Food Safety Guide - the risk of food poisoning is increasing, as thousands die and millions become ill each year

Caroline Smith Dewaal

Remember when food safety simply meant no egg salad, cole slaw, or other mayonnaise-based dishes at your picnics? No more. * As we approach the millennium, the list of potential food poisoning culprits has mushroomed. It could be ground beef, chicken, turkey, salami, hot dogs, oysters, ice cream, or eggs. It could be alfalfa sprouts, lettuce, raspberries, apple cider, scallions, parsley, cantaloupe, or toasted oat cereal. In short, it could be almost any food. * Don't get us wrong. Most food is safe, and most people don't get sick from eating food with low levels of contaminants. But when you're the one with food poisoning, that's little comfort. * Our "Food Safety Guide" can save you time, confusion, and maybe a tour of your local emergency room.

Thousands of deaths. Tens of millions of illnesses. That's the estimated yearly damage caused by food poisoning.

And it's getting worse: Microbes are showing up in foods they never used to inhabit. "When I started working on food-borne pathogens many years ago, Salmonella was only found in foods of animal origin," says Morris Potter, director of the Food Safety Initiative at the Food and Drug Administration (FDA). "Now it's in fresh produce."

Some of the nastiest bugs simply weren't around before. "Food-borne E. coli O157:H7 didn't exist before 1982," says Potter. "The cider producers of two generations ago didn't have to contend with it."

And bad bugs spread further and faster than they used to.

"Our food supply is more centrally produced and it's more global--we're eating fresh foods from all over the world," explains Robert Tauxe of the Centers for Disease Control (CDC) in Atlanta. So one slip-up on a farm in Guatemala can sicken thousands of people across the U.S.

And we've profoundly changed the way we raise animals--a major source of food-borne germs.

"In the last 50 years we've moved from small family farms to animal cities with hundreds of thousands of animals all in the same apartment complex," says Tauxe. "Any time you bring that many animals together, there is the opportunity for infections to spread."

One answer is to clean up the farm. "There are ways of improving basic sanitation on produce and animal farms that aren't expensive or difficult," says Tauxe.

"Making the animals' feed free of pathogens, disinfecting their drinking water, properly treating the manure they produce, and isolating the contagiously ill are all part of the coming sanitary revolution on the farm," he recently wrote in the medical journal The Lancet.

Until then, you can take steps to protect yourself. For example, many people assume that if food looks and smells good, it's safe, and that if it looks and smells bad, it's unsafe. Wrong. There are two families of bacteria, explains the U.S. Department of Agriculture (USDA):

* Spoilage bacteria cause foods to smell and taste bad. They can grow in the refrigerator, even if you follow the USDA's advice and keep the temperature at or below 40 [degrees] F. But they probably won't make you sick.

* Disease-causing bacteria usually don't change the taste, smell, or appearance of food, but they can make you sick. They grow rapidly between 40 [degrees] F and 140 [degrees] F--the "Danger Zone." Some can double in number within 20 minutes. That's why it's best to toss perishable foods if they've been above 40 [degrees] F for more than two hours.

And that's just bacteria. Your raspberries, lettuce, seafood, and other foods can also be contaminated with parasites, viruses, and toxins (see "Meet the Bugs," page 9).

How can you keep them from causing a meltdown in your gut? If you're on the Web, go to www.foodsafety. gov. It has links to all the government food-safety sites. If your computer's too heavy to lug to the store with you, check out our food-by-food safety guide. It may cut your chances of having to spend hours--or days--within sprinting distance of the nearest bathroom.

Keep in mind that animal foods account for the lion's share of food poisoning. That means you have to handle raw meat, seafood, poultry, and eggs as though they were contaminated.

WHAT TO DO

* At the checkout counter, have the cashier put the meat, seafood, or poultry in a separate bag so leaking juices don't contaminate other foods. At home, refrigerate them as soon as possible.

* After touching raw meat, poultry, seafood, or eggs, wash your hands, utensils, and surfaces thoroughly with hot, soapy water.

* Don't use the same utensils and platters for raw and cooked meat, poultry, or seafood.

* Completely thaw frozen meat, poultry, and seafood in the refrigerator before cooking.

* Marinate food in the refrigerator, not on the counter.

* Don't use the marinade from raw meat, poultry, or seafood on cooked food unless it has been brought to a boil first to kill any bacteria.

* Check the internal temperature of meat, poultry, and seafood with an oven-safe, dial instant-read or digital meat thermometer.

* To make sure your thermometer is accurate, put the tip at least two inches into a cup of crushed ice topped off with tap water. It should read 32 [degrees] F after 30 seconds (be careful not to let it touch the side or bottom of the cup).

BEEF, PORK, LAMB, VEAL

In December 1992, Lauren Rudolf was the first child to die after eating an undercooked Jack in the Box hamburger infected with the deadly E. coli O157:H7 bacterium. For three weeks--until the source of the contamination was identified--people in four western states continued to eat contaminated burgers. The toll: four children dead and more than 700 people ill.

"E. coli O157:H7 produces a toxin that damages the intestine, kidney, and brain," says Tauxe. "It's an extremely potent toxin. It takes only a small number of the bacteria and only a small amount of the toxin to cause illness."

The bug sickens an estimated 25,000 people--and kills an estimated 100--in the U.S. every year.

"The illness is essentially untreatable," says Tauxe. "It doesn't matter if you take an antibiotic. The antibiotic just kills the bacteria, releasing more toxin."

E. coli O157:H7 is more likely to contaminate ground beef than steaks, roasts, and other cuts because bacteria on the surface can end up inside the patty, where cooking temperatures may not be high enough to kill them.

"Mechanically tenderized" meat can also harbor E. coli O157:H7. If pins are used to soften the meat, they can drive the bacteria below the surface.

So far, E. coli O157:H7 hasn't shown up in pork, veal, lamb, or poultry, even if they're ground.

WHAT TO DO

* Use a meat thermometer to make sure your meat--especially ground beef--reaches an internal temperature of 160 [degrees] F. Checking the color of a hamburger (to make sure it isn't pink inside) doesn't guarantee that all E. coli are dead.

* Always cook pork (including pork sausage) to at least 160 [degrees] F to kill any Trichinella, a parasite that can cause abdominal pain, diarrhea, and (two or three weeks later) muscle pain, fever, and swelling.

POULTRY

It's the way we raise and slaughter chickens and turkeys that leads many birds to be contaminated.

After they're killed and their blood has been drained, they're put in a communal bath--a perfect way to spread bacteria from one carcass to another. Then rubber "fingers" rub the skin to remove the feathers. That pushes bacteria into the pores. After the insides are removed, the carcasses are chilled, which closes the pores ... and traps any bacteria.

Of all the germs that inhabit the chicken coop, Campylobacter is king. It causes more cases of food poisoning than any other bug. The microorganism sickens an estimated two to four million people--and kills 120 to 360--in the U.S. each year.

The worst part of a Campylobacter infection may not be the vomiting and diarrhea. In an estimated one in a thousand cases, it may also lead to Guillain-Barre Syndrome, a neurological disease that can cause (temporary or permanent) numbness, pain, progressive weakness, and paralysis.

WHAT TO DO

* Use a minimum cooking temperature of 325 [degrees] F and cook turkey or chicken until it reaches a temperature of 180 [degrees] F (dark meat) or 170 [degrees] F (white meat), measured by a meat thermometer stuck in the thickest part of the meat. Cook boneless turkey roast to 170 [degrees] F to 175 [degrees] F.

* Even if the bird comes with a pop-up thermometer, check the temperature with a meat thermometer.

* If you use a microwave to defrost frozen chicken or turkey, cook the bird as soon as it's thawed.

* If you defrost a frozen turkey in the refrigerator, allow 24 hours for every five pounds. (That means a 20-pound frozen turkey for Thanksgiving has to start defrosting the previous Sunday.)

* If a frozen turkey is wrapped in leak-proof plastic, you can defrost it in cold water, but the water should be changed every 30 minutes. Allow 30 minutes of defrosting per pound.

* If you buy a hot, take-out turkey (or any other food), keep it at or above 140 [degrees] F if you'll be eating it within two hours. If you'll be eating it more than two hours later--or if you buy a cold pre-cooked turkey--dismantle your feast and refrigerate it. Remove the stuffing and cut the turkey off the bone. Wings and legs can be left whole. When you're ready to eat, reheat the meat and stuffing to 165 [degrees] F and boil the gravy.

Stuffing

It's safest to cook stuffing separately. If you do cook it in the bird:

* Stuff the bird loosely just before you put it in the oven (about 3/4 cup of stuffing per pound of poultry).

* Use a meat thermometer to make sure that the center of the stuffing reaches 165 [degrees] F.

* If the chicken or turkey is done before the stuffing is fully cooked, remove the stuffing and heat it on the stovetop to 165 [degrees] F. Avoid prestuffed fresh chickens or turkeys.

SEAFOOD

You never know which bugs you'll find in raw or undercooked shellfish.

Vibrio vulnificus is the most dangerous and Norwalk virus is the most common. And unlike other pathogens, which target people with weakened immune systems, Vibrio parahaemolyticus can make just about anybody sick.

"Parahaemolyticus is an equal-opportunity gut wrencher," says George Hoskin of the FDA's Office of Seafood.

In June 1998, 416 people in 13 states were made ill by a strain of Vibrio parahaemolyticus.

"This strain appears to be more virulent," says Hoskin. Some speculate that it got to the Gulf of Mexico in ballast water dumped by a passing ship.

Even if your seafood is thoroughly cooked, it could make you sick. Ciguatera toxin is a neurotoxin found in fish harvested from reef areas. Scombroid poisoning comes from histamine that can form on the flesh of fresh tuna, mahi mahi, and some other fish that aren't kept cold enough (usually before they reach the store). Neither is killed by heat.

WHAT TO DO

* Don't eat raw shellfish, especially from the Gulf Coast.

* To cut your risk of ciguatera poisoning, avoid locally caught grouper, amberjack, and red snapper in tropical areas. It's especially a problem in Florida, the Caribbean, and Hawaii. Avoid barracuda everywhere.

* The fish most likely to cause scombroid poisoning are fresh (not canned) tuna and mahi mahi.

DAIRY

It wasn't the ice cream plant or the people who worked there. It wasn't the chocolate flavoring that went into the ice cream. The source of the largest Salmonella outbreak in U.S. history was the tanker trailers that transported the pasteurized "premix" to a Schwan's plant in Minnesota, where it was made into ice cream.

A few months before the 1994 outbreak, the trucking company used by Schwan's started transporting greater quantities of unpasteurized eggs from plants in Nebraska and Iowa to egg processors in Minnesota.

"To save time, drivers could elect to bypass the cleaning procedure after unloading the eggs," explained Thomas Hennessy of the Minnesota Department of Health.

The damage: an estimated 224,000 people sickened. In Minnesota, over half the victims had diarrhea that lasted a week or more plus (in most cases) fever and chills and (in nearly half) bloody stools. A quarter had to be hospitalized.

What's more, when researchers at the CDC surveyed Schwan's customers in Georgia, they found that in nearly a third of the 72 households that had Schwan's ice cream in the freezer when a family member heard about the recall, someone in the family later ate the ice cream anyway.

"In 90 percent of those households, people just didn't believe there was a problem with the ice cream," says the CDC's Laurence Slutsker.

WHAT TO DO

* Watch for recalls in the local paper or on the news. Don't eat the food, even if it appears to be safe.

* Avoid raw (unpasteurized) milk and cheeses made from raw milk, unless they've been aged for at least 60 days (it should say on the label). All could harbor a bacterium called Listeria, which is especially dangerous for pregnant women and their fetuses.

* You can also get Listeria from soft cheeses (like feta, Brie, Camembert, blue-veined, or Mexican-style "queso blanco"--whether they've been pasteurized or not), but not from cottage cheese, cream cheese, or hard cheeses.

EGGS

"This morning there were 70 people who were symptomatic and by lunchtime it was around 100 and this afternoon it is about 120," Curtis Thorpe of the Henrico (Virginia) Health Department told the Richmond Times-Dispatch in June.

All of the 100+ victims had worked or eaten at an International House of Pancakes (IHOP) restaurant outside of Richmond. The culprit: Salmonella enteritidis in eggs used to make French toast that hadn't been cooked enough to kill the bacteria. When the Richmond IHOP re-opened, it switched to pasteurized eggs.

WHAT TO DO

* Avoid foods that traditionally use raw eggs unless the eggs have been pasteurized. That includes Caesar salad dressing, tiramisu, chocolate mousse, lemon (or other) meringue pie, and homemade ice cream. The eggs in lasagna, baked ziti, French toast, or rice, banana, or bread pudding can also be undercooked.

* Keep eggs in their original cartons, and use them within a month or so.

* Discard any cracked eggs.

* Thoroughly cook all egg dishes (to a temperature of 145 [degrees] F), including French toast and omelets. Cook fried or sunnyside-up eggs until the yolks are firm.

* Don't lick cake batter, raw cookie dough, or homemade frosting that contains raw eggs. If you can't resist licking, bake with pasteurized egg products (like Egg Beaters).

* Store-bought eggnog is pasteurized. If you make your own, use pasteurized eggs. If you use whole eggs, gradually heat the egg-milk mixture to 160 [degrees] F or until it coats a metal spoon.

FRUITS & VEGETABLES

Salmonella from cantaloupe. Hepatitis A from strawberries. Cryptosporidium from scallions. Shigella from parsley. The list of disease-causing microbes in fruits and vegetables is almost as varied as our supply of fresh produce. A few key examples:

Lettuce

In 1996, Rita Bernstein of Wilton, Connecticut, served mixed, prewashed lettuce to her daughter Haylee, then three years old. That salad almost blinded the child.

The lettuce--which sickened 60 others in New York, Illinois, and Connecticut--was contaminated with E. coli O157:H7. After visiting the California farm where it was grown, investigators weren't surprised.

The workers who picked the lettuce washed it in water that came from wells near cattle pastures, and no one had added chlorine to the water to kill any bacteria.

"They picked the lettuce and dunked it in a bath of cold water--called a hydrocooler--to cool it down quickly," says the CDC's Robert Tauxe. "In a big, centralized food supply, that's how one dirty hand or manure run-off on a few heads of lettuce spreads to thousands and thousands of heads going all over the country. If the bath is contaminated, it spreads to all of the produce."

California now makes sure that only clean water is used in the hydrocoolers on its produce farms, says Tauxe. But there was recently an outbreak of another bacteria, Shigella, in parsley from a farm in Baja California, Mexico.

"The hydrocooler was using water from the local village water supply, which wasn't chlorinated," he explains. "In fact, the farmworkers got bottled water as part of their contract so they wouldn't have to drink the local water."

Says Tauxe: "If the food industry is going to wash produce that I'm going to eat without cooking, I want them to use water that I would drink."

Berries

"I got ferociously ill," Barney Savage, a 32-year-old administrator at York University, told the Toronto Star in April.

The previous May, Savage and five friends had eaten a raspberry dessert at a restaurant. Within a week, all six were statistics in the 1998 Canadian Cyclospora outbreak in which 200 people became ill.

Cyclospora is a microscopic parasite that invades the gut about a week after it's ingested. It causes diarrhea, extreme fatigue, cramps, and nausea.

The first big Cyclospora outbreak hit in 1996. At least 1,465 people in the U.S. and Canada got sick. It didn't take long for investigators to finger Guatemalan raspberries, which probably picked up the bug from contaminated water.

After another Cyclospora outbreak in 1997 in which 1,000 people became ill after eating raspberries from Guatemala, the U.S. cut off raspberry imports. Canada didn't. In 1998, the year Barney Savage became ill, no Americans got sick. But some 200 Canadians did.

In 1999, the U.S. reopened raspberry imports from a few select Guatemalen farms. Health authorities are hoping there are no new illnesses.

Sprouts

In the first large U.S. outbreak (which also hit Finland), 242 cases of Salmonella poisoning were reported to health authorities in 1995. Officials estimate that between 5,000 and 24,000 people got sick.

All the seeds in that outbreak were traced to a shipper in the Netherlands. In its warehouse, investigators found rodents and birds (which could have spread the bacteria) and debris-filled bags of seeds imported from Italy, Hungary, or Pakistan.

"Bacteria and seeds like precisely the same conditions--warmth and moisture--to grow well," explains the FDA's Morris Potter. It has become clear that there is no way to guarantee the safety of sprouts.

"Consumers need to understand that, at this time, the best way to control this risk is not to eat raw sprouts," said FDA Commissioner Jane E. Henney in July.

WHAT TO DO

* Before you cut cantaloupes or other melons, scrub the skins with water and a brush. (If you don't, cutting them could transfer pathogens from the rind to the flesh.)

* Wash berries, lettuce (pre-washed or not), and other non-scrubbable fruits and vegetables with fast-running water. The friction of the running water helps remove bacteria. That's better than soaking.

* Wash fruit even if you plan to peel it. If there are microbes on the peel, they can contaminate the rest of the fruit when you peel it.

* Eat only cooked sprouts (including home-grown).

* Ask restaurants not to add raw sprouts to your sandwich or salad.

JUICE & CIDER

"This is the smoking gun," John Kobayashi, a Washington State epidemiologist, told the Associated Press on June 28, 1999.

Health officials had detected Salmonella muenchen in fresh, unpasteurized orange juice made by Sun Orchard Inc. of Tempe, Arizona.

The juice was also sold under the brand names Aloha, Earls & Joey Tomato's, Markon, Sysco, Trader Joe's, Viola, and Zupan. All told, more than 200 people in 15 states and two Canadian provinces got sick.

In other outbreaks, unpasteurized apple cider may have become contaminated with E. coli from manure that touched the apples when they fell to the ground. But it's not clear how Salmonella got into Sun Orchard's orange juice.

"The company may have mixed juice from its California plant with unpasteurized orange juice that came from Mexico in tanker trucks," says the CDC's Tauxe.

Asked if he's surprised to find Salmonella in an acidic beverage like OJ, the FDA's Potter says no. "Foodborne pathogens don't read textbooks. They show up and survive where they're not supposed to as a matter of routine these days."

WHAT TO DO

* Buy pasteurized juice and cider, especially if you're serving it to the elderly, children, or people with weak immune systems. (Frozen juice concentrates and unrefrigerated juices are always pasteurized. With refrigerated juices, check the label.)

* If you buy unpasteurized cider, heat it to 160 [degrees] F (or boil it if you don't have a thermometer). You can serve it warm or cold.

PREPARED FOODS & SALADS

"The calls started at 11 a.m. on Wednesday, June 10, three or four days after the parties," Sean McDermott, a spokesman for the Cook County Public Health Department, told the Chicago SunTimes last year.

"The first three complaints we had were hosts of parties," said McDermott. "The common link at that time is that they had parties that were catered by Iwan's Deli."

Iwan's is famous for its potato salad ... so famous that it had prepared a 2,300-pound batch for roughly 530 graduation celebrations and other events on June 6 and 7. Of the 20,000 people who ate the salad, an estimated 6,500 reported symptoms ranging from diarrhea to vomiting, chills, and headaches.

The culprit: E. coli O6:H16, also known as ETEC. It's the same bacterium that causes traveler's diarrhea. Fortunately, it's not as virulent as its cousin, E. coli O157:H7.

"Health officials never figured out how it got into the potato salad," says Douglas Powell of the University of Guelph in Canada. "These things are very difficult to trace back."

E. coli isn't the only bug that can make its way into prepared salads and other foods. In 1997, one person died and at least 43 others contracted hepatitis A from eating cole slaw sold at The Stage and Co. Deli outside of Detroit. The virus usually gets into food from infected food handlers.

WHAT TO DO

* Don't eat at restaurants that look dirty.

* Report any illnesses from restaurant prepared foods to your local health department.

HOT DOGS & DELI MEATS

The first illness occurred on August 2, 1998. By February 8, 1999, about 100 people living in 22 states had been diagnosed with listeriosis, and 15 adults and six fetuses had died.

The source: a strain of the bacterium Listeria monocytogenes traced to the Bil Mar Foods plant in Michigan. In December 1998, Bil Mar recalled more than 28,000 pounds of hot dogs and deli meats sold under the Ball Park, Bryan, Grillmaster, Hygrade, Mr. Turkey, Sara Lee, and other brand names.

"The lesson is that food processors can never forget basic sanitation," says Guelph's Powell. "A lot of meat packing and slicing machinery is going to be redesigned to make it easier to clean," he adds. "The dairy industry went through this in the '80s, when they had their outbreaks."

WHAT TO DO

* Cook all hot dogs thoroughly--that is, until they are steaming.

* Check the expiration date on the package when you buy meat. If you don't plan to use it before that date, store it in the freezer.

MEET THE BUGS

                   Possible Symptoms
Name               (from most to least common)

Campylobacter      diarrhea (can be bloody), fever, abdominal
(bacteria)         pain, nausea, headache, muscle pain

Ciguatera          numbness, tingling, nausea, vomiting,
(toxin)            diarrhea, muscle pain, headache, temperature
                   reversal (hot things feel cold and cold things
                   feel hot), dizziness, muscular weakness,
                   irregular heartbeat

Clostridium        marked fatigue; weakness; dizziness; double
botulinum          vision; difficulty speaking, swallowing, and
(bacteria)         breathing; abdominal distention

Cyclospora         watery diarrhea, loss of appetite, weight
(parasite)         loss, cramps, nausea, vomiting, muscle aches,
                   low-grade fever, extreme fatigue

E. coli O 157:H7   severe abdominal pain, watery (then bloody)
(bacteria)         diarrhea, occasionally vomiting

Hepatitis A        fever, malaise, nausea, loss of appetite,
(virus)            abdominal pain, jaundice

Listeria           fever, chills, and other flu-like symptoms;
(bacteria)         headache; nausea; vomiting; diarrhea;
                   infections of the blood (septicemia);
                   inflammation of the brain (encephalitis) or
                   membranes of the brain or spinal cord
                   (meningitis); spontaneous abortion or
                   stillbirth

Norwalk virus      nausea, vomiting, diarrhea, abdominal pain,
(virus)            headache, low-grade fever

Salmonella         nausea, vomiting, abdominal cramps, diarrhea,
(bacteria)         fever, headache

Scombrotoxin       tingling or burning sensation in the mouth,
(toxin)            upper body rash, reduced blood pressure,
                   headache, itching, nausea, vomiting, diarrhea

Vibrio             diarrhea, abdominal pain, nausea, vomiting,
parahaemolyticus   headache, fever, chills
(bacteria)

Vibrio             diarrhea (in healthy people), bloodstream
vulnificus         infection (in people with liver disease,
(bacteria)         diabetes, or weak immune systems)

                   Foods that Have
Name               Caused Outbreaks

Campylobacter      chicken, raw milk
(bacteria)

Ciguatera          grouper, barracuda, snapper,
(toxin)            jack, mackerel, triggerfish

Clostridium        home-canned foods, sausages,
botulinum          meat products, commercially
(bacteria)         canned vegetables, seafood
                   products

Cyclospora         raspberries, lettuce, basil
(parasite)

E. coli O 157:H7   ground beef, raw milk, lettuce,
(bacteria)         sprouts, unpasteurized juices

Hepatitis A        shellfish, salads, cold cuts,
(virus)            sandwiches, fruits, vegetables,
                   fruit juices, milk, milk
                   products, infected food
                   handlers

Listeria           hot dogs, deli meats, raw milk,
(bacteria)         cheeses (particularly
                   soft-ripened cheeses like feta,
                   Brie, Camembert, blue-veined,
                   or Mexican-style "queso
                   blanco"), raw and cooked
                   poultry, raw meats, ice cream,
                   raw vegetables, raw and smoked
                   fish

Norwalk virus      shellfish, salads, infected
(virus)            food handlers

Salmonella         poultry, eggs, raw meats, milk
(bacteria)         and dairy products, fish,
                   shrimp, sauces and salad
                   dressings, cream-filled
                   desserts and toppings, fresh
                   produce (including sprouts)

Scombrotoxin       fresh tuna, mahi mahi,
(toxin)            bluefish, sardines, mackerel,
                   amberjack, abalone

Vibrio             raw oysters and clams, crabs,
parahaemolyticus   shrimp
(bacteria)

Vibrio             raw oysters and clams, crabs
vulnificus
(bacteria)

                   How Soon it         How Soon it
Name               Typically Strikes   Typically Ends

Campylobacter      2 to 5 days         7 to 10 days
(bacteria)

Ciguatera          within 6 hours      several days
(toxin)                                (neurological
                                       symptoms can
                                       last for weeks
                                       or months)

Clostridium        18 to 36 hours      get treatment
botulinum                              immediately
(bacteria)

Cyclospora         1 week              a few days to 30
(parasite)                             days or more

E. coli O 157:H7   1 to 8 days         get treatment
(bacteria)                             immediately

Hepatitis A        10 to 50 days       1 to 2 weeks
(virus)

Listeria           a few days to       get treatment
(bacteria)         3 weeks             immediately

Norwalk virus      1 to 2 days         1 to 2 1/2 days
(virus)

Salmonella         6 hours to          1 to 2 days
(bacteria)         2 days

Scombrotoxin       immediate to        3 hours to
(toxin)            30 minutes          several days

Vibrio             4 hours to          2 1/2 days
parahaemolyticus   4 days
(bacteria)

Vibrio             within 16 hours     get treatment
vulnificus         (diarrhea)          immediately
(bacteria)                             (bloodstream
                                       infection)

Sources: Centers for Disease Control, Center for Science in the Public Interest, Environmental Protection Agency, Food and Drug Administration, U.S. Department of Agriculture.

RELATED ARTICLE: IF YOU GET SICK

Most food-borne illnesses require no treatment other than fluids and rest. But drinking fluids may not be so easy when you're throwing up every ten minutes.

"Try drinking small quantities frequently," says physician Glenn Morris of the University of Maryland. Even a sip or two every few minutes can keep you from becoming dehydrated. "Fluids like Pedialyte are best, but other clear liquids like ginger ale or apple juice may also help.

"People get into trouble when they don't keep up with the fluid loss," adds Morris. Even though you lose liquids when you throw up, there's a net gain.

And if you want something to reduce a fever, says Morris, take acetaminophen (Tylenol) rather than aspirin or ibuprofen (Advil), which could irritate your stomach.

Call the doctor if you have any of these symptoms:

* Bloody diarrhea or pus in the stool. "They generally are signs of a bacterial infection with organisms like E. coil O 157:H7, Campylobacter, or Shigella," says Morris. "While you may not need antibiotics, it's a good idea to check with your doctor."

* Fever that lasts more than 48 hours. In adults, it could signal an infection that's not getting better. (Children are far more likely to develop non-threatening fevers that last more than a day or two.)

* Faintness, rapid heart rate, or dizziness after sitting or standing up suddenly, or a significant drop in the frequency of urination. They could mean life-threatening dehydration.

One final suggestion: Getting a stool culture is the only way to find out what caused your illness and to help public health officials identify an outbreak. The problem is that it can cost $150 or more and many health plans won't pay for it.

"The number of people getting stool cultures is going down, because the general feeling is that there's nothing we're going to do other than plug an IV into them," says Morris. "And in today's world of managed care, if it costs money, who cares about the public health consequences?"

If you suspect that you got food poisoning from eating at a restaurant, call your local health department.

RELATED ARTICLE: WHEN TRAVELING

* If you'll be traveling for more than 30 minutes, store any perishable foods in a cooler with ice or freezer packs.

* Pack perishable foods directly from your refrigerator or freezer into the cooler.

* Keep raw meat, poultry, and seafood in sealed bags away from cooked foods or foods meant to be eaten raw.

* In the summer, keep the cooler in the air-conditioned passenger compartment of your car, not in the hot trunk. At the beach, partially bury the cooler in sand, cover with blankets, and shade with a beach umbrella.

* Carry moist towelettes to keep hands clean when handling food.3

COPYRIGHT 1999 Center for Science in the Public Interest
COPYRIGHT 2000 Gale Group