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foodborne_disease_-3.ppt

Foodborne Disease

Part Tres

Food Intoxications

  • Toxins not destroyed by cooking.
  • Appears more rapidly than food infections

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Can present in 30 minutes. Some blame on 24 hour flu.

Bacillus cereus

  • Intoxication or toxin-mediated
  • Spore forming
  • Facultative
  • Vomiting, diarrhea

Symptoms and Onset Time

  • 30 minutes to 6 hours (vomiting)
  • 8-16 hours (diarrhea)

Common Foods

  • Rice, potatoes,
  • Also meats, milk, vegetables, fish

Pasta

Tofu

  • Made from soybeans, water and a coagulant, or curdling agent.
  • Coagulating soy milk, and then pressing the resulting curds into blocks.
  • High in protein and calcium

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ability to absorb new flavors through spices and marinades. The production of tofu from soy milk is similar to the production of cheese from milk (fermentation),

  • Staple of Asian cuisines for hundreds of years
  • Recently become popular in Western vegetarian cooking.

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Tofu is…

  • low in calories
  • contains beneficial amounts of iron (especially important for women of child bearing age)
  • no cholesterol

Depending on the coagulant used in manufacturing, the tofu may also be high in calcium (important for bone development and maintenance), and magnesium (especially important for athletes).

Transmission of Bacillus Cereus

  • Improperly stored (cooled, hot held)
  • Allows conversion of spores to vegetative cells
  • Vegetative cells produce the toxins
  • Toxins lead to illness

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Chicken fried rice at Child Care Center

Prevention

  • Cooked and held at 135°F
  • Cooled to 41°F (rapidly)

Clostridium perfringens

  • Anaerobic, spore-forming
  • 24 hour flu
  • Toxin-mediated infection

(ingested cells colonize and then produce a toxin in the intestinal tract)

Symptoms and Onset Time

  • Abdominal pain and diarrhea
  • Onset 8 to 22 hours

Common Foods

  • Meats (boiled, steamed stewed, braised or insufficiently roasted)
  • Improperly cooled
  • Improperly reheated

  • Institutional feeding (school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities of food are prepared several hours before serving.
  • The young and elderly are the most frequent victims of perfringens poisoning.

Transmission

  • PHFs temperature abused
  • Improperly cooled
  • Improperly reheated

Example

  • 10 gallon pot of chili prepared for next days lunch (beans, meats, spices tomato base)
  • Cooked to boil
  • Vegetative cells die, but spores may survive

  • Chili stored in 10 gallon pot
  • 3 days to cool

Prevention

  • Cooked adequately
  • Cooled from 135°F to 70°F (2 hours) then
  • 70°F to 41°F (4 hours)
  • Reheated rapidly to 165°F
  • Reheat one time

Cooling Foods Quickly

  • Cut large items (roast, ham or turkey) into smaller pieces.
  • Ice water bath
  • Shallow containers
  • Do not stack pans
  • #1 cause of FBI

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  • Stir frequently
  • Measure temps periodically
  • Loosely cover to allow steam to escape
  • The leading cause of foodborne outbreaks

Staphylococcus aureus

  • Facultative anaerobic
  • Foodborne intoxication
  • Heat stable
  • Grows on cooked foods
  • Do not compete well when other microbes are present.
  • Found on human skin, hands, hair, nose and throat.

  • Burns, infected cuts, pimples, boils
  • Grow in foods with high salt or high sugar and low Aw.

Symptoms and Onset Time

  • Severe nausea, acute abdominal pain, vomiting, diarrhea
  • Onset time: 1 to 6 hours
  • Last 1-2 days

Common Foods

  • Cooked, RTE foods (luncheon meat, egg salad, vegetable salads)
  • Ham (high salt)
  • Milk and dairy products

Transmission in Foods

  • Humans are primary reservoir
  • Hands
  • Droplets of saliva (coughing, sneezing near food)
  • Tasting foods (spoons)

Prevention

  • No bare hand contact
  • Employees with cuts
  • Handwashing
  • Reuse “tasting” spoons
  • Danger zone

People are the prime source of Staph.

  • Healthy adults carry Staph in their noses and skin.
  • Foodhandlers must be conscious of what they touch and to wash hands frequently.

Clostridium botulinum

  • Anaerobic, spore-forming
  • Foodborne intoxication
  • Improperly heated processed foods (especially home canned)
  • Produces a neurotoxin
  • Not heat stable

Symptoms and Onset Time

  • Fatigue, headaches, dizziness
  • Inability to swallow
  • Respiratory paralysis
  • Onset time 12-36 hours
  • Several days - year

Common Foods

  • Low acid foods (pH 4.6), inadequately heat processed, packaged anaerobically (canned or vacuum pouch)
  • Held in the danger zone

  • Sautéed onions, Patty Melt sandwich (Illinois)
  • 28 victims (1 died)
  • Louisiana – foiled wrapped baked potato
  • Left out overnight

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Infant botulism – honey or pacifiers dipped in honey.

Transmission

Ingestion of food that were not heat processed correctly and packaged anaerobically.

Canned Foods

  • Swollen ends
  • Leaks and flawed seals
  • Rust
  • Dents

Foodborne Disease

Viruses

What are viruses?

  • not a bacterium
  • not an independently-living organism
  • cannot survive in the absence of a living cell within which to synthesize copies of itself (replicate).

  • Unlike living organisms, cannot reproduce independently
  • But like living organisms, can reproduce.

  • Has some fundamental information which allows it to make copies of itself.
  • Must be inside a living cell

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A virus is not strictly alive.. nor is it strictly dead..

Even though the smallest viruses are only about one-millionth of an inch long, they live up to their Latin namesake—poison.

Foodborne Illness Caused by Viruses

  • Smaller than bacteria
  • Require a living host
  • Do not reproduce or grow in foods

Percentage of Foodborne Illness Attributable to Known Pathogens

Mead et al., 1999

  • Usually transferred from one food to another from food handler or contaminated water supply.
  • PHF not needed to support survival
  • RTE foods most frequently associated with viral infection.

  • Viruses usually have a tough outer covering.
  • Can survive on surfaces for several seconds up to a couple of days.

Viruses also are more likely to remain dangerous on hard or non-porous surfaces than if they are on porous surfaces.

3 Viruses

  • Hepatitis A
  • Norwalk virus
  • Rotavirus

Handwashing is the key!

Hepatitis A

  • Viral infection
  • Causes a liver disease (infectious)
  • Food worker can harbor disease for up to 6 weeks w/o symptoms
  • Food workers are infectious one week before onset of symptoms

Hepatitis A continues to be one of the most frequently reported vaccine-preventable diseases in the United States. 

From 1980 through 2001, an average of 25,000 cases each year were reported to the Centers for Disease Control and Prevention (CDC)

However…

  • Underreporting
  • Asymptomatic infections
  • Estimated average of 263,000 HAV infections occurred per year

The 411

  • Liver disease caused by the hepatitis A virus.
  • Can affect anyone.
  • Can occur in situations ranging from isolated cases of disease to widespread epidemics.

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In the United States

  • Good personal hygiene and proper sanitation can help prevent hepatitis A.
  • Vaccines- for long-term prevention of hepatitis A virus infection in persons 12 months of age and older.

Symptoms and Onset Time

  • Fever, nausea, vomiting, abdominal pain, fatigue
  • Swelling of liver, jaundice (yellow skin)
  • Onset time: 15-50 days
  • Last several weeks – several months

Common Foods

  • infected food worker preparing salads
  • lunch meats, salad bar items
  • sandwiches, bakery items.

Raw oysters, clams harvested from polluted waters.

Raw vegetables irrigated or washed with contaminated water.

Transmission in Foods

Ingestion of food and water that contains the Hepatitis A virus.

  • …has been traced to diversed foods (donuts, strawberry sauce, sandwiches, salads.
  • Virus shed in urine, feces (poor personal hygiene)

Can lead to liver damage.

HAV contamination of a food product can occur at any point during cultivation, harvesting, processing, distribution, or preparation.

The source of most reported foodborne hepatitis A outbreaks has been HAV-infected food handlers present at the point of sale (such as in a restaurant) or who prepare food for social events (such as a wedding).

A single HAV infected food handler can transmit HAV to dozens or even hundreds of persons and cause a substantial economic burden to public health.

In Da’ News…..Transmission during growing, harvesting, processing, or distribution.

HAV-contaminated frozen strawberries were implicated as the source of an outbreak involving at least 262 persons in 5 states.

HAV-contaminated shellfish

Factors

Inappropriate or illegal shellfish harvesting near known sources of sewage.

Inappropriate discharge of sewage from fishing boats or oil platforms near shellfish beds.

Fecally contaminated water & harvested live shellfish.

Prevention

  • Handle foods properly
  • Cooked to proper temperature
  • Avoid eating raw seafood
  • Wash hands and fingernails thoroughly after using the toilet.

Mandating proof of vaccination for food handlers or offering tax credits for food service operators who provide hepatitis A vaccine to employees have been implemented in some areas.

Also need to…

  • Encourage ill foodhandlers to seek medical attention and to stay out of the workplace.
  • Exclusion from duties that involve contact with food for at least 1–2 weeks after the onset of jaundice or until symptoms resolve is reasonable.

Providing sanitary facilities for field workers and discouraging the presence of children in areas where food is harvested reduces the potential for contamination of food during harvesting or processing.

Chlorinated water or water from a source not likely to be contaminated by sewage should be used for rinsing produce or ice used for packing.

However

Other than thorough cooking, no reliable disinfection method for shellfish exists.

Reducing HAV contamination of foods should be possible using approaches, such as Hazard Analysis and Critical Control Point (HACCP) systems.

Haccp

HAZARD ANALYSIS CRITICAL CONTROL POINTS

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Hazards – chemical, physical, biological

Analysis – see what’s causing the hazard

The Flow of Food

RECEIVING

STORAGE

PREPARING

COOKING

RE-HEATING

COOLING

SERVING

HOT HOLDING

Handwashing is critical

Handwashing 101

Wet Hands

Apply Soap

Rub Hands for 20 sec.

Rinse Well

Open Door w/towel

Turn off w/paper towel

Dry with Paper Towel

Norwalk Virus

  • Viral infection
  • Viruses of the Norwalk type are now classified as noroviruses.

In Da’ News..

  • Large outbreaks of gastroenteritis which occurred in Pennsylvania and Delaware in 1987 were caused by Norwalk virus.
  • A contaminated well was the source of both outbreaks.

In Pennsylvania, the ice was used at a football game and at a cocktail party in Delaware.

Symptoms and Onset Time

  • Nausea, vomiting, diarrhea, abdominal pain
  • Headache, low grade fever
  • Onset : 24-48 hours
  • 1-3 days

Common Foods

  • Sewage contaminated water
  • Shellfish
  • Raw clams or oysters
  • Food handled by ill food handlers

Transmission in Foods

Ingestion of food and water that has been contaminated with feces that contain the Norwalk virus.

Prevention

  • Potable water
  • Proper cooking
  • Proper handling
  • Avoid raw seafood

Pathogens with Extremely Low Infectious Dose

Hepatitis A virus ~ 10 or less viral particles

Norovirus ~ 10 to 100 viral particles

EHEC is as low as 10 bacterial cells

Shigella spp. can be as low as 10 bacterial cells

S.Typhi is considered low ~ 1000 bacterial cells

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Potential Transmission Level Norovirus

Shed in the feces at levels up to 10,000,000 viral particles per gram of feces.

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  • One projectile vomiting incident can potentially contaminate the environment with 30,000,000 viral particles
  • Infectious dose of NoV is estimated from 10-100 viral particles

Transmission of Norovirus

  • Fecal-Oral Route
  • Airborne Inhalation
  • Person-to-Person
  • Environment-to-Person

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Norwalk Virus

  • 1st recognized in a school outbreak in Norwalk, Ohio. (1968)
  • Water was suspected.

Cake frosting and salads, as well as drinking water, have been implicated as a common source of viral infection in several outbreaks.

Norwalk and Norwalk-like viruses also are referred to as "noroviruses." infection symptoms include nausea, vomiting, diarrhea and abdominal cramps.

NV vs. Duke University & Florida State Football Teams . . . Norovirus Won

  • 9/18/98: Duke Univ. football team ate turkey sandwiches prepared by ill food employee
  • 9/19/98: Duke team players - suddenly ill during game, w/ vomiting & diarrhea; continued to play

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College football players sick with food poisoning transmitted the virus to the opposing team on the gridiron in the first documented case of its kind in sports. The Duke University team started vomiting in the locker room and on the sidelines during the Sept. 19,1998 game against Florida State. Duke lost the game 62-13, but got their revenge when the virus crossed the line of scrimmage. The only contact between the 2 teams was on the playing field. The virus was passed by people touching each other’s contaminated hands, uniforms and the football. Game films showed ill Duke players with vomit on their jerseys colliding with Florida State players on the field, and Duke players wiping their mouthpieces on their hands, then touching opponents’ faces and later shaking their hands. Many players and staff were ill by game time, approximately one day after eating turkey sandwiches in a box lunch, from a deli that were prepared by an ill or infected food preparer. By the middle of the second quarter, several players, including three of the defensive starters were on IVs in the locker room. 43 of the Duke players and staff who ate the turkey, or 62% got ill. They transmitted it to 11 other Duke personnel who had not eaten the sandwiches and to 11 Florida State players on the Offensive line. All ill players on the Duke Team and Florida State team, and the food preparer had the same genotype I NV strain, which is rare in the U.S., and more commonly found in Europe.

NV crossed the line of scrimmage

  • Transferred via football & player’s hands
  • 11 FSU players became sick
  • 1st documented case of person-to-person transmission of NV at sports event

  • In most people, the illness lasts for about one or two days. People with norovirus illness are contagious from the moment they begin feeling sick until at least three days after they recover.
  • Infection can be more severe in young children and elderly people. Dehydration can occur rapidly and may require medical treatment or hospitalization.

 

Some people may be contagious for even longer, she added.

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Rotavirus

  • Viral infection
  • Rotavirus gastroenteritis
  • Lead cause of severe diarrhea among infants and children.

  • When a Rotavirus infects a human being it affects the cells in the digestive tract causing severe diarrhea.
  • Pediatric diarrhea caused by this Rotavirus is directly responsible for the death of 1 million children around the world.

  • Rotavirus is very easy to catch.
  • Large amounts of rotavirus are shed in the stool.

Remember… viruses

  • Do not multiply in food.
  • Small infectious dose
  • Poor personal hygiene
  • Sewage polluted water

  • Need a living cell to reproduce
  • Do not require PHF to get around
  • Some survive freezing and boiling

GOOD PERSONLAL HYGIENE it the best prevention against viruses!

The Inn

Check Bb!

Wash Yo’ Hands!!

Viruses

67%

Protozoa

3%

Bacteria

30%