foodborne disease surveillance in the u.s.: foodnet, pulsenet, and outbreak alert! caroline smith...
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Foodborne Disease Surveillance Foodborne Disease Surveillance in the U.S.: FoodNet, PulseNet, in the U.S.: FoodNet, PulseNet,
and and Outbreak Alert!Outbreak Alert!
Caroline Smith DeWaalCaroline Smith DeWaalCenter for Science in the Public Interest (U.S.)Center for Science in the Public Interest (U.S.)
Geneva, SwitzerlandGeneva, Switzerland June 8, 2005June 8, 2005
The Burden of IllnessThe Burden of Illness
According to the U.S. Centers for Disease According to the U.S. Centers for Disease Control and Prevention (CDC), there are an Control and Prevention (CDC), there are an estimated:estimated:
76 million76 million foodborne illnessesfoodborne illnesses annually annually in the U.S.in the U.S.
325,000 hospitalizations325,000 hospitalizations due to due to foodborne illness annually in the U.S.foodborne illness annually in the U.S.
5,000 deaths5,000 deaths due to foodborne illness due to foodborne illness annually in the U.S.annually in the U.S.
Foodborne Disease Surveillance & Foodborne Disease Surveillance & Investigation in the U.S.Investigation in the U.S.
FoodNet – FoodNet – active surveillanceactive surveillance
PulseNet – PulseNet – laboratory network that laboratory network that
performs microbialperforms microbial
sub-typingsub-typing
Outbreak Alert!Outbreak Alert! – food attribution – food attribution
Foodborne Diseases Active Foodborne Diseases Active Surveillance Network (FoodNet)Surveillance Network (FoodNet)
Active, laboratory-based surveillance Active, laboratory-based surveillance within ten well-defined surveillance within ten well-defined surveillance areas around the United Statesareas around the United States
Monitor trends in foodborne diseasesMonitor trends in foodborne diseases
Conduct case-control studiesConduct case-control studies
FoodNet (FoodNet (cont.cont.))
FoodNet PathogensFoodNet PathogensCampylobacterCampylobacter
CyclosporaCyclospora
CryptosporidiumCryptosporidium
Escherichia coliEscherichia coli O157:H7 O157:H7
Listeria monocytogenesListeria monocytogenes
SalmonellaSalmonella
ShigellaShigella
VibrioVibrio
Yersinia enterocoliticaYersinia enterocolitica
Approximately Approximately 15,000 laboratory-15,000 laboratory-diagnosed cases, diagnosed cases, each yeareach year
Data collected Data collected includes patient includes patient demographics, co-demographics, co-morbidities, hospital morbidities, hospital stay details, and stay details, and laboratory resultslaboratory results
PulseNet USAPulseNet USA
National database of pulsed-field gel National database of pulsed-field gel electrophoresis (PFGE) patternselectrophoresis (PFGE) patterns
Enables outbreak cases and Enables outbreak cases and concurrent sporadic cases to be concurrent sporadic cases to be distinguisheddistinguished
Does not include routine PFGE Does not include routine PFGE patterns from food and animal patterns from food and animal sourcessources
What is PFGE?What is PFGE?
DNA “fingerprinting”DNA “fingerprinting”
A method used to differentiate specific A method used to differentiate specific strains of bacteria using DNA migration by strains of bacteria using DNA migration by size in an agarose gel stimulated by an size in an agarose gel stimulated by an electrical currentelectrical current
More sensitive and discriminating than More sensitive and discriminating than conventional gel electrophoresis because conventional gel electrophoresis because the electrical field used to stimulate DNA the electrical field used to stimulate DNA migration is pulsed (constantly changing) migration is pulsed (constantly changing) rather than uniformrather than uniform
PulseNet USA (PulseNet USA (cont.cont.))
PulseNet PathogensPulseNet PathogensCampylobacter jejuniCampylobacter jejuni
CyclosporaCyclospora
CryptosporidiumCryptosporidium
Escherichia coliEscherichia coli O157:H7 O157:H7
Listeria monocytogenesListeria monocytogenes
SalmonellaSalmonella
ShigellaShigella
VibrioVibrio
Yersinia enterocoliticaYersinia enterocolitica
The PulseNet The PulseNet database database includes tens of includes tens of thousands of thousands of PFGE patternsPFGE patterns
Labs at the Labs at the national, state, national, state, and local levels and local levels have access to have access to the databasethe database
Outbreak Alert!Outbreak Alert!
Food CategoriesFood CategoriesBeefBeefBeveragesBeveragesBreads & BakeryBreads & BakeryDairyDairyEggs & Egg DishesEggs & Egg DishesGameGameLuncheon/Other MeatsLuncheon/Other MeatsMulti-Ingredient FoodsMulti-Ingredient FoodsMultiple FoodsMultiple FoodsPorkPorkPoultryPoultryProduceProduceSeafoodSeafood
Outbreaks in the U.S. Outbreaks in the U.S. occurring between occurring between 1990-20031990-2003
Contains almost 4,500 Contains almost 4,500 outbreaks including outbreaks including over 138,000 individual over 138,000 individual cases of foodborne cases of foodborne illnessillness
A project managed and A project managed and maintained by a maintained by a private, non-profit, private, non-profit, consumer advocacy consumer advocacy groupgroup
Trends in Outbreak Reporting, 1990-2003Trends in Outbreak Reporting, 1990-2003
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
# o
f O
utb
reak
s
Seafood
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
# o
f O
utb
reak
s
Produce
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
# o
f O
utb
reak
s
Poultry
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
# o
f O
utb
reak
s
Beef
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
# o
f O
utb
reak
s
Eggs
Source: Center for Science in the Public Interest, Outbreak Alert! database, 2005
Outbreak Alert!Outbreak Alert! ( (cont.cont.))
Useful for alerting consumers to food Useful for alerting consumers to food safety hazards, providing better safety hazards, providing better information for food safety resource information for food safety resource allocation, and identifying gaps in the allocation, and identifying gaps in the U.S. outbreak reporting systemsU.S. outbreak reporting systems
Outbreak Alert!Outbreak Alert! is scheduled to be is scheduled to be updated and released in September updated and released in September 2005. Available at:2005. Available at:http://www.cspinet.org/foodsafety/http://www.cspinet.org/foodsafety/
ConclusionsConclusions
Importance of consumer groups Importance of consumer groups providing government oversightproviding government oversight
U.S. surveillance programs need to U.S. surveillance programs need to be more integrated and coordinatedbe more integrated and coordinated
A single, unified food safety agency A single, unified food safety agency would strengthen the U.S. foodborne would strengthen the U.S. foodborne disease surveillance programs, and disease surveillance programs, and the food safety infrastructure overallthe food safety infrastructure overall