Producers are not required to keep poultry with salmonella bacteria off the market. The government considers some contamination inevitable and relies on consumers to kill the pathogen with proper cooking.

Most recently, 78 people were sickened, including one death, after eating ground turkey infected with antibiotic-resistant Salmonella. The outbreak, which began in March and rapidly spread to 26 states, led to the recall of almost 36 million pounds of ground turkey that came from a Cargill plant in Arkansas.

In 1994, the government banned the sale of raw ground beef containing E. coli O157:H7, the main pathogen associated with beef; but did not ban the sale of meat tainted with Salmonella, the most common pathogen found in poultry.

Americans eat far less ground turkey than ground beef, but nearly the same number of people get sick from both. Since 2007, ground turkey has sickened 116 people, including one who died, while ground beef has sickened 164 people, including three fatalities.

Production of ground beef production far outpaces that of ground turkey. In 2009, U.S. companies processed 415 million pounds of ground turkey, compared with nearly 10 billion pounds of ground beef, according to figures from the National Turkey Federation and the American Meat Institute.

Because government investigators piece together evidence of outbreaks over weeks or months, contaminated products can remain for sale in stores, or at home in consumers’ freezers, for a while without people realizing the potential risk.

In the recent outbreak, illnesses from the antibiotic-resistant strains of Salmonella stacked up month after month as companies continued selling the contaminated ground turkey. Bacteria that are resistant to antibiotics are even more dangerous because fewer drugs are effective in fighting them, resulting in more serious infections.

Ground meats pose a greater contamination risk than do whole cuts because the grinding process can mix clean meat with tainted meat. Salmonella is found in ground chicken and ground turkey nearly twice as often as in whole cuts of poultry, according to government data. Also, companies use chemicals such as chlorine to kill Salmonella on whole birds but generally don’t add extra chemicals during grinding.

During grinding, salmonella on the outside of the meat mixes with interior meat that might not yet have been exposed to contamination. With the Salmonella now throughout the mix, cooking the ground poultry to the proper internal temperature is necessary to kill the pathogen.

“You’re increasing the surface area that bacteria have to grow on,” said Christine Alvarado, associate professor of poultry science at Texas A&M University.

Agriculture Department tests from 2010 show that industry averages of salmonella in ground chicken and ground turkey – 18.8 and 10.2 percent, respectively – are more than twice as high as those for whole birds. A 2009 study by the Food and Drug Administration found nearly 15 percent contamination in ground turkey for sale in stores.

Varying Meat Standards

Ground poultry facilities can have almost half of their meat samples test positive for Salmonella and still comply with federal regulations, because the government expects consumers to kill Salmonella themselves by cooking their meat to 165 degrees.

This performance standard, enacted in 1998, allows contamination of 44.6 percent of ground chicken sampled and 49.9 percent of ground turkey sampled by USDA. This year, the USDA lowered the standard for whole chickens to 7.5 percent, targeting what it says is a main source of Salmonella. But the standards for ground chicken and ground turkey did not change.

These are benchmarks, not requirements. Though Salmonella can cause serious, sometimes fatal, illness, a federal court decided in 2001 that Salmonella is natural in poultry. It ruled that the government can test for it but has no authority to shut down a processing plant for routinely exceeding the performance standards.

In 2010, USDA tested 21 plants that produce ground turkey and 10 plants that produce ground chicken – compared with 303 plants producing ground beef.

Sherrie Rosenblatt of the National Turkey Federation says outbreaks in ground turkey can be traced through a company, which owns or monitors all levels of the supply chain.

In general, poultry companies own their own grinding facilities and sometimes grind meat in the same location as the slaughterhouse. Beef grinding plants, in contrast, more often grind together meat from numerous sources and companies, and on a much larger scale, making tracing more difficult.

But, as the most recent outbreak of Salmonella-contaminated ground turkey shows, tracing the pathogen to the source can still trigger a ponderous, multi-agency process requiring months of interviewing victims, collecting receipts and searching for patterns of what and where the victims ate.

Traceback, Recall Deficiencies

In early August, two days after the federal Centers for Disease Control and Prevention warned consumers of a Salmonella outbreak related to ground turkey, the Cargill subsidiary recalled nearly 36 million pounds of meat.

As of Aug. 5, the pathogen, identified as the drug-resistant Heidelberg strain of Salmonella, had been linked to one death in California and 77 other illnesses coast to coast, the CDC said.

Before the Aug. 3 announcement of the recall, one of the largest meat recalls in U.S. history, the agency did not tell consumers which brands of turkey to avoid, even though government data suggested a possible source. Instead, the agency advised consumers to fully cook their ground turkey to kill any bacteria.

Earlier this year, government tests unrelated to the outbreak found four ground turkey samples that tested positive for the same strain of Salmonella now linked to the outbreak, according to a CDC advisory. Three of the samples were from one facility, which was identified only as a “common production establishment.”

Positive test results are not enough to trigger a recall. The CDC refused to identify that “common production establishment” until investigating agencies could show that people who had gotten sick had also eaten food from that plant.

After the New York Times reported on Aug. 2 that the USDA was investigating Cargill, the Minnesota-based meat processor announced a recall the next day. It was the company’s third recall in two years because of a Salmonella outbreak: In 2009, 42 illnesses in nine states prompted two recalls of Cargill’s ground beef.

The USDA’s Food Safety and Inspection Service has no power to demand a recall but can request one when problems arise, such as illnesses, adulteration or mislabeling.

The CDC relies on state health departments to collect data about illnesses in their state. Of the 58 salmonella victims who provided information in the recent outbreak, nearly half reported having eaten ground turkey. Carlota Medus, an epidemiologist with the Minnesota Department of Health, said this was strong evidence to link ground turkey to the outbreak, given that only 11 percent of the general public report eating ground turkey in a seven-day period, according to a CDC population sur
vey.

Bu
t connecting victim data with the plant that produced the ground turkey in question was a tougher proposition. In any outbreak, by the time state epidemiologists interview the victims, they may not remember what they ate or where they bought it. Or they might have eaten the product mixed in with other ingredients and not known it.

“That’s the kind of stuff that makes … any investigation difficult,” said Medus. “‘Do you happen to have a package of ground turkey that you ate three weeks ago?’ No. I mean, not only did you throw it out, but your garbage has been picked up by now, so you can’t even go through your garbage and find the package.”

Antibiotics Resistance

There was extra urgency to find the source of this outbreak because the Heidelberg strain is resistant to many commonly prescribed antibiotics, giving doctors fewer options for treating severe cases. This can lengthen the duration of symptoms and raise the death rate.

Unless treated with proper antibiotics, salmonella infection can spread from the intestines to the bloodstream and then to other areas of the body. When the first line of antibiotics fails, doctors must resort to less conventional medications, many of which are more costly and have more serious side effects.

Antibiotic-resistant bacteria was also linked to a ground turkey outbreak in April that sickened a dozen people in 10 states, resulting in three hospitalizations. Jennie-O Turkey Store, Inc., recalled 54,960 pounds of frozen, raw turkey burgers four months after the first illness was reported.

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Jeffrey Benzing, Esther French and Andy Marso wrote this story while Carnegie-Knight News21 fellows from Maryland. News21 reporter Vanessa Burke-Payne contributed to this report. The story was part of the “How Safe is Your Food?” project of News21, a program of the Carnegie Corporation of New York and the John S. and James L. Knight Foundation to foster in-depth, interactive and innovative investigative journalism at journalism schools across the country. News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education. It is headquartered at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication. Republished with permission.

Over the next two months, these chicks will peck at the dirt, nibble on pellets, get packed into crates, be trucked to a slaughterhouse, get cut into parts and arrive at a distribution center for shipment to supermarkets and restaurants.

Government and industry readily expect that some of those chickens will arrive at their destinations contaminated with Salmonella, a foodborne pathogen that can lead to salmonellosis – an infection in humans that causes diarrhea, fever and stomach cramps, and, in severe cases, can spread from the intestines to the bloodstream.

Despite measures taken to reduce Salmonella from farm to fork, it’s a tough pathogen to eliminate. So consumers and food service handlers are told to cook poultry thoroughly and to avoid cross contamination.

That approach hasn’t worked.

Unlike other foodborne illnesses, not only has the rate of Salmonella infections failed to decline in the last 15 years, it’s actually gone up recently by 10 percent, sickening more than a million Americans a year. The Centers for Disease Control and Prevention has called for strong and specific actions to address the problem.

Salmonella is found in a range of food products, including meat, produce and eggs. Chicken is the single biggest source of infection among cases where a food has been identified, causing about 220,000 illnesses, 4,000 hospital stays and at least 80 deaths annually in the U.S., according to an analysis of CDC data by the Emerging Pathogens Institute at the University of Florida.

But gaps in government oversight – including meaningful testing and enforcement – along with inconsistent practices among farms and processing plants and varying levels of industry commitment to spend money on the problem have all led to a fractured effort, leaving the ultimate responsibility for food safety with the consumer.

Salmonella jumps from one link in the chicken chain to the next, with multiple openings for contamination along the way. 

The Farm

Food safety experts and poultry scientists say that Salmonella control has to start on the farm, but federal food safety inspectors never set foot there. The Agriculture Department’s Food Safety and Inspection Service lacks the legal authority to test for Salmonella on farms or to require farmers to have a food safety plan.

As a result, measures to prevent Salmonella are implemented voluntarily by farmers or because poultry processing companies ask them to – a situation that leads to a patchwork of efforts, some of which work better than others.

For instance, vaccinating the hens used in breeding can reduce the incidence of Salmonella in their offspring. Researchers at the University of Georgia in a study published in 2010 found that 20 percent of chicks hatched from vaccinated breeders tested positive for Salmonella before slaughter, compared with 30 percent of chicks from unvaccinated hens. And research published this year by the same group found that if a vaccinated chicken is contaminated with Salmonella, it will have, on average, 50 percent fewer cells of the bacteria than an unvaccinated bird.

The cost of the vaccines, including administering them, runs about 38 cents per bird for Perdue Farms, according to company spokeswoman Julie DeYoung.

While vaccination has been on the rise over the last two years, the practice has not been widely embraced by the poultry industry as a whole. Among those breeding operations that do vaccinate their birds, the number of doses given and the strains of Salmonella that are targeted vary widely. This can impact the vaccines’ effectiveness in keeping Salmonella out of flocks.

From the hatchery, baby chicks are trucked by the thousands in huge tractor-trailers to independently owned chicken houses that raise the birds under contract with poultry companies.

At one such operation, Mike Weaver’s poultry farm in Fort Seybert, W.Va., pallets containing about 10,000 chicks each are dumped on the floor of the houses, where workers direct the birds toward the feed trays and water lines. Outside the chicken houses are T-shaped PVC traps to catch rats and other rodents.

Properly chlorinated water, pest control, sanitation and biosecurity are crucial for controlling salmonellosis (as well as other diseases). The government requires none of these measures, so farmers follow a variety of practices, some of which are mandated by companies but may not be scientifically monitored.

Weaver raises birds for Pilgrim’s Corp., the country’s second-largest poultry processing company. Pilgrim’s supervisors visit his farm every week or two but do not test his water or birds.

In fact, live birds are almost never tested for Salmonella. And the bacteria, which have no odor and cannot be seen by the naked eye, do not make the birds sick, so they show no signs of being infected.

With no test results, farmers don’t know whether their chicks have Salmonella – and, if they do, how widespread the infection is – or whether their interventions have been effective. This moves the onus of killing the pathogen later down the line.

“When it goes down to the processing plant, it’s all cleaned anyway,” said Timothy Turner, who worked for Weaver.

This is a risky, often untrue premise.

“You don’t want every play to be goal-line defense,” said Joe Forsthoffer, spokesman for Perdue Farms Inc. “The less you bring into a plant, the better results you have.”

The birds’ trip to the plant in open-air trucks also leaves them vulnerable to infections. The dirty conditions in their tightly packed crates present opportunities for pathogens to spread, and contaminated feces from one flock can taint the next flock because the trucks are cleaned infrequently. Crates and trucks are not washed regularly between shipments because there is often not enough time to allow them to dry properly. Loading flocks into damp crates and trucks could make the situation worse, since bacteria thrive in moist environments.

Transport to the slaughterhouse also can weaken a chicken’s immune system, increasing Salmonella levels in its gut. USDA researcher Marcos Rostagno noted that overcrowding, extreme temperatures, food and water deprivation, rough handling and even just the normal motions of a truck lumbering down a highway can produce stress, allowing Salmonella to thrive.

And once Salmonella bacteria enter a processing plant, poultry experts say, it’s difficult to get them out.

The Slaughterhouse

Strung up on racks like clothes at a dry cleaner, chicken carcasses whiz by – about 200 of them per minute – in the alternately steamy and uncomfortably cold Perdue plant in Georgetown, Del. About a million birds are slaughtered at the plant each week.

Fresh from having their throats slit, the birds snake along in lines, their bodies pale, limp and lanky. After a communal bath, they are de-feathered and strung back up for evisceration. Each chicken’s guts are mechanically removed and placed on a plate for the USDA inspectors to check for signs of disease that make the birds sick. Overhead, the corresponding carcasses are checked for visible fecal contamination, which can be a sign that Salmonella is present. The government conducts microbiological sampling for Salmonella only once a year in most plants.

After inspection, the birds get a chilly bath, bobbing and soaking for two hours to lower their body temperatures. Then the carcasses are disassembled – manually and by machine – into the pieces consumers will
ultimately eat.

At every step along the way, there are opportunities for Salmonella contamination to spread and opportunities to prevent it. USDA requires every processing plant to have a food safety plan – a list of points in the production process where dangers can arise and how the company plans to control them. But companies set their own strategies. It’s up to them to decide how thorough the interventions are, leading to variations in the level of pathogen control at different plants.

On its website, USDA lists the names and locations of slaughter plants where Salmonella has been detected in more than 10 percent of the poultry tested by the agency. Since the end of 2007, the list has included nine of Tyson Foods’ 33 broiler plants and six of Pilgrim’s 26 plants that were operating as of August (but no Perdue plant currently in operation). Together, the country’s three largest poultry producers – Tyson is No. 1, Perdue No. 3 – account for about half of the 38 billion pounds of chicken produced in the U.S. each year.

In addition to its Georgetown processing plant, Perdue gave News 21 a tour of one of its hatcheries and a feed mill, along with a farm with which it has a contract. Companies generally own all aspects of poultry production with the exception of the farms.

At the Georgetown plant, brushes, treated water and antimicrobial rinses are constantly monitored throughout the line, and Perdue voluntarily tests birds for Salmonella throughout the week at various stages of the process. Contamination can vary from flock to flock and season to season, said Bruce Stewart-Brown, the company’s vice president of food safety and quality.

The key to killing Salmonella is being vigilant in maintaining proper temperature, pH level and chemical concentration of the water as well as keeping a close eye on other controls. For example, if the flow of fresh water in the scalder is not managed properly, each carcass will continually be rinsed by dirty water, exposing it to cross contamination.

“From what I saw, some [companies] work harder than others,” said Stan Bailey, a retired USDA microbiologist, who declined to name specific companies. “I think different people have different attitudes on how much they’re willing to spend.”

Companies that do not want to spend money on extra food safety precautions don’t have a big incentive to do so. No matter how much Salmonella USDA finds in raw meat, it cannot be kept off the market.

Looking Back

That wasn’t always the case – or at least it wasn’t the intent.

In 1998, USDA, citing regulations allowing it to set enforceable performance standards, told meat and poultry processors they would be shut down if their Salmonella contamination level exceeded 20 percent – then the industry’s average – for three consecutive tests. Production would halt. Money would be lost. And a plant would have to fix the problem before it could reopen.

A Texas-based meat company sued. The company, Supreme Beef Processors Inc., said USDA had no legal authority to shut it down after it failed three Salmonella tests over eight months.

The courts agreed. In 2001, a federal appeals court upheld a lower court’s decision accepting the company’s argument that because Salmonella is naturally occurring, the government cannot close a plant due to Salmonella contamination.

Elsa Murano, USDA’s undersecretary for food safety at the time, told News21 that the agency still has the power to close plants for failing to follow their own food safety plans, and she said that Salmonella testing is just one indicator the agency uses to measure companies’ performance.

Salmonella doesn’t pose a danger if chicken is thoroughly cooked, Murano noted. “Raw chicken can have bacteria on it. Cooked chicken better not.”

Efforts in Congress to give the performance standards teeth have stagnated.

Following the court decision in the Supreme Beef case, Sen. Tom Harkin, D-Iowa, introduced legislation to give USDA the legal authority to shut down plants that repeatedly violate performance standards. Senate Republicans voted as a bloc to kill it, joined by two Democrats who had received campaign donations from agribusiness in the previous election cycle. When Harkin, chairman of the Senate Agriculture Committee at the time, introduced a similar amendment a year later, it was derailed before reaching a vote.

Harkin then made repeated efforts to advance legislation known as Kevin’s Law – in memory of a Wisconsin toddler who died in 2001 after eating a hamburger contaminated with E. coli O157:H7 – but the measures never got out of committee. Similar bills on the House side sputtered as well.

Kevin’s mother, Barbara Kowalcyk, who became a food safety advocate after her son’s death, said a key to controlling Salmonella and other pathogens is for government to have enforceable performance standards. If processing plants exceed agency-set limits, Kowalcyk wants USDA to have the power to shut them down.

Some of the ideas in Kevin’s Law were included in the Food Safety Modernization Act, signed into law in January. It gives inspectors from the Food and Drug Administration the authority to order recalls and shut down processors that repeatedly sell contaminated produce, eggs or other non-meat products. But the new law doesn’t apply to USDA and the meat processors it oversees.

Despite USDA’s lack of enforcement muscle, in July it tightened its performance standards for poultry slaughterhouses for the first time. Under the new standard, no more than 7.5 percent of a plant’s raw chickens can test positive for Salmonella bacteria – down from 20 percent previously and in line with the industry’s recent average.

As an incentive to comply, plants that don’t meet USDA’s standards are posted online.

In general, the government tests processing plants for Salmonella once a year – with a sample of 51 birds a year. Problem facilities are tested more often.

But the tests don’t accurately reflect the level of contamination when the chicken leaves the plant, said Robert Tauxe, deputy director of the Division of Foodborne, Waterborne and Environmental Diseases at the CDC.

Tauxe explained that the tests sample whole carcasses at the end of the slaughter line – after almost all of the steps to contain Salmonella have been taken but before the birds are cut into pieces, when further cross contamination can happen.

This helps explain why the USDA’s Salmonella contamination rate of 7.5 percent in slaughter plants is lower than what the FDA has found in retail stores. In 2009, FDA tests showed that 21 percent of the chicken breasts it sampled from grocery stores were contaminated with Salmonella. (The FDA measures Salmonella in USDA products for its research on antibiotic-resistant pathogens.) The 2009 finding, the most recent such study available, showed that contamination in chicken breasts had spiked sharply since 2007, to its highest level in seven years.

“The chickens walk into the slaughterhouse with Salmonella on board and they leave with Salmonella on board,” said Tauxe.

And it still has opportunities to spread. 

To Market

On the loading dock of the Perdue plant in Delaware, packaged poultry is readied for shipment. The back of each truck is sealed with a plastic loop to prevent tampering. A guard wanders the lot every hour, checking the thermometers on the outside of each tractor-trailer to make sure that temperatures haven’t risen to dangerous levels.

Before a truck can leave the lot, a guard breaks its seal and inspects the shipment. The seal is then replaced. From now on, temperature control is the driver’s res
ponsibility.

At this point, if Salmonella is present it can no longer be reduced. Levels can remain the same, or they can increase.

Heat is the main danger.

When fresh poultry is not kept below 41 F, bacteria multiply. In just a few hours, a small concentration can expand into a thriving pathogenic colony.

Companies record the temperature of packaged meat as it enters and exits a refrigerated trailer. Some large retailers require suppliers to record in-transit temperatures, too. But most transporters don’t take these readings, so who’s to know if their meat got too warm inside the trailer?

A 2007 industry study found unsafe temperatures in 30 percent of food transports between processors and distribution centers and in 15 percent of food transports between distribution centers and retail stores.

Here again, the government isn’t really checking. Federal regulation of food transport has been shared and tossed around among various agencies over the last half century and hasn’t always taken food safety into account.

In 1957, Congress directed USDA to establish rules for storage and transport of poultry, but the final regulations were not issued until 1975 – and they didn’t address temperatures. In 2003, USDA issued voluntary guidelines for the transport of poultry – including recommended temperatures – but has taken no further action.

Meanwhile, the Department of Transportation was supposed to implement the 1990 Sanitary Food Transportation Act; but after a proposal that went nowhere, the department determined in 1998 that it lacked the expertise to do so. In 2005, Congress transferred responsibility for regulating food transport to the FDA, which is still trudging through the rule-making process.

“There’s probably less attention paid to transportation than there should be,” said Sarah Klein, staff attorney at the Center for Science in the Public Interest, a consumer advocacy group. The regulation of food transportation, she said, is “a little bit of a no man’s land.”

The Kitchen

At a Giant Food store in Baltimore, Shemaiah Miller pulled an anti-bacterial wipe from a dispenser and swiped the handle and inside of her shopping cart, hoping it would take care of any invisible pathogens from any raw chicken or hamburger that occupied the cart before her lettuce.

“I just like to think I’m wiping it away,” she said.

Her gesture drives home the point: Whatever Salmonella has accumulated on food during its journey from the farm ends up in the hands of consumers, whether they expect it or not. And it’s up to them to know how to kill it (during cooking) and prevent cross contamination during preparation.

To reduce the risk from Salmonella, USDA says poultry should be cooked to 165 F, as measured by a meat thermometer. To prevent cross contamination during food preparation, people should wash their hands with soap and warm water for 20 seconds before and after handling raw poultry or other foods and they should wash cutting boards, utensils and countertops with hot, soapy water or a bleach solution after cutting raw poultry or other meats.

Although USDA has spent millions of dollars to educate the public about food safety, studies indicate that consumers don’t always know, or practice, the techniques recommended by government and industry.

Half of American consumers do not use food thermometers, 40 percent don’t separate raw from ready-to-eat foods, and almost half use the same cutting boards for raw poultry and produce, according to a 2011 survey by the International Food Information Council Foundation, a public education group based in Washington, D.C.

The survey also found that only 39 percent of Americans accept some responsibility for food safety; 71 percent said it’s the government’s job and 67 percent said food manufacturers should share in the responsibility.

“Food that comes into your home contaminated – not your fault,” said Klein, the CSPI attorney. “The food shouldn’t have been contaminated in the first place.”

——————————-

Jeffrey Benzine, Esther French, Judah Gross and Robyne McCullough wrote this story while Carnegie-Knight News21 fellows from Maryland. The story was part of the “How Safe is Your Food?” project of News21, a program of the Carnegie Corporation of New York and the John S. and James L. Knight Foundation to foster in-depth, interactive and innovative investigative journalism at journalism schools across the country. News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education. It is headquartered at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication. Republished with permission.

But egg producers in much of the rest of the country haven’t followed suit. Last summer, two large Iowa producers recalled 500 million Salmonella-tainted eggs – the largest egg recall in history – as more than 1,900 people nationwide got sick and scared many consumers away from eggs.

Jim Bussey was one of them. He ate an egg-and-sausage taco served from a catering truck outside his office in Houston. That breakfast led to a four-day hospital stay, during which his kidneys nearly failed. A year later, diarrhea still plagues him and he needs surgery.

Millions of Americans suffer from foodborne illness each year. Michael Batz, head of food safety programs at the University of Florida’s Emerging Pathogens Institute, calculates the cost to all of those victims. He factors in missed work, medical bills, victims’ assessments of how their illness harmed them (called “quality-adjusted life”) and premature deaths.

Batz figures that the monetary loss from Salmonella-contaminated eggs is $370 million annually. The non-monetary loss is also substantial. An estimated 115,000 people suffer this type of food poisoning each year, resulting in 42 fatalities, Batz estimates.

Spending two-tenths of a penny per dozen eggs to protect consumers may not sound like much, but it adds up in an industry that produces 90 billion eggs each year. It’s an example of the cost-benefit calculations some companies make as they consider implementing new food safety measures.

Profits for egg farmers are small, and lax regulations have made it more attractive for some producers to cut corners rather than invest in sanitation. Consumers, meanwhile, have little information about who produces the eggs stacked in their grocery store coolers.

New federal rules, based on the Pennsylvania program, are the first safety measures required of egg producers. The rules, which went into effect in July 2010 for large producers (about 80 percent of the industry), followed a decades-long discussion that began after the Centers for Disease Control and Prevention first traced Salmonella to eggs in 1986.

The new rules initially specified that the FDA would inspect egg farms annually, but that was later reduced to once every three years. When inspections began in September 2010, the FDA announced it would visit 600 facilities by January 2012. But a shortage of inspectors resulted in only 35 farms being reviewed in the first four months. At that rate, initial inspections won’t conclude until the end of 2014, nearly three years behind schedule.

Nor have reports been filed on all of the completed inspections. Twelve of 35 reports are unfinished because inspectors were called away to cover outbreaks associated with sprouts and cheese, according to the FDA’s website.

Nevertheless, some members of Congress wanted to cut FDA’s funding.

“The major reason food is safe in America isn’t because of government. It’s because the private sector does a huge job of self-policing,” said Rep. Jack Kingston, R-Ga., who chairs the House Appropriations subcommittee that oversees funding for the FDA.

Sarah Klein, staff attorney for the consumer-oriented Center for Science in the Public Interest, disagrees. “Forty-eight million Americans get food poisoning every year,” she said. “It’s disingenuous to say … policies that allow industry to police itself without oversight from the government are effective.”

Thin profit margins make investing in safety difficult, farmers say. The higher safety standards mean even thinner profits.

“When I worked for an egg company, we had to take things out to the fourth decimal place to see if we were making a profit or loss,” said Paul Hostetter, who now works for the nonprofit PennAg Industries Association and helps Pennsylvania egg producers comply with sanitation guidelines.

Pennsylvania’s safety efforts began in the early 1990s after eggs from that state were linked to widespread Salmonella contamination in New York. Faced with the possibility of losing their largest market, Pennsylvania egg farmers began a quality assurance pilot program.

Iowa, the source of last year’s massive egg recall, is the largest egg-producing state by a wide margin, turning out 14 billion eggs annually. An egg quality assurance effort there had gone inactive in recent years.

The FDA estimates that the new federal rules, which are slightly more rigorous than the Pennsylvania standards, will cost large egg producers $100,000 each year. That means the 175 biggest companies, which constitute 95 percent of the industry, together will spend about $20 million annually to comply. That’s a fraction of the $370 million that Batz calculates as the annual cost of egg-related Salmonellosis.

Even so, egg producers interested in keeping their costs down may not see the potential savings to consumers as an incentive to pay for better sanitation, despite the new FDA rules. At the grocery store, customers still won’t know if the eggs they are buying come from sanitary farms.

“Obviously [many in the industry] don’t want to unduly burden themselves with preventive measures that are costly,” said Klein. “Especially when they believe the chances of causing an outbreak – or having an outbreak traced to them – are small.”

In the event that an illness is traced to its source, the offending farmer does pay a considerable price. For example, Wright County Egg, the larger of the two major Iowa producers responsible for the 2010 recall, was shut down for four months last year. Both farms face numerous lawsuits over the contamination.

“There’s that risk assessment of the cost of complying versus the cost of getting caught,” said Daniel Otto, an economist at Iowa State University. “You have to have commensurate penalties and a high probability of detection and enforcement” for the new regulation to be effective.

Wright County Egg, one of several egg farms and related businesses (until recently) owned and operated by Austin “Jack” DeCoster and his family, produces about 1.4 billion eggs each year, or more than one out of every 100 eggs in the country. In a 2003 article about DeCoster’s businesses, which have frequently been fined for health and safety violations, the Omaha World-Herald estimated his annual profits at $13.3 million.

When inspectors checked Wright County Egg’s barns after last year’s salmonella outbreak, they reported finding uncontained mountains of chicken manure; feces in the hens’ food supply; rodents; and maggots and flies “too numerous to count.”

In testimony before Congress in September 2010, DeCoster’s son Peter said the Salmonella contamination had likely come from the chicken feed used on his family’s farms, not the conditions of the farms themselves. Peter DeCoster did not return several calls seeking comment for this story.

Jim Bussey has been sick for more than a year now. His job with a defense contractor makes it difficult for him to miss work, but he said he has no choice but to take time off. His doctor has told him he needs hemorrhoid surgery to repair the damage from his Salmonella attack.

—————-

Mattea Kramer wrote this story while a Carnegie-Knight News21 fellow from Harvard. The s
tory was part of the “How Safe is Your Food?” project of News21, a program of the Carnegie Corporation of New York and the John S. and James L. Knight Foundation to foster in-depth, interactive and innovative investigative journalism at journalism schools across the country. News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education. It is headquartered at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication. Republished with permission.

The two were on Capitol Hill representing the interests of small farms as Congress drafted legislation to revamp the food safety system. Congressional staffers had just informed the pair that, in the version of the bill then under consideration, the same industrial-level regulations would apply to every food “facility” – whether a multimillion-dollar Cargill operation or a rural family’s jam-making enterprise.

Snyder and Libby said the plan sounded unrealistic for small farms.

But by the time the legislation passed, in late December 2010, the two men had found common ground with an unexpected and surprisingly powerful coalition: locavore consumers who savor food from local growers, tea party members fighting big government, and small farmers with a deep mistrust of the Food and Drug Administration, which will implement the new law.

Together, coalition members successfully pushed lawmakers to include an exemption for tens of thousands of small farms in the sweeping Food Safety Modernization Act (FSMA).

Yet in the polarizing year-and-a-half-long debate that preceded passage, Congress missed a chance to create a workable food safety plan for small farms. Instead, it opted for exemptions based on farm size and a loose definition of “local” that critics say leaves the country open to multistate outbreaks of disease.

The new food safety act expands the FDA’s authority to require food producers to evaluate hazards and write detailed safety plans. It also authorizes the agency to establish science-based standards for the harvesting and handling of raw fruits and vegetables.

The exemption for small farms, spelled out in the act’s Tester-Hagan Amendment, was based on the argument that implementing the new requirements would be too expensive and burdensome for small-scale growers. At the heart of the amendment, however, is the belief that food from small farms doesn’t make large numbers of people sick – an assertion not supported by scientific evidence.

The Tester-Hagan Amendment, sponsored by Democratic Sens. Jon Tester of Montana and Kay Hagan of North Carolina, defines small farms as those that average annual gross revenue of less than $500,000 over three years and that sell a majority of their products directly to consumers, restaurants or grocery stores within the same state as the farm or within 275 miles of it. Farms that meet this definition will be exempt from developing a detailed food safety plan, keeping extensive records, and complying with produce safety rules the FDA will finalize over the next two years.

“There’s no scientific basis for Tester,” said David Plunkett, senior staff attorney for the Center for Science in the Public Interest, one of the consumer advocacy groups that took part in the FSMA debate. “It’s an accommodation so that the bill would be able to make its way through the Senate and the Congress and get to the president’s desk.”

The measure does direct the FDA to study, for the first time, the incidence of foodborne illness in relation to the size of food producers and the operations they employ. Advocates for small, local farms hope that the findings, which are expected next year, bolster their contention that small-scale growers produce safer food, in part because fewer people handle it.

What’s more, they say, if an outbreak of illness does occur, it can be traced quickly because of the direct-sales relationship between small-scale producers and their customers.

But consumer advocates point out that exempted small farms can still sell almost half of what they produce to large distributors – food that can wind up reaching a lot of people.

“It’s a loophole. It’s a loophole that is going to come back and harm small producers in the long run,” said Bill Marler, a food safety advocate and lawyer who represents victims of foodborne illness. (Marler is the publisher of Food Safety News.)

Tainted Spinach

In one such case, spinach from a small farm that was sold through a distributor sickened at least 13 people in Washington and Oregon in 2008. Two of the victims developed hemolytic uremic syndrome, an infection that can cause life-threatening kidney failure.

The spinach was tainted with deadly E. coli O157:H7 bacteria. Health investigators eventually traced the source through the distributor, Organically Grown Company, based in Eugene, Ore., to Willie Green’s Organic Farm in Monroe, Wash. Willie Green’s sells a majority of its food directly to consumers and likely would qualify as exempt under the new law.

Health officials from Oregon and Washington who investigated the outbreak confirmed Willie Green’s as the source. But William E. Keene, senior epidemiologist at the Oregon Public Health Division, said the problems found weren’t any different from what he’s seen on other small farms. Small outbreaks happen often, he said, but most never get reported.

“We have very limited resources and other things come along,” Keene said. “People don’t have the time or the budget to do a gigantic investigation on everything. And even if we did, there’s no guarantee we would find anything.”

Since the outbreak, Willie Green’s has worked to pass an inspection of its food safety practices; owner Jeff Miller says food safety is a top priority on the 21-acre farm.

“[The outbreak] happened; you don’t want it to happen, but you do the best you can and improve and move forward,” Miller said.

Safety Sells

Small farms like Willie Green’s are implementing food safety plans not because the government requires them, but because they want access to large retail food markets. Buyers for those markets know that their customers want locally grown food, but the stores shy away from farms that lack tough safety standards. Also, in the event of an outbreak, farms with tough standards may lessen their liability – and that of the buyers – by showing their attention to food safety.

In the sprout house at Edrich Farms in Randallstown, Md., safety agreements with buyers mean that Amy Annable, the manager of sprout operations, spends at least 30 minutes each day and an additional hour each week on paperwork and testing to assure those buyers that her sprouts are safe. Even her seed supplier wants verification that she is testing its seeds before she sprouts them, so that they can share liability should the sprouted seeds make someone sick.

Annable’s knows that if her sprouts sicken anyone, it would kill her business. “An outbreak,” she said, “is my worst nightmare.”

Even though some in the industry have implemented contractual food safety plans with farm suppliers, consumer advocates say it’s still not enough.

“Is a system that relies only on voluntary and private contractual agreements comprehensive enough to ensure safer food? The answer is no,” said Sandra Eskin, director of the food safety campaign at the Pew Charitable Trusts. “Those things can be add-ons, but we need a floor of enforceable government regulations.”

Assessing Risk

Snyder, the director of the Pennsylvania Association for Sustainable Agriculture, who lobbied for small-farm interests during the debate over the FSMA, said the discussion over food safety on small farms should have focused on the ability to trace food back to its source, not the size of the farm.

The idea was part of a House amendment that als
o focused on risk. It fail
ed. The subsequent Senate debate was quickly dominated by the anti-government fervor brewing in the tea party and by the locavore belief that small farms equal safe food.

“Let’s face it: Dangerous foodborne outbreaks don’t start with family agriculture,” Tester said in a statement released by his office after he introduced his exemption amendment. “Food produced on that scale shouldn’t be subject to the same expensive federal regulations as some big factory that mass-produces food for the entire country.”

The large agriculture lobbies that originally supported FSMA switched sides once the amendment was added. They argued that an outbreak of any type hurts every farm, regardless of size, by scaring off customers.

To make sure the bill would pass, consumer groups grudgingly accepted the amendment, but only after the “local” food distribution radius was trimmed from 400 to 275 miles and lawmakers included a provision that any farm linked to an outbreak could lose its exemption.

——————

Madhu Rajaraman, Maggie Clark and Andy Marso wrote this story while Carnegie-Knight News fellows from Maryland. The story was part of the “How Safe is Your Food?” project of News21, a program of the Carnegie Corporation of New York and the John S. and James L. Knight Foundation to foster in-depth, interactive and innovative investigative journalism at journalism schools across the country. News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education. It is headquartered at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication. Republished with permission.

Since 2006, Salmonella outbreaks from products such as eggs, cantaloupe and turkey burgers have sickened at least 6,000 people, resulting in more than 700 hospitalizations and 11 deaths, according to the U.S. Centers for Disease Control and Prevention.

A News21 analysis of Salmonella reporting practices found that differences across the country put residents of the worst-performing states at risk and undermine national outbreak surveillance by placing disproportionate responsibility on smaller states.

California, Texas, Florida and Illinois make up more than 30 percent of the U.S. population, but they contribute 15 percent to national Salmonella outbreak surveillance. Meanwhile, Massachusetts and Missouri comprise 4 percent of the population and contribute nearly 9 percent to surveillance.

Disease reporting relies on highly variable state requirements. States like Colorado and Alabama that allow up to a week to submit a report for many illnesses, including Salmonella and E. coli, may take longer to learn about an outbreak than states with more stringent requirements.

In the summer of 2008, one of the biggest and most widespread outbreaks in American history tested surveillance measures in 43 states and exposed weaknesses in the nation’s ability to identify and respond to outbreaks.

When it was over, Salmonella-tainted jalapeno and serrano peppers had left two men dead in Texas, and around the country put 308 people in hospitals and made at least 1,500 others across the country sick enough to seek medical attention.

In large outbreaks, underperforming states prevent efficient responses and rely on the surveillance of other states. The same is true in smaller outbreaks; some of these elude surveillance entirely.

“There are multistate outbreaks out there that we don’t recognize and we don’t know about,” said Dr. Tim Jones, state epidemiologist for the Tennessee Department of Health. National outbreak surveillance depends on the collaboration of 2,800 state and local health departments subject to at least 50 different reporting requirements.

In some states, reports from doctors and hospitals go directly to the state health department, which handles large-scale outbreak surveillance. Reporting in bigger states is often more fragmented, with reports going to largely independent local health departments, which then report to the state.

For Salmonella, E. coli and other bacterial illnesses, requirements for reporting can also include the submission of what is called an isolate to the state health department, which can be tested to identify outbreaks.

In the same way miners extract metal from certain rocks, laboratories can extract a Salmonella isolate from a patient’s stool sample.

On May 22, 2008, the New Mexico Department of Health performed high-tech testing on isolates from four Salmonella victims and identified the same genetic “fingerprint” on each of them: they were part of the same outbreak.

The New Mexico state laboratory uploaded the test results to a national database known as PulseNet. The next day, health officials in Texas and Colorado used the database to match fingerprints of local cases with those in New Mexico, proving they were associated with the outbreak.

Though PulseNet can identify local outbreaks, the network specializes in discovering widespread outbreaks associated with “industrial contamination events,” where the food is infected in the supply chain before reaching grocery stores and restaurants, said Dr. Ian Williams, chief of the CDC’s outbreak response and prevention branch. These outbreaks often result in a handful of reported cases in multiple states. Without PulseNet connecting the dots, epidemiologists have few leads to investigate the source of illness.

“PulseNet is the engine that finds [multistate] outbreaks,” Williams said, “and my group is the engine that investigates the outbreaks.”

Though the CDC coordinates investigations when these multistate outbreaks occur, it can only “provide guidelines and recommendations” as a non-regulatory agency, Williams said. Without a federal standard, each state has a unique set of disease-reporting requirements and practices.

For diseases that require reporting to the health department, the urgency and speed of response are at the discretion of each state.

In eight states, health departments must be notified immediately about cases of E. coli O157, which can cause kidney failure and death from eating contaminated foods, including raw milk, meats and vegetables. Seven states allow a week, the longest timeframe in the country, to submit the same report.

The breakdown between stringent and lax reporting requirements among states holds true for most illnesses, provided that requirements exist at all. CDC recommends reporting for 20 foodborne illnesses, but fewer than half of the states require reporting for all of them.

Though every state requires reporting for Salmonella, 12 states and the District of Columbia do not require the submission of isolates to the state public health laboratory.

As the most populous state without the requirement, Texas received the third fewest isolates for its cases in the country before the 2008 hot pepper outbreak. Its contributions to national surveillance through PulseNet would be proportional for a state with 8 million fewer people.

By June 2, 2008, Texas reported the most cases of the hot pepper outbreak in the country. The Texas Department of State Health Services acknowledged the need to increase surveillance.

“We sent out a letter to all the clinical labs in the state and we asked them to please submit all Salmonella isolates to the state lab,” said Dr. Linda Gaul, the foodborne epidemiologist for the Texas Department of State Health Services.

By simply asking, Texas received “twice as many isolates” for the rest of the outbreak, Gaul said. Over the next two months, the lab tested more than 1,200 isolates. In all of 2007, the state performed 1,835 of these tests.

By June 20, 2008, the number of cases reported in Texas doubled as a result of improved surveillance, according to CDC. Of 552 people sickened across the country, 264 were in Texas.

To begin the outbreak investigation process, epidemiologists interview victims about what they ate in the week before they got sick.

“It’s very difficult to [find the cause of an outbreak] from a single case,” said Dr. David Acheson, former associate commissioner for foods in the U.S. Food and Drug Administration. “Because you’ve got one person’s memory and they say, ‘Well, I usually buy my tomatoes at Safeway,’ but unbeknownst to them, that week they stopped at a Food Lion.”

Localized groups of related illnesses called clusters offer epidemiologists clues. By interviewing victims of clusters, investigators may learn whether they all ate at the same restaurant or bought a certain food from the same grocery store.

Clusters are difficult to investigate when too much time passes between the illness and the interview. A survey conducted by the Council for State and Territorial Epidemiologists, an organization of public health epidemiologists, found that “delayed notification from reporting sources was the most common barrier to inv
estigation of foodborne…
illness outbreaks.”

“If I line up six people and say, ‘Tell me what you ate a month ago,’ we’re going to have trouble figuring that out,” said the CDC’s Williams.

The time between getting sick, seeing a doctor, reporting the illness and testing isolates allowed two weeks to pass for more than half of the illnesses before they were identified as part of the hot pepper outbreak. From there, the speed of response and success of the investigation depend on a state’s health department.

“Minnesota is often the first out of the gate with the answer and that, in my opinion, is driven heavily by the fact that they move things through really quickly,” said Acheson. “If there were a barometer of how quick to do it, they’d be…the poster child.”

On June 23, 2008, the Minnesota Department of Health identified its first case of the hot pepper outbreak, which proved to be part of a cluster. Fifteen days later it had “unequivocally implicated jalapenos,” according to a congressional testimony by Dr. Kirk Smith, state epidemiologist in Minnesota.

Texas reported the same results earlier that week – more than a month after its first cases in late May – taking more than twice the time to reach the same conclusion. On July 9, 2008 with evidence mounting, the CDC issued a nationwide alert advising consumers to avoid jalapeno and serrano peppers, following indications that tomatoes played a role early in the outbreak.

The News21 analysis found that Texas experienced significant underreporting of Salmonella isolates before the hot pepper outbreak, handicapping its ability to identify clusters and respond to outbreaks.

With nearly 8 percent of the country’s population, Texas provided 5 percent of the nation’s Salmonella surveillance through PulseNet between 2001 and 2007. Over that same time, Texas reported the fourth fewest Salmonella outbreaks per 100,000 people, suggesting outbreaks went unidentified or unreported more frequently in Texas than in 46 other states.

These underreporting practices characterized Texas’ Salmonella surveillance before the hot pepper outbreak. As it spent the first weeks of the investigation relying on data from insufficient reporting, the outbreak continued to spread.

When it was over, the outbreak had sickened 1500 people in 43 states, Washington, D.C. and Canada, hospitalizing 308 and resulting in two deaths.

Since the outbreak, Texas has continued to request that all isolates be submitted to the state lab and increased its contribution to national outbreak surveillance to a level more proportional to population.

State health officials are discussing how to include mandatory isolate submission for Salmonella in Texas’ disease reporting requirements, Gaul said.

If the requirement is added, Florida would replace Texas as the most populous state without mandatory isolate submission for Salmonella.

Since 1998, the Florida Department of Health has received isolates for less than 20 percent of its cases, the lowest percentage in the country and less than half that of Nebraska – the state with the second lowest submission rate. Florida’s contribution to national Salmonella outbreak surveillance accounts for less than a third of its population.

With a large population, disproportionately low participation in national outbreak surveillance and no isolate submission requirement, Florida’s Salmonella surveillance mirrors Texas before the hot pepper outbreak. While Texas was able to improve its surveillance by asking for isolates, budget constraints limit Florida’s surveillance capacity, said Richard Hopkins, the state epidemiologist for the Florida Department of Health.

“If somehow, by some magic, Florida hospitals started sending the other 80 percent [of isolates] to the state public health lab, they wouldn’t have the capacity to do the [testing] that they do,” said Hopkins.

Funding issues are not limited to Florida, with health departments hurting across the country, said the CDC’s Williams. Without sufficient funding, departments have fewer resources to test isolates, conduct interviews and undertake investigations.

Foodborne outbreaks are more likely to go undetected in states lacking those surveillance and response mechanisms. While most of them will be small, localized clusters of illness, some with the scope of the hot pepper outbreak will also slip through the cracks, Tennessee’s Jones said.

“It’s just Russian roulette, waiting for enough bad things to line up,” he said, “And it’ll happen again.”

———————

Max Levy, Dustin Volz and Joe Yerardi wrote this story while Carnegie-Knight News21 fellows from Arizona State.  The story was part of the “How Safe is Your Food?” project of News21, a program of the Carnegie Corporation of New York and the John S. and James L. Knight Foundation to foster in-depth, interactive and innovative investigative journalism at journalism schools across the country. News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education. It is headquartered at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication. Republished with permission.

“It’s great to see these guys who are passionate about the food that they bring here,” said Dagli while shopping at the Ferry Plaza Farmers Market on a recent Saturday morning. “If I go to Safeway, it has no heart. There is heart here at the farmers market.”

He’s not the only one who feels that way. Dagli is part of a fast-growing consumer trend: Demand for local food is expected to reach $7 billion by 2012, nearly doubling since 2002, according to the Agriculture Department. And with more than 6,000 farmers markets currently operating in the United States — a 40 percent jump in the past five years — they are an easy place for consumers to go to get their fresh-food fix.

But the rise in popularity is accompanied by a parallel rise in concerns about how best to keep these local consumers safe from the same pathogens responsible for nationwide outbreaks of salmonella and E. coli in commercially produced foods.

Although the fare sold at farmers markets often is perceived as more wholesome than what’s available on grocery shelves, there is no evidence that it is less prone to cause foodborne illness — and it generally receives less federal and local oversight.

While few pathogen outbreaks have been linked to farmers markets, most sources of foodborne illness are never identified, and small outbreaks often go unreported. For instance, for every confirmed case of salmonellosis, at least 29 cases go unreported, according to federal estimates.

Congress exempted small farms from the more rigorous safety requirements of the new Food Safety Modernization Act. The exemption applies to farms that gross under $500,000 annually and sell the majority of their products directly to consumers, restaurants or stores in their state or within 275 miles of the farm.

State and local governments have jurisdiction over farmers markets. But while health inspectors may visit once or twice a season, most markets are left to set their own rules. Only 14 percent of market managers reported state government regulation of market rules and bylaws, according to the 2006 USDA National Farmers Market Manager Survey. Just 20 percent reported city, county or municipal government involvement.

That leaves whether and how to oversee food safety largely to the markets’ managers and vendor-operated boards of directors.

Each farmers market organization develops its own policies and means of enforcement, according to Stacy Miller, executive director of the Farmers Market Coalition, a nonprofit that promotes farmers markets, representing more than 3,500 markets. Prospective vendors may be required to submit an application, present proof of insurance and any relevant licenses, and be inspected, she added.

The Ferry Plaza Farmers Market features 80 local farms and attracts some 25,000 shoppers over the three days each week that it is open. The variety of produce on display is rivaled only by the variety of people who shop there: home cooks, gourmet chefs, health nuts, tourists and food devotees known as locavores.

Because space is limited and very popular with vendors, the market has exceptionally tough requirements. Farmers wishing to join must complete an application up to 17 pages long, be screened for several months and undergo an on-site examination by market managers regarding the farm’s food safety and sustainability practices concerning soil, crops, water, pests, waste, harvest, storage, energy, labor and sales.

Managers who conduct these inspections have a general understanding of agriculture and handling guidelines for food safety from USDA and the Food and Drug Administration, but they are not specifically trained, said Dave Stockdale, executive director of the nonprofit Center for Urban Education about Sustainable Agriculture, which has operated the market since 1999.

California requires all farmers markets to be certified through the local county health department’s agriculture commissioner. Market managers must make sure that vendors are following state health codes and farmers are selling only food they grew themselves.

“Food safety is a concern,” Stockdale said. “In the state of California, there are no specific on-farm food safety certifications that people must possess. That’s one of the reasons we ask so many questions and have such a long application, because it helps us understand what to look for when we go visit a site.”

Elsewhere, vendor selection is not always as strict.

In Arizona, for example, the Phoenix Public Market has a one-page application for prospective sellers wanting to join the 120 vendors currently active in the semi-weekly open-air market and accompanying grocery store, which are operated by Community Food Connections.

“Somebody from here tries to get out and visit the different growers,” said Cindy Gentry, the nonprofit’s founder and executive director, but sometimes farms aren’t inspected until after they start selling at the market.

When conducting farm visits, Gentry looks for production quantity to match growing capabilities, and also analyzes worker sanitation, farming methods, processing and distribution.

“It’s been a learning curve for me,” she said, adding that she has received some on-the-job training from farmers who sell at the market regarding proper agricultural and handling practices used to ensure food safety.

Gentry said small farms should not be held to the same government standards as commercial farms due to their limited resources and the greater level of transparency in direct sales between farmer and consumer.

However, Richard Molinar, small farm program adviser for the University of California Cooperative Extension in Fresno, thinks the local food movement will put pressure on local farms to develop food safety plans.

“Certainly more people are wanting to buy fresh and buy local; that doesn’t mean that they’re not concerned about food safety,” said Molinar, who helps small farmers develop scaled-down food safety manuals. “When you go to swap meets or farmers markets, I think at some point consumers are going to want to see or know if those farmers have some kind of policy in place.”

Elizabeth Armstrong has already reached that point. The Indianapolis mother two represents an exceptionally motivated local food devotee.

In 2006, her then-2-year-old daughter nearly died of kidney failure after eating commercially produced spinach contaminated with E. coli. As a result, Armstrong refuses to buy grocery store produce, instead serving her family vegetables from their own garden and fruits bought at farmers markets just minutes from their home.

“What’s important for us, as a consumer, is just to have the transparency that the farmer will tell us how he is producing his food and what steps he’s taking to ensure that it’s safe,” she said. “Then it’s our choice.”

——————

Stephanie Snyder wrote this story while a Carnegie-Knight News21 fellow from Arizona State.

News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education

Rather than identifying the specific strain of E. coli, such as O157 or O104, faster tests only recognize a poisonous toxin known as shiga, casting doubt on the accuracy of official numbers reported by the Centers for Disease Control and Prevention, according to foodborne disease epidemiologists interviewed by News21.

Most E. coli strains are harmless, but a few hundred harbor shiga toxin, which causes bloody diarrhea and can lead to kidney failure and death, usually in small children. E. coli O157 and other shiga toxin strains are typically transmitted by consuming undercooked ground beef, raw produce and unpasteurized milk.

“If (physicians) know there’s shiga toxin in there, that’s all they need to know for treating the patient,” said Dr. Tim Jones, Tennessee’s state epidemiologist and a leading researcher of foodborne disease surveillance.

But knowing what strain of E. coli a patient has is crucial to uncovering foodborne outbreaks and improving public health surveillance. The interests of public health and patient care do not always align, however, especially when cost is an issue.

“All of the sudden, it’s cheaper for clinicians to do toxin tests,” said Dr. Laurene Mascola, chief of communicable disease control for the Los Angeles County Department of Health. “So that’s sort of a scary trend for the future.”

Since 1996, CDC has been assessing national trends in foodborne diseases based on surveillance data through a system called FoodNet. Of the foodborne diseases monitored during the last 15 years, only E. coli O157 declined enough – by 50 percent – to meet the government’s 10-year national health objective set in 2000, according to the agency’s annual report released in June 2011.

“It’s definitely true that the reported rates have gone down, but it’s not possible to tell from that if the true rates have gone down,” said Dr. Bela Matyas, a foodborne disease epidemiologist and chief health officer for Solano County in Northern California.

For decades, physicians had the tools to test for only E. coli O157 by taking a patient’s stool sample and growing a culture, which could take two to three days.

During the last 10 years, new rapid tests have allowed doctors to test broadly for the shiga toxin without identifying the exact strain. These tests allow for diagnosis within a few hours instead of a few days.

But as the Center for Infectious Disease Research & Policy at the University of Minnesota reported in July, “Clinical laboratories are increasingly using (rapid) tests to detect (E.coli), either along with or instead of the traditional method of growing the bacterium in a culture.”

When labs forgo culture testing, the specific strain of E. coli is not identified. It is not known how many of these unidentified strains are O157, and they are not counted in CDC reports.

CDC officials acknowledge that they can’t account for rapid testing in their surveillance. The agency does not know how prevalent the toxin tests for E. coli are becoming and is uncertain how surveillance results are affected, said Dr. Olga Henao, who leads coordination of FoodNet.

Part of Mascola’s job in Los Angeles involves urging physicians to perform culture tests, but arm-twisting only goes so far, she said, when hospitals don’t consider culture tests cost effective. Her experience highlights the growing divide between individual patient care and public health.

“They really don’t care from a personal point of view whether you have salmonella or shigella; they just want you to get better,” Mascola said. “Whereas from a public health point of view, we want to know about every possible foodborne organism to see whether or not it’s part of a bigger picture.”

Without a culture test, labs lack the puzzle pieces to link cases in a way that identifies an outbreak. This makes it almost impossible to trace an outbreak to its food source, putting the public’s health at greater risk.

Additionally, research demonstrates that rapid testing is a problem when used for other foodborne diseases. A 2010 Minnesota Department of Health study found traditional non-rapid testing identified cryptosporidiosis, which causes diarrhea and vomiting, as a correct illness 97 percent of the time. Rapid testing in clinical laboratories led to a correct cryptosporidiosis diagnosis 56 percent of the time.

Similar tests are coming out for campylobacter, which can cause bloody diarrhea, according to Dr. Kirk Smith, a senior foodborne epidemiologist in Minnesota and co-author of the study. Campylobacter sickens more than 2.4 million Americans each year.

Since 2009, the CDC has recommended that labs perform both a rapid test and a culture test for E. coli, a suggestion Tennessee’s Jones said is increasingly unrealistic because of the costs and labor involved. More labs, he said, are beginning to use only rapid tests.

A survey Jones conducted found that only 16 percent of labs in his state performed rapid tests for E. coli in 2007. By 2010, that rate had increased to 52 percent. During the same period, a third of Tennessee’s E. coli cases were tested only for shiga toxin, meaning a specific strain was never identified.

Cases simply labeled as shiga toxin-producing E. coli are not counted by the CDC as confirmed, though the U.S. Food and Drug Administration accepts them.

“CDC is saying, ‘We don’t know how good those tests are, we’re not going to count them,’ … and it’s going to look like (E. coli) is going away,” Jones said. “When that’s absolutely not going to be the case.”

To combat the increased use of rapid tests, some states are requiring that clinical labs send samples to state public health labs for a culture tests after shiga toxin is found.

Although this process leads to a delay in matching specimens and places an added burden on state labs operating on taxpayer dollars, it is better than the alternative, Jones said. He added that rapid tests are an unavoidable reality of modern public health surveillance for a growing number of infectious diseases.

“Next it’s going to be salmonella, and who knows what else after that,” he said.

———————

Dustin Volz wrote this story while a Carnegie-Knight News21 fellow from Arizona State. The story was part of the “How Safe is Your Food?” project of News21, a program of the Carnegie Corporation of New York and the John S. and James L. Knight Foundation to foster in-depth, interactive and innovative investigative journalism at journalism schools across the country. It is headquartered at Arizona State University’s Walter Cronkite School of Journalism and Mass Communication. Republished with permission.

News21 is part of the Carnegie-Knight Initiative on the Future of Journalism Education.