1. FOOD SAFETY – A COMMUNITY PERSPECTIVE FOODBORNE ILLNESS OUTBREAKS AND THEIR EFFECTS ON PEOPLE AND INDUSTRY Lisa Hainstock, R.S. Michigan Department of Agriculture and Rural Development 2012 Genesee County Health Department Public Health Week Conference April 3, 2012

2. 2 FOODBORNE ILLNESS IN THE US (CDC, 2010) Estimated 48 million cases of foodborne diseases annually in the US 1 out of every 6 people 128,000 hospitalizations 3,000 related deaths annually Most never able to identify pathogens

3. HEALTHCARE COST OF FOODBORNE ILLNESS Foodborne disease still costs the US up to $77.7 billion a year The most expensive foodborne diseases are associated with: Salmonella, $11.39 billion per year Campylobcter, $6.88 billion Norovirus, $3.68 billion Toxoplasma gondii, $3.46 billion Listeria monocytogenes, $2.04 billion Escherichia coli O157:H7, $635 million Non-O157 strains of Shiga toxin–producing E coli, $154 million Scharff RL. Economic burden from health losses due to foodborne illness in the United States. J Food Protect 2012;75(1):123-31

4. www.stopfoodborneillness.org/content/stop-honor-wall

5. Multistate Outbreak of Listeriosis Linked to Whole Cantaloupes, 2011

6. LISTERIA INFECTIONS The disease primarily affects older adults, persons with weakened immune systems, and pregnant women and their newborns. Symptoms :N, D, muscle aches, fever Incubation from a few days to 2+ months Stillbirths, abortions, neonatal deaths (25-50%) Meningitis Septicemia Endocarditis pneumonia

7. September 2: The Colorado Department of Public Health and Environment (CDPHE) notifies the Centers for Disease Control and Prevention (CDC) of seven ill persons with listeriosis (Listeria infection) reported since 8/29/11. September 5: Cantaloupes are collected by CDPHE for Listeria testing from the home of an ill person. September 6: PulseNet defines outbreak strains in CO patients and identifies ill person in NE, another in TX, infected with an outbreak strain of Listeria. Initial interviews of 7 ill persons in CO with standard CDC questionnaire find all ate cantaloupe. Three ill persons report eating cantaloupe from one region in Southeastern CO ("Rocky Ford").PulseNet September 7: CDC begins coordinating the multistate investigation. September 8: CDC asks states to use the supplemental questionnaire created by CDPHE to learn more about cantaloupe eaten by ill persons. FDA begins investigation with initial information collected by CDPHE to identify sources of cantaloupe eaten by ill persons. Cantaloupes are collected by CDPHE for Listeria testing from retail locations where ill persons reported buying cantaloupes.

8. September 9: CDPHE announces that cantaloupes are the likely cause of illness and warns high-risk CO residents not to eat them. Cantaloupes are collected by FDA for Listeria testing from retail locations where ill persons reported buying cantaloupes. September 10: FDA and CDPHE visit Jensen Farms for an inspection and to collect environmental and product samples. The broker for Jensen Farms stops distribution of cantaloupes and tells grocery stores to remove Jensen Farms cantaloupes from shelves. September 11: Preliminary traceback investigation suggests that cantaloupe produced at Jensen Farms was sold at several retail locations where ill persons reported buying cantaloupe marketed as coming from one region in Southeastern CO. September 12: CDC posts initial web announcement about the investigation, saying that the multistate outbreak of listeriosis is linked to cantaloupes marketed as coming from one region in Southeastern CO, and warning persons at high risk nationwide not to eat them.

11. SUMMARY DATA Onsets July 31, 2011 through October 27, 2011. A total of 146 persons infected with any of the four outbreak- associated strains of Listeria monocytogenes were reported to CDC from 28 states. Thirty deaths were reported (probably closer to 34 deaths) Ages ranged <1 to 96 years, median age of 77 years. Most ill persons were over 60 years old. Fifty-eight percent of ill persons were female. Among the 144 ill persons with available information on whether they were hospitalized, 142 (99%) were hospitalized. Seven illnesses related to a pregnancy; three were diagnosed in newborns and four were diagnosed in pregnant women. One miscarriage was reported.

12. October 19 th - FDA released report detailing unsanitary conditions and widespread contamination throughout the Jensen Farms packing facility Jensen Farms has just scored a 96 on a scale of 100 during a food safety audit conducted by a third-party private company days before the outbreak was announced.

13. BENEFITS OF BEING FAST AND BEING RIGHT The number of deaths would have been higher had it not been for an effective, coordinated response by: CDC state and local health departments & regulatory agencies, FDA Lives were saved because the outbreak was detected, its source was identified, and a national warning was issued – all in just a matter of days. (CDC) Its the fastest listeria investigation Ive ever seen, (Dr. Robert Tauxe, CDC)

14. ECONOMIC COSTS TO INDUSTRY

15. FOODBORNE OUTBREAKS…HOW MUCH DO THEY AFFECT US PERSONALLY? May have to throw out a recalled product May not be able to get product on demand May become angry at food industry or government because they are not doing their job. After a while, its common for people may not remember many details

16. THE ONE THING WE TYPICALLY REMEMBER Public will continue to feel fearful or uneasy about eating food implicated in outbreaks, even if its not the same brand or type

17. ROCKY FORD MELONS SOURCE OF OUTBREAK (WWW.KASA.COM, SEPT 13, 2011)WWW.KASA.COM The victims of a foodborne outbreak are more than just ill people and their families Listeria leaves Colorado town stunned and scared (P. SOLOMON BANDA - Associated Press | AP – Fri, Sep 30, 2011)

18. ROCKY FORD MELONS $8 million industry Most commercial cantaloupe ~10% sugar Rocky Ford Melons ~ average 12% often reaching the Extra Fancy status >70% CO acreage planted in cantaloupes in RF region Known as Melon capital of the world RF high school team is the Meloneers A melon worth the drive!

19. COMMUNITY AND INDUSTRY EFFECTS Initially, associated with Rocky Ford melons, not Jensen Farms cantaloupes Jensen Farms 85 miles from Rocky Ford Acres of melon at other farms not responsible for the outbreak went un-harvested People put out of work At least seven lawsuits have already been filed, totaling in the millions

20. www.marlerclark.com

21. Listeria outbreak in cantaloupes is deadliest in a decade: (MARY CLARE JALONICK Associated Press September 28, 2011 6:12AM ) PUBLIC PERCEPTION "For the public, it's important to know that if you know the cantaloupe you have is not Jensen Farms, then it's OK to eat. But if you're in doubt, throw it out." (Dr. Thomas Frieden, CDC, ABC News, Sept. 28, 2011).

22. INDUSTRY STATISTICS

23. OUTBREAK DINGS ALL MELON SALES (TOM KARST, THE PACKER, 12/2/2011) Appeared that people were not only avoiding cantaloupe but ALL melons

24. Listeria outbreak devastates Calif. Cantaloupes (USA Today, 10/14/2011) "We can't sell the fruit," said Rodney Van Bebber, sales manager for Mendota-based Pappas Produce Company. "Retail stores are taking cantaloupes off the shelves, and growers are disking in their fruit because people are afraid to eat them."

25. IMPORTANCE OF DOING IT RIGHT THE FIRST TIME Rapid epidemiologic and regulatory investigation and sharing of information Not making statements based on incomplete or faulty information that might implicate the wrong food and place people at further risk Not making statements based on public pressure

26. 2011 – E. COLI O104 – EUROPE 5/25 - German authorities issue warning on consumption of lettuce, tomatoes or cucumbers 5/26 - Germany links OB cucumbers imported from Spain, even though testing was not complete. 5/30 - Russia bans import of all vegetables from Germany and Spain 5/31 - Germany says its not Spanish cucumbers -Spain and the Netherlands demand EU compensation after their vegetable sales collapse. -Cost to Spanish exporters 200M US$ per week 6/2 - Russia bans imports of fresh vegetables from the 27 EU member states. 6/8 - EU Commission raises its offer of compensation to 210 million euros for vegetable farmers, from an earlier 150 million euros. 6/10 - Germany identifies contaminated sprouts as the source of the bacteria, lifts its warning on eating raw lettuce, tomatoes and cucumbers.

27. WHO IS AFFECTED BY FOODBORNE ILLNESS AND HOW? Who gets hurt? Sick people and their families Employers Food industry Communities supporting those industries Trade – Interstate & International Health care/Insurance Taxpayers/consumers Who benefits? Food safety consultants and auditors Attorneys

28. WHAT INVESTIGATORS SHOULD REMEMBER There is always a human cost There is always collateral damage What is said or implied can have far-reaching positive or negative effects By prematurely jumping to conclusions on the certain foods, officials may unwittingly allowed the outbreak to continue. We have to be fast and we have to be right

29. If we ever lose sight of why we do what we do, we just have to remember who we do it for.