Happy Thanksgiving… Food Safety Considerations

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[The following information is con- densed from Food Safety and Inspec- tion Service United States Department of Agriculture web site] Each year, an esti- mated 45 million turkeys are eaten in the United States at Thanksgiving. Tur- key provides a sig- nificant amount of protein as well as other nutrients. Fat, saturated fat and cholesterol are also present, with most of the fat being in the skin.

A three ounce serving of baked turkey breast with skin has 160 calories, 6 grams of fat, 65 milligrams of cholesterol and 24 grams of protein; without skin, 120 calories, 1 gram of fat, 55 milligrams of cholesterol and 26 grams of protein. All turkeys found in retail stores are either inspected by the United States Department of Agriculture (USDA) or by state systems which have standards equivalent to the federal government. Each turkey and its internal organs are inspected for evidence of disease.

The "Inspected for wholesomeness by the U.S. Department of Agriculture" seal ensures that it is wholesome, properly labeled and not adulterated. Foodborne Organ- isms Associated with Turkey A large crowd to cook for, a big bird to roast, and to many cooks in the kitchen can lead to foodborne illness from ... more. less.

holiday dining. But handling and cooking a turkey needn 9t be an illness waiting to happen. Salmonella Enteritidis may be found in the intestinal tracts of livestock, poultry, dogs, cats and other warm- blooded animals, and inside fresh shell eggs. Salmonella infections oc- cur when a person ingests live Salmo- nella bacteria, which then survive di- gestion and reproduce in the small in- testine to numbers large enough to cause symptoms. This strain is only one of about 2,000 kinds of Salmo- nella bacteria. Thorough cooking de- stroys Salmonella bacteria. Campylobacter jejuni is one of the most common causes of diarrheal ill- ness in humans. It is found in the in- testinal tracts of chickens, turkeys, cattle, swine, sheep, dogs, cats, ro- dents, monkeys, some wild birds and some asymptomatic humans. It has also been found in water, soil and sewage sludge. Avoiding cross Happy Thanksgiving& Food Safety Considerations Mary Jo Trepka, MD, MSPH Director, Office of Epidemiology and Disease Control 1350 NW 14 Street BLDG. 7 Miami, Florida 33125 Tel: 305-324-2413 Fax: 305-325-3562 Email: Maryjo_Trepka@doh.state.fl.us Website:www.dadehealth.org Inside this issue: V OLUME 3. I SSUE 11 NOVEMBER 2002 P AGE -1 Happy Thanksgiving Food Safety Consid- erations 1 Acute Weakness Asso- ciated with West Nile Virus Infection 3 Influenza Vaccine 4 Selected Reportable Diseases/Conditions in Miami-Dade County, October 2002 5 Radiation, Biological, and Chemical Emer- gencies: Response and Triage 6 contamination and proper cooking prevent infection by this bacterium. Staphylococcus aureus can be carried on human skin, in infected cuts and pimples, in nasal passages and throats. The bacteria are spread by improper food handling. Always wash hands and utensils be- fore preparing and serving food. Cooked foods that will not be served immediately should be refriger- ated in shallow, covered containers. Perishable foods should not be left at room temperature more than 2 hours. Temperature abuse can allow the bac- teria to grow and produce staphylococcal entero- toxin. Thorough cooking destroys staphylococcal bacterial cells, but staphylococcal enterotoxin is not destroyed by heat, refrigeration or freezing. Listeria monocytogenes bacteria are common in the intestines of humans and animals and in milk, soil, leafy vegetables, and food processing environments. It can grow slowly at refrigerator temperatures. It is destroyed by cooking but a cooked product can be contaminated by poor personal hygiene. Observe "keep refrigerated" and "use-by dates" on labels. Following basic USDA recommenda- tions will help ensure safe, confident cooking and prevent foodborne ill- ness for diners Safe Thawing There are three safe ways to thaw food: in the refrigerator, in cold water, and in the microwave oven. Store frozen turkeys in the freezer until time to thaw. While frozen, a turkey is safe in- definitely. However, if the turkey is allowed to thaw at a temperature above 40° F, any harmful bacteria that may have been present before freezing can be- gin to multiply again unless proper thawing meth- ods are us ed. When thawing a turkey in the refrigerator, plan ahead. Place the turkey on a platter and place in the refrigerator. For every 5 pounds of turkey, allow ap- proximately 24 hours of thawing in a refrigerator set at 40° F. For thawing in cold water, allow about 30 minutes per pound. Be sure the turkey is in leak-proof pack- aging and submerge it in cold tap water. Change the water every 30 minutes until the turkey thaws. When thawing in the microwave, follow the manu- facturer 9s instructions. For both defrosting in cold water and in the microwave, cook the turkey imme- diately after thawing because conditions were not temperature controlled. Stuffing a Turkey The safest way to cook stuffing is in a casserole, not inside a bird. Bake the casse- role in an oven set no lower than 325° F -- or in a microwave oven -- until the internal temperature reaches at least 165° F on a food thermometer. Harmful bacteria can survive in stuffing that has not reached a safe temperature, possibly resulting in foodborne illness. Cooking a stuffed turkey is riskier than cooking one not stuffed. However, if both the stuffing and turkey are handled safely and a food thermometer is used, it is possible to cook a stuffed turkey safely. Mix wet and dry stuffing ingredients just before spoon- ing it loosely into the turkey cavity, and roast the turkey immediately. Check the temperature of both the stuffing and the turkey. Do not remove the tur- key from the oven until the stuffing reaches 165° F. Cooking a Turkey Safely Thawing and stuffing a turkey safely are the first two basics. But cooking is the only way to destroy bacteria. The oven tempera- ture must be set no lower than 325° F. Overnight cooking of a turkey at a low temperature can result in foodborne illness. The internal temperature, on a food thermometer, of a whole turkey must reach 180° F in the innermost part of the thigh. If the turkey has a "pop-up" tem- perature indicator, it is also recommended that a food thermometer be used to test the turkey in several places. To read more "Turkey Basics" and print a cooking time chart, go to www.fsis. usda.gov/oa/pubs/tbcook.htm. Handling Precooked Dinners and Leftovers Some cooks forego home-cooking a turkey alto- gether and choose to purchase precooked dinners. There are also basic safety measures for the safe handling of these holiday meals. If the dinners are Volume 3. Issue 11 November 2002 Page-2 to be picked up hot, keep the food hot. Keeping foods warm is not enough. Harmful bacteria multi- ply fastest in the "danger zone" between 40 and 140° F. Set the oven temperature high enough to keep the internal temperature of the turkey and side dishes at 140° F or above. Eat the food within 2 hours of pickup. When picking up cold turkey dinners, refrigerate them as soon as possible, always within 2 hours. Serve the meal within 1 to 2 days. Turkey may be eaten cold, but reheating a whole turkey is not rec- ommended. To reheat, slice breast meat (legs and wings may be left whole), and heat turkey pieces and side dishes thoroughly to 165° F. Perishable foods should not be left out of the refrigerator or oven for more than 2 hours. Refrigerate or freeze all leftovers promptly in shallow containers. It is safe to re- freeze leftover turkey and trim- mings even if they were previously frozen. Acute Weakness Associated with West Nile Virus Infection [This notice is selected from Emerging Infections Network Discussion Group, 11/24/02] West Nile virus (WNV) infection has been associ- ated with a broad range of clinical presentations, ranging from subclinical infection to severe en- cephalitis and death. In previous outbreaks, acute weakness has been noted, and has been attributed to an acute axonal or demyelinating process (Guillain- Barre syndrome [GBS]), stroke, myopathy, or other etiology. Recently, acute WNV infection has been associated with a poliomyelitis (Leis et al, N Engl J Med 2002; 347: 1279-1280; Glass et al, N Engl J Med 2002; 347: 1280-1281; CDC, MMWR Sept. 20, 2002; 51(37): 825-828). The cases described in these reports all had similar features, which in- cluded a) acute onset of asymmetric weakness, often presenting with monoplegia; b) onset of the weak- ness during the acute phase of infection, often within 48 hours of onset of other symptoms of in- fection; c) absence of sensory loss, pain, or pares- thesias; and d) a cerebrospinal fluid with both mildly elevated protein and a pleocytosis. In addi- tion, electrodiagnostic studies (electromyography and nerve conduction studies) were consistent with a process localized to the anterior horn cells of the spinal cord. All of these features suggest a central process, and are inconsistent with GBS, stroke, or other etiologies of acute weakness. Physicians are urged to consider poliomyelitis in pa- tients presenting with acute weakness in the setting of WNV infection, and to pursue appropriate diag- nostic testing, including CSF examination and elec- trodiagnostic studies, before initiating therapies di- rected at GBS, stroke, myopathy, or other causes of acute weakness. In an effort to further define the scope of this mani- festation of acute WNV infection, and to identify additional cases, the Centers for Disease Control and Prevention (CDC) is requesting information on cases of acute flaccid paralysis associated with acute WNV infection. Health-care workers who are aware of patients with the findings described above, as well as patients with atypical features (weakness associated with pain; weakness of delayed/chronic onset) are requested to contact CDC; information may be directed to: James J. Sejvar, MD Medical Epidemiologist Division of Viral and Rickettsial Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention 1600 Clifton Road, MS A-39 Atlanta GA 30333 Ph 404-639-4657 Fax 404-639-3838 Email zea3@cdc.gov Volume 3. Issue 11 November 2002 Page-3 Influenza Vaccine [The National Immunization Program (NIP) of the Cen- ters for Disease Control and Prevention (CDC) is pub- lishing and distributing periodic bulletins to update part- ners about recent developments related to the production, distribution and administration of influenza vaccine for the 2002-2003 influenza season. All recipients of this bulletin are encouraged to distribute each issue widely to colleagues, members and constituents.] Influenza Vaccine Supply and Production Current projections suggest about 93 million doses of influenza vaccine are available in the U.S. market this season and several million doses remain avail- able for purchase. f Health care providers who wish to pur- chase influenza vaccine should contact their regular sources of pharmaceuticals. f After November, many persons who should or want to receive influenza vac- cine remain unvaccinated. The Advisory Committee on Immunization Practices (ACIP) recommends that vaccination ef- forts for all groups, especially persons at high risk, their household contacts, and health care workers, should continue into December or later, for as long as vaccine is available. Influenza Vaccine Distribution and Administra- tion f An adult immunization schedule is now avail- able to help family physicians, gynecologists, inter- nists, and other health care providers to assess the vaccine needs of patients during office visits and to administer the appropriate vaccines (including influ- enza vaccine). f The Recommended Adult Immunization Schedule was approved by the Advisory Committee on Immunization Practices in February 2002 and has been accepted by the American Academy of Family Physi- cians and the American College of Ob- stetricians and Gynecologists. Providers can use the schedule to promote the use of standing orders, patient-reminder/ recall systems, provider-reminder sys- tems and other strategies that reduce missed opportunities to vaccinate pa- tients. A printable, annotated, color ver- sion of the schedule is available at http:// www.cdc.gov/nip Influenza Vaccine Communications Flu patient-education ccatch-up d material is now available from CDC. f The CDC National Immunization Pro- gram has developed new patient- education print material to encourage people who have delayed getting a flu shot to obtain this valuable protection. These ccatch-up d posters and flyers sup- plement the materials that were made available in September. All of the pa- tient-education materials for flu season can be viewed and reproduced directly from the NIP website at www.cdc.gov/ nip/flu/gallery.htm Black and white master copies of the flyers can be downloaded from this site and repro- duced on an office copy machine. Com- mercial printers can access the .pdf PRESS files to reproduce higher quality materials, large quantities of materials, items in multiple colors, posters, or but- tons. Commercial printers may also re- quest a CD-ROM with traditional Quark XPress 5.0 files by calling (404) 639- 8375 or e-mailing NIPINFO@cdc.gov Influenza surveillance through November 9 indicates some sporadic activity in the U.S. f During the week of November 3 3 No- vember 9, one state and territorial health department reported regional influenza activity, 17 reported sporadic activity and 32 reported no influenza activity. More information on influenza surveil- lance in the United States can be found at http://www.cdc.gov/ncidod/diseases/ flu/weekly. Volume 3. Issue 11 November 2002 Page-4 Volume 3. Issue 11 November 2002 Page-5 Monthly Report Selected Reportable Diseases/Conditions in Miami-Dade County, October 2002 * Data on AIDS are provisional at the county level and are subject to edit checks by state and federal agenci es. ** Data on tuberculosis are provisional at the county level. 2002 2002 2001 2000 1999 1998 this Month Year to Date Year to Date Year to Date Year to Date Year to Date AIDS *Provisional 61 978 1080 1153 1198 1392 Campylobacteriosis 17 90 105 129 119 83 Chancroid 0 0 0 0 0 2 Chlamydia trachomatis 322 3763 3169 2646 3583 2643 Ciguatera Poisoning 0 6 0 2 0 0 Cryptosporidiosis 4 10 13 28 21 11 Cyclosporosis 0 1 0 0 0 1 Diphtheria 0 0 0 0 0 0 E. coli , O157:H7 0 2 3 5 2 0 E. coli , Other 1 2 1 1 0 1 Encephalitis 0 0 0 0 0 0 Giardiasis, Acute 32 186 228 204 123 82 Gonorrhea 127 1616 1623 1769 2462 1951 Granuloma Inguinale 0 0 0 0 0 0 Haemophilus influenzae B (invasive) 0 0 1 2 1 1 Hepatitis A 0 97 157 75 79 113 Hepatitis B 5 38 55 47 20 67 HIV *Provisional 165 3566 3225 3188 3288 3471 Lead Poisoning 25 259 238 Not available Not available Not available Legionnaire's Disease 1 2 3 0 0 1 Leptospirosis 0 0 0 0 1 0 Lyme disease 0 2 6 7 0 2 Lymphogranuloma Venereum 0 0 0 0 0 0 Malaria 2 12 14 21 15 23 Measles 0 0 0 0 0 0 Meningitis (except aseptic) 5 13 17 21 28 15 Meningococcal Disease 1 11 14 25 18 11 Mumps 0 0 0 1 2 0 Pertussis 0 3 2 7 10 14 Polio 0 0 0 0 0 0 Rabies, Animal 0 0 0 0 0 1 Rubella 0 0 0 1 0 0 Salmonellosis 46 278 263 243 264 206 Shigellosis 23 218 126 196 165 208 Streptococcus pneumoniae, Drug Resistant 10 90 149 169 158 75 Syphilis, Infectious 20 180 167 115 60 22 Syphilis, Other 105 785 721 617 606 581 Tetanus 0 0 1 1 0 0 Toxoplasmosis 9 23 11 0 0 0 Tuberculosis *Provisional 35 191 186 215 217 245 Typhoid Fever 1 3 2 2 15 3 Vibrio , c holera 0 0 0 0 0 0 Vibrio , Other 0 0 0 0 0 1 Diseases/Conditions

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