The Anatomy of Food-borne Disease Outbreaks In New York : A Study of the Food Service Establishment

1
The Anatomy of Food-borne Disease Outbreaks In
New York A Study of the Food Service
Establishment

• Ifeanyi Malu, Ph.D. Student
• Walden University
• PHBH 8165-1
• Instructor Dr. Robert Marino
• Fall, 2011

2
Learning Objectives

• By the end of this presentation, stakeholders
  will be able
• to
• Describe the environmental causes of disease
  outbreaks.
• Define the environmental causes of disease
  outbreaks.
• Recognize the challenges posed by food-borne
  disease outbreaks in the state.
• Develop strategies for the preservation and
  handling of food, understand the importance of
  sanitation and personal hygiene, and distinguish
  between the types of state laws, local ordinances
  and federal Act.
• Design a training program for its workers in
  order to maintain competitive advantage, increase
  customer satisfaction and adopt the inclusion of
  calorie information on food menus.
• Implement motivational action within and across
  food services centers in order to affect changes
  in the industry

3
National Food-borne Disease Outbreak in the
U.S.-1993-1997

• 550 food borne illness outbreak from 1993 to 1997
• 40 percent of these outbreak were attributed to
  food service outlets
• Selman, C. A., Green, L. R. (2008).
  Environmental health specialists' self-reported
  food borne illness outbreak investigation
  practices. Journal of Environmental Health,
  70(6), 1621.

4
Overview of Outbreaks in the U.S. 2007

• 497 outbreaks resulting in 12,767 illnesses
• Bacteria caused 259 outbreaks and 6441 illnesses
• Virus caused 199 outbreaks with 6120 illness
• Chemical agents caused 34 outbreak and 141
  illnesses
• Parasites caused five outbreak with 65 illness
• Center for Disease Control and Prevention
  (August,2010).Surveillance of Foodborne Disease
  Outbreak United States. Retrieved October 9,
  2011 from http//www.cdc.gov/mmwr/pdf/wk/mm5931.pd
  f

5
Overview of 2006 Foodborne Disease Outbreaks In
New York

• 84 foodborne disease outbreak reported
• 1,834 cases of foodborne illness
• 124 people hospitalization
• 42.3 foodborne illness associated with
  calicivirus outbreak
• 33 foodborne disease outbreak attributed to
  bacterial illness
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

6
Overview of 2006 Foodborne Disease Outbreaks In
New York

• Salmonella species accounts for 15 of the 33
  bacterial outbreak
• 11 calicivirus outbreak recorded
• 3 cases of V. parahaemolyticus confirmed
• 2 cases of V. parahaemolyticus suspected
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

7
Analysis of Etiology

• Etiology was confirmed in 53.6 of the 84
  outbreaks in 2006
• Suspected etiology was documented for 9.5
• Unknown etiology was identified for 36.9
• From 2001-2005, 274 outbreak reported
• 28 Confirmed etiology were bacterial (62.2)
• 8 confirmed etiology were viral(17.8)
• 6 confirmed etiology were chemical(13.3)
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

8
Mortality and Morbidity Rate in 2006

• In 2006, no food-borne related death were
  reported in the state
• In 2005, one death was reported in the state
• 124 food-borne disease hospitalization in 2006
• In 2005, 38 hospitalization was reported
• 65.6 of morbidity were calicivirus
• 16.5 of morbidity caused by salmonella
• 8.0 of morbidity caused by perfringens
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

9
In-Year Temporal Trend in NYS

• Disease outbreak peaked in June,July and August
  of 2006
• 13.1 in June, 15.5 in July and 11.9 in August
• November witnessed about 10.7 in foodborne
  disease outbreak in 2006
• In 2006, salmonella caused 32.5 of the 40
  foodborne disease between May and August
• From 2001 through 2005, salmonella species were
  associated with 24.1 of the 108 outbreak in the
  summer months
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

10
Method of Food Preparation in NY

• Cook/serve food caused 22.6 of disease outbreaks
  of the 84 outbreaks in the state,
• Solid masses with potentially hazardous foods
  account for 14.3 of the 84 outbreaks
• Seafood caused 9.5 of the outbreaks
• Starchy food caused 8.3
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

11
New York State Laws

• Article 17-B Licensing of Food Salvagers
• Article 17 Food and Food Products
• Article 5B Sale of Meat and Article 5D Sale of
  Poultry and Poultry Products
• Article 5A Licensing of Slaughterhouses
• Article 20-C Licensing of Food Processing
  Establishments
• New York State Department of Agriculture(n.d.).
  NYS Food Safety Rule and Regulations. Retrieved
  October 1,2011 from http//www.agriculture.ny.gov/
  FS/industry/circs.html

12
New York City Ordinances

• Health Code regulations and Chapter 23, Title 24
  Rules of the City of New York.
• The New York City Smoke-Free Air Act 2002
• New York City Department of Health. (n.d.). Food
  safety and community sanitation. Retrieved
  September, 29,2011 from http//www.nyc.gov/html/d
  oh/html/inspect/insp-scoring.shtml

13
Food Protection Course in NYC

• Satisfies the provision of the state law
• Requires that food service mangers be certified
  in food protection
• Managers are issued a certificate
• Online classes conducted in English, Spanish and
  Chinese
• New York City Department of Health(n.d.). Food
  protection courses. Retrieved October 2,2011 from
  http//www.nyc.gov/html/doh/html/hany/hanyfood.sht
  ml

14
Food borne reporting system in the U.S.

• Electronic Food borne Outbreak Reporting System
  (EFORS)
• National Antimicorobial Resistance Monitoring
  System
• National Electronic Norovirus Outbreak Network
• National Notifiable Disease Surveillance System
• Foodborne Outbreak Surveillance
• Contributing Factors Surveillance
• Center for Disease Control and Prevention.
  (2011). Foodborne illness Surveillance Response
  and Data System. Retrieved September 1, 2011 from
  http//www.cdc.gov/foodborneburden/surveillance-sy
  stems.html
• Selman, C. A., Green, L. R. (2008).
  Environmental health specialists' self-reported
  food borne illness outbreak investigation
  practices. Journal of Environmental Health,
  70(6), 1621.

15
Food borne Surveillance system in the NYS

• New York State Department of Health Foodborne
  Disease Surveillance System
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df

16
Foodborne illness and their causes

• Bacterial infections
• Campylobacter
• Dysentery
• Salmonellosis
• Gastroenteritis
• Moeller, D. (2011). Environmental Health. 4th ed.
  Cambridge MA. Harvard University Press
• FDA (N.D.). Bad bug book Introduction foodborne
  pathogenic. Retrieved September 1,2011 from
  http//www.fda.gov/Food/Food Safety/FoodborneIllne
  ss/FoodborneIllnessFoodbornePathogensNaturalToxins
  /BadBugBook/default.htm

17
Foodborne illness and their causes

• Viral Infections
• Norwalk-like viruses
• Infectious hepatitis
• Bovine spongiform encephalopathy (BSE)
• Moeller, D. (2011). Environmental Health. 4th ed.
  Cambridge MA. Harvard University Press
• FDA (N.D.). Bad bug book Introduction foodborne
  pathogenic. Retrieved September 1,2011 from
  http//www.fda.gov/Food/Food Safety/FoodborneIllne
  ss/FoodborneIllnessFoodbornePathogensNaturalToxins
  /BadBugBook/default.htm

18
Foodborne Illness and their Causes

• Toxins
• Staphylococcus aureus
• Clostridium botulinum
• Escherichia coli. E. coli
• Brevtoxins
• Moeller, D. (2011). Environmental Health. 4th ed.
  Cambridge MA. Harvard University Press
• FDA (N.D.). Bad bug book Introduction foodborne
  pathogenic. Retrieved September 1,2011 from
  http//www.fda.gov/Food/Food Safety/FoodborneIllne
  ss/FoodborneIllnessFoodbornePathogensNaturalToxins
  /BadBugBook/default.htm

19
Food Poisoning in the U.S.

• 48 million reported being sick( 1 in 6 Americans)
• 3000 die each year
• 76 million suffer food-borne disease each year
• 31 pathogen caused 9.4 million illness
• Unspecified agents caused 38.4 million illness
• New York Times (2010). Food safety. Retrieved
  October 10, 2011 from http//topics.nytimes.com/to
  p/reference/timestopics/subjects/f/food_safety/ind
  ex.html
• Center for Disease Control and Prevention.
  (2011). Estimates of foodborne illness in the
  United States. Retrieved October 1,2011 from
  http//www.cdc.gov/foodborneburden/index.html

20
Preservation and Handling

• Cooking
• Canning
• Drying and dehydration
• Preservatives
• Refrigeration
• Freezing
• Pasteurization
• Moeller, D. (2011). Environmental Health. 4th ed.
  Cambridge MA. Harvard University Press
• Images courtesy of the health department of the
  city of New York. Retrieved from
  http//www.nyc.gov/html/doh/downloads/pdf/inspect/
  food_safety_fact.pdf

21
Sanitation, Hygieneand Inspection

• Equipment and facilities
• Personnel training
• Hand washing
• Standards and regulation
• Enforcement and monitoring
• Moeller, D. (2011). Environmental Health. 4th ed.
  Cambridge MA. Harvard University Press

22
Keep Your Food Safe from BacteriaWhen in Doubt,
Throw it Out!
23
Stakeholders

• New York State Department of Health
• New York City Department of Health
• Food and Drug Administration
• Center for Disease Control and Prevention
• NYS Department of Agriculture
• U.S. Department of Agriculture
• National Institute of Health
• National Restaurant Association
• NYS Association for Food Protection
• The Public

24
Recommendations

• Improved technology and new CDC reporting
  guidelines
• Increase databases to identify place of
  contamination
• Improve and extend the current grading system in
  NYC to all counties in the state
• Hire more food inspectors

25
Thank you
26
References

• Center for Disease Control and Prevention
  (August,2010).Surveillance of Foodborne Disease
  Outbreak United States. Retrieved October 9,
  2011 from http//www.cdc.gov/mmwr/pdf/wk/mm5931.pd
  f
• New York State Department of Health( April 2006).
  Foodborne Disease Outbreak in New York
  State,2006. Retrieved October 1,2011 from
  http//www.health.state.ny.us/statistics/diseases/
  foodborne/outbreaks/2006/2006_outbreak_report_bw.p
  df
• New York City Department of Health. (n.d.). Food
  safety and community sanitation. Retrieved
  September, 29,2011 from http//www.nyc.gov/html/do
  h/html/inspect/insp-scoring.shtml
• New York Time. (2010). Food Safety. Retrieved
  October 10, 2011 from http//topics.nytimes.com/to
  p/reference/timestopics/subjects/f/food_safety/ind
  ex.html
• Moeller, D. (2011). Environmental Health. 4th ed.
  Cambridge MA. Harvard University Press
• Selman, C. A., Green, L. R. (2008).
  Environmental health specialists' self-reported
  food borne illness outbreak investigation
  practices. Journal of Environmental Health,
  70(6), 1621.

27
References

• Center for Disease Control and Prevention.
  (2011). Foodborne illness Surveillance Response
  and Data System. Retrieved September 1, 2011 from
  http//www.cdc.gov/foodborneburden/surveillance-sy
  stems.html
• FDA (N.D.). Bad bug book Introduction foodborne
  pathogenic. Retrieved September 1,2011 from
  http//www.fda.gov/Food/Food Safety/FoodborneIllne
  ss/FoodborneIllnessFoodbornePathogensNaturalToxins
  /BadBugBook/default.htm

28
Further Readings

• Centers for Disease Control and Prevention (CDC)
  Environmental Health Data and Statistics.
• http//www.cdc.gov/environmental/
• MacKenzie, W., Hoxie, N., Proctor, M., Gradus,
  M., Blair, K., Peterson, D., et al. (1994). A
  massive outbreak in Milwaukee of Cryptosporidium
  infection transmitted through the public water
  supply. New England Journal of Medicine, 331(3),
  16116
• Selman, C. A., Green, L. R. (2008).
  Environmental health specialists' self-reported
  food borne illness outbreak investigation
  practices. Journal of Environmental Health,
  70(6), 1621.