Today in the Morbidity and Mortality Weekly Report (MMWR) the CDC published its foodborne illness outbreak data for 2008 with a comparison to the averages of 2003 – 2007. According to the CDC, during 2008 1,034 foodborne disease outbreaks were reported, which resulted in 23,152 illness, 1,276 hospitalizations, and 22 deaths. However, the CDC does estimate that foodborne agents (known and unknown) still cause 48 million illnesses, 125,000 hospitalizations and 3,000 deaths annually in the United States. According to MMWR, 2008 bacterial infections related to known and unknown agents ranked:
- Salmonella – 117 Outbreaks with 4,960 Illnesses
- Clostridium perfringens – 40 Outbreaks with 1,409 Illnesses
- E. coli (both O157 and non) – 36 Outbreak with 920 Illnesses
- Campylobacter – 25 Outbreaks with 615 Illnesses
- Bacillus cereus – 15 Outbreaks with 122 Illnesses
- Staphylococcus enterotoxin – 14 Outbreaks with 311 Illnesses
- Shigella – 6 Outbreaks with 170 Illnesses
- Clostridium botulinum – 4 Outbreaks with 10 Illnesses
- Listeria – 3 Outbreaks with 33 Illnesses
- 10. Vibrio parahaemolyticus – 1 outbreak with 2 Illnesses
In the report in 2008 only three viruses from known and unknown agents commanded the CDC’s attention:
- Norovirus – 356 Outbreak with 9,175 Illnesses
- Hepatitis A – 1 Outbreak with 22 Illnesses
- Rotavirus – 1 Outbreak with 27 Illnesses
In 2008 of the outbreaks related to a known food vehicle, outbreaks were most often attributed to poultry (15%), beef (14%), and finfish (14%). Interestingly, outbreak-related illnesses were more often attributed to fruits and nuts (24%), vine-stalk vegetables (23%), and beef (13%).
In 2008 of the total number of outbreak-related foodborne illnesses, 1,276 (6%) resulted in hospitalization. Salmonella was the most common cause of outbreak-related hospitalizations, causing 62% of hospitalizations reported, followed by Shiga toxin producing Escherichia coli (STEC) (17%) and norovirus (7%). Outbreaks caused by Clostridium botulinum resulted in the highest proportion of persons hospitalized (90%), followed by Listeria outbreaks (76%).
In 2008 among the 22 deaths associated with foodborne disease outbreaks, 20 were attributed to bacterial etiologies (13 Salmonella, three Listeria monocytogenes, three STEC [two O157, one O111], one Staphylococcus), one to norovirus, and one to a mycotoxin.
Taking with wind a bit out of the sail of “blame the consumer,” in 2008 among the 868 outbreaks with a known single setting where food was consumed, 52% resulted from food consumed in a restaurant or deli, 15% in a private home, and the remainder in other locations.
The CDC also provided a nice comparison between the average numbers of outbreaks in the five years 2003-2007 to 2008. Using the “bugs” highlighted above the average yearly number of outbreak and illnesses from known and unknown agents 2003-2007:
- Salmonella – 129 Outbreaks with 3,290 Illnesses
- Clostridium perfringens – 44 Outbreaks with 1,815 Illnesses
- E. coli (both O157 and non) – 27 Outbreak with 402 Illnesses
- Campylobacter – 22 Outbreaks with 623 Illnesses
- Bacillus cereus – 18 Outbreaks with 138 Illnesses
- Staphylococcus enterotoxin – 35 Outbreaks with 472 Illnesses
- Shigella – 11 Outbreaks with 500 Illnesses
- Clostridium botulinum – 3 Outbreaks with 10 Illnesses
- Listeria – 2 Outbreaks with 13 Illnesses
10. Vibrio parahaemolyticus – 2 outbreak with 109 Illnesses
The Average annual outbreak and illness data for viruses from known and unknown agents in 2003-2007 are here:
- Norovirus – 376 Outbreak with 10,534 Illnesses
- Hepatitis A – 5 Outbreak with 234 Illnesses
- Rotavirus – 1 Outbreak with 17 Illnesses
What is striking in the comparison is that Salmonella, E. coli and Listeria were all up in 2008 compared to the average in 2003 – 2007 with most of the rest of the “bugs” either flat or down, with Shigella and Hepatitis A down significantly.
Frankly, these statistics comport with the reality of foodborne illnesses that I saw “on the ground” during that time frame. We saw a steep decline of E. coli O157:H7 cases in our office from 2002 to mid-2006. Cases then increased from June 2006 through 2008. There has been a heartening downturn since then with E. coli O157:H7. Non-O157 E. coli seems to be going the opposite way. And, well, Salmonella, seems to have a mind all its own – especially the antibiotic-resistant variety.