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

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

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

4. 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)

5. 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)

6. 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

7. 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

8. 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 persons
Includes: meals lost per illness, lawsuits, legal fees, fines and higher insurance premiums
Source: Johns Hopkins Bloomberg School of Public Health

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

10. 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

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

12. Toxins and Chemicals Marine algae toxins Fungal toxins Fish toxins

13. Disease Outbreaks with Confirmed Etiology
Source: Foodborne Disease Outbreak Surveillance System

14. 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

15. 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)

16. 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

17. 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

18. 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

19. 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

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