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Press Briefing Transcript

CDC Telebriefing on New Food Safety data

Thursday, April 18 at Noon ET

OPERATOR: Good morning or good afternoon.  This is the conference coordinator.  All lines will be placed on listen only until we're ready for the question and answer session of today's call.  This call is also being recorded.  If you do have any objections, you may disconnect at this time.  I would now like to introduce your speaker, Ms. Lola Russell.  You may begin, ma'am.  Thank you. 

LOLA RUSSELL: Thank you for joining us today.  Thank you so much, Lori, for this telebriefing on the report that the Centers for Disease Control and Prevention is releasing today on incidence and trends of foodborne disease.  We describe it as the nation's annual Food Safety Report Card.  With us are three principals to discuss this issue.  We have Dr. Rob Tauxe who is deputy director of CDC's Division of Foodborne, Waterborne and Environmental Diseases.  Joined by Dr. David Goldman who is assistant administrator, Office of Public Health Science of the Department of Agriculture's Food Safety and Inspection Service.  And Dr. Jeff Farrar, director of Intergovernmental Affairs and Partnerships of the Food and Drug Administration.  Each speaker will provide opening remarks and then will move to the question and answer session.  So I will now turn it over to Dr. Tauxe. 

ROBERT TAUXE: Well, thank you very much, Ms. Russell.  I’m very glad to be here today with all of you and with our colleagues from the Food and Drug Administration and the Department of Agriculture's Food Safety and Inspection Service.  We have worked together for many years to track foodborne illnesss, or what is commonly referred to as food poisoning, here in the United States.  This information helps us know how we're doing in reducing foodborne illness and what germs or pathogens are most responsible for those illnesses.  Following the trends over time, which pathogens are increasing, infections decreasing or staying the same offers some insights to many partners on how to save lives and protect people. Every year we estimate that about 48 million of us, that would be one in six people in the United States, get sick from eating contaminated food.  This person who gets sick could be you, could be your spouse, could be your children, your parents or other loved ones.  CDC is the agency that's tasked with monitoring human infections at the national level and tracking the connections to contaminated food and other sources. 

One important way that we do this is using FoodNet, the Foodborne Disease Active Surveillance Network, which captures information about illnesses that are diagnosed in 15 percent of the population of the United States.  Today's report in the CDC journal, the Morbidity Mortality Weekly Report or MMWR, summarizes the 2012 data from the CDC FoodNet program which tracks how we are doing with nine infections that are transmitted commonly through food.  In 2012, the FoodNet surveillance program identified about 19,500 infections, about 4,500 hospitalizations and 68 deaths.  Remember, this is just 15 percent of the total population, and these are the illnesses that are diagnosed by a microbiological laboratory, isolating the organism that caused the illness.  FoodNet reports that the overall incidence of these infections considered together has not changed significantly in recent years. 

Let me say that FoodNet is a powerful collaboration of CDC, ten different state health departments, the U.S. Department of Agriculture, and the Food and Drug Administration.  And since 1996, partners in food safety have relied on FoodNet to provide reliable data that give us snapshots of problems and progress in decreasing foodborne illness.  And the FoodNet data helped to show whether regulatory policies and industry changes are working and when improvements are needed.  So what can we say by looking in more detail at the 2012 FoodNet data which are going to be published and available on the MMWR website at CDC here very shortly, if not already. We see that once again, Salmonella was the most commonly diagnosed and reported cause of infection among those that are tracked.  The frequency of Salmonella infections in general in the population that FoodNet follows has remained constant over time since 1996.  Now, that constancy masks some changes because the type of Salmonella that used to be the most common, which is called serotype Typhimurium has actually decreased substantially over time.  Unfortunately, other types have increased, so the total number has not changed.  Perhaps this represents some success that Salmonella infections have not increased over time, but the fact that we're still where we were a decade ago means that further efforts will be needed to prevent more Salmonella infections and bring that number of infections lower than they are now. 

The second most common infection is caused by the bacteria Campylobacter.  We see that after real progress in the 1990s when there were declines in the early years of FoodNet surveillance, the incidence of Campylobacter in the last few years has increased recently.  So that the -- it's still lower than it was in the 1990s, but it has increased by 14 percent since a baseline period of 2006 to 2008.  Then FoodNet data also show that Vibrio infections, which are really quite rare, increased also when compared with 2006 to 2008.  I should say that Vibrio organisms are found in marine waters where shellfish are harvested and many Vibrio infections are due to eating oysters.  However, not all infections are due to oysters, and some infections are acquired from contact with marine water, causing, for instance, wound infections. 

We also, looking at E.coli 0157, see that the levels in 2012 are similar to those that were observed in 2006- 2008.  And past declines, substantial declines, in E.coli 0157 were observed following regulatory change and improvements in the food industry that particularly targeted ground beef, and it is still the case now that numbers are lower than they were back in the 1990s, but this -- the recent modest increase in the last couple of years means that we're right now just about where we were in 2006- 2008.  And we may need to identify additional ways to reduce contamination as well as heightening awareness among consumers about the importance of thoroughly cooking and safely handling ground beef in their own homes. 

We also calculate a general measure combining the incidence of six key pathogens that are usually transmitted by food and put that together to let us say something about general progress.  And in general, that general measure is down 22 percent from where we were in the late 1990s, although in the last years since 2006-2008, it really hasn't changed.  One other thing FoodNet tells us is who was affected by these infections.  The reporter incidence is highest for many of these infections among children who are less than 5 years old and are at particular risk for severe illness.  And for other infections, older people over the age of 65 are at greater risk than other people for hospitalizations and for deaths highlighting the need for prompt diagnosis and treatment in this age group. 

There are some limitations to keep in mind, looking at FoodNet data.  We do not cover the entire country.  It is 15 percent of the U.S. population and may not always reflect the entire country.  It is still, however, the best and most reliable information we have about the incidence and trends of these infections.  Second, we have to remember that some of these illnesses are acquired from sources other than foods.  So incidence rates don't reflect foodborne illness exclusively.  And finally, FoodNet relies on what clinical laboratories diagnose and can report, and some common infectious agents like the norovirus that are transmitted through food often are not under surveillance in FoodNet because they are just not tested for in clinical laboratories. 

So with this information that many of these foodborne infections are not decreasing in most recent times, 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.  It's important to also note that consumers have a role to play following simple food safety guidelines for the foods they prepare for themselves and others, especially when they prepare them for people at higher risk for severe illness.  At CDC, we continue to improve the systems that help us detect illnesses and outbreaks.  CDC and our colleagues at FDA and USDA are active and vigilant and will keep working together to measure our progress and identify the factors that ensure that our food is healthy and safe.  I will now turn the floor over to Dr. David Goldman, assistant administrator for the Office of Public Health Science in the USDA's Food Safety and Inspection Service.  Dr. Goldman. 

DAVID GOLDMAN: Thank you very much, Dr.  Tauxe.  And thanks to all of you who have joined us today as FSIS together with FDA and CDC look forward to discussing this year's FoodNet report that was released today.  I want to emphasize a couple of things that Dr. Tauxe has said.  One is that FSIS has been a collaborator since its inception, and we believe very firmly in this annual report as a report card.  We take it quite seriously, and it fits right with our priority which is to protect consumers from foodborne illness, given that we are the public health agency of the USDA.  We work with our partners every day to implement the best science in the policies that we develop, and we take advantage of new technologies, whether that's through software or technologies having to do with pathogen detection or other sorts of technologies that will help us stay on the cutting edge of our strategies to fight foodborne illness and lead to lower risk of foodborne illness among the American public. 

This annual report reminds us that the rates of illness and occurrences of outbreaks are quite variable, as was noted just a few minutes ago.  This agency has set goals that are aligned with the Healthy People 2020 goals which you will see in the FoodNet report.  And as I said earlier, we aim our policies at meeting those goals.  We have seen, as was mentioned by Dr. Tauxe, that there have been some positive trends particularly given -- or going back over the broad expanse of FoodNet now, 15-plus years, but compared to recent years, we have seen some troubling trends that we continue to address at FSIS so last year, for example, this agency extended its zero tolerance policy for Shiga Toxin producing E.coli beyond E.coli 0157 to include six additional strains.  So we have been testing for those additional serogroups or strains in beef trim products since last June.  And, of course, we continue to evaluate the data that comes in from that testing.  And as well consider the possibility of expanding that testing to other beef products, which is under consideration at the moment. 

I also want to point out that last -- in July 2011, FSIS implemented the first-ever more stringent performance standards.  It was the first time we actually lowered the performance standards for Salmonella in this case in chickens and turkeys.  And we implemented brand-new Campylobacter performance standards again back in July 2011.  So this occurred just less than two years ago, and the agency has announced in the Federal Register Notice that led to this change that we would be evaluating the first two years’ worth of data.  So that means that through June of this year, we will have two years’ worth of data for the majority of the plants operating and producing chickens and turkeys, and we hope to gain a very clear picture of the effect of both more stringent Salmonella standards as well as implementing new Campylobacter standards. 

Those standards are tough, but we have at least preliminary indications are that the industry has responded well and is meeting those standards, or most of them are meeting those standards.  And 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.  And I would also say that the update to the performance standards that I mentioned for Salmonella, which is the first time we had lowered our performance standard, was part of the President's Food Safety Working Group charge to FSIS, and we have collaborated on many of those activities with FDA as the two regulatory agencies aim to reduce the burden of human illness related to Salmonella.  With that, I will stop my opening comments and look forward to your questions.  And I’ll turn it back to Dr.  Tauxe. 

ROBERT TAUXE: Thank you very much, Dr.  Goldman.  And now let me turn the floor to Dr. Jeff Farrar at the Food and Drug Administration.  Dr. Farrar. 

JEFF FARRAR: Thank you, Dr. Tauxe.  We appreciate CDC's publication of this very important update.  As Dr. Goldman reiterated, we take this information very seriously and look forward to it each year.  We're working very closely with our federal and state partners in reviewing this data and better understanding what the data tells us.  And as importantly, what additional questions we need to ask of the data.  The FDA is concerned that the rates of these major foodborne illnesses have not decreased in recent years.  And certainly these data from CDC highlight the importance of the new rules from the Food Safety Modernization Act which will help reduce foodborne illness. 

As you know, in January of this year, we issued two proposed rules, two very significant rules, on preventive controls in human food and new standards for produce safety.  And we're in the process of soliciting comments on those proposed rules now.  We've held a lot of public meetings across the country.  We've conducted a lot of webinars, and we've attended a lot of state-hosted meetings to give information on these very long and complex rules in the case of the produce safety rule.  So with that, I’ll turn it back to you, Dr. Tauxe.  Thank you. 

LOLA RUSSELL: Hi, this is Lola Russell in the CDC press office.  We will now open for questions.  We'll take one question and one follow-up from each reporter who is interested in asking either Dr. Tauxe, Dr. Goldman or Dr. Farrar a question.  Lori, we'll take the first question now. 

OPERATOR: Thank you.  At this time if you would like to ask a question, please press star one.  You will be prompted to record your name.  Press star one to ask a question.  Press star two to withdraw your request.  Our first question comes from Mike Stobbe with the Associated Press.  Your line is open, sir. 

MIKE STOBBE: Hi.  Thank you for taking the question.  I have two.  I guess I’ll use the second one as the follow-up.  The first one was for Dr.  Goldman and Dr. Farrar.  Why do you guys think campylobacter is up?  Hello? 

JEFF FARRAR: David, would you like to take a shot at that? 

DAVID GOLDMAN: Sure.  I’ll start.  Yes, I’ll be glad to start.  As I mentioned in my opening remarks, we have instituted brand-new performance standards for campylobacter.  I did allude to the fact that we are seeing decreases in the two products that we're looking for campylobacter in that is whole chickens and whole turkeys.  So at least among the products that we are most concerned about being contaminated with campylobacter, we are seeing what appears to be decreasing numbers.  And I’ll refer back to -- there's a baseline study that's posted on our website.  And that baseline was conducted in the years 2007 and 2008.  And there was a much higher percentage of chickens in that case that were contaminated with campylobacter.  So the evidence that we have, and as I said, it's preliminary, and we haven't done our final analysis on the first two years of these standards, is that campylobacter contamination is decreasing at least on whole chickens and whole turkeys.  There are and always will be questions about other food products, and in particular, ground products as well as cut-up parts, what we call parts.  We've done additional baseline studies on chicken parts.  And that analysis will be posted on our website very soon.  So we will look at that data as well as we're about to begin testing ground chicken and ground turkey.  And we'll add that data to our knowledge base and then see where we are.  So my answer is we are seeing less campylobacter in the products that we regulate.  So I guess it doesn't really answer your question directly. 

MIKE STOBBE: Dr. Goldman, do you have anything you wanted to throw in on that? 

DAVID GOLDMAN: That was Dr. Goldman speaking. 

MIKE STOBBE:  That was Dr. -- I’m sorry, Dr. Farrar? 

JEFF FERRAR: Not a lot.  As I mentioned, these are the questions we're asking ourselves right now and working with CDC and USDA to try and get answers as best we can.  There's a lot we don't know yet.  This state is very helpful, as I said, but there's still a lot we don't know about each of these.  Campylobacter, in many cases, occurs sporadic illnesses.  And we don't always have a clear link with those sporadic cases to what the cause of agent or vehicle or, you know, food was that caused the illness.  So we are engaged in a working group with CDC and USDA to get at what we call attribution.  So in this particular pathogen, we would be asking questions such as what percentage of campylobacter cases are due to poultry exposure versus other foods.  That collaboration is ongoing, and we are beginning to put some data together and hopefully we'll have some data in the near future that will help us. 

MIKE STOBBE: Okay.  Can I ask my follow-up? 

LOLA RUSSELL: Yes, you may.  Go ahead, Mike. 

MIKE STOBBE: Thanks. This is for Dr. Tauxe; I just wanted to make sure I understood something.  You mentioned an estimate that CDC has previously made, there are as much as 48 million cases of foodborne illness in the US, and I just wanted to reconcile that with these numbers.  These numbers -- these new numbers are based on reports from ten states.  That's 15% of the population.  I know it's not apples to apples, but 15% of 48 million is more like 7 million, 7.5 million cases.  We have 19,000 in FoodNet and is contrasted with potentially in the neighborhood of 7 million based on the other estimate.  Why is there such a difference?  Is it because this FoodNet is just lab confirmed in just the nine illnesses? 

ROBERT TAUXE: Thanks for the question.  Mike, this is Rob Tauxe at CDC.  Yeah, that's it, basically.  FoodNet tracks the infections that are actually diagnosed in laboratories, clinical laboratories, from sick people.  And it's of this specific list of infections which are the ones that the laboratories can look for.  And so we know already that there are many infections that occur in addition to those that are actually diagnosed.  We know this from outbreaks when a large group of people become ill, but a smaller group of people actually go to see the physician or get cultured and turn up as culture confirmed.  And we know this from our surveys of the population.  So we know that -- we've estimated that something between 20 and 30 people get sick for every one case that's reported.  And the other thing is that we also assume that there are infections that are caused by agents which aren't routinely looked for.  We may not even have identified all the agents that cause foodborne illness, and so there's a factor for additional infections due to -- in pathogens we don't have very much information about or may not have discovered yet.  So the 48 million is the much larger estimate of all the people who get sick.  The 19,000 here is in this group of states.  That's who actually -- was cultured for these pathogens specifically in the clinical labs. 

LOLA RUSSELL: Can we have the next question, please? 

OPERATOR: Our next question comes from James Andrews with Food Safety News. 

JAMES ANDREWS: Hello.  Am I on?  Hello? 

OPERATOR: Sir, your line is open. 

JAMES ANDREWS:  Okay.  Thanks.  So my first question is for Dr. Tauxe.  Basically I’m wondering if you would say that labs are testing for more pathogens or getting better at testing for pathogens over time, and perhaps -- I guess I’m wondering if there's a chance rates really are going down, but we're getting better at finding, say, a higher percentage of pathogens? 

ROBERT TAUXE: Yeah.  This is Dr. Tauxe at the CDC.  I think you raised a question about laboratory practices.  And it's a good question.  One of the things that we track in FoodNet is whether laboratories are changing their practices, whether they are more likely to do cultures or whether the methods they used to do cultures change.  And so far there's been very little change in that, in those practices.  However, that is something that we want to keep a very close eye on because there are new technologies that are being developed and implemented in clinical labs that may -- a little bit like the dipsticks that are used around strep throat diagnosis, you know, if your child has a strep throat or thinks they might have a strep throat, the doctor can do a test in the office.  And then if that test is positive, send a swab off to the lab to see -- and get it cultured.  And some of these rapid diagnostic tests that don't involve culture could change things a bit.  We're monitoring that very closely.  So far we think that's had little impact.  It could mean that people were more likely to get diagnosed because the test is easy and fast.  Or it could mean that if they don't do cultures in the future, that accounts would appear to decrease because the cultures just aren't being done anymore.  So as a trend, we're watching closely for the future, but don't think it's had much impact yet. 

JAMES ANDREWS:   Okay.  Thank you.  And my follow-up question is for Dr. Goldman.  I was wondering if you might be able to elaborate at all on your statement that FSIS is considering expanding s-tech testing to other beef products. 

DAVID GOLMAN: Yes, thank you.  This is Dr. Goldman at FSIS.  The agency, when it put out the original notice about the testing of trim, beef trim, which is what we've confined our testing to up to now, in that notice, we've said that we would consider -- we would look at that data and consider the need to expand that testing to other beef products.  And of course, the most prominent of those would be ground beef.  So we are still in that process of considering the benefit that might accrue by expanding the testing beyond beef trim. 

LOLA RUSSELL: Next question, please. 

OPERATOR: Our next question comes from Bill Thompson with Dow Jones. 

BILL THOMPSON: Yes.  Hi.  On the vibrio results.  The FDA has said that they're monitoring closely what the states are doing to improve the way they detect this and the way they try to prevent it.  I’m wondering why there isn't a federal effort to set new standards much as the USDA does in meat products. 

JEFF FERRAR:  Hi, this is Dr. Farrar with FDA.  I’ll try to respond to that.  The safety of shellfish that go into interstate commerce in the US is provided through a program called the National Shellfish -- National Shellfish Sanitation Program, or NSSP.  This is what we refer to as a cooperative program administered primarily by the states but involving FDA, CDC, NOAA, EPA, academia in the shellfish industry.  These various entities work together through a group called the Interstate Shellfish Sanitation Conference, or ISSC, that sets and requires standards and monitors these controls for the growing, harvesting, processing and packaging of shellfish going into interstate commerce.  So this is a program that FDA is involved in.  It is administered primarily at the state level.  We continue to work with our colleagues at state regulatory agencies and our industry stakeholders in looking at this vibrio data and in fact are working with the ISSC to strengthen the time and temperature controls currently in existence for vibrio.  So we are actively engaged in working with our partners on this. 

BILL THOMPSON: Okay.  A follow-up quick to Dr. Goldman.  You had me a bit confused on the campylobacter.  The numbers here clearly show an increase in campylobacter not only from last year but from the baseline years.  And yet you seem to be saying that the USDA data shows that campylobacter contamination of poultry is declining.  Are you certain of that?  I mean, is it -- I just -- I don't understand.  What would you -- if this is a report card, what's USDA's grade? 

DAVID GOLMAN:  Yeah, this is Dr. Goldman.  Thank you for that question.  And maybe a chance to elaborate a little bit.  And I want to hearken back to what Dr. Farrar said about attribution because that’s really the key to this answer and as he said it’s worth repeating.  Campylobacter is an illness that is rarely documented through outbreaks.  We get information about attribution and the food products that lead to those illnesses through outbreak investigations.  And because there is this relative lack of outbreak data on campylobacter, it really is quite a challenge to all of us, all three of the agencies in trying to determine what leads to this second most common bacterial cause of foodborne illness.  So we often have the case where we have testing data and the overall illness numbers don't seem to coincide, as you point out, and it's just because we are never going to account for all the various exposures that lead to any particular illness.  And as in this case -- and I don't know off the top of my head what the numbers are -- campylobacteriosis may be attributed to a relatively small minority of exposures to chickens, to use that example, compared to other exposure or to unknown exposure.  So, I think it's quite possible we have what seems to be disparate data between the illness rates and the contamination rates.  And that's why we continue to do this work on attribution. 

LOLA RUSSELL: Next question, please. 

OPERATOR: Our next question comes from Bob Roos with CIDRAP News. 

BOB ROOS: Hi, thanks for taking my question.  I was just curious of the FoodNet surveillance coverage area; it's stayed the same for many years.  I just wondered if there were plans or consideration to expand that to cover more of the country at all. 

ROBERT TAUXE: This is Dr. Tauxe at CDC.  Thank you for the question.  I think when we started FoodNet; we were able to start it in five states.  And the plan always was to expand it to the ten states, a surveillance that we have now.  And we think we have reasonably good coverage of the country with these ten sites.  And there are no plans to expand it at the moment.  I would say that there are other efforts to help other states improve their capacity to track foodborne infections and to investigate outbreaks.  And that includes a group of states that is somewhat different from those in FoodNet who are developing methods to investigate outbreaks more rapidly, and under FISMA, CDC nominated a new panel, the Centers of Excellence, that include some FoodNet sites and other states to help translate the best methods we have and make them more available for all the other states in the country. 

BOB ROOS: Thank you. 

LOLA RUSSELL: We’ll take two more questions, Lori.  Can we have this question and then another question and we'll close the telebriefing. 

OPERATOR: Thank you, ma'am.  Our next question comes from Lynne Terry with The Oregonian News.

LYNNE TERRY: Yeah, hi.  Thanks for taking my question.  Can you hear me?  Hello? 

OPERATOR: Yes, we can hear you, ma'am. 

LYNNE TERRY: Okay.  Thank you very much.  Yeah, I have a question about salmonella.  Dr. Tauxe said that salmonella -- some strains of the bacteria had decreased, and others had increased.  I'd like a little bit more detail about that, and could you address antibiotic-resistant strains of salmonella and what they represented in terms of the overall picture? 

ROBERT TAUXE: Yes, good afternoon.  Or good morning in your case. 

LYNNE TERRY: Thank you. 

ROBERT TAUXE: Thank you for your question.  Yes, salmonella is actually a whole group of organisms that can be divided up in a laboratory and to several -- actually many different types or we call them serotypes.  And as I noted, the most common type, what used to be the most common type, typhimurium, has actually decreased substantially over time even as some other types have remained stable or have increased.  The ups and downs in the individual serotypes doesn't seem to have much to do with whether they're antibiotic resistant or not.  And we think they reflect what's going on in the reservoirs or the places in nature or the places in agriculture where the salmonella may naturally live.  Antibiotic resistance in salmonella is a separate issue.  And it is of concern.  It's something that we have been tracking not in FoodNet in the past but in another surveillance system we call the National Antimicrobial Resistance Monitoring System which is also a collaborative effort between FDA, the US Department of Agriculture, and CDC.  And salmonella is of concern, and there has been, of course, problems with antibiotic resistance.  We think it would be very useful and important to be able to link the antibiotic resistance information to the information that we have in FoodNet.  And we've been working hard on methods and mechanisms to make that happen.  But that is not something we're able to do overnight.  Thank you.  

LOLA RUSSELL: Do you have a follow-up, Lynne? 

LYNNE TERRY: Yeah, I do.  I’m kind of befuddled.  We've had a couple questions about campylobacter.  I’m a bit befuddled about the response because there's been an increase, and just what exactly that increase has come from.  Dr. Goldman said that it's a relatively small amount has been attributed to chicken, but is that a question of, you know, the way the system works that when USDA inspectors go in there, you know, a week or whatever later after there's been an outbreak and they're checking, you know, a different lot of chicken, and they haven't been able to find it.  I’m sorry I’m so long-winded here, but we recently had a case here in Oregon where they identified a strain of salmonella, and USDA has yet to make any announcement about it.  So if you could kind of maybe give a little bit more detail because I think I suspect I’m not the only person who's kind of befuddled about in increase in campylobacter and what it's attributed to.  Thank you. 

ROBERT TAUXE: This is Rob Tauxe at CDC.  Perhaps I could add a comment here.  I think it is a little bit of a puzzle.  And it is something that we don't have a good answer for.  In the past, what we know about campylobacter is that the most frequently identified source of those sporadic cases, which are just about all cases because outbreaks are so rare, in the past, that was poultry, raw poultry, undercooked poultry, poultry that dripped on something else that was eaten without further cooking.  And the easy assumption is, well, it must still be poultry.  But I should say that campylobacter has also been a problem in unpasteurized raw milk.  In fact, some numbers of the outbreaks that occur are actually among children who drink raw milk.  And it has also been a problem traced to raw produce, although those outbreaks are quite squarely detected.  So it can come from a range of sources.  And the easy assumption that it's mostly poultry has been a default assumption, but it's not one that, you know, we should accept without question.  And I think that there are methods that we are exploring to help us do that attribution better.  There's some new and sophisticated laboratory methods for comparing strains that we are preparing to evaluate in our laboratory.  And that may help us learn more about what the actual sources and reservoirs of campylobacter are. 

LOLA RUSSELL: Last question, please. 

OPERATOR: Our next question comes from Doug Ohlemeier with The Packer Newspaper. 

DOUG OHLEMEIER: Yes, thank you very much.  Just curious, Dr. Farrar, what does the data say about produce?  Are you seeing any improvement in the illness rates?  What kind of challenges do you see in fresh produce? 

JEFF FERRAR:  Are you speaking specifically about campylobacter or broadly? 

DOUG OHLEMEIER:  Broadly on fresh produce.  I write for a publication covering the fresh produce industry. 

JEFF FERRAR:  Again, those are questions we are asking ourselves of the data, again, referring you back to our -- the importance of our work on attribution.  And for each of these pathogens really understanding what proportion of illnesses from salmonella, 0157, from each of these are due to produce.  Right now we don't have a very specific handle on that.  What we do know is that as you're well aware, the proposed produce safety rule put some very -- proposes some pretty significant new standards for how we grow and harvest produce on the farm.  We're confident that once those rules are finalized and implemented, that they will prevent a significant number of illnesses.  I think in our preamble on the produce safety rule, we estimated that when fully implemented and with high rates of compliance, we estimate that the -- there will be well over 1 million illnesses reduced or eliminated as a result of infections from produce.  So that's not a direct answer, I realize, but it's probably the best we can do at the moment. 

DOUG OHLEMEIER:  I was just curious how, you know, if produce has improved.  I know the rules are coming from, but what the report shows about produce right now.  That was the general gist of the question. 

JEFF FERRAR:  Yeah, I wish we had that attribution data for all the commodities for all these pathogens.  We're a little ways away from that yet. 

LOLA RUSSELL: Thank you so much. We thank all of you for calling in today.  Again, we thank our speakers, Dr. Tauxe, Dr. Goldman as well as Dr. Farrar.  We will have a transcript available later on today of this telebriefing.  There is also a press release and a digital press kit that will also be available on the CDC website.  Again, thank you so much for dialing in. 

OPERATOR: Thank you.  That does conclude today's conference call.  Thank you all for joining.  You may disconnect at this time. 



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