Food Safety News

Higher fridge temperatures in the homes of older people could be putting them at greater risk of Listeria infection, according to a study.

Researchers looked at the temperatures of domestic refrigerators in the Netherlands and the impact on listeriosis cases related to ready-to-eat (RTE) cooked meat products.

A survey among 1,020 Dutch consumers assessed their knowledge and behavior regarding refrigerators.

The mean temperature of 534 domestic refrigerators on the bottom shelf was 5.7 degrees C (42.2 degrees F). The 24-hour profiles of an additional 50 refrigerators showed temperatures on the upper shelf were higher at 7.7 degrees C (45.8 degrees F). In the Netherlands, it is recommended that the temperature of refrigerators should be 4 degrees C (39.2 degrees F).

Outcomes of the survey were used to estimate the number of listeriosis cases per year due to consumption of RTE-cooked meat products among different population risk groups.

Fridge temp findings
The analysis of measured temperatures of 534 refrigerators on the bottom shelf showed they varied from −1 degrees C to 17 degrees C (30.2 to 62.6 degrees F), with two-thirds showing 6 degrees C (42.8 degrees F) or lower, according to the study published in the International Journal of Food Microbiology.

The survey found that only 28 percent of consumers said 4 degrees C (39.2 degrees F) was the correct temperature of a fridge. Around 8 percent indicated a lower temperature; the same amount indicated 8 degrees C (46.4 degrees F). People familiar with the recommended setting had a significantly lower temperature in the refrigerator. 

Most participants never checked the refrigerator’s temperature; 37 percent occasionally did it, and 2 percent did it regularly. 

The measured temperatures of the refrigerators of consumers aged 65 and older were, on average, higher than those of people below 35. Younger consumers were more aware of the recommended temperature. Fridges with the highest temperatures of 16 and 17 degrees C (60.8 and 62.6 degrees F) were owned by participants aged 79 and 86. Refrigerator type and age did not significantly affect temperature.

The survey showed that two-thirds of participants stored meat products on the bottom or middle shelf. The general advice is to keep RTE-cooked meat products on these two shelves.

Impact on Listeria risk
Modeling predicted an average number of 191 illnesses per year through the consumption of RTE-cooked meat products. As expected, the high-risk populations had a higher risk of listeriosis. 

Storing opened RTE cooked meat products at home for either under 7 days or at temperatures below 7 degrees C (44.6 degrees F) resulted in a significant reduction in predicted illness cases, said scientists.

An analysis was conducted on the impact of various variables on the estimated risk of listeriosis from RTE-cooked meat products. Results showed that consumer behavior, such as reducing storage time and controlling refrigerator temperature at home, can significantly reduce the risk.

Scientists said that despite recommendations being included in numerous food safety campaigns aimed at consumers, the storage temperature of chilled foods is frequently above 6 degrees C (42.8 degrees F). Contributing factors include a lack of perceived importance or risk control benefit. 

“Our study showed that the more extreme high storage conditions were found in refrigerators of the elderly, and this indicates that there is a need for more targeted communication about good storage practices that can be taken in the home kitchen,” said researchers.

“Specific advice can be given to the elderly, such as setting a maximum temperature for the home refrigerator, storing RTE cooked meat products on the bottom or middle shelf, and consuming within two to three days after opening.”

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Authorities in Iceland have issued a warning after six people were diagnosed with Listeria infections.

The Icelandic Food and Veterinary Authority (MAST) wanted to increase awareness of the disease among at-risk groups and of preventive measures that food companies can take.

Risk groups are people with a weakened immune system, those on immunosuppressive drugs or undergoing cancer treatment, pregnant women, young children, and the elderly.

The source of the foodborne infection has not yet been identified. Officials did not say if cases were sporadic or part of an outbreak.

In recent years, two and five sick people have been reported annually in Iceland. Still, in 2024, six Listeriosis cases were diagnosed by blood culture at Landspítala’s bacteriology and virology department. Of five cases with available information, four are men, and one is a woman. They are aged 70 to 85 years old.

In Iceland, Listeria infection was made a reportable disease in 1997. In a study from 1978 to 2000, 40 cases were described, and the mortality rate was around 33 percent.

In an e-newsletter published by the Directorate of Health (Embætti land­læknis), the increasing incidence of Listeria in Europe, especially in older people, was noted as a matter of concern because of the seriousness of the illness in vulnerable people.

The note said it was essential to educate high-risk groups about the association of Listeria with certain foods that are served uncooked, such as soft and raw milk cheeses, vegetables and salad, and ready-to-eat food such as sandwiches and smoked salmon.

MAST advised companies to ensure they clean food contact surfaces and other areas properly and are aware of biofilms, which aid the survival of Listeria. Maintenance was also emphasized to stop the bacteria from surviving or multiplying in the production environment.

The agency added that companies that produce ready-to-eat foods must regularly monitor Listeria in the production environment and in products, with the frequency of analysis depending on a risk assessment.

Consumers can ensure their fridge temperature is not above 4 degrees C (39.2 degrees F), do not eat foods after their use-by date, and heat prepared dishes to 75 degrees C (167 degrees F).

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has developed symptoms of Listeria infection should seek medical treatment and tell their doctors about possible Listeria exposure.

Also, people should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

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The Illinois Senate has passed SB2637 over to the House. It would ban certain food additives.

The Food, Drug, and Cosmetic Act would, if enacted by the House, ban foods containing entities from manufacturing, selling, delivering, distributing, holding, or offering for sale a food product for human consumption that contains brominated vegetable oil, potassium bromate, propylparaben, or red dye 3.

It passed with just one Senate floor amendment:  It was: “Provides that, beginning January 1, 2027, a person or entity shall not manufacture (rather than manufacture, sell, deliver, distribute, hold, or offer for sale) a food product for human consumption that contains brominated vegetable oil, potassium bromate, propylparaben, or red dye 3. Beginning January 1, 2028, prohibits the sale, distribution, holding, or offering of a food product that contains those substances for human consumption.”  It was a conforming change.

The bill provides that a person or entity that violates the prohibition shall be liable for a civil penalty not to exceed $5,000 for a first violation and not to exceed $10,000 for each subsequent violation.

As it went over to the Illinois House, SB 2637 would ban the four food additives that are commonly found in candy, soda, and baked goods.

The Illinois Food Safety Act passed the Senate on a 37-15 bipartisan vote and will head to the House for consideration. 

The action to ban the chemicals arrived in Illinois, mimicking one in California, the first state to take the move this past year.

New York State is also on track to join the food additive ban.

The banned chemicals would include brominated vegetable oil, red dye No. 3, propylparaben and potassium bromate.

Those additives are used in a wide variety of food products. Brominated vegetable oil stabilizes citrus flavoring in sodas from separating from the solution and floating to the top. Propylparaben and potassium bromate are used as preservatives in baked goods. Red dye 3 is a common food dye used in candy and other products.

“This legislation does not seek to ban any product or take away any of our favorite foods,” said bill sponsor state Sen. Willie Preston, D-Chicago, “This measure sets a precedent for consumer health and safety to encourage food manufacturers to update their recipes to use safer alternatives.”

Last year, the FDA proposed to revoke brominated vegetable oil after a study found that the chemical affects the thyroid, creating negative health impacts.  

Meanwhile, the Center for Science in the Public Interest said red dye 3 may cause animal cancer. The International Agency for Research on Cancer, a World Health Organization unit, found potassium bromate to be possibly carcinogenic.

The bill had bipartisan support in the state Senate, with both state Sen. Seth Lewis, R-Bartlett, and state Sen. Steve McClure, R-Springfield, voting for it.

The FDA banned red dye 3 for use in makeup more than 30 years ago. So, the FDA doesn’t allow you to put it on your face for makeup. “But yet kids are eating this in candy,” McClure said in the Senate Thursday. “That, to me, is outrageous. So, for that reason, I am voting for this bill.”

Preston previously said he was considering adding titanium dioxide to the ban, but that plan was scrapped during negotiations. He said if additional research becomes available, “we’ll explore that option at that time.” In 2021, the European Food Safety Authority said it was concerned that titanium dioxide could alter people’s DNA.

The Illinois Manufacturers’ Association opposed the bill throughout the legislative process. In January, the IMA stated opposition to “this well-intentioned legislation,” claiming it would undermine the FDA and negatively impact Illinois’ economy as it would “create a confusing and costly patchwork of regulations.”

The National Confectioners Association, in a statement, said it would “increase food costs, undermine consumer confidence, and create confusion around food safety.” The group also argued food regulation should “rely on the scientific rigor of the FDA.”

Last year, California became the first state to ban additives.  It takes effect in 2027.  The New York Senate is currently debating a similar bill. 

The European Union bans or regulates the additives. Food additives are already regulated or banned in parts of the European Union.

In Illinois, the additives would be banned from manufacturing beginning Jan. 1, 2027, with the sale, delivery, distribution, and holding of products containing the additives being banned beginning in 2028.

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Data showing the scale of pesticide residues on food have been published by the European Food Safety Authority (EFSA).

110,829 food samples were collected in the European Union in 2022. Results show that 96.3 percent were within legally permitted levels. Of these, 65,374 samples did not contain quantifiable residues, while 37.3 percent had residues not above the limits.

Overall, 4,148 exceeded the maximum residue level (MRL), of which 2,383 were non‐compliant after considering measurement uncertainty and triggering legal sanctions or enforcement actions.

In 2021, 96.1 of the samples were within permitted levels. The MRL exceedance rate was 3.9 percent, and the non-compliant rate was 2.5 percent compared to 3.7 percent and 2.2 percent in 2022.

In 2022, the MRL exceedance and non-compliance rates were four times higher in samples from non-EU countries than in food products grown in one of the reporting countries.

Pesticides with a higher than 1 percent MRL exceedance rate were copper compounds, ethylene oxide, and chlordecone. A decreased exceedance rate was noted for ethylene oxide from 2021, while the other two substances increased.

Results from 12 product groups
The 2022 report on pesticide residues in food, prepared by EFSA, gives an overview of the official control work in EU member states, Iceland and Norway.

For the 11,727 samples analyzed for 193 pesticide residues as part of the EU-coordinated control program, 98.4 percent were within legal limits. This program analyses samples randomly collected from 12 products every three years. For 2022, these were apples, strawberries, peaches, wine, lettuce, head cabbages, tomatoes, spinach, oat grain, barley grain, cow’s milk, and swine fat.

Half of the samples were free of quantifiable levels of residues. More than 5,500 contained one or more residues in concentrations below or equal to MRLs. 192 samples had residues exceeding the permitted levels, and 100 were non-compliant when accounting for measurement uncertainty.

EU non-approved substances were responsible for 75 percent of the non-compliant samples, randomly taken from non-EU countries, and 50 percent for food products harvested in the EU.

The highest number of multiple residues was found in a sample of tomatoes where 16 different pesticides were quantified, followed by strawberries with 15 different pesticides and red wine with 14 pesticides. The tomato and wine samples were grown in the EU, but the strawberry sample had an unknown origin.

Ethylene oxide findings
Ethylene oxide is not approved at the EU level. However, out of 2,026 samples where the substance was analyzed, the MRL was exceeded 47 times. Of those, six samples were of turmeric coming from India, five were of chili peppers from India and Uganda, five were of peppercorn from India, Vietnam, and Lebanon, and four samples of dried beans from India.

In their monitoring programs, EFSA said national authorities should consider ethylene oxide in turmeric, chili peppers, peppercorn, and dried beans from non-EU countries, especially India.

The number of samples with multiple pesticide residues was 23 percent, a decrease from 26.4 percent in the previous year. In a sample of chili peppers in the form of paprika powder of unknown origin, up to 43 different pesticides were reported.

In organic farming, MRL exceedance and non-compliance were in the same range as in 2021, with 2.4 percent exceedances and a 1.4 percent non-compliance rate. Non-authorized substances were reported sporadically in samples. One example was chlorpyrifos, mostly in India’s dry beans, rice, and cumin seed.

In 75 samples of baby food, the MRL was exceeded. When measurement uncertainty was taken into account, 15 led to non-compliant results. MRLs were exceeded in 46 honey samples, and 28 were judged to be non-compliant.

Results from the monitoring programs are a source of information for estimating the dietary exposure of EU consumers to pesticide residues. 

EFSA carried out a dietary risk assessment as part of its analysis of results. This showed the probability that consumers will be exposed to a quantity of residues above a certain safety threshold. EFSA concluded that there was a low risk to public health from the estimated exposure to pesticide residues in the foods tested.

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— OPINION —

By Steven Grossman, Executive Director of the Alliance for a Stronger FDA

Consistent with the overall discretionary spending targets set forth in last year’s budget agreement, the President’s FY 25 budget request for FDA is substantially less than his FY 24 request. As a result, all of FDA is at risk for another lean year in FY 25.

For already-underfunded food safety programs at FDA, this is a particularly bad harbinger that is coming just as new investments are most needed. 

The multi-stakeholder Alliance for a Stronger FDA advocates on behalf of the entire stakeholder community. We just announced our FY 25 FDA funding “ask” (here), which provides Congress with insight into FDA’s needs. 

We call for a budget authority (BA; non-user fee) appropriation of $3.896 billion for salaries and expenses (S&E). This is $214 million more than the President’s FY 25 budget request and $377 million more than the FY 24 funding level. While these numbers may seem particularly large, it is in part because the agency needs $115 million in FY 24 just to pay for mandatory pay raises. 

Accordingly, the Alliance’s request for FY 25 is heavily focused on the program areas that most need attention in FY 25 (which starts October 1, 2024). 

Working with Alliance members interested in HFP, CFSAN, and CVM food safety, we have urged Congress to fund the following food-related programs:  

• Food Chemical Safety. A robust food chemical safety/post-market review program is a pressing need that is supported by a broad range of consumer and industry stakeholders, many of whom view it as their highest food safety funding priority. Additional funding–well beyond the President’s budget request—is needed to ensure rigorous and timely review of chemical and toxicological issues now pending before the agency, including twenty-one chemicals currently prioritized for reassessment. Such reviews can take many months to complete, so there is an urgency to get started and a need for substantial funding in FY 25.

• Rule Implementation and Prevention Activities. FDA, state partners, and industry are currently working to implement the traceability rule and are anticipating upcoming changes to agricultural water standards. This, combined with advancements in the scientific understanding of the root causes of food contamination make it important for FDA to maintain and grow efforts to work with state regulators and industry stakeholders to implement standards and practices that can improve food safety. 

• Cooperation with State and Local Governments. FDA’s cooperative relationships with state and local regulatory programs (including state human and animal food testing laboratories) have been extremely valuable and should be sustained and made more predictable. In many instances, the agency achieves better coverage at lesser expense by having a state and local presence.

• Establishing Nutrition Center of Excellence. The planned reorganization of the Human Foods Program includes the establishment of a Nutrition Center of Excellence. Given the relatively small size of the current nutrition program at FDA, additional funds will be needed to realize the vision for nutrition in the new organization. Priorities include children’s health, chronic disease, and consumer-facing food labeling.

• Enhancements in Risk-Based Targeting of Foods and Animal Health Program Oversight Activities. As the agency restructures to establish a new Human Foods Programs, additional resources (advanced data systems, external data sets, and data scientists) are needed to create a data-driven foundation to improve risk-based oversight and surveillance activities in both human foods and animal food and drugs. More substantial investments in FY 25 could also help to accelerate work planning and data sharing with state regulatory partners.

For more information, go to the Alliance’s website: www.strengthenfda.org. 

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New Zealand Food Safety has issued new import rules for frozen berries that aim to help keep citizens safe and improve processes at the border.

Changes will come into effect on Aug. 1, and importers have 18 months until Jan. 31, 2026, to transition to the modified requirements. 

From 2022 to 2023, there was an outbreak of hepatitis A virus associated with frozen berries from Serbia, affecting 39 people.

Changes to requirements
Vincent Arbuckle, New Zealand Food Safety deputy director-general, said several countries have recalled frozen berries in the past because of concerns about hepatitis A, which is not killed by freezing temperatures.

“We’ve worked hard to identify and implement ways to improve food safety rules to manage the risk to consumers better. As part of this, we worked closely with major frozen berry importers, who have expressed strong support for the changes,” he said.

“Now that the outbreak is over and affected products have been removed from the shelves, the risk to consumers has been reduced. Hepatitis A virus in imported frozen berries, however, remains a potential risk. If consumers have concerns or are part of a vulnerable population group, then they can heat-treat frozen berries to over 85 degrees C (185 degrees F) for at least 1 minute.”

Frozen berries have been moved from an Increased Regulatory Interest food to the High Regulatory Interest food category, which requires clearance to enter the country.

Requirements for microbiological testing of berries at the border have been replaced with stricter rules for manufacturers before shipping. 

In a first for the country, the changes introduce independent and third-party certification to confirm that an overseas manufacturer’s food safety systems meet New Zealand’s standards. Written assurance must be provided by an official certificate that meets certain requirements or a Global Food Safety Initiative (GFSI)-recognized certificate accompanied by a manufacturer’s declaration.

New Zealand Food Safety does not intend to limit the use of third-party certificates to GFSI-recognized ones, but others must be assessed and approved by the agency.

Arbuckle said this gives the agency more confidence that risks associated with frozen berries are being managed before they come to New Zealand.

Consultation response
The rules apply to frozen berries, including mixed frozen food containing frozen berries imported from any country ready to eat (RTE). Examples of berries include blueberry, cranberry, raspberry, and strawberry.

It does not cover RTE frozen berries subjected to treatment sufficient to eliminate hazards, including norovirus and hepatitis A, and where evidence is shown to MPI of such methods. RTE frozen processed food containing berries, such as ice cream, frozen yogurt, and frozen desserts, are also exempt.

In July 2023, New Zealand Food Safety proposed the new import requirements, and a comment period was held between October 2023 and January 2024. Nine submissions were received from Foodstuffs New Zealand, Horticulture New Zealand, and United Fresh.

Overall, respondents supported the new requirements, especially third-party certification as an option for meeting clearance requirements.

Two parties raised concerns about the practicality and reliability of GFSI-recognized certification as applied to growers at primary production and asked for an alternative to be provided. The draft rules had already included another option.

Australia’s Department of Agriculture, Fisheries and Forestry (DAFF) backed the planned changes. The United States requested clarification on whether a certificate issued by the Food and Drug Administration (FDA) to foreign governments for products covered by the notice would be acceptable. New Zealand Food Safety said it would reply directly to understand better the certificate referred to and to address the request for clarification.

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Long definitions exist for the Farm Bill.  Here are a couple:

“In the United States, the farm bill is a comprehensive omnibus bill that is the federal government’s primary agricultural and food policy instrument. Congress typically passes a new farm bill every five to six years. Congress makes amendments to provisions of permanent law, reauthorizes, amends, or repeals provisions of preceding temporary agricultural acts, and puts forth new policy provisions for a limited time into the future.” 

Or another:

“The Farm Bill is a huge, complex piece of legislation, and its path through Congress will be filled with twists and turns. We’re closely following this journey, looking at how the proposed bills in the House and Senate will impact farmers, eaters, and residents of rural communities.”

In the months ahead, reports will keep updated with the latest news on the Farm Bill and opportunities. Some of the provisions in the legislation involve food safety.

House Ag Committee Chairman Glenn Thompson is defending his proposal to fund the farm bill to move the legislation by Memorial Day.

“Anyone who criticizes our funding framework is either ignorant of the details or being disingenuous,” he said.

Thompson, R-PA., also indicated he would include a scaled-back alternative to the Ending Agricultural Trade Suppression (EATS) Act in the farm bill. The EATS Act — previously garnered support from pork-state lawmakers but opposition from many Capitol Hill Democrats and states

He will also address Prop 12 within the farm bill,  the EATS Act. “It will be very respectful of states’ rights and states deciding within their borders what their agricultural practices are.”

Thompson said the odds are pretty good for obtaining support from Democrats on the committee.

A $1.7 trillion farm bill must come together by September because that’s when the current bill expires.

Rep. Thompson’s Senate counterpart, Sen. Debbie Stabenow, D-MI, is retiring at the end of the year.

The Farm Bill comes up for renewal every five years. The current version was passed in 2018

The bill comprises 12 titles and a broad range of items; money can go toward research, colleges, and rural development like broadband expansion.

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The number of Shiga toxin-producing E. coli (STEC) O157 infections remained steady but non-O157 cases increased in England in 2021 according to recently released data.

Overall, 1,151 confirmed cases of STEC were reported in England during 2021. This included 365 cases of STEC O157 and 786 cases where non-O157 was isolated. For another 443 patients, samples were confirmed as STEC by testing positive by PCR for Shiga toxin genes, but E. coli was not cultured.

Fourteen confirmed cases were infected with multiple serogroups, according to data from the UK Health Security Agency (UKHSA).

In 2020, 365 O157 cases were recorded, down from 515 in 2019. The rates in 2020 and 2021 were the lowest reported annually since 1996. Officials said it was likely that the COVID-19 pandemic and reduced travel abroad contributed to these findings.

E. coli O157 and four outbreaks
About a third — 127 out of 365 — of confirmed STEC O157 patients were hospitalized and six developed hemolytic uremic syndrome (HUS), a severe complication that can lead to kidney failure. Duration of hospitalization ranged from 1 to 7 days with a median of 2 days. Three HUS patients were younger than age 5 but overall they ranged from 1 to 25 years old.

The lowest incidence of STEC O157 was in the East Midlands region and the highest in the North East. Children aged 1 to 4 years old had the highest annual incidence of infection. A peak of infection was recorded in the summer months of July and August.

Four outbreaks of E. coli involved 52 people, with 10 to 19 patients each. Two were STEC O157 and suspected vehicles were identified and two involved STEC O26 and the sources were not found.

The first O157 outbreak involved 10 people with two hospitalized. One person with underlying health issues died. Epidemiological investigations pointed to a composite product, a multi-ingredient pasta pot, as the likely vehicle of infection.

The second O157 outbreak affected 17 people, of which 10 lived in England, six in Wales, and one in Scotland. The median age was 21 years old. Six people were hospitalized. Epidemiological investigations identified watermelons as the likely vehicle of infection.

In an E. coli O26 outbreak, there were 25 confirmed cases, with 17 in England, three in Scotland, two each in Northern Ireland and Wales, and one in Ireland. Ten people were hospitalized.

In another E. coli O26 outbreak, there were 19 patients, of whom 15 were lab confirmed. Eleven lived in England, while Northern Ireland, Scotland, and Wales all had one patient each. The median age was 41 years old.  

Non–O157 data
During 2021 in England, 6,610 human fecal samples were received for testing and 1,234 were confirmed as non-O157 STEC cases, an increase of 46 percent compared to 2020. Of these, 786 culture positive cases of 83 serogroups were confirmed. Three people died.

The five most common serogroups were O26, O146, O91, O128ab, and O145. The main isolated type was STEC O26 on 145 occasions.

Of 1,234 confirmed non-O157 patients in England, 555 were female. The lowest incidence was in Yorkshire and Humber while the highest was in the London region and children younger than the age of 1 had the highest incidence of infection.

Overall, 274 out of 431 of confirmed non-O157 patients were hospitalized and 14 of 1,234 cases developed HUS. Of the HUS cases, O26 was isolated nine times and O145 twice. HUS patients ranged from 7 months to 29 years of age and eight were between 1 and 4 years old.

“Since 2018, the number of STEC O157 notifications has declined and the number of STEC non-O157 has increased two-fold (218 percent). Overall, there is an increase in STEC notifications, and the burden placed on public health and clinical services is also increasing, especially given the two-fold increase in hospitalization reported in 2021 for non-O157 cases,” said UKHSA.

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The Food and Drug Administration continues using import alerts to enforce U.S. food safety regulations for food from foreign countries. The agency updates and modifies the alerts as needed.

Recent modifications to FDA’s import alerts, as posted by the agency, are listed below. 

Click here to go to the FDA page with links to details on specific alerts. See chart below for list of alert modifications.

Click on chart to enlarge. Use link above to go to FDA page with links to specific alerts.

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A dozen people have fallen sick in recent weeks in a Salmonella outbreak in Denmark.

During March and April, 12 cases of Salmonella Typhimurium have been reported, said the Statens Serum Institut (SSI).

People were infected with the same type of Salmonella. Patients are between 5 and 80 years old with a median age of 35. Six are males and six are females. Patients have been reported from different parts of the country.

The SSI, Danish Veterinary and Food Administration (Fødevarestyrelsen), and DTU Food Institute are investigating the outbreak.

SSI is performing whole genome sequencing of patients’ Salmonella isolates and interviewing patients or relatives to try and identify a possible source of infection.

Whole genome sequencing of bacteria isolated from patients revealed samples were very closely related and all belonged to sequence type 19.

In 2022, 899 Salmonella cases were recorded in Denmark, which was up from 2021 and 2020 but down from 2019.

Salmonella caused 11 outbreaks in 2022, with three of them part of international incidents. The largest was a Salmonella Enteritidis outbreak, where 24 cases were reported between March and September. The source could not be identified, but chicken products from Poland were suspected.

About Salmonella
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has developed symptoms of Salmonella food poisoning should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions. Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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Amy’s Kitchen Inc. of Petaluma, CA is recalling Amy’s Kitchen Enchilada Verde Whole Meal because of Listeria monocytogenes contamination.

According to the details posted online by the Food and Drugs Administration (FDA), the recall was initiated on March 21, 2024, and is ongoing.

The recalled products were distributed in California, Connecticut, Florida, Georgia, Iowa, Idaho, Illinois, Indiana, Maryland, Missouri, North Carolina, Nebraska, New Hampshire, New York, teriaOregon, Pennsylvania, South Carolina, Texas, Utah, Washinton and Wisconsin.

Recalled product:

Amy’s Kitchen Enchilada Verde Whole Meal 10 oz. 12 pk Item # 000085

• Product Quantity: 8,563 cases
• Lot # 60D2522, Lot # 60H2222, Lot # 60J2622 
• Best Before: 04/2024, 8/2024, 10/2024

Consumers should not use this product. Recalled products should be thrown out or returned to their place of purchase.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause severe and sometimes life-threatening infections. Anyone who has eaten any recalled product and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about possible Listeria exposure.

Also, anyone who has eaten recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

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in the month after H5N1, bird flu spread to more humans, especially dairy cow herds, more experts in the United States are focusing more attention on the issue.

It was unexpected news last month that cows from a milking herd in Texas had tested positive for H5N1, but apparently, pasteurization of milk kills this specific virus.

 Meanwhile, the World Health Organization (WHO) is expressing “great concern” over the increase in bird flu cases in humans, Michigan health officials are warning against raw milk, and a prominent journalist is demanding more information from USDA.

These are among the reactions that have occurred since about April 1, when a second human bird flu illness was reported in the United States.

WHO has “great concern” that the bird flu virus might evolve and develop an ability to infect humans.

Michigan put raw or unpasteurized milk on the foods most susceptible to the bird flu virus.

Journalist Helen Branswell, writing for STAT, raises a lot of food safety implications from bird flu, including milk, raw milk, and possible spread from chickens to cattle and even people and/or pigs.

She reports an inevitable failure in either transparency or fast-response research.

USDA claims that since the bird flu outbreak began in early 2022,  the department has been practicing “timely and transparent release of information.”

Outside USDA, researchers are demanding the government gather samples on an ongoing basis to check for dangerous changes in the virus, but only a few genetic sequences from this outbreak have been uploaded to GISAID, the Global Initiative on Sharing All Influenza Data, 

Previously, it was known as the Global Initiative on Sharing Avian Influenza Data, a global science initiative established in 2008 to provide access to GISAID, an international database widely used by scientists. 

Genetic sequences are shared from early in the outbreak, which prevents outside scientists from monitoring if the virus has changed as it has moved from cow to cow or herd to herd.

 USDA said it has offered outside scientists copies of a sample virus for research purposes. The department offers that USDA is analyzing other virus outbreaks, and the Centers for Disease Control and Prevention sequences will be shared in the coming days.

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The Food and Drug Administration sends warning letters to entities under its jurisdiction as part of its enforcement activities. Some letters are not posted for public view until weeks or months after they are sent. Business owners have 15 days to respond to FDA warning letters. Warning letters often are not issued until a company has been given months to years to correct problems.

F1 Foods Inc. D/B/A Flavor First Foods Inc.
West Bridgewater, MA

A food firm in Massachusetts is on notice from the U.S. Food and Drug Administration (FDA) for various federal violations and not maintaining the facility in a clean and sanitary condition. Issues cited include the presence of insects and rotting fruit.

In a March 14, 2024, warning letter, the FDA described a July 18 through Aug. 15, 2023, inspection of Flavor First Foods Inc.’s ready-to-eat (RTE) prepared foods processing facility in West Bridgewater, MA.

FDA investigators found serious violations of the Emergency Permit Control regulation, Acidified Foods regulation, Seafood Hazard Analysis and Critical Control Point (HACCP) regulation, and the Current Good Manufacturing Practice, Hazard Analysis, and Risk-Based Preventive Controls for Human Food regulation (CGMP & PC rule).

After the inspection, the FDA investigator issued a Form FDA-483, Inspectional Observations, listing deviations found at their facility.

Some of the significant violations are as follows:

Acidified Foods Violations:

1. The firm failed to provide the FDA, before packing any new product, information on the scheduled processes from a qualified person filed with FDA for their (redacted by the FDA) Marinara Sauce as required. Specifically, no scheduled processes are on file for (redacted by the FDA) Marinara Sauce in any size or container the firm produces and distributes.

2. The firm failed to have operators of processing and packaging systems under the operating supervision of a person who has attended and satisfactorily completed a school approved by the FDA for pH controls and critical factors in acidification, as required. Specifically, no one in their facility has attended a Better Process Controls course or any other approved FDA training in the manufacturing of acidified foods.

Seafood HACCP Violations:

The firm must implement the monitoring procedures and frequency that they have listed in their HACCP plan. However, the firm did not implement the monitoring procedures at the following critical control points listed in their HACCP plan for refrigerated, ready-to-eat, heat treated, clam chowder in reduced oxygen packaging:

1. The firm did not follow the monitoring procedure of continuous monitoring of the product temperature to ensure minimum internal temperature of (redacted by the FDA) at the Hot Fill CCP with a (redacted by the FDA) inspection of the continuous time and temperature recording chart before starting each batch. They are not continuously monitoring the time and temperature and do not use a continuous monitoring device for either their cooking kettle or their holding tank. They were observed using a stem thermometer to monitor the temperature of the clam chowder before filling. FDA recommends continuous temperature monitoring at the hot fill step to ensure the cooked soup is hot filled at or above (redacted by the FDA).

2. The firm did not follow the monitoring procedure of “maintain temp at (redacted by the FDA)” at the Cooking CCP to control pathogenic bacteria survival through cooking. On July 26, 2023, they were observed taking only a single temperature during the cooking step for a batch of clam chowder which was observed to be (redacted by the FDA); however, they did not continue to measure the temperature for a period of (redacted by the FDA) to ensure that the clam chowder stayed at (redacted by the FDA) to ensure pathogen reduction as required by their HACCP plan. Furthermore, the first several bags of finished clam chowder that were used to prime the bagging system were reintroduced back into the kettle and never reverified time/temperature requirement of a (redacted by the FDA) as required by their HACCP plan. FDA recommends monitoring of the cook step be conducted using a continuous temperature recording device installed where it measures the coldest temperature in the cook vessel and through visual observation at the start and end of each cook cycle for each batch.

3. The firm did not follow their monitoring procedure of monitoring the water bath for residual chlorine using a (redacted by the FDA) before the use of the water bath at the Cooling After Cooking CCP to control the hazard of post-production contamination. They did not implement this monitoring procedure. Additionally, during the inspection on July 26, 2023, finished sealed bags of clam chowder were observed being cooled in water which was recovered water from their ice machine condensate drainpipe that was untreated. The finished bags of clam chowder were cooled in this water for approximately (redacted by the FDA) before being transferred to separate vats of ice water which was made with (redacted by the FDA) water and ice but was not monitored with (redacted by the FDA) for residual chlorine as required by their HACCP Plan. In addition, the Cooling After Cooking CCP should include a critical limit that ensures residual chlorine is present in the cooler water.

Current Good Manufacturing Practice:

1. The firm did not take reasonable measures and precautions to ensure that all persons working in direct contact with food wash hands thoroughly (and sanitize if necessary to protect against contamination with undesirable microorganisms) in an adequate hand-washing facility before starting work, after each absence from the work station, and at any time when the hands may have become soiled or contaminated, as required. Specifically, on July 18, 2023, during the production and packaging of RTE marinara sauce in 24 oz. glass jars with a manufacturing date of July 18, 2023, the firm’s owner was observed not wearing gloves and 2 other employees were observed wearing soiled gloves while (redacted by the FDA) capping finished filled jars of RTE marinara sauce with several instances of both the owner and the employees observed touching the rim of the jar during the capping process. During this process the owner and the other employees were observed touching other pieces of non-food contact equipment and then going back to (redacted by the FDA) capping the jars. The owner and the employees were not observed washing or sanitizing hands before, during, or after touching nonfood contact surfaces where the hands may have become soiled or contaminated.

2. The firm did not maintain buildings, fixtures, and other physical facilities of their plant in a clean and sanitary condition and in repair adequate to prevent food from becoming adulterated, as required. Specifically,
    a. On July 18, 2023, rusted metal plates with black debris and a white substance were observed directly above exposed glass jars of marinara sauce that were in the process of being filled.
    b. On July 18, 2023, clutter was observed along the walls and floor wall junctures of the dry storage area including but not limited to the storage of old plastic totes, pallets, old equipment, maintenance supplies, puddles of old standing water.
    c. On July 26, 2023, the stem thermometer used to measure the temperature of their clam chowder was observed stored in a PVC pipe that was soiled with a brown substance. There was condensate dripping directly inside the pipe. Several rusty metal steam pipes with dripping condensate were located directly next to the stored thermometer. The investigator observed dripping condensate come into direct contact with the thermometer.
    d. The firm does not have a bathroom inside their facility. Employees must access the adjacent firm to use a bathroom. On July 26, 2023, this bathroom was noted with cobwebs, black dirt and the toilet fixtures and wash sinks were soiled and not clean. The floor of the bathroom had clutter and black dirt. The entrance to the bathroom was cluttered with old equipment, trash, and debris on the floor.

3. The firm did not take effective measures to exclude pests from the manufacturing, processing, packing, and holding areas to protect against the contamination of food on the premises by pests, as required. Specifically,
    a. On July 18, 2023, multiple flying insects were observed by the manufacturing, packaging, and holding areas.
    b. On July 26, 2023, (redacted by the FDA) bushels of apples with a total weight of (redacted by the FDA) pounds were stored on the production floor in a broken walk-in cooler where they package products. The apples were in various stages of quality including many that were bruised and rotting. Fruit flies and other flying insects were noted in the immediate area.

4. The firm did not clean non-food-contact surfaces of equipment in a manner and as frequently as necessary to protect against allergen cross-contact and against contamination of food, food-contact surfaces, and food-packaging materials, as required. Specifically,
    a. On July 18, 2023, during the packaging/capping of marinara sauce, metal caps that were being used to cap the jars were observed to be stored exposed, in an open soiled white container.
    b. On July 26, 2023, the firm and another employee were observed using a (redacted by the FDA) to (redacted by the FDA) the floor and the side surface of the kettle where the clam chowder batch (redacted by the FDA) was being actively cooked with the cover of that kettle in the partial upright position, exposing the clam chowder to aerosols from (redacted by the FDA). Overspray and mist from the (redacted by the FDA) was observed contacting the surface of the lid to the kettle.

5. The firm did not conduct all food manufacturing, processing, packing, and holding under such conditions and controls as are necessary to minimize the potential for the growth of microorganisms and contamination of food, as required by 21 CFR 117.80(c)(2). Specifically,
    a. On July 18, 2023, multiple (redacted by the FDA) sealed bags of acidified marinara sauce Lot (redacted by the FDA) were observed being (redacted by the FDA) in (redacted by the FDA) of untreated water which was recovered water from their ice machine drainpipe. This process is used for all their (redacted by the FDA)-sealed bagged products including the refrigerated RTE, Reduced Oxygen Packaged, (redacted by the FDA) Treated Not Shelf Stable Clam Chowder. These processes can lead to the product becoming contaminated as the bags being (redacted by the FDA) in the untreated (redacted by the FDA) water may have faulty seals allowing the (redacted by the FDA) water from the ice machine to enter the bags.
    b. On July 18, 2023, during the packaging of the jarred marinara sauce, the product transfer hose that was transferring the marinara sauce from the cooking kettle to the hot fill kettle was observed in direct contact with the floor.

6. The firm did not maintain the grounds around their plant in a condition adequate to protect against the contamination of food by properly storing equipment and removing litter and waste that may constitute an attractant, breeding place, or harborage for pests, as required. Specifically, outside of the facility, the FDA investigator observed overflowing dumpsters, an old camper with broken windows and broken open door, and other discarded equipment providing harborages for rodents, birds, and pests.

The full warning letter can be viewed here.

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Singapore held the fifth meeting of an international food safety network this past week.

The annual meeting of the International Heads of Food Agencies Forum (IHFAF) took place from April 16 to 20, under the theme “Food Safety for a Resilient and Sustainable World”.

Heads of food agencies from 17 countries and 22 organizations, including the World Health Organization (WHO), The U.N.’s Food and Agriculture Organization (FAO), and the Codex Alimentarius Commission, attended the event.

National perspectives
Dr. Hisham bin Saad Aljadhey, CEO of the Saudi Food and Drug Authority (SFDA), headed the agency’s delegation. Aljadhey chaired two sessions on the safety assessment, regulatory frameworks, and risk communication for novel foods.

Other sessions covered topics such as climate resilience and safe food, sustainability and food safety, as well as discussing the activities of IHFAF.

SFDA officials held meetings with the Chilean Food Safety and Quality Agency (ACHIPIA), the New Zealand Ministry for Primary Industries (MPI), and the German Federal Institute for Risk Assessment (BfR).

Posting on social media, Sandra Cuthbert, Food Standards Australia New Zealand (FSANZ) CEO, said food systems are interconnected and working together was important.

“Sharing information between agency heads across the globe helps us all, and I am grateful for the strong collaboration and openness of everyone who joined. With thanks to the Singapore Food Agency for hosting this years’ forum. I’m already looking forward to seeing everyone again next year in Chile,” she said.

Gail Carroll, director of regulatory affairs and compliance, and Wayne Anderson, director of food science and standards, represented the Food Safety Authority of Ireland (FSAI) at the forum, which was held in Ireland in 2023.

FSAI said IHFAF has been crucial in building its global network, learning from other countries, and sharing expertise and experience in ensuring swift and effective response to any potential emerging risks and threats to the food chain. 

BfR and SFA to cooperate
The Singapore Food Agency (SFA) and the German Federal Institute for Risk Assessment (BfR) signed a Joint Declaration of Intent (JDI) at the event to cooperate on emerging developments in food safety, research, and risk assessments.

“The topic of food safety is constantly growing and evolving. For us, this means that our research must also continuously expand and improve,” said Tanja Schwerdtle, vice president of the BfR.

Schwerdtle traveled to Singapore as part of the IHFAF meeting to sign the document with Tan Lee Kim, SFA’s director-general and deputy CEO.

“We are optimistic that this collaboration can help to strengthen food safety science and risk assessment in both countries,” said Tan Lee Kim.

A multi-year work plan was defined, which covers cooperation in various subject areas to close research and data gaps as well as exchanging knowledge.

BfR and SFA scientists also discussed the safety of alternative proteins, emerging environmental contaminants affecting the food supply, food contact materials, and genetically modified food.

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The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert for ground beef products from Greater Omaha Packing Co. Inc. that may be contaminated with E. coli O157:H7.

FSIS is issuing this public health alert to ensure that consumers are aware that these products should not be consumed. 

A recall was not requested because the products are no longer available for purchase.

The raw ground beef items were produced on March 28, 2024. The products have a “Use/Freeze by” date of April 22, 2024, and packaging date of “032824.” The list of products that are subject to the public health alert can be found here.

The products subject to the public health alert bear establishment number “EST. 960A” inside the USDA mark of inspection. These items were shipped to food service institutions and retail locations nationwide.                           

The problem was discovered by the establishment while conducting an inventory of product that was on hold because it was found positive for E. coli O157:H7. The company notified FSIS that they inadvertently used a portion of the contaminated beef to produce ground beef products that they subsequently shipped into commerce.

There have been no confirmed reports of illness due to consumption of these products. 

FSIS is concerned that some product may be in consumers’ and food service institutions’ freezers. Consumers who have purchased these products are urged not to consume them and food service institutions are urged not to serve these products. These products should be thrown away or returned to the place of purchase.

FSIS advises all consumers to safely prepare their raw meat products, including fresh and frozen, and only consume ground beef that has been cooked to a temperature of 160 F. The only way to confirm that ground beef is cooked to a temperature high enough to kill harmful bacteria is to use a food thermometer that measures internal temperature, https://www.fsis.usda.gov/safetempchart.

Consumers with questions about the public health alert can contact Gina Adami, Greater Omaha Packing Co. Inc. Representative, at 402-575-4702 or gadami@gmail.com.

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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Consumers these days are being warned about the health hazards of highly processed foods. The message is that the health-conscious consumer should buy more whole foods and process them minimally. However, not all whole foods are safe, either, and some should come with a warning label. 

One of the most common problems caused by some fresh, natural foods are skin issues. Dermatitis can result from sensitivity and allergy to any food, or it can result from a food containing a chemical that makes your skin more sensitive to the sun.

Citrus fruits are notorious for causing dermatitis when exposing skin to fruit juice and peel. This includes oranges, lemons, grapefruit, and especially limes and bergamot. In fact, there is a disease called Lime Disease, (which is not the same as Lyme disease), which is caused by the blistering effect of lime juice on the skin when exposing the skin to the sun. It’s also called Margarita Disease, named after the drink that includes lime.

If you don’t want your skin to peel, then you don’t want to peel the skin of a citrus fruit when you are in the sun. 

What does sunshine have to do with it? 
The sun emits powerful ultraviolet light, which causes chemical reactions to occur. Ultraviolet light is a small part of the light spectrum coming from the sun, but when these wavelengths of light hit certain chemicals, the light energy is absorbed and a chemical bond is broken. This starts a cascade of reactions among unstable chemicals, ultimately result in skin damage. 

This is why you don’t want to leave out in the sun any fabric or plastic or other materials that can decompose under UV radiation. UV breaks down materials. This is also why you don’t want your skin to have too much sun. 

Keep in mind that all terrestrial life on Earth has evolved to live with solar radiation, and can heal from the damaging effects of UV.  In fact, plants and animals have evolved to use UV light for many necessary functions. In humans, for example, we need UV irradiating our skin to make Vitamin D. 

It is as though sunshine is an essential nutrient. But like all nutrients, there can be too much of a good thing.  

Plants, of course, have lots of chemicals, called phytochemicals, with the prefix phyto- meaning plant. Some of these phytochemicals are beneficial, such as vitamins, and are extracted from plants for their uses in medicine, perfumes, foods, cosmetics, and other products. But some of these plant chemicals are toxic, and these toxic chemicals can be in the same plant as the beneficial chemicals. 

In this case, the dangerous chemical is a furanocoumarin, which is a class of chemical compounds that are activated by UV light. Psoralen is the parent of this class of chemicals. 

Psoralen makes sunburn much more severe. If psoralen is on, or in, the skin, UV light from the sun activates the psoralen, making it highly reactive. This causes the psoralen molecule to bond with DNA in skin cells, which causes these cells to die. Symptoms of psoralen burning the skin include redness of the skin, edema, and blisters. 

UV rays can penetrate deep into the epidermis, into the dermis, so any psoralen on the skin, or in the skin, can be activated by the sun to make blister-forming eruptions. For some people, this also causes the skin to change color when healing, and can cause allergic or hypersensitivity reactions in other parts of the body with repeated exposure. 

The medical term for this problem is phytophotodermatitis, a word that literally means plant-sun-skin inflammation. It is not an allergic condition, since it does not require prior exposure. The blistering develops after about 24 hours of exposure, and peaks at 48-72 hours. It can take weeks to heal.

Skin reactions like this are a problem in farmers, grocers, and people who work with psoralen-containing foods. Of course, homemakers who cook for their families handle these daily. 

Unfortunately, lots of common, otherwise healthy foods have psoralen. This includes parsley, parsnips, carrots, and celery. Figs are also a problem, which can even cause skin blistering from simply touching the leaves or sap. Cloves are also high in psoralen. And all citrus fruit is high in psoralen, especially limes and bergamot. Bergamot oil is added to lots of drinks and other foods for flavoring, making these other foods also high in psoralen.

To give you an idea of what psoralen can do, consider its use in medicine to treat psoriasis eczema, and some other skin lesions, in a process called PUVA. This type of therapy is called photochemotherapy. Patients are given a psoralen drug, called methoxsalen, which within a short time is circulated throughout the body and into the skin. This gets the skin highly sensitive to UV rays, especially UVA, which is one of the UV wavelengths that goes deeply into the skin when you are in the sun. The patient is irradiated for up to 10 minutes over a series of treatments, essentially burning away the bad skin.

PUVA has been used for decades, and herbal remedies for skin ailments have included psoralen-containing plants being applied to the skin. However, there are side effects of this therapy. 

According to WebMD, “Psoralens can make your skin more sensitive to sunlight. They can raise your risk of sunburn, cataracts, and skin cancer. And your skin might age faster…Don’t eat limes, carrots, celery, figs, parsley, or parsnips while you take oral psoralens. It could boost the amount of natural psoralen in your system and make your skin even more sensitive to the sun.”

This means you are at risk of photosensitivity from eating foods containing psoralen, or applying those foods to your skin. This can lead to burns, skin cancer, and eye damage. 

Unfortunately, avoiding these foods will not make you safe from photosensitizers that you are consuming in medications. Some medications can directly be activated by UV to attack your skin when in the sun, as with psoralen. But other medications can cause damage to the skin by impairing the healing process. 

According to the North Carolina Department of Health and Human Services, “Certain food/drugs do not mix with ultraviolet light. Anyone taking any medication should consult with a physician PRIOR to tanning. Note: This is not a complete list of drugs or foods.” It then lists a frightening amount of drugs, including the most commonly used, which all make people more sensitive to sunlight and causing burns. 

This long list includes: 

Antihistamines

Anticonvulsants

Antifungals

Anti-inflammatory

drugs (Ibuprofen, Ketoprofen, Naproxen, etc.)

Antiseptics

Anitbiotics

Anticholesterol Medications

Antidepressants

Antipsychotic Medications

Artificial Sweeteners

Blood Pressure Medications

Coal Tar Productions (Tegrin, Denorex)

Oral Contraceptives & estrogen

Major Tranquilizers

Oral Diabetes meds

Sulphur based meds

Diuretics (fluid Pills)

Some Antimalarials –

Fansidar (a sulfa drug)

Chloroquine

Some deodorants

(perfumes colognes)

Cosmetics

Some herbal Products

Some Sunscreens

Tattoos

And the list goes on…

It also includes some foods:

Carrots

Celery

Citrus Fruits

Clover

Coumarin

Dill

Eggs

Figs

Garlic

Ginko Biloba

Grass (wheat, barley)

Lady’s Thumb (tea)

Lime oil

Mustards

Onions

Parsley

Parsnips (vegetables)

Saint John’s Wort

Smartweed (tea)

Vanilla oil

It is interesting that skin cancer is the leading type of cancer, and so many of these chemicals affect the skin and can cause cancer when in the sun. It’s not just the sun that harms the skin; it’s medications people take that increase the harm to the skin from the sun. 

Medications causing photosensitivity may be a reason why the medical industry has been encouraging people to wear sunscreen when in the sun, to minimize UV exposure. However, the sunscreen must be able to block UVA, which many do not unless they say “full spectrum”. However, even sunscreen lotions contain skin sensitizers, as the list above mentions. Ironically, this means sunscreen can possibly cause sunburns and skin cancer. 

According to a recent academic review, Drug‐induced photosensitivity: culprit drugs, potential mechanisms and clinical consequences:

“Drug‐induced photosensitivity, the development of phototoxic or photoallergic reactions due to pharmaceuticals and subsequent exposure to ultraviolet or visible light, is an adverse effect of growing interest. This is illustrated by the broad spectrum of recent investigations on the topic, ranging from molecular mechanisms and culprit drugs through epidemiological as well as public health related issues to long‐term photoaging and potential photocarcinogenic consequences…In total, 393 different drugs or drug compounds are reported to have a photosensitizing potential, although the level of evidence regarding their ability to induce photosensitive reactions varies markedly among these agents. The pharmaceuticals of interest belong to a wide variety of drug classes. The epidemiological risk associated with the use of photosensitizers is difficult to assess due to under‐reporting and geographical differences. However, the widespread use of photosensitizing drugs combined with the potential photocarcinogenic effects reported for several agents has major implications for health and safety and suggests a need for further research on the long‐term effects.”

These drugs and foods are common. If you are taking NSAIDS, such as aspirin, ibuprofen, or naproxen, you can more easily burn in the sun. The same goes for taking antibiotics, or antihistamines, or high blood pressure medication. Add to that having citrus or figs or a healthy salad or juice made of celery, parsley, and carrots, and you will be even more sensitive to the sun. Peel an orange at the beach or in the sunny park, and let the sunshine activate all the psoralen, and get ready for a few days of burned, blistered, red, hot, and damaged skin. 

This may also be why tanning is such a significant cause of skin cancer. The UV from these tanning treatments will be more damaging if you are priming your skin with psoralen from your diet or medications.  

If you want to keep the sunshine in your life, but want to minimize the risk of phytophotodermatitis from food, and chemophotodermatitis from medication, keep in mind the following:

1. Limit sun exposure to avoid peak sun intensity from 10 a.m. to 2 p.m. But don’t avoid the sun altogether. A little sun is necessary for health, including mental health. (Season Affect Disorder is from lack of sun.)

2. Wear loose-fitting, natural-fiber clothing when you want to block the sun from your skin. 

3. If you use sunscreen, make sure all the ingredients are safe. Look each ingredient up to see if it increases photosensitivity. Amazingly, many sunscreens contain chemicals that make your skin sensitive to the sun. 

4. Keep in mind that all chemicals on your skin will be irradiated with UV from the sun. This includes all lotions, creams, perfumes, and cleansers. Nobody is studying the many UV by-products from solar radiation of these chemicals, which then can get absorbed into your skin. 

5. When going out in the sun, remember the photosensitizing medications you are taking, and take precautions. 

6. Avoid foods that contain psoralen if you have any skin issues. 

7. Be cautious of foods that contain “natural flavors” or other unnamed natural ingredient, which could contain bergamot oil, or some other photosensitizing agent. 

8. Avoid tanning in a salon if you are on medications or eat foods that contain psoralen. 

9. Wash your hands well with soap and warm, not hot, water after handling any foods that contain psoralen. 

10. When preparing a picnic for a nice, sunny day at the park or beach, avoid UV-activated foods. 

11. Avoid tight clothing. This interferes with lymphatic circulation in the skin, which is essential for healing. After time in the sun, make sure your skin has proper circulation to allow the drainage of toxic, UV-irradiation chemical products. 

12. Keep in mind that, while the first skin contact exposure to psoralen and UV may result in blistering without an immune response, further exposure to these substances after that initial response may result in allergic reactions when taking that substance internally. This means the orange that you peeled at the beach in the sun which gave you blisters may now be giving you a rash when you eat citrus foods. The immune system learns to attack foods that cause dermatitis, and can generalize the attack, resulting in allergies to related foods. 

13. The phytophotodermatitis effect is directly related to sun exposure time and intensity, and photochemical concentration. The longer you are in the sun and the more intense the rays, the worse the skin burn. And the more foods you eat that contain psoralen, the worse the burn. 

14. If you develop a skin problem within 48 hours of tanning or of being in the sun, then look for causes in your diet or medications. 

15. Finally, discuss the need to avoid the sun with your healthcare provider. You may need Vitamin D supplementation. Or you may be able to use a different medication or treatment that doesn’t have to take the sunshine out of your life.  

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Botulism—A Rare, But Deadly Disease

Botulism is a rare, life-threatening paralytic illness caused by neurotoxins produced by an anaerobic, gram-positive, spore-forming bacterium, Clostridium botulinum.[1] Unlike Clostridium perfringens, which requires the ingestion of large numbers of viable cells to cause symptoms, the symptoms of botulism are caused by the ingestion of highly toxic, soluble exotoxins produced by C. botulinum while growing in foods.[2] These rod-shaped bacteria grow best under anaerobic (or, low oxygen), low-salt, and low-acid conditions.[3] Bacterial growth is inhibited by refrigeration below 4° C., heating above 121° C, and high water-activity or acidity.[4] And although the toxin is destroyed by heating to 85° C. for at least five minutes, the spores formed by the bacteria are not inactivated unless the food is heated under high pressure to 121° C. for at least twenty minutes.[5] C. botulinum bacteria and spores are widely distributed in nature, because they are indigenous to soils and waters.[6] They occur in both cultivated and forest soils, bottom sediment of streams, lakes, and coastal waters, in the intestinal tracts of fish and mammals, and in the gills and viscera of crabs and other shellfish.[7]

The incidence of foodborne botulism is extremely low.[8] Nonetheless, the extreme danger posed by the bacteria has required that “intensive surveillance is maintained for botulism cases in the United States, and every case is treated as a public health emergency.”[9] This danger includes a mortality rate of up to 65% when victims are not treated immediately and properly.[10] Most of the botulism events[11] that are reported annually in the United States are associated with home-canned foods that have not been safely processed.[12] Occasionally, though, commercially-processed foods are implicated as the source of a botulism events, including sausages, beef stew, canned vegetables, and seafood products.[13]

Symptoms of Botulism

After their ingestion, botulinum neurotoxins are absorbed primarily in the duodenum and jejunum, pass into the bloodstream, and travel to synapses in the nervous system.[14] There, the neurotoxins cause flaccid paralysis by preventing the release of acetylcholine, a neurotransmitter, at neuromuscular junctions, thereby preventing motor-fiber stimulation.[15]The flaccid paralysis progresses symmetrically downward, usually beginning with the eyes and face before moving to the throat, chest, and extremities.[16] When the diaphragm and chest muscles become fully involved, respiration is inhibited and, unless the patient is ventilated, death from asphyxia results.[17]

Classic symptoms of botulism include nausea, vomiting, fatigue, dizziness, double vision, drooping eyelids, slurred speech, difficulty swallowing, dryness of skin, mouth, and throat, lack of fever, muscle weakness, and paralysis.[18] Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.[19] Throughout all such symptoms, the victims are fully alert and the results of sensory examination are normal.[20]

In foodborne botulism cases, symptoms usually begin anywhere between 12 and 72 hours after the ingestion of toxin-containing food.[21] Longer incubation periods—up to 10 days—are not unknown, however. The duration of the illness is from 1 to 10 (or more) days, depending on host-resistance, the amount of toxin ingested, and other factors.[22] Full recovery often takes from weeks to months.[23] And, as earlier indicated, mortality rate can be from 30% to 65%, with rates generally lower in European countries than in the United States.[24]

Detection and Treatment of Botulism

Although botulism can be diagnosed based on clinical symptoms, its differentiation from other diseases is often difficult—especially in the absence of other known persons affected by the condition.[25] Once suspected, the most direct and effective way to confirm the diagnosis of botulism in the laboratory is testing for the presence of the botulinum toxin in the serum, stool, or gastric secretions of the patient.[26] The food consumed by the patient can also be tested for the presence of toxins.[27] Currently, the most sensitive and widely used method for the detection of the toxins is the mouse neutralization test, which involves injecting serum into mice and looking for signs of botulism.[28] This test typically takes 48 hours, while the direct culturing of specimens takes 5-7 days.[29] Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.[30]

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood.[31] This can prevent patients from worsening, but recovery still takes many weeks.[32] The mainstay of therapy is supportive treatment in intensive care, and mechanical ventilation in case of respiratory failure, which is common.[33]

Long-Term and Permanent Injury

Although a minority of botulism patients eventually recover their pre-infection health, the majority do not. For those who fully recover, the greatest improvement in muscle strength occurs in the first three months after the acute phase of illness.[34] The outside limit for such improvement appears, however, to be one year.[35] Consequently, physical limitations that still exist beyond the one-year mark are more probably than not permanent. Recovery from acute botulism symptoms may also be followed by persistent psychological dysfunction that may require intervention.[36]

According to a recently-published study that tracked the long-term outcomes of 217 cases of botulism, a large majority of patients reported “significant health, functional, and psychosocial limitations that are likely the consequences of the illness.”[37] These limitations included: fatigue, weakness, dizziness, dry mouth, and difficulty lifting things. The victims also reported difficulty breathing caused by moderate exertions, such as walking or lifting heavy items. They were also more likely to have limitations in vigorous activities, like running or playing sports, climbing up three flights of stairs, or carrying groceries. Summarizing its finding, the study concluded that:

Even several years after acute illness, patients who had botulism were more likely than control subjects to experience fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and difficulty breathing caused by moderate exertion….In addition, patients…reported worse overall psycho-social status than did control subjects, with patients being significantly less likely to report feeling happy, calm and peaceful, or full of pep.[38]

There is, as a result, no question that the damaging effects of botulism are life-long.

References

[1] See J. Sobel, et al., Foodborne Botulism in the United States, 1990-2000, Emerging Infectious Diseases, Vol. 10, No. 9, at 1606 (Sept. 2004).

[2] James M. Jay, MODERN FOOD MICROBIOLOGY, 466 (6th Ed. 2000)

[3] Id. at 469-71; see also Sobel, supra note 2, at 1606.

[4] Sobel, supra note 2, at 1606.

[5] Id.

[6] Jay, supra note 3, at 467-69. See also, generally H. Houschild, Clostridium Botulinum, in FOODBORNE BACTERIAL PATHOGENS, at 112-89 (M. Doyle Ed. 1989)

[7] Jay, supra note 3, at 467-69.

[8] Sobel, supra note 2, at 1607-09; Jay, supra note 3, at 472-76.

[9] Sobel, supra note 2, at 1606-07 (also noting that the CDC maintains a 24-hour clinical consultation and emergency antitoxin release service).

[10] Jay, supra note 3, at 474.

[11] With botulism, the broader term “event” is used to encompass both outbreaks—i.e., two or more cases of botulism caused by a common-source, as well as individual (or sporadic) cases.

[12] Sobel, supra note 2, at 1610; Jay, supra note 3, at 474.

[13] Id.

[14] Thomas P. Bleck, Clostridium botulinum (Botulism), in MANDELL, DOUGLAS AND BENNETT’S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASE 2543, 2544 (5th ed. 2000).

[15] Id.; Sobel, supra note 2, at 1606.

[16] Bleck, supra note 15, at 2545; see also BOTULISM FACT SHEET, National Agricultural Bio-Security Center, Kansas State University, online at http://nabc.ksu.edu/content/factsheets/category/Botulism#f26

[17] Bleck, supra note 15, at 2545; Sobel, supra note 2, at 1606.

[18] Sobel, supra note 2, at 1606; Jay, supra note 3, at 474.

[19] Jay, supra note 3, at 476-77.

[20] Sobel, supra note 2, at 1606.

[21] Jay, supra note 3, at 474.

[22] Id.

[23] R. Shapiro, et al., Botulism in the United States: A Clinical and Epidemiologic Review, Ann. Intern. Med. 1998; 129:221-28.

[24] Jay, supra note 3, at 474.

[25] Bleck, supra note 15, at 2546 (noting that “botulism has a limited differential diagnosis”).

[26] Sobel, supra note 2, at 1607; see also FDA/CFSAN Bad Bug Book, Clostridium Botulinum, available at http://vm.cfsan.fda.gov/~mow/chap2.html

[27] Id.

[28] Bleck, supra note 15, at 2546. See also, e.g. MMWWR, supra note 1, at 2 (“CDC detected botulinum toxin Type A by mouse bioassay in the man’s serum sample”).

[29] Bad Bug Book, supra note at 25.

[30] Sobel, supra note 2, at 1606; Shapiro, supra note 23, at 223.

[31] Jay, supra note 3, at 474; Sobel, supra note 2, at 1606.

[32] Id.; Bleck, supra note 15, at 2546-67.

[33] Sobel, supra note 2, at 1606.

[34] Bleck, supra note 15, at 2547. See also P. Wilcox, et al., Recovery of Ventilatory and Upper Airway Muscles and Exercise Performance After Type-A Botulism, Chest, 98:620-26 (1990); J. Mann, et al., Patient Recovery From Type-A Botulism: Morbidity Assessment Following a Large Outbreak, Am. J. Public Health, 71 (3):266-69 (Mar. 1981).

[35] Id.

[36] Bleck, supra note 15, at 2547. See also F. Cohen, et al., Physical and Psychosocial Health Status 3 Years After Catastrophic Illness—Botulism, Issues Mental Health Nurs., 9:387098 (1988)

[37] S. Gottlieb, et al., Long-Term Outcomes of 217 Botulism Cases in the Republic of Georgia, Clin. Infectious Disease, 45: 174-80, at 180 (220&).

[38] Id. at 179.

The number of Salmonella cases in England has returned to pre-COVID-19 pandemic levels and 11 outbreaks were reported in 2022.

Salmonella Enteritidis went back to being the most frequently reported serovar and Salmonella Typhimurium infections also increased, said the UK Health Security Agency (UKHSA).

In 2022, there were 8,125 Salmonella cases in England, compared to 5,033 in 2021, 4,712 in 2020 and 8,398 in 2019.

Salmonella Enteritidis reports jumped from 747 in 2021 to 2,044 in 2022. Salmonella Typhimurium infections rose from 1,219 in 2021 to 1,731 in 2022. Salmonella Infantis was in third place with 310 reports, followed by Salmonella Newport, Mbandaka, Agona, and Virchow.

Data comes from the Second Generation Surveillance System (SGSS) and the Gastrointestinal Infections and Food Safety (One Health) (GIFSOH) division’s eFOSS (electronic foodborne and non-foodborne outbreak surveillance system).

The age group with the most laboratory reports was children younger than the age of 10. This category, accounted for 26 percent of lab reports. Patients were split equally between males and females.

London had the highest number of Salmonella lab reports with 1,631 and was the region with the highest rate with 18.4 reports per 100,000 population. The North East had the lowest number of Salmonella reports with 408 but the East Midlands had the lowest reporting rate at 11.5 per 100,000 population.

In 2022 across 30 countries in Europe and the European Economic Area (EEA), more than 66,700 Salmonella cases were recorded with 81 deaths. France, Germany and Spain reported more cases than England.

Outbreak details
Eleven outbreaks were recorded in England in 2022 with 591 patients and four were caused by Salmonella Typhimurium.

The largest affected 133 people in England with 26 hospitalized. This was caused by contaminated Ferrero Kinder chocolate. Another outbreak with 91 cases was linked to meat products. A ready meal contaminated with Salmonella Typhimurium sickened 24 people with two deaths. Five people fell ill after drinking raw milk at a farm.

Two Salmonella Infantis outbreaks were linked to chicken. The first affected 50 people and the second had 58 cases.

One person died and 10 were hospitalized in a Salmonella Mbandaka outbreak with 112 cases caused by chicken.

A Salmonella Gueuletapee outbreak with 47 patients was linked to kebab meat and a Salmonella Agona outbreak with 16 patients was caused by cucumbers.

Fresh coriander served at a restaurant sickened 33 people with four hospitalized because of Salmonella Java. The source of another Salmonella outbreak that affected 22 people was not found.

Some of these outbreaks also involved other countries. The Salmonella Typhimurium chocolate outbreak had 455 lab confirmed cases in 17 countries.

As of March 2024, the Salmonella Mbandaka outbreak had sickened at least 300 people in seven countries, including 173 in the UK. The outbreak strain was found in frozen chicken breast fillets produced in Ukraine.

The Salmonella Agona incident affected more than 100 people in three European countries. Cucumbers from Spain were the suspected source.

The UK was also involved in a Salmonella Virchow outbreak caused by chicken kebab meat and a Salmonella Senftenberg outbreak linked to cherry-like tomatoes.

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The FDA has asked Sammy’s Milk of Newport Beach, CA, to provide a warning against the use of its toddler formula as an infant formula.

The agency is concerned that the formula may not meet requirements for infant formula and may be unsafe and not provide sufficient nutrition when used as an infant formula.

The FDA’s concerns were provided to Sammy’s Milk in a meeting with agency officials this week that identified representations on the Sammy’s Milk website and social media platforms that could be interpreted to indicate the product is safe for infants to consume.

The company says its product is specifically formulated for children between the ages of 12 and 36 months, as clearly indicated on its packaging and website. The product at issue was only available online, and included lot code SD348, with a “Best by” date of August of 2025.

“It is crucial that users adhere to the recommended age range for the consumption of our product. Sammy’s Milk does not recommend the use of Goat Milk Toddler Formula for infants under 12 months of age. If you are feeding our product to an infant, we recommend that you stop doing so because the FDA has concerns that Goat Milk Toddler Formula does not meet all FDA requirements for infant formula and may be unsafe and not provide sufficient nutrition when used as an infant formula,” the company said in a statement posted by the FDA.

“For further inquiries or clarification regarding the appropriate use of Sammy’s Milk Goat Milk Toddler Formula, please contact our customer service team at info@sammysmilk.com.”

In 2016 the company recalled all lots of Sammy’s Milk Baby Food because of the possible presence of Cronobacter, a bacteria that can cause severe and sometimes fatal blood infections or meningitis in infants.

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Another brand of fresh, organic basil has been linked to an outbreak of Salmonella infections.

Melissa’s-brand organic basil sold in 2-ounce and 4-ounce packages at Dierberg’s stores in Illinois and Missouri between Feb. 10 through Feb. 20, has been added to a recall by Infinite Herbs, LLC, of Miami, FL.

The company already recalled Infinite Herbs-brand fresh organic basil sold at Trader Joe’s stores and Fruit Center Marketplace from Feb. 1 through April 6 in relation to the outbreak, which has sickened 12 people with one requiring hospitalization.

Although the basil is no longer for sale, the Centers for Disease Control and Prevention is asking people to watch for symptoms of Salmonella infection after eating fresh basil and seek medical treatment. Doctors should report such infections to public health officials to aid with the outbreak investigation.

“If you previously purchased recalled basil and then froze it, you should throw it away if it’s part of the recall or if you cannot tell if it’s part of the recall,” the Food and Drug Administration said in an outbreak update today.

The Infinite Herbs brand fresh basil was sold in Trader Joe’s stores in Alabama, Connecticut, Washington D.C., Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Maine, Michigan, Minnesota, Missouri, North Carolina, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Vermont and Wisconsin.

The outbreak investigation is ongoing to determine the source of contamination and whether additional products are linked to illnesses. 

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has eaten any fresh organic basil and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop severe illness and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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