When government health officials wrapped up a three-month investigation of a Salmonella Enteritidis outbreak that sickened 68 people in 10 states, the final report on Jan. 19 included nearly every detail -- except the name of the place that sold the food.

JoNel Aleccia of msnbc.com writes the U.S. Centers for Disease Control and Prevention has refused to identify the source, other than as “Restaurant Chain A,” a Mexican-style fast-food chain.

“It will eventually come out and it will be the company that looks bad,” said Doug Powell, a professor of food safety at Kansas State University and author of a food safety blog. “A lot of these problems could be reduced if government agencies were more transparent about how they decide when to go public.”

Dr. Robert Tauxe, a top CDC official, defended the agency’s practice of withholding company identities, which he said aims to protect not only public health, but also the bottom line of businesses that could be hurt by bad publicity.

“The longstanding policy is we publicly identify a company only when people can use that information to take specific action to protect their health,” said Tauxe, the CDC’s deputy director of the Division of Foodborne, Waterborne and Environmental Diseases. “On the other hand, if there’s not an important public health reason to use the name publicly, CDC doesn’t use the name publicly.”

The trouble, say food safety advocates, is that it’s not clear when or why CDC officials decide to withhold the identity of firms involved in outbreaks and when they decide to go public.

"No one is happy, and that's largely because there are no guidelines people can at least point to, whether they agree with the guidance or no," Powell said.

Tauxe acknowledged there’s no written policy or checklist that governs that decision, only decades of precedent.

“It’s a case-by-case thing and all the way back, as far as people can remember, there’s discussions of ‘hotel X’ or ‘cruise ship Y,” he said.

Epidemiology, like humans, is flawed. But it’s better than astrology. The more that public health folks can articulate when to go public and why, the more confidence in the system. Past risk communication research has demonstrated that if people have confidence in the decision-making process they will have more confidence in the decision. People may not agree about when to go public, but if the assumptions are laid on the table, and value judgments are acknowledged, then maybe the focus can be on fewer sick people.

I understand the flexibility public health types require to do their jobs effectively, but much of the public outrage surrounding various outbreaks – salmonella in tomatoes/jalapenos, 2008, listeria in Maple Leaf deli meats, 2008, the various leafy green recalls and outbreaks of 2010, and the delay in clamping down on Iowa eggs – can be traced to screw ups in going public.

It’s long been a tenet of risk communication that it is better to default to early public information rather than later. People can handle all kinds of information, especially when they are informed in an honest and forthright manner.

A bus driver is blaming a Brooklyn chicken joint for sending him to the hospital with piece of wire lodged in his larynx.

Lajzer Grynsztajn, 50, said he nearly choked to death on a 2-inch coil he claims was cooked in a two-piece order he bought at JFK Fried Chicken near his Sunset Park bus depot.

“The more I think about it, I get angry. I almost died for something stupid like that?” said Grynsztajn, of Bensonhurst.

In a Brooklyn Supreme Court lawsuit, the 11-year Metropolitan Transportation Authority veteran is seeking unspecified damages for the near-fatal food fiasco.

Grynsztajn charges that the clerk who took his order seemed more concerned about him paying for the meal than why he was choking at the counter.

“He asked for $5 before I passed out or something,” said Grynsztajn.

The father of three said the scare happened Jan. 9 when he stopped at the Fifth Ave. eatery on his way to work and ordered two chicken breasts and fries.

“I felt a sharp pain, like I was choking,” he recalled. “I thought I was choking on a bone.”

After leaving the restaurant, he started coughing blood and was taken to Lutheran Medical Center, where a doctor discovered the real culprit, he said.

The wire was stuck so deep in his throat, he had to be put under anesthesia before it could to be dislodged, according to court papers.

A man who answered the phone at JFK Fried Chicken denied the bus driver’s charges.

“I think this guy is bull-------g us,” he said and hung up.

I'm currently experiencing the warmest winter I've ever had - Raleigh hasn't had a day below freezing (a few nights) and I have yet to scrape my car off in the morning. Yesterday I strapped my kids into a bike trailer and rode around on a few paved trails and tomorrow it's going to be close to 70F. I love the south. But just because it's warm doesn't mean that the state will avoid norovirus - the famed winter vomiting sickness.

In 1929 Dr. John Zahorsky wrote about a history of gastrointestinal illness events, which would become norovirus. After seeing children develop sporadic cases of vomiting, supplemented by watery diarrhea each year between November and May, through over 30 years of clinical practice, he coined the term winter vomiting sickness.

Over 125 folks in Conover NC dealt with a norovirus outbreak back in mid January. According to the Raleigh News & Observer, most illnesses were linked to eating at the Harbor Inn Seafood restaurant on January 13 and 14 - but some folks got sick after eating there as recently as January 20th.

Catawba County Public Health has been working with the N.C. Division of Public Health to figure out what's been making people sick since the first cases were reported Jan. 17.

Although Public Health has not announced what food or foods caused the illness, victims have stated that the members of their party who got sick after eating at Harbor Inn were the ones who ate tossed salad.

Neither tossed salad or an exposure period of over a week would be all that surprising - tossed salad can be prepped by someone who doesn't see themselves as a food handler - and noro, especially in cooler months, is pretty stable in the environment (and could stick around to infect for weeks).
 

The UK Health Protection Agency is issuing a seasonal warning to pregnant women about the potential risk associated with close contact with animals that are giving birth.

Pregnant women who come into close contact with sheep during lambing, for example, may risk their own health, and that of their unborn child, from infections that can occur in some ewes.

Although the number of human pregnancies affected by contact with an infected animal is extremely small, it is important that pregnant women are aware of the potential risks and take appropriate precautions.

It is also important to note that these risks are not only confined to the spring (when the majority of lambs are born), nor are the risks only associated with sheep: cows and goats that have recently given birth can also carry similar infections.

To avoid the possible risk of infection, pregnant women are advised that they should:

• not help to lamb ewes, or to provide assistance with a cow that is calving or a nanny goat that is kidding;
• avoid contact with aborted or new-born lambs, calves or kids or with the afterbirth, birthing fluids or materials (eg bedding) contaminated by such birth products;
• avoid handling (including washing) clothing, boots or any materials that may have come into contact with animals that have recently given birth, their young or afterbirths; and,
• ensure partners attending lambing ewes or other animals giving birth take appropriate health and hygiene precautions, including the wearing of personal protective equipment and adequate washing to remove any potential contamination.

I look forward to Thursdays because a new issue of Eurosurveillance appears and they always have outbreak summaries of interest.

French health-types report eight cases of diarrhea, including two cases of hemolytic uremic syndrome (HUS), identified among 22 French tourists who travelled to Turkey in September 2011. A strain of Escherichia coli O104:H4 stx2-positive,eae-negative, hlyA-negative, aggR-positive, ESBL-negative was isolated from one HUS case. Molecular analyses show this strain to be genetically similar but not indistinguishable from the E. coli O104:H4 2011 outbreak strain of France and Germany.

Although the source of infection was not identified, the authors concluded the HUS cases had probably been infected in Turkey but there was no evidence to link this STEC O104:H4 outbreak to the consumption of fenugreek sprouts, as was the case for the German and French outbreaks in May to June 2011. None of the 22 travel group members reported the consumption of sprouts before and during their trip to Turkey.

Except that over there, sprouts are added to everything, more so than a Jimmy John’s sandwich.

Turkey is among several destinations where European tourists had previously travelled before developing STEC O104 infection between 2004 and 2009 (n=4), along with Afghanistan, Egypt and Tunisia. This outbreak supports data suggesting that the STEC serogroup O104 circulates in these areas. Further evidence is provided by the three additional cases that were subsequently identified in Germany and Denmark among persons also returning from Turkey within the same approximate time frame. Public health authorities and clinicians should be vigilant for possible STEC O104 infection in individuals returning from these areas who present with post-diarrheal HUS.

The complete paper is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20065.

Outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli O104:H4 among tourists returning from Turkey, September 2011
26.jan.12
Eurosurveillance, Volume 17, Issue 4
N Jourdan-da Silva, M Watrin, F X Weill, L A King , M Gouali, A Mailles, D van Cauteren, M Bataille, S Guettier, C Castrale, P Henry, P Mariani, V Vaillant, H de Valk

Nancy Shute of NPR describes the Jones' Mock Salt recall as a collision of two distressing trends: contamination of herbs and spices, and safety issues with organic products.

It's made by June Jones, a hairdresser in Tacoma, Wash., who invented the seasoning a few years ago, after one of customers complained that the salt-free seasonings in the supermarket tasted terrible. Her little start-up has been a success.

But one of the ingredients in Jones's secret recipe is organic celery seed. And that's the source of the trouble.

Over the past few months Safeway and other big retailers have recalled organic celery seed because a batch of the seeds positive for salmonella, which can cause fatal infections. No illnesses have been reported, but the suspect seeds were distributed from last May through December.

Recalls and outbreaks caused by contaminated herbs and spices are not uncommon. Hundreds of people in 44 states fell ill with salmonella in 2009 and 2010 after eating Italian-style sausage. The culprit was red and black pepper used to season the meat.

We called up June Jones to find out what went wrong. "My supplier actually sent to me a recall letter," she said. "I pulled everything off the shelves in December, and recalled online orders. It's very hard."

Her business will survive, she says, but she has taken a big hit financially. And she's worried because most of her customers use salt substitute because they have health problems.

"It was very disturbing to me. I supply to a heart transplant patient in Minnesota," Jones says. "I take every precaution myself as a manufacturer to make sure my product is totally safe, and I expect other people do to that, too."

Because spices can be contaminated with bacteria and insects, big retailers routinely irradiate spices to kill pathogens.

We asked Jones if the celery seed she bought was irradiated. "Irradiated? I didn't ask about that. I made my product from products that are supposed to be safe."

So we called up her supplier, Starwest Botanicals of Rancho Cordova, Calif. Lisa O'Keeley, the customer service supervisor, told us that the firm had found out about the contamination after a manufacturer using their seeds tested a batch and found salmonella.

"Typically all of our products get run through a full gamut of testing by our quality assurance department," O'Keeley told The Salt. "When that product was approved, there was no evidence of salmonella at the time."

The seeds in question came from Egypt, which also happens to be the source of the tainted fenugreek sprouts that were linked to the E. coli outbreak in Germany last year.

O'Keeley says her Egyptian seeds were given an organic certification by an outside inspector. "We have very strict guidelines on what we can call certified organic. "

Were the seeds irradiated? "We won't purvey irradiated herbs," Keeley said. "Even if it's not organic we don't."

But organic certification doesn't measure food safety; it's only about how a food was grown. Recalls of organic tomatoes, lettuce, and other produce for contamination with salmonella and other deadly pathogens are, alas, common.
Organic foods have even spread botulism — like the Italian stuffed olives we covered last year.

"Consumers think organic is safer," says Doug Powell, a professor of food safety at Kansas State University. "But it doesn't. It's just a word. It really doesn't mean much aside from how it was grown."

He should know; he researches outbreaks, and covers them on barfblog, a go-to source on all things icky in food safety.

He doesn't have much sympathy for June Jones's situation, particularly since there's been an explosion of small food producers like her in recent years.

"If you're going to sell to the public, you'd better know what you're selling. Whether she thinks she's part of the industry or just a small little producer, it doesn't matter. You make people barf, they're doing to come after you."

James Gorman of the New York Times writes that disgust is having its moment in the light as researchers find that it does more than cause that sick feeling in the stomach. It protects human beings from disease and parasites, and affects almost every aspect of human relations, from romance to politics.

In several new books and a steady stream of research papers, scientists are exploring the evolution of disgust and its role in attitudes toward food, sexuality and other people.

Paul Rozin, a psychologist who is an emeritus professor at the University of Pennsylvania and a pioneer of modern disgust research, began researching it with a few collaborators in the 1980s, when disgust was far from the mainstream.

“It was always the other emotion,” he said. “Now it’s hot.”

Speaking last week from a conference on disgust in Germany, Valerie Curtis, a self-described “disgustologist” from the London School of Public Hygiene and Tropical Medicine, described her favorite emotion as “incredibly important.”

She continued: “It’s in our everyday life. It determines our hygiene behaviors. It determines how close we get to people. It determines who we’re going to kiss, who we’re going to mate with, who we’re going to sit next to. It determines the people that we shun, and that is something that we do a lot of.”

It begins early, she said: “Kids in the playground accuse other kids of having cooties. And it works, and people feel shame when disgust is turned on them.”

Dr. Curtis is involved in efforts in Africa, India and England to explore what she calls “the power of trying to gross people out.” One slogan that appeared to be effective in England in getting people to wash their hands before leaving a bathroom was “Don’t bring the toilet with you.”

Whatever the fine points of disgust, its power to affect behavior is unquestioned, and that power ought to be put to good use, Dr. Curtis said. So, in one of her projects, she has worked with an Indian public relations agency to come up with a disgust-based campaign to encourage hand washing among mothers in small villages, which could save countless children’s lives lost to diarrhea and other diseases.

The result, now being tested, is a skit involving two characters, one a supermom and the other a disgusting, dirty man. The man makes sweets using mud and worms, stops in the middle of the performance to rush off because he has diarrhea, never washes his hands and does everything possible to be revolting.

Supermom is scrupulously clean. Her children don’t get sick, the skit makes clear. In fact, her baby grows up to be a doctor. She washes her hands all the time.

The prominence of diarrhea in the skit is no accident. One thing about studying disgust, Dr. Curtis said, is that it makes you realize how important it is to talk about the very things that disgust us, because they often present dangers to public health.

“We need to talk about” excrement, she said, using a punchier single-syllable word for maximum effect — a word she is unapologetic about using, as befits a disgustologist.

“Which is worse?” Dr. Curtis asked. To talk about it, “or to make kids die.

Shock and shame.

We’ve been using disgust for a long time. It is called barfblog.

RiverStone Health in Montana was criticized last month when it raised concerns about a man who wanted to make Christmas dinner in his family’s kitchen and deliver the meals to shut-ins.

Health officials say they were only doing their job.

“Let’s imagine the unimaginable,” said RiverStone Health CEO John Felton. “Suppose 35 people got salmonella. What would the question of RiverStone Health have been at that point? We would not have been the Grinch who stole Christmas. We would have been the folks who allowed 35 people to get sick because we didn’t execute our responsibility.”

RiverStone objected to Cody Walter, owner of Delivery 2u, using private kitchens to prepare and distribute food. RiverStone provided Walter with information on food safety. They also identified a number of commercial kitchens so the holiday meals could be prepared in a facility equipped to safely store and prepare the food and milk donations he was receiving.

Walter said he was “shut down” and suggested the Grinch had stolen Christmas.
Public sentiment overwhelmingly sided with Walter.

“What needs to be clear is that we don’t have any interest whatsoever in preventing churches, nonprofit organizations and others from doing the good they do in the community,” Felton said. “Our compelling interest is to protect the safety and health of the public. What we don’t want is to have a bunch of people get sick because we didn’t provide the information they need.”

RiverStone Health employs nine registered sanitarians, six of whom are involved in food inspections. In fiscal year 2011, they conducted 1,750 unannounced inspections in 1,000 licensed establishments. The number of inspections does not include temporary events such as Christmas Stroll, Saturday Live and the Strawberry Festival.

“Cody Walter was doing a good thing,” Felton said. “If we would have had advanced notice we could have worked closely with him. We don’t want to discourage people from doing those types of things. He seems like a good-hearted guy, but there is a huge difference between cooking for five people and cooking for 50 and then delivering it.”

Walter said he understands now that RiverStone Health was only trying to protect him as well as those to whom he would deliver meals. “There are no hard feelings. They were only doing what they should be doing,” he said. “They are there for a reason.”

Another in the weekly we’ve-been-doing-it-this-way-all-our-lives-and-never-got-sick declarations from a restaurant tentatively fingered in an outbreak of illness.

The Hickory Daily Record reports 40 people have complained to officials at Catawba County Public Health that they got sick after eating a meal at Conover’s Harbor Inn Seafood restaurant.

One thing the victims have in common is that they ate at Harbor Inn on Jan. 13.
Health officials are working to determine what the illness is and what caused it, said Catawba County Public Health Outreach Manager Amy McCauley

The first complaints came in on Jan. 17. As of Monday, 40 cases had been reported. None have required hospitalization, said Catawba County Health Director Doug Urland.

“Our Environmental Health workers have been to the restaurant almost every day to investigate and educate the staff about proper food handling techniques and to make sure they are stringent about safe food handling techniques,” McCauley said.

George Ziogas owns the Conover Harbor Inn and said he has no idea why some of his customers got sick following their Friday the 13th meal.

“The Health Department came in and they could not find anything. All of the food temperatures were OK. All of the salad bar temperatures were OK,” he said. “We’ve been open for 23 years and we’ve never had a problem.”

Recent inspection results have given Harbor Inn consistently high marks.
The most recent inspection came on Dec. 29 and Harbor Inn got an A with a score of 99.5. Three months earlier the restaurant scored 99.5. In June, Harbor Inn earned a 100.5.

“I want people to know we’re going to be here a long time – we’re not going anywhere – we’ve been here 23 years and this was a one-time incident,” Ziogas said.

“I eat here all the time and I like the food – if I didn’t, I wouldn’t come back,” said Cora Greene, of Mountain View, on Tuesday, after sharing a meal of whitefish with her son. “This can happen anyplace, but I’ve never gotten sick. I’ll be back.”

Health officials are working to identify the mysterious illness and its cause, but won’t speculate on what it may be.

On Friday, Catawba County Public Health began distributing stool sample kits to the victims of the illness at the request of the North Carolina Division of Public Health. The people complaining of illnesses related to Harbor Inn meals have been instructed to use the kit and return it to Catawba County Public Health, which will then send the kits to the state lab for testing.

It takes about a week to process the tests, and it won’t be clear what’s been making people sick until the results are in.

None of the distributed kits had been returned to Catawba County Public Health as of Tuesday, McCauley said.

The symptoms associated with the Harbor Inn outbreak are intense nausea, vomiting and diarrhea. The onset came within 12 to 24 hours following the Jan. 13 meal and lasted from 24 to 36 hours for most of the victims, according to reports from Catawba County Public Health.