By Lt. Cmdr. Rajal Mody, MD, MPH, U.S. Public Health Service
Outbreaks caused by eating contaminated sprouts--“sproutbreaks”--have occurred every year in the United States since at least 1995. These episodes have taught us that sprouts are a risky food to eat.
Sprouts were found to be the cause of a devastating outbreak of Shiga toxin-producing E coli infections in Europe this summer. Ultimately, this outbreak caused more than 4,000 illnesses, more than 900 cases of hemolytic uremic syndrome, and 50 deaths.
Why are sprouts a risky food, you might ask? Some people think of them as the ultimate healthy food -- fresh and natural. In fact, raw sprouts can be anything but safe. Lessons from outbreaks have taught us that it is a good idea for people who want to lower their risk for food poisoning to cook raw sprouts or avoid eating them raw.
Here is what we have learned:
Lesson 1: A sprouted seed is a perfect vehicle for pathogens.
A sprouting seed offers as inviting and nourishing an environment as bacteria like Salmonella or E coli could want--and the warm, moist conditions in which sprouts are produced only make matters worse. A single Salmonella organism on the outside of a seed can easily grow to an infectious dose after it has sprouted. The bacteria in or on growing sprouts cannot be washed off. Because even a low dose of Shiga toxin-producing E coli can make you sick, sprouts are a powerful vehicle for transmitting illness. Sprouts have also been the vehicle for Listeria, which causes a very dangerous infection for pregnant women and the elderly.
Lesson 2: Sprouts have caused many outbreaks of illness.
Since sprouts were first recognized as a source of food poisoning in the mid-1990s, they have become one of the "usual suspects" that foodborne disease epidemiologists look for when investigating an E coli or Salmonella outbreak. Since 1998, more than 30 outbreaks have been reported to the Centers for Disease Control and Prevention (CDC), due to many different kinds of sprouts -- alfalfa, bean, clover, and others. In fact, CDC's foodborne disease surveillance systems have identified three sprouts-associated outbreaks since June of 2010 that spread across multiple states.
Lesson 3: It is difficult to grow "safe" sprouts.
Once the potential dangers of sprouts became known, the U.S. Food and Drug Administration (FDA) developed guidance to help sprout growers reduce the risk of germs contaminating sprouts they produce and sell. Many sprouts growers now use practices to decontaminate seeds before sprouting, but no available method has proved completely effective. People who eat raw sprouts, including those who grow their own sprouts, ought to know that they are taking a risk, because contamination typically starts with the seed.
Lesson 4: Sprouts can make even young and healthy people ill.
This is one of the biggest lessons learned from the outbreak in Europe in 2011 and from our experience with outbreaks in this country. Sproutbreaks in the United States mainly affect healthy people aged 20-49 years. A typical victim may be an especially health conscious person in the prime of life. But illnesses from sprouts can be particularly severe in vulnerable populations, such as young children, older adults, pregnant women, and people with compromised immunity.
Lesson 5: It can be hard for those who become ill to remember having eaten sprouts.
We have found in our investigations that people often do not remember having eaten sprouts, because they are often just a garnish or one of many ingredients in a food dish. It is not necessary to eat large quantities of sprouts to get sick. An ill person's inability to accurately recall what they ate sometimes makes it difficult to pinpoint an outbreak of sprouts.
For more information, visit these resources:
- Food Safety at CDC
CDC Multistate Outbreaks Reports
by Robin Woo, FDA Center for Food Safety and Applied Nutrition
Traveling to other countries – and staying healthy – requires planning, preparation, self-discipline, and vigilance.
The Food and Drug Administration (FDA) inspects international facilities that make FDA-regulated products to ensure that those products are safe for consumers. So some FDA staffers travel a lot. Here are some precautions they take to keep from getting sick during a trip.
Before You Go
Research. Learn where to find reliable medical care at your destination. Good resources include:
- The Centers for Disease Control and Prevention (CDC) Travelers' Health1
- The CIA World Fact Book2 3
- U.S. Department of State Travel Information4
While in Developing Countries
Avoid tap water. This includes water from the tap and beverages with ice. Don’t drink when brushing your teeth or bathing. In developing countries, water may be contaminated by bacteria, parasites, and viruses that cause hepatitis, cholera, and typhoid fever. Even a small amount of contaminated water can make you ill.
Drink safe beverages.
- Boiled water – One minute of boiling should adequately disinfect most water, but boiling water for 3 minutes is recommended.
- Treated water – Commercial iodine or chlorine tablets provide substantial protection if used according to directions.
- Beverages made with boiled water and served steaming hot (such as tea and coffee).
- Bottled water or canned beverages. Because water on the outside of cans and bottles may be contaminated, they should be wiped clean and dried before being opened.
Water contaminated with fuel or toxic chemicals will not be made safe by boiling or disinfection; travelers should use a different source of water if they suspect this type of contamination.
Avoid raw fruits and vegetables. This includes salads and uncooked vegetables. These may be contaminated or may have been rinsed with unsafe water. Eat only food that has been cooked and is still hot, or fruit that you know has been washed in safe water and you have peeled yourself.
Other foods to avoid include:
- Raw or undercooked meat, poultry, seafood, and eggs
- Unpasteurized milk and milk products, especially soft cheeses
- Prepared food that has been left unrefrigerated for several hours, especially food containing meat, poultry, eggs, and dairy products
- Food prepared by street vendors
Eat safe foods.
- Thoroughly cooked fruits and vegetables
- Fruits with a thick covering (citrus fruits, bananas, and melons) that have been washed in safe water and that you peel yourself
- Thoroughly cooked meat, poultry, eggs, and fish
- Dairy products from large commercial dairies, such as ultra-pasteurized (shelf-ready) milk or hard cheeses
If you get sick
Remember that adequate fluid intake is essential to preventing dehydration. So it’s important to keep drinking safe water even if you have diarrhea. The most common cause of “Travelers' Diarrhea” can be treated with over-the-counter products, used according to directions. Effective drugs that control the frequency of diarrhea include Lomotil, lomodium, and Kaopectate. Find reliable medical help if you have severe abdominal cramps or pain, high fever, blood or mucus in your stool, and/or severe dehydration.
Don't use EnteroVioform. This drug, widely distributed abroad for treating diarrhea, has been linked to nervous system complications.
As a parent and grandparent myself, I understand the concern over recent reports that arsenic has been found in apple juice, especially since it is a staple in many children’s daily diets.
We here at the U.S. Food and Drug Administration (FDA) are familiar with the issue of arsenic being found in certain food and beverage products, but I realize that hearing this may be new to you. I would like to take the time to make sure you understand why it is there, how it got there and if you should be concerned.
Why is there arsenic in fruit juice products?
Arsenic is present in the environment as a naturally occurring substance and as a result of contamination from human activity, such as from the use of certain pesticides and fertilizers. It is found in water, air, food and soil.
There are two types of arsenic: organic and inorganic. The inorganic forms of arsenic are the harmful forms, while the organic forms of arsenic are essentially harmless. Because both forms of arsenic have been found in soil and ground water, small amounts may be found in certain food and beverage products, including fruit juices and juice concentrates.
What is the FDA doing to protect the public against arsenic in fruit juice products?
The FDA has been testing for arsenic contamination in juice products for several years as part of FDA programs that look for harmful substances in food. We have been aggressively testing samples of both domestic and imported fruit juices and juice concentrates, and have not found evidence that juice is unsafe for consumers young or old.
I have heard reports of test results showing high levels of arsenic in apple juice products. Are they true?
Unless we can determine that the test methods used were for inorganic arsenic and that the method was accurate and properly performed, we are not able to specifically address the test results. It is important to remember that test results for total arsenic do not distinguish between the essentially harmless organic forms of arsenic and the harmful inorganic forms of arsenic. It would be inappropriate to draw conclusions about the safety of a product based on the total arsenic level.
When the FDA wants to determine if a food has unsafe levels of arsenic, we test the food specifically for the harmful, inorganic forms of arsenic. It is common to test for total arsenic as a quick and easy way of seeing how much arsenic is in the sample. However, a total arsenic test does not tell us how much inorganic arsenic is in the sample. In fact, organic arsenic can make up the bulk of total arsenic in some foods. If you want to know if there are harmful amounts of arsenic in the sample, you must test specifically for inorganic arsenic.
Does the FDA have a response to the information recently reported on the Dr. Oz Show?
The FDA is aware of the episode of the Dr. Oz Show that aired on Sept. 12, 2011, where test results for arsenic in apple juice were discussed. The FDA has reviewed the test results performed by EMSL Analytical, Inc., on behalf of the Dr. Oz Show, and we can confirm that the results that were revealed are for total arsenic. The results do not distinguish between the essentially harmless organic forms of arsenic and the harmful inorganic forms of arsenic. Therefore, these results cannot be used to determine whether there is an unsafe amount of arsenic in the juice tested by the Dr. Oz Show.
Did the FDA test any of the samples tested by the Dr. Oz Show?
On Sept. 10-11, 2011, the FDA completed laboratory analysis of the same lot of Gerber apple juice that was tested by the Dr. Oz. Show, as well as several other lots produced in the same facility. The FDA’s testing detected very low levels of total arsenic in all samples tested. These new results were consistent with the FDA’s results obtained in the FDA's routine monitoring program and are well below the results reported by the Dr. Oz Show. The FDA has concluded that the very low levels detected during our analysis are not a public health risk and the juice products are safe for consumption.
Are apple and other fruit juices safe to drink?
Yes. There is currently no evidence to suggest a public health risk from fruit juices, including apple juice.
Where can I get more information?
- FDA: Apple Juice is Safe To Drink http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm
- Arsenic and Apple Juice: Questions and Answers http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271595.htm
- Letters from FDA to The Dr. Oz Show Regarding Apple Juice and Arsenic http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271746.htm