Understanding the Public Health Significance of Shiga Toxin-Producing E. coli. Betsy Booren, Ph.D. Director, Scientific Affairs

Transcription

1 Understanding the Public Health Significance of Shiga Toxin-Producing E. coli Betsy Booren, Ph.D. Director, Scientific Affairs June 21, 2011

2 A New Concern for the Meat Industry? The meat industry has long recognized that all STEC, including non-o157: H7 STEC (nstec), have the potential to cause illness in humans under the right conditions. The industry has initiated research to show that process management systems are effective against nstec as the originating source of the contamination, the same as E. coli O157:H7 Industry has supported development of new intervention technologies and testing methodologies.

3 Food Safety Food safety top industry Food safety is a non-competitive issue in a highly competitive industry Companies in the meat industry openly share food safety information with one another

4 Annual Foodborne Illness Estimates Known Foodborne Pathogens 1 Unspecified Agents 2 Total Illnesses 9.4 million 38.4 million 47.8 million Hospitalizations 55,961 71, ,839 Deaths 1,351 1,686 3,037 Total Illnesses from All FSIS Regulated Products 3 584,335 1 Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson M-A, Roy SL, Jones JL, and Griffin PM. (2011). Foodborne illness acquired in the United States major pathogens. Emerg Infect Dis. 17(1): Scallan E, Griffin PM, Angulo FJ, Tauxe RV, and Hoekstra RM. (2011). Foodborne illness acquired in the United States unspecified agents. Emerg Infect Dis. 17(1): USDA FY 2012 Budget Summary and Annual Performance Plan.

5 Illnesses Attributed to Foodborne Transmission of Known Pathogens Source: Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson M-A, Roy SL, Jones JL, and Griffin PM. (2011). Foodborne illness acquired in the United States major pathogens. Emerg Infect Dis. 17(1): 7-15.

6 Deaths Attributed to Foodborne Transmission of Known Pathogens Source: Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson M-A, Roy SL, Jones JL, and Griffin PM. (2011). Foodborne illness acquired in the United States major pathogens. Emerg Infect Dis. 17(1): 7-15.

7 Incidence of Foodborne Illnesses 2010* Salmonella Campylobacter STEC**O157 Listeria Non-O157 STEC *Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, **Shiga toxin-producing Escherichia coli

8 Progress towards Healthy People 2010 Objectives for Foodborne Illnesses Salmonella Campylobacter STEC**O157 Listeria Incidence in 2010 Health People 2010 Objective **Shiga toxin-producing Escherichia coli Source: Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

9 Progress towards Healthy People Objectives for Foodborne Illnesses Salmonella Campylobacter STEC**O157 Listeria Incidence in 2010 Healthy People 2010 Healthy People 2020 **Shiga toxin-producing Escherichia coli Source: Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

10 Incidence per 100,000 Population Incidence of Foodborne Illness : E. coli O157* National Health Objective: National Health Objective: *Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

11 Incidence per 100,000 Population Incidence of Foodborne Illness : Salmonella* National Health Objective: National Health Objective: *Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

12 Incidence per 100,000 Population Incidence of Foodborne Illness : Campylobacter* National Health Objective: National Health Objective: *Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

13 Incidence per 100,000 Population Incidence of Foodborne Illness : Listeria* National Health Objective: National Health Objective:.20 *Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

14 Comparison of O157 and Non-O157 STEC All Food O157 Non-O157 Illnesses 63, ,752 Hospitalizations 2, Hospitalization Rate 46.2% 12.8% Deaths 20 0 Death Rate 0.5% 0.3% Travel Related 8% 4% Source: Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson M-A, Roy SL, Jones JL, and Griffin PM. (2011). Foodborne illness acquired in the United States major pathogens. Emerg Infect Dis. 17(1): 7-15.

15 Number of Outbreaks Foodborne Outbreaks: Multi-ingredient Seafood 684 Produce Poultry Beef Other Foods Pork Dairy Breads and Bakery Luncheon and Other Meats Eggs Beverages 14 Game Source: Outbreak Alert: Analyzing Foodborne Outbreaks , Closing the Gaps in Our Federal Food-Safety Net, Center for Science in the Public Interest (

16 Non-O157 STEC Outbreaks 1 U.S. Year State Serogroup Setting Vehicle 1990 Ohio O111 Home/family outbreak Unknown 1994 Montana O104 Home Pasteurized milk Montana O121 Camp Unknown 1999 Texas O111 Camp Salad bar; Ice from barrel Connecticut O121 Community Recreational lake water Minnesota O145 Daycare Person-to-person 2000 Minnesota O111 Camp Animal contact - calves Washington O103 Banquet hall Water-based punch Utah O111 Camp Irrigation water 2001 Minnesota O111, O51 Camp Animal contact - calves Minnesota O26 Swimming beach Recreational lake water South Dakota O111 Daycare Person-to-person 2004 New York O111 Community Unpasteurized apple cider 2005 Nevada O26 Daycare Person-to-person Oregon O145 Camp Drinking water New York O45 Correctional facility Ill food workers 1 Centers for Disease Control and Protection. Accessed June 10, 2011.

17 Non-O157 STEC Outbreaks 1 U.S. Year State Serogroup Setting Vehicle 2006 North Carolina O45 Family farm Animal contact - goats Nebraska O121 Daycare Person-to-person Utah O121 Catered event Lettuce Massachusetts O26 Community Strawberries, blueberries 2007 Maine O111 Daycare Person-to-person North Dakota O111 Elementary school Person-to-person North Dakota O111 Private home Ground beef Colorado O121, O26, O84 Correctional facility Pasteurized American cheese, margarine New Hampshire O45 Fair petting zoo Animal contact 2008 Oklahoma O111 Restaurant Unknown Minnesota O111 Daycare Person-to-person 2010 Multi-state 2 O145 Food service Romaine lettuce Multi-state 3 O26 Home Ground beef 1 Centers for Disease Control and Protection. Accessed June 10, Centers for Disease Control and Protection. Accessed June 10, Food Safety and Inspection Service. Accessed June 10, 2011.

18 CDC Outbreaks Among Pathogens - All Food : Source: CDC Foodborne Outbreak Online Database. Accessed February 18, 2011.

19 CDC Foodborne Outbreaks: O157 Non-O157 All Foods Beef Related 93 0 % Beef Related 31% 0% Source: CDC Foodborne Outbreak Online Database. Accessed February 18, 2011.

20 CDC All Food STEC Outbreaks: E. coli O157:H7 nstec Source: CDC Foodborne Outbreak Online Database. Accessed February 18, 2011.

21 Source: Mody R and Luna RE. Surveillance for Non-O157 STEC Infections and Outbreaks, United States. CDC Enteric Disease Epidemiology Branch. Presentation. January 5, 2011.

22 Source: Mody R and Luna RE. Surveillance for Non-O157 STEC Infections and Outbreaks, United States. CDC Enteric Disease Epidemiology Branch. Presentation. January 5, 2011.

23 Source: Mody R and Luna RE. Surveillance for Non-O157 STEC Infections and Outbreaks, United States. CDC Enteric Disease Epidemiology Branch. Presentation. January 5, 2011.

24 Incidence per 100,000 Population Incidence of Foodborne Illness : E. coli O157* National Health Objective: National Health Objective: *Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food Foodborne Diseases Active Surveillance Network, 10 U.S. Sites,

25 Percent Positives Prevalence of E. coli O157:H7 in Ground Beef* % Reduction * Microbiological results of raw ground beef products analyzed for Escherichia coli O157:H7.

26 Percent Postitives Prevalence of E. coli O157:H7 in Ground Beef * 99** Fiscal Year 08*** Microbiological results of raw ground beef products analyzed for Escherichia coli O157:H7. * In 1998 FSIS increased sample size from 25 g to 375 g. ** In July 1999 FSIS changed to a more sensitive analytical method. *** In 2008, FSIS changed to a more sensitive enrichment broth

27 E. coli O157:H7 Recalls Meat Products Total No. of Recalls * ** * 81 No. of Recalls due to Illness Investigation (%) 3 (50%) 4 (80%) 0 10 (50%) 5 (33%) 5** (27%) 4 (36%) 31 (38%) No. of Recalls due to FSIS/ Company Sample (%) 3 (50%) 1 (20%) 8 (100 %) 10 (50%) 10 (67%) 11 (73%) 7 (64%) 50 (62%) *Does not include August 30 Health Alert **Recall associated with both a positive sample and illness outbreak is included in illness investigation *** 2010 data does not include recall for E. coli O26

28 Public Health Agencies Consumer Meat Industry Regulatory Agencies

29 What is needed Public health agencies provide accurate and timely foodborne illness attribution data. Allow stakeholders to allocate resources and scientifically justify food safety decisions. Regulators and the meat industry can accurately identify and improve any food safety gaps that may exist. Help to identify emerging foodborne risks Especially when risks not previously associated with specific foods. This rapid adjustment to improve food safety can only occur if accurate data is made available as soon as possible to all food safety stakeholders.

30 What is needed To complement public health data, FSIS should consider and evaluate how public health would be improved by declaring nstec to be adulterants or if there are alternative regulatory paths that could be more effective. To do this, FSIS needs to better understand the prevalence of all STEC, including nstec, in the U.S. beef supply. Baseline is a needed metric in determining whether declaring nstec to be adulterants in beef will improve public health or if food safety measures currently employed by the U.S. beef industry are effective in controlling STEC contamination

31 What is needed The meat industry should also employee a process management system that addresses all STEC, which may include using E. coli O157:H7 as an indicator organism. Process management systems are used to assess the adequacy of control within a food safety program using microbiological monitoring and could be used to make decisions in mitigating the risk of STEC on beef products.

32 What is needed Consumers should better understand the risks associated with raw agricultural products in order to make the best purchasing and handling decisions for their lifestyle.

33 Conclusions Given the history of STEC outbreaks and the industry s success in reducing E. coli O157:H7 prevalence in beef products, E. coli O157:H7 is likely the best microorganism to target in reducing the risk when consuming beef products as the number of confirmed illnesses within the U.S. have been more attributed to E. coli O157:H7 than to nstec. Also, E. coli O157:H7 could be used as an indicator organism in a systematic food safety process management system used to control STEC contamination

34 Final Thoughts The last decade has shown the important role cooperation and communication between public health officials, regulators, the meat industry, and other allied stakeholders have had on improving food safety. This collaborative success story, lessons learned, and the need for additional research can develop the blueprint in mitigating the STEC risk in beef products

35 Understanding the Public Health Significance of Shiga Toxin-Producing E. coli Betsy Booren, Ph.D. Director, Scientific Affairs June 21, 2011