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February 6, 2014

Salmonella outbreaks expose weaknesses in USDA oversight

The Agriculture Department inspector showed up at Rick Schiller's home last November to collect potential evidence from his freezer: three pounds of chicken thighs, wrapped in plastic and stamped with a Foster Farms label.

Schiller, a 51-year-old California advertising executive, had recently returned from a five-day stay in the hospital, prompted by severe vomiting, diarrhea and an infection that left his joints throbbing and his right leg purple and twice its normal size.

 "I've been around the block. I've had some painful things," he said. "But nothing like this."

State lab tests run on Schiller had already confirmed the diagnosis: a salmonella infection linked to Foster Farms chicken, part of a widespread outbreak that has food-safety advocates and some public health officials warning about the potential for food-borne illnesses to become more and more severe in the age of antibiotic-resistant "superbugs."

Federal regulators and poultry companies are scrambling to find new ways to reduce salmonella contamination, which sickens a million Americans annually. And the Agriculture Department is planning to expand rules to limit salmonella on chicken parts, not just whole birds.

But food-safety groups say this doesn't go far enough and the USDA should ban the most perilous salmonella strains from poultry altogether, just as it did with other dangerous bacterial strains in many beef products.

 Poultry processors have resisted such an approach, arguing that it would be expensive and ultimately futile, because salmonella is so pervasive.

The salmonella strain that sent Schiller to the hospital - a type known as Heidelberg - has been linked to numerous outbreaks in recent years, including the one at Foster Farms, which officially has sickened 430 people in 23 states but likely has harmed many more. The pathogen has sent double the usual rate of victims to hospital emergency rooms, one reason the Centers for Disease Control and Prevention called dozens of experts and investigators back to work during the government shutdown last fall to more closely track the outbreak. Some strains of Heidelberg also have proven resistant to several types of commonly prescribed antibiotics.

 "This isn't your grandmother's salmonella," said Sarah Klein, an attorney for Center for Science in the Public Interest (CSPI), a nonprofit health watchdog group.

Noah Craten was 18 months old when he ended up in an Arizona children's hospital last October after an unshakable fever that lasted nearly a month. Doctors eventually discovered that an infection in his bloodstream had caused abscesses on the boy's brain. Surgeons had to slice open his scalp and cut open a piece of his skull to remove them.

After three weeks in an isolated hospital room and countless doses of antibiotics, Noah returned home in early November. Tests run by state health officials showed he had been infected with a Heidelberg strain, linked to the Foster Farms outbreak.

Cases similar to Noah's prompted the CSPI to file a petition with the USDA in 2011, outlining legal arguments for why it believes certain strains of salmonella should be banned because they present acute health risks, especially to the very old and very young.

The petition points to the USDA's own efforts with dangerous, drug-resistant E. coli strains, beginning with its ban a decade ago of E. coli 0157:H7.

The agency declared a zero-tolerance policy for the strain in many beef products after hundreds of Americans fell ill and four children died in 1993 after eating tainted hamburger meat from fast-food chain Jack in the Box.

As researchers eventually identified other types of E. coli that were particularly virulent and resistant to antibiotics, those likewise got labeled "adulterants" by the USDA, meaning the agency considers them dangerous substances that should be banned from commerce. A ban gives the USDA legal authority to order recalls, something it does not have with salmonella.

The result: Over time, deaths and infections from E. coli have decreased significantly.

"It worked," said Seattle lawyer Bill Marler, who specializes in food poisoning cases and is representing Schiller. "Ninety-five percent of my cases used to be E. coli. Today it is nearly zero. The industry will kick and scream, but they can fix it."

The chicken industry has long argued that it would not be realistic to expect processors to do away with salmonella on raw meat and that consumers must bear some responsibility in appropriately preparing it.

"Eliminating bacteria entirely is always the goal. But in reality, it's simply not feasible," said Tom Super, a spokesman for the National Chicken Council. "No legislation or regulation can keep bacteria from existing. . . . The only way to ensure our food is safe 100 percent of the time is by following science-based procedures when raising/growing, processing, handling and cooking it."

 Both salmonella and E. coli can be killed by cooking meat to the appropriate temperature, but the USDA has determined that the risks are too great to place that responsibility on the shoulders of consumers when it comes to the more dangerous E. coli strains.

CSPI and epidemiologists hope that by expanding this approach to select salmonella strains the industry will be provided with the incentive it needs to scale back on the overuse of antibiotics on the farm. Experts say this practice has contributed to the rise of superbugs, both in animals and in humans.

As George Washington University epidemiologist Lance Price explains it, as more and more antibiotics are used on chickens, some types of salmonella are better able than others at surviving the bacteria-killing treatments. "It's like someone is shooting at the bacteria and some of them have put on bulletproof vests," Price said. "The bacteria with the bulletproof vests are going to be the ones that survive."

 Some of those bulletproof bacteria are rendering numerous classes of antibiotics all but useless, and public health officials have warned of the long-term consequences.

"We don't want to live in a world without our most effective antibiotics," Price said. "There's not an infinite number of ways to kill bacteria. This is not a game we can play indefinitely."

Daniel Engeljohn, an assistant administrator at USDA's Food Safety and Inspection Service, said the agency is reviewing the legal petition from CSPI and is not making any public comments about whether some salmonella strains should be banned. But in private conversations, food safety advocates say, USDA officials expressed concern that prohibiting the strains could invite a legal challenge from industry.

 In the meantime, Engeljohn said the agency's current focus on improved sanitary conditions and more stringent pathogen testing in plants will "have a positive impact on public health."

The USDA is also touting a proposal that would revamp its poultry safety inspection system altogether, something they say will reduce salmonella illness rates by 1.9 percent, according to an agency study. The Government Accountability Office, however, said this figure is suspect, given that it uses incomplete and antiquated data.

Even as the USDA has shown little appetite for banning any type of salmonella in the near term, the agency is trying to tackle what almost everyone agrees is a shortcoming in current oversight: contamination standards apply only to whole chicken carcasses, not parts.

In 1998, the USDA told processors that no more than 23 percent of whole chickens in any plant could test positive for salmonella. In 2011, the agency lowered that limit to 7.5 percent and began posting test results online.

 "The result is the contamination rate of the carcasses has dropped," said Robert V. Tauxe, CDC's deputy director for the division of food-borne, water-borne and environmental diseases. "But here's the puzzle: The frequency of human illness didn't change."

Why?

"Just about everybody buys [chicken] parts," Tauxe said, but there's no government standard for salmonella levels in chicken breasts, thighs and legs. "If you look at how much salmonella is on the parts, there's a lot more than is on the whole carcass."

The USDA itself suspected this, and two years ago collected data on salmonella levels in chicken parts. The results provided a possible explanation for why illness rates remained so high: 24 percent of parts were contaminated with salmonella, nearly four times the amount as on chicken carcasses. That same percentage held true at the Foster Farms plants tested during the recent outbreak, USDA officials said.

The USDA has said it plans to institute new standards regulating chicken parts as soon as this year. Aware of that, the National Chicken Council said the poultry industry has been taking a "hard look" at how to further reduce contamination, particularly in the processes that involve slicing whole chickens into parts, which can introduce and spread bacteria.

Under the cloud of crisis, Foster Farms has said it has adopted "23 new processes" to reduce salmonella. While the company has declined to provide specifics, USDA officials said many of these changes involve applying antimicrobial treatments to chicken parts after they are processed, such as adding new equipment to spray and soak chicken parts with bacteria-killing chemicals.

"Foster Farms is among the first to do this unilaterally," Engeljohn said.

To meet any new standard, companies will probably rely on greater use of chemicals. USDA inspectors and plant workers have previously complained of severe respiratory disorders as the use of chemicals in poultry plants has spiked in recent years.

In its latest update, the CDC said the Foster Farms outbreak finally appeared to be over, 212 days after investigators first began tracking it.

But for some victims, the fallout of the outbreak won't end anytime soon.

There are lingering questions about exactly how salmonella infected Rick Schiller, Noah Craten and others - whether from undercooked chicken or perhaps a contaminated fork or spoon. There are also questions about their recovery.

At home in Glendale, Ariz., Noah's parents keep a close eye on their youngest son as he approaches his 2nd birthday. Still at risk for infection, he must undergo an MRI every few months. He takes medication to prevent seizures, and doctors have warned he could suffer learning and vision issues as a result of his brain surgery.

"It's just really going to be a waiting game," said his mother, Amanda.

Schiller still eats poultry, but only if it's completely burnt on the outside. Doctors have given him cortisone shots and steroids to help with the lingering pain in his right knee, part of a condition known as reactive arthritis often associated with severe salmonella infections.

He takes drops for his right eye, which is constantly congested, red and itchy. On cold nights, he carries firewood in his left arm because his right still feels weak.

"I don't know what the long term prognosis is going to be," he said. "I'm just thankful that I'm alive."



 

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