Published on January 7, 2008
The Food and Drug Administration (FDA) Ranking of Food Hazards: The Food and Drug Administration (FDA) Ranking of Food Hazards ranking* 1. microbial contamination 2. naturally occurring toxicants 3. environmental contaminants (e.g., metals 4. nutritional problems (i.e., malnutrition, undernutrition) 5. pesticide residues 6. food additives *1 being most dangerous, 6 least dangerous Definitions: Definitions Infection Intoxication Metabolic food disorder Allergy Idiopathic illness Foodborne disease is any illness resulting from the consumption of food contaminated with one or more disease-producing agents. These include bacteria, parasites, viruses, fungi and their products as well as toxic substances not of microbial origin. Risks — perception vs. reality: Risks — perception vs. reality What is the likelihood that you will die of foodborne illness? Deaths per year from selected causes in the United States (NCHS, 1986) All causes 2,105,361 Ischemic heart disease 520,729 All cancers 476,106 Heart attack (acute myocardial infarction 261,002 Motor vehicle accidents 47,885 Diabetes mellitus 37,184 Chronic liver disease and cirrhosis (alcohol not mentioned) 13,867 Firearm assaults, including handguns 13,029 Falling (accidental) 11,444 Chronic liver disease and cirrhosis (alcoholic) 11,060 Choking on a piece of food 3,692 Firearm accidents, including handguns 1,452 Intestinal infectious diseases 466 — A one-in-a-million risk of death in the U.S. in 1986 — 242 Salmonella infections 102 Lightning 78 Botulism 3 Outbreaks vs. Cases: Outbreaks vs. Cases Foodborne disease outbreak: an incident in which two or more persons experienced a similar illness after ingestion of a common food, and epidemiologic analysis implicated a food as the source of illness. Foodborne disease case: one individual experiences illness after ingestion of an epidemiologically incriminated food. Estimates of the yearly incidence of foodborne illness: Estimates of the yearly incidence of foodborne illness The estimates vary greatly but thought to be around 76 million cases per year Cost estimates range from $5–23 billion per year High cost due to many factors: medical care, investigation of illness, loss of productivity, loss of business, legal activities Infection: Infection Definition: a disease state caused by the presence of viable, usually multiplying organisms at the site of inflammation Bacteria - Salmonella, Campylobacter Virus - hepatitis A, Norwalk virus Protozoa - Cryptosporidium, Cyclospora other parasites - Trichinella spiralis Intoxication: Intoxication Definition: a disease state, caused by exposure to a toxic chemical, that is not mediated immunologically and is not primarily the result of a genetic deficiency. Staphylococcal food poisoning, botulism Saxitoxin, ciguatera Examples of foodborne infections/intoxications: Examples of foodborne infections/intoxications Disease Reservoir Botulism food intoxication Soil contaminated foods Campylobacteriosis Cattle, poultry, shellfish Clostridium perfringens Soil contaminated foods food poisoning Salmonellosis Animals and birds Staphylococcal food poisoning Human carriers Vibrio parahaemolyticus Seafoods infection Yersinia enterocolitica Animal intestines infection Metabolic food disorder: Metabolic food disorder Definition: a disease state caused by exposure to a chemical that is toxic to certain individuals only because they exhibit some genetic deficiency lactose intolerance favism Allergy: Allergy Definition: a disease state caused by exposure to a particular chemical that (often proteinaceous) to which certain individuals have a heightened sensitivity (hypersensitivity) that has an immunological basis proteins (heat resistant and resistant to digestion) cow’s milk: b-lactoglobulin, casein, etc. egg-ovalbumin small molecules penicillin Idiopathic illness: Idiopathic illness Definition: any illness of uncertain pathogenesis that may possibly but not certainly be due to foods; also, any food-caused illness that does not fit into one of the other categories Chinese restaurant syndrome celiac disease hyperkinesis Objectives of foodborne disease surveillance: Objectives of foodborne disease surveillance prevention and control: identification of contaminated products knowledge of disease causation: observe the track record of various illness-causing agents administrative guidance: assessment of trends to justify regulatory decisions/actions Information reported to and compiled by the Centers for Disease Control (CDC): Information reported to and compiled by the Centers for Disease Control (CDC) Outbreaks of known etiology = where laboratory evidence indicated a specific agent Outbreaks of unknown etiology = where epidemiological evidence implicated foodborne transmission, but the etiological agent was not identified. 4 subgroups based on incubation period: < 1 hr = probable chemical poisoning 1 – 7 hr = probable Staphylococcus aureus poisoning 8 – 14 hr = probable Clostridium perfringens food poisoning > 14 hr = probably other infectious/toxic agents Outbreaks of known vehicle = a particular food item was associated with the illness Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology — United States, 1993–1997: Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology — United States, 1993–1997 Bacterial 655 (23.8) 43,821 (50.9) 28 (96.6) Chemical 148 (5.4) 576 (0.7) 0 (0) Parasitic 19 (0.7) 2,325 (2.7) 0 (0) Viral 56 (2.0) 4,066 (4.7) 0 (0) Confirmed etiology 878 (31.9) 50,788 (59.0) 28 (96.6) Unknown etiology 1,873 (68.1) 35,270 (41.0) 1 (3.4) Total 1993–1997 2,751 (100.0) 86,058 (100.0) 29 (100.0) No. (%) No. (%) No. (%) Outbreaks Cases Deaths ex MMWR Table 1, Vol. 49/No. SS-1, p. 11 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4901a1.htm Estimated illnesses for known foodborne pathogens, United States: Estimated illnesses for known foodborne pathogens, United States Disease or agent Estimated total cases Bacteria 5,204,934 Parasites 2,541,316 Viruses 30,883,391 Grand Total 38,629,641 ex Mead, P. S., L. Slutskaer, V. Dietz, L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V. Tauxe. Food-related illness and death in the United States. Emerging Infectious Diseases 5(5):607–625 (1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm Top Twelve Factors Contributing to 345 Outbreaks of Foodborne Disease Caused by Mishandling and/or Mistreatment of Foods in Homes in the U.S., 1973–1982: Top Twelve Factors Contributing to 345 Outbreaks of Foodborne Disease Caused by Mishandling and/or Mistreatment of Foods in Homes in the U.S., 1973–1982 Ranking Contributing Factor Percent* 1. Contaminated raw food/ingredient 42.0 2. Inadequate cooking/canning/heat processing 31.3 3. Obtained food from unsafe source 28.7 4. Improper cooling 22.3 5. Lapse of 12 or more hours between preparing and eating 12.8 6. Colonized person handling implicated food 9.9 7. Mistaken for food 7.0 8. Improper fermentations 4.6 9. Inadequate reheating 3.5 10. Toxic containers 3.5 11. Improper hot holding 3.2 12. Cross-contamination 3.2 *Percentage exceeds 100 because multiple factors contribute to single outbreak “The World Health Organization’s Golden Rules for Safe Food Preparation”: “The World Health Organization’s Golden Rules for Safe Food Preparation” 1. Choose foods processed for safety 2. Cook food thoroughly 3. Eat cooked foods immediately. 4. Store cooked foods carefully. 5. Reheat cooked foods thoroughly. 6. Avoid contact between raw and cooked foods. 7. Wash hands repeatedly. 8. Keep all kitchen surfaces meticulously clean. 9. Protect foods from insects, rodents, and other animals. 10. Use pure water. The future and foodborne illness: The future and foodborne illness Demographics Human behavior changing Technology changing Global market Populations sensitive to foodborne disease: Populations sensitive to foodborne disease Pregnant women Neonates Elderly (over 65) Residents in nursing home or related care facilities Cancer patients (nonhospitalized) Organ transplant patients AIDS patients The aging population: The aging population Population: Population Earth’s increasing population 1900 1.7 billion people 1998 6.0 billion people 2050 8.2 billion people (medium population projection) Future water usage: Future water usage Competition between agriculture, industry, and personal households. Modern agriculture accounts for 70–80% of water usage.