FoodHACCP Newsletter
08/05 2013 ISSUE:559


Cyclospora outbreak heightens food safety concerns
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By EDITORIAL BOARD , Star Tribune (AUG 04, 2013)
Was it a contaminated bagged lettuce mix that caused a foodborne outbreak that has now made 400 people sick in 16 states, including Minnesota? Or was it something else?
More than a month after the first illnesses caused by a foodborne parasite known as cyclospora were reported in Iowa, state health officials there and in Nebraska released the results of their outbreak investigations last week. The culprit, according to them, at least, was a bagged salad mix that consumers could have been exposed to at restaurants or grocery stores.
Consumers normally can breathe a sigh of relief when health officials pinpoint an outbreak’s source. Products that likely made people sick will be pulled off store shelves and out of restaurants. Those who have become ill can connect the dots of what they’ve eaten and where they’ve eaten and get the medical care they need.
But last week’s bagged lettuce announcement by these states’ health officials inspired far more questions than confidence that the outbreak culprit has been nailed down and that the investigation is progressing as it should. The announcement also underscored public health experts’ growing concerns — former Minnesota state epidemiologist Michael Osterholm is among those sounding the alarm — about the investigation’s time frame, methodology and accountability.
Soon after Wednesday’s announcement, statements from the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention suggested strongly that these leading food safety agencies aren’t fully on board with the conclusion reached by the two states.
While initial statements from both federal agencies were difficult to interpret — and looked like an attempt to save face for Iowa and Nebraska officials by glossing over differences — eventually, the agencies made it clear when contacted by an editorial writer that the outbreak has not yet been solved.
“The states of Iowa and Nebraska have announced the results of their analysis in their respective states. FDA has been working to combine the Iowa and Nebraska information with information collected from other affected states with the goal of identifying a specific food item linked to the illnesses,’’ said FDA spokeswoman Theresa Eisenman on Thursday afternoon.
Iowa and Nebraska officials’ refusal to name restaurants or the supplier that may have sold contaminated products also raises unflattering questions about whether these state health officials’ priority is protecting consumers or protecting industry. While Iowa officials cite state laws that limit them from naming businesses caught up in outbreaks, it appears they have leeway to do so if the information is needed to protect the public.
Given that this outbreak’s bug can cause severe diarrhea lasting for a month and can cause weight loss of 10 to 20 pounds, consumers should be given the information they need to determine if they’ve been exposed and need medical care. Twenty-two people have been hospitalized in the current outbreak.
On Friday afternoon, the FDA stepped into the information gap somewhat. While still saying only that the Iowa-Nebraska investigation had linked the salad mix to the outbreak, the agency said it had found that “illness clusters” at restaurants in those two states were traced to a common supplier, Taylor Farms de Mexico. The agency on Friday then confirmed that patrons of Olive Garden and Red Lobster restaurants in those two states were included in the illness clusters .
It’s frustrating from a Minnesota perspective to watch the investigation unfold just to the south. This state’s foodborne disease investigators have an international reputation for cracking outbreaks with speed and accuracy — salmonella cases involving peppers and peanut butter are two high-profile recent examples.
While state lines and other jurisdictional issues can create counterproductive barriers in investigations, the need to quickly trace the source of an outbreak means that everyone who works in public health is on the same team. As the cyclospora outbreak continues, the Editorial Board  hopes that federal officials and Iowa and Nebraska investigators will tap into Minnesota’s willingness to work with its neighbors.
In the months ahead, the cyclospora outbreak’s lead investigators also should take advantage of a Minnesota-made measure within the new federal Food Safety Modernization Act. Thanks to Sen. Amy Klobuchar’s work on this law, newly established regional food safety “centers of excellence” provide an unprecedented opportunity to retrospectively analyze outbreak investigations and to identify ways to improve in the future.
Minnesota has one of these centers, and lawmakers from across the Midwest should be pressing Iowa and Nebraska officials to use it. Food safety experts have long been urging this type of post-outbreak analysis, and the cyclospora outbreak is a compelling example of why this should be done. The important lessons learned would help the entire public health system respond more effectively — and potentially save lives — when the next foodborne outbreak occurs.

UPDATE 1-Fonterra shares, New Zealand dollar hit by food safety concerns
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By (AUG 04, 2013)
* NZ dollar drops 1.5 pct, Fonterra units slump near 9 pct
* NZ Prime Minister questions delay disclosure
WELLINGTON Aug 5 (Reuters) - The New Zealand dollar and units in dairy giant Fonterra's shareholders' fund slid on Monday after bacteria that can cause botulism was found in some dairy products, raising safety concerns about the country's top export earner.
Fonterra, the world's biggest dairy exporter, said over the weekend that contaminated New Zealand-made whey protein concentrate had been exported to China, Malaysia, Vietnam, Thailand and Saudi Arabia and used in products including infant milk powder and sports drinks.
In response, China has halted all milk powder imports from New Zealand and Australia, New Zealand Trade Minister Tim Groser said. Some food producers including Danone said they have recalled products that may have contained the contaminated whey.
Dairy produce accounts for about a quarter of New Zealand's NZ$46 billion ($36 billion) in annual export earnings, and the currency is sensitive to Fonterra's fortunes.
Prime Minister John Key questioned why Fonterra took so long to disclose the contamination, which affected product made in May 2012.
"When ... your whole business is about food safety and food quality, you think they'd take such a precautionary view to these things and say if it's testing for some reason in an odd way that (the product) would just be discarded till they're absolutely sure it's right," Key said on Radio New Zealand.
He said Fonterra was New Zealand's flagship and the issue went right to the "heart of undermining consumer confidence".
The New Zealand dollar fell nearly 2 U.S. cents to a one-year low of $0.7670. It was also weaker against most other major currencies and on a trade weighted basis was down 1.1 percent against a basket of currencies.
"Further reaction is possible but will depend on the nature of fresh information which unfolds," said Westpac senior currency strategist Imre Speizer. "Indeed, reaction reversals are possible if the scale of the issue is less than media reports initially implied."
The kiwi last traded at $0.7750/60 against the U.S. dollar.
Units in Fonterra's Shareholders Fund, which offer outside investors exposure to the cooperative's farmer shareholder dividends, plunged as much as 8.7 percent before trading 5.9 percent lower at NZ$6.70.
Fonterra issued a statement to the New Zealand stock exchange saying it had yet to hear officially of any product ban.
"As far as Fonterra is aware, the New Zealand Government is working with Chinese authorities to determine the scope of the reaction, and no official notification has been received," it said.
Fonterra's chief executive, Theo Spierings, flew to China on Saturday and is expected to give a news conference later on Monday.

What’s up with E. coli and Mexican Restaurants? A Bit(e) of History
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By Bill Marler (AUG 04, 2013)
As of August 1, 2013, at least 11 people who ate at the Federico’s Mexican Restaurant in the West Valley outside of Phoenix, Arizona have fallen ill with E. coli infections. According to news reports, 8 of the 11 cases were hospitalized and another 4 E. coli cases have yet to be confirmed.  I have been on the phone today with two victims of this outbreak – one whose daughter has developed hemolytic uremic syndrome (HUS).
It made me think of past outbreak and past lawsuits.
Los Burritos Mexicanos:  An E. coli outbreak in DuPage County, Illinois, is suspected to have been caused by food served at the Los Burritos Mexicanos restaurant in Lombard.  The restaurant was closed on June 14, 2013 during an E. coli outbreak investigation.  The DuPage County Health Department counted 31 confirmed and probable E. coli cases as part of the Los Burritos Mexicanos outbreak.
Ixtapa Family Mexican Restaurant:  In October of 2008, Snohomish County Health Department (SCHD) epidemiologists investigated an E. coli O157:H7 outbreak among patrons of the Ixtapa Family Mexican Restaurant in Lake Stevens, Washington.  Dates of illness onset ranged from October 7-17, 2008.  An investigation by the SCHD and the Washington State Department of Health (WSDOH) identified sixty-four cases of E. coli infection linked to the consumption of food at Ixtapa restaurant.  Four confirmed cases were hospitalized, and one developed hemolytic uremic syndrome (HUS), a severe complication of E. coli that can lead to kidney failure.
El Mexicano Mexican Restaurant:  In May of 2012, the South Carolina Department of Health and Environmental Control (DHEC) announced that it was investigating an outbreak of E. coli O157:H7 that had sickened 11 individuals in the Spartanburg area. All 11 victims reported eating at the same El Mexicano Mexican restaurant. Two of the victims developed hemolytic uremic syndrome (HUS). Illnesses were related to eating at the restaurant during the last week of April.
Coco Locos Restaurant: In May 2013, the source of an E. coli O157:H7 outbreak in Brazos County, Texas is being investigated by public health officials and is believed to have been caused by E. coli-contaminated ground beef served at the Coco Locos restaurant located in 300 block of George Bush Drive in College Station, TX.  According to news reports, at least 10 people were part of the E. coli outbreak, which has been linked to ground beef served at the restaurant.  Health officials have not yet determined whether the E. coli outbreak stemmed from under-cooked ground beef or from cross-contamination between raw ground beef and other foods or surfaces in the restaurant kitchen.
Habaneros Mexican Restaurant:  In late August of 2003, staff in the Communicable Disease (CD) section at the St. Clair County Health Department (SCCHD) received a report that four Illinois residents who had recently traveled to the St. Clair area were experiencing bloody diarrhea and had gone to emergency rooms in their respective hometowns for treatment.  On Tuesday, September 2, SCCHD was notified that E. coli O157:H7 had been isolated from at least one of the four people’s stool specimens.  At the same time, the SCCHD began receiving other reports of diarrheal illness in patients seen by local physicians.  Preliminary interviews of ill persons revealed that all had eaten at Habaneros prior to the onset of diarrhea.   SCCHD conducted a foodborne outbreak investigation and found that of 64 persons, including seven employees, who had eaten at Habaneros between August 15, 2003 and September 5, 2003, thirty (47%) reported having diarrheal symptoms; ten sought medical care.  An extensive food consumption history was obtained from each person interviewed, but no specific food-item was statistically associated with illness.
Taco Johns:  In December 2006, Iowa and Minnesota health officials investigated an E. coli O157:H7 outbreak among patrons at Taco John’s restaurants in Cedar Falls, Iowa, and Albert Lea and Austin, Minnesota. As of December 13, 2006, the Iowa Department of Health had confirmed that at least 50 Iowans had become ill with E. coli infections after eating at Taco John’s, and the Minnesota Department of Health had confirmed that at least 27 Minnesotans were part of the outbreak.
Taco Bell:  Taco Bell restaurants were the source of an E. coli outbreak during the last week of November and the beginning of December 2006. Residents of New Jersey, New York, Pennsylvania, Delaware, and South Carolina were confirmed by the Centers for Disease Control and Prevention (CDC) as being part of the Taco Bell E. coli outbreak, which was traced to contaminated lettuce served in foods at Taco Bell restaurants. On December 13, 2006, the CDC announced that at 71 people had become ill with E. coli infections associated with the Taco Bell restaurant outbreak. Of those 71, 53 people had been hospitalized, 48 people were confirmed ill with E. coli, and 8 developed hemolytic uremic syndrome.

New Zealand dairy giant issues global botulism alert
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By (AUG 03, 2013)
The authorities in New Zealand have recalled up to 1,000 tonnes of dairy products across seven countries, including Australia, because of a contamination scare.
.The authorities in New Zealand have recalled up to 1,000 tonnes of dairy products across seven countries, including Australia, because of a contamination scare.
The country's biggest dairy producer Fonterra has reported that tests have found a strain of bacteria in batches of whey protein that can cause botulism.
New Zealand's Ministry of Primary Industries has confirmed the tainted products include infant formula, sports and protein drinks and other beverages.
The government said the contaminated whey protein concentrate, or products using this ingredient, had been exported to Australia, China, Malaysia, Saudi Arabia, Thailand and Vietnam.
Potentially fatal botulism is one of the most dangerous forms of food poisoning, often leading to paralysis.
The ministry's acting director-general, Scott Gallacher, says the government is trying to clarify the full extent of the problem.
"Over the last 24 hours, things have been very fluid," he said.
"Information has been changing on a rapid basis as we try to get to grips with exactly the situation and scenario that we're dealing with."
Fonterra, which manufactured the product more than a year ago, said eight customers had been advised and were investigating whether any of the affected product was in their supply chains.
There have been no reports of any illness linked to consumption of the affected whey protein.
New Zealand trade minister Tim Groser said health authorities around the world, including the World Health Organisation, had also been alerted to the contamination.
"As soon as New Zealand authorities were notified of this risk, we immediately acted to inform relevant authorities around the world," Mr Groser said.
"This has included formally notifying Infosan, the World Health Organisation's international food safety regulators network. As more information on this issue is confirmed we will provide our trading partners with further updates.
"We understand that the markets to which contaminated whey protein concentrate, or products using this ingredient, has been exported are Australia, China, Malaysia, Saudi Arabia, Thailand and Vietnam."
Sports drinks, baby formula in botulism scare
Fonterra said the affected product was used in a range of drinks including infant formula and sports drinks.
"We are doing everything we can to assist our customers in ensuring any product containing this ingredient is removed from the marketplace and that the public is made aware," Fonterra chief executive Theo Spierings said.
Three batches of whey protein concentrate manufactured in May last year recently tested positive for Clostridium botulinum.
The batches have been used to form 870 tonnes of products sold in a variety of markets, Mr Gallacher said.
The symptoms of botulism include nausea, vomiting and diarrhoea, followed by paralysis, and it can be fatal if not treated.
Fonterra said the potential impact on someone consuming a contaminated product would depend on their age and the amount they consumed.
For an adult, a small amount of contaminated whey protein "would probably pass through unnoticed", Fonterra's managing director of New Zealand milk products, Gary Romano, told reporters.
Dairy exports are New Zealand's major earner and its products are particularly popular in Asia, where they are considered the gold standard.
According to government data the dairy industry contributes 2.8 per cent to New Zealand's GDP and about 25 per cent of its exports. It is worth NZ$10.4 billion (US$8.5 billion) annually.
New Zealand accounts for one-third of the world's cross-border trade in dairy products.
Fonterra, the world's largest dairy exporter, reported revenues of NZ$19.8 billion in the 2012 financial year.

Utah Ancestor Square Pizza Factory Hepatitis A Exposure
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By Linda Larsen (AUG 02, 2013)
According to the Southwest Utah Public Health Department (SWUPHD), a food worker at the Ancestor Square Pizza Factory in Washington County, Utah has tested positive for hepatitis A. Anyone who ate at this restaurant during certain hours in July may have been exposed to the virus.
If you ate there July 19 from 6:00 to 9:30 pm, July 20 from 6:00 to 9:30 pm, July 23 from 5:00 to 9:00 pm, July 26 from 6:00 to 9:30 pm, or July 27 from 5:00 to 9:30 pm, contact the Southwest Utah Public Health Department for more information. You can get a vaccination against the virus within 14 days of exposure. The vaccination could be immune globulin or the hepatitis A vaccine, depending on your age and other conditions.
No other Pizza Factory restaurants are affected by this issue. There are no confirmed hepatitis A cases related to this restaurant reported to date. Call SWUPHD at 435-673-3528 for more information. The department has an immunization clinic at 620 S. 400 E. (level 3) that is open Monday, Wednesday, & Thursday from 7:30 am to 5:00 pm, on Tuesday from 1:00 pm to 5:00 pm, and every other Friday (starting August 2, 2013) from 8:00 am to 4:30 pm. Bring your immunization records, picture I.D., and insurance card.
The symptoms of hepatitis A include yellowing of the eyes and skin, fatigue, loss of appetite, light colored stools, dark colored urine, nausea, abdominal pain, diarrhea, and fever. There is no treatment for the illness except for palliative care.

Food safety experts: Mixing, washing, packaging of bagged greens increase contamination risks
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By Associated Press (AUG 02, 2013)
DES MOINES, Iowa — The outbreak of a stomach bug two states have linked to bagged salad came as little surprise to food safety experts, who say the process of harvesting, washing and packaging leafy greens provides numerous opportunities for contamination.
Although nutritionists stress the chances of getting sick from vegetables are low compared to the dangers of a diet without them, packaged salads heighten the risk because leaves from several batches often are mixed together.
“The washing and comingling of different batches of lettuce means a hazard that may appear in one field can show up in lots of bags of lettuce because of the common bath,” said Caroline Smith DeWaal, director of the food safety program for the Center for Science in the Public Interest, a consumer health advocacy organization based in Washington.
Officials in Iowa and Nebraska say a packaged salad mix containing iceberg and romaine lettuce, carrots and red cabbage was infected with cyclospora, a parasite blamed for sickening 397 people in 16 states. It’s not clear whether the produce also was to blame for the outbreak in the other states.
Last year the Food and Drug Administration issued more than 20 recalls for packaged salads, romaine lettuce or spinach. Most were due to tests finding listeria or E. coli bacteria, both of which can cause serious illness.
However, of the 693 food product recalls between October 2011 and September 2012 — the last available year of records — only about 15 pertained to bagged lettuce or salads, according to FDA data.
The U.S. Centers for Disease Control and Prevention has estimated that one in six Americans — 48 million people — get sick from foodborne illnesses each year. About 128,000 are hospitalized and 3,000 die.
In March the CDC released a study that looked at more than 4,500 food-related outbreaks between 1998 and 2008 and found more illnesses attributed to leafy vegetables — 22 percent — than to any other food. The agency didn’t say what percentage of those was packaged.
Dr. Robert Tauxe, the CDC’s deputy director of foodborne, waterborne and environmental diseases, said the industry that cuts and bags fresh produce has made significant improvements in its processes since 2006. An outbreak that year tied to E. coli-contaminated spinach caused three deaths and sickened 205 people.
“A lot has been done so that actually the bagged lettuce-type produce is a good deal safer now that it was five years ago,” he said.
Michael Doyle, director of the University of Georgia’s Center for Food Safety, said lettuce is susceptible to contamination because it grows close to the ground and is more susceptible to microbial contamination. Water used for irrigation can be contaminated, and there could be issues with workers lacking good hygienic practices, he said.
“There are a lot of inherent issues and that’s why we’re seeing so many recalls and problems,” Doyle said. “I don’t eat bagged salads if I can avoid them. I haven’t for a long time because I know how they’re processed and there’s no true kill step in that process that will kill harmful bacteria in the lettuce.”
Head lettuce is easier to clean because contaminants reside on the outside leaves, which can be removed and the head washed. Leaf lettuce like romaine and spinach, often the subject of recalls, are harder to clean because of their stalky nature.
When lettuce is cut it attempts to heal the cut by sealing it to keep moisture in, but if a processing facility has contaminated water that sealing process could also seal in some contaminants into the leaf, making them more difficult to wash away, Doyle said.
Even still, the risk from eating package salads is tiny, said Scott Horsfall, chief executive officer of the California Leafy Greens Marketing Agreement, a trade group of shippers of green leaf products.
The organization estimates about 50 billion servings of leafy green vegetables leave California and Arizona every year and little of it has any issues.
“Any illness is too many, but the reality is the food supply is very safe,” he said.
He said the industry focuses on preventing contamination from reaching vegetables by walking fields and assessing environmental risks including intrusion from animals, enforcing worker cleanliness rules, requiring frequent water testing, and testing fertilizer and compost to eliminate pathogens.
Packaged salad mixes are about 14.8 percent of the $45 billion fresh vegetables market, according to Progressive Grocer’s 2012 Consumer Expenditures Study released in September. That $6 billion in sales has grown significantly from about $600 million a decade ago.
Cyclospora is caused by parasites that are spread when people ingest food or water contaminated with feces. People who are exposed usually become sick after about a week and have bad diarrhea and other flu-like symptoms that can last from a few days to several months if untreated with antibiotics.
Iowa Epidemiologist Dr. Patricia Quinlisk said she is convinced the product that sickened people is gone, either eaten or expired.
 “I would feel very comfortable buying or eating at a restaurant prepackaged salad mixtures,” she said. “The risk would be so low as to not discourage me from it.”
Jennifer Nelson, an associate professor of nutrition at Mayo Clinic College of Medicine, said ultimately consumers shouldn’t shy away from an otherwise important part of a healthy diet because of a small risk of contamination.
“Any food does bring along with it some inherent risk. It all gets back to common sense in food preparation,” she said. “If you are going to be eating leafy greens be sure you wash them, even prewashed lettuce. Give it several good washes and rinses and you’re about as assured as you can be of being as safe as possible.”
Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Some food safety experts worry salad not outbreak culprit
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By Elizabeth Weise, USA TODAY (AUG 01, 2013)
Food safety experts are beginning to grumble that an investigation into the latest food-borne illness is taking too long to find the exact source of the outbreak. Two states, Iowa and Nebraska, have reported they believe the outbreak is linked to prepackaged, bagged salad mix, but others aren't so sure.
The number of victims in the national outbreak of the food-linked diarrheal disease cyclospora rose to 397, with illnesses reported in 16 states, the Centers for Disease Control and Prevention reported late Wednesday.
The CDC says it is working to determine whether the possible link to bagged salad mix applies to cases in other states as well.
The Food and Drug Administration "can't speak to an ongoing investigation," said FDA spokeswoman Theresa Eisenman.
"With 390-some people ill, you'd think it would be fairly easy to triangulate the trace back" to the food causing the illnesses, said Dave Gombas, senior vice president for food safety with United Fresh Produce Association, a produce trade group in Washington, D.C. "So the fact that FDA and CDC aren't going along with Iowa and Nebraska gives me pause."
Cyclospora is an intestinal illnesses caused by the microscopic parasite Cyclospora cayetanensis. It is transmitted when feces enter the food or water supply and are consumed. The disease causes watery and sometimes explosive diarrhea and is treated with antibiotics. Symptoms can include fatigue, anorexia, bloating, stomach cramps, vomiting, muscle aches and a low fever.
At least 22 people in five states have been hospitalized in the outbreak.
Iowa's public health system first caught the outbreak on June 25 when Michael Last, a parasitologist at the State Hygienic Laboratory at the University of Iowa in Coralville, recognized the parasite in a stool sample sent in by a physician for testing.
He is "a good, good, good microbiologist," said Patricia Quinlisk, Iowa's state epidemiologist.
The parasite is rarely seen in the United States. "We haven't had a major outbreak from cyclospora in almost a decade," said Caroline Smith DeWaal with the Center for Science in the Public Interest in Washington, D.C. Her database shows the most recent large outbreak was in Florida in 2005, where 592 people were sickened with contaminated basil. The nation's largest-known cyclospora outbreak was in 1996 when raspberries from Guatemala sickened 1,465 in multiple states, she said.
Using Twitter, Facebook and other media, Iowa officials made sure health workers across the state were looking for similar illnesses. Very quickly more cases came in, including from Nebraska next door. Most of the patients had gotten sick in mid-June.
"At the peak of this outbreak we were seeing anywhere from seven to 12 new cases a day," said Mary DeMartino, who runs Iowa's Disease Control Division of the State Hygienic Laboratory.
Iowa health workers established that about 80% of the people who had gotten sick had eaten the same brand of prepackaged salad mix containing iceberg and romaine lettuce, carrots and red cabbage. Packaged lettuce has a short shelf life, so by the time investigators began interviewing people "the bags were long gone," Quinlisk said. That means there wasn't anything for them to test to see which of the mix's four ingredients was responsible for the illnesses.
The last person Iowa tested got sick on June 28. State officials believe the tainted lot of salad mix is gone from store shelves and the outbreak is waning there. What's going on in other states is difficult to say because "their epidemiology looks a little different," Quinlisk said.
It wouldn't surprise her at all if there were more than one outbreak going on, Quinlisk said. "When we look at the data from other states, the people who are getting ill are not necessarily the same as we saw; they're not getting sick at the same time." Bagged salad may not explain all the illnesses in the nation.
Some of the food safety world feels the investigation has not moved as quickly as it should have. "This thing should have been solved a month ago," said Michael Osterholm, Minnesota's former state epidemiologist who now directs the Center for Infectious Disease Research and Policy at the University of Minnesota.
The fact that patrons of a large number of restaurants became ill, including several national chains, "should have helped them," he said. "They were national chain restaurants all owned by one company, which in turn got its ingredients from a single source."
Finding the culprit isn't easy and takes time, Quinlisk said. "Most people's idea of an outbreak is everybody went to the same grocery store and bought the same item. It's not like that. It wasn't one brand name, it was a salad mixture that came into Iowa in a variety of ways in different packaging."
Another issue is that Iowa, like at least 30 other states, has laws on the books protecting agricultural producers. These laws encourage states not to make public information about possible contamination of food that might harm sales unless there is an ongoing outbreak that puts people at risk.
"They don't say 'Thou shall not tell who the business is,'" said Bill Marler, a lawyer in Seattle who has been involved in food-borne illness outbreaks for decades. Instead it's a discretionary decision that has led to a "culture of non-disclosure" that he and others believe is hampering the investigation.
"This ain't done yet. I think the investigation has a long way to go," Gombas said.

Cyclospora Hits Des Moines, Cedar Rapids Hard
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By Carla Gillespie (July 31, 2013)
Cyclospora is a one-celled parasite that can cause a laundry list of unpleasant gastrointestinal symptoms persisting as long as two months. The parasite is rare and usually associated with tropical or sub-tropical regions, hardly how anyone would describe Iowa. Yet that state has been hit the hardest by a Cyclospora outbreak that may include almost 400 cases in 15 states.
Most of Iowa’s cases are in two counties. Linn County, where Cedar Rapids is located has 42 cases.  Polk County, where Des Moins is located has 17.  The remaining 84 cases are scattered throughout the sate.
The cases in Iowa were caused by the same source as the 78 cases reported in Nebraska, five of whom required treatment at a hospital. Yesterday, health departments from both of those states announced that the food source of the outbreak was pre-washed, pre-packaged salad mix sold at stores and served at restaurants. The salad mix contained romaine and iceberg lettuces, carrots and red cabbage.
The brand name of the salad, where it was grown, sold and distributed has not been released by officials. And it probably won’t be.  ”The Department of Inspections and Appeals (DIA) has no plan to release the names of the mixed salad brands, stores, or restaurants involved in the recent cyclospora outbreak.  DIA only releases that information if there is a public health risk.  At this point, with the prepackaged salad mix no longer available to the public, we do not have that risk.  Regarding the grower of the products, it will be up to the U.S. Food & Drug Administration (FDA) to conduct the trace-back on the products’ origin.  As the product was sold in interstate commerce, the FDA has jurisdiction,” David Werning, Public Information Officer, for Iowa Department of Public Health’s office of  Inspections and Appeals, told Food Poisoning Bulletin this morning. Cases in Iowa and Nebraska make up 55 percent of Cyclospora Illnesses reported in a total of 15 states. Not all of the illnesses are part of the same outbreak. Case count reported to Food Poisoning Bulletin on July 30 were as follows: Iowa (143), Texas (122), Nebraska (76), Florida (24), Wisconsin* (10), New York (5), Illinois* (4) Georgia (3), Connecticut (2), Missouri (2),  Arkansas* (1), Kansas *(1), Minnesota (1), New Jersey (1), Ohio (1), (*Notes: Arkansas health officials don’t think  their case is part of the outbreak based on information from an interview with the patient. Florida hasn’t found a common restaurant or food exposure among its case patients.  One of the cases in Illinois was likely exposed while visiting Iowa. The case in Kansas was likely exposed while visiting Nebraska. In Wisconsin, eight of the 10 cases are linked to the outbreak, one is not and one is pending test results.  The total number of cases in this story is current per each state today and therefore exceeds the number on the CDC’s most recent update.)

China Expands Ban on Poultry
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By (July 31, 2013)
China's ban on poultry and poultry products shipped from Arkansas has expanded to include Wisconsin and New York, according to the Food Safety and Inspection Service (FSIS).
As stated in a release on the FSIS website, all poultry and poultry products shipped from Wisconsin and Arkansas on or after July 22, 2013, and products shipped from Wisconsin to New York State on or after Jan. 28, 2013 are ineligible for export. The Animal and Plant Health Inspection Service reported that Japan banned Arkansas poultry as of June 20, 2013, and Russia had already banned poultry imports from the state
The H7N7 virus was confirmed on June18 at a breeder chicken farm in Scott County, Ark. The farmer was a supplier for Tyson Foods, Inc. The entire flock was euthanized to stop the virus from spreading. Arkansas is the second-leading producer of broiler chickens, according to the U.S. Department of Agriculture.
Also, a deadly piglet virus, Porcine Epidemic Diarrhea virus (PEDv), was recently discovered on two hog farms in North Carolina.

Irish Consumers Buying Less Frozen Burgers and Processed Foods Containing Meat
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By (July 30, 2013)
The Food Safety Authority of Ireland (FSAI) has published research into the impact of the horse meat contamination issue on Irish consumer confidence and trust in the food they purchase.
The survey reveals significant changes in consumers’ purchasing habits with over half (51%) of people who purchased frozen burgers in the past now buying less of these products (48% buy the same amount). Virtually all adults in the country (98%) said they were aware of horse meat issue, with almost three quarters (72%) stating they have confidence in Irish food safety controls and regulations (just 13% were not confident, while 15% were not sure).
Overall, the issue has resulted in a marked increase in awareness around food safety, with 50% of respondents saying they are now more conscious about food safety issues in general. Looking at the implications of the issue for consumer purchasing behaviour, 45% of consumers say they now spend more time reading labels on food products. Over half (53%) say they are now more conscious of the ingredients that go into manufactured food products, while 56% say they are more conscious about the country of origin of food products.
Of those who bought processed foods containing meat in the past (e.g. lasagne, shepherd’s pie, etc), 42% say they now buy less of these products, while 56% continue to buy the same amount. Buying habits were broadly unchanged for fresh burgers, with 69% saying they buy the same amount as before (16% buy less, 15% buy more). Almost two out of every five (39%) of those who consume meat say they were concerned as the issue unfolded, while 61% were unconcerned. Of those expressing concern, the following reasons were cited:
· Concern about what else might be unknowingly in other meat products (88%)
· Concern about the presence of chemicals, medicines and antibiotics (86%)
· Concern about food safety (83%) and possible health risks (76%)
· Repulsion by the idea of eating horse meat (55%)
Commenting on the research findings, Prof. Alan Reilly, Chief Executive, FSAI said: “It is six months since the FSAI uncovered what would eventually transpire to be a pan-European problem of adulterated beef products across almost all Members States. Understandably, the issue has given rise to widespread debate about food safety and labelling and this has changed the way people in Ireland view the foods they purchase and consume. When buying processed foods, people are not in a position to identify what raw materials are used and, therefore, they rely on labelling as their only source of information. They are in effect putting their trust in the hands of manufacturers and retailers who have a legal obligation to ensure that all ingredients in their products are correctly labelled.”
“A key lesson for food businesses is that they must have robust supplier controls in place at all times to ensure that they know who is supplying them and that all products and all ingredients are authentic. Purchasing raw materials on face value is a high risk strategy for food processors. Progress has already been made with enhanced controls and sophisticated tools such as DNA testing now being a part of the food safety armoury,” said Prof. Reilly. “Given the added controls now in place, I believe that the eventual outcome of this food fraud scandal will be a positive one for consumers.”
Prof. Reilly noted that the FSAI will continue its routine monitoring and surveillance programmes to monitor foods on the Irish market to ensure that they are complying with the requirements of food law and that they are safe to eat.

What is the common national restaurant chain in the Cyclospora outbreak? Will public health announce it?
Source :
By Bill Marler (July 30, 2013)
After talking to more that a few people who seem to be part of this nationwide and ongoing Cyclospora outbreak, perhaps a common vegetable is not becoming clear – yet, but it is becoming more evident that there is a common restaurant chain that links they vast majority of those sickened.
Question is – will public health announce it?
As I said last night, according to CIDRAP, the Cyclospora illness total has reached 373 as opposed to the 353 reported by the CDC to date.  According to the CDC, as of July 26, 2013, the CDC has been notified of 353 cases of Cyclospora infection from the following 15 health departments: Iowa, Texas, Nebraska, Florida, Wisconsin, Illinois, New York City, Georgia, Missouri, Arkansas, Connecticut, Kansas, Minnesota, New Jersey, and Ohio.
21 patients from three states have been hospitalized, but no deaths have been reported.
CIDRAP reports that Iowa, Nebraska, and Texas have reported more cases since the July 26 announcement.
The Iowa Department of Public Health (IDPH) reported 5 more cases, boosting its total to 145. The Nebraska Department of Health and Human Services (DHHS) announced 6 more cases, raising its total to 77.  Texas Department of State Health Services (TDSHS) said on Jul 26 that a total of 101 Cyclospora infections have been reported in that state so far, 9 more than reflected in the CDC update.

DIA Media Release: Prepackaged Salad Mix Implicated in Recent Cyclospora Outbreak
Source :
By Bill Marler (July 30, 2013)
A prepackaged salad mix has been implicated as the source of the cyclospora outbreak that sickened more than 100 Iowans last month, the State’s top food inspector said today. Steven Mandernach, chief of the Food and Consumer Safety Bureau of the Iowa Department of Inspections and Appeals (DIA), said epidemiological data and food history interviews conducted with ill Iowans links a bagged salad mix with the foodborne illness.
“The evidence points to a salad mix containing iceberg and romaine lettuce, as well as carrots and red cabbage as the source of the outbreak reported in Iowa and Nebraska,” Mandernach said, adding: “Iowans should continue eating salads as the implicated prepackaged mix is no longer in the state’s food supply chain.”
Once epidemiological results from the Iowa Department of Public Health (IDPH) was provided to DIA, the Department’s food inspection staff traced potential products through the food distribution and production system. DIA’s investigation found an exposure to a common prepackaged salad mix from a single source in approximately 80 percent of the cases. “Additionally, food histories are challenging as individuals do not always remember the foods eaten during the past several weeks,” Mandernach added.
Compounding the State’s investigation was the fact that by the time the parasitic-induced illness was identified, most if not all of the suspect product was no longer on the shelves. “Because it can take more than a week for the first symptoms to appear after ingesting the contaminated food, there wasn’t a product on the shelf to be examined for the parasite. As a result, most of the foodborne illness investigation focused on trying to trace-back suspected food products through the food chain,” Mandernach explained.
The statewide investigation was conducted jointly by DIA, IDPH, the State Hygienic Laboratory (SHL), local health departments, and officials in Nebraska who were investigating a related outbreak. Despite the challenges of the investigation, Mandernach said a number of successes were also recognized, including the initial detection of the cyclospora by the SHL technicians. “Additionally, the investigation was helped by the excellent communication and collaboration between the involved local, state, and federal agencies, and the cooperation of the public, medical providers, and the food industry,” he added.
Iowa’s public health and regulatory agencies have been working for several years on improving the investigation process for foodborne illness. “We saw those efforts pay off during this investigation, as all the players worked together seamlessly to the betterment of the public,” the food inspector said.
Mandernach noted that Iowa received a three-year cooperative grant in 2012 from the FDA to establish a Food and Feed Rapid Response Team. The Team includes not only those agencies involved in the cyclospora investigation, but integrates the Iowa Department of Agriculture and Land Stewardship (IDALS) and the FDA into the State’s investigative and response process.
“Our goal, when investigating a foodborne illness, is to as quickly as possible identify the source of the outbreak and stop the spread. The Rapid Response Team assists in this effort by promoting coordination and communication among the various agencies, and making available dedicated staff that are focused on the early detection of potential foodborne illness,” he added.
The State will continue to work closely with local health departments, other states, and the Centers for Disease Control and prevention (CDC) and FDA as the investigation moves forward. For the latest cyclospora outbreak information, go to Outbreak Investigation.

Healthwatch: Cyclospora outbreak prompts food safety tips
Source : Healthwatch: Cyclospora outbreak prompts food safety tips
By Tom Lehman (July 30, 2013)
A rash of Cyclospora cases across the U.S. is prompting Delaware health officials to remind the public about safe food habits.
WDEL's Tom Lehman has more in this week's WDEL Delaware HealthWatch.
Emily Knearl with the Division of Public Health says Cyclospora infections are caused by a parasite that can cause symptoms such as diarrhea, weight loss, cramping, bloating, gas, nausea and fatigue.
"It actually occurs when people consume food or water that is contaminated with the parasite," Knearl says.
Knearl says only one person currently in Delaware has come down with Cyclospora.
"The bug was acquired from out of the country, but we do think it's an important opportunity to remind people how to prevent foodborne illnesses during the summertime," she says.
If you're storing food, it's recommended that you keep it refrigerated and prepared properly to safeguard against foodborne illnesses.
"We're also telling people to cook food--ground beef, meat and eggs--to an internal temperature of 155 degrees Fahrenheit and these foods should be served hot," she says.
She also says you should avoid putting cooked food back on the same surface where it was once raw.
If you do come down with an illness like Cyclospora, it's also recommended that you take slow, controlled sips of water to stay hydrated without causing additional vomiting.

CDC Encouraging Telediagnosis in Cyclospora Outbreak
Source :
By Linda Larsen (July 29, 2013)
The Centers for Disease Control and Prevention is encouraging a new way to confirm cases in the multi-state Cyclospora outbreak called telediagnosis. Public health officials say that labs should use this method, which lets state health labs submit images showing suspected Cyclospora oocysts to the CDC. So far, 33 cases have been confirmed in CDC labs.
At least 363 people have been sickened in this outbreak. Our numbers are different from the CDCs numbers because we call each health department individually to get the latest updates. So far, at least 21 people in three states have been hospitalized for complications from this illness. Most of the illness onset dates in this outbreak have ranged from mid-June through early July. The outbreak is growing by the day, and now fifteen states have been affected.
Health officials do not know if all of the reported cases are linked to the same contaminated food. Some agencies suspect the cause is imported vegetables, but no single food has been fingered.
To help protect yourself, thoroughly wash all fruits and vegetables before eating and preparation. Parasites and bacteria can cling to food, especially food with crenelated surfaces such as lettuce and raspberries. But it can be difficult to wash the oocysts of the Cyclospora parasite off the produce.
If you have experienced the symptoms of a Cyclospora infection, including watery diarrhea, fatigue, loss of appetite, stomach cramps, muscle aches, nausea, and vomiting, see your health care provider. The symptoms of this infection can recur more than once if the illness is not treated. And since the most effective treatment for a Cyclospora infection is sulfa, which many people are allergic to, treatment can be difficult.

Food safety prosecutions up 50%
Source :
By Lu Chen (July 29, 2013)
Shanghai prosecutors have charged 34 people with food safety crimes in the first half of this year as the city cracked down on crimes that directly affect residents' daily lives, the Shanghai Municipal People's Prosecutor's Office said Monday.
Prosecutors across the city brought 50 percent more food safety cases to court compared with the same period last year, according to a press release from the Shanghai Municipal People's Prosecutor's Office.
The rise in the number of cases shows the government has strengthened the enforcement of food safety laws due to the danger that violations pose to public health, the prosecutor's office said.
The cases involved a variety of violations, such as recycling used cooking oil and moon cake filling.
In one case, Fengxian district prosecutors accused five people from Shanghai Panpan Food Co Ltd of mixing expired moon cake filling with the new filling that the company was producing for the seasonal holiday treat.
Local food safety inspectors received a tip from one of the company's workers on August 7, 2012. A subsequent test found that the filling failed to meet bacteria standards, according to a report in the Xinmin Evening News.
The company's owners had decided to reuse the expired filling to save money, the report said. The company had been suffering financial difficulties from poor sales.
It ended up selling nearly 100,000 yuan ($16,309) worth of moon cakes to local supermarkets and buyers from other provinces.
The number of cases involving counterfeit and substandard goods accounted for 46.5 percent of the total number of cases that directly related to people's daily lives, the prosecutor's office said.
In the first six months, prosecutors charged 447 people in 278 cases that involved manufacturing counterfeit products with registered trademarks, manufacturing counterfeit drugs and producing other substandard products, the press release said.
Of the 91 people charged in 76 cases, 96 percent were involved with the sale of fake contraceptives and other sex-related drugs.

Publisher’s Platform: It is Past Time to Step Up on Foodborne Illness Surveillance
Source :
By Bill Marler (July 29, 2013)
Cyclospora outbreak going on since June 1 and we do not know the source.
Did you hear the joke about the two doctors and a trial lawyer?
I am sure there might be something funny here if it were not that part of the story involves 321 sick with Cyclospora in 15 states and me getting a bit between Dr. Patricia Quinlisk, medical director for the Iowa Department of Public Health and Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, in an recent article by Tony Leys of the Des Moines Register entitled: “Iowa’s Cyclospora response criticized – Expert: Source should have been pinpointed quickly.”
In a nutshell the unfunny joke goes something like:
“If this same number of cases had happened in Minnesota as happened in Iowa, this would have been solved weeks ago.”  – Dr. Osterholm
“I guess it’s easy to be critical if you’re not involved in the investigation.”  – Dr. Quinlisk
“It seems to me that by now the health departments and the CDC and the FDA should have identified the products.” “[I] don’t know all the details of the investigation, [but I agree] with Osterholm that the Minnesota health department, along with the one in Oregon, often manages to quickly track down the source of tainted food.”  – Ambulance Chaser Marler
The reality is that Minnesota’s and Oregon’s foodborne illness surveillance works and works well.  They work in large part because of the people and the commitment to good epidemiology.  The goal for both is to find the source of the outbreak fast so illnesses are stopped as quickly as possible and so the correct food product gets off the shelves.  There is a misconception that you must go slowly to confirm that the right product is implicated.  In 20 years of following foodborne illness outbreaks worldwide, I have not seen Minnesota’s and Oregon’s prompt responses name a wrong product or manufacturer.
Beyond stopping an outbreak is the traceback to the source so lessons can be learned to prevent another outbreak.  Minnesota and Oregon do not wait for the U.S. Food and Drug Administration or the USDA’s Food Safety and Inspection Service to do a product traceback. Certainly, the Feds play a role, but there have been times in the past where federal traceback was unusually slow and manufacturers, shippers and retailers were left unnamed.
In Minnesota, Team D (D for diarrhea) is a squad of graduate students at the University of Minnesota School of Public Health and epidemiologists at the Minnesota Department of Health (MDH) performing epidemiological interviews in trace back investigations. Armed with tantalizing knowledge of the gastrointestinal system, telephones, and a lot of gumption, the work of Team D gives Minnesota an unusual prowess in cracking some of the most infamous foodborne illness cases in the U.S.
By Minnesota state law (oddly, only 35 states in the U.S. mandate Cyclospora as reportable), doctors must send stool cultures believed to be from cases of foodborne illness to the MDH laboratory where they are pulsed field gel electrophoresis (PFGE) tested to create DNA finger printing – which tell investigators if different samples likely came from a common host.  Team D gets to work immediately, interviewing the victims, often as they are suffering symptoms, looking for commonalities in what, where, and when they ate. Whereas some states may take weeks to perform the interview portion of an investigation, it is this real-time history gathering that adds an invaluable level of depth to trace back investigations, something it seems that this Cyclospora outbreak desperately needs.
Team D is a model that all states should emulate.
Of course, you cannot do without individual knowledge.  Dr. William Keene, senior epidemiologist is the top foodborne illness investigator at Oregon’s Division of Public Health. Keene has been unraveling the path of pathogens from victims to the source for over 30 years, and has an impressive list of solved cases under his belt.  One of his most valuable contributions to the food safety world is the shotgun questionnaire, which lists hundreds of foods for foodborne illness victims to choose from to help them recall what they recently ate.
But, do not take it just from me.
In 2011, the Center for Science in the Public Interest released a nationwide report card grading the 50 states and the District of Columbia on how well they detect, investigate, and report outbreaks of foodborne illness (See Report). The report shows that there is a need for improvement. CSPI assigned a letter grade and created an outbreak profile for each state.
A: Oregon, Minnesota, Florida, Hawaii, Maryland, Washington, and Wyoming.
B: Colorado, Illinois, Kansas, Maine, Michigan, Ohio, and Vermont.
C: Alabama, Alaska, California, Connecticut, Iowa, New Hampshire, North Dakota, and Wisconsin.
D: Delaware, the District of Columbia, Georgia, Idaho, Massachusetts, Montana, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah and Virginia.
F: Arizona, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, Oklahoma, South Carolina, Texas, and West Virginia.
In addition to states being committed quickly and accurately seeking the source of a foodborne illness outbreak, perhaps too the answer to the low grades and the lack of a source in this Cyclospora outbreak may lie in overlooked Sec. 205 of the Food Safety Modernization Act.  The Section should:
- Coordinate Federal, State and local systems, including complaint systems and networks of public health, food regulatory agencies and labs;
- Facilitate sharing of findings between FDA, USDA, State and local agencies, and the public;
- Develop improved epidemiological tools;
- Improve systems that attribute an outbreak to a specific food;
- Expand fingerprinting and other detection strategies for food-borne agents;
- Allow public access to aggregated, de-identified surveillance data;
- Publish findings at least yearly;
- Rapidly initiate scientific research by academic institutions;
- Integrate surveillance systems and data with other bio surveillance and public health entities.
Also, is the creation of “PARTNERSHIPS,” which appears to actually be a “working group of experts and stakeholders from Federal, State and local food safety and health agencies, the food industry, consumer organizations and academia.”  In addition, Sec. 205 (c) adds “strengthen[ing] the capacity of State and local agencies to carry out inspections and enforce safety standards” and, “the Secretary to (within a year) complete a review of State and local capacities, including staffing levels, laboratory capacity, outbreak response, inspection and enforcement functions.”
Stopping outbreaks sooner, means less ill people. Honestly, that is not good for my business. Tracing it to the source gives everyone a better understanding of how the outbreak happened and what can be done to prevent the next one.  Hmm, that does not help my bottom line either.
So, if the states and the federal government did a better job of figuring out foodborne illness outbreaks, there would be fewer ill people and fewer outbreaks?
Wait, I just figured out, this joke could well be on me!

Experts weigh in on new rules for food safety
Source :
By Taunya English, @taunyaenglish (July 29, 2013)
Food industry experts and consumer advocates are poised to offer their opinion of a proposed rule that would shift more oversight responsibility to the companies that import food into the United States.
Right now government inspectors physically check only about 2 percent of U.S. food imports.
Sandra Eskin, head of the food safety project at the Pew Charitable Trusts, said the proposed rules enlist more on-the-ground help by requiring companies to better track the safety profile of the food they bring into the states.
"The importer is the responsible party who should be the one who assures the safety," Eskin said.
An outbreak of hepatitis A this summer was linked to imported pomegranate seeds from Turkey and, once again, underscored the need for more oversight. Eskin said the new rule gives the U.S. Food and Drug Administration another tool to protect consumers.
"So FDA could go to the importer and say: 'Let me see your records. Let me see the evidence that you have that certifies, that assures, that verifies that the product you are importing is safe,'" she said.
What happens next--be it fines or a simple block on a particular import--isn't entirely clear. Eskin and other watchdogs say they're still digging into the proposed rules to figure if the rule has regulatory teeth.
"I don't think anything's going to be foolproof," said Martin Bucknavage, a senior food safety extension associate based at Penn State University.
"There are many things that can happen in the food supply chain, but certainly, it helps set standards for companies that are going to make shipments to the United States."
Bucknavage said the proposed rules also establish a system of third-party auditors to keep tabs on importer activities.
Nearly two-thirds of all fruits and vegetables consumed here, come from outsides the U.S., according to the FDA.
Overall, the American appetite for foreign foods is growing, according to FDA data. But after a health scare this summer, one central California family is wary.
Polly Sirles's husband Aaron fell ill with hepatitis A after the family drank smoothies made with frozen organic berries from Townsend Farms which were sold at Costco and linked to the hep A illness.
Aaron was out of work for four weeks, and Sirles says her husband's medical bills are near $70,000.
The Sirles family plans on eating only local food--for a little while at least.
"It will absolutely be a higher price for my family, but this has absolutely turned our family upside down," Sirles said. "I'm not willing to take the risk right now."
Sirles said she's hopeful the new rule for importers will improve food safety, but she'd like to see more government inspectors on the job too.
"Being someone who's gone through the nightmare of having something contaminated," she said, "I just need everybody to step up, it has definitely changed my view of how I'm going to purchase in the future."




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