Food poisoning - What the Cronuts outbreak should be bringing up about our food safety system

Cronuts (mega burger on a croissant-donut bun smothered in a sauce that looks like pure grease), you might be taking your life in your hands to eat one given the caloric content, but what the heck, isn’t gorging in unusual fatty foods part of the fun of the host of fairs, including the CNE.  That is assuming they are not also contaminated with food poisoning.  For over 150 people this past week, a couple of days of vigorous vomiting, stomach pains and feeling really bad appear to have been caused by cronut consumption.

Food poisoning is common.  Health Canada claims about 4 million cases per year in the country.

Food poisoning from food service establishment is not, but when it occurs two things are notable.  First, there are larger numbers exposed than in the typical family kitchen.  Second, it makes for great media headlines.

Canada’s food inspection system deserves kudos.  Multiple barriers through handler education, HACCP control programs (where facilities monitor their own critical control points), public health inspections, and surveillance for illness are reasonably well honed instruments.   Of course, we all eat, and in doing so put pressure on the food preparation system where plenty can go wrong.

And it does.

If Canada has one soft spot, it is not great and maintaining statistics nationally, in part a function that foodborne illness itself is not a nationally notifiable illness and CFIAs involvement is limited to widespread food production settings and interprovincial outbreaks.  It does have a better system for notification of certain illness which lead to a ill-informed Conference Board of Canada report that claimed more illness in Canada than the US which is likely not the case.  document protected site  Huffington Post synthesis

So, we turn south of the border to the US for good national surveillance, recently complied MMWR supplement June 2013.   Over a 1000 outbreaks a year.  Of these only a few dozen are multistate suggesting contaminated produce like a recent Cryptospordium outbreak DrPHealth.  Nearly 2/3 are associated with food preparation settings like restaurants, not quite 10% are associated with catered events.

Here in lies the manipulation of statistics.  Of the restaurant outbreaks, the median number of ill persons was 5 (yes five).  That means of the estimated 48 Million cases of food poisoning annually in the US, only about 0.01% are associated with restaurants.  Well likely a bit more because of underreporting, but at less than 1% of food poisoning cases, we have a very elaborate system for protecting against foodborne illness that likely misses the main culprit – poor food hygiene in the home.

The classic description of foodborne illness, similar to the Cronut outbreak, is onset of vomiting hours after consumption of the food and readily attributed to the last meal.   The three commonest causes of foodborne illness have incubation periods over at least a day (Noroviru (39%)s, Salmonella(26%), E. Coli 6%)). Staphylococcus aureus toxin which has been implicated in the Cronuts is 6^th on the list causing only 3% of outbreaks. 

For the 150 or more than became ill, the system failed them.   If you look at the burger, the natural assumption is that it was the meat – but for that to occur, the meat must have been mishandled and kept at room temperature for extended time, something that even the most naive of food handlers will not likely let happen, and given the speed at which they were being sold, meat did not sit around long.   Just as likely would be the sauce, prepared in advance and kept handy to slobber on at the time of serving.  Both culprits should be under investigation TPH on Cronut outbreak cause