Page 133 - Journal of Special Operations Medicine - Fall 2017

Other problematic findings surrounding the outbreak included coverage. PM teams inspect and evaluate local storage, prepa-
a lack of traceability in the food supply chain, both retroac- ration, and serving areas, as well as any wastes or leftovers.
tively (track-back capability) and prospectively (trace-forward Effectively, the DoD implements a system of checks similar to
capability). It took more than 8 days of comparing shipping those of the U.S. Food and Drug Administration and the U.S.
manifests, examining supplier records, and looking at finan- Department of Agriculture. Food-related illnesses and out-
cial transactions to determine the route the contaminated breaks are now much rarer occurrences at DoD dining facili-
foodstuffs took to reach Baghdad. Once the spinach, arugula, ties than in the past. In a forward setting, food stuffs are often
mint, and parsley were identified as culprits (the potato salad sourced internationally from different countries and procured
was made with contaminated parsley), only the fact that all locally; yet, they are still held to the stringent DoD system of
those were grown only on one farm in Turkey allowed the scrutiny. Other nations, however, may be less stringent or use
warehouse to purge its stocks from contaminated suppliers. less scrutiny than the U.S. DoD.
Had the warehouse used multiple sources of those particular
foodstuffs, the warehouse would have had to purge its entire Conclusion
stock of those foods. The warehouse would have been unable
to differentiate different shipments as well. A foodborne gastroenteritis outbreak occurred on a diplo-
matic compound in Baghdad, Iraq, from 30 September to
All food supply chain nodes should maintain a system to iden- 12 October 2016. Phylogenetic analysis to compare clinical
tify sources and recipients of each item. For each step in the strains was impossible owing to technical limitations and con-
supply chain, food shipments should include the immediate straints. A preponderance of evidence, however, implicated the
past source of the commodity, lot identification, quantity, most probable etiological agent as E. coli. Produce and salad
packing date, receipt date, identity of the carrier, and recipient items from the dining facility served as the vehicles of trans-
of shipment. The investigators were unable to determine the mission. Spinach and potato salad made from contaminated
number of lots contaminated because the warehouse did not ingredients served in the only communal dining area were in-
break up lots. Of note, because the warehouse service had not criminated at the source of production. All time, temperature,
identified or numbered separate lots of produce, investigators preparation, and hygienic procedures for storage, preparation,
had to purge all the lots. and serving had been followed. The outbreak had not been
exacerbated by living conditions or hygienic practices of the
Other points to consider include that when using high-risk food affected population.
sources, it is recommended to either exclude the foods entirely
from consumption or to cook the foods thoroughly. There is References
a case for seasonally excluding produce based on risk profile. 1. World Health Organization and Food and Agriculture Organi-
For instance, produce contamination spikes during the spring zation of the United Nations. Codex Alimentarius: international
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/en/. Accessed 16 August 2017.
fertilization. Another factor is that highly vascular plants are 2. Department of the Army. Tri-service food code. http://www.med.
able to recover viable cells from inner tissues; therefore, E. coli navy.mil/directives/Pub/5010-1.pdf. Accessed 16 August 2017.
can migrate to internal plant tissue, where it is inaccessible to 3. Departments of the Army and U.S. Marine Corps. Department of
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Robust local national agency controls or U.S. Army veterinar- tion of chlorinated water in killing pathogenic bacteria on raw
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