Effect Measure

It would be surprising if failure to fund local public health and neutering regulation would result in a decrease in foodborne illness. Alas, there is nothing surprising about CDC’s latest report on incidence of foodborne illness in the US. They put the best face on it they could, pointing to a decrease in E. coli O157H7 cases, but they’ve seen that kind of progress in E. coli before only to slip back.

In reality we aren’t sure how much food poisoning occurs each year. Most of it is self-limited and never comes to the attention of medical or public health authorities. It never gets counted. More serious cases may or not be recognized as foodborne. CDC has a Foodborne Diseases Active Surveillance Network (FoodNet) within its Emerging Infections Program which conducts active surveillance in 10 states, counting lab confirmed cases for specific intestinal agents often transmitted via food. Foodnet provides an estimate for the incidence (“risk”) of lab confirmed foodborne illness per capita for various enteric pathogens going back to 1996:

FoodNet surveillance data for 2009 show reductions in the incidence of STEC O157 [E. coli] and Shigella infections, but little or no recent progress for other pathogens. Of the four infections with Healthy People 2010 targets (Campylobacter, Listeria, Salmonella, and STEC O157), only the target for STEC O157 was met in 2009 [but also briefly met in 2004]. Salmonella infections declined slightly in 2009. A modest increase in the incidence of Listeria infection is a concern; however, the incidence of Listeria infection continues to be substantially lower than at the start of FoodNet surveillance in 1996. Continued increase in the incidence of Vibrio infection points to a need for improved prevention measures. Shigella is often transmitted directly from person-to-person, so food safety measures might not relate to the decrease in shigellosis.

To optimally prevent foodborne illness, the routes of exposure to these pathogens must be understood better so that additional targeted control measures can be developed, even as U.S. food consumption patterns and food industry processes evolve. FoodNet studies have demonstrated associations between illness and consumption of foods such as undercooked ground beef, chicken, and eggs. Recent outbreak investigations have identified novel food and nonfood vehicles, including jalapeno peppers, peanut butter–containing products, raw cookie dough, and direct contact with baby chicks, turtles, and African dwarf frogs (CDC, Morbidity and Mortality Weekly Reports).

Using Foodnet data things seem to have gotten better since counting began in 1996, but this is still a guess since most of foodborne illness goes uncounted in ways that are probably only crudely reflected in lab confirmed data. Real progress will depend on adequate regulation and enforcement of interstate food producers and food and restaurant inspection by local public health. While we might expect some progress at the federal level, state and local agencies are so squeezed by the bad economy and inadequate support that I doubt things will improve much. They might even deteriorate.

The only saving grace is that without being able to count it or recognize it, we’ll never know how bad it it is.

Comments

  1. #1 Farmer
    April 17, 2010

    Revere,

    Although this surveillance is conducted under a foodborne disease program, don’t forget that many of these pathogens (STEC, Shigella, Campylobacter, Salmonella, Cryptosporidium, etc.) may also be waterborne.

    As our national public drinking water infrastructure continues to degrade, and municipal water treatment systems are squeezed by a combination of degrading water quality and lack of funding, we may find that a larger proportion of these infections are ultimately attributable to contaminated drinking water.

  2. #2 revere
    April 17, 2010

    Farmer: You are correct. That’s why I was careful to say in the post “specific intestinal agents often transmitted via food.”

  3. #3 MoM
    April 17, 2010

    An article headlined at the bottom of the food quality news article you linked points to a story about a Produce Safety Project report by Robert Scharff estimating the overall cost of foodborne illness at a staggering $152 Billion per year. To get there, he includes the cost of “pain and suffering”, which I find problematic. Even without that padding, he comes up with over $100B a year. The link in the article to the whole report is broken, but the Pew Trust has it here: http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Produce_Safety_Project/PSP-Scharff%20v9.pdf?n=1136

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