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Food borne Diseases

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Page 1: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food borne Diseases

Page 2: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Major identified foodborne pathogens,

Bacterial: Bacillus cereus Brucella Campylobacter* Clostridium botulinum Clostridium perfringens E. coli O157:H7* E. coli, non-O157 STEC* E. coli, other diarrheagenic* Listeria monocytogenes* Salmonella Typhi Salmonella non-typhoidal Shigella Staphylococcus Streptococcus Vibrio cholerae, toxigenic*

Bacterial (continued) Vibrio vulnificus* Vibrio, other* Yersinia enterocolitica*

Parasitic Cryptosporidium* Cyclospora* Giardia* Taenia Toxoplasma* Trichinella

Prions Viral

Norwalk-like viruses* Rotavirus* Astrovirus* Hepatitis A

* Recognized as foodborne in last 30 years

Page 3: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

The varied sources of foodborne pathogens

Pathogens Sources

C. Botulinum Home canned foods

Campylobacter Poultry, raw milk

Cyclospora Imported berries

E. Coli O157:H7 Ground beef, produce, water, animal contact

Listeria monocytogenes Ready to eat meats, pate, soft cheeses

Norovirus Ill food-handlers, produce, shellfish

Salmonella Meat, eggs, raw milk, animal contact

Toxoplasmosis Cat feces, raw meat (pork, lamb venison)

Vibrio Shellfish

Yersenia Pork products (chitterlings)

Page 4: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Disease Characteristics

Foodborne Disease and WIC Population

Epidemiology of pathogens

Disease in the WIC Population

Page 5: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Foodborne Illness and the WIC Population Pregnancy places women in a temporary immune-compromised

status Certain pathogens, such as Listeria and Toxoplasmosis, have

specific disease outcomes in pregnant women and their fetuses not seen in the healthy general population

Other pathogens, such as Yersenia, Shigella, and E. coli have specific implications in young children and can all be prevented with proper food handling and simple infection control procedures

Recent increases in infections due to contaminated produce items may shift the focus of food safety education to women, the main consumers of fresh produce items

Strict adherence to proper food handling techniques and attention to food safety may reduce the morbidity and mortality due to foodborne infections

Education of pregnant women and new mothers is essential to the reduce the occurrence food related illness in this population

Page 6: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Salmonella Bacterial illness characterized by diarrhea, abdominal cramps, tenderness and

fever. Two distinct syndromes, typhoidal (Salmonella Typhi) and non-typhoidal. Most cases of Salmonella in the US are non-typhoidalOver 2000 serotypes Most Common serotypes and source of infection:

• Enteritidis – contaminated egg products• Newport – beef, animal contact• Typhimurium – bovine products, poultry

Asymptomatic infections may occur Reservoir: domestic and wild animals Transmission: by ingestion of contaminated food items, contact with infected

animals, or by fecal-oral person to person contact Incubation period, 12-36 hours (range 6 hours to 7 days) Infectious throughout the course of infection. A temporary carrier state can

continue for months, especially in infants. Prevention measures include improved sanitation, adequate personal hygiene,

proper sewage treatment, exclusion of infected individuals as food-handlers and health care providers. In addition, the sale of pet turtles should be prohibited and the sale of other reptiles should be restricted. Eggs and other foods of animal origin should be thoroughly cooked.

Page 7: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Salmonella in the WIC Population No specific risk to pregnant women except for the generic

increase in susceptibility to all infections during pregnancy Children are at an increased risk of infection due to immature

immune systems and frequent hand-to-mouth contact Many, if not all, amphibians and reptiles are colonized with

Salmonella species. Contact with animals such as turtles, salamanders, and lizards put children at a increased risk of infection5

It is estimated that some ~74,000 Salmonella infections annually in the US result from exposure to reptiles and amphibians5

Wild and domestic animals may be colonized with Salmonella and show no signs of illness or infection. Contact with these animals increases the risk of infection.

Breast feeding may decrease the risk of sporadic Salmonellosis2

Page 8: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Shigella Bacterial illness of variable severity characterized by

diarrhea, fever, nausea, abdominal cramps, and tenesmus

Asymptomatic infections may occur. Transmission: By ingestion of contaminated food or

water or by fecal-oral person-to-person contact. Secondary household cases are common

Incubation period varies from 1 to 7 days Infectious throughout acute infection and until agent is

no longer present in feces, usually within 4 weeks after illness. Asymptomatic carriers are rare. Outbreaks are common in in daycare and school settings.

Prevention measures include improved sanitation and adequate personal hygiene. Hand washing should be encouraged and supervised in young children.

Page 9: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Shigella in the WIC Population

No specific risk to pregnant women except for the generic increase in susceptibility to all infections during pregnancy

Children are at an increased risk of infection due to immature immune systems and frequent hand-to-mouth contact

Shigella is spread easily from person to person and household contacts are quite common

Children in a daycare or school setting spread Shigella readily. Prompt infection control needs to be practiced to reduce morbidity.

Proper food handling techniques may reduce the incidence of foodborne infection with Shigella.

Hand washing, supervised in young children, will reduce the spread of Shigella.

Page 10: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Campylobacter

Illness characterized by diarrhea, cramps, malaise, fever, nausea, and vomiting

Reservoir: animals, most commonly cattle and poultry Transmission: by ingestion of undercooked meat,

contaminated food or water, or contact with infected animals Incubation period: 2 to 5 days (range 1 to 7 days) Cases are infectious throughout their course of infection

(usually 2 to 5 days). Untreated cases may shed Campylobacter in their stool for up to 7 weeks

Page 11: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Campylobacter in the WIC Population

No specific risk to pregnant women except for the generic increase in susceptibility to all infections during pregnancy

Children are at an increased risk of infection due to immature immune systems and frequent hand-to-mouth contact

Campylobacter is the most common cause of bacterial gastroenteritis in the United States6

Campylobacter has a disproportionately high burden in infants less than 1 year of age, with over twice the disease incidence of healthy adults3

Proper food handling techniques and consumption of potable water may reduce the incidence of foodborne infection with Shigella.

Page 12: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Escherichia coli O157:H7 (STEC) Shiga toxin producing E. coli (STEC) produce an illness

characterized by diarrhea (often bloody) and cramps May be complicated by Hemolytic Uremic Syndrome

(HUS), mostly found in young children Asymptomatic infections may occur Reservoir: cattle and deer (humans may serve as a

reservoir for person-to-person transmission) Transmission: by ingestion of contaminated food or

water, contact with infected animals, or through person-to-person contact with an infected case

Incubation period: 2 to 8 days Prevention measures include improved sanitation,

adequate personal hygiene and avoiding consumption of undercooked ground beef and unpasteurized dairy and fruit juice products

Page 13: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Sequence of events in E. coli O157:H7 infection

E. coli O157 ingested

3-4 days

Non-bloody diarrhea, abdominal cramps

bloody diarrhea

5 days

1-2 days

resolution

94%

6%

HUS

Page 14: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Listeria monocytogenes Illness characterized fever, muscle aches, and sometimes

nausea or diarrhea Infection can lead to many clinical syndromes including

stillbirths, listeriosis of a newborn, meningitis, bacterimia, or localized infection

Asymptomatic infections are common Reservoir: soil, forage, water, mud, and silage are the primary

environmental reservoirs. Infected animals, foul, and humans may also serve as reservoirs

Transmission: by ingestion of contaminated food including (but not limited to) unpasteurized dairy products (soft cheeses in particular), ready-to-eat meats, raw vegetables, smoked fish, fermented raw meat sausages

Incubation period: 3 weeks Listeria can grow and multiply at refrigeration temperatures

Page 15: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Listeria in the WIC Population Pregnant women are at a 20% increased risk of contracting

Listeria infection than the general population Newborns suffer the serious health affects of infection in the mothers

• Septic abortion• Stillbirth• Neonatal sepsis/meningitis

Most diagnosis made in third trimester of pregnancy Speculated reasoning: Because most fetal deaths in the first and some

in the second trimester are thought to be due to routing causes of miscarriage and the mothers/fetus are not tested for Listeria infection

Incidence of disease is highest among the Hispanic population, particularly in infants and women of child-bearing age7

Hispanic infants had a 12-fold higher incidence of listeriosis than their non-Hispanic counterparts

Hispanic women had a 13-fold greater incidence than non-Hispanic women in the same age group

Prevention strategies should be targeted toward protecting infants and women of childbearing age in the Hispanic community

Page 16: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Listeria : General Recommendations Thoroughly cook raw food from animal sources, such as beef, pork, or

poultry Separate raw meat, poultry, and seafood from vegetables and cooked or

ready-to-eat foods Wash hands, knives, and cutting boards after handling raw foods Wash uncooked vegetables thoroughly before eating Do not drink unpasteurized (raw) milk Refrigerate perishable items that are precooked or ready-to-eat at 40° F or

below and consume as soon as possible or freeze “When in doubt, throw it out”. Pay attention to “sell-by” and “use-by” dates Store unopened hot dogs, deli meats, and luncheon meats no longer than 2

weeks in the refrigerator, or freeze them Store opened hot dogs no longer than 1 week and opened deli meats and

luncheon meats no longer than 3-5 days in the refrigerator Use a refrigerator thermometer to make sure the temperature stays at 40° F or

below Clean the refrigerator regularly and right after spills of juices from hot dog

packages or raw meat or poultry.

Reference: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm

Page 17: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Toxoplasmosis Illness caused by parasite Toxoplasma gondii Infections generally mild and symptoms may include malaise,

fever, fatigue and lymphadenopathy Many infections are asymptomatic Reservior: Cats and other felines. Intermediate hosts include

swine, cattel, sheep, goats, rodents, and birds. Transmission: Three primary ways humans are infected

Ingestion of undercooked infected meat Ingestion of oocysts passed in feline feces through contact with litter or

soil Verticle transmission during pregnancy or delivery

Incubation period: Average 7 days, range 4 to 23 days Infections in immunocomprimised are severe

Page 18: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Hepatitis A Acute viral infection with fever, fatigue,

malaise, loss of appetite, nausea, abdominal pain, dark urine, and jaundice

Severity of disease varies, asymptomatic infections are possible.

Reservoir: Humans Transmission: Primarily foodborne.

Sexual transmission can occur and rarely bloodborne transmission occurs.

Incubation period is usually 28 to 30 days

Highly infectious, requiring only a few virus particles to cause infection

Page 19: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Hepatitis A and the WIC Population No specific risk to pregnant women except for the generic increase in

susceptibility to all infections during pregnancy Children are at an increased risk of infection due to immature immune

systems and frequent hand-to-mouth contact Severity of infection generally increases with age

Children rarely are symptomatic, they are however infectious and can easily infect household members

Disease is most common among school age children and young adults Hepatitis A, even during the acute infectious period, is generally not a

contraindication to breastfeeding Special attention should be paid to infection control procedures in

the home Perinatal transmission of hepatitis A is rare, and there is no evidence

for transmission through breast milk In the US, sporadic transmission of Hepatitis A is frequent in daycare

centers with diapered children A vaccine is available and licensed for adults and children over the age

of 2 years

Page 20: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

There are no vaccines for most foodborne pathogens

Educating consumers, foodhandlers and producers is important, but not sufficient to reduce illness

Contamination of food products can occur from farm to table, at any step along the production chain

Use outbreaks and other investigations to learn how to prevent disease, through targeted prevention strategies

Educational campaigns to certain populations, i.e. the WIC population

How do we prevent foodborne disease?

Page 21: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

The chain of production from farm to table: A generic prevention scenario

Production

Processing

Final preparation and cooking

{Pathogen Killing Step}

On-farm sanitation, safety ofanimals' food and waterbiosecurity, and other"Good Agricultural Practices“Factory sanitation, quality controlHACCP, inspection and other "Good Manufacturing Processes"

Foodhandler certificationConsumer education,Restaurant inspection

Pasteurization, retort canning

This is where we target!

Page 22: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Many different diseases can be caused by contaminated foods (More than 250 were listed in a 1981 manual)

For many of these diseases, the source of an individual case might be food, or it might be water, animal contact, or contact with other ill persons

For an individual case of illness, it is often impossible to know the source of the infection

Outbreaks are our best opportunity to learn the specific source of infection

We track individual cases of some diseases, regardless of whether or not they may be from food or other sources (pathogen or condition-specific surveillance)

We also track outbreaks of foodborne diseases, regardless of which microbe caused them (source-specific surveillance)

Core concepts in the surveillance of foodborne disease

Page 23: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety Food Safety is complex and requires a

multifaceted approach to ensure success

Safe food handling can be broken down into four easy and user friendly steps

Clean

Separate

Cook

Chill

Fightbac – Great resource for educational materials regarding food safety and foodborne illness prevention http://www.fightbac.org

Page 24: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety: Clean

Clean: Wash hands and surfaces often Wash hands in hot soapy water before preparing food

and after using the bathroom, changing diapers and handling pets. For best results, consumers should use warm water to moisten their hands and then apply soap and rub their hands together for 20 seconds before rinsing thoroughly.

Wash cutting boards, knives, utensils and counter tops in hot soapy water after preparing each food item and before going on to the next one.

Use plastic or other non-porous cutting boards. Cutting boards should be run through the dishwasher - or washed in hot soapy water - after use.

Consider using paper towels to clean up kitchen surfaces. Or, if using cloth towels, consumers should wash them often in the hot cycle of the washing machine.

Source: http://www.Fightbac.org

Page 25: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety: Separate Separate: Don't cross-contaminate Cross-contamination is how bacteria spreads from one food

product to another. This is especially true for raw meat, poultry and seafood. Experts caution to keep these foods and their juices away from ready-to-eat foods.

Separate raw meat, poultry and seafood from other food in the grocery shopping cart.

Store raw meat, poultry and seafood on the bottom shelf of the refrigerator so juices don’t drip onto other foods.

If possible, use one cutting board for raw meat products and another for salads and other foods which are ready to be eaten.

Always wash cutting boards, knives and other utensils with hot soapy water after they come in contact with raw meat, poultry and seafood.

Never place cooked food on a plate which previously held raw meat, poultry or seafood.

Source: http://www.Fightbac.org

Page 26: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety: Cooking

Food safety experts agree that foods are properly cooked when they are heated for a long enough time and at a high enough temperature to kill the harmful bacteria that cause foodborne illness.

Use a meat thermometer, which measures the internal temperature of cooked meat and poultry, to make sure that the meat is cooked all the way through.

Cook roasts and steaks to at least 145°F. Whole poultry should be cooked to 180°F for doneness.

Cook ground meat, where bacteria can spread during grinding, to at least 160°F. Information from the Centers for Disease Control and Prevention (CDC) links eating undercooked, pink ground beef with a higher risk of illness. If a thermometer is not available, do not eat ground beef that is still pink inside.

Source: http://www.Fightbac.org

Page 27: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety: Cooking (continued)

Cook eggs until the yolk and white are firm, not runny. Don't use recipes in which eggs remain raw or only partially cooked.

Cook fish until it is opaque and flakes easily with a fork.

Make sure there are no cold spots in food (where bacteria can survive) when cooking in a microwave oven. For best results, cover food, stir and rotate for even cooking. If there is no turntable, rotate the dish by hand once or twice during cooking.Bring sauces, soups and gravy to a boil when reheating. Heat other leftovers thoroughly to 165°F.

Source: http://www.Fightbac.org

Page 28: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety: Chill Chill: Refrigerate properly and promptly Refrigeration at 40°F or below is one of the most

effective ways to reduce risk of foodborne illness Microorganisms grow more rapidly at warmer temperatures,

and research shows that keeping a constant refrigerator temperature of 40°F or below helps slow growth of these harmful microbes.

Use a refrigerator thermometer to be sure the temperature is consistently 40°F or below The best way to make sure your refrigerator is maintaining the

recommended temperature of 40°F or below is to check it with a refrigerator thermometer. This type of thermometer is usually a separate tool that stays in the refrigerator and displays the actual temperature. It is not a numbered dial that helps you adjust temperature. Refrigerator thermometers are available at grocery, discount and hardware stores and are recommended for all home refrigerators.

Source: http://www.Fightbac.org

Page 29: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

Food Safety: Chill (continued) The Chill Factor. Refrigerate or freeze perishables,

prepared foods and leftovers within two hours of purchase or use. Always marinate foods in the refrigerator.

The Thaw Law. Never defrost food at room temperature. Thaw food in the refrigerator. For a quick thaw, submerge in cold water in an airtight package or thaw in the microwave if you will be cooking it immediately.

Divide and Conquer. Separate large amounts of leftovers into small, shallow containers for quicker cooling in the refrigerator.

Avoid the Pack Attack. Do not over-stuff the refrigerator. Cold air must circulate to keep food safe.

Rotate Before It’s Too Late. Use or discard chilled foods as recommended in the USDA Cold Storage Chart found at http://www.foodsafety.gov/~fsg/f01chart.html.

Don’t Go Too Low. As you approach 32°F ice crystals can begin to form and lower the quality of some foods such as raw fruits, vegetables and eggs. A refrigerator thermometer will help you determine whether you are too close to this zone.

Source: http://www.Fightbac.org

Page 30: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

How to prevent the spread of illness

Hand washing is the single

most important

way to prevent the spread of germs!!!!

Page 31: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

How do I properly wash my hands?

Use soap and running water Use lots of friction- for at least

10 seconds Wash all surfaces, especially

under nails and thumbs Dry with a disposable paper

towel Turn off the faucet with paper

towel Discard paper towel

Page 32: Food borne Diseases. Major identified foodborne pathogens,  Bacterial:  Bacillus cereus  Brucella  Campylobacter*  Clostridium botulinum  Clostridium

When should I wash my hands?

Before Preparing or eating food Treating a cut or wound Tending to someone who is sick

After Using the bathroom Changing a diaper or helping a child in

the bathroom Handling raw meats, poultry or eggs Touching pets Sneezing or blowing your nose Tending to someone who is sick or

injured