Dietary, socioeconomic, and maize handling practices associated with aflatoxin and fumonisin exposure among women tortilla makers in 5 departments in Guatemala.

Previous research has demonstrated human exposure to mycotoxins among Guatemalans, with high levels of mycotoxins being found in blood and urine samples as well as in maize for human consumption. Mishandling of crops such as maize during pre- and post-harvest has been associated with mycotoxin contamination. The overarching goal of this study was to identify risk factors for aflatoxin and fumonisin exposure in Guatemala. A cross-sectional survey of 141 women tortilla makers was conducted in the departments of Guatemala, Sololá, Suchitepéquez, Izabal, and Zacapa in February 2022. Maize and tortilla samples were collected and analyzed for aflatoxin B1 (AFB1) and fumonisin B1, B2, and B3 contamination (FB1, FB2, FB3). Urine samples were collected and analyzed for urinary FB1 (uFB1) contamination. A questionnaire was administered to collect data on sociodemographic characteristics, dietary intake of maize-based foods the week prior to the study, and maize handling practices. Descriptive statistics were used to describe common maize handling practices. A univariable analysis was conducted to identify predictors of low/high AFB1, total fumonisins, and uFB1. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). During tortilla processing, a reduction in the AFB1 and total fumonisin levels was observed. The presence of AFB1 in maize was associated with department and mean total fumonisin level in maize (OR: 1.705, 95% CI: 1.113-2.613). The department where the tortilleria was located was significantly associated with the presence of fumonisins in tortillas. Increased consumption of Tortrix was significantly associated with the presence of FB1 in urine (OR: 1.652, 95% CI: 1.072-2.546). Results of this study can be used in the development and implementation of supply chain management practices that mitigate mycotoxin production, reduce food waste and economic loss, and promote food security.

Ranking Food Safety Priorities of the Fresh Produce Industry in the United States.

A broad understanding of community member food safety priorities in the fresh produce supply chain does not currently exist. This information is essential to improve food safety knowledge and practices effectively and efficiently throughout the fresh produce industry; therefore, the goal of this study was to identify and rank community produce safety priorities in the United States. Survey questions were designed and approved by food safety experts for participants to rank 24 fresh produce safety priorities. The anonymous survey was distributed online via Qualtrics™ to fresh produce community members from November 2020 to May 2021. A score was calculated for each priority by summing weighted ranking scores across responses. Descriptive statistics and logistic regression were used to determine frequencies and distribution of response and identify factors (e.g., role in produce safety, size/location of organization/operation) that influenced rankings. A total of 281 respondents represented fourteen different roles in the fresh produce industry, with most identified as growers (39.5%). Produce operations were distributed across the U.S. and annual produce sales ranged from below $25,000 to over $5,000,000. Health and hygiene, training, postharvest sanitation, traceability, and harvest sanitation were ranked as the top five food safety priorities. These findings provide insight into community member priorities in fresh produce safety and can be used to inform intervention efforts, ranging from specialized training for produce growers and packers, industry-driven research projects, and gaps in risk communication strategies.

Dietary and socioeconomic risk factors for fumonisin exposure among women of reproductive age in 18 municipalities in Guatemala from 2013 to 2014.

Fumonisin exposure is common in populations where maize is a dietary staple, such as in Guatemala, and has been associated with negative health outcomes including neural tube defects. The objective of this study was to estimate fumonisin B1 (FB1) exposure among Guatemalan reproductive-age women and develop a better understanding of the dietary and sociodemographic risk factors for exposure. A cross-sectional study in 18 municipalities in Guatemala was conducted. Midwives and study nurses enrolled consenting women and collected individual and household demographic and socioeconomic data. A food frequency questionnaire was administered to estimate quantity and types of food products consumed. A urine sample was collected and urinary fumonisin B1 (uFB1) concentration was measured. A univariable analysis was conducted to identify predictors of low/high uFB1. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). In total, 775 women had analyzable urine samples. Higher uFB1 levels were associated with speaking Mayan (OR = 2.33, 95% CI:1.44-3.77), less than high school education (OR = 1.61, 95% CI:1.12-2.30), increasing dietary proportion of maize-based foods (OR = 1.02, 95% CI:1.01-1.03), and consumption of tostadas (fried tortillas) (OR = 1.11, 95% CI:1.02-1.22). Lower uFB1 levels were associated with consumption of highly processed maize-based foods (OR = 0.93, 95% CI:0.87-0.99). Tortillas were the most frequently consumed maize-based food among study participants and significantly associated with high uFB1 exposure in the univariable but not multivariable analysis. Consumption of >4,750 grams/week of maize-based foods, >5,184 g/week of locally produced maize-based foods, and >110 servings/week of tortillas were also significantly associated with high uFB1 exposure in univariable analysis. Populations with low socioeconomic status/education levels and high consumption of maize-based foods had higher fumonisin exposure. Interventions aimed at reducing the risk of exposure to mycotoxins through maize in Guatemala, including the increased consumption of non-maize-based foods, should be further explored.

Risk-based Decision Making Definition: A Scoping Review of Food, Agricultural, Environmental, and Medical Literature.

Risk-based decision making (RBDM) is a term that is used frequently as an aspirational goal in many fields, including health, engineering, environmental science, regulatory and, more recently, food safety. When RBDM is used in the literature, many different types of criteria are used to characterize a decision process as being "risk-based." Like the parable about the blind men and the elephant, everyone is confident they know what RBDM means even though there is no universal definition. The use of RBDM is gaining wide acceptance and implies a level of rigor and focus that many decisionmakers and stakeholders are interested in adopting. However, without one clear definition, there are questions about what a RBDM approach really means. This study summarizes peer-reviewed and gray literature that uses the term "RBDM" from the last 50 years in the agricultural, environmental, and medical areas. The criteria discussed were identified and organized into themes. A foundational definition is proposed to represent the most fundamental use of RBDM in the literature, and three themes covering the additional concepts presented in some of the literature were identified and added as themes within the definition. Results from this research will inform practitioners interested in following the principles of RBDM, and will help guide researchers who are interested in advancing this approach. The most immediate use will be to guide the development of a roadmap for a risk-based food safety system for low- and middle-income countries and to aid the global food safety community in moving toward RBDM.

Comparison of Statistical Methods for Identifying Risk Factors for Salmonella Contamination of Whole Chicken Carcasses.

ABSTRACT: The complexity of the food system makes analyzing microbiological data from food studies challenging because many of the assumptions (e.g., linear relationship between independent and dependent variable and independence of observations) associated with common analytical approaches (e.g., analysis of variance) are violated. Repeated sampling within an establishment introduces longitudinal correlation that must be accounted for during analyses. In this study, statistical methods for clustered or correlated data were used to determine how correlation impacts conclusions and to compare how assumptions associated with statistical methods impact the appropriateness of these methods within the context of food safety. Risk factor analyses for Salmonella contamination of whole chicken carcasses were conducted as a case study with regulatory data collected by the U.S. Department of Agriculture Food Safety and Inspection Service between May 2015 and December 2019 from 203 regulated establishments. Three models, generalized estimating equation, random effects, and logistic, were fit to Salmonella presence or absence data with establishment demographics and inspection history included as potential covariates. Beta parameter estimates and their standard errors and odds ratios and their 95% confidence intervals were compared across models. Conclusions drawn from the three models differed with respect to geographic region, whether the chicken establishment also slaughters turkeys, and establishment noncompliance with 9 CFR §417.4 (hazard analysis critical control point system validation, verification, and reassessment) in the 84 days leading up to sample collection. The results of this study reveal the need to consider clustering and correlation when analyzing food microbiological data, provide context for selecting a statistical method, and suggest that generalized estimating equation and random effects models are preferrable over logistic regression when analyzing correlated food data. These results support a renewed focus on statistical methodology in food safety.

Risk Factors for Salmonella Contamination of Whole Chicken Carcasses following Changes in U.S. Regulatory Oversight.

ABSTRACT: Salmonella is a common cause of foodborne illness in the United States and often is linked to chicken products. Salmonella contamination has been associated with meat processing facility characteristics, such as the number of employees (i.e., hazard analysis critical control point [HACCP]-based definition of size). The risk factors for Salmonella contamination in U.S. poultry have not been evaluated since implementation of the New Poultry Inspection System (NPIS) in 2014. The goal of this study was to determine whether risk factors for Salmonella contamination changed after implementation of the NPIS. Presence or absence of Salmonella in whole chicken carcasses was modeled using microbiological testing data collected from 203 poultry processing establishments by the U.S. Department of Agriculture Food Safety and Inspection Service between May 2015 and December 2019. A model was fit using generalized estimating equations for weekly presence or absence of Salmonella, and production volume, geographic location, and season were included as potential covariates among other establishment demographics. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from the marginal model. Of the 40,497 analyzable samples, 1,725 (4.26%) were positive for Salmonella. Odds of contamination was lower among establishments slaughtering ≥10,000,000 birds per year (OR = 0.466; 95% CI, [0.307, 0.710]) and establishments producing ready-to-eat finished products (OR = 0.498; 95% CI, [0.298, 0.833]) and higher among establishments historically (previous 84 days) noncompliant with HACCP regulations (OR = 1.249; 95% CI, [1.071, 1.456]). Contamination also significantly varied by season and geographic region, with higher odds of contamination during summer and outside the MidEast Central region. These results support continuation of targeted food safety policies and initiatives promoting pathogen reduction by establishments with smaller volumes and those noncompliant with HACCP regulations.

Food Safety Challenges in Refugee Camps: What Do We Know?

ABSTRACT: Refugee camps provide basic necessities such as food, water, shelter, and medical treatment for displaced persons. Unsanitary conditions in refugee camps due to overcrowding, poor sanitation systems, lack of clean water, and minimal ways to cook and store food can lead to an increased risk of foodborne illness. This article reviews the limited literature on the epidemiology of foodborne illness in refugee camps, effective risk mitigation strategies, and opportunities for future research. Eleven relevant articles were identified, suggesting that research in this area is limited. Identified research focused on three pathogens-Vibrio cholerae, Salmonella, and hepatitis E virus-that can cause serious diseases such as cholera, salmonellosis, typhoid fever, and hepatitis E. Storage and handling of clean water for personal hygiene and food preparation were critical components for ensuring food safety. Knowledge pertaining to best practices for hygiene and food preparation also were identified as important. Gaps in current research include determination of the prevalence of pathogens in food sold in refugee camps and development of culturally relevant food safety supply chain quality management systems. More research that focuses on burden and attribution of foodborne illness and food safety interventions in refugee camps is necessary.

The Public Health Impact of Implementing a Concentration-Based Microbiological Criterion for Controlling Salmonella in Ground Turkey.

Despite initiatives to improve the safety of poultry products in the United States, progress has stalled, and salmonellosis incidence is still above Healthy People 2020's goal. One strategy to manage Salmonella and verify process control in poultry establishments is to implement microbiological criteria (MC) linked to public health outcomes. Concentration-based MC have been used by the food industry; however, the public health impact of such approaches is only starting to be assessed. This study evaluated the public health impact of a concentration-based MC for Salmonella in raw ground turkey consumed in the United States using a quantitative risk assessment modeling approach. The distribution of Salmonella concentration in ground turkey was derived from USDA-FSIS monitoring surveys. Other variables and parameters were derived from public databases, literature, and expert opinion. Based on considered concentrations, implementing a MC of 1 cell/g led to an estimated 46.1% reduction (preventable fraction, PF) in the mean probability of illness when consumer cooking and cross-contamination were included. The PF was consistent across scenarios including or excluding cross-contamination and cooking, with slightly lower mean PF when cross-contamination was included. The proportion of lots not compliant with the 1 cell/g MC was 1.05% in the main scenarios and increased nonlinearly when higher Salmonella concentrations were assumed. Assumptions on concentration variability across lots and within lots had a large impact, highlighting the benefit of reducing this uncertainty. These approach and results can help inform the development of MC to monitor and control Salmonella in ground turkey products.

Facilitating Evaluation of Hemolytic Uremic Syndrome Long-Term Health Outcomes Through Social Media Support Groups.

Individual burden and cost of hemolytic uremic syndrome (HUS)-a medical condition characterized by acute kidney failure-can be substantial when accounting for long-term health outcomes (LTHOs). Because of the low incidence of HUS, evaluation of associated LTHOs is often restricted to physician and outbreak cohorts, both of which may not be representative of all HUS cases. This exploratory study recruited participants from private social media support groups for families of HUS cases to identify potential LTHOs and costs of HUS that are not currently measured. Additionally, this study sought to identify case characteristics that may confound or modify these LTHOs and costs of HUS. Respondents self-selected to complete an online cross-sectional survey on acute and chronic illness history, treatments, and public health follow-up for HUS cases. Posttraumatic stress among respondents (typically case parents) was also evaluated. Responses were received for 74 HUS cases from 71 families representing all geographic regions, and levels of urbanicity within the US self-reported symptoms were typical for HUS, while 35.1% of cases reported antibiotic treatment at any point during the acute illness. Hospital transfers were reported by 71.6% of cases introducing possible delays to care. More than 70% of cases reported experiencing at least one LTHO, with 45% of cases reporting renal sequelae. Posttraumatic stress symptoms were frequently reported by respondents indirectly affected by HUS. Potentially large economic costs that are not addressed in existing analyses were identified including both financial and more general welfare losses (lost utility). While biases in the study design limit the generalizability of results to all HUS cases, this study provides new insights into unmeasured LTHOs and costs associated with HUS. These results suggest that robustly designed cohort studies on HUS should include measures of psychosocial impacts on both the affected individual and their family members.

Evaluation of U.S. Poison Center Data for Surveillance of Foodborne Disease.

INTRODUCTION: Enhancing foodborne disease (FBD) surveillance and improving the timeliness of outbreak detection have been identified as public health priorities. Consumer complaint data have become increasingly useful for FBD surveillance and the detection of outbreaks. Calls to poison centers are a potential source of consumer complaint data. A retrospective analysis of data from the National Poison Data System (NPDS) (2000-2011) was undertaken to evaluate the value of data collected through the United States poison centers for detection of large national outbreaks and recalls. METHODS: Demographic and clinical data were summarized. Prevalences of FBD calls were calculated and analyzed for time trends. Significant increases in daily call prevalences were identified, and dates of the increases were compared to the announcement of 18 national outbreaks/recalls. RESULTS: Over the 12-year period, there were 433,788 unique calls self-reporting a suspected FBD exposure in humans. Overall, daily call prevalences decreased over time. Only about half of callers reported common gastrointestinal clinical effects. Of the 42 identified significant increases in call prevalences, none occurred within 14 days before an outbreak announcement; 7 occurred within 14 days after an outbreak announcement. CONCLUSIONS: Based on this analysis, there are significant limitations to using self-reported FBD exposures to NPDS as a source of information for FBD surveillance of large national outbreaks and recalls; however, a syndromic approach may yield different results and should be explored. Improved data collection and coordination with public health agencies may improve the ability to use NPDS data to monitor FBD in near real-time, identify potential outbreaks, and improve situational awareness.