EpiReady FOODBORNE ILLNESS AND ITS IMPACT Module 2
Epi-Ready FOODBORNE ILLNESS AND ITS IMPACT Module 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 2 -2
Foodborne Illness in the United States 47. 8 million cases per year 128, 000 hospitalizations 3000 deaths 2 -3
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) 2 -4
Average Cost per Case Pathogen Total Cost Total Cases Identified Average Cost per Case $319, 850, 293 96 $3, 331, 773. 89 $2, 834, 444, 202 1, 591 $1, 781, 548. 84 $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 Vibrio vulnificus Listeria monocytogenes E. coli O 157 (STEC) 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) 2 -5
Burden on the Food Industry Brand Damage §Seldom limited to one company §May impact entire community Lost Sales Burden on Industry Direct costs §Indirect costs also include: § Litigation § Regulatory compliance §Direct cost can reach $10 million 2 -6
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 2 -7
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 250 persons § Includes: meals lost per illness, lawsuits, legal fees, fines and higher insurance premiums Source: Johns Hopkins Bloomberg School of Public Health 2 -8
Bacterial Pathogens §Ability to multiply outside of host §Three pathways to illness: § Preformed toxin § Infection followed by enterotoxin production E. coli 2 -9
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 2 -10
Parasites §Free living or cause infection within a host §Protozoa § Cyclospora § Cryptosporidium § Toxoplasma gondii §Worms (Helminths) § Taenia saginata § Taenia solium § Trichinella spiralis Cyclospora cayetanensis 2 -11
Toxins and Chemicals § Marine algae toxins § Fungal toxins § Fish toxins § Chemicals 4 -12
Disease Outbreaks with Confirmed Etiology Viral Bacterial 39% 53% Parasitic 1% Toxin/Chemical 7% Source: Foodborne Disease Outbreak Surveillance System 2009 -2015 2 -13
Illness Characteristics Intoxication Food consumed with preformed toxin Rapid onset of symptoms Nausea and vomiting Infection Enterotoxin Food consumed that is contaminated with microorganism Delayed onset of symptoms Diarrhea and possibly fever No secondary spread of Secondary spread of illness likely Delayed onset of symptoms Diarrhea May have some secondary exposures 2 -14
Common Food Source Attributions Listeria monocytogenes Fruits Dairy E. coli O 157 Campylobacter Salmonella Vegetable Row Crops Chicken Seeded Vegetables Seafood Chicken Beef Seeded Vegetables Vegetable Row Crops Eggs Other Produce Pork Beef Fruits Source: Interagency Food Safety Analytics Collaboration (IFSAC) 2 -15
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 2 -16
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 2 -17
Goals of the Outbreak Investigation Identify the agent causing disease Implement shortterm controls to eliminate the source Find the source of the outbreak Take action to prevent additional cases of illness Identify the cause of the outbreak Establish institutional controls to prevent similar outbreaks 18
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 2 -19
Coming Up Next Response Teams – Planning and Preparation 2 -20
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