The Food and Drug Administration Ranking of Food Hazards

The Food and Drug Administration (FDA) Ranking of Food Hazards ranking* 1. microbial contamination 2. naturally occurring toxicants 3. environmental contaminants (e.g., metals 4. nutritional problems (i.e., malnutrition, undernutrition) 5. pesticide residues 6. food additives *1 being most dangerous, 6 least dangerous Definitions Foodborne disease is any illness resulting from the consumption of food contaminated with one or more disease-producing agents. These include bacteria, parasites, viruses, fungi and their products as well as toxic substances not of microbial origin.      Infection Intoxication Metabolic food disorder Allergy Idiopathic illness Risks — perception vs. reality What is the likelihood that you will die of foodborne illness? Deaths per year from selected causes in the United States (NCHS, 1986) All causes 2,105,361 Ischemic heart disease 520,729 All cancers 476,106 Heart attack (acute myocardial infarction 261,002 Motor vehicle accidents 47,885 Diabetes mellitus 37,184 Chronic liver disease and cirrhosis (alcohol not mentioned) 13,867 Firearm assaults, including handguns 13,029 Falling (accidental) 11,444 Chronic liver disease and cirrhosis (alcoholic) 11,060 Choking on a piece of food 3,692 Firearm accidents, including handguns 1,452 Intestinal infectious diseases 466 — A one-in-a-million risk of death in the U.S. in 1986 — 242 Salmonella infections 102 Lightning 78 Botulism 3 Outbreaks vs. Cases  Foodborne disease outbreak: an incident in which two or more persons experienced a similar illness after ingestion of a common food, and epidemiologic analysis implicated a food as the source of illness. Foodborne disease case: one individual experiences illness after ingestion of an epidemiologically incriminated food.  Estimates of the yearly incidence of foodborne illness    The estimates vary greatly but thought to be around 76 million cases per year Cost estimates range from $5–23 billion per year High cost due to many factors:  medical care, investigation of illness, loss of productivity, loss of business, legal activities Infection  Definition: a disease state caused by the presence of viable, usually multiplying organisms at the site of inflammation  Bacteria - Salmonella, Campylobacter  Virus - hepatitis A, Norwalk virus  Protozoa - Cryptosporidium, Cyclospora  other parasites - Trichinella spiralis Intoxication  Definition: a disease state, caused by exposure to a toxic chemical, that is not mediated immunologically and is not primarily the result of a genetic deficiency.  Staphylococcal food poisoning, botulism  Saxitoxin, ciguatera Foodborne Diseases Infections Intoxications Toxicoinfection Invasive Infection Chemical Poisoning Poisonous Plant Tissues Poisonous Animal Tissues Microbial Intoxications Other Neurotoxins Enterotoxins Intestinal Mucosa Mycotoxins (Fungal Toxins) Algal Toxins Bacterial Toxins Systemic Other Tissues or Organs (Muscle, Liver, Joints, Fetus, Other) Diarrhogenic Emetic Enterotoxins Neurotoxins Other Foodborne Diseases Intoxications Infections Toxicoinfection Invasive Infection Other Neurotoxins Enterotoxins Intestinal Mucosa Systemic Other Tissues or Organs (Muscle, Liver, Joints, Fetus, Other) Foodborne Diseases Intoxications Infections Chemical Poisoning Poisonous Plant Tissues Poisonous Animal Tissues Microbial Intoxications Mycotoxins (Fungal Toxins) Algal Toxins Bacterial Toxins Diarrhogenic Emetic Enterotoxins Neurotoxins Other Examples of foodborne infections/intoxications Disease Reservoir Botulism food intoxication Campylobacteriosis Clostridium perfringens food poisoning Salmonellosis Staphylococcal food poisoning Vibrio parahaemolyticus infection Yersinia enterocolitica infection Soil contaminated foods Cattle, poultry, shellfish Soil contaminated foods Animals and birds Human carriers Seafoods Animal intestines Metabolic food disorder  Definition: a disease state caused by exposure to a chemical that is toxic to certain individuals only because they exhibit some genetic deficiency  lactose intolerance  favism Allergy  Definition: a disease state caused by exposure to a particular chemical that (often proteinaceous) to which certain individuals have a heightened sensitivity (hypersensitivity) that has an immunological basis  proteins (heat resistant and resistant to digestion)  cow’s milk: b-lactoglobulin, casein, etc.  egg-ovalbumin  small molecules  penicillin Idiopathic illness  Definition: any illness of uncertain pathogenesis that may possibly but not certainly be due to foods; also, any food-caused illness that does not fit into one of the other categories  Chinese restaurant syndrome  celiac disease  hyperkinesis Objectives of foodborne disease surveillance prevention and control: identification of contaminated products knowledge of disease causation: observe the track record of various illnesscausing agents administrative guidance: assessment of trends to justify regulatory decisions/actions Information reported to and compiled by the Centers for Disease Control (CDC) Outbreaks of known etiology = where laboratory evidence indicated a specific agent Outbreaks of unknown etiology = where epidemiological evidence implicated foodborne transmission, but the etiological agent was not identified. 4 subgroups based on incubation period: < 1 hr = probable chemical poisoning 1 – 7 hr = probable Staphylococcus aureus poisoning 8 – 14 hr = probable Clostridium perfringens food poisoning > 14 hr = probably other infectious/toxic agents Outbreaks of known vehicle = a particular food item was associated with the illness Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology — United States, 1993–1997 Outbreaks Cases Deaths No. Bacterial Chemical Parasitic Viral Confirmed etiology Unknown etiology Total 1993–1997 148 19 56 (%) (5.4) (0.7) (2.0) No. 576 2,325 4,066 (%) (0.7) (2.7) (4.7) No. 28 0 0 0 28 1 (%) (96.6) (0) (0) (0) (96.6) (3.4) 655 (23.8) 43,821 (50.9) 878 (31.9) 1,873 (68.1) 2,751 (100.0) 50,788 (59.0) 35,270 (41.0) 86,058 (100.0) 29 (100.0) ex MMWR Table 1, Vol. 49/No. SS-1, p. 11 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4901a1.htm Estimated illnesses for known foodborne pathogens, United States Disease or agent Estimated total cases Bacteria Parasites Viruses 5,204,934 2,541,316 30,883,391 Grand Total 38,629,641 ex Mead, P. S., L. Slutskaer, V. Dietz, L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V. Tauxe. Food-related illness and death in the United States. Emerging Infectious Diseases 5(5):607–625 (1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm Top Twelve Factors Contributing to 345 Outbreaks of Foodborne Disease Caused by Mishandling and/or Mistreatment of Foods in Homes in the U.S., 1973–1982 Contributing Factor Percent* Contaminated raw food/ingredient 42.0 Inadequate cooking/canning/heat processing 31.3 Obtained food from unsafe source 28.7 Improper cooling 22.3 Lapse of 12 or more hours between preparing and eating 12.8 6. Colonized person handling implicated food 9.9 7. Mistaken for food 7.0 8. Improper fermentations 4.6 9. Inadequate reheating 3.5 10. Toxic containers 3.5 11. Improper hot holding 3.2 12. Cross-contamination 3.2 *Percentage exceeds 100 because multiple factors contribute to single outbreak Ranking 1. 2. 3. 4. 5. ―The World Health Organization’s Golden Rules for Safe Food Preparation‖ Choose foods processed for safety Cook food thoroughly Eat cooked foods immediately. Store cooked foods carefully. Reheat cooked foods thoroughly. Avoid contact between raw and cooked foods. Wash hands repeatedly. Keep all kitchen surfaces meticulously clean. Protect foods from insects, rodents, and other animals. 10. Use pure water. 1. 2. 3. 4. 5. 6. 7. 8. 9. The future and foodborne illness     Demographics Human behavior changing Technology changing Global market Populations sensitive to foodborne disease        Pregnant women Neonates Elderly (over 65) Residents in nursing home or related care facilities Cancer patients (nonhospitalized) Organ transplant patients AIDS patients The aging population 450 Numbers of people (in millions) 400 350 300 250 200 150 100   65 years of age 263 276 Population Earth’s increasing population  1900 1.7 billion people  1998 6.0 billion people  2050 8.2 billion people (medium population projection) Future water usage  Competition between agriculture, industry, and personal households. Modern agriculture accounts for 70–80% of water usage. 