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CDC Telebriefing Transcript
Major Foodborne Illnesses
Post Dramatic Six-Year Decline
with Dr. Robert Tauxe, CDC; Dr. Robert Brackett, FDA; Dr. Leeanne Jackson,
FDA; and Dr. Merle Pierson, USDA
April 18, 2002
CDC MODERATOR: Thank you for joining today's telebriefing. Our
spokesperson today is Dr. Robert Tauxe of CDC's Foodborne Division. Dr.
Tauxe is going to give a brief summary of this week's MMWR article on the
new FoodNet data.
Also on this call with us are Drs. Brackett and Jackson with the FDA.
Following Dr. Tauxe's comments, we will open it up to questions and answers.
You may then ask questions of Dr. Tauxe or Drs. Brackett or Jackson of the
FDA.
Dr. Tauxe?
DR. TAUXE: Well, thank you very much, Katie Hoskins and good afternoon to
you.
In an article in today's MMWR, we present data from the last six years that
come from an active surveillance system for foodborne disease in the United
States called FoodNet. These data show that there has been a sustained
decline in the incidence of infection caused by several different important
foodborne pathogens. That includes Ursinia, which is not very common, but
has declined; Listeria; Campylobacter; and Salmonella.
These declines in infections by caused by these foodborne pathogens
represent important progress towards national health objectives that are set
for 2010. These declines mean we are headed in the right direction, but we
still have a long way to go. Additional measures will be needed to further
reduce the incidence of these diseases.
We do not think that these declines are related to a change in the way
laboratories work or change in the way the medical system works. We think
they represent a real decrease in the actual numbers of these infections,
and we think that there are a number of possible contributing factors that
altogether are helping these numbers go down. Among them is a change in the
way that food safety in meat slaughter, animal slaughter and processing is
managed. Beginning in 1997, the Department of the Agriculture began
implementing a new pathogen-reduction strategy for regulating meat and
poultry slaughter and processing plants, and these declines in Ursinia,
Listeria, Campylobacter and Salmonella are happening at the same time as
that new strategy was being implemented.
Of course, there are other things happening as well in food safety in this
country, including new strategies for preventing Salmonella enteritidis
infection on the farm and during egg transportation, better agricultural
practices on farms, regulations of fruit and vegetable juice, food safety
education and our own efforts to improve the surveillance identifying
outbreaks, finding new control points and stimulating new prevention
measures.
So there are a number of reasons why these infections might be going down.
However, I should say that not all infections are going down. We have not
observed a sustained decline in E. coli 0157. And some strains of Salmonella
are actually increasing, while others are going down.
Preventing foodborne disease will not be a simple task, but will require
further efforts all along the chain from farm, and processing, and
slaughter, and in the kitchen. But these declines that we report here, which
are sustained and important declines in those particular infections, mean
that I think we are headed in the right direction, and with further efforts
we should be able to meet the objectives in 2010.
CDC MODERATOR: Okay. Gail, we are now ready for questions. Again, you may
ask a question of Dr. Tauxe or Dr. Bob Brackett or Dr. Leeanne Jackson of
the FDA.
AT&T OPERATOR: Ladies and gentlemen, if you wish to ask a question, please
depress the one on your touch tone phone. You will hear a tone indicating
you have been placed in queue. You may remove yourself from the queue at any
time by pressing the pound key. If you are using a speaker phone, we ask
that you please pick up your handset before pressing the numbers.
Our first question comes from Marin McKenna from Atlanta Journal. Please go
ahead.
QUESTION: Hi. Thanks for doing this.
Dr. Tauxe, could you discuss a bit more any potential hypotheses for the
increase in those strains of Salmonella.
DR. TAUXE: Yes, thank you very much.
The question is about changing incidence of particular strains of
Salmonella. It's actually, Salmonella is an interesting collection of
organisms. Some strains, including those that are most common have been
declining for some years. However, we have seen increases in two of the
strains, one called Salmonella newport and one called Salmonella javiana.
Newport is a serotype of Salmonella that is actually now the third most
common in the country and has been increasing in recent years in several
parts of the country. This appears to be happening at the same time as
illness in animals that is being caused by the same strain, particularly
illness in cattle, and those may be related.
CDC MODERATOR: Next question, please.
AT&T OPERATOR: We'll now go to the line of Erin McClean with Associated
Press. Please go ahead.
QUESTION: Yes. Hi. I wonder if you could talk a little more about how
confident you are that these numbers represent a real decline, and there's a
couple of things I would like you to address.
First, over these five years we saw the expansion of FoodNet to cover almost
40 million people. So we are dealing with a much larger population size.
And, secondly, is it possible that more people just aren't going to the
doctor with these infections or maybe there's some reporting issues there.
DR. TAUXE: Yes, an excellent question, and both of those are issues that we
have been considering in some detail. As you point out, FoodNet, which is
active surveillance in several states around the country began with a much
smaller group of states--five sites around the country in 1996, now expanded
to nine sites. So it has really almost doubled. And as we added in the
sites, each of which had somewhat different rates, that meant we couldn't
just simply compare year-to-year what we were getting because the panel of
reporting sites had changed.
We used a statistical model that allowed us to factor in that site-to-site
difference and examine the changes over time that were occurring in all of
the sites after we subtracted out what was introduced by just adding in new
sites. So our statistical model accounted for that expansion, and those
numbers that we report in the MMWR come from that statistical model.
Your second question was about our confidence in the change in--whether
there was a change in whether people go to the doctor or whether doctors get
tests and so forth. One of the things new in FoodNet is a regular survey of
the people who live in those areas asking them questions like whether they
have had a diarrheal illness and if they did, did they see a physician, and
if they saw a physician, did the physician order a culture.
We did that survey back at the beginning of FoodNet, and we have recently
completed a follow-up survey that tells us that the rate at which people go
to physicians and the rate at which physicians get cultures have not changed
materially in that time. So we are pretty confident that that does not
account for this decrease in diagnosed infections.
CDC MODERATOR: Next question, please.
AT&T OPERATOR: We'll go to the line of Nancy Metcalfe with Consumer Reports.
Please go ahead.
QUESTION: Yes, Dr. Tauxe, you mentioned that one of the reasons that you
believe some of the infections have gone down is because of improved
infection or contamination control measures in meat and poultry plants, and
yet you also said that E. coli has not--E. coli 0157 has not declined. I
wonder, since that is also something that would be addressed by the HACP
[ph] program in meat and poultry plants, especially meat plants, I guess,
why that would not have been going down as well.
DR. TAUXE: Well, that is a very good question, and I think that the lack of
a sustained decline in E. coli 0157 tells us that we really need to have
increased efforts focused on this pathogen.
I think E. coli 0157 is not going to be a simple pathogen to prevent because
it can be transmitted through food, water, person-to-person contact and
direct animal exposure. I think that the question is sort of whether we are
seeing a decline, whether the changes in meat, slaughter, hygiene and
sanitation over the last few years actually have reduced that part of E.
coli 0157 which is related to meat, while it's expanding in, transmission is
expanding in other ways. That is an open question we don't know the answer
to. It is also possible that without those measures in the slaughter plants,
E. coli 0157 would actually have been increasing. And so to have a
relatively constant line for E. coli 0157 may be more of a success than we
realize.
I think E. coli 0157 remains a challenge to the entire food safety system.
MR. : Dr. Tauxe?
DR. TAUXE: Yes?
MR. : This is USDA. Dr. Merle Pierson is on the phone, too.
CDC MODERATOR: Oh, okay. Please, Dr. Pierson.
DR. PIERSON: Hi. This is Merle Pierson. I agree with what's been said so
far. We have in place the requirement for HACP systems, and the HACP systems
have to be verified. When it comes to raw meat, raw ground beef, there is
the potential for the presence of enteric pathogens, and one of these being
E. coli 0157:H7. FSIS has declared that to be an adulterant, and we do have
strict regulatory enforcement relative to that pathogen.
We are strongly advising our processors to put in place further
pathogen-reduction systems to further address that particular microorganism
and the concerns. As far as the variations in data, Dr. Tauxe is exactly
right. What we don't know is--in fact, if we didn't have these HACP systems
in place, those numbers could have increased. What is encouraging is that
there's a decline, there has been a 21-percent decline, and this has
occurred since 2000. So that part of the trend is very positive.
CDC MODERATOR: Gail, before we go to our next question, I just want to let
our participants know that Dr. Merle Pierson of the USDA has joined our
telebriefing, and you may also direct questions to him as well.
Next question, please.
AT&T OPERATOR: We'll go to the line of Edward Eddleson with Healthscout.com.
Please go ahead.
QUESTION: Is it possible to make an estimate of how many fewer of these
infections there are annually in the United States?
DR. TAUXE: That is a good question. We don't have good national data on
exactly how many of these infections are diagnosed. FoodNet, in those nine
states now, gives us our best representation of what the national picture
might look like. Using the FoodNet information that we have, we would
estimate that there have been tens of thousands of actual diagnosed cases of
illness prevented, that is, that the number of diagnosed cases prevented
now, compared to back in 1996, is tens of thousands.
CDC MODERATOR: Thank you. Next question, please.
AT&T OPERATOR: We'll go to the line of Marilyn Marshioni with the Milwaukee
Journal Sentinel. Please go ahead.
QUESTION: Good morning. Thanks.
I wonder, first, if I could ask a housekeeping measure, if we could please
get the spellings of Dr. Pierson's first and last name and also of the two
FDA doctors that are there.
And, again, I was going to ask Dr. Tauxe if you could just summarize clearly
the situation with E. coli. Is it only from 2000 to 2001 that you saw a
decline? Before that is it flat? If you can characterize a little more about
exactly what was seen with E. coli.
And then a more summary statement. Is there anything about the consumers'
behavior with respect to foodborne illness that you can conclude or that you
know from these or other surveillance that you have done?
CDC MODERATOR: Why don't we begin by letting Dr. Tauxe answer the question
and also spelling his name and then follow with Drs. Brackett, Jackson and
Pierson, if you would let the reporter know the correct spelling of your
name.
DR. TAUXE: To go for that question about E. coli 0157, there is a graph in
the MMWR on Figure 2 which shows as a solid line the E. coli 0157 incidence
relative to 1996. It actually goes up and down a bit. It went down in 1997,
which was cause for early expectations, but then in 1998 it went back up to
an even higher rate than in 1996, and it basically stayed relatively level,
and then in 2001 again, it declined again.
So it has varied from year to year enough that we really find it difficult
to see a trend. It did decline from 2000 to 2001, and overall it is down 21
percent from where we were in 1996, but it has varied enough that we really
have no confidence that it would stay down, and so it may go back up again
next year.
The question about consumer behavior was a good one. I think we have done
surveys about how often people like to eat their ground beef rare or their
eggs undercooked and that sort of thing. We have not seen major shifts in
what the population is doing in those surveys, but we would like to think
that increased awareness in consumers about things they can do to prevent
foodborne disease is helping and may be playing a role in reducing these
overall numbers a bit. Certainly, there are things consumers can do, and
there have been real efforts to try to bring those to the attention of the
average person.
My name is Robert Tauxe. That is spelled T-a-u-x-e. And over to the others?
CDC MODERATOR: Dr. Brackett?
MS. : Dr. Brackett's name is Robert Brackett, B-r-a-c-k-e-t-t.
CDC MODERATOR: And Dr. Jackson?
DR. JACKSON: My name is Leeanne Jackson, spelled L-e-e-a-n-n-e Jackson.
CDC MODERATOR: Thank you.
And Dr. Pierson?
DR. PIERSON: Yes. My name is Merle Pierson. It's M-e-r-l-e P-i-e-r-s-o-n.
I'm Deputy Under Secretary of Food Safety with USDA.
CDC MODERATOR: Thank you.
Next question, please.
AT&T OPERATOR: We'll go to the line of Mark Kauffman with the Washington
Post. Please go ahead.
QUESTION: Thank you. Two questions. The first is just a small introductory.
You had said that there were perhaps tens of thousands of actual diagnosed
cases of illnesses prevented. Are you speaking about that over the period of
'96 through 2001 or is that an annual figure that you are using?
The second question has to do with how you folks were accounting for some of
the decline and what were the causes of it. Certainly, there is a discussion
of how the HACP has been very helpful. I wanted to see if you believed that
the performance standard aspect of HACP was significant as well or if you
are talking about the actual implementation of that system.
DR. TAUXE: Let me address that briefly, and perhaps Dr. Pierson would also
like to comment on it.
As for the estimate of tens of thousands, that would be in the year 2001,
not accumulated over the whole 6-year period, but in the year 2001.
QUESTION: Okay.
DR. TAUXE: And as for how one explains this decline of 21 percent in these
organisms that have been tracked for the 2010 objectives, the change in meat
safety, the change in operations were quite profound and were implemented
over a number of years and had a number of different aspects, and I am not
able to comment on whether one or another aspect of the whole HACP plan
pathogen reduction plan was more important than another.
The change over time in the whole system I think is very likely to be part
of the explanation for the decline.
CDC MODERATOR: Dr. Pierson?
DR. PIERSON: The performance standards were created based upon baseline
studies, and we then required companies to meet these performance standards.
For example, for broilers, the baseline study indicated overall prevalence
of 20 percent, and then we had an associated performance standard that had
to be met.
Did the performance standard actually drive down what we see now as the
lower prevalence of Salmonella? The performance standard, in and of itself,
would not because that was based upon the prevalence at the time the
baseline studies were performed.
What happened is that companies were required to implement HACP systems and
required to implement SSOPs for sanitation--standard operating procedures
for sanitation. And in doing so, they had to implement specific sanitation
requirements and intervention steps to either prevent, eliminate or reduce
potential pathogens. And as a result, we now see, through our compliance
sampling, a lower incidence of Salmonella, overall incidence of Salmonella,
in raw meat and poultry, as compared to the baseline study.
And so we believe it is, in fact, implementing the HACP systems that has
driven down our lower prevalence of indicating prevalence of Salmonella. Our
hope is, is that has, at the same, time seen that lower incidence level has
contributed to this decline that CDC is reporting in the overall incidence
of foodborne illness.
CDC MODERATOR: Next question, please.
AT&T OPERATOR: We'll go to the line of Dom Costaldo with Meat Processing
Magazine. Please go ahead.
QUESTION: Yes. My question is will some of the new technologies that are
coming about, such as irradiation or some of the proteinated or not
proteinated, but the propionic acids and the hand-held steam systems, will
they have an impact on reducing foodborne illness infection specifically in
meat, and when can we expect to see those declines occur if they do?
DR. PIERSON: This is Merle Pierson.
Yes, we are strongly encouraging specific interventions for raw meat and
poultry in order to further reduce the level and incidence of pathogens such
as Salmonella in these products. We feel that there is a whole arsenal of
potentially effective interventions that could be potentially utilized, and
we are strongly encouraging effective implementation of those strategies.
CDC MODERATOR: Next question, please?
AT&T OPERATOR: Ladies and gentlemen, if there are additional questions at
this time, please press the one on your touch tone phone.
CDC MODERATOR: While we are waiting for those additional questions, Dr.
Tauxe mentioned some of the measures in place that have helped these numbers
to decline, particularly Salmonella and egg safety.
Drs. Brackett or Jackson, could you make comment about that for our
listeners?
DR. BRACKETT: This is Bob Brackett.
There are a number of interventions throughout the country that have been
made toward egg safety. We have the Egg Safety Action Plan that was rolled
out several years ago, and with that, both FDA and USDA [inaudible], and
also worked with the industry and the state groups to use that strategy to
try to improve the safety of these egg safety programs, both in state, as
well as with the government actions.
There has also been a big increase in the amount of food safety education,
and particularly with cooperative programs such as the Fight Back campaign
and also direct education of the public with information specifically
towards eggs, both by the government, as well as the industry. And so these
may have added a lot to increasing the safety of eggs.
CDC MODERATOR: Thank you.
DR. BRACKETT: We have also had two regulations also in the last few years;
one dealing with the refrigeration of eggs, which we think is important in
keeping down any pathogen safety problems in eggs and another one on
labeling so that consumers are aware of the issue as well.
CDC MODERATOR: Thank you very much, Dr. Brackett.
Gail, we have time for one more question.
AT&T OPERATOR: We'll go to the line of Nancy Metcalfe with Consumer Reports.
Please go ahead.
QUESTION: Actually, I have two, one I hope is kind of brief.
The first one is if anybody can comment on I believe it was called Supreme
Beef Processors' successful challenge of the ability to regulate Salmonella,
whether that is going to impact your ability to improve your numbers here.
The second thing is Dr. Tauxe mentioned earlier that better agricultural
practices on farms might have contributed to the decline in so many of the
foodborne infections, and I wondered whether he could talk a little bit
about what those might be.
DR. PIERSON: This is Merle Pierson, and I will address your question
relative to the Supreme Beef case. In that particular case, the indicated
we, for the ground beef, that we could not use the performance standard for
enforcement, we could not base that enforcement of regulatory action on the
performance standard.
However, we still conduct microbiological testing for Salmonella based upon
that same protocol, and we use, in effect, a performance standard to then
determine whether or not that HACP system is effective. And so we still use
the same numbers, we still do the same testing, we still have the same
capability or ability to take enforcement action if, in fact, companies are
not complying or if they are not implementing effective HACP systems.
So, no, we don't feel that we are held back at all. In fact, we are using
the performance standards exactly as discussed in the final rule, to be used
as a verification process.
QUESTION: And my question about farm practices?
DR. TAUXE: I can address that very briefly. This is Dr. Tauxe at CDC.
I think the most specific example is the egg quality assurance programs that
are now being adopted in a number of states. I believe 13 states now have
egg quality assurance programs which are a series of practices that egg
farms barely[?] adhere to that may reduce the contamination of eggs. I think
that this is an example of really extending the systems approach, the HACP-type
approach to agricultural practice that includes both this systematic
sanitation attention and microbiological validation of the results.
These egg quality assurance programs are one example of how this whole
approach could be extended back to the farm and into other areas and other
foods other than the meat, poultry, and seafood that HACP has already been
applied to.
I think that the early evidence that we have now that we are heading in the
right direction suggests that the general approach could be applied more
broadly and could be extended to more foods and could be extended back to
address contamination issues on the farm, as well as for some, as was
mentioned, there are new technologies to really further reduce pathogens on
food, including electronic debridement and other new technologies that are
going to be I think increasingly important in the future, as well as
increasing sanitation throughout the food chain.
DR. BRACKETT: This is Bob Brackett. This has also been applied to fresh
produce. We have had increased attention at the farm level on fresh produce
safety. In particular, we have had a lot of emphasis on providing, and
directing, and instructing farmers in good agricultural practices both at
the domestic level, as well as internationally in ways that contamination at
the farm level can be reduced.
CDC MODERATOR: Thank you very much.
Ladies and gentlemen, this will conclude our telebriefing. A transcript of
the telebriefing will be available on-line at the CDC website later this
afternoon or you can call our office at 404-639-3286 and a copy can be sent
to you.
