PulseNet International: Tracking foodborne disease outbreaks throughout the world

In February 2007, millions of Americans heard news reports about a large multi-state outbreak of Salmonella traced to peanut butter produced in Georgia. Because foodborne disease outbreaks do not respect borders, and with increasing international trade of food, CDC’s PulseNet program was also working closely with federal and international partners to ensure global detection of the outbreak.

PulseNet USA is the national surveillance network for foodborne infections. Members of PulseNet USA include public health and
food regulatory agency laboratories that perform DNA “fingerprinting” on bacteria that may spread through food. Network members identify and label each “fingerprint” pattern for rapid comparison through an electronic database maintained at CDC. This helps identify and track particular strains of bacteria that are harmful to human health.

During the Salmonella outbreak, PulseNet International, a global network modeled after U.S. PulseNet, informed network countries that the contaminated product had been exported to many countries. Suspect cases were reported in several European countries, but tests ultimately showed none had the “fingerprint” identified in the U.S. outbreak.

PulseNet International has confirmed global cases in other outbreaks. One example is an outbreak of shigellosis that was associated with air travel from Hawaii in 2004. By sharing DNA fingerprints from the bacterial strains isolated from patients, public health officials confirmed cases in the United States, Canada and Japan.

Today [second quarter 2007], 67 countries/regions are members of the PulseNet International network. Goals for PulseNet International include:

• Developing partnerships between public health laboratories throughout the world
• Establishing efficient communication systems between the networks
• Building capacity for molecular surveillance of foodborne infections

Today, PulseNet USA and PulseNet Canada are sharing data in real-time through direct connection between their respective databases. This real-time communication is also planned with the other PulseNet networks. PulseNet International is currently exploring the possibility of establishing PulseNet networks in Africa and the former Soviet Union. This work is done in cooperation with WHO’s Global Salmonella Surveillance program (WHO GSS). These expanded collaborations are expected to further improve global surveillance and control of foodborne diseases, which in turn will lead to fewer people being affected by foodborne infection worldwide.

For the original story and more information, see CDC Global Health E-Brief [PDF - 5 pages].

http://www.fsis.usda.gov/News_&_Events/NR_060613_01/index.asp

http://www.cspinet.org/new/201306061.html

http://www.consumerfed.org/news/677

FSIS Proposes New Labeling Rules for Mechanically Tenderized Beef Products
New labels and cooking instructions will give consumers information they need to safely enjoy these products

WASHINGTON, June 6, 2013 – The U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) is proposing new requirements for labeling beef products that have been mechanically tenderized, including adding new cooking instructions, so that consumers can safely enjoy these products.

“Ensuring that consumers have effective tools and information is important in helping them protect their families against foodborne illness,” said Under Secretary Elisabeth Hagen. “This proposed rule would enhance food safety by providing clear labeling of mechanically-tenderized beef products and outlining new cooking instructions so that consumers and restaurants can safely prepare these products.”

To increase tenderness, some cuts of beef go through a process known as mechanical tenderization, during which they are pierced by needles or sharp blades in order to break up muscle fibers. Research has shown that this process may transfer pathogens present on the outside of the cut to the interior. Because of the possible presence of pathogens in the interior of the product, mechanically tenderized beef products may pose a greater threat to public health than intact beef products, if they are not cooked properly.

The proposed rule would require that mechanically tenderized product is labeled so that consumers know they are purchasing product that has been mechanically tenderized. The rule would also require the labels of mechanically tenderized product to display validated cooking instructions, so that consumers have the information they need to cook this product in a way that destroys illness-causing pathogens.

Since 2003, the Centers for Disease Control and Prevention has received reports of five outbreaks attributable to needle or blade tenderized beef products prepared in restaurants and consumers’ homes. Failure to thoroughly cook a mechanically tenderized raw or partially cooked beef product was a significant contributing factor in all of these outbreaks. In developing this proposed rule, FSIS used data from its own research, from the Agricultural Research Service, and from the CDC to determine the public health risk associated with undercooking mechanically tenderized products, and the benefits of the proposed rule.

The proposal was posted today on the FSIS website at www.fsis.usda.gov/regulations_&_policies/
Proposed_Rules/index.asp and soon will publish in the Federal Register. The comment period will end 60 days after the proposal publishes in the Federal Register and must be submitted through the Federal eRulemaking Portal at www.regulations.gov, or by mail to the U.S. Department of Agriculture (USDA), FSIS, OPPD, RIMD, Docket Clearance Unit, Patriots Plaza III, Room 8-164, 355 E Street, S.W., Washington, D.C. 20024-3221. All items submitted by mail or electronic mail must include the Agency name and docket number, which will be assigned when it is published in the Federal Register.

Consumer Federation of America Applauds USDA Decision to Label Mechanically Tenderized Meat

(June 6, 2013) – Consumer Federation of America today applauded USDA’s Food Safety and Inspection Service for its proposal to label mechanically tenderized meat.

“This is good news for consumers,” said Chris Waldrop, Director of the Food Policy Institute at Consumer Federation of America. “Without labeling, consumers would never know that the steak they are purchasing has been mechanically tenderized and may present a greater risk for foodborne illness.”

Mechanical tenderization is a process by which small needles or blades are repeatedly inserted into the product. These needles or blades pierce the surface of the product increasing the risk that any pathogens, such as E. coli or Salmonella, located on the surface of the product will be transferred to the interior. The process is often used on less expensive cuts of meat to increase tenderness.

In order to kill pathogens which may be located on the interior of these products, consumers must cook these products differently than they would intact steaks and roasts. Without labeling to identify these products as mechanically tenderized, and information on how to properly cook these products, consumers may be unknowingly at risk for foodborne illness. Labeling of mechanically tenderized products would allow consumers to identify these products in the supermarket and handle them appropriately.

In December 2009, 21 people in 16 states were sickened with E. coli from mechanically tenderized steaks. Mechanically tenderized steaks and roasts were also implicated in the largest beef recall in Canadian history by XL foods, in which 18 people were sickened in that country.

Contact: Chris Waldrop 202-797-8551

http://www.cdc.gov/salmonella/live-poultry-04-13/index.html

Highlights

http://www.nbcnews.com/id/51944817/ns/local_news-raleigh_nc/t/possible-cases-fayetteville-salmonella-outbreak/

70 possible cases in Fayetteville salmonella outbreak

“……The hotel’s General Manager…..said the first 14 reported cases were all staff members at the hotel, including himself.

Deal said the health department investigators have asked questions of the restaurant kitchen staff and reviewed how they handled food. They are also checking what foods were shipped to the hotel……”

http://www.fda.gov/Safety/Recalls/ucm353311.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.

Eco-Cuisine Recalls Product Because of Possible Health Risk

Contact:
Consumer:
303-402-0289

FOR IMMEDIATE RELEASE May 20, 2013 – Eco-Cuisine of Boulder, Colorado is recalling all lots of T3314 Basic Brownie Mix, T3333 Betty Brownie Mix with Vanilla, T3388 Ground Beef Style Quick Mix, T3394 Sausage Style Quick Mix, T3416 Chocolate Cookie Mix, T3417 Lemon Muffin Mix, and T3418 English Scone Mix, CM25COOK Basic Cookie Mix 25 lb. bag, CM25MUFF Basic Muffin Mix 25 lb. bag, CM25SCON Basic Scone Mix 25 lb. Bag, because it has the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

The baking mix products were distributed nationwide through direct sales and food service distribution centers.

Products affected are:

No illnesses have been reported to date.

The recall was as the result of notification by CHS Foods that ingredients used in the aforementioned products were being recalled for Salmonella. The company has ceased the production and distribution of the product as FDA and the company continue their investigation as to what caused the problem.

Consumers who have purchased the above listed products are urged to return it to the place of purchase for a full refund. Consumers with questions may contact Eco-Cuisine Monday through Friday 8 am to 5 pm MDT at 303-402-0289

###

RSS Feed for FDA Recalls Information¹ [what's this?²]

Photo: Product Labels³

Recalled Product Photos Are Also Available on FDA’s Flickr Photostream.⁴

http://www.wral.com/salmonella-cases-in-fayetteville-up-to-51/12459724/

Posted: 4:38 p.m. Friday
Updated: 6:19 p.m. Friday

Salmonella cases in Fayetteville up to 51

“……….All of the patients reported eating at the Holiday Inn Bordeaux in Fayetteville, and health officials are asking anyone who ate or drank at the hotel since May 1 to be aware of symptoms, including diarrhea, fever and abdominal cramps………..”

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.cdc.gov/salmonella/live-poultry-04-13/index.html

Multistate Outbreak of Human Salmonella Infantis and Salmonella Mbandaka Infections Linked to Live Poultry

Posted May 10, 2013 01:15 PM ET

Highlights

http://www.fda.gov/Safety/Recalls/ucm351630.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.

Krinos Foods, LLC. is Expanding its April 28, 2013 Recall to Include Additional Expiration Dates Jan 01-2014 to Jun 08-2014 of Tahini Products Because of Possible Health Risk

Contact:
Consumer
(718) 729-9000

FOR IMMEDIATE RELEASE – May 9, 2013 – Krinos Foods, LLC. of Long Island City, New York is voluntarily recalling its TAHINI sesame paste, because it has the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

The Tahini product was distributed nationwide through retail stores.

The TAHINI sesame paste product is sold in 1 LB glass jars, 2 LB glass jars and in 40 LB plastic pails. The UPC codes for the following products: 1 LB jar is 0-75013-28500-3, 2 LB jar is 0-75013-28510-2 and 40 LB pail 0-75013-04018-3. The recalled lots have a code stamped on the lid between “EXP JAN 01 – 2014 up to and including EXP JUN 08 – 2014” and “EXP OCT 16 – 2014” up to and including “EXP MAR 15 – 2015”.

To Krinos’s knowledge, no illnesses have been reported to date in connection with this recall.

The potential for contamination was noted after the Michigan Department of Agriculture conducted routine testing on a sample of the product in a retail store and advised Krinos of the positive test results. Krinos has ceased distribution of the product as FDA, the Michigan Department of Agriculture, and the company, continue their investigation as to what caused the problem.

Consumers who have purchased the recalled product are urged to discard the product and return the gold cap stamped with the following dates: “EXP JAN 01 – 2014 up to and including EXP JUN 08 – 2014” and EXP OCT 16 – 2014” up to and including “EXP MAR 15 – 2015. Provide proof of purchase for a full refund to:

Krinos Foods LLC 4700 Northern Blvd. Long Island City, NY 11101

If consumers do not have a proof of purchase, Krinos will reimburse them $8.00 per jar plus $.50 for postage.

Consumers with questions may contact the company at (718) 729-9000 between 8:30am and 4:30pm EST.

Please refer to the Previous Press Release¹.

###

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