The food safety net just showed us another huge tear as the result of contaminated peanut butter products. The problem will be felt for years in the peanut industry and will likely change the food safety landscape in many ways.

 

The government reaction has been harsh and focused in this latest deadly outbreak. More government action means more regulation, and as yet, we have not seen any sweeping changes, but they are likely to come. For the first time we have the highest level of government showing concern, namely the White House. The One Big Agency concept keeps emerging and it is good to examine why proponents believe it is necessary, namely reducing duplication and closing gaps. There is also the idea that policy on food safety could come from one office. We now also have possible criminal behavior on the part of one of the food industry, and the legal consequences of causing an outbreak are becoming clearer and deeper. On the positive side, in this latest crisis there is a real sense of openness for change.

 

The foodborne outbreaks caused by once thought harmless items such as peanut butter has been the icing on the cake for a very mean period in the history of food safety. It is ironic that at the time the food safety concept is rapidly growing, the hazards keep building against controls.

 

The question is what we are going to do about it; what do we do before something like this happens again? We have had in the past a vacuum as far as any true leadership to get us out of the problem. Its been a long time since there were any definitive changes in the way we do food safety and there is real room for improvement. So what are we going to do prevent the next outbreak? Do we call for more reforms? Is this the same pattern of business as usual or do we expect something a little bit more decisive from government after peanuts?

 

Obama joins calls for improving US food safety regime:

http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/feb0209fda.html

 

Peanut butter may get ‘high risk’ designation as government tightens oversight of food makers

http://www.startribune.com/politics/national/congress/39465507.html?elr=KArks8c7PaP3E77K_3c::D3aDhU6:_0c:QyDiiUiacyKUnciaec8O7EyUr

No one disputes the fact that our food safety net has several gaping holes. Like clockwork, one can seemingly depend on a major foodborne illness outbreak to occur every few weeks. This month it is peanut butter, again, a few months back it was peppers and tomatoes, before that potpies, veggie snacks, canned chili, etc, etc.

Proponents for a massive reorganization of our regulatory agencies continue to make their voices heard. However, few if any of these proponents really appreciate what has caused the dysfunction in our food safety systems. A reorganization of our federal agencies is a dangerous idea that simply will not work and political motives are behind much of the "One Big Food Safety Agency" movement.

While our agencies do seem overwhelmed, actually the solutions are relatively simple; more industry self-control and more oversight by a properly funded and managed government would make a world of difference.

First, industry self-controls should be mandatory, not voluntary! Regardless of the industry, process or commodity, it is the producer that holds the key to food safety. Yet, except for red meat, juice, poultry, seafood and the dairy industry, most of the food industry, including the entire food service industry operates with no formal requirements for a food safety system. Industry self-control does not necessarily mean government should back away from its authority. In fact, mandatory self-regulation would bolster governmental efforts if government were in true partnership with industry and not simply shifting the cost and burdens of public health protection, as seems to be the case.

When operators properly develop and implement food safety systems, they work. Health authorities are no longer reporting juice outbreaks. Statistics show some progress in reducing outbreaks of E. coli O157:H7 in red meat, especially at the retail level and there are very few reports of large-scale outbreaks of salmonella from poultry. This is probably the result of government-mandated self-regulation, although it is somewhat uncertain why we see declines in outbreaks in some pathogens.

The record of the highly regulated seafood industry is remarkably good. We do not have nationwide outbreaks associated with seafood. While groups such as the Centers for Science in the Public interest have misunderstood the statistics related to seafood outbreaks, the seafood industry is undoubtedly one of the safest in spite of the fragility and propensity for bacterial growth of its products.

Government, especially the FDA, is terribly underfinanced, poorly managed and lacks political support. Its counterpart, USDA, seems to fare a little better in its budget, but politics at the highest levels in USDA ensures less effectiveness as a public health agency. These two facts are the major reasons we have a weakened food safety system. Opponents of self-regulation should consider that a mandatory self-imposed food safety system with a strong government oversight is a very different model from voluntary self-regulation where government has no jurisdiction, or abdicates its authority.

An example for how things are improving exists today in the produce industry, probably the most hazardous of all food industries. The California leafy greens industry and the Florida tomato industry have adopted self-regulation, and in the absence of federal oversight, state government has stepped in to provide the needed regulatory oversight. We have an excellent developing model where strict governmental regulations of producers are coupled with demands from buyers for validated self-control systems. We need across the board what is happening in Florida and California, and not just in the produce industry. If we had mandatory industry self-control, coupled with strict government oversight, large-scale foodborne illness outbreaks would stop, and sporadic incidence would dramatically drop.

The panacea of creating One Big Food Safety Agency will not solve our food safety problems. It will however make it much worse. As a government manager who has been through government reorganization, I will tell you it takes years for the agency to recover. Generally, the politics that occur are so damaging to morale and the mission of the agency that any meaningful efforts come to a standstill. It is incredibly naive to think that two massive agencies with 100 years of protocols and independence can be merged into a single agency successfully just by an edict in Washington. While the problem of “who inspects what pizza” makes good fodder for those with an anti-regulatory agenda, this archaic problem can be easily solved by an interagency agreement, or memo of understanding between the two agencies.

If Mr. Obama is smart, he will look to make USDA and FDA efficient and accountable and give them the support they need. These agencies have served us very well up until recently when politics and politicians gutted FDA. USDA is a separate problem. USDA has suffered by being an advocate for industry while simultaneously shouldering a serious public healthy responsibility.

Food safety is a critical public health issue, so what are the leaders in public health concentrating on? Take a look at the American Public Health Association, or the Association of Colleges of Public Health. They are bellwethers for what is on the mind of the public health scientists in this country. Few in these groups are seriously interested in food safety. Colleges of public health do not teach food safety as a public health specialty although there may be a lecture or two in the environmental health track. A long-term solution to strengthening the food safety system is for the public health academic community to attract and train more qualified food safety experts and deploy them into both regulatory and industry food safety positions. It is time for the public health scientists to get out their ivory academic towers and embrace contamination of the food supply as a major public health concern.

We should not waste precious resources in a useless and dangerous reorganization of the federal bureaucracy. It is time for public health scientists, industry leaders and government officials to develop an initiative similar to the “President’s Food Safety Initiative” of 1998. The result of the 1998 effort yielded tremendous progress on many fronts, very cost-effectively.

Providing leadership in Washington, sensible tweaking and funding of our existing regulatory systems, and requiring industry to shoulder more weight to protect the public are what we need. Advocating for “One Big Food Safety Agency” is a colossal mistake in thinking and such an effort will guarantee that we fall further behind the microbes in their incessant attack on people through food. Thankfully, President Obama is probably going to be too busy to make this happen anytime soon.

In years past the practice in the US was to require a health certificate to work in the food industry. While on the surface this sounds like something to consider, the use of medical evaluation of food workers was often done without specific tests, medical personnel relying on medical history and a physical exam. Without specific tests carriers of infection are difficult to detect, and such exams alone cannot predict future health status. In many parts of the world, this practice is still evoked while it  is no longer considered to be necessary in the US.

Since a medical screen is relied upon by some as a preventive measure, our scientific methods of developing food safety systems makes us have to evaluate the validity of this process. We must determine the reliability of results for preventing foodborne illness alone. In a food safety system, other communicable disease such as sexually transmitted disease, or strictly respiratory diseases like TB or influenza do not enter into the hazard analysis..

A medical screening process proven effective through a validated method would be in conformance with ISO22000:2005 or HACCP methods; requirements based on them would then be food safety preventive measures.

To be in conformance, tests must be specific for etiological agents of disease, be predictive of communicable disease status at time of employment and be relative to future health status. Reliable tests provide the validity for a medical exam at time of employment. Tests for Salmonella typhi, Giardia, other protozoan and higher parasites, skin and upper respiratory infections (staph and strep) and other chronic or semi chronic disease (hepatitis A-D, mononucleosis)  transmissible through food might be considered. In addition, triage of employees might be beneficial in a “hazard analysis” context as one might try to discriminate and sort between:

  • 1) Those who are not infected and not likely to be infected in the future
  • 2) Those who are likely to be infected in the future
  • 3) Those who are likely to be infectious now
  • 4) Those for whom immediate care might make a positive difference in outcome

The food safety and public health benefits of any medical-screening model needs to be tested before including it in a food safety management system.

In the past, the medical screening of food workers has proven not to be predictive of future infectious status and both the public health and medical communities question its value in public health protection.

While each country and region has its own relatively unique disease transmission issues, prevention of disease in the first place is always better than testing for it afterwards.

 

Public health policy and food protection are issues that we expect the new Obama administration to address eagerly. Financial problems, wars in Afghanistan and Iraq, and Home Land Security have shifted focus away from our core public health agenda, and now is the time to return our focus. Everyone agrees that public health programs have suffered in the last eight years. Keep in mind, however, that public health protection is possible in the US more so than in many places around the world. We have public health infrastructure, a little decrepit, but still there.

The new administration should take an accounting of what is on the ground now, what is working and what is not, and develop a comprehensive plan of action similar to the "President’s Food Safety Initiative" of 1998.. Safety-net type programs that were instituted like PulseNet www.cdc.gov/pulsenet/ and FoodNet www.cdc.gov/FoodNet/  are now very valuable. If the new administration is wise, it will invest in these and other types of surveillance programs and set meaningful public health goals. Most importantly, the new administration must implement strategies to achieve its goals based on science and a risk assessment.

The Obama team should develop true partnerships where government and industry equally share the burdens of food protection. One possible way to do this is to strengthen the existing industry-driven, self-regulation model. The Obama administration can accomplish this through better federal agency oversight and verification of the entire food supply chain. Presently, there are major gaps in federal regulation of the US food supply that weaken industry efforts.  

Applying technology is a quick way to move forward rapidly. For example, the food industry is applying sophisticated food safety data capture devices in their food safety management systems. Programs are built into common platforms that run on the I Phone and PDA of a wide assortment. Data is also transmitted through the Internet to database management systems that track and analyze data-see http://www.scbs.net.au/index.htm. Tapping into the resources of industry food-safety professionals and the available technology can definitely strengthen public health protection.

“One big agency” to bring all regulation for the food supply under one umbrella is a compelling thought that the Obama team must evaluate. The new administration should consider first, however, how to enhance what is already functioning. There may be some advantages in combining some functions of the USDA Food Safety and Inspection Service-see www.fsis.usda.gov/and the FDA Center for Food Safety and Applied Nutrition-see www.foodsafety.gov/list.html.

Without question, the new administration should call for more coordination and better allocation of resources in both USDA and FDA, and then properly fund these agencies to meet the administration’s public health goals. The last administration failed to recognize that our agencies have been less than capable in managing the risks in the US food supply. This administration should first honestly evaluate the successes and failures of current public health policies as regards food safety and other pressing matters and then lead us forward.

We recommend that the administration seriously look at the Office of the Surgeon General- see www.surgeongeneral.gov and strengthen the role of the nation’s "Chief Health Officer". The Surgeon General has not voiced any support for food safety efforts since he last spoke out publically on the issue, back in 1999. This vastly underutilized post should come to the fore under President Obama. We should expect the Surgeon General’s Office to take initiatives in the interest of public health to elicit more support and involvement in food safety from the medical and public health communities, and to speak to the American people about food protection.

 

This outbreak is an example of scombroid poisoning. Scombroid enterotoxin is actually a heat stable bi-product of histamine, and results when dark-fleshed fish begin to decompose. Its one of the few illnesses through food that have a correlation directly to spoilage although there may be others (certain strains of C botulinum). Because the symptoms occur rapidly and are easily recognized by the victim as food related, few outbreaks go unreported and uninvestigated. This illness is an example of how reporting artifacts confound epidemiological statistics. A recent study by the Centers for Science in the Public Interest reported that fish and seafood are the vehicles most often identified in foodborne illness outbreaks. Failure to understand the effect of reporting bias in the data related to fish, makes that work and its conclusions flawed. In addition, that study also relied upon data on shellfish infections and intoxications, and ciguatera intoxication. These data also suffer from the same type of reporting bias issues.

However, tuna and other species of Scromboid fishes (jacks, mahi) have a very high risk of this hazard. Its occurrence is quite an important issue as HACCP has been in place in fisheries in the US for many years. Without rigorous supplier controls controlling risks all the way to harvesting, HACCP as an intervention in this illness is weak.

There is a corollary between Scomboid poisoning and other hazards such as those found in fresh produce, that lack a kill step.

UK: Tuna ‘link’ in sickness outbreak
05.dec.08
BBC News
http://news.bbc.co.uk/2/hi/uk_news/scotland/north_east/7767327.stm
A tuna meal may have been to blame for an illness outbreak at Aberdeen Exhibition and Conference Centre, NHS Grampian has said.
Twelve people needed hospital treatment after the emergency services were called out on Thursday afternoon.
The health board said the common link between the patients was a tuna dish for lunch. Samples are being tested.
One man who fell ill, who did not want to be named, said the symptoms were rashes, headaches and palpitations.

 

 

In a recent message to its members, Food and Water Watch says:

 

“Protecting Our Food: End Food Industry Self-Policing”. Consumers need strong standards and strong enforcement by government inspectors. The USDA must abandon attempts to let meat plants do their own inspections. The Food and Drug Administration needs new authority and resources to inspect food processing plants and should be reorganized so it can devote proper attention and inspection resources to imported foods.”

Food and Water Watch describes themselves as:

(Foodandwaterwatch.org is a nonprofit consumer organization that works to ensure clean water and safe food. We challenge the corporate control and abuse of our food and water resources by empowering people to take action and by transforming the public consciousness about what we eat and drink).

As practicing food safety experts, we have seen many improvements in food facility operations as a result of industry self-control procedures. However, a serious deficit exists when government fails to support voluntary, industry food-safety-systems with a public health goal in mind. To enhance industries efforts public health agencies should:

1.      Create mandatory baseline requirements for the entire food chain

2.      Effectively validate and verify industry efforts and coordinate them

3.      Ensure firms create food safety systems primarily to protect public health making this their primary goal

 

While meat, fish, poultry and juice have mandatory food safety systems, not all of the food supply is covered.

 

In the produce sector, we have only buyer driven pressure on producers throughout the supply chain to meet voluntary standards. Many retail firms such as Wal-Mart, Albertson’s and Publix require their suppliers to maintain detailed food safety programs based on Hazard Analysis Critical Control Point. However in the absence of regulation (FDA may have primacy but does not exert its power until the fruit is processed), many non-compliant firms still sell to buyers in need of product.

 

There is no mandatory regulation and baseline of safety in the produce industry and many firms operate without a food safety system; while at the opposite extreme, we have exceptional firms with ISO based HACCP models controlling minute aspects of production from growing through distribution.

 

Industry self-policing is critically necessary in produce, however it is same in every food industry. This is the case because all day-to-day operation in any industry are in the hands of the firm. The challenge is for government to use its resources wisely and build upon industry efforts, while at the same time providing a strong safety net for the consumer.

 

Our response to Food and Water Watch and its members is:

 

1. Ending self-policing is not wise; we should strengthen self-policing.

 

2. Public health agencies should be more intelligent about the way they assure food safety for the American consumer and accept their responsibility for protecting the public health while delegating more of the monitoring the safety of the food safety system to industry.

 

3. Ending self-policing will not result in food protection, but just the opposite. Strengthening this model on the other hand holds a great deal of promise

 

I referred this “anonymous sanitation complainant” to the proper authorities in the jurisdiction in question. This message brings up some very interesting points:

1. Working conditions and health of employees and the duty of the employer

2. Attitudes about cleanliness

3. Motivation

4. Self esteem

5. Communications

6. Duty to the public

7. Duty to the firm

 

I don’t think the health department can fix all of these problems. 

 

REGARDING: My Compliant

PROBLEM: Everything is falling apart. Roaches are EVERYWHERE. The place has a very unclean atmosphere.

I have problems keeping myself in the mood to continue my employment there. But if anything, maybe this letter will find the right ears and maybe something can be done.

I’m not sure how much I’ve eaten from that restaurant, but now that I work there and have seen 1st hand the environment in which the food is subject to (roaches crawling on walls, floors, equipment; finding roaches in drink mixes) – the place is NASTY and I cannot find another job at the moment to get out of blank.

  

I request to be ANONYMOUS – If I can be entitled to some claimsuit after seeing how the food has been prepared and served in such an environment, food that I have eaten most recently, I feel I’ve been violated, my trust misplaced, my money wasted on food that is not of high quality.

  

Please let me know my options or what you or anyone else can do.

What a lot of people who travel do, myself included, is just stop at the first restaurant that is convenient. I might make a decision as to what kind of food I feel like having but the venue is kind of arbitrary. I am like most folks; I expect the operator of any establishment to protect my food from contamination. Most QSR’s are under some sort of quality system, self imposed of course because most health agencies do not require it. These places are inherently less likely to pass on contaminated foods because they have internal standards they must meet. This is the case for every restaurant; if the there is no continual assurance of safety on a daily then risks are higher. I frequent proprietary restaurants, those without a national "brand", but I also recognize risks are probably higher there.
 
So that is the basic idea. If the facility has a posted score from the regulatory agency, this is even better, because it means whatever internal programs exist they are validated.
 
You cannot tell the risk of contaminated food by observation of the eatery. It is absurd to suggest to consumers that they look around the dining area, closely watch the buss boy, or inspect the bathroom. That is not where contaminated foods come from. You, I and all consumers are basically putting our trust in the hands (literally) of folks we do not know. Doesn’t it make sense that the facility operator should be required to properly protect my food? If you can spend the time to learn the system ( they do not make it easy) take a look at the inspection records in Florida. What you will see are repeated cases of critical items out of compliance, and very spotty enforcement.
 
I do not become uninterested in food safety just because I am a consumer. In Florida, I ask to see the last inspection report (except when dining with my wife whom insists I do not do this). It is law that they show it to me. In Palm Beach  County, I look to see that the sign advising consumers that they may "request to see the latest report" is there. If they balk, I will report them.
 
The Florida Restaurant Association fought hard here to keep the restaurant inspection findings from posting, and have temporarily succeeded. They also are very much against any type of posted sanitation rating.
 
With the poor record of compliance in Florida (and most places) consumers need to have complete transparency to make a decision about where to eat
 
That is why my company provides a certification to restaurants that participate in my program, known as "Ten to Win" (see www.safefoods.tv). My perspective is consumers shouldn’t have to ask about compliance with the law, or guess about sanitation. 
 

 

 

Food-borne Illness and its Effect on Tourism in Egypt

Egypt is a land of mystery and excitement that has drawn world travelers for centuries. Unlike many developing nations, the rich history and close ties to our own culture makes this travel destination especially attractive.

Whether one travels to Mexico City, Madrid, Hong Kong or Cairo, however, the dilemma is the same. According to the CDC “Traveler’s Diarrhea” is a common aliment affecting up to 50% of persons visiting foreign destinations”. However, sometimes it is more than a brief, self-limiting illness.

Many nations, including our own, struggle with food safety issues and fixing them takes a coordinated approach amongst many constituents such as government, industry and the public. Food safety problems often intersect with wider public health needs and progress is hindered if problems such as poverty, social unrest and political instability are not also addressed.

Egypt suffers like the US from fragmentation in its public health mission. Currently, there are multiple agencies with similar responsibilities to protect the public from food safety hazards and little formal coordination between them. To make food safety a reality for tourists essentially means that food safety must be assured for the average Egyptian; therefore, Egypt needs a strong, coordinated public health infrastructure.

Tourists might not stop coming to Egypt due to a few reports of diarrhea, however, widespread reporting of severe cases, and lawsuits, will make tour operators much more selective, and bring pressure on the Egyptian hospitality industry to clean up its act.

The greater challenge is for Egypt to ensure that it has the capacity to sustain a safe food supply for its own people. In doing so, it ensures safe food for the rest of us who want to see Egypt for ourselves.

 

UK: Couple seek legal help in holiday illness fight

 

A couple who say they were left with long-term debilitating illnesses after contracting a bug on holiday are taking legal action. Nina Shenton, aged 20, is still undergoing tests for continuing sickness. Her partner Richard Gerrard, aged 24, has been diagnosed with painful reactive arthritis triggered by a virus (bacteria? – dp) following their week-long trip to the Zouara Hotel, Sharm El Sheikh, Egypt, in April.

The pair came down with stomach bugs within hours of arriving and were stuck in their rooms for the rest of the week, ruining their first holiday together. Miss Shenton, of Barn Gate Street, Leek, said: "To me, the food was disgusting. We felt the meat was undercooked and the buffet was left out for long periods of time, with new food being piled on top of the old food – we even noticed flies landing on the food.

"Also, lots of other guests were complaining about illness.

"We fell ill after our first meal there. I had terrible stomach cramps and was being sick.

"Six months later, my stomach is still swollen, I have chronic pain and bouts of sickness.

"I can’t believe people are still being sent there on holiday after what we have been through."

Mr Gerrard, of Church Lane, Cauldon, had to be signed off work as a builder for five weeks and is still recovering.

He said: "The holiday was a complete nightmare”.

"We were still sick for a month afterwards and when that went, I had terrible pain in my joints and was in so much agony I couldn’t stand."

Now the couple want to recover the costs of the holiday, at £400 per person, medical bills, including more than £500 spent on prescriptions, and loss of earnings.

Joanne Beddow, of Irwin Mitchell Solicitors, who is representing the couple, said: "Mr Gerrard and Miss Shenton are not the only people to have suffered illness at the Zouara Hotel.

"We see no end to the complaints from holidaymakers who return having suffered illness abroad.

"Incidents such as this should be a trigger for tour operators and hoteliers to do more to ensure the health and safety of their guests."

A spokesman for tour operator youtravel.com said: "We have launched a full enquiry and are liaising with Jetline Travel, the travel agent who booked the holiday, to ensure a response as soon as possible."