An Economic Assessment of Food Safety Regulations
Table 1--Cases of illness and death for seven major microbial pathogens
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Table 1--Cases of illness and death for seven major microbial pathogens
Estimated Estimated Estimated Foodborne Foodborne Pathogen and annual
annual share
annual annual
disease/complication cases
deaths foodborne cases deaths
------------Number----------- Percent
-------------Number----------- Bacteria Campylobacter jejuni or coli Campylobacteriosis 2,000,000-10,000,000 200-730 55-70
1,100,000-7,000,000 110-511
Clostridium perfringens C. perfringens intoxications 10,000 100
100 10,000
100 Escherichia coli O157:H7 E. coli O157:H7 disease 10,000-20,000 100-250 80 8,000-16,000 80-200 Hemolytic uremic syndrome 1 400-820
120-291 80 320-656 96-233 Subtotal
N/A 220-541
N/A N/A
176-433 Listeria monocytogenes 2 Listeriosis 1,092-1,860 270-510
85-95 928-1,767 230-485 Complications 26-43 0
22-41 0 Subtotal N/A 270-510
N/A N/A
230-485 Salmonella (non-typhoid) Salmonellosis 800,000-4,000,000 1,000-2,000 87-96 696,000-3,840,000 870-1,920 Staphylococcus aureus S. aureus intoxications 8,900,000 2,670 17
454 Parasite Toxoplasma gondii 3 Toxoplasmosis 435 79 50 217 40 Complications 3,083 0 50 1,541 0 Subtotal 3,162 79 N/A 1,581 40 Total 4 11,700,000-22,900,000 4,500-6,600 N/A 3,300,000-12,300,000 1,900-3,900 Notes: N/A = Not applicable. 1 Kidney failure. 2 Includes only hospitalized patients because of data limitations. 3 Includes only toxoplasmosis cases related to fetuses and newborn children who may become blind or mentally retarded. Some cases do not have noticeable acute illness at birth but develop complications by age 17. Does not include all other cases of toxoplasmosis. Another high-risk group for this parasite is the immunocompromised, such as patients with AIDS. 4 Totals are rounded down to reflect the uncertainty of the estimates. Source: Buzby and Roberts, 1996. 4 Economic Research Service/USDA An Economic Assessment of Food Safety Regulations lobacter jejuni/coli, Staphylococcus aureus, Escherichia coli (E. coli) O157:H7, Clostridium perfringens, Listeria monocytogenes, and Toxoplasma gondii. The table also presents the estimated percent attributable to foodborne sources and the resulting cases of foodborne illness cases and associated deaths. Human illness caused by Salmonella is frequently associated with poultry, beef, and egg consumption (Lin, Roberts, and Madison, 1993). Symptoms generally occur 6-72 hours after eating contaminated food (Benenson, 1990), and can last from days to weeks (although most last only a day or two). Acute symptoms include abdominal pain, nausea, stomachache, vomiting, cold chills, fever, exhaustion, and, in rare cases, bloody stools. Endocarditis (infection of the heart), meningitis (infection of the brain), and pneumonia may follow the acute stage. The pathogen can also cause chronic complications such as rheumatoid syndromes, colitis, and thyroiditis. Death may result from the illness. A new strain,
Salmonella enteritidis, can be passed to eggs before the shell forms if the hen is infected. Raw shell eggs and their products can be contaminated with Salmonella enteritidis. Home-made foods containing raw eggs, such as ice cream, egg nog, mayonnaise, cake frosting, lightly cooked egg dishes, and Caesar salad, are potentially risky. A recent outbreak of Salmonella enteritidis-related illness in the Midwest was traced to ice cream transported in containers that had previously carried unpasteurized liquid eggs. Human illness caused by Campylobacter has been linked to chicken or poultry consumption. Symptoms usually begin 1-10 days after exposure to contaminated food (Benenson, 1990) and can last for days. These symptoms include malaise, diarrhea, vomiting, severe abdominal pain, (occasionally) bloody diarrhea, and fever. Other complications may follow, such as meningi- tis, arthritis, cholecystitis, urinary tract infection, appendi- citis, septicemia, Reiter syndrome, and Guillain-Barré syndrome (GBS) -- a major cause of nontrauma-related paralysis in the United States. A small proportion of patients die. Illness caused by E. coli O157:H7 is less widespread, but has received considerable publicity following a 1993 outbreak in California, Idaho, Nevada, and Washington attributed to undercooked hamburgers in a fast-food restaurant chain, a 1996 outbreak in Japan of unknown origin, and a 1996 outbreak related to unpasteurized apple juice in the Midwest. The pathogen has also been found in raw milk, unpasteurized apple cider, processed sausage, and home-prepared hamburgers. The latter present a particular risk; the bacteria can live on the surface of meat products and are normally destroyed by cooking. However, when meat is ground to make hamburger or sausage the organism can be distributed throughout the product, and the raw meat ground into hamburger can come from many different meat car- casses. (This can increase the probability of contamina- tion.) If the sausage or hamburger is undercooked or eaten rare, the bacteria in the center of the meat might not be killed. It generally takes 3-7 days before symp- toms occur after eating contaminated food. Acute symptoms, lasting 6-8 days, are diarrhea (often bloody), abdominal pain, vomiting, and little or no fever. Chronic consequences include hemolytic uremic syndrome (HUS), which is characterized by kidney failure and strikes mostly children under the age of 5. Some propor- tion of patients will die. Not all segments of the population are equally at risk from microbial foodborne disease. Much of the in- creased risk is from impaired immune systems; organ- isms, which a healthy immune system can fight, may pose a greater risk to some population subgroups than others (table 2). Elderly individuals may undergo a decrease in immune function as they age. The immune system of neonates (newborn children) and young children is not fully developed. Pregnancy puts the fetus at special risk of foodborne illness caused by pathogens such as
Listeria monocytogenes and Toxoplasma gondii; miscarriage, stillbirth, or fetal abnormality may occur. Since, by definition, the immune systems of people with AIDS or infected by the HIV virus are damaged or destroyed, these patients are also at greater risk of foodborne disease. Foodborne illness trends over time are not consistent across pathogens. Some illnesses may be decreasing over time, while others may be increasing. The U.S. population is increasing at a little over 1 percent each year, and part of this growth is attributed to a greater number of children and elderly people, two categories most affected by foodborne illnesses (although the proportion of children as a share of the total population is expected to decline). However, it seems clear that, as
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