Food Causes of Enteric Outbreaks in New South Wales, Australia, from 2000 to 2017

There are an estimated 4.7 million cases of foodborne illness in Australia each year, but the contaminated food items that are the source of these illnesses are rarely identified. Current knowledge relies largely on the few foodborne outbreaks where the implicated food commodity was identified. To better understand which foods cause outbreaks, we analyzed 18 years of foodborne outbreak data collected in New South Wales (NSW) and classified the food dishes responsible for the outbreaks into standardized categories based on type of dish and preparation method. A total of 869 outbreaks were reported in NSW from 2000 to 2017. Outbreaks with a suspected contaminated food or dish reported (57.1%) underwent dish reclassification that assigned the implicated food into two groupings that characterized the food consumed into commonly understood dish types (e.g., sandwich, stew, etc.) and how it was prepared (e.g., sliced, heated, etc.). The dish type associated with the most outbreaks was sandwiches (18.8%) followed by desserts (13.1%) and then stir fries (9.1%). The dishes associated with more serious outbreak outcomes (higher numbers of cases, hospitalizations, and deaths per outbreak) were those associated with ready to eat fresh produce. Dish preparations that did not involve a cooking step also resulted in more serious outcomes. While identifying contaminated food is crucial for food safety reasons, people rarely consider these risks when eating. Food carries the combined risks posed by the ingredients and preparation method followed. Education of food business operators and consumers needs to promote a view of food safety risk that goes beyond unsafe commodities, encouraging a holistic perspective that considers ingredients and preparation methods.