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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

When you are talking tens of millions sickened by foodborne illnesses annually, does it really matter if the trend numbers are down?

Since the 1999 article by Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV., Food-related illness and death in the United State have been estimated at approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents (a.k.a., norovirus) account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths.

It is expected that the numbers above are likely to be adjusted downward soon. This is not because we have figured out a way not to poison as many people, but most likely a better way of counting actual ill people and the causes of the illnesses.

The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC’s Emerging Infections Program has been conducting active, population-based surveillance in 10 U.S. states for all laboratory-confirmed infections with select enteric pathogens transmitted commonly through food. The trend lines per 100,000 population are as follows:

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In 2009, a total of 17,468 laboratory-confirmed cases of infection were identified. In comparison with the first 3 years of surveillance (1996–1998), sustained declines in the reported incidence of infections caused by Campylobacter, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157, Shigella, and Yersinia were observed. The incidence of Vibrio infection continued to increase. Compared with the preceding 3 years (2006–2008), significant decreases in the reported incidence of Shigella and STEC O157 infections were observed.

When you deal daily with the aftermath of foodborne illnesses, the trend lines – although hopeful – are hard to keep in context. I am looking forward to the new CDC foodborne illness numbers.

  • The headline and first sentence demonstrate to me an acceptance of several IDEAS as if they are FACTS, including:
    1) The estimates in the 1999 Mead study are fairly accurate.
    2) The Mead estimates are the CDC estimates AND they are the definitive estimates.
    3) ALL foodborne illness is inherently bad.
    4) It is possible to dramatically reduce the number of these illnesses ACROSS THE BOARD.
    None of these are FACTS; all are only ideas and each can be questioned very strongly.
    In order, here are my quick responses:
    1) Thanks to “Foodborne Illness by the Numbers” by Alex Ferguson in “Food Safety News”
    (http://www.foodsafetynews.com/2010/03/foodborne-illness-by-the-numbers/), I was introduced to “Deaths due to Unknown Foodborne Agents” by Paul D. Frenzen
    (http://www.cdc.gov/ncidod/EID/vol10no9/03-0403.htm). This 12 page study was published 9/04 in “Emerging Infectious Diseases,” the very same journal of the CDC which published the Mead study. It raises very significant questions about the methodology used in Mead to develop the estimate of deaths due to “unknown pathogens.” Those same questions apply to the estimated number of illnesses and hospitalizations.
    The push-polls done by the Pew Charitable Trust in October 2009 also contained 2 questions about self diagnosed foodborne illness that were NOT mentioned in the press releases. They produced an estimate of less than 10% of people having a foodborne illness annually whereas the Mead estimate is over 25%. That’s a rather huge disparity.
    In fact, even with the huge extrapolations from recorded illnesses used in Mead, less than 19% of its estimates were from known pathogens and over 2/3’s of those were Norwalk-type viruses (aka, stomach flu). The remaining 81+% were due to “unknown pathogens.”
    Clearly, the Mead estimates are way off.
    2) The Mead estimates are NOT the CDC’s estimates. There are NO CDC estimates. There are only estimates that were made FOR the CDC. By that logic, Frenzen’s PEER REVIEWED article would also be an official CDC position and equally authoritative. Of course, that’s equal hogwash.
    In fact, there are NO definitive estimates. Mead, like all others, are only estimates.
    And, after a BS in math and 35 years of professional work trying to tickle out the meaning in quantifiable data via statistics, I find Paul Frenzen’s criticism of Mead quite mild.
    3) We are all exposed to pathogens all day, every day. Those miniscule attacks are absolutely necessary for us to have a healthy immune system. As one writer put it, a light bout of foodborne illness once a year might actually be good.
    Yet, I hear food safety advocates regularly decry ALL foodborne illness as if it needs to be eradicated.
    4) As the British and Danes have shown us, we have known for a couple of decades how to dramatically reduce the incidence of Salmonella enteritidis (SE) and have not had the regulatory nor political will to do what is needed to reduce them. (See “Unscrambling the Egg Mess: What the British Have Done” by Phyllis Entis
    [http://efoodalert.blogspot.com/2010/08/unscrambling-egg-mess-what-british-have.html]) The more I research SE and the FDA’s Final Shell Egg Rule, the more appalled I am at what are regulators are permitting.
    We have essentially wiped out certain foodborne illnesses in the past (e.g., trichinosis and BSE) and minimized others (e.g., tapeworms) so, clearly, we can clearly reduce some foodborne illnesses dramatically.
    And, I would argue that the same techniques used to minimize SE could be applied to E. coli 0157:H7 and other STEC. Instead, we are allowing and even supporting the spread of these even more dangerous pathogens throughout nature so that soon we may no longer be able to contain them.
    It is idea that we can cause “ACROSS THE BOARD” dramatic reduction NOT specific disease reduction that is what bothers me.
    Other foodborne illnesses (e.g., Norwalk-type viruses) are like the common cold and seasonal flu, they will NEVER be even well contained unless a vaccine is developed to minimize them.
    So, where does this lead me?
    First, there is NO food safety crisis in America and a crisis mentality will only lead us to foolish actions which can very well reduce safety of food in the long term. We have the time, and need to take the time, to carefully consider changes to our food safety regulatory system.
    Second, focused efforts on specific diseases and there vehicles and vectors are what will lead to clear improvements. The huge broad scale changes called for in both S 510/HR 2749 will keep us from controlling that which we can control.
    Third, there are existing techniques well within the existing authority of the FDA and FSIS that they are not using and we need to hold them accountable for their failure to use those powers efficaciously.
    The Wright County Egg/Hillandale egg recall is a prism that clearly shows almost all of the component issues of food safety and the failure of both the FDA and FSIS to use those existing authorities to address a well-known threat. We need to learn the right lessons from it not the wrong ones.