November 9, 2015 Liz Borkowski, MPH 2Comment

Last week, the CDC published a report on multistate foodborne illness outbreaks that occurred in the US from 2010 – 2014, and the news is sobering. During that five-year period CDC received reports of 120 multistate foodborne disease outbreaks with an identified pathogen and food or common setting. While these outbreaks accounted for only 3% of the 4,163 foodborne outbreaks during that time period, they were responsible for 34% of hospitalizations and 56% of deaths associated with these outbreaks.

Salmonella bacteria were responsible for the majority of hospitalizations in multistate foodborne illness outbreaks. The largest of the Salmonella outbreaks were linked to eggs, chicken, and “raw scraped ground tuna product”; fruits, seeded vegetables, nuts and seeds, and sprouts were implicated in others.

The report authors describe some of the ways the government addresses foodborne illness outbreaks:

Rapid identification of the food that caused the outbreak, discovering where the contamination occurred along a complex supply chain, and recalling a food distributed across the country and perhaps around the world are challenging tasks. Public health departments and government agencies can work more closely with the food industries, which understand how their foods are produced and distributed, to speed up multistate state foodborne disease outbreak and traceback investigations. Lessons learned from these investigations can inform industry and government efforts to improve food safety practices.

Focusing on foods that are prominent in multistate outbreaks can guide industry and government in targeting interventions. The finding that many multistate outbreaks were caused by contaminated produce suggests a need for strengthening produce safety. Stronger safety measures in the production of fruits and vegetables are a key provision in the Food Safety Modernization Act (FSMA), enacted in 2011. FSMA granted FDA, the federal agency responsible for oversight of produce safety, new powers to improve the safe production and harvesting of produce by creating standards for environmental factors including staff hygiene, microbial levels in agricultural water, uses of animal waste in growing foods, and equipment sanitation.

The Food Safety Modernization Act could indeed be a powerful tool for reducing the toll of foodborne illness outbreaks in an era of complex food supply chains that often involve multiple countries. But, as Maryn McKenna reports at Germination, food-safety advocates are concerned that FSMA hasn’t been adequately funded:

[CDC Director Thomas] Frieden said the CDC is relying on the reorganization of federal food safety created by the Food Safety Modernization Act (FSMA for short), which gave the FDA new tracking and enforcement powers, and aims to push the responsibility for detecting contaminated imports from the very limited federal workforce to foreign governments cooperating with the US.

But, as Helena B. Evich of Politico reported in an investigation published last July, the 2010 FSMA is effectively an unfunded mandate, all but abandoned by the administration that pushed so hard for its passage. The FDA, she said, is $276 million short of what it needs to implement the law’s sweeping changes and has not been able to implement any of the tough new rules it created.

Funding is the critical component that would allow federal food safety to peer into supply chains and keep such large outbreaks from occurring again, agreed Sandra Eskin, director of food safety at The Pew Charitable Trusts. She points out that, according to the CDC’s report, fresh produce causes an ever-larger proportion of complex outbreaks, and that the unpredictable contamination that occurs in fields demands sophisticated, predictive responses that agencies can’t now afford.

Last year, Food Safety News used USDA data and calculated that foodborne illnesses cost the US economy more than $15 billion per year. The $276 million needed for FSMA is a small fraction of that. I’d like to see Congress less focused on cutting expenditures and more focused on investing in public health.

2 thoughts on “Multistate foodborne illness outbreaks are disproportionately deadly

  1. Is it that multistate outbreaks are more likely to be deadly, or that deadly outbreaks are more likely to be fully investigated and correctly identified as multi-state?

  2. Young CC Prof: Or could it also be that the types of foods involved in multi-state outbreaks are more likely to be consumed by people who are already at greater risk of death from food borne diseases? I’m specifically thinking of the peanut paste outbreak, where the product was mostly sold to schools, hospitals and other institutional groups.

    It will be interesting to see if greater use of PulseNet (the system that monitors the molecular fingerprint of pathogens involved in food borne diseases) will show that most outbreaks are actually multi-state and we just didn’t have the data to connect them.

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