Foodborne Outbreaks: More Complex, Deadlier, Harder To Stop

The complex paths that ingredients take to become the foods we eat, and that foods follow to reach our plates, are creating foodborne disease outbreaks that occur in many places at once and are more common and more deadly than ever before.

That’s the conclusion of a new report from the Centers for Disease Control and Prevention, released Tuesday at the same time that fast-casual chain Chipotle Mexican Grill is struggling with an outbreak of E. coli that has sickened 37 of it customers in several states. More than half of the deaths due to food that occurred in the United States between 2010 and 2014 came from multi-state food-related outbreaks, the CDC said. Overall, outbreaks that crossed state lines accounted for only 3 percent of the 4,163 food-related outbreaks the agency analyzed—but those outbreaks accounted for much more illness and death than usual, including 11 percent of the 71,747 food-related illnesses, 34 percent of the 4,247 hospitalizations, and 56 percent of the 118 deaths attributed to food.

Such outbreaks are becoming more virulent: The multi-state outbreaks were more likely to be caused by Salmonella, Listeria or toxin-producing strains of E. coli, while outbreaks that were confined to individual states tended to be caused by the vomiting disease norovirus. They are also becoming more common: There were fewer than three per year between 1973 and 1980. The CDC said Tuesday that there are an average of 24 per year now.

“On average, there are about two (outbreaks) per month, and they can be big and they can be lethal,” Dr. Thomas R. Frieden, the CDC’s director, said in a briefing for reporters.

Frieden said the disease-detective agency hopes the food industry will work with federal officials to take more responsibility for delineating the complex processes that both assemble ingredients into finished foods and also distribute them through nationwide—sometimes worldwide—networks.

The Chipotle outbreak of pathogenic E. colioutbreak of pathogenic E. coli, which has affected customers in two states, sending 12 of them to hospitals, has led the chain to close 43 of its West Coast restaurants. The company is meeting with federal officials, according to Dr. Kathleen Gensheimer of the Food and Drug Administration, who shared the media briefing with Frieden.

Even the simplest foods can have astoundingly complex “supply chains.” In the graphic below, the European nonprofit Forest 500 traces the components of a burger, fries and packaging from a typical fast-food meal served in Europe, and identifies 75 different supply chains that escort the various ingredients through more than a dozen countries, sometimes traveling halfway around the world.

And at the 2013 Digital Disease Detection conference in San Francisco, former military epidemiologist Amy Kircher, DrPH, director of the University of Minnesota’s Food Protection and Defense Institute, said the average American burger contains the products of 82 supply chains—and that importing those components opens a portal not just for naturally occurring diseases but for deliberate contamination as well.

The CDC sad Tuesday that 15 percent of complicated outbreaks over the past five years originated in imported food, mostly from Mexico and secondarily from Turkey. Fruit, nuts and seeds, fish and vegetables, and bagged salad mix were the main foreign culprits.

Frieden said the CDC is relying on the reorganization of federal food safety created by the Food Safety Modernization Act (FSMA for short), which gave the FDA new tracking and enforcement powers, and aims to push the responsibility for detecting contaminated imports from the very limited federal workforce to foreign governments cooperating with the US.

But, as Helena B. Evich of Politico reported in an investigation published last July, the 2010 FSMA is effectively an unfunded mandate, all but abandoned by the administration that pushed so hard for its passage. The FDA, she said, is $276 million short of what it needs to implement the law’s sweeping changes and has not been able to implement any of the tough new rules it created.

Funding is the critical component that would allow federal food safety to peer into supply chains and keep such large outbreaks from occurring again, agreed Sandra Eskin, director of food safety at The Pew Charitable Trusts. She points out that, according to the CDC’s report,  fresh produce causes an ever-larger proportion of complex outbreaks, and that the unpredictable contamination that occurs in fields demands sophisticated, predictive responses that agencies can’t now afford.

“These outbreaks underscore the need for FDA’s new prevention-based safety standards for fruits and vegetables,” she said. “However, If FDA does not receive the funding necessary to effectively implement these standards, then consumers will continue to be sickened with foodborne illnesses that are largely preventable.”