Preventive Measures Scrutinized as Outbreaks of Illness Skyrocket

February 7, 2004
By Diane Lindquist
UNION-TRIBUNE STAFF WRITER

OTAY MESA – With a U.S. inspector looking on, Eleutero Chávez popped open a cardboard box from the back of his truck, releasing the pungent odor of green onions picked and packed just two hours earlier on a farm near Ensenada.

"There's no problems with these onions," the Mexican truck driver declared at the U.S. commercial border crossing at Otay Mesa in late December.

With more food arriving from foreign countries each year, ports of entry are among the most visible inspection points for preventing disease-tainted products from reaching dining tables across the United States.

But the system is far from foolproof, as demonstrated by the recent discovery of mad cow disease in a Holstein imported from Canada and hepatitis A deaths associated with green onions from Baja California.

Although the U.S. food supply is among the world's safest, illnesses from both domestic and foreign food products have skyrocketed in the past several years.

In 1997, 29 produce-related outbreaks caused 2,449 illnesses but no deaths, according to U.S. government statistics. In 2000, tainted food caused 76 outbreaks, sickened millions of people and caused 4,000 deaths.

Better reporting of outbreaks has contributed to the startling increase, but scientists believe changing eating habits and new and evolving microbes also play major roles.

So far, neither the food industry nor a patchwork system of federal, state and local agencies has been able to curb the outbreaks.

"They attempt to manage the crises, but they don't have the ability to prevent problems before they arise," said Caroline Smith DeWall, food safety director for the Center for Science in the Public Interest.

Consumer advocates level strong criticism at the federal government. They say food safety issues should be consolidated under one agency instead of the 10 or more that share jurisdiction today.

Critics also want the government to create more effective rules at all levels of the system and to spend more money to do a better job.

Two-thirds of food-borne illness outbreaks are linked to foods regulated by Food and Drug Administration agencies, yet the FDA's budget is just 31 percent of the U.S. budget for food safety inspections.

Food safety advocates also say private industry could do more to monitor the U.S. food supply chain, which includes 50,000 food manufacturers, processors and warehouses.

The government created the basis of its current food safety system in the mid-1990s. Known as Hazard Analysis and Critical Control Point, it provides resources and training for the industry to identify, monitor and control problems at critical points in food production and processing.

Two key programs developed from HACCP: Good Agricultural Practices for growers, and Good Manufacturing Practices for food processors. The government also developed "trace-back" techniques to identify where products are grown and who handles them during shipping.

However, growers and processors aren't required to use the programs or the trace-back procedures. And when food-borne illness outbreaks occur, the government can request that companies recall contaminated food products, but can't require it.

"You can pull Barbies off the market, but (the government) can't recall beef," said Michael Hansen, senior research associate of the Consumer Union's Consumer Policy Institute.

Following an E. coli outbreak from unpasteurized apple juice in the late 1990s, Safeway and most other large supermarket chains began demanding that their suppliers follow the government practices.

But too much is being left up to private companies, Hansen said.

He wants the government to impose mandatory standards to prevent food-borne illnesses and to limit and affix responsibility when there are outbreaks.

"There's a lot more that needs to be done," Hansen said.
More difficult today
Protecting the U.S. food supply is more difficult today than in the past because eating habits and the food distribution system have changed dramatically.

"Your mom probably prepared most (dishes) from products grown locally," said Jane Henney, a former Food and Drug Administration commissioner and now an administrator at the University of Cincinnati Medical Center. "The way we get food now is so much different."

The number of produce items carried by the typical grocery store grew to 345 from 173 during the past decade. Individual consumption of fresh fruit and vegetables rose to 339 pounds in 2000 from 249 pounds in 1981, a 36 percent jump.

People also are eating more poultry, fish and prepared foods, which, along with fruits and vegetables, are linked to a larger share of outbreaks. And they're eating more often at fast-food places and other restaurants, where U.S. consumers nowadays spend nearly half their food dollars – up from a third in 1970.

Contaminated food served at a single restaurant can sicken hundreds of people at one time. More than 700 diners got hepatitis A after eating salsa made with tainted green onions at a Chi-Chi's restaurant in Pennsylvania late last year. Three people died.

Today, more food also is grown outside the United States, making seasonal products available year-round – lingonberries in June, for example, and raspberries in January.

Seafood, fresh produce and other foods from outside the United States account for about $15 billion worth of what Americans eat each year, while $240 billion comes from such domestic sources as orchards, farms, lakes and oceans.

There is no evidence that foreign food products are more prone to safety problems than domestic products.

"There are bad producers in the United States, and there are bad producers in foreign countries," said Roberta Cook, a University of California Cooperative Extension specialist.

But health risks from international products outweigh risks from domestically produced products in at least one important respect: They can spread pathogens, pests and diseases into countries traditionally free of these hazards.

Until the diseased Holstein was discovered in Washington state in early December, mad cow disease – bovine spongiform encephalopathy – had not been detected in the United States.
Volume has soared

U.S. agents believe that the contaminated green onions that ended up at the Chi-Chi's restaurant entered the United States through the Calexico commercial crossing between early August and mid-September. If so, the produce was among 6.5 million pounds of onions that passed through the port of entry during that period.

The volume of imported food products has soared in past decades, said Sam Longanecker, an agricultural specialist supervisor for U.S. Customs and Border Protection at the Otay Mesa crossing. But the quality also has risen.

"In the early '70s, you rarely saw goods professionally packaged," Longanecker said. Now most arrive that way, increasing the probability that good sanitary practices are being followed.

At the Otay Mesa facility, 40 of the 104 inspection docks are dedicated to Mexican-grown produce and cut flowers, most coming from Baja California's fields and greenhouses. At least a carton or two of each shipment is examined by Customs and Border Protection inspectors and by Food and Drug Administration inspectors.

The inspectors zero in on banned items, the product's appearance, pesticide residues and pests such as bugs and worms.

Because the microbial pathogens that cause most food-borne illnesses aren't visible to the naked eye, inspectors are rarely able to detect them. Testing for pathogens would take so much time that shipments would spoil before the tests were completed.

Even if the various microbes could be identified immediately, they might be missed unless they happened to be in the sampled boxes.

Scientists are racing to develop faster, more reliable food safety tests. The FDA alone is sponsoring more than 90 research projects to develop new procedures.

No one, however, predicts that a foolproof testing program will be created anytime soon. This is because new pathogens are continually emerging, evolving into more-virulent strains, and becoming resistant to antibiotics or leaping from one species or product to another.

Mad cow, for example, became a human health issue in 1996 when a connection was found between bovine spongiform encephalopathy and a human version of the illness, called variant Creutzfeldt-Jakob disease. Both are fatal. Since then, more than 115 people worldwide have died of Creutzfeldt-Jakob Disease.

E. coli was first identified in ground hamburger in 1982. In 1993, it showed up in undercooked meat from Jack in the Box, killing four people and making hundreds sick in San Diego County and Washington state.

E. coli later was found in produce, too, including a November 2003 outbreak that sickened 40 people in Southern California, most from San Diego County, who ate contaminated lettuce at Pat & Oscar's restaurants.

Food safety advocates complain that, too often, the government waits until an outbreak to pass new regulations.

The good-practice standards weren't implemented until Cyclospora outbreaks were linked to Guatemalan raspberries in 1996 and hepatitis A outbreaks were linked to Baja California strawberries in 1997. Those episodes also triggered a sweeping initiative that added resources to raise domestic standards and ensure that imports were equally safe.

The discovery of mad cow in the United States has prompted a rash of new USDA regulations.

No new rules, however, have yet resulted from the green onion hepatitis A outbreaks.

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