Foodborne Illness Outbreaks Reported to National Surveillance, United States, 2009-2018.

Foodborne outbreaks reported to national surveillance systems represent a subset of all outbreaks in the United States; not all outbreaks are detected, investigated, and reported. We described the structural factors and outbreak characteristics of outbreaks reported during 2009-2018. We categorized states (plus DC) as high (highest quintile), middle (middle 3 quintiles), or low (lowest quintile) reporters on the basis of the number of reported outbreaks per 10 million population. Analysis revealed considerable variation across states in the number and types of foodborne outbreaks reported. High-reporting states reported 4 times more outbreaks than low reporters. Low reporters were more likely than high reporters to report larger outbreaks and less likely to implicate a setting or food vehicle; however, we did not observe a significant difference in the types of food vehicles identified. Per capita funding was strongly associated with increased reporting. Investments in public health programming have a measurable effect on outbreak reporting.

Effects of Antimicrobial Interventions on Indicator Organisms during Beef Carcass Dressing.

ABSTRACT: Beef slaughter establishments employ many interventions to help minimize the occurrence of pathogens in their products. This study explored the effectiveness of various common interventions on microbial load using the results of the Beef-Veal Carcass Baseline Survey conducted in 2014 to 2015. The Food Safety and Inspection Service analyzed swab samples taken from 1,135 carcasses at 139 establishments. These included paired samples from post-hide removal (before evisceration) and prechill (after evisceration). Samples were tested for pathogens (Salmonella and Shiga toxin-producing Escherichia coli) and indicators (E. coli, Enterobacteriaceae, coliforms, and aerobic count [AC]). The sample size for pathogen-positive samples was small, impeding the establishment of a direct correlation between interventions and pathogens. However, we observed associations between pathogen-positive rate and log AC, indicating similar intervention effectiveness of pathogens and indicators in this study. Generally, the use of interventions reduced indicator concentrations. Each intervention produced a range of effectiveness, suggesting that how interventions are applied may be as important as which interventions are applied. The range of effectiveness for single interventions was a 0.4- to 1.9-log AC reduction; for multihurdle interventions, it ranged from 1.6- to 2.9-log AC reduction. The results of this study may be used by slaughter establishments to help identify effective intervention options for pathogen reduction.

Assessment of Meat and Poultry Product Recalls Due to Salmonella Contamination: Product Recovery and Illness Prevention.

Data from the recalls of meat and poultry products from 2000 through 2012 due to Salmonella contamination were used to assess the factors associated with the recovery of the recalled product and to develop quantitative models to estimate the number of illnesses prevented by recalls. The percentage of product recovered following a recall action was not dependent on establishment size, recall expansions, complexity of the distribution chain, type of distribution, amount of time between the production and recall dates, or number of pounds of product recalled. However, illness-related recalls were associated with larger amounts of recalled product, smaller percentages of recalled product recovered, a greater number of days between the production date and recall date, and nationwide distribution than were recalls that were not illness related. In addition, the detection of recall-associated illnesses appeared to be enhanced in states with strong foodborne illness investigation systems. The number of Salmonella illnesses prevented by recalls was based on the number of illnesses occurring relative to the number of pounds consumed, which was then extrapolated to the number of pounds of recalled product recovered. A simulation using a program evaluation and review technique probability distribution with illness-related recalls from 2003 through 2012 estimated that there were 19,000 prevented Salmonella illnesses, after adjusting for underdiagnosis. Recalls not associated with illnesses from 2000 through 2012 prevented an estimated additional 8,300 Salmonella illnesses, after adjusting for underdiagnosis. Although further improvements to ensure accurate and complete reporting should be undertaken, our study demonstrates that recalls are an important tool for preventing additional Salmonella illnesses. Moreover, additional training resources dedicated to public health agencies for enhancing foodborne illness detection, investigations, and rapid response and reporting would further prevent illnesses.

Assessment of Shiga Toxin-Producing Escherichia coli O157 Illnesses Prevented by Recalls of Beef Products.

Beef product recall data from 2005 through 2012 associated with Shiga toxin-producing Escherichia coli (STEC) O157 contamination were used to develop quantitative models to estimate the number of illnesses prevented by recalls. The number of illnesses prevented was based on the number of illnesses that occurred relative to the number of pounds consumed, then extrapolated to the number of pounds of recalled product recovered. A simulation using a Program Evaluation and Review Technique (PERT) probability distribution with illness-related recalls estimated 204 (95% credible interval, 117-333) prevented STEC O157 illnesses from 2005 through 2012. Recalls not associated with illnesses had more recalled product recovered and prevented an estimated 83 additional STEC O157 illnesses. Accounting for underdiagnosis resulted in an estimated total of 7500 STEC O157 illnesses prevented over 8 years. This study demonstrates that recalls, although reactive in nature, are an important tool for averting further exposure and illnesses.

Beyond compliance: environmental health problem solving, interagency collaboration, and risk assessment to prevent waterborne disease outbreaks.

A systems approach to environmental health problem solving was used to investigate two waterborne norovirus outbreaks in Wyoming and can serve in the development of improved prevention strategies. An interagency collaboration to prevent waterborne disease involving local, state, and federal partners was designed to coordinate response to outbreak investigations. Improved risk assessment and reporting procedures were also integrated to ensure better availability of necessary data. Public health entities should implement sustainable intersectoral interventions to prevent waterborne disease that not only improve regulatory compliance but also have a positive impact on community health outcomes. Collaborative preventive health and water system protection activities should receive priority attention for implementation in state and local jurisdictions.

Behavior modification following a diagnosis of hepatitis C infection.

OBJECTIVES: To determine the extent of postdiagnosis counseling and to characterize behavior before and after diagnosis of hepatitis C infection. METHODS: We interviewed 133 persons diagnosed with hepatitis C in Wyoming from 1999 to 2001. RESULTS: Approximately two thirds of cases received counseling at the time of diagnosis. Older and symptomatic patients were more likely to receive counseling. Counseling was significantly associated with increases in condom use, wound covering, and hepatitis A and hepatitis B vaccination, but not with changes in addictive behaviors. CONCLUSIONS: Counseling was an effective strategy for promoting several desirable behavior changes among persons with hepatitis C infection.

West Nile virus infection among health-fair participants, Wyoming 2003: assessment of symptoms and risk factors.

Wyoming experienced heavy West Nile virus (WNV) activity for the first time in 2003 and the area hardest hit was Goshen County. Little was known about the epidemiology of WNV in this region. This study describes the symptomatology of WNV and the association between certain behaviors and infection in Goshen County. Study participants were recruited from attendees of a health-fair sponsored by a local hospital, held October 1-3, 2003. A blood sample for WNV testing was obtained from each participant, and participants completed a questionnaire seeking information about the presence of specified symptoms consistent with WNV infection and risk factors possibly associated with infection. The samples were tested for anti-WNV IgM and IgG at the Wyoming Public Health Laboratory. Eight-hundred sixty-nine residents of Goshen County participated, and 122 (14.0%) were seropositive for anti-WNV IgM or IgG. Sixty (59.4%) of 101 persons seropositive for anti-WNV IgM experienced at least one symptom in the previous 4 months consistent with WNV infection, compared with 323 (43.2%) of 747 seronegative persons, resulting in an attributable risk of WNV seropositivity of 16.2%. Of the many symptoms queried, muscle aches (OR 2.63, 95% CI 1.69-4.09), skin rash (OR 6.35, 95% CI 3.74-10.80), fever (OR 2.56, 95% Cl 1.50-4.36), and muscle weakness (OR 2.33, 95% CI 1.34-4.02) were significantly associated with seropositivity on univariate analysis. By multivariate analysis, only skin rash remained significant. Risk factor analysis showed those spending > or =3 hours outside per day were more likely to be seropositive than those spending less time outside per day ( p < 0.05). This study corroborates the belief that a minority of persons infected with WNV develop symptoms attributable to WNV, and also demonstrates that some symptoms are more significantly associated with infection than others.

Waterborne outbreak of gastroenteritis associated with a norovirus.

The Wyoming Department of Health investigated an outbreak of acute gastroenteritis among persons who dined at a tourist saloon in central Wyoming during October 2001. Human caliciviruses (HuCVs) were suspected as the etiological agent of the outbreak based on the incubation period, duration of illness, and symptoms observed in ill patrons. A retrospective cohort study demonstrated that ill patrons were 4.5 times more likely to have exposure to drinking water and/or ice than nonill patrons. No food items were associated with illness. An environmental investigation gave evidence that the saloon's groundwater was contaminated with sewage. Water from the saloon's only well was processed for viruses. The processed water sample and stool samples collected from three ill patrons were analyzed by reverse transcription-PCR (RT-PCR) for the presence of HuCV. All positive RT-PCR results were confirmed by sequence and phylogenetic analyses of cloned RT-PCR products. A genogroup I, subtype 3, HuCV stain was found to be present in the well water sample and two stool samples. In addition, a genogroup II, subtype 6, strain was detected in one stool sample. The identification of the same HuCV strain in both the well water and stool samples strongly suggests a link between exposure to well water and the outbreak of gastroenteritis. The presence of a genogroup II, subtype 6, strain in one of the stool samples suggests that multiple HuCV strains may have been involved in this outbreak. The laboratory isolation of HuCV strains from outbreak-associated drinking water is relatively novel in the United States. This investigation outlines the procedure for virus isolation and illustrates the utility of RT-PCR for the identification of HuCV in large volumes of water and stool samples obtained during outbreaks of acute nonbacterial gastroenteritis.

A waterborne outbreak of Norwalk-like virus among snowmobilers-Wyoming, 2001.

In February 2001, episodes of acute gastroenteritis were reported to the Wyoming Department of Health from persons who had recently vacationed at a snowmobile lodge in Wyoming. A retrospective cohort study found a significant association between water consumption and illness, and testing identified Norwalk-like virus (NLV) in 8 of 13 stool samples and 1 well. Nucleotide sequences from the positive well-water specimen and 6 of the positive stool samples were identical. This multistrain NLV outbreak investigation illustrates the importance of NLV as a cause of waterborne illness and should encourage monitoring for NLVs in drinking water.