How Do We Manage a Food Illness Outbreak
AND WHAT ARE ITS COSTS ?
By Claudio Gallottini, ITA Ccorporation
In the United States different entities work together to protect consumers from foodborne illnesses. Every year in the U.S. there are 43 milion cases of foodborne illnesses with 2,500 deaths. In the EU there are 25 million cases, with 5,000 deaths, in South Asia 175 milion cases with 175,000 deaths. So how does America manage all of these cases and what is the cost? What can we do about developing a food safety culture?
FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network was created to manage not just outbreak response, but also the surveillance and post-response activities related to incidents involving multiple illnesses that are linked to FDA-regulated human and animal food and cosmetic products. CORE is a network that includes resources across FDA, the federal government and state and local partner agencies. Within the FDA, the network includes, among others, the Office of Crisis Management, the Office of External Relations, the subject matter experts at FDA’s Center for Food Safety and Applied Nutrition and the Center for Veterinary Medicine, staff from Office of Regulatory Affairs at both headquarters and within the FDA Districts, and the Office of International Programs. Outside the FDA, the CORE network includes the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Agriculture, and food safety, agricultural, regulatory, public health and laboratory professionals at state and local government agencies.
During a multi-state foodborne disease outbreak, CDC serves as lead coordinator between public health partners to detect the outbreak, define its size and extent, and to identify the source. Public health officials investigate outbreaks to control them, so more people do not get sick in the outbreak, and to learn how to prevent similar outbreaks from happening in the future. When a foodborne disease outbreak is detected, public health and regulatory officials work quickly to collect as much information as possible to find out what is causing it, so they can take action to prevent further illness. During an investigation, health officials collect three types of data: epidemiologic, traceback, and food and environmental testing.
A foodborne outbreak investigation goes through several steps. One way health officials find outbreaks is through public health surveillance. By routinely gathering reports of illnesses, they know how many illnesses to expect in a given time period in a given area. If a larger number of people than expected appear to have the same illness in a given time period and area, it’s called a cluster. When an investigation shows that ill people in a cluster have something in common to explain why they all got the same illness, the group of illnesses is called an outbreak. What happens when a doctor suspects a person has a foodborne illness?
- The patient may be asked to submit a stool sample (or some other type of sample) to help figure out what germ is making them ill.
- The patient’s sample is sent to a clinical laboratory.
- The clinical laboratory tests and may identify the germ (for example, a bacteria or virus) that is making them ill.
- The clinical laboratory tells the doctor’s office the results of their testing so the doctor can treat the illness.
- The germ may then be sent to the state public health laboratory for DNA fingerprinting.
For some pathogens, like the bacteria Salmonella and E. coli O157, public health laboratories and state laboratories report their DNA fingerprinting results to the PulseNet database. PulseNet is a national laboratory network that connects foodborne illness cases to detect outbreaks. PulseNet uses DNA fingerprinting, or patterns of bacteria making people sick, to detect thousands of local and multistate outbreaks. It can take several weeks (from the day the person became ill to the day the results of fingerprinting are known) before the bacteria is added to the PulseNet database.
Case definitions are developed by health officials to spell out who will be included as part of the outbreak. Case definitions may include details about:
- Features of the illness
- DNA fingerprint (if the pathogen is tracked by PulseNet)
- The pathogen or toxin (if known)
- Certain symptoms typical for that pathogen or toxin
- Time range for when the illnesses occurred
- Geographic range, such as residency in a state or region
There might be several case definitions for an outbreak investigation, each with a different purpose. For example, one case definition might be for confirmed illnesses and another for probable illnesses. The number of illnesses that meet the case definition is called the case count. Investigators watch the progression of an outbreak by tracking who becomes ill, when they become ill and where they live. Investigators begin by trying to pinpoint how the pathogen spread. They review details such as the specific pathogen causing illness, where sick people live, how old they are, their sex, and race/ethnicity, and did they have contact with a sick person.
Investigators collect information from sick people (cases) and non-sick people (controls) to see if sick people were more likely to have eaten a certain food or to report a particular exposure. Case-control studies try to include controls who have had the same opportunities to be exposed to an unsafe food item as a case has. To achieve this goal, controls are carefully chosen using matching or selection techniques.
What are outbreak control measures?
- Cleaning and disinfecting food facilities;
- Temporarily closing a restaurant or processing plant;
- Recalling food items;
- Telling the public how to make the food safe (such as cooking to a certain temperature) or to avoid it completely;
- Telling consumers to throw away the suspect food from their pantry or refrigerator.
An outbreak ends when the number of new reported illnesses drops back to the number normally expected. The epidemic curve helps investigators see that illnesses are declining. Even when illnesses from the outbreak appear to have stopped, public health officials continue surveillance for a few weeks to be sure cases don’t start to increase again.
What is the cost?
Let’s consider some statistics about the economic cost of foodborne illness in the United States, such as medical expenses and deaths, along with lost wages and economic productivity. A 2014 estimate from the U.S. Department of Agriculture placed the direct and indirect costs associated with illnesses caused by major foodborne pathogens at $15.6 billion per year. A more recent estimate from Ohio State University that covered all causes of foodborne illness, not just illness from the major foodborne pathogens, was at least $55.5 billion.
And what about costs associated with food recalls? In 2012, the Grocery Manufacturers Association (GMA) and the Food Marketing Institute estimated that the average cost for a food recall in the United States was $10 million. That number was just for the direct costs to the company, such as the retrieval and disposal of the recalled product. There are also indirect costs, including lawsuits, damage to a company’s or product’s reputation, and sales losses.
GMA also did a survey of several dozen multi-national corporations, and 18 percent indicated they had been involved in recalls with estimated costs between $30 million and $99 million each. Another 5 percent said they had been involved in recalls that cost more than $100 million.
Developing a Food Safety Culture
All around the world food industries have implemented the international voluntary standard for food safety, but the numbers of foodborne illnesses do not decrease. So new strategies will be less about standards, and more about food safety culture. This is the direction adopted by food leaders and globally accepted. When employees, managers, and leaders feel personally committed to food safety, they will do the right thing even when nobody is watching, even when it is not the cheapest or fastest approach. A strong organizational culture can help create and sustain that commitment. Over time, good food safety practices become the normal way of doing things. In the long run, a robust food safety culture will prevent foodborne illnesses and will reduce the likelihood of scandals that destroy brand value.
ITA Corporation is a company specializing in food safety, inspection and auditing worldwide. Its main focus is to offer support, awareness and guidance about Food and Drug Administration (FDA) regulatory matters. ITA thoroughly assists both domestic and foreign food facilities in meeting the requirements of the Food Safety Modernization Act (FMSA) with consulting, auditing and training programs. Services cover all FSMA rules, HACCP, labeling and U.S. regulations. To contact ITA, e-mail: cgallottini@itacorporation.org or call + 347-964-0171 in the U.S.