See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/243462186

Foodborne diseases in India – A review

Article  in  British Food Journal · May 2012

DOI: 10.1108/00070701211229954

CITATIONS READS

14 13,635

3 authors, including:

Sudershan Rao Vemula Naveen Kumar

National Institute of nutrition, Hyderabad India Indian Council of Medical Research
62 PUBLICATIONS   702 CITATIONS    16 PUBLICATIONS   76 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Detection of adulteration of edible oils View project

read b4 u eat View project

All content following this page was uploaded by Naveen Kumar on 29 March 2016.

The user has requested enhancement of the downloaded file.

British Food Journal
Emerald Article: Foodborne diseases in India - a review
Sudershan Rao Vemula, R. Naveen Kumar, Kalpagam Polasa

Article information:
To cite this document: Sudershan Rao Vemula, R. Naveen Kumar, Kalpagam Polasa, (2012),"Foodborne diseases in India - a review",
British Food Journal, Vol. 114 Iss: 5 pp. 661 - 680
Permanent link to this document:
http://dx.doi.org/10.1108/00070701211229954
Downloaded on: 10-05-2012
References: This document contains references to 85 other documents
To copy this document: permissions@emeraldinsight.com

Access to this document was granted through an Emerald subscription provided by Emerald Author Access

For Authors:
If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service.
Information about how to choose which publication to write for and submission guidelines are available for all. Additional help
for authors is available for Emerald subscribers. Please visit www.emeraldinsight.com/authors for more information.
About Emerald www.emeraldinsight.com
With over forty years' experience, Emerald Group Publishing is a leading independent publisher of global research with impact in
business, society, public policy and education. In total, Emerald publishes over 275 journals and more than 130 book series, as
well as an extensive range of online products and services. Emerald is both COUNTER 3 and TRANSFER compliant. The organization is
a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive
preservation.
*Related content and download information correct at time of download.
 The current issue and full text archive of this journal is available at
www.emeraldinsight.com/0007-070X.htm

Foodborne
Foodborne diseases in diseases in India
India – a review
Sudershan Rao Vemula, R. Naveen Kumar
and Kalpagam Polasa 661
Food and Drug Toxicology Research Center,
National Institute of Nutrition (ICMR), Hyderabad, India Received 13 May 2010
Revised 22 July 2010
10 December 2010
Accepted 14 December 2010
Abstract
Purpose – The purpose of this paper is to review the nature and extent of foodborne diseases in India
due to chemical and microbial agents.
Design/methodology/approach – The scientific investigations/reports on outbreak of foodborne
diseases in India for the past 29 (1980-2009) years due to adulteration, chemical, and microbiological
contamination have been reviewed. Reported scientific information on foodborne pathogens detected
and quantified in Indian foods has also been reviewed.
Findings – A total of 37 outbreaks involving 3,485 persons who have been affected due to food
poisoning have been reported in India. Although the common forms of foodborne diseases are those
due to bacterial contamination of foods, however, higher numbers of deaths have been observed due to
chemical contaminants in foods.
Originality/value – A national foodborne disease surveillance system needs to be developed in
India in order to enable effective detection, control and prevention of foodborne disease outbreaks.
Keywords Foodborne disease, Adulteration, Contamination, India
Paper type Literature review

Introduction
Safe food and water is a public health requirement. Safety refers to all the hazards that
make food injurious to health. These hazards arise from improper agricultural
practices, poor sanitary and hygiene conditions at all stages of the food, lack of
preventive controls in food processing operation, misuse of food additives and
chemicals coupled with inappropriate storage and handling. Specific concerns about
food hazards are mainly chemical, microbiological, pesticide residues, veterinary drug
residues and allergic compounds.
Food safety is intricately woven with food security and nutrition, while chronic food
insecurity is associated with poverty and arises due to continuous inadequate diet,
transient food insecurity is related to the risks related to availability of food that is safe
for human consumption. Foodborne diseases are a worldwide problem of great
magnitude both in terms of human suffering and economic costs. It is one of the causes
of morbidity and mortality in developed and developing countries (Glavin, 2003).
Foodborne disease can be defined as “any disease usually either infectious or toxic in
nature, caused by agents that enter the body through ingestion of food” (Adams and
Moss, 2003). Foodborne disease could be due to microbial pathogens, naturally British Food Journal
Vol. 114 No. 5, 2012
produced toxins, or other chemicals that have entered the food supply chain pp. 661-680
(Hall et al., 2008; Hui et al., 2001). In the coming decades more foodborne pathogens can q Emerald Group Publishing Limited
0007-070X
be expected due to changed production methods and agricultural practices. The Center DOI 10.1108/00070701211229954
BFJ for Disease Control and Prevention (CDC) surveillance report for 1993-1997,
114,5 surveillance for foodborne disease outbreaks – United States, identifies the most
significant contributing factors directly relate to food safety concerns within retail and
food service establishments and are collectively termed by the FDA as “foodborne
illness risk factors” these five broad categories are, food from unsafe sources,
inadequate cooking, improper holding temperature, contaminated equipment and poor
662 personal hygiene (Food and Drug Administration, 2009).
The globalization of food trade increases the potential to spread foodborne hazards
around the world. Concerns regarding the likely contamination of food with chemicals
and microbial hazards in recent years resulted in banning of imported food products by
nations. As a result several developing countries have lost millions of dollars in export
earnings (Bhat, 2004). The pathogenic organisms of public health importance that may
be transmitted through contaminated foods are bacteria, viruses, protozoa, trematodes,
cestodes and nematodes. Among these the most important organisms which cause
foodborne diseases include bacteria like Staphylococcus aureus, Bacillus cereus,
Campylobacter jejuni, Clostridium botulinum, Clostridium perfringens, Escherichia coli,
Brucella, Listeria monocytogenes, Salmonella typhi and paratyphi, Shigella
spp.,Vibrio cholerae, Vibrio parahaemolyticus (Rao et al., 1989).
Globally the task of estimating foodborne diseases with accuracy, is truly
formidable as in most countries it is poorly recorded. The variety and extent of
foodborne diseases are such that accurate data on their incidence or prevalence is
difficult to arrive at and most of the times it will not come to the notice of health
authorities. Therefore most of the foodborne disease cases go unreported while only a
few cases are reported in the newspapers (Sudhakar et al., 1988). Although the rate of
foodborne diseases is high, there have been hardly any scientific investigations
undertaken for the isolation of etiological agents from the implicated foods. This
clearly indicates that the laboratory as well as epidemiological investigations are
lacking in many of the outbreaks. It is estimated by the WHO that only 10 percent in
developed countries and 1 percent in the developing countries the foodborne disease
episodes are notified (Bhat and Nageswara Rao, 1987). In India the exact magnitude of
the problem of food borne disease is not clearly recognized.
In India, majority outbreaks of foodborne disease go unreported, unrecognized or
un-investigated and may only be noticed after major health or economic damage has
occurred. In such a condition controlling the outbreaks, detection and removal of
implicated foods, identification of the factors that contribute to the contamination,
growth, survival and dissemination of the suspected agent, prevention of future
outbreaks and strengthening of food safety policies and programmes is not possible.
Foodborne disease surveillance is one of the components of food control systems.
Food safety concerns are gaining importance in view of the fact that India has signed
for WTO agreement and therefore has to follow sanitary and phyto sanitary (SPS)
measures. Being a signatory to WTO India is also required to compliance with the
TBT agreements. Foodborne disease surveillance would be therefore required to
generate data on nature of the hazard, extent to which the foods are contaminated, the
types of food that are likely to contaminate and to develop remedy measures. This
review is an attempt to compile data available on different types of foodborne illnesses
in the country from published sources during the period range from 1980-2009.
 A case of foodborne disease can be defined as “illness brought about by Foodborne
consumption of contaminated food which manifests in the form of gastrointestinal diseases in India
disturbance e.g. vomiting and diarrhea”. The cases, which were classified as outbreaks
were attributed to incidents in which:
.
two or more persons experience a similar illness after ingestion of a common
food; and
.
epidemiological analysis of the implicated food as the source of the etiological 663
agent.

Reported scientific information on foodborne diseases due to adulteration, chemical

contamination, bacterial food poisoning, viral food poisoning, phycotoxicosis and
mycotoxicosis are presented. In addition, common foodborne pathogens in Indian
foods and their level of contamination are described. The reported foodborne disease
outbreaks in India during 1980-2009 are indicated in Table I.

Foodborne diseases due to adulteration

Food adulteration is a major public health hazard, which affects the quality of life of
people. In order to ensure the quality of food available to the consumers, the
Government of India had enacted several legislations, including the Prevention of Food
Adulteration Act (PFA). The nature of food adulteration may vary from state to state
or there could be newer adulterants arising as a result of changing environmental
factor, improved production or cultivation practices (Sudershan et al., 1996). The
following are some of the reported foodborne diseases, which were caused due to
adulteration.

Epidemic dropsy (argemone oil)

Epidemic dropsy is a clinical state resulting from the use of edible oils adulterated with
the oil extracted from the seeds of Argemone mexicana. The Argemone mexicana seeds
closely resemble the mustard seeds. Sanguinarine and dehydrosanguinarine are two
major alkaloids of argemone oil, which cause widespread capillary dilation,
proliferation and increased capillary permeability. Epidemic dropsy is characterized

Number of
persons Number of
Disease affected outbreaks Place Deaths

Epidemic Dropsy 242 2 Delhi 7

Botulism 34 1 Gujrat 3
Pesticide poisoning 96 2 Ahmedabad, Delhi 3
Methaemoglobinaemia 86 1 – –
Mycotoxicosis 1,548 2 Various parts of the country –
Sodium nitrate poisoning 22 1 Hyderabad 14
Bacterial food poisoning 1,130 24 Various parts of the country –
Lead poisoning 30 1 Hyderabad – Table I.
Rancidity of food 125 1 Hyderabad – Reported outbreak of
Excess color usage in Aniseed 40 1 Hyderabad – foodborne diseases in
Phycotoxin 132 1 Mumbai 4 India during 1980-2009
BFJ by edema over ankles, gastrointestinal disturbances, vascular changes, ocular changes
114,5 and cardiac insufficiency. Illness begins with the gastro enteric symptoms followed by
cutaneous erythema and pigmentation. Respiratory symptoms such as cough,
shortness of breath and orthopnoea progressing to frank right sided congestive cardiac
failure are seen. Mild to moderate anaemia, hypoproteinaemia, glaucoma, renal
azotemia are common manifestations. There is no specific therapy for epidemic dropsy.
664 Non-use of adulterated oil and symptomatic treatment of cardiac failure and
respiratory symptoms along with the administration of antioxidants and
multivitamins, remain the mainstay of the treatment (Sharma et al., 1999).
In a major outbreak of epidemic dropsy, which occurred in Delhi, India; during
August-September 1998 as reported by Singh et al. (2000) 212 adults were affected due
to the consumption of contaminated mustard oil. Pitting pedal edema (100 percent),
skin erythema (75 percent), limb tenderness (63 percent), diarrhea (51 percent) and
hepatomegaly (34 percent) were the prominent clinical manifestations observed in the
patients. Cardiac failure was present in 14 percent of the patients. There were six
deaths, all of whom had intractable cardiac failure. A unique feature of this outbreak
was the documentation of acute renal failure in three patients, a phenomenon never
described previously (Singh et al., 2000). An outbreak of epidemic dropsy in the
Barabanki District of Uttar Pradesh, India was reported by Kumar et al., during 1992.
The study was performed on 24 persons who consumed argemone contaminated
mustard oil. On examination, the subjects revealed characteristic edema over limbs
(95.8 percent) accompanied by tenderness (79.2 percent) and diffuse erythema
(95.8 percent) (Kumar et al., 1992). Narasimhan et al. (1999) reported an outbreak of
epidemic dropsy in Andhra Pradesh during August-September 1987. A total 30
persons from six families were identified and examined. Ghee and one oil sample was
found to be contaminated with the toxic compound sanguinarine (Narasimhan et al.,
1999).

Excess color/dye usage (Metanil Yellow)

Chandra and Nagaraja (1987) reported a food poisoning outbreak affecting 14 persons
due to consumption of sweetmeat colored with non-edible dye. Cyanosis due to
methemoglobinemia was the main clinical feature and the particular dye was found to
be sodium phenyl amidobenzene metasulphonate or metanil yellow (Chandra and
Nagaraja, 1987). Another outbreak of foodborne disease occurred in Hyderabad in 1993
due to aniseed consumption involving 40 children. The major symptoms in the affected
children were ulceration of tongue and burning sensation while eating food. Ponceau
4R color was responsible for the outbreak of foodborne disease and the color was
detected in the aniseed samples (Rao and Sudershan, 2008)

Acquired toxic methemoglobinaemia (metanil yellow)

Methemoglobinemia also known as met-Hb is a disorder characterized by the presence
of a higher than normal level of methemoglobin in the blood. Methemoglobin is a form
of hemoglobin that does not bind oxygen. When its concentration is elevated in red
blood cells, functional anemia and tissue hypoxia occur. Methemoglobin normally is
present in the blood at levels less than 1 percent. Higher levels may become toxic as
hemoglobin is oxidized to methemoglobin. Sachdeva et al. (1992) reported a case study
on acquired toxic methemoglobinemia during 1992 in which 86 persons were affected
due to this disorder. A total 86 adult males presented central cyanosis following Foodborne
ingestion of meal from a common kitchen. The epidemiological study and toxicological diseases in India
examination revealed that metanil yellow used for coloring the rice was responsible for
the disorder (Sachdeva et al., 1992).

Food borne diseases due to chemical contamination

Chemical contaminants present in food may result from their natural occurrence in soil, 665
e.g. cadmium, lead and mercury pollution arising from industrial or agricultural
practices like pesticides, fertilizers, certain polycyclic aromatic hydrocarbons and lead
enter food chain during food processing/packaging. These contaminants may present a
potential hazard for human health if exposure exceeds tolerable levels. The reported
foodborne disease outbreaks due to chemical contamination in India during 1980-2009
indicated that there were eight outbreaks affecting 641 persons including 24 deaths.
Following are some of the foodborne diseases due to chemical contamination that has
been reported in India. Gautami et al. (1995) reported accidental acute fatal sodium
nitrite poisoning in Hyderabad during 1995. The food poisoning outbreak occurred
resulting in the death of 14 of the 22 affected persons. Analysis of urine, gastric
contents, food materials, liver and kidney confirmed the presence of sodium nitrate and
potassium arsenate (Gautami et al., 1995).
Food poisoning outbreak in student hostel due to improper tin coating in Hyderabad
during 1995 was reported by Sudershan et al. (1996). The disease was characterized by
nausea, abdominal pain and vomiting. The food poisoning was associated with the
consumption of rice and soup contaminated with lead and copper. Lead was detected in
rice (119.65ppm), soup (42.6ppm), vegetable curry (42.9), and vomitus (120.6ppm)
while copper was detected in soup (47.0ppm) and vomitus (40.2ppm). Improper tin
coating of the copper vessels used for cooking was responsible for the outbreak
(Sudershan et al., 1996). Bhat et al. (1995) have recorded foodborne disease outbreak
due to consumption of rancid biscuits in Hyderabad during 1995. In this outbreak of
foodborne disease 125 persons were affected. Epidemiological, hospital and laboratory
investigations of the outbreak indicated that the disease was associated with
consumption of rancid biscuits. Rancidity of the biscuits was confirmed by high
peroxide value and acidity of extracted fat.

Pesticide residues
The presence of pesticide residues in foods has been much debated. The possible
harmful effects of pesticides ingestion by humans include delayed neurotoxicity,
behavioral toxicity, enzyme imbalance, effect on reproductive system, effect on
immune system, loss of memory and carcinogenicity. Chaudhry, Balalall, Mishra and
Dhawan (1998) reported a foodborne outbreak of organophosphate poisoning in New
Delhi during 1997. A total of 60 men aged 20-30 years were affected. The 60 men who
affected due to food poisoning had eaten a lunch cooked in the community kitchen.
Detailed questioning of those working in the kitchen showed that on the morning of the
outbreak the kitchen had been sprayed with pesticide containing an organophosphate
Malathion. The raw materials for cooking were stored in open jute bags. All 60 people
who had eaten the meal were affected (Chaudhry, Balalall, Mishra and Dhawan, 1998).
Repeated episodes of endosulfan poisoning in Ahmedabad was reported by Dewan
et al. during 2004. A number of families in a rural area of Jabalpur District (Madhya
BFJ Pradesh), India, were affected by repeated episodes of convulsive illness. In total
114,5 36 persons of different age groups had illness of varying severity over a period of three
weeks. Three children died during this period. Endosulfan poisoning was suspected as
many villagers were using empty pesticide containers for food storage. The blood and
food samples analyzed showed the presence of endosulfan, which led to the conclusion
that contamination of wheat grains or flour with endosulfan and its consumption over
666 a period of time was the most likely cause of repeated episodes of convulsions
(Dewan et al., 2004).
There are many newspaper reports on the presence of formalin, starch, sodium
bicarbonate and sodium carbonate in milk, vanaspati in ghee but none of the cases
were investigated and reported in scientific journals. A survey on veterinary drug use
and its residues in milk was carried out in Hyderabad during 1993 by Sudershan et al.
The study indicated that oxytocin and oxytetracycline were frequently found in milk.
Out of 205 milk samples analyzed, 9 percent of market samples and 73 percent of
individual animal milk samples contained oxytetracycline residues (Sudershan et al.,
1996).

Foodborne diseases due to microorganisms

Wide ranges of foodborne diseases are prevalent in developing countries. These
include Diarrhoeal diseases, Cholera, Salmonellosis, Campylobacteriosis, Shigellosis,
Amoebiasis, E.coli infections, Mycotoxicosis, Phycotoxicosis and Botulism etc.

Bacterial food poisoning

The total count of bacteria per gram of food is a good guide to the hygiene and
temperature control process in the preparation of food. The higher the number of
bacteria, the greater is the risk that food poisoning organisms may be present in the
food. Recorded food poisoning outbreaks are very few in India. The reported bacterial
foodborne disease outbreaks in India during 1980-2009 indicated that 24 outbreaks
have occurred involving 1,130 persons. It is observed that the important bacterial
agents, which caused these outbreaks were Staphylococcus aureus, Vibrio, Salmonella,
E.coli and Yersinia enterocolitica (Table II).
Singh et al. (1998) recorded an outbreak of Salmonella food poisoning during 1998
among soldiers of an army unit located at high altitude in western Himalayas. A total
of 78 of the 103 soldiers who had consumed the incriminated meal suffered from the
illness. They have isolated Salmonella enteritidis from six stool samples and in one
blood sample. Epidemiologically, frozen fowl was traced as the probable incriminating
food agent responsible for the outbreak (Singh et al., 1998). An outbreak of food
poisoning in a Tamil Nadu village affecting 25 of 48 individuals who participated in a
feast was reported by Abraham et al. during 1997. The risk of developing illness was
associated with the consumption of buttermilk. Toxin producing Y.enterocolitica was
isolated from 11 stool samples from affected individuals, as well as water sample from
the source used to dilute the buttermilk. This was the first report from India of a food
poisoning outbreak associated with this organism (Abraham et al., 1997).
Outbreak of food poisoning in May 1995 due to Salmonella paratyphi A var durazoo
(2, 12: a:-) in Maharastra was reported by Fule et al. (1996). Thirty three persons were
affected during this outbreak after consuming vegetarian food. The organism was
isolated from 12 fecal samples. This serovar of Salmonella as a causative agent of food
 Foodborne
Number of persons
Place Incidences affected Microorganism Food diseases in India
Party 3 98 Salmonella Veg-food
Paratyphi A
Var durazoo Coconut balls
S.aureus Fish and meat 667
V.paraheamolyticus sandwiches
Mess 1 76 E.coli serotype 020 Dinner
Home 2 5 Salmonella Stale rice
welteverden,
Salmonella bornum Chicken
Feast 1 25 Yersinia Butter milk
enterocolitica
1 14 Vibrio fluvialis Bread and vegetable
Religious ceremony curry
Army unit 1 78 Salmonella Frozen food
enteritidis
Marriage party 1 500 Vibrio vulnificus Fish
School 2 135 Escherichia coli Soyabean milk
Staphylococcus Bhalla
aureus
Hostel 1 34 Salmonella Fish
welteverden Table II.
Reported foodborne
Educational 1 150 Salmonella Kheer
disease outbreaks due to
institution enteritidis
bacteria in India during
Hospital 10 10 Salmonella wein Poultry products 1980-2009

poisoning is unusual in India (Fule et al., 1996). An outbreak of food poisoning

suspected to be caused by Vibrio fluvialis was reported in Pune, India. Fourteen
persons were affected due to this food poisoning after having the meal in a religious
ceremony. Vibrio fluvialis was isolated from nine out of 14 stool samples (Thekdi et al.,
1990). Epidemiological investigation of a food poisoning outbreak in college of
Haryana, India was reported by Mandokhot et al. during 1987. A total of 31 persons
suffered from this illness. Epidemiological investigation indicated that Sweet meat
(coconut ball) contaminated with S.aureus was responsible for the food poisoning
(Mandokhot et al., 1987). Isolation of Salmonella bornum for the first time in India from
a food poisoning case in Bihar, India during 1985 was reported by Choudhary et al.
(1985). The affected person has consumed chicken two days before the onset of the
symptoms of frequent vomiting and diarrhea. Salmonella bornum was isolated from
the sample for the first time in India (Choudhary et al., 1985).
An outbreak of food poisoning in a family due to Salmonella weltevreden at Delhi
was reported by Aggarwal et al. during 1985. Four persons were affected due to this
food poisoning. The stale rice contaminated with the organism was responsible for the
BFJ outbreak. Salmonella weltevreden was isolated from stools of three out of four patients
114,5 who consumed the stale rice (Aggarwal et al., 1985). An outbreak of gastroenteritis due
to Vibrio parahaemolyticus in Vellore, India was reported by Lalitha et al. (1983).
Contamination of the fish preparation served at function coupled with
cross-contamination of the meat, which was used as sandwich paste were thought to
be responsible for this outbreak. Among 34 people who consumed contaminated food
668 and were infected, 29 had clinical manifestations of illness. V.parahaemolyticus was
isolated from feacal samples of the ten patients (Lalitha et al., 1983). An outbreak of
food poisoning due to Salmonella enterica serotype weltevreden (S.weltevreden)
involving 34 students has been reported from Mangalore by Antony et al. (2009b). A
study on outbreak of food poisoning in an army unit with 42 cases was investigated by
Nayar et al. (1993). The results of the study indicated that food poisoning was due to
the toxin production by Staphylococcus aureus. This may be attributed to delay in
preparation of meat (Nayar et al., 1993).
A study on outbreak occurred in the state of Madhya Pradesh involving more than
100 children after the consumption of a snack called “Bhalla” made up of potato ball
fried in vegetable oil indicated that the outbreak was due to the enterotoxin produced
by Staphylococcus aureus (Nema et al., 2007). An investigation on outbreak of
gastroenteritis that occurred in an education institution involving 150 students of
Kharar in Punjab indicated that foodborne outbreak was due to Salmonella enteritidis
transmitted by kheer (a sweet prepared from milk and rice) (Dikid et al., 2009). A study
on ten cases of gastroenteritis due to Salmonella wein were reported from a tertiary care
hospital in Mangalore during April 2008. The food source caused the disease was more
likely to be chicken or some other poultry products (Antony et al., 2009a).

Viral food poisoning

Foodborne disease outbreak caused by Norwalk-Like Virus (NLV) in India was
reported for first time by Girish et al. (2002). This is the first report of a foodborne
outbreak attributable to NLVs from India. This outbreak of food poisoning has
occurred in the nurses’ hostel of a civic hospital in Delhi. All the affected 130 nurses
had eaten sandwiches at the party. NLV was detected in the six stool samples collected
from the affected persons (Girish et al., 2002).

Foodborne botulism
Foodborne botulism is thought to be an uncommon clinical condition in India and is
rarely reported. Botulism is a neuroparalytic illness resulting from the action of a
potent neurotoxin produced by clostridium botulinum, an anaerobic spore forming
bacterium. Foodborne botulism follows ingestion of toxin produced in food by
C.botulinum. The most frequent sources are canned vegetables, fruits, and meat
products. Neurotoxigenic Clostridium butyricum was first reported in 1986 in two
cases of infant botulism in Rome (Aureli et al., 1986). In China Neurotoxigenic
Clostridium butyricum was isolated from the food implicated in an outbreak of
clinically diagnosed type E botulism (Meng et al., 1997). Outbreak of suspected
Clostridium butyricum botulism was first time reported in India by Chaudhry,
Dhawan, Kumar, Bhatia, Gandhi, Patel and Purohit (1988). In rural Gujarat 31 students
were affected and three students died due to this outbreak. Sevu, a food prepared from
gram flour was found responsible for this outbreak (Chaudhry, Dhawan, Kumar, Foodborne
Bhatia, Gandhi, Patel and Purohit, 1988). diseases in India
Phycotoxicosis
Food poisoning due to ingestion of algal toxin/phycotoxin is phycotoxicosis. Bhat et al.
(1988) reported a foodborne disease outbreak due to consumption of fish in Bombay,
India. A total of 132 persons were affected and four persons died during this outbreak 669
(Bhat et al., 1988). Based on epidemiological, clinical, analytical and toxicological
studies in mice it was concluded that the disease occurred due to consumption of fish
from a nearby freshwater pond which might have become toxic due to ingestion of
algal toxins by fish.

Mycotoxicosis
Two outbreaks of mycotoxicosis involving 1,521 persons were observed in Rajasthan,
Banswada and Gujarat of India. The toxins produced by fungi are collectively termed
as mycotoxins and the disease caused by them is referred as mycotoxicosis. Bhat et al.
(1997) reported a foodborne disease outbreak due to the consumption of moldy
sorghum and maize containing fumonisin mycotoxins in southern part of India. In this
foodborne disease outbreak 1,424 persons were affected. Human consumption of rain
damaged moldy sorghum was responsible for the outbreak. Fusarium spp. was found
in the sorghum and maize samples containing fumonisin B1 in the range of
0.14-7.8 mg/kg and 0.25-64.7 mg/kg respectively. The higher water activity in the
grains left in the field following harvest led to the production of high levels of
fumonisin B1 and consumption of such grains by humans resulting in the disease.
Outbreak of Trichothecene mycotoxicosis associated with consumption of mould
damaged wheat products in Kashmir valley, India was reported by Bhat et al. (1989). A
total of 97 persons were affected due to this food poisoning outbreak. Epidemiological
investigations and laboratory based studies indicated that the outbreak was associated
with the consumption of bread made out of from mould contaminated wheat floor.

Pathogenic bacteria from different Indian foods

The type of pathogenic bacteria isolated from different food items was also studied.
Some of the new emerging pathogens like Listeria monocytogenes (Pednekar et al.,
1997, Bhilegaonkar et al., 1997) Yersinia enterocolitica (Kushal and Anand, 2001),
Campylobacter jejuni (Kumar et al., 2001), E.coli 0157:H7 (Dutta et al., 2001-2002) were
found to be isolated from different food products. Milk, milk based sweets,
non-vegetarian foods like meat and fish were found to contain more pathogenic
bacteria (Table III).

Common foodborne pathogens and their percentage of contamination in

Indian foods
The percentage of contamination of different foodborne pathogens in Indian foods
varied from 1-75 percent (Table IV). The percentage contamination of B.cereus in milk
ranged from 16-50 percent (Shah et al., 1996; Raju and Kumar, 1988; Prabha et al., 1996)
and in meat it was 35 percent (Sharma et al., 2005; Bacchil et al., 1995; Rao, 1983; Desai
and Kamat, 1998; Bachhil and Jaiswal, 1988a,b; Sharma et al., 1995). The Salmonella
spp. in poultry products was about 11 percent and in meat it was 3-5 percent.
BFJ
Type of food Bacteria
114,5
Milk Listeria monocytogenes, Yersinia enterocolitic
Bacillus cereus, Srteptococcus feacalis, Escherichia
coli
Meat Bacillus cereus, Escherichia coli Stahylococcus aureus,
670 Vibrio parahaemolyticus
Beef sample Escherichia coli 0157:H7
Sweets Salmonella Newport, Salmonella enteritidis
Dahi (yogurt), Khoa Escherichia coli, Enterobacter aerogenes Salmonella
Newport, Salmonella enteritidis, Fecal coliforms
Prawns Vibrio parahaemolyticus
Cooked and uncooked rice Bacillus cereus
Poultry Campylobacter jejuni, Salmonella bornum
Fish Staphylococcus, Escherichia coli
Samosa S.aureus

Table III. Batatawada S.aureus

Pathogenic bacteria Tamarind Salmonella, Staphylococcus, Shigella
isolated from different
Indian foods Butter milk Yersina enterocolitica

Salmonella was detected in meat, poultry, sea foods (Singh and Kulshrestha, 1994;
Beri et al., 1989; Thanoyran and Surendran, 1998; Anand et al., 2002; Singh et al., 1996)
and khoa (desiccated milk product) (Kakar and Udipi, 1997, Kakar and Udipi, 1998)
while E.coli was detected more in khoa (Vardaraj and Nambudripad, 1981); vegetables
(Bandekar et al., 2005), beef, fish (Kumari et al., 2001) and meat. Milk, meat, lassi
(Pillai et al., 1993), vegetables (Guha et al., 1983) and rice were found to contain Bacillus
cereus (Meena et al., 2000) in addition to other organisms. The microbial population
of different Indian food products varied from 0-400 £ 106 cfu/g (Table V) (Kumar et
al., 2001).

Atropine poisoning
An accidental outbreak of non bacterial food poisoning in soldiers at high altitude, caused
by accidental ingestion of a dish made out of a atropa accuminata plant leaves containing
atropine related alkaloids was reported by Kushwaha et al. during 2008. The outbreak was
due to the use of a locally grown plant as a vegetable. Of the 39 people who consumed the
meal, 29 fell ill due to this outbreak. The toxicological analysis of food sample established
the presence of atropine alkaloids (Kushwaha et al., 2008)

Discussion
Foodborne illness causes considerable morbidity and associated losses of work and
functional activity. The increasing commitment to the documentation and control of
 Foodborne
Type of food Bacteria % of contamination
diseases in India
Milk B.cereus 16-50
L.monocytogenes 6
Yersinia 5-59
Aeromonas 7
Vibrio 8 671
Meat Salmonella spp 3-5
Staphylococcus spp 21
E.coli 9-14
Aeromonas 13
B.cereus 35
Poultry C.jejuni 41
Salmonella spp 11
Aeromonas 28
Fish E.coli 7
Vibrio 16-32
Shigella 4
Seafoods Salmonella spp 1
Vibrio spp 1
Listeria 1
Beef E.coli 0157:H7 60
Rice B.cereus 28-46
Vegetables B.cereus 24
Coliforms 75
E.coli 75
Listeria 12
C.jejuni 3 Table IV.
Common foodborne
Lassi B.cereus 5
pathogens and their
Khoa Staphylococcus spp 20-36 percentage of
Salmonella spp 5 contamination in Indian
E.coli 9 foods

foodborne diseases indicate an increasing awareness of its significance in terms of

morbidity, mortality and economic loss. In India there are very few reviews of
foodborne diseases, however there is one study in India by Bhat and Nageswara Rao
(1987). The study conducted by Bhat and Nageswara Rao (1987) on outbreaks of
foodborne diseases in India during 1957-1985 indicated that there were 44 outbreaks
involving 4,891 persons (Bhat and Nageswara Rao, 1987). This report on incidences of
foodborne disease outbreaks in India during 1980-2006 indicates that there were 29
outbreaks involving 3,279 persons. The present review reveals that there has been
decline in the outbreaks of epidemic dropsy, lathyrism and mushroom poisoning when
compared to foodborne disease outbreaks in India during 1957-1985. A study of
recorded cases of foodborne diseases at Hyderabad during 1984 and 1985 indicated
that during both the years the majority of the outbreaks (70 percent) involved group of
BFJ
Food Bacteria Microbial population
114,5
Meat Staphylococcus spp 7.2 £ 101/g
B.cereus 9.65 £ 104/g
Aeromonas 9.0 £ 103/g
Clostridia 4.4 £ log10/g
672 Fish Staphylococcus 3.7 £ 106cfu/g
Salmonella 8.9 £ 102
Coliform 1.3 £ 103
Dairy products Staphylococcus spp 7.2 £ 103cfu/g
Seafoods E.coli 0-102cfu/g
Staphylococcus spp 106cfu/g
Rice B.cereus 1.0 £ 102-9.0 £ 105
Lassi Salmonella 74 £ 102cfu/ml
Yersinia 43 £ 102cfu/ml
C.jejuni 90 £ 102cfu/ml
Table V.
khoa Staphylococcus spp 400 £ 106cfu/g
Pathogenic bacterial
populations in different Mich Dahi E.coli 5 £ 106cfu/g
Indian food products E.aerogenes 0-46 £ 101cfu/g

two-to-five persons while 17 percent involved groups of six-to-ten persons. Larger

outbreaks involving more than 20 persons accounted for only 5 percent of cases.
During this time a total of 209 sporadic cases were recorded (Rao et al., 1989). The
outbreaks of suspected food poisoning cases in and around Hyderabad reported in
newspapers during 2000-2002 revealed about 24 outbreaks involving 944 persons.
These food poisoning cases were reported in newspapers but none of them were
investigated
During 1957-1985, 11 outbreaks of epidemic dropsy cases have been identified. The
outbreaks of epidemic dropsy have been drastically reduced during study period. The
decline in outbreaks of epidemic dropsy could be probably due to the selective
cultivation of yellow mustard by farmers, strict enforcement of the prevention of Food
Adulteration Act (PFA) and exemplary punishment to unscrupulous traders (Sharma
et al., 1999). Earlier studies (1957-1985) show that there were four outbreaks of
lathyrism, which were due to toxic factor BOAA (b-Oxalyl amino alanine) present in
Lathyrus sativus (kesari dal ). The increase in the incidence of lathyrism in the 1960s
would be due to Lathyrus sativus seeds given as wages to bonded labourers in Madhya
Pradesh (Northern state in India). The gradual decline and the eventual virtual
disappearance by the late 1980s was indeed a surprising and paradoxical development.
The striking finding was that the contract agricultural laborers, unlike in the past,
were no longer getting lathyrus sativus in lieu of their wages. Instead they were getting
either money or wheat and other millets. The poor landless laborers were being saved
from the poisonous seed not because of the researchers and educational programme of
the last two decades, but solely due to the intervention of market forces (Gopalan, 1999)
 However there has been an increase in the incidence of outbreaks as a result of Foodborne
mycotoxicosis, bacterial contamination and pesticide residues. The incidence of diseases in India
mycotoxicosis has increased possibly due to poor storage of grains, contaminated
grains, wet harvest which facilitate fungal growth, holding cereals in moist and damp
conditions, mixing of contaminated and uncontaminated grains.
It is known that foodborne illness of microbial origin is the most serious problem.
The Centre for Disease Control and prevention reports document that in United States 673
79 percent of outbreaks between 1987 and 1992 were bacterial. This review indicates
that the incidences of bacterial food poisoning cases in India are more when compared
to other foodborne disease outbreaks. This may be due to improper food storage
conditions and holding time between preparation and consumption, inadequate
cooking or reheating, cross contamination from low to high risk or ready to eat foods,
infected food handlers, inadequate hot holding temperatures, inadequate hand
washing, contaminated raw food and ingredients, improper cleaning of equipment and
utensils. In India it is reported that 86 percent of the families store cooked food of which
75 percent leave it at room temperature thereby exposing themselves to the risk of
foodborne diseases especially by consuming it the next day (Polasa et al., 2006).
The KABP (Knowledge, Attitudes, Beliefs and Practices) study on food and drug
safety in India surveyed 20,719 households from five regions spread over 28 states.
About 13.2 percent households reported that at least one person in each household
suffered from foodborne illness during the previous 15 days of the survey. At
community level 3 percent of the villages surveyed indicated that there was at least one
foodborne disease outbreak in the community during previous one year. It is reported
that distribution (%) of foodborne diseases according to food safety awareness and
practices by region wise (North, South, East, West and North East) indicated that
occurrence of foodborne disease was high in the western region (24.2 percent) from the
nearest region i.e. North East (10.9 percent) (Polasa et al., 2006).
In India the pathogenic bacteria like Salmonella was found to be more common in
meat, poultry, seafood and khoa but in other country like UK it is more common in
meat (Busani et al., 2004), poultry (Shelly et al., 2006), eggs and dairy products. The
virulence properties and genetic diversity of E.coli 0157:H7 isolates have been widely
studies in the United States and other developed countries (Feng, 1995). Far less is
known about 0157 prevalence in developing countries, where diarrheal disease and
associated mortality are much more pervasive. In India E.coli 0157 (Dutta et al.,
2001-2002) was found in beef, milk paneer and ice cream (Singh et al., 2009) but in UK it
is more common in beef burgers, meat and dairy products. In India the percentage
contamination of B.cereus in milk varies from 16-50 percent (Shah et al., 1996; Prabha
et al., 1996) in other countries like China it is about 17 percent (Wong et al., 1998). In
China the average population of B.cereus in dairy products was 15-280 cfu/ml or cfu/g
(range 5-800). The percentage contamination of B.cereus in Indian meat was 35 percent
and the count was 9.65 £ 104/g. A study conducted in Turkey indicated that 22.4
percent of the meat samples contained detectable levels of B.cereus with counts
ranging from log 10 0.69-4.80 cfu/g (Guven et al., 2006). The percentage contamination
of Salmonella in Indian meat is 11 percent; however the study conducted in Germany
indicates that salmonellae were detected in 15.8 percent of the minced meat samples.
The mid day meal scheme is the popular name for school programme in India. A
total 120 million children are covered under the mid day meal scheme so for, making it
BFJ the largest school programme in the world. Several sporadic cases of food poisoning
114,5 were reported in the newspapers but none of the cases were investigated. The reasons
such as consumption of stale food or by drinking contaminated water or impure water
were given in the newspapers to be the cause of the outbreaks.
Various studies reported in India indicated that the cause for incidences of
foodborne diseases were the sandwiches, stale rice, chicken, bread and vegetable curry,
674 butter milk where as studies in other countries indicated the incidence of foodborne
diseases due to consumption of beef, pork meet, frozen steaks, poultry and other meat
items. In India about 64.4 percent of people are non-vegetarians of whom 63 percent
store the cooked non-vegetarian food at room temperature. Only 29.4 percent consume
stored food after thorough heating while the others may be exposing themselves to the
risk of foodborne diseases. Four non-vegetarian items like egg, chicken, fish and
mutton are usually consumed by most of the respondents in the country (Polasa et al.,
2006). In other countries like USA the meat consumption per day is 339 g, 216 g per day
in Brazil and 243 g per day in Europe, which shows that the intake of non-vegetarian
foods among the Indian population is comparatively low as compared to other
countries. Occurrence of outbreak of food poisoning may be attributed to the type of
food being consumed, which is based on the food habits of the people specific to the
country.
Foodborne disease has emerged as a significant public health and economic
problem in many countries. The direct and indirect economic costs associated with
foodborne disease are known to be high, but actual quantitative estimates are difficult
to obtain. Differences on what costs to measure and how to measure them, combined
with serious data limitations, make comparison of pathogens overtime frame or across
among countries is extremely difficult. It is essential to have the best possible estimates
of the economic costs that are based on the cost benefit analysis of measures so that
policy makers can take measures to prevent incidence of foodborne diseases (World
Health Organization, 2002).
The Centre for Disease Control and Prevention (CDC) estimates 76 million people
suffer from foodborne illness each year in the United States accounting for 3,25,000
hospitalization and more than 5000 deaths. Health expert’s estimate that the yearly
cost of all foodborne diseases in the US are 5-6 billion dollars in direct medical expenses
and lost productivity (Kirch, 2008). Infections with the bacteria alone account for
$ 1billion yearly in direct and indirect medical costs. The economic impact of S.aureus
outbreak in India showed that 41 percent of the total cost of the outbreak was borne by
the affected persons which included loss of wages or productivity loss and other
expenses (Sudhakar et al., 1988). A recent study on economic impact of foodborne
disease in Hyderabad indicated that the economic cost of the foodborne disease
outbreak for 60 persons was Rs 91901/- (US $ 2070 @ 44/- per dollar) (Sudershan et al.,
2010). On the basis of the percentage of per capita income the economic burden on
affected people in India would be higher than in the case of similar outbreaks in USA. It
should be realized that many developing countries still lack the scientific capabilities
and do not have food control measures, alert system to curtail foodborne diseases. In
industrialized countries up to 30 percent of people suffer from foodborne illness every
year. An estimated 70 percent of the approximately 1.5 billion annual cases of
diarrhoea in the world are caused by biological contamination of food.
 Foodborne disease outbreak information is available in the comprehensive food Foodborne
safety information website, FoodHACCP.com from 2002-2010, and also in the website diseases in India
www.indiaenvironmentportal.org.in managed by the center for science and
environment. But none of the food poisoning cases were investigated and reported
in scientific journals.
WHO has initiated Global Foodborne Infections Network (GFN) with many
countries to detect, control and prevent foodborne and other enteric infections from 675
farm to table. The main objectives of the network is to strengthen and enhance the
capacities of national and regional laboratories in the surveillance of Salmonella, the
other major foodborne pathogens and antimicrobial resistance in Salmonella and
Campylobacter from humans, food and animals through the programme activities
(FAO/WHO, 2010).

Conclusions and recommendations

Though the socioeconomic impact of foodborne diseases is very high, there are limited
effective measures to reduce them. The reason being absence of surveillance system in
India. Moreover the burden due to foodborne disease is not fully understood.
According to WHO, food safety should be considered as an integral part of the primary
health care delivery system. For this health authorities in India should strengthen
considerably the present system in to an effective foodborne disease surveillance
system. There is a need to strengthen the work already undertaken and further
improve interdisciplinary approaches in order to tackle public health issues and curb
economic losses. This will also allow policy makers to design appropriate preventive
strategies to lower the incidence of foodborne illnesses and reduce the risk of morbidity
and mortality in Indian population. To prevent both ongoing transmissions of diseases
and similar outbreaks in the future, strengthening of food safety policies and
programmes, acquisition of epidemiological data for risk assessment of foodborne
pathogens should be done. In India, there is a need to increase awareness pertaining to
recognition of food spoilage, foodborne disease and its symptoms and development of
effective food control measures. The initiatives like continuous monitoring of
foodborne disease recording can be used to set up a database, which can become a
component of rapid alert system that has to be developed in the country.

References
Abraham, M., Pai, M., Kang, G., Asokan, G.V., Magesh, S.R., Bhattacharji, S. and Rama Krishna,
B.S. (1997), “An outbreak of food poisoning in Tamil Nadu associated with Yersinia
enterocolitica”, Indian Journal of Medical Research, Vol. 106, pp. 465-8.
Adams, M.R. and Moss, M.O. (2003), “Significance of food borne diseases”, Food Microbiology,
2nd ed., RSC Publishing, Cambridge, pp. 160-4.
Aggarwal, P., Singh, S.M. and Bhattacharaya, M.M. (1985), “An outbreak of food poisoning in a
family due to S.weltevreden at Delhi”, Journal of Diarrheal Disease Research, Vol. 3,
pp. 224-5.
Anand, C., Jeyasekaran, G., Jeyashakila, R. and Edwind, S. (2002), “Bacteriological quality of
seafood landed in Tuticorin fishing harbour of Tamil Nadu, India”, Journal of Food Science
and Technology, Vol. 39 No. 6, pp. 694-7.
BFJ Antony, B., Scaria, B., Dias, M. and Pinto, H. (2009a), “Salmonella wein from gastroenteritis cases
encountered in Mangalore, India: a report of ten cases and review of the literature”, Indian
114,5 Journal of Medical Sciences, Vol. 63, pp. 195-7.
Antony, B., Dias, M., Shetty, A.K. and Rekha, B. (2009b), “Food poisoning due to Salmonella
enterica serotype weltevreden in Mangalore”, Indian Journal of Medical Research,
Vol. 27 No. 3, pp. 257-8.
676 Aureli, P.K., Fenicia, L., Pasolini, B., Gianfranceschi, M., McCroskey, L.M. and Hatheway, C.L.
(1986), “Two cases of type E infant botulism caused by neurotoxigenic Clostridium
buytyricum in Italy”, Journal of Infectious Diseases, Vol. 154, pp. 207-11.
Bachhil, V.N. and Jaiswal, T.N. (1988a), “Occurrence of salmonella in meats”, Journal of Food
Science and Technology, Vol. 25 No. 5, pp. 310-2.
Bachhil, V.N. and Jaiswal, T.N. (1988b), “Bacillus cereus in meats: incidence, prevalence and
enterotoxigenicity”, Journal of Food Science and Technology, Vol. 25 No. 6, pp. 371-2.
Bandekar, J.R., Dhokane, V.S., Shashidhar, R., Hajare, S., Ghadge, N., Kamat, A.S. and Sharma, A.
(2005), “Microbiological quality of carrot, tomato and cucumber from Mumbai Market”,
Journal of Food Science and Technology, Vol. 42 No. 1, pp. 99-101.
Beri, H.K., James, M.A. and Solanki, K.K. (1989), “Bacterial flora of some fishes of Maharastra
and Saurastra coasts (India)”, Journal of Food Science and Technology, Vol. 26 No. 6,
pp. 318-21.
Bhat, R.V. and Nageswara Rao, R. (1987), “Foodborne diseases in India”, Indian Journal of
Pediatrics, Vol. 54 No. 4, pp. 553-62.
Bhat, R.V., Gautami, S., Shashidhar, R.B. and Lakhani, A.S. (1988), “A foodborne disease
outbreak in man due to fish consumption possibly containing phycotoxins in Bombay,
India”, Proc Japanese Journal of Mycotoxicology, Vol. 28, pp. 37-9.
Bhat, R.V., Vasanthi, B., Shashidhar, R.B., Rao, N.R. and Rao, V.S. (1997), “Aflotoxin
B1 contamination in maize samples collected from different geographical regions of India
– a multicentric study”, Food Additives and Contaminants, Vol. 14, pp. 151-6.
Bhat, R.V., Shashidhar, R.B., Ramakrishna, Y. and Munshi, K.L. (1989), “Outbreak of
trichothecene mycotoxicosis associated with consumption of mould damaged wheat
products in Kashmir Valley in India”, Lancet, Vol. 333 No. 8628, pp. 35-7.
Bhat, R.V. (2004), “Safety and quality of processed foods”, Indian Food Industry, Vol. 23 No. 6,
pp. 58-61.
Bhat, R.V., Vemula, S.R., Pokkunuri, Y., Siddula, G. and Purnachandra, G.K. (1995), “Foodborne
disease outbreak due to consumption of rancid biscuits”, Journal of Cinical Toxicology,
Vol. 33 No. 3, pp. 219-22.
Bhilegaonkar, K.N., Kulshrustha, S.B., Kapoor, K.N., Kumar, A., Agarwal, R.K. and Singh, B.R.
(1997), “Isolation of Listeria monocytogenes from milk”, Journal of Food Science
Technology, Vol. 34 No. 3, pp. 248-50.
Busani, L., Graziani, C., Battisti, A., Franco, A., Ricci, A., Vio, D., Digiannatale, E., Paterlini, F.,
D’Incau, M., Owczarek, S., Caprioli, A. and Luzzi, I. (2004), “Antibiotic resistance in
Salmonella enterica serotypes Typhimurium, Enteritidis and Infantis from human
infections, food stuffs and farm animals in Italy”, Epidemiology & Infection, Vol. 132,
pp. 245-51.
Chandra, S.S. and Nagaraja, T. (1987), “A food poisoning outbreak with chemical dye:
an investigation report”, Medical Journal Armed Forces India, Vol. 43 No. 4, pp. 291-3.
Chaudhry, R., Balalall, S., Mishra, B. and Dhawan, B. (1998), “A foodborne outbreak of
organophosphate poisoning”, BMJ, Vol. 317, pp. 268-9.
Chaudhry, R., Dhawan, B., Kumar, D., Bhatia, R., Gandhi, J.C., Patil, R.K. and Purohit, B.C. (1998), Foodborne
“Outbreak of suspected Clostridium Butyricum Botulism in India”, Emerging Infectious
Diseases, Vol. 4 No. 3, pp. 506-7. diseases in India
Choudhary, S.P., Narayan, K.G., Saxena, S.N., Mago, M.L. and John, P.C. (1985), “Isolation of
Salmonella Bornum (6, 7, 14:Z38) for the first time in India”, Indian Journal of Medical
Sciences, Vol. 39 No. 3, pp. 45-6.
Desai, B. and Kamat, M.Y. (1998), “Recovery and characterization of enterotoxigenic strains of 677
staphylocci and microbiological quality of processed Indian foods”, Journal of Food
Science Technology, Vol. 35 No. 5, pp. 461-4.
Dewan, A., Bhatnagar, V.K., Mathur, M.L., Chakma, T., Kashyap, R., Sadhu, H.G., Sinha, S.N. and
Saiyed, H.N. (2004), “Repeated episodes of endosulfan poisoning”, Journal of Clinical
Toxicology, Vol. 42 No. 4, pp. 363-9.
Dikid, T., Hpalya, S.S., Thakur, J.S., Taneja, N., Thapar, R. and Kumar, R. (2009), “Salmonella
food poisoning outbreak in Karar town of Punjab”, Indian Journal of Public Health, Vol. 53
No. 4, p. 265.
Dutta, S., Ghosh, S. and Dutta, P. (2001-2002), “Search for Shiga Toxin producing Escherichia coli
(STEC) including 0157:H7 strains in animals, animal products, hospitalized bloody
diarrhoea cases and amongst the healthy human population in a defined community”,
National Institure of Cholera and Enteric Diseases Annual Report, No. 49.
FAO/WHO (2010), Joint FAO/WHO Food Standards Programme Committee of the Codex
Alimentarious Commission, CX/CAC10/33/15, Geneva.
Feng, P. (1995), “Escherichia coli serotype 0157:H7: novel vehicles of infection and emergence of
phenotypic varients”, Emerging Infectious Diseases, Vol. 1, pp. 47-52.
Food and Drug Administration (2009), “Management of food safety practices – achieving active
managerial control of foodborne illness risk factors”, Food Code, Annex 4,, pp. 501-35.
Fule, R.P., Ingole, K.V., Jalgaonkar, S.V. and Bharthi, U. (1996), “Outbreak of food poisoning due
to Salmonella Paratyphi A var durazzo (2,12:a: -) in Yavatmal (Maharashtra) in May 1995”,
Indian Journal of Medical Research, Vol. 103, pp. 74-6.
Gautami, S., Rao, R.N., Raghuram, T.C., Rajagopalan, S. and Bhat, R.V. (1995), “Accidental acute
fatal sodium nitrite food poisoning”, Clinical Toxicology, Vol. 33, pp. 131-3.
Girish, R., Broor, S., Dar, L. and Ghosh, D. (2002), “Foodborne outbreak caused by a Norwalk like
virus in India”, Journal of Medical Virology, Vol. 67, pp. 603-7.
Glavin, M.O’K. (2003), “A single microbial sea: food safety as a global concern”, SAIS Review,
Vol. 23 No. 1, pp. 203-20.
Gopalan, C. (1999), “The changing epidemiology of malnutrition in a developing society – the
effect of unforeseen factors”, Bulletin of the Nutrition Foundation of India, Vol. 20, pp. 1-5.
Guha, A.K., Roy, R., Das, H. and Roy, B.R. (1983), “Bacteriological quality of cucumber slices and
its public health significance”, Journal of Food Science and Technology, Vol. 20, pp. 245-6.
Guven, K., Mutlu, M.B. and Avci, O. (2006), “Incidence and characterization of Bacillus cereus in
meat and meat products consumed in Turkey”, Journal of Food Safety, Vol. 26 No. 1,
pp. 30-40.
Hall, G., Vall, H. and Kirk, M. (2008), “Foodborne illnesses: overview”, International Encyclopedia
of Public Health, pp. 638-53.
Hui, Y.H., Merle, D., Pierson, J. and Gorham, R. (2001), “Surveillance of foodborne diseases”,
Foodborne Disease Handbook, Vol. 1, pp. 541-3.
Kakar, D.A. and Udipi, S.A. (1997), “Microbiological quality of khoa and selected milk sweets”,
Indian Journal of Dairy Science, Vol. 50 No. 3, pp. 187-92.
BFJ Kakar, D.A. and Udipi, S.A. (1998), “Microbiological quality of fried ready to eat foods sold in
Mumbai (Bombay) City”, Journal of Food Science Technology, Vol. 35 No. 4, pp. 333-5.
114,5
Kirch, W. (2008), “Microbiological hazards, food safety”, Encyclopedia of Public Health, p. 457.
Kumar, A., Agarwal, K., Bhilegaonkar, K.N., Shome, B.R. and Bachhil, V.N. (2001), “Occurrence
of compylobacter jejuni in vegetables”, International Journal of Food Microbiology, Vol. 67
Nos 1-2, pp. 153-5.
678 Kumar, A., Hussian, F., Das, M. and Khanna, S.R. (1992), “An outbreak of epidemic dropsy in the
Barabanki district of Uttar Pradesh, India: a limited trial for the scope of antioxidants in
the management of symptoms”, Biomedical and Environmental Sciences, Vol. 5 No. 3,
pp. 251-6.
Kumari, S., Prasad, B.N., Kumari, G., Quasim, A., Sinha, B.K. and Singh, J.N. (2001),
“Microbiological quality of fish, rohu marketed in Patna and its public health
significance”, Journal of Food Science and Technology, Vol. 38 No. 6, pp. 607-8.
Kushal, R. and Anand, S.K. (2001), “Isolation, biochemical characterization and antibiotic
susceptibility of Yersinia enterocolitica isolates from milk”, Journal of Food Science and
Technology, Vol. 38 No. 2, pp. 129-34.
Kushwaha, A.S., Aggarwal, S.K., Sharma, L.R., Singh, M. and Nimonkar, R. (2008), “Accidental
outbreak of non bacterial food poisoning”, Medical Journal Armed Forces of India, Vol. 64
No. 4, pp. 346-9.
Lalitha, M.K., Walter, N.M., Jesudason, M. and Mathan, V.I. (1983), “An abstract of
Gastroenteritis due to Vibrio parahaemolyticus in Vellore”, Indian Journal of Medical
Research, Vol. 78, pp. 611-5.
Mandokhot, U.V., Garg, S.R. and Chandiramani, N.K. (1987), “Epidemiological investigation of a
food poisoning outbreak”, Indian Journal of Public Health, Vol. 31 No. 2, pp. 113-9.
Meena, B.S., Kapoor, K.N. and Agarwal, R.K. (2000), “Occurrence of multi drug resistant bacillus
cereus in foods”, Journal of Food Science and Technology, Vol. 37 No. 3, pp. 289-91.
Meng, X., Karasawa, T., Zou, K., Kuang, X., Wang, X. and Lu, C. (1997), “Characterization of a
neurotoxigenic Clostridium butyricum strain isolated from the food implicated in an
outbreak of foodborne type E botulism”, Journal of Clinical Microbiology, Vol. 35,
pp. 2160-2.
Narasimhan, C., Thomus, G., Isreal, J., Rao, P.S. and Pullmood, B.M. (1999), “Epidemic dropsy in
Andhra Pradesh due to contaminated ghee”, Journal of the Association of Physicians of
India, Vol. 39 No. 10, pp. 749-50.
Nayar, K.R., Krishnan, S.K. and Gorthi, S.P. (1993), “Epidemiological investigation of an outbreak
of food poisoning”, Medical Journal of Armed Forced in India, Vol. 49, pp. 257-60.
Nema, V., Agrawal, R., Kamboi, D.V., Goel, A.K. and Singh, L. (2007), “Isolation and
characterization of heat resistant enterotoxigenic Staphylococcus aureus from a food
poisoning outbreak in Indian subcontinent”, International Journal of Food Microbiology,
Vol. 117, pp. 29-35.
Pednekar, M.D., Kamat, A.S. and Hemachandra, R.A. (1997), “Incidence of listeria species in milk
and milk products”, Indian Journal of Dairy Science, Vol. 50 No. 2, pp. 142-51.
Pillai, R.A.V., Khan, M.H.M. and Reddy, P.V. (1993), “Incidence aerobic spore forms in lassi”,
Journal of Food Science and Technology, Vol. 30 No. 2, pp. 141-2.
Polasa, K., Sudershan, R.V., Rao, G.M., Rao, M., Rao, P. and Sivakumar, B. (2006), “A report on
KABP study on food and drug safety in India”, National Institute of Nutrition (ICMR),
pp. 93-102.
Prabha, R., Krishna, R. and Shankar, P.A. (1996), “Identification of gram negative rod shaped Foodborne
psychrotrophic bacteria of dairy origin”, Indian Journal of Dairy Science, Vol. 49 No. 8,
pp. 517-24.
diseases in India
Raju, R.V.V. and Kumar, K.M. (1988), “Incidence of spore forming bacteria in milk heated to
above 1000C”, Journal of Food Science and Technology, Vol. 25 No. 6, pp. 366-7.
Rao, N.D. (1983), “Salmonella in meat”, Journal of Food Science and Technology, Vol. 20,
pp. 157-60. 679
Rao, P. and Sudershan, R.V. (2008), “Risk assessment of synthetic food colors; a case study in
Hyderabad, India”, International Journal of Food Safety, Nutrition and Public Health,
Vol. 1 No. 1, pp. 68-87.
Rao, N.R., Sudhakar, P., Bhat, R.V. and Gupta, C.P. (1989), “A study of recorded cases of
foodborne diseases at Hyderabad during 1984 and 1985”, Journal of Tropical Medicine and
Hygiene, Vol. 92, pp. 320-4.
Sachdeva, S.M., Mani, K.V., Adaval, S.K., Jalpota, Y.P., Rasela, K.C. and Chandhan, D.S. (1992),
“Acquired toxic methaemoglobinaemia”, Journal of the Association of Physicians of India,
Vol. 40 No. 4, pp. 239-40.
Singh, B.R., Kapoor, K.N., Kumar, A., Agarwal, R.K. and Bilegaonkar, K.N. (1996), “Prevalence of
enteropathogens of zoonotie significance in meat, milk and their products”, Journal of
Food Science Technology, Vol. 33 No. 3, pp. 251-4.
Singh, B.R. and Kulshrestha, S.B. (1994), “Incidence of Escherichia coli in fishes and seafood:
isolation, serotyping, biotyping and electrotoxigenicity evaluation”, Journal of Food
Science and Technology, Vol. 31 No. 4, pp. 324-6.
Singh, J., Batish, V.K. and Grover, S. (2009), “A scorpion probe based real-time PCR assay for
detection of coli 0157:H7 in dairy products”, Foodborne Pathogens and Disease, Vol. 6 No. 3,
pp. 395-400.
Singh, N.P., Anuradha, S., Dhanwal, D.K., Singh, K., Prakash, A., Madan, K. and Agarwal, S.K.
(2000), “Epidemic dropsy – a clinical study of the Delhi outbreak”, Journal of the
Association of Physicians of India, Vol. 48 No. 9, pp. 877-80.
Singh, M., Kalghatgi, A.T., Narayanan, K., Rao, K.S. and Nagendra, A. (1998), “Outbreak of
salmonella food poisoning at high attitude”, Medical Journal Armed Forces India,
Vol. 54 No. 2, pp. 96-8.
Shah, R.C., Wadher, B.J. and Reddy, B.G.L. (1996), “Incidence and characteristics of Bacillus
cereus isolated from Indian foods”, Journal of Food Science and Technology, Vol. 33 No. 3,
pp. 249-50.
Sharma, C.S., Gill, J.P.S., Aulakh, R.S., Bedi, S.K., Bedi, J.S. and Sharma, J.K. (2005), “Prevalence of
enterotoxigenic Escherichia and Salmonella typhimurium in meat and meat products”,
Journal of Food Science and Technology, Vol. 42 No. 1, pp. 56-8.
Sharma, B.D., Malhotra, S., Bhatia, V. and Rathee, M. (1999), “Epidemic dropsy in India”, The
Fellowship of Postgraduate Medicine, Vol. 75, pp. 657-61.
Sharma, V.D., Dixit, V. and Joshi, R.K. (1995), “Occurrence of salmonella serovars in foods of
animal origin with special reference to antibiogram and enterotoxigenicity”, Journal of
Food Science and Technology, Vol. 32 No. 3, pp. 221-3.
Shelly, R., Abiodun, A., Zinora, A. and Willium, S. (2006), “Occurrence of selected foodborne
pathogens on poultry and poultry giblets from small retail processing operations in
Trinidad”, Journal of Food Protection, Vol. 69 No. 5, pp. 1096-105.
BFJ Sudershan, R.V., Amruth, P.R., Prabhavathi, P., Bapu, S.R. and Bhat, R.V. (1996), “Foodborne
disease in students hostel due to improper tin coating, a case study”, Journal of College and
114,5 University Food Science, Vol. 2 No. 3, pp. 25-9.
Sudershan, R.V., NaveenKumar, R., Kashinath, L., Bhaskar, V. and Polasa, K. (2010), “Economic
impact of a foodborne disease outbreak in Hyderabad – a case study”, Indian Journal of
Nutrition and Dietetics, Vol. 47, pp. 246-51.
680 Sudhakar, P., Rao, N., Bhat, R.V. and Gupta, C.P. (1988), “The impact of a foodborne disease
outbreak due to Staphylococcus aureus”, Journal of Food Protection, Vol. 51, pp. 898-900.
Thekdi, R.J., Lakhani, A.G., Rale, V.B. and Panre, M.V. (1990), “An outbreak of food poisoning
suspected to be caused by vibrio fluvialis”, Journal of Diarrheal Diseases Research,
Vol. 8 No. 4, pp. 163-5.
Thanoyran, N. and Surendran, P.K. (1998), “Occurrence and distribution of Vibrio Valnificus in
tropical fish and shell fish from Cochin (India)”, Letters in Applied Microbiology,
Vol. 26, pp. 110-2.
Vardaraj, M.C. and Nambudripad, K.N. (1981), “Staphylococcal incidence in market khoa and
their enterotoxins production”, Journal of Food Science and Technology, Vol. 19, pp. 53-7.
World Health Organization (2002), “Foodborne disease in OECD countries: present status and
economic cost”, A Report on Foodborne Disease in the OECD Area, Geneva.
Wong, H.C., Chang, M.H. and Fan, J.Y. (1998), “Incidence and characterization of B.cereus isolates
contaminating dairy products”, Applied and Environmental Microbiology, pp. 699-702.

Further reading
Rao, V. (1989), “Food borne bacterial pathogens”, Journal of Food Science and Technology,
Vol. 26, pp. 370-1.
Shaw, R.K., Berger, C.N., Feys, B., Knutton, S., Pallen, M.J. and Frankel, G. (2008),
“Enterohaemorrrhagic Escherichia coli exploits EspA filaments for attachment to salad
leaves”, Applied and Environmental Microbiology, Vol. 74 No. 9, pp. 2908-14.
Sudershan, R.V. and Bhat, R.V. (1995a), “Changing profile of food adulteration: perception of food
analysts”, Journal of Food Science and Technology, Vol. 32, pp. 368-72.
Sudershan, R.V. and Bhat, R.V. (1995b), “A survey on veterinary drug use and residues in milk
samples in Hyderabad”, Food Additives and Contaminants, Vol. 12, pp. 645-50.

Corresponding Author
Sudershan Rao Vemula can be contacted at: vemulasr@yahoo.com

To purchase reprints of this article please e-mail: reprints@emeraldinsight.com

Or visit our web site for further details: www.emeraldinsight.com/reprints

View publication stats