| Efforts have intensified to keep our Nation’s food supply safe and to forestall public alarm resulting from several recent but unrelated outbreaks of foodborne illness and death. These efforts involve the Federal Government, State and local health agencies, food industry groups, and consumer representatives. This issue of Prevention Report focuses on food safety. It reviews some of the causes of foodborne illness and related trends and populations at risk. It also summarizes some recent activities to prevent foodborne illness, including a major national health education campaign. |
Last summer, the U.S. Department of Agriculture (USDA) ordered the largest food recall in history—25 million pounds of ground beef produced at a meat-packing plant in Nebraska. The ground beef contained a particularly virulent form of bacteria called
E. coli O157:H7. A foodborne parasite called Cyclospora, traced to contaminated fresh basil, was responsible for an outbreak of illness last summer in the Washington, DC, metropolitan area. Salmonella made more than 700 people sick and killed 2 people in November after they ate at a church supper in Maryland.E. coli
O157:H7, Cyclospora, and Salmonella are three members of a whole zoo of microorganisms that can contaminate the food we eat and the water we drink (see accompanying table). Foodborne pathogens may kill as many as 9,000 Americans every year. Estimates of illness range from 6.5 million to 33 million cases annually. The estimated annual economic burden of foodborne illness and death in the United States may run as high as $34.9 billion.A 5-year nationwide surveillance study released in 1996 by the Centers for Disease Control and Prevention (CDC) identified
Salmonella as the most commonly reported cause of foodborne disease outbreaks. (CDC defines an outbreak of foodborne disease as two or more confirmed cases of a similar illness in different people who have eaten the same food.) Salmonella accounted for almost 70 percent of the outbreaks of foodborne illness during the 5-year period of the study.A CDC surveillance study re-leased in 1997 identified
Campylo-bacter, another bacterial pathogen, as the most common cause of sporadic foodborne disease. CDC collected data for this study from the five States participating in the Foodborne Disease Active Surveillance Network, more commonly known as FoodNet. FoodNet is a cooperative program involving CDC, USDA, and the Food and Drug Administration (FDA). Besides Salmonella, Campylo-bacter, and other common pathogens, new microorganisms are emerging that threaten our food supply. E. coli O157:H7 was not discovered until 1982. Other once obscure or un-known foodborne pathogens such as Cyclospora, Cryptosporidium, and Listeria have been identified in recent years as causes of foodborne illness.Fortunately, most bacteria and other foodborne pathogens cause only temporary discomfort in people who are otherwise healthy. Diarrhea, nausea, vomiting, abdominal cramps, and fever are the most common symptoms and can result in misseddays at work or school and occasionally in hospitalization. Some pathogens, however, can cause rare but more serious complications, including kidney damage, Guillain-Barré syndrome, and chronic reactive arthritis.
Certain individuals and populations are at increased risk of death from foodborne illness. Groups at increased risk include the elderly, infants and children, and people whose immune systems are compromised, such as cancer patients under-going chemotherapy and people infected with HIV. According to the CDC’s 5-year surveillance study, 85 percent of the deaths attributable to
Salmonella occurred among nursing home residents.In recent years, the rate of
Salmonella infection has decreased, but the actual number of reported cases has doubled over the past two decades. This increase in the number of cases may be related to several factors, including an increase in the size of the elderly population. The elderly are at increased risk of infection from Salmonella and other foodborne pathogens. According to current population projections, the elderly population in the United States will continue to grow in the years ahead, doubling between now and the year 2030, when an estimated 83 million people will be 60 or older.Changing dietary trends in the United States also may increase the risk of exposure to foodborne pathogens. The popularity of fast-food restaurants has increased the demand for and production of ground beef. Undercooked hamburger is a prime source of exposure to
E. coli O157:H7. American consumers also have come to expect a variety of once-seasonal produce year-round. The result is an increasing reliance on imported fruits and vegetables from countries where the standards of food safety may not match those of the United States. Also, Americans now more than ever are eating meals prepared outside the home. One of the results of eating out and ordering out may be a lack of knowledge among consumers about safe methods for preparing, cooking, and storing food.| 10 LEAST WANTED FOODBORNE
PATHOGENS* 1. Campylobacter jejuni - Major bacterial cause of diarrhea and associated with Guillain-Barré syndromeSources: raw and undercooked poultry and meat, raw milk, and untreated water 2. Clostridium perfringens - Produces sudden onset of colic followed by diarrhea and nauseaSources: improperly cooked roast beef, ground beef, pork, turkey, and chicken 3. E. coli O157:H7 - Causes bloody diarrhea, abdominal pain, and vomiting and can cause hemolyticuremic syndromeSources: meat such as undercooked or raw hamburger, raw milk, unpasteurized apple juice, and produce 4. Listeria monocytogenes - Causes serious disease in newborns, adults with weakened immune systems, and pregnant women, including complications such as spontaneous abortion and stillbirthSources: raw and undercooked meat, poultry, and seafood, produce, and unpasteurized or improperly processed dairy products 5. Salmonella - Causes headache, vomiting, diarrhea, abdominal cramps, and feverSources: raw and undercooked eggs, under-cooked poultry and meat, dairy products, seafood, fruits, and vegetables 6. Staphylococcus aureus - Produces an infection that can cause vomiting, diarrhea, abdominal cramps, and prostrationSources: ham, raw meats, poultry, dairy products, salads, and shrimp, along with the hands of food preparers 7. Shigella - Major cause of dysenterySources: salads, milk and dairy products, produce, untreated drinking water, and the hands of food preparers 8. Toxoplasma gondii - Parasite that causes a disease called toxoplasmosis; symptoms include fever, sore throat, swollen glands, and, in severe cases, disorders of the liver and central nervous systemSources: meat (primarily pork) 9. Vibrio vulnificus - Causes gastroenteritis, chills, fever, and prostration and can be fatal in high-risk individualsSources: raw or undercooked seafood, particularly raw oysters from the Gulf Coast States 10. Yersinia enterocolitica - Causes diarrhea and vomitingSources: pork, dairy products, and produce *Based on the severity of illness or the number of reported cases. |
Food Safety Initiative
To combat these and other potential threats to our food supply, the Federal Government early in 1997 launched the $42.3 million Food Safety Initiative. The Food Safety Initiative represents a model of cooperation between key Federal, State, and local agencies and private organizations involved in food production, marketing, preparation, and consumption. The initiative focuses on five broad areas—surveillance and early warning, risk assessment, research, inspections and compliance, and consumer education. An expanded and up-graded early-warning system will help detect outbreaks of foodborne illness quickly and provide data needed to prevent future outbreaks.
To determine the health risks associated with foodborne pathogens, the Food Safety Initiative is establishing an interagency consortium to coordinate risk-assessment research. The results are expected to help in determining acceptable levels of exposure to foodborne pathogens and identify where in the food chain to apply resources to control the threat of foodborne illness.
Other new research will be aimed at improving methods for detecting and identifying foodborne pathogens and developing new ways to prevent or eliminate them. In addition, research will focus on understanding how bacteria and other microorganisms become resistant to processing methods, such as heating or chilling, that are designed to kill foodborne pathogens or keep them from growing and spreading. Many experts are concerned about human and animal resistance to antibiotics. One type of
Salmonella, known as Typhimurium Definitive Type 104 (TD104), is already resistant to at least five antibiotic drugs.New and more accurate methods for detecting hazardous microorganisms are replacing existing sight, touch, and smell techniques used to inspect food. In addition, the Hazard Analysis and Critical Control Point (HACCP) approach is being emphasized. Started in 1995 and administered by the FDA and the USDA’s Food Safety and Inspection Service, HACCP places the responsibility on the food industry to design and implement procedures to prevent food contamination rather than relying on detection after it has occurred.
Food in the United States was once largely grown and consumed locally, but today food can become contaminated at any point along a complicated and global system of food production and distribution. This food chain leads from the field or pasture to the processing plant and from there through the wholesaler and retailer to the consumer. HACCP requires food producers and processors to apply science-based methods to prevent contamination at various critical points on this food chain. Under HACCP, for example, individual poultry, beef, and seafood companies are responsible for developing and implementing methods for producing and processing food that will prevent or control contamination by bacterial pathogens.
Finally, the Food Safety Initiative is focusing on consumer education. One of the ironies of foodborne illness is that a few relatively simple procedures can eliminate or prevent the growth of most harmful microorganisms found in or on food. Cooking a hamburger to 160 degrees, for example, will kill any
E. coli bacteria that may be present.To educate consumers about food safety practices, the Department of Health and Human Services, USDA, and the Department of Education have joined with food industry trade associations, consumer groups, and public health organizations to form the Partnership for Food Safety Education (see
Spotlight, page 8).Besides the Food Safety Initiative, other recent milestones on the road to a safer food supply include the Food Quality Protection Act of 1996, which set health-based safety standards for pesticides in foods, and the FDA’s approval in December 1997 of the use of irradiation to control disease-causing microorganisms in beef, lamb, and pork. Also in December, HACCP regulations for seafood became effective, and in January the Pathogen Reduction and HACCP rule took effect.
| What Consumers Can Do To Prevent Foodborne
Illness Clean Separate Cook Chill Source: Preventing Foodborne Illness, A Guide to Safe Food Handling, USDA, September 1990. |
Healthy People 2000 Outlook
Four food safety objectives are included in Healthy People 2000. Together, these objectives are aimed at ensuring a safe food supply by reducing or eliminating the health risks posed by contaminated foods, foodborne infections, and improper food handling. At the midcourse review in 1995, the incidence of foodborne infections caused by
Salmonella and Listeria monocyto-genes already had dropped to the rates called for in Healthy People 2000.Food safety objectives are expected to be included in Healthy People 2010 as well, scheduled for release in draft form this fall. In addition, the Food Safety Initiative is addressing food safety on several fronts. New research is focusing on improving methods of detecting, identifying, reporting, preventing, and treating foodborne illness. Under HACCP, food producers, processors, shippers, wholesalers, and retailers are expected to develop and maintain their own food safety programs. Improved inspection methods are using modern technology to detect food contaminants. Public education programs are informing consumers about what they can do to prevent foodborne illness. Through the Food Safety Initiative and other similar programs, the Federal Government, the food industry, State health agencies, and consumer groups are continuing to work together to keep our food supply as safe as possible.
Select Food Safety Resources |
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| Food and Drug
Administration, Center for Food Safety and Applied Nutrition (FDA/CFSAN) http://vm.cfsan.fda.gov/list.html FDA/CFSAN Consumer Research on Foodborne Illness Food Safety Consortium Food Safety Home Page Food Safety Resources (North Carolina Cooperative
Extension Service) National Center for Infectious Diseases, foodborne
illness page U.S. Department of Agriculture USDA/FDA Foodborne Illness Education Information
Center USDA Food Safety Inspection Service |
American Dietetic
Association 216 West Jackson Boulevard Chicago, IL 60606-6995 (312) 899-0040 FAX: (312) 899-1979 http://www.eatright.org FDA Seafood Hotline www.fda.gov International Food Information Council Suite 430 Washington D.C. 20036 E-Mail: foodinfo@ific.health.org http://ificinfo.health.org USDA Meat and Poultry Hotline National Food Processors Association Suite 223 Washington, DC 20015 (202) 298-0624 Centers for Disease Control and Prevention Extension Food Safety Education Database (Michigan
State University) Fight BAC! Fighting the Problem of Foodborne Illness (Partnership forFood Safety Education) (see Spotlight)http://www.fightbac.org/index.html |
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