Foodborne Disease Surveillance in the U.S.: FoodNet, PulseNet, and Outbreak Alert! Caroline Smith DeWaal Center for Science in the Public Interest (U.S.) Geneva, Switzerland June 8, 2005 June 8, 2005

The Burden of Illness According to the U.S. Centers for Disease Control and Prevention (CDC), there are an estimated:  76 million foodborne illnesses annually in the U.S.  325,000 hospitalizations due to foodborne illness annually in the U.S.  5,000 deaths due to foodborne illness annually in the U.S.

Foodborne Disease Surveillance & Investigation in the U.S.  FoodNet – active surveillance  PulseNet – laboratory network that performs microbial sub-typing  Outbreak Alert! – food attribution

Foodborne Diseases Active Surveillance Network (FoodNet)  Active, laboratory-based surveillance within ten well-defined surveillance areas around the United States  Monitor trends in foodborne diseases  Conduct case-control studies

FoodNet (cont.) FoodNet Pathogens CampylobacterCyclosporaCryptosporidium Escherichia coli O157:H7 Listeria monocytogenes SalmonellaShigellaVibrio Yersinia enterocolitica  Approximately 15,000 laboratory- diagnosed cases, each year  Data collected includes patient demographics, co- morbidities, hospital stay details, and laboratory results

PulseNet USA  National database of pulsed-field gel electrophoresis (PFGE) patterns  Enables outbreak cases and concurrent sporadic cases to be distinguished  Does not include routine PFGE patterns from food and animal sources

What is PFGE?  DNA “fingerprinting”  A method used to differentiate specific strains of bacteria using DNA migration by size in an agarose gel stimulated by an electrical current  More sensitive and discriminating than conventional gel electrophoresis because the electrical field used to stimulate DNA migration is pulsed (constantly changing) rather than uniform

PulseNet USA (cont.) PulseNet Pathogens Campylobacter jejuni CyclosporaCryptosporidium Escherichia coli O157:H7 Listeria monocytogenes SalmonellaShigellaVibrio Yersinia enterocolitica  The PulseNet database includes tens of thousands of PFGE patterns  Labs at the national, state, and local levels have access to the database

Outbreak Alert! Food Categories BeefBeverages Breads & Bakery Dairy Eggs & Egg Dishes Game Luncheon/Other Meats Multi-Ingredient Foods Multiple Foods PorkPoultryProduceSeafood  Outbreaks in the U.S. occurring between  Contains almost 4,500 outbreaks including over 138,000 individual cases of foodborne illness  A project managed and maintained by a private, non-profit, consumer advocacy group

Trends in Outbreak Reporting, Source: Center for Science in the Public Interest, Outbreak Alert! database, 2005

Outbreak Alert! (cont.)  Useful for alerting consumers to food safety hazards, providing better information for food safety resource allocation, and identifying gaps in the U.S. outbreak reporting systems  Outbreak Alert! is scheduled to be updated and released in September Available at:

Conclusions  Importance of consumer groups providing government oversight  U.S. surveillance programs need to be more integrated and coordinated  A single, unified food safety agency would strengthen the U.S. foodborne disease surveillance programs, and the food safety infrastructure overall