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    Saturday, May 2, 2009


    The latest Swine flu scare is concentrating the minds of us all to illnesses initiated from animals in our food chain. We remained glued to CNN reporting on deaths from Swine flu. At this writing, only one death has occurred even though more are tragically expected. However, what we must also realize is that the US has regular epidemics of food borne illnesses, which annually kill hundreds of Americans.

    Mead PS et al. [Food-related illness and death in the United States. Emerg Infect Dis. 1999 Nov-Dec; 5(6):840-2.] estimates that food borne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths.

    Recent reported food-borne illnesses include Cyclosporiasis associated with imported raspberries, hepatitis A associated with green onions, Salmonella serotype Saint Paul infections associated with multiple raw produce items, Shiga toxin-producing Escherichia coli in beef cattle and their products and Salmonella infections associated with peanut butter and peanut butter-containing products.

    L. R. Schiller [Food-borne infections in 2009 echoes this. Gastroenterology and Hepatology 6, 197-198 (April 2009) |doi:10.1038/nrgastro.2009.40]

    Schiller tells us that the recent outbreak of Salmonella typhimurium, associated with peanut butter and products containing it in the US and Canada, highlights our ongoing susceptibility to food-borne infections despite advanced food production systems. As the globalization of food resources continues, it is increasingly difficult to control outbreaks and minimize their effect on health.

    We live in a germy world, says Schiller. We have more bacterial cells in and on our bodies than we do human cells, and every day we are exposed to countless microorganisms: in the air that we breathe, on the surfaces we touch, in the water we drink, and in the food, we eat. Most of the time human mechanisms and barriers against germs work well, but sometimes they are weak or, in some cases, microorganisms evolve counterstrategies, and we become ill.

    Despite 21st century improved sanitation, fecal–oral transmission of disease is still prevalent, even in the Western world, and as many as 9,000 Americans die each year from food-borne illnesses. Why? Globalization of food sources has made cases of imported disease more likely. Outbreaks of Cyclospora from imported raspberries, hepatitis A from green onions, salmonellosis from peppers, and Escherichia coli from meat and fruit juice have all been reported in the US.

    A global network, which facilitates the spread of food-borne diseases. The centralization of food production has increased the potential for cross-contamination during processing, and broadened the distribution of contaminated products to millions of people.

    The outbreak of Salmonella typhimurium associated with peanut butter and products containing it that took place in the US and Canada between September 2008 and January 2009 is a good example of this problem. A reported 529 people from 43 American states and 1 person from Canada were infected, and the contamination may have contributed to eight deaths. Prompt recognition of the outbreak by the Centers for Disease Control's PulseNet surveillance staff and local public-health partners led to identification of the source of the outbreak—a peanut processing plant in Georgia. What can be learned from this experience? About 40,000 laboratory-confirmed. However, only an estimated 3% of salmonella infections are laboratory-confirmed; therefore, about 1.2 million cases probably occur each year. During the 2003–2007 periods, an average of 18 S. typhimurium outbreaks was reported to the US Center for Disease Control each year. Industrialized food production thus can place millions at risk.

    What might have been only a local problem with the recent peanut butter infections was magnified as its plant produced peanut butter and other peanut products that were distributed to over 2,000 food companies in the US and 23 other countries. This necessitated over 400 peanut-containing products were recalled because of potential contamination.

    Food processing says Schiller must include sufficient safeguards to ensure that contaminants are not introduced during manufacture and that the integrity of systems is checked at critical junctures. If not then we can expect pandemics of food-borne illnesses to worsen. Clean transport and maintenance of a cold chain (when necessary) are essential and proper handling, cooling and preparation of food at stores and restaurants should be mandatory. In the home --clean preparation, avoidance of cross-contamination, thorough cooking, and chilling can all reduce the chance of pathogenic, food-borne bacteria being ingested. A simple step such as using a disposable paper towel on top of a cutting board will decrease the chances of the next food item on that cutting board from being infected too.

    “We needn’t have been so surprised by the swine flu, and we must make sure that we are not caught off guard by the epidemics that will certainly follow it,” said
    Nathan Wolfe, the director of the Global Viral Forecasting Initiative in an April 30, 2009 NYT OP-ED PIECE “How to Prevent a Pandemic”
    He continued-
    “Many federal agencies — including the Centers for Disease Control and Prevention, the United States Agency for International Development and the Department of Defense — as well as the World Health Organization are looking for ways to stop pandemics early. Nevertheless, much more work is needed. To establish a worldwide safety net, we would need to devote more resources to expanding disease surveillance in people and in wild and domestic animal populations throughout the world. Our current global public health strategies are reminiscent of cardiology in the 1950s — when doctors focused solely on responding to heart attacks and ignored the whole idea of prevention.”

    According to reports “State and federal officials intensifying their response to the swine flu outbreak with President Obama asking Congress for $1.5 billion in supplemental funding.

    ”Since Obama’s staff director has been quoted as saying something to the effect that “a crisis should be taken advantage of, perhaps this is the time to spend some of this money answering the question of where in the community are various infectious agents being harbored, and also how to curtail the transmission of infectious agents.

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