outcomes


Nov 8, 2011 - powder and added to animal feed as a filler to keep costs low. Melamine is a chemical made from coal - workers in this heavily polluted ...

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A historical perspective on BC outbreaks, illnesses and incidents Promoting a Culture of Food Safety in BC November 8, 2011 Lorraine McIntyre Food Safety Specialist, Environmental Health Services BC Centre for Disease Control

"Those who cannot remember the past are condemned to repeat it." • Describe the event • Focus on the outcome • Explore how these events became a driver for change

Where to start? Decade

No. of outbreaks, illnesses and incidents

1970’s and earlier 1980’s

13

1990’s

11

2000’s

23

2010 forward

3..

ILLNESSES 2003 • 2 children, both hospitalized • Std lab method – Non-H2S producer

• OUTCOMES • Media & scientific attention • Coincided with meat regulation amendments

J Food Prot. 2004 Jun;67(6):1111-5. and Epidemiol Infect. 2005;133(5):809-16. http://www.gazette.gc.ca/archives/p2/2004/2004-12-15/html/sor-dors280-eng.html

2003 Box of Chicken Strips from Food Poisoning Investigation

2005 Box of Chicken Nuggets from the same company

1980’s – the decade of botulism • Commercial product: single case (outbreak) Alaskan canned salmon recalls (1982) – 1 death (Belgium)

• Home canned products: 5 outbreaks (1982 to 1984) – 9 ill, 1 death (smoked salmon, canned corn, gink) • BC Medical Journal. 1986;28(7):504-7.

• Restaurant outbreaks: garlic-in-oil (1985) and bottled Chanterelle mushrooms (1987)

Chopped garlic in soybean oil at a family restaurant (1985) OUTBREAK • 2nd largest outbreak of botulism in North America • 37 ill, no deaths (7 required ventilation) cases in Canada, US, NL – atypical presentation, onset 7 days to 2 weeks

• Vehicles included beef dip, steak sandwich garlic buttered bread. • Chopped dessicated garlic from CA; rehydrated in NJ in soybean oil; shipped refrigerated to Canada – labelled as “keep refrigerated”. • Type B botulism detected. • Issues at restaurant: – Not refrigerated, left on shelf 8 months – pH >4.6 (range 4.6 to 5.7)

1. Ann Intern Med. 1988 Mar;108(3):363-8.

2. Canada Diseases Weekly Report. 1985;12(13):53. 3. MMWR Morb Mortal Wkly Rep. 1985 Oct 18;34(41):643.

Bottled mushrooms at a fine-dining restaurant (1987) OUTBREAK • 6 ill (31 exposed), no deaths (5 hospitalized, 3 ventilated) • Type A botulism detected. • Vehicle was Chanterelle mushrooms in 2 dishes • Mushrooms from Van. Isl. • Issues at restaurant: – Canning procedure – pH 5.2, room temperature storage 1. MMWR Morb Mortal Wkly Rep. 1987 Feb 27;36(7):103.

2. Canada Diseases Weekly Report. 1988;14(10):41-2. 3. Canada Diseases Weekly Report. 1987;13(8):35-6.

Multiple hurdle concept US OUTBREAK 1989 NY dinner party outbreak – also garlic in oil. 3 ill OUTCOMES • Multiple barriers: pH, refrigeration • No non-commercial canned foods in restaurants • Laboratory service in BC • HLBC file on how to avoid botulism in home canning Food Control. 1990:139-41. Am J Public Health. 1990 Nov;80(11):1372-3.

ALASKAN CANNED SALMON OUTBREAK • Can defects (7 ¾ oz). 22 of 300,000 cans • All production from 1980-81 recalled • Marketed in UK as John West Pink Columbian river salmon • 10 class I recalls • 131 cans with a defect (at 9 canneries)US • Approx. 60 million cans of salmon recalled • Canada: no can defects reported? • Slow market recovery OUTCOMES 1. Canned defect manual (CFIA)

http://www.inspection.gc.ca/english/fssa/fispoi/man/canboi/canboie.shtm l

2. 3.

Manufacturing technology improvements “John West”

Public Health Rep. 1983 Sep-Oct;98(5):412-5.

OUTBREAK • 1st time this serotype (Nima) ever found in Canada • 29 illnesses in Canada 4 in US 3 in UK • Christmas, 1985 • Cheese? • Case interview Sep 1986 • Targeted questionnaire about colored bags of chocolate coins and medallions – “Chocolaterie Albert 1er” • 17 samples + counts: 101 - 102 CFU per g (medallion coins, bagged coins) • H&W Canada recalled coins on October 3, 1986 J Food Prot. 1989;52(1):51-4. Canada Diseases Weekly Report. 1986;12(41):183-4.

OUTCOMES • Chocolate as a vehicle for Salmonella in BC and Canada

E.coli O157:H7 in ground beef

1992 and 1993

OUTCOMES: HC Guideline No. 10, issued March 1999 Recommended action when ground beef is tested for E.coli O157:H7 Product

E.coli O157:H7

Level of Generic E.coli in Ground Beef

Recommended Product Action

Follow-up

Ground Beef

Detected

Not done

Recall to consumer level

GMP/HACCP review

Detected

>100cfu/g in any of five sample units per lot

Recall to consumer level

GMP/HACCP review

Detected

≤ 100cfu/g in five sample units per lot

Recall to retail level

GMP/HACCP review

Not detected

>100cfu/g in any of five sample units per lot

No action

GMP/HACCP review

Not detected

≤ 100cfu/g in five sample units per lot

No action

Not required

Recommended action for ground beef derived from trimmings, beef carcasses or an equipment surface in direct contact with ground beef which has been found positive for E.coli O157:H7 Product

Level of Generic E.coli in Derived Ground Beef

Recommended Product Action

Follow-up

Ground Beef derived from trimmings, carcasses or an equipment surface that tested positive for E.coli O157:H7

>100cfu/g in one or more of five random samples of ground beef derived from positive product

Recall to consumer level

GMP/HACCP review

≤ 100cfu/g in five random samples Recall to retail level of ground beef derived from positive product

GMP/HACCP review

http://www.hc-sc.gc.ca/fn-an/legislation/guide-ld/guidelines_raw_ground_beefdirectives_boeuf_hache_cru-eng.php

OUTCOMES: Labelling • 1995 1st consultation in Canada • 1998 US FSIS Industry regulation www.fsis.usda.gov/pdf/labeling_requi rements_guide.pdf • 2011 active file  voluntary industry labelling?

Pg. 51-52 “Under the heading “Safe Handling Instructions,” the safe handling information must appear on the label as follows. This product was prepared from inspected and passed meat and or poultry. Some food products may contain bacteria that could cause illness if the product is mishandled or cooked improperly. For your protection, follow these safe handling instructions. This statement is in turn accompanied by the following additional required statements. • Keep refrigerated or frozen. Thaw in refrigerator or microwave. (This statement must appear next to a graphic illustration of a refrigerator.) • Keep raw meat and poultry separate from other foods. Wash working surfaces (including cutting boards), utensils, and hands after touching raw meat or poultry. (This statement must appear next to a graphic illustration of soapy hands under a faucet.) • Cook thoroughly. (This statement must appear next to a graphic illustration of a skillet.) • Keep hot foods hot. Refrigerate leftovers immediately or discard. (This statement must appear next to a graphic illustration of a thermometer.) “

OUTBREAK • 143 ill – 30% hospitalized – 4% HUS • Hungarian and cervalet salami • PFGE match, case-control study • Company followed the HACCP plan • Product Recalls

OUTCOMES • HC Guideline no. 12 – Heat – 5D reduction – End-product testing – HACCP, raw product testing and 2D reduction – Alternative evaluation • PFGE, Pulsenet Canada OTHER OUTBREAK ILLNESSES • 47 cases of Yersinia enterocolitica • Linked by case-control • Not detected in salami’s

OUTBREAK • International • 45 ill (5 HUS) • Median age, 5 yrs

OUTCOMES • HC and CFIA Guidelines – Managing Health Risk Associated with the Consumption of Unpasteurized Fruit Juice/Cider Products (July 21, 2000) – Code of practice for industry.

• Health Link BC file • Annual fall BCCDC/PHO advisory Oct 19, 2011 • USFDA Code of Guidance

MMWR Morb Mortal Wkly Rep. 1996 Nov 8;45(44):975. http://www.hc-sc.gc.ca/fn-an/legislation/pol/rev_unpast_juice_policy-rev_politique_jus_non_past_14-09-2000-eng.php http://www.inspection.gc.ca/english/fssa/protra/codee.shtml http://www.healthlinkbc.ca/healthfiles/hfile72.stm http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/Juice/ucm072557.htm

OUTBREAK 1995 / 1996 • 133 ill • BC, western Oregon • Single seed lot • Netherlands wholesaler • 9100 kg unsprouted seeds recalled • 9 months • 65% illnesses in women JAMA. 1999 Jan 13;281(2):158-62.

OUTCOMES • New lab method sprout seeds before testing HPB-20A

OUTBREAK • 51 ill • Multiple serotypes • 66% female, <30 yrs old • Kentucky seed-cleaner • AB distributor • Class II Recall

OUTCOMES ??? • HC Health Risk Assessment draft 2001

Can Commun Dis Rep. 2001 Aug 15;27(16):133-7

More Canadian Outbreaks DATE TYPE Apr-Jun 00 Mung Feb 01 Mung Jun 04 Alfalfa Oct-Dec 05Mung

PATHOGEN S. Enteritidis PT11 S. Enteritidis PT913 S. Bovismorbificans S. Enteritidis PT13

CASES 10 46 12+ ~646

AREA AB/SK AB BC/WA ON

OUTCOMES Health Canada • Health Risk Assessment (2006) • Guideline (2006) • Policy (2006) CFIA • Code of Practice • Educational video and brochures http://www.sproutnet.com/sprout_research.htm

May 29, 1985 OUTBREAK • >300 reports of illness & 500 calls to poison centre • Source: fresh greenhouse grown long English cucumbers • Symptom profile: • Onset: 2 – 8 hrs • Vomiting, diarrhea, cramps • Muscle spasms • Dizziness • Blurred vision

RESULT: • Total market recall of all cucumbers (no code marks) • 28 growers • Product removed in BC and parts of NW US

Illegal use of pesticide - aldicarb • Aldicarb residue – 0 to 26ppm 0.01 – 0.02 mg/kg BW • NOEL 0.1 – 0.25 mg/kg BW

OUTCOMES • Industry and buyers • NOAEL 0.01 mg/kg BW ADI 0.001 mg/kg BW per day (Health Canada RA) • Pesticide poisoning in fruits/vegetables RARE, result of misuse

July 4, 1985

OUTBREAK • 692 probable cases in Calif 483 in other US states & Canada (206 in BC) • Found at 2.7 ppm • Melons destroyed OUTCOME • Melons stickered for compliance after July 10th

Melamine

2007 – Pet Food 2008 – Baby Milk

Pieces of melamine displayed by a worker. The melamine is ground into a powder and added to animal feed as a filler to keep costs low. Melamine is a chemical made from coal - workers in this heavily polluted northern city openly admit that the substance is routinely added to animal feed as a fake protein. Source: aftermathnews.wordpress.com May 1, 2007

OUTCOMES • CFIA lab time • New methods • renewed interest in ingredient sourcing and traceability

2011 – Taiwan scandal DEHP, plasticizer for PVC

BC Milk Outbreaks, Incidents and Issues Year

Agent / Issue

# Ill

Vehicle

1998

Yersinia pseudotuberculosis

74

Homogenized pasteurized milk

2001

E. coli O157:H7

5 children (2 HUS)

Raw goat’s milk from a cooperative

2001

Bacillus cereus

1

Milk sold one month past expiry date

2007

Dioxins

0 (Monitoring)

BC milk via dairy cattle grain silos

2008

Raw milk sales

0

Chilliwack cooperative

Irrigation Water Implicated

2001 – Shigella 2004 - Cyclospora

• Both leafy greens (spinach, cilantro) – Agents never found on produce – traced back to same farm – washing and irrigating of produce OUTCOMES • Upgrades at farm • Committees • Upgrades in catchment area • Reports

http://www.env.gov.bc.ca/epd/regions/lower_mainland/water _quality/reports/ready-to-eat/ready_to_eat.pdf http://www.for.gov.bc.ca/hfd/library/documents/bib97170.pdf

Other outcomes • Outlining of jurisdictional responsibilities Water Test Result (per 100 mL) <77 generic E. coli <200 fecal coliforms <1000 total coliforms

• Establishment of irrigation water guidelines • Recognition of need for GAP’s • Projects with UBC MFS

Other Outbreaks, Illnesses, Incidents • • • •

Bacillus cereus (40 FBI outbreaks from 1991 to 2005) Scombroid poisonings (histamine) Ricin in castor bean (1990) Staphylococcus aureus toxin in – canned mushrooms (1985) – Smoked oysters (2001)

• • • •

Yersinia in tofu (1993) Bacillus cereus in crumpets (1990) SE in baked goods from Chinese bakery (2000) Copper poisoning – From coffee, when machine cleaned with vinegar (1988) – From chicken soup served to school kids (2005)

• Botulism in Watermelon Jelly (2011) • Fukoshima (2010) and Chernobyl (1986)– water, and food affects (fish, dairy from grazing)… • Maggots in mushrooms and Glass in baby food and Chilean grapes tampering and Salmonella in frog’s legs from China and Sulphites in canned crab…..

"Those who cannot remember the past are condemned to repeat it."

• If you see something, say something • Share your stories

Acknowledgements Federal services • • • • • • • • • • • •

Terry Peters Carol Crawford Karen Catherwood Barry Morgan Jerry Hirsch Jennifer Liu Deirdre Kelly Dave Graham Lance Hill Pascal Delaquis Rick Szabo Kevin Carlisle

Provincial and Regional services • Laura Macdougall • Lynn Wilcott • Sion Shyng • Elsie Friesen • Shendra Brisdon • Joe Fung • Julie Wong • Ana Paccagnella Industry • Marty Wilder (FPAC)