Diarrhea Digest: May 8, 2009

Diarrhea Digest is an eFoodAlert regular feature that presents a weekly snapshot of foodborne and person-to-person gastroenteritis outbreaks from around the world.

Each week, we'll survey the globe and discover what all of us have in common – a shared susceptibility to the bacteria and viruses that cause gastrointestinal disease.

For the first edition of Diarrhea Digest, we'll play some "catch-up" on news from the past month.

Asia and Africa

• Bangladesh, April 14 – Eighteen workers at a slum development company were taken to hospital with food poisoning after sharing an on-the-job meal. Most of the remaining work crew complained of milder symptoms, including stomach pain and diarrhea. 
  
• China, April 10 – Dozens of students in Heilongjiang Province complained of nausea and vomiting after eating at the university's No. 2 Canteen. Of the 101 ill college students, ten were hospitalized, 76 were given intravenous treatment and released, and 15 required no treatment.
  
• China, April 14 – Thirty film crew members and movie extras became ill with stomach pain and vomiting after eating take-out food from a local diner while filming on location in Shanghai.
  
• China, May 7 – An outbreak of food poisoning that sickened 186 people in Gansu Province has been blamed on Salmonella-contaminated spices that were used in the preparation of snack foods. The outbreak, reported on April 29, affected residents of three neighboring villages. At least 28 of the victims were hospitalized.
  
• Hong Kong, April 21 – Thirteen staff members in a seniors home in Fanling reported suffering mild symptoms of gastroenteritis, including abdominal pain and diarrhea. There were no reports of illness among the elderly residents of the home.
  
• India/Sri Lanka, April 11 – Eight passengers of an Air Lanka flight from India to Colombo were taken ill with symptoms of food poisoning after having been served snacks that had passed their expiry dates.
  
• Jordan, April 14 – Some high school students at Amer Ben Jarrah Secondary School became ill after eating hummus from a restaurant located near the school. Fifteen of the ill students were treated in hospital and then released.
  
• Singapore, April 7 – The Ministry of Health received reports of 137 cases of gastroenteritis in an outbreak that appears to be due to Vibrio parahaemolyticus. The pathogen, which is most often associated with raw seafood, was recovered from two of the outbreak victims. Thirty-seven of the victims were hospitalized, while the remaining 100 received out-patient treatment and were released. Consumers were warned to avoid eating food from the "Rojak Geylang Serai" stall, thought to be the source of the outbreak.
  
• Sri Lanka, April 22 – A group of 30 elementary school children were admitted to hospital with symptoms of food poisoning after consuming string hoppers with dhal curry at breakfast.
  
• Viet Nam, April 27 – More than 500 residents of a district in the southern province of Dong Nai were stricken with gastroenteritis. Authorities are investigating the source of the outbreak, which they suspect is due to contaminated water.
  

Australia, New Zealand and Pacific Islands

• New Zealand, May 5 – The owner/operator of a Gisborne restaurant was told to pay fines, reparations and court costs after he lost his appeal against a conviction under the Food Act. Robin Pierson had been charged with selling contaminated food to restaurant patrons on Christmas Day. Turkey left over from the buffet was found to contain high levels of Clostridium perfringens; the same microbe also was recovered from stool samples submitted by some of the affected patrons.
  

Europe, Including Russia

• Bulgaria, April 13 – Seven school boys were taken to hospital after complaining of dizziness, vomiting  and stomach pains. Preliminary reports suggest that canned fish may have been the source of the food poisoning incident.
• Russia, May 8 – Students from Samara who were visiting St. Petersburg were handed an unwanted souvenir on their trip – food poisoning. The students believe that the source of their illness was a restaurant meal that they shared at the "Waterfall Desires" in St. Petersburg. Seventeen of the students have returned home, but others remain in a St. Petersburg hospital.
  
• Scotland (UK), April 17 – Three cases of scombroid food poisoning have been linked to tuna steaks purchased from a Tesco store in Inverness. Scombrotoxin sometimes is produced when tuna has been stored improperly. 
  

Western Hemisphere

• Chile, May 2009 – Between December 2008 and April 2009, the country registered 104 outbreaks of diarrhea caused by Shigella sonnei. Most of the 739 outbreak victims were no more than 10 years old. Shigellosis, which is transmitted directly from person to person, often is associated with nursery and child care settings.
  
• USA (New Hampshire), April 14 – 75 people who attended a Passover seder in Franconia fell victim to Salmonella food poisoning after sharing dishes prepared and brought to seder by the 150 participants.
  
• USA (New Hampshire), April 29 – An environmental camp that was the venue for a Salmonella outbreak earlier in the month has been given the all-clear to reopen after health officials traced the food poisoning outbreak to pudding prepared by Purity Springs. 
  

Please join us again next week for another edition of Diarrhea Digest.

If you would like to receive automatic email alerts for all new articles posted on eFoodAlert, please submit your request using the link on our sidebar.

School Kids And Salmonella: A Follow-Up

Last December, I mentioned a Salmonella outbreak that hit 14 students attending St. Benedict's School in Whitehaven, Scotland. It now seems that health authorities suspect a pre-Christmas turkey dinner might have been the source of the outbreak.

Nevertheless, according to the article which appeared in The News and Star on February 23rd, the source of the outbreak might never be confirmed. Health inspectors pronounced the school's kitchens to be "clean". The investigation is continuing, but the scent is growing colder by the day.

On reading this news article, I decided to check the UK Food Standards Agency web site for their advice on how to cook turkey safety. To my dismay, I discovered that their directions omit any mention of a meat thermometer. Here is what the Food Standards Agency says:

If you're checking a whole chicken or other bird, pierce the thickest part of the leg (between drumstick and thigh) with a clean knife or skewer until the juices run out. The juices shouldn't have any pink or red in them.

Perhaps the British "stiff upper lip" is a result of eating undercooked meat and poultry?

Dear Martha,

You are recognized everywhere for your many talents - in home decor, landscaping, color sense and cuisine - and for your exquisite taste. Even my husband’s persnickety Westport, CT aunt thinks that you’re wonderful. But after browsing through the Jan/Feb 2008 issue of “Everyday Food” magazine, it’s very obvious to me that a course in safe food preparation is missing from your resume.

First, let’s talk turkey. Unless you have spent the last few decades living in an isolation booth, you must know that by USDA’s own admission, 20-25% of raw ground turkey meat is contaminated with Salmonella. Yet your recipe directions do not provide for a reliable “kill” step. For example, your “Whole-wheat spaghetti and turkey meatballs” recipe directs the reader to prepare the meatballs as follows:

“In a skillet, heat 1 tablespoon olive oil over medium high. Cook 20 frozen Light Turkey Meatballs until browned, 5 to 7 minutes. Add 1 1/2 cups store-bought marinara sauce and 1/2 cup water: Cook until heated through, 5 minutes.”

These instructions leave too much to the reader’s imagination. Browning alone is not enough to cook the meatballs completely, and “heated through” can mean different things to different people. Starting with hard-frozen meatballs increases the risk that the center of the meatballs won’t reach 165ºF, which is the “safe” temperature recommended by USDA.

I also take strong exception to your instructions for cooking chicken in the microwave. Microwave cooking is a notoriously unreliable way to kill bacteria, especially in a solid piece of meat such as a chicken breast. Customers who purchased ConAgra’s Banquet pot pies found that out the hard way. Cooking the chicken breasts until the meat is “...just opaque throughout...” is not a guarantee of microbiological safety.

A few weeks ago, when I was browsing eggnog recipes on-line, I came across yours. It sounded very tasty, but also very risky. It was completely inappropriate for you to publish a recipe that called for raw eggs without adding at least a precautionary statement about the possibility that the eggs might contain Salmonella Enteritidis. You could easily have recommended that pasteurized eggs be used in the recipe.

According to (now 10 year old) data from the US Centers for Disease Control and Prevention, there are approximately 76 million cases of food-borne disease in the US every year. That is more than one case of food-borne illness for every four people in this country every year. It is time that you, and others like you, shouldered some responsibility for teaching the public how to cook meals that are not only tasty and nutritious, but also are microbiologically safe.

Sincerely,

Phyllis Entis, MSc., SM(NRM)

Asia Food News

It's a busy day for food safety reporting in Asia. Here's the latest from that part of the world.

Food Poisoning In Hong Kong: Ten men reported symptoms of food poisoning, including nausea, vomiting, diarrhea and abdominal pain. The symptoms began between 1 and 6 hours after the men had eaten turkey purchased from a restaurant. The turkey was purchased on December 26th, and eaten on December 27th. The report makes no mention of how the 10 men stored the cooked turkey.

Don't Always Blame Bacteria: Kidney beans contain a natural toxin, known as lectin, which is inactivated by cooking - something that 248 students in Yunnan Province of China may have found out the hard way. Their school lunch included kidney beans, which authorities suspect were undercooked. The students, who suffered bouts of nausea and vomiting as a result of the meal, are all expected to recover.

Let Them Eat Cake Again: The Singapore bakery chain, Prima Food, which closed early in December due to an outbreak of Salmonella, has been allowed to conduct a trial production run. The trial run is being closely monitored by the local health authorities, who are taking samples at every step of the process and analyzing the samples in the government labs.

Safe Holiday Eating

Meatingplace.com, an on-line meat industry publication, sponsored a survey on consumer food safety knowledge and practices this fall. They found that food safety information is reaching many consumers, but not everyone puts their knowledge to good use.

The magazine reports that more than 60% of consumers say that they thaw their frozen food in the refrigerator, and the majority of consumers know that poultry should be cooked to an internal temperature of 165ºF. But 63% of those surveyed admitted that they rarely, if ever, used a meat thermometer, and one third claimed to be able to tell that meat was "done" simply by looking at it.

Government agencies and food safety educators spend a great deal of time and effort trying to "get the message out". While they appear to be having some degree of success, the next question is how to get consumers to implement that information.

For starters, here are a few reminders for a food-safe holiday season.

1. Use a meat thermometer when roasting your holiday turkey. You can find details at the USDA web site, and in my blogs of November 23rd and December 12.

2. Use pasteurized eggs to prepare your eggnog, or choose a recipe that includes a cooking step to prevent the possiblity of Salmonella in your eggnog. Remember, there isn't enough alcohol in the eggnog to kill Salmonella.

3. Always clean up very thoroughly after handling or preparing raw meat, eggs or poultry. Remember that Salmonella, Campylobacter and other microbes can be transferred from sponges, dishrags, countertops, sink faucets and the handles of knives and utensils - not just cutting boards.

4. Thaw frozen food in the refrigerator, not at room temperature.

5. Cool cooked food quickly - in the refrigerator, not on the countertop. Your refrigerator can handle the load. Do not try to cool the food in large, deep batches. Spread it out in a shallow layer in several containers, if necessary, to cool it rapidly. Then, once the food has cooled, you can consolidate it into a single container.

If you have any tips of your own to add, or questions about safe handling, please post a comment.

Have a happy and safe holiday!

Stuffing and Nonsense

The Irish Food Safety Promotion Board has just released its recommendations for safely stuffing and cooking a Christmas turkey. Their web site offers time/oven temperature recommendations for gas or electric ovens, with or without convection. They have even provided a recipe for the stuffing. But their suggestions for determining when the turkey has been safely cooked leave something to be desired. Specifically, the Board cautions,

"And remember, always make sure your cooked turkey is piping hot all the way through, with no pink meat, and all the juices run clear."

Has the Irish Food Safety Promotion Board never heard of meat thermometers? In my post-Thanksgiving "Turkey P.S." posting of November 23rd, I reported that the internal temperature of the cavity stuffing was 10ºF lower than the temperature in the thickest part of the breast meat. A fully-cooked turkey is no guarantee of safe stuffing.

Please remember - always use a meat thermometer. Place it in the center of the stuffing and cook that turkey until the temperature of the meat thermometer reaches 165ºF (74ºC). This is the ONLY way to be sure that your Christmas turkey and its stuffing won't come back to haunt you after your Christmas dinner.

A Turkey P.S.

We decided to run a little experiment in our kitchen yesterday. We monitored our turkey's temperature with two probes - one in the thickest part of the breast meat and the other in the center of the stuffing (we stuff our bird with home-made bread stuffing). The temperature of the stuffing lagged the temperature of the meat by 10ºF. When the breast meat reached 160ºF (71ºC), the stuffing was only 150ºF (65ºC). We checked the probes against each other at that point by removing the stuffing probe and transferring the meat probe into the stuffing. They agreed within 1ºF, so we simply continued to monitor the stuffing temperature.

USDA recommends cooking poultry (chicken, turkey or whatever) until all parts of the bird and its stuffing reach 165ºF (74ºC). If you have only one temperature probe and you stuff your birds, the best place to monitor cooking temperature is in the center of the stuffing.

One last reminder. Refrigerate any leftovers promptly - don't wait for them to cool to room temperature first - and, preferably, in shallow containers so that they cool quickly to 40ºF or below.

Microwave Oven Safety

Yesterday, the Food and Drug Administration released a "Consumer Update" about microwave ovens. This update covered a lot of territory - how microwave ovens work, the types of injuries that can result from their use, and how to operate a microwave oven safely. But they forgot to mention one detail. Microwave ovens are a very poor way to cook food safely.

Twenty years of research into cooking poultry in microwave ovens have led to one consistent conclusion. It is neither safe nor reliable. Any of us who have tried to cook a piece of meat or a chicken pot pie knows that food heats very unevenly in a microwave.

As long ago as 1989, researchers compared the performance of conventional ovens, microwave ovens, and convection microwave ovens side-by-side. They found that a whole chicken, when cooked to an internal temperature of 185ºF in a microwave oven, still contained live Salmonella. The chickens cooked to the same temperature (or lower) in conventional or convection-microwave ovens were Salmonella-free. Other researchers in other countries have confirmed this performance both with Salmonella and with other dangerous microbes such as Listeria monocytogenes.

We should be thankful that FDA took the time to remind all of us not to stand too close to the microwave oven while it's running, and to handle hot liquids with care, but it would have been even better had they told us not to use it to prepare our Thanksgiving turkey.