Transcript – CDC Telebriefing: CDC data show progress in reducing some foodborne infections in 2014

Please Note: This transcript is not edited and may contain errors.

OPERATOR: Welcome and thank you for standing by. At this time, all participants are in a listen-only mode until the question and answer session of today’s call. At that time, if you would like to ask a question, you may do so by pressing star one. Today’s conference is also being recorded. If you have any objections, you may disconnect at this time. I now would like to turn the meeting over to Ms. Christine Pearson. You may begin.

CHRISTINE PEARSON: Thank, everyone, for joining us for a telebriefing on a report the CDC is releasing today on incidents and trends in foodborne disease. With us are three primary speakers, Dr. Patricia Griffin, Chief of Enteric Diseases Epidemiology Branch in CDC’s division of foodborne, waterborne and environmental diseases, joined by Kathleen Gensheimer, Director and Chief Medical Officer of FDA’s coordinated outbreak response and evaluation team, and David Goldman, Assistant Administrator of the Department of Agriculture’s Food Safety and Inspection Service. Each will provide brief opening remarks and then we’ll move to questions and answers. When we do do question and answer sessions, we will have one question followed by a follow-up. I will now turn the call over to Dr. Griffin.

PATRICIA GRIFFIN: Well, thank you. It’s good to be here with our colleagues from the food regulatory agencies and thanks to all of you for listening in on this call. CDC monitors human infections at the national level. We estimate that each year, one in six people in the United States gets sick from eating contaminated food. Our ability to systematically track and assess trends in disease is critical for food safety. We use FoodNet, the foodborne diseases active surveillance network, to track nine infections transmitted commonly through food. FoodNet is a powerful collaboration among CDC, ten state health departments, the USDA and FDA. For 20 years, this network has provided timely data to track progress and identify areas of concerns. Within a few months after the close every year, FoodNet reports the frequency of illnesses and how they have changed or not compared with previous years. FoodNet data also provide a strong foundation for estimating the true number of foodborne illnesses, which includes people who didn’t see a health care provider or have a lab test done. And public health officials, regulatory agencies, the food industry and consumer groups use FoodNet data to track progress and to guide prevention efforts. Well, today’s MMWR report summarizes 2014 data. The news is mixed. Some infections declined, but others increased and most did not change. Clearly, more work is needed. Targeted prevention efforts and continued close monitoring of foodborne illness is key. Reducing all types of foodborne infections will require a variety of approaches and collaboration among public health regulatory agencies, industry and the public. Food that captures data on 15 percent of the U.S. population, about 48 million people are under the surveillance intensity. And in 2014, FoodNet identified about 19,500 infections, about 4400 hospitalizations, and 71 deaths in the surveillance area. So, here are some of the major findings for 2014. Salmonella, as usual, was the most frequent cause of infection, accounting for 38 percent of infections. Campylobacter was second 33 percent and E. coli caused 6 percent. There are several pieces of good news. The frequency of o157 infections has decreased by more than 30 percent since the 2006/2008 baseline years and it’s also lower than in the previous three years. Another piece of good news is that the frequency of infection with the second most common type of salmonella, called Typhimurium, has been decreasing, it was lower in 2014 than in 2006/08 baseline years and also lower than in the previous three years, 2011 to 2013. But as I indicated before, the news isn’t all good. Overall, the frequency of salmonella infection has remain unchanged for a long time, and in 2014, the frequency of some types of salmonella increased. Moreover, the frequency of campylobacter infections in 2014 was higher in the ’06 ’08 baseline years, continuing a pattern that we saw in 2013. And frequency of other infections’ track has not changed. I think it’s worth thinking about the implications of the good news that E. coli o157 and salmonella Typhimurium infections have decreased. The most obvious implications is that fewer people are getting sick with these organisms. Another important implication is success in reducing foodborne ill as soon as possible. For E. coli o157, success was achieved mainly because USDA and industry implemented intervention to decrease contamination of ground beef. Similarly, to reduce the incidence of salmonella infections, we will need targeted interventions aimed at types of salmonella that are increasing or staying level. The particular interventions that work for each type of salmonella may vary. Now, you may be wondering why salmonella serotype Typhimurium infections decreased. The reasons aren’t clear, people get Typhimurium infections from a wide type of foods, including beef and poultry. The levels declined we are seeing something bigger and more systematic than simply a change in consumers’ behavior. Regulatory agencies and industry have both implemented many measures to improve the safety of meat and poultry and the data indicate contamination of whole chickens with this type of salmonella has decreased. We eat a lot of chicken, so that could have contributed to the decrease in infections. I also want to point out that getting the bacteria that makes people sick and testing them is an important part of this work. For example, health departments test salmonella from sick people to determine what type, for example, Typhimurium, of salmonella they have. That’s needed for FoodNet surveillance and also for detecting outbreaks. Outbreaks are the major way we learn what foods are making people sick. CDC and health departments have begun to analyze bacteria with an exciting new fingerprinting method called whole genome sequencing. In the past year, we have used this technique to detect and solve more listeria outbreaks than in the past and we are now starting to use this method for salmonella. So, I would summarize by saying that the 2014 data shows some clear successes and some major challenges. We think that we will need targeted interventions to decrease salmonella illnesses, we are excited about the opportunity the whole genome sequencing is providing to help us better figure out the sources of people’s illnesses and FoodNet will continue to track illnesses so we can measure trends in foodborne infections, to track whether prevention measures are working. Now I would like to introduce Dr. David Goldman, Assistant Administrator for the Office of Public Health Science in USDA’s food safety and inspection service. Dr. Goldman?

DAVID GOLDMAN: Thank you, Dr. Griffin. And thanks for those who have joined us on the phone. I need to start also by thanking CDC for its leadership of the FoodNet program since its inception and in particular the hard work of the ten FoodNet sites, the sites in the ten states that gather the information that we are reviewing today. As most of you know, USDA’s FSIS has been an active partner in FoodNet since its inception and look forward to many more years of collaboration. This year’s FoodNet report shows a significant decline in the incidence of shiga toxin producing E. coli o157, as we just pointed out. FSIS is confident with that this reduction consistent with our own science-based approach to beef inspection as well as to the many changes in regulatory oversight of this industry that has occurred over recent years. I want to mention also that accompanying this is another action that we hope will prevent hundreds of E.coli-related illnesses every year. Today, FSIS published a final rule that requires clear labeling of mechanically tenderized beef products and that this product must display detailed cooking instructions on how to safely prepare these products. In addition, FSIS has established several years ago a strategic performance working group to perform reviews and develop ideas within the agency to improve overall performance and a recent undertaking in the last year has been a group focused on controlling s tech illnesses through enhancements of our inspection of sanitary dressing procedures performed by the industry. In addition, this year, FoodNet report shows a reduction in salmonella Typhimurium, reduction of 27 percent compared to data of 2011 through 2013. In January, FSIS produced new pathogen production reduction standards for salmonella and campylobacter in chicken parts and comminuted chicken and comminuted turkey. We estimate that within two years, these standards should help to prevent an estimated 50,000 cases of salmonella in campylobacter annually. As we look forward — look toward the future, FSIS will continue to use a science-based approach to inspections, science is rooted in the work of researchers, our collaborators in ARS and academic researchers as well as public health experts, both within the government and outside of government. By doing so, we are confident that we will continue to see declines in illnesses caused by bacterial sources. Thank you. I will turn it back to Dr. Griffin.

CHRISTINE PEARSON: This is Christine at CDC. We’ll now turn the call over to Dr. Kathleen Gensheimer, Director and Chief Medical Officer — Director and Chief Medical Officer of the FDA’s coordinated outbreak response and evaluation team. Dr. Gensheimer?

KATHLEEN GENSHEIMER: Yes, good morning to all of you and I’m going to extend my thanks as well to CDC and to the FoodNet sites whose work is absolutely critical to our endeavors at the national level, federal level to better understand the whole climate out there as far as food safety which was so well described by Dr. Griffin. I’m certainly pleased to be here with my close colleagues in the battle against foodborne illness from CDC and USDA’s Food Safety and Inspection Service. As you can all imagine, no one agency or organization can operate in a vacuum on their own in order to deal effectively with any public health issue, including food safety and hence, it is this continued integration of the operations at FDA, CDC, USDA and our partners at the state and local level that are so critical and essential in establishing our firm food safety investigative efforts that are so critical to ongoing monitoring and responding to food safety events. We are always encouraged by improvements in these trends, yet the data always reminds us as the job is not done, as was pointed out by Dr. Griffin. Those of us working in regulatory and public health careers always looking toward the constant improvement of our endeavors and programs like FoodNet help direct our energies and resources. Under FISMA, we will always want to respond quickly to foodborne illnesses, but our true goal is to move forward with preventive measures implemented from the farm to the consumer for a – – to approve. In the past, FDA has addressed specific food such as seafood and juice through the mandatory hazard analysis and critical control programs, or HACCP, as it’s been termed. However, the food safety modernization act addresses prevention, which is so critical here, of foodborne illness across the board. Even foods not previously implicated in outbreaks need to be covered, because we never know when that first outbreak will happen, nor do we always appreciate or understand what the next microbial niche will be in our food safety supply. The recent outbreak of listeria metacyclogenesis attributed to caramel apples that we all saw across the media and affecting several individuals nationwide last fall and into the winter, are certainly a good example of a new, emerging entity. In order to implement FISMA, FDA is on schedule to issue final rules beginning in the late summer of 2015. Among the areas covered in the final rules to be issued are product safety, preventative controls for food, producing facilities and the safety of imported food. Once implemented, we will continue to use FoodNet as a tool by which we can evaluate the effect of each rule. In addition to the final rules a number of enforcement tools, such as the authority for mandatory recall are already in effect. Other activities, such as the continued inspections under the authority of the shell egg safety rule are another testament to our commitment to prevention. Today, virtually all eggs are produced under FDA’s rule, which was issued in 2009 and implemented in full in 2012 to prevent contamination of eggs with salmonella enteritidis. The rule requires preventive measures during the production of eggs in poultry houses and requires refrigeration during storage and transportation. Since the implementation of the inspections, about 1200 inspections have been conducted. With the shell egg rule in place, we hope to avoid outbreaks such as the one in 2010, – -. The same effort is needed, the data released today gives us encouragement and yet still tell us that the road is long. Our preventive strategy is strategy that is being executed by teams that encompasses the local, state and federal levels, the key to reaching the goal at the end of the road. We will continue to strive for constant improvement and continue to use FoodNet as a guide on this journey. FDA is committed to promoting its public health mission with a scientific approach and working together with our partnerships and our partners to achieve preventive modes and safety efforts. Thank you.

CHRISTINE PEARSON: Thank you so much. We would now like to open the floor to questions. Simone, could you remind everyone how to ask a question?

OPERATOR: Certainly. At this time, if you would like to ask a question, you may do so by pressing star 1. Please wait for the prompt and record your first and last name along with your media affiliation, as your name is required to introduce the question. To withdraw your question, simply press star 2. If you would like to ask a question, you may do so at this time by pressing star 1. Our first question comes from Mike Stobbe. You may ask your question, sir with the Associated Press.

MIKE STOBBE: Hi, that you for taking the question. Regarding the decline in s tech, could you say a little bit more about the — y’all talked about the beef industry. Could you say a little bit more about the produce industry? It’s mentioned that, you know, the 2006 spinach outbreak and changes were — what changes specifically or what regulatory changes might have contributed to this decline in s tech?

CHRISTINE PEARSON: Dr. Gensheimer, would you like to address that? Dr. Gensheimer?

PATRICIA GRIFFIN: This is Patricia Griffin. I will just step in while we are waiting for Dr. Gensheimer. And I will say that I know that the 2006 — of an outbreak from spinach was a wakeup call — of leafy greens, who package leafy greens in bags and many of them looked at that outbreak and the sources of it and decided they didn’t want anything like that to happen with any of their products. And we have talked with lettuce growers and know that many of them have looked at what can be done better in their operations and have implemented changes. And we know that from talking to the industry, although I’m sure that FDA would know more about the industry than CDC does.

KATHLEEN GENSHEIMER: Yeah, and thanks, Dr. Griffin, sorry, we didn’t get the phone off mute fast enough. But there have been significant efforts by both FDA and other industries to put in place guidance and standards to help prevent future foodborne illnesses, for not only s tech but also, of course, salmonella. Examples include the commodity specific guidance issued by the FDA for leafy greens, melons and tomatoes as well as the industry of efforts in both California and the Arizona leafy green marketing, the Florida tomato good agricultural practices, and tomato best management practices. Also, the North American Tomato Trade Work Group and United Fresh Produce Association developed guidelines for the fresh tomato supply chains. Clearly, our partnerships within the industry are critical to these endeavors.

MIKE STOBBE: This has been voluntary efforts by the produce industry?

KATHLEEN GENSHEIMER: Yes, this has been voluntary.

MIKE STOBBE: Okay. And when we talk about the decrease in s tech, the rate, it went from a little above 1 for 100,000 to a little below 1 per 100,000, that’s the 30 percent, 20 percent decrease we are talking about, is that correct?

PATRICIA GRIFFIN: So, um, the rate of E. coli o157 infections declined pretty impressively in recent years. It does go up and down over time. But it’s been tracking down in the past few years and so its good progress.

CHRISTINE PEARSON: Next question, please.

OPERATOR: Our next question comes from Leonard Bernstein with the Washington post.

LEONARD BERNSTEIN: caller: Thanks for taking my question.  Just a quick data question, since this covers 48 million people, is it safe to say — to multiply this by six or so, if you wanted to apply it to the whole country? How would we do that?

PATRICIA GRIFFIN: So, we don’t multiply it by six to apply to the whole country. I guess you could do that as sort of a poor man’s estimate, but the sites were not chosen to be representative of the country and if different sites were chosen, we might have slightly different rates. And what’s most important is that we are measuring in the same surveillance area year after year after year so that we can see whether there are changes. The exact rates could be slightly different if we had measured in a different place, which is why we don’t simply multiply out. Many of the aspects of the population under surveillance are very similar to the U.S. population.

LEONARD BERNSTEIN: It’s roughly representative of the whole population?

PATRICIA GRIFFIN: It’s roughly representative.

LEONARD BERNSTEIN: Great. Thank you very much.

CHRISTINE PEARSON: Just for clarification, that was Dr. Griffin speaking. Next question, please.

OPERATOR: Just a reminder, if would you like to ask a question, you may do so at this time. Please record your first and last name along with your media affiliation by pressing star one. Please wait for the prompt. Our next question comes from Lisa Schnirring with CIDRAP News. Lisa, your line is open.

LISA SCHNIRRING: Hi, thanks so much for explaining everything that’s in the report. It’s really interesting reading. One thing that caught my eye was the rise in the different salmonella subtypes, like the Javiana. I just wonder if you think that’s just a kind of general expansion of that type of salmonella or other ones, too, that you mentioned or are there specific foods? Just wondering what your take is on that. Thanks so much.

PATRICIA GRIFFIN: Hi. This is Dr. Griffin talking. I think you’re right to point out the different serotypes and it’s very interesting to look at trends in different serotypes and they do differ in what — where their reservoirs are and how they are behaving. So, for example, Typhimurium is in many of our food-producing animals. Javiana, for example, which is one of the ones that’s been increasing, has been — the illnesses due to Javiana typically have been concentrated in the southeastern United States. What we have seen over the past several years is that they have moved out into more of the southeastern states and are even moving geographically more and more beyond the southeast. That’s very different pattern from Typhimurium which we see very much scattered across the United States. So there are really quite differences among the serotypes and looking at them separately we think is the way to address prevention.

CHRISTINE PEARSON: Next question, please.

OPERATOR: Our next question comes from Steven Reinberg with health bay.  Steven, your line is open.

STEVEN REINBERG: Yeah, I was wondering what’s the trend been with listeria?

PATRICIA GRIFFIN: So, this is Patricia Griffin from CDC. We haven’t seen a change in listeria infections compared with our baseline years, which are now 2006, 2008. If you look back over the long term, back from when FoodNet started 20 years ago, there was a — there’s been a remarkable decrease in listeria infections. It has leveled off in recent years, but that doesn’t take away from the fact that there had been a marked decline in listeria infections and that decline in listeria infections paralleled a decline in the contamination with listeria of processed meat products. And in fact, you may remember that there used to be a lot of big, deadly listeria outbreaks from processed meats, including deli turkey meat and hot dogs and we see very few of these kinds of listeria outbreaks now. We are seeing outbreaks more from dairy products and from produce, indicating that those are vehicles where we need new control measures and you have heard from FDA about the planned new control measures in those areas.

CHRISTINE PEARSON: Next question, please.

OPERATOR: Our final question comes from Lynne Terry with Oregonian. Lynne, your line is open.

LYNNE TERRY: Thank you. Thanks for talking my call. I wanted to ask Dr. Goldman something that he said that sort of surprised me. You said within two years that the standards, the part standards would prevent 15,000 illnesses. About a month ago, in an interview, al monza said 2020 is your goal. So, I’m just kind of curious, within a month what made you revise that down? Hello?

DAVID GOLDMAN: Yeah, this is David Goldman. Thank you for the question.  The — when we set out and proposed the performance standards for chicken parts and comminuted turkey and chicken, we estimated based on the risk assessment model that was used that within two years of full compliance by the industry, we would reduce illnesses on an annual basis by 50,000. That’s different that the targets that we have set for reductions of overall salmonella-related illnesses to — for healthy people 2020. We use healthy people 2020 in that risk assessment process, but I just wanted to explain the difference in the numbers.

LYNNE TERRY: Um, okay, thank you. Something Dr. Griffin said about Typhimurium that — on whole carcasses, tetra type, there’s less pure positives, I should say for Typhimurium, I wasn’t aware that FSIS was subtyping but apparently, FSIS is, so, Dr. Goldman, could you talk to me — talk to us or tell us about other subtypes and in particular, could you address Heidelberg, which isn’t a discussion in the report at all. In terms of poultry, what are you seeing in terms of the types? What’s going up? What’s going down? Thank you.

DAVID GOLDMAN: This is David Goldman again. Thank you for the question. I don’t have the serotype report with me here. I will tell that you we have updated the serotype report and we’ve been doing serotyping of salmonella isolates for many years and putting out a periodic report. It is undergoing its final clearance here and so what you will see in the near future will be the 2013 data, so, I don’t — again, I didn’t have that in front of me here, but we do track the serotypes that we find and we report out on the top, I think the top 20 or so that we find and the products that we regulate across all the commodities, not just poultry, so you will see this in the near future.

LYNNE TERRY: What about Heidelberg though?  The report — sorry to ask another question, but the report doesn’t address Heidelberg. I’m wondering, you know, why not and where does that stand, ’cause it’s a pretty, you know, can be a pretty very virulent strain.

PATRICIA GRIFFIN: Okay. This is Patricia Griffin. You were asking about the report and why it didn’t address Heidelberg?

LYNNE TERRY: Yeah, just wondering what, you know, what can you tell us about Heidelberg and where it stands in illnesses.

PATRICIA GRIFFIN: Sure, I would be glad to tell you that. So Heidelberg is our seventh most common salmonella serotype, which means is not very common, not nearly as common, for example, Enteritidis or Typhimurium or Newport. We have not seen a significant change in Heidelberg infections compared with our baseline 2006, 2008 period or compared with the previous three years before this report. And that’s why we didn’t mention it in the report because we haven’t seen a change. We only talked about the salmonella serotypes and the top ten for which there had been a change, but if you look way back in time to when FoodNet started 20 years ago, we have seen a 43 percent decline in Heidelberg infections. So, very interesting situation. You know that Heidelberg is quite tied to poultry products, that is not the only place it’s found, but it is quite tied to poultry products. You’ve heard that resistance in Heidelberg is a problem and it’s been increasing. You’ve heard that people with Heidelberg can get more severe infections, but at the same time as all those concerns, Heidelberg infections have been decreasing.  Not in recent years, but over the long run, they have been decreasing.

LYNNE TERRY: Are you all discouraged by these figures? When you look at the chart, campylobacter and salmonella have pretty much flat lined. It doesn’t look like a big success story. I know you’re o157, that’s different story, but in terms of the salmonella and campylobacter, they are just not budging.

PATRICIA GRIFFIN: So, to say salmonella is not budging, you have to look within it, and there’s a lot of movement within salmonella. And we are looking at that with the regulatory agencies very carefully. Campylobacter has been continuing to increase and we are concerned about both salmonella and campylobacter and that’s why we are so excited about the new FSIS regulations focusing on poultry parts and the new FDA regulations that will come in this fall.

CHRISTINE PEARSON: Simone, next question, please.

OPERATOR: There are no questions in queue at this time, ma’am.

CHRISTINE PEARSON: Okay. Let’s give people another minute, if they need to queue up again. Are you showing any additional?

OPERATOR: There are no questions in queue still at this time, ma’am.

CHRISTINE PEARSON: Okay. Great, then we will turn it over to Dr. Griffin for closing remarks.

PATRICIA GRIFFIN: So, thanks for your great questions and for your interest in foodborne illnesses. Reducing those illnesses requires systematic targeted changes that makes food safer before it reaches consumers. At the end of the day, those changes should mean fewer people getting sick. CDC FoodNet continues to prove itself as a trusted and essential resource for decision making about diseases transmitted commonly by food and the progress report that we were discussing today points to areas were improvements were needed and reminds us how these diseases affect our health.

CHRISTINE PEARSON: Thank you all for joining us today. We will have a transcript up on the CDC media website, which is www.CDC.gov/media later today. And if you have any additional questions that would you like to ask, you can call the CDC’s main press office at 404-639-3286. Thanks so much. Have a great day.

OPERATOR: This now concludes today’s conference. All lines, please disconnect at this time.

Please Note: This transcript is not edited and may contain errors.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES