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