Health Risk Communication: Foodborne Illness and Food Product Safety

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In late 2015 an apparent foodborne illness outbreak related to the popular fast food chain Chipotle was reported in national news headlines. In fact, there appears to have been more than one “wave” of illness outbreak associated with consumption of Chipotle products.

The initial E. coli outbreak traced to Chipotle sickened 52 people in nine states, mostly in Washington and Oregon. The identified bacteria were a strain called Shiga toxin-producing Escherichia coli O26 (STEC O26). Tanya Lewis’ writing for The Business Insider notes that foodborne illness and infectious outbreaks are actually more common than most people realize:

“While the Chipotle outbreak was caused by E. coli, it’s not the most common cause of infection….Salmonella infections — which commonly results from eating infected eggs, poultry, meat or other foods — appear to have been the most common foodborne illness in 2014, with more than 15 confirmed infections per 100,000 people, according to FoodNet. Campylobacter, which most often results from eating raw or undercooked poultry, was second, sickening more than 13 people per 100,000, and Shigella,, which results from exposure to infected fecal matter, was third at nearly 6 cases per 100,000. Compared to the period 2006-2008, 2014 saw a 52% increase in Vibrio infections, which usually result from exposure to seawater or raw or undercooked seafood. Campylobacter infections also increased over the same time period, by 22%. Meanwhile, infections of E. coli O157, a severe, sometimes fatal, form of E. coli that causes bloody diarrhea, and Yersinia, an infection often caused by consuming raw or undercooked pork, decreased by 32% and 22%, respectively. The number of Listeria and Salmonella infections remained about the same from 2006 to 2008.”

In an article in Fast Causal (which reports on the “fast food – casual” restaurant industry segment) by Cherryh Cansler titled What operators can learn from Chipotle’s Salmonella outbreak she identified the following vital lessons to be learned:

“Restaurants should be aware of any recalls, and should know if there is any possibility that they utilize any products involved in a recall, said Wade Winters, VP, supply chain, for Consolidated Concepts. When dealing with produce recalls, however, it is a bit more difficult to determine if a restaurant is at risk. “It’s important to check the origin of product, and the details provided in the recall,” he said. ‘If they are unsure, they should check with their supplier, the FDA website, and always follow CDC protocol. To properly dispose of any produce contaminated with salmonella, operators should always use latex gloves, move product to a durable garbage bag, douse with bleach, seal bag and with assistance, remove to a trash receptacle. They should sanitize all surfaces that have been in contact with the product.’ Winters said it’s important to only use suppliers who have thorough and tested recall procedures and are pro-active in contacting customers that might be threatened by any potential food safety issues related to their products. {Emphasis Added} ‘I would suggest applying for all FDA recall, market withdrawals, and safety alerts which can be done at www.fda.gov/Safety/Recalls ,’ he said. Lastly, it is critical that restaurants have a food safety training program for all of their team members, including managers. ‘Food safety is an absolute necessity. Nothing can close a restaurant’s doors faster than having a customer get sick or worse,’ Winters said.”

Food Product Safety

The need to consider food-related health communication processes and capabilities is not limited to restaurants. During 2015 there were hundreds of serious food product safety issues from a wide range of companies. (My own personal angst was tied to the national recall of Blue Bell Ice Cream products). In just the month of December 2015 alone, major food-safety related issues have resulted in warnings, notifications and major recalls in the U.S. These include common food products and familiar restaurant chains such as: Tyson Chicken; Bellisio Foods; All American Meats (Ground Beef); Mars Chocolate Dove Candy bars and Sweet Leaf Tea Company (Ice Tea). Food safety health communication and consumer notification is a significant and serious challenge for both public and private sector entities.

According to The Business Insider, the CDC estimates that as many as 1 in 6 Americans (about 48 million people) get sick with a foodborne illness each year. MarlerClark™, a law firm that represents the victims of foodborne illness, states that:

“The Centers for Disease Control and Prevention (CDC) estimates that 48 million foodborne illness cases occur in the United States every year. At least 128,000 Americans are hospitalized, and 3,000 die after eating contaminated food.  While most foodborne illness cases go unreported to health departments, and are thus of unknown origin, the CDC estimates that 9.4 million of the illnesses are caused by 31 known foodborne pathogens, and that 90% of all illnesses due to known pathogens are caused by seven pathogens: Salmonella, norovirus, Campylobacter, Toxoplasma, E. coli O157:H7, Listeria and Clostridium perfringens. According 2010 estimates, norovirus in the most common of the known pathogens, responsible for 5.4 million illnesses and 149 deaths each year.  Salmonella is now estimated to cause more than a million illnesses and 378 deaths annually. E. coli toxins are estimated to cause 176,000 illnesses and 20 fatalities a year. Campylobacter is estimated to cause 845,024 illnesses and 76 deaths. Listeria is one of the most lethal pathogens, estimated to cause 1,591 illnesses and 255 deaths.”

The FDA states: “While the American food supply is among the safest in the world, the Federal government estimates that there are about 48 million cases of foodborne illness annually—the equivalent of sickening 1 in 6 Americans each year. And each year these illnesses result in an estimated 128,000 hospitalizations and 3,000 deaths.”infographic outbreak vitalsigns CDC

Economic Costs

A 2011 report sponsored by the Grocers Manufacturing Association (GMA) describes the results of a major survey of recalls. The findings include that 77% of those who have managed a recall in the past five years estimated an average cost of $30 million dollars (23% reported even higher costs). The same report also finds that these recalls are rising and increasing in both frequency and severity. (I recommend that all business continuity professionals read this Capturing Recall Costs whitepaper to better understand the hidden costs of reputation damage and market recovery, whether you are working in the food/food services sector or not).

The USDA estimates the costs to the economy of foodborne illnesses at more than $15.6 billion, (or about one-half of the $32 billion the World Health Organization says the Ebola outbreak will cost the world economy). The USDA further states that each year, more than 8.9 million Americans will be sickened by one of the 15 pathogens, with more than 5.4 million of those illnesses due to the stomach-churning, but usually short-lived, Norovirus and that foodborne illness sends 53,245 Americans to hospitals annually, which is where the majority are when infections take the lives of 2,377.

Jane McGrath writing in Money: How Stuff Works (10 Costly Food Recalls) notes that:

“In the United States, the economy hemorrhages about $7 billion every year due to these outbreaks [source: Washington Times]. The recall costs, which include getting food off shelves, handling lawsuits, revamping plants and repairing public relations, can be gargantuan for companies. And that’s not counting the tainted reputation and lost sales that can be difficult to monetize.”

Warning, Alerts and Notifications

According to the CDC, in response to identified instanced infectious food products resulting in foodborne illness, there are a number of health-response agents that are all essential for responding and warning the public. These include local public health agencies (who investigate and issue warnings) and state public health agencies (who investigate, coordinate with other departments and jurisdictions and issue notifications and public notices). If the outbreak is substantial, the Centers for Disease Control and Prevention (CDC) may assist or lead in investigations, especially those that affect many states at once and serve as a clearinghouse of health information for the public. Other Federal regulatory agencies, such as the Food and Drug Administration (FDA), the USDA’s Food Safety and Inspection Service (FSIS) and the Environmental Protection Agency (EPA), are involved throughout all phases of an outbreak investigation. In the case of an outbreak of foodborne illness, these federal agencies work to find out why it occurred, take steps to control it and look for ways to prevent future outbreaks. Typically, one or more of these Federal regulatory agencies are responsible to announce regional or national food recalls or issue health-risk communication warnings to the public.

Safety Alerts

In addition to product and market withdrawals, public and private sector agencies also send safety alerts to notify and warn select targeted audiences about potential health risks. The importance of having a communication plan, robust communication capability and highly reliable push and pull communication technology is essential.

The FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network manages not just outbreak response, but surveillance and post-response activities related to incidents involving multiple illnesses linked to FDA-regulated human and animal food and cosmetic products. This includes an emphasis on health-risk communication issues responding to an outbreak. A list of recent outbreaks reported by CORE is available here. Effective communication is one of the most important factors in successful management of a public health emergency.

Private companies typically issue food product related recalls and safety alerts. The FoodSafety.Gov website contains a fairly comprehensive list of current recalls (both voluntary and mandatory) on their website. A food recall occurs when there is reason to believe that a food may cause consumers to become ill. A food manufacturer or distributor initiates the recall to take foods off the market. In some situations, food recalls are requested by government agencies (USDA or FDA).

Contacting retail stores and other vendors to notify them of issues or a recall request is certainly part of the emergency notification task. In most cases, however, there is a risk that customers have already consumed the suspect products, eaten in an associated restaurant or may have the suspect product in their homes, although not yet consumed. This makes the potential target audience for notification much larger than a list of vendors and creates challenges for effective health-risk communication.

Private Sector Communication Preparedness Best Practices

Communicating effectively in food and product safety situations is both a matter of importance to public safety, but also important to the continuity of your business operations. Effective communication sustains safe handling, processing, preparing and consumption of foods and minimizes the risks of illness and infection. To ensure both the well-being of people and the continuity of your business operations, you must be capable and adept at fast and efficient warning notification communication.

All product manufacturers and food service providers have an obligation to ensure that only safe products are marketed, this especially includes all food products and services. Businesses should communicate clear instructions for proper use (this includes warnings against possible misuses) including handling, storage, preparation and discarding. Obviously, businesses should meet (or even exceed) industry and regulatory safety standards. It is important for each company or business to develop, test and revise a complete safety alert and product recall communication plan. This should include message maps, advance targeting and all essential procedures to ensure effective communication. The communication plan should utilize both push and pull strategies and be ready to enable quick response to any safety concerns that (will inevitably) arise.

As Ed Van Rens wrote in How Much do Product Recalls Really Cost? (Infinity QS Blog) “Once it is discovered that your company is indeed responsible for a faulty product, the public must be informed—and your organization is going to have to spread the message.”

Communicating during emergency events, such as food recalls, presents unique challenges. The “facts” or other important information can change significantly as the process unfolds. Reaching everyone with key messages presents a significant challenge. Inconsistent contact or updates can result in confusion or misunderstanding. After an event is over, effective communication is needed to ensure that consumers can be assured that it is once again safe to purchase or consume the previously recalled product. In fact, resuming sales after urging customers to not purchase or consume a product is itself an aspect where it is important to communicate effectively. Blue Bell Ice Cream’s return to the market provides an interesting case study for consideration.

A high-speed outbound notification system capable of broadcasting voice, text, email and automated survey messages is a foundational tool for communication preparedness. High-speed targeted notification is one of the most powerful tools available to easily deliver hundreds (or even thousands) of messages to vendors, suppliers, employees, customers, constituents, stakeholders and regulators. Because you never know where you will be when you need to initiate safety notification, the tool should make it easy to launch messages from any phone, smart device or web connected computer. An Inbound/Outbound telephone information hotline is equally important. If this can be integrated with an interactive message retrieval system designed specifically for such situations, all the better.

Are you prepared to communicate to the right people at the right time with the right message using the right tool? If not, why not?

To download a copy of the FDA’s Strategic Plan for Risk Communication please click here.

Image: http://www.foodsafety.gov/poisoning/responds/

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