Wednesday, July 23, 2008

Health Care and Salmonella

This is the year of the upset stomach and diarrhea. Salmonella has been the buzzword in the food and drug industry over the past few months, and the tomato industry has suffered unspeakable damage due to the FDA warning about this health care issue. Last week, this government agency lifted the warning regarding eating tomatoes that were thought to be responsible for the recent Salmonella outbreak. Attention has now shifted to the jalapeño pepper as the likely culprit. Since concerns remain regarding the risk of becoming ill from food contaminated with Salmonella, it is still relevant to know about Salmonella and diseases that it can cause in humans. And according to eDocAmerica,the FDA is continuing to investigate the current Salmonella outbreak in order to confirm the source of contaminated food. This is an extremely labor intensive process, since fresh produce can become contaminated at any point along the supply chain, from the field or greenhouse where it is grown to distribution points to food preparation in restaurants and homes.

The CDC reports that it is collaborating with public health officials in many states, the Indian Health Service, and the U.S. Food and Drug Administration (FDA) to investigate an ongoing multi-state outbreak of human Salmonella serotype Saintpaul infections. An initial epidemiologic investigation in New Mexico and Texas comparing foods eaten by persons who were ill in May to foods eaten by well persons identified consumption of raw tomatoes as strongly linked to illness. A similar but much larger, nationwide study comparing persons who were ill in June to well persons found that ill persons were more likely to have recently consumed raw tomatoes, fresh jalapeño peppers, and fresh cilantro. These items were commonly, though not always, consumed together, so that study could not determine which item(s) caused the illnesses. Recently, many clusters of illnesses have been identified in several states among persons who ate at restaurants. Most clusters involve fewer than 5 ill persons. Three larger clusters have been intensively investigated. In one, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeño peppers. In the other two, illnesses were linked to an item containing fresh jalapeño peppers and no other of the suspect items. Other clusters are under active investigation. The accumulated data from all investigations indicate that jalapeño peppers are likely to be a major cause of this outbreak. Fresh serrano peppers and fresh tomatoes remain under investigation. Investigators from many agencies are collaborating to track the source of the implicated peppers and other produce items. Since April, 1256 persons have been infected with Salmonella Saintpaul.

As reported by eDocAmerica, Salmonella is a type of bacteria that can live in the intestines of animals and humans. There are a number of strains of Salmonella bacteria and one is even responsible for causing Typhoid Fever. The particular strain of Salmonella that is responsible for the current epidemic is known as Salmonella Saintpaul. An infection with Salmonella bacteria is called salmonellosis. Symptoms include diarrhea, fever, and abdominal cramps. The illness usually lasts 4 to 7 days and most people recover without treatment. In some instances, the diarrhea becomes very severe, resulting in dehydration. The infection can also spread from the intestine into the blood stream to other parts of the body. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.

The folks at eDocAmerica go on to say that Salmonella live in the intestinal tracts of humans and other animals, including birds, pet reptiles, dogs and cats, pigs and cattle. Infected humans, contaminated water, raw dairy products and chicken eggs can also serve as reservoirs for spread of the illness. The illness can develop when the Salmonella bacteria is ingested. This could occur in a variety of ways. Eating contaminated food, particularly poultry, meat and eggs is one of the most common ways. Food may also become contaminated by the hands of an infected food handler who did not wash their hands with soap after using the bathroom. With the current epidemic, contaminated tomatoes and peppers have both been suspected although recently, tomatoes were cleared. Infection can also occur after handling pet reptiles that harbor the bacteria or even after cleaning up after your dog. In those with a normal immune system, Salmonella infections usually resolve after 4 to 7 days and no treatment other than oral hydration is necessary. When severe diarrhea and dehydration complicates the illness, hospitalization and administration of intravenous fluids may be required. There are antibiotics that are effective against Salmonella however; indiscriminate use can result in the development of antibiotic resistance. Use of antibiotics is typically reserved for when the infection travels outside of the intestines to other parts of the body.

Be sure that high risk foods such as poultry, ground beef and eggs are cooked thoroughly as warned by eDocAmerica. Don't eat or drink foods containing raw eggs (Caesar salad dressing, homemade ice cream, etc.) or raw (unpasteurized) milk. Kitchen work surfaces and utensils should be washed with soap and water if they came in contact with potentially contaminated food. Since infants, the elderly, and those with immune compromise are particularly at risk from salmonellosis, be especially careful with their food preparation. Hands should be washed with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces. At this time, the FDA is advising people in high risk populations such as elderly persons, infants and people with impaired immune systems to avoid eating raw jalapeño and raw serrano peppers. And, consumers may continue to eat canned jalapeños and serranos processed in a commercial food-processing facility, or foods that contain them; for example, the canned processed jalapeños and processed salsas sold in grocery stores.

The CDC recommends that consumers everywhere are advised to follow the general food safety guidelines below:
--Refrigerate within 2 hours or discard cut, peeled, or cooked produce items
--Avoid purchasing bruised or damaged produce items, and discard any that appear spoiled.
--Thoroughly wash all produce items under running water.
--Keep produce items that will be consumed raw separate from raw meats, raw seafood, and raw produce items.
--Wash cutting boards, dishes, utensils, and counter tops with hot water and soap when switching between types of food products.
--Cooking vegetables kills bacteria, including Salmonella.

Advice from the CDC also concludes that the contaminated peppers may still be in grocery stores, homes, and restaurants. Until more is known about the likely location of contamination, the FDA is advising all persons to avoid consuming raw jalapeño peppers and dishes containing those raw peppers. Consumers should be aware that raw jalapeño peppers are often used in the preparation of fresh salsa, pico de gallo, guacamole, and other dishes. Cooked or pickled peppers from jars and cans are not part of this warning.

The FDA recommends the following safe-handling practices for fresh produce for food-service providers, retailers, and restaurateurs:
--Wash hands thoroughly with soap and warm running water before and after handling fresh produce.
--Make sure that food employees are reporting illness and are not working while sick.
--Purchase food from known safe sources and maintain its safety from time of receiving through service.
--When fresh produce is received, follow supplier recommendations, if provided, regarding handling, storage temperatures, "use by" dates, and other recommendations for the produce.
--Avoid receiving or using damaged and partially decayed produce.
--Store raw produce such that it does not contaminate other foods with soil, etc. Store any fresh produce, whole or cut, where other products – especially raw meat and poultry – cannot cross-contaminate it.
--Segregate fresh produce from other refrigerated foods in refrigeration units by using a separate set of storage racks or separate cooler, if possible. Cover and store washed cut produce above unwashed, uncut fresh produce. Store all produce off the floor.
--Wash, rinse, and sanitize all sinks, utensils, cutting boards, slicers, and food preparation surfaces before use with fresh produce.
--Always wash fresh produce under running, potable water before use. Soaking produce or storing it in standing water is not recommended for most types of fresh produce. Commercial, “fresh-cut” tomatoes and other produce have already been washed before processing and should be considered ready-to-eat with no further need for washing unless the label says otherwise.
--Refrigerate foods prepared with fresh-produce ingredients.
--Do not re-serve freshly prepared dishes containing raw produce, including dishes made with raw tomatoes, cilantro, and hot peppers, such as salsa and guacamole.

Mexican food restaurants and other eateries have been taking a hit this summer as a result of the Salmonella outbreak. The tomato industry will survive, but it has been a rough patch for growers and food distributors. The FDA continues to search for the basis of the contamination, but it has been a long slow tortuous path, and the end is not in sight yet. However, the current culprit appears to be fresh jalapeno peppers as advised by the various government agencies and private health care groups. So, be careful what and where you eat. Pay attention to how your food is prepared. Make sure that you consume food that has been properly cooked.

Until next time. Let me know what you think.

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