You ate what?

CDC research shows outbreaks linked to imported foods increasing.

Foodborne diseases from imported food appeared to rise in 2009 and 2010, and nearly half of the implicated foods were imported from areas not previously associated with outbreaks.

During the five-year period of 2005-2110, 39 outbreaks and 2,348 illnesses were linked to imported food from 15 countries. 17 of the outbreaks occurred in 2009 and 2010 alone. Overall, fish (17) were the most common source, followed by spices (6) such fresh or dried peppers. Nearly half of the problem foods came from Asia.

As much as 85 percent of the seafood eaten in the United States is imported, and depending on the time of the year, up to 60 percent of fresh produce is imported.

Bottom Line

“As our food supply becomes more global, people are eating foods from all over the world, potentially exposing them to germs from all corners of the world, too,” says the CDC. 

Binge drinking is bigger problem than previously thought

“It takes only one drink to get me drunk. The trouble is, I can't remember if it's the thirteenth or the fourteenth.”
-George Burns

Anyone who has attended college has most likely observed (or even participated in) binge drinking. The Centers for Disease Control and Prevention (CDC) defines binge drinking as consuming at least four drinks for women (five+ for men) on one occasion. More than 38 million U.S. adults binge drink an average of four times a month and frequently they don't stop at the 4-5 drink threshold. The binge average is now eight drinks according to a new Vital Signs report.  And it's not just the young adults (ages 18–34). There are drinkers age 65 and older who binge on average five to six times a month.

The CDC reports binge drinking is more common among household incomes of $75,000 or more, but households earning less than $25,000 drink more in one sitting (eight to nine drinks). Adult binge drinking is most common in the Midwest, New England, the District of Columbia, Alaska and Hawaii, the report said. However, binge drinkers consume more drinks in the southern part of the Mountain states (Arizona, Nevada, New Mexico, and Utah), the Midwest, and some states where binge drinking is less common – including Louisiana, Mississippi and South Carolina.

Binge drinkers put themselves and others at risk for many health and social problems, including car crashes, other unintentional injuries, violence, liver disease, certain cancers, heart disease, sexually transmitted diseases, and both unintended and alcohol–exposed pregnancies.

Drinking too much causes more than 80,000 deaths in the United States each year, making it the third leading preventable cause of death. Over half of these deaths result from injuries that disproportionately involve young people.

“Binge drinking by adults has a huge public health impact, and influences the drinking behavior of underage youth by the example it sets,” said Substance Abuse and Mental Health Services Administrator Pamela S. Hyde. “We need to reduce binge drinking by adults to prevent the immediate and long–term effects it has on the health of adults and youth.”

Bottom Line

For more information about binge drinking and how to prevent this dangerous behavior, visit the CDC’s Alcohol and Public Health website at http://www.cdc.gov/alcohol/index.htm. Members of the public who are concerned about their own or someone else's binge drinking can call 1–800–662–HELP to receive assistance from the national Drug and Alcohol Treatment Referral Routing Service.

For state–specific estimates of alcohol–related deaths and years of potential life lost by condition, visit the Alcohol–Related Disease Impact system at https://apps.nccd.cdc.gov/ardi/HomePage.aspx.

Preventing Foodborne Disease this Holiday Season

"Holidays are the best. I couldn't imagine being from a small family."
-Kim Kardashian

The Centers for Disease Control and Prevention estimate that one out of six Americans (48 million people) will get sick, 128,000 will be hospitalized, and 3,000 will die from foodborne diseases this year. (See A Fatal Cantaloupe?) So far in 2011 the CDC has investigated 65 outbreaks of food illness.

Evidence shows that preventing illness begins with the basics. Stay safe during this holiday season by following these safety tips:

• Clean. Wash hands, cutting boards, utensils, and counter tops.
• Separate. Keep raw meat, poultry, and seafood separate from ready-to-eat foods.
• Cook. Use a food thermometer to ensure that foods are cooked to a safe internal temperature: 145°F for whole meats (allowing the meat to rest for 3 minutes before carving or consuming), 160°F for ground meats, and 165°F for all poultry.
• Chill. Keep your refrigerator below 40°F, and refrigerate food that will spoil.
• Report suspected illness from food to your local health department.
• Don't prepare food for others if you have diarrhea or have been vomiting.
• Be especially careful when preparing food for children, pregnant women, those in poor health, and older adults.

Bottom Line

For more information see

• “Check Your Steps”
• CDC Food Safety
• Foodborne Illness
• It’s Turkey Time

A Fatal Cantaloupe?

"Acting in 'Star Wars' I felt like a raisin in a giant fruit salad, and I didn't even know who the cantaloupes were."
- Mark Hamill (Luke Skywalker)

Who knew that cantaloupes could be deadly? The Centers for Disease Control and Prevention, says 72 people across 18 states have fallen ill with listeriosis, traced back to contaminated cantaloupes. The fruits come from Colorado's Rocky Ford region and were shipped between July 29 and Sept. 10. Thirteen people have died.

The illness and death were caused by the bacteria listeria which causes diarrhea, muscle aches and fever. The disease primarily affects older adults, pregnant women, newborns, and adults with weakened immune systems. Listeria monocytogenes is found in soil and water. Animals can carry the bacterium without appearing ill and can contaminate meats and dairy products. When Listeria bacteria get into a food processing factory (like the cantaloupe factory), they can live there for years.

Listeria is killed by pasteurization and cooking so you're most likely to catch it from ready-to-eat foods like hot dogs and deli meats which were contaminated after factory cooking but before packaging. Unlike most bacteria, Listeria bacteria can grow and multiply in some foods in the refrigerator so it's recommended that you eat your sliced deli meats within a few days of purchasing - old meat could make you sick.

Bottom Line

How can you protect yourself from listeria?

• Thoroughly cook raw food, such as beef, pork, or poultry to a safe internal temperature. See http://perpetualpreparedness.blogspot.com/2011/09/is-it-done-yet.html
• Rinse raw fruits and vegetables thoroughly under running tap water before eating.
• Keep uncooked meats separate from cooked foods and ready-to-eat foods. Avoid cross-contamination by washing hands, knives, counter tops, and cutting boards after handling and preparing uncooked foods.
• Do not drink raw (unpasteurized) milk.
• Consume perishable and ready-to-eat foods as soon as possible. Don't assume the fridge will keep it safe for weeks.

Is It DONE Yet?

While barbecuing on Labor Day my coals were quite hot and I was surprised at how quickly everything cooked. That's not necessarily a good thing. With a hot flame it's easy to burn the outside while the inside is still undercooked. While I enjoy meats with a bit of red or pink inside there's a risk of sickness if the center is not sufficiently hot. The Centers for Disease Control and Prevention estimate that every year about 48 million people in the United States become ill from harmful bacteria in food; of these, about 3,000 die.

The signs and symptoms of foodborne illness range from upset stomach, diarrhea, fever, vomiting, abdominal cramps, and dehydration, to more severe illness including death. This can be prevented by cooking food to a safe temperature.

According to the CDC, many people assume that if a hamburger is brown in the middle, it is done. According to US Dept of Agriculture research, 1 out of every 4 hamburgers turns brown before it reaches a safe internal temperature. The only safe way to know if hamburger is safe is to measure 160 °F in the center.
The CDC would like everyone to know that "Thermometers Aren't Just for Turkey Anymore". The food thermometer should be placed in the thickest part of the food and should not be touching bone, fat, or gristle. Check the temperature in several places to make sure the food is evenly heated. Make sure to clean your food thermometer with hot, soapy water before and after every use! Imagine you stick the thermometer into meat that is under cooked and bacteria clings to the thermometer. Then later you stick the thermometer into meat properly cooked but now you've reinserted the bacteria!

Cross contamination from bacteria can also occur if you put cooked meat back onto the plate that held the raw meat. I saw one friend rightly freak out after carefully cooking chicken on the grill, another person then started to place raw meat on the grill right next to his chicken. My friend knew the risk of cross contamination.
Raw meat can contaminate everything it touches including your hands! Be sure to wash hands with soap and warm water for 20 seconds after handling uncooked meat.

Bottom Line

While watching a cooking competition show for professional chefs, two contestants were challenged to cook filet mignon rare, medium and well done for three judges. I was surprised to see they used thermometers to measure the degree of doneness. I thought "real" professionals could tell by the firmness of the meat.

So I learned that thermometers were not just for safety but also for cooking food "just right".

Special precautions in hot weather

A message from the CDC,

The Centers for Disease Control and Prevention encourages coaches, athletes, and those exercising outside in hot weather to know the warning signs for heat-related illness and take action when needed. 
“Any athlete dying from heat is a tragedy that can be prevented,” said CDC’s Robin Ikeda, M.D., M.P.H., Deputy Director for Noncommunicable Diseases, Injury and Environmental Health.  “Coaches, parents, teachers, and athletes should educate themselves on how to recognize and prevent heat-related illness.”
CDC estimates that, each year, there are almost 6,000 emergency department visits for sports and recreation heat illnesses. CDC says the most common activities leading to the hospital visits are football, and exercises such as walking, jogging, running, and calisthenics.  People who exercise in extreme heat are more likely to become dehydrated and get heat-related illness.
Extremely hot weather can cause illness or death, but all heat-related illnesses and deaths are preventable.
Here are some ways to act against heat-related illness:

• Stop all activity and get to a cool environment if you feel faint or weak.
• Limit outdoor activity, especially midday when the sun is hottest.
• Schedule workouts and practices earlier or later in the day when the temperature is cooler.
• Pace activity. Start activities slow and pick up the pace gradually.
• Drink more water than usual and don’t wait until you′re thirsty to drink more.
• Have a workout partner. Monitor each other’s condition.
• Wear loose, lightweight, light-colored clothing.
• Seek medical care immediately if you or a teammate has symptoms of heat-related illness.

Coaches can learn more about how to protect the athletes in their care by taking CDC′s accredited Web–based course on how to recognize, treat, and prevent heat–related illness. School nurses and athletic trainers may also find the course useful for sharing information with others who work with athletes.

CDC has also published a toolkit to educate readers, especially caregivers for vulnerable groups such as athletes, as well as older adults and small children, about how to recognize warning signs of heat illness.  Materials such as posters for locker rooms and water bottle labels are targeted for use with school athletic programs.  

More information about heat illness in high school athletes can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5932a1.htm.

For more information on extreme heat and heat safety, call 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/.

Chicken Pox

“When the itch is inside the boot, scratching outside provides little consolation”
-Chinese Proverbs

"Rachel got poison ivy on her brain. The only way she can scratch it is to think about sandpaper."
-Steven Wright

The Centers for Disease Control and Prevention (CDC) has some good news about chickenpox. Since the government first recommended the new pox vaccine for all children starting in 1995, deaths from chickenpox have fallen from 105 in 1990 to just 14 in 2007. Almost all the deaths were adults who suffered complications like skin infections, swelling of the brain and pneumonia. Severe cases are more common among teens and adults who get it for the first time late in life.

About 8 to 9 of every 10 people who are vaccinated are completely protected from chickenpox. In addition, the vaccine almost always prevents against severe disease. If a vaccinated person does get chickenpox, it is usually a very mild case lasting only a few days and involving fewer skin lesions (usually less than 50), mild or no fever, and few other symptoms.

"The disease is spread by coughing and sneezing (highly contagious), by direct contact, and by aerosolization of virus from skin lesions." Aerosolization? Sounds like the virus can leap off the skin and become airborne. I wonder if the pox pustuals rupture like a burst pimple?  My only exposure to chickenpox was at age 8 so my memory of the disease is patchy (but I do remember the itching and still bear a scare from one pox bump I scratched too much).

Bottom Line

All children and adults without evidence of immunity to varicella need the vaccine. Evidence of immunity includes any of the following:

• Documentation of two doses of varicella vaccine
• Blood tests that show you are immune to varicella or laboratory confirmation of prior disease
• Born in the United States before 1980, excluding health-care workers, pregnant women, and immunocompromised persons.  These individuals need to meet one of the other criteria for evidence of immunity.  
• Receipt from a healthcare provider of a) a diagnosis of chickenpox or b) verification of a history of chickenpox
• Receipt from a healthcare provider of a) a diagnosis of herpes zoster (shingles), or b) verification of a history of herpes zoster (shingles).

You do NOT need the chickenpox vaccine, if you meet any of the above criteria for evidence of immunity.

Stay Cool to Stay Healthy As Temperatures Soar

Here is a message from the US Center for Disease Control (CDC) regarding the summer heat:
The Centers for Disease Control and Prevention officials are warning people to stay cool, hydrated and informed to prevent illnesses and injuries as cities across the Midwest, South and East Coast continue to issue heat warnings and watches. Extreme heat can lead to very high body temperatures, brain and organ damage, and even death. On average, 675 people die from complications related to extreme heat each year in the United States – more than tornadoes, hurricanes, floods, lightning or any other weather event combined.
"Extreme heat affects all of us but the most vulnerable are the elderly, those who work or exercise outdoors, infants and children, the homeless or poor, and people with a chronic medical condition," said Christopher Portier, PhD, director of CDC's National Center for Environmental Health. "Taking precautions to stay cool, hydrated and informed helps to prevent serious health effects such as heat exhaustion or heat stroke during this massive heat wave."
Heat related deaths and illness are completely preventable yet every year many people succumb to the effects of extreme heat. People suffer heat-related illness when their bodies are unable to compensate and properly cool themselves. Common sense practices will keep you safe and healthy during the scorching days of summer.

Stay cool

Air-conditioning is the number one protective factor against heat-related illness and death. If a home is not air-conditioned, people can reduce their risk for heat-related illness by spending time in public facilities that are air-conditioned like shopping malls and libraries. (http://www.cdc.gov/nceh/extremeheat/)

Stay hydrated

Drink cool non-alcoholic beverages and increase your fluid intake regardless of your activity level; increase your intake hourly if you are outdoors working or exercising. Drink more water than usual and don't wait until you're thirsty to drink. Make sure your family, friends and neighbors are drinking enough water. (http://www.cdc.gov/nceh/extremeheat/)

Stay active

Doing too much on a hot day, spending too much time in the sun or staying too long in an overheated place can cause heat-related illnesses especially during sports and recreational activities.
"Take breaks; stay hydrated and move physical activities to the cooler parts of the day if they can't be moved indoors," said Linda Degutis, Dr. PH, M.S.N., director of CDC's National Center for Injury Prevention and Control. "We encourage people to continue sports and recreational activities as much as possible during this heat wave, but take the necessary steps to prevent heat-related illness and injury."
Be sure to gradually increase exercise frequency, duration and intensity to allow your body to adjust to the heat if you are just getting started or returning to practices (e.g. football or band rehearsals). It's also a good idea to have an exercise partner or practice partner and watch for signs and symptoms of heat illness in each other. If leading organized activities, follow established guidelines from schools, sports organizations or medical organizations regarding changing or canceling activities to prevent heat illness, and alter practices to remove the need for heavy safety gear (e.g., football pads) on hot or humid days.

Stay safe

Even short periods of high temperatures can cause serious health problems, debilitating injury or death, never leave infants, children or pets in parked cars; check on people who are overweight they may be prone to heat sickness because of their tendency to retain more body heat. People who suffer from chronic conditions such as heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation, may be affected by extreme heat. Know the symptoms of heat disorders, overexposure to the sun, and be ready to give first aid treatment. http://www.cdc.gov/Features/ExtremeHeat/

Bottom Line

Check your local news for extreme heat warnings and safety tips, or sign up for free weather alerts to your phone or e-mail from websites such as www.weather.com/mobile. Visit http://www.cdc.gov/ for tips for preventing heat sickness, keep an eye on your friends, family and neighbors and be aware of weather and heat safety information.
For more information on extreme heat and heat safety, call 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/.

Proper Ways to Handle Swine Flu

“Panic is quite rare. What's quite common is denial; denial is why panic is rare. We are organized such that, when we're about to panic, we trip a circuit breaker instead and go into denial.” - Peter Sandman, Risk Communication Specialist

My column yesterday could be viewed as a form of denial. I suggested ignoring the media-hype and twitter panic on swine flu and calming preparing for a possible pandemic that was unlikely to happen. Since then I’ve done more reading from the opposing view point of “don’t risk your life, respond now.”

The NYT Health section this week includes a well-written article on Assessing the Danger of New Flu. It discusses the complications in judging how dangerous flu might be and then looks at Hong Kong as a model for proper government response.

Contagion and virulence
Two measurements describe flu or any disease. Contagion = how easily does the disease spread from person to person? Virulence = how deadly is it? (i.e. what percentage of people die from catching the disease?)
- The Spanish influenza of 1918 had a mortality rate of ONLY 2.5% but was very contagious and killed tens of millions.
- Bird Flu (global/current) kills 61% of those afflicted but so far infects mostly birds, rarely people. The total number of fatalities is 257.
- SARS (Hong Kong 2003) was virulent (17%) and spreadable. But it killed only 299.
It is not easy to figure out which flu bugs will be pandemics and which ones won’t before it is too late.

Lessons Learned
Hong Kong (HK) learned much from SARS about how to respond to an epidemic:
- By weeks end, HK will have six laboratories studying the genetic markers for Swine Flu to allow for rapid detection and diagnosis of new cases
- HK has tens of thousands of doctors and nurses, including retirees, on standby and ready to be mobilized. (The US has a similar program called the Medical Reserve Corps created under President Bush.)
- HK has contingency plans to keep public transport, electricity, food supplies, telecommunications and other vital services running if large numbers of people fall ill.
- Since SARS Hong Kong has added 1,400 respiratory isolation unit beds to hospitals.
- HK with a population of seven million people has stockpiled 20 million treatment courses of Tamiflu. The US with 300 million people has 50 million courses of Tamiflu.
- HK is quickly passing a law to require all health professionals to notify authorities of any suspected cases of Swine Flu. This allows the disease to be accurately tracked.
- HK has broad and detailed legal powers to quarantine possible cases. The US (after six years) is still debating how to handle legal issues during a possible pandemic.

Bottom Line
Several articles today have suggested that a little panic is good for public health. As discussed above it is very hard to know which flu bugs will fade quickly and which ones will be deadly killers. By the time authorities do know, the bug may have already spread widely making quarantines useless. The safest course for individuals and the public is to follow the example set in Mexico at the first hint of a new flu virus. Order the public to stay home and close the schools, non-essential business and all public events. If you must go out, wear a facemask.

Staying home and sitting out the flu will save lives but at terrible economic cost in lost business, lost jobs, etc. While you and I may value our life over money, not so for governments which feed on tax revenues. Since governments exist to prevent panic and to promote business, they will placate, lie, under report illnesses & deaths, over promote actions & cures, etc, to keep the peace. So Mexico deserves credit for putting the people first by declaring a National Emergency and quarantine.

Updates
WHO Raises Swine Flu Alert Level but stopped short of declaring a global emergency.
The suspected number of deaths rose to 149 in Mexico, the epicenter of the outbreak with nearly 2,000 people believed to be infected. The number of U.S. cases rose to 48, the result of further testing at a New York City school, although none was fatal.

Swine Flu

How quickly can Swine Flu make you sick? About 90 minutes of CNN should do it. -American Digest

There is nothing better for a news company than FEAR. When they can sell the idea of "Watch our news or you might die", ratings improve and they make money. Too bad if the alarm was false or too extreme and you ended up wasting your time and your money.

Last night I was watching some conference talks from TED.com online. (Highly recommended!) One speaker from Africa described how his team put together a text messaging emergency alert system to cover riots, government-police actions, etc. It worked very well. In fact too well. The amount of public created "emergency" traffic from tweet and texting far exceeded the ability of responders to read it. In version 2 of the system they had to install ratings to judge the accuracy and reliability of senders to separate the wheat from the chaff.

Now Swine Flu is real and it is back. It is not yet a pandemic but people are acting as if it were. AmericanDigest.org shows how The Virus Does Not Travel at the Speed of Tweet, But the Tweet of the Virus Does. Panicked Tweeters were publishing "breaking news" from the CDC (Center of Disease Control) claiming that the virus was spreading and "could not be contained." USA Today reports Swine flu spreads panic in Mexico City. With 81 possible deaths in all of Mexico since April 13, health officials ordered some 500 cultural and sporting events cancelled. According to Bloomberg.com, the Mexican President declared an emergency April 25 and canceled school at all levels in Mexico City and the state of Mexico until further notice.

Precaution and preparation is important - for example Mexicans are urged to wear face masks in public. But keep a sense of perspective. In the US (2001 data) 2525 people died every day from heart attacks and 120 died every day from auto accidents. Why don't we see panics and government emergencies over butter and cars as agents of death? Every year the CDC estimates that 36,000 people in America die of "normal" flu but people still refuse to get "normal" flu shots. Blogger Ryan Sager writes

Our brains are pretty bad at assessing risk — we worry about flying (which is safe), while we love driving (which kills far more people); we worry about terrorism (which kills virtually no one), while we die of heart disease (No. 1 killer in the United States) — and so we vastly overestimate the chances that we, personally, might get swine flu.

In the article, Risk Communication Before and During Epidemics the author notes that there is a very low correlation between risk/harm and outrage/perceived risk.

Whatever your measure of harm, across a wide range of risks, the correlation between how much harm [a risk is] going to do and how upset people are going to get is this absurdly low 0.2 correlation.

Swine flu may get worse but right now driving your car is 40 to 100 times more deadly.

Bottom Line
Swine flu is serious but the 20 known cases in the US appear to be a mild strain. Watch the blogs and Internet for news but filter it for truth vs bias and rumors. Prepare but don't panic. If you have flu symptoms see a doctor and get tested for Swine flu, don't go to work or school and share the virus with others. Avoid people who are coughing or sneezing and wash your hand frequently. If you are very concerned: avoid crowds or wear a face mask (very common on Japan!)

Don't rely totally on the US government for information (and never rely on evening news casts). Governments will under AND over react. The Washington Post reports that U.S. public health officials did not know about a growing outbreak of swine flu in Mexico until nearly a week after that country started invoking protective measures, and didn't learn that the deaths were caused by a rare strain of the influenza until after Canadian officials did. (This despite our huge Department of Homeland Security!) Now with 20 mild cases of Swine flu in NY and CA and TX the US Department of Health declared "a public health emergency" on April 26. According to Homeland Security Secretary Janet Napilotano, the emergency declaration is standard operating procedure and enables 12 million doses of the drug Tamiflu to be distributed from Federal stockpiles to states that need to deal with a flu outbreak. The terminology here is terrible! An "emergency declaration" is standard operating procedure? What will the goverment call a real pandemic and crisis?

Update

US government claims it is prepared to handle Swine Flu despite the fact that after Obama's first 100 days we have no Surgeon General, no Secretary of Health and Human Services, and no appointees in any of the department’s 19 key posts.

NYT Story - To quarantine or not? Lesson from the 1918 Spanish Flu Pandemic

Resources
The CDC Swine Flu website is www.cdc.gov/swineflu/swineflu_you.htm
CDC Health Advisory, April 25, http://www.cdc.gov/swineflu/pdf/HAN_042509.pdf
CDC Travel Advisories: http://wwwn.cdc.gov/travel/notices.aspx
World Health Organization (WHO) Epidemic News: http://www.who.int/csr/don/en/
Health Map: http://healthmap.org/en
Swine Flu News: http://health.einnews.com/news/swine-flu

Google Alerts: create an email alert of "Swine Flu" news as soon as it hits the internet.
Amazon has a site for a Bird Flu survival kit www.amazon.com/Bird-Flu-Survival-Kit-Basic/lm/RWDK3B57W2U2Q/