PowerPoint Presentation

Elaheh SayyadPhD student of Pubic HealthWalden UniversityFoodborne illness- Salmonella April 21, 2013

My name is Elaheh Sayyad and I am a PhD student of public health from Walden university. My presentation is about foodborne illness that cause by Salmonella.1Salmonellosis is an infection with bacteria called Salmonella. Salmonella serotype typhimurium and Salmonella serotype enteritidis are the most common in USA. The infected persons developed:DiarrheaFever and abdominal cramps 12 -72 hours after infection.

Salmonellosis

Salmonellosis is one of the most common foodborne disease that cause by bacteria called salmonella. Salmonella is a gram negative bacteria and the most common types of the Salmonella are typhimurium and enteritidis. Symptoms of Salmonellosis include diarrhea, fever, abdominal cramps between 12-72 hours after infection.2Infected by SalmonellaSalmonella live in the intestinal tracts of humans and animals (such as birds).Human by eating foods contaminated with animal fecesContaminated foods are beef, milk, eggs, and poultry, also vegetables can be contaminated.

Foods can be contaminated by the hands of an infected food handlerSalmonella may also found in the faces of some pets, especially those with diarrhea, and people can become infected after contact with pets or pet feces.

Salmonella live in the intestinal tracts of humans and other animals such as birds. Human can be infected by eating foods that contaminated with animal feces. Contaminated foods are often animal origin such as beef, poultry, milk, and eggs but vegetables and fruits may become contaminated as well. Person to person transmission o salmonella occurs when an infected persons faces, unwashed from hands of the infected person during the food preparation or handling. Salmonella can also be acquired directly from animals such as pets , birds, dogs, etc.3

Our EcosystemThe ecosystem shows that Salmonella can be found in the gut of animals, reptiles, birds and some infected humans, and it can be found in food of animal origin and vegetables (KnowSalmonella, 2008).4Diagnostic TestThe diagnostic laboratory tests that identify salmonella in the stool of an infected person.

Salmonella infection can be detected by testing a sample of the stool of an infected person, but most people have recovered from their symptoms by the time the test results prepare.5

Fig.1.Incidence Rate Per 100,000 Population by Age GroupOverall Salmonella incidence rate in 2010 (17.6 per 100,000 persons)Healthy People 2020 objective (11.4 per 100,000 persons)Healthy People 2010 objective (6.8 per 100,000 persons)

This graph is showing the national laboratory confirmed salmonella incidence rate per 100,000, by age group. I have shown in the three colors as follow; Red one is indicating the incidence rate in 2010, the green color is the Healthy People 2010 objective, and the blue color is the Healthy People 2020 objective.

6Fig.1. The Laboratory confirmed Salmonella incidence rate per 100,000 population , by age group, as compared to the overall incidence rate and the national health objectives for 2010 and 2020, United States (CDC, 2011).The incidence of laboratory confirmed salmonella infection was 17.6 cases per 100,000 persons in 2010 (Red Line).This was more than twice the US Healthy People 2010 objective of 6.8 cases per 100,000 persons (Blue line).

Explanation of Fig.2

As the slide expatiation shows the most infected age are children between age 5-9 and the second age group is 60 years old. The disease burden of Salmonellosis has remained substantial in the United States in spite of ongoing public health and regulatory efforts to prevent and control this infectious disease.7Per CDC the incidence of salmonella infections in 2010 was significantly higher than during 2006-2008 representing an increase of about 10% with the confidence interval of 95%.

Healthy People 2020

Conclusion, the overall incidence of laboratory confirmed salmonella infection was 17.6 cases per 100,000 persons in 2010, which remains higher than the healthy people 2020 objective of 11.4 cases per 100,000 persons (Figure 1)

8In Aug, 2012 the Food and Drug Administration (FDA), and Center of Disease Control and Prevention (CDC) and state health departments began to investigate a multi-state outbreak of salmonellosis. The investigational evidence indicated the cantaloupes from Chamberlain farms in the Indiana.According to the CDC ( 2013) from 24 states was 21 persons infected with Salmonella typhimurium and Salmonella Newport.

A Case of Salmonella

The cantaloupes from Chamberlain farms in the Indiana that cause a deadly Salmonella outbreak that sickened at least 260 people in 24 states last year has been warned by FDA to address insanitary conditions.9Among 94 persons were hospitalized. Three deaths were reported in Kentucky.55% of the patients were femalePer FDA and Indiana State Department of Health regulatory inspection, the outbreak of the salmonella of the Chamberlain farms may due to one of the following conditions: Equipment Design & Packing and Holding

Cont. A Case of Salmonella

Between July Sep 2012, the people that infected by salmonella shows 55% of the patients were female, and 3 deaths were reported in Kentucky. Chamberlain farms recalled all cantaloupes from the marketplace after a joint investigation by State, local and federal public health agencies identified the cantaloupes as the source of a multistate Salmonella outbreak.10Packinghouse and equipment sanitary designPest control/intrusionCleaning and sanitizing practicesWashing and drying the fresh and raw productCooling, Packing , and transportation Packinghouse Area

The packinghouse serve as a collection center for fruits and vegetables prior to distribution and marketing. This is an important operation and as above shown the packinghouse equipment should always be maintained in clean condition.11Equipment Design:Food contact and non- food contact surfaces at the farms packinghouse were constructed of materials that could not be effectively cleaned or sanitized. Specially, carpeting was used as cushioning and wood was used as directional mechanism for conveyances.Multiple locations of the conveyer food contact surfaces used to transport cantaloupe such as rollers and belts were noted to have an accumulation of organic materials and biofilms.

Cont. A Case of Salmonella

The products from the Chamberlain farms may due to one of the following conditions: Equipment Design & Packing and Holding. The products from the Chamberlain farms may due to one of the following conditions: Equipment Design & Packing and Holding. The equipment design as shown in above is an important step at the farms packinghouse procedure.

12Packing and Holding:

1. Witten procedures or records were not available to demonstrate that water used in the cantaloupe packinghouse (such as dump tank and cantaloupe brush washing) was monitored for water disinfectant concentration or pH level to ensure the maintenance of an effective level of wash water disinfectant to prevent product to wash water to product cross contamination.

Cont. A Case of Salmonella

As shown in the above slide, the packing and holding is another step of the farms packinghouse procedure. The procedures of packing and holding for the employees should be a written procedures or records.132. An accumulation of debris including trash, wood, and dirt was observed the conveyer belt in the cantaloupe packinghouse (FDA, 2013).

3. Cantaloupes were not pre-cooled after packing before shipment to retail stores (FDA, 2013)

Cont. A Case of Salmonella

Other procedure at the farms packinghouse procedure includes the accumulation of trash, dirt, etc. and the pre cooling after packing and before shipment. 14Areas of focus for the agricultural production operations included:Agricultural waterSoil amendmentsHarvesting and transporting to the packinghouseAnimal intrusionAdjacent land useEmployee health and hygiene practice

Good Agriculture Practice (GAP)

Good Agricultural Practices (GAP) are specific methods which, when applied to agriculture, create food for consumers or further processing that is safe and wholesome.

15

The Food Production Chain

The above diagram shows the food production chain that include; production, processing, Distribution, Retail or restaurant, home food preparation and restaurant preparation, and home consumers or restaurant consumer.

16Production means growing the plants we harvest or raising the animals we use for food (CDC, 2009). The food comes from domesticated animals and plants, and their production occurs on farms or ranches.Some foods are caught or harvested from the wild, such as some fish, mushrooms, cucumbers, fish vegetables, and chill fruits (CDC, 2009).Example of contamination in production; fish in some tropical reef may acquire a toxin from the smaller sea creatures they eat (CDC, 2009). Cont. The Food Production Chain

The first step of the chain is the production. As described on previous slides the human can contaminated from the both sources animals and plants can be infected. 17Processing means changing plants or animals into buying as food. Processing involves different steps for different kinds of foods (CDC, 2009). Processing can be :Cleaning and sortingRimming , slicing or shredding and bagging.Example of contamination in processing; peanut butter can become contaminated if roasted peanuts are stored in unclean conditions or come into contact with contaminated raw peanuts (CDC, 2009). Cont. The Food Production Chain

The food in the processing part of the chain can be infected as shown in the above slide. 18

Incidence of Salmonella Link to Live Poultry

This slide is showing the incidence of Salmonella due to live poultry from 1990-2011.19As Centers for Disease Control an Prevention (2011) noted that since the 1990s, 45 Salmonella out breaks have been linked to live poultry. During this period 1563 illness has been reported, 221 patients admitted in hospitals, and 5 people deaths (CDC, 2011).Per CDC (2012) the total of 93 persons infected with the outbreak strain of Salmonella montevideo were reported from 23 states and Puerto Rico that linked to live poultry.Cont. Incidence of Salmonella Link to Live Poultry

The previous slide and the above explanation shows the number of the patients that been admitted in the hospitals or deaths that has been reported and the data has been collected by Centers for disease Control and Prevention, and the outbreak strain has been identified by the laboratory confirmation of Salmonella. 20The CDC monitors the frequency of Salmonella infections in the country and assists the local and State health departments in investigating outbreaks and devising control measures (CDC, 2010).CDC monitors the types of Salmonella that are reportedThe Food and Drug Administration (FDA) inspects imported foods, oversees inspection of milk pasteurization plants, and promotes better food preparation techniques in restaurants and food processing plants (CDC, 2010). Government Responsibilities

The CDC data and report has been collected with the assists of the local and States health departments, and FDA.21Hand Washing

When to wash hands ? How to wash hands? Why is this so important? Are very important and is a simple way of prevention of the infectious diseases and also cheaper than treatment. 22Wash hands before starting preparing foodCook poultry until it reaches an internal temperature of 165 FCook beef and pork until they reach 160 FCook egg until they reach 160 F or until the yoke is solidDo not eat or drink foods containing raw eggsDo not drink raw or unpasteurized milkAvoid using the microwave for cooking the foods of animal originPrevention of Salmonella

The main prevention of the Salmonella is personal hygiene, but the temperature of cooking foods , particularly animal origins ,eggs, and milk are very important items. 23Avoid cross contamination. Should not allow foods that not cooked to come into contact with raw foods of animal originWash hands after handling reptiles, amphibians or birdsDo not use an alcohol based (waterless) sanitizer instead of washing the hands when cooking or when hands are visibly soiled.Hands should be washed with soap and clean warm running water for 20 second.Cont. Prevention of Salmonella

Other area of the prevention can be the correct method of hand washing , train the workers in the food processing and restaurants.24Centers for Disease Control and Prevention ( May, 2008). National Center for Emerging and Zoonotic infectious Diseases: Salmonellosis. Retrieved April 10, 2013 from: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/salmonellosis/#whatCenters for Disease Control and Prevention (Jan, 2010). Foodborne Outbreak Investigations. Retrieved April 13, 2013 from: http://www.cdc.gov/outbreaknet/investigations/figure_food_production.htmlReferences

Centers for Disease Control and Prevention (Oct, 2011). Salmonella: New! Learn More About Salmonella. Retrieved April 12, 2013 from: http://www.cdc.gov/salmonella/Centers for Disease Control and Prevention (Dec, 2009).Foodborne Outbreak Investigations: The Food Production Chain- How Food Gets Contaminated. Retrieved May 4, 2013 from:http://www.cdc.gov/outbreaknet/investigations/production_chain.html

References

Centers for Disease Control and Prevention (Sep, 2010). Salmonella: Additional Information. Retrieved April 12, 2013 from: http://www.cdc.gov/salmonella/general/additional.htmlCummings, L. P. , Sorvillo, F. & Kuo, T. (2011). The Burden of Salmonellosis in the United States. Retrieved April 18, 2013 from: http://cdn.intechopen.com/pdfs/26420/InTech-The_burden_of_salmonellosis_in_the_united_states.pdfReferences

Choctaw Nation Health Services (2013). Hand Washing. Retrieved May 11, 2013 from: http://www.cnhsa.com/hand-washing.aspx

KnowSalmonella (2008). Public Health. Retrieved May 12, 2013 from: http://www.knowsalmonella.com/en/foodsafety.html

Mayo Clinic (April, 2011). Salmonella Infection : Prevention. Retrieved April 17, 2013 from: http://www.mayoclinic.com/health/salmonella/DS00926/DSECTION=prevention

References

U.S. Food and Drug Administration (March, 2013). Environmental Assessment: Factors Potentially Contributing to the Contamination of Fresh Whole Cantaloupe Implicated in a Multi-State Outbreak of Salmonellosis. Retrieved April 12, 2013 from: http://www.fda.gov/Food/FoodSafety/FoodborneIllness/ucm341476.htm

References

U.S. Food and Drug Administration (March, 2013). Environmental Assessment: Factors Potentially Contributing to the Contamination of Fresh Whole Cantaloupe Implicated in a Multi-State Outbreak of Salmonellosis. Retrieved April 12, 2013 from: http://www.fda.gov/Food/FoodSafety/FoodborneIllness/ucm341476.htm

References