CHICAGO — Even though more foodborne illness outbreaks are being detected than there were a few years ago, state and federal officials say significant progress has been made in the fight for food safety.
Technological and scientific advances such as whole genome sequencing are credited for much of the progress, but the three P’s are the most effective weapon in the arsenals of public health and private business. People. People. People. People to provide good examples for employees, people to pursue pathogens, people to persevere when it’s not popular.
Town hall participants for the 20th annual Food Safety Summit this week in suburban Chicago were, from left, Steve Mandernach, Robert Tauxe, Stephen Ostroff and Paul Kiecker.
“We all have to model good behavior. Managers must follow the rules,” said Steve Mandernach, bureau chief for food and consumer safety at the Iowa Department Inspections and Appeals.
“(It) takes traceback and that needs more people,” said Rob Tauxe, director of the Division of Foodborne, Waterborne, and Environmental Diseases at the Centers for Disease Control and Prevention.
“Regulations are not a substitute for a food safety culture among people at all levels,” said Stephen Ostroff, deputy commissioner for foods at the Food and Drug Administration.
The trio joined Paul Kiecker, USDA’s acting administrator for the Food Safety and Inspection Service, on stage Thursday for a town hall meeting with attendees of the 20th annual Food Safety Summit in suburban Chicago.
Each of the heavy hitters took their turn at the speaker’s podium before taking questions from the audience. About 1,800 people attended the summit this year.
The public officials had individual messages from the perspective of the agencies they represent, but common threads ran through their presentations. Their common goals include reducing foodborne illnesses through preventive practices and reducing the size of foodborne outbreaks through early detection and transparent traceback to the source of the implicated food.
Here are some of the highlights from their remarks.
Steve Mandernach — Iowa Department of Appeals and past president of the Association of Food and Drug Officials
With a high percentage of foodborne illness outbreaks attributed to restaurants, Mandernach said the industry is not keeping up with “change leaders” from other food businesses. In 2015, he said, there were 902 outbreaks, with 60 percent attributed to the restaurant sector.
“But food safety still isn’t much of a focus for restaurants,” Mandernach said. “You know those message boards you see in the back of every restaurant? I’ve never seen one say anything about food safety.”
A question restaurant operators should be asking every employee every day is “How are you feeling?” Foodservice workers just can’t work when they are ill or there is no way restaurants can stay ahead of problems.
“I have the same problem with my inspectors. It’s our nature to keep going even if we are sick. That can’t happen if we want to reduce foodborne illnesses,” he said. 
The restaurant sector also needs to catch up to other groups in the food industry in terms of environmental testing. If you don’t know what’s there, you can’t get rid of it, Mandernach said. Restaurant operators also need to take their heads out of the sand and deal with reality.
“When you get a health department report that shows violations, respond. Be proactive. That will reduce illnesses,” he said. “… Be proactive about outbreak suspicions, too. If norovirus is suspected, go ahead and do the noro clean. Don’t wait for it to be confirmed.”
Robert Tauxe — Director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases
Science is front and center at the CDC, Tauxe said, and technological advances in the past 25 years have given the agency’s scientists, epidemiologists and researchers ever-increasing accuracy in their investigations.
“We investigate about 200 clusters (of foodborne illnesses) each year,” Tauxe said, citing whole genome sequencing of pathogens as a game changer for disease detectives.
“But sequencing must be paired with patient interviews to see the whole picture.”
The CDC saw great results with its recent project to sequence isolates of Listeria monocytogenes. Tauxe said the project added DNA fingerprints of many Listeria monocytogenes strains to the public health database. That means when listeriosis is diagnosed, there is a much better chance of determining if a patient is part of an outbreak or just an isolated case.
Tauxe said by the end of this year the CDC will begin similar sequencing projects for E. coli and Salmonella. But patient testing is only one factor in an outbreak.
“We need the collaboration of industry when we identify a specific food in an outbreak investigation,” he said.
Paul Kiecker — USDA’s acting administrator for the Food Safety and Inspection Service
Whole genome sequencing is also an important tool for the federal agency responsible for meat, poultry, and certain egg products, aka the U.S. Department of Agriculture. It’s an example of how the USDA’s Food Safety and Inspection Service (FSIS) has embraced modernization.
“All FSIS labs use whole-genome sequencing,” Kiecker said. “We do real-time sequencing on all regulatory samples now.”
Kiecker said regulators and industry must work harder to detect problems.
“Sequencing gives us a better way to understand pathogens,” he said. “It’s also a tool for industry to use in their reviews of their own operations to make important decisions.”
However, just because the agency’s labs are using sequencing technology, it doesn’t mean everything’s up to date at FSIS. 
Kiecker said he and the agency are focused on modernization right now. “Can we do things better? Are we using the most modern inspection tools and procedures?”
The bottom line for Kiecker is a higher bar.
“We have so much more that we can accomplish,” he said.
Stephen Ostroff — deputy commissioner for food and veterinary medicine at the Food and Drug Administration
As the only person on the town hall stage Thursday to mention current foodborne outbreaks, Ostroff put his cards face up on the table. 
He discussed the status of the Salmonella outbreak traced to Rose Acre Farms, the E. coli outbreak associated with romaine lettuce, and the Salmonella outbreak traced to multiple kratom products. 
The Salmonella outbreak traced to dried coconut also made Ostroff’s outbreak update list, providing him the chance to remind importers in the audience about the requirements regarding verification of foreign suppliers’ food safety programs. While all outbreaks are challenging, the coconut investigation was a relatively quick, straightforward task.
That has not been the case in the Salmonella outbreak involving kratom products. To begin with, FDA still isn’t sure which regulations are most appropriate for the plant leaves, which are most often consumed in powdered form or tea. Is it a  drug, or a food, or a dietary supplement? Various companies that produce, import and sell kratom products have differing labeling claims that fit the three category definitions.
But the FDA has compelling evidence that various forms and brands of kratom available in the United States are dangerous. The agency has been investigating the substance for several years, but the ongoing Salmonella outbreak traced to it has prompted the agency to intensify its focus on kratom.
“We have sampled (tested) 80 or 90 products,” Ostroff said. “Fifty percent are positive for Salmonella.”
The agency doesn’t have that kind of laboratory evidence in the ongoing E. coli O157: H7 outbreak associated with romaine lettuce, mostly because of the short shelf life of fresh produce, but Ostroff said the epidemiological evidence is clear. That clarity is clouded, however, by as yet unknown factors.
“This is a very unfortunate reminder of what needs to be done better,” he said of the elephant in the room. Virtually everyone at the Food Safety Summit was aware of and closely following the outbreak linked to romaine, but few presenters broached the topic.
“Clearly something relatively cryptic is going on in this outbreak. If we knew more we would have reported it,” Ostroff said.
The FDA’s top food cop said the leafy greens industry has taken significant steps to address situations like the current outbreak since the deadly 2006 E. coli outbreak traced to fresh spinach. However, he did not go so far as to say the industry has done everything possible.
For example, he said, it’s pretty obvious that the implicated romaine was grown in the Yuma, AZ, area. So obvious that since April 13 both FDA and CDC have been warning consumers to avoid romaine from that area.
“But how do consumers know where it came from? Better labeling in that regard would help consumers a great deal,” Ostroff said.