# Presentation: 750040

## Caroline Smith DeWaal
USDA Food Risk Analysis Meeting
April 5, 2007

***USDA Food Risk Analysis Meeting***
***April 5, 2007***

**Outbreak Alert!:**
**The Role of Outbreak Data in Risk Attribution**

## Outbreak Alert

**CSPI started collecting data on FBI outbreaks in 1997 and organizing it by regulatory agency. **
**Data from CDC were not available without a FOIA. With our continued requests, CDC started posting yearly line-listings on the internet.**
**In 1999, CSPI published the first line-listing of FBI outbreaks organized by food category and by regulatory agency.**
**CSPI’s methodology for data compilation is published in the July 2006 edition of Food Protection Trends.**

## Outbreak Alert Methodology

**The CSPI database contains 5,000 FBI outbreaks and covers 15 years of data.**
**The database is maintained in Microsoft Access by trained CSPI staff.**
**Outbreak Data Selection**
**Meets CDC’s outbreak definition: event where 2+ people acquire the same illness after consuming the same contaminated food.**
**Has an identified food and pathogen****.**
**Ensuring Data Integrity**
**Outbreak data must come from a reliable source, such as the CDC, scientific articles, health department postings, etc.**
**Discrepancies in outbreak reports are clarified by state or local public health officials.**

## Outbreak Alert!

**Source: *****Outbreak Alert!*****  Center for Science in the Public Interest, 2005**

**Notes:**
Mention this is an MS Access database.

## Outbreak Categorization:

**Outbreak Categorization:**

**FDA-Regulated**
**Beverages**
**Breads and Bakery**
**Dairy**
**Eggs**
**Game**
**Multi-Ingredient Foods**
**Produce**
**Seafood**

**USDA-Regulated**
**Beef**
**Pork**
**Poultry**
**Luncheon/Other Meats**
**Both – Foods Regulated By Both Agencies**

**Outbreaks are grouped by food vehicle, and placed in one of 13 food categories separated by regulatory agency**

## Outbreak Categorization: USDA-Regulated Food Categories and Subcategories

**Beef**
**Ground Beef**
**Beef Dishes **
**Other Beef**
**Poultry**
**Chicken**
**Turkey**
**Poultry Dishes**
**Other Poultry**

**Pork**
**Ham**
**Pork Dishes**
**Other Pork**
**Luncheon/Other Meats**
**Luncheon**
**Meat Dishes**
**Other Meats**

## Outbreak Trends: USDA-Regulated Food Categories and Subcategories

**Note: In 1998, CDC began enhanced surveillance efforts to increase FBI reporting.**

## Population Represented

**Population Represented**

**Data comes primarily from CDC, which collects data from state and local health departments.**
**Data relies on the quality of outbreak investigation and reporting.**

**Outbreaks per 100,000 State Population**

## Incomplete Outbreak Data Reporting

**FBI outbreaks are difficult to investigate, as they require laboratory confirmation of pathogens, timely reporting of illnesses, and thorough follow-up with ill persons to determine common foods and locations.**
** **
**In the years 1990-2002, the cause of 64% of outbreaks reported to CDC was unknown.**
**State and local epidemiologists diagnose an average of just 36% of the nation’s reported outbreaks.**

**Source:** Hargrove, T.  “A Russian roulette of food poisoning in American States.” *Scripps  Howard News Service*
-                Hargrove, T. “States Vary on Diagnosis Rates.”  *Scripps Howard News Service.*

**Notes:**
In December 2006, the Scripps Howard News Service published a study on state identification of foodborne illness outbreaks.  They researched over 6,000 outbreaks from Jan 2000 – Dec 2004.  Nearly 2/3 of the outbreaks in that time period were listed as “unknown.”

Scripps Howard News Service analyzed outbreak diagnoses by state and found that state and local epidemiologists are diagnosing an average of just 35% of the nation’s reported outbreaks – even though some outbreaks may have hundreds of victims.  Alabama proved to be the worst in the nation, diagnosing only 5% of reported outbreaks.

[CLICK]
Other states with worse than average diagnosis rates include: Alabama, California, Florida, Maryland, Montana, Illinois, New Jersey, Mississippi, Washington, Delaware, Michigan, Missouri.

[CLICK]
States with the best diagnosis rates include: Wisconsin, Hawaii, Minnesota, Tennessee.

## Limitations of CSPI’s database

**Delays in release of CDC data result in untimely data.**
**Does not include deaths or hospitalizations.**
**Represents a small percentage of actual FBI.**
**Represents about 25%-30% of reported FBI outbreaks, because it excludes outbreaks with unknown food or pathogen.**
**Sporadic cases of foodborne illnesses are omitted, e.g. *****Campylobacter *****and *****V. vulnificus***** are underreported.**

## Database Applications

**Outbreak data provides food and pathogen attribution that are critical to conduct a food/hazard analysis for HACCP.**
**CSPI’s Outbreak Alert database can:**
**Give the source of an outbreak closest to the time of consumption**
**Identify the frequency of food and pathogen outbreaks**
**Assess food types and pathogens causing outbreaks by location, i.e. states, home- vs. restaurant-prepared foods.**

## USDA Expert Elicitation

**Panel of  23 experts, mostly from industry, with some experts from academia and federal government.**
**Asked experts to rank 24 categories of processed meat and poultry products based on relative risk to human health.**
**Did not address severity of illness.**
**Lacked boundaries for expert scoring.**

## Median Rankings: Low Risk Items

- Source: USDA Table entitled “Relative Risk of Illness per Serving Among 24 Types of Processed Meat and Poultry Products”

**1 - RTE meat fully-cooked without subsequent exposure to the environment **
**1 - RTE poultry fully-cooked without subsequent exposure to the environment **
**2 - RTE acidified/fermented meat (without cooking) **
**2 - RTE acidified/fermented poultry (without cooking) **
**2 - RTE dried meat **
**2 - RTE dried poultry **
**2 - RTE salt-cured meat **
**2 - RTE salt-cured poultry **
**3 - RTE fully-cooked meat **
**3 - RTE fully-cooked poultry **

## Median Rankings: Moderate Risk Items

- 4 - Raw intact pork
- 5 - Raw intact beef
- 5 - Raw intact meat - no beef or pork
- 7 - Raw otherwise processed meat
- 7 - Raw otherwise processed poultry

- Source: USDA Table entitled “Relative Risk of Illness per Serving Among 24 Types of Processed Meat and Poultry Products”

## Median Rankings: High Risk Items

**8 - Raw intact chicken **
**8 - Raw intact poultry ****- no chicken or turkey**** **
**8 - Raw ground or otherwise non-intact pork **
**9 - Raw intact turkey **
**9.7 - Raw ground or otherwise non-intact meat ****- no beef or pork**** **
**10 - Raw ground or otherwise non-intact beef **
**10 - Raw ground or otherwise non-intact chicken **
**10 - Raw ground or otherwise non-intact turkey **
**10 - Raw ground or otherwise non-intact poultry ****- no chicken or turkey**

- Source: USDA Table entitled “Relative Risk of Illness per Serving Among 24 Types of Processed Meat and Poultry Products”

## Relative Risk of Illness CSPI’s Review of the Expert Elicitation

**Due to the lack of uniformity between outbreak data reporting and the USDA risk categories, CSPI grouped the risk categories into 3 broad groups.**
**Lowest Risk (Median Ranking 1-3)**
**Ready-to-eat (RTE) meats**
**Moderate Risk (Median Ranking 4-7)**
**Raw, intact meats**
**High Risk (Median Ranking 8-10)**
**All unprocessed poultry; all ground meats and poultry**

## How Does Outbreak Data Align with the USDA Risk Rankings?

**Low Risk: Ready-to-eat meats**
**Outbreaks: 91, Illnesses: 2,172**
**Examples: Jerky, Chicken Nuggets, Hot Dogs, Deli Meat**
**Moderate Risk: Raw, intact meat (not poultry)**
**Outbreaks: 324, Illnesses: 11,121**
**Examples: Steak, Prime Rib, Ham, Veal, Goat**
**High Risk: Ground meat; Unprocessed poultry**
**Outbreaks: 497, Illnesses: 14,809**
**Examples: Ground Beef, Chicken, Turkey, Taco Meat**

## Pathogen Breakdowns by Category

**Pathogen Breakdowns by Category**

## Consideration of Frequency & Severity

| Pathogen | FoodNet* | Mead Estimates |  |  |
| --- | --- | --- | --- | --- |
|  |  | Illnesses* | Hospitalizations | Deaths |
| Salmonella | 14.55 | 1.3 | 16,430 | 553 |
| Campylobacter | 12.72 | 2.0 | 10,539 | 99 |
| STEC (all) | 1.39 | 0.06 | 1,843 | 52 |
| Shigella | 4.67 | 0.09 | 1,246 | 14 |
| Listeria | 0.30 | 0.002 | 2,298 | 499 |

***per 100,000**
**Sources:**** **
- Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food --- 10 Sites, United States, 2005; MMWR 2006; 55(14);392-396
- Mead PS, et al. Food-related illness and death in the United States. EID 1999;5:607-25.

## Conclusion

- Outbreak data alone can not be used to rank food risks. Experts should also look at sporadic cases and product testing.
- To determine severity, hospitalizations and deaths from outbreaks and sporadic cases must also be considered.
- Outbreak data rely on thorough investigations and reporting of outbreaks. Foods involved in outbreaks are not reported in terms consistent with USDA’s specific risk categories.
- Future outbreak data reporting could be improved with more specifics on implicated foods to contribute to a better understanding of food risk attribution.

## Contact Information

**Caroline Smith DeWaal**
**Food Safety Director**
**Center for Science in the Public Interest**
**1875 Connecticut Ave, NW Suite 300**
**Washington, DC 20009**
**Phone: (202) 777-8366  Fax: (202) 265-4954**
**E-mail: **_[cdewaal@cspinet.org](mailto:cdewaal@cspinet.org)__ _
**On the internet: **_[www.cspinet.org](http://www.cspinet.org/)__  and  __[www.safefoodinternational.org](http://www.safefoodinternational.org/)_** **