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Food Poisoning


The food industry is rapidly transforming.  Advances in production technology, globalization of food sources, corporate consolidation, and rapid methods of distribution have changed the industry.  Red barns and green pastures dwindle as production and processing are centralized in large industrial facilities in different parts of the United States and the world.  Consolidation of food production has concentrated power in the hands of fewer and fewer corporations.  These factory farms produce food in high volume with little regard for food safety or the environment. 

Take the example of ConAgra.  With a 03/23/2007 market value greater than 12 billion, ConAgra Foods is organized into three businesses:  Consumer Foods; Commercial Products, which includes the ConAgra Foods Trade Group that manages a portfolio of agricultural and energy commodities and services; and International.  Yet ConAgra failed to control moisture from a leaky roof and a faulty sprinkler system in its Sylvester, Georgia plant.  As a result ConAgra recalled Peter Pan and Great Value peanut butter in February 2007 after a salmonella outbreak sickened at least 425 people from 44 states.


Federal Agencies and Food Safety

How effective are U.S. agencies that oversee agribusiness?  The Centers for Disease Control and Prevention (CDC) estimates that 76 million Americans get sick (26,000 cases for 100,000 inhabitants); 325,000 are hospitalized; and 5,000 die from unsafe food each year.  These are estimates because the local and state health departments that primarily investigate food-borne illness outbreaks are not required by law to report outbreaks to the CDC.  For example, CDC estimates that 38 cases of salmonellosis actually occur for every case that is diagnosed and reported to authorities.

The CDC helps investigate large or multi-state outbreaks and is also responsible for nationwide surveillance of outbreaks and for tracking new and emerging pathogens.  CDC estimates that unknown or undiscovered agents cause 81 percent of all food-borne illnesses and related hospitalizations.  However, we do know that more than 200 known diseases can be transmitted through food.

At least one dozen federal agencies share responsibility for food safety, including the Food and Drug Administration (FDA) and the Department of Agriculture (USDA).  The USDA oversees meat, poultry, and processed egg products, while FDA oversees all other foods.  Although FDA-regulated foods are linked to more than twice as many outbreaks with known causes, FDA’s budget is only 38 percent of the total federal budget for food safety.  The USDA inspects meat-processing plants on a daily basis, while FDA inspects plants processing seafood, eggs, lettuce or processed foods containing less than two percent meat on the average of one time every five to ten years.  Neither the USDA nor the FDA has the authority to order recalls of contaminated food when food borne illness outbreaks occur.  They must ask food companies to voluntarily remove foods from the market, delaying the recall and increasing the number of illnesses in an outbreak.

Recognizing FDA shortcomings, FDA Commissioner Dr. Andrew C. von Eschenbach announced the creation of the position of Assistant Commissioner for Food Protection to provide advice and counsel on strategic and substantive food safety and food defense matters on May 1, 2007.  Dr. Von Eschenbach appointed Dr. David Acheson to this new senior leadership role.  Dr. Acheson’s first project is to develop an agency-wide, visionary strategy for food safety and defense.  Are U.S. physicians reassured?  The results of an informal Medscape opinion poll show that 50 percent believe the move will not be very effective and 28 percent believe the move will be not at all effective.  Only two percent believe the new position will be very effective.  (Check again on June 5 when polling ends.)

Food-Borne Illness Outbreaks

According to the Center for Science in the Public Interest (CSPI), an organization that maintains a database of food-borne illness outbreaks, the food categories most commonly linked to outbreaks include seafood, produce, multi-ingredient foods (such as salads, pizza, and sandwiches), poultry, beef, and eggs. 

The produce category was linked to the largest number of outbreak-associated illnesses, comprising 21% of all cases in the database.  According to CSPI, pathogens can jump from animals to produce via contaminated irrigation water, direct application of inadequately processed manure to soil, or cross-contamination from raw meats in the kitchen.  The spinach linked to the September 2006 enterohemorrhagic E. coli outbreak was traced back to Salinas Valley, California, where samples of cattle feces was found near a field that produced the contaminated spinach.  The genetic pattern of the strain of cattle E. coli matched the pattern found in the people who became ill.  The bagged fresh spinach sickened 205 persons and killed at least three.


Causes of Food Poisoning

Known causes of food poisoning are divided into two categories:  infective agents (viruses, bacteria, and parasites) and toxic agents (such as poisonous mushrooms, improperly prepared exotic foods, and pesticides on fruits and vegetables).  One of the most common forms of food poisoning, salmonellosis, accounts for one billion dollars in medical costs and lost work time.  Other causes of the most commonly recognized food-borne infections include Campylobacter and E. coli O157:H7 and the group of viruses called calicivirus, also known as the Norwalk and Norwalk-like viruses.

CSPI documented the following pathogens as the most commonly found:

FDA-Regulated Foods



Seafood and seafood dishes

Finfish: scombrotoxin, ciguatoxin. 

Shellfish: Vibrio spp., Noroviruses. 

Produce and produce dishes

Salmonella spp., Noroviruses, Escherichia

Multi-ingredient foods

Salmonella spp., Noroviruses

Egg and egg dishes

Salmonella Enteritidis


Salmonella spp., Campylobacter spp.

Breads and bakery

Salmonella spp., Noroviruses


Chemicals, Noroviruses, Salmonella spp., E. coli



USDA-Regulated Foods

Food of Food Dish


Poultry and poultry dishes

Salmonella spp., Clostridium perfringens, Staphylococcus aureus, Noroviruses

Beef and beef dishes

E. coli, Clostridium perfringens, Salmonella spp.

Pork and pork dishes

Staphylococcus aureus

Luncheon and other meats

Clostridium perfringens

FDA/USDA Regulated Foods

Food of Food Dish


Multiple foods (meals such as chicken served with salad, pork with coleslaw, and ground beef with potatoes)

Salmonella spp.



Food poisoning is a common, usually mild, but sometimes fatal illness.  Symptoms typically include nausea, vomiting, abdominal cramping, and diarrhea.  Depending on the cause and the amount eaten symptoms may develop rapidly, within 30 minutes, or up to 48 hours, and may worsen over days to weeks.  Fever and chills, bloody stools, and dehydration may follow.  In general, those who are most at risk for food poisoning include the elderly, young children, pregnant women and their fetuses, and the immuno-compromised.

Less common but more serious complications include:  respiratory distress, kidney failure, bleeding disorders, arthritis, nervous system disorders, pericarditis, and death.


Many food-borne infections are not identified by routine lab tests and require specialized, experimental, and/or expensive tests that are generally unavailable.  Because many ill persons do not seek attention and others are not tested, many cases of food-borne illness go undiagnosed.

Culturing stool samples may identify bacteria such as Campylobacter, Salmonella, and E. coli O157 and parasites.  Viruses are usually identified by testing stool samples for genetic markers.


There are many different kinds of food-borne diseases and treatment depends on the cause and the symptoms.  When symptoms are primarily diarrhea or vomiting that can lead to dehydration, replacing the lost fluids and electrolytes is important.  Patients should consult a health care provider for a diarrheal illness accompanied by high fever, blood in the stools, prolonged vomiting, signs of dehydration, and/or diarrhea lasting more than three days.  At risk patients should consult a health care provider immediately.

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