Roger Ramjet, rainbow unicorns, and a Missouri girl’s poop-themed third birthday party

In grade 10, I would race home on my bicycle at lunch to take in 30 minutes of animated joy that was a predecessor to all the satire 40 years later of pompous American superheros, and I was convinced the writers were all stoned.

Roger Ramjet.

Greatest TV cartoon ever (read the start of the wiki entry to get of how deepl weird the show was and how we are living it today).

Today’s weirdest non-political animation is the pooping unicorn, which has reached its demographic epoch in the same way that 7-year-olds hang posters of Michael Jackson or Katy Perry, when a friend of daughter Sorenne asked, “Do you know what the colorful unicorn is?

Yes, yes I do, we covered it over a year ago and it has to do with a colorful unicorn and some stoned student pitching a device for the proper popping posture.

But is the unicorn effect spreading like diarrhea?

As Caroline Bologna of Huffington Post writes, when a Missouri mom named Rebecca asked her daughter, Audrey, how she’d like to celebrate her third birthday, the toddler had only one theme in mind: “poop.”

“For months, every time we mentioned her party, Audrey requested ‘poop balloons and a poop cake,’” Rebecca told The Huffington Post. “I tried suggesting other themes, but she always insisted on poop.”

Ultimately, she and her husband decided to “embrace the weird” and give Audrey the party she wanted.

The unconventional party took place in October at the family’s home in St. Louis.

The guests played “pin the poop,” enjoyed a poop emoji-shaped piñata filled with Tootsie Rolls and Hershey’s Kisses, and received whoopee cushion favors. Rebecca even dressed in a poop costume.

The mom said everyone loved the party and thought it was hilarious. “I expected the grandparents to question it, but they all just laughed when I told them,” she added.

Rebecca believes the birthday party embodied her daughter in many ways. “Audrey is definitely her own person,” she explained. “I hope she always has the confidence she has now. She is so funny and the best big sister.”

Rebecca hopes Audrey’s party can inspire other parents in the throes of birthday planning.

Surf cops: Investigating microbes of surfers and the sea to understand resistance

Peter Andrey Smith of the New York Times writes that on a recent trip, Cliff Kapono hit some of the more popular surf breaks in Ireland, England and Morocco. He’s proudly Native Hawaiian and no stranger to the hunt for the perfect wave. But this time he was chasing something even more unusual: microbial swabs from fellow surfers.

Mr. Kapono, a 29-year-old biochemist earning his doctorate at the University of California, San Diego, heads up the Surfer Biome Project, a unique effort to determine whether routine exposure to the ocean alters the microbial communities of the body, and whether those alterations might have consequences for surfers — and for the rest of us.

Mr. Kapono has collected more than 500 samples by rubbing cotton-tipped swabs over the heads, mouths, navels and other parts of surfers’ bodies, as well as their boards. Volunteers also donate a fecal sample.

He uses mass spectrometry to create high-resolution maps of the chemical metabolites found in each sample. “We have the ability to see the molecular world, whether it’s bacteria or a fungus or the chemical molecules,” he said.

Then, working in collaboration with U.C.S.D.’s Center for Microbiome Innovation — a quick jaunt across the quad from his lab — Mr. Kapono and his colleagues sequence and map the microbes found on this unusually amphibious demographic.

He and his colleagues are looking for signs of antibiotic-resistant organisms. Part of their aim is to determine whether, and to what extent, the ocean spreads the genes for resistance.

Many antibiotics used today derive from chemicals produced by microbes to defend themselves or to attack other microorganisms. No surprise, then, that strains of competing bacteria have also evolved the genetic means to shrug off these chemicals.

While drug resistance comes about because of antibiotic overuse, the genes responsible for creating resistance are widely disseminated in nature and have been evolving in microbes for eons. Startlingly, that means genes giving rise to drug resistance can be found in places untouched by modern antibiotics.

Several years ago, researchers identified antibiotic-resistant genes in a sample of ancient permafrost from Nunavut, in the Canadian Arctic. William Hanage, an epidemiologist at the Harvard School of Public Health, was among those showing that these genes conferred a resistance to amikacin, a semi-synthetic drug that did not exist before the 1970s.

“There was a gene that encoded resistance to it in something that was alive 6,000 years ago,” he said in an interview.

Another group led by Hazel Barton, a microbiologist at the University of Akron, discovered microorganisms harboring antibiotic-resistance genes in the Lechuguilla Cave in New Mexico. These bacteria, called Paenibacillus sp. LC231, have been isolated from Earth’s surface for four million years, yet testing showed they were capable of fending off 26 of 40 modern antibiotics.

It’s all cool research, but all I could think of was Celebrity, a skit by The Kids in the Hall.

Hang 10, you’re booked.

Golf ball parts in McCain’s frozen potatoes

When I was a kid my family used to spend a couple of weeks on Canada’s east coast every summer. My aunt, uncle and cousins lived in Halifax, we lived in Toronto and a few times we met for a week of cold water beaches, mussels, Anne of Green Gables, and golf on Prince Edward Island.

We rented an old farm house set back from the road a couple of hundred yards. I know the rough distance because I spent a lot of time driving golf balls from in front of the porch towards the road.

Over a field. I don’t think it was potatoes. Maybe it is now. Maybe that’s what lots of people in PEI do over potato fields.

Today, McCain foods recalled some frozen potato products because there might be golf ball parts in them.

McCain Foods USA, Inc. announced today it is voluntarily recalling retail, frozen hash brown products that may be contaminated with extraneous golf ball materials, that despite our stringent supply standards may have been inadvertently harvested with potatoes used to make this product.

 

 

This is a new one.

Some call it hockey? Shortest workout possible

Super-short workouts are all the rave in media space.

Me, I want to go back to working out 3 hours a day, and being mindful of it.

Gretchen Reynolds of The New York Times wrote in Feb. 2007, in an exaggerated example of exercise porn, that she had written about seven-minute, six-minute, four-minute, and even one-minute workouts. They are appealing because they require so little time, but they also demand straining effort.

Martin Gibala is the scientist we most have to thank for the popularity of very brief, very hard exercise. All of these workouts are built around the concept of high-intensity interval training, in which you push yourself almost to exhaustion for a brief spurt of minutes or seconds, and then rest and recover for a few minutes before repeating the intense interval.

It’s called hockey (the ice kind).

45-seconds shifts, go hard or go home, and do it again.

4 Hours at the White House with Ted Nugent, Sarah Palin and Kid Rock

There was this time, I was 17-years-old, and I drove from Brantford to Kitchener, Ontario, Canada, with my girlfriend and her mom.

Mom sat in the front, so I decided to crank up my 8-track (seriously, it was an 8-track) and put on something offensive: Ted Nugent’s Wango Tango.

I understand with the hindsight of age I was acting out, trying to get attention, or was just an asshole.

Mom didn’t flinch, just politely indulged me for the little child I was being.

If that 17-year-old became President of the U.S., there may be some problems.

Yet there was President Trump, hosting Ted Nugent, Kid Rock and Sarah Palin  for several hours Wednesday night to a white-china private dinner, a room-by-room tour and free-range policy chat.

(Hopefully, Trump steaks weren’t served).

“We were there for four hours, man!” Mr. Nugent, a 68-year-old Detroit native, said in a telephone interview on Thursday, using a four-letter expletive to signal his amazement at Mr. Trump’s willingness to spend so much time with his three casually dressed visitors.

“He gave us a wonderful personal tour of every room and talked about the origins of every carpet and every painting — there was a Monet — and then we had dinner,” said Mr. Nugent, who has referred to former President Barack Obama as a “mongrel” and to Hillary Clinton with an array of unflattering epithets.

Ted, an avowed bow hunter (so was Hubbell) may want to be careful with his cull, after the Lorain County General Health District in Ohio warned anyone who purchased or received deer meat processed at Ketchem’s Country Meats during the 2016-2017 hunting season.

The district is urging anyone who may fall into that category to call 440-322-6367.

Officials say it’s a preventative measure.

There have been no reported cases of foodborne illnesses associated with Ketchem’s as of Wednesday.

While investigating an odor nuisance, public health professionals found that the facility did not have water or electricity for refrigeration and yet was still processing deer. In order to prevent foodborne illness, all perishable foods must be properly refrigerated.

Palin said, “Asked why I invited Kid Rock and Ted Nugent, I joked, ‘Because Jesus was booked.’”

These 675 people make your meals: Illinois man gets 18 months for food safety bribes

A Lynwood, Illinois man has been sentenced to 18 months in federal prison for accepting bribes in exchange for allowing students in his food safety training classes to bypass sanitation certification testing, according to the U.S. attorney’s office in Chicago.

Ernest Griffin, 71, was sentenced Wednesday and also ordered to pay a $5,000 fine, according to the office.

Griffin had pleaded guilty in March 2016 to one count of federal program bribery, according to court records.

His business, Food Safety Awareness, contracted with the Illinois Department of Public Health to offer food handling courses. Students needed to complete a 15-hour course and take an exam in order to receive sanitation certificates from the health department.

In exchange for bribes, Griffin submitted false certifications and false test results to the department, although prosecutors and Griffin’s lawyer disagreed on the total amount of bribes the man received, court documents show.

Prosecutors said that starting in at least 2008 and continuing through January 2015 Griffin received bribes from students, taking in a total of almost $152,000. His lawyer, in a filing, said that Griffin admitted to receiving more than $5,000 a year in bribes from 2010 through 2014.

The government said that Griffin’s bribery scheme ended only after he was confronted by FBI agents in January 2015.

The government contended that during that four-year period, about 675 students who hadn’t taken the required class or exam were given sanitation certificates.

Restaurants, food porn, coke: Brisbane’s Miami Vice

Despite the food porn on TV, the back kitchen of most restaurants seem about the same: bad food safety, a lot of drugs, and an inordinate amount of Pink Floyd.

A high profile Brisbane restaurateur has been charged with cocaine trafficking, following raids on his home and restaurant on Friday.

Daniel Milos, 40, was arrested a little more than two months after a man was acquitted of the violent murder of his brother Peter Milos, also a chef, at a home in the affluent suburb of Morningside, in May 2014.

Daniel Milos was one of several people arrested in 11 simultaneous raids in Brisbane on Friday morning that allegedly netted $750,000 worth of drugs, including cocaine and ice.

Police have described it as one of the largest cocaine busts in Queensland history.

Milos owns the up-market Italian restaurant Mariosarti in the riverside suburb of Toowong and has been a frequent donor to Queensland’s Liberal National Party.

He counts former premier Campbell Newman and former prime minister John Howard among those he has rubbed shoulders with, while, in 2016, a $300 per head LNP fundraiser with Julie Bishop as keynote speaker was abruptly moved, when party supporters raised concerns with the foreign minister’s office over Milos’ alleged drugs links.

Milos has previously been jailed for drug trafficking, in 2000.

He was sentenced to nine years for selling heroin but paroled after just 12 months.

Food Safety Talk 124: Talking about Mike Scorpion

This episode starts with a chat about the need for butter refrigeration, bats and scorpions in leafy greens (oh my).  The guys briefly celebrate Ben’s birthday before talking about risk attribution, and yet another hot take on the 5 second rule, eating insects on purpose, and “food safety” tips from the internet. They make two book recommendations before talking about rat lungworm and other disgusting things.  The show wraps with an example of doing food safety right, and breaking news about doing food safety wrong before a brief dip into pop culture.

Kids, kids: Foodnet report is out

It’s my favorite day of the year: The annual U.S. Foodnet report, where data is presented, mulled over, and then crammed into politically suitable food safety fairytales.

When a scientific report leads with, “The incidence of infections transmitted commonly through food has remained largely unchanged for many years,” isn’t it time to try something different?

The U.S. Centers for Disease Control reports reducing foodborne illness depends in part on identifying which illnesses are decreasing and which are increasing. Yet recent changes in the use of tests that diagnose foodborne illness pose challenges to monitoring illnesses and progress toward preventing foodborne disease, according to a report published today in CDC’s Morbidity and Mortality Weekly Report.

Rapid diagnostic tests help doctors diagnose infections quicker than traditional culture methods, which require growing bacteria to determine what is causing illness. But without a bacterial culture, public health officials cannot get the detailed information needed to detect and prevent outbreaks, monitor disease trends, and identify antibiotic resistance.

The MMWR article includes the most recent data from CDC’s Foodborne Diseases Active Surveillance Network, or FoodNet, which collects data on 15% of the U.S. population. It summarizes preliminary 2016 data on nine germs spread commonly through food. In 2016, FoodNet reported 24,029 infections, 5,512 hospitalizations, and 98 deaths. This is the first time the numbers used for calculations of trends include bacterial infections diagnosed only by rapid diagnostic tests as well as those confirmed by traditional culture-based methods. Previously, these calculations used only those bacterial infections confirmed by culture-based methods. The most frequent causes of infection in 2016 were Salmonella and Campylobacter, which is consistent with previous years.

 Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2013–2016

Marder EP, Cieslak PR, Cronquist AB, et al.

MMWR Morb Mortal Wkly Rep 2017;66:397–403. DOI: http://dx.doi.org/10.15585/mmwr.mm6615a1

https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a1.htm?s_cid=mm6615a1_e#suggestedcitation

The incidence of infections transmitted commonly through food has remained largely unchanged for many years. Culture-independent diagnostic tests (CIDTs) are increasingly used by clinical laboratories to detect enteric infections.

What is added by this report?

Compared with the 2013–2015 average annual incidence, the 2016 incidence of confirmed Campylobacter infections was lower, incidences of confirmed Shiga toxin-producing Escherichia coli (STEC), Yersinia, and Cryptosporidium infections were higher, and incidences of confirmed or CIDT positive–only STEC and Yersinia infections were higher. However, CIDTs complicate the interpretation of surveillance data; testing for pathogens might occur more frequently because of changes in either health care provider behaviors or laboratory testing practices. A large proportion of CIDT positive specimens were not reflex cultured, which is necessary to obtain isolates for distinguishing pathogen subtypes, determining antimicrobial resistance, monitoring trends, and detecting outbreaks.

What are the implications for public health practice?

Some information about the bacteria causing infections, such as subtype and antimicrobial susceptibility, can only be obtained for CIDT positive specimens if reflex culture is performed. Increasing use of CIDTs affects the interpretation of public health surveillance data and ability to monitor progress toward prevention measures.

Foodborne diseases represent a substantial public health concern in the United States. CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013–2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culture; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.

FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service, and the Food and Drug Administration. FoodNet personnel conduct active, population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia for 10 sites covering approximately 15% of the U.S. population (an estimated 49 million persons in 2015). Confirmed bacterial infections are defined as isolation of the bacterium from a clinical specimen by culture. Confirmed parasitic infections are defined as detection of the parasite from a clinical specimen by direct fluorescent antibody test, polymerase chain reaction, enzyme immunoassay, or light microscopy. CIDTs detect bacterial pathogen antigen, nucleic acid sequences, or for STEC, Shiga toxin or Shiga toxin genes, in a stool specimen or enrichment broth.§ A CIDT positive–only bacterial infection is a positive CIDT result that was not confirmed by culture. Hospitalizations occurring within 7 days of specimen collection are recorded. The patient’s vital status at hospital discharge (or 7 days after specimen collection if not hospitalized) is also recorded. Hospitalizations and deaths occurring within 7 days of specimen collection are attributed to the infection. FoodNet also conducts surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a potential complication of STEC infection, by review of hospital discharge data through a network of nephrologists and infection preventionists. This report includes HUS cases among persons aged <18 years for 2015, the most recent year with available data.

Incidence of infection for each pathogen is calculated by dividing the number of infections in 2016 by the U.S. Census estimates of the surveillance area population for 2015. Incidence is calculated for confirmed infections alone and for confirmed or CIDT positive–only infections combined. A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence of confirmed bacterial and parasitic infections and confirmed or CIDT positive–only bacterial infections in 2016 compared with 2013–2015, adjusting for changes in the surveillance population over time. For STEC, incidence is reported for all STEC serogroups combined because it is not possible to distinguish between serogroups using CIDTs. Insufficient data were available to assess change for Cyclospora. For HUS, the 2015 incidence was compared with incidence during 2012–2014.

Cases of Infection, Incidence, and Trends

During 2016, FoodNet identified 24,029 cases, 5,512 hospitalizations, and 98 deaths caused by confirmed or CIDT positive–only infections. The largest number of confirmed or CIDT positive–only infections in 2016 was reported for Campylobacter (8,547), followed by Salmonella (8,172), Shigella (2,913), STEC (1,845), Cryptosporidium (1,816), Yersinia (302), Vibrio (252), Listeria (127), and Cyclospora (55). The proportion of infections that were CIDT positive without culture confirmation in 2016 was largest for Campylobacter (32%) and Yersinia (32%), followed by STEC (24%), Shigella (23%), Vibrio (13%), and Salmonella (8%). The overall increase in CIDT positive–only infections for these six pathogens in 2016 was 114% (range = 85%–1,432%) compared with 2013–2015. Among infections with a positive CIDT result in 2016, a reflex culture was attempted on approximately 60% at either a clinical or state public health laboratory. The proportion of attempted reflex cultures differed by pathogen, ranging from 45% for Campylobacter to 86% for STEC and 88% for Vibrio. Among infections for which reflex culture was performed, the proportion of infections that were positive was highest for Salmonella (88%) and STEC (87%), followed by Shigella (64%), Yersinia (59%), Campylobacter (52%), and Vibrio (46%).

The incidence of confirmed infections and of confirmed or CIDT positive–only infections per 100,000 persons was highest for Campylobacter (confirmed = 11.79; confirmed or CIDT positive–only = 17.43) and Salmonella (15.40; 16.66), followed by Shigella (4.60; 5.94), Cryptosporidium (3.64; N/A**), STEC (2.85; 3.76), Yersinia (0.42; 0.62), and lowest for Vibrio (0.45; 0.51), Listeria (0.26; N/A), and Cyclospora (0.11; N/A). Compared with 2013–2015, the 2016 incidence of Campylobacter infection was significantly lower (11% decrease) when including only confirmed infections, yet was not significantly different when including confirmed or CIDT positive–only infections. Incidence of STEC infection was significantly higher for confirmed infections (21% increase) and confirmed or CIDT positive–only infections (43% increase). Similarly, the incidence of Yersinia infection was significantly higher for both confirmed (29% increase) and confirmed or CIDT positive–only infections (91% increase). Incidence of confirmed Cryptosporidium infection was also significantly higher in 2016 compared with 2013–2015 (45% increase).

Among 7,554 confirmed Salmonella cases in 2016, serotype information was available for 6,583 (87%). The most common serotypes were Enteritidis (1,320; 17%), Newport (797; 11%), and Typhimurium (704; 9%). The incidence in 2016 compared with 2013–2015 was significantly lower for Typhimurium (18% decrease; CI = 7%–21%) and unchanged for Enteritidis and Newport. Among 208 (95%) speciated Vibrio isolates, 103 (50%) were V. parahaemolyticus, 35 (17%) were V. alginolyticus, and 26 (13%) were V. vulnificus. Among 1,394 confirmed and serogrouped STEC cases, 503 (36%) were STEC O157 and 891 (64%) were STEC non-O157. Among 586 (70%) STEC non-O157 isolates, the most common serogroups were O26 (190; 21%), O103 (178; 20%), and O111 (106; 12%). Compared with 2013–2015, the incidence of STEC non-O157 infections in 2016 was significantly higher (26% increase; CI = 9%–46%) and the incidence of STEC O157 was unchanged.

FoodNet identified 62 cases of postdiarrheal HUS in children aged <18 years (0.56 cases per 100,000) in 2015; 33 (56%) occurred in children aged <5 years (1.18 cases per 100,000). Compared with 2012–2014, in 2015, no significant differences in incidence among all children or children aged <5 years were observed.

Discussion

The number of CIDT positive–only infections reported to FoodNet has been increasing markedly since 2013, as more clinical laboratories adopt CIDTs. Initially, increases were primarily limited to Campylobacter and STEC; followed by substantial increases in Salmonella and Shigella beginning in 2015 (6). The pattern continued in 2016, with large increases in the number of CIDT positive–only Vibrio and Yersinia infections. When including both confirmed and CIDT positive–only infections, incidence rates in 2016 were higher for each of these six pathogens. The increasing use of CIDTs presents challenges when interpreting the corresponding increases in incidence. For example, the incidence of confirmed Campylobacter infections in 2016 was significantly lower than the 2013–2015 average. However, when including CIDT positive–only infections, a slight but not significant increase occurred. For STEC and Yersinia, the incidence of confirmed infections alone and confirmed or CIDT positive–only infections in 2016 were both significantly higher than the 2013–2015 average; the magnitude of change approximately doubled when analyzing CIDT positive–only infections.

Because of the ease and increasing availability of CIDTs, testing for some pathogens might be increasing as health care provider behaviors and laboratory practices evolve (2). Among clinical laboratories in the FoodNet catchment, the use of CIDTs to detect Salmonella, for which the only CIDTs available are DNA-based gastrointestinal syndrome panels, increased from 2 per 460 laboratories (<1%) in 2013 to 59 per 421 laboratories (14%) in 2016 (FoodNet, unpublished data). This increased use paralleled significant increases in incidence of Cryptosporidium, STEC, and Yersinia, and slight but not significant increases in incidence of Campylobacter, Salmonella, Shigella, and Vibrio, all of which are also included in these panel tests. The increase in STEC incidence is driven by the increase in STEC non-O157, which is not typically included in routine stool culture testing because it requires specialized methods. Routine stool cultures performed in clinical laboratories typically include methods that identify only Salmonella, Campylobacter, Shigella, and for some laboratories, STEC O157 (4,5). The increased use of the syndrome panel tests might increase identification, and thus, improve incidence estimates of pathogens for which testing was previously limited.

Results are more quickly obtained using CIDTs than traditional culture methods (3). Because of this, health care providers might be more likely to order a CIDT than traditional culture (2). Increased testing might identify infections that previously would have remained undiagnosed. However, sensitivity and specificity vary by test type. Evaluations of DNA-based syndrome panel tests have indicated high sensitivity and specificity for most targets (3). However, among pathogens for which antigen-based CIDTs are often used, such as Campylobacter and Cryptosporidium, sensitivity and specificity have varied more widely, with a large number of false positive results (7,8). Including CIDT positive infections to calculate incidence, some of which could be false positives, might provide an inaccurate estimate. When interpreting incidence and trends in light of changing diagnostic testing, considering frequency of testing, sensitivity, and specificity of these tests is important. The observed increases in incidence of confirmed or CIDT positive–only infections in 2016 compared with 2013–2015 could be caused by increased testing, varying test sensitivity, an actual increase in infections, or a combination of these reasons.

These changes in testing are also important to consider when monitoring progress toward Healthy People 2020 objectives.†† The current objectives were created before the use of CIDTs and were based on confirmed infections. In the future, just as incidence measures should adjust for these changes, objectives should also be evaluated in light of changing diagnostics.

CIDTs pose additional challenges because they do not yield the bacterial isolates necessary for essential public health surveillance activities, such as monitoring trends in pathogen subtypes, conducting molecular testing, detecting outbreaks and implicating vehicles, and determining antimicrobial susceptibility. Reflex culture performed to yield an isolate places an additional burden on laboratories’ budgets, personnel, and time. Specimen submission requirements differ by state and pathogen, and this responsibility often falls to state public health laboratories (9). As CIDT use increases and more pathogens are affected, state public health laboratories will be challenged to sufficiently increase their testing capacity and will likely have to prioritize specimens on which to perform reflex culture (10). Clinical laboratories should review state specimen submission requirements and the Association of Public Health Laboratories guidelines§§ for reflex culture and submission of CIDT positive specimens.

The findings in this report are subject to at least two limitations. First, the changing diagnostic landscape with unknown changes in frequency of testing, varying test performance, and decreasing availability of isolates for subtyping make interpreting incidence and trends more difficult. Second, changes in health care–seeking behavior, access to health services, or other population characteristics might have changed since the comparison period, which could affect incidence.

Foodborne illness remains a substantial public health concern in the United States. Previous analyses have indicated that the number of infections far exceeds those diagnosed; CIDTs might be making those infections more visible (11). Most foodborne infections can be prevented, and substantial progress has been made in the past in decreasing contamination of some foods and reducing illness caused by some pathogens. More prevention measures are needed. Surveillance data can provide information on where to target these measures. However, to accurately interpret FoodNet surveillance data in light of changes in diagnostic testing, more data and analytic tools are needed to adjust for changes in testing practices and differences in test characteristics. FoodNet is collecting more data and developing those tools. With these, FoodNet will continue to track the needed progress toward reducing foodborne illness.

Acknowledgments

Foodborne Diseases Active Surveillance Network staff members, Emerging Infections Program; Brittany Behm, Staci Dixon, Elizabeth Greene, Jennifer Huang, Clare Wise, and FoodNet Fast Development Team, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.