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From: TSS ()
Subject: Re: USDA botched testing of mad cow suspect
Date: July 22, 2005 at 12:27 pm PST
In Reply to: USDA botched testing of mad cow suspect posted by TSS on July 22, 2005 at 11:07 am:
----- Original Message ----- From: "Terry S. Singeltary Sr." To: Sent: Saturday, June 25, 2005 4:53 PM Subject: TAKING QUALITY BSE MAD COW SAMPLES IN USA ##################### Bovine Spongiform Encephalopathy #####################
FOR folks not wanting to use GW et als (North America) Triple SSS policy for BSE surveillance, please see below.
IF you go to page 65 out of 154 of the ;
Procedure Manual for
Bovine Spongiform Encephalopathy (BSE) Surveillance October 2004 TAKING QUALITY BSE SAMPLES IN USA
NOTE: The samples in these photos are suitable for ELISA testing and if negative by ELISA
there would not be a problem, but if the results were inconclusive then it would be difficult to process for IHC and additional testing. ALSO, PLEASE see pages 119 - 133 for proper sampling collection protocols ; http://www.aphis.usda.gov/vs/nvsl/BSE/bse_surveillance_manual.pdf
TSS #################### https://lists.aegee.org/bse-l.html #################### Subject: re-USDA's surveillance plan for BSE aka mad cow disease Date: Mon, 02 May 2005 16:59:07 -0500 From: "Terry S. Singeltary Sr." To: paffairs@oig.hhs.gov, HHSTips@oig.hhs.gov, contactOIG@hhsc.state.tx.us
Greetings Honorable Paul Feeney, Keith Arnold, and William Busby et al at OIG,
snip... full text of TSS submission to OIE on the TEXAS inconclusive and USA BSE surveillance (or the lack of); http://www.vegsource.com/talk/madcow/messages/94595.html Taking a Quality Sample
Too Little Tissue Submitted Too Little Tissue Submitted NOTE: The samples in these photos are suitable for ELISA testing and if negative by ELISA there would not be a problem, but if the results were inconclusive then it would be difficult to process for IHC and additional testing. August 24, 2004 Taking a Quality Sample: E4 snip...end http://www.aphis.usda.gov/vs/nvsl/BSE/Manual/appendixe.pdf Getting a Sample of Sufficient Quality Unless the sample is of sufficient quality, it will be unusable and not count towards the survey. Please see Appendix E for guidance on collecting a quality sample. If the sample is not of sufficient quality, STOP: DO NOT TAKE THE SAMPLE. This does NOT apply to samples taken from: • animals that are highly suspicious for BSE or that involve an FAD investigation • animals that were condemned in an antemortem inspection BSE sampling using a spoon Step 1 • Place head upright – On head rack or barrel – On table edge – On the ground facing down if no other option
snip... http://www.aphis.usda.gov/vs/nvsl/BSE/procedure_manual.pdf Factsheet Animal and Plant Health Inspection Service June 2005 APHIS The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, or marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720–2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326–W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC 20250–9410 or call (202) 720–5964 (voice and TDD). USDA is an equal opportunity provider and employer. Safeguarding American Agriculture Animal and Plant Health Inspection Service • United States Department of Agriculture • Immunohistochemistry (IHC) • Primary confirmatory test for USDA’s BSE surveillance program. • Recognized by the World Organization for Animal Health, or OIE. • Allows scientists to determine if a sample is positive for BSE in two distinct ways: visually (spongiform changes), and through a staining technique (presence of abnormal prion protein). • Involves looking at an intact portion of the brain, the obex, to see if there are lesions (holes or a “spongy” appearance) present that are characteristic for BSE, and using a staining process using antibodies that detect the abnormal protein prion. • Takes four to seven days to run. • Freezing samples does not interfere with performing the IHC test as long as the sample is confirmed as obex. Western Blot • Several types, with the SAF Immunoblot being the one recognized by OIE. • Used under USDA protocol when a sample is “not suitable for IHC”, i.e., if it is autolyzed (or degraded) or brain stem architecture is not evident microscopically. • Uses a large portion of obex brain tissue; the abnormal prion protein in brain material is enriched by ultracentrifugation, and the sample is exposed to protease, an enzyme, to destroy any normal prion proteins that may be present, leaving only abnormal prion proteins. Remaining sample is then run through a gel to separate the abnormal prion protein components by molecular weight. After the transfer of the proteins to a membrane, proteins are stained using antibodies that can identify a specific banding pattern associated with prion diseases including BSE. A diagnosis is made by recognizing three distinctive bands that are identified as a result of a reaction with the anti-prion protein antibody. • Freezing samples does not interfere with the performance of western blot tests. Similarities/Differences: • Both IHC and the SAF Immunblot (Western blot) are internationally recognized as confirmatory tests for BSE. • The tests use different methods to determine if the abnormal prion protein is present in brain tissue of an animal. • The IHC test additionally allows for the viewing of brain tissue to determine if lesions characteristic to BSE are present. • Both tests are equally effective at detecting the classical form of BSE. BSE Confirmatory Tests
http://www.aphis.usda.gov/lpa/pubs/fsheet_faq_notice/faq_BSE_confirmtests.pd f SAMPLE JOB AID
http://www.aphis.usda.gov/vs/nvsl/BSE/Manual/appendixd.pdf Procedure Manual for Bovine Spongiform Encephalopathy (BSE) Surveillance August 24, 2004 Page 16 Step 8 • You should be able to identify the Obex area of the brain • Make sure your samples contain the Obex • The Obex MUST be collected for the sample to be used in BSE the surveillance data Procedure Manual for Bovine Spongiform Encephalopathy (BSE) Surveillance August 24, 2004 Page 17 Note: • The area marked in black is the location of the Motor Nucleus of the Vagus nerve • The nucleus appears as “pink fleshy” areas • This nucleus is the area we examine in the lab • The pointer at the “V” is the Obex Step 9 • Cut the samples as pictured • The middle piece of tissue contains the Obex and the Motor Nucleus of the Vagus • The Obex is the key area Procedure Manual for Bovine Spongiform Encephalopathy (BSE) Surveillance snip... http://www.aphis.usda.gov/vs/nvsl/BSE/procedure_manual.pdf
Procedure Manual for Bovine Spongiform Encephalopathy (BSE) Surveillance Procedures for Obtaining and Submitting Samples from Targeted High-Risk and Apparently Normal Cattle
□ Collect the brain stem, including the obex. Use a brain tissue spoon or other suitable device. Sampling spoons and tools will be provided by NVSL to sample collectors. □ Prepare samples for shipping. Sample collectors must evaluate the acceptability of the tissue sample. Samples that are taken from the wrong location or that are significantly autolyzed are not testable, and should not be submitted unless specific arrangements are made in advance. The only exception to this is for samples taken from cattle condemned as a result of an antemortem inspection. See Appendix E for guidance on taking and submitting a quality sample. http://www.aphis.usda.gov/vs/nvsl/BSE/procedure_manual.pdf USDA 2003
We have to be careful that we don't get so set in the way we do things that we forget to look for different emerging variations of disease. We've gotten away from collecting the whole brain in our systems. We're using the brain stem and we're looking in only one area. In Norway, they were doing a project and looking at cases of Scrapie, and they found this where they did not find lesions or PRP in the area of the obex. They found it in the cerebellum and the cerebrum. It's a good lesson for us. Ames had to go back and change the procedure for looking at Scrapie samples. In the USDA, we had routinely looked at all the sections of the brain, and then we got away from it. They've recently gone back. Dr. Keller: Tissues are routinely tested, based on which tissue provides an 'official' test result as recognized by APHIS . Dr. Detwiler: That's on the slaughter. But on the clinical cases, aren't they still asking for the brain? But even on the slaughter, they're looking only at the brainstem. We may be missing certain things if we confine ourselves to one area. snip.............
Dr. Detwiler: It seems a good idea, but I'm not aware of it. Another important thing to get across to the public is that the negatives do not guarantee absence of infectivity. The animal could be early in the disease and the incubation period. Even sample collection is so important. If you're not collecting the right area of the brain in sheep, or if collecting lymphoreticular tissue, and you don't get a good biopsy, you could miss the area with the PRP in it and come up with a negative test. There's a new, unusual form of Scrapie that's been detected in Norway. We have to be careful that we don't get so set in the way we do things that we forget to look for different emerging variations of disease. We've gotten away from collecting the whole brain in our systems. We're using the brain stem and we're looking in only one area. In Norway, they were doing a project and looking at cases of Scrapie, and they found this where they did not find lesions or PRP in the area of the obex. They found it in the cerebellum and the cerebrum. It's a good lesson for us. Ames had to go back and change the procedure for looking at Scrapie samples. In the USDA, we had routinely looked at all the sections of the brain, and then we got away from it. They've recently gone back.
Dr. Keller: Tissues are routinely tested, based on which tissue provides an 'official' test result as recognized by APHIS . Dr. Detwiler: That's on the slaughter. But on the clinical cases, aren't they still asking for the brain? But even on the slaughter, they're looking only at the brainstem. We may be missing certain things if we confine ourselves to one area. snip...
FULL TEXT;
Completely Edited Version PRION ROUNDTABLE
Accomplished this day, Wednesday, December 11, 2003, Denver, Colorado
http://www.vegsource.com/talk/madcow/messages/94513.html HISTORY OF THIS COW AND TESTING OF IT;
http://www.vegsource.com/talk/madcow/messages/94622.html Aguzzi Letter http://www.vegsource.com/talk/madcow/messages/94620.html Markus Moser Prionics BSE-L http://www.vegsource.com/talk/madcow/messages/94621.html Q&A Dr. Jean-Philippe Deslys http://www.vegsource.com/talk/madcow/messages/94629.html BIO-RAD
> > -------- Original Message -------- > > Subject: USA BIO-RADs INCONCLUSIVEs > > Date: Fri, 17 Dec 2004 15:37:28 -0600 > > From: "Terry S. Singeltary Sr." > > To: susan_berg@bio-rad.com > > > > > > > > Hello Susan and Bio-Rad, > > > > Happy Holidays! > > > > I wish to ask a question about Bio-Rad and USDA BSE/TSE testing > > and there inconclusive. IS the Bio-Rad test for BSE/TSE that complicated, > > or is there most likely some human error we are seeing here? > > > > HOW can Japan have 2 positive cows with > > No clinical signs WB+, IHC-, HP- , > > BUT in the USA, these cows are considered 'negative'? > > > > IS there more politics working here than science in the USA? > > > > What am I missing? > > > > > > > > -------- Original Message -------- > > Subject: Re: USDA: More mad cow testing will demonstrate beef's safety > > Date: Fri, 17 Dec 2004 09:26:19 -0600 > > From: "Terry S. Singeltary Sr." > > snip...end > > > > > > Experts doubt USDA's mad cow results > > > > snip...END > > WELL, someone did call me from Bio-Rad about this, > however it was not Susan Berg. > but i had to just about take a blood oath not to reveal > there name. IN fact they did not want me to even mention > this, but i feel it is much much to important. I have omitted > any I.D. of this person, but thought I must document this ; > > Bio-Rad, TSS phone conversation 12/28/04 > > Finally spoke with ; > > > Bio-Rad Laboratories > 2000 Alfred Nobel Drive > Hercules, CA 94547 > Ph: 510-741-6720 > Fax: 510-741-5630 > Email: XXXXXXXXXXXXXXXXXX > > at approx. 14:00 hours 12/28/04, I had a very pleasant > phone conversation with XXXX XXXXX about the USDA > and the inconclusive BSE testing problems they seem > to keep having. X was very very cautious as to speak > directly about USDA and it's policy of not using WB. > X was very concerned as a Bio-Rad official of retaliation > of some sort. X would only speak of what other countries > do, and that i should take that as an answer. I told X > I understood that it was a very loaded question and X > agreed several times over and even said a political one. > > my question; > > Does Bio-Rad believe USDA's final determination of False positive, > without WB, and considering the new > atypical TSEs not showing positive with -IHC and -HP ??? > > ask if i was a reporter. i said no, i was with CJD Watch > and that i had lost my mother to hvCJD. X did not > want any of this recorded or repeated. > > again, very nervous, will not answer directly about USDA for fear of > retaliation, but again said X tell > me what other countries are doing and finding, and that > i should take it from there. > "very difficult to answer" > > "very political" > > "very loaded question" > > outside USA and Canada, they use many different confirmatory tech. in > house WB, SAF, along with > IHC, HP, several times etc. you should see at several > talks meetings (TSE) of late Paris Dec 2, that IHC- DOES NOT MEAN IT IS > NEGATIVE. again, look what > the rest of the world is doing. > said something about Dr. Houston stating; > any screening assay, always a chance for human > error. but with so many errors (i am assuming > X meant inconclusive), why are there no investigations, just false > positives? > said something about ''just look at the sheep that tested IHC- but were > positive''. ... > > > TSS > > -------- Original Message -------- > Subject: Your questions > Date: Mon, 27 Dec 2004 15:58:11 -0800 > From: To: flounder@wt.net > > > > Hi Terry: > > ............................................snip Let me know your phone > number so I can talk to you about the Bio-Rad BSE test. > Thank you > > Regards > > > > Bio-Rad Laboratories > 2000 Alfred Nobel Drive > Hercules, CA 94547 > Ph: 510-741-6720 > Fax: 510-741-5630 > Email: ================================= > > > END...TSS > > > ######### https://listserv.kaliv.uni-karlsruhe.de/warc/bse-l.html ########## > > ===================================================== > ===================================================== > > END....TSS > FULL TEXT; http://www.vegsource.com/talk/madcow/messages/94627.html TSS TEXAS MAD COW LIVES !
still disgusted in Bacliff, Texas Terry S. Singeltary Sr. #################### https://lists.aegee.org/bse-l.html #################### ----- Original Message ----- From: "Terry S. Singeltary Sr." To: Sent: Friday, July 22, 2005 1:15 PM Subject: USDA botched testing of mad cow suspect ##################### Bovine Spongiform Encephalopathy #####################
----- Original Message ----- From: "Terry S. Singeltary Sr." To: Sent: Friday, June 24, 2005 10:06 PM Subject: The IHC Test Variables (USA BSE SURVEILLANCE) ##################### Bovine Spongiform Encephalopathy #####################
The IHC Test Variables: • IHC has been the primary confirmatory test for USDA’s BSE surveillance program and is recognized by the World Organization for Animal Health, or OIE. • IHC allows scientists to determine if a sample is positive for BSE in two distinct ways: 1.) A staining technique (presence of abnormal prion protein) that uses antibodies to detect abnormal prion protein in the brain. 2.) A visual examination to determine whether there are lesions (holes or "spongy" appearances) present in the brain. • Several variables could yield conflicting results: o IHC is not a standardized, commercially available test. It involves variables, including several options in types of antibodies and other reactive agents. The sensitivity of any given test is influenced by those variables. o If the level of infectivity in the animal is extremely low, the abnormal prion in the brain will be minimal and therefore more difficult to detect. o Variations in the conditions under which the staining process is performed, such as chemicals and reactive agents used, temperature and length of antibody exposure, can also cause the test to yield different results. Testing History on This Animal: • In November 2004, a sample from this animal returned inconclusive for BSE on a Biorad screening test. • The sample was subjected to an IHC confirmatory test, which returned negative. • USDA scientists also ran an additional, experimental IHC "rapid" tissue fixation test for academic purposes, which can be conducted more quickly than the IHC confirmatory test and is therefore of interest to the scientific community, but it has not been approved internationally. • While some abnormalities were noted in the experimental IHC test results, because the test was not a validated procedure, and because the two approved IHC tests came back negative, the results were not considered to be of regulatory significance and therefore were not reported beyond the laboratory. • A Western blot test conducted the week of June 5, 2005, returned positive for BSE. • An additional IHC confirmatory test conducted the week of June 13, 2005, by USDA scientists utilizing different antibodies from the November 2004 test, confirmed this case as weakly positive for BSE. • The Veterinary Laboratories Agency in Weybridge, England, conducted a series of diagnostic tests including an IHC, using different antibodies from those used by USDA in November 2004, which returned positive results for BSE. • Experts from the Weybridge lab confirmed the accuracy of the results of USDA’s November confirmatory IHC test, concurring that the case could not have been confirmed on the basis of this sample. • Weybridge experts also examined the November experimental IHC test and interpreted the results to be positive. Potential Causes of Conflicting Results: • USDA scientists are consulting with Weybridge scientists to determine the cause of the conflicting IHC test results. • Several factors could cause or contribute to the discrepancy as follows: o This animal had a very low level of infectivity and therefore the sensitivity of USDA’s routine IHC test might not have been sufficient to detect the disease. o Weybridge experts indicate that deposits of abnormal prion in the brain tissue were not uniformly distributed and were present at low concentration, which means that even adjacent samples of brain tissue might not give identical results. Factsheet Veterinary Services June 2005 APHIS USDA Protocol Review: • USDA will develop a protocol to conduct dual confirmatory tests, the IHC and the Western blot, when the screening test, the Biorad, returns an inconclusive result. • USDA and Weybridge scientists are in agreement that the Biorad test is a very effective and appropriate screening test. • USDA scientists will consult with Weybridge scientists to assess the array of antibodies available for use in IHC confirmatory tests to determine the most appropriate for use in United States confirmatory tests. Those consultations will be repeated periodically. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, or marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720–2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326–W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC 20250–9410 or call (202) 720–5964 (voice and TDD). USDA is an equal opportunity provider and employer. Safeguarding American Agriculture Animal and Plant Health Inspection Service • United States Department of Agriculture • http://www.usda.gov/documents/vs_bse_ihctestvar.pdf THIS confirms that the June 2004 Enhanced BSE cover-up, was just that. Like i said before, due to this terribly flawed system, those 388,000 testing to date for BSE in the USA were meaningless and should be retested. ...
TSS #################### https://lists.aegee.org/bse-l.html #################### ----- Original Message ----- From: "Terry S. Singeltary Sr." To: Sent: Friday, June 24, 2005 10:12 PM Subject: FDA Statement on USDA BSE Positive Test Results ##################### Bovine Spongiform Encephalopathy #####################
FDA STATEMENT: June 24, 2005 Media Inquiries: Suzanne Treviño, 301-827-6242 Consumer Inquiries: 888-INFO-FDA FDA Statement on USDA BSE Positive Test Results
"The Food and Drug Administration, along with the USDA, is committed to ensuring the safety of the U.S. human food and animal feed supply from BSE (bovine spongiform encephalopathy). Today we saw that the system worked. The safety measures that FDA and USDA have put in place successfully kept this animal that has tested positive for BSE out of the food and feed supply. These existing safeguards have proven extremely effective, and the American public should feel secure in knowing that the current animal feed rule already provides significant protection against the spread of BSE. We will continue to work closely with the USDA on this important public health issue and evaluate every option to strengthen the 1997 animal feed ban." ####
http://www.fda.gov/bbs/topics/NEWS/2005/NEW01193.html
>We will continue to work closely with the USDA on this important public health issue <
damn, i wish they could make there mind up. you got johann et al saying it is NOT a public health issue, and the FDA saying it IS. i know it is, but i wish they would get there stories straight. I remember similar statements made by USDA/APHIS et al before, when that 2003 Washington Cow old Dave capped, that _healthy walker_ not a downer, i remember those same similar statements at first. I am very curious; 1. cohorts history of this animal, the same feed they ate as the cow that tested postive. so where are they and who comsumed them? 2. the feed this animal ate. where was it purchased and what other cows consumbed this feed? 3. ITS been 8 months and we still dont know officially the exact location of this animal. where was this animal from? exact location. the consumer needs to know. what happened to all that timely information we were to recieve? what about those that consumed the other cohorts of the other mad cow in the USA? * GAO-05-51 October 2004 FOOD SAFETY (over 500 customers receiving potentially BSE contaminated beef) - TSS 10/20/04
October 2004 FOOD SAFETY USDA and FDA Need to Better Ensure Prompt and Complete Recalls of Potentially Unsafe Food
snip... Page 38 GAO-05-51 Food Recall Programs To examine the voluntary recall of beef products associated with the December 2003 discovery of an animal infected with BSE, we analyzed the distribution lists USDA collected from companies and the verification checks it conducted to develop a diagram illustrating the location and volume of recalled beef that reached different levels of the distribution chain. We compared the distribution lists and verification checks to identify how many customers listed on the distribution lists did not receive the recalled beef and the number of customers not listed on distribution lists that received the recalled beef. We interviewed USDA and FDA staff involved with the recall to understand the timing of recall actions and the challenges encountered during the recall. To develop information on the 2002 recall of ground beef by a ConAgra plant in Greeley, Colorado, we reviewed USDAs recall file and other documents on the recall. We also met with the departments Office of Inspector General and reviewed the Inspector Generals September 2003 report.1 We conducted our review from May 2003 through August 2004 in accordance with generally accepted government auditing standards. 1U.S. Department of Agriculture, Office of Inspector General, Great Plains Region Audit Report: Food Safety and Inspection Service: Oversight of Production Process and Recall at ConAgra Plant (Establishment 969), Report No. 24601-2-KC (September 2003). Page 39 GAO-05-51 Food Recall Programs Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Appendix II On December 23, 2003, USDA announced that a cow in the state of Washington had tested positive for BSEcommonly referred to as mad cow disease. This appendix describes the actions USDA took to recall the meat and the actions FDA took with respect to FDA-regulated products, such as animal feed and cosmetics, made from rendered parts of the animal. Beef Recall Was Triggered by a BSEPositive Sample from One Cow On December 9, 2003, the recalling company slaughtered 23 cows. USDA, in accordance with its BSE surveillance policy at the time, took a sample of 1 cow that was unable to walk, although the condition of the tested cow is now disputed. USDA did not process the sample in its Ames, Iowa National Veterinary Services Laboratory in an expedited manner because the cow did not show symptoms of neurological disorder. USDA test results indicated a presumptive positive for BSE on December 23, 2003. Recall Begun in December 2003 Was Completed in March 2004 On December 23, 2003, after learning about the positive BSE test, USDA headquarters notified the Boulder District Office, which is the field office with jurisdiction over the recalling firm. The Boulder District began gathering information about the recalling companys product distribution. Field staff telephoned the recalling company and were on-site at 7:00 p.m. The Boulder District initially thought 3 days of the recalling companys production would have to be recalled, but further examination of facility cleanup and shipping records revealed that it was only necessary to recall 1 day of production. USDA recall staff convened at 9:15 p.m. and discussed the science related to BSE and whether the recalling companys cleanup practices were sufficient to limit the recall to 1 day of production. Following USDAs determination to conduct a Class II recallthat is, the beef posed a remote possibility of adverse health consequencesUSDA contacted the recalling company to discuss recall details and the press release. The press release and Recall Notification Report were released that evening. On December 24, 2003, USDAs Food Safety and Inspection Service (FSIS) sent inspectors to the recalling companys primary customers to obtain secondary customer distribution lists and product shipping records. USDA conducted 100 percent verification checks for this recallit contacted every customer that received the recalled meat. This level of verification checks is well above the percentage of checks conducted by USDA district offices for the Class I recalls we reviewed. Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 40 GAO-05-51 Food Recall Programs On December 26, 2003, USDA began checking the primary and secondary customers of the recalling company that it was aware of, although the entire product distribution chain was unknown. During the checks, USDA tried to determine if the product was further distributed, and it used verification checks to acquire distribution lists for secondary and tertiary customers of the recalling company. Verification checks continued until February 25, 2004. Three USDA districts conducted these verification checks. The Boulder District coordinated the checks and assigned checks to the Minneapolis District Office for customers in Montana and to the Alameda District Office for customers in California. USDA required that 100 percent of the primary checks, 50 percent of the secondary checks, and 20 percent of the tertiary checks be conducted on-site. According to USDA, more than 50 percent of the secondary checks were actually conducted on-site. FDA officials helped conduct verification checks. According to USDA, the recall took a long time to complete because USDA contacted each customer at least twice. USDA first contacted each customer to conduct the check and again to verify product disposition. On February 25, 2004, the Boulder District concluded that the recall was conducted in an effective manner. On March 1, 2004, USDAs Recall Management Division recommended that the agency terminate the recall, and USDA sent a letter to the recalling company to document that USDA considered the recall to be complete. Recall Was Complicated by Inaccurate Distribution Lists and Mixing of Potentially Contaminated and Noncontaminated Beef USDA used distribution lists and shipping records to piece together where the recalled product was distributed. According to USDA, one of the recalling companys three primary customers was slow in providing its customer list. USDA could not begin verification activities for that primary customer without this list. Furthermore, some customers of the recalling company provided USDA with imprecise lists that did not specify which customers received the recalled product. As a consequence, USDA could not quickly determine the scope of product distribution and had to take time conducting extra research using shipping invoices to determine which specific customers received the product. Even when USDA determined the amount and location of beef, the agency still had trouble tracking the beef in certain types of establishments, such as grocery store distributors. USDA could not easily track the individual stores where those distributors sent the beef because of product mixing Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 41 GAO-05-51 Food Recall Programs and the distributors record-keeping practices. Generally, distributors purchase beef from multiple sources, mix it in their inventory, and lose track of the source of the beef they send to the stores that they supply. To deal with this problem, USDA first identified the dates when recalled beef was shipped to the distributors and then asked for a list of the stores that were shipped any beef after those dates. Consequently, some stores were included in the recall that may never have received recalled beef. The recall was also complicated by repeated mixing of recalled beef with nonrecalled beef, thereby increasing the amount of meat involved in the recall. The recalling company slaughtered 23 cows on December 9, 2003, and shipped those and 20 other carcasses to a primary customer on December 10, 2003. The recalling companys carcasses were tagged to identify the slaughter date and the individual cow. The primary customer removed the identification tags and mixed the 23 recalled carcasses with the 20 nonrecalled carcasses. Because the carcasses could not be distinguished, the recall included all 43 carcasses at the primary customer. After one round of processing at the primary customer, the meat from the carcasses was shipped to two other processing facilities. Both establishments further mixed the recalled meat from the 43 carcasses with meat from other sources. In all, the mixing of beef from 1 BSE-positive cow resulted in over 500 customers receiving potentially contaminated beef. Imprecise distribution lists and the mixing of recalled beef combined to complicate USDAs identification of where the product went. Specifically, on December 23, 2003, USDAs initial press release stated that the recalling company was located in Washington State. Three days later, on December 26, 2003, USDA announced that the recalled beef was distributed within Washington and Oregon. On December 27, 2003, USDA determined that one of the primary customers of the recalling firm distributed beef to facilities in California and Nevada, in addition to Washington and Oregon, for a total of four states. On December 28, 2003, USDA announced that some of the secondary customers of the recalling company may also have distributed the product to Alaska, Montana, Hawaii, Idaho, and Guam, for a total of eight states and one territory. On January 6, 2004, over 2 weeks from recall initiation, USDA determined that the beef went to only six statesWashington, Oregon, California, Nevada, Idaho, and Montanaand that no beef went to Alaska, Hawaii, or Guam. To reach that conclusion, USDA used the distribution lists, shipping records, and sales invoices that it received from companies to piece together exactly where the recalled beef may have been sent. The lists Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 42 GAO-05-51 Food Recall Programs showed that 713 customers may have received the recalled beef; 6 of those may have received beef from more than one source. USDA determined that 176 customers on the lists did not actually receive recalled beef, including the customers in Guam and Hawaii. USDAs review also indicated that recalled beef was probably not shipped to Alaska or Utah, and USDA checked 2 retailers in Alaska and 3 retailers in Utah to confirm that was the case. In total, USDA conducted verification checks on 537 of the 713 customers on the lists. USDAs initial checks identified an additional 45 customers that may have received the recalled beef that were not included on the distribution lists, for a total of 582 verification checks. Figure 4 summarizes USDAs verification efforts during the recall. Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 43 GAO-05-51 Food Recall Programs Figure 4: USDAs Recall Verification Checks by Location and Customer Type for Meat Associated with the Animal Infected with BSE Note: USDA checked 15 primary, 40 secondary, and 526 tertiary customers plus the recalling company, for a total of 582 verification checks. USDAs press release stated that the recall involved 10,410 pounds of beef products, and the USDA recall coordinator for this recall told us that downstream processors mixed the recalled beef with nonrecalled beef, for a total of more than 38,000 pounds of beef that was distributed at the secondary customer level. According to USDA officials involved with the D = Distributor R = Retailer SF = Storage facility P = Processor Primary customers (15 total) Recalling slaughterhouse (WA) 1 R (OR) 1 P (WA) 1 P (OR) 1 P (OR) 11 R (WA) Secondary customers (40 total) Tertiary customers (526 total) 1 R (OR) 1 SF (OR) 3 D (OR) 3 D (WA) 2 dual D (OR) 59 R (OR) 79 R (WA) 5 R (ID) 3 R (UT) 4 R (MT) 161 R (WA) 8 R (ID) 15 R (OR) 2 R (AK) 31 R (OR) 8 R (WA) 10 R (NV) 5 R (ID) 10 R (CA) 2 R (CA) 17 R (OR) 5 R (WA) 1 D (NV) 11 R (CA) 85 R (NV) 3 D (OR) 11 R (OR) 2 D (CA) 26 R (CA) 2 R (WA) ( ) Acronyms in parentheses are postal abbreviations for each state. Source: GAO analysis of USDA verification check documents. Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 44 GAO-05-51 Food Recall Programs recall, the precise amount of meat that was sold at the retail level is unknown because retailers at the tertiary level further mixed nonrecalled meat with potentially contaminated meat. USDA told us that more than 64,000 pounds of beef was ultimately returned or destroyed by customers, and that, because of the mixing, it was not able to determine how much of the original 10,410 pounds of recalled beef was contained in the 64,000 pounds that were recovered. FDAs Role in USDAs Recall Parts of the BSE-infected animal slaughtered on December 9, 2003, were not used for food, but they were sent to renderers to be separated into raw materials, such as proteins and blood. Rendered materials are used for many purposes, including cosmetics and vaccines. FDA has jurisdiction over renderers. When USDA learned of the BSE-infected cow on December 23, 2003, the agency immediately notified FDA. On December 24, 2003, FDA sent an inspection team to a renderer that handled materials from the BSE cow. Inspectors confirmed that the parts of the slaughtered BSE positive cow were on the premises. FDA later identified a second company that potentially rendered material from the slaughtered BSE cow. Both renderers agreed to voluntarily hold all product processed from the diseased cow and dispose of the product as directed by FDA and local authorities. On January 7, 2004, 15 containers of potentially contaminated, rendered material (meat and bone meal) were inadvertently loaded on a ship, and on January 8, 2004, the ship left Seattle, Washington, for Asia. The renderer initiated steps to recover the shipped material, so it could be disposed of as directed by FDA and local authorities. The ship carrying the material returned to the United States on February 24, 2004, and the material was disposed of in a landfill on March 2, 2004. On January 12, 2004, FDA asked both renderers to expand their voluntary holds to rendered materials processed from December 23, 2003, through January 9, 2004, because they may have rendered some recalled meat or trim that was recovered from retail establishments. Both renderers agreed to the expanded product hold. In total, FDA requested that renderers voluntarily hold approximately 2,000 tons of rendered material. FDA confirmed that none of the potentially contaminated, rendered material entered commerce, because FDA accounted for all rendered material. FDA Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 45 GAO-05-51 Food Recall Programs reported that no recall was necessary because no product was distributed commercially by the rendering companies. USDA and FDA Worked Together on the Recall USDA and FDA worked together in two ways. First, both agencies notified each other if their investigations yielded any information about products within the jurisdiction of the other agency. For instance, when conducting the second round of verification checks, USDA tracked the disposition of the product to renderers and landfills and notified FDA when the product went to renderers. Second, FDA officials helped conduct verification checks. FDA conducted 32 of the 582 verification checks (approximately 5 percent) for the USDA recall. Officials from both agencies indicated they regularly interacted and shared information. Table 3 outlines the agencies actions. Table 3: Detailed Timeline of USDA, FDA, and Company Actions Related to the Discovery of an Animal Infected with BSE Date USDA recall actions FDA actions Company actions 12/9/03 " USDA samples cow for BSE. " BSE cow is slaughtered. 12/11/03 " Sample is sent to Ames, Iowa, for BSE testing. " Recalling company sends carcasses to primary customer for processing. 12/12/03 " Primary customer sends meat products to two other primary customers for further processing. 12/12 - 12/23/03 " Other primary customers distribute recalled product to secondary customers. " Secondary customers distribute recalled product to tertiary customers. 12/23/03 " BSE test results are presumptively positive. " Recall meeting. " Initiation of voluntary recall. " Press release. " FDA notified of BSE test results. " FDA dispatches investigation teams. 12/24/03 " FDA inspects Renderer 1. " FDA determines some rendered material from Renderer 1 is intended for Indonesia. " FDA discovers some material may have been sent to Renderer 2. " Renderer 1 agrees to hold remaining rendered material. " Recalling company contacts primary customers. " Primary customers contact their customers. Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 46 GAO-05-51 Food Recall Programs 12/25/03 " USDA receives confirmation from reference lab in England that cow in question is BSE positive. 12/26/03 " Verification checks begin " USDA announces recalled product in Washington State and Oregon. " FDA begins process of comparing records to ensure all products from Renderers 1 and 2 are accounted for. " Renderer 2 agrees to hold all material that may have been derived from BSE cow. None of the rendered material has been distributed. 12/27/03 " USDA announces recalled product was distributed in Washington State, Oregon, California, and Nevada. " FDA issues statement confirming that the rendering plants that processed all of the nonedible material from the BSE cow have placed a voluntary hold on all of the potentially infectious product, none of which had left the control of the companies and entered commercial distribution. 12/28/03 " USDA announces recalled product was distributed in Washington State, Oregon, California, Nevada, Montana, Idaho, Alaska, Hawaii, and Guam. 12/29/03 " Food Safety and Inspection Service determines that the recalled meat products were distributed to 42 locations, with 80 percent of the products distributed to stores in Oregon and Washington State. 12/31/03 " FDA offers assistance to USDA to complete recall verification checks. 1/6/04 " USDA determines recalled product was only distributed in Washington State, Oregon, California, Nevada, Montana, and Idaho. 1/8/04 " FDA is notified by the renderer that some of the rendered material on hold from Renderer 1 was inadvertently shipped to Asia. Renderer 1 commits to isolate and return the rendered material. " Rendering company notifies FDA of shipment of product on hold. (Continued From Previous Page) Date USDA recall actions FDA actions Company actions Appendix II Federal Actions Associated with the Discovery of an Animal in the United States Infected with BSE Page 47 GAO-05-51 Food Recall Programs Source: GAO analysis of USDA and FDA information. 1/12/04 " FDA advises Renderers 1 and 2 that they may have rendered meat or trim subject to recall from retail stores. " FDA requests Renderers 1 and 2 to place all rendered material from December 23 to January 9 on hold. " FDA determines neither renderer had shipped rendered material manufactured after December 23, 2003. 2/9/04 " All rendered material was disposed of in landfill, except material shipped to Asia. 2/24/04 " Ship carrying rendered material returns to U.S. port. 2/25/04 " Verification checks complete. " USDA Boulder District Office concludes recall is effective. 3/1/04 " Recall is closed. 3/2/04 " FDA observes disposal in landfill of remaining rendered material... snip... REPORTS 1. Food Safety: USDA and FDA Need to Better Ensure Prompt and Complete Recalls of Potentially Unsafe Food. GAO-05-51, October 7.tss http://www.gao.gov/cgi-bin/getrpt?GAO-05-51 Highlights - http://www.gao.gov/highlights/d0551high.pdf USDA botched testing of mad cow suspect By Steve Mitchell Medical Correspondent Jul. 21, 2005 at 5:44PM U.S. Department of Agriculture officials tracing cattle that may have been associated with the country's first case of mad cow disease in 2003 botched the testing of a cow considered "at risk" and did not run a confirmatory test called a Western blot, according to agency documents obtained by United Press International. The documents, obtained via the Freedom of Information Act, show a pattern that is similar to how the agency handled a Texas cow that was initially ruled negative but seven months later was found to be positive for the deadly disease on the Western blot test. The cow related to the 2003 case appears to have arrived from Canada in the same herd as the infected animal and resided at the same dairy cattle finishing farm in Washington state. The USDA found the animal at a farm in Mabton, Wash., and was testing it for mad cow -- formally known as bovine spongiform encephalopathy, or BSE -- because it was deemed to be at risk for the disease. The USDA documents indicate an ELISA rapid test was run that turned out negative. This was followed by a test called immunohistochemistry, or IHC, that also came back negative, but the result was coded as "loc" instead of the usual "neg." A note in the document states the "loc" notation "means that the IHC test was negative, but the wrong location of the brain was sampled for testing. There is no longer any possibility to test the proper location." BSE experts said the notation did not make sense and questioned why the agency did not run a Western blot test, which may have helped determine if the cow was carrying BSE. "That's bizarre," Markus Moser, a molecular biologist and chief executive officer of Prionics, a Swiss firm that manufactures BSE test kits, told UPI. "If the ELISA has been done on the correct piece of brain, then it was done on the obex," Moser said. "If it was done correctly, then it was done on one hemisphere of the obex and you have the other hemisphere for IHC or another test. If they say they don't have any correct tissue for doing that, then what exactly did they use for the first ELISA?" If the ELISA test was run on an incorrect portion of the brain, then its results are unreliable. USDA officials acknowledged there were problems with the brain sample. "The person who collected the sample made a notation that the sample was not a good sample, meaning it could have been torn or mangled," agency spokeswoman Amy Spillman told UPI. This applied only to the IHC test, however. She said there was no indication the sample was unsuitable for the ELISA test. "They didn't make any notes the sample wasn't viable for ELISA, so we would assume it would be acceptable for" that test, Spillman said. Moser said he still would run the Western blot test in a case like this, even if the correct brain region was not available. Another renowned BSE testing expert agreed it would have been appropriate to run the Western blot test. The expert, who spoke to UPI on condition of anonymity, said there are several reasons why the obex may have been damaged or found to be unsuitable for IHC tests. "The best you can do is to throw more tests at it," the expert said, "especially ones that concentrate prion protein (thought to be the mad cow agent), such as the SAF Immunoblot (Western blot), and if that still comes up negative too, forget it." Spillman said the Western blot was not run because it "wasn't part of our protocol then." The USDA also failed to run the Western blot on the Texas cow that last month was deemed positive, making it the second case of the disease detected in U.S. herds. That cow had tested positive on two rapid tests last November, but the agency subsequently ran an IHC test and told the public it had come back negative. It was not until June -- and at the insistence of the agency's inspector general -- that the USDA would run a Western blot that came back positive. In announcing the June results, the USDA also informed the public that one of three IHC tests run in November had come back positive. This was not disclosed in November, and the revelation still has experts questioning why the agency would ignore a positive result and not run further tests -- such as a Western blot -- to determine more precisely if the cow was infected. The finding of a BSE-infected cow can have major economic consequences. A recent study conducted by Kansas State University researchers calculated the U.S. beef industry already has lost billions of dollars in exports due to foreign nations closing their borders in response to the 2003 mad cow case. In the past, the USDA has been quick to use the Western blot to confirm or rule out cases. In 1997 two cows that initially were suspected of having mad cow were tested using both the IHC and Western blot. Neither showed evidence of infection. Even in the 2003 case, the infected animal was retested using Western blot to confirm it had the disease. The USDA changed its policy after the Texas cow blunder, stating it would run both the IHC and the Western blot on cows that initially test positive on rapid tests. Michael Hansen, with the watchdog group Consumers Union, said the agency's failure to run the Western blot raises questions about the validity of the BSE surveillance program. "You don't know whether it's incompetence or some nefarious scheme, but its very Keystone Coppish," said Hansen, a biologist and senior research associate with CU. "Neither of those possibilities -- gross bureaucratic incompetence or political interference suggesting a coverup -- instills confidence in the public that the agency is doing the right thing," he told UPI. Another BSE expert told UPI of a similar problem with the USDA lab on a sheep that was tested for scrapie, a similar disease to BSE. The expert had observed the brain being extracted from the sheep and knew it was the correct region for testing, but the USDA lab later said it received the wrong brain region. UPI previously reported that from 2001 to 2003 the USDA collected the wrong part of the brain in more than 200 cows that were being screened as part of its BSE surveillance program. The USDA documents also indicate the agency never was able to identify or test 52 cows that came into the United States in 2001 along with the Washington cow that tested positive in 2003. Of these, 11 were considered to be "high risk" because they were born within a year and on the same premises as the infected cow. These cows may have gone into the food supply and been consumed by people. The concern is humans can contract a fatal brain disease from eating beef products contaminated with the mad cow pathogen. "It's possible those animals went to slaughter, but (USDA) would've done ante-mortem inspection and if those animals had exhibited signs (of BSE) they wouldn't have been allowed into the food chain," Spillman said. Hundreds of seemingly healthy animals in Europe have tested positive for the disease, however, and several eyewitnesses said the infected Washington cow was walking and did not appear ill the day of slaughter. The USDA's inability to locate these cows demonstrates the need for a stronger animal-identification program so officials can trace the final destinations of animals if there is a problem, Hansen said. -- E-mail: sciencemail@upi.com http://www.washtimes.com/upi/20050721-043953-6306r.htm
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