Foodborne illness complaints
It is estimated that up to 48 million people get a foodborne illness in the United States each year. Most illnesses are infections caused by viruses, bacteria, and parasites. Others are caused by harmful toxins or chemicals in food. For most, the precise cause is never determined because many people don't get sick enough to go to the doctor, and of those who do see a doctor, laboratory testing often isn't done. This makes it hard to keep accurate statistics on foodborne illness. An estimated 3,000 people a year die from food borne illness in the United States, and many others suffer long term effects. Food borne illness is most dangerous for the very young, the very old, and those whose immune systems are weak. Foodborne illness investigations are initiated in response to reports of suspected foodborne illnesses by citizens, health care professionals, and restaurants.
Surveillance for food borne illnesses is done through reportable conditions (e.g., enteric diseases including Shiga-toxin producing E. coli, Salmonella, Campylobacter, Listeria, Vibrio, typhoid fever) and through reports of possible foodborne illness complaints and outbreaks.
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Foodborne illness in King County
Purpose of surveillance:
- To identify outbreaks
- To identify and eliminate sources of transmission including contaminated food and water
- To identify unsafe food preparation and handling practices, particularly in commercial food establishments
Public Health received 597 foodborne illness (FBI) complaints in 2013. These are reports of possible foodborne illness associated with a vendor and reported by citizens, health care providers, and restaurants/food vendors. The reports are investigated to determine if they indicate a true foodborne illness and if action is needed to prevent further illnesses. Of the 597 FBI complaints, 100 (16.7%) resulted in an inspection of the food service establishment by Public Health's Environmental Health Division, and 15 (2.5% of total complaints) were categorized as probable or confirmed foodborne complaints. To count as a probable foodborne complaint, there must either be evidence of unsafe food handling during an environmental health investigation or strong epidemiologic evidence of an outbreak linked to the food source. Confirmed complaints must meet the probable criteria and have laboratory confirmation of the suspected pathogen in the food or persons affected.
Thirty-eight FBI investigations were initiated in response to laboratory-confirmed cases of Vibrio parahaemolyticus among diners that had consumed raw oysters at King County restaurants or grocery stores. During investigations, Public Health staff retrieve shellfish tags containing information on the origin of the product from the vendor. Implicated shellfish can then be traced back to the area where they were harvested. These areas are placed under restrictions and monitoring for the duration of the high risk season for Vibrio (May-September).
Norovirus is the most common foodborne illness pathogen nationally. Norovirus infection causes sudden onset diarrhea and vomiting (sometimes accompanied by muscle aches, chills, or fever) and typically resolves within 24 to 72 hours. Most cases of norovirus-related illness are not reported. Norovirus-like illness accounted for 11 of the 15 confirmed and probable reports in 2013.
Three suspected cases of scombroid poisoning, an illness caused by ingestion of histamine in the meat of decomposing fish and that resembles an allergic reaction, were reported. Symptoms begin within minutes of ingestion and include flushing, dizziness, headache, palpitations, and mouth numbness and tingling.
One notable FBI investigation in 2013 was initiated when it was discovered through routine case investigation that three confirmed cases of Escherichia coli O157:H7 had eaten at the same restaurant during their exposure periods. The investigation of the restaurant revealed multiple violations which may have contributed to cross-contamination and unsanitary conditions. Of note, two of the three cases were vegetarian; although in the past E. coli has generally been associated with exposure to contaminated meat (particularly beef), recent years have seen an upsurge in infections associated with fruits and vegetables, which can become contaminated at several points in the food chain. The facility was closed temporarily to give time for staff to correct observed violations in food handling procedures.