Have Foodborne Illness Outbreaks Really Increased?

Last week, it was reported that an infant died from a Listeria infection in an outbreak tied to ready-to-eat-meat products. Meanwhile, recalls continue after an outbreak of Escherichia coli from bagged organic carrots led to 15 hospitalizations and a death.

What seems like a marked rise in reports of foodborne illnesses in recent months may not be an illusion — but experts say the reasons behind a presumed increase may be more related to how we track these outbreaks than the outbreaks themselves.

MedPage Today spoke with food safety experts to find out what’s behind the headlines on contaminated onions, carrots, ground beef, and lunch meat.

More Outbreaks?

According to FDA data, recalls and recalled products have not actually had an unusual uptick this year. The total number of food and cosmetic “recall events” is even down slightly from last year: 465 from 473.

Recalled products by year in this category did increase, but not dramatically — from 1,563 last year to 1,908 this year. In past years, the numbers have been much higher: well over 3,000 products were recalled in both 2015 and 2017.

“I don’t feel like I’m necessarily seeing more recalls … but I will say I think I’m seeing more outbreaks, and the outbreaks are smaller,” Bill Marler, JD, a managing partner of Marler Clark who specializes in foodborne illness cases, told MedPage Today.

For a number of reasons, experts suspect more outbreaks are emerging and being caught before they sicken many people.

Tracking Pathogens

For one, the way foodborne pathogens are tracked has changed. Beginning in the mid-2010s, the use of whole genome sequencing to identify pathogens became more widespread, Sarah Sorscher, JD, MPH, of the Center for Science in the Public Interest in Washington, D.C., told MedPage Today. This has allowed investigators to become more precise in their analysis of bacteria found in sick persons, to share the information, and to link similar molecular fingerprints in disparate geographic areas more quickly.

“Reporters tend to publish stories about food safety outbreaks when they’re affecting multiple states and when they’re deadly, and so really having that information about these solved outbreaks is what generates a lot of these big stories,” Sorscher said.

Marler agreed. “There have been lots of recalls without illnesses, which is kind of what the purpose is, you know? It’s a good thing,” he said. “And then, with some exceptions, I also think whole genome sequencing has been a game changer for being able to isolate that.”

Sorscher said diagnostic tools have also improved, and can test for more than a dozen gastrointestinal illness-causing bacteria at once. “It used to be, you couldn’t diagnose Salmonella without sending off to the lab and waiting for the bacteria to grow on a petri dish and culturing it,” she said. “Now we have culture-independent diagnostic tests, which will tell you rapid-fire.”

COVID-19 and Climate Change

Foodborne illness tracking systems may be ramping back up after a dip in surveillance during the COVID pandemic. “Basically, the people who used the whole genome sequence information to solve the outbreak[s] were all detailed to do COVID work, to solve COVID outbreaks, so that suppressed things,” Sorscher said, adding that we may be seeing a rebound effect from food safety problems left undetected until now.

She also touched on continuing supply chain disruptions and an ongoing labor shortage, especially in food safety inspection. The FDA’s food program, she said, has been “starved” of resources.

Climate change has allowed illnesses from Cyclospora, a parasite, and Vibrio bacteria to spread north, she explained, and aging infrastructure has led to hazardous conditions in some food facilities. In the recent Boar’s Head Listeria outbreak, for example, Listeria contamination stemmed from problems like leaks and condensation. “The company was just sort of putting the patches on and not actually addressing the underlying core issues,” Sorscher said.

Food Safety Policies

The FDA Food Safety Modernization Act (FSMA), passed in 2011 as part of a sweeping effort to focus on prevention of contamination rather than reaction to it, may also have something to do with a jump in reports.

According to Sorscher, the high number of recalls in 2015 and 2017 may reflect contaminated food being caught by new FSMA safety standards. “It’s actually almost a good signal,” she said.

Marler, who said he had worked hard on getting the act passed in 2009-2010, wasn’t so sure. The law, he noted, has been painfully slow in its implementation.

“There’s things that had just taken forever to get finalized, and then there’s some things that haven’t gotten finalized at all, and now, with the new administration coming in, I don’t think anything’s going to get finalized,” said Marler.

Sorscher pointed out that a number of policies to prevent foodborne illnesses are currently in limbo: The U.S. Department of Agriculture (USDA) issued a policy banning Salmonella at high levels in raw breaded stuffed chicken products like chicken cordon bleu, which are particularly prone to undercooking and foodborne pathogens. Salmonella in raw poultry is common, and not currently illegal. In addition, an FDA final rule established better record-keeping for those who process, manufacture, or pack foods — for example, keeping track of lot numbers so contaminated food can be removed more quickly from the market.

However, “the retail industry has come out in force opposed to this rule, because they don’t want to have to upgrade their inventory systems,” Sorscher said, adding that this was also the case for the USDA’s policy on Salmonella. “There are policies being considered that could help really put a dent in some of these numbers, but having a new administration is going to derail a lot of that progress,” she said.

A ‘Sense of Security’

Marler said he suspects some uptick in outbreaks may have to do with overall attitudes toward food safety. He recalled an outbreak from hamburgers sold at Jack in the Box in 1992-1993. For years until the early 2000s, he said, 99% of his work at the law firm was from E. coli linked to hamburgers. Then, he noted, it disappeared, thanks largely to federal interventions.

“I think people have kind of gotten lulled into a false sense of security that they can have their hamburger medium and not risk it,” he said.

“The meat supply is safer, you know, there’s no question about it,” he added. “But it’s not so safe that you could say … ‘hey, I don’t care how I cook my hamburger.'”

In the meantime, physicians have a role to play: diagnosing foodborne illness promptly and treating with the right antibiotic, for instance. “Ordering stool cultures, making sure that people are tested, would be a great way of making sure that outbreaks are discovered quickly and then they’re smaller,” Marler said.