Doctors' dual role in foodborne illness: healer and reporter

With millions getting sick from contaminated food, physicians can treat patients and help them avoid infection as well as report cases to public health agencies.

By — Posted May 6, 2013

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The nation's food safety report card for 2012 is out, and chances are you are seeing patients who have been infected by something they ate.

An estimated 48 million Americans — one in every six people — get sick annually from eating contaminated food, based on data published April 19 in the Centers for Disease Control and Prevention's journal Morbidity and Mortality Weekly Report.

Salmonella accounted for most infections in 2012, making up 40% of all illnesses, a rate that has remained relatively unchanged since 1996, the report showed. But two pathogens were on the rise: Campylobacter and Vibrio.

Infections from Campylobacter were up 14% in 2012 compared with 2006-08. Campylobacter accounts for 35% of reported infections, second only to Salmonella. It can be found in, among other things, raw or undercooked poultry, raw milk and produce. Ill patients may have diarrhea, cramping, abdominal pain and fever within two to five days after encountering the organism. The diarrhea may be bloody and accompanied by nausea and vomiting. Most infections are self-limited but could lead to arthritis and Guillain-Barre syndrome, according to the CDC.

Vibrio infections were 43% higher in 2012 compared with 2006-08. However, it is a rare illness. Only 0.4 cases are reported per 100,000 people. The pathogen most often is linked to eating raw oysters and can be found in the Gulf of Mexico and Atlantic and Pacific oceans, particularly in warmer months. Among the symptoms within 24 hours of contact: watery diarrhea, abdominal cramping, nausea, vomiting, fever and chills. The symptoms usually last three days but can cause a life-threatening infection, especially in patients with liver disease, according to the CDC.

Officials are studying why these two pathogens caused more illnesses in 2012.

The numbers are calculated based on information that the Foodborne Diseases Active Surveillance Network — FoodNet for short — collects from 10 state health departments that account for about 15% of the U.S. population. FoodNet is a collaboration of the CDC, 10 state health departments, the Dept. of Agriculture's Food Safety and Inspection Service and the Food and Drug Administration.

Overall in 2012, FoodNet's 10 sites reported 19,531 illnesses that resulted in 4,563 hospitalizations and 68 deaths. Children younger than 5 had the highest incidence of infection for most of the pathogens the study tracked. Those older than 65 were most likely to be hospitalized and to die from foodborne infections, the study showed.

“The U.S. food supply remains one of the safest in the world. However, some foodborne diseases continue to pose a challenge,” said CDC Director Thomas Frieden, MD, MPH.

Gauging effect of regulatory changes

Health officials said they believe recently proposed regulatory changes and further industry efforts could lower the number of foodborne infections.

“We know that in the past, targeted efforts by industry and regulators have been successful for specific problems. And we think that recently proposed regulatory changes and further industry efforts may well have an effect soon,” said Robert V. Tauxe, MD, MPH, the CDC's deputy directory of the agency's division of foodborne, waterborne and environmental diseases.

Children younger than 5 have the highest incidence of infection for most food pathogens.

Among the changes officials expect to make a difference are the Dept. of Agriculture's FSIS's July 2011 implementation of more stringent performance standards, including tougher Salmonella standards in chickens and turkeys. New Campylobacter performance standards also were implemented in 2011. This summer, the agency plans to begin evaluating the two years of data under the new rules.

“We expect that once the standards are met that we may prevent as many as 25,000 illnesses per year from both Salmonella and Campylobacter combined,” said David P. Goldman, MD, MPH, assistant administrator of the office of Public Health Science of FSIS.

The Center for Science in the Public Interest, a health advocacy group based in Washington that focuses on nutrition and food safety policies, said the increase in infections from Campylobacter and Vibrio was “troubling ” and called for targeted controls for chicken and shellfish. Caroline Smith DeWaal, CSPI's food safety director, said other countries reduced Campylobacter by testing flocks for the pathogen and requiring contaminated chicken to be frozen.

“Clearly, better controls are needed in the U.S.,” DeWaal said in a statement.

Doctors have reporting role

Physicians on the front lines can help in identifying foodborne illnesses, said Olga Henao, PhD, FoodNet team lead for the CDC's division of foodborne, waterborne and environmental diseases.

If a patient comes in with diarrhea or gastrointestinal distress, it could be a sign of a foodborne illness, she said.

“If [physicians] are talking to patients and asking if they know what is at play, a patient may say it happened after they ate something,” Henao said. “If a patient mentions that other people in their group have the same symptoms, that could be a sign of foodborne illness, too.”

If physicians suspect the illness could be foodborne, they should first contact the local health department, which may be getting similar reports from other people, Henao said. Physicians also should take a stool sample to evaluate if a foodborne pathogen is present.

As America heads into the summer picnic season, she said, doctors also can remind patients to take their own precautions, such as washing hands frequently, avoiding undercooked meat and making sure that refrigerated items are kept cold. For example, Henao said, “if you get to a picnic and a potato salad has been kept out for hours, it is best to avoid it.”

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Culprits that can make food unsafe

Campylobacter and Vibrio — pathogens commonly found in poultry and raw shellfish, respectively — caused an increasing amount of foodborne illnesses in 2012 compared with 2006-08. Infections caused by other pathogens often linked to foodborne germs did not change significantly during that time.

Pathogen causing illness Change since 2006
Campylobacter 14%
Listeria -6%*
Salmonella 3%*
Shigella -13%*
Shiga toxin-producing Escherichia coli (STEC) 0157 -10%*
Vibrio 43%
Yersinia -6%*

* Not statistically significant

Source: Foodborne Diseases Active Surveillance Network report released by the Centers for Disease Control and Prevention; April (link)

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External links

Centers for Disease Control and Prevention on how to report foodborne illness (link)

Food safety information from the CDC (link)

Food safety tips compiled by six government agencies (link)

Food facts for consumers from the U.S. Food and Drug Administration (link)

"Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996-2012", Morbidity and Mortality Weekly Report, April 19 (link)

Foodborne Diseases Active Surveillance Network report released by the CDC, April (link)

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