Foodborne infections and intoxications edited by j glenn morris, jr , morris e potter

Contents List of Contributors ...xxiii Preface ...xxix Preface to the Third Edition ...xxxi Dedication ...xxxiii SECTION 1 FOODBORNE DISEASE: EPIDEMIOLOGY AND DISEASE BURDEN CHAPTER 1 Es

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Foodborne Infections

and Intoxications

Fourth Edition

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Contents

List of Contributors xxiii

Preface xxix

Preface to the Third Edition xxxi

Dedication xxxiii

SECTION 1 FOODBORNE DISEASE: EPIDEMIOLOGY AND DISEASE BURDEN CHAPTER 1 Estimates of Disease Burden Associated with Contaminated Food in the United States and Globally 3

Elaine Scallan, Martyn Kirk, and Patricia M Griffin Introduction 3

Estimates of foodborne disease in the United States 4

Major known pathogens 4

Unspecified agents 9

Estimation in other countries 11

Global efforts 13

Methodological considerations 14

Conclusions 15

References 16

CHAPTER 2 The Foods Most Often Associated with Major Foodborne Pathogens: Attributing Illnesses to Food Sources and Ranking Pathogen/Food Combinations 19

Michael B Batz Introduction 19

Integrated measures of disease burden 19

Methods of foodborne illness source attribution 20

Analysis of US outbreak data for food source attribution 24

Assessing the applicability of outbreak-derived attribution estimates 26

Ranking pathogen/food combinations 27

Acknowledgments 30

References 30

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CHAPTER 3 Microbial Food Safety Risk Assessment 37

Anna Lammerding Introduction 37

Background 38

Managing microbial food safety risks 42

The risk assessment framework 43

Hazard identification 43

Exposure assessment 43

Hazard characterization 44

Risk characterization 45

Risk assessment approaches 45

Summary 49

References 49

CHAPTER 4 Development of Risk-based Food Safety Systems for Foodborne Infections and Intoxications 53

Julie A Caswell Introduction 53

Building blocks for a risk-based food safety system 54

Elements of a risk-based food safety system 55

Step 1: Strategic planning 55

Step 2: Public health risk ranking 58

Step 3: Targeted information gathering and consideration of other factors 59

Step 4: Analysis and selection of interventions 60

Step 5: Design of intervention plans 61

Step 6: Monitoring and review 61

The overall risk-based decision process 61

Challenges in implementing risk-based food safety systems 61

Summary 62

References 63

SECTION 2 FOODBORNE INFECTIONS: BACTERIAL CHAPTER 5 Pathogen Updates: Salmonella 67

Tine Hald Introduction 67

The disease in man 67

Symptoms and sequelae 67

Incidence and burden of human salmonellosis 68

Epidemiology and disease transmission in humans 71

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Microbiology 72

Classification 72

Characterization and virulence 73

Typing methods for tracing the sources of human infections 73

Source attribution: approaches and discussion of studies 75

Source attribution using microbial subtyping 75

Source attribution using outbreak data 79

Source attribution using systematic review of case-control studies 82

Other approaches for source attribution 83

Discussion of sources of human salmonellosis 86

Prevention and control 88

Prevention and control at the farm level 89

Control and prevention post harvest 90

Conclusions 90

References 91

CHAPTER 6 Clostridium perfringens Gastroenteritis 99

Ronald G Labbé and V.K Juneja Introduction 99

Clinical features 99

Symptoms associated with foodborne illness 99

Mode of action of C perfringens enterotoxin 99

Microbiology 100

Taxonomy 100

Location of CPE 100

Factors affecting growth 101

Growth during cooling 101

Sporulation 102

Enterotoxin formation during sporulation 102

Spore heat resistance 103

Spore germination 103

Detection of the organism and enterotoxin 103

Molecular methods 105

Exposure pathways 106

Reservoirs 106

Points of entry 106

Infectious dose 106

References 107

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CHAPTER 7 Vibrios 113

Anita C Wright and Valerie J Harwood Introduction 113

Disease manifestations 113

Host susceptibility 115

Microbiology 116

Genetics and evolution of pathogenic Vibrios 116

Diagnosis and species identification 118

Detection of virulence factors 119

Molecular and genomic typing 119

Reservoirs and entry into the food supply 120

Approaches to food attribution 121

Hazard analysis of critical control points 121

Vibrio monitoring 121

Post-harvest processing 122

Conclusions 122

References 122

CHAPTER 8 Escherichia coli 129

Teresa Estrada-Garcia, Kim Hodges, Gail A Hecht, and Phillip I Tarr Introduction 129

Enterohemorrhagic E coli (EHEC) 130

Clinical features of EHEC infections 131

Microbiology of EHEC infections 131

Exposure pathways for EHEC infections 132

Prevention and control of EHEC infections 133

Enterotoxigenic E coli (ETEC) 134

Clinical features of ETEC infections 134

Microbiology of ETEC infections 134

Exposure pathways for ETEC infections 135

Prevention and control of ETEC infections 136

Enteropathogenic E coli (EPEC) 136

Clinical features of EPEC infections 138

Microbiology of EPEC infections 138

Exposure pathways for EPEC infections 139

Prevention and control of EPEC infections 139

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Enteroaggregative E coli (EAEC) 139

History 139

Clinical features of EAEC infections 140

Microbiology of EAEC infections 141

Exposure pathways for EAEC infections 143

Prevention and control of EAEC infections 143

Enteroinvasive E coli (EIEC) 143

Clinical features of EIEC infections 144

Microbiology of EIEC infections 144

Exposure pathways for EIEC infections 144

Prevention and control of EIEC infections 145

Diffusely adhering E coli (DAEC) 145

Clinical features of DAEC infections 145

Microbiology of DAEC infections 145

Exposure pathways for DAEC infections 145

Prevention and control of DAEC infections 146

The 2011 Escherichia coli O104:H4 outbreak 146

Acknowledgments 147

References 148

CHAPTER 9 Campylobacter 165

Guillermo Ignacio Perez-Perez and Sabine Kienesberger Introduction 165

The acute clinical illness 165

Sequels of infection 167

Genetics, characteristics and evolution 168

Diagnosis and identification 169

Diagnosis 169

Identification 170

Typing schemes 170

Exposure pathways—risk factors for human illness 171

Poultry consumption 171

Commercially prepared foods 172

Unpasteurized milk 172

Water 173

Zoonotic transmission 173

Foreign travel 173

Treatment indication and antimicrobial usage 173

Point of entry into the food supply and prevention 174

Processing controls 174

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Food handling 175

Zoonosis prevention 175

Food 175

Milk and water 176

Other Campylobacter species 176

C lari 176

C fetus subspecies fetus 176

C hyointestinalis 177

C upsaliensis 177

Acknowledgments 177

References 177

CHAPTER 10 Yersinia 187

Truls Nesbakken Introduction 187

Clinical features of illness associated with infection in humans 187

Impact of host susceptibility on occurrence of illness 188

Microbiology 188

Phenotypic characterization 188

Yersinia pseudotuberculosis 188

Characteristics of Y enterocolitica and Y pseudotuberculosis including genetics and evolutionary considerations 189

Approaches to diagnosis and identification 189

Reservoirs 190

Infectious dose, pathogenesis, and immunity 192

Y pseudotuberculosis 192

Occurrence in animals 193

Water and vegetables 193

General control aspects connected to survival and growth of Y enterocolitica 193

Control in the meat chain 194

Control of milk and dairy products 195

Drinking water and vegetables 195

Animal contact 196

Y pseudotuberculosis 196

References 196

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CHAPTER 11 Listeria 199

Siyun Wang and Renato H Orsi Introduction 199

Microbiological characteristics of Listeria spp .199

Nature of infection in man and animals 202

Risks of Listeria monocytogenes contamination 203

Listeria monocytogenes as a high risk in ready-to-eat (RTE) foods 203

Prevalence of Listeria monocytogenes in foods 203

Quantitative microbiological risk assessment (QMRA) of L monocytogenes in RTE foods 205

Persistence of Listeria monocytogenes in processing environments 206

Prevention and control of listeriosis 208

Detection of Listeria spp and L monocytogenes 208

Subtyping of L monocytogenes 209

Prevention and treatment of listeriosis 209

Concluding remarks 210

References 210

CHAPTER 12 Shigella 217

Benjamin Nygren and Anna Bowen Introduction 217

Clinical features of illness associated with infection 217

Microbiology 218

References 221

CHAPTER 13 Streptococcal Disease 223

J Glenn Morris, Jr. Introduction 223

Clinical presentation 223

Streptococcal pharyngitis 223

Foodborne streptococcal disease 224

Microbiology 225

References 226

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CHAPTER 14 Aeromonas and Plesiomonas 229

Christopher J Grim Introduction 229

Gastroenteritis 229

Extraintestinal infections 230

Microbiology 231

Aeromonas 231

Virulence factors of Aeromonas spp 231

Aeromonas spp and clinical syndrome 232

Isolation of Aeromonas 232

Plesiomonas shigelloides 232

Isolation of P shigelloides 233

Food attribution 234

References 235

CHAPTER 15 Brucellosis 239

Morris E Potter Introduction 239

Microbiology 241

Acknowledgments 249

References 249

CHAPTER 16 Cronobacter Species (formerly Enterobacter sakazakii) 251

B.D Tall, C.J Grim, A.A Franco, K.G Jarvis, L Hu, M.H Kothary, V Sathyamoorthy, G Gopinath, and S Fanning Introduction 251

Clinical features of illness associated with infection 251

Microbiology 252

General features 252

Thermoresistance properties 252

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Isolation and identification 252

Species-specific identification 253

Serotyping 253

Virulence mechanisms 253

References 255

SECTION 3 FOODBORNE INFECTIONS: VIRAL CHAPTER 17 Noroviruses 261

Melissa Jones and Stephanie M Karst Introduction 261

Disease manifestations 261

Genetic diversity 263

Epidemiology 263

Microbiology 265

Norovirus diagnostics 265

Reservoirs 266

Points of entry and movement from farm to fork 267

Food processing to eliminate noroviruses 269

Advances in norovirus vaccination and development of therapeutics 271

References 271

CHAPTER 18 Hepatitis A 279

Umid M Sharapov Introduction 279

Microbiology 280

References 283

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CHAPTER 19 Hepatitis E 287

Eyasu H Teshale Introduction 287

Microbiology 288

References 290

CHAPTER 20 Astroviruses as Foodborne Infections 293

Erik A Karlsson and Stacey Schultz-Cherry Introduction 293

Clinical features of illness 293

Microbiology 293

Diagnosis/Detection 295

References 298

CHAPTER 21 Rotavirus 303

Paul A Gastañaduy, Aron J Hall, and Umesh D Parashar Introduction 303

Age distribution 304

Clinical presentation 304

Microbiology 304

Rotavirus structure 304

Rotavirus classification 305

Strain prevalence 305

Diagnosis 305

Immunity 306

Endemic childhood rotavirus disease 308

Foodborne rotavirus disease 308

References 309

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CHAPTER 22 Sapovirus 313

Aron J Hall, Ben A Lopman, and Jan Vinjé Introduction 313

Microbiology 314

References 318

SECTION 4 FOODBORNE INFECTIONS: PARASITES AND OTHERS CHAPTER 23 Toxoplasma gondii 323

Marieke Opsteegh, Joke van der Giessen, Titia Kortbeek, and Arie Havelaar Introduction 323

Toxoplasmosis 323

Congenital toxoplasmosis 323

Acquired toxoplasmosis 324

Microbiology 325

Life cycle 325

Genetic variation 327

Subtyping 327

Sources of infection 327

Source attribution 328

Primary prevention 330

Secondary prevention 331

References 332

CHAPTER 24 Mycobacterial Species 337

Michael J Dark Introduction 337

Microbiology 338

References 340

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CHAPTER 25 Trichinella 343

Heather Stockdale Walden Introduction 343

Biology of Trichinella 345

From farm to fork 349

Control and prevention 349

References 350

CHAPTER 26 Food Safety Implications of Prion Disease 353

Alan J Young and Jürgen A Richt Introduction 353

Microbiology 356

References 362

SECTION 5 INTOXICATIONS CHAPTER 27 Clostridium botulinum 371

Kathleen Glass and Kristin Marshall Introduction 371

Characteristics of the disease 371

Botulism 371

Diagnosis of botulism 373

Microbiology 373

Characteristics 373

Genetics and evolutionary considerations 375

BoNT structure and function 376

Isolation and identification of C botulinum and botulinum neurotoxins 377

Reservoirs 378

Infectious dose 379

Food attribution 380

Spore destruction 381

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Growth inhibition 382

References 384

CHAPTER 28 Staphylococcal Food Poisoning 389

Mariza Landgraf and Maria Teresa Destro Introduction 389

The microorganism 390

Staphylococcal enterotoxins 391

Detection of S aureus and enterotoxins 394

Factors influencing growth and survival 395

Reservoirs 396

Outbreaks 396

Conclusions 397

References 397

CHAPTER 29 Bacillus cereus 401

Tarek F El-Arabi and Mansel W Griffiths Introduction 401

Clinical features of Bacillus cereus food poisoning 401

Bacillus cereus diarrheal syndrome 401

Bacillus cereus emetic syndrome 402

Characteristics of Bacillus cereus 403

Growth and survival 403

Identification of Bacillus cereus 404

Presence of B cereus in foods 404

Treatment and prevention 405

References 405

CHAPTER 30 Mycotoxins 409

John I Pitt Introduction 409

Aflatoxins 409

Health effects 409

Fungal species producing aflatoxins 411

Aflatoxin formation in crops and its control 411

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Ochratoxin A 412

Health effects 412

Fungal species producing OTA 413

Control of OTA formation in crops 414

Fumonisins 414

Health effects 414

Fungal species producing fumonisins 415

Control of fumonisin formation in crops 415

Deoxynivalenol (DON) 415

Health effects 415

Fungal species producing DON 416

Control of DON formation in crops 416

Zearalenone 416

Health effects 416

Fungal species producing zearalenone and control 416

Methodology in mycotoxin detection 416

References 417

CHAPTER 31 Seafood Intoxications 419

Lynn Grattan, Sailor Holobaugh, and J Glenn Morris Introduction 419

Ciguatera fish poisoning (CFP) 420

Diagnosis, clinical symptoms, and treatment 424

Paralytic shellfish poisoning (PSP) 425

Neurotoxic shellfish poisoning (NSP) 426

Amnesic shellfish poisoning (ASP) 427

Diarrheic shellfish poisoning (DSP) 428

Tetrodotoxin poisoning/puffer fish poisoning 428

Scombroid poisoning 429

Prevention of seafood intoxication 430

References 431

References related to Figure 31.1 (all accessed on 1/24/2012) 434

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CHAPTER 32 Plant Toxins 435

Ahmed Mohamed Galal Osman, Amar G Chittiboyina, and Ikhlas A Khan Introduction 435

Alkaloids 436

Pyrrolizidine alkaloids 436

Tropane alkaloids 440

Quinolizidine alkaloids 441

Glycoalkaloids 442

Pyrimidine alkaloids 443

Cyanogenic glycosides 444

Glucosinolates and isothiocyanates 445

Furanocoumarins 446

Conclusion 447

References 447

SECTION 6 POLICY AND PREVENTION OF FOODBORNE DISEASES CHAPTER 33 Effects of Food Processing on Disease Agents 455

Alfredo C Rodriguez Introduction 455

Food processing 456

Hazard analysis and critical control point (HACCP) 457

Drying 457

Refrigeration 458

Freezing 458

Canning—sterilization and pasteurization 458

Trimming and cleaning 459

Fermentation 459

Nixtamalization 459

Measurement of the microbial population density 459

Relationship between the microbial population density and the probability of failure 460

Initial population density or bioburden 462

Reduction of the population density 468

Inactivation 469

Calculation of the population density 471

Cleaning 474

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Post-process growth 476

Conclusion 477

References 477

CHAPTER 34 Food Safety Post-processing: Transportation, Supermarkets, and Restaurants 479

Richard H Linton and David Z McSwane Introduction 479

Transportation of food 480

Food safety risks and preventive measures during transportation 481

Retail and food service 481

Food safety risk factors for food service, restaurant, and retail food establishments 481

The Conference for Food Protection 486

The FDA Food Code 486

Food safety management programs for transportation, retail, and food service 487

Good manufacturing practices (GMPs) 489

Good retail practices (GRPs) 489

Risk-based inspections 491

Global food safety initiative 492

FDA Food Modernization Act 493

Education, training, and food safety culture 493

References 494

CHAPTER 35 HACCP and Other Regulatory Approaches to Prevention of Foodborne Diseases 497

Neal D Fortin Introduction 497

Hazard Analysis and Critical Control Point (HACCP) 498

Pre-HACCP implementation of systems control 498

HACCP implementation 499

HACCP implementation for seafood 499

HACCP implementation for raw juice 500

HACCP implementation for meat and poultry 501

HACCP for retail food establishments 502

FSMA and new science-based, preventive controls 503

Mandatory risk-based preventive controls 503

Mandatory produce safety standards 505

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Contaminant-specific, science-based performance standards 506 Inspection and compliance 507Some points about compliance 507 Prerequisites neglect 508 Preparing a risk control plan 508 Verification, validation, and monitoring 509 Conclusion 509

References 510

CHAPTER 36 The Legal Basis for Food Safety Regulation

in the USA and EU 511

Caroline Smith DeWaal, Cynthia Roberts, and David Plunkett

Introduction 511

Early food laws in the United States 511 The advent of federal regulation 512Meat, poultry, and eggs 513 The federal meat inspection acts 513 Additional legislation for meat, poultry, and eggs 514Non-animal products, dairy, and seafood 515 The Pure Food and Drugs Act 515 The Food, Drug, and Cosmetic Act (FDCA) 515 Dairy 516 Seafood 517Pesticides and food additives 517 The Federal Insecticide, Fungicide and Rodenticide

Act (FIFRA) 518 The Food Quality Protection Act (FQPA) 518

A modern food safety system 520 Hazard Analysis and Critical Control Points (HACCP) 520 The 2011 FDA Food Safety Modernization Act 521Development of food safety law in the European Union 522 European food law from the Middle Ages to today 522 Food safety crises 1990–2002 and modern developments 523 Elements of European food law 523 Challenges for European food law 524 References 525

Index 529

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List of Contributors

Anna Bowen

Division of Foodborne, Waterborne, and Environmental Diseases, Centers for

Disease Control and Prevention, Atlanta, GA, USA

Department of Infectious Diseases and Pathology, College of Veterinary

Medicine, University of Florida, FL, USA

Maria Teresa Destro

Department of Food and Experimental Nutrition, Faculty of Pharmaceutical

Sciences, University of Sao Paulo, Sao Paulo, Brazil

Caroline Smith De Waal

Center for Science in the Public Interest, Washington, DC, USA

UCD Centre for Food Safety, WHO Collaborating Centre for Research,

Reference, and Training on Cronobacter, School of Public Health,

Physiotherapy & Population Science, UCD Veterinary Sciences Centre,

University College Dublin, Belfield, Dublin, Ireland

Neal D Fortin

Institute for Food Laws and Regulations, Michigan State University,

East Lansing, MI, USA

A.A Franco

U.S Food and Drug Administration, Laurel, MD, USA

Paul A Gastañaduy

Epidemic Intelligence Service, Centers for Disease Control and Prevention,

Atlanta, GA, USA; National Center for Immunization and Respiratory Diseases,

Centers for Disease Control and Prevention, Atlanta, GA, USA

Kathleen Glass

Food Research Institute, University of Wisconsin, Madison, WI, USA

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xxiv List of Contributors

Center for Food Safety and Applied Nutrition, U.S Food and Drug

Administration, Laurel, MD, USA

Tine Hald

National Food Institute, Technical University of Denmark

Aron J Hall

National Center for Immunization and Respiratory Diseases, Centers for

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Department of Food and Experimental Nutrition, Faculty of Pharmaceutical

Sciences, University of Sao Paulo, Sao Paulo, Brazil

Richard H Linton

College of Agriculture and Life Sciences, North Carolina State University,

Raleigh, NC, USA

Ben A Lopman

Norwegian School of Veterinary Science, Department of Food Safety and

Infection Biology, Norway

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xxvi List of Contributors

Department of Food Science, Cornell University, Ithaca, New York, USA

Ahmed Mohamed Galal Osman

The University of Mississippi, MS, USA

Umesh D Parashar

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

Guillermo Ignacio Perez-Perez

Department of Medicine, NYU Langone Medical Center, New York, NY, USA; Department of Microbiology, NYU Langone Medical Center, New York, NY, USA

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Joke van der Giessen

RIVM, Utrecht, the Netherlands

Jan Vinjé

Heather Stockdale Walden

Infectious Diseases and Pathology, University of Florida, FL, USA

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Preface

Foodborne Infections and Intoxications was first published in 1969, under the

editor-ship of Hans Riemann In the intervening 44 years there have been two additional editions, published in 1979 (2nd edition, edited by Hans Reimann and Frank Bryan) and 2006 (3rd edition, edited by Hans Reimann and Dean Cliver) These texts have provided an outstanding scientific resource for multiple generations of students, investigators, and food safety practitioners, and have documented our changing understanding of and approach to food safety through almost half a century

With this edition the editorship has passed on, shifting from University of California (Davis) to University of Florida (and FDA/CDC) The focus has also evolved: The current edition places a strong emphasis on estimates of disease bur-

den, and development of risk-based approaches to food safety and food safety

regu-lation There remain traditional chapters on each of the major pathogens, but with

an expansion to include newly recognized agents (particularly viral agents), and a focus in each “agent” chapter on understanding how the pathogen is introduced into the food supply The microbiology is presented, but in the context of public health and disease prevention

Development of a comprehensive text of this type is a major undertaking, and

we are deeply indebted to our 72 authors, from three continents, who contributed their expertise to this task We hope that this text will prove as useful to the cur-

rent generation of food safety students and practitioners as have the prior editions, providing an ongoing, and intellectually challenging, resource for development of strategies to prevent human disease

J Glenn Morris, Jr

Morris E Potter

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Preface to the Third Edition

A quarter of a century has passed since the second edition of Foodborne Infections and Intoxications was published Significant discoveries and developments have taken place during this time, and many journal articles and several books dealing with foodborne pathogens have been published Some important foodborne patho-

gens (e.g noroviruses, enterohemorrhagic Escherichia coli) were unknown at the time of the second edition, and organisms such as Yersinia and Campylobacter were not conclusively proven to be foodborne

In this third edition of Foodborne Infections and Intoxications, experts present updated accounts of the known characteristics of the most important foodborne path-

ogens, including their host ranges and the characteristics of the diseases they cause The present volume also has a completely revised chapter on the epidemiology of foodborne diseases, with emphasis on investigation procedures, and a new chapter

on risk assessment has been added The chapter on the effects of food-processing procedures has been expanded to include a number of newer techniques, and the chapter on food safety presents a detailed discussion of hazard analysis-critical con-

trol points (HACCP) as a tool to assure safety Four new chapters have been added,

on E coli, Campylobacter and related organisms, Yersinia, and Listeria, in addition

to a chapter on other natural toxins (not including mycotoxins)

Much new information about the detection and identification of foodborne

path-ogens has been presented in books and articles in recent years Still, about half the reported foodborne disease outbreaks in countries like the US have no identified agent Without doubt many of these outbreaks are caused by viruses, which sug-

gests a need for virus-detection procedures that can be applied by laboratories

rou-tinely charged with testing of suspect food samples Since sampling and testing per

se do not prevent foodborne disease outbreaks, there is also a need for research to develop effective interventions against common foodborne diseases and methods to assure the implementation of such interventions; the last two chapters of the book address this need

There is, furthermore, a need for better setting of research priorities on

food-borne diseases; some diseases, like human prion diseases, are so rare that even a

90 per cent reduction in incidence would have negligible public health significance The chapter on risk assessment describes an important tool for setting priorities

The editors especially thank the authors for contributing their vast expertise to this book

Hans RiemannDean Cliver

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The current edition is dedicated to Hans Reimann, Frank Bryan, and Dean Cliver, who shepherded this text through three editions across almost half a century All three were giants in the field of food safety, and their commitment and dedication to science, public health, and food safety stand as an outstanding example to those of us who follow in their footsteps.

At a personal level, we would also like to dedicate this text to our wives and families, who have provided unswerving support through our careers They have tolerated the long hours (and the use of laptops at home during evenings and week- ends to edit yet one more document), and we thank them for their valuable input, patience, and understanding.

J Glenn Morris, Jr.Morris E Potter

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1 Estimates of Disease Burden Associated with Contaminated Food in the

United States and Globally 03

2 The Foods Most Often Associated with Major Foodborne

Pathogens: Attributing Illnesses to Food Sources and Ranking

Pathogen/Food Combinations 19

3 Microbial Food Safety Risk Assessment 37

4 Development of Risk-based Food Safety Systems for Foodborne

Infections and Intoxications 53

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Foodborne Infections and Intoxications.

Estimates of Disease

Burden Associated with

Contaminated Food in the

Elaine Scallan, 1 Martyn Kirk, 2 and Patricia M Griffin 3

1 Colorado School of Public Health, Aurora, CO, USA, 2 The Australian National University,

Canberra, ACT, Australia, 3 Enteric Diseases Epidemiology Branch, Division of Foodborne,

Waterborne, and Environmental Diseases, Centers for Disease Control and

Prevention, Atlanta, GA, USA

these agents For example, Escherichia coli O157:H7 infections may be acquired

by ingesting contaminated food or water or by direct contact with infected animals

or persons Third, a fraction of illnesses are confirmed by laboratory testing and reported to public health agencies and most surveillance systems do not attempt to determine the proportion of infections that are transmitted through food Finally, unknown or unrecognized agents are likely to cause an important additional frac-

tion of illnesses due to contaminated food Indeed, many important foodborne

path-ogens, such as Campylobacter and E coli O157, were only recognized in recent

decades [1,2]

Surveillance for laboratory-confirmed infections provides essential information for assessing trends in diseases and detecting outbreaks Information derived from surveillance may assist regulatory efforts to prioritize and evaluate interventions However, because only a fraction of illnesses are diagnosed and reported, periodic assessments of the total number of illnesses, including those that are not labora-

tory-confirmed, are also needed to help set public health goals, allocate resources, and measure the economic impact Several countries, including Australia, the Netherlands, the United Kingdom, and the United States, have conducted

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4 CHAPTER 1 Estimates of Disease Burden

prospective population-based or cross-sectional studies to supplement surveillance and estimate the overall human health impact of foodborne disease [3] In 2006, the World Health Organization (WHO) convened a meeting of foodborne disease experts that recommended the formation of the Foodborne Disease Epidemiology Reference Group (FERG) to advise WHO about how to estimate the global burden

of foodborne disease [4] The FERG began estimating the global burden of borne disease in 2007

food-The purpose of this chapter is to describe the methods used by various countries

to estimate the burden of foodborne disease We begin by describing estimates of foodborne illness in the United States and then compare these methods and esti-mates with those in some other countries We also discuss the WHO FERG initia-tive to estimate the global burden of foodborne disease

Estimates of foodborne disease in the United States

In 2011, the US Centers for Disease Control and Prevention (CDC) published new estimates of the numbers of foodborne illnesses caused by contaminated foods con-sumed in the United States (hereafter, domestically acquired foodborne illnesses) [5,6] Together, major known pathogens and unspecified agents transmitted by food were estimated to cause 47.8 million illnesses each year, resulting in 127,839 hospi-talizations and 3037 deaths (Table 1.1)

Major known pathogens

Data from surveillance, surveys, and other sources were used to estimate the ber of domestically acquired foodborne illnesses, hospitalizations, and deaths caused by 31 major known pathogens, including 21 bacterial, 5 viral, and 5 para-sitic pathogens (see Table 1.1) [6] These known pathogens were estimated to cause 9.4 million (90% credible interval [CrI]: 6.6–12.7 million) domestically acquired foodborne illnesses, 55,961 hospitalizations (90% CrI: 39,534–75,741), and 1351 deaths (90% CrI: 712–2268) each year Norovirus was estimated to cause the most

num-foodborne illness (58%), while nontyphoidal Salmonella spp was the leading cause

of hospitalization (35%) and death (28%) Seven pathogens—Campylobacter spp.,

Clostridium perfringens , E coli O157, Listeria monocytogenes, nontyphoidal

Salmonella spp., norovirus, and Toxoplasma gondii—were estimated to cause 90%

of domestically acquired foodborne illnesses, hospitalizations, and deaths due to the major known pathogens

Estimating illness using the “burden-of-illness pyramid”

Most known pathogens had laboratory-based surveillance data available; therefore, the total number of illnesses was estimated using the “burden-of-illness pyramid” approach (Figure 1.1) Several steps are necessary for an illness to be included in laboratory-based surveillance: the ill person must seek medical care, a specimen

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Table 1.1 Estimated Annual Number of Illnesses, Hospitalizations, and Deaths Caused by Major Known Pathogens and Unspecified Agents Transmitted

by Food (United States) [5,6].

Category

Total—All Transmission Sources a Domestically Acquired—Foodborne Transmission

d NA = not available.

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