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TRANSCRIPT
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
