EMBRACING A CHANGING WORLD

1
EMBRACING A CHANGING WORLD
Foodborne Infection The Toll and the Challenges

BCFPA
2
WHY AM I HERE?

• Is it the logo?

3
Is it Desolation Sound?
4
Is it a trip to Richmonduh, the airport?
5
Im Here for Those Who Cannot Be
6
Foodborne Illness Costs Everyone
7
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, 23,344-49,
8
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.

9
Remember the Good Old DaysBefore There was any
Foodborne Illness?
10
Back then, there was only the stomach fluWhat
happened?
11
Those Pesky Environmental Health People Came Along
12
Of Course, There Really is the Stomach Flu Its
Called Norovirus

13
If You Need a Break from Worrying About Food, Try
worrying About Water
14
Crypto and Recreational Water Go Together
15
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 washingnot 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 15199(4)467-76

16
Its Not a Tummy Ache

• Ive 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 1207 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

17
For Bugs, Its Getting Harder to Hide

• Stool, Blood and Food Tests
• Mandatory Reporting
• More cultures for bloody stool
• PFGE/MLVA
• PulseNet
• Titer Tests

18
Fluorescing Bacteria on a Petri DishCommon
ancestor of all E. coli O157 strains existed ca.
40,000 years agoRobert Koch demonstrated that
anthrax, Mycobacterium tuberculosis, and
Vibrio cholera cause human disease in the 1870s
and 80s
19
Epidemiology In Action

• 1923first compilations of milk outbreak in US
• 1938more complete date on food and waterborne
  outbreaks
• 1966CDC starts outbreak summary publication
• 1972CA Foodborne Disease Reporting Center beings
  publishing outbreak information

John Snow, M.D., 1813-1858 A Father of
Epidemiology
20
Eating GreenIncreased 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."

21
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
  O157H7

Source USDA-ERS, Amber Waves, June 2007
22
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

23
This Woman Might Die From Eating Cookie
DoughWashington Post 9.1.09
Nestles 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.
24
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 O157H7 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.

25
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

26
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.

27
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 1108am. Final diagnosis
Salmonella gastroenteritis.
28
Cause of Death Peanut Butter
29
I ask myself every day, Why me? and Why from
a hamburger? Stephanie Smith
October 3, 2009
30
Its Not a Question of Resources

• Cargill, whose 116.6 billion in revenues last
  year made it the countrys 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.

31
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

32
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

33

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,
34
Will Consumers Pay for Safe Food?
Extra Safe Meat
Sort of Safe Meat
1.99lb.
35
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)
36
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.

37
Theres a Lot to Do

• ENGAGE
• EDUCATE
• ENFORCE

38
Educate, Irradiate, and Enforce
39
Our Clients Are Just Like You and Your Friends
Family
40
Food Safety News
Read Contribute News Blogs Opinion Job
Listings Event Listings
41

• 6600 Columbia Center
• 701 Fifth Avenue
• Seattle, WA 98104
• Tel [phone]
• Fax [phone]
• email bclark_at_marlerclark.com
• web www.marlerclark.com