Foodborne Illness and Hazards

Part 1
Foodborne Illness

1
 Introduction

■ Food is essential both for growth and for the

maintenance of life.
■ It supplies the energy, materials required to build and replace
tissues.
■ Failure to consume enough of the right kind of food will impede
growth and impair health.
■ For example, protein-energy malnutrition can lead to a range of
clinical manifestations (protein deficiency).
■ Even when a diet provides enough protein and energy, it may not
supply sufficient essential minerals or vitamins and may thus give
rise to characteristic deficiency disorders.

2
Introduction

3
 Introduction

■ Illness can also result from what a food contains rather than from
what it lacks (Intrinsic).
■ Other foodborne hazards can be described as Extrinsic (i.e., their
presence is a result of contamination of the food) possibilities
summarized in Table 1.3.
■ In most cases where the food supply is generally varied and
plentiful and established processing and handling procedures are
followed, the majority do not cause serious problems.
■ Natural food toxins are described in more detail in the next
Chapter

4
Introduction

5
Introduction

6
 Introduction

■ In most cases foods are not contaminated

intentionally but rather from carelessness or
insufficient education or training in food safety.
■ In some cases, contamination may be deliberate
as, for example, in the misuse of food additives
such as prohibited coloring.
■ In one serious case in Spain, contaminated industrial rapeseed
(Canola) oil was sold for human consumption, killing more
than 500 people and crippling more than 20,000.

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 Relative Importance of Hazards

■ General public is concerned with hazards

associated with:
■ Pesticide residues
■ Environmental chemical contaminants
■ The use of food additives .
■ Experience shows that most outbreaks of
foodborne disease are associated with
microbiological contamination.
■ People are 100,000 times more likely to become ill as a result
of microorganisms in food than as a result of pesticides.

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Relative Importance of Hazards

9
 Relative Importance of Hazards

■ Several different types of organism can cause

foodborne illness.
■ Bacteria and single celled organisms (typical dimensions of
around 1μm)
■ Their ability to multiply in food; increase the hazard they pose.

■ Fungi (molds) can also grow in foods (some produce toxic

substances known as mycotoxins) .
■ A number of human viruses can be transmitted by
food and human diseases.
■ Animal parasites are also problems of emerging
importance in a number of countries.
1
 Extent of Foodborne Illness

■ Many developed countries have sophisticated

systems for collecting data on the incidence and
causes of foodborne illness.
■ These data represent only a fraction of the number of
cases that occur.
■ Infected individuals may not seek medical advice or their
illness may not be recognized as foodborne in origin.
■ May not be reported to the relevant authority for recording.
■ Estimates believed that in developed countries less than 10%
of cases of foodborne illnesses ever reported.

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 Extent of Foodborne Illness

■ Statistics show an increasing trend in foodborne

illness over recent years.
■ Probably due to improvements in the way data are collected.

3
 Extent of Foodborne Illness

■ A number of factors have contributed to this

trend.
■ Increasing industrialization and urban living.
■ Food chain has become longer and more complex, increasing
opportunities for contamination.
■ More people are likely to be affected by a single breakdown in
food hygiene.
■ Rapid population growth have not been matched by
development of the health-related infrastructure, including
basic sanitation.
■ Led to increased risk of contamination of the food and water
supply.

4
 Extent of Foodborne Illness

■ Increasing wealth in other areas has led to greater

consumption of foods of animal origin such as meat, milk,
poultry and eggs.
■ These foods are recognized as more common vehicles of
foodborne pathogens.
■ Great international movement of both foods and people.
■ Exotic (Foreign)Salmonella serotypes have been introduced
into Europe and the United States as a result of importing
animal feeds.
■ Tourism: more and more people travel abroad where they are
exposed to increased risk of contracting foodborne illness.

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 Extent of Foodborne Illness

■ Changing lifestyles
■ Food preparation may be in the hands of the relatively
inexperienced as more people eat pre-prepared foods, meals
from catering establishments or food from street vendors.
■ An increasing proportion of the population is more
susceptible to foodborne illness.
■ Elderly, those who have some underlying condition such as liver
disease and those who are immunocompromised.

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 Foodborne Illness

■ Bacteria cause foodborne illness by two

mechanisms:
■ Infection
■ Intoxication.

7
 Infection

■ Infection occurs when living bacteria are:

■ Ingested with food (in numbers sufficient for some to survive
the acidity of the stomach).
■ The survivors then pass into the small intestine where they
multiply and produce symptoms.
■ Infections can be invasive or non-invasive.
■ In non-invasive infections, the organism attaches
itself to the gut surface or epithelium to prevent
itself from being washed out.

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 Infection

■ In non-invasive infections:
■ The organism attaches itself to the gut surface or
epithelium to prevent itself from being washed out.
■ In some cases, such as infection with enteropathogenic
Escherichia coli , this produces changes in the gut
epithelium which reduce its absorptive capacity or cause
fluid secretion.
■ Colonizing bacteria can also produce enterotoxins; toxins
that alter the function of the cells lining the gut and cause
them to secrete water and electrolytes into the intestine to
produce a profuse watery diarrhea.

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 Infection

■ Invasive infections:
■ Pathogens are not confined to the intestinal lumen but
can penetrate the cells lining the gut.
■ In some cases their penetration is limited to the
immediate vicinity of the gut (non-typhoid salmonellas).
■ Some pathogens invade the mucosa of the large
intestine rather than the small intestine (producing
inflammation, superficial abscesses and ulcers).
■ In other cases, microbial invasion is not restricted to
the gut’s immediate locality (organism spreads further
through the body, producing symptoms other than
diarrhea).

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 Intoxication

■ With foodborne intoxications, the bacteria grow

in the food producing a toxin.
■ When the food is eaten, it is the toxin, rather than the
microorganisms, that causes symptoms.

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 Intoxication

■ There is no direct person-to-person spread (as can

occur with some enteric infections) and the incubation
period (the time between consumption of the food and the
appearance of symptoms) tends to be shorter.
■ Toxin begins to act as soon as it reaches the site
of action (infections the microorganisms need time to multiply in
the body).

12
 Introduction

■ Foodborne diseases, especially those caused by

pathogenic organisms, remain a serious problem
in all countries.
■ Diarrhea is a feature of most of these diseases
and up to 70% of all episodes of diarrhea may
result from the ingestion of contaminated food
and water.

1
 Infectious Dose

■ Infective pathogens can be introduced into the

body from a variety of sources.
■ In the past, it was thought that contaminated water was the
main source of the pathogens that cause diarrhea.
■ This is probably true in many cases, but it has been shown
more recently that food may also be the vehicle of
contamination in up to 70% of cases.

2
 Infectious Dose

■ To cause illness, a sufficient number of cells must

be consumed (infectious dose).
■ Infectious dose varies from one organism to
another and from person to person.
■ ForCampylobacter jejuni the infectious dose is
thought to be quite low, while relatively high numbers
of non-typhoidSalmonella are normally required to
produce illness.

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Infectious Dose

4
 Infectious Dose

■ Successful infection is the result of the

interaction of two variable factors:
■ The virulence of the pathogen (its ability to cause illness).
■ The susceptibility of the individual.

5
 Health Consequences of Foodborne Illness

■ Incidents of foodborne illness are unpleasant

■ Generally mild and self limiting indispositions.
■ Restricted to gastroenteritis.
■ Not usually life threatening.
■ Exceptions occur with particularly susceptible
individuals such as the very old or very young,
pregnant women or those who are already very sick
or weak for some other reason.
■ These vulnerable groups constitute quite a large proportion of the
population and for many of them diarrhea disease can be fatal.

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 Health Consequences of Foodborne Illness

■ Sometimes extra-intestinal disease transmitted by

food is particularly associated with certain
susceptible individuals.
■ Listeria monocytogenes can vary from a mild, flu-like illness
to meningitis and meningoencephalitis.
■ Serious in pregnant women; the mother may experience
relatively mild symptoms but infection of the fetus can result in
abortion.
■ Listeriosis is more than 300 times more common in AIDS
patients than in the general population.
■ Cancer patients and other immunocompromised individuals
are subject to bacteraemia caused by foodborne bacteria.

7
Health Consequences of Foodborne Illness

8
 Focus for Health Education

■ Underlining the importance of the education of

consumers and food handlers
■ Urges governments to take the initiative to develop
systematic and continuous program of health
education based on modern approaches to food
safety.
■ Identifies the health care system as one of the most
important vehicles for health education in food safety.

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 Focus for Health Education

■ To be able to assume their role in food safety

health workers should know:
■ About the epidemiology of the principal foodborne diseases
■ About the sociocultural conditions that encourage them.
■ They should receive some training:
■ In the investigation of foodborne disease outbreaks
■ Hazard Analysis and Critical Control Point (HACCP) studies
■ In the investigation of sociocultural characteristics of the
population.

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 Focus for Health Education

■ Health workers should also be inspired to take action in their

daily work to:
■ Raise public awareness of food safety
■ Advise the mothers of small children or pregnant women in safe
food preparation
■ Assist the community in improving food safety.

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Foodborne Illness and Hazards

Part 2
Biological hazards

1
 Biological Hazards
Parasites

■ Include protozoa and helminthes (worms).

■ Larger and more complex than other organisms.
■ Have complex life cycles; some time is spent in the
tissues of an animal host.
■ Can cause a variety of illnesses ranging from
diarrhea to liver cancer.
■ Infection with is normally the result of fecal
contamination of a food or water source and direct
person-to-person spread can occur.
■ Others can infect the tissues of meat animals and be
transmitted by undercooked meat.
■ Can be killed by thorough cooking

2
 Biological Hazards
Parasites

■ Some spend part of their life cycle in a water snail which

may then be eaten by humans.
■ The pork and beef tapeworms respectively are widely
distributed in Congo, Ethiopia and Kenya, more than
10% of the population are infected.
■ In the former Yugoslavia up to 65% of children were
found to harbor the organism.

3
 Biological Hazards
Viruses

■ Viruses cannot replicate outside a susceptible

host cell (do not therefore multiply in foods).
■ Food and water can be the vehicle for transmission
of a number of different viruses that infect humans.
■ The result of contamination of food possibly via some
intermediary vehicle such as water or equipment.
■ Poliomyelitis and hepatitis A are the most serious viral
diseases that are known to be transmitted by this route.

4
 Biological Hazards
Bacteria

■ Bacteria are generally considered to be the most

important agents of foodborne illness.
■ The individual organisms and the illnesses they
cause are described in Appendix and available on
Moodle as documents A-1.
■ Specific aspects of bacterial behavior and
foodborne illness feature prominently in the next
Chapter.

5
 Chemical Hazards

■ For many, a low level of consumption is both

unavoidable and harmless.
■ Various national regulatory authorities and international bodies
have established threshold values for individual additives and
contaminants below which there is no appreciable risk.
■ These levels of acceptable daily intake (ADI) or provisional
tolerable daily (or weekly) intake are expressed as the number of
milligrams of the chemical which may be safely consumed by a
human for each kilogram of the consumer’s body weight.
■ They are usually derived from experiments at which the chemical
has no adverse effect known as the no-observed-adverse-effect
level (NOAEL).

6
 Chemical Hazards
Sources

■ Industrial pollution of the environment:

■ Modern industry produces huge numbers of chemical
products that can contaminate the food chains.
■ Most attention in this area has focused on heavy
metals such as mercury, cadmium, lead and arsenic.
■ Mercury often found in fish since industrial effluents
containing mercury are discharged into rivers or seas.
■ Lead can be introduced into the environment by industry
or in exhaust fumes from vehicles using leaded fuel.
■ A local cooking salt used by some villagers in Nigeria was
found to contain very high levels of lead.
■ Sometimes the chemistry of the soil itself can give rise to
contamination problems.

7
 Chemical Hazards
Sources

■ Agricultural practices:
■ Foods can also carry residues of pesticides and
veterinary drugs.
■ Organochlorine pesticides such as DDT were identified in the
early 1970s as a particular problem since they persist in the
environment.
■ Contamination is particularly associated with milk, animal fats,
fish and eggs.
■ The use of organochlorin pesticides (DDT) has been
restricted in many countries and residue levels in foods have
shown a decline over recent years.
■ Residual levels in foods from developing countries are generally
higher, but data are not available from many countries.

8
 Agricultural Practices
Causes of Outbreaks

■ Contamination during transport or storage

■ Example: sugar or flour transported or stored with a
pesticide or in a place previously contaminated with
pesticide.
■ Ingestion of seed dressed for planting
■ Mainly associated with mercury fungicides.

■ Mistaken use in food preparation

■ Occurs when pesticides are mistaken for food
materials.
■ Misuses in agriculture
■ Due to misuse near harvesting time, misuse of
containers, contamination of ground water and use of
excessively high doses in agriculture.
9
 Food Processing

■ Chemical contaminants can sometimes be

introduced as a result of food processing and
storage.
■ Drinking water can be contaminated from lead used in
water storage tanks and piping.
■ Lead poisoning in children.
■ Can is the major source.
■ Nitrates and nitrites occur naturally in the
environment and are also deliberately added to some
processed foods as a preservative and as color fixative.

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 Natural Toxicants in Foods

■ Many plants that serve as staple human foods often

contain a range of secondary compounds that are
produced to deter predators.

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 Biological Sources
Mycotoxins

■ Some molds have the ability to produce toxic

metabolites, known as mycotoxins
■ Can produce a range of disorders from
gastroenteritis to cancer.
■ More than 300 mycotoxins have been identified.
■ Small number have been shown to occur in foods and
feeds at levels sufficient to cause concern.
■ The Aflatoxins are the most extensively studied
mycotoxins.
■ They were discovered in the United Kingdom in the early
1960s.

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 Biological Sources
Mycotoxins

■ Aflatoxins are acutely toxic and have been shown

to be carcinogenic for some animals.
■ The involvement of Aflatoxin with human cancer is
more complex and remains to be defined.
■ Mycotoxins can also occur in milk, meat and their
products as a result of animals consuming mycotoxin
contaminated feed.

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Biological Sources
Mycotoxins

14
Biological Sources
Mycotoxins

15
 Biological Sources
Factors influencing the production of mycotoxins in foods

16
 Biological Sources
Ranges of regulatory limits for mycotoxins

17
 Physical Hazards

■ Food can be contaminated with physical material

(at any stage in its production).
■ Very diverse.
■ Difficult to categorize.
■ Include pieces of glass, pose an obvious risk of
cutting the consumer’s mouth or doing even
greater damage if swallowed.

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 Key Points

■ Foodborne hazards can be classified as biological,

chemical or physical.
■ Biological hazards can be posed by parasites, viruses
or bacteria.
■ Chemical contaminants in foods can come from
industrial and agricultural sources, from food
processing or from the food itself.
■ Toxic chemicals come from biological sources such as moulds
and algae.
■ Foreign objects present in food could constitute a
physical hazard to the consumer.

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Foodborne Illness and Hazards

Part 3
Factors Leading to Microbial
Foodborne Illness

1
 Microbial Foodborne Illness

■ Three key factors generally contribute to

outbreaks of microbial foodborne illness:
■ Contamination - pathogens must be present in the
food.
■ Growth - in some cases they must also have the
opportunity to multiply in the food in order to produce
an infectious dose or sufficient toxin to cause illness.
■ Survival - when present at a dangerous level they must
be able to survive in the food during its storage and
processing.

2
 Microbial Foodborne Illness
Contamination

■ Microorganisms, particularly bacteria, can be

found almost everywhere.
■ They are present in the air, water and soil; they can
grow wherever higher organisms can grow.
■ Foods carry a mixed population of microorganisms
derived from the natural micro-flora of the original
plant or animal.

3
 Microbial Foodborne Illness
Contamination

■ Most of the microorganisms in our environment

cause us no harm.
■ When they occur in foods, many of have no effect on
the food or the person consuming it.
■ In some cases, microorganisms may actually produce
beneficial changes in the food (fermented foods).
■ Others, however, will spoil the product making it unfit
for consumption.
■ Some can be harmful to humans causing illness when
they or the toxins they produce are ingested.

4
Microorganisms Occur Naturally in Foods
Indigenous Microflora

■ Food materials carry their own microflora during

life and this can persist into the food product.
■ Natural microflora is of greatest importance in animal
products.
■ Healthy animals and poultry is usually almost completely free
from microorganisms.
■ Intestines carry a very large and diverse microflora including
Campylobacter, Salmonella and certain strains ofEscherichia
coli .
■ In most cases the animal or bird will carry organisms without
showing signs of illness.
■ In the process of slaughter and butchering a carcass,
these organisms may be spread to other meat surfaces.

5
 Natural Inhabitants of the Environment

■ Many pathogens can be found as natural

inhabitants of the environment (Can contaminate food
products).
■ Examples:
■ Clostridium botulinum andClostridium perfringens are found
in soil and mud.
■ Bacillus cereus spores can be isolated from soil and air.
■ Listeria monocytogenes is a relatively common environmental
organism found in unpolluted water and mud.

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Natural Inhabitants of the Environment

7
 Microorganisms Growth

■ Bacterial pathogens can grow and multiply in some foods

in a relatively short period to numbers sufficient to cause
illness.
■ Bacteria multiply by a process of doubling.
■ The period between cell divisions is known as the generation or
doubling time (typically around 20 minutes)
■ Molds and yeasts also have the capacity to grow in foods.
■ Optimum growth conditions differ slightly for bacteria,
yeasts and molds.
■ Molds and yeasts generally grow more slowly than bacteria.
■ Unless conditions in the food are sufficiently inhibitory to bacterial
growth giving molds and yeast a competitive advantage.

1
 Factors Affecting Microbial Growth

■ Availability of nutrients:
■ Foods generally contain a variety of nutrients.
■ Not usually limiting factors for microbial growth in foods.
■ Raw food contain a diverse microbial population
competing for nutrients.
■ If a pathogen is present it may not do well in this competition.
■ If pathogen is introduced after the food has been cooked
■ Natural microflora has been eliminated or severely reduced.
■ Little or no competition for growth.
■ Pathogens will grow more quickly.
■ Pathogen growth is much less likely to occur in water where
the nutrient supply is more limited.

2
 Factors Affecting Microbial Growth

■ Temperature:
■ Microorganisms can grow at temperatures ranging
from about -10 oC up to more than 100oC.
■ Water should be present in its liquid state.
■ Individual microorganisms will not grow over such a
wide temperature span and are normally restricted to
a range of about 35 oC.
■ They have a minimum and a maximum temperature
below and above which they cannot grow.

3
Factors Affecting Microbial Growth

4
 Factors Affecting Microbial Growth

■ Temperature:
■ Most foodborne pathogens are mesophiles with an
optimum growth temperature around body
temperature of 37oC.
■ No pathogenic bacteria will grow at temperatures
above about 60oC and this defines the upper limit of a
“danger zone”.

5
 Factors Affecting Microbial Growth

■ Acidity/pH
■ Acidity and alkalinity are measured by pH number reflecting the
concentration of hydrogen ions present.
■ As with temperature, microorganisms will grow over a restricted
range of pH and have a smaller pH range over which they grow
fastest.
■ For most bacteria the optimum pH is around neutrality (pH 7);
yeasts and molds generally have an optimum more on the acid
side (below 7).
■ Pathogens cannot grow in the more acidic foods but are relatively
unaffected by the pH found in most food materials.

6
 Factors Affecting Microbial Growth

■ Water activity (aw)

■ All microorganisms require liquid water to enable them
to grow.
■ If there is little water present, or the water that is present is
not available to the microbe, then its growth is slowed or even
prevented.
■ Water availability is often measured or expressed in terms of
water activity (aw) in a scale from 0 to 1.

7
Factors Affecting Microbial Growth

8
Factors Contributing to Outbreaks of
Foodborne Illness

9
 Factors Contributing to Outbreaks of
Foodborne Illness

■ Preparation of food several hours prior to

consumption:
■ Combined with storage at conditions that favor growth of
pathogenic bacteria/formation of toxins.
■ Insufficient cooking or reheating of food to
reduce or eliminate pathogens.
■ Cross-contamination.
■ People with poor personal hygiene handling the
food.

10