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					Challenges for Foodborne Disease Prevention

 Sean Altekruse DVM, MPH, PhD, ACVPM (Epidemiology)
             CAPT, US Public Health Service


              Spring Public Health Institute:
    “Integrating Public Health Into All Communities”
           Penn State Conference Center Hotel
                    State College, PA
                       May 24, 2007
 Healthy People 2010 Objectives

 Foodborne infectious diseases
                                   Baseline       FoodNet         Target
Pathogen                          1996-1998       2006         HP 2010
Listeria †                           4.9           3.1           2.5
Campylobacter *                      24.7         12.7          12.3
E. coli O157 *                       2.3          1.31           1.0
Salmonella *                         13.5         14.79          6.8
S Enteritidis outbreaks               44          34 (2005)      22
                                      * Cases / 100,000
                                     † Cases / 1,000,000


                        Source: CDC, MMWR April 13, 2007 56;336-339
                 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a4.htm
            Human Salmonella infection rates
Cases / 100,000
20

18                17.7                     Need PFGE data to attribute illnesses

                                             16.1
16                                                                         14.79
14                       Outbreaks: fraction of illnesses
         13.5
12

10                       Sporadic cases: most illnesses

 8
            HP 2010 Objective: 6.8
 6
     96-8    1999    2000      2001     2002     2003       2004   2005    2006

                                   Source: CDC, FoodNet
         Pathogen subtyping
• Serotype
• Pulsed-field Gel Electrophoresis (PFGE)
• Antimicrobial Resistance
                Timeliness

• Acquisition, analysis, sharing
• Data for decision-making
• Consumer protection
 Subtyping of FSIS Salmonella isolates, 2006
FSIS Program                      Source        No. isolates PFGE Lab
Salmonella (RTE)*            Ready to eat foods            2   FSIS
Salmonella (HACCP)              Raw meat &                      2223       ARS*
                                  poultry

*Agreement with ARS to share data on Salmonella patterns from Raw meat and
poultry with PulseNet has pended for years. FSIS spends millions of dollars per year
to collect these valuable isolates from operations throughout the United States

 FSIS Websites:
 Salmonella RTE:
 http://www.fsis.usda.gov/Science/Table17_Micro_Testing_RTE_1990-2006/index.asp
 Salmonella HACCP:
 http://www.fsis.usda.gov/Science/Progress_Report_Salmonella_Testing_Tables/index.asp
Value of FSIS Salmonella strains, raw meat & poultry

Step                            Cost No./year FSIS cost
Sample kit, shipment to plant   $14   45,000   $ >600,000
FSIS inspector time             $12   45,000   $ >500,000
Laboratory time, resources      $42   45,000   $ ~2 million
Shipping/handling/serotyping $45      2223     $ ~100,000
FSIS cost per year                             $ >3 million
Cost over 10 years                             $ >30 million

Value added resource                           $ >60 million
                 Salmonella serotypes
•   Over 2000 serotypes
•   Top 20 account for >80% of human salmonellosis
•   Unique ecological niches
•   Serotyping used by states since 1950s
•   Fine tune case definition
    – Discriminate outbreaks from background cases
 Human Salmonella infections by serotype,
Number       1993-2005         1. Typhimurium
12000
                                                                 2.   Enteritidis *
10000                                                            3.   Newport
                                                                 4.   Heidelberg
8000                                                             6.   S I 4,[5],12:i:-
                                                                 7.   Montevideo
6000                                                    *

4000

2000

   0                                                          Not shown: 5. Javiana
        93 94 95 96 97 98 99 0          1   2   3   4   5     (rare in FSIS products)
  http://www.cdc.gov/Ncidod/dbmd/phlisdata/salmtab/2005/SalmonellaTable1_2005.pdf
Percent of human salmonellosis caused by
some common serotypes in meat and poultry
   Percent
      25
           19.3         18.6                 Together, these 10 serotypes account
      20
                                             for 62% of human illnesses
      15

      10                       9.1
                                       5.3
      5                                       2.3    2.2    1.9    1.4    1.2        1
      0
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                                     Source: CDC, PHLIS, 2006
Selected common human Salmonella serotypes
          in raw poultry, 1998-2006

                       Broiler Ground Turkey
           Typhimurium >1000
           Enteritidis >500
           Heidelberg  >1800       >400
           4,5,12:i:-  >100
           Montevideo  >200



        Source: FSIS, HACCP Salmonella Verification Program
Selected common human Salmonella
 serotypes in raw meat, 1998-2006

                  Hogs Ground Beef
      Typhimurium >300    >500
      Newport             >400
      Montevideo          >700




   Source: FSIS, HACCP Salmonella Verification Program
Other common human Salmonella serotypes
        in raw poultry, 1998-2006

                       Broilers Grd Turkey
        Saintpaul                 >100
        Infantis        >100
        Thompson        >100
        Mbandaka        >100
        Schwarzengrund >200       >100

       Source: FSIS, HACCP Salmonella Verification Program
Selected common human Salmonella
 serotypes in raw meat, 1998-2006

                      Grd Beef Hogs
             Infantis  >100 >100
             Agona     >200
             Mbandaka >200




  Source: FSIS, HACCP Salmonella Verification Program
Salmonella Enteritidis in broilers, 2000–2005

                      Three-fold increase in since 2000

                      Sporadic human illness associated
                      with eating chicken

                      SE implicated in human outbreaks
            Salmonella Enteritidis outbreaks
60
                    53
50    48
             49                    42    40
40
                          37                                            34
30                                                        29
       HP 2010 Objective: 22                    29               28
20

10                             Chicken implicated
      4      3      5                     3         3           3       6
                                                         2
                           5
0
     1996   1997   1998   1999   2000   2001   2002     2003   2004   2005
                               Source: CDC, FDDB
                   PulseNet

• Laboratory Network
  – 50 state health departments
  – Federal agencies (CDC, USDA, FDA)
  – Primary I.T. support at CDC
• Comparison of foodborne pathogens
• Pulsed Field Gel Electrophoresis (PFGE) patterns
    Some applications of PulseNet

•   Attribute sporadic disease to source
•   Outbreak detection
•   Infection control
•   Surveillance for action
         Process to compare PFGE patterns




Laboratory --        Database manager --     CDC names patterns --
.tif of gel:         .bdl of band weights:   for interlaboratory
barcode-like image   numeric data            comparisons
                           PulseNet
Participating Labs          PFGE Patterns   PulseNet National
                                            PulseNet National
Participating Labs          PFGE Patterns
                                            Databases (CDC)
                                             Databases (CDC)




               Local
               Databases
 Increased PulseNet activity, 1996-2006
60000

50000

40000

30000

20000

10000

   0
        1996      1998        2000        2002         2004        2006

 Over 144,000 Salmonella isolates submitted to PulseNet during these years
      Successful use of PulseNet in outbreak
                  investigation:

Salmonella in beef jerky (Ready to eat food)*


*Agreement with ARS to share data on Salmonella patterns from Raw meat and
poultry with PulseNet has pended for years. FSIS spends millions of dollars per year
to collect these valuable isolates from operations throughout the United States
Salmonella Kiambu in beef jerky (RTE), 2003

                                                      PulseNet 60-day
                                                    “hot list” search


                                                      “Matches” from
                                                   states and FSIS/USDA


                                                     Epidemiology and
                                                   pattern implicated
                                                   New Mexico facility



   FSIS/USDA isolate from search matched human pattern
         Investigation led to a recall


• Violations uncovered
  in implicated facility

• On September 30,
  2003 New Mexico
  recalled beef jerky
                  PulseNet goal

• Integrate USDA VetNet and PulseNet
  – Compare pathogens from humans, animals, and foods
  – ARS agreements with both FSIS and CDC pending
        Three components of PulseNet




1. Data acquisition               2. Data analysis




                      3. Data exchange
         PFGE analysis of FSIS isolates
• PulseNet (CDC)
  –Salmonella -- ready to eat food (<10 isolates/year)
  –CDC designates PFGE pattern
  –PFGE patterns shared with FDA, USDA, 50 states

• VetNet (ARS)
  –Salmonella -- raw product (>2000 FSIS isolates/year)*
  –ARS designates PFGE pattern (FSIS IDs removed)
  –PFGE patterns not routinely shared with PulseNet, FSIS

                                      * ~$60 million dollar resource
National Antimicrobial Resistance Monitoring
                  System
 FDA, CDC, USDA and 50 states

 Foodborne pathogen resistance to human and veterinary drugs

 Three principal laboratories:
   FDA/CVM (retail meat and poultry)
   CDC (human clinical)
   USDA ARS (primarily FSIS slaughter)

 -ARS agreements to report to FSIS and FDA pending
      Human infection with drug resistant
                 Salmonella
Patients with these infections have elevated rates of
–Bloodstream infections
–Hospitalization
–Death


These strains are present in meat, poultry & eggs
 Selected outbreaks-drug resistant Salmonella
                  infection
Salmonella Strain         Location     Yr Ill        Food
Newport                   Northeast    02 47      Ground beef
Typhimurium DT 104          VA         03 59       Beef roast
Newport                     WI         03    12   Ground beef
Typhimurium                 AK         03    47   Ground beef
Typhimurium DT 104        Northeast   03-4   56   Ground beef
Typhimurium DT 104           MI        04     9   Roast pork

Source: CDC, NCID, FDDB
            Molecular serotype method

•   Classical method is costly, technically outmoded
•   New CDC molecular assay on horizon
•   Being validated in state labs
•   Should allow FSIS to screen more effectively for
    common human serotypes

				
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