This document summarizes progress on food safety objectives from 1997-2003. Key points include: - 76 million illnesses, 325k hospitalizations, and 5k deaths occur annually from foodborne disease costing $23 billion. Major pathogens are Campylobacter, Salmonella, E. coli O157:H7, and Listeria. - Rates of major foodborne infections decreased from 1997-2003 except Listeria which showed little change. - Outbreaks of E. coli O157:H7 and Salmonella Enteritidis decreased from 1997-2002 but did not reach 2010 targets. - Antimicrobial resistance in Salmonella increased over 1997-2002 for several drugs but did not meet

1. Focus Area 10
Food Safety
Progress Review
May 11, 2004

2. Production
Preparation
Transportation
Retail
Consumer
Processing
A Framework for Reducing Foodborne Illness through
Prevention
Regulations, Enforcement, and Guidance
Consumption
Distribution
and
Storage
Illness
?
Obj 10-5
Objs 10-6, 7
Objs 10-1, 2,
3, and 4
Education Training Surveillance Research
Food Safety Focus Area Objectives

3. Estimated Annual Burden of
Foodborne Disease
• 76 million illnesses
• 325,000 hospitalizations
• 5,000 deaths
• $23 billion in costs
Source: Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. Food-Related
Illness and Death in the United States. Emerging Infectious Diseases 5(5):607-625. 1999.

4. Burden of Foodborne Diseases Pyramid
Exposure in the general population
Person becomes ill
Person seeks care
Specimen obtained
Culture-confirmed case
Reported to
Health Department/CDC
Lab tests for organism

5. 10-1. Infections caused by key foodborne
pathogens
a. Campylobacter species
b. Escherichia coli O157:H7
c. Listeria monocytogenes
d. Salmonella species
e. Cyclospora cayetanensis
f. Postdiarrheal hemolytic uremic syndrome
g. Congenital Toxoplasma gondii
10-2. Outbreaks of infections caused by key
foodborne bacteria
a. Escherichia coli O157:H7
b. Salmonella serotype Enteritidis
10-4. Deaths from anaphylaxis caused by
food allergies
10-5. Consumer food safety practices
10-7. Human exposure to organophosphate
pesticides from food
Food Safety Focus Area Objectives
Improving Getting worse Little or no change Cannot assess (limited data)
10-3. Isolates of Salmonella species resistant to
antimicrobial drugs from Humans:
a. Fluoroquinolones
b. Third-generation cephalosporins
c. Gentamicin
d. Ampicillin
Cattle, Poultry, or Swine at slaughter
e, i, m. Fluoroquinolones
f, j, n. Third-generation cephalosporins
g, k, o. Gentamicin
h, l, p. Ampicillin
10-6. Safe retail food preparation
a. Hospitals
b. Nursing homes
c. Elementary schools
d. Fast food restaurants
e. Full-service restaurants
f. Deli departments
g. Meat/poultry departments
h. Produce departments
i. Seafood departments

6. 0
5
10
15
20
25
1997 1998 1999 2000 2001 2002 2003
0
5
10
15
20
25
Rate per 100,000 population
Campylobactor species
Salmonella species
Escherichia coli O157:H7
Listeria monocytogenes
2010
Targets
HUS*
Objs. 10-1a-d, f
Major Foodborne Infections, 1997-2003
Note: 2003 data are preliminary. *New measure for postdiarrheal hemolytic uremic
syndrome (HUS) for children under 5 years; target to be determined.
Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies.

7. 0
20
40
60
80
1997 1998 1999 2000 2001 2002
0
20
40
60
80
Escherichia coli O157:H7
Number of outbreaks
Salmonella serotype
Enteritidis
2010 Target for Salmonella serotype Enteritidis
2010 Target for Escherichia coli O157:H7
Objs. 10-2a, b
Source: Foodborne Disease Outbreak Surveillance System, CDC, NCID.
Outbreaks of Infections Caused by
Key Foodborne Bacteria

8. 0
5
10
15
20
1997 1998 1999 2000 2001 2002
0
5
10
15
20
Percent
Ampicillin
2010
Targets
Human Isolates of Non-Typhi Salmonella
Species Resistant to Selected Antibiotics
Fluoroquinolones
Cephalosporins
Gentamicin
Objs. 10-3a-d
Source: National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS-Enteric
Bacteria, CDC, NCID; FDA, CVM; USDA, FSIS, APHIS, and ARS; Foodborne Disease Active Surveillance
Network (FoodNet), CDC, FDA, USDA, and State agencies.

9. • ICD-10 codes for food-induced anaphylaxis were developed
but do not necessarily reflect all allergen-related deaths
• Research indicates expected number of deaths to be
around 125 annually
• Death certificates currently show about 20 deaths annually
• Proposed Midcourse Review modification will add an objective
to measure severe allergic reactions to food among adults with
a food allergy diagnosis
• Proposed baseline is 27% from the Food Safety Survey,
FDA and USDA, FSIS
Reduce Deaths from
Anaphylaxis Caused by Food Allergies
Obj. 10-4

10. 1. Clean – wash hands and surfaces often
2. Separate – don’t cross-contaminate
3. Cook – cook to proper temperatures
4. Chill – refrigerate promptly
FightBAC Campaign
Key Food Safety Practices
R
Obj. 10-5

11. 0
25
50
75
100
Percent
73 76
73
76
70
74 75
2010 Target
Total Black White Female Male Less than High At least
high school some
school graduate college
75 73
75 78
72 75
73
76
71
Consumer Food Preparers Who Follow
Key Food Safety Practices
1998 2001
Source: Food Safety Survey (FSS), FDA; USDA, FSIS. Obj. 10-5

12. 0 20 40 60 80 100
Seafood departments
Produce departments
Meat/Poultry departments
Deli departments
Full-service restaurants
Fast food restaurants
Elementary schools
Nursing homes
Hospitals
Percent
80
82
80
80
60
74
81
76
83
2010
Targets
Retail Food Establishment Employee Food
Safety Practices in Compliance with FDA
Guidelines, 1998
83
73
Source: Retail Food Database of Foodborne Illness Risk Factors, FDA, CFSAN. Objs. 10- 6a-i

13. Progress review data and
slides can be found on the
web at:
http://www.cdc.gov/nchs/hphome.htm