GAO reports increased foodborne disease in schools, urges more safety steps

May 8, 2002 (CIDRAP News) – Foodborne disease outbreaks in public schools increased about 10% per year and made 16,000 students sick in the 1990s, according to the US General Accounting Office (GAO). The agency recommends the creation of a single federal food safety agency with increased authority as one of several steps to improve food safety in the schools.

The report came in the form of testimony prepared for two congressional committees by Lawrence J. Dyckman, the GAO's director of natural resources and environment. He called for increased cooperation between federal, state, and local authorities to ensure that food bought for the National School Lunch Program and the School Breakfast Program is safe. The two programs provided food to more than 27 million school children daily in fiscal 2001, he said.

Dyckman said 292 school-related foodborne disease outbreaks were reported to the Centers for Disease Control and Prevention (CDC) between 1990 and 1999. Outbreaks averaged 17 per year in the first 4 years of the decade, 28 in the next 4 years, and 57 in the last 2 years. Most of those affected were children, and the most common pathogens involved were Salmonella and Norwalk-like viruses, Dyckman said.

Some of the increase in outbreaks can be attributed to the CDC's change from passive to active surveillance in early 1998, when the CDC began to ask the states for more complete outbreak information, according to the report. In addition, the CDC said increased spending on outbreak investigations and greater public awareness might also explain some of the increase. However, the GAO's statistical analysis of the CDC data suggests that a real increase occurred, Dyckman said.

"Our analysis of CDC's data indicates that, even after adjusting for CDC's improved data collection, the number of school-related foodborne outbreaks increased, on average, about 10 percent a year between 1990 and 1999," he said. Further, the increase in outbreaks did not simply reflect more students participating in the school meal programs, because that number increased only about 12% for the whole decade.

However, Dyckman cautioned that the CDC data do not show how many of the outbreaks were actually linked to meals served by the schools and how many to food brought from home or other sources. To shed light on that, the GAO gathered state and local health department information for the 20 largest school outbreaks reported to CDC in 1998 and 1999 and found that 13 of the 20 (65%) were associated with the school meal programs.

The GAO report does not seem to fit well with a recent CDC report showing that the incidence of seven foodborne bacterial diseases in nine states dropped 23% between 1996 and 2001. The report from the Foodborne Diseases Active Surveillance Network, or FoodNet, said the incidence of Salmonella infections dropped 15% over the 5 years and Campylobacter infections declined 27%. The report, which did not mention Norwalk-like viral infections, covered outbreaks in general, not just school-related outbreaks. CDC officials attributed the improvements partly to the advent of the Hazard Analysis/Critical Control Points system of inspection. The report appeared in the Apr 19 issue of Morbidity and Mortality Weekly Report.

Dyckman testified that the US Department of Agriculture (USDA) has responded fairly well to food-safety recommendations the GAO made in February 2000, but more needs to be done. His most far-reaching recommendation is a call for a single food-safety agency, instead of the present dual system in which the USDA and the Food and Drug Administration (FDA) regulate different classes of foods.

"The existing food safety system is a patchwork structure that hampers efforts to adequately address existing and emerging food safety risks whether those risks involve inadvertent or deliberate contamination," Dyckman said. Citing "overarching problems" that affect food safety, he continued, "For example, when unsafe foods are detected, neither USDA nor FDA has the authority to recall them from distributors, although the appropriate agency can request manufacturers to do so voluntarily. Therefore, today we re-emphasize the need for the creation of a single food safety agency with new legislative authority. Such an action would go a long way toward improving overall food safety."

Short of such a major step, the government can still do things to make school meals safer, Dyckman testified. Because state and local school officials buy most of the food used in school meal programs (and are reimbursed by the USDA), they could benefit from having access to the USDA's and FDA's inspection information on food suppliers, he said. When presented with this suggestion, he said, FDA offcials said it "might have merit," but USDA officials said there could be legal obstacles to such information sharing.

Another recommendation involves holding or recalling food when safety questions arise. Dyckman said the USDA has a process for holding and recalling the food it buys and then gives to schools; he suggested that the department consider extending this procedure to include school-purchased foods so that USDA could coordinate safety actions related to all foods served in school meal programs. "USDA officials agreed with this concept and indicated that they intend to share the hold and recall procedures with schools in fiscal year 2003," Dyckman stated.

He said the USDA has already followed an earlier GAO recommendation to set up a database to track all its holds and recalls of foods bought for the schools. The GAO also recommended previously that USDA revise its school food service manual to include guidance for state and local school authorities on safety provisions that the USDA uses in its food purchasing contracts. USDA now plans to include an illustrative example in its food service manual, but the GAO believes that more information should be included, Dyckman said.

See also:

The GAO report "Food Safety: Continued Vigilance Needed to Ensure Safety of School Meals." To access it, go to the GAO site (http://www.gao.gov/) and click on "GAO reports" in the middle column. Next, click on "Today's Reports" and select April 30, 2002 in the list that appears. In the new page that appears, scroll down to "Testimonies" and select item 1 in the list.

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