Food Safety Guest Speaker Evaluations Viewer Call-In Phone: Fax: Thank You to our Sponsors February 18, 2010

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1 Food Safety February 18, 2010 Guest Speaker Dale Morse, MD, MS Assistant Commissioner Office of Science New York State Department of Health Thank You to our Sponsors School of Public Health, University at Albany NYS Department of Health NYS Community Health Partnership Special Thanks to NYS Association of County Health Officials NYS Nurses Association Viewer Call-In Phone: Fax: Evaluations Please visit to fill out your evaluation and post test. Nursing Contact Hours, CME, CHES are available. Thank you!

2 Changing Patterns of Foodborne Disease: Vignettes of a State Epidemiologist and Science Officer Dale L. Morse, MD, MS Public Health Live! New York State Department of Health February 18, 2010 Diarrhea and foodborne illness have been around a long time I am poured out like water, and all my bones are out of joint: My heart is like wax; it is melted in the midst of my bowels. Psalms 22: 14 The Bible Oswego: An Outbreak of Gastrointestinal Illness Following a Church Supper S. aureus outbreak among church picnic attendees. The classic, straightforward 1940 outbreak investigation in a defined population. Changing Epidemiology of Foodborne Outbreaks scope local global occurrence isolated widespread detection unit epi lab timeframe point propagated scale of contamination small large Reportable Foodborne Diseases Botulism Campylobacteriosis Cholera Cryptosporidiosis Cyclosporiasis Shigatoxin producing E. coli Hepatitis A Listeriosis Salmonellosis Shigellosis Staphylococcal enterotoxin B poisoning Trichinosis Typhoid Vibriosis Yersiniosis Foodborne outbreaks

3 We eat out of everybody else s garden. Dan Colley, CDC New York Times September 29, 1997 Health Burden of Foodborne Diseases in the United Estimated 76 million ilnesses, 323,000 hospitalizations, 5,000 deaths (1999) Burden of Foodborne Diseases Pyramid Reported to Health Dept./CDC Most illness appears to be sporadic 1,300 foodborne outbreaks reported Most severe disease is in the very young, the elderly, and the immunocompromised ~Health-related costs of 7 major infections: $9 - $48 billion (2008 $) Mead, EID 1999 Buzby and Roberts, Food Review 1997 States Annual Estimates Culture confirmed case Lab tests for organism Specimen obtained Person seeks care Person becomes ill Illness in the general population Active surveillance Laboratory survey Physician survey Population survey Challenge: Many Different Pathogens and Toxins More than 250 pathogens and toxins transmitted by food; More pathogens continue to be identified; Many pathogens also spread through water, direct animal or human contact; The 6 most important pathogens are: Estimates of Annual Food-Related Illnesses Deaths Norovirus 9,200, Campylobacter 1,900, Salmonella 1,350, Toxoplasma 1,125, E. coli O157:H7 et al* 93, Listeria 2, *And other Shiga toxin-producing E. coli NYS: Foodborne Disease Outbreaks Number of Outbreaks Updated 02/ Reporting Year

4 THE NEW YORK TIMES, WEDNESDAY, SEPTEMBER 29, 1982 We must remain devoted to the canons of science that are so much part of the practice of medicine and the practice of the allied arts. To do otherwise would be to build public policy on quicksand. - - David Axelrod, MD Clam and Oyster Associated Outbreaks outbreak 234 ill outbreaks 1017 ill outbreaks 888 ill Attack rates 36-53%, dose response Etiology norovirus, hepatitis A Source NY 51%, RI 21%, MA 6%, Eng 6% Morse et. al, NEJM 1986; NYS Shellfish Actions Education of Public/Industry Warning not to eat raw shellfish How to cook safely Proper labeling, handling, storage Inspection Inspectors check for tags Traceback to source Enforcement Citations (14% of 908 sites) Closing of polluted waters Embargoes Scientific/Legislative Meetings Guzewich and Morse, J Food Prot 1986; 49: Long Term Results Better enforcement of harvesting, tagging and monitoring requirements Easier tracebacks Adoption of Uniform Standards

5 Confirmed Or Suspected Outbreaks With Shellfish As Significant Ingredient In Implicated Food: NYS Total # of Shellfish Associated Outbreaks = 240 STEC O157 Cases of E.coli 0157:H7 Infection by Week of Onset, MN, 1994 Cases of E.coli: 0157:H7 Infection by PFGE Pattern by Week of Onset, MN 1994 *NEJM 1997; 337:

6 Examples of Usefulness of PFGE for Major Outbreaks 1998 Salmonella agona and toasted oats cereal 11 states 203 illnesses (NY 24) 1998 Listeriosis and hot dogs 22 states 101 illnesses (NY 14) 1999 Washington County Fair E. coli 0157:H7 (775 cases) and Campylobacter (44 cases) water associated outbreak (NY) A Paradigm Shift: NYS Use of PFGE in National Foodborne Outbreaks, Outbreaks 31 Food items 24 (ground beef 9, tomatoes 3, cereal 2) States 3-47 (avg 16) US cases (avg 170) NYS cases 2-84 (avg 18) Some Recent Large US Multi-State Outbreaks of Foodborne Infections (n=20) E. coli O157 and bagged spinach E. coli O157 and shredded lettuce (restaurant chain A) E. coli O157 and shredded lettuce (restaurant chain B) Botulism and commercial pasteurized carrot juice Salmonella and fresh tomatoes E. coli O157 and frozen pizza Salmonella and peanut butter Salmonella and a vegetarian snack food Salmonella and dry dog food Salmonella and microwaveable pot pies Salmonella and dry puffed breakfast cereal E. coli O157 and ground beef Botulism and canned chili sauce A new food vehicle Salmonella and cantaloupe identified in 12/20 of E. coli O157 and ground beef the outbreaks Salmonella and fresh produce items Salmonella and peanut butter containing foods Salmonella and imported white and black pepper Salmonella and alfalfa sprouts 2009 E. coli O157 and prepackaged cookie dough Source: CDC, Ian Williams 2007 Ground Beef Outbreak PFGE linked 12 cases from 5 states 4 NYS cases ate ground beef 17 frozen patties from two cases tested at NYS lab 4 + with outbreak pattern 4 + with different pattern USDA Action not yet! NYS Departments of Health and Agriculture and Markets: searched for unopened boxes issued a joint consumer advisory based on opened package positives Tested and confirmed E.coli from patties of an unopened box USDA posted a Recall Notice after Consumer Advisory issued

7 Topps-Summary NYS 13 Cases 12/13 recalled consuming ground beef 10/12 recalled consuming Topps brand Hospitalized (10), HUS (1) 43 Cases in 10 States 10 meat samples positive with 11 PFGE patterns Recall of 21.7 million pounds of ground beef Traced back to a Canadian firm that provided beef trim to Topps As of 03/05/2008 Results are preliminary and not for dissemination. Investigating One Case Can Have National Significance E.coli 015:H7 confirmed in 58 year old New York female Tested opened ground beef patties from freezer PFGE pattern of beef and patient isolates matched Based on code on meat package, purchased unopened package in Michigan - E. coli 0157:H7 positive with same PFGE Resulted in recall of thousands of pounds of beef patties from meat distributor in California Foodborne Outbreak Response Partners, NYS, 2009 Council to Improve Foodborne Outbreak Response (CIFOR) NYS Food Supply Chain Farms Food Processors Food Warehousing Retail Food Stores Homes Food Services If tampering is suspected State Police* NYS Dept. Agriculture & Markets Food Laboratory Primary Investigation Responsibility* Ill Persons USDA FDA CDC NYDEC Industry Academia Federal Agencies State Agencies State District Offices City & County Health Departments County HD Labs NYSDOH Communicable Disease Food Protection Wadsworth Laboratory Private/Hospital Labs State Regional Offices Communicable Disease Food Protection NEHA NASDA USDA/ FSIS NACCHO AFDO FDA ASTHO APHL CDC CSTE * State Police is lead agency for investigation of product tampering cases EXTRAS

8 Current Salmonella Montivideo Outbreak Investigation As of January 31, 203 confirmed cases from 42 states with same PFGE pattern 16 cases from NYS Illnesses associated with consumption of salami Same PFGE pattern found in opened and unopened product National recall of salami product underway Black pepper component also being investigated Some Recent Large US Multi-State Outbreaks of Foodborne Infections (n=20) E. coli O157 and bagged spinach E. coli O157 and shredded lettuce (restaurant chain A) E. coli O157 and shredded lettuce (restaurant chain B) Botulism and commercial pasteurized carrot juice Salmonella and fresh tomatoes E. coli O157 and frozen pizza Salmonella and peanut butter Salmonella and a vegetarian snack food Salmonella and dry dog food Some Recent Large US Multi-State Outbreaks of Foodborne Infections (n=20) Salmonella and microwaveable pot pies Salmonella and dry puffed breakfast cereal E. coli O157 and ground beef Botulism and canned chili sauce Salmonella and cantaloupe E. coli O157 and ground beef Salmonella and fresh produce items Salmonella and peanut butter containing foods Salmonella and imported white and black pepper Salmonella and alfalfa sprouts 2009 E. coli O157 and prepackaged cookie dough Evaluations Please visit to fill out your evaluation and post test. Nursing Contact Hours, CME, CHES are available. Thank you!