What we are seeing now in the latest peanut butter recall and the problem with hazelnuts is this continued change in illness patterns from animal derived foods, to plant derived foods.  See Bill Marler’s blog on the topic.

http://www.marlerblog.com/lawyer-oped/defranco-e-coli-hazelnut-and-skippy-salmonella-peanut-butter-recall-announcement—a-side-by-side-co/

The situation is fueled by increased consumption, scrutiny, better detection methods and more industry testing. Small outbreaks and recalls ( small-if numbers remain low) remind us that the pathogens are poised to contaminate foods wherever they can. We seem to be catching the problem earlier but the reservoirs of infection persist.

Of  chief concern to me is whether our preventive techniques are working and how well.

De Franco was certified, I would be surprised if the Skippy plant was not licensed and inspected.

So where does this leave us in prevention, what do we have to do to reduce the potential for outbreaks further so that intermittent sporadic episodes like this do not occur, or occur so infrequently that we can consider it acceptable? We are far from there, but I would like to be sure we are going in the right direction and so am interested in what further issues might be revealed by these incidents.

 

I do not agree that one food safety agency is better. Such a behemoth will be bound by a morass of red tape. The agencies have evolved over the last 100 years, They have their own culture and hierarchy. The turbulence caused by any drastic change will hurt the public health mission of all the agencies involved and will take 20 years to sort out, This is a dangerous move and must not happen.

What is needed is better funding, more focus on the consumer and enlisting the private sector in a true partnership with public health.

GAO report supports single food safety agency

By Tom Karst Published on 03/04/2011 03:03PM

thepacker.com/GAO-report-supports-single-food-safety-agency/Article.aspx

Consolidating food safety oversight into one agency could save the federal government money and improve performance, the U.S. Government Accountability Office reports.

The report, called “Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue,” concludes the current oversight of food safety is inconsistent, inefficient and ineffective.

Although reducing fragmentation in federal food safety oversight may not result in significant cost savings, new costs may be avoided by preventing further fragmentation, the report said.

The U.S. Department of Agriculture’s Food Safety and Inspection Service and the Food and Drug Administration are the primary food safety agencies, but the report said 15 agencies have some degree of oversight on 30 food-related laws.

The increasing popularity of raw foods, rising imports and the vulnerability of some of the population to foodborne illness make efficient federal oversight of food safety more important than ever, the GAO said.

The FDA is the agency for federal oversight of produce safety so consolidation is not a huge industry priority, said Kathy Means, vice president of government relations and public relations for the Newark, Del.-based Produce Marketing Association.

She said the recently passed Food Safety Modernization Act made some improvements in how the FDA approaches risk-based oversight.

“There are ways to gain efficiency without monster reform,” she said.

Even if consolidation does occur, it would take several years and require existing agencies to operate well in the meantime, she said.

While not agreeing with all of the GAO report recommendations, Rep. Rosa DeLauro, D-Conn., said in a statement that the study provides additional evidence for the need to consolidate food safety oversight into one independent agency.

“I have introduced legislation that would establish such an agency since 1999 and believe that this is a critical step toward preventing foodborne illnesses and protecting public health,” DeLauro said in a statement.

Schools are skipping out on thier responsibility to prepare food safety plans.

Under the Richard B. Russell School Lunch Act of 2004, all schools were to have HACCP plans in place years ago.

www.fns.usda.gov/cnd/governance/…Policy…/2005-01-10.pdf

Here below is a perfect example of why. Schools that do not have a monitoring system in place are in default of federal guidelines. Whether the temperature abuse problem that led to this outbreak was wholly caused or partially caused by the school, the lack of temperature controls for 4 hours and failure to test incoming product temperature is what HACCP was meant to correct.

While retailers demand food safety management systems for suppliers, the food service, institutions and retail firms at the vulnerable end of the supply chain have resisted developing food safety systems.

The Richard B Russell act was supposed to fix this in schools, but there are few if any schools who have heeded this requirement. The political protection that schools enjoy (being part of the county, just like the health departments) is partially to blame, as is lack of funding for health departments at the county level. It’s a Federal Program! An “unfunded mandate”, or so say the health departments. The insulation that retailers and food service firms enjoy from the political action campaigns of the National Restaurant Association is also wrong.

Here we see the convergence of hazards from the retail level and the school coming together to make pedople ill. All of them should thank God it was not E coli O157:H7. In any event this outbreak was easily preventable.

When will the consumer become the focus of food safety?

Well it seems only when the restaurants and schools who cause these outbreaks are sued, and so let the lawsuits fly.

Wake up people!

ILLINOIS: Merle’s owner decries ‘reckless’ health report
04.mar.11
Evanston Review
Karen Berkowitz
http://www.pioneerlocal.com/evanston/news/3097534,ev-merles-criticizes-health-report-030411-s1.article

Thanks to http://barfblog.foodsafety.ksu.edu/barfblog

The owner of Merle’s BBQ Restaurant in Evanston Friday decried the Evanston Health Department’s "rush to judgment" in blaming the restaurant for the outbreak of foodborne illness after an event Feb. 16 at Haven Middle School.

Merle’s owner Larry Huber said the restaurant had no control over how the food was served after it dropped off the food order.

"The event was not a fully catered event, but a drop-and-go delivery," said Huber. "If it had been a fully catered event, we would have had the appropriate staff and equipment to maintain the presentation and quality."

One of the 30 people who reportedly became ill after eating the food, served "buffet style" during parent-teacher conference night, filed a lawsuit Tuesday against the eatery.

The lawsuit quoted the findings of the Evanston Health Department, as summarized in a Feb. 24 press release that was posted on the city’s website and reported on in the media.

http://www.cityofevanston.org/news/2011/02/health-dept-update-on-haven-middle-school-food-borne-illness/

(This is an excellent study on Clostridium perfringens and worth reading)

The Health Department identified unsafe food handling and temperature storage at both Merle’s and Haven Middle School as possible causes and concluded "that it’s unlikely the exact cause of the outbreak will be determined."

The food was prepared at Merle’s, 1727 Benson Ave., and delivered to Haven Middle School, 2417 Prairie Ave., where it was served without a heating source between 3 p.m. and 7 p.m., according to the Health Department.

Huber said he was told by a Health Department manager that none of the samples taken from Merle’s tested positive for “Clostridium perfringens”, which was determined to be the cause of the outbreak.

Huber was informed the restaurant did not take hourly time and temperature logs, but he contends the practice is not required by the health codes of either the state of Illinois or the city of Evanston.

According to Huber, the restaurant was in full compliance of the requirement that foods prepared and then cooled for later serving be labeled with the time and date they are made.

Eric Palmer, communications director for the city of Evanston, said Friday the city has no comment and stands behind the statement issued last week.

While tomatoes were identified early as an outbreak vehicle, subsequent investigation revealed Serrano and jalapeno peppers as the common food item in later outbreaks. I agree with Dr. Acheson that the epidemiological association is only an approximation and there will be a potential for things to occur by chance alone and confounders, but the relationships here are difficult to dismiss without some kind of explanation.

The short list includes cross contamination during repacking, common growing or harvesting methods, in common contaminated water supplies and irrigation, maybe even run-off.

We really do not know exactly what went wrong at the various production stages with these commodities and there is something important to learn from this either way.

2008 Outbreak of Salmonella Saintpaul infections associated with raw produce
23.feb.11
New England Journal of Medicine
Casey Barton Behravesh, D.V.M., Dr.P.H., Rajal K. Mody, M.D., M.P.H., Jessica Jungk, M.P.H., Linda Gaul, Ph.D., M.P.H., John T. Redd, M.D., M.P.H., Sanny Chen, Ph.D., M.H.S., Shaun Cosgrove, B.A., Erin Hedican, M.P.H., David Sweat, M.P.H., Lina Chávez-Hauser, M.A., Sandra L. Snow, M.D., Heather Hanson, M.P.H., Thai-An Nguyen, M.P.H., Samir V. Sodha, M.D., M.P.H., Amy L. Boore, Ph.D., M.P.H., Elizabeth Russo, M.D., Matthew Mikoleit, M.A.S.C.P., Lisa Theobald, B.S., Peter Gerner-Smidt, M.D., D.M.S., Robert M. Hoekstra, Ph.D., Frederick J. Angulo, D.V.M., Ph.D., David L. Swerdlow, M.D., Robert V. Tauxe, M.D., M.P.H., Patricia M. Griffin, M.D., and Ian T. Williams, Ph.D. for the Salmonella Saintpaul Outbreak Investigation Team
http://www.nejm.org/doi/full/10.1056/NEJMoa1005741
 

Background
Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008.
 

Methods
We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted.
 

Results
Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case–control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source.
 

Conclusions
Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.

 

I have now been involved in over 60 investigations of foodborne illness as an expert, on the sides of both plaintiffs and defendents, some reflections:

1. Most outbreaks that result in lawsuits have evidence of multiple major sanitation deficiencies

2. Most have pest problems as part of the documentation

3. Many have serious time and temperature issues

4. Many have personal hygiene issues

It seems like to have an outbreak that results in a lawsuit requires a lot of negligence. It is usually not some failure at a CCP, or an invalid HACCP plan due to some error in thinking. Its gross sanitation issues that put people in this spot more often than not. Those that have at least a semi scientific program with oversight of any type and are managing basic sanitation adequately seem less likely to get into deep trouble with litigation, and if they do, there is less likely to be a smoking gun.

Food safety auditing and inspection is a complex world thanks to the prevalence of food hazards and the repeated nature of outbreaks where some type of inspection or audit was a feature. As I spend about 40% of my time doing this type of work, I would like to spell out what I see as the food safety inspection system roles.

In the food supply, we have provisions for self assessment, regulatory inspection and second and third party assessment Recently, we have seen media reports on the so called failures of assessment methods used by third party auditors to determine food safety risk. But the scope of recent criticism has also involved regulatory inspections. To date, much of the arguments are simplistic.

barfblog.foodsafety.ksu.edu/barfblog/tag/washington-post

The Washington Post article below, the basis for the above blog by Doug Powell did not take into account the limitations in these models, nor did it recognize the full breadth of what this field entails.

http://www.washingtonpost.com/wp-dyn/content/article/2010/10/21/AR2010102106900.html

While flaws exist in this model, there is a basic need for an accurate determination of risk that only an an accurate assessment and inspection of controls by people both in and out of the organization will provide.

As the food safety inspection science and practice has evolved, we rely upon internal reviews of food safety systems and outside entities, private and public, to provide some type of oversight, control and guidance.

Inspection by regulatory agencies are assessments of compliance with codes. Such rules are developed to protect the public and are laws. Only the inspection agency has the authority to take legal actions to protect the public. Powers include inspection without notice, closing an operation, seeking fines, and seek other administrative penalties. The inspection agency in most instances has the duty to embargo, destroy and or withhold from sale any contaminated or adulterated commodity. They may take immediate action to protect the public when an imminent health hazard is present. Licenses are issued and the privilege to maintain the license is based on compliance with the law. These roles are very different from the roles of other assessors. Protecting public health is the first, and most important public health capability of an inspection agency.

Self audits are performed by operators themselves. Th requirement for a self audit is often missing at the retail level and at the various levels of the food supply that have little or no regulatory or third party oversight. In order to perform an adequate self audit the operator must have specific training in risk assessment. While some believe that “walking around” a kitchen a few times is sufficient to make a food safety risk assessment, the findings mean little or nothing if there is no risk based method. Typically the risk based methods used by anyone performing a food safety assessment are found in codes and in third party standards.

Second party inspection is performed by buyers of products. These may be random. The second party inspector may or may not have specific food safety skills. The buyers may visit an establishment for several reasons other than inspection. While some have argued that the direct assessment of risk by buyers is the best answer to the oversight problem this method of risk assessment is also problematic when the buyer is unfamiliar with actual risks and how they develop in an operation.

Third parties are hired by firms to prove to buyers that the buyers rules are in place through a pre arranged audit of the facility and records. The voluntary third party rules or standards are complex, have many over lapping areas with laws and rules, blending diverse codes and buyer requirements that may be outside the cope of laws to provide controls for chemical, physical and biological contamination. They go further than inspection and also provide an insight into management controls and supervision; they are at once an evaluation of an organization as well as compliance with laws and rules or codes of practice. Instead of relying solely on law the third parties use a standard devloped in cooperation with the industry.

Third party auditing is also complex because the auditor often has duties of assessing risk in a wide number of arenas. Some auditors or companies have risk assessment capacity specific to a commodity, but many auditors and firms are generalists.

These roles are continuing to evolve, as the standards and laws guidance documents and rules evolve.

Do not be surprised to see more apparent dysfunction of the audit or inspection process to prevent illness. Preventing illness and injury through food is not simply a matter of inspection and involves much more than what audit company went where and who got what score.

The complicity of the auditor with the auditee and audit bias that might result from business relationships is a human problem that will not be solved by re arranging "who pays who" for an audit. The third party audit is buyer driven, meant to be educational in nature, and voluntary (in that the firm should be able to seek whatever assessment company it desires to satisfy an audit). Of course third party auditing is a competitive business and operates like one, lets be clear about those limitations.

The inspection by regulatory agencies on the other hand has the capacity to prevent illness much more readily than a third party audit. We cannot at this point, due to the limitations in the  industry driven roles and models, expect the third party auditor to prevent outbreaks or act as a go between for the regulatory agency. We can strengthen these models in some important ways but there will be a limit to how close non-regulatory frameworks will come to a regulatory audit and true public health protection.

In reality, the self audit has the most capacity to thwart risk, but only if the operational controls are well grounded on science. This is where the important strengthening must be made and this is what ideally the third party systems should focus on.

I believe that the self inspection, and second and third party models must be based upon a solid requirement that no unsafe operations are allowed to be licensed in the first place. Once we have this fundamental, the other parts of the system can function. The other parts of the food safety inspection system cannot and do not stand in the gap for laws and rules and their enforcement.

While critics are accurate in saying the third party audits at Quality Egg and PCA failed to prevent an outbreak, and thus were ineffective risk assessments, these same firms had very poor regulatory oversight.

Neither of these firms should have been open for business, and where this is the case, you will see the other parts of the model flounder badly.

 
 

Doug Powell below writes in his Barfblog about the delay in CDC notifying the public about the source of the current SE outbreak in eggs. The CDC went public in mid August when apparently sufficent information existed in late July to implicate Iowa’s Wright Egg Farms.

Other outbreaks in the recent past had the same scenario, a delay between identifying the likely source of outbreaks and public disclosure.

There might be a couple of explanations for the delay in the naming of names as a result of epidemiological findings. The strength of the epidemiological data sometimes is not strong enough to make confirmation completely bullet proof, remember we are dealing with relative risk.
Second, when an agency goes public they can be wrong and end up with well…egg on their faces, and much worse.

On the other hand, when there is a strong likelihood of a public health threat there might be good reason to go public even if all data crunching is not complete, a common supplier is certainly suspicious. I agree with Doug, the key is the strength of the data.

The FDA is investigating a nationwide outbreak of Salmonella in  shell eggs.

http://www.emergencyemail.org/newsemergency/anmviewer.asp?a=578&z=34&ref=fem

While many believe that contaminated water and feed and rodents are to blame, if you go further back into the causation you will find that the egg is contaminated because of the absence of salmonella pullorum in the gut of the chicken.

Programs to combat the one disease of chickens in the 1980’s some believe led inadvertently to the colonization of the gastrointestinal tract and reproductive organs of chicks by the human pathogen, SE. It doesn’t necessarily mean that the first event caused the other, but there is biological plausibility to this argument and the temporal association I think is striking. Especially, given this disease occurred in several parts of the world almost simultaneously. So the rodent that has been in the hen house for millennia causing limited human disease (through contaminated egg shells) becomes now a vector for a widespread invasive disease of poultry and humans and spreads to other food animals. Not to minimize the rodent’s infectious properties and need for control, but human meddling with bacteria doesn’t always turn out for the best for mankind. Interestingly, Salmonella pullorum is not treated with antibiotics, culling the bird is the intervention. 
 
Denmark has been successful in control of SE in broiler chickens, layer hens, and pigs through careful surveillance, culling, farm sanitation, pasteurization, and sanitary slaughter.
 
Denmark has now has the safest eggs in the world. And they achieved this only by an effective industry-government partnership, something we should take special note of, given the positive political climate in the US right now. See the paper from CDC below for a review of the Danish approach.
 
http://www.cdc.gov/ncidod/EId/vol9no7/pdfs/03-0024.pdf
 

 

Florida presses on its reckless path of destroying public health and continues its sinking spiral of deregulation. Here is another story about how political pressure by industry and lack of public outrage whittles away our safety net. All of this is occurring at a point in time where federal efforts are strengthening public health agencies to protect the food supply. Florida’s Restaurant and Health Care lobbies dictate public health policy and the apathy in Florida is truly remarkable. Transfer of public health protection to untrained licensure officials coupled with less inspection will mean more hazards and illnesses. This is exactly what we saw in the restaurant industry when the health authorities were removed from restaurant inspection.

Are we saving money? Nobody seems to think so. So what is the real motive? Its simple, here in Florida our legislature listens to industry, and whatever they want they get, what is best for the consumer is not even considered in these decisions. Not once has anyone said "this is in the best interests of the people of the state of Florida". Our political machine is off the hook here, what a SHAME.

Read more about it in Florida Today

www.google.com/url

 

 

 

 

8-4-10

An Open Letter to Carol B. Dover of the Florida Restaurant Association.

Dear Ms Dover:

In reply to your recent Tampa Tribune article

,http://www2.tbo.com/content/2010/aug/04/na-food-inspections-strong/
 

you failed to mention several important facts about your involvement in food safety and inspections in Florida. From an historical perspective, I have personally seen and experienced what you and FRA have done in regards the Division of Hotels and Restaurants (the Division), inspection. and food safety training. As you are a former Director of the Division, you should recall the following facts.

Prior to 1990, the Division, within the Florida Department of Business Regulation (DBR) shared the statutory responsibility for regulating restaurants with the Florida Department of Health and Rehabilitative Services (HRS) who contracted with the county health departments to perform the inspections. While there was duplication in this relationship, the county had the authority to bring legal action through DBR and DBR ultimately controlled the license, the county had only permitting authority.

In 1990, the Office of Restaurant Programs (ORP), a state level organization, was formed under HRS to regulate restaurants, taking the food safety program from the individual counties, but leaving the DBR licensing structure in place. ORP operated for 2 years and in that time completed all requirements for inspections. Additionally, the focus under the state brought uniformity to DBR enforcement and compliance was moving forward very rapidly. In 1992, Florida had few reported foodborne illness outbreaks, and this was also the last year all inspections were performed as required in Florida.

In 1992, you successfully prevailed upon the legislature to move the new and effective health program- ORP, to the licensing agency- DBR, your former agency. Your argument at that time was that 67 counties were performing inspection 67 ways which was a facetious argument because command was already centralized in Tallahassee . But those of us in the organization saw the real reason behind this move. That reason had to do with controlling the inspection process.

DBR’s takeover of the health department’s food program was disastrous. The first cycle produced only 50% of the required establishment inspections. The transferred inspectors from ORP had to receive additional training in lodging laws and rules as well as fire safety. Conditions in Florida’s restaurants deteriorated and in 1997 we had recorded over 350 outbreaks, 10 times as many outbreaks in just 3 years.

Under the leadership of the Divisions’ head staff, a revamping of the inspection process took place and the state’s Hospitality Education Program operating from only a $6.00 fee per establishment per year trained nearly all of the state’s food service managers. Regrettably, this year the Hospitality Education Program (HEP) was decommissioned. In recent years, the HEP program had been reduced to a minor role at the Division in spite of its outstanding record, and one can only speculate the reasons behind this

In 2000, your organization successfully passed legislation requiring all Florida food workers to be trained in food safety. While training is a good idea, your organization through its political power won the right to “preferred” training provider status and the industry narrowly escaped having all other current training programs in place at that time made illegal There is no coincidence here. The new requirements for training launched a very successful FRA SafeStaff program which generates millions of dollars a year for your organizations’ lobbying efforts.

Because of your record in Florida, it is difficult for me to see your statements in the Tribune about Florida’s food safety inspection program as anything but mere political posturing. The lack of credibility at the FRA is made even more acute as your organization has the capacity to do much good for the citizens and visitors of this state.

I understand you had for many years a sign in your office in Tallahassee that read “the only good regulation is no regulation”. I might add that the only good regulation is one that benefit’s the people, and where public health and safety is concerned, those decisions traditionally have been in the hands of qualified public health scientists and medical personnel. Many believe they should remain there..

While responsible representation from industry is vital to the legislative process, public health decision making should be open, and public health laws and rule making should be as free from political pressure as our current system can make it. Right now, I am afraid recent news reports show Florida again as a bad example of how to go about food safety.

Respectfully,

Roy E Costa RS MS(MBA)