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The New England Journal of Medicine has just published a CDC report bringing the Salmonella Saintpaul outbreak of 2008 to an apologetic close (for a quick rundown on the history of this incident, see my previous posts).

The investigation of this outbreak first implicated tomatoes, with devastating effects on the tomato industry.  As the paper concludes:

Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.

Yes it does.   Jalapeño and serrano peppers turn up in salsas and guacamoles.  These are mixtures of many ingredients that are often eaten with chips or prepared foods.  People have a hard time remembering whether they ate peppers or not, particularly when the peppers are chopped fine.  As the investigators explained:

This outbreak investigation highlights the recurring challenges of epidemiologic identification of ingredients in foods that are commonly consumed, rapid identification and investigation of local clusters, the need to continue exploring hypotheses during an ongoing outbreak, and produce tracing in the supply chain.

Traceback issues such as commingling, repacking, varying degrees of product documentation throughout the supply chain, difficulty in linking incoming with outgoing shipments to the next level in the distribution chain, and the complexity of the distribution chain continue to hinder product-tracing efforts….

In addition, an understanding of the mechanisms and ecologies that can lead to contamination of produce on farms and the institution of additional control measures from the source throughout the supply chain are critical for preventing similar outbreaks in the future.

In other words, we badly need farm-to-table safety controls for all foods, no exceptions.

But, as the accompanying editorial by Michael Osterholm explains,

The new law has a major shortcoming: dollars. There was no appropriation approved by the Congress for the act or authorization in the bill for the FDA to assess fees on the companies that it inspects. The Congressional Budget Office estimated that implementing this legislation would require $1.4 billion between 2011 and 2015….

Recent reports in the media calling this act “historic legislation” must be tempered by the reality that without the necessary resources, requiring the FDA to carry out the law’s required activities will be like trying to get blood out of a rock.

Blood out of a rock?  The House just passed a bill that would CUT the FDA’s food safety budget by $241 million.

Of course the FDA doesn’t need the funds.  After all, only 21% of the 1,500 people known to have gotten sick with Salmonella Saintpaul had to be hospitalized, and only 2 died.  And Salmonella Saintpaul is in foods that real Americans don’t eat anyway, like peppers with funny foreign names and alfalfa sprouts.

I used to say that Congress would never move on food safety until a close relative of a senior Senator became seriously ill with food poisoning.   Now I have to include a senior House member.

So it wasn’t tomatoes; it was a jalapeno pepper (maybe). Congress wants to know what took the FDA so long and why the Florida tomato industry got creamed in the process. But every proverbial cloud has a silver lining: the food industry wants more regulation. It’s about time.  They finally figured out that a stronger FDA would be good for business. Look what it took to teach them this lesson!  Not a pretty sight.

Michael Osterholm writes in the current New England Journal of Medicine that despite claims that foodborne illness is declining in the United States, that is only part of the story. His editorial refers to the now-published study of Salmonella Saintpaul that I talked about in a previous post.  He says:

All these findings, however, must be interpreted with caution, since most of the decreases occurred between 1996 and 2000, and there has been little additional change since then.

When the 2009 incidence of infections with the eight primary bacterial and parasitic pathogens is compared with their incidence in the period from 2006 through 2008, no significant change can be seen for six pathogens; only the infection rates with shigella and STEC O157 show significant decreases (see graph).

In addition, recent studies have demonstrated a significant increase in the incidence of foodborne disease caused by emerging non-O157 STEC, suggesting that surveillance for O157 is no longer sufficient to determine the effect of foodborne STEC infections.

On the basis of FoodNet data for the past 14 years,we must conclude that the improvements made in the late 1990s in the safety of our food supply are still having a positive effect. But we’ve made little additional progress in the past decade.

The graph he refers to comes from Pathogen. It represents the percent change in laboratory-confirmed foodborne infections from 2006–2007 to 2009.  The horizontal line represents no change.

The epidemic of illness caused by the unusual saintpaul type of Salmonella has now affected more than 800 people, and federal agencies seem more than perplexed about its source. The FDA says tomatoes, and called for their removal from the market, an action with devastating consequences for the tomato industry. But cases are still turning up. Perhaps that is why the CDC thinks maybe something else might be the cause. Salsa? Guacamole? The produce industry is understandably interested and two websites are excellent sources of day-to-day information: the straight-news Packer, and the tell-it-like-it-is Perishable Pundit. Go to the FDA website for updates on the ongoing investigation and also provides lists of tomatoes safe to eat. Part of the difficulty in following this story is that two federal agencies are involved: the FDA and the CDC. The CDC has its own version of events (with useful maps of where the cases are in the U.S.). The USDA , which only deals with animal foods, doesn’t seem to be part of this one. It should be. The ultimate source of this outbreak has to be animal waste. This tomato (?) outbreak is precisely why we need a single food agency to oversee food safety. When, oh when?

Update, July 1: The Wall Street Journal reviews the outbreak and explains why the produce and restaurant industries are so angry.

Update, July 2: The Wall Street Journal quotes the Secretary of Health and Human Services, Mike Leavitt , saying that because multiple countries and multiple agencies are involved in the investigation, “it shows the need for better cooperation.” No. It shows the need for a single food agency!

Update, July 3: I’ve just discovered USA Today’s nifty time line of the tomato saga.

So the tomato saga continues, with the source of the Salmonella Saintpaul still not announced.  This means that you need to know which state a tomato comes from so you can avoid eating potentially tainted tomatoes from states that are still under suspicion. State-of-origin labeling, anyone? And you must take draconian measures to protect yourself from killer tomatoes: buy only the good ones (not plum, Roma, or round unless they are from OK states), wash and dry them carefully, and take your chances. Not sure what to do? Drop them in boiling water or cook them into tomato sauce. Isn’t this exciting? Not for anyone who cares about food safety or, alas, for tomato farmers likely to take the same kind of hit the spinach growers did. Check out what the Perishable Pundit has to say about all this. The Packer.com is another good place to follow this story from the industry’s perspective.

And I’ll say it again: it’s time to do something about our food safety system or the lack thereof. In the meantime, according to the New York Times, Congress again and again asked Commissioner von Eschenbach how much money the FDA needs to do the job right, but “again and again Dr. von Eschenbach refused to give an answer.” Of course he refused.  He has to.  He’s a political appointee.

So now tomatoes are contaminated with Salmonella, this time with the uncommon serotype, Saintpaul, and the FDA says not to eat tomatoes from a bunch of states in the Southwest.  But the New Mexico government says the contaminated tomatoes come from Mexico.  If this is correct, it’s globalization time again.  The FDA notes that tomatoes from everywhere are now coming into harvest. That is why, in 2007, the agency started a “tomato safety initiative” to get growers to take action to prevent Salmonella contamination. Initiatives are voluntary, here and in Mexico. Surely, it is time for mandatory? And mandatory import inspections?  Michael Doyle, a food safety expert based at the University of Georgia, says globalization raises food safety risks. This may seem evident, but I like his quote: “It is the industry that is responsible for producing safe foods. It is the government’s responsibility to verify that they are producing safe foods.”

As for the perspective of strong supporters of the produce industry, check out what the Perishable Pundit has to say about the way the FDA is handling this incident.   What he calls the “gracious” comments of California tomato growers are also worth a look.