Transcript for CDC Telebriefing: Safer Food Saves Lives

OPERATOR: At this time, all parties are on listen-only mode through the question and answer session. At that time, you'll be able to press star one. Today's conference is being recorded and if for any reason you object to that, you may disconnect at this time. I'll hand the conference over to Mr. Tom Skinner. You may begin.

KATHY HARBEN: Thank you Ted and thank you all for joining us today for the release of a new CDC Vital Signs on stopping multistate foodborne outbreaks. We are joined by the director for the Centers of Disease Control and Prevention, Dr. Tom Frieden. Joining us today also is Philip Derfler, Deputy Administrator for the U.S. Department of Agriculture Food Safety and Inspection Service, and Dr. Kathleen Gensheimer, Director and Chief Medical Officer of the Coordinated Outbreak Response and Evaluation (CORE) Network at the Food and Drug Administration. At the end of our speakers' comments, you will be able to pose questions.

TOM FRIEDAN: Thank you very much and thank you for joining us. CDC works 24/7 to keep America safe, healthy and secure. And each Vital Signs we focus on a disease from the front lines of CDC science to tell you what can be done to protect and save more lives.

This month's Vital Signs is about food safety - and I know many of you on the line are wondering about the most recent outbreak to hit the news. This is a cluster of E.coli infections in Washington and Oregon State linked to eating from Chipotle Mexican grill restaurants. We don't have much more to tell you about this outbreak other than it is an example of a multi-state outbreak that we're describing in this particular vital signs. More information will be available day by day with it. We don't yet know the vehicle or what food caused it or what the association is or even whether all of the cases identified there are related to each other.

We do know that Chipotle has closed many of its restaurants until more information is available. There is no reason to believe that this is associated it with prior outbreaks that have affected them but the investigation is really just starting now.

This month's Vital Signs is about foodborne outbreaks that occur when contaminated food is sent to several states and makes people sick from the same particular organism. Not only can foodborne outbreaks make a lot of people sick; they can be hard to uncover and trace back to the source of contamination.

Here are the facts: Every year, around 1 in 6 Americans get sick from eating contaminated food. CDC disease detectives are finding an increasing number of outbreaks that occur in many states at once. On average, we find about two per month­ every year. These multistate foodborne outbreaks can be big and they can be lethal, and are caused by food contaminated on farms or in production facilities, before it gets to a restaurant or home kitchen.

The problem of multistate outbreaks is that you can have many more people sick, in more places because of food production and distribution. Foods today come from lots places and countries, and are usually distributed into more than one state.

I'm delighted to be joined by colleagues from the US Department of Agriculture's Food Safety and Inspection Service, and the Food and Drug Administration as well. We've been working together for many years to prevent and stop foodborne illness. They will be speaking about new rules and regulations to make food safer.

Let's look at what's happening with the diversity of foods in outbreaks: In 2014, our disease detectives - working together; with state and local governments, with the FDA and USDA uncovered a Listeria outbreak linked to caramel apples that made 35 people sick in 12 states. Tragically, seven people died. CDC is now working now with other public health agencies tracking a Salmonella outbreak that has sickened more than 760 people in 36 states. Sadly, so far, four have died. This outbreak, linked to cucumbers imported from Mexico, is one of the largest multistate foodborne outbreaks that CDC has investigated in the past decade.

Investigating these outbreaks often finds problems on the farm or in processing or distribution that lead to contaminated food. We look to the lessons learned from these outbreaks to help strengthen food safety.

For this Vital Signs report, our scientists looked at outbreaks for a five to six year period from 2009 to 2014 120 multi-state foodborne outbreaks. The report focuses on illnesses and deaths linked to them.

While multistate outbreaks account for just 3percent of all foodborne outbreaks, they cause 11percent of illnesses, 34percent of hospitalizations, and 56percent of deaths in foodborne outbreaks. Some of these outbreaks are caused by antibiotic-resistant germs, which increase the risk of hospitalization, a bloodstream infection, or an untreatable infection.

Multistate outbreaks have much more serious health effects than other foodborne outbreaks. It's a little confusing or a puzzle to say why that should be so. The reason we believe is that the germs that cause most of the multistate outbreaks are deadlier. 91 percent of these multistate outbreaks are caused by three bacteria - Salmonella, E. coli, and Listeria.

And the numbers don't tell the whole story. We estimate that for every single case of reported Salmonella infection, there are 29 unreported cases. For every E. coli O157-H7, there 26 unreported cases for every reported case. For Listeria, there are about twice as many total cases reported.

This year, multidrug-resistant Salmonella sickened more than 150 people in an outbreak linked to pork. 24 were hospitalized. In 2013 and 2014, the Salmonella that caused a large outbreak linked to chicken, was resistant to several commonly used antibiotics. 634 people got sick in that outbreak and nearly 40percent hospitalized. The 2016 Budget requests additional funding for CDC to improve the detection and tracking of drug-resistant Salmonella and other antibiotic resistance threats. The proposal would allow CDC to check Salmonella for resistance in nearly every sick person, and to check a larger proportion of other bacterial infections as well.

Finding these outbreaks often depends on DNA fingerprinting of the germ that makes people sick. That's beginning to happen more in public health labs around the country. One reason we are finding more outbreaks is that our laboratory methods for finding them are getting better. Thanks to funding from Congress for the past several years, we've initiated an advanced molecular detection initiative, using whole genome sequencing to find specific infections in fingerprints – working very closely with our partners at the FDA, USDA, and the National Institutes of Health. We are finding more Listeria outbreaks, solving them quicker and getting contaminated food off the shelf faster. In fact, this has been a way of not just stopping outbreaks but preventing them from spreading when they could've spread much more widely.

Many types of food are linked to multistate outbreaks: Leafy greens, fruit, beef, sprouts, chicken, raw scraped ground tuna, dairy products - Sorry to go over all of these at the lunch hour but we look at food safety and there's no reason anyone should have to worry about getting sick from the food that they buy and eat. Some of these outbreaks were in foods that had never been linked to outbreaks - caramel apples as an example. Disease detectives traced the implicated foods, working with the FDA and USDA to their source and were able to find the implicated foods in nearly three-quarters of these outbreaks they are cracking the cases much more frequently than we have been in past years because we have this new fingerprinting DNA tool being used increasingly. Still, too many outbreaks go unsolved. And that's the case because it's often hard to determine quickly what food is linked to an outbreak and where the contamination occurred. People eat lots of different things and don't always remember all the foods they've consumed. That's even harder if the food is imported as an increasing proportion of where are food is.

Most of our foodborne outbreaks happen in small groups of people in one area, such as people who all ate at the same restaurant or community event. We want to prevent those, too. But we are focusing, in this report, on multistate outbreaks today because make so many people seriously sick and appear to account for most of the deaths from foodborne illness.

The food industries play a critical role in improving our food safety that includes everything from the farms to table. Farms, transport, distribution, and processing, and at supermarkets or restaurants. Industry-led best practices have resulted in significant improvements in food safety. Each time there is an outbreak, industry can help investigators trace the contaminated food and quickly notify customers who bought it by using store loyalty card records.

This Vital Signs comes at a time of increasing federal focus on ways to improve food safety and reduce foodborne disease, that includes the new Food Safety Modernization Act, regulations from the FDA, and new USDA standards designed to reduce Salmonella and Campylobacter contamination in chicken and turkey.

Some companies and industry groups are already taking the lead to keep food safe. Walmart has worked with CDC to change its requirements for food suppliers and set new controls from farm to fork to reduce potential contamination. Costco uses its membership card lists to notify customers if a product they bought has been recalled.

And trade groups, such as the Beef Industry Food Safety Council and the California Leafy Green Products Handler Marketing Agreement, are focusing on industry-led best practices.

I'm now delighted to turn this over to Dr. Kathleen Gensheimer, Chief Medical Officer over at the FDA.

KATHLEEN GENSHEIMER: Thanks very much Dr. Friedan. I'm very pleased to be here joining CDC and USDA to discuss how we work together to prevent foodborne disease outbreaks.

The continued collaboration between FDA, CDC, USDA, state and local public health, agriculture, regulatory, environmental and laboratory partners is essential to effectively responding to foodborne outbreaks but, even more importantly as you heard DR. Friedan note, to preventing them in the first place.

Foodborne illness not only impacts the individuals and families affected, it also causes significant disruption and cost on the food system, as well as posing a burden on the healthcare system especially in these multi-state outbreaks.

When there are illnesses are associated with an outbreak, FDA's Coordinated Outbreak Response and Evaluation network (otherwise known as CORE) collaborates with CDC, USDA and our many partners on a 24/7 basis to find the implicated foods, to trace back efforts and get moving from the point of exposure back through the distribution chain to stop further illness by rapidly removing the adulterated products from store shelves and to prevent future outbreaks through educational outreach, policy settings or collaboration with our partners and industry.

The goal of the CORE Network is to build upon the best of what FDA does in incident response, and to both streamline and strengthen FDA's efforts to detect, respond and prevent foodborne outbreaks.

In its four years of existence, CORE, working again with its many partners has investigated more than 120 multi-state outbreaks involving cantaloupe, peanut butter, tuna, cheese, tomatoes, mangoes, papayas, lettuce, sprouts, berries, dietary supplements, infant formula, oysters, salad and the list goes on.

To think about prevention action and think back to the mid, late even early 1990s, we know that Salmonella is associated with shell eggs with a public health concern in this country. We recognized the large outbreak of Salmonella that was reported in 2010.

But today, virtually all eggs are produced under the egg rule which was issued in 2009 and implemented in full in 2012 to prevent the contamination of eggs with Salmonella. Since the implementation of inspections, there have been about 1,200inspections have been conducted and we have not seen another egg-related outbreak. This is a testament to the fact that prevention, working with our partners and industry can and does work.

We have one of the safest food supplies in the world, but more needs to be done and more is being done.

Congress passed the FDA Food Safety Modernization Act (FSMA) in December 2010 which was the biggest overhaul in food safety since FDA was established in 1906.

This sweeping piece of legislation was enacted because of wide-spread concern among legislators, consumers and industry about foodborne illnesses that sickened thousands of individuals each year. Depending on the population affected, high-risk individuals including young children and the elderly suffer serious complications of foodborne disease including hospitalization and death.

Today's Vital Signs highlight new vehicles associated with foodborne illness and we've seen this past year, and is highlighted again by Dr. Friedan whose included caramel apples and ice cream and certainly has highlighted the diversity of challenges within the food system.

Illnesses can arise from any food commodity that's not produced and handled properly, regardless of whether it is produced in the United States or overseas. But, again to emphasize the food safety problems we experience have that one thing in common: they are largely preventable.

Congress passed the Food Safety Modernization Act to enable FDA to focus more on preventing food safety problems rather than relying primarily on reacting to problems after they occur.

Before FSMA, addressing foodborne illness was reactive. People had to get sick, and then we had to identify contributing factors in a facility to take action.

But reacting to problems isn't sufficient in today's food system nor is it the best way to practice public health. FSMA is about incorporating principles based on science-based approach how companies can build into their food systems with controls we know are effective.

FSMA brings prevention to all segments of the farm-to-table chain, from processing plants, to farms, to transportation, and to imports.

That is how we will protect public health, strengthen consumer confidence, and avoid the market disruptions and economic costs of foodborne illness.

The produce-related outbreaks have been one that has consumed much of our attention since CORE was enacted and I would like to just highlight that the produce safety rule will create an entirely new regulatory landscape for the produce industry.

 It will establish for the first time mandatory standards from growing, harvesting, packing and holding produce. It will focus on areas such as agricultural water, biological soil amendments health and hygiene of the farm personnel, animals in the growing area, equipment, tools and building.

We're at a critical junction in our implementation of FSMA. The infrastructure must be built now to support the science-based food figure systems designed to institute new safety controls on the farm. Facilities and countries exporting foods to the United States.

I wanted to thank CDC, USDA and to our many State and local partners for all they have done to contribute to our collaborative efforts to investigate and to respond effectively to the foodborne outbreaks over the last several years.

I look forward to our continued collaboration as we work to create a food safety system focused on prevention. Thank you.

TOM FRIEDAN: We'll now turn over to USDA spokesperson Philip Derfler, Deputy Administrator for the U.S. Department of Agriculture Food Safety and Inspection Service,

PHILIP DERFLER: Thank you Dr. Friedan. I want to thank the Centers for Disease Control and Prevention for publishing this very important Vital Signs report on and I want to thank all everyone who's on the phone for joining the call today.

Outbreak prevention is something that FSIS takes very seriously. We have inspectors in every Federal meat, poultry, and egg and plant every day to ensure that products entering commerce are free of pathogens that can cause illness. Products are not eligible to enter commerce unless our inspectors find that they are safe. To minimize risk to human health from FSIS regulated products, our Agency requires that meat and poultry plants have in place a Hazard Analysis and Critical Control Point (HACCP) plan to prevent or reduce contamination to the extent possible.

This year, FSIS proposed new industry performance standards to reduce Salmonella and Campylobacter in raw chicken parts, we also proposed stricter standards for Salmonella and Campylobacter in ground chicken and ground turkey. These standards should help to reduce the occurrence of future outbreaks from poultry products.

We anticipate finalizing these new standards early next year. We are examining ways to tighten our Salmonella standards for beef and pork to reduce the chance that these products will cause illness. We're confident that industry will strive to meet all of the standards that we are developing.

As is evident in this Vital Signs report, however, foodborne illness outbreaks occur despite our best efforts to prevent them. If meat or poultry is implicated in an outbreak, FSIS will build upon the work done by our important partners, the state and local governments and CDC. The information gathered by the states and the local governments and CDC is critically important to FSIS because if that information suggests that meat or poultry is involved, we will conduct trace back activities to attempt to identify the specific product that is the source of the outbreak.

Our employees work to obtain information about the situation. For example, FSIS investigators visit patients and their families in an effort to gather information from shopper loyalty cards and analyzing unopened packages of product from people's refrigerators. We analyze the product in our laboratories and send expert teams to conduct assessments at plants that produce the implicated product.

To facilitate our trace backs, in the near future we hope to finalize a proposed rule that will require operations that grind beef, including grocery stores, to keep detailed records on the source of the materials they use. These records can provide crucial information in trying to identify the source of a foodborne illness outbreak. If we conclude in consultation with CDC that products we regulate cause the outbreak, we will take appropriate action; including asking a company to recall contaminated products, withdrawing our inspectors from the plant so that it cannot operate until the cause of the problem has been corrected or both.

As we look to the future, FSIS will continue to work with CDC, FDA, the States, and local governments and industry to advance our science-based approach to inspection and illness prevention. Through collaboration, we can reduce the number of multistate outbreaks. Thank you, Dr. Friedan

TOM FRIEDAN: Thank you very much, and before we turn to questions, I'd like to just give you the bottom line here. Americans shouldn't have to worry about getting sick from the food they eat. We have done a lot to improve food safety but we need to do more. There are food processors and producers who've made a big difference and have improved practices made our food safer.

A few additional actions that can be done are things like; keeping records so that tracing food from its source to destination is quicker and more frequently possible; choosing only suppliers that use food safety best practices; using store loyalty cards to help identify what made people sick; sharing proven food safety solutions with others in industry. Food safety is not a competitive sport, food safety is a collaborative sport for players throughout the food industry to work on together and meet or even exceed new food safety regulations and standards. Let's now go to your questions, looking forward to hearing from those on the phone.

MAGGIE FOX: Hi thank you very much I have two very unrelated questions, but can you first of all comment about what Chipotle has done in closing so many of its outlets and is that useful in trying to stop foodborne illness outbreaks (and I have a follow up).

TOM FRIEDAN: I think it's always better to take a broad action then narrow it down as we learn more so I think from what we've understood from the situation so far, they're being very responsible in their actions in response to the cases that have been reported.

MAGGIE FOX: I was struck in the report that how few of the outbreaks are actually multi-state and how few are related to imported foods. Does the fact that food borne illnesses mostly a local event kind of mask the effects of the bigger outbreaks and does it make it harder to determine the range and scope of an outbreak?

TOM FRIEDAN:  One of the things that helped us is the advancing use of networks like wholenet and foodnet which allow us to track what happens with the food supply. It's really quite striking for those of us who worked in public health for a long time to find new vehicles or new foods that can be contaminated with bacteria that we just hadn't seen before. And that's impossible to find because there's increased testing using different genetic methods of identifying the fingerprint of different organisms. So I think the multi-state outbreaks are being identified with increasing numbers because we're looking more but also because there's perhaps has been some consolidation in the food production network and that means if there is a problem, it's frequently disseminated across multiple states. If you look at table three in the report, there's a whole list of outbreaks from imported foods ranging from fruits to fish to nuts and seeds and dairy. So we have seen quite a bit from both imported and domestically produced foods.

MIKE STOBBE: Thank you for taking my call. First, Dr. Friedan if you could just say a little bit more about – you were talking about the fatalities and hospitalizations in these multi-state out breaks. I believe you said the reason we believe the germs that cause multistate outbreaks are deadlier. I guess I wasn't really clear on why these more dangerous germs would be spreading across states more than the not quite as lethal ones. And then I have a second question.

TOM FRIEDAN: So many of the less lethal organisms are often spread by food safety practices in restaurants or in the home and when you have end of the food supply chain contamination, that's more likely to be something like a norovirus or rotor virus which is more common but less deadly in contrast where you have a production that goes through multi-states you may be more likely to have a Listeria or an E.coli which are more deadly or salmonella which can be very widespread and have some fatalities as well. That's why we believe that although these outbreaks accounted for a relatively small proportion of all of the recognized outbreaks, they accounted for more than half of the recognized deaths.

MIKE STOBBE: Thank you. The second question is just kind of playing on something you said before about better detection. You gave a statistic which we've heard before that one in six Americans will get sick from contaminated food. That number is not changing right? The overall foodborne illnesses holding at steady levels… Is what we're seeing with the multistate outbreak because of better detection and coordination of communication that we're seeing what used to be outbreaks in different states now grouped together that maybe weren't grouped together in the past?

TOM FRIEDAN: There were a few different trends here. One of them is that we're, I believe, getting better at finding outbreaks because we have a larger database, because more samples are being tested, because we're able to trace back to the food item more frequently than we could in the past. Second, there does appear to be some consolidation of supply chains and that means if there is a problem anywhere in that supply chain, it can rapidly become a multistate problem. And then in terms of the overall safety of our food, everything we've seen suggests, that overall, our food is safe. However it could certainly be safer if more industries, more sectors, and more people who are active in food production, distribution and serving, continued to improve their practices and meet or exceed the new food safety regulations and standards.

NADIA KOUNANG: Hi, Thanks so much for taking my call. I wanted ask a question in regards to best industry practices. I'm curious if there are any efforts to kind of target some of these industries or chains that may be repeat offenders in food safety issues. For example, obviously we're talking about the Chipotle outbreak but I think they also had a salmonella outbreak earlier this year with tomatoes. Is there any efforts to investigate perhaps why there may be repeat offenders in terms of where are they supplying their food from or is there any sort of punitive action that can be directed toward repeat offenders?

KATHLEEN GENSHEIMER: This is Dr. Gensheimer withy FDA and a good question. As I noted before, there are many partners that we work with in the conduct of responding and preventing foodborne outbreaks and certainly industry is one of the very critical partners. No one agency, no one organization can really work to really implement a fully full-proof food safety system without pulling in all those partners. And Industry has really come to the table and recognized that need and in fact industry really came together to work with FDA as far as support of the food safety modernization act and adding input on the rules that will be going forward . When it comes specifically to Chipotle, when we became aware of this investigation which was really over the weekend, we had a conversation with corporate management late yesterday afternoon and Chipotle fully understands the significance of the problem, although this investigation, as I'll emphasize again, is still in its early stages. And we do not have yet identified any specific true vehicle associated with illness. But never the less, Chipotle is sharing all of their records with us, working with us in any way possible to give us information about their suppliers and at the end of that call yesterday, we did confer the fact that we have seen them associated with some of the clusters this past year and once the smoke dies down a bit from this current ongoing investigation, Chipotle has indicated interest in coming to FDA to meet with us to discuss what practices might be contributing to these investigations and in these instances, we do invite CDC to these discussions which we have actually done with other industrial partners in the past and have been very successful with those conversations.

KATHY HARBEN: Will our Operator check for more questions please?

TOM FRIEDAN: Looks like we may be through with the key questions for now, I'd just like to first thank the FDA, the USDA, this is truly a whole of government approach, we meet regularly to review all potential outbreaks and each of our entities brings something to the table that the others don't and we're able to do things together that none of our entities are able to do on their own. So it really is a partnership among us and with industry to improve food safety for Americans so Americans don't have to worry about getting sick from the foods they eat and so that we do make more progress preventing food contamination and see a larger number of food producers and processors keeping records, using safety best practices, tracking food supplies so that we can quickly find and stop an outbreak if it does occur, and sharing proven solutions so that we can continuously make our food safer. I'd like to thank you all and also thank the staff at CDC, the scientists who worked hard on this report, the colleagues at USA and FDA. Thank you very much.

KATHY HARBEN: This concludes our telebriefing. Thank you for joining us today. A transcript of this call will be posted in a few hours to the CDC Media Relations homepage. If you need additional information or have questions please call the CDC press office at 404-639-3286. Thank you.

OPERATOR: You may disconnect at this time.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES