1.4: High Risk Populations

Introduction

Foodborne illnesses can cause serious illness and even death. A foodborne illness outbreak occurs when two or more cases of the same illness result from eating a common contaminated food.  In the United States, there are an estimated 1,000 outbreaks of foodborne illnesses each year, affecting millions of people. Most of these outbreaks can be avoided, as many outbreaks can be attributed to bad food handling and preparation methods, including incorrect holding temperatures, inadequate cooking, and contaminated equipment.

The Food and Drug Administration (2017) estimates that as many as 128,000 hospitalizations and 3,000 deaths in the US may be caused annually by foodborne illnesses. In 2009-2015, 75% of outbreaks reported in the US from restaurants, banquet halls, and catered food service locations (Dewey-Mattia et al., 2018). Individuals experiencing food borne illness symptoms may describe it as the stomach flu or food poisoning (Stine & Hawkes, 2023). Foodborne illness and its consequences can be prevented by any foodservice employee who recognizes the importance of food safety (Stine & Hawkes, 2023).

The Scale of Foodborne Illness in the United States

Foodborne illness is a significant public health issue. As of 2021, the United States Department of Agriculture (USDA) reported that roughly 48 million Americans suffer from foodborne illness annually, and these diseases caused 3,800 deaths per year. However, according to the Centers for Disease Control and Prevention, multiple foodborne illnesses go undiagnosed and undocumented, and people are reluctant to seek medical help when they become ill (Scallan, 2011). Therefore, safe food production is best addressed through prevention.

Foodborne illnesses are costly to society, the food industry, and individuals (Milton & Mullan, 2012; Kouabenan & Ngueutsa, 2016). As reported by the USDA-ERS (2021), the 15 most common pathogens account for $15.5 billion in economic costs. Medical damage cause by foodborne illnesses in retail foodservice are as high as $6 billion (Scallan et al., 2011). Despite the USDA-ERS (2021) report indicating foodborne illnesses decreased in 2020 by 26%, this could be attributed to the COIVID-19 pandemic, not better food safety as CDC regulations were implemented because of the pandemic. The new CDC regulations led to increased handwashing and reduced international travel, factors that may have reduced foodborne illness (Ray et al., 2021).

According to a review of 404 foodborne illness outbreaks during 2014-16, 60% of the outbreaks resulted from eating food made by sick foodservice employees (Lipcsei et al., 2019). The (2019) findings are also consistent with a nationwide review of outbreaks of foodborne illness (n = 9,788) published between 1998 and 2013 demonstrating up to 25% of outbreaks originated from foodservice workers (Angelo et al, 2017). All these findings point to the importance of foodservice workers to food safety. Since foodborne illness can happen in any foodservice establishment, foodservice workers need to be taught about food safety and have access to the resources to practice safe food handling techniques (Trafialek et al., 2017).

Major Pathogens Causing Foodborne Illness

While there are many different pathogens responsible for foodborne illnesses, a few cause most cases. These include bacteria, viruses, and parasites. The Food and Drug Administration (FDA) and Centers for Disease Control (CDC) identify six pathogens which are exceedingly infective and easily transmitted by foodservice employees (Stine & Hawkes, 2023).

• Norovirus: The leading cause of severe gastroenteritis, vomiting, and diarrhea in the United States. Responsible for about 58% of all foodborne illnesses in the United States, about 2,500 reported cases. Norovirus spreads easily and is often linked to contaminated water, produce, and shellfish.
• Salmonella spp. (nontyphoidal): A leading cause bacterial illness, resulting in diarrhea. It accounts for about 150 million illnesses and 60,000 deaths each year globally.  https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/salmonellosis-nontyphoidal
• Hepatitis A: a disease caused by infection of the liver. Is transmitted from person to person through the fecal-oral route or by consuming contaminated food or water. Over 2,200 reported cases each year, with a total estimated number of 4,500 infections and 118 deaths reported in 2022. https://www.cdc.gov/hepatitis/statistics/2022surveillance/hepatitis-a.htm
• Salmonella typhi (typhoid-like fever): In 2020, there were 157 Salmonella Typhi cases were reported in the U.S. The median age of patients with the infection was 26 years. Of the 157 cases reported, 113 traveled or lived outside of the U.S. 30 days before the illness.
• Shiga toxin-producing Escherichia coli (E. coli): Each year, an estimated 265,000 infections occur in the U.S. Symptoms related to STEC range from mild diarrhea to ischemic colitis and hemolytic uremic syndrome (HUS) (Tack et al., 2021).
• Shigella spp. (causes Shigellosis): There are an estimated 450,000 infection in the U.S. annually, resulting in $93 million in medical costs. Most people experiencing shigellosis experience diarrhea that may be prolonged, fever, and stomach pain. https://www.cdc.gov/shigella/about/index.html

This section provides an overview of the scope of foodborne illness in the United States, the pathogens most commonly responsible for these illnesses, and the measures that can help prevent outbreaks. Understanding the statistics surrounding foodborne illness is critical for appreciating the importance of rigorous food safety practices.

References

https://www.cdc.gov/norovirus/data-research/index.html

https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/salmonellosis-nontyphoidal

https://www.cdc.gov/hepatitis/statistics/2022surveillance/hepatitis-a.htm

https://www.cdc.gov/shigella/about/index.html

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