Data Needed to Measure HACCP Impacts on Public Health
Jack Guzewich, R.S., M.P.H.
Pathogen Reduction Dialogue
Panel 2
May 6, 2002
Data Needed to Measure HACCP Impacts on Public
Health
Jack Guzewich R.S., M.P.H.
FDA
Center for Food Safety and Applied Nutrition
How to Measure or Determine Impact
• Disease trends• Microbiological or other testing of food or the
food environment• Inspectional or compliance findings• Enforcement actions• Consumer behavior and attitudes
Disease Trends
• Sporadic cases• Outbreaks• Special studies and surveillance, e.g.
FoodNet• Agent risk factor studies• U.S. foodborne illness estimates:
- 76 million cases each year- 325,000 hospitalizations each year- 5,000 deaths each year
Determining the Burden of Foodborne Diseases
Exposure in the general population
Person becomes ill
Person seeks care
Specimen obtained
Culture-confirmed case
Reported to Health Dept/CDC
Lab tests for organism
FoodNet Goals
Describe the epidemiology of new and emerging bacterial, parasitic, and viral foodborne pathogens.
Estimate the frequency and severity of foodborne diseases that occur in the United States per year.
Determine how much foodborne illness results from eating specific foods, such as meat, poultry, and eggs.
76 Million Cases of Illness
• 81% of cases from unknown agents• Known agents
– Norwalk-like agents 67%– Campylobacter spp. 14.2%– Salmonella spp. 9.7%– L. monocytogenes 0.0%– E. coli O157:H7 0.5%
5,000 Deaths
• 64% of deaths from unknown agents• Known agents
– Norwalk-like agents 7%– Campylobacter spp. 5.5%– Salmonella spp. 30.6%– L. monocytogenes 27.6% – E. coli O157:H7 2.9%
Micro/Other TestingFood and Environment
• Raw material testing • In process or in-line samples• Processing plant environmental samples• End-product testing
Example: Salmonella spp.
testing for meat and poultry
Inspectional and Compliance Findings
• Decrease in violations noted during inspections following HACCP implementation.
• Must have had regular inspections and a database of findings so the comparison can be made.
• Pathogen or indicator testing by regulators• Surveys of end-product or retail product for
pathogens
Enforcement Actions
• Seizures
• Recalls
• Injunctions
• Prosecutions
Consumer Behavior and Attitudes
• Consumer understanding of HACCP • Consumer confidence in food safety• Consumer recognition of safer food
Problems with the Measurement Methods
• No baseline or poor baseline data• Inconsistent data collection over time• Epidemiological and lab methods not
consistent• Outcome data were not collected with the
idea of answering this question
Problems with the Measurement Methods
• Surveillance changes over time• No one contributing factor or vehicle causes
only one foodborne disease
• Many interventions were being implemented at the same time as HACCP: education, sampling, inspection, new technologies
Problems with Measurements: New York SE Outbreaks and Cases
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SE
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Outb
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SE Cases
SE Outbreaks
HACCP Use in the U.S.
• Voluntary use by many processors
• Mandatory for :– Seafood: fish and fishery products– Meat and poultry – Juice
HACCP Use in the U.S.
• Voluntary programs for:
– Retail food
– Milk shippers Required in some states
• Required by some local governments
• Required by some state governments
Com pStat in NYC Police
Im pact:S afer c ity
Outcom es:C rim e ra te
Output:C on vic tion s
Activities:R esp on se t im e
A rres ts
Input:C rim e
Im pact of HACCP on Public Health
Im pact:Im p roved
P u b lic H ea lth
Outcom es:L ess F ood b orn e
D isease
Output:L ess -con tam in a ted
F ood
Activities:In sp ec tion , H A C C P
E d u ca tion , S am p lin gN ew Tech n o log ies
Input:C on tam in a tion
o f F ood
What we measure the best
What we don’t measure as well
? ? How do we know
Has HACCP Had an Impact on Public Health?
Conclusions• It will be very difficult to demonstrate that any
one intervention has resulted in a specific percent reduction in foodborne disease in general or in one agent or vehicle.
• HACCP has changed the focus of government, industry, academia and consumers.
• HACCP has prompted us to improve surveillance of disease and of agents in foods.
Conclusions• The dialogue HACCP has prompted has had
a major impact on changes in how food safety has been addressed, in all types of interventions, compared to 10 or so years ago.
• We will continue to try to link measurements of foodborne disease with interventions, sometimes with more success than others, e.g. Salmonella Enteritidis in eggs.
Conclusions
What we can say is that FoodNet data show a decrease in some major pathogens at the same time as HACCP and a number of other interventions have been implemented.