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 Form Foodborne Disease in the United States Food Safety in the 21st Century Jessica Jensen L 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 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 Listeria monocytogenes 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 twothirds 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 210 days and symptoms are diarrhea headache cramping nausea vomiting and low grade few that can last up to two weeks Special filters have to be installed to keep the water supply safe from this organism because chlorine does not kill it The 2005 incidence for Cryptosporidia was 2