E D I T O R I A L C O M M E N TA R Y

Foodborne Disease: The More Things Change, the More They Stay the Same
Michael T. Osterholm
Center for Infectious Disease Research and Policy, School of Public Health, University of Minnesota, Minneapolis

(See the article by Jay et al. on pages 17)

The more things change, the more they stay the same. Alphonse Karr

Despite efforts by the public health community and the food production and service industries, Escherichia coli O157:H7 remains an important foodborne pathogen in the United States. The article by Jay et al. [1] detailing a multistate outbreak of E. coli O157:H7 caused by the consumption of contaminated beef tacos is another unfortunate story in the book on foodborne disease [1]. The source of the contamination was precooked ground beef, a supposedly safe product that my colleagues and I [2] had previously demonstrated 14 years ago is a source for E .coli O157:H7 infection. In 1996, the Centers for Disease Control and Prevention (CDC) Emerging Infections Program established the foodborne disease active surveillance network (FoodNet) to follow trends of specic foodborne infections by using laboratory-based surveillance for culture-conrmed illnesses

Received 16 March 2004; accepted 16 March 2004; electronically published 11 June 2004. Reprints or correspondence: Michael T. Osterholm, Center for Infectious Diseases Research and Policy, School of Public Health, University of Minnesota, 420 Delaware St. SE, MMC 263, Rm. C-315, Minneapolis, MN 55455 (mto@umn.edu). Clinical Infectious Diseases 2004; 39:810 2004 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2004/3901-0002$15.00

caused by several enteric pathogens commonly transmitted through food. One of the pathogens surveyed was E. coli O157: H7 [3]. Recent analysis of the FoodNet data of 19962002 found that the incidence of E. coli O157:H7 infection did not signicantly change at the FoodNet sites, despite implementation of several major control measures, including initiation of the pathogen reduction/hazard analysis critical point systems regulations for meat and poultry slaughterhouses and processing plants sponsored by the US Department of Agriculture (USDA) Food Safety Inspection Service. These national surveillance data, as well as the continued occurrence of outbreaks of Salmonella and E. coli O157:H7 infections associated with ground beef consumption, give us reason to reconsider further steps needed to reduce the burden of disease associated with pathogens transmitted through meat and poultry. The outbreak investigation reported by Jay et al. [1] and our ongoing collection of foodborne disease surveillance data illustrate 2 very important lessons. First, there will be only limited gains in reducing the incidence of meat- and poultry-related foodborne illnesses until the implemen-

tation of food irradiation becomes standard. Second, most foodborne disease outbreak investigations are initiated after the fact and have little real-time public health impact for preventing additional cases of illness; the investigation by Jay et al. [1], although comprehensive and thoughtful, offers no exception. It is disappointing that Jay et al. [1] did not mention the use of food irradiation in their discussion of ways in which similar outbreaks can be prevented in the future. Because of the support for food irradiation by the federal food-safety agencies in the United States, which include the CDC, the US Food and Drug Administration, and the USDA, public health ofcials should use every opportunity to promote this important technology, particularly in the context of foodborne outbreaks. Food irradiation has the potential to dramatically decrease the incidence of foodborne disease and is widely supported by international and national medical, scientic, and public health organizations, as well as groups in the food processing industry (table 1) [4]. The CDC has determined that if even 50% of meat and poultry consumed in the United States were irradiated, the potential impact on foodborne

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Table 1. Selected organizations that support the safety of food irradiation.

Organization US government agencies Department of Agriculture Department of Health and Human Services Food and Drug Administration Centers for Disease Control and Prevention Scientic and health-related organizations United States American Academy of Pediatrics American Dietetic Association American Medical Association American Veterinary Medical Association Council for Agricultural Science and Technology Council of State and Territorial Epidemiologists Infectious Diseases Society of America National Association of State Departments of Agriculture International Codex Alimentarius Commission Food and Agriculture Organization of the United Nations International Atomic Energy Agency Scientic Committee for Food of the European Union World Health Organization Food processing, food service, and related groups American Meat Institute Institute of Food Technologists Food Marketing Institute Grocery Manufacturers of America

disease would be a reduction of 900,000 cases and the elimination of 352 deaths each year [5]. Unfortunately, !0.002% of fruits, vegetables, meats, and poultry are currently irradiated in the United States [6]. My colleagues and I have recently detailed the role of irradiation in food safety and the potential barriers that cause it to be largely unused [4]. The bottom line messages are that (1) health and public health professionals are largely unaware of the benets of food irradiation, (2) there is an enormous body of data demonstrating the safety of this process, and (3) we must detail specic steps necessary to realize its potential benets as a widely used food safety technology. Commercial use of irradiation for meats and poultry is conceptually similar to milk pasteurization. It uses high-energy irradiation in any of 3 approved forms: g rays, radiography, and electron beam. Pasteur-

ization by irradiation is not intended to eliminate all bacteria in meat and poultry, but rather to eliminate a large proportion of pathogenic organisms. Thus, irradiation does not eliminate the need for established safe food handling and cooking practices, but it will reduce the dangers of primary and cross-contamination. Currently in the United States, irradiation is approved for insect disinfestation, shelflife extension, pathogen and parasite control, and sprout inhibition. Foods that have been approved for irradiation include red meat, poultry, pork, fruits and vegetables, aromatic spices, seeds, herbs and seasonings, enzyme preparations, eggs, and wheat. Without a technology like irradiation, even with other recent efforts by the meat and poultry processing industries, it is impossible to eliminate all contamination of these products, particularly in the slaugh-

terhouse environment. In 2003, the USDA Food Safety and Inspection Service found that 0.32% of ground beef samples were contaminated with E. coli O157:H7 [7]. Because the United States produces 3.6 billion kg of ground beef annually, even this exceedingly low level of contamination means that an estimated 11.6 million kg of E. coli O157:H7contaminated ground beef will be produced each year. Until the use of irradiation as a food safety technology for food products like ground beef is taken seriously in the United States, there will continue to be reports of outbreaks similar to those discussed by Jay et al. [1]. Finally, although I applaud the comprehensive nature of outbreak investigation conducted by Jay et al. [1], it highlights a major shortcoming of many similar foodborne disease investigations reported recently: too little, too late. Despite the occurrence of cases of illness in early November 1999, an investigation-related case-control study to identify risk factors was not initiated until early December 1999. The subsequent trace-back studies of implicated food products necessarily did not start until weeks after the start of the case-control study. So, despite the relatively timely use of PFGE for surveillance-based analysis of isolates of E. coli O157:H7 recovered from patients, the implicated food product (i.e., undercooked precooked ground beef) had cleared through the food distribution system before investigators could identify it. This is typical for most food commodityrelated outbreaks today, particularly those involving perishable items such as fresh produce. Although such outbreak investigations can be very instructive in discovering deciencies in the safety of a given commodity or food process and provide guidance for preventing future outbreaks, rarely do such investigations actually allow for meaningful removal of the implicated item from the market or make possible specic warning to consumers. The outcome of this investigation was no different.

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So, we are really left with the fact that we must only consider these important investigations largely as lessons for the future, not as smoke alarms capable of early warning and cause for immediate prevention. This concept brings us full circle; we must begin to use food irradiation if we are really to make a difference in food safety.

2.

3.

References
1. Jay MT, Garrett V, Mohle-Boetani JC, et al. A multistate outbreak of Escherichia coli O157:H7

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5.

infection linked to consumption of beef tacos at a fast-food restaurant chain. Clin Infect Dis 2004; 38:17 (in this issue). Belongia EA, MacDonald KL, Parham GL, et al. An outbreak of Escherichia coli O57:H7 colitis associated with consumption of precooked meat patties. J Infect Dis 1991; 164:33843. Nelson JM, Vugio DJ, Cronquist AB, et al. Incidence of foodborne illness in the United States, FoodNet 2002. In: Program and abstracts of the International Conference on Emerging Infectious Diseases (Atlanta). Atlanta: Centers for Disease Control and Prevention, 2004:194. Osterholm MT, Norgren AP. The role of irradiation in food safety. N Engl J Med 2004; 350: 1898901. Tauxe RV. Food safety and irradiation: pro-

tecting the public from foodborne infections. Emerg Infect Dis 2001; 7:51621. 6. US General Accounting Ofce (GAO). Food irradiation: available research indicates that benets outweigh risks. Publication no. GAO/ RCED-00-217. Washington, DC: GAO, 2000. 7. Roybal J. Beef industry logs successful week in E. coli O157:H7 battle. BEEF Magazines CowCalf Weekly. 26 September 2003. Available at: http://enews.primediabusiness.com/enews/beef /cowcalf_weekly/current- a030926_4. Accessed 30 September 2003.

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