Transcript Separating the Chaff from the Wheat

Foodborne Infection: The Toll and
the Challenges
BCFPA
EMBRACING A CHANGING WORLD
WHY AM I HERE?
Is it the logo?
Is it Desolation Sound?
Is it a trip to Richmond—uh, the airport?
I’m Here for Those Who Cannot Be:
Foodborne Illness Costs Everyone
THE COSTS OF FOODBORNE ILLNESS
Estimated 76 million cases of
foodborne illness each year
325,000 hospitalizations, and
5,000 deaths [Mead at p. 614]
For FIVE foodborne pathogens,
medical costs, productivity
losses, and costs of premature
death total: $6.9 Billion a year1
1.
Crutchfield, S.R. and T. Roberts. 2000. “Food
Safety Efforts Accelerate in the 1990s,” FOOD
REVIEW, 23,3:44-49,
Kids Suffer the Most
In Canada, it appears that children less than 10
years, young adults 20 to 24 years … are at an
increased risk for AGI [acute gastrointestinal
illness]. In children, this increased risk may
reflect an increased susceptibility to
gastrointestinal infections due to immune status,
and in young adults, this increased risk may be
due to behavioural factors.
Demographic determinants of acute gastrointestinal illness in Canada: a population study
BMC Public Health. 2007; 7: 162.
Remember the Good Old Days—Before
There was any Foodborne Illness?
Back then, there was only the “stomach flu”
What happened?
Those Pesky Environmental Health People
Came Along
Of Course, There Really is the Stomach
Flu: It’s Called Norovirus
If You Need a Break from Worrying About
Food, Try worrying About Water
Crypto and Recreational Water Go Together
90% of Enteric Illnesses are Sporadic
• Kitchen cutting boards after handling raw meat
• Eating out at restaurants
• Private well water and septic fields
• Produce from sealed bags
• Recreational water
• Daycare and hand washing—not so much
Denno, DM et al. Tri-county comprehensive assessment of risk factors for
sporadic reportable bacterial enteric infection in children. J Infect Dis. 2009
Feb 15;199(4):467-76
It’s Not a Tummy Ache
• “I’ve had women tell me that E. coli is more painful than
childbirth,” said Dr. Phillip I. Tarr, Washington University,
St. Louis and world expert on STEC
• C.S.Cody wrote on Oct 8, 2009 12:07 PM:
" This was not a simple "tummy ache". This was a
dangerous parasite that caused these illnesses. We have
never heard the full story about what the State did here.
Thousands got sick! Some folks landed in the hospital.
I'm glad someone is finally getting to the bottom of this
and didn't just quit because it took so long to fight this
fight! “—letter to the Editor, Finger Lakes Times
For Bugs, It’s Getting Harder to Hide
•
Stool, Blood and Food Tests
– Mandatory Reporting
– More cultures for bloody
stool
– PFGE/MLVA
– PulseNet
– Titer Tests
Fluorescing Bacteria on a Petri Dish
Common ancestor of all E. coli O157 strains existed ca. 40,000 years ago
Robert Koch demonstrated that anthrax, Mycobacterium tuberculosis, and
Vibrio cholera cause human disease in the 1870’s and 80’s
Epidemiology In Action
• 1923—first compilations of milk
outbreak in US
• 1938—more complete date on
food and waterborne outbreaks
• 1966—CDC starts outbreak
summary publication
• 1972—CA Foodborne Disease
Reporting Center beings
publishing outbreak information
John Snow, M.D., 1813-1858
A Father of Epidemiology
Eating Green=Increased Risk of Illness
Dr. Robert V. Tauxe, an epidemiologist with the
federal Centers for Disease Control and
Prevention, said, "The American diet has really
shifted, and we are eating more that is minimally
processed and getting it from a broader variety of
different sources." He added: "There has been
an increase in the volume of production, so when
something goes wrong it goes wrong on a bigger
scale. It's a difficult trade-off if you want to have
fresh produce in the off-season."
E. Coli in Your Salad
• Since 1996:
• 34% of all outbreaks due to
microbial contamination traced
back to a specific fruit or vegetable
• 10% of illnesses
• 34% of deaths
• 20 of the 24 outbreaks have
involved E.coli O157:H7
Source: USDA-ERS, Amber Waves, June 2007
Lettuce and Spinach
• 21 E. coli outbreaks since 1995
– At least 1,000 reported illnesses
and 7 deaths
• Fresh or fresh-cut lettuce or
spinach implicated as outbreak
vehicle
• 8 outbreaks traced back to produce
from Salinas, California
• LGMA costs about 1% of revenue
22
This Woman Might Die From Eating Cookie
Dough—Washington Post 9.1.09
“Nestle’s cookie dough is packaged with labels
warning consumers not to eat it raw. But people tend
to disregard the warning -- 39 percent of consumers
eat raw cookie dough, according to Consumer
Reports.”
Linda is Still in the Hospital
“Linda Rivera has just been trying to stay alive. Her
cascading problems started about seven days after she
ate the dough when her kidneys shut down and she went
into septic shock. Then doctors had to remove part of her
colon, which had become contaminated. Soon, her
gallbladder was inflamed and had to be excised. Shortly
after, her liver stopped functioning. It is unclear exactly
what is causing her loss of speech, although the toxin
produced by the E. coli O157:H7 bacteria can attack the
brain.”
"You made it this far -- don't give up on us, Mom," said
Tony, one of her 17-year-old twin boys, who sniffled
beneath his face mask. "You've done everything for me in
my life." From the Post article.
PCA & Salmonella Typhimurium
• Peanut industry estimates
lost sales and production
over $1 billion
• Peanut recall nearly $500
million
• Over $2 billion because of
a company that
processed only 2.5% of
annual US crop
• PI claims not a part of
these costs
Self-Regulation Only Works If You are
Serious About it
• Kellogg, one of the companies that recalled peanut
products, received reports of third-party independent
audits of Peanut Corporation of America in 2007 and
2008. The audits, paid for by the peanut company to
meet food manufacturers’ requirements, were intended to
assess its compliance with federally mandated
manufacturing practices, including the condition of the
plant and equipment and cleanliness, said Kris Charles, a
spokeswoman for Kellogg.
• Each audit, conducted by AIB International, gave the
Blakely plant a “superior” rating.
This PB client won 3 Purple Hearts in Korea
Pt previously treated with Cipro for diagnosis of Salmonella. Returned
to SNF and continued to decline. "There has been an outbreak of
Salmonella at the nursing home." At the time of assessment pt. is "in
such a state that he cannot carry on any useful conversation.”
Some persistence of his diarrhea, bloody x1 with at least 4-6 emesis.
Episodes of vomiting through the night. Blood culture collected at 0645
positive for Salmonella species. Stage II pressure sore on coccyx. Plan
for central line placement and transfusion of apheresed platelets.
Condition deteriorated rapidly and pt. passed away on the morning of
1/12/09. Death pronounced at 11:08am.
Final diagnosis: Salmonella gastroenteritis.
Cause of Death: Peanut Butter
“I ask myself every day, ‘Why me?’ and
‘Why from a hamburger?’ ”—Stephanie
Smith
October 3, 2009
It’s Not a Question of Resources
Cargill, whose $116.6 billion in revenues last
year made it the country’s largest private
company, declined requests to interview
company officials or visit its facilities. “Cargill is
not in a position to answer your specific
questions, other than to state that we are
committed to continuous improvement in the area
of food safety,” the company said, citing
continuing litigation.
Factors Contributing to Foodborne Illness
Outbreaks Washington State 2000-2005
Contributing Factor
Percentage of Outbreaks
• Bare hand contact with food
33%
• Food handler working when ill
22%
• Slow cooling of foods
19%
• Inadequate hand-washing
18%
• Room temperature storage of foods
16%
• Insufficient reheating of foods
14%
• Cross contamination of foods
13%
Big Outbreaks Require Lots of Mistakes
OTTAWA — A "void in leadership" within the federal government
during last summer's deadly listeriosis outbreak came after company
officials and over-worked meat inspectors failed to identify a
persistent listeria problem at the Maple Leaf Foods plant, according
to a highly critical report by an independent investigator.
No player in the listeriosis outbreak escaped criticism from Sheila
Weatherill, who released her report Tuesday.
But Weatherill zeroed in on a "vacuum in senior leadership" among
government officials at the Public Health Agency of Canada and the
Canadian Food Inspection Agency that caused "confusion and weak
decision-making.“
Michael McCain, CEO
Maple Leaf Foods
A CORE PROBLEM:
Safety is Invisible
“For the most part, food safety is a
credence attribute, meaning the
consumers cannot evaluate the
existence or quality of the attribute
before purchase, or even after they
have consumed [it].”1
1. See E. Golan, et al., Savvy Buyers Spur
Food Safety Innovation in Meat Processing,
AMBER WAVES, April 2004,
33
Will Consumers Pay for Safe Food?
Extra Safe Meat
Sort of Safe Meat
$1.99lb.
A “Rational” Actor Will Not
Invest in Food Safety, Unless:
 receives higher prices for
higher quality good, or
 lowers the cost of production, or
 reduces risk of loss or damage.
“Appropriability, the ability to control and exploit
the benefits from innovation, play a key role in
driving investment in innovation. Only if firms
expect to be able to reap the benefits of an
innovation will they have an incentive to
innovate.” (Golan at 3)
35
LAWSUITS: A Weak or Strong Incentive?
• Process and product
innovation more often occurs
after an outbreak, and
because of outbreak.
• Most “good” cases do not go
to trial; and settlements are
kept strictly confidential.
• Insurance and indemnity
agreements transfers risk of
paying judgment/settlement
away from manufacturer.
36
There’s a Lot to Do
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