Healthy People 2010 Focus Area 10: Food Safety Progress Review December 20, 2007

1. Healthy People 2010 Focus Area 10:Food SafetyProgress ReviewDecember 20, 2007 • Edward J. Sondik • National Center for Health Statistics

2. Estimated Annual Burden ofFoodborne Disease • 76 million illnesses • 325,000 hospitalizations • 5,000 deaths • $23 billion in costs Source: Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. Food-Related Illness and Death in the United States. Emerging Infectious Diseases 5(5):607-625. 1999.

3. Foodborne Diseases Pyramid Reported to Health Department/CDC Culture confirmed case Lab tests for organisms Specimen obtained Person seeks care Person becomes ill Exposure in the general population

4. Food Safety Focus Area Objectives A Framework for Reducing Foodborne Illness Through Prevention, Intervention and Response Production Obj 10-5 Consumer Transportation Preparation Processing Retail Distribution and Storage Objs 10-6, 7 Consumption ? Regulations, Enforcement, and Guidance Illness Objs 10-1, 2, 3, and 4 Education Training Surveillance Research

5. Highlighted Objectives Target met or exceeded 10-3c,d Antimicrobial drug resistance Improving 10-1a-c,f Foodborne infections 10-2b Foodborne outbreaks (Salmonella) 10-5 Food safety practices Getting worse 10-1d Foodborne infections (Salmonella spp.) 10-2a Foodborne outbreaks (E. coli O157:H7) 10-4b Severe allergic reactions to food Little or no progress * 10-3a,b Antimicrobial drug resistance No tracking data 10-6a-i Safe retail food preparation *Percent of targeted progress achieved is between -10% and 10%, and/or not statistically significant.

6. Major Foodborne Infections Decrease desired Rate per 100,000 population Escherichia coli O157:H7 HUS* 2010 Targets Listeria monocytogenes Notes: Rates are the number of culture-confirmed cases of illness for all persons. *Data for for postdiarrheal hemolytic uremic syndrome (HUS) (2000-2004) are for children under 5 years. Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies. Objs. 10-1b,c, f

7. Major Foodborne Infections Decrease desired Rate per 100,000 population Campylobacter species Salmonella species 2010 Targets Notes: Rates are the number of culture-confirmed cases of illness for all persons. Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies. Objs. 10-1a,d

8. Major Foodborne Infections Estimated† percent of total foodborne deaths Rate per 100,000 population Salmonella spp. 30.6 % Listeria monocytogenes 27.6% Campylobacter spp. 5.5% E. coli O157:H7 2.9% Campylobacter species Salmonella species Listeria monocytogenes HUS* Escherichia coli O157:H7 Notes: Rates are the number of culture-confirmed cases of illness for all persons. *Data for for postdiarrheal hemolytic uremic syndrome (HUS) (2000-2004) are for children under 5 years. Source: Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies. †Source: Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. Food-Related Illness and Death in the United States. Emerging Infectious Diseases 5(5):607-625. 1999. Objs. 10-1a-d, f

9. Outbreaks of Infections Caused by Key Foodborne Bacteria Decrease desired Number of outbreaks † Salmonella serotype Enteritidis 2010 Targets Escherichia coli O157:H7 Notes: † A foodborne disease outbreak is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food, among the U.S. resident population and reported to CDC. Source: Foodborne Disease Outbreak Surveillance System, CDC, NCID. Objs. 10-2a, b

10. Human Samples of Non-Typhi Salmonella Resistant to Antibiotics Percent Ampicillin 2010 Targets Fluoroquinolones Gentamicin Cephalosporins Notes: The target for 10-3a and 10-3b is zero (0). Source: National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS-Enteric Bacteria), CDC, NCID; FDA, CVM; USDA, FSIS, APHIS, and ARS; Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and State agencies.. Objs. 10-3a-d

11. Severe Allergic Reactions† to Food in Persons With Allergies 2006 2001 Decrease desired Percent 2010 Target: 21 % * Some College Total Female Male High School 18-59 60 + Black White Gender Race Age Education Notes: † Persons 18 years and older with doctor-diagnosed food allergies who report an allergic reaction within the last 5 years and who report that the allergic reaction was severe (required the use of epinephrine, or treatment in a hospital or doctor’s office, or an overnight stay in a hospital). * Data are statistically unreliable and are suppressed. Source: Food Safety Survey (FSS), FDA and USDA, FSIS. Obj. 10-4b

12. Deaths From Severe Food Allergies Developmental • ICD-10 codes for food-induced anaphylaxis were developed but do not necessarily reflect all allergen-related deaths. • Research indicates expected number of deaths to be around 125 annually* • Death certificates currently show about 20 deaths annually * Yocum, MW, and DA Khan. Assessment of patients who have experienced anaphylaxis: a 3-year survey. Mayo Clin. Proc. 1994; 69:16-23 Source:National Vital Statistics System—Mortality (NVSS—M), CDC, NCHS; Food Safety Survey (FSS), FDA and USDA, FSIS. Obj. 10-4a

13. Key Food Safety Practices R • Clean – wash hands and surfaces often • Separate – don’t cross-contaminate • Cook – cook to proper temperatures • Chill – refrigerate promptly Obj. 10-5 FightBAC Campaign

14. Consumer Food Safety Practices† Increase desired 1998 2006 Percent 2010 Target: 79 % 0 High School Some College Total Black White Less than High School Female Male Gender Race Education Notes: † The percents of consumers over 18 years of age who report they follow each of 4 key food safety practices, Clean, separate, cook, and chill, among the U.S. civilian non-institutionalized population. Source: Food Safety Survey (FSS), FDA and USDA, FSIS. Obj. 10-5

15. Retail Food Establishment Compliance with FDA Guidelines, 1998 2010 Targets 80 82 80 74 60 73 81 76 83 Percent Notes: Percent of employee behaviors and food preparation practices, directly related to foodborne illness risk, that are observed to be in compliance during observational, non-regulatory inspections by FDA. Source: Retail Food Database of Foodborne Illness Risk Factors, FDA, CFSAN. Objs. 10- 6a-i

16. Status of Food Safety Objectives Target met or exceeded Improving Getting worse Little or no progress* No tracking data Dropped at midcourse Retained as developmental 2 6 3 2 9 15 1 *Percent of targeted progress achieved is between -10% and 10%, and/or not statistically significant.

17. Contributors: • Elisa Elliot, FDA Sara Fein, FDA • Delila Parham, USDA Katherine Vierk, FDA • Holly McPeak, ODPHP Glenda Lewis, FDA • Elizabeth Jackson, CDC Olga Henao, CDC • Jeffrey Pearcy, CDC Ellis Davis, ODPHP

18. Progress Review data and slides can be accessed on the web at: http://www.cdc.gov/nchs/hphome.htm