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Foodborne Illness Outbreaks and Sprouts FDA Public Meeting: 2005 Sprout Safety May 17, 2005 Amy Dechet, M.D. Foodborne and Diarrheal Diseases Branch Centers for Disease Control and Prevention, Atlanta, GA
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76 million illnesses 325,000 hospitalizations 5,000 deaths Annual Burden of Foodborne Illness in the United States Mead et.al., 1999, EID
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76 million cases annually means: 1 in 4 Americans ill 1 in 1000 Americans hospitalized ≥ $6.5 billion in medical and other costs What Does This Really Mean?
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Foodborne Outbreak Surveillance Local and state health departments Detect, investigate, and control outbreak CDC Collect reports: # of cases, implicated food, etiology Define an outbreak: 2 or more cases of a similar illness resulting from the ingestion of a common food Reporting Voluntary and incomplete
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Foodborne Outbreaks Reported to CDC, 1990 - 2003 1 1 By states to the Foodborne Disease Outbreak Surveillance System Enhanced surveillance
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Produce Associated Outbreaks Reported to CDC 1998-2002* 249 outbreaks 6% of outbreaks with reported food source 13% of outbreak-associated cases Implicated produce Generic or multiple:144 outbreaks Lettuce:22 Sprouts:14 Juice:10 Melon:9 Tomato:8 Berries:6 Other produce:36 67% of outbreaks with single vehicle (*Preliminary information)
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Produce Item, Outbreaks, Consumption Produce# outbreaks% population eating item (1998-2002) (FoodNet Survey 2002) Lettuce22 73% Sprouts14 8% (“stealth” vehicle) Juice10 26-65% Melon9 21-28% Tomato8 68% Berries6 21-33%
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Sprouts: Where Does Contamination Occur? Multiple opportunities for contamination from farm to table –Field: grazing animals –Mixing: same harvest machinery and processing facilities –Scarification: bacteria enters seed –Transport: many steps along the way
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Sprouts: Bacterial Growth, Detection, and Elimination Sprouting: warm, moist environment perfect for bacterial growth –2-4 log increase in CFU/gram Difficult to detect pathogens –Non-homogenous distribution –Low-level contamination Rarely washed or cooked by consumer
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Sprouts: Why They Are Unique Multiple pathogens implicated in outbreaks –Salmonella: Typhimurium, Mbandaka, Saintpaul, Muenchen, Enteritidis, Kottbus, Chester, Cubana, Bovismorbificans –E. coli: O157:H7, O157:non-motile Multiple kinds of sprouts –alfalfa, mung bean, clover, broccoli, etc. International partners
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Sprout Outbreaks by Year
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Alfalfa Sprout Outbreaks by Year (N=26)
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Alfalfa Sprout Outbreaks by Year FDA advises chlorination of seeds
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Alfalfa Sprout Outbreaks and Compliance with FDA Guidelines by Year FDA advises chlorination of seeds
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Average Size Outbreak by Year # of Outbreaks # of CasesMean # of Cases 19984>4816 1999539278 20002Unknown 2001132 2002155 200355311 200423819
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Produce Item, Outbreaks, Consumption Produce# outbreaks% population eating item (1998-2002) (FoodNet Survey 2002) Lettuce22 73% Sprouts14 8% (“stealth” vehicle) Juice10 26-65% Melon9 21-28% Tomato8 68% Berries6 21-33%
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Using Outbreaks to Observe the Effect of Interventions: Juice-Associated Outbreaks, 1994-2004* Juice Labeling reg *National foodborne outbreak reporting system, 2004 data preliminary Juice HACCP reg Apple juice or cider Orange juice Lemonade Other juice
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Conclusions Sprout-associated outbreaks represent a small proportion of foodborne outbreaks Sprouts are one of the most common vehicles identified in produce-associated outbreaks Current practices are not adequate to prevent disease from sprouts Outbreak surveillance offers opportunities for tracking effectiveness of interventions
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Thank you!
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Alfalfa Sprout Outbreaks and Consumption by Month
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