How to avoid food poisoning.

"I want to tell you about what it's like to survive a severe attack of Salmonella, because there are too many people who have died and can't tell you what it is like.

"I got Salmonella from something I ate. The most likely culprits are a chicken sandwich and an overcooked egg salad sandwich.

"I first got diarrhea which lasted for days and days. Then quite suddenly, the diarrhea stopped. Soon I felt as if there was a red brick inside me.

"It was the most awful thing I had ever experienced. I knew that I had to go to the hospital. And I knew that I was going to need surgery to live...." 200,000 and 1,000,000 actual infections" caused by Salmonella enteritidis, CDC Director Satcher testified in May.

The culprit? "Shell eggs accounted for 80 percent of those outbreaks for which a vehicle was determined," said Satcher. Even scarier: Most tainted eggs are contaminated within the hens' ovaries before their shells form. So washing the eggs before cracking them open is no guarantee that they'll be clean.

While no deaths from outbreaks caused by Salmonella- contaminated eggs were reported to federal authorities in 1994, disease-control experts remain concerned.

"The big news is that the number of infections has tripled in Southern California," says CDC epidemiologist David Swerdlow, who adds that California now accounts for about 25 percent of all Salmonella infections in the country.

What's more, most of the Southern California infections are due to a new, worrisome form of Salmonella enteritidis called "phage type 4." (Bacteria can be distinguished from one another by the phages, or viruses, that infect them.)

"Phage type 4 has been a more virulent form of Salmonella in Europe, but we don't know yet whether that will also be true in the United States," says Richard Gast, a microbiologist at the U.S. Department of Agriculture's Southern Poultry Research Laboratory in Athens, Georgia.

"So far, we haven't been able to determine in the lab whether it's a nastier bacteria," Gast adds. "If we can't, we may be reduced to watching what happens in the western United States." Phage type 4 has now also been detected in Utah and Arizona.

So who's minding the egg carton? Nobody. There is no nationwide program that systematically monitors bacteria levels in eggs. But a new USDA survey suggests that the rate may be rising.

"Our analysis of eggs sent to processing plants for pasteurization in the Northeast showed that 39 percent of the samples were contaminated with Salmonella enteritidis in 1995, compared with 20 percent in 1991," says USDA animal scientist Allan T. Hogue. "And in the West," he adds, "12 percent were contaminated in 1995 versus six percent in 1991."

Many restaurants--and most high-risk sites like hospitals and nursing homes-use pasteurized eggs because the process kills disease-causing bacteria. Unfortunately, nobody knows whether the high rate of Salmonella contamination of eggs destined for pasteurization applies to the eggs sold in local supermarkets.

BEEF

Remember E. coli 0157:H7? That's the bug that made more than 700 people ill--and sent four children to their graves-in 1993 in Washington State, California, Idaho, and Nevada. The source was undercooked fast food hamburgers.

E. coli 0157:H7 does its damage by producing a substance called "Shiga toxin," which causes the bloody diarrhea that strikes most victims. "The toxin leads to kidney failure in about five percent of the victims, and then death in about five percent of those whose kidneys fail," says microbiologist David Acheson of the New England Medical Center in Boston.

Since cooking beef to 165 degrees kills the bacteria, E. coli on the surface of steaks and roasts is easily destroyed, even if they're eaten rare. But when raw beef is ground up, any bacteria on its surface can become incorporated into the mix. If the burger isn't cooked thoroughly, the E. coli that's on the inside can escape destruction.

And escape destruction is what 0157:H7 bacteria continue to do.

"In 1994 and 1995, 64 more outbreaks involving about 1,000 people-but no deaths-were reported to us," says Phyllis Sparling, a USDA epidemiologist at the CDC.

The real toll is probably far higher. That's because the CDC numbers only count outbreaks, which involve two or more people who become sick from the same food. Individual cases aren't included in the official tally.

So the CDC never knew about the death last year of two-year-old Elizabeth Paige Hall, for example. The toddler died at the Cleveland Clinic Hospital four weeks after attending a cookout at which she ate a tainted hot dog. It picked up the 0157:H7 from raw hamburger meat that had sat on the same plate.

After the 1993 outbreaks, the USDA started regularly testing raw ground beef for bacterial contamination.

"Each year, we analyze about 5,000 samples of ground beef from retail stores and processing plants for the presence of E. coli 0157:H7," says Glenn Morris, director of epidemiology and emergency response at the USDA's Food Safety and Inspection Service (FSIS). "Since 1994," he adds, "only about one in 1,700 samples has tested positive."

That's good, but it may lull authorities into a false sense of security. A new study concludes that 0157:H7 may not be the only culprit.

When David Acheson analyzed ground beef from 12 supermarkets in Boston and Cincinnati, he found Shiga toxin in a quarter of the samples. "Even more alarming," he says, "is that none of the toxin came from E. coli 0157:H7. It was all produced by other kinds of E. coli."

"That has huge implications, because the USDA only looks for E. coli 0157 H7 in ground beef."

"The other E. coli are responsible for many of the cases of bloody diarrhea and kidney failure caused by Shiga toxin in North America," says Mohamed Karmali, a microbiologist at the Hospital for Sick Children in Toronto.

And nobody's looking for those other bacteria in ground beef. That needs to change (see coupon to the USDA).

(1) New England Journal of Medicine 334: 1281,1996.

RELATED ARTICLE: When to Get Help

Food poisoning usually involves nausea, vomiting, or diarrhea. Most cases clear up by themselves within a day or two without medical care. But if you get any of these symptoms, says infectious diseases specialist William Bishai of the Johns Hopkins School of Public Health, you need to call the doctor:

* Bloody diarrhea or pus in the stool. "That's the classic sign of an E. coli O157:H7 infection, which probably won't get better without medical care," says Bishai.

* Headache, stiff neck, and fever. When all three occur together, it may be a sign of a Listeria monocytogenes infection. Untreated, it can kill you.

* Fever that lasts more than 24 hours. It could signal an infection that's not getting better. (Children are more likely to develop non-threatening fevers that last more than a day.)

* Faintness, rapid heart rate, or dizziness after sitting or standing up suddenly, but only when it's accompanied by nausea, vomiting, or diarrhea. Those are the signs of dehydration, which can lead to kidney failure.

* Diarrhea that hasn't let up after three days. It could lead to life-threatening dehydration.

* Weakness, numbness, or tingling, usually in the arms or legs, but sometimes around the mouth. It could be a sign of botulism or food poisoning from tainted seafood.

If you get food poisoning, report it to your local health department. That's the only way to get it into the official count. And drop us a note (CSPI--Food Poisoning Registry, Suite 300, 1875 Connecticut Ave., N.W., Washington, D.C. 20009).

RELATED ARTICLE: Who's Most Vulnerable?

"Some people are more likely to get food poisoning and more likely to come down with a bad case of it," says William Bishai of the Johns Hopkins School of Public Health:

* The elders & infants.

* Pregnant women. "To accommodate the growth of the fetus, their immune systems, in a sense, relax," says Bishai. "That makes them more susceptible to some microorganisms." Topping the hit list is Listeria monocytogenes, which is most often found in hot dogs, luncheon meats, and unaged cheeses.

* People with suppressed immune systems. That includes people with AIDS or those who are taking immunosuppressant drugs as part of their treatment for cancer, organ transplants, or conditions like asthma.

* Heavy antacid users or people with modified GI tracts. "Stomach acid helps destroy bacteria," says Bishai, "so people who take antacids, or drugs like Tagamet and Zantac, day in and day out are at much greater risk of developing food poisoning than people who take them sporadically or not at all." No studies have looked at whether taking a couple of Tums (as some people do for its calcium) or a swig of Maalox every day lowers resistance enough to matter.

Also, people who've had some of their stomach or intestines surgically removed may not be able to efficiently sweep harmful bacteria out of their bodies.

RELATED ARTICLE: The Safe Food Kitchen

Eight tips to make your kitchen safer:

1. Handle raw meat, poultry, seafood, and eggs as if they were contaminated. Even if they don't start out with enough bacteria to make you sick, mishandle them and you could be in trouble. Don't let the raw juices touch other foods, whether raw or cooked. After you handle raw meat, etc., wash your hands, utensils, and all surfaces that touched the raw food thoroughly with hot, soapy water.

2. Never eat shellfish like oysters, clams, or mussels, unless they've been thoroughly cooked. They could contain bacteria and viruses that cause food poisoning or hepatitis.

3. Marinate raw meat and poultry in the refrigerator, not on the counter. And don't baste your food with the uncooked marinade or serve the marinade unless you've cooked it.

4. Stuff raw poultry just before cooking it. Better yet, cook your poultry and stuffing separately.

5. Cook meats thoroughly, but don't overcook them. Heat kills bacteria, but too much heat causes meat, poultry, and fish to form possibly carcinogenic heterocyclic aromatic amines(HAAs). To reduce the formation of HAAs, microwave your meat, poultry, or fish on "high" for 30 to 90 seconds or until the juices start to flow. Then pour off the juice before you start cooking.

6. Don't let your eggs run. They're safe when the whites are completely firm and the yolks are just beginning to thicken. Don't lick any batter that contains raw eggs.

7. Microwave your sponges on high for 30 to 60 seconds. That will keep them clean, says microbiologist Dean Cliver.

8. Antibacterial sponges, soaps, and sprays don't make up for sloppy kitchen hygiene. Until we can evaluate any published independent tests, we can't vouch for whether these products work...or are safe:

* 3M's O-Cel-O antibacterial sponge has zinc pyrithione bonded to it. That's the active ingredient in Head & Shoulders and some other dandruff shampoos. The company claims that germs that end up in the sponge are killed.

* Palmolive, Dial, and other dishwashing detergents with antibacterial hand soap contain triclosan, which the FDA recently approved for use in toothpaste. The companies claim that the products kill germs on hands, not dishes.

* Lysol and other antibacterial kitchen cleaners contain substances that have been approved by the Environmental Protection Agency as safe and effective for killing bacteria on kitchen surfaces.

RELATED ARTICLE: Duel of the Cutting Boards

Which is safer: wooden or plastic cutting boards?

Until 1993, the conventional wisdom was that plastic was easier to keep free of bacteria. Then along came Dean Cliver of the University of Wisconsin at Madison.

The microbiologist smeared nine wooden and four plastic boards with chicken juice or broth that he had spiked with E. coli, Listeria, or Salmonella. Then he waited. After three minutes, the surfaces of the plastic boards had up to 23 times more bacteria than the surfaces of the wooden boards. More amazingly, within ten minutes the wooden boards had completely absorbed the bacteria, and Cliver couldn't recover them.(1)

"On wooden boards, bacteria are absorbed down into the wood fiber and remain beneath the surface," Cliver explains. "On plastic boards they cling to the surface, where they can more easily rub off onto other objects like food."

In 1994, Food and Drug Administration microbiologist Ben Tall weighed in with his own cutting board study.(2) "Wood seems to be more forgiving, in that the bugs get down deep and it's probably harder for them to come back out," agrees Tall. But that was only true of new wooden boards, or of "freshly cleaned" boards that had been"sanitized through a dishwasher."

"A used wooden cutting board, which is what most people have in their homes," he adds, "probably get down deep and it's would act more like a plastic board." In other words, it would be more likely to spread bacteria.

Until the question is settled, the best advice is to use either kind of board...as long as you keep it clean.

* Wood. "If you put your wooden boards in the microwave for five minutes, you'll even kill the bacteria that are lurking deep inside," says Cliver.

* Plastic. "If it's knife-scarred," says Cliver, "the only effective way to clean it is in the dishwasher. It doesn't get hot enough in the microwave."

And if any board really gets hacked up, toss it. (1) Journal of Food Protection 57: 16,1994. (2) Journal of Food Safety 14: 163,1994.