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Food borne

:Diseases
By: Dr. Amr El-Dakroury
Dept. of Medical
commission
Supreme Council of Health
The etiology of Food-borne
:diseases
Food-borne diseases are those diseases that are
the result of exposure to pathogenic
microorganisms, such as bacteria, viruses and
parasites, which tend to have acute effects on
human health.
However, chronic, and in some cases acute, food-
borne illness may also be caused by the presence
of various chemical substances including residues
of pesticides and veterinary drugs, unlawful food
additives, mycotoxins, biotoxins and radionuclides
that enter the food intentionally or
unintentionally.
The problems :due to consumption of
contaminated food and its detrimental effect on
human health .
:Epidemiology of FBD
WHO estimates that one in three people worldwide
suffer from a food-borne disease every year,
1.8 million die from severe food and waterborne
diarrhea ,related illness
Most of these illnesses are due to microorganisms
and chemical contaminants, which may occur
naturally or be introduced at some point along the
food chain.
Campylobacter and Salmonella species account for
over 90% of all reported cases of bacteria related to
food poisoning worldwide.
As most cases of food borne disease are not reported,
the true dimension of the problem is unknown.
Today food safety is one of WHOs top eleven
priorities
:Food safety and security
The World Food Summit, organized by FAO in
1996, recognized that access to safe food is in
itself an element of food security,
The World Health Assembly Resolution on Food
safety from May 2000 stated that :
1. Everyone should have the right to an adequate
supply of safe, nutritious food ,
2. Encourages WHO member states to implement
and keep national and, when appropriate,
regional mechanisms for food borne disease
surveillance
3. Governments should take the necessary
measures to ensure the availability of safe food
for all in order to sustain the health and
economic development of their people.
The Response in Qatar
The Programme on Food- and Waterborne
Diseases and Zoonoses (FWD) in Qatar was set up
with the establishment of SCH ,

One of the key objectives for the programme is


improving and harmonizing the surveillance
system in Qatar in order to increase the scientific
knowledge regarding etiology, risk factors and
burden of food- and waterborne diseases and
zoonoses.

at present covers the following diseases:


brucellosis, campylobacteriosis, cholera,
giardiasis, hepatitis A, salmonellosis, shigellosis,
toxoplasmosis, typhoid and paratyphoid fever,
Escherichia coli infection,
Objectives of the FWD programme
: Improving and harmonizing surveillance
and control interventions of FWD
Improving knowledge of prevention and
control of FWD
Strengthening SCH and Stakeholders
capacities in the area of FBD .
Improving early detection and
coordinated response to Qatar-wide FWD
outbreaks ,as well as control interventions
.
Facilitating collaboration between public
health, municipality veterinary and food
sectors
surveillance activities in Qatar

Food borne disease data collected


through :

1. Routine surveillance activities

2. Outbreaks investigations and

3. Conducting special studies.


Aims of FBD surveillance
:system
Food borne disease surveillance is essential
for:
1. Estimating the burden of food borne
diseases, and monitor trends;
2. Identifying priorities and setting policy in
the control and prevention of food borne
diseases;
3. Detecting, controlling and preventing food
borne disease outbreaks;
4. Identifying emerging food safety issues; and
evaluating food borne disease prevention
and control strategies.
Overview

Organisms
Epidemiology
Transmission
Foodborne illness
Prevention and Control
Organisms
There are an estimated 250 pathogens that can
cause foodborne related illnesses.
Foodborne illness is defined as two or more cases of a
similar illness resulting from ingestion of a common food. It
can result from consuming foods contaminated with various
pathogens. In most cases bacteria are the major
pathogen followed by viruses, then parasites.
However, natural or manufactured chemicals and
toxins from organisms can also cause foodborne
illnesses.
The most commonly recognized foodborne infections
are caused by Campylobacter, Salmonella, E. coli
O157:H7 and by caliciviruses (better know as
Norwalk viruses.)
Epidemiology
Epidemiology
Many foodborne illnesses are not recognized or
go unreported for a variety of reasons:
First, routine surveillance may not detect a
mild foodborne illness.
second, some of the same pathogens that
cause foodborne illness can also be
transmitted in water or from person to person.
Lastly, some pathogens are emerging and are
not yet identifiable or able to be diagnosed.
Considering these factors, the above listed
number of illnesses, hospitalizations and
death may be obsolete.
High Risk Groups
The elderly
Children
Immunocompromised individuals are
usually at the greatest risk for these
illnesses.
Transmission
Transmission
Transmission of foodborne pathogens occurs via the oral
route.

How those pathogens contaminate food can vary based


on the organism, its reservoir, food handling/processing,
and cross-contamination prior to serving.

Some organisms rely on a human reservoir, such as


Norwalk-like virus, Shigella, Campylobacter.

Others have an animal reservoir such as Campylobacter,


Salmonella, E. coli 0157:H7, Listeria, and Toxoplasma.
Transmission
Contamination can occur at several
points along the food chain
On the farm or in the field
At the slaughter plant

During processing

At the point of sale

At home
Produce Processing
Animal products are not
the only food that can
be contaminated.
Various foodborne
disease outbreaks have
occurred due to fruits
and vegetables.

This table indicates the


many possible sources
for contamination
during the processing of
produce.
Important Organisms

Although many pathogens can cause


foodborne illnesses, we will briefly
cover those of greatest impact.
These may also be potential
bioterrorism agents for food sources.
Important Organisms
Norwalk-like viruses
Campylobacter
Salmonella
E. coli O157:H7
Clostridium botulinum
Shigella
Toxoplasma
Emerging organisms
Norwalk-like Viruses
Norovirus; Caliciviridae family
They are an important cause of sporadic
gastrointestinal disease outbreaks
throughout the world. It is considered the
most common foodborne infectious agent
and an estimated 23 million cases occur
each year.
Sources
Person-to-person :
Shed in human feces (up to 2weeks), vomitus.
Outbreaks in daycares, nursing homes, cruise ships
Contaminated raw shellfish.
Campylobacter jejuni
Leading cause of bacterial diarrhea.
It is considered the leading bacterial cause of
foodborne related diarrhea affecting 2.4 million people
each year (5-14% of all diarrheal illnesses worldwide).
Usually these are children under the age of 5 and
young adults (15-29 years of age).

Very few deaths are caused by this organism . Recently


Guillain-Barr Syndrome has been associated with a
small number of Campylobacter cases. This syndrome
is the leading cause of acute paralysis and develops 2-
4 weeks after a Campylobacter infection (after
diarrheal signs disappear).
Campylobacteriosis
It is caused primarily by Campylobacter jejuni,
but also C. fetus and C. coli.
Sources
Raw or undercooked poultry
Non-chlorinated water
Raw milk
Infected animal or human feces
Poultry, cattle, puppies, kittens, pet birds

Clinical signs
Diarrhea, abdominal cramps,
fever, nausea
Duration: 2-5 days
Salmonellosis
Salmonella is a gram negative bacteria with
many serotypes that cause foodborne related
illnesses. The ones we most commonly associated
with human foodborne illness are S. typhimurium
and S. enteritidis
They account for about 41% of all human cases
reported
causes an estimated 1.4 million reported cases
annually with 580 deaths
Salmonellosis
Sources
Raw poultry and eggs
Raw milk
Raw beef
Unwashed fruit
Reptile pets: Snakes, turtles, lizards
Signs
Onset: 12-72 hours
Diarrhea, fever, cramps
Duration: 4-7 days
E. coli O157:H7
Escherichia coli is another major pathogen of
foodborne related illnesses.
Harmless strains of E. coli are found in nature,
including the intestinal tracts of humans and
animals.
Diarrheal disease is caused by several different
strains of harmful E. coli. The most dangerous
type is enterohemorrhagic E. coli (EHEC).
It gets its name because it can cause bloody
diarrhea and can lead to kidney failure in
children or immunocompromised persons. E. coli
O157:H7 is the most common EHEC and its
enterohemorrhagic toxin is what actually causes
the disease
E. coli O157:H7
Signs
Watery or bloody diarrhea, nausea,
cramps
Onset: 2-5 days
Duration: 5-10 days

Sequela
Hemolytic Uremic Syndrome (HUS)

Most commonly affecting children. HUS is


the most common cause of acute kidney
failure in children.
Botulism
Botulism is caused by a neurotoxin from
Clostridium botulinum
This toxin causes flaccid paralysis and
cranial nerve deficits, and can lead to
death.
The most common sources are home-
canned foods, fermented meats and honey
Signs
Double vision, drooping eyelids, difficulty
speaking and swallowing
Onset: 18-36 hours
Shigellosis
Shigellosis is also known as bacillary dysentery
Most cases are caused by Shigella sonnei.
However, S. dysenteriae, S. flexneri and S. boydii
can also cause foodborne related illnesses.
Sources:
Human fecal contamination of food, beverages,
vegetables, water
Signs:
Watery or bloody diarrhea, nausea, vomiting, cramps,
fever
Onset: 2 days
Duration: 5-7 days
Toxoplasmosis
Toxoplasmosis is caused by an intracellular protozoan,
Toxoplasma gondii

It is one of the three leading causes of death from a foodborne


disease the others were Salmonella and Listeria
Pregnant women and immunocompromised individuals, especially
HIV positive patients, are at the greatest risk of toxoplasmosis
The source of this protozoan include infected cats shedding in
their feces, soil, undercooked meat, and mechanical vectors such
as cockroaches and flies
Clinical signs in humans can by asymptomatic to fever, headache,
and swollen lymph nodes. If the protozoan cysts develop in tissue,
other more severe clinical signs can be observed.
To prevent infection, gloves should be worn while gardening,
changing cat litter boxes and thoroughly washing raw fruits and
vegetables before eating. Irradiation and thoroughly cooking
meat to 160oF internal temperature to destroy the Toxoplasma
cysts.
Emerging Pathogens

Cyclospora (Protozoan)
Sources >>>> Imported raspberries

Listeria monocytogenes
Sources
Ready-to-eat meats, soft cheeses
Signs
Human abortions and stillbirths
Septicemia in young or low-immune

As stated earlier listeriosis is one of the 3 most


common causes of food borne related death.
Prevention and
Control
HACCP
Food producers and processors have implemented
the HACCP program in their operation to reduce
the possibility of food-borne pathogens.

The Hazard Analysis Critical Control Point


(HACCP) program is used to monitor and control
the production process by identifying food safety
hazards. Additionally, critical control points in
production, processing and marketing are
identified. Critical limits for each of these points is
established and monitored for food quality and
safety. It is applied to the meat, poultry and egg
industries.
On Farm Strategies
To help control Salmonella Testing and removal this
is done through:
Serologic testing, fecal or hide culturing of animals to
identify carriers of the bacteria
Vaccination
It is important to remember that vaccines are not 100% effective,
and with the various serotypes of bacteria and immune status
of animals, they should be used in accordance with other
prevention methods.
Minimize rodents, wild birds
as they are often carriers of bacteria, will also help reduce the
transmission.
Isolation of new animals
will also help decrease the chance of spread.
At the Slaughter Plant
FSIS (Food Safety Inspection Service)
has Identified target organisms :
Salmonella and E. coli
Control points
Removal of internal organs.
Minimize contact between carcasses.
Proper movement through facilities .
Chilling .
Cooking processes (proper time,
temperature).
At Home
Drink pasteurized milk and juices.
Wash hands carefully and frequently
After using the bathroom.
Changing infants diapers.

Cleaning up animal feces.

Wash hands before preparing food.


At Home
Wash raw fruits and vegetables
before eating
After contact with raw meat or
poultry
Wash hands, utensils and kitchen
surfaces.
Hot soapy water.

Defrost meats in the refrigerator


At Home
Cook beef/beef products thoroughly
Internal temperature of 160oF
Cook poultry and eggs thoroughly
Internal temperature of 170-180oF
Eat cooked food promptly
Refrigerate leftovers within 2 hours
after cooking
Store in shallow containers
Special Attributes
to Dr. Farah
:REFERENCES
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