FOOD BORNE DISEASES

UNDERSTANDING AND MITIGATING RISKS;

SAFEGUARDING PUBLIC HEALTH

DR H.O-MENSAH
OUTLINE
• INTRODUCTION
• EPIDEMIOLOGY
• CLINICAL PRESENTATION
• DIAGNOSIS & MANAGEMENT
• SURVEILLANCE
• PUBLIC HEALTH RESPONSE
INTRODUCTION
• Food-borne illnesses are diseases
caused by the consumption of
contaminated food and drinks
• Commonly caused by viruses,
bacteria and parasites
• Symptoms range from mild GI
discomfort to severe illness
• Most people with food-borne
diseases do not seek medical
• Therefore marked under-reporting
of cases of food-borne diseases
globally affecting their incidence
CLASSIFICATION OF FOOD BORNE
ILLNESES FOOD-BORNE
FOOD PRODUCTION CHAIN
EPIDEMIOLOGY - 1
• Every year unsafe food causes 600 million cases of food-
borne diseases and 420 000 deaths
• 30% of FBD deaths occur in U5s
• Seasonal(rainy season) and geographic pattern
• FBDs have been associated with eating some specific foods
eg. Milk –Campylobacter, shell-fish-norovirus, raw meat-
Listeria, raw eggs- Salmonella
 EPIDEMIOLOGY -2
• HOST- WHO BECAME
agent ILL?
*age *immunity
• High risk
EPIDEMIC
TRIAD infants, young children,
elderly, pregnant women and
host
Enviro immunocompromised
nment
EPIDEMIOLOGY-AGENTS -3
BIOLOGICAL CHEMICAL PHYSICAL
AGENTS AGENTS AGENTS
• bacterial • Toxic metals • Metal
• Viruses • Pesticides shavings
• Fungi • Additives from cans
• Parasites • preservatives • hair
• Mushroom • dust
toxins
EPIDEMIOLOGY-BIOLOGICAL AGENTS -4

BACTERIAL VIRAL FUNGI PARASITES

• Salmonella • Viral Hepatitis • yeast • Giardia
• Shigella A • mold • cyclospora
• C. perfringes • Norovirus
• Campylobacter • Rotavirus
• E. Coli
• V. cholerae
EPIDEMIOLOGY-4
SOURCES OF AGENTS SOURCES OF AGENTS
*Internal –natural toxins e.g.
mushrooms
*External – handling, production,
storage, processing, preparation
• Only a few agents are
exclusively transmitted by food
e.g. Listeria
• Most are transmitted through
food and water
EPIDEMIOLOGY - 3

ENVIRONMENT RISK FACTORS

• Schools/ refugee camps, • Inadequate food safety
excursions to mountains practices

• water-stressed areas • Improper food handling and

storage
• disaster zones • contaminated water
• season • Poor personal hygiene
• Poor sanitation
• Previous travel
CLINICAL PRESENTATION
• Nausea, vomiting, diarrhea and abdominal pain are frequent
symptoms of FBD
• No single clinical syndrome for all food-borne diseases
• Severity of Sxs may vary based on causative agent
• The presenting symptoms largely depend on the causative agent
e.g. S. typhi –fever, diarrhea, abdominal cramps
C. perfringes -abdominal cramps and diarrhea (no vomiting, no fever)
• The onset of symptoms varies from hours to days depending on the
causative organism
LABORATORY DIAGNOSIS
• Stool sample/ rectal swab for
culture and RE (most laboratories
do not routinely test the common
causative agents. If suspected,
should be requested)
*C/S-immunocompromised, febrile,
severe sxs, bloody diarrhea
*stool R/E –travel hx, unresponsive to
anti-microbial, persistent
• FBC, Blood c/s –
bacteremia/septicemia
• Food sample
MANAGEMENT
• Appropriate txt contingent on the identification of implicating
pathogen
• Cues to identifying pathogen
*incubation period (C. perfringes i. p. = 6-24hrs, S. typhi i. p. = 6hrs-
6 days)
*duration of illness (longer with S. typhi, shorter with C. perfringes)
*predominant clinical symptoms
*population involved in the outbreak
*type of food consumed
AGENT INCUBA SIGNS & DURATI ASSOCI LAB TREAT
TION SXS ON OF ATED TESTS MENT
PERIOD ILLNESS FOODS
Salmonella 1-3dys Diarrhoea, 4-7dys Egg, Stool C/S Supportive
spp. fever, poultry, treatment,
abdominal milk, raw Antibiotics
pain, fruits and
vomiting vegetables
Shigella spp. 24-48hrs Abdominal 4-7days Usually Stool C/S Supportive
cramps, person- care,
fever, person/ Antibiotics
bloody feco-oral
diarrhoea transmissio
n.
Raw/ready-
to-eat foods
Staph a. 1-6hrs N/V, abd. 24-48hrs Improperly Clinical dx Supportive
cramps refrigerated most often treatment
foods
AGENT INCUBA SIGNS & DURATI ASSCIA LAB TREAT
TION SXS ON OF TED TESTS MENT
PERIOD ILLNESS FOODS
V. cholerae 24-72hrs Profuse 3-7dys Contaminat Stool C/S Aggressive
watery D/V ed water, IV/oral
street- hydration,
vendored tetracycline
food or
doxycycline
Listeria 9-48hrs Fever, Variable Unpasteuriz Blood C/S Supportive
muscle ed milk, (invasive care and
aches, fresh cheese disease), Antibiotics
Nausea or CSF when
Diarrhea there is
bacterial
meningitis
MANAGEMENT
• Many episodes of FBD are self-limiting and require fluid
replacement and supportive treatment
• ORS –mild to moderate dehydration, IVFs –severe
dehydration
• Anti-microbial treatment can be initiated based on clinical
signs and sxs, lab dx and susceptibility testing
PUBLIC HEALTH IMPACT
• Morbidity
• Mortality
• Healthcare costs
• Productivity loss
SURVEILLANCE
GOALS Standard Case Definition
• Identify unusual 2 or more people who
clusters/outbreaks consumed food/drinks from a
common source, presenting
• Monitor the magnitude of with similar Sxs
FBDs and risk factors
• Identify high-risk foods
SURVEILLANCE-CBF
NOTIFIABLE FOOD BORNE DISEASES
• Cholera
• Typhoid fever (Salmonellosis)
• Shigellosis
• Acute viral hepatitis
APPROACH TO INVESTIGATING AN
OUTBREAK OF FBD
• A collaborative effort between Public health officers, FDA
reps and Environmental health officers.
• Establish the existence of an outbreak -2 or more people
presenting with similar GI symptoms who consumed
food/drink from the same source
• Confirm diagnosis – clinical and laboratory
*record review of patient folders, collect additional
information
APPROACH TO INVESTIGATING AN
OUTBREAK OF FBD
• fill CBF for suspected cases, entry on SORMAS
• Line listing of cases (epid id, age, sex, geographical location,
date of onset, date of admission and discharge, signs and
symptoms, food history)
• Leftover food samples from the suspected source should be
collected for investigation
APPROACH TO INVESTIGATING AN
OUTBREAK OF FBD
• An environmental health assessment should be conducted
- Interviews with food vendor
- Direct observations at site of food preparation
• Develop an outbreak case definition and find additional cases
-record review from hospital registers (IPD/OPD)
-active case search e.g. school, snowballing /guest list for an
event
-update line list
APPROACH TO INVESTIGATING AN
OUTBREAK OF FBD
• Analyze preliminary data and generate a hypothesis
*Plot data on epi curve to display time characteristics, source of
outbreak and incubation period
*Geographical location of cases can be shown using a spot map
*Person characteristics and food history can be displayed on
graphs and tables where appropriate using frequencies and
proportions
• Test and refine hypothesis
* Retrospective cohort / case control study
APPROACH TO INVESTIGATING AN
OUTBREAK OF FBD
*Bivariate analysis or chi-square – RR,OR, X2, p-values
obtained
• Communication
*notification report, preliminary report, final report
* Risk communication
PUBLIC HEALTH RESPONSE –CONTROL &
PREVENTION
CONTROL THE
SOURCE
• Remove food product from the market, shop or restaurant e.g. Food
recall, food seizure
• Temporarily close food processing site/ restaurant till problem is
resolved
• Modify food production or preparation process i.e. if investigation
implicates production and preparation process
PUBLIC HEALTH RESPONSE –CONTROL &
PREVENTION
CONTROL OF
TRANSMISSION
• Public Health education on hand-hygiene, food
safety practices
• Exclusion of infected people from work and school
• Appropriate case management with strict
adherence to IPC
• Patient education on personal hygiene
CONCLUSION
• Safeguarding public health from foodborne illnesses
requires an understanding of the epidemiology of the illness
and implementing preventive measures
• Prevention is multi-faceted and requires a collaborative
effort between regulators, producers, inspectors and
consumers.
• Surveillance is key to identifying outbreaks of foodborne
illness and controlling them.