NEAL CONAN, host:
Yesterday, government inspectors finally got a big break in the search for the elusive cause of a nationwide salmonella outbreak that sickened more than 1,200 people. They found the suspect strain of bacteria on a single Mexican-grown jalapeno pepper in a distribution facility in South Texas. Investigations into the source of that contamination, whether it happened at the farm, at the packing house, or at the distributors, are still underway. With an official warning not to eat fresh jalapenos, some farmers worry about how they're going to sell their crops and tomato growers believe their losses could add up to 250 million dollars and wonder why they are still suspects.
Today, we'll talk to the Food and Drug Administration's food safety chief about what goes on inside a food safety investigation and why this recent outbreak of salmonella has been so difficult to figure out. If you have been affected by the outbreak, either as a consumer or if you're a farmer, give us a call at 800-989-8255, e-mail us, email@example.com. You can also the join the conversation on our blog at npr.org/blogofthenation. Joining us now is Dr. David Acheson. He's the associate commissioner for foods for the Food and Drug Administration. He's been in charge of tracking the salmonella outbreak for them, and he joins us now by phone from his office in Rockville, Maryland. Nice to have you on the program today.
Dr. DAVID ACHESON (Associate Commissioner for Foods, Food and Drug Administration): Great pleasure. Thank you for inviting me.
CONAN: And how did you finally trace the salmonella to a jalapeno pepper?
Dr. ACHESON: That's all part of the - of tracing back from clusters. A cluster is when a group of people get sick and they visited the same restaurant, or they bought the product from the same store. And FDA investigators go in there essentially follow the trail back, in terms of where did that restaurant get their peppers, and we go back to that supplier, where did they get their peppers, and you go back to that supplier. You work your way back down to the distribution system and at each critical step, we get investigators in there taking samples, looking for problems and a group of clusters traced back through this distribution center in McAllen, Texas. And when we sampled peppers that were in that distribution center, we found it positive. The key thing is, did the contamination occur in that distribution center, or was that pepper already contaminated when it arrived at the distribution center? And that's one of the most important questions that we're currently trying to address.
CONAN: And what are the things that people are curious about in terms of this investigation and perhaps we've been spoiled. But the investigation not so long ago into an E. coli outbreak involving a spinach, as it turned out. That seemed to go very quickly.
Dr. ACHESON: Yes. Big difference. One of the big differences is there when people got sick and we interviewed them, many of them still had bags of spinach sitting in their refrigerators that have lot codes, bar codes, manufacturers' names on them and that takes you right back to the manufacturer. When people get sick from tomatoes, when they get sick from peppers, they don't have them, they don't keep them. They may not even remember where they bought them from, or ate them considering it's usually two to three weeks after they get sick before it finally gets to the point where somebody will interview them. Because it takes that long to get the genetic profile linked together to the outbreak.
CONAN: The genetic profile of that particular strain of, in this case, salmonella.
Dr. ACHESON: Exactly, exactly. Every time we get a salmonella out of somebody, it is genetically typed to see if it's the identical fingerprint pattern to the outbreak strain so that it can be linked. That process from the time somebody gets sick to the time the genetic typing is done, if it's running really fast, is like 10 to 12 days but it's more likely two to three weeks.
CONAN: And you're asking them about everything they ate because it might have been when you were still looking, the tomatoes, the peppers, it could have come from a lot of different places.
Dr. ACHESON: Yeah. Initially, when we start these things, we really don't have a clue where it's from. And that's the first part of the investigation, is you're asking somebody maybe two weeks ago, come to think back two weeks, what did you eat and where did you eat it? And that's, I mean, that's a struggle for anybody. You know, frankly, I struggle to remember what I ate yesterday, let alone what I ate two weeks ago, or where I may have eaten it. And people forget, so you're at the mercy of people's memories, which is why clusters are so helpful because typically, someone will remember oh, you know, I had dinner out of such and such a restaurant.
And then if you find that this five or 10, 15, 20 people who all have that memory in the same kind of time frame, that's a really positive lead. I mean, I had a couple of those that came a little later in this outbreak, but the first few weeks of this was what we call sporadic cases, just individuals. They weren't linking back to a restaurant or anything like that.
CONAN: And one of the things that tomato farmers are complaining about is that they were initially suspect in this and a lot of tomatoes, well, didn't get sold and they had a lot of losses and now they feel like we were unfairly targeted.
Dr. ACHESON: Yes. When this outbreak first occurred, which, well, it takes us back to the middle of April. And the state health authorities with their local counterparts and the Centers for Disease Control are going through this questionnaire process. They're asking people, what did you eat? Where did you eat it? And they're built a list of foods that are sort of common themes. Tomatoes is one of those, along with some other things, I believe, they did go back...
CONAN: They were looking at cilantro at one point, yeah.
Dr. ACHESON: Yeah, exactly. They then go back to the patients and asked much more specific questions around the half dozen or so foods that looked like there's a common theme to determine where there's a really strong significant statistical association with any particular type of food. And when that was done through the month of May, there was a very clear, strong association with tomatoes. I think 80 percent of the people who got sick remembered eating tomatoes as compared with some 50 percent of the controls who didn't get sick. Now that typically in a case control study is a pretty good shot that it's right. That's what we did. Some of your listeners may remember - you may remember when we had a peanut butter outbreak with salmonella last year. Same kind of deal.
You're working off that, sort of, science of epidemiological case control investigations. And then it's only after the fact that we said 'oh, OK, this is peanut butter.' You go to somebody who has got sick. Do they still have the peanut butter at home and yeah, that's a long shelf life product, so we're able to get it, test it, find the salmonella and thereby prove the link. With the tomatoes, we're dealing with very strong epidemiology that put us in the direction of tomatoes. But of course, by the time that's all come together, which wasn't until the end of May, some six weeks after the start of the illness. There are not many tomatoes left in the system that you can find that are likely to be still positive. And we did a lot of tomato testing, but never found one. Then as the outbreak evolved and CDC went back and asked questions of a whole new set of patients, like has something changed here? How come this is still going on?
CONAN: That's the Centers for Disease Control, yeah.
Dr. ACHESON: Yes, Centers for Disease Control. What changed here? This is strange. Produce outbreaks, if you think about it, if you take a piece of fresh produce, it doesn't last very long. And usually, a produce outbreak starts fast, peaks, and then goes away. This one was going on, and on, and on, and still is. And so it's like well, this is weird, this is different. Let's do another case control study with the new cases, see if something different surfaces. And on the second time around, tomatoes were still in the mix big time. But the jalapeno and serrano peppers were actually coming slightly ahead of tomatoes. So hence, the switch, the focus to those two kinds of peppers.
CONAN: And I'm sure you're aware of the economic impact when you announced that people should be wary about eating - I know the fresh tomatoes at that time were from specific areas, but yeah, of course, all tomatoes are going to be considered tainted by some people.
Dr. ACHESON: Right, right. What we tried to do very carefully working with states and industry was, try to identify the growing areas of tomatoes where they weren't growing at the time this outbreak began. So they weren't implicated and informing consumers that those kinds of tomatoes weren't part of the outbreak and were OK to consume. But you're right. Consumers don't necessarily see that level of detail and will just sort of say oh, it's tomatoes. It's all tomatoes. Can't be bothered to figure out what's safe and what's not safe. I'm just going to avoid tomatoes. FDA's primary mission is to protect public health. I mean, that's what we're here for, that's the expectation from consumers. And I don't think consumers would be very happy if we sat on very strong scientific data and said well, you know, we really shouldn't tell consumers because we don't actually have a positive sample in a tomato.
But we got really good evidence that they're positive, we just don't have the proof. Otherwise, we wouldn't have jumped on spinach and we wouldn't have jumped on peanut butter. We'd have been waiting, more people would have got sick. So when you have a public health mission, you've got to look at the science and really go with the strongest science. And it's not just done without a lot of consideration and thought as to what's the optimal pathway that's going to result in optimal public health protection.
CONAN: Our guest is Dr. David Acheson, associate commissioner for foods for the FDA. We're talking about the investigation into the salmonella outbreak that has sickened 1,200 people across the country. 800-989-8255 if you'd like to join us. Email, firstname.lastname@example.org and Kerry (ph) is on the line. Kerry with us from Denison in Iowa.
KERRY (Caller): Yeah. I only half jokingly say this, but it sounds like a conspiracy against the anti-vegetarians, by anti-vegetarians. It seems to me that produce is not inherently contaminated with E. Coli, Listeria. or Salmonella. Seems to me that it has to come in contact with an animal product at some point or it can't become contaminated. So I'm wondering what is the actual source of the E. Coli, Salmonella, or Listeria? It's not produce.
Dr. ACHESON: Yes, you're right. It has to come into contact with something to do with an animal, and it depends how you define animal product. But frankly and graphically, the most likely source of contamination is animal fecal material that gets on the produce. Salmonella is a very, very common bacteria that lives in a lot of the intestinal tracts of animals, mammals, a lot of amphibians, frogs, snakes, lizards, turtles. Many of them have salmonella just living in their system. It doesn't make animals sick. So when the fecal material from these animals gets in contact with either the irrigation systems or the produce themselves, that is often the source of the problem.
KERRY: When I go to my subway sandwich place and he puts on his plastic gloves, touches all of the meat and then goes over and touches my vegetables, it wasn't the vegetables' fault.
Dr. ACHESON: Well, hopefully, the meat he is touching is cooked. He's - by doing that, he's trying to protect you from anything that he may have on his hands.
KERRY: Well, if he was truly trying to protect me, he'd be a little more conscious about not cross contamination.
Dr. ACHESON: Oh, I see what you mean. Yes, yes.
CONAN: All right, Kerry. Thanks very much for the call and we'll be watching that counterman at the subway. We're talking about the salmonella investigation. You're listening to Talk of the Nation from NPR News. And let's get Matt on the line. Matt is calling us from Tucson, Arizona.
MATT (Caller): Hi. I was curious as to whether, when people come in with symptoms that resemble these, are emergency rooms encourage to try and get any information on the patient's history whether there's - where came from or what could have caused it in order to have that information for the CDC or the FDA for later on analysis? And I'll take my answer off the air.
CONAN: OK, Matt. Thanks very much. And Dr. Acheson, also tell us, it is easy to identify that in an emergency room that a patient is suffering from salmonella poison?
Dr. ACHESON: No, not at all. Salmonella, when you show up in the emergency room, it's going to cause gastroenteritis. Chances are, you may have a slight fever, some vomiting, nausea, abdominal pain and diarrhea. And that is typical in many, many things. Many viruses and bacteria that can do that. E. Coli can do that. Viruses can do that. There are many, many causes. There are an estimated 1.5 million cases of salmonella in the United States every year. That's a lot. There are an estimated 23 million cases of what's called norovirus which is the virus that's been associated with cruise ships.
So, people showing up at emergency rooms with gastroenteritis is pretty common and there's no way really that an emergency room physician could take a reasonable history to determine what the likely sources in a sporadic case. Somebody says while I was on a cruise ship and half the rest of the passengers were sick, then you - that's a very different matter. So the way it works is if that patient is sick enough, the doctor would take a stool sample, it would get cultured. That takes a couple of weeks to finally do the genetic typing and then if it's part of an outbreak, that is what triggers the questions from the local health authority in terms of where that person may have eaten.
CONAN: And do the inquiries then go to the Centers for Disease Control or to you at the FDA?
Dr. ACHESON: No. This is all done through the Centers for Disease Control. It begins with the states and the locals, the questions of the patients that's sort of the human health part of this. Determining what those people ate is under the jurisdiction control of the local and state health departments and the Centers for Disease Control. Once the food has been identified, in this case, tomatoes initially and then switched into peppers as well, that's the point at which FDA becomes involved to address where did this food come from, what was the problem and how can we shut it down?
CONAN: And this also involves, in this case, we know is a jalapeno pepper that was grown in Mexico and people said, wouldn't this be picked up in inspections as that food comes across the border?
Dr. ACHESON: Not very likely. The chances that an inspection would find it - because an inspection alone isn't going to determine whether salmonella is present or not. You'd have to do some sampling. And it hadn't been found through inspections and sampling. Not that it would be completely impossible to either inspect or certainly sample, everything that's coming across the border. It just, it wouldn't be cost effective. You'd be doing a mountain of testing with very little game.
CONAN: Let's get Blake on the line. Blake with us from Sacramento, California.
BLAKE (Caller): Hi. Yeah, I was just wondering, you know, my husband and I eat a lot of fruits and vegetables and I guess, what are your suggestions? I mean, if the food that we're getting isn't necessarily clean or bacteria disease free any of these types of things, what do you do? I mean, do you use a veggie spray? Do you just have to cook everything? Can we still eat raw vegetables? Do I have to buy organic? I mean, I guess I'm kind of left in the produce isle with no suggestions.
Dr. ACHESON: Right, right.
CONAN: A lot of questions.
Dr. ACHESON: No. I mean, it's an excellent question and I'm sure you're not the only person who is having that same thought. You've got to look at the risk benefit part of this. And the benefits from eating fresh fruits and vegetables or any kind of produce, five to nine times a day are enormous. I mean there's all kinds of health benefits associated with that. And the risks associated with consuming fresh produce relative to the benefits are tiny. If you think of the millions of servings of fresh produce the people are consuming in the United States every week, 300 million and others eating meals two to three times a day, and somebody getting sick enough to have to make a visit to the emergency room is a pretty rare event when you put it in that context. So...
CONAN: We're just running out of time. But right now avoid fresh jalapenos.
Dr. ACHESON: Right now avoid fresh jalapenos until we've got this figured out which hopefully we'll do soon.
CONAN: Blake, good luck with the cooking without the jalapenos.
BLAKE: Thank you so much.
CONAN: And Dr. Acheson, thank you so much for your time today. We appreciate your patience.
Dr. ACHESON: Thanks for having me on. Great pleasure.
CONAN: David Acheson, associate commissioner of foods for the FDA with us by phone from his office in Rockville, Maryland where I'm sure he's going to go home and eat a plate of fresh vegetables this evening. I'm Neal Conan. You're listening to Talk of The Nation from NPR News.