Contributing Factors of Foodborne Illness Outbreaks - National Outbreak Reporting System, United States, 2014-2022.

IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Meghan M Holst, Beth C Wittry, Carolyn Crisp, Jeffrey Torres, D J Irving, David Nicholas
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Although illnesses from outbreaks account for a small portion of all foodborne illnesses, outbreak investigations reveal how these illnesses originate by offering crucial data through epidemiologic, environmental health, and laboratory analyses and aid in outbreak mitigation and prevention.</p><p><strong>Period covered: </strong>2014-2022.</p><p><strong>Description of system: </strong>The Foodborne Disease Outbreak Surveillance System (FDOSS), via the National Outbreak Reporting System (NORS), captures data from foodborne enteric illness outbreak investigations in the United States. Epidemiology or communicable disease control and environmental health programs of state and local health departments collect and voluntarily report the data to NORS, which is managed by CDC. These data include information about cases (e.g., case counts, symptoms, duration of illness, and health care-seeking behaviors), laboratory specimens, settings of exposure, implicated food items, and contributing factors (i.e., how the outbreak occurred). A foodborne illness outbreak is defined as two or more cases of a similar illness associated with a common exposure (e.g., shared food, venue, or experience). Data collected from an outbreak investigation help the investigator identify contributing factors to the outbreak. Contributing factors are food preparation practices, behaviors, and environmental conditions that lead to pathogens getting into food, growing in food, or surviving in food and are grouped into three categories: contamination (when pathogens and other hazards get into food), proliferation (when pathogens that are already present in food grow), and survival (when pathogens survive a process intended to kill or reduce them).</p><p><strong>Results: </strong>A total of 2,677 (40.5%) foodborne illness outbreaks reported during 2014-2022 with information on contributing factors were included in this analysis. Foodborne outbreak periods were categorized into three time frames: 2014-2016 (first), 2017-2019 (second), and 2020-2022 (third). Of the 2,677 outbreaks, 1,142 (42.7%) occurred during the first time frame, 1,130 outbreaks (42.2%) during the second time frame, and 405 outbreaks (15.1%) during the third time frame. The proportion of bacterial outbreaks increased from the first (41.9%) to the third time frame (48.4%), and the proportion of viral outbreaks decreased (33.3% to 23.2%). Over the three time frames, the proportion of outbreaks with a contamination contributing factor decreased (85.6%, 83.6%, and 81.0%, respectively). The proportion of outbreaks with a proliferation contributing factor category decreased from the first (40.3%) to the second time frame (35.0%), then increased during the third time frame (35.1%), and the proportion of outbreaks with a survival contributing factor category decreased from the first (25.7%) to the second time frame (21.9%), then increased during the third time frame (25.7%). The proportion of outbreaks with aquatic animals as an implicated food item increased from the first (12.0%) to the second time frame (18.5%), then decreased during the third time frame (18.3%). The proportion of outbreaks with land animals as an implicated food item decreased from the first (16.7%) to the second time frame (14.2%), then increased during the third time frame (15.1%).For outbreaks with a contamination contributing factor, the proportion of food contaminated by an animal or environmental source before arriving at the point of final preparation increased over the three time frames (22.2%, 27.7%, and 32.3%, respectively), and the proportion of outbreaks with contamination from an infectious food worker through barehand contact with food decreased (20.5%, 15.2%, and 8.9%, respectively). For the proliferation category, the proportions of outbreaks associated with allowing foods to remain out of temperature control for a prolonged period during preparation and during food service or display decreased over the three time frames (15.2%, 12.2%, and 9.9%, respectively; and 13.6%, 10.4%, and 8.9%, respectively), and the proportion of improper cooling of food decreased from the first (9.4%) to the second time frame (8.8%), then increased during the third time frame (10.9%). For the survival category, the proportion of outbreaks associated with inadequate time and temperature control during initial cooking/thermal processing of food decreased from the first (12.1%) to the second time frame (9.6%) and increased during the third time frame (12.1%).For bacterial outbreaks, cross-contamination of foods was among the top five contributing factors during the first (22.0%) and second time frames (20.8%) but not during the third time frame. Inadequate time and temperature control during initial cooking of food was among the top five contributing factors during all three time frames (23.8%, 20.4% and 20.9%, respectively). Improper cooling was not among the top five contributing factors during the first and second time frames but was during the third time frame (17.3%). For viral outbreaks, contamination from an infectious food worker through barehand contact with food was among the most common contributing factors during the first (47.1%) and second time frames (37.7%) and decreased to the third most common contributing factor during the third time frame (28.7%). Contamination from an infectious food worker through gloved-hand contact with food was among the top five contributing factors during the first (32.1%) and second time frame (25.5%) and was the most common contributing factor during the third time frame (42.5%).</p><p><strong>Interpretation: </strong>Many foodborne illness outbreaks occur because of contamination of food by an animal or environmental source before arriving at the point of final preparation. Most viral outbreaks are caused by contamination from ill food workers. The decrease in the proportion of viral outbreaks and the proportion of outbreaks with a contamination contributing factor during 2020-2022 might be attributed to effects from the COVID-19 pandemic. Nonpharmaceutical interventions (e.g., increased glove use, cleaning and disinfection, and closure of restaurant dining areas) implemented during the COVID-19 pandemic likely led to a reduction in norovirus, which is typically spread by infectious food workers. 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引用次数: 0

Abstract

Problem/condition: Approximately 800 foodborne illness outbreaks occur in the United States each year. These outbreaks include approximately 15,000 illnesses, 800 hospitalizations, and 20 deaths. Although illnesses from outbreaks account for a small portion of all foodborne illnesses, outbreak investigations reveal how these illnesses originate by offering crucial data through epidemiologic, environmental health, and laboratory analyses and aid in outbreak mitigation and prevention.

Period covered: 2014-2022.

Description of system: The Foodborne Disease Outbreak Surveillance System (FDOSS), via the National Outbreak Reporting System (NORS), captures data from foodborne enteric illness outbreak investigations in the United States. Epidemiology or communicable disease control and environmental health programs of state and local health departments collect and voluntarily report the data to NORS, which is managed by CDC. These data include information about cases (e.g., case counts, symptoms, duration of illness, and health care-seeking behaviors), laboratory specimens, settings of exposure, implicated food items, and contributing factors (i.e., how the outbreak occurred). A foodborne illness outbreak is defined as two or more cases of a similar illness associated with a common exposure (e.g., shared food, venue, or experience). Data collected from an outbreak investigation help the investigator identify contributing factors to the outbreak. Contributing factors are food preparation practices, behaviors, and environmental conditions that lead to pathogens getting into food, growing in food, or surviving in food and are grouped into three categories: contamination (when pathogens and other hazards get into food), proliferation (when pathogens that are already present in food grow), and survival (when pathogens survive a process intended to kill or reduce them).

Results: A total of 2,677 (40.5%) foodborne illness outbreaks reported during 2014-2022 with information on contributing factors were included in this analysis. Foodborne outbreak periods were categorized into three time frames: 2014-2016 (first), 2017-2019 (second), and 2020-2022 (third). Of the 2,677 outbreaks, 1,142 (42.7%) occurred during the first time frame, 1,130 outbreaks (42.2%) during the second time frame, and 405 outbreaks (15.1%) during the third time frame. The proportion of bacterial outbreaks increased from the first (41.9%) to the third time frame (48.4%), and the proportion of viral outbreaks decreased (33.3% to 23.2%). Over the three time frames, the proportion of outbreaks with a contamination contributing factor decreased (85.6%, 83.6%, and 81.0%, respectively). The proportion of outbreaks with a proliferation contributing factor category decreased from the first (40.3%) to the second time frame (35.0%), then increased during the third time frame (35.1%), and the proportion of outbreaks with a survival contributing factor category decreased from the first (25.7%) to the second time frame (21.9%), then increased during the third time frame (25.7%). The proportion of outbreaks with aquatic animals as an implicated food item increased from the first (12.0%) to the second time frame (18.5%), then decreased during the third time frame (18.3%). The proportion of outbreaks with land animals as an implicated food item decreased from the first (16.7%) to the second time frame (14.2%), then increased during the third time frame (15.1%).For outbreaks with a contamination contributing factor, the proportion of food contaminated by an animal or environmental source before arriving at the point of final preparation increased over the three time frames (22.2%, 27.7%, and 32.3%, respectively), and the proportion of outbreaks with contamination from an infectious food worker through barehand contact with food decreased (20.5%, 15.2%, and 8.9%, respectively). For the proliferation category, the proportions of outbreaks associated with allowing foods to remain out of temperature control for a prolonged period during preparation and during food service or display decreased over the three time frames (15.2%, 12.2%, and 9.9%, respectively; and 13.6%, 10.4%, and 8.9%, respectively), and the proportion of improper cooling of food decreased from the first (9.4%) to the second time frame (8.8%), then increased during the third time frame (10.9%). For the survival category, the proportion of outbreaks associated with inadequate time and temperature control during initial cooking/thermal processing of food decreased from the first (12.1%) to the second time frame (9.6%) and increased during the third time frame (12.1%).For bacterial outbreaks, cross-contamination of foods was among the top five contributing factors during the first (22.0%) and second time frames (20.8%) but not during the third time frame. Inadequate time and temperature control during initial cooking of food was among the top five contributing factors during all three time frames (23.8%, 20.4% and 20.9%, respectively). Improper cooling was not among the top five contributing factors during the first and second time frames but was during the third time frame (17.3%). For viral outbreaks, contamination from an infectious food worker through barehand contact with food was among the most common contributing factors during the first (47.1%) and second time frames (37.7%) and decreased to the third most common contributing factor during the third time frame (28.7%). Contamination from an infectious food worker through gloved-hand contact with food was among the top five contributing factors during the first (32.1%) and second time frame (25.5%) and was the most common contributing factor during the third time frame (42.5%).

Interpretation: Many foodborne illness outbreaks occur because of contamination of food by an animal or environmental source before arriving at the point of final preparation. Most viral outbreaks are caused by contamination from ill food workers. The decrease in the proportion of viral outbreaks and the proportion of outbreaks with a contamination contributing factor during 2020-2022 might be attributed to effects from the COVID-19 pandemic. Nonpharmaceutical interventions (e.g., increased glove use, cleaning and disinfection, and closure of restaurant dining areas) implemented during the COVID-19 pandemic likely led to a reduction in norovirus, which is typically spread by infectious food workers. Two common contributing factors to bacterial outbreaks are allowing foods to remain out of temperature control for a prolonged period and inadequate time and temperature control during cooking. Proper time and temperature controls are needed to effectively eliminate bacterial pathogens from contaminated foods and ensure safe food operations.

Public health action: Retail food establishments can follow science-based food safety guidelines such as the Food and Drug Administration Food Code and Hazard Analysis and Critical Control Points (HACCP) plans. Restaurant managers can mitigate contamination by ill food workers by implementing written policies concerning ill worker management, developing contingency plans for staffing during worker exclusions, and addressing reasons why employees work while sick. Health department staff members who investigate outbreaks and conduct routine inspections can encourage restaurants to follow their HACCP plans and other verified food safety practices, such as cooling, to prevent outbreaks.

食源性疾病暴发的影响因素——国家暴发报告系统,美国,2014-2022。
问题/状况:美国每年大约发生800起食源性疾病暴发。这些疫情包括大约1.5万人患病,800人住院,20人死亡。虽然疫情引起的疾病占所有食源性疾病的一小部分,但疫情调查通过流行病学、环境卫生和实验室分析提供关键数据,揭示了这些疾病的起源,并有助于缓解和预防疫情。涵盖时间:2014-2022年。系统描述:食源性疾病暴发监测系统(FDOSS)通过国家暴发报告系统(NORS)获取美国食源性肠道疾病暴发调查的数据。州和地方卫生部门的流行病学或传染病控制和环境卫生项目收集并自愿向NORS报告数据,NORS由疾病预防控制中心管理。这些数据包括病例信息(如病例数、症状、病程和求医行为)、实验室标本、接触环境、涉及的食品和影响因素(即疫情如何发生)。食源性疾病暴发被定义为与共同暴露(例如,共用食物、场所或经历)相关的两个或两个以上类似疾病病例。从爆发调查中收集的数据有助于调查人员确定导致爆发的因素。致病因素是导致病原体进入食物、在食物中生长或在食物中存活的食物制备方法、行为和环境条件,并分为三类:污染(病原体和其他危害进入食物时)、增殖(已经存在于食物中的病原体生长时)和存活(病原体在旨在杀死或减少它们的过程中存活时)。结果:2014-2022年期间报告的食源性疾病暴发总数为2677例(40.5%),并包含了影响因素信息。食源性暴发期分为三个时间框架:2014-2016年(第一)、2017-2019年(第二)和2020-2022年(第三)。在2,677起疫情中,1,142起(42.7%)发生在第一个时间框架内,1,130起(42.2%)发生在第二个时间框架内,405起(15.1%)发生在第三个时间框架内。细菌暴发的比例从第一个时间段(41.9%)上升到第三个时间段(48.4%),病毒暴发的比例从33.3%下降到23.2%。在三个时间框架内,污染导致的疫情比例分别下降了85.6%、83.6%和81.0%。扩散因子类暴发的比例从第一个时间段(40.3%)下降到第二个时间段(35.0%),然后在第三个时间段(35.1%)上升;生存因子类暴发的比例从第一个时间段(25.7%)下降到第二个时间段(21.9%),然后在第三个时间段(25.7%)上升。以水生动物为受影响食品的暴发比例从第一次(12.0%)增加到第二个时间框架(18.5%),然后在第三个时间框架(18.3%)下降。以陆生动物为受影响食物的暴发比例从第一个时间段(16.7%)下降到第二个时间段(14.2%),然后在第三个时间段增加(15.1%)。对于有污染因素的疫情,在到达最终制备点之前被动物或环境源污染的食品比例在三个时间框架内增加(分别为22.2%、27.7%和32.3%),通过赤手接触食品的传染性食品工人污染的疫情比例减少(分别为20.5%、15.2%和8.9%)。在扩散类别中,与食品在制备和食品服务或展示期间长时间不受温度控制有关的爆发比例在三个时间框架内分别下降了15.2%、12.2%和9.9%;,分别为13.6%、10.4%和8.9%),并且食品冷却不当的比例从第一个时间段(9.4%)下降到第二个时间段(8.8%),然后在第三个时间段(10.9%)上升。就生存类而言,与食品最初烹饪/热加工期间时间和温度控制不当有关的暴发比例从第一个时间段(12.1%)下降到第二个时间段(9.6%),并在第三个时间段(12.1%)增加。对于细菌爆发,食品交叉污染在第一个时间框架(22.0%)和第二个时间框架(20.8%)是前五大促成因素之一,但在第三个时间框架中则不是。在所有三个时间范围内,食物最初烹饪的时间和温度控制不足是前五大影响因素(23.8%,20.8%)。 分别为4%和20.9%)。在第一个和第二个时间框架中,不当冷却并不在前五大影响因素之列,但在第三个时间框架中(17.3%)。对于病毒暴发,在第一个时间框架内(47.1%)和第二个时间框架内(37.7%),传染性食品工人通过赤手接触食物造成的污染是最常见的影响因素之一,在第三个时间框架内下降到第三个最常见的影响因素(28.7%)。在第一个时间段(32.1%)和第二个时间段(25.5%),传染性食品工人通过戴手套接触食物造成的污染是前五大影响因素之一,在第三个时间段(42.5%)是最常见的影响因素。解释:许多食源性疾病暴发是由于食品在到达最后制备点之前被动物或环境源污染而发生的。大多数病毒爆发是由生病的食品工人造成的污染引起的。2020-2022年期间,病毒暴发比例和污染促成因素暴发比例的下降可能归因于COVID-19大流行的影响。在2019冠状病毒病大流行期间实施的非药物干预措施(例如,增加手套使用、清洁和消毒以及关闭餐馆用餐区)可能导致诺如病毒的减少,诺如病毒通常由传染性食品工人传播。导致细菌爆发的两个常见因素是食物长时间不受温度控制,以及烹饪过程中时间和温度控制不充分。需要适当的时间和温度控制,以有效地消除受污染食品中的细菌病原体,确保食品安全运营。公共卫生行动:食品零售企业可以遵循以科学为基础的食品安全指导方针,如食品和药物管理局食品法典和危害分析和关键控制点(HACCP)计划。餐厅经理可以通过实施有关患病工人管理的书面政策,制定工人排除期间的人员配备应急计划,以及解决员工带病工作的原因,来减轻患病食品工人的污染。调查疫情并进行例行检查的卫生部门工作人员可以鼓励餐馆遵循他们的HACCP计划和其他经过验证的食品安全措施,如冷却,以防止疫情爆发。
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来源期刊
Mmwr Surveillance Summaries
Mmwr Surveillance Summaries PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
60.50
自引率
1.20%
发文量
9
期刊介绍: The Morbidity and Mortality Weekly Report (MMWR) Series, produced by the Centers for Disease Control and Prevention (CDC), is commonly referred to as "the voice of CDC." Serving as the primary outlet for timely, reliable, authoritative, accurate, objective, and practical public health information and recommendations, the MMWR is a crucial publication. Its readership primarily includes physicians, nurses, public health practitioners, epidemiologists, scientists, researchers, educators, and laboratorians.
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