Matt Arteaga, 51, is one of about 500 people who got sick this summer in an outbreak linked to McDonald's salads. The cause was a parasite, cyclospora.
Arteaga fell ill on a Thursday afternoon in June. He was in his office in Danville, Ill., when he says the symptoms came on quickly. "The chills, and body aches, severe cramping, sharp pain in my stomach," Arteaga recalls.
After a test revealed he was infected with cyclospora, his case was reported to the Illinois Department of Public Health. At about the same time, there was "an uptick in reports of cyclospora that were being submitted to us," the director of the department, Dr. Nirav Shah, told us.
To figure out what the source of the cyclospora might be, health department investigators asked Arteaga — and others who'd gotten sick — to make a list of every food they'd eaten before they fell ill. Arteaga says he used bank records to jog his memory.
"I pay with my debit card all the time. [I] just went through every restaurant [transaction] in the two weeks prior to getting sick," he recalls. "I had a salad at McDonald's three times."
When many of the others sickened by cyclospora also reported they'd eaten salads at the chain, Shah says his department took action. They notified the Food and Drug Administration, the Centers for Disease Control and Prevention, and other public health agencies in nearby states.
"We got on the phone with McDonald's and advised them of what we recommended, and made sure we notified the public immediately," Shah says.
McDonald's halted sales of salads at about 3,000 locations until it could switch to a different lettuce supplier. An FDA analysis confirmed the presence of cyclospora in an unused package of lettuce that had been distributed to to the chain.
So, is this a success story? An example of quick coordination and detective work by public health agencies to identify and halt an outbreak before it grew bigger? Or, is it evidence of the risks that exist in the food supply?
Twenty years ago, this outbreak may have been hidden. "It's unlikely we would have detected this outbreak, because the test that doctors use to diagnose cyclospora wasn't even approved by the FDA until May of 2014," Shah told us.
Back then, Arteaga and others may have chalked up their sicknesses to a stomach bug and moved on. Earlier tests for cyclospora were more complicated and less reliable. And testing for cyclospora wasn't automatic — a clinician had to suspect the parasite and specifically request testing for it. What's more, older testing methods required visual inspection of a stool sample, and sometimes multiple stool specimens, to find the parasite.
Today, the tests yield quick results — within an hour or two — and can detect many common pathogens at once.
"Technology has been a game changer for foodborne outbreaks," Shah says.
So, perhaps not surprisingly, diagnoses of cyclospora are up. In Illinois, there were 47 cases in 2017, compared with just two cases in 2012.
"We're now in a situation where people know, if I go to my doctor I can get tested, I can get a diagnosis," Shah says. And when these foodborne illnesses are reported to health authorities, "we can actually link up what's going on."
In addition to better testing for pathogens, detection of outbreaks has improved, too. "We've seen a great advance in the methodologies that we use for detecting foodborne outbreaks," says Edward Dudley, an associate professor of food science at Penn State.
He points to the use of a technique known as whole genome sequencing to help detect a listeria outbreak linked to Blue Bell brand ice cream.
"There were only 10 individuals that were ever linked to the outbreak. The first one became ill in 2010 and the last one [became ill] in 2015," explains Dudley.
So, how did scientists figure out these 10 cases were all connected to Blue Bell's ice cream products? After all, there were hundreds of other cases of listeria sicknesses from other foods during that time period.
Whole genome sequencing allows scientists to produce high-resolution DNA fingerprints of the organisms under investigation.
"The advantage of whole genome sequencing is that it gives us a lot more information when we're trying to tell whether an organism we isolate from a food is the same exact [organism] that we isolate from the individuals who became ill," says Dudley. In outbreaks, scientists are looking for a direct match.
Older technology gives only a few dozen data points, Dudley says. "Whereas whole genome sequencing is giving us 4 to 5 million pieces of data" to make the match.
With Improved Detection Comes Perception of More Risk
So, this takes us back to a key question. Since we tend to hear more about foodborne illness outbreaks, there's a perception that the risk has gone up. But, is our food supply any more or less safe than it used to be? All the experts I spoke with had similar answers.
"There's really no evidence that our food supply is more unsafe than it has been in the past," Dudley told us.
This view is echoed by Nirav Shah. "Our food system today is probably the safest it's even been in history of the United States," he told us.
FDA Commissioner Scott Gottlieb has weighed in as well. In a statement last June he wrote, "We believe food is safer than perhaps ever before." He went on: "What's happening is that our ability to identify outbreaks has dramatically improved due to new information technologies and laboratory techniques."
So, though it may seem like a paradox, even as the CDC investigates lots of multi-state outbreaks, by many accounts our food supply is no less safe.
Another thing that adds to the perception of risk: We hear about recalls — even when they're not linked to illness. Take for example, the recent Goldfish cracker recall. In this case there were no sicknesses linked to the cracker. However, the manufacturer of an ingredient used in some varieties of Goldfish found salmonella in its facility. So, Pepperidge Farm, out of an abundance of caution, voluntarily recalled four varieties of Goldfish crackers.
Another example: Kraft Heinz recalled its Taco Bell brand of queso from stores because of a risk of botulism. No illnesses were linked to the product, but jars showed signs of separation, which could create the conditions for the bacteria that causes botulism to grow.
When you look at the overall number of people getting sick from foodborne illness in the U.S., it's relatively stable. From year to year, the numbers vary some, but "the overall picture is that we're not seeing a large increase in the number of people getting sick," says Matt Wise of the CDC's outbreak response and prevention branch.
At the same time, there seems to be an increase in outbreaks this year.
"You can't question that this year's been a, sort of, bumper year. We've had a lot of outbreaks that have been detected and investigated," says Wise. "So, we'll have to wait and see whether this becomes a new normal, or whether this just happened to be a blip on the radar."
And, of course, there's still plenty of room for improvement when it comes to food safety. The CDC estimates that about 1 in 6 people get a foodborne illnesses each year. That equates to millions of sicknesses.
In the meantime, Matt Arteaga says the cyclospora infection took its toll. His GI distress lasted for weeks. He has hired a lawyer who is considering legal action.
RACHEL MARTIN, HOST:
It seems like we've been hearing a lot about unsafe food these days. Just this year, there have been recalls for romaine lettuce, some varieties of the snack Goldfish and a Taco Bell-brand queso dip. McDonald's stopped selling salads at thousands of locations for a while because there was a risk of getting sick. But does all that mean our food supply is generally less safe? NPR's Allison Aubrey reports.
ALLISON AUBREY, BYLINE: On a Thursday afternoon in late June, Matt Arteaga was at his office in Danville, Ill., when he began to feel sick. It came on quickly. It kind of felt like the flu.
MATT ARTEAGA: The chills and body aches and severe cramping and sharp pain in my stomach.
AUBREY: After a test revealed he had an infection caused by cyclospora, a parasite, he had a lot of questions. Where did he get it, for starters? His doctor could not answer this, but did report his case to the Illinois Department of Public Health. Nirav Shah is the director.
NIRAV SHAH: In early July, our team of disease detectives observed an uptick in reports of cyclospora that were being submitted to us.
AUBREY: And they would soon find out that nearby states saw the same. Now, to figure out what the source of the cyclospora might be, health officials got in touch with Matt Arteaga and others who'd gotten sick and asked them to make a list of every food they'd eaten before they got sick. Matt Arteaga says he used his bank records to help jog his memory.
ARTEAGA: What we did was, because I pay with my debit card all the time, just went through every restaurant that I had eaten in the two weeks prior to getting sick. And I had a salad at McDonald's three times.
AUBREY: Turned out many of the people sickened with cyclospora also reported they'd eaten salads at McDonald's. Here's Director Shah again.
SHAH: We got on the phone with McDonald's, advised them of what we recommended and made sure that we notified the public immediately.
AUBREY: The chain halted sales of salads at about 3,000 locations until they could switch to a different lettuce supplier. And FDA testing confirmed the presence of cyclospora in an unused package of lettuce that had been distributed to the chain. This added to the evidence that the salads had been the likely source. All told, about 500 people in 16 states got sick. Now, this may not sound like a success story given all the sickness. But if it had happened 20 years ago, could've been worse. Shah says the outbreak may never have been detected.
SHAH: Because the test that doctors use to diagnose cyclospora wasn't even approved by the FDA until May of 2014.
AUBREY: This would have made it harder to identify the parasite and to trace the sicknesses back to a common source. So in a case like this, McDonald's salads may never have been identified. And the chain would not have been able to pull them from the market to prevent more people from getting sick.
SHAH: But we're now in a situation where people know if I go to my doctor, I can get tested. I can get a diagnosis. And as a result of that, they report these conditions, and now we can actually link up what's going on.
AUBREY: It doesn't always work out, but Shah says the better testing, combined with newer techniques that make it possible to get high-resolution DNA fingerprints of foodborne pathogens, makes a big difference.
SHAH: Technology has been a game-changer for foodborne outbreaks.
AUBREY: So this takes us back to a key question. Is our food supply any more or less safe than it used to be? Shah says despite hearing more about outbreaks...
SHAH: Our food system today is probably the safest it has ever been in the history of the United States or in the world.
AUBREY: Lots of experts I spoke to shared this view, including several academic food scientists. But of course there's still room for improvement. The CDC estimates about 1 in 6 people get a foodborne illness each year. That's millions of sicknesses, and the CDC's Matthew Wise says the number of people who get sick is fairly steady. But with improved surveillance and technology, he says it's possible to detect more outbreaks.
MATTHEW WISE: This year's been sort of a bumper year. We've had a lot of outbreaks that have been detected and investigated. And so I think we'll have to wait and see for the next couple of years whether this becomes a new normal or whether this just happened to be sort of a blip on the radar.
MARTIN: Allison is here in the studio to talk a little bit more about this and her reporting. So Allison, what we're hearing is not that there's necessarily more people getting sick from foodborne illnesses. It's just that...
AUBREY: That's right.
MARTIN: ...We are able to detect it more often than not.
AUBREY: That's right. This seems to be the case. I mean, it may sound like a paradox, but think about what we just heard from Matt Arteaga and the cyclospora outbreak. On paper, cyclospora cases are way up in Illinois. But part of this is that they're catching them. They're detecting the cases that in the past, they would not have known existed. And that's due to improved testing.
MARTIN: Health officials are saying that our food supply is as safe as it's ever been. But I mean, clearly, there are still lots of people who get sick. So how do we all avoid...
MARTIN: ...Becoming one of them?
AUBREY: Right. Well, you know, when we cook in our own kitchens, we have a lot of control, right? We're told to cook meats to a proper temperature. This kills pathogens. We're told to wash our produce, not cut fruits and vegetables on the same tray that we use to cut raw meat.
AUBREY: But when we eat out or buy prepared foods, we hand over that control.
MARTIN: And that's where a lot of the outbreaks are happening?
AUBREY: Well, in addition to the salads, if you look at the outbreaks this summer, there were several linked to fresh-prepared foods. There was a vegetable tray recall and a separate outbreak linked to sliced or precut melons. So think of it this way. Every time a food is handled or processed, there is an opportunity for contamination. Now, the risk is very small. I mean, millions and millions of people eat these foods and don't get sick. But if you've got small children or elderly or immunocompromised people in your home, you may want to think about which foods you buy.
MARTIN: So what about when we're eating out? What about people who eat in restaurants? Anything you can do to limit your risk there?
AUBREY: Now, this may come as a surprise, but the most common foodborne illness is not the bacteria we tend to hear about, such as salmonella or E. coli. The most common is norovirus. It's sometimes referred to as the cruise ship virus because clusters of people...
AUBREY: ...Get sick all at once. Now, a common way people get it is from sick workers in restaurants. So say a line cook or a server shows up sick, contaminates the food. You're the unlucky person served that food. You can get sick. And unfortunately, there's just not much you can do about that.
MARTIN: What about washing our hands? We hear all the time how if we wash our hands, that can help.
AUBREY: Too late. It's too late. Now, if the sick worker washed their hands, that could help. But the best thing is if that sick worker stayed home. Now, some restaurants and chains are better than others at encouraging sick workers to stay home by giving them paid sick leave.
MARTIN: Right. NPR's Allison Aubrey. Thanks so much.
AUBREY: Thanks, Rachel.
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