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Problems associated with foodborne infections

In Germany, more than 200,000 cases of human infection apparently transmitted via food-borne pathogens are registered each year. The main pathogens, which cause bacterial infections, are Salmonella, Campylobacter jejuni, Yesinia enterocolitica and pathogen E. coli strains. A significant number of infections are also caused by viruses and parasite infections (approximately 200,000 cases of novovirus infections in 2007).

It is assumed that over the next few years foodborne infections will also constitute a serious  problem both nationally and internationally in the field of public health. The significance of these infections is based primarily on the high number of cases of disease, whereby the estimated number of unreported cases exceeds by far (approximately ten-fold) the diagnosed and reported cases.

Causes

The problems associated with foodborne infections are characterized by several complexes. The most important are:

• The discovery of new (“emerging”) pathogenic agents, like e.g. EHEC and Campylobacter jejuni or Methicillin-resistant Staphylococcus aureus (MRSA). The importance of the possible involvement of Mycobacterium paratuberculosis in foodborne diseases has not yet been determined.

• The return (“re-emergence”) of ‘old’ pathogens with new or mutated characteristics e.g. multi-resistant Salmonella typhimurium strains.

• The global food trade and the subsequent worldwide spread of “exotic” pathogens.

• The unclear role  of various micro-organisms that form toxins, their involvement in foodborne intoxications (e.g. enterotoxins caused by staphylococci and Bacillus cereus), their implication as food contaminants (e.g. a particular kind of intoxication caused by Clostridium botulinum) and the emergence of biogenic amines (assessment of histamine in cheese, inter alia).

• Despite the incorporation of Hazard Analysis and Critical Control Point concepts (abbr. HACCP) through the in-house monitoring systems of food processing plants, the level of food contamination has remained unchanged over the years. Hence, it is assumed that proper hygienic measures are not being correctly applied in the handling of food by catering services and in household kitchens.

• Changes in food production (e.g. increased production of mildly salted, mildly smoked and other mildly stabilized products which require consistent refrigeration (cold chain) during their entire shelf-life period in order to prevent decay), the increase in nation-wide food distribution as well as changes in consumer eating habits, lead to changes in the  “outbreak scenarios”. It has been observed that, in addition to the “classical” outbreak situations caused by highly contaminated food, which can be narrowed down to a specific location and time period (e.g. outbreaks associated with a buffet or on a cruise ship), “diffuse” outbreaks are one the rise. They occur on a wide geographical scale and are caused by food with a low level of contamination. As a result of these changes in the “outbreak scenarios” it becomes more difficult to distinguish or isolate sporadic (single) infections of epidemiological outbreaks of cases of foodborne disease. New diagnostic methods (e.g. clonal identification of pathogens), the coordination and the systematic nationwide analysis of data reported by the Länder and federal authorities are required.

BfR Committee for Hygiene

An effective strategy is needed  to prevent foodborne infections given the complex nature of this phenomenon. In this context a Hygiene Committee structure which draws on a coordinated, multi-disciplinarynetwork of the experts (epidemiology, microbiology, food technology, human and veterinary medicine) from regional and federal health and veterinary authorities, related organisations from the food industry and the end consumers, is essential.

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