Foodborne diseases are associated with significant morbidity and mortality in people of all ages. The Centers for Disease Control and Prevention (CDC) estimates that there are more than 76 million cases of foodborne diseases in the United States each year, resulting in approximately 325 000 hospitalizations and 5000 deaths. Young children, the elderly, and especially immunocompromised people particularly are susceptible to illness and complications caused by many of the organisms associated with foodborne illness. Four general rules to maintain safety of foods are:

• Wash hands and surfaces often.


• Separate-don't cross contaminate.


• Refrigerate foods promptly.


• Cook food to the proper temperature.

The following preventive measures can be implemented to decrease the risk of infection and disease from potentially contaminated food.
Unpasteurized milk and cheese.

The American Academy of Pediatrics (AAP) strongly endorses the use of pasteurized milk and recommends that parents and public health officials be fully informed of the important risks associated with consumption of unpasteurized milk. Interstate sale of raw milk is banned by the US Food and Drug Administration (FDA). Children should not consume unpasteurized milk or products made from unpasteurized milk, such as cheese and butter, from species including cows, sheep, and goats. Serious systemic infections attributable to Salmonella species, Campylobacter species, Mycobacterium bovis, Listeria monocytogenes, Brucella species, Escherichia coli O157:H7, and Yersinia enterocolitica have been attributed to consumption of unpasteurized milk, including certified raw milk. In particular, an increasing number of outbreaks of campylobacteriosis among children are associated with school field trips to farms and consumption of raw milk. Raw milk consumption should be prohibited during educational trips. Cheese made from unpasteurized milk has been associated with illness attributable to Brucella species, L monocytogenes, Salmonella species, and E coli O157.

Eggs.

Children should not eat raw or undercooked eggs, unpasteurized powdered eggs, or products containing raw eggs or undercooked eggs. Ingestion of raw or improperly cooked eggs can result in severe salmonellosis. Examples of foods that may contain raw or undercooked eggs include some homemade frostings and mayonnaise, ice cream from uncooked custard, tiramisu, eggs prepared "sunny-side up," fresh Caesar salad dressing, Hollandaise sauce, and cookie and cake batter.

Raw and undercooked meat.

Children should not eat raw or undercooked meat or meat products, particularly hamburger. Various raw or undercooked meat products have been associated with disease, such as poultry with Salmonella or Campylobacter species; ground beef with E coli O157:H7 and other enterohemorrhagic E coli (also known as Shiga-toxin producing E coli ) or Salmonella species; hot dogs with Listeria species; pork with trichinosis; and wild game with brucellosis, tularemia, or trichinosis. Ground meats should be cooked to an internal temperature of 160°F. Using a food thermometer is the only sure way of knowing that food has reached a high enough temperature to destroy bacteria. Color is not a reliable indicator that ground beef patties have been cooked to a temperature high enough to kill harmful bacteria such as E coli 0157:H7. Knives, cutting boards, plates, and other utensils used for raw meats should not be used for preparation of fresh fruits or vegetables until the utensils have been cleaned properly.

Unpasteurized juices.

Children should drink only pasteurized juice products unless the fruit is washed and freshly squeezed (eg, orange juice) immediately before consumption. Consumption of packaged fruit and vegetable juices that have not undergone pasteurization or a comparable Treatment have been associated with foodborne illness attributable to E coli O157:H7 and Salmonella species. To identify a packaged juice that has not undergone pasteurization or a comparable Treatment, consumers should look for a warning statement that the product has not been pasteurized.

Seed Sprouts.

The FDA and the CDC have reaffirmed health advisories that people who are at high risk of severe foodborne disease, including children, people with compromised immune systems, and elderly people, should avoid eating raw seed sprouts until intervention methods are implemented to improve the safety of these products.² Raw seed sprouts have been associated with outbreaks of illness attributable to Salmonella species and E coli O157:H7.

Fresh fruits, vegetables, and nuts.

Many fresh fruits and vegetables have been associated with disease attributable to Cryptosporidium species, Cyclospora species, noroviruses, hepatitis A virus, Giardia species, E coli, Salmonella species, and Shigella species. Washing can decrease but not eliminate contamination of fruits and vegetables. All fruits and vegetables should be washed with cool tap water immediately before consumption. Produce should be scrubbed with a clean produce brush. Knives, cutting boards, utensils, and plates used for raw meats should not be used for preparation of fresh fruits or vegetables until the utensils have been cleaned properly. Raw shelled nuts have been associated with outbreaks of salmonellosis.

Raw shellfish and fish.

Children should not eat raw shellfish, especially raw oysters. Raw shellfish, including mussels, clams, oysters, scallops, and other mollusks, have been associated with many pathogens and toxins (see Appendix IX). Vibrio species contaminating raw shellfish may cause severe disease in people with liver disease or other conditions associated with decreased immune function. Some experts caution against children ingesting raw fish which has been associated with transmission of parasites.

Honey.

Children younger than 1 year of age should not be given honey. Honey has been shown to contain spores of Clostridium botulinum. Light and dark corn syrups are manufactured under sanitary conditions, and although the manufacturer cannot ensure that any product will be free of C botulinum spores, no cases associated with light and dark corn syrups have been documented.

Food irradiation.

There is no process to eliminate all foodborne diseases; however, food safety experts believe that irradiation of food can be an effective tool in helping control foodborne pathogens. Irradiation involves exposing food briefly to radiant energy (such as gamma rays, x-rays, or high-voltage electrons) and often is referred to as "cold pasteurization." More than 40 countries worldwide have approved the use of irradiation for various types of foods. In addition, every governmental and professional organization that has reviewed the efficacy and safety of food irradiation has endorsed its use. Irradiated meat and some produce items are available to US consumers. The risk of foodborne illness in children can be decreased significantly with the routine consumption of irradiated meat, poultry, and produce.