Download Foodborne Poisoning

FOODBORNE
ILLNESS
(What you can’t see can harm you)
Anthony Gatt
MD, Dip IMC RCS (Ed), MSc, MMCFD
24 November 2014
Directorate of Health Promotion and Disease Prevention
1
Definition
AKA – foodborne disease; food poisoning
WHO Definition:
Foodborne illnesses are diseases usually
either infectious or toxic in nature, caused by
agents that enter the body through the
ingestion of food.
2
What is foodborne illness?
Illness resulting from the consumption of
contaminated food or water.
Contamination can be due to unnatural
chemical or natural toxins, or infectious
pathogens (bacteria, viruses, parasites).
Contamination can occur before, during,
and after food preparation.
3
The Food Chain
POINT of PURCHASE
or CONSUMPTION
Delis
Cafeterias
Take away
Restaurants
Grocery store
Consumer
Transportation
Agriculture
Processing
Packaging
Slaughter
Pasteurisation
Washing produce
Canning
Storage
Warehousing
Repacking
Reprocessing
Movement of ingredients and food products across borders
4
How Many Types Are There?
There are more than 250 known foodborne
illnesses types (more likely to exist).
5
Types of foodborne pathogens
General: bacterial – viral – parasites –
‘chemical’
Bacteria:
Campylobacter
Salmonella
Escherichia coli
Shigella
Listeria
Yersinia
Brucellosis
Vibrio cholera
6
Other foodborne pathogens
Viruses
Norovirus
Enteroviruses
Rotavirus
Hepatitis A
Parasites:
Giardia lamblia; Amoeba histolytica
Chemical
Exotoxins: Clostridium botulinum; Clostridium perfringens; Staphylococcus
aureus; Bacillus cereus
Natural: scombrotoxic, mushroom poison
Man made: melamine
Prions
7
Most Common causes of Foodborne Illness
Those caused by the bacteria:
Campylobacter
Salmonella
E. coli O157:H7
Those caused by a group of viruses:
Noroviruses, Enteroviruses
8
Symptoms of gastroenteritis
Nausea
Vomiting
Abdominal pain
Diarrhoea
watery
greenish
blood stained
Myalgia
Arthralgia
Headache
Fever
Rigors
Prostration
9
Infectious versus toxic FBI
Infectious FBI
Incubation period long
e.g. -Campy – 1-10 days
-Salm – 6-72 hrs
-Hep A – 21-50 days
Constitutional symptoms may be
severe
Fever usual & may be high
Hospitalization likely
Illness may take days
Symptoms: D, N, V, ABD pain,
H, Rigors, Myalgia/arthralgia
Toxic FBI
Short IP – hours
e.g: -Histamine FBI – 30mins
-Staph. aureus Toxin – 2-6 hrs
Constitutional symptoms not severe
Fever unlikely
Hospitalization v. rare
Short lasting (hours)
Vomiting or rash the commonest
10
Sources
Unsafe food practices (all pathogens)
Raw meats that have become contaminated with animal waste
(all pathogens especially E. coli O157)
Improperly cooked meats especially poultry (Salm; Campy)
Undercooked or raw eggs (Salm)
Food left at improper temperatures for too long (Staph toxin)
Break in the cold chain
Cross contamination at any stage of food chain or food
preparation
Infected food handlers (Hep A, Norovirus)
Poor food handling practices
Animals, pets & reptiles
11
Number of Foodborne outbreaks in 2012 - 28 (yearly mean – 27)
Foodborne outbreaks in Malta according to source in 2012
Take away
11%
Supermarket
2%
Hotel
2%
Canteen
2%
Household
27%
Restaurant
26%
School
2%
NK
28%
12
NB This slide refers to all types of foodborne illness
Antibiotic use for FBI
Usually not necessary
Most community gastroenteritis is viral
Most resolve spontaneously within 5-7days or less
Rx symptomatically
Ab* Rx for those who are toxic/hospitalised/those at risk
E.coli O157: Certainly not indicated- may ↑ risk of HUS**
Increasing antibiotic resistance
Antibiogram to guide Rx
*Ab = Antibiotic **Haemolytic Uraemic Syndrome
13
People with a higher risk for
foodborne illness include ...
14
Infants
15
Pregnant women
16
Children & the elderly
17
Immunocompromised persons
18
Why surveillance & OB investigations
SURVEILLANCE
Considerable morbidity & potential mortality
Follow trends
Evaluate intervention programmes
OUTBREAKS
Stop outbreak
Understand what happened and why
Prevent future outbreaks
Improve our knowledge
Improve surveillance and outbreak detection
Learn epidemiology by doing so
19
Surveillance
Campylobacteriosis
Salmonellosis non-typhoidal
Salmonellosis typhi
Giardiasis
Shigellosis
Escherichia coli (e.g. E. coli O157)
Yersiniosis
Listeriosis
Hepatitis A
vCJD
Botulism
Brucellosis
Cholera
Reporting to ECDC
20
Notifications
Form:
Snail post
E-mail
SMS
Fax
Phone
Word of mouth
Media
21
Maltese law
Statutory obligations to notify FBI
Doctors (Public Health Act 2003)
Suspected cases including outbreaks
Confirmed cases including outbreaks
Laboratories (Medical & Kindred Professions Ordinance)
22
Investigation of notified cases
History
Stool c/s ± viral studies
OB:
Epidemiological studies + statistical analysis
Environmental health and PH lab:
Inspections; risk assessment
Food/environmental sampling
Follow up
Legal action (±)
Veterinary services investigations
23
Who is at risk?
EVERYONE
Industrialised countries: 30% of the
population suffers from FBI/year
Important cause of preventable morbidity &
mortality
Important public health problem
Changing epidemiology
Globalisation
24
International burden of foodborne disease
In the USA*
48 million become ill/year
128,000 hospitalized/year
3000 die/year
European Union (2010) [confirmed cases]**
99,020 Salmonellosis
212,064 Campylobacteriosis
Malta (2013)
Salmonellosis – 85 confirmed cases – estimated 2013 sum = 3230
Campylobacteriosis – 245 confirmed cases – estimated 2013 sum = 9310
*http://www.cdc.gov/foodborneburden/; 2014 reports.
**The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2010;
25
http://www.efsa.europa.eu/en/efsajournal/pub/2597.htm
Reported zoonotic rates - confirmed human cases in the EU, 2008
Rabies
4
TB (M. bovis)
107
Brucellosis
619
Trichinellosis
670
Echinococcosis
981
Listeriosis
1,381
Q fever
1,594
VTEC
3,159
Yersiniosis
8,346
Salmonellosis
131,468
Campylobacteriosis
190,566
0
5
10
15
20
25
Rates/ 100,000 population
30
35
40
45
26
Salmonellosis disease burden
It constitutes a major public health burden and
represents a significant cost in many countries
(WHO).
E.g. Denmark: the annual estimated cost of
foodborne salmonellosis is US$ 15.5 million (2001).
Complications: Reactive Arthritis
(rate: 2-15%)
Irritable Bowel Syndrome
Bacteraemia
Osteomyelitis
Infective arthritis
27
Campylobacteriosis disease burden
Campylobacter bacteria are a major cause of foodborne
diarrhoeal illness in humans and are the most common
bacteria that cause gastroenteritis worldwide (WHO).
Cost in Europe/ human case estimated at
>€69 – >€97
UK: Total cost estimated at almost €1billion each year
Complications e.g. Guillain-Barré Syndrome
Reactive arthritis
28
Determining scale of disease
Notified
Culture
confirmation
Stool specimen
Person seeks care
Person becomes ill
29
Incidence rates of Salmonella/Campylobacter in Malta 1990-2012
Campylobacter
Salmonella
Incidence rate/100,000 population
70
60
50
40
30
20
10
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
30
Salmonella in Malta 2007-2011
distribution with age
80
2007
2008
2009
2010
2011
70
No. of cases
60
50
40
30
20
10
0
0-5
6-14
15-24 25-34 35-44 45-54 55-64 65-74 75-84
Age groups
>85
NK
31
Prevention
32
Enjoy your food
33