FOODBORNE DISEASE.

Alimentary depended diseases include the diseases and the syndromes of an insufficient and an
excessive nutrition and diseases related with food quality (or foodborne diseases).
Diseases of insufficient nutrion include
 diseases caused by insufficient intake of proteins and energy (kwashiorkor and nutritional
marasmus or cachexia);
 hypo-and avitaminoses;
 gipomicroelementoses.
Diseases of excessive nutrion include
 obesity;
 diseases of the CVS;
 liver disease;
 kidney disease;
 metabolic disorders;
 hypervitaminosis.
Foodborne diseases (foodborne illness, food poisoning) encompass a wide spectrum of illnesses
and are a growing public health problem worldwide. They are the result of ingestion of
foodstuffs contaminated with microorganisms or chemicals. The contamination of food may
occur at any stage in the process from food production to consumption (“from farm to fork”) and
can result from environmental contamination, including pollution of water, soil or air.
The classification of foodborne disease is presented at the Scheme 1.2. The main principle of this
classification is the source of an etiological factor of a foodborne disease.
This section is mainly devoted to foodborne diseases.

The top 10 causes of foodborne illness in its priority order are the following (according to
WHO):
1. Improper cooling.
Some pathogens can form heat-resistant spores, which can survive cooking temperatures. When
the food begins cooling down and enters the danger zone, these spores begin to grow and
multiply. If the food spends too much time in the danger zone, the pathogens will increase in
number to a point where the food will make people sick. That is why the cooling process is
crucial. Cooked food must be cooled from 60 °C to 20 °C (140 °F to 70 °F) in two hours or less,
and then from 20 °C to 4 °C (70 °F to 40 °F) in four hours or less.

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2. Advance preparation.
Advance preparation is the cause of many food-poisoning outbreaks, usually because food has
been improperly cooled. Often, foods that are prepared well before serving spend too much time
in the danger zone (the food is left out at room temperature too long; the food is not heated or
reheated properly or not cooled properly; the food is brought in and out of the danger zone too
many times).
3. Infected person. Many people carry pathogens somewhere on or in their bodies in their gut,
in their nose, on their hands, in their mouth, and in other warm, moist places. People who are
carrying pathogens often have no outward signs of illness. However, people with symptoms of
illness (diarrhea, fever, vomiting, jaundice, sore throat with a fever, hand infections, etc.) are
much more likely to spread pathogens to food.
4. Inadequate reheating for hot holding. Many restaurants prepare some of menu items in
advance or use leftovers in their hot hold units the next day. In both cases, the foods travel
through the danger zone when they are cooled for storage and again when they are reheated.
Foods that are hot held before serving are particularly vulnerable to pathogens. In addition to
travelling through the danger zone twice, even in properly operating hot hold units, the food is
close to the temperature that will allow pathogens to grow.

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 Groups of foodborne diseases

Diseases caused by environmental contaminants Diseases caused by special Diseases caused by natural food
substances added during cooking ingredients that can be harmful

Biological Chemical Authorized food Unauthorized food additives

contaminants contaminants additives in excess
quantities
Food poisoning Antinutritive components of food

Toxicoses Environmental pollutants Unusual components of new sources of

raw food materials
Bacterial toxicoses Fertilizers

Pesticides Components with expressed

Mycotoxicoses
pharmacological activity

Toxicoinfections Substances used for the

product falsification Products that contain natural toxins
(toxic components)
Infections
Compounds migrating from
materials of tools and Products are toxic by nature
Bacterial infections equipment for cooking,
storage and transportation of
Viral infections products into food plant origin
Substances that accumulate in
Protozoal invasions animal origin
the products as a result of heat
treatment 3
Helminthoses

Products are toxic in certain

Scheme 1.2. Classification of foodborne disease. conditions
5. Improper hot holding.
Hot hold units are meant to keep hot foods at 60 °C (140 °F) or hotter. At or above this
temperature, pathogens will not grow. However, a mistake in using the hot hold unit can result in
foods being held in the super danger zone – between 20 °C and 49 °C (70 °F and 120 °F),
temperatures at which pathogens grow very quickly.
6. Contaminated raw food or ingredient with biological agents, natural toxins or chemical
substances. We know that many raw foods often contain pathogens, yet certain foods are often
served raw. While some people believe these foods served raw are “good for you,” the truth is
that they have always been dangerous to serve or eat raw (raw oysters served in the shell, raw
eggs in certain recipes, rare hamburger, sushi/sashimi, steak tartare, etc.).
7. Unsafe source.
Foods from approved sources are less likely to contain high levels of pathogens or other forms of
contamination. Approved sources are those suppliers that are inspected for cleanliness and safety
by a government food inspector. Foods supplied from unreliable or disreputable sources, while
being cheaper, may contain high levels of pathogens that can cause many food-poisoning
outbreaks.
8. Use of leftovers.
Using leftovers has been the cause of many outbreaks of food poisoning because of improper
cooling and reheating (of “hot” leftovers). Leftovers that are intended to be served hot pass
through the danger zone twice (during the initial cooling of the hot food and when reheating).
Those leftovers intended to be served without reheating, or as an ingredient in other foods (e.g.,
sandwich filler), go through the danger zone during cooling and then, when being prepared and
portioned, often stay in the danger zone for another long period.
9. Cross-contamination.
You can expect certain foods to contain pathogens, especially raw meat, raw poultry, and raw
seafood. Use extreme caution when you bring these foods into a kitchen. Cross-contamination
happens when something that can cause illness (pathogens or chemicals) is accidentally put into
a food where not previously found. This can include, for example, pathogens from raw meats
getting into ready-to-eat foods like deli meats. It can also include nuts (which some people are
very allergic to) getting into a food that does not normally have nuts (e.g., tomato sauce).
10. Inadequate cooking.
Proper cooking is one of the best means of making sure your operation does not cause a food-
poisoning outbreak. Proper cooking kills all pathogens (except spores) or at least reduces their
numbers to a point where they cannot make people sick. Inadequate cooking is often done by
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accident: for example, cooking still-frozen poultry or meat; attempting to cook a stuffed bird
using the same time and temperature as an unstuffed bird; using an inexperienced cook.
So all causes of foodborne illness can be divided on the two groups:
 the entering biological and/or chemical contaminants into the food product (causes number 3,
6 and 9);
 the creating conditions conducive to the massive reproduction of microorganisms and their
toxins (causes number 1, 2, 4, 5, 7, 8, 10).

Prevention of bacterial foodborne disease.

The prevention of bacterial foodborne disease requires control measures at all stages of the food
chain, from agricultural production on the farm to processing, manufacturing and preparation of
foods in both commercial establishments and household kitchens. The prevention measures are
directed in the prevent food from being contaminated and prevent the bacteria in the food from
growing and multiplying.
The preventive measures include
1. Select fresh and wholesome foods.
Buy your food and ingredients from approved sources only. If you are not sure a supplier has
been approved, contact your local environmental health officer.
2. The compliance with the temperature storage conditions, terms of realization and commodity
neighborhood of products.
Keep refrigerators in good working order. Monitor the temperature of the refrigerator daily.
Clean refrigerators regularly. Shelves should be shallow and well vented to make such cleaning
quick and easy. Store raw products below cooked or ready-to-eat products. Designate areas in
the refrigerator for certain items, and keep only those items in their designated place. Raw and
cooked food should be stored separately to avoid cross contamination.
3. The compliance with the rules of the cold and heat treatment of product.
The compliance with the flowsheets of products cooking. Cook food thoroughly, especially
meat, poultry, eggs and seafood. Bring foods like soups and stews to boiling to make sure that
they have reached 70 °C. For meat and poultry, make sure that juices are clear, not pink. Ideally,
use a thermometer.
4. The compliance with the terms of realization of ready meals.
Do not leave cooked food at room temperature for more than 2 hours. Refrigerate promptly all
cooked and perishable food. Do not store excessive amount of food in the refrigerator to avoid
affecting cold air circulation.

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5. The compliance with the terms of realization and storage temperature of buffet products.
Leftover food should be stored in the refrigerator and re-heated thoroughly before consumption
Reheat leftovers only once. Throw out any leftovers that have already been reheated once.
Do not mix leftover foods with fresh foods. Be sure to follow the proper cooling and reheating
procedures when handling leftovers.
Cool leftovers in uncovered containers separate from any raw foods. After they are cooled, cover
them tightly.
6. The compliance with the sanitary requirements for process equipment, tools and utensils.
The maintaining a clean work environment. Use different sets of chopping blocks and knives for
cutting raw and cooked food.
7. The exclude the presence of cockroaches, flies, rodents on public catering establishment.
8. The compliance with the rules of personal and industrial hygiene.
Timely medical examinations and preventive examinations, vaccinations, identification of
patients and carriers, and those who has intestinal infections in a family (or in the apartment).
Make sure all food handlers wash their hands properly after any job that could dirty their hands
(e.g., using the toilet, eating, handling raw meats, blowing their nose, smoking).
Food handlers with infected cuts on their hands or arms (including sores, burns, lesions, etc.)
must not handle food or utensils unless the cuts are properly covered (e.g., waterproof bandage
covered with a latex glove or finger cot).
When using gloves or finger cots, food handlers must still wash their hands. As well, gloves or
cots must be replaced if they are soiled, have a hole, and at the end of each day.
Food handlers with infection symptoms must not handle utensils or food and should be sent
home.
Where possible, avoid direct hand contact with food – especially ready-to-eat foods (e.g., use
plastic utensils plastic or latex gloves).

Diseases related with food quality

Food toxicoses (intoxications) occurs when bacteria grow in food and produce a waste product
called a toxin (poison). When the food is eaten, the toxins are immediately introduced into the
body, causing a rapid reaction.

Food bacterial toxicoses are acute foodborne diseases caused by microbe toxins. There are
botulism and staphylococcal toxicosis.

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Botulism is a rare but serious foodborne disease. It is an intoxication usually caused by ingestion
of the botulinum toxins, formed in contaminated foods. Person to person transmission of
botulism does not occur. Spores produced by the bacteria Clostridium botulinum exist widely in
the environment, and in the absence of oxygen they germinate, grow and then excrete toxins.
The causative agent characteristics. Spores of C. botulinum are heat-resistant and survive 2 h at
100 °C and are inactivated at 120 °C. C. botulinum are gram positive, spore producing bacilli.
They are obligate anaerobic. C. botulinum will not grow in acidic conditions (pH less than 4.6).
The toxin produced by bacteria growing out of the spores under anaerobic conditions is
destroyed by boiling. Toxin is inactivated after 1 min at 85 °C, or 5 min at 80 °C. Due to plasmid
contained in some C. botulinum organisms they can product 7 neurotoxic types of botulinum
toxin: A, B, C, D, E, F, G under anerobic conditions. There are released by autolysis as a
prototoxin. Bound to hemagglutinins and inhibits degradation by digestive enzymes is doubtful.
Risk associated food-stuffs include low-acid preserved vegetables, such as green beans, spinach,
mushrooms, and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat
products, such as ham and sausage; home-canned or home-bottled foods, honey. The food
implicated differs between countries and reflects local eating habits and food preservation
procedures. Occasionally, commercially prepared foods are involved.
The clinical picture. There are two different illnesses: adult botulism and infant botulism. For
infants one source of these spores is honey.
Symptoms usually appear within 12 to 36 hours (within a minimum and maximum range of 4
hours to 8 days) after exposure.
When contaminated food is eaten by adults, toxin is absorbed from the intestines and attaches to
the nerves causing the signs and symptoms of botulism. Early symptoms include blurred vision,
diplopia, dry mouth, difficulty in swallowing or speaking, marked fatigue, weakness and vertigo
and shortness of breath. Vomiting, constipation and abdominal swelling may also occur. The
disease can progress to weakness in the neck and arms, after which the respiratory muscles and
muscles of the lower body are affected. There is no fever and no loss of consciousness. The
illness may progress to complete paralysis, respiratory failure, and death.
Infant botulism is more common in spring and summer and is rare in winter. Infants younger
than one year of age, particularly between the ages of two to four months, are at highest risk.
Symptoms include muscle weakness, a weak cry, a poor suck (difficulty in feeding), feeble
crying, constipation, head lag, increased heart rate and a decreased gag reflex. A baby with infant
botulism is described as a “floppy baby”, as the baby will have weak muscles, especially in the
arms, legs and neck.
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Prevention measures. Incidence of botulism is low, but the mortality rate is high. Although there
are very few cases of botulism poisoning each year, prevention is extremely important.
Prevention of foodborne botulism is based on good practice in food preparation particularly
during heating/sterilization and hygiene. Foodborne botulism may be prevented by the
inactivation of the bacterium and its spores in heat-sterilized (for example, retorted) or canned
products or by inhibiting bacterial growth and toxin production in other products. The vegetative
forms of bacteria can be destroyed by boiling but the spores can remain viable after boiling even
for several hours. However, the spores can be killed by very high temperature treatments such as
commercial canning.
Commercial heat pasteurization (including vacuum packed pasteurized products and hot smoked
products) may not be sufficient to kill all spores and therefore the safety of these products must
be based on preventing bacterial growth and toxin production. Refrigeration temperatures
combined with salt content and/or acidic conditions will prevent the growth of the bacteria and
formation of toxin.
Successful treatment depends significantly on early diagnosis and the rapid administration of the
botulinum antitoxin. Diagnosis is made by the presence of appropriate neurologic symptoms and
by laboratory tests that detect toxin or by culture of Clostridium botulinum bacterium from the
patient’s stool. Food samples associated with suspect cases must be obtained immediately, stored
in properly sealed containers, and sent to laboratories in order to identify the cause and to
prevent further cases.

Staphylococcal food poisoning (staphyloenterotoxicosis; staphyloenterotoxemia) is the name of

the condition caused by the enterotoxins which some strains of Staphylococcus aureus produce.
The causative agent characteristics. S. aureus is a spherical bacterium (coccus) which in
microscopic examination appears in pairs, short chains, or bunched, grape-like clusters. These
organisms are gram-positive and heat-labile. Some strains are capable of producing a highly
heat-stable protein toxin that causes illness in human (is destroyed at 170 oC).
The sources. Staphylococci exist in air, dust, sewage, water, milk, and food or on food
equipment, environmental surfaces, humans, and animals.
Humans and animals are the primary reservoirs. Staphylococci are present in the nasal passages
and throat and on the hair and skin of 50 % or more of healthy individuals. This pathogen has
also been associated with other illnesses of the skin that can be as mild as pimples and infected
cuts to sepsis leading to death. This incidence is even higher for those who associate or come in
contact with sick individuals and hospital environments.

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Food-stuffs that are frequently incriminated in staphylococcal food poisoning include milk and
dairy products; meat and meat products; poultry and egg products; salads such as eggs, tuna,
chicken, potatoes, and pasta; bakery products such as cream-filled pastries, cream pies, and
chocolate eclairs; and sandwich fillings.
The clinical picture. All people are believed to be susceptible to this type of bacterial
intoxication; however, intensity of symptoms may vary. The onset of symptoms in
staphylococcal food poisoning is usually rapid and, in many cases, acute, depending on
individual susceptibility to the toxin, the amount of contaminated food eaten, the amount of toxin
in the food ingested, and the general health of the victim.
The most common symptoms are nausea, vomiting, retching, abdominal cramping, and
prostration. Some individuals may not always demonstrate all the symptoms associated with the
illness. In more severe cases, headache, muscle cramping, and transient changes in blood
pressure and pulse rate may occur. Recovery generally takes two days. However, it is not
unusual for complete recovery to take three days and sometimes longer in severe cases. Death
from staphylococcal food poisoning is very rare, although such cases have occurred among the
elderlies, infants, and severely debilitated persons.
The true incidence of staphylococcal food poisoning is unknown for a number of reasons,
including poor responses from victims during interviews with health officials; misdiagnosis of
the illness, which may be symptomatically similar to other types of food poisoning (such as
vomiting caused by Bacillus cereus toxin); inadequate collection of samples for laboratory
analyses; and improper laboratory examination.
The diagnostics. In the diagnosis of staphylococcal foodborne illness, proper interviews with the
victims and gathering and analyzing epidemiologic data are essential. Incriminated food-stuffs
should be collected and examined for staphylococci. The presence of relatively large numbers of
enterotoxigenic staphylococci is good circumstantial evidence that the food contains toxin. The
most conclusive test is the linking of an illness with a specific food or in cases where multiple
vehicles exist, the detection of the toxin in the food sample(s). In cases where the food may have
been treated to kill the staphylococci, as in pasteurization or heating, direct microscopic
observation of the food may be an aid in the diagnosis.
The control measures to prevent Staphylococcus intoxication are considerable handling during
preparation, proper time and temperature control and good personal hygiene. Food-stuffs after
preparation should be kept hot enough (60 °C or above) or cold enough (7.2 °C or below).

Mycotoxicoses are diseases caused by mycotoxins. They are toxic compounds that are naturally

9
produced by certain types of moulds (fungi). Moulds that can produce mycotoxins grow on
numerous foodstuffs such as cereals, dried fruits, nuts and spices. Mould growth can occur either
before harvest or after harvest, during storage, on/in the food itself often under warm, damp and
humid conditions. Most mycotoxins are chemically stable and survive food processing.
Several hundred different mycotoxins have been identified, but the most commonly observed
mycotoxins that present a concern to human health and livestock include aflatoxins, eochratoxin
A, patulin, fumonisins, zearalenone and nivalenol/deoxynivalenol. The most significant among
mycotoxicoses are aflatoxicoses, fusariotoxicoses and ergotism.

Aflatoxins are amongst the most poisonous mycotoxins and are produced by certain moulds
(Aspergillus flavus and Aspergillus parasiticus) which grow in soil, decaying vegetation, hay,
and grains. Crops that are frequently affected by Aspergillus spp. include cereals (corn, sorghum,
wheat and rice), oilseeds (soybean, peanut, sunflower and cotton seeds), spices (chili peppers,
black pepper, coriander, turmeric and ginger) and tree nuts (pistachio, almond, walnut, coconut
and Brazil nut). The toxins can also be found in the milk of animals that are fed contaminated
feed, in the form of aflatoxin M1. Large doses of aflatoxins can lead to acute poisoning
(aflatoxicosis) and can be life threatening, usually through damage to the liver. Aflatoxins have
also been shown to be genotoxic, meaning they can damage DNA and cause cancer in animal
species. There is also evidence that they can cause liver cancer in humans.

Ergotism. Infection of grasses and cereals with fungal species of genus Claviceps produces
sclerotia (compact hyphal structure).
The fungus lives over winter in the form of sclerotium, a dense mass of fungus cells. Usually the
sclerotia are somewhat larger and also less dense than the seeds of the host plant on which they
are borne.
The ergot alkaloids are rapid acting, powerful oxytoxics, they stimulate the smooth muscle of the
uterus. They are also vasoconstrictors. There were severe internal feeling of heat and intense
thirst, multiple ulcerations of the skin, a burning sensation of the limbs, the feeling of ants and
mice crawling underneath the skin, the drying and turning black of hands, arms, feet and legs,
blindness, dementia and mental degeneration.
Acute ergot poisoning today is essentially a problem only in chemotherapy and rarely has it
occurred recently as a result of eating.

Fusarium fungi are common to the soil and produce a range of different toxins, including
trichothecenes such as deoxynivalenol (DON), nivalenol (NIV) and T-2 and HT-2 toxins, as well
10
as zearalenone (ZEN) and fumonisins. The formation of the moulds and toxins occur on a variety
of different cereal crops. Different fusarium toxins are associated with certain types of cereal.
For example, both DON and ZEN are often associated with wheat, T-2 and HT-2 toxins with
oats, and fumonisins with maize (corn). Trichothecenes can be acutely toxic to humans, causing
rapid irritation to the skin or intestinal mucosa and lead to diarrhea. Reported chronic effects in
animals include suppression of the immune system. ZEN has been shown to have hormonal,
estrogenic effects and can cause infertility at high intake levels, particularly in pigs. Fumonisins
have been related to oesophageal cancer in humans, and to liver and kidney toxicity in animals.
Also hematopoietic, autonomic nervous and endocrine systems injury may be.

To minimize the health risk from mycotoxins, people are advised to:
 inspect whole grains (especially corn, sorghum, wheat, rice), dried figs and nuts such as
peanuts, pistachio, almond, walnut, coconut, Brazil nuts and hazelnuts which are all regularly
contaminated with aflatoxins for evidence of mould, and discard any that look mouldy,
discoloured, or shrivelled;
 avoid damage of grains before and during drying, and in storage, as damaged grain is more
prone to invasion of moulds and therefore mycotoxin contamination;
 buy grains and nuts as fresh as possible;
 make sure that foods are stored properly – kept free of insects, dry, and not too warm;
 not keep foods for extended periods of time before being used;
 ensure a diverse diet – this not only helps to reduce mycotoxins exposure, but also improves
nutrition.

Food toxicoinfections are acute noncontagious diseases, developing during consumption of food
heavily polluted with agents (105 – 106 microbes per 1 g or 1 ml).
They are characterized by:
 short incubation period (average 6 – 24 h);
 specific dietary history for all sick persons;
 outbreaks and epidemics if product was realized through centralized catering organization or
trade organization;
 local epidemiology;
 fast outbreak cessation after removal of source (incrimed product);
 gastroenteritis.
The agents that may cause a toxicoinfecion include: Clostridium perfringens, Bacillus cereus,
Enteropathogenic & enterotoxigenic E.coli, Streptococcus (St. faecalis and St. bovis),
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Citrobacter, Klebsiella, Enterobacter, Proteus mirabilis and vulgaris, Pseudomonas,
Aeromonas, Acinetobacter, Serratia, Hafnia, Edwardsiella, Providencia, Alcaligenes, Vibrio
parahaemolyticus, etc.

Escherichia coli is a bacterium that is commonly found in the gut of humans and other warm-
blooded animals. While most strains are harmless, some can cause severe foodborne disease. E.
coli infection is usually transmitted through consumption of contaminated water or food, such as
undercooked meat products and raw milk. Symptoms of disease include abdominal cramps and
diarrhea, which may be bloody and with mucus. Fever and vomiting may also occur. Most
patients recover within 10 days, although in a few cases the disease may become life-threatening.

Clostridium perfringens is an anaerobic, grampositive, sporeforming rod. It is widely distributed

in the environment and frequently occurs in the intestines of humans and many domestic and
feral animals. Spores of the organism persist in soil, sediments, and areas subjected to human or
animal fecal pollution. C. perfringens bacteria capable of producing the food poisoning toxin.
The source. In most instances, the actual cause of poisoning by C. perfringens is temperature
abuse of prepared food-stuffs. Small numbers of the organisms are often present after cooking
and multiply to food poisoning levels during cool down and storage of prepared food-stuffs.
Meat, meat products, and gravy are the food-stuffs most frequently implicated. Institutional
feeding (such as school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities
of food are prepared several hours before serving is the most common circumstance in which
perfringens poisoning occurs.
The clinical picture. The common form of perfringens poisoning is characterized by intense
abdominal cramps, nausea and multiple fetid diarrhea which begin 8 – 22 h after consumption of
food-stuffs containing large numbers of those. The illness is usually over within 24 h but less
severe symptoms may persist in some individuals for 1 or 2 weeks.
A few deaths have been reported as a result of dehydration and other complications. Necrotic
enteritis caused by C. perfringens is often fatal. This disease also begins as a result of ingesting
large numbers of the causative bacteria in contaminated food-stuffs. Deaths from necrotic
enteritis are caused by infection and necrosis of the intestines and from resulting septicemia. This
disease is very rare.
The young and elderly people are the most frequent victims of perfringens poisoning. Except the
case of necrotic enteritis, complications are few in persons under 30 years of age. Elderly
persons are more likely to experience prolonged or severe symptoms.
The diagnostics. Standard bacteriological culturing procedures are used to detect the organism in
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implicated food-stuffs and in feces of patients. Serological assays are used for detecting
enterotoxin in the feces of patients and for testing the ability of strains to produce toxin. The
procedures take 1 – 3 days.

Infection occurs when food contains living pathogens that grow in the human intestinal tract
after the food is eaten. Because the bacteria continue to multiply in the body and cause infection,
the reaction will be slower. These diseases are contagious, because there are several transmission
mechanisms in the spread of them (oral with food, oral with water, contact-household).
The infections may be caused by bacteria, viruses, protozoa or helminths (Table 1.15).
Table 1.15
The examples of the cause of foodborne infections
Pathogenic bacteria Viruses Helminths Protozoa
Salmonella rotavirus, Nematodes Сryptosporidium spp,
(except S. thyphi & hepatitis A Trichinella spiralis, Entamoeba
parathyphi), genus Shigella, and E, Cestodes histolytica,
Yersinia enterocolitica and Norwalk and Diphyllobothrium Giardia lamblia,
pseudotuberculosis, Norwalk-like latum, Toxoplasma gondii,
enteroinvasive and virus, Echinococcus Cyclospora
enterohaemorrhagic E.coli, enterovirus, multilocularis cayetanensis, etc.
Vibrio cholerae 0-1 and 0-139, etc. Trematodes
genus Campylobacter, Opisthorchis felineus,
Listeria monocytogenes, etc. Fasciola hepatica, etc.

Listerosis. Listeria monocytogenes can grow well under refrigeration temperatures, although
very slowly.
The source. This is the basis for the seven day date marking requirements for refrigerated
potentially hazardous foods here are several outbreaks each year associated with fresh soft
cheeses made from unpasteurized milk, ready-to-eat meat products (such as cooked, cured and/or
fermented meats and sausages) and cold smoked fishery products. Queso fresco is a cheese that
is very popular in the Hispanic community.
The clinical picture. There are two main types of listeriosis: a non-invasive form and an
invasive form.
Noninvasive listeriosis (febrile listerial gastroenteritis) is a mild form of the disease affecting
mainly otherwise healthy people. The incubation period is short (a few days). Symptoms

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include diarrhea, fever, headache and myalgia (muscle pain). Outbreaks of this disease have
generally involved the ingestion of foods containing high doses of L. monocytogenes.
Invasive listeriosis is a more severe form of the disease and affects certain high risk groups of
the population. These include pregnant women, patients undergoing treatment for cancer,
AIDS and organ transplants, elderly people and infants. This form of disease is characterized
by severe symptoms and a high mortality rate (20 – 30 %). The incubation period is usually
one to two weeks but can vary between a few days and up to 90 days. The symptoms include
fever, myalgia (muscle pain), septicemia, meningitis. Listeriosis can lead to spontaneous
abortions or fetal death even if the mother is asymptomatic. The death rate among newborn
children can be as high as 50 %.
The control measures for controlling illness include prevention of cross-contamination and using
pasteurized milk.

Salmonella is a genus of bacteria that are a major cause of foodborne illness throughout the
world. The bacteria are generally transmitted to humans through consumption of contaminated
food of animal origin, mainly meat, poultry, eggs and milk.
The symptoms of Salmonella infection usually appear 12 – 72 hours after infection, and include
fever, abdominal pain, diarrhea, nausea and sometimes vomiting. The illness usually lasts 4 – 7
days, and most people recover without treatment. However, in the very young and the elderly,
and in cases when the bacteria enter the bloodstream, antibiotherapy may be needed.

Trichinosis was typically associated with pork. A change in the feeding practices has led to a
reduction in this illness as well as a reduction in the cooking temperatures for pork. This
pathogen is still a major concern in certain wild game populations.
The symptoms: fever, muscle pain (especially the intercostal muscles, the masseter muscle),
swelling of the face, skin rash, high eosinophilia, damage of myocard, lung, central nervous
system.
The source: meat affected by trichinosis (pigs, wild boar, bear, walrus and other animals).
The prevention measures: veterinary control. Meat affected by Trichinella spiralis must not be
cooked! It’s a sanitary dangerous product, it must be destroyed.

Trematodes
People get the infection when they ingest the second intermediate host that is infected with larval
forms of the parasite (see Table 1.16 for details).
Early and light infections often pass unnoticed, as they are asymptomatic or only scarcely
14
symptomatic. Conversely, if the worm load is high, general malaise is common and severe pain
can occur, especially in the abdominal region.
Chronic infections are invariably associated with severe morbidity. Symptoms are mainly organ-
specific and reflect the final location of the adult worms in the body.
Eosinophilia is characteristic for all helminthiases.
Table 1.16
Epidemiological characteristics of foodborne trematodiases and disease symptoms
Acquired Natural final
Infectious
Disease Symptoms through hosts of the
agent
consumption of infection
Clonorchiasis Clonorchis The adult worms lodge in Dogs and
sinensis the smaller bile ducts of the other fish-
Fish
liver, causing inflammation eating
and fibrosis of the adjacent carnivores
Opisthorchiasis Opisthorchis tissues with a potential to Cats and
viverrini, cause cholangiocarcinoma, other fish-
O. felineus a severe and fatal form of eating
Fish
bile duct cancer. Both are carnivores
classified as carcinogenic
agents.
Fascioliasis Fasciola The adult worms lodge in Sheep, cattle
hepatica, the larger bile ducts and the and other
F. gigantica gall bladder, where they herbivores
cause inflammation, Aquatic
fibrosis, blockage, colic vegetables
pain and jaundice. Liver
fibrosis and anaemia are
also frequent.
Paragonimiasis Paragonimus The final location of the Cats, dogs
spp. worms is the lung tissue. Crustaceans and other
They cause symptoms that (crabs and crustacean-
can be confounded with crayfish) eating
tuberculosis: chronic cough carnivores

15
 with blood-stained sputum,
chest pain, dyspnoea
(shortness of breath) and
fever. Migration of the
worms is possible: cerebral
locations are the most
severe.

Prevention and control

Control of foodborne trematodiases aims to reduce the risk of infection and at controlling
associated morbidity.
Like other diseases including an animal cycle, for the control of food-borne trematodes, an
approach which links animal, human and environmental aspects should be used.
The preventive measures are aimed at the decrease or elimination of risk factors:
- unhygienic preparation and storage of food;
- the consumption of raw fish and seafood;
- the using of unprocessed human and animal faecal waste as manure or even deliberately as
fish feed.
The following measures are recommended:
- veterinary measures;
- public health measures;
- food safety practices and education;
- improved access to treatment using safe and effective anthelminthic medicines (drugs that
expel the worms);
- define at-risk populations based on consumption patterns of raw fish and focus on these for
medication;
- preventive chemotherapy. It involves a population-based approach where everyone in a given
region or area is given medicines, irrespective of their infection status. It is recommended in
areas where large numbers of people are infected. A vigilant use of this preventive treatment
is recommended due to rarely observed side effects.

Natural toxins are toxic compounds that are naturally produced by living organisms. These
toxins are not harmful to the organisms themselves but they may be toxic to other creatures,
including humans, when eaten. These chemical compounds have diverse structures and differ in

16
biological function and toxicity.
Some toxins are produced by plants as a natural defense mechanism against predators, insects or
microorganisms, or as consequence of infestation with microorganisms, such as mould, in
response to climate stress (such as drought or extreme humidity).
Other sources of natural toxins are microscopic algae and plankton in oceans or sometimes in
lakes that produce chemical compounds that are toxic to humans but not to fish or shellfish that
eat these toxin-producing organisms. When people eat fish or shellfish that contain these toxins,
illness can rapidly follow.

Products that contain natural toxins can be

 toxic by nature: poisonous mushrooms, bitter nuclei of stone fruit, poisonous plants (Atrópa
belladónna, Paris quadrifolia, Sambúcus nígra, etc.), caviar and soft roe of some fish species,
endocrine glands (adrenal glands, pancreas gland etc.) of slaughtered animals, etc.
 toxic in certain conditions: conditionally edible mushrooms, without necessary cooking
(morels, Agaricus necator, Agaricus emeticus, etc.); nuts of beech, tung-tree, raw beans;
sprouted (turned green) potatoes; fat fish (scombroid fish poisoning), etc.
Some of the most commonly found natural toxins that can pose a risk to our health are described
below.

Aquatic biotoxins
Toxins formed by algae in the ocean and fresh water are called algal toxins. Algal toxins are
generated during blooms of particular naturally occurring algal species. Shellfish such as
mussels, scallops and oysters are more likely to contain these toxins than fish. Algal toxins can
cause diarrhea, vomiting, tingling, paralysis and other effects in humans, other mammals or fish.
The algal toxins can be retained in shellfish and fish or contaminate drinking water. They have
no taste or smell, and are not eliminated by cooking or freezing.
Another example is ciguatera fish poisoning (CFP) which is caused by consuming fish
contaminated with dinoflagellates that produce ciguatoxins. Some fish known to harbor
ciguatoxins include barracuda, black grouper, dog snapper, and king mackerel. Symptoms of
ciguatera poisoning include nausea, vomiting, and neurologic symptoms, such as tingling
sensation on fingers and toes. There is currently no specific treatment for ciguatera poisoning.

Furocoumarins
These toxins are present in many plants such as parsnips (closely related to carrots and parsley),
celery roots, citrus plants (lemon, lime, grapefruit, bergamot) and some medicinal plants.

17
Furocoumarins are stress toxins and are released in response to stress, such as physical damage
to the plant. Some of these toxins can cause gastrointestinal problems in susceptible people.
Furocoumarins are phototoxic. They can cause severe skin reactions under sunlight (UVA
exposure). While mainly occurring after dermal exposure, such reactions have also been reported
after consumption of large quantities of certain vegetables containing high levels of
furocoumarins.

Cyanogenic glycosides
Cyanogenic glycosides (such as amygdaline) are phytotoxins (toxic chemicals produced by
plants) which occur in at least 2000 plant species, of which a number of species are used as food
in some areas of the world. Cassava, sorghum, stone fruits, bamboo roots and almonds are
especially important foods containing cyanogenic glycosides. The potential toxicity of a
cyanogenic plant depends primarily on the potential that its consumption will produce a
concentration of cyanide that is toxic to exposed humans. In humans, the clinical signs of acute
cyanide intoxication can include: rapid respiration, drop in blood pressure, dizziness, headache,
stomach pains, vomiting, diarrhea, mental confusion, cyanosis with twitching and convulsions
followed by terminal coma. Death due to cyanide poisoning can occur when the cyanide level
exceeds the limit an individual is able to detoxify.

Poisonous mushrooms contain cyclic octapeptides called amanitins.

Wild mushrooms may contain several toxins, such as muscimol and muscarine, which can cause
vomiting, diarrhea, confusion, visual disturbances, salivation, and hallucinations. Onset of
symptoms occurs 6 – 24 hours or more after ingestion of mushrooms. Fatal poisoning is usually
associated with delayed onset of symptoms which are very severe, with toxic effect on the liver,
kidney and nervous systems. Cooking or peeling does not inactivate the toxins. It is
recommended to avoid any wild mushrooms, unless definitively identified as non-poisonous.

Pyrrolizidine alkaloids
Pyrrolizidine Alkaloids (PAs) are toxins produced by an estimated 600 plant species. The main
plant sources are the families Boraginaceae, Asteraceae and Fabaceae. Many of these are weeds
that can grow in fields and contaminate food crops. PAs can cause a variety of adverse health
effects; they can be acutely toxic and of main concern is the DNA-damaging potential of certain
PAs, potentially leading to cancer.

Solanines and chaconine

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All solanacea plants, which include tomatoes, potatoes, and eggplants, contain natural toxins
called solanines and chaconine (which are glycoalkaloids). While levels are generally low,
higher concentrations are found in potato sprouts and bitter-tasting peel and green parts, as well
as in green tomatoes. The plants produce the toxins in response to stresses like bruising, UV
light, microorganisms and attacks from insect pests and herbivores. To reduce the production of
solanines and chaconine it is important to store potatoes in a dark, cool and dry place, and not to
eat green or sprouting parts.

Lectins
Many types of beans contain toxins called lectins, and kidney beans have the highest
concentrations – especially red kidney beans. As few as 4 or 5 raw beans can cause severe
stomachache, vomiting and diarrhea. Lectins are destroyed when the dried beans are soaked for
at least 12 hours and then boiled vigorously for at least 10 minutes in water. Tinned kidney beans
have already had this process applied and so can be used without further treatment.

Scombriotoxicosis (scombroid fish poisoning, “histamine poisoning”) is caused by the ingestion

of food-stuffs that contain high levels of histamine and possibly other vasoactive amines and
compounds.
Histamine and other amines are formed by the growth of certain bacteria (e.g., specific bacteria
of fish specific bacteria of fish intestines) and the subsequent action of their decarboxylase
enzymes on histidine and other amino acids in food, either during the production of a product or
by spoilage of food-stuffs. It may be due to re-freezing or using food additives for softening the
small bones of fish during preservation. These entails output histidine from fish muscle cells and
histamine formation as a decarboxylation reaction result.
The source. Any food that contains the appropriate amino acids and is subjected to certain
bacterial contamination and growth may lead to scombroid poisoning when ingested. Fishery
products that have been implicated in scombroid poisoning include the tunas (e.g. skipjack and
yellowfin), mahi-mahi, bluefish, sardines, mackerel, amberjack, fat herring and abalone. Many
other products also have caused the toxic effects. The primary cheese involved in intoxications
has been Swiss cheese. The toxin forms in a food when certain bacteria are present and time and
temperature permit their growth. Distribution of the toxin within an individual fish fillet or
between cans in a batch can be unequal, with only some sections of a product causing illnesses
and others not. Neither cooking nor canning, or freezing reduces the toxic effect.
The clinical picture. The onset of intoxication symptoms is rapid, ranging from immediate to 30

19
min. Initial symptoms may include a tingling or burning sensation in the mouth, a rash on the
upper body and a drop in blood pressure. Frequently, headache, skin redness and itching of the
skin are encountered. The symptoms may progress to nausea, vomiting, and diarrhea and may
require hospitalization, particularly in the case of elderly or impaired patients. The duration of
the illness is usually 3 hours, but may last for several days.
All humans are susceptible to scombroid poisoning; however, the symptoms can be severe for
the elderlies and for those taking medications such as isoniazid. Because of the worldwide
network for harvesting, processing, and distributing fishery products, the impact of the problem
is not limited to specific geographical areas.
The diagnostics. Diagnosis of the illness is usually based on the patient’s symptoms, time of the
onset, and the effect of treatment with antihistamine medication. The suspected food must be
analyzed within a few hours for evaluating levels of histamine to confirm a diagnosis.
Common sensory examination by the consumer cannot ensure the absence or presence of the
toxin. Chemical testing is the only reliable test for evaluation of a product.

To minimize the health risk from natural toxins in food, people are advised to:
 not assume that if something is 'natural' it is automatically safe;
 throw away bruised, damaged or discolored food, and in particular mouldy foods;
 throw away any food that does not smell or taste fresh, or has an unusual taste; and
 eat only mushrooms or other wild plants or animal products that have definitively been
identified as nonpoisonous.

Chemical contaminants are represented by the following groups:

 Pesticides
 Fertilizers
 Environmental pollutants
• heavy metals (cadmium, methyl mercury, lead, copper, zinc, cadmium)
• arsenic
• benzo(a)hyrene
• phenyl polychlorides
• dioxins, etc.
 Compounds migrating from polymeric and other materials (tools and equipment for
cooking, storage and transportation of products) into food
 Substances used for the product falsification
 Substances that accumulate in the products as a result of heat treatment
20
  hydrogenated fats
 acrylamide, etc.

Pesticides. There are more than 1000 pesticides used around the world to ensure food is not
damaged or destroyed by pests.
Many of the older, cheaper (off-patent) pesticides, such as dichlorodiphenyltrichloroethane
(DDT) and lindane, can remain for years in soil and water. These chemicals have been banned
by countries who signed the 2001 Stockholm Convention – an international treaty that aims to
eliminate or restrict the production and use of persistent organic pollutants.
Each pesticide has different properties and toxicological effects. The toxicity of a pesticide
depends on its function and other factors. For example, insecticides tend to be more toxic to
humans than herbicides. The same chemical can have different effects at different doses (how
much of the chemical a person is exposed to). It can also depend on the route by which the
exposure occurs (such as swallowing, inhaling, or direct contact with the skin). When people
come into contact with large quantities of pesticide, this may cause acute poisoning or long-term
health effects, including cancer and adverse effects on reproduction.
None of the pesticides that are authorized for use on food in international trade today are
genotoxic (damaging to DNA, which can cause mutations or cancer). Food should comply with
chemical regulations, in particular with maximum residue limits. Adverse effects from these
pesticides occur only above a certain safe level of exposure.

Dioxins are a group of chemically-related compounds that are persistent environmental

pollutants (POPs).
Dioxins are found throughout the world in the environment and they accumulate in the food
chain, mainly in the fatty tissue of animals.
More than 90 % of human exposure is through food, mainly meat and dairy products, fish and
shellfish. Many national authorities have programs in place to monitor the food supply.
Dioxins are highly toxic and can cause reproductive and developmental problems, damage the
immune system, interfere with hormones and also cause cancer.
Due to the omnipresence of dioxins, all people have background exposure, which is not expected
to affect human health. However, due to the highly toxic potential, efforts need to be undertaken
to reduce current background exposure.
Prevention or reduction of human exposure is best done via source-directed measures, i.e. strict
control of industrial processes to reduce formation of dioxins.

Acrylamide has been found in certain foods that have been cooked and processed at high
21
temperatures, and the levels of acrylamide increase with the time of heating. Acrylamide is
formed as a by-product during food processing (frying, baking) at high temperatures (above 120
° C) in products containing significant amount of carbohydrates.
Exposure assessment. Based on the available data, food is estimated to make a significant
contribution to total exposure of the general public to acrylamide. Average intakes for the
general population were estimated to be in the range of 0.3 to 0.8 microgram of acrylamide
intake per kilogram of body weight per day. Within a population, it is anticipated that children
will generally have intakes that are two to three times those of adults when expressed on a body
weight basis. Dietary intakes of acrylamide by some consumers may be several times higher than
the average.
Toxicity. Neurotoxicity is the key non-cancer, non-genotoxic effect of acrylamide in humans and
animals. No neurotoxic effects are to be expected from the levels of acrylamide encountered in
food. Acrylamide may induce heritable damage.
The presence of acrylamide in food as a major concern in humans is recognized based on the
ability to induce cancer and heritable mutations in laboratory animals.
It is provided some advice to minimize whatever risk exists, including avoiding excessive
cooking of food, choosing healthy eating, investigating possibilities for reducing levels of
acrylamide in food, and establishing an international network on acrylamide in food.

Food additives are substances that are added to food to maintain or improve the safety,
freshness, taste, texture, or appearance of food.
Additives are needed to ensure processed food remains safe and in good condition throughout its
journey from factories or industrial kitchens, during transportation to warehouses and shops, and
finally to consumers.
The use of food additives is only justified when their use has a technological need, does not
mislead consumers, and serves a well-defined technological function, such as to preserve the
nutritional quality of the food or enhance the stability of the food.
Prevention measures.
The safety assessments are used by the joint intergovernmental food standard-setting body of
Food and Agriculture Organization and World Health Organization, the Codex Alimentarius
Commission, to establish levels for maximum use of additives in food and drinks. Codex
standards are the reference for national standards for consumer protection, and for the
international trade in food, so that consumers everywhere can be confident that the food they eat
meets the agreed standards for safety and quality, no matter where it was produced.

22
Once a food additive has been found to be safe for use and maximum use levels have been
established in the Codex General Standard for Food Additives, national food regulations need to
be implemented permitting the actual use of a food additive.
A container with food additives should be marked with name of the chemical substance.
All food additives used in the product should be listed on labels.

Sodium nitrite is the inorganic compound with the chemical formula NaNO 2. It is a white to
slightly yellowish crystalline powder that is very soluble in water and is hygroscopic.
Sodium nitrite is used as an additive in food to inhibit growth of disease-causing
microorganisms; give taste and color to the meat; and inhibit lipid oxidation that leads to
rancidity. The ability of sodium nitrite to address the above-mentioned issues has led to
production of meat with improved food safety, extended storage life and improving desirable
color/taste. It is known as a food additive to prevent botulism. It has the E number E250.
Sodium nitrite has high level of toxicity. It induces methemoglobinemia, i.e. reduces the amount
of oxygen that is transported with hemoglobin.
A principal concern about sodium nitrite is the formation of carcinogenic nitrosamines in meats
containing sodium nitrite when meat is charred or overcooked. Such carcinogenic nitrosamines
can also be formed from the reaction of nitrite with secondary amines under acidic conditions
(such as occurs in the human stomach) as well as during the curing process used to preserve
meats. Nitrate or nitrite (ingested) under conditions that result in endogenous nitrosation has
been classified as “probably carcinogenic to humans” by International Agency for Research on
Cancer (IARC).

Reference:
1. WHO estimates of the global burden of foodborne diseases: foodborne disease burden
epidemiology reference group 2007 2015. Geneva: World Health Organization; 2015, 268 p.
2. Volume 94 Ingested Nitrate and Nitrite, and Cyanobacterial Peptide Toxins IARC
Monographs on the Evaluation of Carcinogenic Risks to Humans. International Agency for
Research on Cancer (IARC) World Health Organization (WHO). 2010. Retrieved 25
September 2016.
3. List of classifications, Volumes 1–116 IARC Monographs on the Evaluation of
Carcinogenic Risks to Humans. International Agency for Research on Cancer (IARC) World
Health Organization (WHO). 2010. Retrieved 25 September 2016.
4. Handbook of Hygiene Control in the Food Industry. 2nd Edition. Editors: H. L. M. Lelieveld
John HolahDomagoj Gabric, 2016, 756 р.
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5. BC Open Textbook Project. Food Safety, Sanitation, and Personal Hygiene. Authors: BC
Cook Articulation Committee and The BC Cook Articulation Committee. Available at:
https://opentextbc.ca/foodsafety/chapter/causes-of-foodborne-illnesses/ (accessed 17 December
2018).
6. Foodborne Diseases and the Investigation of Disease Outbreaks. Available at:
http://www.open.edu/openlearncreate/pluginfile.php/4707/mod_oucontent/oucontent_download/
word/d1d51a47e507b33c36465f42263f8856edfa60ed/9._foodborne_diseases_and_the_investigat
ion_of_disease_outbreaks.doc (accesses 17 December 2018).

THE ALGORITHM OF ANSWERS ON THE SOME TYPICAL TASK QUESTIONS

Typical questions:
1. Name the product, the consumption of which leaded to food poisoning in this case.
2. What group (and subgroups) according to the classification of foodborne diseases include this
disease?
3. Make an etiological diagnosis of the foodborne disease.
4. What other diseases are in this subgroup of foodborne diseases?
5. List the main activities to prevent food-borne disease in this case.

The algorithm of answers

1. Name the product, the consumption of which leaded to food poisoning in this case.
1.1. Analyze the list of products in the task, select one of them. Your choice should be done
according to the circumstances of the poisoning.
1.2. Explain why this product began dangerous for people in this case.
1.3. From list of top causes of foodborne illness select one (two) that is (are) appropriate for this
case.
Example of answer:
1.1. The cream cakes consumption leaded to the food poisoning in this case.
1.2. Because they kept at inappropriate temperature for a long time.
1.3. The causes are “advanced preparation” and “improper cooling”.

2. What group (and subgroups) according to the classification of foodborne diseases

include this disease?
There are three large groups according the classification of foodborne diseases (see Scheme 1.2):
diseases caused by contaminants, diseases caused by special substances added during

24
technological process of cooking (food additives), and diseases caused by natural food
ingredients that can be harmful. The first and third groups have some subgroups.
2.1. According to clinical picture and circumstances of the poisoning identify the source of
etiological factor in this case (contaminant/ natural ingredient/ food additive).
If you consider that is a contaminant, select nature of it biological or chemical.
2.2. Choose the appropriate subgroup.
Example 1:
According to the clinical picture you suspect that this foodborne disease caused by Proteus
mirabilis.
2.1. Group is diseases caused by contaminants of biological nature.
2.2. Subgroup - toxicoinfections.
Example 2
According to the clinical picture you suspect that this foodborne disease caused by bitter nuclei
of stone fruit.
2.1. Group is diseases caused by natural food ingredients that can be harmful.
2.2. Subgroup products that are toxic by nature of plant origin.

3. Make an etiological diagnosis of the foodborne disease .

It means to name a biological agent or chemical substance that may cause the described clinical
symptoms or health disorders.
3.1. According to the task data list the specific circumstances of the poisoning, test results,
clinical symptoms, which allow you to suspect a particular disease or group of diseases.
3.2. According the data of the item 3.1 name the disease and its causative agent/toxin/chemical
substances.
Example 1:
3.1. Specific symptoms: chronic cough with blood-stained sputum, chest pain, dyspnoea
(shortness of breath) and fever. Specific food: crabs.
3.2. Disease is paragonimiasis, causative agent – Paragonimus spp.
Example 2:
3.1. Symptoms cyanide poisoning: rapid respiration, drop in blood pressure, dizziness, headache,
stomach pains, vomiting, diarrhea, mental confusion, cyanosis with twitching. Specific
circumstances of the poisoning: the child has eaten a few bitter apricot nuclei.
3.2. The poisoning is caused by amygdalin (cyanogenic glycosides).

25
4. What other diseases are in this subgroup of foodborne diseases? or
What other agents may cause diseases of this subgroup?
Example:
Suppose you made diagnosis of the disease from the task data. This is hepatitis A. The subgroup
according classification of foodborne disease viral infections. List other viruses causing
foodborne infections that you know. They are rotavirus, hepatitis E, Norwalk and Norwalk-like
virus, enterovirus, etc.

5. List the main activities to prevent food-borne disease in this case.

The section “Prevention of biological foodborne disease” contains the common list of all
activities against the foodborne disease caused by any biological agent. This list includes the
eight groups of measures. According to violations identified at the previous stage select
appropriate protective measures.
Some sections devoted to the individual subgroups of foodborne diseases contain additional
measures.
Example 1:
Suppose it was determined that the infection with a toxicoinfection was due to the fact that the
cheese was cut on a cutting board for raw meat.
The cause of the disease in this case Cross-contamination.
Therefore, we choose the prevention measures: the compliance with the sanitary requirements
for process equipment, tools and utensils.
The maintaining a clean work environment. Use different sets of chopping blocks and knives for
cutting raw and cooked food.
Example 2.
Suppose it was determined that patients have aflotoxicosis. Aflotoxicosis is a mycotoxicosis.
Therefore, the preventive measures in this case should be aimed at minimize the health risk from
mycotoxins:
• inspect whole grains (especially corn, sorghum, wheat, rice), dried figs and nuts such as
peanuts, pistachio, almond, walnut, coconut, Brazil nuts and hazelnuts which are all regularly
contaminated with aflatoxins for evidence of mould, and discard any that look mouldy,
discoloured, or shrivelled;
• avoid damage of grains before and during drying, and in storage, as damaged grain is more
prone to invasion of moulds and therefore mycotoxin contamination;
• buy grains and nuts as fresh as possible;

26
• make sure that foods are stored properly – kept free of insects, dry, and not too warm;
• not keep foods for extended periods of time before being used;
• ensure a diverse diet – this not only helps to reduce mycotoxins exposure, but also improves
nutrition.

27