Emerging Foodborne Diseases

Emerging and reemerging infections have been defined as new, recurring, or drug-resistant infections whose incidence in humans has increased in the past two decades, or whose incidence threatens to increase in the near future (22). This subject has been reviewed by Altekrusse (23). A committee of the Institute of Medicine recognized as early as 1992 the microbial threats to health in the United States of emerging infections and made recommendations (22). A number of factors contribute to the emergence of foodborne diseases (24).

A growing segment of the population is immunocompromised because of advancing age, chronic diseases, or infection with human immunodeficiency virus (HIV). Advances in medical sciences have extended life expectancies of persons with chronic diseases such as cancer, thus increasing their susceptibility to foodborne diseases.

Changes have occurred in industry, technology, agriculture, and lifestyles. There has been an increase in the consumption of fruits and vegetables. Produce is susceptible to microbial contamination during growth, harvest, and distribution. There has also been an increase in the demand for fresh-cut produce. The larger surface area makes this type of product more susceptible to contamination. Outbreaks have been associated with alfalfa sprouts, unpasteurized cider, fresh-squeezed orange juice, and frozen strawberries. Consumers have increased their spending on foods eaten away from home. Food service is a growing market. Improper cooking of items such as hamburgers, holding foods at improper temperatures, and cross-contamination are some of the causes of outbreaks. Extensive use of antibiotics has led to the emergence of multi-drug-resistant Salmonella typhomurium (DT) 104. Bovine spongiform encephalopathy (BSE) has emerged as an infectious agent, mainly in the form of adult dairy cattle in the United Kingdom. There is evidence that this prion-derived disease was a result of feeding cattle meat and bonemeal derived from dead ruminants such as sheep and slaughterhouse products infected with scrapie as a protein supplement. The problem was compounded by reduction of temperature used in heat treatment, and elimination of solvent extraction of animal tissue during meat and bone-meal processing led to a failure to inactivate BSE prion and thus allowed its contraction into the cattle population (24).

Allergenic mites are emerging as a food safety issue. Four species of food-contaminating mites have been reported to have caused allergenic reactions, including anaphylaxis in persons who consumed mite-contaminated foods. The mite species are the American house dust mite Dermatophagoides farinae Hughes (Acarina: Pyroglyphi-dae), the scaly grain mite Suidasia sp prob. pontifica Oudemans (Acarina: Suidasiidae), an acarid mite Thyreo-phagus entomophagus Portus and Gomez (Ascarina: Acar-idae), and the mold mite fyrophagus putrescentiae (Schrank) (Acarina: Acaridae) (25).

FDA guidance is delineated in Compliance Policy Guide 585.500, Mushrooms, Canned or Dried (Freeze Dried or Dehydrated)—Adulteration Involving Maggots, Mites, Decomposition. These levels are based on the assumption that the contaminants are harmless and unavoidable. The true level of safety to allergenic mites is unknown (25).

Miller mentions a number of pathogens that might potentially emerge, including prior induced variant of Kreutzfeld-Jakob disease, viruses, Citrobacter freundii, the newer genes of Salmonella such as S. enteriditus PT4 and S. typhomurium DT104, and parasites such as Cy-clospora. Miller recommends strategies to anticipate the emerging pathogen challenge. They include intelligence, contingency, and strategic planning. Intelligence consists of gathering information through a global surveillance program. Contingency is rapid resource mobilization and assures that resources are available to quickly characterize the emerging pathogen. Strategic planning requires futuristic thinking to anticipate what may happen, taking into consideration the various factors such as society, economics, and technology.

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