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2009 FoodNet Telebriefing Transcript, Thursday April 15, 2010

Thursday, April 15, 2010.

Operator: Welcome and thank you for standing by.  At this time all participants are in a listen-only mode.  During the question and answer session, if you'd like to ask a question, please press star-1 on your touchtone phone.  Today's call is being recorded.  If you have any objections, you may disconnect at this time.  I would now like to send the meeting over to miss Lola Russell.  Thank you, you may begin. 

Lola Russell: Thank you so much, Lisa.  Good afternoon, everyone.  Today we will be discussing findings from preliminary 2009 data reported by the foodborne disease active prevalence network or food net, which is a collaborative project of CDC, the U.S. Department of Agriculture, Food Safety and Inspection Service, the U.S. Food and Drug Administration, and ten state health departments.  FoodNet is the most complete and up-to-date source of information about trends in foodborne illnesses in the United States.  Our speakers today will be Dr. Chris Braden, Acting Director of CDC's proposed Division of Foodborne, Waterborne, and Environmental Diseases.  Dr. David Goldman, Assistant Administrator of Office of Public Health Science, USDA Food Safety and Inspection Service.  And Dr. Jeff Farrar, Associate Commissioner for Food Protection, FDA.  Following their comments we will open the lines for the media to ask questions that may be addressed to Doctors Braden, Goldman, and Farrar.  Each reporter will be allowed one question and one follow-up.  If you have any questions following this press briefing you may call the CDC media line at 404-639-3286.  The FDA's media line at 301-827-9182.  Or USDA's media line at 202-720-9113.  The transcript from this briefing is both manuscript and audio files will be posted to the CDC division of media relations website within a few hours.  I will now turn it over to Dr. Braden. 

Chris Braden: Good morning, and thank you for joining us today.  And thanks, also, to my colleagues here at CDC, the USDA, FDA, and our FoodNet sites around the country who are fatal partners in doing this important work.  Let me start out by saying that foodborne diseases affects millions of people each year and remain an important problem in the United States.  Solutions to this problem will require multifaceted approaches that involve public health, regulatory agencies, industries, consumer groups, and consumers.  Working together, I believe we can protect more Americans from preventable foodborne illnesses. 

Today, we're publishing the preliminary data for the year 2009 from our foodborne diseases active surveillance network, which we refer to as FoodNet.  This is a surveillance system that collects information from sites in ten states about diseases that are caused by nine organisms commonly transmitted through food.  It is designed to detect everyone in the ten sites who went to a health care provider, had a sample tested, and was diagnosed with one of these infections.  FoodNet has the best data for monitoring trends in these diseases over time.  FoodNet gives us important information about which foodborne diseases are becoming less common, and which need more concerted attention. 

The MMWR report released today describes preliminary results from 2009, and compares them with data in the form of multiyear averages in two time frames.  The first comparison is with the three years of food net -- excuse me the first three years of FoodNet surveillance from 1996 to 1998.  The second comparison is with the three years preceding 2009.  That is from 2006 to 2008.  Overall, this year's report indicates that there have been reductions in the number of illnesses due to many of these important pathogens over the past 10 to 15 years.  This improvement reflects the impact of measures to prevent foodborne illnesses.  But additional measures are needed to meet the challenge to achieve further reductions.  Now let me describe in the 2009 data, compared with previous years in FoodNet surveillance.  Here are some highlights about the specific pathogens. 

First of all, we can say that since FoodNet began surveillance in 1996, campylobacter, listeria, salmonella, shiga toxin producing e. coli o-157, shigella, and yersinia, six of the pathogens that we track, have all declined.  In this 2009 limb near results, we are reporting that while campylobacter, listeria, salmonella and yersinia showed earlier declines, the rate of infection for these four foodborne diseases has remained unchanged since 2004.  This indicates that further measures are needed to prevent more illnesses due to these pathogens in particular. 

Second, while the rates of infection for shiga toxin producing e. coli 0157, the e. coli strain which causes one of the most severe forms of foodborne illnesses showed an early decline the rates then plateaued.  In 2009 preliminary results, indicate that e. coli 0157 has decreased by 25% compared with the previous three years, and has reached its lowest level since 2004.  This decrease may be due to at least, in part, the continuing efforts to decrease contamination of ground beef, and of leafy green vegetables consumed raw. 

Third in 2009, when compared with the preceding three years the incident of shigella infections decreased by 27%.  This is probably -- there are probably many reasons for this decrease in shigella infections.  Shigella infections are most often transmitted directly from person to person, often among children in child care settings, rather than through contaminated food.  Rates of shigella infections tend to fluctuate from one year to another.  The decrease in shigella infections is more likely due to these yearly fluctuations than to specific foodborne disease prevention programs. 

Next, salmonella continues to be a challenge.  Salmonella is the most commonly diagnosed and reported foodborne illness.  The incidence of salmonella infections has declined by 10% since surveillance began in 1996, but it is furthest of any of the pathogens from the goals we have set for reductions.  It's important to remember, though, that not all salmonella infections are transmitted by food and that people may also become infected with salmonella after coming in direct contact with animals such as baby chicks, turtles and frogs, and their environments or by drinking contaminated water.  So control efforts are needed in many areas. 

Last, infections increased by 85% compared with the first three years of surveillance.  While the overall number diarrheal infections is a small percentage of all foodborne infections the infections may cause severe illness or death, particularly in people with weakened immune systems.  Most diarrheal infections are the result of eating raw or undercooked shellfish. 

Finally, I would like to share some highlights about specific groups of people who are affected by illness from these pathogens.  Infants and young children.  The incidence of many of these infections is highest among infants and young children, however, for infants and young children, in particular, the risk of these infections may be associated with visiting or living on a farm, living in a home with pets such as baby chicks, turtles and frogs, or attending a day care facility, in addition to foodborne illness.  The higher incidence in this age group is also due in part to the fact that young children are more likely than older persons to receive medical attention for their diarrheal illness.  We encourage breast-feeding because it protects young infants from diarrheal illnesses.  It is also evident that for many of these infections, persons over the age of 50 are at greatest risk for hospitalization and death than younger persons.  Highlighting the need for prompt diagnosis and treatment in this age group. 

In closing, please let me remind you that the FoodNet is a collaborative effort among CDC, ten state health departments, the U.S. Department of agriculture's food safety and inspection service and the FDA.  All foodborne illnesses occur at local levels.  Therefore the local and state health departments are the first responders for investigation and control efforts.  Without our local and state public health partners, CDC cannot conduct stational surveillance to track foodborne illnesses in the U.S., and make that information available as quickly as possible so that consumers, industry, and government agencies can use it to improve the safety of our food supply.  Thank you very much for your time today. 

Lola Russell: We will now hear from Dr. David Goldman with the USDA's food safety and inspection service. 

David Goldman: Thank you, Lola.  Again, I’m David Goldman.  With the food safety and inspection service office of public health science and I would like to start by thanking our colleagues at the CDC, at FDA as well as FoodNet partners who aren't on the phone from the ten sites for the opportunity to participate in this briefing today.  We at USDA food safety inspection service for FSIS always find the FoodNet annual surveillance report to be highly important.  Our food safety program require good data to inform and drive the policy decisions that we make as we work to prevent foodborne illnesses. 

As has been mentioned, the FoodNet data indicates that the government's combined efforts to reduce e. coli 0157 contamination are showing progress.  In that regard, today's report confirms our past success in combating foodborne illness by setting an aggressive goal, designing an effective system to meet that goal, and relentlessly implementing it.  Following the 1993 outbreak of e. coli 0157, the government declared 0517 to be an adulterant in raw ground beef.  We introduced systems to prevent foodborne contamination and established FoodNet and pulse-net in setting a goal of cutting 0157 illnesses in half by the year 2010.  Around the time that FoodNet began, in the mid '90s, USDA began requiring mandatory implementation of hafa in slaughter and in processing facilities to prevent bacteria from entering in to the food supply looking back it seems logical that we require establishments to have process control systems designed to identify and prevent microbial and other hazards in the food production.  Systems that include steps designed to prevent problems before they occur, and to correct deviations as soon as they are detected.  And it has made a difference.  But, as just mentioned, there is more work to do.  And in particular salmonella remains a challenge.  As measured by FoodNet and reported this year, we have not been as successful in moving the trend line in the right direction, despite the effort that FSIS and others.  This underscores the need for better understanding of illness attributions.  That is determining which exposure, whether foodborne or not, has resulted in the illness that's been reported to public health officials.  Foodborne diseases remain a public health concern in our country, and under the president's food safety working group, we at FSIS are setting new goals and modernizing our system to meet those goals so that we can see renewed progress, and continued progress, in cutting foodborne illnesses.  Our strong partnership within FoodNet has fostered ties that will only become stronger as we all work to produce the instance of foodborne illnesses.  Once again, thank you all for the opportunity to participate in this briefing today. 

Lola Russell:  Thank you so much Dr. Goldman.  We will now hear from Dr. Jeff Farrar associate commissioner for food protection, FDA. 

Jeff Farrar: Thank you, Lola.  Thank you this is Jeff Farrar, f-a-r-r-a-r, Associate Commissioner for Food Protection here at FDA.  It's a pleasure to join my colleagues from CDC, and USDA and our FoodNet partners at the state and local level.  Thank you for having us today.  The collaboration that you're hearing from the previous speakers among FDA, CDC, USDA and our partners at the state and local levels is really critical to address the need we have to improve food safety.  We each play an important role.  This collaboration's important in targeting, designing and implementing measures that will reduce the number of foodborne illnesses and death each year.  It's also helpful in evaluating our progress in reducing these illnesses and deaths. 

Which brings us to FoodNet.  The FoodNet surveillance system is an invaluable tool for revealing trends concerning certain foodborne pathogens.  The data from FoodNet helped inform us as we review our current policies and programs, and as we plan and develop new initiatives.  We are very encouraged by improvements we have seen over the history of FoodNet, and especially in these recent results.  However, we recognize that many challenges remain.  There's much more to be done to bring down the number of illnesses and deaths for all pathogens.  There are lots of discussions under way, what the best route are to reduce these illnesses and deaths.  We do have broad consensus inside and outside of government on the need to focus additional resources on preventing illnesses and outbreaks.  Also, we have broad agreement for ensuring that our prevention-based approaches are science and risk-based.  And, that we take in to account the issues associated with large and small firms. 

We are moving forward under our existing authorities to implement many prevention-based efforts.  As an example, we have recently developed new preventive measures for the production of shell eggs to reduce the risk of contamination with salmonellaEnteritidis.  This new rule will become effective this summer.  Our estimates are that this rule may review salmonellaEnteritidis infections caused by eggs by up to 60%.  This is important as this type, particular type of salmonella accounted for the largest percentage of infections among the ten types of salmonella included in this year's FoodNet report.  This egg rule is part of a coordinated strategy between FDA and FSIS, and state and local agencies, because we share regulatory responsible for egg safety.  We're working to ensure that egg safety measures are consistent, coordinated and complementary.  FDA also is in the process of developing a very important proposed rule to address produce safety. 

roduce safety is one of the most technically challenging food safety issues we face because of the diversity of crops, the diversity of growing, planting, harvesting practices, and the diverse scale of operation.  But we do know we need prevention and risk-based standards to address the potential hazards that produce poses.  Illness attributed to produce in recent years really illustrate that pathogens can, and often do, expand their reach to new kinds of foods.  And we must design our programs to be flexible enough to apply emerging science to these new vehicles for infections.  Detecting and responding to outbreaks also is a very important real for FDA.  In California, a rapid response team was instrumental in utilizing a close, approach between state, federal and local agencies, using experts in numerous other agencies for wildlife, water and other areas during a spinach outbreak.  We're now providing funding to nine states to develop similar rapid response teams.  Another significant initiative we have implemented is a new early warning mechanism called the reportable food registry.  Which tells us about problems that we might not have suspected before.  These and many others are important steps that we are implementing under our current authority.  FDA looks forward to updating you next year on our progress with our partners at CDC and USDA.  Back to you, Lola. 

Lola Russell:  Thank you so much, Dr. Farrar.  We will now take questions from the reporters.  Remember, each reporter is allowed to ask one question, with one follow-up.  First question, please. 

Operator: The first question comes from mike Stobbe with Associated Press.  Your line is open. 

Mike Stobbe: Hi, thanks for taking the question.  My initial question has to do with listeria.  I thought that the packaged meat industry was working on it, or there were some regulations.  Would you mind talking about what might have accounted for the increase in listeria, and the idea that maybe delicatessens are a factor?  And I have a follow-up. 

David Goldman: This is David Goldman at FSIS, and I think I heard most of your question, having to do with listeria and packaged meat.  Is that correct? 

Mike Stobbe: That’s correct. 

David Goldman: Well, there was a study that was recently published and the results of that study will be incorporated into an interagency risk assessment that is currently under way between FSIS, FDA, and CDC.  That will examine the risk of deli meats among other exposures that might occur in a deli at a retail location.  And so there is a, as I said a risk assessment under way.  There's no proposals that I’m aware of in our agency regarding new regulations in that regard. 

Lola Russell:  Mike, do you have a follow-up? 

Mike Stobbe: Okay.  Yeah, I guess I’ll ask about vibrio?  And also the idea, if you mind commenting on the idea that water temperature may be contributing to unusual growth of that? 

David Goldman: This is Jeff from the Food and Drug Administration.  I have with me Mr. Don Kramer from our Center of Food Safety and Applied Nutrition who perhaps can shed some light on that. 

Don Kramer: It sounds like the question you're asking has to do with climate change?  Is that where you're headed? 

Mike Stobbe: Well, if you have other reasons I’d like to hear them.  But I’d also like you to comment on climate change and whether that's contributing in the increase in vibrio, yes. 

Don Kramer: Certainly there's no way to definitively know.  We do see changes in some microorganisms as a result of changes in the water temperature.  But, and that could manifest itself as higher illness.  I don't think we know enough to know of that effect of contributing to the increase that we're seeing them. 

Mike Stobbe: Is that doctor or Mr. Kramer? 

Don Kramer: Mr. K-r-a-m-e-r

Mike Stobbe:  Is it d-o-n?  Oh, Donald. 

Lola Russell: Can you please give us your title, please? 

Don Kramer: Yes, I’m the Deputy Director, Office of Food Safety at FDA. 

Lola Russell: Thank you.  Next question, please. 

Operator: The next question comes from Elizabeth Weiss with USA Today.

Elizabeth Weiss: Hi, thanks for taking my call.  First I wanted to ask, in previous years with the FoodNet data you've had a lovely little chart that shows the upward and downward trend of the illnesses that you're tracking.  Will that be made available? 

Chris Braden: So this is Chris Braden speaking from CDC.  That graphic is part of the publication that will be coming out today in the MMWR.  It will also be posted on our website for facts and figures.  And can I confirm which website that will be?  Yes. It’s on FoodNet. It’s www.CDC.gov/FoodNet/factsandfigures.  Did you hear that?

Elizabeth Weiss: Yes, I did. 

Lola Russell: Did you have another question? 

Elizabeth Weiss: I wanted to ask FDA about vibrio.  Now FDA tries very hard this last year to ban the sale of oysters from the gulf coast in warm weather months to lower the incidence of vibrio, and there was rather a political on that and that rule was overturned.  I’m wondering if you can talk a bit about that effort, and do you think if that effort had gone through that we would have seen these numbers come down? 

Don Kramer: Thanks, this is Don Kramer again.  I think, first, I would -- I would want to clarify on the term ban.  I think that's been widely used.  But it's important to note that what we were looking for is a treatment of the raw product in a way that would still render it as a raw product but eliminate the -- one of the pathogens that is in the vibrio group.  And as you mentioned, there were some concerns raised by that FDA, has put a statement on its website, which is still there, that explains that we are, in fact, sensitive to the issues that have been raised about the complications of moving towards what's called a post-harvest processing.  So we're in the process of looking at the costs associated with that and the steps that would need to be taken in order to facilitate the industry moving towards a post-harvest processing.  Certainly the implementation of post-harvest processing would have a very dramatic effect on the levels of vibrio vulnificus, although I think it's important to note that it's a very small percentage of the numbers of vibrio illnesses that are in that graph. 

Operator: The next question comes from Joanne Silberner with National Public Radio. 

Joanne Silberner: Yes, thanks for taking the question.  During the national discussion over the food safety legislation going through congress right now, the numbers that are always given are 325,000 hospitalizations a year, and 5,000 deaths.  If that's a 10-year-old number, can you tell me if that's true?  And then if your numbers today speak to whether those numbers are too high, too low, or just right? 

Chris Braden: This is Chris Braden at CDC and the estimates that you're referring to were published in 1999.  So yes those statements are over a decade hold now.  We have been working on new estimates and we hope to have those published this year.  It's too early to say what differences there might be in the new estimates versus the old. 

Joanne Silberner:  Thanks. 

Lola Russell: Is there another question? 

Joanne Silberner:  No, that's it. 

Lola Russell: Thank you.  Next question, please. 

Operator: Our next question is from Lyndsey Layton with the Washington Post. 

Lyndsey Layton: Hi, thanks so much for taking my call.  I don't mean to harp on vibrio but I still don't have an understanding of why we are seeing such a spike in 85%, and I wonder if someone might address, you know, if there are some theories about what is causing that. 

Don Kramer: This is Don Kramer again.  The -- the subject of vibrio is a bit more complex than maybe we'd all want it to be.  There are a number of species of vibrio that contribute to that -- to the total vibrio numbers.  We talked just a little while ago about vibrio vulnificus which is a small percentage of the numbers although a very significant illness when it does occur.  The largest numb remembers are for vibrio parahemolyticus which is gastroenteritis but the numbers are much larger, and these are typically associated with -- or the illnesses are typically attributed to temperature exposure of the shellfish after they're harvested.  So what we have been trying to do is to improve the practices in the industry in that record.  States have, within the last couple years, implemented some controls, but unfortunately, we haven't seen enough to reduce the exposure.  But unfortunately we haven't seen the numbers come down.  So what we are doing is taking a look at why that is.  The controls that they put in place should be bringing down vibrio parahemolyticus numbers.  But we're not seeing that.  So we're reassessing what needs to happen to get those numbers to come down. 

Lyndsey Layton: Thank you. 

Lola Russell: Another question? 

Lyndsey Layton: No, I’m good, thank you. 

Lola Russell: Next question, please. 

Operator: Our next question comes from Bob Roos, CIDRAP News. 

Bob Roos: Thanks for taking my question.  I was wondering if you can say for how many cases in the FoodNet data were specific food vehicles identified, and if so, which foods were the most common sources in 2009? 

Chris Braden: This is Chris Braden at CDC.  If you recall how the food net surveillance system works, this is a surveillance system that captures when a person goes to their doctor, has a specimen taken, and a laboratory confirmation of the pathogen causing the illness.  It's very difficult on an individual basis to identify what made a person ill.  Just the fact that most illnesses, if it is foodborne, which may not even be the case, but if it is foodborne, it could be anything that the person ate in the up to week or ten days before they became ill.  And it's really impossible to determine that on an individual basis.  So, the FoodNet data doesn't tell us the foods that are responsible for these illnesses, or even if it was the food.  What we do have, however, are some other surveillance systems that give us some more information in that regard.  And it's the outbreaks where we can determine the food vehicle, where we have multiple people that have been ill by consumption of a common food, and that's recognized.  We can try and identify that common food using our epidemiologic and statistical methods.  So when we do outbreak surveillance, we ask our state and local health partners to report to us the results of their outbreak investigations, and we get between 1,000 and 1200 of those reports every year and that's the information that we use to determine what foods are causing the most illness and in what types of -- with what types of pathogens. 

Lola Russell: Bob, do you have another question? 

Bob Roos: No, thank you. 

Lola Russell: Thank you so much.  Next question, please. 

Operator: Our next question is from Salynn Boyle from Web MD.

Salynn Boyle: I have a couple of questions.  Just to revisit vibrio here and dumb it down a little bit.  So how -- I’m confused, how much may be due to higher consumption of shellfish or sushi?  Or is it that simply we're eating just more contaminated? 

Don Kramer:  There’s probably a number of other possible explanations.  But, the -- there hasn't been, actually, a significant increase in consumption of shellfish, particularly oysters, which is the predominant cause.  So that's not likely to be the source.  Certainly reporting is always the possibility of an issue, whether we're getting greater reporting.  But, to be honest, I think we really don't know why we're seeing an increase in this and what our efforts are geared towards is to try to address the risk factors as I mentioned a few minutes ago.  To get those numbers to come down. 

Salynn Boyle: Is that Donald? 

Don Kramer: Yes. 

Lola Russell: Okay, thanks.  Do you have another question? 

Salynn Boyle: Just one follow-up.  As far as the eggshell initiative, can someone kind of elaborate on that as far as addressing salmonella? 

Jeff Farrar: This is Jeff Farrar with the FDA.  The egg rule is published, and available.  We'll give you the website for that.  Shortly.  Hopefully.  You can find it on our FDA.gov website.  The rule puts in place several measures that egg producers are required to follow.  This involves potentially testing their flocks, testing the environment, purchasing pellets from s.e. Tested sources.  There's a number of requirements in that current rule.  And I’d rather than not give you some of those, I’ll just point you to the website, where it's listed. 

Salynn Boyle: Okay, thank you. 

Lola Russell: Last question, please. 

Operator:  Our last question comes from Betsy McKay with the Wall Street Journal. 

Betsy McKay: Hi, thanks very much.  I wondered if we could turn back to e. coli for a second.  You talked about measures that have been implemented over several years to help bring the rates down.  I wondered if you could talk about what you think has been done over the past years to cause the decrease in 2009 over the 2006-2008 period. 

David Goldman:  Thank you, this is David Goldman at FSIS.  And thanks for that question.  FSIS has been continually interested in bringing down e. coli 0157 contamination in the products that we regulate.  So there have been, as you allude to this, initiatives over time.  But just in the past year there are several things I think worth noting.  Starting last summer, midyear, in 2009, we announced a new testing program for what is called bench trim.  So the trim that's taken off of steaks and roasts as they're being processed that go in to ground beef, that was not a component of ground beef that we were testing up until last July.  So we believe that's a very important addition to the program, and may have attributed to what you see in this report.  We have expanded now to include in our testing programs all components of raw ground beef.  So I mentioned the bench trim, there's also manufacturing trim that comes directly from the slaughterhouse which is a different source of the source material for raw ground beef as well as there are other components that go into ground beef.  And we now have implemented testing of all those components.  At the same time last summer, we issued new instructions to our employees, directing them to verify that plants are following sound sanitary practices in processing beef carcasses.  So, they were given explicit instructions about how to verify that a plant was conducting its beef carcass processing in a sanitary manner.  We certainly believe that the sanitary dressing procedures are at a critical point in the possibility that contamination might occur, and so it would be important for us to reemphasize this to our inspection personnel.  And then this kind of gets into the end of the year.  We've had several meetings which have been focused, and one of which was joint with FDA in December of '09, and then more recently, just in march of this year, meetings focused on record keeping and traceback.  And these meetings were really focused, at least for FSIS, on helping us to get back to the ultimate source of contamination.  And in so doing, when we are able to get back to the source of contamination, whether or not that's resulted in illness, or just a contaminated product that doesn't cause illness, it allows our agency to go in to that plant, do a thorough examination of their food safety system, and request corrective action.  So we believe that these are some of the more recent initiatives which might have had an impact on the illness rate.  Thank you. 

Lola Russell: Do you have a follow-up? 

Betsy McKay: Yes, a quick one if you don't mind.  First, thanks to everybody for asking about vibrio because those questions were answered.  I wondered if you could give a little more detail about this proposed rule for produce safety, or perhaps it's something that you'll point us to on the website.  Either way. 

Jeff Farrar: Yeah, this is Jeff Farrar with the FDA.  We recently opened a docket, and I'm looking for the website for that.  If we don't have it handy we'll get it to you shortly. To receive public input on this proposed rule that we have under development.  The rule will basically take a very prevention oriented approach, a very risk-based approach to finding those measures that can and should be implemented at the growing level to reduce the risk of contamination. We're taking a very pro-active effort here to reach out to industry all across the United States.  We've had quite a large number of listening sessions already to get input from those people who do this on a daily basis. Who understand the business.  We're very sensitive to input from small growers.  As well. So we're trying to get those proposed rule right before we write it.  So that's part of our outreach.  The docket number is 2010-n-0085.  You can submit the comments electronically drew www.regulations.gov. If you put in the docket number and the keyword "field" it will take you to the right place there. 

Betsy McKay: Thanks. 

Lola Russell: Thank you.  We will now have one final comment by David Goldman, with the USDA food safety and inspection service.  I'd also like to make one correction.  The FDA press line number is 301-796-4540.  Dr. Goldman? 

David Goldman: Thank you, Lola.  Again, David Goldman at FSIS.  I wanted to take just a second to mention that we have recently concluded a hugely successful food safety education conference down in Atlanta, Georgia, last month, and it was co-sponsored by our colleagues on the phone call, FDA and CDC.  And I think it's worth noting that although from our perspective at FSIS, hasa requires that the industry develop food safety systems, that we verify through our inspection activities and through our sampling activities that consumers can always protect themselves optimally if they follow our four safe handling practices, clean, separate, cook and chill.  And I think it's always worth noting that, certainly for FSIS regulated products that this provides some extra measure of safety for anyone in their own home in terms of trying to prevent foodborne illness, which is our goal.  Thank you. 

Lola Russell: Thank you so much, Dr. Goldman.  This concludes our briefing today.  Thank you so much for joining us.  Again, the FDA press line is 301-796-4540.  The CDC press line is 404-639-3286.  And the USDA media line is 202-720-9113.  If you have any additional requests or information you may call the main press office here or with our partners.  We also would like to refer you to our transcript which will be available later, as well as an audio file.  Thank you so much for joining us today. 

Operator: Thank you, that does conclude today's conference, and you may disconnect at this time. 

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