http://www.fsis.usda.gov/News_&_Events/NR_051013_01/index.asp

New Study by USDA, FDA Aims to Enhance Food Safety in Retail Delis
Risk Assessment Targets Listeria monocytogenes (Lm

http://www.fsis.usda.gov/PDF/Interagency_RA_Lm_Retail_Report_May2013.pdf

http://www.phac-aspc.gc.ca/efwd-emoha/efbi-emoa-eng.php

Estimates of Food-borne Illness in Canada

The Public Health Agency of Canada estimates that each year roughly one in eight Canadians (or four million people) get sick due to domestically acquired food-borne diseases. This estimate provides the most accurate picture yet of which food-borne bacteria, viruses, and parasites (“pathogens”) are causing the most illnesses in Canada, as well as estimating the number of food-borne illnesses without a known cause.

In general, Canada has a very safe food supply; however, this estimate shows that there is still work to be done to prevent and control food-borne illness in Canada, to focus efforts on pathogens which cause the greatest burden and to better understand food-borne illness without a known cause.

About the estimates of food-borne illness in Canada

Findings

The Public Health Agency of Canada estimates that each year roughly one in eight Canadians (or four million people) get sick with a domestically acquired food-borne illness.

The Agency has estimates for two major groups of food-borne illnesses:

• Known food-borne pathogens: There are 30 pathogens known to cause food-borne illness. Many of these pathogens are tracked by public health systems that monitor cases of illness.
• Unspecified agents: Because you can’t “monitor” what is not yet identified, estimates for this group of agents were developed by first looking at the health effects or symptoms that they are most likely to cause—acute gastrointestinal illness (AGI) (i.e. vomiting and diarrhea). Unspecified agents were defined as: agents with insufficient data to estimate agent-specific burden; known agents not yet identified as causing food-borne illness; microbes, chemicals, or other substances known to be in food whose ability to cause illness is unproven; and agents not yet identified.

To estimate the total number of food-borne illnesses, the Agency estimated the number of illnesses caused by both known food-borne pathogens and unspecified agents.

Table 2. Top four pathogens causing domestically acquired food-borne illnesses in Canada, circa 2006

Pathogen	Estimated annual number of illnesses (90% credible interval)	%
Norovirus	1,047,733 (679,576 – 1,434,048)	65
Clostridium perfringens	176, 963 (95,225 – 270,160)	11
Campylobacter spp.	145,350 (95,686 – 212,971)	8
Salmonella, nontyphoidal	87,510 (58,832 – 125,525)	5
Subtotal		89

Journal publication

The full article entitled “Estimates of the Burden of Food-borne Illness in Canada for 30 Specified Pathogens and Unspecified Agents, circa 2006” is published in the journal Foodborne Pathogens and Diseases.

If you would like a copy of the article in either English or French please contact: enteric.surveillance.entérique@phac-aspc.gc.ca.

Methods and Data Sources

Surveillance and Data Systems

Many surveillance systems are used in Canada to provide information about the occurrence of food-borne illness. Most of the Agency’s surveillance systems rely on data from provincial/territorial and local public health ministries/units/authorities. Systems focus on specific pathogens likely to be transmitted through food to detect outbreaks, monitor trends and risk factors.

Each surveillance system plays a role in detecting and preventing food-borne illness and outbreaks.

Under-reporting and under-diagnosis

In general, to be captured in a Canadian surveillance system a sick individual must: seek care; have a sample (stool, urine or blood) requested; and submit a sample for testing. In addition, the sample must be tested with a test capable of identifying the causative agent; and finally the positive test result must be reported to the surveillance system (Figure 1). Surveillance systems only capture a small portion of total illnesses given all these necessary steps (i.e. there is under-diagnosis and under-reporting taking place).

Figure 1 Burden of illness pyramid

Text Equivalent – Figure 1

Methodological Approaches

Estimating Canadian food-borne illnesses for 30 known food-borne pathogens

Two main methods were used to estimate the number of Canadian food-borne illnesses for the Listing of 30 known pathogens.

The first approach:

For each pathogen with surveillance data, we used data from various surveillance systems and corrected for under-reporting and under-diagnosis. We then multiplied the adjusted number by the proportion of illnesses acquired in Canada (that is, not acquired during international travel) and the proportion transmitted by food, to estimate the number of illnesses that are domestically acquired and food-borne (Figure 2).

The second approach:

For common pathogens that are not part of standard surveillance, we estimated the number of Canadians who would experience symptoms (e.g. diarrheal illness) and the proportion of those symptoms that is related to the particular pathogen. We then multiplied this number by the proportion of illnesses acquired in Canada and the proportion transmitted by food, to yield an estimated number of illnesses that are domestically acquired and food-borne (Figure 3).

Alternative approaches were used to estimate illnesses where suitable data from surveillance or data on proportion of symptoms attributed to the pathogen were not available.

Then, the estimates for each of the pathogens were added together to arrive at an overall pathogen specific total. An uncertainty model to generate a point estimate and 90% credible interval (i.e. upper and lower limits that account for variability and uncertainty of the data) was used.

Figure 2^{Figures 2 and 3 – Footnote *} First approach: For pathogens where laboratory-confirmed cases were scaled up

Text Equivalent – Figure 2

Figure 3^{Figures 2 and 3 – Footnote *} Second approach: For pathogens where Canadian population was scaled down

Text Equivalent – Figure 3

Footnote *

Probability distributions were used to model uncertainty in each data inputs. Point estimates were bounded by a 90% credible interval.

Listing of 30 known pathogens by estimation method

Pathogens for which laboratory-confirmed illnesses were scaled up

National reportable disease data

• Brucella spp.
• Campylobacter spp.
• Clostridium botulinum
• Cryptosporidium spp.
• Cyclospora cayetanensis
• VTEC O157
• Giardia sp.
• Hepatitis A
• Salmonella spp., nontyphoidal
• Salmonella Typhi
• Shigella spp
• Vibrio cholera
• Vibrio spp., other
• Vibrio vulnificus

Provincial reportable disease data

• Trichinella spp.
• Listeria monocytogenes
• Vibrio parahaemolyticus
• Yersinia enterocolitica

Pathogens for which Canadian population scaled down

• Adenovirus
• Astrovirus
• Norovirus
• Rotavirus
• Sapovirus
• Toxoplasma gondii
• Clostridium perfringens

Other methods

• E. coli, other diarrheagenic
• ETEC
• VTEC non-O157
• Bacillus cereus
• Staphylococcus aureus

Estimating Canadian food-borne illnesses for unspecified agents

Unspecified agents that cause acute gastrointestinal illness fall into four general categories:

• Agents with insufficient data to estimate agent-specific burden
• Known agents not yet recognized as causing food-borne illness
• Microbes, chemicals, or other substances known to be in food that could at some time be shown to cause illness Agents not yet described
• Agents not yet described

To estimate food-borne illnesses from unspecified agents, we used symptom-based data from surveys to estimate the total number of episodes of acute gastrointestinal illnesses (AGI) and then subtracted the number of illnesses accounted for by known AGI pathogens. We then multiplied this number by the proportion of domestically acquired illnesses and of illnesses attributable to food, just as we did for the known agents. Finally, as with the known-pathogens estimate, we used an uncertainty model to generate a point estimate and 90% credible interval (upper and lower limits) (Figure 4).

Food-borne illnesses due to chemicals that cause acute gastrointestinal illness are included in the estimate of illnesses due to unspecified agents. However, chemicals or unspecified agents that do not cause acute gastrointestinal illness are not included in the estimates.

Figure 4^{Figures 4 – Footnote *} Approach for unspecified agents

Text Equivalent – Figure 4

Footnote *

Probability distributions were used to model uncertainty in each data input. Point estimates were bounded by a 90% credible interval.

Footnote **

Estimated proportions were based on 25 known pathogens that cause acute gastrointestinal illness. Five pathogens were not included because their primary symptoms are not acute gastrointestinal illness.

Improvements to previous estimates

The Agency’s 2013 estimates of illnesses from food-borne diseases in Canada are more accurate than the estimates published in 2008 of 11 million episodes of food-borne illness each year based on better data and methodologies. The 2008 estimates used values from earlier United States Centers for Disease Control and Prevention estimates applied to a Canadian estimate of the average number of episodes of acute gastrointestinal illness per person occurring each year. In addition, the methodology used for the 2013 estimates is different from that used in 2008. As a result of these differences, no strict side-by-side comparison can be made between the two sets of estimates. The 2013 estimates do not mean that there is less food-borne illness occurring, but rather, that more accurate estimates are now possible.

The 2013 estimates of illnesses from food-borne disease in Canada reflect improvements in methodology since 2008. Perhaps most importantly, these new estimates identify and rank the most important bacteria, viruses and parasites (“pathogens”) responsible for causing food-borne illness. These more specific estimates can further inform policy and regulatory priorities to prevent future illnesses.

The following list highlights the major differences in data and methodology between the new estimates and those published in 2008, and how they affect the estimates of illnesses from food-borne diseases in Canada.

Differences between 2008 and 2013 methodology

2008

• Included international travel-related illnesses.
• Did not estimate illness for individual pathogens.
• Utilised 1.3 episodes per person/year based on the following AGI case definition: any diarrhea or vomiting in the past 28 days excluding those with chronic conditions.
• 36% = Proportion applied to rate of acute gastrointestinal illness (known pathogens and the unspecified agents included) estimated to be food-borne (based on the US 1999 estimates).
• Uncertainty and variability of each input was not calculated.

2013

• Excluded international travel-related illnesses.
• Estimates of illness for 30 known pathogens.
• Pathogen-specific multipliers used to adjust for under-reporting and under-diagnosis.
• Pathogen specific proportion domestically acquired and food-borne applied.
• Utilised 0.63 episodes per person/year based on the following AGI case definition: 3 or more loose stools in 24 hours or any vomiting in the past 28 days excluding those with chronic conditions, or concurrent symptoms of coughing, sneezing, sore throat or runny nose.
• 20% = Proportion of the unspecified agents estimated to be food-borne (based on pathogen specific information on proportion food-borne).
• The Agency used many data sources, with varying degrees of reliability, to determine the estimates of food-borne illnesses. For each estimate, a formula was used to account for the cumulative effect of uncertainty and variability of the data inputs.

Effects of Difference

• 2013 estimate focused on food-borne illnesses acquired in Canada: 2013 estimates were limited to food-borne illnesses that were acquired in Canada, which reduced the number of food-borne illnesses in 2013 vs. 2008.
• 2013 estimated number of illnesses caused by known pathogens: more accurate: Utilising specific multipliers and proportion domestically acquired and food-borne for the 30 known pathogens yielded more accurate estimates for each known pathogen and, ultimately, greater accuracy in the overall estimate of food-borne illness.
• 2013 estimate of acute gastrointestinal illnesses (AGI): more precise: A more specific case definition for AGI was used to be more precise in the estimate and to minimize the chance of estimating illness that was not infectious (i.e. related to chronic illnesses such as Crohn’s disease) and not truly gastrointestinal (i.e. symptoms related to a respiratory infection). The impact of this is a lower overall estimate in 2013 vs. 2008.
• 2013 estimate used a smaller proportion of unspecified AGI determined to be food-borne: Reduced the number of food-borne illnesses in 2013 vs. 2008.
• 2013 estimate accounted for uncertainty: The results were upper and lower 90% credible limits, (i.e. a 90% credible interval). This means that 90% of the time the true value of the estimate falls within the upper and lower values.

Although we cannot compare these estimates to determine trends, we can turn to other data sources for information about trends in some important infections that are transmitted commonly through food.

Trends

Data from the Canadian Notifiable Disease Surveillance System (CNDSS) and National Enteric Surveillance Program (NESP) provide the best measures of disease trends. Although these systems include only a portion of the pathogens that make up the estimates, it does allow us to see changes over time for these important food-borne pathogens.

According to these systems some food-borne illnesses have dropped substantially over the past decade, but infections caused by one of the most common pathogens – Salmonella have not declined.

Trends in food-borne illness for 2011 compared to the 1998-2000 baseline period:

• No significant change in the rate of Salmonella infection (NESP).
• 35% decrease (95%CI 33-36%) in the rate of campylobacteriosis (CNDSS)
• 68% decrease (95%CI 65-71%) in the number of O157 Verotoxigenic Escherichia coli (VTEC) infections (NESP)
• 27% decrease (95%CI 22-32%) in the rate of shigellosis (CNDSS)

Other important pathogens commonly transmitted through food (e.g. norovirus, Clostridium perfringens, Toxoplasma gondii) are not tracked in part because they cause mild symptoms of short duration and because of current limitations in laboratory capacity and techniques. Common prevention measures (e.g. safe food handling) that would decrease illness caused by tracked pathogens would also decrease illness caused by pathogens not currently being tracked.

Figure 5 Relative rates of laboratory-confirmed infections with Campylobacter, VTEC O157, Salmonella, and Shigella compared with 1998–2000 rates, by year, 2001–2011, CNDSS and NESP

Text Equivalent – Figure 5

Comparison to US methodology and results

Canada used similar methodologies as the United States Centre for Disease Control and Prevention (US-CDC) for estimating the burden of food-borne illness in their country.

Findings

The overall total estimate (specified and unspecified agents) for Canada is slightly less than the US-CDC estimate with approximately one in eight Canadians compared to the US-CDC estimate of one in six Americans, experiencing food-borne illness per year.

Top 4 Pathogens contributing to total domestic food-borne illness in:

Canada

• Norovirus
• Clostridium perfringens
• Campylobacter spp
• Salmonella spp., non-typhoidal

The United States

• Norovirus
• Salmonella spp., non-typhoidal
• Clostridium perfringens
• Campylobacter spp.

Methods

Canada

• Inclusion of adenovirus and exclusion of Mycobacterium bovis and Streptococcus Group A (pathogens excluded are not relevant to Canada’s domestic food supply).
• Incorporated duration of illness and bloody diarrhea to define severe cases for some pathogens.
• Ratio of Bacillus cereus and Staphylococcus aureus to Clostridium perfringens using reported provincial data was applied to the estimate obtained through the population incidence of Clostridium perfringens from UK study.
• Estimated rotavirus, astrovirus and sapovirus for the total population.
• Included illnesses due to viruses for the total population as part of specified pathogen estimate.

The United States

• Did not include adenovirus but did include Mycobacterium bovis and Streptococcus Group A.
• Included only bloody diarrhea in definition of severe cases for some pathogens.
• Used data from outbreak reporting system and then applied an outbreak to sporadic ratio for Bacillus cereus, Staphylococcus aureus and Clostridium perfringens.
• Estimated rotavirus, astrovirus and sapovirus for < 5 years of age only.
• Illnesses related to viruses for those greater than 5 years of age are included in the unspecified agents’ estimate.

Effects of Methods

• Pathogens causing food-borne illness included in the estimate: Minimal impact to differences in overall estimates.
• Canadian definition of severity of illness included duration: Results in a higher proportion of cases being considered severe, and ultimately in a lower estimate of under-diagnosis in Canada compared to the United States.
• Approach to estimating bacterial food-borne toxins: Different approaches therefore difficult to compare the effect.
• Viruses calculated for total population: Reduced the number of cases in the unspecified portion as these were now part of the number of viruses estimated within the specified pathogens portion for Canada compared to the United States. Results in a lower total food-borne estimate for Canada compared to the US as these viruses have a low proportion food-borne.
• Unspecified agents: Reduced the number of cases estimated in the unspecified portion (60% of total) compared to the US (80% of total). Also reduces proportion food-borne (20%) compared to US (25%) applied to AGI caused by unspecified agents

Additional Information

• Food Safety – Public Health Agency of Canada
• Food Safety Videos
• Anatomy of a Food-borne Illness Outbreak
• Prevention and Education: Safe food handling and preparation
• FoodSafety.gc.ca

Percentage Change in 2012 compared with 2006-2008: Campylobacter - 14% increase, E. coli O157 – no change, Listeria – no change, Salmonella – no change, Vibrio – 43% increase, Yersinia – no change

2012 rate per 100,000 Population: Campylobacter - 14.30, E. coli O157 – 1.12, Listeria – 0.25, Salmonella – 16.42, Vibrio – 0.41, Yersinia – 0.33

2020 target rate per 100,000 Population: Campylobacter - 8.5, E. coli O157 – 0.6, Listeria – 0.2, Salmonella – 11.4, Vibrio – 0.2, Yersinia – 0.3

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a2.htm?s_cid=mm6215a2_e

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

Weekly

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

Foodborne diseases are an important public health problem in the United States. 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. A total of 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. These findings highlight the need for targeted action to address food safety gaps.

FoodNet conducts active, population-based surveillance for laboratory-confirmed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin–producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia in 10 sites covering 15% of the U.S. population (48 million persons in 2011).§ FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). Hospitalizations occurring within 7 days of specimen collection date are recorded, as is the patient’s vital status at hospital discharge, or at 7 days after the specimen collection date if the patient was not hospitalized. All hospitalizations and deaths that occurred within a 7-day window are attributed to the infection. Surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a complication of STEC infection characterized by renal failure, is conducted through a network of nephrologists and infection preventionists and by hospital discharge data review. This report includes 2011 HUS data for persons aged <18 years.

Incidence was calculated by dividing the number of laboratory-confirmed infections in 2012 by U.S. Census estimates of the surveillance population area for 2011.¶ A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence from 2006–2008 to 2012 and from 1996–1998 to 2012 (1). The overall incidence of infection with six key pathogens for which >50% of illnesses are estimated to be foodborne (Campylobacter, Listeria, Salmonella, STEC O157, Vibrio, and Yersinia) was calculated (2). Trends were not assessed for Cyclospora because data were sparse, or for STEC non-O157 because of changes in diagnostic practices. For HUS, changes in incidence from 2006–2008 to 2011 were estimated.

Incidence and Trends

In 2012, FoodNet identified 19,531 laboratory-confirmed cases of infection (Table 1). The number of infections and incidence per 100,000 population, by pathogen, were as follows: Salmonella (7,800; 16.42), Campylobacter (6,793; 14.30), Shigella (2,138; 4.50), Cryptosporidium (1,234; 2.60), STEC non-O157 (551; 1.16), STEC O157 (531; 1.12), Vibrio (193; 0.41), Yersinia (155; 0.33), Listeria (121; 0.25), and Cyclospora (15; 0.03). As usual, the highest reported incidence was among children aged <5 years for Cryptosporidium and the bacterial pathogens other than Listeria and Vibrio, for which the highest incidence was among persons aged ≥65 years (Table 2).

Among 6,984 (90%) serotyped Salmonella isolates, the top three serotypes were Enteritidis, 1,238 (18%); Typhimurium, 914 (13%); and Newport, 901 (13%). Among 183 (95%) Vibrio isolates with species information, 112 were V. parahaemolyticus (61%), 25 were V. vulnificus (14%), and 20 were V. alginolyticus (11%). Among 496 (90%) serogrouped STEC non-O157 isolates, the most common serogroups were O26 (27%), O103 (23%), and O111 (15%). Among 2,318 (34%) Campylobacter isolates with species information, 2,082 (90%) were C. jejuni, and 180 (8%) were C. coli.

The estimated incidence of infection was higher in 2012 compared with 2006–2008 for Campylobacter (14% increase; confidence interval [CI]: 7%–21%) and Vibrio (43% increase; CI: 16%–76%) and unchanged for other pathogens (Figure 1). In comparison with 1996–1998, incidence of infection was significantly lower for Campylobacter, Listeria, Shigella, STEC O157, and Yersinia, whereas the incidence of Vibrio infection was higher (Figure 2). The overall incidence of infection with six key pathogens** transmitted commonly through food was lower in 2012 (22% decrease; CI: 11%–32%) compared with 1996–1998 and unchanged compared with 2006–2008.

The incidence of infections with specific Salmonella serotypes in 2012, compared with 2006–2008, was lower for Typhimurium (19% decrease; CI: 10%–28%), higher for Newport (23% increase; CI: 1%–50%), and unchanged for Enteritidis. Compared with 1996–1998, the incidence of infection was significantly higher for Enteritidis and Newport, and lower for Typhimurium.

Among 63 cases of postdiarrheal HUS in children aged <18 years (0.57 cases per 100,000 children) in 2011, 33 (52%) occurred in children aged <5 years (1.09 cases per 100,000). Compared with 2006–2008, the incidence was significantly lower for children aged <5 years (44% decrease; CI: 18%–62%) and for children aged <18 years (29% decrease; CI: 4%–47%).

Hospitalizations and Deaths

In 2012, FoodNet identified 4,563 hospitalizations and 68 deaths among cases of infection with pathogens transmitted commonly through food (Table 1). The percentage of patients hospitalized ranged from 15% for Campylobacter to 96% for Listeria infections. The percentage hospitalized was greatest among those aged ≥65 years for STEC O157 (67%), Vibrio (58%), Salmonella (55%), Cyclospora (50%), Shigella (41%), STEC non-O157 (34%), Cryptosporidium (33%), and Campylobacter (31%). At least 95% of patients with Listeria infection in each age group†† with cases were hospitalized. The percentage of patients who died ranged from 0% for Yersinia and Cyclospora to 11% for Listeria infections. The percentage that died was highest among persons aged ≥65 years for Vibrio (6%), Salmonella (2%), STEC O157 (2%), Cryptosporidium (1%), Shigella (1%), and Campylobacter (0.2%).

Reported by

Debra Gilliss, MD, California Dept of Public Health. Alicia B. Cronquist, MPH, Colorado Dept of Public Health and Environment. Matthew Cartter, MD, Connecticut Dept of Public Health. Melissa Tobin-D’Angelo, MD, Georgia Dept of Public Health. David Blythe, MD, Maryland Dept of Health and Mental Hygiene. Kirk Smith, DVM, Minnesota Dept of Health. Sarah Lathrop, PhD, Univ of New Mexico. Shelley Zansky, PhD, New York State Dept of Health. Paul R. Cieslak, MD, Oregon Health Authority. John Dunn, DVM, Tennessee Dept of Health. Kristin G. Holt, DVM, Food Safety and Inspection Svc, US Dept of Agriculture. Susan Lance, Center for Food Safety and Applied Nutrition, Food and Drug Admin. Stacy M. Crim, MPH, Olga L. Henao, PhD, Mary Patrick, MPH, Patricia M. Griffin, MD, Robert V. Tauxe, MD, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Corresponding contributor: Stacy M. Crim, scrim@cdc.gov, 404-639-2257.

Editorial Note

In 2012, the incidence of infections caused by Campylobacter and Vibrio increased from the 2006–2008 period, whereas the incidence of infections caused by Cryptosporidium, Listeria, Salmonella, Shigella, STEC O157, and Yersinia 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 (3). 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 (4,5).

Declines in U.S. campylobacteriosis during 1996–2001 might have been related to measures meat and poultry processors implemented to comply with the Pathogen Reduction and Hazard Analysis and Critical Control Points (HACCP) systems regulations issued by USDA-FSIS in the late 1990s.¶¶ In 2011, USDA-FSIS issued new Campylobacter performance standards for U.S. chicken and turkey processors.*** Continued FoodNet surveillance can help to assess the public health impact of these standards and other changes. Detailed patient exposure information coupled with information on strain subtypes could help in assessing the relative contribution of various sources of infection and the effectiveness of control measures.

Although a significant increase was observed in reported Vibrio infections, the number of such infections remains low (6). Vibrios live naturally in marine and estuarine waters, and many infections are acquired by eating raw oysters (7). These infections are most common during warmer months, when waters contain more Vibrio organisms. Infections can be prevented by postharvest treatment of oysters with heat, freezing, or high pressure (8), or by thorough cooking. Persons who are immunocompromised or have impaired liver function should be informed that consuming raw seafood carries a risk for severe Vibrio infection. Vibrios also cause wound and soft-tissue infections among persons who have contact with water; for example, Vibrio alginolyticus typically causes ear infection (9).

The decrease in incidence of HUS in 2011 compared with 2006–2008 mirrors the decrease in the incidence of STEC O157 infection observed in 2011. The incidence of STEC O157 infection, which had declined since 2006, was no longer decreasing in 2012, and now exceeds the previously met Healthy People 2010 target of one case per 100,000 persons. The continued increase in STEC non-O157 infections likely reflects increasing use by clinical laboratories of tests that detect these infections.

FoodNet surveillance relies on isolation of bacterial pathogens by culture of clinical specimens; therefore, the increasing use of culture-independent tests for Campylobacter and STEC might affect the reported incidence of infection (10). Data on persons with only culture-independent evidence of infection suggests that in 2012, the number of laboratory-identified Campylobacter cases could have been 9% greater and the number of STEC (O157 and non-O157) cases 7%–19% greater than that reported (CDC, unpublished data, 2013). The lack of recent decline in STEC O157 incidence is of concern; continued monitoring of trends in the incidence of HUS and use of culture-independent testing might aid in interpreting future data on STEC O157 incidence.

The findings in this report are subject to at least four limitations. First, health-care–seeking behaviors and other characteristics of the population in the surveillance area might affect the generalizability of the findings. Second, many infections transmitted commonly through food (e.g., norovirus infection) are not monitored by FoodNet because these pathogens are not identified routinely in clinical laboratories. Third, the proportion of illnesses transmitted by nonfood routes differs by pathogen, and the route cannot be determined for individual, nonoutbreak-associated illnesses and, therefore, the data provided in this report do not exclusively relate to infections from foodborne sources. Finally, in some cases counted as fatal, the infection with the enteric pathogen might not have been the primary cause of death.

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. In 2010, FDA passed the Egg Safety Rule,††† designed to decrease contamination of shell eggs with Salmonella serotype Enteritidis. In 2011, USDA-FSIS tightened its performance standard for Salmonella contamination to a 7.5% positive rate for whole broiler chickens.§§§ Finally, the Food Safety Modernization Act of 2011 gives FDA additional authority to improve food safety and requires CDC to strengthen surveillance and outbreak response.¶¶¶ 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.****

Acknowledgments

Workgroup members, Foodborne Diseases Active Surveillance Network (FoodNet), Emerging Infections Program; communications team, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, CDC.

References

1. Henao OL, Scallan E, Mahon B, Hoekstra RM. Methods for monitoring trends in the incidence of foodborne diseases: Foodborne Diseases Active Surveillance Network 1996–2008. Foodborne Pathog Dis 2010;7:1421–6.
2. Henao OL, Crim SM, Hoekstra RM. Calculating a measure of overall change in the incidence of selected laboratory-confirmed infections with pathogens transmitted commonly through food, Foodborne Diseases Active Surveillance Network (FoodNet), 1996–2010. Clin Infect Dis 2012;54(Suppl 5):S418–20.
3. Samuel MC, Vugia DJ, Shallow S, et al. Epidemiology of sporadic Campylobacter infection in the United States and declining trend in incidence, FoodNet 1996–1999. Clin Infect Dis 2004;38(Suppl 3):S165–74.
4. Friedman CR, Hoekstra RM, Samuel M, et al. Risk factors for sporadic Campylobacter infection in the United States: a case-control study in FoodNet sites. Clin Infect Dis 2004;38(Suppl 3):S285–96.
5. Taylor EV, Herman KM, Ailes EC, et al. Common source outbreaks of Campylobacter infection in the USA, 1997–2008. Epidemiol Infect 2012;15:1–10 [Epub ahead of print].
6. Newton A, Kendall M, Vugia DJ, Henao OL, Mahon BE. Increasing rates of vibriosis in the United States, 1996–2010: review of surveillance data from 2 systems. Clin Infect Dis 2012;54(Suppl 5):S391–5.
7. Altekruse SF, Bishop RD, Baldy LM, et al. Vibrio gastroenteritis in the US Gulf of Mexico region: the role of raw oysters. Epidemiol Infect 2000;124:489–95.
8. DePaola A, Jones JL, Noe KE, Byars RH, Bowers JC. Survey of postharvest-processed oysters in the United States for levels of Vibrio vulnificus and Vibrio parahaemolyticus. J Food Prot 2009;72:2110–3.
9. Dechet AM, Yu PA, Koram N, Painter J. Nonfoodborne Vibrio infections: an important cause of morbidity and mortality in the United States, 1997–2006. Clin Infect Dis 2008;46:970–6.
10. Cronquist AB, Mody RK, Atkinson R, et al. Impacts of culture-independent diagnostic practices on public health surveillance for bacterial enteric pathogens. Clin Infect Dis 2012;54(Suppl 5):S432–9.

http://www.fsis.usda.gov/News_&_Events/Recall_028_2013_Expanded/index.asp

Louisiana Firm Recalls Cooked Meat, Poultry, and Deli Products Due To Possible Listeria Monocytogenes Contamination

Recall Release CLASS I RECALL FSIS-RC-028-2013 HEALTH RISK: HIGH Congressional and Public Affairs Lilia McFarland (202) 720-9113 Editor’s Note: This release is being reissued to expand the April 10, 2013 recall to include additional products. WASHINGTON, April 12, 2013 – Manda Packing Company, a Baker, La., establishment, is expanding its recall to include approximately 468,000 pounds of roast beef, ham, turkey breast, tasso pork, ham shanks, hog head cheese, corned beef, and pastrami due to possible contamination with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. Recommendations for people at risk for Listeriosis Wash hands with warm, soapy water before and after handling raw meat and poultry for at least 20 seconds. Wash cutting boards, dishes and utensils with hot, soapy water. Immediately clean spills. Keep raw meat, fish and poultry away from other food that will not be cooked. Use separate cutting boards for raw meat, poultry and egg products and cooked foods. Do not eat hot dogs, luncheon meats, bologna or other deli meats unless reheated until steaming hot. Do not eat refrigerated paté, meat spreads from a meat counter or smoked seafood found in the refrigerated section of the store. Foods that don’t need refrigeration, like canned tuna and canned salmon, are safe to eat. Refrigerate after opening. Do not drink raw (unpasteurized) milk and do not eat foods that have unpasteurized milk in them. Do not eat salads made in the store such as ham salad, chicken salad, egg salad, tuna salad or seafood salad. Do not eat soft cheeses such as Feta, quesco blanco, quesco fresco, Brie, Camembert cheeses, blue-veined cheeses and Panela unless it is labeled as made with pasteurized milk. Use precooked or ready-to-eat food as soon as you can. Listeria can grow in the refrigerator. The refrigerator should be 40° F or lower and the freezer 0° F or lower. Use an appliance thermometer to check the temperature of your refrigerator. Various weights of the following products are subject to recall: Roast Beef: Manda Supreme Roast Beef Four Star Cajun Roast Beef Four Star Roast Beef Cajun Prize Roast Beef Manda Supreme Natural Roast Beef Manda Natural Roast Beef Manda New Orleans Style Roast Beef Manda Whole Wet Pack Roast Beef Manda Roast Beef S&W Roast Beef LA Pride Roast Beef Leblancs Roast Beef Thompsons Roast Beef Christiana Roast Beef Manda Italian Roast Beef Deli Pride Roast Beef Chef Master Roast Beef Scariano Roast Beef Marques Roast Beef Cajun Rite Roast Beef Each package has a “Sell by” date of May 13-June 22, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. Ham Manda Ham Cajun Prize Ham Leblancs Ham Four Star Ham Christiana Ham S&W Ham Thompsons Ham Chef Master Ham Rouses Ham Each package has a “Sell by” date of May 13-July 1, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. Turkey Leblancs Turkey Breast Manda Turkey Breast Cajun Prize Turkey Breast Christiana Turkey Breast Each package has a “Sell by” date of May 13-June 22, 2013, and bears the establishment number “P-8746A” inside the USDA mark of inspection. Corned Beef Manda Corned Beef Four Star Corned Beef Each package has a “Sell by” date of May 13-June 22, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. Pastrami Manda Pastrami Four Star Pastrami Each package has a “Sell by” date of May 13-June 22, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. Hog Head Cheese Manda Hog Head Cheese S&W Hog Head Cheese Rouses Hog Head Cheese Big Cajun Hog Head Cheese Each package has a “Sell by” date of May 13-June 22, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. Tasso Pork Manda Tasso Diversified Tasso Rouses Tasso Each package has a “Sell by” date of May 13-July 2, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. Ham Shanks Manda Ham Shanks Each package has a “Sell by” date of May 13-June 9, 2013, and bears the establishment number “EST. 8746A” inside the USDA mark of inspection. These products may have been sliced at retail delis, and if so will not bear this packaging information. The products were shipped for further distribution, for sale at retail, and to retail deli stores in Alabama, Arkansas, Florida, Georgia, Illinois, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, and Texas. FSIS was alerted to the problem by the Tennessee Department of Agriculture, who took an intact sample of cooked roast beef at a retail establishment on April 5, 2013, which later confirmed positive for Listeria monocytogenes. The recall is now being expanded because of additional samples from additional production dates which returned positive for Listeria monocytogenes. FSIS and the company have received no reports of illnesses associated with consumption of these products. FSIS routinely conducts recall effectiveness checks to verify that recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list(s) will be posted on the FSIS website at: www.fsis.usda.gov/FSIS_Recalls/Open_Federal_Cases. Consumption of food contaminated with Listeria monocytogenes can cause listeriosis, an uncommon but potentially fatal disease. Healthy people rarely contract listeriosis. However, listeriosis can cause high fever, severe headache, neck stiffness and nausea. Listeriosis can also cause miscarriages and stillbirths, as well as serious and sometimes fatal infections in those with weakened immune systems, such as infants, the elderly and persons with HIV infection or undergoing chemotherapy. Individuals concerned about an illness should contact a health care provider. Media and consumers with questions about the recall should contact Josh Yarborough, Director of Quality Assurance and Food Safety, at (225) 344-7636, ext. 59. Consumers with food safety questions can “Ask Karen,” the FSIS virtual representative available 24 hours a day at AskKaren.gov or via smartphone at m.askkaren.gov.“Ask Karen” live chat services are available Monday through Friday from 10 a.m. to 4 p.m. ET. The toll-free USDA Meat and Poultry Hotline 1-888-MPHotline (1-888-674-6854) is available in English and Spanish and can be reached from 10 a.m. to 4 p.m. ET Monday through Friday. Recorded food safety messages are available 24 hours a day.

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http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317138367615?p=1317137526707

HPA study shows poor hygiene practices at mobile vendors

13 March 2013

Research from the Health Protection Agency (HPA) has revealed that food, water, chopping boards, cleaning cloths and security wristbands sampled from mobile and outdoor food vendors were contaminated with a range of bacteria including E.coli. This bacteria, which originates from human or animal faeces indicates either poor hygiene, undercooking or cross-contamination in the kitchen.

The report ‘A follow-up study of hygiene practices in catering premises at large scale events in the United Kingdom’ is now published on the HPA website.

Over a seven month period in 2010, 1,662 samples were collected from 153 events by Local Authority sampling officers and tested by the HPA for a range of bacteria including Enterobacteriacae, E.coli and Staphylococcus aureus.

The events where samples were taken included 50 concerts or music festivals, 20 sports events, 39 carnivals, fetes and fairs and 44 ‘other’ events of a type not stated.

Eight per cent of food samples (53/659) were noted as being of an unsatisfactory quality with a further one per cent (seven samples) containing potentially hazardous levels of bacteria including, among others, the presence of Salmonella and Clostridium perfringens. Food poisoning caused by this bacteria most often occurs when food, usually meat, is cooked and then kept warm for several hours before serving.

Of the water samples tested, results revealed that 27 per cent (56/209) contained unacceptable levels of coliform bacteria which can be found in the environment in soil, water and on plants and may also be a sign of faecal contamination. E.coli and/or enterococci bacteria (of faecal origin) were found in 16 samples (eight per cent).

Environmental swabs were taken from chopping boards, food containers, serving counters, utensils, work surfaces and other areas. The study shows that chopping boards had the most unsatisfactory levels of contamination with 60 per cent (84/141) not meeting the required standard. Overall, of 585 swabs from environmental testing 188 (32 per cent) were not of the required standard.

Bacterial levels twenty times what is considered acceptable were found on 56 per cent (97/156) of the cleaning cloths tested. Bacterial contamination is measured in colony forming units with 97 cloths showing the presence of 10,000 colony forming units (cfu) of Enterobacteriacae where the acceptable level is 500 or less. Some cloths also tested positive for E.coli and species of Listeria.

Some events now require vendors to wear a security wristband for the duration of the event as proof of their authorisation to trade. As these are worn permanently it was considered that there may be some risk of cross contamination. Of those tested one fifth (6/33) of wristbands worn by catering staff were contaminated with Enterobacteriacae, E.coli which are all common bacteria found in the human gut and/or Staphylococcus which lives on the skin.

Dr Caroline Willis, a specialist microbiologist at the HPA’s Food, Water and Environment laboratory in Porton Down and one of the authors of the report, said: “Gastrointestinal illnesses are some of the most common problems encountered by people attending festivals and large-scale outdoor events. Various studies have looked at the microbiological standards of food and environments in such locations and although this study showed some improvement in standards of cleanliness there is clearly a lot of room for improvement.

“There are various reasons why hygiene is lower at such events including the volume of customers, use of temporary staff, working in cramped conditions, lack of storage space and difficulties with on-site cleaning. These all combine to lead to greater cross contamination risks which can be increased if levels of personal hygiene are not good.

“Local Environmental Health Departments have done much to improve standards at mobile and outdoor catering premises over recent years but staff need to ensure that both cooking standards and thorough hygiene are rigorously maintained to avoid the risk of people becoming unwell.”

Ends

Notes to editors

1. The report can be found from the HPA website’s LG Regulation Reports page.
2. E.coli bacteria are only found in the human or animal gut. Contamination with E.coli could have occurred by caterers not washing their hands after using the toilet or by cross-contamination from raw meat that becomes contaminated with faecal material in the abattoir.
3. Species of Enterobacter can be found in the environment and are also part of the normal flora in the human intestines. The presence of Enterobacteriaceae are indicators of poor hygiene but not necessarily of faecal contamination. They may indicate cross-contamination from raw salad ingredients.
4. Staphylococci are a group of bacteria which are often found on the skin or inside the nose. They can cause disease if the bacteria enters the body via cuts or medical procedures.
5. The Environmental Health officers were asked to collect samples as follows: ready-to-eat foods; a cleaning cloth that had been used in areas where ready-to-eat foods were prepared; and swabs from food contact surfaces including empty, clean food containers used for ready-to-eat food; utensils, chopping boards used for ready-to-eat foods and work surfaces or serving counters. There was also an option to collect a water sample as the customer would receive it or as the caterer would use it from the vendor’s main supply of water; and to take a swab of the outer surface of a food handler’s security wrist band.
6. Of the one per cent of food samples that we considered to be potentially injurious to health four had elevated levels of Bacillus species; one had Clostridium perfringens; one tested positive for coagulase-positive staphylococci and the last one tested positive for Salmonella.
7. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. On 1 April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: http://www.hpa.org.uk or follow us on Twitter @HPAuk or ‘Like’ us on Facebook at www.facebook.com/HealthProtectionAgency [external link].
8. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email colindale-pressoffice@hpa.org.uk. Out of hours the duty press officer can be contacted on 0208 200 4400.

Last reviewed: 13 March 2013

http://www.fda.gov/Safety/Recalls/ucm340249.htm?source=govdelivery

Recall — Firm Press Release

FDA posts press releases and other notices of recalls and market withdrawals from the firms involved as a service to consumers, the media, and other interested parties. FDA does not endorse either the product or the company.

MKG Provisions Voluntarily Recalls Atlantic Smoked Salmon Due to Possible Health Risk

Contact
Consumer
Michael Gibson
(305)835-0171

FOR IMMEDIATE RELEASE – February 6, 2013 – MKG Provisions of Miami, FL is recalling Atlantic Smoked Salmon Batch# 1768 consisting of several brands of products listed below which have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women.

The product batch # 1768 was distributed during the time period from January 23, 2013 through February 1, 2013 to Gold Kosher of North Miami Beach, FL, Sally Sherman Salads of Ft. Lauderdale, FL, Boca Raton Resort & Club, In Boca FL. US Foodservice South Florida, US Foodservice Baltimore, Deer Run of Longwood, FL, L’Chaim of Delray Beach, FL, Prestige Smokehouse of Riviera Beach, FL, and Best Value of Miami, FL. There is a square sticker placed on the bag of each product which reads the lot# 1768. Product and packaging details are listed below.

1. UpRiver Brand Norwegian presliced sides In Upriver vacuum pouch bags
2. Prestige Brand Scottish presliced sides in clear vacuum pouch bags
3. Legendary Brand Norwegian pre-sliced sides in legendary vacuum pouch bags
4. Prestige Brand Pastrami pre-sliced sides in clear vacuum pouch bags
5. UpRiver Brand Scottish pre-sliced sides in UpRiver vacuum pouch bags
6. UpRiver Brand Trimmings in clear bags in clear vacuum pouch bags
7. UpRiver Brand Pastrami pre-sliced sides in UpRiver vacuum pouch bags
8. UpRiver Brand Peppered pre-sliced sides in Up River vacuum pouch bags
9. UpRiver Brand Tequila/Cilantro pre-sliced sides in UpRiver vacuum pouch bags
10. Prestige Brand 16 oz. retail packs in clear vacuum pouch bags
11. UpRiver Brand 4 oz. Nwgn retail packs in UpRiver vacuum pouch bags
12. Prestige Brand 4 oz. Irish retail packs in clear vacuum pouch bags
13. Prestige Brand 4 oz. Nwgn retail packs in clear vacuum pouch bags
14. Prestige Brand 4 oz. Nova retail packs clear vacuum pouch bags
15. UpRiver Brand 4 oz. Gravalax retail packs UpRiver vacuum pouch bags
16. UpRiver Brand Norwegian Presliced sides UpRiver vacuum pouch bags

The recall was the result of an audit by the Florida Department of Agriculture where finished product lab testing contained bacteria. MKG is voluntarily recalling this product. No illnesses have been reported to date.

Consumers should return any of the products purchased mentioned above

Consumers with questions may contact:

Michael Gibson
MKG Provisions Inc.
Phone 305-835-0171
Fax 305-835-0198
From 9:00 AM to 5:00 PM Eastern Time

The recall was the result of an audit by the Florida Department of Agriculture where finished product lab testing contained bacteria. MKG is voluntarily recalling this product. No illnesses have been reported to date.

Consumers should return any of the products purchased mentioned above.

Consumers with questions may contact:

###

http://www.cdc.gov/foodborneburden/attribution-1998-2008.html

Attribution of Foodborne Illness, 1998-2008

Painter JA, Hoekstra RM, Ayers, et al. Attribution of foodborne illnesses, hospitalizations, and deaths to food commodities by using outbreak data, United States, 1998-2008. Emerg Infect Dis 2013 March;19:3 (Early online publication) [Full text]

Figure A

Hierarchy of 17 Food Commodities Used in Outbreak Analysis [PDF - 1 page]

Figure B

Contribution of Different Food Commodities (Categories) to Estimated Domestically-Acquired Illnesses and Deaths, 1998-2008

Figure C

Foodborne Disease Outbreaks by Type of Food Implicated,1998-2008

Figure D

Groups of 17 Food Commodities (Categories) Used in Outbreak Analysis [PDF - 1 page]

Figure E

Examples of Foods in Commodities (Categories) [PDF - 1 page]

Questions and Answers

What is this study about?

This study addresses the important question: Which foods make us ill?

For the first time, CDC developed a comprehensive set of estimates of the food sources of all foodborne illnesses acquired in the United States. The paper provides a historical baseline of estimates that will be further refined over time with more data and improved methods.

It builds on the estimates of foodborne illness published in 2011 that told us that about 48 million people (1 in 6) get sick each year from food. More than 9 million of these illnesses are caused by major pathogens [PDF - 1 page] CDC tracks.

The paper focuses on known causes of illness and uses data from nearly 4600 outbreaks to estimate the number of illnesses attributed to each of 17 food categories (called “commodities” in the paper). This is the first time CDC has attempted such a comprehensive set of estimates. Figure A.

Why is this paper is important?

This study offers the most comprehensive look to date in attributing illness to specific food commodities based on outbreak data, including those where complex foods (that is, foods that have ingredients from several food categories) were implicated in outbreaks.

These findings underscore roles of industry and government that help keep food safe. These attribution estimates are important because they can help regulatory agencies and industry target prevention efforts that will improve the safety of the foods that we need and that we love to eat.

We developed a method of attributing illnesses to specific food groups based on a decade of outbreak data, including those that implicate complex foods (that is, foods that have ingredients from several food categories.) Figure A.

Among all types of foods, produce accounted for nearly half of illnesses, which were most often caused by norovirus. However, the CDC emphasizes that a healthy and safe diet that is high in fruits and vegetables is an important part of a healthy lifestyle. The most common food sources of fatal infections were meat and poultry, much due to Salmonella and Listeria. Figure B

What did the study show?

The estimates used 4,589 foodborne disease outbreaks reported over the 11 year span from 1998 to 2008. Both the contaminant and the specific food causing the outbreak was reported.

• This included outbreaks linked to a food belonging to a single food category (a “simple” food) as well those linked to foods made from more than one food category (a “complex” food). Figure C
• Half of outbreak investigations with a known food implicate a complex food. Because complex foods have ingredients from more than one food category, they do not fit into the 17 food categories and have not been included in previous analyses. Figure C

Illness was attributed to all the 17 different food categories. The proportion accounted for by each category varied.

• Figure B shows the contributions of different food commodities (categories) to estimated illnesses and deaths.
• Figure D shows the main groupings of food categories.
• Figure E gives examples of foods in categories.

Produce (a combination of six plant food categories [Fruits-Nuts, Fungi vegetables, Leafy vegetables, Root vegetables, Sprout vegetables, Vine-Stalk vegetables]) accounted for nearly half of illnesses (46%). Figure E provides examples of foods in these groups.

• Among the individual food categories, leafy vegetables accounted for the most illnesses. Many of those illnesses (46%) were caused by norovirus.

Meat and poultry (a combination of four animal food categories[Beef, Game, Pork, and Poultry) accounted for fewer illnesses, but for 29% of deaths. Figure E provides examples of foods in these groups.

• Poultry accounted for the most deaths (19%); many of those were caused by Listeria and Salmonella infections.
• This is partly due to three large Listeria outbreaks linked to sliced processed turkey that occurred in the last decade, though fewer have occurred in recent years.

Your findings attribute many illnesses from produce to norovirus. Do you know how food became contaminated with norovirus?

This paper does not address where contamination of food occurs along the food production chain. A recent CDC study on “Epidemiology of Foodborne Norovirus Outbreaks, United States, 2001-2008” looked at this issue in relation to norovirus. Here are some of the main findings about the food sources from norovirus:

• Sick food handlers specifically caused 53 percent of the foodborne norovirus outbreaks by contaminating food and may have contributed to another 29 percent of the outbreaks. Over 80 percent of outbreaks involved food prepared in commercial settings, such as restaurants, delis, or catering businesses.
• Among the 364 outbreaks that involved a single contaminated food, over half were produce, primarily leafy vegetables or fruits. These foods, which are commonly eaten raw, were most often contaminated during preparation or service by a sick food handler. A few outbreaks were caused by produce that was contaminated during production or processing. Mollusks, such as oysters, were also often involved in outbreaks due to contamination during production.
• Web link to the paper

What are the advantages of using outbreak data to estimate the sources of foodborne illnesses?

Outbreak investigations definitively link illnesses to particular foods and pathogens

• Outbreaks are caused by a wide range of agents, including bacteria, viruses, parasites, toxins, and other chemicals so they provide good coverage of foodborne agents
• Outbreak investigations capture data on common and uncommon pathogens, and on common and uncommon foods
• CDC has a very good outbreak database, Foodborne Outbreak Online Database (FOOD)

What are some of the limitations of the study?

Estimates were not made for pathogens that did not cause outbreaks. Toxoplasma and Vibrio vulnificus did not cause outbreaks but have high fatality rates. Adding these might result inMeat and Mollusks (e.g., oysters, clams) being more important source of deaths than is indicated in the study.

• The study used data from an 11-year period and did not account for changes over this period. A shorter, more recent period is desirable when major implicated commodities have changed. For example, Listeria outbreaks caused by contamination of ready-to-eat meats markedly decreased after 2002.
• The estimates are presented as ranges of high, low, and most likely estimates for the number of illnesses, hospitalizations and deaths attributed to each food category. The ranges reflect the uncertainty in the estimates.
• The estimates depend on the general assumption that the foods implicated in outbreaks are the same foods that cause individual illnesses not part of outbreaks.
• The risk for foodborne illness is just one part of the risk-benefit equation for foods; the health benefits of consuming a diet high in fruits and vegetables must also be considered.

Top of Page

Does this mean I should not eat produce and poultry?

No, that is not the message from this paper. A healthy and safe diet is an important part of a healthy lifestyle. These findings do not mean that people should avoid certain categories of foods.

• Fruits and Vegetables: The Dietary Guidelines for Americans 2010 encourage us to eat more fruits and vegetables as a part of a healthy diet. Eating fruits and vegetables is associated with reduced risk of many chronic diseases including heart attack, stroke, and certain types of cancer. When properly cleaned, separated, cooked, and stored to limit contamination, fruits and vegetables safely provide some essential nutrients that would otherwise be lacking in most American diets.
• Raw Poultry: Food items, like chicken, often contains harmful bacteria such as Salmonella and Campylobacter. Washing poultry does not remove bacteria.
  • Kill these bacteria by cooking chicken to the proper temperature
  • Use a food thermometer to ensure that cooked foods reach a safe internal temperature: 165°F for poultry, 145°F for whole meats (allowing the meat to rest for 3 minutes before carving or consuming), and 160°F for ground meats.

What types of additional data and methods are you planning to use to improve the estimates?

The attribution of illness to foods can be done in several different ways, some highly specific for one type of infection or one type of food, and others more general.

• For example, by comparing the characteristics of Salmonella found in foods and animals with those found in people, one can attribute Salmonella infections back to specific animal sources.
• A working group of scientists from CDC, FDA and USDA has been collaborating on several projects to improve these estimates. This Interagency Food Safety Analytics Consortium (IFSAC) is bringing together more data from across the agencies, and evaluating methods for analyzing them, and will be providing more refined estimates in the future.

Will you ever be able to tell us the top foods that make us sick?

This study goes a long way toward doing that, and CDC is working to refine the estimates. FDA is working to develop the list of the riskiest foods among the foods that they regulate.

• The Interagency Food Safety Analytics Consortium is developing a more detailed breakdown of foods and food groups (beyond the 17 general categories) that will help in future work. Learn more about IFSAC and their current projects.

How will CDC partners benefit from this study?

The study provides extensive documentation for industry, consumer groups, and researchers to use and review. Regulatory agencies can use these data to conduct risk analyses required in the rulemaking process.

• Outbreak data are used to measure Healthy People 2020 goals. Outbreak data are also used to inform the Food and Drug Administration’s (FDA) regulations, such as the Egg Safety Rule, and provide rationale for adoption of FDA’s recently proposed rules on produce safety standards and preventive controls for human food.
• Outbreak data are used by the US Department of Agriculture, Food Safety and Inspection Service (FSIS) to evaluate control measures for poultry and beef, informed by success in the reduction of E. coli O157 illnesses and are in line with the Agency’s 2011-2016 Strategic Plan.

http://www.fda.gov/Safety/Recalls/ucm336951.htm?source=govdelivery

Recall — Firm Press Release

FDA posts press releases and other notices of recalls and market withdrawals from the firms involved as a service to consumers, the media, and other interested parties. FDA does not endorse either the product or the company.

Whole Foods Market Recall Whole Catch Wild Alaskan Sockeye Salmon Because of Possible Health Risk from Listeria

Contact
Consumer
512-542-0060

Media
Libba Letton
Libba.letton@wholefoods.com
 

FOR IMMEDIATE RELEASE – January 25, 2013 – Whole Foods Market is recalling one lot code of Whole Catch Wild Alaskan Sockeye Salmon (4 oz), cold smoked and sliced, sold in stores in 12 states, because it may contain Listeria Monocytogenes, an organism which can cause a sometimes fatal infection in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer short term symptoms, such as high fever, severe headaches, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

The recalled items were sold in stores in Colorado, Connecticut, Florida, Idaho, Kansas, Maine, Massachusetts, New Jersey, New Mexico, New York, Rhode Island, and Utah.

The recalled salmon is sold in black-and-gold, flat, rectangular vacuum-sealed packages; the lot code being recalled is 7425A2298B. The lot code is ink-jet printed on the back of the package, on the upper left side. The UPC code is 0 99482 40880 0. Signage is posted in Whole Foods Market stores to notify customers of this recall. Pictures of the product are enclosed.

No illnesses have been reported. A sample of the product tested positive for listeria.

Customers should dispose of the product in the garbage and wash their hands immediately to avoid any potential cross-contamination. Full refunds will be given at the store. Customers with questions may call 512-542-0060, Monday through Friday, 8:00 am to 5:00 pm Central.

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http://www.dailytelegraph.com.au/news/soft-cheese-listeria-outbreak-spreads/story-e6freuy9-1226561642576

Soft cheese listeria outbreak spreads

From: AAP

January 25, 201311:20AM

“THREE more people have been struck down by listeriosis after eating soft cheese.

The cases in NSW follow seven cases last week.

They bring the total number of people affected nationwide to 21.

Two Australians have died and a pregnant woman has miscarried……..”