latter parts of the production chain, using heating and radiation, continues the report.

The Swedish method attempts to make ¡®a polluted product clean¡¯, the control points are moved backwards in the production chain, including the egg production site, as well as strong focus on hygiene related matters.

The global incidence of foodborne disease such as salmonella is difficult to estimate, but it has been reported that in 2000 alone 2.1 million people died from diarrhoeal diseases, or which a great proportion were linked to food contamination and drinking water.

In industrializsed countries, the percentage of people suffering from foodborne diseases each year has been reported to be up to 30 per cent and in the US, for example, around 76 million cases of foodborne diseases, resulting in 325,000 hospitalisations and 5,000 deaths, are estimated to occur each year.

While most foodborne diseases are sporadic and often not reported, foodborne disease outbreaks may take on massive proportions. In 1994, an outbreak of salmonellosis due to contaminated ice cream occurred in the USA, affecting an estimated 224,000 persons.

Drinking-water disinfectant produces toxic compound
September 21, 2004
Reuters
Amy Norton
NEW YORK- Michael J. Plewa, a genetic toxicologist at the University of Illinois at Urbana-Champaign and colleagues were cited as reporting in the current issue of the journal Environmental Science & Technology that a chlorine alternative used in the U.S. to disinfect some public drinking water can produce a class of byproducts far more toxic than those generated by chlorine.
The story says that the byproducts, a family of chemicals called iodoacids, have been discovered only in chloramine-treated drinking water in Corpus Christi, Texas. Chloramines are a combination of chlorine and ammonia used in some municipal water supplies as an alternative to chlorine.
The story explains that research over the past 30 years has shown that when chlorine interacts with natural organic matter in drinking water, the process can generate byproducts that are linked to an increased risk of certain cancers and birth and developmental defects.
Some of these byproducts are regulated by the Environmental Protection Agency (EPA), and the agency is now finalizing a new rule that will toughen the standards for chlorine byproducts with known health effects -- a move expected to cause at least some water treatment facilities to switch to chlorine alternatives.
But, the story says, the new findings highlight how little is known about the potential health effects of these chlorine alternatives.
Plewa was cited as saying in an interview that no one should "panic" over the water situation in Corpus Christi, adding "If I were in Corpus Christi. I'd still drink from a water fountain."
Water disinfection, the researcher pointed out, must be done to prevent outbreaks of infectious disease. What scientists must continue to do, he said, is to study the biological effects of known disinfection byproducts, and keep identifying and analyzing new byproducts.
According to Plewa, researchers have chemically defined only about half of the disinfection byproducts that can occur in chlorinated drinking water, and much less is known about the byproducts of chlorine alternatives. Overall, he estimated, experts have a handle on the biological effects of only about 30 percent of all identified byproducts.
Plewa was further cited as saying that to create sound policy, regulators should have the best scientific evidence on the range of disinfection byproducts -- a "rank ordering" that defines those byproducts with the lowest potential for harming human health.
In their study, Plewa and his colleagues found that in hamster cells, the one iodoacid they tested was anywhere from twice as toxic to nearly 300 times more toxic than chlorine byproducts.
SOURCE: Environmental Science & Technology, September 15, 2004.

RETAIL FOOD SAFETY

Source of Article: http://www.meatnews.com/

Employees at retail stores and foodservice establishments contribute to foodborne illness outbreaks a study finds.
In 1998, the U.S. Food and Drug Administration's National Retail Food Team initiated a study to identify and measure the occurrence of food preparation practices and employee behaviors most commonly reported to the Centers for Disease Control and Prevention contributing factors in foodborne illness outbreaks.The study called for conducting data collection inspections of various types of foodservice and retail food establishments at five-year intervals to observe and document the occurrence of obtaining food from unsafe sources, improper storage, inadequate cooking, poor personal hygiene, and contaminate equipment. FDA designated these contributing factors as ¡°foodborne illness risk factors.¡± The National Retail Food Team issued its first report in 2000 based on data collected in 1998. The 2004 report is the second report in the series and presents data collected in 2003. A third data collection is scheduled for 2008.

The 2000 report called attention to the need for greater active managerial control of foodborne illness risk factors. It suggested that more innovative and effective strategies to improve food safety practices in retail and foodservice establishments were needed. The report highlighted operational areas most in need of improvement including employee handwashing, cold-holding of potentially hazardous foods, date marking of ready-to-eat foods, and cleaning and sanitizing of food contact surfaces.

In 2003, FDA¡¯s regional retail food specialists collected data during site-visits of more than 900 establishments representing nine distinct facility types. Direct observations, supplemented with information gained from discussions with management and food workers, were used to document the establishments' compliance status for 42 individual data items based on provisions in the 1997 FDA Food Code. In each establishment, the compliance status for each data item was recorded in terms of in-compliance, out-of-compliance, not observed (meaning the behavior or practice was not observed during the visit), or not applicable (meaning the behavior or practice did not apply to the establishment).

In the 2004 report, the high incidence of out-of-compliance for improper holding/time and temperature risk factor was most commonly associated with improper cold-holding of potentially hazardous food and inadequate date marking of refrigerated ready-to- eat PHF.

Within the poor personal hygiene risk factor, the proper, adequate hand-washing data item had the highest percent out-of-compliance value for every facility type. Percent out-of-compliance values for proper, adequate hand-washing ranged from approximately 34 percent for hospital foodservice to approximately 73 percent for full service restaurants.

Of the data items related to the contaminated equipment/protection from contamination risk factor, improper cleaning and sanitizing of food contact surfaces before use was the item most commonly observed to be out-of-compliance in each facility type. Percent Out of Compliance values for this data item ranged from 25 percent in elementary schools to 58 percent in delicatessen departments.

This report also includes a comparison between the data collected from food establishments that had a Certified Food Protection Manager (CFPM) from a program recognized by the Conference for Food Protection and those that did not. The data suggests that the presence of a certified manager has a positive effect on the control of certain risk factors, especially in fast food restaurants, full service restaurants, meat and poultry departments, and produce departments. Poor personal hygiene appears to be the risk factor for which the presence of a certified manager had the most positive effect.

The 2003 data collection effort included several supplemental data items that were not included in the 1998 data collection. While the 42 primary data items in the study remained the same from 1998 to 2003, the supplemental data items addressed changes made to the FDA Food Code since 1998. These items related to the cooking temperature for pork, minimum hot holding temperatures, employee health, juice, eggs, and highly susceptible populations.

Data gathered for the supplemental data items suggest that reducing the minimum hot holding temperature for potentially hazardous foods from 140 degrees F (60 degrees C) to 135 degrees F (57 degrees C) and reducing the minimum cooking temperature for pork from 155 degrees F (68 degrees C) to 145 degrees F (63 degrees C) had minimal effect on the industry's control of these risk factors.

Results from the 2003 data collection indicate that the recommendations made to foodservice and retail food operators and regulators in the 2000 report need to be reemphasized. Foodservice and retail food operators must ensure that their management systems are designed to achieve active managerial control over the risk factors. Likewise, regulators must ensure that their inspection, education, and enforcement efforts are geared toward the control of the risk factors commonly found to be out of compliance.
Web posted: September 16, 2004

Managing Customer Complaints in the Laboratory

A new version of software for handling customer complaints (CCMS) has been launched by Autoscribe. Designed to track and trace the status of a complaint from notification through to resolution the software also assists in identifying spurious claims from serial complainers. It has the potential to cut fraud, identify acts of extortion and deliberate product contamination, and to highlight production faults that are leading to repeated complaints.

The system deals with every aspect of complaint management. For example, it can be linked to word processing packages to facilitate the production of standard acknowledgement letters, and to other packages, such as image capturing software, which will allow a photograph of the faulty product to be linked to the relevant complaint. Where complaints might lead to court action, the system assists in maintaining the full traceability of evidence, a factor which may prove vital in establishing and fighting a defence.

The CCMS can also allocate a laboratory testing regime to the sample or product that has resulted in a complaint where relevant. The testing regime can be assigned automatically or on an ad hoc basis. Test results are easily compared against expected values and product specifications. Once completed, the test findings can be easily incorporated into reports for the customer and the complainer.

Statistical analysis can also be applied to the results of several tests to identify trends in complaints, or steps that may need to be taken to prevent the recurrence of a specific problem.
Request more information about this news item
Source: Autoscribe Ltd.
Posted: September 10, 2004

MTI spears US food testing market

Source of Article: http://www.foodproductiondaily.com/news/news-NG.asp?n=54705-mti-spears-us

14/09/2004 - UK analytical instrument firm Monitoring Technologies International builds a stronger platform in the US food testing market, signing a distribution agreement with Strategic Diagnostics.


SDI will market and sell MTI's PDV-6000 heavy metal analyser and reagents, designed to rapidly detect multiple metal contaminants on-site in food matrices.

The UK has developed a system for the rapid detection of multiple heavy metals, including arsenic, lead, chromium VI, and mercury, all at ¡®very low detection levels¡¯.

¡°The combinations of MTI technology for metal detection and SDI assays for chemical contamination, gives the customer a high power tool box," said John Morris, president of MTI.

Rarely do contamination problems involve only one metal. The MTI system allows our customers to rapidly perform multiple metals analysis, added Matthew Knight, Strategic Diagnostics' president.

White House Creates Working Group on Disease-Causing Prions

Detection of Salmonella in Environmental Samples from Poultry Houses

Food poisoning a major threat
September 16, 2004
The Calgary Herald
A14
Canadian Press
Stephanie Gravelle of Brandon, Man., was cited as telling the annual conference of the Canadian Institute of Public Health Inspectors that food poisoning is at the top of their priority list, adding, "There is still a lot of food poisoning that occurs every year. ¡¦ You know, you need a licence to drive a car and you'd think you'd need some basic training to work in the food industry."

Traceability boost: Australia¡¯s livestock identity plan¡¯s management is strengthened with ISO certification
September 15, 2004
MeatNews.com
An important milestone in strengthening the integrity of the National Livestock Identity System database in Australia has been reached this month with the department developing and managing the database to obtain International Standards Organization 9000:2001 certification. NLIS manager Mick Prendergast said that gaining ISO accreditation would provide further assurances about the integrity of the NLIS database.
¡°The ISO quality management system is world's best practice. Being ISO certified means that our NLIS database team operates using systems and processes that are comparable with the best in the world,¡± Prendergast said. ¡°More importantly it means NLIS participants can be confident that MLA is managing the database in accordance with a world recognized quality management system.¡±
The ISO certification process required MLA's NLIS database team to understand the quality management system requirements, evaluate its activities against these requirements and make changes accordingly. An independent auditor then evaluated the systems and process against the international standard to see if the team complied.
"During the lead-up to the final audit we had to assess the way we conducted our business against the international standard and make improvements to the way we manage the NLIS database," Prendergast said. ¡°The benefits of operating under a quality management system are quite clear - we've made improvements in the way we listen to customers and their requirements, and we've made changes to the NLIS database that will deliver a better service to users. ISO certification will enable MLA to continue to deliver a robust and secure NLIS database that meets the needs of industry and state governments as NLIS is rolled out.¡±

Chain of command in food recall process often has weak links
September 14, 2004
Knight-Ridder Tribune
Cheryl Welch, Star-News, Wilmington, N.C.
Zocia Barr, a Porters Neck-area grandmother, was cited as walking to her white side-by-side refrigerator, taking out a frozen chicken pot pie and reading the numbers on its side, adding, "Boy, I'll tell you what . . . it was like reading the numbers on a lottery ticket," as she described how she matched the numbers from a news article about recalled pot pies to the numbers on her pot pie box
Barr was cited as calling the grocery store from which she purchased the frozen item to find out what she should do with it, assuming the grocery store was on top of the recall and probably knew about it well before she read it in her Sunday newspaper.
However, the story says, when she called that morning in late July, she talked to store employees who didn't know about the recall and found that some of the chicken pot pies -- reported by the manufacturer to possibly have small pieces of plastic and glass in them -- were still on the store's shelves.
The story says that consumers often assume the items they grab off grocery store shelves are safe or they wouldn't be there. But with more than 350 documented food recalls each year in the United States, should they?
A report to Congress in 2000 by the United States General Accounting Office, was cited as saying there's too little governmental regulation over the recall process, and that for the most part, manufacturers themselves carry out food recalls while the Food and Drug Administration or the U.S. Department of Agriculture monitor the process and handle publicity. Typically a recall starts when a manufacturer realizes something was wrong in the production of a certain batch of food or the batch of food is linked to an illness or injury by a third-party investigation.
The story explains that if it's a meat or poultry product, the USAD is notified. If it's any other food product, the FDA is notified. These agencies give direction to the manufacturer and issue press releases that are passed along to the news media, food associations and affected wholesalers. Then it's up to the manufacturer to contact, by phone or e-mail, wholesalers, distributors, warehouses and individual grocery stores that were sent the recalled food. These agencies then confirm they disposed of the items.
Jake Chevalier, store manager of the Food Lion at 3600 S. College Road, was cited as saying his store usually learns of a food recall from the corporate office and is given a deadline -- usually just a few hours -- by which employees must take the product off the shelves, adding, "It's a major priority when we have a recall. It's a stop now, as soon as you get out of the chair kind of deal."

Computer to aid in hunt for root of student illness Wilkes group on a field trip came down with nausea, vomiting

By Monte Mitchell
JOURNAL REPORTER
Source of Article: http://www.journalnow.com/
WILKESBORO

Health investigators are building a database with more than 20,000 variables for a computer-assisted search to figure out the cause of severe nausea and vomiting that sent dozens of Wilkes County students and adult chaperones to hospitals during a Sept. 9 field trip.Of more than 100 who felt sick enough to go to the hospital, 92 required treatment. Some received anti-nausea medications and IVs. None were admitted.

The incident started when some students from North Wilkes Middle School started vomiting in the parking lot of a restaurant where they had just eaten. The Wilkes County Health Department said that the symptoms appeared to resemble stomach flu.But even that is puzzling to investigators, because experts say that the typical food-borne illness that causes those kinds of symptoms may take days or weeks to develop. It's rare for symptoms to come on as early as 30 minutes after eating.The school group stopped to eat at Kabuki Japanese Steak House. That day, county health inspectors visited the restaurant and found no evidence that the problem started at the restaurant, which carries an A rating of 96.5 percent.Laboratory tests of food at the restaurant and the school cafeteria were negative for elevated levels of bacteria. Blood tests showed nothing unusual.Now, the county health department is finishing up health surveys of 205 Wilkes students on the trip, said Shirin Scotten, the department's public-health epidemiologist.

Each student will be asked 100 "yes" or "no" questions such as "Did you eat chicken?" or "Did you ride this bus?"The data will be entered into a computer program from the federal Centers for Disease Control and Prevention."It could be one of those things that we never find the answer to," Scotten said."That's frustrating. You feel like if you could just ask the right question, it would be right there."The computer will help narrow the possibilities in an attempt to find common factors among those who got ill. That could lead to more laboratory testing of samples being kept by the state health lab.Both the county health department and the state health department's general communicable-disease branch will run the health profile data through the computer program.The process has taken a little longer than expected, in part out of consideration for the students. Compilation of data was put off while the group was so sick.

Last week, health officials worked with the schools to make sure that there were no lingering illnesses.This week, health officials met with school officials to finish up the health surveys and add any further details.The onset of the illness was sudden, with extended bouts of vomiting or retching that left some students so weak that they could hardly walk.There were about 300 students on the trip, including 100 or so from Alleghany County. The students had attended morning musical performances at the Walker Center of Wilkes Community College, and were to attend another that afternoon.At lunch, the students were split into two groups. The Alleghany students ate at the restaurant first, while the other group toured the community college.

A handful of the students in the first group got sick, but most of the sick students were in the second group that ate at the restaurant.Health officials emphasized yesterday that they don't know that the restaurant had anything to do with the illness. Still, it is part of the investigation scenario, as are other sites that the students may have in common.Health officials say they will let parents and others know the results as soon as possible."All we can do is ask for patience and continue to work hard," Scotten said.
"We're working really hard on it."

Outbreak of Cyclosporiasis Associated with Snow Peas, Pennsylvania, 2004
18 Sep 2004

Source of Article:
http://www.medicalnewstoday.com/

During June and July 2004, public health officials in Pennsylvania were notified of cases of the parasitic disease cyclosporiasis (1,2) among persons associated with a residential facility (e.g., residents, staff, and volunteers). CDC confirmed the diagnosis of Cyclospora cayetanensis infection (1) by examining stool specimens from multiple patients.

By early July, local public health officials had been notified of approximately 50 potential cases of cyclosporiasis associated with the facility; onsets of illness were from early June through early July.

This report describes the findings of the epidemiologic and traceback investigations, which determined the cases were linked to consumption of raw Guatemalan snow peas at five special events, for which food was prepared by the facility staff, from late May through late June.

This is the first documented outbreak of cyclosporiasis linked to snow peas. The Food and Drug Administration (FDA) and CDC are working with Guatemalan officials to determine the sources of the snow peas and possible modes of contamination.

A case of cyclosporiasis was defined as onset of illness 1--14 days after consumption of food or beverages served at one or more of the five special events. Persons with laboratory-confirmed cases had infection confirmed by CDC by examining stool specimens for Cyclospora (1), and at least one gastrointestinal (GI) symptom (i.e., diarrhea [loose or watery stool], nausea, vomiting, abdominal cramps, loss of appetite, or unintentional weight loss) or constitutional symptom (i.e., fever, chills, muscle aches, joint aches, generalized body aches, headache, or fatigue). Persons with probable (clinically defined) cases of infection either had 1) three or more loose or watery stools during a 24-hour period and at least one other symptom or 2) five or more symptoms, including at least three GI symptoms.

Of the 349 persons associated with the facility who were in the population potentially at risk for infection, 315 (90%) persons were interviewed to ascertain exposure (e.g., event attendance) and illness status; 215 (68%) of the 315 interviewed had attended at least one event. Of the 215 persons, 96 (45%) had illness that was consistent with one of the case definitions; 40 cases were laboratory confirmed, and 56 were probable. All of the cases were associated with special events (i.e., none were attributable to other meals at the facility, which were prepared by the same staff and in the same kitchen), and each of the five events was associated with laboratory-confirmed cases. Therefore, the investigation focused on identifying an item served at all five events, but not at other meals.

Only pasta salad met these criteria. In addition, pasta salad was the only food item statistically significantly associated with illness in retrospective cohort studies, which were conducted among persons who attended the two most recent events (events D and E) ; data for 77 attendees were included in analyses. The summary relative risk for these two events (i.e., for the association between pasta salad and illness) was 32 (95% confidence interval: 5--219; p<0.001). Specifically, 90% (38 of 42) of the persons who ate the salad had cases of cyclosporiasis, compared with 3% (one of 35) of the persons who did not eat the salad. The median incubation periods for illness associated with events D and E were 8 days (range: 1--13 days) and 7 days (range: 1--10 days), respectively.

The pasta salad included multiple types of raw produce, none of which were implicated in investigations of previous outbreaks of cyclosporiasis (1). Of the produce used in the salad, only snow peas met all of the following criteria: 1) were included in all three batches of the salad served at the five events, 2) were from the same "lot" (i.e., from one container, purchased on 1 day, and from one supplier), and 3) were not served at other meals except the five events. Event A on May 31 was the first occasion in 2004 at which pasta salad or snow peas were served by the facility.

All of the snow peas used by the facility came from the same 4.5-kg container, which was purchased on May 21 and refrigerated thereafter. On June 22, after the last (third) batch of salad was prepared, the residual snow peas were discarded; none were available for testing for Cyclospora oocysts or DNA when the investigation was initiated. In an investigation conducted by FDA, the snow peas were traced to an exporter in Guatemala.

The snow peas were handled only on days when batches of salad were prepared. For each batch, a handful of peas (approximately 1 kg) was removed from the container, washed in municipal water, and added to the salad. None of the food handlers who prepared or served the salad had symptoms consistent with cyclosporiasis before the onset of the outbreak or on the days the first two batches were prepared or served. One person who helped prepare the third batch had a probable case of cyclosporiasis after eating salad from the first two batches.

Reported by: A Crist, PhD, York Hospital, York; C Morningstar, R Chambers, T Fitzgerald, D Stoops, M Deffley, Y Reyes, T Hiden, J Sullivan, D Hawk, MD, York City Health Bur; P Lurie, MD, M Moll, MD, Div Infectious Disease Epidemiology; S Yeager, L Lind, MPH, J Burkee, K Warren, MPH, M Marcus, J Reeser, H Davidson, S Thomas, Bur of Community Health Systems, Pennsylvania Dept of Health. Food and Drug Administration, College Park and Rockville, Maryland. BL Herwaldt, MD, M Hlavsa, MPH, SP Johnston, MS, H Bishop, A daSilva, PhD, A Hightower, MS, Div Parasitic Diseases, National Center for Infectious Diseases; DK El Reda, DrPH, N Flowers, MD, EIS officers, CDC.

Editorial Note:

The findings of this investigation indicate that raw Guatemalan snow peas were linked to this outbreak of cyclosporiasis in Pennsylvania. No evidence of ongoing transmission has been obtained, despite heightened surveillance for cases of cyclosporiasis. This is the first investigation in which snow peas have been implicated as the vehicle of an outbreak of cyclosporiasis. Several other types of fresh produce (e.g., raspberries, basil, and mesclun lettuce), from various countries, have previously been implicated as vehicles of U.S. cyclosporiasis outbreaks (1).

FDA and CDC are working with Guatemalan officials to determine the sources of the snow peas (e.g., farms or cooperatives) and possible modes of contamination. The modes of contamination of implicated vehicles have not been definitively determined for any previous foodborne outbreak of cyclosporiasis (1); better understanding of the biology and epidemiology of the parasite is needed. For imported vehicles of infection, international collaboration is critical to the success of investigations and to the identification of appropriate prevention and control measures. Produce should be thoroughly washed before it is eaten. This practice might decrease but not eliminate the risk for transmission of Cyclospora (1,3).

Health-care providers should consider the diagnosis of Cyclospora infection in persons with prolonged or remitting-relapsing diarrheal illness and specifically request testing of stool specimens for this parasite (1); such testing is not routinely conducted by most laboratories. Trimethoprim/sulfamethoxazole (TMP/SMX) has been shown in a placebo-controlled trial to be effective treatment for Cyclospora infection (4). Adults should receive TMP 160 mg plus SMX 800 mg (one double-strength tablet) orally, twice a day for 7 days. Some patients might benefit from longer courses of therapy. Alternative treatments for persons allergic to sulfa drugs have not yet been identified (1).

Newly identified clusters of cases of cyclosporiasis should be investigated to identify the vehicles of infection and their sources and modes of contamination. Although cases of cyclosporiasis are not yet reportable in all U.S. states and territories, such cases are nationally notifiable. Clinicians and laboratorians who identify cases of cyclosporiasis, especially ones unrelated to foreign travel, are encouraged to inform the appropriate local public health officials, who are encouraged to contact CDC's Division of Parasitic Diseases, National Center for Infectious Diseases. To report cases and potential outbreaks, contact CDC, telephone 770-488-7319; for questions about laboratory diagnosis of infection, 770-488-4474; for clinical questions, 770-488-7775. Additional information about cyclosporiasis is available at http://www.cdc.gov/

Acknowledgments

This report is based in part on contributions by W Ness, MBA, D German, S Leyland, community partners, Pennsylvania. R Klein, PhD, Medical Entomology Research and Training Unit/Guatemala City, Guatemala; C Bern, MD, M Bartlett, Div Parasitic Diseases, National Center for Infectious Diseases, CDC.

References

1 Herwaldt BL. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 2000;31:1040--57.

2 Ortega YR, Sterling CR, Gilman RH, Cama VA, Diaz F. Cyclospora species---a new protozoan pathogen of humans. N Engl J Med 1993;328:1308--12.

3 Ortega YR, Roxas CR, Gilman RH, et al. Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru. Am J Trop Med Hyg 1997;57:683--6.

4 Hoge CW, Shlim DR, Ghimire M, et al. Placebo-controlled trial of cotrimoxazole for Cyclospora infections among travellers and foreign residents in Nepal. Lancet 1995;345:691--3.

Rapid test 'may change the face of medicine'
(Filed: 20/09/2004)
Source of Article: http://health.telegraph.co.uk/
The first DNA-based test that can diagnose a range of diseases within 30 minutes is to go on trial in British hospitals.

The test could change the face of general practice and veterinary medicine. Rapid diagnosis could help GPs to prescribe antibiotics only when necessary by revealing if a sore throat is caused by a virus or bacterium, and cut the inappropriate use of antibiotics, which drives the rise of superbugs.

The DNA test can quickly pin down the cause of food poisoning, help farmers detect foot and mouth, and show if a woman is a carrier of the bacterium that causes chlamydia, a "silent disease" that can cause fertility problems.The portable mini-lab is a spin-off from biological warfare research and works by hunting for the DNA of target organisms, said Dr David Squirrell, one of the developers at the Defence Science and Technology Laboratory, Dstl, Porton Down.The team bases the test on the PCR (polymerase chain reaction) process, which amplifies target DNA, a method that won Dr Kary Mullis the Nobel prize.

Yesterday, speaking at a conference in Bournemouth, Dr Mullis said tests based on the method had huge potential because "you need to know what a disease is before you can do anything about it".At first, Porton Down wanted to find a way to use PCR for fast battlefield detectors of biological warfare agents such as anthrax but its wider potential was realised and Dstl has launched a joint venture with industry, called Enigma Diagnostics.

The tests will offer GPs and vets much faster results than currently possible and they could eventually cost less than ?0 each.The team plans to provide two rapid, automated PCR machines for various uses.

The first trials, at hospitals in Portsmouth and Liverpool, will be in using urine samples to diagnose infections, notably chlamydia, within 40 minutes.At present chlamydia testing requires samples to be sent away for analysis and it can take up to two weeks to get the results back.

Trials of the "while you wait" test, backed by the Department of Health and called NPTGold, will be used in genito-urinary clinics by the end of the year.There will also be quick-testing at GP surgeries and clinics to give correct and effective prescription of medicines.The test will be used to detect genetic modifications in food and spot contamination by organisms such as salmonella, listeria and E.coli.

There will also be in-the-field testing for animal diseases, including foot and mouth or tuberculosis in cattle within 30 minutes, rather than having to send samples to a lab.Tim Rubidge, Dstl head of technology transfer and investments group, said the idea of a tabletop DNA test laboratory was no longer a "a twinkle in the eye of a research scientist looking far out into the future"."We have a portfolio of more than 20 strong patents, field-tested instruments and continuing research projects supporting the MoD and Department of Health," he said. "It is fair to say that we have taken PCR out of the research lab and into the field where it is most needed."

The heart of the device relies on polymerase chain reaction, which heats and cools samples using an enzyme from a heat-tolerant bacterium to generate billions of copies of segments of DNA from a sample.It is normally a laboratory-based technique. The Porton team uses custom-built test tubes made from a novel, electrically-conducting polymer to heat and cool samples. This not only speeds up the process, but also creates a lighter, more portable instrument.

New Oxoid Medium Enhances MRSA Screening

Oxoid Limited has launched a new broth medium for the quick and easy screening of clinical samples for the presence of MRSA. Available in a convenient, ready-to-use format, Oxoid Selective Mannitol Broth (as originally described by Gurran et al. Ref 1) saves time and resources by enabling the laboratory to screening out negative samples.Samples from patients and hospital staff are simply inoculated into vials containing 5 ml Selective Mannitol Broth (order code: EB1016C) and incubated overnight. Selective agents within the medium are designed to inhibit the growth of other organisms, whilst permitting the MRSA to grow. MRSA are able to ferment the mannitol in the broth. This acidifies the medium, causing the colour to change from red to yellow, giving a presumptive positive reaction. All the negative broths can be discarded, while confirmatory tests are performed on isolates from the positive broths only.

Multiple samples from an individual can be pooled (depending on knowledge of their previous MRSA status), reducing the number of tests required, and the ability to screen out negative cultures reduces the number of confirmation tests required.

A recent review of MRSA isolation policies concluded that it should be possible to eradicate an endemic MRSA problem with an effective isolation policy (Ref 2), over time. In addition, such a policy could result in cost savings by reducing length of stay in the hospital. New Oxoid Selective Mannitol Broth contributes to an effective isolation policy by providing a fast and efficient method for the screening of clinical samples for MRSA.

References:
1. Gurran, C., Holliday, M.G., Perry, J.D., Ford, M., Morgan, J. and Orr,
K.E. (2002) J Hosp Infect 52: 148-151, A Novel Selective Medium for the Detection of Methicillin-Resistant Staphylococcus aureus Enabling Results Reporting in Under 24hrs.
2. Cooper, B.S. et al. (2003) Health Technology Assessment 7 No. 39; O Queen's Printer and Controller of HMSO 2003, Systematic Review of Isolation Policy of Methicillin-Resistant Staphylococcus aureus; a Review of the Literature with Epidemiological and Economical Modelling.
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Source: Oxoid Ltd.
Posted: September 15, 2004