Listeria in Stone Fruit May Have Resulted in Illnesses in US

In July of 2014, a California packing house recalled stone fruit due to Listeria that was discovered through testing.   There were no illnesses reported at the time.

CDC took the PFGE patterns from the Listeria isolated at the peach facility and matched against human cases of Listeria infection across the country.  Two cases, one in Minnesota and one in Massachusetts had matching patters and had  eaten fruit that may have come from the company.
If the connection is truly there, this would be the first cases of listeriosis from stone fruit.

But what about the scenario here?  Basically FDA (or USDA) isolates Listeria from a product followed by the CDC running the isolate's DNA patter through their database to match that bacteria’s DNA pattern with any cases of illness that have occurred across the country . Then in those cases where there is a DNA match, they happen to find that person ate (or may have ate) that product at some point, then that food would be implicated. But was it really the food that resulted in the illness?  Or is it circumstantial evidence?  Could that person have eaten another item that contained that specific strain of Listeria?


CDC MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6410a6.htm?s_cid=mm6410a6_e
Notes from the Field: Listeriosis Associated with Stone Fruit — United States, 2014
Weekly
March 20, 2015 / 64(10);282-283
Brendan R. Jackson, MD1, Monique Salter, MPH2, Cheryl Tarr, PhD1, Amanda Conrad, MPH1,3, Emily Harvey4, Lisa Steinbock5, Amy Saupe, MPH6, Alida Sorenson, MPH7, Lee Katz, PhD1, Steven Stroika1, Kelly A. Jackson, MPH1, Heather Carleton, PhD1, Zuzana Kucerova, MD, PhD1, David Melka2, Errol Strain, PhD2, Mickey Parish, PhD2, Rajal K. Mody, MD1 (Author affiliations at end of text)

On July 19, 2014, a packing company in California (company A) voluntarily recalled certain lots of stone fruits, including whole peaches, nectarines, plums, and pluots, because of concern about contamination with Listeria monocytogenes based on internal company testing (1). On July 31, the recall was expanded to cover all fruit packed at their facility during June 1–July 17 (2). After the initial recall, clinicians, state and local health departments, CDC, and the Food and Drug Administration (FDA) received many inquiries about listeriosis from concerned consumers, many of whom had received automated telephone calls informing them that they had purchased recalled fruit. During July 19–31, the CDC Listeria website received >500,000 page views, more than seven times the views received during the previous 52 weeks. However, no molecular information from L. monocytogenes isolates was available to assess whether human illnesses might be linked to these products.

CDC Report - Attribution of Foodborne Illnesses, Hospitalizations, and Deaths

The CDC issued a report that attributes foodborne illness cases to different foods. Calculations, based on known cases over the period from1998 to 2008, are used to estimate the number of cases caused by each disease causing agent as well as to attribute to one of 17 food types.

There are some big assumptions that are made in the report that I feel limits what headlines will report. 1) It applies known outbreaks to apply to sporadic cases. Because of this, it underestimates the number of cases caused by organisms that have illnesses which tend to be more sporadic in nature, such as Campylobacter. 2) Along those same lines, mass distributed product where a single contamination event results in a large number of illnesses, such as in bagged produce, outweighs foods that may are considered high risk for contamination. 3) In the cases where mixed food caused an illness, the blame is put on the item commodity that they determined to have caused the biggest
proportion of illnesses, rather than the real risk. 4) Some organisms don't even show up, such as Taxoplasma spp.. even though that organism is claimed to be one of the major pathogens associated with meat....(although owning multiple cats is probably a bigger risk).

The headlines from some of the major news outlets give the impression that certain foods are risky.

Philly.com - U.S. Officials Pinpoint Common Sources of Foodborne Illnesses
Reuters - U.S. government report outlines foods most prone to pathogens
Time - Here’s What Foods Are Most Likely To Have E. Coli or Salmonella

 It is hard to get a real sense of real risk there is no calculation associated with the units consumed. Without this, many will jump on items that show to have a caused a higher percentage of the number of illnesses caused, but not the real risk.

My takeaways:

• Produce - Because of the way that produce is processed and distributed, a contamination event involving produce will impact many and thus gets seen as having a big impact in this report.  However, if we look at the number of units sold, produce is a much smaller risk than it appears to be in this report when compared to other commodities.  Not to say that there is not work that needs to be done, especially in preventing contamination events that can impact thousands of units.  However, people should not be discouraged from produce due to the potential for foodborne illness.
• Dairy - raw milk should be considered the highest risk dairy product, and on the further processed side, cheese accounts for many of the cases of Listeria recently seen.
• Mollusks - raw shellfish is a high risk item, especially when you consider the small number of people that eat raw shellfish (compared to produce)
• Poultry - because it has a natural association with Salmonella and Campylobacter, there have been outbreaks.  Looking at USDA monitoring records, while the levels of Salmonella in whole chicken are low, for ground poultry and parts, it is higher.  So while the industry is working to lessen the prevalence of these pathogens in poultry products, elimination is unlikely.
• Meat - ground meat is the primary source of STEC E.coli.  USDA testing indicates that about 0.5% of ground meat tested was positive. 
• As for pathogens, Salmonella is a pathogen that seems to find its way to the consumer via a number of different food products.  As for Campylobacter, it has a high prevalence on chicken, but we don't necessary see the cases; probably, because most cases are sporadic. In recent outbreaks, raw milk has been the culprit.

Has the number of foodborne illness cases dropped recently?  While that seems to be the case, it is hard to tell in this report.  And if policy decisions are going to be made on this report, even using weighting the data from the last five years, there may be some issues.  For example, our ability to determine the agent (detection of Campylobacter as an example) has improved dramatically in the last few yeas.  Additionally, issues that occurred 2 to 5 years ago may not be as big as an issue today  Granted it is difficult to trend when working with  minimal data.  However, considerations must be taken if these calculations are used to set policy.

CDC - Emerging Infectious Diseases

http://wwwnc.cdc.gov/eid/article/19/3/11-1866_article

Volume 19, Number 3—March 2013

Research

Attribution of Foodborne Illnesses, Hospitalizations, and Deaths to Food Commodities by using Outbreak Data, United States, 1998–2008

 

John A. Painter(http://wwwnc.cdc.gov/eid/article/19/3/11-1866_article#comment) , Robert M. Hoekstra, Tracy Ayers, Robert V. Tauxe, Christopher R. Braden, Frederick J. Angulo, and Patricia M. Griffin

Author affiliations: Author affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA

   

Abstract

 

Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998–2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne illness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.

Trichinellosis Surveillance in the United States, 2008 - 2012 - Summary of CDC Report

CDC issued a surveillance report on cases of Trichinellosis.  This is a quick summary.

 

Trichinellosis is a parasitic disease caused by Trichinella, a nematode. It had been traditionally associated with undercooked pork, but more recently it is more associated with wild game.  [Prior to improvements in pig husbandry in 1940's and 1950's, it was estimated that over 15% of people in the US had been infected by Trichinella.]

 

From the report:

"Trichinella infection in human hosts can be divided into an intestinal (enteral) phase and a muscular (parenteral) phase, with clinical manifestations ranging from asymptomatic infection to fatal disease, depending on the number of larvae ingested. After ingestion, larvae are released into the intestinal mucosa and subsequently migrate to the blood vessels, from which they spread throughout the body before reaching the skeletal muscles."

 During the initial phase, within the first few days of infection, symptoms can range from asymptomatic to severe gastrointestinal distress.  As the parasite migrates to the muscle and embeds itself, the person can have fever, muscle pain, and swelling.  Death can occur in cases where this is inflammation of the heart, brain, or lung tissue as well as due to respiratory failure from a high level of infection of encysted worms in the diaphragm muscle [it gets so many encysted worms that the muscle can't work...tell me that isn't a miserable way to buy the farm].

 

During the reporting period, 2008-2012, there were 84 confirmed cases.

• 22 cases were linked with pork products, including 10 with commercial pork products, 6 with wild boar, and 1 with home-raised swine, and 5 unspecified.
• 41 cases were linked to bear meat
• 2 cases with deer meat
• 2 with ground meat
• 17 cases unknown
• From 51 cases that were further investigated, 24 reported eating raw or undercooked meat [for the other cases, as we know, people hate to admit being stupid...who wants to admit eating bear tartare, or drinking the fresh blood of their hunted bear prey...yeah, you know that guy].

So the number of cases has continued to decline thanks to commercial pork practices and better cooking practices by the consumer, but vigilance is still needed, especially with wild game.  Consumers of pork and game must follow proper cooking or freezing methods to destroy the parasite.

CDC's An Atlas of Salmonella

Plot a bunch of illness-causing strains of Salmonella over 4 decades onto the maps of the US and you get the Atlas of Salmonella.  There are those geeks out there (you know who you are) that will really stick their nose in this, and some that may even consider wall papering their bathroom with it, but for most others.....not really sure at this point.

CDC Website
http://www.cdc.gov/salmonella/
New! Public health scientists have tracked Salmonella infections in the United States since 1962. By identifying the structures on the bacteria’s surfaces, scientists can classify the many types of Salmonella into serotypes.
An Atlas of Salmonella in the United States, 1968-2011  [PDF - 248 pages] is the first-of-its-kind report that charts over 40 years of laboratory-confirmed surveillance data on 32 Salmonella serotypes. The report includes analyses by age, sex, season, and geography, down to the county level. This is the first time CDC has posted these data online in a downloadable format.

Cheese recalled after it was linked to illness

UPDATE - April 4, 2014, CDC issued Notes from Field report.


Whole Foods is recalling Crave Brothers Les Frères cheese in response to a recall issued by the manufacturer, Crave Brothers, when their cheese was linked with 5 illnesses and one death.

 According to the company website, the type of cheese, Les Freres, is a semi-soft cheese.  

(http://www.cravecheese.com/our-cheese.php?Cheesecyclopedia-5)

Description
This European style farmstead cheese was developed with great care to reflect the Crave Brothers' Irish-French heritage. This one-of-a-kind washed-rind cheese has an earthy, mushroomy, fruity flavor and a creamy texture that is softer than Brie and has a nutty aftertaste. It is available in a small version-- Le Petit Frère®.

Appearance
It has a light-colored paste that does not become too runny, and holds its shape well.

Texture
Semi-soft.

Flavor
It is a rich, rind washed cheese with an earthy, fruity flavor. It has just a mildly mushroomy appeal.

The product sold at Whole Foods was packaged pre-cut wedges. Crave Brothers is also recalling - Les Frères (LF225 2/2.5#) with a make date of 7-1-13 or prior, packaged in white plastic with a green and gold label; Petit Frère (PF88 8/8 oz) with a make date of 7-1-13 or prior, packaged in small round wooden boxes; and Petit Frère with Truffles (PF88T 8/8 oz) with a make date of 7-1-13 or prior, packaged in small round wooden boxes.

FDA News Release
Whole Foods Market Recalls Cheese Because of Possible Health Riskhttp://www.fda.gov/Safety/Recalls/ucm359697.htm
FOR IMMEDIATE RELEASE - July 5, 2013 -Whole Foods Market announces that it is recalling Crave Brothers Les Frères cheese in response to a recall by the Crave Brothers Farmstead Cheese Company of Waterloo, Wisconsin. The cheese is being recalled because it has the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women. To date, one illness and one death have been reported. Crave Brothers was informed by regulatory agencies of an ongoing investigation related to potential health risks associated with Listeria monocytogenes. The company immediately ceased the production and distribution of the products.

CDC Report: Listeria Illnesses, Deaths, and Outbreaks — United States, 2009–2011

CDC just released a report detailing Listeria outbreaks in the United States, 2009-2011. In this time frame, ,1651 cases were reported nationally. 

In summary, Listeria monocytogenes is a foodborne pathogen that primarily impacts those in high risk groups – elderly, immunocompromised, and pregnant women. Listeria infection in these individuals leads to bacteremia (bacterial blood infection), meningitis, and death (mortality rate of 21%).

Soft cheeses and cheeses made from unpasteurized milk are the primary vehicles, although there have been cases related to produce (cut celery and cantaloupe). So for high risk groups, individuals in these high risk groups may want to forgo the soft cheeses, cheeses made from unpasteurized milk, and unpasteurized milk.

I think it is important to note what is not on list of responsible food items in this reporting period – deli meats. The meat industry has done a good job in reducing the risk associated with those ready-to-eat meat items. But work needs to continue with all refrigerated RTE items that can support the growth of Listeria. Recently, an interagency report on the risk of Listeria in Retail Delicatessens (http://pennstatefoodsafety.blogspot.com/2013/05/risk-assessment-of-listeria-in-retail.html) highlighted the practices retail stores can take to reduce the risk of Listeria contamination.


CDC MMWR Repot  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0604a1.htm?s_cid=mm62e0604a1_w

Vital Signs: Listeria Illnesses, Deaths, and Outbreaks — United States, 2009–2011

Early Release
June 4, 2013 / 62(Early Release);1-5

Abstract

Background: Older adults, pregnant women, and persons with immunocompromising conditions are at higher risk than others for invasive Listeria monocytogenes infection (listeriosis), a rare and preventable foodborne illness that can cause bacteremia, meningitis, fetal loss, and death.

Methods: This report summarizes data on 2009–2011 listeriosis cases and outbreaks reported to U.S. surveillance systems. The Listeria Initiative and PulseNet conduct nationwide surveillance to rapidly detect and respond to outbreaks, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, sentinel population–based surveillance to track incidence trends, and the Foodborne Disease Outbreak Surveillance System (FDOSS) receives reports of investigated outbreaks to track foods and settings associated with outbreaks.

Results: Nationwide, 1,651 cases of listeriosis occurring during 2009–2011 were reported. The case-fatality rate was 21%. Most cases occurred among adults aged ≥65 years (950 [58%]), and 14% (227) were pregnancy-associated. At least 74% of nonpregnant patients aged <65 years had an immunocompromising condition, most commonly immunosuppressive therapy or malignancy. The average annual incidence was 0.29 cases per 100,000 population. Compared with the overall population, incidence was markedly higher among adults aged ≥65 years (1.3; relative rate [RR]: 4.4) and pregnant women (3.0; RR: 10.1). Twelve reported outbreaks affected 224 patients in 38 states. Five outbreak investigations implicated soft cheeses made from pasteurized milk that were likely contaminated during cheese-making (four implicated Mexican-style cheese, and one implicated two other types of cheese). Two outbreaks were linked to raw produce.
Conclusions: Almost all listeriosis occurs in persons in higher-risk groups. Soft cheeses were prominent vehicles, but other foods also caused recent outbreaks. Prevention targeting higher-risk groups and control of Listeria monocytogenes contamination in foods implicated by outbreak investigations will have the greatest impact on reducing the burden of listeriosis.

Implications for Public Health Practice: Careful attention to food safety is especially important to protect vulnerable populations. Surveillance for foodborne infections like listeriosis identifies food safety gaps that can be addressed by industry, regulatory authorities, food preparers, and consumers.

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.

 

Norovirus 2013 - Sydney Strain

Jeff Mullhollem, Penn State Live 2/1/13
http://live.psu.edu/story/64019
UNIVERSITY PARK, Pa. -- A new strain of norovirus, known as GII.4 Sydney 2012, is making the rounds this winter, causing a significant number of acute outbreaks. According to the U.S. Centers for Disease Control and Prevention, it has become the dominant strain, causing more than 140 reported outbreaks in the United States so far this year.

People should try to limit their exposure to norovirus and try to minimize its spread, advised an expert in Penn State's College of Agricultural Sciences.
"There are some important reasons that lead to so many people becoming ill from norovirus," said Martin Bucknavage, extension food safety specialist.

"One is this virus's low infectious dose. It is estimated that it may take less than 20 viral particles to make someone ill. Then, there is the ability of the virus to survive on dry surfaces for two weeks or more and in water for months."

The virus can be spread in contaminated food or water, from contaminated surfaces, directly from a sick person or from the intake of aerosolized droplets of vomitus. Norovirus is not related to the flu (or influenza), which is a respiratory illness caused by a different virus, and flu shots do not protect against it.

The main symptom of norovirus infection is another factor in its spread -- acute-onset vomiting.

"This prevents people from becoming sick in a secure location," Bucknavage said. "Rather, rapid onset can occur at a dinner table, in a meeting or on the bus. People usually become ill within 12 to 24 hours of exposure, although longer incubation periods do occur."

Once someone is sick, they can experience symptoms for 24 to 72 hours and can remain contagious for up to three days, Bucknavage noted.

"Because of this short incubation time, low infectious dose and ease of spread, one can see why it spreads through a school or a cruise ship so quickly," he said. "While rarely fatal, people who become ill need to be sure to consume liquids so they don't become dehydrated."

The key to preventing infection is frequent, but correct, hand washing -- scrubbing hands with soap and warm water. In addition, it is important for people to stay home when ill, especially when they may have been exposed to someone who has had the illness.

"They also should stay home for at least 48 hours after symptoms have subsided," Bucknavage said. "Contaminated surfaces must be cleaned using a strong chlorine bleach solution, one cup of bleach to one gallon of water. Cooking also will destroy the organism."

To learn more about norovirus, visit the Centers for Disease Control and Prevention website at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm.

 

Salmonella from Hedgehogs and Other Pets

The poor hedgehog took a beating from the media as the poor critter was linked to 20 cases of Salmonellosis.
Hedgehog - http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6204a3.htm?s_cid=mm6204a3_w

 Hedgehogs are not the only pets that have been responsible for outbreaks. Many reptiles and amphibians have had past history of being a source of salmonella outbreaks.
Reptiles and amphibians - http://www.cdc.gov/Features/SalmonellaFrogTurtle/

 Turtles have caused a number of Salmonella outbreaks over time including last year.
Turtles - http://www.cdc.gov/salmonella/small-turtles-03-12/

Along with turtles, we have frogs, lizards, and snakes.
Frogs - http://www.cdc.gov/salmonella/water-frogs-0411/
Lizards - http://www.cdc.gov/mmwr/preview/mmwrhtml/00017445.htm
Snakes - http://wwwnc.cdc.gov/eid/article/12/2/pdfs/05-0692.pdf

Birds are another group of animals that also get flagged for causing Salmonella outbreaks. Both chicks and ducklings that are given as pets top the list.
Chicks - http://www.cdc.gov/mmwr/preview/mmwrhtml/00046940.htm
Ducklings - http://www.cdc.gov/mmwr/preview/mmwrhtml/00016299.htm

But there is also a link with the exotic birds, such as parrots and macaws. (My Dad had a macaw and that was one messy bird with regard to its watery poop).
Exotic birds - http://vdi.sagepub.com/content/7/2/270.full.pdf

Even feeding birds has its risk. Bird seed has been recalled because of Salmonella contamination.
Bird seed - http://www.fda.gov/Safety/Recalls/ucm325609.htm

And of course, wild birds can carry Salmonella. This is why it is important to maintain clean bird feeders.
Wild birds (including songbirds) - http://vetmed.tamu.edu/common/docs/public/schubot/SalmonellosisinWildBirds.pdf.
http://www.wildcarebayarea.org/site/PageServer?pagename=TakeAction_Salmonella_Outbreak

Pet rodents have been a issue, but in most cases, the animal will be ill from the Salmonella infection. That is, they are not as good as carriers when compared to reptiles.
Rodent pets such as guinea pigs - http://www.webmd.com/news/20050505/cdc-pet-rodents-can-carry-salmonella

Dogs and cats are generally not an issue unless it comes via their food.
Pet food - http://www.cdc.gov/salmonella/dog-food-05-12/vet-info.html
http://www.nwhc.usgs.gov/disease_information/other_diseases/salmonellosis.jsp
Regular pets - http://www.cdc.gov/salmonella/typhimurium/salmonella_pets.html

Petting zoos have a history of causing illness via cross contamination of Salmonella and STEC E. coli.
Petting zoos - http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a1.htm

Handwashing is among one of the many control steps for petting zoos.
Preventing disease in animal settings - http://www.cdc.gov/mmwr/pdf/rr/rr6004.pdf

Finally, we have this from CDC on reducing risk of Salmonella from animals.
Pets - http://www.cdc.gov/healthypets/diseases/salmonellosis.htm

CDC Report on Ciguatera Fish Poisoning in NY - 2010 to 2011

Wen discussing chemicals hazards in food, we often mention ciquatoxin, a natural toxin found in tropical predator fish such as grouper and barracuda. CDC’s MMWR (Feb 1, 2013), Ciguatera Fish Poisoning - New York, 2010-2011, is a case study that looks at 28 cases of ciguatera fish poisoning (CFP) in 28 individuals that occurred in a one year period, from August, 2010 to July 2011. 13 people became ill after eating barracuda, and 15 after eating grouper.

 

The toxin originates as a precursor in dinoflagellates (microalgae) which live in coral reef areas. These algae are eaten by smaller fish and the precursor toxin is converted to the toxic form. Predator fish such as barracuda, grouper, snapper, amberjack and surgeonfish eat these small fish, and over time, this toxin accumulates in the larger fish’s body. People eat these larger fish and then suffer the symptoms of CFP. “CFP is characterized by various gastrointestinal, cardiovascular, and neurologic symptoms. A prolonged period of acute illness can result, and the neurologic symptoms can last months, with variable asymptomatic and symptomatic periods.” Typical symptoms include diarrhea, abdominal cramps, dizziness, headache, faintness, nausea, vomiting and tingling in the extremities (fingers and toes).

Two interesting points made in this report:

• “CFP is considered a highly underreported illness, with only an estimated 10% of cases reported to health authorities (7). Increasing awareness among health-care providers might improve reporting and investigation. However, CFP prevention is complicated by difficulty in identifying high-risk fishing grounds and inadequate industry knowledge and compliance with the FDA seafood Hazard Analysis and Critical Control Point (HACCP) regulations.† Premarket testing of fish for CTX is not feasible because of the lack of rapid field methods and the sporadic distribution of toxic fish, even in endemic areas. Coordinated tracebacks of implicated fish by federal and state agencies to specific fishing grounds remains the primary strategy for managing CFP.”

• “This investigation demonstrates the value of CFP-implicated fish traceback along with updated information on emerging CFP risks, including new harvest areas and species. Prevention through education alone might be limited by seafood mislabeling.”

 

Ciguatera Fish Poisoning — New York City, 2010–2011

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6204a1.htm?s_cid=mm6204a1_x

Weekly

February 1, 2013 / 62(04);61-65

During August 2010–July 2011, the New York City Department of Health and Mental Hygiene (DOHMH) received reports of six outbreaks and one single case of ciguatera fish poisoning (CFP), involving a total of 28 persons. CFP results from consumption of certain large, predatory, tropical reef fish that have bioaccumulated ciguatoxins (CTX). CFP is characterized by various gastrointestinal, cardiovascular, and neurologic symptoms. A prolonged period of acute illness can result, and the neurologic symptoms can last months, with variable asymptomatic and symptomatic periods. The first two outbreaks and the single case, involving 13 persons, were reported during August 6–September 13, 2010. DOHMH distributed a health alert in November 2010 requesting health-care providers be alert for CFP signs and symptoms. The health alert resulted in identification of 11 more cases that month and an additional two outbreaks involving four persons in July 2011. In comparison, only four CFP outbreaks, involving 21 persons total, had been reported in New York City (NYC) during the preceding 10 years (2000–2009). DOHMH's investigation revealed that 13 persons became ill after eating barracuda, and 15 became ill after eating grouper. Although specific and highly sensitive laboratory analyses can detect and confirm CTX in fish, no practical field tests are available for fish monitoring programs. CFP prevention depends on educating the public, seafood suppliers, and distributors about known CFP endemic areas and high-risk fish species. Traceback investigations of fish associated with outbreaks provide valuable information regarding fishing areas associated with CFP. Not all fish from CFP endemic areas are ciguatoxic, but persons who eat fish from endemic regions are at higher risk for CFP. If an illness is suspected to be CFP, public health authorities should be notified and informed of the case history for possible investigation and intervention measures.

CDC Releases Report on Commodities Responsible for Foodborne Illness

The CDC released a study that attributes foodborne illness to food commodities. "CDC developed a comprehensive set of estimates using data from more than a decade of foodborne disease outbreaks and previously published estimates on how many illnesses can be attributed to each food category." Of course, every news outlet has issued a relase listing a highlight or two from this CDC report.
With any report of this nature, there is a lot of extrapolation. One of the biggest is the fact that many foods involved in outbreaks were classified as complex foods - foods with more than one commodity involved. And the number of reported illnesses is small considering it is over a ten year period (270,000 illnesses compared to an estimated 460,000,000 cases that would have estimated to occur 46 million X 10 years OR less than 1%).
And it cannot be overlooked that the data is now 5 years old.
There is some information we can glean from the report. Produce and meat/poultry are important commodities when it comes to foodborne illness. Norovirus is the leading cause of illness, Some excerpts are listed below. Beyond that, it makes for press releases keeping food safety in the news.

For full report: http://wwwnc.cdc.gov/eid/article/19/3/11-1866_article.htm

 

Attribution of Foodborne Illnesses, Hospitalizations, and Deaths to Food Commodities by using Outbreak Data, United States, 1998–2008

Painter JA, Hoekstra RM, Ayers T, Tauxe RV, Braden CR, Angulo FJ, et al. Attribution of foodborne illnesses, hospitalizations, and deaths to food commodities by using outbreak data, United States, 1998–2008. Emerg Infect Dis [Internet]. 2013 Mar [date cited]. http://dx.doi.org/10.3201/eid1903.111866

• During 1998–2008, a total of 13,352 foodborne disease outbreaks, causing 271,974 illnesses, were reported in the United States (Technical Appendix 1 Table 1 [PDF - 723 KB - 8 pages]). Of those outbreaks, 4,887 (37%), causing 128,269 (47%) illnesses, had an implicated food vehicle and a single etiology; 300 of those outbreaks were excluded because information about the vehicle was insufficient to categorize the ingredients. We also did not include the 3% of outbreaks that had multiple etiologies reported.
• Norovirus caused the most outbreaks (1,419) and outbreak-associated illnesses (41,257), far above the median for all agents (29 outbreaks, 1,208 illnesses).
• Produce commodities (fruits-nuts and the 5 vegetable commodities) accounted for 46% of illnesses; meat-poultry commodities (beef, game, pork, and poultry) accounted for 22%. Among the 17 commodities, more illnesses were associated with leafy vegetables (2.1 million [23%]) than any other commodity. The high estimate for illnesses attributable to leafy vegetables was many times higher than the low estimate (Figure 2, panel A), which indicates that leafy vegetables were frequently found in complex foods. After leafy vegetables, the commodities linked to the most illnesses were dairy (1.3 million [14%]), fruits-nuts (1.2 million [12%]), and poultry (900,000 [10%]). Norovirus comprised 57% of all illnesses.
• Most bacterial illnesses were attributed to dairy (18%), poultry (18%), and beef (13%) commodities (Table 1). Most chemical illnesses were attributed to fish (60%, most caused by the marine biotoxin ciguatoxin).
• Most viral illnesses were attributed to leafy vegetables (35%), fruits-nuts (15%), and dairy (12%). Of the 20 outbreaks associated with simple foods and caused by norovirus transmitted by dairy, 14 (70%) were transmitted by cheese products.

E. coli 0145 Outbreak, 14 Cases, Source Currently Unknown

According to news reports (link below), health officials from Georgia and CDC are investigating an outbreak of E. coli O145 that has made 14 ill across 6 southern states (GA, AL, TN, FL, CA and LA). One 21-month-old girl from New Orleans has died as a result of complications of infection. The source of this outbreak is not yet known.

E. coli O145, like the E. coli O157:H7 strains can cause severe diarrhea as well as damage kidney function. It has not been linked to as many outbreaks as the O157 strain, but was responsible for the 2010 outbreak linked to shredded romaine lettuce where there 26 confirmed cases and 7 probable. http://www.cdc.gov/ecoli/2010/ecoli_o145/index.html

USDA identifies this O145 strain along with O157 and 5 other STEC strains as adulterants and began testing for these strains on meat trimmings on June 4, 2012. From the USDA May 31st news release (below): “ The additional strains that will be treated as adulterants beginning today are Shiga-toxin producing E. coli (STEC) serogroups O26, O45, O103, O111, O121 and O145. Like E. coli O157:H7, these serogroups can cause severe illness and even death, and young children and the elderly are at highest risk.”


E. coli outbreak in six states sickens 14, kills childJune 8, 2012 1:21 PM CBS News Staff
http://www.cbsnews.com/8301-504763_162-57449652-10391704/e-coli-outbreak-in-six-states-sickens-14-kills-child/
(CBS/AP) - Health officials are investigating a mysterious and scattered outbreak of the E. coli bacteria linked to 14 illnesses and one death.

The Centers for Disease Control and Prevention said no form of contaminated food or other cause has been identified in the illnesses, which occurred in April and May. They are spread among six states. 

Three people were hospitalized. One - a child in the New Orleans area - died last week. The Georgia Department of Public Health on Wednesday confirmed to the Atlanta Journal-Constitution the state has five confirmed cases with one sufferer needing hospitalization.

The outbreak strain is E. coli 0145, a dangerous but not well-known type of bacteria. The strain was fingered in a 2010 outbreak that sickened more than two dozen people in at least five states. The most commonly identified strain in North America is E. coli O157, and has been responsible for numerous outbreaks.

Some strains of E. coli are harmless, but others can cause serious and potentially lethal illnesses, according to the Centers for Disease Control and Prevention. E. coli infection typically causes stomach cramps, diarrhea (sometimes bloody), vomiting, and mild fever. Some kinds of E. coli can cause diarrhea, while others cause urinary tract infections, respiratory illness and pneumonia, and other illnesses. 

Symptoms typically appear within four days, though sometimes the "incubation period" can last a week.

Diamond Pet Foods Linked to Salmonella Outbreak

For Update (http://pennstatefoodsafety.blogspot.com/2012/05/updates-on-salmonella-linked-to-tempeh.html)

CDC reports that there are 14 cases of Salmonella linked to dry dog food produced by Diamond Pet Foods. People become ill from handling the pet food itself and from interaction with the pet who ate the food (yes, and there are probably a few people who may take a little bite themselves).

From the CDC information, it appears that cases could have been seen as early as late 2011, but cases have been coming in sporadically over a 5 or 6 month period. FDA released the first recall notice by Diamond on April 6, (http://www.fda.gov/Safety/Recalls/ucm299606.htm) but indicated no illnesses were reported. Diamond expanded the recall again on April 26th (http://www.fda.gov/Safety/Recalls/ucm302137.htm) and again on April 30th (http://www.fda.gov/Safety/Recalls/ucm302514.htm) to include puppy formula, but in both recall notices did not indicate whether people were affected. Much of this delay is probably related to the low level of cases that occurred over the last 5 months in that connecting illnesses to a product becomes difficult. Couple that with the slow movement of pet food from manufacture to store shelf to purchase to use and to illness. The company started the recall when they got test results back from Michigan Department of Ag , but that expanded the recall as Ohio Dept of Health found Salmonella in product during an illness investigation.  It appears then that CDC had sufficient information to link illnesses with product.

From past incidents with Salmonella in dry dog food such as the Mars Pet Foods in 2008, Salmonella can establish itself in pet food plants and be very difficult to eliminate. This Mars facility that was linked to the Salmonella outbreak was eventually shuttered. If one had to determine how this occurs, Salmonella comes in on the raw materials, and ross contaminates (through air movement via dust particles, personnel movement, etc) the post process side or finished product side of the operation (after the heating step known as extrusion). Once there, Salmonella can make its way into the nooks and crannies and slowly be released into the final product. This can be seen in the Diamond Pet Foods case because there is not just one product implicated, but rather a number of products.

If consumers have Diamond Pet Foods, they should cease use and return to store or dispose.  

Multistate Outbreak of Human Salmonella Infantis Infections Linked to Dry Dog Food
CDC News Release Posted May 3, 2012 5:15 PM ET
http://www.cdc.gov/salmonella/dog-food-05-12/index.html

· A total of 14 individuals infected with the outbreak strain of Salmonella Infantis have been reported from 9 states.

· The number of ill persons identified in each state is as follows: Alabama (1), Connecticut (1), Michigan (1), Missouri (3), North Carolina (3), New Jersey (1), Ohio (2), Pennsylvania (1), and Virginia (1).
· Among the 9 patients with available information, 5 (56%) were hospitalized. No deaths have been reported.
· Multiple brands of dry pet food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections.
· Consumers should check their homes for recalled dog food products and discard them promptly. People who think they might have become ill after contact with dry pet food or with an animal that has eaten dry pet food should consult their health care providers.

Norovirus Outbreaks 2012

The leading cause of foodborne disease is making its mark this winter. Just this February, Norovirus caused more than 200 attendees at a cheerleader camp in Washington State to become ill. In St. Maarten, a cruise ship returned to port as 31 became ill. In Virginia, an elementary school was closed because so many students were ill. And in New Jersey, more than 400 college students become ill at three universities located in the same county.

There are some important reasons that lead to so many people becoming ill from Norovirus. One is the virus’s low infectious dose. It is estimated that it may take only 10 viral particles to make someone ill. Then, there is the ability of the virus to survive for up to two weeks on dry surfaces and in water for months. The virus can be spread through a number of ways including through contaminated food or water, from contaminated surfaces, directly from a sick person, or from the intake of aerosolized droplets of vomitus.

The main symptom of Norovirus infection is another factor for its spread – acute-onset vomiting. This prevents people from becoming sick in a secure location. Rather, rapid onset can occur at a dinner table, on a carpet, or on the bus. People usually become ill within 24 hours of exposure, although longer incubation periods do occur. Once someone is sick, they can experience symptoms for 24 to 72 hours, and can remain contagious for up to 3 days.  

Because of this short incubation time, low infectious dose, and ease of spread, one can see why it spreads through a school or a cruise ship so quickly. While rarely fatal, people who become ill need to watch so that they do not become dehydrated.

The most important key in preventing infection is frequent, but correct hand washing – scrubbing hands with soap and warm water. Additionally, it is important for people to stay home when ill, especially when they may have been exposed to someone who has had the illness. They should also stay home for at least 48 hours after systems have subsided. Contaminated surfaces must be cleaned using a strong chlorine bleach solution, 1 cup of bleach o one gallon of water.  Cooking will destroy the organism.

CDC link for additional information
http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm

Outbreak cases
http://www.inquisitr.com/193064/norovirus-outbreak-2012-washington-state-cheerleading-competition/
http://www.huffingtonpost.com/2012/02/13/crown-princess-departs-af_0_n_1272706.html
http://www.nbc12.com/story/16958672/norovirus-outbreak-causes-school-to-close
http://www.nj.com/mercer/index.ssf/2012/02/mercer_county_colleges_report.html

E. coli O26 infections linked to Clover Sprouts

Raw sprouts are responsible for another outbreak of foodborne illness and at least the fourth outbreak linked to the same restaurant chain, Jimmy Johns. In this latest case, there are 12 people infected with STEC O26 (CDC and AP link below). 

After the last outbreak linked to the restaurant chain in late 2010 where close to 120 people became ill with Salmonella, the chain switched from alfalfa sprouts to clover sprouts. But sprouts are sprouts – they are a higher risk food item in that it can be difficult to remove organisms such as Salmonella and E.coli from the seeds, and the process that allows the seed to sprout also may allow the organism to grow. Now, it appears the chain will drop sprouts from its menu (http://www.kirksvilledailyexpress.com/news/x1793836666/Jimmy-Johns-permanently-pulls-sprouts-from-menu). 

Tainted sprouts again linked to Jimmy John’s, outbreak is fourth linked to restaurantBy Associated Press, Published: February 15
http://www.washingtonpost.com/business/tainted-sprouts-again-linked-to-jimmy-johns-outbreak-is-fourth-linked-to-restaurant/2012/02/15/gIQAGxFVGR_story.html

WASHINGTON — Raw sprouts from the sandwich chain Jimmy John’s have been linked to an outbreak of foodborne illness — again.

The federal Centers for Disease Control and Prevention said Wednesday that 12 cases of E. coli poisoning in five states are linked to raw clover sprouts eaten at Jimmy John’s restaurants. The outbreak comes a year after raw alfalfa sprouts from one of the chain’s suppliers were linked to 140 salmonella illnesses. Sprouts from the chain’s suppliers were also linked to a 2009 salmonella outbreak in several Midwestern states and were suspected in an E. coli outbreak in Boulder, Colo. in 2008.

Salmonella and Taco Bell - CDC to release or not to release

CDC released the final report on a multistate outbreak of Salmonella Enteritidis which was associated with eating food from a Mexican-style fast food restaurant chain, Restaurant Chain A.  This report, issued on January 19, 2011 (http://www.cdc.gov/salmonella/restaurant-enteriditis/011912/index.html) indicated that 68 individuals from 10 different states became ill from October, 2011 through November, 2011.

Much of the controversy now is that CDC or the FDA did not release the name of the restaurant which we now know is Taco Bell.  It is not agencies’ policy to release the name of establishments when it is determined that the release of this information will have no impact on other people becoming ill.  (http://abcnews.go.com/Blotter/hidden-outbreak-restaurants-stay-anonymous/story?id=15505386).  Having been to many food safety conferences over the years where CDC and FDA presented case study reports, I have seen that they never state the name of the company involved in the case being presented.

On one side, I can see the value in not releasing this name.  Often, the case is ongoing, so they need cooperation from the establishment.  Additionally, releasing this information can have a huge financial impact on the company.  We assume these investigations are air-tight, but that is absolutely the case.  We just need to look at how tomatoes were wrongly blamed in 2008 when peppers were actually the source. In that salsa outbreak, the tomato industry was devastated. (http://www.bloomberg.com/apps/news?pid=newsarchive&refer=columnist_skrzycki&sid=agA9XKef6P20).  In many investigations, the indictment of a food and associated producer is based on a statistical analysis without actual product testing, as was the case with Taco Bell.

On the other side, as a consumer, I want to know which establishments present a likely risk to me and my family.  The fact that an given establishment is involved indicated that they have a insufficient food safety system.  An added concern is the fact that there seems to be no clue as to the actual cause of the Salmonella contamination.  So, to what degree do we look at this company and question whether they have a potential condition under control?  In a statement, (http://blogs.ajc.com/business-beat/2012/02/02/taco-bell-salmonella-outbreak-remains-mystery/?cxntfid=blogs_business_beat) Taco Bell indicates that it is probably at the suppler level.  Is that giving you any confidence in the safety of their food?

CDC lists Multistate Foodborne Outbreaks for 2011

CDC has updated their Multistate Foodborne Outbreak listing for 2011 (http://www.cdc.gov/outbreaknet/outbreaks.html). This is a nice reference page for reviewing major food outbreaks that have occurred over the past 6 years. (An outbreak, as defined by CDC is “When two or more people get the same illness from the same contaminated food or drink”)

 A few things to note:

• This does not include recalled products – products recalled due to only the presence of pathogens (pathogens were detected in the product, but there were no illnesses reported). There have been many recalls that have occurred due to positive analysis for a pathogen, especially now with the Reportable Registry (http://www.fda.gov/food/foodsafety/foodsafetyprograms/rfr/default.htm). And so it follows, it does not include recalls for allergens – the major cause for companies to conduct recalls.
• This list does not include single state outbreaks – so this list is manly large companies that produce products. This does not mean that smaller establishments do not have issues.
• A few items were actually not food, but rather pets (frogs and chicks/ducklings in 2011, and water frogs and frozen rodents, which are used to feed slithering pets, in 2010). One item was dog food, which we will count as food – you dog food eaters know who you are.
• There appears to be an increase in the number of entries each year on this listing. I don’t suspect things are getting worse, but rather detection and reporting are getting better.
• Of the 41 entries over the 6 year period where a cause can be found (dropping the pet related entries and the laboratory entry), fresh ground meat had 6 entries, alfalfa sprouts had 5, leafy greens had 5, and cantaloupe had 3.
• Salmonella related outbreaks accounted for roughly 2/3 of the entries. This is due to the wide prevalence of Salmonella in the enviornment.
• FDA regulated product entries accounted for 25 entries, USDA for 11, and I suspect that two of the outbreaks were from facilities that had both USDA and FDA oversight.
• Roughly 27 are what one would consider ready to eat (no required consumer cooking step). 14 entries were products would be considered products that required cooking, that if done sufficiently by the consumer, would have prevented illness (reasons why vary - cookie dough traditionally eaten raw, pot pies – poor cooking instructions, raw meat – no thermometer use).
• As a consumer, I avoid alfalfa sprouts, use a thermometer to cook my ground meat, really wash my cantaloupes, pray my chopped lettuce was not harvested from a farm located next to a cow barn, cook my cookie dough to have crunchy cookies, and refuse to buy my kids turtles, frogs, and snakes (that have to fed frozen rodents.) I have also ceased from eating dog food.

 Multistate Foodborne Outbreaks

 http://www.cdc.gov/outbreaknet/outbreaks.html

When two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne outbreak. Public health officials investigate outbreaks to control them, so more people do not get sick in the outbreak, and to learn how to prevent similar outbreaks from happening in the future.

CDC and partners ensure rapid and coordinated surveillance, detection, and response to multistate foodborne outbreaks.

Outbreaks by Year

 2011

 · Ground Beef - Salmonella Typhimurium

 · Romaine Lettuce - Escherichia coli O157:H7

 · Kosher Broiled Chicken Livers - Salmonella Heidelberg

 · Turkish Pine Nuts - Salmonella Enteritidis

 · Jensen Farms Cantaloupes - Listeria monocytogenes

 · Ground Turkey - Salmonella Heidelberg

 · Whole, Fresh Imported Papayas - Salmonella Agona

 · African Dwarf Frogs - Salmonella Typhimurium

 · Alfalfa and Spicy Sprouts – Salmonella Enteritidis

 · Travel to Germany - Shiga toxin-producing E. coli O104

 · Chicks and Ducklings - Salmonella Altona and Salmonella Johannesburg

 · Microbiology Laboratories - Salmonella Typhimurium

 · Turkey Burgers - Salmonella Hadar

 · Lebanon Bologna - Escherichia coli O157:H7

 · Del Monte Cantaloupe - Salmonella Panama

 · Hazelnuts - Escherichia coli O157:H7

CDC: No Progress in Salmonella During Past 15 Years

According to the CDC, the US has not made progress on reducing the incidence of Salmonella infections over the past 15 years. In fact, there has been an increase of 10% over recent years. Illnesses from other foodborne pathogens, namely E. coli, have decreased.

Why?

·      There are numerous sources of Salmonella – from wild birds to reptiles to farm animals.

·       It has the ability to survive in dry environments. 

·      Many strains have a low infectious dose. 

·      Infection can result in severe diarrhea, lasting for days, and in some cases, leading to life threatening situations.

In all, this organism has a higher likelihood of being present to take advantage of any lapses in our handling and preparation of food -  from the farm, to processing, to retail or foodservice, and to the consumer’s home.  Increased regulatory presence may be one part of the picture, but there also needs to be compliance all along the food chain -  Good Agricultural Practices in the field, GMPs and HACCP in the processing sector, and proper handling and preparation by retail and foodservice establishment employees as well as by the consumer.

There is still an amazing amount of people who don’t use a thermometer or know proper cooking temperatures, or that don’t properly clean to prevent cross contamination, especially washing fruit and veggies from the field (where birds poop).  Salmonella is adapted to take advantage of these miscues, whether it is a tub of peanut butter open to cross contamination,  a cantaloupe from a field where manure was improperly applied, or a chicken that was improperly cooked on the grill.

No Progress in Salmonella During Past 15 Years

Food safety annual report card targets hard-to-prevent infection

http://www.cdc.gov/media/releases/2011/p0607_vitalsigns.html?source=govdelivery

Salmonella infections have not decreased during the past 15 years and have instead increased by 10 percent in recent years, according to a new Vital Signs report released today by the Centers for Disease Control and Prevention. During the same time period, illnesses from the serious Shiga toxin-producing E. coli O157 have been cut nearly in half and the overall rates of six foodborne infections have been reduced by 23 percent, the report said.

The Vital Signs report summarizes 2010 data from CDC's Foodborne Diseases Active Surveillance Network (FoodNet), which serves as America's report card for food safety by tracking whether nine of the most common infections transmitted through foods are increasing or decreasing.

"Although foodborne infections have decreased by nearly one-fourth in the past 15 years, more than 1 million people in this country become ill from Salmonella each year, and Salmonella accounts for about half of the hospitalizations and deaths among the nine foodborne illnesses CDC tracks through FoodNet," said CDC Director Thomas R. Frieden, M.D., M.P.H. "Salmonella costs hundreds of millions of dollars in direct medical costs each year. Continued investments are essential to detect, investigate, and stop outbreaks promptly in order to protect our food supply."

Salmonella, which is responsible for an estimated $365 million in direct medical costs each year in the United States, can be challenging to address because so many different foods like meats, eggs, produce, and even processed foods, can become contaminated with it and finding the source can be challenging because it can be introduced in many different ways.

In response to that challenge, the U.S. Food and Drug Administration, which regulates eggs, produce and many processed foods, has developed new rules for the egg industry to follow under its recently expanded regulatory authorities.

"Last summer, FDA began implementing new shell egg safety requirements that should significantly reduce illnesses caused by Salmonella enteritidis in eggs," said FDA Deputy Commissioner for Foods Michael R. Taylor. "The recently enacted Food Safety Modernization Act wisely mandates a comprehensive approach to preventing illnesses from many types of Salmonella and a wide range of other contaminants that can make people sick. The current outbreak of E. coli in Europe demonstrates the importance of the new law, and FDA is committed to implementing the new law as fully as possible within available resources."

In 2010, FoodNet sites, which include about 15 percent of the American population, reported nearly 20,000 illnesses, 4,200 hospitalizations and 68 deaths from nine foodborne infections. Of those, Salmonella caused more than 8,200 infections, nearly 2,300 hospitalizations and 29 deaths (54 percent of the total hospitalizations and 43 percent of the total deaths reported through FoodNet). CDC estimates that there are 29 infections for every lab-confirmed Salmonella infection.

The rate of E. coli O157 cases reported by FoodNet sites was 2 cases per 100,000 people in 1997 and, by 2010, had decreased to .9 cases per 100,000 people. The nearly 50 percent reduction in E. coli O157 incidence is considered significant when compared to the lack of change in Salmonella incidence. CDC credits the reduction in E. coli to improved detection and investigation of outbreaks through CDC's PulseNet surveillance system, cleaner slaughter methods, testing of ground beef for E. coli, better inspections of ground beef processing plants, regulatory improvements like the prohibition of STEC O157 in ground beef and increased awareness by consumers and restaurant employees of the importance of properly cooking beef. The U.S. Department of Agriculture, the agency that regulates meat, has led these efforts.

"Thanks to our prevention based approach to food safety, as well as industry and consumer efforts, we have substantially reduced E. coli O157 illnesses," said Elisabeth Hagen, M.D., Under Secretary for Food Safety in the U.S. Department of Agriculture. "This report demonstrates that we've made great progress. However, far too many people still get sick from the food they eat, so we have more work to do. That is why we are looking at all options, from farm to table, in-order to make food safer and prevent illnesses from E. coli, Salmonella, and other harmful pathogens."

The pathogens included in the overall 2010 rate reduction of 23 percent when compared to 1996-1998 are: campylobacter, E. coli STEC O157, listeria, Salmonella, vibrio and yersinia. Rates of vibrio infection were 115 percent higher than in 1996-1998, and 39 percent higher than in 2006-2008. Most vibrio infections are the result of eating raw or undercooked shellfish.

People who want to reduce their risk of foodborne illness should assume raw chicken and other meat carry bacteria that can cause illness and should not allow them to contaminate surfaces and other foods, such as produce. While it's important to wash produce thoroughly, they should never wash meat and poultry. They should also cook chicken, other meats, meat, poultry, and eggs thoroughly well, avoid consuming unpasteurized milk and juice as well as and unpasteurized soft cheese, and make sure shellfish are cooked or treated for safety before eating.

About FoodNet

FoodNet is a collaboration of CDC, ten state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service, and the Food and Drug Administration. FoodNet collects information to analyze foodborne disease trends and track rates of laboratory-confirmed illnesses caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing E. coli O157 and non-O157, Shigella, Vibrio and Yersinia. Annual data are compared with data from 2006-2008 and with data from the first years of surveillance (1996-1998) to measure progress. FoodNet covers 46 million people, or about 15 percent of the American population. The sites are the states of Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, and Tennessee, and selected counties in California, Colorado, and New York.

About Vital Signs

CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators—cancer prevention, obesity, tobacco use, alcohol use, HIV/AIDS, motor vehicle safety, health care-associated infections, cardiovascular health, teen pregnancy, asthma, and food safety.

CDC Releases New Numbers for Foodborne Illness Cases Each Year

Finally, we can stop quoting the ole ‘76 million people get stick each year from foodborne illness, with 300, 000 hospitalizations, and 5,000 deaths’.  Now it is 48 million sick, 128,000 hospitalizations, and 3,000 deaths. They claim the number is more accurate, which means the number we have been quoting for the last umpteen years was not accurate.  I think most of us guessed that, but in conference after conference, news report after news report, that number was laid out there.  All hail the new number, but think of the number of PowerPoint’s that will need to be changed.

CDC Reports 1 in 6 Get Sick from Foodborne Illnesses Each Year

New estimates more precise

About 48 million people (1 in 6 Americans) get sick, 128,000 are hospitalized, and 3,000 die each year from foodborne diseases, according new estimates from the Centers for Disease Control and Prevention. The figures are the most accurate to date due to better data and methods used. The data are published Wednesday in two articles in the journal Emerging Infectious Diseases.

The papers provide the most accurate picture yet of what foodborne pathogens are causing the most illness, as well as estimating the proportion of foodborne illness without a known cause. The reports are the first comprehensive estimates since 1999 and are CDC's first to estimate illnesses caused solely by foods eaten in the United States.

"We've made progress in better understanding the burden of foodborne illness and unfortunately, far too many people continue to get sick from the food they eat," said CDC Director Thomas Frieden, M.D, M.P.H. "These estimates provide valuable information to help CDC and its partners set priorities and further reduce illnesses from food."

CDC's new estimates are lower than in the 1999 report. The difference is largely the result of improvements in the quality and quantity of the data used and new methods used to estimate foodborne-disease. For example, it is now known that most norovirus is not spread by the foodborne route, which has reduced the estimate of foodborne norovirus from 9.2 to approximately 5.5 million cases per year. Because of data and method improvements, the 1999 and current estimates cannot be compared to measure trends.

CDC's FoodNet surveillance system data, which tracks trends among common foodborne pathogens, has documented a decrease of 20 percent in illnesses from key pathogens during the past 10 years. However, these FoodNet pathogens make up only a small proportion of the illnesses included in the new estimates.

Of the total estimate of 48 million illnesses annually, CDC estimates that 9.4 million illnesses are due to 31 known foodborne pathogens. The remaining 38 million illnesses result from unspecified agents, which include known agents without enough data to make specific estimates, agents not yet recognized as causing foodborne illness, and agents not yet discovered. In both the 1999 and current estimates, unspecified agents were responsible for roughly 80 percent of estimated illnesses.

"Foodborne illnesses and deaths are preventable, and as such, are unacceptable," said FDA Commissioner Margaret A. Hamburg, M.D. "We must, and can, do better by intensifying our efforts to implement measures that are prevention-oriented and science-based. We are moving down this path as quickly as possible under current authorities but eagerly await passage of new food safety legislation that would provide us with new and long overdue tools to further modernize our food safety program."

Among the additional findings for foodborne illness due to known pathogens:

·         Salmonella was the leading cause of estimated hospitalizations and deaths, responsible for about 28 percent of deaths and 35 percent of hospitalizations due to known pathogens transmitted by food.

·         About 90 percent of estimated illnesses, hospitalizations, and deaths were due to seven pathogens: Salmonella, norovirus, Campylobacter, Toxoplasma, E.coli O157, Listeria and Clostridium perfringens.

·         Nearly 60 percent of estimated illnesses, but a much smaller proportion of severe illness, was caused by norovirus.

"People expect food to nourish them, not to harm them. So we need to intensify efforts to decrease the number of illnesses and deaths due to foodborne diseases," said Christopher Braden, M.D., director of CDC's Division of Foodborne, Waterborne, and Environmental Diseases. "We now know more than ever what pathogens are causing the most harm, and we will continue our work to help protect people from these illnesses. Much that remains unknown about how and why people get sick and we are committed to learning more in the future."

CDC continues to encourage consumers to take an active role in preventing foodborne infection by following safe food-handling and preparation tips of separating meats and produce while preparing foods, cooking meat and poultry to the right temperatures, promptly chilling leftovers, and avoiding unpasteurized milk and cheese and raw oysters.

The full report is available online at http://www.cdc.gov/eid. For more detailed information on the estimates and methods, please visit http://www.cdc.gov/foodborneburden. To learn more about foodborne illness trends, visit the FoodNet site at http://www.cdc.gov/FoodNet/. To learn about how to prevent foodborne illness, visit http://www.foodsafety.gov.