“Turkeys in the news: A talk on food safety and prevention of illness”

1. “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

2. 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

3. Turkeys as food vehicles

4. 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.

5. 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).

6. 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)

7. 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)

8. 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.

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

10. 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

11. 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.

12. 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

13. 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.

14. 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?

15. 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

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

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

18. Approvals in place for irradiation

19. 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”