EMERGING FOODBORNE DISEASES

Background

Some foodborne diseases are well recognized, but are considered emerging because they have recently become more common. For example, outbeaks of salmonellosis have been reported for decades, but within the past 20 years the disease has increased in incidence on many continents. In the Western hemisphere and in Europe, Salmonella serotype Enteritidis (SE) has become the predominant strain. Investigations of SE outbreaks indicate that its emergence is largely related to consumption of poultry or eggs.

However, in 1994, there was a nationwide outbreak of salmonellosis in the United States as a result of contamination of pasteurized ice cream during transport in lorries that had previously carried nonpasteurized liquid eggs containing Salmonella enteritidis. It is estimated that 224,000 persons were affected by the outbreak.

While cholera has devastated much of Asia and Africa for years, its introduction for the first time in almost a century into the Western hemisphere in 1991 makes it another example of an infectious disease that is both well-recognized and emerging. While cholera is often waterborne, many foods also transmit infection. In Latin America, ice and raw or underprocessed seafood are important epidemiological pathways for cholera transmission.

Other foodborne pathogens are considered emerging because they are new microorganisms or because the role of food in their transmission has been recognized only recently. Infection with Escherichia coli serotype O157:H7 (E. coli) was first described in 1982. Subsequently, it has emerged rapidly as a major cause of bloody diarrhoea and acute renal failure. The infection is sometimes fatal, particularly in children. Outbreaks of infection, generally associated with beef, have been reported in Australia, Canada, Japan, United States, in various European countries, and in southern Africa.

In 1996, an outbreak of Escherichia coli O157:H7 in Japan affected over 6,300 school children and resulted in 2 deaths. This is the largest outbreak ever recorded for this pathogen.

Listeria monocytogenes (Lm) is considered emerging because the role of food in its transmission has only recently been recognized. In pregnant women, infections with Lm can cause abortion and stillbirth, and in infants and persons with a weakened immune system it may lead to septicemia (blood poisoning) and meningitis. The disease is most often associated with consumption of foods such as soft cheese and processed meat products that are kept refrigerated for a long time because Lm can grow at low temperatures. Outbreaks of listeriosis have been reported from many countries, including Australia, Switzerland and the United States. Two consecutive outbreaks of Listeria monocytogenes in France in 1992 and 1993 were caused by contaminated pork tongue and potted pork.

Foodborne trematodes are also emerging as a serious public health problem, especially in south-east Asia, in part due to a combination of increased aquaculture production, often under unsanitary conditions, and of underprocessing of aquaculture products during their preparation. Foodborne trematodes can cause acute liver disease, and may lead to liver cancer.

Why do foodborne diseases emerge?

New foodborne disease threats occur for a number of reasons. These include international travel and trade, microbial adaptation and changes in the food production system, as well as human demographics and behaviour.

• The globalization of the food supply. A large outbreak of Shigella sonnei infections occurred in Great Britain, Norway, and Sweden in 1994 due to contaminated lettuce imported from southern Europe.
• The inadvertant introduction of pathogens into new geographic areas. Vibrio cholerae was introduced into waters off the coast of southern United States when a cargo ship discharged contaminated ballast water in 1991. It is likely that a similar mechanism led to the introduction of cholera for the first time this century into Latin America in 1991.
• Travellers, refugees, and immigrants exposed to unfamiliar foodborne hazards while abroad. International travellers may become infected by foodborne pathogens that are uncommon in their countries. It is estimated that about 90% of all cases of salmonellosis in Sweden are imported.
• Changes in microorganisms. Changes in microbial populations can lead to the evolution of new pathogens, development of new virulent strains in old pathogens, development of antibiotic resistance that might make a disease more difficult to treat, or to changes in the ability to survive in adverse environmental conditions.
• Change in the human population. The population of highly susceptible persons is expanding world-wide because of ageing, malnutrition, HIV infections and other underlying medical conditions. Age is an important factor in susceptibility to foodborne infections because those at the extremes of age have either not developed or have partially lost protection from infection. Particularly for the elderly, foodborne infections are likely to invade their blood stream and lead to severe illness with high mortality rates. People with a weakened immune system also become infected with foodborne pathogens at lower doses which may not produce an adverse reaction in healthier persons. Seriously ill persons, suffering, for example, from cancer or AIDS, are more likely to succumb to infections with Salmonella, Campylobacter, Listeria, Toxoplasma, Cryptosporidium, and other foodborne pathogens. In developing countries reduced immunity due to poor nutritional status render people, particularly infants and children, more susceptible to foodborne infections.
• Changes in lifestyle. Greater numbers of people go out and eat meals prepared in restaurants, canteens, fast food outlets, and by street food vendors. In many countries, the boom in food service establishments is not matched by effective food safety education and control. Unhygienic preparation of food provides ample opportunities for contamination, growth, or survival of foodborne pathogens.

All food-borne diseases pose a considerable threat to human health and the economy of individuals, families and nations. Their control requires a concerted effort on the part of the three principal partners, namely governments, the food industry and consumers. As part of its food safety education campaign, WHO issued the 10 Golden Rules for Safe Food Preparation and a guide on Safe Food for Travellers.

For further information, contact WHO's Office of Public Information, Geneva. Telephone (41 22) 791 2584. Fax (41 22) 791 4858. E-Mail: inf@who.int

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