Public Health

  • Giving thanks to local public health types

    Posted: June 11th, 2012 - 7:53am by Doug Powell

    The daily grind for health department professionals is underappreciated.

    Armchair quarterbacks are quick to point out the failings of health types without recognizing the pressures of a standard epidemiological investigation, along with requirements to test pools, investigate dog bites, and soothe political egos.

    As reported by The Daily Courier, Brian Supalla went before the Yavapai County Board of Supervisors Monday (that’s in Arizona) with new food safety regulations expecting a rubber stamp.

    Instead, he found himself under fire.

    Supalla, county health program manager, was holding a "courtesy public hearing" intended to introduce the board to the 2009 FDA Food Code - safety regulations which the Yavapai County Community Health Services Board of Health wants the supervisors to adopt.

    Supalla wasn't far into his PowerPoint presentation when he mentioned one of the provisions of the new code - that restaurants would not be allowed to offer hamburgers cooked less than well-done on their children's menus.

    He said that's because kids don't have well-developed immune systems and are more susceptible to food-borne illnesses.

    But Supervisor Chip Davis stopped him. "Do we have a lot of kids getting sick in Yavapai County from eating rare hamburgers?" Davis asked.

    "That's a difficult question to answer," Supalla said, because most people who become ill from contaminated food will never go to a doctor. "In the 15 years I have been with the county, we have never had a death reported to us determined to be associated with food (contamination)," he said.

    Supalla went back to his presentation, outlining the changes to be adopted.
    When he was finished, Supervisor Carol Springer spoke up.

    "I have a real problem with this," she said. "How did all of us manage to survive without health departments?"

    With that door open, she began to talk about events like farmers' markets and chili cook-offs, which are not specifically addressed by the food code changes.

    "I think that's kind of a trend these days, and we've had a number of complaints about the health department stepping in," Springer said. "I'm having a real problem with our county health department saying, 'No, you can't have this kind of event' because you're serving some food product."

    Supalla, unprepared for the topic, did his best to answer Springer, but she pressed on.

    "I think this is too much government control when you say, 'You can't have a salsa contest," she said, referring to Cottonwood's Old Town Sizzlin' Salsa competition, which was planned for spring.

    "We have not disapproved any requests for a chili cook-off or a salsa competition," Supalla replied. "Every facet of that salsa-tasting complaint, our investigation found, was based on a complete misunderstanding by the event organizers," who were new to the event this year.

    Davis called the new regulations "burdensome" and said he didn't "see the necessity to increase to an additional level of scrutiny on the restaurant business."

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  • It’s not all about pets: US urges action to nurture public, food and research veterinarians

    Posted: June 3rd, 2012 - 1:23pm by Doug Powell

    As food inspection regulators in the U.S., Canada, Australia and elsewhere grapple with how best to get the most bang per regulatory buck, the U.S. National Academy of Sciences has issued a report identifying the future skills veterinarians should possess to actually implement such changes.

    With more than half of veterinary students seeking training in companion animal medicine, many veterinary sectors, including academia, industry, food animal and public service, face potential shortages of qualified veterinarians that could have significant effects on public health, according to a National Research Council of the National Academies of Science report released May 30, 2012.
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    The report, written by the Committee to Assess the Current and Future Workforce Needs in Veterinary Medicine, warned that without immediate action, the academic veterinary community may not successfully prepare future generations of veterinarians for faculty teaching and research positions, jobs in state diagnostic laboratories and federal research and regulatory agencies, and the pharmaceutical and biologics industry.

    This potential shortage could be exacerbated by a strengthening economy that could create many new jobs in industry, according to committee member Fred Quimby, retired vice president and senior director of the Laboratory Animal Research Center at Rockefeller University in New York.

    The rising cost of veterinary education contributes to the situation, as costs could deter some veterinarians from pursuing advanced degrees and others from applying for lower paying positions, including government jobs in food safety, epidemiology and wildlife management. Moreover, the report found that a declining return on investment for veterinary education could reduce the quality of future applicants to veterinary school and diminish the quality of the education itself.

    This potential shortage of veterinarians with advanced training could diminish food safety and animal health standards, human and veterinary drug development, infectious disease control and wildlife and ecosystem management, according to the report.

    “Companion animal medicine and its growing number of specialties that improve the health and lives of pets has been a success story, but it dominates veterinary schools’ curriculum and resources, sometimes to the detriment of equally critical fields,” said Alan Kelly, chair of the committee that wrote the report and emeritus professor of pathology and pathobiology at the University of Pennsylvania School of Veterinary Medicine. “We must ensure that schools train qualified veterinarians in sync with the diverse and growing array of societal needs.”

    Food safety and zoonotic disease prevention are among those societal needs, especially as meat production in developing, and often hot and humid, countries, according to Kelly.

    “The fact that 60 percent of all infectious diseases in humans are of animal origin and 75 percent of emerging infection diseases in the last decade arose from animals underscores the importance of maintaining expertise in other areas of veterinary medicine,” he said.

    The 320-page report culminates with five conclusions and 10 recommendations, including discussion of shortening the length of veterinary education by combining the DVM degree with other advanced degrees (notably MPHs, Ph.D.s, and MBAs).

    The report is available for download at: www.nap.edu.
     

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  • Eggs in Toronto: When local goes public and health types step in

    Posted: April 2nd, 2012 - 7:34pm by Doug Powell

    Alysa Golden didn't want to become an egg mogul. She just wanted a good egg - farm fresh, free from hormones, laid by chickens raised in a cruelty free environment.

    Her quest for the perfect egg led her to a Mennonite community in Southwestern Ontario. The farm delivered them to her front door.

    "The eggs were wonderful, full and thick and rich," says Golden. Two months ago Golden started ordering eggs for her east end Toronto neighbours. She leaves the eggs on her porch and her neighbours pick them up, cross their name off a clipboard and stuff a cheque in a box.

    It's based on an honor system. And she hasn't lost a dime.

    According to the Toronto Star, Golden’s venture spoke to the untapped need of many consumers to get back to basics and to understand where their food is from at the most elemental level.

    The locavore movement is not new, of course. Buying food from nearby farms makes sense, both from a health and carbon footprint standpoint, although Toronto Public Health warns consumers against purchasing eggs outside normal channels.

    Many high-end restaurants exploit the farm fresh movement in their marketing. But this wasn't about eating a fancy dinner. It was about city parents, tired of stuffing processed food into their kids, wanting to introduce their children to a "real" egg, says Golden.

    Buoyed by her success, Golden started distributing eggs from her company, which she called Eggy Weggs. The other "depots" included a couple of health food stores in Toronto and most recently the popular Lazy Daisy Café in the Leslieville neighbourhood.

    Chapman doesn't make a profit off the sales. Her café is simply a pick up station. And like Golden's home, the honor system is in effect, with egg buyers picking up their trays and crossing their name off the clipboard.

    The eggs cost $6.50 per dozen, which is about a buck and a half below what comparable products might sell for, says Golden.

    But Jim Chan, manager of healthy environments for Toronto Public Health, says shoppers should ask if the eggs have been graded and are legal. "Just because it says farm fresh, that's not good enough. Everything's farm fresh, it's not like the guy got them out of his basement," says Chan.

    Chan's staff cracked down on egg vendors in February and March. Six vendors were notified they will be charged for having ungraded eggs. By law, eggs must be sorted, washed, and inspected to be free of leaks and cracks. Only Canada Grade A eggs are allowed for human consumption.

    "If there is a hairline crack you could get salmonella or bacteria inside the shell which can lead to real health problems," says Chan.

    Last February, Toronto Public Health charged six other vendors. Farm Fresh Supermarket at Sheppard Ave. E was fined $10,000 on egg-related charges.

    Golden says her eggs are from farms that have their produce graded at the Green Meadow Eggs grading station in Southwestern Ontario.

    An official from the Canadian Food Inspection Agency contacted by the Star said Green Meadows is a certified grader.

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  • Increased salmonella activity in Toronto

    Posted: March 3rd, 2012 - 4:05am by Doug Powell

    This showed up on a public list, although the authors may have wanted it private. Regardless, it’s out there, and shows the kinds of questions and leads public health types are constantly pursuing, in conjunction with the medical community.

    Toronto Public Health reports as of Feb. 28, 2012, it has received reports of 114 cases of salmonellosis, compared to the previous 10-year average of 70 cases for the same period. This increased activity is affecting individuals across the city and related to several potential sources.

    The known clusters of recent Salmonella infection include:
    1) a large catered event in York Region on February 11 that resulted in transmission of S. typhimurium to numerous attendees who continue to report illness since that time;
    2) an outbreak of a less common species of Salmonella (S. heidelberg) across the GTA. This is under investigation by Public Health Ontario;
    3) an increase of S. enteriditis (the most common strain of Salmonella reported in Toronto) linked to recent travel to Cuba.

    In addition, with a general increase in circulating Salmonella infection there is higher chance of person-to-person transmission.

    TPH recommends:

    • Consider salmonellosis in the differential diagnosis of patients presenting with signs and symptoms of gastroenteritis.
    • Infants, elderly and immunocompromised individuals are at higher risk of bacteremia. Extraintestinal focal infections (e.g., arthritis, meningitis, pneumonia) can occur in those with bacteremia.
    • Remind ill patients of the potential for transmission to others.
    • Emphasize the importance of proper hand hygiene and safe food handling practices.
    • Public Health requires individuals infected with Salmonella who work in or attend high risk environments such as food premises and child care facilities to be excluded from these settings until symptom-free for 24 hours (or until cleared with two negative stool specimens if asymptomatic with poor hygiene practices).
     

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  • Public health protects public health; if people got sick we wouldn’t be doing our job

    Posted: January 25th, 2012 - 2:23pm by Doug Powell

    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.”

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  • Poopy nuts update; public health hopeless at straight talk

    Posted: April 8th, 2011 - 9:32am by Doug Powell

    walnuts.sorenne.apr_.11.jpg

    I generally buy walnuts in a plastic bag, already shelled. Once home, they go into a glass container where I’ll grab a few while puttering in the kitchen, or toss some on a salad, or into Amy’s oatmeal cookies or fiber-brownies (right, displayed this morning by daughter Sorenne).

    When the E. coli O157:H7 outbreak in walnuts was first announced, early on April 4, 2011, the Canadian Food Inspection Agency said people were sick but wouldn’t say how many while fingering walnuts imported from California and imported by Amira Enterprises of St. Laurent, Quebec as the suspected source.

    Later on April 4, 2011, the Public Health Agency of Canada issued its own statement, saying 13 were sick and that “consumers who have raw shelled walnuts in their home can reduce the risk of E. coli infection by roasting the walnuts prior to eating them. Consumers should place the nuts on a cooking sheet and bake at 350°F for 10 minutes, turning the nuts over once after five minutes.”

    Sorenne won’t be doing that.

    At the time I noted this advice does not account for the risk of cross-contamination with a virulent pathogen and that my microbiology friends look forward to testing it out.

    On April 7, 2011, Quebec health types confirmed the death of one person linked to the walnuts and a spokesthingy said, "The Canadian Food Inspection Agency has serious doubts as to whether the infections are related to walnuts, but it's the most probable source.”

    (Are you getting a sense of how well single-food inspection agencies work?)

    Late last night, PHAC issued another statement, saying there were 14 people sick in Quebec, Ontario and New Brunswick, including 10 hospitalizations, 3 cases of hemolytic uremic syndrome, and one death.

    The PHAC statement emphatically states:

    “If you have these products in your home, don’t consume them.”

    But then goes on to less emphatically state,

    “Until further notice, consumers who have raw shelled walnuts in their home can reduce the risk of E. coli infection by roasting the walnuts prior to eating them. Consumers should place the nuts on a cooking sheet and bake at 350°F for 10 minutes, turning the nuts over once after five minutes. Wash your hands and cooking utensils thoroughly after handling the walnuts.”

    So PHAC added a washing recommendation in recognition of cross-contamination risks.

    This is sorta hopeless. Throw any suspect walnuts out and don’t underestimate the risk of cross-contamination.

    PHAC then ritually stated how people should cook meat to the proper internal temperature, wash fresh fruits and vegetables before eating them, clean counters and cutting boards and wash your hands regularly.

    Sorenne wonders what this has to do with walnuts.

    Public Health Agency of Canada, with all your salaries and collaborating bureaucrats, why are you so terrible at talking about food safety (see anything related to PHAC and listeria, 2008).

    Consumers are not the critical control point (CCP) for walnuts sitting in a jar at home.
     

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  • Nosestretcher alert: food safety is not simple, even if a $5 billion corporation says it is

    Posted: January 21st, 2011 - 1:01pm by Doug Powell

    Memo to Michael McCain, CEO, Maple Leaf Foods Inc.:

    You or your company, or both, really suck at this communication about food safety risk thing.

    In the two years since your killer deli meats actually killed 23 Canadians with listeria and sickened another 50 or so, the best you can do is remind Canadians they should do more?

    I understand you probably had some PR-type tell you that Maple Leaf needed third-party experts to validate and endorse your food safety messages, what with killing all those people. Except that third-party validation has been invalidated since the mid-1990s. As a company, you’re better to make public everything you’re doing.

    And I understand the web site being promoted by the Canadian Public Health Association was underwritten by the company, and the messages probably came unfiltered from CPHA.

    But it’s your name, and your company’s reputation on the web site.

    And it doesn’t look good.

    After the listeria mess of 2008 in Canada, your company has taken a bunch of baby steps to apparently engage the Canadian public, like targeting bloggers, showing up at food safety meetings and talking about culture.

    But if you really want to regain the trust of Canadians, like my parents, who were in Kansas the other day, and my father who said he’d never buy Maple Leaf again, here’s what you can actually do:

    * make listeria test results in Maple Leaf plants public;
    • add warning labels on deli meats for at-risk populations, like pregnant women and all those old people that unnecessarily died; and,
    • market Maple Leaf’s food safety efforts at retail so consumers can actually choose.

    Instead, you and your company decide to put your resources into a web site – who doesn’t need another web site – that says,

    “Although Canada has one of the best food safety systems in the world, there are still 11 to 13 million cases of foodborne illness across the country each year. That means your ability to stay healthy—whether or not you’re pregnant—depends on what food you eat, how well you store your food at home, and how carefully you prepare it before you eat. …

    “As the consumer, once you buy a food product, you are the next link in the chain that keeps your food safe and healthy. This website will give you the information you need to guide you in choosing the right foods, and preparing and storing them safely”

    “Eat Safe! is brought to you by the Canadian Public Health Association (CPHA) in partnership with Maple Leaf Foods.

    “The contents are for informational purposes only and should never replace the advice and care of a health care professional. Neither CPHA nor Maple Leaf Foods guarantees that the information is accurate, complete, or timely. Neither CPHA nor Maple Leaf Foods will be liable for any direct or indirect loss, damage, or injury caused by the use of this information. CPHA does not endorse and shall not in any way be seen as endorsing any products or services that may be referred in this website. Food Safety For Higher Risk Canadaians is brought to you by the Canadian Public Health Association (CPHA) supported through an unrestricted educational grant from Maple Leaf Foods Inc.”

    Wow. Instead of saying, treat deli meats like raw chicken poop, or toxic waste, cause a lot of people can die in a listeria outbreak, CPHA offers up Maple Leaf-funded platitudes that consumers should do more.

    I look forward to the evaluation of such nonsense being published in a peer-reviewed journal so the rest of us mortals can better understand the methodology and thinking behind such nonsensical statements.

    I do like the multiple language components of the website, but the rest is derogatory, paternalistic, and corporate. It’s like listening to a Journey song and having someone insist it’s real rock and roll.
     

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  • Woman's arm, hand become stuck in mixer at pretzel shop

    Posted: November 23rd, 2010 - 1:38pm by Doug Powell

    This is unfortunate, and gross, and it’s often the job of public health types to clean up the mess.

    mycentraljersey.com is reporting that a 35-year-old borough woman was airlifted to a local hospital after her hand became stuck in a dough twister at Jim's Pretzels on S. Main Street.

    Police Chief Mark Peltack said the incident happened at 10:53 a.m. Monday when local resident Loretta Jones, an employee at the establishment, had been attempting to make pretzels. Peltack said it took rescue-squad workers a short amount of time to release her hand from the machine.

    Jones was then airlifted via state police helicopter to Robert Wood Johnson University Hospital in New Brunswick. Jones was listed in fair condition at the hospital late Tuesday afternoon.

    At the shop, there are various sizes and types of pretzels, an assortment of dips and pretzels wrapped around sausages and hot dogs. The shop also is known for its catered events, in which the store makes platters of pretzels nuggets and five dips, such as spicy or hot mustard; cheddar or nacho cheese; and sweet cream cheese.

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  • Florida not inspecting food at hospitals, nursing homes

    Posted: July 31st, 2010 - 7:16am by Doug Powell

    In a few weeks we’ll be leaving for a month of seaside (Gulf-side) writing in Florida.

    As food safety dude and axman Roy Costa has pointed out, I sure hope I don’t end up in a Florida hospital, because no one is doing food inspections.

    The Department of Health told Associated Press yesterday it's working with other agencies to figure out who will handle inspections at the state's 286 hospitals and 671 nursing homes. Meanwhile, the Department of Children & Families is temporarily taking over the inspection of day-care centers, which were also part of the cuts.

    The health department had been inspecting facilities four times a year until Gov. Charlie Crist signed a bill (HB 5311) stopping them. Experts say people at these facilities are the most vulnerable for foodborne illnesses.

    DCF Secretary George Sheldon said his agency decided to fill the gap at day cares and will temporarily oversee inspections because ``it was the right thing to do.''

    DCF employees already inspect day-care facilities for safety issues. Sheldon said the Legislature was trying to consolidate inspections to prevent multiple state agencies from visiting the same facilities to inspect different standards.

    The health department inspected more than 15,000 day-care centers last year, finding nearly 12,000 violations, including food from unsafe sources, poor hygiene and contaminated equipment.

    I don’t really care who inspects as long as there is accountability in the system through -- at a minimum -- public availability of results and mandatory training for anyone who handles and prepares food.
     

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  • Cause of Florida woman's near-fatal food illness a mystery; exposes failures in system

    Posted: June 24th, 2010 - 11:23am by Doug Powell

    The Palm Beach Post reports this morning that Amber Dycus, 38, of Loxahatchee, Florida, went to the hospital after four days of illness. The doctors told her she was in acute kidney failure, hours from death. She endured six days of intensive care, multiple blood transfusions and, so far, 196 bags of plasma.

    There are more treatments to come, and no signs yet that her kidney function is approaching normal. She feels lucky to be alive, but also very afraid - afraid of eating out, afraid of catching germs, afraid of never getting better.

    Dycus desperately wants to know what did this to her. Her lawyer, Craig Goldenfarb, thinks the public ought to feel the same way.

    A health department inquiry has resulted in the brief closure of a Royal Palm Beach restaurant where Dycus often ate. Inspectors found roaches, improper food temperatures, slime in the freezer and a dishwasher with almost no sanitizer in it. After a thorough cleaning and a tuneup on the dishwasher, the restaurant, Hilary & Sons, has reopened.

    But was it really the source of her illness? A series of missed opportunities, miscommunications, delays, and no small measure of scientific uncertainty means there may never be a conclusive answer.

    At Palms West last month, Dycus was diagnosed with hemolytic-uremic syndrome. It's an often fatal condition that happens when toxins cause red blood cells to shear apart and clog capillaries, shutting down the kidneys and leading to a buildup of waste in the blood.

    It's associated with outbreaks of dangerous E.coli O157 food poisoning.

    Normally, when E.coli O157 is suspected, the health department is notified immediately, so that a public health investigation can be launched.

    Dycus said her doctors told her she must have eaten contaminated beef. She's grateful to them, and the nurses at Palms West, whom she says saved her life. But one thing they did not do was notify health authorities. A spokeswoman for Palms West said she could not comment.

    It wasn't until Dycus contacted a lawyer, and her lawyer called the media, that a health inquiry began. By then, a month had passed, the foods Dycus had eaten had long since disappeared, and the ability to tell exactly what sickened her had become nearly impossible to discern.

    Courtesy Nailsea Court

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