The changing epidemiology of foodborne disease in the 1990s: Implications for surveillance, control and prevention

The epidemiology of foodborne disease in the United States (US) has been changing in response to changes in the type and source of foods consumed, new methods of food production and processing, and the emergence of new infectious agents and new trends with known agents transmitted through food. Recent foodborne outbreak investigations conducted in Minnesota have demonstrated the importance of many of these factors. The fact that these outbreaks were recognized in Minnesota, a state with only two percent of the U.S. population suggests that foodborne disease problems are actually much more widespread.; The American diet has changed in response to concerns relating diet to health. The increased demand for fresh fruits and vegetables has increased the potential for exposure to a wide variety of pathogens. Increasingly, we are discovering extensive outbreaks of foodborne disease with long incubation periods, low attack rates and widely dispersed cases that appear to be sporadic infections.; Outbreaks of Salmonella javiana and S. oranienburg associated with cheese, S. javiana associated with tomatoes and S. poona associated with cantaloupes, were only recognized because they were caused by uncommon serovars. An airline-associated outbreak of shigellosis was identified only because of the occurrence of an index outbreak involving a professional football team. Outbreaks of Brainerd diarrhea associated with raw milk, thyrotoxicosis due to consumption of bovine thyroid in hamburger and eosinophilia myalgia syndrome associated with food supplements containing L-tryptophan were not initially suspected because the clinical presentation was not typical of foodborne disease.; The emergence of Escherichia coli O157:H7 as a new foodborne pathogen and the emergence of eggs as an important vehicle for Salmonella enteritidis infection provide additional challenges to public health surveillance of foodborne disease. Developing and maintaining a public health infrastructure capable of conducting surveillance for foodborne disease is a key food safety issue for the 1990s. We in public health must accept, as part of any basic public health program, responsibility for disease surveillance and pursue the necessary resources for rapid investigation of potential outbreaks.