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?

Yes.

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

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a2.htm?s_cid=mm6215a2_x

Are fewer people getting sick from food? Is reporting getting worse

Foodborne illness outbreaks are trending downward, according to a new review of outbreaks by the nonprofit Center for Science in the Public Interest.

From 2001 to 2010, the latest 10-year period for which data is available, outbreaks related to E. coli, Salmonella, and other dangerous pathogens appear to have decreased by more than 40 percent. Better food safety foodnet.pyramid.fbi.reportingpractices, notably the adoption of Hazard Analysis and Critical Control Points (HACCP) programs in the meat, poultry, and seafood industries, may have contributed to the decline, says CSPI. But the group cautions that incomplete reporting of outbreaks by understaffed and financially stretched public health agencies may also influence the data.

“Despite progress made by the industry and by food safety regulators, contaminated food is still causing too many illnesses, visits to the emergency room, and deaths,” said CSPI food safety director Caroline Smith DeWaal. “Yet state and local health departments and federal food safety programs always seem to be on the chopping block. Those financial pressures not only threaten the progress we’ve made on food safety, but threaten our very understanding of which foods and which pathogens are making people sick.”

Maybe I’ll move: reporting of foodborne illness varies from state-to-state

I’m often asked in my international travels, why does the U.S. have so many high profile outbreaks of foodborne illness?

I say better disease reporting, and a vigilant (though declining) media watchdog.

But what about within the U.S.?

Health types from Tennessee and elsewhere in the U.S. examined variability from state-to-state and found those states requiring submissions to a state lab reported higher rates of foodborne illness.

Abstract below

Variability among states in investigating foodborne disease outbreaks

Foodborne Pathogens and Disease

Timothy F. Jones, Lauren Rosenberg, Kristy Kubota, and L. Amanda Ingram

http://online.liebertpub.com/doi/abs/10.1089/fpd.2012.1243

Abstract

Over 1,100 foodborne disease outbreaks cause over 23,000 illnesses in the United States annually, but the rates of outbreaks reported and successful investigation vary dramatically among states. We used data from the Centers for Disease Control and Prevention’s outbreak reporting database, Association of Public Health Laboratories’ PulseNet laboratory subtyping network survey and Salmonella laboratory survey, national public health surveillance data, and national surveys to examine potential causes of this variability. The mean rate of reporting of Salmonella outbreaks was higher in states requiring submission of all isolates to the state public health laboratory, compared to those that do not (5.9 vs. 4.1 per 10 million population, p=0.0062). Rates of overall outbreak reporting or successful identification of an etiology or food vehicle did not correlate at the state level with population, rates of sporadic disease reporting, health department organizational structure, or self-reported laboratory or epidemiologic capacity. Foodborne disease outbreak surveillance systems are complex, and improving them will require a multi-faceted approach to identifying and overcoming barriers.

231 sick; 2 different E. coli outbreaks at Belfast restaurant

BBC News reports the type of E. coli linked to a restaurant in north Belfast this month is a different strain than four cases reported there in August.

The Public Health Agency (PHA) said there are now 29 confirmed cases and 202 probable cases.

Fifteen people have been hospitalised since the start of this month’s food poisoning outbreak at Flicks restaurant in the Cityside complex.

The PHA confirmed that the type of E. coli O157 in cases in October is different from the type found in August cases associated with the same restaurant.

It said the four cases in August which were linked to this restaurant were investigated thoroughly at the time and all tests on the restaurant were negative.

Further environmental health inspections were conducted, it added, all of which were satisfactory, and enhanced surveillance to monitor for cases was also put in place.

It said the current cases came to light through that enhanced monitoring.

If that’s the case, how many cases of foodborne illness, everywhere, would be detected with enhanced surveillance?

Should all poop samples be tested for dangerous E. coli?

There was this one time, Chapman came to Manhattan (Kansas) and lasted one quarter of a Kansas State football game before rushing home with explosive diarrhea.

My whiny kid didn’t help either.

He spent the rest of the visit holed up downstairs, sucking back Gatorade and sitting on the toilet.

When he got back to North Carolina he had the wherewithal to donate a stool sample, and eventually found out he was part of a state-wide antibiotic-resistant campylobacter outbreak.

In light of the German-based E. coli O104 outbreak in raw sprouts last year, researchers in Germany and Sweden are now calling for all stool samples from patients with diarrhea to be tested for enteropathic E. coli.

Writing in Eurosurveillance, the authors state:

Following an outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Germany 2011, we observed increases in EHEC and non-EHEC E. coli cases in Bavaria. We compared the demographic, clinical and laboratory features of the cases reported during the outbreak period, but not related to the outbreak, to the cases reported before and after. The number of EHEC and non-EHEC E. coli cases notified per week during the outbreak was fivefold and twofold higher respectively, compared to previous years. EHEC cases notified during the outbreak were more often reported with bloody diarrhoea, and less often with unspecified diarrhoea, compared to the other periods. They were more often hospitalised during the outbreak and the following period compared to the period before. Their median age (26.5 years, range: 0–90) was higher compared to before (14.5 years, range: 0–94) and after (5 years, range: 0–81). The median age of non-EHEC E. coli cases notified during the outbreak period (18 years, range 0–88) was also higher than before and after (2 years, p<0.001). The surveillance system likely underestimates the incidence of both EHEC and non-EHEC E. coli cases, especially among adults, and overestimates the proportion of severe EHEC cases. Testing all stool samples from patients with diarrhoea for enteropathic E. coli should be considered.

Still lots of people getting sick; CDC says most foodborne illness rates remain static

Only Washington-types could take a story about recent successes and failures in foodborne illness rates and surveillance – 18 fascinating papers — and turn it into a whine about how lobbyists were excluded from access, ahead of mere mortals.

The Washington Post reports that unlike last year, the U.S. Centers for Disease Control released the data without reaching out to consumer groups and other key stakeholders who typically are notified in advance. Instead, the charts and graphs were quietly posted online Friday.

I’m not sure who these key stakeholders are, and how many of them are self-proclaimed. The solution is for CDC to publish a press release summarizing the findings, note their existence, and releasing it to everyone at the same time.

And only in Washington would people whine that delayed passage of the Food Safety Modernization Act is leading to increases in foodborne illness.

“Everyone was hoping that this new food safety law would be in place and we’d start seeing improvements by now,” said Erik Olson, a director at the Pew Health Group. “What these CDC numbers show is that unless new protections are put into place, millions of Americans are going to continue to get sick from contaminated food.”

I’m immediately suspicious of people who speak on behalf of everyone (and people who say trust me). I have yet to see a credible, detailed analysis that shows FSMA will lower rates of foodborne illness.

But that’s the bizness of Washington. They don’t seem good at it.

Four years ago, the CDC numbers yielded the same story – rates were stagnant, but still way too many sick people. There is no evidence educational campaigns do anything except make people feel like they are doing something, there is no evidence legislation does much, yet that’s always the punchline: we need more laws, we need more education.

Doesn’t work.

We need new messages using new media to really create a culture that values microbiologically safe food.

That’s what I said four years ago, it could have been 20 years ago. Same as it ever was.
The most recent figures from the Centers for Disease Control and Prevention show that the rates of infections linked to four out of five key pathogens it tracks — salmonella, vibrio, campylobacter and listeria — remained relatively steady or increased from 2007 through 2011. The exception is a strain of E. coli, which has been tied to fewer illnesses in the same time frame.

The CDC found that the most frequent cause of infection in 2011 was salmonella, followed by campylobacter.

Below are actual excerpts from the CDC summary report. All 18 abstracts will appear on bites-l as soon as I complete a long plane ride, custom(s) probing, and return to the land of unlimited Internet.

Foodborne disease is an important public health problem in the United States, with an estimated 9.4 million domestically acquired illnesses and 1351 deaths from known pathogens each year. The Foodborne Diseases Active Surveillance Network (FoodNet) tracks important foodborne illnesses, generating information that provides a foundation for food safety policy and prevention efforts. FoodNet has provided information that contributes to food safety efforts by estimating numbers of foodborne illnesses, monitoring trends in incidence of specific foodborne illnesses over time, attributing illnesses to specific foods and settings, and disseminating information. Since it started in 1996, FoodNet has been an excellent example of partnership among federal and state agencies. This Clinical Infectious Diseases supplement contains a variety of articles that provide new information on current issues; together, they highlight FoodNet’s central role in U.S. surveillance and investigation of foodborne disease.

FoodNet’s core work is ongoing active, population-based surveillance for laboratory-confirmed infections caused by 9 pathogens transmitted commonly through food, as well as for hemolytic uremic syndrome. Several articles in this supplement report on these core data, examining trends and providing regulatory and public health agencies, industry, and consumer groups with data needed to prioritize and evaluate food safety interventions and monitor progress toward national health objectives. For example, Ong et al report the dramatic decline in Yersinia enterocolitica infections since 1996, particularly among young black children. Not all the news is good, however; Newton et al [analyze data from FoodNet and the Cholera and Other Vibrio Illness Surveillance System (COVIS), showing that Vibrio infections have increased nationally. Two articles in this supplement examine FoodNet surveillance data on invasive listeriosis. The article by Silk et al summarizes trends in surveillance data from 2004 to 2009, whereas Pouillot et al use FoodNet surveillance data to estimate the relative risk of listeriosis by age, pregnancy, and ethnicity, providing new insights into variations in risk across the population. Together, these articles emphasize that to substantially decrease the incidence of listeriosis, prevention measures should target higher-risk groups, particularly pregnant women, especially Hispanics, and older adults. Hall et al examine trends in Cyclospora infection, showing that outbreaks and international travel play an unusually large role in the epidemiology of these infections and suggesting that prevention efforts would most effectively focus on foods from and travel to endemic areas.

FoodNet continuously works to improve the quality of its surveillance data and methods for analysis. In this supplement, Henao et al describe the methods and rationale surrounding the introduction, in 2011, of a measure of overall change in the incidence of infection over time using surveillance data on infections caused by 6 bacterial pathogens. This measure, which provides a comprehensive picture of changes in incidence of foodborne infections, documents a 23% decline overall in incidence for these pathogens in 2010 compared with the first 3 years of surveillance (1996–1998). Although it does not replace pathogen-specific trend data, this summary measure can help inform the development and assessment of policies and interventions to prevent foodborne illness. Another article, by Manikonda et al, reports on a study to validate the reporting of deaths in FoodNet surveillance, an important issue because deaths, although rare, are disproportionately responsible for the economic and human costs of foodborne disease. Finally, Ong et al examine the impact of case ascertainment strategies and case definitions on surveillance for pediatric hemolytic uremic syndrome in FoodNet.

Several articles in the supplement elucidate aspects of the “surveillance steps” that are necessary for a case of infection to be ascertained by FoodNet surveillance. FoodNet and many other surveillance systems for bacterial enteric infections are based on culture-confirmed infections, so FoodNet surveillance data must be interpreted in the context of the “surveillance steps” that lead to culture confirmation: the ill person must seek medical care, a stool specimen must be submitted, and the clinical laboratory must test for and identify the pathogen. In particular, the recent and ongoing shift among clinical laboratories toward culture-independent methods for detecting enteric pathogens is of great importance.

In 2011, the CDC released new estimates of the number of foodborne illnesses in the United States, the Food Safety Modernization Act was signed into law, and new national health objectives for foodborne illness were set as part of the Healthy People 2020 goals. All of these initiatives, as well as continued concern about food safety on the part of the public and policy makers, emphasize the need for precise and accurate information about foodborne disease. Regulators and other public health officials, consumer advocates, industry, and others need information on trends, high-risk populations, and the foods causing illness so that interventions can be targeted most efficiently and effectively. FoodNet provides the articles in this supplement as part of its efforts to disseminate the results of its surveillance and analytic work. Although FoodNet surveillance is conducted in a geographic area that covers only 15% of the US population, the data it generates are a valuable resource for the entire United States. The FoodNet program shows the impact that high-quality, nationally coordinated surveillance can have on public health and policy.

Doyle writes: China can learn from US food safety net

Mike Doyle, Regents Professor and director of the Center for Food Safety, University of Georgia, writes in China Daily today:

“The food-borne disease surveillance system in the United States has become so robust that it has detected hundreds of outbreaks in the past six years that previously would likely have gone unrecognized.

“This has resulted in many foods being newly identified as vehicles of illnesses. This increased awareness of weaknesses in the U.S. food safety net has by and large led to the Food Safety Modernization Act, which will raise the level of attention that food producers, processors, distributors and importers must give to ensuring their products are safe for human and animal consumption.

These new regulations will have direct relevance to the Chinese food industry, especially if foods or ingredients from China are exported to the U.S.. Also, many of the new rules, if applied in China, could enhance the overall safety of its food supply. …

“Although federal oversight of food processors is important, there is a fundamental principle that must be adopted by the entire food industry for a food safety net to be robust and effective. Everyone involved in the food continuum must be focused foremost on providing consumers with safe foods. Producers who are more motivated by economics and consider food safety to be secondary can undermine public confidence and the integrity of a country’s entire food system.

The approaches to enhancing the safety of the U.S. food supply are largely the result of decades of experience by food safety regulatory agencies and the food industry in mitigating the risk of food contamination.

With a national food safety program under development in China, the Chinese food industry and regulatory agencies could readily benefit from the U.S. experience in improving the safety of their foods by adopting and implementing similar practices and policies.

Reform falters in Europe after 53 deaths from E. coli O104 in sprouts

In May, 2011, the delayed reporting of cases between agencies due to a decentralized government and its agencies was a contributing factor in the Germany-based E. coli O104 outbreak that led to 53 deaths and over 4,000 sick people. The E. coli strain responsible for the outbreak was unusually virulent, with high mortality and hemolytic uremic syndrome (HUS) rates observed in healthy adults.

A year later, Marian Turner writes in Nature that governments have made little progress towards improving the monitoring and reporting systems that allowed the crisis to drag on for weeks.

Although the panic has sparked some proposed policy changes, these have become mired in political debate at both German and European levels.

Under Germany’s current system, it can take up to 18 days for local and state health departments to relay case reports to the Berlin-based Robert Koch Institute (RKI), the German federal agency for disease surveillance. Legislators have proposed a law to bring the country’s disease-reporting schedule into line with the World Health Organization’s International Health Regulations. The law would require local health authorities to report cases of notifiable diseases to state authorities on the next working day; the states would then have another day to relay the information to the RKI. “We’ve been waiting almost a decade for this,” says Alexander Kekulé, a microbiologist at the Martin Luther University of Halle-Wittenberg in Halle, Germany.

The draft law has been passed by Germany’s federal parliament but is stuck in negotiations at the legislative council that represents Germany’s 16 states. For scientists, though, this change would still not be enough. “What really delayed the detection of this outbreak was the irregularity with which patients were referred for microbiological follow-up,” says Gérard Krause, an epidemiologist at the RKI. Like many European countries, Germany does not require that a patient with bloody diarrhoea or haemolytic uraemic syndrome (a life-threatening complication of some E. coli infections) be tested for the causative bacterial strain. The same is true of the United States.

After the outbreak, German diagnostic laboratories were provided with kits to test samples for genes belonging to certain pathogenic strains of bacteria, such as those expressing particular toxins, or proteins involved in adhesion or invasion.

But physicians are responsible for requesting the tests, and the cost is not covered by German health-insurance companies. “The problem is mostly getting the money to use these kits,” says Angelika Fruth, a microbiologist at the RKI, “and that situation is just the same as before the outbreak.”

In the wake of the outbreak, the European Food Safety Authority concluded that sprouted seeds pose a particular food-safety concern, and recommended that a standardized test for sprouts be developed and adopted across the European Union (EU). But EU member countries are still discussing the proposal, and scientists have yet to develop reliable methods to isolate pathogenic bacteria from seeds or sprouts.

Foodborne disease surveillance in France: a foundation for food safety

The French published their own series of detailed foodborne disease surveillance papers, and did it the day before the Americans.

A special issue of the Bulletin épidémiologique hebdomadaire (BEH) and the Bulletin épidémiologique Anses-DGAL, May 2012, number 50, Microbiological hazards in food products of animal origin: monitoring and evaluation contains 13 research papers.

In an editorial, the author writes foodborne illness surveillance is an important and complex issue. Important because tens of thousands of cases of foodborne outbreaks are still reported each year, complicated by the difficulty in assessing and controlling the risk throughout the supply chain — from the farm to the fork.

Thanks to Albert Amgar for passing along the information and some translation.

The abstracts are available at http://www.anses.fr/bulletin-epidemiologique/Documents/BEP-mg-BE50.pdf and are available in English. They are also available in the daily bites-l listserv and at bites.ksu.edu.

Foodborne disease surveillance: a foundation for food safety

 Based on numerous media interviews today, the take-home message will be, foodborne illness has declined by 23 per cent over 14 years.

Nope.

Instead, what the U.S. Centers for Disease Control has done is publish 18 papers today that provide a glimpse into the intricacies, problems and potential of foodborne illness surveillance. There are many caveats, there will be many criticisms, but the approach is consistent with a risk analysis approach to problems: this is what we know, these are the assumptions we made, this is what we think it means, let’s discuss how to make it better.

And bring evidence to the table.

The papers also highlight the complexities of food-pathogen interactions while reinforcing that food safety happens in lots of places in lots of ways, from farm-to-fork. The next time someone says food safety is simple, roll your eyes, walk away, respond with derision, whatever your preference.

But bring some data to the table. This issue of Clinical Infectious Disease will help with that.

Below are the urls for the 18 abstracts:

http://cid.oxfordjournals.org/content/54/suppl_5/S381.extract
http://cid.oxfordjournals.org/content/54/suppl_5/S385.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S396.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S405.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S411.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S421.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S424.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S432.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S440.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S446.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S453.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S458.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S464.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S472.abstract
http://cid.oxfordjournals.org/content/54/suppl_5/S480.abstract http://cid.oxfordjournals.org/content/54/suppl_5/S498.abstract