FoodCORE Centers: Current Efficiency Practices and Initiatives

Mar 19 2013 :: Published in Food Safety

By Jessica Monmaney, Associate Specialist, Infectious Disease and Food Safety, APHL

Since its inception in 2009, FoodCORE has allowed participating laboratories to increase outbreak response times through improvements in patient interviews, data processing and information sharing. A number of FoodCORE laboratories have continued to implement further measures to increase efficiency.

What is FoodCORE?

Salmonella enteritidis in colorSpecimen Courier Services

Six out of seven FoodCORE centers have introduced a courier service that allows them to improve turnaround times and address limitations of partner laboratories. Stacey Kinney, the Lab Director in Connecticut, notes that “we are not sure what will happen if funding is cut but if this happens, we are hoping this will be supported either through state funds or another federal grant. It has gotten positive reviews especially by hospital labs that do not have their own couriers and usually put the samples in the mail. We are getting samples quicker from these hospitals and [the courier service] has improved turnaround time.”

Concurrent Pulsed-Field Gel Electrophoresis (PFGE) and Serotyping

Standard protocol requires the serotyping of isolates before isolates can be subtyped through PFGE. This can often result in a significant delay, as well as an incomplete specimen record, as Tim Monson, the Lab Director in Wisconsin found upon his laboratory’s participation in FoodCORE: “Prior to becoming a FoodCORE center…[subtyping] took anywhere from six to eight days. Since becoming a FoodCORE center in the fall of 2010, it takes only three days to receive and upload PFGE patterns on average. In addition, PFGE subtyping all Salmonella isolates has paid off since the fall of 2010 with the contribution of S. Nchanga, S. Enteritidis, S. Bareilly, S. Schwarzengrund, S. Baildon, S. Pomona and S. Litchfield isolates…to national clusters of illness. None of the aforementioned serotypes would have been PFGE subtyped routinely prior to becoming a FoodCORE center. “

Molecular Serotyping

The process of serotyping allows laboratories to determine which bacterial isolates will cause diseases (i.e. are pathogenic, versus non-pathogenic). Previous methodologies utilized antisera to identify types of bacteria that were more pathogenic than others.  Molecular serotyping has emerged as a means to acquire more specific information more efficiently.  The Chief of New York City’s public health laboratory, Laura Kornstein, is beginning to see how switching to molecular serotyping is affecting her laboratory, and has found that although the change was made as recently as December 2012. “This is already having a positive impact on our Salmonella PFGE turnaround times.”

The measures above allow FoodCORE centers to increase laboratory efficiency and to further their quality improvement efforts, but require adequate funds to initiate and maintain. State and local public health laboratories hope that federal funding will continue to support them in their efforts.

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Improving Outbreak Response with FoodCORE: an Introduction to Food Safety Success Stories

Oct 11 2012 :: Published in Food Safety

By Jessica A. Monmaney, Senior Technician, Food Safety and Infectious Diseases, APHL

A few months ago, you may have heard about an ongoing and growing Salmonella outbreak. By the end of the outbreak, there were 425 people sick across 28 states, and 55 people hospitalized. However, without the quick action by the states and cities involved, many more people could have become ill. In large part due to CDC’s Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE) program, the outbreak’s cause was identified as scraped raw frozen tuna and further illnesses were prevented.

FoodCORE is a program that started in 2009 and is currently made up of 7 centers: Connecticut, New York City, Ohio, South Carolina, Tennessee, Wisconsin and Utah. FoodCORE finds solutions to outbreaks more rapidly through a system of comprehensive interviews, prompt DNA fingerprinting of pathogens and efficient information sharing among partners. Interviews with sick individuals regarding recent food consumption allow FoodCORE centers to identify potentially contaminated products, fingerprint the DNA of the bacteria and combine information to determine what made people sick.

PulseNet Logo

At the 16th Annual PulseNet and 8th Annual OutbreakNet Update Conference, the FoodCORE team provided crucial input/participation throughout numerous facets of the conference as a whole, and collaborated for a member networking session and an open session. The following people deserve a round of applause for their efforts leading up to, and throughout, the conference: Jennifer Mitchell, Julia Hall and Kim Quinn as General Session moderators; Katie Garmin, Marilee O’Connor and Jenni Wagner as Regional Breakout Session Facilitators; Heather Hanson, HaeNa Waechter, Jeannette Dill, Amy Woron, Katie Garmin, Tim Monson and David Young as speakers and poster presenters; and all of the FoodCORE members who took the time to engage PulseNet and OutbreakNet partners during the Sunrise Sessions and the Q&A portions of the General Sessions.

The FoodCORE Members Networking Session was attended by over 40 people, including staff from FoodCORE centers, as well as partners from CDC’s Outbreak Response and Prevention Branch, leadership and sites from FDA’s Rapid Response Team (RRT), APHL and the Public Health Agency of Canada. Center participants met in small groups to discuss center-specific future goals and upcoming projects. Attendees successfully concluded the meeting in agreement on team-wide projects and goals, such as improving the process of reporting metrics and the development of model practices documentation.

An open session on the first day of the conference provided over 70 conference attendees with the opportunity to become more familiar with FoodCORE and the lessons learned while resolving outbreaks that lead to success stories. In addition to the raw scraped tuna outbreak, the Ohio state lab created an innovative way to provide information on norovirus infection and protection through social media, New York City used their a “Team Salmonella” to solve an outbreak of Salmonella related to kosher chicken livers, and Utah utilized FoodCORE resources to resolve an outbreak of Salmonella in queso fresco that had stumped state public health officials for two years. For more details on these outbreaks – including interviews with staff at FoodCORE centers from the frontlines of these success stories – please stay tuned for the upcoming fall issue of APHL’s Lab Matters!

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In response to the State of the Union: What are the labs doing?

2012 State of Union

In his 2012 State of the Union address, President Obama described his vision for improving the economy, increasing employment and protecting the interests of the United States. The President also mentioned that he will continue his support for federal actions that protect children from mercury poisoning, ensure safe food and assure clean water (click here to see the portion of the State of the Union speech where the President says this). The nation’s governmental health laboratories play a critical role in the surveillance and detection of harmful air pollutants like mercury; contaminants like Salmonella in food and pesticide residues that have short and long-term health consequences; and pollutants in drinking water. How exactly?  Governmental health laboratories are:

  • Routinely monitoring food samples at retail stores and in the distribution chain to check for microbial pathogens and pesticide contaminants in a variety of commodities
  • Performing on-going characterization of bacterial isolates from ill people, submitting their fingerprints to the National PulseNet Database at CDC so that cases with indistinguishable patterns can be linked and investigated
  • Implementing the latest laboratory techniques to quickly and accurately confirm diagnoses, serotype isolates, and fully characterize linked  pathogens
  • Partnering with other food safety professionals who analyze laboratory findings, providing critical data to help solve outbreaks, determine root causes of contamination, and assess the impact of industry changes designed to prevent future illnesses
  • Monitoring and detecting environmental threats by conducting testing in people, air, water, soil and more
  • Conducting tests to support enforcement of water, air, food, dairy and environmental safety laws
  • Carrying out research to investigate illness trends and emerging contaminants such as pharmaceuticals
  • Conducting exposure studies to determine if environmental contaminants, such as mercury and lead, are getting into people
  • And responding to natural disasters, suspected terror events and industrial accidents, such as the 2010 Gulf Coast Oil Spill.

Beyond those items mentioned in President Obama’s State of the Union speech, labs are doing so much more:

  • They are detecting disease causing organisms and other harmful substances. The laboratories have innovative scientists that develop new methods to detect and fight infectious diseases, environmental pollutants and toxins. Remember the 2009 H1N1 pandemic? Public health laboratories tested thousands of specimens from patients and quickly provided results on whether or not a patient had H1N1 or some other form of influenza.
  • They are serving as integral members of national networks, such as the CDC’s Laboratory Response Network (LRN) where they prepare for, respond to and recover from all-hazard threats. Think anthrax 2001 – the public health laboratories in the LRN responded, testing thousands of specimens from patients as well as samples collected from the environment, and assuring first responders and the public that it was safe to reopen and enter buildings.
  • And they are providing training and conducting educational outreach to thousands of other laboratories, such as hospitals in their states. The hospitals know where to send potential threat samples and other items for specialized testing.

We are pleased to hear the President support important public health matters in this country. Mr. President, we assure you that laboratories at the state and local levels of government continue to demonstrate their ability to provide accurate and actionable information in all of these areas, and stand ready to continue their operations.

 

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Barf-humbug! Holiday cookies, latkes and everyday safe egg handling

Dec 20 2011 :: Published in Food Safety

By Michelle Forman, Senior Media Specialist, APHL

Ah, the holidays… whatever holiday it is that you celebrate (or just the holiday called “Quiet Time in the Office”), I think it is safe to assume that your holiday is overflowing with deliciousness.  Friends hosting parties; family gathering for dinners; coworkers bringing treats to share.  Whether sweet or savory, this time of year screams FOOD.  (And that means my pants scream LOOSEN ME.) However you choose to celebrate – or not celebrate – this time of year, let’s talk about some ways to make sure your holiday season doesn’t scream BARF-HUMBUG!

Egg

Around Thanksgiving we talked about safely handling raw meatQuick! Do we rinse our turkeys or not?  I hope you said NOT.  This time of year I think we need to talk about eggs and Salmonella.  That unexciting ingredient that goes into cookies, cakes and other sweet treats, and let’s not forget about latkes, a Chanukah staple, and of course eggnog.  I don’t know about you, but I often quickly add them and move on to the more exciting ingredients like chocolate chips!  Let’s take a step back and think about those eggs.

Shell eggs (ie, eggs in their shells as opposed to the egg product in a carton – more on this below) are not pasteurized.  That means they can contain Salmonella.  There are regulations in place that mandate certain procedures to clean the outside of eggs sold commercially so you’re good there.  The issue is that Salmonella can live inside the shell.  That means we have to be careful.

Here are a few suggestions to make sure you aren’t contaminating your kitchen:

1. When handling raw egg, you should think of it like raw meat.  Would you rub your raw chicken all over your countertops?  Would you get raw chicken on your hand, wipe it on your dishtowel and just move on without washing with soap and water?  I hope not.  And if you do, please don’t invite me over for dinner.  After you crack your eggs into the bowl, wash your hands and anything else you touched.  Wash with water AND soap.  Come on.  Will these soaps that look like bacterial cultures help make hand washing more fun?

2. Now don’t forget that whatever you just mixed your egg into has raw egg in it.  Did that sound like the most obvious statement ever?  Then why would you roll cookie dough out on your counter, cut out your adorable Rudolph cookies, line them up like a reindeer army marching across your baking sheet, and then NOT wash your hands again and anything else you touched including the counter?  I mean, really people!  If your eggs are contaminated, you just shmeared Salmonella all over the place and *bing bong* your guests are here and not interested in eating your Salmonella cookies while gathered around your Salmonella countertops.  Do everything you possibly can to NOT cross contaminate.

Thumbprint cookies

3. Ok.  Now we need to have a difficult talk.  This won’t be easy for either of us to discuss but it is necessary.  Eating raw cookie dough.  I know, I know… it is delicious.  I’m right there with you!  So I’m not going to tell you not to eat raw cookie dough.  I know you’ll stop reading right now and brush me off as the mean lady who ruined your favorite indulgence.  What I am going to tell you is that you have to lick those delicious spoons at your own risk.  Just like with raw meat or fish, it could make you sick.  Any egg could contain Salmonella.  Just because you got it at Fancy Pants Grocery doesn’t mean it is exempt from contamination.  Officially we don’t recommend eating raw cookie dough.  Unofficially? You decide if you feel it is worth the risk.  I would strongly discourage you from letting your kids, an elderly friend or relative or anyone with a compromised immune system have it.  In that case, it probably is not worth the risk.  Salmonella is potentially very dangerous.  And to those of you tough guys who are like, “Oh, I eat raw cookie dough all the time and I’m still alive!”  You may get sick – you may not get sick.  But ask any person who has ever contracted Salmonella and they will likely tell you about the time when they wish they weren’t alive as they slept on the bathroom floor cuddled up to the toilet.

4. As I already mentioned, most shell eggs are not pasteurized but egg product is. Egg product is the stuff that comes in cartons.  Many restaurants use egg product for that reason – Pasteurized! No lawsuit!  Hooray!  If you’re making sauces that call for raw egg (Caesar dressing, Hollandaise, béarnaise, etc), using egg product is safer.  Some egg product won’t work well for baking so check the side of the carton first.  It will tell you.

5. Make sure things are cooked all the way through.  You’re not going to stick a meat thermometer in every cookie and latke, but you can still check to make sure they aren’t raw in the center.  You want the chocolate chips to be gooey, not the cookie part.  And when frying latkes, be sure your pan isn’t too hot so they cook through before the outside burns.  In both cases, break one in half to check the center.  Oh, and you know those delicious runny sunny side up eggs you love to dip your toast in?  Yeah, those aren’t cooked all the way through.  Just like with the cookie dough, eat at your own risk.

6. Don’t drink unpasteurized eggnog.  You can get pasteurized eggnog, so why risk it?  Friends don’t let friends drink unpasteurized eggnog and hold their own hair back… if you know what I mean.

As GI Joe said, “Now you know, and knowing is half the battle.”  He was obviously referring to safe food handling when he said that.

Why do we go to so much trouble to entertain and be entertained this time of year?  Because it is nice.  Because seeing people enjoy cookies and latkes that you made makes you feel good. You know what won’t make you feel good?  Seeing people snacking on thumbprint cookies with a dollop of Salmonella in the center where a Hershey kiss should be.   That won’t end well for anyone.

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DO NOT RINSE YOUR TURKEY! And other Thanksgiving food rules for every day

Nov 21 2011 :: Published in Food Safety

Thanksgiving Turkey

By Michelle Forman, Senior Media Specialist, APHL

Thanksgiving is a time to celebrate family and friends, enjoy the fall harvest, and to stuff our faces full of delicious food.  No matter your specific traditions, I’m certain the stuffing-of-faces is common across all Thanksgiving tables.

I must confess, I’ve never prepared a full Thanksgiving meal although I have contributed dishes.  When I cook any time of year, not just for Thanksgiving, I have two goals: 1) Make delicious food and 2) Not make people sick.  Both require following some simple rules – for #1, a recipe.  For #2, a set of rules that I’ve learned from the Food Safety Team at APHL. Rules that effectively put bacteria on a stake in your front yard as a warning to all other bacteria saying “You are not welcome here! You will be cooked properly!”  Not following these rules means inviting Auntie Campylobacter and Cousin Salmonella to your table.  Unless you would like to spend the best shopping weekend of the year doubled over with a fever, diarrhea, and abdominal cramps, pay attention.  And, truth be told, these rules don’t just apply to Thanksgiving.

Roughly half of all meat in the US is contaminated with some sort of bacteria.  While that is pretty gross, you can follow these rules to avoid the grossness:

  1. DO. NOT. RINSE.  Did you hear me?  Don’t listen to your grandmother and her grandmother and all the grandmothers who tell you to rinse your poultry.  DO NOT RINSE YOUR POULTRY.  I’ve got science on my side on this one, Grandma!  Rinsing your poultry – any bird, not just turkey – can actually cause bacteria to aerosolize (how’s that for an image?) and spread around your kitchen up to three feet! Three feet!  That’s really far!  Within three feet of my sink, I have my spice rack, cooking utensils, coffee pot and my baby’s bottles sitting on a drying rack.  What is within three feet of your sink?  Yeah… gross, huh? Plus, it is completely unnecessary.  Rinsing poultry does nothing to get rid of most bacteria – the bacteria that it does eliminate are now splashing around your kitchen.  What does eliminate bacteria? Proper cooking (we’ll get to that).  We aren’t the only ones who will tell you this.  Our friend, USDA, agrees.   And, from a cook’s perspective, you really want a dry skin on your poultry so it can get nice and crispy.
  2. Avoid cross contamination.  When you handle that big beautiful bird, make sure nothing else is around.  You don’t want any of those raw turkey juices getting on anything that you can’t immediately clean.  If Tom needs to be trimmed, use a separate cutting board and knife than you plan to use for your veggies.  Did you happen to see Dr. Richard Besser on The Chew talking about safe food handling?  Cross contamination can happen to the best of us, but we should do everything we can to prevent it.
  3. Wash your hands.  Wash your hands.  Wash your hands.  What was that?  Wash your hands.  You cannot wash your hands too much while handling raw meat.  Think about everything you touch while preparing food – utensils, towels, the countertop, your clothes, your body (why does my nose always itch when I’m cutting up chicken?), even the soap dispenser.  Washing your hands properly will help keep all that bacteria from making its way onto every item in your kitchen.  And if it does get on another surface, wash it.
  4. Don’t thaw your turkeysicle on the counter.  The raw turkey needs to be kept at 40 degrees.  If you thaw it on the counter, the outside (the part that is defrosting the fastest) will likely get warmer than 40 degrees and therefore become more susceptible to bacteria.  Thaw your turkey either in the fridge or in cold water.  Yes, it takes a very long time to thaw a big bird that way so be prepared!  Here is a handy chart with thawing times.  Another good tip – put your turkey in a dish while it sits in the fridge.  You would hate to find out about that tiny hole in the plastic while it is defrosting… a flood of raw turkey juices in your fridge is not so pretty.  Er, so I’ve heard.
  5. Cook your turkey to a safe temperature – which also means getting a good meat thermometer.  All poultry should be cooked to 165 degrees.  We’ll talk about stuffing next, but if you plan to cook your stuffing inside of your turkey that means it also needs to be cooked to 165 degrees.  It is that simple, folks.  Pay no attention to those popper things that come in the turkey.  Check the temperature yourself.  Unlike with your kids, you actually want your turkey to have a fever of 165. Recipe
  6. Let’s talk about stuffing.  First of all, I’m from the South where we call it dressing.  For the sake of food safety, we should all call it dressing.  Why?  Because stuffing can be unsafe because it is stuffing.  Let’s break this down… you fill the cavity of the bird with stuffing so that Tom’s delicious juices add great flavor to your stuffing.  Correct?  As we discussed above (see points one through, well, all of them), Tom’s juices are loaded with bacteria.  Those bacteria are now in your stuffing in the center of the turkey, the part that is farthest from the heat source and therefore takes the longest to reach a safe temperature (165 degrees).   So you have two choices.  You could: 1) Cook the turkey to its perfect temperature while it is still perfectly moist, serving it with the stuffing that is not cooked to the perfect temperature and therefore at risk of carrying bacteria that is going to send your guests home with a party favor they did NOT ask for, or 2) Cook the bird and the stuffing until the stuffing in the center is cooked to a safe temperature thus overcooking and drying out your turkey.  If I had to pick from those options – undercooked stuffing or overcooked turkey – I’d choose… tofurky.  There are two secret options that mean everybody wins.  Either 1) Cook your stuffing separately.  Use a delicious, rich stock (chicken, turkey, or vegetable) to add the flavor you’re looking for.  I promise it will taste good.  Or 2) Cooking the stuffing in the bird, remove it, and continue cooking it outside of the turkey until it reaches a safe 165 degrees.  Recipe
  7. Avoid BPAs.  Now, this next “rule” is really more of a suggestion.  I think by now most people know that canned goods have a liner that often contains Bisphenol A or BPA.  We buy BPA free water bottles and BPA free toys for our kids yet somehow on Thanksgiving all of that knowledge of BPAs goes out the window because, goshdarnit, we Americans love our canned cranberry sauce.  If it isn’t still in the shape of the can complete with rings, we don’t want it!  Myself included!  Well, not anymore.  I didn’t order harmful chemicals with my cranberry sauce, thanks.  Make it yourself from fresh or frozen cranberries.  It is easy and delicious… and much safer.  Recipe

Remember the two goals I mentioned at the beginning – making delicious food and not making people sick?  They can both happen at the same time by following some simple rules.  When it comes to safe food handling, it is all about awareness.  Be aware of cross contamination, what you touch, and the internal temperature of your food.  Follow these rules and your guests will be thankful that they didn’t learn the word “campylobacter” for the first time while at your house.

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Culture Assays: Protecting Us From the Next Foodborne Outbreak

Sep 12 2011 :: Published in Food Safety

By Robyn Atkinson, PhD, Unified Utah State Public Health Laboratory Director

As hard as science tries, no microbiological diagnostic laboratory test is 100% perfect. The identification of infectious organisms by culturing patient samples is the gold-standard and is the measure by which all new tests are based. However, even culture has its inherent drawbacks. Not all organisms thrive on synthetic media and the numbers of organisms present in a clinical sample may not be of a sufficient density to yield a recognizable colony. 

Manufactures have worked for years to help clinical laboratories overcome these issues while improving upon turn-around-time for results. With the advent of PCR, the drive to default to DNA based tests is appealing since the results should be undeniable and require a minute amount of sample. Either the organism is present and DNA is detected, or the organism is not present and no DNA is detected. In a perfect world, this would be correct, but even PCR assays have a limit of detection and very rarely will these assays detect a single organism’s DNA.

The key hindrance to any type of non-culture based test is that the clinical and public health community lose access to the actual organism. This prevents further study of these organisms for antimicrobial resistance testing to ensure proper patient treatment, prevents the detection of enhanced virulence factors and prevents public health from monitoring the spread of a particular clone of a bacterial species within the population. This tracking of organisms by public health across communities and across states during an outbreak has become the corner stone for foodborne pathogen surveillance.  Without access to these organisms, valuable organism characteristics are lost. 

A perfect example of a scenario that relied upon the isolation of an organism is the current outbreak and massive recall linked to ground turkey. The organism responsible is a highly antimicrobial resistant strain of Salmonella Heidelberg. This organism was cultured from ground turkey and tested for antimicrobial resistance as a part of the National Antimicrobial Resistance Monitoring System and was subjected to molecular analysis through the PulseNet Program. Once this organism was isolated from a clinical sample, the match was made! Without either of these programs utilizing culture to isolate and describe the characteristics of this organism, we still might not have the connection between the ground turkey and over 100 ill persons.

Maintaining culture is the only way to ensure that we remain prepared for what bacterial pathogens have in-store for us next!

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Salmonella in eggs causes one of the largest foodborne outbreaks in history

Jan 11 2011 :: Published in Food Safety

By Kara Watarida, Associate Specialist, PulseNet, APHL

Looking back at 2010, one of the largest foodborne outbreaks in history occurred.  Who would have suspected that a national increase of Salmonella ser. Enteritidis infections would make history?  This outbreak was linked to shell eggs and thus far is the largest S. Enteritidis outbreak and the largest egg recall to date.  Nearly 2,000 reported cases were likely associated with this outbreak and over 500 million shell eggs recalled.  This investigation was one of the largest collaborative efforts by public health professionals across the country.

Fried egg, sunny side up

This outbreak proved to be a challenge for laboratorians, epidemiologists and investigators.  S. Enteritidis is one of the most common Salmonella serotypes reported and the outbreak strain is the most common S. Enteritidis PFGE pattern in the PulseNet database.  Because of the commonality of this S. Enteritidis PFGE pattern, relying strictly on PFGE subtyping was not sufficient to determine which cases might have been outbreak-associated.  Also, eggs are a common food item, whether eaten or used as an ingredient.  All these factors complicated the investigation but through the collaborative work between laboratorians, epidemiologists and environmental health specialists, eggs from a common supplier were found to be the likely source of this outbreak. 

The coming years will show if the recent FDA Egg Rule, implemented in July 2010, will decrease the incidence of egg-associated S. Enteritidis infections.  APHL will continue to work collaboratively with public health and agriculture laboratories, CDC, FDA and USDA, as well as with food safety partners to ensure the safety of our food supply and the health of our nation.

For more information on S. Enteritidis infections and prevention, please visit the CDC website.

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