World Sneezes; U.S. Diners Get Sick

Madeline Drexler is a Boston-based journalist and author of "Secret Agents: The Menace of Emerging Infections."

If it's not the scallions, it's the raspberries, strawberries, cantaloupe, watermelon, alfalfa sprouts, lettuce, tomatoes, apple cider, orange juice, parsley, basil, cilantro or cole slaw. Or perhaps the hamburger, hot dogs, chicken, turkey, milk, eggnog, ice cream, cheese, oysters, clams, crab cakes, pastrami or macaroni salad.

So goes a very partial tasting menu of foods that have spawned epidemics over the last few years. Put another way, the recent outbreak of hepatitis A, in which fecally contaminated green onions chopped into salsa killed three and sickened more than 600 customers of a Pennsylvania Chi-Chi's restaurant, was just the latest chapter in an endless saga of food-borne infections.

This episode is also emblematic of how such epidemics have evolved in recent years. They're global: The offending scallions in Pennsylvania came from Mexico. They're diffuse: The same farm's widely distributed produce may have launched similar waves of disease in Georgia and Tennessee. They're insidious: Many victims didn't even realize they were infected, because of the monthlong incubation period of the virus. And they're a reminder that the United States desperately needs to fortify its border inspections, state health departments and assistance to nations that lack our public health resources.

We often hear that the U.S. has the world's safest food supply. Yet according to the federal Centers for Disease Control and Prevention, each year 76 million Americans -- nearly 1 in 4, and that's a low-ball estimate -- become infected by their food. Most find themselves dolefully memorizing a pattern of bathroom floor tiles. Two million suffer drawn-out, sometimes lifelong medical complications. About 325,000 land in the hospital. More than 5,000 -- an average of 14 a day -- die from eating contaminated food.

Lately, we've been seeing new patterns of "food poisoning," a now-quaint term from the early 20th century, when dramatic illness was usually traced to toxins that had grown on spoiled foods such as a badly sealed jar of preserves or chicken salad left out too long in the summer heat. When local health officials worked up these classic "point source outbreaks," they would find that a knot of victims had all eaten a single dish.

Today's epidemics are much more complex, because of profound shifts in what we eat, where our food comes from, how it's made and who makes it. Fifty years ago, grocery stores stocked about 200 items. Seventy percent of those were grown, produced or processed within a 100-mile radius of the store. Today, the average supermarket carries 50,000 food items or more. In the winter, as much as 75% of our fresh fruits and vegetables are harvested beyond U.S borders, where sanitary standards may be less stringent. More and more, an entree may be made with ingredients from a dozen far-flung locales.

As a result, in our miraculous food economy of scale, when things go wrong, they go wrong in a big way. One contaminated tidbit -- a shred of meat from an infected steer mixed with hundreds of other carcasses for hamburger, melting ice from a box of tainted lettuce dripping down on the rest of an outbound lot, a soiled production line of cereal shipped coast to coast under 30 different brand names -- can (and have) spread disease far and wide.

Which means that many modern outbreaks are not so much "point source" as pointillist. Mass-distributed items with spotty or low-level contamination are consumed by people living far from the source. Often, this leads to a new, diffuse kind of epidemic: one with low attack rates (less than 5% of those who eat the contaminated food) but large numbers of dispersed victims, with the hardest hit being the elderly and immune-compromised, who can least afford it. In 1994, for example, a single salmonella-contaminated batch of ice cream infected an estimated 224,000 people across 48 states.

So how can we make the world's safest food supply (a disputed claim) even safer? Some contend that the main responsibility for preventing food-borne illness rests on the individual. They say it's often carelessness close to home -- either in your kitchen or a restaurant's -- that inflicts the most damage. Admittedly, culinary negligence is rampant. The more we rely on packaged and microwaveable food, the faster we forget the temperature and hygiene precautions of 19th century home economics, and the more apt we are to mishandle raw ingredients. Moreover, changes in work and family life have led us to cook less and eat out more -- Americans spend more than half of their food dollar away from home -- exposing us to the ministrations of young, often-naive food handlers.

Yet, pristine food preparation techniques would not have averted the Chi-Chi's disaster. The hepatitis A virus in those scallions could not have been easily rinsed off or neutralized with chlorine; through prolonged soaking in contaminated ice, the virus had probably seeped deep inside the onions, just as disease-causing organisms have been found in the tissue of alfalfa sprouts, parsley and other perishables.

Much of today's raw produce is notoriously difficult to clean. Raspberries, for example -- another recent source of repeat outbreaks -- are deeply creviced and pitted, providing perfect hideaways for pathogens. Fresh fruits and vegetables, bursting with nutrition, are the fastest-growing source of food-borne epidemics precisely because they lack the most reliable kill step for viruses and bacteria: high-heat cooking.

Clearly, the solution goes beyond individual initiative. Critics of American food safety have called for a single independent government agency to replace the current patchwork of bureaucracies and fiefdoms -- the U.S. Department of Agriculture, the Food and Drug Administration, the CDC -- which are all understaffed and often operate at cross-purposes.

Short of that, the FDA's two new security-minded regulations, one requiring importers to specifically describe to the agency what food shipments will be arriving at U.S. ports, the other requiring registration of domestic and foreign food facilities, may also leave us feeling somewhat less queasy when they take effect Dec. 12.

Another part of keeping the domestic food supply safe would be to improve living and working conditions abroad. The epidemic in Pennsylvania could have been caused by anything from sewage-laden irrigation water to handling by a sick fieldworker who couldn't afford to take a day off without pay.

Note to Congress and the White House: Homeland security isn't just about terrorism. It's also about measures that protect us in our daily lives. What we call the world's safest food supply is actually the world's food supply. In an era of globalization, the tasting menu gets longer every day.

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