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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?


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 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.


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.


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.


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.


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.


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.

Thank you.

[Whereupon, the telebriefing was concluded.]

Listen to the telebriefing

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