Transcript Food borne Diseases

Food borne Diseases:
By: Dr. Amr El-Dakroury
Dept. of Medical commission
Supreme Council of Health
The etiology of Food-borne diseases:
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Food-borne diseases are those diseases that are the result
of exposure to pathogenic microorganisms, such as
bacteria, viruses and parasites, which tend to have acute
effects on human health.
However, chronic, and in some cases acute, food-borne
illness may also be caused by the presence of various
chemical substances including residues of pesticides and
veterinary drugs, unlawful food additives, mycotoxins,
biotoxins and radionuclides that enter the food
intentionally or unintentionally.
The problems :due to consumption of contaminated food
and its detrimental effect on human health .
Epidemiology of FBD :
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WHO estimates that one in three people worldwide suffer
from a food-borne disease every year,
1.8 million die from severe food and waterborne diarrhea
,related illness
Most of these illnesses are due to microorganisms and
chemical contaminants, which may occur naturally or be
introduced at some point along the food chain.
Campylobacter and Salmonella species account for over 90%
of all reported cases of bacteria related to food poisoning
worldwide.
As most cases of food borne disease are not reported, the true
dimension of the problem is unknown.
Today food safety is one of WHO’s top eleven priorities
Food safety and security :
The World Food Summit, organized by FAO in 1996,
recognized that access to safe food is in itself an element of
food security,
 The World Health Assembly Resolution on Food safety
from May 2000 stated that :
1. Everyone should have the right to an adequate supply of
safe, nutritious food ,
2. Encourages WHO member states ‘‘to implement and keep
national and, when appropriate, regional mechanisms for
food borne disease surveillance’’
3. Governments should take the necessary measures to ensure
the availability of safe food for all in order to sustain the
health and economic development of their people.
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The Response in Qatar
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The Programme on Food- and Waterborne Diseases and
Zoonoses (FWD) in Qatar was set up with the establishment of
SCH ,
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One of the key objectives for the programme is improving and
harmonizing the surveillance system in Qatar in order to increase
the scientific knowledge regarding etiology, risk factors and
burden of food- and waterborne diseases and zoonoses.
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at present covers the following diseases: brucellosis,
campylobacteriosis, cholera, giardiasis, hepatitis A, salmonellosis,
shigellosis, toxoplasmosis, typhoid and paratyphoid fever,
Escherichia coli infection,
Reported food Borne Cases During 2006 -2010 in Qatar
4000
3511
3500
3000
2500
1889
2000
1398
1500
1000
500
312
156
404
0
Brucellosis
Food poisoning
Other
Infc.Diarrhea
(N.Diarreh)
Salmonella
Shegellosis
Typhoid
Objectives of the FWD programme :
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Improving and harmonizing surveillance and
control interventions of FWD
Improving knowledge of prevention and control of
FWD
Strengthening SCH and Stakeholders capacities in
the area of FBD .
Improving early detection and coordinated
response to Qatar-wide FWD outbreaks ,as well as
control interventions .
Facilitating collaboration between public health,
municipality veterinary and food sectors
surveillance activities in Qatar
Food borne disease data collected through :
1. Routine surveillance activities
2. Outbreaks investigations and
3. Conducting special studies.
Aims of FBD surveillance system :
Food borne disease surveillance is essential for:
1. Estimating the burden of food borne diseases, and
monitor trends;
2. Identifying priorities and setting policy in the
control and prevention of food borne diseases;
3. Detecting, controlling and preventing food borne
disease outbreaks;
4. Identifying emerging food safety issues; and
evaluating food borne disease prevention and
control strategies.
Overview
Organisms
 Epidemiology
 Transmission
 Foodborne illness
 Prevention and Control
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Organisms
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There are an estimated 250 pathogens that can cause foodborne
related illnesses.
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Foodborne illness is defined as two or more cases of a similar illness
resulting from ingestion of a common food. It can result from consuming
foods contaminated with various pathogens. In most cases bacteria are
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the major pathogen followed by viruses, then parasites.
However, natural or manufactured chemicals and toxins from
organisms can also cause foodborne illnesses.
The most commonly recognized foodborne infections are caused
by Campylobacter, Salmonella, E. coli O157:H7 and by caliciviruses
(better know as Norwalk viruses.)
Epidemiology
Epidemiology
Many foodborne illnesses are not recognized or go
unreported for a variety of reasons:
 First, routine surveillance may not detect a mild
foodborne illness.
 second, some of the same pathogens that cause
foodborne illness can also be transmitted in water or
from person to person.
 Lastly, some pathogens are emerging and are not yet
identifiable or able to be diagnosed.
Considering these factors, the above listed number of
illnesses, hospitalizations and death may be obsolete.
High Risk Groups
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The elderly
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Children
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Immunocompromised individuals are usually at
the greatest risk for these illnesses.
Transmission
Transmission
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Transmission of foodborne pathogens occurs via the oral route.
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How those pathogens contaminate food can vary based on the
organism, its reservoir, food handling/processing, and crosscontamination prior to serving.
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Some organisms rely on a human reservoir, such as Norwalk-like virus,
Shigella, Campylobacter.
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Others have an animal reservoir such as Campylobacter, Salmonella, E. coli
0157:H7, Listeria, and Toxoplasma.
Transmission
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Contamination can occur at several points along
the food chain
On the farm or in the field
 At the slaughter plant
 During processing
 At the point of sale
 At home
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Produce Processing
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Animal products are not the
only food that can be
contaminated. Various
foodborne disease outbreaks
have occurred due to fruits and
vegetables.
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This table indicates the many
possible sources for
contamination during the
processing of produce.
Important Organisms
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Although many pathogens can cause foodborne
illnesses, we will briefly cover those of greatest
impact. These may also be potential bioterrorism
agents for food sources.
Important Organisms
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Norwalk-like viruses
Campylobacter
Salmonella
E. coli O157:H7
Clostridium botulinum
Shigella
Toxoplasma
Emerging organisms
Norwalk-like Viruses
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Norovirus; Caliciviridae family
They are an important cause of sporadic
gastrointestinal disease outbreaks throughout the world.
It is considered the most common foodborne
infectious agent and an estimated 23 million cases occur
each year.
Sources
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Person-to-person :
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Shed in human feces (up to 2weeks), vomitus.
Outbreaks in daycares, nursing homes, cruise ships
Contaminated raw shellfish.
Campylobacter jejuni
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Leading cause of bacterial diarrhea.
It is considered the leading bacterial cause of foodborne related
diarrhea affecting 2.4 million people each year (5-14% of all
diarrheal illnesses worldwide). Usually these are children under
the age of 5 and young adults (15-29 years of age).
Very few deaths are caused by this organism. Recently GuillainBarré Syndrome has been associated with a small number of
Campylobacter cases. This syndrome is the leading cause of acute
paralysis and develops 2-4 weeks after a Campylobacter infection
(after diarrheal signs disappear).
Campylobacteriosis
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It is caused primarily by Campylobacter jejuni, but also C. fetus and
C. coli.
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Sources
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Raw or undercooked poultry
Non-chlorinated water
Raw milk
Infected animal or human feces
 Poultry, cattle, puppies, kittens, pet birds
Clinical signs
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Diarrhea, abdominal cramps,
fever, nausea
Duration: 2-5 days
Salmonellosis
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Salmonella is a gram negative bacteria with many serotypes that
cause foodborne related illnesses. The ones we most commonly
associated with human foodborne illness are S. typhimurium and
S. enteritidis
They account for about 41% of all human cases reported
causes an estimated 1.4 million reported cases annually with 580
deaths
Salmonellosis
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Sources
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Raw poultry and eggs
Raw milk
Raw beef
Unwashed fruit
Reptile pets: Snakes, turtles, lizards
Signs
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Onset: 12-72 hours
Diarrhea, fever, cramps
Duration: 4-7 days
E. coli O157:H7
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Escherichia coli is another major pathogen of foodborne related
illnesses.
Harmless strains of E. coli are found in nature, including the
intestinal tracts of humans and animals.
Diarrheal disease is caused by several different strains of harmful
E. coli. The most dangerous type is enterohemorrhagic E. coli
(EHEC).
It gets its name because it can cause bloody diarrhea and can lead
to kidney failure in children or immunocompromised persons. E.
coli O157:H7 is the most common EHEC and its
enterohemorrhagic toxin is what actually causes the disease
E. coli O157:H7
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Signs
Watery or bloody diarrhea, nausea, cramps
 Onset: 2-5 days
 Duration: 5-10 days
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Sequela
Hemolytic Uremic Syndrome (HUS)
Most commonly affecting children. HUS is the most
common cause of acute kidney failure in children.
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Botulism
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Botulism is caused by a neurotoxin from Clostridium
botulinum
This toxin causes flaccid paralysis and cranial nerve
deficits, and can lead to death.
The most common sources are home-canned foods,
fermented meats and honey
Signs
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Double vision, drooping eyelids, difficulty speaking and
swallowing
Onset: 18-36 hours
Shigellosis
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Shigellosis is also known as bacillary dysentery
Most cases are caused by Shigella sonnei. However, S. dysenteriae, S.
flexneri and S. boydii can also cause foodborne related illnesses.
Sources:
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Human fecal contamination of food, beverages, vegetables, water
Signs:
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Watery or bloody diarrhea, nausea, vomiting, cramps, fever
Onset: 2 days
Duration: 5-7 days
Toxoplasmosis
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Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii
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It is one of the three leading causes of death from a foodborne disease the
others were Salmonella and Listeria
Pregnant women and immunocompromised individuals, especially HIV
positive patients, are at the greatest risk of toxoplasmosis
The source of this protozoan include infected cats shedding in their feces,
soil, undercooked meat, and mechanical vectors such as cockroaches and flies
Clinical signs in humans can by asymptomatic to fever, headache, and swollen
lymph nodes. If the protozoan cysts develop in tissue, other more severe
clinical signs can be observed.
To prevent infection, gloves should be worn while gardening, changing cat
litter boxes and thoroughly washing raw fruits and vegetables before eating.
Irradiation and thoroughly cooking meat to 160oF internal temperature to
destroy the Toxoplasma cysts.
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Emerging Pathogens
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Cyclospora (Protozoan)
 Sources >>>> Imported raspberries
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Listeria monocytogenes
 Sources
 Ready-to-eat meats, soft cheeses
 Signs
 Human abortions and stillbirths
 Septicemia in young or low-immune
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As stated earlier listeriosis is one of the 3 most common causes
of food borne related death.
Prevention and Control
HACCP
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Food producers and processors have implemented the HACCP
program in their operation to reduce the possibility of foodborne pathogens.
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The Hazard Analysis Critical Control Point (HACCP) program is
used to monitor and control the production process by
identifying food safety hazards. Additionally, critical control
points in production, processing and marketing are identified.
Critical limits for each of these points is established and
monitored for food quality and safety. It is applied to the meat,
poultry and egg industries.
On Farm Strategies
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To help control Salmonella Testing and removal this is done
through:
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Serologic testing, fecal or hide culturing of animals to identify carriers of
the bacteria
Vaccination
It is important to remember that vaccines are not 100% effective, and with the
various serotypes of bacteria and immune status of animals, they should be
used in accordance with other prevention methods.
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Minimize rodents, wild birds
as they are often carriers of bacteria, will also help reduce the transmission.
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Isolation of new animals
will also help decrease the chance of spread.
At the Slaughter Plant
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FSIS (Food Safety Inspection Service)
has Identified target organisms :
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Salmonella and E. coli
Control points
Removal of internal organs.
 Minimize contact between carcasses.
 Proper movement through facilities .
 Chilling .
 Cooking processes (proper time, temperature).
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At Home
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Drink pasteurized milk and juices.
Wash hands carefully and frequently
After using the bathroom.
 Changing infant’s diapers.
 Cleaning up animal feces.
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Wash hands before preparing food.
At Home
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Wash raw fruits and vegetables before eating
After contact with raw meat or poultry
Wash hands, utensils and kitchen surfaces.
 Hot soapy water.
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Defrost meats in the refrigerator
At Home
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Cook beef/beef products thoroughly
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Cook poultry and eggs thoroughly
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Internal temperature of 160oF
Internal temperature of 170-180oF
Eat cooked food promptly
Refrigerate leftovers within 2 hours after
cooking
Store in shallow containers
Special Attributes
to Dr. Farah
REFERENCES:
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