Current and Emerging Issues Relevant to Food Safety Communicators: Observations of an “Emerging Epidemiologist”

1. Current and Emerging Issues Relevant to Food Safety Communicators: Observations of an “Emerging Epidemiologist” June 13, 2006 Food Safety Network Communicators Conference University of Guelph

2. Background “Emerging Foodborne Diseases: an Evolving Public Health Challenge” R.V. Tauxe 1997 Emerg Infect Dis 3:425-434 • Emerging foodborne pathogens • New vehicles of transmission • New outbreak scenario • New approaches to prevention

3. Recent information relevant to food safety communicators

4. The First Step… … determining the “picture” of acute gastrointestinal illness in the population. • Traditional surveillance and outbreak investigations are subject to bias and under-reporting • In order to more accurately determine what’s happening in the general community (sporadic illness, unreported illness), population-based studies are used • In 2000, the National Studies on Acute Gastrointestinal Illness (NSAGI) initiative was undertaken to determine the burden of acute GI in the population www.phac-aspc.gc.ca/nsagi-engma/index.html

5. Results of the NSAGI Pilot • 1.3 episodes of acute GI occurred per person-year (95% C.I. 1.1; 1.4) • 10% monthly prevalence (95% C.I. 9.94%; 10.14%) • Prevalence of acute GI was higher in women, and those <10 and 20-24 years of age • When the data and analyses were standardized, the prevalence of GI in this Canadian site was remarkably comparable to the US and Australia for the same year Majowicz et al. 2004 Epidemiol Infect 132:607-17 Scallan et al. 2005 Int J Epidemiol 34:454-60

6. † p=0.0637 † p=0.0082

7. Results of the NSAGI Pilot Annual estimates per 100,000 population: • 126,320 cases of GI, with… • 37,000 physician visits, 4,400 ER visits, 30 hospitalizations • 25,000 cases taking anti-diarrheals • 23,000 cases and 6,000 caregivers missing 93,000 days of work The total cost of GI was $1,089 per case ($115 per capita) …IF we generalize from Hamilton, Ontario, to Canada… Majowicz et al. 2006 J Food Prot 69:651-9

8. 1 positive reported to province 1.24 positives reported locally 1.56 stools positive 14 stools tested 15 submit the stool 19 have stool requested 73 cases visit physician 313 community cases of gastrointestinal illness Majowicz et al. 2005 Can J Public Health 96:178-81

9. Other NSAGI Results Circa 2000, estimated Canadian annual rates per 1,000 population: 0.7 to 3.4 cases of VTEC infection (10 to 49 community cases per nationally reported case) 2.5 to 6.9 cases of salmonellosis (13 to 37 community cases per nationally reported case) 9.3 to 19.7 cases of campylobacteriosis (24 to 50 community cases per nationally reported case) Thomas et al. 2006 Can J Infect Dis Med Microbiol (in press)

10. Consumption Patterns Food items consumed in the past week: • Unpasteurized milk → 0.7% • Cheese made from unpasteurized milk → 1.1% • Egg dishes with runny yolk → 42.3% • Food items containing raw egg → 5.9% • Meat pâté → 5.6% • Raw fish (i.e. sushi) → 7.9% • Chicken → 91.7% • Chicken nuggets/strips 19.2% • Pork → 60.2 % • Pink/undercooked pork 3.3% Nesbitt 2006 M.Sc. Thesis (U. Guelph), draft

11. Consumption Patterns Food items consumed in the past week: • Raspberries → 7.6% • Unpasteurized juices → 6.2% • Bean sprouts → 9.3% • Alfalfa sprouts → 3.4% • Fresh basil → 11.6% • Raw nuts → 36.3% Nesbitt 2006 M.Sc. Thesis (U. Guelph), draft

12. Consumption Patterns Bottled water: • Primary drinking water source for 27% of respondents • Not consumed by 60% of respondents • Consumption was associated with age (increasing to ~age 31, then decreasing) • Was more likely to be consumed on weekends than weekdays Jones et al. 2006 J Water Health 4:125-38

13. Consumption Venues Respondents ate an average of 3 meals outside the home a week… Location of meal consumption: • Pizza or donut shop  43% • Sit down restaurant  36% • Fast food chain  34% • Salad bar  19% • Buffet or cafeteria  14% • Catered event  9% Nesbitt 2006 M.Sc. Thesis (U. Guelph), draft

14. Consumer Food Safety Source of food safety knowledge: • Family/friend → 75.1% • Television/news → 18.6% • School/home economics → 15.1% • Public health/primary health care → 1.16% Cooking practices: How do you know when meat is cooked enough to eat? • Visually → 63.0% • Time → 32.7% • Thermometer → 13.6% • Taste → 9.7% Nesbitt 2006 M.Sc. Thesis (U. Guelph), draft

15. e.g. GI in Food Handlers Do we need to revisit the effectiveness of existing educational material? In a survey of 223 employed adults with GI in British Columbia, 14 (6%) were food handlers, 2 (1%) were day care workers, and 22 (10%) were health care workers Relative risk of discontinuing working when ill (compared to those working in low-risk employment settings): • Health care workers: 1.5 • Day care workers: 2.0 • Food handlers: 1.0 Thomas et al. 2006 CCDR (in press)

16. Emerging trends relevant to food safety communicators

17. Food Attribution Defining “attribution”: • Definition chosen may depend on eventual use of the information • Standardizing definitions? • Comparing information that uses different definitions • Source versus reservoir versus vehicle • Subsequent communication of “what it means” to the public

18. Specific Foods and Food Types • Increasing importance of foods of plant origin (berries, melons, lettuce, herbs) • Pre-bagged and ready-to-eat foods • Locations available for food purchase (and the types of food available there) • Changing opportunities for cross-contamination creating “new” routes of transmission… expecting the unexpected!

19. Globalization • Increased movement of people and food: • Air travel • Migrant workers • Outbreaks over large geographic areas, crossing borders • Wide commercial distribution of food products and increased international trade • Pathogens common to the developing world causing illness in developed countries • Development of global surveillance networks

20. Other Issues • Antibiotic use in the food industry and antibiotic residues in food • Aging population and increased susceptibility • Determinants of illness and defining target audiences for key messages • Farm to retail traceability • Consumers demanding fresher foods • Increased capacity for detection of microbes (rapid development of laboratory technologies; molecular typing)

21. Future trends which may be relevant to food safety communicators

22. Environmental Factors • Impact of climate or extreme weather events on food production markets (old ones giving way to new ones) • Habitat destruction • Rising gas and fuel prices • Rising energy consumption (e.g. power outage, late summer 2003)

23. Trade and Politics • Availability of food and ability to market food may become a main political driver • Microbiological quality of food as a trade requirement or marketing advantage (compounded by our improvement in detection) • Zero tolerance market demands • Differences in the sensitivity of detection systems between countries/different standards across borders

24. Complexity of Information • Exponential increase in the speed at which science proceeds and information is generated • Rapid change in risk factors, risk groups, routes of transmission • Increased uncertainty or ambiguity in the information • The need for trusted, clear sources of information amidst the information overload

25. Redefining “Safe” and “Food” • Dealing with the fallacy of “zero risk”, and defining the true risks to consumers • Reconciling public perception with the scientists’ perception and the policy makers’ perceptions • Balancing the consumer’s right to choose versus mandated safety • Microbiological, chemical, allergenic, and nutritional aspects of food • Redefining the concept of “food”