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Study ranks top foodborne pathogens

Research examines which illnesses carry the most the costs

A new study from the University of Florida urged the foodservice industry to step up safety efforts as it ranked the riskiest combinations of food and illness-causing pathogens.

The study, “Ranking the Risks: The 10 Pathogen-Food Combi¬nations with the Greatest Burden on Public Health,” was released Thursday by the school’s Emerging Pathogens Institute in Gainesville, Fla. It lists estimates of the number of illnesses and of the costs and overall public health toll of specific microbes in particular types of food, the school said.

Estimates released last year by the federal Centers for Disease Control and Prevention in Atlanta showed that foodborne pathogens annually sicken about 48 million Americans, or about one in six, hospitalizing 128,000 and killing 3,000.

The UF report estimated that 14 foodborne pathogens annually cause $14.1 billion in treatment and other costs tied to illness as well as the loss of more than 61,000 QALYs, or quality adjusted life-years. QALYs are a tool used in medicine to measure the health-related quality of life associated with different health states, such as in recovery from a foodborne illness with long-lasting complications.

The report noted that just five of the 14 highlighted pathogens were responsible for more than 90 percent of the estimated economic and QALY losses associated with the group: Salmonella, Campylobacter, Listeria monocytogenes, Toxoplasma gondii and norovirus.

The top 10 food-and-pathogen combinations are responsible for more than $8 billion in costs of illness annually and nearly 37,000 lost QALYs, representing almost 60 percent of the impacts estimated across all 168 combinations, the report found.

Top 10 Pathogen-Food Combinations in Terms of Annual Disease Burden
(Source: University of Florida Emerging Pathogens Institute)

The report pointed out that government studies for numerous pathogens “consistently show higher risks for foods prepared outside the home.”

“Considerable burden of disease is caused by food handling and preparation problems in foodservice and retail settings,” the authors said.

“Complex food,” or multi-ingredient dishes, often prepared by restaurants, caterers, cafeterias and other foodservice establishments, are the third leading food group in terms of associated burden of disease, the study found.

The study analyzed illness outbreaks associated with complex food between 1998 and 2008 and found that 70 percent of Salmonella outbreaks and 80 percent of norovirus outbreaks resulted from meals made by professional kitchens.

“This suggests that there remains room for significant improvement in food safety in professional kitchens, both through private sector efforts to facilitate a culture of food safety, and through the strengthening of the critical efforts of state and local public health and regulatory agencies that oversee these establishments,” said authors Michael B. Batz, Sandra Hoffmann and J. Glenn Morris Jr.

Catherine Adams Hutt, a food safety and nutrition consultant to the National Restaurant Association, said studies suggesting higher risk from food prepared outside the home may not paint a fully accurate picture of how many foodborne illnesses are tied to foodservice and retail establishments.

Adams Hutt, a registered dietician with RdR Solutions Consulting of Aubrey, Texas, said consumers are less likely to report to authorities illnesses caused by food prepared in their homes or at a neighbor’s house than they are to call in sicknesses they believe are tied to restaurants.

What’s more, she said, such private party illnesses, which may have a variety of causes, are less likely to stand out in statistical screenings, which often use common traits among victims, such as pathogen type and visits to a specific restaurant, to identify and track foodborne outbreaks and their causes.

The UF study made several recommendations to improve food safety at foodservice establishments, including:

• Have government take action to improve retail and foodservice food safety, including fully funding state and local inspection activities.

• Increase the adoption by states of the most recent U.S. Food and Drug Administration “Model Food Code.”

• Increase the risk-basis of inspection criteria.

• Increase the education and training of food workers and government inspectors.

Some of the recommendations, such as moves to more fully fund foodservice-inspection activities, are likely to face challenges in the short term, as Congress and many state and local governments look to cut spending.

Additionally, numerous companies and trade groups from a variety of industries are warning such government bodies that too many additional fees or taxes could slow the economic recovery and put jobs at risk.

But some of the other recommendations in the report already have the support of the NRA and the National Council of Chain Restaurants.

Both of those Washington-based groups support broader adoption of the FDA’s Model Food Code by states and local jurisdictions, for example. The NRA and NCCR also have expressed support for including in future editions of the Food Code a requirement that individual restaurants employ certified food protection managers.

Adams Hutt said the NRA favors increased state and local adoption of provisions in the FDA’s Model Food Code because “they are the best science and best practices that we are aware of.” She added that the “Food Code represents a consistent message to foodservice operators” who can find it confusing when given different guidelines by different state and local health authorities.

The NRA applauded the release of the University of Florida report, Adams Hutt said, as “it is always helpful and important to call out for consumers the risks regarding food safety” and remind all food preparers “of the importance of hand washing and proper temperature controls.”

The authors of the report said tying estimated economic and quality of life costs to specific pathogen-food combinations will allow regu¬lators “to target scarce public dollars toward the biggest food safety problems and find solutions to protect consumers.”

“I think one of the most difficult issues in food safety is trying to quantify the costs; for the most part settlements are confidential, business losses are not reported and medical costs are not consistent enough,” said attorney Bill Marler of Seattle’s Marler Clark law firm, which represents consumers in foodborne illness lawsuits against manufacturers, restaurants and other businesses.

He added: “This report seems to get close to quantifying the problem enough to use as a basis for making policy and investment decisions.”

The full report may be downloaded here:

Contact Alan J. Liddle at [email protected].

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