A multistate outbreak of Salmonella Heidelberg infections linked to ground turkey in 2011 sickened 136 people, causing 37 hospitalizations and one death. The Pew Charitable Trusts' analysis of the outbreak found numerous inadequacies in the foodborne illness surveillance system that, if addressed, could help to prevent illnesses and, in some cases, deaths.
April 2013
The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Pew applies a rigorous, analytical approach to improve public policy, inform the public, and stimulate civic life.
The food safety project seeks to reduce health risks from foodborne pathogens by strengthening federal government authority and the enforcement of food safety laws.
The Pew Charitable Trusts
Susan K. Urahn, executive vice president
Erik Olson, deputy director of food programs
The food safety project — Sandra Eskin, Juliana Ruzante, Colin Finan, and Ben Kessler — would like to thank Pew staff members Pete Janhunen, Juli Putnam, Joshua Wenderoff, Lisa Gonzales, and Liz Visser for providing valuable feedback on the report, and Natalia Pelayo and Steve Howard for Web support. Our thanks also go to designer Penelope Malish and fact checker Betsy Towner Levine.
The report benefited from the insights and expertise of external reviewers Craig Hedberg, Ph.D., professor in the School of Public Health at the University of Minnesota, and Ian Williams, Ph.D., chief of the Outbreak Response and Prevention Branch, National Center for Emerging and Zoonotic Infectious Diseases at the U.S. Centers for Disease Control and Prevention.
For additional information, please visit pewhealth.org/foodsafety.
1. Elaine Scallan, Robert M. Hoekstra, Frederick J. Angulo, Robert V. Tauxe, Marc-Alain Widdowson, Sharon L. Roy, Jeffery L. Jones, and Patricia M. Griffin, “Foodborne Illness Acquired in the United States — Major Pathogens,” Emerging Infectious Diseases 17 (2011): 7-15.
2. Robert L. Scharff, “Economic Burden from Health Losses Due to Foodborne Illness in the United States,” Journal of Food Protection 75 (2012): 123-131.
3. Shua J. Chai, Patricia L. White, Sarah L. Lathrop, Suzanne M. Solghan, Carlota Medus, Beth M. McGlinchey, Melissa Tobin-D’Angelo, Ruthanne Marcus, and Barbara E. Mahon, “Salmonella enterica Serotype Enteritidis: Increasing Incidence of Domestically Acquired Infections,” Clinical Infectious Diseases 54 (2012): S497.
4. Michael B. Batz, Sandra Hoffmann, and J. Glenn Morris, Jr., “Ranking the Risks: The 10 Pathogen-Food Combinations With the Greatest Burden on Public Health,” 2011, accessed June 14, 2012, www.folio.iupui.edu/bitstream/handle/10244/1022/72267report.pdf.
5. Scallan et al., “Foodborne Illness Acquired in the United States—Major Pathogens,” 7-15.
6. “Investigation Update: Multistate Outbreak of Human Salmonella Heidelberg Infections Linked to Ground Turkey,” Centers for Disease Control and Prevention, accessed June 14, 2012, www.cdc.gov/Salmonella/heidelberg/111011.
7. Rendi Murphree, Katie Garman, Quyen Phan, Karen Everstine, L. Hannah Gould, and Timothy F. Jones, “Characteristics of Foodborne Disease Outbreak Investigations Conducted by Foodborne Diseases Active Surveillance Network (FoodNet) Sites, 2003-2008,”Clinical Infectious Diseases 54 (2012): S503.
8. “Multistate Foodborne Outbreaks: CDC’s Role,” Centers for Disease Control and Prevention, accessed Nov. 9, 2012, www.cdc.gov/outbreaknet/outbreaks-cdc-role.html.
9. “Multistate Foodborne Outbreak Investigations,” Centers for Disease Control and Prevention, accessed June 14, 2012, www.cdc.gov/outbreaknet/outbreaks.html.
10. Pathogen Reduction; Hazard Analysis and Critical Control Point (HACCP) Systems; Final rule No. 144, 9 C.F.R. 304 (July 25, 1996).
11. Contamination with Microorganisms; Process Control Verification Criteria and Testing; Pathogen Reduction Standards; 9 C.F.R. 381.94.
12. Food Safety and Inspection Service, “Nationwide Raw Ground Turkey Microbiological Survey,” 1996, accessed Oct.
11, 2012, www.fsis.usda.gov/OPHS/baseline/rwgrturk.pdf.
13. Section 205 of the FDA Food Safety Modernization Act; Public Law 111-353, 124 STAT. 3885 (Jan. 4, 2011).
14. Scallan et al., “Foodborne Illness Acquired in the United States—Major Pathogens,” 7-15.
15. “Reports of Selected Salmonella Outbreak Investigations,” Centers for Disease Control and Prevention, accessed June
14, 2012, www.cdc.gov/salmonella/outbreaks.html.
16. Batz et al., “Ranking the Risks: The 10 Pathogen-Food Combinations With the Greatest Burden on Public Health,”
2011.
17. Batz et al., “Ranking the Risks: The 10 Pathogen-Food Combinations With the Greatest Burden on Public Health,”
2011.
18. Centers for Disease Control and Prevention, “Vital Signs: Incidence and Trends of Infection With Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996-2010,” Morbidity and Mortality Weekly Report 60 (2011): 749-755, accessed Dec. 12, 2012, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a5.htm.
19. Centers for Diseases Control and Prevention, “Healthy People 2010: Final Review,” 2010, accessed June 16, 2012, www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf.
20. “Healthy People 2020 Topics & Objectives,” Centers for Disease Control and Prevention, accessed June 18, 2012, http://www.healthypeople.gov/2020/topicsobjectives2020/ overview.aspx?topicid=14.
21. Centers for Disease Control and Prevention, “Vital Signs: Incidence and Trends of Infection With Pathogens Transmitted Commonly Through Food—Foodborne Disease Active Surveillance Network, 10 U.S. Sites, 1996-2010,” 749-755.
22. “Healthy People 2010: Final Review.”
23. “Healthy People 2020 Topics & Objectives.”
24. Council of State and Territorial Epidemiologists, “2010 Food Safety Epidemiology Capacity Assessment,” 2010, accessed June 12, 2012, http://www.cste2.org/webpdfs/fseca.pdf.
25. David Boxrud, Timothy Monson, Tracy Stiles, and John Besser, “The Role, Challenges, and Support of PulseNet Laboratories in Detecting Foodborne Disease Outbreaks,” Public Health Reports 125 (2010): 57-62.
26. Ian Williams, e-mail message, Feb. 15, 2012.
27. This data comes from a survey done by the Association of Public Health Laboratories. Out of 55 PulseNet laboratories,
41 agreed to provide their survey information to Pew.
28. Max Levy, Joe Yerardi, and Dustin Volz, “Flawed State Reporting Leaves Consumers Vulnerable,” News21, accessed June 12, 2012, http://foodsafety.news21.com/2011/response/analysis.
29. A video on how contaminated food is identified during an outbreak can be found at http://www.youtube.com/ watch?v=XKD7eNn8bFs.
30. “Multistate and Nationwide Foodborne Outbreak Investigations: A Step-by-Step Guide.” Centers for Disease Control and Prevention, accessed March 8, 2013, www.cdc.gov/outbreaknet/investigations/investigating.html.
31. “Multistate Outbreak of Listeriosis Linked to Whole Cantaloupes From Jensen Farms, Colorado,” Centers for Disease Control and Prevention, accessed June 14, 2012, www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/ index.html.
32. Chai et al., “Salmonella enterica Serotype Enteritidis: Increasing Incidence of Domestically Acquired Infections,” S497.
33. “Making Food Safer to Eat: Reducing Contamination from the Farm to the Table,” Centers for Disease Control and Prevention, accessed June 14, 2012, http://www.cdc.gov/ vitalsigns/foodsafety/.
34. Scharff, “Economic Burden from Health Losses Due to Foodborne Illness in the United States,” 123-131.
35. “FDA Warns Consumers Nationwide Not to Eat Certain Types of Raw Red Tomatoes,” U.S. Food and Drug Administration, accessed June 18, 2012, www.fda.gov/ NewsEvents/Newsroom/PressAnnouncements/2008/ ucm116908.htm.
36. Scharff, “Economic Burden from Health Losses Due to Foodborne Illness in the United States,” 123-131.
In January 2011, President Barack Obama signed the FDA Food Safety Modernization Act (FSMA) into law, signaling the first major update to our nation’s food safety oversight framework since the Great Depression. Despite widespread support for the legislation and its implementation, the Obama administration still has not issued all of the proposed rules under FSMA.
More infoThe Pew Charitable Trusts applauds Sen. Barbara Mikulski (D-MD) for her efforts to strengthen food safety protections under the FDA Food Safety Modernization Act, and provide grant funding to help school cafeterias across the nation upgrade their equipment to serve healthy, appealing meals to millions of school children. Funding for both programs was included in a larger bill approved by the Senate Appropriations Committee on Thursday.
More info"Being a Minnesotan, Jeff Almer searched for a polite term to describe how he feels about a congressional push to roll back the new food safety laws his family fought for when his elderly mother died after eating salmonella-laced peanut butter in late 2008."
More infoThe Pew Charitable Trusts commends Representative Tom Latham (R-IA) for his leadership in securing approximately $27 million for food safety in the House appropriations bill funding the U.S. Food and Drug Administration, or FDA. The new money would help the FDA protect millions of Americans from the dangers of foodborne illnesses and strengthen consumer confidence in the food supply.
More infoAs a pediatrician, my No. 1 concern is to keep children safe and healthy. Inside the walls of my office, I can provide services and counseling to help do just that, whether by giving an infant her first childhood vaccine, providing a mental health screening to an adolescent patient or counseling parents about how to keep their homes as safe as possible. Unfortunately, there are some threats to children's health that are beyond my control, including the food they consume.
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