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Foodborne Illnesses

Background

It is estimated that 76,000 illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year can be traced to the food we eat. More than 250 known diseases are contracted through food contaminated by bacteria, viruses, parasites, toxins, metals, and prions. Foodborne-disease outbreaks (FBDOs) happen every year, sometimes affecting multiple states and many people, which can be traced back to of variety of food items.

For example, during the months of September and October in 2006 two FBDOs occurred that could be traced to fresh produce. The first, caused by a bacteria called Escherichia coliform (E.Coli), infected approximately 200 people in 26 states from California to Maine. This outbreak was traced back to contamination of fresh spinach. Additionally, during those two months in 2006, a bacteria called Salmonella was implicated in a tomato contamination that affected 183 individuals in 21 states. Back in 1985 a large isolated outbreak, caused by the pathogen Clostridium perfringens (C. perfringens), occurred in Connecticut after a group of factory workers enjoyed their employee banquet. The culprit causing this outbreak, which affected approximately 600 employees, was determined to have been the gravy, which had been improperly cooled and then reheated prior to being served at the banquet.

These three bacteria, E. Coli, Salmonella, and C. perfringens, represent some of the most common causes of foodborne illness. These illnesses are easily diagnosed due to tests that allow for the detection of the pathogen in a person’s system. Additional information regarding these bacteria is included as follows:

E. coli: This bacteria is carried in cattle or similar animals. Illness from this bacteria is caused by consumption of food or water contaminated by small amounts of feces. You can also contract E. coli by consuming unpasteurized products. E. Coli can spread from person to person. The symptoms resulting from this infection include severe and bloody diarrhea and painful abdominal cramps. These symptoms are usually not accompanied by a fever. Three to five percent of the E. coli cases lead to hemolytic uremic syndrome that can lead to temporary anemia, profuse bleeding, and kidney failure.

Salmonella: This is a bacteria carried in the intestines of birds, reptiles and mammals. It is contracted by ingesting a variety of different raw or undercooked foods from animal origin. The symptoms resulting from infection by these bacteria include fever, diarrhea, and abdominal cramps as well as headaches and nausea.

C. perfringens: This is a rod-shaped bacteria that lives in environments that do not contain oxygen, such as in the intestines of humans and domesticated animals. This bacteria is commonly called the “cafeteria germ” as it results from food left at room temperature for extended periods of time. These bacteria produce spores that exist in soil, sediment, and areas prone to human or animal fecal pollution. The symptoms resulting from infection by this bacteria include abdominal cramps and diarrhea that usually resolve in 1 to 2 days. Ingesting large numbers of these bacteria could lead to necrotic enteritis, leading to severe damage to the intestines, which can be fatal.

Diagnosis

As stated before, illnesses caused by these pathogens can be definitively diagnosed due to tests that can detect the pathogen in a person’s system or in the food that was consumed. However, many foodborne illnesses are caused by pathogens that cannot be detected or have not been identified, thus these sicknesses remain undiagnosed. In fact, nearly 82% of illnesses and hospitalizations, and approximately 64% of deaths caused by foodborne illness each year remain undiagnosed.

This inability to diagnose many of the illnesses caused by our food has led to complication in detecting when FBDOs are occurring in the population. Additionally, although some foodborne diseases cause extreme symptoms such as kidney failure, paralysis, or even death, many cause common flu-like symptoms such as vomiting and fever. Because of this, many cases of foodborne illness simply go unreported. The Centers for Disease Control and Prevention (CDC) has instituted procedures that aid in the surveillance of foodborne illnesses in order to determine and act upon any FBDOs that may occur.

The CDC has defined a FBDO as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Often it is a combination of events which contribute to an outbreak. However, the ability to monitor FBDOs has steadily become more effective in recent years due to the electronic Foodborne Outbreak Reporting System (eFORS). This electronic database allows local, state, territorial, and federal health agencies to report food-borne illness cases as they happen. The CDC then monitors this database and performs any investigations needed into multiple cases of the same illness, or patterns of illness in the population. This database has made it possible to react to FBDOs that may be occurring within the population quickly and effectively, maximizing the ability of health care providers to treat those that have been affected and increasing the safety and awareness of consumers.

Prevention

Although strides have been made to cope with FBDOs as they happen, there are a few simple habits that you can personally do that significantly decrease your chances of contracting a foodborne illness. When purchasing, transporting, storing and preparing food there are measures that should be taken in order to ensure the safety of the food you are consuming. Many foodborne illnesses arise out of carelessness in the handling of our food prior to consumption. According to the USDA food borne illnesses peak in summer months. The following is a list of practices that can be followed to minimize the likeliness of contracting a foodborne disease.

Choosing the Right Food at the Right Time:

• When shopping, get canned and packaged foods first before heading to the refrigerated sections of the grocery store. Make sure cans are not bulging or dented. Check for cracks in jars and avoid jars with bulging lids. If canned or packaged goods are sticky on the outside this could indicate a leak, and these products should be avoided.
• Choose pasteurized milks and cheeses, as well as juices and ciders that have been pasteurized or treated. Pasteurization is accomplished by significantly elevating the temperature of the product during processing, thus killing any microorganisms that may cause illness.
• Select eggs that are refrigerated and check the eggs, before leaving the store, for any cracks. Cracks can allow microorganisms to enter the eggs, thus increasing the chances for illness.
• Wait to select frozen food and perishables, such as meat, poultry, and seafood, until the end of your shopping trip, and bag these products separately in plastic bags so the drippings do not contaminate other food in the shopping cart.
• Bring a cooler full of ice to keep frozen and perishable foods cold if your return trip from the grocery store will be longer than one hour.

Storage:

• Refrigerate (40°F) or freeze (0°F) perishables immediately upon arrival home from the store.
• Store eggs in carton in the refrigerator. Avoid storing them in the door because the temperature is warmer here due to the door being opened and closed.
• Meats, poultry and fish can be placed in the refrigerator in the packaging from the grocery store if they are to be cooked within 1–2 days. For longer storage, these items should be wrapped tightly and placed in the freezer.
• Keep cold food cold and hot food hot.

Preparation:

• Produce should be cleaned prior to preparation in order to remove any dirt and grime. Pay special attention to cleaning produce that will be eaten raw because there will be no heat involved during preparation to kill lingering bacteria.
• Wash hands, utensils and cutting boards that have come in contact with meat or poultry before preparing other foods. This reduces the possibility of cross contamination.
• Cook meat, poultry and eggs thoroughly. Ground beef should reach an internal temperature of 160°F, and eggs should be cooked until the yolk is firm. Make sure to use a meat thermometer to check internal temperatures.
• Make sure to refrigerate any leftovers promptly so contamination is not allowed to occur.

Restaurant Safety:

• Restaurants are inspected by the local health department. Only patronize restaurants that passed the health inspection.
• Order your steaks or hamburgers well done and send your meal back if the meat is still pink in the center.
• Ask if the eggs and other dairy products used to prepare your food are pasteurized.

These prevention measures are needed to limit the possibility of contamination of our food as it travels from the farm to our tables. However, if contamination does occur, and a foodborne illness results, it is important to report this to your local health department. With the information you provide, health officials can gain a better understanding regarding the initialization, transmission, and other contributing factors to FBDOs.

Commonly Asked Questions

Sources for More Information

For more information please visit:

The Centers for Disease Control and Prevention FBDO toolkit
http://www.cdc.gov/foodborneoutbreaks/toolkit.htm

The U.S. Food and Drug Administration Info on Foodborne Illness
http://www.cfsan.fda.gov/~mow/foodborn.html

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Please Note: The information contained in this publication is intended for general information purposes only. This publication is not a substitute for review of the applicable government regulations and standards, and should not be construed as legal advice or opinion. Readers with specific questions should refer to the cited regulation or consult with an attorney.