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The Nature and Extent of Foodborne Disease

Chapter · January 2016


DOI: 10.1016/B978-0-12-800723-5.00001-2

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C. Adley Michael P Ryan


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1 Book title: Antimicrobial Food Packaging
2
3 Chapter Title: The nature and extent of food borne disease.
4

5 Authors: Catherine C Adley* and Michael P Ryan

8 Name and Address of Institute at which the work was preformed:

9 Microbiology Laboratory Department of Chemical and Environmental Sciences, University

10 of Limerick, Limerick, Ireland

11

12 Keywords: foodborne disease, zoonosis, Salmonella, CDC, DALY

13

14 * Correspondent footnote:

15 Microbiology Laboratory
16 Department of Chemical and Environmental Sciences
17 University of Limerick
18 Limerick
19 Ireland
20 Phone: +353 61 202646
21 E mail: Catherine.adley@ul.ie
22
23
24
25
26
27
28
29

1
30 Abstract:
31 Foodborne disease (also referred to as foodborne illness or food poisoning) is any illness that
32 results from the consumption of contaminated food, pathogenic bacteria, viruses, or parasites
33 that contaminate food. The economic costs associated with foodborne disease can be severe
34 on people, food companies and country reputation. Foodborne disease globally is still not
35 under control and outbreaks can cause health and economic losses. The causes are unhygienic
36 practices in food production, harvesting and preparation. There are 31 main foodborne
37 pathogens causing diseases, the significant ones such as Salmonella non typhoidal,
38 Campylobacter, Listeria and Shiga toxin producing Escherichia coli are monitored by
39 national authorities, and outbreaks are assessed in depth to assess trends and to determine the
40 steps necessary to combat future outbreaks. Foodborne diseases can be mild with recovery in
41 days or can be severe resulting in hospitalisation and death in certain patients.

42 Introduction
43 Food borne diseases span an array of issues from farm to fork. The food production line from
44 growth, harvesting, transport and preparation in unhygienic environments and without proper
45 temperature/environment control measures, provides the route for infection in humans and
46 animals. The term zoonosis refers to the transmission either through directly or indirectly
47 means of pathogens between animals and humans. Zoonoses transmissible through food
48 causes human suffering, work days lost, as well as significant economic losses to both the
49 food production and food processing industry. Some people are more at risk than others and
50 are more likely to die of zoonotic diseases including: children under 5 years old; pregnant
51 women; older adults over the age of 65 years and the immune-compromised such as cancer
52 patients undergoing chemotherapy or people infected with HIV. There are 31 pathogens
53 (Table 1) known to cause the majority of food borne disease, of which 21 are bacteria, five
54 parasites and 5 viruses. Data on priority organisms for example the bacteria Campylobacter
55 spp., Shiga/Vero toxin–producing E. coli (STEC) 0157, STEC non 0157, [parallel
56 nomenclature system for Shiga/Vero toxin-producing E.coli exist such as (STEC) and
57 (VTEC) respectively]. Listeria, Salmonella spp. non typhoidal, Salmonella enterica serotype
58 Typhi, Shigella spp. and Yersinia entercoliotica and parasites Cryptosporidium spp.,
59 Cyclospora cayetanensis, are tracked in numerous countries and by health organisations for
60 prevention purposed and to determine the source and location of outbreaks for control and
61 future prevention.

2
62 A summary breakdown of priority organisms causing food borne disease, time of onset of
63 disease, duration and common food sources are outlined in Table 1.

64 Regulation and Directives: USA and EU


65 The nature and extend of food borne disease are surveyed and control systems have been put
66 in place to help reduce risks of food-borne infections. In the USA, the National Centre for
67 Emerging and Zoonotic Infectious Diseases (NCEZID) was established in 2010, one of its
68 many objectives is surveillance and outbreak investigations (http://www.cdc.gov/ncezid/).
69 Foodborne disease is thought to affect as many as one in six (48 million illnesses) US
70 residents every year. This can lead to an estimated 128,000 hospitalizations, and 3,000 deaths
71 annually (CDC 2014).
72 A significant number of bodies are involved in risk analysis relating to food safety in the
73 USA including; the Codex Alimentarius Commission (Codex 2007); the National Academy
74 of Sciences (NAC, 1998, 2003, 2010) and the USA General Accounting Office (USGAO
75 2011). The FDA at its Centre for Food Safety and Applied Nutrition (CFSAN), regulates the
76 USA food market (worth $417 bn (billion) per annum) and $49 bn of imported foods
77 (http://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/default.htm).
78 The FDA Food Safety Modernization act (FSMA) was signed into law on January 4, 2011
79 (FDA 2011); this has provided the Food and Drug Administration (FDA) an instruction to
80 follow an approach based upon scientific principles and deals with potential hazards from the
81 farm to the table, putting the main prominence on prevention foodborne disease. A synopsis
82 of major provisions of the act includes:
83 • Food production and processing facilities are required to have written preventive
84 control safety plans to avert or minimize the possibility of problems occurring.
85 • The FDA is to create science-based standards for the safe growth and harvesting of
86 fruits and vegetables. These must include looking at man-made and naturally-
87 occurring hazards, such as hazards posed by the soil, animals, and water in the
88 growing area.
89 • The FDA to increase the number of inspections that take place.
90 • Improving foodborne disease surveillance and the usefulness of such surveillance for
91 preventing foodborne disease.
92 • The FDA is sanctioned to issue recalls of unsafe food if it believes it to be unsafe if a
93 food company fails to issue a recall voluntarily.

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94 The precise cost of implementation of FSMA not yet known but it is estimated that it will be
95 in the region of $1.4 bn over the next five years. With cost cutting plans of offices, facilities
96 and laboratories in the USA, to reduce costs by €150 million, the implementation of the act
97 will be challenging.
98 The Centre for Disease Control (CDC) collates data on laboratory-confirmed infections
99 caused by 7 bacterial pathogens (Campylobacter, Listeria monocytogenes, Salmonella, Shiga
100 toxin-producing Escherichia coli [STEC], Shigella, Vibrio, and Yersinia), 2 parasitic
101 pathogens (Cyclospora and Cryptosporidium), and haemolytic uremic syndrome (HUS). This
102 data is taken from state health departments and local health agencies through its FoodNet
103 programme.
104 FoodNet Annual Reports are summaries of information of which a preliminary version of
105 these reports becomes available in the spring of each year and forms the basis of each
106 year's Morbidity and Mortality Weekly Report (MMWR) FoodNet Surveillance
107 (http://www.cdc.gov/mmwr/).
108 In 2012, the FoodNet programme identified 19,637 laboratory-confirmed cases of food borne
109 disease with 4,600 hospitalizations, and 68 deaths. For individual pathogens tracked, the
110 number of infections and incidence were as follows, in order of highest incidents: Salmonella
111 (7,842; 16.37 cases per 100,000 population, the most common Salmonella serotypes were
112 Enteritidis (1,239 [18%]), Typhimurium (922 [13%]), and Newport 907 [13%])),
113 Campylobacter (6,812; 14.22 cases per 100,000 population, with C. jejuni (2444 [89%]), C.
114 coli (223 [8%]), and C. upsaliensis 53 [2%]), being the most prevalent), Shigella (2,141; 4.47
115 cases per 100,000 population, of which S. sonnei (1,611 [80%]), S. flexneri (368 [18%]), and
116 S. boydii (14 [0.7%] were identified), Cryptosporidium (1,258; 2.63 cases per 100,000
117 population), STEC non-O157 (557; 1.16 cases per 100,000 population); STEC O157 (533;
118 1.11 cases per 100,000 population accounting for O157 (533 [49%]), O26 (139 [13%]), and
119 O103 (120 [11%]), Vibrio (197; 0.41 per 100,000, the most common included V.
120 parahaemolyticus (113 [59%]), V. alginolyticus (26 [14%]), and V. vulnificus (21[11%]).),
121 Yersinia (159; 0.33 per 100,000), Listeria (123; 0.26 cases per 100,000 population), and
122 Cyclospora (15; 0.03 cases per 100,000 population) (FoodNet 2014). Data for 2013 has
123 shown a reduction in laboratory-confirmed cases of food borne infections to 19,056 cases,
124 hospitalizations reduced to 4,200, but an increase in death rates to 80 deaths (Crim et al.,
125 2014).
126 The European Union has a centralised system in place to control and prevent zoonoses in its
127 member states. This centralised was set up under Council Directive 92/117/EEC of 17
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128 December 1992 concerning measures for protection against specified zoonoses and specified
129 zoonotic agents in animals and products of animal origin in order to prevent outbreaks of
130 food-borne infections and intoxications (EU 1993) This directive also provided for the
131 establishment of a system for the monitoring of certain zoonosis both at the level of
132 individual Member States and at EU wide level.
133 the EU Commission annually collects the results of the monitoring system from Member
134 States (MS) and compiles them, with the assistance of the Community reference laboratory,.
135 The results of this annual compilation are then published and have been every year since
136 1995. These results give a foundation for the assessment of the existing situation concerning
137 zoonoses and zoonotic agents. However as of 2015, data collection systems/methods for
138 zoonoses and zoonotic agents between Members States are not harmonised and therefore do
139 not allow accurate comparisons between them. The European Food Safety Authority (EFSA
140 http://www.efsa.europa.eu/) and the European Centre for Diseased Prevention and Control
141 (ECDC http://www.ecdc.europa.eu/en), are the reporting bodies.
142
143 This EU Directive 92/117/EEC covers:
144 (a) The monitoring of zoonoses and zoonotic agents.
145 (b) The monitoring of related antimicrobial resistance amongst zoonotic agents.
146 (c) The epidemiological investigation of food-borne outbreaks.
147 (d) The exchange between Member Sates of information related to zoonoses and zoonotic
148 agents.
149
150 Under the EU directive a food-borne ‘outbreak’ is classed as an incidence that is observed
151 under a particular set of circumstances, where two or more human cases of the same disease
152 and/or infection are linked, to the same food source, or a situation in which the observed
153 number of cases of the disease surpasses the probable number and where the cases are linked
154 (or there is a strong probably that they are linked) to the same source of food. At the time the
155 EU Committee identified control and identification of Salmonella spp., Campylobacter spp.,
156 verotoxigenic Escherichia coli (VTEC), Listeria monocytogenes, Cryptosporidium spp.,
157 Echinococcus granulosus/multilocularis and Trichinella spiralis as specific public health
158 aims (EU 1993)

5
159 Economic importance of food industry
160 The global food and drinks industry has seen substantial growth over the last five years and
161 this trend is expected to continue with the industry forecast to be worth US$5,776 bn by 2017
162 (Lucintel 2012). The EU food and drinks industry report 2011 (FoodDrinks Europe 2012),
163 outlined a turnover of €956.2 bn and the largest manufacturing sector in the EU employing
164 4.1 million people and exporting €65.3 bn (+21% compared to 2009).
165 Globalization of the food supply means new food-safety risks and contaminated food can be
166 spread across greater geographic areas. In addition, the food pathogens contain multi
167 resistance to antibiotics (Dowling et al., 2013). Food-safety concerns may reduce demand for
168 certain products, alter international food trade patterns, and limit market access for some
169 exporters. The food industry must reduce costs overall and political advocates are pushing
170 for greater food safety controls to reduce health costs associated with contaminated food, this
171 included the introduction of sensors in food processing industries and in food distribution
172 centres (Adley and Ryan, 2014, Adley 2014) for early detection of pathogens.
173 In the Food System, Agribuisnes and Beverages (FAB) sector, challenges and risks are
174 complex. In a global risk management survey in 2013 (AON 2014), 91 respondents placed
175 ‘product recall’ as number 8 in the top ten risks for their company, commodity price risk
176 being first. When broken down by sector the food processing and distribution sector placed
177 ‘produce recall’ as the third risk with commodity pricing and damage to reputational /brand
178 second.

179 Cost of food borne disease


180 Many approaches have been undertaken to quantify the societal impact of food borne
181 diseases (Murray 1994; Tariq et al 2011). Health burden is estimated using Disability
182 Adjusted Life Years (DALY). DALY equals the population sum of Year of Life Lost (YLL)
183 due to premature mortality and years lived with a disability for each included health outcome
184 of the disease (Murray 1994). Driven by the Global Burden of Disease (GBD) projects
185 initiated in the early 1990s, the World Health organisation (WHO) officially adopted the
186 Burden of Disease and DALY approach for reporting on health information (WHO 2007).
187 The DALY has now become the dominant summary measures of population health burden.
188 The use of the DALY approach has disadvantages including the necessity for making strong
189 value judgments on disability and age, this places major weight on death and morbidity in
190 young adulthood. However, this measure facilitates the comparison of the relative impact of
191 diseases and risk factors and the monitoring of public health over time. One DALY equals the

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192 lost one year of healthy life. DALY’s must facilitate inclusion of non-fatal illness and not
193 just children under 5 year of age; DALYs are internally consistent estimates of disease and
194 decouple epidemiological assessment from advocacy, and must quantify the burden of
195 disease using a measure that could also be used for cost effectiveness (WHO 2001).
196 Ischaemic heart disease was the foremost cause of DALYs globally in 2010 (increasing by
197 29% from 1990 levels and rising from up from fourth rank), followed by lower respiratory
198 infections (top rank in 1990); and then diarrhoeal diseases, (second in 1990; a 51% decrease)
199 (Murray et al., 2012).

200 In an extensive study of fourteen food pathogens (Salmonella, Listeria, Campylobacter spp.,
201 E coli 0157, Clostredia perfringens, Yersina entercolitica, Vibrio vulnificus, Shigella spp.,
202 Vibrio spp., E coli STEC non 0157, the parasites Toxiplasms gondi and Cyclospora
203 cayetanenis and the Norvirus, in 12 categories of food, were ranked to determine cost burden
204 (Batz et al; 2011; 2012). Across all of the 14 pathogens, poultry and pork, produce and more
205 complex foods such as deli meats were responsible for nearly 60% of the total cost of illness
206 and loss of Quality Adjusted Life Years (QALY) and cost the US economy more than any
207 other sources of food-borne disease, the cost of illness, to include lost wages and medical
208 bills.
209 The top five food pathogen and food combinations by annual cost of illness and by QALY
210 loss were Campylobacter and poultry, costing $1.3bn and 600,000 victims a year; Toxiplasms
211 and pork which is primarily a danger to pregnant women, was second; Listeria and deli
212 meats, third with Salmonella and poultry and Listeria and dairy produce in fourth and fifth
213 place. Ranking of the fourteen pathogens on annual burden of disease, sorted by overall
214 public health impact were: Salmonella spp., ranked highest, with Toxiplasma gondii and
215 Listeria monocytogenes Campylobacter spp., and Norovirus following (Batz et al 2011;
216 2012).
217 Reports of cost of burden of food borne pathogens in Europe is not common and difficult to
218 get actual data, reports in literature are also scare. Taking VTEC as an example from an
219 economic perspective, costs associated with individual outbreaks of VTEC can be substantial.
220 The healthcare costs of cases associated with an outbreak of 71 cases in a rural community in
221 Scotland in 1994 were estimated at £649,167, that is, £9,143 per case (Roberts et al., 2000).
222 Estimates of Cost of Illness (COI) and DALY in Sweden found that VTEC and
223 Campylobacter gastroenteritis were the main causes of productivity losses. However
224 Campylobacteriosis was considered under-reported (Toljander et al. 2012). In the

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225 Netherlands where approximately 2100 persons per year experience symptoms of
226 gastroenteritis due to STEC 0157 the disease burden at the population level was calculated as
227 DALY’s and the annual cost of undiscounted illness including direct health care costs and
228 indirect non health care costs were estimated to be €9.1 m (Tariq et al., 2011).

229 The ability to track a food borne pathogen has been demonstrated where multiantibiotic-
230 resistant isolates of Salmonella enterica serotype Kentucky that displayed high levels of
231 resistance to ciprofloxacin was traced from Egypt. 489 cases were identified beginning in
232 2002 (3 cases) and ending in 2008 (174 cases). The national Salmonella surveillance systems
233 of Denmark, England and Wales, the USA, and France identified the strain. Poultry was
234 identified as a probable major vector for infection by this strain (Le Hello et al 2011). In a
235 study of contaminated pig ear pet treats by Salmonella, the source was traced back to a single
236 supplier; three of the isolates showed low level ciprofloxacin resistance of 0.25 mg/L (Adley
237 et al 2011).

238 Estimates of Major Food Pathogens


239 As mentioned above food borne disease is projected to affect one in six US residents each
240 year. Table 2 outlines the top five pathogens causing domestically acquired food borne
241 diseases in the USA in 2011. Norovirus was found to be the leading cause of foodborne
242 disease with non-typhoid Salmonella, Clostridium perfringens, Campyloabacter and S.
243 aureus following. The top five food borne pathogen infections resulting in death in 2011 is
244 outlined in Table 3 (CDC 2014). Nontyphoidal Salmonella is overall the most commonly
245 reported cause of infection in the USA and the most common cause of multistate foodborne
246 disease outbreaks (CDC 2014, Johnson et al., 2014). The incidence rate of
247 Salmonella infection increased from 14.53 cases per 100,000 in 2014 to a rate of 15.19 in
248 2013. Yearly variation ranged from 0.5% to 16.8%, and the average annual percent change
249 was an increase of 1.3% from 2005 to 2013 (Johnson et al., 2014).
250 From 2005 to 2013, the rate of Salmonella serotype Enteritidis infection ranged between 2.36
251 and 3.53 cases per 100,000 population. The annual percent change for the period was an
252 increase of 3.0%, with yearly variation ranging from 0 to 33.7% (Johnson et al., 2014). The
253 incidences of outbreaks by Salmonella as an example, are diverse and are outlined in Table 4.
254 The incidence of Listeria infection varied from 2005 through 2013 from 0.26 to 0.32 cases
255 per 100,000 population. Year-to-year changes ranged from 0 to 23.1%. The average annual
256 percent change for the period was a decrease of 0.8%. From 2005 to 2013, the rate of STEC
257 O157 infection ranged between 0.95 and 1.30 cases per 100,000 population. The average

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258 percent change for the period from 2005 to 2013 was a decrease of 1.2% per year, with
259 annual differences ranging from 2.1% to 22.6%.
260 In the EU data gathered for 2013, from reports from 27 member states (MS) and four non-
261 member states, provides a summary report on trends and sources of zoonoses, zoonotic
262 agents and food-borne outbreaks in 2013 (EFSA 2015). A total of 5,196 food-borne
263 outbreaks, including water-borne outbreaks, were reported in the EU for that year. Most
264 food-borne outbreaks were caused by Salmonella, followed by viruses, bacterial toxins
265 and Campylobacter, whereas in 28.9 % of all outbreaks the causative agent was unknown.
266 Important food vehicles in food-borne outbreaks were eggs and egg products, followed by
267 mixed food, fish and fish products.
268 In 2013, Campylobacter was to be the most regularly reported gastrointestinal bacterial
269 pathogen in humans in the EU (Table 4) and has been since 2005. In 2013 214,779 confirmed
270 cases of human campylobacteriosis were identified. Of foodstuffs tested, 31.4% of the
271 samples (single or batch) of fresh broiler meat (chicken) were found to be positive for
272 Campylobacter. In 2013, 414 Campylobacter outbreaks were reported, of which 32 were
273 strong-evidence outbreaks. The sources of these strong-evidence outbreaks were, in
274 decreasing order of importance, broiler meat and its products; other, mixed or unspecified
275 poultry meat and their products, and milk and mixed food (EFSA 2015).
276 In 2013, a total of 82,694 confirmed salmonellosis cases were reported by EU27, resulting in
277 a notification rate of 20.4 cases per 100,000 population. This was a 7.9 % decrease in the EU
278 notification rate when compared with 2012. Fifty-nine fatal cases were reported by nine
279 member states among the fourteen member states that provided data on the outcome of their
280 cases. The most commonly reported Salmonella serovars in the 2013 cases were S. Enteritidis
281 and S. Typhimurium, representing 39.5 % and 20.2 %, respectively. Salmonella was most
282 frequently detected in poultry meat, and less in pig or bovine meat. Salmonella was rarely
283 found in table eggs, due to continuing strict Salmonella control regulations (EU 2003). Most
284 cases reported during summer months.
285 Salmonella continued to be the most commonly detected cause in reported food-borne
286 outbreaks (22.5 % of total outbreaks). From 2008 to 2013, the annual total number of
287 Salmonella outbreaks within the EU decreased noticeably by 38.1 %, from 1,888 to 1,168
288 outbreaks. As in previous years, eggs and egg products were the most common identified
289 food vehicles for Salmonella outbreaks being associated with 44.9 % of these. Eggs were
290 followed by sweets and chocolates, these being implicated in 10.5 % of strong-evidence
291 outbreaks. These were then followed by pig meat and its products (EFSA 2015). Table 5
9
292 outlines the nine diverse outbreaks due to salmonella in the USA in 2014, six were from
293 ingested food, four from contact with animals and one outbreak from exposure in a teaching
294 laboratory.
295 In 2013, 27 EU member states reported 1,763 confirmed human cases of listeriosis, showing
296 an increasing EU trend in 2009-2013. The EU notification rate was 0.44 cases per 100,000
297 populations which represented an 8.6% increase compared with 2012. A total of 191 deaths
298 were reported in 2013 due to listeriosis, with France reporting the highest number, 64 cases
299 (Table 5). In ready-to-eat foods Listeria was seldom detected above the legal safety limit
300 (ESFA, 2015).
301 In 2013, a total of thirteen Listeria outbreaks were reported by seven MS and one non-MS.
302 This was slightly higher than in the previous years. Eight of the outbreaks reported in 2013
303 were supported by strong evidence, where crustaceans, shellfish and molluscs and related
304 products, were involved in three outbreaks (EFSA 2015).
305 The number of confirmed Vero Cytotoxigenic Escherichia coli (VTEC) infections in humans
306 increased in 2013, where 6,043 confirmed cases were reported. The EU notification rate was
307 1.59 cases per 100,000 population, which was 5.9 % higher than in 2012. In 2013, there were
308 13 deaths reported, which resulted in an EU case-fatality rate of 0.36 % among the 3,582
309 confirmed cases for which this information was provided (Table 5). The most commonly
310 reported VTEC serogroup in 2013 was, as in previous years, O157 (48.9 % of cases with
311 known serogroup). Serogroup O26, the second most common in 2013, increased by 65.1 %
312 between 2011 and 2013. The proportion of non-typable VTEC strains doubled in the same
313 period. The serogroup which increased the most between 2011 and 2013 was O182 which
314 was reported by five countries in 2013 compared to only one in 2011 and 2012.
315 No trend for VTEC was reported from food and animals. VTEC serogroup O157 was
316 primarily detected in ruminants (cattle, sheep and goats) and meat thereof. In 2013, a total of
317 73 outbreaks caused by VTEC were reported. The main food vehicle was bovine meat (EFSA
318 2015).

319 Conclusion
320 The nature of foodborne disease is multifaceted with it being defined as any illness that
321 results from the ingestion of contaminated food, pathogenic bacteria, viruses, or parasites that
322 contaminate food. They can be caused by a variety of different organisms (Table 1). The
323 extent of foodborne disease globally is difficult to quantify as monitoring and surveillance

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324 and reporting systems differ and comparisons therefore not possible. What are evident are the
325 serious consequences both in terms of human health and economic losses.

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481

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482 Table 1: The major food borne pathogens
Common Name of Onset Time After
Organism Signs & Symptoms Duration Food Sources
Illness Ingestion
Bacteria
B. cereus food
Bacillus cereus 10-16 hrs Abdominal cramps, watery diarrhoea, nausea 24-48 hours Meats, stews, gravies, vanilla sauce
poisoning
Raw milk and soft cheeses made with
Brucella spp. Brucellosis 1-2 months Profuse sweating and joint and muscle pain Variable
unpasteurized goat or cow milk
Raw and undercooked poultry,
Campylobacter Diarrhoea, cramps, fever, and vomiting;
Campylobacteriosis 2-5 days 2-10 days unpasteurized milk, contaminated
jejuni diarrhoea may be bloody
water
Vomiting, diarrhoea, blurred vision, double Improperly canned foods, especially
Clostridium vision, difficulty in swallowing, muscle home-canned vegetables, fermented
Botulism 12-72 hours Variable
botulinum weakness. Can result in respiratory failure and fish, baked potatoes in aluminium
death foil
Meats, poultry, gravy, dried or
Clostridium Perfringens food Usually 24
8-16 hours Intense abdominal cramps, watery diarrhoea precooked foods, time and/or
perfringens poisoning hours
temperature-abused foods
Diarrheagenic E. Food poisoning Varied 1-8 days Watery or bloody diarrhoea, abdominal cramps, Varied 3-10 Varied: Water or food contaminated
coli* with or without fever days with human or animal faeces.
9-48 hrs for Fever, muscle aches, and nausea or diarrhoea.
gastro-intestinal Pregnant women may have mild flu-like illness, Unpasteurized milk, soft cheeses
Listeria
Listeriosis symptoms and infection can lead to premature delivery or Variable made with unpasteurized milk, ready-
monocytogenes
2-6 weeks for stillbirth. The elderly or immunocompromised to-eat deli meats
invasive disease patients may develop bacteraemia or meningitis.
Mycobacterium Bovine Raw milk and soft cheeses made with
Variable Tuberculosis like symptoms Variable
bovis Tuberculosis unpasteurized cow milk
Eggs, poultry, meat, unpasteurized
Salmonella spp. Salmonellosis 6-48 hrs Diarrhoea, fever, abdominal cramps, vomiting 4-7 days milk or juice, cheese, contaminated
raw fruits and vegetables
Shigellosis, Abdominal cramps, fever, and diarrhoea. Stools Raw produce, contaminated drinking
Shigella spp. 4-7 days 24-48 hrs
Bacillary dysentery may contain blood and mucus. water, uncooked foods and cooked
15
foods that are not reheated after
contact with an infected food handler
Sudden onset of severe nausea and vomiting. Unrefrigerated or improperly
Staphylococcus Staphylococcal
1-6 hours Abdominal cramps. Diarrhoea and fever may be 24-48 hrs refrigerated meats, potato and egg
aureus food poisoning
present. salads, cream pastries
2-48 hrs
Vibrio spp. Vibriosis Diarrhoea, vomiting, abdominal pain 2-8 days Raw or undercooked seafood
1-7 days
Raw or undercooked pork,
Yersinia
Yersiniosis 4-7 days Diarrhoea, vomiting, abdominal pain 1-3 weeks unpasteurised milk or contaminated
Enterocolitica
water
Viruses
Astrovirus Variously called 3-4 days Diarrhoea, followed by nausea, vomiting, fever, 3-4 days Faecal-oral transmission, and handler
stomach Flu, viral malaise and abdominal pain contaminated food
gastroenteritis
Hepatitis A Jaundice 10-50 days Lethargy, loss of appetite, nausea, vomiting, 2 weeks - 3 Seafood and handler contaminated
fever, months food
jaundice
Noroviruses Variously called 12-48 hrs Nausea, vomiting, abdominal cramping, 12-60 hrs Raw produce, contaminated drinking
viral diarrhoea, fever, headache. Diarrhoea is more water, uncooked foods and cooked
gastroenteritis, prevalent in adults, vomiting more common in foods that are not reheated after
winter diarrhoea, children. contact with an infected food handler;
acute non- bacterial shellfish from contaminated waters
gastroenteritis,
food poisoning,
and food infection
Rotaviruses Variously called Up to 2 days Diarrhoea in infants and children 3 to 8 days Faecal-oral transmission, and handler
stomach Flu, viral contaminated food
gastroenteritis
Sapovirus Variously called 24-48 hrs Nausea, diarrhoea, vomiting, abdominal cramp, 12-60 hrs Faecal-oral transmission, and handler
stomach Flu, viral headache, myalgia and fever. contaminated food
gastroenteritis
Parasites

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Cryptosporidium spp Cryptosporidiosis 2-10 days Diarrhoea (usually watery), stomach cramps, May be Uncooked food or food contaminated
upset stomach, slight fever remitting by an ill food handler after cooking,
and contaminated drinking water
relapsing
over weeks
to months
Cyclospora Cyclosporiasis 7 days Diarrhoea, loss of appetite, weight loss, stomach Days to a Uncooked food or food contaminated
cayetanensis cramps/pain, bloating, increased gas, nausea, month by an ill food handler after cooking,
fatigue, vomiting, body aches, headache, fever, contaminated drinking water
and other flu-like
Giardia intestinalis Giardiasis 1-3 weeks Diarrhoea, flatulence, stomach or abdominal 2 to 6 Contaminated meat
cramps, nausea, dehydration weeks
Toxoplasma gondii Toxoplasmosis 5 - 23 days Flu–like symptoms Weeks to Undercooked meat such as pork,
months lamb, and venison
Trichinella spp Trichinellosis 1 day to 8 weeks Diarrhoea, fever, profuse sweating, weakness, Months Contaminated meat especially pork
muscular pain, swelling around eyes and wild game
483 Source: Information above taken from a variety of sources including: Adley and Dillon (2011); CDC (2015a); FDA, (2015); Kaper et al.,(2004);
484 Ryan et al., (2011); *Six pathotypes are associated with diarrhea and collectively are referred to as diarrheagenic E. coli, including traveler’s
485 diarrhea (enterotoxigenic E. coli), hemorrhagic colitis and hemolytic-uremic syndrome (enterohemorrhagic E. coli), persistent diarrhea
486 (enteroaggregative E. coli), and watery diarrhea of infants (enteropathogenic E. coli).

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487 Table 2: Top five pathogen causing domestically acquired food borne illnesses in 2011in the
488 USA
Pathogen Estimated number of 90% credible %
illnesses interval
Norovirus 5,461,731 3227,078- 58
8,309,480
Salmonella spp., 1.027.561 644,789-1,679,667 11
nontyphoidal
Clostridium perfringens 965,958 192,316-2,483,309 10
Campylobacter spp. 845,024 337,031-1611,083 9
Staphylococcus aureus 241,148 72,341-529,417 3
489 Source: CDC 2014
490
491 Table 3: Top five pathogens causing domestically acquired food borne illnesses resulting in
492 death in 2011 in the USA
Pathogen Estimated annual 90% credible %
number of deaths interval
Salmonella spp 378 0 - 1,011 28
nontyphoidal
Toxoplasma gondii 327 200 - 482 24
Listeria monocytogenes 255 0 - 733 19
Norovirus 149 84 - 237 11
Campylobacter spp. 76 0 - 332 6
493 Source: CDC 2014

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494 Table 4: Salmonella outbreaks in USA in 2014
Contaminated Food Salmonella serovar Outbreak Details
Beansprouts Salmonella Enteritidis Case count: 115
States: 12
Deaths : 0
Recall: No
Nut butter Salmonella Braenderup Case count: 6
States: 5
Deaths : 0
Recall: Yes
Organic spouted Chia powder Salmonella Newport, Case count: 31
Salmonella Hartford, States: 16
Salmonella Oranienburg Deaths : 0
Recall: Yes
Chicken Salmonella Heidelberg Case count: 9
States: 1
Deaths : 0
Recall: Yes
Raw cashew cheese Salmonella Stanley Case count: 17
States: 3
Deaths : 0
Recall: Yes
Contact with frozen feeder Salmonella Typhimurium Case count: 41
rodents States: 21
Deaths : 0
Recall: No
Contact with Live poultry Salmonella Infantis, Case count: 363
Salmonella Newport, or States: 43
Salmonella Hadar Deaths : 0
Recall: N/A
Contact with reptile-pet Salmonella Cotham Case count: 161
bearded dragons or Salmonella Kisarawe States: 36
Deaths : 0
Recall: N/A
Exposure in Teaching laboratory Case count: 41
exposure States: NA
Deaths : 0
Recall: N/A
495 Source: CDC (2015b)

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496 Table 5: The top five confirmed food borne infections, hospitalisation and case fatality rate
497 due to zoonosis in confirmed cased in the EU in 2013
Disease Number of Reported hospital Reported deaths
confirmed cases cases 2013 2013
2013
Campylobacteriosis 214,779 11,922 56
Salmonellosis 82,694 7,841 59
Yersiniosis 6,471 481 2
VTEC Infections 6,043 922 13
Listeriosis 1,763 753 191
498 Source: EFSA (2015)
499

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