This article originally appeared in the September-October 1997 FDA Consumer.
The version below is from a reprint of the original article and contains revisions made in May 1998.

Focus on Food Safety

Initiative Calls on Government, Industry, Consumers
To Stop Food-Related Illness

Most people don't give much thought to food safety until a food-related illness prompts concern. But the threats are real, numerous and varied, as headlines in recent years have documented: E. coli O157:H7 in meat and apple juice, Salmonella in eggs and on vegetables, Cyclospora on fruit, Cryptosporidium in drinking water, and, most recently, Hepatitis A virus in frozen strawberries.

The U.S. food supply is among the world's safest. But as many as 9,000 Americans--mostly the very young and elderly--die each year, and millions more are sickened, as the result of a food-related illness, according to government estimates.

The Clinton administration has proposed an ambitious, $43-million Food Safety Initiative that, if fully funded by Congress, is designed to reduce the incidence of food-borne illness by strengthening and improving food safety practices and policies. The initiative includes expanded education efforts aimed at consumers, food service workers, and various other segments of the food community; enhanced food safety inspection and monitoring efforts; an increase in research to develop new and more rapid methods to detect food-borne pathogens and to develop preventive techniques; and improved intergovernmental communications and coordination of response to food-borne outbreaks, as well as expansion of the nationwide FoodNet system, which gathers data on the occurrence of food-borne illnesses.

"The Food Safety Initiative is extremely important in reducing food-borne illness in the United States," says Janice Oliver, deputy director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition (CFSAN). "The illnesses and deaths that are occurring [now] are just not acceptable." Joe Madden, Ph.D., CFSAN's strategic manager for microbiology, adds, "We have limited resources but through the Food Safety Initiative, we can identify those foods that cause the most problems. We can direct our resources to focus on those foods from production to processing."

In January 1997, President Clinton announced he would request $43.2 million for the 1998 budget to fund a nationwide plan aimed at improving the safety of the nation's food supply. A 50-page report, "Food Safety From Farm To Table," was prepared at the president's request by the Department of Health and Human Services, the U.S. Department of Agriculture, and the Environmental Protection Agency; released in May, the report outlines recommendations on improving U.S. food safety.

The centerpiece of the inspections segment of the initiative revolves around the HACCP (Hazard Analysis and Critical Control Point) concept, a science-based preventive approach to safe food production. Industry identifies possible points in food production, manufacturing and transportation where contamination could occur, called "critical control points," and then puts control measures in place. FDA's seafood HACCP regulations went into effect in December 1997, and USDA is in the process of implementing HACCP regulations for meat and poultry. FDA will also propose preventive measures, including HACCP, for the manufacture of fruit and vegetable juices, while USDA and FDA jointly will propose HACCP for eggs and egg products.

"HACCP itself varies from plant to plant and product to product," says Karen Carson, food science policy coordinator on CFSAN's executive operations staff. "HACCP causes a company to go in and analyze the system they're using internally. It's preventive in nature. Rather than depending on end-product testing, HACCP controls can help ensure that the end product is safe."

"Food sampling is not the way to make sure food is safe," explains Madden, "because, if a pathogen is statistically present in low numbers, it will be difficult to locate. For example, if you have something present in a 0.1 percent level and you look at 60 samples of a given lot, there's a 94 percent chance of not finding it. Pathogens are not homogeneous throughout a food. They form pockets and are found sporadically."

LeeAnne Jackson, Ph.D., science policy analyst with CFSAN, notes that HACCP puts the responsibility for food safety on the food industry. Although the Food Safety Initiative will add 80 new investigators, fewer than 700 investigators and lab personnel now oversee 53,000 U.S. plants and imported foods.

"Current statistics show that FDA-regulated plants are inspected only once every 10 years, on average, because of the sheer enormity of the job," she explains.

HACCP is a more efficient use of FDA inspection resources, says Carson, "because we can focus on the records the company is keeping on these critical control points."

New Problems Emerge

The impact of food-borne infections can be substantial. Some pathogens give rise to diseases far more serious than the uncomfortable vomiting or diarrhea that accompanies what most people call "food poisoning." Food-borne infections can cause spontaneous abortion, reactive arthritis, Guillain-Barré syndrome (the most common cause of acute paralysis in both children and adults), and HUS (hemolytic uremic syndrome), which can lead to kidney failure and death.

Why has food-borne illness become a significant problem? Reasons identified in the "Food Safety From Farm To Table" report include the emergence of new food-borne pathogens; existing organisms expressing increasing virulence or new ways to evade immune defenses; and the susceptibility of certain people to food-borne infections (such as pregnant women, children, the elderly, people taking antibiotics or antacids, and people with lowered immunity due to HIV/AIDS, medications for cancer treatment, or organ transplants). Solutions include education for consumers and food service/industry workers; enhanced government coordination when food-related illnesses occur; and more research related to pathogens and organisms that threaten food safety.

Currently FDA, the Centers for Disease Control and Prevention, and USDA's Food Safety and Inspection Service support seven FoodNet (Foodborne Disease Activity Surveillance Network) early-warning sites at state health departments to track cases of food-borne infections and determine their sources. The Food Safety Initiative calls for new FoodNet sites, creating a powerful network for detection, response and prevention of food-borne illness. Funding in the new initiative will also allow sites to update technology and build a national "fingerprinting" database of bacterial DNA.

"When you find bacteria such as E. coli O157:H7 in a product linked to a food-borne illness outbreak," explains Oliver, "you will find that each strain has a specific [DNA] 'fingerprint.' So when microorganisms isolated from individuals [associated with an outbreak] who actually became ill are fingerprinted, researchers can match the fingerprint to the source."

For example, such technology would permit rapid recognition that a bacterium cultured from a patient in Washington is indistinguishable from one isolated from another patient in California, suggesting to public health investigators that a product distributed in both states was contaminated with the same organism.

Because some food-borne pathogens are acquiring resistance to antimicrobial agents, making infections hard to treat, the plan calls for increased surveillance and epidemiologic studies to monitor and reduce the incidence of diseases associated with emerging drug-resistant pathogens.

Education for All

Prevention of pathogens in food requires an understanding of how foods become contaminated during production, processing and distribution. Studies show that over half of all consumers eat raw or undercooked eggs, 23 percent eat undercooked hamburger, 17 percent consume raw clams and oysters, and 26 percent do not wash cutting boards after using them for raw meat or poultry. And often, food preparers and handlers at each stage of the "food chain" lack knowledge about risks and safe food-handling practices.

In May 1997, a "memorandum of understanding" was signed forming the public/private Partnership for Food Safety Education. The partnership members include FDA, CDC, USDA, industry, consumer groups, and the U.S. Department of Education. Last September, the partnership launched a nationwide food safety education campaign for the general public. Future activities include development of multilingual programs that promote safe food handling and preparation in the food service industry and address the impact of high turnover of employees. The target audiences for these programs will include teen workers, small businesses, and entrepreneurs.

"In both consumer education and the retail/industry level, we'll need to address a variety of literacy levels and multilingual issues: retail food jobs are often the first jobs filled by new immigrants," says Carole Schiffman, director of CFSAN's consumer education staff. "And retail workers are also consumers. So teaching one group will impact the other in positive ways. To reach all the various groups, we hope to use more of the available new technology, such as the Internet, and e-mail in the future. These can link us easily with food safety educators in all arenas-- consumers, health professionals, and retailers."

Future activities may also include research to develop a visual communication tool conveying food safety principles akin to what the dietary guidelines and Food Guide pyramid do to illustrate nutrition principals.

"Consumers have a lot of control to protect themselves from food-borne illnesses," Schiffman explains. "Make some simple practices habits: Wash your hands before handling food, after using the restroom, or after changing baby diapers. Don't let raw foods such as uncooked meat, poultry, and seafood touch ready-to-eat foods, since bacteria from the uncooked food can be spread."

"Keep hot foods hot and cold foods cold," Oliver adds. "Don't use a cutting board for [raw] chicken and then use the same board for [chopping] salad."

Madden is even more succinct when advising consumers: "Treat all foods as if they are potentially contaminated. Keep them refrigerated, watch for any cross-contamination between raw and cooked products, and cook food thoroughly."

Personal responsibility coupled with common sense and education may go a long way in reducing food-borne illness. The Food Safety Initiative promises concrete action designed to reduce the incidence of food-borne illness in this country. It's an important recognition that people have to eat--but they don't have to get sick or die while doing it.

Audrey Hingley is a writer in Mechanicsville, Va.

(Illustration by Richard Thompson Jr.)

For More Information

USDA's Meat and Poultry Hotline
(1-800) 535-4555

National Food Safety Initiative Website
http://vm.cfsan.fda.gov/~dms/fs-toc.html

FDA's Home Page
http://www.fda.gov/

FDA's Center for Food Safety and Applied Nutrition
Foodborne Illness Information

Publication No. (FDA) 98-2314

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