The Food and Drug Administration (FDA) Ranking of Food Hazards

ranking* 1. microbial contamination 2. naturally occurring toxicants 3. environmental contaminants (e.g., metals 4. nutritional problems (i.e., malnutrition, undernutrition) 5. pesticide residues 6. food additives
*1 being most dangerous, 6 least dangerous

Definitions
Foodborne disease is any illness resulting from the consumption of food contaminated with one or more disease-producing agents. These include bacteria, parasites, viruses, fungi and their products as well as toxic substances not of microbial origin.

Infection Intoxication Metabolic food disorder Allergy Idiopathic illness

Risks perception vs. reality

What is the likelihood that you will die of foodborne illness?
Deaths per year from selected causes in the United States (NCHS, 1986) All causes 2,105,361 Ischemic heart disease 520,729 All cancers 476,106 Heart attack (acute myocardial infarction 261,002 Motor vehicle accidents 47,885 Diabetes mellitus 37,184 Chronic liver disease and cirrhosis (alcohol not mentioned) 13,867 Firearm assaults, including handguns 13,029 Falling (accidental) 11,444 Chronic liver disease and cirrhosis (alcoholic) 11,060 Choking on a piece of food 3,692 Firearm accidents, including handguns 1,452 Intestinal infectious diseases 466 A one-in-a-million risk of death in the U.S. in 1986 242 Salmonella infections 102 Lightning 78 Botulism 3

Outbreaks vs. Cases

Foodborne disease outbreak: an incident in which two or more persons experienced a similar illness after ingestion of a common food, and epidemiologic analysis implicated a food as the source of illness.

Foodborne disease case: one individual experiences illness after ingestion of an epidemiologically incriminated food.

Estimates of the yearly incidence of foodborne illness

The estimates vary greatly but thought to be around 76 million cases per year Cost estimates range from $523 billion per year High cost due to many factors: medical care, investigation of illness, loss of productivity, loss of business, legal activities

Infection

Definition: a disease state caused by the presence of viable, usually multiplying organisms at the site of inflammation Bacteria - Salmonella, Campylobacter Virus - hepatitis A, Norwalk virus Protozoa - Cryptosporidium, Cyclospora other parasites - Trichinella spiralis

Intoxication

Definition: a disease state, caused by exposure to a toxic chemical, that is not mediated immunologically and is not primarily the result of a genetic deficiency. Staphylococcal food poisoning, botulism Saxitoxin, ciguatera

Foodborne Diseases

Infections

Intoxications

Toxicoinfection

Invasive Infection

Chemical Poisoning

Poisonous Plant Tissues

Poisonous Animal Tissues

Microbial Intoxications

Other

Neurotoxins

Enterotoxins

Intestinal Mucosa Mycotoxins (Fungal Toxins) Algal Toxins Bacterial Toxins

Systemic

Other Tissues or Organs (Muscle, Liver, Joints, Fetus, Other)

Diarrhogenic

Emetic

Enterotoxins

Neurotoxins

Other

Foodborne Diseases Intoxications Infections

Toxicoinfection

Invasive Infection

Other

Neurotoxins

Enterotoxins

Intestinal Mucosa

Systemic

Other Tissues or Organs (Muscle, Liver, Joints, Fetus, Other)

Foodborne Diseases Intoxications Infections

Chemical Poisoning

Poisonous Plant Tissues

Poisonous Animal Tissues

Microbial Intoxications

Mycotoxins (Fungal Toxins)

Algal Toxins

Bacterial Toxins

Diarrhogenic

Emetic

Enterotoxins

Neurotoxins

Other

Examples of foodborne infections/intoxications

Disease Reservoir

Botulism food intoxication

Campylobacteriosis Clostridium perfringens food poisoning Salmonellosis Staphylococcal food poisoning Vibrio parahaemolyticus infection Yersinia enterocolitica infection

Soil contaminated foods

Cattle, poultry, shellfish Soil contaminated foods Animals and birds Human carriers Seafoods Animal intestines

Metabolic food disorder

Definition: a disease state caused by exposure to a chemical that is toxic to certain individuals only because they exhibit some genetic deficiency lactose intolerance favism

Allergy

Definition: a disease state caused by exposure to a particular chemical that (often proteinaceous) to which certain individuals have a heightened sensitivity (hypersensitivity) that has an immunological basis proteins (heat resistant and resistant to digestion) cows milk: b-lactoglobulin, casein, etc. egg-ovalbumin small molecules penicillin

Idiopathic illness

Definition: any illness of uncertain pathogenesis that may possibly but not certainly be due to foods; also, any food-caused illness that does not fit into one of the other categories Chinese restaurant syndrome celiac disease hyperkinesis

Objectives of foodborne disease surveillance

prevention and control: identification of contaminated products knowledge of disease causation: observe the track record of various illnesscausing agents administrative guidance: assessment of trends to justify regulatory decisions/actions

Information reported to and compiled by the Centers for Disease Control (CDC)
Outbreaks of known etiology = where laboratory evidence indicated a specific agent

Outbreaks of unknown etiology = where epidemiological evidence implicated foodborne transmission, but the etiological agent was not identified. 4 subgroups based on incubation period: < 1 hr = probable chemical poisoning 1 7 hr = probable Staphylococcus aureus poisoning 8 14 hr = probable Clostridium perfringens food poisoning > 14 hr = probably other infectious/toxic agents Outbreaks of known vehicle = a particular food item was associated with the illness

Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology United States, 19931997
Outbreaks No. (%) 655 (23.8) 148 19 56 (5.4) (0.7) (2.0) Cases No. (%) 43,821 (50.9) 576 2,325 4,066 (0.7) (2.7) (4.7) Deaths No. (%) 28 (96.6) 0 0 0 28 1 (0) (0) (0) (96.6) (3.4)

Bacterial Chemical Parasitic Viral Confirmed etiology Unknown etiology

878 (31.9) 1,873 (68.1)

50,788 (59.0) 35,270 (41.0)

Total 19931997

2,751 (100.0)

86,058 (100.0)

29 (100.0)

ex MMWR Table 1, Vol. 49/No. SS-1, p. 11 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4901a1.htm

Estimated illnesses for known foodborne pathogens, United States

Disease or agent Estimated total cases

Bacteria
Parasites Viruses Grand Total

5,204,934
2,541,316 30,883,391 38,629,641

ex Mead, P. S., L. Slutskaer, V. Dietz, L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V. Tauxe. Food-related illness and death in the United States. Emerging Infectious Diseases 5(5):607625 (1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm

Top Twelve Factors Contributing to 345 Outbreaks of Foodborne Disease Caused by Mishandling and/or Mistreatment of Foods in Homes in the U.S., 19731982 Ranking 1. 2. 3. 4. 5. Contributing Factor Percent* Contaminated raw food/ingredient 42.0 Inadequate cooking/canning/heat processing 31.3 Obtained food from unsafe source 28.7 Improper cooling 22.3 Lapse of 12 or more hours between preparing and eating 12.8 6. Colonized person handling implicated food 9.9 7. Mistaken for food 7.0 8. Improper fermentations 4.6 9. Inadequate reheating 3.5 10. Toxic containers 3.5 11. Improper hot holding 3.2 12. Cross-contamination 3.2 *Percentage exceeds 100 because multiple factors contribute to single outbreak

The World Health Organizations Golden Rules for Safe Food Preparation
Choose foods processed for safety Cook food thoroughly Eat cooked foods immediately. Store cooked foods carefully. Reheat cooked foods thoroughly. Avoid contact between raw and cooked foods. Wash hands repeatedly. Keep all kitchen surfaces meticulously clean. Protect foods from insects, rodents, and other animals. 10. Use pure water. 1. 2. 3. 4. 5. 6. 7. 8. 9.

The future and foodborne illness

Demographics Human behavior changing Technology changing Global market

Populations sensitive to foodborne disease

Pregnant women Neonates Elderly (over 65) Residents in nursing home or related care facilities Cancer patients (nonhospitalized) Organ transplant patients AIDS patients

The aging population

450

Numbers of people (in millions)

400 350 300 250 200 150 100 50 0

65 years of age 392

263

276

1995

2000

2050

Year

Population
Earths increasing population 1900 1.7 billion people 1998 6.0 billion people 2050 8.2 billion people (medium population projection)

Future water usage

Competition between agriculture, industry, and personal households. Modern agriculture accounts for 7080% of water usage.