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A Taste of Food Poisoning
The Washington Post
Tuesday, July 5, 2005;
Carole Sugarman, a former Washington Post food reporter who now covers the Agriculture Department for Food Chemical News, writes that her daughter never met a chicken tender she didn't like. But during a recent family vacation in Florida, 9-year-old Anna was struck with a bad case of salmonellosis -- disease caused by salmonella. And while we'll never know for sure, we strongly suspect it was caused by contaminated, undercooked poultry at one of her daily restaurant chicken meals.

Sugarman says that as a food writer for 25 years, she's interviewed numerous victims of food-borne diseases and parents of children who've died from them, and attended scores of conferences and hearings where food safety issues are debated among government officials, industry and activist groups. But this was the first time she got to see firsthand how devastating full-blown food-borne illness can be. And while the experience illuminated many of the food safety issues that she has long covered, she was still surprised and overwhelmed by Anna's illness. Surprised at the nonchalant attitude of doctors toward food-borne disease and the uneven follow-through of the public health system. Surprised at the gap between the bureaucratic rhetoric and the reality of the problem. And overwhelmed by a very sick daughter, whose condition she accurately described as "having my butt on full blast."

Sugarman says that the Centers for Disease Control and Prevention (CDC) estimates that there are 76 million cases of food-borne illness a year in the United States. (We're dealing here only with sickness caused by a bacteria or virus in a contaminated food. The CDC estimate does not include the untold millions of upset stomachs caused by overeating, rich foods and such that many people mistake for food-borne illness.) The problem sends nearly 325,000 people a year to the hospital; 5,000 a year die from it. The young, the old and the immune-compromised are hit hardest.

Some progress is being made, however. In April, when Anna was home sick, the CDC announced its latest food-borne diseases surveillance figures -- a story Sugarman (ironically) had to cover.

The good news: Infections caused by five hard-to-spell bacteria - - E. coli O157:H7, campylobacter, cryptosporidium, listeria and yersinia -- underwent significant declines in 2004, compared with 1996-1998. The bad news: Salmonella infections showed the smallest decline. Of 15,806 laboratory-diagnosed cases of food- borne infections from the 10 states under CDC surveillance, more cases -- 6,464 -- were from salmonella than any other bug.

In what may be the most surreal exchange of my career, Sugarman asked Agriculture Secretary Mike Johanns during a telephone press conference why there hadn't been more progress made in combating salmonellosis -- and what the U.S. Department of Agriculture (USDA) planned to do about it. Johanns passed the question to another USDA official, who said that the agency was committed to developing policies to address the problem. Somehow, with her salmonella-infected daughter groaning in the next room, she didn't find this answer adequate.

Even CDC surveillance data don't get at the real scope of the problem. Most food-borne infections go undiagnosed and unreported because many sick people don't seek attention. Of those who do, many are not tested. In the case of salmonellosis, the CDC estimates that 38 cases occur for every one that's actually reported.

Sugarman says that when her family brought Anna to the hospital with severe stomach pains, diarrhea and dehydration, the doctor - - who seemed intent on diagnosing appendicitis -- ordered a sonogram, an X-ray and finally a CT (computed tomography) scan, which shows the most detailed images. But a stool culture -- the standard diagnostic test for food-borne illness and a cinch to collect while your child is perennially on the pot -- was not even mentioned, even though frequent diarrhea and stomach pains are hallmarks of the illness.

While it was prudent to rule out appendicitis, you might think food poisoning would have been high on the list of next suspects. But her requests for a culture were ignored.

The second doctor on duty finally agreed to take a stool sample, but said she doubted the problem was linked to anything Anna had eaten. She said that Anna probably had a gastrointestinal virus - - like the other five kids in the ER that night. Sugarman doesn't know how many (if any) of them were tested for a food-borne infection.

Patricia Griffin, chief of the food-borne disease branch of the CDC, said that an emergency room physician recently told her that she doesn't take stool cultures anymore since the results generally don't come back for a couple of days -- after the patient has been discharged. Plus, she said, a positive result wouldn't affect treatment: Although the type and severity of food-borne disease determines the specific therapy, many infections are not treated with antibiotics or anti-diarrhea medications. That's because antibiotics can complicate the condition and possibly lead to drug resistance, and anti-diarrheals keep the disease-causing bacteria in the system rather than help get it out. Since in many cases, there's no treatment other than keeping hydrated, doctors may figure it's fruitless to take a culture.

Sugarman says that although state procedures vary somewhat, the basic protocol for responding to a suspected food-borne illness is this: If a stool sample tests positive for food-borne bacteria, the results are supposed to be reported to the state, which then alerts the CDC. The hospital or private lab is urged to send a sample of the bacteria to the state, which does further testing to determine the serotype -- the specific strain of the bacteria identified. Knowing the serotype may help identify the food that caused the problem, since certain serotypes are more common to specific foods. Monitoring serotypes also helps the CDC keep tabs on which strains are increasing in prevalence and which are decreasing.

The state labs may also take a genetic fingerprint of the bacteria and enter it into a CDC database, to see if there are any matches. Since food processors distribute their food nationwide, people in Maine and California could get sick from the same firm's hamburgers. DNA matches could help spot outbreaks and stop them from spreading.

In Sugarman's case, the state never received her bacteria sample from the hospital, so her salmonella was never serotyped, and a genetic fingerprint was never sent to the CDC. She knows this from Holly Conners, a nurse with the epidemiology and surveillance branch of the Montgomery County Health Department and the bright light of this whole ordeal. Conners ran interference for Sugarman to get this information, as she learned that protocol and privacy acts make it difficult to get it yourself -- even when it's your own kid.

All we know from the lab report is that Anna had salmonella Group D, which consists of nearly 200 strains, but that it was not the kind that can lead to typhoid fever.

Figuring out what made an individual person get sick often is impossible. Donna Rosenbaum, a food safety consultant and the first executive director of Safe Tables Our Priority (STOP), an advocacy group for victims of food-borne disease, was quoted as saying, "Sometimes you can, sometimes you can't. Occasionally you get lucky."

Sometimes, too much time has elapsed to find evidence, such as a suspect food item or a food service worker who failed to wash hands or follow sanitary procedures. When a lot of people at a wedding reception or restaurant get sick, the chances are greater that a link will be uncovered. But what are the chances that one cooking error or contaminated turkey sandwich will ever be tracked down?

Trying to piece the puzzle together yourself can become practically a full-time job. All while your child is screaming her head off on the toilet.

Sugarman says it took five days after her daughter got sick in Florida for her to be diagnosed with salmonellosis. (By that time she'd been flown back to Maryland and was hospitalized.) Then it took another day to reconstruct exactly what she ate during our week-long vacation, and where she ate it.

While we will never be sure of the meal that did it, several factors point to the chicken tenders Anna ate in a restaurant 10 hours before she made her first beeline to the bathroom. For one, when we told her that she probably got sick from something she ate, she immediately said, "I know where." With no prompting, she told us that parts of the chicken tenders tasted cold and hard. For another, it seemed obvious that the busy restaurant had a doneness problem: Sugarman says her fish was dry and overcooked and when she called the restaurant to inquire further into the situation, the owner said he believed the tenders were purchased partially cooked and frozen. Perhaps, she suggested, the fry cook didn't fully cook them? If the tenders were contaminated with salmonella, undercooking them might not kill the bacteria.

The restaurant owner, who appeared to listen sympathetically, told me he would check with the kitchen staff and get back to me. He never did. Concerned about the possibility of further illnesses, she reported the restaurant to the Florida authorities -- the county department of business regulation, not the health department.

It took three weeks and lots of follow-up calls to confirm that an inspector had been dispatched to the restaurant. By then, of course, none of the implicated food was available. But she was told that the inspector found no refrigeration or cooking temperature violations, no sick employees who could have transmitted the infection, and no other reported food-borne illnesses from the day we ate there.

"It's tough to catch these things," a state official told her.

Sever Weather and Food Safety.
Provided by ESIQual, Summer 2005
The Weather Service is forecasting several hurricanes this year. Severe weather is always a challenge so here are some suggestions to help you develop a Crisis Management Plan to help minimize the adverse effects.

  • Confirm walk-in and reach-in coolers, as well as cold and hot holding units, are equipped with thermometers mounted in the warmest (or coldest) area of the unit.
  • Confirm your cold-holding units are set to operate at
    32-35°F; freezers at -5°F or lower.
  • Freeze as much as possible.
  • Get dry ice. Dry ice lasts several days, so order it when
    severe weather warnings are issued.
  • Get Bottled Water. Crated 5 gallon containers, if possible.
    Bottled water shelf life is often a year or longer.
  • Update your emergency contact list, include
  • Utility providers (phone, electrical, gas);
  • Wet Ice suppliers, outside your water district (in case
    the water in your district becomes contaminated);
  • Dry Ice suppliers (list multiple sources);
  • Medical Caregivers;
  • Law enforcement;
  • Health Department;
  • Fire Department;
  • Temporary Help Agencies;
  • Poison Control Center;
  • Civil Defense or Emergency Management Agencies;
  • Insurance providers;
  • Management and key personnel, with cell phone numbers;
  • Identify who the manager on duty should call first.
  • Confirm you have supplies of single use eating and drinking
  • Store food on dunnage racks that will be safely out of the
    way of contaminated water in case of flooding.
  • Remove rodent bait boxes and insecticides from the floor when flooding is imminent. Replace them as soon as the threat is over. Use rubber gloves.
  • Unplug electrical equipment and move electrical box levers to the off position when flooding is imminent.
  • Remove liners from cooler shelves.
  • Keep products together in the cooler.
  • Discard refrigerated perishables including meat, poultry, fish, soft cheeses, milk, eggs, leftovers and deli items when their internal temperature is above 50°F for 6 hours or longer. Cook or use perishables when their internal temperature is between 41°F and 50°F for more than 6 hours.
  • Discard all food in soft-sided packaging that has been in contact with flood waters
  • Wash and sanitize food prep areas after flooding.

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