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

0

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400

500

600

Year

SE

Ca

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.