Why Farmers Markets and Food Safety Are Here to Stay Produce Continues to Be a Major Contributor to Foodborne Illnesses

Indiana State Department of Health Food Protection Program

November 2017

FoodBytes Volume 17 Issue 3 revised

Why Farmers Markets and Food Safety are Here to Stay Produce continues to be a major contributor to foodborne illnesses. In attributing the contri- bution by commodity to domestically acquired foodborne illnesses and deaths, CDC estimates 46% of illnesses and 23% of deaths between 1998 and 2008 were from produce.1 This year Indiana received a FSMA Produce Safety grant which will ultimately provide new approaches to assure a safer Indiana product. The Indiana State Department of Health team of JoAnna Beck, Su- pervisor, phone 317-476-0056, and Jennifer Cole- man, Food Safety Farm Consultant, phone 317- Inside this issue: 476-0059 are reporting that a new produce facility EATS TRAINING 2 registration form is now available on the ISDH web page at: http://www.in.gov/isdh/25773.htm. 2017 TIM SULLIVAN The form will register wholesale produce growers MEMORIAL AWARD with a focus on certain commodities and growers NOROVIRUS – A.K.A. 3-4 covered by the federal Produce Safety Rule. Staff “STOMACH FLU” From Purdue Agriculture August 2, 2017 will do outreach to growers potentially impacted by the Produce Safety Rule. Purdue University staff will work closely with ISDH and the NOROVIRUS DISIN- 5 Indiana State Department of Agriculture to implement the program. An article in Purdue FECTION Agricultural News, August 2, 2017, describes what is happening in Indiana to improve produce safety. The complete article is at: SAFE USE OF NACHO- 6 http://www.purdue.edu/newsroom/releases/2017/Q3/why-farmers-markets-and-food- CHEESE DISPENSERS safety-are-here-to-stay.html. Farms should determine their status. We suggest they go to the FDA information sites providing more information and read “I Have a Farm–Does KEEPING LIVE POUL- 7 the Proposed Preventive Controls Rule Affect Me?.” It may be found at TRY http://www.fda.gov/downloads/Food/GuidanceRegulation/FSMA/UCM365377.pdf or at: http://sustainableagriculture.net/wKara Burdett ([email protected]) GLUTEN-FREE LABELING 8 p-content/uploads/2008/08/FSMA-PRODUCE-RULE-FINAL.pdf. Produce Safety questions for ISDH may be sent to: [email protected]. INDUSTRIAL HEMP UP- 9 DATE 1. https://www.cdc.gov/foodborneburden/attribution-1998-2008.html

FROM THE DIRECTOR’S 10 By JoAnna Beck and Jennifer Coleman, ISDH, and Amanda Deering, Purdue University. DESK NEWS FROM RRT National Food Safety Education Month September 2017 LEADING BY EXAMPLE

Thank you to ISDH, local health depart- CDC’s FOOD Tool is a tracking tool where TIDBITS, CRUMBS, AND 11 ments, industry, national and academic part- data is available on Indiana foodborne LEFTOVERS ners that work to create a culture of food incidents: safety and do research to enable a safe food http://www.cdc.gov/foodborneoutbreaks supply in the United States. The Centers for Disease Control (CDC) esti- CDC has created a web page with educa- mates that 48 million people get sick, tional resources that can be shared to raise 128,000 are hospitalized, and 3000 die from awareness. It is worth a look at: https:// foodborne diseases in the United States each www.cdc.gov/foodsafety/education- year. month.html Improve Outbreak Response Using Environmental Assessments

Improve Outbreak Response Using as those from scientific, industry and The course can be completed in about Environmental Assessments is a course consumer groups. The course allows 8-10 hours or broken down into that may be of interest to our partner the practice of critical skills through smaller sections completed over time. agencies and their environmental simulated exercises, such as interview- This course explains the difference health specialists. This course address- ing food workers and conducting an between an environmental assessment es the role of environmental assess- environmental assessment of a restau- and a routine inspection and is rec- ments within the broader context of rant implicated in an outbreak (CDC). ommended for anyone who may be outbreak investigations and the food conducting an environmental assess- safety system. The skills needed to Participants will learn how to: ment in response to an outbreak. participate in an outbreak investigation are different from those needed 1. Investigate foodborne illness out- The link to register for the course is to inspect restaurants, and the role of breaks as a member of a larger below: the environmental health staff is criti- outbreak response team, https://www.cdc.gov/NCEH/EHS/ cal (CDC). 2. Identify an outbreak’s environ- eLearn/EA_FIO/index.htm mental causes, and This online course is designed specifi- 3. Recommend appropriate control By Laurie Kidwell, ISDH RRT Coordinator cally for environmental health profes- measures (CDC). sionals and food safety program offi- cials in government agencies, as well

IEHA 2017 Tim Sullivan Memorial Award Mark Mattox was honored posthu- mously with the Tim Sullivan Me- morial Award for outstanding work and service in the area of Food Pro- tection. Wife Rhon- da accepted the award along with her mother and daughter.

The award nomina- tion was in the works prior to Mark’s passing and we are honored that it could be pre- sented posthumous- ly. Mark’s family Pictured at the award ceremony: Scott Gilliam, Chelsea Rhea, Rhonda Mattox, Beverly Sayre Cowar, Krista graciously accepted Click, and George Jones the invitation to Annual IEHA Fall Educational Confer- By George Jones, Deputy Director, Indi- receive the award on his behalf. Many ence awards ceremony September 25 in ana Food Protection Program, Indiana heartfelt stories were shared with his Lawrenceburg, IN. State Department of Health. family members and the evening was very much appreciated. This picture was taken at the 67th

Page 2 Food Bytes NOROVIRUS – A.K.A. “STOMACH FLU”

Norovirus is the leading cause of ill-  shellfish (such as oysters) (CDC).  Avoid preparing food for others ness and outbreaks from contaminat- while you are sick and for at least ed food in the United States (CDC) . Importantly, any food that is consid- 48 hours after symptoms stop. We have all experienced it, or known ered ready to eat can become con- someone who has, the dreaded taminated. Some common sources of  Wash your hands carefully and “stomach flu.” Of course, norovirus is Norovirus outbreaks include often with soap and water for at not the same as the influenza virus, healthcare settings, restaurants, cruise least 20 seconds. but to a person suffering with the ships, and schools/daycares. Howev- er, most norovirus outbreaks from  Rinse fruits and vegetables and hallmark symptoms of vomiting and cook shellfish thoroughly. diarrhea, this point is not important contaminated food occur in food ser- or appreciated. vice settings like restaurants.  Clean and sanitize kitchen uten- A quick summary of some Norovirus sils, counters and surfaces routine- statistics: ly.  Causes 19–21 million cases of  Wash table linens, napkins and acute gastroenteritis other laundry thoroughly (CDC). (inflammation of the stomach or If you have complainants who are intestines or both). experiencing gastrointestinal illness  leads to 1.7–1.9 million outpatient with an unknown cause, you may visits and 400,000 emergency suspect norovirus. department visits, primarily in young children. To help determine if you are poten-  Contributes to about 56,000– tially facing a Norovirus case or out- 71,000 hospitalizations and 570- break, use the Kaplan Criteria: 800 deaths, mostly among young  A mean (or median) illness dura- children and the elderly (CDC). tion of 12 to 60 hours, Infected food workers are frequently While sick, people shed billions of the source of these outbreaks, often  A mean (or median) incubation tiny viral particles in their stool and by touching ready-to-eat foods, such period of 24 to 48 hours. vomit. It takes a very small amount— as raw fruits and vegetables, with as few as 18 viral particles—to make their bare hands before serving them.  More than 50% of people another person sick. People can get 1 in 5 food service workers have re- with vomiting, and sick if they are exposed to a tiny ported working while sick with vom- amount of stool or vomit from an iting and diarrhea. Fear of job loss  No bacterial agent found infected person (CDC, Preventing No- and leaving co-workers short staffed rovirus Outbreaks). were significant factors in their deci- When all four criteria are present, it is sion (CDC, Preventing Norovirus Out- very likely that the outbreak was Norovirus is an important concern for breaks). Foodborne outbreaks of no- caused by norovirus. However, about those involved in the food industry, rovirus illness have also occurred in 30% of norovirus outbreaks do not both private and public part- banquet halls, and even at family din- meet these criteria. If the criteria are ners. About 50% of all outbreaks of ners, where people eat food handled not met, it does not mean that the food-related illness are caused by no- or prepared by others. Norovirus out- outbreak was not caused by norovirus rovirus. Food can become contami- breaks can also occur from fecal (CDC, Preventing Norovirus Out- nated with norovirus at any point (stool) contamination of certain foods breaks). Confirmation of a norovirus when it is being grown, shipped, han- at their source. For example, oysters outbreak would be provided with a dled, or prepared (CDC, Norovirus). harvested from contaminated water positive stool sample result. and raspberries irrigated with contam- Foods that are commonly involved in inated water have caused norovirus outbreaks of norovirus illness are— outbreaks (CDC). Continued on page 4

 leafy greens (such as lettuce), Food workers can prevent the spread  fresh fruits, and of norovirus by:

Page 3 Food Bytes NOROVIRUS – A.K.A. “STOMACH FLU”

Continued from page 3 when sick, by considering such Norovirus Prevention Strategy used Food service workers often go to measures such as paid sick leave in Indiana work when they are sick and may and a staffing plan that includes contaminate food. on-call workers (CDC, Preventing Indiana scored a green light rating for Norovirus Outbreaks). norovirus prevention because the Of outbreaks caused by infected food Indiana rules includes all four provi- workers, 54% involve food workers Food service workers can: sions that are critical to reducing touching ready-to-eat-foods with their  Tell a manager when sick with foodborne illness; bare hands. Ready-to-eat foods are vomiting and diarrhea. foods that are ready to be served  Excluding ill food service staff without additional preparation, such  Wash hands carefully and often from working until at least 24 as washed raw fruits and vegetables hours after symptoms of vomiting for salads or sandwiches, baked with soap and warm water for at least 20 seconds (time it takes to and diarrhea have ended (410 goods, or items that have already IAC 7-24, infection control sec- been cooked. sing the "Happy Birthday" song through twice), especially after tions 120-127) Observations of food service workers have shown that they practice proper using the restroom.  Prohibiting bare hand contact hand washing only 1 of 4 times that with ready-to-eat food (410 IAC they should (CDC, Preventing No-  Use utensils and single-use dispos- 7-24, section 171) rovirus Outbreaks). able gloves to avoid touching

ready-to-eat foods with bare Norovirus is hard to kill and stays on hands.  Requiring at least one employee food, kitchen surfaces, and utensils. It in a food service establishment to can:  Regularly clean and sanitize kitch- be a certified food protection en surfaces and frequently manager  Remain infectious on foods even touched objects, using a chlorine (410 IAC 7-24, sections 117-119 at freezing temperatures and until based product or other sanitizer and 410 IAC 7-22) heated above 140°F. approved by the Environmental Protection Agency for use against  Requiring food service employees  Stay on countertops and serving norovirus. to wash their hands (410 IAC 7- utensils for up to 2 weeks. 24, sections 128-131)

 Immediately block off, clean, and  Resist many common disinfectants Norovirus food protection compli- disinfect areas where there has and hand sanitizers (CDC, Pre- ance statistics for Indiana can be ac- venting Norovirus Outbreaks). been a vomiting or diarrheal inci- cessed on the CDC Prevention Status dent. Reports (PRS) at: https://wwwn.cdc.gov/psr/? What can be done? Well, the food Everyone can: service industry can: state=Indiana  Adhere to food safety laws and  Wash hands carefully and often regulations. with soap and warm water for at least 20 seconds and avoid pre-  Certify kitchen managers and paring food for others while sick. train food service workers in food By Tracy Hawkins, RRT Epidemiologist safety practices.  Report suspected illness from food to your local health department.  Establish policies that require

workers to stay home while sick Visit www.FoodSafety.gov for the with vomiting and diarrhea and latest information (CDC, Preventing for at least 48 hours after symp- Norovirus Outbreaks) toms stop. Preventing Norovirus Outbreaks

infographic is available at:  Foster a work environment that https://www.cdc.gov/vitalsigns/ encourages workers to stay home norovirus/infographic.html

Page 4 Food Bytes Disinfection after a Norovirus Incident

When there is known contamination of surfaces, cleanup Communicable Disease Reporting Rule definition of disin- needs to go beyond the usual wash, rinse, sanitize proce- fection for communicable diseases. dure, it includes a disinfection step as well. Killing no- References: https://www.cdc.gov/infectioncontrol/pdf/ rovirus requires the stronger solutions listed below. It is guidelines/disinfection-guidelines.pdf. important to rinse surfaces or flush equipment with pota- ble water after disinfecting because bleach concentrations http://www.disinfect-for-health.org/resources above 200 ppm are toxic. An excerpt from the 2013 FDA Model Food Code on clean-up of vomiting and diarrheal events is listed below, along with the Indiana

ALWAYS USE BLEACH TO CLEAN FOR NOROVIRUS! To clean surfaces: Remove vomit or diarrhea right away with kitty litter or baking soda Clean frequently touched surfaces with soapy water Rinse thoroughly with plain water Wipe dry with paper towels To disinfect surfaces: If hard surface: 1/3 cup of bleach + 1 gallon of water = 1000 ppm If porous surface: 1 2/3 cup of bleach + 1 gallon of water = 5000 ppm Always let surface air dry and rinse with plain water before use Wear protective clothing Wash all fabrics that may have come in contact with vomit or diarrhea and machine dry Wash hands thoroughly with soap and water for at least 20 seconds Use common sodium hypochlorite (bleach) to disinfect. Quaternary ammonium and non- hospital grade bleach wipes are NOT effective.

CODE AND CLEAN UP OF NOROVIRUS FDA Model Food Code 2013-2.5 Responding to Contamination Events; Procedures for Responding 2-501.11 Clean-up of Vomiting and Diarrheal Events A food establishment shall have procedures for employees to follow when responding to vomiting or diarrheal events that involve the discharge of vomitus or fecal matter onto surfaces in the food establishment. The procedures shall address the specific actions employees must take to minimize the spread of contamination and the exposure of employees, consumers, food, and surfaces to vomitus or fecal matter. Communicable Disease Reporting Rule 410 IAC 1-2.5 became effective 12/16/15. 410 IAC 1-2.5-27 "Disinfect" defined Sec. 27. "Disinfect" means the use of directly applied chemical or physical means, or other appropriate processes to destroy or inactivate communicable disease causing agents on inanimate objects. (Indiana State Department of Health; 410 IAC 1-2.5-27)

By Tracy Hawkins, RRT Epidemiologist ISDH Food Protection

Page 5 Food Bytes Safe Use of Nacho Cheese Dispensers

length of time a product can remain The cheese was past the “Best By” at elevated holding temperatures. In date. The plastic tool designed to some cases the product may only be open the bag of cheese was not used

held above 135 deg. F. for 4-6 days. by the employees. The machine implicated was NSF and UL listed. The dis- 2. Management should ensure that penser instructions indicate it can hold records are maintained indicating cheese for up to 5 days and takes 4-6 when bagged cheese was last hours to heat the bag to a safe serving changed. This may be accomplished by writing the date the product was temperature of 140° F. This machine added to the warmer on the bag it- must not be turned off during this time. Nacho Cheese Dispensers are found in self. many retail locations such as sporting More botulism in the events, gas stations, convenience 3. Management should ensure that stores, bars, state parks and fairs. This the warming and dispensing units are news…….. year, C. botulinum was linked to a not turned off at night or plugged On September 20, 2017, a multi-state nacho dispenser in a gas station in into a timer. These types of machines recall for canned coffee caught every- California. need to remain “on” at all times. This will ensure that appropriate tempera- one’s attention. Death Wish Coffee Botulism produces a toxin that affects tures are maintained in this ready-to- Company announced a recall of nerves and causes pain, vomiting, eat food. canned Nitro Cold Brew from retail- breathing problems and paralysis. It is ers and online. Although no illnesses essential that it is correctly diagnosed 4. Management and employees were reported, the product was with- so that anti-toxin can be given quickly should ensure that any supplied tools to prevent death. for opening the bags of cheese are drawn based on a Process Authority’s determination that additional step(s) In the spring of 2017, California suf- used per the product directions. These devices need to be washed, rinsed are needed in the manufacturing pro- fered an outbreak with 10 cases, 7 cess. This product and others that are requiring ventilator support. One per- and sanitized between uses. In some low acid foods and canned in reduced son died. So who would think that cases these opening tools are only oxygen packaging are at risk for Clos- drizzling a little nacho sauce over supplied with warming and dispens- some chips could land you in inten- ing units. tridium botulinum. Food Safety News sive care or worse? This tragic incident has more details. 5. Management and employees is a reminder to be vigilant about should verify on a regular basis that food safety. the internal temperature of the hot After a thorough investigation, the held cheese product is being held at California Department of Health the proper temperature. The internal

(CDPH), Food and Drug Branch temperature can be measured by plac- (FDB), reported on what caused this ing the cheese product in a cup with a Emergency Contact Information incident and have recommendations thermometer to verify the product is that they suggest sharing with opera- maintaining the minimum hot holding The CDC webpage Information for tors and inspectors. temperature of 135 deg. F as required Health Professionals lists more about The following is from the memo dat- under the California Retail Food signs and symptoms. If botulism is ed September 6, 2017: Code Section113996 or hot holding suspected, it is recommended that temperature as recommended by the health professionals either contact “1. Management and employees manufacturer (this is similar to Indiana Indiana State Department of Health should follow the instructions for 410 IAC 7-24-188)“. each type of machine and product at 317-233-1325 or CDC 24/7 at 770- they use. Instructions for use may be 488-7100. included on the packaging of the Due to the extensive nationwide dis- bagged nacho cheese or included on tribution of the cheese with no other By Sharon Farrell, ISDH Food Protection the interior panels of the warming cases, and subsequent testing, it was and dispensing unit. These directions determined that the cheese was likely may include pre-heating and the contaminated at the retail location.

Page 6 Food Bytes Keeping Live Poultry CDC has published safety guidelines, a wholesale food establishment if the Healthy Families and Flocks, https:// eggs are not sold to the end user, or www.cdc.gov/healthypets/resources/ as a retail food establishment if sold backyard-flock-8x11.pdf. Dirty eggs directly to the consumer. should be brushed or lightly sanded, not washed as water will cause any Assuming the producer only raises salmonella on the surface to enter the and sells raw eggs, there is likely to egg. Toss broken eggs as they may not be any equipment required other already be contaminated. than refrigeration and there are no It can be fun to keep live poultry Most people recover from a Salmo- building requirements. Eggs need to such as chickens, ducks, geese and nella infection, however young chil- be labeled with the name and address turkeys, but again this year Indiana dren, older adults and people with of the producer either on the carton has investigated Salmonella cases weakened immune systems are most or on a placard. Include a statement linked to backyard poultry flocks. susceptible to complications. Some- of net quantity such as count or net times there are long term effects that weight and identity of product; exam- To date in 2017, seven of the 961 include reactive arthritis where people ple: Quail Eggs. cases in 48 states were in Indiana. develop pain in their joints, irritation This year nationwide, backyard poul- of the eyes and painful urination. An- Used egg cartons, if allowed to be try salmonella infections resulted in tibiotic treatment used, must be relabeled with the 215 hospitalizations and one death. of the initial in- name and address of the supplier of Nationwide, 74% of ill people re- fection does not eggs. ported contact with live poultry. seem to prevent arthritis. If the selling site is the same as the These outbreaks are caused by several production site, the eggs would have DNA fingerprints of different Salmo- Duck and Quail Eggs to be kept at an ambient air tempera- nella bacteria: Salmonella Backyard flocks may include species ture of 45° F. Fresh eggs would be Braenderup, Salmonella Enteritidis, other than chickens and the question warm and there is no time limit to Salmonella Hadar, Salmonella I 4, often comes up about who regulates read this cooling temperature. [5],12:i-, Salmonella Indiana, Salmo- these eggs and are there any special Once in a retail establishment, the nella Infantis, Salmonella Litchfield, rules. Only chicken eggs may be sold eggs must be placed in refrigeration at Salmonella Mbandaka, Salmonella from the farm or home without a 41° F. A date of production, a date of Muenchen, and Salmonella Typhi- local health depart- murium, source Centers for Disease ment permit. Duck Cook eggs until both the yolk and white are firm or 145°F; 155 F° if Control (CDC)). Salmonella was dis- and quail eggs are hot held. Cook poultry until the thickest part is 165 °F and watch for uneven covered by an American scientist Dr. not regulated by cooking in a microwave. Salmon 125 years ago and the the Indiana State Eggs and egg dishes may be refrigerated for serving later but should Serovar Indiana was first reported in Egg Board as that be thoroughly reheated to 165 °F before serving. Toss eggs 1955. According to CDC, Salmonella, agency only regu- that are not hot held (135°F) longer than 2 hours. Use cooked eggs and poultry within one week after cooking. causes millions of cases of foodborne lates chicken eggs. Cooked chicken and poultry dishes can be frozen for 4-6 illness annually and is the leading Therefore, the reg- months. For additional storage information see, cause of foodborne deaths. Tess Gor- ulation of the pro- https://www.foodsafety.gov/keep/foodkeeperapp/index.html. den, MPH, Enteric Epidemiologist, duction, use, and Prevent cross contamination of kitchen surfaces by washing, rinsing and sanitizing all surfaces that come into contact with raw eggs Indiana State Department of Health, sale of duck or or poultry. Sanitize using 1 teaspoon unscented bleach to one confirmed that none of the seven quail eggs defaults gallon water. Indiana cases were Serovar Indiana to ISDH or Local Wash hands frequently and do not prepare or handle food if sick. (we could not verify the connection Health Depart- to our state), which has high levels of ments. The seller may not operate packing or a use by date are recom- drug resistance. under the Indiana Home Based Ven- mended. dor law since they cannot meet the CDC cautions that though the live requirements of 16-42-5-29. They poultry appear well, they can carry would be regulated under IC 16-42, the illness and transfer it to humans 410 IAC 7-21 (Wholesale) or 410 IAC though handling the chicken or eggs. 7-24 (Retail). Specifically, the produc- By Sharon Farrell, ISDH Food Protection er must be registered with the ISDH as

Page 7 Food Bytes Gluten Free Labeling Update

FoodBytes first report- According to FDA, “Producers of Restaurant Association. “We will con- ed on the new gluten- foods that are by nature free of gluten tinue to work with restaurant opera- free labeling laws in (e.g., bottled spring water, fresh fruits tors and chefs to assist and ensure a the April 2014 edi- and vegetables, and fresh seafood) favorable dining experience for con- tion. The final rule may or may not choose to label these sumers.” defines “gluten-free” foods as gluten-free even though the for voluntary use in foods could be consumed as part of a What about local regulators duties? the labeling of foods. This rule applies gluten-free diet. For foods that are by Most of the burden of compliance to both foreign and domestic prod- nature free of gluten, but are at high will fall with the ISDH Manufactured ucts and includes all Food and Drug risk of gluten cross-contact (e.g., prod- foods inspectors checking compliance Administration (FDA ) regulated pack- ucts made from grains, legumes, and with the rule. If during an inspection, aged food, beverages and dietary sup- seeds), the appearance of a gluten- local regulators find products labeled plements. There are other foods free claim on the labels would pro- gluten-free, they should ask addition- whose labeling is under the U.S De- vide consumers with the expectation al questions to ensure the food is in partment of Agriculture (USDA) such that any gluten present is less than 20 compliance or from an approved as meats, poultry, and certain egg ppm. Persons with celiac disease or source and is not adulterated. The products (FDA regulates the labeling who are otherwise sensitive to gluten Indiana Food Protection Program of shell eggs). The Alcohol and Tobac- should seek the advice of their health may ask a local health department to co Tax and Trade Bureau (TTB) regu- care providers when selecting appro- do an “effectiveness check” to assist lates the labeling of most alcoholic priate foods they can consume when in an investigation of a complaint or beverages and malted beverages. FDA following a gluten-free diet.” Gluten recall. regulated food products bearing this is not part of the federal Allergens label must be in full compliance with regulations at present. This may What about Gluten-Free Hemp? the rule. Unlike other labeling rules, change at some point so producers Those with celiac disease and non- there are no specific instructions on should keep up to date with regula- celiac gluten sensitivity are interested size of type, or position of the label tions. in healthy products. Hemp, a very on a product. close but non-psychoactive food re- What About in Restaurants? lated to the cannabis plant known as Gluten Levels Some restaurants use the term “gluten marijuana, is often found in healthy 20 ppm is the level that celiac disease -free” on their menus. FDA says that foods and hemp is gluten-free in its researchers and some epidemiological restaurants making a gluten-free claim pure form. Examples are hemp cere- evidence suggest is tolerated. Manu- on their menus should be consistent al, hemp cookies, hemp milk or facturers labeling their food gluten- with FDA’s definition. The gluten-free hemp butter. However, hemp may free must do testing to prove that the final rule only applies to packaged be cross-contaminated with gluten if concentration of gluten in the product foods, which may be sold in some the field where it was grown is part is less than 20 ppm. In fermented and retail and food-service establishments of a crop rotation with wheat or the hydrolyzed foods there are issues with such as some carry-out restaurants. same equipment is used for harvest. methods to detect gluten. Because Again, the producers must provide scientifically valid methods do not State and local governments play an evidence that products meet the 20 currently exist, FDA is planning on important role in oversight of restau- ppm or less gluten limits if the prod- issuing a proposed rule on this issue. rants. FDA will work with partners in ucts are sold as gluten-free. A manufacturer may state that their state and local governments with re- foods contain a specific amount of spect to gluten-free labeling in restau- Reporting adverse health effects to gluten if the statement is truthful and rants. Consumers who are concerned FDA not misleading. about gluten-free claims in restaurants If a person sensitive to gluten eats a should ask questions when ordering product labeled gluten-free and be- Compliance foods described as gluten-free, for comes ill or otherwise experiences FDA has a full range of post- example, “how is the item prepared?” adverse health effects, can they re- marketing activities to enforce the “With the new FDA gluten-free regu- port this to FDA? Yes, contact FDA’s final rule, including sampling, periodic lations now being enforced, restau- inspection and food labeling reviews. rants will be well-served to ensure They will also act on consumer com- they are meeting the FDA-defined plaints. claim,” said Joy Dubost, Ph.D., R.D., Senior Director of Nutrition, National Continued on page 9

Page 8 Food Bytes Gluten-free labeling update continued Hemp in Food Products Update from page 8

Center for Food Safety and Applied In speaking with Don Robinson Nutrition’s Adverse Event Reporting from the IN Seed Chemist Office, Purdue has grown the hemp crop System called “CAERS” by phone, 240 on University property and two pri- -402-2405 or email, vate farmer’s fields since the pass- [email protected]. Consumers ing of IC 15-15-13-1 and IC 15-15- and manufacturers can also report 13-17 in 2014 and 2015. Purdue any complaint they may have about also received federal permission to an FDA-regulated food (e.g., poten- grow and test hemp seeds for suita- tial misuse of gluten-free claims on bility as a new Indiana crop. Test- food labels) to an FDA Consumer ing continues at Purdue and none Complaint Coordinator for the Industrial Hemp seeds. Courtesy Office of of the current Indiana crop is for state where the food was purchased. Purdue Seed Chemist sale and no other farmers are per- A list of FDA Consumer Complaint mitted to grow or sell it at present. Coordinators is posted at FDA’s web- The summer 2015 FoodBytes article The goal is a crop with 0.3% tetra- site. “New foods-HEMP” described im- hydacannabinol (THC) or less by https://www.fda.gov/Safety/ ported hemp containing food products that can be sold in Indiana if the weight that grows well in Indiana ReportaProblem/ farm fields and to eventually allow hemp is obtained from approved ConsumerComplaintCoordinators/ Purdue to license growing approved sources. This is because in 1970, the default.htm seeds. Mr. Robinson stated that federal government banned growing Gluten and Food Labeling References any food products currently sold in all hemp in the U. S. due to the pro- Food Facts Indiana must use imported pensity to grow the psychoactive ma- FDA Gluten Guidance ‘denatured hemp’ not grown in In- rijuana. But federal law does allow diana. The State Seed Chemist site products with less than 0.3% tetrahy- Gluten Free Terms contains up to date information at: dacannabinol (THC) or less by weight http://www.oisc.purdue.edu/seed/ FDA regulations pertain to these to be imported. Since the 2015 article, industrial_hemp.html. four variations more food products using hemp as an Gluten-free ingredient are being offered in various Not affecting current food products hemp inspired dishes and drinks or testing of seeds being conducted at Free of gluten served in restaurants as well as sold at Purdue, effective July 1, 2017, House No gluten farmers markets. enrolled Act 1148 added a new section to the Indiana Code defining Without Gluten Hemp is the low tetrahydacannabinol (THC) form of the cannabinoid plant, “Cannabidiol” and who may purchase AccordingBy Sharon Farrell to FDA, ISDH an Food ingredient Protection often termed marijuana. Marijuana this drug with a special card anywhere that has been derived from a glu- contains higher levels of THC and it is sold, for use by persons with ten-containing grain can be la- other chemicals and is illegal to grow ‘treatment resistant epilepsy’. This beled as gluten free if it has been or possess in Indiana. Hemp also can- product also must not contain more that 0.3% THC by weight and must processed to remove gluten and not be legally grown in Indiana (see have at least 5% Cannabidiol by the use of that ingredient results Purdue exception below) but non- psychoactive flours, seed, oils, flow- weight and contain no other con- in the presence of less than 20 ers, and more can be legally imported trolled substances. The new law in no ppm of gluten in the food. under FDA regulations, for example way changes hemp food products from Canada. Denatured (non- regulations. psychoactive) hemp as a food is high in protein, contains all the essential By Sharon Farrell, ISDH Food Protection amino acids making it a complete protein source, and is also high in Omega-3 fatty acids important for By William Houchin, Retail Foods cholesterol control, heart, and brain Supervisor and Sharon Farrell ISDH health. Besides food, hemp is used for Food Protection textiles, paper products, construction and more.

Page 9 Food Bytes From the Director's Desk

Many local health department (LHD) complaint may be shared or re- food safety inspectors are unsure leased. what they need to do when foodborne illness complaints or other Leading by Example agency referrals require them to conduct an environmental assessment at a When inspectors go into an estab- restaurant where individuals claim lishment to conduct an inspection or environmental assessment, they they ate or purchased a meal or food have a lot of responsibilities. In- that made them sick. This research spectors are professionals who provided a compare and contrast for work diligently with food establishment operators to reduce the risk By Krista Click, pictured of foodborne illness. Inspectors are investigating, but also educating at the Announcements same time. It is important for food Dr. Kristina Box was announced as inspectors to the next Indiana State Health Com- remember missioner by Governor Eric J. Hol- that while comb. Dr. Jerome Adams now proud- inspecting or ly serves as the 20th U.S. Surgeon assessing, General. Pam Pontones served as they set the Interim State Health Commissioner. standard on how one Dr. box’s first day with the agency Pictured: Stan Danao presenting should han- was October 16, 2017. at the 2017 I.E.H. A. Fall Educa- dle them- tional Conference. ISDH has contracted with Computer selves in a food Al Houchin wearing his ISDH ball cap. AID, Inc. to implement the USAFood- establishment. risk based food safety regulatory in- There are many Safety system. Current CodePal users spections versus environmental assess- will be transitioned and LHDs may be eyes watching how you are dressed, ments, where a foodborne illness is how you behave, and what you say added after the initial implementation suspected. Assumptions are made that issues are resolved. New will be the during the entire visit. Inspectors the LHD inspectors have had food- should dress and behave as if they are ability to submit food sample infor- borne illness outbreak specific training mation electronically. Also new, once the one working in the area being such as Epi-Ready or CDC Environ- inspected or assessed. This means ap- the system is populated, is the ability mental Assessment Training (EATS) of the public to search inspection rec- propriately washing hands and cover- and would contact the appropriate ing hair. While donning the hair re- ords. ISDH Food Protection Staff. straint, it is an excellent time to check for any jewelry (earrings, necklaces, Dr. Barbara Almanza will be assisting New Disclaimer Statement for Com- Food Protection during her upcoming rings with stones) that may possibly plaint Documents fall into the food products. As a re- sabbatical the Spring of 2018. Plans The following paragraph is the new are to assist with collecting and ana- minder, we live in a time when cell disclaimer to be used when referring phones easily capture videos, and lyzing data used by Food Protection complaints to the appropriate jurisdic- and others to evaluate continuous good role models are needed. Always tions. Let Laurie Kidwell know if you act professionally, and lead by exam- improvements. have any questions. As stated in IC 16- ple. 42-1-35, the following information of News from the RRT Section the individual who filed the com- At the 2017 IEHA Fall Educational By William Houchin, Retail Foods plaint shall remain confidential and Supervisor ISDH Food Protection Conference, Stanley Danao gave a protected from record release: name, wonderful presentation explaining the address, telephone number, electronic new research and procedures for mail address, personal health infor- environmental assessments. To see the mation, or any other information full version of the poster, visit Rapid that could identify the complainant. Response on the Food Protection Other details associated with the webpage.

Page 10 Food Bytes Food Protection

Program

Indiana State Department of Health

Food Protection Program

100 N. Senate Ave., N855 FoodBytes is published by the Indianapolis, IN 46204 Food Protection Program, Indiana State Department of Health.

Phone: 317-234-8569 Kristina Box, MD, FACOG

Fax: 317-233-9200 State Health Commissioner Editorial Staff Sharon Farrell, MS, RD Trent Fox FoodBytes Editor FIND US ON THE WEB! Interim Chief of Staff Krista Click, @ Dr. Judith Lovchik Food Program Director Assistant Commissioner, Public Health Protection and Email www.foods.isdh.in.gov Laboratory Services [email protected]

Send your questions and comments to the e-mail or postal address on this page.

Tidbits, Crumbs, and Leftovers

Foreign Supplier Verification (FSVP) Food Safety and Defense Task Force Managing Food Emergencies; Strate- Meetings gies for a Community Response FDA FSMA Program for Importers of (MGT 447) Food for Humans and Animals is operat- ing at the Federal level. Upcoming: Partners and those interested in joining the Indiana Food This course was held on November Anticipated Inspections Planned Safety and Defense Task Force are 14 and 15, 2017 in Nashville, Indiana.  325 FSVP inspections in 2017 invited to the next meeting on No- The course was taught by National vember 29th at the Ivy Tech Culi- Biomedical Research and Training at  2000 FSVP inspections in 2018 nary School in Indianapolis. The Louisiana State University, U.S. De- Reference: agenda is packed and promises to be partment of Homeland Security. https://www.fda.gov/downloads/Food a great meeting. Contact Laurie Kid- Required course prerequisites are ICS /GuidanceRegulation/FSMA/UCM4728 well, RRT Coordinator, at 100.B –Introduction to Incident Com- 91.pdf [email protected] for more information or to reserve a spot. mand Systems (Formerly ICS 100 and ICS 7000. The course is restricted to HACCP vs HARPC citizens of the United States. A FEMA ER310: Food Safety Issues in the SID can be obtained at The similarities and differences between Event of Disaster: A Practical Applica- https://cdp.dhs.gov/femasid This per- these plans are explained in the Food tion was a success. Speakers were Joe sonal identification number will com- Safety Magazine article September 19, CorbySafer (AFDO) food promises with Cameron healthier Smoak bine FEMA training records under 2017, “HACCP vs. HARPC: A Compari- andand Dan longer Dump lives (University and less of costly Arkan- one number. son. sas).health care, as well as a more https://www.foodsafetymagazine.com/ resilient food industry. enewsletter/haccp-vs-harpc-a- HealthyPeople.gov comparison/?mobileFormat=false