Emerging foodborne diseases and NEHA's response.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 sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention or disability. Examples of these diseases and their outcomes are
* listeriosis Listeriosis Definition
Listeriosis is an illness caused by the bacterium Listeria monocytogenes that is acquired by eating contaminated food. The organism can spread to the blood stream and central nervous system. (which can cause miscarriages and meningitis in patients with chronic diseases),
* Escherichia coli Escherichia coli (ĕsh'ərĭk`ēə kō`lī), common bacterium that normally inhabits the intestinal tracts of humans and animals, but can cause infection in other parts of the body, especially the urinary tract. O157:H7 infections (which can cause hemolytic uremic syndrome hemolytic uremic syndrome
A syndrome in which hemolytic anemia and thrombocytopenia occur with acute renal failure, marked in children by sudden gastrointestinal bleeding, urine that contains red blood cells and is scanty in volume, and , the most common cause of acute kidney failure Acute Kidney Failure Definition
Acute kidney failure occurs when illness, infection, or injury damages the kidneys. Temporarily, the kidneys cannot adequately remove fluids and wastes from the body or maintain the proper level of certain in children in the United States),
* salmonellosis salmonellosis (săl'mənĕlō`sĭs), any of a group of infectious diseases caused by intestinal bacteria of the genus Salmonella, (which can lead to invasive disease, reactive arthritis Reactive arthritis
Another name for Reiter's syndrome.
Mentioned in: Reiter's Syndrome
reactive arthritis Reiter syndrome, see there , 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 star·tle
v. star·tled, star·tling, star·tles
1. To cause to make a quick involuntary movement or start.
2. To alarm, frighten, or surprise suddenly. See Synonyms at frighten. 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 cryptosporidium (krĭp'tōspərĭd`ēəm), genus of protozoans having at least four species; they are waterborne parasites that cause the disease cryptosporidiosis. cayetanensis; E. coli O157:H7 and related E. coli (e.g., O111:NM, O104:H21); Listeria Listeria /Lis·te·ria/ (lis-ter´e-ah) a genus of gram-negative bacteria (family Corynebacterium); L. monocyto´genes causes listeriosis.
n. 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 immigration, entrance of a person (an alien) into a new country for the purpose of establishing permanent residence. Motives for immigration, like those for migration generally, are often economic, although religious or political factors may be very important. (i.e., immigrants bring different foods and food preparation techniques);
* microbial microbial
pertaining to or emanating from a microbe.
the breakdown of organic material, especially feedstuffs, by microbial organisms. adaptation and resistance to antimicrobials;
* economic development and land use; and
* the breakdown of the public health infrastructure (especially for surveillance).
The NEHA NEHA National Environmental Health Association
NEHA National Executive Housekeepers Association
NEHA Northern Estates Homeowners Association (Indianapolis, Indiana) position stated: "With the recent demise of many environmental and public health programs, the existing capacity of the public and environmental health infrastructure at the local, state, national, and international level to respond to these challenges is limited." Recommendations were as follows: Human resource, equipment, and facility needs must be identified and addressed. Training needs of environmental and public health professionals, as well as [others], must also be identified and addressed. Additional emphasis should be given to the critical importance of communicating guidelines for disease prevention; the need for educating the public and policy makers about the importance of these issues; the need for strengthening existing partnerships and developing new ones; and the need to carefully identify priorities.
NEHA has taken its own message to heart and has moved aggressively toward providing a cadre of individuals credentialed in food safety In their December 1998 meeting, the NEHA Board of Directors approved a newly named credential, Certified Food Safety Professional, and the criteria necessary to obtain that credential. Any person sitting for the exam (which I understand is quite thorough!) must meet strict prerequisites in education and experience. In addition, Certified Food Safety Professionals must renew their credential every two years by taking approved continuing-education courses.
On other fronts, NEHA is working toward marketing new tools for hazard analysis critical control point (HACCP HACCP
hazard analysis critical control points. ) education, possibly including short courses to be offered throughout the United States. Finally, we are forming new ties and strengthening old ones with industry and other food safety organizations, such as the Council for Food Protection.
To paraphrase the NEHA mission in Star Trekker terms, we have "boldly advanced food safety education for the environmental health professional to provide a safer food supply for all." I may not be Captain Picard, but I am pleased NEHA "made it so!"