2. “Turkeys in the news: A talk on food safety and prevention of illness” Marilyn B. Lee School of Occupational and Public Health Ryerson University December 17, 2002

3. Outline of today’s talk 1. Turkeys as a food vehicle 2. Consequences of food-borne illness - sequelae 3. Solutions from the food industry perspective - FSEP in Canada, HACCP in the US - Food irradiation 4. Strategies for prevention

4. Turkeys as food vehicles

5. Minimize the risk of illness from preparing a whole turkey by: Defrosting bird thoroughly such that bird is not partially frozen when it goes into the oven. Defrosting a 11 kg (25 lb) bird can take 3 days or longer in the refrigerator! Ensure that raw turkey juices on countertop are wiped up with a paper towel and thrown out. Then wipe countertop with a paper towel dipped into a solution of diluted chlorine bleach. Utensils should go into the dishwasher or be washed in hot sudsy water, rinsed, and then ideally dipped into a solution of diluted chlorine bleach (1 mL bleach/4 L water is more than enough). Washing hands with warm water and soap.

6. Placing a meat thermometer into bird even if a pop-up timer is used. Placing into stuffing or into breast. Placing bird in oven set no lower than 325°C oven Removing bird when the thermometer reads at least 74°C. (You may want to recommend cooking until 82°C as that affords an additionally safety margin.) Not leaving bird out more than 2 hours. (Before storing in the refrigerator stuffing should be removed and carcass cut into quarters).

7. Multistate Listeria monocytogenes outbreak in 2002 - 46 culture confirmed cases in Northeast U.S. - 7 deaths and 3 stillbirths/miscarriages - linked to sliceable turkey deli meats - poultry processing plant in PA had same strain of LM - recalled 27.4 million pounds of fresh and frozen ready- to-eat turkey and chicken products - LM is usually a post-processing contaminant MMWR 51(42):950-951. (Oct. 25, 2002)

8. Multistate Listeria monocytogenes outbreak in 1998 - 40 cases in 10 states (Ohio, NY, Michigan, Georgia, Oregon, …) - 4 deaths, 3 elderly and 1 fetus - cooked hot dogs eaten in month before illness from Bil Mar (Sara Lee) plant - outbreak strain of organism isolated from opened bag of hot dogs MMWR 47(50): 1085-1086. (Dec. 25 1998)

9. - later newspaper reports said that LM found in 4 unopened packages - 82 illnesses, 15 deaths and 6 miscarriages - 3 year federal investigation - Sara Lee pleaded guilty to adulteration of meat charge, fined $200,000. and agreed to pay $3. million to UMichigan for food safety research - plant tested for psychrotrophic bacteria before outbreak. After some construction counts rose. Stopped testing.

10. Consequences of food-borne illness  acute illness  death  longer term illness arising from acute illness – “sequelae”

11. Sequelae Reactive arthritis following sporadic Salmonella typhimurium infection in British Columbia reactive arthritis is an acute inflammation of the joints following urethritis or dysentery from Salmonella, Shigella, Campylobacter, or Yersinia case-control study in BC during 2000 looked at sequelae within 3 mos following Salmonella typhimurium diarrhea 66 cases, 48 controls

12. 35 (53%) cases reported symptoms outside GI tract cases were more than 4 times likely to report joint symptoms than controls (p=0.02) 4 (6%) cases diagnosed with reactive arthritis Buxton et al. J. Rheumatology 29(10):2154-2158. October 2002.

13. Reactive arthritis and Reiter’s syndrome following a Salmonella enteritidis outbreak Reiter’s syndrome is characterized by arthritis, conjunctivitis, and urethritis RS previously reported following gastroenteritis from Salmonella, Shigella, Yersinia, Campylobacter, and Clostridium difficile outbreak in Washington state in 1994 was actually 6 events, 2,110 persons exposed 423 persons identified with GI symptoms within 4-72 h eating at 1 event

14. food vehicle was likely turkey or raw eggs in the stuffing 29% of cases had symptoms of RA and 3% of cases had symptoms of RS persons with more severe symptoms of Salmonella may be at greater risk of RA treatment of Salmonella infection was associated with a small increased risk for RA (RR=1.6 [CI 1.1-2.5] - needs to be confirmed by other studies Dworkin et al. Clinical Infectious Diseases 33:1010-1013. 2001.

15. POTENTIAL SOLUTIONS Controlling pathogens on hazardous foods (primary producers and food manufacturing industry) FOOD SAFETY ENHANCEMENT PROGRAM (FSEP) prerequisite programs: staff training, sanitation, pest control, recall, transportation and storage, equipment HACCP Can you really eradicate pathogens at the farm or during food manufacturing?

16. FOOD IRRADIATION Three sources of energy for irradiation: accelerated electrons... high energy electron beams …can control with switch, electrons can’t penetrate food well gamma- irradiation with Cobalt 60 or Cesium 130 …radioactive source x-rays. …for irradiation of meats, poultry, fruit and vegetables on pallets

17. Potential number of health problems prevented annually in the U.S. if 50% of meat and poultry are irradiated

18. Effect of decontamination methods on raspberries to remove coccidial parasites

19. Approvals in place for irradiation

20. Strategies to further reduce food-borne illness PHIs will continue to assess and correct risks related to food handling during inspections. PHIs will continue to investigate cases/outbreaks promptly to discover source. When controlled, prevents a secondary wave of transmission. Mandatory food handler education will finally arrive. Biggest reductions in food-borne illness in the next few years will come from irradiation of poultry and hamburger. Would be useful to have a national “hot-line”