Beth Krietsch | Food Safety News

Food Safety and Socioeconomic Status: Is There a Link?

Beth Krietsch — Tue, 18 Nov 2014 07:00:57 +0000

Curious about how race and socioeconomic factors factor into foodborne illness risk, a number of researchers over the past few years have looked at foodborne illness risk among low-income and minority populations. Study findings show increased risk among minority populations, but researchers experience difficulty ascertaining whether disparities exist at the income level, mainly because of the way foodborne illness data is tracked. Jennifer Quinlan, an associate professor in the Department of Nutrition Sciences at Drexel University whose research focuses on identifying food safety risks for minority racial/ethnic and low-income populations, says that, overall, data shows a greater risk of foodborne illness among minority populations, but income-level data is hard to come by. Quinlan’s research has found that food safety problems are more prevalent at small, independently owned markets where many urban, low-income and minority populations shop. Risks include produce with high microbial counts, bacteria in milk and fecal coliform contamination. Quinlan and her fellow researchers speculate these risks could be related to transportation, sanitation and refrigeration practices at resource-constrained establishments. In addition to risks in the retail environment, cultural background and knowledge of best food safety practices also play a role in foodborne illness rates. Safe food handling practices in the home are of particular importance. A study out of the Emerging Infections Program at the Yale School of Public Health found that among children under age 10, more cases of campylobacteriosis occurred among low socioeconomic status populations. Food safety risk may be higher among low socioeconomic status groups due to limited food safety knowledge, crowded homes and smaller kitchens, James Hadler, one of the authors of the study, told Food Safety News in June. Focus groups conducted as part of a Cornell University study on food safety risk among Mexican-Americans living in the United States found that most focus group participants (80 percent of whom were from low-income populations) did not properly defrost meat; many frequently left food out for more than two hours before refrigerating, hastily washed cutting boards and utensils before reusing, consumed raw eggs despite knowledge of Salmonella risk and believed food thermometers are unnecessary, according to Pilar Parra, research associate and senior lecturer at Cornell University’s Division of Nutritional Sciences and lead author of the study. She says the study also gave her group insight into how to improve food safety practices among the population represented by the focus groups. “The study shows we have a very nice window of opportunity to launch very tailored messages,” said Parra in an interview. Researchers speculate that resources for maintaining safe food preparation and handling practices within the home could be more limited among low socioeconomic status populations. For example, they might not have access to adequate cleaning supplies or water hot enough for cleaning. “There’s a poverty issue but there’s not funding to look at it,” Quinlan told Food Safety News in an interview. “There is a basic lack of resources for proper safety and sanitation.” According to Christopher Waldrop, director of the Food Policy Institute at the Consumer Federation of America, it appears that foodborne illness risk is higher among low-income populations, but research in this area is not robust or conclusive enough to paint a strong picture of the situation. As outlined above, most studies involving food safety among low-income or minority populations are small or regionally focused, making it hard to generalize findings. These small studies are helpful for understanding issues that may be relevant to very specific populations, but a major initiative in this area would be helpful, Parra says. One challenge contributing to the limited research in this area is that there is no data tracking foodborne illness by income level. The Centers for Disease Control tracks foodborne illness data by factors including age, sex and ethnicity, but not by income. Researchers interested in foodborne illness risks among low-income populations agree that data collection at the income level would be helpful for advancing findings in this area and protecting public health. As of now, “The best you can do is try to correlate [foodborne illness with] minority populations, which tend to be low-income and tend to have higher risk of foodborne illness,” Quinlan says. Income-level data would allow researchers and public health professionals to better understand how foodborne illness impacts low income populations, as well as to better allocate resources and create more targeted public health programs and interventions to address potential disparities. “CDC has capacity to develop a broad strategy and get all stakeholders on board in terms of how to collect that information at the local level,” Waldrop says. “They are in a really good position to drive that approach.” Until then, public health advocates must remember that while increasing access to nutritious and affordable foods among low income populations is of extreme importance, efforts must be made to ensure the foods sold are safe and that consumers know how to prepare and store foods in a way that protects their health.

Food Fraud: Money Scam and Health Hazard

Beth Krietsch — Mon, 10 Nov 2014 07:00:46 +0000

Despite the common belief that food fraud in the United States is a rarity, the globalized nature of our food supply chain means many of our favorite foods and ingredients travel far and wide before they reach our plates, making adulteration and other types of food fraud a considerate problem here as well. And it’s not just one food being called another (e.g. escolar as tuna) that we need to worry about. Many of the foods we consume every day are filled with ingredients that aren’t supposed to be there. Food fraud occurs with varying frequency in foods across the board—oils, dairy, meats, alcohol, sweeteners, spices and more. As much as food fraud is a cost-driven economic issue, it’s important to remember that it is also a public health issue. Much adulteration involves unconventional contaminants that we know little about, making the health risks difficult to quantify yet still substantially problematic, and also hard to address. “Food fraud is complex,” says John Spink, director of the Food Fraud Initiative at Michigan State University, in an interview. “It happens because bad guys are good at finding small gaps.” In a recent revision to Food Safety Modernization Act (FSMA) rules, currently open for public comment, the U.S. Food and Drug Administration proposes to address economically motivated adulteration (EMA) within the preventive controls rule rather than within the intentional adulteration rule. FDA suggests a focus on adulterants that are most likely to cause illness, as well as on circumstances where there has been a pattern of adulteration in the past. The problem with this thinking, explains Karen Everstine, research associate at the National Center for Food Protection and Defense at the University of Minnesota, is that historically, many of the most impactful adulterants have been the ones that no one expected. After all, most cases of adulteration are organized by experienced criminals who work hard to avoid detection. Take, for example, the Chinese milk scandal in 2008 when six people died and hundreds of thousands were sickened by milk products adulterated with melamine. Yet, prior to the incident, authorities and stakeholders were unaware of any potential problems surrounding the adulterant at hand. This is why proactive, rather than reactive, thinking is important in food fraud prevention efforts. Instead of simply testing products for adulterants, this could mean working to think more like a criminal, Everstine says. U.S. companies looking to prevent food fraud in the products they source from overseas are increasingly turning to food fraud vulnerability assessments, which identify and investigate parts of a food supply chain most likely to be subject to food fraud incidents. These assessments look at factors including supply chain characteristics, relationships with suppliers’ quality assurance measures, fraud history, economic indicators and geopolitics, always looking to identify opportunities for fraud before it can happen. “We try to determine why a criminal would perceive a crime opportunity,” Spink says. “When we understand that motivation we can try to put systems in place to prevent it.” Vulnerability assessments sometimes involve looking at large amounts of data, such as hundreds of seemingly random incidents that when analyzed together may cluster into groups and help stakeholders focus on areas of concern. Everstine believes big data has potential to play an important role in addressing food fraud in the future. For example, a protected data platform that facilitates data sharing between industry and government could be helpful for gathering intelligence. “Its about finding a way to tackle the problem together and share the intelligence that will give people a way to proactively address things,” Everstine says. A food fraud detection and prevention company called Inscatech conducts on-the-ground food fraud intelligence investigations as a way of getting closer to the root of the problem. The company employs a network of undercover operatives around the world who discretely investigate food fraud on behalf of many large U.S.-based companies that are concerned about the authenticity and safety of the foods they import. Some companies are proactive when it comes to making these investigations happen, but other companies remain more passive, worrying an investigation has the potential to open a costly and complex can of worms. One way of reducing food fraud is to encourage companies to be more diligent about conducting background screenings of their suppliers, says Mitchell Weinberg, president and CEO at Inscatech. For example, if a commodity is cheaper than average, the buyer might want to figure out whether food fraud played a role in driving down that price. “If companies were to source as much as possible in the U.S., our foods would be much safer,” Weinberg says. “But our industry is driven by costs, so they are going to markets outside the U.S.”

Food Safety Challenges: Bridging the Gap Between the Public and Private Sectors

Beth Krietsch — Mon, 03 Nov 2014 05:09:36 +0000

Until recently, just a few standard methods were used for foodborne pathogen identification. But these days, technological advances, including culture independent testing and whole genome sequencing, are quickly changing the space and speeding the testing process, but also sometimes complicating it. Though government agencies maintain foremost control in protecting our food supply, many times these cutting-edge advances originate in academic institutions and laboratories within the private and non-profit sectors, and it can be tough for government to keep up with all the developments. In response, both the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) launched food safety contests this fall, looking to bridge the gap between the public and private sectors. While the approaches and end goals are slightly different, each challenge aims to spur innovation in the field of pathogen detection by tapping into communities of academics, entrepreneurs and others who do not work for government labs. Both challenges were developed through the America COMPETES Reauthorization Act, which allows federal agencies to launch prize-based competitions to find innovative solutions to tough problems. The challenges facilitate collaboration between the public and private sectors, contributing to a stronger research arena capable of birthing innovations that can make Americans both healthier and safer, according to the U.S. Chamber of Commerce. With its Food Safety Challenge, FDA is calling for groundbreaking ideas around the detection of Salmonella in minimally processed fresh produce. With a hefty prize pool of $500,000, the agency hopes the contest will spur involvement from scientists, entrepreneurs and academics outside government walls who may not traditionally work in food safety but still have potential to expand FDA’s food testing capabilities and efforts to maintain a safe food supply. In addition to innovative pathogen-detection processes, FDA is hoping for concepts that speed up testing without scarifying specificity or sensitivity. Think spectroscopy, quantum detection, electrical detection, whole genome sequencing and nanotubes, for example. With speed acting as a central factor, FDA is asking participants to describe how and where in the testing process their innovation saves time. Whether the concept is completely new or works well in conjunction with existing methods is up to the participant, but the end goal ideally is to come up with a product FDA could actually use, says Dave White, chief science officer and research director at FDA’s Office of Foods and Veterinary Medicine. “The idea is that the challenge will encourage more rapid innovation and dialogue in how to apply these new technologies to detection and identification of foodborne pathogens, as well as possibly lead to future partnerships,” White says. Keeping with the theme of generating broad interest among non-governmental innovators, the prize money most probably will not go to one participant alone. FDA plans to award up to five finalists with $20,000 and an invitation to participate in a field accelerator program. Each of the finalists will then present their ideas to a team of judges from FDA, CDC and the U.S. Department of Agriculture, who will select a winner to receive the remainder of the prize money. Meanwhile, over at CDC, wheels are spinning to develop non-culture based diagnostic tests to maintain and improve public health activities for a range of pathogenic organisms. Launched in September, the agency’s No Petri-Dish Diagnostic Test Challenge is similar to the FDA Food Safety Challenge in that it aims to involve non-governmental scientists and researchers in proposing innovative solutions to testing challenges. The task is particularly important given that foodborne outbreak surveillance networks such as PulseNet rely on isolates of bacteria in their detection and surveillance work, but new culture-independent diagnostic tests that do not rely on pure bacterial cultures are proliferating in clinical labs, posing a challenge to PulseNet’s outbreak identification efforts. “There is general concern that if we lose the ability for PulseNet to be effective, there could be impacts on food safety,” says John Besser, deputy chief of the Enteric Diseases Laboratory Branch at CDC. Thus, PulseNet and CDC are focused on validating and developing new subtyping methods that address the shift from culture-based to culture-independent diagnostic testing. A big part of these efforts involves strengthening collaborative efforts with other stakeholders who may be able to help, including those from the food industry, academia and the non-profit and for-profit sectors. “We are very interested in the positive effects of culture-independent diagnostic tests,” Besser says. “They will most likely be very beneficial to patients, labs, and users of lab data.” With a $200,000 prize purse, CDC is calling upon participants to develop non-culture based methods to characterize or straintype Shiga toxin producing E. coli (STEC) by isolating STEC from the clinical sample in such a way that important information is immediately available for public health use. Speed and applicability are of the essence here, so CDC is requesting all solutions submitted are scalable and have a sample-to-answer turnaround time of less than two days. Submissions are due by Nov. 30, and judges will announce the winner by Dec. 15. Like FDA, CDC sees its challenge as a way of expanding the work it’s doing and improve public health by increasing collaboration with creative thinkers who do not work for the government. “We are pursuing a number of different options right now, but we don’t know the full world of ideas out there,” Besser says. “This really represents a mechanism for fleshing out new ideas we haven’t thought of.” For both agencies, the multipronged approach of encouraging involvement from individuals and groups it does not traditionally work with is a way to drive more creative solutions toward addressing difficult public health challenges related to the safety of our food system.

Lab Testing: Hunting for Pathogens on Poultry

Beth Krietsch — Mon, 28 Oct 2013 05:01:45 +0000

The mishandling or undercooking of raw chicken meat associated with the recent Foster Farms Salmonella outbreak has sickened nearly 340 people across 20 states and Puerto Rico since March and has caused concern among consumers, consumer groups, and food-safety advocates about the safety of our food system and the efficacy of testing systems designed to keep our nation’s food supply safe. After identifying three California processing facilities as the likely source of the Salmonella outbreak, the U.S. Department of Agriculture issued a public health alert and allowed the plants to remain open. USDA did not mandate a recall nor did Foster Farms issue a voluntary recall, but the company agreed to implement practices to improve food safety at its three Central California processing plants. Currently, federal law under USDA allows for 7.5 percent of whole chicken carcasses to be contaminated with pathogenic bacteria such as Salmonella and Campylobacter. This means that products contaminated with Salmonella and Campylobacter have become common and are frequently shipped from production facilities to stores. It is up to the consumer to follow safe handling and cooking practices to avoid being sickened. USDA Food Safety and Inspection Service guidelines require microbiological sampling to monitor raw poultry for harmful pathogenic bacteria such as Salmonella and Campylobacter, but the regulations are not necessarily enforceable because no strains of Salmonella and Campylobacter are classified as adulterants. This means that most pathogen-testing standards within the poultry industry are written at the company level. Oftentimes, the testing is done so that the processors are able to ensure that their own control systems are working, said Dave Theno, CEO at Gray Dog Partners, who added that the companies that test most aggressively are the ones that achieve the highest levels of microbial control. “You use microbiological sampling to gauge the health of your business or the health of your systems,” Theno said. “It’s necessary because you are managing something you can’t see with the naked eye. So you manage the bits and pieces that you can see, but the only way to really find out if the magic is working is to take the products and sample them.” Brad Goskowicz, CEO of Microbiologics, added that a particular challenge for meat producers lies in finding methods for pathogen testing that are fast and have high accuracy, and all for a relatively low cost. Typically, to test a poultry product for pathogenic bacteria, a sample will be collected at a processing facility and sent to a lab where the sample can be tested and analyzed. A whole bird rinse is the uniformly accepted method for collecting a sample, according to FSIS, and involves placing a whole-bodied bird in a plastic bag with a set amount of dilutant. The next step involves shaking the bag before removing a portion of the rinse fluid that can be tested according to each company’s previously determined baseline levels. The specific guidelines can be found in section 4.5.6 of the USDA Laboratory Notebook. Additionally, some processors will sample specific products such as chicken legs, breasts, and thighs for microbiological testing. When a sample is tested for a pathogen such as Salmonella, the testing is done on a general basis and not for specific subspecies such as Salmonella Heidelberg. No mandates regulate the percentage of birds that must be tested from each production facility. Instead, companies develop their own best practices. A large processing center may typically sample one bird every hour or two, but a large amount of variation exists, Theno said. Large-scale production facilities typically test products within their own labs, which helps save time, while some smaller producers ship their samples to outside labs. USDA issued a guide in June that helps provide guidance for selecting a commercial or private lab for microbiological testing. “It was encouraging to see the agency document the need for proper quality control, proficiency testing, and validated method use when analyses of meat and poultry samples are conducted,” said Robin Stombler, president of Auburn Health Strategies. Because the lack of government regulations and mandates leave pathogen-testing protocols to be set by individual companies for the most part, procedures and rigor of testing vary widely from company to company. But the lack of regulations does not necessarily imply that most companies do not test to a sufficient degree. “Of the major players, I think everyone is pretty aggressive at it,” Theno said. Though frequent dialogue exists about reforming pathogen-testing standards (such as stricter government regulation) to ensure a safer food system, the issue is complicated due to the large number of constituents and considerations involved. These include the “needs of the public, the costs, the limits of technology that is available today, and how you’re going to enforce a lot of the regulations,” Goskowicz said. Mandating that all microbiological testing be conducted in accredited laboratories is one idea for improving testing and the overall safety of the food that comes out of the nation’s food-processing facilities, but costs can also be a deterrent for some. “The Food Safety Modernization Act would level the playing field so that the use of an accredited laboratory with model laboratory standards becomes the ‘right thing’ for all,” Stombler said. It is important to keep in mind that although poultry-processing operations that adhere to, or exceed, USDA pathogen-testing requirements work toward preventing harmful bacteria from occurring on raw poultry, there is no way to actually eliminate the existence of this bacteria, according to USDA. This is why safe handling practices at the consumer level remain extremely important.

Emerging Pathogens: Antibiotic Resistance Slowly Growing in Salmonella

Beth Krietsch — Mon, 16 Sep 2013 05:01:54 +0000

The number of antimicrobial-resistant Salmonella serotypes hasn’t increased drastically in recent years, but drug-resistant Salmonella continues to pose a public health threat in the United States, particularly as resistance spreads across classes of drugs, necessitates the use of more expensive drugs, makes treatment less effective, and, in worse-case scenarios, leaves infections untreatable. A recent Centers for Disease Control and Prevention study identified increasing resistance to a class of drugs called Cephalosporins, which are commonly used to treat severe Salmonella infections in adults and are the main drug of choice when treating children, for whom the fluoroquinolone class of drugs is not recommended. Currently, about five percent of Salmonella strains are resistant to Cephalosporins, mostly in cases of Salmonella Heidelberg and Salmonella Newport. Cephalosporin resistance is the biggest current issue in drug-resistant Salmonella, said Robert Tauxe, deputy director of the Division of Foodborne, Waterborne, and Environmental Diseases at the National Center for Emerging and Zoonotic Infectious Diseases at the CDC. Bhushan Jayarao, director of the Animal Diagnostic Lab at Pennsylvania State University, echoed that sentiment, adding that Salmonella Typhimurium and Salmonella Heidelberg are at risk of acquiring CTX-M resistance to cephalosporins. CTX-M is one form of the beta-lactamase enzymes that breaks down cephalosporins (which are used to treat severe Salmonella infections in humans) and thereby confers resistance to the bacteria that produces this enzyme. READY-TO-EAT MEAT The CDC study found that the main mechanism of resistance to cephalosporins is the production of beta-lactamases, which are enzymes that manage to inactivate the antimicrobial agent. Of concern to the researchers is the fact that the genes related to antimicrobial resistance are often mobile, moving between bacteria and Salmonella serotypes, humans and animals. “The same genes were seen in several different kinds of Salmonella and in Salmonella collected from meat, animal and human samples, which shows that this gene is now pretty widespread,” said Maria Karlsson, research microbiologist with the National Antimicrobial Resistance Surveillance team at CDC. “The Salmonella are sharing this gene.” Assessing the genetic structure of resistance to provide evidence that the exact same genes are flowing from animal to food to humans and between types of Salmonella is an advanced method of public-health surveillance and is something the CDC hopes to do more of in the future, Tauxe said. It is typically difficult to trace the transmission of Salmonella strains within and between animal and human populations because of the rapidly changing nature of resistance patterns in bacteria. However, researchers from Penn State recently developed a way to identify and track Salmonella Typhimurium as it evolves and spreads. The research centers on virulence genes and regions of the bacteria’s DNA called CRISPRs, short for clustered regularly interspaced short palindromic repeats. CRISPRs are present in a large number of foodborne pathogens and can be used to identify antibiotic-resistance patterns within Salmonella Typhimurium. The researchers chose to study resistance and spread within Salmonella Typhimurium because it is the most frequently isolated serotype in humans, food, animals and the environment. Information garnered from the study of Salmonella Typhimurium isolates is now being applied to other serotypes, including Kentucky, Heidelberg, Enteritidis and Infantis. Additionally, Penn State researchers are engaged in studying antimicrobial resistance in pathogens other than Salmonella that are significant to animal and human health. The research includes looking at mechanisms associated with antimicrobial resistance and undertaking genome sequence analysis in order to determine which genetic determinants, aside from antibiotic0resistant genes, influence the emergence of antibiotic resistance. “I am very certain that, in the next couple of years, we will be able to identify key global genetic determinants in bacteria that make them more susceptible or drug-resistant,” Jayarao said. “The science of genomics and proper interpretation of the genome data will truly be able to find and answer for us.” Drug resistance within serotype Salmonella Kentucky has largely increased overseas in recent years, posing a significant problem in Africa and the Middle East and sounding an alarm among researchers, food-safety professionals and public health specialists in the U.S. “If it comes to this country and gets into our poultry farms, we will run out of antibiotics to treat it,” said Susan Vaughn Grooters, food-safety research and policy associate at the Center for Science in the Public Interest. Improper agricultural use of antibiotics is often pegged as a main contributor to the problem of drug-resistant Salmonella, but other studies have failed to find evidence that these practices contribute to increased antibiotic resistance. Other theories for the development of resistance exist, such as improper use of antibiotics among humans, or even, as Jayarao noted, the spread of antibiotic-resistant clonal types not influenced by antibiotic use in animals or humans. “The most recent evidence is to suggest the spread of CTX-M resistance that was first observed in Indonesia, then in India, Pakistan and the Middle East, which then spread to Europe and very recently has emerged in Canada and the U.S.,” Jayarao said. Consumer awareness of resistance and a demand for transparency surrounding it is important, as is increased regulation regarding antibiotic use. “This is a public-health crisis and a key area for interest for CSPI and food-safety advocates and should be on the radar screen of consumers far above issues that have been getting more attention but are actually much less urgent,” Grooters said. “We have to act before it’s too late. It’s not if a multi-drug-resistant outbreak that’s too deadly to treat will occur, but when.”

What Should You Know About Diabetes and Foodborne Illness?

Beth Krietsch — Thu, 05 Sep 2013 05:01:35 +0000

Similar to any individual living with a weakened immune system or compromised body systems due to chronic disease, those with diabetes-related complications may be susceptible to increased risk and impact of foodborne illnesses. One reason those with diabetes may suffer increased impact of a foodborne illness is because diabetes-related complications may delay an individual’s natural response to infection. It can also lengthen the process of recovering from a foodborne illness compared to someone without diabetes. The most well-known complications of diabetes are related to vascular disease and frequently impact the eyes, kidneys and blood flow to the extremities. Gastrointestinal problems are also fairly common and may impact digestion by keeping food in the stomach longer. “When those types of things happen, that’s when they’re going to be at a higher risk,” said Dr. Christopher Braden, director of the Division of Foodborne, Waterborne and Environmental Diseases at the Centers for Disease Control and Prevention. The immune system of someone with diabetes may not appropriately recognize harmful bacteria or pathogens, which can increase the risk of developing infection. Likewise, gastrointestinal and kidney problems may lead to a longer illness duration and healing process if the individual does develop an infection. High glucose levels can directly affect the immune system through suppressing the functioning of white blood cells, so a person having difficulty regulating glucose levels may have a higher risk of contracting a foodborne illness. “Someone with a very hard time controlling their glucose levels could have a higher risk because of the direct effect of the glucose on the blood cells,” Braden said. It is important to keep in mind that, even among those with diabetes, the risk of foodborne illness lies on a spectrum. A person living with diabetes for quite a long time and who is on dialysis will be at a much greater risk for a foodborne illness than another individual who does not have this level of diabetes-related complications, Braden said. For someone with diabetes, the presence of a foodborne illness may have a huge impact on blood glucose levels due to the way the illness impacts what an individual can or cannot eat at the time. Thus, it is important for those with diabetes to prepare a sick-day plan for reacting appropriately upon becoming ill, said Matt Petersen, managing director of medical information at the American Diabetes Association. This plan includes basic but important factors such as having electrolytes on hand, checking glucose levels more frequently, and knowing when to call the doctor. For example, when diarrhea and a fever are both present or if dehydration sets in. “If people with diabetes are ill, they have a lot of issues to factor in,” Petersen said. “Especially if they are using insulin.” Many of the same food-safety considerations for individuals without diabetes apply to those with diabetes such as handling, cooking and cleaning food properly. But those with diabetes should be more cognizant of these ideas and ready to call a doctor when they become sick, said Dawn Sherr, practice manager at the American Association of Diabetes Educators. “The big thing is making sure to prevent foodborne illness and doing whatever you can to avoid contracting a foodborne illness,” Sherr said.

Social Media Apps Use Twitter to Track Illness Outbreaks

Beth Krietsch — Mon, 19 Aug 2013 05:01:37 +0000

The opportunity to use social media platforms to report and track foodborne illnesses is becoming increasingly feasible as more and more people use social media to discuss the ins and outs of daily life. In April, a few volunteer developers in Chicago launched an app called Foodborne Chicago, which aims to facilitate a connection between the Chicago Department of Public Health and individuals who may have been affected by a foodborne illness. The app searches Twitter for keywords that may be related to a foodborne illness, and a team of developers responds to relevant tweets by encouraging affected individuals to use an online interface to file a simple food poisoning report. The complaint forms are connected to the city’s Open311 service, which means that each report is issued a tracking number to help the affected person and the city health department keep in touch and up to date on the status of the complaint as time passes. More than 70 complaints have been submitted since Foodborne Chicago’s April launch, but not all submissions were driven through Twitter interactions. “Outside of Twitter, a lot of people are finding this form randomly as a way of logging an incident of food poisoning,” said Cory Nissen, one of the app’s developers. Nissen and Joe Olson, another developer behind the project, emphasized that a receptive and open city health department is needed to get a project such as Foodborne Chicago off the ground. “Getting [the local health department’s] cooperation is a big challenge,” Olson said. “It’s a huge barrier, but other than that, the technology is fairly easy to replicate in another city, and the costs are pretty low to implement it.” The team hopes their data can be used to more appropriately schedule restaurant inspections in a city pressed for both resources and time. They are currently working to improve the app’s rate of correctly reaching out to people who mention a possible foodborne illness over Twitter. “We are not giving 100-percent return on that, and we want to know why,” Olson said. Many keywords related to foodborne illnesses may actually have nothing to do with an illness, so it can be hard to sift through all the information on Twitter and pull out relevant information. Foodborne Chicago has been specifically designed to filter information that is not applicable, and the app has become smarter over time, the developers say. But Foodborne Chicago isn’t the only technology integrating health investigators and social media. Researchers at the University of Rochester recently developed a somewhat similar technology called nEmesis, which uses location-based Twitter data to find people who have reported symptoms of food poisoning following a restaurant visit. The tool has only been utilized as a research project thus far, but, during its testing phase, it found 480 reports of possible food poisoning among 3.8 million tweets and identified a correlation between local health department public inspection data and the cases it had identified. To be effective, nEmesis strongly relies on location data. Once a tweet is determined to be important, the technology will track the individual’s tweets for an additional 72 hours in order to capture further information that may be help to identify the presence of an illness. Researchers behind the project hope that one day the technology may complement other methods for monitoring food safety such as restaurant inspections. “If this can be developed appropriately, nEmesis could be a nice example of how crowd-sourced computational epidemiology will look in the future,” said Vincent Silenzio, a co-author of the nEmesis project and a professor at University of Rochester. Silenzio added that the tool could also be used by restaurants looking to monitor themselves and also by health professionals interested in estimating risk for a specific individual in real time. David Steigman, health communications specialist at the U.S. Food and Drug Administration, said that apps designed to track foodborne illnesses hold promise as early warning systems for possible illnesses and outbreaks. But as this type of technology continues to grow and mature, many challenges still exist such as accurately filtering and identifying Twitter and other social media platforms for correct keywords. “While these apps will never replace established outbreak response functions such as clinical identification of a pathogen or traceback investigations to identify an outbreak source, they may in the future play a significant role in outbreak surveillance,” Steigman said.