Education key in fighting foodborne illnesses

Washington -- Public health officials are now more quickly able to identify outbreaks of foodborne illness by genetically connecting the dots that represent individual cases. But they rely on primary care physicians to supply those important dots.

It is often the report of an astute physician that leads to the detection of an outbreak and its rapid containment, said Arthur P. Liang, MD, MPH, director of the Centers for Disease Control and Prevention's Food Safety Initiative.

Physicians hold a vital position in recognizing foodborne illnesses -- no small matter, as more than 200 diseases are known to be transmitted through food -- and educating patients on the need for food safety.

"Understanding this important role will help health professionals recognize the necessity of testing patients with gastrointestinal symptoms for foodborne illnesses and will lead to earlier detection," said AMA Trustee Cecil B. Wilson, MD, an internist from Winter Park, Fla.

Foodborne illnesses affect 76 million Americans every year -- even more than the common cold -- causing 300,000 hospitalizations and 5,000 deaths, said Dr. Wilson.

On April 7, Dr. Liang, Dr. Wilson and others released an updated edition of a free primer for physicians on diagnosing and managing foodborne illnesses.

The primer, a collaborative effort by the AMA, the American Nurses Assn., the CDC, the Food and Drug Administration and the Dept. of Agriculture, includes sections on newly identified foodborne illnesses as well as information on the intentional contamination of food and water -- a heightened concern as a result of stepped-up terrorism awareness.

The primer provides up-to-date information on a range of illnesses. Since more than 75% of deaths are caused by three pathogens, Listeria, Salmonella and Toxoplasma, information on the latter two has been added to the new primer. The Listeria section has been updated. There are also new sections on hepatitis A and norovirus.

It offers 2.75 hours of category I continuing medical education credit for physicians and 3.3 hours for nurses and includes a consumer guide on food safety to share with patients.

The guide, produced by the Agriculture Dept., can be copied and distributed, said Barbara Masters, DVM, acting administrator of the USDA's Food Safety and Inspection Service.

A changing society

An outbreak of hepatitis A in Georgia, North Carolina, Pennsylvania and Tennessee last year was traced to contaminated green onions imported from Mexico and served at a chain restaurant. In Pennsylvania alone, 555 illnesses were linked to the onions and three people died.

Also last year, a Michigan supermarket employee deliberately contaminated beef with an insecticide, causing those who ate the beef to become sick with nicotine poisoning.

And outbreaks of the norovirus on cruise ships made headlines in 2002.

These experiences underscore how society has changed. As a result, physicians should remember to ask ill patients about recent travel, restaurant food eaten and whether other family members were sick.

As the nation's population ages and is less able to rebound from symptoms that can range from mild gastroenteritis to life-threatening neurologic syndromes, food safety will be of even greater concern, noted David Acheson, MD, FDA director of food safety and security. Pregnant women, infants and children, and individuals with suppressed immune systems are also particularly vulnerable, he said.

New pathogens are continually emerging to take the place of older enemies. Some of the more notorious foodborne pathogens, such as Cyclospora, Cryptosporidium and the agent causing bovine spongiform encephalopathy, were unknown before the 1980s and 1990s, said Dr. Liang. "In fact we think there are still many causes of foodborne illness yet to be discovered."

Dr. Liang estimated that from 50% to 80% of foodborne illnesses are caused by agents that have not yet been identified. While physicians should be on the lookout for new illnesses, the garden variety reportable diseases are still important to track, said Dr. Liang. "We are getting much better at connecting the dots."