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A matched case-control study in Quebec, Canada, evaluated consumption of veal liver as a risk factor for campylobacteriosis. Campylobacter was identified in 28 of 97 veal livers collected concurrently from slaughterhouses and retailers. Veal liver was associated with human Campylobacter infection, particularly when consumed undercooked.

The growing popularity of unpasteurized milk in the United States raises public health concerns. We estimated outbreak-related illnesses and hospitalizations caused by the consumption of cow’s milk and cheese contaminated with Shiga toxin–producing Escherichia coli, Salmonella spp., Listeria monocytogenes, and Campylobacter spp. using a model relying on publicly available outbreak data. In the United States, outbreaks associated with dairy consumption cause, on average, 760 illnesses/year and 22 hospitalizations/year, mostly from Salmonella spp. and Campylobacter spp. Unpasteurized milk, consumed by only 3.2% of the population, and cheese, consumed by only 1.6% of the population, caused 96% of illnesses caused by contaminated dairy products. Unpasteurized dairy products thus cause 840 (95% CrI 611–1,158) times more illnesses and 45 (95% CrI 34–59) times more hospitalizations than pasteurized products. As consumption of unpasteurized dairy products grows, illnesses will increase steadily; a doubling in the consumption of unpasteurized milk or cheese could increase outbreak-related illnesses by 96%.

Our findings do not warrant rejecting the hypothesis that outbreak and sporadic illnesses are similar. Comparing Sporadic and Outbreak Foodborne Illness, Outbreak data have been used to estimate the proportion of illnesses attributable to different foods. Applying outbreak-based attribution estimates to nonoutbreak foodborne illnesses requires an assumption of similar exposure pathways for outbreak and sporadic illnesses. This assumption cannot be tested, but other comparisons can assess its veracity. Our study compares demographic, clinical, temporal, and geographic characteristics of outbreak and sporadic illnesses from Campylobacter, Escherichia coli O157, Listeria, and Salmonella bacteria ascertained by the Foodborne Diseases Active Surveillance Network (FoodNet). Differences among FoodNet sites in outbreak and sporadic illnesses might reflect differences in surveillance practices. For Campylobacter, Listeria, and Escherichia coli O157, outbreak and sporadic illnesses are similar for severity, sex, and age. For Salmonella, outbreak and sporadic illnesses are similar for severity and sex. Nevertheless, the percentage of outbreak illnesses in the youngest age category was lower. Therefore, we do not reject the assumption that outbreak and sporadic illnesses are similar.

Overall incidence of foodborne gastroenteritis declined but remains high, and the incidence of salmonellosis and campylobacteriosis increased., Foodborne disease is a major public health problem worldwide. To examine changes in foodborne illness in Australia, we estimated the incidence, hospitalizations, and deaths attributed to contaminated food circa 2010 and recalculated estimates from circa 2000. Approximately 25% of gastroenteritis cases were caused by contaminated food; to account for uncertainty we used simulation techniques to estimate 90% credible intervals. We estimate that circa 2010, 4.1 million foodborne gastroenteritis cases occurred, and circa 2000, 4.3 million cases occurred. Circa 2010, contaminated food was estimated to be responsible for 30,840 gastroenteritis-associated hospitalizations, 76 associated deaths, and 5,140 nongastrointestinal illnesses. Cases of salmonellosis and campylobacteriosis increased from 2000 to 2010 and were the leading causes of gastroenteritis-associated hospitalizations; Listeria monocytogenes and nontyphoidal Salmonella spp. infections were the leading causes of death. Although the overall incidence of foodborne illnesses declined over time in Australia, cases of foodborne gastroenteritis are still common.

During an investigation of an outbreak of gastroenteritis caused by Salmonella enterica serovar Paratyphi B variant L(+) tartrate(+), we identified unpasteurized tempeh as a novel food vehicle and Rhizopus spp. starter culture as the source of the contamination. Safe handling of uncooked, unpasteurized tempeh should be emphasized for prevention of foodborne illnesses.

Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998–2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne ill ness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.

Most dairy-associated outbreaks occurred in states that permitted sale of these products., Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993–2006. We found 121 outbreaks for which the product’s pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product–associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number (≈150× greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons

The risk for illness associated with raw milk consumption is far greater than previously realized., Raw milk has frequently been identified as the source of foodborne illness outbreaks; however, the number of illnesses ascertained as part of documented outbreaks likely represents a small proportion of the actual number of illnesses associated with this food product. Analysis of routine surveillance data involving illnesses caused by enteric pathogens that were reportable in Minnesota during 2001–2010 revealed that 3.7% of patients with sporadic, domestically acquired enteric infections had reported raw milk consumption during their exposure period. Children were disproportionately affected, and 76% of those

Surveillance was enhanced and a retrospective interview study performed in 1998-99 to determine incidence, causes, and costs of foodborne illnesses in Uppsala, Sweden. Sixty-eight percent of the detected foodborne illness incidents were single cases, and 32% were outbreaks. Most (85%) of the incidents came to the attention of the municipal authorities through telephone calls from affected persons. Calicivirus, Campylobacter spp., and Staphyloccocus aureus were the most common etiological agents; meat, meat products, and mixed dishes were the most implicated food categories. The incidence of foodborne illness was estimated to be 38 cases per 1,000 inhabitants per year. The estimated average costs per illness were 2,164 Swedish Krona (SEK) ($246) to society and 500 SEK ($57) to the patient. The annual cost of foodborne illnesses in Sweden was estimated to be 1,082 million SEK ($123 million).

To the Editor: Clostridium difficile is a toxigenic enteropathogen responsible for 15%–20% of antimicrobial drug–associated diarrhea and for almost all cases of pseudomembranous colitis. Two protein toxins (TcdA and TcdB) play a major role in the pathogenesis of infections. C. difficile is also recognized as a cause of disease in several animal species, which could be potential reservoirs (1). In the past few years, the presence of C. difficile in raw diets for dogs and cats and in retail meat sold for human consumption has been reported in the United States and Canada at rates from 6% to 42% (2–5). To determine C. difficile contamination of meat in France, we evaluated 105 packages of ground beef (vacuum packed or not), 59 pork sausages, and 12 packages of feline raw diet meat purchased from 20 urban and suburban Paris retail stores and supermarkets during September 2007–July 2008. C. difficile spores or vegetative forms in samples were found as described by Rodriguez-Palacios et al. (4). Briefly, 5 g of each samplewas cultured in 100 mL of prereduced brain–heart infusion (BHI) broth supplemented with cefoxitin (10 µg/mL), cycloserine (250 µg/mL), and taurocholate (0.1%). After the samples were incubated under anaerobic conditions at 37°C for 72 h, subculturing with and without alcohol shock for spore selection was performed. The BHI broth culture was treated with 2 mL of absolute ethanol (1:1 vol/vol) for 30 min and centrifuged at 3,800 × g for 10 min, and the pellet was resuspended in 200 µL of prereduced BHI broth. Serial dilutions of the BHI broth and the pellet were injected onto Columbia cysteine agar supplemented with cefoxitin-cycloserine, taurocholate, and 5% horse blood and incubated anaerobically for 48 h at 37°C. C. difficile colonies were identified classically, and susceptibilities to moxifloxacin, teicoplanin, vancomycin, metronidazole, linezolid, levofloxacin, telithromycin, erythromycin, and lincomycin were determined by the agar disk-diffusion methods described by the French Society for Microbiology (www.sfm.asso.fr). PCR amplifications of a species-specific internal fragment of the triose phosphate isomerase (tpi) gene, an internal fragment of the toxin B (tcdB) gene, and the 3′ region of the toxin A (tcdA) gene were performed as described by Lemee et al. (6). Strains were characterized by toxinotyping according to Rupnik et al. (7) and PCR-ribotyping as described by Bidet et al. (8). The detection threshold of the enrichment method was established by spiking known uninfected samples (ground beef, pork sausage, and feline raw diets) with vegetative cells and spores of C. difficile (VPI 10463 strain). For ground beef samples, the detection thresholds for vegetative forms and spores were 2 CFU/5 g and 4.5 CFU/5 g of meat, respectively. For pork sausages, the detection thresholds were 14 CFU/5 g and 38 CFU/5 g of sample after 72 h, for vegetative forms and spores, respectively. For feline raw diets, the detection threshold of spores was 2 CFU/5 g of sample. In addition, toxin B was detected in the culture supernatants by the cytotoxicity assay onto MRC-5 cells. Toxin detection showed 100% agreement with the culture method. C. difficile was not detected in pork sausages or in commercial feline raw diets. C. difficile was isolated from 2 (1.9%) of 105 ground beef, but only from those packages that were vacuum packed. The anaerobic atmosphere of vacuum packaging could facilitate the survival of C. difficile and the germination of spores. These 2 isolates were fully susceptible to moxifloxacin, teicoplanin, vancomycin, metronidazole, and linezolid but resistant to levofloxacin, telithromycin, erythromycin, and lincomycin. They harbored genes encoding for Tpi protein and for TcdA and TcdB. The 2 strains belonged to the toxinotype 0 and PCR-ribotype 012. Toxinotype 0 was already identified in meat samples in Canada (4). PCR-ribotype 012 belongs to the 10 ribotypes most frequently isolated from humans (9). The prevalence of C. difficile in ground meat in France is low compared with the prevalence reported by other countries. In Canada, Rodriguez-Palacios et al. (4) studied 60 beef samples and found the prevalence of C. difficile to be 20%. These same authors, by using a broader sampling scheme (214 meat samples), isolated C. difficile from 6% of the samples (5). Also in Canada, Weese et al. (10) reported that 12% of ground beef and ground pork samples were contaminated. In the United States, C. difficile was isolated from 42% of meat samples (beef, pork, and turkey products) (3). For a better understanding of the sources of C. difficile in France, it would be interesting to determine its prevalencein different animal fecal samples and the toxinotypes associated with animals. The low prevalence in retail meat in France could result from hazard analysis critical control point principles and microbiologic quality controls implemented throughout the food production chain, which help reduce the spread of C. difficile and minimize the risk for infection for the consumer.