Chapter 154

Foodborne disease is an illness that occurs in two or more people after consumption of a common contaminated food.1 Contamination can occur from a variety of pathogens, including bacteria, viruses, and protozoans. In the past, foodborne illnesses often caused local or regional outbreaks. However, technologic advances in food production and transportation have created a truly global food supply. Modern food distribution systems facilitate overnight delivery of food throughout the U.S. and the developed world. Therefore, current outbreaks from contaminated food are often widespread, and foodborne disease has become a major public health, geoeconomic, and geopolitical issue.

Other factors increasing the risk of foodborne disease include increased processing of fresh “ready to eat” foods at the farm level. This results in greater food handling and an increased opportunity for the introduction and growth of pathogens. In addition, increased international travel and migration also has resulted in a greater risk of foodborne disease. Travelers are at high risk to develop foodborne gastroenteritis due to pathogens to which their immune systems have never been exposed. Migrants and travelers coming from endemic areas may also contribute to the dissemination of foodborne diseases.

### Epidemiology

The Centers for Disease Control and Prevention (CDC) estimates that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5000 deaths in the U.S. each year.4 It is estimated that one in five episodes of all diarrhea illnesses are due to a foodborne disease, and the average U.S. resident will have a foodborne infection every 3 to 4 years.2 In the majority of cases, a causative agent is never identified.2 However, laboratory-identified pathogens account for 14 million illnesses, 60,000 hospitalizations, and 1800 deaths annually. Salmonella, Listeria, and Toxoplasma cause 1500 (75%) of these deaths each year.2 Based on CDC data collected from 1996 to 2006, the incidence of laboratory-confirmed cases of foodborne disease per 100,000 in the U.S. is as follows: Salmonella 14.8, Campylobacter 12.7, Shigella 6.1, Cryptosporidium 1.9, and Shiga toxin–producing E. coli (STEC; both O157 and non-O157) 1.8.3

Viruses cause approximately 23 million cases of foodborne disease annually in the U.S. alone. Therefore, viruses are the most common cause of foodborne disease. Norwalk-type viruses, astroviruses, rotaviruses, and enteric adenoviruses are the viruses typically responsible for foodborne diseases.2,3

In 2007, there were 21 recalls of ground beef from STEC contamination in the U.S. Ten of these outbreaks caused significant illnesses and occurred over a wide geographic area.4 In 2008, a widespread outbreak occurred from peanut butter contaminated with Salmonella.5

It has been estimated that up to 75% of produce on grocery shelves is imported.6 Several recent outbreaks have been traced to imported produce, including peppers, spinach, lettuce, and tomatoes. A study published in 2003 demonstrated that 99.3% of retail packaged salad vegetables were of acceptable microbiologic quality, whereas 0.7 % were contaminated with pathogens, ...

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