Download Senior Citizens and Foodborne Diseases

A fact sheet from The Pew Charitable Trusts and the American Geriatrics Society
Nov 2014
Getty Images
Senior Citizens and Foodborne Diseases
The U.S. Centers for Disease Control and Prevention, or CDC, estimates that each year, 1 in 6 Americans—48
million people—suffers from a foodborne illness, resulting in 128,000 hospitalizations and 3,000 deaths.1 Senior
citizens (those age 65 and older) are particularly at risk and may experience conditions such as chronic illness or
disability and undergo major surgeries, which can exacerbate susceptibility to foodborne illnesses and their resulting
complications. Some die from these preventable illnesses, and many others suffer lasting health problems.
Factors that put senior citizens at higher risk for foodborne illness2
•• Immune system function decreases with age, which makes it harder for the body to fight infections.
•• Chronic diseases and ailments such as malnutrition and immobility occur at high rates in seniors and can
increase their vulnerability to infections.
•• Changes in the digestive system of older adults can reduce their production of stomach acid, which is an
important defense against foodborne pathogens. The frequent use of antacids and antibiotics can further
hamper acid production and can disrupt beneficial bacteria in the gut that offer some protection from harmful
foodborne contaminants. Older adults also typically exhibit slower digestion, giving pathogens an extended
amount of time to colonize and infect the body.
By the numbers: Seniors and foodborne illness
•• According to CDC’s most recent surveillance data, the highest percentages of persons who were hospitalized
with foodborne illness and who eventually died from infection were those age 65 and older.3
Senior citizens are especially vulnerable to infections caused by
Listeria, Salmonella, Escherichia coli O157:H7, and Vibrio.
•• From 2011 to 2013, seniors were affected by 30 of the 31 multistate foodborne outbreaks listed on CDC’s
website* that identified the age range of patients and the food source of transmission, including two outbreaks
of Listeria monocytogenes infections in 2011 and 2012 linked to imported ricotta cheese and cantaloupe grown
in the United States. In these outbreaks, the median age of the victims was 77.4
•• According to the CDC database, from 1998 to 2012 nearly 200 foodborne outbreaks, with confirmed and
suspected sources, occurred in nursing homes, and/or assisted-living facilities, resulting in 6,415 illnesses, 330
hospitalizations, and 54 deaths.5
•• These constitute only a small fraction of the total estimated number of foodborne illnesses among
seniors. A vast majority of the illnesses do not occur during outbreaks and often go underreported and
underdiagnosed.6
•• Senior citizens are especially vulnerable to infections caused by Listeria, Salmonella, Escherichia coli O157:H7,
and Vibrio. (See Figures 1 and 2.)
•• The most recent data from 2013 found that the highest incidences of Cyclospora, Listeria, and Vibrio infections
appeared in adults age 65 or older.7
•• In 2013, 12 percent of foodborne infections, 23 percent of hospitalizations, and 51 percent of deaths
captured in the Foodborne Diseases Active Surveillance Network (FoodNet) system† occurred among
adults 65 years of age or older.8
•• A recent study using data from FoodNet found that the risk of contracting a Listeria infection increases
dramatically with age. Individuals ages 70 to 79, 80 to 84, and 85 and older are, respectively, almost 29,
38, and 54 times more likely to get sick than those ages 15 to 44.9
•• Elderly people have higher rates of invasive Salmonella infections.‡
• In FoodNet surveillance sites, people age 60 years and older with invasive Salmonella infections
experienced the highest hospitalization rates. In addition, 45 percent of the deaths from this
illness occurred in people in this age group.10
•• Seniors are not any more susceptible to illnesses from Campylobacter than the general population. However,
hospitalizations and long-term health consequences such as Guillain-Barré syndrome occur at higher rates in
older individuals.11 (See Figure 2.)
*
The selected multistate outbreaks listed on CDC’s website do not represent the totality of those reported to the agency during that period.
†
The Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora,
Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157:H7 and non-O157, Shigella, Vibrio, and Yersinia. The network is a
collaborative program among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service,
and the Food and Drug Administration. The surveillance area includes 15 percent of the U.S. population (about 48 million people).
‡
An “invasive infection” arises when the bacterium enters the bloodstream or other parts of the body that are usually sterile, such as the
brain, and causes a systemic infection.
Policy recommendations
Infants and young children, pregnant women, older adults, and people with weakened immune systems are at
highest risk for serious foodborne illnesses. Therefore:
•• When setting food safety standards, policymakers and regulators should consider the greater impact of these
illnesses on at-risk populations.
Incidence rate per 100,000
3 receives adequate resources to fully implement
•• Congress must ensure that the Food and Drug Administration
the FDA Food Safety Modernization Act, which includes new
2.5 requirements that food producers must adopt to
reduce the incidence and spread of foodborne diseases
2
Learn more at www.pewtrusts.org/foodsafety.
Figure 1
Listeria
60 to 69
70 to 79
≥80
All ages
1.5
1
0.5
People Age 60 and Up Are Especially Vulnerable to Listeria and
Vibrio Infections
0
2008
2009
2010
2011
Incidence of Listeria and Vibrio illnesses per 100,000 people,
2008-12
Listeria
60 to 69
70 to 79
2012
All ages
≥80
3
2
3
2.5
70 to 79
60 to 69
0.8
70 to 79
1.5
Vibrio
≥80
All ag
All ages
≥80
70 to
≥80
0.6
All ages
1
10.5
0.5
60 to 69
Listeria
1.0
2
1.5
Vibrio
Incidence rate per 100,000
Incidence rate per 100,000
Incidence rate per 100,000
Listeria
2.5
60 to
0.4
0.2
0
0
2008
2008
60 to 69
60
2009
to 69
2009
2010
2010
70 to 79
2011
2012
All ages
≥80
70 to≥80
79
0.0
2012
2011
2008
60 to 69
All ages
2009
2010
70 to 79
2011
≥80
2012
All ages
Source: FoodNet Annual Reports–final data, http://www.cdc.gov/foodnet/data/reports.html.
© 2014 The Pew Charitable Trusts
Vibrio
Incidence rate per 100,000
Incidence rate per
100,000
1.0
All ages
≥80
0.81.0
0.6
0.8
0.4
0.6
0.2
70 to 79
0.2
All ages
For information on safe food handling practices that
risk
≥80
60 tocan
69 minimize the
of contracting a foodborne illness, go to::
70 to 79
http://www.fightbac.org/safe-food-handling
60 to 69
0.0
0.4
Vibrio
2008
2009
60 to 69
2010
70 to 79
2011
≥80
2012
All ages
0.0
2008
60 to 69
2009
70 to 79
2010
2011
≥80
2012
All ages
In FoodNet surveillance sites, people aged 60 years and older
with invasive Salmonella infections experienced the highest
hospitalization rates. In addition, 45 percent of the deaths from
this illness occurred in people in this age group.
Campylobacter
50
Percentage hospitalized
Figure 2
All ages
≥80
40
70 to 79
30
60 to 69
20
Foodborne Illnesses Often Lead to Hospital Stays for People Age 60
and Up
10
0
Proportion of people hospitalized for Campylobacter, Salmonella, E. coli 0157:H7, and
Vibrio illnesses, 2008-2012
2008
2009
60 to 69
Campylobacter
2010
2011
70 to 79
2012
All ages
≥80
Salmonella
E. Coli O157
Salmonella
Campylobacter
100
70
40
Percentage
hospitalized
Percentage
hospitalized
Percentage hospitalized
50
30
20
10
60
80
50
60
40
40
30
≥80
70 to 79
60 to 69
20
20
10
0
0
0
2008
60 to 69
2009
E. coli 0157:H7
2010
70 to 79
2011
2008
2008
2012
All ages
≥80
All ages
All ages
≥80
≥80
70 to 79
70 to 79
60 to 69
60 to 69
All ages
2009
2009
60 to 69
60 to 69
Vibrio
2010
2010
70 to 79
70 to 79
2011
2011
2012
2012
All ages
All ages
≥80
≥80
Listeria
E. Coli O157
Salmonella
70
2.5100
70
280
60
Percentage hospitalized
Percentage
hospitalized
Percentage
hospitalized
Incidence rate per 100,000
3
50
1.560
40
140
30
20
0.520
10
0
0 0
All ages
60 All ages
≥80
50 ≥80
70 to 79
40 70 to 79
60 to 69
30 60 to 69
Vibrio
60 to 69
All ages
70 to 79
≥80
≥80
All ages
70 to 79
60 to 69
20
10
0
2008
2008
2008
60 to 69
60 to 69
60 to 69
2009
2009
2009
70 to 79
70 to 79
2010
2010
70 to 79
2010
≥80
≥80
2011
2011
2012
2011
2012
All ages
All ages
≥80
2012
2008
60 to 69
2009
70 to 79
2010
2011
≥80
All ages
Sources: FoodNet Annual Reports–final data, http://www.cdc.gov/foodnet/data/reports.html.
Vibrio
© 2014
The Pew Charitable Trusts
70
,000
ercentage hospitalized
60
1.050
40
0.830
20
All ages
≥80
70 to 79
60 to 69
Vibrio
All ages
≥80
2012
All ages
Endnotes
1
Elaine Scallan, et al., “Foodborne Illness Acquired in the United States—Major Pathogens,” Emerging Infectious Diseases 17 (2011): 7–15,
doi:10.3201/eid1701.P11101; and Elaine Scallan et al., “Foodborne Illness Acquired in the United States—Unspecified Agents,” Emerging
Infectious Diseases 17 (2011): 16–22, doi:10.3201/eid1701.P21101.
2 Patricia A. Kendall, et al., “Food Safety Guidance for Older Adults,” Clinical Infectious Diseases 9 (2006): 1298–1304, doi:10.1086/503262;,
and Extension Service, “Seniors and Food Safety: Why Are Seniors at Risk for Foodborne Illness?” North Dakota State University, accessed
May 1, 2014, http://www.ag.ndsu.edu/pubs/yf/foods/fn698.pdf.
3
Centers for Disease Control and Prevention, “Tables and Figures—2013 Preliminary Data,” accessed May 1, 2014, http://www.cdc.gov/
foodnet/data/trends/tables-2013.html.
4 Centers for Disease Control and Prevention, “List of Selected Multistate Foodborne Outbreak Investigations,” accessed May 1, 2014,
http://www.cdc.gov/foodsafety/outbreaks/multistate-outbreaks/outbreaks-list.html; Centers for Disease Control and Prevention,
“Multistate Outbreak of Listeriosis Linked to Imported Frescolina Marte Brand Ricotta Salata Cheese (Final Update),” accessed May 5,
2014, http://www.cdc.gov/listeria/outbreaks/cheese-09-12/index.html; and Centers for Disease Control and Prevention, “Multistate
Outbreak of Listeriosis Linked to Whole Cantaloupes From Jensen Farms, Colorado,” accessed May 5, 2014, http://www.cdc.gov/listeria/
outbreaks/cantaloupes-jensen-farms/120811/index.html.
5 Centers for Disease Control and Prevention, “Foodborne Outbreak Online Database (FOOD),” accessed Feb. 15, 2013, http://wwwn.cdc.
gov/foodborneoutbreaks/.
6 Centers for Disease Control and Prevention, “Surveillance for Foodborne Disease Outbreaks—United States, 2009–2010,” accessed Feb.
26, 2013, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6203a1.htm?s_cid=mm6203a1_w.
7 Centers for Disease Control and Prevention, “Incidence and Trends of Infection With Pathogens Transmitted Commonly Through Food—
Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006–2013,” Morbidity and Mortality Weekly Report 63 (2014): 328–32,
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6315a3.htm.
8 Centers for Disease Control and Prevention, “Tables and Figures—Preliminary Data 2013,” accessed May 27, 2014, http://www.cdc.gov/
foodnet/data/trends/tables-2013.html.
9 Regis Pouillot et al., “Relative Risk of Listeriosis in Foodborne Diseases Active Surveillance Network (FoodNet) Sites According to Age,
Pregnancy, and Ethnicity,” Clinical Infectious Diseases 54 (2012): S405–S410, doi: 10.1093/cid/cis269.
10 Duc J. Vugia et al., “Invasive Salmonella Infections in the United States, FoodNet, 1996–1999: Incidence, Serotype Distribution, and
Outcome,” Clinical Infectious Diseases 38 (2004): S149–S156.
11 James L. Smith, “Foodborne Illness in the Elderly,” Journal of Food Protection 9 (1998): 1229–39.
For further information, please visit:
pewtrusts.org
americangeriatrics.org
Contact: Matt Mulkey, manager, communications Email: [email protected] Project website: pewtrusts.org/foodsafety
The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Pew applies a rigorous, analytical
approach to improve public policy, inform the public, and invigorate civic life.