Hey kids, the snails are back: CDC releases 2013 FoodNet data

That’s the tagline from a Far Side cartoon and what immediately came to mind upon reading yet again that reductions in foodborne illness were stagnant for 2013.

There were successes, failures and shifting profiles of what foods lead to foodborne illness, because whatever Americans choose to eat, under whatever production system, some smart bug is going to figure out how to flourish.

And the FoodNet data remains the best and most publicly available surveillance data in the world; that’s right, best in the world.

The Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010–2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall. Since 2006–2008, the overall incidence has not changed significantly. More needs to be done.

Yes, more needs to be done. Part of that involves abandoning archaic communications and invoking current, compelling and credible food safety messages using a variety of media, at the places where people make food decisions – whether it’s the local market or the megalomart.

cdc.fbi.annual.13The complete report is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6315a3.htm?s_cid=mm6315a3_e

Incidence and trends of infection with pathogens transmitted commonly through food — Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006–2013.

CDC MMWR 63(15);328-332

Stacy M. Crim, Martha Iwamoto, Jennifer Y. Huang, Patricia M. Griffin, Debra Gilliss, Alicia B. Cronquist, Matthew Cartter, Melissa Tobin-D’Angelo, David Blythe, Kirk Smith, Sarah Lathrop, Shelley Zansky, Paul R. Cieslak, John Dunn, Kristin G. Holt, Susan Lance, Robert Tauxe, Olga L. Henao


WTF? 524 now confirmed sick with Salmonella linked to Foster Farms chicken

This is why microbial food safety should be marketed so consumers have a choice.

As of April 7, 2014, the U.S. Centers for Disease Control reports a total of 524 people have been infected with seven outbreak strains of Salmonella Heidelberg from 25 states and Puerto Rico, since March 1, 2013.

Foster-Farms-Chicken-BreastCDC says it is working closely with the U.S. Department of Agriculture to assess interventions implemented at Foster Farms facilities to prevent future illnesses.

But people keep getting sick. And what are these interventions?

The lack of information, the lack of a recall despite continued illnesses, is sorta mind-numbing.

Just cook it doesn’t cut it.

Listeria being sequenced to better understand food poisoning

Chances are you’ve heard of mapping genes to diagnose rare diseases, predict your risk of cancer and tell your ancestry. But to uncover food poisonings?

The nation’s disease detectives are beginning a program to try to outsmart outbreaks by routinely decoding the DNA of potentially deadly bacteria and viruses.

listeriaThe initial target is Listeria, the third-leading cause of death from food poisoning and bacteria that are especially dangerous to pregnant women. Already, the government credits the technology with helping to solve a listeria outbreak that killed one person in California and sickened seven others in Maryland.

“This really is a new way to find and fight infections,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

With genome sequencing becoming faster and cheaper, the CDC is armed with $30 million from Congress to broaden its use with a program called advanced molecular detection. The hope is to solve outbreaks faster, foodborne and other types, and maybe prevent infections, too, by better understanding how they spread.

“Frankly, in public health, we have some catching up to do,” said the CDC’s Dr. Christopher Braden, who is helping to lead the work.

As a first step, federal and state officials are rapidly decoding the DNA of all the Listeria infections diagnosed in the U.S. this year, along with samples found in tainted foods or factories.

It’s the first time the technology has been used for routine disease surveillance, looking for people with matching strains who may have gotten sick from the same source.

The Listeria project began as officials were investigating some sick Maryland newborns and their mothers. Genome sequencing showed publix.deli.warningthose cases were linked to a California death, helping investigators determine which foods to focus on, said Dr. Robert Tauxe, CDC’s leading foodborne disease sleuth.

Standard tests prompted recall of the FDA’s suspect, a brand of Hispanic-style cheese. Last month, the government announced that sequencing also confirmed listeria from the recalled cheese matched germs from the patients.

“We expect to be able to match more and more of what we find in people to what we find in food,” as the project grows, Tauxe said.

40 years of U.S. Salmonella data now available

Forty years of data on a major cause of food poisoning now is available to the public, the food industry, and researchers in a new report from the Centers for Disease Control and Prevention (CDC). The data, collected by state and federal health officials, provides a wealth of information on Salmonella, the top foodborne cause of hospitalizations and deaths in the United States.

Available for hands-on web access for the first time, the Atlas of Salmonella in the United States, 1968-2011 summarizes surveillance data on 32 types of Salmonella isolates from p0326-salmonella-data-lgpeople, animals, and other sources. The information is organized by demographic, geographic and other categories.

“Salmonella causes a huge amount of illness and suffering each year in the United States. We hope these data allow researchers and others to assess what has happened and think more about how we can reduce Salmonella infections in the future,” said Robert Tauxe, M.D., deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “The more we understand Salmonella, the more we can make progress in fighting this threat all along the farm to table chain.”

CDC estimates that Salmonella bacteria cause more than 1.2 million illnesses each year in the United States, resulting in more than 23,000 hospitalizations and 450 deaths. Salmonella infections most often cause vomiting or diarrhea, sometimes severe. In rare cases, Salmonella illness can lead to severe and life-threatening bloodstream infections.

By providing data by age, sex, geography, and season of the year in a downloadable format, the Atlas allows users to view national trends in reported cases of human Salmonella infection over time, problems in specific geographic areas, sources of Salmonella, and the connection between animal and human health. In addition to reports of human infections, it includes reports of Salmonella in animals, the environment, and animal feeds, which can be sources of antibiotic resistant strains.  

Serotyping has been the core of public health monitoring of Salmonella infections for over 50 years. Now, scientists use DNA testing to further divide each serotype into more subtypes and to detect more outbreaks. With the next generation of sequencing technology, advancements continue as the laboratory can find information about the bacteria in just one test.

The data presented likely represent just the tip of the iceberg since many cases of human salmonellosis are not diagnosed and reported to the health department. This underreporting may occur because the ill person does not seek medical care, the health care provider does not obtain a stool culture for testing, or the culture results are not reported to public health officials.

The Salmonella group of bacteria has more than 2,500 different serotypes, but fewer than 100 cause the vast majority of infections in people. Older adults, people with weakened immune systems, and children under five years old have a higher risk for Salmonella infection. Infections in these groups can be more severe, resulting in long-term health consequences or death.

To access the Atlas, please visit http://www.cdc.gov/salmonella/reportspubs/salmonella-atlas/index.html. For more information on Salmonella, please visit: http://www.cdc.gov/salmonella/

Pukefest aboard Royal Caribbean’s Explorer of the Seas

How could I resist that headline, as my parents head for Florida for a cruise?

Cruise Law News reports there is an outbreak of gastrointestinal sickness of a large percentage of cruise passengers aboard Royal Caribbean’s Explorer of the Seas cruise ship.

The U.S. Centers for Disease Control and Prevention announced that 281 passengers (9.21% of total passengers) are suffering from norovirus type vomit cruiseof symptoms. The symptoms include vomiting, nausea, headaches and diarrhea.

The pro-cruise site Cruise Critic calls the problem a “small outbreak” but the truth is that 9% is a high percentage.  It is not unusual for passengers not to report the illness in order to avoid being quarantined in the cabin or for crew members who rely on tips to keep working after they are ill. The total numbers are often under-reported. In addition to sick passengers, 22 crew members are reportedly ill according to the CDC. The CDC website states that an environmental health officer and an epidemiologist will board the ship in St. Thomas, USVI on January 26, 2014 to conduct an epidemiologic investigation. 

Deadly outbreaks: How medical detectives save lives threatened by killer pandemics, exotic viruses, and drug-resistant parasites

Atif Kukaswadia writes in this review on Public Health Perspectives blog: Anyone who follows my writing knows that I’m a big proponent of using stories to talk about science. We’ve discussed how you can use science fiction teach science, zombies to talk about disease outbreaks, and my TEDx talk discussed using principles of storytelling in how we discuss science. So when I was asked to review (see disclaimer below) Dr sandwichAlexandra Levitt’s new book “Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses and Drug-Resistant Parasites,” I jumped on the opportunity.

The CDC has a program known as the Epidemiologic Intelligence Services, where individuals trained in fields such as epidemiology, medicine, statistics and veterinary sciences come together to identify causes of diseases. For an overview of the EIS, check out this review of “Inside the Outbreaks” by Travis Saunders over at Obesity Panacea. The EIS was set up Alexander Langmuir, who has been profiled on the blog, and their work has been instrumental in learning about, and thus containing, disease outbreaks all over the world. Dr Levitt is well positioned to speak on these issues, having worked at the CDC since 1995, although it should be noted that this was written in her free time, not as part of her position at the CDC.

The book is comprised of 7 distinct chapters, each one covering a unique disease outbreak. In an almost “House-ian” style, the EIS agent will hear about an outbreak, go into an area, and then have to uncover what it is that is causing people to get sick, often with very little information to go on. I’m going to keep the details deliberately vague, as part of the joy of reading the book is guessing what is causing the outbreak, and following the train of thought of the investigators.

Another thing I really enjoyed about the book was how Dr Levitt deals with all important stakeholders, and talks about their history. One chapter deals with a Native American population that has undergone a disease outbreak, and does a great job explaining the history of these people. This is very pertinent information, as the problems of going into this community are a direct result of how these communities have been treated historically, and everything from the equipment you bring in, to the name of the disease, has to be cleared by elders and community leaders. The history of a group is something public health practitioners need to be aware of and sensitive to in order to work with these people to identify causes of disease, and this was illustrated well in this book.

Finally, at a more stylistic level, a conscious decision the author makes is to provide context for the characters. For example, in Chapter 1 the “protagonist” is eagerly anticipating her wedding, and at one point goes for dinner and discusses this with a colleague while talking about the case at hand. In a later chapter, the author describes Dr Stacy Holzbauer, a veterinarian, as someone whose “plan was to become a Sopranos_season3_episode01large-animal veterianian, marry a cowboy, live on a ranch on the Great Plains, and raise cowboys,” a vivid and charming description. While she did become a veterinarian, she then pursued a MPH and now does brilliant public health work. This makes the characters that much more fleshed out and human, rather than being 2-dimensional and alien, a welcome respite from the socially awkward, comically inept, and often evil, scientist of television and film. At points I found this transition jarring, but it adds to the overall feel of the book, and I think helps the book connect with the general public.

And the general public, especially those with an interest in public health, is the target audience. I would recommend this book to those interested in learning more about public health, both from an infectious disease epidemiology.WATER PUMP3_Page_4standpoint, as well as from a practical, i.e. how do we actually investigate disease outbreaks, standpoint. It’s written for a lay audience, and avoids jargon and delving too far into statistics or biology, which makes it easy and straightforward to follow. If you’re considering pursuing an MPH and want to do “shoe leather epidemiology,” it’s a must read.

From 8 to 1: US shutdown hampers foodborne illness tracking

The U.S. government shutdown is, according to NPR, pushing the nation’s food safety system to its limits.

There is normally a team of eight people overseeing Pulsenet, the critical foodborne illness tracking database. Centers for Disease Control Director Tom Frieden said pulsenetpost-shutdown, there’s only one. Some research and reference labs have gone from a staff of 80 to 2, and staff at the 20 quarantine stations dotted along the country’s borders and ports has been reduced by 85 percent.

The CDC is currently monitoring about 30 clusters of foodborne illnesses around the country, which is typical at any given time. About half the CDC staffers involved in surveillance and outbreak response have also been furloughed.

Probably poop and pee in that pool

Sorenne has been taking swimming lessons at this huge outdoor pool complex for over a year, and even with all the babies, I haven’t seen poop in the pool.

But it happens, as shown by all those summertime Cryptosporidium outbreaks pool.pooplinked to pools, and according to CDC, it happens a lot.

So in honor of the ninth annual Recreational Water Illness and Injury Prevention Week, the U.S Centers for Disease Control has concluded that 58% of water samples from public pools tested positive for E. coli, bacteria commonly found in human feces.

CDC says its findings indicate that swimmers are contaminating the water either through “fecal incidents” in the pool, or because they haven’t showered properly and the germs remain on their body when they enter the water.

The results are based on 161 filter samples from public swimming pools in the Atlanta area.

And there’s not just poop in the pool; 59% of water samples also tested positive for Pseudomonas aeruginosa, which can cause skin rashes and ear infections.

Here’s what the CDC recommends swimmers do to stay healthy and keep others healthy – whether swimming in a pool, lake, river or ocean (or using a hot tub):

– Stay out of swimming water when you have diarrhea.

– Shower with soap before swimming.

– Take children for bathroom breaks every 60 minutes.

– Wash your hands with soap after using the toilet or changing diapers.

sorenne.pool.sep.12– Avoid changing diapers next to the pool.

– Avoid swallowing the water.

And according to NPR, the CDC knows you pee in the pool, too. The nitrogen in urine depletes free chlorine in pool water, making it harder to kill germs. Nitrogen also converts the chlorine into a form that irritates the eyes and lungs. So stop doing that.

Keep doing same thing, expect different result? Crazy. Foodborne illness in US up slightly in 2012

The annual FoodNet data is out, which pundits will view through their own political filters to reach a pre-ordained conclusion, usually involving the need for regulations, edumucation, and technology.

My filter is: are more people barfing?


It can be depressing to write the same thing ever year – nothing’s changed, and if anything, getting worse. So maybe try something different.
vomit.salmBut that would require imagination, creativity and commitment, the things that get stifled in any kind of bureaucracy.

Foodnet tracks the barfing.

The Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance in 10 U.S. sites for all laboratory-confirmed infections caused by selected pathogens transmitted commonly through food to quantify them and monitor their incidence. This report summarizes 2012 preliminary surveillance data and describes trends since 1996:

• 19,531 infections, 4,563 hospitalizations, and 68 deaths associated with foodborne diseases were reported in 2012;

• for most infections, incidence was highest among children aged <5 years;

• the percentage of persons hospitalized and the percentage who died were highest among persons aged ≥65 years;

• in 2012, compared with the 2006–2008 period, the overall incidence of infection was unchanged, and the estimated incidence of infections caused by Campylobacter and Vibrio increased.

• estimated incidence of infection was higher in 2012 compared with 2006–2008 for Campylobacter (14% increase; confidence interval [CI]: 7%–21%) andVibrio (43% increase; CI: 16%–76%) and unchanged for other pathogens;

• among 2,318 (34%) Campylobacter isolates with species information, 2,082 (90%) were C. jejuni, and 180 (8%) were C. coli;

• among 496 (90%) serogrouped STEC non-O157 isolates, the most common serogroups were O26 (27%), O103 (23%), and O111 (15%);

• among 6,984 (90%) serotyped Salmonella isolates, the top three serotypes were Enteritidis, 1,238 (18%); Typhimurium, 914 (13%); and Newport, 901 (13%); and,

• among 183 (95%) Vibrio isolates with species information, 112 were V. parahaemolyticus (61%), 25 were V. vulnificus (14%), and 20 were V. alginolyticus (11%).

In 2012, the incidence of infections caused by Campylobacter and Vibrio increased from the 2006–2008 period, whereas the incidence of infections caused byCryptosporidium, Listeria, Salmonella, Shigella, STEC O157, and bureaucratYersinia was unchanged. These findings highlight the need to continue to identify and address food safety gaps that can be targeted for action by the food industry and regulatory authorities.

After substantial declines in the early years of FoodNet surveillance, the incidence of Campylobacter infection has increased to its highest level since 2000.Campylobacter infections are more common in the western U.S. states and among children aged <5 years. Although most infections are self-limited, sequelae include reactive arthritis and Guillain-Barré syndrome. Associated exposures include consumption of poultry, raw milk, produce, and untreated water, and animal contact.

Most foodborne illnesses can be prevented. Progress has been made in decreasing contamination of some foods and reducing illness caused by some pathogens, as evidenced by decreases in earlier years. Collection of comprehensive surveillance information further supports reductions in foodborne infections by helping to determine where to target prevention efforts, supporting efforts to attribute infections to sources, guiding implementation of measures known to reduce food contamination, and informing development of new measures. Because consumers can bring an added measure of safety during food storage, handling, and preparation, they are advised to seek out food safety information, which is available online.

Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996–2012

Morbidity and Mortality Weekly

April 19, 2013 / 62(15);283-287