Tag Archives: Surveillance

US disease agency reaches abroad to stem outbreaks

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Julie Steenhuysen of Reuters reports that when a patient in Uganda fell ill with Ebola virus last month, the advice of U.S. disease experts helped local officials contain its spread.

"You didn’t read about it in the papers because for the first time ever we identified a single case, not an outbreak," said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention.

The Atlanta-based CDC is expanding its involvement in cases of illness overseas, from helping track the source of the highly toxic E. coli outbreak in Germany to homing in on the cause of cholera in the aftermath of Haiti’s earthquake.

Frieden said during a tour of CDC headquarters in Atlanta that CDC has more than 50 staff members in outposts around the world, replicating a program it first implemented at home to teach state health authorities how to best contain outbreaks.

He was reluctant to criticize Germany’s handling of the recent E. coli outbreak, the deadliest ever recorded, which has sickened 4,000 people.

But Frieden said the United States recently had a small, three-state outbreak of the more common E. coli 0157:H7, part of a class of bacteria known as Shiga toxin-producing Escherichia coli, or STEC. The E. coli strain that caused the German outbreak was also in this class.

"There were just a tiny handful of cases, but because we do DNA fingerprinting, we knew they were linked and we very quickly identified hazelnuts as the source and had them pulled," Frieden said.

As a result, there were just eight cases in the United States. "That type of system is very important," Frieden said.
 

Same as it Ever Was: U.S. FoodNet data for 2009 shows nothing has changed

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I finished our U.S. taxes early this morning and filed before the April 15 deadline.

Amy wasn’t taking advantage of our full deductions, so I pompously declared I would do the taxes this year – my first time filing in the U.S. – and then of course waited until the last day to file.

They’re done, at least until we get audited, so it’s back to foodborne illness and the annual FoodNet data which is awesome because it provides an annual snapshot, and sucks because it shows nothing is changing.

All the talk in Washington, all the outbreaks, all the Pulitzer-prize winning media coverage, all the ridiculously boring coverage of so-called foodborne illness in the vanity presses by those who can afford them and … the incidence of foodborne illness isn’t changing. So maybe it’s time to do something different.

In 2009, a total of 17,468 laboratory-confirmed cases of infection were identified. In comparison with the first 3 years of surveillance (1996–1998), sustained declines in the reported incidence of infections caused by Campylobacter, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157, Shigella, and Yersinia were observed. The incidence of Vibrio infection continued to increase. Compared with the preceding 3 years (2006–2008), significant decreases in the reported incidence of Shigella and STEC O157 infections were observed. For most infections, reported incidence was highest among children aged <4 years; the percentage of persons hospitalized and the case fatality rate (CFR) were highest among persons aged ≥50 years. In 2009, the Healthy People 2010 target of ≤1.0 case per 100,000 population for STEC O157 infection (objective 10-1b) was met (2). Further collaborative efforts with regulatory agencies and industry are needed to sustain and extend recent declines and to improve prevention of foodborne infections.

Maybe someone should take leadership and stop gassing on about collaboration.

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Nosestretcher alert: how much foodborne illness is the fault of home cooks?

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Does the majority of foodborne illness really happen in the home?

The statement is repeatedly repeated, but usually with no supporting data.

A story most recently proclaimed, “More than 50 percent of foodborne illnesses come from food prepared in the home.”

There was no reference.

The stats that have been reported in peer-reviewed journals are all over the place: anywhere from 15-90 per cent of foodborne illness apparently happens in the home.

So if a consumer ate bagged spinach in fall 2006 at home, would that mean they possibly got sick at home, or that the contamination originated on the farm and there was little consumers could do?

Casey Jacob and I attempted to tackle this question in the journal, Foodborne Pathogens and Disease, and concluded,






“Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.”

Robert Tauxe of the U.S. Centers for Disease Control noted in a recent talk there have been 10 new food vehicles indentified in multistate outbreaks of foodborne illness since 2006: bagged spinach, carrot juice, peanut butter, broccoli powder on a snack food, dog food, pot pies, canned chili sauce, hot peppers, white pepper and raw cookie dough.

Few, if any of these have to do with consumers.
 

Food safety: Canada is #5 or really sucks; dueling academics

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In May 2008, a couple of Canadian researchers at the University of Regina put out a report that ostensibly attempted to rank 17 industrialized countries based on their food safety performance.

And who doesn’t love a completely meaningless top-17 list, that placed Canada fifth, the U.S. seventh and the United Kingdom first. Make mine piping hot.

Dr. Richard Holley of the University of Manitoba takes a different approach in the current Canadian Medical Association Journal, asserting that Canada’s food safety system is reactive, lags behind other countries, and investment is needed to ensure it can adequately protect Canadians.

I’ll go with Holley.

Foodborne illness surveillance is needed to ensure safety from gastrointestinal infections caused by bacteria such as toxigenic E.coli, Salmonella, Campylobacter and Listeria. As there is no national foodborne illness surveillance program in Canada, the estimated 11 million cases of foodborne illness every year are based on surveys of self-reported gastrointestinal illness. More accurate data are needed to execute meaningful intervention.

European Union countries, the US and Australia have surveillance systems that allow them to collect information on food vehicles and organisms that cause foodborne illness, something Canada cannot currently do. Canada’s multi-government system with national, provincial and local governments that share responsibility for health, as well as monitor the safety and quality of food are key reasons that we have a fragmented system with poor focus. The US suffers from the same problem, yet does a better (though not perfect) job.

Steps to food safety in Canada:

1. Government must go beyond interagency memoranda of understanding to develop permanent systems that promote cooperation and sharing of information on surveillance of foodborne illness and investigations of outbreaks.

2. Investment is needed to develop a surveillance program on foodborne illness that will characterize risks related to food and food pathogens in Canada.

3. Data from surveillance must be used to develop inspection policy that is based on risk and is uniform across the coun- try. That policy’s main priority must be to validate that approved food safety systems are operated properly.
 

5 years later, Canada releases illness data; trends for Salmonella, Campylobacter, verotoxigenic E. coli and Shigella

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The Public Health Agency of Canada, which was created to streamline various public health duties like providing meaningful data on foodborne illness and provide leadership on public health issues (totally useless during the 2008 listeria in deli meats outbreak that killed 22) has gotten around to releasing so-called integrated surveillance data for selected enteric diseases in Canada.

This report focuses on the years 2000 to 2004. The pathogens described are Salmonella, Campylobacter, verotoxigenic Escherichia coli and Shigella. From 2000 to 2004, a general decline in reported rates of all four pathogens was observed in all except a few provinces. When looking at more long-term trends from 1995 to 2004, a similar decline was seen in nationally reported rates for all four pathogens. S. Typhimurium was the most frequently reported Salmonella serovar during the five-year period described, followed by S. Heidelberg and S. Enteritidis. C. jejuni remained the most prevalent Campylobacter species reported between 2000 and 2004. E. coli O157 comprised the majority of verotoxigenic E.coli isolates over these five years. Shigella sonnei was the most frequently reported Shigella species.

Hospitalizations, deaths, outbreaks and case clusters, as well as unusual isolation sites and travel-acquired infections are also explored in this report. Pathogenic E. coli was associated with the highest hospitalization rates over the five-year period, although Salmonella infections resulted in the largest number of deaths overall. Data on outbreaks and case clusters is limited to those reported to the National Enteric Surveillance Program (NESP) and the National Microbiology Laboratory (NML).

Which means, not much. The data is exceedingly limited, and why it took at least 5 years to report is baffling. Canadians can comfortably go back to sleep.

Google Bacterium is on its way

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Following the lead of mash-up artist Girl Talk, the Centre for Molecular Epidemiology led by Professor Frank Møller Aarestrup at Technical University of Denmark (DTU), is planning on creating a infectious disease surveillance tool by combining elements of google maps/pulsenet.  The new tool, nicknamed Google Bacterium, could allow laboratories across the globe to see outbreaks of foodborne illness in almost real-time (as soon as PFGE maps or sequences are uploaded).

The centre will develop software and hardware solutions which can handle these large volumes of data, analyse DNA sequences and swiftly return clinically, biologically and epidemiologically relevant information on bacteria species, strains, antimicrobial resistance and treatment options as an open source solution.

The plan is to start with salmonella, staphylococci and coli bacteria – with the potential for expanding the collaboration to also include viruses, parasites and other bacteria. In the long term, the system will also be able to include the identification of ‘good’ bacteria for industrial uses.

The centre will also develop an Internet platform which will show all the data on a world map to visualise the global spread of bacteria. It will be a bit like a Google Bacterium which will be accessible to everyone on the Internet.

Sounds awesome, mash it up, I’d love to be able to get email alerts about clusters of illnesses in certain geographic areas.

Washington Post: A reasonable and rational discussion of microbial food safety

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Tomorrow’s Washington Post has a food safety feature with some relevant history and reminders that get lost in the vitriol of activist politics. Excerpts (some will say cherry picking, go read the article yourself) below.

Arthur Allen, a Washington writer and the author of "Ripe: The Search for the Perfect Tomato" (March 2010, Counterpoint), writes that whatever our politics, we increasingly eat from a communal kitchen.

“The increasing number of front-page outbreaks and the high-profile critiques of the food system by such writers as Michael Pollan ("The Omnivore’s Dilemma") and Eric Schlosser ("Fast Food Nation") can give the impression that the U.S. food supply is spiraling out of control. But is Americans’ food, in fact, more dangerous that it was in the day of home-cooked meals? People who have studied the numbers aren’t convinced. …

“In the mid-1990s, the CDC began bolstering its surveillance of food-borne illness. One result was the ability to measure whether food was becoming more or less safe. Between 1998 and 2004, illnesses reported by CDC that were caused by E. Coli, listeria, campylobacter and a few other bacteria decreased by 25 to 30 percent, perhaps because of improvements in the handling of meat and eggs. Since about 2004, however, the rate of these illnesses has basically remained steady.”

John Glenn Morris, director of the Emerging Pathogens Institute at the University of Florida at Gainesville, said,

"It’s an ongoing problem, and consumers need to use reasonable caution in terms of food preparation. But it’s not a ‘go screaming down the hall the world is coming to an end’ kind of thing."

Based on its evolutionary tree, scientists think that O157:H7 probably has existed for hundreds or even thousands of years. But it hadn’t been noticed in our food supply until 1982, when a small-town doctor in Oregon reported to the CDC that he’d seen a group of patients with bloody diarrhea. Another group got sick with the same symptoms in Michigan a little later. All had eaten hamburgers at McDonald’s, said Michael Doyle, director of the Food Safety Center at the University of Georgia (left, exactly as shown).

McDonald’s hired Doyle to help fix the problem, and he told company officials that one way to be sure to kill O157:H7 was by heating their hamburgers to at least 155 degrees. McDonald’s officials grumbled that they would lose customers, but they did what he told them, Doyle says. At the time, FDA guidelines recommended heating to 140 degrees.

Most other hamburger chains kept cooking at lower temperatures in order to produce juicier burgers that attracted customers who didn’t like the "hockey pucks" being served at McDonald’s. That continued until 1993, when Jack-in-the-Box reaped the consequences of looking the other way — crippling lawsuits, bankruptcy, $160 million in losses.

But the O157:H7 seems to be out of the barn — and into the pasture. … studies have shown that "natural," grass-fed cattle are now also likely to carry it. In the Earthbound Farm case, genetic fingerprinting indicated that the spinach had been contaminated with bacteria carried by cattle that ranged on land nearby.

Centralization doesn’t necessarily mean less-safe food. A well-run centralized industry is arguably easier to police and control than a more decentralized one. For example, a handful of companies produce most of the 12 million tons of tomato paste that makes its way into pizza and spaghetti sauces, ketchup, salsas and other products. This industry’s record is very clean, in terms of contamination.

3 stricken with E. coli O157 in Washington State from raw milk; is that food safety hysteria?

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Chapman wasn’t feeling particularly hysterical as he kept crapping himself while he was in Manhattan (Kansas) a couple of weeks ago and was then confirmed to be suffering from campylobacter.

I didn’t feel hysterical with my own case of the green apple splatters over the weekend while sitting in the backseat with Sorenne, as Amy drove the five hours to Lebannon, Missouri, for a Thanksgiving dinner with her father and family. I spent the six hours we were there in the bed or bathroom, along with the five hour drive home, topped off with an, uh, uncomfortable night.

Parents of children who have died from foodborne illness, like Mason Jones of the U.K., are not hysterical. I prefer to discuss the multiple food safety failures that led to the outbreak so that others can be prevented – fewer sick people, fewer grieving parents. That’s not hysterical.

And the three people who have been stricken with E. coli O157 linked to drinking raw, unpasteurized milk from the Dungeness Valley Creamery in Washington State, reported this afternoon by the Washington State Department of Health, probably don’t feel they are being hysterical.

No E. coli has been found in samples from the dairy’s current batch of milk, but during an investigation at the dairy, WSDA found the same bacteria that caused one of the illnesses.

That, according to would-be raw milk guru David Gumpert, would probably mean health types were being hysterical because they didn’t have better proof of causation.

While acknowledging in some sort of column-opinion piece released last week that there are tragic cases, Gumpert attempted to blow the lid off the foodborne-illness-sick-people-hype by saying the data are incomplete and then sets up the rhetorical strawperson thingy:

“So what’s behind the hysteria on foodborne illness? Clearly, part of it has to do with the dramatic cases being reported of individuals who have suffered serious long-term repercussions. … They are tragic.”

I wrote a book with a professor who liked to begin every other paragraph with, “Clearly …” Maybe with the perspective of hindsight things are clear, but when outbreaks are actually going on, things are confusing. I’m much more comfortable saying, “I don’t know, how can we find out more,” rather than, “Clearly.”

We didn’t write together again.

Gumpert also said in his piece last week, “But there’s another factor at work here as well: a drive to broadly expand the powers of the FDA.”

The government conspiracy angle.

Gumpert apparently has issues with the U.S. Food and Drug Administration, and says “if you examine the data on foodborne illness, you find a different sort of crisis—a crisis of credibility, based on ineffective and incomplete data gathering and investigation.”

It’s been that way for a long time, because of the uncertainties of investigating the incidence and causes of foodborne illness.

The FoodNet surveillance system was established within the U.S. Centers for Disease Control in 1995 to determine more precisely and to monitor better the burden of foodborne diseases and to determine the proportion of foodborne diseases which are attributable to specific foods and pathogens. Whatever criticisms and uncertainties exist, the establishment of FoodNet was revolutionary in better understanding the impact of foodborne illness.

For every known case of foodborne illness, there are 10 -300 other cases, depending on the severity of the bug.?????? Most foodborne illness is never detected. It’s almost never the last meal someone ate or whatever other mythologies are out there. A stool sample linked with some epidemiology or food testing is required to make associations with specific foods.

Foodborne illness is vastly underreported – it’s known as the burden of reporting foodborne illness, or the burden of illness pyramid (right), a model for understanding foodborne disease reporting. Someone has to get sick enough to go to a doctor, go to a doctor that is bright enough to order the right test, live in a State that has the known foodborne illnesses as a reportable disease, and then it gets registered by the feds. All of this happened for Chapman’s campylobacter.

FoodNet additionally conducts laboratory surveys, physician surveys, and population surveys to collect information about each of these steps.

The World Health Organization (WHO) estimated that up to 30 per cent of individuals in developed countries acquire illnesses from the food and water they consume each year. U.S., Canadian and Australian authorities support this estimate as accurate (Majowicz et al., 2006; Mead et al., 1999; OzFoodNet Working Group, 2003) through estimations from available data, active disease surveillance and adjustments for underreporting. WHO has identified five factors of food handling that contribute to these illnesses: improper cooking procedures; temperature abuse during storage; lack of hygiene and sanitation by food handlers; cross-contamination between raw and fresh ready to eat foods; and, acquiring food from unsafe sources.

Putative food safety legislative changes involving FDA set a minimal bar for food safety; it can be improved, but the best food producers and processors will go far beyond government standards, provide testing data and market food safety directly to consumers at retail – but only if the data exists to validate such claims.

Majowicz, S.E., McNab, W.B., Sockett, P., Henson, S., Dore, K., Edge, V.L., Buffett, M.C., Fazil, A., Read, S. McEwen, S., Stacey, D. and Wilson, J.B. (2006), “Burden and cost of gastroenteritis in a Canadian community”, Journal of Food Protection, Vol. 69, pp. 651-659. ??????

Mead, P.S., Slutsjer, L., Dietz, V., McCaig, L.F., Breeses, J.S., Shapiro, C., Griffin, P.M. and Tauxe, R.V. (1999), “Food-related illness and death in the United States”, Emerging Infectious Diseases, Vol. 5, pp. 607-625.

OzFoodNet Working Group. (2003), “Foodborne disease in Australia: Incidence, notifications and outbreaks: Annual report of the OzFoodNet Network, 2002”, Communicable Diseases Intelligence, Vol. 27, pp. 209-243.
 

Consumer groups, industry, lots of others, misuse food safety data for political gain

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Chapman already commented on some of the, uh, failings of the recent top 10 (PR stunt) allegedly most dangerous foods issued by the poorly named Center for Science in the Public Interest – there wasn’t much science or public interest in that last report.

The produce industry types responded with the blame-the-consumer routine, which is (incredibly dumb) unfortunate given that many outbreaks involving fresh fruits and vegetables clearly need to be prevented on the farm and have nothing to do with consumers.

“Consumers and other food handlers play a huge role in preventing illnesses, and they do need more information on safe handling.”

Neither approach is helpful. Casey Jacob and I tried to contribute to the public conversation about foodborne illness, where it happens and who’s to blame, with the appropriately titled paper, Where Does Foodborne Illness Happen—in the Home, at Foodservice, or Elsewhere—and Does It Matter? in the journal, Foodborne Pathogens and Disease.

The paper has been published online ahead of print. We conclude,

While some occurrences of foodborne illness result from unsafe practices during final preparation or serving at the site where food was consumed, others are consequences of receiving contaminated food from a supplier, or both. Data gathered on instances of contamination that lead to illness make greater contributions to the development of programs that reduce the risk of foodborne illnesses, than data or assumptions that describe locations where contaminated food is consumed.

The abstract is below.

Foodservice professionals, politicians, and the media are often cited making claims as to which locations most often expose consumers to foodborne pathogens. Many times, it is implied that most foodborne illnesses originate from food consumed where dishes are prepared to order, such as restaurants or in private homes. The manner in which the question is posed and answered frequently reveals a speculative bias that either favors homemade or foodservice meals as the most common source of foodborne pathogens. Many answers have little or no scientific grounding, while others use data compiled by passive surveillance systems. Current surveillance systems focus on the place where food is consumed rather than the point where food is contaminated. Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.
 

Where does foodborne illness happen–in the home, at foodservice, or elsewhere–and does it matter?

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Casey Jacob did a nice job on this brief paper, responding to the suggestions of reviewers and, dare I say, developing as a writer.

Foodborne Pathogens and Disease published the abstract this evening, but not the full paper, by Jacob and Powell.

So here’s the abstract as a teaser.

Foodservice professionals, politicians, and the media are often cited making claims as to which locations most often expose consumers to foodborne pathogens. Many times, it is implied that most foodborne illnesses originate from food consumed where dishes are prepared to order, such as restaurants or in private homes. The manner in which the question is posed and answered frequently reveals a speculative bias that either favors homemade or foodservice meals as the most common source of foodborne pathogens. Many answers have little or no scientific grounding, while others use data compiled by passive surveillance systems. Current surveillance systems focus on the place where food is consumed rather than the point where food is contaminated. Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.