Download ENVR 191

Food Safety and Foodborne
Disease
ENVR 890-2
Mark D. Sobsey
Spring 2009
WHO Definition of Foodborne Illness
• Foodborne illnesses are defined as
diseases, usually either infectious or
toxic in nature, caused by agents that
enter the body through the ingestion of
food.
– Every person is at risk of foodborne illness.
Magnitude of Foodborne Illness
• A widespread and growing public health problem in developed
and developing countries.
• Global incidence of foodborne disease is difficult to estimate
• In 2005 1.8 million people died from diarrhoeal diseases.
– A great proportion of these cases can be attributed to
contamination of food and drinking water
• Diarrhea is also a major cause of malnutrition in infants and
young children
• Industrialized countries: %age of population suffering from
foodborne diseases each year estimated to be up to 30%.
– USA: ca. 76 million cases/yr
– Resulting in 325,000 hospitalizations and 5,000 deaths
per year
Magnitude of Foodborne Disease
• Developing countries bear the greatest burden:
– Presence of a wide range of foodborne diseases,
• including those caused by parasites
– High prevalence of diarrheal diseases,
• suggests major underlying food safety problems.
• Most foodborne diseases are sporadic and often not
reported
• Foodborne disease outbreaks may take on massive
proportions.
• Examples:
– USA: 1994 outbreak of salmonellosis due to
contaminated ice cream affected ca. 224,000
persons.
– China: 1988 outbreak of hepatitis A from
consumption of contaminated clams affected ca.
300,000 people
Emerging Foodborne Diseases: Why they Emerge
• Increase in international travel and trade
• Microbial adaptation and changes in the food production
system
• Changing human demographics and behaviur:
• The globalization of the food supply
– cyclosporiasis in USA in 1996-7 linked to raspberries
from South America.
• The inadvertant introduction of pathogens into new
geographic areas:
– Vibrio cholerae introduced into waters off coast of South
America in 1991.
• Travellers, refugees, and immigrants exposed to unfamiliar
foodborne hazards while abroad:
Emerging Foodborne Diseases: Why they Emerge
• Changes in microorganisms:
– New virulent strains in old pathogens, antibiotic resistance,
new zoonoses
• Change in the human population:
– Ageing, malnutrition, HIV infections, other underlying health
conditions
– In developing countries reduced immunity due to poor
nutrition of children
• Changes in lifestyle
– eating meals prepared in restaurants, canteens, fast food
outlets, and by street food vendors.
– Lack of effective food safety education and control.
– Unhygienic preparation of food
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Foodborne Bacteria
Salmonella spp.
Clostridium botulinum
• Enterovirulent
Staphylococcus aureus
Escherichia coli Group
Campylobacter jejuni
(EEC Group)
Yersinia enterocolitica and Y.
• Escherichia coli pseudotuberculosis
enterotoxigenic (ETEC)
Listeria monocytogenes
• Escherichia coli Vibrio cholerae O1, non-O1
enteropathogenic
V. parahaemolyticus; V. spp.
(EPEC)
Vibrio vulnificus
Clostridium perfringens
• Escherichia coli
Bacillus cereus
O157:H7
Aeromonas hydrophila and spp.
enterohemorrhagic
Plesiomonas shigelloides
(EHEC)
Shigella spp.
• Escherichia coli Streptococcus
enteroinvasive (EIEC)
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
•
•
•
•
•
Noroviruses – the most prevalent foodborne viruses
Hepatitis A virus
Hepatitis E virus
Rotaviruses
Other viral agents
Prions:
Spongioform Encephalopathic Agents
“Mad Cow Disease” Agent; Creutzfeldt-Jacob
Disease Agent; Scrapie in sheep, etc.
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
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
Foodborne Enteric Microbial Contamination Sources:
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
• 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
• 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
• 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
Hazard Analysis/Critical Control Points (HACCP)
A program of process control to (1) identify microbial
hazards, (2) identify the most vulnerable (critical) sites
or steps in the process and (3) implement an in-house
monitoring system for quality assurance and hygiene.
Incorporates elements of:
(i) education and training,
(ii) ingredient or commodity control,
(iii) process control,
(iv) inspection, and
(v) microbiological and related surveys
Design and implement on a commodity-specific and production
facility-specific basis
Methods to Control Fecal Contamination of Foods
• Prevent exposure to fecal contamination in the environment, after
harvest or during processing, preparation and handling
• Maintain sanitation in the environment:
– harvest shellfish only from waters that are not fecally contaminated;
– irrigate fruits and vegetables with non-fecally contaminated water.
– fertilize fruits and vegetables with uncontaminated fertilizers.
• Maintain uninfected herds and flocks of animals
– Immunize animals against infectious diseases:
• Brucella abortus: brucellosis from cattle; raw milk/dairy products
– Colonize animals with harmless microflora:
• Colonize baby chicks with harmless bacteria competitive to Salmonella
– Destroy animals harboring pathogens:
• Bovine Spongiform Encephalopathy (BSE; “mad cow” disease);
– Caused by a prion able to infect humans (neural tissue in meat)
Methods to Control Fecal Contamination of Foods - II
• Maintain adequate hygiene and sanitation during harvest,
processing, storage and distribution.
• Source control: use of non-fecally contaminated foods and
ingredients;
• Use clean water for washing, processing, cleaning and worker
hygiene;
• Adequate human and food waste treatment and disposal
facilities
• Plant and equipment sanitation: clean, sanitize, etc.
• Personal hygiene, food handling practices and employee health
(education, training and policies).
• Criteria and standards and guidelines for fecal contamination
(pathogens and microbial indicators).
• Inspection, monitoring and surveillance (product testing)
Methods to Control Fecal Contamination of Foods
• Prevention: keep enteric microbes out
• Remove enteric microbes:
– identify and remove contaminated food items and ingredients
– wash to remove contaminants filtration or other physical
separation methods
– depurate or relay live shellfish.
• Use of heat
– sterilize
– disinfect (e.g., pasteurize and cook to destroy pathogens
• Use of cold and freezing
– cold storage and freezing to prevent proliferation
• Drying, dehydration and intermediate-moisture processing
• Chemical treatments: disinfect and sanitize
• Irradiation: UV and gamma (ionizing) radiation
Heat and Thermal Treatment
• Effects of heat vary with:
– food composition: water, fat, proteins, carbohydrates, salts and pH
– organism factors: form, composition, growth stage, age, etc.
• Sterilize (or nearly sterilize) foods (destroys all viable microbes)
– Heat >100oC; usually uses high pressure and steam;
– Typical target temperature is 115-116oC for about 60 minutes.
• Example: Retorting of Canned Foods.
• Pasteurization:
– Intended to kill pathogens;
– Does not sterilize the food;
– Often used prior to subsequent cold storage so pathogens or
spoilage organisms do not proliferate.
• High Temperature-Short Time Method: 72oC; 15 sec. (milk)
• Low Temperature-Long Time Method: 62.8oC for 30 min.(milk)
– Pasteurization times and temperatures for other foods depend on the
effects of heat on the food, food composition and the target
organisms of interest.
Thermal Destruction of Microbes:
Thermal Death Time and D Value
– Assumes first-order
(exponential; log-linear)
destruction kinetics
100-----
Survivors (%)
• Thermal Death Time (TDT):
time needed to kill a specified
number of organisms at a
specified temperature.
• D value: time needed to
destroy 90% or 1 log10 of
organisms at a specified
temperature
10------------------1--
D value
Time (min.)
Drying, Dehydration and Desiccation
• Low moisture foods: usually <15% moisture
• Intermediate moisture foods (IMF): 15-50% moisture
– fruits, cakes, syrups, candies, jams, milks, some meats and cheeses
•
•
•
•
Sun (natural) drying: often used for fruits
Heat drying (dehydration; desiccation)
Freeze drying (lyophilization; cryophilization)
Condensing or evaporating: reducing moisture in a liquid
food; e.g., evaporated or sweetened condensed milk.
• Drying destroys some enteric microbes but is not very
effective for others.
– Inhibitors are often used for dried and IMF foods:
• ex.: potassium sorbate and calcium propionate as fungistats
Chemical Treatments
• Preservatives:
–
–
–
–
–
–
–
–
Most are ineffective against viruses and protozoan cysts
most are designed to control certain bacteria and molds.
propionates, sorbates, benzoates and p-hydroxybenzoates: molds
Nitrates and nitrites (ex., for Clostridia.)
Sulfur dioxide and sulfites
Acetic, lactic and other organic acids
NaCl and sugars
Ethylene and propylene oxides
• Disinfectants and sanitizers:
–
–
–
–
Used to treat (by washing or dipping) certain meats and produce
Chlorine, peroxyacetic acid, ozone, hydrogen peroxide
10s to 100s of mg/l; contact times of seconds to minutes
Organic acids (acetic, lactic and citric) at 2-7%; less effective
Food Irradiation
• Ionizing Radiation (X-rays and gamma rays)
– Becoming more widely used.
• Gamma radiation from Co-60 and Cs-137 sources)
– Effectiveness depends on: organism, composition of the food,
temperature, and presence of oxygen
• Undesirable changes in foods from excessive radiation: radiolysis of
water and other chemical reactions on amino acids, etc..
– Doses(approximate) to inactivate 1 log10 of organisms:
• vegetative bacteria: 100-200 Krad
• viruses: 500 Krad
• Cysts and Spores: 500 Krad
• UV Radiation:
– Low (monochromatic 254 nm) mad medium (polychromatic)
– Used primarily for beverages: water, juices, ciders, etc.
Shellfish Sanitation:
Monitoring Fecal Contamination in
• Harvest waters undergo “shoreline survey”
– sanitary inspection for fecal sources
• Harvest waters and shellfish are monitored for
bacterial indicators of fecal contamination
– Total or fecal coliforms or E. coli
• Current bacterial indicators of shellfish microbial
quality do not adequately predict the presence
and risks of viral contamination of bivalves or
their harvest waters
– Viruses have been detected in approved shellfish
and harvest waters
– Viral outbreaks have been detected in approved
shellfish and harvest waters
Shellfish Depuration and Relaying
• Place live bivalve mollusks shellfish in clean flowing seawater
– Normal pumping, feeding and related activity rids accumulated
microbes
• Relaying:
– transfer shellfish from contaminated (restricted) waters to
uncontaminated natural estuarine waters.
– Typical holding times in the clean water are two weeks or longer.
• Depuration:
– Place restricted shellfish in shore-based tanks of clean, flowing
seawater under controlled conditions for periods of several days
– Factors influencing deputation efficiency:
• tank geometry and loading (quantity of shellfish per volume of tank),
• water quality
• temperature
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.
Regularly Clean the Kitchen and Other Food
Preparation Areas to Reduce Risks of Crosscontamination and Foodborne illness
• ?Use antibacterial products for added protection
in the kitchen to prevent foodborne illness?
• Wash hands thoroughly
• Clean and sanitize all surfaces frequently
Hands Spread Foodborne Pathogens
from the Food to Other Places
•
•
•
•
•
•
•
•
•
refrigerator
door handles
hot and cold sink faucets,
dishcloths,
counter-tops,
stove knobs
high chairs
appliances
etc.
Sponges Versus Paper Towels
• Foodborne bacteria can multiply quickly in
kitchen towels, sponges and cloths.
• Wash sponges and cloth items in the washing
machine or dishwasher frequently to reduce
bacteria levels.
– For quick treatment, microwave them till very
hot to reduce bacteria levels
• Paper towels reduce cross-contamination risks
– they are disposable, so they less readily spread
bacteria if discarded after a single use
Cutting Boards: Plastic or Wood
• Plastic cutting boards:
– less porous
– absorb and retain less bacteria than porous wood
• Wood cutting boards
– more porous
– absorb more bacteria, but may actually be antibacterial
• After meal preparation, wash cutting board with soap and
water and then clean with an antibacterial cleaner or bleach
and water mixture.
– Always follow the product label's directions.
• Plastic and solid wood cutting boards are dishwasher safe.
Reducing Foodborne Illness Risks in
Food Shopping
• Shop only at reputable stores.
• Check expiration dates of meats, dairy products, etc.
• Select canned foods free of dents and cracks
– (bulging lids and cans indicate a food poisoning threat).
• Avoid cross-contamination in your shopping cart
– do not allow raw meat, poultry or seafood juice to drip
on to your other groceries.
• Buy perishables last and keep them in the coolest part of
your car.
• Refrigerate or freeze promptly upon arrival at home.
Keeping Foods Clean
•
•
•
•
•
•
•
•
•
•
Work with clean hands, hair, fingernails, and clothing.
Wash hands with soap and water after using the toilet
Wash hands after smoking or blowing your nose
Wash hands after touching raw meats, poultry & seafoods
Avoid using hands to mix foods; use clean utensils
Keep hands away from mouth, nose, and hair.
Cover coughs and sneezes with disposable tissues and
wash hands thoroughly afterward.
Avoid using the same spoon more than once for tasting food
while preparing, cooking, or serving.
Clean all dishes, utensils, and work surfaces with soap and
water after each use esp. if used for raw food
Treat utensils and work surfaces with a solution of 1
tablespoon (about 1 capful) of chlorine laundry bleach to 1
gallon of cool water.
Salmonella Infection
• Causes an estimated 1.4 million foodborne
illnesses/year
• From 1993-1997, only 189,304 Salmonella infections
(~38,00/year) reported through the National
Salmonella Surveillance System
– a passive, laboratory-based system.
• In the same period, 357 recognized outbreaks of
Salmonella infection resulting in 32,610 illnesses
were reported through the Foodborne-Disease
Outbreak Surveillance System.
• These system greatly underestimate the burden of
foodborne disease.
4 Steps to
Preventing Foodborne Illness
•
•
•
•
Clean: Wash hands and surfaces often
Separate: Don't cross-contaminate
Cook: Cook to proper temperatures
Chill: Refrigerate promptly
Cool
Refrigerate/Freeze
•
•
•
•
•
•
Refrigerate uncooked foods
Stored cooked foods in refrigerator
Defrost frozen foods in refrigerator
Set refrigerator for 40-41oF (18oC)
Use uncooked or cooked foods in 1-4 days
Use frozen foods in 1-4 months, depending on food
Wash
• Wash hands before preparing food and after
handling raw meat, poultry and fish
• Wash hands after using toilet
• Wash cutting boards, utensils and other items in
contact with raw meat and poultry
– use hot, soapy water
• Prevent meat, poultry or its juices from touching
other foods or other objects
• Wash fresh produce with water or with dilute bleach
in water.
• Keep inside of refrigerator clean
Cook
• Cook meat and poultry until no longer ping and
juices are clear
• Cook fish until flaky, not rubbery when cutting
• Cook evenly: turn, rotate and/or stir
• Cook to safe internal temperatures
– Meat and poultry: 165 oF
• Refrigerate cooked leftovers immediately
• Reheat all leftovers covered at 165 oF or more
• Cook eggs until white and yolk are solid, not runny
• Avoid foods containing raw eggs: cookie dough,
cake batter, etc.
Protect Against Foodborne Illness by Following
these Food Safety Rules :
• Buy pasteurized dairy products (see label) & hard cheeses marked
"aged 60 days" (or longer) if made from unpasteurized milk
• After handling or cutting raw meat, poultry or seafood, wash your
hands, the cutting board, counter, knives, and any other utensils
you've used with hot soapy water before using again.
• Thoroughly cook meat, poultry and seafood, esp. shellfish.
• Cover and store leftover cooked food in refrigerator ASAP.
• Reheat all leftovers until steaming hot.
• Thoroughly wash raw fruits and vegetables with tap water.
• Follow label instructions on products that must be refrigerated or
that have a "use by" date.
• Keep the inside of the refrigerator and counter tops clean.
Consumer Education and Outreach
Programs in Food Safety
• Government:
– US Department of Agriculture
– US Food and Drug Administration
– UC Centers for Disease Control and Prevention
• Private Sector
• Consumer and Public Interest Groups
• Partnerships and Consortia
– The Partnership for Food Safety Education
Foodborne Disease and Child
Nutrition in the Developing World
Infant Feeding
• Breastfeeding: a basic intervention to protect infants
from infectious disease
• Protects by decreasing exposure to water and
foodborne pathogens
– Bolsters immune defenses
• Breastfeeding reduces diarrheal illness
• Ex: in a case-control study in Brazil, infants <2
months of age who were not breastfed have a 25
times greater risk of dying of diarrhea than those who
are exclusively breastfed
• Consumption of supplemental fluids and foods by
fully breastfed infants greatly increases their risk of
diarrheal illnesses and stunting of growth
Foodborne Disease and Child
Nutrition in the Developing World
Weaning and Weaning Foods
• Infants most vulnerable to diarrhea when weaning begins
• Level of contamination may be higher in weaning foods
than in drinking water
• Weaning foods are probably more important than water
diarrheal disease transmission in developing countries
• Weaning foods often become contaminated with
pathogens when prepared under unhygienic conditions
• Mixed-fed infants have greater diarrhea risks than do fully
breastfed infants
– They are fed supplemental foods such as other types
of milk, formula, juices and/or solids.
– These foods may be prepared with contaminated
water or served in contaminated containers
Increasing Food Safety for Children and
Families in the Developing World - WHO
•
•
•
•
Identifies global food safety as a top priority
Developed a global strategy for food safety
Goal: reduce the health and social burden of foodborne disease
Key elements of the strategy:
– Interdisciplinary and interagency collaboration
– Enhance risk communication advocacy efforts
– Strengthen capacity-building in developing countries
• WHO global strategy for food safety: safer food for better
health.
– http://www.who.int/foodsafety/publications/general/global_strategy/en/
• Food Safety for Nutritionists and Other Health Professionals.
Teacher's Handbook: CD-ROM
– http://www.who.int/foodsafety/publications/capacity/healthworkers_cd/en/index.html
Conceptual framework linking household food
technologies for safe complementary foods and
improving their nutrient content