Abstract
BackgroundAbout 1.4 million Salmonella infections, a common food-borne illness, occur in the U.S. annually; the elderly (aged 65 or above) are most susceptible. In 1997, the USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Points Systems (PR/HACCP) which demands regular Salmonella testing in various establishments processing meat products, such as broiler chickens. Impact evaluations of PR/HACCP on hospitalizations related to Salmonella are lacking.MethodsHospitalization records of the U.S. elderly in 1991-2004 were obtained from the Centers of Medicare and Medicaid Services. Harmonic regression analyses were performed to evaluate the long-term trends of Salmonella-related hospitalizations in pre- and post-HACCP periods. Seasonal characteristics of the outcome in the nine Census divisions of the contiguous U.S. were also derived and contrasted.ResultsPredicted rates decreased in most divisions after 1997, except South Atlantic, East South Central, and West South Central. These three divisions also demonstrated higher overall hospitalization rates, pronounced seasonal patterns, and consistent times to peak at about 32nd to 34th week of the year.ConclusionThe impact of HACCP was geographically different. South Atlantic, East South Central, and West South Central divisions should be targeted in further Salmonella preventive programs. Further research is needed to identify the best program type and timing of implementation.
Highlights
About 1.4 million Salmonella infections, a common food-borne illness, occur in the U.S annually; the elderly are most susceptible
Is the HACCP regulation associated with lower salmonellosis rates? It is important to realize that the raw difference in divisional rates is not the outcome of interest for two reasons: (i) the rate of hospitalization is not just a function of disease prevalence and of other factors, such as the number of hospital beds per citizen, practices of disease coding, and health-seeking behaviors, (ii) the implementation of the HACCP regulation studied here was very unlikely to have impacted on the divisional medical infrastructure, in this analysis, we chose to focus on the change of hospitalization rates in the pre- and post-HACCP period within each division, and it is these changing patterns that we wish to compare and contrast
Some divisions did not show expected results: the hospitalization rates in East South Central, West South Central, and South Atlantic divisions were originally decreasing before pre-HACCP, they became stable in the post-HACCP period (Figure 2)
Summary
About 1.4 million Salmonella infections, a common food-borne illness, occur in the U.S annually; the elderly (aged 65 or above) are most susceptible. Salmonella infection is a common food- and water-borne disease in the U.S.; about 1.4 million cases occur annually [1], of which 22% lead to hospitalization. As the U.S is rapidly aging, preventing Salmonella infections in the elderly is important [6,7]. The total estimated medical cost in 2006 due to Salmonella infections was US$191 million [8]. This medical expense is very likely to rise with the expanding proportion and size of the elderly population
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