CDC - Surveillance study on the cause of reported foodborne Outbreaks

CDC issued a surveillance study on the cause of reported foodborne Outbreaks.

• During 2009–2015, FDOSS received reports of 5,760 outbreaks, resulting in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths 
• Where a single agent was confirmed (in 2,953 outbreaks) with a single confirmed etiology, 

1. Norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]). 
2. Salmonella was the second most common single confirmed etiology reported, with 896 outbreaks (30%) and 23,662 illnesses (35%)
3. Shiga toxin-producing Escherichia coli (STEC) (191 outbreaks [6%]), 
4. Campylobacter (155 [5%]), 
5. Clostridium perfringens (108 [4%]), 
6. Scombroid toxin (95 [3%]), 
7. Ciguatoxin (80 [3%]), 
8. Staphylococcus aureus (35 [1%]), 
9. Vibrio parahaemolyticus (35 [1%]), and 
10. Listeria monocytogenes (35 [1%]). 

• Listeria, Salmonella, and STEC were the most common causes of hospitalizations (82%) and deaths (82%) reported among persons in outbreaks with a single confirmed etiology.
• Salmonella and STEC were two of the most common causes of large outbreaks.
• Restaurants accounted for the largest percentage followed by Catering, Private Home, and then Institutional.
• The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]).
• The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941

Limitation of analysis:

1. "Because CDC’s foodborne outbreak surveillance is dynamic and agencies can submit, update, or delete reports at any time, the results of this analysis might differ slightly from previous or future reports". 
2. "Not all outbreaks are identified and the majority of foodborne illnesses occur outside the context of a recognized outbreak. The degree to which the food vehicles, etiologies, and locations implicated in outbreaks represent the vehicles, etiologies, and locations of sporadic foodborne illness is unknown." 
3. "Some outbreaks have an unknown food vehicle, an unknown etiology, or both, and analyses and conclusions drawn from outbreaks with an identified food vehicle and confirmed etiology might not be representative of all outbreaks." 
4. "Pathogens that are not known to cause illness sometimes are reported as a confirmed or suspected etiology."

https://www.cdc.gov/mmwr/volumes/67/ss/ss6710a1.htm?s_cid=ss6710a1_e
Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015
Surveillance Summaries / July 27, 2018 / 67(10);1–11

FDA Phone Survey Finds that Food Safety Knowledge Among Consumers Still Lacks

 FDA conducted a phone survey of consumers to gain an understanding of food safety knowledge and attitudes.  Phone surveys can be sketchy, so it is always important to review results with some skepticism.  Here are a few of the results that are interesting:

1. While the majority people owned a thermometer, not many people actually used them, especially on products where thermometer use would be most helpful - when cooking hamburgers (only 10%) and cooking chicken (19%).
2. Not everyone washes their hands - 15% surveyed don't when handling raw meats and 25% don't wash their hands before preparing food.
3. But it is interesting that about half the people think that they are more likely to get foodborne illness when eating out rather than in the home. 

Food Safety Survey Shows Consumer Knowledge Up, Still Room to Grow

November 17, 2016

Survey Shows that Many Distrust Large Food Companies More than Small

A survey conducted by the Center for Food Integrity (CFI) shows that people have more trust in smaller, more entrepreneurial companies than in larger food companies.  In general, the larger the company, the more likely the belief that those companies will put profit ahead of principle.  This despite the fact that larger companies normally have much more resources (people, access to technology, established procedures, etc) to produce products more safely and efficiently compared to small companies

This is not surprising. Certainly this goes hand-in-hand with the increased demand for less processed foods, going for foods that appear fresher and with less preservatives.  Here again, the reality is that fresher, less processed foods can actually represent a higher risk.

Where does this skepticism come from?  There are probably a number of reasons, but here are a few.
One is the press that has come from past product issues where large companies hid information or provided misleading information.  There is big tobacco and information on linkage with cancer.  Or we can look at the most recent recall of Volkswagen cars after the company mislead consumers on emission testing.  Being large companies, these issues receive national press coverage and with that, garner public outrage.

Another reason is food related ingredients or chemicals that got bad press regardless of whether they were used incorrectly or at all.  One of the biggest controversies which was a major factor for the organic food movement was alar, the chemical added to orchards to help regulate apple maturing.   Another controversy was the use of mechanically recovered meat (pink slime).  This recovered meat product was painted as a big company way of adding a cheap alternative into our food (as opposed to a more sustainable method for protein recovery).

I believe another issue is that the public has been conditioned to view large corporate entities and government institutions negatively through movies and television shows watched every day.  How many times do we see a big company as the villain?  And the Federal government receives gets a worse rap.  The Lego Movie.  Jurassic World.  Wolf of Wall Street. Here is a list. Then of course there are the movies that directly smack the industry  such as Food, Inc or Super Size Me.
 
Food Navigator-USA.com
http://www.foodnavigator-usa.com/Manufacturers/Why-don-t-consumers-trust-big-food-asks-Center-for-Food-Integrity/?utm_source=newsletter_daily&utm_medium=email&utm_campaign=18-Nov-2015&c=v8GVp68XEjZbZUWKo1RlOg%3D%3D&p2=
The bigger the food company, the less consumers trust it, reveals new research

By Elaine Watson+Elaine WATSON, 18-Nov-2015

Big food companies are consistently trusted less than small, entrepreneurial ones, even though their scale and resources arguably mean they are able to produce products more safely, efficiently and sustainably than their smaller, sexier, counterparts, according to new research.

http://www.foodnavigator-usa.com/Manufacturers/Why-don-t-consumers-trust-big-food-asks-Center-for-Food-Integrity

Using the Smartphone for Stealth Auditing

Is that person checking the score of the Steeler game....or I am getting audited? 


Penn State News
http://news.psu.edu/story/372963/2015/10/01/research/phone-app-allows-researchers-conduct-concealed-food-safety
Phone app allows researchers to conduct concealed food safety observations
By Jeff Mulhollem
October 1, 2015

UNIVERSITY PARK, Pa. -- Smartphones are so ubiquitous, and text messaging and social media activities so common in public places, that no one questions what anyone does with their phone. That pervasiveness allows a phone application to be used in direct, concealed observations without alerting the people being observed.

That is the conclusion of food science researchers in Penn State's College of Agricultural Sciences, who studied whether phones could be used in place of the traditional clipboards to improve the quality of data collection related to food safety observations.

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.

Poll - Americans think more oversight will lessen their fears of unsafe food

Results from The Harris Poll indicate that people are concerned about the safety of their food and that food recalls are an issue.  In light of this, many feel that more government is needed.

It would be interesting to ask people some different questions:
Have actually become sick from food, provided they really know the symptoms of foodborne illness?  In our informal polling, we find that very few have had foodborne illness in their lives, never mind in the last few years.
Do you actually worry about the food currently in your house?  Again, most we talk with say no.

In this report, it is interesting that people rarely blame their own actions, but rather look to the few cases of foodborne illness that arise (mostly because of the amount of press that accompanies it), where it was indeed some big companies fault.

They also look at local food as inherently more safe...which as we know, is not necessarily the case.

Each day, 300 million people eat 2 to 3 meals a day (hopefully),  and yet we focus on that on those few cases that occurred somewhere in the nation within the past month.

This is not to say we can't do better.  Certainly each link along the food chain has to their part to ensure safety and quality of the food, including the consumer.

In the end, will the cost of additional oversight actually reduce the real risk of unsafe foods, or even the perceived risk?

(I hate news reports on polling people….it almost adds credence to what people already think even if it is wrong…for example a poll finds that out of 2000 people, most think that sasquatches exist…hell, that many people can’t be wrong, maybe they do exist ).

PR Newswire
Nearly Three-Quarters of Americans Looking to Government for More Food Safety Oversight
Vast majority at least somewhat concerned about food health and/or safety recallshttp://www.einpresswire.com/article/188993634/nearly-three-quarters-of-americans-looking-to-government-for-more-food-safety-oversight
PR Newswire
NEW YORK, Feb. 5, 2014 /PRNewswire/ -- Food recall announcements have become something of a news cycle staple in the past few years. From spinach and peanut butter to chicken and pet foods, there seems to be little left in the U.S. food supply that should not be viewed with at least a modicum of suspicion. As such, it's likely not surprising that strong majorities of U.S. adults say food recalls have them at least somewhat concerned (86%, with 58% somewhat concerned and 28% seriously concerned) and believe there should be more government oversight in regards to food safety (73%). 

These are some of the results of The Harris Poll® of 2,236 adults surveyed online between January 15 and 20, 2014. (Full results, including data tables, available can be found here)

Food recall concerns – and calls for increased government oversight where the food supply is concerned – are stronger among some subsets of Americans than others:
Women are more likely than men to indicate being both seriously (31% women, 25% men) and somewhat (61% and 55%, respectively) concerned; they are also more likely than their male counterparts to believe there should be more government oversight in regards to food safety (77% and 69%, respectively).
Americans in low income households – specifically households with an annual income under $35,000 – are more likely than those in higher earning households to describe food recalls as a serious concern (36% in households earning <$35k, 21% in households earning $35k-$49,999, 26% in $50k+ households).
Turning to political leanings, Democrats (32%) are more likely than Republicans (25%) to characterize food recalls as a serious concern. The call for more government oversight rings most loudly from the Democrats' camp (86%) and least so from Republicans (60%), with Independents in the middle (70%).

Social Media Taking Over for Mom

The Progressive Grocer discusses a study" Clicks & Cravings: The Impact of Social Technology on Food Culture, which finds social/digital media is replacing Mom as the go-to culinary source of knowledge for many people."  These surveys are great references - we sense that more people are using social media as a tool for deciding what to eat, how to prepare it, and then chatting about it with others, but here is a study to support those notions.  

http://www.progressivegrocer.com/top-stories/headlines/consumer-insights/id34891/social-media-redefining-our-relationship-with-food/

"The study was jointly developed and conducted by consumer research firm The Hartman Group and Publicis Consultants USA, a food and nutrition marketing agency. Study results show almost half of consumers learn about food via social networking sites, such as Twitter and Facebook, and 40 percent learn about food via websites, apps or blogs."

Impact on food safety - the internet is the wild west of information, where anyone can write anything.  It is alway important for people to use trusted sites, and to review information provided in that recipe against validated information (foodsafety.gov for example).  If a recipe suggests that you undercook an item, for example to cook chicken to 150F instead of 165F, you should consider not using that recipe.