Perspective on Foodborne Illness Surveillance and Prevention from a Mom Snowbird, Utah September 23, 2009 Barbara Kowalcyk Kowalcyk,, M.A. Director of Food Safety Center for Foodborne Illness Research & Prevention

The Center for Foodborne Illness Research & Prevention ((CFI)) A national,, nonnon-p profit health organization g dedicated to preventing foodborne illness th through h research, h education, d ti y and service. advocacy

A Global Food Market

Recent Foodborne Illness Outbreaks

Foodborne Illness is a serious public health issue!

Preliminary 2008 FoodNet Data

Source: Centers for Disease Control and Prevention. Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly through Food - 10 States, 2008. MMWR 2009;58(13):333-7.

GAO Reports to Congress In 2007, 200 the Government G Accountability Office Off added transforming the federal oversight of food safety to its list of high risk areas in its High High-Risk Risk Update to Congress. In 2008, GAO identified food safety as one of the 13 urgent issues facing President Obama and 111th Congress. Congress

The Cost of Foodborne Illness

Barb, B b Mik Mike, M Megan & K Kevin i K Kowalcyk l k July 2001, Acadia National Park, Maine

The Cost of Foodborne Illness

Kevin Michael Kowalcyk, age 2 1/2 12/10/98 - 8/11/01

Public Health Response August 6 – First A Fi contact with i h llocall h health lhd department staff. Family members submit stool specimens for laboratory testing. September 10 – Family contacts health department for more information and first learns of Michael and Megan’s Megan s positive laboratory results results. September 11 – Family contacts health department with q questions about p potential exposures. p September 18 – Family contacts health department and are informed investigation is closed.

Finding the Source Family is frustrated and contacts MarlerClark. - 25+ 25 record d requests t -9p public agencies g - Investigation lasted over 3 years

PFGE Match

The Xba1 and Bln1 Bionumeric pattern designations for 01BC2510 are: Xba: EXHX01.0074

Bln1: EXHA26.0014

The Xba1 and Bln1 Bionumeric pattern designations for two USDA ground beef samples collected 8/31/01 are: Xba1: EXHX01.0074

Bln1: EXHA26.0014

P d t Traceback Product T b k November 2003 – Local Grocer asked to provide records. May 2004 – Grocer declines to provide records. July Ju y 2004 00 – MarlerClark a e C a files es su suit to o force o ce release e ease o of records. eco ds September 2004 – Records provided but unable to establish conclusive link between food consumed and producer producer. November 2004 – Litigation abandoned.

The Reality of Foodborne Illness

CDC Estimates 76 million Americans are sickened, 325,000 Americans are hospitalized and 5,000 , Americans die each year from food-borne illnesses. Source: Paul S. Mead, et al., Food-Related Illness and Death in the United States, Emerging Infect. Dis. (No. 5) 607, 614 (1999).

Vulnerable Populations

Costs of Foodborne Illness Foodborne F db ill illnesses accountt ffor about b t 1 off every 100 hospitalizations h it li ti and 1 of every 500 deaths1. Camplyobacter, Salmonella, E. coli O157:H7, Listeria monocytogenes and Toxoplasma gondii cause an estimated $6.9 billion in medical costs, lost productivity and premature deaths2 EACH YEAR! This represents only a fraction of the total costs due to foodborne illness and does not include pain and suffering, which is difficult to quantify, and other costs, such as public health expenditures, that are often overlooked.

1 Buzby,

Frenzen,and Rasco. Food and Rural Economics Division, Economic Research Service, S USDA. S Agricultural Economic Report No. 799: Product Liability and Microbial Foodborne Illness. 2 Buzby. Food and Rural Economics Division, Economic Research Service, USDA. Children and Microbial Foodborne Illness. Food Review, Vol 24, Issue 2.

More Than Just a Stomach Ache

According to the Food and Drug Administration, an estimated 2 to 3 percent of foodborne illness victims develop secondary long-term medical complications. complications

That’s That s1 1.5 5 million lingering health problems each year year.

Source: Buzby. Food and Rural Economics Division, Economic Research Service, USDA. Children and Microbial Foodborne Illness. Food Review, Vol 24, Issue 2.

Long--term Health Impacts Long •

S l Salmonella ll is i a lleading di predictor di t for f reactive ti arthritis. th iti

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Campylobacter is a leading cause of Guillian-Barre Syndrome. Syndrome

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Listeria monocytogenes kills over 1/3 of its perinatal victims. victims

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E. coli O157:H7 and other shiga-toxin producing pathogens are almost the exclusive cause of HUS HUS, the leading cause of acute kidney failure in children in the U.S.

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One third of HUS survivors will suffer life-long One-third life long medical problems.

The Real Cost of Foodborne Illness

Recognizing a Serious Public Health Issue In 2008, the International Food Information Council’s Council s Food and Health Survey found that 45% of American consumers are confident of the safety of the United States food supply. In 2009, a poll by the Harvard School of Public Health found that 32% of American consumers were confident in the safety of the food supply. Food Marketing Institute Institute’ss 2005 Annual Food Survey found Americans were 85% confident in the food supply. Sources: International Food Information Council Foundation. 2008 Food and Health Survey: Consumer Attitudes Toward Food, Nutrition and Health. 2008,, pp. 41. Harvard School of Public Health, http://www.hsph.harvard.edu/news/press-releases/2009-releases/peanut-product-recallsurvey-americans-reduce-risk-sick.html Food Marketing Institute. Grocery Shopper Trends: Economic Concerns Shaping How Consumers Shop, Cook and Dine. 2005, www.fmi.org

Federal Food Oversight

Food Oversight System

The Challenges 1. Fragmented oversight system 2. Communication within/between agencies 3. Critical data gaps and lack of data sharing 4. Traceabilityy 5. Insufficient resources 6 Workforce crisis 6. We can improve the system by working together to build an integrated food safety system!

Surveillance and the Policy Cycle 1. Assessing the magnitude of the problem 2 Identifying causes of the problem 2. 3. Establishing priorities 4. Choosing prevention/control strategies 5. Defining targets 6 Measuring Success 6.

Integrating Epidemiology, Risk Assessment, Economics Values Risk Assessment Animal Contact

C t Costs

Food Pathways

Exposure

Disease

Ch Change

Environment

Epidemiology

Ch i Choice Source: Modified from Havelaar et al. Integrating risk assessment, epidemiology and economics to support decision making in food safety. Report no. 06-001. February 2006. Figure 1.

An Integrated Surveillance System Collection, synthesis and analysis of data from: • Human, plant, animal surveillance y pathogen p g surveillance • Laboratory-based • Food surveillance • Behavioral surveillance

Solutions for the 21st Century •

Development of an integrated surveillance system

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Better communication and data sharing among agencies

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Adequate resources for state, local and federal agencies

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Improve victim assistance at all levels

The ultimate goal is to prevent this from happening to others.

Thank You! For more information, contact Center for Foodborne Illness Research & Prevention P O Box P.O. B 206 Grove City, PA 16127 (724) 458 458-0767 0767 [email protected] www.foodborneillness.org