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Hope Waisner
Gloria Creed-Dikeogu
Research Techniques and Technologies
1 March 2015
Understanding Food Poisoning in the U.S.
According to the U.S. Food and Drug Administration (FDA), there are about 48 million
cases of foodborne illness in the U.S. per year; about 1 in 6 Americans. The FDA also states that
there are about 128,000 hospitalizations and 3,000 deaths. The FDA reports that common
symptoms of foodborne illness include abdominal cramps, diarrhea, fever, fatigue, etc. Many
people in the U.S. have experienced foodborne illness or will at some point in their lives.
Foodborne illness is not simple to diagnose or identify. In this paper, many aspects of
foodborne illness will be investigated, such as the causes, the prevention, and the costs
associated with this illness. There are many pathogens identified as being causative agents of
foodborne illness, but some have been implicated more than others. Preventing foodborne illness
is a difficult task, but there are specific guidelines regarding the prevention of foodborne illness
and education of consumers and healthcare professionals is increasing. Finally, the costs of
foodborne illness can be astronomical. Patients spend a lot of money to treat foodborne illness,
as does the U.S. However, there are more than just economical costs.
Many people in the U.S. have experienced foodborne illness and are somewhat aware of
how it is spread. However, most people still dont completely understand how they can contract
foodborne illness. Identifying some of the many causes of foodborne illness are one way to begin
to understand this illness and what the U.S. can do about it.
Causes of food poisoning

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The causes of food poisoning are still being debated. According to Foodsafety.gov, food
poisoning can be caused by bacteria and viruses, parasites, molds, toxins, contaminants, and/or
allergens. Foodsafety.gov implements the biggest contributors of food poisoning to Salmonella,
Norovirus, Campylobacter, Toxoplasma, E. coli 0157, Listeria, and Clostridium perfringens.
Norovirus is a virus (as stated in the name), but the rest of these are bacteria. Therefore, the main
focus for the causes of food poisoning will be bacteria.
According to Scallan et al., there is accurate data to implicate about 31 pathogens as the
causes of food poisoning in the United States from 2000-2008 (7). Scallan et al. reports that each
year, 58% of food poisoning cases are caused by norovirus, followed by 11% caused by
nontyphoidal Salmonella species, 10% caused by Clostridium perfringens, and 9% caused by
Campylobacter species (7). However, the majority of the hospitalizations and deaths from food
poisoning were caused by Salmonella species (Scallan et al., 7). The authors for this paper only
included data that met the following criteria: the ill person sought medical care, a specimen was
tested in a laboratory and identified as the causative agent, and the illness was then reported to
public health officials (Scallan et. al, 8). Therefore, if the first step is eliminated because the
person chooses not to seek medical care, then that case of food poisoning would not have made it
into this study.
While the authors of this study report that per year, there are only about 323 laboratory
confirmed cases of food poisoning caused by Staphylococcus aureus, there are several studies
that discuss Staphylococcus aureus enterotoxins and their ability to cause food poisoning
(Scallan et al., 11). According to Argudn, Mendoza, and Rodicio, about 20-30% of
Staphylococcus aureus is found to persistently colonize human skin (1752). Therefore,
contamination by Staphylococcus aureus is mostly associated with improper handling of cooked

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and/or processed foods, followed by storing the food in conditions that support the growth of
Staphylococcus aureus and its enterotoxins (Argudn, Mendoza, and Rodicio, 1752). There are
many different enterotoxins that Staphylococcus aureus produces and according to Argudn,
Mendoza, and Rodicio the specific enterotoxins that cause food poisoning differ from country to
country (1762). For example, the authors found that in the United States, SEA1 most commonly
causes food poisoning, causing 77.8% of the outbreaks due to Staphylococcus aureus, followed
by SED2 and SEB3(Argudn, Mendoza, and Rodicio, 1762). According to Argudn, Mendoza, and
Rodicio the mode of action of these Staphylococcus aureus enterotoxins is still being debated,
though there are several possible suggestions for how the enterotoxins of this bacteria cause
emesis (1755). However, it is important to understand that this bacteria and many others are
capable of causing food poisoning, though they may be less frequently implicated in regards to
hospitalizations and deaths.
It can also be helpful to understand that while food poisoning is not caused by the food
itself, it is associated with specific foods. According to the Centers for Disease Control and
Prevention (CDC), any raw food of animal origin is likely to be contaminated (i.e. raw meat and
poultry, raw eggs, unpasteurized milk, and raw shellfish). The CDC also warns that mingled
products of many individual animals can cause food poisoning, because any one contaminated
individual can contaminate the whole batch (i.e. single hamburger made with the meat of many
different animals, an omelet containing eggs from hundreds of chickens, etc.). Finally, the CDC
is particularly concerned about the consumption of raw fruits and vegetables because washing
11 Staphyloccocus aureus Enterotoxin A
2 Staphyloccocus aureus Enterotoxin D
3 Staphyloccocus aureus Enterotoxin B

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can only decrease contamination, but cannot eliminate it. The causes of contamination in regards
to these fresh fruits and vegetables is related to the processing of these foods under unsanitary
conditions, fresh manure used to fertilize vegetables, which can provide conditions for
contamination, and unpasteurized fruit juice which may have been made with fruits containing
pathogens that can cause food poisoning.
This information provided by the CDC is particularly helpful for those with less than scientific
backgrounds. While some people may not understand how the viruses, bacteria, parasites, etc.
cause food poisoning, they can understand that they must be careful in handling specific foods.
There have also been specific food handling procedures described to help people avoid food
poisoning at home, at restaurants, or even while traveling.
Consumer knowledge and prevention of food poisoning
Langiano et al. went through a very specific process of using questionnaire-based
interviews to gain information about food safety procedures at home (47). The authors of this
article found that 39.9% of those interviewed were aware of the role that microorganisms play in
food safety (Langiano et al., 49). Additionally, 26.4% were aware of the role that temperature
plays in food safety, but only 5.0% were aware of the role played by both temperature and light
(Langiano et al., 49). The authors found that while women were more aware of the definition of
foodborne illnesses, they were not knowledgeable about the way in which these diseases cause
illness, nor which microorganisms actually cause illness (Langiano et al., 49).
According to these authors, most food purchased in the surveyed households was bought
by either the mother or both parents and was usually purchased on a weekly basis (Langiano et
al., 49-50). The authors also said that the purchasers of food report being especially cautious in

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regards to expiration dates of food, integrity of the package, price, and appearance of food
(Langiano et al., 52). However, many individuals responded that sometimes they found that
canned food they had already purchased was rusted, bended, showed the presence of mold, etc.
(Langiano et al., 52).
As far as food preparation was concerned, Langiano et al. found that 62.7% of those
surveyed defrost meat and fish at room temperature, rather than in the refrigerator (52).
However, the authors found that 24.0% of those surveyed stored food in the refrigerator after it
cooled to room temperature, while 28.0% stored food in the refrigerator within 24 hours
(Langiano et al., 52). More concerning was that Langiano et al. found that direct contact between
cooked and raw foods was only avoided by those surveyed 36.5% of the time (52). However,
those surveyed had a pretty good understanding about hand-washing procedures in regards to
raw meat or fish (Langiano et al., 53). Additionally, the authors report that 79.2% of those
surveyed reported that they were aware of their lacking knowledge regarding food safety and
handling, while many also expressed interest in gaining more knowledge on the topic (Langiano
et al., 54).
While the study done by Langiano et al. covered a variety of topics and ideas related to
food safety and handling, Kovats et al. covers a very specific aspect of food safety and handling
temperature (Kovats et al., 443). Kovats et al. was specifically concerned with the affects that
outdoor temperatures had on the presence of Salmonella species on food (Kovats et al., 443).
According to these authors, the peak in foodborne illness from Salmonella peaked in the
summer, right after temperatures peaked (Kovats et al., 447). This study suggests that there is a
threshold outdoor temperature, that when reached or exceeded correlates with an increase in
foodborne illness outbreaks from Salmonella (Kovats et al., 446-447). This is a very interesting

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idea related to foodborne illness. While it likely needs to be expanded and there needs to be more
data to support this correlation, it is yet another factor that consumers must consider in regards to
food safety and handling. Many individuals may not understand how outdoor temperatures can
affect foodborne illnesses.
While consumers have some knowledge in regards to food safety and handling,
MedlinePlus has very specific guidelines they encourage consumers to follow. These guidelines
include hand-washing, cooking food all the way through, using only clean utensils when eating,
using thermometers to determine when beef, poultry, or fish has been cooked all the way
through, and specific guidelines about storing food. Other tips about preventing food poisoning
include not eating anything with raw eggs in it and not eating raw honey, soft cheeses, or
shellfish that has been exposed to red tide. MedlinePlus also recommends that consumers take an
active role in preventing the contraction of foodborne illness when eating out or traveling. Such
recommendations include ensuring that fruit juices have been pasteurized, only using salad
dressing, sauces, etc. that come in single-serve packages, drinking only boiled water (specifically
if traveling), and eating only hot, freshly cooked food.
Another way to prevent the spread of foodborne illnesses is to ensure that these incidents
are reported to health officials. In a study done by Arendt et al. both consumers and health care
professionals were surveyed in regards to foodborne illness (3687-3688). The authors found that
consumers showed a varying level of concern about food purchased to prepare at home, with
11.4% not at all concerned, 17.1% somewhat concerned, and 25.7% very concerned (Arendt et
al., 3690). However, consumers showed more concern about food prepared away from home,
with 28.6% somewhat concerned, 25.6% concerned, and 31.4% very concerned (Arendt et al.,
3690). In this study, Arendt et al. reported that 91.4% of consumers surveyed said that as adults,

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they had gotten ill from something they ate, but only 31.4% sought medical treatment (3692). Of
those that sought medical treatment, only 14.3% were confirmed to have food poisoning through
a stool sample (Arendt et al., 3692).
There were slightly different results obtained in this study regarding healthcare
professionals. Of those surveyed, 6.3% were not very concerned about food safety, 25% were
somewhat concerned, and 18.8% were very concerned (Arendt et al., 3701). Of those surveyed,
50% reported never seeing a patient who complained about something they ate, or seeing less
than one of these patients a month (Arendt et al., 3701). According to Arendt et al., only 33.3%
of healthcare professionals surveyed said they had had a patient with a confirmed foodborne
illness (3701). These healthcare professionals identified time between food ingested and
treatment sought, lack of patient knowledge, cost, and unavailability of suspected food as
barriers to the reporting and confirmation of incidents of foodborne illness (Arendt et al., 3701).
Both consumers and healthcare professionals indicated that the best ways to reduce the
risk of foodborne illness are better quality control, better consumer education, and more
inspections (Arendt et al., 3692). This study identifies that there need to be improvements in the
healthcare field in regards to the confirmation, reporting, and treatment of foodborne illness,
especially as the U.S. population increases (Arendt et al., 3711). However, as aforementioned,
there are many ways in which consumers and healthcare professionals can continue to reduce the
risk of the spread of foodborne illnesses before any illness is actually contracted.
Economical and societal effects of food poisoning
There are many costs associated with the contraction of an illness, such as food
poisoning. There are economical costs, as well as physical, emotional, and social costs.

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McLinden et al. evaluated multiple studies that have addressed the variety of costs within the
healthcare field as far as food poisoning goes. The economical costs include drug costs (i.e.
prescriptions), ambulance costs, laboratory costs (i.e. pathogen diagnosis analysis), personnel
costs (i.e. physicians, consultants, specialists, etc.), and hospital service costs (i.e. emergency
room visit, intensive care unit, etc.) (McLinden et al., 5). This study reported indirect costs of
food poisoning as well, such as productivity losses (i.e. sick leave from work to care for self or
others), patient transportation (non-ambulance) costs, and value-of-life costs (i.e. pain and
suffering, risk aversion behaviors, etc.) (McLinden et al., 5).
There are also societal costs related to food poisoning, such as industry costs (i.e. product
recall, farm-related costs, etc.), public health costs (i.e. outbreak investigation costs, prevention,
etc.), legal costs (i.e. product liability suits, insurance-related, etc.), and government and
regulatory costs (McLinden et al., 7). Therefore, this study does address many different costs that
a country and a society can incur due to foodborne illnesses.
Scharff addresses the costs of food poisoning in a more economical sense. Scharff reports
that the average cost per case of foodborne illness is $1,068 in the basic model, and is $1,626 in
the enhanced model (128). Additionally, Scharff estimates that the total health-related cost of
foodborne illness in the United States is $51.0 billion in the basic model, and is $77.7 billion in
the enhanced model (128). The major difference between the basic model and the enhanced
model is that the enhanced model includes costs related to a lost quality of life, but excludes
costs related to own-illness productivity loss (Scharff, 125). Therefore, these differences effect
the actual economical costs of foodborne illness according to this study. This study also showed
that cost varies depending on what pathogen is causing the foodborne illness (Scharff, 127).

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Scharff demonstrates that there are a multitude of factors that affect the economic cost of
foodborne illness.
Conclusion
There are still a lot of unknowns related to food poisoning. There are many different
pathogens causing foodborne illness and there are many cases that go undocumented and
unreported. However, according to the Centers for Disease Control and Prevention there was a
lower number of reported cases of foodborne illness caused by Salmonella in 2013 than there
were in 2010-2012. However, the average still remained at 15.19 cases per 100,000 population,
which is higher than the objective of 11.4 cases per 100,000 population. Additionally, the
incidence of Vibrio infections was higher in 2013 than in 2010-2012.
According to the Centers for Disease Control and Prevention, diagnostic practices testing
for foodborne illness are changing. There are new culture independent diagnostic tests being
used to confirm cases of foodborne illness. These new testing practices could perhaps help the
U.S. do a better job of evaluating and reporting foodborne illness. There are also many
government agencies attempting to educate the general population on how to prevent food
poisoning.
All countries still has a lot of work to do in order to control the spread of foodborne
illness. However, in the U.S. there have been many strides in the education of consumers, which
can help prevent food poisoning and ensure that cases of food poisoning are reported. Also, the
statistical analysis that has been done to show the costs of foodborne illness can help healthcare
professionals and the government understand what needs to be done to lower these costs.

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Therefore, the U.S. is on its way to understanding foodborne illness better and what can be done
about it.

Works Cited

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"Foodborne Illnesses: What You Need To Know." U.S. Food and Drug Administration.
N.p., 29 Jan. 2015. Web. 1 Mar. 2015. <http://www.fda.gov/Food/
ResourcesForYou/Consumers/ucm103263.htm>.
"Food Poisoning." Foodsafety.gov. U.S. Department of Health and Human Services,
n.d. Web. 23 Feb. 2015. <http://www.foodsafety.gov/poisoning/
index.html>.
Scallan, Elaine, et al. "Foodborne Illness Acquired in the United States - Major
Pathogens." Emerging Infectious Diseases 1 Jan. 2011: 7-15. Print.
Argudin, Maria Angeles, Maria Carmen Mendoza, and Maria Rosario Rodicio. "Food
Poisoning and Staphylococcus aureus Enterotoxins." Toxins 5 July 2010:
751-73. Print.
"Foodborne Illness, Foodborne Disease, (sometimes called Food
Poisoning)." Centers for Disease Control and Prevention. N.p., 23 Sept.
2014. Web. 21 Feb. 2015. <http://www.cdc.gov/foodsafety/facts.html>.
Langiano, Elisa, et al. "Food safety at home: knowledge and practices of
consumers." Journal of Public Health 1 July 2011: 47-57. Print.
Kovats, R. S., et al. "The effect of temperature on food poisoning: a
time-series analysis of salmonellosis in ten European countries."
Epidemiology and Infection 12 May 2004: 443-53. Print.

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Vyas, Jatin M. "Food poisoning prevention." MedlinePlus. U.S. National Library
of Medicine and National Institute of Health, 12 May 2014. Web. 20 Feb.
2015. <http://www.nlm.nih.gov/medlineplus/ency/article/001981.htm>.
Arendt, Susan, et al. "Reporting of Foodborne Illness by U.S. Consumers and
Healthcare Professionals." International Journal of Environmental Research
and Public Health 19 Aug. 2013: 3684-714. Print.
McLinden, Taylor, et al. "Component costs of foodborne illness: a scoping
review." BMC Public Health 1 June 2014: 1-12. Print.
Scharff, Robert L. "Economic Burden from Health Losses Due to Foodborne Illness
in the United States." Journal of Food Protection 26 Sept. 2011: 123-31. Print.
"Trends in Foodborne Illness in the United States." Centers for Disease Control
and Prevention. N.p., 8 May 2014. Web. 22 Feb. 2015. <http://www.cdc.gov/
foodborneburden/trends-in-foodborne-illness.html>.