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Food Safety Risk Assessment of NSW Food Safety Schemes

March 2009 NSW/FA/FI039/0903

Food Safety Risk Assessment of New South Wales Food Safety Schemes
Table of contents
Executive summary .........................................................................................................6 Introduction ................................................................................................................. 12 Dairy food safety scheme............................................................................................... 16 Meat food safety scheme ............................................................................................... 39 Plant products food safety scheme ................................................................................. 70 Seafood safety scheme.................................................................................................. 87 Vulnerable persons food safety scheme......................................................................... 109 Egg food safety scheme (draft) .................................................................................... 126 Risk Assessment - Conclusion....................................................................................... 144 Appendix 1: Microbiological and chemical hazards of concern.......................................... 145 Appendix 2: Australian food recalls (2004 to 2008) ........................................................ 179 Appendix 3: Australian foodborne illness outbreaks (1995-2008) ..................................... 184

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Table of tables
Dairy food safety scheme Table Table Table Table Pathogenic microorganisms detected in raw milk............................................... 17 Microbiological hazards in dairy products .......................................................... 18 Consumption of dairy products ........................................................................ 21 Summary of foodborne illness outbreaks attributed to dairy products and foods including dairy as an ingredient...................................................................... 23 Table 5 NZFSA risk profile outcomes examining hazards in dairy products ....................... 28 Table 6 Risk ranking for dairy products contaminated with Listeria monocytogenes .......... 30 Table 7 Risk ranking of dairy products.......................................................................... 31 Meat food safety scheme Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table 8 Microbiological hazards in livestock and poultry ................................................. 41 9 Consumption of meat and meat products in Australia ........................................ 45 10 Consumption of processed meats in Australia .................................................. 45 11 Summary of foodborne illness outbreaks attributed to all meat (including poultry, game meat and processed meat products)...................................................... 46 12 Prevalence of microbiological hazards in Australian beef and sheep meat........... 48 13 Prevalence of microbiological hazards on chicken meat in NSW......................... 50 14 Foodborne illness outbreaks of listeriosis from processed meats........................ 52 15 Prevalence of Listeria monocytogenes in processed meats................................ 53 16 NZFSA risk profile outcomes examining hazards in meat................................... 55 17 Risk ranking for meat and meat products........................................................ 56 18 Risk ranking for processed poultry meat products ............................................ 58 19 NZFSA risk profile outcomes examining hazards in poultry meat ....................... 58 20 NZFSA risk profile outcomes examining hazards in processed meats.................. 61 21 Risk ranking for processed meat products ....................................................... 62 22 Risk ranking for L. monocytogenes-contaminated processed meats ................... 64 1 2 3 4

Plant products food safety scheme Table Table Table Table 23 24 25 26 Microbiological hazards associated with plant products..................................... 70 Consumption of fruits and vegetables in Australia ............................................ 74 Summary of foodborne illness outbreaks attributed to plant products ................ 77 Risk ranking for plant products contaminated with Listeria monocytogenes ........ 81

Seafood safety scheme Table Table Table Table Table Table Table Table Table Table Table 27 28 29 30 31 32 33 34 35 36 37 Hazards in seafood and seafood products ....................................................... 87 Summary of international hazard identification studies for seafood.................... 89 Production volumes for seafood in Australia and NSW 2006/07 ......................... 91 Consumption of fish and seafood products in Australia ..................................... 92 Failure rate for imported seafood products (1998 2003) ................................ 93 Summary of Australian seafood testing results ................................................ 94 Summary of high mercury levels in NSW seafood ............................................ 95 Prevalence of L. monocytogenes in UK retail smoked fish ................................. 95 Summary of foodborne illness outbreaks attributed to seafood ......................... 96 Risk ranking for seafood products contaminated with Listeria monocytogenes .. 103 Seafood consumption required to reach reference doses for methylmercury..... 105

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Vulnerable persons food safety scheme Table 38 Summary of foodborne illness outbreaks attributed to food served to vulnerable persons...................................................................................................... 115 Table 39 Institutional foodborne illness outbreaks as a percentage of all outbreaks........ 115 Table 40 Relative susceptibility to listeriosis for different sub-groups............................. 118 Table 41 Estimated cases of listeriosis for vulnerable population sub-groups for each food category .................................................................................................... 119 Egg food safety scheme Table Table Table Table Table Table 42 43 44 45 46 47 Hazards in the production of shell eggs and egg products .............................. 127 Prevalence of chemical residues in eggs........................................................ 129 Consumption of eggs and egg products in Australia ....................................... 132 Summary of foodborne illness outbreaks attributed to eggs ............................ 133 Prevalence of Salmonella in Australian eggs .................................................. 133 Risk ranking for type and use of eggs ........................................................... 136

Appendix 1 Table Table Table Table Table Table Table Table Table Table Table Table Table 48 49 50 51 52 53 54 55 56 57 58 59 60 Top Salmonella serovars from major sources................................................. 147 Characteristics of Salmonella........................................................................ 149 Characteristics of Campylobacter .................................................................. 151 Characteristics of Staphylococcus aureus ...................................................... 153 Characteristics of Clostridium perfringens ...................................................... 155 Characteristics of Bacillus cereus .................................................................. 156 Characteristics of Listeria monocytogenes ..................................................... 159 Characteristics of Vibrio parahaemolyticus ..................................................... 162 Characteristics of Shigella spp. ..................................................................... 163 Characteristics of pathogenic Escherichia coli ................................................ 165 Characteristics of Clostridium botulinum........................................................ 167 Characteristics of Yersinia enterocolitica ........................................................ 168 Important Aspergillus, Fusarium and Penicillium species and their mycotoxins.. 175

Appendix 2 Table Table Table Table 61 62 63 64 Recalls Recalls Recalls Recalls of of of of dairy products between 2004 and 2008.......................................... 179 meat products between 2004 and 2008 ......................................... 181 plant products between 2004 and 2008 ......................................... 183 seafood products between 2004 and 2008 ..................................... 183

Appendix 3 Table 65 Foodborne illness outbreaks attributed to milk, dairy products and dairy products used as an ingredient .................................................................... 185 Table 66 Foodborne illness outbreaks attributed to meat, meat products and meat products used as an ingredient.................................................................................. 187 Table 67 Foodborne illness outbreaks attributed to plant products ................................ 196 Table 68 Foodborne illness outbreaks attributed fish and seafood products ................... 198 Table 69 Foodborne illness outbreaks attributed to foods served to vulnerable persons .. 207 Table 70 Foodborne illness outbreaks attributed to eggs, egg products and eggs used as an ingredient .................................................................................................. 210

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Abbreviations
aw ABARE ABS ACMF ACMSF AECL ANZDAC AMRA APL APVMA ASP ASQAP ATDS APVMA AQIS BSE BTEC CAC cfu CFR CJD DAFF DFSV DSP EFSA EHEC ERL EU FAO FDA FRDC FRSC FSA FSAI FSANZ FSIS GAP GBR GHP GMP HACCP HAV HTST HUS ICMSF JECFA KP MAP MeHg ML MLA Water activity Australian Bureau of Agricultural and Resource Economics Australian Bureau of Statistics Australian Chicken Meat Federation Advisory Committee on the Microbiological Safety of Food (UK) Australian Egg Corporation Limited Australia New Zealand Dairy Authorities Committee (formerly ADASC) Australian Milk Residue Analysis Survey Australian Pork Limited Australian Pesticide and Veterinary Medicines Authority Amnesic Shellfish Poisoning Australian Shellfish Quality Assurance Program Australian Total Diet Survey/Study Australian Pesticides and Veterinary Medicines Authority Australian Quarantine and Inspection Service Bovine Spongiform Encephalopathy Brucellosis and Tuberculosis Eradication Campaign Codex Alimentarius Commission Colony forming unit Code of Federal Regulation (US) Creutzfeldt-Jakob Disease Department of Agriculture Fisheries and Forestry (Australian Government) (formerly AFFA) Dairy Food Safety Victoria Diarrhoetic Shellfish Poisoning European Food Safety Agency Enterohaemorrhagic E. coli Extraneous Residue Limit European Union Food and Agricultural Organization of the United Nations Food and Drug Administration (US) Fisheries Research and Development Corporation Food Regulation Standing Committee Food Science Australia Food Safety Authority of Ireland Food Standards Australia New Zealand (formerly ANZFA) Food Safety and Inspection Service (US) Good Agricultural Practices Geographical BSE Risk Good Hygienic Practices Good Manufacturing Practices Hazard Analysis Critical Control Point Hepatitis A virus High Temperature Short Time pasteurisation Haemolytic Uremic Syndrome International Commission on Microbiological Specifications for Foods Joint FAO/WHO Expert Committee on Food Additives Kanagawa phenomenon Modified atmosphere packaging Methylmercury Maximum Level Meat & Livestock Australia
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Food Safety Scheme Risk Assessment

MMWR MRL NARM NEPSS NGSP NRS NZFSA OC OP PHLS PIRSA PISC PSP PTWI REPFEDS RIRDC RIS RTE SARDI SSOP STEC SWG TFAP TVC UCFM UHT USDA WHO YMT

Morbidity and Mortality Weekly Report Maximum Residue Limit National Antibacterial Residue Minimisation program National Enteric Pathogen Surveillance Scheme National Granuloma Submission Program National Residue Survey New Zealand Food Safety Authority Organochlorine Organophosphate Public Health Laboratory Service, UK Primary Industries and Resources South Australia Primary Industries Standing Committee Paralytic Shellfish Poisoning Provisional Tolerable Weekly Intake Refrigerated processed foods of extended durability Rural Industries Research and Development Corporation Regulatory Impact Statement Ready-to-eat South Australian Research and Development Institute Sanitation Standard Operating Procedures Shiga toxigenic E. coli Sector Working Groups Tuberculosis freedom assurance program Total Viable Count Uncooked comminuted fermented meats Ultra Heat Treated US Department of Agriculture World Health Organization Yolk Mean Time

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Executive summary
The NSW Food Regulation 2004 contains food safety schemes that outline the regulatory requirements for dairy, meat, plant products, seafood businesses and businesses serving food to vulnerable persons in NSW. A draft egg food safety scheme is currently being finalised for inclusion in the Regulation. The regulatory requirements in the food safety schemes have been introduced over a number of years, either by the NSW Food Authority or its predecessor organisation SafeFood Production NSW. Dairy and meat food safety schemes were carried over from previous legislation. Individual risk assessments were carried out prior to the introduction of both the seafood and plant products food safety schemes. The development of the vulnerable persons food safety scheme occurred following the introduction of Standard 3.3.1 - Food Safety Programs for Food Service to Vulnerable Populations of the Australia New Zealand Food Standards Code. In respect to the egg food safety scheme, the NSW Food Authority conducted a risk assessment prior to developing requirements for the scheme. Within each sector covered by the food safety schemes there are a wide variety of hazards that may potentially be present and cause illness in the consumer. The degree of illnesses caused by these hazards can range from mild illness through to severe and life threatening disease. In general, it is the microbiological hazards associated with foods that are considered more significant, as chemical and physical hazards are rarely detected in food. This risk assessment document summarises the known information from previous risk assessments, risk profiles and hazard assessments, and includes new or updated information where it is available and applicable to food businesses in NSW.

Dairy food safety scheme


In 2006/2007 there were 684 million litres of milk sold in NSW and ACT, with the average person consuming in excess of 100 L of pasteurised milk each year. A wide variety of bacteria may be present in raw milk with the microbial status of milk being influenced by animal health, the farm environment and production methods. Pasteurisation was successfully introduced to eliminate tuberculosis and brucellosis from milk and nowadays the main microbiological hazards associated with milk and dairy products include Salmonella, Listeria monocytogenes, pathogenic Escherichia coli, Staphylococcus aureus, Campylobacter spp., Yersinia enterocolitica and Enterobacter sakazakii. Between 1995 and 2008 there were 14 Australian outbreaks attributed to dairy products, none occurring in NSW. Nine of these outbreaks were associated with consumption of unpasteurised milk. Internationally foodborne outbreaks associated with dairy products have been attributed to the use of unpasteurised milk, contaminated non-dairy ingredients, faulty pasteurisation process and poor hygiene. Controlling the safety of milk and dairy products relies on using raw materials (milk and non-dairy ingredients) of good quality, ensuring correct formulation, effective

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processing, prevention of recontamination and maintenance of temperature throughout the cold chain. Dairy products identified as high risk include unpasteurised milk, soft cheese, dairy desserts, fresh cheeses and dairy dips, as these products may support the growth of pathogenic microorganisms. Two critical steps in controlling pathogens in milk and dairy products are effective pasteurisation, followed by good manufacturing practices to ensure postpasteurisation contamination does not occur. Food safety programs targeting these controls have been an effective mechanism for controlling microbial hazards in milk and dairy products. There are several potential sources of chemical contamination associated with milk production including agricultural and veterinary chemicals, environmental contaminants and chemicals from animal feed. The implementation of on-farm food safety programs has managed these risks, and the risk is considered low as surveys of dairy products have not detected significant levels of chemicals in Australian milk and dairy products.

Meat food safety scheme


It has been estimated that Australians each consume 38.2 kg beef and veal, 11.4 kg lamb, 2.7 kg mutton and 14.4 kg bacon and ham products each year. Various microbiological hazards are associated with different types of meats, with Salmonella, pathogenic E. coli, Clostridium perfringens, Campylobacter jejuni and the parasite Toxoplasma gondii associated with beef and sheepmeat, while the primary pathogen of concern in pigmeat is Yersinia enterocolitica. Livestock and poultry can serve as a reservoir for pathogenic microorganisms and within the abattoir environment these pathogens can be transferred from the gut to the external surfaces of the carcase and contaminate equipment and workers. Currently the risk associated with red meat is considered low, due to the control measures implemented by the meat industry, such as the Australian Standards for the hygienic production of meat and game meat. However, cross-contamination of raw meat with ready-to-eat (RTE) foods is considered a potential issue of concern. It has been estimated that if the cross-contamination rate of Salmonella increased from 1% to 10% there would be an extra 5000 cases of foodborne illness, while an increase to 50% would result in more than 29,000 cases of salmonellosis across Australia each year. Poultry is the most widely consumed meat in Australia, with each person consuming 39.5kg of poultry each year. The primary hazards of concern in poultry meat are Salmonella and Campylobacter spp. Contamination of poultry can occur on farm through breeding stock, contaminated water, litter, insects, rodents, wild birds and farm workers. Surveys have identified poultry meat as a significant source of foodborne illness, with 46 confirmed outbreaks and 1170 cases of illness between 1995 and 2002. Due to significant under-reporting, it is estimated that cases of foodborne illness due to processed chicken products may be as high as 79,000 cases per year. A through chain approach is the preferred option to reduce contamination of poultry meat, with estimates that this could reduce levels of poultry-related foodborne illnesses by between 74% and 93% each year.

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Processed meat products have also been identified as high risk, with the pathogens of concern including pathogenic E. coli, Salmonella and L. monocytogenes. There have been a large number of recalls of processed meats due to L. monocytogenes, and a significant number of foodborne illness outbreaks. Between 1991 and 2000, 323 cases of illness and one death were attributed to consumption of processed meats with a total cost to the community estimated to be $77 million. Controlling pathogens in processed meats include effective cooking, curing or fermentation with starter culture, and implementation of good hygienic practices (GHP) to limit the potential for post-processing contamination with L. monocytogenes. Food safety programs have been widely implemented in the processed meat sector to ensure control measures are in place. However, it was estimated that if these programs are not complied with, and poorly controlled or unreliable processing was allowed to occur in the production of uncooked comminuted fermented meats, this could lead to a significant increase in risk, with estimates the number of foodborne illness cases in Australia due to pathogenic E. coli could be up to 604 cases per year.

Plant products food safety scheme


Previous risk assessment work conducted on the risk associated with plant products found that fresh cut fruit and vegetables, seed spouts, vegetables in oil and unpasteurised juice present a high risk. This was due to a history of foodborne illness outbreaks in Australia, mainly due to Salmonella, in addition to a number of outbreaks overseas. Annual NSW consumption of these products has been estimated as being 11,000 tonnes of fresh cut vegetables, 150 tonnes of fresh cut fruits, 2,600 tonnes of seed sprouts, 1000 tonnes of vegetables in oil products, and 100,000 L of unpasteurised juice. Surveys of plant products have shown the potential for these high risk plant products to be contaminated with L. monocytogenes, Aeromonas spp., B. cereus and Salmonella. Contamination of fresh cut fruit and vegetables can occur during growth, harvest or processing with the main pathogens of concern being L. monocytogenes and C. botulinum in modified atmosphere packaged product. These products are considered high risk when they are consumed raw. Seed sprouts can become contaminated with B. cereus, Salmonella and pathogenic E. coli during growth and harvest of the seeds and also during the sprouting process, which provides a near perfect environment for the growth of microorganisms. The oxygen reduced environment provided by vegetables immersed in oil allows for the growth of anaerobic microorganisms including C. botulinum, the cause of botulism. To reduce the risk, the vegetables or fruits are usually cooked and acidified prior to placement in oil. Unpasteurised fruit juices may become contaminated during the juicing process, either due to contamination on the exterior of the fruit or the use of damaged and mouldy fruit. Because the juice is not heat treated, any pathogenic microorganisms present are able to survive, and acid tolerant strains of pathogenic E. coli and Salmonella may grow.

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Seafood safety scheme


Annual consumption of seafood has been estimated at approximately 15.1 kg per person. The hazards associated with seafood vary depending on the type of seafood and processing methods employed. Shellfish, particularly oysters, as filter feeders can accumulate contaminants from the growing environment. The hazards of concern for shellfish include pathogenic bacteria and viruses, algal toxins and chemical contaminant from the growing environment. Viral contamination of shellfish is recognised as the highest risk for all seafood and is effectively managed by the implementation of shellfish safety programs that manage the waterway and harvesting of the shellfish. Algal toxins in shellfish are generally considered low risk where harvest management programs manage the risk. Where no programs are in place, the risk associated with algal toxins increases to medium. Severe illness has been associated with the consumption of oysters contaminated with V. vulnificus. Wild caught prawns particularly those caught in estuarine waters are susceptible to contamination from the environment, such as naturally occurring Vibrio spp. present in the waterway. Prawns treated with metabisulphite may present a problem to consumers who suffer from asthma-related conditions. The on-board cooking and cooling of prawns also has the potential to introduce bacterial contamination when water from the waterway is used to cool the prawns. Hazards associated with wild caught finfish include ciguatera and histamine, depending on the type of fish caught. Ciguatera poisoning is generally regarded as medium risk, with most illnesses occurring with fish caught near tropical reefs. Histamine poisoning is usually associated with certain fish such as tuna, swordfish, mahi mahi and blue grenadier and can be controlled by effective temperature control through out the supply chain. If the fish are to be consumed raw, hazards such as parasites and Vibrio spp. become significant. Mercury in finfish presents a risk to pregnant women or women planning to become pregnant. Because mercury is naturally present in the marine environment, management strategies have relied on education of the consumer, in particular advising pregnant women to avoid consuming large predatory fish which are known to contain higher levels of mercury. Processed, ready-to-eat (RTE) seafood products (including smoked seafood) can support the growth of L. monocytogenes, however contamination is thought to occur during the handling and packaging of the finished product. Strict hygiene and sanitation programs can reduce the likelihood of contamination. The packaging of smoked seafood under modified atmosphere packaging may allow the growth of C. botulinum. While botulism poisoning associated these products is rare, the illness is severe and is considered a medium risk.

Vulnerable persons food safety scheme


Certain population sub-groups are more at risk of foodborne illness or can develop more severe conditions due to foodborne illness when compared to the general population. The degree of vulnerability depends on the susceptibility of the individual and the pathogenicity of the pathogenic microorganism. In general terms, the

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vulnerable population group includes children under five years of age, people over 65 years old, pregnant women and persons with depressed immunity. It is estimated that the number of meals served to vulnerable persons in NSW facilities such as hospitals, aged-care facilities, hospices, day care establishments and childcare centres is approximately 133 million meals per year. It is estimated that up to one million meals per year served at these facilities may be contaminated with a foodborne pathogen. Since 1995 there have been 65 foodborne illness outbreaks in Australian aged-care facilities, childcare centres and hospitals with 758 illnesses and 75 fatalities. The pathogens implicated have included Salmonella, C. perfringens, L. monocytogenes and Campylobacter. The prevalence of foodborne-related illness and deaths in the elderly living in nursing homes is far greater than the baseline level of illness in general population, while children appear more at risk to Salmonella due high salmonellosis rate in children seen both in Australia and overseas. The major hazard of concern to vulnerable persons is L. monocytogenes, with some sub-groups within the vulnerable population being 100 times more susceptible to listeriosis than the general population. Other hazards of concern include infants exposed to C. botulinum through consumption of contaminated honey, neonatal infants consuming E. sakazakii contaminated infant formula and individuals with liver dysfunction exposed to Vibrio vulnificus via raw oysters. Other organisms that may result in more severe illness in vulnerable sub-groups include pathogenic E. coli, S. aureus and C. perfringens. When assessing the risk associated with foods, it is important to consider food preparation and hazardous scenarios. Businesses catering to vulnerable persons need to consider the susceptibility of their consumers when designing menus and sourcing, preparing and serving foods. Under the Food Standards Code, these establishments are required to implement a food safety program including, substitution of high risk foods with lower alternatives; effective cleaning and sanitation of fruits and vegetables to be consumed raw; limiting the storage of reconstituted infant formula; minimising storage times/temperatures for RTE foods; ensuring foods are cooked properly and effective cleaning and sanitation of equipment.

Egg food safety scheme (draft)


The average Australian consumes approximately 137 eggs per year, equating to over 800 million eggs being consumed in NSW each year. The primary hazard of concern is Salmonella, in particular Salmonella Typhimurium which may contaminate the egg shell through environmental contamination and through contact with bird faeces. Overseas foodborne illness outbreaks attributed to eggs have been predominantly due to Salmonella Enteritidis, however Australia layer flocks remain free of Salmonella Enteritidis. While Salmonella may be present in the farm environment, surveys have found the prevalence of Salmonella on shell eggs to be very low. However, eggs and egg products can also become contaminated during the grading and processing due to improper crack detection, incorrect washing of eggs and poor hygiene and sanitation during the processing of eggs into pulp and other products. Although egg products
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such as liquid pulp are pasteurised, the heat treatment is only mild and therefore it is important to limit the level of microbiological contamination. There is significant epidemiological evidence to suggest that a major contributing factor of salmonellosis in Australia is the use of dirty and cracked eggs, especially in products that receive minimal or no cook step. The Food Standards Code limits the sale of cracked eggs to businesses where the egg will be further processed and receive a heat treatment. Depending on the hygienic practices on farm and proper grading, processing and storage of eggs, the potential number of egg-related illnesses was estimated up to 1800 cases per year across Australia. Current industry practices to address these issues include strict biosecurity on farm, implementation of quality assurance systems during grading and processing and effective supply chain management. Potential sources of chemical contamination of eggs on farm include contaminated soil, insecticide spray, incorrect use of medication and inappropriate egg washing solutions and concentrations. However, in general, only low levels of chemicals have been detected in eggs and previous risk assessment has assessed the risk of chemicals in eggs as low. The exception to this are specialty eggs such as Balut, salted and century eggs, where surveys have detected the unauthorised use of lead as an additive, leading to chemical contamination of some products. These products may also become contaminated with pathogens due to the extensive handling during processing.

Conclusion
This review has illustrated that across the food safety schemes there are many potential hazards that can impact on human health with microbiological hazards considered the most significant. It concludes that for food businesses within these schemes, mitigating food safety risks requires the development and implementation of reliable, systematic and preventative procedures. Such procedures are the core elements of food safety programs, introduced either due to regulatory requirements or through industry sponsored Codes of Practices. The review acknowledges that mitigating food safety risk necessitates a multi-factorial approach extending beyond the controls implemented by a food business operating under a food safety scheme.

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Introduction
Purpose
Under current legislation, the NSW Food Authority (the Authority) can establish food safety schemes in respect to different type or classes of foods, food businesses or food activity (Food Act, 2003). The food safety schemes aims to assist in improving the safe production and handling food by outlining the regulatory requirements for the food, food businesses or food activity (or activities) covered by the scheme. Currently food safety schemes exist for dairy, meat, plant products and seafood businesses operating in NSW, as well as businesses serving food to vulnerable persons. In addition to these schemes that have already been implemented, an egg food safety scheme is currently being finalised. These commodities have been identified as containing high risk products that may potentially cause outbreaks of foodborne illness, and where the cost benefit analysis justified a regulatory presence, and the use of regulatory tools such as the implementation of food safety programs based on principles of Hazards Analysis Critical Control Point (HACCP). Current legislation also requires a risk assessment be undertaken when establishing a new food safety scheme. The risk assessment provides the science to underpin the food safety scheme and is required to be based on national or international standards. The Authority or its predecessor SafeFood Production NSW, previously commissioned risk assessment prior to the introduction of food safety schemes relating to seafood and plant products. In addition, risk assessments were conducted on the proposed scheme for egg and egg products and during the review of the dairy food safety scheme. The requirements under the meat food safety scheme were carried over from a previous legislation which did not require a risk assessment to be conducted and as such the Authority has not previously conducted a risk assessment in relation to meat. The vulnerable populations food safety scheme was introduced following the gazettal of Standard 3.3.1 - Food Safety Programs for Food Service to Vulnerable Populations of the Australia New Zealand Food Standards Code. Food service to vulnerable populations were identified as high risk in the National Risk Validation Project (Food Science Australia and Minter Ellison, 2002) The purpose of this risk assessment document is to provide a scientific review of hazards and their associated risks for food businesses covered by the food safety schemes. This risk assessment summarises the known information from previous risk assessment and where new or updated information is available, this has been incorporated into the information.

Scope
This risk assessment will review the hazards associated with food businesses regulated under the food safety schemes of the NSW Food Regulation 2004 and includes: Dairy
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Meat Plant products fresh cut fruits and vegetables, unpasteurised juice and vegetables in oil Seafood Food service to vulnerable persons Eggs and egg products (draft food safety scheme currently being finalised)

Overview of risk assessment


Risk assessment forms part of an overall process, called risk analysis. Risk analysis is used by governments and industry to assess, manage and communicate the risk associated with particular food or food groups and in turn aims to reduce the potential for foodborne illness. The Codex Alimentarius Commission divides risk analysis into three components (CAC, 1999): Risk assessment a process by which the potential risk posed by food safety hazard(s) is determined Risk management the process of determining alternatives for control the hazards identified in the risk assessment and Risk communication the exchange of information on risk and risk management amongst interested parties. Further, CAC (1999) has identified four components of risk assessment: Hazard identification the process of identifying potential hazards associated with the food Exposure assessment an estimation of the potential human exposure to the hazard and includes the use of data such as the occurrence in the food and/or potential consumption rates of the food Hazard characterisation the evaluation of the potential illness associated with the hazard Risk characterisation the process of determining the probability of occurrence and severity of the adverse health effects based on the information collected in the hazard identification, exposure assessment and hazard characterisation.

Previous risk assessment work


When developing a food safety scheme, the NSW Food Authority has previously commissioned risk assessments or sourced information from risk assessments performed by other government and non-government organisations. These risk assessments have included: Ross, T. & Sanderson, K. (1999). A risk assessment of selected seafoods in NSW. Food Science Australia (2000). Final report Scoping study on the risk of plant products.

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Food Science Australia & Minter Ellison Consulting (2002). National risk validation project. Final report. Miles, D. (2004). Risk assessment of the NSW dairy industry. Miles, D. and Chan, C. (2007). Risk profile and risk management of eggs and egg products in NSW. In addition, risk assessments have been conducted in Australia by other government and non-government organisations. These include: Sumner, J. (2002). Food safety risk profile for primary industries in South Australia. Department of Primary Industries and Resources SA, Adelaide. FSANZ [Food Standards Australia New Zealand] (2002). Final assessment report proposal P263. Safety assessment of raw milk very hard cooked-curd cheeses. Food Standards Australia New Zealand Report. FSANZ (2006). A risk profile of dairy products in Australia. Food Standards Australia New Zealand Report. MLA [Meat & Livestock Australia] (2003). Through chain risk profile for the Australian red meat industry Part 1: Risk Profile. FSANZ (2005). Scientific assessment of the public health and safety of poultry meat in Australia FSANZ (2006). Public health and safety of poultry meat in Australia. Explanatory summary of the scientific assessment, Canberra. MLA (2006) Listeria monocytogenes in smallgoods: Risks and controls. Ross, T. Walsh, P. and Lewis, T. (2002). Risk assessment of fish cold smoking and marination processes used by Australian businesses. Biodevelopment Consulting Pty. Ltd for SafeFood Production NSW. FSANZ (2005). Final assessment report, P265, primary production and processing standard for seafood (Attachment 10). Daughtry, B., Sumner, J. Hooper, G., Thomas, C. Grime, T., Horn, R., Moses, A. & Pointon, A. (2005). National food safety risk profile of egg and egg products. A report for the Australian Egg Corporation Limited (AECL) Publication No 05/06 Project SAR-47. Thomas, C., Daughtry, B., Padula, D., Jordan, D., Arzey, G., Davey, K., Holds, G., Slade, J., & Pointon, A. (2006). An egg: Salmonella quantitative risk assessment model. AECL publication.

Current approach
As there has been a considerable amount of risk assessment work already undertaken on industries covered by the food safety schemes, the approach taken in this document was to provide a review of previous work conducted. This information has been supplemented with other more recently published information where necessary (CAC, 2007). To minimise repetition, information common to the different food safety schemes has been placed in the appendices to the document:

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Appendix 1 - Common microbiological and chemical food safety hazards Appendix 2 - Food recalls in Australia Appendix 3 - Foodborne illness outbreaks in Australia A number of methods have been used to estimate the level of exposure to hazards. The approaches used include production data, consumption data, imported foods testing failures, recalls, epidemiological data and results of food surveys. When considering exposure the fate of the hazard during processing and preparation must be taken into account.

References
CAC [Codex Alimentarius Commission] (1999). Principles and guidelines for the conduct of microbiological risk assessment. CAC/GL-30. Retrieved 14 October 2008, from http://www.codexalimentarius.net/download/standards/357/CXG_030e.pdf. CAC [Codex Alimentarius Commission] (2007). Working principles for risk analysis for food safety for application by governments. CAC/GL 62/2007. Retrieved 22 December 2008, from http://www.codexalimentarius.net/download/standards/10751/CXG_062e.pdf. Food Act 2003, New South Wales Government (2008). Food Regulation 2004, New South Wales Government (2008). Food Science Australia & Minter Ellison Consulting (2002). National risk validation project. Final report 2002.

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Dairy food safety scheme


Hazard identification
The safety of milk and milk products has been extensively reviewed by regulatory agencies in Australia and internationally. A large number of risk assessments and risk profiles have been undertaken, examining the risks across the entire dairy supply chain and conducting in-depth evaluations of specific pathogen-product combinations. This risk assessment will summarise the major body of relevant work undertaken to date. In 1999, the former NSW Dairy Corporation commissioned Food Science Australia to review the food safety systems that had been implemented in the NSW dairy industry (Jansson et al, 1999). The report included a brief risk assessment and endorsed the preventative approach to food safety through the implementation of Hazard Analysis Critical Control Point (HACCP)-based food safety programs throughout the dairy supply chain. This was later updated in 2004, when the NSW Food Authority completed a qualitative risk assessment of the NSW dairy industry which examined the microbiological and chemical hazards along the dairy supply chain (Miles, 2004). This was developed as an internal document to provide scientific rigour to the updated dairy food safety scheme and provide a basis for determining the priority classification for segments of the industry. In 2002, Primary Industries and Resources South Australia (PIRSA) commissioned a food safety risk profile on primary production, including milk and dairy products (Sumner, 2002). This report highlighted consumption of raw (unpasteurised) milk as a high risk activity. In 2006, Food Standards Australia New Zealand (FSANZ) undertook a comprehensive risk profile of dairy products in Australia to inform the development of the Primary Production and Processing Standard for dairy products (FSANZ, 2006). The FSANZ risk profile examined both microbiological and chemical hazards. The findings of the FSANZ risk profile are reported here. Microbiological hazards A wide range of microbiological hazards may be introduced into milk during primary production and processing. Raw milk may have a diverse range of bacteria present in it, either shed directly into the milk from the udder as a result of illness or disease, or through contamination from the external surface of the cow and the milking environment. FSANZ (2006) highlighted the on-farm factors that most significantly impact on the microbiological quality of raw milk as: animal-related factors (eg animal health, herd size, age and production status) environmental factors (eg housing, faeces, feed, soil, and water) method of milking, operation of milking and storage equipment (eg cleanliness of equipment and lines, appropriate storage temperature to limit pathogen growth) The initial levels of bacteria in raw milk can vary considerably, dependent on the level of control over these factors. Boor (1997) reviewed the different types of pathogenic microorganisms that have been detected in raw milk (Table 1).

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Table 1 Pathogenic microorganisms detected in raw milk Microorganism Enterobacteriaceae pathogenic Escherichia coli (eg EHEC, STEC) Disease Gastroenteritis, other complications involve Haemolytic uraemic syndrome (HUS) and Thrombotic thrombocytopenic purpura (TTP) Gastroenteritis, typhoid fever Dysentery Gastroenteritis Gastroenteritis Gastroenteritis Gastroenteritis Brucellosis (Bangs Disease) Gastroenteritis Anthrax Gastroenteritis Botulism Emetic intoxication Sore throat Scarlet fever/sore throat Pharyngitis, nephritic sequelae Listeriosis (various manifestations) Diphtheria Tuberculosis Tuberculosis Johnes disease (ruminants) Crohns disease (unproven in humans) Q fever Enteric infection Foot-and-mouth disease (not a human disease) Infectious hepatitis Mycotoxicoses Cryptosporidiosis Amoebiasis Giardiasis Toxoplasmosis

Salmonella Shigella Yersinia enterocolitica


Vibrionaceae and Campylobacter

Campylobacter jejuni Aeromonas hydrophila


Other Gram-negatives

Pseudomonas aeruginosa Brucella spp.


Gram-positive sporeformers

Bacillus cereus Bacillus anthracis Clostridium perfringens Clostridium botulinum


Gram-positive cocci

Staphylococcus aureus Streptococcus agalactiae Streptococcus pyogenes Streptococcus zooepidemicus


Miscellaneous Gram-positives

Listeria monocytogenes Corynebacterium spp. Mycobacterium bovis Mycobacterium tuberculosis Mycobacterium paratuberculosis
Rickettsia

Coxiella burnetii
Viral Enteroviruses, including polioviruses and Coxsackie virus, Rotaviruses Foot and mouth disease virus Hepatitis virus Fungi Mould (and associated aflatoxins) Protozoan parasites

Cryptosporidium parvum Entamoeba histolytica Giardia lamblia Toxoplasma gondii


adapted from Boor (1997)

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In the past, prior to the introduction of mandatory pasteurisation for milk in Australia, the most important human diseases disseminated by the consumption of raw milk were tuberculosis and brucellosis. These diseases have now been eradicated in Australian dairy cow herds. As a result, the FSANZ risk profile (FSANZ, 2006) went on to identify the most significant pathogenic microorganisms to public health and safety for the Australian dairy industry (Table 2). Further details on these microbiological hazards are available in Appendix 1.
Table 2 Microbiological hazards in dairy products
Pathogens pathogenic Escherichia coli Significance in dairy products Pathogenic strains of E. coli can be found in cattle and may enter milk through faecal contamination. Is destroyed by pasteurisation

Salmonella

Salmonella is occasionally present in raw milk but is destroyed by pasteurisation. Can contaminate products after pasteurisation, with nondairy ingredients a source of contamination. Frequently isolated in milk powder Y. enterocolitica is destroyed by pasteurisation and its presence in heat
treated milk products is due to environmental contamination after heat treatment. Y. enterocolitica is able to grow in dairy products held at refrigeration temperatures and therefore may be considered as a hazard in prolonged shelf-life products

Yersinia enterocolitica

Campylobacter spp.

Campylobacter spp. is destroyed by pasteurisation and its presence in milk products is due to environmental contamination after heat treatment. Not normally able to grow in foods
Vegetative cells of B. cereus do not survive pasteurisation, however spores will survive. B. cereus is rapidly outgrown by psychrotrophic bacteria at refrigeration temperatures. However, in the absence of a competitive microflora, growth to levels of concern is possible Vegetative cells of C. botulinum do not survive pasteurisation, however spores will survive. Will only grow under anaerobic conditions May enter raw milk through udder infection. S. aureus is destroyed by pasteurisation, however toxins are heat stable. S. aureus does not grow well at refrigeration temperatures or compete with starter cultures

Bacillus cereus

Clostridium botulinum Staphylococcus aureus

Listeria monocytogenes

L. monocytogenes is destroyed by pasteurisation. Its presence in dairy products is due to post-pasteurisation contamination. Can grow in milk products at refrigeration temperatures E. sakazakii will not survive pasteurisation. Recontamination of powdered infant formula during manufacture is a risk. E. sakazakii cannot grow in a dry substrate, but it can survive for long periods of time and is a potential hazard when the powder is reconstituted and held at favourable temperatures. Contamination and subsequent growth may occur during reconstitution and preparation

Enterobacter sakazakii

adapted from FSANZ (2006)

These hazards were considered significant due to either: association with reported incidents of foodborne illness (including overseas outbreaks) the potential to contaminate dairy products after pasteurisation.

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This conclusion is supported by other work, such as that by Todd & Harwig (1996) in a risk analysis of Canadian food, who stated that although 21 microbial hazards have been reported to occur in Canadian milk, only eight of those presented a significant risk to the human population, with Campylobacter jejuni, Salmonella spp. and E. coli O157:H7 identified as the most important hazards. Johnson et al (1990) identified Salmonella, Listeria monocytogenes and pathogenic E. coli as the three high risk organisms to the cheese industry in the USA. Chemical hazards Chemicals are used by the dairy industry for a number of purposes, including pest and weed control on farm, animal health and sanitising equipment. As a result, milk may be susceptible to chemical contamination if proper controls are not in place. The FSANZ risk profile evaluated the following potential chemical hazards (FSANZ, 2006): agricultural and veterinary chemical used in dairy primary production environmental contaminants, including heavy metals, organic contaminants and micro nutrients naturally-occurring chemicals found in plants or in fungi or bacteria associated with plants which may be ingested by grazing cattle food processing by-products food additives, processing aids, and those chemicals that may migrate from packaging into dairy products. Dairy products must comply with Standard 1.4.1 - Contaminants and Natural Toxicants and Standard 1.4.2 - Maximum Residue Limits of the Food Standards Code. These Standards sets out the Maximum Levels (MLs) of specified metal, nonmetal contaminants and natural toxicants and the Maximum Residue Limits (MRLs) for agricultural and veterinary chemical residues present in food respectively.

Agricultural and veterinary chemical hazards


Without appropriate controls and the observance of appropriate withholding periods for treated dairy cattle, it is possible for residues of these chemicals to occur in raw milk. In Australia, the Australian Pesticide and Veterinary Medicines Authority (APVMA) is responsible for registering agricultural and veterinary chemical products, granting permits for use of chemical products and regulating the sale of agricultural and veterinary chemical products. Veterinary chemicals administered to dairy cattle are mainly antimicrobials and endo- and ectoparasiticides. Other veterinary chemical uses include reproductive therapy and use of anti-inflammatory drugs or anaesthetics. If the cow is lactating, then the product must specifically state that it can be used in lactating dairy cows, and a milk withholding period may be specified. The use of environmentally persistent pesticides, such as organochlorines, still poses a potential problem for grazing animals. Potential hazards include excessive levels of herbicides, pesticides or fungicides. Cereals and treated seeds used as animal feed supplement are the most likely source of these contaminants, with the most significant hazard to human health being those chemicals that can accumulate in animal tissues or are excreted in the milk.

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Aflatoxins
Grain crops can become contaminated with biological toxins, such as aflatoxins, a group of extremely toxic metabolites produced by the fungi Aspergillus flavus and Aspergillus parasiticus. When these moulds are allowed to germinate and grow on harvested seed crops, the aflatoxins can be formed and ingested by dairy cattle during feeding, eventually contaminating the milk. Aflatoxin contamination of milk is more common in Europe where intensive supplementary feeding of dairy herds is conducted. In Australia, where herds predominantly graze on pasture, aflatoxin contamination has not been reported (ANZFA, 2001).

Cleaning chemicals
Milking premises and equipment must be cleaned and sanitised to prevent the risk of contaminating the milk with microbiological pathogens. However, overuse of these chemical can in itself create a hazard with the risk of chemical residues being left on equipment. All chemicals used in detergents and sanitisers have the potential to leave a residue on the dairy equipment surface if not used in the correct manner. Physical hazards The probability of introducing physical hazards on-farm, which ends up in the final products is thought to be minimal. Any physical hazard contamination that may be introduced on farm should be removed at the farm level. Most dairy farms include a filter sock through which the milk passes prior to entering into the farm vat. This filter will remove most gross physical contaminants. The introduction of physical hazards at the processing level has occasionally happened in the past, with pieces of equipment ending up in a dairy product. The instances of this occurring are very rare, and the preventative maintenance of equipment means the risk is very low.

Exposure assessment
Consumption of pasteurised milk and dairy products Consumption of milk and milk products forms a significant part of the average Australians diet. Standard 4.2.4 Primary Production and Processing Standard for Dairy Products of the Food Standards Code requires all milk for human consumption (including milk used to make dairy products) to be pasteurised at a minimum of 72C for 15 seconds (or equivalent), unless an applicable law of a State or Territory provides an exemption 1. There is no such exemption for cows milk in NSW, therefore all dairy products commercially sold in NSW are made from pasteurised milk. In 2006/07, 684 million litres of milk were sold in NSW/ACT, including modified and flavoured milk. Data from Dairy Australia shows the average consumption of dairy products in Australia each year is 103.6 L milk, 11.9 kg cheese, 6.8 kg yoghurt and 3.9 kg butter/blends per person (Dairy Australia, 2007). A closer analysis of consumption trends is shown in the Australian National Nutrition Survey (ABS, 1995),

Standard 4.2.4A Primary Production and Processing Standard for Specific Cheeses of the Food Standards Code does allow imported Gruyere, Sbrinz, Emmental and Roquefort to be made from raw milk.

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which showed that 84% of people surveyed consumed dairy products at an average amount of 347 g/day with the quantity ranging from 209-471 g/day (Table 3). Consumption of dairy products varies with age, declining from 98% of children aged 2-3 years to 90% of adults aged 19-24 years and then increasing again to 95% of persons aged 65 years and over. Liquid milk accounts for approximately 70% of the mean daily intake of dairy products for persons of all ages. However, the trend of milk consumption within Australia has been changing to more specialty types. Whole milk accounts for around 56% of milk sales, with lower fat lines increasing to 26%, long life or ultra high temperature (UHT) treated milk 8.5%, and the remainder as flavoured and specialty milks (Dairy Australia, 2007). Cheese consumption in Australia has jumped more than 20% in the past decade. The recent consumer trend has been away from cheddar cheeses to non-cheddar cheese types, and this is also being reflected in Australias cheese exports, where the non-cheddar share of total export sales has increased from 45% to 57% over the past seven years.
Table 3 Consumption of dairy products
Sex Age Proportion of persons consuming milk products and dishes 2 (%) Male Male Male Male Male Male Male Male Male Female Female Female Female Female 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 2-3 4-7 8 - 11 12 - 15 16 - 18 98.2 95.5 90.9 92.8 94.2 89.1 93.7 91.3 94.5 98.1 96.0 93.3 90.8 87.3 471.8 365.0 401.4 424.0 392.2 323.0 263.2 258.0 255.0 394.3 280.5 312.0 297.7 258.0 Median daily intake per consumer of milk products and dishes (g/day)

Milk products and dishes are defined in the National Nutrition Survey (ABS, 1995) as including the following: - Dairy milk - Yoghurt - Cream - Cheese - Frozen milk products (eg ice -cream) - Other dishes where milk or a milk product is the major component - Milk substitutes (eg soy-based milk) - Flavoured milks

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Sex

Age

Proportion of persons consuming milk products and dishes 2 (%) 90.1 94.3 94.7 95.6

Median daily intake per consumer of milk products and dishes (g/day) 251.3 209.3 216.6 225.8

Female Female Female Female

19 - 24 25 - 44 45 - 64 65+

adapted from National Nutrition Survey (ABS, 1995)

Consumption of raw milk The current Dairy food safety scheme in the Food Regulation 2004 does not provide an exemption from the requirement to pasteurise cows milk sold for human consumption. However, no such limit exists on the private consumption of raw cows milk. This is believed to be limited to small communities in NSW, such as farm families. The amount of raw milk consumed on farm within NSW is difficult to estimate, but is considered to be extremely small when compared to the volume of pasteurised milk. The US Food and Drug Administration (FDA) and US Department of Agriculture (USDA) quantitative risk assessment on listeriosis estimated raw milk consumption to be less than 0.5% of total milk consumption in the USA (FDA/USDA, 2003). Todd & Harwig (1996) made the assumption that farm families were the people most likely to consume unpasteurised dairy products and consequently be exposed to the microbiological hazards that may contaminate raw milk. The Dairy food safety scheme does provide an exemption to allow the sale of unpasteurised goats milk in NSW. This was initially a continuation of the permit system implemented by NSW Health, however, the former SafeFood NSW commissioned a risk assessment (AgriQuality New Zealand, 2002), but the authors could not fully determine the risk from unpasteurised goats milk due to a lack of data. Recommendations from the report included the implementation of HACCPbased food safety programs and a microbiological survey of unpasteurised goats milk to generate data to provide the basis for a risk assessment. The National Nutrition Survey (ABS, 1995) estimated that less than 1% of respondents consumed goats milk and there is no evidence to suggest this has increased in recent years. In fact the number of licensed goat milk producers in NSW has declined. Recently cosmetic and bathing raw milk products have become available for sale in NSW and other states. Although marketed for non-food use, it is believed these labelling terms are being used to bypass the Food Standards Code, and that these products are being consumed. While the volume consumed is considered to be very small, the products are potentially unsafe. As such, the NSW Food Authority has taken enforcement action when these products have been identified in the marketplace, as they do not comply with the Food Standards Code requirements for pasteurisation of cows milk for human consumption. FSANZ are currently considering Proposal P1007 - Primary Production & Processing Requirements for raw milk products. The outcome of that process could influence the volumes of unpasteurised dairy product offered for sale in Australia.

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Hazard characterisation
Foodborne illness outbreaks from milk and dairy products Australian dairy products enjoy a reputation for high standards of quality and safety. There have been few reported failures leading to incidents of foodborne illness attributed to dairy products in the market place in recent years. FSANZ reviewed the foodborne illness data associated with milk and milk products in Australia. This data is summarised in Table 4, with more detailed information on each outbreak included in Table 65 (Appendix 3). Between 1995 and 2008 there were 14 reported outbreaks directly attributed to specific dairy products, affecting 284 people. Of these, nine were associated with consumption of unpasteurised milk and none occurred in NSW. In addition, there were 12 outbreaks identified involving a food product that contained dairy products as an ingredient. However, because dairy products are an ingredient in many foods, it is often difficult to determine whether they are the actual cause of an outbreak. There have been a number of reports of outbreaks associated with consumption of dairy products overseas. While unpasteurised dairy products have been a common cause of dairy-associated outbreaks of illness, pasteurised dairy products have also been implicated where there have been poor food safety control measures in place, including the use of contaminated non-dairy ingredients, faulty pasteurisation process, poor hygiene or contamination post pasteurisation.
Table 4 Summary of foodborne illness outbreaks attributed to dairy products and foods including dairy as an ingredient
Hazard Australian outbreaks (1995-2008) Cases Hospitalisations Deaths

Salmonella spp. Campylobacter


Norovirus

7 6 3 1 1 1 1 6 26

226 85 123 27 23 8 2 86 582

5 0 0 0 0 3 0 1 10

0 0 0 0 0 0 0 0 0

C. perfringens
Chemical contamination

Cryptosporidium S. aureus
Unknown Total

While there is little corresponding evidence in Australia linking consumption of pasteurised dairy products to foodborne illness, the widespread consumption of dairy foods has been demonstrated by some large scale foodborne illness outbreaks overseas. In 2000, over 15,000 people were sick and 165 people hospitalised in Japan from dairy products made by the Snow Brand Milk Products Co. that were contaminated with S. aureus enterotoxin. In addition, the 2008 deliberate adulteration of Chinese milk with melamine resulted in worldwide recalls of dairy

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products and a wide range of other foods where milk powder was used as an ingredient. The broad distribution of Chinese milk powder graphically demonstrated that a food safety incident in one country can have international repercussions and encompass a broad spectrum of products. Pathogenic Escherichia coli in raw milk Cattle have been identified as an important reservoir for pathogenic E. coli, and although pasteurisation does eliminate E. coli, outbreaks of E. coli O157:H7 infections overseas have been attributed to contaminated raw milk and some pasteurised dairy products. A 1998 Australian study examined the incidence of pathogenic E. coli in dairy cattle on four farms, with evidence of shiga toxigenic E. coli (STEC) detected in the faeces of 39% of the 843 cattle tested (Desmarchelier, 1998). The prevalence rates varied between farms, although generally milking cows had a lower rate (24%) than younger animals (33-41%). The STEC isolated from dairy cattle included E. coli O157:H7 (0.9%) and E. coli O26 (0.16%), both known pathogenic strains. However, when the prevalence of pathogenic E. coli in Australian raw milk was assessed, it was found to be relatively low (Desmarchelier, 1998), with STEC isolated from 27 of 1,802 samples (1.5%). It was hypothesised that low level carriage may normally be present in the dairy herd and this is periodically stimulated by some host or environmental factor. It appears that during these episodes of increased faecal shedding, there is an increase in environmental contamination and associated increased risk of milk becoming contaminated.

Salmonella in dairy products


The first significant case of Salmonella in an Australian milk product occurred in 1943 in Victoria. A typhoid-carrying farm worker contaminated raw milk, which was then distributed for public consumption, resulting in over 400 cases of typhoid fever and 23 deaths (Merrilees, 1943). Since that time, there has been only one other major incident involving Salmonella in pasteurised dairy products. This occurred in Victoria during the 1970s and was traced to milk powder becoming contaminated due to contaminated lining of the spray dryer. The former Australian Dairy Authorities Standards Committee (now ANZDAC) produced the Australian Manual for control of Salmonella in the dairy industry (ADASC, 1999b) to specify control measures for limiting the risk of dried milk products becoming contaminated with Salmonella. In addition, unpasteurised milk contaminated with Salmonella has been the responsible for several reported outbreaks in South Australia where, until recently, the sale of raw cows milk was allowed for human consumption.

Yersinia enterocolitica in milk Y. enterocolitica has been isolated from raw and pasteurised milk in various parts of the world. Although some strains occasionally associated with human disease have been isolated from raw milk, the main pathogenic types generally do not predominate. Milk has been associated with sporadic cases and outbreaks of Y. enterocolitica infections overseas, but not in Australia.

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Campylobacter spp. in milk


Both Campylobacter jejuni and Campylobacter coli are found in the faeces of cattle and can cause cases of subclinical mastitis. Hutchinson et al (1985) reported a milkborne outbreak resulting from the consumption of raw milk from cows exhibiting no outward evidence of illness. Healthy lactating cows can carry C. jejuni in the intestinal tract, providing an extrinsic source of contamination. In one US study of 193 healthy dairy cows at three dairies, 77 (40%) had positive rectal cultures (Martin et al, 1983). Overseas surveys of Campylobacter in raw milk have shown a prevalence of 1 to 6% (Wallace, 2003), however, these organisms are unlikely to grow in milk or dairy products. Nevertheless, several outbreaks of Campylobacter food poisoning from consumption of raw milk in Australia have been reported among children who were taken on a class trip to a dairy and given raw milk to drink.

Bacillus cereus in liquid milk


Raw milk is frequently contaminated with Bacillus spores, with the milk often contaminated at the farm. Sanitation of the teats prior to milking was able to reduce the incidence of B. cereus in raw milk (Christiansson et al, 1999). The presence of B. cereus in processed dairy product is often associated with the ability of the spores to survive pasteurisation, which may then colonise pipes, tanks and filling machines (Lin et al, 1998). Notermans et al (1997) examined the risk from B. cereus in pasteurised liquid milk in the Netherlands. The study estimated that up to 7% of pasteurised milk may contain B. cereus, with levels up to 105/mL. However, pasteurised milk has not figured as a cause of B. cereus food poisoning in Australia. One reason for this is the germination of B. cereus spores and its growth in pasteurised milk leads to the development of off flavours and an appearance discouraging consumption.

Clostridium botulinum in dairy products


Dairy products have not traditionally been associated with outbreaks of botulism. Since 1912 fewer than 20 outbreaks associated with dairy products worldwide have been recorded. However, spores of C. botulinum survive the normal milk pasteurisation process, and therefore control factors such as aw (water activity), redox potential, pH and temperature must be used in dairy products such as cheeses and dairy-based spreads and sauces to reduce the risk of botulism. In 2007, one case of botulism was reported in Victoria and was associated with the consumption of nationally distributed ready-to-eat nachos meal. The neurotoxin was detected in discarded remains of that meal pathogen (OzFoodNet Working Group, 2007). One of the components was a cheese sauce and subsequent laboratory testing showed that the sauce provided an environment that would support growth of the organism. This case is not included in Appendix 3 data as it was not classed as an outbreak, affecting only one person. Botulism in dairy herds is caused by ingestion of preformed toxins produced by the growth of C. botulinum in decaying crops, vegetation or carcase material, or by the animal acquiring a gastrointestinal infection with the organism. The presence of
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neurotoxin in milk from animals diagnosed with botulism is periodically raised as a concern. When these incidents occasionally occur in dairy herds in Australia, farmers voluntarily remove affected animals from supplying milk. There is little evidence in the scientific literature to suggest the transfer of botulinum neurotoxins or the organism itself to milk occurs from either symptomatic or asymptomatic animals in affected herds.

Staphylococcus aureus in milk S. aureus can be frequently found in raw milk from cows with undetected mastitis. Even in subclinical cases of mastitis up to 105 cfu/mL of S. aureus can be shed into the milk. S. aureus is a poor competitor, and will not grow well in the presence of other bacteria commonly present in raw milk, however it is believed that toxin can be produced under any conditions that permit growth. The Snow Brand Milk Products Co. outbreak in Japan was suspected to be due to poor cleaning of distribution pipes in the production facility, leading to the opportunity for S. aureus to grow to high levels and produce toxin. Listeria monocytogenes in dairy products L. monocytogenes has a history of causing large outbreaks overseas from dairy products, with a 1985 outbreak in the USA from Mexican-style soft cheese affecting 142 people and causing 48 deaths and an outbreak in Switzerland from Vacherin Mont D'Or cheese affecting 122 people and causing 34 deaths (Ryser, 1999). The FDA/USDA risk assessment on Listeria monocytogenes examined 11 categories of dairy products (FDA/USDA, 2003), while the New Zealand Food Safety Authority (NZFSA) commissioned a series of risk profiles examining the risk of L. monocytogenes contamination in ice-cream, low moisture cheese and soft cheeses. The worldwide incidence rate for Listeria spp. in raw milk is estimated to be around 3-4% (Sutherland et al, 2003), while in Australian raw milk the incidence also appears low. A NSW Dairy Corporation survey of 600 raw milk samples failed to detect L. monocytogenes, however, 0.4% of samples were positive for Listeria spp. (Sutherland & Porritt, 1995). The organism is eliminated by pasteurisation, therefore the primary concern is postpasteurisation contamination with L. monocytogenes , as it is a common inhabitant of dairy processing facilities. In dairy factories, the major areas that have been identified as sources of the organism are drains, floors, conveyors, refrigerated storage areas and crate wash lines (Sutherland et al, 2003). Enterobacter sakazakii in infant formula E. sakazakii is a rare, but life threatening cause of neonatal meningitis, sepsis, and necrotising enterocolitis. In general, the reported case-fatality rate varies from 3380% among newborns diagnosed with this type of severe infection (Lai, 2001). Premature infants and those with underlying medical conditions may be at highest risk for developing an E. sakazakii infection, however it should be noted that healthy

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infants may not always be immune to E. sakazakii infections (Nazarowec-White & Farber, 1997). In 2002 the US FDA issued an alert to health care professionals regarding the risk associated with E. sakazakii infections among neonates fed milk-based, powdered infant formulas (FDA, 2002). There have been several E. sakazakii outbreaks reported among infants fed milk-based powdered formula in neonatal intensive care units in England, Netherlands, Iceland, Belgium, Greece, U.S. and Canada (Biering et al, 1989; Lai, 2001; Van Acker et al, 2001; Himelright et al, 2002). These outbreaks have involved several deaths and were associated with temperature abuse of reconstituted powdered infant formula. In addition, there have been cases in premature babies in New Zealand (NZ Ministry of Health, 2005): in 1986, a premature infant contracted E. sakazakii septicaemia, but survived, apparently without serious sequelae in 1991, premature twins contracted E. sakazakii meningitis one twin suffered serious permanent neurological effects, and the other recovered fully in 2004, a premature infant contracted E. sakazakii meningitis, and died. At the time of writing, there have been no reported cases of neonatal illnesses associated with E. sakazakii in infant formula in Australia, however it must be noted that the organism is not a notifiable disease in Australia. Powdered infant formula is not a commercially sterile product, unlike liquid formula which is subjected to sufficient heat to render it commercially sterile. Powdered infant formula may be subject to contamination by opportunistic pathogens such as E. sakazakii through improper cleaning of production lines. While the pathogen does not grow in the powder it can survive for many months.

Chemicals
The prevalence of chemical in dairy products is assessed by several surveys conducted each year in Australia to detect chemical residues. The Australian Milk Residue Analysis (AMRA) survey, the Australian Total Dietary Survey (ATDS), the National Antibacterial Residue Minimisation (NARM) program, and other targeted testing programs provide an indication of the potential for chemical contaminants ending up in dairy products. The AMRA survey from 1998 to 2005 showed the following: 89,121 analyses for antimicrobials showed 99.997% compliance with the maximum residue limit (MRL) for veterinary chemicals residues in milk (there was one detection of Cloxacillin at a level at the MRL of 0.01 mg/kg in June 2002 in a bulk milk sample in NSW) 33,382 analyses for agricultural chemical residues, including organochlorines, organophosphates and synthetic pyrethroids, showed no detections Targeted testing of milk in areas subject to locust plagues has also shown very high compliance rates for organochlorines, organophosphates and Fipronil (a broad spectrum insecticide). In 2000/2001 123 samples were tested in NSW, with no residues detected (DFSV, 2002).

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The NARM program conducts tests on bobby calves and cull dairy cows that are presented to abattoirs. Testing on NSW cull dairy cows from 2000 to 2002 showed that 44 from 455 (9.7%) were positive. Of these positive trace results, eight were shown to be greater than MRL with Neomycin, and Sulphadiazine found in dairy cull cows, and Oxytetracycline and Sulphadiazine in the export calves. Chemical residues persist in meat much longer than milk, and this is reflected in recommended withholding periods. Traceback investigations where residues were detected showed that causes ranged from not obeying the withholding period, use of the wrong withholding period (milk rather than meat) and accidental feeding of medicated milk to calves (NSW Agriculture, 2001 NSW Agriculture, 2002). The ATDS detected no agricultural chemical residues in milk and milk products available on retail shelves. Naturally occurring aflatoxins are not considered a high risk, as a small survey of 40 dairy products by the NSW Food Authority in 2005 detected aflatoxin M1 in trace levels in only one sample, all others were below the limit of detection.

Risk characterisation
Risk ranking dairy products The NZFSA commissioned risk profiles to examine various hazards on hazards in dairy products, predominantly L. monocytogenes and STEC. The conclusions are summarised in Table 5. In addition, the FDA/USDA (2003) estimated the risk per serving and risk per annum of listeriosis for 11 RTE dairy products, based on the predicted number of annual illnesses associated with the consumption of these foods. The predictions were based on the estimate of US population used in the FDA/USDA (2003) risk assessment of 260 million and extrapolated to the Australian population of approximately 21.6 million (ABS, 2009) by dividing by a factor of 12 (see Table 6). These estimates are approximate, as it is acknowledged that may be differences in the consumption levels of particular dairy products between American and Australian consumers.
Table 5 NZFSA risk profile outcomes examining hazards in dairy products
Hazard cheeses Risk Data on the prevalence of L. monocytogenes indicate that contamination rates are very low, most likely to occur postpasteurisation. Current risk to the general is considered low, although susceptible populations will have a greater risk Found no evidence to link consumption of ice-cream with cases of L. monocytogenes infection in New Zealand Contamination with L. monocytogenes is unlikely unless introduced post-pasteurisation from environmental sources, added ingredients or further processing such as grating. Surveys of low moisture cheese suggest that contamination with L. monocytogenes is infrequent and that growth in product is unlikely. Even taking into account the high consumption of low moisture cheese, the available data indicates that L. monocytogenes in low moisture cheese does not represent a significant risk to human health

Listeria monocytogenes in soft

(Lake et al, 2005b) Listeria monocytogenes in iceListeria monocytogenes in low

cream (Lake et al, 2003)

moisture cheese (Lake et al, 2005a)

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Hazard Shiga-toxin producing Escherichia coli in raw milk (Gilbert et al, 2007)

Risk Approximately 10% of notified human cases of STEC infection (mostly E. coli O157:H7) in New Zealand reported consumption of raw milk. E. coli O157 has been reported, albeit rarely, in faecal samples from dairy and beef cattle. However, there is insufficient data on the prevalence and numbers of STEC in raw milk to robustly estimate the risk from consumption of raw milk in New Zealand

Dairy products likely to support the growth of pathogens and prone to contamination after pasteurisation may be categorised as higher risk than other dairy products. Alternatively, dairy products that do not support the growth of pathogens, if correctly formulated, can be classified as low risk. FSANZ ranked the degree of risk based on (FSANZ, 2006): intrinsic properties of the product (ie the impact of aw, pH, salt concentration, and their effect on the growth of contaminating microorganisms) extent to which food is exposed to factory environment or handling after heat treatment hygiene and control during distribution and retail sale degree of reheating or cooking before consumption (many dairy products are RTE, so this is rarely a factor).

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Table 6 Risk ranking for dairy products contaminated with Listeria monocytogenes
Dairy product Unpasteurised fluid milk High fat and other dairy products (eg butter, cream, other miscellaneous milk products) Soft unripened cheese, >50% moisture (eg cottage cheese, cream cheese, ricotta) Pasteurised fluid milk Fresh soft cheese Semi-soft cheese, 39-50% moisture (blue, brick, monterey, muenster) Soft ripened cheese, >50% moisture (brie, camembert, feta) Ice-cream and other frozen dairy products Processed cheese (cheese foods, spreads, slices) Cultured milk products (yoghurt, sour cream, buttermilk Hard cheese, <39% moisture (cheddar, Colby, parmesan) adapted from FDA/USDA (2003) Risk ranking (per serve) High Moderate Moderate Moderate Low Low Low Low Low Low Low Predicted cases of listeriosis per serve (in Australia) 3 7.1 x 10-9 2.7 x 10
-9

Risk ranking (per annum) Moderate High Moderate High Low Low Low Low Low Low Low

Predicted annual number of listeriosis cases (in Australia) 4 0.25 4.7 0.6 7.5 0 0 0 0 0 0 0

1.8 x 10-9 1.0 x 10-9 1.7 x 10


-10

6.5 x 10-12 5.1 x 10-12 4.9 x 10-14 4.2 x 10


-14 -14

3.2 x 10

4.5 x 10-15

The risk per serving is inherent to the particular food category, and is therefore assumed to be the same in Australia as that calculated for the USA (FDA/USDA, 2003). This is based on the assumption that consumption patterns for these foods are identical in Australia and the USA. The risk per annum has been adapted from USA population data contained in the FDA/USDA (2003) risk assessment of 260 million and extrapolated to Australian population data of approximately 21.6 million (ABS, 2009) by dividing by a factor of 12

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Table 7 provides a relative risk ranking for categories of dairy products (FSANZ, 2006), however the ranking can be quite variable. For example, once a shelf-stable UHT product is opened, it may become contaminated via cross-contamination and when subjected to temperature abuse it could become a high-risk food. In contrast, the low pH and low water activity of extra hard cheese means it is unlikely to support the growth of any pathogen that contaminates the surface. Dried milk powders and infant formulae are inherently stable products due to their low water activity, however these products may be prone to contamination, and upon reconstitution become higher risk, especially if improperly reconstituted and stored.
Table 7 Risk ranking of dairy products
Risk ranking Higher risk Dairy product Unpasteurised milk Soft cheeses Risk characterisation No pathogen reduction step Mild pH, long shelf life allowing growth of Listeria monocytogenes (Bemrah et al, 1998) Mild pH, fermentable carbohydrate, long shelf-life Dependent on variety - some have low acid, high moisture Dependent on variety some have low acid, high moisture, added ingredients Absence of salt, high moisture content Absence of salt, high moisture content Storage temperature only hurdle to control post-pasteurisation contamination Stored frozen, but soft serve may allow growth of Listeria monocytogenes Low pH does not allow growth of pathogens High salt concentration Low water activity, low pH Low water activity, low pH Commercially sterile Low water activity, however prone to contamination

Dairy desserts Fresh cheese Dairy dips Intermediate risk Unsalted butter Low fat spreads Pasteurised milk Ice-cream Low risk Yoghurt Salted butter Hard cheese Extra hard cheeses UHT milk Dried milk powder adapted from FSANZ (2006)

Consumption of raw milk The consumption of unpasteurised milk appears to represent a significant risk on a per serving basis, with the FDA/USDA risk assessment categorising unpasteurised milk as high risk for listeriosis (FDA/USDA, 2003), and the majority of foodborne illness attributed to dairy products worldwide due to the consumption of unpasteurised milk and dairy products made from unpasteurised milk. However, the predicted number of annual illnesses is very low because of the low levels of
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consumption of raw milk. FSANZ consumption data tends to estimate the consumption of raw milk as less than 1% of overall milk consumption (FSANZ, 2006), while the FDA/USDA risk assessment estimated consumption to be less than 0.5% (FDA/USDA, 2003). Primary Industries and Resources South Australia (PIRSA) commissioned a food safety risk profile on primary production, including milk and dairy products. This report highlighted consumption of raw milk as a high risk activity and predicted much higher rates of foodborne illness. It was predicted the risk of illness from all foodborne pathogens associated with raw milk to be in the order of 36 illnesses per annum among the 1000 consumers, compared with one illness in 20 years for pasteurised milk (Sumner, 2002). Control measures FSANZ found that the factors having the most significant impact on the safety of processed Australian dairy products are (FSANZ, 2006): the quality of raw materials correct formulation effective processing the prevention of recontamination of product maintenance of temperature control through the dairy supply chain. While pathogenic microorganisms may contaminate raw milk supplies, pasteurisation is a very effective Critical Control Point (CCP) in eliminating pathogens, good manufacturing practices must also be employed to ensure that post-pasteurisation contamination does not occur.

Prevalence of pathogens in milk


The effectiveness of pasteurisation is dependent upon the microbiological status of the incoming raw milk. Control measures at the primary production level involve minimising the likelihood of microbiological hazards contaminating the raw milk. This is achieved through the implementation of a food safety program incorporating good agricultural practices (GAP). These measures are effective in reducing the microbial load of milk being sent for processing. However, should microbial contamination of raw milk occur, it is critical that milk is stored at a temperature that minimises the opportunity for the bacteria to multiply. Temperature abuse of the milk may allow growth of pathogenic bacteria to the extent where the pasteurisation process may not eliminate all pathogenic bacteria and/or toxins.

Chemical hazards
Milk from multiple farms may be batched together, either within a milk tanker, or within a silo at a processing facility, therefore the potential exists for chemically tainted milk from a single farm to contaminate a large volume of milk within a tanker and silo at the processing factory. However, the implementation of on-farm food safety programs has also minimised the presence of chemicals in milk.

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In addition to these testing programs, processing factories receiving milk from farms test incoming batches of milk for the presence of chemical hazards, such as antibiotics which can adversely affect starter cultures during cheese production.

Correct formulation
Ingredients used in the manufacture of dairy products that are added post pasteurisation must be of a high microbiological standard. Many non-dairy ingredients added to ice-cream mix after heat treatment include fruits (canned, fresh, or frozen and usually in concentrated sugar syrups), nuts, chocolate, pieces of toffee and biscuit, colours and flavours. These ingredients and those added to other dairy products such as yoghurt, dairy desserts, dairy dips and cheese may introduce pathogens into the product (ICMSF, 1998). This is readily illustrated by a botulism outbreak involving a yoghurt product in the UK. In this outbreak it was not the yoghurt itself but hazelnut pure added to the yoghurt that was the source of the intoxication. The hazelnut pure was under processed, had a pH (between 5.0 and 5.5) and a high aw conducive to the growth of the pathogen. Previous batches were sweetened with sugar but the producer had recently switched to aspartame. The subsequent rise in aw was not compensated for by additional processing changes. A total of 27 people were affected and one died (Critchley et al, 1989). This addition of ingredients added after pasteurisation was identified as a high risk factor by Jansson et al (1999) who recommended that dairy products with these additions (eg ice-cream and cheeses) be moved into the high risk category and the finished product be subject to additional end product microbiological analysis. The microbial quality of dry-blended ingredients into infant formula was identified as a significant source of contamination by FSANZ, as there is no heat treatment to destroy bacteria in the final product (FSANZ, 2006).

Effective processing (pasteurisation)


Dairy processing facilities primarily use High Temperature Short Time (HTST) pasteurisation (minimum 72C for 15 seconds) or batch pasteurisation (minimum 65C for 30 minutes) to eliminate the pathogens of concern in milk. The minimum times and temperatures for pasteurisation are stated in Standard 4.2.4 Primary Production and Processing Standard for Dairy Products of the Food Standards Code. However, most factories actually heat the milk to higher temperatures and hold it for a longer time period as an in-built safety margin. Juffs & Deeth (2007) undertook an extensive evaluation of the effectiveness of pasteurisation in reducing pathogens in milk and milk products. They concluded that Australian consumers can be assured that pasteurisation does destroy the pathogens of concern in milk and dairy products. They also observed that: literature data indicate that the most significant milk-borne pathogens are destroyed by pasteurisation with a reasonable margin of safety the pasteurisation times and temperatures used by Australian processors meets the minimum requirements prescribed in the Food Standards Code, and in many cases products are heated to a temperature and/or a time often well in excess of the prescribed minimums lack of epidemiological data indicating that pasteurised milk products have been implicated in foodborne illness outbreaks in Australia in recent years, in contrast

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outbreaks have been associated with consumption of raw milk, in Australia and overseas. in most cases, milk and dairy products are consumed as RTE foods and will readily support the growth of any contaminating microorganisms. In the past, the dairy industry has been subjected to a high level of food safety regulation, ensuring high levels of hygiene and sanitation are maintained. The pasteurisation process eliminates all pathogenic bacteria found in raw milk, with the exception of the spore forming bacteria B. cereus and C. perfringens. However, neither of these organisms has been identified in incidents of foodborne illness from dairy products. It is improbable that C. perfringens can germinate and multiply under the normal conditions of milk storage, while spoilage bacteria will outgrow B. cereus at refrigeration temperatures.

The prevention of recontamination of product


Post-pasteurisation contamination can pose a major problem where good manufacturing practices are not employed (Zottola & Smith, 1991). Pathogenic microorganisms can be introduced into a dairy processing environment with raw milk. Once these organisms gain access to the processing plant, the presence of nutrients and moisture can allow not only for survival, but multiplication of these organisms. The application of food safety programs including elements of Good manufacturing practice (GMP) and Good hygienic practice (GHP) are critical to limit the potential for pathogens to contaminate dairy products after pasteurisation. The primary organisms of concern are Listeria monocytogenes for most dairy products and Salmonella in dried milk products. A large number of dairy products have been recalled due to contamination with L. monocytogenes, with nine recalls between 2004-2008 (Table 65 in Appendix 2). In 1999, the state dairy regulatory authorities introduced two manuals for the control of post-pasteurisation contamination with Listeria (ADASC, 1999a) and Salmonella (ADASC, 1999b). These manuals highlight steps to control entry of these organisms into dairy processing areas, as well as recommend frequencies for finished product and environmental testing, and clearance programs if the organisms are detected.

Maintenance of temperature control through the dairy supply chain


The intrinsic nature of many dairy products means they will support the growth of pathogenic bacteria that may contaminate the product. This categorises these products as potentially hazardous foods under the definition in Standard 3.2.2 Food Safety Practices and General Requirements of the Food Standards Code. The exception to this are products such as yoghurt and hard cheeses (low pH) and icecream (stored frozen). As potentially hazardous foods, maintenance of temperature control through the dairy supply chain is critical to ensure these foods remain safe and suitable.

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Conclusion
The FSANZ risk profile concluded that (FSANZ, 2006): a wide range of microbiological hazards may be associated with raw milk and dairy products, but these do not represent a significant problem under current management practices which: o control animal health o ensure adherence to good milking practices o require effective heat treatment (eg pasteurisation) and o have controls to prevent post-pasteurisation contamination in the dairy processing environment current risk management measures ensure that pathogenic microorganisms are unlikely to be present in high numbers in raw milk pasteurisation provides the kill step to effectively eliminate all but the sporeforming bacteria there are extensive regulatory and non-regulatory measures in place along the dairy industry primary production chain resulting in minimal public health and safety concerns regarding the use or presence of chemical in dairy products extensive monitoring of chemical residues in milk over many years has demonstrated a high level of compliance with the regulations Australian dairy products have an excellent reputation for food safety, and this is supported by the lack of evidence attributing foodborne illness to dairy products and continuation of the current management practices, particularly monitoring programs for chemical along the primary production chain, will ensure that the dairy industry continues to maintain a high standard of public health and safety. The NSW Food Authority and its predecessor organisations have taken a proactive role in implementing HACCP-based food safety programs along the dairy supply chain, a position that may well have contributed to the excellent safety record of dairy products in NSW. This, when combined with improvements in primary production practices that effectively manage animal health, adherence to good milking practices, and improvements in the hygiene of milking equipment and buildings have been important in reducing the microbial load in raw milk entering NSW dairy processing facilities. The adoption of industry codes of practice and the extensive implementation of food safety programs in the dairy industry has helped to underpin these regulatory control measures.

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References Milk and dairy products


ABS [Australian Bureau of Statistics] (1995). National Nutrition Survey: Foods Eaten, Australia, 1995. Australian Bureau of Statistics report. ABS Cat no 4804.0. Retrieved 13

January 2009, from http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CA25687100069892CA256888001C D460/$File/48040_1995.pdf ABS [Australian Bureau of Statistics] (2009). Population clock. Retrieved 20 February 2009, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Web+Pages/Population+Clock?opendocument? utm_id=PC

ADASC [Australian Dairy Authorities Standards Committee] (1999a). Australian Manual for Control of Listeria in the Dairy Industry. Australian Dairy Authorities Standards Committee Manual. ADASC [Australian Dairy Authorities Standards Committee] (1999b). Australian Manual for control of Salmonella in the Dairy industry. Australian Dairy Authorities Standards Committee Manual. AgriQuality New Zealand Ltd. (2002). Risk Assessment of Sheep and Goat Milk for SafeFood (Production) NSW 4.0. Biering, G., Karlsson, S., Clark, N.C., Jnsdttir, K.E., Ldvgsson, P. & Steingrmsson, O. (1989). Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. Journal of Clinical Microbiology 27(9), 2054-2056. Bemrah, N., Sanaa, M., Cassin, M.H., Griffiths, M.W. & Cerf, O. (1998). Quantitative risk assessment of human listeriosis from consumption of soft cheese made from raw milk. Preventative Veterinary Medicine 37, 129-145. Boor, K.J. (1997). Pathogenic microorganisms of concern to the dairy industry. Dairy, Food and Environmental Sanitation 17, 714-717. Christiansson, A., Bertilsson, J. & Svensson, B. (1999). Bacillus cereus spores in raw milk: factors affecting the contamination of milk during the grazing period. Journal of Dairy Science 82, 305-314. Critchley, E.M.R., Hayes, P.J. &. Isaacs, P.E.T. (1989). Outbreak of botulism in Northwest England and Wales. Lancet ii, 8667. Dairy Australia (2007). Australian Dairy Industry in Focus 2007. Dairy Australia Report. Southbank, Victoria. Desmarchelier, P.M. (1998). Enterohaemorrhagic Escherichia coli in Dairy Cattle and Raw Milk. Dairy Research and Development Corporation Report. DFSV [Dairy Food Safety Victoria] (2002). Report on the Australian Milk Residue Analysis Survey 1 July 2000 30 June 2001 Results. Australian Dairy Authorities Standards Report prepared by Dairy Food Safety Victoria. FDA [Food and Drug Administration, US] (2002). Health Professionals Letter on Enterobacter sakazakii Infections Associated With Use of Powdered (Dry) Infant Formulas in Neonatal

Intensive Care Units. Retrieved 15 January 2009, from http://www.cfsan.fda.gov/~dms/infltr3.html

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Quantitative assessment of relative risk to public health from foodborne Listeria monocytogenes among selected categories of ready-to-eat foods. Retrieved 30 October 2008,

FSANZ [Food Standards Australia New Zealand] (2002). Final Assessment Report Proposal P263. Safety Assessment of raw milk very hard cooked-curd cheeses. Food Standards Australia New Zealand Report. FSANZ [Food Standards Australia New Zealand] (2006). A Risk Profile of Dairy products in Australia. Food Standards Australia New Zealand Report.
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Gilbert, S, Lake, R. Hudson, A., & Cressey, P. (2007). Risk Profile: Shiga-toxin producing Escherichia coli. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 13 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/FW0604_STEC_in_raw_milk_July_07.pdf Himelright, I., Harris, E., Lorch, V. & Anderson, M. (2002) Enterobacter sakazakii infections associated with the use of powdered infant formula Tennessee, 2001. Journal of the American Medical Association 287, 22042205. Hutchinson, D.M., Bolton, F.J., Hinchcliff, P.M., Dawkins, H.C., Horsely, S.D., Jessop, E.G., Robertshaw, P.A. & Counter, D.E. (1985). Evidence of udder excretion of Campylobacter jejuni as the cause of milk-borne campylobacter outbreak. Journal of Hygiene 94, 205-215.

Professional, London.

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Jansson, E., Moir, C. & Richardson, K. (1999). Final Report Review of Food Safety Systems developed by the NSW Dairy Corporation. Food Science Australia Report. Johnson, E.A., Nelson, J.H., & Johnson, M. (1990). Microbiological safety of cheese made from heat-treated milk, Part II. Microbiology. Journal of Food Protection, 53, 519-540. Juffs, H. & Deeth, H. (2007). Scientific evaluation of pasteurisation for pathogen reduction in milk and milk products. Report prepared for Food Standards Australia New Zealand,

Canberra.

Lai, K.K. (2001) Enterobacter sakazakii infections among neonates, infants, children, and adults: case reports and a review of the literature. Medicine 80, 113122. Lake, R. Hudson, A. & Cressey, P. (2003). Risk Profile: Listeria monocytogenes in ice-cream. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 13 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/lmono-in-ice-cream.pdf Lake, R. Hudson, A., Cressey, P. & Gilbert, S. (2005). Risk Profile: Listeria monocytogenes in low moisture cheeses. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 13 January 2009, from http://www.nzfsa.govt.nz/science/riskprofiles/FW0440_L_mono_in_low_moisture_cheese_Final_Mar_2007.pdf

Lake, R. Hudson, A., Cressey, P. & Gilbert, S. (2005). Risk Profile: Listeria monocytogenes in soft cheeses. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 13 January 2009, from http://www.nzfsa.govt.nz/science/riskprofiles/FW0440_L_mono_in_low_moisture_cheese_Final_Mar_2007.pdf

Lin, S., Schraft, H., Odumeru, J. A. & Griffiths, M. A. (1998). Identification of contamination sources of Bacillus cereus in pasteurized milk. International Journal of Food Microbiology 43, 159-171. Martin, W.T., Patton, C.M., Morris, G.K., Potter, M.E. & Puhr, N.D. (1983). Selective enrichment broth medium for isolation of Campylobacter jejuni. Journal of Clinical Microbiology 17, 853-5. Miles, D. (2004). Risk assessment of the NSW Dairy Industry. Report for the NSW Food Authority, Sydney (unpublished). Merrilees, C. R. (1943). Report on typhoid fever in the City of Moorabbin, 1943. Commission of Public Health, Victoria.

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Nazarowec-White, M. & Farber, J.M. (1997). Enterobacter sakazakii a review. International

Notermans, S., Dufrenne, J., Teunis, P., Beumer, R., te Giffel, M. & Peeters Weem, P. (1997). A risk assessment study of Bacillus cereus present in pasteurised milk. Food Microbiology 14(2), 143-151.

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NSW Agriculture (2001) National Antibacterial Residue Minimisation Program 2000 / 2001 Annual Report. NSW Agriculture Report NSW Agriculture (2002). National Antibacterial Residue Minimisation Program 2001 / 2002 Annual Report. NSW Agriculture Report. NZ Ministry of Health (2005). Inquiry into Actions of Sector Agencies in Relation to Contamination of Infant Formula with Enterobacter Sakazakii. Retrieved 17 February 2009, from http://www.moh.govt.nz/moh.nsf/pagesmh/4020?Open

Communicable Diseases Intelligence 31(2), 234239.

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Ryser, E.T. (1999). Foodborne listeriosis. In E.T. Ryser & E.H. Marth (Eds.) Listeria, Listeriosis and Food Safety (p 299-358) Marcel Dekker, New York. Sumner, J. (2002). Food Safety Risk Profile for Primary Industries in South Australia (Final Report). Department of Primary Resources SA, Adelaide. Retrieved 30 September 2008, from http://www.pir.sa.gov.au/__data/assets/pdf_file/0003/25068/SA_PI_Risk_profile.pdf Sutherland, P. & Porritt, R. (1995). Dissemination and ecology of Listeria monocytogenes in Australian dairy factory environments. In ISOPOL XII (Twelfth International Symposium on the Problems of Listeriosis). Perth, Australia: Sutherland, P.S., Miles, D.W. & Laboyrie, D.S. (2003). Listeria monocytogenes. In Hocking, A.D. (Ed.). Foodborne Microorganisms of Public Health Significance (pp. 381443). Australian Institute of Food Science and Technology, Waterloo.

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Van Acker, J., de Smet, F., Muyldermans, G., Bougatef, A., Naessens, A. & Lauwers, S. (2001) Outbreak of Necrotizing Enterocolitis Associated with Enterobacter sakazakii in Powdered Milk Formula. Journal of Clinical Microbiology, 39(1), 293-297. Wallace, R.B. (2003). Campylobacter. In Hocking, A.D. (Ed.). Foodborne Microorganisms of Public Health Significance (pp. 311-331). Australian Institute of Food Science and Technology, Waterloo. Zottola, E.A. & Smith, L.B. (1991). Pathogens in cheese. Food Microbiology, 8, 171-182.

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Meat food safety scheme


The Meat food safety scheme under the Food Regulation 2004 regulates food safety practices across broad sections of the meat industry, from harvesting of game meat in the field, through to primary processing at the abattoir and further processing into ready-to-eat (RTE) meat products. In order to effectively assess the risks, and consider the different production systems and inherent hazards associated with different sectors of the meat industry, the following definitions have been used to categorise the data: Meat the dressed carcase and carcase parts of an animal (bovine, bubaline, camelidae, caprine, cervidae, ovine, porcine and soliped species) the edible part of any poultry (fowl, duck, geese, turkeys, pigeons, pheasants, quails, guinea fowls and other avian species) intended for human consumption. For the purposes of this report, this also includes processed poultry meat the edible part of any wild game animal (any vertebrate animal of a species that is not farmed, but is killed in the field and can be legally harvested, excluding fish) meat that is further processed (such as curing, heat treated, dried, canned, fermented, rendered) to form a meat product with different characteristics and flavours.

Poultry meat

Game meat

Processed meat

Hazard identification
Meat In Australia, the most comprehensive work has been funded by the meat industry itself, through Meat and Livestock Australia (MLA), who commissioned a risk profile of the red meat industry to identify (MLA, 2003): public health hazards that enter any point of the food chain for meat products produced in Australia and rank them in terms of risks to the consumer hazard:product combinations in which further risk analysis might be performed. From a regulatory viewpoint, FSANZ will be undertaking a scientific assessment of the hazards that occur for meat, due to be completed in mid 2009. This work will be used to underpin the broadening the scope of Standard 4.2.3 Primary Production and Processing Standard for Meat of the Food Standards Code to include requirements for primary production. The standard currently only contains requirements for producers of RTE meat products.

Beef and sheepmeat


There are a significant number of pathogens that may be associated with livestock (Table 8). Bacterial pathogens such as Salmonella spp. and pathogenic E. coli can persist for extended periods of time in the farm environment, where they may contaminate feed, water, pasture, farm equipment through to individual animals or entire herds. It is well established that cattle are a major reservoir for pathogenic
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organisms such as Clostridium perfringens, Campylobacter jejuni, pathogenic Escherichia coli and Salmonella spp. in their gut, but pathogens have also been isolated from the rumen, caecum, colon and rectum (McEvoy et al, 2004). From these locations, pathogens are frequently transferred to the exterior, such as the hide and hooves. In addition, sheep, cattle and pigs grazing on contaminated pastures can become infected with the encysted form of the parasite Toxoplasma

gondii.

Because livestock may serve as a reservoir for pathogens, it is not surprising that a number of these animals will carry pathogens into the abattoir environment. While the muscle tissue of healthy live animals is essentially sterile at the time of slaughter, the external surfaces of carcases may become contaminated during de-hiding and dressing, and if the intestinal tract is punctured and the gut contents escape. This can also lead to direct or indirect contamination of equipment and workers during dressing and processing, which may further contribute to carcase cross contamination. Internationally, risk assessment work on the meat industry has tended to concentrate on specific hazards such as E. coli O157:H7 in hamburgers (Cassin et al, 1998) and in tenderised meat (FSIS, 2002). Although a hazard of concern internationally, in particular the USA, the prevalence of E. coli O157:H7 on Australian carcases appears to be very low and it does not appear to be a significant source of foodborne illness in Australia. In addition to the traditional bacterial pathogens, world-wide attention became acutely focussed on the possible acquisition of variant Creutzfeldt-Jakob Disease (CJD) from Bovine Spongiform Encephalopathy (BSE) infected animals. However, under the assessment of Geographical BSE Risk (GBR), Australian livestock are considered highly unlikely as having BSE (EFSA, 2007). The potential risk factors for BSE have been addressed through the implementation of appropriate control measures within Australia, and therefore, BSE will not be further considered in this risk assessment.

Pigmeat
Pigs are often associated with the carriage of Yersinia enterocolitica, appearing to be the primary source of Yersinia infections in humans caused by bioserotype 4,O:3 (Barton & Robins-Browne, 2003). The pork tapeworm Taenia solium (larval stage Cysticercus cellulosae) and the nematode worm Trichinella spiralis are often associated with pork overseas. However these organisms are not present in Australian pigs (DAFF, 2004), and are therefore are not further considered in this risk assessment.

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Table 8 Microbiological hazards in livestock and poultry


Livestock Pathogenic bacteria pathogenic Escherichia coli Poultry

Salmonella spp. Campylobacter jejuni

Salmonella spp. Brucella Campylobacter jejuni Yersinia enterocolitica Coxiella burnetii Listeria monocytogenes Staphylococcus aureus Bacillus anthracis Clostridium spp. Mycobacterium bovis Streptococcus spp.
Parasites

Cysticercus bovis Cysticercus ovis Onchocerca spp. Taenia saginata Toxoplasma gondii
Prions Bovine Spongiform Encephalopathy (BSE) adapted from Sumner (2002); FSANZ (2005)

The rate of carriage of the pathogenic organisms in the gut by livestock may be affected by factors such as animal handling, husbandry techniques and other onfarm practices that can affect animal health. Practices such as co-mingling of animals, intensive rearing methods and stress (such as starvation and transport) have been shown to increase the shedding and transmission of pathogens in animals. Chemical hazards in the red meat industry were assessed as part of the risk profile conducted by the MLA. This work found that the current system for registering and monitoring the use of chemicals in the meat industry to be well managed. The incidence and levels of residue contamination reported by the National Residue Survey (NRS) and the Australian Total Diet Survey (ATDS) are very low. In instances where chemical residues have been detected in meat, the levels found have been too low to be considered a public health risk The MLA risk profile could find no data on physical hazards.

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Poultry meat Internationally, a huge amount of resources have been employed to undertake risk assessment work on poultry. This work has concentrated on the pathogens considered to be most significant, namely Salmonella (FAO/WHO, 2001; WHO/FAO, 2002) and Campylobacter (FAO/WHO, 2003). While in Australia, FSANZ has undertaken a comprehensive scientific assessment of the poultry meat industry to underpin the development of Standard 4.2.2 - Primary Production and Processing Standard for poultry meat (FSANZ, 2005). This work considered: the extent of food safety risk associated with the consumption of poultry meat and poultry meat products in Australia the factors along the poultry meat supply chain that have the greatest impact on public health and safety. A range of microbiological hazards may be introduced to poultry meat during the primary production stages. These include bacterial pathogens that may contaminate breeding stock, feed, water and the environment. The FSANZ scientific assessment considered Salmonella spp., Campylobacter spp., pathogenic E. coli, Staphylococcus aureus, Clostridium perfringens and L. monocytogenes as potential hazards in poultry meat. Poultry are exposed to Salmonella via sources such as feed or through environmental contamination. Once infected, a bird will excrete large numbers of salmonellae in its faeces which can lead to rapid spread throughout the flock. Salmonella positive birds at the time of slaughter have high numbers of organisms in their intestines as well as on external surfaces. Slaughtering and processing operations have the potential to contaminate the poultry carcase with faecal material and to facilitate crosscontamination between pathogen-positive birds and pathogen-negative birds, leading to increased prevalence of Salmonella in finished products. This may occur at various stages of processing including unloading of birds, scalding, plucking, evisceration, washing and chilling. Care must be taken during evisceration to ensure the viscera is not damaged or ruptured as this can lead to significant contamination of the carcase. The means by which broiler chickens become exposed to contamination with Campylobacter during primary production is multi-factorial (FSANZ, 2005). Numerous factors in combination result in the introduction and spread of the organism within a flock. Campylobacter will colonise individual birds at two or three weeks of age, and usually within a week virtually all birds in the flock will become infected. Horizontal transmission is mainly through contaminated water, litter, insects, rodents, and wild birds and by farm workers via their boots (Wallace, 2003). The implication of this is that unless a flock is Campylobacter free, virtually all birds in a positive flock will be carrying Campylobacter in their intestinal tract at the time of slaughter in high numbers. The FSANZ risk assessment concluded that although poultry meat may occasionally be contaminated with other pathogens, Salmonella and Campylobacter are the primary pathogens of concern and risk management strategies should be targeted to controlling these organisms (FSANZ, 2005). These two organisms are the leading causes of foodborne illness in Australia each year and are frequently isolated from raw poultry meat. They become associated with poultry during primary production and their prevalence and/or levels may be amplified during primary processing and further handling through to consumption.
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The FSANZ risk assessment found that the risk associated with the other pathogens was primarily a concern during the production of processed poultry meat products and temperature abuse of RTE poultry products (FSANZ, 2005). The hazards associated with further processing of poultry meat are outlined in the sections on processed meat. Game meat The main species harvested as game meat are kangaroo and pigs. Very little data exists for hazards in game meat, however kangaroo meat has been studied in some depth as the industry attempts to market the product to increase consumption rates in the general population. Kangaroo meat is anecdotally stated as being a particular risk for toxoplasmosis and salmonellosis, however it appears as if there is little evidence to substantiate that kangaroo meat has Salmonella rates higher than other animals, and there is no known case of toxoplasmosis being transmitted by eating kangaroo meat in Australia. There is a risk of physical hazards in game meat, however strict guidelines exist for the harvesting of product. The animal must be head shot, not only to ensure a quick kill but also to prevent damage to the skin, carcase and internal organs which are required for inspection purposes, and to limit the potential for shot to contaminate the meat. Processed meats The risk posed by processed meats, such as manufactured and fermented meats was highlighted in the National Risk Validation Project (Food Science Australia & Minter Ellison Consulting, 2002), with these products classified as a high risk and earmarked for the introduction of food safety programs. The pathogens of significance for processed meats were identified as L. monocytogenes, Salmonella and pathogenic E. coli, as these had been previous causes of foodborne illness outbreaks in Australia. The primary sources of contamination for processed meats includes the contaminants associated with raw meat (eg pathogenic E. coli, Clostridium spp.), other ingredients such as spices (eg Salmonella spp.) and from the processing environment (eg L. monocytogenes), especially for products that are subject to further processing such as slicing. Control of these organisms is normally through appropriate processing with Critical Control Points (CCPs) to inactivate these pathogens, such as cooking, fermentation with starter cultures and curing. However, this does not eliminate any contamination that occurs post-processing, and as such L. monocytogenes has been the cause of many recalls of processed meats (Table 62 in Appendix 2) and responsible for several very large outbreaks overseas from RTE processed meat products. A potential chemical hazard with processed meat is the inclusion of preservatives such as sorbate and nitrate salts, particularly for cured products, in exceedance of limits in the Food Standards Code.

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Exposure assessment
Consumption of meat Daily consumption of meat and meat products was assessed during the National Nutrition Survey (ABS, 1995), which examined overall consumption of meat, including poultry and processed meats. The survey showed that approximately three quarters of the Australian population regularly consume meat and meat products, with males consuming slightly higher levels than females (Table 9). Consumption of specific types of meat was estimated in the ABARE report (ABARE, 2007) and by MLA through production statistics (MLA, 2008a; MLA 2008b).

Beef
Consumption of beef and veal in 2006 was estimated by ABARE at 38.1 kg per person per year, while MLA estimates beef consumption alone at 35.6 kg beef per year (MLA, 2008a). Consumption of beef and veal has been steadily decreasing since the peak consumption period of the late 1970s.

Sheepmeat
Australians are among the highest consumers of lamb in the world, consuming 11.4kg of lamb and 2.7kg of mutton per person every year (MLA, 2008b).

Pigmeat
A considerable amount of the 23.5 kg pork consumed by each person per year is eaten as processed product (see consumption of processed meats). Consumption of fresh pork in 2006 was estimated at 11.1 kg per person (APL, 2008). Consumption of poultry meat Annual per capita consumption of poultry meat in 2006 was estimated at 39.5 kg (ABARE, 2007). Chicken consumption accounts for approximately 95% of all poultry consumed, with the annual consumption of turkey and duck in Australia estimated at 1.6 kg and 0.5 kg per person respectively (FSANZ, 2005). FSANZ estimated the total number of poultry servings in Australia annually to be 2,880,000,000, with an average serving size of 250g. Consumption of game meat Very little consumption data specific to game meat is available, and when compared to the major meat categories, forms a very small part of the average persons diet. Ampt & Owen (2008) surveyed consumer attitudes towards the consumption of kangaroo meat and found that 58.5% of respondents had tried the meat, with 14.5% having eaten kangaroo meat at least 4 times in the past year (classed as medium to high consumers). In NSW/ACT there were 549 respondents surveyed, with 14.2% were classified as medium to high consumers, 19.5% were non consumers, 43.9% were one-off or low consumers and 22.4% objected to eating kangaroo meat. Men were marginally more likely to consume kangaroo than women. Ampt & Owen (2008) went on to report that although there had been considerable changes in the kangaroo industry over the past 10 years, with the widespread availability of kangaroo in domestic supermarkets, the industry still remains reliant on export markets.
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Table 9 Consumption of meat and meat products in Australia


Sex Age Proportion of persons consuming meat, poultry, 5 game products and dishes (%) Male Male Male Male Male Male Male Male Male Female Female Female Female Female Female Female Female Female 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 76.7 72.4 77.0 78.8 80.9 84.1 84.4 87.6 84.7 71.7 73.6 78.3 80.2 74.5 74.0 76.9 77.5 79.7 Median daily intake for consumers of meat, poultry, game products and dishes (g/day) 62.7 84.3 115.6 143.0 196.0 224.0 191.8 168.0 126.5 52.3 77.9 95.3 113.1 131.0 141.4 126.0 114.3 83.0

adapted from National Nutrition Survey (ABS, 1995)

Table 10 Consumption of processed meats in Australia


Product category Processed meats (hams, whole muscle cooked meats) Cooked sausages (frankfurters, saveloys) Pt and meat paste adapted from MLA (2006) 63 108 40 - 56 Daily serving size (grams per person) 28 58

Meat, poultry and game meat products and dishes are defined in the National Nutrition Survey (ABS, 1995) as including the following: - muscle meat, - poultry and other feathered game, - organs meats and offal, products and dishes, - sausages, frankfurts and saveloys, - processed meat, - mixed dishes where beef or veal is the major component, - mixed dishes where lamb or pork, bacon or ham is the major component, - mixed dishes where poultry or game is the major component

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Consumption of processed meats The MLA (2006) reported consumption data for categories of processed meats, on any given day between 20 and 50% of the population consume processed meats. The amounts consumed are shown in Table 10. Consumption of processed pig meat, as bacon and ham, contributes approximately 14.4 kg per person per year (APL, 2008).

Hazard characterisation
Foodborne illness outbreaks from meat and meat products Table 11 summarises the foodborne illness outbreaks attributed to all meat and meat products, including poultry, game meat and processed meat. This data also includes outbreaks where meat was an ingredient in an implicated food (more detailed information on each outbreak is included in Table 66 in Appendix 3). Meat The European Food Safety Agency (EFSA, 2008) evaluated the relative contribution of different meat categories to cases of foodborne salmonellosis infections in humans and found that poultry was more often implicated than beef, pork and lamb. Adak et al (2005) used data from foodborne illness outbreaks in England and Wales to attribute to source of various types of meats. In this study the most important cause of foodborne illness was chicken (398,420 cases, 141 deaths) while red meat was also a very significant source (287,485 cases, 164 deaths).
Table 11 Summary of foodborne illness outbreaks attributed to all meat (including poultry, game meat and processed meat products)
Hazard Australian outbreaks (1995-2008) Cases Hospitalisations Deaths

Salmonella spp. C. perfringens Campylobacter spp


Toxin Norovirus Viral

74 27 14 6 5 5 4 2 1 1 1 63 203

1829 804 106 520 201 175 51 20 32 173 13 766 4690

97 0 2 0 5 0 5 0 0 0 0 5 114

2 0 0 0 0 0 0 0 0 1 0 0 3 Page 46 of 214

S. aureus B. cereus L. monocytogenes


Pathogenic E. coli

Shigella spp.
Unknown Total Food Safety Scheme Risk Assessment

Three major microbiological baseline surveys have been undertaken by MLA of red meat processed in Australian abattoirs (MLA, 2000; MLA, 2005). These surveys provide a useful indication of the prevalence and levels of hygiene indicators such as Total Viable Count (TVC), as well as pathogens such as Escherichia coli O157:H7 and Salmonella spp. on carcases and in boneless meat (see Table 12). The surveys have shown an improvement in both the prevalence and levels of microbiological contamination every 5-6 years that the surveys have been conducted. This has been attributed to significant improvements in hygiene and sanitation during primary processing and efficient cooling of carcases. A baseline survey of NSW abattoirs by the NSW Food Authority (Bass et al, 2008) found a strong commitment to food safety and that facilities were managing food safety issues well. Surveys of carcase and meat portion load-out temperatures found that 96% of product complied with temperature requirements, however only 38% of offal samples complied. The microbiological hygiene of beef carcases sampled were categorised as excellent 6 or good, with TVC counts ranging from 0.48 log cfu/cm2 to 3.95 log cfu/cm2. One quarter of the beef carcases sampled tested positive for E. coli. This prevalence is higher than that found in the national MLA surveys, but the levels detected were quite low, with counts ranging from -0.89 log cfu/cm2 to 0.69 log cfu/cm2. Almost all sheep carcases (lamb/hogget/mutton) were rated as excellent or good for TVC and E. coli respectively. The sheep TVC counts ranged from 0.30 log cfu/cm2 to 5.47 log cfu/cm2. Just over half (53%) of the sheep carcases tested were positive for E. coli, counts ranging from -0.48 log cfu/cm2 to 2.24 log cfu/cm2. The hygiene results for pig carcases showed that 80% were rated as excellent or good for TVC, and 91% rated as excellent or good for E. coli. The pig TVC counts ranged from 0.85 log cfu/cm2 to 5.03 log cfu/cm2. The percentage of carcases testing positive for E. coli was 63%, with counts ranging from -1.10 log cfu/cm2 to 1.30 log cfu/cm2. European surveillance schemes have found the proportion of fresh beef positive for Salmonella spp. to be below 0.6% at slaughter, with higher levels at retail (8.3%) (EFSA, 2008). Despite worldwide consumption of lamb and mutton, these products have rarely been associated with salmonellosis in humans. There has been a two pronged approach to controlling hazards in the meat industry. Hazards related to zoonotic diseases have been controlled through the application of preventative programs, such as the Brucellosis and Tuberculosis eradication campaign (BTEC), which was aimed at eradicating brucellosis and tuberculosis from all Australian cattle. As a result, Australia has been free of brucellosis caused by Brucella abortus since 1989 and bovine tuberculosis-free status was achieved in 1997, which is now assessed through the Tuberculosis Freedom Assurance Program (TFAP) and National Granuloma Submission Program (NGSP).
6

Meat Standards Committee (2002) Microbiological testing for process control in the meat industry - guidelines defined the following categories: - Total Viable Count (TVC) Excellent (<103 cfu/cm2) Good (103-104cfu/cm2) Acceptable (104105cfu/cm2) Marginal (105-106cfu/cm2) - E. coli Excellent (not detected) Good (>0-10 cfu/cm2) Acceptable (10-100cfu/cm2) Marginal (100-103cfu/cm2).

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Table 12 Prevalence of microbiological hazards in Australian beef and sheep meat


1993-93 survey Beef carcases Number of samples TVC (mean log cfu/g) 1043 3.02 19 128/465 (27.5%) 4/1043 (0.38%) 4/1036 (0.38%) 4/190 (2.1%) 2/753 (0.26%) 0 1268 2.43 11 3.9 0.6 not detected 1155 1.33 4.9 20.1 0 0.1 1998 survey 2004 survey

E. coli (%) S. aureus (%) Salmonella (%) E. coli O157:H7 (%) Listeria Campylobacter
Boneless beef Number of samples TVC (mean log cfu/g)

929 2.77 16.7 n/a 6/921 (0.65%) 0/804 (not detected)

987 3.52 5.1 17.5 0.1 not detected

1082 1.19 1.1 2.6 0.1 0

E. coli (%) S. aureus (%) Salmonella (%) E. coli O157:H7 (%)


Boneless sheepmeat Number of samples TVC (mean log cfu/g)

415 3.47 47.7 n/a 27/415 (6.5%) 1/342 (0.3%)

467 3.29 24.5 38.6 1.3 1.3

560 1.81 4.3 14.1 0.5 0.2

E. coli (%) S. aureus (%) Salmonella (%) E. coli O157:H7 (%)

adapted from MLA (2000); MLA (2005)

NSW legislation requires that any abattoir processing meat must comply with the AS4696:2007 the Australia Standard for the hygienic production and transportation of meat and meat products for human consumption (FRSC, 2007c). As part of compliance with this standard, all abattoirs must have qualified meat safety inspectors (meat safety officer) to conduct ante-mortem inspections of livestock prior to slaughter. This is used to identify any stock suspected of carrying infectious zoonotic diseases, which may then be culled to prevent spread to healthy stock. Online post-mortem inspection in abattoirs is used to identify and excise diseased tissues and organs and/or to exclude diseased carcases from human consumption. Many studies have been undertaken to assess the influence of different processing practices in contributing to microbial contamination of carcases. Widders et al (1995) showed that the level of microbial contamination meat was influenced by the level of carcase contamination at boning, and by the boning process itself. If carcases were heavily contaminated, the contamination of processing surfaces was irrelevant in
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determining eventual microbial loads on meat. However, where carcase contamination was at low to moderate levels, cutting boards were a major source for microbial dissemination during the boning process. It was shown that improved sanitation of cutting surfaces in the boning room could result in a significant reduction in microbial contamination on the surface of meat. Special control measures have also been implemented to target specific hazards of concern in pigs. In order to minimise pig carcase contamination with Y. enterocolitica during slaughter, the tongue and pharynx are removed early in the slaughter process to reduce the leakage of saliva and contaminated material from the tongue and tonsils onto the carcase (Barton & Robins-Browne, 2003). The NRS and Australian Total Diet survey results show that misuse of agricultural and veterinary chemicals within the meat industry is low, with most analyses returning either no detectable residues or residues well below established legal limits. As a result, the Australian dietary exposure to pesticides and contaminants falls well within acceptable health standards (MLA, 2003). Poultry meat The FSANZ poultry risk assessment summarised OzFoodNet data for foodborne illness outbreaks in Australia from poultry meat products (FSANZ, 2005). Between 1995 and 2002 they reported 46 outbreaks involving 1170 cases. The data in Table 66 of Appendix 3 includes and updates the outbreaks from the FSANZ report. From 1995-2008, 94 outbreaks were attributed to products containing chicken, affecting 1815 people and 54 requiring hospitalisation. In addition to these outbreaks, another 6 outbreaks were observed in institutional settings serving vulnerable persons. Details on these outbreaks are included in Table 69 of Appendix 3. A case control study conducted on foodborne illness outbreaks in New Zealand concluded that consumption of raw and undercooked chicken was the most important source of human campylobacteriosis (Eberhart-Phillips et al, 1995). The EFSA (2008) reported prevalence of Salmonella in EU member countries at slaughter ranging from 5.7% to 21.5%, while prevalence in fresh turkey meat varied from 0 to 11%, fresh duck meat from 15 to 39% and 10% in fresh geese meat. Although data is not readily available for contamination rates at slaughter for Australian birds, a survey of retail chicken in NSW found 47.7% of poultry samples contained low levels of Salmonella. However, of the Salmonella serovars approximately 65% were the serovar S. Sofia, considered of very low virulence to humans. In addition, 87.8% of poultry samples were found to be contaminated with Campylobacter (Pointon et al, 2008, summarised in Table 13. All facilities slaughtering and processing poultry in NSW are required to comply with AS 4465:2005 the Australian Standard for the Construction of Premises and Hygienic Production of Poultry Meat for Human Consumption (FRSC, 2007a). This requires ante-mortem inspection of poultry presented for slaughter to reject any moribund, unhealthy or diseased birds and post-mortem inspection to identify and apply a disposition to any carcase and parts that are not considered wholesome for human consumption. In addition to the regulatory requirements, there are various industry codes of practice and guidelines, such as the National Biosecurity Manual Contract Meat Chicken Farming (ACMF, 2003), Model Code of Practice for the Welfare of Animals Food Safety Scheme Risk Assessment Page 49 of 214

Land Transport of Poultry (PISC, 2006). These Codes of Practice concentrate on

prevention of animal disease and welfare aspects, with potential implications for food safety. The extent of compliance with these control measures varies within the poultry industry, depending on whether it is a legislative requirement or a voluntary scheme.

Table 13 Prevalence of microbiological hazards on chicken meat in NSW


Retailer Product Number positives / total samples (%) Butcher Skin off Skin on Whole bird Supermarket Skin off, bulk Skin off, tray Skin on, bulk Skin on, tray Whole bird Specialty store Skin off Skin on Whole bird TOTAL 18/28 (64.3) 29/47 (61.7) 7/9 (77.8) 21/37 (56.8) 39/106 (36.8) 28/50 (56.0) 63/150 (42.0) 11/37 (29.7) 14/28 (50.0) 28/47 (59.6) 4/10 (40.0) 262/549 (47.7)

Salmonella
Mean concentration SD NonSofia (%)

Campylobacter
Number positives / total samples (%) 27/28 (96.4) 40/47 (85.1) 8/9 (88.9) 35/37 (94.6) 95/106 (89.6) 42/50 (84) 124/150 (82.7) 34/37 (91.9) 25/28 (89.3) 44/47 (93.6) 8/10 (80) 482/549 (87.8) Mean concentration SD

-1.31 0.58 -1.18 0.70 -1.70 0.95 -1.41 0.33 -1.38 0.41 -1.43 0.47 -1.48 0.67 -1.75 0.76 -1.33 0.58 -1.38 0.60 -2.05 0.04 -1.42 0.60

7.1 44.7 0.0 13.5 16.0 18.0 9.3 5.4 21.4 21.3 10 15.8

1.14 0.57 1.24 0.64 1.11 1.00 1.06 0.35 0.90 0.27 0.82 0.23 0.66 0.36 0.61 0.53 1.04 0.35 0.90 0.35 0.77 0.37 0.87 0.45

adapted from Pointon et al (2008)

The high risk factors for poultry becoming contaminated with Salmonella or Campylobacter were identified in the FSANZ scientific assessment (FSANZ, 2005). The development of Standard 4.2.2 - Primary Production and Processing Standard for poultry meat in the Food Standards Code aims to reduce the contamination of poultry, poultry carcases and poultry meat by pathogenic Salmonella and Campylobacter through the implementation of control measures on farm, as well as maintain existing control measures during processing at abattoirs.

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Game meat NSW legislation requires that harvesting facilities, primary processing and storage facilities and vehicles comply with AS4464:2007the Australian Standard for the hygienic production of wild game meat for human consumption (FRSC, 2007b). This requires that all carcases are subject to inspection by a qualified meat safety inspector and temperature control of the carcase is maintained. There is no data to indicate that game meat has been the subject of any foodborne illness outbreaks or recalls. There is also no recent data to indicate prevalence of microorganisms on game meat carcases, although it is assumed that with similar control measures in place to the broader meat industry, that the prevalence of pathogens may be similar. The incidence of zoonoses and other public health risks from kangaroo meat was investigated and summarised by Andrew (1988), quoted in Pople & Grigg (1999). The work summarised the records of inspections between 1980 and 1987 made of carcases by AQIS officers at export game meat establishments. Of the 204,052 kangaroo carcases harvested, 196,104 were passed as fit for human consumption and 7,948 were rejected. Of those rejected, 81% were rejected for reasons not associated with parasites or pathology, mainly poor handling, particularly inadequate refrigeration. Of the rest, 1,452 were rejected because of a nematode parasite, Pelicitus roemeri, which is harmless to humans but is considered unsuitable for human consumption. Processed meat products Processed meat products have been implicated in several large scale food poisoning outbreaks, both overseas and within Australia (see Table 14; Table 66 of Appendix 3). For the period 1991-2000, the National Risk Validation Project identified greater than 323 cases of foodborne illness and one death attributed to the consumption of fermented meats, with a further 97 cases and two deaths attributed to manufactured meat products. The pathogens implicated in these outbreaks were pathogenic E. coli, L. monocytogenes and Salmonella and the total cost of foodborne illness associated with fermented and manufactured meats was calculated to $77 million per year (Food Science Australia & Minter Ellison Consulting, 2002) The most significant outbreak from a processed meat product occurred in 1995 in South Australia from Garibaldi-brand Mettwurst, with over 150 people ill and the death of a young child. Well controlled fermentation and maturation should achieve a low pH and water activity to eliminate any pathogens present in the raw meat ingredient, however uncontrolled fermentation, as was the case with the Garibaldi product, can lead to survival of pathogens. This outbreak led to changes to the Food Standards Code and regulations regarding the manufacture of uncooked comminuted fermented meats. An outbreak of listeriosis from Conroys smallgoods occurred in South Australia in 2005, resulting in three deaths of hospital patients. Listeria was isolated from the slicing machines in the factory used to slice the deli meats. Details are included in Table 69 in Appendix 3, as the food was served to vulnerable persons. The cost of the subsequent recall by Conroys was in the order of $2 million. A Canadian outbreak in 2008 from Maple Leaf Foods Inc. resulted in 20 deaths, and the resultant recall of more than 220 product lines and settlements from class action lawsuits was in the order of $27 million (AUS$ 33 million).
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The manual handling associated with preparing and packaging processed meat products tend to lend themselves to contamination with L. monocytogenes. Surveys have shown a significant number of RTE processed meat products are contaminated with this organism ( Table 15). Sliced meats in particular tend to have high contamination rate with L. monocytogenes, although actual numbers of organisms are quite low. The long shelf life associated with these products (~ 6 weeks) can allow growth of the organism to occur. Advice provided to susceptible persons, such as pregnant women, is to avoid consuming pre-packaged sliced meats. Table 62 of Appendix 2 shows the number of recalls from RTE processed meats from 2004-2008, during which time there have been 33 recalls, mostly due to contamination with L. monocytogenes. NSW legislation requires that any facility producing processing meat must comply with AS4696:2007 the Australia Standard for the hygienic production and transportation of meat and meat products for human consumption (FRSC, 2007c). In addition to this, there are industry produced documents such as Guidelines for the safe manufacture of smallgoods (MLA, 2003) and Listeria monocytogenes in smallgoods: Risks and controls (MLA, 2006) which provide information on hygiene and sanitation and CCPs for controlling hazards.
Table 14 Foodborne illness outbreaks of listeriosis from processed meats
Year 1987-89 1990 1992 1993 1996 1998-99 1999 1999 1999 2000 2000-01 2002 2005 2008 Country United Kingdom WA France France SA USA France USA France New Zealand USA USA SA Canada Processed meat Pt Pt Jellied pork tongue Pork rillettes, pt Diced chicken Hot dogs and deli meats Ham rillettes Pt Jellied pork tongue Corned beef Turkey franks Deli meats (poultry) Corned beef Deli meats Cases 366 11 279 39 5 101 >6 11 23 2 >29 >50 5 50 Deaths 94 6 85 11 1 21 2 3 7 >7 11 3 20

adapted from MLA (2006); Doolittle (2008)

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Table 15 Prevalence of Listeria monocytogenes in processed meats


Product category Processed meats (hams, whole muscle cooked meats) Cooked sausages (Frankfurters, saveloys) Pt and meat paste adapted from MLA (2006) Contamination rate (%) 4.8 2.8 1.2

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Risk characterisation
Meat The MLA risk profile examined the risk of fresh meats consumed in the home and found that meat consumed as cuts, roasts, chops, steak are low risk (MLA, 2003). These products normally receive a cooking step by the end consumer that will reliably eliminate most pathogenic bacteria. However, the importance of cross contamination from pathogens in raw and undercooked meat across to RTE foods was highlighted by Lake et al (2004) as a potential source of infection from Yersinia in pork (Table 16), and as a potential source for large numbers of Salmonella food poisoning cases (Table 17). It was predicted that if the cross contamination rate of Salmonella from raw meat increased from 1% to 10% would result in almost an extra 4800 case, while an increase to a 50% cross contamination rate would result in more than 26,000 cases of foodborne illness in Australia each year, where fresh meat was the cause (MLA, 2003). Another hazard categorised as high risk by the MLA risk profile was consumption of undercooked sheep meat or liver contaminated with Toxoplasma gondii, particularly for pregnant women (MLA, 2003). This area was identified as a data gap in work undertaken on the New Zealand meat industry by Lake et al (2002b). While it was predicted there may be more than 600 cases of illness due to infection Toxoplasma gondii per annum (200 in pregnant women), further work was required to fully understand the risk factors involved. Undercooked meat and hamburgers is associated with survival of pathogenic E. coli being ranked as a medium hazard in some instances. However, a study by the FSIS (2002) in the USA calculated the probability of illness occurring as extremely low. This work estimated that the probability of E. coli O157:H7 surviving in a piece of cooked steak was 0.000026% (2.6 of every 10 million servings), given normal cooking practices. It was shown that even inadequate cooking of meat would still reduce the numbers of pathogenic E. coli present on the meat, albeit to a lesser degree than proper cooking. The predicted number of food poisoning cases from E. coli O157:H7 in cooked steaks was calculated to be 1 case for every 15.9 million servings (FSIS, 2002). The risk of illness from pathogenic E. coli in New Zealand meat was considered low by Lake et al (2002a), as there was no data to link illness to pathogenic E. coli in that country. The risk from comminuted meat such as hamburgers is considered greater, as the contamination may be spread throughout the product, as opposed to just the surface on an intact steak. The MLA risk profile estimated that if all hamburgers were appropriately cooked, there would be no illness, however if 20% of hamburgers were undercooked, there would be 6 illnesses per annum (MLA, 2003). The NZFSA also commissioned risk profile work on tuberculosis (Cressey et al, 2006) and Campylobacter (Lake et al, 2007c) from red meat, and both were considered low risk (Table 16). These were not examined in the MLA risk profile, as Australia has been declared tuberculosis free and a definitive association of Campylobacter with red meat could not be established (MLA, 2003). The risk from C. perfringens from meat consumed in the home was considered medium (Table 17), with poor cooling and reheating the main contributing factors. Problems with C. perfringens have arisen more in large scale catering-type

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operations than in the home, where the spore forming bacteria have been allowed to germinate and grow due to poor cooling of meat-based dishes.
Table 16 NZFSA risk profile outcomes examining hazards in meat
Hazard Shiga toxin-producing Escherichia coli in red meat and meat products (Lake et al, 2002a) Risk Overseas studies have consistently linked human cases of STEC infection and particularly E. coli O157:H7 to consumption of red meat in the form of undercooked hamburgers, not one case in New Zealand has been associated with regulated foods.

Toxoplasma gondii in red meat


and meat products (Lake et al, 2002b)

Toxoplasma gondii is a protozoan parasite that causes disease in

humans with a range of outcomes including, at worst, miscarriages. Cysts in the muscle tissue of meat animals may result in infection when eaten. The significance of human infections, especially congenital toxoplasmosis, in New Zealand is unknown and has been identified as a knowledge gap

Yersinia enterocolitica in pork (Lake et al, 2004)

Pigs are known to be frequently contaminated with Y. enterocolitica, but effective cooking or pasteurisation will eliminate Y. enterocolitica from foods. Pork consumption has consistently been associated with yersiniosis in studies in New Zealand and overseas, with cross contamination from uncooked meats to RTE foods a potential source of infection.

Mycobacterium bovis in red meat (Cressey et al, 2006)

Mycobacterium bovis. While transmission of tuberculosis to humans through consumption of M. bovis-infected meat is

A proportion of human tuberculosis cases have been caused by possible, no cases of this have been confirmed in New Zealand and it is considered low risk. Seventeen outbreaks of campylobacteriosis in New Zealand from 1999 to 2004 have been associated (weakly) with red meat consumption. Data in New Zealand indicates there is low but consistent contamination across pork, beef, and sheep meat. On this basis it is identified as a minor risk factor for exposure to Campylobacter in New Zealand.

meat (Lake et al, 2007c)

Campylobacter jejuni/coli in red

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Table 17 Risk ranking for meat and meat products


Meat product Hazard Severity 7 Probability Growth required to cause illness Effect of production, processing, handling on the hazard Consumer does pathogen reduction step Epidemiological link Risk rating Predicted annual number of illnesses (in Australia) 8

Retail meats consumed in the home (steak, mince, chops, roast, fresh sausages) Consumed undercooked/raw Consumed undercooked Reheated roasts Reheated roasts

Toxoplasma gondii

IB

Medium

No

freezing,

Yes/No

Yes

High

715 (242 in pregnant women) No estimate No estimate No estimate No estimate No estimate No estimate No estimate

EHEC

IB III III III III/IB III III

Low Low Medium Low Low Low? Low??

Yes Yes Yes Yes N/A Yes Yes

??

Yes No No Yes ?? Yes Yes

Yes Yes Yes No ?? ??No ?

Medium Medium Low Low Low Low Low

C. perfringens S. aureus Aeromonas Mycobacterium paratuberculosis Bacillus Yersinia enterocolitica

Potential pathogen Poor cooling

ICMSF (2002) defines the level of severity as follows: IA Severe hazard for general population, life threatening or substantial chronic sequelae or long duration IB Severe hazard for restricted populations, life threatening or substantial chronic sequelae or long duration II High hazard incapacitating but not life threatening sequelae rare moderate duration. III Moderate, not usually life threatening no sequelae normally short duration symptoms are self limiting can be severe discomfort. Data from Sumner (2002) predicted annual numbers of illness per annum for the South Australia population (1.5 million), the MLA Risk Profile (MLA, 2003) used an Australian population figure of 19.7 million. These estimates have been extrapolated to the current population of Australia estimated by ABS (2009) as approximately 21.6 million, by multiplying by a factor of 14.4 and 1.1 respectively.

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Meat product

Hazard

Severity 7

Probability

Growth required to cause illness

Effect of production, processing, handling on the hazard

Consumer does pathogen reduction step

Epidemiological link

Risk rating

Predicted annual number of illnesses (in Australia) 8

Retail meats consumed in the home (steak, mince, chops, roast, fresh sausages) Assume 1% cross contamination rate Assume 10% cross contamination rate Assume 50% cross contamination rate

Salmonella Salmonella Salmonella

II/IB II/IB II/IB

Low Low Low

Yes Yes Yes

Yes Yes Yes

Yes Yes Yes

Medium High High

583 5,830 29,370

Enterohaemorrhagic E. coli in hamburger Hamburgers Hamburgers - assume 50% undercooked Hamburgers EHEC EHEC IA/IB IA/IB II/IB Low Low Low No No Yes Yes Yes Yes Yes Yes Yes Low Low Low 0 7 0

Salmonella

adapted from Sumner (2002); MLA risk profile (MLA, 2003)

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Table 18 Risk ranking for processed poultry meat products


Processed meat product Hazard Severity Probability Growth required to cause illness Effect of production, processing, handling on the hazard Consumer does pathogen reduction step Epidemiological link Risk rating Predicted annual number of illnesses (in Australia) 9 864 86,400

Processed chicken Processed chicken

Salmonella Campylobacter

II/IB IB

Low Low

Yes Yes

No No

Yes Yes

High High

adapted from Sumner (2002)

Table 19 NZFSA risk profile outcomes examining hazards in poultry meat


Hazard Risk Salmonellosis is the second most frequently notified enteric disease in New Zealand. Poultry meat is regarded as an important source of infection

Salmonella (non-typhoid) in poultry (whole and pieces) (Lake et al, 2004)


(Lake et al, 2007a)

Campylobacter jejuni/coli in poultry

Campylobacter is the most frequently notified cause of enteric disease in New Zealand. Consumption of chicken was linked with Campylobacter infection and several outbreaks of campylobacteriosis identified undercooked chicken as the transmission vehicle
The consumption of poultry and mammalian offal is low in comparison to other meat types. However the high prevalence of Campylobacter in raw sheep and chicken livers is of concern, especially when some advice to consumers is to cook chicken livers "until they're pink in the middle" or "lightly sauted". Offal for pet food is frequently contaminated and handling may provide a risk of infection

offals (Lake et al, 2007b)

Campylobacter jejuni/coli in mammalian and poultry

Data from Sumner (2002) predicted annual numbers of illness per annum for the South Australia population (1.5 million). These estimates have been extrapolated to the current population of Australia estimated by ABS (2009) as approximately 21.6 million, by multiplying by a factor of 14.4.

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Poultry meat In the FSANZ scientific assessment of poultry meat, it was found that on the basis of epidemiological data, results from microbiological surveys of raw poultry carcase and outputs from a probabilistic model, there is reasonable evidence to indicate poultry is the vehicle for a significant proportion of campylobacteriosis and salmonellosis cases in Australia (FSANZ, 2006). Sumner (2002) estimated large numbers of foodborne illness cases to be due to processed chicken products, in the order of 79,000 cases per annum from Salmonella and Campylobacter (Table 21). Work commissioned by the New Zealand Food Safety Authority has also found the presence of these organisms on poultry to be a significant source of infection (Table 19). Management of both Salmonella and Campylobacter requires an approach across both primary production and processing. Good hygienic practices and good agricultural practices are necessary prerequisites for the management of Salmonella and Campylobacter, and appropriate hygiene and sanitation is required during processing to minimise cross contamination between birds. Surveys of poultry pieces available for retail sale show that a large proportion of poultry carries these organisms, creating a risk of foodborne illness from consuming undercooked chicken, but also the risk of cross contamination occurring in food preparation areas. FSANZ (2005) found that the implementation of control measures to reduce the prevalence and levels of Salmonella and Campylobacter by ten-fold at the end of processing could result in a 74% and 93% reduction in the number of predicted cases of illness respectively. FSANZ identified the significant factors contributing to contamination of poultry meat with Salmonella and Campylobacter as: On-farm contamination with Salmonella is mainly due to contaminated feed and water, environmental sources and transmission from contaminated eggs Important on-farm risk factors for Campylobacter are the age of the birds and environmental factors The presence and amount of Salmonella on a chicken after processing largely determines the likelihood of salmonellosis Inadequate hand washing and food handling practices determine the likelihood of human illness from Campylobacter Adequate cooking is the main means of minimising the risk to human health from both pathogens. The FSANZ scientific assessment found little evidence of public health risks associated with chemical hazards from Australian poultry meat. The report concluded that the current regulatory measures appear to adequately protect public health and safety with respect to chemical hazards (FSANZ, 2006). Game meat Evidence suggests that the consumption of kangaroo meat and other game meat present little risk as a source of foodborne illness when compared to other forms of meat.

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Processed meats Sumner (2002) stated that the highest risk products in the meat industry are smallgoods, predominantly due to pathogenic E. coli, Salmonella and L. monocytogenes. The risk of L. monocytogenes from processed RTE meats was examined by Lake et al (2002), who found that these products were a significant route of infection in New Zealand. The FDA/USDA risk assessment for L. monocytogenes identified processed meats products or deli meats as the highest risk food from the 23 RTE foods examined (FDA/USDA, 2003). Deli meats were the only food to be ranked as very high risk and when extrapolated to the Australian population are predicted to be responsible for 133 cases of listeriosis per annum (see Table 22). In addition, frankfurters that were not reheated were ranked as high risk. However it is not believed that this practice is as common in Australia as in the US. Pt and meat spreads were ranked as high risk on a per serving basis, predominantly due to the probability of contamination with L. monocytogenes post cooking, but this did not correlate with a high number of predicted illnesses due to low consumption rates. The MLA risk profile examined different scenarios for processed meat products and provided risk rankings and predicted numbers of illness (MLA, 2003, summarised in Table 21). It was predicted that processed meat were responsible for 43 cases of listeriosis in Australia per annum. Although there are 50-60 cases of listeriosis reported each year in Australia, it is estimated that due to under-reporting, the true number is closer to 120 per year. Therefore, processed meats were considered to be the source of approximately one third of listeriosis cases in any one year (MLA, 2006). The MLA guideline Listeria monocytogenes in smallgoods: risks and controls (MLA, 2006) proposes measures to control post processing contamination with L. monocytogenes in processed meat: install effective GMPs and sanitation standard operating procedures (SSOPs), particularly in post-cooking operations such as slicing/portioning and packing incorporate antimicrobials into formulations of products which are intended for slicing and packing as long shelf-life products employ technologies for in-pack pasteurisation. In late 2008, the NSW Food Authority implemented national testing requirements for sliced pre-packaged RTE meat products (Meat Standards Committee, 2008). This Listeria management program involved the introduction of minimum finished product and environmental testing to any facilities manufacturing these products (NSW Food Authority, 2008). The MLA risk profile and the work of Gilbert et al (2007) considered the risk of pathogenic E. coli (STEC and EHEC) from UCFM products such as salami. Both studies found that well controlled processes, including efficient fermentation and a maturation producing a low pH and water activity, effectively controlled the hazard (Table 20 and Table 21), with a 2-3 log reduction in E. coli. As a result, with a well controlled process, it was predicted that no illnesses would result from these products. However, if contaminated meat was used, and an unreliable process was not able to reduce the hazard, then there may be up to 604 illnesses in a year (see Table 21). In addition, if susceptible members of the population consumed product

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with high levels of pathogenic E. coli present there may be up to 114 cases per annum. It was predicted that Salmonella may cause 11 illnesses per from UCFM products, while green runners used for casings of sausages and salami would not cause any illness. Given the level of specialist skills and knowledge required to safely make these products, specific requirements for the production of UCFM products are included in Standard 4.2.3 Primary Production and Processing Standard for Meat of the Food Standards Code. Salmonella was considered a medium risk, while the risk from L. monocytogenes in UCFM products was considered low, as it will not grow in the product, however it may survive for extended periods. The risk from Toxoplasma in UCFM products was also considered low, as the risk can be considerably if the meat is frozen before use, as this will kill the organism. Kebabs were predicted to be a significant source of illness if allowed to be recontaminated in the drip tray after cooking, with approximately 25,000 illnesses per annum. Under normal conditions for cooking kebabs, or even when an extra cook step was added, it was modelled that in 1% of cases, there may still be an element of undercooking or some other mishandling to allow survival of Salmonella. In this scenario, there were still 25 illnesses per annum predicted with kebabs as the cause. A survey of NSW kebab retail outlets (Jansson et al, 2008) showed that 92% of outlets undertook an extra cooking step after slicing the meat from the kebab.
Table 20 NZFSA risk profile outcomes examining hazards in processed meats
Hazard Risk Several notified cases in New Zealand and an outbreak of noninvasive listeriosis in February/March 2000 associated with corned silverside and ham indicate that processed RTE meats are a route of infection for listeriosis in New Zealand. While uncooked comminuted fermented meat (UCFM) products might appear to be a higher risk, well controlled processing to lower the pH and water activity control STECs.

Listeria monocytogenes in

processed ready-to-eat meats (Lake et al, 2002)

Shiga-like toxin producing Escherichia coli in uncooked comminuted fermented meat products (Gilbert et al, 2007)

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Table 21 Risk ranking for processed meat products


Processed meat product Hazard Severity Probability Growth required to cause illness Effect of production, processing, handling on the hazard Consumer does pathogen reduction step No No Yes No Yes Yes Epidemiological link Risk rating Predicted annual number of illnesses (in Australia) 10; 43 0.8 >0.01 0.04 0 27,500

Deli meats Terrines Fresh sausage Cooked sausages Green runners Kebabs Kebabs contaminated in drip tray Kebabs normal Kebabs - finished with extra cook step

L. monocytogenes L. monocytogenes L. monocytogenes L. monocytogenes Salmonella Salmonella

IB IB IB IB II/IB II/IB

Low Low Low Low N/A Low

Yes Yes Yes Yes Yes Yes

Yes Yes No No No Yes

High Medium Low Low Low High

Salmonella Salmonella

II/IB

Low

Yes

Yes

Yes

Medium

28

II/IB

Low

Yes

Yes

Yes

Medium

28

10

Data from Sumner (2002) predicted annual numbers of illness per annum for the South Australia population (1.5 million), the MLA Risk Profile (MLA, 2003) used an Australian population figure of 19.7 million. These estimates have been extrapolated to the current population of Australia estimated by ABS (2009) as approximately 21.6 million, by multiplying by a factor of 14.3 and 1.1 respectively.

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Processed meat product

Hazard

Severity

Probability

Growth required to cause illness

Effect of production, processing, handling on the hazard

Consumer does pathogen reduction step

Epidemiological link

Risk rating

Predicted annual number of illnesses (in Australia) 10;

Uncooked comminuted fermented meat (UCFM) products Salami - general population EHEC IA/IB II/IB IB IB IA/IB Low Low Low Low Low No Yes Yes No No freezing No No No No No Yes Yes No No Yes high level contamination Yes Medium Medium Low Low Medium 1 12 >0.01 0 125

Salmonella L. monocytogenes Toxoplasma gondii

Salami vulnerable population Salami unreliable process

EHEC

EHEC

IA/IB

Low

No

No

High

604

adapted from Sumner (2002); MLA risk profile (MLA, 2003)

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Table 22 Risk ranking for L. monocytogenes-contaminated processed meats


Processed meat product Risk ranking (per serve) High High High Low Low Predicted cases of listeriosis per serve (in Australia) 11 7.7 x 10
-8

Risk ranking (per annum)

Predicted annual number listeriosis cases (in Australia) 12 133 2.5 0.3 0.03 0

Deli meats Frankfurters, not reheated Pt and meat spreads Frankfurters reheated Dry / semi-dry fermented sausage

Very high High Moderate Low Low

6.5 x 10-8 3.2 x 10-8 6.3 x 10-11 1.7 x 10-11

adapted from FDA/USDA (2003)

Conclusions
The production and processing of meat has a long history of successful regulation. The preventative programs implemented by government and industry have improved animal health to the point that many diseases are no longer present in Australian animals. The meat food safety scheme under the Food Regulation 2004 requires compliance with national meat standards, leading to ante-mortem and post mortem inspections at abattoirs that have been effective in ensuring that meat produced in NSW is safe and suitable for human consumption. The microbiological surveys of meat production have shown a steady increase in the quality of meat produced. However, epidemiological data suggests that the prevalence of Salmonella and Campylobacter on raw poultry significantly contributes to the burden of foodborne illness within the community, not only from the consumption of contaminated poultry itself but the added potential for the introduction of these pathogens from poultry into food preparation areas where they may be a source of cross contamination onto RTE foods. Currently the food safety scheme requires compliance with the national poultry meat standard, however this only provides control measures for the processing sector. A whole chain approach is considered necessary, with control measures introduced at the primary production level to reduce the prevalence of these foodborne pathogens. With this aim in mind, FSANZ are currently finalising the development of Standard 4.2.2 - Primary Production and Processing Standard for poultry meat into Chapter 4 of the Food Standards Code. When finalised, this will be adopted into NSW legislation. The contamination of processed meats with

11

The risk per serving is inherent to the particular food category, and is therefore assumed to be the same in Australia as that calculated for the USA (FDA/USDA, 2003). This is based on the assumption that consumption patterns for these foods are identical in Australia and the USA. One significant difference would be that frankfurters are not commonly eaten without reheating in Australia, with MLA (2003) estimating that only 5% are eaten without further cooking The risk per annum has been adapted from USA population data contained in the FDA/USDA (2003) risk assessment of 260 million and extrapolated to Australian population data of approximately 21.6 million (ABS, 2009) by dividing by a factor of 12

12

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L. monocytogenes continues to cause issues for meat processors, including a substantial number of product recalls. Additional hygiene and sanitation measures, including mandating the testing of finished product and food contact surfaces in high risk processing facilities, such as those packaging sliced RTE meats, aims to minimise contamination of this organism in product.

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ACMF [Australian Chicken Meat Federation] (2008). Industry facts and figures. Retrieved 4 December 2008, from http://www.chicken.org.au/page.php?id=4. Adak, G.K., Meakins, S.M., Yip, H., Lopman, B.A. & OBrien, S.J. (2005). Diseases risks from foods, England and Wales, 1996-2000. Emerging Infectious Diseases, 11, 365-72. Ampt, P. & Owen, K. (2008). Consumer attitude to kangaroo meat products. RIRDC Publication No 08/026. Retrieved 27 November 2008, from http://www.rirdc.gov.au/reports/NAP/08-026.pdf. Andrew, A.E. (1988). Kangaroo meat - Public health aspects. Australian Zoologist, 24(3), 138140. APL [Australian Pork Limited] (2008) Annual Report 2007-08. Retrieved 4 December 2008, from http://www.australianpork.com.au/pages/images/PORK%2012566%20AnnRep%200708%20Cover&Internals%20WEB%20V1.pdf. Barton, M.D. & Robins-Browne, R.M. (2003). Yersinia enterocolitica. In Hocking A.D. (Ed.) Foodborne Microorganisms of Health Significance (pp. 577-596). Australian Institute of Food Science and Technology, Waterloo. Bass, C., Crick, P. & Cusack, D. (2008). NSW domestic red meat abattoir evaluation Final report. Retrieved 4 December 2008, from

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New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/FW0320_Mbovis_in_meat_final_May_2006.pdf

DAFF [Department of Agriculture, Fisheries and Forestry, Australian Government of] (2004). Generic Import Risk Analysis (IRA) for pig meat - final import risk analysis report. Retrieved 5 December 2008, from http://www.daffa.gov.au/__data/assets/pdf_file/0018/18081/200401b.pdf Doolittle, R. (2008, December 18). Maple Leaf settles listeria suits for $27M. The Toronto Star Retrieved 19 January 2009, from http://www.thestar.com/business/article/555873 Eberhart-Phillips, J., Walker, N., Garrett, N., Bell, D., Sinclair, D., Rainger, W., & Bates, M. (1997). Campylobacteriosis in New Zealand: results of a case-control study. Journal of Epidemiology and Community Health 51:686-691 EFSA [European Food Safety Authority] (2007). Geographical BSE Risk (GBR) assessment covering 2000-2006. List of countries and their GBR level of risk as assessed by the Scientific Steering Committee and the European Food Safety Authority (EFSA). Retrieved 14 January 2009, from
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www.efsa.europa.eu/cs/BlobServer/Scientific_Document/GBR_assessments_table_Overview_ assessed_countries_2002-2006,0.pdf EFSA [European Food Safety Authority] (2008). A quantitative microbiological risk assessment on Salmonella in meat: Source attribution for human salmonellosis from meat. The EFSA Journal 625, 1-32. FAO/WHO [Food and Agriculture Organization of the United Nations / World Health Organization] (2001). Risk characterization of Salmonella spp. in eggs and broiler chickens and Listeria monocytogenes in ready-to-eat foods. FAO Food and Nutrition Papers 72. Joint FAO/WHO Expert Consultation on Risk Assessment of Microbiological Hazards in Foods. Retrieved 30 October 2008, from http://www.fao.org/docrep/008/y1332e/y1332e00.HTM FAO/WHO [Food and Agriculture Organization of the United Nations / World Health Organization] (2003). Risk assessment of Campylobacter spp. in broiler chickens and Vibrio spp. in seafood. FAO Food and Nutrition Papers 75. Joint FAO/WHO Expert Consultation on Risk Assessment of Microbiological Hazards in Foods. Retrieved 30 October 2008, from http://www.who.int/foodsafety/publications/micro/en/aug2002.pdf

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Food Science Australia & Minter Ellison Consulting (2002). National Risk Validation Project. Final Report. FSIS [Food Safety and Inspection Service, USDA] (2002). Comparative Risk Assessment For Intact And Non-Intact (Tenderized) Beef: Executive Summary. Retrieved 14 January 2009, from http://www.fsis.usda.gov/PDF/Beef_Risk_Assess_Report_Mar2002.pdf FRSC [Food Regulation Standing Committee] (2007a). Australian standard for construction of premises and hygienic production of poultry meat for human consumption. FRSC Technical

Report No 1. CSIRO publishing www.publish.csiro.au

FRSC [Food Regulation Standing Committee] (2007b). Australian standard for the hygienic production of wild game meat for human consumption. FRSC Technical Report No 2. CSIRO publishing www.publish.csiro.au FRSC [Food Regulation Standing Committee] (2007c). Australia standard for the hygienic production and transportation of meat and meat products for human consumption. FRSC Technical Report No 3. CSIRO publishing www.publish.csiro.au FSANZ [Food Standards Australia New Zealand] (2005). Scientific Assessment of the Public Health and Safety of Poultry Meat in Australia is available. Retrieved 14 January 2009, from http://www.foodstandards.gov.au/_srcfiles/P282_Poultry%20_%20DAR%20Attach3.pdf FSANZ [Food Standards Australia New Zealand] (2006). Public health and safety of poultry meat in Australia. Explanatory summary of the scientific assessment., Canberra. Gilbert, S., Lake, R., Hudson, A. & Cressey, P. (2007). Risk profile: Shiga toxin-producing Escherichia coli in uncooked comminuted fermented meat products. Institute of

Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/riskprofiles/FW0611_STEC_in_UCFM_August_2007_Final.pdf ICMSF [International Commission on Microbiological Specifications for Foods] (2002). Microorganisms in Foods 7: Microbiological testing in food safety management. Kluwer Academic/Plenum Publishers, New York. Jansson, E., Bird, P., Saputra, T. & Arnold, G. (2008) 'Food Safety Survey of Retail Doner Kebabs in NSW', Food Australia. 60 (3), 95-98. Lake, R., Hudson, A. & Cressey, P. (2002a). Risk profile: Shiga toxin-producing Escherichia coli in red meat and meat products. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/stec-in-red-meat.pdf

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Lake, R., Hudson, A. & Cressey, P. (2002b). Risk profile: Toxoplasma gondii in red meat and meat products. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/toxoplasma-gondii-in-red-meat.pdf

Lake, R., Hudson, A. & Cressey, P. (2004). Risk profile: Yersinia enterocolitica in pork. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/yersinia-in-pork.pdf Lake, R., Hudson, A., Cressey, P. & Gilbert, S. (2007a). Risk profile: Campylobacter jejuni/coli in poultry (whole and pieces). Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/campylobacter.pdf Lake, R., Hudson, A., Cressey, P. & Gilbert, S. (2007b). Risk profile: Campylobacter jejuni/coli in Mammalian and Poultry Offals. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/riskprofiles/FW0465_Campy_in_Offal_PVDL_final_comments_Mar_2007.pdf

Lake, R., Hudson, A., Cressey, P. & Gilbert, S. (2007c). Risk profile: Campylobacter jejuni/coli in red meat. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/riskprofiles/FW0485_Campy_in_red_meat_Final_sent_to_NZFSA_Jan_07.pdf Lake, R., Hudson, A., Cressey, P. & Nortje, G. (2002). Risk profile: Listeria monocytogenes in processed ready-to-eat meats. Institute of Environmental Science and Research Limited

report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/risk-profiles/listeria-in-rte-meat.pdf Lake, R., Hudson, A., Cressey, P. & Wong, T. & Gilbert, S. (2004). Risk profile: Salmonella (non typhoidal) in poultry (whole and pieces). Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/data-sheets/salmonella-poultryupdate.pdf

Leech, A., Shannon, P., Kent, P., Runge, G., Warfield, B. (2003) Opportunities for Exporting Game Birds. Rural Industries Research and Development Corporation (RIRDC). Report

Number 03/106. Retrieved 6 November 2009, from http://www.rirdc.gov.au/reports/NAP/03106.pdf

McEvoy, J.M., Sheridan, J.J. & McDowell, D.A. (2004). Major pathogens associated with the processing of beef. In Smulders F.J.M & Collins, J. D. [Eds] Food safety assurance and veterinary public health Volume 2. Safety Assurance during food processing pp 57-80. Wageningen Academic Press. , Wageningen Netherlands Meat Standards Committee (2002). Microbiological testing for process control in the meat industry guidelines. Retrieved 19 February 2009, from http://www.primesafe.vic.gov.au/uploads/Microbiological%20Guidelines.pdf Meat Standards Committee (2008). Regulatory guidelines for the control of Listeria. In NSW Food Authority (2008) Listeria management program. MLA [Meat & Livestock Australia] (2000). The Microbiology of Australian Meat (1998). North Sydney: Meat and Livestock Australia. MLA [Meat & Livestock Australia] (2003). Through chain risk profile for the Australian red meat industry, PRMS.038c, part 1: risk profile. North Sydney: Meat and Livestock Australia. MLA [Meat & Livestock Australia] (2003). Guidelines for the safe manufacture of smallgoods. North Sydney: Meat and Livestock Australia. MLA [Meat & Livestock Australia] (2005). Microbiological quality of Australian beef and sheepmeat results of the industrys third national abattoir study. North Sydney: Meat and Livestock Australia.
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MLA [Meat & Livestock Australia] (2006). Listeria monocytogenes in smallgoods: Risks and controls. North Sydney: Meat and Livestock Australia. MLA [Meat & Livestock Australia] (2008a). Fast facts 2008. Australias beef industry. Retrieved 14 January 2009 from, http://www.mla.com.au/NR/rdonlyres/3EF73ECB-4FBB4455-A561-14CC636D7ADB/0/BeefFastFacts2008.pdf MLA [Meat & Livestock Australia] (2008b). Fast facts 2008. Australias sheepmeat industry. Retrieved 14 January 2009, from http://www.mla.com.au/NR/rdonlyres/70C05D4D-5D3E425D-96F7-4B973E5BFF55/0/SheepmeatFastFacts2008.pdf NSW Food Authority (2008). Listeria management program. Retrieved 19 February 2009, from http://www.foodauthority.nsw.gov.au/_Documents/industry_pdf/listeria-managementprogram.pdf PISC [Primary Industries Standing Committee] (2006). Model Code of Practice for the Welfare of Animals - Land Transport of Poultry. PISC Report 91. Pointon, A., Sexton, M., Dowsett, P., Saputra, T., Kiermeier, A., Lorimer, M., Holds, G., Arnold, G., Davos, D., Combs, B., Fabiansson, S., Raven, G., McKenzie, H., Chapman, A. & Sumner, J. (2008). A baseline survey of the microbiological quality of chicken portions and carcasses at retail in two Australian states (2005 to 2006). Journal of Food Protection, 71, 1123-1134. Pople, T. & Grigg, G. (1999). Commercial harvesting of kangaroos in Australia background paper. Retrieved 10 November 2008, from http://www.environment.gov.au/biodiversity/trade-use/wildharvest/kangaroo/harvesting/index.html Ross, T. & Shadbolt, C.T. (2001). Predicting pathogen inactivation in uncooked comminuted fermented meat products. Report for Meat & Livestock Australia. Sumner, J. (2002). Food Safety Risk Profile for Primary Industries in South Australia (Final Report). Department of Primary Resources SA, Adelaide. Retrieved 30 September 2008, from http://www.pir.sa.gov.au/__data/assets/pdf_file/0003/25068/SA_PI_Risk_profile.pdf Wallace. R.B. (2003). Campylobacter in. In Hocking A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 311-331). Australian Institute of Food Science and Technology, Waterloo. Widders, P.R., Coates, K.J., Warner, S., Beattie, J.C., Morgan, I.R. & Hickey, M.W. (1995). Controlling microbial contamination on beef and lamb during processing. Australian Veterinary Journal, 72(6), 208-211. WHO/FAO [World Health Organization/Food and Agriculture Organization of the United Nations] (2002). Risk assessment of Salmonella in eggs and broiler chickens: Interpretive summary. Retrieved 14 January 2009, from www.who.int/foodsafety/publications/micro/salmonella/en/index/html

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Plant products food safety scheme


Hazard identification
In 2000, the former SafeFood Production NSW commissioned Food Science Australia to determine the relative food safety risks for various plant products produced and/or marketed in NSW (FSA, 2000a). This work resulted in six products being ranked as high risk due to microbiological hazards (Table 23), and formed the scientific basis for the introduction of the Plant products food safety scheme into the Food Regulation 2004. The scheme was developed to introduce minimum regulatory requirements for businesses producing high risk plant products, and to implement control measures to minimise the risks from the microbiological hazards associated with these products.
Table 23 Microbiological hazards associated with plant products
Plant product Fresh cut vegetables may be consumed raw High risk ranking Pathogenic E. coli Medium risk ranking

Salmonella spp. L. monocytogenes L. monocytogenes C. botulinum C. botulinum


Pathogenic E. coli

Fresh cut vegetables chilled, MAP or extended shelf life Vegetables in oil Seed sprouts

B. cereus L. monocytogenes Cryptosporidium parvum


Enteric viruses

Salmonella spp.
Fresh cut fruit Pathogenic E. coli

Salmonella spp. L. monocytogenes


Fruit juice / drink (unpasteurised) adapted from FSA (2000a)

Salmonella spp.
Pathogenic E. coli

Fresh cut vegetables Fresh cut fruits and vegetables are raw agricultural products that have been processed by means of washing, trimming, cutting or slicing to make them ready for consumption. Contamination of vegetables may occur during growth, harvest, or processing. Under certain conditions microorganisms can also become internalised within the vegetables. Conditions that promote internalisation of microorganisms include damage to the natural structure (eg punctures, stem scars, cuts, splits) and placing warm produce into cooler, contaminated wash water. The actual process of cutting and/or removing the protective outer surfaces of the plants may increase the potential for pathogenic bacteria to survive and/or grow.
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Many vegetable products do not undergo a kill step that will completely eliminate pathogens, however measures such as sanitising washes may be used to reduce microbial contamination of pathogens. Many fresh cut vegetables are packaged under modified atmosphere packaging (MAP) and refrigerated to extend the shelf life. This form of processing may lead to an increased risk with pathogens such as L. monocytogenes and psychrotrophic strains of C. botulinum by enhancing the conditions for their survival and allowing additional time for growth. MAP products may become fully anaerobic if the plant tissue is actively respiring and uses up all the oxygen. As any competition from aerobic spoilage organisms is inhibited, this may increase the opportunity for anaerobic or facultative anaerobic pathogens to grow. Fresh cut fruit Fresh fruit are normally perceived as low risk foods, as they tend to have a thicker protective skin than most vegetables and most are harvested from trees or bushes. The notable exceptions are melons and strawberries, which are considered higher risk because they grow close to the ground and their surfaces may become contaminated with soil. Contamination of fruit may occur at any point from growing (soil, fertilisation, irrigation water, animal/bird waste), through to harvesting, processing (including washing), distribution, marketing and consumption. Many microbial pathogens cannot survive or grow on most fruit due to the low pH environment. However, melons and strawberries have relatively high pH which makes them more likely to be a food safety hazard. In addition, the skin of rockmelon tends to be porous which may allow the penetration of pathogens and agricultural chemicals into the fruit. Melons are often dipped in a sanitising solution after harvest (FSA, 2000a). Fresh cut fruits may be value added by peeling, chopping, slicing and packaging (FSA, 2000a). Many fresh cut fruit are packaged under MAP and refrigerated to extend the shelf life. With additional time, this can lead to an increased risk from pathogens that are adapted to the acidic environment of fruit and are able to survive and grow in these foods. A range of bacterial and viral pathogens and enteric parasites have been identified as being of concern in fresh cut fruit. The actual process of cutting and/or removing protective outer surfaces of the fruit may increase the potential for pathogens to survive and/or grow. Fruit pickers and handlers with infections are also an important source of contamination. Vegetables in oil This product category includes a diverse range of vegetables and mixtures of vegetables and herbs that may be used fresh, dried, roasted or acidified. Oil is added to exclude air, which prevents discolouration of the vegetable. Although immersion of vegetables in oil reduces the available oxygen in the container, contrary to popular belief, it does not preserve the food. Some pathogenic bacteria are able to survive and grow in reduced levels of oxygen and even under anaerobic conditions in the absence of oxygen.

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C. botulinum is the main pathogen of concern because of its ability to grow

anaerobically and it has been linked to outbreaks of illness from the consumption of vegetables in oil. Vegetables may be contaminated by C. botulinum spores, which are frequently associated with soil and processes such as cooking and acidification may be insufficient to inactivate the spores or prevent their germination and growth. Seed sprouts

Seed sprouts are usually consumed raw and include alfalfa, mung bean, chickpeas, cress, fenugreek, soy, lentils, sunflower, onion and radish. Seeds for sprouting generally do not receive any special treatment during harvesting and transport and so may become contaminated with pathogenic organisms in the field or during harvesting, handling, processing and distribution. While some bean sprouts may be cooked prior to consumption, many others are consumed raw, for instance with salads. The microbiological pathogens frequently found associated with seeds for sprouting include B. cereus, Salmonella spp., and E. coli and these organisms have also been implicated in foodborne illness outbreaks. The rough surfaces and cracks in the seed may protect the pathogens from microbiocidal treatments and may make detection during routine analysis difficult. High levels of organic matter also reduce the effectiveness of chlorine treatments during seed washing and seed sprouting. Bacterial populations of 102-107 cfu/g have been observed on seeds for sprouting and this natural population can rapidly increase under the high moisture and moderate temperature conditions used in sprouting facilities. Microorganisms may also become internalised in the sprout during growth so sanitising wash treatments of sprouted seeds are not likely to be effective (FSA, 2000a). Unpasteurised fruit juice Fruit juices are made by extracting fruit (citrus juices) or by macerating fruit (grape, cherry, berry, apple juice, etc.). This may be followed by clarification, filtration, pasteurisation, and/or other processes to reduce the microbial load. In recent years there has been a trend to produce natural fruit juices containing no preservatives and receiving little or no heat treatment. Any microorganisms present on the surface of fruit may potentially contaminate the juice made from it. Bacterial, viral or protozoan pathogens are unlikely to grow due to the low pH but may be able survive for extended periods. The length of time the microorganism may survive is dependent on the pH of the juice, storage temperature and the physiological state of the microorganism. Some Salmonella spp. and strains of pathogenic E. coli are known to be particularly acid tolerant, with this response thought to be activated by previous exposure to sub lethal pH values. Apple and pear juice are can become contaminated by the mycotoxin patulin which is produced by several Penicillium and Aspergillus species. P. expansum appears to be the main patulin producer in apples and apple products. Since patulin is concentrated in the rotting tissue of fruit, it is a good indicator of the quality of fruit used to make the juice. The acidic nature of fruit juices makes them corrosive to metals. To avoid potential chemical contamination, only stainless steel or corrosion resistant vessels should be
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used to store these products. Other metals such as copper can leach into the beverage during storage.

Exposure assessment
Production data Leafy salad vegetables, such as lettuce, rocket and baby spinach are the most common products in the fresh cut category, contributing towards an estimated national production value of $44 million for the year 1997/98 (Szabo & Coventry, 2001). The Regulatory Impact Statement (RIS) prepared for the Food Regulation 2004, based on limited industry information, estimated annual NSW consumption of the fresh cut fruit and vegetables (NSW Food Authority, 2004) as: 11,000 tonnes fresh cut vegetables, with a high proportion imported from Victoria and Queensland 150 tonnes of fresh cut fruit Approximately 1000 tonnes of vegetables in oil, with the vast majority imported from overseas and interstate and Between 2100 and 2600 tonnes of seed sprouts. Subsequent recent surveys by the NSW Food Authority of the NSW sprout industry suggest that 2007/08 production was in the order of 3630 tonnes, with some of this product being sold interstate. NSW fruit juice suppliers suggest that manufacture of unpasteurised fruit juices occurs at relatively low volume, about 100,000 L/year, not including juices prepared in retail premises (NSW Food Authority, unpublished). Consumption of plant products Consumption data for fruits and vegetables from the National Nutrition Survey are summarised in Table 24 (ABS, 1995). During the period 1997-98 and 1998-99, fruit and fruit products (including fruit juices), consumption increased by 8.3% from 124.7 kg per capita to 135.0 kg. In the same period, imports for oranges and other citrus fruit rose by more than 62% (ABS, 2000). Consumption of vegetables has shown a steady 9.4% increase over the last decade. Per capita consumption of tomatoes showed a significant increase from 20.9 kg in 1997-98 to 24.9 kg in 1998-99, a rise of 19%. The category of other vegetables showed an increase in consumption in 1998-99 of 4.6% to 25.1 kg per person. Data from the Australian 1995 National Nutrition Survey (ABS, 1995) indicates that fruit juices and drinks are consumed in significant amounts by a large proportion of the population. Approximately 35% of all respondents consumed fruit juices and drinks with the mean consumption being 250mL per day. The consumption data does not provide information on how much unpasteurised juice is consumed, however the Australian Fruit Juice Association believes that approximately 95% of juice sold has undergone some form of pasteurisation process.

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Table 24 Consumption of fruits and vegetables in Australia


Sex Age Proportion of persons consuming fruit products and dishes 13 (%) Male Male Male Male Male Male Male Male Male Female Female Female Female Female Female Female Female Female 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 2-3 4-7 8 - 11 12 - 15 16 18 19 - 24 25 - 44 45 - 64 65+ 77.6 65.6 56.4 49.9 39.9 31.9 45.8 59.5 69.6 75.4 72.8 62.5 58.0 41.1 41.4 55.0 69.8 75.6 Median daily intake for consumers of fruit products and dishes (g/day) 153.6 168.0 166.0 167.2 172.0 179.2 210.0 229.0 202.0 140.0 166.0 150.8 172.0 191.0 166.0 188.4 192.0 196.0 Proportion of persons consuming vegetable products and dishes 14 (%) 68.1 72.7 77.0 78.8 83.1 84.7 86.6 91.0 91.7 79.2 79.7 77.0 85.9 85.8 86.5 88.0 91.0 91.5 92.1 118.0 165.0 223.0 253.6 271.3 263.0 297.8 280.4 95.2 122.5 158.0 180.8 185.0 220.5 216.1 258.5 239.3 Median daily intake for consumers of vegetable products and dishes (g/day)

adapted from National Nutrition Survey (ABS, 1995)

13

Fruit products and dishes are defined in the National Nutrition Survey (ABS, 1995) as including the following: - Pome fruit, berry fruit, citrus fruit, stone fruit, tropical fruit, other fruit - Mixtures of two or more groups of fruit - Dried fruit, preserved fruit - Mixed dishes where fruit is the major component 14 Vegetable products and dishes are defined in the National Nutrition Survey (ABS, 1995) as including the following: - Potatoes, cabbage, cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf and stalk vegetables, peas and beans, tomato and tomato product, other fruiting vegetables - Other vegetable and vegetable combinations - Dishes where vegetable is the major component

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Prevalence of hazards in plant products There have been a small number of surveys of Australian plant products. Arnold & Cable (1995) in a broad survey of NSW food found 1/54 samples (1.9%) of RTE salads and vegetables positive for L. monocytogenes. Szabo et al (2000) tested 120 minimally processed, cut and packaged lettuce samples. Three samples (2.5%) were positive for L. monocytogenes, 66 samples (55%) were positive for Aeromonas hydrophila or A. caviae and 71 samples (59%) were positive for Yersinia enterocolitica. The Victorian Department of Human Services (DHS) surveyed the microbiological quality of freshly squeezed juices from retail businesses across the state (Victorian DHS, 2005). L. monocytogenes was detected in 1/291 samples (0.3%), but the level was sufficient to classify the sample as potentially hazardous. E. coli was detected in 7/291 samples (2.4%). Salmonella and coagulase positive S. aureus were not detected. The Western Australian Department of Health (WA Health, 2006) tested 261 samples of sprouted seeds from retail stores. E. coli was detected in 7 samples (2.7%), while Listeria and Salmonella were not detected in any samples. The NSW Food Authority undertook a small survey in 2006 to determine the safety of fresh cut vegetables sold in NSW. E. coli was detected in 1/119 samples (0.8%), while Salmonella, L. monocytogenes and verotoxigenic E. coli were not detected in any samples (NSW Food Authority, unpublished). The Authority has also undertaken several surveys of seed sprouts. In 2005, all 30 samples were found to be microbiologically acceptable. In 2006, 1/36 samples (2.7%) was found to be potentially hazardous due to the presence of verotoxigenic E. coli (VTEC) and a further two samples were categorised as unsatisfactory due to elevated levels of E. coli. A more extensive survey in 2008 of 122 samples found 99.2% of samples were microbiologically acceptable, with a single sample categorised as unsatisfactory due to B. cereus at a level of 5500 cfu/g (NSW Food Authority, 2008). There has been considerable international interest in the safety of plant products. OBrien et al (2000) prepared a discussion paper on the microbiological status of RTE fruit and vegetables for the UK Advisory Committee on the Microbiological Safety of Food (ACMSF). The report provided a summary of foodborne illness outbreaks and surveys of plant products. The report concluded that while contamination of raw vegetables usually occurs at low prevalence, it is pervasive. The Food Safety Authority of Ireland (FSAI) surveyed the bacteriological safety of a range of plant products as part of a European Commission coordinated program (FSAI, 2003). Pre-cut fruit and vegetables had samples classed as unacceptable/potentially hazardous due to the presence of Salmonella in 1/529 samples (0.2%) and L. monocytogenes in 1/344 samples (0.3%). Qualitative tests found 21/513 samples (4.1%) positive for L. monocytogenes. No sprouted seeds samples were classed as unacceptable or potentially hazardous. L. monocytogenes was detected in 1/26 samples (3.8%). No problems were detected with unpasteurised fruit and vegetable juices. A similar European Commission program surveyed pre-packed mixed salads from retail premises in the UK for L. monocytogenes (Little et al, undated). L. monocytogenes was detected in 4.8% of samples collected. A parallel survey by
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the FSAI included Salmonella testing in the survey design (FSAI, undated). Qualitative analysis showed L. monocytogenes was present in 19/714 samples (2.7%). Quantitative analysis detected two samples with L. monocytogenes at levels exceeding 100 cfu/g, however Salmonella was not detected in any sample. Little & Gillespie (2008) summarised microbiological results of surveys of prepared salads and fruit examined in the UK. No isolations of E. coli O157 or Campylobacter were reported. Five of 3852 samples (0.1%) of bagged salad vegetables were positive for Salmonella but other commodities were negative. L. monocytogenes and E. coli were detected in most commodities surveyed, usually at low incidence. Crepet et al (2007) used statistical techniques on 165 prevalence studies and concentration data from 15 studies of L. monocytogenes in fresh vegetables to estimate an overall probability of significant counts being found in the products. Their mathematical method required a minimum of one positive sample in each survey. However, as some survey sets had no actual detections, this change was made to data sets to accommodate the statistical analysis. Acknowledging this deliberate overestimation, the authors calculated the probability of sample contamination with L. monocytogenes exceeding 10 cfu/g as 1.4%, exceeding 100 cfu/g as 0.6% and exceeding 1000 cfu/g as 0.2%.

Hazard characterisation
Foodborne illness outbreaks from plant products An indication of the exposure to hazards in plant products is provided by an examination of the Australian foodborne illness outbreaks between 1995 and 2008 attributed to fresh produce and plant products, summarised in Table 25 (details of each outbreak are included in Table 67 of Appendix 3). Prior to this, two other Australian outbreaks of significance brought plant products into the spotlight as a significant source of foodborne illness. In NSW in 1989 there were three separate outbreaks from fruit salad due to Salmonella Bovismorbificans traced to a single NSW salad manufacturer (Biffin & McCarthy, pers comm), while in 1991 a nationwide outbreak from Norwalk-like virus (norovirus) was attributed to the consumption of unpasteurised orange juice. The juice was served on airline flights and was responsible for more than 3000 cases of illness (Foodlink, 2002). In addition, the risk of listeriosis from plant products was highlighted by an outbreak of listeriosis from contaminated fruit salad in NSW aged care facilities and hospitals in the Hunter Valley area. Through 1998-1999, six deaths of elderly patients occurred and nine were affected (this outbreak is included in outbreak data for the section on the Vulnerable persons food safety scheme). Internationally, there have been many examples of outbreaks that have been attributed to plant products. Sivapalasingham et al (2004) summarised the outbreaks attributed to fresh produce in the USA from 1993 to 1997. The authors identified 190 produce-associated outbreaks, resulting in 16,058 illnesses, 598 hospitalisations and eight deaths. They report that produce-associated outbreaks were an increasing proportion of all reported foodborne outbreaks with a known food cause, rising from 0.7% in the 1970s to 6% in the 1990s. Salad, lettuce, juice, melon, sprouts, and berries were the fresh produce most frequently implicated. Sivapalasingham et al (2004) also recognised Cyclospora and E. coli O157:H7 as novel causes of foodborne illness from plant products.
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Table 25 Summary of foodborne illness outbreaks attributed to plant products


Hazard Australian outbreaks (1995-2008) Cases Hospitalisations Deaths

Salmonella spp. Campylobacter spp.


Norovirus

11 2 1 1 1 10 26

941 128 18 55 61 192 1395

33 0 0 0 0 2 35

1 0 0 0 0 0 1

Shigella spp.
Viral Unknown Total

DeWall & Bhuiya (2007) also reviewed outbreaks in the USA from fruit and vegetables for the period 1990 to 2005. They reported greens-based salads contaminated with norovirus as the most common cause of outbreaks, followed by lettuce with norovirus, sprouts with Salmonella, fruit with norovirus, greens-based salads with Salmonella and melon with Salmonella. Produce-related outbreaks resulted in an average of 47.8 cases, which is higher than reported for outbreaks from poultry, beef and seafood. Doyle & Erickson (2008) presented an overview of the problems associated with fresh produce. Four further outbreaks that occurred in 2006 were discussed; an outbreak traced to fresh spinach contaminated with E. coli O157; salmonellosis traced to tomatoes and two outbreaks linked to lettuce contaminated with E. coli O157:H7. Little & Gillespie (2008) reviewed outbreaks related to prepared salads in England and Wales in the period 1992 to 2006. The authors reported 82 outbreaks from prepared salads with 3434 people affected, 66 hospitalisations and one death. Peck et al (2008) reviewed the potential for growth and neurotoxin formation by non-proteolytic C. botulinum in short shelf-life foods designed to be chilled. Their foodborne illness examples included seven outbreaks of botulism in products of plant origin. The implicated products were commercial garlic-in-oil, hazelnut yoghurt (attributable to the hazelnut conserve, see the section on the Dairy food safety), restaurant potato dip, restaurant aubergine dip, commercial black bean dip, commercial hummus and commercial refrigerated carrot juice. Temperature abuse was suspected to be contributing factor in four of the outbreaks. The following international outbreaks warrant individual mention because of either their size or novel cause: In 1996 an outbreak of E. coli O157:H7 infection occurred among schoolchildren in Sakai City, Osaka, Japan. The outbreak was attributed to white radish sprouts served in a centralised luncheon program servicing 56 schools. Over 8000 children developed symptoms and 398 children were hospitalised. Two further incidents of E. coli O157:H7 in neighbouring areas were also related to white radish sprouts. All the implicated sprouts were traced back to one farm (Michino et al, 1999). This illustrates the size of an outbreak that can result when a hazard becomes a reality in a centrally processed and is a widely distributed product.
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In 1998 an outbreak of cyclosporiasis (a gastrointestinal illness caused the parasite Cyclospora) occurred in Ontario, Canada. A further 12 clusters of cyclosporiasis were identified with a total of 192 cases. The investigation linked the clusters to raspberries imported from Guatemala. Outbreaks of cyclosporiasis in North America during the spring of 1996 and 1997 were also linked to Guatemalan raspberries. This is an example of repeated outbreaks attributable to parasites due to failures in the growing and handling of raspberries (MMWR, 1998). In 2003 an outbreak of Hepatitis A was traced to a restaurant in Pennsylvania, USA and linked to the consumption of green onions (similar to shallots). Early in the outbreak 555 cases had been identified and three people died. The report noted that green onions require extensive handling during harvesting and preparation for packing. Contamination by Hepatitis A virus (HAV) could occur by contact with infected workers or contaminated workers (MMWR, 2003). This is a large outbreak of viral illness attributable to fresh produce. In 2006 a multi-state outbreak of E. coli O157:H7 attributed to consumption of fresh bagged spinach occurred in the USA. By January 2007, 205 cases had been reported with 103 hospitalisations and 31 cases of haemolytic uraemic syndrome (HUS) and 3 deaths confirmed. Contamination was traced back to one farm. While no definitive determination of how the pathogens contaminated the spinach could be made, the presence of wild pigs near the growing fields and the irrigation wells were determined to be environmental risk factors. Processing of the spinach included washing, did not eliminate the problem and may have facilitated the spread of pathogens from contaminated to uncontaminated spinach (California Food Emergency Response Team, 2007). This is an example of a widespread outbreak of severe bacterial illness attributable to hygiene failures in the growing and processing of spinach. In 2007, 55 cases of Salmonella Senftenberg infection in England and Wales were linked to fresh basil. Scotland, Denmark, the Netherlands and the USA reported 19 further cases with the outbreak strain. Eight samples of fresh packed basil from Israel tested positive with the same strain. Microbiological evidence suggested an association between contamination of fresh basil and the cases of Salmonella Senftenberg infection, leading to withdrawal of basil from all potentially affected batches from the UK market (Pezzoli, 2008). In 2008 a large outbreak of Salmonella Saintpaul in the USA and Canada was associated with multiple raw produce items. As at August 2008, 1442 people had been affected, with at least 286 hospitalisations and the outbreak might have contributed to 2 deaths. The epidemiological data suggested the major vehicle for the spread of the pathogen was jalapeno peppers. However, serrano peppers were also considered to be a vehicle, and early in the outbreak tomatoes were considered a source. Contamination of produce may have occurred on the farm or during processing or distribution. The outbreak strain of Salmonella has been found in one growing area and an associated packing facility in Mexico (MMWR, 2008). This is the largest culture confirmed outbreak in the USA in the last decade. As many persons with Salmonella illness do not seek care or have stool specimens tested, many more unreported illnesses may have occurred. As previously discussed, the Food Science Australia plant products scoping study ranked five specific plant product as high risk due to specific pathogens (FSA, 2000a), these are discussed as follows:
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Fresh-cut vegetables and fresh cut fruit

Listeria monocytogenes
Survey data shows that L. monocytogenes occurs in cut vegetables at low prevalence and usually at low levels. Lake et al (2005) presented data showing that L. monocytogenes can grow in a range of vegetables, however growth is typically slow at refrigeration temperatures but numbers can increase by several logs in some commodities stored at 10-15C for 7-10 days. The potential for growth in refrigerated short shelf-life products would seem to be low. These products have no final cooking process to eliminate contamination. Where product is packaged in MAP, the potential longer shelf life increases the potential for pathogen growth.

Pathogenic Escherichia coli


The potential exists for pathogenic E. coli to be present on vegetables from contamination with ruminant faeces or from food handlers that carry the organism in their gut. However, surveys of pre-cut vegetables and salads, other than in Mexico, rarely, if ever, detect pathogenic E. coli. Gilbert et al (2006) reviewed the dose response estimates for E. coli O157:H7 and original estimates of infectious dose were less than a few hundred cells. Later work estimated the probability of infection from exposure to differing numbers of cells. One model predicted a dose of 5.9 x 105 organisms would result in infection in 50% of consumers, while the probability of illness from 100 organisms was 2.6 x 10-4. A second study calculated a median dose (50% of people exposed become symptomatic) of 1.9 x 105 and a probability of 6 x 10-2 of infection when exposed to 100 cells. An analysis of data from the Sakai City elementary school outbreak with E. coli O157:H7 indicates much higher probabilities of infection at lower doses than previous models. Gilbert et al (2006) also reported dose-response for E. coli O111 and O55. The dose for infection of 50% of the exposed population was 2.6 x 106 organisms. The probability of illness when exposed to 100 cells was 3.5 x 10-4. Gilbert et al (2006) state that the organism will grow on leafy vegetables at temperatures above 7C. However, due to the low infectious dose of the organism in food, growth may not be required to cause illness.

and spices with the prevalence shown to be below 10%. They note that numbers of salmonellae on raw vegetables are usually <1 cfu/g, but numbers as high as 240 cfu/g have been found on Dutch endive. Jay et al (2003) also includes information about an outbreak in Germany traced to paprika and paprika powdered potato chips which resulted in an estimated 1000 cases of Salmonellosis. The numbers of salmonellae detected in the food were very low, around 2.5 Salmonella cfu/g in the paprika and 0.04-0.45 Salmonella cfu/g of chips.

Salmonellae Jay et al (2003) included data on the incidence of salmonellae in fruit, vegetables

Clostridium botulinum
The risk of botulism is increased for products packaged in MAP, with the longer shelf life increasing the potential for spore germination and pathogen growth. Food Science Australia rated the risk of this pathogen / product pair as high (FSA, 2000a). The contributing factors were the severity of the illness, the fact that processing increases the risk and the existence of an epidemiological link. That rating remains

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appropriate, particularly as longer shelf life vegetable products are becoming more available. Vegetables in oil The US Food and Drug Administration (FDA, undated) lists a history of botulism attributed to inadequately acidified foods and notes that products processed by 29 firms were found to be inadequately acidified. The FDA concluded that the evidence demonstrated that certain manufacturers of acidified foods did not realise the importance of adequate pH control. This resulted in the development of a specialised regulation for acidified foods in Title 21 of the Code of Federal Regulation (21 CFR 114). Despite the acidified foods regulation being published in 1979, two serious outbreaks of botulism were reported in the 1980s in Canada and the USA. Chopped garlic in oil was clearly identified as the source of botulism toxin (St Louis et al, 1988). The concern about vegetables in oil and botulism remains current. The products are popular and home production is common. According to Food Science Australia (FSA, 2000b), two false assumptions persist about vegetables in oil: That the addition of oil has a preservative effect o Incorrect. The only function of the oil is to prevent oxidation from air in the container which can lead to discolouration of some foods. By excluding air from the surface, this establishes anaerobic conditions which actually favour the growth of some types of bacteria, including C. botulinum.

That some herbs and spices, and especially garlic, have significant anti-microbial

properties
o

Incorrect. The preservative effect of these materials is slight and inconsistent as outbreaks of botulism in Canada and the USA have demonstrated.

Seed sprouts Outbreak investigations have identified several factors that affect the microbiological safety of sprouted seeds. To date, contaminated seeds have been the likely source for most outbreaks. Seed contamination could have occurred at the farm, seed processor, or sprouting facility. The hydrophobic surface of seeds makes sanitation and removal of contaminating microorganisms difficult. Conditions during sprouting (time, temperature, aw, pH and nutrients) are ideal for growth of pathogenic bacteria leading to an increased risk. Unpasteurised fruit juice The majority of outbreaks caused by consumption of juice have been attributed to the use of fruit that has been contaminated by animal faeces. Orchards are often located near livestock or wildlife with the potential for microbial contamination. Contamination of juice is more likely to occur where the skin or peel of the fruit is in contact with the juice during processing.

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Risk characterisation
Fresh-cut vegetables and fresh cut fruit

Listeria monocytogenes
To date, there has been no epidemiological evidence to link cases of L. monocytogenes infection in Australia with fresh cut vegetables. As such, there is sparse outbreak data to support the high risk rating allocated by Food Science Australia (FSA, 2000a). The FDA/USDA (2003) quantitative risk assessment on L. monocytogenes assigned low relative risk rankings to fruits, vegetables and delitype salads (Table 26). The report acknowledged the diversity of the product group and supported further study. While it appears the probability of infection is low, even for persons vulnerable to listeriosis, the consequences of the illness remain severe. This was graphically demonstrated by the Hunter Valley outbreak where six persons died from consumption of Listeria-contaminated fruit salad. The high risk rating is also applied to modified atmosphere products (MAP) that are stored for extended periods. The potential for growth in storage increases the ranking for MAP vegetables and salads.
Table 26 Risk ranking for plant products contaminated with Listeria
Plant product Risk ranking (per serve) Low Low Low Predicted cases of listeriosis per serve (in Australia) 15 2.8 x 10-12 1.9 x 10 5.6 x 10
-11 -13

monocytogenes

Risk ranking (per annum) Low Low Low

Predicted annual number of listeriosis cases (in Australia) 16 0.02 0.08 0

Vegetables Fruits Deli-type salads

adapted from FDA/USDA (2003)

Pathogenic Escherichia coli


There have been a number of E. coli outbreaks attributed to this group of products around the world. Consequences of illness are potentially severe with high rates of hospitalisation and long terms effects such as HUS and kidney problems. Food Science Australia (FSA, 2000a) rated the risk as high, while Gilbert et al (2006) placed pathogenic E. coli in the highest severity category but lowest incidence category for New Zealand foods. It was concluded that it is essential that efforts continue to prevent the likelihood of foodborne transmission from this group of organisms.

15

The risk per serving is inherent to the particular food category, and is therefore assumed to be the same in Australia as that calculated for the USA (FDA/USDA, 2003). This is based on the assumption that consumption patterns for these foods are identical in Australia and the USA. The risk per annum has been adapted from USA population data contained in the FDA/USDA (2003) risk assessment of 260 million and extrapolated to Australian population data of approximately 21.6 million (ABS, 2009) by dividing by a factor of 12

16

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Salmonellae
Food Science Australia rated the risk of Salmonella in these products as high risk, based on the severity of the illness and no consumer cooking step to eliminate the hazard (FSA, 2000a). Basset & McClure (2008) rated Salmonella spp. as a significant hazard for both fruit and vegetables based on similar criteria to Food Science Australia, but note that growth in the product is not required for illness to eventuate. This appears consistent with the many outbreaks attributed to products in which Salmonella might survive but not grow.

Clostridium botulinum
Food Science Australia (FSA, 2000a) rated the risk of C. botulinum in these products as high. The contributing factors were the severity of the illness, the fact that processing and packaging in MAP may increase the risk and the existence of an epidemiological link. There is no domestic epidemiological evidence to support the high risk ranking but, to date, longer shelf life vegetable products have had limited availability. Vegetables in oil There appears clear potential for products prepared without appropriate control measures to result in a poorly acidified product, with potential to cause severe illness from pathogens such as C. botulinum. These products are sometimes prepared by small and medium enterprises, which is considered to increase the risk if knowledge of food safety controls is not adequate. Seed sprouts The conditions during sprouting (time, temperature, water activity, pH and nutrients) are ideal for growth of pathogenic bacteria such as Salmonella and pathogenic E. coli leading to seed sprouts to be considered a high risk product (FSA, 2000a). The potential for growth of pathogenic organisms during sprouting increases the risk substantially, and there is epidemiological evidence to demonstrate that contamination does occur. The implementation of control measures, such as sanitation of seeds prior to sprouting, may lower the prevalence of pathogens. Unpasteurised fruit juice The Food Science Australia high risk ranking of unpasteurised juice is appropriate (FSA, 2000a). The potential sources of contamination are virtually identical as for fresh cut fruit, and there is strong epidemiological evidence to justify the risk. The two large scale outbreaks in Australia in 1991 and 1999, due to contamination of unpasteurised juice with Salmonella spp. have clearly demonstrated the potential for unpasteurised juice to cause illness.

Conclusion
The introduction of a plant products food safety scheme into the Food Regulation 2004 targeted the five plant products categorised as high risk by the Food Science

Australia scoping study (FSA, 2000a). Minimum food safety control measures were
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introduced with the aim of avoiding outbreaks of foodborne illness from these products. While plant products such as fresh cut fruit and vegetables generally have an image as healthy foods and form an important part of a healthy nutritious diet, the occurrence of several large scale outbreaks of foodborne illness in the US affecting thousands of consumers highlights the potential risks associated with these products. Due to the increasing demand for convenience foods from consumers, the market share of pre-packed fresh cut fruits and vegetables on supermarket shelves has increased dramatically in the last several years, therefore it is important that food safety control measures are in place to ensure that the consuming public is protected. In addition to pre-packaged salads, there has been a history of unpasteurised juice causing two large outbreaks in Australia, while seed sprouts have a history of causing foodborne illness outbreaks overseas and within Australia. While the history associated with vegetable in oil products does not involved large outbreaks, there exists the potential for severe illness, from pathogens such as C. botulinum, if these products are not produced in a controlled manner. The food safety scheme requirement for businesses producing plant products to implement a food safety program means that appropriate control measures are applied, and that verification of those controls occurs at regular intervals through testing of finished product.

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References Plant products


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January 2009, from http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CA25687100069892CA256888001C D460/$File/48040_1995.pdf ABS [Australian Bureau of Statistics] (2000). 1997-98 and 1998-99 Apparent consumption of foodstuffs Australia. Australian Bureau of Statistics. Retrieved 12 December 2008, from

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Allens Arthur Robinson (2003), Salmonella outbreak from contaminated orange juice: supplier liable, despite absence of negligence. Allens Arthur Robinson, Annual Review of Insurance & Reinsurance Law 2003 - Duty of care, trade practices and common law liability. Retrieved 15 December 2008, from http://www.aar.com.au/pubs/ari/2003/care.htm#Salmo1

Baert, K., De Meulenaer, B., Kamala, A., Kasase, C., & Devlieghere, F. (2006). Occurrence of patulin in organic, conventional and handcrafted apple juice marketed in Belgium. Journal of Food Protection 69(6), 13711378 Bennett, C. M., Dalton, C., Beers-Deeble, M., Milazzo, A., Kraa, E., Davos, D., Puech, M., Tan, A. & Heuzenroeder, M. W. (2003). Fresh garlic: a possible vehicle for Salmonella Virchow. Epidemiology and Infection 131, 1041-1048 Burda, K. (1992). Incidents of patulin in apple, pear, and mixed fruit products marketed in NSW. Journal of Food Protection 55, 796-8. California Food Emergency Response Team (2007), Investigation of an Escherichia coli O157:H7 outbreak associated with Dole pre-packed spinach. Retrieved 27 November 2008, from http://www.marlerclark.com/2006_Spinach_Report_Final_01.pdf Crepet, A., Albert, I., Dervin, C., & Carlin, F. (2007). Estimation of microbial contamination of food from prevalence and concentration data: application to L. monocytogenes in fresh vegetables. Applied and Environmental Microbiology, Jan 2007, p. 250-258. Retrieved 4 December 2008, from http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1797144&blobtype=pdf Fazekas, Watkins, & Palmer. (1988). Internal report. State Chemistry Laboratory, Victoria, Australia. FDA [Food and Drug Administration, US] (Undated), Guide to Inspections of Acidified Food Manufacturers, . US Food and Drug Administration. Retrieved 14 January 2009, from FDA [Food and Drug Administration, US] (1999). Potential for Infiltration, Survival and Growth Of Human Pathogens within Fruits and Vegetables. Retrieved 26 Nov 2008, from FDA/USDA [Food and Drug Administration/ United States Department of Agriculture] (2003).

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Quantitative assessment of relative risk to public health from foodborne Listeria monocytogenes among selected categories of ready-to-eat foods. Retrieved 30 October 2008,

Foodlink (2002). Facilitation and guidance of a risk management process for high risk plant products (Draft 4). Report for SafeFood Production NSW, Foodlink Management Services, September 2002.

(NS4), European Commission co-ordinated programme for the official control of foodstuffs for 2002, Bacteriological safety of pre-cut fruit & vegetables, sprouted seeds and unpasteurised fruit & vegetables juices from processing and retail premises. Retrieved 2 December 2008,
from http://www.fsai.ie/surveillance/food_safety/microbiological/4thQuarter2.pdf FSA [Food Science Australia] (2000a). Final report scoping study on the risk of plant products. Food Science Australia prepared for SafeFood NSW.
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FSAI [Food Safety Authority of Ireland] (2003). Results of 4th quarter national survey 2002

FSA [Food Science Australia] (2000b) Fact Sheet Preservation of vegetables in oil and vinegar. Retrieved 14 January 2009, from http://www.foodscience.afisc.csiro.au/oilvine.htm FSAI [Food Safety Authority of Ireland] (undated). 3rd Trimester National Microbiological Survey 2005 (05NS3): EU Coordinated programme 2005, bacteriological safety of prepackaged mixed salads. Food Safety Authority of Ireland, Retrieved 2 December 2008, from http://www.fsai.ie/surveillance/food_safety/microbiological/mixed_salads.pdf Food Standards Agency UK (2004). Survey of baby foods for mycotoxins. Retrieved 22 November 2008, from http://www.food.gov.uk/multimedia/pdfs/fsis6804.pdf. Jay, S., Davos, D., Dundas, M., Frankish, E., & Lightfoot, D. (2003). Salmonella in Hocking, A.D. (Ed.). Foodborne Microorganisms of Public Health Significance (pp. 207-266). Australian Institute of Food Science and Technology, Waterloo. Little, C.L. & Gillespie, I.A. (2008). Prepared salads and public health. Journal of Applied Microbiology, Volume 105, (6) 1729-1743. Retrieved 28 November 2008, from http://www3.interscience.wiley.com/cgi-bin/fulltext/120125069/PDFSTART Little, C., Taylor, F. & Sagoo, S. (undated). European Commission Co-ordinated Programme for the Official Control of Foodstuffs for 2005: Bacteriological safety of pre-packaged mixed salads from retail premises for L. monocytogenes. UK Food Standards Agency, Local

Authorities Co-ordinators of Regulatory Services and the Health Protection Agency. Retrieved 2 December 2008, from http://www.food.gov.uk/multimedia/pdfs/scwgecsurveymixedsalads.pdf Mincino, H., Araki, K., Minami, S., Takaya, S., Sakai, N., Miyazaki, M., Ono, A., & Yanagawa, H. (1999). Massive outbreak of Escherichia coli O157:H7 infection in schoolchildren in Sakai City, Japan, associated with consumption of white radish sprouts. American Journal of Epidemiology 120(8), 787-795. Retrieved 27 November 2008, from http://aje.oxfordjournals.org/cgi/reprint/150/8/797 MMWR [Morbidity and Mortality Weekly] (1998). Outbreak of Cyclosporiasis Ontario, Canada, May 1998. Morbidity and Mortality Weekly Report October 2, 1998 / 47(38), 806-9. Retrieved 27 November 2008, from http://www.cdc.gov/mmwr/preview/mmwrhtml/00055016.htm MMWR [Morbidity and Mortality Weekly] (2003). Hepatitis A outbreak associated with green onions at a restaurant Monaca, Pennsylvania, 2003. Morbidity and Mortality Weekly Report November 28, 2003 / 52(47), 1155-1157. Retrieved 27 November 2008, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5247a5.htm MMWR [Morbidity and Mortality Weekly] (2008). Outbreak of Salmonella serotype Saintpaul infections associated with multiple raw produce items --- United States, 2008. Morbidity and Mortality Weekly Report August 29, 2008 / 57(34), 929-934. Retrieved 27 November 2008, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5734a1.htm NSW Health (2000). A cluster of Listeriosis in the Hunter. NSW Public Health Bulletin Vol 11, No. 3. Retrieved 15 December 2008, from http://www.publish.csiro.au/?act=view_file&file_id=NB00022.pdf NSW Food Authority (2008). Report on the microbiological quality of sprouts. NSW Food Authority. Retrieved 4 December 2008, from http://www.foodauthority.nsw.gov.au/aboutus/science%2Dand%2Dresearch/evaluating%2D what%2Dwe%2Ddo/plant%2Dproducts/ OBrien, S., Mitchell, R., Gillespie, I. & Adak, G. (2000). The microbiological status of readyto-eat fruit and vegetables. A discussion paper prepared for the UK Advisory Committee on

the Microbiological Safety of Food (ACMSF). Retrieved 2 December 2008, from http://www.food.gov.uk/multimedia/pdfs/ACM476.PDF

OzFoodNet (2006), OzFoodNet: quarterly report, 1 January to 31 March 2006, Communicable Diseases Intelligence, Volume 30 Number 2 - June 2006. Retrieved 15 December 2008, from http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3002-pdfcnt.htm/$FILE/cdi3002f.pdf

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OzFoodNet (2006B), OzFoodNet quarterly report, 1 April to 30 June 2006. Communicable Diseases Intelligence, Volume 26 Issue number 4. Retrieved 14 January 2009, from http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-2002-cdi2604-pdfcnt.htm/$FILE/cdi2604g.pdf OzFoodNet (2007), OzFoodNet quarterly report, 1 October to 31 December 2006,

January 2009, from http://www.health.gov.au/internet/main/publishing.nsf/Content/cdacdi3101-pdf-cnt.htm/$FILE/cdi3101j.pdf Peck, M., Goodburn, K., Betts, R., & Stringer, S. (2008). Assessment of the potential for growth and neurotoxin formation by non-proteolytic Clostridium botulinum in short shelf-life commercial foods designed to be stored chilled. Trends in Food Science & Technology 19, 207-216. Pezzoli, L., Elson, R., Little, C., Yip, H., Fisher, I., Yishai, R., et al (2008). Packed with Salmonella Investigation of an international outbreak of Salmonella Senftenberg infection linked to contamination of prepacked basil in 2007. Foodborne Pathogens and Disease 5(5),

Communicable Diseases Intelligence, Volume 31, Number 1 - March 2007. Retrieved 14

661-668, 2008.

St. Louis, M., Peck, S., Bowering, D., Morgan, G., Blatherwick, J., Satyen Banerjee, et al (1988) Botulism from chopped garlic: delayed recognition of a major outbreak. Annals of Internal Medicine 108, 363-368. Stafford, R., lMcCall, B., Neill, A., Leon, D., Dorricot, G., Towner, C. & Micalizzi, G. (2002), A statewide outbreak of Salmonella Bovismorbificans phage type 32 infection in Queensland. Communicable Diseases Intelligence 26(4) Retrieved 15 December 2008, from http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-2002-cdi2604-pdfcnt.htm/$FILE/cdi2604k.pdf Szabo, E., Scurrah, K. & Burrows, J. (2000). Survey for psychrotrophic bacterial pathogens in minimally processed lettuce. Letters in Applied Microbiology 30, 456-460. Retrieved 3 December 2008, from http://www3.interscience.wiley.com/cgibin/fulltext/119183907/PDFSTART Szabo, E.A & Coventry, M.J (2001). Vegetables and Vegetable Products. Spoilage of Processed Foods: Causes and Diagnosis. In Moir, C.J. et al (Eds) Spoilage of Processed Foods Causes and Diagnosis. Australian Institute of Food Science and Technology, Waterloo. Victoria DHS (2005). Microbiological survey of freshly squeezed juices from retail businesses across Victoria. Victorian Government Department of Human Services, Food Safety Unit. Retrieved 4 December 2008, from http://www.health.vic.gov.au/foodsafety/downloads/fruit_juice_survey_report_aug05.pdf

WA Health (2006). Doubts about sprouts, environmental health guide. Department of Health Western Australia. Retrieved 4 December 2008, from http://www.health.wa.gov.au/envirohealth/food/docs/Doubts_About_Sprouts.pdf

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Seafood safety scheme


Hazard identification
The food safety hazards of seafood have been extensively studied. The former SafeFood Production NSW (predecessor organisation of the NSW Food Authority) commissioned several studies in preparation for the introduction of the Food Production (Seafood safety scheme regulation) 2001. Subsequent studies have been undertaken by NSW, South Australian and Australian Governments and by international agencies. Walsh & Grant (1999) identified hazards as shown in Table 27.
Table 27 Hazards in seafood and seafood products
Priority High Sector Wild caught finfish Hazard Histamine/Scombroid ; Ciguatera ; Mercury ; Bivalve molluscs Pathogenic bacteria ; Viruses ; Algal toxins: Paralytic shellfish poisoning (PSP), Diarrhoetic shellfish poisoning (DSP), Amnesic shellfish poisoning (ASP), Neurotoxic shellfish poisoning (NSP) ; Cold smoked fish RTE Hot smoked fish RTE Smoked fish vacuum packed or modified atmosphere packaged (MAP) Medium High Medium Bivalve molluscs Wild caught finfish (raw) Bivalve molluscs Aquaculture crustaceans Raw fish vacuum packaged or MAP Surimi RTE Cooked whole prawns Cooked peeled prawns or crabmeat Salted seafood adapted from Walsh & Grant (1999) ; Those marked were subsequently evaluated by Ross & Sanderson (2000).

Listeria monocytogenes ; L. monocytogenes ; Clostridium botulinum ;

Vibrio spp.
Parasites ; Agrichemicals

Vibrio spp. ; C. botulinum L. monocytogenes


Post-cooking contamination by pathogenic bacteria pathogens

L. monocytogenes, Staphylococcus aureus, general S. aureus

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Ross & Sanderson (2000) prepared a risk assessment of selected seafood in NSW. The seafood selected for their study were extracted from the lists developed by Walsh & Grant (1999). The report noted that the incidence of foodborne illness due to most hazards was low, but recognised that oysters and other shellfish have repeatedly been involved in outbreaks. Ciguatera and histamine poisonings are also relatively common, but are generally less severe in their outcomes (Ross & Sanderson, 2000). On behalf of SafeFood Production NSW, Woods & Ruello (2000) facilitated five industry Sector Working Groups (SWG) to examine the food safety hazards associated with the five high priority seafood sectors shown in Table 27, and to recommend practical risk mitigation measures. Ross, Walsh & Lewis (2002) studied the food safety risks associated with cold smoking and marination processes used by Australian businesses. This report identified and ranked hazards with L. monocytogenes, C. botulinum, scombroid and parasites identified as most significant. Sumner (2002) undertook a risk profile on seafood and aquaculture products in South Australia, and based on outbreak data and recalls the report identified ciguatera, scombroid, viruses, bacterial pathogens and algal toxins as the hazards of concern. Huss, Ababouch & Gram (2004) considered the management of seafood safety and quality from an international viewpoint. The risks they identified were based on cases of foodborne illness traced to seafood and rejections of seafood imports (Table 28). During development of Standard 4.2.1 Primary Production and Processing Standard for Seafood, to underpin the standard A Risk Ranking of Seafood in Australia was prepared (FSANZ, 2005). The report identifies hazards along the seafood supply chain and also includes details on imported food testing failures and epidemiological data. The identified hazards were consistent with those mentioned in other risk assessment work. Some detailed description on the nature of the hazards is included below: Bivalve molluscs (oysters, pipis, mussels) Bivalve molluscan shellfish are filter feeders, extracting marine algae, bacteria and nutrients from surrounding waters. Because of this they are prone to contamination from the growing environment. Some pathogenic bacteria, especially Vibrio spp. are endogenous to aquatic environments and can survive and grow in oysters, presenting a risk to health if ingested. Bacterial pathogens may also be introduced into shellfish growing areas through pollution from sewage and animal waste. These organisms can multiply quickly, particularly at higher temperatures, potentially rendering oysters unsafe. Pathogenic viruses may be introduced into shellfish growing waters through sewage pollution and can survive for long periods in shellfish. Oysters can extract chemical contaminants from their growing waters and bioaccumulate them to hazardous concentrations in their flesh. Certain species of toxin-producing algae present a food safety risk from shellfish consumption. Toxins can accumulate to high levels in shellfish especially, particularly during periods of an algal bloom.

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Table 28 Summary of international hazard identification studies for seafood


Data analysed USA, fish, foodborne illness Hazard Scombroid Ciguatera

C. botulinum
Bacterial pathogens Norwalk virus Poisonous fish (puffer fish) Chemical contaminants USA, molluscan shellfish, foodborne illness

Vibrio spp.
Norwalk virus Algal toxin Bacterial pathogens Scombroid Ciguatera Parasite

UK, seafood, foodborne illness

Scombroid Algal toxin Virus Bacterial pathogens Unknown

USA, seafood, import refusals

Bacterial pathogens Scombroid Poison Other

EU, seafood, import rejection/detention

Vibrio spp.
Bacterial pathogens Hepatitis virus Algal toxins Pesticides Metal contaminants Antibiotics Other chemical contaminants Parasites

adapted from Huss, Ababouch & Gram (2004)

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Prawns wild caught Prawns are also potentially exposed to a range of indigenous microbial contaminants from the water environment. Vibrios are known to utilise the chitinous exoskeleton of crustacea as points of attachment and to metabolise it as a carbon/energy source (Karunasagar et al, 1986). V. parahaemolyticus, V. vulnificus and V. cholerae are considered part of the indigenous microflora of estuarine prawns. Enteric pathogens derived from faecal contamination may become established as environmental contaminants in water from which prawns are harvested and have the potential to contaminate free-living prawns prior to catch. During on-board processing, dipping of prawns in metabisulphite to inhibit formation of blackspot can present a risk to asthmatics. Prawns may also be exposed to chemical hazards from the environment, including the metals arsenic and mercury. Other chemical residues may be present in wild-catch crustacea due to industrial pollution and agricultural run-off. This will be a greater risk in estuarine prawns than those caught in open marine waters (Ross & Sanderson, 2000). Processing of prawns can lead to the potential for contamination with marine pathogenic bacteria, other pathogenic bacteria or chemical contaminants. Cooked prawns can be subject to cross-contamination between raw and cooked prawns. Finfish At the point of harvest, hazards potentially present in finfish include metals (eg arsenic and mercury) and indigenous pathogens from the marine or estuarine environment which are naturally present in live fish. Marine toxins such as ciguatoxin may be a significant hazard in tropical reef fish. Ciguatoxin is heat stable, and is not inactivated by normal cooking. Histamine/scombroid is a hazard in certain species of fish, particularly if the fish are harvested from warmer waters, die before landing or are subject to time/temperature abuse after landing. Histamine is heat stable. A number of parasites may be associated with fish species harvested from particular locations. This is particularly significant for finfish sourced from overseas locations and have been associated with illness in humans after ingestion of raw or undercooked fish. C. botulinum (type E non-proteolytic strains), which causes botulism, is commonly associated with the marine environment. As spores tend to be associated with the gut of the fish, evisceration will reduce the risk of exposure. Other strains may also be present in the processing environment. Cold smoked fish have a number of significant hazards. Processing temperatures are too low to ensure freedom from pathogens or parasites. L. monocytogenes may occur post-harvest and during processing and prolonged storage may allow numbers to increase. With sushi, the primary concern is related to product prepared in advance and stored without refrigeration. Hazards include vibrios, other bacterial pathogens and viruses. Sashimi hazards of concern are parasites and V. parahaemolyticus.

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Exposure assessment
Consumption of seafood Production data for seafood in Australia is summarised in Table 29. From these figures, the estimated annual consumption of seafood in Australia is about 396,000 tonnes or 18-19 kg per person. This equates to about 10kg of edible weight when the conversion factor used by Walsh & Grant (1999) is applied. The Fisheries Research and Development Corporation (FRDC, 2002) estimated the yearly per capita seafood consumption, expressed as edible weight, to be 15.1 kg in Sydney and 14.7 kg in Perth. Data on the consumption of fish and seafood products by sex and age from the National Nutrition Survey (ABS, 1995) is shown in Table 30. This data showed that seafood was consumed by approximately 20% of the population, with consumption levels varying between different age groups.
Table 29 Production volumes for seafood in Australia and NSW 2006/07
Sector Australia Tonnes (gross) Wild caught Aquaculture Seafood imports Seafood exports 185,925 59,663 198,602 48,010 Value ($000) 1,429,328 793,039 1,184,394 1,157,909 NSW Tonnes (gross) 15,462 5200 Value ($000) 80,657 45,975

adapted from Australian Fisheries Statistics 2007 (ABARE, 2008)

Prevalence of hazards in seafood The FSANZ (2005) risk ranking report includes statistics on failed tests for seafood tested upon entry to Australia. These are summarised in Table 31. In addition, information from FSANZ (2005) on Australian and international surveys of seafood used to rank risk is included in Table 32.

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Table 30 Consumption of fish and seafood products in Australia


Sex Age Proportion of persons consuming fish and seafood products and dishes 17 (%) Male Male Male Male Male Male Male Male Male Female Female Female Female Female Female Female Female Female 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 2-3 4-7 8 - 11 12 - 15 16 18 19 - 24 25 - 44 45 - 64 65+ 9.6*
18

Median daily intake for consumers of fish and seafood products and dishes (g/day) 63.3* 71.0 100.5 148.0 114.8* 134.6 120.0 120.0 95.2 47.5* 48.0 90.4 105.0 95.0 99.0 86.3 96.0 74.5

10.6 11.8 12.8 8.8 16.0 16.6 20.8 20.3 13.3 16.8 11.5 11.2 16.7 15.8 17.2 20.5 18.8

adapted from National Nutrition Survey (ABS, 1995)

17

Fish and seafood products and dishes are defined in the National Nutrition Survey (ABS, 1995) as including the following: - Fin fish (excluding canned) - Crustacea and molluscs (excluding canned) - Other sea and freshwater foods - Packed (canned and bottled) fish and seafood - Fish and seafood products - Mixed dishes with fish or seafood as the major component 18 Results marked with * had a relative standard error of 25 50% due to small sample size

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Table 31 Failure rate for imported seafood products (1998 2003)


Commodity Molluscs Hazard Mercury Failure Rate (%) 1.0 0.5 0.2 (Oysters 1.0) 2.4 (Oysters 4.8) 0.8 3.5 1.9 0.8 1.3 0.9 0.3 5.4 5.3 5.9 1.3 15.1 1.6 6.5 1.7

Salmonella V. cholerae E. coli L. monocytogenes


Standard plate count Crustacea Sulphur dioxide

Salmonella V. cholerae E. coli


Staphylococcal enterotoxins Standard plate count Chloramphenicol Antibiotics Finfish Mercury

L. monocytogenes
Scombroid/Histamine

E. coli
Standard Plate Count

adapted from Imported Foods Inspection Scheme data (FSANZ, 2005)

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Table 32 Summary of Australian seafood testing results


Hazard Commodity Marine fish at market Unopened oysters Opened oysters Pacific oysters Scallops, mussels, oysters, fish Detected/Sampled 39/66 (59%) 16/16 (100%) 13/14 (93%) (69-74%) 20/80 (25%) Detected at low numbers 1/285 (0.4%) 2/433 (0.4%) 8/61 (29.5%) sic 2/49 (4.1%) (31%) (10%) (3%) (1.5%)
19

V. parahaemolyticus

V. vulnificus L. monocytogenes

Oysters Smoked salmon fillets & slices Salmon pt Smoked fish and mussels Marina mix Smoked fish Seafood salad Flake Smoked salmon*

10/56 (17.9%) 0/11 3/5 (60%) 10/21 (47.6%) 2/8 (25%) 12/380 (3.2%) 1/11 (9%) <100mg/kg 0/13 3/5 (60%) <100mg/kg 1/5 (20%) 653 mg/kg

Other smoked fish* Salmon cheese* Salmon dip* Salmon mousse/ pt* Cooked prawns Histamine Retail seafood Smoked fish Dried fish

Canned fish Canned tuna Mercury adapted from (FSANZ, 2005)

1/7 (15%) <100mg/kg 3/107 (2%) 50-100mg/kg

Several species exceed the regulatory limit see Table 33

A sampling program undertaken by the NSW Food Authority from 2004 to 2007 tested 658 samples spanning 60 species to gauge the extent of exposure to mercury from NSW retail seafood (NSW Food Authority, unpublished). The higher level results summarised in Table 33 do not necessarily imply non-compliance with Standard 1.4.1 Contaminants and Natural toxicants of the Food Standards Code. The Maximum level (ML) is applicable to the mean of results for a prescribed number of sampling units (determined by the size of the sample lot). Overall 85% of individual samples were below the appropriate ML but the results suggest that limiting intake of some fish types remains a valid risk management strategy.
19

Results marked with * is data is from a NSW retail survey. The report includes international information on Hepatitis A virus and the parasite Anisakis simplex

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Table 33 Summary of high mercury levels in NSW seafood


Fish Type Angel fish Flake Ling Marlin Shark Swordfish Number of samples 5 41 5 22 23 37 Maximum (mg/kg) 20 1.002 3.35 1.03 1.682 3.47 4.092 Mean (mg/kg) 21 0.712* 0.880 0.503 0.851 0.690 1.454*

adapted from NSW Food Authority (unpublished)

Listeria monocytogenes in smoked fish


The UK Food Standards Agency recently surveyed L. monocytogenes in smoked fish (UKFSA, 2008) and the results are summarised in Table 34. Detection of Listeria and L. monocytogenes were relatively common in cold smoked fish. Detections were less common in hot smoked fish but L. monocytogenes at levels greater than 100cfu/g were only found in hot smoked fish. These results are consistent with Ross & Sanderson (2000) who reported that cold smoked fish were more prone to contamination by L. monocytogenes but, due to lower levels of background flora, there is potential for growth to higher numbers in hot smoked fish.
Table 34 Prevalence of L. monocytogenes in UK retail smoked fish
Cold smoked fish Number of samples 1,344 282 (20.5%) 236 (17.4%) 0 Hot smoked fish 1,878 96 (5.2%) 66 (3.4%) 3 (0.06%)

Listeria spp. detected L. monocytogenes detected L. monocytogenes > 100cfu/g


adapted from UKFSA (2008)

Algal biotoxins The Shellfish program of the NSW Food Authority averaged 15-16 oyster harvest areas closures each year attributable to biotoxin issues from July 2004 to June 2008 (unpublished data). The closures were based on either very high levels of potentially toxic phytoplankton or positive results from screening tests for algal biotoxins. The NSW pipi industry also experiences closures due to potential biotoxin issues, typically in summer or early autumn. Six biotoxin closures were recorded for the period July 07 to June 08. Pipi biotoxin management plans were introduced following the 1997 and 1998 diarrhoetic shellfish poisoning (DSP) outbreaks and there have been no subsequent reports of DSP attributed to NSW pipis.
20

Results for individual samples exceed the maximum level (ML) specified in Standard 1.4.1 Contaminants and Natural toxicants of the Food Standards Code 21 Results marked with *, the mean exceeds the ML specified by Standard 1.4.1 Contaminants and Natural toxicants of the Food Standards Code, which is generally 0.5 mg/kg for most fish and 1mg/kg for some fish, rays and sharks

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Fate of hazards A number of hazards are of additional concern because they are not eradicated by further processing or cooking. These include: Histamine / scombroid Ciguatera Mercury contamination Algal toxins Certain commodities are of additional concern because they may be consumed without adequate cooking and bacterial pathogens or viruses, if present, are not eliminated. Oysters RTE cold smoked and hot smoked fish Fish intended for consumption raw (eg in sushi and sashimi) Cooked prawns and other crustaceans Clostridium botulinum spores Agrichemicals S. aureus toxin.

Hazard characterisation
Foodborne illness outbreaks from seafood OzFoodNet annual reports for 2002-2006 tabulated 85 foodborne illness outbreaks attributed to seafood, with 558 people affected and 77 hospitalisations. Table 35 includes an updated summary of Australian foodborne illness outbreaks attributed to fish and seafood products from 1995 to 2008, while more details of these outbreaks are provided in Table 68 of Appendix 3.
Table 35 Summary of foodborne illness outbreaks attributed to seafood
Hazard Australian outbreaks (1995-2008) 85 32 9 9 6 5 3 2 2 2 2 23 180 Cases Hospitalisations Deaths

Ciguatoxin Scombroid Norovirus

449 126 303 64 72 517 15 41 58 115 11 208 1979

83 17 1 29 0 64 3 0 1 0 0 9 207

0 0 0 0 0 1 0 0 0 0 0 0 0

Salmonella spp.
Wax ester Hepatitis A

Vibrio spp. B. cereus C. perfringens


DSP Toxin Unknown Total

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Several large food poisoning outbreaks related to consumption of oysters occurred in NSW: in the mid 1980s there were a series of outbreaks of Norwalk virus from oysters harvested from the Georges River, the largest outbreak affected over 2000 people and in 1997, an outbreak of Hepatitis A virus (HAV) from Wallis Lake oysters affected around 467 people with one death. It is estimated the cost to the industry from the Wallis Lake outbreak was around $30 million and was the catalyst for the introduction of the NSW Shellfish Quality Assurance Program, the forerunner to the current NSW Shellfish Program operated by the NSW Food Authority. Prior to 1997, there was some voluntary monitoring by shellfish farmers, but no consistent testing of water quality in harvest areas. The implementation of harvest area management plans has gone a long way to minimising the risk from shellfish (Food Science Australia & Minter Ellison Consulting, 2002). The National Risk Validation Project highlighted producers, harvesters, processors and vendors of raw ready-to-eat seafood (including shellfish) as one of five high risk foods (Food Science Australia & Minter Ellison Consulting, 2002). FSANZ (2005) reports that 3 outbreaks (with 102 people affected) of shellfish poisoning occurred in Australia in the period 1990-2000. Mussels with levels of paralytic shellfish poisoning (PSP) toxin exceeding regulatory limits were detected in Victoria in 1988 and every year between 1990 and 1995. PSP toxins exceeding regulatory limits have been reported in Tasmanian mussels, oysters and scallops. Outbreaks of DSP were caused by NSW pipis in 1997 and 1998. There has been a detection of amnesic shellfish poisoning (ASP) toxin (domoic acid) above regulatory limits in scallop viscera from Victoria. Ross & Sanderson (2000) prepared detailed risk assessments on 10 hazard/product pairs. Current national and international data suggests that their selections remain appropriate. The extracts below are from their report and the FSANZ risk ranking. Viral contamination of shellfish. Enteric viruses can be introduced into aquatic environments through contamination with sewage. They may persist longer than enteric bacteria in marine environments and can be accumulated in bivalve molluscs. As a consequence, their presence in shellfish does not always correlate with bacterial indicators of faecal pollution in marine environments. Viruses may also take longer to depurate from contaminated shellfish than enteric bacteria and viruses are more resistant to inactivation during cooking than bacteria. Outbreaks of viral food poisoning associated with shellfish continue to occur in Australia and worldwide. In general, the incidence of seafoodborne viral food poisoning is low, suggesting that existing control strategies are effective. Australian outbreaks have been associated with failures or nonimplementation of control strategies. Noroviruses (previously known as Norwalk-like viruses) cause human gastrointestinal illness. Symptoms in children are generally mild and self-limiting. A more severe gastroenteritis with dehydration as the result of vomiting or diarrhoea may occur.
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Mortality in the absence of other compromising factors is extremely rare. Infections in adults typically manifest as explosive projectile vomiting and/or diarrhoea. Incubation times are dose dependant, typically 15 50 hours with a mean of 24 48 hours (Ross & Sanderson, 2000). Hepatitis A (HAV) is usually a mild illness characterised by sudden onset fever, malaise, nausea, anorexia and abdominal discomfort followed in several days by jaundice. The incubation period for HAV varies from 10 to 50 days (mean 30 days), and is dependent upon the number of infectious particles consumed. Many infections with HAV do not result in clinical illness, especially in children. When illness does occur, it is usually mild and recovery is complete in one or 2 weeks. Occasionally the symptoms are severe and convalescence can take several months. Patients suffer from chronic tiredness during convalescence, and their inability to work can cause financial loss. Less than 0.4% of the reported cases in the U.S. are fatal. These rare deaths are usually in the elderly (Ross & Sanderson, 2000). Algal toxins in shellfish Shellfish poisoning is caused by a group of toxins elaborated by planktonic algae upon which the shellfish feed. The toxins are accumulated and sometimes metabolised by the shellfish. Since shellfish toxins are heat stable, the form in which shellfish are consumed does not affect the level of the hazard. All individuals are susceptible to shellfish toxins, although the elderly may be more severely affected, particularly by amnesic shellfish poisoning (ASP). There are about 20 toxins responsible for PSP, and all are chemical derivatives of saxitoxin, but differ in the type and localisation of the derivation. PSP toxins are also produced by species of cyanobacteria found in Australian freshwater rivers and lakes. PSP toxins block the sodium channels of excitable membranes of the nervous system and associated muscles. The extreme potency of PSP toxins has, in the past, resulted in an unusually high mortality rate. In humans 120-180 g of PSP toxin can produce moderate symptoms, 400-1060 g can cause death, but 2000-10,000 g is more likely to constitute a fatal dose. DSP is caused by a group of high molecular weight polyethers, including okadaic acid, the pectenotoxins and yessotoxin produced by the armoured dinoflagellate algae including Dinophysis spp. and Prorocentrum spp. These species are omnipresent but their toxicity is variable and unpredictable. Dense blooms can sometimes be completely non-toxic, but at other times shellfish can become toxic even when only sparse dinoflagellate populations are present. No human fatalities have been reported due to DSP and patients usually recover within 3 days. Recovery is generally complete with no after effects and the poisoning is generally not life threatening. In extreme cases chronic exposure may promote tumour formation in the digestive system. ASP is caused by the unusual amino acid, domoic acid, produced by chain-forming diatoms of the Pseudonitzschia spp. The toxicosis is particularly serious in elderly patients. All fatalities (up to a report date of 2003) had involved elderly patients. During an outbreak in Canada, the affected people had consumed mussels containing 300-1200 g/g of domoic acid.

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Vibrio parahaemolyticus in molluscs and crustaceans


Illness is caused when the ingested organism attaches itself to an individuals small intestines and secrets a toxin. Not all strains of the organism are pathogenic. There appears to be a lack of correlation between pathogenicity and serotype of V. parahaemolyticus isolates. Virulence correlates with the ability to produce a thermostable direct haemolysin termed the Kanagawa Phenomenon (KP) haemolysin. KP negative strains appear to be non-pathogenic (Sanyal & Sen, 1974). Human volunteer studies have established an infectious dose for KP positive strains between 2 x 105 and 3 x 107 cfu. V. parahaemolyticus can multiply rapidly in seafood at permissive temperatures. In a study numbers of V. parahaemolyticus on octopus stored at 30C increased from 102/g to 108/g in 6 hours.

Listeria monocytogenes in RTE smoked fish products.


Indications of the nature of foodborne listeriosis have emerged from outbreak data, animal studies and mathematical modelling of illness. Knowledge is incomplete because of difficulties such as: some strains of L. monocytogenes are pathogenic but others are not; the determinants of pathogenicity are not well understood and so the distribution of pathogenic strains in food is not known. However, there is general acceptance of some elements of the disease process (Ross & Sanderson, 2000): The infectious dose of L. monocytogenes cannot be stated with precision but it appears that human listeriosis does not usually occur in the absence of a predisposing risk factor (such as compromised immunity) Most commentators consider doses of <1000 organisms are highly unlikely to cause illness in normal individuals, and this has been reflected in food safety regulations Attempts to link exposure to the organism to observed levels of illness suggest the infective dose is much higher than 1000 organisms but it appears in some cases fewer than 1000 organism may cause illness This difference between observed and predicted cases of illness suggests that the human population susceptible to listeriosis is actually a much smaller sub-group of the immunocompromised population. However, it could also be an artefact of under-reporting of listeriosis cases, due to some cases only developing mild flulike symptoms.

Clostridium botulinum in vacuum-packed RTE fish products


Foodborne botulism results from eating food contaminated with preformed botulinum toxin due to the presence and growth of Clostridium botulinum bacteria. Botulism varies from a mild illness to an acute disease which can be fatal. With treatment, death due to respiratory failure or airway obstruction is rare. The case fatality rate in North America has fallen from 60% to 20% due to the availability and prompt administration of antitoxin. Provision of artificial respiration greatly increases the chances of recovery from intoxication. Nonetheless, recovery may take many months.

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Internationally, the aquatic environment of fish is frequently contaminated with C. botulinum spores and so fish will often be contaminated also. The organism only grows in the absence of air, and represents a risk only in those products which exclude oxygen by virtue of their packaging (eg vacuum packaged, MAP) or contain anaerobic regions (eg gut left intact). The toxin is heat labile, so the hazard is primarily limited to RTE seafoods that are stored in vacuum or anaerobic packaging. For seafoods, botulism is most commonly associated with C. botulinum type E. This type is capable of growth and toxin production at refrigeration temperatures but generally needs weeks of growth to produce amounts of toxin to cause foodborne illness. This is significantly greater than the shelf life generally observed for seafood and seafood products. Botulism is a concern in extended shelf life products and thus the concern with vacuum packaging and canning. Ciguatera poisoning Ciguatera is a form of human poisoning caused by the consumption of subtropical and tropical marine finfish which have accumulated naturally occurring toxins through their diet. In the US, ciguatera intoxication is considered to be one of the two most common sources of seafood-borne food poisoning associated with finfish. Human populations of tropical and subtropical marine regions have a much higher incidence of ciguatera intoxication. A relatively high incidence of ciguatera poisoning has been reported in Queensland. Only a small volume of reef fish from Queensland or other problem areas is on sale in NSW. There have been several large scale outbreaks in NSW involving scores of victims. The true incidence of ciguatera poisoning in NSW is unknown. The illness has only recently become known to the general medical community and there is a concern that the incidence is largely under-reported because of the general non-fatal nature and short duration. The ciguatoxins are lipid-soluble toxins that are relatively inert molecules and remain toxic after cooking and exposure to mild acidic and basic conditions. The minimum toxic dose is estimated to be about 1ng/kg body weight. In one incident 6 US soldiers became ill after eating fish containing approximately 20ng ciguatoxin/g flesh. Scombroid / Histamine poisoning Scombroid poisoning (histamine poisoning) is associated with the ingestion of foods that contain high concentrations of histamine and possibly other vasoactive amines and compounds. Histamine is the physiological amine involved in allergic reactions and is the main toxin involved in histamine fish poisoning. A missing factor might be required to produce illness. Due to uncertainty about its aetiology, it is difficult to determine the susceptible population for scombroid poisoning. A wide range of histamine concentrations in implicated foods, particularly the increasing number of incidents associated with low histamine concentrations, suggests that some individuals are more susceptible to the toxin than others. Symptoms can be severe for the elderly and for those taking medications such as isoniazid, a potent histamine inhibitor.

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Mercury in seafood The commentary provided by Ross & Sanderson (2000) on mercury in NSW seafood has not lost currency. Based on acute mercury food poisonings in Japan and Iraq, it is known that high levels of dietary mercury may cause measurable deficits in mental and physical development of young children exposed during gestation. Low levels of mercury are naturally present in the environment and in all foods. Inorganic mercury is poorly absorbed via the diet, however, in aquatic environments bacteria can convert inorganic mercury to methylmercury (MeHg) which is readily absorbed by the human body. MeHg is bioaccumulated in aquatic food chains, so all fish contain small amounts of mercury in their muscle tissue. Predatory fish or mammals such as whales at the top of the food web have the highest amounts. Mercury levels in most commercially harvested oceanic fish in the US and Australia are <0.5 mg/kg MeHg, but some large predators such as sharks, marlin and swordfish may have higher levels. Numerous studies have shown that nearly all the human exposure to MeHg occurs via seafood (predominately finfish) consumption. Therefore individuals who regularly consume large amounts of fish (particularly those fish with high mercury levels) could be exposed to dangerous levels of mercury. Corbett & Poon (2008) reported on cases in NSW where elevated mercury levels were found in three infants, who had eaten fish congee (a rice and fish porridge) as a weaning food and ate fish regularly as toddlers. The parents had sought medical advice as a result of the children displaying either developmental delay or neurological symptoms. Fish congee is a common weaning food in coastal regions of southern China and South-East Asia. The authors recommended the development of multilingual information about fish and mercury be made available to pregnant women and mothers, especially targeting groups who are likely to be frequent consumers of fish and who use fish in weaning and infant foods.

Risk characterisation
Viral contamination of shellfish There is very little information on levels of enteric viruses in shellfish available on which to base a risk characterisation. The greatest uncertainties in assessing the risk are the levels of the viruses of concern (HAV and norovirus) in contaminated shellfish, the frequency of shellfish contamination and the rate of loss of infectivity of the viruses in the environment and the oyster (Ross & Sanderson, 2000). FSANZ concluded that the overall public health risk for bivalve molluscs is relatively high for products harvested in polluted waters and/or waters not subject to a monitoring scheme such as the Australian Shellfish Quality Assurance Program (ASQAP). The relative risk ranking is not significantly reduced where these products are lightly cooked or steamed prior to consumption (FSANZ, 2005). Where the implementation of shellfish safety management schemes, such as ASQAP, is taken into account, the relative risk ranking for oysters and other bivalves is reduced to medium. The Seafood safety scheme requires shellfish harvesters to comply with the harvest area management plans developed by the NSW Food Authority. These plans are established to ensure compliance with ASQAP requirements.

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Algal toxins in shellfish Ross & Sanderson (2000) assessed the risk of algal biotoxins as low from commercial harvest areas and medium from recreational harvest areas. The difference was due to the algal monitoring and area management that occurs in commercial harvest areas. FSANZ found the relative risk is medium for waters that are subject to pollution, but where harvesting of shellfish is controlled under an effective management system. The risk rating is elevated to high if there is no effective management system in place (FSANZ, 2005).

Vibrio parahaemolyticus in molluscs and crustaceans


Levels of V. parahaemolyticus in Australian seafood are similar to that found in other parts of the world. It has been estimated that a meal of raw shellfish would contain no more than 104 cfu KP positive cells, based on typical numbers of V. parahaemolyticus present in fish and shellfish and the low incidence of KP positive isolates in the marine environment. For an infectious dose to be reached, mishandling of food at temperatures allowing the growth of the bacterium would be required. As Vibrio spp. are sensitive to heat, it is raw or inadequately cooked product that poses the greatest risk of vibriosis. However, several documented cases have involved post processing contamination. The rapid growth rate of the organism at ambient temperatures exacerbates the consequences of post-processing contamination. Although pathogenic Vibrio spp. are often found in bivalve molluscs and on crustaceans, the incidence of illness is low. For healthy individuals, doses of organisms higher than those normally found on food are required. The risk of contamination is seasonal, corresponding to the increased levels of Vibrio spp. in growing areas as water temperatures rise. The risk of thermal abuse also increases during summer. The FSANZ relative risk ranking for V. parahaemolyticus is low but V. vulnificus and V. cholerae are rated medium based on severity of illness. The ranking for V. parahaemolyticus might change if the pandemic O3:K6 strain naturalises in Australian waters.

Listeria monocytogenes in RTE smoked fish products.


Based on models developed overseas Ross & Sanderson (2000) estimated that 6-7 cases of listeriosis in NSW per annum would be attributable to smoked salmon. This estimate is about the same order of magnitude as the overall level of incidence observed from all potential avenues of exposure. The estimate was noted to be conservative because Australian regulations are tighter than those countries on which the models were based. Their revised estimate was, at most, a few cases of listeriosis from smoked vacuum packed seafood per annum in NSW. The outcome of the FDA/USDA (2003) risk assessment for L. monocytogenes predicted cases of listeriosis from RTE seafood products to occur very rarely (Table 36), however the risk per serving for cooked RTE crustaceans was considered high.
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Ross & Sanderson (2000) then estimated the likely affect of a single, high contamination event. Depending on the assumptions used for different scenarios, a single batch of contaminated product was predicted to impact <1, about 20 or 65 immunocompromised consumers. FSANZ found that contamination of cold smoked products with L. monocytogenes at levels representing a health risk to the general population is considered unlikely. This rose to likely where there is insufficient management of risk through the food chain and for susceptible sub-populations. This rises further to very likely when both conditions apply. Other than scrupulous factory hygiene, there is no critical control point (CCP) available to prevent contamination of RTE cold smoked seafood products. Hot smoking can reduce the levels of L. monocytogenes on the product, but postprocessing contamination can occur. It appears that some factories are able to achieve very low levels of contamination relatively consistently, but others are not and rapidly become recolonised.
Table 36 Risk ranking for seafood products contaminated with Listeria

monocytogenes

Plant product

Risk ranking (per serve) High High Low Low

Predicted cases of listeriosis per serve (in Australia) 22 5.1 x 10-9 6.2 x 10-9 2.0 x 10
-11

Risk ranking (per annum) Moderate Moderate Low Low

Predicted annual number of listeriosis cases (in Australia) 23 0.2 0.1 0 0

Cooked RTE crustaceans Smoked seafood Raw seafood Preserved fish

2.3 x 10-11

adapted from FDA/USDA (2003)

Clostridium botulinum in vacuum-packed RTE fish products


On the basis of the low incidence of spores in products likely to be available in the Australian market, and in particular the typical salt levels in these products, type E botulism risk from these products is considered to be negligible. Product shelf lives also mitigate against the risk of sufficient growth of C. botulinum potentially present to reach toxic doses. Ross & Sanderson (2000) note that other products (including those with the gut intact) and products from other regions (where C. botulinum spores could be more frequent) may represent a greater risk.

22

The risk per serving is inherent to the particular food category, and is therefore assumed to be the same in Australia as that calculated for the USA (FDA/USDA, 2003). This is based on the assumption that consumption patterns for these foods are identical in Australia and the USA The risk per annum has been adapted from USA population data contained in the FDA/USDA (2003) risk assessment of 260 million and extrapolated to Australian population data of approximately 21.6 million (ABS, 2009) by dividing by a factor of 12

23

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FSANZ (2005) ascribes a medium relative risk rating for C. botulinum in smoked fish products. This reflects the balance between severity (severe) and likelihood (unlikely). Ciguatera poisoning Ciguatoxins are responsible for many outbreaks of foodborne illnesses due to fish consumption in Australia. In the period 1995 to June 2002, outbreaks were recorded in all states except South Australia and Tasmania. Queensland and NSW accounted for the great majority of outbreaks, reflecting both the linkage of the illness with fish caught near tropical reefs in Queensland and the role of Sydney as the hub for marketing seafood on the east coast of Australia. A number of fish species were involved, with coral trout, queenfish, Spanish mackerel and cod species predominant. FSANZ (2005) rates the relative risk as medium for tropical fish species (in particular larger members of particular species from certain fishing areas). Scombroid / Histamine poisoning Time-temperature abuse during transport, processing, storage or display will potentially allow formation of histamine. Scombroid species of fish, which have high levels of histadine, are more likely to accumulate high concentrations of histamine under conditions of temperature abuse, but many non-scombroid species have also been involved in outbreaks of histamine fish poisoning. Data from testing samples at retail and results from testing imported fish products indicate a low level of histamine in whole fish and fish fillets available in Australia. However, epidemiological data shows a significant number of outbreaks in commercial and restaurant settings, indicating potential problems in the cold chain and resultant time-temperature abuse. Tuna, blue grenadier and mahi mahi have been identified as species involved in these outbreaks. FSANZ allocated a relative risk rating of low, due to a moderate severity of disease and the probability of occurring as likely (FSANZ, 2005). Mercury in seafood Ross & Sanderson (2000) approached a risk assessment for mercury in seafood by calculating the weight of fish required to equal the provisional tolerable weekly intake (PTWI) of methylmercury for consumers of varying body weights and various mercury levels. Their tables are reproduced in Table 37, except that the Joint FAO/WHO Expert Committee on Food Additives (JECFA) Provisional tolerable weekly intake (PTWI) estimate has been reduced following a review (JECFA, 2004). Estimates in Table 37 are based on the JECFA PTWI and US EPA reference dose, for comparison.

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Table 37 Seafood consumption required to reach reference doses for methylmercury


Mercury level mg/kg Body weight 13 kg 40 kg 60 kg 70 kg 13 kg 40 kg 60 kg 70 kg

Weekly consumption (g) required to reach JECFA PTWI of 1.6ug/kg body weight/week 0.15 0.5 1.0 1.5 146 44 22 15 449 135 67 45 674 202 101 67 786 236 118 79

Weekly consumption (g) required to reach to USEPA reference dose of 0.7ug/kg body weight/week 63 19 10 6 196 59 29 20 295 88 44 29 344 103 52 34

adapted from Ross & Sanderson (2000) JECFA (2004)

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Table 37Table 37 shows that for non-predatory fish (average mercury level 0.15 mg/kg - Ross & Sanderson 2000) significant consumption is required to exceed the PTWI. Average consumption figures quoted above equate to 200-300g of seafood per week. Consumers who predominately consume predatory fish or those consuming above average levels of fish are at risk. JECFA noted the existing PTWI of 1.6 g/kg body weight was set in 2003 based on the most sensitive toxicological end-point (developmental neurotoxicity) in the most susceptible species (humans). However life-stages other than the embryo and foetus may be less sensitive to the adverse effects of methylmercury (JECFA, 2006). In the case of adults, intakes of up to about two times higher than the existing PTWI of 1.6 g/kg body weight would not pose any risk of neurotoxicity. Although in the case of women of childbearing age, the intake should not exceed the PTWI, in order to protect the embryo and foetus. JECFAs data did not allow firm conclusions to be drawn regarding the sensitivity of infants and children compared to that of adults. While it is clear that they are not more sensitive than the embryo or foetus, they may be more sensitive than adults because significant development of the brain continues in infancy and childhood. The joint committee could not identify a level of intake higher than the existing PTWI that would not pose a risk of developmental neurotoxicity for infants and children (JECFA, 2006).

Conclusion
The Wallis Lake Hepatitis outbreak in 1997 graphically demonstrated the need for tighter food safety controls on commercial harvesting of shellfish for human consumption. Since that time, the implementation of a Seafood safety scheme and the NSW Shellfish Program has significantly improved the safety of shellfish through the classification of harvest areas and the implementation of harvest area management plans which identify high risk events such as heavy rainfall and holiday periods which may contribute to pollution of the waterways and compromise shellfish safety. As coastal populations continue to increase and place additional pressure on local infrastructure such as sewage treatment plants, it is considered that the future role of the NSW Shellfish Program in ensuring the continued safety of shellfish is vital. This was acknowledged by FSANZ when it ranked shellfish harvested from managed areas as a medium risk, as opposed to high risk when these controls were not in place. The management of other food safety hazards associated with seafood, such as minimising the risk of histamine poisoning, requires general food safety control measures such as hygiene and sanitation and the application of appropriate storage temperatures. The seafood safety scheme requires businesses processing seafood to implement a food safety program, to ensure appropriate control measures are implemented for hazards such as L. monocytogenes and C. botulinum. Because it naturally occurs in seafood, the issue of mercury is addressed through consumer education campaigns, particularly targeting high risk consumers such as pregnant women.

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References Seafood
ABARE [Australian Bureau of Agricultural Resource] (2008). Australian Fisheries Statistics 2007. Australian Bureau of Agricultural Resources. Retrieved 30 September 2008, from http://www.abare.gov.au/publications_html/fisheries/fisheries_08/08_fishstats.pdf ABS [Australian Bureau of Statistics] (1995). National Nutrition Survey: Foods Eaten, Australia, 1995. Australian Bureau of Statistics report. ABS Cat no 4804.0. Retrieved 13

January 2009, from http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CA25687100069892CA256888001C D460/$File/48040_1995.pdf Corbett, S.J. & Poon, C.C.S. (2008). Toxic levels of mercury in Chinese infants eating fish congee. Medical Journal of Australia. 188(1), 59-60.

Food Science Australia & Minter Ellison Consulting (2002). National Risk Validation Project. Final Report. FRDC (Fisheries Research and Development Corporation] (2002). Retail Sale and Consumption of Seafood (Revised Edition). Ruello and Associates for the Fisheries Research and Development Corporation. Retrieved 14 January 2009, from http://www.frdc.com.au/bookshop/Seafood_report.pdf FSANZ (2005). Final Assessment Report, P265, Primary Production and Processing Standard for Seafood (Attachment 10). Retrieved 3 September 2008, from

http://www.foodstandards.gov.au/_srcfiles/P265_Seafood_PPPS_FAR.pdf#search=%22risk% 20ranking%20seafood%22 Huss, H.H., Ababouch, L. & Gram, L. Assessment and management of seafood safety and quality. FAP Fisheries technical Paper 444. Retrieved 30 September 2008, from ftp://ftp.fao.org/docrep/fao/006/y4743e/y4743e00.pdf

JECFA [Joint FAO/WHO Expert Committee on Food Additives] (2004), WHO Food Additives Series 52, Safety Evaluation of Certain Additives and Contaminants. Retrieved 21 November 2008, from http://whqlibdoc.who.int/publications/2004/924166052X.pdf JECFA [Joint FAO/WHO Expert Committee on Food Additives] (2006), Joint FAO/WHO Expert Committee on Food Additives Summary and Conclusions of the 67th Meeting. Retrieved 21 November 2006, from http://www.who.int/ipcs/food/jecfa/summaries/summary67.pdf Karunasagar, I, Venugopal, M.N., Karunasagar, I. & Segar, K. (1986). Role of chitin in the survival of Vibrio parahaemolyticus at different temperatures. Canadian Journal of Microbiology 32, 889-891. OzFoodNet (2002 to 2006). Annual Report of the OzFoodNet Network (5 individual annual reports). Retrieved 30 September 2008, from http://www.ozfoodnet.org.au/internet/ozfoodnet/publishing.nsf/Content/reports-1 Ross, T. & Sanderson, K. (2000). A Risk Assessment of Selected Seafoods in NSW (Final report December 2000). SafeFood Production NSW. Ross, T. Walsh, P. & Lewis, T. (2002). Risk Assessment of Fish Cold Smoking and marination Processes Used by Australian Businesses. Biodevelopment Consulting Pty. Ltd for SafeFood Production NSW. Sanyal, S.C. & Sen, P.C. (1974). Human volunteer study on the pathogenicity of Vibrio parahaemolyticus. In T. Fujino, G. Sakaguchi, R. Sakazaki, Y. Takeda (Eds) International Symposium on Vibrio paramhaemoylticus (pp. 227-230) Saikon Publishing Co. Tokyo. Sumner, J. (2002). Food Safety Risk Profile for Primary Industries in South Australia (Final Report). Department of Primary Resources SA, Adelaide. Retrieved 30 September 2008, from http://www.pir.sa.gov.au/__data/assets/pdf_file/0003/25068/SA_PI_Risk_profile.pdf UK Food Standards Agency (2008). A microbiological survey of retail smoked fish with http://www.food.gov.uk/multimedia/pdfs/fsis0508.pdf

particular reference to the presence of Listeria monocytogenes, Food Survey Information sheet 05/08. Retrieved 30 September 2008, from
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Walsh, P. & Grant, N. (1999). Consultancy for Researching the Business Profile of the NSW Seafood Industry & Food Safety Hazards of Seafood in NSW (Final Report). Food Factotum. Woods, J. & Ruello, N. (2000). Report of Seafood Sector Working Groups Development of Model Food Safety Programs. Ruello and Associates Pty. Ltd. For SafeFood Production NSW.

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Vulnerable persons food safety scheme


From time to time certain population subsets within the community are more at risk to foodborne illness or can develop more serious complications from foodborne illness than the general population (Acheson & Lubin, 2008). Exactly defining who is vulnerable can be problematic. This is predominately due to the differing degree of vulnerability from one person to the next and the varying degrees of virulence of some pathogenic microorganisms to different vulnerable sub-populations (Acheson & Lubin, 2008). Acheson & Lubin (2008) provides an overview of the different factors that influence vulnerability and in general terms vulnerability is due to a suppressed immune system, either due to age, pregnancy, disease or pharmacologic therapy (ie chemotherapy or immunosuppressive drug use after an organ transplant). As such it is common to include the following sub-groups within the vulnerable population group: Children under 5 years old People over 65 years of age Pregnant women and Persons with depressed immunity due to either some underlying condition, therapy treatment or medication. The increased risk posed by the vulnerable populations require businesses that cater specifically to these groups to consider the risk when deciding on the types of foods and how they prepare, store and serve these foods. In developing Standard 3.3.1 Food Safety Program for Food Service to Vulnerable Populations of the Food Standards Code, Food Standards Australia New Zealand (FSANZ) defined the vulnerable population by considering the types of businesses likely to serve food to these people (FSANZ, 2006). Standard 3.3.1 of the Food Standards Code (FSANZ, 2008) includes a list of these businesses to which the standard applies, these include: Hospitals Nursing homes Hospices Certain day care establishments and Childcare centres. In performing a risk assessment on businesses catering to vulnerable populations, it is acknowledged that the businesses can supply a variety foods to these groups and the methods for preparation will vary from complete preparation and assembly within the business through to purchase of ready-to-eat (RTE) foods. To avoid duplication this section should be ready in conjunction with other sections within this risk assessment in respect to the risk posed by different foods. Information will be provided to illustrate areas of concerns and elaborate on other foods not covered in other sections of this document.

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This section will focus on microbiological hazards, only as the risks posed by chemical and physical hazards are not known to be influenced by a decreased immunity. It should be noted that most of the risk assessments conducted do not specifically address establishments serving to vulnerable populations. Where they do examine specific hazards that affect the vulnerable population (eg L. monocytogenes ) the context is usually within that of the general population and includes both those situated in care-type establishments and those living outside these establishments. Wherever possible, this risk assessment will attempt to focus on the risks associated with those people within care-type establishments, although due to the lack of information specific to these establishments this may not always be possible.

Hazard identification
When considering the food safety hazard presented to vulnerable populations, the hazards can be separated into two groups: Specific hazards those hazards that present a unique risk to vulnerable populations and General hazards those hazards that, due to a decrease in immunity of an individual, can result in a greater prevalence in illness when compared to the general population or result in more serious illnesses. General information concerning the hazards included in this section can be found in Appendix 1. Specific hazards

Listeria monocytogenes
It is well documented the importance of controlling L. monocytogenes in foods consumed by the vulnerable population. While the exact dose needed to cause illness in the vulnerable populations is ill-defined and open for much debate, it is generally agreed that lower infective doses are needed for illness to occur within the vulnerable population. However, the type and severity of illness may be dependent on virulence of the pathogen, host susceptibility and the food matrix (FDA/USDA, 2003). Sutherland et al. (2003) notes that while the infective dose is not clearly defined, some studies suggest infective doses as low as 102 to 103 cfu/g may cause illness.

L. monocytogenes is of concern in any RTE food or foods not likely to receive a heat treatment prior to consumption. This is predominately due to the organism being ubiquitous in nature, the potential for cross-contamination after cooking and the ability of the organism to grow at refrigeration temperatures. In their risk assessment, the FDA/USDA (2003) ranks the potential risk posed by some RTE foods. Those of very high to high risk include:
Deli meats and uncooked frankfurters Pt and meat spread Unpasteurised milk Smoked seafood
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High fat and other dairy milk Pasteurised milk and Soft unripened cheese Others which present a low risk include cooked crustacean, salads, fermented smallgoods, other soft cheese and fruits and vegetables. In general terms, any foods that can support the growth of L. monocytogenes and does not include a cook step prior to consumption can potentially present some level of risk to the vulnerable populations.

Clostridium botulinum
Infant botulism has been reported in many countries including Australia. It is caused by the ingestion of C. botulinum spores which subsequently germinate, multiply and produce toxin in the infants gastrointestinal tract. It usually occurs in infants aged one year or less. Symptoms include constipation followed by weak sucking and crying ability. The illness affects the nervous system and while death can occur, mortality rates are generally low due to good intensive car facilities. In cases of infant botulism, the cause is often unknown, however the presence of C. botulinum in honey is thought to be one cause of infant botulism (Szabo & Gibson, 2003).

Enterobacter sakazakii E. sakazakii, recently reclassified into the genus Cronobacter, is a pathogenic

microorganism that has been linked to foodborne illness outbreaks predominately affecting infants (Lenhner & Stephan, 2004). While there is limited surveillance data, FAO (2008) reports at least 120 cases worldwide with 27 deaths. Powdered infant and follow-on formula have been identified as the main food vehicle, with practices such as reconstitution with warm water and holding bottles at room temperature increasing the risk of foodborne illness (FAO, 2007 FAO, 2008). Other factors thought to increase the risk of illness include: age of the infant, nutritional status, HIV status, other clinical conditions, pharmaceutical treatmen,t low birth weight and premature birth (FAO, 2008). As with other Enterobacter species, E sakazakii isolates are thought to have a high rate of antibiotic resistance (Lehner & Stephan, 2004).

Vibrio vulnificus
A specific sub-group within the vulnerable population are at risk from infection by V. vulnificus is found in the marine environment and can contaminate seafood. V. vulnificus infections normally affect people with liver dysfunctions (eg cirrhosis, hepatitis) and also patients with malignancies or those who have undergone gastrectomy (ICMSF, 1996). Symptoms of infection from V. vulnificus include fever, chills and nausea (Desmarchelier, 2003). While infections are rare, mortality rates are high. Most illnesses have been linked to consumption of raw seafood, predominately raw oysters (Desmarchelier, 2003). General hazards When vulnerable populations are exposed to other pathogenic microorganisms the resulting illnesses are like to be more prevalent and more severe than in the general population. Buzby (2002) attributed this in elderly people to age related factors (eg decreased immune function and stomach acid production, digestive orders,
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medication and altered sense of smell and taste) and a decrease in stomach and intestinal contractions resulting in a longer time required to eliminate pathogens and allowing a greater time for toxin formation and damage. Buzby (2002) also reports that in the US, rates of foodborne illness can be 10 to 100 times greater for elderly people within nursing homes when compared to the general population and that the elderly are more vulnerable to gastroenteritis-induced deaths. Other sub-groups within the vulnerable population exhibit increased sensitivity to foodborne illnesses due to decreased immunity. Acheson & Lubin (2008) contribute this increased risk due to many factors including the use of antibiotics that, while they aim to treat illnesses caused by certain pathogens, they can also eliminate from the intestinal tract certain microorganisms that inhibit or suppress the growth of pathogenic microorganisms. Cancer and transplant patients also have greater susceptibility to foodborne illness due to their treatments lowering the immune system, with mortality rates from foodborne illness higher than the general population (Acheson & Lubin, 2008). Jay et al (2003) also suggests that the immunocompromised or those with underlying disease are at a greater risk of infection from Salmonella and the infection is likely to result in more serious illness. It is thought that the lower gastric acidity and immature immune response may influence the sensitivity of children to salmonellosis (Jay et al, 2003). This appears to be supported by a higher number of reported Salmonellosis infections in children aged four or under, at least three times higher than other age groups (NSW Health, 2008). Other pathogens where increased prevalence or severity has been observed in the vulnerable population include: Enteropathogenic E. coli strains of shiga toxigenic E. coli (STEC) are known to cause severe illness in infants and the elderly and can result in death (Desmarchelier & Fegan, 2003) Staphylococcus aureus while for the healthy populations staphylococcal food poisoning is rarely fatal, fatalities have been reported in infants and the elderly (Stewart, 2003) Clostridium perfringens fatal cases of C. perfringens food poisoning are generally associated with the elderly in institutionalised settings (Bates & Bodnaruk, 2003) in the general population fatalities are rare and Bacillus cereus fatal cases are very rare, when reported they have been linked to children with liver failure (Dierick et al, 2005)

Exposure assessment
Estimating the exact portion of the vulnerable population who are in care-type establishment that provide food, and the number of meals served by these facilities is difficult, although there is some information that may be used to estimate potential numbers of both. Population figures from the Australian Bureau of Statistics surveys (ABS, 2005; ABS, 2008) indicate that in NSW: In June 2008 there were 225,945 children aged 4 years old or younger and
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In 2005, there were 17.5% and 35.8% of children aged 0 to 2 years old and 3 to 4 years old respectively in long day care. Using these figures it could be assumed that approximately 26.6% of children aged less than 5 years old are in long day care, which would correlate to 60,214 children in long day care facilities. It should be noted that not all these children would be served meals prepared by the facility and the number of meals each facility serves may differ.

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A survey conducted by the NSW Food Authority (2008a) indicates that: 1,856 childcare centres in NSW provide food for approximately 79,808 children each day and Approximately 26,815,488 meals are served in childcare centres each year. ABS data (ABS, 2008) also indicate that in June 2007, there were 422,656 people aged 65 or older. The NSW Food Authority (2008b) surveyed other businesses included in the definition of Standard 3.3.1 - Food Safety Program for Food Service to Vulnerable Populations of the Food Standards Code and found that: there are 1867 facilities in NSW as defined by Standard 3.3.1 (excluding childcare facilities) and these facilities serve approximately 106,824,172 meals each year Therefore in total food service to vulnerable populations facilities would serve approximately 133 million meals per year in NSW. It would be expected that some of the components of these meals may present a risk to sub-groups within the vulnerable population.

Hazard characterisation
Foodborne illness outbreaks involving food service establishments for vulnerable populations Table 38 provides a summary of foodborne illness outbreaks in food served to vulnerable persons in Australian institutions (Table 69 of Appendix 3 provides more detailed information on each outbreak). Since 1995 there have been 67 foodborne illness outbreaks across Australia involving establishments that serve food to vulnerable populations, with 1138 illnesses, 64 hospitalisations and 12 fatalities. These outbreaks occurred in aged-care facilities, childcare centres and hospitals and the most common organism implicated was Salmonella, others organisms involved include C. perfringens, L. monocytogenes and Campylobacter. An outbreak in 1998-1999 in aged-care facilities and hospitals in the Hunter Valley, NSW highlighted the risks of listeriosis from foods served in these establishments. The implicated food was fruit salad and the outbreak affected 9 patients, with 6 deaths resulting. All patients were elderly, and some had underlying conditions making them more susceptible to infection with L. monocytogenes. All the establishments served food prepared in a central catering facility (Food Science Australia & Minter Ellison Consulting, 2002). One sample of fruit salad subsequently tested positive for low levels (<50 cfu/g) of L. monocytogenes, a level considered unlikely to cause illness, even in immunosuppressed individuals. Vulnerability to foodborne illness Previous sections of this chapter provide some insight into the factors why some groups within the population are more vulnerable to foodborne illness than others. This can be further illustrated by reviewing foodborne illness surveillance data. Table 39 provides a breakdown on the percentage of outbreaks reported to have occurred in facilities serving food to the vulnerable populations.
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Table 38 Summary of foodborne illness outbreaks attributed to food served to vulnerable persons
Hazard Australian outbreaks (1995-2008) Cases Hospitalisations Deaths

Salmonella spp. C. perfringens Campylobacter spp. L. monocytogenes


Norovirus Toxin Viral

23 10 7 5 4 3 3 1 1 1 1 8 67

395 267 101 24 111 44 38 19 7 4 2 126 1138

43 1 6 5 0 1 0 0 0 0 0 8 64

4 1 0 7 0 0 0 0 0 0 0 0 12

B. cereus St. aureus Cryptosporidium


Pathogenic E. coli Unknown Total

Table 39 Institutional foodborne illness outbreaks as a percentage of all outbreaks 24


Year Outbreaks (% of total) 2001 2002 2003 2004 2005 2006 5.8% 8.7% 15.1% 9.3% 12.7% 6.1% Cases (% of total) 2.9% 5.6% 16.2% 8.1% 10.3% 6.4% Hospitalisation (% of total) 1.4% 4.8% 32.4% 24.1% 6.0% 24.6% Deaths (% of total) NR 25 50% 66.7% NR NR NR

adapted from outbreak data from OzFoodNet 2002-2006 (OzFoodNet Working Group, 2003; 2004; 2005; 2006; 2007)

Based on NSW Food Authority research (2008) and ABS data (ABS 2005 ABS 2008a ABS, 2000b), the percentage of the NSW population within facilities catering to vulnerable populations is approximately 2.5%. When this is compared to the figures in Table 39, it can be seen that foodborne illness affecting individuals in facilities

24 25

Institutions include aged-care facilities, child-care, hospitals and institutions NR not reported

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catering to vulnerable populations are over-represented compared to the entire population which may be an indication of their increased vulnerability. Prevalence of pathogens Very little information is available on the prevalence of pathogens or other microorganisms in foods served to vulnerable populations. Other chapters within this document provide some general information on the prevalence of microorganisms in certain commodities some of which would be served to vulnerable populations. A study conducted by Gillespie et al (2001) looked at the microbiological quality of sliced cold RTE meats from catering establishments. They found that 26% of samples were categorised as unsatisfactory when compared to UK Public Health Laboratory Services microbiological guidelines, with 0.4% of samples categorised as unacceptable or potentially hazardous. Gillespie et al (2001) also compared the results of various food handling practices and found: A higher level of unsatisfactory or unacceptable results with product made external to the kitchen when compared to product made in-house A higher level of unsatisfactory or unacceptable results with product purchased pre-sliced when compared to product sliced in-house.

similar to samples that had been subjected to temperature abuse scenarios (Odumeru et al, 1997).

L. monocytogenes in 5/135 samples (3.7%) and also found total bacterial levels

A review of ready-to-use vegetables from health-care facilities found

During 2005 and 2006, Little et al (2008) undertook a study on the microbiological safety of sandwiches served in hospitals and other health care establishments in the UK. In this study they found L. monocytogenes in 2.7% of 88 samples which included samples collected from wards. They also found a higher frequency of L. monocytogenes in sandwiches prepared outside the establishment, where the filling included poultry meat or contained salad ingredients, soft cheese and/or mayonnaise. Food service operations Food service operations by establishments preparing foods for vulnerable populations can undertake a variety of methods to prepare these foods. The types of operations can include: Preparation and plating of raw or RTE foods Preparation and plating of previously cooked foods without further heating Preparation and plating of freshly cooked foods Reheating and plating of foods previously cooked using: o o Cook chill for short shelf life or Cook chill for extended shelf life.

There are also some other specific operations for certain sub-groups that present specific hazards and will influence the risk to the vulnerable populations. Examples of these include:

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Visitors to some establishments (eg hospitals, aged-care facilities) bringing food to patients or residents, some of which can present a risk to the sub-population (Wall, 2008) Texture-modified or pured foods provide the opportunity for recontamination of cooked foods due to improperly cleaned and sanitised equipment (Tallis et al, 1999) Extended storage and handling of reconstituted infant formula can increase the risk of foodborne illness in infants due to E. sakazakii (Lehner & Stephan, 2004). In addition to these operations, food establishments may also purchase some foods or meals ready cooked, which then require little or minimal handling by the establishment. The hazard and subsequent risks associated with the foods served to the vulnerable populations will be influenced by the type of operations they undertake. For example: Inadequate control of the cook chill process (eg poor cooling rates, improper storage temperatures and inadequate reheating) can result in the growth and survival of pathogenic microorganisms (Cox & Bauler, 2008) Improper storage time and temperature of RTE foods that require no further heat treatment can result in the growth of L. monocytogenes (ILSI, 2005) Inadequate cooking and poor post-cooking temperature growth can result in the survival and subsequent growth of pathogenic microorganisms (Cox & Bauler, 2008) and For foods served raw, inadequate control steps to minimise the presence of pathogenic microorganisms and inhibit their growth during storage (Desmarchelier & Fegan, 2003; Sutherland et al, 2003).

Risk characterisation
Risk of listeriosis The high risk associated with listeriosis in establishments serving foods to the vulnerable population has also been noted in the National Risk Validation Project (Food Science Australia & Minter Ellison Consulting, 2002). In this report the authors ranked L. monocytogenes and foodservice operations for sensitive populations as the highest risk rating due to the ability of the pathogen to grow at refrigeration temperatures and the high mortality and hospitalisation rates associated with the listeriosis infection.

RTE foods that assessed the relative susceptibility of different groups within the population to listeriosis (Table 40). From this table it can be seen that the subgroups within the vulnerable population are more susceptible to listeriosis and in turn the food served to them presents a greater risk of foodborne illness than the food consumed by the general population. In their risk assessment on L. monocytogenes in RTE foods, the FDA/USDA (2003) estimated the number of cases of listeriosis per serving and per annum for different
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L monocytogenes. FAO (2004) published a risk assessment on L. monocytogenes in

The main hazard affecting the vulnerable population that has been studied is

food categories for certain sub-groups of the vulnerable population. Assuming similar consumption rates in Australia and using Australian population figures, the potential number of listeriosis cases per year within Australia for each food category can be estimated (Table 41). It can be seen from this data that the risk of contracting listeriosis from any single serving of food is extremely rare, even for the highest risk foods (eg deli meats, estimated cases are 3.0 x 10-7 per serve for the elderly, therefore 30 million serves of deli meats would result in 1 case of listeriosis). However, when combined with the number of meals consumed by the elderly each year (not only those residing in facilities), there is the potential for 70 cases of listeriosis each year. Due to the control measures initiated by establishments serving vulnerable populations, the number of people actually exposed to L. monocytogenes is likely to be much lower.
Table 40 Relative susceptibility to listeriosis for different sub-groups
Condition Transplant Cancer blood AIDS Dialysis Cancer pulmonary Cancer gastrointestinal and liver Non-cancer liver disease Cancer bladder and prostate Cancer gynaecological Diabetes, insulin dependant Diabetes, non-insulin dependant Alcoholism Over 65 years old Less than 65 years, no other condition (reference or general population) adapted from FAO (2004) Relative susceptibility 2584 1364 865 476 229 211 143 112 66 30 25 18 7.5 1

Risk of foodborne illness associated with C. perfringens A risk profile published by Meat and Livestock Australia (2003) examined the risk posed by C. perfringens in institutional meals for the aged where food safety programs have been implemented. In determining the risk, factors such as severity, probability, and the effect of processing and handling were considered. From this information it was concluded that the risk rating of C. perfringens in institutional meals for the aged was high with an estimated of 250 cases of C. perfringens foodborne illness in Australia per year. The ABS (2008) estimates that 33.8% of the population aged over 65 reside in NSW. Assuming the proportion of elderly within aged-care facilities is similar, it can be estimated that the number of cases of foodborne illness due to C. perfringens in facilities in NSW would be 84.5 per annum.
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Table 41 Estimated cases of listeriosis for vulnerable population sub-groups for each food category
Product Dairy Pasteurised fluid milk High fat and other dairy products Soft unripened cheese Unpasteurised fluid milk Fresh soft cheese Ice-cream/frozen dairy products Processed cheese Hard cheese Cultured milk products Soft ripened cheese Semi-soft cheese Meat Deli meats Pt and meat spreads Frankfurters (reheated) Dry/Semi-dry fermented sausages 3.3 x 10-8 1.2 x 10 2.7 x 10
-8 -11

Intermediate age 26 Per serve


27

Elderly
28

Perinatal Per annum 4.2 2.9 0.4 0.1 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 70.8 0.2 0.02 <0.01 Per serve 1.5 x 10-7 3.2 x 10-7 2.0 x 10
-7

Per annum 2.6 1.4 0.2 0.09 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 49.1 0.1 <0.01 <0.01

Per serve 3.4 x 10-9 8.3 x 10 4.9 x 10 1.0 x 10 9.2 x 10 9.2 x 10 2.2 x 10 3.0 x 10
-9 -9

Per annum 0.7 0.3 0.04 0.03 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 13.4 0.03 <0.01 <0.01

4.4 x 10-10 1.0 x 10 5.8 x 10 1.2 x 10 1.3 x 10


-9 -10

2.9 x 10-9
-10 -14

2.2 x 10-8
-9 -14

9.9 x 10-7 4.2 x 10 6.5 x 10 8.1 x 10


-8 -12

1.4 x 10-14 3.4 x 10 2.1 x 10 2.9x 10


-15

9.3 x 10-14
-15

6.7 x 10-12
-13

9.5 x 10-15
-12 -12

5.6 x 10-14
-11 -11

4.7 x 10-12 1.3 x 10 1.6 x 10


-9 -9

3.0 x 10-7 1.1 x 10 2.7 x 10


-7 -10

1.2 x 10-5 4.5 x 10-6 1.6 x 10


-8

6.0 x 10-12

6.2 x 10-11

3.7 x 10-9

26

Intermediate age includes susceptible populations not captured in other groups (eg cancer, AIDS and transplant patients). The risk per serving is inherent to the particular food category, and is therefore assumed to be the same in Australia as that calculated for the USA (FDA/USDA, 2003). This is based on the assumption that consumption patterns for these foods are identical in Australia and the USA The risk per annum has been adapted from USA population data contained in the FDA/USDA (2003) risk assessment of 260 million and extrapolated to Australian population data of approximately 21.6 million (ABS, 2009) by dividing by a factor of 12

27
28

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Product Plant Products Fruit Vegetables Deli type salads Seafood Cooked RTE crustacean Smoked seafood Raw seafood Preserved seafood adapted from FDA/USDA (2003)

Intermediate age 26 Per serve


27

Elderly Per serve 5.1 x 10-11 8.2 x 10


-12

Perinatal Per annum 0.05 <0.01 <0.01 0.1 0.07 <0.01 <0.01 Per serve 2.8 x 10-9 4.8 x 10
-10

Per annum 28 0.02 <0.01 <0.01 0.08 0.03 <0.01 <0.01

Per annum <0.01 <0.01 <0.01 0.03 <0.01 <0.01 <0.01

5.0 x 10-12 8.4 x 10


-13

1.7 x 10-13 2.2 x 10-9 2.1 x 10 1.3 x 10


-9 -11

1.4 x 10-12 1.9 x 10-8 1.9 x 10 1.3 x 10


-8 -10

8.8 x 10-11 7.4 x 10-7 8.4 x 10


-7 -9

6.7 x 10

6.4 x 10-12

6.7 x 10-11

4.1x 10-9

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Risk based on meals served and prevalence rates The potential risk can also be calculated using the information collected on the number of meals served within establishments catering to the vulnerable population and studies undertaken on the prevalence of pathogens in foods from these establishments. As reported by Gillespie et al (2001), 15/3494 (0.4%) of cold sliced RTE meats where found to be of unacceptable / potentially hazardous, due to the presence of high levels of E. coli, S. aureus, Listeria and C. perfringens 29. Using the information collected by the NSW Food Authority on meals served and assuming one meal per day consists of sliced cold meat then it could be expected that: 35,753 meals per annum served in childcare facilities that include sliced cold meats could be potentially hazardous and 142,432 meals per annum served in other establishments catering to the vulnerable population could be potentially hazardous. As mentioned previously, the contamination rate of L. monocytogenes in RTE vegetables and sandwiches from health care facilities were found to be 3.7% and 2.5% respectively (Odumeru et al, 1997; Little et al, 2008). Again, assuming these foods were served at one meal per day, the number of meals potentially contaminated with L. monocytogenes would be: 330,724 meals per annum containing RTE vegetables at childcare facilities 1,137,498 meals per annum containing RTE vegetables at other facilities serving to vulnerable populations 241,339 sandwiches served per annum at childcare facilities 961,417 sandwiches served per annum at other facilities catering to vulnerable populations. These figures are likely to be an over estimation as exact information on meal types is not known and it is likely that establishments will have risk managements strategies in place to minimise the risks associated with food service to vulnerable populations. Characterising the risk associated with other hazards within food service for vulnerable populations is problematic due to the lack of information on the types of meals served within these establishments. Other chapters within this document provide an estimation of the risk for certain potentially hazardous foods and the risk posed is likely to be similar for establishments serving food to the vulnerable population. Control measures in food service for vulnerable populations The risk characterisation and predicted number of listeriosis cases stated previously are generally not observed due to the risk management strategies or control measures implemented by establishments serving food to vulnerable populations. The main strategy to assist in reducing the risk of foodborne illness at these establishments is the effective development and implementation of a food safety program. Woody & Benjamin (2008) provide an overview of the practicalities of implementing a food safety program in healthcare settings. In addition, in
29

Unacceptable / potentially hazardous was defined from categories in the Public Health Laboratory Service (PHLS) Guidelines for the microbiological quality of some ready-to-eat foods at the point of sale (PHLS, 2000)

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implementing the requirements of Standard 3.3.1 - Food Safety Program for Food Service to Vulnerable Populations of the Food Standards Code, the NSW Food Authority developed guidance material to assist industry meet the requirements (NSW Food Authority, 2008c). These documents provide some potential control measures for establishments serving vulnerable populations including: Substitution of high risk foods with lower risk alternatives Effective cleaning and sanitation of fruits and vegetables to be consumed raw Limited storage of pre-prepared infant formula Minimise storage times of foods to be consumed without further heat treatment Proper cooking of foods Effective cleaning and sanitation of equipment, in particular those used for foods that will not receive a further heat treatment.

Conclusion
A small sub-group within the population are known to be more susceptible to foodborne illness. This group is generally referred to as the vulnerable population and includes children under five years of age, the elderly over 65 and those with underlying immune suppressant conditions. The hazards affecting the vulnerable population can be unique to certain groups such as L. monocytogenes and E. sakazakii or may involve well known foodborne pathogens such as Salmonella resulting in more severe illness in the vulnerable persons. This tends to be reflected in epidemiological data, where institutional outbreaks are over-represented in the number of foodborne illness outbreaks, cases of illness and deaths from food sources. Based on prevalence data for bacterial pathogens, it is estimated that over one million of the 133 million meals served at institutions catering to vulnerable populations in NSW each year may be potentially contaminated with a food pathogen. This emphasises the importance in implementing control measures such as food safety programs at establishments catering to the vulnerable populations, to ensure the safety of their consumers.

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References Food service to vulnerable populations


Acheson, D. & Lubin, L. (2008). Vulnerable populations and their susceptibility to foodborne disease. In B. M. Lund & P. R. Hunter (Eds), The microbiological safety of food in healthcare settings (pp. 290-319). Oxford: Blackwell Publishing Ltd. Ashbolt, R. et. al (2002) Enhancing foodborne disease surveillance across Australia in 2001: the OzFoodNet Working Group. Communicable Diseases Intelligence, 26(3), 375-406. ABS [Australian Bureau of Statistics] (2005). 4402.0 Child care survey. Retrieved 30 November2008, from http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/4FB69C9AE4BBC0EBCA257186007 BAA38/$File/44020_nsw.xls. ABS [Australian Bureau of Statistics] (2008). 3101.0. Australian demographic statistics. Retrieved 22 October 2008, from http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/B6C3FC4377C676B9CA2574CD001 250C1/$File/31010_mar%202008.pdf. Bates, J.R. & Bodnaruk, P.W. (2003). Clostridium perfringens. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp 479-504). Australian Institute of Food Science and Technology, Waterloo. Buzby, J. C. (2002). Older adults at risk of complications from microbial foodborne illness. Food Review, 25(2), 30-35. Cox, B. & Bauler, M. (2008). Cook chill for food service and manufacturing: guidelines for safe production, storage and distribution. Alexandria: Australian Institute of Food Science and

Technology.

Desmarchelier, P.M. (2003). Pathogenic vibrios. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 333-358). Australian Institute of Food Science and Technology, Waterloo. Desmarchelier, P.M. & Fegan, N. (2003) Enteropathogenic Escherichia coli. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 267-310). Australian Institute of Food Science and Technology, Waterloo. Dierick, K., Van Coillie, E., Swiecicka, I., Meyfroidt, G., Devlieger, H., Meulemans, A., Hoedemaekers, G., Fourie, L., Heyndrickx, M., & Mahillon, J. (2005). Fatal Family Outbreak of Bacillus cereus-associated Food Poisoning. Journal of Clinical Microbiology, 43(8), 4277-4279. FAO [Food and Agricultural Organization of the United Nations] (2004). Risk assessment of Listeria monocytogenes in ready-to-eat foods. Retrieved 17 October 2008, from ftp://ftp.fao.org/es/esn/jemra/mra4_en.pdf FAO [Food and Agricultural Organization of the United Nations] (2007). Enterobacter sakazakii and Salmonella in powdered infant formula: meeting report, MRA series 10. Retrieved 19 November 2008, from http://www.who.int/foodsafety/publications/micro/es.pdf. FAO [Food and Agricultural Organization of the United Nations] (2008). Microbiological risk assessment series: Enterobacter sakazakii (Cronobacter spp.) in powdered follow-up formulae. Retrieved 17 October 2008, from http://www.fao.org/ag/agn/agns/jemra/Sakazaki_FUF_report.pdf. FDA/USDA [Food and Drug Administration/ United States Department of Agriculture] (2003).

from http://www.foodsafety.gov/~dms/lmr2-toc.html.

Quantitative assessment of relative risk to public health from foodborne Listeria monocytogenes among selected categories of ready-to-eat foods. Retrieved 30 October 2008,

Food Science Australia & Minter Ellison Consulting (2002). National Risk Validation Project. Final Report. FSANZ [Food Standards Australia New Zealand] (2006). Final assessment report. Proposal P288. Food safety program for food service to vulnerable populations. Canberra, ACT: Author. FSANZ [Food Standards Australia New Zealand] (2008). Australia New Zealand Food Standards Code. Standard 3.3.1. Food safety programs for food service to vulnerable populations. Retrieved October 30, 2008, from
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http://www.foodstandards.gov.au/_srcfiles/Standard_3_3_1_FSPs_%20Vulnerable_pops_v95. pdf. Gillespie, I., Little, C. & Mitchell, R. (2001). Microbiological examination of cold ready-to-eat sliced meats from catering establishments in the United Kingdom. Journal of Applied Microbiology, 88(3), 467-474. Goulet, V., Hedberg, C., Le Monnnier, A. & de Valk, H. (2008). Increasing incidence of listeriosis in France and other European countries. Emerging Infectious Disease, 14(5), 734740. ILSI Research Foundation/Risk Science Institute (2005). Achieving continuous improvement in reductions in foodborne listeriosis a risk-based approach. Journal of Food Protection. 68(9), 1932-1994.

Microorganisms in Foods 5: Microbiological specifications of food pathogens. Roberts, T.A.,


Baird-Parker, A.C. & Tompkin, R.B. (Eds.). Blackie Academic & Professional, London. Jay, S., Davos, D., Dundas, M., Frankish, E. & Lightfoot, D. (2003). Salmonella. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 207-266). Australian Institute of Food Science and Technology, Waterloo.

ICMSF [International Commission on Microbiological Specifications for Foods] (1996).

Enterobacter sakazakii. Journal of Food Protection, 67(12), 2850-2857.

Lehner, A. & Stephan, R. (2004). Microbiological, epidemiological and food safety aspects of

Little, C.L., Barrett, N.J., Grant, K. & McLauchlin, J. (2008). Microbiological safety of sandwiches from hospitals and other health care establishments in the United Kingdom with a focus on Listeria monocytogenes and other Listeria species. Journal of Food Protection, 71(2), 309-318. MLA [Meat & Livestock Australia] (2003). Through chain risk profile for the Australian red meat industry, PRMS.038c, part 1: risk profile. North Sydney: Meat & Livestock Australia. NSW Food Authority (2008a). Regulatory impact statement: food amendment (child care centres) regulation 2008. Sydney: NSW Food Authority. NSW Food Authority (2008b). Regulatory impact statement: food amendment (vulnerable persons food safety scheme) regulation 2008. Sydney: NSW Food Authority. NSW Food Authority (2008c). Vulnerable persons food safety scheme manual: policy and information to help businesses comply with the food service to vulnerable populations food safety scheme under the food regulation 2004. Retrieved 11 December 2008, from

http://www.foodauthority.nsw.gov.au/_Documents/industry_vp_pdf/vulnerable_persons_food _safety_scheme_manual_compl.pdf.

NSW Health (2008). Salmonellosis notification in NSW residents. Retrieved 15 October 2008, from http://www.health.nsw.gov/data/diseases/salmonellosis.html. O Brien, S.J. (2008). Foodborne Disease Outbreaks in Healthcare Setting. In Lund, B.M. & Hunter, P.R. (Eds.), The microbiological safety of food in healthcare settings (pp. 251-289). Oxford: Blackwell Publishing Ltd. Odumeru, J.A., et al. (1997). Assessment of the microbiological quality of ready-to-use vegetables from health-care food services. Journal of Food Protection, 60(8), 954-960. OzFoodNet Working Group (2003). Foodborne disease in Australia incidence, notifications and outbreaks. Annual report of the OzFoodNet network, 2002. Communicable Diseases Intelligence, 27(20), 209-243 OzFoodNet Working Group (2004). Foodborne disease investigation across Australia: Annual report of the OzFoodNet network, 2003. Communicable Diseases Intelligence, 28(3), 359389. OzFoodNet Working Group (2005). Reported foodborne illness and gastroenteritis in Australia: Annual report of the OzFoodNet network, 2004. Communicable Diseases Intelligence, 29(2), 164-190. OzFoodNet Working Group (2006). Burden and causes of foodborne disease in Australia: annual report of the OzFoodNet network, 2005. Communicable Diseases Intelligence, 30(3), 278-300.
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OzFoodNet Working Group (2007). Monitoring the incidence and causes of disease potentially transmitted by food in Australia: Annual report of the OzFoodNet, 2006. Communicable Disease Intelligence, 31(4), 345-365. PHLS [Public Health Laboratory Service, UK). (2000). Guidelines for the microbiological quality of some ready-to-eat foods samples at the point of sale. Communicable Disease and Public Health 3(3), 163-167. Stewart, C. (2003). Staphylococcus aureus and staphylococcal enterotoxins. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 359-379). Australian Institute of Food Science and Technology, Waterloo. Sutherland, P., Miles, D. & Laboyrie, D. (2003). Listeria monocytogenes. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 381-443). Australian Institute of Food Science and Technology, Waterloo. Szabo, E. A. & Gibson, A. M. (2003). Clostridium botulinum. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 505-542). Australian Institute of Food Science and Technology, Waterloo. Tallis, G., et al. (1999). A nursing home outbreak of Clostridium perfringens associated with pureed food. Australian and New Zealand Journal of Public Health. 23(40), 421-423. Wall, P. (2008). Overview. In Lund, B.M. & Hunter, P.R. (Eds.), The microbiological safety of food in healthcare settings (pp. 1-11). Oxford: Blackwell Publishing Ltd. Woody, J-M. & Benjamin, D.L. (2008). Practical implementation of food safety management systems in healthcare setting. In Lund, B.M. & Hunter, P.R (Eds.), The microbiological safety of food in healthcare settings (pp. 351-380). Oxford: Blackwell Publishing Ltd.

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Egg food safety scheme (draft)


Hazard identification
The NSW Food Authority previously undertook a risk profile on the NSW egg industry (Miles & Chan, unpublished) and proposed several risk management strategies to underpin the incorporation of an Egg food safety scheme into the Food Regulation 2004. As SafeFood NSW, the Authority also commissioned Food Science Australia to provide a scoping study on plant products, which also examined eggs (FSA, 2000). This report identified potential hazards associated with the production of eggs and egg products, shown in Table 42. In addition the egg industrys peak body, the Australian Egg Corporation Ltd (AECL) commissioned the South Australian Research and Development Institute (SARDI) to complete two sections of work, a risk profile on eggs and egg products to examine all potential hazards (Daughtry et al, 2005), and a quantitative risk assessment concentrating on evaluating the risks from Salmonella spp. (Thomas et al, 2006) All bodies of work include comprehensive assessments of both microbiological and chemical hazards in eggs and egg products. Risk assessment work on the Australian egg industry is currently being undertaken by Food Standards Australia New Zealand (FSANZ) to underpin the development of a Primary Production and Processing Standard for Eggs, Proposal P301 (FSANZ, 2006). Microbiological hazards In an assessment of microbiological standards for eggs and egg products, the former Australia New Zealand Food Authority (now FSANZ) identified the following microorganisms of concern in relation to the commercial production, processing and distribution of eggs (ANZFA, 1999): Salmonella spp. Bacillus cereus Listeria monocytogenes Staphylococcus aureus It is recognised that pathogenic organisms may contaminate the shell of the egg, through environmental and faecal contamination. Bacillus cereus (van Netten et al, 1990), Listeria monocytogenes (McKellar, 1993) and Staphylococcus aureus (Papadopoulou et al, 1997) have all been detected during analysis of eggs and/or egg products. However, an analysis of foodborne illness attributed to eggs in Australia shows that virtually all outbreaks have been due to Salmonella spp., with Salmonella Typhimurium the dominant serovar responsible for illness associated with egg consumption. A risk profile undertaken by the New Zealand Food Safety Authority (NZFSA) concentrated on non typhoidal Salmonella in and on eggs as the main hazard (Lake et al, 2004) and the AECL quantitative risk assessment work focused on Salmonella as the primary hazard of concern.

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Table 42 Hazards in the production of shell eggs and egg products


Product Shell eggs Hazard Contamination with Salmonella spp. Growth of Salmonella spp. Contamination with other pathogens Penetration of pathogens during egg production and handling Pathogen survival due to undercooking Development of antibiotic resistant pathogens Mycotoxins Pyrrolizidine alkaloids from feed transferred to eggs Heavy Metals Agricultural and veterinary chemicals Pesticide residues (eg organochlorine residues) in free range and backyard eggs Polychlorinated biphenyls Potential contamination of eggs or egg products from packaging Egg products Contamination with Salmonella spp. or other pathogens Pathogen survival due to inadequate process treatment Contamination of raw and processed product with heavy metals, chemicals (including agricultural compounds and veterinary medicines) or other toxicants adapted from FSA (2000)

Overseas, the focus of egg safety assessment has been slightly different, as Salmonella Enteritidis has become endemic in overseas laying flocks since the 1980s. This has provided a major problem for the overseas egg industry as Salmonella Enteritidis has the unusual ability to colonise the ovarian tissue of hens and this causes Salmonella cells to be present within the contents of newly laid intact shell eggs. Contamination of eggs and of egg products with Salmonella Enteritidis is believed to be the cause of the large increase in human infections in Europe and North America. The Centre for Disease Control in the USA attributed 77-82% of Salmonella Enteritidis-related foodborne outbreaks to eggs and egg products. In many of these cases the outbreaks were associated with the consumption of Grade A shell eggs (WHO, 2002). Currently Australian layer flocks remains free of Salmonella Enteritidis, and it has been estimated that this is worth around $48 million per annum to the Australian egg industry (Sergeant et al, 2003). Given this, there is a strong push from the industry peak body, the AECL, for the implementation of quality assurance programs and codes of practice in the industry, including biosecurity measures on farm to ensure the maintenance of the Salmonella Enteritidis-free status (AECL, 2005a, AECL, 2005b). However, other Salmonella serotypes are intrinsic in the Australia poultry industry and form part of the microbiota in the intestinal tract of chickens. The external surfaces of eggs may become contaminated with faecal material, including Salmonella bacteria between when the egg is laid and when it is collected. However, if the egg is kept dry it is likely that the bacteria will die on the outside of the shell. In a survey of Australian farms that included testing of faecal samples and egg pulp, Cox et al (2002) found that S. Singapore was the dominant organism. This
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was thought to be related to the high numbers of Salmonella found in the feed intended for the chickens, which in turn showed in the numbers found in the faecal specimens. Survival of Salmonella on the egg surface may be enhanced by high relative humidity and the organism may penetrate the egg shell if it is wet, as the shell becomes more porous. Cox et al (2002) showed that S. Infantis, S. Typhimurium, S. Heidelberg and S. Singapore were all capable of migrating into the egg under favourable conditions. Normally the contents of an intact shell egg are essentially sterile when laid and the intrinsic structure of an egg, with the cuticle, shell and shell membranes combining to form a protective barrier against bacteria penetrating into the egg. However, if the egg is cracked (the shell is cracked but the shell membrane is intact) or broken (shell is cracked and shell membrane is also broken), this can facilitate access of pathogenic bacteria into the egg contents, where they may be able to increase in numbers in the nutrient-rich yolk.

Standard 2.2.2 Egg and egg products of the Food Standards Code prohibits cracked eggs being made available for retail sale or for catering purposes, due to the increased risk of bacterial contamination. However, there is anecdotal evidence to suggest that cracked eggs are being sold at a substantially reduced price for use in restaurants and for catering purposes. A Canadian risk assessment on the use of cracked eggs stated that any country producing eggs has to recognise that, despite regulations controlling the use of cracked eggs, economics will dictate that some of these will be consumed as whole eggs and a management plan is desirable to limit hazardous practices associated with these eggs (Todd, 1996).
Chemical hazards Dawson et al (2001) listed the possible sources of chemical contamination of eggs including: free range birds feeding on contaminated soil insecticide sprays used while birds are present water medication at incorrect rate eggs washed in inappropriate solutions egg washing compound mixed at wrong concentrations systemic pesticides used in grower sheds shed fumigation while birds are present chemical feed additives included at wrong rate use of antibiotics or other veterinary medicines Survey results from the National Residue Survey (NRS), and Market Basket Survey have shown occasional detections of heavy metals. Dieldrin residues have also been found in free range eggs (FSA, 2000). Free range hens are considered a higher risk for coming into contact with environmental chemical contaminants because they have the opportunity to source their own food outside, thus increasing the potential for eating contaminated vegetation or soil. However, all detections have been at levels well below the Maximum Residue Level (MRL), and the health risk to humans was concluded to be low.

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There have been detections of veterinary chemical residues in eggs above the MRL, in the past several years (Table 43). The use of antiprotozoals is common to control coccidiosis in the hens, and is mainly used as a feed additive. The traceback investigations of positive detections on farm have tended to indicate mix ups with feed. The use of cages has reduced the need for veterinary chemical usage because the hens are housed off the floor and parasitic infections are less of a problem (FSA, 2000). The AECL risk profile concluded that there was no evidence that pesticides, veterinary medicines or other chemical contaminants, present a food safety or public health risk (Daughtry et al, 2005). Despite occasional low level detections, in general eggs are residue free and no egg samples have been found to contain chemical residues which would present an immediate health risk.
Table 43 Prevalence of chemical residues in eggs
National Residue Survey 1991 1992 1997 National Residue Survey 1998 1999 1999-2000 2000-2001 2001-2002 Number of analyses 617 564 228 Number of samples 248 83 158 122 92 Number with residues 21 (3.4%) 30 (5.3%) 1 (0.44%) Number of analyses 703 1190 3242 1683 1387 Residues above MRL/ERL 0 0 0 0 0 Number of residues above MRL

1 (0.16%) 2 (0.35%) 0 Residues above ML 0 30 0 31 1 32 0 0

No testing of eggs was conducted in 2002-2003 or 2003-2004 2004-2005 2005-2006 2006-2007 75 75 75 1000 1000 1025 2 33 2 34 2
35

0 0 0

adapted from BRS (1996); BRS (1998); AFFA (1999); AFFA (2000); AFFA, (2001); AFFA (2002); DAFF (2003); DAFF (2005); DAFF (2006); DAFF (2008)

30 31 32 33

1998 - two Dieldrin residues detected in free-range eggs, at concentrations of less than 20% MRL 1999 - one residue of Dieldrin in free-range eggs, at concentrations of less than 20% MRL 1999-2000 one residue of copper above the ML was detected

2004 -2005 - both residues were due to anticoccidials. One sample containing Lasalocid was thought to be the result of a mix-up with feed. The traceback for sample containing Nicarbazin was not complete when the NRS report was published. 34 2005-2006 - two samples showed residue levels of Nicarbazin (anticoccidial) above the Australian Standard and were found to be the result of a mix-up with feed. 35 2006-2007 two samples showed residue levels of Nicarbazin (anticoccidial) above the Australian Standard and were found to be the result of a mix-up with feed.

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Physical hazards Due to the protection offered by the shell of the egg, there is a very small likelihood of physical contaminants affecting eggs. The main physical hazards present on farm are blood spots, rodent droppings and insects. Blood spots may be present in eggs when they are laid and may reach the consumer if the eggs are not carefully checked during grading. The candling process used for crack detection of commercial eggs should prevent eggs containing physical contaminants from entering the market. FSANZ concluded that physical hazards are no a significant issue for eggs and egg products (FSANZ, 2006). Other eggs The Australian egg industry is primarily based on eggs and egg products produced from hens. Other egg-producing avian species, such as ducks, quails, pheasants, pigeon, geese, turkey and guinea fowl form a very minor part of the egg market. There is little detailed information is available about the national production of eggs and egg products from these species (FSANZ, 2006), or on the microbiological and chemical status of these products. There is some evidence to suggest that duck eggs may be more highly contaminated with Salmonella spp. than chicken eggs. Overseas studies have shown up to 14% of duck eggs contaminated with Salmonella spp. This is possibly due to the added potential for external contamination of the eggs from less on-farm controls, but also through an increased probability of vertical transmission, particularly of Salmonellae with ducks (Jay et al, 2003). Most duck eggs are processed into specialty products, such as salted eggs, century eggs and Balut egg. While the primary microbiological hazard of concern remains Salmonella spp., the manual handling associated with specialty egg production could possibly lead to contamination with other pathogens such as S. aureus and E. coli. The NSW Food Authority has detected high level of lead in century eggs made from duck eggs (McCreadie et al, 2007). Traditional practices involved the use of lead oxide in the pickling solution, believed to modify the porosity of the egg shell, and thus influence the rate of ingress of the alkaline pickling solution into the egg. This was thought essential to produce century eggs with the desirable semi-solid yolk texture. The Authority survey found a single NSW processor adding lead oxide to the brine the eggs were soaked in. Lead oxide can be extremely poisonous and is not permitted as a food additive in Australia. Given the traditional use of lead salts in specialty egg products, there may be a need to monitor the lead content of these products periodically in case of processors go back to a proven traditional technique.

Exposure assessment
Consumption of shell-eggs (table eggs) In NSW, it is estimated there are 139 egg producers with annual production of almost 58 million dozen eggs worth an estimated $90 million per annum (ABS, 2006). While egg consumption has been steadily declining, consumption data indicates that the Australian population consumes an average 137 eggs per person each year (ABS, 2000). The National Nutrition Survey (ABS, 1995) reported that 16.1% of the NSW population consumed eggs and egg products (see Table 44).
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Overall results showed that rates of consumption ranged from 8.5% (females aged 16 to 18) to 20.5% (males aged 45 to 64). Of those males consuming eggs and egg products, average daily consumption varied from 27.8 g/day (2 to 3 years) to 74.0 g/day (12 to 24 years), while for females average daily consumption varied from 43.0 g/day (2 to 3 years) to 50.0 g/day (25 to 44 years). The consumption data only recorded the consumption levels of eggs (eg fried egg, poached egg) and dishes where egg was the major ingredient (eg omelette, souffl, scrambled eggs). It did not record consumption of foods where egg may be included as one of many ingredients (eg mayonnaise, desserts). The national consumption data reveals that between 12-13% of infants (2-3 yrs) and 14-17% of the elderly (65+ yrs) regularly consume eggs. No distinction was made in what form the eggs were consumed, whether they were served lightly or thoroughly cooked. This demonstrates that a significant proportion of the vulnerable population are regular consumers of eggs. Use of shell eggs It is estimated that 87% of all egg production is sold at retail as shell eggs, with the remaining 13% being further processed into egg products such as pasteurised liquid egg (ABS, 2000). Where egg products are processed, they must meet prescribed microbiological criteria under Standard 1.6.1 Microbiological Limits for Food of the Food Standards Code. Of those eggs sold at retail, it is estimated that 30% are used as an ingredient in a food where it will be thoroughly cooked. There is little data on the consumption patterns of eggs by Australian consumers, but an American survey estimated that 27% of all egg dishes consumed in the US are lightly cooked (Lin et al, 1997), translating to each person on average consuming lightly cooked eggs 20 times a year. Lightly cooked eggs are described as "runny", "runny yolk" or "runny white and may allow the survival of any pathogenic bacteria that are present within the egg. Eggs fried "over easy" and "sunny side up" accounted for almost half (49%) of the lightly cooked eggs eaten. Of instances where raw eggs were consumed as an ingredient in an uncooked or very lightly cooked food, 52% was in frosting, salad dressing (18.5%), blended milk beverages (16%), homemade ice-cream (6%), and hollandaise sauce. Although Australian consumption patterns may be different to the American data cited here, this does provide an indication of the potential exposure to pathogens from undercooked eggs. Consumption of specialty duck egg products and quail eggs Production data on specialty egg products is limited, and it is assumed that the level of consumption forms a very small portion of overall egg consumption. Moreover, they are likely to be consumed by specific minority groups and/or as delicacies only occasionally rather than as part of routine diet. A per capita consumption figure is not available for these products.

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Table 44 Consumption of eggs and egg products in Australia


Sex Age Proportion of persons consuming egg products and dishes 36 (%) Male Male Male Male Male Male Male Male Male Female Female Female Female Female Female Female Female Female 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 2-3 4-7 8 - 11 12 - 15 16 - 18 19 - 24 25 - 44 45 - 64 65+ 12.6 11.1 14.0 12.3 18.1 15.7 17.9 20.5 17.6 13.9 12.2 10.7 8.7 8.5 12.8 15.2 16.8 14.2 27.8 50.0 58.0 74.0 74.0 74.0 62.5 57.0 72.0 43.0 50.0 50.0 50.0 49.0 50.0 50.0 50.0 50.0 Median daily intake for consumers of egg products and dishes (g/day)

adapted from National Nutrition Survey (ABS, 1995)

Hazard characterisation
Foodborne illness outbreaks from eggs A summary of foodborne illness outbreaks attributed to eggs, or where egg was used as an ingredient in the implicated food is shown in Table 45 (more detailed information on these outbreaks is included in Table 70 of Appendix 3). It is clear from epidemiological data and the literature that Salmonella spp. is the primary pathogen of concern in relation to foodborne illness associated with eggs. Prevalence of Salmonella in Australian eggs Survey data included in the AECL risk assessment provides the best prevalence data of Salmonella spp. on and within Australian eggs (Thomas et al, 2006). The external surface of 11,036 eggs from various sources (caged, free range and barn-laid) and the internal contents of 20,000 caged egg samples were sampled (see Table 46).
36

Egg products and dishes are defined in the National Nutrition Survey (ABS, 1995) as including the following: - Eggs; - Dishes where egg is the major ingredient; - Egg substitutes and dishes.

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Table 45 Summary of foodborne illness outbreaks attributed to eggs


Hazard Australian outbreaks (1995-2008) Cases Hospitalisations Deaths

Salmonella spp. Streptococcus pyogenes


Toxin Norovirus

103 1 1 1 1 3 110

3808 72 16 11 2 32 3941

265 0 0 0 1 0 266

0 0 0 0 0 0 0

Campylobacter
Unknown Total

Table 46 Prevalence of Salmonella in Australian eggs


Egg type Number of samples tested

Salmonella detected

(estimated prevalence) Shell eggs ungraded Caged (shell) Free range (shell) Barn laid (shell) Shell eggs - graded Caged (shell) Caged (internal contents) adapted from Daughtry et al (2004) 6476 20,000 0 (0 0.06%) 0 (0 0.02%) 2160 1200 1200 0 (0 0.2%) 0 (0 0.3%) 0 (0 0.3%)

Based on comparable prevalence of external contamination to overseas data (0.21%), Thomas et al. (2006) concluded that the prevalence of internal contamination by Salmonella in Australian eggs is likely to be close to the overseas reported rate of 0.004%, roughly equivalent to one egg every 25,000 being contaminated with Salmonella. This prevalence must be considered in the context that there are over 800 million eggs consumed in NSW each year, both as shell eggs and as an ingredient in food. At this prevalence, there may be 32,000 eggs contaminated with Salmonella consumed each year in NSW. Effect of yolk mean time (YMT) on exposure to Salmonella While it appears inevitable that Salmonella will penetrate into a small proportion of eggs, the bacteria will not begin to increase in numbers immediately. Studies have shown that Salmonella will not grow in the iron restricted environment of the albumen (egg white), and is only able to grow after a considerable period of time. As the egg ages, the vitelline membrane surrounding the yolk breaks and allows the Salmonella to enter the yolk and utilise the rich iron supply within the yolk to grow and rapidly increase in numbers. This length of time for the membrane to break down is determined by the yolk mean time (YMT) and is affected by the temperature
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the egg is stored at. Humphrey (1994) observed large numbers of Salmonella in both the yolk and albumen after the resolution of YMT. Thomas et al. (2006) estimated that 75% of eggs in Australia are consumed before resolution of YMT, based on average industry practices and storage temperatures throughout the production, distribution and retail chain. In effect, this minimises the opportunity for Salmonella to proliferate to high numbers within the egg and results in eggs being a low risk food. However, where eggs are stored at elevated temperatures for extended periods of time, this can allow the YMT to resolve and provide the conditions for any Salmonella which may be present in the egg to grow. Under these conditions, the risk of foodborne illness is increased unless the egg is fully cooked prior to consumption to eliminate the Salmonella. Grading and processing of eggs Several processes used in the grading and processing of eggs may lead to cross contamination of eggs and egg products if sufficient food safety controls are not in place. Efficient crack detection is required when the eggs are graded to ensure that cracked eggs are identified and are re-directed for further processing where they will be pasteurised. To ensure the efficacy of the crack detection method, it should be validated and verified. Washing of eggs is sometimes undertaken by graders and processors to remove any gross faecal or environmental contamination from the shell of the eggs prior to sale. However, if not carefully controlled, the washing process has the potential to damage the shell cuticle and actually increase the risk of microbial penetration into the egg. Inadequate control of temperature, pH and insufficient changes in wash water can result in a build up of microorganisms and lead to cross contamination of eggs. In addition, the incorrect use of chemicals has the potential to cause unacceptable levels of chemical residues in the egg. Eggs must be dried after washing as inadequately dried eggs can allow microbial growth and any remaining bacteria may be aspirated into the egg. The design and hygiene of equipment used in the processing of eggs is of considerable importance to avoid niches for bacterial growth (Jones et al, 2003). The method used to separate the egg contents from the shell for further processing into liquid pulp can have a major impact on the microbiological content of the resulting pulp. The risk of bacterial contamination is markedly worsened by the use of dirty eggs. Liquid egg pulp made from cracked or broken eggs is more likely to be associated with pathogens or increased pathogen numbers than pulp prepared from intact shell eggs. Industry practice is to discard broken eggs, as they are considered a microbiological risk for both safety and quality. The exception to this appears to be where eggs may be broken just prior to where they are pulped. The production of egg products must involve pasteurisation, with the minimum times and temperatures defined in Standard 1.6.2 Processing Requirements of the Food Standards Code, or an equivalent treatment may be used. Pasteurisation of egg pulp must deliver a sufficient heat treatment to ensure the finished product complies with the microbiological standards specified in Standard 1.6.1 Microbiological Limits for Food of the Food Standards Code. The pasteurisation process for egg pulp is relatively mild as coagulation of the egg protein needs to be avoided (ICMSF, 1998). The effectiveness of the pasteurisation process is influenced by the microbial load, so the higher the bacterial load prior to pasteurisation, the higher the bacterial population
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remaining after processing. Thomas et al. (2006) demonstrated that the pasteurisation parameters set by the Food Standards Code delivers a relatively small log reduction of Salmonellae for liquid egg yolk and albumen and the presence of viable Salmonellae in processed products has been demonstrated (NEPSS, 2003). To ensure the effectiveness of the pasteurisation process, the process must be monitored and verified through end product testing and additional control measures implemented to limit the extent of contamination, and the opportunity for growth of contaminating organisms in the raw material. Hygienic handling of pasteurised product must be undertaken to ensure pasteurised product is not recontaminated. Egg pulp remains vulnerable to further contamination post pasteurisation if good manufacturing practices (GMP) are not implemented. Salmonella spp. are able grow rapidly in egg yolk under both aerobic and anaerobic conditions (ICMSF, 1998), unless the product is stored under appropriate temperature control or kept in a frozen state. Specialty duck egg products Production of processed duck eggs exposes the eggs to greater risks of invasion by pathogens likely to be found in the prevailing environment (eg Salmonella serovars). The extensive manual handling these products receive may also introduce pathogens such as S. aureus and E. coli. However, reported cases of illness implicating these pathogens in processed duck eggs are rare. Salted duck eggs and Balut eggs are intended to be eaten cooked. The one documented case of Salmonella poisoning implicating salted eggs was probably an example of uninformed use of that product (Campbell, pers comm.). There is a high risk of chemical contamination with the use of non food grade chemical such as lead oxide, if processors resort to traditional methods for making century eggs.

Risk characterisation
The primary hazard to human health from eggs and egg products are Salmonella serovars. This is evident from the epidemiological data, with Salmonella spp. determined as the cause for the majority of foodborne illness cases attributed to eggs in Australia. While it is possible that other pathogens may also contaminate the shell of the egg through faecal and environmental contamination, this is not reflected in foodborne illness data across Australia. In the AECL-funded risk profile, Daughtry et al (2005) examined 33 different scenarios of egg production and storage and final usage. An estimate was made of how many eggs were captured by each scenario, and an estimate made of the risk per serving and predicted annual number of illnesses attributable to each (see Table 47). It is acknowledged that there are a number of assumptions made in generating such predictions, however this information can provide a useful indication of the highest risk practices and be used to focus risk management strategies.

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Table 47 Risk ranking for type and use of eggs


Scenario Cracked/Intact

Salmonella
growth (YMT resolved)

Salmonella kill step


MR , SR , RE , NE 40
37 38 39

Risk ranking

Predicted cases of Salmonellosis per serve (in Australia)

Predicted annual number of Salmonellosis cases (in Australia) 41 3.34 x 10-2 3.34 x 10-5 0 772 7.72 x 10-1 0 3.43 x 10-3 3.43 x 10-6 0 79 7.92 x 10-2 0 1.32 x 10-3 1.32 x 10-6

Eggs subjected to pathogen reduction step (eg cooking) 1. 2. 3. 4. 5. 6. 7. 8. 9. Commercial eggs Commercial eggs Commercial eggs Commercial eggs Commercial eggs Commercial eggs Non-commercial eggs Non-commercial eggs Non-commercial eggs Intact Intact Intact Intact Intact Intact Intact Intact Intact Intact Intact Intact Cracked Cracked None None None 5-log 5-log 5-log None None None 5-log 5-log 5-log None None MR SR RE MR SR RE MR SR RE MR SR RE MR SR Low Low Low Medium Low Low Low Low Low Medium Low Low Low Low 4 x 10-11 4 x 10-14 0 4 x 10 4 x 10 0 4 x 10 0 4 x 10-6 4 x 10-9 0 4 x 10
-9 -11 -6 -9

4 x 10-14

10. Non-commercial eggs 11. Non-commercial eggs 12. Non-commercial eggs 13. Non-commercial eggs 14. Non-commercial eggs

4 x 10-12

37 38 39

MR moderate reduction 100-fold decimal reduction in Salmonella (eg light cooking, fried sunny side up, microwave, boiled where liquid yolk remains) SR substantial reduction 10,000 fold decimal reduction in Salmonella (eg fried easy over, lightly scrambled or omelette, pasta) RE reliably eliminates 1,000,000,000 fold decimal reduction in Salmonella (eg hard boiled or scrambled, cakes, biscuits) NE - no effect no reduction in Salmonella (eg raw egg drinks, some desserts) Data from Daughtry et al (2005) used an Australian population figure of 19.5 million. These estimates have been extrapolated to the current population of Australia estimated by ABS (2009) as approximately 21.6 million, by multiplying by a factor of 1.1, for consistency with other sections of this risk assessment.

40
41

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Scenario

Cracked/Intact

Salmonella
growth (YMT resolved)

Salmonella kill step


MR , SR , RE , NE 40 RE MR SR
37 38 39

Risk ranking

Predicted cases of Salmonellosis per serve (in Australia) 0 4 x 10-4 4 x 10 0 4.0 x 10-9 4 x 10
-5 -9 -7

15. Non-commercial eggs 16. Non-commercial eggs 17. Non-commercial eggs

Cracked Cracked Cracked

None 5-log 5-log

Low Medium Low Low Low Medium Low Medium Low Medium High Medium Medium Low Low Low Low Low Low

Predicted annual number of Salmonellosis cases (in Australia) 41 0 66 6.60 x 10-2 0 2.57 x 10-1 643 7.92 x 10-2 198 1.32 x 10-2 13 10 11 2.15 x 10-1 2.68 x 10-4 0 10

18. Non-commercial eggs Cracked 5-log RE Consumed without pathogen reduction step in raw egg drinks and cold desserts 19. Commercial eggs 20. Commercial eggs 21. Non-commercial eggs 22. Non-commercial eggs 23. Non-commercial eggs 24. Non-commercial eggs 25. Non-commercial eggs Commercial liquid egg pulp 26. Commercial eggs 27. Commercial eggs 28. Commercial eggs 29. Commercial eggs 30. Commercial eggs 31. Commercial eggs 32. Commercial eggs Intact Intact Intact Intact Cracked Cracked Cracked eggs in egg butter Unpasteurised pulp Unpasteurised pulp Unpasteurised pulp Unpasteurised pulp Pasteurised pulp Pasteurised pulp Pasteurised pulp None 5-log None 5-log None 5-log 3-log 1-log 1-log 1-log 1-log None None None None NE NE NE NE NE NE NE NE SR RE MR NE SR RE MR

4.0 x 10 4 x 10-5 4 x 10
-7

4 x 10-4 4 x 10
-6

2.5 x 10-4 2.5 x 10 0 2 x 10


-7 -9 -6

2.50 x 10-9

2.00 x 10 0

1.29 x 10-1 1.29 x 10-4 0

2.00 x 10-12

33. Commercial eggs Pasteurised pulp adapted from Daughtry et al (2005)

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The highest risk per serving was for scenarios where the storage conditions of the eggs allowed the YMT to be resolved and therefore allowed the numbers of Salmonella to significantly increase (scenario 16, 24 from Table 47), resulting in a risk per serving of 400 predicted illnesses per million servings. However, this did not necessarily translate to a large number of predicted illnesses, as the number of eggs actually captured by the particular scenario may not be that large. These two particular scenarios looked at non-commercially produced eggs, which account for a very small portion of overall egg production. The largest number of actual predicted illnesses was from scenario 4, where the storage conditions for the eggs allowed the resolution of the YMT, and final use only involved a moderate kill step. Thomas et al (2006) estimated that as many as 25% of shell eggs in Australia are consumed after resolution of YMT, and although the risk per serving was predicted to be 4 illnesses per million servings, because of the large number of eggs captured by this scenario, it results in a prediction of 772 illnesses each year when extrapolated to the current Australian population. Total numbers of predicted illnesses from all scenarios was greater than 1800 cases per annum. The final estimate for the level of illness was shown to be dependent on a number of factors, namely: the quality of hygienic practices on-farm (ie level and prevalence of contamination with Salmonella) hygienic practices during processing time and temperature of egg storage (ie whether this allowed the resolution of YMT and subsequent increase in levels of Salmonella in the egg) and end use of the eggs (level of cooking and subsequent reduction in Salmonella) The risk profile undertaken previously by the NSW Food Authority (Miles & Chan, unpublished) identified that the significant control measures to manage microbiological and chemical hazards were as follows: Biosecurity measures on farm Continued strict biosecurity measure will be necessary on commercial farms to maintain the S. Enteritidis-free status. Because of the small number of breeder flocks in Australia, and the already high level of biosecurity on these flocks, it is concluded that the probability of a breeding flock becoming infected with S. Enteritidis is low. However, should a breeding flock become infected and remain undetected, there would be significant spread to a large number of layer flocks throughout Australia (Arzey, 2002). If this should happen it is believed there would be significant increase in the number of human cases of S. Enteritidis -related illness from eggs (Sergeant et al, 2003), as has been observed in other countries where S. Enteritidis has become endemic. To ensure laying hens and breeding stock remain free from S. Enteritidis the Australian egg industry has proactively initiated and developed various generic egg quality Codes of Practice and food safety programs to manage relevant food safety and quality risks at specific stages of the supply chain for both eggs and egg products (AECL, 2005a; AECL, 2005b). However the uptake of these by industry is voluntary. Through-chain regulatory control and implementation of food safety controls and traceability on farm may aid in maintaining the S. Enteritidis-free status.

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Control measures for grading and processing of eggs and egg products Higher risk operations, including grading and washing of eggs, handling and processing of egg pulp, and processing of specialty duck eggs, should be carried out with adequate control through the implementation of HACCP-based food safety program. The revised Codex Code of Hygienic Practice for Eggs and Egg products emphasises the use of the Hazard Analysis Critical Control Point (HACCP) approach wherever appropriate to minimise food safety hazards (Codex, 2006). Pasteurisation of all liquid egg preparations should be monitored, recorded and periodically verified. Monitoring should include evidence of the effectiveness of the process. Thomas et al (2006) stated that the epidemiological data shows that few foodborne outbreaks in Australia can be attributed to the ingestion of clean intact shell eggs that are produced under a quality control system, graded and retailed commercially. Effective management of the supply chain The time and temperature that eggs are stored at determines the length of time to resolve the YMT. Resolution of the YMT can allow significant growth of Salmonella within the egg, with Daughtry et al (2005) demonstrating that this was a significant factor in increasing the risk of illness from egg consumption. While Thomas et al (2006) estimated that 75% of eggs are consumed before the YMT is resolved, management of the supply chain should ensure that a realistic shelf life is applied to shell eggs, according to the expected storage conditions through the distribution, wholesale and retail supply chain. Prohibition on sale of cracked eggs The Food Standards Code prohibits the sale of eggs with cracked shells unless those eggs are sold for further processing. Crack detection forms a significant food safety control for eggs, and as stated previously this should be undertaken with an implemented food safety program in place. There is epidemiological evidence pointing to the use of ungraded eggs and dirty, cracked/seconds eggs being sold direct off-farm leading to outbreaks of Salmonellosis. A requirement for egg farms to notify of their operation to the NSW Food Authority would ensure greater ability to trace back to the potential sources of foodborne illness. Use of unpasteurised liquid egg preparations Risk assessment work demonstrates that consumption of uncooked, or lightly cooked foods containing raw eggs represent an increased risk for foodborne illness. Use of unpasteurised liquid egg preparations, where sold, should be clearly identified as an ingredient only for foods that will receive adequate heat treatment to destroy Salmonella. Due to the potential for survival and growth of Salmonella spp. in unpasteurised egg pulps, these are unsuitable for use in processed foods unless the foods receives a sufficient heat treatment to ensure any Salmonella that may be present are inactivated.

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Food service to vulnerable populations Epidemiological data from foodborne outbreaks consistently points to the use of raw eggs in foods where it will not be well cooked, and/or the use of cracked and/or dirty eggs in catering situations. Education of food service to vulnerable populations should be undertaken on the risks of using raw eggs in foods or drinks that will not be cooked. As an alternative, these institutions should look to use pasteurised egg pulp that has been tested and certified as pathogen free.

Conclusions
The risk assessment work undertaken on eggs and egg products consistently demonstrates that Salmonella is the primary hazard of concern. This is clearly evident from the epidemiological evidence from outbreaks around Australia where eggs have been implicated as the cause. However, prevalence data indicate that the use of clean intact eggs before the resolution of YMT, and/or consumed either well cooked or used as an ingredient where the egg will be well cooked should present very little risk to the consuming public. But with the number of outbreaks attributable to eggs appearing to increase in the past few years, there continues to be issues with the management of hazards throughout the egg supply chain. This risk assessment has identified a number of areas that may, if not addressed through the implementation of appropriate control measures, potentially contribute to the contamination of eggs and egg products with Salmonella and lead to further increases in the outbreaks of foodborne illness attributable to eggs. The development of a draft egg food safety scheme aims to implement control measures across the egg supply chain to minimise further foodborne illness attributable to eggs.

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References Egg and egg products


ABS [Australian Bureau of Statistics] (1995). National Nutrition Survey: Foods Eaten, Australia, 1995. Australian Bureau of Statistics report. ABS Cat no 4804.0. Retrieved 13

January 2009, from http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CA25687100069892CA256888001C D460/$File/48040_1995.pdf ABS [Australian Bureau of Statistics] (2006). Value of Agricultural Commodities produced 2004-05. ABS Cat no 7503.0. Retrieved 13 January 2009, from

http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/758410C5AB68DCA9CA2571E6001 C8F0F/$File/75030_2004-05.pdf AECL [Australian Egg Corporation Limited] (2005a). Code of Practice for shell egg, production, grading, packing and distribution. Australian Egg Corporation Limited.

Egg Products. Australian Egg Corporation Limited.

AECL [Australian Egg Corporation Limited] (2005b). Code of Practice for the manufacture of

AFFA [Agriculture, Fisheries and Forestry Australia] (1999). Report on the National Residue Survey 1998 Results, National Office of Food Safety, Department of Agriculture, Fisheries and Forestry Australia, Canberra AFFA [Agriculture, Fisheries and Forestry Australia] (2000). Report on the Australian National Residue Survey Results 1999-2000. Agriculture, Fisheries and Forestry Australia, Canberra. AFFA [Agriculture, Fisheries and Forestry Australia] (2001). Report on the Australian National Residue Survey Results 2000-2001. Agriculture, Fisheries and Forestry Australia, Canberra. AFFA [Agriculture, Fisheries and Forestry Australia] (2002). Report on the Australian National Residue Survey Results 2001-2002. Agriculture, Fisheries and Forestry Australia, Canberra. ANZFA [Australia New Zealand Food Authority] (1999). Review of Microbiological Standards Egg and Egg Products. Australia New Zealand Food Authority, Canberra. Arzey, G. (2002). Salmonella Enteritidis in Australia Facts and fiction. Proceedings of Poultry Information Exchange (PIX) 2002 pp 165-170 BRS [Bureau of Resource Science] (1996). Report on the National Residue Survey Results 1991-92 Results. Bureau of Resource Sciences, Canberra. BRS [Bureau of Resource Science] (1998). Report on the National Residue Survey Results 1997 Results. Bureau of Resource Sciences, Canberra. Codex (2006). Code of Hygienic Practice for Eggs and Egg Products. CAC/RCP 15. Codex Alimentarius Commission. Cox, J.M., Woolcock, J.B. & Sator, A.L. (2002). The significance of Salmonella, particularly S. Infantis, to the Australian egg industry. Rural Industries Research and Development

Corporation (RIRDC) Web Publication W02/028. Retrieved 21 January 2009, from http://www.aecl.org/Images/03-b%20The%20significance%20of%20Salmonella.pdf

Daughtry, B., Sumner, J., Hooper, G., Thomas, C., Grimes, T., Horn, R., Moses, A. & Pointon, A. (2005). National food safety risk profile of eggs and egg products. A report for the Australian Egg Corporation Limited (AECL) Publication No 05/06 Project SAR-47. DAFF [Department of Agriculture, Fisheries and Forestry] (2003). National Residue Survey Annual Report 2002-2003. Australian Government Department of Agriculture, Fisheries and Forestry, Canberra. DAFF [Department of Agriculture, Fisheries and Forestry] (2005). National Residue Survey Annual Report 2004-2005. Australian Government Department of Agriculture, Fisheries and Forestry, Canberra. DAFF [Department of Agriculture, Fisheries and Forestry] (2006). National Residue Survey Annual Report 2005-2006. Australian Government Department of Agriculture, Fisheries and Forestry, Canberra.

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DAFF [Department of Agriculture, Fisheries and Forestry] (2007). National Residue Survey Annual Report 2006-2007. Australian Government Department of Agriculture, Fisheries and Forestry, Canberra. Dawson, R.C., Cox, J.M., Almond, A. & Moses, A. (2001). Food Safety Risk Management in Different Egg Production Systems. RIRDC Publication No 01/111. Lin, C.-T.J., Morales, R.A. & Ralston, K. (1997). Raw and undercooked eggs: A danger of salmonellosis. Food Review, January-April 1997, pp. 27-32. Retrieved 20 January 2009, from http://www.ers.usda.gov/publications/foodreview/jan1997/jan97d.pdf FSA [Food Science Australia] (2000). Final report scoping study on the risk of plant products. Food Science Australia prepared for SafeFood NSW. FSANZ (2006). Initial Assessment Report Proposal P301. Primary Production and Processing Standard for Eggs and Egg Products. Food Standards Australia New Zealand, Canberra. Humphrey, T.J. (1994). Contamination of egg shell and contents with Salmonella enteritidis: a review. International Journal of Food Microbiology, 21, 31-40. ICMSF [International Commission on Microbiological Specifications for Foods] (1998). Eggs and egg products in Microorganisms in Foods 6. Microbial ecology of food commodities. (p. 475-520). Blackie Academic and Professional, London. Jay, S., Davos, D., Dundas, M., Frankish, E. & Lightfoot, D. (2003). Salmonella. In Hocking, A.D. (Ed.) Foodborne Microorganisms of Public Health Significance (pp. 207-266). Australian Institute of Food Science and Technology, Waterloo. Jones, D.R., Northcutt, J.K., Musgrove, M.T., Curtis, P.A., Anderson, K.E., Fletcher, D.L. & Cox, N.A. (2003). Survey of Shell Egg Processing Plant Sanitation Programs: Effects on Egg Contact Surfaces. Journal of Food Protection, 66,1486-1489 Lake, R. Hudson, A., Cressey, P. & Gilbert, S. (2004). Risk Profile: Salmonella (non-typhoidal) in and on eggs. Institute of Environmental Science and Research Limited report prepared for the New Zealand Food Safety Authority. Retrieved 14 January 2009, from http://www.nzfsa.govt.nz/science/data-sheets/Salmonella-eggs.pdf

McCreadie, K., Rizzo, J. & Keygan, M. (2007). Survey of specialty egg products in NSW. Poster presented at Australian Institute of Food Science and Technology Convention Melbourne 2007. McKellar, R.C. (1993). Effect of preservative and growth factors on secretion of listeriolysin O by Listeria monocytogenes. Journal of Food Protection, 56, 380-384. Miles, D. and Chan, C. (unpublished). Risk Profile and Risk Management of eggs and egg products in NSW. NSW Food Authority report. NEPSS [National Enteric Pathogen Surveillance Scheme] (2003). Non-human Annual Report 2002. Microbiological Diagnostic Unit, The University of Melbourne. National Enteric Pathogen Surveillance Scheme report. Papadopoulou, C., Dimitiou, D., Levidiotou, S., Gessouli, H., Panagiou, A., Golegou, S. & Antoniades, G. (1997). Bacterial strains isolated from eggs and their resistance currently used antibiotics: is there a health hazard for consumer? Comparative Immunology, Microbiology and Infectious Diseases, 20:35-40 Sergeant, E.S.G., Grimes, T.M., Jackson, C.A.W., Baldock, F.C. & Whan, I.F. (2003). Salmonella Enteritidis surveillance and response options for the Australian egg industry. RIRDC Publication No 03/006. Thomas, C., Daughtry, B., Padula, D., Jordan, D., Arzey, G., Davey, K., Holds, G., Slade, J., & Pointon, A.. (2006). An Egg: Salmonella Quantitative Risk Assessment Model. AECL Publication

Food Microbiology, 30, 125-143.

Todd, E. (1996). Risk Assessment of use of cracked eggs in Canada. International Journal of

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van Netten, P., van de Moosdijk, A., van Hoensel, P., Mossel, D.A.A. & Perales, I. (1990). Psychrotrophic strains of Bacillus cereus producing enterotoxin. Journal of Applied Bacteriology, 69, 73-79 WHO/FAO [World Health Organization/Food and Agriculture Organization of the United Nations] (2002). Risk assessment of Salmonella in eggs and broiler chickens: Interpretive summary. Retrieved 14 January 2009, from www.who.int/foodsafety/publications/micro/salmonella/en/index/html

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Risk Assessment - Conclusion


Risk is a function of the probability of a hazard occurring, multiplied by the severity of the outcome. It is dependent on the food, the potential sources of contamination, the hazard of concern, the type of processing, eventual use of the food product, and the resulting illness. The latter can range from mild illness through to severe and life threatening illnesses. This risk assessment document provides a scientific review of the hazards and their associated risks for food businesses covered by the food safety schemes of NSW Food Regulation 2004. The document summarises the information from previous risk assessments or risk profiles and supplements it with new and updated information as available. The review has illustrated that across the food safety schemes there are many potential hazards that can impact on human heath. In general, microbiological hazards were considered the most significant, as chemical and physical hazards were rarely detected in foods, or where chemical hazards were detected, they were at levels that do not cause adverse health effects. The review notes that mitigating the risk presented by such hazards involves a multifactorial approach that often extends beyond the controls implemented by a food business operating under a food safety scheme of NSW Food Regulation 2004. The implementation of control measures along the entire food chain, from on-farm controls through to retail, is seen as being the most effective strategy for mitigating risks.

implementation of reliable, systematic and preventative procedures. Such procedures are the core elements of food safety programs, which are either introduced due to regulatory requirements or through industry sponsored Codes of Practice.

Food Regulation 2004 mitigating food safety risks requires the development and

It is concluded that for food businesses covered by the food safety schemes of NSW

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Appendix 1: Microbiological and chemical hazards of concern


This Appendix provides additional information on selected microbiological and chemical hazards, as a supplement to the information included the main part of this risk assessment. The information included in this Appendix is limited to key points that have particular relevance to the food commodities covered by the food safety schemes discussed in previous chapters. In-depth descriptions of the microbiological hazards and extensive reference lists are available in the reference documents listed at the end of this Appendix.

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Salmonella
Nature of the illness Salmonellosis is one of the most important public and animal health disease problems, causing worldwide morbidity and mortality of humans and animals. Salmonellosis is a communicable disease readily transmissible from animals to man, either directly or through contaminated products of plant or animal origin (Jay et al, 2003). Gastroenteritis is caused by the penetration and passage of Salmonella cells from the gut lumen into the epithelium of the small intestine where inflammation occurs. Acute symptoms include nausea, vomiting, abdominal cramps, diarrhoea, fever and headache. The onset time varies between 6-48 hours after consumption of contaminated food. In some cases, chronic arthritis follows 3-4 weeks after the onset of acute symptoms (FDA, 1992).

Salmonella spp. are important causes of gastrointestinal illness in humans. Salmonella Enteritidis and S. Typhimurium are the most frequently reported non-

typhoidal serotypes in many countries and outbreaks have been associated with a diverse range of food. However, a wide variety of serotypes have been associated with outbreaks involving fresh produce. Although most Salmonella infections are selflimiting, in a small proportion of cases these may lead to bacteraemia. The case fatality rate in industrialised countries is less than 1% (EU SCF, 2002).

The infective dose for causing foodborne Salmonellosis in humans was, for decades, believed to be high, that is 100,000 to one million cells. However, a number of outbreaks have now occurred where the infective dose was found to be much lower, for example <10100 cells. This is particularly the case where products containing a high fat level are involved, such as chocolate, cheese and salami (Bell & Kyriakides, 2002). Associated foods Salmonellosis has been associated with many foods including raw meats, poultry, eggs, dairy products, fish, yeast, coconut, salad dressings, cake mixes, dried gelatine, peanut butter, cocoa and chocolate (FDA, 1992). Salmonellae reside in the intestinal tract of infected animals. They are shed in the faeces and can be readily transmitted to other animals or man. Most colonised individuals become healthy excreters, resulting in contamination of the environment. Contamination is spread amongst animals during transport, holding in confined quarters and slaughter. Foods of animal origin become contaminated following faecal contamination of the environment and equipment (ICMSF, 1996). Table 48 is a recent history of common isolates of salmonellae from major animal sources. Cross-contamination is produced by contaminated raw foods during further processing and preparation. Salmonellae can also become established and multiply in the environment and equipment of a variety of food-processing facilities (ICMSF, 1996).

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Contamination of eggs, and particularly of egg contents, is believed to be a cause of the large increase in human infections with S. Enteritidis in Europe and North America since the 1980s. Contamination of intact eggs with S. Enteritidis is mainly the result of infection of the hens reproductive system. Australia has been an exception to the S. Enteritidis problem. Poultry and eggs in Australia have remained free of S. Enteritidis (Jay et al, 2003).
Table 48 Top Salmonella serovars from major sources
Source 2007 Number of isolates Serovar & incidence Human 2185 Typhimurium 34.3% Enteritidis 6.7% Bovine 313 Bovismorbificans 33.5% Typhimurium 23.6% Dublin 13.7% Porcine 118 Derby 27.1% Johannesburg 16.9% Typhimurium 10.2% Raw meats 236 London 24.4% Derby 22.9% Stanley 13.6% Ovine 131 Bovismorbificans 48.9% Typhimurium 44.3% Chicken broilers 3842 II Sofia 33.8% Typhimurium 14.8% Infantis 10.2% Chicken layers 631 Typhimurium 17.3% Virchow 13.3% Mbandaka 10.5% Eggs 102 Typhimurium 30.4% 2006 Number of isolates Serovar & incidence 1792 Typhimurium 34.3% Bovismorbificans 15.0% 280 Bovismorbificans 43.9% Typhimurium 30.4% Dublin 10.0% 226 Derby 51.3% London 11.9% Johannesburg 10.2% 98 Heidelberg 29.6% Bovismorbificans 7.1% Chester 7.1% 297 Bovismorbificans 52.2% Typhimurium 39.4% 4386 II Sofia 43.3% Typhimurium 16.2% Infantis 6.6% 791 Mbandaka 20.9% Typhimurium 15.8% Agona 10.7% 63 Anatum 36.5% 2005 Number of isolates Serovar & incidence 1713 Typhimurium 34.3% Enteritidis 8.8% 293 Bovismorbificans 48.8% Typhimurium 23.9% Dublin 10.9% 208 Infantis 34.1% Derby 23.6% Anatum 13.0% 501 Johannesburg 29.1% London 15.2% Derby 13.4% 66 Bovismorbificans 54.5% Typhimurium 31.8% 6011 II Sofia 49.8% Infantis 11.1% Typhimurium 7.8% 364 Typhimurium 13.5% Kiambu 11.8% Mbandaka 10.4% 84 Typhimurium 38.1%

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Source

2007 Number of isolates Serovar & incidence Agona 12.7% Anatum 10.8%

2006 Number of isolates Serovar & incidence Montevideo 19.0% Ohio 19.0%

2005 Number of isolates Serovar & incidence Anatum 22.6% Singapore 10.7%

adapted from Australian Salmonella Reference Centre 2007 Annual Report (Davos, 2007)

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Table 49 Characteristics of Salmonella


Minimum Temperature (C) pH aw 5.2* 3.8 0.94 Optimum 35-43 7-7.5 0.99 Maximum 46.2 9.5 >0.99

Limits for growth of Salmonellae when other conditions are near optimum * Most serotypes fail to grow at <7C Survival in food Survival in environment Survive for long periods in foods 10 week in butter, 28 days in refrigerated vegetables and very stable in chocolate Survive well on ceramic, glass and stainless steel surfaces. Survive on human skin. Can become established and multiply in a food processing environment, where they become a source of contamination A kill step, such as cooking, to assure destruction of Salmonellae in contaminated foods, especially raw meats Prevention of contamination (cross-contamination) of RTE foods Low or high temperature storage of foods to prevent growth Control of contamination in food processing areas

Controls

adapted from ICMSF (1996)

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Campylobacter
Nature of the illness

Campylobacter is now recognised as an important enteric pathogen. Surveys have shown that Campylobacter jejuni is the leading cause of bacterial diarrhoea in the USA. It causes more illness than Shigella spp. and Salmonella spp. combined (FDA, 1992). Symptoms of campylobacteriosis (also known as campylobacter enteritis or gastroenteritis) often include fever abdominal pain, nausea, headache, and muscle pain as well as diarrhoea. The illness usually occurs 2-5 days after ingestion of the contaminated food or water. Illness generally lasts 7-10 days but relapses are not uncommon, occurring in about 25% of cases (FDA, 1992).
Complications are relatively rare, but infections have been associated with reactive arthritis, haemolytic uraemic syndrome, and following septicaemia, infections of nearly any organ. Meningitis, recurrent colitis, acute cholecystitis and Guillain-Barre syndrome are very rare complications (FDA, 1992). Associated foods

Campylobacter frequently contaminates raw chicken, with surveys showing that 20-

100% of raw retail chickens are contaminated. Raw milk is also a source of infections. The bacteria are often carried by healthy cattle and by flies on farm. Nonchlorinated drinking water may also be a source of infections. staff before being transferred to RTE foods or causing self-infection.

Campylobacter from raw meat may contaminate work areas and the hands of kitchen
Raw milk was the most frequently reported vehicle in food related outbreaks of Campylobacter (Wallace, 2003; ICMSF, 1996). Those references also noted evidence that sporadic (as opposed to outbreak) illness was linked to poultry consumption. A more recent case-control study of Campylobacter infection found that consumption of chicken at restaurant was the largest attributable factor, followed by consumption of non-poultry meat at a restaurant (Friedman et al, 2004).

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Table 50 Characteristics of Campylobacter


Minimum Temperature (C) pH aw 32 4.9 >0.987 Optimum 42-43 6.5-7.5 0.997 Maximum 45 ~9

Limits for growth of Campylobacter when other conditions are near optimum The organisms are do not tolerate high levels of oxygen and grow best with 5-6% oxygen and 10% carbon dioxide Survival in food Growth usually does not occur in foods due to the minimum temperature requirement not being met. The organism is relatively fragile and is inactivated by oxygen, drying, heating, disinfectant and acid conditions. Despite declining numbers, the organism does survive in moist foods for variable lengths of time Survival on surfaces is prolonged by blood and the fluid obtained from the thawing of frozen meat A kill step, such as cooking, to assure destruction of Campylobacter in contaminated foods, especially raw meats and raw milk Prevention of contamination (cross-contamination) of RTE foods Prevention of infection of flocks has been proposed as a control measure

Survival in environment Controls

adapted from ICMSF (1996)

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Staphylococcus aureus
Nature of the illness Some strains of Staphylococcus aureus are capable of producing a highly heat stable protein toxin that causes illness in humans. Onset of symptoms of food poisoning occurs between 1 and 7 (usually 2-4) hours after the ingestion of food containing staphylococcal enterotoxins. The most common symptoms are nausea, vomiting, retching, abdominal cramps and diarrhoea. In severe cases, headache and collapse may occur. Recovery is rapid, usually within two days (ICMSF, 1996). A toxin dose of less than 1.0 microgram in contaminated food will produce symptoms of staphylococcal intoxication. This toxin level is reached when S. aureus populations exceed 100,000 per gram (FDA, 1992). Associated foods Foods that require considerable handling during preparation and that are kept at slightly elevated temperatures after preparation are frequently involved in staphylococcal food poisoning. Frequently implicated foods include meat and meat products; poultry and egg products; salads such as egg, tuna, chicken, potato and macaroni; bakery products such as cream-filled pastries, cream pies and chocolate clairs; sandwich fillings; and milk and dairy products. Staphylococci are wide-spread in the environment. Humans and animals are the primary reservoir. Staphylococci are present in the nasal passages and throats and on the hair, and skin of 50% or more of healthy individuals. Although food handlers are the main source of food contamination in food poisoning outbreaks, equipment and environmental surfaces can also be sources of contamination with S. aureus (FDA, 1992).

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Table 51 Characteristics of Staphylococcus aureus


Growth Optimum Temperature (C) pH aw 37 6-7 0.98 Growth Range 7-48 4-10 0.83->0.99 Toxin Optimum 40-45 7-8 0.98 Toxin Range 10-48 4.5-9.6 0.87->0.99

Limits for growth and toxin production for S. aureus when other conditions are near optimum and aerobic Survival in food Bacteria are easily killed by heat but are salt tolerant and resistant to drying and can survive for extended periods in food. The toxins are very resistant to heat and will survive cooking Bacteria survive well under most environmental conditions and can persist for some time in food-production areas Protect foods from contamination Avoid conditions (mainly temperatures) where S. aureus growth can occur For products such as salami and cheese that are held at temperatures where S. aureus can grow, it is very important to exercise control over the raw materials as well as the fermentation and maturation stages

Survival in environment Controls

adapted from ICMSF (1996)

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Clostridium perfringens
Nature of the illness Food poisoning caused by Clostridium perfringens continues to be an important cause of morbidity in the community. Large outbreaks are still common in Australia (Bates & Bodnaruk, 2003). Spores of the organism persist in soil, sediments, and areas subject to human or animal faecal pollution. From the natural environment it is easily spread to foods. All foods are considered potential sources of the organism, however according to Bates & Bodnaruk (2003) only about 2-5% of C. perfringens isolated from food and animals produce C. perfringens enterotoxin (CPE). The common form of perfringens food poisoning is characterised by intense abdominal cramps and diarrhoea which begins 8-22 hours after consumption of foods containing large numbers of C. perfringens. More than 108 vegetative cells are required and the strain of C. perfringens must be capable of producing the food poisoning toxin. This illness is a food infection or toxicoinfection only one episode has ever implied the possibility of intoxication (ie illness from preformed toxin). Toxin production occurs in the digestive tract and is associated with sporulation (FDA, 1992). Associated foods Diarrhoea due to C. perfringens is most commonly associated with the consumption of cooked, uncured meat products that have been cooled slowly or stored under inadequate refrigeration and then consumed without thorough reheating. C. perfringens is commonly found on all meats, but in relatively low numbers. It is largely derived from the intestines of the animal. C. perfringens produces a spore which helps it survive harsh environmental conditions. The spores of food poisoning strains are more heat resistant and can survive cooking.

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Table 52 Characteristics of Clostridium perfringens


Minimum Temperature (C) pH aw 12 5.5-5.8 0.93* Optimum 43-47 7.2 0.95-0.96 Maximum 50 8.0-9.0

Limits for growth of C. perfringens when other conditions are near optimum * Reports vary depending on the humectant Survival in food Survival in environment The bacterial spore survives well in food

C. perfringens is widely distributed in the environment where it survives well. It frequently occurs in the intestines of humans and many domestic and feral animals
Control relies almost entirely on cooking and cooling procedures. An effective control measure is to cool the product rapidly, particularly through the temperature range 55 to 15C Vegetative cells are readily killed by heat and an effective reheating process will ensure that large numbers of vegetative cells are not consumed

Controls

adapted from ICMSF (1996)

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Bacillus cereus
Nature of the illness Foodborne illnesses associated with Bacillus cereus may occur as two distinct syndromes: diarrhoeal and emetic. The diarrhoeal illness has a typical incubation period of 10-13 hours. The gastroenteritis is usually mild with abdominal cramps, profuse watery diarrhoea, rectal spasms and moderate nausea, usually without vomiting. Evidence indicates that diarrhoeal illness is caused by the consumption of moderate to high numbers of organisms and production of toxin in the gut. The emetic illness usually has an onset from 1-5 hours after consuming the implicated food. Acute nausea and vomiting are the major symptoms with diarrhoea being uncommon. The symptoms of the emetic syndrome are toxin mediated. The emetic toxin is a heat stable peptide that appears to produced when B. cereus grows on particular substrates such as those containing starch or other farinaceous materials (Jenson & Moir, 2003). Associated foods A wide variety of foods including meats, milk, vegetables and fish have been associated with the diarrhoeal type food poisoning. The vomiting type outbreaks have generally been associated with rice products, however other starchy foods such as potato, pasta and cheese products have also been implicated. Food mixtures such as sauces, puddings, soups, casseroles, pastries, and salads have frequently been incriminated in food poisoning outbreaks (FDA, 1992). Every well-documented report of B. cereus intoxication has described time/temperature abuse that allowed relatively low (innocuous) levels of B. cereus in foods to greatly increase.
Table 53 Characteristics of Bacillus cereus
Minimum Temperature (C) pH aw 4 5.0 0.93 Optimum 30-40 6.0-7.0 Maximum 55 8.8

Limits for growth of B. cereus when other conditions are near optimum Survival in food Survival in environment The bacterial spore survives well in food including cooked foods

B. cereus is widely distributed in nature. It is readily isolated from soil,

dust, cereal crops, vegetation, animal hair, fresh water and sediments. Consequently, it is not surprising to find the organism on virtually every raw agricultural commodity

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Minimum Controls

Optimum

Maximum

adapted from ICMSF (1996)

Prevention of illness requires the control of spore germination and the growth of vegetative cells in cooked RTE food. Cell multiplication during inadequate cooling of cooked cereal-based or protein-containing foods is a major concern Food to be stored should be cooled rapidly to a temperature that prevents the growth of B. cereus Food that is to be held warm should be maintained above 60C Once formed in a food the emetic toxin is heat stable and can withstand normal cooking or reheating temperatures

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Listeria monocytogenes
Nature of the illness Foodborne listeriosis presents in three ways (Sutherland et al, 2003): Infection during pregnancy acquired following the consumption of food contaminated with Listeria monocytogenes. This is a mild flu-like illness or asymptomatic in the mother but with serious implications for unborn infants including spontaneous abortion, foetal death, stillbirth and meningitis. Infection is more common in the third trimester. Infection of non-pregnant adults acquired following the consumption of contaminated food. Asymptomatic or mild illness which might progress to central nervous system infection such as meningitis. Most common in the immunocompromised or elderly. Listeria food poisoning following consumption of food with exceptionally high levels of L. monocytogenes (>107/g). Vomiting and diarrhoea, sometimes progressing to bacteraemia but usually self resolving. The onset time to serious forms of listeriosis is unknown but may range from a few days to three weeks. The onset time to gastrointestinal symptoms is unknown but is probably greater than 12 hours. When listeric meningitis occurs, the overall mortality may be as high as 70% from septicaemia 50% from perinatal/neonatal infections greater than 80%. The mother usually survives infections during pregnancy (FDA, 1992). Lake et al (2005) comments that it is becoming increasingly realised that the only completely safe dose of L. monocytogenes is zero, even in healthy people. However, the probability of invasive disease following exposure to even moderate levels of cells is very low. The probability of illness for a given dose is about 100 times higher for at risk populations (the elderly, the immunocompromised and the perinatal). The dose response model used by Lake et al (2005) for a significant L. monocytogenes dose of 106 cells generates probabilities of illness of about 10-6 for the more at risk and approaching 10-8 for the general population. When compared with probabilities of illness in generated in the FDA/USDA (2003) risk assessment on RTE foods, this appears to be a conservative. Associated foods

L. monocytogenes has been associated with such foods as raw milk, supposedly pasteurised milk, cheese (particularly soft-ripened varieties), ice-cream, raw vegetables, fermented raw-meat sausages, raw and cooked poultry, raw meats and raw and smoked fish. Its ability to grow at low temperatures permits multiplication in refrigerated foods.
The vast majority of cases are sporadic, making epidemiological links to food very difficult.

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Table 54 Characteristics of Listeria monocytogenes


Minimum Temperature (C) pH aw -0.4* 4.39 0.92 Optimum 37 7.0 Maximum 45 9.4

Limits for growth of L. monocytogenes when other conditions are near optimum * Growth can occur in a variety of foods at normally encountered refrigeration temperatures Survival in food

L. monocytogenes is quite hardy and resists the deleterious effects of freezing, drying and heat remarkably well for a bacterium that does not form spores Listeria have been isolated from a wide variety of habitats, including soil, silage, sewage, and food-processing environments. Wet surfaces in foodprocessing plants often harbour listeriae and this, combined with the ability of listeriae to grow at low temperatures, is reflected in their occurrence in refrigerators and on chilling units. Owing to the prevalence of L. monocytogenes in raw materials and its ability to multiply in the environment of many food-processing, traditional cleaning and disinfection methods, equipment design and management practices may be inadequate or even impair the control of L. monocytogenes

Survival in environment

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Controls

The prevention of human listeriosis begins at the farm and continues through processing to the selection and handling of food by the consumer. A complete diet that is free of L. monocytogenes is impossible to obtain. However, the application of farm-to-consumer controls can reduce the risk of foodborne listeriosis On farm: Silage should be rapidly acidified to pH <4.0 to prevent the development of high numbers of L. monocytogenes. This is particularly important for use on dairy farms where milk could be used for raw milk cheeses Minimise the growth of L. monocytogenes in raw materials, particularly before and during the processing of raw foods

In processing:

L. monocytogenes

Where possible use listericidal processes to assure the destruction of

Minimise the risk of recontamination of RTE foods that are further processed after receiving a listericidal treatment through environmental controls and GMP Storage at 5C or below will retard, but not prevent, multiplication in many food products Separate raw food of animal origin from RTE foods Use an effective method, at appropriate intervals, of disinfecting slicing equipment and display cases Maintain proper storage and display temperatures and monitor use by and best before dates The risk of foodborne listeriosis is much greater among persons with reduced immunity (eg pregnant women, persons with malignant disease or AIDS) and patients with certain underlying illnesses (eg heart disease, diabetes, renal disease). These groups should follow published advice on the selection and handling of foods to reduce the risk of listeriosis

Storage:

Retail:

Consumers:

adapted from ICMSF (1996)

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Vibrio parahaemolyticus
Nature of the illness Pathogenic and non-pathogenic forms of Vibrio parahaemolyticus can be isolated from marine and estuarine environments and from fish and shellfish dwelling in these environments. Gastroenteritis is the most common clinical syndrome caused by V. parahaemolyticus. The infectious dose for healthy individuals, recorded in outbreaks, is about 105 to 109 viable cells and results in an acute illness, following a short incubation period of between 4-30 hours. The major symptoms include diarrhoea which can be bloody, abdominal pain, nausea, and vomiting. Usually gastroenteric infections remain in the gut and are self limiting however, a death due to V. parahaemolyticus following the consumption of oysters was reported in NSW in 1992 (Desmarchelier, 2003). The infectious dose may be markedly lowered by the coincident consumption of antacids (FDA, 1992) Associated foods Infections with this organism have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and the warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the probability of infection. A pandemic strain of V. parahaemolyticus O3:K6 has caused epidemics in Southeast Asia and North America since 1995. In Australia, sporadic cases occasionally occur and these often have a recent history of overseas travel (Desmarchelier, 2003). Serotype O3:K6 and its serovariants are undergoing global spread (Balakrish Nair et al, 2007). The organism could arrive in Australia in ballast water, imported seafood or carried by a traveller. International evidence suggests that domestic foodborne illness could result. Other Vibrio spp. of concern include Vibrio cholera and Vibrio vulnificus. There is a risk associated with imported seafood and travellers arriving from countries where cholera is endemic.

V. vulnificus is found in Australia and there have been rare episodes of foodborne illness. The controls listed above for V. parahaemolyticus are effective against V. vulnificus. There is a strong association between V. vulnificus infection and

patients with underlying chronic conditions including liver disease, malignancy and increased serum iron levels. Avoidance of raw seafood is recommended in these cases.

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Table 55 Characteristics of Vibrio parahaemolyticus


Optimum Temperature (C) pH aw Salt (%) 37 7.8-8.6 0.981 3 Range 5-43 4.8-11 0.940-0.996 0.5-10

Survival in food

V. parahaemolyticus die when exposed to temperatures below 5-7C the


rate of mortality is highest between 0-5C. The organisms are only moderately sensitive to freezing and will persist in frozen seafoods for long periods

Survival in environment

The number of culturable V. parahaemolyticus in water is directly related to temperature and the organisms are rarely isolated when water temperatures are <15C. The apparent disappearance of vibrios in the aquatic environment when conditions are suboptimal may be explained in part by the ability of the organisms to enter a dormant or viable but non-culturable state. Associations between vibrios and higher organisms and animals play a significant environmental role for vibrios and may be protective during adverse conditions The primary control measure is to prevent multiplication of the organism after harvesting and this is most readily achieved by chilling seafoods to <5C and holding them under refrigeration. Since temperatures are maintained in the range 0-5C in fish storage and distribution systems this may considerably reduce the risk. (Note that live bivalve molluscs have differing storage requirements) Cooking to an internal temperature of >65C will effectively destroy

Controls

V. parahaemolyticus

Cross-contamination of cooked foods, such as crabs or prawns, should be avoided by strict separation of raw and cooked products and by preventing transfer via containers or shared surfaces or by employees preparing both raw and cooked products

adapted from ICMSF (1996)

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Shigella species
Nature of the illness Shigellosis is principally a disease of humans and rarely occurs in animals. Most cases of shigellosis result from the ingestion of faecally contaminated food or water. The major contribution to contamination of food is poor personal hygiene of food handlers. The illness is caused when virulent Shigella organisms attach to, and penetrate, epithelial cells of the intestinal mucosa. Some strains produce endotoxin and Shiga toxin (very much like the verotoxin of E. coli O175:H7). After invasion, they multiply intracellularly and spread to contiguous cells resulting in tissue destruction. Symptoms include abdominal pain cramps diarrhoea fever vomiting blood, pus or mucous in stools and tenesmus. The onset time is from 12 to 50 hours. Infections are associated with mucosal ulceration, rectal bleeding and drastic dehydration. The fatality rate may be as high as 10-15% with some strains. Reiters disease, reactive arthritis and haemolytic uremic syndrome are possible sequelae that have been reported following shigellosis. Associated foods A variety of foods have been associated with shigellosis. Faecally contaminated water and unsanitary handling by food handlers are the most common cause.
Table 56 Characteristics of Shigella spp.
Minimum Maximum

S. sonnei
Temperature (C) pH Salt (%) 6.1 4.9 47.1 9.34 5.18

S. flexneri
Temperature (C) pH Salt (%) Survival in food Survival in environment Controls 7.9 5.0 45.2 9.19 3.78 Shigellae survive in a wide range of foods On inanimate surfaces shigellae survive well between -20C and 37C Contamination can be prevented or minimised by using clean utensils instead of hands. Control is achieved by good personal hygiene and hand washing prior to working with food is most important Cooked foods should not be touched with the hands Persons who are ill should be excluded from areas where food is prepared

adapted from ICMSF (1996)

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Escherichia coli
Nature of the illness

Escherichia coli is a normal non-pathogenic and useful inhabitant of the bowel. There are a minority of enterovirulent strains within the species that cause illness ranging from travellers diarrhoea through to a destructive and, not uncommonly, fatal illness. Enterohaemorrhagic E. coli (EHEC) are associated with hamburger disease in the USA and the Garibaldi outbreak in Australia. EHEC produce potent toxins known as Shiga toxins which are toxic to cultured Vero cells (thus the abbreviations STEC and VTEC) and other toxic factors.
The illness caused by EHEC is called haemorrhagic colitis. It is characterised by severe cramping and diarrhoea which is initially watery but becomes grossly bloody. Occasionally vomiting occurs. Fever is usually low grade or absent. The illness is usually self limiting and lasts for an average of eight days. Some victims, particularly the very young, have developed haemolytic uremic syndrome (HUS), which is characterised by renal failure and haemolytic anaemia. From 0-15% of haemorrhagic colitis victims may develop HUS. The illness can lead to permanent loss of kidney function. In the elderly, HUS with fever and neurologic symptoms constitute thrombotic thrombocytopenic purpura. This illness can have a mortality rate in the elderly as high as 50% (FDA, 1992). Associated foods Undercooked or raw hamburger mince has been implicated in many of the documented US EHEC outbreaks. However, E. coli O157:H7 outbreaks have implicated alfalfa sprouts, unpasteurised fruit juices, dry-cured salami, lettuce, game meat and cheese curds. Raw milk was the vehicle in a school outbreak in Canada (FDA, 1992). Other EHEC strains include O111 and O26. Humans are believed to be the major, if not the only, source for most of the enterovirulent E. coli that cause human illness. Infected food handlers can contaminate food. Humans may also be carriers of EHEC strains. However, the major reservoirs of a number of important EHEC strains that infect humans are the intestinal tract of ruminants such as cattle and sheep (Desmarchelier & Fegan, 2003).

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Table 57 Characteristics of pathogenic Escherichia coli


Minimum Temperature (C) pH aw ~ 7-8 4.4 0.95 Optimum 35-40 6-7 0.995 Maximum ~ 44-46 9.0

Survival in food

Pathogenic E. coli generally survive well in refrigerated and foods and in frozen ground beef. EHEC may survive for long periods in fermented or acid foods

Survival in environment

E. coli is capable of growth in food and on inadequately cleaned surfaces associated with food processing. It can also become established in food processing plants (Desmarchelier & Fegan, 2003). Pathogenic E. coli have no unique resistance to chlorine
Protect vegetable crops from manures and untreated sewage effluent Rapidly cool carcases after slaughtering and processing Use safe food handling techniques and proper personal hygiene to avoid contamination of RTE foods Properly heat foods to kill pathogens and hold food at appropriate temperatures Do not use un-chlorinated water for cleaning food-processing equipment or food contact surfaces Avoid raw and partially cooked meats and unpasteurised milk

Controls

adapted from ICMSF (1996)

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Clostridium botulinum
Nature of the illness Foodborne botulism is a severe type of food poisoning caused by ingestion of foods containing the potent neurotoxin formed during the growth of the organism. As little as 30 ng of neurotoxin is sufficient to cause illness and even death. The toxin is heat labile and can be destroyed if heated at 80C for 10 minutes or longer. The incidence of illness is low but is of considerable concern because of its high mortality rate if not treated immediately and properly. Limiting the pathogens growth in foods is important for public health. Onset of symptoms in foodborne botulism is usually 18 to 36 hours after ingestion of food containing the toxin, although cases have varied from four hours to eight days. Early signs of intoxication consist of marked lassitude, weakness and vertigo followed by double vision and progressive difficulty in speaking and swallowing. Difficulty in breathing, weakness in other muscles, abdominal distension and constipation may also be common symptoms. Foodborne botulism is primarily associated with two physiologically and genetically distinct obligately anaerobic bacteria, proteolytic C. botulinum and non-proteolytic C. botulinum. Proteolytic C. botulinum is a mesophile, while non-proteolytic C. botulinum is a psychrotroph that grows and forms toxin at 3C. With an ability to grow at chill temperatures, non-proteolytic C. botulinum is the principal microbiological safety concern, in relation to spore-forming bacteria, in the manufacture of chilled foods (Peck et al, 2008). Associated foods Any food that is conducive to outgrowth and toxin production, that when processed allows spore survival and is not subsequently heated before consumption can be associated with botulism. Almost any type of food that is above pH 4.6 can support the growth and toxin production by C. botulinum. Botulism toxin has been isolated in a considerable variety of foods such as canned corn, peppers/capsicum, green beans, soups, beets, asparagus, mushrooms, ripe olives, spinach, tuna, chicken and chicken livers and liver pt, luncheon meats, ham, sausage, stuffed eggplant, lobster, smoked and salted fish and chopped garlicin-oil (FDA, 1992). Refrigerated processed foods of extended durability (REPFEDS) are of concern as some strains of C. botulinum grow and form toxin at refrigeration temperatures (Szabo & Gibson, 2003). Peck et al (2008) reviewed data from 1307 independent challenge tests. The results from some of those tests demonstrate that non-proteolytic C. botulinum, if present, is able to form toxin in certain foods and materials at <10C within 10 days. At 8C, 100/514 (19.5%) independent challenge tests were positive for toxin by day 10, while at 4-7C only 5/387 (1.3%) tests were positive. The products that were positive for toxin by day 10 were mainly fish and meat products. One cooked vegetable food was also positive.

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Peck et al (2008) noted that 1010 prepared chilled meals have been produced in the UK over the last two decades. In that time no reports could be identified of foodborne botulism associated with correctly stored commercial chilled food. They attribute the lack of botulism to one or more unquantified controlling factors (eg raw material quality, heats process that damage spores, high hygiene during manufacture, good chill chain) and note the need for better understanding of the controlling factors.
Table 58 Characteristics of Clostridium botulinum
Proteolytic C. botulinum Minimum Temperature (C) pH aw 10 4.6 ~ 0.94 Optimum Maximum 45-50

Non-proteolytic C. botulinum Minimum Temperature (C) pH aw 3.3 5.0 ~ 0.97 Optimum Maximum 40-45

C. botulinum produces heat resistant spores and grows in the absence of oxygen
Survival in food Survival in environment Controls Spores survive well in foods. Also survive normal cooking temperatures

C. botulinum is ubiquitous and survives well in a wide variety of environmental conditions


Retort low acid canned food correctly. Outbreaks are mostly reported with home canned products and rarely with commercial products following a formulation change Ensure all components of high acid foods and acidified foods are below pH 4.6 Include additional hurdles to Clostridial growth or limit shelf life of products on RTE chilled foods

adapted from ICMSF (1996); Szabo & Gibson (2003)

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Yersinia enterocolitica
Nature of the illness Yersiniosis is frequently characterised by such symptoms as gastroenteritis with diarrhoea and/or vomiting however, fever and abdominal pain are the hallmark symptoms. Yersinia infections mimic appendicitis and mesenteric lymphadenitis, but the bacteria may also cause infections of other sites such as wounds, joints and the urinary tract. Illness onset is usually 24-48 hours after the ingestion of food or drink. The major complication is the performance of unnecessary appendectomies, since one of the main symptoms of infections is abdominal pain in the lower right quadrant. Reactive arthritis occurs in 2-3% of cases bacteraemia and diffuse disease occur rarely (FDA, 1992). Associated foods Strains of Yersinia enterocolitica can be found in pork, beef, lamb, oysters, fish and raw milk, however not all serotypes carry the plasmid encoding the virulence factors for pathogenicity (Barton & Robins-Brown, 2003). The exact cause of food contamination is unknown. However, the prevalence of this organism in soil, water and in animals offers ample opportunities for it to enter the food supply. Pigs are believed to be the principal reservoir of bioserotypes pathogenic to humans (ICMSF, 1996).
Table 59 Characteristics of Yersinia enterocolitica
Minimum Temperature (C) pH - 1.3 4.2 Optimum 25-37 7.2 Maximum 42 Growth at 9.6 No Growth at 10 NaCl (%) Growth at 5 No Growth at 7

Survival in food

Y. enterocolitica is quite resistant to adverse storage conditions. Since it

capable of multiplying at very low temperatures, refrigerated storage may not be a reliable means of preventing foodborne illness

Survival in environment Controls

The organism survives well in water and soil. The major reservoir is the live pig Reduction in contamination of pig carcases can be achieved by changes in pig slaughtering procedures (Barton & Robins-Browne, 2003) Proper handling of raw pork when preparing food in food-service establishments and the home. Especially separating raw pork from RTE foods

adapted from ICMSF (1996)

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Enterobacter sakazakii
Enterobacter sakazakii has been associated with neonatal meningitis, necrotising
enterocolitis, bacteraemia and necrotising meningoencephalitis. Reported mortality rates are high 10-55% for necrotising enterocolitis and 40-80% for meningitis.

Invasive E. sakazakii illness is not a common occurrence in infants. Approximately 60 cases were reported between 1958 and 2008. However, there is concern that it has been underreported. Studies estimate the annual rate of invasive E. sakazakii to be 1 per 100,000 children under 12 months old and 9.4 per 100,000 in very low birth weight infants. Meningitis tends to be associated with near-term infants of normal birth weight where infection occurred soon after birth. Bacteraemia tends to be associated with pre-term infants of very low birth weight where infection occurs in the first two months of life (FSAI, 2007).

E. sakazakii has been isolated from many foods and environmental sources and can
be considered to be ubiquitous. The role of these sources in neonatal infection has not been determined. However, infection studies provide evidence of the role of powdered infant formula:

Eight cases cite infant formula as the suspected cause with the source unknown or not specified in the other 19 cases In 26 cases where feeding patterns were specified 24 were fed on powdered infant formula 15 of the formula samples yielded E. sakazakii in 13 of the cases the clinical and formula strains were indistinguishable.

E. sakazakii has been isolated from infant formula milk powder on many occasions, although contamination can be considered as low and sporadic.
A number of control measures are emerging: Tight microbiological specifications on powdered infant formula The use of recommended procedures for the preparation of formula Limitations on hang times for prepared formula The use of commercially sterilized ready-to-feed formula in some circumstances.

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Parasitic protozoa and worms


Foodborne infections due to parasites have been known since ancient times, and continue to be of great importance in many regions of the world (ICMSF, 1996). Some may be confined to tropical regions for climatic reasons. Others are world-wide in distribution, although they are more often found at a higher level of prevalence, in such areas as Third World countries, being associated with conditions of poor sanitation and hygiene. While some parasitic diseases may be a significant cause of human mortality, most cause chronic illness and are associated with unbelievably high levels of morbidity, especially in the developing countries of the world. Parasites may be involved with food in a number of ways: The may directly contaminate food or water, mainly through direct or indirect faecal contamination of the soil or via infected food handlers They may contaminate invertebrates which are eaten as food or accidently ingested on salads They may infect food animals comprising a direct part of their life cycle as an intermediate host (or as a transfer or transport host where no development occurs) and which infects the human host when the meat is eaten (Goldsmid et al, 2003). Many of the strategies used to control foodborne parasites are commonplace in Australia. General sanitation levels are high, water quality is good, community infection rates are low and meat inspection is required. Manure control and effluent reuse are possible issues.

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Viruses
Hepatitis A and viral gastroenteritis are the only viral diseases that have been regularly shown in recent years to be foodborne. Foodborne viral gastroenteritis is commonly caused by members of the small, round, structured viruses group, the best known being the Norwalk and Norwalk-like viruses. The human body is the only ultimate source of the contamination by the human enteric viruses discussed here. The viruses are shed in large quantities in the faeces of infected persons for a period varying from a few days to several weeks. Contamination of food occurs only through direct (eg food handlers) or indirect (eg environmental) faecal contamination. Two general types of food have been dominant amongst reports of viral contamination: bivalve molluscs harvested from polluted waters and foods prepared by infected food handlers and not subsequently cooked. Contamination of food by infected food handlers is attributed to poor personal hygiene. Bivalve molluscs feed by filtering large volumes of surrounding water in order to trap suspended particles. Bivalves can contain human enteric viruses and increase their concentration to a higher level than that in water. Viruses are introduced into watercourses and coastal waters by the routine discharge of treated and untreated domestic sewage and by runoff from land during rain. Bivalves are generally eaten raw or after light cooking that does not inactivate viruses. Prevention of contamination by food handlers relies on the adoption of appropriate work practices. Food handlers must not work while suffering from intestinal illness. Food handlers must practise good personal hygiene and should use food-handling techniques that prevent the contact between the hands and foods that will not receive a virucidal treatment. Control of shellfish-borne viral illness is difficult. The main measure is ensuring that shellfish growing areas are sufficiently remote from sources of pollution with human waste to be considered safe. This has reduced the incidence of shellfish-borne illness but failed to eliminate the transmission of viruses (ICMSF, 1996). Survival of noroviruses Based on infectivity in human dose response research studies norovirus is stable and resistant to heat, acid and solvents. The virus retained infectivity after incubation at 60C for 30 min. Pasteurisation is not sufficient to eliminate viruses. Resistance is reported to be greater in foods and shellfish. Steaming of oysters might not inactivate norovirus (Greening et al, 2003). Under refrigeration and freezing conditions the virus remains intact (and presumably viable) for several months, possibly years. Freezing generally does not inactivate viruses. Norovirus resists gastric acids at pH 3-4. The virus retained infectivity after exposure to pH 2.7 for 3 hours at room temperature. It is believed to be sensitive to pH >9.0 but this is unproven. Norovirus is resistant to drying. Infectious norovirus were detected on environmental surfaces, including carpets, for up to 12 days after outbreaks in institutions.

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Survival of Hepatitis A Hepatitis A is caused by a nonenveloped RNA picornavirus that infects only primates. Lack of a lipid envelope confers resistance to bile lysis. The virus is hardy, surviving on human hands and fomites and requiring temperatures higher than 85C for inactivation. Hepatitis A virus survives for extended periods in seawater, fresh water, wastewater, and soil. The virus is resistant to freezing, detergents, and acids, but it is inactivated by formalin and chlorine (Brundage & Fitzpatrick, 2006).

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Scombroid poisoning Scombroid poisoning or histamine fish poisoning is the most common form of toxicity caused by the ingestion of fish (Hahn & Capra, 2003). It is caused by the ingestion of food that contains high levels of histamine and possibly other vasoactive amines and compounds. Histamine and other amines are formed by the growth of certain bacteria and the subsequent action of their decarboxylase enzymes on histadine and other amino acids (FDA, 1992). Fishery products that have been implicated in Scombroid poisoning include tuna, mackerel and other fish with dark flesh. However, any food that contains the appropriate amino acids and is subject to certain bacterial contamination and growth may lead to scombroid poisoning. For example, Swiss cheese has been implicated with intoxication. Neither cooking, canning nor freezing reduces the toxic effect. Common sensory examination by the consumer cannot ensure the absence or presence of the toxin (FDA, 1992). Prevention of scombroid poisoning in fish can be achieved by appropriate post harvest practice. Handle fish hygienically to reduce bacterial contamination and ice fish to control decomposition.

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Ciguatera
Ciguatera poisoning is caused by the consumption of toxic fish from tropical and subtropical marine environments. Ciguatera has a circumtropical distribution, usually in close association with coral reefs. It is caused by ingestion of small quantities of a group of closely related, very powerful toxins that occur in the tissues of offending fish. The toxins are bioaccumulated by fish through dietary exposure prior to capture. Toxin and toxin precursors are produced by a dinoflagellate alga named Gamberierdiscus toxicus. Ciguatoxins enter the human food chain by grazing fish and then move through the various trophic levels. In Australia ciguatera poisoning in humans usually occurs after consumption of high level carnivorous fish such as Spanish mackerel and coral trout. After ingestion the illness often follows a reasonably predictable pattern. Initial symptoms usually occur about 6 hours after ingestion and include vomiting, diarrhoea and abdominal cramps. Neurological symptoms usually begin to appear 1218 hours after consumption of toxic fish. Symptoms can include tingling of the lips and extremities, bone pain, muscle pain, dental pain, convulsions, muscular paralysis, vertigo, severe headache, short term memory loss, temperature perceptions reversals, sweating and itching. The neurological symptoms are prominent and account for the major discomfort of most victims. In some cases symptoms are evident for months or years (Hahn & Capra, 2003).

Shellfish poisoning
Microscopic unicellular algae form an important component of the plankton diet of shellfish such as oysters, mussels and scallops. Some species of dinoflagellates and diatoms produce potent neurological toxins which can find their way though shellfish to humans. When humans eat seafood contaminated by these microalgae, they may suffer gastrointestinal and neurological illnesses. These include paralytic shellfish poisoning (PSP) which in extreme cases can lead to death through respiratory paralysis diarrhoetic shellfish poisoning (DSP) which causes severe gastrointestinal problems and may promote stomach cancers and amnesic shellfish poisoning (ASP) which can lead to permanent brain damage including short-term memory loss (FDA, 1992). Poisonous seafood neither looks or tastes different from uncontaminated seafood. Cooking and other treatments do not destroy the toxins. If precautions are not taken with shellfish harvest then public health problems can be considerable. Control measures include routine monitoring of shellfish harvest areas for levels of toxic algae and testing shellfish for toxin presence (Hallegraeff, 2003).

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Mycotoxins / Aflatoxins
Toxic fungal metabolites, mycotoxins, have been responsible for a number of major epidemics in man and animals during recent historical times. Historically, the most important epidemics have been ergotism, which have killed hundreds of thousands of people in the last millennium; alimentary toxic aleukia, which was responsible for the death of at least 100,000 Russian people between 1942 and 1948; stachybotryotoxicosis, which killed tens of thousands of horses in the USSR in the 1930s; and aflatoxicosis, which came to attention when it killed 100,00 young turkeys in the United Kingdom in 1960 and has caused death and illness in many other animals, including man (Hocking & Pitt, 2003).
Table 60 Important Aspergillus, Fusarium and Penicillium species and their mycotoxins
Toxigenic species Mycotoxins Aflatoxins B1, B2 Affected commodities Maize, peanuts, cottonseed, oilseed, tree nuts, spices Maize, peanuts, cottonseed, oilseed, tree nuts Milk Maize Nuts, barley, processed meats, and many others Maize, wheat Toxic effects Acute liver damage, carcinogenic, teratogenic, immunosuppressive Acute liver damage, carcinogenic, teratogenic, immunosuppressive Carcinogenic Carcinogenic Kidney damage, teratogenic, immunosuppressive Gastrointestinal symptoms

Aspergillus flavus

Aspergillus parasiticus

Aflatoxins B1, B2, G1, G2 Aflatoxin M1 Fumonisin B1 Ochratoxin A

Hydroxylated metabolites of aflatoxin B

Fusarium verticillioides Aspergillus ochraceus, Penicillium verrucosum Fusarium graminearum, Fusarium culmorum, Fusarium crookwellense Fusarium graminearum, Fusarium culmorum, Fusarium crookwellense Penicillium expansum

Zearalenone

Deoxynivalenol

Maize, wheat

Gastrointestinal symptoms

Patulin

Apple, pears

Kidney damage, chromosomal aberration

adapted from Hocking & Pitt (2003)

Aflatoxicosis is poisoning that results from ingestion of aflatoxins in contaminated food or feed. Aflatoxins are toxic compounds produced by certain strains of the fungi Aspergillus flavus and Aspergillus parasiticus. Under favourable conditions of temperature and humidity, these fungi grow on certain foods and feeds, resulting in the production of aflatoxins. The most pronounced contamination has been encountered in tree nuts, peanuts and other oilseeds, including corn and cottonseed. The major aflatoxins of concern are designated B1, B2, G1 and G2. Aflatoxin B1 is usually prominent and is the most toxic. Aflatoxin M is a major metabolic product of aflatoxin B1 in animals and is usually secreted in the milk and urine of dairy cattle.

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Aflatoxins produce acute necrosis, cirrhosis and carcinoma of the liver in a number of animal species. In well-developed countries contamination rarely occurs in foods at levels that cause acute aflatoxicosis in humans. Studies on human toxicity from ingestion of aflatoxins have focussed on their carcinogenic potential (FDA, 1992). While it will never be possible to eliminate mycotoxins completely from the food supply, better cropping, harvesting, storage and processing techniques can minimise the opportunities for fungi to produce toxic metabolites in food (Hocking & Pitt, 2003).

Gempylotoxin
Purgative properties are reported for fish of the marketing groups escolar (Lepidocybium flavobrunneum, Ruvettus pretiosus) and rudderfish (Centrolophus niger and Tubia species). Escolar are commonly sold in the domestic market mislabelled as 'rudderfish' or 'butterfish'. Studies have found that both escolar and rudderfish have higher oil composition than most seafood, but it is the high wax ester content in escolar oil that explains the purgative property. In humans, indigestible wax esters accumulate in the rectum causing oily diarrhoea (Yohannes et al, 2002).

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References Appendix 1
AIFST (2008). Hocking, A.D. (Ed.). Foodborne Microorganisms of Public Health Significance. Australian Institute of Food Science and Technology, Waterloo. Barton, M.D. & Robins-Brown, R.M. (2003). Yersinia enterocolitica. (pp. 577-596). Bates, J.R. & Bodnaruk, P.W. (2003). Clostridium perfringens. (pp. 479-504). Desmarchelier, P.M. (2003). Pathogenic vibrio. (pp. 333-358). Desmarchelier, P.M. & Fegan, N. (2003). Enteropathogenic Escherichia coli. (pp. 267310). Goldsmid, J.M., Speare, R. & Bettiol, S. (2003). The parasitology of foods. (pp. 703-722). Hahn, S. & Capra, M.F. (2003). Fishborne illnesses: Scombroid and ciguatera poisoning. (pp. 689-702). Hallegraeff, G.M. (2003). Algal toxins in Australian shellfish. (pp. 675-688). Hocking, A.D. & Pitt, J.I. (2003). Mycotoxigenic fungi. (pp. 641-674). Jay, S., Davos, D., Dundas, M., Frankish, E., & Lightfoot, D. (2003). Salmonella (pp. 207266). Jenson, I. & Moir, C.J. (2003). Bacillus cereus and other Bacillus species. (pp. 445478). Sutherland, P.S., Miles, D.W. & Laboyrie, D.S. (2003). Listeria monocytogenes. (pp. 381 443). Szabo, E.A. & Gibson, A.M. (2003). Clostridium botulinum. (pp. 479-504). Wallace, R.B. (2003). Campylobacter. (pp. 311-331).

Balakrish Nair, G. et al. (2007). Global Dissemination of Vibrio parahaemolyticus Serotype O3:K6 and its Serovariants. Clinical Microbiology Reviews, Jan 2007, 39-48. Retrieved 1 September 2008, from http://cmr.asm.org/cgi/content/abstract/20/1/39 Bell, C. & Kyriakides, A. (2002). Salmonella, a practical approach to the organism and its control in foods. Blackwell Science. Brundage, S. & Fitzpatrick, A. (2006). Hepatitis A. American Family Physician 73 (12) (web version). Retrieved 19 December 2008, from http://www.aafp.org/afp/AFPprinter/20060615/2162.pdf Davos, D. (2007). Australian Salmonella Reference Centre 2007 Annual Report, Institute of Medical and Veterinary Science. EC SCF [European Commission, Scientific Committee on Food] (2002). Risk profile on the microbiological contamination of fruits and vegetable eaten raw, 29 April 2002. European Commission Health & Consumer Protection Directorate-General, Scientific Committee on Food. Retrieved 8 December 2008, from http://ec.europa.eu/food/fs/sc/scf/out125_en.pdf FDA (1992). The Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins Handbook US Food and Drug Administration, Center for Food Safety and Nutrition. Originally published 1992, with periodic updates. Retrieved 25 August 2008 from http://www.cfsan.fda.gov/~mow/intro.html Friedman C. R. et al. (2004). Risk Factors for Sporadic Campylobacter Infection in the United States: A Case-Control Study in FoodNet Sites. Clinical Infectious Diseases 38(3), S285-96. Retrieved 25 August 2008, from http://origin.cdc.gov/enterics/publications/70_friedmanc.pdf FSAI [Food Safety Authority of Ireland] (2007). Guidance Note 22: Information Relevant to the Development of Guidance Material for the Safe Feeding of Reconstituted Powdered Infant Formula. Retrieved 12 September 2008, from

http://www.fsai.ie/publications/guidance_notes/gn22.pdf

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Greening, G., et al (2003) Risk Profile: Norwalk-like Virus in Mollusca (Raw). Institute of Environmental Science and research Ltd, Christchurch, NZ.

Microorganisms in Foods 5: Microbiological specifications of food pathogens. Roberts, T.A.,


Baird-Parker, A.C. & Tompkin, R.B. (Eds.). Blackie Academic & Professional. Peck, M.W., Goodburne, K.E., Betts, R.P. & Stringer, S.C. (2008). Assessment of the potential for growth and neurotoxin formation by non-proteolytic Clostridium botulinum in short shelflife commercial foods designed to be stored chilled. Trends in Food Science & Technology 19(4), 207-216. Yohannes, K. et al. (2002). An outbreak of gastrointestinal illness associated with the consumption of escolar fish. Communicable Diseases Intelligence, Volume 26(3). Retrieved 11 September 2008, from http://www6.health.gov.au/internet/main/publishing.nsf/Content/cdapubs-cdi-2002-cdi2603-htm-cdi2603l.htm

ICMSF [International Commission on Microbiological Specifications for Foods] (1996).

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Appendix 2: Australian food recalls (2004 to 2008)


Table 61 Recalls of dairy products between 2004 and 2008 Product 1. 2. 3. 4. 5. 6. 7. 8. 9. Ice-cream cake Custard Haloumi Yoghurt Custard Cream Milk, UHT, flavoured (variety) Cheese, soft Cheese, soft Reason for recall Was the recall instigated due to illness? Not reported Not reported Not reported Not reported Not reported Not reported n/a No No No No No No No No No No No No No No No No No No Distribution WA National VIC NSW National WA National National WA NSW, ACT National NSW NSW National NSW, ACT National QLD National NSW NSW VIC QLD National National NSW
pp

Year 2004 2004 2004 2004 2004 2004 2005 2005 2005 2005 2006 2006 2006 2006 2006 2007 2007 2007 2007 2007 2008 2008 2008 2008 2008

Escherichia coli
Possibility of spoilage before expiry date Coagulase positive staphylococcus

Escherichia coli
Microbial spoilage

Escherichia coli
may spoil before expiry date.

Listeria monocytogenes Escherichia coli Listeria monocytogenes Listeria monocytogenes Escherichia coli Escherichia coli Listeria monocytogenes Escherichia coli
mould mould (Salmonella)

10. Bocconcini, soft 11. Cheese, hard 12. Cream 13. Cream 14. Goats cheese 15. Milk 16. Infant formula 17. Ricotta 18. Cheese, hard + ingredients 19. Dairy dessert 20. Cheese, hard + ingredients 21. Mozzarella, shredded 22. Milk, goats, frozen unpasteurised, 23. Cheese, hard 24. Feta 25. Ice-cream +

Salmonella Listeria monocytogenes Escherichia coli Listeria monocytogenes Salmonella Zanzibar Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes

pp

National includes distribution to three or more states and territories

Food Safety Scheme Risk Assessment

Page 179 of 214

Product ingredients

Reason for recall

Was the recall instigated due to illness?

Distribution

Year

Food Safety Scheme Risk Assessment

Page 180 of 214

Table 62 Recalls of meat products between 2004 and 2008 Product Reason for recall Was the recall instigated due to illness? Not reported Not reported Not reported Not reported Not reported Not reported Not reported Not reported Distribution Year

1. 2. 3. 4. 5. 6. 7. 8.

Chicken, BBQ, shaved Ham, sliced Pork, pickled Beef, roast, sliced Ham, sliced Brawn Frankfurts Salami

Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes
Insufficient salt added during processing that may result in microbial growth

WA NSW NSW NSW NSW NSW National National

2004 2004 2004 2004 2004 2004 2004 2004

9.

Meat, roast

Listeria monocytogenes Listeria monocytogenes Escherichia coli


Some product not thoroughly cooked.

Not reported No No No No No No No Not reported No No No No

National VIC WA National QLD National VIC, NSW NSW, ACT National National NSW National NSW

2004 2005 2005 2005 2005 2005 2006 2006 2006 2006 2007 2007 2007

10. Chicken, breast, sliced 11. Pork pies 12. Devon 13. Smallgoods (variety), sliced 14. Smallgoods (variety), sliced 15. Silverside 16. Chicken, whole, smoked 17. Smallgoods 18. Lamb, sliced 19. Cacciatore 20. Chicken breast, shaved 21. Prosciutto Ham, slices & whole legs 22. Smallgoods 23. Silverside 24. Beef, cooked, sliced 25. Ham Silverside, sliced 26. Pastrami

Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Salmonella Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes

Salmonella Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes

No No No No No

National National SA, NT QLD National

2007 2007 2007 2007 2007

Food Safety Scheme Risk Assessment

Page 181 of 214

Product

Reason for recall

27. Cabanossi 28. Chicken breast, smoked 29. Ham, sliced 30. Bacon 31. Ham 32. Beef, cooked, sliced Pastrami, sliced 33. Chicken breast, sliced

Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes Listeria monocytogenes

Was the recall instigated due to illness? No No No No No No

Distribution

Year

National National National QLD National National

2008 2008 2008 2008 2008 2008

Listeria monocytogenes

No

National

2008

Food Safety Scheme Risk Assessment

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Table 63 Recalls of plant products between 2004 and 2008 Product 1. 2. Peppercorns Mushrooms, in brine Reason for recall Was the recall instigated due to illness? Not reported No Distribution National National Year 2004 2005

Salmonella
Not commercially sterile - Suspected under processing.

3. 4. 5. 6. 7.

Parsley, fresh Alfalfa Alfalfa Sprouts Orange juice

Listeria monocytogenes, Salmonella Salmonella Oranienburg Salmonella, Listeria Escherichia coli Salmonella

No No No No No

National WA VIC, TAS National NSW, VIC.

2006 2006 2006 2007 2007

Table 64 Recalls of seafood products between 2004 and 2008 Product 1. 2. 3. 4. 5. 6. 7. Prawns, cooked & peeled Mackerel, in oil Salmon, smoked, sliced Prawns, frozen, cooked & peeled Clams, frozen Tuna, steaks Tuna, canned Reason for recall Was the recall instigated due to illness? not reported not reported Not reported No No Yes No Distribution National National NSW SA, QLD National SA National Year 2004 2004 2004 2005 2005 2008 2008

Salmonella Infantis
Histamine

Listeria monocytogenes
Microbial contamination Potential Salmonella contamination Histamine Potential pathogenic contamination

Food Safety Scheme Risk Assessment

Page 183 of 214

Appendix 3: Australian foodborne illness outbreaks (1995-2008)


The tables on the following pages list foodborne illness outbreaks affecting two or more people from 1995 to 2008 and attributed to foods that are regulated by the food safety schemes contained in the Food Regulation 2004, or where those foods were included as an ingredient in the food implicated in the outbreak.
-

These tables use the epidemiological data from the following sources: Food Science Australia & Minter Ellison Consulting (2002). National Risk Validation Project. Final Report.

OzFoodNet Working Group (2002). Enhancing foodborne disease surveillance across Australia in 2001: the OzFoodNet Working Group. Communicable Diseases Intelligence, 26(3), 375-406. OzFoodNet Working Group (2003). Foodborne disease in Australia: incidence, notifications and outbreaks. Annual report of the OzFoodNet network, 2002. Communicable Diseases Intelligence, 27(2), 209-243. OzFoodNet Working Group (2004). Foodborne disease investigation across Australia: Annual report of the OzFoodNet network, 2003. Communicable Diseases Intelligence, 28(3), 359-389. OzFoodNet Working Group (2005). Reported foodborne illness and gastroenteritis in Australia: Annual report of the OzFoodNet network, 2004. Communicable Diseases Intelligence, 29(2), 164-190. OzFoodNet Working Group (2006). Burden and causes of foodborne disease in Australia: Annual report of the OzFoodNet network, 2005. Communicable Diseases Intelligence, 30(3), 278-300. OzFoodNet Working Group (2007). Monitoring the Incidence and Causes of Diseases Potentially Transmitted by Food In Australia: Annual Report of the OzFoodNet network, 2006 Communicable Diseases Intelligence, 31(4), 345-365.

Key for contributing factors (CF) T1 T2 T3 T4 T5 C1 C2 E1 E2 R1 R2 R3 P a Improper heating Improper reheat Inadequate storage Preparation far in advance Inadequate thawing Food handler contamination Cross contamination Insufficient hygiene Inadequate facilities Contaminated raw ingredient Infected animals Food from unsafe source Inadequate process Assumption made on the basis of information available eg implicated microorganism, normal mode of transmission

Temperature misuse

Inadequate handling Inadequate environment Raw material Process

Food Safety Scheme Risk Assessment

Page 184 of 214

Table 65 Foodborne illness outbreaks attributed to milk, dairy products and dairy products used as an ingredient
State SA WA SA VIC SA VIC ACT QLD VIC VIC WA NSW VIC VIC NSW QLD QLD SA VIC Year 1998 1998 1999 1999 2000 2000 2001 2001 2001 2001 2001 2002 2002 2002 2003 2003 2003 2003 2003 Food vehicle Gelato Unpasteurised milk Unpasteurised milk Continental custard cake Unpasteurised milk Unpasteurised milk Cheese sticks Unpasteurised pets milk (cow) Unpasteurised milk Unpasteurised milk (suspected) Cranachan (dessert) Cream filled cake Cream filled cakes/pastries Cheesecake (suspected) Apple strudel Cheese Trifle Unpasteurised milk Unpasteurised milk/animal contact
43

Agent

Contributing factors (CF) C2 R3 R3 T3


a

Number affected 102 9 12 54 12 25 2 8

Hospitalised (deaths)

Setting prepared Manufacturer Camp Farm Bakery Retail dairy Camp Restaurant

S. Oranienburg Campylobacter S. Typhimurium 44 S. Typhimurium 9 Campylobacter Campylobacter


unknown Cryptosporidiosis Unknown

R3 R3 T3 R3

3 0 0 1

Community Camp Camp Function Bakery Bakery Commercial caterer

12 12 50 29 10 25 67 23 31

Campylobacter
Unknown

S. Typhimurium 135 S. Typhimurium U290


Norovirus Norovirus Sorbic acid Norovirus

0 1 0 0 0

Restaurant Childcare Restaurant Camp Camp/excursion

Campylobacter Campylobacter

R3

14 13

43

Unpasteurised cows milk is not currently regulated under the dairy food safety scheme or the Food Standards Code, however FSANZ is reviewing the regulatory requirements relating to unpasteurised milk as part of Proposal P1007 - Primary Production & Processing Requirements For Raw Milk Products

Food Safety Scheme Risk Assessment

Page 185 of 214

State SA QLD SA NSW VIC SA

Year 2004 2005 2006 2007 2007 2008

Food vehicle Creamed cakes Custard filled dumplings Sweet potato and feta cheese salad Fruit, meringue and custard tart Fetta cheese (suspected) Milk (suspected)

Agent

Contributing factors (CF)

Number affected 13 2 6 9 10 5

Hospitalised (deaths) 5 0

Setting prepared Bakery Grocery store/delicatessen Restaurant Unknown Restaurant Camp

S. Typhimurium 108 S. aureus


S. Typhimurium 9 Unknown Unknown Unknown

Food Safety Scheme Risk Assessment

Page 186 of 214

Table 66 Foodborne illness outbreaks attributed to meat, meat products and meat products used as an ingredient
State ACT NSW NSW NSW NSW, ACT, QLD, VIC SA ACT QLD NSW NSW VIC NSW NSW NSW NSW NSW SA VIC VIC VIC, SA WA NSW SA Year 1995 1995 1995 1995 1995 1995 1995 1996 1996 1996 1996 1996 1997 1997 1997 1997 1997 1997 1997 1997 1997 1998 1998 Food vehicle Roast chicken Deboned roast pork Sandwiches BBQ chicken Meat or chicken Mettwurst (uncooked) Cold chicken, salad, prawns, custard Anglaise sauce Ham sandwiches (suspected) Chicken soup Beef & pork cooked on spit Chicken or thai-style beef salad Cold chicken pieces Meat loaf & gravy Turkey/pork Bread rolls with meat filling Beef/lamb curry with rice Ham & corned beef Sliced corned beef / ham Roast lamb Ham & potato bake Ham Agent Contributing factors (CF) T1a T1 C2 T3 C1 T3 C2 E1 P U R1 R3 C2
a

Number affected 3 22 17 19 157 173 14 >500 20 67 33 17 171 78 8 85 71 9 25 32 12 32 13

Hospitalised (deaths)

Setting prepared Takeaway

S. Bredeney S. Typhimurium pt 9
Suspected viral Unknown

Camp Commercial caterer Private residence

S. Bredeney E. coli O:111 S. Bredeney S. Heidelberg pt 16


Norwalk-like virus Suspected viral

23 unknown (1)

Takeaway Manufacturer Commercial caterer Commercial caterer

Commercial caterer Commercial caterer Commercial caterer

C1 T3 C1 C2 E1 T3 C2 T3 C2 E2 U T1 T3 T1a T3a C2a E2a T3


a

C. perfringens C. perfringens S. Typhimurium pt 9


Unknown

Beef, chinese cabbage & sprouts S. Typhimurium 135

5 3 2

Restaurant Commercial caterer Function Institution Institution Manufacturer Commercial caterer Manufacturer

invasive)

S. Typhimurium 135 S. Typhimurium 135 C. perfringens S. Anatum S. Muenchen C. perfringens L. monocytogenes (nonS. sonnei biotype g

C2a Pa T3 C2 T3a T1 T3 C1

unknown (2)

Manufacturer Commercial caterer Commercial caterer Commercial caterer

Food Safety Scheme Risk Assessment

Page 187 of 214

State SA SA SA TAS VIC VIC NSW NSW QLD QLD QLD QLD VIC VIC VIC VIC VIC VIC ACT ACT ACT NSW NSW NSW

Year 1998 1998 1998 1998 1998 1998 1999 1999 1999 1999 1999 1999 1999 1999 1999 1999 1999 1999 2000 2000 2000 2000 2000 2000

Food vehicle Spatchcock Chicken nuggets Steak roll Chicken Chicken meal Cooked chicken Salami (suspected) Chicken kebab Spit roast pork Roast lamb Meat pie Curried chicken Chicken vol au vents Pancake with meat filling Chicken briyani Stir-fry chicken & vegetable (or sweet and sour pork) Chicken vietnamese dish Chicken/beef satay, beef dish Chicken breast Lamb curry Venison stew Range of foods especially sliced smallgoods and antipasto Thai beef salad Beef enchiladas/nachos

Agent

Contributing factors (CF) T1 T2 T1 U C1


a

Number affected 38 18 200 15 32 46 92 4 29 74 >2 3 >34 >11 35 16 >14 32 3 14 2 35 21 3

Hospitalised (deaths)

Setting prepared Commercial caterer Private residence Takeaway Commercial caterer Restaurant Takeaway Function Takeaway Commercial caterer Commercial caterer Manufacturer Takeaway Commercial caterer Commercial caterer Private residence Private residence Restaurant

S. Typhimurium rdnc ao45 S. Typhimurium 12


Unknown Suspected viral

S. Typhimurium 64 S. Typhimurium 64
Unknown

T1 T1a T3a C2a E1 T3 T1 T3 C1 T3 T3 T3 T1 T3 C2 T3a T3 T3 T1 C2 T3 T3 T3 C1 T3 C1

S. Typhimurium C. perfringens
Viral

C. perfringens C. perfringens C. perfringens S. Hessarek S. aureus C. perfringens


Unknown

S. Virchow 34
Unknown

Wholesaler Restaurant Restaurant Restaurant Commercial caterer Restaurant Restaurant

C. perfringens
Unknown Norwalk-like virus

Salmonella spp
Unknown

Food Safety Scheme Risk Assessment

Page 188 of 214

State NSW NSW NT QLD QLD QLD QLD QLD VIC VIC VIC

Year 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000

Food vehicle Roast beef & roast pork Meat pie & gravy Chicken-a-la-king Burger (suspected) Steak salad & chip meal Chicken meal Lemon chicken Chicken Frankfurters Sucuk Chicken kebabs

Agent

Contributing factors (CF) T3 E1 U T3 U C2 T3 C2 C1a U T1 T1 R3 P T1

Number affected 5 3 56 2 5 3 2 4 5 8 3

Hospitalised (deaths)

Setting prepared Restaurant Bakery Commercial caterer

C. perfringens
Unknown

C. perfringens
Unknown Unknown

National franchised fast food Restaurant Takeaway Takeaway Takeaway Private residence Private residence Takeaway

S. aureus
Suspected viral Unknown

S. Typhimurium 9 S. Typhimurium 170 S. Virchow pt 34/campylobacter/s. Typhimurium pt64


Suspected toxin Suspected toxin Suspected toxin Suspected toxin Unknown Unknown Unknown Unknown

ACT ACT ACT ACT ACT ACT NSW NSW NSW NSW NSW NSW NSW

2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001

Spit roast meal (suspected) Spit roast meal (suspected) Spit roast meal (suspected) Spit roast meal (suspected) Spit roast Chicken burger Prawn stuffed chicken breast Honey chicken (suspected) Roast beef with gravy Chicken pizza Takeaway chicken (suspected) Chicken kebab (suspected) BBQ chicken (suspected)

22 110 68 31 U U C2 T3 9 3 9 10 27 2 2 2 3

0 0 0 0

Function Function Function Function Restaurant Takeaway Commercial caterer

0 1 0 0 0

Restaurant Restaurant Takeaway Takeaway Takeaway Takeaway

C. perfringens S. Typhimurium 126


Unknown Unknown Unknown

Food Safety Scheme Risk Assessment

Page 189 of 214

State NSW, VIC QLD QLD QLD QLD QLD QLD QLD QLD SA SA SA VIC VIC VIC VIC VIC VIC VIC WA WA NSW NSW NSW NSW

Year 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2002 2002 2002 2002

Food vehicle Chicken kebab Cajun chicken Chicken salad in pita bread Chicken Duck liver Beef curry Beef curry Chicken kebabs Chicken kebabs Chicken Chicken Homemade italian sausages Soup or roast beef (suspected) Lamb's fry Potato and bacon soup (suspected) BBQ chicken/meat Eye fillet meal Sausages (suspected) Kebabs (suspected) Chicken (suspected) Spit roast beef/and or pork Chicken casserole Chicken Beef dish (suspected)

Agent

Contributing factors (CF) T1 C2 T3a

Number affected 38 6 36 2 2 8

Hospitalised (deaths)

Setting prepared Takeaway Commercial caterer

S. Virchow pt 36 var 1 B. cereus S. Bovismorbificans 32 S. Virchow pt 8 Campylobacter C. perfringens C. perfringens C. jejuni C. jejuni S. Typhimurium 126 Salmonella spp. S. Typhimurium 135a
Suspected toxin

6 0 0 0 0 unknown 0 0 2 0 2 1 0 1 0 0

Community Function Restaurant Restaurant Restaurant Takeaway Takeaway Community Farm Private residence Function Hotel Hotel Private residence Restaurant Restaurant Takeaway Function Restaurant Commercial caterer Commercial caterer Fast food outlet Restaurant

T3 T1

15 3 3 88

R1

50 2 269 22 9 11 95 65 3 56 6 16 3 3 4

S. Typhimurium 99 C. perfringens S. Virchow 34 S. Typhimurium 99


Norwalk virus Unknown (1 positive Salmonella) Norwalk virus

Undercooked turkey (suspected) Unknown

C. perfringens
Unknown

S. Virchow
Unknown

Food Safety Scheme Risk Assessment

Page 190 of 214

State NSW NSW NSW NSW NSW NSW NSW NSW NSW QLD QLD SA SA VIC VIC VIC VIC NSW NSW NSW NSW NSW NSW NSW NSW

Year 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2003 2003 2003 2003 2003 2003 2003 2003

Food vehicle Beef curry Lamb curry Bbq chicken Pasta (suspected) Thai salad Baked beans/chilli con carne Kebabs (suspected) Pizza Pizza Chicken Pizza Potato and meat pie Sliced ham Roast chicken Home bbq chicken Pea and ham soup Steak or sauce Chicken Chicken / eggs (suspected) Soccerball ham Pork dish Chicken Pigeon meat Chicken Pigs ear salad, ducks gizzard

Agent Unknown

Contributing factors (CF)

Number affected 2 70 2 20 21 132 2 4 5 24 8 8 5 19 6 10 5 19 20 1 4 3 61 12 20

Hospitalised (deaths)

Setting prepared Restaurant Restaurant Takeaway Private residence Restaurant School Takeaway Takeaway Takeaway Community National franchised fast food Private residence Community Private residence Private residence Restaurant Restaurant

C. perfringens
Unknown Unknown

S. Typhimurium 126 S. Typhimurium 9


Unknown Unknown Unknown

C. jejuni S. aureus C. perfringens S. Typhimurium 43 S. Typhimurium 135 S. Typhimurium 135


Unknown Unknown

Campylobacter S. Typhimurium
Unknown

0 2 0 1 0 5 0 0

Camp/excursion Community Private residence Restaurant Restaurant Restaurant Takeaway Takeaway

Salmonella S. Typhimurium S. Typhimurium S. Typhimurium S. Typhimurium

Food Safety Scheme Risk Assessment

Page 191 of 214

State NT NT NT NT QLD QLD VIC VIC VIC NSW NSW NSW NSW NSW NSW NSW NSW NSW QLD QLD VIC ACT ACT NSW

Year 2003 2003 2003 2003 2003 2003 2003 2003 2003 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2005 2005 2005

Food vehicle Rice, beef and black bean sauce Quail (suspected) Pizza Roast turkey (suspected) Beef burgundy Roast pork Roast pork Roast pork Club sandwiches BBQ meat pizza (suspected) Roast pork Chicken Cold chicken sandwiches chicken (suspected) Bacon & ham (suspected) Chicken (suspected) Takeaway chicken Chicken Meat pizza Chicken kebab Chicken vol au vents Pork bruschetta & duck tart Chicken salad & chicken pasta Beef casserole

Agent

Contributing factors (CF)

Number affected 5 10 18 7 7 21 20 12 17 5 27 13 7 21 12 3 5 141 6 2 20 25 11 13

Hospitalised (deaths) 4 0 0 0 0 2 0 0 0 1 1 3 0 1 0 1 0 unknown 0 0 0 1 1 0

Setting prepared Camp/excursion Commercial caterer Private residence Takeaway Restaurant Restaurant Commercial caterer Commercial caterer Commercial caterer National franchised fast food Other Restaurant Restaurant Restaurant Restaurant Takeaway Takeaway Unknown National franchised fast food Takeaway Commercial caterer Commercial caterer Restaurant Commercial caterer

S. aureus
Unknown Unknown

S. Typhimurium
Unknown

Salmonella S. Typhimurium S. Typhimurium


Unknown Unknown

S. Typhimurium 170,
Rdnc

S. Typhimurium 170
Unknown

Campylobacter
Unknown

S. Typhimurium 170
Unknown

S. Typhimurium 12 C. perfringens Campylobacter


Suspected toxin Norovirus

Campylobacter
Unknown

Food Safety Scheme Risk Assessment

Page 192 of 214

State NSW NSW NSW NSW NSW NSW NSW QLD QLD QLD QLD SA VIC VIC VIC VIC NSW NSW NSW NSW NSW NSW NSW NT

Year 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2006 2006 2006 2006 2006 2006 2006 2006

Food vehicle Lambs liver Chicken caesar salad burger Lamb & beef Chicken Chicken Ham pizza Chicken kebabs Beef rendang Chicken and lamb guvec Chicken meat Marinated chicken roll Veal rolls & red curry Chicken vol-au-vents Gravy & pork Pork (suspected) Chicken curry Cooked chicken Pork dish or fried ice-cream (suspected) Chicken pizza Chicken schnitzel in gravy Chicken/beef burgers with eggs (suspected) Roast pork Sticky rice balls with chicken (suspected)

Agent

Contributing factors (CF)

Number affected 43 3 5 2 2 9 4 4 3 14 2 9 40 29 17 20 70 14 2 2 3 4 80 2

Hospitalised (deaths) 13 2 0 0 0 0 3 0 0 0 1 0 0 0 1 0 0 2 0 0 2 0 0

Setting prepared Private residence Restaurant Restaurant Restaurant Restaurant Restaurant Takeaway Grocery store/delicatessen Restaurant Restaurant Takeaway Restaurant Commercial caterer Commercial caterer Commercial caterer Restaurant Commercial caterer Commercial caterer Restaurant Restaurant Takeaway Takeaway Takeaway Private residence

S. Typhimurium 197
Unknown Unknown Unknown Unknown Unknown

Chicken, rice, coleslaw, potatoes S. Typhimurium 9

Campylobacter C. perfringens C. perfringens S. Typhimurium 170/108 S. Typhimurium 170/108


Unknown Unknown Unknown

S. Typhimurium 170/108 C. perfringens B. cereus S. Typhimurium 170


Unknown Unknown

S. Typhimurium 170 C. perfringens S. Oslo

Food Safety Scheme Risk Assessment

Page 193 of 214

State QLD QLD QLD QLD QLD QLD SA SA SA VIC WA NSW NSW NSW NSW NSW NSW NSW NT QLD QLD VIC

Year 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007

Food vehicle Chow mien Chicken teriyaki sushi roll Chicken and lamb guvec Chicken teriyaki sushi rolls (suspected) Lamb korma Beef/lamb kebab (suspected) Chicken dish Ravioli Silverside Salami (non commercial) Capocollo

Agent

Contributing factors (CF)

Number affected 2 2 13 6 6 4 5 23 4 5 15 9 7 5 4 5 4 2 3 7 8 5

Hospitalised (deaths) 1 0 0 1 0 0 0 7 0 0 4

Setting prepared Restaurant Restaurant Restaurant Restaurant Restaurant Takeaway Commercial caterer Other Private residence Unknown Commercial manufactured food Restaurant Restaurant Restaurant Takeaway Takeaway Takeaway Takeaway Commercial caterer Private residence Restaurant Restaurant

S. Singapore
Unknown

C. perfringens S. Typhimurium 135 C. perfringens


Unknown

Campylobacter S. Typhimurium 108 S. Typhimurium 135 S. London S. Bovismorbificans 11

Chicken stir-fry / beef massaman Unknown Marinated chicken dish, noodle dish, fried rice (suspected) Chicken schnitzel (suspected) Fried chicken (suspected) Hot dogs Beef & chicken kebabs (suspected) Meat kebab Roast pork (suspected) Wurst Duck pt Chicken massaman curry (suspected)

S. Typhimurium 12
Unknown Unknown Unknown Unknown

Campylobacter S. Oslo
Unknown

S. Typhimurium 135a S. Typhimurium 9

Food Safety Scheme Risk Assessment

Page 194 of 214

State VIC VIC NSW NSW NSW NSW QLD QLD SA VIC VIC VIC VIC

Year 2007 2007 2008 2008 2008 2008 2008 2008 2008 2008 2008 2008 2008

Food vehicle Meat curry (suspected) Roast chicken and/or stuffing Chicken curry, curry pumpkin, rice with lamb, plain rice Chicken rissoles (suspected) Chilli beef dish Stir-fry beef Chicken Chicken liver pt Chicken (suspected) Chicken & pasta salad and ham Chicken & pasta salad and ham Chicken curry Roast pork

Agent Unknown Unknown

Contributing factors (CF)

Number affected 17 20 75 5 7 2 2 4 3 18 4 21 14

Hospitalised (deaths)

Setting prepared Takeaway Commercial caterer Commercial caterer Commercial caterer Restaurant Restaurant Restaurant Restaurant Private residence Commercial caterer Commercial caterer Commercial caterer Restaurant

C. perfringens / B. cereus S. Typhimurium 135 S. Typhimurium U290


Unknown

Campylobacter Campylobacter S. Typhimurium 9 S. Typhimurium 170 Campylobacter


Unknown

S. Johannesburg

Food Safety Scheme Risk Assessment

Page 195 of 214

Table 67 Foodborne illness outbreaks attributed to plant products


State SA NSW NSW NSW, VIC, QLD, SA SA, VIC QLD ACT QLD VIC NSW VIC VIC NSW TAS WA VIC VIC WA WA NSW Year 1995 1998 1998 1998 1999 2000 2001 2001 2001 2003 2003 2004 2005 2005 2005 2006 2006 2006 2006 2007 Food vehicle Cucumber Cold salad Pasta salad or coleslaw, tossed salad Semi-dried tomatoes with garlic in oil Orange juice, unpasteurised Vegetables & dips Salad at BBQ (suspected) Lettuce Tomato and cucumber salad Salad (suspected) Cucumbers (suspected) Gourmet rolls/red onion Self serve salad bar Salad rolls/sandwiches Alfalfa sprouts Alfalfa sprouts Bean shoots (suspected) Rockmelon Paw paw Watermelon (suspected) Agent Contributing factors (CF) C2 U T3 C1 E1 E2 R1 P E1 R1 C2 C2 E1 Number affected 78 26 29 85 533 3 61 36 50 24 6 28 37 6 125 15 11 79 17 7 0 0 0 3 1 0 11 2 1 12 4 0 unknown (1) 1 Hospitalised (deaths) Commercial caterer Commercial caterer Commercial caterer Manufacturer Manufacturer Restaurant Function Takeaway Function Restaurant Community Commercial caterer Institution Bakery Contaminated primary produce Contaminated primary produce Restaurant Contaminated primary produce Contaminated primary produce Private residence Setting prepared

Campylobacter
Unknown Unknown

S. Virchow 8 S. Typhimurium 135a


Unknown Suspected viral

S. Bovismorbificans 32 Campylobacter
Unknown Salmonella

S. Typhimurium 12a
Unknown

S. Typhimurium 135 S. Oranienburg S. Oranienburg S. Saintpaul S. Saintpaul S. Litchfield


Unknown

Food Safety Scheme Risk Assessment

Page 196 of 214

State NSW NSW QLD VIC VIC NSW

Year 2007 2007 2007 2007 2007 2008

Food vehicle Mushroom & cos lettuce (suspected) Fresh fruit juice (suspected) Baby corn Passionfruit coulis (suspected) Fruit salad Fattouch salad

Agent Unknown Unknown

Contributing factors (CF)

Number affected 6 6 55 37 18 17

Hospitalised (deaths)

Setting prepared Restaurant Takeaway Contaminated primary produce Commercial caterer Commercial caterer Restaurant

S. sonnei biotype g
Unknown Norovirus Unknown

Food Safety Scheme Risk Assessment

Page 197 of 214

Table 68 Foodborne illness outbreaks attributed fish and seafood products


State NSW NSW QLD QLD WA WA NSW NSW, QLD NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW, QLD, WA NT VIC NSW NSW NSW NT Year 1995 1995 1995 1995 1995 1996 1996 1997 1997 1997 1997 1997 1997 1997 1997 1997 1997 1997 1997 1998 1998 1998 1998 Food vehicle Chargrilled tuna Coral trout Spanish mackerel steak Coral trout Pilchards Rock cod Oysters Prawns Coral trout Coral trout Pipis Marlin Coral trout Prawns Fish Pipis Oysters, raw Coral cod Maori wrasse fish Spotted cod Cod Spotted cod Barracuda Agent Scombroid poisoning Contributing factors (CF) T3 R3 R1 R1 R1 T3 R1 R3 T1 R3 R1 R1 R1 T3 R1 C1a R3 R1 R1 R3 R1 R1 R1 R1 R1 R1 1995/1996 Prawns Number affected 4 4 4 15 4 >6 2 97 23 6 10 59 2 6 17 8 56 467 20 18 12 3 10 7 3 6 64 (1) 4 17 4 3 1 Hospitalised (deaths) Restaurant Restaurant Private residence Retail Private residence Restaurant Private residence Community Restaurant Community Community Community Private residence Private residence Restaurant Retail Unknown Community Community Restaurant Private residence Private residence Private residence Private residence Setting prepared

S. Typhimurium
Ciguatoxin Ciguatoxin Ciguatoxin Scombroid poisoning Ciguatoxin Norwalk-like virus Hepatitis A Ciguatoxin Ciguatoxin Diarrhoetic shellfish toxin Scombroid poisoning Ciguatoxin Hepatitis A Ciguatoxin Diarrhoetic shellfish toxin Hepatitis A Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin

Food Safety Scheme Risk Assessment

Page 198 of 214

State SA VIC VIC VIC VIC VIC VIC NSW NSW NT QLD QLD QLD VIC VIC VIC QLD NSW QLD QLD QLD QLD QLD QLD

Year 1998 1998 1998 1998 1998 1998 1998 1999 1999 1999 1999 1999 1999 1999 1999 1999 1999 2000 2000 2000 2000 2000 2000 2000

Food vehicle Scampi Thai fish cakes Fish head soup Fish head soup Fish Seafood risotto Tuna steaks Tuna Curried prawns Grenadier fish fillets Mackerel Leatherskin/queenfish Red claw crayfish Spanish mackerel Pasta with tuna and chilli sauce Rudderfish (butterfish) Scallops or trout & ham dish, mildly cooked prawn dumplings Black trevally Coronation trout Spotted mackerel Queenfish Black kingfish Coral trout Cod

Agent Unknown Scombroid poisoning Ciguatoxin Ciguatoxin

Contributing factors (CF) T1 T5 R1 T3 R1 R1 T3


a

Number affected 38 9 3 5 9 3 6 4 39 5 2 7 10 4 unknown >14 14 unknown 9 unknown unknown unknown 4 3

Hospitalised (deaths)

Setting prepared Commercial caterer Function Private residence Private residence Restaurant Restaurant Restaurant Private residence

B. cereus
Scombroid poisoning Scombroid poisoning Scombroid poisoning

T3 T3 T3 T3 E2 T3 R1 R1 C2 R1 T3 R1 T1a C1a R1 R1 R1 R1 R1 R1 R1

C. perfringens
Scombroid poisoning Ciguatoxin Ciguatoxin

1 1

Restaurant Restaurant Private residence Private residence

V. cholerae non 01, non


139 Ciguatoxin Scombroid poisoning Wax ester (butterfish diarrhoea) Norwalk-like virus Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin

Restaurant Private residence Restaurant Restaurant Commercial caterer Private residence Private residence Private residence Private residence Private residence Private residence Restaurant

Food Safety Scheme Risk Assessment

Page 199 of 214

State QLD QLD VIC ACT NSW NSW QLD QLD QLD QLD QLD QLD QLD QLD QLD VIC VIC VIC VIC NSW NSW NSW NSW NSW NSW

Year 2000 2000 2000 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2001 2002 2002 2002 2002 2002

Food vehicle Crab cakes & sweetlip Flake Coral trout / coral cod Prawns Escolar

Agent Ciguatoxin Marine toxin Ciguatoxin Unknown Escolar wax esters

Contributing factors (CF) R1 R1 R1 U R1 T3 R1 R1 R1 R1 R1 R1 R1 R1 T3 T3 R1 R1 R1

Number affected 2 2 unknown 3 20 9 14 14 2 3 4 9 2 4 4 6 16 17 5 6 5

Hospitalised (deaths) 2

Setting prepared Restaurant Takeaway Private residence Restaurant

0 7 11 11 0 3 0 0 0 0 0 0 0

Function Takeaway Commercial caterer Private residence Private residence Private residence Private residence Private residence Private residence Restaurant Restaurant Community Private residence Private residence Restaurant Restaurant Fast food outlet Private residence Restaurant Restaurant Takeaway

Fish curry made using rudderfish Scombroid poisoning & wax ester Spanish mackerel steak Spanish mackerel Spotted mackerel Barracuda Coral trout Spanish mackerel Spotted mackerel Mahi mahi Mahi mahi Suspect oysters Coral trout Coral trout Butterfish Seafood sauce (suspected) Seafood vehicle (suspected) Spanish mackerel Seafood (suspected) Seafood (suspected) Fish Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Scombroid poisoning Scombroid poisoning

S. Mississippi
Ciguatoxin Ciguatoxin Wax ester (butterfish diarrhoea) Unknown Unknown Ciguatoxin Unknown Unknown Unknown R1

7 3 4 2

Food Safety Scheme Risk Assessment

Page 200 of 214

State NSW QLD QLD QLD VIC WA WA ACT NSW NSW NT QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD

Year 2002 2002 2002 2002 2002 2002 2002 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003

Food vehicle Yum cha Striped perch Brunter bream Spanish mackerel Suspect rudderfish Oyster shooters Seafood salad Fish Sardines Prawns Japanese IQF oysters Coral trout Mackerel steaks Coral trout Tuna patties Fish (Mooloolaba bay) Curried prawn dish Cod fish heads Giant trevally fish Barracuda Fish head soup - red emperor Fish species unknown Dolphin fish Spanish mackerel Escolar fish

Agent Hepatitis A Ciguatoxin Ciguatoxin Ciguatoxin Suspected wax ester Unknown Norovirus Unknown Scombroid poisoning Hepatitis A Norovirus Ciguatoxin Ciguatoxin Ciguatoxin Scombroid poisoning Ciguatoxin

Contributing factors (CF) R1 R1 R1 R1

Number affected 8 2 3 2 10 unknown 60 3

Hospitalised (deaths)

Setting prepared Restaurant Private residence Private residence Takeaway Restaurant Commercial caterer Restaurant

0 2 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0

Private residence Private residence Restaurant Restaurant Private residence Private residence Private residence Private residence Private residence Private residence Private residence Private residence Private residence Private residence Private residence Restaurant Restaurant Restaurant

T3 R1 R1 R1 R1 T3 R1 R1 R1 R1 R1 R1 T3 R1 R1

2 2 48 2 3 7 2 3 19 2 3 5 3 4 3 15 20

C. perfringens
Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Scombroid poisoning Ciguatoxin Wax ester (butterfish diarrhoea)

Food Safety Scheme Risk Assessment

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State VIC VIC VIC VIC ACT ACT NSW NSW NSW NSW NSW NT QLD QLD QLD QLD QLD QLD QLD QLD QLD

Year 2003 2003 2003 2003 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004

Food vehicle Japanese IQF oysters Escolar fish Japanese IQF oysters Escolar fish Calamari Seafood (suspected) Ling fish Oysters Fish cakes Chinese style minced fish balls Fried rice, pipis Crab Oysters (frozen) Oysters (frozen) Spanish mackerel/trevally Oysters (frozen) Golden spotted trevally fish Fish species unknown Trevally Grey mackerel Coral trout Grey mackerel

Agent Unknown Scombroid poisoning Norovirus Wax ester (butterfish diarrhoea) Unknown

Contributing factors (CF) T3 R1 R1

Number affected 17 22 35 3 16 12

Hospitalised (deaths) 0 0 0 0 0 2 1 0 2 6 2 0 0 unknown unknown 2 0 0 0 1 0

Setting prepared Commercial caterer Restaurant Restaurant Restaurant Restaurant Restaurant Contaminated primary produce National franchised fast food Private residence Restaurant Restaurant Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Private residence Private residence Private residence Private residence Restaurant Takeaway

S. Typhimurium 197
Norovirus R1

24 3 3 7 3 5

S. Typhimurium u290 S. Typhimurium u290


Unknown

S. Typhimurium 135
Unknown Norovirus Ciguatoxin Norovirus Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin R1 R1 R1 R1 R1 R1 R1 R1 R1

4 5 2 2 2 3 4 4 4

Food Safety Scheme Risk Assessment

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State VIC VIC NSW NT QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD TAS TAS

Year 2004 2004 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005

Food vehicle Butter fish (rudderfish) Redfin Tuna steak Vietnamese rice paper rolls Mackerel steaks Black trevally Yellowtail kingfish Spanish mackerel Black king fish Spanish mackerel Trevally Barracuda Yellowtail king fish Prawn soup Yellow fin tuna Seafood mornay & rice Seafood (suspected) Yellow fin tuna

Agent Suspected toxin Unknown Scombroid poisoning

Contributing factors (CF) R1

Number affected 9 7

Hospitalised (deaths) 0 3 0 1 0 0 0 2 0 0 0 0 0 22 0 0 0 0

Setting prepared Commercial caterer Contaminated primary produce Private residence Private residence Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Private residence Restaurant Restaurant Private residence Restaurant

T3 R1 R1 R1 R1 R1 R1 R1 R1 R1

4 4 4 2 2 17 5 2 2 10 8 23

S. Typhimurium rdnc
Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin

S. Typhimurium 44
Scombroid poisoning Unknown T3

2 18 2

Vibrio
Scombroid poisoning T3

Food Safety Scheme Risk Assessment

Page 203 of 214

State VIC VIC VIC VIC VIC NSW NSW NSW NSW NSW NSW NT QLD QLD QLD QLD QLD

Year 2005 2005 2005 2005 2005 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006

Food vehicle Fijian snapper Fish Seafood platter, baked fish, octopus Tuna Spanish mackerel seafood (suspected) Tuna and salmon sushi rolls Nile perch seafood (suspected) Oysters seafood (suspected) White bait Tuna steaks Yellowtail kingfish fillets Slate sweetlips fish Cod fish heads Blue fin tuna Trevally Spanish mackerel Spanish mackerel

Agent Ciguatoxin Scombroid poisoning Unknown Scombroid poisoning Unknown

Contributing factors (CF) R1 T3

Number affected 5 2 16

Hospitalised (deaths) 0 0 0 0 0 0 0 0 2 1 6 4 0 0 0 4 0

Setting prepared Contaminated primary produce Contaminated primary produce Restaurant Restaurant Restaurant Commercial manufactured food Private residence Private residence Private residence Restaurant Restaurant Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce

T3

2 11 6 4 6 3

S. Typhimurium 170
Unknown Unknown

V. cholerae
Scombroid poisoning Scombroid poisoning Ciguatoxin Ciguatoxin Scombroid poisoning Ciguatoxin Ciguatoxin Ciguatoxin T3 T3 R1 R1 T3 R1 R1 R1

2 6 14 2 2 2 4 2

Food Safety Scheme Risk Assessment

Page 204 of 214

State QLD VIC VIC NSW NSW NSW NSW NSW NT NT QLD QLD QLD QLD QLD QLD QLD QLD

Year 2006 2006 2006 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007

Food vehicle Black kingfish Coral perch or coral trout Kingfish Fish balls Tuna kebab steaks Seafood platter Tuna steaks Oysters Tinned tuna Reef cod Mackerel Mackerel Coral trout Mackerel Coral trout Coral trout Spanish mackerel Tuna

Agent Ciguatoxin Ciguatoxin Scombroid poisoning

Contributing factors (CF) R1 R1 T3 T3 T3 R1 T3 R1 R1 R1 R1 R1 R1 R1 R1 T3

Number affected 4 2 2 32 3 4 2 19 2 2 2 6 3 2 5 2 2 2

Hospitalised (deaths) 0 0 0

Setting prepared Contaminated primary produce Contaminated primary produce Restaurant Commercial caterer Delicatessen Restaurant Restaurant Restaurant Commercial manufactured food Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Contaminated primary produce Private residence

B. cereus
Scombroid poisoning Unknown Scombroid poisoning Norovirus Suspect scombroid poisoning Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Ciguatoxin Scombroid poisoning

Food Safety Scheme Risk Assessment

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State QLD TAS VIC VIC NSW NSW QLD QLD

Year 2007 2007 2007 2007 2008 2008 2008 2008

Food vehicle Tuna kebabs Oysters (suspected) Tuna Mahi mahi Marinated mussels (suspected) Rice or salt & pepper prawn Black kingfish Yellowtail kingsfish

Agent Scombroid poisoning Unknown Scombroid poisoning Scombroid poisoning Unknown Unknown Ciguatoxin Ciguatoxin

Contributing factors (CF) T3

Number affected 4 19

Hospitalised (deaths)

Setting prepared Private residence Contaminated primary produce Restaurant Restaurant Restaurant Restaurant Contaminated primary produce Private residence

T3 T3

2 2 7 7

R1 R1

6 2

Food Safety Scheme Risk Assessment

Page 206 of 214

Table 69 Foodborne illness outbreaks attributed to foods served to vulnerable persons


State NSW NSW NSW QLD TAS VIC NSW SA NSW NSW VIC NSW NSW VIC NSW QLD QLD VIC QLD QLD SA SA SA QLD Year 1995 1995 1996 1996 1996 1996 1996 1996 1997 1997 1998 1998 1998 1999 1999 1999 1999 2000 2000 2000 2000 2000 2001 Food vehicle Unknown Unknown Eggs flip Sandwiches Chicken with gravy Unknown Sandwiches & meat salad Chicken (cooked) Beef casserole Unknown Chicken soup Unknown Eggs Unknown Unknown Unknown Oranges Egg flip Chicken nuggets (suspected) Unknown Unknown Unknown Unknown Agent Suspect S. Infantis Unknown Contributing factors (CF) T3 C2 U R3 U T3 U U C2 C2 R1 T3 T4 E1 T3 U U T1a R1 C1a U U R3 Number affected 39 64 13 52 32 2 5 5 9 36 25 13 20 12 25 8 29 unknown 12 T1 U U U 24 4 12 13 19 0 6 unknown (1) unknown (1) unknown (6) 1 unknown (1) Hospitalised (deaths) unknown (3) Aged-care facility Aged-care facility Aged-care facility Hospital Aged-care facility Childcare Hospital Hospital Aged-care facility & hospital Aged-care facility Aged-care facility Hospital & MOW Childcare Aged-care facility Aged-care facility Childcare Childcare Childcare Aged-care facility Childcare Childcare Childcare Childcare Aged-care facility Setting prepared

1997-1999 Fruit salad

Salmonella spp. S. Typhimurium C. perfringens E. coli O157 L. monocytogenes L. monocytogenes o1 L. monocytogenes C. perfringens C. perfringens
Suspect viral Norwalk-like virus

S. Virchow PT 34
Norwalk virus Unknown

(4cx+)

Salmonella spp. S. Typhimurium 135a S. Heidelberg pt 1


Norwalk virus geno 2

Cryptosporidiosis Rotavirus Rotavirus Unknown

Food Safety Scheme Risk Assessment

Page 207 of 214

State QLD QLD QLD QLD SA SA VIC QLD QLD QLD VIC VIC VIC NSW QLD VIC NSW SA SA VIC VIC VIC VIC VIC VIC QLD

Year 2001 2001 2001 2001 2001 2001 2001 2002 2002 2002 2002 2002 2002 2003 2003 2003 2004 2004 2004 2004 2004 2004 2004 2004 2004 2005

Food vehicle Unknown Unknown Eggs (suspected) Eggs flip Raw eggs Rice pudding, potato pie Unknown Eggs white dish (suspected) Eggs sandwiches (suspected) Eggs sandwiches (suspected Rice Gravy (suspected) Gravy (suspected) Chicken schnitzel Raw eggs (suspected) Gravy (suspected) Beef curry (suspected) Unknown Unknown Unknown Unknown BBQ (suspected) Drinking water (suspected) Unknown Unknown Braised steak and gravy

Agent

Contributing factors (CF)

Number affected 3 19 12

Hospitalised (deaths) 0 6 6 3 3 1 0 0

Setting prepared Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Childcare Childcare Childcare Aged-care facility Aged-care facility

S. Muenchen Suspect B. cereus S. Heidelberg PT 1 S. Heidelberg PT 1 S. Typhimurium 135 S. Typhimurium 135 Campylobacter S. Typhimurium 102 S. Typhimurium 135a S. Typhimurium 135a S. aureus C. perfringens C. perfringens
Unknown

T3a C2a E1a E1 R3

12 17 18 49 12 12 16 7 15 23 3 47 42 5 13 2 22 9 24 7 14 21 36

3 16 DK 5 0 2 1 1 2 0 unknown unknown 0

Hospital Aged-care facility Aged-care facility Hospital Aged-care facility Hospital Aged-care facility Aged-care facility Aged-care facility Aged-care facility Hospital Hospital Aged-care facility

S. Typhimurium C. perfringens
Unknown

S. Typhimurium 126 var Listeria C. perfringens


Suspected toxin

Campylobacter Campylobacter
Suspected toxin Suspected toxin

C. perfringens

Food Safety Scheme Risk Assessment

Page 208 of 214

State SA VIC NSW NSW NSW QLD SA VIC VIC VIC VIC VIC VIC VIC SA VIC WA

Year 2005 2005 2006 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2008 2008 2008

Food vehicle Cold meats Eggs (suspected) Undercooked chicken Beef sausages (suspected) Tiramisu & cream, fruit salad, strudel & custard (suspected) Unknown Unknown Unknown Unknown Unknown Several foods were suspected Unknown Unknown Unknown Vitamised foods Unknown Unknown

Agent

Contributing factors (CF)

Number affected 3 7 3 4 6 2 6 22 17 6 30 6 3 4 38 6 42

Hospitalised (deaths) 3 2 3

Setting prepared Hospital Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Aged-care facility Hospital Aged-care facility Aged-care facility Aged-care facility

Listeria S. Enteritidis 26 var C. jejuni


Unknown Unknown

S. Kiambu Campylobacter S. Typhimurium 44


Unknown

Campylobacter C. perfringens Campylobacter S. Saintpaul S. Typhimurium 9 S. Typhimurium 135 C. perfringens


Norovirus

Food Safety Scheme Risk Assessment

Page 209 of 214

Table 70 Foodborne illness outbreaks attributed to eggs, egg products and eggs used as an ingredient
State VIC VIC VIC NSW NSW NSW QLD QLD QLD ACT NSW QLD WA NSW SA SA NSW QLD SA TAS WA SA Year 1996 1997 1997 1998 1999 1999 1999 1999 1999 2000 2000 2000 2000 2000 2001 2001 2001 2001 2001 2001 2001 2001 Food vehicle Mayonnaise Pork rolls Pork rolls Curried eggs (suspected) Fish & eggs sauce Curried eggs rolls Tiramisu Eggs-based dessert Hollandaise sauce Curried eggs or home-made mayonnaise Fried ice-cream Eggs sandwich Ice-cream dessert Mango mousse Custard tarts Custard tart with strawberries and a jelly glaze Chicken, mayonnaise Eggs Tiramisu dessert Duck eggs whites (suspected) Fried ice-cream Mango pudding Agent Contributing factors (CF) A015 R1 T1 T3 C2 T1 T3 C2 E1 R1 R1 C1 T3 R1 R1 T1
a

Number affected 36 150 808 11 16 72 51 60 17 22 41 27 53 40 9 9 17 8 11 6 36 28

Hospitalised (deaths)

Setting prepared Caf

S. Typhimurium RDNC S. Typhimurium 9 S. Typhimurium 1 S. Typhimurium 135 S. Typhimurium Streptococcus pyogenes


Group A B-haemolytic

8 79 2

Bakery Bakery Commercial caterer Commercial caterer Institution Restaurant Restaurant Restaurant Takeaway

S. Typhimurium PT 8 S. Typhimurium PT 8 S. Typhimurium 135 S. Typhimurium PT 9 S. Typhimurium PT 9 S. Mbandaka S. Typhimurium 135 S. Typhimurium PT 9 S. Typhimurium 126 S. Typhimurium 126 S. Typhimurium 126 S. Montevideo S. Typhimurium 135a S. Typhimurium 9 S. Typhimurium 64 S. Typhimurium 64 var

T3 R1 C2 E1 T3 C2 R1 C1 T3 C2 E1

Restaurant Manufacturer Unknown

1 3 11 0 4 1 4 0

Restaurant Bakery Takeaway Restaurant Hotel Private residence Private residence Restaurant Restaurant

Food Safety Scheme Risk Assessment

Page 210 of 214

State SA NSW NSW NSW NSW QLD QLD SA VIC VIC VIC VIC NSW NT QLD QLD VIC VIC NSW SA NSW NSW QLD

Year 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2003 2003 2003 2003 2003 2003 2003 2003 2004 2004 2004

Food vehicle Custard and cream cakes Deep fried ice-cream Vietnamese pork/chicken rolls Eggs based dressing Caesar salad dressing, mayonnaise Salmon/eggs/onion/rice patties

Agent

Contributing factors (CF)

Number affected 22 8 32 17 12 10 3 78 20 6 3 4 41 11 18 6 213 52 2 6 43 11 5

Hospitalised (deaths)

Setting prepared Bakery Restaurant Bakery Restaurant

S. Typhimurium 99 S. Typhimurium 9 S. Typhimurium 126 S. Potsdam S. Potsdam

Restaurant Private residence

S. Typhimurium 135a Asparagus egg surprise dish S. Hadar 22 Caesar salad S. Typhimurium 8 Vietnamese pork rolls S. Typhimurium 135 Hedgehog - possibly eggs S. Typhimurium 170 Raw egg mayonnaise (suspected) S. Hessarek Caesar salad with raw egg S. Typhimurium 135
mayonnaise (suspected) Mayonnaise

Restaurant Restaurant Bakery Private residence

1 0 0 0 3 1 22 4 1 1 17 3 5

Restaurant Restaurant Restaurant Commercial caterer Restaurant Private residence Bakery Restaurant Restaurant Community Institution Private residence Bakery

S. Typhimurium
Norovirus

Curried eggs sandwiches Sauces based on raw eggs (suspected) Mousse (suspected) Pork rolls Raw eggs dishes Caesar salad Cold set cheesecake Custard Tiramisu Custard fruit tarts

S. Typhimurium S. Typhimurium S. Typhimurium S. Typhimurium Campylobacter S. Typhimurium 4 S. Typhimurium 135 S. Typhimurium 126 S. Typhimurium 135a

Food Safety Scheme Risk Assessment

Page 211 of 214

State QLD SA SA SA VIC VIC ACT NSW NSW NSW NSW NT QLD QLD TAS TAS TAS VIC VIC VIC VIC ACT

Year 2004 2004 2004 2004 2004 2004 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2006

Food vehicle Japanese rice balls, omelette, chicken, fish Home made ice-cream Boiled eggs Potato bake, lemon meringue, chicken patty Sauce - raw eggs (suspected) Eggs (suspected) Hollandaise sauce Raw eggs dishes (suspected) Caesar salad dressing Pork rolls Tiramisu Vietnamese pork rolls Eggs based filled dumplings Eggs and bacon roll Bakery products Sauces/dressing containing raw eggs Mayonnaise & tartare sauce Pork rolls (suspected) Chocolate mousse Eggs (suspected) Hollandaise sauce Free range eggs

Agent Mixed toxins

Contributing factors (CF)

Number affected 16 4 4 8 8 11 5 16 8 21 7 5 13 3 107 11 77 6 14 5 13 4

Hospitalised (deaths) 0 0 0 0 1 5 2 2 1 0 0 7 0 6 2 2 0 5 0 5 1

Setting prepared Restaurant Private residence Private residence Private residence Caf Contaminated primary produce Restaurant Restaurant Restaurant Retail Private residence Private residence Bakery Private residence Bakery Restaurant Restaurant Bakery Commercial caterer Private residence Restaurant Contaminated primary produce

S. Typhimurium 9 S. Saintpaul S. Typhimurium 108 S. Typhimurium 9 S. Typhimurium 126 S. Hessarek S. Typhimurium 9 S. Typhimurium 44 S. Typhimurium 9 S. Typhimurium 44
Unknown

S. Typhimurium 197 S. Typhimurium 44 S. Typhimurium 135 S. Typhimurium 135 S. Typhimurium 135


Unknown

S. Typhimurium 9 S. Typhimurium 126 var 4 S. Typhimurium 9 S. Typhimurium 44

Food Safety Scheme Risk Assessment

Page 212 of 214

State ACT NSW NSW NSW NSW NSW NSW

Year 2006 2006 2006 2006 2006 2006 2006

Food vehicle Free range eggs Pikelets made from whole eggs (suspected) White chocolate mousse Plain hamburger cross contaminated with eggs Eggs (suspected) Eggs Chicken/beef hamburger cross contaminated with eggs (suspected) Eggs through a bakery Homemade ice-cream and icecream topping Beef burger with bacon & eggs Eggs (suspected)

Agent

Contributing factors (CF)

Number affected 13 4 47 3 2 4 3

Hospitalised (deaths) 0 0 32 2 1 3 1

Setting prepared Contaminated primary produce Childcare Institution Takeaway Takeaway Takeaway Camp/excursion

S. Typhimurium 170 S. Potsdam S. Typhimurium 170 S. Montevideo S. Typhimurium 135a S. Typhimurium 170 S. Typhimurium 170

SA SA SA VIC VIC VIC VIC NSW NSW NSW QLD QLD QLD QLD

2006 2006 2006 2006 2006 2006 2007 2007 2007 2007 2007 2007 2007 2007

S. Typhimurium 9 S. Typhimurium 108

15 7 5 43 4 10 16 3 12 294 21 3 12 6

1 0 0 9 4 1

Bakery Private residence Restaurant Community Private residence Private residence Restaurant Private residence Restaurant Takeaway Community Restaurant Restaurant Restaurant

S. Anatum S. Typhimurium 44 Milkshake containing raw eggs S. Typhimurium 44 Hazelnut gateau cake made with S. Typhimurium 44
raw eggs mousse filling

Chicken foccacia/raw eggs aioli Eggnog Fried ice-cream Vietnamese pork & chicken rolls Eggs (suspected) Eggs (suspected) Eggs (suspected) Eggs (suspected)

S. Typhimurium 44 S. Typhimurium 29 S. Typhimurium 9 S. Typhimurium 9 S. Typhimurium 197 S. Typhimurium 197 S. Typhimurium 197 S. Typhimurium 197

Food Safety Scheme Risk Assessment

Page 213 of 214

State QLD TAS VIC VIC VIC VIC VIC VIC VIC WA QLD NSW VIC NSW NSW NSW TAS TAS VIC VIC VIC

Year 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2008 2008 2008 2008 2008 2008 2008 2008 2008 2008

Food vehicle Eggs (suspected) Eggs (suspected) Pork rolls Milkshake includes raw eggs Trifle - includes raw eggs Tiramisu - include raw eggs Chocolate mousse Caesar salad dressing includes raw eggs

Agent

Contributing factors (CF)

Number affected 2 20 45 4 11 10 8 15 13 75 7 17 21 41 4 3 3 78 12 4 4

Hospitalised (deaths)

Setting prepared Restaurant Bakery Bakery Private residence Private residence Private residence Private residence Restaurant Restaurant Restaurant Bakery Private residence Commercial caterer Private residence Private residence Restaurant Private residence Restaurant Private residence Private residence Restaurant

S. Typhimurium 197 S. Typhimurium 135a S. Typhimurium 44 S. Typhimurium 44 S. Typhimurium 44 S. Typhimurium 44 S. Typhimurium 9 S. Typhimurium 44

Eggs used in a undercooked food S. Typhimurium 44 (risottini) Caesar salad Cheesecake Custard cake Continental custard cake Eggs Suspect eggs

S. Typhimurium U307 S. Typhimurium 135a S. Typhimurium 170


Unknown

S. Typhimurium 126/126 var 1 S. Typhimurium 135 Raw eggs dressing S. Typhimurium 126/126 var 1 Eggs (suspected) S. Typhimurium 135a Eggs (suspected) S. Typhimurium 135a Lemon dessert S. Typhimurium 44 Eggs (suspected)/custard dessert S. Typhimurium 135a Suspect dessert S. Typhimurium 44

Food Safety Scheme Risk Assessment

Page 214 of 214

NSW Food Authority


6 Avenue of the Americas Newington NSW 2127 PO Box 6682 Silverwater NSW 1811 Phone 1300 552 406 Fax 02 9647 0026 www.foodauthority.nsw.gov.au

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