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Toronto Food forensics: How do you investigate a possible case of food-borne illness?

Toronto emergency services ambulances.

Fred Lum/The Globe and Mail

After nearly 100 people complained earlier this week of feeling sick from eating at the Canadian National Exhibition, Toronto Public Health officials are investigating one vendor – EPIC Burgers and Waffles – as a possible cause.

In a statement Thursday, EPIC Burgers and Waffles said that the company has a clean health record and that all of its staff has been trained in food safety.

"We take health and safety very seriously," the statement read. "It's very important to us that our food is not only enjoyed, but also trusted."

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To find out what goes into a public health investigation for food-borne illness, The Globe talked to Paul Callanan, who oversees restaurant inspections for the Region of Peel.

What are investigators in Toronto likely doing now?

With respect to the particular food premises, they would typically do such things as look at how foods are prepared, and whether or not hazardous foods like meats are being kept in what we refer to the "temperature danger zone" (between 4 and 60 C, in which pathogenic bacteria can grow) for an inordinate period of time.

They're also making sure that refrigeration is adequate, that food preparation surfaces are cleaned and disinfected, and that there's no potential contamination between ready-to-eat foods and foods that are raw and maybe contaminated.

From the people who made the complaint, we get a food history: what did they eat, when did they eat it, look at what we refer to the incubation time – that's time between when you ate the food and when you came down with symptoms – what the symptoms were, how long they lasted, and whether they'll submit a stool specimen.

How do you confirm a case of food-borne illness?

What you want is to find the pathogen or causative agent – whatever bacteria or virus is responsible in the food itself, and in a person's stool sample. Unfortunately, that's relatively rare.

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A suspected case might be finding a pathogenic agent in a stool sample or a food sample and not having the other one to say 'yeah, it's the same organism.'

What kind of equipment is involved?

Thermometers are one of the key pieces: maximum hold thermometers (that's a thermometer that gives you the maximum temperature of, say, a dishwasher thermometer), or probe thermometers (which take the internal termperature of food products) are probably what inspectors would be using in this case.

There's also ways of testing sanitation of surfaces – swabs or Rodac plates (clear disks that you press against a surface to try and capture bacteria).

What is the most common cause for food-borne illness?

Probably the most common is temperature – where foods are kept in the temperature danger zone for an inordinate amount of time, probably more than two or three hours. If the food is in the temperature danger zone, the bacteria multiples, so you start off with two, then it goes to four, then eight, then 16 and on and on.

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Do seasonal or temporary event like the CNE pose specific risks?

My understanding is that it's all commercial equipment, and the standard of food handling would be no different at the CNE than at a restaurant. I also understand that all food handlers are trained beforehand by Toronto Public Health.

For investigations, it does – the volume of food they're turning out. Often, the best you can do is get a control sample – just trying to get the same types of food that were part of a meal.

In cases like the CNE where there has been so much media coverage, do investigators take into account the element of hysteria – people think they're sick even if they're not?

We do take it into account and try as best we can to go on the basis of an objective assessment.

So if a person alleges that they were part of a food-borne illness, then you gather their food history, find out about their symptoms, and if they're symptomatic, try and collect their sample. The proof is in the pudding, in a sense.

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