Mad cows and mushy peas; is Italy really better than UK at food safety? Don’t look, don’t find

Friend of the barfblog Luca Bucchini writes that, “Food safety is a British problem, they have bad food,” or so says one of Italy’s top food safety officials, Umberto Agrimi of Italy’s National Institute of Health, or the Istituto Superiore di Sanità (ISS).

In Italy, the ISS is the chief scientific adviser to the Ministry of Health, which is the food safety regulator. Dr Agrimi heads the Veterinary Public Health italy.foodand Food Safety Department within ISS.

In an article which debated the consumption of foods past their use-by or sell-by date , the journalist cited the 1.7 million cases of food poisoning recently reported in the England and Wales alone.

In his remarks, Agrimi dismisses the idea that the problem has a similar magnitude in Italy, jokingly adding that the problem was down to the low quality of British cuisine and diet. He also added that, though Italy has its share of food poisonings, the statistics, contrary to the UK ones, do not raise any alarm. Later in the article he adds that most cases of food poisoning in the UK are down to pork and poultry, whereas in Italy they can be attributed to fish.

These statements are illustrative of how not to deal with food safety – in any country.

Such statements often are the consequence of ignoring or misreading – in good faith – the data.

Campylobacteriosis is the leading cause of foodborne disease in the European Union since 2005. In the most recent European data Italy reported 468. A difference of this magnitude can only be explained by vastly different surveillance systems: Italy does not have a reliable system of reporting, and, having never heard of Campylobacter (as Italy has no alarming food safety problem, communication is not a priority), physicians do not probably prescribe any testing. In the same report, Latvia looks almost immune to the disease (7 cases in 2011, 1 or no cases in previous years), whereas other Baltic states are orders of magnitude worse.

For salmonellosis, the European Food Safety Authority (EFSA) data figures look comparable, with Italy at 3,344, and the UK at 9,455, and in favor of surveillanceItaly. In 2012, however, EFSA tried to estimate the true incidence of salmonellosis across Europe using data from Swedes returning from different European countries with salmonellosis (useful table in, page 75). Using that estimate, Italy had 298,000 cases in the reference year, the UK had 76,500, or less than a third. Most likely, Italy has many more cases of salmonellosis than the UK.

The EFSA report on zoonoses, (page 231) maintains Italy reported no outbreaks with strong evidence of the virus as the culprit. Are Italians immune to norovirus? I doubt it. Is Italian food norovirus free?  Nothing would suggest as much.  We have the same viral strains that circulate in Europe but Italy does not have a surveillance system for norovirus (and if one’s been set up very recently it has not been publicized), unlike the UK.

Italy seems to have had fewer cases of listeriosis than the Netherlands in 2011, and more or less half the cases of the UK. Do Italy and UK have comparable surveillance systems? Hard to say. Until recently, the only Italian region (16% of national population) with a more accurate reporting system contributed 55% of the total reported cases raising doubts on the overall figures. Is there an effect of food habits? Impossible to draw a firm conclusion.

Whatever the real situation with listeriosis, there is little evidence to say that Italy has a better epidemiological situation for foodborne pathogens than the UK: campylobacteriosis (no reliable data), salmonellosis (UK seems to fare better) and norovirus (no data). The only reliable data, for salmonellosis, actually suggest the opposite. If the situation in the UK is alarming, than Italy should rush to get better data.

Is fish really the main vehicle of concern? The EFSA report which I have cited above looked at food vehicle/pathogen correlations, but unfortunately Italy seems to have contributed no data. If there are unpublished data Agrimi was referring to, they would present an interesting finding as seafood is normally a significant, but not leading, contributor to foodborne disease burden.

Italy has many good food safety officials. They often state that we have more and better controls – especially better than the Brits.

Ignoring data leads to biased resource allocation, inadequate risk management and risk communication (there is still no news on how the Italian hepatitis A outbreak is evolving, after the initial admission on May 23 that there could be one). In dealing with the media, scientists should be mindful of what they communicate.

There are excellent food safety officials in most countries, including Italy; it is important that they are led and do not fall into complacency traps, in all cases, but especially when data warrant no complacency at all.