Real burden and potential risks from foodborne infections: the value of multi-jurisdictional collaborations

The burden of foodborne infections on the public health is substantial. Many different microbes can contaminate foods and cause illness in the consumer. New and emerging problems are identified with regularity, as a result of microbial change, of changing patterns of production and trade, and the complex ecologies in which we produce and process the foods we eat. In the United States, the zoonotic pathogens Salmonella, Campylobacter, Shiga toxin-producing Escherichia coli (such as E. coli O157:H7), Listeria and Toxoplasma are major challenges. Public health surveillance is vital to estimate the burden, to detect outbreaks, and to track trends in the illness as interventions take place. Cases reported to public health authorities represent only a small fraction of those that occur, but if that fraction is known, the total number of cases can be estimated. Most cases are sporadic, occurring outside of recognized outbreaks. With systematic molecular methods for surveillance, large and dispersed outbreaks can be identified. Investigation of outbreaks of illnesses can detect new pathogens, establish new food vehicles, and identify likely points of contamination. The results of surveillance, of research based on sporadic cases, and of outbreak investigations can guide the important multi-disciplinary research in food science, veterinary and ecological sectors that are critical to improving prevention upstream from the consumer. Because microbes travel freely across boundaries, this increasingly requires a transnational approach. We can anticipate more unexpected challenges, even as current challenges are controlled. Robust, stable and flexible public health platforms for surveillance, for investigation, and for supporting interdisciplinary research that improves prevention are important to sustained progress in the field of food safety.