Fighting foodborne pathogens: A tool for the battle

We've all seen the headlines. Just last year, an outbreak of hepatitis A worked its way through Georgia, North Carolina, Pennsylvania and Tennessee. The pathogen was ultimately traced to contaminated green onions imported from Mexico and served at a chain restaurant -- but not before significant harm was done. In Pennsylvania alone, 555 illnesses were linked to the onions, and three people died.

Other high-profile outbreaks have occurred in the past two years -- whether involving an onslaught of norovirus on cruise ships or intentionally contaminated beef sold in Michigan. But even these news stories do not capture the breadth of the foodborne disease problem. Statistics offer a more complete vision.

An estimated 76 million Americans -- more than the tally of those who get the common cold -- are affected every year, leading to 325,000 hospitalizations and 5,000 deaths. The cost to the U.S. economy is set between $8 billion and $23 billion in medical expenses and lost productivity. The very young, elderly and those with compromised immune systems are most at risk. And estimates indicate that about 3% of all cases result in secondary long-term conditions.

That's why the American Medical Association has focused on trying to aid physicians in their efforts to identify foodborne illness. After all, it is often action by doctors that spurs the detection and rapid containment of outbreaks.

Listeria. Escherichia coli. Salmonella. Campylobacter. Yersinia. These are just a few examples. Physicians must be armed with up-to-date information to combat these bugs. To this end, the AMA, in collaboration with the American Nurses Assn., the Centers for Disease Control and Prevention, the Food and Drug Administration and the Dept. of Agriculture, released last month an updated version of Diagnosis and Management of Foodborne Illness: A Primer for Physicians and Other Health Care Professionals. This important educational tool should have a prominent place on physicians' desks or bookshelves.

First available in 2001, the revised edition 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 terrorism fears.

The materials, free to health care professionals, include charts, scenarios and a four-step consumer food safety guide for physicians to share with patients. The primer also offers 2.75 hours of category I continuing medical education credit.

According to the CDC, FDA and other government agencies, there is some good news in the nation's efforts to control foodborne illness. A report published recently in the Morbidity and Mortality Weekly Report indicates advances in controlling some of these pathogens. Incidence of E. coli0157:H7 infections dropped dramatically between 2002 and 2003. Yet the need for vigilance remains.

The message from the AMA to physicians and other health care professionals in the trenches is clear: They need to be aware of the prevalence of foodborne illness, and they need to know how to treat these cases once detected. Reporting is also crucial. Identifying the source of an outbreak and taking swift steps to contain the problem are hinged to this element.

Currently, foodborne illnesses are underreported in the United States by both patients and health care professionals -- a fact that undermines national efforts to control this significant public health problem. Physicians play a key role in diagnosing individual cases and in identifying clusters of unusual symptoms -- both of which are key bits of information used by state and local health officials to connect the dots and detect outbreaks.

The AMA's primer is a valuable resource to assist physicians in their part -- the identification, diagnosis, treatment and, of course, reporting of foodborne disease. As a result, fewer people will be at risk or suffer the consequences.