Foodborne Disease

MADYA ARDI WICAKSONO

AT EITHER END OF ANY FOOD CHAIN YOU FIND A BIOLOGICAL SYSTEM—A PATCH OF SOIL, A HUMAN BODY—AND THE HEALTH OF ONE IS CONNECTED—LITERALLY—TO THE HEALTH OF THE OTHER.

Michael PollanThe Omnivore’s Dilemma, 2006

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Background

• The diet transformed significantly in– What food we eat– How we grow or raise that food– How that food arrives in our tables

• Industry consolidation and globalization• Health concerns and dietary

recommendations• Culinary trends and dining habits

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Dietary changes

• Instant foods• Lifestyle• Culture• Dining habits

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Food products

• Industrialization of food production processing & packaging methods

• Animal feeding & breeding• Agricultural practices pesticides & insecticides• Broadening distributions of food products

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Food product recalls

• Distributors or manufacturers voluntarily recall their food products for either of two reasons:– a problem discovered in the course of routine

inspection of the food or its processing or distribution

– suspicion or identification of the product as the cause of human or animal disease

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Definition

• considered to be any illness that is related to food ingestion

• gastrointestinal tract symptoms are the most common clinical manifestations of foodborneillnesses

• numerous and varied, involving biological and nonbiological agents

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Causes

• Biological agents– Bacteria– Virus– Fungus– Parasite– Biological toxins

• Chemical agents

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Type of agent: BacteriasGeneral mechanism of actions

Example

Preformed toxin Bacillus cereusClostridium botulinumStaphylococcus aureus

Infection and production of enterotoxins

Bacillus cereusClostridium botulinumClostridium perfringensEnterohemorrhagicEscherichia coliEnterotoxigenic E. coli (ETEC)Vibrio cholerae

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Type of agent: BacteriasGeneral mechanism of actions

Example

Infection Bacillus anthracisBrucella spp. (B. melitensis, B. abortus, B. suis) Campylobacter jejuniEnteroinvasive E. coliListeria monocytogenesPlesiomonas shigelloidesSalmonella spp.Shigella spp.Streptococcus pyogenesVibrio parahaemolyticusVibrio vulnificusYersinia enterocolytica and Y. pseudotuberculosis

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Type of agent: VirusesGeneral mechanism of actions

Example

Infection Hepatitis ANorovirus (and other caliciviruses)RotavirusAstroviruses, adenoviruses, parvoviruses

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Type of agent: ParasitesGeneral mechanism of actions

Example

Infection CryptosporidiumCyclospora cayetanensisDiphyllobothrium latumEntamoeba histolyticaGiardia lambliaTaenia saginataTaenia soliumToxoplasma gondiiTrichinella spiralis

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Type of agent: Marine algae toxinsGeneral mechanism of actions

Example

Preformed toxin Brevetoxin (neurotoxicshellfish poisoning)Ciguatoxin (ciguatera)Domoic acid (amnesticshellfish poisoning)Saxitoxin (paralytic shellfish poisoning)

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Type of agent: Fungal toxinsGeneral mechanism of actions

Example

Preformed toxin AflatoxinMushroom toxins (amanitin, ibotenic acid, museinol, muscarine, and psilocybin)

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Type of agent: Fish toxinsGeneral mechanism of actions

Example

Preformed toxin Gempylotoxin (escolar)Scombrotoxin(histamine fish poisoning)Tetrodotoxin (puffer fish)

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Type of agent: Chemicals

AntimonyArsenicCadmiumCopperFluorideLead

MercuryNitritesPesticides (e.g., organophosphates, carbamate)ThalliumTinZinc

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Determining the etiologic agent

• Clues– Predominant signs and symptoms among ill

individuals– Incubation period, if known– Duration of illness, and– Suspected food, if known

• Laboratory confirmation

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Signs, symptoms, incubation period, and duration of illness: toxins

• Preformed toxins bacteria-releasing toxins into food during growth in the food (Staphylococcus aureus, Bacillus cereus, and Clostridium botulinum) ingested live bacteria do not need to be consumed to cause illness

• Illness from a preformed toxin manifests more rapidly time for growth and invasion of the intestinal lining is not required the incubation period: minutes or hours

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Signs, symptoms, incubation period, and duration of illness: toxins

• Signs and symptoms depend on the toxin ingested but commonly include:– Vomiting– Nausea– Diarrhea– Interference with sensory and motor functions, such as

double vision, weakness, respiratory failure, numbness, tingling of the face, and disorientation

– Fever is rarely present.

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Signs, symptoms, incubation period, and duration of illness: infections

• Viruses, bacteria, or parasites invade the intestinal mucosa and/or other tissues, multiply, and directly damage surrounding tissues

• Bacteria and certain viruses invade and multiply in the intestinal tract and then release toxins that damage surrounding tissues or interfere with normal organ or tissue function (enterotoxins)

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Signs, symptoms, incubation period, and duration of illness: infections

• The necessary growth of the microorganism, damage of tissues, and production and release of toxins takes time the incubation periods for infections are relatively long, often days

• The incubation periods for viruses (excluding hepatitis A) tend to be shorter than for bacteria which tend to be shorter than the incubation periods for most parasites.

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Signs, symptoms, incubation period, and duration of illness: infections

• Sign and symptoms of infection usually include:– Diarrhea– Nausea– Vomiting– Abdominal cramps– Fever– Elevated white blood cell count

• Spread to other organs longer duration, increased severity, and signs and symptoms associated with the particular organ affected

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Examples of food items and commonly associated microorganisms

Item Commonly associated microorganism

Raw seafood Vibrio spp., Hepatitis A, Noroviruses

Raw eggs Salmonella (particurlarly serotype Enteritidis)

Undercooked meat or poultry

Salmonella and Campylobacter spp., Shiga toxin-producing Escherichia coli (STEC), Clostridium perfringens

Unpasteurized milk or juice

Salmonella, Campylobacter, and Yersinia spp., ETEC

Unpasteurized soft cheeses

Salmonella, Campylobacter, Yersinia, and Listeria spp., ETEC

Home-made canned Clostridium botulinum 23

Prevention: control of source• Foods associated with food-service

establishments or home processing– Removing food from consumption– Cleaning and sanitizing– Training– Modifying a food-production or food-

preparation process– Modifying the menu– Removing infected food workers– Closing food premises– Communication with the public

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Prevention: control of source

• Foods associated with a processor/producer– Procedures for removing food from the market– Communication with the public– Postrecall reporting by the business

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Prevention: control of secondary transmission

• Information for Health-Care Providers• Information for the Public

– Personal protection from disease outbreak– Proper food preparation

• Exclusion of Infected Persons from Settings Where Transmission Can Occur

• Infection Control Precautions• Prophylaxis

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Prevention: simple recommendations

• Cook meat, poultry and eggs and other raw foods thoroughly

• Separate cooked and uncooked food. Avoid cross-contamination by not using platters or utensils contaminated by raw foods for cooked foods. Put cooked foods on clean platters, not the ones that held the raw meat.

• Chill leftovers promptly. Don't leave food out for more than 4 hours

• Clean produce. Wash hands before preparing food and immediately after handling raw foods.

• Report suspected food borne illness to the local health department.

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Prevention: in an epidemiological setting

• Surveillance system• Hazard Analysis Critical Control Point (HACCP)• Quarantine system

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Tujuan dari surveilans penyakit bawaan makanan

• Menentukan besaran masalah kesehatan masyarakatyang diakibatkan oleh penyakit bawaan makanan, dan memonitor trennya

• Mengindentifikasi wabah penyakit bawaan makananpada tahap awal sehingga tindakan pengobatandapat diberikan tepat pada waktunya

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Tujuan dari surveilans penyakit bawaan makanan

• Menentukan besarnya peranan makananyang bertindak sebagai jalur transmisimikroba patogen yang spesifik, danmengidentifikasi makanan beresiko tinggi, pengolahan makanan yang beresiko tinggidan populasi rawan resiko

• Mengukur efektifitas program untuk meningkatkan keamanan pangan

• Menyediakan informasi untuk perancangankebijakan kesehatan tentang penyakitbawaan makanan (termasuk di dalamnyaadalah perancangan dan penentuanprioritas strategi pencegahan)

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Sources of information for public health surveillance

Public health

surveillance

Human disease

Environmental data

Animal data

Healthcare services data

Population characters

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Burden of illness pyramid reflecting the proportion of foodborne illnesses that make it through each step of the diagnosis and reporting process

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HACCP

• HACCP adalah suatu sistem jaminan mutu yang berdasarkankepada kesadaran bahwa hazard (bahaya) dapat timbul padaberbagai titik atau tahap produksi tertentu, tetapi dapatdilakukan pengendaliannya untuk mengontrol bahaya bahayatersebut. Kunci utama HACCP adalah antisipasi danidentifikasi titik pengawasan yang mengutamakankepada tindakan pencegahan, daripada mengandalkankepada pengujian produk akhir.

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HACCP

• Food safety / keamanan pangan• Wholesomeness / kebersihan• Economic fraud / pemalsuan

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Manfaat HACCP• Menjamin keamanan pangan• Mencegah kasus keracunan pangan• Mencegah/mengurangi terjadinya

kerusakkan produksi atau ketidakamananpangan

• Menjadi standar internasional danpersyaratan wajib pemerintah,

• Memberikan efisiensi manajemen keamanan pangan

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Prinsip HACCP

1. Mengidentifikasi potensi bahaya yang berhubungan denganproduksi pangan pada semua tahapan, mulai dari usaha tani, penanganan, pengolahan di pabrik dan distribusi, sampaikepada titik produk pangan dikonsumsi.

2. Menentukan titik atau tahap prosedur operasional yang dapat dikendalikan untuk menghilangkan bahaya ataumengurangi kemungkinan terjadi bahaya tersebut.

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Prinsip HACCP

3. Menetapkan batas kritis yang harus dicapai untuk menjaminbahwa CCP berada dalam kendali

4. Menetapkan sistem pemantauan pengendalian (monitoring) dari CCP dengan cara pengujian atau pengamatan

5. Menetapkan tindakan perbaikan yang dilaksanakan jika hasilpemantauan menunjukkan bahwa CCP tertentu tidakterkendali

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Prinsip HACCP

6. Menetapkan prosedur verifikasi yang mencakup daripengujian tambahan dan prosedur penyesuaian yang menyatakan bahwa sistem HACCP berjalan efektif

7. Mengembangkan dokumentasi mengenai senua prosedurdan pencatatan yang tepat untuk prinsip-prinsip ini danpenerapannya.

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Quarantine / Karantina

• Dasar peraturan– UU no 18/2009 tentang peternakan dan kesehatan hewan– UU no 16/1992 tentang karantina hewan, ikan, dan

tumbuhan

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Quarantine / Karantina

• Karantina adalah tempat pengasingan dan atau tindakansebagai upaya pencegahan masuk dan tersebarnya hama danpenyakit (termasuk foodborne disease) dari luar negeri, dandari suatu area ke area lain di Indonesia, maupun keluarnyahama dan penyakit dari dalam wilayah negara RepublikIndonesia

• Setiap lalu lintas media pembawa hama penyakit harusmemenuhi persyaratan karantina

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Persyaratan karantina

• Dilengkapi dengan sertifikat kesehatan atau sanitasi

• Melalui tempat yang telah ditetapkan• Dilaporkan dan diserahkan kepada petugas karanti

na untuk dilakukan tindakan karantina• Dapat dikenakan kewajiban tambahan yang

berhubungan dengan sifat penyakit, sesuai kaidahilmu kedokteran hewan

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Pelaksanaan tindakan karantina

• Dilakukan kepada media pembawa hamapenyakit hewan karantina (HPHK)

• HPHK adalah penyakit yang ditetapkan olehmenteri untuk dicegah masuk, keluar dantersebarnya

• Media pembawa HPHK adalah– hewan (misalnya sapi)– bahan asal hewan (misalnya daging, susu, telur)– hasil bahan asal hewan (misalnya bakso, sosis,

keju)

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Tindakan karantina

• Pemeriksaan• Pengasingan• Pengamatan• Perlakuan• Penahanan• Penolakan• Pemusnahan• Pembebasan

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Tempat pelaksanaan

• Negara asal• Tempat pemasukan (pelabuhan, bandara)• Tempat transit• Tempat pengeluaran (pelabuhan, bandara)

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Waktu pelaksanaan

• Saat akan dimasukkan ke dalam wilayah RI (impor)• Saat akan dilalu-lintaskan antar area dalam wilayah RI• Saat akan dikeluarkan ke dalam wilayah RI (ekspor)

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