Reporting the Risks of Foodborne Illness

This past week, two reports relating to the topic of food risk were issued resulting in a media frenzy. 

One of those reports was CDC’s annual Trends in Foodborne Illness in the United States 2012 (below). CDC analyzes data from FoodNet, a system that tracks foodborne illness in roughly 10 states, and then projects these numbers for the entire country. News stories that were issued, including this Time article (http://healthland.time.com/2013/04/22/cdc-food-safety-report-card/), point out that the rates of foodborne illness have largely remained unchanged.   

Salmonella still remains one of the most common causes of foodborne illness and the number of cases remained roughly the same.

The report indicated that there was an increase in the rate of Campylobacter infection I think it can be argued however, that this may be the result of increased testing for Campylobacter and that the methodology for testing has improved. Campylobacter has traditionally not been an easy organism to culture, so as methodologies have improved, one would guess that labs will find it more often. http://wwwnc.cdc.gov/eid/article/18/3/11-1266_article.htm.  

Raw poultry is a main source of Campylobacter, and while the industry is working to reduce levels on poultry, at this time there is no magic bullet for eliminating it from poultry at the processing level. So it comes down to the consumer controlling it through proper preparation (cooking it to the right temperature), as well as proper handling (preventing cross contamination of food items with the raw product).

Vibrio is another pathogenic organism that has seen an increase. The primary vehicle for Vibrio is raw oysters. There are not many cases reported, probably because there are not many people who eat raw oysters. If consumers ate raw oysters as much as they ate bagged leafy greens, the numbers for Vibrio infections would dwarf all others.

So have the numbers of foodborne illness changed? We know that there are foods that are risky (raw oysters), and that practices for handling and preparing food need to improve throughout the food chain from the farm to the table, but perhaps we can look for a sign from the businesses that aid victims of foodborne illness - the food illness lawyers. According to a posting by one of the preeminent firms from that group….business is down. http://www.marlerblog.com/legal-cases/foodborne-illness-rates-continue-to-fall-and-that-is-a-good-thing/

The other report that garnered media attention, Risky Meat: A CSPI Field Guide to Meat & Poultry Safety (http://cspinet.org/foodsafety/riskymeat.html), was issued by Center for Science in the Public Interest. I think the title of this should have been title….Meats that Pose a Risk for Those Who Fail to Properly Cook and Clean. The strength of the CSPI report is that it reminds us that raw meat has the potential to carry pathogenic bacteria. But the sound bite heard over and over in the media was that chicken and hamburger are high risk meats. Well, these meats are only risky if they are not properly handled and prepared.

While the meat and poultry industry works to reduce the levels of pathogenic microorganisms on raw meat products, those items still have the potential to carry pathogenic microorganisms. But the risk is for people who mishandle or improperly prepare them. CSPI did provide guidance on proper handling and preparation.

 
Trends in Foodborne Illness in the United States, 2012
http://www.cdc.gov/features/dsfoodnet2012/

Each year, foodborne illness, commonly known as food poisoning, affects about 48 million people in the United States. Food poisoning can happen anywhere, to anyone, and from foods we might not expect. Public health surveillance, such as that conducted by the Foodborne Diseases Active Surveillance Network (FoodNet), provides needed data for tracking trends.

FoodNet: Report Card for Food Safety

Each year, FoodNet reports on the changes in the number of people sickened with foodborne infections that have been confirmed by laboratory tests.

Foodborne diseases monitored through FoodNet include infections caused by the bacteria Campylobacter, Listeria, Salmonella, Shiga toxin-producing E. coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia, and the parasites Cryptosporidium and Cyclospora. The data collected by FoodNet also lets CDC, its partners, and policy makers know how much progress has been made in reaching national goals for reducing foodborne illness.

Highlights of the 2012 FoodNet Data

Data from FoodNet, which monitors 15% of the US population, provide the best measure of trends in foodborne disease in the United States. Overall, the 2012 FoodNet data showed a lack of recent progress in reducing foodborne infections and highlight the need for improved prevention.

FoodNet identified 19,531 laboratory-confirmed cases of infection.
The incidences of laboratory-confirmed Campylobacter, Cryptosporidium, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, and Yersinia infection were highest among children aged <5 years.
The incidences of Listeria and Vibrio infection were highest in adults aged ≥65 years.
The incidences of laboratory-confirmed Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157, and Yersinia infection did not change significantly in 2012 compared with 2006–2008.
Campylobacter was the second most common infection reported in FoodNet (14.3 cases reported per 100,000 population). Incidence of infection was 14% higher in 2012 compared with 2006–2008.
Campylobacter infections are usually self-limited, but may result in severe complications such as Guillain-Barré syndrome (a type of paralysis), and arthritis.
Exposures related to Campylobacter infection include consumption of undercooked poultry, raw milk, produce, untreated water, and contact with young animals.
Vibrio infections are rare (0.41 cases reported per 100,000 population). Incidence of Vibrio infection was 43% higher in 2012 compared with 2006–2008.
Some types of Vibrio infections are often serious.
Many Vibrio infections are acquired by eating raw oysters. These infections are most common during warmer months when waters naturally contain more Vibrio organisms.
Infections can be prevented by thoroughly cooking oysters and by not exposing wounds to bodies of warm seawater.
As a group, the incidence of infection with six key pathogens transmitted commonly through food (Campylobacter, Listeria, Salmonella, E. coli O157, Vibrio, and Yersinia) was not significantly different in 2012 than in 2006–2008. 

Long-term Trends

Comparison with the first three years of FoodNet surveillance (1996–1998) shows some clear changes:

The incidence of infections caused by Campylobacter, Listeria, STEC O157, Shigella, and Yersinia has declined, mostly in the first years.
The overall incidence of Salmonella was unchanged, but the incidence of some types of Salmonella have increased while others have decreased.
The incidence of Vibrio infection is now 116% higher.
The overall incidence of infection with six key foodborne pathogens (Campylobacter, Listeria, Salmonella, STEC O157, Vibrio, and Yersinia) was 22% lower.

Recent Efforts and Next Steps

Most foodborne illnesses can be prevented. Some progress has been made in decreasing contamination of some foods and reducing illness caused by some pathogens. Recent efforts to reduce contamination of food and prevent these illnesses include:

Establishment in 2011 of performance standards for Campylobacter contamination of whole broiler chickens in processing plants.
Approval of more stringent time and temperature controls for oysters after harvest to prevent Vibrio vulnificus infections.
The Food Safety Modernization Act of 2011: It gives FDA additional authority to regulate food facilities, establish standards for safe produce, recall contaminated foods, oversee imported foods, and which requires improvements in surveillance and response to outbreaks. It calls on CDC to strengthen surveillance and outbreak response. 

More can be done. Determining where to target prevention efforts that will reduce foodborne infections requires continued collection of information to understand sources of infection, implementation of measures known to reduce food contamination, and development of new measures.