State health officials warned consumers today not to eat certain Fresh Choice red leaf lettuce sold at three Southern California grocers, due to possible Salmonella contamination.

The lettuce was sold between Oct. 20 and Nov. 1 at Canton Food Co. in Los Angeles, Cardenas Market and Numero Uno Market locations throughout
Southern California, according to California Department of Public Health director Dr. Mark Horton.

Fresh Choice Marketing of Oxnard produced the lettuce and made it available in grocery stores as whole head lettuce without identifying labels, Horton said.

In 2004, I spent a week at a cottage with a couple of my children in Eastern Ontario near Sandbanks Provincial Park on Lake Ontario. Lovely spot.

One rainy day, we toured around and ended up at a cheese shop. They produced the cheese in the factory at the back, and had a charming market outlet that seemed to trap tourists like bees on sap.

Upon entering the store, a sign declared, “HACCP – A food safety program; Hazard Analysis Critical Control Pont.” Cool. I asked one of the staff what it meant. She said she didn’t know. 

But beside the HACCP proclamation was a sign that read, “Public bathroom is out of order; for your convenience there is a blue Johnny on the spot behind the building.”


No handwashing facilities or sanitizer. I watched people go to the porta potty and then come into the cheese shop and do what people do at quaint cheese shops: stick their unwashed hands into shared samples of curds (that’s one of my daughters looking disgusted in the middle, right, not because of the practice, but because I have to take pictures and be a food safety geek everywhere we go). HACCP really doesn’t mean much unless there is a culture of food safety amongst the employees and everyone involved in making a product, like cheese or deli meat.



These public sampling stations can be cross-contamination nightmares. But the best hygiene won’t prevent food safety foul-ups when the product itself is contaminated.

Multiple sources are reporting tonight that Arizona and four other states reported cases of E. coli O157 in cheese products sold in Costco stores in October.

Twenty-five cases of Escherichia coli were confirmed by officials, 11 in Arizona lone, according to a statement issued Thursday by the Arizona Department of Health Services.

The outbreak appears to have been associated with cheese available for purchase at Costco "Cheese Road Shows," and Costco was working with state officials to remove the tainted product from its stores.

Early data from health officials suggests that Dutch-style Gouda cheese is the culprit. Costco is cooperating with the investigation: they have removed all suspect products from shelves and are notifying customers who purchased cheese from the road show.

A U.S. Food and Drug Administration press release states:]

• Bravo Farms Dutch Style Gouda cheese, (Costco item 40654) offered for sale and in cheese sampling events at Costco Wholesale Corporation (Costco) locations is preliminarily linked with an outbreak of E.coli O157:H7 infections.

• Consumers who have any of this cheese should not eat it. They should return the cheese to the place of purchase or dispose of it in a closed plastic bag and place in a sealed trash can to prevent people or animals, including wild animals, from eating it.

• Most people infected with E. coli O157:H7 develop diarrhea and abdominal cramps, but some illnesses may last longer and can be more severe. While most people recover within a week, some may develop a severe infection. Rarely, as symptoms of diarrhea improve, a type of kidney failure called hemolytic uremic syndrome (HUS) can occur; this can happen at any age but is most common in children under 5 years old and in older adults. People with HUS should be hospitalized immediately, as their kidneys may stop working and they may be at risk for other serious health problems.

• As of Thursday, November 4, 2010, 25 persons infected with the outbreak strain of E. coli O157:H7have been reported from five states since mid-October. The number of ill persons identified in each state with this strain is as follows: AZ (11), CA (1), CO (8), NM (3) and NV (2). There have been 9 reported hospitalizations, 1 possible case of hemolytic uremic syndrome (HUS), and no deaths.

Costco may need to check its suppliers. Again.
 

Over 100 school kids (and a few adults) have been confirmed sick by salmonella in ground beef patties in Poitiers, France.

The source of original contamination has not been uncovered.

So far cases are limited to the Department of Vienne. Health authorities sent out a national alert but the school holidays hampered the investigation. It was an ER doctor in Poitiers who sent out the alert after seeing 8 patients arrive in the University Hospital with the same symptoms and from the same school. At that point they started a "regional cell of sanitary surveillance.” (Amy’s not sure on that translation).

Thanks to Albert Amgar for forwarding the story.
 

I spent five summers in high school and university hammering nails and planks with a couple of Danish craftsmen. They taught me many things, including how to eat pate and beet sandwiches (lunch today, right), along with raw herring and vast quantities of aquavit.

Eurosurveillance reports this week on an outbreak of campylobacter associated with chicken liver parfait served in Scotland in June. Undercooking appears to be the culprit, probably because the cooks went with ‘piping hot’ rather than a thermometer. One web site says a chicken liver pate becomes a chicken liver parfait (French for perfect) when the cooked liver mixture is pushed through a sieve to remove any sinewy bits, resulting in a silkier, smoother and luscious liver parfait.

It’s on the Internet so it must be true. The full report follows.

In an outbreak of 24 cases of gastroenteritis among guests at a wedding reception, 13 cases had confirmed Campylobacter infection. In a cohort study, univariate analysis revealed a strong association with consumption of chicken liver parfait: risk ratio (RR): 30.08, 95% confidence interval (CI): 4.34-208.44, p<0.001, which remained after adjustment for potential confounders in a multivariable model: RR=27.8, 95% CI=3.9-199.7, p=0.001. These analyses strongly support the hypothesis that this outbreak was caused by the consumption of chicken liver parfait.

Background
Campylobacteriosis is an acute bacterial enteric disease, caused by infection with Campylobacter. Common symptoms include diarrhoea, abdominal pain, malaise, fever, nausea, and/or vomiting [1] and may persist for a week or even longer [2]. Onset is usually between two and five days after exposure, but may be up to 10 days. The infectious dose required to cause Campylobacter illness is estimated to be as low as 500 organisms [3]. Campylobacter infection continues to be the most commonly reported cause of foodborne illness in England and Wales, with 57,772 laboratory reports of Campylobacter cases received by the Health Protection Agency (HPA) in 2009 [4].

Despite the high incidence of this disease, the HPA received only 114 reports of foodborne Campylobacter outbreaks between 1992 and 2009, of which 25 (22%) were recorded as being linked to consumption of poultry liver dishes [5]. Chicken liver foods carry a high risk of Campylobacter infection as the bacteria can infect both the external and internal tissue of chicken livers [6], and may remain in chicken liver if insufficiently cooked [7]. The association between poultry liver dishes and outbreaks of Campylobacter infection has been illustrated by two recently published studies from Scotland [8,9].

On 5 July 2010, a suspected outbreak of campylobacteriosis was reported to the North East Health Protection Unit (HPU) by Environmental Health Officers from Northumberland County Council. Reports of illness were received from guests at a wedding held at a luxury hotel in Northumberland on 25 June 2010. One guest was hospitalised with Campylobacter infection following the event. In total, 13 guests who ate at the event submitted samples that tested positive for Campylobacter. The event consisted of a wedding breakfast (afternoon meal) and an evening buffet.

At the first Outbreak Control Team meeting on 7 July 2010, the decision was made to undertake an analytical study. Reports of illness were only received from guests who had attended the wedding breakfast, and accordingly the study was carried out on this group.

Method
Study design and cohort

A retrospective cohort study was used. The cohort was defined as persons who had eaten the wedding breakfast at the luxury hotel on 25 June 2010 (n=67). Contact details for these 67 guests were obtained from the event organiser. The evening buffet was excluded because no cases were reported in guests attending only the evening buffet. All reported cases attended the wedding breakfast (three of them attended only the wedding breakfast).

Data collection
Of the 67 guests listed by the event organiser, 65 were posted a questionnaire with a covering letter and a stamped and addressed return envelope. The remaining two guests, resident outside the United Kingdom (UK), were sent an electronic copy of the covering letter and questionnaire via email in order to maintain the timeliness of the investigation. One week after the first posting, a follow-up letter was sent to those guests whose questionnaires were still to be received.

Case definition
Cases were defined as persons who attended the wedding at the hotel on 25 June 2010, who reported an illness with diarrhoea or vomiting, with or without other gastrointestinal symptoms, and with an onset of illness between 26 June 2010 and 5 July 2010. Guests with illness onset dates less than one day or greater than 10 days after the event were included as non-cases.

Response rate

Of the 67 persons on the guest list, two were found to be infants who did not eat the wedding breakfast and were excluded from the study, giving a potential cohort size of 65. Completed questionnaires were received from 60 of 65 remaining guests (92%).

Questionnaire content

The questionnaire contained questions regarding personal details, illness information, travel history, other illness in the household, food and drink consumed at the meal, in addition to other questions relating to the participant’s stay at the hotel. The menu for the wedding breakfast was obtained from the hotel; details from this menu were used to inform the content of the questionnaire.

Statistical analyses

Data were double-entered using EpiData v3.1 (EpiData Association) and then verified and analysed using STATA 10.1 (StataCorp). The association between exposure variables and illness was examined using univariate, stratified methods (using Mantel-Haenszel risk ratios and the Woolf test for homogeneity) and multivariable methods (logistic and binary regression).

Results
Descriptive epidemiology
Of the 60 individuals included in the study, 24 fitted the case definition. Of these 24, 13 received laboratory confirmation of Campylobacter infection. Illness onset dates for cases ranged from 26 to 30 June 2010 (Figure 1). The incubation period ranged from one to five days (mean = 2.25 days). The symptoms experienced by cases are shown in Table 1; duration of symptoms ranged from 1 to 18 days. A mean duration of symptoms cannot be calculated as 13 of 24 cases were still experiencing symptoms when answering the questionnaire.

Analytical epidemiology
In a univariate analysis, the strength of association between the risk of becoming a case and 40 exposures was calculated. Of these, four exposures were significantly (p<0.05) associated with illness; these are shown in Table 2. From this univariate analysis, chicken liver parfait was the variable most strongly associated with illness, with a risk ratio (RR) of 30.08.

Of variables significantly associated with illness, chicken liver parfait, onion marmalade and the mixed leaf salad were served in the same set dish. Whilst cheesecake is positively associated with illness, it only explains 14 of the 24 cases, whereas chicken liver parfait explains 23 of the 24 cases.

To examine potential confounding and effect modification between variables, significant exposures (p<0.05) were stratified for exposure to chicken liver parfait and Mantel-Haenszel RRs calculated (Table 3). Consumption of chicken liver parfait strongly confounded each of these variables, and after stratification the association between these exposures and illness was no longer significant.

Multivariable analysis was conducted using logistic and binary regression models. The four variables significantly associated with illness in the univariate analysis were included in an initial logistic regression model. Variables were then removed in a stepwise fashion, in the order of the univariate p value, and a likelihood ratio (LR) test was conducted. As these models did not have significantly different log likelihoods (LR test p<0.05), the original model was used.

As the results of the multivariable model show (Table 4), when adjusting for other significant exposures, chicken liver parfait (RR= 27.8, 95% CI: 3.9-199.7) remained significantly associated with illness.

Microbiology
Due to the time between the event and notification of the outbreak (10 days), no samples of food from the wedding remained for microbiological analysis. However, environmental samples from the kitchen were taken. Based on results from these environmental samples, the general hygiene of the premises was determined to be satisfactory.

Discussion
These results show a very strong association between consumption of chicken liver parfait at the wedding breakfast and Campylobacter illness. The multivariable analysis of food items demonstrates that even after adjusting for confounding variables, guests who ate chicken liver parfait had a risk of illness that was 28 times greater than guests who did not eat this food.

An investigation by Environmental Health Officers identified concerns about the method used to prepare the chicken liver parfait for this event. Information from the hotel indicates that after mixing raw chicken livers with a red wine reduction and raw eggs, the parfait mixture was heated, using a bain marie (water bath), to a core temperature of 65°C and then immediately removed from the oven and cooled for 15 minutes. According to the UK Food Standards Agency advice, if liver is cooked at 65°C, it should be held at this temperature for at least ten minutes to ensure adequate cooking [10].

One of the most positive elements in the implementation of this study was the high response rate (92%) to the postal questionnaire. This may have been due to factors such as the prompt posting of the questionnaire after the wedding, the type of event concerned and the high proportion of guests reporting illness.

Other factors, such as the relatively short length of questionnaire, the inclusion of a personalised letter, first class postage, the inclusion of a stamped and addressed return envelope, and follow up contact of non-respondents, have all been previously associated with increasing response rates to postal questionnaires [11].

It is possible that the study was affected by an ascertainment bias, in that the suggestion that chicken liver parfait had caused the outbreak may have circulated among guests, biasing their responses in the questionnaire. However, the number of portions recorded as having been eaten in the questionnaires was similar to the hotel’s estimate of portions served, suggesting that the effect of this bias was inconsequential. Also, the case definition was such that guests reporting diarrhoea or vomiting, independent of other symptoms, were included as cases. This may have led to the misclassification of non-cases as cases, reducing the strength of observed associations.

The outbreak investigation was conducted in a timely fashion, which minimised recall bias in questionnaire responses and enabled prompt implementation of control measures. As a result of this outbreak investigation, the hotel, one of a group of six, reviewed their catering operations, removing certain high risk foods from their menus and implementing quarterly unannounced kitchen inspections.

Of the 25 foodborne Campylobacter outbreaks linked to chicken liver parfait/pâté reported to the HPA between 1992 and 2009, 17 were recorded to have been due to errors in food handling during preparation of the chicken liver dishes. These food handling errors included inadequate cooking of blended livers in a bain marie [5].

From 2007 to 2009, the proportion of foodborne Campylobacter outbreaks in England and Wales that were linked with chicken liver dishes increased significantly [12], indicating that the consumption of this food is a public health issue of escalating importance.

From the evidence available, it is likely that the cooking method used for the chicken liver parfait was insufficient to ensure that the food was free from Campylobacter bacteria. These findings demonstrate the importance of influencing catering practice with regard to the cooking of chicken livers, to reduce the risk of campylobacteriosis outbreaks.

References
Heymann DL, editor. Control of Communicable Diseases Manual. 19th ed. Washington, DC: American Public Health Association; 2008: 94-8.
Butzler JP, Oosterom J. Campylobacter: pathogenicity and significance in foods. Int J Food Microbiol. 1991;12(1):1-8.
Robinson DA. Infective dose of Campylobacter jejuni in milk. BMJ (Clin Res Ed). 1981;282(6276):1584.
Health Protection Agency (HPA). Campylobacter infections per year in England and Wales, 1989-2009. London:HPA; [Accessed 1 Nov 2010]. Available from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Campylobacter/EpidemiologicalData/campyDataEw/
Little CL, Gormley FJ, Rawal N, Richardson JF. A recipe for disaster: Outbreaks of campylobacteriosis associated with poultry liver pâté in England and Wales. Epidemiol Infect. 2010;138(12):1691-4.
Baumgartner A, Grand M, Lininger M, Simmen A. Campylobacter contaminations of poultry liver – consequences for food handlers and consumers. Archiv Lebensmittelhyg. 1995;46:1-24
Whyte R, Hudson JA, Graham C. Campylobacter in chicken livers and their destruction by pan frying. Lett Appl Microbiol. 2006;43(6):591-5.
O'Leary MC, Harding O, Fisher L, Cowden J. A continuous common-source outbreak of campylobacteriosis associated with changes to the preparation of chicken liver pâté. Epidemiol Infect. 2009;137(3):383-8.
Forbes KJ, Gormley FJ, Dallas JF, Labovitiadi O, MacRae M, Owen RJ, et al. Campylobacter Immunity and Coinfection following a Large Outbreak in a Farming Community. J. Clin. Microbiol. 2009;47(1):111-16.
Food Standards Agency (FSA). Caterers warned on chicken livers. London:FSA. Accessed 28 Jul 2010. Available from: http://www.food.gov.uk/news/newsarchive/2010/jul/livers
Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, et al. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002;324(7347):1183.
Health Protection Agency (HPA). Food-borne outbreaks of Campylobacter (associated with poultry liver dishes) in England. Health Protection Report. 3(49); 11 Dec 2009. Available from: http://www.hpa.org.uk/hpr/archives/2009/news4909.htm

Dozens of tri-delts who became sick after a meal at their University of Michigan sorority house were stricken with norovirus.

The Detroit Free Press reports lab results released Wed. by the Washtenaw County Public Health Department confirmed norovirus. Spokeswoman Susan Cerniglia, said the outbreak was “most likely,” the result of food poisoning, but the virus also may have been transmitted through personal contact or shared surfaces at the Delta Delta Delta house near the university.
 

I won’t get asked to serve on the sustainability committee.

I got tired of talking about organics, local, genetic engineering and sustainability a long time ago.

There’s good farmers and bad farmers, whatever system they’re using, and I’m more interested in making sure people don’t barf, whatever kind of food they choose.

There are endless scientific reports about which system is better, but they don’t say much. A new report in the Journal of Agricultural and Food Chemistry found that organically grown onions, carrots, and potatoes generally do not have higher levels of healthful antioxidants and related substances than vegetables grown with traditional fertilizers and pesticides.

In the study, Pia Knuthsen and colleagues point the health benefits of organic food consumption are still controversial and not considered scientifically well documented.
 

When state regulators closed SanGar Fresh Cut Produce of San Antonio after linking the plant with four, maybe five deaths due to listeria, on Oct. 20, 2010, Sangar President Kenneth Sanquist Jr. said in a statement,

“The state's claim that some of our produce now fails to meet health standards directly contradicts independent testing that was conducted on the same products. This independent testing shows our produce to be absolutely safe, and we are aggressively fighting the state's erroneous findings.”

The U.S. Food and Drug Administration announced this morning they found the same listeria at the facility, matching testing done by the Texas Department of State Health Services at SanGar.

The tests found listeria bacteria in multiple locations in the plant.

Messages left for an attorney for SanGar by The Associated Press were not immediately returned.
 

There’s no shortage of food safety press releases, repeated and regurgitated using funky new media tools; there is a shortage of evidence-based, incisive approaches that challenge food safety norms and may eventually lead to fewer sick people.

barfblog.com is the fastest way to stay current on food safety issues. Powell, Chapman and assorted food safety friends offer evidence-based opinions on current food safety issues. Opinions must be reliable – with references -- rapid and relevant.

Anyone can subscribe directly to barfblog.com and receive an e-mail immediately when something new is posted. Go to barfblog.com and click on the ‘subscribe’ button on the right side of the page.

Food safety infosheets are designed to influence food handler practices by utilizing four attributes culled from education, behavioral science and communication literature:
• surprising and compelling messages;
• putting actions and their consequence in context;
• generating discussion within the target audiences’ environments; and
• using verbal narrative, or storytelling, as a message delivery device.

Food safety infosheets are based on stories about outbreaks of foodborne illness. Four criteria are used to select the story: discussion of a foodborne illness outbreak; discussion of background knowledge of a pathogen (including symptoms, etiology and transmission); food handler control practices; and emerging food safety issues. Food safety infosheets also contain evidence-based prescriptive information to prevent or mitigate foodborne illness related to food handling. They are available in several languages.

The bites.ksu.edu listserv is a free web-based mailing list where information about current and emerging food safety issues is provided, gathered from journalistic and scientific sources around the world and condensed into short items or stories that make up the daily postings. The listserv has been issued continuously since 1994 and is distributed daily via e-mail to thousands of individuals worldwide from academia, industry, government, the farm community, journalists and the public at large.

The listserv is designed to:
• convey timely and current information for direction of research, diagnostic or investigative activities;
• identify food risk trends and issues for risk management and communication activities; and
• promote awareness of public concerns in scientific and regulatory circles.

The bites listserv functions as a food safety news aggregator, summarizing available information that can be can be useful for risk managers in proactively anticipating trends and reactively address issues. The bites editor (me – dp) does not say whether a story is right or wrong or somewhere in between, but rather that a specific story is available today for public discussion.

If you only want to receive specific news, use RSS feeds.

RSS (Rich Site Summary, or Really Simple Syndication) is a format for delivering regularly changing web content. Many news-related sites, weblogs and other online publishers syndicate their content as an RSS Feed to whoever wants it.

If you only want stories about food safety policy, or norovirus, go to bites.ksu.edu and click on that section. Then click on the RSS symbol, and add to your reader. barfblog.com is also available as a RSS feed.

Breaking food safety news items that eventually appear in bites-l or barfblog.com are often posted on Twitter (under barfblog or benjaminchapman) for faster public notification.

These are the various information products we deliver daily, in addition to research, training and outreach. Sponsorship opportunities are available for bites.ksu.edu, barfblog.com, and the bites-l listserv.

Any money is used to support the on-going expenses of the news-gathering and distribution activities, and to develop the next generation of high school, undergraduate and graduate students who will integrate science and communication skills to deliver compelling food safety messages using a variety of media. Research, training and outreach are all connected in our food safety world.

New Zealand restaurants and food service outlets feed 1.5 million people daily.
Food safety is an integral part of this experience. It's a competitive advantage and an absolute necessity for one of the country's cornerstone industries; it's a customer's expectation and right to buy food, enjoy it and live to tell the tale.

So says Steve Mackenzie, chief executive of the Restaurant Association of New Zealand, writing in the New Zealand Herald.

But the hospitality business is about to get a shake up by way of a long-awaited Food Bill that will focus on food safety. The intent of the bill is to move food regulation in line with other developed countries, by shifting from an inspection-based system to a risk-based approach.

Whereas the present system involves an environmental health officer calling unannounced and touring the premises, the new operations will involve proprietor records, premise inspection and interviews with staff.

The Restaurant Association of New Zealand represents a select group of hospitality businesses and has been involved in consultation and pilot-testing of this new programme. Most association members support the new bill.

Members who participated in trials reported that they liked having control and accountability of their business back in their hands.

Simple documentation procedures, one handy manual covering all food safety aspects and clear guidelines for staff were also useful. In many cases the proposed changes were less onerous than the current programmes.

But with less than 12 months until transition, more than 90 per cent of the country's eateries haven't registered. That's around 13,500 businesses.

A survey in April that confirmed the association's worst fears: many business operators will wait until the last minute to make changes.

Worse still, many are not aware the changes are coming, and even those who were aware that the review was taking place, more than 55 per cent had little knowledge of the impact that this would have on their businesses in less than a year.

And despite knowing that there is proposed change, 60 per cent of those surveyed have made little or no preparation.

The biggest hurdle as we have seen in our survey results is awareness. There are many businesses that simply do not know they need to make changes.

The association recommends that the select committee working on the bill considers extending the first year transition of high-risk businesses from 12 months to 24, to ensure that under-resourced councils will be able to properly assist with implementation.