unreported, either because the victim doesn’t see a doctor or there is no spe- cific diagnosis, according to Charles Ler- ner, MD, epidemiologist for Methodist Healthcare System in San Antonio and past chair of the TMA Committee on In- fectious Diseases. Food-borne infections, however, can cause serious illness and death. Dr. Lerner says prompt reporting by health care professionals to their local
health departments is necessary to halt the spread of food-borne illness. He testified before the House Com- mittee on Public Health in August 2010 when it conducted a hearing on the safe- ty of the food supply in Texas. During his presentation, Dr. Lerner described physicians as “the eyes and ears of the community” in relation to food-borne ill- ness. Physicians, he said, are responsible for treating ill patients and fulfilling the
New regulations affect farmers’ markets, cottage foods
Senate Bill 81 by Senator Jane Nelson (R-Flower Mound), chair of the Senate Committee on Health and Human Services, addresses food safety in cottage food operations and at farmers’ markets. The new statute allows the Texas Department of State Health
Services (DSHS) or a local health department to issue a temporary food establishment permit — valid for up to one year — to a per- son selling food at a farmers’ market. The Texas Health and Human Services Commission can set temperature requirements for food prepared, sold, or distributed on site at a farmers’ market, but can’t mandate the specific method for complying with temperature control. Cities with farmers’ markets may adopt rules specifying the method used to comply with the temperature control requirements. The temporary permit regulation doesn’t apply to farmers’ mar-
kets in counties with fewer than 50,000 people and that have no local health department. The statute also defines a cottage food production operation to include people who operate out of their homes and produce and sell baked goods, canned jams or jellies, or dried herbs or herb mixes. SB 81 applies to cottage food operators who sell directly to consumers from their homes and who have annual gross incomes of $50,000 or less from the sale of food. Local health departments don’t have authority to regulate the
production of food at a cottage food operation, but they will main- tain records of complaints made against a cottage food production operation. The new regulations prohibit cottage food operations from sell- ing their products through the Internet and require them to label foods sold to consumers with the name and address of the opera- tion and a statement that neither DSHS nor the local health depart- ment inspected the food.
28 TEXAS MEDICINE November 2011
duty to report notifiable conditions to their local health departments. DSHS says physicians must report these food-borne illnesses:
• Salmonellosis, • Shigellosis, • Shiga toxin-producing Escherichia coli infections,
• Vibriosis, • Listeriosis, • Campylobacteriosis, • Typhoid fever, and • Botulism.
To view a complete list of notifiable conditions and reporting requirements, visit the DSHS website,
www.dshs.state
.tx.us/idcu/investigation/conditions. A list of disease-reporting contacts by county is available at
www.dshs.state
.tx.us/idcu/investigation/conditions/ contacts. According to CDC, foods most com- monly associated with food-borne illness include raw meat and poultry, raw eggs, unpasteurized milk, and raw shellfish. The agency notes that raw fruits and vegetables, especially those processed under less-than-sanitary conditions, are of particular concern. Raw celery was the culprit in a South
Texas Listeria outbreak last year. Last Oc- tober, DSHS ordered Sangar Fresh Cut Produce in San Antonio to stop process- ing food and recall all products shipped from the plant since January 2010. Lab- oratory tests of chopped celery from the plant indicated the presence of Listeria monocytogenes, a bacterium that can cause severe illness. The testing was part of a DSHS investigation into 10 listerio- sis cases, including five deaths, reported to the department in eight months. DSHS inspectors found sanitation
problems at the plant, including a con- densation leak above a food product area, soil on a preparation table, and hand-washing issues. “Listeria isn’t a common organism,” Dr.
Lerner said. “It was caught and solved with a low number of infected people because our reporting and investigative capabilities are much better than they were years ago.”
Symptoms of listeriosis can include
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