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The Prevalence of Foodborne Illness

Days ago, the U.S. Centers for Disease Control and Prevention (CDC) released its most recent yearly summary of foodborne illness outbreaks in the United States. The summary covered the year 2013, and it found that 818 foodborne outbreaks were reported in the country during that year — a number consistent with the 800 to 850 outbreaks reported for each of the previous four years.

http://www.dreamstime.com/royalty-free-stock-image-united-states-night-map-network-earth-space-elements-image-furnished-nasa-image42631056But the number of reported foodborne outbreaks has significantly declined over the past 10 to 15 years. In 2000, CDC received reports of 1,417 outbreaks, as well as another 1,243 in 2001 and 1,330 in 2002.

At first glance, the drop in outbreak reports might suggest a decline in the prevalence of foodborne illness over the years. But while the data show that the prevalence of some foodborne pathogens is declining, the drop in reported outbreaks has less to do with improved food safety and more to do with the actual logistics of reporting.

New information on the reporting of foodborne illness outbreaks indicates that the decline in reports is in part due to changes with how some outbreaks are reported, and — more alarmingly — a decline in funding for outbreak investigations at the state level.

CDC estimates that foodborne illness sickens about 48 million people in the U.S. each year, resulting in 128,000 hospitalizations and 3,000 deaths. Some 30 percent of the population — young children, the elderly, and pregnant women and their expected children — are especially susceptible to foodborne pathogens such as SalmonellaE. coli and Listeria.

The vast majority of those illnesses go unreported simply because so many factors must come together for the reporting to occur. The ill person needs to consult with a healthcare provider, who then needs to test a stool sample for the right pathogen, and then the infection needs to be reported to the local health department.

But you need at least two illnesses to make an outbreak. That’s why health investigators monitor for illnesses that connect and form outbreaks.

From there, they can work to warn the public, assure recalls occur, and monitor for additional illnesses. But before they can report on these outbreaks and work to stop them, they need resources such as staffing, infrastructure and funding.

A new report from the consumer group Center for Science in the Public Interest (CSPI) suggests that the decline in reported outbreaks may be partially due to state-level funding cuts for public health.

Not only are fewer outbreaks being reported, fewer are being solved. CSPI found that 41 percent of reported outbreaks were solved in 2003, compared to only 29 percent by 2012.

The ability of states and county health departments to detect and investigate outbreaks appears to be at least partly tied to budgets, according to CSPI. (A sudden drop in outbreak reports after 2009 was also attributed to a change in reporting that allowed for norovirus outbreaks to be attributed to more than just food.)

Since 2005, the National Association of County & City Health Officials has seen up to an 18-percent decline in the number of environmental health specialists whose primary responsibilities include preventing foodborne illness. In 2011 alone, 10 percent of local health departments reduced or eliminated their food safety programs.

These cuts have come despite health departments already lacking sufficient funds to meet recommended resources and staffing levels, according to the association.

As a result, neighboring states are reporting hugely different rates of foodborne illness, seemingly as a result of their budgets for public health investigations into foodborne illness. When adjusted for population, Florida reported fives times as many outbreaks as neighboring Alabama, and Maryland reported four times as many outbreaks as West Virginia.

The resources and priorities of state and local health departments really do have an impact on how many outbreaks get reported, said Dr. Robert Tauxe, deputy director for the Division of Foodborne, Waterborne and Environmental Diseases at CDC.

“One of the most outbreak-ridden states seems to be Minnesota, but that’s not because Minnesota is having more dangerous outbreaks than other states,” Tauxe told Food Safety News. “It means they make food outbreaks a priority and they’re investigating more of them.”

It might be even more difficult for states to investigate outbreaks if not for support from federal CDC programs such as FoodNet and PulseNet, said Caroline Smith Dewaal, the former director of food safety at CSPI who just joined the U.S. Food and Drug Administration as the agency’s international food policy manager.

“The state officials I talked to said that it’s essential for the CDC to continue to fund these programs,” Dewaal said.

“If they didn’t have CDC money, their results would be even worse that what we’ve documented,” she added, referring to the CSPI’s report on the decline in outbreak reporting.

CDC’s FoodNet and PulseNet programs, among others, aid state and local health departments in outbreak investigations. CDC wants those health departments detecting more outbreaks and detecting them faster, Tauxe said.

The support from CDC helps identify gaps in the nation’s food safety system, said Nils Fischer, a food safety research associate at CSPI.

The prevalence of foodborne illness has led to an estimated $15 billion in annual healthcare costs for Americans, and our best defense is outbreak surveillance, Fischer said.

In the meantime, outbreaks are occurring through food vehicles never before associated with foodborne pathogens, Tauxe added. Food contaminated with Listeria, such as caramel apples and ice cream, have been connected to illnesses and deaths in Americans for the first time this year.

A key part of the strategy to detect and report these outbreaks will be new technologies. Already, some public health laboratories are field-testing a technology known as whole-genome sequencing to more accurately identify pathogens that sicken people — and therefore more easily identify outbreaks.

Some food companies are even adopting whole-genome sequencing for testing their own products or internally investigating contaminations that appear in their facilities. At the same time, other companies are adopting newer technologies to prevent illnesses, including devices with sensors that continually transmit data to the Internet to monitor for temperature abuse and other food safety red flags.

Tauxe said that in the next five years, new technologies should be significantly improving the detection and reporting of outbreaks, along with allowing food companies to more easily prevent problems at their facilities.

Everyone in the food safety system — from the food companies to the government regulators and public health investigators — wants a landscape with a lower prevalence of foodborne illness, Tauxe said. New technologies are going to help bridge that gap.

“The goal is to find food safety problems we would not otherwise have a way of knowing about,” Tauxe said.

© Food Safety News
  • heavyhanded

    An insightful article!

  • Jack Guzewich

    A few clarifications on this article.

    Paragraphs 5 and 6 leave the impression that sporadic case detection and linking are the major way foodborne disease outbreaks are detected. This is not the case. Most reported foodbonre disease outbreaks in the US result from investigations into consumer complaints. It still remains that state and local agencies need the staffing and resources to follow-up on those complaints if and when there are received.

    A later paragraph suggests that the recent Listeria outbreak linked to ice cream was a first. Actually ice cream was a common vehicle for raw eggs associated outbreaks linked to home made ice cream in years past and several years ago there was a very large multi-state outbreak of salmonellosis linked to Schwan’s ice cream due to raw egg contamination of tanker trucks.

    One last point is that so much of foodborne disease surveillance in the US depends on funding from CDC. This is certainly is true, but it avoids saying the sad point that most state and local legislatures and governors and local executives do not see their way fit to pay for foodborne disease surveillance for their citizens to the point that if the federal government will not fund this basic public health function they seem willing to forgo it.

  • Jim Mann

    Great summary of the challenges in reporting. Handwashing For Life’s experience totally follows your Minnesota and Florida examples. I don’t buy the budget cuts as a major contributing factor in this issue. It is more about prioritization. Are Norovirus outbreaks included in the numbers?

    Better handwashing will do more in lowering outbreaks than any other factor. This is our interpretation of CDC’s often stated view. Here is an outline for a workshop where an operator can more clearly see the risk of the unwashed hand and set a course of continuous improvement: handwashingforlife.com/handsonsystem/serveready-hands/risk-assessment

    Data drives behavior change from the C-suites to the kitchens and will drive down outbreaks more effectively than any legislation.