Lecture 10 Foodborne

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Published on January 3, 2008

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Foodborne Disease :  Foodborne Disease John Scott Meschke Office: Suite 2338, 4225 Roosevelt Phone: 206-221-5470 Email: jmeschke@u.washington.edu Types of Foodborne Disease:  Types of Foodborne Disease Infection Foodhandler Food Concentration Direct Contamination Water-washed Intoxication (food poisoning) Bacterial and Fungal Toxins Shellfish Toxins Metals, Chemicals, etc. Allergy Sources of Foodborne Enteric Microbial Contamination:  Sources of Foodborne Enteric Microbial Contamination Food handler‑associated contamination Inadequate personal hygiene  fecal contamination of foods (e.g., hands) Food processing Equipment, packaging and personnel contaminate foods during processing Food Storage: time and temperature abuse  bacterial growth Fecal contamination prior to harvest or collection Animal foods contaminated naturally by infection (e.g., salmonella) Surface contamination (e.g., feces on fur, feathers, hooves, etc.) Shellfish and other fish contaminated in their environment Fecal (sewage) contamination of water  pathogen uptake by filter‑feeding on waterborne particles Fish and shellfish naturally colonized by aquatic pathogens Vibrio cholerae in copepods, fish and shellfish Produce contaminated by irrigation with sewage or contaminated water or fertilization with nightsoil (feces) or animal feces. Soil contaminating plants and animals with bacteria, fungi, etc. Foods Implicated in Foodborne Illness: Meats:  Foods Implicated in Foodborne Illness: Meats Red Meats High contamination in comminuted and processed meats (e.g., ground beef, sausage) High surface area, increased contact with processing equipment; increased handling; variety of sources from the animal (organs, trimmings, etc.). Ex., E. coli O157:H7 outbreaks due to undercooked hamburger Poultry High contamination levels in cut‑up poultry Increased handling, processing and contact with common equipment Salmonella and campylobacters are prevalent in some poultry flocks can contaminate an entire processing plant via equipment and process baths (e.g., chiller tank) Eggs Endogenous contamination by Salmonella enteritidis in some flocks Time and temperature abuse leads to proliferation in the egg Raw/undercooked eggs a source of exposure and infection Foods Implicated in Foodborne Illness: Fish:  Foods Implicated in Foodborne Illness: Fish Contamination depends on type of seafood,quality of harvest water and amount of processing, handling and storage. Bivalve mollusks (oysters, clams, mussels, etc.); filter feeders Accumulate enteric pathogens from fecally contaminated waters Acquire high levels of vibrios from their environmental waters Crustaceans (e.g., crabs) Acquire some pathogens by feeding on mollusks Acquire high levels of vibrios from their water environment Vibrio levels can increase during handling, processing and storage, especially if temperatures are too high. Fin fish Outer surface and epithelial lining (e.g., gut) contamination by enteric microbes in fecally contaminated waters; Contamination during processing (e.g., filleting). Endogenous contamination: Ex:: Diphyllobothrium latum; fish tapeworm; anemia; undercooking Other Foods Implicated in Foodborne Illness:  Other Foods Implicated in Foodborne Illness Produce (fruits and vegetables) fecal contamination in irrigation water and other fecal sources (animal droppings, birds, etc.) inadequate or unsanitary picking, washing or processing. Dairy Products In developed countries milk and related dairy products are usually made from pasteurized milk. Raw milk and products (e.g., cheeses) made from unpasteurized milk are high risk of bacteria contamination salmonella, campylobacter, brucella, yersinia, listeria,). Unpasteurized fruit juices and other beverages fecal contamination from animal and human sources Deli, "Fast" and Restaurant Foods salads, sandwiches, other fast, deli or restaurant foods become fecally contaminated during preparation and handling Cereal and Grain: inadequate storage of cooked rice/grain BACTERIA:  BACTERIA Salmonella spp. Clostridium botulinum Staphylococcus aureus Campylobacter jejuni Yersinia enterocolitica and Y. pseudotuberculosis Listeria monocytogenes Vibrio cholerae O1, non-O1 V. parahaemolyticus; V. spp. Vibrio vulnificus Clostridium perfringens Bacillus cereus Aeromonas hydrophila and spp. Plesiomonas shigelloides Shigella spp. Streptococcus Enterovirulent Escherichia coli Group (EEC Group) Escherichia coli - enterotoxigenic (ETEC) Escherichia coli - enteropathogenic (EPEC) Escherichia coli O157:H7 enterohemorrhagic (EHEC) Escherichia coli - enteroinvasive (EIEC) NATURAL TOXINS:  NATURAL TOXINS Ciguatera poisoning (fish) Shellfish toxins (PSP, DSP, NSP, ASP) Scombroid poisoning (fish) Tetrodotoxin (Pufferfish) Mushroom toxins Aflatoxins Pyrrolizidine alkaloids Phytohaemagglutinin (Red kidney bean poisoning) Grayanotoxin (Honey intoxication) Enteric Viruses:  Enteric Viruses Hepatitis A virus Hepatitis E virus Rotavirus Norwalk virus group Other viral agents Prions: Spongioform Encephalopathic Agents “Mad Cow Disease” Agent; Creutzfeldt-Jacob Disease Agent; Scrapie in sheep, etc. Parasitic Protozoa and Worms:  Parasitic Protozoa and Worms Giardia lamblia Entamoeba histolytica Cryptosporidium parvum Cyclospora cayetanensis Anisakis sp. and related worms Diphyllobothrium spp. Nanophyetus spp. Eustrongylides sp. Acanthamoeba and other free-living amoebae Ascaris lumbricoides and Trichuris trichiura Foodborne Disease in The USA: 1993-1997:  Foodborne Disease in The USA: 1993-1997 FBDOs with a known etiology: multistate outbreaks caused by contaminated produce and outbreaks caused by E. coli O157:H7 remained prominent. S. enteritidis remains a major cause of illness and death. ~40% of persons who died from S. enteritidis were residents of nursing homes. Seriousness of S. enteritidis in elderly persons, many of whom might be immunocompromised. Decrease risks for egg-associated infections of S. enteritidis by not eating raw or undercooked eggs. Nursing homes, hospitals, and commercial kitchens should use pasteurized egg products for all recipes requiring pooled or lightly cooked eggs. Proper egg storage in homes. Several outbreaks involved imported food items, emphasizes the role of food production and distribution in FBDOs. Foodborne Disease Burden in the Unites States:  Foodborne Disease Burden in the Unites States Foodborne diseases are common, but only a fraction of these illnesses are routinely reported to CDC Passive surveillance system Many diseases not reportable a complex chain of events must occur to report a foodborne infection to CDC Most household foodborne infection are not recognized or reported Foodborne Disease in The USA: 1993-1997:  Foodborne Disease in The USA: 1993-1997 Bacterial pathogens caused most outbreaks/infections with a known etiology But, 68% of reported FBDOs were of unknown etiology Need improved epidemiologic and lab investigations. ~ 50% had incubations period of >15 hours, suggesting viral etiology. Viruses (e.g., Norwalk-like viruses) are likey a much more important cause of foodborne disease outbreaks than is currently recognized. Local and state public health lack resources and expertise to diagnose viral pathogens, but the methods are now increasingly available in some state laboratories. Viral outbreaks are more likely to detected in the future. Foodborne Disease in the Home:  Foodborne Disease in the Home About half of all Salmonella cases result from unsafe handling of food in the home. Foodborne illness costs the United States $23 billion annually. Foodborne illness is often mistaken for “the flu, as many of the symptoms are similar: stomach pain, diarrhea, nausea, chills, fever, and headache. Many experts believe the kitchen is home to more potentially dangerous bacteria than even the bathroom. Active Surveillance Network for Foodborne Disease in the United States: FoodNet:  Active Surveillance Network for Foodborne Disease in the United States: FoodNet Foodborne disease component of the CDC's Emerging Infections Program (EIP). Established in 1995 Collaborative project among CDC, several EIP sites (states cities and territories), U.S. Department of Agriculture (USDA), and the U.S. Food and Drug Administration (FDA). Consists of active surveillance for foodborne diseases and related epidemiologic studies designed to help public health officials better understand the epidemiology of foodborne diseases in the United States. FoodNet Surveillance Sites:  FoodNet Surveillance Sites Goals of FoodNet:  Goals of FoodNet Describe the epidemiology of new and emerging bacterial, parasitic, and viral foodborne pathogens Estimate the frequency and severity of foodborne diseases that occur. Determine how much foodborne illness results from eating specific foods, such as meat, poultry, eggs produce, etc. Components of FoodNet:  Components of FoodNet Active laboratory-based surveillance Survey of clinical laboratories Survey of physicians Survey of the population Epidemiologic Studies FoodNet Program:  FoodNet Program Tracks foodborne illness using: surveys of physicians and laboratories, case-control studies active case finding of targeted pathogens Targeted Pathogens: Bacteria: Campylobacter E. coli O157 Listeria Salmonella Shigella Vibrio Yersinia Parasites: Cryptosporidium Cyclospora FoodNet Website: http://www.cdc.gov/foodnet/default.htm Produce Related Food-borne Disease:  Produce Related Food-borne Disease

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