With a trial run in Armenia completed, Penn State wants to take its Extension Service’s food safety program international to combat conditions that lead to nearly one in 10 people worldwide getting sick each year from eating contaminated food.

That’s 600 million people.

Food safety best practices are common in the United States, but that’s not the case in many countries around the world, where restaurant patrons risk being subjected to foodborne illnesses. It’s also a big factor in food production, and the Penn State group is working to educate food processors and producers as well as those who prepare and serve food.

“The food-safety practices that Americans take for granted — such as washing hands with soap, refrigerating perishables, and not cutting raw meat and vegetables on the same surface without disinfection — may not be practiced widely in other places around the world,” said Catherine Cutter, professor of food science and Penn State Extension assistant director for food safety and quality programs.

In fact, 420,000 die annually from foodborne illness, 125,000 of them younger than 5, according to World Health Organization.

Cutter and her colleagues in the College of Agricultural Sciences want to change that.

They are working to internationalize Penn State Extension, which has been vital to establishing food safety in the United States. She says doing so would help protect people in the U.S., as well, because some of the food Americans eat is imported from other countries.

“We work on food safety on a number of different fronts,” Cutter said by phone on Thursday. “Our educators are nationally recognized in a number of areas.”

Penn State works in Pennsylvania with, for example, Amish growers and other local processors, and it does training in other states in the U.S.

Some of Cutter’s colleagues are doing work in Honduras and Costa Rica. She’s heading for both the Ukraine and Africa this summer. They find they’re welcome wherever they go, she said.

“They’re happy to have us,” Cutter said. “If they can’t export their strawberries to the U.S., that’s business for them. And from the import standpoint, you want those suppliers to have good training.”

People who complete the course with a Tech Food-Safety System Management certificate.

First, Armenia

“From the international standpoint we kick-started it off with the Armenia project,” Cutter said. “Then we jumped to the Ukraine … and then to Africa with food safety laboratories focused on getting them up to speed with information on trouble shooting, data recording, how process procedures are being done.”

In Africa, Penn State will work in Mozambique, Uganda and Ethiopia, funded by the the U.S. Agency for International Development (USAID).

Cutter and her colleagues believe the program will not only improve food safety, it will draw more people to Penn State’s programming and help create healthier communities and economies.

Last year, Cutter’s research group offered the Food-Safety System Management curriculum to 30 students and two instructors in the Agribusiness Teaching Center at the National Agrarian University in Yerevan, Armenia, as part of a joint venture between Penn State, Virginia Tech and the International Center for Agribusiness and Education. The project was funded by the USAID.

A couple of years ago, Armenia experienced a number of  outbreaks and deaths from botulism poisoning, listeriosis and pathogenic E. coli. Penn State responded to the resulting call for food safety training there.

Cutter and her team collected demographic data and administered a test to gauge food-safety knowledge, behaviors and attitudes of participants before training. After the students completed the curriculum, the research team did a post-test and found that students’ food-safety attitudes, skills, knowledge and behaviors had improved significantly, according to lead researcher Siroj Pokharel, a postdoctoral scholar in Cutter’s research group. He noted that a follow-up survey of food-safety attitudes and behaviors performed three months later suggested the training had made a lasting difference, according to a story on the project in Penn State News.

Zaruhi Danielyan, an Armenian student who completed the curriculum this year, said in the January 2018 issue of International Center for Agribusiness and Education News that she and her classmates gained understanding about the biology of dangerous food-related microbes; the types of sanitation measures needed to ensure surfaces and equipment that come into contact with food are properly cleaned, sanitized and maintained and how to detect allergens, among other things.

“We live in a society where food safety is still a serious challenge, and there is no all-encompassing national food-safety system covering the entire food chain, from soil to fork,” she wrote. “Armed with the Penn State and Virginia Tech Food-Safety System Management certificate, the proper knowledge, and the will to change the country, my friends and I will join the army of professionals in their combat against illiteracy in food safety.”

Starting this fall, local instructors will teach the program, Cutter said.

On to Ukraine and beyond
Cutter plans to replicate the program in Ukraine beginning in June this year with financial assistance from the Woskob New Century Fund, an endowment within the College of Agricultural Sciences created by the Woskob family to promote partnerships among Penn State and institutions in the Ukraine.

She said the Woskob family is from the Ukraine and is interested in helping improve the economy and food safety there.

While training the next generation of food-industry professionals in food safety best practices is important, Cutter also sees a need to help those already working in the industry. In Latin America, for example, she is developing fact sheets and videos in Spanish to help prepare countries for the Food and Drug Administration’s new Food Safety Modernization Act regulations.

“Any country that wants to export to the United States has to meet the FDA’s Food Safety Modernization Act requirements for shipping produce,” said Cutter.

In addition, she is developing a comprehensive food safety training program for laboratory personnel working in food-testing in East and South Africa.

The WHO estimates Africa has the highest burden in foodborne diseases. The international organization has most recently been working in South Africa to help with the world’s largest ever outbreak from Listeria monocytogenes bacteria.

“To combat foodborne illness, it is important to revamp the proven scientific methods in Africa to handle, prepare and store food,” Cutter told Penn State News. “Training of laboratory personnel to detect biological and chemical hazards, to assess data, and to make recommendations based on the laboratory findings is crucial.”

Cutter said she is in communication with representatives of several other nations about the possibility of implementing Extension’s food safety programs in their countries.

“The bottom line is that food safety is a global issue,” she said, “and Penn State can make a big difference in the world.”

And yes, the challenge can be overwhelming. Cutter said Thursday.

“I feel like we’ve got a  lot of work to do. But (this) is natural progression. Instead of food industry professionals coming here for a week we bundled it into four weeks and then we get on the ground and teach it.

“My thinking is that this is going to help the next generation not only with employment opportunities, but they’ll talk about what Penn State did for them and that will help drive people to our online programs. The costs are not exorbitant and if it means difference between your company being able to export and get in the market, a lot of companies are willing to pay that.”

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Food-related outbreaks of Hepatitis A are often associated with contamination of food during preparation. That can happen when a foodservice worker is infected by the highly contagious liver disease.

Person-to-person transmission of Hepatitis A occurs via the “fecal-oral route,” meaning infected food handlers who don’t practice good enough hand-washing techniques can contaminate the foods and beverages they prepare or serve. And, because the peak time of infectivity usually occurs a couple of weeks before symptoms appear, food handlers often don’t even know they are infected and therefore continue to work.

Food handlers include people who stock produce aisles in grocery stores and those who maintain self-serve snack and beverage machines in convenience stores and gas stations.

Hepatitis A symptoms may not occur until several weeks after exposure and may include abdominal discomfort, fever, malaise, muscle aches and a yellowing of the skin called jaundice. In severe cases, Hepatitis A causes liver failure and death.

While the Centers for Disease Control and Prevention recommended in 2006 that all children 1 to 2 years old be vaccinated, the CDC has not recommended Hepatitis A vaccinations for food service workers.

Some local public health officials have hosted vaccination clinics for restaurant workers in recent months as reports of infected foodservice workers, but the vaccination is not required by federal or state laws..

One Hepatitis A-positive foodservice worker can infect large numbers of customers and cause thousands of others to seek preventive vaccines. Illnesses and vaccines can cost thousands if not millions of dollars, and can cost restaurants its viability either by a downturn in customers or civil lawsuits.

All of this is preventable by a vaccine.

Food Safety News contacted health officials in each of the 50 states asking about the incidence of Hepatitis A cases. Not all states provided all of the information requested. Most gave only “preliminary” counts for 2017 and 2018.

Alabama: 23 cases in 2017; three so far this year. The numbers are consistent with previous years. No probable source has been determined and no link found to state with Hep A outbreaks.

Alaska: Zero cases in 2017. That’s normal.

Arizona: 59 cases in 2017; eight so far this year; not unusual. In 2017, the CDC confirmed a 12-person outbreak associated with an Arizona homeless shelter was the same from the strain responsible for the outbreak in San Diego.

Arkansas: 8 cases in 2017; 13 so far this year (*new data 4/30); numbers are a little higher than usual, mostly due to person-to-person spread. The state is investigating but officials say they haven’t found links between Arkansas cases and other outbreaks.

California: 919 for 2017; numbers are dropping in 2018, but public health officials did not give a number. The number of cases reported in 2017 was substantially higher than in previous years due to widespread infections among homeless and/or substance abusers. The original source for the outbreak has not been identified. However, once introduced, Hepatitis A virus spread very fast in people with limited access to restrooms and hand-washing facilities.

San Diego, Santa Cruz, Monterey and Los Angeles counties have declared local outbreak status, and outbreak-associated cases have been confirmed in other California jurisdictions.

Here’s a county-by-county breakdown for 2017: San Diego 586 cases, with 401 people hospitalized and 20 dead; Santa Cruz 76 cases, 33 hospitalized, 1 dead; Los Angeles 12 cases, 8 hospitalized, none dead; Monterey, 12 cases, 10 hospitalized, none dead; other counties, 17 cases, 8 hospitalized; none dead. Total: 703 cases, 460 hospitalized, 21 dead.

Colorado: 63 cases in 2017; five so far this year; higher than usual, and officials say about a third of the cases were from transmission between men who have sex with men. Twenty cases were identified in this population, which is an increase compared to previous years.

Two cases occurred in persons who were homeless; other cases likely were due to international travel and exposure to household members who were infected. Two cases in 2017 and one in 2018 are linked to outbreaks in homeless populations in other parts of the country.

Several 2017 Colorado cases that occurred in men who reported having sex with men had the same molecular sequence seen in several New York City male cases who reported having sex with men.

Connecticut: 17 cases in 2017; four so far this year; not unusual. Risk factors were normal, and no link was established to outbreaks elsewhere.

Delaware: Six cases in 2017, two so far in 2018; not unusual. Probable source has not been determined. Delaware has one case that was linked to an outbreak in the Baltimore area involving men who have sex with men.

Florida: 275 cases in 2017; 42 so far in 2018. The numbers represent an increase over previous years, but seem to be dropping in 2018. Most cases are defined as sporadic and not linked to other known cases.

Georgia: 24 cases in 2017; seven so far this year; not unusual. Patient interviews are attempted for all cases, but are not always successful in determining source or risk factors. One case involved a Michigan resident who got sick and was diagnosed while visiting Georgia and one case was in a South Carolina resident; neither of those cases is included in Georgia’s count. In previous several years, 25 to 30 percent of patients who were interviewed traveled internationally and were not vaccinated.

Hawaii: Eight cases for 2017, none so far this year. Two were matched to California outbreak. Others were unrelated to outbreak or to each other.

Idaho: Five cases in 2017; three so far this year; lower than usual. One 2017 case and one 2018 case were associated with international travel. It is suspected that one case in 2017 and in 2018 are linked to the multi-state outbreak, which includes Utah.

Indiana: 20 cases in 2017; 71 so far this (*New data May 4); higher than normal. Person-to-person transmission is the likely source for most of these cases, and risk factors include the usual ones. Many of the 2018 cases have been tied to the multi-state outbreak, which includes Kentucky.

Iowa: nine in 2017; one so far this year. No other information was available.

Kansas: Six in 2017; two so far this year. No other information was available.

Kentucky: 341 in 2017 with 238 hospitalizations and four deaths. Statewide outbreak was declared November 2017. Viral sequencing has linked several cases in Kentucky with the multi-state outbreak. The 10-year average in Kentucky has been about 20 cases per year. In April, public health officials urged people to get vaccinated. The state is requiring that all public school students who are not already vaccinated get the vaccine before the beginning of the 2018-19 school year.

Louisiana: eight cases in 2017. Other information not available.

Maine: Seven cases in 2017, two so far in 2018; not abnormal. No single common point of origin and no link to outbreaks in other states.

Maryland: 29 confirmed cases in 2017; 10 so far this year. In 2017, more than 50 percent of the confirmed cases had no specific source identified; 25 percent reported international travel as a source of infection; some cases were genetically matched to strains circulating in New York and parts of Europe; and other confirmed cases matched to a strain circulating in Colorado; one of those Maryland patients had traveled to—and was potentially infected in one of the outbreak states.

Michigan: 632 in 2017; 112 so far this year. The state had 802 cases from Aug. 1, 2016, to April 4, 2018, with 25 deaths. Between 2011 and 2015, 327 Hepatitis A cases were reported. This is the largest outbreak in the state’s history. Transmission appears to be through direct person-to-person spread.

Minnesota: For 2017, 30 cases; four so far this year; higher than past three years, but within typical range over past 10. Minnesota has determined a source for some but not all of its cases. The most common risk factor is travel outside of the U.S., and public health officials say the cases are not linked to recent outbreaks.

Missouri: 27 in 2017; 73 so far in 2018; higher than normal. Public health officials say the cases are due to an outbreak in Missouri and don’t believe they are associated with outbreak cases elsewhere.

Mississippi: Did not respond.

Montana: three cases in 2017; none so far this year; normal. Foreign travel is most common risk factor. No connection to outbreaks in other states.

Nebraska: Seven cases in 2017, three so far this year; not abnormal. No known connection to outbreak states.

Nevada: Twenty cases in 2017; five so far this year. This represents a slight uptick. None has been linked to outbreaks elsewhere.

New Mexico: zero cases in 2017 and so far this year.

New York: 82 cases in 2017. Numbers for this year were not provided. Numbers exclude New York City. Sequencing analysis available for some cases demonstrated that some are linked to outbreaks in other states.

North Dakota: zero in 2017; two in 2008, 13 in 2009; two in 2016. No other information available.

Ohio: 46 cases in 2017, 31 so far this year; higher than normal. Some cases linked to those in Michigan and Kentucky

Rhode Island: Six cases in 2017; one so far this year; normal. One case was associated with incarceration in San Diego County, as well as food service employment in LA County, and could possibly be linked to the California outbreak.

South Carolina: 21 cases in 2017; one so far this year; not abnormal. Exact source generally not known.

Tennessee: seven cases in 2017; six so far this year; not unusual. One case got the infection in Michigan.

Texas: Information not available.

Utah: 149 cases in 2017; 68 so far this year; state typically sees fewer than 10 each year, and those are usually associated with travel or other risk factors. Several cases have been linked by investigation and/or viral sequencing to national outbreak of Hepatitis A.

Washington: 27 cases in 2017; 10 so far this year; not abnormal; no clusters. A few cases had exposure while visiting outbreak areas. None of the cases were homeless and no evidence of ongoing person-to-person transmission.

Washington D.C.: one in 2017; none this year. Not abnormal. No link to other outbreaks.

West Virginia: Six cases in 2017 and 17 so far this year; slightly higher than normal. Source yet to be determined, but is likely caused by person-to-person spread. Some cases reported visiting a restaurant that employed a reported Hepatitis A-positive food service worker. One case has been confirmed to be genetically linked to the multi-state outbreak occurring in other states.

Wisconsin: 16 cases in 2017; lower than normal. In six of the 2017 cases, the infection was acquired via travel outside the USA; three cases were likely from visits to states where known large outbreaks were. Numbers likely reflect known outbreaks in California, Michigan, Kentucky and Utah, combined with the mobility of the population.

Wyoming: 18 cases in 2017; four so far this year, sigjnificant increase because of an outbreak in Natrona County. Usual occurrence is two cases each year.

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In recent months, these headlines popped up in a Google search for “Hepatitis A Outbreak” — “KY hepatitis A outbreak kills 3 people, hospitalizes hundreds” “20th death reported in San Diego’s hepatitis A outbreak” “Michigan posts 25th hepatitis A death.”

And on May 4, the Indiana State Department of Health posted an outbreak update reporting 91 confirmed cases, with a 48 percent hospitalization rate. States with outbreak cases are using different starting dates for their outbreaks. Indiana started counting outbreak cases in November 2017. The state usually averages 20 cases per year.

Hepatitis A is most commonly spread when a person eats or drinks something contaminated with microscopic traces of fecal matter from an infected person, according to the Mayo Clinic. It does not spread through sneezing or coughing.

The genotype of some cases in Indiana matches that responsible for the ongoing outbreaks in Arizona, Kentucky, California, Michigan and Utah, the Indiana health department reported.

The Centers for Disease Control and Prevention declared the multi-state outbreak in March 2017. Since then, at least 1,200 cases have been reported, and more than 40 people have died of the highly contagious liver infection. The federal agency is no longer posting information on a regular basis, instead leaving outbreak updates to individual states.

Food Safety News surveyed all 50 states in recent weeks about their Hepatitis A cases. At least 14 reported increases in their number of Hepatitis A cases during the outbreak period, when compared to their usual average annual case counts.

While officials are pointing primarily to cases among people who are homeless and/or substance abusers and their close direct contacts. However, there are increasing reports of infected people who are neither homeless nor substance abusers.

More cases of the highly contagious virus are also being confirmed in foodservice employees in the outbreak states. Public health officials warn that large numbers of people can be exposed to the virus by foodservice workers. People are usually contagious before their symptoms, further increasing the danger of spreading the virus to others.

What is it and what are the consequences

“Hepatitis A, if it doesn’t kill you initially, you will recover,” said Seattle food safety attorney Bill Marler. “But it does have a pretty significant morbidity rate and it does have a pretty significant rate of people whose livers fail and who need a transplant.”

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the Hepatitis A virus, according to the Centers for Disease Control and Prevention. It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Hepatitis A is a self-limited disease that does not result in chronic infection.

Most adults with Hepatitis A have symptoms including fatigue, low appetite, stomach pain, nausea and jaundice. For otherwise healthy adults, most symptoms usually resolve within a couple of months. Most children younger than 6 do not have symptoms or have an unrecognized infection. The best way to prevent Hepatitis A infection is to get vaccinated.

The vaccination is a two-injection treatment with the shots given six months apart.  Getting a vaccine or an injection of the antibody immunoglobulin within two weeks of exposure to Hepatitis A can protect against the infection.

For elderly people, pregnant women and people with suppressed immune systems, Hepatitis A can be life-changing.

“Even people who are modestly sick will feel like they have the worst case of the flu for about a month — that’s kind of a minimum,” Marler said. “The liver is a hugely important part of your body, and when your liver’s off you feel horrible.”

The virus is endemic in many parts of the world, often infecting people through the water. Antibodies produced in response to the infection last for life and protect against reinfection, so the people who live in places where it is common often have that lifetime protection and don’t need to be vaccinated.

But in the United States, most people are not immune — hence the outbreak sweeping the nation.

The states named by the CDC in the outbreak, with case counts tabulated by the states’ public health officials are:

• California, which had 919 cases in 2017.
• Indiana, which had 20 cases in 2017 and 71 so far this year.
• Kentucky, with 448 cases since August 2017, including 315 hospitalizations and four deaths. The most recent death was reported this past week.
• Michigan, with 828 cases, 665 hospitalizations and 26 deaths since the outbreak was declared there in August 2016.
• Utah, 149 cases in 2017 and 82 so far this year, with two deaths.

In addition, public health officials in Hawaii, Idaho, New York, Rhode Island, Washington, West Virginia, Wisconsin and Maryland say cases in those states are or could be linked to outbreaks elsewhere, according to a survey responses provided to Food Safety News.

Missouri reported 27 cases in 2017 and 73 so far this year. Officials there say the cases are the result of an outbreak there and said none of the people affected reported traveling to states with ongoing outbreaks during their likely period of exposure.

Officials don’t know where or exactly when the outbreak started. They haven’t found what Marler calls an index case, or the first illness. They know many cases in different states are part of one outbreak because samples from infected people have undergone whole genome sequencing and they have the same genetic fingerprint.

The start could have come from an unvaccinated person who traveled to a country or area where the virus is endemic, or someone who ate, say, imported frozen sushi or strawberries that carried the virus.

In recent days, Indiana public health officials warned that people going to Kentucky should be vaccinated. Kentucky health officials, meanwhile, insist it’s safe to come to their state.

“I don’t remember any other time where people were warned about going to another state,” Marler said. “A lot of states and cities – Detroit, San Diego, Salt Lake City, Louisville – are (encouraging) foodservice workers to get vaccinated. … That just makes sense.”

While the CDC in 2006 urged that all 1- to 2-year-old children should be vaccinated, it has not taken the step of requiring foodservice workers to get the vaccine.

In response to the ongoing outbreak, Kentucky has enacted a requirement that all children, regardless of age, who attend public school must be vaccinated before the 2018-19 school year begins.

The current outbreak has been spreading quickly through the homeless population, in part because people who are homeless often don’t have access to restrooms and hand-washing facilities. It’s also prevalent among people who share needles when using illegal drugs. Other groups at risk are men who have sex with men and people who travel to places where the virus is endemic.

The Mayo Clinic offers these suggestions to people traveling to such places:

• Wash and peel all fresh fruits and vegetables yourself.
• Don’t eat raw or undercooked meat and fish.
• Drink bottled water and use it when brushing your teeth.
• Avoid all beverages of unknown purity, with or without ice.
• If bottled water isn’t available, boil tap water before drinking it.

Hepatitis A signs and symptoms typically don’t appear until a person has had the virus for a few weeks. They include fatigue, sudden nausea and vomiting, abdominal pain or discomfort, especially on the upper right side between the lower ribs near the liver, clay-colored bowel movements, loss of appetite, low-grade fever, dark urine, joint pain, yellowing of the skin and whites of the eyes and intense itching.

People who have such signs or symptoms should see a doctor.

In rare cases, hepatitis A can cause a sudden loss of liver function, especially in older adults or people with chronic liver diseases. Acute liver failure requires a stay in the hospital for monitoring and treatment. Some people with acute liver failure may need a liver transplant.

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Note: Seattle attorney Bill Marler is publisher of Food Safety News.

Howard mentioned the May 5 Kentucky Derby and urged people to come on down to Churchill Downs.

“As you probably know, a small number of counties in our state are dealing with a Hepatitis A outbreak,” Howard said.

“At the Department for Public Health we are aggressively responding to the situation. In fact, while working with the Centers for Disease Control, or CDC, on this issue, they’ve called our response the ‘gold standard.’ ”

The CDC, he noted, has not recommended that people planning to travel to Kentucky get vaccinated first.

“Still, some misleading information has raised concerns about travel to Kentucky and even the Derby,” Howard said. “Let me say that it is safe to travel to Kentucky and it is safe to attend the Kentucky Derby.”

 The highly contagious virus can easily contaminate foods, beverages, kitchen surfaces, and food preparation and serving utensils when an infected person touches them. A number of restaurant and foodservice employees in Kentucky and other states have tested positive, which potentially exposed everyone who ate or drank anything from those establishments. Hepatitis A vaccinations are not mandatory for foodservice workers. Infected people are usually contagious before the Hepatitis A virus symptoms develop.

Kentucky has had 352 cases associated with the break, including 246 people who required hospitalization and three who died since the outbreak was declared in November. The risk of contracting Hepatitis A is greatest in those in high-risk groups, which include homeless people and substance abusers.

Signs and symptoms of Hepatitis A include yellowing of the skin or eyes, dark-colored urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea and fever. Microscopic amounts of the virus are found in the stool of people infected with hepatitis A and is typically foodborne or spread through person-to-person contact.

While there are no travel restrictions, the CDC does recommend vaccination for children, people with risk factors, and those living in an outbreak area who wish to be protected. Kentucky’s vaccine recommendations are in compliance with these CDC recommendations, Howard said.

The Kentucky Health Department is recommending vaccination for children older than 1 and for and adult residents of Jefferson, Bullitt, Hardin, Greenup, Carter and Boyd counties.

Although the majority of the outbreak cases in Kentucky, as well as several other states involved in the outbreak, are among homeless people or substance abusers, the Kentucky health alert reported at least 30 percent of the victims in the state are nor in any of the high-risk groups.

The Hepatitis A virus is primarily spread through fecal-oral transmission. The virus can also be spread by close personal contact or sexual contact with someone who has Hepatitis A. As long as people who have not been vaccinated continue to come in contact with contaminated environments or have at-risk activities, the virus will continue to spread, Howard said in the statement.

“We have to increase vaccination rates and adherence to good hand hygiene practices to reduce the spread,” according to his statement.

Howard said the CDC has advised that similar outbreaks usually peak after six to eight  months.

Nationwide, the outbreak has sickened 1,200 people, killing more than 40.

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Brexit means the UK will need a stronger Food Safety Agency, they say, because the country will no longer be able to rely upon on the European Food Safety Authority, according to a report in The Conversation. The UK is scheduled to depart the European Union on March 29, 2019.

The UK’s food safety regime is not working properly and is failing to ensure an acceptably safe food supply, The Conversation says. Confirmed cases of Campylobacter bacteria infections, for example, increased by about 46 percent from 2008 to 2012, according to a government report.

Campylobacter infection, or campylobacteriosis, is an infectious disease caused by Campylobacter bacteria and a common cause of diarrheal illness, sometimes leading to hospitalization. Many cases go undiagnosed and unreported, according to the U.S. Centers for Disease Control and Prevention.

People with Campylobacter infection usually have diarrhea (often bloody), fever and abdominal cramps. The diarrhea may be accompanied by nausea and vomiting. These symptoms usually start within two to five days after exposure and last about a week. Some infected people do not have any symptoms. In people with weakened immune systems Campylobacter infection can spread to the bloodstream and cause a life-threatening infection.

Since 2014, the UK’s Food Standards Agency (FSA) has said poultry reachers retailers with high levels of the pathogen. That means consumers have a much higher risk of spreading the bacteria to household appliances, hard surfaces such as countertops and cooking utensils. Meanwhile, consumer trust is understandably low, and the food industry is focused on the uncertainties arising from Brexit.

According to Mintel.com, the level of trust consumers have in the food and drink industry is low, with few believing either retailers or manufacturers have complete information on their supply chains. Consumer faith in the role of the state, or official bodies, in guaranteeing the safety of food and drink in the UK is also low. In addition, “best-before” and “use-by” dates are misunderstood and ignored.

The FSA says it wants to improve the way it delivers regulatory controls for food and create a modern, risk-based, proportionate, robust and resilient system.

The current system of regulation has been in place for more than 30 years and has not kept pace with technological change in the food industry, the FSA said in a report this past summer. Further, it said, the FSA is not flexible enough to adapt to the changing environment.

For the UK to continue to be a strong, credible player in the global food economy, the regulatory regime needs to keep pace with rapid changes in that economy. Leaving the EU will change patterns of food production, trade and consumption, emphasizing the need for a flexible and responsive regulatory system, FSA officials have said.

The agency has developed a blueprint and is testing it, involving everyone working in food – from consumer groups to private assurance scheme owners, local authorities to food businesses of all sizes, food regulators in other countries to non-food regulators in the UK. Further, it said, it has done feasibility studies to test ideas and approaches, and learned from them.

FSA promised to recognize businesses doing the right thing for consumers and take action against those that do not.

The Conversation report said the FSA plans to change who conducts food safety inspections in the UK and transfer responsibility for many food safety inspections and audits from the public sector to private commercial assurance providers, which, it says, will not primarily serve the public interest but rather will focus on their food industry clients’ interests, creating conflicts of interests between commercial inspectors and the consuming public.

Just when the public needs a stronger body to ensure that standards are not weakened in future trade deals, the FSA and local authorities’ enforcement services are being undermined, it says.

And, it says there are no plans to increase the FSA budget to meet its new responsibilities.

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The food handlers could have exposed the public to the highly contagious virus. There is a narrow window of opportunity for exposed customers and fellow employees to receive post-exposure treatment. If it is not administered within two weeks of exposure it is not effective.

In Louisville, two Kroger grocery stores are involved, one at 520 N. 35th St. and one at Sarino at 1030 Goss Ave. Customers and employees who were in the 35th Street Kroger store between March 2 and 19 may have been exposed to the virus. People people who ate at the Sarino Avenue between Feb. 24 and March 15 could have been exposed.

On Thursday, Floyd County, IN, officials said an employee at the Bob Evans in New Albany had been diagnosed with hepatitis A and that people who ate there between Feb. 20 and March 9 could have been exposed.

People who do not have the opportunity to receive the post-exposure treatment should monitor themselves in the coming for symptoms to develop, which can take 50 days in some cases.

Symptoms of Hepatitis A can include fatigue, loss of appetite, stomach pain, nausea and the yellowing of the eyes or skin. Some people who are infected do not develop symptoms.

The outbreak strain in Indiana and Kentucky is the same one that has infected more than 1,200 people in several states, killing more than 40.

The outbreak in Kentucky started in 2017. In November 2017, public health officials there reported 19 cases in Louisville. They said then that some common risk factors included homelessness or substance abuse, according to the Louisville Courier Journal.

However, the virus can easily spread via foods and beverages. Of the states involved in the ongoing outbreak, between one-fourth and one-third of the victims are neither homeless nor substance abusers. Infected people, including foodservice workers and other food handlers, can spread the virus before they develop symptoms.

The virus can also spread through close personal contact and contaminated surfaces. It can survive freezing temperatures for years.

Kentucky
Earlier this month, officials learned that a Kroger employee who worked in the produce aisle of a Kentucky grocery store in February exposed an unknown number of people to the hepatitis A virus.

Consumers were told to throw away produce purchased at the Kroger store at 4915 Dixie Highway Store officials said the employee did not continue working after the hepatitis A diagnosis.

Kentucky’s outbreak of hepatitis A is centered in Jefferson County, which has more than 150 cases, a significant increase in a state that typically sees about 20 cases per year. A health department spokesman said Friday that the city has confirmed 159 cases.

Since November, at least four Louisville foodservice employees have beed identified as having been infected while they were working.

Indiana
Last week, hepatitis A cases prompted the temporary closure of one Indiana school district campus, which includes three Henryville schools. Staff and students returned to school Monday, the Courier Journal reported Friday.

A health officer said Friday there were 29 cases in Clark County, up from 25 last week.

“It’s almost like one big general outbreak in Kentuckiana,” Dr. Eric Yazel told the Louisville paper, adding that the county was treating the cases with the highest level of precaution.

Utah
The hepatitis A outbreak is spreading in Salt Lake County, UT, where it has affected mainly people who are homeless.

County health department officials there are giving the vaccine on the street to reach people who are homeless and substance abusers. The Salt Lake County Health Department has confirmed 144 cases, compared to five in a typical year, according to KUER radio, the local NPR station.

One of the risks for people who are homeless is lack of access to good hygiene, and officials in Utah are working to set up hand-washing stations.

Health department data in Utah shows the outbreak hasn’t peaked.

Michigan
In Michigan, as of March 14, public health officials had confirmed 783 cases, resulting in 25 deaths and 632 hospitalizations.

Health officials from the state and hardest hit municipalities are working to vaccinate people who are at highest risk, including people who are homeless or incarcerated, drug users and men who have sex with other men.

A number of food handlers in Michigan have been confirmed as infected with the virus, spurring post-exposure vaccination recommendations from health officials.

Canada
In Edmonton, Alberta,  health officials are warning people about a case of hepatitis A in a cafeteria worker at an Edmonton hospital.

Alberta Health Services says patients, visitors and staff who consumed food or drink prepared in the cafeteria at the Grey Nuns Community Hospital on certain days between Feb. 26 and March 18 may have been exposed.

It was not immediately clear whether the hepatitis A strain is the outbreak strain that is behind the outbreak in the United States.

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The plant was owned by CRF Frozen Foods and is set to reopen as a new joint venture between J.R. Simplot and CRF’s parent company, R.D. Offutt, according to the Tri-City Herald newspaper. The company’s new name will be Simplot RDO.

The company has said it’s shooting for a spring reopening, but details aren’t available as to when that might happen. A Simplot official didn’t respond to a call seeking comment. Local government officials are similarly vague. Colin Hastings of the Pasco Chamber of Commerce said he hasn’t heard when the plant might reopen.

In 2016, CRF Frozen Foods was linked to nine Listeria infections in four states. All nine people required hospitalization and three died, according to the Centers for Disease Control and Prevention.

The plant closed in April 2016 after CRF recalled hundreds of products under dozens of brands, spurring a series of secondary recalls of products made with the recalled frozen vegetables. Lab analysis of samples of the company’s frozen corn and peas showed they were contaminated with the same strain of Listeria monocytogenes that had infected people in at least three states.

The CDC’s investigation into the listeriosis outbreak traced to frozen vegetables from CRF Frozen Foods Inc. ended this past summer, but the federal agency expressed continuing concern that consumers may have foods in their freezers that were processed by CRF Frozen Foods. The latest “sell by” date for the recalled frozen vegetables is April this year.

The products recalled included more than 350 frozen products packaged by CRF Frozen Foods Inc. under 42 brands, according to the Food and Drug Administration (FDA).  Recalled products were sold across the U.S. and Canada. A list of recalled products for CRF Frozen Foods may be found on foodsafety.gov.

The FDA facilitated the recall of at least 456 products related to the outbreak. CRF Frozen Foods recalled 358 products and at least 98 other products were recalled by other firms that received CRF-recalled products, according to FDA.

“We’re doing a significant remodel and rebuild that includes refitting the factory to include the latest in sanitary methods and processes ensuring the highest levels of food safety,” J.R. Simplot spokesman Josh Jordan told the Tri-City Herald. “We’re also having ongoing consultation with the (Food and Drug Administration) to ensure the facility meets or exceeds the highest levels of their food safety requirements,”

The former home of CRF just west of the Pasco-Kahlotus Highway is being remodeled, rehabbed and expanded to more than 100,000 square feet to provide day-to-day processing and distribution of local crops like corn and peas.

The 25,000-square-foot expansion is valued at $2.48 million, the Tri-City Herald reported.

Jordan said the new facility will include state-of-the-art updates to process an increased demand for raw product. The company chose the location because of the import and export possibilities in the area, as well as the growing population and trained work force in Franklin County, he said.

Hastings, of the Pasco Chamber of Commerce, said the city has grown quickly and has a robust work force.

An initial recall on items made by CRF Frozen Foods affected frozen vegetables processed and distributed in fall 2015. The recall was eventually expanded to include all organic and traditional frozen fruits and vegetable products processed at the Pasco facility from spring 2014. This included products sold under more than 40 brand names, including Columbia River Organics, Northwest Growers Select and Organic by Nature.

Listeriosis is a serious infection caused by the germ Listeria monocytogenes. People usually become ill with listeriosis after eating contaminated food. The disease affects pregnant women, newborns, older adults and people with weakened immune systems most seriously, according to the CDC.

The J.R. Simplot Co., based out of Boise, calls itself one of the largest privately held food and agribusiness companies in the nation. In addition to food processing, it has farming and ranching operations in the Northwest and Nevada. This includes the management of about 40 farms, including Grand View Farms-Pasco, as well as feedlot operations, also in Pasco.

Simplot’s partner in the project, R.D. Offutt Company, is based out of Fargo, NDR.D. Offutt Company, and its farming operations focus mainly on potatoes. It had been the parent company of CRF Frozen Foods before its shutdown in 2016.

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“We have seen a number of recent recalls of raw milk and it’s important that consumers remember and understand that there are risks with drinking raw milk,” MPI Animal and Animal Products Director Paul Dansted said in a the notice.

Raw milk has not been treated with heat, or pasteurized, to kill harmful bacteria, parasites and viruses. In 2014, New Zealand put in place rules that require farmers selling raw milk to meet safety guidelines, but consumers still need to take care when drinking raw milk, Dansted said.

The concern is Campylobacter, E. coli, tuberculosis, Listeria, Salmonella or other pathogens that can cause infections and other diseases. Many such cases go undiagnosed or unreported, according to the U.S. Centers for Disease Control and Prevention.

People with foodborne illnesses usually have diarrhea — often bloody — fever and abdominal cramps. The diarrhea may be accompanied by nausea and vomiting. These symptoms usually start within two to five days after exposure and last about a week. However, with hepatitis A and Listeria, it can take 50 or 70 days, respectively, for symptoms to develop. Some people with foodborne illnesses do not have any symptoms.

High-risk groups include people with weakened or undeveloped immune systems, such as those with the blood disorders thalassemia and hypogammaglobulinemia, HIV patients or people receiving certain kinds of chemotherapy. In these groups, infections can more easily spread to the bloodstream, causing life-long complications and sometimes death.

“Some people who drink raw milk may not always fully understand the risks and don’t realize that there is the possibility of getting sick from the harmful bacteria in the milk,” said New Zealand’s Dansted.

Pregnant women, babies and young children, elderly people and people with weakened immune systems are at the greatest risk of getting sick and the consequences for them can be more severe, and in some cases can lead to death, he said.

“No matter how carefully the animals are milked, there is always a risk that harmful bacteria can get into the milk,” Dansted said.

“There is no way of telling by taste, sight or smell if the milk you are drinking contains harmful bacteria, so we recommend that people heat their raw milk until just boiling — or to 70°C for one minute — before drinking it.”

Data shows numerous outbreaks
Between 2009 and 2016, there were 46 outbreaks of illness in which consuming raw milk was a risk factor in New Zealand. Of these, at least 70 percent involved children from 1 to 6 years old. Campylobacter was responsible for 28 outbreak and E. coli caused four.

In 2015, there were four outbreaks:

• All involved children younger than 16.
• Three outbreaks were caused by Campylobacter and one by Cryptosporidium.
• Five children and one elderly patient were hospitalized.
• One child and one elderly patient developed serious life-threatening complications.

In 2016 there were five outbreaks:

• All involved children younger than 16.
• Four outbreaks were caused by Campylobacter and one by STEC.
• Four children and one elderly patient were hospitalized.
• One child developed serious life-threatening complications.

Recommendations from New Zealand public health officials for people who drink raw, unpasteurized milk include:

• Keep it chilled while transporting it home from the farm.
• Keep raw milk in the coldest part of your fridge; (usually the lower levels are 4 degrees Celsius or less.
• Throw it out if it’s been unrefrigerated for two or more hours.
• When you want to drink your raw milk, heat it first until just boiling (or to 70 degrees Celsius for one minute).
• Drink or toss it by its use-by date.
• If you’re serving raw milk to other people’s children, friends or visitors, make sure you let them know what the risks are.
• Buy it only from a registered supplier.

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Some professional cooks say they can squeeze a piece of chicken or poke a steak with their finger and determine if it’s done.

Some people go by cooking time, and some by appearance.

But the U.S. Department of Agriculture and the Centers for Disease Control and Prevention strongly urge cooks to take the temperature of the turkey, beef or pork they’ve got in the oven or on the grill or stovetop.

So, if you want to follow the rules, you’re going to need a kitchen thermometer, and the choices vary from what appears to be the Cadillac of food thermometers that goes for $99 to a $60 digital thermometer to an $11 analog instant-read device.

Of the $99 ThermoWorks Thermapen Mk4, New York Magazine writer Maxine Builder said this: “The Thermapen is shockingly versatile, and over the last year, it’s become one of the most-used tools in my own kitchen, perhaps second only to my knife.”

“I was initially skeptical about this meat thermometer’s utility, but it’s the only tool that helped me overcome my anxiety of roasting whole chickens, something I long avoided for fear of accidentally giving myself salmonella while simultaneously worrying that I’d overcook the bird until it became inedibly dry,” Builder wrote in an article in The Strategist. “Same goes for steak, which I never wanted to buy and cook on my own because there’s nothing sadder than cutting into a beautiful (and expensive) slab of meat only to realize that it’s gone from perfectly medium-rare to well-done.”

According to the USDA’s Food Safety and Inspection Service (FSIS), using a food thermometer is the only reliable way to ensure safety and to determine desired “doneness” of meat, poultry and egg products.

“To be safe, these foods must be cooked to a safe minimum internal temperature to destroy any harmful microorganisms that may be in the food,” the FSIS says. “’Doneness’ refers to when a food is cooked to the desired state and indicates the sensory aspects of foods such as texture, appearance, and juiciness.

“Unlike the temperatures required for safety, these sensory aspects are subjective. Color is not a reliable indicator.”

So there goes the it-looks-done-to-me theory.

For example, FSIS says, ground beef may turn brown before it reaches a temperature where pathogens are destroyed. A consumer preparing hamburger patties and using color as an indicator is taking a chance that pathogenic microorganisms may survive. A hamburger cooked to 160 °F, as measured with a meat thermometer, regardless of color, is safe.

The temperature at which different pathogenic microorganisms are destroyed varies, as does the “doneness” temperature for different meat and poultry, the agency says, adding that it’s essential to use a food thermometer when cooking meat, poultry, and egg products not only to prevent undercooking but to verify that food has reached a safe minimum internal temperature and prevent foodborne illness.

The FSIS recommends letting meat rest for at least three minutes before carving or eating.

Fans of the Thermapen say it is the fastest, recording the internal temperature of a piece of meat in less than 3 seconds.

“That speed makes a noticeable difference when you’re balancing a roasting pan on a hot oven door as you try to take the temperature of whatever’s inside without burning yourself or letting out too much heat,” Builder writes.

FSIS lists a variety of food thermometers, including the thermocouple, which shows the temperature on a digital display after measuring at the junction of two fine wires located in the tip of the probe. Thermocouples used in scientific laboratories have very thin probes, similar to hypodermic needles, while others may have a thickness of 1/16 of an inch.

The Strategist piece features a digital thermometer called the Lavatools PT12 Javelin Digital Instant Read Meat Thermometer, which sells for $25 and has a magnet that sticks to the side of your stove.

Wireless remote digital thermometers include the ThermoPro TP20 Wireless Remote Digital Cooking Food Meat Thermometer that sells for $60 and has a dual probe.

For $24, the Eleckcity 1022D Dual Laser Digital Infrared Thermometer Temperature Gun measures everything from meat to pottery to a cat’s body temperature, according to an online review.

And $18 will get you a ThermoPro TP-16 Large LCD Digital Cooking Food Meat Thermometer that you can stick into a piece of meat and leave in place while it cooks.

For $11, you can get an OXO Good Grips Chef’s Precision Analog Instant Read Meat Thermometer.

Just Google meat thermometers or stop in at a kitchen, discount or department store and you’re sure to find something that meets your needs.

And finally, here’s a CDC chart that shows what temperatures you need to reach to eat safely.

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“The investigation showed that five laboratories and the company’s analysis departments falsified results” shown to health inspectors, federal police said in a statement reported by New Vision news.

Brazilian Agriculture Ministry representative Alexandre Campos da Silva said the department received 410 notifications of salmonella presence from 12 countries that imported the meat in question last year, 80 percent of which were in the EU.

Monday’s sweep — the third since the scandal was uncovered — involved 270 police officers and 21 health agents across five Brazilian states.

Federal Police Commissioner Mauricio Boscardi Grillo said 10 of 11 people targeted with arrest warrants were detained, including Pedro de Andrade Faria the former CEO of Brazil Foods. The business is one of the largest food companies in the world, exporting products, primarily meat, to more than 120 countries.

During the first stage of the investigation in March 2017, widespread corruption was uncovered among food safety inspectors who certified rotten meat in exchange for bribes.

Brazil’s huge export industry has been thrown into disarray as countries have temporarily banned imports of its beef and poultry. Accusations included sales of spoiled food and meat tainted with materials like cardboard and acid.

Last year, results of a two-year probe came to light when federal authorities revealed how meatpackers paid off the inspectors and politicians, including the Brazilian president, to overlook improper practices.

The newest development in the probe comes as Brazil’s once-tottering economy improves and its stock market posts one of the world’s best rallies. So far, investors have been mostly unfazed, but the scandals could cause more volatility ahead of October’s presidential election, in which many of the potential candidates have been accused of corruption.

The resurfacing of the so-called Operation Weak Flesh investigation comes after processed foods and poultry giant BRF has seen four chief executive officers in five years. Its shareholders are at odds over how to revive the company and are looking to replace the board. The stock lost 20 percent of its value Monday, the most since 1998, according to Bloomberg.

BRF said in a statement that issues being investigated by police pose no health threat and that the company follows all domestic and international regulations regarding food safety.

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The initial report  on Feb. 20 from the Centers for Disease Control and Prevention said 28 people across 20 states were confirmed with the outbreak strain of Salmonella I 4,[5],12:b.

Forty-five percent of people who are sick have been hospitalized. No deaths had been reported to CDC as of March 2.

The outbreak strain of Salmonella I 4,[5],12:b was found in leftover kratom powder collected from sick people in North Dakota and Utah. Investigation findings link the outbreak to kratom products, but the evidence collected to date has not identified a common brand or supplier of kratom.

Kratom is a plant native to southeast Asia that is consumed for its stimulant effects and as an opioid substitute. It is typically brewed in a tea, chewed, smoked or taken in capsules. Kratom may also be known as Thang, Kakuam, Thom, Ketom and Biak.

One person from each of these states has been newly reported reported sick from kratom: Delaware, Georgia, Minnesota, Missouri, Virginia, Washington and Wisconsin.

At this time, CDC recommends that people not consume kratom in any form because it could be contaminated with Salmonella. The recommendation may change as more information becomes available.

The Food and Drug Administration also warned the public in recent days about contaminants in kratom. The FDA reported its investigation is not related to the outbreak currently under investigation by the CDC.

However, the FDA reported it is aware of 44 deaths related to kratom products.

People should talk to their health care provider before taking any supplement, especially if they are in a group more likely to get a severe Salmonella infection, according to the CDC. These groups include people with weakened immune systems, including those who are receiving chemotherapy or have HIV, pregnant women, children younger than 5 and older adults.

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Picture this. You walk into the breakroom at work and instead of – or in addition to – the tired-looking ham/chicken/egg salad sandwiches and cans of chili, there’s a vending machine chock full of fresh romaine, kale, arugula, snow peas, fresh edamame, cherry tomatoes and more.

Meet Sally the Salad Robot.

Not unlike Jane and George Jetson’s robotic maid, Rosie, in the 1960s cartoon, Sally will serve you a customized, fresh and healthy salad instead of ramen noodles or days-old sandwiches.

Step up to the touch screen and pick from as many as 22 fresh ingredients at a time, plus salad dressing. Or, select from a number of preprogrammed salads. Sally will tell you how many calories and carbs you’ve selected before filling a bowl with lettuce, vegetables and toppings in less than a minute and a half.

The vending machine created by Redwood City, California-based Chowbotics ensures precise calorie counts and keeps ingredients fresh, sanitary and separate, according to the company’s product information.

Sally’s target audience includes workplace cafeterias, restaurants, hotels and other commercial venues.

So, it’s not quite time to have a Rosie – or a Sally – in your own home, but Chowbotics aims to automate repetitive tasks to increase productivity and enable creativity, both in and out of the kitchen, company officials said in a news release. Sally the Salad Robot is the company’s first product and is being shopped around in the Silicon Valley.

“It’s better than salad bar, and it’s safer because … all of the ingredients are contained within the robot so there’s no risk of cross contamination,” said Lib Riddiford, public relations consultant for af&co. restaurant and hospitality consultants.

No worry that someone will grab a handful of croutons without using the tongs or sneeze or cough onto the garbanzo beans or diced chicken.

“Another benefit is not overloading like you do with a salad bar,” Riddiford said. “There are calorie counts on the touch screen that interface for each ingredient you pick. So, if you’re trying to maintain a diet it’s nice to know that you’re walking away with a really healthy product. If you want to do a 500-calorie lunch you can easily do that with Sally.”

The robotic vending machines will be filled and maintained by whatever food provider a given company has, she said.

“And even though they might have a cooling component in a salad bar,” Riddiford added, “the food is still exposed to air. With Sally, the freshness is at a much higher level … and the risk of contamination is so much lower because it’s just one individual instead of exposing ingredients to customers.

“You can’t control what other people do (but) you can control food service workers in terms of washing their hands and wearing gloves.”

Chowbotics’ proprietary technology provides precise calorie counts and protects the integrity of ingredients, keeping them refrigerated, fresh, sanitary and separate and reducing the risk of foodborne illness, the company said.

That remains to be seen.

Trevor Suslow, an extension researcher at the University of California-Davis, said he heard talk of such technology at the Postharvest Unlimited Expo in Madrid this past October.

“They seem to generate a lot of curiosity and seem a nice addition for on-the-go convenience in healthy food choices,” he said.

That said, Suslow noted that the devil is in the details.

“Maintaining high standards of hygiene in pilot trials is certainly a plus, but achieving this in many point-of-purchase venues is a significant challenge as this still requires the diligence of the service employee or contractor,” Suslow said.

“At this time, we have no details upon which to assess the safety of these units, including temperature control, critical time-temperature exceedance limits and failsafe alerts, modern elements of hygienic design and full cleanability of multiple integral parts to deliver multi-component fresh foods and ingredients in a blending array, and intervals of deep cleaning to prevent biofilm establishment.

“Though exceptionally rare,” Suslow said, “inherent contamination of the raw materials and processed materials used to stock the units remain a concern for the industry and consumers.”

Sally’s developers believe they have addressed potential food safety problems. They say Sally is a safer option than salad bars, especially in higher-risk facilities such as schools, retirement homes and hospitals, the developers contend. Fast-casual restaurants, convenience stories, hotels and airports are other potential markets.

Future robots are planned to offer breakfast as well as Mexican and other ethnic foods.

Chowbotics has done Sally trials at Twitter in San Francisco, as well as at Uber and Google, Riddiford said.

“We’re looking to sell directly to the food service director at those companies, who will pick what ingredients to put in,” she said.

Sally retails for $30,000. Companies that buy her will determine the cost of an individual salad, Riddiford said. The salad vending machine has passed Underwriters Laboratories (UL) and NSF-25 safety and sanitation standards, the company said.

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The announcement came just days after the Food Standards Agency (FSA) was criticized by a parliamentary committee for failing to take definitive action to improve standards following an undercover investigation last year by The Guardian and ITV. The Guardian reported the nationwide review on Feb. 1.

Further, the government has pledged to require closed-circuit television cameras to be installed in all meat cutting plants.

In the wake of the investigation, 2 Sisters, the country’s largest supplier of supermarket chicken, shut its West Bromwich chicken site for five weeks this past autumn for staff retraining.

In January, Jamie Oliver’s Italian restaurant chain and Wetherspoon pubs were among businesses caught up in a meat recall scandal at Russell Hume when FSA inspectors said they had found serious issues during a surprise visit to the company’s Birmingham premises on Jan. 12. Since then, meat production has been suspended at Russell Hume plants, the Guardian reports.

FSA Chairwoman Heather Hancock and Food Standards Scotland Chairman Ross Finnie issued a joint statement, saying: “In the last six months the FSA and FSS have faced two serious incidents involving major players in the meat sector. People rightly expect food businesses to keep to the rules, rules designed to keep consumers safe and to sustain public trust in food – and food businesses have a duty to follow the regulations.”

“In the light of these recent incidents,” the statement continued, “the FSA and FSS will be taking forward reviews of cutting plants and cold stores used for meat. Further details will be published later this month and the results will be fully available to the public.”

An investigation into meat processing factories was expected, The Guardian reported, but the scale of the problems that have emerged since September prompted regulators to expedite the launch.

Last year’s hearings into 2 Sisters by Parliament’s Environment, Food and Rural Affairs Committee were a direct response to The Guardian and ITV undercover footage from 2 Sister’s West Bromwich chicken plant, The Guardian reports. The footage showed poultry being dropped on the floor and returned to the production line, as well as an instance of labels recording the slaughter dates of birds being changed.

2 Sisters has denied the footage showed any food safety breaches and said it temporarily suspended production three days later because of process failures, adding that its “internal investigation has shown some isolated instances of non-compliance with our own quality management systems.”

Said a spokesman for 2 Sisters: “We welcome any further reviews the FSA would wish to carry out at all cutting facilities in the UK.”

The FSA said its investigation into Russell Hume includes examining the “extended use of ‘use by’ dates, and the food safety management system that the business has in place.” The regulator also launched its own, ongoing investigation into 2 Sisters.

“Our investigation into the major non-compliances we found at the Russell Hume plants in England and Scotland is intensifying,” said Jason Feeney, chief executive of the FSA.

“We have already stopped these plants producing meat products, have ensured the withdrawal and disposal of the products and now we are looking at the root cause of the incident and any culpability.”

Feeney said there is no indication people have gotten sick from eating meat supplied by Russell Hume.

The company did not respond to invitations from The Guardian to comment.

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And there they’d sit – on a small saucer on the toaster – and people would nibble at them all afternoon and into the evening.

While my mom used to scrub the Thanksgiving turkey with a brush and Palmolive dish soap – seriously – before she put it in the oven at midnight to cook ever so slowly and provide a beautiful breeding ground for bacteria, I kind of give my turkey a quick rinse under the faucet and plop it into the roaster.

Wash produce? Never have.

Pay attention to expiration dates? I’m the daughter of Depression-era Germans. I don’t like to throw things out. My older son once cleaned out my canned foods cupboard and made an artistic display of everything that had expired before he was born. He was a teenager at the time.

But since starting work for Food  Safety News a few weeks ago, I actually washed the romaine lettuce I bought recently. I put those scrambled eggs into the refrigerator sooner than I used to. I’ll try to pay more heed to “use by” dates. (But really, what if there’s a zombie apocalypse and there’s no food in my cupboards? Kidding … sort of.)

And I’ll very likely pay more attention to the buffet of cornbread, Rice Krispies treats, cinnamon rolls, spinach dip, salsa, etc., that sits out all day long at the chili contest I enter – and lose – each year on Super Bowl Sunday. At least the chili entries are kept warm in Crock Pots as the day goes on, and on, and on, until winners are announced at halftime.

By all rights, given what I’ve learned in recent weeks, I should have been sick many times – or dead – and so should my family. I guess we’re lucky, but I will pay closer attention.

Speaking of the chili contest, I rarely cook without cutting myself, so I’ll probably start keeping some finger cots on hand.

Meanwhile, here are some tips from the Centers for Disease Control for a food-poisoning-free Super Bowl LII. By the way, the CDC says Americans eat more food on Super Bowl Sunday than any other day of the year except Thanksgiving. It doesn’t mention alcohol consumption, or emergency room visits, but here goes.

Keep it clean

• Wash your hands with soap and running water for at least 20 seconds before preparing, eating or handling food. Also, wash your hands after using the bathroom and touching pets and pet food.
• Wash your cutting boards, dishes, utensils and countertops with hot, soapy water after preparing each food item.
• Wash or scrub fruits and vegetables under running water– even if you do not plan to eat the peel – so there’s less of a chance of dirt and germs transferring from the surface to the inside when you cut them.

Cook it well

• Use a food thermometer to test meat and microwaved dishes on your menu to get rid of harmful germs.
  • Make sure chicken wings and any other poultry reach a minimum internal temperature of 165 degrees F and that any ground beef items reach 160 degrees F.
  • Follow frozen food package cooking directions when cooking in a microwave.

Avoid the danger zone

• If preparing food in advance, divide cooked food into shallow containers and store in a refrigerator or freezer until the party begins. This encourages rapid, even cooling.
• Keep hot foods at 140 degrees F or warmer. Use chafing dishes, slow cookers and warming trays to keep food hot on the buffet table.
• Keep cold foods,  like salsa and guacamole, at 40 degrees F or colder. Use small service trays or nest serving dishes in bowls of ice.
• Make sure to keep takeout or delivery foods hot, and cold foods cold. Divide large pots of food, such as soups or stews, and large cuts of meat, such as roasts or whole poultry, into small quantities for refrigeration to allow them to cool quickly and minimize their time in the temperature “danger zone” between 40 degrees F and 140 degrees F.

Watch the clock

• Follow recommended microwave cooking and standing times.
  • “Cold spots” — areas that are not completely cooked — can harbor bacteria, viruses and parasites.
  • Always follow directions for “standing time”— the extra minutes food should rest to finish cooking.
• Track the time food stays on the buffet.
  • Throw away any perishable foods that have been at room temperature for two hours or more.

Avoid mix-ups

• Separate raw meats from ready-to-eat foods like veggies when preparing, serving and storing food.
  • Make sure to use separate cutting boards, plates and knives for produce and for raw meat, poultry, seafood and eggs.
• Offer guests serving utensils and small plates to discourage them from eating dips and salsa directly from bowls.

Store and reheat leftovers the right way

• Divide leftovers into smaller portions or pieces, place in shallow containers and refrigerate or freeze.
• Leftover foods should be refrigerated at 40 degrees F or below as soon as possible and within two hours of preparation. It’s OK to put hot foods directly into the refrigerator.
• Refrigerate leftovers for three to four days at most. Freeze leftovers if you won’t be eating them sooner.
• Leftovers should be reheated to at least 165 degrees F before serving. This includes leftovers warmed up in the microwave.

About the author: Catharine Huddle is a long-time Lincoln, NE, journalist. She started her career at the Lincoln Journal in 1978, moving from the “death and weather girl” position to a reporter for the city desk to covering the state’s prison system. She was eventually promoted to weekend editor/assistant city editor for the newspaper, which is now known as the Journal Star. Click on her photo for additional details.

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Ron and Darlene Fields had been married for 26 years when they decided to take a “free” 12-day trip to Hawaii in fall 2016.

Ron was 62 then, and his construction business in Sarasota, FL, was really taking off. Darlene, who does paperwork for the company, had saved up credit card reward points so they could fly to Los Angeles, spend a night there and then fly to Maui for five nights before moving on to the Big Island.

The only things they expected to pay for were food and an excursion from one side of the Big Island to the other.

The Fieldses, physically fit and devoted for the past dozen years to eating organically, were a couple of days away from heading home when Ron got sick.

“My husband woke up in the middle of the night and couldn’t quite describe what was going on with his skin,” Darlene said during a telephone interview from their Florida home. “It was worse in L.A., and more when we got home. … We arrived home on a Saturday and by Thursday, he laid down in the bed — and he couldn’t get up for months.

“He called it burning skin pain. Then he started to have bladder problems and couldn’t urinate.”

Ron and Darlene Fields would end up taking a journey longer than any they’d imagined when they booked their flight to Hawaii.

Along the way, they’d go to emergency rooms, a hospital in Gainesville, FL, and an integrated health center. They’d see neurologists and urologists, general practitioners and meningitis specialists, medical marijuana consultants and acupuncturists and hypnotists.

The cause
The likely culprit behind it all: a tiny slug hiding in one of the many salads the couple ate during their trip.

The slug likely was home to a disgusting little parasite called rat lungworm that is carried in rat feces, which slugs and snails eat. The slugs and snails serve as intermediate hosts for the rat lungworms, which can’t mature or reproduce in humans but can cause a host of physical problems including eosinophilic meningitis and ocular Angiostrongylus if people ingest them.

Rat lungworm infections typically come from eating raw or undercooked snails — or slugs — that can be in lettuce or other raw produce that hasn’t been washed thoroughly and/or cooked throughly. It has been endemic in Hawaii for at least the past 50 years, according to public health records.

Ron and Darlene Fields didn’t eat any snails, so they’re pretty sure Ron contracted the infection from a salad, which they ate every day of their vacation.

“You know, a Caesar salad or whatever they had in the restaurants,” Ron said in recent days.

Experts say early symptoms of rat lungworm infection can include headaches, neck stiffness, nausea and vomiting and that the illness might incubate for a single day or for as long as six weeks before symptoms appear. Infected people are not contagious. Recovery time varies in many cases from a couple of weeks to a couple of months.

Not so in the case of Ron Fields.

“We would go to the emergency room and to our family doctor. We tried acupuncture for the pain,” Darlene said. “During the couple of weeks after we arrived home, I could get him in the car and get him to the emergency room, but when he was home, he just lay in bed, too weak to walk, and any jostle in the car just caused excruciating pain.”

How they discovered the cause
A couple of weeks into the whole thing, Darlene’s mom was flipping through the TV channels one day and caught the words “Big Island” and “rat lungworm” on the Animal Planet network. That sent Darlene on an internet search that led them to the answer.

Rat lungworm disease is reported in about 30 countries in Asia, Africa and Caribbean and Pacific Islands. In Hawaii 80 percent of land snails carry the parasite, which has caused two deaths in the islands since 2007. The state typically experiences one to nine rat lungworm cases a year.

In 2017, however, the Hawaii Department of Health recorded 18 laboratory-confirmed cases, said Anna Koethe of the department’s communications office.

Ron Fields’ case is one of an unknown number not included in the public count because his illness, like other people who get sick after returning home, wasn’t reported to Hawaiian public health authorities.

In fact, despite dozens – if not hundreds – of medical tests, doctor visits and exams, Ron never got confirmation that he was infected by rat lungworm disease.

“We were confident of what it was, but they wanted to do another spinal tap to take more fluid, and my wife said no,” he said.

“It was confirmed that it was a parasitic form of meningitis, though.”

During all of their efforts to get a diagnosis and help, they encountered no one in Florida who had heard of the condition.

”They diagnosed all these silly things,” said Darlene. “We thought he was dying, and they said acid reflux, stress. It was just weird. Even after we found out what it was and told doctors, nobody had ever heard of it.

“We diagnosed it ourselves from the internet. I called the Big Island, the hospital, the CDC, I think, trying to get hold of a doctor who had treated it to see what we could do. … I finally called an emergency room in Honolulu and got a doctor who said it was  untreatable but it would go away eventually.

“I said, ‘How long?’ and she said, ‘A long, long time.’ She said, ‘months,’ and I said, ‘He won’t make it months.’ ”

In the end, Ron Fields spent 10 months with a catheter because he couldn’t urinate. He spent nine days he doesn’t remember in the Gainesville hospital. He had IV treatments of vitamin C and he had problems with his bowels. He developed meningitis and had to have a spinal tap.

The time in Gainesville was a nightmare, Darlene said.

“All I did was tell my story every day, all day long,” she said. “Students, neurologists, doctors – and nobody knew anything. They were giving him a lot of antibiotics … trying to eliminate kinds of meninigitis.

“There was nothing to do to help him. He was losing weight. He was getting weaker and sicker instead of better. We went home after nine days and between October 2016 and January or February 2017, he determined he was never going to get better.”

Good days and bad days
Ron is 64 now, and, most days, he goes to work but does less physical labor. He’s lost weight and agility.

“I don’t know if words can really describe (it),” he said. “It’s been challenging. As far as my balance and ability to be able to work every day without disability is about 90 percent.

“It took a while to get there. I still suffer from the neuropathy from the nerve damage that happened to me, and it’s just been a real struggle with that.”

Said Darlene: “Now, every morning he has to go through agony just to get his shirt on. It hurts so badly.”

Ron had to kick morphine, which doctors had him on for three or four months for the pain. He takes a nerve pain medication, but the Fields worry that it’s not good for him long-term. So, he uses medical marijuana, which has been legal in Florida since 2016.

The marijuana, which he uses in vaping form, makes life tolerable.

“We’re so thankful that medical marijuana is legal in Florida,” said Darlene, adding that it helps her husband sleep.

It doesn’t get him high.

“He doesn’t act drunk or high or anything but he’s not able to think as clearly,” she said.

“I thought it was wrong before,” she said of marijuana use. “But a neurologist recommended it and as a Christian he explained how he used to feel the same way, but as soon as we realized how many people it helped … it doesn’t bother us at all.

“Being able to sleep now is a big boost,” Darlene said.

The Fieldses have a type of alternative health insurance through Christian Healthcare Ministries for major medical expenses, but a lot of the treatment and pain relief they tried wasn’t covered.

It’s been challenging, Ron Fields said, but they’ve had help.

“I am a Christian, and if it wasn’t for the love of Jesus Christ and the relationship I have with him to give me the strength, I would never have made it.

“I have good days and I have bad days.”

Ron said he doesn’t rule out a return to Hawaii, but both he and his wife say they’d do things differently – no salads, and probably not even fruit or fruit juice.

“It’s changed our lives,” Darlene said. “We’ve lost hundreds of thousands of dollars. His business was really starting to thrive … and when we came back, he just couldn’t work.”

They considered seeking compensation through a lawsuit but since they don’t know where Ron picked up the parasite, there’s really no one to sue.

“We don’t want to sue,” she said. “That’s not the point. What bothered us is that nobody knew about it. We wouldn’t have gone to Hawaii in the first place, and we certainly wouldn’t have eaten like we did.

“We went to Hawaii because I always love to find ways to travel for free … I tell everybody it was the most expensive free trip ever.”

Public health action
The Hawaii Department of Health launched a statewide public education campaign to raise awareness and inform people about best practices they can implement into their daily routines to prevent the spread of rat lungworm disease.

The first initiative, launched late in 2017, included a statewide broadcast media component through a partnership with the Hawaii Association of Broadcasters.

The campaign consists of three radio and three television commercials currently airing on 40 radio stations and seven television stations through the end of June 2018.

The department also has large-scale graphic advertisements displayed in malls and shopping centers across the state. It’s educational materials include rack cards, door hangers and posters that are being distributed during community events and health fairs.

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Vinyl gloves, also called PVC gloves, contain a heavy chlorine content. PVC is a widely produced synthetic plastic polymer. The rigid form of PVC is used to make pipes.

California-based Eagle Protect is not alone.  China stopped manufacturing the gloves last year due to severe pollution. Factories have reopened if they can meet the new pollution standards. Japan banned their use in food service in 2001 because of documented adverse effects on health, Eagle Protect company officials said. In the United States, Kaiser Permanente also switched from vinyl gloves to nitrile because of the same concerns.

And, the European Union in 2008 banned the use in food safety products of at least one material used in making vinyl gloves out of concern the chemical could leach into food and be ingested. Sweden proposed restrictions on PVC use in 1995 and is working toward discontinuing it entirely.

In banning production of the gloves, China noted that factories use coal-fired boilers during manufacturing to keep costs down, resulting in increased pollution and negative environmental effects.

The problem
Manufacturing PVC releases dioxins into the atmosphere, as does burning or disposing of them in landfills. Exposure to dioxins has been shown by some researchers to cause reproductive, developmental and other health problems. At least one dioxin is classified as a carcinogen.

Vinyl gloves can also contain phthalates, which have been shown to leach from the gloves into the human body and leach into and evaporate into food, particularly fatty food. Some phthalates have been found to adversely affect human health and are on California’s list of known carcinogens.

In addition, studies have proven vinyl gloves have an increased permeability to bacteria and virus, and in some cases begin leaking as soon as they are donned. New research also shows vinyl gloves are an ineffective barrier during food handling and have three times the cross-contamination potential of quality nitrile gloves.

While vinyl gloves are less expensive than nitrile, the economics go beyond per-unit cost, according to Eagle Protect. But many glove supply companies and procurement managers don’t see it as such, failing to factor in food safety aspects, human health implications and environmental concerns.

The new pollution laws in China could affect vinyl glove cost, causing businesses and consumers to buy nitrile gloves instead.

The rundown on gloves
Latex gloves are made out of rubber and are biodegradable, but some people are allergic.

Nitrile gloves are made out of a synthetic rubber, and are an ideal alternative when latex allergies are of concern. They are also more resistant to chemicals that can compromise gloves made of other materials.

Vinyl gloves are a popular choice for the food industry and situations in which high levels of durability and protection are less of a priority. They are the less expensive option.

CDC recommendations
The Centers for Disease Control has no direct guidelines regarding what kind of gloves should be used in handling food and has not studied vinyl versus other kinds of gloves, according to Brittany Behm, a public affairs specialist in CDC’s Division of Foodborne, Waterborne, and Environmental Diseases.

The agency does recommend handwashing and wearing gloves when making food. Based on studies, the FDA notes that workers are more likely to wear gloves in chain restaurants, suggesting that use may be partially determined by restaurant managers.

Use of PVC in health care
Out of concern for toxic chemicals in products, health-care institutions around the world, including U.S.-based Kaiser Permanente, have opted for nitrile gloves rather than vinyl. Kaiser, the nation’s largest integrated health care delivery program and user of more than 50 million gloves a year, also has moved away from tubing made from PVC.

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The number of people sick in a Tacoma, WA-area norovirus outbreak hit 542 this week, increasing by almost 40 percent since Jan. 11.

Norovirus has been confirmed by Tacoma-Pierce County Health Department officials as the pathogen responsible for the outbreak. Of the 542 reported victims, 520 ate at an El Toro restaurant in Tacoma. Another 22 people are possibly sick after eating at the chain’s restaurant in a nearby suburb, the department reported Thursday.

The number of sick patrons is up from 391, reported Jan. 11 in the health department’s weekly update. However, county officials reported in the Jan. 18 update that the situation appears to have peaked and they will not continue regular updates.

When it started
The health department began receiving reports of possible food poisoning on Jan. 5 from customers in separate households who had eaten at the Tacoma restaurant between Dec. 31 and Jan. 2. Earlier this week, the department learned of suspected cases at the University Place site from customers who had eaten there this past weekend.

The customers experienced one or two days of symptoms, including vomiting and diarrhea, about 24 to 36 hours after eating at the restaurant, the health department reported.

The implicated restaurants are the at 5716 N. 26th St. in Tacoma and at 3820 Bridgeport Way West in University Place.

A lab test identified the norovirus as the culprit in the Tacoma outbreak, but tests are pending for the University Place illnesses, according to the health department.

Both restaurants were closed for at least one day for thorough cleaning and sanitation, the department said. They have since reopened.

How it spread
Norovirus is highly contagious and is more common during cold weather. Environmental Health Supervisor Christina Sherman from the department’s Food and Community Safety Program said outbreaks can last a few days, a few weeks or a few months.

Many cases of norovirus go unreported, but people who get sick at a restaurant can go home and infect family members and others during the incubation period. The average length for that period is 12 to 48 hours.

People likely get norovirus an average of five times in their lives but don’t necessarily realize what it is — and they probably don’t report it, Sherman said in an interview on the Health Department’s website.

The Tacoma exposure period had gone on for eight days before the department got word that people were sick, she said.

The El Toro restaurants had each failed a routine inspection but passed on follow-up visits, the department said. But even restaurants that pass muster can go on to have foodborne illness outbreaks.

What to do
The virus can live on surfaces for as long as two weeks, so hard surfaces must be sanitized with bleach and water. Cloth and other surfaces must be heated and/or steamed, the health department said.

And, it’s critically important that food workers wash their hands often, not touch ready-to-eat food with their bare hands and stay home when they’re sick.

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French authorities are searching five sites run by dairy giant Lactalis in an investigation into the botched mass recall of baby milk products amidst a salmonella outbreak.

The Paris prosecutor’s office told The Associated Press on Wednesday the sites being searched include the company’s  headquarters in western France and the factory in Craon, where salmonella bacteria was found last year. The factory has been closed.

French fraud and health authorities launched a criminal investigation into the handling of the massive recall. At midweek, recalled baby milk products remained available in French hospitals, pharmacies and supermarkets — weeks after they were ordered pulled from shelves.

The head of Lactalis said the recall affected more than 12 million products in 83 countries.

Salmonella infections can be life-threatening, particularly for young children. So far, three dozen infants in France have been confirmed sick and a number of children in Spain and Greece may be sick from contaminated Lactalis products.

The privately owned company exports its products to dozens of countries in Europe, Africa and Asia.

Lactalis sells products in the United States, but none of the recalled baby milk has been traced to U.S. distributors at this time.

This past week, the Reuters reported that the company was widening the recall to cover all baby milk manufactured by the factory at the center of the contamination, Finance Minister Bruno Le Maire said.

The move came as the government sought to contain damage to the reputation of France’s agri-business industry in overseas markets.

After talks with Lactalis management, Le Maire said the company would recall all infant formula milk products made at its Craon factory that were still in warehouses and on store shelves, regardless of the date of manufacture.

“The aim of this radical step is simple: to avoid delays, problems in sorting batches and the risk of human error,” Le Maire said.

The tough measure reflects high-level frustration at the botched handling of the crisis after France’s biggest supermarkets — including Carrefour, Auchan and Leclerc — said some Lactalis products subject to recalls in December still found their way onto shelves in recent days.

The incident has been particularly embarrassing for the government after President Emmanuel Macron pushed food exports during a recent state visit to China.

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