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| Addressing
the Problem of Foodborne and Waterborne Diseases |
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Infectious
diseases are a continuing menace to all segments of society, regardless
of age, gender, lifestyle, ethnic background, and socioeconomic status.
They cause suffering and death and impose an enormous financial burden on
society. Because we do not know what new diseases will arise, we must always
be prepared for the unexpected. The Centers for Disease Control and Prevention
(CDC) has recently released a plan, Preventing Emerging Infectious Diseases:
A Strategy for the 21st Century, which describes steps that we can take
to move toward the realization of CDC’s vision of a world in which all people
join in a common effort to address today’s emerging infectious diseases
and prevent those of tomorrow.
The national emerging infectious disease plan targets
specific categories of emerging infectious disease problems and particular
groups of people who are at special risk. The nine target areas are antimicrobial
resistance; foodborne and waterborne diseases; diseases transmitted through
blood transfusions or blood products; chronic diseases caused by infectious
agents; vaccine development and use; diseases of people with impaired
host defenses; diseases of newborns and pregnant women; and diseases of
travelers, immigrants, and refugees. This booklet focuses on foodborne
and waterborne diseases. Public health activities for the nine target
areas are organized under four broad, intersecting goals: surveillance
and response, applied research, infrastructure and training, and prevention
and control.
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The goal of surveillance and response is to detect, investigate, and
monitor emerging pathogens, the diseases they cause, and the factors influencing
their emergence, and to respond to problems as they are identified. For
applied research, the goal is to integrate laboratory science and epidemiology
to better understand and optimize public health practices for the prevention
and control of emerging infectious diseases. The goal of infrastructure
and training is to strengthen the underlying foundation of public health
surveillance, research, and programs by supporting the planning, delivery,
and evaluation of public health activities and practices. Finally, the
goal of prevention and control is to ensure prompt implementation of prevention
and control strategies and enhance communication of public health information
about emerging infections.
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Centers for Disease Control and Prevention Responds |
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The CDC’s National Center
for Infectious Diseases (NCID) has developed specific public health activities
that address the nine target areas. Many of the activities build on existing
efforts or are in the planning stages. Others represent new efforts. These
activities are described in individual booklets for each target area.
Foodborne and waterborne infections are major public health problems.
Each year, millions of people in the United States are infected with foodborne
diseases, and several thousand die. Hospitalization costs for these illnesses
are estimated at over $3 billion a year, and costs from lost productivity
are much higher. Waterborne diseases also contribute significantly to
the U.S. disease burden. Many different pathogens can be foodborne or
waterborne, and more are likely to be discovered. Preventing these diseases
depends on understanding how food or water becomes contaminated and involves
working with many partners to reduce or prevent contamination.
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Foodborne pathogens are numerous and have many ways to enter the food
chain, which makes disease prevention very complex. Some emerging foodborne
pathogens are found in food animals, including cattle, poultry, fish,
and shellfish. Although these animals may appear healthy, the meat, eggs,
milk, or other products derived from them can be contaminated with Escherichia
coli O157:H7, Salmonella, or other pathogens. Fresh produce is an
important component of a healthy diet, but fruits and vegetables can also
be sources of infection if they are contaminated in the field or after
harvest. Moreover, some pathogens are spread from infected people who
contaminate the food while preparing it. Safe food production and preparation
practices applied throughout the food industry can reduce the risk of
contamination. For some food products, further safety may be ensured by
pasteurization, irradiation, or similar processes.
New challenges due to foodborne pathogens are likely to emerge in the
future. Wide commercial distribution of food products means that outbreaks
can affect many people simultaneously over a large geographic area. Pathogens
common in the developing world now cause illness in the United States
because more of our food crosses international borders. In addition, the
frequent use of antibiotics in food animals may select for antibiotic-resistant
bacteria that can be transmitted to humans.
The problems posed by waterborne pathogens are also changing. In the
past, most cases of waterborne diseases were due to bacterial contamination,
which can be prevented by standard water disinfection treatments such
as chlorination. In much of the developing world, however, this level
of protection remains unachievable. In the United States and Europe, pathogens
that are resistant to routine disinfection are now more commonly recognized
as causes of waterborne diseases. These include Norwalk-like viruses and
the parasite Cryptosporidium, which caused the largest single waterborne
disease outbreak in the United States in 1993, affecting more than 400,000
people. Of the waterborne outbreaks reported to CDC during 1993 and 1994,
more than half of those for which an infectious cause could be identified
were due to contamination by chlorine-resistant microbes.
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In partnership with other governmental agencies and
international groups, the CDC is working toward effective global surveillance
and control of foodborne and waterborne pathogens. The CDC is a major
participant in the National Food Safety Initiative (NFSI), which was created
in 1997 to address food safety problems in the United States. Through
the NFSI, the CDC is improving surveillance and response to foodborne
diseases, while the FDA, the USDA, and other agencies are expanding food
safety inspection, research, training, and prevention activities. Similarly,
the CDC is collaborating with the EPA and the drinking water industry
to better estimate the risk of waterborne disease, develop better methods
for detecting new pathogens in drinking water, and identify human and
animal sources of water contamination.
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