November 01, 2020

A series of Salmonella outbreaks in Israel sickened people from spring 2017 through summer 2019.

Dr. Riva Ben-Ezra, deputy chief veterinarian for the control of animal products in the Israeli Ministry of Agriculture Veterinary Services, said human and animal health authorities ultimately issued three recalls together affecting millions of eggs. The government diverted millions more eggs for heat treatment and depopulated about 350,000 chickens in a response repeatedly hampered by a lack of conclusive evidence on the source of contamination. Epidemiology work pointed to one farm, but the owner denied the eggs originated from the facility, blaming instead Israel’s recurring problem of eggs smuggled into the country with fraudulent identification.

“Could the amount of birds culled have been lessened?” Dr. Ben-Ezra said. “Was there more that could have been done to curtail the illnesses, to educate the public regarding the safe use of eggs to discover and eliminate the source of Salmonella?”

In the Aug. 20 presentation “Whose Health is Number One? Mitigating Policy Clashes in a One Health Approach to Food Safety” at the AVMA Virtual Convention 2020, Dr. Ben-Ezra described how government investigators debated whether to risk public health by letting the farm continue selling eggs or risk needless animal deaths by killing flocks without proof they were the source of illnesses.

“There is one instance where the protection of public health may potentially clash with veterinary medical ethics, and that is culling or depopulation,” she said. “Doctors treating humans have an obligation to protect human life at all costs, whereas veterinary doctors have the ability—and sometimes even the obligation—to destroy their patients for the greater good to protect animal health or to protect human health.”

Starting in March 2017, investigators saw Salmonella Enteritidis outbreaks spread, first among child care centers and later among adults. Related outbreaks continued through June 2019.

Dr. Ben-Ezra said genetic analysis eventually provided more conclusive links between the suspect farm and illnesses. Some eggs confiscated from smugglers were contaminated with Salmonella Enteritidis, but the bacteria had genetic differences from the outbreak strain.

In addition to illustrating potential ethical conflicts, Dr. Ben-Ezra said the outbreaks showed the need for clear lines of communication, with designated spokespeople who could work across regulatory agencies, and a single agency to give consistent information to consumers and other stakeholders.

“It may be difficult to identify them in advance, but potential policy clashes should be discussed and unified before the crisis to prevent zigzagging messages and to ensure smooth operations during an event,” she said. “And, finally, when there are two or more agencies performing their own risk assessments, the potential for policy clashes increases.”