Food Safety and Environmental Health Blog : Disease Prevention, Public Health, Sanitation Information & Analysis : Environ Health Associates

Tomatoes are once again implicated in a large and serious foodborne illness outbreak. To date CDC has identified hundreds of victims of Salmonella saintpaul, a somewhat unusual or rare serotype of Salmonella, and one death is suspected.

Investigators are hampered by lack of traceability amongst other problems. FDA reports that investigators are encountering boxes of tomatoes without labels. Such problems make it difficult to determine safe from unsafe sources, and force FDA to only issue general information about which tomatoes are likely safe. As a result, hundreds of millions of tomatoes must be destroyed and the US tomato industry has experienced huge financial losses. This is extremely troubling at a time when food scarcities are enveloping many of the world's poorest nations.

Much of the blame for this tragic situation lies squarely with FDA's non-existent and ineffective regulation of the produce industry. There are no laws specifically regulating how produce is grown, labled and handled. FDA has been providing guidance to the produce industry for at least 10 years but it is unknown if  the industry is applying it since there are no regulatory inspections of produce safety. Florida and North Carolina are attempting to work with FDA on a state inspection program called the Tomato Initiative, but the work is very preliminary and will not be effective for years.

The produce industry is filling in the gaps by self-regulation whereby growers, packers and distributors are subject to industry mandated food safety audits conducted by third party firms. The weakness in this "buyer driven" safety model is that buyers, the middlemen between the retailer and the producer, make buying decision based primarily on price and quality and do not hold food safety as their first priority.

The consumer is now at the mercy of this ineffective food safety system and the produce industry is reeling from the financial effects. Lobbying by the associations representing the food industry since the mid 1990's has kept regulatory agencies under financed and ineffective. Now that they need them, they are incapable of providing protection. It is indeed interesting to note these associations now have their own food safety schemesthat they sell to the industry as a fix for the very problem they helped create. Industry interference with regulatory efforts is to blame for the crisis state of FDA, and the produce industry is now reaping a bitter harvest of unsafe foods.

Clearly the answers to unsafe foods must be found in Washington. However, with the distractions of war, inflated fuel prices and a sluggish economy (mostly caused by unregulated profiteering in the housing market) Washington is ill prepared to mount an effective food safety policy and to fix America's neglected public health infrastructure.

Consumers are losing confidence in supermarket produce and are turning to local farmers for a better quality and presumably safer product. Supermarkets will continue to suffer as consumers spend their food dollar elsewhere. Self seeking food industry leaders must blame only themselves for their tomato woes.

The "Great Escapes Resort" Can't Escape Scrutiny After Viral Outbreak

The Norovirus Outbreak

A Six Flags water park and resort complex in up-state New York known as "Great Escapes", is the focus of a large norovirus outbreak.  Norovirus is transmitted from infected human carriers to food, water, and environmental surfaces. The US Centers for Disease Control and Prevention recognize norovirus (and related viral strains) as the leading cause of foodborne illness in the US. The gastrointestinal illness is highly communicable and easily spread by hand to hand contact and even through the air. Outbreaks occur in resorts and other facilities when ill persons contaminate the environment, food and water through vomit and feces. Rapid and effective measures well-known to the public health community are needed to stop transmission. Many of these measures are developed by the US Public Health Service. Cruise lines have experienced many norovirus outbreaks and therefor there is much known about the pathogen and how to address it.

Untimely Responses to the Problem 

According to the local health department a case of norovirus at the Great Escapes is defined as a person with norovirus symptoms at the resort on or after March 7, 2008. The health department  therefore belives the date of March 7 was the beginning of the outbreak, but did not for some unexplained reason begin an investigation for ten days. It is not known to this writer when the operator of the facility was first aware of that employees and patrons were becoming ill. We are also unaware of how or when the health department was officially notified of the problem. The official coordinated response to this outbreak began on March 17, a full 10 days after the outbreak apparently began. By March 21, there were already 200 cases. The number of reported cases eventually reached at least 435 as news of the incident spread.

Rapid tests using sophisticated molecular testing platforms are available to provide confirming results of norovirus infection in 24 hours, yet investigators over 1 week into the investigation still didn't have a confirming diagnosis from the state lab.  The slow state lab results were an unnecessary delay, as approved private labs are available.

Early recognition of this problem is critical. Once it is known that norovirus is in the environment, investigators can implement timely and appropriate sanitation and safety precautions to combat transmission. One example of appropriate response was the closing of the food service. But this only occured after numerous employees of the kitchen reported symptoms of norovirus. The pools, food and lodging facilities are undoubtedly regulated. Delay in the the implementation of this and other preventive measures at this public, regulated facility likely increased the potential for the exposure of large numbers of unsuspecting people to the pathogen over several days. The  operator's delay in recognizing and reporting a large number of ill patrons and staff, the response of the authorities once notified, and the timeliness and effectiveness of prevention measures taken are critical questions.

Lawsuits

Four members of a family sickened by the resort have filed a lawsuit. Key issues that must be scrutinized are the delay between the start of the outbreak and notification of the health authorities, the large number of food service staff ill and whether they worked while ill, the basis to close the kitchen, and the basis for management's decision to allow the rest of the facility to remain open..

Ill patrons have also filed a class action suit against Six Flags Great Escape Lodge and Indoor Waterpark.

Unanswered Questions

A detailed analysis of the cases and their relationships to the food service or other environmental exposures will be key to determining the causes of this large and serious outbreak and whether the operator responded in an effective and timely manner to protect both it's employees and guests.

Could the large number of cases of illness been reduced if more timely and effective prevention measures were implemented at Great Escapes?

To read more, select the links below.

Health Department official statement 

Norovirus at Great Escapes Water Park

1st article from the Post Star. March 21st, 200 cases reported

www.poststar.com/articles/2008/03/21/news/latest/doc47e42f8f8280b851143779.txt

2 nd article from the Post Star, March 16th, 435 cases  reported

www.poststar.com/articles/2008/03/26/news/latest/doc47eabb1d9c7e1811279240.txt

Channel 6 report. Lawsuits filed.

www.cbs6albany.com/news/water_1254308___article.html/

For our manual on Norovirus Contamination and Control send an email to rcosta1@cfl.rr.com