Chuck Jolley of Cattlenetwork interviewed Bill Marler on February 3, 2009. To quote Mr. Jolley, the interview had two mainthemes (1) What the hell is going on? And (2) What will be the effects on the cattle industry? MRSA comments are in bold.
Q. Bill, despite changes in federal rules and regs and your decade-and-a-half of court room work, food borne illnesses still seem to be piling up year-after-year. Let’s look at the Salmonella illnesses that began appearing half a year ago. It took five months to link it to King Nut peanut butter’s Blakely, GA plant. Why did it take so long and what did it cost in deaths and illnesses?
A. The PCA facility was in bad shape. They were shipping product for about 2 years that they knew was bad. So far, 120 people have been hospitalized and 8 have died. According to published reports, over 540 have been sickened in 43 states. We know our surveillance isn’t perfect, though. For every reported case, maybe 40 are missed so we could be looking at many more hospitalizations and deaths and over 20,000 illnesses.
It was an epidemic, but we figured it out only after it had just about run its course. After the tomato, spinach and ground beef problems, we need to put more effort into catching these things sooner rather than later and throwing a whole industry under the bus.
Q. Peanut butter spiked with Salmonella is the hottest news item these days but I’ve read reports of trace amounts of mercury found in High Fructose Corn Syrup, antibiotic-resistant staph bacteria in CAFO pigs and you’ve been quoted as saying we’re losing the fight against E. coli – a contaminant found in meat and produce. With all of the federal, state and local organizations charged with overseeing the safety of our food, why are we unable to move the dial on this thing?
A. We have a real failure in our ability to survey bacterial and other food borne illnesses. The problem is each state has its own skill sets at finding and tracking these outbreaks. Some states are very good, some states are abysmal. We have too many organizations, too, that don’t communicate well with each other.
Q. With a new administration in place and new hands like Tom Vilsack on deck at the USDA, do you see a chance for improvements – a new emphasis on food safety - at the federal level?
A. I sent an open letter to the FSIS with some suggestions. It’s posted on my blog (http://www.marlerblog.com/). In it, I said:
• ‘Improve surveillance of bacterial and viral diseases. First responders - ER physicians and local doctors - need to be encouraged to test for pathogens and report findings directly to local and state health departments and the CDC promptly.’
• ‘These same governmental departments, whether local, state or federal, need to learn to “play well together.” Turf battles need to take a back seat to stopping an outbreak and tracking it to its source.’
• ‘Require real training and certification of food handlers at restaurants and grocery stores. There also should be incentives for ill employees not to come to work when ill. We should impose fines and penalties on employers who do not cooperate.’
• ‘Stiffen license requirements for large farm, retail and wholesale food outlets, so that nobody gets a license until they and their employees have shown they understand the hazards and how to avoid them.’
• ‘Increase food inspections. While domestic production has continued to be a problem, imports pose an increasing risk, especially if terrorists were to get into the act. Points of export and entry are a logical place to step up monitoring.’
• ‘Reorganize federal, state and local food safety agencies to increase cooperation and reduce wasteful overlap and conflicts. Reform federal, state and local agencies to make them more proactive, and less reactive.’
• ‘There are too few legal consequences for sickening or killing customers by selling contaminated food. We should impose stiff fines, and even prison sentences for violators, and even stiffer penalties for repeat violators.’
• ‘We need to use our technology to make food more traceable so that when an outbreak occurs authorities can quickly identify the source and limit the spread of the contamination and stop the disruption to the economy.’
• ‘Promote university research to develop better technologies to make food safe and for testing foods for contamination. Provide tax breaks for companies that push food safety interventions and employee training. Greatly expand irradiation of raw hamburger and other high-risk products.’
• ‘Improve consumer understanding of the risks of food-borne illness.’
Q. Let’s talk about existing laws and regulations. Peanut Corporation of America was not required to inform the FDA or state food-safety agencies that its products had tested positive for Salmonella. They merely went ‘lab shopping,’ had the product re-checked, then placed it into commerce. A Georgia state dismissed the practice when he said, "It's just basically a loophole that has been there." How many loopholes are out there and why do they exist?
A. A few companies are less concerned about food safety – more concerned about their profit margins. They crank up line speeds and reduce labor. Everyone suffers. The problem is a lack of organization and turf battles among competing inspection systems at the federal, state and local levels.
Q. Focus on the cattle and beef industries now. What do you see as our biggest challenges in 2009 and what can we do to meet those challenges?
A. The past 15 years will show you the next 15. Emerging pathogens, new pathogens, antibiotic resistant strains – think MRSA, Methicillin-resistant Staphylococcus aureus. It’s an infection caused by a strain of bacteria that is highly resistant to treatment. They’re coming at us hard. You’ll be challenged by pathogens that didn’t exist then as they do now.
You’ll need to do everything you can to minimize end-product contamination and that will include how you raise animals. Are CAFO’s the right way, for instance? You’re faced with feeding a growing world population but you’ll have to ask if the efficiencies of CAFO’s are worth it. How will a production change affect the price and the availability of food?
There is a lack of cooperative spirit among the regulators, companies and buyers and sellers. It has to be fixed. Everyone in the food chain, every facility, needs to cooperate on science-based pathogen testing. It should be mandatory and the results must be transparent.
It’s clear that the vast majority of businesses are well-run, well-maintained and dedicated to putting out the high quality product that consumers have a right to expect. We really have to take a hard look at how plants are inspected, though. We’re using to much of the ‘poke and sniff’ techniques of the early 20th century to find pathogens that didn’t exist until a few years ago.
If anyone in Seattle was eating bacon for breakfast this morning, Post-Intelligencer Senior Correspondent Andrew Schneider,made them think twice about it.
Schneider reported that Tara Smith, an assistant professor at the University of Iowa Department of Epidemiology (along with her graduate researchers) found MRSA in more than 70 percent of the pigs they tested on farms in Iowa and Illinois.
In what is apparently the first testing of swine for MRSA in the U.S., Smith and her team swabbed the noses of 209 pigs on 10 farms. They also found the bacteria among livestock workers employed by those hog operations.
On Friday, at the annual meeting of the American Society for Microbiology in Boston, Abby Harper, one of Smith's graduate assistants, presented the results of the study on farmworkers. She said she and Michael Male tested 20 workers at the Iowa swine farms and found that 45 percent carried the same MRSA bacteria as the pigs.
The MRSA blog provides news and information about MRSA (Methicillin-Resistant Staphylococcus Aureus). Because of the long name, the abbreviation MRSA is often used (and pronounced "mursa"). MRSA is also referred to as CA-MRSA, nosocomial acquired MRSA , hospital acquired MRSA, or staph. The MRSA blog is intended be a forum for discussion among the site’s authors and users. The authors of the MRSA blog monitor matters related to MRSA stories, recalls and outbreaks and their impact on individuals and families in different cities, states, and regions. Please join us in a conversation about MRSA commenting on posts that you find interesting.
About MRSA (Methicillin-Resistant Staphylococcus Aureus)
Overview
Staphylococcus aureus (S. aureus), often referred to as "staph," is a bacterium commonly carried on the skin or in the nose of healthy people. S. aureus typically causes a skin infection, but can cause infections in the bloodstream and major organs. Methicillin-resistant S. aureus (MRSA) occurs when the bacteria become resistant to the antibiotic, methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin, making it more difficult to treat. The rate of invasive MRSA (infections in typically sterile sites like the bloodstream) is estimated to be 32 per 100,000 persons in the United States; the mortality (death) rate is thought to be about 6 per 100,000 persons. The risk of invasive MRSA infections is highest among older individuals, Blacks/African Americans, and men.
MRSA infections were initially limited to hospitals and nursing homes, especially among patients with weakened immune systems. Since the 1980s, community-acquired cases and outbreaks also have been reported. Community acquired cases are those not related to past year hospitalization or medical procedures like dialysis, surgery, or catheterization. These infections typically occur among otherwise healthy individuals and are more likely to be limited to skin infections. An increase in the virulence of MRSA bacteria in the past decade, however, has been responsible for more severe and sometimes fatal community acquired infections. More recently, MRSA has been identified in food animals and a few outbreaks have been ‘food-initiated’ or foodborne. In one such outbreak, those affected developed typical foodborne illness symptoms, such as vomiting and stomach cramps.
Sources and Transmission
The major site where people carry S. aureus is in the nasal passages. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) with S. aureus, but only about 1% of the population is colonized with MRSA. The main mode of transmission of staph and MRSA is through hands, which may become contaminated by contact with colonized or infected individuals or through contact with colonized or infected body sites of other persons. Contact with devices, items, or environmental surfaces contaminated with body fluids containing staph or MRSA may also cause infection. Other factors contributing to transmission include close skin-to-skin contact, crowded conditions, and poor hygiene.
Studies in recent years have demonstrated that food-producing animals also carry MRSA. Studies conducted in the U.S. as well as several other countries, including Austria, Canada, China, Belgium, Denmark, France, Italy, South Korea, Taiwan, and The Netherlands, have isolated MRSA mainly from pigs. Other animals testing positive for MRSA have included chickens, cattle, and dairy cows. In addition, the testing of raw meat samples from slaughter houses and retail markets has revealed MRSA in several countries. This is likely due to the high use of antibiotics in food animal production. Estimates of the amounts of growth-promoting antibiotics used in U.S. animal production range from 3.1 million to approximately 25 million pounds annually. In some instances, animal strains are similar or identical to human strains. In fact, the presence of MRSA in food-producing animals has also led to the transmission of MRSA to farmers, their families, and veterinarians, resulting in human colonization.
Of even greater concern is the identification of MRSA in retail meats and food products, including pork, beef, and diary products. This has occurred in the U. S. as well as in Austria, China, The Netherlands, Portugal, and South Korea. However, few foodborne or food-initiated outbreaks have been reported. One ‘food-initiated’ outbreak in The Netherlands involved the transmission of MRSA from a colonized but healthy hospital dietary worker to a patient through food. The contaminated food (which tested positive for MRSA) was ingested by the patient who was severely immunocompromised, and the patient contracted a fatal infection. Transmission from that patient to other hospital workers and subsequently to other patients resulted in a major outbreak. In another food-related case, a community-acquired foodborne illness outbreak occurred in Tennessee. In that outbreak, a family developed typical foodborne illness symptoms after eating food prepared by a commercial foodhandler who was colonized with MRSA (see details below).
Symptoms
Community-acquired MRSA infections most often present as a skin or soft tissue infection such as a boil or abscess. Individuals frequently recall a “spider bite”. The involved site is red, swollen, and painful and may have pus or other drainage. MRSA infections also can cause more serious infections, such as necrotizing fasciitis, a rapidly progressive, life-threatening infection that involves skin, soft tissue, and deep fascia; bloodstream infections; or pneumonia, leading to symptoms of shortness of breath, fever, and chills. As seen in at least one outbreak, individuals with foodborne illness caused by MRSA may experience nausea, vomiting and stomach cramps.
According to the Centers for Disease Control and Prevention (CDC), individuals with MRSA infections that meet all of the following criteria likely have community-acquired MRSA infections:
Diagnosis was made in the outpatient setting or by a culture positive for MRSA within 48 hours after admission to the hospital.
No medical history of MRSA infection or colonization.
No medical history in the past year of:
Hospitalization
Admission to a nursing home, skilled nursing facility, or hospice
Dialysis
Surgery
No permanent indwelling catheters or medical devices that pass through the skin into the body.
Detection and Treatment
In general, a culture is obtained from the infection site (skin, blood, or urine) and sent to the microbiology laboratory. In the case of a skin Infection, a culture is taken from a small biopsy of skin or drainage from the infected site. A sputum culture should be taken in the event of pneumonia. If S. aureus is isolated, the organism should be tested to determine which antibiotics will be effective for treating the infection.
Staph skin infections, such as boils or abscesses, may be treated by incision and drainage, depending on severity. Antibiotic treatment, if indicated, should be guided by laboratory testing of the bacteria to determine antibiotic susceptibility.
Prevention
Frequent handwashing is the most important way to prevent spread of staph in the community. If an individual has a skin infection, it should be kept covered. Keep wounds that are draining or have pus covered with clean, dry bandages until healed. Bandages and tape can be discarded with the regular trash.
Family members and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound. Do not share personal items, such as towels, washcloths, razors, clothing or uniforms, that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.
Since little is known about the transmission of MRSA through food, other than through foodhandlers, there are no specific recommendations about the prevention of foodborne illness with regard to MRSA. In general, individuals should wash their hands with soap and water before preparing food, especially commercial foodhandlers; wash produce; wash cutting boards often; wash hands, utensils, and cutting boards after they have been in contact with raw meat or poultry and before they touch another food; and refrigerate food within 2 hours of serving. Use a food thermometer to cook meat and poultry to proper temperatures and keep hot foods hot; cold foods should be kept at 40°F or below.
Isolation and Characterization of Methicillin-Resistant Staphylococcus aureus Strains from Louisiana Retail Meats
Researchers in Baton Rouge, Louisiana investigated the prevalence MRSA in 120 retail meat samples from 30 grocery stores in Baton Rouge. The samples were randomly collected over a six-week period in early 2008. On each sampling day, five stores were chosen based on geographical proximity to each other. Three prepackaged pork chops and one beef steak in the refrigerated fresh meat section were collected from each store.
S. aureus strains were recovered from 45.6% of pork samples and 20% of beef samples; MRSA strains were isolated from 5% of samples (five pork samples and one beef sample). The majority (73%) of grocery stores surveyed had S. aureus-contaminated meats, and 10% sold MRSA-positive meats. All four meat samples (three pork samples and one beef sample) from one store (belonging to supermarket chain A) were positive for MRSA only. The two remaining MRSA-positive pork samples were obtained from two other stores (chain B). Five out of six MRSA-positive meat samples (all were pork) were chain-branded meats. The MRSA-positive samples were determined to be of two unique human epidemic strains; therefore, humans (foodhandlers) rather than animals were the likely source of contamination.
An Outbreak of Community-Acquired Foodborne Illness Caused by Methicillin-Resistant Staphylococcus aureus
A local health department in Tennessee investigated a report of foodborne illness in a family that purchased shredded pork barbeque and coleslaw from a convenience-market delicatessen. The pork was reheated in a home microwave, and three adults ate the food 30 minutes after it was purchased. Approximately 3 to 4 hours after eating the meal, the three adults―who had not eaten another common meal together in the preceding week—had nausea, vomiting, and stomach cramps. Two children at the dinner who did not eat barbeque or coleslaw did not become ill. Two of the three ill adults were taken to a hospital for evaluation, where they were treated and released.
Twelve cultures of S. aureus recovered from stool samples of the ill family members, food specimens, and nasal swabs of the food preparers were sent to the CDC for further testing. S. aureus was recovered from the stool cultures of the three ill persons, three samples taken from the barbequed pork, one sample from the coleslaw, and five nasal swabs from three food handlers at the convenience market. Five isolates were indistinguishable using molecular typing by pulsed-field gel electrophoresis (PFGE), including those from the stool cultures of three family members, the coleslaw, and the nasal swab of one food preparer. This strain produced staphylococcal enterotoxin C and was identified as being MRSA. Two different strains of S. aureus recovered from the nasal swab of the second food preparer also produced staphylococcal enterotoxin C and differed only slightly from the MRSA strain by PFGE. Those isolates were methicillin-sensitive S. aureus but were categorized as closely related subtypes of the outbreak strain. The S. aureus isolate recovered from the third food preparer was also methicillin-sensitive, produced staphylococcal enterotoxin A, and was determined by PFGE to be unrelated to the outbreak strain. Although the S. aureus isolates from the samples of pork barbeque each produced staphylococcal enterotoxin C, they were methicillin-sensitive and unrelated to the outbreak strain.
The barbequed pork and coleslaw were prepared at the store where they were purchased. An environmental inspection of the facility performed after the outbreak revealed no apparent lapses in technique or procedure that would have contributed to the outbreak. No additional cases of illness related to this outbreak were reported to the local health department. The foodhandler who was carrying the outbreak strain of MRSA performed various tasks at the store, including preparing foods and handling barbecued pork and coleslaw. She reported no recent gastrointestinal illness, chronic health problems, history of admission to a hospital, or use of antibiotics in the previous six months. She did intermittently visit an elderly relative who resided in a nursing home before the outbreak. She reported that this person had a staphylococcal infection and had subsequently died. Further medical information or isolates from that person were not available.
It appears that MRSA-contaminated food was the vehicle in this outbreak affecting low-risk persons within the community, and that this food was likely contaminated by a healthy carrier whose only apparent exposure were visits to a possibly infected relative in a nursing home. This outbreak could be a health-care-associated infection that spread to the community. The outbreak strain of MRSA, however, was resistant only to penicillin and oxacillin and was sensitive to all other antibiotics tested. A strain originating in a health-care facility more likely would have been a multidrug resistant organism.
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Correspondent Andrew Schneider,made them think twice about it.