This document discusses foodborne illness trends in the United States. It outlines the objectives of describing foodborne illness trends, explaining outbreak investigations and reporting, identifying common agents that cause foodborne illness, and describing how multi-state outbreaks are identified and controlled. It provides data on the top pathogens causing foodborne illnesses and deaths in 2011. It also summarizes the processes for investigating outbreaks at the local, state, and national level through the CDC.

1. FOODBORNE ILLNESS
Food Quality

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By the end of class you should be able to:
– Describe foodborne illness trends in the U.S.
– Explain how outbreaks are investigated and
reported
– Name agents and causes of foodborne illness
– Explain the steps in foodborne illness outbreak
investigations
– Describe how multi-state foodborne illness
outbreaks are identified
– Explain how outbreaks are controlled
Objectives

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Foodborne Illness (FBI)
Outbreaks in the US, 2013
CDC, 2015

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Rates of Foodborne Infection by Year,
1996-2012
CDC, 2011

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Changes in Bacterial Infection Incidence,
2006-2008 to 2012
CDC, 2011

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Top 5 pathogens causing foodborne
illnesses in 2011
CDC, 2011

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Top 5 pathogens causing foodborne-
related deaths in 2011
CDC, 2011

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• aka “Stomach Flu” or “24 hour flu”
• Symptoms: vomiting, diarrhea, stomach cramping lasting for 24
hours
• Onset: symptoms within 12-24 hours after ingesting virus
• Very contagious: found in stool and vomit of infected people
• Spread by not washing hands after using toilet or via aerosolized
vomit
• Very difficult to detect in the lab
• Hand sanitizer does not inactivate!
• *Known cause of FBI 20%; unknown 80% = Norovirus
Norovirus
CDC, 2011

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• Process for local health departments
– Ill persons report to state
– Occurrence of two or more similar illnesses
resulting from ingestion of a common food
• If two or more separate parties report illness from same
establishment, outbreak investigation occurs
• State acquires:
– history of persons who have eaten at establishment
– Employee information
– Employee illness logs
• Local health department performs interviews of ill
persons/all employees
• Collection of stool samples
• Epidemiologic analysis/report by state
– Case-control
Foodborne Illness Outbreak
Investigations
CDC, 2011

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• Process for CDC
– Active surveillance system: Foodborne Illness
Surveillance, Response, and Data Systems
(FoodNet)
– Information collected weekly from clinics in
surveillance areas (10 states)
– Confirmed cases: 10 different foodborne pathogens
– Use samples from confirmed cases to fingerprint
DNA and link cases across the country through
PulseNet (Pulsed-field Gel Electrophoresis)
• National molecular subtyping network for foodborne
bacterial pathogens
Foodborne Illness Outbreak
Investigations
CDC, 2011

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Sliced Tomatoes: Salmonella
CDC, 2011

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• 23 cases (18 confirmed)
• No foodworkers ill prior to cases
• Tomatoes highly significant in ingredient-specific
analysis
• Grown in California
Sliced Tomatoes: Salmonella
CDC, 2011

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CDC, 2011

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CDC, 2011

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1. Purchasing food from unsafe source
2. Failing to cook food adequately
3. Holding food at incorrect temperature
4. Using contaminated equipment
5. Poor personal hygiene
Top 5 CDC Risk Factors for FBI

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• Restaurant inspections (high, med, low)
• Temporary events
• School kitchens
• Plan reviews for new construction
• HACCP audits
• Foodborne illness outbreak investigations
• Food Code
• Critical and non-critical violations
Food safety: health inspection