SPECIAL OFFER: - Limited Time Only!
(The ad below will not display on your printed page)
John Spratt's illness was as sudden as it was intense. One day in mid-October 2003, the 46-year-old senior financial service associate for a large payroll company in the Pittsburgh area found himself doubled over in pain from stomach cramps, nausea, chills, and a raging fever. "He looked miserable, but we figured he was just battling the flu," says his wife, Robin, 49. The normally buoyant and hearty Spratt was in bed for more than a week. He seemed to recover, however, and on Saturday, October 25, he felt well enough to drive about 25 miles with his brother, Joseph, to watch his beloved University of Pittsburgh Panthers football team play their arch rivals, the Syracuse University Orangemen.
That evening, however, his symptoms returned with a vengeance. On Tuesday he went to the doctor, who thought it might be the flu and prescribed antibiotics because of his fever. But over the next few days Spratt only felt worse. The following Monday, November 3, after having the dry heaves almost nonstop for days and with a fever of 102, he checked himself into the local hospital and was found to be suffering from severe dehydration.
A blood test revealed that Spratt was infected with the hepatitis A virus, which had attacked and damaged his liver. Doctors told Robin her husband might need a liver transplant. "I was absolutely floored," she recalls. That same day, Pennsylvania public-health officials issued a hepatitis A advisory in the Beaver Valley area, near where the Spratts live. In the following weeks, emergency rooms were flooded with people complaining of flu-like symptoms, and at least 100 were hospitalized. Most tested positive for the hepatitis A virus, which can incubate in the body for two to six weeks before symptoms, which can wax and wane, become evident. After epidemiologists interviewed victims, it became clear that almost all of them had something in common: They had eaten the salsa at a Chi-Chi's restaurant in the Beaver Valley Mall in the past few weeks. Sure enough, Spratt had eaten at Chi-Chi's with his 17-year-old daughter, Jacki, three weeks earlier.
Health experts traced the source of infection to the raw scallions in the salsa. Chi-Chi's parent company moved swiftly to shut down the Beaver Valley Mall outlet and pulled scallions from the menu of the other 100 restaurants in the Chi-Chi's chain. It was ruled out that food handlers had been the source of the infection: If they had been, they would have gotten sick long before the customers, not at the same time. So although the restaurant chain unwittingly spread the virus in its salsa, the contamination actually began much earlier, in the country in which the green onions were grown.
Hepatitis A is spread by contact with fecal matter (not by kissing or sneezing, for instance), which can happen when someone carrying the virus, such as a farm worker or food service employee, does not wash his hands well after going to the bathroom and then touches things that other people touch. It is a hardy virus that can remain infectious outside the body for four weeks or even longer. It can also infect produce when the fruits and vegetables are irrigated with, washed in, or packaged in ice made from water that has come in contact with infected fecal matter. The scallions used to make the large batches of salsa that infected Spratt were imported from Mexico, and experts suspect the virus became embedded in the tight layers of the onions, which means that even washing them with clean water wouldn't have been enough to remove the virus. (Only cooking the scallions would have killed the germs.) In fact, the Beaver Valley Chi-Chi's had consistently gotten top marks for its food-safety standards from the local health department.
But this discovery didn't help John Spratt, who was sinking fast. (Jacki, Spratt's daughter, tested positive for hepatitis A, too, but she may have ingested less of the salsa and had only mild symptoms. She recovered within a day or two.) By Wednesday evening, Spratt was having trouble breathing, and his blood pressure dropped so low his doctor could barely detect a pulse. He was put on a ventilator and airlifted before dawn to the University of Pittsburgh Medical Center, where he was evaluated for a possible liver transplant. "We were in shock," says Robin, who describes the next week as a nightmarish roller-coaster ride.
Spratt was heavily sedated to keep him comfortable and conserve his energy while doctors fought to save his life. Robin, Jacki, the couple's 13-year-old daughter Kristen, and friends stayed at the hospital day and night. But Spratt never regained consciousness, and his liver, kidneys, pancreas, and lungs began to shut down, making him too sick for a transplant. On Friday, November 14, a week and a half after he had first been admitted to the hospital, John Spratt died.
The family was devastated by his unexpected death from a virus the doctors said was usually fairly benign. "It was an extremely painful time, but it was also a blessed one," says Robin, crediting their faith as born-again Christians, "because we were able to share our love for him in those last days."
Spratt was the third of three fatalities in the largest-known hepatitis A outbreak from a single source in U.S. history. More than 650 people got sick; a 38-year-old father of two and a 51-year-old woman who celebrated her 32nd wedding anniversary at Chi-Chi's also died. According to experts, this tragedy highlights a worrisome trend that threatens the health of millions of Americans.
Approximately 25 to 35 percent of the fruits and vegetables we consume are grown in and imported from other nations, up from 20 percent in 1997. That figure can climb as high as 70 percent during winter months, when some domestically grown fruits and vegetables are out of season. Imported produce, from such countries as Mexico, Guatemala, and the Philippines, is more than three times as likely as U.S.-grown produce to contain harmful pathogens such as salmonella, shigella, and E. coli, according to a recent FDA study. "The reality is that we're more vulnerable to deadly food-borne germs crossing the border hidden inside produce than we are to a terrorist attack directed at our food supply," says Carol Tucker Foreman, head of the Food Policy Institute for the Consumer Federation of America (CFA), in Washington, D.C., and a former USDA official.
Because symptoms of food-borne illness are usually mild, the vast majority of cases go unreported. If you look at the statistics involving those that are recorded, though, you'll see a big jump. From 1997 to 2001, the annual number of reported food-borne outbreaks caused by tainted produce increased from 29 to 79, infecting more than 16,000 people, according to the Center for Science in the Public Interest, a consumer watchdog group in Washington, D.C. Although no one can confirm the total number of illnesses from tainted produce each year, expert estimates range from 4.5 million to as high as 38 million, or about half of all food-borne illnesses. One of the reasons fruits and vegetables are one of the top sources of food-related epidemics is because they are often eaten raw. While any food can harbor dangerous viruses or bacteria, cooking usually kills them. "Meat is safer than produce," says Michael P. Doyle, PhD, a microbiologist and director of the Center for Food Safety at the University of Georgia, in Griffin. "Based on conversations I've had with other experts, produce is responsible for more cases than any other food right now."
In otherwise healthy people, illness from tainted produce may cause a mild case of diarrhea or nausea that makes them feel miserable for a few days to a week. But for pregnant women, the frail elderly, young children, and people with chronic ailments such as diabetes, food-borne illnesses can be catastrophic and cause miscarriages, kidney failure, paralysis, and even death. And as with John Spratt, sometimes the disease is inexplicably fatal to those who have none of the usual risk factors.
"Virtually all of these illnesses and loss of life could be prevented if the right measures were taken at each step from the farm to the table," says Michael R. Taylor, former head of the USDA's Food Safety and Inspection Service and a one-time deputy commissioner at the FDA. All farms, whether foreign or domestic, are encouraged to follow good agricultural practices. But here in the U.S., we have a strong sanitation infrastructure. Growers in other nations don't always operate under the same safe circumstances.
The reason meat has a better safety record than produce is not just because meat is usually cooked, thus killing pathogens. The USDA, which is responsible for meat, poultry, and egg safety, has about 7,600 inspectors covering 6,500 processing plants. By congressional mandate dating back nearly a century (for beef), the USDA is empowered to inspect every slaughtered animal and all meat as it goes through processing. And if foreign meat and poultry companies want to do business in the U.S., they must pass inspection to show that they meet the same stringent food-safety standards. The USDA can dispatch inspectors to foreign countries to ensure the rules are being followed, and it can inspect the meat again when it enters the U.S.
The FDA is charged with overseeing the safety of fresh produce. And yet it is not armed with a congressional mandate to police the imported food supply adequately. Additionally, many consumer advocates insist the agency is woefully low on resources. The FDA doesn't get as much federal money for food safety as the USDA does, says Taylor, who is currently director of the Risk, Resource, and Environmental Management Division of Resources for the Future, a Washington, D.C.-based think tank. And as the amount of fruits and vegetables the U.S. imports has increased, the percentage of foreign produce inspected at the border by the FDA has actually dropped from 8 percent in 1992 to less than 2 percent now. Just 900 inspectors must cover 420,000 places where food is held, processed, or transported in the U.S. Worse, the FDA is allowed to stop shipments only at the border, which does nothing to fix the source of contamination.
When contamination is spotted, the government moves as quickly as possible to contain the problem by tracking the source of infection and seizing the food. In the Chi-Chi's case, although the scallions were obviously not stopped on their way into this country, FDA investigators were able, after the outbreak, to trace the scallions to four food growers in northern Mexico. Inspections of their fields later identified many potential contamination sources, including inadequate hand-washing facilities, lack of sanitizing systems to remove harmful germs from produce, inadequate water purification systems, and antiquated pipe systems that might have allowed seepage from sewage lines to water lines.
To stem further infections, the FDA halted shipments from these growers at the border, according to David Acheson, MD, chief medical officer for the FDA's Center for Food Safety and Applied Nutrition in College Park, Maryland. But by then, of course, scores of people were ill. (There is a continuing import alert on scallions from these growers, which means they can be withheld from coming into the U.S. until they meet FDA standards.)
Today, FDA practices have come under the congressional spotlight, but ironically, it was a non-food-related event that put them there: the September 11th attacks and the subsequent establishment of the Department of Homeland Security. In December 2003, under the Homeland Security Act, the FDA was given more power and resources to inspect shipments at the border in order to thwart possible bioterrorist attacks. But critics say ramping up inspections at the border is too little, too late: The agency still has little sway with foreign growers and can inspect their fields only with local authorities' permission. The FDA needs to be able to go to Mexico, Guatemala, and the dozens of other countries that export produce and certify that the farms have clean water and sanitary conditions. We do it for meat and poultry, experts say, so we ought to be doing it for fruits and vegetables, too.
"By the time produce reaches the border, it's already too late," says Dr. Doyle. Although inspectors are empowered to collect samples of produce and ship them to nearby laboratories for evaluation, "The reality is that inspection isn't going to solve the food-safety problem," he says. "We need a greater presence for the FDA in the fields, and in the handling and processing areas in other countries." Only strict enforcement of more sanitary conditions on the farms can prevent these contaminations.
Public health officials have long known about the systemic weaknesses that allow food-borne pathogens to slip into this country. Yet precious little legal action has been taken to remedy the situation. In the late 1990s, two high-profile outbreaks were caused by foreign produce: Mexican strawberries tainted with hepatitis A sickened 250 teachers and schoolchildren in Michigan, and raspberries grown in Guatemala infected with Cyclospora bacteria made more than 2,000 people ill in the U.S. and Canada. These outbreaks prompted a probe by the General Accounting Office (GAO), the investigative arm of Congress. The GAO's 1998 report concluded that the FDA's monitoring system was woefully inadequate. The biggest barrier to ensuring the safety of imported food, it said, was that the agency doesn't have the power to insist that food-exporting countries have the same food-safety system that the U.S. does. At the time, a deputy FDA commissioner hailed the findings as "a wake-up call to Congress," and appealed to lawmakers for more resources to implement reforms.
In 1999, several bills were introduced in Congress that would provide more resources and combine all food-safety functions into one superagency. They proposed replacing the current patchwork quilt of overlapping bureaucracies, including the USDA, FDA, the National Marine Fisheries Service (which inspects fish), and nine other regulatory agencies that are chronically understaffed and underfunded. A 1999 GAO report highlighted the absurdity of having one agency, the USDA, inspecting frozen meat pizza while another, the FDA, regulated frozen cheese pizza. But the proposed laws were never enacted because, says the CFA's Foreman, "the food industry lobbied against them, not wanting to implement the changes the inspectors might mandate."
Richard Durbin (D-Illinois) plans to introduce a retooled Safe Food Act, and an identical bill will be introduced in the House by Rep. Rosa DeLauro (D-Connecticut). Both bills would consolidate all food safety, inspection, and labeling functions into one superagency funded by the combined budgets of the current programs in 12 different agencies, presumably decreasing waste and improving efficiency while reallocating resources. This would raise the level of standards across the board so that produce, whether imported or domestic, would be monitored using stringent standards similar to what the USDA currently has in place for meat. "Our current food-safety system is a food fight among federal agencies playing by 12 rule books," says Durbin, who serves on the Senate Appropriations Subcommittee on Agriculture. "We have politics at their worst in an area where American families rightfully demand our best."
Sadly, these efforts are too late for people like John Spratt, who might be alive today if such protections had already been in place. "He had such a warm, funny personality that everyone was taken with him," says Robin, his wife of 19 years, "and he was very involved in our daughters' lives. It still hasn't really sunk in that he's gone. But because of our faith, we are comforted to know we will meet again in heaven."
1. Don't buy produce that's badly bruised or cut. Bacteria or viruses can infect the produce more quickly through openings. If you buy fruits and vegetables that have been cut up in the supermarket, buy only produce that is refrigerated or surrounded by ice.
2. Wash fresh fruits and vegetables under rushing water, because the pressure of the water can remove dirt and other unwelcome intruders. Be especially thorough with foods you eat raw. Seriously consider not eating scallions raw as it's nearly impossible to clean their tight layers with water.
3. Wash the rind or skin of produce with water and a vegetable brush, even if you're going to peel it. If you don't wash the outside and you cut into the produce, microbes on the surface may be pushed into the inner flesh.
4. Don't assume you don't have to wash organic produce. It's often cultivated in manure, which may expose it to more microbes than other produce.
5. Dry fruits and vegetables with disposable paper towels rather than a dish towel to avoid cross contamination.
6. Wash your hands frequently in hot, soapy water for at least 20 seconds to rinse off surface bacteria before and after handling raw meat and fresh produce to avoid cross contamination.
7. Sanitize cutting boards after meal preparation. Plastic cutting boards can be washed in the dishwasher, though water temperatures have to be hotter than 140 degrees to kill bacteria. If your wooden cutting board fits in the microwave, you can nuke it for about five minutes on high to sanitize it, as long as it has no metal pieces.
8. Microwave moist dish towels and sponges for about one minute or until steamy to eradicate harmful microbes. Launder kitchen towels regularly, too, using bleach in the wash cycle.
9. Use a different cutting board and knife for meats than for fresh produce.
Hepatitis is a virus that attacks the liver, causing inflammation that impairs its role in fighting infections, stopping bleeding, and removing drugs, impurities and other poisons from the blood. In the U.S., the most common types are A, B and C; a simple blood test can detect each virus. All have similar symptoms initially, including fatigue, dark urine, stomach cramps, loss of appetite, fever, joint pain, nausea and jaundice (the eyes and skin develop a yellowish glow), although some people may have no symptoms. Here are key facts about each of these infections.Hepatitis A
How it's transmitted: The virus is spread through fecal matter that is then ingested orally, whether through close personal contact with someone who is infected or by drinking contaminated water or eating tainted food.
Long-term effects: Once people have been infected and recover, they are immune to the disease. While in most cases the infection is relatively mild, more than 100 Americans die every year from consequences of the disease.
Treatment: None, though victims may be hospitalized to treat dehydration.
Incidence: About 10,600 cases are reported each year; many thousands more may go unreported and undetected.
Vaccine: Routine immunization for those over age 2 is currently recommended only in 11 states where incidence is twice the national average. In an additional six states, vaccinations may also be advisable. Also recommended for tourists to regions with high rates of the virus, such as Latin America, Africa, Eastern Europe, and Asia.Hepatitis B
How it's transmitted: The blood-borne virus is spread through exposure to blood or bodily fluids from an infected person, including having unprotected sex, sharing needles, getting needle sticks on the job (healthcare workers), or from an infected mother to her baby during birth.
Long-term effects: Can cause cirrhosis and liver cancer; anywhere from 15 to 25 percent of chronically infected people die.
Treatment: Interferon, which is given by injection, and two oral medications, Lamivudine and Adefovir dipivoxil, can reduce levels of the virus.
Incidence: About 1.25 million Americans have chronic infections. About 5,000 die each year.
Vaccine: All children in the U.S. and adults at higher risk of contracting the virus should be inoculated.Hepatitis C
How it's transmitted: The blood-borne virus is spread mainly from sharing needles and accidental needle sticks on the job; it is rarely sexually transmitted.
Long-term effects: About 75 to 85 percent of infected people have a long-term chronic infection, and a few eventually require a liver transplant. About 8,000 to 10,000 die each year.
Treatment: Two anti-viral drugs, Interferon and Ribavirin, can, in combination, eradicate the virus in some people.
Incidence: An estimated 3.9 million Americans are infected with the virus.
Originally published in Ladies' Home Journal magazine, May 2004.