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)