Foodborne Disease in the United States Food Safety in the 21st Century Jessica Jensen Outline 1. Foodborne Disease 2. Emerging and Reemerging Pathogens - Campylobacter - Salmonella - Shigella - E. coli O157:H7 - C. botulinum - Cryptosporidia - Cyclospora - L. monocytogenes - V. vulnificus - Y. enterocolitica 3. Preparation and Storage of Foods 4. Global Issues 5. At Risk Groups 6. Recent Outbreaks 7. Diagnosis of Foodborne Disease 8. Outbreak Investigations - E. coli O157:H7 Outbreak 9. Goals for Food Safety 10. Food Safety, Inspection, and Consumer Information 11. References 12. APPENDIX 1. Foodborne Outbreak Complaint Form 13. APPENDIX 2. Foodborne Outbreak Reporting FormFoodborne Disease in the United States Food Safety in the 21st Century Jessica Jensen ast school year at a local college, Mary asked her friend, Amy, if Amy would be willing to drive her to the emergency room in the middle of the night should she need to go. She explained that she had not been feeling well and had been experiencing abdominal pain and bloody diarrhea. At the time, Amy did not think that her friend could have possibly contracted Escherichia coli O157:H7. Then a few days later, she received an e-mail that Mary had been diagnosed with E. coli O157:H7. It was a little scary for Mary to know that a close friend she lived with contracted E. coli because everyone in the dorm consumed food from the same caterer. At the same time, there was an outbreak of E. coli O157:H7 in bagged spinach in the town neighboring the college campus. Unfortunately due to the fact that Mary did not eat beef, she was probably at an increased risk for contracting E. coli O157:H7 because on some nights salad was the only option for her to eat. L Foodborne Disease Approximately 76 million cases of foodborne disease occur each year. As many as 325,000 people may be hospitalized for foodborne disease in a year, and 5,200 may die.1 Although surveillance of foodborne disease has become better, it is estimated that only 40 to 45% of all foodborne disease cases are reported each year.2 Hospitalization bills for foodborne illness as estimated at $3 billion per year, and the economic impact of foodborne disease is thought to be as high as $25 billion per year.3 Foodborne disease is caused by eating food or drinking beverages that are contaminated with harmful microbes or toxic chemicals. Over 250 different foodborne diseases have been documented, and most are caused by a variety of bacteria, viruses, or parasites that cause infection. The majority of foodborne disease is caused by bacteria, such as Campylobacter, Salmonella, and Escherichia Coli O157: H7, and viruses, such as the group of viruses known as calicivirus (Norwalk or Norwalk-like viruses),4 therefore this chapter will focus on bacterial and viral infections. There are many issues that will make food safety increasing more difficult and more important in the coming years. These include emerging and reemerging pathogens, preparation and storage of food practices, global food supply, and groups that are at increased risk of contracting foodborne disease. This chapter will discuss these issues, and then it will talk about recent outbreaks of foodborne disease, what doctors and public health agencies can do in the event of a suspect case or outbreak of foodborne disease, what the Healthy People 2010 goals for food safety are, and where consumers can find additional information on foodborne disease and food safety. Emerging and Reemerging Pathogens Some of the most common pathogens associated with foodborne disease are Campylobacter, Salmonella, Shigella, and E. coli O157:H7, and some of the less common pathogens associated with food borne outbreaks are Clotridium botulinum, Cryptosporidia, Cyclospora, Listeriamonocytogenes, Vibrio vulnificus, and Yersinia enterocolitica5. Each of these common pathogens will be discussed along with their associated symptoms and diseases. Campylobacter The sources most associated with Campylobacter are chicken, unpasturized milk, and water. The incubation period before symptoms are noticed is one to seven days. After this time, two-thirds of exposed people develop fever and one-half have bloody diarrhea; people can also develop cramps and abdominal pain. For most people, this disease normally lasts for 7-10 days, but it can have chronic effects in some people. These effects include Guillain-Barre syndrome and reactive arthritis. The 2005 incidence for Campylobacter was 12.72 per 100,000 people.6 Salmonella Sources associated with Salmonella include animal foods (especially poultry), eggs, fruits, and vegetables. Salmonella disease (Salmonellosis) has an incubation time of 1-2 days, and usually lasts less than ten days. Symptoms of Salmonellosis are gastroenteritis with diarrhea and vomiting. While there is normally no treatment required for this disease, some cases can lead to a chronic condition, reactive arthritis. The 2005 incidence for Salmonella was 14.55 per 100,000 people. 6 Shigella This disease is associated with fruits, vegetables, and shellfish that have been contaminated with fecal matter. The incubation period of Shigella is 1-2 days, and the symptoms, including fever, strained bowel movements, nausea, abdominal cramps, can last for 5-7 days. Shigella can also cause dysentery, and the chronic condition that can result from Shigella is reactive arthritis. The 2005 incidence for Shigella was 4.67 per 100,000 people.6 E. coli O157:H7 Outbreaks of E. coli O157:H7 have been associated with alfalfa sprouts, hamburgers, salami, unpasturized milk and juice, lettuce, and water. E. coli O157:H7 has created some of the largest outbreaks of foodborne disease, and estimated 200,000 cases occur annually with approximately 250 deaths per year.7 The common symptoms of E. coli O157:H7 are abdominal pain and bloody diarrhea. Hemolytic uremia syndrome is reported in 2-7 percent of all E. coli O157:H7 cases. The 2005 incidence for E. coli O157:H7 was 1.06 per 100,000 people.6 C. botulinum Home-canned foods are commonly associated with C. botulinum. Twelve to seventy-two hours after exposure paralysis illness can present and lead to respiratory and musculoskeletal paralysis. Other symptoms are nausea, vomiting, diarrhea, and cramps. Cryptosporidia This is usually associated with water contaminated with fecal matter. The incubation period is 2-10 days, and symptoms