Foodborne Illness and its Impact Epi-Ready Foodborne Illness and its Impact Module 2

Module Objectives By the end of this module, participants will be able to identify the agents of foodborne illness and the associated burden on the United States. Explain the burden of foodborne illness in the United States Describe the various agents that cause foodborne illness Apply terminology used by outbreak response teams

Foodborne Illness in the United States 47.8 million cases per year 128,000 hospitalizations 3000 deaths

Cost Associated with Foodborne Illness Average annual economic burden associated with the 15 major pathogens identified through outbreak response = $15.5 billion Acute and chronic illness medical costs Costs associated with lost wages Costs associated with premature deaths Source: United States Department of Agriculture - Economic Research Service (2014)

Average Cost per Case   Pathogen Total Cost Total Cases Identified Average Cost per Case Vibrio vulnificus $319,850,293 96 $3,331,773.89 Listeria monocytogenes $2,834,444,202 1,591 $1,781,548.84 E. coli O157 (STEC) $271,418,690 63,153 $4,297.80 Salmonella spp. (nontyphoidal) $3,666,600,031 1,027,561 $3,568.26 Norovirus $2,255,827,318 5,461,731 $413.02 The high costs associated with Vibrio vulnificus and Listeria monocytogenes stem from costs attributed to premature deaths (97% of the cost for Vibrio vulnificus, and 75% of the cost for Listeria monocytogenes). Source: United States Department of Agriculture - Economic Research Service (2014)

Burden on the Food Industry Burden on Industry Brand Damage Direct costs Lost Sales Seldom limited to one company May impact entire community Indirect costs also include: Litigation Regulatory compliance Direct cost can reach $10 million

Salmonella Saintpaul Outbreak - 2008 Initially tomatoes were implicated in an outbreak of 1442 ill in 43 states, D.C., and Canada FDA issued a warning not to eat tomatoes Ongoing investigation revealed that Jalapeno and Serrano peppers were the cause of the outbreak. Florida and Georgia tomato growers lost $100 to $125 million Tomatoes that were selling for $18-19 per box before the FDA announcement were selling for just $4 afterwards. Some Florida growers reported selling boxes for $0.50

Restaurant-Associated Burden $4000 for an outbreak involving 5 people in a fast food restaurant No loss of revenue and no lawsuits, legal fees, or fines $2.6 million for a Listeria outbreak in a fine dining restaurant involving 250 persons Includes: meals lost per illness, lawsuits, legal fees, fines and higher insurance premiums Source: Johns Hopkins Bloomberg School of Public Health

Bacterial Pathogens Ability to multiply outside of host Three pathways to illness: Preformed toxin Infection Infection followed by enterotoxin production E. coli

Viral Pathogens Must replicate in a host cell Cause of illness is infection Virus commonly associated with foodborne illness in the U.S.: Norovirus Hepatitis A Virus Norovirus

Parasites Free living or cause infection within a host Protozoa Cyclospora Cryptosporidium Toxoplasma gondii Worms (Helminths) Taenia saginata Taenia solium Trichinella spiralis Cyclospora cayetanensis

Toxins and Chemicals Marine algae toxins Fungal toxins Fish toxins

Disease Outbreaks with Confirmed Etiology Source: Foodborne Disease Outbreak Surveillance System 2009-2015

Illness Characteristics Intoxication Infection Enterotoxin Food consumed with preformed toxin Food consumed that is contaminated with microorganism Rapid onset of symptoms Delayed onset of symptoms Nausea and vomiting Diarrhea and possibly fever Diarrhea No secondary spread of illness Secondary spread of illness likely May have some secondary exposures

Common Food Source Attributions Listeria monocytogenes Fruits Dairy E. coli O157 Vegetable Row Crops Beef Campylobacter Chicken Seafood Seeded Vegetables Salmonella Eggs Other Produce Pork Source: Interagency Food Safety Analytics Collaboration (IFSAC)

Cluster or Outbreak Investigation A cluster is a higher than the expected number of cases A foodborne outbreak is an incident in which two or more persons become ill after ingestion of a common source

Exception to Outbreak and Cluster Rules Requires a Response! Botulism. A case of botulism poses a significant health risk, prompt response is necessary to administer life-saving medical attention and remove product from distribution. Others such as Vibrio parahaemolyticus infection and Scombrotoxin

Goals of the Outbreak Investigation Identify the agent causing disease Find the source of the outbreak Take action to prevent additional cases of illness Implement short-term controls to eliminate the source Identify the cause of the outbreak Establish institutional controls to prevent similar outbreaks

Summary Recognize the burden foodborne illness causes in the United States Describe the various agents that cause foodborne illness Understand the terminology used by outbreak response teams

Response Teams – Planning and Preparation Coming Up Next Response Teams – Planning and Preparation