EMBRACING A CHANGING WORLD

BCFPA

Foodborne Infection: The Toll and the Challenges

WHY AM I HERE?

Is it the logo?

Is it Desolation Sound?

Is it a trip to Richmond—uh, the airport?

I’m Here for Those Who Cannot Be:

Foodborne Illness Costs Everyone

THE COSTS OF FOODBORNE ILLNESS

Estimated 76 million cases of foodborne illness each year

325,000 hospitalizations, and 5,000 deaths [Mead at p. 614]

For FIVE foodborne pathogens, medical costs, productivity losses, and costs of premature death total: $6.9 Billion a year1

1. Crutchfield, S.R. and T. Roberts. 2000. “Food Safety Efforts Accelerate in the 1990s,” FOOD REVIEW, 23,3:44-49,

Kids Suffer the Most

In Canada, it appears that children less than 10 years, young adults 20 to 24 years … are at an increased risk for AGI [acute gastrointestinal illness]. In children, this increased risk may reflect an increased susceptibility to gastrointestinal infections due to immune status, and in young adults, this increased risk may be due to behavioural factors.

Demographic determinants of acute gastrointestinal illness in Canada: a population study

BMC Public Health. 2007; 7: 162.

Remember the Good Old Days—Before There was any Foodborne Illness?

Back then, there was only the “stomach flu”What happened?

Those Pesky Environmental Health People Came Along

Of Course, There Really is the Stomach Flu: It’s Called Norovirus

If You Need a Break from Worrying About Food, Try worrying About Water

Crypto and Recreational Water Go Together

90% of Enteric Illnesses are Sporadic

• Kitchen cutting boards after handling raw meat

• Eating out at restaurants

• Private well water and septic fields

• Produce from sealed bags

• Recreational water

• Daycare and hand washing—not so muchDenno, DM et al. Tri-county comprehensive assessment of risk factors for sporadic reportable bacterial enteric infection in children. J Infect Dis. 2009 Feb 15;199(4):467-76

It’s Not a Tummy Ache

• “I’ve had women tell me that E. coli is more painful than childbirth,” said Dr. Phillip I. Tarr, Washington University, St. Louis and world expert on STEC

• C.S.Cody wrote on Oct 8, 2009 12:07 PM:

" This was not a simple "tummy ache". This was a dangerous parasite that caused these illnesses. We have never heard the full story about what the State did here. Thousands got sick! Some folks landed in the hospital. I'm glad someone is finally getting to the bottom of this and didn't just quit because it took so long to fight this fight! “—letter to the Editor, Finger Lakes Times

For Bugs, It’s Getting Harder to Hide

• Stool, Blood and Food Tests

– Mandatory Reporting

– More cultures for bloody stool

– PFGE/MLVA

– PulseNet

– Titer Tests

Fluorescing Bacteria on a Petri Dish

Common ancestor of all E. coli O157 strains existed ca. 40,000 years ago

Robert Koch demonstrated that anthrax, Mycobacterium tuberculosis, and Vibrio cholera cause human disease in the 1870’s and 80’s

Epidemiology In Action

• 1923—first compilations of milk outbreak in US

• 1938—more complete date on food and waterborne outbreaks

• 1966—CDC starts outbreak summary publication

• 1972—CA Foodborne Disease Reporting Center beings publishing outbreak information

John Snow, M.D., 1813-1858A Father of Epidemiology

Eating Green=Increased Risk of Illness

Dr. Robert V. Tauxe, an epidemiologist with the federal Centers for Disease Control and Prevention, said, "The American diet has really shifted, and we are eating more that is minimally processed and getting it from a broader variety of different sources." He added: "There has been an increase in the volume of production, so when something goes wrong it goes wrong on a bigger scale. It's a difficult trade-off if you want to have fresh produce in the off-season."

E. Coli in Your Salad

• Since 1996:

• 34% of all outbreaks due to microbial contamination traced back to a specific fruit or vegetable

• 10% of illnesses

• 34% of deaths

• 20 of the 24 outbreaks have involved E.coli O157:H7

Source: USDA-ERS, Amber Waves, June 2007

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Lettuce and Spinach

• 21 E. coli outbreaks since 1995

– At least 1,000 reported illnesses and 7 deaths

• Fresh or fresh-cut lettuce or spinach implicated as outbreak vehicle

• 8 outbreaks traced back to produce from Salinas, California

• LGMA costs about 1% of revenue

This Woman Might Die From Eating Cookie Dough—Washington Post 9.1.09

“Nestle’s cookie dough is packaged with labels warning consumers not to eat it raw. But people tend to disregard the warning -- 39 percent of consumers eat raw cookie dough, according to Consumer Reports.”

Linda is Still in the Hospital“Linda Rivera has just been trying to stay alive. Her cascading problems started about seven days after she ate the dough when her kidneys shut down and she went into septic shock. Then doctors had to remove part of her colon, which had become contaminated. Soon, her gallbladder was inflamed and had to be excised. Shortly after, her liver stopped functioning. It is unclear exactly what is causing her loss of speech, although the toxin produced by the E. coli O157:H7 bacteria can attack the brain.”

"You made it this far -- don't give up on us, Mom," said Tony, one of her 17-year-old twin boys, who sniffled beneath his face mask. "You've done everything for me in my life." From the Post article.

PCA & Salmonella Typhimurium

• Peanut industry estimates lost sales and production over $1 billion

• Peanut recall nearly $500 million

• Over $2 billion because of a company that processed only 2.5% of annual US crop

• PI claims not a part of these costs

Self-Regulation Only Works If You are Serious About it

• Kellogg, one of the companies that recalled peanut products, received reports of third-party independent audits of Peanut Corporation of America in 2007 and 2008. The audits, paid for by the peanut company to meet food manufacturers’ requirements, were intended to assess its compliance with federally mandated manufacturing practices, including the condition of the plant and equipment and cleanliness, said Kris Charles, a spokeswoman for Kellogg.

• Each audit, conducted by AIB International, gave the Blakely plant a “superior” rating.

This PB client won 3 Purple Hearts in KoreaPt previously treated with Cipro for diagnosis of Salmonella. Returned to SNF and continued to decline. "There has been an outbreak of Salmonella at the nursing home." At the time of assessment pt. is "in such a state that he cannot carry on any useful conversation.”

Some persistence of his diarrhea, bloody x1 with at least 4-6 emesis. Episodes of vomiting through the night. Blood culture collected at 0645 positive for Salmonella species. Stage II pressure sore on coccyx. Plan for central line placement and transfusion of apheresed platelets.

Condition deteriorated rapidly and pt. passed away on the morning of 1/12/09. Death pronounced at 11:08am. Final diagnosis: Salmonella gastroenteritis.

Cause of Death: Peanut Butter

“I ask myself every day, ‘Why me?’ and ‘Why from a hamburger?’ ”—Stephanie Smith

October 3, 2009

It’s Not a Question of Resources

Cargill, whose $116.6 billion in revenues last year made it the country’s largest private company, declined requests to interview company officials or visit its facilities. “Cargill is not in a position to answer your specific questions, other than to state that we are committed to continuous improvement in the area of food safety,” the company said, citing continuing litigation.

Factors Contributing to Foodborne Illness Outbreaks Washington State 2000-2005Contributing Factor Percentage of Outbreaks

• Bare hand contact with food 33%

• Food handler working when ill 22%

• Slow cooling of foods 19%

• Inadequate hand-washing 18%

• Room temperature storage of foods 16%

• Insufficient reheating of foods 14%

• Cross contamination of foods 13%

Big Outbreaks Require Lots of Mistakes

OTTAWA — A "void in leadership" within the federal government during last summer's deadly listeriosis outbreak came after company officials and over-worked meat inspectors failed to identify a persistent listeria problem at the Maple Leaf Foods plant, according to a highly critical report by an independent investigator.

No player in the listeriosis outbreak escaped criticism from Sheila Weatherill, who released her report Tuesday.

But Weatherill zeroed in on a "vacuum in senior leadership" among government officials at the Public Health Agency of Canada and the Canadian Food Inspection Agency that caused "confusion and weak decision-making.“

Michael McCain, CEO

Maple Leaf Foods

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A CORE PROBLEM:

Safety is Invisible

“For the most part, food safety is a credence attribute, meaning the consumers cannot evaluate the existence or quality of the attribute before purchase, or even after they have consumed [it].”1

1. See E. Golan, et al., Savvy Buyers Spur Food Safety Innovation in Meat Processing,

AMBER WAVES, April 2004,

Will Consumers Pay for Safe Food?

Extra Safe Meat

Sort of Safe Meat $1.99lb.

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receives higher prices for higher quality good, or

lowers the cost of production, or

reduces risk of loss or damage.

A “Rational” Actor Will Not Invest in Food Safety, Unless:

“Appropriability, the ability to control and exploit the benefits from innovation, play a key role in driving investment in innovation. Only if firms expect to be able to reap the benefits of an innovation will they have an incentive to innovate.” (Golan at 3)

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LAWSUITS: A Weak or Strong Incentive?

• Process and product innovation more often occurs after an outbreak, and because of outbreak.

• Most “good” cases do not go to trial; and settlements are kept strictly confidential.

• Insurance and indemnity agreements transfers risk of paying judgment/settlement away from manufacturer.

There’s a Lot to Do

ENGAGE

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