Advanced Food and Industrial Microbiology FSHN 573

Cary Adams Review Paper 1A February 2nd, 2018

The article, Foodborne Illness Acquired in the United States—Unspecified Agents is the
opposite of to the other article we reviewed this week. It was written by Elaine Scallan,1
Patricia M. Griffin, Frederick J. Angulo, Robert V. Tauxe, and Robert M. Hoekstra some CDC
members. Their specific intent in performing this study was to identify the incidence of acute
gastroenteritis was severe enough to cause illness, hospitalizations, and deaths in the United
States other than other than the 31 major known pathogens identified in the considered in the
other article. There intent was to experimentally determine the total contribution of four
potential sources of acute gastroenteritis: the number of agent-specific illness caused by known
pathogens, the impact of pathogens that we don’t know can be foodborne, microbes,
chemicals, and other substances known in food and haven’t been identified, and those
pathogens in food that have yet to be discovered. The authors hypothesize, “An additional
proportion of foodborne illness is probably caused by a heterogeneous group of less
understood agents.”1
To determine their unspecified sources’ contribution, all they essentially did was work
backward from the first estimates they got on the 24 major known pathogens, with the
requirement that it had causes diarrhea or vomiting. Over a year they used the FoodNet
surveys to collect data from people. A positive indecent was defined by a person, “who had
positively confirmed (>3 loose stools in 24 hours) or vomiting in the past month, each lasting >1
day or resulting in restricted daily activities.”1 The data were collected during three twelve
month periods, which had an average of .6 cases of acute gastroenteritis/person/year. To
collect hospitalization incidences, the authors used CDC NCHS and NHDS data in addition to
NCHS National Ambulatory and National Hospital Ambulatory Medical Care Surveys. It had to
be in the top 3 diagnoses, according to the ICD9-CM diagnostic codes, to be positive. They
performed a PERT distribution to get three annual rates of low modal and high. To determine
deaths from UC they did the same thing. They state there were 71,878 hospitalizations and
1,686 deaths caused by unknown foodborne sources of UC.
The design is sound for data estimation purposes. There are not many other ways to
collect that kind of data. Again, they can’t be said to have control. The previous data, from
1999, would be closest, but there is no real null hypothesis to reject. I would have liked to see
them collect newer data. I feel the Foodnet self-reporting is unreliable.
The conclusion could very well be true. I feel it is the best estimate to date on the nature
of foodborne UC illness in the US. The significance of their work is that we need to be stricter in
our identification of disease cause; just treating symptoms says nothing. If it is unknown,
research needs to be undertaken as to why to increase the health and wealth fare of everyone.
We need to start by looking at what else is in food, and the author’s state best how,
“Systematic laboratory investigation of specimens from well-investigated outbreaks of
foodborne disease of undetermined cause, and detailed investigations of specific syndromes,
may identify new agents.”