The Food Journal and Food, Nutrition & Science

An alliance between The Lempert Report and The Center for Food Integrity

Communicating Outbreaks

Communicating Outbreaks

In the News

September 28, 2008

 Recently, the FDA lifted its advice to consumers to avoid eating both peppers (jalapeño and Serrano) and tomatoes (raw red round, Roma, and red plum), saying that the outbreak that sickened more than 1400 people over the summer appears to be over.
But fallout from the outbreak is ongoing. To date, consumer avoidance of peppers and tomatoes has cost the industry an estimated 250 million dollars. Regaining consumer trust could take additional months or years. Now, suppliers, retailers and manufacturers want to know how tomatoes made the risk list in the first place. Insiders say the answer is complicated.
When multiple people fell ill from the same type of Salmonella – Salmonella Saintpaul – in April, investigators determined that many of the sick had recently eaten tomatoes. Later in the summer, this same Salmonella strain was found on a Mexican-grown jalapeño pepper. By the time blame shifted, the damage to tomatoes had already been done.
“Epidemiology is largely circumstantial evidence based on people’s memories,” says Dr. David Gombas, Senior Vice President of Food Safety and Technology for United Fresh Produce Association. “Investigators tested their (tomato) assumption by looking for evidence. Failure to find that evidence dragged out the investigation, and the outbreak, until the initial assessment was questioned, and the investigation shifted to peppers.”
Jalapeño peppers were not initially implicated, says the Centers for Disease Control (CDC), because in an early study interviewing the sick, only 39% of case-patients had reported eating jalapeño peppers. Comparatively, 85% of those interviewed reported consuming raw tomatoes.
However, according to the CDC, even if tomatoes had not been the initial source of the outbreak, the finding of Salmonella on peppers from two farms supported the possibility of contamination of other produce items along the supply chain. And thatlist included tomatoes too.
The CDC also points out that during a large outbreak like the one in question, local, state and federal response capacity is often strained, and that can cause delays in identifying cases. Interestingly, in this case, the median time from illness onset to PulseNet was 17 days. The average time interval (per a CDC study of enteric disease timelines, known as the EDITS study) is actually 15 days for E. coli – and 18 days forSalmonella.
“In an outbreak investigation, CDC and FDA have to be fast and they have to be right.  We’ve done ‘fast’, now we have to do ‘right’,” says Gombas. “While it is theoretically possible for peppers on different farms to become contaminated by cross-contact in some packing facility, we don’t have to rely on theory. The industry, CDC, FDA and others involved in the investigation together need to perform a rigorous re-examination of the evidence.”
Food outbreaks tend to hit retail hard, as speculations affect consumers’ perceptions of safety. Sometimes, even a green light from the FDA does little to restore consumer confidence. Spinach is still struggling to get to where they were before the last E.colioutbreak – and that was back in 2006. Total losses from the spinach outbreak have been estimated at about $100 million.
“If a reputable organization like CDC won’t say that tomatoes weren’t responsible, a consumer has to think, maybe they were contaminated, and maybe they’re still not safe. Consumers need closure on an outbreak, just like the industry,” says Gombas. “It is important to remove the taint tomatoes are now labeled with if, in fact, tomatoes were not a vehicle in this outbreak. And it is time to create a protocol for validating outbreak conclusions after the fact.” 
In order to avoid shutting down the tomato industry, CDC and FDA went to extraordinary lengths to create and communicate a tomato “safe list.” To better help retailers, though, the FDA should have directed their message – “tomatoes from these regions are safe” – to the industry, says Gombas, and required retailers and foodservice distributors to verify the source of their tomatoes. That way, consumers could’ve been told that all tomatoes available for sale were safe.
“Consumers should not have to ask, ‘Where are these tomatoes from?’”
Today, outbreak investigations are limited to public health officials, who have great knowledge of laws, regulations and how to perform an investigation, but don’t necessarily have the knowledge of supply sources, distribution chains and supply timing that the industry is expert at. One way to avoid this type of situation in the future, says Gombas, is to find a way for knowledgeable individuals within the affected industry to work with these public health officials during an outbreak.
“Had they been more involved in the investigation, and had access to more of the information available only to public health officials, the investigation may have refocused on peppers sooner,” he says.