Common Questions About Foodborne Illness

Common questions about foodborne illness and disease:

How are foodborne illnesses contracted? How long does it take to show symptoms of foodborne illness? How do I know if I have a foodborne illness? We discuss these, and some of the other most common questions to help the public understand the facts about foodborne infection.

Why should we be so concerned about foodborne illness? Doesn’t the United States have the safest food supply in the world?

It’s impossible to say. There is no statistical evidence to back up such a claim, yet many food producers, lobbyists, lawmakers, and even government regulators reiterate this statement every time there’s a foodborne illness outbreak or major food recall. It is almost impossible to compare food safety statistics between different countries. Most foodborne illnesses go unreported, so government agencies must come up with estimates of how many occur. Cultural differences, severity of illness, and varying accessibility to healthcare and insurance also affect how many foodborne illnesses are reported which can result in misleading interpretations of data.

Don’t all doctors receive formal training on how to diagnose and treat foodborne illnesses?

There is no specific mandatory foodborne illness education in medical schools. Furthermore, every state has its own reporting laws and processes around infectious diseases and foodborne illness. Local and state health departments do very little outreach to educate the medical professionals in their areas on these issues.

There is a single person or agency that is in charge of food safety, right?

Wrong. There is not a single person or federal agency that is in charge of food safety in the United States. The USDA, FDA, EPA, and other agencies all play a role in overseeing food production and regulating food products in the U.S. and often operate under different rules with separate objectives.

I see a lot of foodborne illness outbreaks reported in the press. Shouldn’t this make it easy for public health officials to figure out what causes foodborne disease?

Actually, the reported outbreaks that you hear and read about in the press are just a small fraction of total foodborne illness cases. Most people don’t report their illnesses to doctors or health departments. Only 4-6% of all cases of foodborne disease are linked to outbreaks with an identified food item — as most people who fall ill do not seek medical care and most are not associated with an outbreak. Only a small portion of these cases gets diagnosed through stool culture tests and an even smaller number of those diagnosed go on to be reported to and investigated by health departments. Because of these factors, health departments have a very difficult time linking different cases to a common food source.

How quickly and efficiently does the government remove/recall products known to be harmful from the public food supply?

It is a difficult and lengthy process to actually find and identify the food products that are making people sick. During this time, consumers are still purchasing and eating foods that have the potential to make them ill. In 2011, the Food Safety Modernization Act (FSMA) was passed, giving the FDA the authority to order mandatory recalls. However, companies will be provided with an informal hearing and an opportunity to voluntarily recall a product before the government forces the recall to be made. More information on the FSMA can be found here.

How regularly does the health department inspect restaurants?

Restaurant inspections vary a great deal in terms of frequency and thoroughness and are based upon the county and the funding available. Some restaurants are inspected 3-4 times a year, while others are inspected yearly or less. There is also considerable variation in punishment when food safety violations are found, and how and when inspection information is shared with the public. For information on your state’s inspections click here.

Is the last thing you ate always the cause of foodborne illness?

Unfortunately, foodborne illness can be caused by food eaten a few hours ago, a few days ago, a few weeks ago, and sometimes even a few months ago. The length of time between when you eat something and when you get sick (called the incubation period) varies between different types of pathogens.

I ate with a large group of people and I was the only one to get sick. Can I rule out that meal as the source of my foodborne illness?

The microbes that cause foodborne disease may not be equally distributed throughout your food — some parts of the food may have a very high microbial load while other parts of it might have none. In addition, every person has a unique immune system, which may react differently even when eating the same contaminated food.

Susceptibility to a foodborne illness is dependent on many factors including age, general health, and the strength of the immune system of the individual. The virulence (strength and impact) of the particular microbe and the amount ingested, as well as the timing and quality of medical care can also determine the severity and occurrence of foodborne illness.

Is eating contaminated food the only way to contract a foodborne illness?

No. Sick people can also pass certain illnesses to healthy people when someone handles or serves food without washing their hands thoroughly after using the bathroom. This so-called fecal-oral transmission can also occur when water used for drinking or for washing produce and/or dishes is contaminated with feces.

Environments that are high-risk for this kind of transmission include: day cares, hospitals, nursing homes, and restaurants. Good hygiene practices should be followed. Sick and recovering people should stay at home to avoid the spread of foodborne illness. People who are ill and have diarrheal accidents in community pools or local ponds can do the same. There is even potential for becoming ill at petting zoos and fairs through contact with animals such as reptiles and birds that are carriers of certain pathogens.

Is the “stomach flu” the same thing as the seasonal flu?

The term “stomach flu” refers to symptoms of gastroenteritis, which include irritation and inflammation of the stomach and intestines. This term is often used incorrectly and interchangeably with “the flu,” which is a respiratory illness caused by the influenza virus. The seasonal flu has symptoms of fever, congestion, muscle aches, and tiredness.

If I drop food on the floor or in the sink isn’t it okay to eat as long as it’s picked up quickly?

The 5-second rule is an urban myth. You can’t drop food on the floor or in the sink for any amount of time without with the risk of it coming into contact with germs. Even before 5 seconds pass, a piece of food that looks dirt-free may contain harmful pathogens. Your kitchen is often the most common source of harmful microbes in your home.

I found mold on my food but I cut the moldy part out. Is the rest of the food safe to eat?

If you can see mold with your naked eye, it probably means the whole piece of food has been contaminated. The larger spots of mold you can see are colonies of mature mold spores, but invisible threads of immature mold extend away from those spores into what looks like unaffected areas of a food. When in doubt, throw it out.

I’ve heard people say that they can tell if a food will make them sick by the way it smells or tastes? Makes sense to me. Isn’t foodborne illness caused by food that’s spoiled or “gone bad”?

Food that smells or tastes funny may be spoiled, which could have the potential to make you ill. However, many foodborne illnesses are caused by contamination by bacteria, viruses, and parasites that are too small to affect the appearance, taste, smell, or texture of food. Proper storage, as well as safeguards at the manufacturing and distribution level, and in the home can ensure that the food you eat is safe.

I’ve read that there may be health benefits to drinking raw, unpasteurized milk. Is it safe to give to my family?

In its December 12, 2008 newsletter, The Academy of Pediatrics stated, “Raw or unpasteurized milk can transmit many serious infectious diseases to children. Furthermore, there are no documented health benefits associated with ingestion of unpasteurized milk or milk products.” Pregnant women, young children, the elderly, and those with weakened immune systems should avoid unpasteurized products. Always ask before buying or ordering a juice or dairy product if you don’t see a prominent pasteurization label.

Is it safe to assume all fresh juice and dairy products are pasteurized?

Federal law requires that all fresh juices that cross state lines be pasteurized. However, juices that are produced and consumed within one state are exempt from this rule. That means it is not legally required that roadside, farm-fresh juices and ciders as well as those fresh–squeezed on-site for smoothies and restaurant meals be pasteurized.

Several states also allow the sale of “raw” unpasteurized milk and the sale of cheeses made with unpasteurized milk. Popular soft cheeses such as blue cheese, Feta, and Queso Blanco, are often unpasteurized. Information about raw milk and fresh juice safety can be found here and here.

I buy all organic food, won’t that keep my family safe from foodborne illness?

Organic processes offer protection against pesticides and chemicals, but this is not a guarantee of the absence of microbial contamination. Organically certified foods still have the possibility of harboring foodborne pathogens.

I’ve heard people thaw meat on their kitchen counter. Is that safe?

No. When you thaw meat on your kitchen counter, it increases the risk of cross-contamination. In addition, the meat is stored at room temperature (usually between 40°F and 140°F), in a temperature “danger zone” that can allow many types of bacteria to multiply rapidly. The refrigerator is the safest place to thaw meat and poultry because it keeps meat out of this “danger zone”. If you need to thaw meat quickly, defrost it in the microwave and then cook it immediately.

Is washing my meat and poultry before cooking a good way to reduce the chance of foodborne illness?

Washing can only remove pathogens from the surface of meats and poultry. In addition, you run a large risk of cross-contaminating your kitchen in the process. Using a meat thermometer to indicate the internal temperature of the food is the best way to kill pathogens both on the surface and on the inside.

As long as I cook raw meat thoroughly my dinner should be safe to eat, right?

While cooking raw meat to their recommended temperatures is a safeguard that can help protect families, cross-contamination from raw meat and poultry to utensils, hands, platters, and cutting boards presents many risks.

Be sure to wash—with soap and hot water—your hands, utensils, countertops and anything else that comes in contact with raw meat or meat juices. In addition, fresh fruits and vegetables eaten without a cooking “kill” step may still contain harmful foodborne pathogens. Tips on handling and washing fresh produce can be found here.

I can tell that my food is thoroughly cooked just by looking at it, can't I?

The only way to know with certainty that a food is cooked to a temperature high enough to kill foodborne pathogens is with a meat thermometer. For example, 1 in 4 hamburgers appear brown before they have been cooked to a safe internal temperature. Research shows some ground beef patties look done at internal temperatures as low as 135ºF. Physical properties alone are not an accurate sign of doneness. Recommendations for internal temperatures of meat can be found here.

Are there particular people who are more susceptible to foodborne illness?

While certain populations such as small children, the elderly, pregnant women, and those with weakened or compromised immune systems are most at risk for severe disease, anyone can contract a severe case of foodborne illness. More information about food guidelines for kids and seniors can be found here and here.

I’m pregnant. Are there really foods I should avoid to keep myself safe from foodborne illness?

Pathogens of concern include Listeria, E. coli and Salmonella. Listeriosis is especially harmful for pregnant women and can cause an early delivery or even miscarriage. Listeria monocytogenes bacteria are found in many ready-to-eat foods including hot dogs, cold cuts, soft cheeses, and patés. Listeria grows at refrigeration temperatures and can be killed by thoroughly heating foods to 165 degrees F before consumption.

More information and safety guidelines can be found here and here.

Should I be concerned about long-term health complications from foodborne illness?

While some foodborne illnesses only cause a temporary and minor inconvenience, many have been linked to long-term disease, severe health consequences, and even death. E. coli O157:H7 is the leading cause of acute kidney failure in American children and can also lead to diabetes, high blood pressure, and seizures. Salmonellosis can lead to reactive arthritis, while Campylobacteriosis is responsible for a significant number of cases of sudden-onset paralysis (also known as Guillain-Barré Syndrome). More information here.

If E. coli is found in the digestive tracts of healthy humans, why is it so dangerous when it’s found in the food we eat?

While all mammals have some types of harmless and even beneficial strains of E. coli in their digestive tracts, there are about 100 strains of E. coli known as shiga- toxin producing E. coli, which are found in the animals that are used for our food supply. Meat can become contaminated when fecal matter from these animals comes into contact with it during slaughter and processing, while produce can become contaminated when this fecal matter is introduced into the water supply used to irrigate crops.
The most well-known strain of this pathogen is E. coli O157:H7. When an infection occurs, E. coli O157:H7 and other shigatoxic E. coli release a very potent chemical (known as shigatoxin), which can cause bloody diarrhea and a variety of other severe complications including kidney failure and death. Food must be cooked to 180°F in order to kill these bacteria. Foodborne illness from E. coli is of extra concern in fresh produce, as many types of fruits and vegetables are eaten raw without a “kill” step. Find more information on E. coli here.

How concerned should I be about Salmonella?

Salmonella is a widespread and diverse pathogen – there are close to 2,500 different strain types of Salmonella! Some strains are found in very specific places and types of food while others are more general in their distribution. Although most people recover from a Salmonella infection, it can cause very serious complications including a debilitating disease known as Reactive Arthritis.

The very young, the elderly, and those with weakened immune systems are most likely to develop serious complications. Cooking poultry and eggs to 165°F will kill the bacteria, however, juices from raw chicken or egg can cross-contaminate hands, utensils, counters, cutting boards, sinks, kitchen towels, and anything else they come in contact with. Make sure you thoroughly wash your hands and any surfaces in the kitchen after handling raw poultry or eggs. Find more information on poultry and egg handling here and here.

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