Food safety: Needs speed, technology — and funds

Perhaps you remember the Great Tomato Scare of 2008.

It started in mid-May, when the New Mexico Department of Health told the Centers for Disease Control and Prevention that it had identified a  Salmonella cluster: four people who were infected with an identical, uncommon strain called Salmonella Saintpaul, and another 15 who seemed to be part of the same outbreak but whose infections hadn’t been characterized enough for authorities to be certain. Then there were cases in Texas, and then more cases in the Navaho Nation. By June 9, 2008, there were at least 150 cases nationwide; by July 1, the count was 869. By the time the outbreak ended in late August, there would be 1,499 victims — almost certainly an undercount — in 43 states. Two people died.

The outbreak was chaotic. On June 3, based on some early studies, the Food and Drug Administration warned people in New Mexico and Texas against eating certain types of raw tomatoes; on June 7, the FDA expanded the warning to nationwide. Investigators were puzzled by tomatoes causing an outbreak so early in the season, and hypothesized that they must have been grown in a warm climate area — maybe California, Florida or Mexico. Then they were troubled by how widely the outbreak spread. Because tomatoes can come from so many different places, they wondered whether the source of the contamination wasn’t the growing fields, but rather a packing house or a wholesaler where fruit from many different farms came together.

Consumers were just as confused. The FDA said raw red plum, red Roma and red round tomatoes were no-gos, but cherry tomatoes, grape tomatoes and tomatoes sold on the vine were OK. People were unsure what was safe to eat and from where it was safe to buy. The entire enormous tomato industry — 8 billion pounds per year in the US — ground to a halt.

There was just one problem: The cause of the outbreak wasn’t tomatoes at all.

As recounted last night in the New England Journal of Medicine, the actual culprit was jalapeno and serrano peppers. That possibility began to emerge in late June, when the Texas health department realized that 33 sick people who had all eaten at one Mexican restaurant had eaten a salsa made of canned tomatoes. That was peculiar, because the heat of canning would have killed any Salmonella — until they realized the salsa contained raw jalapenos as well. There were two clusters in the next week, in Minnesota and North Carolina, both associated with Mexican restaurants, and on July 9, the FDA also warned consumers against eating hot peppers, but kept the tomato warning in place too. There seemed to be good reason: After the initial warning against tomatoes, new cases of Salmonella did seem to slow down.

But tomatoes continued to be a frustrating suspect. As the CDC recounted in a post-outbreak summation that August:

The (FDA) traced back the processing and distribution pathway for tomatoes associated with several ill persons. These tracebacks did not converge onto a single packer, distributor, or growing area of tomatoes. Tomatoes linked to ill persons and tomatoes randomly collected from the distribution chain in several states were cultured; none of these cultures yielded Salmonella. (CDC, MMWR)

But in mid-July, FDA investigators zeroed in on a produce distributor in Texas that had received shipments from a packing facility in Mexico, which was accepting peppers from multiple farms and middlemen dealers. Eventually the agency narrowed the search to two farms:

Farm A, which grew Roma tomatoes in addition to jalapeno and serrano peppers, harvested all three crops between late April and late July and was an indirect supplier to the packing facility… Farm B, located approximately 100 miles from farm A, was this packing facility’s main pepper supplier. Agricultural water samples from Farm A yielded salmonella but not the outbreak strain… The outbreak strain was isolated from two environmental samples, agricultural water, and serrano peppers on Farm B, which grew jalapeno peppers and serrano peppers, but not tomatoes. (NEJM Behravesh)

The tomato warning was lifted on July 17, but the damage to the industry was vast. Growers lost more than $100 million, and many tons of tomatoes were discarded or left to rot.

What could have helped? More speed, for one thing — in identifying victims, analyzing outbreaks, and tracing the path of produce through complex, braided, multi-national system by which food is distributed and sold. And better technology, for another. For years before this outbreak, researchers had been agitating for a “FedEx system” for tracking produce; thanks to this outbreak, they got the promise of that in last autumn’s Food Safety Modernization Act, though its traceability requirement will take years to implement.

Improvements in product-tracing systems and the ability of the systems to work together are needed for more rapid tracing of implicated products through the supply chain in order to maximize public health protection and minimize the economic burden to industry. (NEJM Behravesh)

But there’s just one other problem: Faster speed — which means more investigators in the field and more technicians in the lab — demands more money. Better tracking technology requires spending too. The Food Safety Modernization Act did mandate more FDA funding. But a companion editorial in NEJM is skeptical:

The Congressional Budget Office estimated that implementing this legislation would require $1.4 billion between 2011 and 2014… The actual effect of this important law will at best be extremely limited if Congress and the administration don’t appropriate and sign additional legislation providing the necessary funds to carry out its mandates. (NEJM Osterholm)

In fact, that prediction may already be coming true. In early January, Reuters reported key Republicans saying that “the food safety legislation will have to compete for funding with a litany of other priorities.” And on Tuesday, ace food-safety journalist Helena Bottemiller of Food Safety News reported that the House version of the continuing resolution necessary to keep the federal government operating from March to September calls for a minimum $222 million cut to the FDA budget.

Cites: Behravesh CB et al. 2008 Outbreak of Salmonella Saintpaul Infections Associated with Raw Produce. NEJM, Feb. 23 2011. doi: 10.1056/NEJM081005741; Osterholm MT. Foodborne Disease in 2011 — the Rest of the Story. NEJM Feb. 23 2011. doi: 10.1056/NEJMp1010907



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