13 



small fraction of the actual number of outbreaks that occur, so we 

 cannot measure the precise size of the problem of foodborne dis- 

 ease. Secondly, we cannot compare the frequency of foodborne dis- 

 ease outbreaks in one area with another area because the investi- 

 gative ability of the State and local health departments vary great- 

 ly. For example, the State of Washington reports a relatively large 

 number of outbreaks of foodborne disease, but that does not mean 

 that Washington has a lot more outbreaks than other States. 

 Washington is just better at investigating the outbreaks. Third, the 

 relative importance of the various foodborne pathogens and toxins 

 is unclear because some outbreaks are more likely to be reported 

 than others. Reported outbreaks are more likely to be large, inter- 

 state, restaurant-associated, involve serious illness or death, and 

 have short incubation periods. These are the ones that get atten- 

 tion. Fourth, a final limitation of the surveillance system is that it 

 only detects outbreaks, and most foodborne disease occurs as single 

 sporadic cases. 



In collaboration with the National Marine Fisheries Service and 

 FDA, we have analyzed foodborne disease outbreaks reported be- 

 tween 1973 and 1991. Keeping in mind the many limitations of 

 these data which I have just gone over, these are the overall re- 

 sults: During this period of 19 years there were 4,591 outbreaks of 

 disease reported in which the causative food was known. These out- 

 breaks affected 202,850 persons. Seafood accounted for 5 percent of 

 the foodborne outbreak associated cases compared to 10 percent for 

 poultry, 9 percent for beef, and 2 percent for eggs. 



How can surveillance be improved to help control seafood-related 

 and other foodborne diseases? First, we need to have nationwide 

 rapid reporting and analysis of foodborne disease. The current 

 system is very slow and usually runs several years behind. CDC 

 has developed a computer-based data reporting and management 

 system which permits public health laboratories to report electroni- 

 cally and is working with State public health lab directors in in- 

 stalling the system in all public health laboratories right now. 



Second, simply making the existing surveillance system more 

 complete and more rapid is not enough. We also need to have a 

 sentinel surveillance system, with a few sentinel sites throughout 

 the country where the epidemiologic and laboratory resources have 

 been improved to allow intensive surveillance and investigation of 

 foodborne disease. With such sites, we can more completely identify 

 foodborne hazards, characterize their risk, help set foodborne dis- 

 ease prevention priorities, and evaluate the effectiveness of food 

 safety programs and the impact of regulatory change. 



To conclude, CDC collaborates with FDA, National Marine Fish- 

 eries Service, USDA, and State and local authorities in responding 

 to food safety issues. Improving food safety and meeting emerging 

 foodborne disease problems in the 21st Century will require 

 changes in our surveillance program. Thank you for the opportuni- 

 ty to testify before the Committee. I will be happy to answer any 

 questions you may have. 



[The statement of Mr. Blake can be found at the end of the hear- 

 ing.] 



Mr. Manton. Thank you. Dr. Blake. 



