Foodborne Illness Acquired in the United States—Major Pathogens

Estimating the number of illnesses caused by foodborne pathogens is critical for allocating resources and prioritizing interventions. We estimated the number of illnesses, hospitalizations, and deaths in the United States caused by 7 major foodborne pathogens by using surveillance data and other sources, adjusted for underreporting and underdiagnosis. Campylobacter spp., Clostridium perfringens, invasive Listeria monocytogenes, norovirus, nontyphoidal Salmonella serotypes, and Shiga toxin–producing Escherichia coli caused ≈9.9 million (90% credible interval [CrI] 5.9–15.4 million) domestically acquired foodborne illnesses in 2019. Together with Toxoplasma gondii, those pathogens caused 53,300 (90% CrI 35,700–74,500) hospitalizations and 931 (90% CrI 530‒1,460) deaths. Norovirus caused most illnesses (≈5.5 million illnesses, 22,400 hospitalizations), followed by Campylobacter spp. (1.9 million illnesses, 13,000 hospitalizations) and nontyphoidal Salmonella serotypes (1.3 million illnesses, 12,500 hospitalizations). Salmonella infection was the leading cause of death (n = 238). Foodborne illness estimates can inform policy and direct food safety interventions that reduce those illnesses.

An Economic Evaluation of PulseNet: A Network for Foodborne Disease Surveillance.

Incidence of Foodborne Diseases in the United States and Canada

To review the evidence on the application of tools for dengue outbreak prediction/detection and trend monitoring in passive and active disease surveillance systems in order to develop recommendations for endemic countries and identify research needs. Systematic review of literature in the Cochrane Database of Systematic Reviews, PubMed, EMBASE, Lilacs, WHO library database, manual reference search and grey literature. Two reviewers independently applied pre-defined inclusion and exclusion criteria and assessed the level of evidence. Studies describing the outcome of dengue disease surveillance with respect to trend monitoring and outbreak prediction/detection based on empirical data were included. Twenty-four studies (of 1804 references) met the eligibility criteria. Different indicators and their respective threshold values were identified as potential triggers for outbreak alerts through retrospective analysis of data from passive and/or active surveillance systems. Some indicators are potentially useful for predicting imminent outbreaks in the low transmission season and others for detecting outbreaks at an early stage. However, the information collected is mainly retrospective and often site-specific and appropriate levels of sensitivity and specificity of the outbreak indicators/triggers could not be determined. Retrospective and prospective virus surveillance studies were not conclusive regarding the question of whether a newly introduced serotype is an outbreak predictor, but contributed additional indicators for outbreak prediction/detection. Under-reporting was a major concern. Taking cost and feasibility issues into account, it remains an open question whether dengue surveillance should be passive (based on routine reporting) or active (based on more costly sentinel or other active population based surveillance systems). Adding active surveillance elements to a well-functioning passive surveillance system improves sensitivity; adding laboratory elements to the system improves specificity. In view of the lack of evidence about the most feasible and sustainable surveillance system in a country context, countries could use a stepwise approach to locally adapt their passive routine surveillance system into an improved combined active/passive surveillance approach. Prospective studies are needed to better define the most appropriate dengue surveillance system and trigger for dengue emergency response.

A spatial hierarchical model for integrating and bias-correcting data from passive and active disease surveillance systems

Consumer Food-Handling Behaviors Associated with Prevention of 13 Foodborne Illnesses

How Safe Is Our Food?

The Philadelphia Department of Public Health (PDPH) conducts active surveillance for varicella in West Philadelphia. For its approximately 300 active surveillance sites, PDPH mandates biweekly reports of varicella (including zero cases) and performs intensive case investigations. Elsewhere in Philadelphia, surveillance sites passively report varicella cases, and abbreviated investigations are conducted. We used active varicella surveillance program data to inform the transition to nationwide passive varicella surveillance. We compared classification of reported cases, varicella disease incidence, and reporting completeness for active and passive surveillance areas for 2005-2010. We assessed reporting completeness using capture-recapture analysis of 2- to 18-year-old cases reported by schools/daycare centers and health-care providers. From 2005 to 2010, PDPH received 3,280 passive and 969 active surveillance varicella case reports. Most passive surveillance reports were classified as probable cases (18% confirmed, 56% probable, and 26% excluded), whereas nearly all of the active surveillance reports were either confirmed or excluded (36% confirmed, 11% probable, and 53% excluded). Overall incidence rates calculated using confirmed/probable cases were similar in the active and passive surveillance areas. Detection of laboratory-confirmed, breakthrough, and moderate-to-severe cases was equivalent for both surveillance areas. Although active surveillance for varicella results in better classified cases, passive surveillance provides comparable data for monitoring disease trends in breakthrough and moderate-to-severe varicella. To further improve passive surveillance in the two-dose-varicella vaccine era, jurisdictions should consider conducting periodic enhanced surveillance, encouraging laboratory testing, and collecting additional varicella-specific variables for passive surveillance.

Measures of disease burden such as quality-adjusted life years (QALYs) are increasingly important to risk-based food safety policy. They provide a means of comparing relative risk from diverse health outcomes. We present detailed disease-outcome trees and EQ-5D scoring for 14 major foodborne pathogens representing over 95% of foodborne illnesses, hospitalizations, and deaths due to specified agents in the United States (Campylobacter spp., Clostridium perfringens, Cryptosporidium parvum, Cyclospora cayetanensis, Escherichia coli O157:H7, Shiga toxin-producing E. coli non-O157, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella, Toxoplasma gondii, Vibrio vulnificus, Vibrio parahaemolyticus and other noncholera Vibrio, and Yersinia enterocolitica). We estimate over 5800 QALYs lost per 1000 cases of L. monocytogenes and V. vulnificus, compared to 125 QALYs lost per 1000 cases of T. gondii, 26 for E. coli O157:H7, 16 for Salmonella and Campylobacter, and 14 for Y. enterocolitica. The remaining 7 pathogens are estimated to cause less than 5 QALYs lost per 1000 cases. In total, these 14 pathogens cause over 61,000 in QALY loss annually, with more than 90% due solely to acute infection being responsible for 65% of total QALY loss, with premature mortality and morbidity due to chronic and congenital illness responsible for another 28%. These estimates of the burden of chronic sequelae are likely conservative; additional epidemiological research is needed to support more accurate burden estimates. This study shows the value of using integrated metrics for comparing disease burden, and the need to consider chronic and congenital illness when prioritizing foodborne pathogens.

Impacts of Microbial Food Safety in China and Beyond.

Each year, 31 major known pathogens acquired in the United States caused an estimated 9.4 million episodes of foodborne illness. Additional episodes of illness were caused by unspecified agents, including known agents with insufficient data to estimate agent-specific illness, known agents not yet recognized as causing foodborne illness, substances known to be in food but of unproven pathogenicity, and unknown agents. To estimate these additional illnesses, we used data from surveys, hospital records, and death certificates to estimate illnesses, hospitalizations, and deaths from acute gastroenteritis and subtracted illnesses caused by known gastroenteritis pathogens. If the proportions acquired by domestic foodborne transmission were similar to those for known gastroenteritis pathogens, then an estimated 38.4 million (90% credible interval [CrI] 19.8-61.2 million) episodes of domestically acquired foodborne illness were caused by unspecified agents, resulting in 71,878 hospitalizations (90% CrI 9,924-157,340) and 1,686 deaths (90% CrI 369-3,338).

A recent Food and Drug Administration (FDA) proposal aims to speed the evaluation process for new high-risk medical devices that are intended to address unmet medical needs,1 much like existing expedited approval processes, such as the humanitarian device exemption rule for devices intended to treat rare diseases. Such programs are strongly supported by the medical device industry and some patient advocacy groups, which have criticized the FDA for being too stringent in its evidentiary requirements for investigational devices, leading to delays in the approval of potentially helpful products.2–4 For example, in 2011, the FDA approved a transcatheter aortic valve replacement system that demonstrated significant improvements over conventional treatment options for selected patients with severe aortic stenosis.5,6 However, the United States was the 43rd country to approve the device, roughly 4 years after the European Union.7 Yet expedited approval for high-risk medical devices raises the possibility that these devices will not be as effective as predicted in their limited premarket testing or that they could cause unanticipated harms after approval.8 Of course, well-studied devices may present unexpected safety concerns years after approval,9,10 and even the most rigorous conventional premarket approval process will result in some devices later found to be unsafe or ineffective.11–13 Safety of approved medical devices and the proper scope of premarket testing remain contentious issues after recalls of several widely used devices, including popular models of implantable cardioverter defibrillator leads14,15 and metal-on-metal hip implants.16 Inherent limitations in premarket testing, along with the prospect of lowered evidentiary standards for expedited device reviews, place greater pressures on postapproval monitoring of devices to follow clinical performance and to identify emerging public health problems. Medical device manufacturers routinely perform this sort of vigilance, …

The Economics of Enteric Infections: Human Foodborne Disease Costs

The term food borne diseases or food-borne illnesses or more commonly food poisoning are used to denote gastrointestinal complications that occur following recent consumption of a particular food or drink. Millions of people suffer worldwide every year and the situation is quiet grave in developing nations creating social and economic strain. The food borne pathogens include various bacteria viz., Salmonella, Campylobacter, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Staphylococcus, Arcobacter, Clostridium perfringens, Cl. botulinum and Bacillus cereus and helminths viz., Taenia. They also include protozoa viz., Trichinella, Sarcocystis, Toxoplasma gondii and Cryptosporidium parvum. The zoonotic potential and the ability to elaborate toxins by many of the microbes causing fatal intoxication are sufficient to understand the seriousness of the situation. The viral agents being host specific their transmission to humans through food of animal origin is not yet confirmed although these animal viruses are similar to that of viruses infecting human. Food-borne bacteria; protozoa and helminthes have complex distribution pattern in the environment and inside the host system. This along with complexity of the maintenance chain and life cycle (of parasites) has made it difficult for epidemiologist and diagnostician to undertake any immediate safety measures against them. Serological and molecular diagnostic tests viz. ELISA, Latex agglutination test, Lateral flow assays, Immunomagnetic separation assays, molecular assays viz. Polymerase Chain Reaction (PCR), multiplex PCR, immuno-PCR, Realtime PCR, Random Amplified Polymorphic DNA (RAPD)-PCR, DNA microarrays and probes are widely used. Along with these LAMP assays, Capillary Electrophoresis-Single Strand Confirmation polymorphism (CE-SSCP); Flow cytometry, FISH, Biosensors, Direct epifluorescent filter technique, nanotechnology based methods and sophisticated tools (ultrasonography, magnetic resonance imaging and chlonangio-pancreatography) have aided in the diagnosis greatly. Most of the food-borne illnesses are self-limiting but in many instances antibiotics are recommended. With the increased drug resistance however use of chicken immunoglobulin, bacteriophage therapy, probiotics and herbs are gaining much importance these days. Adoption of proper prevention and control measures (including cooking procedures; hygiene, strict adherence to HACCP principles, public awareness and disease surveillance and monitoring) are the need of hour. All these have been discussed vividly in this review to help epidemiologists, diagnosticians, clinicians and above all common people so as to enable them avoid negligence regarding such serious issue.

Environmental DNA (eDNA) is useful for delimiting species ranges in aquatic systems, whereby water samples are screened for the presence of DNA from a single species. However, DNA from many species is collected in every sample, and high-throughput sequencing approaches allow for more passive surveillance where a community of species is identified. In this study, we use active (targeted) and passive molecular surveillance approaches to detect species in the Muskingum River Watershed in Ohio, USA. The presence of bighead carp (Hypophthalmichthys nobilis) eDNA in the Muskingum River Watershed was confirmed with active surveillance using digital droplet polymerase chain reaction (ddPCR). The passive surveillance method detected the presence of eDNA from northern snakehead (Channa argus), which was further confirmed with active ddPCR. Whereas active surveillance may be more sensitive to detecting rare DNA, passive surveillance has the capability of detecting unexpected invasive species. Deploying both active and passive surveillance approaches with the same eDNA samples is beneficial for invasive species management.