ISOPOL XVII, Porto, 5-8 May 2010 Andrew Wadge Chief Scientist Food Standards Agency, UK How can the social sciences help us understand the prevalence of listeriosis in the UK?

Outline of talk Foodborne disease – the burden and priorities Our strategic plan – safe food FSA messaging Trends in listeriosis in England and Wales Advisory Committee on the Microbiological Safety of Food (ACMSF) Consumption patterns in over 60s Contribution of the social sciences

Estimated number of cases and deaths associated with indigenous foodborne disease: England and Wales 2007 Cases (%) Deaths (%) Campylobacter 333,652 (36.0) 80 (18.1) Cl. perfringens 18,540 ( 2.0) 20 (4.5) Salmonella 32,155 (4.3) 92 (20.8) E. coli O (<0.1) 21 (4.7) L.monocytogenes 455 (<0.1) 162 (36.6) Norovirus 175,250 (18.9) 29 (6.5) All agents 925, Source: HPA data FSA Strategic plan – “Reduce foodborne disease further”

Estimated annual foodborne disease cases England & Wales Sources: HPA and FSA data No. cases Total cost of illness includes the direct costs to NHS and individuals in loss of earnings as well as indirect costs

FSA’s strategy Outcomes Food produced or sold in the UK is safe to eat Reduce foodborne disease using a targeted approach - tackling Campylobacter in chicken as a priority - Listeria in ready to eat chilled foods Intelligence on, global food chains to identify and reduce the impact of potential new and re-emerging risks- particularly chemical contamination Consumers understand about safe food and healthy eating, and have the information they need to make informed choices Improve public awareness and use of messages about healthy eating and good food hygiene practice at home Full strategy at

Listeriosis in England & Wales 1983 to 2008 Source: Health Protection Agency

Listeriosis in England & Wales 1990 to Source: Health Protection Agency

Host factors Microorganism Consumer Behaviour Food Consumption patterns Food hygiene Travel Disease, age, medication Characteristics including Virulence and pathogenicity

Age group specific rates of human listeriosis in England and Wales Source: Health Protection Agency

Conclusions of the ACMSF ad hoc group on vulnerable groups Increase in UK and some European counties mostly in patients aged over 60 years with bacteraemia – no evidence of a common source relationship The increase and shift in presentation of listeriosis cannot be attributed to improved diagnostics Elderly individuals are more likely to have underlying conditions which predispose to listeriosis than younger age groups. Evidence suggests that the incidence and levels of L.monocytogenes at the points of production and sale are not higher than those detected in the late 1980s Maintaining active surveillance for Listeria spp. in foods is important to inform control of this organism More information is needed on food consumption and food handling and storage behaviours in the home of the over 60s, including those who are vulnerable

Adults 65+ are more likely to eat homemade foods, fresh foods and chilled foods. They are less likely to consume frozen and ambient foods. % of individual meal occasions Total In Home, 52 w/e end Aug 2007 Source: ACMSF report on the increased incidence of listeriosis in the elderly 2009 acmsf.food.gov.uk/acmsfreps/

Contribution of the social sciences to the problem Are behaviours contributing to the risk of listeriosis in the over 60’s? In particular: consumption patterns, food storage and food preparation practices What underpins these behaviours? –Socio-demographics, lifestyle, accommodation, health status, beliefs and attitudes. Can’t explain the increase – lack of historical data But, can explore what is happening now and create a baseline for future comparisons

Defining the group at risk Diverse age group Wide variety of socio-demographic characteristics: age, income, household composition, marital and employment status, health, ethnicity etc. Different generations and cohorts Significant life changes All have effects on health status and wellbeing, in turn contribute to daily living and food habits Lack of differentiation characteristic of the current literature

What have we done so far? Advice paper produced by the Social Science Research Committee: “Liseria monocytogenes and the food storage and food handling practices of the over 60s at home” Conducted preliminary literature search and interviews with experts Found existing literature to be somewhat fragmented with topics explored in isolation Recommended thorough review of literature Developed recommendations for primary research

Challenges How to measure behaviours that are often latent Actual behaviours versus stated behaviours Who to research –Who is at risk? Need to consider the diversity of older households within the UK –Particular methodological considerations for this age group Lack of existing data in general

What will we do next? “Food and You” survey, including a module of questions on food safety and hygiene Evidence review Considering observational research and household study with those who have had listeriosis Refrigerator survey Robust cross disciplinary approach Exploring the international response

Contact us with suggestions Dr Andrew Wadge: Social Science Research Committee:

Acknowledgements Advisory Committees ACMSF SSRC Food Standards Agency Robyn Ackerman Jane Barrett Joyce Brown Paul Cook Bob Martin Health Protection Agency Ian Gillespie