Press Briefing Transcript

CDC Vital Signs: Food Safety and 2010 FoodNet Data

Tuesday, June 7, 2011 – 12:00pm ET

• Audio recording (MP3, 8.70MB)

Operator: Welcome and thank you for standing by. At this time all participants are in listen-only mode. During the question and answer session you may press star 1 to ask a question. Today's conference is being recorded and at this time I'll turn the call over to Mr. Tom skinner. You may begin, sir.

Tom Skinner: Thank you, Shirley, and thank you all for joining us today for this telebriefing on a Vital Signs report that the CDC is releasing today on incidents and trends of foodborne disease. With us today are three principals to discuss this issue. We have Dr. Thomas Frieden, the director of the centers for disease control and prevention. Mr. Michael Taylor, who's deputy commissioner for foods at the food and Drug administration. And Dr. Elisabeth Hagen, the undersecretary for food safety at the United States department of agriculture. Each will provide brief opening remarks, and then we will move to question and answers. So I will turn it over to Dr. Frieden at this time.

Tom Frieden: Thank you very much for joining us. And thank you to my colleagues at the FDA and USDA for being on the call and also for having been part of the process, both of developing the information and of implementing measures to prevent foodborne illness. The bottom line today is that foodborne illness, particularly Salmonella, is still far too common. It costs hundreds of millions of dollars in medical costs each year and continued investments at the federal, state, and local levels are essential to continue to enhance our ability to detect, respond to, and prevent foodborne illness. I'm sure there may be questions about what's going on in Europe now. So I just want to make a couple of points at the outset. As you know, the outbreak in Germany serves as a reminder of the challenges posed by foodborne disease. The CDC is working with states in this country to identify cases in the U.S. We have identified four individuals who traveled to Germany and appear to have the disease in the U.S. We have not identified additional cases. We have not identified spread from any of those individuals. We have not identified anyone who's become ill in this country from products that might have been consumed from elsewhere. The food and Drug administration oversees safety of food in the U.S. And we will continue to monitor closely as well as to continue to offer technical support and assistance if and as requested by our colleagues in Germany and in Europe.

Turning to today's report, the Vital Signs report, which I would note was actually scheduled about a year in advance. So it's not related to the recent outbreak. The Vital Signs report notes that there are nearly 50 million people per year who become ill from food in the U.S. That's about 1 in 6 Americans. There are an estimated 128,000 hospitalizations from foodborne illness and about 3,000 deaths per year. Salmonella is the single most important foodborne disease now. And some of the materials provide information about how widespread and how broad the risk of Salmonella is. It's not only eggs and poultry but also other products, pork as well as fruit and vegetables and beef. So a wide variety of products can be sources of Salmonella, which makes control more difficult but still possible. There is real progress that we've made. So you can see that there is a reduction in the deadliest infection, E. coli 0157:h7 by about half and an overall reduction over the past decade or so of about 23% in six key pathogens. We think this is a real decline in foodborne illness. But still, we need to do more because illness remains too common. Reducing Salmonella infections by a quarter would save more than $400 million per year in direct medical costs. Prevention is going to require action from the farm to the table. From production—and we saw through the egg contamination event recently how widespread that can be to manufacturing. And we saw to everything from peanut butter to other products that manufacturing can be an issue, to preparation and consumption in restaurants and grocery stores and distribution and delivery ensuring refrigeration to home preparation and consumption.

At every step in that table there is a responsibility that applies to individuals, to corporations, and to governments. I think people have a right to expect that their government will do everything reasonable and possible to prevent their food from being contaminated. State and local governments have a responsibility to meticulously monitor for infectious diseases and rapidly detect them so they can control outbreaks and trace them to the source. Industry and restaurants have a responsibility to good manufacturing practices and to adherence with all laws and regulations. And individuals have a responsibility to themselves and their family and their communities to keep food clean and prevent the burden of preventable foodborne illness. So with that I'll now turn it over to Mike Taylor from the FDA. Mike?

Mike Taylor: Thank you, Dr. Frieden. And I'm glad to be here with you and Dr. Hagen. And welcome all on the call. I first want to thank CDC for its continuing work on FoodNet, which really is the best metric that we have for determining whether we are making progress in reducing foodborne illness. The 2010 FoodNet data released today show that we still have a lot of work ahead to address the threat of foodborne illness in the United States, as you explained, Dr. Frieden. In particular, as you note, the incidence of Salmonella has not declined. We know that Salmonella is a big challenge because it is spread through many foods and through non-food sources as well. And while poultry and eggs are most often associated with Salmonella, we know that dairy products, fruits and vegetables, and even nuts can be vehicles for transmission. And that is why it will take more than one intervention to bring the incidence of Salmonella infection down.

Fortunately, FDA is making significant changes to address Salmonella and other food safety hazards under the recently enacted food safety modernization act. The new law mandates preventive controls in all food processing facilities. It requires science-based minimum standards for the safe production and harvesting of fruits and vegetables. And the law provides—or makes importers responsible for ensuring that their foreign suppliers have adequate preventive controls in place. We're now in the process of implementing these and other provisions contained in this law. In addition, we continue to focus on Salmonella by implementing the shell egg safety rule, which requires preventive measures during the production of eggs in poultry houses and also requires refrigeration during storage and transportation. The requirements of this egg safety rule became effective last July, a year ago, for the largest egg producers, representing about 80% of production. Smaller producers have until next July, 2012, to comply with the requirements. But when fully implemented, we expect the rule, the egg safety rule to reduce the number of Salmonella and derivatives infections from eggs by nearly 60%. The tragic E. coli outbreak in Europe of course reminds us that investing in prevention of food safety problems is ultimately the only way to provide the protection that consumers expect and to avoid the economic and social disruption caused by foodborne illness. The food safety modernization act provides a framework, we think, for that investment. We need to invest in science, to understand the hazards and how best to prevent them. We need to train our field force in new inspection techniques and provide technical assistance and guidance to industry, especially smaller firms. And we need to invest in leveraging state and local resources, as Dr. Frieden indicated, and in building a new import oversight system for global sized food supply. By focusing on prevention and making these investments, we can reduce foodborne illness and we can maintain public confidence in our food supply. Thank you. And again, I will—I'm glad to be here with my colleagues and pass the baton to Dr. Hagen.

Elizabeth Hagen: Thanks, Mike. And thanks, Tom. We appreciate your leadership as we work together to address these very important topics vital to the health of the American public and to the economy. This report outlines some great progress that we've made in reducing foodborne illness, but it also demonstrates, as everybody has said, we have a lot more work to do. 1 in 6 Americans will get sick this year from the food that we eat. That is not acceptable to consumers, and it is not acceptable to us. And that is why we are pursuing a prevention-based strategy to make food as safe as possible.

Today I'd like to take a few minutes to talk about some of the policies that USDA, specifically the food safety and inspection service, has implemented that have produced real results for consumers as well as initiatives that we're working on now that are going to keep moving us forward toward a safer food supply. USDA, FDA, and CDC along with help from consumers and the industry have made great strides in reducing E. coli 0157:h7 illnesses. As the report points out, 0157:h7 illnesses have declined by nearly half over the last 14 years and in the last two years the nation's public health objective has been met. This success is due in large part to the prevention-based beef safety policies that we've advanced at USDA. But we're taking more steps to build upon the gains we've made. We're looking at how best to move prevention upstream at meatpacking plants so less risk will need to be handled down the line. We're improving our trace-back policies so we can identify sources of contamination quickly, not just during outbreaks but before contaminated food ever reaches consumers. We're improving our laboratory testing and we're sampling a broader range of source materials that go into ground beef. And we recently announced companies could not release products into commerce until USDA's test results are negative. The progress we've made in controlling 0157:h7 has prevented thousands of illnesses. However, we're continuing to explore ways to further protect consumers from this and other threats in the beef supply. Science and data and the pathogens themselves evolve, and we must do the same if we're going to keep pace with emerging threats. While making progress and reducing harmful E. coli in beef is certainly a top priority, as today's report points out we have a lot of work to do when it comes to Salmonella. That work includes collecting more data about which foods are most associated with Salmonella illnesses as well as driving the industry to continue their progress in reducing contamination. Several years ago USDA implemented performance standards for the poultry industry. These standards led to major improvement in Salmonella contamination rates in poultry.

However, too many people still get sick with Salmonella from food, and we need to continue to raise the bar and to make improvements. That's why in March of this year USDA announced new performance standards aimed at further reducing Salmonella and Campylobacter in young chickens and turkeys. This policy will prevent an estimated 25,000 illnesses early and result in hundreds of millions of dollars in economic benefit from reduction in health care costs and we will soon expand a program that incentivizes industry to collect and provide USDA more data and to improve process control. FSIS is also making an unprecedented effort in improving communication with consumers. Because we understand that until the food safety system is perfect it is our responsibility to empower consumers with information about risk and what steps they can take to reduce that risk. As an example, just last month USDA launched mobile Ask Karen, a mobile-based application that instantly answers food safety questions. And later this month we will together with CDC launch a multilingual ad campaign aimed at changing food-handling behaviors. The list goes on. Food safety is achieved by making sure that appropriate safeguards are in place at every step along the process. And it is achieved by having everyone involved focused on one singular role, protecting consumers. At FSIS we are dedicated to preventing foodborne illness. Nothing will divert us from that mission. I'm sure that I can safely speak for this group in saying that we all do the work that we do because more than 300 million Americans count on us. Real people, real families. And we must get this right. That's why I, Secretary Vilsack, and the 10,000 employees at the food safety and inspection service, are committed to doing every day.

Tom Skinner: Okay, Shirley, I think we're ready for questions. And I'll remind our speakers to identify themselves prior to answering questions. So Shirley, first question, please.

Operator: Yes, thank you, we will now begin the question and answer session. If you would like to ask a question, please press star 1 and record your name quickly. Again, press star 1 to ask a question. And our first question comes from Mike Stobbe with the Associated Press.. You may ask your question.

Mike Stobbe: Hi. Thank you for taking the question. Two questions. First, the egg outbreak last year, do you know what percentage of the Salmonella cases from these ten states is attributable to that particular outbreak? And I had a second question about vibrio for Dr. Hagen. I was wondering. You see that vibrio keeps increasing year after year. I was wondering if USDA, if that's your jurisdiction. If not FDA, the question's for is doing anything in the way of added protections regarding vibrio?

Tom Frieden: Thank you. I'll take the first question. This is tom Frieden. The large outbreak last year was of course greatly curtailed by the recall of more than half a billion eggs. And the number of cases didn't account for the slight increase in Salmonella last year in the food net system. Dr. Hagen?

Elizabeth Hagen: Thanks for the question on vibrio. Vibrio is a pathogen that's generally associated with seafood. That is in fact outside of the jurisdiction of the USDA. So I'll ask if Mr. Taylor can—

Mike Taylor: Yep. I will happily take that question. FDA regulates shellfish including oysters, which is the primary food to which vibrio infections are attributed, through a cooperative program with the states and the oyster industry through something called the interstate shellfish sanitation conference. We've been working with that group for a number of years on both regulatory standards for the safety of the water from which oysters are harvested but also handling practice that would reduce the incidence of infection. It's been a challenging problem to solve. We're looking at additional approaches including various approaches to post-harvest processing of oysters. So there's substantial ongoing work to deal with this incidence. The number of cases in absolute terms is small but the rate of death among cases involving vulnerable populations is very high. So it's a significant problem. And we're working to make progress on it.

Operator: Thank you. Our next question comes from Richard Knox with National Public Radio. You may ask your question.

Richard Knox: Thanks. A couple of things, if I may. First on Salmonella, are the estimated annual 1.2 million Salmonella infections based upon reported cases, or does the figure take into account the 29 out of every 30 that are not reported? And I have a second question.

Tom Frieden: Okay. I'll turn to Dr. Chris Braden, who's the director of our foodborne, waterborne, and environmental disease unit.

Chris Braden: Yes. Thank you. This is Chris Braden. The numbers that are reported in FoodNet are those that are laboratory confirmed in FoodNet sites. And if people remember, the FoodNet sites are partners in ten state health departments around the country. FoodNet covers about 15% of the U.S. Population. And what they do in those sites is they actually go and audit clinical laboratory records for hospitals in their area to determine those infections that are diagnosed in those hospital laboratories and report that through that surveillance system. We think it is accurate, but by no means is it complete in that there are a lot of people who either do not go to their doctors or if they go to the doctor's don't have a sample taken for testing that go undiagnosed. But the FoodNet numbers that are reported are laboratory confirmed.

Tom Skinner: Follow-up question, Dick?

Richard Knox: Just to be clear on that one, so we should really—the real suspected incidence of Salmonella infections is 29 times higher than that?

Chris Braden: Earlier this year, if you remember, we published the estimates of foodborne illnesses in the United States. And so the estimated total numbers of Salmonella is approximately 1.2 million per year.

Tom Skinner: Dick, you had one follow-up question?

Operator: One moment, please.

Richard Knox: Non-0157 E. coli cases. Is the reason for the sparse data is testing isn't done for non-0157? And are children more likely to be tested, and so does that explain why—if children have a higher incidence of non-0157 E. coli cases than 0157, does that suggest that they're tested more often and therefore the general population may now have a higher incidence of non-0157 than 0157?

Chris Braden: This is Chris Braden speaking again from CDC. A couple—I heard a couple of questions there. Let me start by the issue about the diagnosis of non-0157 shiga toxin-producing E. coli. They are more difficult to produce than, for instance, the shiga toxin-producing E. coli and surely more than the other common pathogens like Salmonella. There are tests that are being promoted for clinical use to be able to screen for them. But actually, it is reference laboratories at state departments of health or at the federal level that actually are needed to fully identify them. So they are more difficult to handle. And that is one of the reasons why we think that there is so much underreporting of non-0157 shiga toxin-producing E. coli. The increase that's been seen in FoodNet we think is probably this artifact of an increase in diagnosis and reporting over time. For the first time this year we're seeing more non-0157 shiga toxin-producing E. coli than the 0157 strains. And we think that that's probably been the case all along, that these other organisms are likely to be more common. As for who gets these infections, there's probably some aspect of parents more likely to take a child to caregivers and those caregivers taking the careful time to make the diagnosis for a young child. That may be part of it. But there is, we think, also an increased risk for children of these infections and also the tragic result of some of these infections like the hemolytic uremic syndrome that we're seeing in Germany that leads to kidney failure. The young children, especially those under 5, are at greater risk of both infection and the severity of the disease.

Tom Skinner: Next question, Shirley, please.

Operator: And our next question comes from William Neuman with the New York Times. You may ask your question.

William Neuman: Hi. I have questions about two groups of pathogens. I just want to ask about Salmonella first, then I have a question about the non-0157. Dr. Frieden, I don't understand your answer about how last year's egg outbreak cannot somehow be reflected in the increase in Salmonella last year. There were almost 2,000 reported cases, and we were told repeatedly that this was one of the largest Salmonella outbreaks ever reported in this country. So how could that not be reflected in last year's increase in FoodNet?

Tom Frieden: I'll ask Chris Braden for that, to address that.

Chris Braden: Yeah, Chris Braden again from CDC. So yes, there is some reflection in there. But remember the background of Salmonella that we're talking about. You know, we're talking about tens of thousands of Salmonella cases. And so would the outbreak last year account for the 10% increase we've seen more recently in all of Salmonella? There's some of that there. But it probably doesn't account for all 10%. And I think that's the takeaway message.

William Neuman: Okay. And then—can you hear me?

Chris Braden: Yes.

William Neuman: Then my question about the non-0157s, you say the increase you see in FoodNet has a lot to do with the increase in lab testing and reporting but I want you to interpret the increase in the number of cases that we're seeing in white of the outbreak with another non-0157 strain in Germany currently, and then I wanted to ask Dr. Hagen to talk about what FSIS has proposed to do about it. There's the question of whether or not they will be declared adulterant or regulated in some other way. So please, Dr. Hagen, tell us what you plan to do about the non-0157s.

Chris Braden: So—this is Chris Braden at CDC again. I'll take the first part of that question about the testing in light of the terrible outbreak in Germany. So the CDC has put out guidelines recently to clinical laboratories to increase the testing for shiga toxin as a screen for all of the shiga toxin-producing E. colis, whether it be 0157 or non-0157. And that's important just for the reason that we're seeing in Germany now, to increase that testing capacity. But as I also said, the real identification actually needs to take place in public health laboratories at the state and the federal level. And this is very important. You know, pathogens are good at changing and emerging in unexpected ways. The outbreak in Germany illustrates the potential for new or rare organisms to find their way into foods and other sources and causing many illnesses. In the United States we have established surveillance systems and networks to effectively identify and investigate illnesses and outbreaks. And even though we don't expect the outbreak from Germany to jump to the U.S., we need to take care to invest in the public health capacity, to detect and respond to problems and to control and prevent these events to begin with.

Tom Frieden: This is Dr. Frieden. I'd like to add to that that CDC was created more than 60 years ago with the primary purpose of supporting state and local health departments in this country in their ability to detect and respond to health threats. And over the past two years we have heard from our colleagues at the state and local level of really unprecedented cutbacks in disease detection and response programs. Laboratories having to lay off staff. Laboratories no longer doing testing on nights and weekends for lack of resources. Outbreaks that aren't being investigated or investigated as promptly as they otherwise would have been. These are critical safety and health measure that's are essential at the state and local level, and the outbreak in Germany reminds us of how important it is to continue to enhance and strengthen our food safety actions here. And the entire national system, which relies on state and local governments, it relies on health providers, it relies on private and public sector laboratories, and it relies on a collaboration between industry and government at all levels. And now I'll turn it over to Dr. Hagen.

Elizabeth Hagen: Thanks, tom. And thanks for your question, Willie. The food safety and inspection service is a public health agency. We are the public health agency at the U.S. Department of agriculture. And as a public health food safety agency it's important to understand the risks as he this exist today and to make sure the policies we have in place and the policies we may put forward will address those risks to the greatest extent possible. As Dr. Braden already noted, pathogens evolve. I don't think we can afford to stand still when the threats are evolving around us. Our policy on 1057 h 7 have produced remarkable results as evidenced by the data we're discussing here today. But we know that 0157:h7 is not the only type of shiga toxin-producing E. coli that can be present in food and cause great harm to consumers. We've studied the issue, we've developed other test methodologies and we've proposed a policy that we believe will improve our ability to protect consumers. We're working with the office of management and budget to address some technical issues and we're hopeful that we'll be able to move forward on that very soon.

Tom Skinner: Okay, Shirley, next question, please.

Operator: Our next question comes from Lindsay Layton with the Washington Post. You may ask your question.

Lindsay Layton: Thanks very much for taking my call. I have two questions. Dr. Hagen, just what you just said. I'm wondering whether you believe that your proposal has stalled at omb. And then second, can anybody offer maybe, Dr. Braden or Mr. Taylor, some theories as to why we're seeing this persistent presence of Salmonella in the food supply and increase over time as opposed to reduction when there are all these efforts to try to bring those numbers down, why do they keep increasing? So two questions. One for Dr. Hagen and one for Mr. Taylor or Dr. Braden.

Tom Frieden: Maybe let us at CDC start with the second question.

Lindsay Layton: Sure.

Tom Frieden: First to clarify, we're not seeing a significant increase in Salmonella. Rather we're seeing the failure of it to decline significantly. As a general rule. And we think that the major reason for that is the very large number of products that can be contaminated with Salmonella. There are, as you know, different subtypes and some different characteristics of what types of food. There's different subtypes. Can contain. The egg rule, which we all believe will have a significant effect reducing Salmonella in eggs, that's still only 18% by our estimates of the total Salmonella illnesses that are associated with outbreaks. And if we presume that outbreaks are representative of the general spread, then even if we get the reduction of 50%, 60%, that's still less than a 10% reduction in overall Salmonella. So it really reiterates our point that food safety requires a system that is safe at multiple steps in the process and at multiple different processes for different meats, poultry, and fruit, vegetables, and even nuts. Dr. Braden, do you want to add to that?

Chris Braden: I think that pretty much summarizes this. But one other—having to do with foodborne illnesses. The other point to—however, to understand is that FoodNet encompasses all of Salmonella laboratory-confirmed cases. And there are a portion of them that are not foodborne. Salmonella can also come from direct contact with animals, as we've seen with pet turtles and most recently water frogs. There's a lot of different potential sources of Salmonella. So it makes it even harder to make a dent in those—especially those subtypes that can be associated with animal contact or from the environment. So we—one of the things I think we need to do is to be better at what we measure for the progress in food safety.

Tom Frieden: For the second question Mike Taylor at the FDA, do you want to add to that?

Mike Taylor: Just a couple points. I think, again, the difficulty of bringing Salmonella numbers down I think is as CDC has indicated a function in part of the diversity of the sources and the diversity of foods involved and recognizing that while there's a lot of work that's gone on in the private sector to try to improve food safety we've really from a public oversight and standards setting and accountability standpoint, we're really just at the beginning of taking a systematic, comprehensive approach to prevention. We've addressed Salmonella reduction in meat and poultry, and Dr. Hagen mentioned some things that are going on at USDA to strengthen that and make further progress. But on the FDA side we've just gotten the new law that says build in, you know, comprehensive preventive approaches from farm to table for all hazards and all food commodities. And so I think we think we know broadly what can work. That is, having the right targeted efforts at every stage along the way of production, processing, transport, all the way through to consumers. You know, targeting those things that we know can work and seeing that it's happening on a consistent basis. And we think the food safety modernization act as we implemented over the coming years will make a difference. And it's critical to us that FoodNet be there to monitor those trends and give us a reliable benchmark. Because having a science-based system, which is what congress has called for, requires just the kind of feedback loop and continuous improvement efforts to better reduce risk over time. And Salmonella absolutely deserves priority as we go down that pathway.

Tom Frieden: Dr. Hagen?

Elizabeth Hagen: Yeah. Lindsay, your question about the policy at OMB. I guess what I would say is that as with any new policy questions and suggestions are going to arise when others have a chance to review a new policy and to weigh in. And we're working closely with OMB to get any kind of remaining, you know, technical issues addressed. And we all want to get this right.

Operator: Thank you. Our next question comes from JoNel Aleccia at MSNBC.com You may ask your question.

JoNel Aleccia: Hi. Thanks very much for taking questions today. I'm sorry. I have a cold. I have a question about the U.S. Engagement with the outbreak in Germany. Dr. Frieden, you said that CDC has—is willing to provide technical support if and as requested. You know, obviously, they're having a hard time detecting the source of this outbreak. Has CDC offered technical support, and has that support either been rejected or accepted?

Tom Frieden: We have offered support. We have had informal discussions and consultations. We recognize that identifying the source of foodborne outbreaks can be extremely challenging, particularly in diseases such as this which may have a period of two, three, four weeks between consumption and illness. So these can be very challenging outbreaks to investigate, both or epidemiologic and our laboratory scientists have had informal discussions. And Dr. Braden, do you want to say more?

Chris Braden: As we know that there are, for instance, four cases that are suspect cases in the United States that were exposed in the Hamburg area, and we've also been working with the German officials in providing them information from these cases that might help in their investigation, because as you might expect, somebody living there day in and day out, the foods there, but if somebody flies in and has a couple of meals, those might be really critical pieces of information about where they ate that they were exposed. So we're sharing that information with them on an ongoing basis.

JoNel Aleccia: Great. Can I ask just one other question? Since 0104:H4 hadn't been seen here before, has CDC asked for a sample of the bug, and do you have it?

Chris Braden: Again, as you—this is Chris Braden at CDC. As you heard, there are suspect cases in the United States. And we're working with the state health departments to obtain samples from these cases in order to confirm this infection. The shiga toxin-producing E. coli, 0104:H4 from these. So yes, we are collecting samples here at CDC in order to characterize them and also to do the appropriate research and share them with our research partners.

Tom Skinner: Okay. The next—Shirley, we've got time for maybe a couple more questions.

Operator: Thank you. Our next question comes from Lisa Schnirring with CIDRAP News. You may ask your question.

Lisa Schnirring: Hi. Thanks for being available today. I have a quick question about Salmonella and then also follow-up about vibrio. I haven't seen the whole Vital Signs report yet, but I'm wondering what you saw in the past year with the different types of Salmonella. I'm specifically wondering if you've been able to see the needle move with Salmonella enteritidis as a hallmark with the egg infections, wondering if there's been any effect that you've been able to see with the new shell egg rules.

Tom Frieden: I think your question in part in terms of the egg rule, because of the FoodNet system and the phase-in of that, we don't expect to see an impact overall by now on human disease. I don't know, Mike Taylor, if you want to talk about the adherence issues and industry actions in response to the egg rule.

Mike Taylor: I would just agree that because we're so early in the implementation I think it's too early to expect a measurable decline in 2010. But in coming years we hope to see that decline.

Lisa Schnirring: Okay.

Tom Frieden: And in terms of the different types of Salmonella, Dr. Braden?

Chris Braden: Again, Chris Braden from CDC. As I was talking about before Salmonella being a number of different sources and depending upon the type of Salmonella we're talking about, we see that in actually the numbers in FoodNet when we start looking at the different types of Salmonella. Some are going up. Some are going down. For instance, compared to the original baseline in 1996 to 1998, Salmonella enteritidis we've seen an increase of 76%. And even since 2006, 2008 time period a 36% increase. Whereas contrasting, Salmonella typhimurium, another serotype of Salmonella, has seen a 53% decrease since 1996 to 1998. And then there's another one that's coming into the void called Salmonella newport. Now, when you multiply these changes that we're seeing with different subtypes of Salmonella by the fact that there are over 2,500 different serotypes, you can see the complexity of this organism at play.

Lisa Schnirring: Okay.

Tom Skinner: Okay, Shirley, another question?

Operator: Thank you. Our next question comes from Lisa Baertlein with Reuters. You may ask your question.

Lisa Baertlein: Hi. Thanks for taking my question. I'm wondering how much screening for shiga toxin would increase costs at local labs. And I'm also wondering, do you have to change the monitoring for E. coli when you're looking at vegetables rather than meats?

Chris Braden: This is Chris Braden at CDC concerning the diagnostics. There is additional costs to using the screening tests for shiga toxin. You know, and that's what clinical laboratories have to take into account. And frankly, I think that's part of the reason why they haven't taken up this test even though it's been available for some period of time. But we're of the opinion that the cost-benefit ratio is actually in favor of doing this testing. Detecting and diagnosing these infections and doing what we can to prevent them in the future.

Lisa Baertlein: Do you have a sense of how much more it costs?

Tom Skinner: One last question.

Operator: Thank you. Our last question comes from Miriam Falco with CNN Medical News. You may ask your question.

Miriam Falco: Hi. Thanks for taking my question. It's actually a very quick one. The folks who came from Germany, the four cases, one confirmed, three suspected, that are in the U.S., have been here a while. How long does it take to get confirmation? Why is it taking so long?

Chris Braden: Well, for one thing, these cases were diagnosed sometimes fairly late in their illness. For instance, by the time a person develops the hemolytic uremic syndrome, their diarrheal illness is gone and so forth. And so it can be actually very difficult to make the diagnosis and confirm the infection in those cases. We do have at our disposal at CDC and other reference laboratories at least at the national level, sometimes at the state level, advanced methods to try and fish out that particular organism and be able to characterize it. But it can be difficult, and it takes a bit of time, including just getting those specimens, shipping them and so forth. And then the laboratory tests are extensive.

Tom Frieden: Okay. Well, thank you all for your interest. If there are follow-up questions, tom skinner from the CDC press office will be available to either answer them if they are for CDC or direct them to the other agencies. Just to reiterate, foodborne disease, particularly Salmonella, remains a serious problem, costing hundreds of millions of dollars in direct medical costs every year. We have had significant progress with a decline in E. coli 0157:h7 by about half and nearly a quarter over the past decade overall for six key pathogens. More is needed from many parts of society to reduce foodborne illness. And we are concerned about the kind of reductions that we're seeing in state and local public health departments, which may undermine our ability to both detect and respond to outbreaks as well as contribute to further prevention. We're encouraged, though, by the new initiatives through FDA, USDA, and CDC to better detect, rapidly respond, to and better prevent foodborne illness. And preventing foodborne illness is something that everyone from food producers to consumers can do something about to ensure that our food not only tastes great but also doesn't make us sick. Thank you all very much.

Tom Skinner: Thank you.

Operator: Thank you. And this does conclude today's conference. We thank you for your participation. At this time you may disconnect your lines.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES