The Food Safety Information Handbook 2001 PDF

 THE FOOD SAFETY INFORMATION HANDBOOK ❖ Cynthia A. Roberts Oryx Press 2001 This Page Intentionally Left Blank  The rare Arabian Oryx is believed to have inspired the myth of the unicorn. This desert antelope became virtually extinc...

 THE FOOD SAFETY INFORMATION HANDBOOK ❖ Cynthia A. Roberts Oryx Press 2001 This Page Intentionally Left Blank  The rare Arabian Oryx is believed to have inspired the myth of the unicorn. This desert antelope became virtually extinct in the early 1960s. At that time, several groups of international conservationists arranged to have nine animals sent to the Phoenix Zoo to be the nucleus of a captive breeding herd. Today, the Oryx population is over 1,000, and over 500 have been returned to the Middle East. Library of Congress Cataloging-in-Publication Data Roberts, Cynthia A. The food safety information handbook / Cynthia A. Roberts. p. cm. Includes bibliographical references and index. ISBN 1–57356–305–6 (alk. paper) 1. Food adulteration and inspection. 2. Food contamination. TX531.R57 2001 363.19′26—dc21 2001021435 British Library Cataloguing in Publication Data is available. Copyright © 2001 by Cynthia A. Roberts All rights reserved. No portion of this book may be reproduced, by any process or technique, without the express written consent of the publisher. Library of Congress Catalog Card Number: 2001021435 ISBN: 1–57356–305–6 First published in 2001 Oryx Press, 88 Post Road West, Westport, CT 06881 An imprint of Greenwood Publishing Group, Inc. www.oryxpress.com Printed in the United States of America The paper used in this book complies with the Permanent Paper Standard issued by the National Information Standards Organization (Z39.48–1984). 10 9 8 7 6 5 4 3 2 1 This Page Intentionally Left Blank For Andy, who had to do without This Page Intentionally Left Blank  CONTENTS Preface xiii Acronyms xv Part 1. Overview of Food Safety 1. An Overview of Food Safety 3 Safe Food Defined 4 Food Hazards 5 Chemical Hazards 5 Food Additives 5 Food Allergens 6 Drugs, Hormones, and Antibiotics in Animals 7 Naturally Occurring Toxins 8 Pesticides 10 Microbiological Hazards 12 Bacteria 12 Viruses 18 Protozoa and Parasites 19 Bovine Spongiform Encephalopathy (BSE) 20 Physical Hazards 21 Factors That Contribute to Foodborne Illness 21 Demographics 21 Consumer Lifestyles and Demand 22 Food Production and Economics 24 New and Evolving Pathogens 24 History of Food Safety 25 The Role of Food Preservation in Food Safety 28 Sources 32 2. Issues in Food Safety 37 Genetically Engineered Foods 37 Regulation 38  Contents The Case against Food Biotechnology 39 Human Health Hazards 39 Environmental Hazards 40 Socioeconomic Hazards 42 The Case in Favor of Food Biotechnology 42 Human Health Benefits 43 Environmental Benefits 43 Socioeconomic Benefits 44 Sources 45 Bovine Somatotropin 45 Human Health Issues 47 Animal Health Issues 48 Socioeconomic Issues 48 Sources 49 Food Irradiation 49 Background 49 The Case in Favor of Irradiation 51 The Case against Irradiation 52 Sources 53 Pesticide Residues in Foods 53 Introduction 53 Pesticide Regulation 56 Environmental Protection Agency (EPA) 56 Food and Drug Administration (FDA) 57 U.S. Department of Agriculture (USDA) 58 Food Quality Protection Act (FQPA) 59 Are Pesticide Residues Dangerous? 59 Sources 61 Drinking Water Quality 63 History 63 The U.S. Water Supply 64 Hazards to the Water Supply 65 Regulation 66 Safe Drinking Water Act 68 Sources 69 Restaurant Food Safety 69 Regulating the Industry 70 Public Posting of Inspection Scores 71 Education 72 Sources 72 3. Chronology of Food Safety-Related Events 75 Sources 87 4. Food Safety Regulation 89 History of Food Safety Regulation 90 Early Food Safety Regulation in the United States 91 Twentieth Century Food Safety Regulation in the United States 92 The Food and Drugs Act 93 The Federal Meat Inspection Act 94 The Food, Drug and Cosmetic Act (FDCA) 94 The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) 96 Amendments to the Food, Drug and Cosmetic Act (FDCA) 97 Additional Regulation of Poultry, Meat, and Eggs 97 The Safe Drinking Water Act (SDWA) 98 viii  Contents Saccharin Study and Labeling Act 98 The Infant Formula Act 99 The Food Quality Protection Act (FQPA) 99 Hazard Analysis and Critical Control Points (HACCP) 100 Who Regulates Food Safety Today? 101 Food Safety at the Federal Level 102 Food and Drug Administration (FDA) 102 U.S. Department of Agriculture (USDA) 103 Environmental Protection Agency (EPA) 104 Centers for Disease Control and Prevention (CDC) 105 National Marine Fisheries Service (NMFS) 105 Federal Trade Commission (FTC) 106 U.S. Customs Service 106 Bureau of Alcohol, Tobacco and Firearms (ATF) 106 National Institutes of Health (NIH) 106 Food Safety at the State and Local Levels 106 Food Safety at the International Level 107 What Is the Federal Government Doing about Food Safety Now? 108 President’s Food Safety Initiative 108 Healthy People 2010 110 Dietary Guidelines for Americans 111 Sources 112 5. Food Safety Statistics 115 Foodborne Diseases Active Surveillance Network (FoodNet) 116 CDC Surveillance for Foodborne-Disease Outbreaks, 1993–1997 121 Waterborne Disease Outbreaks, 1997–1998 122 Medical Costs of Foodborne Illness 125 Behavioral Risk Factor Surveillance Systems (BRFSS) 126 Home Food Safety Survey 127 Sources 128 6. Careers in Food Safety 131 Education 133 Credentials 133 Certified Food Safety Professional (CFSP) 133 Registered Environmental Health Specialist/Registered Sanitarian(REHS/RS) 134 Certified Food Protection Professional (CFPP) 136 National Certified Professional Food Manager (NCPFM) 136 Food Safety Manager Certificate (FSMC) 137 National Restaurant Association ServSafe 137 Continuing Education Courses in Food Safety 138 Distance Learning Courses 138 Scholarships, Internships, and Fellowships 140 Part 2. Resources 7. Reports and Brochures 143 Reports 144 Brochures 159 8. Books and Newsletters 163 Books 164 ix  Contents Reference Books 164 General Food Safety Books 165 Children’s General Food Safety Books 167 Books on Specific Food Safety Topics 168 Additives 168 Animal Health 169 Bovine Spongiform Encephalopathy (BSE) 169 Food Allergy 170 Food Allergy Books for Children 171 Food Biotechnology 171 Food Irradiation 173 Food Preservation 173 Food Safety Regulations 174 Naturally Occurring, Environmental, and Chemical Toxins 175 Pesticides 176 Water 176 Texts 176 Newsletters 178 Food Biotechnology 178 Food Safety Regulations 179 General Food Safety for Consumers 179 General Food Safety for Educators and Food Professionals 180 Pesticides 184 9. Internet Web Sites and Electronic Media 185 Internet Web Sites 186 Food Allergy 186 Food Biotechnology 186 Food Preservation 188 Food Professionals’ Web Sites 188 General Food Safety 189 Microbiology 191 Miscellaneous 192 Pesticides 193 Risk Assessment 193 Water Quality 193 Databases 194 General Reference and Resource Databases 194 Bibliographic Databases 194 Databases with Data on Additives, Pesticide and Drug Residues, Toxins 195 Water Quality Databases 196 Miscellaneous Databases 197 Email Discussion Groups 198 Email News Distribution Groups 199 Reference Tools 200 10. Educational Materials 203 Children—General Food Safety 204 Children—Biotechnology, Pesticides, Additives 210 Consumers—General Food Safety 211 Consumers—Biotechnology, Pesticides, Additives 215 Consumers—Seniors 217 Food Service Workers—General Food Safety 218 Food Service Workers—HACCP 223 x  Contents Handwashing 225 Providers at Child Day Care Centers and Institutions 227 School Food Service 229 Volunteers at Picnics, Church Suppers, Fairs, Food Banks 230 11. Organizations, Cooperative Extension, Hotlines, State and Local Agencies 233 Organizations 234 Cooperative Extension Offices 267 Food and Drug Administration (FDA) Public Affairs Specialists 283 Northeast Region 283 Central Region 284 Southeast Region 285 Southwest Region 285 Pacific Region 286 Hotlines 287 Non-Food Company Hotlines 287 Food Company Hotlines 288 State Departments of Health and/or Agriculture 290 State Meat Inspection Programs 295 Glossary 299 Index 305 xi This Page Intentionally Left Blank  PREFACE Food safety is both a solid issue and an enigmatic one. Ask anyone on the street for a definition, and they’ll probably answer that it means food that is safe to eat. But breaking this down into its components is a harder task. If one asks important ques- tions such as what is safe food, how safe is safe, how many people get sick from unsafe food, what are the major causes of unsafe food, how can food be made safe, and who’s responsibility is food safety, the seemingly solid nature of the discipline dis- solves. While this book cannot pretend to answer questions that even experts in the field are grappling with, it does try to give the reader some possible answers, a broad over- view of the subject, and the tools necessary to interpret the quality of the food they eat and the validity of the information to which they are exposed. The audience for the book includes those who eat food, whether they be parents, students, cooks, food industry workers, dietitians, health professionals, educators, or librarians. The first part of the book offers an introduction and overview to the field of food safety. Chapter 1 begins with food hazards, exposing the reader to information about viruses, pathogenic bacteria, naturally occurring toxins, pesticides, and other dangers. Although humankind has been working to protect the food supply for mil- lennia, pathogens and other forces have been similarly changing throughout the mil- lennia to thwart attempts to make the food supply safe. These factors are examined, followed by a short history of discoveries that have contributed to the current state of scientific knowledge about food safety. Finally, readers are introduced to some of the techniques that have been developed to make food safer, the result of which can be seen in the aisles of grocery stores. In Chapter 2 the reader is introduced to several hot topics and the issues on each side of the debate over food biotechnology, bovine somatotropin, food irradiation, pesticides, drinking water quality, and restaurant food safety. Chapter 3 provides a chronology of events covered under the umbrella of food safety—inventions, dis- coveries, foodborne illness outbreaks, legislation, and other events that have shaped our understanding of the safety of food. Chapter 4 traces the evolution of the laws  Preface and policies that guide food production in the United States. The reader will follow a chronological path from the earliest laws enacted in the 1600s to modern food safety regulations of the late 1990s. Agencies responsible for regulating food safety at the federal, state, and local levels are examined. Foodborne and waterborne illness statis- tics make up Chapter 5, which includes what we know, what we don’t know, and why we don’t know it. Chapter 6 explores options for working in the field of food safety and choices of education and certifications available, along with ideas on where to find scholarships, internships, and fellowship opportunities. The second part of the book, Chapters 7 through 11, offers food safety resources. These resources cover the whole range of food safety—food allergy, food biotech- nology, general food safety, food microbiology, pesticides, food irradiation, water quality and safety, and food preservation. Chapter 7 presents reports on food safety topics from government agencies, nonprofit research institutions, consumer advo- cacy groups, and academic institutions. This chapter also lists consumer-level bro- chures. Chapter 8 covers books, from those suitable for children to those for food professionals. Internet and electronic resources are highlighted in Chapter 9, includ- ing Web sites, databases, reference tools, and Internet news and discussion groups. Chapter 10 lists food safety educational materials for children; adult consumers; food service workers; providers at child day care centers and other institutions; school food service workers; and volunteers at picnics, church suppers, fairs, and food banks. Chapter 11 lists organizations involved in food safety, including Coop- erative Extension Service Offices, Food and Drug Administration public affairs spe- cialists, hotlines, and state agencies and programs. The book closes with a glossary of food safety terms. xiv  ACRONYMS AMS Agricultural Marketing Service APHIS Animal and Plant Health Inspection Service ARS Agricultural Research Service B.C.E. Before current era CDC Centers for Disease Control and Prevention CRADA Cooperative Research and Development Agreement CSREES Cooperative State Research, Education, and Extension Service DHHS Department of Health and Human Services EPA U.S. Environmental Protection Agency ERS Economic Research Service FAO/WHO Food and Agriculture Organization/World Health Organization FDA U.S. Food and Drug Administration FIFRA Federal Insecticide, Fungicide, and Rodenticide Act FQPA Food Quality Protection Act FSI National Food Safety Initiative FSIS Food Safety and Inspection Service GIPSA Grain Inspection, Packers and Stockyards Administration GRAS Generally Recognized as Safe as designated by FDA HACCP Hazard Analysis Critical Control Points JIFSR Joint Institute for Food Safety Research NASS National Agricultural Statistics Service NIH National Institutes of Health NMFS National Marine Fisheries Service NPR National Performance Review NSTC/OSTP National Science and Technology Council/Office of Science and Tech- nology Policy OMB Office of Management and Budget USDA U.S. Department of Agriculture This Page Intentionally Left Blank  PART 1 OVERVIEW OF FOOD SAFETY This Page Intentionally Left Blank  CHAPTER 1 AN OVERVIEW OF FOOD SAFETY Food safety is a matter that affects anyone who eats food. Whether or not a person consciously thinks about food safety before eating a meal, a host of other people have thought about the safety of that food, from farmers to scientists to company presi- dents to federal government officials and sanitarians. This chapter serves as a broad introduction to food safety and the concerns facing those who work with food. After defining safe food and foodborne illness, this chapter examines the various chemical, microbiological, and physical hazards to the food supply, presenting the hazards in this order: I. Chemical hazards 1. Food additives 2. Food allergens 3. Antibiotics in animals 4. Naturally occurring toxins 5. Pesticides II. Microbiological hazards 1. Bacteria 2. Viruses 3. Protozoa and parasites 4. Bovine spongiform encephalopathy (BSE) III. Physical hazards 1. Food Defect Action Levels A table of the most important foodborne pathogens highlights their sources, along with foods involved and symptoms of foodborne illness. Next follows a discussion of the factors that influence foodborne illness, namely:  Overview of Food Safety 1. Demographics 2. Consumer lifestyles and demands 3. Food production and economics 4. New and evolving pathogens A history of food safety concentrates on scientific discoveries from the 1600s to modern times. The chapter ends with a look at food preservation techniques that hu- mankind has practiced over the millennia to make food safer. These techniques range from the earliest methods of drying to newer high-tech methods such as food irradi- ation, and newer lower-tech methods such as using natural antimicrobials. SAFE FOOD DEFINED The concept of safe and wholesome food encompasses many diverse elements. From a nutritional aspect, it is food that contains the nutrients humans need and that helps prevent long-term chronic disease, promoting health into old age. From a food safety aspect, it is food that is free not only from toxins, pesticides, and chemical and physical contaminants, but also from microbiological pathogens such as bacteria and viruses that can cause illness. This book is concerned with the food safety aspect of food, leaving the diet and nutritional properties of food for experts in nutrition. While America’s food supply is among the safest in the world, there are still nu- merous threats to the safety of the food supply. Some of these threats have been around since ancient times, while others are newer, the result of changing lifestyles, production practices, and even evolution of microorganisms themselves. Ensuring the safety of food is a shared responsibility among producers, industry, government, and consumers. A major focus of this book is microbial foodborne illness, a widespread, but often unrecognized, sickness that affects most people at one time or another. It is caused by eating food that is contaminated with pathogens such as bacteria, viruses, or para- sites. At least four factors are necessary for foodborne illness to occur: (1) a patho- gen; (2) a food vehicle; (3) conditions that allow the pathogen to survive, reproduce, or produce a toxin; and (4) a susceptible person who ingests enough of the pathogen or its toxin to cause illness. The symptoms often are similar to those associated with the flu-nausea, vomiting, diarrhea, abdominal pain, fever, headache. Most people have experienced foodborne illness, even though they might not recognize it as such, instead blaming it on the “stomach flu” or “24-hour bug.” Symptoms usually disappear within a few days, but in some cases there can be more long-lasting effects such as joint inflammation or kidney failure. In the most severe cases people die from foodborne illness. Every year more than 5,000 Americans die from eating contami- nated food (Mead 1999). It is difficult to trace a bout of foodborne illness back to a particular food because illness can occur anywhere from an hour to several days, or even weeks, after eating the contaminated food. Epidemiologists faced with tracing a foodborne illness out- break may have to interview dozens of people, asking them to recall everything they ate for the past week. It is difficult for people to remember everything they ate yes- terday, much less one week ago. Further complicating the picture is that one person may eat the contaminated food and not become ill, while someone else in a higher-risk group does. In 81 percent of foodborne illnesses the cause remains un- known (Mead 1999). 4  An Overview of Food Safety Food Hazards Experts describe food safety problems in terms of hazards, with those hazards cat- egorized as chemical, microbiological, or physical. They have long considered the most dangerous hazards to be those of microbiological origin, followed by those of naturally occurring toxins (Wodicka 1977; Cliver 1999). However, pesticides and additives have been prominent subjects for the media, which may lead some people to focus on those hazards more than others. But as more stories emerge of people be- coming ill from bacterial contamination, the public is increasingly aware of the im- portance of microbiological hazards. People do die from microbial hazards, but deaths due to consuming pesticide residues or food additives are rare. Water is a food, and also is subject to microbial contamination. Some pathogens, such as Cryptosporidium parvum, are more waterborne than foodborne. While this chapter does discuss microbial contamination of water, it is beyond the scope of this book to consider waterborne hazards primarily caused by pollution, such as heavy metals, or pathogens that follow pathways other than the digestive tract. Chemical Hazards Chemical hazards include agricultural chemicals such as pesticides, herbicides, rodenticides, insecticides, fertilizers, antibiotics and other animal drugs, cleaning residues, naturally occurring toxins, food additives, allergens, and toxic chemicals from industrial processes that can enter the food chain directly during processing or indirectly through plants and animals. The Environmental Protection Agency (EPA) controls chemicals applied at the farm; the United States Department of Agriculture (USDA) controls antibiotics and animal drugs; and the Food and Drug Administra- tion (FDA) controls additives and residual chemicals on processed foods. Food Additives The use of food additives dates back to ancient times. Examples of these early ad- ditives are salt to preserve meats and fish, herbs and spices for seasoning foods, sugar to preserve fruits, and vinegar to preserve vegetables. Today manufacturers use more than 3,000 food additives. A commonly used definitition of a food additive is any substance added to a food either directly or indirectly through production, process- ing, storing, or packaging. Food additives serve a number of functions: Preservatives to keep food fresh and to prevent spoilage. This is important, as in our modern lifestyle food is rarely eaten at the time or place it is produced. Calcium propionate inhibits molds and is often added to bread products for this purpose. Nutrients to improve or maintain the nutritional quality of foods. Most salt contains iodine to prevent goiter, a condition resulting from iodine deficiency. Processing aids to maintain product texture such as retaining moisture, preventing lumping, or adding stability. Powdered foods such as cocoa contain silicon dioxide to prevent clumping when water is added. Flavors to enhance or change the taste or aroma of a food. These include spices, herbs, flavor enhancers, natural and synthetic flavors, and sweeteners. Colors to give foods an appealing look. Many of the colors we associate with foods are from added colorings, such as caramel to make cola drinks brown and annatto to make margarine yellow. 5  Overview of Food Safety Food additives are derived from naturally occurring and synthetic materials. Sci- entists can now synthesize in the laboratory many additives that used to be derived from natural substances, creating a larger and cheaper supply. Americans consume from 140 to 150 pounds of additives a year, mostly due to additives such as sugar, corn sweeteners, salt, pepper, vegetable colors, yeast, and baking soda. Food addi- tives allow us to enjoy safe, wholesome, tasty foods year-round without the inconve- nience of growing our own foods or shopping daily. Convenience foods are made possible by the use of food additives. FDA approves all food additives before they can be added to foods. USDA autho- rizes additives used in meat and poultry products. Before manufacturers may use an additive, they must prove that the additive does what it was intended to do and that it will not be harmful to humans at the expected level of consumption. Two groups of additives are not subject to FDA’s strict approval process—those that are prior sanc- tioned and those that are generally recognized as safe (GRAS). Prior sanctioned sub- stances were already approved by FDA before the 1958 Food Additives Amendment to the Food, Drug and Cosmetic Act. GRAS substances, including salt, sugar, spices, and vitamins, have been used extensively in the past with no known harmful effects, and therefore experts believe them to be safe. FDA may also label an additive as GRAS based on scientific evidence that it is safe. FDA and USDA continue to moni- tor prior sanctioned and GRAS substances to ensure that they really are safe as new evidence emerges. In addition, FDA operates the Adverse Reaction Monitoring Sys- tem (ARMS) to investigate all complaints related to specific foods, food and color additives, or vitamin and mineral supplements. While the overwhelming majority of additives are safe for all people, small seg- ments of the population are sensitive to some. Sulfites are an example of this; they cause hives, nausea, shortness of breath, or shock in some people. For this reason, in 1986 FDA banned the use of sulfites on fresh fruits and vegetables, such as in salad bars where they were used to keep lettuce and other produce looking fresh. Product labels must list sulfites if they are added. In the 1970s it was thought by some individ- uals that additives may contribute to childhood hyperactivity, but studies conducted since then have found no link. Food Allergens Up to 6 percent of children and 2 percent of adults suffer from food allergy-the body’s immune system reacting to certain substances in food, usually a protein. The immune system misinterprets a chemical component of a food as harmful and re- leases histamines and other chemicals to combat it, which results in hives, swelling, itching, vomiting, diarrhea, cramps, or difficulty breathing. Severe reactions may cause anaphylaxis, which can result in death. Eight foods—egg, wheat, peanuts, milk, soy, tree nuts (such as walnuts and almonds), fish, and shellfish—cause 90 per- cent of all food allergies. The only way to prevent an allergic reaction is to avoid that food entirely. Food intolerance often is confused with food allergy since the symptoms are often the same. Food intolerance is an adverse reaction to a food that does not involve the immune system. Lactose intolerance is an example of food intolerance. A person with lactose intolerance lacks an enzyme needed to digest a form of sugar present in milk. Consuming milk products causes symptoms such as gas, bloating, and abdomi- nal pain, but does not involve any immune system response. If a person has a true al- lergy to milk, the only way to avoid milk allergy symptoms is to avoid all milk 6  An Overview of Food Safety products entirely. Special drops or tablets that help digest the sugar in milk are avail- able for those suffering from lactose intolerance, allowing them to consume milk products. (FAN 2000) To avoid substances to which they are allergic, consumers must know exactly what is in foods. The Food, Drug and Cosmetic Act requires a complete listing of food ingredients on food labels. Many food products are recalled due to improper food labeling, such as ice cream with a label omitting peanuts, or processed foods that do not declare soy products as an ingredient. Common food allergens can also show up in restaurant foods in unexpected places, for example, peanut butter in Asian noodles or egg products in meatballs. Recent cases of students who suffered allergy attacks from peanuts have prompted school officials to ban peanut products from some school cafeterias. This is a difficult task, as not only would this outlaw the popular peanut butter and jelly sandwich, but also any snacks or candies that contain peanuts. While it may be possi- ble to control which foods are sold in schools, it is almost impossible to regulate foods students bring from home. Educating students who have food allergies to read carefully food ingredient labels and not to accept foods if they do not know what the ingredients are is key to reducing food allergy attacks. Drugs, Hormones, and Antibiotics in Animals The use of drugs to control and treat animal disease, and of hormones to promote faster, more efficient growth of livestock is a common practice. An estimated 80 per- cent of U.S. livestock and poultry receive some animal drugs during their lifetime. This includes topical antiseptics, bactericides, and fungicides to treat skin or hoof in- fections and cuts; hormones and hormone-like substances to improve growth; antiparasite drugs; and antibiotics. Improper use of animal drugs may cause residues in the edible tissues of slaughtered animals that could be hazardous to consumers. Before a new animal drug can be marketed in the United States, the FDA Center for Veterinary Medicine (CVM) must approve it on the basis of quality, safety, and effi- cacy. When the drug is for use in food-producing animals, not only must animal drug manufacturers prove that the drug is safe for the animal, but also that the food prod- ucts derived from the treated animals are safe for human consumption. FDA estab- lishes tolerances to include a safety factor to assure that the drug will have no harmful effects on consumers of the food product. FDA and USDA work together to moni- tor the use of animal drugs, identify improper use, and take enforcement action if necessary. There are two issues of concern related to the use of drugs in food animals. The first is the presence of drug residues in meat or milk obtained from an animal that has been given an animal drug. Some of these residues may be allergenic, toxic, or carci- nogenic to humans in large enough doses. According to the National Research Council’s (NRC) 1999 report, The Use of Drugs in Food Animals: Benefits and Risks, FDA programs monitoring drug residues in animals are effective in protecting con- sumers from this danger. Because very few illegal drug residues are detected in meat, milk, or eggs, the health risk posed by drug residues is minimal. Many food safety experts consider the second problem, antibiotic drug residues in farm animals, to be a problem of larger concern. Antibiotics for farm animals have two purposes. First, they are used to prevent and treat diseases, just as they are in hu- mans. The second reason for administering antibiotics to farm animals is to improve growth and to promote feed efficiency—the production of more meat or milk with 7  Overview of Food Safety less input of feed. This is called a subtherapeutic dose, since it is given in doses lower than those required to treat an infection. Subtherapeutic use of antibiotics controls intestinal bacteria that interfere with an animal’s ability to absorb nutrients. It also controls infections before they become noticeable, thus making animals healthier and allowing them to use nutrients for growth and production rather than to fight infections. Antibiotic use is one reason why the U.S. food supply is so abundant and affordable. Bacteria will inevitably become resistant to the antibiotics used to kill them. This is because antibiotics do not generally kill 100 percent of their target bacteria. A few will always survive and pass that resistance on to successive generations of bacteria, and in some cases, to other unrelated bacteria. Eventually the genetic make-up of the bacterial strain changes enough so that the drug is no longer effective. This happens with human pathogens such as tuberculosis, as well as with pathogens that infect ani- mals. The most common cause of antibiotic resistance is overuse of antibiotics. Most animal bacterial diseases cannot be passed on to humans, but there are notable ex- ceptions—Campylobacter and Salmonella. Already these two bacteria have devel- oped resistance to some drugs, particularly the fluoroquinolones, used to combat them. There is some evidence of a relationship between the use of fluoroquinolone drugs in poultry and other food-producing animals and the emergence of fluoroquinolone-resistant Campylobacter and Salmonella in humans (WHO 1998). The possibility exists that as pathogens in farm animals become resistant to antibiot- ics, if those same pathogens are passed on to humans, they will not respond to drug treatments. The NRC report states that there is a link between the use of antibiotics in food animals, the development of resistant microorganisms in those animals, and the spread of those resistant pathogens to humans. However, the report goes on to say that the incidence of this happening is very low, and that there are not enough data to determine whether the incidence is changing. The report concludes that al- ternatives to antibiotic use for maintaining animal health and productivity should be developed. The National Antimicrobial Resistance Monitoring System (NARMS), established in January 1996 as a collaborative effort among FDA, USDA, and the Centers for Disease Control and Prevention (CDC), seeks to gather more data on antimicrobial resistance to clarify the potential risks. Naturally Occurring Toxins In addition to synthetic chemicals such as pesticides, the food supply contains many naturally occurring toxins. In comparison to synthetic chemicals, scientists know very little about these natural toxins in terms of their toxicity and quantity in foods. They pose a greater risk than the synthetic chemicals because we eat at least 10,000 times more of them. Every food is a complex mixture of chemical com- pounds, some beneficial such as vitamins and minerals, but also some that are harm- ful. Even vitamins and minerals can be toxic if taken in great enough quantities. For example, vitamin A, a necessary vitamin, may be toxic in an amount only 15 times the recommended dietary allowance. Plants and animals developed toxic substances as protection against insects, microorganisms, grazing animals, and other potential dangers. One of America’s most loved foods, the potato, contains a very toxic substance called solanine. This naturally occurring toxin is present in larger amounts in the peel and in the eyes than in the potato. In the amounts normally eaten, solanine does not cause illness, but a diet of certain varieties of potato peels and eyes might contain 8  An Overview of Food Safety enough solanine to cause illness and possibly even death. Solanine acts as a natural pesticide that protects the potato from the Colorado beetle, the leaf hopper, and other potato pests. In another instance, herbal teas are enjoying a renewed popular- ity in the United States. Consumers view these teas as a natural way of improving their health or treating diseases. However, chemicals in herbal teas can and have caused illness and death. Herbal teas are touted as the answer to many chronic ail- ments and as such are consumed at much higher levels than they were traditionally, which may lead to natural, but still harmful, side effects. In societies where herbal use is steeped in tradition, knowledge about the benefits and dangers of herbal remedies passes from generation to generation. Very few of the herbs used in natural herbal teas have been studied or tested for safety. One of these is ephedra, commonly known as Ma Huang, an ingredient in many herbal teas marketed as weight loss products. Ephedra is an amphetamine-like compound with potentially powerful stimulant effects on the nervous system and heart. More than 800 adverse events as- sociated with the use of ephedrine-containing products have been reported to the Food and Drug Administration. These range from episodes of high blood pressure, heart rate irregularities, insomnia, nervousness, tremors and headaches to seizures, heart attacks, strokes, and death (FDA 1997). People who shun prescription drugs as unnatural or too strong with too many side effects may think nothing of drinking herbal teas, some of which can provoke very strong drug-like reactions and adverse effects in the body. Seafood products contain some naturally occurring marine toxins that present unique food hazards. Molluscan shellfish, which includes oysters, clams, scallops, and mussels, can pick up toxins from algae that they feed on, and cause paralytic shellfish poisoning (PSP), neurotoxic shellfish poisoning (NSP), amnesic shellfish poisoning, and diarrhetic shellfish poisoning (DSP). The most serious is PSP, with symptoms ranging from tingling, burning, or numbness in the mouth or throat to paralysis, respiratory failure, and in severe cases, death. The algae that produce these toxins can be found during the warmer months anywhere. State authorities monitor harvest waters and close them to shellfish harvesting if algae is present. Since these toxins are not destroyed by heat, and can’t be detected visually, the best control is for people to consume shellfish only from approved waters. Tropical and subtropical reef fish such as grouper, barracuda, snappers, jacks, and king mackerel can accumulate ciguatera toxin by feeding on smaller fish that have in- gested toxin-forming algae. Ciguatera can cause nausea, vomiting, diarrhea, and headaches in humans. Tuna, mahi mahi, bluefish, and mackerel have been the sources of scromboid poisoning, a type of foodborne illness caused by the consump- tion of scombroid and scombroid-like marine fish species that have begun to spoil. This occurs when the amino acid histidine breaks down into histamine, usually as a result of inadequate refrigeration. Scromboid symptoms include a rash, burning or peppery taste sensations about the mouth and throat, dizziness, nausea, headache, itching, and swelling of the tongue. Puffer fish, known as fugu in Japan, is a great and dangerous delicacy in that country. An extremely toxic poison called tetrodotoxin accumulates in the internal organs of the fish. Only specially trained and licensed chefs are allowed to prepare fugu fish, as improperly prepared fugu causes paralysis, respiratory failure, convulsions, and cardiac arrhythmia within 20 minutes. Death is not uncommon. Fungi, which include mushrooms and molds, also produce toxins that are harm- ful to humans. Molds produce toxins called mycotoxins, with the major 9  Overview of Food Safety mycotoxin-producing molds being Aspergillus, Fusarium, and Claviceps species. Molds usually grow on damp cereal grains such as rye, wheat, corn, rice, barley, and oats, or oilseeds (peanuts), and then excrete their mycotoxins during their life cycle. Most of these mycotoxins are very resistant to heat, so cooking does not reduce their harmfulness. The only way to prevent intoxication is by preventing the mold from contaminating the product during harvesting, drying, storage, and processing. One mold in particular, Claviceps purpurea, has been implicated in a number of historical events. Eating rye and other cereal grains contaminated with Claviceps purpurea results in the disease ergotism. This disease was first recorded in 857 in the Rhine Valley and has been recorded numerous times since, sometimes affecting up to 40,000 individuals at once. Rye is particularly susceptible to ergot contamination. Cold and damp growing or storage conditions also promote the formation of ergot. Ergot is the source of lysergic acid diethylamide (LSD); it and many other ergot de- rivatives are hallucinogens. The symptoms of ergotism are varied, but include central nervous system disorders such as muscle spasms, confusions, delusions, convulsive fits, hallucinations, visions, sensations of flying through the air, and psychosis. Other common symptoms are a prickly sensation in the limbs, feelings of intense alternat- ing heat and cold, and increased appetite between episodes of fits. Linnda Caporael and Mary K. Matossian propose that the witch trials of 1692 in Salem, Massachu- setts, could very well have been the result of ergot poisoning. They link the weather, crop, and economic conditions from the years 1691 and 1692 to an increased con- sumption of bread made from rye that could have been contaminated with ergot. The symptoms exhibited by those accused of being bewitched are suspiciously simi- lar to the symptoms of ergotism. In another interesting footnote to history, Peter the Great had to cancel his plans to attack the Ottoman Empire in 1722 because his troops and their horses consumed rye contaminated with ergot, which caused hun- dreds either to die or go mad (Caporael 1976; Matossian 1989). Fortunately the body has a very efficient mechanism to destroy many naturally and synthetic chemicals—the liver. The liver is capable of eliminating small quanti- ties of many poisons, which allows humans to safely consume otherwise toxic chemi- cals. However, large quantities of toxins and chemicals can easily overwhelm the body’s defenses. We often think of naturally occurring compounds as relatively safe, but in reality some are among the most toxic substances known. Pesticides Pesticides prevent, destroy, or control pests. Pests are any organism that causes damage to plants, animals, or foods, such as bacteria, viruses, rodents, worms, fungi, insects, or weeds. The term pesticide is very broad and includes herbicides (to con- trol weeds), insecticides (to control insects), fungicides (to control mold, mildew, and fungi), rodenticides (to control rodents), and disinfectants (to control bacteria and viruses). Three-quarters of the pesticide use is for agriculture (mainly on crops in the field), but it is also used post-harvest during transportation and storage to pre- vent mold growth or insect infestation. While we may not think of household clean- ers, pet flea collars, lawn and garden products, and insect repellants as pesticides, they are. About 350 pesticides are used on the foods we eat, and to protect our homes and pets (EPA 1999). Since the beginnings of agriculture humankind has used pesticides in an attempt to control nature to ensure good crop yield. Egyptian records from 1500 B.C.E. con- tain instructions for preparing insecticides to control lice, fleas, and wasps. The 10  An Overview of Food Safety Greeks were using sulfur by 1000 B.C.E. to control insects, as did European farmers in the eighteenth century. The Chinese controlled insects with a mixture of arsenic and water. In 1865 farmers discovered Paris green, a mixture of copper and arsenic, as a way to control the Colorado potato beetle. A similar substance called Bordeaux mixture saved the grape industry in France from a fungal disease in the 1880s (Bohmont 1997). While we may think of pesticides as synthetic chemicals, the above examples show that many natural compounds also act as pesticides. The first syn- thetic insecticides and herbicides were produced in the early 1900s. Currently fed- eral pesticide law registers 21,000 pesticide products and 860 active ingredients (Curtis 1995). See chapter 2 for a discussion of pesticide regulation. Pesticide use has both advantages and disadvantages. In comparison with other nations, the United States has an abundant and affordable food supply. American consumers spend only about 11 percent of their income on food, less than consum- ers in any other country (see table 1-1, below). One reason for this abundance and low cost is improved crop yields, much of which is due to pesticide use. In 1850 each farmer in the United States produced enough food and fiber for four people; by 1990 that number grew to 79 (Bohmont 1997). The American diet consists of more fruits and vegetables in part because of this increased harvest, which leads to an im- provement in public health. Experts agree that the benefits from eating a diet rich in fruits and vegetables far outweigh the potential risks from pesticides. Even with modern methods of pest control, U.S. farmers still lose from 25 to 30 percent of their crop to pests. Globally pests destroy up to 45 percent of the world’s crops (Bohmont 1997). In addition to the benefit of increased yield, pesticide use in the United States satisfies the consumer’s demand for uncontaminated and unblem- ished food. Table 1-1 Percent of Income Spent on Food in Selected Countries United States 10.9 United Kingdom 11.2 Sweden 14.6 France 14.8 Australia 14.9 New Zealand 15.4 Italy 17.2 Germany 17.3 Japan 17.6 Spain 18.2 Israel 20.5 Mexico 24.5 South Africa 27.5 India 51.3 Source: American Farm Bureau Federation. September 12, 2000. Farm Facts. http://www.fb.org/ brochures/farmfacts/. But pesticides can be dangerous to human health and to the environment. Most pesticides break down quickly in the environment, but some may still be present 11  Overview of Food Safety years later, sometimes at a great distance from their original application. Pesticides sprayed on plants can move through the air and end up in the soil or water. Pesticides applied to the soil may end up in rivers and lakes or move down through the soil to contaminate ground water. As an example, DDT, which the United States banned from use more than 20 years ago, is still showing up in the Great Lakes ecosystem, presumably through rainfall and dust from countries that still use it. In addition to being potentially risky, pesticides are expensive. Farmers today are reducing pesticide use in several ways. Many farmers are turning to integrated pest management (IPM) techniques to reduce the need for pesticides. Examples of IPM include using ladybugs or other “good bugs” to destroy unwanted insects, adjusting planting times to avoid pest infestations, disrupting insect reproduction cycles, and destroying areas where pests breed and live. Although pesticides are still used in con- junction with many IPM techniques, the amount used is less. In 1993 the federal government set a national goal that 75 percent of all farms in the United States use IPM techniques by the year 2000. Researchers are also using biotechnology to de- velop crops that are more resistant to insects and viruses, which reduces the need to apply insecticides. Microbiological Hazards Microbiological hazards include disease-causing bacteria, viruses, and parasites. Ta- ble 1-2 lists these organisms, along with their sources and their symptoms. Many of these microorganisms occur naturally in the environment and can be foodborne, waterborne, or transmitted from a person or an animal. Cooking kills or inactivates most pathogens, while proper cooling and storage can control them before or after cooking. Bacteria Bacteria are single-celled organisms so small they can only be seen with a micro- scope. Bacteria are everywhere and most are not pathogenic (disease-causing). The human gastrointestinal tract is home to more than 300 species of bacteria (Doyle 2000). Fortunately, only a few of these cause illness. Some bacteria are beneficial and are used in making foods such as yogurt, cheese, and beer. Others cause food to spoil, but do not cause human sickness. This difference between spoilage bacteria and pathogenic bacteria is important in the prevention of foodborne illness. Since pathogenic bacteria generally cannot be detected by looks, smell, or taste, we rely on spoilage bacteria to indicate that a food should not be eaten. Not many people will eat food that has become slimy or that smells bad. Pathogenic bacteria cause foodborne illness in three different ways (Acheson 1998): Infection. Some bacteria damage the intestines directly. This type of illness occurs from eating food contaminated with live pathogenic bacteria. Cells that are alive and reproducing are veg- etative cells. Many bacteria are killed in the acidic environment of the stomach, but some sur- vive, pass through to the small intestine, and begin to grow in number. When the bacteria have multiplied to a high enough number (this depends on the strain of bacteria, its virulence or strength, and the health and susceptibility of the individual), the person becomes ill. Salmo- nella is a classic example of this kind of bacteria. Salmonella exists in the intestinal tracts of ani- mals, including food-producing animals as well as turtles, cats, dogs, birds, rodents, and wild animals. Raw milk and eggs are also sources of Salmonella. While heat easily destroys Salmo- nella, inadequate cooking allows some of the organisms to survive. Often Salmonella is spread through cross-contamination. This could happen when a cook prepares a piece of raw poultry on a cutting board and then uses the same cutting board without cleaning it to prepare an- 12  An Overview of Food Safety other food that will not be cooked, such as a salad. The second food will not receive any heat treatment to kill the bacteria. Salmonella can reproduce very quickly; they double their num- ber almost every 20 minutes. When the number of Salmonella are very high, there is a better chance that some of them will survive the harsh environment of the stomach and make it to the small intestine. Once there, they will continue to multiply, eventually causing damage to the intestine and symptoms of foodborne illness. With some bacteria the infectious dose, the number of bacteria necessary to cause illness, is very high, in the millions; while in others it can be as low as 10 organisms. Intoxication. Some bacteria produce harmful toxins or other chemicals that are then present in the food. It is not the bug itself that causes illness, but rather the toxin the bacteria produce. This can happen even if the pathogen itself has been killed, as long as it had sufficient time to produce enough toxin before dying. Staphylococcus aureus is an example of this type of bacte- ria. Staphylococci exist in air, dust, sewage, water, milk, animals, humans, and in food or on food equipment. They are present in the nasal passages and throats and on the hair and skin of 50 percent or more of healthy individuals. Illness is caused by ingesting toxins produced in food by some strains of S. aureus, usually because the food has not been kept hot enough or cold enough. Although cooking easily destroys the bacteria, the toxin produced by the bacte- ria is very resistant to heating, refrigeration, and freezing. It is not possible to detect the pres- ence of the toxin in food by smell, appearance, or taste. The likelihood of illness increases with the amount of time the bacteria are left at an improper temperature. Toxico-infection. Some bacteria enter the intestines live, survive the acidic environment of the stomach, and then produce a harmful toxin inside the human digestive system. Toxico-infection is a combination of the previous two examples in that live cells must be con- sumed, but the toxin is produced in the intestine and it is the toxin that really causes the illness. An example of an organism that causes foodborne illness in this manner is Clostridium perfringens. Like many bacteria, this organism is widely distributed in the environment in soil, water, dust, and in the intestines of domestic and wild animals. Large numbers of the bacteria, usually in the millions, need to be ingested to cause illness. These bacteria produce a spore, which is a dormant form of the organism. Vegetative cells may form a spore when the condi- tions for survival are not optimal for the cell, such as high heat or lack of water and food. Heat often does not destroy spores. Once the conditions are conducive to growth again, the spore will again become a vegetative cell. A typical case of foodborne illness occurs when a piece of meat is cooked, but the spores survive. Then, if the meat is not cooled properly the spores re- vert back to their non-dormant vegetative form and reproduce to high numbers. When food contaminated with C. perfringens is eaten, the organism grows in the small intestine and pro- duces a toxin that causes illness. Some bacteria use a combination of the above methods to cause illness. Just how many bacteria or how much toxin needs to be consumed before a person becomes ill depends on a number of factors that will be covered later in the section on factors that contribute to foodborne illness. Onset time, the time between when a person eats the food and when the symptoms start, is also highly variable. Most animals, in- cluding humans, are carriers of all kinds of bacteria, some of which do cause foodborne illness. Additionally, since many bacteria occur everywhere in nature—in the soil, air, water, etc.—it is not possible to totally eliminate harmful bacteria from the food supply. Bacteria need certain elements to survive and grow: Water. Bacteria need water in order to carry out the biologic processes of life, much as humans do. Drying foods and adding salt or sugar to a food, which bind the available water, inhibit mi- crobial growth. This is why foods such as dry pasta do not spoil as easily as a piece of meat. The amount of available water in a food is called water activity (Aw). 13  Table 1-2 Major Foodborne Illness Pathogens 14 15 16 17  Overview of Food Safety Food. Bacteria prefer foods that are high in protein such as meats, dairy products, and seafood. High-fat foods can protect bacteria from acidic juices in the stomach, and can help the bacteria to survive and pass into the small intestine. Foods with a high water and protein content, which are more likely to foster the growth of pathogens are called potentially hazardous foods. Proper temperature. While many pathogenic bacteria grow best at temperatures near human body temperature, they can survive and grow over a temperature range from 40 degrees F to 140 degrees F (or from 4 degrees C to 60 degrees C). This range is called the danger zone, and keeping foods out of the danger zone is one of the main ways of controlling bacterial growth. Bacteria do not grow as well at the extremes of this range, but they can still survive and grow at those extremes. Some bacteria can even grow at temperatures below or above the danger zone, but their growth is very slow at those temperatures. Refrigerator temperature is 40 de- grees F (5 degrees C) to inhibit bacterial growth. Time. Some bacteria grow very quickly; it only takes 20 to 30 minutes for their numbers to double. Table 1-3 shows the number of bacteria that would be present after 10 hours for an organism that reproduces every 20 minutes. Given the right conditions, a single cell can mul- tiply to more than one billion cells in that amount of time, about the same amount of time it would take for the center of a big deep pot of chili to cool below 40 degrees F. For most bacte- ria, large numbers of them must be consumed before illness occurs. There are exceptions to this, such as E. coli 0157:H7 in which consuming as few as 10 cells can cause foodborne illness. Oxygen. Some microorganisms need oxygen to live, while others do not. Bacteria that need oxygen are called aerobic, those that do not are anaerobic. For example, Clostridium botuli- num, the pathogen that causes botulism, only grows in the absence of oxygen. Many patho- genic bacteria, called facultative anaerobes, can grow with or without oxygen but have a preference. Proper pH or acidity. Microorganisms prefer foods that are neutral (pH 7) or slightly acidic. Many foods fall into this category—eggs, meat, poultry, fish, sauces, soups, gravies. Viruses Several viruses also cause foodborne illness. Viruses differ from bacteria in that they are smaller, require a living animal or human host to grow and reproduce, do not multiply in foods, and are not complete cells. Ingestion of only a few viral parti- cles is enough to produce an infection. Humans are host to a number of viruses that Table 1-3 Multiplication Rate for a Bacterium that Reproduces Every 20 Minutes Time Number of Bacteria 20 minutes 2 40 minutes 4 1 hour 8 2 hours 64 3 hours 512 4 hours 4,096 5 hours 32,768 6 hours 262,144 7 hours 2,097,152 8 hours 16,777,216 9 hours 134,220,000 10 hours 1,073,700,000 18  An Overview of Food Safety reproduce in the intestines and then are excreted in the feces. Thus, transmission of viruses comes from contact with sewage or water contaminated by fecal matter or di- rect contact with human fecal material. Raw or undercooked molluscan shellfish (oysters, clams, mussels, and scallops) are the food most often associated with foodborne viral diseases. Human pathogenic viruses are often discharged into ma- rine waters through treated and untreated sewage. As shellfish filter contaminants from these polluted waters, they store them within their edible tissues. Shellfish grown and harvested from polluted waters have been implicated in outbreaks of viral diseases. In spite of this, surveys done in Virginia and Florida estimated that 850,000 and three million people respectively, consume raw oysters (Wittman 1995). The other main source of transmission is from infected food workers who have poor per- sonal hygiene. An infected worker can transfer viral particles to any food. Therefore, proper handwashing and using a clean water supply are vital to controlling the spread of foodborne viruses. Scientists do not know as much about viruses as they do about bacterial patho- gens. One problem has been a lack of good laboratory methods to detect viruses. Without rapid, easy, inexpensive testing methods it has not been possible to study how viruses are transmitted, the number of people who become ill from foodborne viral infections, or the best methods to control viruses. Because of these problems, health care providers often do not order tests to detect viral infections, which causes foodborne illness from viruses to be even more underreported than for bacteria. Epidemiologists estimate that 67 percent of foodborne illnesses can be attributed to viruses, although only a small percentage of total foodborne illness deaths are due to viruses (Mead 1999). Hepatitis A is a virus commonly associated with foodborne infections. The incu- bation period for hepatitis A, before a person develops any symptoms, is anywhere from 10 to 50 days. It is during this period before symptoms appear that a carrier is most infectious and most likely to spread the disease. Hepatitis A, and many other vi- ral and bacterial pathogens, is most often transmitted via a fecal-oral route. The fact that a person is infectious even before they know they have the disease makes it diffi- cult to control. An outbreak of hepatitis A associated with eating clams in China in 1988 sickened 292,000 people. Since 1996 a vaccine offering lifetime immunity to hepatitis A has been available, but rarely used in the United States. Protozoa and Parasites Some parasites also cause foodborne illness. Parasites must live on or inside a liv- ing host to survive. The most common foodborne parasites are Anisakis simplex, Cryptosporidium parvum, Toxoplasma gondii, Giardia lamblia, and Cyclospora cayetanensis. Giardia, Cryptosporidium, and Toxoplasma are all protozoa, or sin- gle-celled organisms. Cyclospora was not known to cause human sickness until 1979, when the first cases were reported. Since then fresh produce has been associated with several outbreaks of foodborne illness from Cyclospora. Giardia has been identified more than any other pathogen in waterborne disease outbreaks, but there also have been foodborne Giardia outbreaks. Cryptosporidium is also primarily a waterborne pathogen. An estimated 21 percent of waterborne outbreaks from drinking water are due to parasitic agents, mainly Giardia and Cryptosporidium. These two para- sites are the most common cause of human parasitic infections in the United States. Toxoplasma gondii is common in warm-blooded animals, including cats, rats, pigs, cows, sheep, deer, chickens, and birds. It can be found in feces and raw meat from 19  Overview of Food Safety these animals. While not a problem for healthy adults, it can cause a very severe infec- tion in unborn babies and in people with immune system disorders. Anisakis simplex and related worms are found in raw or undercooked seafood. Although currently rarely diagnosed in the United States, it is expected that with the increase in con- sumption of raw fish in the country, anisakiasis will increase. As with viruses, parasitic infections are underreported due to poor testing and diagnostic methods. Trichinosis, caused by the parasitic worm Trichinella spiralis and associated with eating undercooked pork, is now relatively rare in the United States. The reported incidence of trichinosis has declined from an average of 400 cases per year in the late 1940s to 13 cases in 1997. This decline is due to laws that prohibit feeding garbage to hogs, the increased freezing of pork (freezing kills the parasite), and the practice of thoroughly cooking pork. The largest outbreak recently, in which 90 persons were infected, occurred in 1990 and was caused by the ingestion of a Southeast Asian dish that is made from raw pork sausage. Other recent cases have been associated with eating undercooked horse meat and undercooked wild game such as cougar, boar, bear, and walrus. Bovine Spongiform Encephalopathy (BSE) Bovine spongiform encephalopathy, or mad cow disease, is a fatal brain disease of cattle. The brain of affected animals appears sponge-like under a microscope. BSE first appeared in the United Kingdom in 1986. Since then more than 173,000 cattle in the United Kingdom have become infected. All these cattle and the herds to which they belonged were destroyed. New cases have dropped significantly since the U.K. government enacted measures to stop its spread. Scientists believe the disease may have first been transmitted through feeding cattle protein made from sheep car- casses infected with scrapie, the sheep form of the disease. Meat-and-bone meal made from infected animals and used as a protein source for cattle feed may also have been a causative factor and was a common practice for several decades. In the early 1980s a change in the manufacturing process that eliminated steam heat treatment may have played a role in the appearance of the disease. Although BSE has not been found in cattle in the U.S., spongiform encephalopathies affect other animals too, and have been found in the United States in sheep (called scrapie), mink, elk, deer, cats, and humans. The human form is Creutzfeldt-Jakob disease (CJD). It is a rare disease that oc- curs in approximately one person per million. A new type of CJD, new variant or nvCJD, has been linked to BSE exposure. This new variant of CJD differs from the traditional type mainly in that it affects younger people. To date, approximately 100 cases of nvCJD have been diagnosed, all in Europe. Although scientists know little about the origin, transmission, and nature of spongiform encephalopathies, the most accepted theory is that the causative agent is a prion, a type of pathogenic pro- tein. In 1997 Stanley B. Prusiner from the University of California, San Francisco, won the Nobel Prize for his work on prions. Infective prions are thought to be found only in the brain tissue, spinal cord, and retina of infected animals, not in meat or milk products. Gelatin and beef tallow both undergo a manufacturing process thought to produce a product free of the BSE causative agent. In Papua New Guinea CJD is known as kuru and is believed to have been transmitted through cannibalism. Scientists were puzzled as to why kuru affected mostly women, until they discovered that during funeral ceremonies women traditionally ate the dead person’s brain, while men ate the muscle. This tradition has recently been curtailed. 20  An Overview of Food Safety So far there have been no cases of BSE or nvCJD in the United States. The USDA Animal and Plant Health Inspection Service has monitored American cattle for BSE for the past 10 years, with all tests for the disease negative. No beef has been im- ported from Britain since 1985, and since 1989 there has been a ban on imported cattle from any country where BSE exists. FDA prohibits the use of most mamma- lian protein in the manufacture of animal feed given to cattle and other ruminants. Much research still needs to be done to better understand this relatively new disease. Physical Hazards Physical hazards are foreign objects such as insects, dirt, jewelry, and pieces of metal, wood, plastic, glass, etc. that inadvertently get into a food and could cause harm to someone eating that food. FDA has established maximum levels of natural or unavoidable defects in foods for substances that present no major human health hazard. These are called Food Defect Action Levels. This is the maximum amount of unavoidable defects that might be expected to be in food when handled under good manufacturing and sanitation practices. They are allowed because it is economically impractical, and sometimes impossible, to grow, harvest, or process raw products that are totally free of natural defects. Unavoidable defects include insect fragments, larvae, and eggs; animal hair and excreta; mold, mildew, and rot; shells, stems, and pits; sand and grit. The allowable levels of these substances are set at very specific lev- els deemed not to be a threat to human health. If a food contains more than these al- lowable levels, it is considered adulterated. While it may be unpleasant to find such substances in food, eating them at such low levels is not a health hazard and will not lead to illness. FACTORS THAT CONTRIBUTE TO FOODBORNE ILLNESS More than a million pounds of beef recalled and destroyed. One child dead and others sick from drinking fresh juice. In Milwaukee 400,000 people sick with diar- rhea and vomiting. Thirty-five percent of residents in a nursing home sick with salmonellosis and four die. Raspberries causing sporadic foodborne illness for three years in a row. Such news stories of people getting sick from food are no longer new to us. Why are we hearing more about foodborne illness today than we did in the past? If foodborne disease is on the rise, what factors account for this increase? News travels fast these days, both electronically and through the news media. What were once isolated events and stories, now reach millions within hours. Diag- nostic techniques are constantly improving, which allows for identification of dis- eases, foodborne and otherwise, that would have been of unknown origin in the past. But even considering these facts, public health officials believe that the risk of foodborne illness has increased over the past 20 years (GAO 1996). Changes in de- mographics, consumer lifestyles and demands, and food production and economics are changing how food is produced and eaten. In addition, the microbial world is evolving. The next few pages examine factors influencing foodborne illness and food safety problems in the United States. Demographics The proportion of the population at serious risk of foodborne illness is increasing with the aging of the U.S. population and the growing number of people with weak- 21  Overview of Food Safety ened immune systems. Susceptibility to foodborne pathogens varies within the pop- ulation. Thus, two people could eat the exact same food and amount; one may become ill while the other does not. People who are at higher risk of becoming seri- ously ill include infants, young children, the elderly, pregnant women, those taking certain medications and those with diseases such as AIDS, cancer, and diabetes that weaken their immune systems. Twenty-five percent of Americans fall into this cate- gory, and the size of this vulnerable population is growing. Demographers predict that the proportion of people over 60 years old in industrialized countries such as the United States will rise from the current 17 percent of the population to 25 percent by 2025 (Kaferstein 1999). Nursing home residents are particularly susceptible to foodborne illness as the weakening of the immune system that comes with age, and the use of antibiotics and other drugs give pathogens a chance to take hold. Foodborne illnesses are more likely to be fatal in a nursing home than in the general population. In a recent survey 89 percent of deaths with diarrhea as an underlying cause were adults 55 and over or children under the age of five (Morris 1997). While anybody can get sick from eating contaminated food, the length of time it takes before they become ill and how ill they become depends on a number of fac- tors. Most important among these are age, amount of contamination consumed, and health status of the individual. The body has a number of defenses to protect it- self against harmful bacteria. The acidic gastric juices of the stomach are one of the first defenses against foodborne pathogens, as many bacteria cannot survive in an acidic environment. Very young infants and aging adults produce less, or less acidic, gastric juices than younger, healthy adults. The normal bacteria present in the gas- trointestinal system form another protective barrier against foodborne illness by pre- venting harmful bacteria from colonizing the gut. Thus antibiotics, which do not discriminate between good and bad bacteria, but rather destroy them all, can also in- crease a person’s susceptibility to foodborne illness. Without the protective bacteria that are normally present in the gastrointestinal tract, pathogenic bacteria can more easily invade and cause illness. Finally, the human immune system, not fully devel- oped at birth, gradually reaches maturity in puberty and then slowly begins to de- cline after about 50 years of age. Consumer Lifestyles and Demand The pace of life in the United States has quickened. We often eat meals on the run, since we do not have time to prepare food at home. This means that by the time you eat your food, whether it is a restaurant meal or convenience food, it may have been transported, cooked, cooled, stored, transported again, reheated, and touched by numerous individuals. Each processing step introduces new hazards that could allow for the survival and growth of pathogenic bacteria that ultimately lead to foodborne illness. Two out of three people ate their main meal away from home at least once a week in 1998. The typical consumer over eight years of age ate food away from home at least four times per week (Collins 1997). Each time you eat food out you are plac- ing your trust in that food establishment and its workers to handle your food prop- erly. Americans spend 50 cents of every food dollar on food prepared outside the home—from supermarkets, restaurants, or institutions. Add to this the abuse that occurs after a consumer purchases food and takes it home, and the likelihood of illness increases. Approximately 20 percent of reported foodborne illness cases occur from food cooked at home. Experts believe that this 22  An Overview of Food Safety number is actually much higher (estimates range from 32 to 80 percent), but that most people do not report cases of illness caused by foods cooked at home (Knabel 1995; Doyle 2000). Americans are cooking less, and that also means they pass on less knowledge of cooking to their children, who are nevertheless increasingly responsi- ble for preparing meals. Young cooks are receiving less training in food preparation than previous generations. This has grave implications for the future of food safety. In a survey of consumer food safety knowledge and practices, 86 percent of respon- dents knew that they should wash their hands before preparing food, but only 66 percent reported actually doing so. Only 67 percent of respondents reported wash- ing or changing cutting boards after cutting raw meat or poultry. Older adults prac- ticed safe behaviors more often than did younger adults (Altekruse 1995). In an Australian study in which researchers asked people about their food safety and kitchen habits, and then filmed them preparing food, there were large differences in what people said they did and what they actually did. Almost half the people who said they washed their hands after handling raw meat did not, and when they did it was often without soap. Nineteen percent of the households that claimed to have soap in the kitchen did not (Jay 1999). Consumers are increasingly demanding fresh and natural products, and products with fewer preservatives. Without the traditional preservatives and processing meth- ods that prevent microbial growth, modern all-natural and fresh products are more perishable. Food processing, mainly canning, freezing, and pasteurizing, not only extend the shelf life of foods, but also inhibit bacterial growth, making food safer. As an example, fresh apple cider has been associated with several foodborne disease out- breaks. An outbreak of E. coli O157:H7 in which a child died was associated with raw unpasteurized apple juice from a company that built its reputation on the naturalness of its products. This company now uses only pasteurized apple juice in its products (Odwalla Web site 2000). While pasteurization will kill harmful bacteria, advocates of fresh juice argue that pasteurization diminishes taste. To inform consumers of the risk posed by fresh, unprocessed juices, FDA revised its food labeling regulations. Fruit and vegetable juice products that have not been processed to prevent, reduce, or eliminate pathogenic microorganisms that may be present must have a warning statement to that effect on the label. As the role of fresh fruits and vegetables in a nutritious diet has become evident, people are including them in their diet more. In 1993 Americans ate 27 percent more fresh produce than they did in 1973. An increase in the number of foodborne illness outbreaks associated with fresh produce has accompanied this increase in con- sumption. In the last 20 years the number of identifiable outbreaks in which produce was the food vehicle doubled (Tauxe et al. 1997). We also want produce year-round, which makes us dependent on foreign imports to meet that demand. Most produce only grows in the United States in certain seasons; yet this seasonal availability has al- most disappeared from our supermarkets. Corn, berries, lettuce, peaches, and toma- toes, to name a few, are available year-round, or at least much longer than their growing season. From 1996 to 1998 Cyclospora cayetanensis sickened more than 2,400 people throughout 20 states and Canada. The only common food vehicle among these individuals was raspberries imported from Guatemala. Smaller out- breaks of Cyclospora have been traced to basil and mesclun lettuce grown in the United States. Very little is known about Cyclospora, and although there are tests to identify it in stool samples, so far there are no good tests to identify it in foods. This 23  Overview of Food Safety lack of ability to test for the organism in food samples complicates the recommenda- tions public health officials should make to the public. Food Production and Economics In the past, outbreaks of foodborne illness were relatively small and local. Illness could be traced back to local events such as weddings, church dinners, and other gatherings where a large number of people ate the same food. Most of the victims lived in the same area and knew each other. That picture has changed today for sev- eral reasons. Today’s food is produced in vastly different ways from even several decades ago. Food used to be grown, produced, and distributed on a local basis. Food production is now centralized and on a larger scale than in the past. Products made in a single processing plant in mass quantities are shipped all over the country, sometimes the world. A mistake made in the processing will be felt nationwide instead of just locally. This is precisely what happened with Schwan’s ice cream in 1994. A study in the New England Journal of Medicine reported that an estimated 224,000 people through- out the nation became ill from Salmonella enteritidis after eating ice cream produced on certain dates at an ice cream processing facility in Minnesota. Several suppliers shipped ingredients for the ice cream in bulk to the plant by tanker truck. The most likely cause of the outbreak was determined to be contamination of the ice cream premix during transport in tanker trailers that had previously carried unpasteurized liquid eggs, a known source of Salmonella enteritidis (Hennessy 1996). Recalls from processing plants are on a larger and larger scale. In 1997 Hudson Foods recalled 25 million pounds of ground beef produced at its large Nebraska facility due to the pres- ence of E. coli 0157:H7. This is a scale unprecedented a generation ago. Even the manner in which farmers raise animals can contribute to an increase in food safety problems. A large number of animals are often crowded together, which increases their stress levels and weakens their immune systems. This crowding also facilitates the spread of disease from one animal to another. In the past a sick animal was fairly isolated and would not pass on illness to the rest of the flock or herd. But with animal-to-animal contact, disease can quickly spread. Many pathogens that cause foodborne illness in humans are present in the animals we consume. However, the pathogens do not cause illness in the animals themselves, making it difficult to distinguish which animals are carrying pathogens and which are not. Cattle infected with E. coli O157:H7 appear just as healthy as those that are not. Little is known on how these animals become infected and how they transmit these pathogens. Research into food safety is expanding to investigate what animals eat and drink and how that ultimately affects humans (Tauxe 1997). New and Evolving Pathogens As recently as 50 years ago scientists had identified four foodborne pathogens. Today five times that number are on the list. Twenty years ago scientists did not even recognize three of the four pathogens that the Centers for Disease Control and Pre- vention considers the most important in causing foodborne illness—Campylobacter jejuni, Listeria monocytogenes, and E. coli O157:H7. Cyclospora cayetanensis first ap- peared in 1979 and is still not well understood. It is likely that scientists will discover new foodborne pathogens as laboratory techniques improve. 24  An Overview of Food Safety As living organisms, pathogens are constantly evolving. With better ability to trace outbreaks, scientists are discovering that some bacteria survive in environments previously thought safe. For example, E. coli O157:H7, originally called hamburger disease because of its presence in undercooked ground beef, has shown up in food as diverse as salami, apple cider, raw milk, and lettuce. It also survives in lower pH con- ditions than originally thought, which leads to outbreaks in acidic foods such as sa- lami and apple cider. It is now known that Yersinia enterocolitica and Listeria monocytogenes can survive and multiply at refrigeration temperatures. Some foods long considered safe recently have been implicated in foodborne out- breaks. For years scientists believed the inside of an egg was sterile and that Salmo- nella enteritidis was not of concern. In 1989, however, they discovered that chickens infected with Salmonella pass this infection along in their eggs, so that the bacteria can be inside the raw egg, making it unsafe to eat raw or undercooked eggs. Knowl- edge of this fact caused food safety experts to advise people to cook eggs thoroughly or to use liquid pasteurized eggs. This means icings, egg drinks, ice cream, cookie dough, sauces, or salad dressings that contain raw eggs could be infected with the bacteria. Recently a private company developed a process to pasteurize whole eggs still in the shell, which could make these uncooked foods safe to eat again. One of the largest outbreaks in the United States came not from food, but from the water supply. In Milwaukee, Wisconsin, an estimated 403,000 people became ill with watery diarrhea in April 1993. Ultimately it was found that Cryptosporidium parvum, a one-celled parasite first documented to infect humans in 1976, was the culprit. While in healthy people cryptosporidiosis is only moderately serious with watery diarrhea lasting seven to 14 days, in the immunocompromised it can lead to severe prolonged diarrhea and even death. In this outbreak 4,400 people were hos- pitalized. Although Cryptosporidium had previously been found in surface water, it was not expected to be found in treated water from a municipal water supply that met state and federal standards for acceptable water quality (MacKenzie 1994). In- creased awareness of the parasite has led to increased testing for it and, not surpris- ing, increased prevalence has been discovered. In addition to drinking water outbreaks, Cryptosporidium is associated with swimming pools and amusement park wave pools. This is particularly important because Cryptosporidium is highly resis- tant to chlorine and other chemical disinfectants. This is a new parasite showing up in new environments with new resistance capabilities. Bacteria have evolved to thwart attempts to eliminate them. Some pathogens are now becoming resistant to common antimicrobial agents. It is thought that the re- sistance may be due to the use of these antibiotics in animals. We are seeing this same adaptability in foodborne bacteria. Salmonella typhimurium DT104 is widely dis- tributed in wild and farm animals, especially in Europe and is resistant to several common antibiotics. There has been a parallel increase of people getting sick from this type of drug-resistant Salmonella. HISTORY OF FOOD SAFETY Very little about foodborne illness or food safety is found in historical records. Sci- entists did not begin to understand bacteria, and their relationship to disease, until the late nineteenth century. People did recognize that food spoils, but the reasons for that and the potential for becoming ill from food were not known. Perhaps the absence of food safety from historical chronicles is an indication that it was less of a 25  Overview of Food Safety concern than were other problems in the past. Even early food regulations were not aimed at making food safer, but rather at preventing economic fraud. So, a history of food safety really does not exist, but numerous discoveries, inventions, and regula- tions have led to the present knowledge and state of affairs in food safety. Chapter 1, in the section on food preservation, covers many of the inventions contributing to food safety; chapter 4 provides extensive coverage of the history of food regulations; and the chronology in chapter 3 presents other details of food safety history. Food preservation methods such as drying, smoking, freezing, marinating, salt- ing, and pickling had their beginnings thousands of years ago. Whether these meth- ods were employed solely to keep food for later use, to improve flavor, or for other reasons is not known. But they also had the effect of keeping food safer. Even cook- ing can be viewed as an ancient method of making food safer. The Chinese Confu- cian Analects of 500 B.C.E. warned against consumption of sour rice, spoiled fish or flesh, food kept too long or insufficiently cooked food. The Chinese disliked eating uncooked food believing, “Anything boiled or cooked cannot be poisonous.” Among the earliest of food safety manuals was one published in China in the year 2 (Needham 1962). It is possible that the practice of drinking tea originated because tea required using hot water, which would make it safer than using unheated con- taminated water (Trager 1995). Doubtless other cultures in antiquity, while oblivi- ous to the causes or prevention of foodborne disease, experienced it and prescribed methods to avoid it. Early scientists grappled with the nature of disease and bacteria, which would set the stage for later discoveries. Much of the present knowledge about pathogens that cause foodborne illness is built on a foundation of scientific discoveries spanning back over three centuries. Aristotle (384–322 B.C.E.) and his Greek philosopher/sci- entist predecessors believed in the spontaneous generation of organisms—that insects and animals arose spontaneously from soil, plants, or other species of animals. Fran- cisco Redi, an Italian physician and poet, set out to disprove this theory in 1668. He believed that maggots did not arise spontaneously in meat, which challenged the common wisdom of the day. He prepared eight flasks with meat in them; four sealed and four left open to the air. No flies could land on the meat in the sealed flasks, thus no maggots grew. The clear conclusion was that maggots did not form by spontane- ous generation, but that flies laid eggs that were too small to be seen. This, however, was not enough to convince skeptics. Italian biologist Lazzaro Spallanzani in 1768 disproved the spontaneous generation theory. Even though Redi proved that insects did not arise from spontaneous generation, scientists still believed that microorgan- isms did. In his experiments, Spallanzani boiled solutions that would normally breed microorganisms for prolonged periods of time, which killed any microorganisms that might be in the solution, on the walls of the flask, or in the air inside the flask. Then he sealed the flasks to prevent any new spores or microorganisms from enter- ing. No microorganisms grew no matter how long he left them standing. The fact that no new microorganisms appeared meant that there was no spontaneous genera- tion (Satin 1999). The discovery of bacteria in the late nineteenth century, the increased under- standing of bacteria’s role in disease, and the realization that there is a connection between human diseases and animal diseases led to the ideas that cleanliness is im- portant and that unsanitary conditions can contribute to disease. In 1847 Hungar- ian physician Ignaz Semmelweiss wondered why women who bore their children in hospitals died of fever during childbirth, while those who gave birth at home usually 26  An Overview of Food Safety did not. Noting that doctors went straight from the operating room to laboring mothers, he concluded that the doctors themselves were carrying disease to the women from the dissecting room. In those days the doctors didn’t wash their hands, but wiped them on their aprons, which were already coated with body fluids. Semmelweiss ran experiments in which he had the doctors wash their hands with soap and water, and then rinse them in a chlorinated lime solution before entering the maternity wards. Death rates plummeted from 10 percent to 1.5 percent, only to climb again when the experiments were discontinued. Thereafter, he forced doctors to wash their hands before treating patients. Unfortunately, the validity of his work was not recognized at the time. His colleagues greeted his theory with ridicule, re- fusing to believe that their own hands were a vehicle for disease. Instead they attrib- uted the deaths to a phenomenon arising from the “combustible” nature of the pregnant women. Historians attribute Semmelweiss’s eventual despondency to the ridicule of his theories and attacks on his character. He was committed to an insane asylum, where he died of blood poisoning (Britannica.com Inc.). Lack of personal hygiene remains one of the main causes of foodborne illness 150 years later. In a classic case of epidemiologic sleuthing, Dr. John Snow demonstrated in 1848 how cholera spread throughout London. He noticed that people who obtained their water from a particular well were more likely to become ill than those drawing their water from another well. He persuaded city officials to remove the pump handle from that particular well, which forced inhabitants to draw water from another well. The number of cholera cases dropped immediately (Frerichs 1999). Louis Pasteur further elucidated the linkage among spoilage, disease, and microorganisms with his work on fermentation and pasteurization in the 1860s and 1870s. In 1872 German scientist Ferdinand Julius Cohn published a three-volume treatise on bacteria, and essentially founded the science of bacteriology. He was the first to attempt to classify bacteria into genera and species, and the first to describe bacterial spores. But this new field of bacteriology needed bacteria on which to conduct experiments and to study. It took Robert Koch in the 1880s to perfect the process of grow