12/09 2013 ISSUE:577
KFC Brings Buckets of Chicken Into Nations
With Food Safety Risks
Source : http://www.businessweek.com/articles/2013-12-06/kfc-brings-buckets-of-chicken-into-nations-with-food-safety-risks
By Venessa Wong (Dec 06, 2013)
Yum! Brands (YUM) will continue its bold push to bring Colonel Sanders
into new territories despite a year of problems in China, the company’s
single-largest market in terms of revenue. This week executives reaffirmed
their commitment to opening more KFC restaurants in both China and
India as well as Russia, Indonesia, Pakistan, Nigeria, Vietnam, Egypt,
Thailand, South Africa, and Malaysia.
Growing in emerging markets is not without its problems, and Yum dwells
on the risks from such factors as disease outbreaks in its annual
report. About 60 percent of the world’s nations—spanning
from Mongolia to Argentina—now have a KFC. Over the next seven
years, Yum plans to invest $10 billion in emerging markets; in 2014
alone, Yum will open 600 new fried chicken outlets on top of the 18,000
KFCs already spread across 120 countries. (Other fast-food chains
like McDonald’s (MCD) and Subway also intend to grow quickly
in these regions.)
Yet KFC’s year-long China debacle highlights how developing
countries combine tremendous opportunity with potentially damaging
problems. The chain is just starting to show signs of stabilizing
after food safety issues tanked sales in China, with same-store sales
flat last month—through help from a limited-time promotion—after
falling every month in 2013 except February. Yum expects “a
strong bounce back” in 2014.
STORY: KFC's Big Bucket of Problems in China
Some of the markets mentioned at its investor conference this week—Vietnam,
India, Pakistan, Indonesia, and Nigeria—rank lower than China
for their food safety environment, according to the Economist Intelligence
Unit’s Global Food Security Index. The ranking, one of many
indicators factored into the larger index, “measures the enabling
environment for food safety. Sub-indicators include: existence of
agency to ensure health/safety of food; access to potable water; presence
of formal grocery sector,” according to the methodology. This
is how the countries fared:
Yum doesn’t seem deterred. Asked about concerns about
food safety in emerging markets, Yum spokesman Jonathan Blum responded
in an e-mail: “We have high food safety standards and requirements
everywhere we operate. We take food safety very seriously.”
KFC is betting consumers’ hunger for well-known American brands
in these areas will keep restaurants busy. “These countries
are coming out, and for them, KFC is a big deal,” Micky Pant,
KFC’s new chief executive officer, explained at the investor
event in New York. “It’s a sign of arrival. You were part
of the community of nations. You get food that you’ve been denied
all along.” So get ready, developing world: The fried chicken’s
on its way.
KFC's Food Safety Campaign Backfiring With
Source : http://investorplace.com/2013/12/kfcs-food-safety-campaign-backfiring-chinese-consumers/
By Karl Utermohlen, InvestorPlace Writer (Dec 4, 2013)
39% of Chinese consumers are concerned about KFC's health practices
Yum Brands’ (YUM) KFC website in China is asking consumers to
trust in the restaurant’s products once again after losing many
customers last year.
website has the slogan “Trust in every bite” which is
part of the chain’s ‘I Commit’ campaign, according
to Reuters. The campaign intends to win back some of its customers
after being scared away by a Dec. 2012 report of Yum using too many
antibiotics in a few of its KFC suppliers. A recent poll surveyed
1,000 consumers and it showed that 39% of them are still concerned
about the Yum’s use of antibiotics. Some consumers have even
said that the ’I Commit’ campaign has pushed them even
further from the company’s chicken.
Yum has about 4,500 restaurants in China which make it the largest
Western restaurant chain in the country. Additionally, KFC restaurants
in China account for about half of chain’s total revenue. The
Shanghai Food and Drug Administration investigated the report’s
claims and they found no evidence of KFC’s chicken being contaminated.
Food Safety Microbiology Training course is now open
Program of Course
(8 hours training)
History of Food Microbiology
Growth Factors for microorganisms
Instrinsic/Extrinsic Factors for microbial growth
Gram Negative bacteria
Gram Positive bacteria
Spore forming bacteria
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Importance of Spore forming bacteria in food
Details for Foodborne pathogens
Pathogenesis and importance of
STEC and E. coli O157:H7
ETEC, EPEC, EHEC, EIEC, EAEC, DAEC
Salmonella/Listeria monocytogenes/Staphylococcus aureus
Bacillus cereus/Clostridium spp./Alicyclobacillus
FDA BAM methods
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DNA Based methods
Immunoassay Based methods
Hurdle Technology to control pathogens
Food Safety Tips for Severe Weather
Source : http://foodpoisoningbulletin.com/2013/food-safety-tips-for-severe-weather/
By Linda Larsen (Dec 6, 2013)
The USDA is offering food safety tips for those affected by severe storms. Power outages from weather emergencies can cause food safety problems. The agency is also offering a video broadcast on this topic you can watch. FSIS also provides food safety information as storms progress from its Twitter feed @USDAFoodSafety.
Before the storm, make sure you have appliance thermometers in your fridge and freezer. Safe temperatures are 40 degrees F or lower in the refrigerator, and 0 degrees F or lower in the freezer. Freeze water in one quart containers before the storm. This will ensure you have fresh water available, and the frozen containers can be used to help keep food in your fridge safe. Freeze leftovers and other items before the storm, since the freezer will keep food safer longer than the fridge. Know where you can get dry ice or block ice.
If the power goes out, keep the refrigerator and freezer doors closed as much as possible. A refrigerator will keep food safe for 4 hours, while a full freezer will hold a safe temperature for 48 hours (24 hours if half-full). Use ice to keep the fridge as cold as you can during an extended outage. Fifty pounds of dry ice can keep a fully stocked freezer cold for two days.
Check the temperature inside the fridge and freezer after the power goes back on. Discard perishable food that has been above 40 degrees F for two hours or longer. Check each food item. Throw out any food above 40 degrees F. If frozen food still has ice crystals, it can be refrozen.
Never taste a food to see if it’s safe. And when in doubt, throw it out.
What is it about Norovirus?
Source : http://www.foodpoisonjournal.com/food-poisoning-information/what-is-it-about-norovirus/
By Bill Marler (Dec 7, 2013)
An Introduction to Norovirus
The Centers for Disease Control and Prevention (CDC) estimates that noroviruses cause nearly 21 million cases of acute gastroenteritis annually, making noroviruses the leading cause of gastroenteritis in adults in the United States. [5, 9, 13, 31] According to a relatively recent article in the New England Journal of Medicine:
The Norwalk agent was the first virus that was identified as causing gastroenteritis in humans, but recognition of its importance as a pathogen has been limited because of the lack of available, sensitive, and routine diagnostic methods. Recent advances in understanding the molecular biology of the noroviruses, coupled with applications of novel diagnostic techniques, have radically altered our appreciation of their impact. Noroviruses are now recognized as being the leading cause of epidemics of gastroenteritis and an important cause of sporadic gastroenteritis in both children and adults. 
Of the viruses, only the common cold is reported more often than a norovirus infection—also referred to as viral gastroenteritis. 
Nature has created an ingenious bug in norovirus.  The round blue ball structure of norovirus is actually a protein surrounding the virus’s genetic material. [16, 33] The virus attaches to the outside of cells lining the intestine, and then transfers its genetic material into those cells.  Once the genetic material has been transferred, norovirus reproduces, finally killing the human cells and releasing new copies of itself that attach to more cells of the intestine’s lining. [12, 15, 33]
Norovirus (previously called “Norwalk-like virus” or NLV) is a member of the family Caliciviridae. [15, 33] The name derives from the Latin for chalice—calyx—meaning cup-like, and refers to the indentations of the virus surface.  The family of Caliciviridae consists of several distinct groups of viruses that were first named after the places where outbreaks occurred.  The first of these outbreaks occurred in 1968 among schoolchildren in Norwalk, Ohio.  The prototype strain was identified four years later, in 1972, and was the first virus identified that specifically caused gastroenteritis in humans. [16, 33] Other discoveries followed, with each strain name based on the location of its discovery—e.g., Montgomery County, Snow Mountain, Mexico, Hawaii, Parmatta, Taunton, and Toronto viruses. [15, 21] A study published in 1977 found that the Toronto virus was the second most common cause of gastroenteritis in children.  Eventually this confusing nomenclature was resolved, first in favor of calling each of the strains a Norwalk-like virus, and then simply, a norovirus – the term used today. [16, 33]
Humans are the only host of norovirus, and norovirus has several mechanisms that allow it to spread quickly and easily.  Norovirus infects humans in a pathway similar to the influenza virus’ mode of infection. [5, 15, 33] In addition to their similar infective pathways, norovirus and influenza also evolve to avoid the immune system in a similar way.  Both viruses are driven by heavy immune selection pressure and antigenic drift, allowing evasion of the immune system, which results in outbreaks. [21, 30] Norovirus is able to survive a wide range of temperatures and in many different environments. [15, 33] Moreover, the viruses can spread quickly, especially in places where people are in close proximity, such as cruise ships and airline flights, even those of short duration. [14, 15] As noted by the CDC in its Final Trip Report,
noroviruses can cause extended outbreaks because of their high infectivity, persistence in the environment, resistance to common disinfectants, and difficulty in controlling their transmission through routine sanitary measures. 
Norovirus outbreaks can result from the evolution of one strain due to the pressure of population immunity. [12, 32] Typically, norovirus outbreaks are dominated by one strain, but can also involve more than one strain. [9, 11, 15] For example, some outbreaks associated with shellfish have been found to contain up to seven different norovirus strains. [30, 38] Swedish outbreak studies also reveal a high degree of genetic variability, indicating a need for wide detection methods when studying these outbreaks. 
By way of further example, in 2006, there was a large increase in the number of norovirus cases on cruise ships. Norovirus cases were increasing throughout Europe and the Pacific at the same time.  One issue with cruise ships is the close contact between people as living quarters are so close, and despite education efforts, there still seems to be a lack of public understanding regarding how the illness is spread. [7, 14] On the other hand, reporting occurs much more quickly in these situations because of the close proximity and concentration of illness, allowing for the quicker detection of outbreaks.  Cruise ship outbreaks often occur when new strains of norovirus are appearing, providing a good indicator system for new norovirus strains. [7, 8] In this case, two new variants appeared within the global epidemic genotype, suggesting a strong pressure for evolution against the human immune system.  This points to the need for an international system of guidelines in tracing norovirus outbreaks. 
How is norovirus transmitted?
Norovirus causes nearly 60% of all foodborne illness outbreaks.  Norovirus is transmitted primarily through the fecal-oral route, with fewer than 100 norovirus particles needed to cause infection. [10, 15, 33] Transmission occurs either person-to-person or through contamination of food or water. [1, 15, 33] CDC statistics show that food is the most common vehicle of transmission for noroviruses; of 232 outbreaks of norovirus between July 1997 and June 2000, 57% were foodborne, 16% were spread from person-to-person, and 3% were waterborne. [6, 31] When food is the vehicle of transmission, contamination occurs most often through a food handler improperly handling a food directly before it is eaten. [4, 9, 10]
Infected individuals shed the virus in large numbers in their vomit and stool, shedding the highest amount of viral particles while they are ill. [5, 33] Aerosolized vomit has also been implicated as a mode of norovirus transmission.  Previously, it was thought that viral shedding ceased approximately 100 hours after infection; however, some individuals continue to shed norovirus long after they have recovered from it, in some cases up to 28 days after experiencing symptoms. [28, 31, 35] Viral shedding can also precede symptoms, which occurs in approximately 30% of cases.  Often, an infected food handler may not even show symptoms.  In these cases, people can carry the same viral load as those who do experience symptoms. [5, 9, 33]
A Japanese study examined the ability of asymptomatic food handlers to transfer norovirus. Approximately 12% of asymptomatic food handlers were carriers for one of the norovirus genotypes.  This was the first report of norovirus molecular epidemiology relating asymptomatic individuals to outbreaks, suggesting that asymptomatic individuals are an important link in the infectivity pathway. [15, 28] Asymptomatic infection may occur because some people may have acquired immunity, which explains why some show symptoms upon infection and some do not. [16, 28, 33] Such immunity does not last long, though. [16, 21, 28] These discoveries reveal just how complicated the pathway of norovirus infection is, as well as how difficult it is to define the true period of infectivity.  Furthermore, it remains unclear why some people do not become sick with norovirus even when they are exposed. [16, 21, 32] Very little is known about the differences in hygiene practices, behaviors, and personal susceptibility between those who become infected and those who do not, which brings up the potential for more research.  Discrepancies exist in the published research about infective doses for norovirus, with earlier studies having used a much higher dose to trigger immune responses. 
Symptoms & Risks of Norovirus Infection
Norovirus illness usually develops 24 to 48 hours after ingestion of contaminated food or water. [5, 16, 33] Symptoms typically last a relatively short amount of time, approximately 24 to 48 hours. [5, 25] These symptoms include nausea, vomiting, diarrhea, and abdominal pain. Headache and low-grade fever may also accompany this illness. [5, 25, 33] People infected with norovirus usually recover in two to three days without serious or long-term health effects. [5, 25]
Although symptoms usually only last one to two days in healthy individuals, norovirus infection can become quite serious in children, the elderly, and immune-compromised individuals. [10, 18, 33] In some cases, severe dehydration, malnutrition, and even death can result from norovirus infection, especially among children and among older and immune-compromised adults in hospitals and nursing homes. [25, 30] In England and Wales, 20% of those over the age of 65 die due to infectious intestinal illness other than Clostridium difficile.  Recently, there have been reports of some long-term effects associated with norovirus, including necrotizing entercolitis, chronic diarrhea, and post-infectious irritable bowel syndrome, but more data is needed to support these claims. 
Diagnosing a Norovirus Infection
Diagnosis of norovirus illness is based on the combination of symptoms, particularly the prominence of vomiting, little fever, and the short duration of illness. [5, 25, 33] If a known norovirus outbreak is in progress, public health officials may obtain specimens from ill individuals for testing in a lab. [5, 9] These lab tests consist of identifying norovirus under an electron microscope. A reverse transcriptase polymerase chain reaction test (RT-PCR assay) also can detect norovirus in food, water, stool samples, and on surfaces. These tests isolate and replicate the suspected virus’ genetic material for analysis. [25, 33] An ELISA can also be performed, which detects antigens. They are easier to perform than RT-PCR, but less sensitive and can also result in many false negatives. [9, 11]
Treating a Norovirus Infection
There is no specific treatment available for norovirus. [16, 33] In most healthy people, the illness is self-limiting and resolves in a few days; however, outbreaks among infants, children, elderly, and immune-compromised populations may result in severe complications among those affected. [16, 27, 30, 33] Death may result without prompt measures. [5, 16, 25, 33] The replacement of fluids and minerals such as sodium, potassium and calcium – otherwise known as electrolytes – lost due to persistent diarrhea is vital. This can be done either by drinking large amounts of liquids, or intravenously. [16, 25]
Recent research has looked into the potential for developing a norovirus vaccine. [9, 16, 37] Researchers indicate that coming up with a norovirus vaccine would be similar to vaccinating for influenza, by using screening in order to select for the most prevalent strains. This is a quite challenging process.  Other challenges include the fact that cell culture and small-animal models are limited, host pre-exposure histories are complicated, and there is always the potential for the evolution of novel immune escape variants, rendering the vaccine useless. [13, 33] Furthermore, scientists would likely face a lack of funding to develop a vaccine because vaccine development is expensive. [12, 21]
Preventing Norovirus Infection
Common settings for norovirus outbreaks include restaurants and events with catered meals (36%), nursing homes (23%), schools (13%), and vacation settings or cruise ships (10%).  Proper hand washing is the best way to prevent the spread of norovirus. [9, 17, 25]
The good news about norovirus is that it does not multiply in foods as many bacteria do. [5, 31, 33] In addition, thorough cooking destroys this virus. [5, 25] To avoid norovirus, make sure the food you eat is cooked completely. [5, 9, 10] While traveling in in areas that have polluted water sources, raw vegetables should be washed thoroughly before being served, and travelers should drink only boiled drinks or carbonated bottled beverages without ice. [9, 16]
Shellfish (oysters, clams, mussels) pose the greatest risk and any particular serving may be contaminated with norovirus; there is no way to detect a contaminated oyster, clam, or mussel from a safe one. [5, 31] Shellfish become contaminated when their waters become contaminated—e.g., when raw sewage is dumped overboard by recreational or commercial boaters). [19, 33] Shellfish are filter feeders and will concentrate virus particles present in their environment. With shellfish, only complete cooking offers reliable protection; steaming does not kill the virus or prevent its transmission.  Some researchers suggest that norovirus monitoring in shellfish areas could be a good preventive strategy as well.  Waterborne norovirus outbreaks are ubiquitous, but difficult to recognize. Improved analysis of environmental samples would have the potential to significantly improve the detection for norovirus in shellfish waters. 
Finally, and as briefly mentioned earlier, outbreaks of norovirus infections have become synonymous with cruise ships. [7, 8, 36] Healthcare facilities also experience a high incidence of norovirus outbreaks. [6, 30, 35]The CDC has published information regarding the prevention of norovirus outbreaks on cruise ships and in healthcare facilities on its website. [6, 7] Once a case has occurred, even more stringent hygienic measures than normal are required in order to prevent an outbreak, particularly on an enclosed space such as a cruise ship. 
Bill Marler is an accomplished personal injury and products liability attorney. He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the Jack in the Box E. coli O157:H7 outbreak. Bill settled Brianne’s case for $15.6 million, creating a Washington state record for an individual personal injury action.
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The Truth About Pork and How America Feeds Itself
Source : http://www.businessweek.com/articles/2013-12-05/food-safety-risk-as-pork-processors-face-fewer-usda-meat-inspectors
By Ted Genoways (Dec 05, 2013)
The Hormel Foods (HRL) plant in Fremont, Neb., is a sprawling complex, just across the Union Pacific tracks on the southern edge of town. Every day of the week, some 1,400 workers arrive before dawn and emerge in the midafternoon, chatting briefly in the parking lot before fanning out onto the highway. It’s a routine with few surprises, but inside the plant, a grand, if largely ignored, experiment is under way, one that is testing the limits of industrial production—and worker and food safety.
Each working day, more than 10,500 hogs are slaughtered here—that’s 1,300 hogs per hour
Each working day, more than 10,500 hogs are slaughtered here—their carcasses butchered into parts and marketed as Cure 81 hams or Black Label bacon, the scraps collected and ground up to make Little Sizzlers breakfast sausages. That’s 1,300 hogs per hour, a 33 percent jump in the last decade. To make that happen, Hormel invested $7 million in a plant expansion in 2005 and added an additional 20,000 square feet in early 2012 to meet demand for its signature product, Spam. “We’ve been fortunate enough to be doing business in Fremont, Neb., producing Spam since 1947,” Donnie Temperley, then the plant manager, told the local newspaper. “The people at the plant are very proud of what they do. They’re outstanding employees.”
What few people, even at the Fremont plant, appreciate is that its remarkable production increases stem from a special program piloted by the U.S. Department of Agriculture in 1997. The program cut the number of Food Safety and Inspection Service (FSIS) inspectors on the processing line from seven to four and permitted participating companies to accelerate line speeds in five pork-processing plants: Excel in Beardstown, Ill.; Hatfield Quality Meats in Hatfield, Pa.; Farmer John in Vernon, Calif.; Quality Pork Processors (QPP) in Austin, Minn.; and Hormel Foods in Fremont.
STORY: Starting With Pork Butt, the Meat Industry Rebrands
The idea for the program sounded promising: If plants hired their own quality-assurance officers to sort out diseased carcasses and parts before they reached government inspectors, then, proponents theorized, there would be fewer carcasses for the USDA to inspect and reject. This weed-out of diseased animals earlier in the process would reduce the chance of food contamination; it would also allow plants the flexibility to devise their own inspection processes, rather than adhering to rigid cookie-cutter requirements; and, best of all, these efficiencies would streamline production, reducing the cost of pork for consumers.
Almost from the moment the program was fully implemented in 2003, the participating meatpackers saw huge benefits. In 2004, Excel and Hatfield achieved the largest production increases (measured by total number of swine) of any two packers in the U.S. The other three plants accelerated production for Hormel—not just at the official Hormel plant in Fremont, but also at QPP, which bills itself as a “custom packer” for Hormel, and at Farmer John, which Hormel purchased at the end of 2004. Thus, for the last decade, Hormel’s three cut-and-kill operations—the plants that supply all 9.4 million hogs annually for its operation nationwide—have been among these select five plants that have profited from dramatically increased line speeds.
Hormel’s corporate strategy since the start of the millennium has been to expand into new product lines and buy up existing brands such as Lloyd’s Barbeque to get its pork into a wider range of ready-made products—and reap greater profits. In 2007, Chief Executive Officer Jeffrey Ettinger announced that Hormel was generating $1 billion in annual sales from products introduced since 2000. That number has since doubled.
But if packers have been delighted by the increased output, workers’ rights advocates say that runaway production increases have also jeopardized safety. While employees have always experienced challenging conditions along the cut line, Darcy Tromanhauser, program director for Immigrants & Communities at the Nebraska Appleseed Center for Law in the Public Interest, warns that line speeds in meatpacking plants are now “dangerously fast.” In September a coalition of civil rights groups, led by Nebraska Appleseed and the Southern Poverty Law Center, called on the U.S. Occupational Safety and Health Administration (OSHA) and the USDA to “reduce the speed of the processing line to minimize the severe and systemic risks faced by workers,” such as repetitive stress injuries and cuts and amputations, which affect meatpacking workers at alarming rates.
CDC Warns: Don't Eat;Tiger Meat or Cannibal
Sandwiches; in Wisconsin
Source : http://www.marlerblog.com/case-news/cdc-warns-dont-eat-tiger-meat-or-cannibal-sandwiches-in-wisconsin/
By Bill Marler (Dec 5, 2013)
Probably, a good rule in all states.
Like some look forward to their favorite magazine, I look forward
to receiving my copy – now online – of the
CDC’s Morbidity and Mortality Weekly Report (MMWR). This
week came with the reminder that people in Wisconsin need to pay a
bit more attention to food safety.
On January 8, 2013, the Wisconsin State Laboratory of Hygiene notified
the Wisconsin Division of Public Health (WDPH) of two patients with
Escherichia coli O157:H7 clinical isolates that had indistinguishable,
but commonly identified, pulsed-field gel electrophoresis (PFGE) patterns.
The two patients were interviewed by local health departments within
1 day of the initial report. They revealed that they had eaten raw
ground beef purchased from the same meat market and served as “tiger
meat” or “cannibal sandwiches.” In this dish, the
raw ground beef typically is served on rye bread or crackers with
onions and is a traditional winter holiday specialty in certain regions
of the upper Midwest. Five agencies (the Watertown Department of Health;
WDPH; Wisconsin Department of Agriculture, Trade, and Consumer Protection;
U.S. Department of Agriculture’s Food Safety and Inspection
Service; and CDC) investigated to determine the magnitude of the outbreak,
prevent additional infections, and better understand raw ground beef
Wisconsin folks, don’t do it.
Salmonella Action Plan; Quietly Released by FSIS
Source : http://www.foodpoisonjournal.com/food-policy-regulation/salmonella-action-plan-quietly-released-by-fsis/
By Bill Marler (Dec 4, 2013)
The U.S. Department of Agriculture’s (USDA) Food Safety and
Inspection Service (FSIS) today released its Salmonella Action Plan
that outlines the steps it will take to address the most pressing
problem it faces–Salmonella in meat and poultry products. An
estimated 1.3 million illnesses can be attributed to Salmonella every
“Far too many Americans are sickened by Salmonella every year.
The aggressive and comprehensive steps detailed in the Salmonella
Action Plan will protect consumers by making meat and poultry products
safer.” said Under Secretary for Food Safety Elisabeth Hagen.
The Salmonella Action Plan is the agency’s strategy to best
address the threat of Salmonella in meat and poultry products.
The plan identifies modernizing the outdated poultry slaughter inspection
system as a top priority. By focusing inspectors’ duties solely
on food safety, at least 5,000 illnesses can be prevented each year.
Enhancing Salmonella sampling and testing programs is also part of
this comprehensive effort, ensuring that these programs factor
in the latest scientific information available and account for emerging
trends in foodborne illness. Inspectors will also be empowered with
the tools necessary to expeditiously pinpoint problems. With
more information about a plant’s performance history and with
better methods for assessing in-plant conditions, inspectors will
be better positioned to detect Salmonella earlier, before it can cause
In addition, the plan outlines several actions FSIS will take to drive
innovations that will lower Salmonella contamination rates, including
establishing new performance standards; developing new strategies
for inspection and throughout the full farm-to-table continuum; addressing
all potential sources of Salmonella; and focusing the Agency’s
education and outreach tools on Salmonella.
These efforts will build upon the work that USDA has done over the
past several years. In 2011, USDA strengthened the performance standards
for Salmonella in poultry with a goal of significantly reducing illnesses
by 20,000 per year. And through the Salmonella Initiative Program,
plants are now using processing techniques designed to directly reduce
Salmonella in raw meat and poultry. Thanks to these innovative
technologies and tough policies, Salmonella rates in young chickens
have dropped over 75 percent since 2006.
Oregon food safety sleuth praised as pioneer
Source : http://www.capitalpress.com/article/20131204/ARTICLE/131209961
By LYNNE TERRY (Dec 4, 2013)
William "Bill" Keene, Oregon's top food safety sleuth, died Sunday at age 56. He was a pioneer in tracking down the causes of food poisoning.
PORTLAND, Ore. (AP) — The first reports of illness trickled in, just as they always do, to the offices of William “Bill” Keene, Oregon’s top food safety sleuth. The outbreak involved a potentially deadly strain of E. coli. Keene and his colleagues sprang into action, interviewing victims on the phone. What had they eaten? Where? When?
They quickly pinpointed local strawberries as the likely culprit. But in 2011, when the outbreak hit, no one had ever heard of strawberries carrying E. coli O157:H7. How could that happen?
Keene had a theory: contaminated deer droppings. So, he tromped through the strawberry fields in Yamhill County, collecting pellets. Turns out they were contaminated with E. coli O157:H7.
Keene was right, as usual.
A brilliant scientist, a man who mentored many and transformed the way food safety investigations are done nationwide, Keene is gone. He passed away Sunday afternoon after a two-week bout with acute pancreatitis caused by gallstones. He was only 56.
His family, friends and colleagues coast-to-coast are devastated. At least one of his co-workers in the Oregon Public Health Division, where Keene was senior epidemiologist, stayed home Monday to grieve. Others dragged themselves around the office, teary eyed. Most found it difficult to grasp that he’s gone.
“I think we’re all pretty much in denial,” said Dr. Katrina Hedberg, Oregon’s state epidemiologist.
A long Oregon Public Health Division statement that listed Keene’s numerous accomplishments summed him up as an individual of “superior intelligence, uncompromising candor, dry wit and quirky personality.”
He grew up in a middle-class family with four siblings in the Seattle area. His older brother, Dr. David Keene, a Los Angeles-area pediatrician, said Keene was ever mischievous, even surprising his mother by being born during a snowstorm in the bathroom. During high school, Keene treated himself to several graduations by donning the appropriate cap and gown and marching across various high school stages with his name on a card, having it read out loud.
His real alma mater was Shorecrest High School outside Seattle where he was president of the graduating class and a member of a bagpipe band. He later went to Yale University, earning a bachelor’s degree in anthropology in 1977. He thought he wanted to work in the field, but after two years in India and Pakistan researching rhesus monkeys, he decided he didn’t want to spend his days in sweltering climates.
He returned to the states and landed a job as a lab technician at the University of California at San Francisco. That led to an interest in parasites. He started graduate school at Johns Hopkins University in Baltimore, intending to study parasitology but ended up transferring to the University of California at Berkeley. In 1989, he graduated from Berkeley with a doctorate in microbiology and a master’s in public health.
A year later, he was hired by the Oregon Health Division as an epidemiologist. He was promoted to senior epidemiologist in 2003, keeping that position to the end of his life.
He made his mark early and often, revolutionizing food-borne outbreak investigations. In the past, epidemiologists interviewed the ill people about what they had eaten. They also questioned a similar number of healthy people as a control; if one food popped up among the patients but not the control group, they knew they had nailed their culprit.
Keene adopted a radical approach that shaved days, even weeks off the investigation by using survey data instead of interviewing healthy people. If four out of four of ill people had eaten bagged spinach, for example, but only 10 percent of those surveyed had done so, the scientists knew that the spinach had caused the outbreak.
This method meant epidemiologists could crack outbreaks much more quickly. But it wasn’t immediately snapped up by federal authorities. In fact, the Centers for Disease Control and Prevention balked at first.
“He really pushed the frontiers forward,” said Dr. Paul Cieslak, head of communicable disease at Oregon Public Health Division. “Eventually, the rest of the country followed suit.”
Keene also created a nine-page survey, filled with lists of foods and questions about restaurants and other places where people may have picked up a bug. This “shotgun” questionnaire, as Keene called it, systematized outbreak investigations. Developed in Oregon, it, too, spread to other health departments across the country.
“He was the one who showed that you could do these (investigations) in a systematic way even in a state that wasn’t loaded with resources,” said Dr. Robert Tauxe, deputy director of food-borne, water-borne and environmental diseases at the CDC.
Keene spent hours in front of his computer, crunching numbers, but he also rolled up his sleeves and trudged through muddy fields, collecting scat, or when needed he waded knee deep in lakes, scooping up contaminated water to test for pathogens.
He told colleagues, they had three missions in their work: protect the public; learn something new and have fun just as long as they didn’t skimp on the first two.
Michael Osterholm, head of the Center for Infectious Disease Research and Policy at the University of Minnesota, said Keene’s unconventional approach was shaped, in part, by his anthropological training.
“A lot of people in epidemiology are high-powered statistical experts who can maneuver data very easily,” Osterholm said. “That kind of expertise is important. But Bill, while capable of doing that, took a step back and looked at the world in a way an anthropologist would. He asked how it all fit together and what had occurred.”
Once he solved a case, he spread the word, informing colleagues, federal health officials, even company executives. He’d call chief executive officers personally to tell them that one of their products was making people sick. He’d also phone the food safety chief at Costco, even in the middle of the night, to tell him about tainted food.
Many epidemiologists hesitate to speak out publicly. Not Keene, though it occasionally got him into trouble.
In 2011, Del Monte Fresh Produce threatened to sue him and the Oregon Public Health Division over an investigation linking salmonella cases to the company’s cantaloupes. The case was eventually dropped.
“He felt very strongly that part of food safety is accountability and he didn’t hesitate to name companies if he thought they were part of an outbreak,” said Tauxe, of the CDC. “Now we usually name names, too.”
Besides his work at the Oregon Public Health Division, Keene was a consultant with the World Health Organization. He took unpaid leave and used vacation time to create infectious disease surveillance systems in Sudan, Thailand, Pakistan, Iran, Indonesia and India. He authored 40 publications, made dozens of presentations and won a number of awards.
Keene met his wife, Elise Gautier, when they were both at Yale. They recently celebrated their 30th anniversary. The couple enjoyed camping and hiking and were known for their “Portland Film Society” screenings in their yard in Southwest Portland of old black and white movies.
He’s survived by his wife; sisters, Pam Keene and Beverly Keene; brother Dr. David Keene; and nieces and nephews.
A celebration of his life is being planned by colleagues. People are expected to come from afar.
Though he died relatively young, he accomplished a lot, said Dr. David Fleming, public health officer of King County, Wash., who originally hired Keene at Oregon Public Health.
“Oregon and the country were very lucky to have him on our side as long we did,” Fleming said.
Hong Kong Worried over Bird Flu
Source : http://www.foodproductdesign.com/news/2013/12/hong-kong-worried-over-bird-flu.aspx
By foodproductdesign.com (Dec 3, 2013)
Posted in News, Agriculture, Poultry, Food Safety, Bacteria, Microbial, International, Business, Economics, Asian, Meat Products Print HONG KONG—An Indonesian woman here is said to have contracted an influenza virus that normally circulates among birds, a development that is worrisome to the city given the potential deadly consequences of the bug.
The 36-year-old maid who purchased and ate a chicken in Shenzhen has contracted Hong Kong's first case of H7N9 avian flu and is in critical condition in a hospital, CNN reported, citing a statement from a Hong Kong health official Ko Wing-man.
As of Nov. 5, 139 cases of Influenza A (H7N9) including 45 deaths had been reported to the World Health Organization (WHO). China's National Health and Family Planning Commission reported all but 1 of the cases. That single case originated from the Taipei Centers for Disease Control.
According to Ko in the CNN article, Hong Kong raised its level of preparedness for an influenza pandemic to "serious".
WHO is not aware of the virus being transmitted between humans, and until recently it had not been detected in people. "The source and mode of transmission remain unknown," WHO states in the Nov. 5 update, "but increasing evidence is pointing to poultry exposure."
H7N9 has impacted the young and old, from a 3-year-old boy from Guangdong Province to a 64-year-old female farmer from Zhejiang Province who was in critical condition as of early last month. The WHO has reported the onset of cases as early as February 2013, and at least some victims died just a few days after their illnesses began, according to a chart from the agency.
On Monday, the news agency Xinhua announced Shanghai would suspend poultry trading from Jan. 31 until April 30 to prevent a recurrence of bird flu.
In December 2011, thousands of birds were destroyed in Hong Kong after a dead chicken tested positive for the H5N1 avian virus.
CDC finds holes in restaurant food safety systems
Source : http://www.cidrap.umn.edu/news-perspective/2013/12/cdc-finds-holes-restaurant-food-safety-systems
By Robert (Dec 03, 2013)
A set of studies released this week by the Centers for Disease Control and Prevention (CDC) and its partners points to widespread holes in restaurant food safety systems, such as risky handling of ground beef and chicken and too-warm shipping temperatures for leafy greens.
At the same time, the CDC announced plans for a new surveillance system designed to help state and local health departments identify underlying factors that contribute to foodborne disease outbreaks in restaurants and other food service venues.
The research findings, published this week in the Journal of Food Protection, deal with the handling of ground beef, chicken, and leafy greens and with sick food workers.
The studies were conducted by the Environmental Health Specialists Network (EHS-Net), which includes experts from the CDC, state and local agencies, the Food and Drug Administration (FDA), and the US Department of Agriculture.
In a press release about the studies, the CDC noted that more than half of all foodborne disease outbreaks in the United States are associated with restaurants, delis, banquet facilities, schools, and other institutions.
The ground beef study involved interviews with managers and observations of ground beef preparation at 385 restaurants in eight states: California, Colorado, Connecticut, Georgia, Minnesota, New York, Oregon, and Tennessee. Two thirds of the restaurants were chain-owned, and a third were independent.
Among the key findings, according to the study and a CDC summary:
Eighty-one percent of restaurants used subjective measures of hamburger doneness, and 49% said they never checked the final cooking temperature
At least two risky handling practices were seen in 53% of restaurants
In 62% of restaurants in which workers used bare hands to handle raw ground beef, they did not wash their hands after handling it.
Only 1% of restaurants reported buying irradiated ground beef, and 29% were unfamiliar with the product
Chain restaurants and those with managers certified in food safety had safer practices than others.
For the chicken study, EHS-Net researchers interviewed 448 restaurant managers. They found that many were not following FDA guidance about preventing cross-contamination and cooking chicken properly and that managers "lacked basic food safety knowledge about chicken."
For example, 40% of managers said they never, rarely, or only occasionally designated certain cutting boards exclusively for raw meat, and more than 50% said that thermometers were not used to determine the final cooking temperature of chicken. Further, only 43% of managers knew the recommended final cooking temperature.
Mixed findings on leafy greens
To examine the handling of leafy greens, the researchers interviewed 349 restaurant managers and checked the temperatures of 37 leafy-greens shipments.
Almost two thirds (65%) of managers said they had rejected a leafy-greens shipment at some point because the greens looked or smelled bad, were not in the right temperature range, or were missing a required label.
Almost all of the managers said they kept purchase records for their leafy greens. The authors concluded that most of the restaurants complied with FDA guidelines for rejecting shipments and keeping records, which could be used to trace products in case of contamination, the CDC said.
However, more than half of the tested shipments were above the FDA-recommended temperature of 41ºF, creating a potential for growth of pathogens, the CDC said.
A fourth study, covered in a CIDRAP News item yesterday, was a survey of restaurant workers, which revealed that 20% of them said they had worked while sick with a gastrointestinal illness within the preceding year.
In an accompanying commentary, Craig W. Hedberg, PhD, wrote that sick food workers may pose the greatest risk factor for foodborne disease outbreaks linked to restaurants. He is a professor in the Division of Environmental Health Sciences at the University of Minnesota's School of Public Health in Minneapolis.
"Because infected food workers were identified as the source for half of foodborne norovirus infection outbreaks in the United States from 2001 through 2008 and may have contributed to transmission in over 80% of these outbreaks, eliminating the motivations of workers to work while ill should be a clear priority," he wrote.
New surveillance system
In connection with the studies, the CDC announced plans to launch a surveillance system that state and local agencies can use to investigate environmental factors in foodborne disease outbreaks. The system is called the National Voluntary Environmental Assessment Information System (NVEAIS).
"The system provides an avenue to capture underlying environmental assessment data that describes what happened and how events most likely lead to a foodborne outbreak," the CDC said.
The agency also pledged to provide a free, interactive electronic course "to help state and local health departments investigate foodborne illness outbreaks in restaurants and other food service venues as a member of a larger outbreak response team, identify an outbreak's environmental causes, and recommend appropriate control measures." The course will also be available to the food industry, academia, and the public.
The surveillance system and the course are scheduled to debut early in 2014.
Food safety is among top concerns for Floridians, UF/IFAS survey finds
Source : http://news.ufl.edu/2013/12/03/pie-food/
By news.ufl.edu (Dec 3, 2013)
GAINESVILLE, Fla. — Food safety is near the top of most Floridians’ concerns, behind only the economy and health care, a survey released today by the University of Florida shows.
The survey covered several food-related issues, including public perceptions about food safety, food insecurity and genetically modified foods. It also found knowledge gaps among Floridians, especially in the area of food safety, and detected conflicted feelings among the public about genetically modified foods.
“I think findings like this are telling us that, while there are some areas where there is correspondence between what consumers know and the actual facts, there are some significant gaps,” said Tracy Irani, director of the UF/IFAS Center for Public Issues Education, or PIE Center, which led the study.
The October online survey reached 510 Florida residents, all 18 or older. The responses were weighted to balance geographic, age, gender, race and ethnicity data to ensure the information was representative of Florida’s population.
Among a list of 15 issues, ranging from the economy to endangered species, food safety ranked third, with 85 percent of respondents calling it extremely or highly important. Food production practices came in ninth, with 74 percent ranking it as extremely or highly important. The issue of genetically modified foods was 14th on the list, with 57 percent calling it important, Irani said.
An example of a knowledge gap between respondents’ perceptions and fact was the response to a question about the safety of different types of food products. For instance, frozen fruits and vegetables enjoyed high consumer confidence, with at least 72 percent of those polled saying they are safe. About 60 percent of respondents felt similarly about canned fruits and vegetables. Raw fruits and vegetables were close behind, with nearly 60 percent of respondents perceiving them as safe.
And that, says Doug Archer, associate dean for research for UF/IFAS, underscores the public’s lack of knowledge. Canned and frozen fruits and vegetables are actually far safer than unwashed raw produce, he said.
“The number of outbreaks of foodborne illness attributable to fresh produce has grown substantially in the last two decades to the point where the Centers for Disease Control and Prevention, and the U.S. Food and Drug Administration have become very concerned,” Archer said.
Joy Rumble, an assistant professor in agricultural education and communication with the PIE Center, said the study also showed that while nearly half the respondents said they were worried about genetically modified or engineered food safety, many were unsure about possible advantages, whether they would ever buy genetically modified food, or whether genetically modified organisms (GMOs) might harm the environment.
But 52 percent approve of using genetic modification to help fight citrus greening, a disease that threatens the state’s $9 billion citrus industry.
Scientists use the term “genetic modification” to describe the ways genes can be used to add favorable traits in new plant varieties and “genetic engineering” or “transgenic development” to describe adding one or two desirable traits to an organism. For example, plants may be genetically engineered to survive herbicide treatments, or to confer pest or virus resistance. Currently the only genetically engineered crops are field corn, soybean, cotton, canola, sugar beet, papaya and squash.
Kevin Folta, interim chair of UF’s horticultural sciences department, genetically engineers plants in his research, and welcomes public discussion on GMOs.
“There has never been a single case of harm to an animal or human eating an estimated 3 trillion meals in the last 17 years, since genetically engineered food became available in the marketplace,” Folta said. “The survey says that we need to be doing more in communicating the science to the public.”
UF has dedicated $1.45 million toward food security, safety and distribution systems as part of its Preeminence Plan – how officials hope to spend the first $15 million from the state Legislature to hire top-flight faculty in targeted areas.
The survey was the last of four PIE Center surveys this year to track public opinion on agriculture and natural resources issues. They hope to conduct the surveys every year to track changes in public opinion.
The PIE Center will host a webinar to explore public opinion about food from 2-3 p.m. Dec. 4. To register, go
Hagan says small farms need more protections in food safety law
Source : http://www.newsobserver.com/2013/12/02/3426787/hagan-says-small-farms-need-more.html
By Renee Schoof on December 2, 2013
In 2010, U.S. Sen. Kay Hagan worked to get an amendment added to a food safety law that exempted small farms that sell directly to consumers or restaurants. Now the Food and Drug Administration is working on the regulations needed to carry out the law, and North Carolina’s Democratic senator says those proposed rules need to be written more clearly in order to help small farms.
Under the amendment that Hagan and Sen. Jon Tester, D-Mon., sponsored three years ago, small producers are exempt from most of the federal rules, but they remain subject to state and local food safety and health requirements.
Hagan and Tester recently wrote a letter to FDA Commissioner Margaret Hamburg, urging her to “rectify the rules to ensure that small farms, farmers’ markets, and local cooperatives are able to thrive while protecting food safety from the biggest threats.” Hagan’s office released a copy of the letter to the Dome on Monday and planned to issue a press release on Tuesday.
The two-page letter suggests more than a half-dozen changes to the rules to clarify them. The letter was dated Nov. 13 and sent during a comment period before the FDA makes the rules final.
“Agriculture is the largest industry in North Carolina, and I am committed to ensuring that family farms selling at farmers’ markets and local co-ops are not burdened by regulations that are designed for large producers,” Hagan said in a statement. “One size does not fit all, and the FDA must follow through and ensure that final rules do not unnecessarily threaten the livelihood of local farmers and hurt economic growth.”
Copyright 2013 McClatchy_Newspapers. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Food safety fast track
Source : http://www.thepacker.com/opinion/fresh-produce-opinion/Food-safety-fast-track-234102821.html
Canada’s food safety regulations appear to be in the passing lane while here in the U.S. lawmakers seek to lengthen the timeline, calling for a second draft and comment period for proposed food safety rules.
The Safe Food for Canadians Act was passed more than a year after the U.S. Food Safety Modernization Act, but officials in Canada have vowed full implementation by January 2015.
Canadians are on pace to beat the U.S. Food and Drug Administration’s Food Safety Modernization Act produce safety regulations, which have a deadline of June 2015.
Regulations crafted under the Safe Food for Canadians Act of 2012 share similar goals to FSMA:
Canada’s regulations are expected to be more outcome-oriented than the FDA’s “prescriptive” scheme, according to Jane Proctor, vice president for policy and issue management for the Ottawa-based Canadian Produce Marketing Association.
Despite different regulatory regimes along the path to new food safety rules, Canadian and U.S. efforts share common areas of agreement and focus, including record-keeping and requirements for importers.
While having final food safety rules in place is a must for the produce industry to move ahead and adopt the new practices, it’s not a race.
Once food safety laws are in place, the industry will have to live with them, as change will require legislators to act.
It’s wise that time be taken for regulators to hear and incorporate industry input before rules are set.
Pet Food Safety: $19-Billion Industry Coming in for Much Closer Scrutiny
Safety Microbiology ONLINE COURSE IS OPEN
Source : http://www.foodsafetynews.com/2013/12/19-billion-pet-food-industry-coming-in-for-much-closer-scrutiny/
By Dan Flynn (Dec 2, 2013)
Seven years ago, mostly in 2007, more than 8,500 cats and dogs in the United States died from eating contaminated pet food. Ever since, American consumers have been fearful and suspicious about the seemingly chaotic pet-food industry.
Concerns deepened when the journal Pediatrics published, “Human Salmonella Infections Linked to Contaminated Dry Dog and Cat Food, 2006-2008,” confirming that exposure to tainted pet food also made humans sick – including many children. Ever since, the pet food industry has come in for more concern and change than at any time since American James Spratt first sold dog biscuits in England around 1860.
Spratt had noticed that the owners of English sporting dogs were at the docks to buy leftover ship’s biscuits for their animals. He “decided he could do better with a carefully compounded preparation of wheat meals, vegetables, beetroot, and meat,” according to the Washington D.C.-based Pet Food Institute (PFI), which has been around to advance the industry since 1958.
Spratt sold his formula and production to a British company, which, in turn, brought the commercial pet food industry to America around 1890, making biscuits and dry kibble available ever since. During World War I, canned horsemeat was sold as dog food. Canned cat food and dry-meat meal dog foods have been sold at retail since the 1930s.
By the 1950s, equipment made to produce breakfast cereals for humans was modified to turn out all the dry pet foods that the market demanded. PFI acknowledges that, early on, the formulation of pet foods was based “more on guesswork than science,” but it has evolved over the years. In the 1960s, with PFI sponsorship, the National Research Council (part of the National Academy of Sciences) developed the first nutrient profiles for pet foods.
Pet food industry sales of dog and cat food reached $19 billion in 2012. That’s nearly 8 million tons of dog and cat food, treats and mixers. Americans buy that much pet food because they care for more than 75 million dogs and almost 85 million cats.
While pet food is sold at all sorts of pet, feed, grocery, convenience and one-stop mom-and-pop stores, a couple of chains are worth mentioning for their size and impact on the industry. Phoenix-based PetSmart, Inc., publicly traded with 24,000 employees and 1,278 retail outlets, had sales last year just shy of $7 billion. San Diego-based Petco, a privately held company with 1,150 stores, is PetSmart’s only big rival.
Although the big pet store chains sell everything from exotic birds to doggy beds, it’s their large pet food sections that bring shoppers back to their stores on a regular schedule. However, a big industry with big retailers does not mean there’s been very much regulation of pet food. That’s about to change, but, up until now, pet owners who have lost a dog or a cat to pet food contamination are usually surprised that they don’t really have any place to turn.
Over the years, the states and the U.S. Department of Agriculture have practiced some oversight of pet food, mostly through a little-known organization called the Association of American Feed Control Officials (AAFCO). Dating back to early in the 20th century, AAFCO came up with definitions and standards to govern the feed industry, including pet food. It accomplished things such as banning the use of the word “pure” in brand names and the like, mostly by writing model laws for states to adopt.
More recently, AAFCO developed nutrient requirements for dogs and cats, caloric statements for pet foods, and policy for mineral supplements, and it has been involved with the content of pet food labels going back to the early 1960s. AAFCO, however, is a frustrating organization for pet owners, especially those who have recently lost an animal to contamination. It only meets a couple times each year, and it has a habit of closing its more interesting sessions to outsiders.
Since 2007, it seems that pet food contamination incidents have been occurring on a more regular basis. The latest involves specific brands of chicken jerky treats, which have sickened thousands of dogs and killed nearly 600. The brands involved are products made in China, and, while authorities suspect certain ingredients must be harmful to dogs, they cannot figure out what is specifically causing the deaths. (The brands are Milo’s Kitchen Chicken Jerky Treats, Nestle Purinas Waggin’ Train and Canyon Ranch Treats.)
Pet food recalls have also been more frequent in recent years. Mass casualty incidents, such as the recent one involving the jerky treats, and people getting sick from handling pet food, are the reasons why pet food and animal feed were included in the Food Safety Modernization Act of 2010 (FSMA). It means the first serious regulation of pet food by the U.S. Food and Drug Administration (FDA) is coming along with new rules for animal feed as well. FDA regulation means, among other things, that pet food will be subject to hazard analysis and risk-based preventive controls.
“Pet food makers share the FDA’s commitment to pet food quality and safety, and we’re proud of the strong safety record of pet food,” said PFI in a statement on FSMA rules for pet food. “We and our member companies have been in close communication with the FDA over the past two years as it developed the proposed regulations. We will continue to work closely with FDA to help ensure that pet owners can have total confidence in the food and treats they feed their pets.”
The pet food safety series on Food Safety News is sponsored by ABC Research, a company that conducts testing on pet food products. Read more about ABC Research pet food testing on the company blog.
Food safety's export role
Source : http://www.stockandland.com.au/news/agriculture/agribusiness/general-news/food-safetys-export-role/2681201.aspx
By stockandland.com.au (Dec 09, 2013)
MAINTAINING rigorous food safety systems will be critical in the growth
of the meat industry.
This is according to the Minister for Agriculture and Food Security
Peter Walsh, who spoke at meat and seafood regulator PrimeSafe’s
annual dinner last night.
He commended the processing sector’s commitment to food safety
and its role in underpinning the success of Victorian exporters.
“Exports of Victorian meat grew significantly last year, particularly
to China,” Mr Walsh said.
Victorian meat exports were valued at $1.78 billion in 2012-13, an
increase of $197 million or 12 per cent on 2011-12.
Victoria accounts for 22 per cent of the value of Australia’s
China was the second largest destination for Victorian red meat, increasing
111 per cent to import $213 million worth.
“This export growth is underpinned by the food safety systems
that provide markets and consumers with confidence in the quality
of Victoria’s meat,” Mr Walsh said.
During the recent Victorian Coalition Government Super Trade Missions
he said he heard Victoria commended countless times for its high quality
and ‘clean’ meat products.
“This week’s conclusion of negotiations on the Australia-Korea
Free Trade Agreement provides even greater export opportunities for
Victorian meat producers," he said.
"It is expected Australia’s agricultural exports to the
Republic of Korea will be 73 per cent higher after 15 years as a result
of the FTA.”
Mr Walsh said the Victorian Coalition Government was committed to
helping the state’s food and fibre industry to double production
Shigella is a Nasty, Infectious Bacteria
Source : http://www.foodpoisonjournal.com/food-poisoning-information/shigella-is-a-nasty-infectious-bacteria/
By Bill Marler (Dec 7, 2013)
Introduction to Shigella
Shigella is a species of enteric bacteria that causes disease in humans
and other primates. [16, 20] The disease caused by the ingestion of
Shigella bacteria is referred to as shigellosis, which is most typically
associated with diarrhea and other gastrointestinal symptoms. [11,
16] “Shigella infection is the third most common cause of bacterial
gastroenteritis in the United States, after Campylobacter infection
and Salmonella infection and ahead of E. coli O157 infection.”
The global burden of shigellosis has been estimated at 165 million
cases per year, of which 163 million are in developing countries.
 More than one million deaths occur in the developing world yearly
due to Shigella infection. [23, 29] By one estimate, Shigella
infections are responsible for 300,000 illnesses and 600 deaths per
year in the United States.  By another estimate, each year
450,000 Americans are infected with Shigella, causing 6,200 hospitalizations
and 70 deaths. 
In general, Shigella is one of the most communicable and severe forms
of the bacterial-induced diarrheas.  No group of individuals is
immune to shigellosis, but certain individuals are at increased risk.
 Small children acquire Shigella at the highest rate, and [24,
28] persons infected with HIV experience shigellosis much more commonly
than other individuals. 
Shigella is easily spread person-to-person because of its relatively
tiny (compared to other bacteria) infectious dose. [16, 23]
Infection can occur after ingestion of fewer than 100 bacteria. [1,
16, 17] Another reason Shigella so easily cause infection is
because the bacteria thrive in the human intestine and are commonly
spread both by person-to-person contact and through the contamination
of food. [11, 22, 32]
The Discovery and Naming of Shigella
The several types of Shigella bacteria have been named after the lead
workers who discovered each one. [11, 16, 20] The first
bacterium to be discovered, Shigella dysentariae, was named after
Kiyoshi Shiga, a Japanese scientist who discovered it in 1896 while
investigating a large epidemic of dysentery in Japan. [22, 37] The
bacterium was also referred to more generally as the dysentery bacillus
(the term “bacillus” referring to a genus of Gram-positive,
rod-shaped bacteria of which Shigella is a member). 
Dr. Shiga dedicated his life to eradicating the disease. In
1936, while an honored guest at the 300th anniversary of the founding
of Harvard University, he gave a speech that began as follows:
The discovery of the dysentery bacillus stirred my young heart with
hopes of eradicating the disease…Many thousands still suffer
from this disease every year, and the light of hope that once burned
so brightly has faded as a dream of a summer night. This sacred fire
must not burn out. [37
Dr. Shiga died at the age of 85 years on 25 January 1957. Shigella
has not yet been eradicated.
In a summary published annually, the CDC provides an overview of the
classification of various types (species) of Shigella bacteria, as
There are 4 major subgroups of Shigella, designated A, B, C and D,
and 44 recognized serotypes. Subgroups A, B, C and D have historically
been treated as species: subgroup A for Shigella dysenteriae; subgroup
B for Shigella flexneri; subgroup C for Shigella boydii and subgroup
D for Shigella sonnei. These subgroups and serotypes are differentiated
from one another by their biochemical traits (ability to ferment D-mannitol)
and antigenic properties. The most recently recognized serotype belongs
to subgroup C (S. boydii). 
S. sonnei, also known as Group D Shigella, accounts for over two-thirds
of shigellosis in the United States. Shigella flexneri, or group B
Shigella, accounts for almost all the rest. [11, 19] More specifically,
according to one recent study, “From 1989 to 2002, S. flexneri
accounted for 18.4% of Shigella isolates submitted to CDC.  From
1973 to 1999, only 49 S. flexneri-associated outbreaks of foodborne
disease were reported.”  In contrast, in developing countries,
S. flexneri is the most predominant cause of shigellosis, but S. dysinteriae
type 1 is still a frequent cause of epidemic throughout the developing
world. [1, 16, 23, 37]
The Incidence of Shigella Infection
The number of shigellosis cases reported annually to the Centers for
Disease Control and Prevention (CDC) has varied over the past several
years, from more than 17,000 during 1978–2003, to an all-time
low of 14,000 in 2004, to almost 20,000 in 2007. [11, 19] But a majority
of cases go undiagnosed or unreported. [12, 16, 37] In one study
done in Oregon, 430 confirmed Shigella cases from July 1995 through
June 1998 were examined.  Among the several findings about those
most likely to fall ill was the following:
Of 430 isolates, 410 were identified to the species level: Shigella
sonnei accounted for 55% of isolates, and Shigella flexneri, for 40%.
The overall annual incidence of shigellosis was 4.4 cases per 100,000
population. Children aged [less than] 5 years (annual incidence, 19.6
cases per 100,000 population) and Hispanics (annual incidence, 28.4
cases per 100,000 population) were at highest risk. 
The CDC estimates that 450,000 total cases of shigellosis occur in
the U.S. every year. [4, 11, 21] Shigellosis is also characterized
by seasonality, with the largest percentage of reported cases occurring
between July and October, and the smallest proportion occurring in
January, February, and March.  Sporadic (or non-outbreak) infections
account for the majority of cases and, in general, the exact means
by which persons are infected (risk factors) are not yet well documented
or understood. [21, 36]
Shigella is an especially common cause of disease among young children,
in large part because it is difficult to control the spread of the
bacteria in daycare settings. [16, 28] The symptoms of shigellosis
vary so widely that children shedding Shigella in their stool may
exhibit no symptoms of infection. A person infected with Shigella
can be asymptomatic (show no symptoms of illness), suffer from moderate
to severe diarrhea, or suffer complications up to and including death.
[11, 17, 26]
More on Incidence Rates and How Shigella is Transmitted
As previously noted, Shigella species are transmitted by the fecal-oral
route, and most infections are transmitted from person to person,
reflecting the low infectious dose.  As also noted, as few as
ten Shigella bacteria can result in clinical infection.  Where
persons who are infected may be present, the risk of transmission
and infection increases with poor hand hygiene, ingestion of contaminated
food or water, inadequate sanitation and toileting, overcrowding,
and sexual contact. [4, 14, 21, 24, 28] Shigella bacteria are present
in the stools of infected persons while they are sick and for up to
a week or two afterwards. [11, 16, 17] It is estimated that up 80%
of all infection is the result of person-to-person transmission. 
Because of its quite common person-to-person spread, shigellosis has
long been associated with outbreaks in daycare centers, nursing homes,
institutional settings (like prison), and cruise ships. [11, 14, 17,
23, 24] Explaining the significance of daycare centers as a source
of Shigella infection, one well-respected study explains as follows:
High shigellosis rates in children are attributable to several factors.
Young children are unable to practice good personal hygiene and have
not yet acquired immunity to S. sonnei. The infectious dose is as
low as 10–200 organisms, and person-to-person transmission is
highly effective. Day-care centers play an important role in the person-to-person
spread of shigellosis and its subsequent dissemination in communities.
Inadequate hand washing, diapering practices, and fecal contamination
of water-play areas, such as kiddie pools, have been associated with
S. sonnei transmission in day-care centers. 
Several studies have demonstrated an increased frequency of shigellosis
cases in young adult men residing in urban settings who have little,
if any, exposure to these traditionally recognized risk groups. [4,
36] Although some of these studies indicated that sex between men
can be a risk-factor, most of these studies occurred before the HIV
epidemic. [4, 23]
Shigella infections also may be acquired from eating contaminated
food. A study published in 2010 estimated more than one-third of U.S.
shigellosis cases annually might be caused by the consumption of contaminated
food.  In the United States, incidence of foodborne illness is
documented through FoodNet, a reporting system used by public health
agencies that captures foodborne illness in over 13% of the population.
[8, 9] Of the 10 pathogens tracked by FoodNet, Salmonella, Campylobacter,
and Shigella are responsible for most cases of foodborne illness.
 An estimated 20% of the total number of cases of shigellosis
involve food as the vehicle of transmission. 
In one oft-cited study summarizing food-related illness and death
in the United States, the following synopsis is set forth at the end,
Reported cases: Outbreak-related cases based on reports to CDC, 1983-1992.
Passive surveillance estimate based on average number of cases reported
annually to CDC, 1992-1997. Active surveillance estimate based on
extrapolation of average 1996-1997 FoodNet rate to the 1997 U.S. population.
Total cases: Because Shigella frequently causes bloody diarrhea,
total cases assumed to be 20 times the number of reported cases, based
on similarity to E. coli O157:H7.
Hospitalization rate: Based on hospitalization rate for culture-confirmed
cases reported to FoodNet, 1996-1997.
Case-fatality rate: Average case-fatality rate among cases reported
to FoodNet, 1996-1997 (23,24).
Percent foodborne: Assumed to be 20%. Although most cases are due
to person-to-person transmission (60), foodborne outbreaks are responsible
for a substantial number of cases 
According to the CDC, Shigella is the third most common pathogen transmitted
through food. In FoodNet surveillance areas in 2008, the rate of Shigella
was 6.6 per 100,000 population, exceeded only by Salmonella (15.2/100,000)
and Campylobacter (12.7/100,000).  During 2006, public health
officials reported a total of 1,270 foodborne-related outbreaks from
48 states in the U.S.  Although Shigella was responsible for only
10 (1%) of those outbreaks, 183 confirmed cases of shigellosis were
nonetheless reported.  This reporting rate contrasts with an average
of 659 cases annually in the previous five years, making it potentially
an aberration or outlier.
Shigella is also responsible for a substantial portion of foodborne
outbreaks on cruise ships. [16, 34] In a review of cruise ship outbreaks
worldwide over several years, 16% of outbreaks were attributed to
Shigella, affecting over 2,000 passengers.  Sanitation violations
related to food handling and communicable disease have decreased substantially,
however, over the past 15 years. 
Symptoms of Shigella Infection
Most people who are infected with Shigella develop diarrhea, fever,
and stomach cramps after being exposed to the bacteria. [11, 16, 26]
Symptoms may start 12 to 96 hours after exposure, usually within 1
to 3 days. [1, 16] Diarrhea may range from mild to severe, and it
usually contains mucus.  When more severe, the diarrhea is bloody
25% to 50% of the time. [1, 16, 22] Rectal spasms, which are technically
referred to as “tenesmus,” are common. 
Shigellosis usually resolves in 5 to 7 days. [1, 11, 26] A severe
infection with high fever may be associated with seizures in children
less than two years old. [16, 19] Some persons who are infected may
have no symptoms at all, but may still pass the Shigella bacteria
to others. [11, 17]
Persons with shigellosis in the U.S. do not often require hospitalization,
although the hospitalization rate has been estimated to be in excess
of 50,000 per year.  Predictably, the hospitalization rate tends
to be highest among older individuals. [9, 10, 16] Those who are immune-compromised,
like persons infected with HIV, are also more likely to face hospitalization
because of the risk of complications. 
The relationship between HIV infection and the subsequent risk for
shigellosis has yet to be conclusively evaluated, although it is known
that “HIV-associated immunodeficiency leads to more severe clinical
manifestations of Shigella infection.”  Moreover, persons
infected with HIV “may develop persistent or recurrent intestinal
Shigella infections, even in the presence of adequate antimicrobial
therapy. They also face an increased risk of Shigella bacteraemia,
which can be recurrent, severe or even fatal.” 
What are the serious and long-term risks of Shigella infection?
Persons with diarrhea caused by S. sonnei in particular usually recover
completely, although it may be several months before their bowel habits
are entirely normal. [1, 11, 26] About 2% of persons who are infected
with S. flexneri later develop pains in their joints, irritation of
the eyes, and painful urination—something typically diagnosed
as Reiter’s Syndrome. [1, 6]
Reiter’s syndrome is more generally referred to as reactive
arthritis, a complication that accompanies other kinds of bacterial
infections as well. [27, 37] This complication occurs because the
immune system, intending to fight Shigella, attacks the body instead.
[6, 31] Reactive arthritis is most common in persons with the
HLA-B27 gene.  (About 80% of people with reactive arthritis have
the HLA-B27 gene. Only 6% of people who do not have the syndrome have
the HLA-B27 gene.) Reactive arthritis can last for months or years
and may be difficult to treat. 
Once someone has suffered a Shigella infection, a certain level of
immunity develops, meaning that the person is not likely to get infected
with that specific type again for at least several years.  This
temporary immunity does not, however, protect against other types
of Shigella. [16, 29]
Shigella bacteria multiply in the human intestinal tract and invade
the cells, which results in much tissue destruction.  Many strains
produce a toxin called Shiga toxin, which is very potent and destructive.
[16, 22] Shiga toxin is very similar to the verotoxin of E. coli O157:H7.
Complications of shigellosis include severe dehydration, seizures
in small children, rectal bleeding, and invasion of the blood stream
by the bacteria (bacteremia or sepsis). [1, 11, 16, 26] In some
cases, the bacteria that cause shigellosis may also cause inflammation
of the lining of the rectum (proctitis) or rectal prolapse. 
In rare cases (but more common in S. dysenteriae infection), there
can also be a deadly complication called “toxic megacolon.”
[1, 26] This rare complication occurs when the colon becomes paralyzed,
preventing bowel movements or passing gas. [16, 26] Signs and symptoms
include abdominal pain and swelling, fever, weakness, and disorientation.
 Untreated, the colon may rupture and cause peritonitis, a life-threatening
condition requiring emergency surgery. 
The other relatively rare complication that can occur with a Shigella
infection is the development of hemolytic uremic syndrome. This rare
complication is more commonly caused by E. coli O157:H7, and it can
lead to a low red blood cell count (hemolytic anemia), low platelet
count (thrombocytopenia), and acute kidney failure. [26, 37]
It is more common to develop HUS after being infected with S. dysenteriae.
Diagnosis and Treatment of Shigella Infections
Because the symptoms of a Shigella infection are consistent with a
fairly large number of potential illnesses, including most foodborne
infections, a diagnosis must be confirmed by a laboratory test. [5,
11, 26] First a stool sample must be obtained from the potentially
infected person, and then the sample is placed on a medium to encourage
the growth of bacteria. If and when there is growth, the bacteria
are identified, usually by looking at the growth under a microscope.
[20, 26] The laboratory can also do special tests to tell which species
of Shigella the person has, and which antibiotics would be best to
treat the infection. [16, 22, 30] Antibiotic-sensitivity tests
are important because Shigella is often resistant to multiple antibiotics.
More advanced testing and surveillance methods, such as plasmid profiling
and chromosomal fingerprinting, can also be used. [11, 20, 29] So-called
“genetic fingerprinting” of the bacterial isolate, using
pulsed-field gel electrophoresis (PFGE) is a molecular technique that
can help to characterize Shigella isolates, whether obtained from
human or food samples. [11, 27] Taken together, all of these tests
can assist public health officials in determining whether cases (confirmed
infections) are isolated or associated with common-source outbreaks.
[19, 20, 27]
Efforts to identify outbreaks of foodborne illness—whether caused
by Shigella or other pathogens—are important to preventing the
secondary spread of infection, especially with bacteria as highly
communicable as Shigella. [1, 11, 21] One major advance in these efforts
was the creation of FoodNet, an active surveillance system for foodborne
illness. As described by the CDC:
FoodNet workers regularly contact more than 300 laboratories for confirmed
cases of foodborne infections in 10 states encompassing a population
of more than 44 million persons. In addition to monitoring the number
of Shigella infections, investigators monitor laboratory techniques
for isolation of bacteria, perform studies of ill persons to determine
exposures associated with illness, and administer questionnaires to
people living in FoodNet sites to better understand trends in the
eating habits of Americans. 
Although shigellosis is usually a self-limited illness, antibiotics
can shorten the course, and in the most serious cases, might be life-saving.
[1, 16, 22] Historically, the antibiotics commonly used for treatment
of bacterial infections, like those caused by Shigella, are ampicillin,
trimethoprim/sulfamethoxazole (TMP-SMZ, also known as Bactrim or Septra),
or ceftriaxone (Rocephin). [1, 11, 26] Ciprofloxacin is also
used commonly to treat adults who are infected. [11, 26, 30].
Unfortunately, Shigella bacteria have become resistant to one or more
of these antibiotics. [16, 30] This means some antibiotics might not
be effective for treatment, and that using (or overusing) antibiotics
to treat shigellosis can sometimes make the bacteria more resistant.
 As noted in one recent study:
Of 369 isolates tested, 59% were resistant to TMP-SMZ, 63% were resistant
to ampicillin, 1% were resistant to cefixime, and 0.3% were resistant
to nalidixic acid; none of the isolates were resistant to ciprofloxacin.
Thirteen percent of the isolates had multidrug resistance to ampicillin,
chloramphenicol, streptomycin, sulfisoxazole, and tetracycline. Infections
due to multidrug-resistant shigellae are endemic in Oregon. 
This study therefore suggests that “[n]either ampicillin nor
TMP-SMZ should be considered appropriate empirical therapy for shigellosis
any longer; when antibiotics are indicated, a quinolone or cefixime
should be used.” 
More on Antimicrobial Resistance in Bacteria
Antimicrobial resistance in bacteria is an emerging and increasing
threat to human health. [2, 3] Physicians are increasingly aware
that antimicrobial resistance is increasing in foodborne pathogens
and that, as a result, patients who are prescribed antibiotics are
at increased risk for acquiring antimicrobial-resistant foodborne
infections. [3, 29] Indeed, “increased frequency of treatment
failures for acute illness and increased severity of infection may
be manifested by prolonged duration of illness, increased frequency
of bloodstream infections, increased hospitalization or increased
The use of antimicrobial agents in the feed of food animals is estimated
by the FDA to be over 100 million pounds per year.  It is
estimated that 36% to 70% of all antibiotics produced in the United
States are used in food animal feed or in prophylactic treatment to
prevent animal disease. [2, 3] In 2002, the Minnesota Medical
Association published an article by David Wallinga, M.D., M.P.H. who
According to the [Union of Concerned Scientists], 70 percent of all
the antimicrobials used in the United States for all purposes—or
about 24.6 million pounds annually—are fed to poultry, swine,
and beef cattle for nontherapeutic purposes, in the absence of disease.
Over half are “medically important” antimicrobials; identical
or so closely related to human medicines that resistance to the animal
drug can confer resistance to the similar human drug. Penicillin,
tetracycline, macrolides, streptogramins, and sulfonamides are prominent
Based on recent research, it is now recommended that doctors avoid
the use of commonly prescribed antibiotics, like tetracycline and
ampicillin, in favor of drugs for which Shigella has not shown resistance,
such as ciprofloxacin.  European countries have reduced the use
of antibiotics in animal feed and have seen a corresponding reduction
in antibiotic-resistant illnesses in humans. 
The Economic Impact of Shigella Infections
The USDA Economic Research Service (ERS) published its first comprehensive
cost estimates for sixteen foodborne bacterial pathogens in 1989.
 Five years later, it was estimated that the medical costs
and productivity losses that Shigella infections caused each year
ran from $907 million to over $1 billion, based on an estimate of
2.1 million cases and between 120-360 deaths.  The average length
of a related hospital stay was 4.6 days, with the cost (based on a
1990 average cost per day of $687) was $16,888. 
Using a different kind of economic analysis, this same 1996 study
estimated that the annual cost of Shigella infections was $63 million,
while the average cost of each confirmed and treated infection was
$390; however, these estimates are based on significantly lower (and
outdated) incidence and death rates.  Most recent estimates are
all much higher. For example, a study published in 2010 estimated
the cost per case (in 2009 dollars) for a treated Shigella infection
to be $7,092, with an estimate of 96,686 cases and 1,227 deaths per
year, and a total cost to U.S. residents of $686 million. 
Real Life Impacts of Shigella Infection
Because the illnesses caused by the ingestion of Shigella bacteria
range from mild to severe, the real life impacts of Shigella infection
vary from person to person.
While anyone can become ill with Shigella infection, very young children,
the elderly, and persons with compromised immune systems are most
likely to develop severe illness.
About 2% of persons who are infected with one type of Shigella, Shigella
flexneri, later develop pains in their joints, irritation of the eyes,
and painful urination. This is called post-infectious arthritis, or
reactive arthritis. The arthritis can last for months
or years, and can lead to chronic arthritis. Post-infectious
arthritis is caused by a reaction to Shigella infection that happens
only in people who are genetically predisposed to it. 
An unknown percentage of patients with Shigella infections develop
digestive disorders, including irritable bowel syndrome.
Although most patients with Shigella infections recover within a few
months, some continue to experience complications for years.
How to Prevent Shigella Infection
According to the World Health Organization, “Despite the continuing
challenge posed by Shigella, there is room for optimism as advances
in biotechnology have enabled the development of a new generation
of candidate vaccines that shows great promise for the prevention
of Shigella disease.”  But such a vaccine has yet to be
perfected. Thus, in the meantime, preventing infection is the best
approach, and that means implementing proper sanitation measures.
[1, 14] Indeed, as noted in one authoritative text summarizing
A safe water supply is important for the control of shigellosis and
is probably the single most important factor in areas with substandard
sanitation facilities. Chlorination is another factor important in
decreasing the incidence of all enteric bacterial infections. Of critical
importance to the establishment of a safe water supply is the general
level of sanitation in the area and the establishment of an effective
sewage disposal system. 
As previously noted, it takes but a few—far less than 100—Shigella
bacteria to cause infection.  Moreover, a person can be
infectious even if there are no symptoms, either because he remained
asymptomatic (never exhibited symptoms of shigellosis), or because
the person continued to shed the bacteria in his stool for a week
or two after recovering. [11, 16, 17]
The spread of Shigella from an infected person to other persons can
be avoided by frequent and careful hand-washing with soap and hot
water. [1, 14, 15] Hand-washing among children should be frequent
and supervised by an adult in daycare centers and homes with children
who have not been fully toilet trained. [24, 28]
If a child in diapers has shigellosis, everyone who changes the child’s
diapers should be sure the diapers are disposed of properly in a closed-lid
garbage can, and should wash his or her hands and the child’s
hands carefully with soap and warm water immediately after the diaper
has been changed. [15, 39] After use, the diaper changing area should
be wiped down with a disinfectant such as diluted household bleach,
Lysol, or bactericidal wipes. [15, 24, 39] When possible, young
children with a Shigella infection who are still in diapers should
not be in contact with uninfected children. [1, 11, 15]
Basic food safety precautions and disinfection of drinking water should
prevent Shigella bacteria from contaminating food and water. [11,
15, 39] Nonetheless, it should go without saying that people with
shigellosis should not prepare food or drinks for others until they
have been confirmed (by a stool culture) to no longer be shedding
Shigella bacteria in their stool. [1, 15] At swimming beaches,
there should be bathrooms and handwashing stations near the swimming
area to help keep the water from becoming contaminated. [14,
29] Daycare centers should not provide water play areas. 
Simple precautions taken while traveling to the developing world can
prevent shigellosis. [1, 39] Drink only treated or boiled water, and
eat only cooked hot foods or fruits you peel yourself. [1, 11] The
same precautions prevent other types of traveler’s diarrhea.
Bill Marler is an accomplished personal injury and products liability
attorney. He began litigating foodborne illness cases in 1993, when
he represented Brianne Kiner, the most seriously injured survivor
of the Jack in the Box E. coli O157:H7 outbreak. Bill settled Brianne’s
case for $15.6 million, creating a Washington state record for an
individual personal injury action.
American Public Health Association (APHA), “Shigellosis,”
in CONTROL OF COMMUNICABLE DISEASES MANUAL, pp. 556-60, edited by
Heymann, David L., (19th Ed. 2008).
Angulo, F.J., et al., “Antimicrobial Use in Agriculture: Controlling
the Transfer of Antimicrobial Resistance to Humans,” SEMINARS
IN PEDIATRIC INFECTIOUS DISEASES, Vol. 15, No. 2, pp. 78-85 (April
Angulo, F.J., et al., “Evidence of an Association Between Use
of Anti-microbial Agents in Food Animals and Anti-microbial Resistance
Among Bacteria Isolated from Humans and the Human Health Consequences
of Such Resistance, JOURNAL OF VETERINARY MEDICINE, Series-B, Vol.
51, Issue 8-9, pp. 374-79 (Oct. 2004).
Baer, JT, et al., “HIV Infection as a Risk Factor for Shigellosis,”
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