While the phrase, “hindsight is 20/20” is often portrayed negatively, that 20/20 clarity of the past can provide lessons for the future. One area in which this was recently seen was the apparent positive impact of the pandemic behavior modifications and public health practices and interventions in decreasing, not only on infectious diseases, but also on other enteric diseases – including those that are foodborne. However, with the post-pandemic return to “normal” came a return to pre-COVID levels of U.S. foodborne illness.
As reported in the recently published CDC Foodborne Diseases Active Surveillance Network (FoodNet) report, “during 2020–2021, FoodNet detected decreases in many infections that were due to behavioral modifications, public health interventions, and changes in health care–seeking and testing practices during the COVID-19 pandemic.” However, those decreases did not continue. Rather, with many of the pandemic interventions ending, there was a resumption of outbreaks, international travel, and other factors leading to enteric infections.
It should be noted, however, that while a greater awareness of hygiene was certainly an important part of managing COVID-19 risks, so was a reluctance to go to a medical professional or hospital during the pandemic. So, the drop in cases during the pandemic was likely a combination of reduced illness and a reduction in documentation of reportable illness due to reduced medical visits for illness that was not serious.
Given those caveats, of the eight pathogens for which FoodNet conducts surveillance for laboratory-diagnosed infections, in 2022:
- Campylobacter, Salmonella, Shigella, and Listeria incidences reverted to 2016-2018 levels.
- The incidence of Salmonella and Campylobacter infections were also above the Healthy People 2030 targets.
- Shiga toxin-producing E. coli, Yersinia, Vibrio, and Cyclospora infection incidences were even higher than in the 2016-2018 reporting period.
- No progress in reducing enteric infection incidence was observed.
- The increased use of culture-independent diagnostic test (CIDT) likely contributed to higher detection rates; however it does not account for the full increases of 2022.
While these FoodNet data provide some interesting statistics, they are much more than that as they show two critical industry impacts: (1) areas in which industry improvement is needed; (2) areas in which regulators can be expected to base their actions, initiatives, focus, etc. As the report stated, “Concerted efforts are needed now to implement strategies to reach national prevention targets and lower the prevalence of enteric infections.”
The needed efforts discussed in the report focused primarily on poultry and leafy greens:
- Poultry meat has been the most commonly identified source of Campylobacter infections in many countries and is estimated to be the most common U.S. source of Salmonella infections. Efforts should be made to reduce the incidence of pathogen colonization in birds (e.g., poultry vaccination and use of prebiotics and probiotics) and minimize contamination of poultry water, feed, and bedding.
- Collaboration among food growers, processors, retail stores, restaurants, and regulators is needed to reduce pathogen contamination during poultry slaughter and to prevent contamination of leafy greens.
- Reducing leafy green contamination by improving agricultural water safety, as promoted by FDA and FSMA, could also reduce Salmonella, STEC, Listeria, and other pathogens that cause foodborne illnesses.
With leafy greens and poultry being called out in the report, we should anticipate greater focus on both these areas from a regulatory perspective in the coming years. It is not good for any administration to see the levels of foodborne illness increase – or appear to increase. We have already seen the focus from FSIS on Salmonella in poultry and we should anticipate a greater focus from FDA on fresh produce – especially given the higher than usual numbers of Cyclospora cases occurring at the moment.
But it also is critical that all industry segments take a look at their systems to continually improve their prevention measures targeted at reducing food contamination. With CDC also noting that a better understanding of reasons for the reduced foodborne illness during the pandemic could help guide mitigation strategies, the industry should take this to heart. Whether a leafy greens, poultry, or other producer, businesses can assess their own pandemic-era practices and actions that may have contributed to reduced contamination rates (e.g., increased handwashing and other hygiene practices) and re-implement requirements and/or strategies to bring those back to the forefront.
