Foodborne Germs and Illnesses

There are many opportunities for food to become contaminated as it is produced and prepared:

• Many foodborne microbes are present in healthy animals (usually in their intestines) that are raised for food. Meat and poultry carcasses can become contaminated during slaughter by contact with small amounts of intestinal contents.
• Similarly, fresh fruits and vegetables can be contaminated if they are washed or irrigated with water that is contaminated with animal manure or human sewage.
• Some types of Salmonella can infect a hen's ovary so that the internal contents of a normal looking egg can be contaminated with Salmonella even before the shell in formed.
• Oysters and other filter feeding shellfish can concentrate Vibrio bacteria that are naturally present in sea water, or other microbes such as norovirus that are present in human sewage dumped into the sea.

Later in food processing, other foodborne microbes can be introduced from infected humans who handle the food, or by cross contamination from some other raw agricultural product:

• For example, Shigella bacteria, hepatitis A virus and norovirus can be introduced by the unwashed hands of food handlers who are themselves infected.
• In the kitchen, microbes can be transferred from one food to another food by using the same knife, cutting board, or other utensil to prepare both, without washing the surface or utensil in between.
• A food that is fully cooked can become recontaminated if it touches other raw foods or drippings from raw foods that contain pathogens.

The way that food is handled after it is contaminated can also make a difference in whether or not an outbreak occurs:

• Many bacterial microbes need to multiply to a larger number before enough are present in food to cause disease. Given warm moist conditions and an ample supply of nutrients, one bacterium that reproduces by dividing itself every half hour can produce 17 million progeny in 12 hours. As a result, lightly contaminated food left out overnight can be highly infectious by the next day.
• If the food were refrigerated promptly, the bacteria would not multiply at all. In general, refrigeration or freezing prevents virtually all bacteria from growing but generally preserves them in a state of suspended animation. This general rule has a few surprising exceptions:
  • Two foodborne bacteria, Listeria monocytogenes and Yersinia enterocolitica can actually grow at refrigerator temperatures.
• High salt, high sugar or high acid levels keep bacteria from growing, which is why salted meats, jam, and pickled vegetables are traditional preserved foods.

Microbes are killed by heat.

• If food is heated to an internal temperature above 160°F, or 78°C, for even a few seconds this sufficient to kill parasites, viruses or bacteria, except for the Clostridium bacteria, which produce a heat-resistant form called a spore.
  • Clostridium spores are killed only at temperatures above boiling. This is why canned foods must be cooked to a high temperature under pressure as part of the canning process.
• The toxins produced by bacteria vary in their sensitivity to heat.
  • The staphylococcal toxin which causes vomiting is not inactivated even if it is boiled. Fortunately, the potent toxin that causes botulism is completely inactivated by boiling.

Routine monitoring of important diseases by public health departments is called disease surveillance. Each state decides which diseases are to be under surveillance in that state.

• In most states, diagnosed cases of salmonellosis, E. coli O157:H7 and other serious infections are routinely reported to the health department.
• The county reports them to the state health department, which reports them to CDC. Tens of thousands of cases of these "notifiable diseases" are reported every year.
• However, most foodborne infections go undiagnosed and unreported, either because the ill person does not see a doctor, or the doctor does not make a specific diagnosis. Also, infections with some microbes, such as norovirus, are not reportable in the first place, unless they are associated with a recognized outbreak.

To get more information about infections that might be diagnosed but not reported, CDC developed a special surveillance system called FoodNet.

• FoodNet is a collaborative program among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA).
• It provides the best available information about specific foodborne infections in the United States, and summarizes them in an annual report.
• FoodNet has conducted active, population-based surveillance for laboratory-confirmed infections caused by Campylobacter, Listeria, Salmonella, STEC O157, Shigella, Vibrio, and Yersinia since 1996; Cryptosporidium and Cyclospora since 1997; and STEC non-O157 since 2000.
• The surveillance area includes 15% of the United States population (49 million persons).

In addition to tracking the number of reported cases of individual infections, states also collect information about foodborne outbreaks, and report a summary of that information to CDC. More than 1,000 foodborne outbreaks investigated by local and state health departments are reported each year. This includes information about many diseases that are not notifiable and thus are not under individual surveillance, so it provides some useful general information about foodborne diseases.

Related Links:

• Surveillance for Foodborne Disease Outbreaks
• Investigating Foodborne Outbreaks
• FoodNet  
• PulseNet
• Council of State and Territorial Epidemiologists (CSTE)

• Raw foods of animal origin are the most likely to be contaminated; that is, raw meat and poultry, raw eggs, unpasteurized milk, and raw shellfish.
• Because filter-feeding shellfish strain microbes from the sea over many months, they are particularly likely to be contaminated if there are any pathogens in the seawater.
• Foods that mingle the products of many individual animals, such as bulk raw milk, pooled raw eggs, or ground beef, are particularly hazardous because a pathogen present in any one of the animals may contaminate the whole batch.
  • A single hamburger may contain meat from hundreds of animals.
  • A single restaurant omelet may contain eggs from hundreds of chickens.
  • A glass of raw milk may contain milk from hundreds of cows.
  • A broiler chicken carcass can be exposed to the drippings and juices of many thousands of other birds that went through the same cold water tank after slaughter.
• Fruits and vegetables consumed raw are a particular concern. Washing can decrease but not eliminate contamination, so the consumers can do little to protect themselves.
  • Recently, a number of outbreaks have been traced to fresh fruits and vegetables that were processed under less than sanitary conditions. These outbreaks show that the quality of the water used for washing and chilling the produce after it is harvested is critical. Using water that is not clean can contaminate many boxes of produce.
  • Fresh manure used to fertilize vegetables can also contaminate them. Alfalfa sprouts and other raw sprouts pose a particular challenge, as the conditions under which they are sprouted are ideal for growing microbes as well as sprouts, and because they are eaten without further cooking. That means that a few bacteria present on the seeds can grow to high numbers of pathogens on the sprouts.
  • Unpasteurized fruit juice can also be contaminated if there are pathogens in or on the fruit that is used to make it.

Learn more about what you can do to prevent foodborne illness.