CUCUMBER TRAVEL ADVICE FOR BRITONS - AND OTHERS

A couple of weeks ago, vacationing or business travel in Germany would have been considered very safe. Not any more. Particularly around Hamburg. This is the center of the "cucumber crisis." Most of the over-thousand hermorragic E.coli-related illnesses have been linked to eating food here. A considerable number have occurred among people from other countries such as Sweden, Denmark, France, visiting this area, or, residents of Germany who ingested the cucumbers and at home and then went abroad and became ill.

Britain is the latest country to be hit by cucumber fears. At least three cases among visiting Germans are suspected to be part of this outbreak, one of them confirmed. In fact, the advice to Britons now is not to eat raw cucumbers - or, raw lettuce or tomatoes (see earlier post) - when visiting Germany. And remember, washing or peeling is not guaranteed to solve the problem. If the cucumber has been sliced up or otherwise prepared in a restaurant or hotel, the risk could be even greater, as it could also be contaminated by a food worker who is a carrier of the bacteria (or others).

The "incubation" period for pathogenic E.coli (the time between ingesting it and developing symptoms of illness) can be as little as one day or a week or even longer. That means that you can feel perfectly well for a while after eating that deadly cucumber, keep working or vacationing and get on that plane and then become ill.

And yes, the bacteria are contagious. That is, they can be passed along not only in food or water, but also from person to person and even from the water in a swimming pool where it can survive for weeks, particularly if not well chlorinated. So I will add a bit more advice to travelers: don't let the water from a public swimming pool enter your mouth - not even a few drops. Don't dive in, don't dive under, and in fact, you may want to think twice about using the pool at all.

To your good health!
TSF

MY GUIDE ON SAFE FOOD AND DRINK FOR TRAVELERS

I just took a look at the World Health Organization's "Guide on Safe Food for Travelers." I don't like it. Apparently it was adopted by China for the Beijing Olympics. No wonder several members of the US track team came down with food poisoning.

As you gather from several recent posts, travel has been on my mind lately (is it spring coming?) and I have certainly done enough of it in my life - mainly for international assignments. Anyway, here's my own guide, which I now always follow except in Europe and certain Asian cities:

• Eat only cooked food, except in the case of fruit which has been grown high on a tree and you can peel (such as bananas, mangos, oranges).
• As far as possible, avoid large catered affairs and buffets.
• Avoid street vendor food, and food sold by small roadside places or in markets, unless it is simple food, cooked in front of you (such as a roasted corn cob, roasted chestnuts).
• Only eat cheese or other dairy if you are certain it is pasteurized.
• Avoid shellfish, unless you are certain that it comes from safe waters and never eat fish or shellfish on a plane.
• Drink only bottled water and drinks, or hot coffee, tea, and avoid ice in anything you drink unless you are sure it is made from bottled water.

And, of course, always wash your hands before you touch food.

TSF

NOROVIRUS OUTBREAK ON A PLANE

Flight 167 from Boston to Los Angeles must certainly have been the trip from hell. The stench was unbearable, people were throwing up all over the place and the first class cabin aisle was fouled with diarrhea. In the end, the situation on board was so bad that the flight had to be aborted: the plane was diverted to Chicago O'Hare International Airport, where it was met with paramedics and ambulances. Several passengers were rushed off to hospital.

This is not a recent incident. It happened in 2008. But there is no reason why it can't happen again any time, any flight, anywhere. In fact, it has happened since then, although with less media coverage. The original reported cause of this incident, was food poisoning on a large tour. Several members of this tour group did not even make the flight home because they were too ill, but about another 41 did get on - some already exposed to Norovirus. This common cause of foodborne illness tends to crop up and spread in places where people are in close contact, such as cruises, tours - and, even planes. You can catch it from food, other people and surfaces. On this particular flight, the virus spread from the sick tour group members to other passengers on the plane just in the matter of a few hours.

Here are a few lessons that just might come in useful. Remember, this virus is very contagious.

• If you are on a flight where someone is throwing up, try to move as far away from them as possible preferably not to an aisle seat. In the case of flight 167, people sitting next to a sick person and those in an aisle seat tended to be the ones who became ill (probably because passengers were running up and down the corridors to the rest rooms, and because of the contaminated aisle).
• Try not to use the rest rooms if you believe someone has thrown up in them, even if it has been cleaned up. This type of quick clean during a flight would not be likely to get rid of the virus. In fact, even a thorough sanitation of the plane after this flight did not get rid of it completely.
• Do not eat or drink anything during the flight.
• Be careful not to touch your mouth during the flight (don't even apply lipstick), and as soon as you land, wash your hands very well with soap and water.
• When you get home or to a hotel, throw everything you are wearing into the wash.Even soap down and wash your handbag or other luggage your had with you in the cabin.

And - just hope and pray you'll never be on a flight like this one!

TSF

WHY ARE CRUISE SHIPS RISKY PLACES TO EAT?

Alright, I still haven't really explained in recent blogs why cruise ships are among the riskiest places to eat. Mea culpa. So here goes.

Not every food borne illness originates on board a cruise ship. Some of the foods purchased for the cruise already carry contaminants (as was believed to be the case with contaminated shrimp served at the embarkation buffet on board one recent cruise). But the studies I have looked at suggest that most get into the food on board the vessel. Often people - crew or passengers - are involved in the spread of illness.

Here are some reasons:

• The mass preparation of food which is usually more prone to contamination ( whether done for catered events, nursing homes, schools, restaurants, conferences or cruise ships).

• The confined area and non-stop socializing among passengers, leading to close contact between people. This means that a crew member handling food can contaminate it, with several passengers (and maybe crew) becoming ill, and then these sick people will pass it on to others (as often happens in the case of Norovirus-caused illness), or, even contaminate more food (if crew members are involved, as they usually seem to be).

• The popularity of buffet service (often with passengers serving themselves): buffets are known to be especially risky type of food for a number of reasons (see future blog).

Investigation of on-board outbreaks has sometimes traced them back to just one ill crew member, which, by the end of the cruise, resulted in over a hundred, or several hundred, illnesses. The original carrier of an illness may also have been a passenger who came on board while ill (not wanting to miss a pre-paid cruise). He or she may then have passed it on to a crew member (cleaning up the mess) and from there to other crew members, including kitchen staff, and on to food and more passengers and crew.

Norovirus - the most common cause of gastrointestinal illness on board - is so very easy to pass on. Just a few viruses on a table surface, a fork or a lettuce leaf will do it. It is also extremely difficult to deep sanitize an infected ship if Norovirus is involved. I have looked at numerous cases in CDC records where the same ship was involved in repeated outbreaks in spite of all the efforts made.

TSF

IS CRUISE SHIP FOOD SAFE TO EAT?

No, eating too much and putting on weight is not what you should worry most about on that cruise you are about to take. Worry instead about gastrointestinal illness, often originating in those mountains of food served.

But look on the bright side: if you do come down with a really bad bout of vomiting and diarrhea, you may even lose weight. Mind you, there is that unfortunate downside: I guess you wouldn't enjoy the cruise all that much if you spent half of it doubled over the "lu" throwing up, instead of sunning on deck, going to all those shows and playing bingo.

The statistics show that cruises are one of the most dangerous places to eat. And things are not improving in spite of special programs such as the US one operated by the Centers for Disease Control (CDC) which inspect ships entering US ports for cleanliness (including of the food), employee hygiene, and collects statistics on the number of illnesses that have occurred on that trip.

I dug up CDC statistics on cruise-ship-based outbreaks of gastrointestinal illness. Let me tell you now, the news is not good. In the year 1999, only one outbreak was recorded on a cruise ship. 2000 and 2001 were pretty good too, with 5 and 4 outbreaks respectively. But during the last 9 years (2002 through 2010) there has been an average of 21.3 outbreaks in the cruise ships entering US ports, with all the major cruise lines involved, from the most expensive to the cheapest. In 2006 there were 33, and in 2004, 32. Some of these were repeats, in the sense that the same ship would have repeated problems, one cruise after another (more on this in another blog). This year - 2011 - is not off to a great start either, with a Celebrity Cruises ship (Celebrity Solstice) and a Royal Caribbean cruise ship (Radiance of the Seas) having outbreaks in January or early February.

And don't think it is just a case of a couple of people becoming ill and you won't be one of them. I haven't finished analyzing all the data yet, but the outbreaks I have looked at so far, show between 3% and 25% of passengers affected (plus a good number of the crew), and of course, as usual, these statistics are likely to be an underestimation, as not everyone who becomes will go to see the ship's doctor.

With a few exceptions, the cause of the illnesses has been Norovirus, which is sometimes called "the cruise ship virus." It is very, very contagious, and the most common way to catch it is from food, although it can be passed from one passenger to another and one crew member to another either directly or indirectly (e.g. through vomit spattered around). Usual symptoms are vomiting and diarrhea, and sometimes also a low-grade fever and headache - not exactly what you want on that long-anticipated cruise that you paid so much for and usually only lasts a few days anyway.

TSF