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development of Hazard Analysis Critical Control Point plans for 

 all foods and menu items. In the short term, effective 

 prevention programs would include geographically and 

 demographically representative sites for intensive surveillance 

 and investigation of acute human illness due to currently 

 recognized high-priority foodborne pathogens. Food microbiologic 

 assessment coordinated with these efforts and foodborne disease 

 outbreak investigations will generate data useful in the dose- 

 response and exposure assessment phases of risk assessment. 

 Collaborative investigations involving FDA, CDC, and state health 

 departments on some foodborne infections, such as listeriosis, 

 salmonellosis, campylobacteriosis, and Vitprio infections, have 

 provided knowledge and experience with active surveillance 

 programs . 



In the longer term, to identify foodborne hazards more 

 completely, characterize their risk, and help set foodborne 

 disease prevention priorities, an expanded active surveillance 

 program would be necessary to include additional infectious and 

 noninfectious hazards, rapidly identify and characterize new and 

 emerging foodborne hazards, and investigate chronic, as well as 

 acute, adverse health effects. Long-term active surveillance and 

 investigation could also be used to evaluate the effectiveness of 

 food safety programs and the impact of regulatory change. 



These activities would permit the comparison of seafood- 

 related hazards with hazards associated with other foods. We 

 could determine which types of seafood were associated with which 

 pathogens by focusing attention on pathogens known or suspected 

 to be transmitted by seafood, such as vibrios (e.g., V. cholerae 

 01 and non-01, and V. parahaemolyticus) , Plesiomonas 

 shigelloides, and some viruses (Norwalk agent, hepatitis A). 

 Subsequently, by comparing seafood eaters who became ill with 

 control seafood eaters who did not become ill, we should be able 

 to learn about the factors which contributed to making the 

 seafood a vehicle for disease, including source, handling between 

 harvest and preparation, method of preparation, 

 cross -contamination during preparation or storage after 

 preparation, and such host factors as underlying diseases and 

 lack of gastric acid. 



We are already performing such studies on a limited scale. 

 Several years ago, CDC and the Louisiana Department of Health and 

 Hospitals conducted a study that successfully identified several 

 factors in the preparation and storage of crabs which contributed 

 to cholera. CDC, in collaboration with FDA and state health 

 officials in Alabama, Florida, Louisiana, Mississippi, and Texas 

 also conducts a special surveillance program for vibrios, 

 organisms invariably linked to seafood or the marine environment. 

 Although this reporting system is passive and probably detects 

 only a small proportion of infections, it has provided important 

 information on how to protect the public from infections with 

 vibrios. CDC, FDA, and state health officials in Louisiana and 

 Texas are also collaborating on an active surveillance project 

 that will attempt to compare the relative importance of various 

 foods in the transmission of foodborne infections with 

 Salmonella, Campylobacter, and Vibrio in the Gulf Coast region. 

 Such studies currently provide information on limited regions of 

 the country and include a limited array of foods and foodborne 

 pathogens . 



Foodborne diseases continue to be a major and growing public 

 health problem in the United States, producing millions of 

 illnesses and thousands of deaths in this country every year. A 

 1991 report of the National Academy of Sciences that summarized 

 data from CDC and other sources found that seafood available to 

 consumers in the United States causes illness only infrequently, 

 foodborne hazards continue to exist in all of our food 

 commodities, including seafood. The authors concluded that 

 continuing efforts are needed to improve our understanding of 



