The U.S. Centers for Disease Control and Prevention (CDC) estimates that each year 76 million people get sick, more than 300,000 are hospitalized, and 5,000 die as a result of foodborne illnesses. Pregnant women, infants, children, the chronically ill, the elderly and the immunocompromised are considered the most vulnerable populations affected. The causes of foodborne illness include viruses, bacteria, parasites, toxins, metals, and prions. The symptoms of foodborne illness range from mild gastroenteritis to life-threatening neurologic, hepatic, and renal syndromes. The estimated cost to the U.S. economy is in the billions of dollars.[1]

The U.S. Food and Drug Administration (FDA) regulates approximately 80% of the U.S. food supply and one of the key issues facing its Center for Food Safety and Applied Nutrition (CFSAN) is finding ways to minimize the incidence of foodborne illness. Adding to the challenge is the fact that demographics, food preferences, methods of food production and distribution systems change over time. At the same time, new strains of foodborne illness have emerged. The approaches to ensuring food safety and prevention of foodborne illnesses are multifaceted and include Good Agricultural Practices (GAPs), Good Manufacturing Practices (GMPs), Hazard Analysis and Critical Control Points (HACCP) procedures and consumer education.

In communities, physicians and other health care professionals are on the front line when it comes to identifying foodborne illness, informing local health authorities about foodborne illness and having an opportunity to educate patients about safe food handling practices. By quickly recognizing and reporting cases of foodborne illness, physicians and other healthcare professionals can play a crucial roll in early identification of possible outbreaks, thus helping to avoid a larger potential public health crisis. The purpose of this article is to discuss FDA’s most recent collaborative effort to educate health care professionals when it comes to properly recognizing and identifying foodborne illnesses.

An Easy-to-Read Primer
Microorganisms are constantly adapting and evolving and pathogens previously familiar to physicians and the public health community have found new ways of transmission. For example, Escherichia coli O157:H7 was originally associated with undercooked ground beef, but has also caused foodborne illness outbreaks associated with a wider range of foods, including unpasteurized apple juice, raw fruits and vegetables (e.g., sprouts), and contaminated water. Recognizing these challenges, in the 1990s the American Medical Assoc-iation’s (AMA) House of Delegates, adopted a resolution to work with key federal agencies and other health professional organizations to educate physicians, the public health community and consumers on the measures to prevent foodborne illnesses. The result was an educational package called Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians, which was published in 2001. Now, three years later, the AMA, the American Nurses Association, FDA, CDC and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA FSIS) have jointly published a new edition called Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians and Other Health Care Professionals.

The easy-to-read primer is intended to help health professionals better understand the pathogens, symptoms, and foods frequently linked to foodborne illness. It provides physicians and other healthcare professionals with current information on the diagnosis, treatment, prevention and reporting of foodborne illnesses. In addition, the primer will help health care professionals recognize that foodborne pathogens could be responsible for a patient’s illness, even when gastrointestinal symptoms are absent. Further, the new primer provides information about obtaining the appropriate tests and cultures to help diagnose cases of foodborne illness quickly and accurately, thereby preventing the spread of these illnesses. The primer also emphasizes the importance of reporting cases of foodborne illnesses to the appropriate public health officials. This is especially important as any patient with a foodborne illness may represent the first case of a more widespread outbreak. In such cases, this information may allow measures to be taken that can mitigate the outbreak and better protect the most vulnerable populations.

To assist health care professionals the primer now includes nine clinical scenarios presented in case study format, which is designed to reinforce medical management information pertaining to the most current and prevalent foodborne pathogens. As well it should elicit key questions to be considered when dealing with a potential case of foodborne illness. Eight different pathogens or conditions are specifically addressed in these booklets: Salmonella, Listeria, congenital toxoplasma, botulism, E. coli O157:H7, Enterotoxogenic E. coli, Hepatitis A, and Norovirus. The ninth booklet, developed in consideration of the post-9/11 environment, emphasizes the importance of physicians and other health professionals being vigilant in their assessments of whether patients with a foodborne illness may have been victims of “intentional contamination” of the food supply. Accordingly, it stresses the importance of physician’s interactions with the public health officials and law enforcement if intentional contamination is suspected. Other educational sections of the primer provide detailed summary tables and charts, references and resources.

Physicians and other health care professionals are not only in a unique position to detect cases of foodborne illness, but also have an opportunity to play an essential role in educating their patients on how to prevent illnesses. To assist them in this endeavor a patient handout detailing the key steps to preventing foodborne illness is included in the primer and can be copied and distributed to patients. The handout, which utilizes materials developed by the Partnership for Food Safety from the “Fight BAC” campaign, promotes the importance of four simple steps to food safety: 1) Clean: Wash hands and surfaces often; 2) Separate: Don’t cross-contaminate; 3) Cook: Cook to proper temperatures; and 4) Chill: Refrigerate promptly. By educating patients about these easy-to-implement, safe food handling practices that can be applied in their own homes, more Americans will be able to greatly reduce the likelihood that they will contract a foodborne illness.

How to Obtain the Primer
In order to facilitate the wide dissemination of the information in the primer it is available in multiple formats in English and Spanish. The primer is online at www.ama-assn.org/go/foodborne, and at www.cdc.gov/mmwr/preview/mmwr html/rr5304a1.htm.

Eileen S. Parish, M.D., is the Medical Advisor for the Food Safety and Security Staff at FDA’s Center for Food Safety and Applied Nutrition. She is board certified in Internal Medicine and has worked at FDA for last 15 years.

Reference
1. Mead, P.S., L. Slutsker, et al. Food-Related Illness and Death in the United States. Emerg. Infect. Dis., 5:607-625. 1999.