Transcript Emerging foodborne pathogens

Emerging foodborne pathogens
黃顯宗
History
1970-1979
• A new and unfamiliar agent, Escherichia
coli O27:H20, which caused outbreak of
gastroenteritis in 1971.
• Disease outbreaks caused by Yersinia
enterocolitica and Campylobacter jejuni
were heard of near the end of the
decade, but received little attention
except from specialists in foodborne
disease control.
1980-1989
• C. jejuni emerged as the leading cause of
gastroenteritis in U.S.
• Y. enterocolitica was also identified in several
outbreaks of gastroenteritis, most of them from dairy
products.
• E. coli O157:H7 first appeared in 1982 and caused
serious outbreaks.
• Aeromonas hydrophila also was recognized in the
early part of the decade as a possible cause of
foodborne disease.
• Beside the conventional V. cholerae and V.
parahaemolyticus, other Vibrio species also attrached
attention. L. monocytogenes also re-emerged as an
important foodborne disease.
1990• Emerging of V. cholerae O139 in 1992
• Emerging of V. parahaemolyticus O3:K6
in 1996
• Cronobacter spp. (Enterobacter
sakazakii )
全球性問題
• 縱然衛生情況，消費者知識，食品的加工處理
等方面的進步，不可避免微生物所導致的食品
致病在全球的公共衛生上仍然重要因子
• 全球而言，WHO 估計每年仍有約15億件下痢，
三百萬五歲以下人口死亡，其中很顯著地因為
食物中污染了動物來源的病菌或微生物毒素。
人畜共同 Zoonotic Diseases
• 人類病菌中，60 %是人畜共同疾病
• 新生疾病中，75 %是人畜共同疾病
新生食品病原菌定義
• 最近才發生和認定者
• 本來是已經確認的病原菌，不過近期在許
多地區快速地增加病例
• 延伸至其他傳播的載體（媒介）
• 近期在許多地區快速地增加病例
• 多年來廣泛分布，不過，透過新方法的發
展，最近才被認定
新生食品病原菌影響
• 造成許多人口的威脅，無論年齡、性
別、生活或社經地位等
• 造成傷痛和死亡
• 經濟的衝擊
新生食品病原菌趨勢
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環境的變遷，氣候，科技等
大量生產，全球供應
經濟的發展
國際旅遊與貿易
人口特性的轉變
公共衛生敗壞
生活型態改變
微生物的適應 adaptation
全球食品病原普遍的原因
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Poor sanitary conditions
Malnutrition
Changing demographics (increasing population of infants, elderly)
Inadequate public health infrastructure
Inadequate hygienic and technological conditions of food
production
Inadequate cooking, reheating and storage conditions
Increasing tourism and international trade
Increasing animal movement and insufficient control of borders
Increasing international trade of animal and food
Inadequate legislation and official control system
Emerging/reemerging foodborne pathogens
Acquisition of virulence and antibiotic genes by nonpathogenic
bacteria
Adaptation and enhanced survival of pathogens in food
Inadequate consumer education
Rapid changes
• Escherichia coli O157:H7 and the epidemic strain of
Salmonella serotype Typhimurium Definitive Type 104
(which is resistant to at least five antimicrobial drugs),
have become important public health problems.
• Well-recognized pathogens, such as Salmonella
serotype Enteritidis, have increased in prevalence or
become associated with new vehicles.
Altekruse SF, Cohen ML and Swerdlow DL. Emerging Foodborne Diseases.
Emerg Infect Dis [serial on the Internet]. 1997, Sep [date cited]. Available from
http://wwwnc.cdc.gov/eid/article/3/3/97-0304.htm
Rapid changes
• Emergence in foodborne diseases is driven by the
same forces as emergence in other infectious
diseases: changes in demographic (人口統計）
characteristics, human behavior, industry, and
technology; the shift toward a global economy;
microbial adaptation; and the breakdown in the public
health infrastructure.
• Addressing emerging foodborne diseases will require
more sensitive and rapid surveillance, enhanced
methods of laboratory identification and subtyping, and
effective prevention and control.
Altekruse SF, Cohen ML and Swerdlow DL. Emerging Foodborne Diseases.
Emerg Infect Dis [serial on the Internet]. 1997, Sep [date cited]. Available from
http://wwwnc.cdc.gov/eid/article/3/3/97-0304.htm
Demographic changes
• Because of in industrialized nations, the proportion of
the population with heightened susceptibility to severe
foodborne infections has increased. In the US, a
growing segment of the population is
immunocompromised as a consequence of infection
with human immunodeficiency virus (HIV), advancing
age, or underlying chronic disease.
• Reported rates of salmonellosis, campylobacteriosis,
and listeriosis were higher among HIV-infected
persons than among those not infected with HIV.
Salmonella (and possibly Campylobacter) infections
are more likely to be severe, recurrent, or persistent
Altekruse SF, Cohen ML and Swerdlow DL. Emerging Foodborne Diseases.
Emerg Infect Dis [serial on the Internet]. 1997, Sep [date cited]. Available from
http://wwwnc.cdc.gov/eid/article/3/3/97-0304.htm
Human Behavior
• Changes in food consumption have brought to light
unrecognized microbial foodborne hazards.
• Fresh fruit and vegetable consumption, for example,
has increased nearly 50% from 1970 to 1994.
• Fresh produce is susceptible to contamination during
growth, harvest, and distribution.
• The surface of plants and fruits may be contaminated
by human or animal feces. Pathogens on the surface
of produce (e.g., melons) can contaminate the inner
surface during cutting and multiply if the fruit is held at
room temperature.
Altekruse SF, Cohen ML and Swerdlow DL. Emerging Foodborne Diseases.
Emerg Infect Dis [serial on the Internet]. 1997, Sep [date cited]. Available from
http://wwwnc.cdc.gov/eid/article/3/3/97-0304.htm
Predicting the future
• They tend to cause infection at relatively low doses in
humans, and to appear in food vehicles that are not
subjected to cooking conditions that kill them.
• Many were first described in animals, so one place to
look for new zoonotic public health threats would be in
the index of a veterinary textbook of infectious
diseases.從畜產病去瞭解
Predicting the future
• Another arena to search for foodborne
pathogens is the unusual and exotic
opportunistic pathogens that cause
serious illness in the
immunocompromised.
Predicting the future
• New pathogens can arise because of new ecologies
and technologies that bring existing pathogens into our
food supply in new and surprising ways.
• For example, in 1996, 1465 persons in 20 states, the
District of Columbia, and two Canadian provinces fell
ill with a distinctive combination of recurrent diarrhea
and extreme fatigue, caused by a recently recognized
parasitic pathogen, Cyclospora cayetanensis （一種原
生蟲）(Herwaldt, 2000). These illnesses were linked to
eating fresh raspberries imported in the spring from
Guatemala
Predicting the future
• New pathogens can evolve when existing organisms
acquire new virulence properties.
• Many enteric pathogens have virulence factors that
are on mobile genetic elements, and appear to have
acquired the critical pathogenic capacity as the result
of horizontal evolution.
• For example, it has recently been shown that V.
cholerae O1, the causative agent of cholera, harbors a
filamentous phage that bears the cholera toxin genes
新生食品病原菌
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細菌
病毒
寄生蟲
普恩蛋白Prion
新生食品病原細菌
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Salmonella (multidrug resistant strain)
Campylobacter jejuni
E. coli O157:H7
Listeria monocytogenes
S. aureus MRSA
Vibrios
Yersinia enterocolitica
Arcobacter spp.
Mycobacterium paratuberculosis
EMERGING OF NEW FOOD-BORNE
PATHOGENIC BACTERIA
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Aeromonas species
Edwardsiella tarda
Enteric Viruses
Plesiomonas shigelloides
Vibrio species
Cronobacter (Enterobacter) sakazakii
新生食品病原病毒
• Hepatit A and E
• Norovirus
• Avian influenza, AI
新生食品病原寄生蟲
• Cryptosporidium parvum 小隱孢子球菌
• Cyclospora cayetanensis 環孢子蟲
• Anisakis spp.異尖線蟲
全球食品中毒事件 1996 - 2006
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▼ Cryptosporidiosis, Leptospirosis, Lyme borreliosis
Reference: WHO
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Brucellosis, E. coli 0157, Salmonellosis
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BSE
美國情況
Pathogen
每年新生食品中毒病例
預估
Cases
No. of
Ilnesses
每年經濟
損失（10
億元）
No. of
Deaths
Campylobacter
spp.
1,963,141
10,539
99
1.2
Salmonella nontyphoidal
1,341,873
15,608
553
2.4
E. coli O157:H7
62,458
1,843
52
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E. coli non-O157STEC
31,229
921
26
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L. monocytogenes 2,493
2,298
499
2.3
Total
31,209
1,229
6.9
3,401,194
Reference: USDA’s Economic Research Service & CDC
世界部分Campylobacter 中毒事件
年份
國家
中毒食品
病人數
cases
2000
U.K & Wales
Raw milk
333
2001-2002 Australia
Chicken
601
2005
Denmark
Chicken salad
4
2005
Scotland
Chicken pate
82
2005-2006 U.S.A.
Water
32
2007
U.S.A.
Cheese (from
unpasteurized milk)
67
2007
Denmark
Water
16
Campylobacter jejuni
世界部分 E. coli O157:H7 中毒事件
國家
年份
病人數
複雜病情
感染來源
Japan
1996
>5499
(students)
12 deaths
Alfalfa
U.S.A
1999
321
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Beef
Canada
2000
27
5 deaths
Water
Sweden
2002
39
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Fermented
sausage
U.S.A
2002
34
5 HUS
Ground beef
Netherlands 2005
32
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Steak tartare
U.S.A
376
3 deaths
Fresh
spinach
2006
本國資訊
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腸病毒屬於小RNA病毒科（Picornaviridae），為一群病毒的總稱，在
1997年以前，已知而被分類的腸病毒共有小兒麻痺病毒（Poliovirus）共3
型（1至3型）、克沙奇病毒（Coxsackievirus），含23種A型（A1至A22
型，A24型）及6種B型（B1-B6型）、伊科病毒（Echovirus）共30型（1
至33型，但8、10及28型除外）及腸病毒（Enterovirus）（68型～）等60
餘型
近年來又陸續發現多種型別，依據基因序列分析結果將之重新歸類，分為
人類腸病毒A、B、C、D（Human enterovirus A、B、C、D）型，其中腸
病毒71型被歸類於人類腸病毒A型。
除了小兒麻痺病毒之外，以腸病毒71型（Enterovirus Type 71）最容易引
起神經系統的併發症，此病毒是在1969年美國加州的一次流行中首次被分
離出來，當時引起很多無菌性腦膜炎與腦炎的病例。此後包括澳洲、日本、
瑞典、保加利亞、匈牙利、法國、香港、馬來西亞等地都有流行的報告，
台灣在十幾年前也曾經流行過，可見此型腸病毒的分布是全世界性的。
感染腸病毒71型後，發生神經系統併發症的比率特別高，但是嚴重程度各
有不同，有的只出現腦膜炎、輕微腦炎、肢體麻痺等非致命性的併發症，
有的則像1998年台灣的流行一樣出現死亡病例，包括保加利亞、匈牙利、
馬來西亞、日本都有過類似的情形，其可能的危險因子尚待進一步的探討
Vibrio species
Vibrio species
• Since 1992, a new pandemic strain of V.
cholerae O139 occurred and rapidly spread
over many countries (Faruque et al., 2003;
Wong et al., 2002).
• Occurrence of O3:K6 strains of V.
parahaemolyticus widely spread all over the
world and are recognized as the first pandemic
strain of this species (Chiou et al., 2000; Wong
et al., 2000).
Cronobacter (Enterobacter)
sakazakii
• The severe consequences of infection in
some cases may be linked to the production
of enterotoxin by E. sakazakii.
• More than 20% of the 18 tested strains
produced enterotoxin.
• When infection does not result in death, the
affected infant may have permanent
neurological or developmental deficiencies.
• Infants may be colonized with E. sakazakii
without developing symptoms (Gurtler et al.,
2005).
ANTIMICROBIAL RESISTANCE
如何控制食源性疾病
• 從農場至餐桌全程作業控管
• 衛生品質保證制度的落實，GMP 和
HACCP
公共衛生的努力
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Public health system
Surveillance
Epidemiology for earlier diagnosis
Early response to outbreaks
Provide to disease patterns changing
Public health lab. support for rapid and accurate
diagnosis
• Rapid communication links
• Communication to public
• Education on prevention and/or detection
參考文獻
Tauxe RV. 2002. Emerging foodborne
pathogens. Int.J.Food Microbiol. 78:31-41.
http://bvs.panalimentos.org/local/file/inclusiones2008/7GSS_PULSEN
ET_AVAN%C7ADO2008/II%20Curso%20Avanz%20WGSSTaller%20WGSSPulseNet/Resources%20for%20CD/Articles/tauxe.pdf
參考文獻
Newell DG, Koopmans M, Verhoef L, Duizer E, Aidara-Kane A,
Sprong H, Opsteegh M, Langelaar M, Threfall J, Scheutz F, van der
Giessen J, Kruse H. 2010. Food-borne diseases - the challenges of 20
years ago still persist while new ones continue to emerge. Int.J.Food
Microbiol. 139 Suppl 1:S3-15.
http://uesc.br/cursos/pos_graduacao/mestrado/animal/bibliografia2013/bi
anca_art1_newell.pdf