Foodborne Infections and the Global Food Supply: Improving Health at Home and Abroad

Article excerpt

ABSTRACT

In recent years, fourteen percent of the U.S. food supply has been imported from other countries, including many fresh and perishable foods. Although most outbreaks of illness and individual cases are related to foods from the United States, large and unusual outbreaks have been traced to imported foods that were likely contaminated in the country of origin. Investigation of these outbreaks requires collaboration across several disciplines as well as across international borders. Successful investigation can not only control the original problem, but can also inform public authorities in both countries about the need for strategies to prevent similar outbreaks from happening in the future. Production of perishable foods in the developing world brings particular challenges because of the deficiencies in basic sanitation and hygiene and other elements of public health that Americans take for granted. The public health infrastructure in such countries is critical to identifying and controlling foodborne and waterborne challenges before they affect exported foods, and strengthening such infrastructure is an important part of general development efforts. Strategies to improve the health of the workers and rural populations in those countries and to increase the capacity of public health and food safety systems are likely to have long-term benefits to health in those countries, as well as preventing infections in the countries to which they export.

TABLE OF CONTENTS

  I.  HISTORICAL INTRODUCTION
 II.  AN INCREASINGLY INTERNATIONAL FOOD SUPPLY
III.  THE ART AND PRACTICE OF THE FOODBORNE
      OUTBREAK INVESTIGATION
 IV.  ILLUSTRATIVE OUTBREAKS
      A. Cyclospora and Central American
         Raspberries
      B. Dysentery and Mexican Parsley
      C. Jaundice and Green Onions
      D. E. coli O157 and Alfalfa Seeds from
         Down Under
      E. Queso Fresco and Listeriosis
      F. The Unintended Consequence of a
         Regulation: Mangoes and Salmonella
         Newport
  V.  TRANSLATING INVESTIGATIONS INTO IMPROVED
      FOOD SAFETY
 VI.  IMPROVING DISEASE PREVENTION IN GENERAL
VII.  MONITORING THE CHANGING RISKS

I. HISTORICAL INTRODUCTION

Food safety is a major and current public health challenge in the United States. The burden of illness has been estimated to be 76 million illnesses and over five thousand deaths each year. (1) Most of the recently recognized food safety challenges, including those related to meat, poultry, produce, and raw shellfish, concern food produced in this country. (2) The Institute of Medicine has reviewed these general challenges and recommended approaches to making further improvements in food safety in the United States. (3) It is also true that imported foods have presented a challenge in the last decade. The issues surrounding these imported foods are the focus of this Article.

Americans enjoy a food supply that is more ample, more nutritious, and safer than our forebears did one hundred years ago, when the publication of Upton Sinclair's novel The Jungle ushered in the modern era of food safety. (4) In 1906, the establishment of the forerunners of the Food and Drug Administration (FDA) and the Food Safety and Inspection Service (FSIS) of the U.S. Department of Agriculture (USDA) brought federal regulatory attention to the food supply. (5) The evolution of our food safety system since then has been spurred by recurrent large outbreaks of illness, informed by research findings from food and agricultural scientists, and driven by the demands of the food marketplace. Pasteurization of milk, reliable high-pressure canning, and the eradication of tuberculosis and trichinosis from our food animals have dramatically improved the safety of our food and are now taken largely for granted. (6) The current system is based on the "farm-to-table" philosophy, in which all the participants in the sequence of production, processing, and final preparation of our food have recognized roles in making the final food safe. …