new outbreaks new pathogens new responses€¦ · final processing consumption irrigation water,...

New OutbreaksNew PathogensNew Responses

Timothy Jones, M.D.Tennessee Department of Health

Produce Imported from Mexico

0

20

4060

80

100

Cantaloupe Green onion Cucumber Tomato

January-March-Hedberg, CID, 1994

Food Expenditures Away from Home

20

30

40

50

1955 1970 1980 1990 2005

Year

Perc

enta

ge

Food Sources

• Typical meal ingredients from at least 6 countries

• Fresh produce travels ~ 1500 miles

Potential FMD Disease SpreadAfter a simulated terrorist attack at 5 Locations

Day 123456789101112131415161718192021222330

Day 5 Disease First Detected

Potential Impact: Even if a national “stop Movement” of all susceptible animals is ordered on Day 8, by the time the disease is eradicated the nation would lose still 23.6 million animals!

States Infected: 5121519232730333537383940

Industry Concentration

• 3 companies process 70% of poultry

• 78% of beef 2% of feedlots

• Hog plants slaughter > 4 million/yr

• Beef processors > 20,000 a week

Large Foodborne Outbreaks

224,000Salmonella1993US

>6,000E. Coli O1571996Japan

>3,050Norwalk1991Australia

>310,000Hep A1988China

>168,000Salmonella1985US

Outbreaks Per State, 1990-2003

0200400600800

10001200

1 2 3 4 5 6 7 8 9 10 11 12 13

State

Num

ber o

f Out

brea

k

Outbreaks Per State, 1990-2003

0200400600800

10001200

1 2 3 4 5 6 7 8 9 10 11 12 13

State

Num

ber o

f Out

brea

k

90% investigated locally

Foodborne Outbreaks, TN

05

101520253035

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

*

Year

# ou

tbre

aks

82%of foodborne illness is caused

by unknown pathogens !

-Mead, EID, 1999

Outbreaks

Known33%

Unknown67%

Etiology

Known60%

Unknown40%

Vehicle

Why So Many “Unknowns”?

• Not reported in time• Not investigated• Adequate stools not collected• Caused by viruses• Undiscovered pathogens

Emerging Infections, 1940-2004

Outbreaks Account for Small Proportion of Confirmed Illnesses Reported

1999

Outbreaks (2.6%)

Produce from Farm to Table

Production and harvest

Initial processing

Distribution

Final processing

Consumption

Irrigation water, manure, field sanitation

Wash water, handling

Ice, dirty trucks

Washing, handling, cross-contamination

Time and temperature

Your vomiting and diarrhea

is our bread and butter

FoodNet

FoodNet Studies

• Sporadic disease epidemiology– Salmonella– Campylobacter– E. coli O157– Listeria– Infants

FoodNet Studies

• STEC– Epidemiology– Changes with new tests– Risk factors for HUS

• Genetic predisposition

– Serotype-specific risks

FoodNet Studies

• Outbreaks– Changing epidemiology– Norovirus– Salmonella incubation times– Foodhandlers– Specimen collection– Who reports

EHS-Net

• Restaurant outbreaks

• Commodity-specific handling studies

• Contributing Factors

• Waterborne disease

• Complaint reporting

Retail Food Study

• 4 meats

• 40 samples / month

• Bacterial contamination

Food Safety Oversight

• 14 separate federal entities

• Administer >35 separate food safety laws

• 28 congressional committees involved

• >70 MOUs to sort it all out…

WHOFAOPPSAPHDWHAUNEPIUFOSTIUPACWMOOECD

JECFAJMPRJEMRAOIEIPCSINTOXGEMSIAEAOCHAGPHIN

SALMSURVIHRCDCBPROFoodNetNARMSHACCPFDAUSDAFSIS

GSFSGAORCEDDOJFBIOCIFERRETOIGARSOEP

*The Deputy Assistant to the Assistant Deputy Administrator for District Enforcement Operations agreed with this report…

…the current food safety system is a patchwork structure that hampers efforts to adequately address existing and emerging food safety risks…

- GAO report, 2001

CDC• FBDD surveillance• Shigella• Outbreaks• FoodNet• Waterborne

– Drinking– Recreational– ………………………………………..Legionella

• NCEH

CDC• FBDD surveillance• Shigella• Outbreaks• FoodNet• Waterborne

– Drinking– Recreational– ………………………………………..Legionella

• NCEH

Norovirus

Council to Improve Foodborne Outbreak

Response

CIFOR

January 2006

CSTE

Partners• AFDO• APHL• ASTHO• CDC• CSTE• FDA / CFSAN• NACCHO• NEHA• USDA / FSIS

Initial Projects

• Resource clearinghouse

• Multi-jurisdictional investigation guidelines

• Performance indicators

• Investigation guidelines

Clearinghouse

• Questionnaires• Guidelines• Protocols• Training resources• Educational materials• Databases

www.cifor.us

Additional Projects

• Increase availability of training

• Lab / epi reporting integration

• PFGE and cluster evaluation

• National foodborne illness complaint system

• Standard hypothesis generating questionnaires

• Coordination with industry

PFGE Projects

• FoodNet Outbreak Working Group

• CIFOR

• APHL

OutbreakNet

• Foodborne epidemiologists

• All states

• Annual meetings

• Unfunded

Epi-Ready

• Outbreak investigation training

• Multi-disciplinary

• NEHA manages

Communication

• Epi-X

• Foodborne Outbreak List-serve

Other Initiatives

• USDA / FDA meetings

• Trust for America’s Health

• Food Safety Research Consortium

– Food Safety Information Infrastructure

• Regulatory consolidation proposals

• Academia

Tim.f.jones@state.tn.us