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New CDC estimates for foodborne illnesses caused by "unspecified agents"
Posted on December 15, 2010 by Drew Falkenstein
How safe is our food? Put another way, how much illness in the United States is caused by foodborne pathogens? It sounds like a simple question. Getting a reasonable answer, however, is far from simple. The basic problem lies in the fact that only a small fraction of foodborne disease cases get reported through official (or unofficial) reporting systems. Calculating the “real” rate of foodborne illness requires development of models that use reported cases as a starting point to estimate underlying disease rates. Given the plethora of pathogens that can be transmitted through foodborne routes, this is a complex, and somewhat daunting, process. It is, however, necessary for assessing the safety of foods and developing strategies for disease prevention.
Morris JG Jr., "How safe is our food?," Emerg Infect Dis. 2011 Jan
The CDC has again undertaken the difficult task of tallying the annual incidence of foodborne disease. Today, CDC announced two studies on the subject; one for 31 major foodborne pathogens, and another that assesses incidence, hospitalization, and deaths caused by foodborne transmission of "unspecified agents." Combined, the known pathogens and unspecified agents cause approximately 47.8 million foodborne illnesses, 127,839 hospitalizations, and 3,037 deaths per year.
These studies follow the 1999 study by Mead et al., which found, using some similar and some different methodologies and classifications as the current studies, that known and unknown foodborne pathogens caused approximately 76 million cases of foodpoisoning annually, 325,000 hospitalizations, and 5,000 deaths.
The "unspecified agents" study pertains to "agents that cause acute gastroenteritis but that were not included in our estimate of foodborne illness caused by 31 major known pathogens." More specifically, "unspecified agents" includes (1) illnesses likely caused by one of the major known pathogens, but where there was insufficient data for an agent-specific diagnosis; (2) known agents not yet recognized as causing foodborne illness; (3) microbes, chemicals, or other substances known to be in food but for which pathogenicity is unproven; and (4) agents not yet described.
The study finds that, of the 47.8 million total annual cases of foodpoisoning in the US, "unspecified agents" account for 38.4 million illnesses, 71,878 hospitalizations, and 1,686 deaths.
The study states that the approximate 33% decrease in the number of illnesses due to nspecified agents since Mead's 1999 study, which found approximately 62 million illnesses annually, is likely not due to any decrease in the actual rate of illness. The current study used a 24% lower estimate for "gastroenteritis" than the 1999 Mead study, excluding illnesses where a concurrent cough or sore throat was reported, where less than 3 episodes of diarrhea or loose stools were reported in a day, and where people reporting vomiting had been ill for less than 1 day or whose illness did not result in restricted daily activities (the1999 estimate included all persons with vomiting).

Salmonella-free eggs: it can be done
Posted on December 15, 2010 by Drew Falkenstein
Pockets in other parts of the world have been producing salmonella free eggs for years. The egg industry here in the US, however, took a big shot to the jaw this year after theWright County Egg recall and outbreak, which sickened approximately 1,900 with confirmed salmonella illnesses (and untold thousands with unconfirmed illnesses). But a release today proves that the manufacture of salmonella free eggs can happen even here at home. The State of Maine, which has among the most stringent requirements nationally with regard to flock and egg safety, is Salmonella free.
Under provisions of the new Egg Safety Rule adopted in July by the U.S. Food and Drug Administration, federal inspectors recently completed a month-long inspection of Maine’s major commercial egg farms. Routine testing of chicken feces found that no positive test results for Salmonella enteriditis were identified, according to an announcement on Wednesday by Maine's Department of Agriculture.
Conditions at the Wright County Egg farm stand in stark contrast to Maine's successes. They collectively show how lack of any attention at all to the infestation and spread of disease can cause a national public health crisis.
Maine got there by paying attention, both by producers and regulators, to building a disease-free flock, examining sources of feed and other raw materials, and taking steps to make sure that the salmonella stayed out. According to an article by Meg Haskell at the Bangor Daily News, "In the more than 20-year history of the Maine program, there have not been any human salmonella illnesses traced to Maine eggs, which are shipped throughout the eastern United States."
Maine’s program contains provisions which are more stringent than the FDA Egg Safety Rule, including that all egg-laying hens be double-vaccinated against salmonella; that birds are blood-tested six to eight weeks after vaccination to assure the vaccine was correctly administered; and that buildings are inspected monthly to assess rodent control. Hoenig said the success of the program demonstrates the importance of the collaborative effort among the state, the testing labs at the University of Maine in Orono and egg farmers.
The FDA estimates that as many as 79,000 illnesses and 30 deaths due to consumption of eggs contaminated with Salmonella enteriditis may be avoided each year through implementation of the new federal rule.

CDC defends itself over mad cow case
ALLEGATIONS:Critics say a man who died in May began treatment for CJD symptoms in 2008, but his case was not publicized for fear it would stir up opposition to US beef
By Shelley Huang, Shih Hsiu-chuan and Vincent Y. Chao / Staff Reporters
The Centers for Disease Control (CDC) yesterday defended its decision not to publicize a case of suspected death from mad cow disease by saying that the cause of death had not been confirmed.
Late on Wednesday, the CDC responded to media reports that a 36-year-old Taiwanese man who spent eight years in the UK died in May from what appeared to be mad cow disease.
The man was in the UK from 1978 to 1986. In 2008, he began to develop symptoms resembling that of Creutzfeldt-Jacob disease (CJD) such as memory loss and hypersomnia, and was reported as a suspected CJD case in March last year, the CDC said. However, the mans family refused to provide tissue for testing or to give permission for an autopsy, making it difficult to confirm the cause of death.
Based on his symptoms and his MRI and EEG records, a medical team has determined this was extremely likely” to be a CJD case.
However, the announcement came only after media outlets had already broken the news. The health authorities were heavily criticized for delaying reporting a serious infectious disease.
The Consumers’ Foundation, which has opposed imports of US beef parts that are at risk of spreading mad cow disease, criticized the CDC, saying it told bold-faced lies by saying there had been no cases of CJD from 1997 to May 29.
The foundation accused the CDC of covering up the information even though it was fully aware of the case to prevent hindrances to importing US beef, which the foundation called “malfeasance to an extreme.
A trade agreement on US beef imports signed in October last year was widely criticized by health professionals and consumer groups, who said at the time that Taiwan had no facilities to deal with a possible outbreak of the disease. The legislature in January barred US ground beef, beef offal and other beef parts such as skulls, eyes and intestines from entering the market.
“The toxin has an incubation period of as long as seven years, so without symptoms or signs of the disease, it is very difficult to prevent and there is no cure for the disease,” Chen Sheng-shun (???), vice president of the Chang Gung Memorial Hospital Kaohsiung Branch, said yesterday.
Democratic Progressive Party (DPP) lawmakers also accused the Department of Health of failing to make public the case despite reportedly having known of it since last year.
Citing information apparently acquired from the government, DPP Legislator Kuan Bi-ling (???) said the victim began receiving treatment at a hospital during the second half of 2008. By March last year, she said, it was almost certain that the victim had acquired some form of mad cow disease.
“The hospital alerted the CDC shortly after, but the government still made no effort to tell the public,” Kuan said.
She suggested the lack of disclosure was because of sensitive talks over the importation of certain kinds of US beef more susceptible to carrying the disease at the time, alleging then-National Security Council secretary-general Su Chi (??) signed the beef-import deal with the US despite the case.
CDC Director-General Chang Feng-yee denied covering up the incident and said that because the family of the victim refused to allow an autopsy, there is no way to confirm that the man died of mad cow disease.
Chang said it was standard protocol in Taiwan and many other countries to publicize only confirmed cases and not suspected cases.
Chinese Nationalist Party (KMT) Legislator Kuo Su-chun also shrugged off the DPPs criticism of the governments beef import policy, saying the DPP was simply taking every opportunity to attack the KMT.
At a separate setting yesterday, Department of Health Minister Yaung Chih-liang said the person then in charge of was the one who decided not to disclose the case, referring to Yeh Chin?), who resigned in August last year to run for Hualien county commissioner.
Yeh probably decided not to make the case known to the public because he thought the case was not of domestic origin, the minister said.
“I respected the decision, but personally I have different opinions,” Yaung said, adding that he was not aware of the case until Wednesday.
The government might have been concerned that a mad cow case at that time might lead to greater opposition to relaxing restrictions on imports of US beef, but the government was duty bound to disclose information on diseases, Yaung said.
When asked why the case was not passed on to him when he succeeded Yeh, Yaung said that Yeh did not have enough time during the transition because he “left in a hurry for the election.

More stringent testing doesnt equal safer meat: study
by Bryan Salvage
WASHINGTON — No scientific basis was found that more stringent testing of meat purchased through the government's ground beef purchase program and distributed to various federal food and nutrition programs – including the National School Lunch Program – would lead to safer meat, a new National Research Council study concluded. The study was sponsored by the US Department of Agriculture.
The US Department of Agriculture's Agricultural Marketing Service (AMS) buys ground beef from suppliers that must meet mandatory process, quality, traceback and handling controls plus comply with strict limitations on the amounts of bacteria in the meat, such as E. coli and Salmonella. AMS then distributes the ground beef to federal programs, including food banks, emergency feeding programs, Indian reservations and disaster-relief agencies.
In assessing AMS's ground-beef purchase program, the committee that wrote the report said validated cooking processes provide greater assurance of ground beef's safety than would additional testing for pathogens. Testing alone cannot guarantee the complete absence of pathogens because of statistical implications associated with how beef is sampled during testing.
The committee's analysis of the number of illnesses since 1998 linked with AMS ground beef provided to schools suggests outbreaks were rare events before AMS requirements became more stringent in February, implying controls already in place were appropriate for protecting public health. No recorded outbreaks of E. coli or Salmonella associated with AMS ground beef have occurred in more than a decade.
Prevention of future outbreaks will depend on eliminating contamination during production and ensuring meat is properly handled, stored and cooked before it is served, the committee said.
The committee also attempted to compare the AMS specifications with those of large industry purchasers of ground beef. Among purchasers, the committee found considerable differences in testing and safety standards and suspected that the intended use of the ground beef could account for the variations.
For example, all raw AMS ground beef is distributed in frozen form, but distributors of fresh meat products may require different standards designed to improve shelf-life. Although AMS safety requirements appear comparable to or more demanding than those of commercial companies on the surface, the lack of information detailing the science used for corporate specifications prevented the committee from making direct comparisons.
Other specifications under the AMS program call for testing food samples and surfaces at the suppliers to look for the presence of "indicator" microorganisms that could denote unsanitary conditions, improper hygiene and processing techniques, post-processing contamination and storage-temperature abuse. Although reducing the number of indicator organisms implies a reduction in the amount of pathogens, the presence of an indicator does not guarantee that a pathogen is also present, the committee said.
For an indicator to be an effective predictor of a pathogen's presence, a statistical association needs to be established. Therefore, the committee recommended that AMS assess the usefulness of its microbiological data as a scientific basis for testing for indicators.
"The report encourages AMS to strengthen its established specifications and requirements for ground beef by utilizing a transparent and clearly defined science-based process," said Gary Acuff, chair of the committee and professor and director of the Center for Food Safety at Texas A&M University, College Station.
The committee recommended AMS base its requirements on standards supported by the International Commission on Microbiological Safety of Foods, the Codex Alimentarius Commission and the Research Council report An Evaluation of the Role of Microbiological Criteria for Foods and Food Ingredients.

Food Safety Bill Passes House, Heads Back to Senate
1 week ago
WASHINGTONThe U.S. House of Representatives narrowly approved a $1.09 trillion appropriations bill Dec. 8 that funds the government for fiscal year 2011 and includes a sweeping overhaul of the nations food safety system. It now goes to the Senate.
The House passed the bill, H.R. 3082, by a 212 to 206 vote. The measure, a so-called continuing resolution would keep the U.S. government operating at 2010 spending levels through most of next year, would cost taxpayers $45.9 billion less than the 2011 budget U.S. President Barack Obama had proposed.
Included in this legislation is the Senates FDA Food Safety Modernization Act, which was passed last month; however, due to Constitutional requirements requiring spending bills to originate in the House of Representatives, the bill will now be sent back to the Senate for final passage.
The bill gives FDA greater authority to initiate recalls, rather than waiting for food companies to voluntarily recall food products. Food processors and farmers also would be required to develop strategies to prevent contaminations, and would be required to allow FDA access to all records.
The bill calls for the FDA to inspect at least 600 foreign food facilities within a year of enactment, and double its number of foreign inspections in each subsequent year for five years. The measure would require inspections every three years for U.S. manufacturing and processing plants the FDA views to be at a high risk for contamination, and every five years for all other domestic facilities. According to the Congressional Budget Office (CBO), 50,000 foreign and domestic food facilities would be inspected in 2015 by FDA or federal, state, local or foreign officials acting on FDAs behalf.
The legislation also would require most food producers to develop hazard prevention plans and would give the FDA access to those records when requested. Some local food producers with annual sales under $500,000 would be exempt from that rule under the Tester amendment.

Meat and Poultry Are Harder Targets Now, Tommy
by Dan Flynn | Dec 10, 2010
Whether it was a Washington gaffe (telling the truth by accident) or whether then U.S. Secretary of Health and Human Services Tommy Thompson really meant to say it, he spoke with unusual candor in 2004 when he said: "I cannot understand why terrorists have not attacked our food supply. Because it would be so easy to do."
A half dozen years have passed since that statement, and it just might be getting harder for would-be food terrorists.
USDA's Food Safety and Inspection Service (FSIS) has been pushing "food defense" ever since Thompson dropped his bombshell. And in its latest survey of meat and poultry processing plants, FSIS found 72 percent have a functional food defense plan in place.
That's up from 62 percent a year earlier in 2009.
Ninety-seven (97) percent of the large plants regulated by FSIS have a food defense plan in place, compared with 82 percent of the small and 64 percent of the very small establishments that have food defense plan.
"Food defense is not the same as food safety," a FSIS "how-to" for creating a plan says. "Food defense focuses on protecting the food supply from intentional contamination, with a variety of chemicals, biological agents or other harmful substances, by people who want to do us harm."
"These agents could include materials that are not naturally occurring or are not routinely tested for. An attacker's goal might be to kill people or disrupt our economy. Intentional acts are generally not reasonable and are hard to predict."
The first step in writing a food defense plan is doing an assessment that begins with asking such questions as whether the plant's exterior is secured to prevent entry by unauthorized persons.
FSIS this year made the voluntary adoption of food defense plans a performance objective for the processing plants it regulated. It has a goal of reaching 90 percent compliance by 2015.

The agency has been monitoring the meat industry's voluntary adoption of food defense plans via annual surveys since 2006.
The survey questions determine whether each FSIS-inspected establishment has a food defense plan and, if so, whether the plan is functional.
A plan is functional if measures are in place to address outside security, inside security, personnel security, and incident response; and if the plan was reviewed and tested in the last year.
The fifth food defense plan survey was conducted in August.
The universe of facilities surveyed was expanded in 2010 to include not only meat and poultry slaughter and processing establishments, but also processed egg products plants and official import inspection establishments.

2010's major food recalls and outbreaks
Posted on December 13, 2010 by Drew Falkenstein
The consumer finance gurus at today released their list of ten major foodpoisoning outbreaks and recalls for 2010. Yes, consumer finance and food outbreaks are tightly linked; some estimates are that every case of E. coli O157:H7 costs an average of $1,000 in physician and hospital services, and medical costs in most of the HUS cases we see easily run into the hundreds of thousands of dollars (not everybody is insured; some go bankrupt as a result; and this says nothing of the other costs, like lost wages, that must be factored into the analysis). But that's beside Walletpop's point. I agree with most of their major food stories for the year:The recall of over 500,000,000 eggs, and an associated outbreak that sickened almost 2,000 people
Sangar Fresh Cut Produce listeria outbreak and forced shutdown
Daniele salami salmonella outbreak ultimately linked to contaminated pepper
Valley Meat beef E. coli O157:H7 outbreak
Bravo Farms gouda cheese E. coli O157:H7 outbreak
Fresh Express lettuce recalls
Zemco Industries listeria lunchmeat recall
Pictsweet Co. frozen vegetables recalled because they contained shards of glass
Lobster meat recall due to listeria contamination
Morningland Dairy's dairy products recalls
It's a good list, but it begs a bigger point with respect to the year's problems with raw dairy. The Morningland Dairy and Bravo Farms cheese recalls are only two in a litany of outbreaks and recalls that occurred over the course of the past year, some linked to raw milk-based cheese and some to raw milk itself. In total in 2010, there have been 11 raw dairy outbreaks with 138 illnesses (also 1 pasteurized dairy outbreak with 23 illnesses), 1 queso fresco Mexican-style cheese outbreak with 5 illnesses, and 3 sporadic illnesses from illegal Mexican-style cheese. As for recalls with no illnesses reported, there have been 5 linked to raw dairy (3 milk, and 2 cheese), and 3 linked to queso fresco cheese, and 1 imported Italian cheese made from pasteurized milk.

Healthy People 2020 – we might not have to wait that long Safety Zone
By: James Marsden
December 13, 2010
Healthy People 2020 involves 13 federal agencies and three federal departments including USDA. This is the second ten year Healthy People initiative. USDA was a co-leader of Healthy People 2010 and will continue to co-lead the food safety components of Healthy People 2020. USDA-FSIS relied heavily on Healthy People to set food safety benchmarks for E. coli O157:H7, Salmonella, Listeria monocytogenes and Campylobacter. The 2010 objectives for E. coli O157:H7 and Listeria monocytogenes were met. The objectives for Salmonella and Campylobacter were not.

Under Healthy People 2020, specific pathogen reduction goals have been established for beef and poultry and other food commodities. The improvement goals per 100,000 people are:
-- beef (from 200 cases to 180)
-- poultry (from 258 to 232)
-- dairy (from 786 to 707)
-- fruits and nuts (from 311 to 280 cases)
-- leafy vegetables (from 205 to 185)

The goals have also been established by pathogen:

-- 33 percent for Campylobacter (from 12.7 cases to 8.5 per 100,000)
-- 50 percent for E. coli O157:H7 (1.2 cases to .6 cases)
-- 25 percent for Listeria monocytogenes (.3 cases to .2 cases)
-- 25 percent for Salmonella (15.2 cases to 11.4 cases)
I am going out on a limb to predict that the ten year goals for beef will be met in the first year. The widespread implementation of effective slaughter interventions combined with the increasing use of pre-harvest and processing interventions are winning the war on E. coli O157:H7.

I also predict that the objectives for Listeria monocytogenes will be met in the first year. RTE plants have made excellent progress in eliminating Lm from processing environments. Another contributing factor is that growth inhibitors which reduce the potential for outgrowth of Listeria during refrigerated storage are widely used across the industry. In addition, post-process pasteurization technologies, including High Hydrostatic Pressure are increasingly being used to virtually eliminate the risk of Listeria in consumer products.
If my predictions are even close, this means that USDA-FSIS will be putting a great deal of emphasis on controlling Salmonella and Campylobacter in raw poultry products. The focus on E. coli O157:H7 will shift to leafy vegetables which are regulated by FDA. The next ten years will be challenging for both of these industries.

New Estimates Lower Incidence of Food Poisoning
by Helena Bottemiller | Dec 16, 2010
The Centers for Disease Control and Prevention has released a new, lower estimate of the overall public health burden of foodborne illness in the United States. CDC now says food poisoning sickens 1 in 6 Americans each year, not 1 in 4 as the agency had estimated in 1999.
According to the new estimates announced Wednesday, about 48 million fall ill, 128,000 are hospitalized, and 3,000 die each year from foodborne diseases. For the past decade, the most reliable estimates were 76 million annual foodborne illnesses, 325,000 hospitalizations, and 5,000 deaths.
CDC officials emphasized that the significantly lower estimates are the result of better data and smarter methodology, not a steep decline in the actual number of illnesses. A number of critical differences in data and methodology impact the numbers--so it is not possible to make a direct comparison between the reports.
"The lower numbers are largely the result of more and in some cases better data than we had in 1999 and also innovative, new methods that we have developed to calculate the current estimates," explained Dr. Chris Braden, director of CDC's Division of Foodborne, Waterborne and Environmental diseases, on a call with reporters. "For this reason, we really can't compare the two estimates to measure trends, as tempting as that may be."
The new report is the first national estimate that focuses solely on illnesses caused by foods eaten in the United States. CDC's earlier report, by Paul Mead et al, included illnesses acquired from food consumed abroad.
The 1999 estimate used 1996-1997 surveys from FoodNet, the 10 states that make up a food surveillance network, and data from U.S. studies conducted before 1980. The new estimate draws on FoodNet surveys ranging from 2000 to 2007.
The new estimate is also based on a stricter definition of gastroenteritis and uses a number of more accurate, and more conservative, multipliers to make estimates about unreported illnesses.
For example, in 1999, CDC found that 15 percent of survey respondents sought medical care for bloody diarrhea, while the new survey results indicate that 35 percent seek care. These numbers greatly impact the CDC's estimates in correcting for under-diagnosis. Most people who come down with foodborne illness aren't counted in CDC's FoodNet detection system, because they didn't see a doctor, cultures weren't taken or testing did not confirm a pathogen.
Out of the estimated 48 million people who get sick from contaminated food each year, CDC estimates that 9.4 million of the illnesses are caused by 31 known foodborne pathogens.
CDC estimates that 90 percent of all illnesses due to known pathogens are caused by seven pathogens: Salmonella, norovirus, Campylobacter, Toxoplasma, E. Coli O157, Listeria and Clostridium perfringens.

According to the revised estimates, norovirus in the most common of the known pathogens, responsible for 5.4 million illnesses and 149 deaths each year. Salmonella is now estimated to cause more than a million illnesses and 378 deaths annually. E. coli toxins are estimated to cause 176,000 illnesses and 20 fatalities a year. Campylobacter is estimated to cause 845,024 illnesses and 76 deaths. Listeria is one of the most lethal pathogens, estimated to cause 1,591 illnesses and 255 deaths.
"The remaining 38 million illnesses are from unspecified agents, which include known agents without enough data to make specific estimates, agents not yet recognized as causing foodborne illness, and agents not yet discovered," according to CDC. "In both the 1999 and current estimates, unspecified agents were responsible for roughly 80 percent of estimated illnesses."
Using the new numbers, reducing foodborne illness by 1 percent would keep about 500,000 Americans from getting sick each year and reducing foodborne illness by 10 percent would keep about 5 million from getting sick, according to CDC.
Reaction from the public health community
Consumer, public health, and industry groups alike welcomed the updated estimates.
Dr. Richard Raymond, former under secretary for food safety at the U.S. Department of Agriculture, lauded the new report. Raymond has been a vocal critic of the way the outdated foodborne illness stats were being used to further political agendas.
"I think it's a tremendous improvement," Raymond told Food Safety News. "They really did the best they can with what they got. Any weakness, as they said, is because of lack of data."
"I think in 10 years form now they will be even better," he added.
Caroline Smith DeWaal, food safety director at the Center for Science in the Public Interest, said she hopes there will be more revisions as better information becomes available. "A report like this should be coming every 2 years, not every 10 years. It is my hope that they can deliver this kind of information more quickly."
DeWaal contends that if CDC kept consistent data sources and methodology, then the estimates could be better used to track increases or decreases in particular pathogens.
"I think the more up-to-date numbers from the CDC are excellent," said Bill Marler, food safety attorney and publisher of Food Safety News. "There are two things that the data show clearly: first, the need for more resources at the CDC and state health departments to track foodborne disease, and second, that the numbers are not mere statistics; they represent real people and families with horrible losses, medical expenses and wage loss, and represent businesses with recall costs and lost sales."
The Consumer Federation of America echoed similar concerns about the ability of local and federal public health agencies to accurately capture the public health costs of foodborne illness.
"[The new report] also demonstrates that, a decade after the first effort to estimate the total burden of foodborne illness, the nation remains largely ignorant of the full human and economic costs of these preventable diseases," the consumer group said in a statement. "The CDC acknowledges that the majority of illnesses are caused by unidentified organisms and that their data rely on estimates because local, state and national surveillance and reporting systems remain primitive. Most people stricken by gastrointestinal illness are never seen by a physician and if they are, only a few are tested to determine the organism that caused the illness."
CFA also said the prevalence of illnesses caused by "unspecified agents" illustrates the lack of adequate information about foodborne illness and the need for more intense surveillance and reporting. It is difficult to prevent people from getting sick, the group noted, if you don't know what is making them sick.
Dr. Braden said the new estimates will serve as a foundation for future reports and that CDC is working to improve foodborne illness surveillance. CDC hopes to release data on food attribution--which foods are most often linked to particular pathogens--in 2011

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