patterns and trends in foodborne illness · 3/5/2017  · • 4,364 illnesses in these tfe or...

PATTERNS AND TRENDS IN FOODBORNE ILLNESS

CASA's 101st Annual Educational and Training Seminar

Saratoga Springs, New York

May 3, 2017

Jack Guzewich

OVERVIEW

• Acknowledgements

• Foodborne disease surveillance

• Sporadic case trends

• Outbreak trends

• Trends in investigation and response

ACKNOWLEDGEMENTS

• State, local, tribal and territorial government agencies

• Federal government agencies particularly CDC

• NoroCore

• PubMed

FOODBORNE DISEASE SURVEILLANCE

STATE AND LOCAL ROLES

• Surveillance:

• laboratory

• epidemiology

• complaints

• Detection

• Investigation

• Response

• Most outbreaks are detected, investigated and reported by state and local agencies

4

SPORADIC CASE SURVEILLANCE

FOODNET

FOODBORNE DISEASES ACTIVE SURVEILLANCE NETWORK—2 DECADES OF

ACHIEVEMENTS, 1996–2015

ANNUAL ILLNESS ESTIMATES – DOMESTICALLY-ACQUIRED1

Agent Illnesses Deaths

Norovirus 5,462,000 149

Salmonella 1,026,000 378

Cl. perfringens 966,000 26

Campylobacter 845,000 76

Staph aureus 241,000 6

Shigella 131,000 10

STEC non-O157 113,000 0

1. Scallan E. EID 2011, 17(1):7-15

OUTBREAK SURVEILLANCE

RESTAURANT ASSOCIATED OUTBREAKS

NUMBER OF OUTBREAKS RETAIL OUTBREAKS AND TOTAL OUTBREAKS, 1998 - 2008

TOP 10 FOOD LOCATION OF PREPARATION SETTINGS*, 1998–2008

*Outbreaks may be counted more than once due to multiple preparation settings listed

Total Number of Outbreaks 1998-2008 With At Least One Preparation Location Listed: 12,903

Total Number of Outbreaks 1998-2008 With Retail-Setting Location Listed: 10,739

TOP 10 SINGLE ETIOLOGIES, RETAIL OUTBREAKS 1998–2008

TOP 10 SINGLE FOOD COMMODITIES, RETAIL OUTBREAKS 1998–2008

Complex food 2161/2561

Undetermined 1157/1355

TOP 10 CONTAMINATION FACTORS, RETAIL OUTBREAKS~, 1998–2008

~Outbreaks may be counted more than once due to multiple contamination factors

TOP 10 PROLIFERATION FACTORS, RETAIL OUTBREAKS, 1998–2008

~Outbreaks may be counted more than once due to multiple contamination factors

TOP 5 SURVIVAL FACTORS, RETAIL OUTBREAKS, 1998–2008

~Outbreaks may be counted more than once due to multiple contamination factors

MANUFACTURED FOODS & PRODUCE

REPORTED OUTBREAKS LINKED TO FDA-REGULATED FOODS BY VEHICLE, 1996-2013

(N=615 OUTBREAKS)

REPORTED OUTBREAKS LINKED TO FDA-REGULATED FOODS, BY AGENT, 1996-2013

(N=615 OUTBREAKS)

REPORTED ILLNESSES LINKED TO FDA-REGULATED FOODS, BY VEHICLE, 1996-2013

(N=37,687 ILLNESSES)

REPORTED ILLNESSES LINKED TO FDA-REGULATED FOODS, BY AGENT, 1996-2013

(N=37,687 ILLNESSES)

TYPES OF PRODUCE ASSOCIATED WITH ILLNESSES,

1996-2013 (N=15,253)

Bacterial

101 (81%)

E. coli O157:H7

34 (94.4%)

Shigella

2 (2.0%)

Salmonella

61 (48.8%)

Leafy Greens - 31

Herbs - 1

Melon - 1

Herbs- 1

Tomatoes - 18

Melons - 15

Other- 10

Berries - 2

Leafy Greens - 5

Agents associated with produce outbreaks

1996-2013 (n=125)

Nut- 1

E. coli

36 (35.6%)

Melon - 1

Other [celery] - 1

Nut- 4

Unknown- 7

Listeria monocytogenes

2 (2.0%)

E. coli O145

2 (5.6%) Leafy Greens - 2

Other [cucumber] - 1

Cyclospora

19 (100%)

Squash - 1

Berries - 8

Herbs - 4

Unknown- 1

Leafy Greens - 3

Other Produce - 3

Agents associated with produce outbreaks,

1996-2013 (n=125); continued

Pomegranate arils - 1

Viral

4 (3.2%)

Hepatitis A

4 (100%)

Parasitic

19 (15.2%)

Toxin

1 (0.8%)

PRODUCE ASSOCIATED OUTBREAKS, 1996-2013 (N=125)

• Of the 125 produce-associated outbreaks, the source of the produce included:– Imported product (29; 23.2%)

• 55.2% was a product from Mexico• 34.5% were from Central and South America• 3.4% was from Canada• 6.9% was from Turkey

– Unknown (29; 23.2%)– Inconclusive (18; 14.4%)– Domestic (49; 39.2%)

Produce-associated outbreaks, 1996 – 2013;

domestic source of vehicle

< 4

4 - 18

> 18

21

2

1

7; 3?

2 1

1

2; 1?

1

2; 1?

4; 2?

1?

1?

2?

OUTBREAKS OF DISEASE ASSOCIATED WITH FOOD IMPORTED INTO THE UNITED STATES,

1996–2014

OUTBREAKS ASSOCIATED WITH NONPASTEURIZED MILK, BY ETIOLOGIC

AGENT AND YEAR, UNITED STATES, 2007–2012

RAW MILK OUTBREAKS BY STATE

OUTBREAKS ATTRIBUTED TO CHEESE: DIFFERENCES BETWEEN OUTBREAKS CAUSED

BY UNPASTEURIZED AND PASTEURIZED DAIRY PRODUCTS, UNITED STATES, 1998-2011

TEMPORARY & MOBILE FOOD OUTBREAKS

REPORTED US FOODBORNE DISEASE OUTBREAKS

• 17,339 reported foodborne disease outbreaks 1998 – 2013

• 129 outbreaks linked to TFE or mobile food

• 4,364 illnesses in these TFE or mobile outbreaks and no deaths

AGENTS

33%

19%10%

5%

5%

5%

23%

Percent of Outbreaks With A Reported Agent

Salmonella-40

Norovirus-23

STEC-12

Campylobacter-6

Scombrotoxin-6

Staph-6

Other-27

VEHICLES

0 5 10 15 20 25 30 35 40 45

Unknown-42

Pork-12

Shellfish-11

Beverage-10

Beef-10

Fish-7

Starhy foods-5

Outbreaks

Outbreaks

ORGANIC FOODS

• Consumption of organic foods increasing

• 18 outbreaks 1992 – 2014

• 779 illnesses, 258 hospitalizations, 3 deaths

• 56% of outbreaks were between 2010 and 2014

• Salmonella in 44% of outbreaks

• E coli O157:H7 in 33% of outbreaks

• 8 produce, 4 unpasteurized dairy, 2 eggs, 2 nut and seed

• 83% likely or definitely USDA certified

NOROVIRUS

CULTURE OF NOROVIRUS:UNIVERSITY OF HOUSTON MED SCHOOL

BURDEN OF NOROVIRUS IN THE US

SEASONALITY

NEW YORK STATE TRENDS

41

62

160

102

159

143142

155

120

146

126

107115

63

79 81

9789

76

58

74

6055

38

62 58

84

53 53

3846

5348

57

42 46

0

50

100

150

200

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

Nu

mb

er

of

Ou

tbre

aks

Reporting Year

Updated 01/2017 - Preliminary data: Not for distribution without permission from BCEHFP

Number of Foodborne Outbreaks,

New York State 1980 – 2015

TOP 10 CONTRIBUTING FACTORS IDENTIFIED IN FOODBORNE OUTBREAKS, NEW YORK

STATE 2001-2015

30

37

39

40

41

41

57

70

110

126

391

0 100 200 300 400 500

Inadequate reheating

Hand contact w/ implicated food

Inadequate hot holding

Inadequate refrigeration

Improper cooling

Inadequate cooking

Natural toxicant

Infected person

Contaminated ingredient

Unknown

Number of Times CF was Identified

Consumption: Raw/ lightly heated

(animal origin)

Updated 01/2017 - Preliminary data: Not for distribution without permission from BCEHFP

Co

ntr

ibu

tin

g F

acto

r (C

F)

SPECIFIC CONTRIBUTING FACTORS IDENTIFIED IN BACTERIAL OUTBREAKS, NEW

YORK STATE 2001-2015121

107

54

3935 35

26 26 24

13 126 6 4

0

20

40

60

80

100

120

140

Contaminated Ingredients Unknown

Inadequate cooking Consumption: Raw/ lightly heated (animal origin)

Inadequate hot-holding Inadequate cooling

Inadequate reheating Inadequate refrigeration

Prep several hours before Infected person

Cross contamination Hand contact with implicated foods

Unclean equipment Other

508 of Contributing Factors identified in 311 Bacterial OutbreaksUpdated 01/2017 - Preliminary data: Not for distribution without permission from BCEHFP

SPECIFIC CONTRIBUTING FACTORS IDENTIFIED IN VIRAL OUTBREAKS, NEW YORK

STATE 2001-2015

7977

22

6

0

10

20

30

40

50

60

70

80

90

Infected person

Unknown

Hand contact with implicated

foods

Other

183 Contributing Factors identified in 160 Viral Outbreaks

Updated 01/2017 - Preliminary data: Not for distribution without permission from BCEHFP

ENVIRONMENTAL ASSESSMENT (ROOT CAUSE ANALYSIS)

NATIONAL ENVIRONMENTAL ASSESSMENT REPORTING SYSTEM (NEARS)

• Identify environmental causes of outbreaks in your jurisdiction.

• Take follow-up action to reduce or prevent future foodborne illness outbreaks.

• Evaluate your food safety program and make improvements based on

established guidelines.

• Develop or modify program policies or regulations.

• Focus limited program resources on actions with the highest impact.

COLLABORATIVE IMPLEMENTATION OF FMSA WORKSHOP ON ROOT-CAUSE

ANALYSIS

• Develop a common understanding around root-cause analysis, including:

• o Definition and core componentso Value and expectations for improving food safety

• - Identify potential areas for improving root-cause analysiso What makes a successful root-cause analysis?o What are common challenges and how they can be overcome?

• - Extract more value from future root-cause analyseso Examine approaches to overcoming common challenges to sharing lessons learned

• from root-cause analysiso Propose additional next steps/actions

SUMMARY

• Foodborne Disease continues to be a significant public health problem

• Public health interventions can make a difference, but we still have a long way to go

• Norovirus is the leading cause of foodborne illness -restaurants

• Bacterial agents are the most common ones in FDA and USDA regulated foods

• Listeria will continue to be a problem as our population ages

• Produce will continue to be a significant vehicle

• Environmental Assessments will highlight the root causes that will need to be addressed