Current State of Foodborne Illness Arthur P. Liang, MD, MPH Director, Food Safety Office National Center for Infectious

2. Conclusions We are not losing the “war.” Unfortunately, we probably can’t win it either. Food Safety folks will always have a job.

3. Causes of Death, United States, 1900

4. Causes of Death, United States, 1992

5. 5 years later the first deaths from what became known as AIDS Est. 250,000 people were already infected.5 years later the first deaths from what became known as AIDS Est. 250,000 people were already infected.

6. Examples of Pathogenic Microbes Identified Since 1973 1973 Rotavirus 1977 Ebola virus 1977 Legionella pneumophila 1980 Human T-lymphotrophic 1981 Toxin-producing Staph aureus 1982 Escherichia coli O157:H7 1982 Borrelia burgdorferi 1983 HIV 1983 Helicobacter pylori 1989 Hepatitis C Virus 1992 Vibrio cholerae O139 1993 Hantavirus Virus 1994 Cryptosporidium 1995 Ehrlichiosis 1996 nvCJD Prion 1997 HVN1 Virus Influenza 1999 Nipah Virus

7. Emergence of non-typhoid Salmonella: Reported infections USA, 1920-1997

8. Emergence of Foodborne Pathogens 1900 Botulism Brucellosis Cholera Hepatitis Scarlet fever (streptococcus) Staphylococcal food poisoning Tuberculosis Typhoid fever 1975-1995 Norwalk-like viruses Campylobacter jenjuni Salmonella Enteritidis Shiga toxin-producing E. coli O157:H7, O111:NM, O104:H21 Listeria monocytogenes Clostridium botulinum (infant) Vibrio cholerae 0139 Vibrio vulnificus Yersinia enterocolitica Arcobacter butzleri Hepatitis E Cryptosporidium parvum Giardia lamblia Cyclospora cayetanensis Toxoplasma gondii BSE prion Nitzchia pungens (dinoflagellate) is our forth point, the emergence of many new kinds of bacteria. 1942: Only 4 pathogens found in foods. 1975-1995: Newly recognized pathogens have dramatically increased. 14 of these new pathogens are listed here. is our forth point, the emergence of many new kinds of bacteria. 1942: Only 4 pathogens found in foods. 1975-1995: Newly recognized pathogens have dramatically increased. 14 of these new pathogens are listed here.

10. Microbe factors

11. Environment factors

12. Democratic Staff Report, US Senate Agriculture Committee (1998) “Animal Waste Pollution in America, An Emerging National Problem” US Manure Estimates, 1997 5 tons of animal manure / person / year 130 times greater than amount of human waste

13. E. coli O157 Scotland (JE Coia et al, J. Infect 36:317, 1998) Handling / preparing raw food (40%) Gardening / garden play (36%) Lived on / visited farm (20%) Direct / indirect contact with manure (17%) Private H20 supply (12%) Recent high coliform counts in H20 supplies (12%)

14. Imported Food Consumption on the RiseSource: USDA Agricultural Research Service Currently, according to FDA 38% Fruit and 12% vegetables are imported. Currently, according to FDA 38% Fruit and 12% vegetables are imported.

15. Examples of U.S. outbreaks traced to foods from other countries

16. 1999 FDA Imported Produce Sampling, n=1003 4.4% positive No E. coli 0157:H7 Salmonella - 80% of violations

17. 215 (65%) of 331 tested patient isolates from 23 states matched by PFGE 675 cases were reported to PHLIS 432 cases (64%) over expected baseline

18. Large, multi-state outbreaks 1988-92 8 multi-state outbreaks 1993-97 = 30 multi-state outbreaks1988-92 8 multi-state outbreaks 1993-97 = 30 multi-state outbreaks

19. Number of multi-state outbreaks, 1990-1999 1988-92 8 multi-state outbreaks 1993-97 = 30 multi-state outbreaks ’98 = 9 ’99 = 8 1988-92 8 multi-state outbreaks 1993-97 = 30 multi-state outbreaks ’98 = 9 ’99 = 8

20. Host factors

21. Changing eating habits

23. Norwalk-like virus Outbreaks, 1997 – 2000

24. E. coli O157 Study, 1999-2000 Restaurant consumption of pink hamburger was NOT associated with infection * FoodNet case-control studies

25. Improved surveillance & detection

26.

27. PulseNet (1995 TX, MA, MN, WA) E.coli, Salmonella, Listeria, & Shigella States in Orange have RT-PCR capability for NLV & have submitted positive samples to CDC for confirmation & typing States in Green have RT-PCR capability, but have not yet submitted positive samples States in Gray have the protocols for RT-PCR, but have not yet tested outbreak samplesPulseNet (1995 TX, MA, MN, WA) E.coli, Salmonella, Listeria, & Shigella States in Orange have RT-PCR capability for NLV & have submitted positive samples to CDC for confirmation & typing States in Green have RT-PCR capability, but have not yet submitted positive samples States in Gray have the protocols for RT-PCR, but have not yet tested outbreak samples

28. Burden of Foodborne Disease, 21st Century

29. Most common causes of foodborne IllnessMead et al, 1999 Restaurant food handling important with NorwalkRestaurant food handling important with Norwalk

31. Where do the microbes come from?

32. Are we winning the war against foodborne disease?

33. Emergence of non-typhoid Salmonella: Reported infections USA, 1920-1997

34. 2001 FoodNet Data 23 percent overall drop in 7 bacterial foodborne illnesses since 1996. 27% Campylobacter 15% Salmonella 35% Listeria 49% Yersinia "Preliminary FoodNet Data on the Incidence of Foodborne Illnesses -- Selected Sites, United States, 2001" Morbidity & Mortality Weekly Report (April 19, 2002) http://www.cdc.gov/mmwr/. 

36. Addressing Food Hazards in the 21th century

37. At the top of Haeckel's tree are Menschen - men, & Haeckel meant white European males. In middle of his tree are reptiles, & below them amphibians At the base of his tree are single celled amoebas, & "monera" - Haeckel's name for the bacteria. Haeckel's picture of evolution was a picture of linear progress from bacteria to humans. Indeed, he defines four explicit stages of progress (on the right side of the picture): Protozoa, Invertebrates, Vertebrates, Mammals.  At the top of Haeckel's tree are Menschen - men, & Haeckel meant white European males. In middle of his tree are reptiles, & below them amphibians At the base of his tree are single celled amoebas, & "monera" - Haeckel's name for the bacteria. Haeckel's picture of evolution was a picture of linear progress from bacteria to humans. Indeed, he defines four explicit stages of progress (on the right side of the picture): Protozoa, Invertebrates, Vertebrates, Mammals.

38. Woesian Tree of Life In terms of bio-diversity, all plants & animals are just twigs compared to the branches that make up micro-organisms. The majority of eukaryotic life is, in fact, microbial (protists). There is far more phenotypic & genotypic diversity in all the protist groups combined than within the plant, animal or fungal kingdoms. Carl Woese University of Illinios in the late 1970s, Woese wanted to determine evolutionary relationships; using ribosomal RNA Bacteria appear about 3.5 billion years ago. The oldest fossil evidence for anatomically modern humans is about 130,000 years old in Africa, & there is evidence for modern humans in the Near East sometime before 90,000 years ago. Bacteria can go through 30 generations in a day; this would be equivalent to 1000 years of human evolution. Bacteria can acquire & spread genetic material laterally via plasmids & transposons. Through biofilms can form alliances with other bacteria & microorganisms In terms of bio-diversity, all plants & animals are just twigs compared to the branches that make up micro-organisms. The majority of eukaryotic life is, in fact, microbial (protists). There is far more phenotypic & genotypic diversity in all the protist groups combined than within the plant, animal or fungal kingdoms. Carl Woese University of Illinios in the late 1970s, Woese wanted to determine evolutionary relationships; using ribosomal RNA Bacteria appear about 3.5 billion years ago. The oldest fossil evidence for anatomically modern humans is about 130,000 years old in Africa, & there is evidence for modern humans in the Near East sometime before 90,000 years ago. Bacteria can go through 30 generations in a day; this would be equivalent to 1000 years of human evolution. Bacteria can acquire & spread genetic material laterally via plasmids & transposons. Through biofilms can form alliances with other bacteria & microorganisms

39. Conclusions We are not losing Microbes rapidly adapt through biologic evolution, transfer of genes. Microbes appear 3.5 Billion years ago Homo sapien adapts through cultural evolution, transfer of information The World is counting on you to pass down the lessons of civiliztion to this and future generations Once you start you can’t stop

40. The Red Queen Principle - Leigh van Valen (evolutionary biologist, 1973) “…in this place it takes all the running you can do, to keep in the same place.“ - Red Queen to Alice in Through the Looking Glass

41. Est. Foodborne Illnesses (thousands) by etiology, Mead et al, 1999