Healthy People 2010 Focus Area 10:

Food Safety

Progress ReviewDecember 20, 2007

Edward J. Sondik National Center for Health

Statistics

Estimated Annual Burden ofFoodborne Disease

• 76 million illnesses

• 325,000 hospitalizations

• 5,000 deaths

• $23 billion in costs

Source: Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. Food-RelatedIllness and Death in the United States. Emerging Infectious Diseases 5(5):607-625. 1999.

Foodborne Diseases Pyramid

Exposure in the general population

Person becomes ill

Person seeks care

Specimen obtained

Culture confirmed case

Reported to Health Department/CDC

Lab tests for organisms

Food Safety Focus Area ObjectivesA Framework for Reducing Foodborne Illness

Through Prevention, Intervention and Response

Production

PreparationTransportation

Retail

Consumer

Processing

Regulations, Enforcement, and Guidance

Consumption

Distributionand

Storage

Illness

?

Obj 10-5

Objs 10-6, 7

Objs 10-1, 2,3, and 4

EducationTrainingSurveillanceResearch

Highlighted Objectives

Getting worse10-1d Foodborne infections (Salmonella spp.)10-2a Foodborne outbreaks (E. coli O157:H7)10-4b Severe allergic reactions to food

10-1a-c,f Foodborne infections 10-2b Foodborne outbreaks (Salmonella)10-5 Food safety practices

Improving

Target met or exceeded10-3c,d Antimicrobial drug resistance

Little or no progress *10-3a,b Antimicrobial drug resistance

No tracking data10-6a-i Safe retail food preparation

* Percent of targeted progress achieved is between -10% and 10%, and/or not statistically significant.

Notes: Rates are the number of culture-confirmed cases of illness for all persons.*Data for for postdiarrheal hemolytic uremic syndrome (HUS) (2000-2004) are for children under 5 years.Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies.

0

1

2

3

4

5

1997 1998 1999 2000 2001 2002 2003 2004 2005

Rate per 100,000 population

Escherichia coli O157:H7

Listeria monocytogenes 2010Targets

HUS*

Objs. 10-1b,c, f

Major Foodborne Infections

Decrease desired

Notes: Rates are the number of culture-confirmed cases of illness for all persons.Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies.

0

5

10

15

20

25

1997 1998 1999 2000 2001 2002 2003 2004 2005

Rate per 100,000 population

Campylobacter species

Salmonella species

Objs. 10-1a,d

Major Foodborne Infections

Decrease desired

2010Targets

Notes: Rates are the number of culture-confirmed cases of illness for all persons. *Data for for postdiarrheal hemolytic uremic syndrome (HUS) (2000-2004) are for children under 5 years. Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies. †Source: Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. Food-Related Illness and Death in the United States. Emerging Infectious Diseases 5(5):607-625. 1999.

0

5

10

15

20

25

1997 1998 1999 2000 2001 2002 2003 2004 2005

Rate per 100,000 population

Campylobacter speciesSalmonella species

Objs. 10-1a-d, f

Major Foodborne Infections

Escherichia coli O157:H7Listeria monocytogenes

HUS*

Estimated† percent oftotal foodborne deaths

Salmonella spp. 30.6 %Listeria monocytogenes 27.6%Campylobacter spp. 5.5%E. coli O157:H7 2.9%

Notes: † A foodborne disease outbreak is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food, among the U.S. resident population and reported to CDC. Source: Foodborne Disease Outbreak Surveillance System, CDC, NCID.

Outbreaks of Infections Caused by Key Foodborne Bacteria

0

10

20

30

40

50

60

1997 1998 1999 2000 2001 2002 2003 2004 2005

Salmonella serotype Enteritidis

Number of outbreaks †

Objs. 10-2a, b

Decrease desired

Escherichia coli O157:H72010

Targets

Human Samples of Non-Typhi Salmonella Resistant to Antibiotics

Notes: The target for 10-3a and 10-3b is zero (0). Source: National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS-EntericBacteria), CDC, NCID; FDA, CVM; USDA, FSIS, APHIS, and ARS; Foodborne Disease Active SurveillanceNetwork (FoodNet), CDC, FDA, USDA, and State agencies..

0

5

10

15

20

1997 1998 1999 2000 2001 2002 2003

Objs. 10-3a-d

Percent

Ampicillin

Gentamicin

Cephalosporins

Fluoroquinolones

2010Targets

0

10

20

30

40

50

60

70

Severe Allergic Reactions† to Food in Persons With Allergies

Notes: † Persons 18 years and older with doctor-diagnosed food allergies who report an allergic reaction within the last 5 years and who report that the allergic reaction was severe (required the use of epinephrine, or treatment in a hospital or doctor’s office, or an overnight stay in a hospital). * Data are statistically unreliable and are suppressed.Source: Food Safety Survey (FSS), FDA and USDA, FSIS.

Percent

Decrease desired

2010 Target: 21 %

Obj. 10-4b

2001 2006

EducationGender

*Black High

SchoolTotal White Female Male Some

College60 +18-59

AgeRace

Deaths From Severe Food Allergies

Source: National Vital Statistics System—Mortality (NVSS—M), CDC, NCHS;Food Safety Survey (FSS), FDA and USDA, FSIS. Obj. 10-4a

• ICD-10 codes for food-induced anaphylaxis were developed but do not necessarily reflect all allergen-related deaths.

• Research indicates expected number of deaths to be around 125 annually*

• Death certificates currently show about 20 deaths annually

Developmental

Yocum, MW, and DA Khan. Assessment of patients who have experienced anaphylaxis: a 3-year survey.Mayo Clin. Proc. 1994; 69:16-23*

Key Food Safety Practices

Obj. 10-5

1. Clean – wash hands and surfaces often

2. Separate – don’t cross-contaminate

3. Cook – cook to proper temperatures

4. Chill – refrigerate promptly

FightBAC Campaign R

50

60

70

80

90

100

Consumer Food Safety Practices†

Notes: † The percents of consumers over 18 years of age who report they follow each of 4 key food safety practices,Clean, separate, cook, and chill, among the U.S. civilian non-institutionalized population.Source: Food Safety Survey (FSS), FDA and USDA, FSIS.

Obj. 10-5

2010 Target: 79 %

Increase desired1998 2006

Black HighSchool

Total White Female Male SomeCollege

Less thanHigh School

Percent

EducationGenderRace

0

Notes: Percent of employee behaviors and food preparation practices, directly related to foodborne illness risk, that areobserved to be in compliance during observational, non-regulatory inspections by FDA.Source: Retail Food Database of Foodborne Illness Risk Factors, FDA, CFSAN.

0 20 40 60 80 100

Seafood departments

Produce departments

Meat/Poultry departments

Deli departments

Full-service restaurants

Fast food restaurants

Elementary schools

Nursing homes

Hospitals

Percent

82

80

80

60

74

81

76

83

73

Objs. 10- 6a-i

Retail Food Establishment Compliance with FDA Guidelines, 1998

2010 Targets

Status of Food Safety Objectives

• Target met or exceeded

• Improving

• Getting worse

• Little or no progress*

• No tracking data

• Dropped at midcourse

• Retained as developmental

2

6

3

2

9

15

1

* Percent of targeted progress achieved is between -10% and 10%, and/or not statistically significant.

Contributors:

Elisa Elliot, FDA Sara Fein, FDA

Delila Parham, USDA Katherine Vierk, FDA

Holly McPeak, ODPHP Glenda Lewis, FDA

Elizabeth Jackson, CDC Olga Henao, CDC

Jeffrey Pearcy, CDC Ellis Davis, ODPHP

Progress Review data and slides

can be accessed on the web at:

http://www.cdc.gov/nchs/hphome.htm