June 30, 2008

Outbreak Puts Focus on Raw Fruits and Vegetables

By Paul Swiech, The Pantagraph, Bloomington, Ill.

Jun. 30--Public health officials want consumers to respect federal warnings, such as the latest recommendation to avoid certain types of tomatoes until the source of the most recent salmonella outbreak is investigated.

But they also urge people to continue to eat raw fruits and vegetables. Just be sure to properly wash them -- and your hands -- before eating.

Public health officials are concerned that the salmonella outbreak traced to certain tomatoes will discourage people from eating raw fruits and vegetables. No salmonella cases linked to raw tomatoes have been reported in McLean County, said Bob Keller, director of the county health department.

Benefits of eating raw produce far outweigh the risks, said Valerie Harlacher, communicable disease investigator and registered nurse with the county health department.

"Everything works better with fresh fruits and vegetables," said Robin Orr, director of programming for nutrition with the University of Illinois Extension in Urbana.

For example, "anyone with a prostate should love tomatoes because they have lycopene," which lowers the risk of prostate cancer, Orr said.

But there has been an increase in food-borne illnesses from produce.

Traditionally, people associate food-borne illnesses with meat that hasn't been thoroughly cooked and that remains a source, said Larry Carius, the health department's food program supervisor. But since the 1990s, there has been an increase in food-borne illnesses traced to raw produce, he said. The U.S. Food and Drug Administration confirmed that since 1990 there have been at least 12 outbreaks associated with contaminated tomatoes alone, and salmonella usually was the bacteria responsible.

Alfalfa sprouts (salmonella), cantaloupe (salmonella) and spinach (e-coli) are among raw produce that have been associated with food-borne illness outbreaks since the 1990s, Carius said.

One reason for the increase is because a lot more produce is imported, Keller said. Vegetables may have been grown in fields in which water used on the plants had been contaminated with animal waste, Keller said. When that happens, the contaminant is in the plant, not on the surface, so the contaminant can't be washed off.

"Poop is a problem," Orr agreed.

Carius added, "A lot of international growers are doing a great job and don't want to be painted with the same brush. They also are interested in where the mishandling occurred."

One answer is increased federal funding to provide better inspection of fresh produce, Orr said.

Improved inspection also would help federal authorities know the source of raw produce. Now, raw produce from one area may be mixed with produce from another, making it difficult to know where the food was grown. That's why federal investigators found difficult to determine the source of the contaminated tomatoes responsible for the current salmonella outbreak.

"We need to recognize that our world is changing," Orr said. "We need to track more closely where food came from, but that will require more money.

"If FedEx and UPS can track a package, why can't we track food?" Orr said.

Another way to reduce your risk of illness from raw produce is to grow your own. Gardening is good exercise, is gratifying and you get to eat home-grown, healthy food. But few people have time or space to grow more than a small percentage of the produce they consume.

Shopping at farmers' markets is a good way to support local farmers while eating fresh produce. But again, those markets likely will have only some of the produce you need.

No matter where you get your raw fruits and vegetables, wash your hands first with warm, soapy water, rinse your hands, then wash the produce with plain water for 20 seconds. Prewashed vegetables should be washed again, said Robin Bagwell, nutrition and wellness program coordinator with the University of Illinois Extension of McLean County.

Produce in which the peel isn't consumed -- such as banana, orange, cantaloupe and watermelon -- also must be washed, Orr said. Otherwise, any bacteria on the peel could be transferred to the edible part of the fruit when the fruit is cut open.

"Don't wash them with soap unless you like diarrhea," Orr said. Also don't use any detergent because that adds chemicals to food, Bagwell said.

Use a vegetable brush on produce that can tolerate the scrubbing, Bagwell said. Produce that can't tolerate scrubbing with a brush should be washed in a colander, she said. Just make sure you wash each piece and don't overfill the colander.

If the produce doesn't look good, don't eat it, Keller said. "When in doubt, throw it out."

Refrigerate uneaten food within two hours.

Run vegetable brushes, cutting boards, utensils and dishes through the dishwasher after each use.

Despite concerns about tomatoes and other raw produce, Carius sought to put the current outbreak in perspective.

"The U.S. is generally considered to have the safest food supply in the world. I don't want to downplay the seriousness of what is occurring but there are 13 million residents in Illinois and 304 million people in the United States," Carius said. As of June 25, 45 people in Illinois and 652 people nationwide had been sickened by tomatoes with salmonella.

"Twenty years ago, tomatoes may not have been implicated as the source of the outbreak and the people would have faded into the woodwork," Keller said.

So the good news is that a lot of people got the warning about salmonella and stopped buying certain types of tomatoes, meaning they avoided getting sick, Keller said.

Food won't ever be completely risk-free, Carius said. In addition to the food safety tips, a good way to reduce the risk of a food-borne illness is to take care of yourself by getting enough sleep, getting exercise and eating healthy, Bagwell said.

A person with a healthy immune system is able to sustain a food-borne illness better than a person with a compromised immune system, Harlacher said.


The current outbreak

--Tomatoes with salmonella have been linked to 652 illnesses in 34 states and may have contributed to one death. At least 71 people have been hospitalized.

--In Illinois, there have been 45 illnesses, all in the northeastern part of the state. Six people were hospitalized.

--Because most people who are ill with salmonellosis (the disease caused by the Salmonella infection) don't seek medical attention, the U.S. Centers for Disease Control and Prevention estimates more than 8,600 people may be ill in the current outbreak.

--U.S. Food and Drug Administration recommended that consumers not eat raw red Roma, raw red plum or raw red round tomatoes unless the tomatoes are from safe sources listed on the FDA's Web site (www.fda.gov). Consumers shouldn't cook these tomatoes, until notified by FDA, because cooking may not ensure that the Salmonella is eliminated.

--FDA said consumers may continue to eat commercially canned or bottled tomato products, as well as raw cherry and grape tomatoes, tomatoes sold with the vine still attached, or tomatoes grown at home.

--Restaurants and supermarkets nationwide and locally pulled the implicated tomatoes from their kitchens and their shelves. But tomato shipments have resumed at many locations.

--FDA said the Salmonella contaminant came from farms in Florida and Mexico and inspectors were at work on those farms and their distribution systems.

SOURCES: FDA, U.S. Centers for Disease Control and Prevention, Illinois Department of Public Health


Food-borne diseases

--A food-borne disease is caused by consuming a contaminated food or beverage.

--Many disease-causing microbes, or pathogens, can contaminate foods. There are more than 250 food-borne diseases.

--After the microbe enters the body, symptoms may not appear for three days. Symptoms may include nausea, vomiting, abdominal cramps and diarrhea and may continue for 24 hours to 12 days. If the disease gets into the bloodstream, it may cause life-threatening infections in people with weakened immune systems.

--Most food-borne diseases are not diagnosed because ill individuals don't seek medical attention. They may be diagnosed by testing stool samples.

--See your doctor if diarrhea is accompanied by high fever, blood in your stool, prolonged vomiting, dehydration, or if the diarrhea lasts more than three days.

--Food-borne diseases include salmonellosis, e. Coli, campylobacter, botulism and listeriosis.

--A century ago, typhoid fever, tuberculosis and cholera were common food-borne illnesses. They have been reduced because of improvements in food safety, such as pasteurization of milk, safer canning and disinfection of water supplies.

--Other food-borne illnesses have taken their place as new microbes have evolved, other microbes have spread around the world, food production practices and consumption habits have changed, and better lab tests have identified microbes that were previously unrecognized.

--An estimated 76 million cases of food-borne disease occur each year in the United States. A great majority of these cases are mild and cause symptoms for a day or two. There are 325,000 hospitalizations and 5,000 deaths related to food-borne diseases each year. Those occur in the young, the old or people with weakened immune systems.

--McLean County Health Department conducted 58 food-borne illness inquiries in 2007. Twenty were found to be salmonellosis, 16 were campylobacter and five were e. Coli.

SOURCES: Illinois Department of Public Health, U.S. Centers for Disease Control and Prevention, U.S. Food and Drug Administration, McLean County Health Department


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