Foodborne Disease Outbreaks in the United States: A Historical Overview

Surveillance of household foodborne disease outbreaks in Zhejiang Province, China, 2010-2022

BACKGROUND

Foodborne diseases are a growing public health concern worldwide and households are a common setting. This study aimed to explore the epidemiological characteristics of household foodborne disease outbreaks in Zhejiang Province and propose targeted prevention and control measures.

METHODS

Descriptive statistical methods were used to analyze household foodborne disease outbreak data collected from the Foodborne Disease Outbreaks Surveillance System in Zhejiang Province from 2010 to 2022.

RESULTS

Household foodborne disease outbreaks showed an upward trend during the study period (Cox-Staurt trend test, p = 0.01563 < 0.05). These outbreaks mainly occurred from June to September, with 62.08% (352/567) of all reported outbreaks. The number of reported outbreaks varied in 11 prefectures, with a maximum of 100 and a minimum of only 7. Household foodborne disease outbreaks had a wide spectrum of etiologic factors. Mushroom toxins accounted for the largest proportion of all etiologies (43.39 %) and caused the highest proportion of hospitalization (54.18%) and death (78.26%). Such outbreaks are caused by accidently eating wild poisonous mushrooms. Bacterial infection (16.23%) was the second most common etiology, with Salmonella spp. and Vibrio parahaemolyticus being the primary pathogens. These outbreaks were caused by improper storage, improper processing or a combination of factors, and the foods involved were mainly aquatic animals, eggs and cooked meat. Other identified etiologies included plant toxins (9.52%), chemicals (7.23%), animal toxins (3.70%), and viruses (1.76%). Among the above-mentioned etiologies, mushroom toxins, bacteria, and animal toxins had seasonal characteristics. Analysis of regions and etiologies revealed that the proportion of various etiologies was different in 11 prefectures. Wild mushrooms (43.39%), aquatic animals (9.88%), and toxic plants (8.47%) were the top three foods involved in these outbreaks. The most common factors contributing to household foodborne disease outbreaks were inedibility and misuse (59.08%), followed by multiple factors (7.58%), improper storage (7.41%), and improper processing (7.41%).

CONCLUSIONS

Household foodborne disease outbreaks were closely related to the lack of knowledge regarding foodborne disease prevention. Therefore, public health agencies should strengthen residents' surveillance and health education to improve food safety awareness and effectively reduce foodborne diseases in households. In addition, timely publicity and early warning by relevant government departments, the introduction of standards to control the contamination of pathogenic bacteria in raw materials, and strengthened supervision of the sale of substances that may cause health hazards, such as poisonous mushrooms and nitrites, will also help reduce such outbreaks.

Evaluation of the Antimicrobial Activity of Triple Enzyme-Embedded Organic-Inorganic Hybrid Nanoflowers (hNFs) in Comparison with Powerful Antimicrobial Agent Chitosan

Organic-inorganic hybrid nanoflowers (hNFs) have high stability, reusability, low production cost, and overcome substrate/product inhibition. Antimicrobial activity of various hNFs has been reported to overcome environmental microbial contaminations and infections, which are considered major public health problems. α-amylase, protease, and lipase are the most common industrial enzymes exerting antimicrobial activity; therefore, we synthesized triple enzyme (α-amylase, protease, and lipase)-embedded hNFs by using pancreatin to evaluate their antimicrobial activity in comparison with one of the most potent antimicrobial polymer chitosan. The broad spectrum of the antimicrobial properties of chitosan is used in industrial products, including cosmetics, food, agriculture, pharmaceuticals, and textiles. SEM analysis, thermogravimetric analysis (TGA), and the degree of deacetylation (%DD) were performed for chitosan characterization, where SEM, FTIR, EDX, and XRD analyses were performed for the characterization of hNFs. The catalytic activity of pancreatin and hNFs was evaluated by measuring lipase, α-amylase, and protease enzyme activities at 37 °C. Antibacterial activities of hNFs, pancreatin, and chitosan were tested on gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria, compared to the pancreatin and chitosan via agar and broth dilution methods. hNFs showed enhanced catalytic activity for protease, lipase, and α-amylase compared to pancreatin at different pH values (pH 8, 9). hNFs showed catalytic activity after being washed and reused up to six times, indicating their reusability and recoverability. hNFs showed significant antimicrobial activity, such as chitosan, Staphylococcus aureus, and Escherichia coli, compared to pancreatin. Our novel hNFs can be used to develop antimicrobial technologies to fight against environmental microbial contaminations and antibiotic resistance-driven environmental pathogens.

Establishment and comparison of in situ detection models for foodborne pathogen contamination on mutton based on SWIR-HSI

Introduction

Rapid and accurate detection of food-borne pathogens on mutton is of great significance to ensure the safety of mutton and its products and the health of consumers.

Objectives

The feasibility of short-wave infrared hyperspectral imaging (SWIR-HSI) in detecting the contamination status and species of Escherichia coli (EC), Staphylococcus aureus (SA) and Salmonella typhimurium (ST) contaminated on mutton was explored.

Materials and methods

The hyperspectral images of uncontaminated and contaminated mutton samples with different concentrations (108, 107, 106, 105, 104, 103 and 102 CFU/mL) of EC, SA and ST were acquired. The one dimensional convolutional neural network (1D-CNN) model was constructed and the influence of structure hyperparameters on the model was explored. The effects of different spectral preprocessing methods on partial least squares-discriminant analysis (PLS-DA), support vector machine (SVM) and 1D-CNN models were discussed. In addition, the feasibility of using the characteristic wavelength to establish simplified models was explored.

Results and discussion

The best full band model was the 1D-CNN model with the convolution kernels number of (64, 16) and the activation function of tanh established by the original spectra, and its accuracy of training set, test set and external validation set were 100.00, 92.86 and 97.62%, respectively. The optimal simplified model was genetic algorithm optimization support vector machine (GA-SVM). For discriminating the pathogen species, the accuracies of SVM models established by full band spectra preprocessed by 2D and all 1D-CNN models with the convolution kernel number of (32, 16) and the activation function of tanh were 100.00%. In addition, the accuracies of all simplified models were 100.00% except for the 1D-CNN models. Considering the complexity of features and model calculation, the 1D-CNN models established by original spectra were the optimal models for pathogenic bacteria contamination status and species. The simplified models provide basis for developing multispectral detection instruments.

Conclusion

The results proved that SWIR-HSI combined with machine learning and deep learning could accurately detect the foodborne pathogen contamination on mutton, and the performance of deep learning models were better than that of machine learning. This study can promote the application of HSI technology in the detection of foodborne pathogens on meat.

Dual functionalized copper nanoparticles for thermoplastics with improved processing and mechanical properties and superior antibacterial performance

The utilization of metal nanoparticles for antibacterial thermoplastic composites has the potential to enhance the safety of human and animal life by mitigating the spread and transmission of foodborne pathogenic bacteria. The dispersion, antioxidant and antimicrobial activities of metal nanoparticles directly affect the application performance of the composites. This study focused on achieving amine-carboxyl co-modified copper nanoparticles (Cu-AC) with excellent antioxidant properties and monodispersity through in situ grafting of amine and carboxyl groups onto the surface of copper nanoparticles via ligand interaction. Polyacrylic acid's extended carbon chain structure was utilized to improve its dispersion and antioxidant properties, and its antibacterial properties were synergistically enhanced using secondary amines. It was found that Cu-AC possesses high antibacterial properties, with a minimum inhibition concentration of 0.156 mg mL-1. Antibacterial masterbatches and their composites (polypropylene/Cu) manufactured by melt blending of polypropylene and Cu-AC exhibited excellent antibacterial rates of up to 90% and 99% at 300 ppm and 700 ppm Cu-AC, respectively. Additionally, Cu-AC bolstered the thermal degradation, processing and mechanical properties of polypropylene. The successful implementation of this product substantiates the potential applications of polypropylene/Cu composite materials across diverse industries.

Vaccine value profile for norovirus

Norovirus is attributed to nearly 1 out of every 5 episodes of diarrheal disease globally and is estimated to cause approximately 200,000 deaths annually worldwide, with 70,000 or more among children in developing countries. Noroviruses remain a leading cause of sporadic disease and outbreaks of acute gastroenteritis even in industrialized settings, highlighting that improved hygiene and sanitation alone may not be fully effective in controlling norovirus. Strengths in global progress towards a Norovirus vaccine include a diverse though not deep pipeline which includes multiple approaches, including some with proven technology platforms (e.g., VLP-based HPV vaccines). However, several gaps in knowledge persist, including a fulsome mechanistic understanding of how the virus attaches to human host cells, internalizes, and induces disease.

Addition of a protected complex of biofactors and antioxidants to breeder hen diets confers transgenerational protection against Salmonella enterica serovar Enteritidis in progeny chicks

Addition of vitamins and antioxidants has been long associated with increased immunity and are commonly used in the poultry industry; however, less is known regarding their use in broiler breeder hens. The objective of this study was to determine if feeding a complex of protected biofactors and antioxidants composed of vitamins and fermentation extracts to broiler breeder hens conferred resistance against Salmonella enterica serovar Enteritidis (S. Enteritidis) in the progeny chicks. Three-day-old chicks from control- and supplement-fed hens were challenged with S. Enteritidis and necropsied 4- and 11-days postchallenge (dpc) to determine if there were differences in invasion and colonization. Serum and jejunum were evaluated for various cytokine and chemokine production. Fewer (P = 0.002) chicks from supplement-fed hens had detectable S. Enteritidis in the ceca (32.6%) compared to chicks from control-fed hens (64%). By 11 dpc, significantly (P < 0.001) fewer chicks from supplement-fed hens were positive for S. Enteritidis (liver [36%]; ceca [16%]) compared to chicks from the control hens (liver [76%]; ceca [76%]). The recoverable S. Enteritidis in the cecal content was also lower (P = 0.01) at 11 dpc. In additional to the differences in invasion and colonization, cytokine and chemokine production were distinct between the 2 groups of chicks. Chicks from supplement-fed hens had increased production of IL-16, IL-6, MIP-3α, and RANTES in the jejunum while IL-16 and MIP-1β were higher in the serum of chicks from the control-fed hens. By 11 dpc, production of IFN-γ was decreased in the jejunum of chicks from supplement-fed hens. Collectively, these data demonstrate adding a protected complex of biofactors and antioxidants to the diet of broiler breeder hens offers a measure of transgenerational protection to the progeny against S. Enteritidis infection and reduces colonization that is mediated, in part, by a robust and distinct cytokine and chemokine response locally at the intestine and systemically in the blood.

Foodborne Outbreak Rates Associated with Restaurant Inspection Grading and Posting at the Point of Service: Evaluation Using National Foodborne Outbreak Surveillance Data

ABSTRACT

A previously conducted national survey of restaurant inspection programs associated the practice of disclosing inspection results to consumers at the restaurant point of service (POS) with fewer foodborne outbreaks. We used data from the national Foodborne Disease Outbreak Surveillance System (FDOSS) to assess the reproducibility of the survey results. Programs that participated in the survey accounted for approximately 23% of the single-state foodborne illness outbreaks in restaurant settings reported to FDOSS during 2016 to 2018. Agencies that disclosed inspection results at the POS reported fewer outbreaks (mean = 0.29 outbreaks per 1,000 establishments) than those that disclosed results online (0.7) or not at all (1.0). Having any grading method for inspections was associated with fewer reported outbreaks than having no grading method. Agencies that used letter grades had the lowest numbers of outbreaks per 1,000 establishments. There was a positive association (correlation coefficient, R2 = 0.29) between the mean number of foodborne illness complaints per 1,000 establishments, per the survey, and the mean number of restaurant outbreaks reported to FDOSS (R2 = 0.29). This association was stronger for bacterial toxin-mediated outbreaks (R2 = 0.35) than for norovirus (R2 = 0.10) or Salmonella (R2 = 0.01) outbreaks. Our cross-sectional study findings are consistent with previous observations that linked the practice of posting graded inspection results at the POS with reduced occurrence of foodborne illnesses and outbreaks associated with restaurants. Support for foodborne illness surveillance programs and food regulatory activities at local health agencies is foundational for food safety systems coordinated at state and federal levels.

HIGHLIGHTS

Evaluating Completeness of Foodborne Outbreak Reporting in the United States, 1998-2019

Public health agencies routinely collect time-referenced records to describe and compare foodborne outbreak characteristics. Few studies provide comprehensive metadata to inform researchers of data limitations prior to conducting statistical modeling. We described the completeness of 103 variables for 22,792 outbreaks publicly reported by the United States Centers for Disease Control and Prevention’s (US CDC’s) electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS). We compared monthly trends of completeness during eFORS (1998−2008) and NORS (2009−2019) reporting periods using segmented time series analyses adjusted for seasonality. We quantified the overall, annual, and monthly completeness as the percentage of outbreaks with blank records per our study period, calendar year, and study month, respectively. We found that outbreaks of unknown genus (n = 7401), Norovirus (n = 6414), Salmonella (n = 2872), Clostridium (n = 944), and multiple genera (n = 779) accounted for 80.77% of all outbreaks. However, crude completeness ranged from 46.06% to 60.19% across the 103 variables assessed. Variables with the lowest crude completeness (ranging 3.32−6.98%) included pathogen, specimen etiological testing, and secondary transmission traceback information. Variables with low (<35%) average monthly completeness during eFORS increased by 0.33−0.40%/month after transitioning to NORS, most likely due to the expansion of surveillance capacity and coverage within the new reporting system. Examining completeness metrics in outbreak surveillance systems provides essential information on the availability of data for public reuse. These metadata offer important insights for public health statisticians and modelers to precisely monitor and track the geographic spread, event duration, and illness intensity of foodborne outbreaks.

Surveillance and Reduction Control of Escherichia coli and Diarrheagenic E. coli During the Pig Slaughtering Process in China

The microbial contamination of pork during the slaughter process, especially that of the hygiene indicator bacteria, Escherichia coli, is closely related to the safety and quality of the meat. Some diarrheagenic E. coli can cause serious foodborne diseases, and pose a significant threat to human life and health. In order to ascertain the current status of E. coli and diarrheagenic E. coli contamination during the pig slaughter process in China, we conducted thorough monitoring of large-sized slaughterhouses, as well as small- or medium-sized slaughterhouses, in different provinces of China from 2019 to 2020. The overall positive rate of E. coli on the pork surface after slaughter was very high (97.07%). Both the amount of E. coli contamination and the positive ratio of diarrheagenic E. coli in large-sized slaughterhouses (7.50–13.33 CFU/cm², 3.44%) were lower than those in small- or medium-sized slaughterhouses (74.99–133.35 CFU/cm², 5.71%). Combined with the current status of sanitary control in slaughterhouses, we determined that pre-cooling treatment significantly reduced E. coli and diarrheagenic E. coli in pork after slaughter, while microbiological testing reduced E. coli. Based on our monitoring data, China urgently needs to establish relevant standards to better control microbial contamination during pig slaughtering progress. This study provided a theoretical basis for the hygiene quality management of the pig slaughter industry in China.

Surveillance of foodborne diseases in Taiwan: A retrospective study

ABSTRACT

Foodborne pathogens cause diseases and death, increasing the economic burden. It needs to identify incident places, media food and pathgens. Our aim is to survey empirical data that provide a retrospective historical perspective on foodborne diseases and explore the causes and trends of outbreaks.We examined publicly available annual summary data on reported foodborne disease outbreaks in Taiwan from 2014 to 2018. We calculated the percentage of places, media food, bacteria and natural toxin sources in foodborne diseases and performed a chi-square test for difference evaluation. The higher risk of places and causes in 2018 compared with 2014 was empolyzed with univariate logistic regression.There were 26847 patients with foodborne diseases during the period from 2014 to 2018. The top 2 primary source locations of the foodborne diseases were schools and restaurants. The top 2 primary food media classifications of the foodborne diseases were boxed meals and compounded foods. The top 2 primary incident bacterial classifications of the observed foodborne diseases were Bacillus cereus and Staphylococcus aureus. The top 2 primary natural toxin classifications of the foodborne diseases were plants and histamines. The incidence of foodborne disease in military facilities, fruits and vegetables, and Staphylococcus aureus was increased in our study.Our study confirmed the high risk and increased incidence of foodborne diseases, food media classifications, bacterial classifications, and natural toxins in Taiwan. It is worthy of attention for the government health department-designed policy to promote disease prevention.

An enhanced antibacterial nanoflowers AgPW@PDA@Nisin constructed from polyoxometalate and nisin

A new composite, AgPW@PDA@Nisin, with shell-core structure was successfully synthesized by a polydopamine (PDA) surfaced conjugated nisin (an antibacterial 34 amino acid polycyclic peptide) as shell and polyoxometalates (Ag₃PW₁₂O₄₀ = AgPW) as core. The composite was characterized by the zeta potential, scanning electron microscopy (SEM), transmission electron microscope (TEM), X-ray diffraction analysis (XRD), fourier transform infrared (FT-IR). The AgPW@PDA@Nisin showed flower hierarchical structure and potential antibacterial activity against S. aureus ATCC29213. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of it were 4 and 32 μg/mL. AgPW@PDA@Nisin nanoflowers-induced bacterial death bears the characteristic of cell morphology, membrane integrity and permeability changing, nucleotide leakage. It indicated that the AgPW@PDA@Nisin interfere with the cell membrane, resulting in antibacterial activity against S. aureus. The cytotoxicity of the nanoflowers was low on HDF-a (human dermal fibroblasts) cells. A new class of hybrid inorganic-organic nanoflowers based on polyoxometalates and nisin with enhanced antibacterial properties can be developed for food preservation.

COVID-19 pandemic underlines the need to build resilience in commercial restaurants' food safety

In the face of the COVID-19 pandemic, the commercial restaurant sector is struggling to organize itself. Resilience is crucial for a system to be able to respond adequately to events of this magnitude, and is aimed at the recovery and adaptation of the concerned sector in view of the adversities. In the commercial restaurant sector, resilience efforts are primarily intended to protect the health of both those who consume food and those who produce it. Amid the creative initiatives of individuals within their workplaces, restaurants, even unconsciously, seek to build resilience in the pandemic by applying the food safety practices recommended by the sanitary legislation and remaining economically active. Targeting public health preparedness, in this letter, we present an overview of the stages of resilience and their interaction with the COVID-19 pandemic in the context of commercial restaurants.

Microfluidic-Based Approaches for Foodborne Pathogen Detection

Food safety is of obvious importance, but there are frequent problems caused by foodborne pathogens that threaten the safety and health of human beings worldwide. Although the most classic method for detecting bacteria is the plate counting method, it takes almost three to seven days to get the bacterial results for the detection. Additionally, there are many existing technologies for accurate determination of pathogens, such as polymerase chain reaction (PCR), enzyme linked immunosorbent assay (ELISA), or loop-mediated isothermal amplification (LAMP), but they are not suitable for timely and rapid on-site detection due to time-consuming pretreatment, complex operations and false positive results. Therefore, an urgent goal remains to determine how to quickly and effectively prevent and control the occurrence of foodborne diseases that are harmful to humans. As an alternative, microfluidic devices with miniaturization, portability and low cost have been introduced for pathogen detection. In particular, the use of microfluidic technologies is a promising direction of research for this purpose. Herein, this article systematically reviews the use of microfluidic technology for the rapid and sensitive detection of foodborne pathogens. First, microfluidic technology is introduced, including the basic concepts, background, and the pros and cons of different starting materials for specific applications. Next, the applications and problems of microfluidics for the detection of pathogens are discussed. The current status and different applications of microfluidic-based technologies to distinguish and identify foodborne pathogens are described in detail. Finally, future trends of microfluidics in food safety are discussed to provide the necessary foundation for future research efforts.

Multi-phased internalization of murine norovirus (MNV) in Arabidopsis seedlings and its potential correlation with plant defensive responses

Norovirus is a highly infectious human pathogen that causes acute foodborne diseases worldwide. As global diet patterns have begun to incorporate a higher consumption of fresh agricultural products, the internalization of norovirus into plants has emerged as a potential threat to human health. Here, we demonstrated that murine norovirus (MNV1) was internalized into Arabidopsis in multiple phases, and this internalization was correlated with Arabidopsis innate immunity responses. Under hydroponic conditions, continuous treatment of MNV1 retarded root growth and facilitated flower development of Arabidopsis without causing necrotic lesions. Examination of viral titers and RNA levels revealed that MNV1 was internalized into Arabidopsis in at least three different phases. In response to MNV1 treatment, the Arabidopsis defensive marker PR1 (a salicylic acid signaling marker) was transiently up-regulated at the early stage. PDF1.2, a jasmonic acid signaling marker, exhibited a gradual induction over time. Noticeably, Arabidopsis RNS1 (T2 ribonuclease) was rapidly induced by MNV1 and exhibited anti-correlation with the internalization of MNV1. Exposure to recombinant Arabidopsis RNS1 protein reduced the viral titers and degraded MNV1 RNA in vitro. In conclusion, the internalization of MNV1 into Arabidopsis was fluctuated by mutual interactions that were potentially regulated by Arabidopsis immune systems containing RNS1.

Whole Genome Sequencing: Bridging One-Health Surveillance of Foodborne Diseases

Infections caused by pathogens commonly acquired from consumption of food are not always transmitted by that route. They may also be transmitted through contact to animals, other humans or the environment. Additionally, many outbreaks are associated with food contaminated from these non-food sources. For this reason, such presumed foodborne outbreaks are best investigated through a One Health approach working across human, animal and environmental sectors and disciplines. Outbreak strains or clones that have propagated and continue to evolve in non-human sources and environments often show more sequence variation than observed in typical monoclonal point-source outbreaks. This represents a challenge when using whole genome sequencing (WGS), the new gold standard for molecular surveillance of foodborne pathogens, for outbreak detection and investigation. In this review, using recent examples from outbreaks investigated in the United States (US) some aspects of One Health approaches that have been used successfully to solve such outbreaks are presented. These include using different combinations of flexible WGS based case definition, efficient epidemiological follow-up, traceback, surveillance, and testing of potential food and environmental sources and animal hosts.

Efficacy of Food Safety Training in Commercial Food Service

Proper food safety training is essential to decrease incidences and overall rates of foodborne illnesses and outbreaks. Though many commercial restaurants should provide proper food safety training to food handler employees, this training is not always offered or effective. Here, we summarize the results of a primary literature study concerning the effectiveness of food safety training in commercial settings. The literature chosen for review contained only studies with experimental food safety training, with before and after training data. Through evaluation of these studies, the best practice for ensuring effective training and follow-through were the use of food safety training programs, which incorporated both knowledge and behavior-based training. PRACTICAL APPLICATION: Food safety managers in food service establishments may consider reevaluating their current food safety training program to incorporate behavioral-based food safety training in addition to knowledge-based training.

Modulation of the Immune Response to Improve Health and Reduce Foodborne Pathogens in Poultry

Salmonella and Campylobacter are the two leading causes of bacterial-induced foodborne illness in the US. Food production animals including cattle, swine, and chickens are transmission sources for both pathogens. The number of Salmonella outbreaks attributed to poultry has decreased. However, the same cannot be said for Campylobacter where 50⁻70% of human cases result from poultry products. The poultry industry selects heavily on performance traits which adversely affects immune competence. Despite increasing demand for poultry, regulations and public outcry resulted in the ban of antibiotic growth promoters, pressuring the industry to find alternatives to manage flock health. One approach is to incorporate a program that naturally enhances/modulates the bird's immune response. Immunomodulation of the immune system can be achieved using a targeted dietary supplementation and/or feed additive to alter immune function. Science-based modulation of the immune system targets ways to reduce inflammation, boost a weakened response, manage gut health, and provide an alternative approach to prevent disease and control foodborne pathogens when conventional methods are not efficacious or not available. The role of immunomodulation is just one aspect of an integrated, coordinated approach to produce healthy birds that are also safe and wholesome products for consumers.