The FDA’s Role in Solving a Foodborne Illness Outbreak

baby mixed lettuces
The Mystery is Solved! The FDA announced on June 28th that the E.coli outbreak tied to romaine lettuce is over. New evidence shows bacteria taken from canal water samples, which link Yuma-based farmers and suppliers, matched the E. coli 0157:H7 strain that caused the outbreak. Federal agency work continues to determine how and why this strain entered into the canal.

Summer is officially underway! Now is the time to enjoy fresh salads loaded with fruits and veggies. And, despite the recent outbreak, we now know the romaine available today is safe so there’s no need to be deterred from enjoying your favorite summer salads.

Pinpointing the source of a foodborne illness outbreak

The FDA is charged with determining how, when and why an outbreak occurred. Collaborating with the CDC, state and local regulatory agents, public health officials, and agriculture departments, the investigative process examines documentation from growers, harvesters, processors and distributors.

The collected data is then shared with the FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network. A CORE response team is assigned to find out the exact cause, control the spread, and ultimately stop the outbreak. The CORE team tracks down the source of the contaminated food and its movement through the supply chain. The data is then compared to what is known about the illnesses to ensure the investigation is on the right track.

Electronic labeling helps the process

About a decade ago, produce industry members started the Produce Traceability Initiative (PTI) and invested heavily in PTI technologies so they could trace harvested products back to the field. Currently, about 60% of the produce industry uses labeling through the initiative.

When fruits and vegetables are harvested in the field, cartons holding the fresh produce are typically labeled with an electronic-coded sticker containing detailed information about the harvest date and time, the grower, farm and location, as well as information about the harvesting company and crew members who performed the harvesting.

While PTI is extremely helpful to trace a product back to its farm source, every other entity along the supply chain to the consumer must also maintain the integrity of product tracing information. One example of this is Supplier X that sells food to restaurants: it may buy lettuce from Companies A, B, and C, and then repackage it into different cartons. These newly repackaged cartons, now containing a variety of lettuces, have new labels that only include data about the product as it was handled at Supplier X and not information from Companies A, B, and C.

Another example is the grocery stores. Have you ever walked behind a restaurant or grocery store and seen a pile of empty boxes that once held food? After the produce is removed, the box with the label telling the restaurant or grocery store where the product came from, when it was picked, who picked it, etc. needs to be properly scanned into the store or restaurant’s system.

The FDA detective work begins….

So, what does the FDA do when they come to a dead-end, like a break in the electronic chain of information? They must sift through the company’s paper records and interview company personnel to piece together as much supply chain information as possible. This elusive detective work takes days – sometimes weeks.

As we know, it is so easy to purchase a bag of pre-mixed vegetables or salad straight from the grocery store. Well, as we saw with romaine, many of these items are mixed together from different suppliers. So you can see how the supply chain gets complicated! Here’s an example of a supply chain that the FDA may encounter during an investigation:

Investigating the supply chain gets complicated! There can be many companies and farms involved.

As you can see, the investigation quickly broadens to include multiple potential paths. Because Company B mixes lettuce from three sources, the FDA must assume that the contaminated lettuce came from any one of Companies C, D, and E. In reality, the contaminated product may only have come from Company C, but the FDA has no way of knowing this since the lettuce from all three companies is mixed together.

To further add to the complexity, Companies C, D, and E each have four farms and each farm has 1,500 acres of lettuce which are divided into multiple lots. If Company B retains the information from the lettuces from their three suppliers, then the FDA may be able to narrow the potential farm sources from 12 to 4, but too often this information is lost when the carton is thrown away.

Environmental Assessments

After tracing the contaminated product as close to its origin as possible, the FDA’s CORE team visits the location where contamination is thought to have occurred. If the location is a farm(s), they conduct what is referred to as an “environmental assessment”, noting potential hazards and taking samples of water, soil, and other agricultural inputs. They also assess the surrounding areas and collect samples related to wildlife and domestic animals (e.g., feces, water troughs, bedding) known to carry the pathogen.

If the contamination is believed to have happened at a facility, they visit the facilities involved and swab equipment, walls, floors, drains, etc. In addition to sampling, CORE members interview personnel who work at the farm or facility, asking questions about their practices and observations, as well as anything out of the ordinary that may have happened before the outbreak.

Race against the clock

When investigating foodborne illness outbreaks, the CORE teams are working against the clock, as weather and other environmental conditions may become unfavorable to pathogen survival and the bug may begin to die off. Even in facilities, conditions change (i.e., equipment is cleaned and sanitized), and the responsible pathogen may no longer be found. Because of this, there is a real possibility we may never know what caused the E. coli outbreak in romaine. However, that does not mean the work will not continue. Industry members join forces with government investigators – meeting with FDA officials and CORE members to discuss their practices, growing conditions, and potential risk factors.

You begin to see how much ground investigators need to cover in order to determine where and how the lettuce became contaminated.  But the FDA CORE teams work tirelessly to ensure that Americans are eating safe produce. While it is a tough job with many challenges, the CORE teams have many tools in their toolbox to help them solve outbreak causes

Farmers and growers continually work on food safety protocols

Farmers and growers need to know how the contamination happened so they can do everything possible to keep it from happening again. In the case of the romaine outbreak, the leafy greens industry has formed a task force and members are actively researching and gathering information as well as re-evaluating their food safety practices. In addition, the produce industry trade associations are working on solutions that will enable the industry to address gaps in traceability to more efficiently find the source of problems when they occur.

Special thanks to Dirt-to-Dinner contributors Susan Leaman and Diane Wetherington of iFoods Decision Sciences.

How Does the CDC Detect Foodborne Illnesses, like E. coli in Romaine lettuce?

vast field of romaine lettuce


As of June 1, 2018, the E. coli O157: H7-contaminated romaine lettuce outbreak has caused 5 deaths, 89 hospitalizations, and 197 known illnesses in 35 states. Even though the contaminated romaine is no longer in our food supply, the impact will undoubtedly be felt for some time as consumers continue to be concerned about eating the lettuce.

If you haven’t seen the headlines, you probably noticed the momentary disappearance of Caesar salads from restaurant menus and romaine lettuce from grocery store shelves when retail and food service companies around the country pulled products containing romaine lettuce from shelves in response to the foodborne illness outbreak linked to the consumption of contaminated romaine lettuce.

How do we determine when foodborne illness outbreaks occur?

The Center for Disease Control (CDC) is the federal government agency responsible for determining when outbreaks occur, identifying the microorganism that caused the outbreak, and identifying the contaminated product. The CDC defines a foodborne illness outbreak as an illness where two or more people get sick from eating the same food in roughly the same timeframe.

Detecting an outbreak is not easy

The CDC collaborates with the FDA and USDA in foodborne illness outbreak investigations, helping to identify what caused the outbreak and alerting the public when a source is identified.

Diagnosing a foodborne illness outbreak is tricky business

Have you ever been sick and wondered if it was a virus or something you ate? Unless your symptoms are very severe and/or have lasted longer than a few days, a visit to your doctor might result in being told to go home, get rest, and stay hydrated. Most often with this circumstance, you will not undergo any tests to determine what is causing your symptoms.

What is not widely known is that the leading cause of foodborne illnesses recorded each year in the U.S. is norovirus. This virus causes more than 5.5 million illnesses and cost more than $2 billion in healthcare and lost productivity costs annually. It accounts for more than 58% of all foodborne illnesses where the agent is known. Norovirus can be transmitted person-to-person or indirectly from contaminated surfaces, food, and water. 

Most foodborne illnesses are detected when many people are eating their meals at the same place and around the same time. Prime examples are school and workplace cafeterias, social gatherings, and foodservice providers on cruise ships or at a resort.

Most foodborne illnesses are detected when many people are eating their meals at the same place and around the same time. Prime examples are school and workplace cafeterias, social gatherings, and foodservice providers on cruise ships or at a resort.

The CDC identified a foodborne illness outbreak — what’s next?

Based on the pathogen detected, state health officials develop a questionnaire for the patients to gather very specific details of what, where, and when they ate the likely contaminated food. Of significant importance is the pathogen’s incubation period — the time from when someone consumes contaminated food until symptoms start. For example, an E. coli O157: H7-caused illness typically takes 3-4 days for symptoms to appear and commonly lasts 5-10 days in healthy adults. An incubation period like this one can be a challenge when patients are asked what they ate up to 10 days before arriving at their doctors’ offices.

After the dietary data is gathered from reporting patients, the information is analyzed to find common foods that were eaten more often than expected based on the typical American diet. This can be a riddle. For example, those infected by the illness may have gotten sick after eating hamburgers at a picnic. But it may be unclear whether the burger, tomato, lettuce, onion, or the mayo was responsible.

Without a clear determination, the CDC lists all potentially responsible ingredients in its PulseNet database as part of the outbreak data collection and investigation process.

Of all the outbreaks studied in 2015, only 40% identified a specific food vehicle or cause. In about half of outbreaks where a food vehicle was identified, multiple food ingredients are typically involved and no particular ingredient has been pinpointed as the vehicle.

The curious case of romaine

In the romaine outbreak, public health officials determined that romaine was what made people sick after interviewing those who had become ill. More than 90% of interviewees reported eating romaine before getting sick. However, identifying exactly where that lettuce came from is a much more complicated process. Before lettuce reaches a restaurant or grocery store, it may pass through several other companies (e.g., distributors, brokers, etc.). When lettuce leaves the field, it is packed into cartons that contain detailed information about how, where, and when it was grown and harvested including the individual harvesting crew members who picked it. But restaurants and grocery stores buying lettuce from the produce industry typically throw the carton away and do not retain all that detailed information tracing product back to the farm and field.

Only in one instance in this outbreak was the FDA able to identify a company that grew some of the contaminated romaine, and that was the prison in Alaska where eight prisoners got sick. But the implicated produce company has several farms in the desert growing region and product information retained by the prison and the distributor from which the prison bought the lettuce was not adequate to identify the field in which the lettuce was grown. In order to solve the mystery of how the lettuce became contaminated, investigators need to know which farm and fields the lettuce came from.

Is it safe to eat romaine lettuce again?

Yes. In the current E. coli O157: H7 outbreak, the CDC stated that the identified food vehicle is romaine lettuce. As of early May, 112 people had been interviewed and of those people, 91% stated they ate romaine lettuce a week before becoming ill. Because romaine lettuce has a shelf-life of approximately 21 days and the last shipment of romaine from the desert-growing region was in mid-April, the CDC, state and local health departments and the industry have all confidently assured the public that romaine lettuce is safe to eat again.

How can we be sure?

The answer lies in the seasonal production in lettuce-growing locations in the west. Arizona and California, the two largest lettuce-producing states in the U.S., grow lettuce in an annual production cycle: as northern California moves into winter around November, lettuce production shifts to the desert in Arizona. And when spring arrives in California, production moves back north in California as the desert becomes too warm to grow – usually in April. The CDC was thus able to isolate the general location of the affected romaine by following the annual production cycle. As we have discussed on Dirt-to-Dinner, seasonality shifts suppliers for U.S. produce. When the seasons change, your produce changes, too— and that also means when a growing season ends in one state it can begin in another.

Despite the tragic consequences of this outbreak, the U.S. has one of the safest food systems in the world. It may be difficult to fathom, but the amount of food circulating in the U.S. on a daily basis is staggering. Our produce is grown by over 200,000 growers, supplemented by millions of other growers around the world. We typically consume this food three or more times a day in our homes or in more than 600,000 restaurants. Public health experts estimate that in our nation of 330 million people, 47.8 million people or 15% get sick, and 3,000 people or 0.0009% die annually in the U.S. from contaminated foods. The goal, of course, is to prevent any illnesses from occurring in the first place.

Special thanks to Dirt-to-Dinner contributors Susan Leaman and Diane Wetherington of iFoods Decision Sciences.

What is the Farm Bill — and why should you care?

red barn in autumn

There’s something that we all come into contact with every day and rarely consider – our food system.

Did you know Americans spend the least amount of our hard-earned income on food when compared to all other countries in the world? Only 10% of our income is spent purchasing food for us to consume at home and elsewhere, like restaurants and take-out…and it comes from one of the safest food systems in the world.

Our Canadian neighbors and many in Western Europe also spend very little of their income on food, less than 10%. On the opposite end of the spectrum, citizens in some countries in Asia and Africa spend almost half of their income on food, making these particular countries susceptible to widespread malnutrition due to food scarcity.

So, what exactly is the Farm Bill?

Simply put, the Farm Bill is a seriously complex blueprint of our national food system. It helps all farmers, from those growing Christmas trees to those harvesting corn, wheat, and chickpeas to dairy farmers. It’s created by farmers, policy makers, economists and academics to further improve all the intricately-moving parts, policies and sectors that come together to provide a system that works for all.

However, its start was a bit more humble as a means to keep farmers in business so we can be assured to have a steady food supply. Back in 1933, the Farm Bill was initiated to stabilize farm income during the great Dust Bowl, which devastated America’s farmland in the Midwest and thus, greatly affected our agriculture sector. Over time, the Bill has been expanded to include market regulation, nutrition assistance programs, trade, research, food safety and conservation.

Today, the Farm Bill affects us all. As you can imagine given all these moving pieces, this is not a simple little bill. In fact, the current Bill is upwards of 600 pages! But within all those pages, we can expect innovations to our agriculture and food programs that will continue providing safe and affordable food to everyone.

Why is the Farm Bill so important?

Every successful food system needs a solid foundation in sound public policy. Those of us in developed countries benefit from having guidelines in place that enable every component in our complex food system to have the incentives, safeguards and consistent regulations to do their jobs more efficiently to provide our food…every day. The relentless drive to improve across the entire food and agricultural chain— to do better, to innovate, to solve any challenge or problem that remains— is the engine driving the system forward.

Every part of our modern food system – from the farmer and rancher at one end of the food chain, to the food manufacturer and preparer at the other, works hard every day to make our food system deliver more and better food at every meal – food that is safe, wholesome, convenient, and above all, readily available and eminently affordable.

The purpose of the Bill is to maintain the policies that will need to be upheld for the following five years to ensure every farmer, manufacturer, preparer and consumer can do their job more efficiently and with the resources they need.

The Farm Bill’s reach extends beyond the food supply system to include improvements in infrastructure and education, too. Since 2009, former Agriculture Secretary Tom Vilsack recently noted that farm bill programs have helped 1.2 million Americans obtain home loans and made broadband services more available to 6 million rural residents.  Water systems have improved, and other infrastructure enhanced. Universities have been strengthened, and access to education improved. Hundreds of thousands of jobs have been created through farm legislation.

What are some of the contentious issues in this Bill?

There is a lot of bipartisan discussions fueled by the concern over crop prices and how to address the amount given to farmers and those in the industry. Currently, much of the funding goes to ‘reference prices’. These prices guarantee payments to the farmers regardless of market price. Free market advocates think the formula for setting the price does not cover deep price declines, as it was originally designed, but just guarantees payments to farmers.

Also, if you have been privy to the developments in the Farm Bill this year, you’re definitely aware that 80% of the funding is allocated to nutritional programs, like the Supplemental Nutrition Assistance Program (“SNAP”, or what was known as “food stamps”). There is a lot of discussion as to why these programs are included in a bill that is really geared toward the production, not consumption, of food. However, nutritional assistance programs were incorporated into the Bill in the 1970s to pass legislation so all U.S. citizens were involved in its policies.

So, how much is this Farm Bill going to cost you?

The farm bill covers not just all sorts of farm and food related provisions but also the host of nutrition assistance programs designed to attract votes from urban legislators. The price tag for the complete farm bill comes to about $90 billion per year— or approximately $275 per American— for arguably the most efficient food system in the world.

Of that $275, about $75 goes for commodity supports, conservation, research, farm credit, food safety, and other ‘traditional’ farm programs. The other $200 goes for nutrition assistance programs, mostly the widely used SNAP program.

When will the Farm Bill be passed?

As in all important matters that affect many people, these things take time. The Bill has already gone back and forth several times. On June 13th, it passed the Senate Agriculture Committee and will now proceed to the Senate floor in the next two weeks. Given such contentious topics as SNAP and other matters of debate, the political outlook surrounding the legislation is still murky. Furthermore, should U.S. trade and NAFTA not have a resolution soon, implications surrounding these issues may end up in the Farm Bill itself, adding further complexity to an already complicated deal. However, there is hope that the Bill will be passed by September-end of this year.

Juice Press’s Misleading Marketing on Conventional Farming

Juice Press products and labels

Recently, in an effort to get an extra serving of veggies with a green juice, a D2D team member came across your new marketing campaign:

Juice Press, in the attempt to distinguish your products and tell your customers that your juice is organic, you decided to use some pretty awful images and language. The hazmat-suited, gas-mask wearing people are completely inaccurate and meant to spark fear in the hearts of consumers. Do you really want to stigmatize the produce industry this way?

Did you know 9 out of 10 Americans do not eat enough fruits & veggies? Fear of pesticides, insecticides, and “dirty produce” is preventing people from enjoying these important foods. Juice Press, your fear mongering feeds the consumer deception that surrounds conventional farming and genetically modified technology.

Juice Press is a juice company that takes fresh produce and makes it into juices, smoothies, and light lunches. They have a vision of “bringing a healthier, more transparent lifestyle platform to the market.” They were founded in 2010 and located in the Northeast, mostly in New York, but expanding to Connecticut, Massachusetts, and other states across the U.S.

Organic produce is not safer than conventional. Organic marketing campaigns often lead you believing that organic crops contain more nutrients and fewer chemicals than conventional—this is not necessarily true. The varying levels of nutritious compounds, like minerals and antioxidants, will depend on where and how it is grown due to the naturally occurring levels present in the respective soil.

There are no credible studies showing that people who eat organically grown food are more healthy than those eating only conventionally grown foods, but there is unquestionable evidence that those who include lots of fruits and vegetables in their diet have better health outcomes than those who do not.

Organic farmers use organic pesticides, some of which are even synthetically produced. In addition to soil type and climatic conditions, other factors such as insect burden and disease exposure also greatly influence the nutrient content of produce. A balanced diet rich in fruits and veggies is one of the most important things we can do for our health; whether the produce is organic or conventional should not matter!

Trust your farmers

D2D has written extensively about the use of GM technology. It is the most heavily tested food technology in history. There is no denying its safety, environmental sustainability, and how helpful it is to our farmers. As we learned when visiting Green Cay Farm, pesticide use can actually be reduced if genetically modified seeds were used as opposed to traditional seeds.

Juice Press, not only are you misleading the consumer on food safety, but also on the type of food they can find that is genetically modified. At the moment, there are only 10 genetically modified crops that have been approved in the United States. Of these ten crops, the only one you could possibly find on the menu at Juice Press is the non-browning apple. So to say we’d be drinking “genetically modified, rank s#*t-tasting, dead juice that smelled like fu#%ing poison” is, quite frankly, absolute bulls#*t!

And what’s even more disconcerting is the disservice this type of marketing does for safe, conventional farmers that use best practices to create healthy produce. When the D2D team visited Salinas Valley, CA, we were shown both conventional and organic practices and found very few differences between the two. In fact, many small scale farmers adopt both organic and conventional techniques in order to create a “best practices” approach that produces healthy crops without requiring the expensive organic certification. For example, Steve and Ingrid McMenamin of Versailles Farm use a hybrid of conventional and organic tools and techniques in order to produce a more flavorful crop. After visiting their farm and learning about the different technologies that are being used, we were excited to try their produce, not afraid of the small applications of pesticide.

As we saw with Stonyfield’s organic marketing blunder and Hunt’s misrepresentation of GM technology, fear-based marketing tactics only serve to spread misinformation. Juice Press, we ask you to stop creating fear about our food system—which is one of the safest in the world— and visit with some conventional farmers and learn about their farming practices before you misrepresent them as poison spraying, dead-food loving growers.