Addressing Foodborne Threats To Health

In December 2004, at a press conference called to announce his departure as Secretary of the Department of Health and Human Services (HHS), Tommy Thompson raised both concern and controversy when he remarked that he could not understand why the terrorists had not yet attacked our food supply "because it is so easy to do." Although to date the United States has been spared such a disaster, the many documented examples of unintentional outbreaks of foodborne disease-some of which have sickened hundreds of thousands of people, and killed hundreds-provide a grim basis for estimating the impact of deliberate food adulteration. Due to the wide variety of potential chemical and biological agents that could be introduced at many vulnerable points along the food supply continuum, contaminating food is considered an especially simple, yet effective, means to threaten large populations. To explore the nature and extent of such threats, possibilities for reducing their impact, and obstacles to this goal, the Forum on Microbial Threats of the Institute of Medicine (IOM) convened the workshop Foodborne Threats to Health: The Policies and Practice of Surveillance, Prevention, Outbreak Investigations, and International Coordination on October 25 and 26, 2005. Workshop participants discussed the threat spectrum and burden of disease associated with foodborne illness and the role that increasing globalization of food production and distribution plays in the transmission of foodborne disease. Participants also reviewed existing research, policies, and practices concerning foodborne threats in order to identify unmet needs, challenges, and opportunities for improving food safety systems, surveillance, and emergency response. Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and presents their beliefs on which areas may merit further attention. However, the reader should be aware that the material presented here expresses the views and opinions of the individuals participating in the workshop and not the deliberations of a formally constituted IOM study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation.

In December 2004, at a press conference called to announce his departure as Secretary of the Department of Health and Human Services (HHS), Tommy Thompson raised both concern and controversy when he remarked that he could not understand why the terrorists had not yet attacked our food supply "because it is so easy to do." Although to date the United States has been spared such a disaster, the many documented examples of unintentional outbreaks of foodborne disease-some of which have sickened hundreds of thousands of people, and killed hundreds-provide a grim basis for estimating the impact of deliberate food adulteration. Due to the wide variety of potential chemical and biological agents that could be introduced at many vulnerable points along the food supply continuum, contaminating food is considered an especially simple, yet effective, means to threaten large populations. To explore the nature and extent of such threats, possibilities for reducing their impact, and obstacles to this goal, the Forum on Microbial Threats of the Institute of Medicine (IOM) convened the workshop Foodborne Threats to Health: The Policies and Practice of Surveillance, Prevention, Outbreak Investigations, and International Coordination on October 25 and 26, 2005. Workshop participants discussed the threat spectrum and burden of disease associated with foodborne illness and the role that increasing globalization of food production and distribution plays in the transmission of foodborne disease. Participants also reviewed existing research, policies, and practices concerning foodborne threats in order to identify unmet needs, challenges, and opportunities for improving food safety systems, surveillance, and emergency response. Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and presents their beliefs on which areas may merit further attention. However, the reader should be aware that the material presented here expresses the views and opinions of the individuals participating in the workshop and not the deliberations of a formally constituted IOM study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation.

Globalization of the food supply has created conditions favorable for the emergence, reemergence, and spread of food-borne pathogens-compounding the challenge of anticipating, detecting, and effectively responding to food-borne threats to health. In the United States, food-borne agents affect 1 out of 6 individuals and cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year. This figure likely represents just the tip of the iceberg, because it fails to account for the broad array of food-borne illnesses or for their wide-ranging repercussions for consumers, government, and the food industry-both domestically and internationally. A One Health approach to food safety may hold the promise of harnessing and integrating the expertise and resources from across the spectrum of multiple health domains including the human and veterinary medical and plant pathology communities with those of the wildlife and aquatic health and ecology communities. The IOM's Forum on Microbial Threats hosted a public workshop on December 13 and 14, 2011 that examined issues critical to the protection of the nation's food supply. The workshop explored existing knowledge and unanswered questions on the nature and extent of food-borne threats to health. Participants discussed the globalization of the U.S. food supply and the burden of illness associated with foodborne threats to health; considered the spectrum of food-borne threats as well as illustrative case studies; reviewed existing research, policies, and practices to prevent and mitigate foodborne threats; and, identified opportunities to reduce future threats to the nation's food supply through the use of a "One Health" approach to food safety. Improving Food Safety Through a One Health Approach: Workshop Summary covers the events of the workshop and explains the recommendations for future related workshops.

How safe is our food supply? Each year the media report what appears to be growing concern related to illness caused by the food consumed by Americans. These food borne illnesses are caused by pathogenic microorganisms, pesticide residues, and food additives. Recent actions taken at the federal, state, and local levels in response to the increase in reported incidences of food borne illnesses point to the need to evaluate the food safety system in the United States. This book assesses the effectiveness of the current food safety system and provides recommendations on changes needed to ensure an effective science-based food safety system. Ensuring Safe Food discusses such important issues as: What are the primary hazards associated with the food supply? What gaps exist in the current system for ensuring a safe food supply? What effects do trends in food consumption have on food safety? What is the impact of food preparation and handling practices in the home, in food services, or in production operations on the risk of food borne illnesses? What organizational changes in responsibility or oversight could be made to increase the effectiveness of the food safety system in the United States? Current concerns associated with microbiological, chemical, and physical hazards in the food supply are discussed. The book also considers how changes in technology and food processing might introduce new risks. Recommendations are made on steps for developing a coordinated, unified system for food safety. The book also highlights areas that need additional study. Ensuring Safe Food will be important for policymakers, food trade professionals, food producers, food processors, food researchers, public health professionals, and consumers.

Recent outbreaks of illnesses traced to contaminated sprouts and lettuce illustrate the holes that exist in the system for monitoring problems and preventing foodborne diseases. Although it is not solely responsible for ensuring the safety of the nation's food supply, the U.S. Food and Drug Administration (FDA) oversees monitoring and intervention for 80 percent of the food supply. The U.S. Food and Drug Administration's abilities to discover potential threats to food safety and prevent outbreaks of foodborne illness are hampered by impediments to efficient use of its limited resources and a piecemeal approach to gathering and using information on risks. Enhancing Food Safety: The Role of the Food and Drug Administration, a new book from the Institute of Medicine and the National Research Council, responds to a congressional request for recommendations on how to close gaps in FDA's food safety systems. Enhancing Food Safety begins with a brief review of the Food Protection Plan (FPP), FDA's food safety philosophy developed in 2007. The lack of sufficient detail and specific strategies in the FPP renders it ineffectual. The book stresses the need for FPP to evolve and be supported by the type of strategic planning described in these pages. It also explores the development and implementation of a stronger, more effective food safety system built on a risk-based approach to food safety management. Conclusions and recommendations include adopting a risk-based decision-making approach to food safety; creating a data surveillance and research infrastructure; integrating federal, state, and local government food safety programs; enhancing efficiency of inspections; and more. Although food safety is the responsibility of everyone, from producers to consumers, the FDA and other regulatory agencies have an essential role. In many instances, the FDA must carry out this responsibility against a backdrop of multiple stakeholder interests, inadequate resources, and competing priorities. Of interest to the food production industry, consumer advocacy groups, health care professionals, and others, Enhancing Food Safety provides the FDA and Congress with a course of action that will enable the agency to become more efficient and effective in carrying out its food safety mission in a rapidly changing world.

In October 2004 the Research Center for Gastroenterology and Liver Diseases of Shaheed Beheshti University hosted in Tehran an Iranian-American workshop on Food Safety and Surveillance Systems for Foodborne Diseases. The purposes of the workshop were to initiate contacts between Iranian and American specialists, exchange information about relevant activities in the two countries, and set the stage for future cooperation in the field. The participants also identified important aspects of food safety that should be addressed more intensively by both countries, including surveillance, research, international trade, and risk assessment. The framework for the workshop had been developed during a meeting of Iranian and American specialists in June 2003 in Les Treilles, France. More that 100 specialists participated in the workshop in their personal capacities, along with representatives of the World Health Organization and the Food and Agriculture Organization. These proceedings include a number of papers that were presented at the workshop together with summaries of discussions following presentation of the papers.

The report presents the first global and regional estimates of the burden of foodborne diseases. The large disease burden from food highlights the importance of food safety, particularly in Africa, South-East Asia and other regions. Despite the data gaps and limitations of these initial estimates, it is apparent that the global burden of foodborne diseases is considerable, and affects individuals of all ages, particularly children

Developments such as the increasing globalization of the food industry, constant innovations in technologies and products, and changes in the susceptibility of populations to disease have all highlighted the problem of emerging pathogens, either newly discovered through more sensitive analytical methods, linked for the first time to disease in humans, or newly associated with a particular food. Designed for microbiologists and quality assurance professionals and for government and academic food safety scientists, this timely reference discusses ways of identifying emerging pathogens and includes chapters on individual pathogens, their epidemiology, methods of detection, and means of control.