Wednesday, December 6, 2023
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Foodborne illness (sometimes referred to as "food poisoning") is common yet preventable. The Centers for Disease Control and Prevention (CDC) estimates that each year, 1 in 6 (48 million) Americans become sick, 128,000 are hospitalized, and 3000 die of foodborne diseases. The incidence is highest among children younger than 5 years,[1] and overall incidence rates are well above national Healthy People 2020 targets.
Reflecting on recent outbreaks of foodborne illness can yield important lessons for the prevention of further outbreaks as the weather turns warmer. The following slides feature recent outbreaks of human illness traced to a food source that was previously unrecognized as a cause of infection (such as raw cashew cheese) or a repeat offender (such as poultry).
Images from iStock; CDC
From March through August 2013[2]:
This was the first multistate foodborne outbreak of hepatitis A virus in the United States in almost 10 years.[3] The common vehicle for the spread of the hepatitis A virus infections was a shipment of frozen pomegranate arils (the juicy red pods surrounding the seeds) from a company in Turkey. The pomegranate arils were used in a frozen berry blend eaten by most of the people who became sick.
Image from iStock
Hepatitis A, unlike other foodborne pathogens, can be prevented if individuals receive the hepatitis A vaccine or immune globulin within 2 weeks after they have been exposed. In the pomegranate investigation, once the product was identified, health officials took rapid action to alert the public and recommend vaccine or immune globulin as postexposure prophylaxis. Hepatitis A virus is resistant to such environmental conditions as freezing, as demonstrated in two previous outbreaks of hepatitis A. In those outbreaks, frozen strawberries that were harvested 1 year or more before they were consumed still caused illness, suggesting that contaminated frozen foods can be a source of hepatitis A illness for a long period.[3]
Image from Science Source
Outbreaks of cyclosporiasis that were probably linked to the consumption of several varieties of fresh produce, including bagged salad mix and cilantro, occurred in the United States during the summers of 2013 and 2014. Cyclosporiasis is an intestinal illness caused by the single-celled parasite Cyclospora cayetanensis.
In 2013[4]:
In 2014[5]:
Image from iStock
Healthcare providers should consider Cyclospora as a potential cause of prolonged diarrheal illness, particularly in patients with a history of recent travel to Cyclospora-endemic areas; for example, countries in the tropics and subtropics. Testing for Cyclospora is not routinely performed in most US laboratories, even when stool is tested for parasites. Therefore, if indicated, healthcare providers should specifically request testing for Cyclospora.[6]
Patients should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet, but also should be proactive about their health, given that fruits and vegetables are among the most common vehicles of foodborne illness and outbreaks. They should follow safe fruit and vegetable handling recommendations: wash, separate, and store.[7] These recommendations apply not only to fresh fruits and vegetables but also to fresh herbs, such as cilantro.
Image courtesy of CDC Public Health Image Library
From May through September 2013[8]:
Infected individuals had consumed raw oysters or clams harvested along the Atlantic coast in the week before becoming ill. The number of cases was probably underestimated because many sick people do not seek medical care, diagnostic testing is not always performed, and some laboratories do not routinely use the specific culture plate required to test for V parahaemolyticus bacteria.
Fish and shellfish can be part of a healthy diet. When ordering shellfish in restaurants, consumers should ask for their food to be fully cooked unless the shellfish has been treated with a method (such as pressure treatment) that reduces Vibrio. Patients with weakened immune systems and chronic liver disease should avoid eating any raw or undercooked shellfish, because these individuals are at a higher risk for becoming ill.[9]
Image from iStock
From November 2013 through January 2014[10]:
Raw cashew cheese was a new vehicle for foodborne illness identified through this outbreak investigation. Cashew cheese is a nondairy product made from raw cashews and other ingredients and has a long shelf life.
This outbreak highlights a changing dietary practice among the US population, including the increasing popularity and availability of vegetarian, vegan, and raw food options. Because many of these foods are consumed raw without any cooking, the manufacturers' interventions to ensure the safety of the food are critical.
Image from iStock
From March 2013 through July 2014[11]:
Consumption of chicken from a common producer was the source of this outbreak. Moreover, the outbreak strains of Salmonella Heidelberg were resistant to several commonly prescribed antibiotics. Although these antibiotics are not typically used to treat Salmonella blood infections or other severe Salmonella infections, antibiotic resistance can be associated with increased risk for hospitalization in infected individuals.
Image from Dreamstime
This outbreak investigation spanned 18 months, making it one of the longest multistate foodborne outbreak investigations in CDC history. The chicken producer linked to the outbreak has since established multiple interventions to reduce Salmonella contamination throughout the entire poultry production process.
This outbreak probably continued for many months because it is not unusual for raw poultry to have Salmonella bacteria, and consumers who are unaware of this fact may have mishandled or improperly cooked it. Therefore, remind your patients to follow food safety tips to prevent Salmonella infection from any raw poultry: cook, clean, separate, and chill.[12]
Image from iStock
From May through July 2013[13]:
Several types of pasteurized soft cheese from one producer were the source of this outbreak. The cheeses that caused illness were recalled. Pasteurized soft cheeses have been linked to several listeriosis outbreaks in recent years. The source of contamination was not the milk used to make the cheese, but sanitary lapses in the cheese-making process.
Those at highest risk for listeriosis are pregnant women, their newborns, older adults, and people with weakened immune systems. The median age of the infected individuals in this outbreak was 55 years. One infection was reported in a pregnant woman and resulted in fetal loss. If you have patients in these higher-risk categories with symptoms of listeriosis who report eating a food recalled for Listeria contamination, you should consider listeriosis when determining a diagnosis.
Image from iStock
From January through July 2014[14]:
Many of the ill people in this outbreak were self-described "healthy eaters." Health officials were able to identify the food responsible for illness by asking people questions about the healthy food items they ate before they became sick. Affected people reported consuming smoothies to which they had added chia powder.
Chia powder is made from chia seeds that are sprouted, dried, and ground into a fine powder. Raw sprouts are already a well-known source of foodborne illness. This outbreak identified a new sprouted product that has the potential to cause foodborne illness and highlights the need for producers to make food safety a priority to ensure that their products are safe for consumers.
Image from iStock
From October 2014 through January 2015[15]:
In autumn 2014, contaminated apples used to produce commercial, prepackaged caramel apples were the source of one of the largest outbreaks of listeriosis in the United States. The contaminated apples were distributed to a wide network of caramel apple producers, affecting multiple brands and resulting in several product recalls. This was the first documented outbreak of listeriosis associated with whole apples. It is not known at this time how the apples originally became contaminated.
Three cases of invasive meningitis occurred among otherwise healthy children aged 5-15 years. Invasive listeriosis in healthy children is uncommon.
Image from iStock
A number of new investigations are underway in 2015. For the most up-to-date information about ongoing and recent multistate outbreak investigations, visit www.cdc.gov/foodsafety/outbreaks/
Image courtesy of AP Photo/Orlin Wagner
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