food and non-food exposures associated with enteric foodborne illness in rural texas—an...
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Food and Non-Food Exposures Associated with Enteric Foodborne Illness in Rural Texas—An Exploratory
Surveillance Study, 2013-2014
Joseph (Greg) RosenPublic Health Associate
Office for State, Tribal, Local and Territorial SupportCenters for Disease Control and Prevention
PHAP/PHPS Summer SeminarJune 1 – 5, 2015
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
What Makes “Food Poisoning” Relevant to Public Health?
9 million infections annually in the U.S. 55,000 hospitalizations
& 1,000 fatalities $100M in preventable
healthcare costs 10,000 cases reported
in Texas (2013)
1 Interagency Food Safety Analytics Collaboration (IFSAC) Project, Foodborne Illness Source Attribution Estimates for Salmonella, Escherichia coli 0147 (E. Coli 0157), Listeria monocytogenes (Lm), and Campylobacter using Outbreak Surveillance Data
2 Case counts and incidence rates in Texas, 2001-2013. Texas Department of State Health Services <https://www.dshs.state.tx.us/idcu/disease/data>.
Campylobacter Salmonella Shigella02468
101214161820
5.2
13.2
9.69.8
18.4
8.9
Incidence of Enteric Foodborne Illness in Texas, 2001-2013
20012013
Pathogen
Inci
denc
e Ra
te (p
er 1
00,0
00)
Bacterial organisms residing in the human and animal intestines
Modality of transmission Contaminated food/water
sources; infected animals Human-to-human: fecal-oral
Prevention required at the individual and systemic levels
Background:Enteric Pathogens – What Are They?
E. coli O157:H7, associated with ground beef
Salmonella Newport, implicated pathogen in an outbreak associated with alfalfa sprouts (2010)
Source attribution difficult for sporadic cases
Food consumption and lifestyle behavior patterns vary across Texas communities
Understand healthcare-seeking behaviors in the population
Antimicrobial-resistant pathogens
Background:Impetus for Risk Factor Analysis in Rural Texas
Courtesy of Texas Department of State Health Services, Center for Health Statistics
Identified case records of Campylobacter, Salmonella, and Shigella in Region 6/5 South (2013-2014)
Used the Texas electronic disease surveillance system
Interview form prompted 7-day exposure history from illness onset date
Methodology:Prospective Study Design
Attempted structured telephone interviews with case-patients
Excluded outbreak-associated case-patients
Calculated demographic and risk factor frequencies
Methodology:Inclusion/Exclusion Metrics in Study Population
Campylobacter, Salmonella, or Shigella pathogen identified?
Resides in one of the seven Region 6/5 South surveillance counties?
Case-patient associated with an outbreak?
Contact to administer food history/exposure
questionnaire
Excluded from analysis
Excluded from analysis
Excluded from analysisNO
NO
NO
YES
YES
YES
139/240 completed interviews
Age ranged from 0-91 years (median=9)
Majority were non-Hispanic Whites (N=55)
Females constituted 56%
Results: Demographic Characteristics of Enteric Foodborne Illness Case-Patients
18-29
30-49
50-64
65+≤ 4
5-9
10-17Case-Patients in Region 6/5 South, by Age Group, 2013-2014 (N=139)
Results: Self-Reported Risk Factors among Case-Patients, Region 6/5 South, 2013-2014 (N=139)
Risk Factor Cases (%)Non-Food Exposures Contact with household pets 69 (50)
Exposure to livestock or poultry 36 (26)
Drinking water from a private well 35 (25)
Ill close contact(s) 23 (17)
Recreational water exposure (pool, lake, water fountain)
17 (12)
Food Exposures Consume any beef products 62 (45)
Fresh fruit consumption 58 (42)
Consume any poultry (chicken, turkey) products
54 (39)
Fresh vegetable consumption 49 (35)
Pork consumption 28 (20)
Handle any raw meat 15 (11)
Consume food with raw or undercooked eggs
14 (10)
Salmonella (55%) most frequently reported pathogen
Mean symptom duration = 9 days
26% hospitalized (50% for > 65+)
Results: Risk or Associated Factors among Case-Patients, by Age Group, 2013-2014 (N=139)
Hospitalized* Handle Raw Meat*
Livestock Contact^
Ill Close Contacts^
0
10
20
30
40
50
60
70
20
3
30
16
59
21 21 18
< 18 (N=77)
18-91 (N=61)
Risk or Associated Factor
Perc
enta
ge
*Difference statistically significant, as determined by a p-value < 0.05 using a Mantel-Haenszel chi-square test.^Difference not statistically significant, as determined by a p-value > 0.05 using a Mantel-Haenszel chi-square test, due to small sample size.
Risk Factors among Case-Patients, by Sex, Region 6/5 South, 2013-2014 (N=139)
Handling Raw Meat^ Livestock Contact^ Beef Consumption^05
101520253035404550
11
30
43
10
23
47
Males (N=61)
Females (N=77)
Risk Factor
Perc
enta
ge
^Difference not statistically significant, as determined by a p-value > 0.05 using a Mantel-Haenszel chi-square test, due to small sample size.
Small sample size Dietary recall biases No measurement of
indicators of food safety, hand hygiene, or healthcare accessibility
No distinction between risky and non-risk food consumption patterns
Limitations
Case-patients in rural Texas reporting high frequencies of non-food related risk factors
Healthcare election bias may account for high concentration of < 18
Examine healthcare-seeking behaviors and care access
Prevention tailored to different age groups Emphasis on animal safety
and hand hygiene
Conclusions and Recommendations
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Questions or Comments?Joseph (Greg) Rosen
[email protected]@dshs.state.tx.us
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support