Food-Borne Diseases Up in California

Reported cases of three food-borne diseases that cause serious illness--and sometimes death--increased in California in 1993, but government officials downplay the significance of the preliminary state figures obtained by The Times.

Three of the four leading food-borne diseases--Salmonellosis, Campylobacteriosis and Hepatitis Type A--were more prevalent in the last 12 months than in 1992. The fourth, Shigellosis, showed a slight decline for 1993.

Salmonellosis and Campylobacteriosis are linked to the consumption of contaminated animal products including milk, chicken, eggs, red meats and seafood. Hepatitis Type A and Shigellosis are transmitted to humans either by contact with contaminated food or other infected humans. Combined, the four diseases are considered indicators for the prevalence of food contamination.

Less-common food-related diseases--such as Vibrio infections--also showed significant increases, according to the Communicable Disease Control Division of the state’s Health Services Dept.

As the nation’s most populous state, California reflects national health trends, and the increase in illnesses here may portend similar rises in the rest of the United States (Any such correspondence, however, cannot yet be confirmed by the Centers for Disease Control and Prevention in Atlanta because their 1993 data for the entire country are still being accumulated.)

“It is just hard to comment on how people get these infections,” said Ben Werner M.D., medical epidemiologist with the state’s Health Services Dept. in Berkeley. “We can’t tell to what extent these (additional) cases are due to improper food preparation or poor hygiene in the home.”

In accumulating the data, counties forward case files to the state listing the illness but not the cause. And an extensive process must take place in order for a cause to be determined.

“First, they need to be diagnosed by physicians or hospitals,” Werner said. “Then the case is investigated by local health officials and then a special form is filled out and sent to us.”

But health officials do not have the personnel or resources to investigate even a fraction of the cases reported, Werner said.

The results, which will not be finalized or published for several weeks, include:

* A 17% increase in Hepatitis Type A to 5,649 cases.

* A 6.1% increase in Campylobacteriosis to 7,434 cases.

* A 2.2% increase in Salmonellosis with 5,697 cases.

* A 1.8% decline in Shigellosis to 5,034 cases.

Werner said that the increases are all within the normal fluctuations reported from one year to the next. Only increases in excess of 15% a year would trigger concern and possible further investigations.

The rise in Hepatitis Type A, he said, has been most pronounced in Stanislaus County, in Central California, where a major outbreak occurred in a low-income housing project. The dense cluster of apartments functioned like a day-care center in which viruses or bacteria are easily transferred from one child to another. A number of the adult residents were also employed by fast-food chains, he said.

“There are pockets in Stanislaus County (which includes Modesto) that had such a bad problem that a study is being done to provide the whole community with Hepatitis A vaccine,” Werner said, “which has never been done before in this country.”

Communicable Disease Control’s figures reflect only those cases that were reported to county health officials throughout the state.

“This category of disease is tremendously underreported (to health authorities),” said Shirley M. Fannin, M.D., Los Angeles County director of disease control programs. “With infections such as Salmonellosis and Shigellosis, the symptoms can be two or three days of diarrhea and some people don’t even go to the doctor (preferring to ride out the illness). So, we look at this figures as fairly underrepresentative (of the actual level of food-borne illness).”

Fannin said there were no noticeable increases in the four indicator diseases in Los Angeles County. Yet, she said food and water have to be considered as suspects for the cause of the statewide rise.

“When you see fecal-oral-transmitted diseases increasing, then you have to think of (the problem being with) food or water,” she said. “They are the two areas to be concerned about.”

There are several theories to explain the rise in food poisonings. An increase in the state’s population might contribute to a growing number of illnesses, but such a development is not likely because the increases in Hepatitis A and Campylobacteriosis exceed California’s growth rate.

The rising number of people especially vulnerable to food-borne illnesses--cancer victims, infants, pregnant women, AIDS patients--may also be a contributing factor. The number of AIDS cases alone rose by 150% from 1992 to 1993, according to the state data.

Health and medical officials are also more aware of food-borne diseases than in the past and may be more likely to diagnose such an illness than, say, 10 years ago.

Another theory centered on the fact that the food supply has become infinitely more complex, with many more opportunities for sanitation failures as the popularity of things such as take-out food, salad bars and fast food proliferate.

Finally, new bacterial and viral strains are emerging and threatening public health. A mere footnote to the rise in illnesses throughout the state is last year’s outbreak of E. coli 0157:H7, the bacterium linked to undercooked, contaminated ground meat. While most of the E. coli infections were in the Pacific Northwest, there were also 80 reported cases in California.

More troubling for health officials was that 12 of these illnesses were reported in December, indicating that the contaminant has taken hold in the food supply and is not isolated to the outbreak linked to Jack in the Box restaurants more than a year ago.