FOODBORNE DISEASES - EMERGING PATHOGEN AND TRENDS

Foodborne diseases have a major public health impact (Table 1).(14,117 ) Although precise figures are lacking, the yearly incidence of foodbo rne illness in the United States is estimated at between 6 and 80 mill ion illnesses resulting in approximately 500 to 9000 deaths.(41) The a nnual economic burden is estimated at 5 billion U.S, dollars.(6) Altho ugh most foodborne illnesses are mild, the consequences can be severe. In addition to acute gastrointestinal symptoms, such as diarrhea and vomiting, many foodborne pathogens can cause invasive disease. For exa mple, infection with Listeria monocytogenes can cause meningitis or se psis in neonates and immunosuppressed patients: and miscarriage in pre gnant women.(91) Salmonellosis may also result in sepsis.(67) Infectio n with some foodborne pathogens can be followed by chronic sequelae or disability. Toxoplasmosis is an important cause of congenital malform ation.(59) Escherichia coli O157:H7 is a leading cause of hemolytic ur emic syndrome, the most common cause of acute kidney failure in childr en.(49) Nontyphoidal Salmonella or Yersinia enterocolitica infection c an cause reactive arthritis,(18,103) and campylobacteriosis can cause Guillain-Barre syndrome, one of the most common causes of flaccid para lysis in the United States since the control of poliomyelitis.(75)The epidemiology of foodborne diseases is rapidly changing as foodborne pa thogens emerge. A variety of factors have contributed to the emergence of foodborne disease. The Institute of Medicine report on emerging in fectious diseases identified six broad categories of change in the soc ial environment that influence the emergence of infectious diseases.(5 7) These include changes in human demographics and behavior, technolog y and industry, international travel and commerce, microbial adaptatio n, economic development and land use, and the public health infrastruc ture. This article presents examples of emerging or reemerging foodbor ne pathogens, followed by examples of factors associated with the emer gence of foodborne diseases. Approaches that may help to prevent and c ontrol emerging foodborne hazards are also discussed.