# Presentation: 020364

## Foodborne Illness Outbreaks 
and Sprouts

- <date/time>

**Foodborne Illness Outbreaks **
**and Sprouts**

**FDA Public Meeting:**
**2005 Sprout Safety**
**May 17, 2005**
**Amy Dechet, M.D.**
**Foodborne and Diarrheal Diseases Branch**
**Centers for Disease Control and Prevention,**
** ****Atlanta, GA**

## 	76 million illnesses	

	325,000 hospitalizations

	5,000 deaths

- 	325,000 hospitalizations
- 	5,000 deaths

- Annual Burden of Foodborne Illness
- in the United States

- Mead et.al., 1999, EID

## 76 million cases annually means:

1 in 4 Americans ill

1 in 1000 Americans hospitalized

≥ $6.5 billion in medical and other costs

- 1 in 4 Americans ill
- 1 in 1000 Americans hospitalized
- ≥ $6.5 billion in medical and other costs

- What Does This Really Mean?

- <date/time>

- Foodborne Outbreak Surveillance

- Local and state health departments
- Detect, investigate, and control outbreak
- CDC
- Collect reports: # of cases, implicated food, etiology
- Define an outbreak:
- 2 or more cases of a similar illness resulting from the ingestion of a common food
- Reporting
- Voluntary and incomplete

## Foodborne Outbreaks Reported to CDC, 1990 - 20031

- Foodborne Outbreaks Reported to CDC, 1990 - 20031

- 1 By states to the Foodborne Disease Outbreak Surveillance System

- Enhanced surveillance

- Produce Associated Outbreaks
- Reported to CDC 1998-2002*

**249 outbreaks**
**6% of outbreaks with reported food source**
**13% of outbreak-associated cases**
**Implicated produce**
**Generic or multiple:****	****	****	****144 outbreaks**
**Lettuce:****	****	****	****	****22**
**Sprouts:****	****	****	****	****14**
**Juice:****	****	****	****	****	****10**
**Melon:****	****	****	****	****	****9**
**Tomato:****	****	****	****	****8**
**Berries:****	****	****	****	****6**
**Other produce:****	****	****	****36**

**67% of outbreaks**
**with single vehicle**

- (*Preliminary information)

## Produce Item, Outbreaks, Consumption

- _Produce_		_# outbreaks_	_% population eating item_
- 				   (1998-2002)		         (FoodNet Survey 2002)
**Lettuce****	****	****	****22****	****	****   73%****	****	**
**Sprouts****	****	****	****14****	****	****   8% ****(“stealth” vehicle)**
**Juice****	****	****	****10****	****	****   26-65%**
**Melon****	****	****	****9****	****	****   21-28%**
**Tomato****	****	****	****8****	****	****   68%**
**Berries****	****	****	****6****	****	****   21-33%**

## Sprouts:  Where Does Contamination Occur? 

- Multiple opportunities for contamination from farm to table
- Field: grazing animals
- Mixing: same harvest machinery and processing facilities
- Scarification:  bacteria enters seed
- Transport:  many steps along the way

## Sprouts: Bacterial Growth, Detection, and Elimination

- Sprouting:  warm, moist environment perfect for bacterial growth
- 2-4 log increase in CFU/gram
- Difficult to detect pathogens
- Non-homogenous distribution
- Low-level contamination
- Rarely washed or cooked by consumer

## Sprouts:  Why They Are Unique

- Multiple pathogens implicated in outbreaks
*Salmonella*: Typhimurium, Mbandaka, Saintpaul, Muenchen, Enteritidis, Kottbus, Chester, Cubana, Bovismorbificans
*E. coli*: O157:H7, O157:non-motile
- Multiple kinds of sprouts
- alfalfa, mung bean, clover, broccoli, etc.
- International partners

## Sprout Outbreaks by Year

## Alfalfa Sprout Outbreaks by Year(N=26)

## Alfalfa Sprout Outbreaks by Year

- FDA advises chlorination of seeds

## Alfalfa Sprout Outbreaks and Compliance with FDA Guidelines by Year

- FDA advises chlorination of seeds

## Average Size Outbreak by Year

|  | # of Outbreaks | # of Cases | Mean # of Cases |
| --- | --- | --- | --- |
| 1998 | 4 | >48 | 16 |
| 1999 | 5 | 392 | 78 |
| 2000 | 2 | Unknown | Unknown |
| 2001 | 1 | 32 | 32 |
| 2002 | 1 | 5 | 5 |
| 2003 | 5 | 53 | 11 |
| 2004 | 2 | 38 | 19 |

## Produce Item, Outbreaks, Consumption

- _Produce_		_# outbreaks_	_% population eating item_
- 				   (1998-2002)		         (FoodNet Survey 2002)
**Lettuce****	****	****	****22****	****	****   73%****	****	**
**Sprouts****	****	****	****14****	****	****   8% ****(“stealth” vehicle)**
**Juice****	****	****	****10****	****	****   26-65%**
**Melon****	****	****	****9****	****	****   21-28%**
**Tomato****	****	****	****8****	****	****   68%**
**Berries****	****	****	****6****	****	****   21-33%**

## Using Outbreaks to Observe the Effect of Interventions:  

**Juice-Associated Outbreaks, 1994-2004***

**Juice Labeling reg**

- *National foodborne outbreak reporting system, 2004 data  preliminary

**Juice HACCP reg**

## Conclusions

- <date/time>

**Conclusions**

- Sprout-associated outbreaks represent a small proportion of foodborne outbreaks
- Sprouts are one of the most common vehicles identified in produce-associated outbreaks
- Current practices are not adequate to prevent disease from sprouts
- Outbreak surveillance offers opportunities for tracking effectiveness of interventions

## Thank you!

## Alfalfa Sprout Outbreaks and Consumption by Month