Here in the Philippines food poisoning is a common problem. We eat local veggies, and grow organic veggies that use a chicken manure based fertilizer.

So when we heard that the US was having a Salmonella outbreak from Tomatoes, my husband Lolo ordered our cook to wash the tomatoes well. No use taking a chance.

The outbreak in the US made over a thousand people sick, and was not the common strain of Salmonella, but an unusual strain. Most salmonella outbreaks are traced to improperly cooked eggs or not washing hands after handling poultry. Last year, there were cases due to contamination of peanut butter at one food processing plant. And I’ve seen cases from pet reptiles, such as turtles.

In other words, docs sometimes see a case every year or two, but outbreaks are rare.

But this strain was an unusual strain, and when the outbreak started in late June, the suspect was tomatoes.

Suddenly the headlines shouted “The attack of the Killer tomatoes”, and a lot of people were thankful that they had plants in their backyards.

The result was a major financial disaster for the tomato growers.

Yet despite this, the epidemic continued. It turns out it wasn’t the tomatoes, it was the peppers.

Within two weeks of the outbreak Minnesota health officials traced the germ to contaminated jalapeno peppers.

The Minnesota team, labeled “Team Diarrhea” by the Minneapolis Star Tribune, investigated 27 people who ate at local restaurants, and through good detective work traced the germ to the peppers, not the tomatoes. The peppers were traced to warehouses in California and Texas, but they originated in Mexico. The FDA has since then confirmed their findings, and issued a warning on jalapenos while withdrawing the previous one on tomatoes, even though some cases of Salmonella can not be traced to the peppers.

So let me tell you about the detective work. It’s not as glamorous as CSI, but it is done all the time, and stops most epidemics before they spread.

When you have an outbreak of a disease, first you collect specimens. I was a doctor at an institution where we had an epidemic that wasn’t stopped by normal methods, so we ended up collecting specimens and FedEx’ing them to the CDC.

We eventually traced who was infected to a certain area of the institution, and then to a single set of rooms. The germ turned out to be Rotavirus, and the source was one of our patients who had immune problems and happened to have poor personal hygiene. The epidemic stopped when we instituted strict handwashing of staff, more frequent washing down of walls and furniture, and mandatory bathing and hand washing by the problem patient.

For food borne illnesses, (usually this means diarrhea, although it can also mean Hepatitis A) you have to find out where the people ate.

Usually the investigation starts when local doctors see someone sicker than the normal stomach flu, and culture the patient’s stool. If an unusual or “reportable” germ is found, the laboratory notifies the health department. If the health department gets enough cases, they investigate what caused it. In this case, it meant checking who was sick, where did they eat, and what did they eat.
Most diarrhea outbreaks are Staph food poisoning, from dairy or other foods left out too long. Once in awhile, you find Salmonella traced to poorly cooked eggs or improper hand washing after handling uncooked chicken. It can also come from pets, such as turtles or other reptiles. I had several patients in one small town epidemic (of Camplobacter) that was turned out to be due to people using raw milk from a local farm.

But a country wide epidemic of an unusual strain of a bad germ like Salmonella brings up many more issues.

First, was it terrorism? Don’t laugh. One of the stranger epidemics was in a Northwestern US town where the local cult decided to make people sick so they couldn’t vote in an election. Three restaurants were involved, and scientists never figured out it was deliberate until the cult followers got into trouble over other things and confessed.

Second: Where did the suspected food come from?

This brings up a lot of questions about NAFTA, since a lot of vegetables come from other countries without as strict standards as in the US.

Three: How was the infection spread?

In this epidemic, not all people who got sick ate tomatoes, or ate salsa, or ate peppers. So it was not exactly easy to figure out what vegetable caused the problem.

How could this happen?

Presumably the peppers were contaminated by germs. Until they find the farm, it will not be known if it was from one worker who was a carrier who didn’t wash his or her hands, or if the water used to spray the vegetables contained the germ.

Salmonella can be spread through “carriers” who no longer have symptoms. Without proper hand washing, they can spread the infection to the food they handle, to those who eat that food, and to those they work with. But a poorly place latrines can result in fecal contamination of the ground water, spreading infections to all who use the contaminated well or stream. (This is why one of our priorities in Africa was digging deep wells to prevent children dying of diarrhea.)

Once the peppers were contaminated, it is possible that the germ could spread to other foods.

But don’t they wash vegetables in stores, and in restaurants?

Most restaurants have food handlers wash the food, wash your hands and use gloves.

Alas, recent reports say that the usual chlorine wash of vegetables and the ordinary hand sanitizers may not kill all problematic germs, which sometimes hide under leaves or in biofilm layers on the surface of produce.

Finally, how does one prevent the next epidemic?

Well, perhaps by mandating ways to monitor where produce comes from, so that the next epidemic can be traced back to the source more quickly.

More stress on hand washing and cleanliness, not only in food handlers but in those who pick and package the produce. (which will be costly and probably not followed in all imported food).

Routine monitoring of produce for infectious diseases at warehouses that ship the food.

There may be a stronger push to treating fresh produce with low dose radiation, a technique that kills germs but leaves no residue that would harm consumers.

And then there are all sorts of questions, about the slowness of the FDA and CDC in tracing the source of the infection. Some question if the food lobby, which had opposed laws to lable and trace all produce, could have indirectly slowed the ability of researchers to find the source of the infection.

Fox Business news has an article disputing if “traceback” data would have actually made a difference, pointing out that Minnesota identified the source of the outbreak quickly, and pointing fingers at the FDA and CDC. Probably the FDA and CDC will defend themselves, pointing out that many of those affected ate tomatoes, not jalapenos.

The end result of all of this?

Higher food prices for produce, and more emphasis on eating local and seasonal foods rather than imported produce.


Nancy Reyes is a retired physician living in the rural Philippines. her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog

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