Chapter 15

If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 15
Community Food and Vector Control
Table of Contents

OBJECTIVES AND PHILOSOPHY
OVERVIEW

HEADLINES, TIMELINES, & MILESTONES
WEB PAGES AND INFORMATION SOURCES
REFERENCES - since publication of 8th edition

DEBATE TOPICS

STUDY QUESTIONS, ACTIVITIES, AND EXERCISES

OBJECTIVES AND PHILOSOPHY

Food has provided a prime vehicle for the transmission of diseases from the earliest history of the human species. The regulation of food sources, processing, manufacture, storage, transport, packaging, marketing, and handling represent fundamental responsibilities of community health agencies in cooperation with agricultural and other sectors. The rates of salmonellosis and some other enteric diseases transmitted by food have increased in North America while most other communicable diseases have declined. This suggests declining effectiveness of food protection and community control of its food supply. This chapter is designed to acquaint you with objectives, principles, and methods of food and vector control.

OVERVIEW

The chapter reviews some history and epidemiology specifically applicable to food-borne and vector-borne diseases. Some case studies are presented to give a more concrete understanding of how outbreaks can be studied to locate the source of infection. Vector control strategies are included in this chapter because most vectors of disease affect community health through food supplies, and the control of some other vectors depends on the hygienic management of food supplies, including animals, that provide reservoirs and intermediate hosts for some vectors.

HEADLINES, TIMELINES, & MILESTONES

Alarms Sound Over Biopharming. (The Atlanta Journal Constitution, November 17, 2003) - Modified cornhusks in a Nebraska grain elevator have tainted the crop in Nebraska. This has raised doubts about the government's ability to protect the nation's crop from genetically engineered crops to produce drugs and chemicals.

Standards Now Define Organic Food. (The Atlanta Journal Constitution, October 21, 2002) - National standards have been instituted to control how organic food is produced. The standards provide a clear definition of what organic means, which includes food cannot be grown with petroleum or sewage sludge-based fertilizers, synthetic pesticides, irradiation, bioengineered organism, growth hormones, or antibiotics.

Such a Deal: A Million Tons of Animal Parts, to Go. (The New York Times, November 26, 2000).

Study: Cleaning House Reduces Lead. CHICAGO (AP, Mar. 2, 1999) - Keeping a clean house can significantly reduce the amount of toxic lead that children absorb into their blood, according to a study published this month in Pediatrics. Researchers followed 99 urban children with high levels of lead in their blood for nine to 15 months after dividing their families into two groups. In one group, the children's caretakers received education and free housecleaning to reduce lead levels in their homes; in the other, caretakers received education only. The cleaning removed dust containing lead particles, presumably from peeling paint, which was found in most of the children's homes. By the end of the study, lead levels among the 46 children whose homes had been cleaned fell an average of 17%. Children whose homes had been cleaned the most - 20 or more times - averaged a 34 % blood-lead reduction. Blood-lead levels among the other children did not change significantly. For full story, go to March 1999 issue of Pediatrics.

USDA OKs Irradiation of Red Meat. WASHINGTON (AP, Feb. 12, 1999) - The Agriculture Department approved irradiation of red meat Friday as a way to curb food-borne illnesses, offering the industry another way to improve food safety. When it comes to food safety, there is no silver bullet, Agriculture Secretary Dan Glickman said in announcing the action in Charlotte, N.C. Used in conjunction with other science-based prevention efforts, irradiation can provide consumers with an added measure of protection. Glickman made the announcement while speaking before a meeting of the National Cattlemen's Beef Association. Under USDA's proposed rule, which will be published in the Federal Register within 10 days, radiation would be permitted for treatment of refrigerated or frozen uncooked meat.

New Director of FDA Food Safety Initiative. (Jan. 8, 1999). Morris E. Potter, DVM was named the Director of the Food and Drug Administration's (FDA) Food Safety Initiative -- an important part of the Clinton Administration's comprehensive food safety effort to reduce the incidence of foodborne illness. Dr. Potter will report directly to Joseph A. Levitt, the Director of theFDA's Center for Food Safety and Nutrition. Most recently, Dr. Potter served as the Assistant Deputy Director for Foodborne Diseases at the Centers for Disease Control and Prevention (CDC).

Condiment Could Ward Off Bacteria. WASHINGTON (AP, Jan. 3, 1999) - Horseradish may do more than just spice up your favorite sandwich. Scientists in Oklahoma believe the condiment can also serve as a food preservative, guarding against a host of contaminants. Both horseradish and mustard oil contain the pungent chemical allyl isothiocyanate. Mustard oil has 93% AITC, but has a milder flavor than horseradish, which has 60% AITC. Because of the presence of the chemical, both condiments can help fight off listeria, E. coli, Staphylococcus aureus and other food pathogens, according to the work of Henry Fleming, a food technologist with the Agricultural Research Service and Oklahoma State University food chemist Brian Shofran.

What is Organic? (International Herald Tribune, April 1, 1998). Americans have an unquenchable thirst to know what is in their food yet once they have the information they tend to ignore the information and eat whatever they like!

Destruction Justified, Canadians Say. (Globe and Mail March 22, 1996)
The Federal Agriculture Department destroyed 363 head of cattle after mad-cow disease was identified in one animal in Canada.

For related news stories, please click here.

WEB PAGES AND INFORMATION SOURCES

Food Safety http://www.foodsafety.gov. (800) 266-5762 (800) COOKSMART	A free "Keep It Clean" brochure is available from the International Food Safety Council.
Operation Clean Hands http://ww.asmusa.org/pcsrc/ochpr.htm	These authoritative pages from the American Society for Microbiology describe the risks of not washing hands, and describe proper handwashing technique.
CDC- Office of Information 1600 Clifton Road N.E., Atlanta, GA 30333 Phone: (404) 329-3286 http://www.cdc.gov/	Morbidity and Mortality Weekly Reports provides case study material on food borne illness from various states.
FDA - Office of Consumer Affairs Parklawn Building (HFE-88) 5600 Fishers Lane, Rockville, MD 20857 Phone: (301) 443-3170 http://www.fda.gov/	Handles inquiries for the FDA. Provides written materials for consumers and professionals.
FDA Center for Food Safety and Applied Nutrition (HFF-40) 200 C Street SW, Washington, DC 20204 Phone: (202) 485-0001 Http://vm.cfsan.fda.gov/list.html	Regulates foods and cosmetics, including color additives and infant formulas prescribed as special foods. List of Center's publications available.
Food and Nutrition Board Institute of Medicine National Academy of Sciences 2101 Constitution Avenue, NW Washington, DC 20418 Phone: (202) 334-2238 http://www.nas.edu/	Committees of both the Food and Nutrition Board and the Institute of Medicine issue reports on the safety of food, published by the National Academy Press. Catalog available free.
USDA Food and Nutrition Information Center Room 304, National Agricultural Library 10301 Baltimore Boulevard Beltsville, MD 20705 Phone: (301) 344-3719 http://www.nal.usda.gov/fnic/	Serves information needs of professionals interested in nutrition education, food service management, and food technology. Lends books, journal articles, and audio-visual materials.
General Services Administration Consumer Information Center-M PO Box 100 , Pueblo, CO 81001 http://www.pueblo.gsa.gov/	The Consumer Information Catalog lists free and inexpensive government publications on food purchasing, preparation and safety.
Office of Public Awareness Food Safety and Inspection Service Department of Agriculture Room 1165-S Washington, DC 20250 Phone: (202) 447-9351 (800) 535-4555 meat and poultry hotline http://www.usda.gov/agency/fsis/homepage.htm	Administers the meat and poultry inspection and labeling program. Produces a wide variety of pamphlets on food safety, labels on meat and poultry products and the inspection program. Food News for Consumers is a periodical for consumer educators.
Center for Science in the Public Interest 1501 16th Street NW Washington, DC 20036 Phone: (202) 332-9110 http://www.cspinet.org/	Nonprofit organization provides public information about food, the food industry, and government regulation of food. Publishes books, posters, brochures, etc.
National Consumers League 815 15th Street NW, Suite 516 Washington, DC 20005 Phone: (202) 639-8140 http://www.natlconsumersleague.org/	Represents consumers through its legislative actions, research, and programs including consumer education on food safety.

REFERENCES

Surveillance for Acute Insecticide-Related Illness Associated with Mosquito-Control Efforts --- Nine States, 1999-2002. Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.

Nicotine Poisoning After Ingestion of Contaminated Ground Beef--- Michigan, 2003. Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.

Preliminary FoodNet Data on the Incidence of Foodborne Illnesses ---Selected Sites, United States, 2002. Morbidity and Mortality Weekly Report, 52(15), Apr 17, 2003.

Poisoning by an Illegally Imported Chinese Rodenticide Containing Tetramethylenedisulfotetramine --- New York City, 2002. Morbidity and Mortality Weekly Report, 52(10), March 14, 2003.

Illnesses Associated with Occupational Use of Flea-Control Products -- California, Texas, and Washington, 1989-1997. Morbidity and Mortality Weekly Report 48 (21), June 4, 1999.
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4821a3.htm
Dips, shampoos, and other insecticide-containing flea-control products can produce systemic illnesses or localized symptoms in the persons applying them. Although these products may pose a risk to consumers, they are particularly hazardous to pet groomers and handlers who use them regularly. Illnesses associated with flea-control products were reported to the California Department of Pesticide Regulation, the Texas Department of Health, and the Washington State Department of Health, each of which maintains a surveillance system for identifying, investigating, and preventing pesticide-related illnesses and injuries. This report describes cases of occupational illnesses associated with flea-control products, summarizes surveillance data, and provides recommendations for handling these products safely.

Recommendations for the Use of Lyme Disease Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report 48 (RR-7), June 4, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4807a1.htm
This report provides recommendations for use of a newly developed recombinant outer-surface protein A (rOspA) Lyme disease vaccine (LYMErix,TM SmithKline Beecham Pharmaceuticals) for persons aged 15-70 years in the United States. The purpose of these recommendations is to provide health-care providers, public health authorities, and the public with guidance regarding the risk for acquiring Lyme disease and the role of vaccination as an adjunct to preventing Lyme disease. The Advisory Committee on Immunization Practices recommends that decisions regarding vaccine use be made on the basis of assessment of individual risk, taking into account both geographic risk and a person's activities and behaviors relating to tick exposure.

Appendix Methods Used for Creating a National Lyme Disease Risk Map. Morbidity and Mortality Weekly Report 48 (RR-7), June 4, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4807a2.htm
Lyme disease risk is measurable as a function of two epidemiologic parameters entomologic risk and human exposure. Entomologic risk for Lyme disease is defined as the density per unit area of host-seeking nymphal ticks infected with Borrelia burgdorferi (1<|>). Field studies needed for determination of entomologic risk require trained entomologists, and such studies are limited to a narrow seasonal window within the life-cycle of vector ticks. Limited resources preclude the direct measurement of entomologic risk over large geographic areas; therefore, indirect measures were used to estimate risk to develop this national Lyme disease risk map. First, data on vector distribution, abundance, B. burgdorferi infection prevalence, and human exposure were compiled on a county-unit scale for the United States. Then geographic information systems (GIS) technology was used to combine these data and categorize each of the 3,140 counties into four risk classes.

Update: Outbreak of Nipah Virus --- Malaysia and Singapore, 1999. Morbidity and Mortality Weekly Report 48(16), April 30, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00057012.htm
During March 1999, health officials in Malaysia and Singapore, in collaboration with Australian researchers and CDC, investigated reports of febrile encephalitic and respiratory illnesses among workers who had exposure to pigs (1). A previously unrecognized paramyxovirus (formerly known as Hendra-like virus), now called Nipah virus, was implicated by laboratory testing in many of these cases. Febrile encephalitis continues to be reported in Malaysia but has decreased coincident with mass culling of pigs in outbreak areas. No new cases of febrile illness associated with Nipah virus infection have been identified in Singapore since March 19, 1999, when abattoirs were closed. This report summarizes interim findings from ongoing epidemiologic and laboratory investigations in Malaysia and Singapore. Reference cited:
CDC. Outbreak of Hendra-like virus--Malaysia and Singapore, 1998-1999. MMWR 48(13):265-9, 1999.

Outbreak of Cyclosporiasis. -- Ontario, Canada, May 1998. Morbidity and Mortality Weekly Report, October 1, 1998/Vol. 47/No. 38.

All of the following articles are found in the September 1/98 volume of the Official Journal of the America Occupational Health Nurse 46(9).

Mock, Victoria. Breast Cancer and Fatigue: Issues for the Workplace, p. 425.
Vetrosky, Dan, White Jr., George L. Prostate Cancer: Clinical Perspectives, p. 434.
Caplan, Lee S., Coughlin, Steven S. Worksite Breast Cancer Screening Programs: A Review, p. 443.

Linnan, L. A., Fava, J. L., Thompson, B., Emmons, K., Basen-Engquist, K., Probart, C., Hunt, M. K., & and Heimendinger, J. (1999). Measuring Participatory Strategies: Instrument Development For Worksite Populations. HEALTH EDUCATION RESEARCH 14(3): 371-386.
ABSTRACT: http://her.oupjournals.org/cgi/content/abstract/14/3/371 .

Milton, Doris Alternative and Complementary Therapies: Integration into Cancer Care, p 454.

Childre, Frances Special Issue: Cancer Issues in the Workplace, p 424.

Lusk, Sally L. McCullagh, Marjorie Linking Practice & Research: Agricultural Workers, p. 465.

W Smith, B Lieber, DM Perrotta, Y Hokama, et al. Ciguatera. Fish Poisoning -- Texas, 1997. Morbidity and Mortality Weekly Report, August 28, 1998/Vol. 47/No. 33. MMWR can be accessed at http://www.cdc.gov/epo/mmwr/mmwr.html

On October 21, 1997, the Southeast Texas Poison Center was contacted by a local physician requesting information about treatment for crew members of a cargo ship docked in Freeport, Texas, who were ill with nausea, vomiting, diarrhea, and muscle weakness. This report summarizes an investigation of this outbreak by the Texas Department of Health (TDH), which indicated that 17 crew members experienced ciguatera fish poisoning resulting from eating a contaminated barracuda.

Trichinellosis Outbreaks --- Northrhine-Westfalia, Germany, 1998--1999. Morbidity and Mortality Weekly Reports 48(23), June 18 1999.
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4823a2.htm
From November 1998 through January 1999, 52 cases of trichinellosis were identified by the public health surveillance systems in 11 cities and districts of the state of Northrhine-Westfalia (NRW), Germany. In comparison, zero to 10 cases were reported annually in Germany during 1987-1997. This report summarizes the investigation of these cases, which indicated the existence of two simultaneous outbreaks--one caused by contaminated ground meat and the other by a commercially prepared raw smoked sausage.

STUDY QUESTIONS, ACTIVITIES, AND EXERCISES

1. Milestones in food and vector control. The Food, Drug, and Cosmetic (FDC) Act is the primary federal legislation that assures Americans of foods that are pure and wholesome, safe to eat, and produced under sanitary conditions. The Food and Drug Administration (FDA) is the federal body charged with the responsibility to enforce this act. Ask a representative of a regional FDA office or the local health department to discuss with the class current problems it is confronting in its efforts to protect the public food supply.

2. Botulism case studies. Botulism, salmonella, and other forms of food poisoning can occur when foods are grown, prepared, and packaged, or stored under unfavorable conditions. Obtain a recent issue of the FDA Consumer from your library. Identify and discuss actions taken by the FDA against food manufacturers.

3. Inspections. Invite a health department sanitarian to class for discussion of local food establishment regulations. How are inspections conducted and what are common violations? Visit a local grocery store, fast food restaurant, or food processing plant and determine what strategies are employed to ensure wholesome products for the consumer. Interview a pest exterminator. Ask what common conditions occur in local food establishments requiring these services. What preventive measures are most helpful in vector control?

4. Home inspections. If possible, obtain a set of guidelines from the local health department about items to assess in conducting a food safety inspection at home, or develop one based on the Food Inspector’s Checklist or the Home Food Safety Musts presented in this chapter. Reasonable items might include: When is the last time the cutting board was washed in soap and water? For how long and where is food thawed? Use Table 15-1 to identify acceptable storage times for various food products. Conduct an inspection of your own home and make recommendations to improve safety.

5. Legislation. As the 8^th edition of the text goes to press, new legislation is pending that will change meat inspections from the touch and sniff approach to a more scientific and reliable one. Track the status of this legislation with the FDA website.

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