10 - Food Safety


10-1.		Reduce infections caused by key foodborne pathogens.

10-1a. Campylobacter species.
National Data Source	Foodborne Disease Active Surveillance Network (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS, OPHS, and State agencies.
State Data Source	State Health Department reports to CDC and sites participating in FoodNet active surveillance.
Healthy People 2000 Objective	12.1 (Food and Drug Safety).
Measure	Rate per 100,000 population.
Baseline	24.6 (1997) (selected sites—see Comments).
Numerator	Number of culture-confirmed cases of illness caused by Campylobacter species reported to CDC.
Denominator	Number of persons.
Population Targeted	Resident population (selected sites—see Comments).
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	FoodNet is a collaborative effort among CDC, FDA, USDA, and participating State Health Departments. This network collects population-based surveillance data on culture-confirmed cases of foodborne illnesses from more than 300 participating clinical laboratories.
	In March 2000, the population at FoodNet sites was 25.4 million persons (10 percent of the resident population) for active surveillance of bacterial pathogens. Baseline information for bacterial infections is based on 1997 active surveillance at FoodNet sites, which included areas of California, Connecticut, Georgia, Minnesota, Oregon, and New York. Since 1997, additional counties or additional sites (New York and Maryland in 1998, Tennessee in 2000, and Colorado in 2001) have been added to the network.
	The data, received by CDC from the States, are based on isolates from human case specimens. The cause of the illness in many, but not all, of the cases, is a contaminated food. The denominator is from Internet site http://www.census.gov/population/ www/estimates/popest.html.
	For more information on FoodNet from the Internet, go to http://www.cdc.gov/ncidod/dbmd/foodnet.
	See Appendix A for focus area contact information.

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10-1b. Escherichia coli O157:H7.
National Data Source	Foodborne Disease Active Surveillance Network (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS, OPHS, and State agencies.
State Data Source	State Health Department reports to CDC and sites participating in FoodNet active surveillance.
Healthy People 2000 Objective	12.1 (Food and Drug Safety).
Measure	Rate per 100,000 population.
Baseline	2.1 (1997) (selected sites—see Comments).
Numerator	Number of culture-confirmed cases of illness caused by Escherichia coliO157:H7 reported to CDC.
Denominator	Number of persons.
Population Targeted	Resident population (selected sites—see Comments).
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-1a for more information.

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10-1c. Listeria monocytogenes.
National Data Source	Foodborne Disease Active Surveillance Network (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS, OPHS, and State agencies.
State Data Source	State Health Department reports to CDC and sites participating in FoodNet active surveillance.
Healthy People 2000 Objective	12.1 (Food and Drug Safety).
Measure	Rate per 100,000 population.
Baseline	0.5 (1997) (selected sites—see Comments).
Numerator	Number of culture-confirmed cases of illness caused by Listeria monocytogenes reported to CDC.
Denominator	Number of persons.
Population Targeted	Resident population (selected sites—see Comments).
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-1a for more information.

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10-1d. Salmonella species.
National Data Source	Foodborne Disease Active Surveillance Network (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS, OPHS, and State agencies.
State Data Source	State Health Department reports to CDC and sites participating in FoodNet active surveillance.
Healthy People 2000 Objective	12.1 (Food and Drug Safety).
Measure	Rate per 100,000 population.
Baseline	13.7 (1997) (selected sites—see Comments).
Numerator	Number of culture-confirmed cases of illness caused by Salmonella species reported to CDC.
Denominator	Number of persons.
Population Targeted	Resident population (selected sites—see Comments).
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-1a for more information.

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10-1e. (Developmental) Cyclospora cayetanensis.
Comments	An operational definition could not be specified at the time of publication.
	A proposed national data source is FoodNet, a collaborative effort among CDC, FDA, USDA, and participating State Health Departments. Proposed State data sources are the State Health Department passive reporting to CDC and participants in FoodNet active surveillance. Cyclospora cayetanensis has only recently been made a nationally notifiable disease and added to Food Net surveillance. National estimates will be based on active surveillance at FoodNet sites. Final 1997 data for Cyclospora cayetanensis were not available at the time of publication. In 1998, the population at FoodNet sites was 24.7 million persons for active surveillance of Cyclospora cayetanensis.
	See Appendix A for focus area contact information.

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10-1f. (Developmental) Postdiarrheal hemolytic uremic syndrome.
Comments	An operational definition could not be specified at the time of publication.
	A proposed national data source is FoodNet, a collaborative effort among CDC, FDA, USDA, and participating State Health Departments. Proposed State data sources are the State Health Department passive reporting to CDC and participants in FoodNet active surveillance. Postdiarrheal hemolytic uremic syndrome has only recently been made a nationally notifiable disease and added to FoodNet surveillance. National estimates will be based on active surveillance at FoodNet sites. Final 1997 data for postdiarrheal hemolytic uremic syndrome were not available at the time of publication.
	See Appendix A for focus area contact information.

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10-1g. (Developmental) CongenitalToxoplasma gondii.
Comments	An operational definition could not be specified at the time of publication.
	A proposed national and State data source is the National Notifiable Disease Surveillance System (NNDSS), CDC, NCID.
	As occurs with other parasitic diseases, examination for toxoplasmosis is often not available or is done infrequently. Efforts are underway in the United States to make congenital toxoplasmosis a nationally notifiable disease, with serological data collection beginning in calendar year 2000. Implementation will be done in a stepwise fashion among the States. Congenital toxoplasmosis data will include neonates and their mothers.
	See Appendix A for focus area contact information.

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10-2.		Reduce outbreaks of infections caused by key foodborne bacteria.

10-2a. Escherichia coli O157:H7.
National Data Source	Foodborne Disease Outbreak Surveillance System, CDC, NCID.
State Data Source	State Health Department passive reports to CDC and sites participating in FoodNet active surveillance.
Healthy People 2000 Objective	Adapted from 12.2 (Food and Drug Safety).
Measure	Number.
Baseline	22 (1997).
Numerator	Number of outbreaks of infections caused by Escherichia coli O157:H7 in the U.S. resident population.
Denominator	Not applicable.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	A foodborne disease outbreak (FBDO) is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. FBDOs are reported to CDC on a standard reporting form. Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained, and specified criteria are met. Most reports are received from State and local health departments; they also may be received from Federal agencies and, occasionally, from private physicians. Not included in this surveillance system are FBDOs on cruise ships; FBDOs if the food is eaten outside United States, even if the illness occurs within the United States; and if the route of transmission from the contaminated food to the infected person is indirect.
	Many foods contain several ingredients, but only one food-vehicle category is chosen for categorizing each outbreak. Therefore, the reported number of outbreaks attributed to a particular food item may not include all the reported outbreaks caused by that item. For example, homemade ice cream containing milk and eggs is listed under “ice cream” rather then “milk” or “eggs.” The category “Mexican food” includes vehicles made from beef, cheese, lettuce, and other ingredients.
	For information on FoodNet, see Comments provided with objective 10-1a.
	This objective differs from Healthy People 2000 objective 12.2, which only tracked outbreaks from Salmonella Enteritidis.
	See Appendix A for focus area contact information.

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10-2b. Salmonella serotype Enteritidis.
National Data Source	Foodborne Disease Outbreak Surveillance System, CDC, NCID.
State Data Source	State Health Department passive reports to CDC and sites participating in FoodNet active surveillance.
Healthy People 2000 Objective	Adapted from 12.2 (Food and Drug Safety).
Measure	Number.
Baseline	44 (1997).
Numerator	Number of outbreaks of infections caused by Salmonellaserotype Enteritidis in the U.S. resident population.
Denominator	Not applicable.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-2a for more information.

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10-3.		Prevent an increase in the proportion of isolates of Salmonella species, from humans and from animals at slaughter, that are resistant to antimicrobial drugs.

10-3a. Salmonella from humans that are resistant to fluoroquinolones.
National Data Source	The National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS: Enteric Bacteria), NCID, CDC; FDA, CVM; USDA, Agriculture Research Service (ARS); Foodborne Disease Active Surveillance Network (FoodNet) FDA, CDC, and USDA, FSIS.
State Data Sources	Participating local and State health departments in 17 NARMS sites—see Comments.
Healthy People 2000 Objective	Not applicable.
Measure	Percent.
Baseline	0 (1997).
Numerator	Number of Salmonella species isolates that are resistant to fluoroquinolones.
Denominator	Number ofSalmonella species isolates tested for resistance to fluoroquinolones.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	Salmonella species isolates from humans (every 10th Salmonellaspecies isolate from each of 17 locations representing 32 percent of the U.S. population), will be tested for resistance to antimicrobial drugs.
	The 17 NARMS sites (including the 8 FoodNet sites) are participating local and State health departments that include California, Colorado, Connecticut, Florida, Georgia, Kansas, Los Angeles County, Massachusetts, Maryland, Minnesota, New Jersey, New York City, New York State, Oregon, Tennessee, Washington, and West Virginia. See Comments provided with objective 10-1a for more information on FoodNet.
	See Appendix A for focus area contact information.

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10-3b. Salmonella from humans that are resistant to third-generation cephalosporins.
National Data Sources	The National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS: Enteric Bacteria), NCID, CDC; FDA, CVM; USDA, ARS; Foodborne Disease Active Surveillance Network (FoodNet) FDA, CDC, and USDA, FSIS.
State Data Source	Foodborne Disease Active Surveillance Network (FoodNet), FDA, CDC, and USDA, FSIS.
Healthy People 2000 Objective	Not applicable.
Measure	Percent.
Baseline	0 (1997).
Numerator	Number of Salmonella species isolates that are resistant to third-generation cephalosporins.
Denominator	Number of Salmonella species isolates tested for resistance to third-generation cephalosporins.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-3a for more information.

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10-3c. Salmonella from humans that are resistant to gentamicin.
National Data Sources	The National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS: Enteric Bacteria), NCID, CDC; FDA, CVM; USDA, ARS; Foodborne Disease Active Surveillance Network (FoodNet), FDA, CDC, and USDA, FSIS.
State Data Source	Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and FSIS.
Healthy People 2000 Objective	Not applicable.
Measure	Percent.
Baseline	3 (1997).
Numerator	Number of Salmonella species isolates that are resistant to gentamicin.
Denominator	Number of Salmonella species isolates tested for resistance to gentamicin.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-3a for more information.

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10-3d. Salmonella from humans that are resistant to ampicillin.
National Data Sources	The National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS: Enteric Bacteria), NCID, CDC; FDA, CVM; USDA, ARS; Foodborne Disease Active Surveillance Network (FoodNet), FDA, CDC, and USDA, FSIS.
State Data Source	Foodborne Disease Active Surveillance Network (FoodNet), CDC, FDA, USDA, and FSIS.
Healthy People 2000 Objective	Not applicable.
Measure	Percent.
Baseline	18 (1997).
Numerator	Number of Salmonella species isolates that are resistant to ampicillin.
Denominator	Number of Salmonella species isolates tested for resistance to ampicillin.
Questions Used To Obtain the National Data	Not applicable.
Expected Periodicity	Annual.
Comments	See Comments provided with objective 10-3a for more information.

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10-3e. (Developmental) Salmonella from cattle at slaughter that are resistant to fluoroquinolones.
Comments	An operational definition could not be specified at the time of publication.
	The proposed national data source for animals at slaughter is the National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS: Enteric Bacteria), supported by surveillance and research activities of FDA, CDC, FSIS, ARS, and USDA, Animal and Plant Health Inspection Service (APHIS). Data are being collected, but were not available at the time of publication.Salmonella species isolates from animals at slaughter (isolates from USDA, FSIS’s Hazard Analysis and Critical Control Point [HACCP] and pathogen reduction program testing for Salmonella species) are being tested for resistance to antimicrobial drugs.
	See Appendix A for focus area contact information.

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10-3f. (Developmental)Salmonella from cattle at slaughter that are resistant to third-generation cephalosporins.
Comments	See Comments provided with objective 10-3e for more information.

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10-3g. (Developmental) Salmonella from cattle at slaughter that are resistant to gentamicin.
Comments	See Comments provided with objective 10-3e for more information.

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10-3h. (Developmental)Salmonella from cattle at slaughter that are resistant to ampicillin.
Comments	See Comments provided with objective 10-3e for more information.

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10-3i. (Developmental)Salmonella from broilers at slaughter that are resistant to fluoroquinolones.
Comments	See Comments provided with objective 10-3e for more information.

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10-3j. (Developmental) Salmonella from broilers at slaughter that are resistant to third-generation cephalosporins.
Comments	See Comments provided with objective 10-3e for more information.

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10-3k. (Developmental) Salmonella from broilers at slaughter that are resistant to gentamicin.
Comments	See Comments provided with objective 10-3e for more information.

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10-3l. (Developmental) Salmonella from broilers at slaughter that are resistant to ampicillin.
Comments	See Comments provided with objective 10-3e for more information.

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10-3m. (Developmental) Salmonella from swine at slaughter that are resistant to fluoroquinolones.
Comments	See Comments provided with objective 10-3e for more information.

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10-3n. (Developmental)Salmonella from swine at slaughter that are resistant to third-generation cephalosporins.
Comments	See Comments provided with objective 10-3e for more information.

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10-3o. (Developmental) Salmonella from swine at slaughter that are resistant to gentamicin.
Comments	See Comments provided with objective 10-3e for more information.

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10-3p. (Developmental)Salmonella from swine at slaughter that are resistant to ampicillin.
Comments	See Comments provided with objective 10-3e for more information.

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10-4.		(Developmental) Reduce deaths from anaphylaxis caused by food allergies.

Comments

An operational definition could not be specified at the time of publication.

The proposed data source is the mortality component of the National Vital Statistics System. The ICD-10 assigns a code to death from food-induced anaphylaxis, although identifiers have not been assigned for various food sources, for example, peanuts, milk products, and eggs. Codes have been assigned to anaphylactic shock due to adverse food reaction in the ICD-9-CM for nonfatal anaphylactic shock due to nonpoisonous foods.

See Appendix A for focus area contact information.

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10-5. Increase the proportion of consumers who follow key food safety practices.
National Data Source	Food Safety Survey (FSS), FDA, CFSAN, USDA, and FSIS.
State Data Source	See Comments.
Healthy People 2000 Objective	Adapted from 12.3 (Food and Drug Safety).
Measure	Weighted average percent.
Baseline	72 (1998).
Numerator	The sum of the average percents of consumers who report they follow each of the four key food safety practices: clean, separate, cook, and chill.
Denominator	Number of practices measured (four) among persons aged 18 years and older who prepare food (consumers).
Population Targeted	U.S. civilian, noninstitutionalized population.
Questions Used To Obtain the National Data	From the 1998 Food Safety Survey:
	CLEAN
	Ø Before you begin preparing food, how often do you wash your hands with soap? Would you say . . . 1) All of the time* 2) Most of the time 3) Some of the time, or 4) Rarely
	Ø After you have cracked open raw eggs, do you usually continue cooking, or do you first rinse your hands with water, wipe them, or wash them with soap? 1) Continue cooking 2) Rinse or wipe hands 3) Wash with soap* Open-ended code: 4) Never handle raw eggs
	Ø After handling raw meat or chicken, do you usually continue cooking, or do you first rinse your hands with water, or wipe them, or wash them with soap? 1) Continue cooking 2) Rinse or wipe hands 3) Wash with soap* Open-ended code: 4) Don’t cut raw meat or chicken
	Ø After handling raw fish, do you usually continue cooking, or do you first rinse your hands with water, wipe them, or wash them with soap? 1) Continue cooking 2) Rinse or wipe hands 3) Wash with soap* Open-ended code: 4) Never handle raw fish
	SEPARATE
	Ø After you have used a cutting board or other surface for cutting raw meat or chicken, do you use it as it is for cutting other food to be eaten raw for the same meal, or do you first rinse it, or wipe it, or wash it with soap? 1) Use it as it is 2) Rinse or wipe it 3) Wash with soap* Open-ended codes: 4) Wash with bleach* 5) Use a different cutting board*6) Don’t cut raw meat or poultry
	Ø After cutting raw fish or shellfish, what do you do with the cutting board or surface? [Do you use it as it is for cutting food to be eaten raw for the same meal, or do you first rinse it, or wipe it, or wash it with soap?] (NOTE: MATERIAL IN BRACKETS MAY NOT NEED TO BE READ). 1) Use it as it is 2) Rinse or wipe it 3) Wash with soap* Open-ended codes: 4) Wash with bleach* 5) Use a different cutting board*

	COOK--PREFERENCE
	Ø In your home, are hamburgers usually served...(PROBE: IF DIFFERENT WAYS FOR DIFFERENT PEOPLE: What is the rarest degree of doneness hamburgers are served?) 1) Rare 2) Medium, or 3) Well done?* Open-ended code: 4) Hamburgers are never served
	Ø If (2), When you say hamburgers are usually served "medium," do you mean they are... 1) Brown all the way through,* or 2) Still have some pink in the middle?
	Ø In the past 12 months, did you eat any of the following foods that contain raw eggs? (Did you eat. . .) (In the past 12 months, did you eat . . .) a) Raw, homemade cookie or cake batter? b) Homemade frosting with raw egg? c) Caesar salad with raw egg? d) Chocolate mousse with raw egg? e) Homemade eggnog? f) Homemade mayonnaise? g) Homemade ice cream with raw egg? h) Shakes with raw egg? i) Homemade hollandaise sauce?
	(NOTE TO INTERVIEWERS: COMMERCIAL FROZEN OR REFRIGERATED COOKIE DOUGH IS PASTEURIZED; IT DOES NOT CONTAIN RAW EGGS EVEN BEFORE IT IS BAKED. COMMERCIAL CAKE AND COOKIE MIXES USUALLY CALL FOR ADDING RAW EGGS, SO THEY COUNT AS EATING RAW EGGS.)
	Ø In the past 12 months, which of the following raw foods did you eat? a) Raw oysters b) Sushi, ceviche (se - VEE - chay), or other raw fish
	COOK--IMPLEMENTATION
	Ø Thinking of your usual habits over the past year, when you prepare the following foods, how often do you use a thermometer?


10-6		Safe food preparation practices in retail establishments


10-1g		Congenital Toxoplasma gondii


10-3a		Fluoroquinolones


10-3b		Third-generation cephalosporins


10-3c		Gentamicin