Veterinarians Seeking Solutions to Food Toxin

Recall of pet food leaves
veterinarians seeking solutions


No one knows how many cats and dogs have fallen ill after eating the pet food subject to a massive recall. Many veterinarians are wondering whether this sort of problem is preventable as they struggle to respond to the situation.

Menu Foods Inc., a Canadian manufacturer of wet pet food, recently recalled more than 60 million containers of cuts and gravy-style food from two U.S. facilities because of concerns about the effect of the products on the renal health of pets. The recall represents about 1 percent of pet food in the United States, according to the Food and Drug Administration.

The FDA, which regulates pet food and many ingredients in pet food, stated that the recall resulted from consumer complaints and the deaths of animals in routine palatability studies. A suspect agent at press time in late March was melamine, which had apparently contaminated the wheat gluten that went into food that was recalled.

As the investigation continues, practitioners have been busy calming clients and stabilizing patients. The veterinary community is sharing information and attempting to develop a treatment protocol. Practitioners also are learning much more about dog and cat food, from details of commercial manufacturing to issues with home preparation.

Tracing the contamination
The veterinary community has been discussing suspect agents, too.

Melamine is used as a fertilizer in Asia and in production of plastics worldwide. An unnamed company first found the melamine in food from the recall. The FDA confirmed the finding and identified melamine in wheat gluten that went into the food.

The Cornell University Animal Health Diagnostic Center also identified melamine in food, urine from cats that ate the food, and the kidney of one cat in the palatability studies. Dr. Donald Smith, dean of the College of Veterinary Medicine, said the relationship between the melamine and the clinical signs in animals is presumptive. Little literature is available about effects of melamine on cats and dogs.

From the beginning, the FDA has looked for a contaminant in the wheat gluten because Menu Foods recently changed suppliers of that ingredient. The agency was tracing shipments from the same supply of wheat gluten, which originated in China.

The FDA determined that another manufacturer of pet food, both wet and dry, received some of the wheat gluten. At press time, the agency was working with the manufacturer to determine whether the ingredient went into any food. The FDA also has begun reviewing and sampling all incoming shipments of wheat gluten from China.

An earlier suspect toxin was aminopterin, an antagonist of folic acid.

The New York State Food Laboratory reported that it found aminopterin in food from the palatability studies. Director Daniel Rice said aminopterin was a cancer drug about 50 years ago in the United States. The Environmental Protection Agency later banned use of the toxin as a rodenticide in this country.

At press time, no laboratory had announced an independent confirmation of the aminopterin finding. Tests continued for other contaminants and ingredients.

Preventing the problem
Even with the changeable nature of the situation, questions have arisen about whether more inspections could have found the contaminantion and whether the recall could have gone any better.

The timing and scope of the recall are one subject of analysis.

Menu Foods manufactured the products in the recall between Dec. 3 and March 6. According to the FDA, the company received the first consumer complaint Feb. 20. Shortly afterward, the company initiated tests of the products in question by internal and external specialists, but results of the tests did not reveal evidence of concern.

The company's routine palatability studies began Feb. 27, according to the FDA, and the first death among those animals was March 2. Menu Foods contacted the FDA March 15 and issued the recall March 16.

The problem appeared to be with cuts and gravy-style food from a Kansas plant, according to the FDA, but Menu Foods extended the recall to the same style of food from a New Jersey plant that was using wheat gluten from the same new supplier. Menu Foods has not confirmed that wheat gluten is the suspect ingredient, but the company stated that production has continued at the plants with another source of the ingredient in question.

Paul K. Henderson, Menu Foods president and chief executive officer, said the company continues to investigate the contamination. The company also is reviewing the manufacturing process and looking for more safeguards.

Henderson said he and his employees are "heart-stricken" by pet owners' losses.

"A pet is an important part of any family," Henderson said. "We understand that."

The scope of FDA food inspections was a subject of analysis before this recall. Recent recalls of human food include peanut butter and spinach. Diamond Pet Foods issued a recall in late 2005 because of aflatoxin contamination.

Dr. Stephen Sundlof, director of the FDA Center for Veterinary Medicine, said regulation of human and animal food doesn't differ substantially. The Food, Drug, and Cosmetic Act requires that foods be pure and wholesome and that they contain no harmful or deleterious substances?-though the act does not specify how manufacturers should ensure safety. The FDA identifies foods with higher risks for more inspections, Dr. Sundlof said, and pet foods are usually very safe.

The agency has limited resources for inspecting animal food and drugs, so it focuses inspections on manufacturers of drugs and of feed for food-producing animals. The FDA typically inspects manufacturers of pet foods if there is a particular reason, such as a complaint. States also maintain programs for regulating and inspecting manufacturers of pet food. The FDA confirmed that it had never inspected Menu Foods' Kansas plant before the recent recall.

Federal law does not mandate the frequency of inspections or premarket approval of foods under FDA jurisdiction, unlike the meat and egg products under the jurisdiction of the Department of Agriculture. The FDA regulates much more of the food supply with much less money than the USDA, according to the Government Accountability Office.

Veterinarians' stories
After the recall announcement, the main concern was for individual animals.

Worried pet owners flocked to their veterinarians. The weekend of March 17-18, Angell Animal Medical Center in Boston treated some 30 patients whose owners feared the tainted food had sickened their pets.

"We found the majority of them to be OK after doing simple blood and urine tests. Their troubles were illnesses other than kidney failure," spokesman Brian Adams said.

Two dogs were treated at the center for kidney problems, however, and later released. Adams couldn't say whether the pet food was responsible for the illnesses.

Similar cases were reported around the country. Dr. Robert L. Santos believes the death of at least one of his patients may be linked to tainted pet food. On March 12, a 7-year-old Pomeranian was brought to the Monte Vista Small Animal Hospital in California. The dog was lethargic, shaking, and vomiting blood. Blood tests revealed that the animal's creatinine concentrations were "off the charts." Bladder stones were also discovered.

"It just looked like a poisoning," Dr. Santos recalled.

The diagnosis didn't make sense because the dog spent most of its time indoors, and the owner insisted that her pet had not been exposed to any toxins. The dog suddenly died in its owner's arms, Dr. Santos said.

After news of the pet food recall broke, the owner told Dr. Santos that she had been feeding her Pomeranian one of the foods.

Dr. William Hope of Hope Veterinary Clinic in West Newton, Pa., said the deaths of five of his patients of renal failure may be attributable to the food. Dr. Hope has been advising owners that pets with signs of kidney failure should be seen immediately by a veterinarian. He also suggests testing the animal for early renal disease.

"I'm telling them to do that so, if for nothing else, they can sleep better at night," Dr. Hope said.

AVMA, veterinary community reach out
As practitioners tried to help clients and patients, the AVMA and other veterinary groups tried to help members and pet owners.

The AVMA Communications Division received an e-mail late Friday evening, March 16, alerting staff to the pending recall. Within 15 minutes, the validity of the content was verified and the notice was forwarded to every state VMA executive director, urging them to distribute it to their membership.

J.B. Hancock, director of the Communications Division, said, "By noon Saturday, the AVMA Web site had begun posting every verifiable fact we knew about the recall. As events progressed, the AVMA became the pre-eminent resource for the media, public, and veterinarians for credible, noninflammatory information, with over 100,000 total page views of our pet food recall pages on Friday, March 23."

One gauge of the magnitude of consumers' concern over the pet food contamination was the Menu Foods Web site. According to Dr. Althea Jones, the AVMA online managing editor, "During the period of highest activity, Menu Foods registered an incredible 3,100 pages being requested per second on its Web site. Those numbers are in the same range as Yahoo.com."

For the first time ever, the Association sent an all-members e-mail March 23 alerting colleagues that the AVMA Web site was being constantly updated with information regarding treatment, reporting procedures, and updates from Menu Foods and the FDA.

Hancock said that throughout the recall, the AVMA has worked closely with allied organizations and specialty groups, the pet food industry, and government agencies to gather information that impacts AVMA members. The Communications Division has responded to media requests from all over the country, including CBS Evening News, CBS Morning News, Fox Cable News, Newsweek, USA Today, Reuters, Associated Press, Business Week, Forbes, MSNBC, Canadian Broadcasting Company, ABC News, and the Chicago Tribune.

"Our leadership have made themselves available on a moment's notice to respond to interview requests," Hancock said. "I'm inordinately proud of everyone, from leadership to volunteers to staff, who have been on call 24 hours a day, including weekends, to bring fact-based information to our members and the pet-owning public."

Commenting on the AVMA's first all-members e-mail alert, AVMA Executive Vice President Bruce W. Little said, "I'm pleased with the overall results of this first-ever attempt to reach out to all of our members simultaneously. The Association had valuable and timely information on the pet food recall that we felt was of great importance.

"But this experience also underscores the necessity of members keeping their contact information up-to-date. Keep in mind that we have only 54 percent of e-mail addresses for our members, and of those, 20 percent were returned to us as 'undeliverable.' Should we need to alert our members in the case of a national disaster or other emergency, those figures would be unacceptable."

Among the resources posted on the AVMA Web site are guidance for veterinarians from the American College of Veterinary Internal Medicine and from The Animal Medical Center of New York. The ACVIM provided information on treating animals that ingested the recalled food.

The AMC offered guidance based on its staff's diagnosis of food-related acute renal failure in eight cats and four dogs. Each of those patients had at least one clinical sign of acute renal failure: 75 percent, anorexia; 50 percent, polyuria and polydipsia; 50 percent, vomiting; and 50 percent, lethargy.

The manufacturing of pet food
One of the AVMA resources posted online was a June 1, 2006, JAVMA "Timely Topics in Nutrition" report on a 2005 aflatoxicosis contamination incident in dogs, which also offered relevant general information about dealing with suspected contaminated commercial foods. The senior author was Dr. Claudia A. Kirk, associate professor of medicine and nutrition, University of Tennessee College of Veterinary Medicine.

Dr. Kirk had some insights about the current recall. While working as a research scientist for a pet food company, she and her food technologists had products manufactured at the Menu Foods plant in Emporia, Kan. This familiarized her not only with the facility but also the manufacturer's production process and the ingredients it used.

The reason so many products are involved in the 2007 recall is that many pet food companies rely on Menu Foods to manufacture their products that involve formed-meat chunks, Dr. Kirk said. The process requires more specialized equipment than most canned and dry food manufacturers have.

Hill's Pet Nutrition Inc., Nestlé Purina PetCare Company, and Procter & Gamble Pet Care, which includes Iams and Eukanuba, were among the premium pet food companies that issued voluntary recalls of certain pet foods they sell that are manufactured or co-manufactured by Menu Foods. The recall represents a very limited portion of these companies' product lines.

Dr. Kirk explained that premium pet food manufacturers as well as private-label companies, such as Wal-Mart and Kroger, use "contract manufacturers," or co-manufacturers, such as Menu Foods, essentially renting the time on the production equipment. Where the process usually differs between premium and private-label makers is with who controls the formula, evaluates the ingredients, and oversees manufacturing.

The premium food manufacturers usually exercise tight control over those things, she said. "Their formulas are going to be unique to that company, and their ingredients are going to pass their own ingredient specifications and quality control."

In contrast, co-manufacturers usually purchase the ingredients and provide nutritionists and food technologists who help the small companies with private-label brands to develop their formulas, Dr. Kirk said.

"The private-label pet foods may be vastly different from each other or may be virtually identical," she noted.

Unless a clinical nutritionist has been involved in developing a home-cooked food plan for a pet, Dr. Kirk believes the possible harm of not providing a balanced diet outweighs the potential for encountering further contamination.

In-plant screening is geared toward common contaminants, not random contamination with a chemical, Dr. Kirk said. "There are millions of compounds out there that are toxic. We just can't screen every ingredient for every compound. We have to have a certain index of suspicion."

Because of those limitations on quality control, manufacturers can derive some assurance that their product will be safe by dealing with suppliers who have a reputation for safety in their overall handling of ingredients from field to factory.

Suppliers typically undergo fairly rigorous screening, and their products are subjected to an overall contaminant screen, Dr. Kirk noted. Premium ingredients may pose a reduced risk of contaminating a product because often they are prescreened to ensure that they meet the company's stringent ingredient and nutritional specifications.

"The caveat to this is that if we look at the spinach supply that was contaminated with E coli," Dr. Kirk said, "it wasn't even surface contamination. It was being taken up in the plant. There are just going to be some things we can't screen for. That happens in the human food supply, and it's going to happen in the veterinary food supply.

"This is going to be a challenge for us, to develop new quality-control methods to address the needs of the future."

Dr. Joseph W. Bartges, nutritionist and internist at the University of Tennessee College of Veterinary Medicine, said pet foods are still very safe and have been subject to relatively few recalls?-particularly in light of global trade. The recent recall is for foods of one style from one manufacturer.

"So far, this has been related only to very specific foods," Dr. Bartges said. "Don't extrapolate to all pet foods."

He said plenty of alternatives are on the market, and he agrees with Dr. Kirk in not recommending home preparation of pet food. Many recipes from the Internet are not nutritionally complete, and raw foods can contain harmful microbes.

Dr. Bartges said the University of Tennessee had seen a couple cases with links to the food from the recall, and he has heard about a few dozen locally.

What's ahead
Four days after the recall, on March 20, the first lawsuit was filed against Menu Foods.

Dawn Majerczyk of Chicago claims her 9-year-old cat became sick and died after eating a single package of one of the recalled foods. She's seeking compensation from Menu Foods for her veterinary bills and the loss of her companion.

Scores of lawsuits against pet food companies followed, many of them seeking class-action status because of the large number of affected pet owners.

Dr. Bartges expects that estimates of thousands of deaths are an overstatement, especially because many of the animals have survived with early recognition and supportive treatment. The number of deaths will likely be in the hundreds, he estimated.

As the recall situation unfolds, the AVMA will continue to provide updates online at www.avma.org.
- KATIE BURNS, SCOTT NOLEN, SUSAN KAHLER, AND ALLISON REZENDES.

AVMA