That outbreak, which caused 714 illnesses and nine deaths across 46 states, was linked to infection with Salmonella Typhimurium from tainted peanut butter and peanut butter paste products.
Researchers who were on the frontlines of that investigation said the experience may help them get a better handle on the ongoing ground-turkey outbreak, which has sickened more than 100 people in over 30 states.
"There were real challenges posed with peanut butter because it served as ingredients in many foods with different distribution channels," said Dr. Casey Barton Behravesh, an epidemiologist with the U.S. Centers for Disease Control and Prevention in Atlanta.
"We had to look at invoices for those foods to help identify the food item and provide rapid trace back to the manufacturer," she said. State and local officials also conducted interviews with people who fell ill, she said.
Ground-turkey, like peanut butter, is an ingredient in many processed foods, including sauces. Contamination can occur during different stages of production, which complicates detection.
Investigators have traced the recent illnesses to infection with Salmonella Heidelberg found in some ground-turkey made by Cargill, Inc.
The 2008-2009 outbreak fueled a massive recall of peanut butter products, some of which were precautionary. The source was traced back to two Peanut Corp. of America processing plants in Georgia and Texas. Inspections revealed rats, insects, roaches, standing water and roof leaks inside the plants. This company filed for bankruptcy amid fallout from the outbreak.
Writing in the Aug. 18 issue of the New England Journal of Medicine, Behravesh and colleagues said tainted peanuts and peanut butter products probably caused many more consumers to become ill than was reported at the time.
"For every case that is lab-confirmed, there are others that didn't go to the doctor or get stool tested. It likely caused thousands of illnesses," said Behravesh.
That outbreak may have had a silver lining, though, in that national attention was redirected toward food safety and prevention of foodborne illnesses. In March 2009, the President's Food Safety Working Group was created, and earlier this year the Food Safety Modernization Act was enacted. The law gives the U.S. Food and Drug Administration unprecedented power to order food recalls and insist that U.S. and foreign food suppliers develop food-safety plans, the authors said.
"What is important with all of this is to improve outbreak responses and detection, identify sick people quickly, interview them more quickly and identify foods causing outbreaks more quickly," Behravesh said.
But these improvements and changes do not take the onus away from individuals, she said. Following safe food-handling precautions when cooking meats and avoiding cross-contamination in the kitchen are still important ways to lower risk of foodborne illness.
Symptoms of Salmonella, the most common foodborne illness in the United States, include fever, diarrhea, abdominal cramps and headache.
Dr. Philip Tierno, director of clinical microbiology and immunology at New York University Langone Medical Center, said if he had to grade the United States on how it handled the peanut butter outbreak, he would give a C-plus. "I wouldn't give a B but we are bordering on a B," he said.
The room for improvement lies in preventing outbreaks, he said. "We are fairly good in terms of having a mechanism in place to track outbreaks, close factories and warn the public, but we are not that good at prevention and that is what we have to work on," he said.
Prevention starts with cutting down on the antibiotics used in agriculture, including plants and meats, he said. This practice has given rise to antibiotic-resistant strains of bacteria identified in some of these outbreaks.
"In the U.S., we use 25 million pounds of antibiotics in agriculture [a year] and only 3 million pounds to treat disease," he said. "We can identify a problem after it happens, but until we eliminate the use of antibiotics in the agriculture industry, this country will be waylaid with outbreaks," he said.
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