The Washington Post published an interesting article this morning, spotlighting the recent E. coli outbreak associated with pre-cut, bagged lettuce that infected 23 people in four states during March and April of this year.  The lettuce was not purchased by consumers, but rather by several food service companies and supermarkets as part of their salad bars and prepared meals.  In fact, the majority of infected people were students at colleges in Michigan, Ohio, and New York who consumed the lettuce at their college dining halls.  This issue brings up an interesting question, however:  Are pre-cut, bagged vegetables more dangerous than whole vegetables?

First, how could E. coli, which is generally associated with animal feces, infect vegetables?  According to Caroline Smith De Wall, the food safety director at the Center for Science in the Public Interest, “The process of harvesting lettuce, chopping it or tearing, washing and putting it in a bag is a process similar to mixing ground beef.”  As any food handler should know, ground beef is potentially more hazardous than whole beef because bacteria on the outside of the meat is mixed into the center during the grinding process.  The same is true for lettuce, and other leafy greens which are grown in fertilized soil.  Fertilizer is largely composed of animal feces, and therefore is full of E. coli and other contaminants.  So when vegetables are processed for packaging, greens from multiple farmers’ fields (both contaminated and uncontaminated) may be tossed in and cut together–infecting all the produce.

Still, there are strong arguments on both sides of this debate.  Those who believe bagged vegetables are more dangerous argue that chlorine spray used to clean the produce before it is packaged does not kill enough of the bacteria.  Whereas when consumers purchase whole vegetables, they will commonly remove the outer leaves, thus physically removing the majority of potentially infectious bacteria.

James Gorny, senior advisor for produce safety at the FDA disagrees with the idea the bagged produce is more dangerous.  He stated that “bagged greens represent a disproportionate number of recalls, chiefly because they’re easier to identify than whole produce.  When you buy a head of lettuce, you have no idea what the brand name is, or who the grower is–so tracing it back is that much harder.”  Essentially he is stating that because the source of contaminated bagged vegetables is so much clearer than for whole vegetables, complaints about foodborne illness for those products is much higher.  In addition, it is much easier for health department officials to trace the source of the infection for packaged produce, and so it often appears as though pre-cut vegetables are more dangerous, even though they may not be.

Unfortunately there is no clear statistic proving that either whole or pre-cut vegetables are more dangerous.  In order to keep your patrons, family, and employees safe at the salad bar–wash your veggies.  Even if the bag states “pre-washed” it is always a good idea to rinse your leafy greens and vegetables that will be served as ready-to-eat items.  There are also several vegetable washes on the market that may be advisable for households with at-risk individuals.  For additional guidance, contact your health department.

This week marks the first anniversary of the identification of the H1N1 virus,or Swine Flu, that first became an epidemic across the United States before quickly  spreading into a full-blown global outbreak.  The most recent studies state that  14,286 people around the world lost their lives to H1N1 during 2009-2010.  Although the premature deaths of so many people is incredibly tragic, the United States government has been able to take advantage of our actions over the last year in order to assess our current ability to combat threats–both biological and man-made.

According to a press release from the USDHH Preparedness and Response, our goal is to supplement our vaccination technology in order to research, develop, and distribute more quickly and efficiently.  This will allow the USDHH to supply life-saving vaccines to sick populations more quickly and effectively.  As expressed by Sec. Kathleen Sebelius, a crucial element in this will be identifying how our response teams would respond to both known threats and unknown threats that may arise.

In responding to H1N1, as many of you are surely aware, vaccines where in short supply.  Worse yet, some vaccines did little or nothing to combat the ever-changing virus.  It is good to know that USDHH is aware of the mistakes that were made and can view this scenario as a learning opportunity so that if, heaven forbid, there is a “next time” we’ll be ready.

Check out the entire press release at flu.gov.

Salmonella

When talking about food safety, salmonella is a disease that gets brought up frequently.  This year, salmonella has prompted hundreds of food recalls from items as diverse as salami, tortilla chips, and salad dressing.  During the past few years, health officials have identified the bacteria in eggs, peanuts, black pepper, spinach, meat products and the list goes on and on.  Salmonella contamination becomes an even greater issue when contaminated food items are sent to multiple locations as ingredients as other products.  It becomes extremely difficult to trace where the infection began, and how far it spread.  This year alone, salmonella-contaminated black pepper was distributed as an ingredient in Italian-style deli meats, which then infected 252 people in 44 different states!  The same contaminated black pepper has also sparked countless spice, snack, and condiment recalls since January 2010.

Of the 2,000 strains of salmonella, only about a dozen can infect humans.  Still, the number of persons infected annually remains high from year to year.  The CDC estimates that there are a 1.4 million cases of salmonella infection each year in the United States, with only about 3% officially reported.  These numbers make is clear that it is impossible to overstate how crucial it is that food handlers become aware of this disease and how to protect consumers from it.

A few things to know about Salmonella:

• Salmonella can be transmitted from animals to humans (see Kissing Frogs) and from food to humans.
• Persons at greater risk for serious infection include infants, small children, chronically ill persons with weak immune systems, and the elderly.
• Salmonella can survive for weeks outside a living body.
• Salmonella is not destroyed by freezing.
• An infectious dose of salmonella can be as small as 15-20 cells (bacteria).
• Incubation period–the time it takes to get sick once a patient has contracted the disease–is anywhere from six to 72 hours.
• Common symptoms of salmonella infection include exhaustion, nausea, vomiting, and diarrhea (which can be bloody in serious cases!).

What can you do to prevent salmonella infection in the workplace?  One of the first things each food service employee must do to prevent infection of any kind is wash their hands.  For salmonella-specific prevention, the Mayo Clinic recommends the following practices:

1. Cook poultry, ground beef, and eggs thoroughly before eating (or serving).   Poultry specifically must reach 160º F throughout before it can be served.
2. Eggs must be cooked until they have a hard yoke.  Pasteurized eggs may also be used.  If consumers insist on soft yokes, they must be made aware of the risk of salmonella infection.
3. Never consume or serve raw milk.  Milk must be pasteurized to be used in a consumer setting.
4. Wash and sterilize hands, utensils, and surfaces immediately after they have come in contact with foods of animal origin.
5. Be extremely cautious when preparing food for babies, children, sick persons, or the elderly as they are at a greater risk of infection.

If you have additional questions about salmonella and how to prevent it, please contact your local health department.

Sources:  Mayo Clinic, Wikipedia

The US Department of Health and Human Services released an interesting article this morning about animals and their uncanny ability to give people salmonella–specifically birds, frogs,  snakes, turtles, and other amphibians.  Contact with these animals causes about 74,000 cases of salmonella each year in the United States, according to the Center for Disease Control (CDC).   Normally, salmonella is considered a foodborne illness, but children tend to handle these animals and then touch their mouths, eyes, and noses without washing their hands.  After the release of the animated film The Princess and the Frog, in 2009, dozens of little girls became ill with salmonella after feeling compelled to kiss frogs.  Even adults can become culprits of spreading salmonella this way when they clean aquariums and fish tanks in the kitchen, thereby contaminating areas where food is prepared.

Linda Capewell of the CDC recommends not having birds, snakes, or amphibians in homes with children under 5 years of age.  When children (and adults) handle these animals, they should wash their hands immediately–scrubbing with antibacterial soap for at least 20 seconds in a steady stream of warm water.

The CDC’s Advisory Committee on Immunization Practices (ACIP) has strongly recommended that ALL persons, 6 months or older, receive a flu vaccine for the 2010-2011 flu season.  The swine flu has hit the 5-17 year-old population especially hard.  Those hospitalized with the disease generally had an underlying illness, like asthma, to weaken their immune system and allow them to be more susceptible to the virus.

As of mid February, 126 million doses of the vaccine had been ordered by states, with health departments targeting at-risk groups for treatment.

If you are pregnant, over 50 years of age, or the parent of small children–get yourself (and your children over 6 months) vaccinated!

View the CDC’s press release.

It’s not hard to believe however.  The CDC estimates that 76 million cases of foodborne illness occur EACH YEAR in the United States, but when you take into consideration that as few as 1 in 5 cases are ever reported, the number could be much higher.

Did you get the “24-hour flu” this year?  You may be surprise to know that there is no such thing as the “24 hour flu.”  What you probably had was foodborne illness. Even the “stomach flu” is really a foodborne illness called gastroenteritis that results from ingesting contaminated food and water.  It’s doubtful you called the health department about your sickness–and just like that, another case of foodborne illness went unreported.

If you are asking youself, “Ok, then do I need to call my doctor every time I get sick??” then we have the answer for you.  Well, actually the CDC does:

“A health care provider should be consulted for a diarrheal illness if it is accompanied by:

• high fever (temperature over 101.5 F measured orally),
• blood in the stools,
• prolonged vomiting that prevents keeping liquids down (which can lead to dehydration),
• signs of dehydration, including a decrease in urination, a dry mouth and throat, and a dizzy feeling when standing up,
• diarrheal illness that lasts more than three days”

If you do contract “stomach flu”-like symptoms, take care of yourself!  This includes resting, drinking LOTS of clear liquids–especially sports beverages to replace electrolytes, and when possible, attempt to eat foods like popsicles, chicken noodle soup, and gelatin.  You’ll be feeling better soon.

For food handlers, always make sure you’re practicing safe food handling procedures.  Just because you didn’t hear about a case of foodborne illness coming from your establishment, doesn’t mean it didn’t happen.

To help us introduce Trichinellosis, we thought we’d use this handy chart:

We had no idea what this chart meant, so we went to the Center for Disease Control’s (CDC) website for some clarification.  Trichinellosis is a cycle of disease.  For the patient, it begins when he or she consumes meat of an animal infected with Trichinella cysts.  Trichinella is a parasitic worm that enters the body of its host through ingestion.  The worm’s larvae are in the form of round cysts with a hard outer shell.  When an animal eats infected meat, the cystic shell dissolves in stomach acid and the baby worm is released into the intestinal tract and become mature within 1-2 days.  Once the mature worm mates, it lays its eggs which develop into immature worms.  The young worms then travel through the host’s and are carried into the muscle tissue where they curl up and become cysts.  When the host tissue (i.e. contaminated pork) is consumed, the cycle begins anew.  Gross, right?  Here are some additional facts from the CDC:

• What is Trichinellosis? Trichinellosis, or Trichinosis, is a disease caused by eating undercooked meat of animals infected with the larvae of the worm Trichinella.  Although this is most common in carnivorous (meat-eating) wild animals, Trichinellosis can also be contracted through domestically-raised pigs.
• What are the symptoms? In the first stages of infection (in the majority of cases) fever, nausea, vomiting, diarrhea, and abdominal pain are all common.  The second phase of symptoms will often add chills, eye swelling, aching joints, muscle pain, itchy skin, and constipation to the list.  For patients who contract a larger infection labored breathing and coordination problems are possible.  Death is rare, but can occur.  Generally symptoms subside in a few months.
• How soon to symptoms appear? Abdominal symptoms can appear within 1-2 days, whereas other symptoms may take as much as 8 weeks to become apparent after eating infected meat.  Severity of symptoms depends on how many Trichinella worms were ingested.
• Am I at risk for Trichinellosis? Do you eat raw or undercooked meat from wild animals such as bears, pigs, felines (cougars), foxes, dogs, horses, seals, or walruses?  Then yes, you are at risk.
• Is Trichinellosis common in the United States? Trichinellosis used to be very common in the US because of undercooked pork.  Today, however, infection is rare.  Infection in the US has decreased due in part to refrigeration and in part to new regulations making it illegal to feed raw meat to hogs.

For more information about Trichinellosis, visit the CDC website.