Consequences in Georgia of a nationwide outbreak of Salmonella infections: what you don't know might hurt you

Food recalls associated with foodborne disease outbreaks, United States, 2006-2016

About 800 foodborne disease outbreaks are reported in the United States annually. Few are associated with food recalls. We compared 226 outbreaks associated with food recalls with those not associated with recalls during 2006–2016. Recall-associated outbreaks had, on average, more illnesses per outbreak and higher proportions of hospitalisations and deaths than non-recall-associated outbreaks. The top confirmed aetiology for recall-associated outbreaks was Salmonella. Pasteurised and unpasteurised dairy products, beef and molluscs were the most frequently implicated foods. The most common pathogen−food pairs for outbreaks with recalls were Escherichia coli-beef and norovirus-molluscs; the top pairs for non-recall-associated outbreaks were scombrotoxin-fish and ciguatoxin-fish. For outbreaks with recalls, 48% of the recalls occurred after the outbreak, 27% during the outbreak, 3% before the outbreak, and 22% were inconclusive or had unknown recall timing. Fifty per cent of recall-associated outbreaks were multistate, compared with 2% of non-recall-associated outbreaks. The differences between recall-associated outbreaks and non-recall-associated outbreaks help define the types of outbreaks and food vehicles that are likely to have a recall. Improved outbreak vehicle identification and traceability of rarely recalled foods could lead to more recalls of these products, resulting in fewer illnesses and deaths.

Shiga Toxin-Producing Escherichia coli (STEC) O157:H7 and Romaine Lettuce: Source Labeling, Prevention, and Business

From May to November most romaine lettuce shipments in the United States come from California's Central Coast region, whereas from December to April most come from the Yuma, Arizona, region. During 2017-2018, the 3 outbreaks of Shiga toxin-producing Escherichia coli (STEC) O157:H7 in US romaine lettuce all occurred at the tail end of a region's production season. During the fall 2018 outbreak, the US Food and Drug Administration (FDA) recommended that suppliers begin labeling romaine packaging so that consumers can identify the product's harvest region.We used publicly available data to show that labels may not avert many illnesses in future outbreaks but may reduce suppliers' financial losses and reduce food loss.Market data available during both 2018 outbreak investigations showed that there was no romaine production from one of the 2 regions when the first illness onset occurred. That is, at the beginning of an outbreak investigation, market data may allow the FDA to quickly rule out an entire production region as a source of contamination.

Crisis communication: an inequalities perspective on the 2010 Boston water crisis

OBJECTIVE

Although the field of crisis risk communication has generated substantial research, the interaction between social determinants, communication processes, and behavioral compliance has been less well studied. With the goal of better understanding these interactions, this report examines how social determinants influenced communications and behavioral compliance during the 2010 Boston, Massachusetts, water crisis.

METHODS

An online survey was conducted to assess Boston residents' knowledge, beliefs, attitudes, mass and interpersonal communication, and preventive behaviors on emergency preparedness topics dealing with the water crisis. Of a total sample of 726 respondents, approximately one-third (n = 267) reported having been affected by the water crisis. Only data from affected participants were analyzed.

RESULTS

Following an order to boil water, 87.5% of respondents refrained from drinking unboiled tap water. These behaviors and other cognitive and attitudinal factors, however, were not uniform across population subgroups. All communication and behavioral compliance variables varied across sociodemographic factors.

CONCLUSIONS

Crisis communication, in conjunction with other public health preparedness fields, is central to reducing the negative impact of sudden hazards. Emergency scenarios such as the Boston water crisis serve as unique opportunities to understand how effectively crisis messages are conveyed to and received by different segments of the population.

Evaluating the effectiveness of food recalls in retail establishments in New York City

Information on how promptly food recalls of U.S. Food and Drug Administration (FDA)-regulated products are disseminated to retailers is not well documented. Store managers were surveyed after recalls were declared to estimate the proportion aware of a recall, to describe the methods by which they learned of the recall, and to ascertain how they would prefer to be notified of recalls in the future. From 1 January 2008 to 31 December 2009, we identified FDA Class I products recalled because of potential contamination with an infectious agent such as Salmonella, which were sold in New York City. After each recall, a sample of retailers who carried the products was contacted, a standardized questionnaire was administered to store managers, and a sample of stores was inspected to determine if the product had been removed. Among nine recalls evaluated, 85 % (range, 12 to 100 % ) of managers were aware of the recall affecting a product at their store. Chain store managers were more aware of recalls than were independent store managers (93 versus 78%, P < 0.0001). More chain store managers first heard about the recall via e-mail as compared with independent store managers (35 versus 4%, P < 0.0001). E-mail notification was preferred by large chain store managers (38 versus 8%, P < 0.0001); on inspection, chain stores were more likely to have removed the item than were independent stores (85 versus 56%, P = 0.0071). Although recall information reaches many stores, faster electronic notifications are not effective at reaching small, independent stores, which may lack computers or fax machines. Alternate means to disseminate recall notifications rapidly are needed for stores without electronic communication capabilities.

Effectiveness of recall notification: community response to a nationwide recall of hot dogs and deli meats

We examined the efficacy of recall notification and advertising in informing the public about a nationwide recall of hot dogs and deli meats. As part of an ongoing random population telephone survey, residents of seven states were interviewed. Data from the survey were weighted to account for the multistage sampling design. Overall, 307 (45%) of 633 knew about the recall. Knowledge was higher among persons older than 40 years (odds ratio = 2.1, 95% confidence interval = 1.4 to 3.3) and persons interviewed after major newspaper notices about the recall. Among those who knew about the recall, 5% believed the products were safe to eat; 23% were not sure. Seventy percent learned about the recall through television. Our findings indicate that routine recall notifications failed to reach a large portion of the population and were not well understood. Messages to the public about recalled products should clearly describe the risks of consuming the recalled product. Supplemental advertising by manufacturers can be beneficial if the risks of consuming the recalled product and recommendations to consumers are clearly described. These policies, coupled with broader distribution through the television and print media, may help increase the proportion of the persons who receive the information they need from future product recalls.

Outbreak of Escherichia coli O157:H7 infections associated with nonintact blade-tenderized frozen steaks sold by door-to-door vendors

Steaks have not been recognized as an important vehicle of Escherichia coli O157:H7 infection. During 11 to 27 June 2003, the Minnesota Department of Health (MDH) identified four O157 infection cases with the same pulsed-field gel electrophoresis (PFGE) subtype. All four case patients consumed brand A vacuum packed frozen steaks sold by door-to-door vendors. The steaks were blade tenderized and injected with marinade (i.e., nonintact). Information from single case patients in Michigan and Kansas identified through PulseNet confirmed the outbreak. The MDH issued a press release on 27 June to warn consumers, prompting a nationwide recall of 739,000 lb (335,506 kg) of frozen beef products. The outbreak resulted in six culture-confirmed cases (including one with hemolytic uremic syndrome) and two probable cases in Minnesota and single confirmed cases in four other states. The outbreak PFGE subtype of O157 was isolated from unopened brand A bacon-wrapped fillets from five affected Minnesota households. A fillet from one affected household was partially cooked in the laboratory, and the same O157 subtype was isolated from the uncooked interior. The tenderizing and injection processes likely transferred O157 from the surface to the interior of the steaks. These processing methods create new challenges for prevention of O157 infection. Food regulatory officials should reevaluate safety issues presented by nonintact steak products, such as microbiologic hazards of processing methods, possible labeling to distinguish intact from nonintact steaks, and education of the public and commercial food establishments on the increased risk associated with undercooked nonintact steaks. Information on single cases of O157 infection in individual states identified through PulseNet can be critical in solving multistate outbreaks in a timely manner.

Characterization of microorganism identification in the United States in 1996

CONTEXT

The National Inventory of Clinical Laboratory Testing Services (NICLTS) was designed to give an unbiased estimate of all patient testing performed by laboratories registered under the Clinical Laboratory Improvement Amendments in 1996.

OBJECTIVE

Survey data were used to develop a profile of laboratory testing primarily intended to identify microorganisms or antibodies to these microorganisms.

DESIGN

Estimates of the extent of microorganism identification were derived from the NICLTS database by identifying associated tests and methods. The volumes for tests performed at locations that primarily prepared blood components for distribution were excluded. Organisms of public health importance were identified from the National Notifiable Disease list maintained by the Centers for Disease Control and Prevention.

PARTICIPANTS

Laboratories that were enrolled in the 1996 Online Certification Survey and Reporting System, maintained by the US Health Care Finance Administration, and that performed laboratory testing in 1996.

OUTCOME MEASURE

Estimated volumes and associated confidence limits by test, method, specimen type, public health importance, and testing location.

RESULTS

Excluding testing of the blood supply, 315 million tests (95% confidence limits, 280-354 million tests) were performed in the United States for microorganism identification. Those tests for which public health consensus requires national reporting represented 38% of this total. Although hospitals performed 46% of all microorganism identification, they only performed 33% of the testing for microorganisms of public health importance. Independent and specialty laboratories performed 38% of all testing but 65% of the testing for microorganisms of public health importance. Direct methods (methods not involving culture) were used in 77% of the tests for microorganisms of public health importance and in 42% of all identification tests.

CONCLUSIONS

The distribution of microorganism identification testing found using NICLTS data is consistent with plans to modernize the public health surveillance system in the United States.

A cross-sectional study on the prevalence of Listeria monocytogenes and Salmonella in New York dairy herds

As part of our long-term objective of assessing risk for Listeria monocytogenes and Salmonella spp. in dairy herds, we carried out a cross-sectional study to determine the prevalence of the two organisms. The study population consisted of a sample of dairy herds enrolled in the Quality Milk Promotion Services at Cornell during the period of April 1998 to March 1999. The sample was stratified by geographical region to assure representation. Four hundred and four dairy farms were enrolled in the study. In-line milk filters were collected from each farm for bacteriological examination of L. monocytogenes and Salmonella spp. Four hypothesized risk factors were evaluated for their association with the likelihood of the presence of each of the two organisms using logistic regression analysis. Listeria monocytogenes was isolated from 51 (12.6%) of the milk filters. We found region-specific differences in the rate of farms with positive milk filters for this pathogen. Salmonella spp. were isolated from 6 (1.5%) milk filters. One isolate was confirmed as Salmonella enterica Serotype Typhimurium DT 104. There was no significant association between any of the hypothetical risk factors and the likelihood of Salmonella spp. isolation. Our study demonstrated that both L. monocytogenes and Salmonella spp. were prevalent in milk filters in New York dairy herds and that Salmonella was isolated at a significantly lower rate then L. monocytogenes.