Emerging Foodborne Diseases and NEHA's Response
Gist, Ginger L., Journal of Environmental Health
On July 3, 1996, NEHA's Council of Delegates adopted a position on emerging infectious diseases (journal of Environmental Health, October 1996). We defined emerging infectious diseases as "infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range, [and which] are currently the leading cause of death worldwide." For the purposes of this column, I am focusing on foodborne diseases.
In the United States, foodborne illnesses affect six million to 80 million people each year, cause 9,000 deaths, and cost an estimated $5 billion. The typical effects of these illnesses - nausea, vomiting, and diarrhea - are well known to most people; however, those of us who work in environmental health know that many of the emerging foodborne diseases may cause chronic sequelae or disability. Examples of these diseases and their outcomes are
* listeriosis (which can cause miscarriages and meningitis in patients with chronic diseases),
* Escherichia coli O157:H7 infections (which can cause hemolytic uremic syndrome, the most common cause of acute kidney failure in children in the United States),
* salmonellosis (which can lead to invasive disease, reactive arthritis, and campylobacteriosis), and
* Guillain-Barre syndrome (which is one of the most common causes of flaccid paralysis in the United States in the last 50 years).
In the past 20 years, we have seen a startling number of new foodborne pathogens emerge in the United States; in addition, several pathogens have been newly recognized as being predominantly foodborne. This list is long, but would include Campylobacter jejuni; Campylobacter fetus sp. fetus; Cryptosporidium cayetanensis; E. coli O157:H7 and related E. coli (e.g., O111:NM, O104:H21); Listeria monocytogenes; Norwalk-like viruses; Nitzschia pungens; Salmonella enteritidis; Salmonella typhimurium DT 104; Vibrio cholerae 01; Vibrio vulnificus; Vibrio parahaemolyticus; and Yersinia enterocolitica.
Why the dramatic increase? Experts agree on several categories of factors that have contributed to the increase of foodborne diseases in the United States. These include
* changes in demographics, such as
- increasing numbers of immuno-compromised individuals,
- an aging population, and
- advances in medical technology that have increased the life expectancy of individuals with chronic conditions;
* changes in behavior, such as
- changes in food consumption patterns (e.g., from 1970 to 1994, consumption of fresh fruit and vegetables increased 50 percent),
- consumption of more food away from home (fast food, salad bars, etc.), and
- a decline in food safety education;
* changes in industry and technology, such as mass-distributed food products and consolidation of industry (in 1945 the typical hen house contained 500 birds, and in 1995 it contained 100,000 birds);
* changes in travel and commerce, including
- a dramatic increase in international travel (in 1950 over 5 million people traveled internationally, and by 2010 that number will increase to 937 million),
- international distribution of foods, and
- immigration (i. …