P1246990957CTRfL

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"Food the Environment" Berkeley,
California September 22-26, 2002
Food Safety Modern Food Production
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Conclusions

• Foodborne illnesses are still common.
• Are these warning signsYES...
• that the system is breaking down? No
• How well does our food safety regulation system
  work?
• How well do you want it to work?

3
Food Safety Regulation System

• Diagnosis
• CDC, State, Local Health departments
• Disease Surveillance
• Disease Investigation,
• Including outbreaks
• Recommendations

• Write the Rx
• Manage the Patient
• FDA/USDA/States/
• Industry
• Food Policy
• Inspection Enforcement

4

• Causes of Death, United States, 1900

PERCENT
5

• Causes of Death, United States, 1992

6
Infectious Disease Mortality, United States,
1900-1996
Armstrong et al, JAMA 1999
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It is time to close the book on the problem of
infectious diseases. (1969) Jesse Steinfeld,
MD, U.S. Surgeon General, 1969-73
The future of infectious diseases will be very
dull. (1972) Macfarlane Burnet, 1960 Nobel
Prize Winner In Medicine
Told students that there were no new diseases to
be discovered. (1976) Lewis Thomas, Dean Yale
Medical School
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Examples of Pathogenic Microbes Identified Since
1973

• 1973 Rotavirus
• 1977 Ebola virus
• 1977 Legionella pneumophila
• 1980 Human T-lymphotrophic
• 1981 Toxin-producing Staph aureus
• 1982 Escherichia coli O157H7
• 1982 Borrelia burgdorferi
• 1983 HIV
• 1983 Helicobacter pylori

• 1989 Hepatitis C Virus
• 1992 Vibrio cholerae O139
• 1993 Hantavirus Virus
• 1994 Cryptosporidium
• 1995 Ehrlichiosis
• 1996 nvCJD Prion
• 1997 HVN1 Virus Influenza
• 1999 Nipah Virus

Source US Institute of Medicine, 1997 WHO,
1999.
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• Emergence of non-typhoid Salmonella
• Reported infections USA, 1920-1997

CDC, National surveillance data
50
45
40
35
Typhoid
30
25
Incidence per 100,000 population
20
15
10
5
0
Years
1920
1930
1940
1950
1960
1970
1980
1990
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Emergence of Foodborne Pathogens

• 1900
• Botulism
• Brucellosis
• Cholera
• Hepatitis
• Scarlet fever (streptococcus)
• Staphylococcal food poisoning
• Tuberculosis
• Typhoid fever
• 1942
• Staphylococcus aureus
• Salmonella
• Clostridium botulinum
• Streptococci

• 1975-1995
• Norwalk-like viruses
• Campylobacter jenjuni
• Salmonella Enteritidis
• Shiga toxin-producing E. coli O157H7, O111NM,
  O104H21
• Listeria monocytogenes
• Clostridium botulinum (infant)
• Vibrio cholerae 0139
• Vibrio vulnificus
• Yersinia enterocolitica
• Arcobacter butzleri
• Hepatitis E
• Cryptosporidium parvum
• Giardia lamblia
• Cyclospora cayetanensis
• Toxoplasma gondii
• BSE prion
• Nitzchia pungens (dinoflagellate)

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• Factors influencing emergence

Host factors Microbe factors Environment
factors
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• Host factors

• Increased numbers of susceptible persons
• Aging , HIV infection, immunosuppressive drugs,
• Changing eating habits
• Dietary, "fast food, eating out,
• Improved surveillance detection

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• Microbe factors

• Evolution of new pathogens
• Norwalk-like virus low dose, no immunity
• E. coli O157H7 - Acid tolerant
• Listeria Yersinia - Refrigeration tolerant
• Antibiotic resistance
• Microbes appear 3.5 Billion years ago
• Man appears 130,000 years ago in Africa

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• Environment factors

• Changes in food production
• . . .e.g., botulism
• Globalization of food supply
• Centralized production
• CAFOs Manure glut

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Factors influencing emergence

• Food industry

• Changes in food preservation
• decreased use of secondary barriers
• e.g. botulism from chopped garlic, soup, and
  cheese sauce
• New products new processes
• Sprouts
• Hazelnut yogurt change from sugar to aspartame
  in hazelnut yogurt ------ botulism

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Imported Food Consumption on the RiseSource
USDA Agricultural Research Service
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Source of Fresh Frozen Imported Produce,
1997by Dollar Value Source USDA Economic
Research Service
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Top Twenty in 2000 Line Entries of foods, food
related products, dietary supplements and
cosmetics
1. Canada 6. Italy 11. South Korea 16. The
Philippines 2. Mexico 7. UK 12. Spain 17.
Indonesia 3. France 8. Netherlands 13.
Chile 18. Ecuador 4. China 9. Germany 14.
Taiwan 19. Ireland 5. Japan 10.Thailand 15.
India 20. Costa Rica
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Recent Outbreaks from Imported Foods

• Cyclospora raspberries Guatemala '96 '97
• Hepatitis A strawberries Mexico '97
• lettuce Mexico '88
• cheese Mexico '96
• Salmonella sp. cheese Mexico '96
• alfalfa sprouts Netherlands '95
• snack food Israel '94
• cantaloupe Mexico '89 '91
• Shigella sp. green onions Mexico '94
• Vibrio cholerae coconut milk Thailand '91
• crab meat Ecuador '91

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Mass production distribution
U.S. Broiler Production Number of Farms, 1975-95
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(No Transcript)
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• Mass production distribution

• 215 (65) of 331 tested patient isolates from 23
  states matched by PFGE
• 675 cases were reported to PHLIS
• 432 cases (64) over expected baseline

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• Examples of large, multi-state outbreaks

• 1985 Salmonella in whole low fat milk 16,000
  cases in 6 states
• 1993 E. coli 0157 in hamburger 700 cases,
  4 died in four states.
• 1994 Salmonella in ice cream 224,000 ill
  in 41 states
• 1995 S. Stanley in Alfalfa sprouts 242 ill in
  17 states
• 1996 Cyclospora imported raspberries 1000
  ill, 22 hospitalizations
• 1997 E. coli 0157 alfalfa sprouts 108 ill
  in 2 states
• 1998 Listeria in hotdogs 100 ill, 21
  deaths in 21 states
• 1999 Salmonella Orange Juice 360 ill in 16
  states and Canada
• 2000 Norwalk-like virus pasta salad 333 ill
  in 13 states

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Number of multi-state outbreaks, 1990-1999
Source Foodborne Outbreak Reporting
System http//www.cdc.gov/ncidod/dbmd/outbreak/us_
outb.htm
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Concentrated Animal Feeding Operations(CAFOs)
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US Manure Estimates, 1997

• Animal Solid Waste (tons / year)
• Cattle 1,229,190,000
• Hogs 112,652,300
• Chickens 14,394,000
• Turkeys 5,425,000
• Total 1.37 billion tons of manure

Democratic Staff Report, US Senate Agriculture
Committee (1998) Animal Waste Pollution in
America, An Emerging National Problem
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The Manure Glut

• 5 tons of animal manure/person/year
• 130 times greater than amount of human waste
• Whats in manure?
• Bacteria, viruses, protozoa
• Chemicals (nitrates, aerosols, antibiotics)
• Other (algae)

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Potential Exposure

• Leakage from storage lagoons
• Surface water
• Ground water
• Application to fields
• Runoff into ground water or surface water
• Direct effect on crops

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E. coli O157

• Scotland (JE Coia et al, J. Infect 36317, 1998)
• Handling / preparing raw food (40)
• Gardening / garden play (36)
• Lived on / visited farm (20)
• Direct / indirect contact with manure (17)
• Private H20 supply (12)
• Recent high coliform counts in H20 supplies (12)

• USA FoodNet Case-control studies
• pink hamburger
• farm animals

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Uses of antimicrobial agents in agriculture

• Food animals
• Therapy of infection
• Disease prevention
• Growth promotion
• Orchards
• Sprayed in orchards for treatment/prevention
• streptomycin and oxytetracycline

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Resistant Campylobacteriosis in Humans due to
Fluoroquinolone Use in Chickens

• Quinolone-Resistant Campylobacter jejuni
  Infections in Minnesota, 19921998 Smith K. E.,
  et al, N Engl J Med 1999 3401525-1532, May 20,
  1999.

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Is the system breaking down?
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• Burden of Foodborne Disease, 21st Century

• Estimated 76 million cases
• resulting in 323,000 hospitalization 5000
  deaths each year in the U.S.
• 1 in 4 Americans will develop a foodborne
  illness
• 1 in 1000 will be hospitalized
• Cost an estimated 6.5 billion per year
• CDC Annual budget

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Infections Associated with Food, 1900 vs 2000

• 1900s
• Botulism
• Brucellosis
• Cholera
• Hepatitis
• Scarlet fever (streptococcus)
• Staphylococcal
• Tuberculosis
• Typhoid fever

• 2000
• Norwalk-like viruses
• Campylobacter
• Salmonella
• Clostridium perfringens
• Giardia lamblia
• Staphylococcal
• Toxoplasma gondii
• Shigella
• Yersinia enterocolitica
• E coli O157H7

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Most common causes of foodborne IllnessMead et
al, 1999
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Deaths due to Foodborne Illness
Salmonella
31.0
Listeria
28.0
21.0
Other
5.0
E. coli 0157
3.0
Campylobacter
5.0
Norwalk-like
7.0
Toxoplasmosis
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• Reported non-typhoid Salmonella infections USA,
  1920-1997

Years
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2001 FoodNet Data

• 23 percent overall drop in 7 bacterial foodborne
  illnesses since 1996.
• 27 Campylobacter
• 15 Salmonella
• 35 Listeria
• 49 Yersinia
• "Preliminary FoodNet Data on the Incidence of
  Foodborne Illnesses -- Selected Sites, United
  States, 2001" Morbidity Mortality Weekly Report
  (April 19, 2002) http//www.cdc.gov/mmwr/. 

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How well does our food safety regulation system
work?

• How well do you want it to work?

40
Tip of the iceberg
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Number of Foodborne Outbreaks by Etiology,1999
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• Est. Foodborne Illnesses (thousands) by etiology,
• Mead et al, 1999

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Average Annual of FB Outbreaks by State, 1988 -
92
VT 1 NH 2 MA 13 RI 0 CT 3
NJ 19 DE 2
MD16 DC 1
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Thank you
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Wide variation by Health District in outbreak
detection, Georgia, 2000
Outbreaks/1,000,000 pop 0 1-4 5-9 10
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How well does our food safety regulation system
work?

• We are not losing the war.
• Microbes rapidly adapt through biologic
  evolution, transfer of genes.
• Microbes appear 3.5 Billion years ago
• Homo sapien adapt through cultural evolution,
  transfer of information.
• The World is counting on you to pass down the
  lessons of civilization to this and future
  generations
• Once you start, you cant stop

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How well does our food safety regulation system
work?

• Meat and Poultry Better USDA Oversight and
  Enforcement of
• Safety Rules Needed to Reduce Risk of Foodborne
  Illnesses. 
• GAO-02-902  August 30, 2002
• http//www.gao.gov/new.items/d02902.pdf

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Foodborne syndromes

• Diarrhea, nausea, vomiting
• (Norwalk Virus, Campylobacter, Salmonella et al)
• Renal failure E. coli 0157H7
• Arthritis Salmonella, Shigella, Yersinia
• Paralysis Clostridium botulinum, Campylobacter
• Miscarriage Listeria
• Birth defects Toxoplasma gondii

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• Addressing Food Hazards

• Heating (1.9 million years Homo erectus)
• Drying (e.g., noodles 300 BC China 1st Century
  AD Rome)
• Freezing
• Chemical preservatives (salting, spice, smoking)
• Fermentation (e.g., beer Mesopotamia Egypt)
• Bottling Nicolas Appert, 1790s
• Canning Peter Durand, 1810

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• Addressing Food Hazards in the 20th century

• Disease monitoring, Outbreak detection
  investigation (1911?)
• Inspection regulation (Meat Inspection Act,
  1906)
• Water chlorination (Jersey City, NJ, 1908)
• Pasteurization, (by law, Chicago, 1908)
• Safe canning (1920s)
• Refrigeration hygienic processing additives
  preservatives
• Public Information Education
• Medical advances antibiotics, vaccines

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Campylobacter

• FoodNet Case-control
• Foreign travel
• Undercooked poultry
• Turkey or chicken cooked outside the home
• Other meat cooked outside the home
• Raw milk
• Raw seafood
• Living on or visiting a farm
• Contact with farm animals
• Contact with puppies
• C. Friedman et al, Intl Conf Emerging Infect.
  Diseases, 2000

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Cryptosporidiosis in Minnesota

• Swimming in public pools (e.g. hotel or school)
• Drinking Well H20
• Visting a farm
• Living on a farm age
• Not living on farm, but with exposure to cattle
  and to manure
• D Soderlund et al, Intl Conf Emerging Infect.
  Diseases, 2000