Foodborne Disease Outbreaks Caused by Biotoxins in Yantai City: A 10-Year Spatiotemporal Monitoring Study.

Unsafe food causes 600 million cases of foodborne diseases and 420,000 deaths every year. Meanwhile, biological toxins such as poisonous mushrooms, saponins, and aflatoxin can cause significant damage to humans. Therefore, it is particularly important to study foodborne disease outbreaks caused by biotoxins (FDOB). We collected FDOB in Yantai City from 2013 to 2022 and further established a corresponding database. Statistical analysis was carried out according to time, place, pathogen, and contamination of pathogenic factors. There were 128 FDOB, resulting in 417 patients and 6 deaths. The third quarter was a high season for foodborne disease outbreaks, the number of events, patients and deaths accounted for 65.63% (84/128), 55.88% (233/417), and 100% (6/6) of the total number, respectively. The highest number of outbreaks per 10,000 persons was Qixia (0.41), followed by Zhifu (0.36) and Laiyang (0.33). The top three causes of outbreaks were poisonous mushroom toxin, saponins and hemagglutinin, and Lagenaria siceraria (Molina) Standl. Sixty-five (50.78%) outbreaks were attributed to poisonous mushroom toxin, 18 (14.06%) outbreaks to saponin and hemagglutinin, and 12 (9.38%) outbreaks to L. siceraria (Molina) Standl. The largest number of outbreaks, patients and deaths all occurred in families, accounting for 82.81% (106/128) outbreaks, 66.19% (276/417) patients, and 100% (6/6) deaths, respectively. Followed by catering service establishments, accounting for 14.84% (19/128), 30.22% (126/417), and 0% (0/6), respectively. The main poisoning link of outbreaks was ingestion and misuse, accounting for 72.66% (93/128), followed by improper processing, accounting for 20.31% (26/128). It is necessary to carry out targeted family publicity and education, strengthen the integration of medical and prevention, explore innovative monitoring and early warning mechanisms for foodborne diseases, and reduce the occurrence of underreporting of foodborne disease outbreaks.

Egg-associated Salmonella enterica serovar Enteritidis: comparative genomics unveils phylogenetic links, virulence potential, and antimicrobial resistance traits.

Salmonella enterica serovar Enteritidis (SE) remains a frequent cause of foodborne illnesses associated with the consumption of contaminated hen eggs. Such a food-pathogen association has been demonstrated epidemiologically, but the molecular basis for this association has not been explored. Comparative genomic analysis was implemented to decipher the phylogenomic characteristics, antimicrobial resistance, and virulence potential of eggs-associated SE. Analyzing 1,002 genomes belonging to 841 sequence types of food-isolated SE strains suggests a high genomic similarity within the egg-related lineage, which is phylogenetically close to SE strains isolated from poultry but is different from those isolated from beef. Core genome- and single nucleotide polymorphism (SNP)-based phylogeny of 74 SE strains of egg origin showcased two distinct sublineages. Time-scaled phylogeny supported the possibility of a common ancestor of egg-related SE lineages. Additionally, genome mining revealed frequent antibiotic resistance due to the presence of aac(6')-Iaa and mdsAB encoded on the genomes of egg-associated SE strains. For virulence gene profiling, 103-113 virulence determinants were identified in the egg-associated SE, which were comparable to 112 determinants found in human-associated SE, emphasizing the capacity of egg-associated strains to infect humans and cause diseases. The findings of this study proved the genomic similarity of egg-associated SE strains, and these were closely related to poultry strains. The egg-associated strains also harbor virulence genes equivalent to those found in human-associated SE strains. The analysis provided critical insights into the genetic structure, phylogenomics, dynamics of virulence, and antibiotic resistance of Salmonella Enteritidis, circulating in eggs and emphasizing the necessity of implementing anti-Salmonella intervention strategies, starting at the production stage of the poultry supply chain.

Predicting Foodborne Disease Outbreaks with Food Safety Certifications: Econometric and Machine Learning Analyses.

Since the late 1990s, food safety certification has emerged as a prominent and influential regulatory mechanism in both the private and public spheres of the contemporary agri-food system. Food safety standards protect consumers from foodborne illnesses and help producers avoid the massive economic losses associated with food safety breaches. We empirically examine the relationship between foodborne disease outbreaks and certification adoption by utilizing the data on food safety certification adoption in the United States and Europe from 2015 through 2020. In our regression models, food safety certification along with select economic variables such as gross domestic product are used to explain the number of illnesses caused by foodborne disease outbreaks. For the United States at the state level, we found that certifications to SQF, PrimusGFS, BRC, or FSSC 22000 are negatively associated with the number of foodborne illnesses. For the case of Europe at the country level, certifications to ISO 22000 or FSSC 22000 are negatively associated with the number of foodborne illnesses. We then proceed to use machine learning techniques to examine how well we can use food safety certification data to predict foodborne disease outbreaks. Applying several algorithms (ordinary least squares, multinomial, decision tree, and random forest) to the U.S. data, we found that our models with food safety certification adoption can predict the number of U.S. foodborne illnesses or deaths with a relatively high degree of precision (testing accuracy at around 70% or better). Feature importance analysis allows us to inspect the relative importance of each explanatory variable (or feature) for making accurate predictions of the illness or death numbers. Through ranking the importance of explanatory variables, our study reveals that certification information could be the second most important variable (after gross domestic product) contributing to explain foodborne disease outbreaks.

Characteristics of Settings and Etiologic Agents of Foodborne Disease Outbreaks - China, 2020.

INTRODUCTION: Foodborne diseases are a growing public health problem and have caused a large burden of disease in China. This study analyzed epidemiological characteristics of foodborne diseases in China in 2020 to provide a scientific basis for prevention and control measures. METHODS: Data were collected from 30 of 31 provincial-level administrative divisions (PLADs) in the mainland of China, excluding Xizang (Tibet) Autonomous Region, via the National Foodborne Disease Outbreaks Surveillance System. The number and proportion of outbreaks, illnesses, hospitalizations, deaths by setting, pathogen-food category pairs and etiology were calculated. RESULTS: In 2020, 7,073 foodborne disease outbreaks were reported, resulting in 37,454 illnesses and 143 deaths. Among the identified pathogens, microbial pathogens were the most common confirmed etiology, accounting for 41.7% of illnesses. Poisonous mushrooms caused the largest proportion of outbreaks (58.0%) and deaths (57.6%). For venues where foodborne disease outbreaks occur, household had the highest number of outbreaks (4,140) and deaths (128), and catering service locations caused the largest proportion of illnesses (59.9%). Outbreaks occurring between June and September accounted for 62.8% of total outbreaks. CONCLUSIONS: Foodborne disease outbreaks mainly occurred in households. Microbial pathogens remained the top cause of outbreak-associated illnesses. Poisonous mushrooms were ranked the top cause of deaths in private homes in China. The supervision and management of food safety and health education should be strengthened to reduce the burden of foodborne diseases. Publicity should be increased to reduce the incidence of mushroom poisonings in families, and supervision and management of food should be strengthened to reduce microbial contamination.

The utilisation of tools to facilitate cross-border communication during international food safety events, 1995-2020: a realist synthesis.

Efficient communication and coordination are needed between countries to prevent, detect and respond to international food safety events. While communication tools, networks and systems exist, current evidence suggests that they are only useful within particular contexts and several only target specific geographic areas. There is a need to unpack and explore the mechanisms of how and in what context such communication tools and their components are effective at facilitating international communication and coordination to keep food safe and mitigate the burden of foodborne disease around the world.A realist synthesis was undertaken to understand how and why certain processes and structures of communication tools, used during international food safety events, influence their utility and effectiveness according to different contextual factors. The focus of this review was explanatory and aimed to develop and refine theory regarding how contextual factors trigger specific processes and mechanisms to produce outcomes. Using the realist context-mechanism-outcome configuration of theory development, a range of sources was used to develop an initial programme theory, including the authors' experience, a scoping review of published papers and grey literature and input from an expert reference committee. Literature was then systematically located and synthesised from several databases with input from the expert reference committee to refine the programme theory.The programme theory developed indicates that when a country has interests in food import or export, has the technical infrastructure to detect and respond to food safety events, and is governed in accordance with regional and/or global laws and regulations relating to food control and global health security, then specific mechanisms will facilitate various outcomes. Mechanisms include trust, experience, support, awareness, understanding, a sense of community, standardisation and intersectoral collaboration. The outcomes include using communication tools to relay information abroad and the prevention of foodborne diseases, among others.Components of such communication tools may be adapted according to different contextual factors to promote, support and improve their use. Improving international coordination and communication during international food safety events is in the interest of global health security and can mitigate the global burden of foodborne disease.

High-Efficiency Machine Learning Method for Identifying Foodborne Disease Outbreaks and Confounding Factors.

The China National Center for Food Safety Risk Assessment (CFSA) uses the Foodborne Disease Monitoring and Reporting System (FDMRS) to monitor outbreaks of foodborne diseases across the country. However, there are problems of underreporting or erroneous reporting in FDMRS, which significantly increase the cost of related epidemic investigations. To solve this problem, we designed a model to identify suspected outbreaks from the data generated by the FDMRS of CFSA. In this study, machine learning models were used to fit the data. The recall rate and F1-score were used as evaluation metrics to compare the classification performance of each model. Feature importance and pathogenic factors were identified and analyzed using tree-based and gradient boosting models. Three real foodborne disease outbreaks were then used to evaluate the best performing model. Furthermore, the SHapley Additive exPlanation value was used to identify the effect of features. Among all machine learning classification models, the eXtreme Gradient Boosting (XGBoost) model achieved the best performance, with the highest recall rate and F1-score of 0.9699 and 0.9582, respectively. In terms of model validation, the model provides a correct judgment of real outbreaks. In the feature importance analysis with the XGBoost model, the health status of the other people with the same exposure has the highest weight, reaching 0.65. The machine learning model built in this study exhibits high accuracy in recognizing foodborne disease outbreaks, thus reducing the manual burden for medical staff. The model helped us identify the confounding factors of foodborne disease outbreaks. Attention should be paid not only to the health status of those with the same exposure but also to the similarity of the cases in time and space.

An outbreak of Salmonella Enteritidis food poisoning following consumption of chicken shawarma: A brief epidemiological investigation.

BACKGROUND: Shawarma, a popular meat-based fast food could be a source of foodborne outbreak due to non-typhoidal Salmonella (NTS). A clustering of acute gastrointestinal (GI) illness following intake of chicken shawarma occurred primarily among the staff and students of a tertiary care hospital in southern India. METHODS: A case-control study was conducted among 348 undergraduate medical students (33 cases, 315 controls).  Data was collected using direct interviews and a simple online questionnaire. Epidemiological associations of GI illness were evaluated at three levels of exposure namely-eating food from any restaurant, eating food from the implicated food outlet, eating chicken shawarma from the implicated outlet. RESULTS: Of 33 cases, 26 had consumed food from a particular food outlet, 4 from other outlets, and 3 did not report eating out. Consumption of food from the suspected food outlet was significantly associated with GI illness (odds ratio 121.8 [95% CI 28.41 to 522.66]; P<0.001); all the 26 cases who had eaten from the particular outlet had eaten chicken shawarma. By comparison, only one of the 315 controls had eaten this dish. Of the 27 persons (cases as well as controls) who had consumed chicken shawarma from the outlet, 26 were ill. Culture of stool samples from 10 affected individuals and implicated food item yielded Salmonella Enteritidis. CONCLUSIONS: Meat-based shawarma is a potential source of NTS infection. Food safety authorities should enforce guidelines for safe preparation and sale of shawarmas and similar products.

Detecting Foodborne Disease Outbreaks in Florida through Consumer Complaints.

ABSTRACT: The Florida Complaint and Outbreak Reporting System (FL-CORS) database is used by the Florida Department of Health's Food and Waterborne Disease Program as one of the tools to detect foodborne disease outbreaks (FBOs). We present a descriptive and spatial network analysis of FL-CORS data collected during 2015 to 2018. We also quantified FBOs that were investigated and confirmed because of a filed complaint and the etiological agents involved in these outbreaks. An increasing number of unique complaints filed in FL-CORS was observed during 2015 to 2018, with a sharp increase during 2017 to 2018 and a different seasonal pattern in 2018. The preferred mechanism of reporting varied by age group, with younger people more frequently filing complaints online and older people preferring reporting in person or by phone. Spatial network analysis revealed that 87% of complaints had the same county of residence and county of presumed exposure. Frequency of complaints was negatively associated with linear distance between place of residence and place of exposure at the zip code level. Counties located in North and Central Florida, as well as some coastal areas in South Florida, had higher incidence rates of complaints. Those counties tend to have a large population density, and some are popular vacation destinations. On average, 96 FBOs were reported in Florida annually, of which 60% were confirmed with successful identification of the causative agent. The 56% of the confirmed FBOs were triggered by a complaint. Throughout the years, 2.4 to 2.8 FBOs and 1.4 confirmed FBOs were identified per 100 complaints. Ciguatera toxin was the cause of 40% of all FBOs in Florida, and only 28% of outbreaks were detected through complaints. In contrast, complaints were the main source of identifying outbreaks of norovirus, nontyphoidal Salmonella enterica, and scombroid food poisoning, as well as rare outbreaks of Clostridium perfringens, Cryptosporidium spp., Shigella spp., and Vibrio vulnificus.

Training for Foodborne Outbreak Investigations by Using Structured Learning Experience.

We created a free and interactive training activity based on playing cards (disease detective cards) that introduces foodborne outbreak investigations to public health professionals and students. Competencies taught cover selected descriptive and analytic epidemiologic topics, such as case definition, epidemic curve, 2-by-2 tables, relative risks, attack rates, stratification, and confounding.

Utilisation of tools to facilitate cross-border communication during international food safety events, 1995-2019: a realist synthesis protocol.

INTRODUCTION: Efficient communication and coordination between countries is needed for prevention, detection and response to international food safety events. While communication tools exist, current evidence suggests that they are only effective within certain contexts and only cover certain geographic areas. There is a need to unpack and explore the mechanisms of how and in what context such communication tools and their components are effective at facilitating international communication and coordination to keep food safe and mitigate the burden of foodborne disease around the globe. METHODS AND ANALYSIS: A realist synthesis will be undertaken to understand how and why certain processes and structures of communication tools, used during international food safety events, influence their utility and effectiveness according to different contextual factors. The focus of this review is explanatory and aims to develop and refine theory regarding how contextual factors trigger specific processes and mechanisms to produce outcomes. Using the realist context-mechanism-outcome configuration of theory development, a range of sources have been used to develop the initial programme theory, including the author's experience, a scoping review of published papers and grey literature and input from an expert reference committee. To support, expand or refute the initial theory, data will be synthesised from published literature and input from the expert reference committee. ETHICS AND DISSEMINATION: Ethical approval is not required for this review as it does not involve primary research. However, it will be conducted according to the appropriate ethical standards of accuracy, utility, usefulness, accountability, feasibility and propriety. The RAMESES publication standards will be followed to report the findings of this review. On completion, the final manuscript will be shared with members of the FAO/WHO International Food Safety Authorities Network (INFOSAN) and published in a peer-reviewed journal.

Foodborne disease outbreaks in Barbados (1998-2009): a 12-year review.

INTRODUCTION: Microbes such as Salmonella, Campylobacter and S. aureus have been implicated in Foodborne disease outbreaks (FBDOs) worldwide, yet information on their occurrence in Barbados is scanty. The purpose of this study was to determine the aetiological agents, food vehicles, locations and peak seasons of FBDOs in Barbados; assess the quality of epidemiological investigations; and identify deficiencies in food production practices and laboratory detection. METHODOLOGY: A search of FBDOs occurring in Barbados between 1998-2009 was conducted among published and unpublished literature sources and reports. The search terms included the keywords "foodborne disease," "outbreaks" and "Barbados". RESULTS: During the period 1998 to 2009, there were 24 foodborne outbreaks, 215 cases of illness, one hospitalisation and no deaths. Overall, 37.5% of outbreaks were associated with hotels/resorts. Salmonella Enteritidis phage type 8 was most commonly implicated with eggs and poultry being the primary vehicles. Three outbreak reports were available for assessment and revealed that there were deficiencies in the outbreak investigations. These reports also recorded high levels of food contamination with indicator organisms, suggesting that improvements in food hygiene and production practices were required. CONCLUSIONS: The number of FBDOs is low in comparison to developed countries. However, the data was likely affected by under-reporting and inadequacies in the outbreak investigations and laboratory detection. Improvements in these areas would lead to not only better detection and characterisation of FBDOs in Barbados but improved food safety control measures.

Bacteria and poisonous plants were the primary causative hazards of foodborne disease outbreak: a seven-year survey from Guangxi, South China.

BACKGROUND: Foodborne diseases are a worldwide public health problem. However, data regarding epidemiological characteristics are still lacking in China. We aimed to analyze the characteristics of foodborne diseases outbreak from 2010 to 2016 in Guangxi, South China. METHODS: A foodborne disease outbreak is the occurrence of two or more cases of a similar foodborne disease resulting from the ingestion of a common food. All data are obtained from reports in the Public Health Emergency Report and Management Information System of the China Information System for Disease Control and Prevention, and also from special investigation reports from Guangxi province. RESULTS: A total of 138 foodborne diseases outbreak occurred in Guangxi in the past 7 years, leading to 3348 cases and 46 deaths. Foodborne disease outbreaks mainly occurred in the second and fourth quarters, and schools and private homes were the most common sites. Ingesting toxic food by mistake, improper cooking and cross contamination were the main routes of poisoning which caused 2169 (64.78%) cases and 37 (80.43%) deaths. Bacteria (62 outbreaks, 44.93%) and poisonous plants (46 outbreaks, 33.33%) were the main etiologies of foodborne diseases in our study. In particular, poisonous plants were the main cause of deaths involved in the foodborne disease outbreaks (26 outbreaks, 56.52%). CONCLUSIONS: Bacteria and poisonous plants were the primary causative hazard of foodborne diseases. Some specific measures are needed for ongoing prevention and control against the occurrence of foodborne diseases.

Foodborne Disease Outbreaks in the United States: A Historical Overview.

Understanding the epidemiology of foodborne disease outbreaks (FBDOs) is important for informing investigation, control, and prevention methods. We examined annual summary FBDO data in the United States from 1938 to 2015, to help understand the epidemiology of outbreaks over time. Due to changes in reporting procedures, before 1998, the mean number of annual outbreaks was 378, and after that, it was 1062. A mean of 42% had a known etiology during 1961-1998; since then the etiology has been identified in ∼65%, with a marked increase in the number of norovirus outbreaks. From 1967 to 1997, a mean of 41% of FBDOs occurred in restaurant settings, increasing to 60% in 1998-2015. Concurrently, the proportion of outbreaks occurring at a home decreased from 25% to 8%. The mean size of outbreaks has decreased over time, and the number of multistate outbreaks has increased. Many social, economic, environmental, technological, and regulatory changes have dramatically affected the epidemiology of foodborne disease over time.

O desinfetante hipoclorito de sódio como barreira sanitária: condições de atividade frente a Staphylococcus aureus isolados em alimentos envolvidos em surtos de toxinfecções alimentares / The disinfectant sodium hypochlorite as a sanitary barrier: activity conditions against Staphylococcus aureus isolated from foods implicated in foodborne disease outbreaks

Para monitorar a eficácia do desinfetante hipoclorito de sódio como barreira sanitária, foi avaliada a atividade frente a 32 isolados de Staphylococcus aureus obtidos, no IPB-LACEN/RS, em alimentos envolvidos em surtos de toxinfecções alimentares. Foi usado o teste de suspensão com o seguinte delineamento: solução com 200 ppm de cloro livre na ausência e presença de matéria orgânica (1% de leite integral); solução com100 ppm de cloro livre; quatro tempos de contato (5, 10, 15 e 30 min). Como resultados: com 200 ppm, na ausência de matéria orgânica, todas os isolados foram inativados; com 200 ppm e matéria orgânica, 27 isolados permaneceram viáveis mesmo após 30 min de contato; a solução com 100 ppm necessitou de 30 min para que 24 isolados se apresentassem inativos. Concluiu-se que, para o uso deste desinfetante na proteção da saúde de comensais frente ao gênero bacteriano confrontado, o recomendado é uma solução com pelo menos 200 ppm de cloro livre, tempo de contato não inferior a 30 min e resíduos orgânicos nas superfícies com níveis inferiores a 1%.

Antimicrobial susceptibility of Staphylococcus aureus and Salmonella spp. [] outbreaks in the north-western region of the State of São Paulo, Brazil, during the period from April 1990 to December 2003 / Susceptibilidade antimicrobiana de cepas de Staphylococcus aureus e Salmonella spp. isoladas de alimentos [...] ocorridos na região noroeste do Estado de São Paulo, no período de abril de 1990 a dezembro de 2003

Complete title: Antimicrobial susceptibility of Staphylococcus aureus and Salmonella spp. strains isolated from foods involved in foodborne bacterial disease outbreaks in the north-western region of the State of São Paulo, Brazil, during the period from April 1990 to December 2003Antimicrobial resistance worldwide emerged in the nineties as one of the topics of most concern in public health. On account of this, the objective of this study was to evaluate the antimicrobial susceptibility of Staphylococcus aureus and Salmonella strains, isolated from foods involved in foodborne disease outbreaks (FBDO) in the north - western region of São Paulo State, Brazil, during the period from April 1990 to December 2003. Using agar disk diffusion technique, 25 (67.6%) of 37 S. aureus strains involved in FBDO as from 1992, and 31 (96.9%) of 32 Salmonella strains involved as from 1990 were analysed. Eight (32.0%) of S. aureus strains were sensitive to all of tested antimicrobial compounds, 4 (16.0%) were resistant to one antibiotic agent; 10 (40.0%) to two; two (8.0%) to three, and one (4.0%) to four drugs. The resistance was mostly frequent to penicillin (56.0%), followed by azitromycin and tetracycline (20.0%), oxacillin (16.0%), and chloramphenicol (12.0%). None of 25 tested S. Enteritidis isolates presented resistance, but intermediate resistance to tetracycline was observed in 12 (48.0%)

Título completo: Susceptibilidade antimicrobiana de cepas de Staphylococcus aureus e Salmonella spp. isoladas de alimentos envolvidos em surtos de doenças bacterianas transmitidas por alimentos, ocorridos na região noroeste do Estado de São Paulo, no período de abril de 1990 a dezembro de 2003Na década de 1990, a resistência aos antimicrobianos emergiu em nível mundial como um dos temas de maior interesse em saúde pública. Ciente do fato, este estudo teve como objetivo avaliar a susceptibilidade antimicrobiana de cepas de Staphylococcus aureus e Salmonella spp. isoladas de alimentos incriminados em surtos de doenças de origem alimentar, ocorridos na região noroeste do Estado de São Paulo, no período de abril de 1990 a dezembro de 2003. Foram analisadas, segundo o método de difusão com disco em ágar, 25 (67,6%) das 37 cepas de S. aureus envolvidas nos surtos, a partir de 1992 e 31 (96,9%) das 32 cepas de Salmonella, a partir de 1990. Das cepas de S. aureus, 8 (32,0%) foram sensíveis a todos os antimicrobianos, quatro (16,0%) resistentes a um antimicrobiano; 10 (40,0%) a dois; dois (8,0%) a três e um (4,0%) a quatro. Os maiores percentuais de resistência foram frente à penicilina (56,0%), seguido de azitromicina e tetraciclina (20,0%), oxacilina (16,0%) e cloranfenicol (12,0%). Das cepas de S. Enteritidis, 12 (48,0%) apresentaram perfil de resistência intermediária à tetraciclina

School Food Safety Practices in USA

The Purposes of this article were to review school meal programs and school food safety practices in USA and to draw up improvement plan of school foodservice in Korea. American school meal programs are composed of national school lunch program(NSLP), school breakfast program(SBP), special milk program(SMP) and summer food service program(SFSP). More than 29 million children receive meals daily. School districts and independent schools that choose to take part in the NSLP get cash subsidies and donated commodities from the USDA for each meal they serve. In case of NSLP, around 59% of the participant students are benefited from free or reduced price. According to the U.S. Government Accounting Office, outbreaks of foodborne disease in schools are rare, but appear to be increasing in incidence proportional to overall increases. School outbreaks tends to comprise a greater number of large outbreaks and this shows a similarity with the foodborne disease trend in Korea. School districts, federal agencies, and state and local agencies in USA use or suggest useful food safety practices for school meal programs. They told that four of these practices had the potential to enhance the safety of school meal programs. The four practices are (1) employing key foodservice personnel who are trained and certified in food safety practices, (2) implementing a risk-based approach for safely preparing, storing, and serving foods, (3) purchasing precooked or irradiated meal and poultry products, and (4) applying the more stringent purchasing specifications that USDA uses when purchasing some of the food commodities it donates to schools.