In 2011, the centers for Disease Control and Prevention (CDC) released its most comprehensive accounting of the occurrence of food borne illness in the United States, calculating that 48 million people contract food borne illness each year. In short, according to the CDC, one in six of us consume food tainted with Norovirus, Salmonella, E. coli, or a host of other pathogens, known and unknown, every year. These pathogens, when identified and properly diagnosed, send approximately 129,000 victims to the hospital each year and kill 3000 Americans annually. Most cases of food borne illness are not reported and never linked to a particular outbreak, a fact easy to see when comparing the 48 million presumed to be ill from food borne illness every year to the fact that the CDC estimates only one in 30 victims seeks medical attention and many fewer are properly diagnosed with a positive stool test collected). But perhaps more surprisingly, in spite of national and local efforts to reduce food borne illness (including the recent passage of the Food Safety Modernization Act, which President Obama signed into law on Jan. 4, 2011), these rates of infection seem to have hit a plateau in recent years.

The “top pathogen” in terms of disease reporting, is still Salmonella, with nearly one million reported cases annually (according to one study, Salmonella accounts for nearly 34% of reported food borne illnesses). And according to data compiled in the 2012 Foodborne Diseases Active Surveillance Network, its place among food borne pathogens has remained fairly constant in the last decade. The rates of infection for histamine fish poisoning (scombroid toxin), E. coli, Listeria, and Yersinia, while lower than Salmonella, have also remained relatively constant in the last decade. According to FoodNet, in 2012 there were a total of 19,531 confirmed (and reported) food borne illnesses, a total of 4,563 hospitalizations, and 68 deaths just from the nine most common pathogens.

[Notably, Norovirus, which can also be linked to food, is perhaps one of the most underreported pathogens – according to Ruby Roy, MD, a pediatrician in Chicago, children present with Norovirus on a daily basis, but rarely is the source of the virus (e.g. food) a medical concern. But according to the CDC, between 1998 and 2008, Norovirus was responsible for at least 1,419 outbreaks and 41,257 outbreak-associated illnesses. Ironically, however, Norovirus is rarely carried in the food from field to table, but introduced into the food by a sick food handler.]

Chicken and Beef Remain the “High Risk” Meats

According to a recent study by the Center for Science in the Public Interest, chicken and beef remain the “high risk” sources of food borne illness among meats in the U.S. (in outbreaks where the pathogen is traced to production). And this makes sense since chicken is the most commonly consumed poultry and beef the most commonly consumed red meat in the U.S. These two sources of protein in the American diet were linked between 1998 and 2010 to at least 1,714 distinct outbreaks that were responsible for 33,372 cases of food borne illness. And in more recent years, “this trend appears to have remained constant,” says Ron Simon, a food safety lawyer representing victims of one of the longest lasting Salmonella outbreaks linked to poultry in recent years (against Foster Farms, one of the nation’s largest chicken producers). “Unlike some restaurant based outbreaks, such as the large Firefly outbreak in Las Vegas recently, these outbreaks are usually traced back to institutional deficiencies in the production of meat and poultry,” says Simon, pointing to numerous deficiencies found by Food Safety and Inspection Service investigators at facilities linked to the Foster Farms outbreak.

Recent Rises in Campylobacter and Vibrio, as Well as Non-Traditional Pathogens

While most pathogens seem to have hit a plateau, some pathogens seem to be on the rise. Among these there has been a noted 15 % increase in the rate of food borne infections caused by Campylobacter, and a 43 % increase in Vibrio. This comes from a study comparing 2006-2008 to more recent years. Campylobacter is widely disseminated in poultry, produce, raw milk and contaminated water, whereas Vibrio is primarily associated with a single product, raw shellfish. According to Eric Larson, president of Safe Foods International Holdings, these startling increases may simply be a matter of improved diagnosis and better reporting of the diseases. But Ron Simon, who is currently representing victims of Vibrio infections, believes it may also be a matter of increase in imported foods, noting strong increases in some other non-traditional pathogens, such as Hepatitis A and Cyclospora, which have hit American consumers in very recent outbreaks, both taking medical and health experts by surprise. These pathogens came from imported berries from Turkey and imported produce from Mexico.

What is the Role of Imported Foods?

Many of the nation’s food safety advocates concur with Ron Simon, and point to importation while noting lower regulatory requirements governing food production in other nations, especially third-world nations. According to Ron Simon, who has represented thousands of food borne illness victims, a number of recent national outbreaks have been linked to imported tuna, berries, and vegetables – all of which are among the most highly imported food products in the U.S. Dr. Hannah Gould, who is an epidemiologist at the CDC, recently explained that about 16% of food consumed in America is imported, and that this was especially true of fish (84%) and for fruits and nuts (nearly one-third). And in fact, according to the CDC, between 2005 and 2010 at least 39 outbreaks implicated imported foods, and while this may represent a small fraction of the outbreaks, between them there were at least 2348 confirmed illnesses, 434 hospitalizations, and 3 fatalities.

This is a stark increase from earlier reporting periods, says Dr. Gould. “The number of foodborne disease outbreaks related to imported foods is increasing,” she explains, recounting that between 1998 and 2004 there were on average 2.7 outbreaks per year that fit this definition (19 in total), whereas more recently there have been about 6.5 per year (or 39 between 2005 and 2010). And since 2010, this trend seems to be holding with a major outbreak of Hepatitis A (centered in California but affecting at least half the nation) having been linked to imported Turkish pomegranate seeds and sickening at least a few hundred in 2013, and two major outbreaks of the parasite Cyclospora having been traced back to produce imported from Mexico having sickened residents of (mostly) Texas, Nebraska, and Iowa, also in 2013. And now another outbreak of Cyclospora, again centered in Texas, may also implicate produce from Mexico this year.

Food Borne Illness Can Lead to Life-Long Complications

Another major development has been the identification of long-term illness related to food borne illness. According to Robert Brackett, director of the Institute for Food Safety and Health at the Illinois Institute of Technology who addressed an audience at a lecture sponsored by the Chicago Council on Science and Technology and the Institute for Food Safety and Health, “foodborne illness is more than just a stomachache . . . when someone gets a foodborne illness, it sometimes triggers an after effect in the individual. That can cause lifelong chronic disease and inflammatory diseases can be worse and can cost more than the initial illness.” This, says national food safety lawyer Ron Simon, is often missed in the numbers. “What I have seen too often is that consumers initially present with the traditional signs of food poisoning, but in a select few, in the weeks and months to come the symptoms seem to continue, and in many cases worsen. I see cases of Irritable Bowel Disease and Irritable Bowel Syndrome, or other complications, that are triggered by an acute case of food born illness in people who did not have any gastrointestinal issues prior to becoming ill.”

But just as concerning, says Simon, in the increase in antibiotic resistant strains of some of the most common pathogens. Simon notes that a number of the sevens strains of Salmonella Heidelberg linked to Foster Farms chicken are antibiotic resistant and causing extreme and acute cases of illness, with much higher hospitalization rates and a high occurrence of infection of the blood. These cases are quite serious, and can lead to the need for very aggressive medical treatment and significant medical expenses for consumers.