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Preliminary FoodNet Data

Moderator: Dr. Robert Tauxe, April 10, 2008, 12:00 p.m. ET

OPERATOR: Good afternoon and thank you all for holding. At this time your lines have been placed on listen only until we open up for questions and answers.

Please be advised, today′s conference is being recorded. If you have any objections you may disconnect at this time. I would now like to turn the conference over to Ms. Lola Russell. Please go ahead ma′am.

LOLA RUSSELL, CDC MEDIA RELATIONS: Today we will be discussing findings from the 2007 data reported to the – to the CDC as part of the agency′s food-borne diseases active surveillance network, FoodNet.

Dr. Robert Tauxe, that′s R-O-B-E-R-T, Tauxe,– T-A-U-X-E, Deputy Director, CDC Division of Food-borne, Bacterial and Mycotic Diseases and Faye Feldstein, that′s F-A-Y-E, F-E-L-D-S-T-E-I-N, Acting Director, FDA′s Office of Food Defense, Communication, will be providing comments on the findings.

Following their comments we will open the lines for discussion and questions from Doctor Tauxe, Ms. Feldstein, as well as Doctor Morris Potter, that′s Morris, M-O-R-R-I-S, P-O-T-T-E-R, lead scientist for Epidemiology in the FDA′s Office of Food Defense, Communication and Emergency Response and Doctor Elisabeth Hagen, that′s E-L-I-S-A-B-E-T-H, Hagen, H-A-G-E-N, Executive Associate for Public Health, United States Department of Agriculture′s Food Safety Inspection Service, Office of Public Health Science.

I will now turn it over to Doctor Tauxe. If you have any questions following this press conference you can call the CDC media line at 404-639-3286. That′s 404-639-3286 or FDA′s media line at 301-827-9182 or USDA′s media line at 202-720-9113. Doctor Tauxe …

ROBERT TAUXE, DEPUTY DIRECTOR, CDC DIVISION OF FOODBORNE, BACTERIAL AND MYCOTIC DISEASES: Well, thank you very much, Ms. Russell, and thank you all for joining. Good afternoon.

We are publishing in the MMWR today the 2007 data from our food-borne diseases active surveillance network which we refer to as FoodNet. FoodNet is a surveillance system that collects information from sites in 10 states around the country about diseases that are caused by organisms that are transmitted commonly through food.

Food-borne illnesses are an important public health challenge in the United States as shown by recent outbreaks. And previous efforts to prevent some infections have been partly successful but I think the data show us that more efforts are needed to keep foods safe in the country.

And we′d like to thank the many people in the local and state and federal agencies who track these infections around the country, who investigate outbreaks and take the actions that help protect people from food-borne issues.

Now FoodNet is unique because it conducts intensive active surveillance for laboratory diagnosed cases of illness. It′s defined to pick up everyone in those 10 sites who went to their doctor′s office with an illness who had a sample tested and were diagnosed with one of those diseases that′s under surveillance in FoodNet.

While only 10 sites are involved, we believe that the FoodNet provides our best data for monitoring the overall trends in the incidents of these diseases over time and gives us important clues about when things are improving and about areas that might need additional work.

So what can we say looking at this data now available from 2007 and comparing it with earlier years? Now FoodNet began in 1996 and if we look back to that early time period, ′96, ′97, ′98, there have been important declines and the incidents of some pathogens incidents, but those declines really had occurred by 2004.

For example, the number of laboratory diagnosed cases of infections, salmonella, campylobacter, listeria, E. coli 0157 had declined and have declined significantly compared to those early years of surveillance. Then if we look at the more recent year, if we compare 2007 with just the previous three years, that′s ′04, ′05 and ′06, we′re not seeing significant changes in the incidents of these pathogens just comparing what was – what came in 2007 with those previous three years and that indicates that further measures are needed to keep prevention on a downward track.

The incidents of salmonella infections actually has changed very little since surveillance began in FoodNet. Salmonella is a bacteria that′s carried in the intestines of many types of animals and transmission to humans can occur by many roots. People may become ill by consuming animal products that might be contaminated or other foods that are contaminated with the bacteria such as raw produce or other food items.

And people may also become infected with salmonella after direct contact with animals that are carrying the bacteria or their environments or by drinking contaminated water.

We need more efforts at all stages of food production, from farm to table, to effectively prevent the contamination of foods with salmonella. And as I′m sure many of you are aware, we experienced several large multistate outbreaks of salmonella in 2007 and these outbreaks brought to our attention the need to prevent contamination of food products that were surprising to us like peanut butter or frozen pot pies.

E. coli 0157 infections actually reached a low point in 2003 and 2004 and then increased again in ′05 and again in ′06. The rate for 2007 is now 1.2 per 100,000. That is 1.2 diagnosed infections for 100,000 and that is a bit lower than in 2006. But if we compare that 2007 number to the three previous years find the difference is not a significant one. 2006 of course was a year of large outbreaks related to spinach and shredded lettuce. 2007 was marked by a number of ground beef recalls. So there seems to be some year to year shift in the food vehicles that are causing the illness perhaps.

We know that E. coli 0157 lives in the intestines of healthy cattle and can spread from those animals through the foods that are made from the cattle but also to their environment which can be a way that other animals or plant crops or even water supplies could be contaminated.

And this emphasizes for us the need to better control E. coli 0157 where it is in cattle and prevent its spread early in the food chain.

One infection actually increased over the last three years and that′s an infection by a parasite called Cryptosporidium. We feel this increase is likely due to better reporting and more frequent diagnostic testing rather than a real increase in the number of infections. There is a new treatment for the illness and this means that more clinicians are likely to be making that specific diagnosis.

Now while the MMWR information from FoodNet is useful, I think it – really it′s most important point is that it serves to remind us that food safety is a continuing problem and that starts at the farm, continues through the food chain all the way to the kitchen, be that the kitchen of a restaurant or someone′s kitchen at home. We have to be vigilant about hygiene practices and prevention all along the way and including the proper preparation and cooking of the food we eat to reduce the risk of food-borne infection.

FoodNet is designed to give us the information on the affect of efforts to control or prevent food-borne infections and to help direct where prevention and research efforts should go. It′s a collaborative effort between the CDC, FDA and USDA as well as the state health departments and others in each of the 10 sites.

We think the information collected provides a comprehensive picture of the trends that are there in food-borne illness. This information is made available now early in 2008 for 2007 to the consumers, to the industry, to federal government agencies and others who are working together to improve the safety of our food supply.

That concludes my introductory remarks and now I′m going to turn the floor over to Ms. Faye Feldstein at the FDA.

FAYE FELDSTEIN, ACTING DIRECTOR, FOOD AND DRUG ADMINISTRATION′S OFFICE OF FOOD DEFENSE, COMMUNIATION AND EMERGENCY RESPONSE: Thank you Doctor Tauxe and good afternoon everyone. From an FDA perspective we would like to reiterate that FoodNet data is extremely valuable for FDA in supporting our food protection activities.

FDA actively supports FoodNet, participates in the steering committee and engages in frequent dialogue with the CDC and the USDA during the year on this and many other initiatives. We′re committed to continued support of this very important endeavor.

As Doctor Tauxe explained, the FoodNet data tells us what the state of the public health problem related to these pathogens of concern is. Therefore, the FoodNet data is a vital portion of the information arsenal that we need on which to base our food protection efforts.

To be affective, as you′ve heard, it′s also essential that we are able to specifically identify where the contamination is occurring along the farm to table continuum. We′re also working with the CDC in their initiative to help us link or attribute food-borne illnesses through specific foods or places in the farm to table continuum where the contamination is occurring.

In the past we have actively utilized the FoodNet data to develop our preventive efforts. This has resulted in such initiatives as the development and implementation of vibrio control plans, listeria monocytogenes guidance, a proposed rule for prevention of salmonella, and a tomato safety initiative nationwide, the issuance of several commodity specific guidance documents for produce and modification to the FDA model food plan to enhance prevention activities at retail and in food service facilities.

Many of these efforts have been accomplished and implemented in conjunction with our broad stakeholder base of federal, state and local regulatory agencies, industry and consumers.

In November of 2007 FDA issued our food protection plan. That is a comprehensive strategy of prevention, intervention and response to increase the safety of the U.S. food supply. The plan focuses FDA efforts to prevent problems before they start by increasing corporate responsibility to prevent food-borne illness, identifying foods vulnerabilities, assessing risk and expanding our understanding and use of affective control or mitigation measures.

This 2007 FoodNet data report will continue to be a significant tool for our FDA food protection efforts related to our food protection plan. Thank you and I′ll be happy to answer any questions that you have at the appropriate time.

With that I′ll turn it back to Lola.

RUSSELL: First question.

OPERATOR: Thank you. At this time, if you would like to ask a question please press star followed by one on your touch-tone phone. Once again, star one for questions. Our first question comes from Elizabeth Weise with USA Today. Please go ahead.

ELIZABETH WEISE, USA TODAY: Hi. Thanks for taking my call. Hi Doctor Tauxe. Question for you; out of the data – and I haven′t had time to go through it yet – is there anything that really jumped out at you as surprising or an especially good sign or an especially bad sign?

TAUXE: Thank you Elizabeth. I should say I think that the most – the most salient observation we see is that there is not a particularly important change from the last few years. A lot of things have been going on to improve food safety and we still, you know, think that they′re likely to bear fruit, they′re likely to be important but we have not seen a particular decrease in the important infections that we′re tracking.

It is true that there are modest declines that can be seen. The lines go up and the lines go down year to year and there are modest declines in this year compared to last year for several of the infections but these, as we – as we show, don′t reach a statistical significance compared to the last few years.

Too early to call any trends and we can′t say we′ve made tremendous progress in the last year.

OPERATOR: Thank you. Our next question comes from Mike Stobbe, Associated Press. Please go ahead.

MIKE STOBBE, ASSOCIATED PRESS: Hi. Thanks for taking the call. Doctor, you said earlier this indicates that further measures need to keep prevention on a downward path. What additional measures that haven′t been called for yet do you think need to take place? And I have a second question about botulism. Are there any botulism statistics available?

TAUXE: The question is about botulism and – actually botulism is one of those conditions that is so rare that it′s not tracked through FoodNet and so it′s not included in this report. Botulism surveillance is done by the centers for disease control and we do – we do track that but that′s not included here. It would be a part of other reports.

And I don′t think the number of botulism cases has been summarized and tallied yet for ′07 in quite the same way so I really can′t comment on it.

STOBBE: What about that first question? What other measures are needed?

TAUXE: Well we have representatives of both of the important regulatory agencies for food on the line and I think that that point is that there is a need to focus attention on some specific ones. I know Ms. Feldstein listed a number of the important initiatives that the FDA has begun. And let me ask both Elisabeth Hagen and Faye Feldstein if they have anything they would like to add.

FELDSTEIN: This is Faye Feldstein. Thank you Doctor Tauxe. The food protection plan that I alluded to is posted on the Web site. And if I can go into a bit more detail, it′s a very comprehensive strategy from farm to fork. The keystones segregate activities in prevention activities, intervention activities and response activities.

Included in that is a significant communication piece where we pledge to communicate – improve our communications with our stakeholders in both of times of emergency or response and outbreaks or other emergencies as well as with our prevention and intervention efforts.

But it′s a very comprehensive plan covering the full life cycle of food from production to consumption with many, many initiatives underneath it. The focus of those initiatives is uniformly risk based, scientifically to sensible so that we can focus our agencies resources on where we see the most need to improve – reduce food-borne illness.

RUSSELL: Doctor Hagen.

ELISABETH HAGEN, EXECUTIVE ASSOCIATE FOR PUBLIC HEALTH, UNITED STATES DEPARTMENT OF AGRICULTURE′S FOOD SAFETY INSPECTION SERVICE, OFFICE OF PUBLIC HEALTH SCIENCE: Sure. Is my line open? Can you all hear me?

RUSSELL: Yes.

HAGEN: OK. Yes. So at first I would start by saying that we too at USDA, Food Safety Inspection services are very proud partners in FoodNet and we think this is a critical activity for public health protection.

We always look forward to the release of the data and we find it to be of tremendous value when we evaluate the efficacy of our existing policies and as we think about developing future initiatives. So I would just say that there is always more work to be done. We think that one of the most important things we can do is continue collaborating with other partners and the regulatory system as well as the epidemiology community at the state and local level as well as CDC.

To that end, we meet very frequently; participate in a lot of collaborative efforts. We, ourselves, are hosting a two day session in Saint Louis in May of this year to specifically address how we can better coordinate and collaborate on investigations of food-borne outbreaks.

We′ve taken a couple of specific steps in relation to specific pathogens. We′re all well aware of the up kick in outbreaks related to ground beef in this past year. We are in the second day today of a two day public meeting in which we′ve brought together all stakeholders to really discuss – focus on challenges and opportunities to control E. coli, try and get a handle on what might have contributed to this up kick in this past year.

We′ve begun increasing the type – the number of types of products that we sample in terms of raw beef products that are used in ground beef. We′ve also completed a survey of more than 2,000 beef slaughter and processing establishments to determine the effectiveness of their food safety programs.

And we′re analyzing these responses and we anticipate that that analysis will lead to enhancement of our policies, directives or possibly rules and regulations. We launched a salmonella initiative in 2006 and we′ve seen substantial declines in the areas of salmonella positives in rows. In fact, the number is at approximately half of what it was earlier in this decade.

And in March of 2008 we began posting on our Web site the names – specific names of (INAUDIBLE) establishments that do not show excellent performance in control of salmonella. So those are just really to name a few – a few initiatives that we′ve taken in the very recent past to address what Doctor Tauxe eluded to, the fact that we haven′t seen as substantial of a decline in food-borne illness as we would all hope to see.

RUSSELL: Next question.

OPERATOR: Thank you. And as a reminder, to ask a question please press star one. Our next question comes from Val Willingham, CNN. Please go ahead.

VAL WILLINGHAM, CNN, PRODUCER: Yes. Hi. I believe Faye Feldstein said that the importance of tracking these food-borne illnesses is to know where they′re coming from. If you′re only doing 10 sites in 50 states how is that possible?

TAUXE: Yes. This is Doctor Tauxe. The point that – the greatest information from FoodNet is tracking the actual number of infections that are diagnosed and adding to that other surveys and studies that are done with the FoodNet site to really get more information about where these individual infections might be coming from.

Those studies are conducted and published in the scientific literature and have not been particularly summarized in this report but they are an important part of what FoodNet does. And so they, for example, show that the salmonella enteriditis problem that used to be closely related to eggs had made a transition earlier in 2000 to also include chicken. Similar studies show that Listeria infections were related to some foods that had not been identified in outbreaks.

CDC and public health in general also do a number of other studies, a number of other investigations outside of FoodNet to help understand where food-borne infections come from and how they – how efforts to prevent them might be focused. FoodNet is not the only source of that information.

And what we′re talking about here today is really sort of the overall summary numbers for how the trends are going.

OPERATOR: Thank you. Our next question comes from Molly McCree (ph), CBS. Please go ahead.

MOLLY MCCREA, CBS: Yes. Hi. Could you give us an idea of how the Cryptosporidium poisonings occurred? And then secondly, are you saying that previous poisonings, Cryptosporidium poisonings that were not reported – were they not reported because there was no affective treatment or did I misunderstand you?

TAUXE: Yes, I can comment on that. The cases that are reported to FoodNet, like the cases of – that are reported to public health in general of infections come from clinical laboratories that do the test and make the diagnosis. And if people don′t visit a physician or if a physician doesn′t send a sample to a laboratory to make that diagnosis the case won′t be identified as the case of cryptosporidiosis and won′t show up in any surveillance system.

What we understand is happening now is that because there is a treatment – a new treatment that′s been approved for Cryptosporidiosis that now people who visit a physician are more likely to – the physician is more likely to ask that the specimen go to the lab and be tested specifically for Cryptosporidiosis.

In the past that person, the physician, might have thought well I don′t – I don′t know what the cause of this illness is, maybe it′s Cryptosporidium maybe it′s not and there wasn′t a compelling reason to get a laboratory test done. And now with the idea that gee, if it′s Cryptosporidiosis it might be something I could treat I think there′s more of a reason to get – to get the specimen to the lab and to have the test done.

So that doesn′t mean that there′s actually more illnesses that are coming from – that there are actually more Cryptosporidiosis illnesses but it means that more are being diagnosed now. There was an earlier study of the sources of Cryptosporidiosis in FoodNet cases that was completed several years ago and my (INAUDIBLE) colleagues are not here around the table to summarize that in any detail. But many of those cases it appeared came from exposure to water, either water that was drunk or water that was swam in.

OPERATOR: Thank you. At this time we have no further questions.

RUSSELL: Thank you so much. Again, you can call the CDC, FDA or USDA media line if you have any additional questions. Thank you so much.

OPERATOR: This does conclude today′s conference call. We thank you for your participation.

END

####

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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