Lessons From a 2016 Large-Scale Contamination of Cereals With Salmonella altona in Israel

A national food safety crisis, caused by a large-scale contamination of popular cereal brands with Salmonella altona, occurred in Israel during the summer of 2016. Previous major food safety events in Israel had led to significant changes in public awareness and perception, as well as in food safety regulations.^1,2 Here, we discuss lessons learned and future influence on national food safety policy and legislation.

THE EVENT

On July 28, 2016, in response to queries from the press, the Israeli branch of a large multinational consumer goods manufacturer disclosed that a month before, it had halted one of its main food assembly lines from production of several popular cereal brands because of Salmonella contamination (Figure 1).³ One day earlier, this company had been asked by journalists about the shortage of those popular breakfast cereal brands in many retail stores around the country. The message delivered to the public at this stage was that of zero risk to consumers from contaminated products because, allegedly, none of the contaminated products’ batches were shipped outside the factory for marketing.

FIGURE 1—

Chronology of the Large-Scale Contamination Event of Cereals With Salmonella altona, June–August 2016, Israel: Israel Association of Public Health Physicians (IAPHP)

Following the delayed announcement by the manufacturer, on July 28, 2016, the Israel Association of Public Health Physicians of the Israel Medical Association issued a public health warning to consumers and regulatory authorities concerning the realistic risk that potentially contaminated food products did arrive to the market after all. This warning became an unfortunate reality on August 4, 2016, when the company announced that contaminated cereals had been eventually marketed. This revelation was possible only after the Ministry of Health ordered the manufacturer to publish the batch numbers of contaminated products, and, shortly after that, consumers reported to have those products at their homes.

The Event’s Aftermath

Apparently, more than 150 000 potentially contaminated individual packs of cereals (approximately 120 tons) from several product batches were quarantined by the manufacturer. The quarantine took place probably at the end of June 2016, after the contamination was first identified by a private laboratory in a routine sample. The manufacturer is a large and established corporation, acknowledged by a Good Manufacturing Practices permit by the Ministry of Health.

The Ministry of Health has since opened an active in-depth official investigation, and has transiently suspended the plant’s Good Manufacturing Practices permit. The event attracted unprecedented public, media, and political attention. An official parliament committee discussed the event, and possible changes to the food safety legislation are currently being considered.

Food Safety Challenges Highlighted by the Event

Public trust.

Public concerns were the apparent lack of timely and appropriate information disclosure by the manufacturer, which appeared to have directly, immediately, and significantly reduced the public trust level in the food industry countrywide. Strengthening trust is one of the cornerstones of the public health ethical code directives.⁴ In particular, trust is fundamental in the food industry, in which it is impossible to test food products at all times by an external audit. Therefore, food safety measures heavily rely on internal food quality assurance programs by the manufacturers.

Risk communication.

The manufacturer’s approach of communicating that there was zero risk to the public from the event failed, once it was obvious that several hundred potentially contaminated packs were marketed, sold, and consumed. The manufacturer then quickly diverted its responsibility to an outsourced external logistics warehouse that was regularly used to store all the manufactured batches. This approach was probably devastating for its lack of credibility and potentially panicked consumers overproportionally to the true risk estimate of exposure to the contamination. Early warning and appropriate information disclosure could have led to earlier investigation and identification of marketed contaminated products. As exemplified in the current event, early reporting and proper information disclosure could be beneficial for all partners.

Self-regulation.

The limitation of a self-regulated quality assurance food safety system heavily dependent on the manufacturer’s infrastructure is clear in this event. According to current food regulations, manufacturers do not need to disclose information on contamination as long as it is fully contained inside the factory. In the current event, the company did not report to the regulator for more than a month, holding to its zero-risk communication; however, there is a very thin line sometimes between an apparent “fully contained” contamination and a potential outbreak of disease, as manifested by the current event. First, contaminated batches of products (approximately 120 tons of cereals) were transported to an external outsourced logistics warehouse together with the noncontaminated batches. Second, the external warehouse was not supervised by the manufacturer’s own employees. Third, the contaminated batches were not physically quarantined in the warehouse but, rather, had an automated “virtual blockade” that was allegedly supposed to prevent any shipment of non–quality-assured products. Fourth, the initial identification of contaminated product was done by a privately owned laboratory, hired by the manufacturer, which is not legally obliged to report to regulatory authorities.

National Food Authority.

The current event highlights a decades-long discussion, since 1966, for and against a National Food Authority. In Israel, the food regulations and supervision responsibilities are historically divided among multiple authorities, which adds unavoidable complexity to communications. This issue has been recently addressed again, by the State Ombudsman office, which concluded in favor of a National Food Authority.

SALMONELLA CONTAMINATION IN DRY FOODS

Salmonella contamination of dry foods is a rare but high-risk potential food safety event. In 2008, a recurrent large multistate salmonellosis outbreak in the United States was linked to a construction project adjacent to a large US-based cereal manufacturer, which created an open wall near the cereal production area, allowing introduction of Salmonella agona into the cereal product, one decade after a similar outbreak was linked to the same plant and same Salmonella strain, highlighting the resilience of Salmonella in dry food production environments.⁵

In 2012, a large multistate salmonellosis outbreak in the United States was linked to one manufacturer. An audit of the manufacturer’s internal microbiological sampling quality assurance program revealed that it was insufficient to adequately prevent shipment of contaminated product. Furthermore, the manufacturer had shipped portions of peanut butter lots that had previously tested positive for multiple Salmonella serotypes.⁶

A recent systematic literature review and meta-analysis found that low-moisture foods were increasingly implicated in outbreaks of foodborne illness, resulting in a significant public health risk,⁷ which could be well underestimated by food producers and regulatory authorities. Cereals and grains were the most commonly investigated low-moisture foods, and Salmonella was the most commonly investigated microbial hazard. Salmonella was linked to most of the outbreaks, several of which were large and widespread, resulting in the most hospitalizations and deaths.⁷

CONCLUSIONS

The crisis raises multiple aspects and discussion points regarding public health, food safety, corporate responsibility, and need for an appropriate regulatory jurisdiction. The lessons learned can serve as an opportunity to enhance and integrate food safety systems in Israel and elsewhere. This major food safety event also emphasizes the important role of independent, civilian, and professional organizations advocating a decisive public health response by policymakers to such events, as well as the unequivocal public demand from the food industry for increased transparency and trustworthiness.