Restaurants And Salmonella: Using Surveillance Data To Improve Policy Development For The Enhancement Of Food Safety

Abstract

As the landscape of the diet in the United States changes in response to shifts in consumer preferences and migrating populations, foodborne illnesses remain an important public health challenge. Public health surveillance – the ongoing, systematic collection and analysis of data to prevent and control disease and injury – is the foundation of a prevention-focused food system. As technological advancements simultaneously enhance and disrupt our current surveillance efforts, there is an increasing need to adapt investigation and prevention activities. There is an opportunity to identify novel methods that use existing data to improve surveillance activities. Salmonella – a bacterial foodborne pathogen – is estimated to cause more than one million illnesses per year and is the leading cause of foodborne illness hospitalization. Restaurants are a frequent setting for outbreak and sporadic (non-outbreak) cases of Salmonella infection. Since Salmonella can take advantage of the major pathways for foodborne illness transmission in a restaurant, understanding and controlling its transmission in restaurants is a useful prevention strategy. This dissertation aims to identify opportunities to improve surveillance activities to drive declines in the incidence of foodborne illness using restaurants and Salmonella as a model. The application of novel methods to outbreak investigations and special studies are used to demonstrate an expanded role for surveillance in enhancing food safety. An outbreak of Salmonella infections associated with a chain of quick-service restaurants (Chapter 2) highlights the importance of using all available information in a restaurant-associated outbreak investigation in order to make informed conclusions. An evaluation of restaurant inspection disclosure methods in New York City (Chapter 3) demonstrates the use of surveillance data to evaluate the public health impact of a public disclosure program for restaurant inspections and creates a framework for evaluating future programs. A survey of Minnesota State Fairgoers (Chapter 4) assesses the consumer interest and preferred formats for public disclosure of restaurant inspection results. A second Salmonella outbreak (Chapter 5) explores routine restaurant inspection data to better understand transmission dynamics in a restaurant-associated outbreak, highlighting the value of these data as hazard surveillance. Collectively, the findings from this dissertation demonstrate an important role for linking routine food establishment inspection data with conventional illness surveillance data to improve our food safety systems. These findings will be useful for policymakers, public health officials, and restaurant operators for surveillance-driven prevention of foodborne illness and create a framework for future work in this area.