Foodborne illnesses are more common than we realize. There are approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths every year due to naturally occurring foodborne illnesses in the United States (CDC 2007). When we consider the fact that many people do not visit a doctor until the situation goes worse and wait for symptoms to disappear, these figures do not reflect the entire picture. The World Health Organization (WHO) identifies foodborne disease outbreaks and incidents as a major global public health threat in the twenty-first century, and such diseases include those arising from natural, accidental, and deliberate contamination of food.

"Food safety" and "food terrorism" are two significant terms in the food health research. While the former stands for the unintentional contamination of a food product, the latter refers to its intentional contamination, thus a crime.

"From farm to fork" defines the entire process of food defense strategies in the protection of the food supply. It is even more critical in today's environment, where productivity has a heightened sense of urgency. Many contamination problems that have occurred in growing numbers recent years are in fact preventable unintentional problems; nevertheless, an intentional problem, whose nature and scope are not well known, is not unlikely.

Harmful agents are easily dispersed via food, because factors like strong flavors, strong odors, various textures, or intense colors make the harmful agents invisible. There are hundreds of biological pathogens, toxins, heavy metals, parasites, radioisotopes that naturally occur, as well as many genetically-engineered organisms in addition to 80,000 chemicals that can cause illnesses in their proper concentration. Due to multiple points of accessibility during the manufacturing process and its distribution across great distances, foodborne illness have the potential for widespread impact, which necessitates preventive actions.

Food terrorism is defined by the World Health Organization (2008) as "an act or threat of deliberate contamination of food for human consumption with chemical, biological or radio nuclear agents for the purpose of causing injury or death to civilian populations and/or disruption of social, economic or political stability." Food terrorism brings unique challenges. Increased food inspection, disease surveillance, laboratory capacity, and awareness among health professionals and the general public are required to assure food safety.

Warring armies targeted civilian food supplies in the past in order to intimidate the enemy. The first known bioterrorist attack happened in 1984 in the USA by members of a religious cult who contaminated salad bars in Oregon, USA with Salmonella typhimurium, causing 751 cases of Salmonellosis. This initial attack was a trial run for a more extensive attack intended to disrupt local elections.

Another case took place in 1996 in Texas, in which an unsatisfied laboratory worker contaminated bakery goods with Shigella dysenteria type 2, causing illness in 12 people.

Although few incidents of food terrorism have been documented, it is prudent to consider basic countermeasures. We can estimate the potential impact of the deliberate sabotage of food by extrapolating from the many documented examples of unintentional outbreaks of foodborne disease. As recorded in the WHO 2008 report, the most well-known incidents include the following:

- Shanghai, China. 1991. Probably the largest foodborne disease incident in history, this was an outbreak of hepatitis A that was associated with consumption of clams. Nearly 300,000 people were affected.

- United States. 1984. 224,000 people in 41 states were affected from an outbreak of S. enteritidis infection from contaminated pasteurized liquid ice cream that was transported as a pre-mix in tanker trucks.

- Japan. 1996. 8,000 children, some of whom died eventually, became ill with Escherichia coli O157:H7 infection from contaminated radish sprouts served in school lunches.

- Turkey. 2004. 96 people in Afyon, Turkey, became ill with Salmonella typhimurium and Shigella dysenteria.

Potential effects of food terrorism

It goes without saying that a deliberate attack with a dangerous agent can be devastating, if one kind of food can infect as many people as in the figures given above. The impact of such an attack will obviously be on the public health, economy, and may even cause political destabilization. Under such an attack, public health services are likely to halt, as they are not prepared to respond effectively in many countries, for their emergency plans do not usually cover food terrorism, and this may lead to errors in diagnosis and in the identification of the infected food.

Economy is also one of the major targets in food terrorism. Large-scale economic loss and disruption of trade with major impact on tourism are some of the most likely objectives of attacks. An example to a domestic-food related health issue becoming a global economic issue is the infamous mad cow disease, or bovine spongiform encephalopathy (BSE), which caused public reaction and the refusal of importing USA beef in Europe and Japan in 2003. 10 thousand tons of frozen ground beef was in recalled in the USA in 2007 because of E. coli O157:H7 contamination. The USA and Canada banned the import of Chilean fruit in 1989 on the grounds that Chilean grapes were allegedly contaminated with cyanide. This ban resulted in a damage of several hundred million dollars, loss of jobs, and bankruptcy involved in this trade.

Another goal behind food terrorism is to generate panic and disrupt civil order. The anthrax attack through the mailing of an envelope showed that the dissemination of biological agents, however simple the means may be, can still cause public anxiety reducing confidence in the political system and government.

According to Dr. Richard Lee, there are only a few methods to weaponize food:

To contaminate, to adulterate, or to take it away. Chemicals or infectious pathogens can be added at various points along the food path, including using water as the vehicle. The longer the distance between the gourmet and the point of adulteration, the more specialized the adulterant must be in order to be viable or to be toxic when eaten by the consumer.

The figure below adapted from "Food as a Weapon" by Richard Lee et al. shows the possible ways of food contamination/adulteration, which can be a road map for us to take in preventive actions in each step of food production.

In order to reduce the burden of foodborne diseases, the food safety systems in many countries are intended to ensure the safety of the food supply, and thus reduce the burden of foodborne diseases. These often include safety management programs for food production, processing and distribution, which can be modified to incorporate basic consideration of food sabotage. The food industry has the primary responsibility for assuring the safety of the food they produce; government agencies, working with the private sector, have regulatory and advisory responsibilities in promoting safe food practices by industry, such as good agricultural and manufacturing practices.

With the globalization of the world's food supply, an attack on one country's food supply cannot be viewed in isolation. Thus, governments must work together against food terrorism with the support of agencies like World Health Organization. Developed countries have various levels of food safety infrastructure and alert and response systems, and they will likely require strengthening to meet the new threat of food terrorism. In its review Terrorist Threats to Food WHO suggests that whether a food safety management program, such as HACCP (Hazard Analysis and Critical Control Points), "is rudimentary or well developed, further elaboration should focus on the nature and extent of the threat. When suspected or adulterated food reaches the consumer, the potential consequences to public health, the economy and social or political stability must be managed by an effective, rapid emergency response system. In most cases, existing systems for surveillance, preparedness and emergency response will need to be strengthened to increase their ability to address food terrorism. Without such improved systems, a food safety incident is more likely to escalate, or be perceived to escalate, into a food safety emergency" (p. 20, 11).

It should be kept in mind that food safety is not only the government's job but each individual's responsibility. Everyone should be careful to obey and enforce the regulations for food safety. Since it is not possible to monitor each individual all the time, it is important to educate individuals to use their conscience/spiritual/humanistic attributes to maintain food safety at every phase of production. In a saying of God's messenger, "The believers are those, from whose tongues and hands others are safe and sound." We should digest and promote this principle to create a society of trust committed to living in peace and comfort.

Hayriye Cetin Karaca is Graduate Research Assistant at Animal and Food Sciences, University of Kentucky.

References

Centers for Disease Control and Prevention. http://www.bt.cdc.gov.

Demirdal T, Demirtürk N, Aktepe OC. "Bir universitede saptanan besin zehirlenmesinin incelenmesi". Trakya Universitesi Tip Fakultesi Dergisi. 2007; 24(3):205-8.

Lee, Richard V., Harbison, Raymond D., Draughon, F. Ann. "Food as a Weapon." Food Protection Trends. 2003; 23(8):664-674.

Tauxe RV. "Emerging foodborne diseases: an evolving public health challenge". Emerging Infectious Diseases. 1997; 3:425-434.

U.S. Department of Agriculture Food Safety and Inspection Service. Food Safety and Security: What consumers need to know. http://www.fsis.usda.gov/OA/topics/foodsec_cons.pdf.

U.S. Department of Health and Human Services, Terrorism and the Food Supply. 2005.

U.S. Food and Drug Administration. FDA introduces new technology to improve food security, 2003. http://www.fda.gov/bbs/topics/NEWS/2003/NEW00960.html.

World Health Organization (WHO), Department of Food Safety. Terrorist Threats to Food. 2008.

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