Food Borne Diseases and Its Prevention
Food Borne Diseases and Its Prevention
Food Borne Diseases and Its Prevention
its prevention
Definitions
Foodborne disease is any
illness resulting from the • Infection
consumption of food
contaminated with one or
• Intoxication
more disease-producing • Metabolic food
agents. These include disorder
bacteria, parasites, viruses,
• Allergy
fungi and their products as
well as toxic substances not • Idiopathic illness
of microbial origin.
The Food and Drug
Administration (FDA) Ranking of
Food Hazards
ranking*
1. microbial contamination
2. naturally occurring toxicants
3. environmental contaminants (e.g., metals
4. nutritional problems (i.e., malnutrition,
undernutrition)
5. pesticide residues
6. food additives
*1 being most dangerous, 6 least dangerous
Major identified foodborne pathogens,
United States – circa 2002
• Bacterial: • Bacterial, continued:
Vibrio vulnificus*
Bacillus cereus Vibrio, other*
Brucella Yersinia enterocolitica*
Campylobacter*
• Parasitic:
Clostridium botulinum Cryptosporidium*
Clostridium perfringens Cyclospora*
Giardia*
E. coli O157:H7* Toxoplasma*
E. coli, non-O157 STEC* Trichinella
E. coli, other diarrheagenic*
• Viral:
Listeria monocytogenes* Norwalk-like viruses*
Salmonella Typhi Rotavirus*
Salmonella non-typhoidal Astrovirus*
Hepatitis A
Shigella Prions*
Staphylococcus
Streptococcus
Vibrio cholerae, toxigenic*
Endotoxins
Released by the bacteria after they die
1. Enterotoxins
Toxins that develop in the gastro-intestinal tract
1. Heat labile – hot temp. alters the toxin protein which get
deactivated
e.g. Clostridium botulinum toxin
Food poisoning: Notifications and
laboratory reports, 1995-2005, Northern
Ireland
Campylobacter sp Cryptosporidium sp Salmonella sp Food Poisoning Notifications
2500
2000
Number of notifications/lab reports
1500
1000
500
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Clostridium
difficile toxin (all specimen types),
1995 – 2005,
Northern Ireland
1600
Number of Lab Reports
1400
1200
1000
800
600
400
200
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Clostridium
perfringens (all specimen types),
1995 – 2005,
Northern Ireland
25
Number of Lab Reports
20
15
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Campylobacter
sp
(all specimen types),
1995 – 2005, Northern Ireland
1200
Number of Lab Reports
1000
800
600
400
200
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of
Cryptosporidium sp
(all specimen types),
1995 – 2005, Northern Ireland
450
Number of Lab Reports
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Escherichia coli
O157
(all specimen types),
1995 – 2005, Northern Ireland
60
Number of Lab Reports
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Giardia lamblia
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Listeria sp
(all specimen types),
1995 – 2005, Northern Ireland
7
Number of Lab Reports
6
5
4
3
2
1
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Rotavirus
(all specimen types),
1995 – 2005, Northern Ireland
700
Number of Lab Reports
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella sp,
1995-2005, Northern Ireland
800
Salmonella (total)
700 S. enteritidis
S. typhimurium
600
Number of Lab Reports
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella sp
(all specimen types),
1995 – 2005, Northern Ireland
800
Number of Lab Reports
700
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella
enteritidis
(all specimen types),
1995 – 2005, Northern Ireland
500
Number of Lab Reports
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella
enteritidis PT4 (all specimen types),
1995 – 2005, Northern Ireland
450
Number of Lab Reports
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella
typhimurium (all specimen types),
1995 – 2005, Northern Ireland
200
Number of Lab Reports
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella
typhimurium DT 104 (all specimen
types),
1995 – 2005, Northern Ireland
160
Number of Lab Reports
140
120
100
80
60
40
20
0
95
96
97
98
99
00
01
02
03
04
05
19
19
20
20
20
19
19
19
20
20
20
Year
Laboratory reports of Shigella sp
(all specimen types),
1995 – 2005, Northern Ireland
300
Number of Lab Reports
250
200
150
100
50
0
92
93
94
95
96
97
98
99
00
01
02
03
04
05
19
19
19
19
19
19
20
20
20
19
19
20
20
20
Year
Laboratory reports of Norovirus
(all specimen types),
1995 – 2005, Northern Ireland
450
Number of Lab Reports
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Outbreaks vs. Cases
• Foodborne disease outbreak: an incident in
which two or more persons experienced a similar
illness after ingestion of a common food, and
epidemiologic analysis implicated a food as the
source of illness.
• Foodborne disease case: one individual
experiences illness after ingestion of an
epidemiologically incriminated food.
Estimates of the yearly incidence of
foodborne illness
• The estimates vary greatly but thought to be
around 76 million cases per year
• Cost estimates range from $5–23 billion per
year
• High cost due to many factors:
– medical care, investigation of illness, loss of
productivity, loss of business, legal activities
Information reported to and compiled by
the Centers for Disease Control (CDC)
Outbreaks of known etiology = where laboratory evidence indicated a specific
agent
Outbreaks of unknown etiology = where epidemiological evidence implicated
foodborne transmission, but the etiological agent
was not identified.
4 subgroups based on incubation period:
< 1 hr = probable chemical poisoning
1 – 7 hr = probable Staphylococcus aureus
poisoning
8 – 14 hr = probable Clostridium perfringens
food poisoning
> 14 hr = probably other infectious/toxic agents
Outbreaks of known vehicle =a particular food item was associated with the
illness
Number of reported foodborne-disease outbreaks, cases, and
deaths, by etiology — United States, 1993–1997
More to be discovered
Estimated illnesses for known
foodborne pathogens, United States
Disease or agent Estimated total cases
Bacteria5,204,934
Parasites2,541,316
Viruses30,883,391
Grand Total38,629,641
ex Mead, P. S., L. Slutskaer, V. Dietz, L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V.
Tauxe. Food-related illness and death in the United States. Emerging Infectious Diseases 5(5):607–625
(1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm
Public health burden of foodborne
disease
Each year an estimated 76 million cases
• 1 in four Americans gets a foodborne illness each
year
• 1 in 1000 Americans is hospitalized each year
• $6.5 billion in medical and other costs
• Microorganisms
• Susceptible Populations
• Infectious Doses
• Intoxication vs. Infection
• Fungal Pathogens
• Parasitic Pathogens
• Bacterial Pathogens
• Viral Pathogens
Pathogenic Microorganisms
• Fungi
• Parasites
• Bacteria
• Viruses
Salmonella - salmonellosis
• Symptoms - 7-72 hrs • Over 2000 Salmonella
• Livestock, poultry, • Grow well at 95 oF
eggs, pets, wild • Healthy adults – ingest
animals, people thousands to get ill;
young children, elderly
• Meat, poultry, - few cells
eggs/products, • Killed by heat if hot
unpasteurized dairy enough – 150o F
Eggs - Salmonella Enteritidis
• Uncracked shell eggs --- 3-7%
• Transmission from hen to egg before egg is
laid
• Processed foods pasteurized eggs required –
examples:
Campylobacter jejuni -
campylobacteriosis
• Sym – headache, fever, abdominal pain, recurring over several
weeks
• Anaerobic bacteria, no spores
• Source: livestock of various species
• Foods: meat, poultry, unpasteurized dairy, cross-contaminated
foods
Infections
Intoxications Infections
Toxicoinfection Invasive
Infection
Intoxications Infections
Chemical Microbial
Poisoning Poisonous Poisonous Intoxications
Plant Animal
Tissues Tissues
Elderlyand infants
Pregnant women
Impaired immune system (AIDS)
Cancer patients
Organ transplant recipients
Predisposing illness (ex. alcoholism,
diabetes, cirrhosis of the liver)
Infectious Doses
Minimum infectious dose (MID) not
determined for most pathogens
Consumption of just a few (10-100)
organisms in some individuals may
cause disease (depends upon immune
status)
High numbers (>106) of organisms may
be required to cause disease in
healthy adults
Infection vs. Intoxication
Foodborne Infection
• occurs when pathogens (bacteria, viruses, or parasites) are ingested
with food and multiply in the human body
• symptoms can occur 1 to 50 days after ingestion
• symptoms may include fever, chills, malaise, headache, vomiting,
diarrhea, dehydration, intestinal cramping, arthritis (3-4 weeks
later), septicemia, miscarriages, stillbirths, death
Examples of Foodborne Infection
• Trichinella spiralis
• Giardia lamblia
• Cryptosporidium parvum
• Cyclospora
Trichinella spiralis
Trichinella spiralis
Nematode/roundworm
AKA=Trichinosis
Foodborne infection; 2-28 days
Symptom: abdominal pain, fever, thirst, bleeding
Found in pigs, wild game
Associated foods: undercooked pork or wild game
Controlled by freezing, cooking, salting, irradiation
Giardia lamblia
Giardia lamblia
• Flagellated protozoan
• Found in domesticated and wild animals,
humans, rodents, contaminated water supplies
• Foodborne infection-1 week
• May require only 1 cyst to cause infection
• Diarrhea
Giardia lamblia
• Associated foods: salads, water
Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Cryptosporidium parvum
Cryptosporidium parvum
• Protozoa, obligate intracellular parasite
• Found in domesticated and wild animals,
humans, rodents, contaminated water supplies
• Foodborne infection
• May require only 10 organisms to cause
infection
• Symptoms: Severe watery diarrhea
Cryptosporidium parvum
• Associated foods: water, vegetables treated with
animal manure
• Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Cyclospora
Cyclospora
• Unicellular parasite
• Associated with contaminated water supplies, human waste
• Foodborne infection-1 week
• Symptoms: Watery diarrhea, explosive bowel movements,
stomach cramping, low grade fever
Cyclospora
• Associated foods: water, fruits and vegetables
treated with animal manure
• Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Bacterial Pathogens
• Staphylococcus aureus
Bacteria
Differentiated according
to ability to retain
specific stains
Gram Stain:
Gram
Positive
Gram
Negative
Salmonella spp.
Salmonella spp.
Gram negative, non-spore forming,
aerobic, motile rod
Found in animals, man, soil, water, insects,
raw meat, poultry, seafood, kitchens
Foodborne infection; 1-2 days
As few as 20 cells-10,000 cells may cause
disease (depends upon host, age, etc).
Symptoms: Diarrhea, fever, vomiting,
severe dehydration
Salmonella spp.
Hepatitis A
Rotavirus
Norwalk
Hepatitis A
Hepatitis A
AKA: type A viral hepatitis
Excreted in feces of infected employees
Foodborne infection (10 to 50 days)
Infection may occur with approximately 10-
100 virus particles
Symptoms: Fever, malaise, nausea,
abdominal discomfort, jaundice
Associated foods: deli meats, salads,
beverages, sandwiches, fruits, dairy
products
Hepatitis A
Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Rotavirus
Rotavirus
AKA: Viral gastroenteritis
Excreted in feces (108-10 ) of infected
employees; found in fecally contaminated
water supplies
Foodborne infection (1-3 days)
Symptoms: Vomiting, diarrhea, dehydration
Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Norwalk Virus
Norwalk Virus
AKA= Norwalk-like virus, viral
gastroenteritis
Found in contaminated water supplies;
contaminated shellfish beds, cruise ships
Foodborne infection: 1-2 days
Symptoms: Nausea, vomiting diarrhea,
abdominal pain, low grade fever
Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Norwalk Virus
• Definition:
any illness of uncertain pathogenesis that may
possibly but not certainly be due to foods;
also, any food-caused illness that does not fit
into one of the other categories
– Chinese restaurant syndrome
– celiac disease
– hyperkinesis
Foodborne diseases:
Philosophy of prevention
No vaccines for most of these pathogens