Data (or not) on US Foodborne Illness Due to Imports Dale Morse, - - PowerPoint PPT Presentation

data or not on us foodborne illness due to imports
SMART_READER_LITE
LIVE PREVIEW

Data (or not) on US Foodborne Illness Due to Imports Dale Morse, - - PowerPoint PPT Presentation

Data (or not) on US Foodborne Illness Due to Imports Dale Morse, MD, MS Senior Advisor Collaborative Food Safety Forum: Imports Session July 20, 2011 National Center for Emerging and Zoonotic Infectious Diseases Division of Foodborne,


slide-1
SLIDE 1

Dale Morse, MD, MS

Senior Advisor Collaborative Food Safety Forum: Imports Session July 20, 2011

National Center for Emerging and Zoonotic Infectious Diseases Division of Foodborne, Waterborne, and Environmental Diseases

Data (or not) on US Foodborne Illness Due to Imports

slide-2
SLIDE 2

Increasing Proportion of Specific Food Categories that are Imported

Food Category 1980 1990 2007* Fruit and Nuts 9.7% 29.4% 32.4% Vegetables 4.7% 7.5% 13.6% Fish and shellfish 45.3% 56.3% 84.3% Red Meat 6.6% 8.3% 9.5% Total food consumed 8.2% 11.3% 15.5%

*Jerado USDA/ERS 2007 (2007 estimates are preliminary)

slide-3
SLIDE 3

Based on US Outbreak Data ─ we would expect several of these foods to pose a risk for illness Causes of illness in 1,565 outbreaks

  • f single food

commodities, 2003-2008

slide-4
SLIDE 4

 Best source of information would be outbreak

investigations

 But, how many foodborne outbreaks are linked to

imported foods?

 A question asking if “contaminated food was

linked to imports?,” was added to the NORS form in 1998, but…

  • Information rarely collected, and
  • Rarely reported

Can we say what the risk of Imported Food Is?

slide-5
SLIDE 5

 33 such outbreaks reported  26 bacterial (15 Salmonella, 2 E. coli O157, 9 other

pathogens)

 3 parasitic (2 Cyclospora)  3 viral (Hepatitis A, 2 norovirus)  1 ciguatoxin  13 fresh produce (9 fruit)  7 seafood  7 dairy (all unpasteurized, 6 queso fresco)  3 alfalfa sprouts  17 from Latin America, 2 from Asia/Pacific

US Outbreaks Linked to Imports 1998-2009

slide-6
SLIDE 6

 Source(s) of sporadic illnesses are rarely

determined

 When a food is implicated during an outbreak, the

source of a contaminated ingredient may not be known or obvious

 Illustrative investigations show how helpful this

information can be to prevention activities

However, foodborne illness data regarding imports ─ is incomplete

slide-7
SLIDE 7

Cyclosporiasis: Parasita non grata

 Cyclospora cayetanensis: causes diarrhea / fatigue  1996: 1,465 cases in 20 states, D.C., and Canada

  • At least 55 local outbreaks

 Epidemiologically linked to raspberries grown in

Guatemala

  • New seasonal crop, recently introduced
  • Flown in fresh in the months of May-June

 CDC, FDA, Guatemalan authorities identified a few

possible farm sources (river water used to mix fungicide sprays?)

  • Some changes made in production and processing
slide-8
SLIDE 8

Still more cyclosporiasis…

 1997: More outbreaks linked to Guatemalan raspberries  Spring illness in children of workers identified as

cyclosporiasis, and linked to drinking river water

 Additional steps taken to maximize hygiene, water quality  1998: US ends Imports of raspberries – outbreaks end

Canada continues imports and has outbreaks

 Reservoir remains unknown. Local wild animal or bird?  Ecology of contamination unclear, but the Central American

Highlands are the wrong place to grow raspberries.

Herwaldt 2000 CID 31:1040-57

slide-9
SLIDE 9

Jaundice and Green Onions - 2003

 2003: 4 large outbreaks of hepatitis in

  • Tennessee
  • Georgia
  • North Carolina
  • Pennsylvania

 In all,1,023 cases reported.  In Pennsylvania alone 124 cases hospitalized and

3 died after eating at one restaurant. About 15,000 gamma globulin shots administered.

 Illness in each state linked to eating green onions.

Three closely related strains of the virus, previously seen on the Texas-Mexico border

slide-10
SLIDE 10

Jaundice and Green Onions: Solved?

 Traceback: green onions traced back to several possible

source farms in northern Mexico

 Onsite investigation by FDA, CDC, Mexico

  • Four likely source farms
  • Water used for rinsing and ice of questionable quality
  • Poor sanitation and handwashing facilities
  • Possibility that young children were in contact with

harvested produce

 Solutions:

  • Failsafe potability of water used in packing shed
  • Keep young children away from harvested produce

Amon 2005 JID 192:1323-30

slide-11
SLIDE 11

 51 ill in 26 states, with onset between Jan 10 - March

10, 2008

 Most adults , wide age range, 59% female  Epidemiological investigation: strongly associated with

eating fresh cantaloupe.

 Traceback of cantaloupe to one large grower in

Honduras

 FDA halts imports – steps taken to reduce risk

Salmonella Litchfield and imported cantaloupe - 2008

http://www.cdc.gov/salmonella/litchfield/

slide-12
SLIDE 12

General Observations

 Only a small number of outbreaks are recognized  These “recognized outbreaks”:

  • Often involve produce eaten without cooking
  • Sometimes involve imported ingredients used in a

domestically produced food

  • Are labor intensive and require multiple agencies
  • Require close international collaboration
  • Provide useful information

Foodborne Disease Outbreaks from Imported Foods

slide-13
SLIDE 13

Most of these outbreaks were multistate , but…

 Of 5,696 foodborne outbreaks in 2004-2008:

  • Only 68 or ~1% were multistate
  • 165 or ~3% were multicounty within a state
  • The rest or 96% were from a single county

 Conclusion: Most outbreak data is local

slide-14
SLIDE 14

After all, how hard can it be?...

So why don’t health departments track implicated imported food items to their source?

slide-15
SLIDE 15

Chevy’s Fresh Mex Annapolis, MD Food Co. Laurel, MD Coastal Sunbelt Savage, MD U.S. Food Jessup, MD Edward G. Rahl Jessup, MD Produce Exchange Livermore, CA Parade Produce Jessup, MD Frontora Produce San Antonio, TX Class Produce Group Jessup, MD Sid Goodman Jessup, MD Brandt Produce Edinburg, TX

Chapman Fruit Co. Immokalee, FL Marker 29 Produce Plant City, FL L&M Companies Raleigh, NC Delfino Marketing Plant City, FL Bailey Farms Oxford, NC United Distributors Los Angeles, CA Nogales Central Dallas, TX

Last updated: July 10, 2008

E.A. Parker & Sons Oak Grove, VA Quality Produce Tifton, GA Harvest Central Fresno, CA Sorantino Produce Vineland, NJ Castellair Farms Vineland, NJ C&B Farms Clewiston, FL Cresci Farms Vineland, NJ Voyager Farms Balm, FL Pacific Collier Immokalee, FL McRae Produce Darien, IL Crown Harvest Plant City, FL Leone Produce Minotola, NJ Int’l Trade Marketing Bronx, NY Seminole Produce Sanford, FL Burch Farms Faison, NC

  • G. Cefalu & Bros.

Jessup, MD

  • L. Holloway & Bros.

Jessup, MD

Maryland Food Center Authority

First Fruits & Vegetables Dillsburg, PA The Greenery Philadelphia, PA MOL Produce The Netherlands Ger-Nis Int’l Brooklyn, NY Amco Produce Leamington, ON River Ranch Fresh Foods Los Angeles, CA Pismo-Oceano Veg Exchange Oceano, CA Ger-Nis Int’l Brooklyn, NY Goodson Farms Balm, FL Severt & Sons

  • St. Augustine, FL

Goodson Farms Balm, FL First Class Fruit & Veg Fresno, CA Coastline/Sunridge Farms Salinas, CA The Nunes Co. Salinas, CA Salyer American Fresh Foods Pittsburgh, PA Gowers Express San Francisco, CA Bengard Ranch Salinas, CA Little River Produce Lake Park, GA Moore & Porter Thomasville, GA Fresh Tex Produce Alamo, TX DeLeon Farms Homestead, FL C&D Fruit & Veg Bradenton, FL Six L’s Packing Co. Immokalee, FL Boskovich Farms Los Angeles, CA

Suppliers of jalapenos (April-July 2008)

All jalapeno shipments sold to Edward G. Rahll

slide-16
SLIDE 16

 Health Departments investigate outbreaks, but once a

possible source is indentified, they refer to USDA or FDA for tracebacks

 Thus, it is not a health department responsibility and

could be considered:

  • An unfunded mandate
  • Duplicative of federal responsibility

 Also, State/local Health Departments are on life support

  • 14,000 state job losses
  • 30,000 local job losses

Post script (P.S.) … Whose responsibility is it to do tracebacks of implicated (imported) foods?

slide-17
SLIDE 17

 Clarify traceback responsibility  Streamline traceback process  Improve traceability mechanisms  Improve sharing of traceback information  Monitor international outbreak data  Consider funding sites that are in place, FoodNet or

Outbreak Sentinel sites, to help collect needed information

How do we get better import outbreak data?

slide-18
SLIDE 18

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Questions? CDC Food Safety Site: http://www.cdc.gov/foodsafety/

Division of Foodborne, Waterborne, and Environmental Diseases National Center for Emerging and Zoonotic Infectious Diseases