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Sprout-Associated Outbreaks
- Janet Mohle-Boetani, MD, MPH;
- Jeff Farrar, DVM, PhD; and
- S. Benson Werner, MD, MPH
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IN RESPONSE:
Dr. Lodato's comments provide us a chance to clarify a few points. The estimated number of cases in our outbreaks is, indeed, small compared with the estimated number of cases in the United States. However, the estimated national cases are mostly sporadic rather than associated with an outbreak. They could have had many sources of exposure, including contact with infected animals and humans; when they do have foodborne sources, these are rarely identified. But investigations of outbreak-associated cases allow us an opportunity to identify foodborne sources and to then intervene to prevent additional cases. While human salmonellosis has had a long history of association with animals and their products (for example, raw milk), investigations by public health agencies have identified a growing number of foodborne outbreaks due to fresh produce items (1-3).
Although we cannot identify the proportion of all cases of foodborne disease that are due to sprouts, we believe it is important that both clinicians and the public know about the risk of eating raw sprouts. Many people know that meat and poultry are commonly contaminated and that these should be handled cautiously and cooked thoroughly before consumption. But many think of sprouts as healthful foods and thus consume these raw. Our caution about eating sprouts should not detract from our continuing recommendation that animal products be handled properly and thoroughly cooked to decrease the risk for foodborne illness.
We agree with Dr. Lodato's statement about the need for a combination of prevention and control steps. This need is addressed in our Discussion section, where we categorized the recommendations into those that should be implemented by the seed growers/seed mills and those that should be implemented by the sprout growers. From sprout harvesting to consumption, proper refrigeration is also critical. We believe that full implementation of these recommendations by all seed growers and sprout growers will significantly reduce foodborne disease due to sprouts. However, we do not believe that even strict adherence to these recommendations will result in pathogen-free products 100% of the time because seeds and sprouts are grown in nonsterile environments that cannot be completely controlled.
We do not concur with Dr. Lodato's suggestion that irradiated foods would be harmful. Irradiation has been shown by numerous scientific studies to be a safe and effective option for controlling pathogens in food products (4, 5). Irradiation has been used successfully for many years in numerous countries, even by our own military forces, with no adverse effects.
Janet Mohle-Boetani, MD, MPH
California Department of Health Services
Berkeley, CA 94704
Jeff Farrar, DVM, PhD
California Department of Health Services
Sacramento, CA 94234
S. Benson Werner, MD, MPH
California Department of Health Services
Berkeley, CA 94704
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
