Food Borne Disease Out Break

Foodborne illnesses

Foodborne illnesses are caused by eating food or drinking beverages contaminated with bacteria, parasites, or viruses. Harmful chemicals can also cause foodborne illnesses if they have contaminated food during harvesting or processing. Foodborne illnesses can cause symptoms that range from an upset stomach to more serious symptoms, including diarrhea, fever, vomiting, abdominal cramps, and dehydration.  Most foodborne infections are undiagnosed and unreported, though the Centers for Disease Control and Prevention estimates that every year about 76 million people in the United States become ill from pathogens, or disease-causing substances, in food. Of these people, about 5,000 die.

Common Sources of Foodborne Illness

Sources of illness: Raw and undercooked meat and poultry
Symptoms: Abdominal pain, diarrhea, nausea, and vomiting
Bacteria: Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, Salmonella

Sources of illness: Raw foods; unpasteurized milk and dairy products, such as soft cheeses
Symptoms: Nausea, vomiting, fever, abdominal cramps, and diarrhea
Bacteria: L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, C. jejuni

Sources of illness: Raw and undercooked eggs. Raw eggs are often used in foods such as homemade hollandaise sauce, caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings.
Symptoms: Nausea, vomiting, fever, abdominal cramps, and diarrhea
Bacterium: Salmonella enteriditis

Sources of illness: Raw and undercooked shellfish
Symptoms: Chills, fever, and collapse
Bacteria: Vibrio vulnificus, Vibrio parahaemolyticus

Sources of illness: Improperly canned goods; smoked or salted fish
Symptoms: Double vision, inability to swallow, difficulty speaking, and inability to breathe. Seek medical help right away if you experience any of these symptoms.
Bacterium: C. botulinum

Sources of illness: Fresh or minimally processed produce; contaminated water
Symptoms: Bloody diarrhea, nausea, and vomiting
Bacteria: E. coli O157:H7, L. monocytogenes, Salmonella, Shigella, Yersinia enterocolitica, viruses, and parasites

 Symptoms

In most cases of foodborne illnesses, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include

• abdominal cramps
• nausea
• vomiting
• diarrhea, which is sometimes bloody
• fever
• dehydration

  Causes

When food is cooked and left out for more than 2 hours at room temperature, bacteria can multiply quickly. Most bacteria grow undetected because they don’t produce a bad odor or change the color or texture of the food. Freezing food slows or stops bacteria’s growth but does not destroy the bacteria. The microbes can become reactivated when the food is thawed. Refrigeration also can slow the growth of some bacteria. Thorough cooking is needed to destroy the bacteria.

Risk factors

Some people are at greater risk for bacterial infections because of their age or an unhealthy immune system. Young children, pregnant women and their fetuses, and older adults are at greatest risk.

Complications

Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious symptoms than vomiting and diarrhea. They can cause spontaneous abortion or death.

The most common symptoms of HUS infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 5 to 10 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases. Other symptoms of HUS include fever, lethargy or sluggishness, irritability, and paleness or pallor. In about half the cases, the disease progresses until it causes acute renal failure, which means the kidneys are unable to remove waste products from the blood and excrete them into the urine. A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely.

See a doctor right away if you or your child has any of the following symptoms with diarrhea:

• High fever—temperature over 101.5°, measured orally
• Blood in the stools
• Diarrhea that lasts more than 3 days
• Prolonged vomiting that prevents keeping liquid down and can lead to dehydration
• Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urination, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing rate
• Signs of shock, such as weak or rapid pulse or shallow breathing
• Confusion or difficulty reasoning

Diagnosed

 Your doctor may be able to diagnose foodborne illnesses from a list of what you’ve eaten recently and from results of appropriate laboratory tests. Diagnostic tests for foodborne illnesses should include examination of the feces. A sample of the suspected food, if available, can also be tested for bacterial toxins, viruses, and parasites.

  Treated

Most cases of foodborne illnesses are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. People who experience gastrointestinal or neurologic symptoms should seek medical attention.

 Prevented

Most cases of foodborne illnesses can be prevented through proper cooking or processing of food, which kills bacteria. In addition, because bacteria multiply rapidly between 40°F and 140°F, food must be kept out of this temperature range.

Follow these tips to prevent harmful bacteria from growing in food:

• Refrigerate foods promptly. If prepared food stands at room temperature for more than 2 hours, it may not be safe to eat. Set your refrigerator at 40°F or lower and your freezer at 0°F.
• Cook food to the appropriate internal temperature—145°F for roasts, steaks, and chops of beef, veal, and lamb; 160°F for pork, ground veal, and ground beef; 165°F for ground poultry; and 180°F for whole poultry. Use a meat thermometer to be sure. Foods are properly cooked only when they are heated long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses.
• Prevent cross-contamination. Bacteria can spread from one food product to another throughout the kitchen and can get onto cutting boards, knives, sponges, and countertops. Keep raw meat, poultry, seafood, and their juices away from all ready-to-eat foods.
• Handle food properly. Always wash your hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. Wash your hands after using the bathroom, changing diapers, or touching animals.
• Wash utensils and surfaces before and after use with hot, soapy water. Better still, sanitize them with diluted bleach—1 teaspoon of bleach to 1 quart of hot water.
• Wash sponges and dish towels weekly in hot water in the washing machine.
• Keep cold food cold and hot food hot.
• Maintain hot cooked food at 140°F or higher.
• Reheat cooked food to at least 165°F.
• Refrigerate or freeze perishables, produce, prepared food, and leftovers within 2 hours.
• Never defrost food on the kitchen counter. Use the refrigerator, cold running water, or the microwave oven.
• Never let food marinate at room temperature—refrigerate it.
• Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator.
• Remove the stuffing from poultry and other meats immediately and refrigerate it in a separate container.
• Wash all unpackaged fruits and vegetables, and those packaged and not marked “pre-washed,” under running water just before eating, cutting, or cooking. Scrub firm produce such as melons and cucumbers with a clean produce brush. Dry all produce with a paper towel to further reduce any possible bacteria.
• Do not pack the refrigerator. Cool air must circulate to keep food safe.

For more information about prevention of foodborne illnesses, the U.S. Department of Agriculture provides a fact sheet on safe food handling.

Food irradiation

Food irradiation is the treatment of food with high energy such as gamma rays, electron beams, or x rays as a means of cold pasteurization, which destroys living bacteria to control foodborne illnesses. The United States relies exclusively on the use of gamma rays, which are similar to ultraviolet light and microwaves and pass through food leaving no residue. Food irradiation is approved for wheat, potatoes, spices, seasonings, pork, poultry, red meats, whole fresh fruits, and dry or dehydrated products. Although irradiation destroys many bacteria, it does not sterilize food. Even if you’re using food that has been irradiated by the manufacturer, you must continue to take precautions against foodborne illnesses—through proper refrigeration and handling—to safeguard against any surviving organisms. If you are traveling with food, make sure perishable items such as meats are wrapped to prevent leakage. Be sure to fill the cooler with plenty of ice and store it in the car, not the trunk. If any food seems warmer than 40°F, throw it out.

Disorders Related to Foodborne Illnesses

Chronic disorders that may be triggered by foodborne pathogens are

• arthritis
• inflammatory bowel disease
• kidney failure
• Guillain-Barré syndrome
• autoimmune disorders

U.S. News offers

About 180 people who ate at a Chipotle restaurant near Kent State University in Kent, Ohio, became sick with a gastrointestinal illness, the Akron Beacon Journal reports. Health officials began investigating the outbreak after people started arriving at local emergency rooms complaining of diarrhea, nausea, and severe vomiting.

Many of those affected were Kent State students who had eaten burritos at the restaurant on Thursday and Friday. Some had donated blood and gotten a coupon for free food at the restaurant, according to WLWT, the Cincinnati NBC affiliate.

The cause of the outbreak could be food-borne bacteria—like salmonella—or a norovirus spread by a sick restaurant employee, health officials said. The restaurant chain reopened on Saturday with employees from other store locations, because of concern that a sick employee might be the source of the outbreak. The restaurant also replaced its food supply and sanitized all equipment, according to the Akron newspaper.

Results from testing of food and stool samples are expected in about five days and should help pinpoint the cause of the outbreak, the newspaper reports. Those who think they might have gotten sick after eating at the restaurant should seek medical treatment and call the Kent Health Department at (330) 678-8109.

Binational Foodborne Illness Seminar
Sponsored by EWIDS in collaboration with ISESALUD, USMBHC-Tijuana Section, and COLEF

Date: July 11, 2008
Place: Mario Ojeda Conference Room of the Colegio de la Frontera Norte (COLEF)
Tijuana, Baja California
Time: 8:00AM to 3:00PM

Objective: to enhance the epidemiological capacity in Baja California to not only to recognize a foodborne illness, but also to determine if it is related to bioterrorism. This seminar was a valuable opportunity for public health professionals within the California and Baja California region to learn the impact of foodborne illnesses along the border region.

Presenters Included:

Dr. Angélica Pon Méndez, Chief of Baja California Epidemiology Department

Q.A. Mariana Jiménez Lucas, Sanitary Operations Commission, Federal Commission for the Protection against Sanitary Risk (COFEPRIS)

Dr. Olga L. Henao, National Center for Zoonotic, Vector-Borne, & Enteric Diseases, Centers for Disease Control and Prevention  (CDC)

José Luís Sánchez Osorio, MC, Direction for the Protection against Sanitary Risk, ISESALUD Sanitary Jurisdiction No.3

Dr. Ben Sun, Veterinary Public Health Section, California Department of Public Health

Dr. Martha Lorena Nava, ISESALUD Sanitary Jurisdiction No. 1

Dr. Akiko C. Kimura, Infectious Diseases Branch, California Department of Public Health

The conference was organized by Dr. Angélica Pon Méndez (ISESALUD), Dr. Gudelia Rangel (USMBHC-Tijuana Section/COLEF), and Dr. Martha Vazquez-Erlbeck (EWIDS, San Diego). For further questions regarding this seminar, please contact Dr. Martha Vazquez-Erlbeck, at [email protected].

Emerging Pathogens Institute

Food-borne Diseases

SYMPTOMS and SIGNS

Symptoms of food-borne illness generally include diarrhea and vomiting, and fever may or may not be present. Onset of disease varies greatly with the particular cause of disease. Symptoms can be due either to toxins that are present following the growth of pathogens in the food or to an actual infection that occurs in the intestinal tract after eating food contaminated with live pathogens. Symptoms from pre-formed toxins generally have fairly rapid onset (less than 24 hours) and are more likely to include vomiting. Food-borne infections generally require at least a day or two before symptoms appear, and in some cases may not be apparent for weeks.

In general, disease caused by protozoan parasites shows slower progression compared to those caused by bacteria or viruses. Bloody diarrhea is generally a symptom of more serious food-borne pathogens, such as Escherichia coli or Shigella. Profuse watery diarrhea, such as that presented by cholera, can be rapidly life-threatening due to dehydration and also requires immediate attention. In susceptible persons, with serious underlying conditions that decrease their resistance to infection (HIV, hemochromatosis, liver disease, diabetes) food-borne infections may be more invasive, leaving the intestinal tract to become systemic and produce toxic shock and rapid death. Some of the more serious diseases, such as typhoid fever and cholera, threaten healthy persons and can cause very large epidemics.

TREATMENT/VACCINE AVAILABILITY

Most persons with food-borne illness will recover without treatment. However, prolonged symptoms may lead to dehydration, which can have serious complications, especially in young children. Re-hydrating solutions are available to ensure both the return of both water and essential salts. Vaccines are available for some food-borne pathogens (V. cholerae, Salmonella, Hepatitis virus) but are generally administered to persons at high risk of exposure, such as travelers to countries where these diseases are endemic.

CAUSES and RELEVANCE to FLORIDA

Causes of food- or water- borne diseases include bacteria, viruses, and protozoan parasites. Non-infectious agents called prions transmit Mad Cow disease, but there is no evidence of this problem in US food supply. Viruses are probably the most common cause of food-borne illnesses and are also the one for which we have the least amount of information and protection.

Viral infections generally produce self-limiting disease but can be rapidly spreading and extremely infectious. Florida cruise ships have had well-publicized outbreaks of norovirus (also call Norwalk virus) that has ruined many vacations. Food-borne illnesses are usually transmitted through ingestion of contaminated food or water, but even causal contact with contaminated surfaces may spread this virus. Salmonella and Campylobacter species are probably the most common source of bacterial infections. Parasitic infections are relatively rare in the US, but present a life-threatening concern to persons with compromised immune systems (HIV or the elderly).

The warmer weather in Florida permits more “tropical” pathogens, particularly parasites, to flourish. Also, foods exposed to warmer temperatures or temperature-abuse have increased growth rate of many microorganisms. Most pathogens grow best at body temperature (98.6F) so particular caution is needed when the air temperatures are over 90F. Warmer water temperatures can promote the growth in fish or shellfish of pathogens that may not be present in seafood harvested from cooler waters.

PREVENTION: WASH YOUR HANDS!

Most food- or water-borne pathogens are transmitted by fecal contaminants associated with poor personal hygiene. Particularly in Florida where so many people eat at places away from home and consume food that was handled by numerous preparers and servers, ample opportunity for contamination with feces can occur either before or after cooking. Therefore, hand washing is critical to maintaining safety in the food preparation and restaurant industries. Adequate hand washing for several minutes (sing “Happy Birthday” twice while washing) is required to kill most microbes. Even at home, improper hand washing can spread infection rapidly through the family. Contamination of surfaces with raw food is a common source of disease, and cutting boards and utensils should be cleaned thoroughly.

Food must be maintained at the appropriate temperatures and refrigerated at 4C or below. Thawing of frozen food should be done in the refrigerator, and thawed food should never be re-frozen. After cooking, maintain heat or transfer the food as soon as possible to the refrigerator. Check the sell-by dates on food packages and do not eat any products that show changes in appearance, smell, taste or texture. These changes generally indicate very high levels of bacteria (over 10,000,000) and may be dangerous to eat.

The food industry maintains a safe food environment through the HACCP program that ensures stringent protocols and critical review at each step in the food processing chain. However, awareness of food safety in the home is also essential to maintain safe food. Information about proper storage and treatment of raw and cooked products is available in stores and through many online services, including the Cooperative Extension Service.

Prepared by Anita C. Wright, Ph.D.
Associate Professor of Food Microbiology
University of Florida Food Science and Human Nutrition Department

Foodborne Illness: A Disease for All Seasons, October 27 and 28, 1998, Newark, Delaware

Sponsored by the Public Health Laboratories of Delaware, Maryland, New Jersey, and Pennsylvania and the National Laboratory Training Network, Eastern Office, this seminar will provide up-to-date information on changes in epidemiology in foodborne diseases, emerging infectious organisms, proper food and clinical specimen collection and testing, and strategies to decrease foodborne illness. Speakers will represent the Centers for Disease Control and Prevention, the Food and Drug Administration, Minnesota Department of Agriculture, Minnesota Department of Public Health, and the University of Maryland.

For more information, contact Christine Ford, National Laboratory Training Network, Eastern Office, Delaware Public Health Laboratory; tel.: 302-653-2841; fax: 302-653-2844; e-mail: [email protected].

THE NATIONAL RESEARCH DEPARTMENT OF FOODBORNE DISEASES

“ The National Research Department of Foodborne Diseases (NRDFD) was established in 1999.It has started its activities with elucidating the epidemiology of diarrheal diseases as one of the major foodborne problems as a way to help other researchers and authorities in enhancing more effective preventive measures. This department is recognized as the first research department, investigating outbreaks of foodborne diseases in Iran. The mission of Department of Foodborne Diseases include: developing and promoting the methods for molecular epidemiology and antimicrobial susceptibility of foodborne pathogens in clinical samples and food specimens and also, establishing a research group on “Foodborne Outbreak Investigation.  NRDFD department serves as the national focus for developing and applying foodborne disease prevention and control, environmental health, and health promotion and education activities designed to improve the health condition of the Iranian people.  “

Abstract

In 2002, OzFoodNet continued to enhance surveillance of foodborne diseases across Australia. The OzFoodNet network expanded to cover all Australian states and territories in 2002. The National Centre for Epidemiology and Population Health together with OzFoodNet concluded a national survey of gastroenteritis, which found that there were 17.2 (95% CI 14.5-19.9) million cases of gastroenteritis each year in Australia. The credible range of gastroenteritis that may be due to food each year is between 4.0-6.9 million cases with a mid-point of 5.4 million. During 2002, there were 23,434 notifications of eight bacterial diseases that may have been foodborne, which was a 7.7 per cent increase over the mean of the previous four years. There were 14,716 cases of campylobacteriosis, 7,917 cases of salmonellosis, 505 cases of shigellosis, 99 cases of yersiniosis, 64 cases of typhoid, 62 cases of listeriosis, 58 cases of shiga toxin producing E. coli and 13 cases of haemolytic uraemic syndrome.

OzFoodNet sites reported 92 foodborne disease outbreaks affecting 1,819 persons, of whom 5.6 per cent (103/1,819) were hospitalised and two people died. There was a wide range of foods implicated in these outbreaks and the most common agent was Salmonella Typhimurium. Sites reported two outbreaks with potential for international spread involving contaminated tahini from Egypt resulting in an outbreak of Salmonella Montevideo infection and an outbreak of suspected norovirus infection associated with imported Japanese oysters. In addition, there were three outbreaks associated with animal petting zoos or poultry hatching programs and 318 outbreaks of suspected person-to-person transmission. Sites conducted 100 investigations into clusters of gastrointestinal illness where a source could not be identified, including three multi-state outbreaks of salmonellosis.

OzFoodNet identified important risk factors for foodborne disease infection, including: Salmonella infections due to chicken and egg consumption, bakeries as a source of Salmonella infection, and problems associated with spit roast meals served by mobile caterers. There were marked improvements in surveillance during 2002, with all jurisdictions contributing to national cluster reports, increasing use of analytical studies to investigate outbreaks and 96.9 per cent of Salmonella notifications on state and territory surveillance databases recording complete information about serotype and phage type. During 2002, there were several investigations that showed the benefits of national collaboration to control foodborne disease. Sharing surveillance data from animals, humans and foods and rapid sharing of molecular typing information for human isolates of potentially foodborne organisms could further improve surveillance of foodborne disease in Australia. Commun Dis Intell 2003;27:209-243.

Methods

Population under surveillance

In 2002, the coverage of the network included the entire Australian population, which was estimated to be 19,662,781 persons.⁸

During 2002, OzFoodNet coverage expanded to include the Northern Territory and all of New South Wales. Prior to this, New South Wales had enhanced surveillance only in the Hunter region.

In 2002, the Hunter site continued to operate as a sentinel for foodborne disease occurrence in New South Wales. The Hunter site conducts thorough local investigation and provides a baseline for foodborne disease incidence in New South Wales. In 2002, the population covered by the Hunter site was estimated to be 544,623 persons.

Data sources

Incidence of gastroenteritis

To determine the burden of gastroenteritis in Australia, the National Centre for Epidemiology and Population Health (NCEPH) conducted a cross-sectional survey between September 2001 and August 2002 on behalf of OzFoodNet. A research company used Computer Assisted Telephone Interviews to interview randomly selected individuals from each state and the Northern Territory. The Australian Capital Territory was included in the sample for New South Wales and there was an over sample in the Hunter region. Respondents were asked whether they had diarrhoea or vomiting in the past four weeks, and about the symptoms related to that episode. Interviewers asked people reporting gastroenteritis in the previous month whether they sought medical care, provided a specimen of faeces for testing, were unable to carry out normal daily activities, or missed paid work.

People were considered to have had ‘infectious gastroenteritis’ if they:

• experienced three or more loose stools and/or two or more vomits in a 24 hour period;
• experienced four or more loose stools and/or three or more vomits in a 24 hour period where they had concomitant respiratory symptoms of respiratory illness; and
• did not have any non-infectious causes, such as pregnancy, medications, chronic illness, or alcohol consumption as a cause for their illness.

The results were analysed using a generalised regression estimator method and jackknife approach to estimation of standard errors (P Bell, Household Surveys Facilities, Australian Bureau of Statistics). Data were weighted by state, age, sex, the number of phone lines in the house and household size.

Estimating the burden of foodborne disease

To estimate the burden of foodborne disease we used Australian data from various sources and adopted the approach taken by Mead, et al.³ OzFoodNet considered 28 ‘known’ bacterial, viral and parasitic pathogens that can cause infectious gastroenteritis. To estimate the community incidence of these pathogens in Australia, data from the National Notifiable Diseases Surveillance System and state surveillance systems, from outbreak investigations in Victoria (Joy Gregory, personal communication, November 2002), from laboratories and from published results of a longitudinal study of gastroenteritis in Australia were used.^9,10,11

Using these data, the literature and a Delphi assessment of Australian foodborne disease specialists, OzFoodNet estimated the proportion of gastroenteritis that was foodborne for each pathogen.¹² It was assumed that the proportion of gastroenteritis due to foodborne transmission among the ‘unknown’ agents was the same as for ‘known’ agents. The estimate of the proportion of foodborne among all these known pathogens was then used as proxy for estimating the proportion of all infectious gastroenteritis that was foodborne.

To account for inherent uncertainty in the data the potential distribution of the estimates were simulated to give credible intervals, similar to Bayesian inferential techniques.¹³ OzFoodNet calculated the credible interval of foodborne disease for a ‘typical year in Australia-2000’.

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Rates of notified infections

All Australian states and territories require doctors and/or pathology laboratories to notify patients with infectious diseases that are important to public health. Western Australia is the only jurisdiction where laboratory notification is not mandatory under legislation, although most laboratories still notify the health department. OzFoodNet aggregated and analysed data on patients notified with the following diseases or conditions, a proportion of which may be acquired from food:

• Campylobacter infections;
• Salmonella infections;
• Listeria infections;
• Yersinia infections;
• shiga toxin producing E. coli infections and haemolytic uraemic syndrome;
• typhoid; and
• Shigella infections.

To compare disease to historical totals, OzFoodNet compared crude numbers and rates of notification to the mean of the previous four years. Where available, numbers and rates of notifications for specific sub-types of infecting organisms were compared to notifications for the previous year.

To calculate rates of notification the estimated resident populations for each jurisdiction for June 2002, or the specified year, were used.⁸ Age specific rates for notified infections in each jurisdiction were calculated.

The date that notifications were received was used throughout this report to analyse notification data. These data are similar to those reported to the National Notifiable Diseases Surveillance System, but individual totals may vary with time and due to different approaches to analysis.

Gastrointestinal and foodborne disease outbreaks

OzFoodNet collected information on gastrointestinal and foodborne disease outbreaks that occurred in Australia during 2002. The reports collate summary information about the setting where the outbreak occurred, the month the outbreak occurred, the aetiological agent, the number of persons affected, the type of investigation conducted, the level of evidence obtained and the food vehicle responsible. To summarise the data, OzFoodNet categorised the outbreaks by aetiological agents, food vehicles and settings where the outbreak occurred. Data on outbreaks due to transmission from animals and cluster investigations were also summarised.

Risk factors for infection

To identify risk factors for foodborne infection in Australia, OzFoodNet reviewed summary data from outbreaks that occurred in 2002 and compared them to previous years. Data from several complementary OzFoodNet studies of foodborne illness in Australia were also examined.

Surveillance evaluation and enhancement

To identify areas where improvements to surveillance are critical, OzFoodNet compared the results of surveillance across different sites, including rates of reporting outbreaks, and investigation of clusters of Salmonella. To measure how well jurisdictions conducted surveillance for Salmonella OzFoodNet examined the completeness of information contained on state and territory databases in 2002. The proportion of notifications with serotype and phage type information were compared with results for the previous two years.

References:

American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606–6995
Consumer Nutrition Hotline: 1–800–877–1600
Internet: www.eatright.org

Center for Food Safety and Applied Nutrition
5100 Paint Branch Parkway
College Park, MD 20740–3835
Food Information Line: 1–888–SAFEFOOD (723–3366)
Internet: www.cfsan.fda.gov

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Phone: 1–800–311–3435 or 404–639–3534
Internet: www.cdc.gov

Gateway to Government Food Safety Information
Internet: www.foodsafety.gov

Partnership for Food Safety Education
50 F Street, NW, 6th Floor
Washington, DC 20001
Phone: 202–220–0651
Internet: www.fightbac.org

U.S. Department of Agriculture
1400 Independence Avenue SW
Washington, DC 20250
Meat and Poultry Hotline: 1–888–674–6854
Internet: www.usda.gov

U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
Phone: 1–877–696–6775 or 202–619–0257
Internet: www.os.dhhs.gov

U.S. Environmental Protection Agency
Ariel Rios Building
1200 Pennsylvania Avenue NW
Washington, DC 20460
Phone: 202–272–0167
Internet: www.epa.gov

U.S. Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857–0001
Phone: 1–888–INFO–FDA (463–6332)
Internet: www.fda.gov