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

Trends in Burdens of Disease by Transmission Source (USA, 2005-2020) and Hazard Identification for Foods: Focus on Milkborne Disease

BACKGROUND

Robust solutions to global, national, and regional burdens of communicable and non-communicable diseases, particularly related to diet, demand interdisciplinary or transdisciplinary collaborations to effectively inform risk analysis and policy decisions.

OBJECTIVE

U.S. outbreak data for 2005-2020 from all transmission sources were analyzed for trends in the burden of infectious disease and foodborne outbreaks.

METHODS

Outbreak data from 58 Microsoft Access® data tables were structured using systematic queries and pivot tables for analysis by transmission source, pathogen, and date. Trends were examined using graphical representations, smoothing splines, Spearman's rho rank correlations, and non-parametric testing for trend. Hazard Identification was conducted based on the number and severity of illnesses.

RESULTS

The evidence does not support increasing trends in the burden of infectious foodborne disease, though strongly increasing trends were observed for other transmission sources. Morbidity and mortality were dominated by person-to-person transmission; foodborne and other transmission sources accounted for small portions of the disease burden. Foods representing the greatest hazards associated with the four major foodborne bacterial diseases were identified. Fatal foodborne disease was dominated by fruits, vegetables, peanut butter, and pasteurized dairy.

CONCLUSION

The available evidence conflicts with assumptions of zero risk for pasteurized milk and increasing trends in the burden of illness for raw milk. For future evidence-based risk management, transdisciplinary risk analysis methodologies are essential to balance both communicable and non-communicable diseases and both food safety and food security, considering scientific, sustainable, economic, cultural, social, and political factors to support health and wellness for humans and ecosystems.

Missingness and algorithmic bias: an example from the United States National Outbreak Reporting System, 2009-2019

Growing debates about algorithmic bias in public health surveillance lack specific examples. We tested a common assumption that exposure and illness periods coincide and demonstrated how algorithmic bias can arise due to missingness of critical information related to illness and exposure durations. We examined 9407 outbreaks recorded by the United States National Outbreak Reporting System (NORS) from January 1, 2009 through December 31, 2019 and detected algorithmic bias, a systematic over- or under-estimation of foodborne disease outbreak (FBDO) durations due to missing start and end dates. For 7037 (75%) FBDOs with complete date-time information, ~ 60% reported that the exposure period ended before the illness period started. For 2079 (87.7%) FBDOs with missing exposure dates, average illness durations were ~ 5.3 times longer (p < 0.001) than those with complete information, prompting the potential for algorithmic bias. Modern surveillance systems must be equipped with investigative capacities to examine and assess structural data missingness that can lead to bias.

Gold Nanoparticle-Based Colorimetric Biosensing for Foodborne Pathogen Detection

Ensuring safe high-quality food is an ongoing priority, yet consumers face heightened risk from foodborne pathogens due to extended supply chains and climate change in the food industry. Nanomaterial-based assays are popular and have recently been developed to ensure food safety and high quality. This review discusses strategies for utilizing gold nanoparticles in colorimetric biosensors. The visible-signal biosensor proves to be a potent sensing technique for directly measuring targets related to foodborne pathogens in the field of food analysis. Among visible-signal biosensors, the localized surface plasmon resonance (LSPR) biosensor has garnered increasing attention and experienced rapid development in recent years. This review succinctly introduces the origin of LSPR theory, providing detailed insights into its fundamental principles. Additionally, this review delves into the application of nanotechnology for the implementation of the LSPR biosensor, exploring methods for utilizing gold nanoparticles and elucidating the factors that influence the generation of visible signals. Several emerging technologies aimed at simple and rapid immunoassays for onsite applications have been introduced in the food industry. In the foreseeable future, field-friendly colorimetric biosensors could be adopted in food monitoring systems. The onsite and real-time detection of possible contaminants and biological substances in food and water is essential to ensure human health and safety.

Assessment of the prevalence, serotype, and antibiotic resistance pattern of Salmonella enterica in integrated farming systems in the Maryland-DC area

Implementation of organic/pasture farming practices has been increasing in the USA regardless of official certification. These practices have created an increasingly growing demand for marketing safe products which are produced through these systems. Products from these farming systems have been reported to be at greater risk of transmitting foodborne pathogens because of current trends in their practices. Salmonella enterica (SE) is a ubiquitous foodborne pathogen that remains a public health issue given its prevalence in various food products, but also in the environment and as part of the microbial flora of many domestic animals. Monitoring antibiotic resistance and identifying potential sources contamination are increasingly important given the growing trend of organic/pasture markets. This study aimed to quantify prevalence of SE at the pre- and post-harvest levels of various integrated farms and sites in Maryland-Washington D.C. area, as well as identify the most prevalent serovars and antibiotic resistance patterns. Samples from various elements within the farm environment were collected and screened for SE through culture and molecular techniques, which served to identify and serotype SE, using species and serovar-specific primers, while antibiotic resistance was evaluated using an antibiogram assay. Results showed a prevalence of 7.80% of SE pre-harvest and 1.91% post-harvest. These results also showed the main sources of contamination to be soil (2.17%), grass (1.28%), feces (1.42%) and unprocessed produce (1.48%). The most commonly identified serovar was Typhimurium (11.32%) at the pre-harvest level, while the only identified serovar from post-harvest samples was Montevideo (4.35%). With respect to antibiotic resistance, out of the 13 clinically relevant antibiotics tested, gentamycin and kanamycin were the most effective, demonstrating 78.93 and 76.40% of isolates, respectively, to be susceptible. However, ampicillin, amoxicillin and cephradine had the lowest number of susceptible isolates with them being 10.95, 12.36, and 9.83%, respectively. These results help inform farms striving to implement organic practices on how to produce safer products by recognizing areas that pose greater risks as potential sources of contamination, in addition to identifying serotypes of interest, while also showcasing the current state of antibiotic efficacy and how this can influence antibiotic resistance trends in the future.

Development and Evaluation of a Next-Generation Sequencing Panel for the Multiple Detection and Identification of Pathogens in Fermented Foods

These days, bacterial detection methods have some limitations in sensitivity, specificity, and multiple detection. To overcome these, novel detection and identification method is necessary to be developed. Recently, NGS panel method has been suggested to screen, detect, and even identify specific foodborne pathogens in one reaction. In this study, new NGS panel primer sets were developed to target 13 specific virulence factor genes from five types of pathogenic Escherichia coli, Listeria monocytogenes, and Salmonella enterica serovar Typhimurium, respectively. Evaluation of the primer sets using singleplex PCR, crosscheck PCR and multiplex PCR revealed high specificity and selectivity without interference of primers or genomic DNAs. Subsequent NGS panel analysis with six artificially contaminated food samples using those primer sets showed that all target genes were multi-detected in one reaction at 10⁸-10⁵ CFU of target strains. However, a few false-positive results were shown at 10⁶-10⁵ CFU. To validate this NGS panel analysis, three sets of qPCR analyses were independently performed with the same contaminated food samples, showing the similar specificity and selectivity for detection and identification. While this NGS panel still has some issues for detection and identification of specific foodborne pathogens, it has much more advantages, especially multiple detection and identification in one reaction, and it could be improved by further optimized NGS panel primer sets and even by application of a new real-time NGS sequencing technology. Therefore, this study suggests the efficiency and usability of NGS panel for rapid determination of origin strain in various foodborne outbreaks in one reaction.

Exploring Risk Factors of Recall-Associated Foodborne Disease Outbreaks in the United States, 2009-2019

Earlier identification and removal of contaminated food products is crucial in reducing economic burdens of foodborne outbreaks. Recalls are a safety measure that is deployed to prevent foodborne illnesses. However, few studies have examined temporal trends in recalls or compared risk factors between non-recall and recall outbreaks in the United States, due to disparate and often incomplete surveillance records in publicly reported data. We demonstrated the usability of the electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS) for describing temporal trends and outbreak risk factors of food recalls in 1998−2019. We examined monthly trends between surveillance systems by using segmented time-series analyses. We compared the risk factors (e.g., multistate outbreak, contamination supply chain stage, pathogen etiology, and food products) of recalls and non-recalls by using logistic regression models. Out of 22,972 outbreaks, 305 (1.3%) resulted in recalls and 9378 (41%) had missing recall information. However, outbreaks with missing recall information decreased at an accelerating rate of ~25%/month in 2004−2009 and at a decelerating rate of ~13%/month after the transition from eFORS to NORS in 2009−2019. Irrespective of the contaminant etiology, multistate outbreaks according to the residence of ill persons had odds 11.00−13.50 times (7.00, 21.60) that of single-state outbreaks resulting in a recall (p < 0.001) when controlling for all risk factors. Electronic reporting has improved the availability of food recall data, yet retrospective investigations of historical records are needed. The investigation of recalls enhances public health professionals’ understanding of their annual financial burden and improves outbreak prediction analytics to reduce the likelihood and severity of recalls.