Florida Association for Food Protection The Impact of the 2018 Romaine Lettuce Outbreaks Past, Present and Future Florida Association for Food Protection February 12, 2019 Will come from VP of CS Food Safety (Jill) Jill Hollingsworth, DVM VP, Food Safety & Regulatory Affairs Chemstar/Sterilox

Today’s Discussion Past – 2018 Spring & Fall Romaine Lettuce Outbreaks Present – What We Know & What’s Happening Now Future – Opportunities for Retailers

Spring 2018 E. coli O157:H7 Infections Linked to Romaine Lettuce https://www.cdc.gov/ecoli/2018/o157h7-04-18/epi.html

Fall 2018 E. coli O157:H7 Infections Linked to Romaine Lettuce https://www.cdc.gov/ecoli/2018/o157h7-04-18/epi.html

Outbreak Comparisons Spring: March 14 – June 28, 2018 Yuma Valley Region Over 200 illnesses, 5 deaths, and 95 hospitalizations Suspected water source Three samples of irrigation canal water tested positive E. coli O157:H7 strain unrelated to the Fall outbreak Fall: October 9, 2018 – January 7, 2019 Three counties in central coastal region of California 62 illnesses; 25 hospitalizations Suspected water source One positive sample from sediment of an agricultural water reservoir on one farm Outbreak strain matches previous outbreaks from 2017 and 2016

Lettuce Fields and Irrigation Supply

The Past – Fall 2018 Romaine Outbreak November 20 CDC and FDA issue nationwide advisories announcing E.coli O157:H7 outbreak linked to romaine lettuce Retailers and restaurants should not sell or serve [any] romaine lettuce November 23-25 Six produce companies negotiate new voluntary labeling program with FDA (location & date) November 26 Traceback to Central Coast growing regions of northern and central California FDA announced voluntary labeling recommendations for romaine lettuce Voluntary program – PURPOSE: to reintroduce romaine into the market

Concerns Raised by Retailers No recall (and no withdrawal) No retail input on labeling agreement between FDA and produce industry Responsibility for labeling included retail signage, verification Retailers responsible for explaining labels and FDA/suppliers actions Labeling for re-introduction of “safe” (not recalled) product Does voluntary = mandatory (“new norm”)

Present Consumers want safe food Retailers only want to sell/serve safe food Labeling the source of product does not make food safer Consumers cannot be expected to buy produce based on signage/labels declaring where and when it was grown/harvested Is there a better way to conduct investigations and traceback?

Present Labeling Issues Posting growing/harvest region signs at retail is not sustainable Constantly changing/multiple growing regions confusing to consumers If all romaine is to labeled with a harvest region, then the suppliers need to put this information on every package, head etc. and not just on cartons Restocking a previously recalled product at retail should not necessitate consumer notification --- retailers only restock with non- recalled, or non-implicated products.

Is Produce Safer Now? Produce Safety Rule (FSMA) implemented; no water standard Agricultural water is the focus of investigations Product is being exposed to contamination on the farm Same growing regions and water are in use

Joint Romaine Task Force Science and Prevention Agriculture water Growing environment Auditing depth Root cause analysis Traceability PTI Provenance Labeling All leafy greens Outbreak Investigation Alerts and Advisories Recalls Organized by United Fresh & PMA FDA CDC Retailers Suppliers Academia

Future - What Should Retailers Expect Traceability Produce Traceability Initiative (PTI) Supply chain-wide adoption of electronic traceability Labeling and record-keeping Consumer purchase information Supplier Agreements Recalls Advisories, Safety Alerts, Notices and Consumer Warnings Retail Best Practices for Leafy Greens Conference for Food Protection (CFP) Committee

CFP Produce Washing and Crisping Committee Charges: Develop a Produce Washing and Crisping Guidance for Retail Food Establishments which includes the following: Detail the handling, cleaning, and sanitation practices related to the washing and crisping of produce. Describe the criteria for produce crisping vs. produce washing. Clarify the types of chemicals and their use for washing and crisping.

Washing and Crisping Produce at Retail Different methods – no single procedure or protocol is being used Pre-requisites are already in the Food Code Supplier – approved source/specifications Employee Health and Hygiene Cleaning and sanitizing Risks include cross-contamination and infiltration Since there is no “kill” step, controlling pathogens in the water is the most effective preventive control Antimicrobial treatments are most efficacious at reducing/minimizing pathogens in the water Washing and Crisping Produce at Retail

“A Fresh Approach to Food Safety” Jill Hollingsworth, DVM 120 Interstate West Parkway Jillh@chemstarcorp.com Lithia Springs, GA 30122 +1 800-327-0777 | chemstarcorp.com

https://blogs. fda. gov/fdavoice/index https://blogs.fda.gov/fdavoice/index.php/2018/05/fda-update-on-traceback-related-to-the-e-coli-o157h7-outbreak-linked-to-romaine-lettuce/

Are there more foodborne illnesses or are we better at finding them Are there more foodborne illnesses or are we better at finding them? fiscal year 2018, In fiscal year 2018, there were a total of 1,935 FDA recalls (food & cosmetics) with 548 that were Class I. That figure represents a five-year low in recalls.

E. Coli 0157:H7 PFGE

Whole Genome Sequencing E. coli O157:H7 Whole Genome Sequencing