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4th International Conference for Food Safety and Quality
(November 3-4)
Key speakers

ISO22000:2005 Training Course
(November 5-6, 2009)

FDA leader discusses improvement plans
Source of Article:

By Walter C. Jones | Morris News Service

Wednesday, August 05, 2009
ATLANTA --- More money, staff and regulatory authority will help the U.S. Food and Drug Administration streamline approval of new drugs and safeguard against food-borne diseases, FDA Commissioner Margaret Hamburg said Tuesday.
Ms. Hamburg met with reporters after touring the agency's regional office, where she described morale as high. Faces particularly brightened, according to her deputy Dr. Joshua Sharfstein, when she announced her decisions would be based on science.
Critics have charged that the Bush administration included political considerations in its decisions rather than strictly following the advice of scientists. Ms. Hamburg, without mentioning her predecessors, said things would be done differently.
For instance, she said the agency would require more of food processors to conduct the tests and guarantee the quality of their ingredients -- even imported ones. She said legislation that passed the House last week would give the agency authority to order recalls of tainted products and increase the frequency of inspections of food processors to prevent a repeat of the Sylvester, Ga., peanut-butter plant whose salmonella contamination led to eight deaths and made 575 people ill.
In the area of approvals for new drugs and medical devices, she is looking at employing new tests early in the process and more sophisticated data analysis that could avoid some of the lengthy and expensive drug trials that contribute to medical inflation.
"We are now starting to understand that there are certain markers that you can use to move the process more quickly, both on the (laboratory) side and on the clinical trials side," she said.
The vaccine for swine flu could be the first notable example. She is considering allowing an additive used in other countries to stretch the vaccine so more people could benefit from the limited quantity that can be produced by flu season.

FDA promises faster, aggressive food safety enforcement
Source of Article:

Published on 08/06/2009 11:38am By Bob Luder

(UPDATED 4:15 p.m. Aug. 6) The Food and Drug Administration will enforce food safety standards faster, crack down on violators and work with state and local health departments when investigating foodborne illness outbreaks.
FDA commissioner Margaret Hamburg announced the agency¡¯s new emphasis on swift, aggressive and effective enforcement of laws and regulations on Aug. 6.
Hamburg said in a news release that some enforcement actions in the past had been ¡°hampered by unreasonable delays¡± and had taken too long to be addressed.
¡°The FDA must be vigilant, the FDA must be strategic, the FDA must be quick, and the FDA must be visible,¡± Hamburg told a group of industry representatives, attorneys, consumers and others attending a speech sponsored by the Food and Drug Law Institute in Washington D.C. ¡°We must get the word out that the FDA is on the job.¡±
Hamburg said procedures for enforcement actions by the agency ¡°can be too long and arduous when the public¡¯s health is in jeopardy.¡±
Hamburg highlighted six steps the agency is taking immediately to improve the effectiveness and timeliness of the enforcement system:
Set shorter deadlines, generally giving no more than 15 days for offenders to respond to inspection findings;
Take steps to speed the warning letter process;
Work closer with other agencies ? for instance, state, local and international officials, who can act more quickly than FDA when public health is at risk;

Prioritize follow-up on enforcement actions;
Be prepared to take immediate action in response to public health risks; and
Implement a formal warning letter close-out process, providing motivation for corrective action by issuing a notice on the FDA¡¯s Web site when such actions are completed.
Hamburg said these steps would ensure that ¡°inspection results are taken seriously, that warning letters and enforcement actions occur in a timely manner and that steps are taken to protect consumers in cases where immediate enforcement action is not possible.¡±
Tom Stenzel, president and chief executive officer of the United Fresh Produce Association, said it is important that state and local governments play key roles in food safety issues, as long as its coordinated under the FDA¡¯s authority.
¡°I think it¡¯s good,¡± Stenzel said. ¡°For too long, the FDA has been complaining people aren¡¯t doing the right things, but take no action. The flipside is, don¡¯t get it wrong if you¡¯re the FDA.
¡°We support strong action as long as they have the right player.¡±

Increased Short and Long-Term Risk of Inflammatory Bowel Disease After Salmonella or Campylobacter Gastroenteritis
Source of Article:
Posted on August 6, 2009 by Bill Marler
Kim O. Gradel, Hans L. Nielsen, Henrik C. Sch©ªnheyder, Tove Ejlertsen, Brian Kristensen, Henrik Nielsen, Received 12 December 2008; accepted 2 April 2009. published online 09 April 2009. Gastroenterology August 2009 (Vol. 137, Issue 2, Pages 415-418)
Various commensal enteric and potentially pathogenic bacteria may be involved in the pathogenesis of inflammatory bowel diseases (IBD). We compared the risk of IBD between a cohort of patients with documented Salmonella or Campylobacter gastroenteritis and an age- and gender-matched control group from the same population in Denmark.
We identified 13,324 patients with Salmonella/Campylobacter gastroenteritis from laboratory registries in North Jutland and Aarhus counties, Denmark, from 1991 through 2003, and 26,648 unexposed controls from the same counties. Of these, 176 exposed patients with IBD before the infection, their 352 unexposed controls, and 80 unexposed individuals with IBD before the Salmonella/Campylobacter infection were excluded. The final study cohort of 13,148 exposed and 26,216 unexposed individuals were followed for up to 15 years (mean, 7.5 years).
A first-time diagnosis of IBD was reported in 107 exposed (1.2%) and 73 unexposed individuals (0.5%). By age, gender, and comorbidity adjusted Cox proportional hazards regression analysis, the hazard ratio (95% confidence interval) for IBD was 2.9 (2.2?3.9) for the whole period and 1.9 (1.4?2.6) if the first year after the Salmonella/Campylobacter infection was excluded. The increased risk in exposed subjects was observed throughout the 15-year observation period. The increased risk was similar for Salmonella (n = 6463) and Campylobacter (n = 6685) and for a first-time diagnosis of Crohn's disease (n = 47) and ulcerative colitis (n = 133).
In our population-based cohort study with complete follow-up, an increased risk of IBD was demonstrated in individuals notified in laboratory registries with an episode of Salmonella/Campylobacter gastroenteritis.

The Dairy Industries Dirty Little Antibiotic Salmonella Newport Secret
Source of Article:
So, the dairy industry pumps the cows full of antibiotics and then when done with them sends them to slaughter to be fed to us.
Use of antibiotic susceptibility patterns and pulsed-field gel electrophoresis to compare historic and contemporary isolates of multi-drug-resistant Salmonella enterica subsp. enterica serovar Newport, Appl Environ Microbiol. 2004 Jan;70(1):318-23, Berge AC, Adaska JM, Sischo WM, Veterinary Medicine Teaching and Research Center, University of California-Davis, Tulare, California 93274, USA.
Recently, multi-drug-resistant (MDR) Salmonella enterica subspecies enterica serovar Newport reemerged as a public and animal health problem. The antibiotic resistance of 198 isolates and the pulsed-field gel electrophoresis patterns (PFGE) of 139 isolates were determined. Serovar Newport isolates collected between 1988 and 2001 were included in the study. One hundred seventy-eight isolates were collected from the San Joaquin valley in California and came from dairy cattle clinical samples, human clinical samples, bulk tank milk samples, fecal samples from preweaned calves, and waterways. Twenty clinical isolates from humans from various regions of the United States were also included in the study. Resistance to 18 antibiotics was determined using a disk diffusion assay. PFGE patterns were determined using a single enzyme (XbaI). The PFGE and antibiogram patterns were described using cluster analysis. Although the antibiotic resistance patterns of historic (1988 to 1995) and contemporary (1999 to 2001) isolates were similar, the contemporary isolates differed from the historic isolates by being resistant to cephalosporins and florfenicol and in their general sensitivity to kanamycin and neomycin. With few exceptions, the contemporary isolates clustered together and were clearly separated from the historic isolates. One PFGE-antibiogram cluster combination was predominant for the recent isolates, which were taken from human samples from all parts of the United States, as well as in the isolates from California, indicating a rapid dissemination of this phenotypic strain. The data are consistent with the hypothesis that the reemergence of MDR serovar Newport is not simply an acquisition of further antibiotic resistance genes by the historic isolates but reflects a different genetic lineage.
Chloramphenicol-resistant Salmonella newport traced through hamburger to dairy farms. A major persisting source of human salmonellosis in California, New England Journal of Medicine, Volume 316:565-570, March 5, 1987, Number 10, JS Spika, SH Waterman, GW Hoo, ME St Louis, RE Pacer, SM James, ML Bissett, LW Mayer, JY Chiu, B Hall, and et al.
Animal-to-human transmission of drug-resistant salmonella and the role of antimicrobial use in food animals in the emergence of these bacteria are controversial subjects. Investigation of a 4.9-fold increase in Salmonella newport isolations from Californians in 1985 showed that 87 percent of the isolates had an unusual antimicrobial-resistance pattern (including chloramphenicol resistance) and a single, identical plasmid. Interviews of 45 patients and 89 matched controls in Los Angeles County showed that illness was associated with penicillin or tetracycline use during the month before onset (P less than 0.001) and with eating ground beef during the week before onset (P = 0.052). The epidemic strain was isolated from hamburger products eaten by cases, abattoirs where the animals from which the meat came were slaughtered, dairies that sent cows for slaughter on days when culture-positive products were processed, and ill dairy cows. Isolation of salmonella from beef carcasses in abattoirs correlated with the proportion of dead or moribund animals received for slaughter (r = 0.60, P less than 0.05). Isolation of chloramphenicol-resistant salmonella from dairy farms was associated with the use of chloramphenicol at those dairies. We conclude that food animals are a major source of antimicrobial-resistant salmonella infections in humans and that these infections are associated with antimicrobial use on farms.
Multi-Drug-Resistant Salmonella Newport in Northern California, CHEUNG M, MOHLE-BOETANI J, ABBOTT S, WERNER S, VUGIA D; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.), Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. LB-15, California Department of Health Services, Berkeley, CA.
BACKGROUND: In late 2001, the California (CAL) Department of Health Services Microbial Diseases Laboratory noted an increase in Salmonella Newport (SN) isolates. Screening for chloramphenicol (C) resistance (R) revealed a large number with probable multi-drug resistance (pMDR), as CR has been used as a proxy for MDR [ampicillin (A), (C), streptomycin (S), sulfisoxazole (Su), tetracycline (T)].
METHODS: To determine possible risk factors for pMDR-SN infection, we conducted a case-control study of 27 patients from Northern (N) CAL with pMDR-SN from specimens collected in January 2002 and 27 age- and ethnicity-matched controls. We calculated matched odds ratios (mOR) for food exposures. We also tested isolates for R to A, C, S, Su, T, sulfamethoxazole/trimethoprim (SXT), ceftriaxone (CTX), and ciprofloxacin (CIP) and compared isolates by pulsed field gel electrophoresis (PFGE).
RESULTS: 95% of pMDR-SN patients were Hispanic and 61% were children; 37% were hospitalized. Consumption of Mexican-style (MS) cream (mOR 8.0, p=0.05) and MS cheese or cream (mOR 5.0, p=0.04) were significantly associated with illness. Purchasing cheese (mOR 10.0, p=0.02) or cream (mOR 5.0, p=0.04) at a Mexican market was also associated with illness. 100% of isolates had R to C, S, Su, and T. In addition, 85% had R to A, 74% to SXT, 85% to CTX, but 0% to CIP. Twenty of 27 isolates had an identical PFGE pattern; all 20 had R to ACSSuT plus CTX and SXT. Random screening of SN isolates from 2001 revealed 85% of NCAL isolates to be pMDR-SN.
CONCLUSIONS: MDR-SN infections have increased in NCAL, disproportionately affecting Hispanics and children and resulting in substantial hospitalization. Most isolates are resistant to antibiotics previously used to treat serious Salmonella infections. We identified an epidemiological association between MS dairy products and MDR-SN infection. Despite warnings to the public about unpasteurized dairy products, cases of MDR-SN infection continue to occur and addressing this public health problem is challenging.
Posted on August 6, 2009 by Salmonella Lawyer

Hamburg details FDA food safety crackdown measures
Source of Article:
By Caroline Scott-Thomas, 07-Aug-2009
FDA chief Margaret Hamburg outlined new measures on Thursday to act ¡°swiftly and aggressively¡± to crack down on firms that violate safety regulations.
The speech, given to an audience of food and drug lawyers, was the first time Hamburg has spoken publicly on the enforcement of food safety since her confirmation as Food and Drug Administration (FDA) Commissioner on
May 18. She used it to highlight her commitment to restoring the image of the agency, which has seen its reputation suffer as a wave of foodborne illnesses has struck the nation in recent years.
She said that the FDA will work more quickly to warn companies about safety violations, and in cases where there is perceived to be a serious risk to public health, the FDA would consider ¡°immediate action ? even before we have issued a formal warning letter.¡±
¡°The FDA must show industry and consumers that we are on the job,¡± she said. ¡°We must publicize our enforcement actions ? and the rationale for those actions ? widely and effectively. This will increase public confidence, encourage compliance, and educate patients and consumers about potential risks.¡±
¡®Close-out¡¯ letters
Hamburg also outlined plans to develop a formal ¡®close-out¡¯ process after a firm has corrected violations detailed in a warning letter, providing it with a ¡®close-out¡¯ letter to show that the agency¡¯s concerns have been successfully addressed. Issuance of ¡®close-out¡¯ letters will be indicated on the FDA¡¯s website.
¡°For ongoing violations, it could play an important motivating role in spurring corrective action,¡± Hamburg said.
¡°¡¦Our expectation is that companies will work to quickly and thoroughly to correct deficiencies and ensure safety. Companies must have a realistic expectation that if they are crossing the line, they will be caught, and if they fail to act, we will.¡±
Response timeframe
Under the Bush Administration, all warning letters were referred to the FDA¡¯s Chief Counsel for review ? a process that the agency now intends to limit to ¡°significant legal issues¡± in order to speed the procedure.
Hamburg told reporters after her speech: ¡°My own naivete might help move the ball forward a bit because some of these timeframes just don¡¯t seem acceptable to me.¡±
Under the new policy, if a company is found to be ¡°significantly out of compliance¡±, it will have fifteen working days to respond before the FDA issues a warning letter or takes enforcement action.
She also emphasized the agency¡¯s commitment to developing closer ties with local, state and international officials who may be able to act more quickly than the FDA in response to a public health risk. Although this is already the intention on a state and local level in terms of food safety, Hamburg mentioned that she met with European officials early in her tenure to discuss how safety standards could become more harmonized worldwide to reflect the globalized nature of the industry.

Beware of Washing Away the Pathogens and Sending Them to the Food
Source of Article:

Newswise ? When it¡¯s time to wash down the facilities in food processing plants to clear out any pathogenic bacteria, industry needs to watch for one unintended consequence. Washing the floor drains could actually make it easier for any Listeria monocytogenes to travel from the drain to points on the processing line.
Food Safety Consortium researchers at Kansas State University already knew that the open floor drains in processing environments can harbor the bacteria, which is why those drains are the targets of high pressure washing and cleaning. They found out a new angle: that the aerosols generated by the washing can transfer the bacterial cells away from the drain as intended but onto surfaces where food is being processed a few feet above the floor.
The situation can be remedied, but workers need to be trained how to do so, said Jasdeep Saini, a KSU doctoral student in food science who researched the issue with food science professors James Marsden and Daniel Fung. The workers would then modify their cleaning procedures.
¡°If the worker who is actually doing that knows that this is the point from where the translocation of bacteria is actually occurring and is told to be careful, some change in that respect can be made,¡± Saini said.
The research team ran tests to find out the potential for translocating L. monocytogenes from drains to food contact surfaces. The researchers placed stainless steel markers at heights of 1, 3 and 5 feet above the drain level. They checked the markers after using a high-pressure hose to wash the drain and took samples after eight hours and again after 48 hours.
The numbers for both the eight-hour and 48-hour tests showed that bacterial cells from the drain were found at all three height levels, the highest number at the 1-foot level closest to the drain. More bacterial cells were present on the contact surfaces after 48 hours than after eight hours, likely because of the longer time available for the cells to proliferate and form a biofilm ? thin, resistant layers of microorganisms ? as protection against
nvironmental stress.
¡°Listeria has been known to form bioflilms,¡± Saini said. ¡°Biofilms develop between 36 and 48 hours. If there are biofilms existing in the drain, how those are actually translocated can cause contamination on the line.¡±

Meat processor linked to salmonella recall warned over animal handling practices
Source of Article:
By Staff reporter, 12-Aug-2009
A US meat processor at the centre of last week's huge recall of beef linked to antibiotic-resistant salmonella was rebuked over animal handling practices last year, it has emerged.
California-based Beef Packers Inc¡¯s voluntary recall of 826,000 pounds (375,000 kg) of ground beef on 5 August has been linked to 28 salmonella-related incidences across nine states.
Electric prods
Yesterday, newly released records show the company was also slapped with an animal handling citation last year after US Department of Agriculture (USDA) inspectors found workers at the Fresno plant were using electric prods to cajole cattle through a narrow chute prior to slaughter. The visit, carried out in March 2008, followed in the wake of the biggest beef recall in US history that was linked to a separate Californian slaughter facility.
The company, a subsidiary of Cargill, was admonished after three cows were stunned when they refused to move ¡°so that they could be pulled through the restrainer to be shackled, hung and bled," said the USDA report.
Under USDA regulations, use of a cattle prod is considered humane when used properly on walking animals. It is understood that dragging unconscious cattle could increase the risk of animals contracting salmonella and E.coli as cow hides can pick up bacteria from feces than can collect around the chute.
Letter of concern
Cargill Meat Solutions said, however, the presence of the inspectors had caused the animals to balk. The company lodged an appeal on the alleged violation and the USDA withdrew the citation. Beef Packers was instead sent a letter of concern from the agency.
Kansas State University's Beef Cattle Institute professor Dan Thomson priased Cargill's safety record and rejected claims that problems with humane handling were connected to contamination at the Fresno plant last week. He said it wasn¡¯t clear that the cows had been dragged long distances across dirty floors and that they may have been moved only a few feet.
¡°A lot of animal hides get contaminated on farms, or in transport to the abattoir," he added.
So far, neither the USDA nor Cargill has issued details over the situation surrounding the recall last week.

Modern Food Production Provides the Perfect Mechanism for Mass Foodborne Illness Outbreaks
Source of Article:

Posted on August 13, 2009 by Colin Caywood
The health staff writers over at the LA Times have written a great article, Eating With the Enemy, on the growing prevalence of widespread foodborne illnesses stemming from products as seemingly disparate as ground beef, romaine lettuce, cilantro, Anaheim peppers, granola nut clusters, alfalfa sprouts and of course, peanuts. The article serves as a preface to a fantastic and informative in-depth piece, The Science of Salmonella, covering many details of the ubiquitous Salmonella bacteria. This is the same bacteria responsible for the laundry list of food items just mentioned, and includes the current antibiotic-resistant Salmonella Newport outbreak associated with Fresno, California¡¯s Beef Packers, Inc (aka Cargill). ground beef products.

As the writers aptly point out, ¡°Food-borne illnesses have always been with us, but outbreaks of food poisoning are no longer confined to a select few who ate improperly cooked antelope or who chose unwisely at the company picnic. The sheer complexity of modern food production gives the bacteria responsible for food-borne illnesses almost infinitely greater range.¡± This point was well illustrated just this past winter when Salmonella contaminated peanuts manufactured by the now-defunct Peanut Corporation of America managed to sicken over 700 people (although the actual number is probably closer to 25,000), and resulted in the recall of over 4,000 products at a economic cost estimated to be hovering somewhere around $1.5 billion. And it all resulted from a 90 person company accounting for only 2.5% of the US's entire annual peanut crop.
To that end, the federal government has finally taken some forward steps beginning with the House¡¯s recent passage of HR 2749, a bill that would, among other things, overhaul US food safety laws by increasing the Food and Drug Administration's authority to inspect food manufacturers and requiring it to craft a better way of tracing food-borne illnesses and giving it greater recall powers. For a more in-depth analysis of this dense piece of legislation, check out Marler Blog here. Farmers and food processors would be required to do their part as well under the new laws. The Senate is expected to consider a similar measure after its August recess.

Antibiotic Resistant Salmonella and the Meat You Eat
Source of Article:
Posted on August 14, 2009 by Drew Falkenstein
The presence of antibiotic resistant Salmonella at the slaughterhouse may be one thing, but its presence in retail meat (i.e. its final stop before consumption) is yet another. So how much retail meat (ground turkey, chicken, beef, and pork) is actually contaminated at the point of purchase? And with what?
An article in the New England Journal of Medicine reported on a study that answers these specific questions. And the results of the study provide only more grist for the mill regarding the current debate over the non-adulterant status of antibiotic resistant Salmonella and other pathogens. Click on image below to view entire article.
The scientists who performed the study selected 200 samples of ground meat (ground turkey, chicken, beef, and pork) being offered for sale at three grocery stores in the greater Washington, DC area: 98 from one store, 54 from the second, and 48 from the third. Testing revealed an alarming level of contamination . . . in my opinion. Salmonella isolates were recovered from 41 of the 200 samples, with 4 samples testing postive for more than one strain of Salmonella. In total, 13 different strains accounted for the 45 Salmonella isolates. Adding to the level of concern, and hopefully the debate over the USDA/FSIS definition of "adulterant," was that 38 of 45 isolates (that's 84%) displayed resistance to at least one antibiotic, and 24 of 45 isolates (53%) displayed resistance to at least three antibiotics.
Constructive dialogue on this important issue can only help delineate the arguments, both for and against expanding the USDA/FSIS's current definition of adulterant to include more bugs that kill people. I guess you could say i'm biased because the people who have been injured or killed, or their families, are the folks we work for. But even putting that aside, doesn't it make just plain good sense that something as harmful, and apparently as prevalent, as antibiotic resistant Salmonella and other dangerous pathogens should be considered "adulterants" on the foods we consume? What are the counter arguments? I know they can't be that this is just an issue of passing concern. As one commenter on one of my recent blog posts puts it:
It is unlikely we can reverse this process or reduce their existance by not using antibiotic resistant bacterial. Once these new organism is formed they only multiply and spread. You can see what happened with HA-MRSA since 1980s.So what are the counter arguments

Salmonella in ground beef less resistant to heat than whole cuts, says study
Source of Article:
By Guy Montague-Jones, 17-Aug-2009
New research indicates that Salmonella in whole cuts of beef is more resistant to heat treatment than it is in ground beef.
Writing in the Journal of Food Science, researchers at the Institute of Food Technologists said the results of its latest study suggest the structure of beef should be taken into account when assessing resistance to Salmonella.
Ground versus whole cuts
The scientists found that there was a significant difference between ground beef and whole beef but that the degree of grinding made had no significant effect on heat resistance.
¡°Therefore, it would be prudent for Salmonella thermal inactivation models to consider whether a product is whole-muscle or ground but not necessarily the degree of grinding,¡± concluded the scientists.
To assess the relationship between the heat resistance of Salmonella and degree of grinding, four product types (whole muscle, coarsely ground, finely ground, and beef puree) were tested.
Thermal resistance of Salmonella was highest (P <0.0001) in whole-muscle (D = 2.7 min), but there were no differences among the 3 ground products (Dmean = 1.2min).
Testing the resistance levels, the scientists contaminated beef with an 8-serovar Salmonella cocktail and then packed it into 5g samples in sterile brass tubes, to be sealed, held at 60¡ÆC and removed at 30 second intervals.
All products were from the same original lot of beef, and were exposed to the same initial Salmonella counts and heat treatment. Differences in heat resistance were therefore due entirely to the degree of grinding.
Explaining the differences
The scientists put forward tentative explanations for the differences based on their own and previous research. They suggested that the water status in meat may influence the effectiveness of Salmonella inactivation and that bacteria may be suspended in the liquid component of the food.
But the authors tempered this suggestion saying they only set out to explore the relationship between physical structure and the thermal resistance of Salmonella and not to explain any links.
Source: Journal of Food Science
¡°Effect of Beef product physical structure on Salmonella thermal inactivation¡±
Authors: Maria Avelinamogollon, Bradley P. Marks, Alden M. Booren, Alicia Orta-Ramirez, and Elliot T. Ryser.

Web searches may have foreshadowed listeriosis crisis
Source of Article:
By Sharon Kirkey, Canwest News Service
Internet chatter foreshadowed the deadly outbreak of listeriosis a month before the first reports of death from the food-borne bacteria surfaced in Canada, a new analysis shows.
Who was searching for information about the disease and why, remain a mystery.
But researchers say Google searches for the term "listeriosis" demonstrated a possible signal of the outbreak linked to the death of 20 Canadians before the official announcement was made in Canada.
The public was officially told on Aug. 20, 2008 that a listeriosis outbreak had killed one person and had sickened 16 others.
But researchers from the University of Ottawa and Harvard Medical School found peak searching for the term "listeriosis" spiked beginning in mid to late July, "nearly a month before the declaration of the public outbreak," the team reports in an article released Thursday by the Canadian Medical Association Journal.
The term "listeriosis" is more technical than listeria. And peak searching for the word coincided with cases as they were occurring, as was confirmed later, and not with public announcements.
"In comparison, a massive increase in searching for the word 'Listeria' coincided perfectly with news media attention," write the authors.
Last summer's deadly outbreak was traced to ready-to-eat meats produced at a Maple Leaf Foods plant in Toronto. The company found listeria building up "deep inside" two slicing machines as the most likely source.
The Internet is "revolutionizing" how intelligence about epidemics and outbreaks is gathered, write Dr. Kumanan Wilson, of the Ottawa Health Research Institute and John Brownstein of Children's Hospital Boston. It's also making it more difficult for countries to hide or to suppress the full extent of an outbreak.
"There's all this massive amount of information that is being posted through a variety of different channels on the web ? blogs, chat rooms, news media ? sources that come outside of traditional public health," says Brownstein. The Montreal native is co-creator of HealthMap, a real-time, web-crawling system that pulls from more than 20,000 sources every hour for information on new and ongoing infectious disease outbreaks.
In November, Google launched Google Flu trends, which estimates how many people have a flu-like illness, based on the day's tally of flu-related search queries.
Health Canada's Global Public Health Intelligence Network identified the outbreak of SARS in Guangdong province in China as early as November 2002 ? more than two months before the World Health Organization published details on the cases.
"In the case of listeriosis, as soon as the outbreak was announced we saw people in Canada searching for the word "listeria'," Brownstein says. "That's not surprising. The media drives a lot of people's search habits on the web."
But searching for the more technical term "listeriosis" began about a month before the public announcement, "and peaked a couple of weeks before."
"We do know it wasn't just in one location, what we can see is that it was in a few different places in the country, so it wasn't like someone who was doing their PhD thesis alone caused the spike," says Wilson, Canada Research Chair at the University of Ottawa and Ottawa Health Research Institute.
It could have been food inspection or industry officials investigating the possibility of an outbreak. Or it could have been doctors, or relatives and friends of people infected early in the outbreak, or people concerned about the initial voluntary recalls, he said.
"The question that arises from this analysis is whether knowledge of this information, either by public health officials or members of the public, could have prompted an earlier response that may have reduced exposure to the contaminated products," write the authors.
"The problem is, this type of data can be highly noisy and set off lots of false signals," Brownstein said in an interview. "How much public health agencies can use this data still is in question. Is it really people who are getting sick? What do the data really reflect?"
Wilson says it will be up to public health and others to decide what's an acceptable false positive rate.
"If you're right even one out of 10 times, if that one time you're able to stop an outbreak that could kill a lot of people, it may be worth it."
The listeria signal "definitely would have suggested something that needed more investigation," Wilson says. "A signal like that could have prompted people to maybe look at this a little more carefully and thoroughly, and see, how much of a problem are we actually dealing with here?"

The Reality is Non-O157:H7 Shiga toxin E. coli Causes Human Illness ? So, Why Does the USDA and FSIS NOT Consider it an Adulterant?
Source of Article:
June Dunning, E. coli O146:H21, 2006, Death
Right up until the time of her death, Ms. Dunning remained an active, self-aware and outgoing woman. Her health had always been good too. For the last seven years of her life, June lived in Hagerstown, Maryland with her daughter, and her son-in-law. On August 28, 2006, June Dunning consumed some Dole baby spinach from a bag her daughter had purchased at the local grocery seven days earlier. The bag would later test positive for E. coli O146:H21.
June fell ill on September 2, 2006. Her illness quickly progressed, and she was taken to the hospital the following day. June was first seen by a triage nurse, who noted a history of a sudden onset of diarrhea the night before, which had progressed to bloody stools and severe abdominal pain in the morning. June rated her pain at ¡°9" on a 1-10 scale. Further examination and blood tests soon revealed a number of disturbing problems. A CT scan showed revealed diffuse thickening and swelling of the colon, with severe, acute inflammatory colitis of the ascending and transverse colon. June¡¯s blood pressure was elevated. Also, June¡¯s blood work demonstrated the onset of renal insufficiency. She was admitted to the hospital, and started on IV fluids.
Admission to the hospital did not slow the deterioration of June¡¯s condition. She began to lose her mental faculties. She spoke, but did not make sense. She spoke of going to see her husband, deceased since 1996. All the while, she continued to suffer from frequent, painful, bloody diarrhea. Her renal failure deepened. The doctors worried about her colitis leading to systemic toxemia, and opted for surgical removal of a portion of her colon.
June survived the surgery, but continued to deteriorate. She became anemic and was placed in ICU. She stopped producing urine, and progressed to a coma-like state. In the early morning hours of September 7, she suffered a grand mal seizure, and underwent an MRI of the brain. On September 9, she suffered another seizure, followed by a drop in her oxygen levels. She was placed on mechanical ventilation. Her medical bills while hospitalized were nearly $50,000.
From this point forward, it was plain what the outcome would be. An EEG on September 11 showed slowing of brain activity. June¡¯s daughter and son-in-law stayed with her for the final hours. Late on September 11, the ventilator and all medical support save Morphine were disconnected. The doctors said they expected June to pass within the hour. Instead, June persevered without life-support. For most of the next 36 hours or so, she appeared to be resting comfortably. In one frightening episode in the wee hours of September 12, June experienced one more seizure. She gripped her daughter¡¯s hand, eyes wide open, moaning and sighing. Thankfully, the seizure passed. June remained until just after dawn on September 13, passing away at 6.45 a.m. Click HERE to see video.
Megan Richards, E. coli O121:H19, 2006
Megan Richards, of Millville, Utah, was a young wife, mother, and educational conference coordinator in 2006, when she consumed a take-out lunch from a Wendy¡¯s restaurant in Ogden, Utah, on June 30, 2006. Her illness was later determined to be one of many illnesses in an outbreak of E. coli O121:H19 linked by public health officials to food served at Wendy¡¯s. Megan fell ill with significant diarrhea on July 3, 2006. Despite treatment by her regular physician her condition did not improve, and on July 10, she developed persistent vomiting. She was seen that day in the emergency room in Logan, Utah.
Blood tests in the emergency room indicated that Megan¡¯s kidneys were failing, and she was admitted to the hospital. Over the next day, her kidney functioned continued to slow, and then halted altogether. She was transferred to McKay-Dee hospital in Ogden, Utah, to receive more specialized care. There, the diagnosis of hemolytic uremic syndrome (HUS) was confirmed. On July 14, Megan endured a kidney biopsy. The results were frightening: ¡°¡¦necrosis of nearly the entire specimen [noted to be kidney cortex].¡± The renal cortex is where the kidney¡¯s filtering units are located and cortical necrosis indicates permanent loss of those filters?a finding typically found only in the most severe cases of HUS. The finding carried dire prognostic significance.
That same day, the nurses found Megan unresponsive and exhibiting seizure-like activity. A code was called. Dr. Pittman responded and arrived on the unit to find Megan with a heart rate of 160 per minute and tonic clonic seizures, with rigid posturing activity. Also, her oxygen saturation level was shockingly low at 71%. The physicians were able to get Megan¡¯s seizures under control, and her oxygen levels back up, but it was clear at this point that she was fighting for her life. On July 15, Megan began hemodialysis and plasmaphoresis to replace the functions her kidneys could no longer complete. Megan remained hospitalized through July 28. When she was discharged, she still had not recovered kidney function, and was started on a program of out-patient hemodialysis.
Megan returned to the hospital three days a week for hemodialysis through September 7, when she was reduced to two sessions a week. Her kidney function remained abnormally low throughout. Megan was finally freed from regular dialysis in early October. Medical bills were over $350,000. Still, the damage to her kidneys was permanent and irreversible. Her prognosis as of 2008 was reported as follows:
Based on the severity of her HUS, the evident extensive damage to her renal cortex, her markedly reduced estimated filtration rate of currently only 35 mls/min and the fact that Megan also now has evidence of significant proteinuria, it is my opinion, based on reasonable medical probability, that Megan will develop end stage renal disease (ESRD) and require renal replacement therapy in the form of chronic dialysis or kidney transplantation in the future.
It is estimated that Megan will require renal replacement therapy or transplant by age 40 to 45. These are some of the challenges that await Megan once she undergoes a kidney transplant:
Megan will need to take immunosuppressive medications for the rest of her life. Those medications are not only very costly, but they also have significant side effects including causing high blood pressure, diabetes, osteoporosis, altered appearance (such as moon faces due to steroids and hair loss or excessive hair growth with calcineurin inhibitors), memory problems, and others. Immunosuppressive medications also significantly increase the risk for life-threatening infection or cancer.
Shiloh Johnson, minor, E. coli O111, 2008
Shiloh Johnson was one of hundreds sickened in the E. coli O111 outbreak at the Country Cottage restaurant in Locust Grove, Oklahoma, in August 2008. Shiloh developed bloody diarrhea, and was hospitalized on August 24, 2008. She would not be discharged until October 3.
Once admitted, Shiloh¡¯s stool was cultured, returning positive for E. coli O111. At this time, she very quickly descended into hemolytic uremic syndrome (HUS): her kidney¡¯s failed, and her red blood cell and platelet counts plummeted. With a complete loss of kidney function, Shiloh needed dialysis to survive. She was placed on continuous renal replacement therapy.
48 hours into her dialysis treatment, though, disaster struck. Shiloh developed a significant pericardial effusion (fluid around the heart) with tamponade (the stoppage of blood flow caused by fluid). Shiloh went into cardiorespiratory arrest. She was endotrachoeally intubated, and the pericardial fluid was drained. She was given a round of epinephrine, and the cardiorespiratory arrest was reversed. Shiloh remained on a ventilator through September 12. The fluid that was overwhelming Shiloh also filled the area around her lungs ? bilateral pleural effusions. This required the placement of chest tubes.
Throughout this time, Shiloh remained in full renal failure. She received round the clock dialysis. The doctors placed a periotoneal catheter on September 10, and converted her to peritoneal dialysis. The dialysis continued through September 27. Her medical bills amounted to $450,000.
The severity of Shiloh Johnson¡¯s HUS, and in particular the length of her renal failure puts her at serious risk of future complications including end stage renal disease. The extent of her long-term injury is still being assessed.
So, really why are these deadly pathogens not considered an adulterant by the USDA and FSIS when E. coli O157:H7 is?
Posted on August 17, 2009 by E. coli Attorney

Marler Clark has Tested Retail Hamburger for Non-O157:H7 Pathogenic Shiga Toxin Producing E. coli
Source of Article:

Posted on August 18, 2009 by Bill Marler
We have completed a portion of the first year¡¯s tests and are in the process of compiling the data. We hope to publish the results in the next month. (See Abstract)
Non-O157 STEC are capable of causing the same debilitating triad of diseases as E. coli O157:H7, including hemorrhagic colitis, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Infection with the non-O157 STEC can result in death in children, the elderly and the immunocompromised. According to the U.S. Centers for Disease Control and Prevention, the number of reported cases of illnesses caused by this group of pathogenic E. coli has been steadily increasing over the past several years. Despite this, Non-O157:H7 STEC is not considered an adulterant under current law in the U.S. That needs to change.
Non-O157:H7 STEC are also known to occur in imported beef from several trading partners, yet the U.S. Department of Agriculture Food Safety and Inspection Service (FSIS) has not required that imported beef be free of these pathogens. The Agency has also failed to devise steps to measure and control the presence of these pathogens in domestic beef production and the ground beef supply, at the slaughterhouse or the grocery store.

CDC Links 80 E. coli O157:H7 to Nestle Toll House Cookie Dough ? 35 Hospitalized ? 10 with Hemolytic Uremic Syndrome
Source of Article:
CDC Published this Morning:
CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.
As of Friday, July 31, 2009, 80 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 31 states. Of these, 70 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (5), Colorado (6), Connecticut (1), Delaware (1), Georgia (2), Iowa (2), Idaho (1), Illinois (7), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (8), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (4), Virginia (2), Washington (6), and Wisconsin (1).
Most persons became ill during May and June. Ill persons range in age from 2 to 65 years; however, 66% are less than 19 years old; 69% are female. Thirty-five persons have been hospitalized, 10 developed hemolytic uremic syndrome (HUS). We represent 24 people sickened - most of them were hospitalized (one still is) - 6 developed HUS. Three lawsuits have been filed - Colorado, California and Washington.
Oddly, despite the overwhelming evidence linking its product to the 80 illnesses, there seems to be a bit of denial by Nestle corporate leadership. Here is a quote from last week:
General Manger of Nestle Baking, Paul Bakus said, "[w]e did find one package of our finished food cookie dough that had e. coli, but it was not the same strain that made people sick. So, we really don't know whether our packaging and our product was responsible, but the reality is that it could have been," Bakus said.

Posted on August 10, 2009 by Bill Marler

Rock Island County Sheriff Slams Healthcare Providers for Dropping Ball on Hepatitis A
Source of Article:

Posted on August 11, 2009 by David Babcock
The Rock Island County Sheriff's Department has released a report stating that Trinity Regional Health System failed to properly notify county health officials of the first of at least 26 Hepatitis A illnesses related to the outbreak at the Milan McDonald's. The outbreak also required over 5,000 McDonald's patrons to obtain shots to avoid falling ill. The Quad City times reported on the statements of County Board Chairman Jim Bohnsack:
"Trinity dropped the ball," Bohnsack said during a news conference Monday at the County Board conference room in Rock Island.
"I'm confident that Trinity will step up and do what's right," he said. Bohnsack added that he hopes the hospital system will reimburse the county for some of the estimated $159,000 spent to help contain the outbreak. The disease was traced to a McDonald's restaurant in Milan, Ill., where some employees who handled food were diagnosed with hepatitis A.
For their part, Trinity did not seem to have much of an explanation for the failure:
Kathleen Cunningham, Trinity's vice president of hospital operations, said later Monday that there are many people responsible for reporting diseases such as hepatitis. She added that the hospital system has made internal changes to its reporting system since the problem came to light and is in a continuing dialogue with Rock Island County officials.
"Our joint aim is to look at this whole process and find opportunities for change," she said.
The illness was first recognized in testing done at Metropolitan Medical Laboratory on June 17, and should have been reported on that day. Trinity allegedly notified the County on June 26, but used an "incorrect" report form. The County did not become aware of the report until July 13, when "a staffer in the county health department returned from vacation."
Trinity's apparent failure in this instance underscores the importance of the reporting of communicable diseases. When labs and hospitals follow regulations and make timely reports of foodborne illness and communicable disease, it allows health departments to take the steps necessary to reduce or eliminate the threat to the public. Without that information, health agencies' ability to protect the public is restrained.

Nestle Toll House Cookie Dough E. coli Outbreak, PFGE, MLVA = CSI
Source of Article:
There are a lot of things I love about my job, but one is the science behind linking people in dozens of states to food that they consumed that poisoned them. Once that link is scientifically determined, and the outbreak stopped, then the time comes to learn from the mistakes so the next outbreak can be avoided. Frankly, we all need to appreciate (can you say increase funding) those public servants who toil in local, state and federal health agencies tracking food borne diseases. Without the work of dedicated people interviewing victims, testing stool and analyzing data, most outbreaks would never be determined, most victims would never be fairly treated, and most outbreaks would repeated without learning from past manufacturing mistakes. The science behind all the hard work is fascinating - especially, the "CSI" part.
The process of obtaining the DNA fingerprint is called PFGE (Pulse Field Gel Electrophoresis). This technique is used to separate the DNA of the bacterial isolate into its component parts. It operates by causing alternating electric fields to run the DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments ? or ¡°fingerprints¡± ? in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of E. coli O157:H7 as well as strains of Listeria and campylobacter, and other pathogenic bacteria. The PFGE pattern of the bacteria can then be compared and matched up to the PFGE pattern of the strain of infected persons who consumed the contaminated product.
MLVA (Multiple Loci VNTR Analysis) is a method employed for the genetic analysis of particular microorganisms, such as pathogenic bacteria, that takes advantage of the polymorphism of tandemly repeated DNA sequences. "VNTR" means "Variable Number of Tandem Repeats". This method is well known in forensic science since it is the basis of DNA fingerprinting in humans. When applied to bacteria, it contributes to forensic microbiology through which the source of a particular strain might eventually be traced back. In a typical MLVA assay, a number of well-selected and characterized (in terms of mutation rate and diversity) loci are amplified by polymerase chain reaction (PCR) so that the size of each locus can be measured. From this size, the number of repeat units at each locus can be deduced. The resulting information is a code that can be easily compared to reference databases.
When PFGE and MLVA patterns match, they, along with solid epidemiological work (e.g., was the person exposed to the suspect food item), are proof that the contaminated product was the source of a person's illness.
In the Nestle Toll House Cookie Dough E. coli O157:H7 outbreak the science and epidemiological work produces the below partial ¡°line list.¡± This list (as of June 25, 2009) lists 76 persons (that number is now 80) who are linked together by a common PFGE of E. coli O157:H7. Most have MLVA patterns reported - some were still pending. The bottom line is that this list, along with solid epidemiological work, show the ¡°CSI¡± link between these 76 people and the Cookie Dough they consumed.

32 Hepatitis A Cases Now Linked to Milan McDonalds
Source of Article:

Posted on August 19, 2009 by Bill Marler
According to the Quad-City Times, the Rock Island County Health Department has reported its 18th case of hepatitis A stemming from an outbreak that began about a month ago.
"This individual is a household contact to one of the cases reported the week of July 13," said Theresa Foes, a spokeswoman for the health department. The person in question did not get immunized against the disease, she added. More than 5,300 people were immunized at clinics the department offered last month.
There have now been at least 32 cases of hepatitis A confirmed in western Illinois and eastern Iowa in connection with the outbreak. All of them involve or are somehow related to people who visited a McDonald's restaurant, 400 W. 1st St., Milan, Ill., earlier this summer.
Three lawsuits have been filed in Rock Island County Circuit Court in connection with the outbreak of the disease.
Hepatitis A is the least serious of all the hepatitis diseases that affect the liver. It has an incubation period of 14 to 28 days, but it can affect people for up to 50 days. Officials think hepatitis A cases will continue to turn up in this area into early September.

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