However, as the papers in this chapter illustrate, findings from outbreak investigations enable public health authorities to identify new foodborne pathogens, trace their entry into the food chain, and thereby reveal opportunities to improve food safety. Most often, outbreak investigations occur after the fact. These circumstances, in addition to the rapid distribution of food on both a national and global scale, make it nearly impossible to detect even a large foodborne outbreak in time to limit its impact see, for example, the description of the 1994 Salmonella outbreak in ice cream, described by Osterholm in Chapter 1. Many people with symptoms of foodborne illness do not seek medical attention, further contributing to underdiagnosis. The annual cost of medical expenses and productivity losses associated with the five most prevalent, diagnosable foodborne illnesses is nearly $7 billion (Vogt, 2005). Because foodborne disease is difficult to diagnose, the vast majority of these illnesses and more than half of such deaths are attributed to “unknown agents” (Mead et al., 1999). Foodborne illness is estimated to affect more than 76 million people in the United States each year, resulting in 325,000 hospitalizations and 5,200 deaths, but its true incidence is unknown (Mead et al., 1999).

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