Upload
ngoque
View
279
Download
1
Embed Size (px)
Citation preview
i
ii
iii
iv
1
2
bakteria,
3
4
5
6
7
8
9
Jika populasi terlalu ramai dan penyiasat tidak
mempunyai cukup anggota untuk melakukan temubual,
pilih sebahagian dari mereka yang ada gejala dan
sebahagian dari yang tidak mengalami sebarang gejala
secara rawak. Langkah ini membolehkan analisa statistik
dibuat mengikut kaedah case control.
Gabungkan hasil analisa dari kajian epidemiologi di atas
dengan penemuan dari ujian makmal dan siasatan
persekitaran untuk merumuskan punca berlakunya
keracunan.
b. Mengambil sampel-sampel klinikal, makanan yang
disyaki, bahan mentah dan sampel lain jika berkaitan
seperti:
spesimen najis
sample muntah
swab rektal
swab peralatan memasak
swab (hidung, tekak, anggota) pengendali makanan
Swab persekitaran (meja, peti ais, kepala paip, effluen
tangki septic dan lain-lain)
PENGAMBILAN SAMPEL KLINIKAL AMAT PENTING kerana
ia boleh memberi petunjuk mengenai jenis patogen penyebab.
Ini kerana, sampel makanan biasanya tidak dapat diperolehi
semasa penyiasatan.
c. Menjalankan pemeriksaan ke atas premis makanan di
mana berlaku kejadian keracunan makanan.
Menganalisa keselamatan makanan menggunakan kaedah
HACCP. Pegawai Teknologi Makanan boleh dipanggil
dalam membantu siasatan.
Menutup premis di bawah Sek 18(1)(d) Akta 342
[Pengawalan dan Pencegahan Penyakit Berjangkit 1988]
atau (seksyen 10 atau 11 Akta Makanan 1983)
Menyita makanan.
Kawalan vektor (LILATI)
d. Pendidikan Kesihatan
Prosedur penyiasatan dan kawalan adalah seperti mana yang
dijelaskan di dalam Garispanduan Umum FWBD/UMU/GP/001
(pindaan2006).
10
11
12
14
Lampiran 2
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Eating unknow
n
va
rie
tie
s o
f
mu
sh
ro
om
s,
mistaking toxic
mu
sh
ro
om
s fo
r
ed
ib
le
va
rie
tie
s
Pu
rch
asin
g
antim
ony conta
ining
utensils, storing high
acid foods in gray
enam
elw
are
Sp
ecim
en
s to
Co
lle
ct
Vom
itus
Vo
mitu
s, sto
ols,
urine
Fo
od
u
su
ally
In
vo
lved
3
Ma
ny va
rie
tie
s
of vild
mu
sh
ro
om
s
High-acid food
and b
evera
ges
Sy
mp
to
ms
a
nd
Sig
ns
Nausea, vom
iting
retching, diarrhea,
ab
do
min
al cra
mp
s
Vo
mitin
g, a
bd
om
in
al
pa
in
, d
ia
rrh
oe
a
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
3 m
in to 2 hours
Few
m
in to
1 hours
Ae
tio
lo
gic
a
ge
nt
an
d so
urce
Po
ssib
ly re
sin
-like
substances in
so
me
m
ush
roo
ms
Antim
ony in gray
enam
elw
are
Dis
ea
se
UP
PE
R G
AS
TR
OIN
TE
ST
IN
AL
, T
RA
CT
S
YM
PT
OM
S A
ND
S
IG
NS
[N
AU
SE
A, V
OM
IT
IN
G] O
CC
UR
F
IR
ST
O
R P
RE
DO
MIN
AT
E
In
cu
ba
tio
n [L
ate
nc
y] P
erio
d U
su
ally
L
es
s th
an
1
h
ou
r
Fu
ng
al A
gen
ts
Gastroin-
testinal
irritating group
mu
sh
ro
om
po
iso
in
in
g
Ch
em
ic
al A
ge
nt
4
Antim
ony
TA
BL
E B
– IL
LN
ES
SE
S A
TT
RIB
UT
ED
T
O F
OO
DS
A C
ON
DE
NS
ED
C
LA
SS
IF
IC
AT
IO
N B
Y S
YM
PT
OM
S, IN
CU
BA
TIO
N P
ER
IO
D, A
ND
T
YP
ES
O
F A
GE
NT
S
1,2
15
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Storing
insecticides in
sam
e areas as
fo
od
s, m
ista
kin
g
pesticides for
po
wd
ere
d fo
od
s
Pu
rcha
sin
g le
ad
containing
ve
sse
ls, sto
rin
g
high acid foods in
lead containing
ve
sse
ls, sto
rin
g
pesticides in sam
e
are
a a
s foo
d.
Using uncoated tin
containers for
storing high-acid
foods
Sp
ecim
en
s to
Co
llect
Vom
itus, gastric
washing
Vom
itus, gastric
wa
sh
in
gs, sto
ols,
blo
od
, u
rin
e
Vo
mitu
s, sto
ols
urin
e, b
lo
od
Fo
od
u
su
ally
In
vo
lved
3
Any accidentally
contam
inated
foods,
particularly dry
foods [such as
dry m
ilk, flo
ur, baking
pow
der,
cake m
ixes]
High acid foods
an
d b
evera
ge
s
sto
re
d in
le
ad
containing
vessels, any
accid
entally
contam
inated
food
High-acid foods
an
d b
evera
ge
s
Sy
mp
to
ms
a
nd
Sig
ns
Salty or soapy taste,
num
bness of m
outh,
vom
iting, diarrhea,
ab
do
min
al p
ain
,
pa
llo
r, cya
no
sis,
dila
te
d p
up
ils,
spasm
s, collapse,
shock
Metalic taste,
burning of m
outh,
ab
do
min
al p
ain
,
milky vom
itus,
bloo
dy or black
sto
ols, fo
ul b
re
ath
,
sh
ock, b
lu
e g
um
line
Blo
atin
g, n
au
se
a,
vom
iting,
abdom
inal, cra
mps,
dia
rrh
oe
a,
he
ad
ache
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
Few
m
in to
2 hours
30
m
in o
r lo
ng
er
30 m
in to 2 h
ours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
So
diu
m flu
orid
e in
insecticides and
rod
enticide
s
Lead in
earthenw
are
vessels,
pesticides, pa
int,
plaster, putty,
soldered joints
Tin
in
tin
ne
d ca
ns
Dis
ea
se
Fluorid
e
poisoning
Le
ad
poisoning
Tin
poisoning
16
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Pu
rch
asin
g
Cadm
ium
containing
utensils, storing
high acid foods in
cadm
ium
containing
containers,
in
gesting
cadm
ium
containing foods
Storing high-acid
fo
od
s in co
pp
er
utensils or using
co
pp
er p
ip
es fo
r
disp
en
sin
g h
ig
h-
acid beverages,
faulty ba
ckflow
prevented valves
in vending
machines
Sp
ecim
en
s to
Co
llect
Vo
mitu
s, sto
ols,
urine, blood
Vom
itus, gastric
washings, urine,
bloo
d
Fo
od
u
su
ally
In
vo
lved
3
High-acid foods
an
d b
evera
ge
s
[m
etal colored
cake decorations]
High-acid foods
an
d b
evera
ge
s
Sy
mp
to
ms
a
nd
Sig
ns
Nause, vom
iting
ab
do
min
al cra
mp
s,
diarrhea, shock
Metalic taste,
nausea, vom
iting
[green vom
itus],
ab
do
mina
l p
ain
diarrh
oea
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
15 to 30 m
in
Few
m
in to
fe
w h
ou
rs
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Ca
dm
ium
in
plated utensils
Co
pp
er in p
ip
es
and utensils
Dis
ea
se
Cadm
ium
po
isoning
Co
oper p
oiso
ning
17
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Storing high-acid
fo
od
s in
ga
lva
nize
d ca
ns
Storing cooked foods at room
te
mp
era
tu
re
, storin
g co
oke
d
foods in large containers in
re
frig
era
tors, prep
arin
g fo
od
s
several hours before serving
Stored cooked food at room
te
mp
era
tu
re
, storin
g co
oke
d
food in large containers in
re
frig
ara
tors, to
uch
in
g co
oke
d
foods, preparing foods several
ho
urs b
efore
servin
g, p
erso
n
with infections containing pus,
holiding foods at w
arm
tem
peratures, ferm
entation of
abnorm
ally low
-acids foods
Sp
ecim
en
s to
Co
llect
Vom
itus, gastric
washings, urine,
blood, stools
Vo
mitu
s, sto
ol
Vo
mitu
s, sto
ols,
re
cta
l sw
ab
.
Carriers: nasal
sw
ab, sw
ab of
le
sio
ns, a
na
l sw
ab
Fo
od
u
su
ally
In
vo
lv
ed
3
High-acid foods
an
d b
evera
ge
s
Bo
ile
d o
r frie
d
Rice
Ham
, m
eat and
poultry pro
ducts,
cre
am
-fille
d
pastries, w
hipped
bu
tte
r, ch
ee
se
, d
ry
milk, fo
od m
ixture,
high protein leftover
fo
od
s.
Sy
mp
to
ms
a
nd
S
ig
ns
Pain in m
outh and
ab
do
me
n, n
au
se
a,
vom
iting, dizzines
Nausea, vom
iting,
occasion
ally
Dia
rrh
oe
a
Nausea, vom
iting,
re
tch
in
g, a
bd
om
in
al
pa
in
, d
ia
rrh
oe
al,
prostrations
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
Fe
w m
in
to
fe
w h
ou
rs
½ to
5
h
ou
rs
1 to 8 hours. M
ean
2 to 4 hours.
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Zinc in galvanized
containers
Exo-enterotoxin of
B.
ce
reu
s.
Organism
in so
il
Exo-enterotoxins A
,
B, C
, D
, E
o
r F
o
f
Staphylococci
aureus. O
rg
anism
from
naoses, skin
and lesions of
in
fe
cte
d h
um
an
s
an
d a
nim
als a
nd
fro
m u
dd
ers o
f co
ws
Dis
ea
se
Zin
c p
oiso
nin
g
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
Ran
ge
of
1 to
6 h
ou
rs
Ba
cte
ria
l A
ge
nts
Ba
cillu
s
ce
re
us
gastroenteritis
Staphylococcal
in
to
xica
tio
n
18
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Using excessive
am
ou
nts o
f n
itrite
s
or nitrates in fo
ods
fo
r cu
rin
g o
r fo
r
covering up
sp
oilag
e,
mistaking nitrites
for com
mon salt
an
d other
co
nd
im
ents,
im
proper
refrigeration of
fresh produce.
Excessive
nitrification of
fertilized fields
Ha
rve
stin
g
sh
ellfish
fro
m
waters w
ith high
concentration of
Din
op
hyse
s
Sp
ecim
en
s to
Co
llect
Blood
Gastric w
ashings
Fo
od
u
su
ally
In
vo
lved
3
Cured m
eats, any
accidentally
contam
inated
food, spinach
exposed to
exce
ssive
nitrification
Mussels, clam
s,
scallops
Sy
mp
to
ms
a
nd
Sig
ns
Nause, vom
iting
cya
no
sis, h
ea
da
ch
e,
dizziness,
weakness, loss of
co
nscio
usn
ess,
choco
late brow
n
co
lo
ure
d blo
od
Nausea, vom
iting
ab
do
min
al cra
mp
s,
chills
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
1 to 2 hours
½ to
1
2 h
ou
rs
usu
ally 4 ho
urs
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Nitrites or nitrates
use
d a
s m
eat
curing com
pounds
or ground w
ate
r
from
shallow
we
lls, fe
rtilize
r
Okad
aic acid a
nd
oth
er to
xin
s
pro
du
ce
d b
y
dinoflage
llates
Dinophyses
acu
minate a
nd
D
.
forti
Dis
ea
se
Ch
em
ic
al A
ge
nts
Nitrite
poiso
ning
Diarrhetic
shellfish
poiso
ning
19
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Eating certain
sp
ecie
s o
f
Am
anita,
Ga
le
rin
e, a
nd
Tyro
mitra
mu
sh
ro
om
s,
eating u
nkn
ow
n
va
rie
tie
s o
f
mushroom
s,
mistaking toxic
mu
sh
ro
om
s fo
r
ed
ib
le
va
rie
tie
s
Sp
ecim
en
s to
Co
llect
Urine
, b
lo
od,
vom
itus
Fo
od
u
su
ally
In
vo
lv
ed
3
Am
anita
ph
allo
id
es, A
,
verna, G
alerina
autum
nalis,
Gyrom
itra
esculenta [false
morels] and
sim
ilar sp
ecies o
f
mu
sh
ro
om
s
Sy
mp
to
ms
a
nd
Sig
ns
Ab
do
min
al p
ain
,
fe
elin
g o
f fu
lln
ess,
vom
iting, protracted
diarrhoea, loss of
stre
ng
th
, th
irst,
muscle cram
ps,
co
lla
pse
, ja
un
dice
,
dro
wsin
ess, d
ila
te
d
pupils, com
a death
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
6 to 24 hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Cyclo
pe
ptid
es a
nd
gyro
mitrin
in
so
me
mu
sh
ro
om
s
Dis
ea
se
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
Ran
ge
of
7 to
12
ho
urs
Fu
ng
al A
ge
nt
Cyclo
pe
ptid
e
and gyrom
itrin
gro
up
s of
mu
sh
ro
om
poisoning
20
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
In
ad
eq
ua
te
rinsing of b
ottles
cle
an
ed
w
ith
ca
ustic sod
a,
in
ad
eq
uate
b
akin
g
of p
re
tze
ls
Pe
rso
ns tou
ch
in
g co
oke
d
fo
od
s, p
erso
ns w
ith
infections containing
pus, room
tem
perature
storage, storing cooked
foo
d in large containers
in refrigerators,
inadequate co
oking or
reheating preparing
foods several hours
before serving.
Sp
ecim
en
s to
Co
llect
Vom
itus
Th
ro
at sw
ab
s,
vom
itus
Fo
od
u
su
ally
In
vo
lv
ed
3
Bo
ttle
d
beverag
es,
pretzels
Ra
w m
ilk, fo
od
s
containing eggs
Sy
mp
to
ms
a
nd
Sig
ns
Burning of lips,
mouth and throat,
vom
iting,
ab
do
min
al p
ain
,
diarrh
oea
So
re
th
ro
at, fe
ve
r,
nausea, vom
iting,
rhinorrhoea,
som
etim
es a rash
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
Few
m
in
1 to 3 days
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Sod
ium
hydroxid
e
in
b
ottle
w
ash
in
g
co
mp
ou
nd
s,
detergents, drain
cle
an
ers, o
r h
air
straighteners
Streptococcus
pyo
ge
ne
s fro
m
throat and lesions
of infected
hum
ans
Dis
ea
se
SO
RE
T
HR
OA
T A
ND
R
ES
PIR
AT
OR
Y S
YM
PT
OM
S A
ND
S
IG
NS
O
CC
UR
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
Les
s th
an 1
ho
urs
Ch
em
ic
al A
ge
nts
Sod
ium
hydroxid
e
poisoning
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
Ran
ge
of
13 t
o 7
2 h
ou
rs
Ba
cte
ria
l A
ge
nts
Be
ta
h
em
olytic
streptococcal
in
fe
ctio
ns
21
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Sto
rin
g co
oke
d fo
od
s
at room
tem
perature,
sto
rin
g co
oke
d fo
od
s
in large containers in
refrigerators, holding
fo
od
s a
t w
arm
[bacterial incubating]
tem
peratures,
pre
pa
rin
g fo
od
s
several hours before
se
rvin
g, in
ad
eq
ua
te
reheating of leftovers
Sto
rin
g co
oke
d fo
od
s
at room
tem
perature,
sto
rin
g co
oke
d fo
od
s
in large containers in
ho
ld
in
g fo
od
s a
t
warm
[bacterial
incubating] tem
perature,
pre
pa
rin
g fo
od
s
se
rvin
g, in
ad
eq
ua
te
reheating of leftovers.
Sp
ecim
en
s to
Co
llect
Sto
ols
Sto
ols
Fo
od
u
su
ally
In
vo
lv
ed
3
Cereal prod
ucts
so
up
s, cu
sta
rd
s
and sauces,
meatloaf,
sa
usa
ge
, co
oke
d
vegetables,
re
co
nstitu
te
d
dried potato
es,
refried beans
Cooked m
eat,
poultry, gravy,
sa
uce
s, so
up
s,
refried beans
Sy
mp
to
ms
a
nd
Sig
ns
Nausea, abdom
inal
pa
in
, w
ate
ry
diarrh
oea
Ab
do
min
al p
ain
,
diarrh
oea
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
8 to 16 hours
[m
ea
n 1
2 h
ou
rs]
8 to 22 hours
[m
ea
n 1
0 h
ou
rs]
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
En
te
ro
to
xin
o
f B
.
ce
reu
s.
Org
an
ism
in soil
Endo-enterotoxin
fo
rm
ed
d
urin
g
sporulation of C
.
perfringens in
in
te
stin
es.
Organism
in
fa
ece
s o
f
hum
ans, oth
er
anim
als, and in
so
il
Disease
LO
WE
R G
AS
TR
OIN
TE
ST
IN
AL
T
RA
CT
S
YM
PT
OM
S A
ND
S
IG
NS
[A
BD
OM
IN
AL
C
RA
MP
S, D
IA
RR
HE
A] O
CC
UR
F
IR
ST
O
R P
RE
DO
MIN
AT
E
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
“Ran
ge
of
7 to
12
ho
urs
”
Ba
cte
ria
l A
ge
nts
Ba
cillu
s cere
us
enteritis
Clo
stridiu
m
perfringens
enteritis
22
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Drinking raw
m
ilk,
eating raw
m
eat,
in
ad
eq
uate
coo
king or
pasteurizatio
n
Obtaining fish and shell
fish from
sew
age
contam
inated w
aters in
endem
ic areas, poor
perso
na
l hygiene,
in
fe
cte
d p
erso
ns
touching foods,
inadequate co
oking
using co
ntam
inated
water to w
ash or freshen
fo
od
s, im
pro
pe
r sew
ag
e
disp
osa
l, usin
g nig
ht so
il
as fertilizer
Sp
ecim
en
s to
Co
llect
Stools, rectal
sw
ab, blood
Stools
Fo
od
u
su
ally
In
vo
lved
3
Ra
w m
ilk, p
ou
ltry,
beef liver, ra
w
clam
s, w
ater
Raw
fish, raw
sh
ellfish
,
crustacea, foods
washed or
pre
pa
re
d w
ith
contam
inated
water, w
ater
Sy
mp
to
ms
a
nd
Sig
ns
Diarrhoea, [often
bloody]
severe ab
do
mina
l
pain, fever,
an
ore
xia
, m
ala
ise
,
headache,
vom
iting
Profuse w
atery
dia
rrh
oe
a [rice
water stools],
vom
iting,
ab
do
min
al p
ain
,
dehydration,
thirst, collapse,
red
uced skin
turgor, w
rinkled
fin
ge
rs, su
nke
n
eyes
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
2 to 7 days,
[m
ean 3 to
5 days]
1 to 3 days
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
C.
jeju
ni
Enterotoxin of
Vib
rio
ch
ole
rae
01
classical an
d E
l
To
r b
io
typ
es, fro
m
faeces of infected
hum
ans
Dis
ea
se
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
“Ran
ge
of
13 t
o 7
2 h
ou
rs”
Bacterial A
gen
ts
Ca
mp
ylo
ba
cte
r
enterocolitis
Cholera
23
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Storing co
oked foods
at room
tem
perature,
sto
rin
g co
oke
d fo
od
s
in large containers in
refrigerators, holding
fo
od
s a
t w
arm
[bacterial incubating]
tem
peratures, inadequate
coo
king an
d re
he
ating
pre
pa
ring
fo
od
s seve
ra
l
ho
urs b
efo
re
se
rvin
g,
cross contam
ination,
im
proper cleaning of
eq
uipm
ent, o
btaining
foods from
co
ntam
inated
sources
In
fe
cte
d p
erso
ns
touching foods,
Im
pro
per
refrigeration,
in
ad
eq
uate co
oking
an
d re
he
ating
Sp
ecim
en
s to
Co
llect
Stools, rectal
sw
abs
Stools, rectal
sw
abs
Fo
od
u
su
ally
In
vo
lved
3
Po
ultry a
nd
m
ea
t
and th
eir p
roducts.
Egg products raw
milk and dairy
pro
du
cts, oth
er
fo
od
s co
nta
min
ate
d
by salm
onella
Any contam
in
ated
fo
od
, fre
qu
en
tly
salads, w
ater
Sy
mp
to
ms
a
nd
Sig
ns
Ab
do
min
al p
ain
,
diarrh
oea, chills,
fever, nausea,
vom
iting, m
alaise
Ab
do
min
al p
ain
,
dia
rrh
oe
a, b
lo
od
y
and m
ucoid
stools, fever
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
6 to 72 hours
me
an
1
8 to
3
6
hours
24 to 72 hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Va
rio
us se
ro
typ
es
of S
alm
on
ella from
faeces of anim
als
Sh
ige
lla
fle
xn
eri
, S
.
dysente
riae,
S.
so
nn
el a
nd S
.
boydii f
ro
m fa
ece
s
of infected
hum
ans
Dis
ea
se
Sa
lm
on
ello
sis
Sh
ig
ello
sis
24
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Obtaining fish and
sh
ellfish fro
m sew
ag
e
contam
inated w
aters,
inadequate co
oking, cross
contam
in
atio
n
In
fe
cte
d p
erso
ns
touching foods,
Im
pro
per
refrigeration,
in
ad
eq
uate
cooking, im
proper
cle
an
in
g a
nd
disinfecting of
equipm
ent, eating
raw
or rare m
eats
[hem
orrhagic
syndrom
e]
Sp
ecim
en
s to
Co
llect
Stools
Stools, rectal
sw
abs
Fo
od
u
su
ally
In
vo
lved
3
Sh
ellfish
, F
ish
So
ft ch
ee
se
, ra
re
ham
burger, w
ater
Sy
mp
to
ms
a
nd
Sig
ns
Watery diarrhoea
[varies from
loose
stools to cholera-
lim
e dise
ase]
Se
ve
re
a
bd
om
in
al
pa
in
, d
ia
rrh
oe
a
[som
etim
es
blo
od
y] n
au
se
a,
vom
iting fever,
ch
ills, h
ead
ach
e,
mu
scu
la
r p
ain
.
[bloody urine-
hem
orrhagic
strains]
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
2 to 3 days
5 to 48 hours
me
an
1
0 to
2
4
hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Non 01 vibrios:
Vib
rio
ch
ole
rae
,
Vib
rio m
imic
us,
Vib
rio f
luvia
lis,
Vib
rio h
olli
sa
e
Entero-
pathoge
nic,
enterotoxigenic,
enteroinvasive
hem
orrhagic
strains [e.g. 0157]
of E
. co
li fro
m
faeces of infected
hum
ans a
nd other
an
im
al
Dis
ea
se
Vibrio
cho
lera-like
gastroenteritis
Pa
th
og
en
ic
Escherichia
coli diarrhea
25
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Inadequate
cooking, im
proper
refrigeration,
cross contam
i-
nation, im
proper
cle
an
in
g o
f
eq
uipm
ent, using
sea w
ater in food
pre
pa
ra
tio
n o
r to
cool cooked fo
ods
Ina
de
qu
ate co
oking
contam
ination after
pasteurization, contam
ination
of foods by w
ater, rodents,
oth
er a
nim
als
Sp
ecim
en
s to
Co
llect
Stools, rectal
sw
abs
Stools, blood
Fo
od
u
su
ally
In
vo
lved
3
Marine fish,
sh
ellfish
,
crustacea [raw
or
contam
inated]
Milk, to
fu
, w
ate
r
Sy
mp
to
ms
a
nd
Sig
ns
Ab
do
min
al p
ain
,
diarrhoea,
nausea, vom
iting,
fever, chills,
he
ad
ache
Se
ve
re
a
bd
om
in
al
pain, fever
headache,
malaise, sore
th
ro
at. M
ay
stim
ulate
ap
pe
nd
icitis
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
2 to 48 hours
me
an
1
2 h
ou
rs
24 to 36 hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Vib
ro
para
haem
oly
ticus
from
se
afood and
seaw
ater
Ye
rsin
ia
ente
rocolit
ica.
Y.
pseudotu
ber-
culo
sis
Dis
ea
se
Vibro para
ha
em
olyticus
gastroenteritis
Ye
rsin
io
sis
26
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
Ou
tb
re
ak
s
Sew
age pollution
of shellfish
grow
ing w
aters,
poor personal
hyg
ie
ne
, in
fe
cte
d
persons touching
foods
Po
or p
erso
na
l
hyg
ie
ne
, in
fe
cte
d
persons touching
fo
od
s, in
ade
qu
ate
cooking and
reheating
Sp
ecim
en
s to
Co
llect
Stools
Stools
Fo
od
u
su
ally
In
vo
lved
3
Cla
ms, o
yste
rs,
cockles, green
sa
la
ds, p
astry,
fostings
Unknow
n
Sy
mp
to
ms
a
nd
Sig
ns
Nausea, vom
iting,
Ab
do
min
al p
ain
,
dia
rrh
oe
a, lo
w
grade fever, chills,
malaise, anorexia
headache;
Duration approxi-
mately 36 h
Diarrhoea, fever,
vom
iting,
ab
do
min
al p
ain
,
som
etim
es
respiratory
sym
ptom
s
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
16
- 4
8 h
ours
3 to 5 days
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
No
rw
alk a
ge
nt
virus
Enteric viruses
[E
HC
O viruses,
Coxsackie
viruses,
reoviruses,
adenoviruses
rotaviruses,
polioviruses]
Dis
ea
se
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
Gre
ater
th
an 7
2 h
ou
rs
Viral A
gen
ts
No
rw
alk a
ge
nt
gastroenteritis
Non specific
viral
gastroenteritis
27
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Po
or p
erso
na
l
hyg
ie
ne
, in
fe
cte
d
pe
rso
ns to
uch
in
g
fo
od
s, in
ad
eq
ua
te
cooking
Po
or p
erso
na
l h
yg
ie
ne
,
in
fe
cte
d p
erso
n to
uch
in
g
fo
od
s, in
ad
eq
ua
te
co
okin
g, im
pro
pe
r
sew
age disposal, w
ater
contam
inated by
anim
als.
Sp
ecim
en
s to
Co
llect
Sto
ols
Sto
ols
Fo
od
u
su
ally
In
vo
lv
ed
3
Ra
w ve
getab
le
s
an
d fru
its [
Salm
on, w
ater
raw
vegetables
an
d fru
its [
Sy
mp
to
ms
a
nd
Sig
ns
Ab
do
min
al p
ain
,
constipation or
diarrhoea [faeces
containing blood
an
d m
uco
us]
Ab
do
min
al p
ain
,
mucoid diarrho
ea
fa
tty sto
ols
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
5 d
ays to several
mon, m
ean 3 to 4
we
eks
1 to 4 w
eeks
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
En
tam
oe
ba
his
toly
tica fro
m
feces of infected
hum
ans
Gia
rdia
la
mb
lia
fro
m fa
ece
s o
f
in
fe
cte
d h
um
an
s
or anim
als
Dis
ea
se
Parasitic A
gen
ts
Am
oe
bic
dysentery
[A
moebiasis]
Giardiasis
28
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Ingestion of raw
fish, inadequate
cooking
Lack of m
eat
in
sp
ectio
n,
in
ad
eq
uate
cooking
in
ad
eq
uate
sew
age disposal,
sew
age
contam
inated
pastures
Inadequate
cooking, im
proper
sew
age disposal,
sew
age
contam
inated
lakes
Lack of m
eat
in
sp
ectio
n,
in
ad
eq
uate
cooking im
proper
sew
age disposal,
contam
inated
pastures
Sp
ecim
en
s to
Co
llect
Stools
Stools
Stools
Stools
Fo
od
u
su
ally
In
vo
lved
3
Rock fish, herring,
cod, squid
Raw
or insufficiently
co
oke
d b
ee
f
Raw
or
Insufficiently
cooked freshw
ater
fish [perch, pike,
turbot, salm
on]
Raw
or
insufficiently
co
oke
d p
ork
Sy
mp
to
ms
a
nd
Sig
ns
Stom
ach pa
in,
nausea, vom
iting
ab
do
min
al p
ain
,
dia
rrh
oe
a, fe
ve
r
Va
gu
e d
isco
mfo
rt,
hunger pain, lo
ss
of w
eig
ht,
abdo
minal p
ain
Va
gu
e g
astro
intestinal
disco
mfo
rt,
anaem
ia m
ay
occur
Va
gu
e d
isco
mfo
rt,
hunger pains, loss
of w
eight
convulsions
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
4 to 6 hours
8 to 14 w
eeks
5 to 6 w
eeks
8 to 14 w
eeks
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Anis
akis
Ph
oca
ne
ma
Porr
ocaecum
Taenia
sagin
ata
form
flesh of
infested cattle
Dip
hyllob
oth
riu
m
latu
m fro
m fle
sh
o
f
infested fish
Taenia
solium
from
flesh of
in
fe
cte
d sw
in
e
Dis
ea
se
Anisakiasis
Be
ef ta
pe
wo
rm
infection
[T
aeniasis]
Fish
ta
pe
wa
rm
infection
[D
ip
hyllo
-
bothriasis]
Pork tapew
orm
infection
[T
aeniasis]
29
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Inappropriate
application for
me
lo
ns, storin
g
nse
cticid
es in
sam
e area as
fo
od
s, m
ista
kin
g
pesticides for
po
wd
ere
d fo
od
s
Spraying foods
just before
harvesting,
storing
insecticides in
sam
e area as
fo
od
s, m
ista
kin
g
pesticides for
dried foods.
Sp
ecim
en
s to
Co
llect
Blood, urine
Blo
od
, u
rin
e, fa
t
biopsy
Fo
od
u
su
ally
In
vo
lved
3
Waterm
elons, any
accidentally
contam
inated food
Any accidentally
contam
inated food
Sy
mp
to
ms
a
nd
Sig
ns
Ep
ig
astric p
ain
,
vom
iting,
ab
norm
al
salivation,
sw
ea
tin
g,
contraction of
pupils, m
uscular
incoordination
Nausea, vom
iting
ab
dom
inal
cram
ps,
dia
rrh
oe
a,
he
ad
ache
nervousness,
blurred vision,
chest pain,
cya
no
sis,
confusion
tw
itching,
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
½ hours
Fe
w m
in
to
fe
w
hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Ca
rb
arly [se
vin
]
Tem
ik [aldicarb]
Orga
no
ph
osph
oro
us
in
se
cticid
es [su
ch
as parathion,
TE
PP
, d
ia
zin
on
malathion]
Dis
ea
se
NE
UR
OL
OG
IC
AL
S
YM
TO
MS
A
ND
S
IG
N [V
IS
UA
L D
IS
TU
RB
AN
CE
S, T
IN
GL
IN
G, A
ND
/O
R P
AR
AL
YS
IS
] O
CC
UR
4
Incubation [
Late
ncy]
Period U
sually L
ess T
han 1
hours
Ch
em
ic
al A
ge
nts
Carbam
ate
poisoning
Organophos
phorous
poisoning
30
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Ha
rve
stin
g
sh
ellfish
fro
m
waters w
ith high
concentration of
Proto
gon
alulax o
r
Gym
no
din
iu
m
sp
ecie
s [R
ed
tid
es]
Eating puffe
r-type
fish
, fa
ilu
re
to
effectively rem
ove
intestines and
go
na
ds fro
m
pu
ffe
r-typ
e fish
if
they are to be
eaten
Sp
ecim
en
s to
Co
llect
Ga
stric
washin
gs
Fo
od
u
su
ally
In
vo
lv
ed
3
Mussels and
calm
s
Pu
ffe
r-typ
e fish
Sy
mp
to
ms
a
nd
Sig
ns
Ting
ling, burning,
num
bness aro
un
d
lip
s, a
nd
fin
ge
r
tip
s, g
id
din
ess,
incoherent
sp
ee
ch
, d
ifficu
lty
to stand
respiratory
paralysis
Ting
ling se
nsatio
n
of fingers and
toes, d
izziness,
pa
llo
r, n
um
bn
ess
of m
outh a
nd
extrem
ities,
gastrointestinal
sym
ptom
s,
haem
orrhage,
desq
uam
ation of
skin
, e
ye
s, fixe
d,
tw
itch
in
g,
paralysis,
cya
no
sis, fa
ta
litie
s
occur
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
Few
m
in to 30 m
in
10 m
in to 3 h
ours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Saxitoxin and
sim
ila
r to
xin
s fro
m
dinoflage
llates
Pro
to
go
na
ula
x
and G
ym
nodinium
species, w
hich are
co
nsu
me
d
Tetro
dotoxin from
intestines and
go
na
ds of
pu
ffe
rtyp
e fish
Disease
To
xic
A
nim
als
Paralytic
ne
uro
lo
gic
shellfish
po
isoning
Tetraodon
[F
ugu/P
uffer]
po
isoning
31
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Eating A
.
muscaria and
related species of
mu
sh
ro
om
s,
eating u
nkn
ow
n
varieties of
mu
sh
ro
om
s,
mistaking toxic
mu
sh
ro
om
s fo
r
ed
ib
le
va
rie
tie
s
,
Eating m
uscarine
group of
mu
sh
ro
om
s,
eatin
g u
nkn
ow
n
varieties of
mu
sh
ro
om
s,
mistaking toxic
mushroom
for
ed
ib
le
m
ushro
om
s
Sp
ecim
en
s to
Co
llect
Vom
itus
Fo
od
u
su
ally
In
vo
lved
3
Am
anita
mu
sca
ria
, A
.
pa
nth
erin
a a
nd
related species of
mu
sh
ro
om
s
Clitocybe
dealbata, C
.
rivu
losa
a
nd m
an
y
species of In
ocybe
an
d B
oletus
mu
sh
ro
om
s
Sy
mp
to
ms
a
nd
Sig
ns
Dro
wsin
ess a
nd
state of
intoxication,
confusion
muscular spasm
s,
de
liriu
m, visu
al
disturbances
Excessive
salivation,
perspiration,
tearing, reduced
bloo
d pressure,
irregular pulse,
pupils constricted,
blurred vision,
asthm
atic
bre
ath
in
g
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
30 to 60 m
in
15 m
in to 2 h
ours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Ibotenic acid and
mu
scin
ol in
so
me
mu
sh
ro
om
s
Muscarine in
so
me
m
ush
roo
ms
Dis
ea
se
Pla
nt T
ox
ic
an
ts
Ibotenic acid
group of
mu
sh
ro
om
po
isoning
Muscarine
group of
mu
sh
ro
om
po
isoning
32
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Eating any pa
rt of
Jim
son w
eed o
r
ea
tin
g to
ma
to
es
from
tom
ato plant
grafted to jim
son
weed stock
Eating w
ater
hem
lock;
mestaking w
ater
hem
lock root for
wild parsnip,
sw
ee
t p
ota
to
, o
r
carrot
Sp
ecim
en
s to
Co
llect
Urine
Urine
Fo
od
u
su
ally
In
vo
lved
3
An
y p
art o
f p
la
nt,
tom
atoes grafted
to
jim
so
n w
ee
d
stock
Ro
ot o
f w
ate
r
hem
lock C
icuta
viro
sa
. C
.
mascula
te,
an
d C
.
dougla
ril
Sy
mp
to
ms
a
nd
Sig
ns
Abnorm
al thirst,
ph
oto
ph
obia,
distorted sight,
difficulty in
sp
ea
kin
g,
flushing, d
elirium
,
co
ma
, rap
id h
eart
beat
Excessive
salivation,
nausea, vom
iting,
stom
ach pain,
frothing at m
outh,
irregular bre
ating,
co
nvu
lsio
ns,
respiratory
paralysis
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
Less than 1 hours
15 to 60 m
in
utes
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Tro
pa
ne
a
lkalo
id
s
Resin and
cicutoxin in
hem
lock root
Dis
ea
se
Jim
son w
eed
Water h
em
lock
poisoning
33
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Storing
insecticides in
sam
e area as
fo
od
, m
ista
king
pesticides for
dried foods
Eating liver,
in
te
stin
es, ro
e,
gonads, or flesh of
tropicfal reef
fishes; usually
large reef fish are
mo
re
co
mm
on
ly
toxic
Sp
ecim
en
s to
Co
llect
Blood, urine,
sto
ols, g
astric
washings
Fo
od
u
su
ally
In
vo
lv
ed
3
An
y a
ccid
en
ta
lly
contam
inated food
Num
erous
va
rie
tie
s o
f
tropical fish, e.g.
ba
rra
cu
da
,
gro
up
er, re
d
sna
ppe
r, a
mb
er
ja
ck, g
oa
t fish
,
skip jack, parrot
fish
Sy
mp
to
ms
a
nd
Sig
ns
Nausea, vom
iting
paraesthesia,
dizziness,
muscular
weakness,
an
ore
xia
, w
eig
ht
loss, confusion
Ga
stro
in
estin
al
sym
ptom
s,
tingling and
num
bness aro
un
d
mouth and
lim
bs, m
uscu
la
r
and joint pain,
dizzin
ess, cold
-
hot sensations,
rash, w
eakness,
slo
wn
ess o
f h
ea
rt
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
30 m
in to 6 h
ours
3 to 5 hours
som
etim
es
lo
ng
er
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Chlorinated
hydrocarb
on
insecticides
Cig
uato
xin
in
in
te
stin
es, ra
w
gonads, and flesh
of trop
ical m
arine
fish
Dis
ea
se
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
Ran
ge
of
1 to
6 h
ou
rs
Ch
em
ic
al A
ge
nts
Chlorinated
hydrocarb
on
poisoning
To
xic
A
nim
als
Cig
ua
te
ra
poisoning
34
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Ina
de
qu
ate he
at
processing of
can
ned fo
ods an
d
sm
oke
d fish
, p
ost-
processing
contam
inatio
n,
uncontrolle
d
ferm
entations,
im
proper curing of
Sp
ecim
en
s to
Co
llect
Blood, stool,
gastric w
ashings
Fo
od
u
su
ally
In
vo
lved
3
Ca
nn
ed
lo
w-a
cid
foods [usually
hom
e canned];
sm
oked fish;
co
oke
d p
ota
to
es;
fro
ze
n p
ot p
ie
s,
me
at lo
af, ste
w
left in ovens
with
out he
at
Sy
mp
to
ms
a
nd
Sig
ns
be
at, p
ro
stra
tio
n,
paralysis.
gastroenteritis
disappears in a
few
days
ne
uro
lo
gica
l
pro
ble
ms m
ay la
st
se
ve
ra
l d
ays.
deaths occur
Ga
stro
in
estin
al
sym
ptom
s m
ay
precede
ne
uro
lo
gica
l
sym
ptom
s.
ve
rtigo
, d
oub
le
or
blurred vision,
dryn
ess of m
outh,
difficulty in
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
2 hours to 8 days
[m
ean
18 to 36 ho
urs]
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Neurotoxins
A,B
,E
, a
nd
F
o
f
Clo
str
idiu
m
botu
linum
. S
po
re
s
found in soil, fresh
wa
te
r m
ud
a
nd
an
im
al
Dis
ea
se
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
in t
he
Ran
ge
of
12 t
o 7
2 h
ou
rs
Bacterial A
gen
ts
Botulism
35
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
ham
s a
nd fish,
tim
e tem
perature
abuse of potatoes,
po
t p
ie
s, ste
ws,
ho
ld
in
g fo
od
s a
t
room
a
nd w
arm
tem
peratures
Stream
s polluted w
ith
mercury com
pounds,
feeding anim
als
grains treated w
ith
mercury fu
ngicides,
eating m
ercury
treate
d grains or
meats from
a
nim
als
feed such grains.
Sp
ecim
en
s to
Co
llect
Urin
e, b
lo
od
, h
air
Fo
od
u
su
ally
In
vo
lved
3
overnight;
fe
rm
en
te
d fish
egg, fish, m
arine
mam
mals,
mu
skra
t ta
ils
Gra
in
s tre
ate
d
with m
ercury
containing
fu
ng
icid
e; p
ork,
fish and shellfish
exposed to
mercury
co
mp
ou
nd
s
Sy
mp
to
ms
a
nd
Sig
ns
sw
allo
win
g,
sp
ea
kin
g a
nd
bre
ath
in
g
descending
muscular
weakness,
co
nstip
atio
n,
pu
pils d
ila
te
d o
r
fixe
d, respiratory
paralysis.
Fa
ta
litie
s o
ccu
r
Num
bness,
weakness of legs,
sp
astic p
ara
lysis,
im
pa
irm
en
t o
f
vision, blindness,
com
a
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
1 w
eek or longer
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Methyl and ethyl
mercury
co
mp
ou
nd
s fro
m
industrial w
aste
and orga
nic
me
rcu
ry in
fungicides
Disease
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
Gre
ater
Th
an 7
2 h
ou
rs
Ch
em
ic
al A
ge
nts
Mercury
po
iso
nin
g
36
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Using com
pound
as food extract or
as cooking or
salad oil.
Failure to
pasteurize m
ilk,
livestock infected
with
b
ru
ce
lla
c
Sp
ecim
en
s to
Co
llect
Bio
psy o
f
gastrocnem
ius
muscle
Blo
od
Fo
od
u
su
ally
In
vo
lv
ed
3
Co
okin
g o
ils,
extracts and other
fo
od
s co
nta
-
min
ate
d w
ith
trio
rth
ocre
sy
phosphate
Ra
w m
ilk, g
oa
t
cheese
Sy
mp
to
ms
a
nd
Sig
ns
Gastrointestinal
sym
pto
ms, [e
g.
pa
in
, u
ng
ain
ly
high stee
ping gait,
fo
od
a
nd
w
rist d
ro
p
Fe
ve
r, ch
ills,
sw
ea
tin
g,
weakness,
malaise,
he
ad
ache, m
uscle
and joint pain,
lo
ss o
f w
eig
ht
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
5 to
2
1 d
ays
[m
ea
n 1
0 d
ays]
7 to
2
1 d
ays
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Trio
rth
ocre
syl
phosphate used
as e
xtra
cts o
r a
s
oil substitute
Bru
ce
lla
ab
ort
us,
B.
melit
enis
is a
nd
B.
suis
fro
m
tissu
es a
nd
m
ilk o
f
in
fe
cte
d a
nim
als
Dis
ea
se
Trio
rth
o-
cresyl
phosphate
poisoning
GE
NE
RA
LIZ
ED
IN
FE
CT
IO
N S
YM
PT
OM
S A
ND
S
IG
N [F
EV
ER
, C
HIL
LS
, M
AL
AIS
E, A
ND
/O
R A
CH
ES
] O
CC
UR
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
Gre
ater
Th
an 7
2 h
ou
rs
Ba
cte
ria
l A
ge
nts
Brucellosis
37
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
In
ad
eq
ua
te
co
okin
g, fa
ilu
re
to
pro
pe
rly
pasteurize m
ilk,
pro
lo
ng
ed
refrigeration
Ingestion of
contam
inated raw
milk, fa
ilu
re
to
pasteurize m
ilk
[1
45
F/6
3C
, 3
0
min
ute
s, 1
61
F/
72
C 1
5 seco
nd
s]
In
fe
cte
d p
erso
ns
touching foods, po
or
personal hygie
ne,
in
ad
eq
ua
te
co
okin
g,
im
proper refrigeration,
im
prop
er sew
age
disposal, obtaining
fo
od
s fro
m u
nsa
fe
sources, harvesting
sh
ellfish fro
m sew
ag
e
contam
inated w
aters
Sp
ecim
en
s to
Co
llect
Blood,
urine
Blo
od
Stools, rectal
sw
ab
s, b
lo
od
Fo
od
u
su
ally
In
vo
lv
ed
3
Co
le
sla
w, m
ilk,
ch
ee
se
, a
nim
al
pro
du
cts
Raw
m
ilk [rare]
Sh
ellfish, a
ny foo
d
contam
inated by
pe
rso
ns w
ho
touch foods, ra
w
milk, p
ost process
contam
inated
me
at, ch
ee
se
,
watercress w
ater
Sy
mp
to
ms
a
nd
Sig
ns
Fever, headache,
nausea, vom
iting,
stillbirths,
me
nin
gitis,
en
ce
ph
alitis,
se
psis
Chills, headache,
weakness,
Malaise
perspiration, fe
ver
co
ug
h, ch
est p
ain
Malaise,
headache, fever,
cough, nausea,
vom
iting,
co
nstip
atio
n,
ab
do
min
al p
ain
,
ch
ills, ro
se
sp
ots,
blo
od
y sto
ols
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
4 – 21 days
14 to 26 days,
me
an
2
0 d
ays
7 to
2
8 d
ays,
me
an
1
4 d
ays
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Lis
teria
mo
no
cyto
ge
ne
s
Co
xie
lla
bu
rne
tii
from
tissue and
milk of infected
anim
als
Sa
lmo
ne
lla t
yp
hi
[typh
oid] from
faeces of infected
hu
ma
ns. O
th
er
se
ro
typ
es o
f
Sa
lmo
ne
lla fro
m
faeces of infected
hum
ans or other
anim
als
Dis
ea
se
Listeriosis
Q fe
ve
r
Typh
oid or
Pa
ra
typ
ho
id
fevers
38
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
In
fe
cte
d p
erso
ns
touching foods, po
or
persona
l hygiene,
inadequate co
oking,
harvesting shellfish
fro
m se
wa
ge
contam
inated
wa
te
rs, im
pro
pe
r
sew
age disposal
Ingesting raw
fo
od
s, in
ade
qu
ate
cooking
Sp
ecim
en
s to
Co
llect
Urine blood
Blo
od
Fo
od
u
su
ally
In
vo
lved
3
Raw
shellfish
sa
la
ds, co
ld
cu
ts,
any food
contam
inated by
hepatitis viruses,
water
Raw
crabs, slugs,
pra
wn
s, sh
rim
p,
snails
Sy
mp
to
ms
a
nd
Sig
ns
Fe
ve
r, m
ala
ise
,
lassitude,
anorexia, nausea,
ab
do
min
al p
ain
,
jaundice
Ga
stro
en
te
ritis,
headache, stiff
neck and back,
low
grade fever
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
10 to to days
me
an
2
5 d
ays
14 to 16 da
ys
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Hepatitis A
virus
from
faeces,
urin
e, b
lo
od
o
f
in
fe
cte
d h
um
an
s
and other
prim
ates
An
gio
str
on
gylu
s
canto
nensis
[ra
t
lung w
orm
] from
rodent faeces and
soil
Dis
ea
se
Viral A
gen
ts
Hepatitis A
[Infectious
hepatitis]
Parasitic A
gen
ts
Angio
strongyliasis
[E
osin
op
hilic
me
nin
go
en
ce
ph
alitis]
39
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
reaks
Eating raw
or
in
ad
eq
ua
te
ly co
oke
d
pork or bear m
eat
in
ad
eq
uate co
oking
or heat processing,
feeding uncooked ro
in
ad
eq
ua
te
ly
heatprocessed
ga
rb
ag
e to
sw
in
e
In
ad
eq
ua
te
cooling, im
proper
refrigeration of
fish, im
proper
curing of cheese
Sp
ecim
en
s to
Co
llect
Blood, m
uscle
bio
psy skin
te
st
Vom
itus
Fo
od
u
su
ally
In
vo
lved
3
Po
rk, b
ea
r m
ea
t,
walrus flesh,
cross
contam
inated
gro
un
d b
eef a
nd
lam
b
Tuna m
ackerel,
Pa
cific d
olp
hin
[m
ahi m
ahi],
bluefish, cheese
Sy
mp
to
ms
a
nd
Sig
ns
Ga
stro
en
te
ritis,
fe
ve
r, o
ede
ma
aro
un
d e
ye
s,
muscular pain,
chills, prostration,
la
boure
d
bre
ath
in
g
He
adache,
dizziness, nausea,
vo
mitin
g, p
ep
pery
taste, b
urning
throat, facial
sw
ellin
g a
nd
flushing, stom
ach
pa
in
, d
ia
rrh
oe
a,
itching of skin
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
4 to 28 days
[m
ean 9 days]
Few
m
in to
1 hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Trichin
ella
spir
alis
[roundw
orm
] from
flesh or infested
sw
ine, be
ar,
walrus
Hista
mine-like
substance
pro
du
ce
d by
Pro
teus s
pp.
or
other bacteria
Dis
ea
se
Trichinosis
AL
LE
RG
IC
T
YP
E S
YM
PT
OM
S A
ND
S
IG
NS
[F
AC
IA
L F
LU
SH
IN
G A
ND
/O
R IT
CH
IN
G] O
CC
UR
Incu
bat
ion
[L
aten
cy]
Per
iod
Usu
ally
Les
s T
han
1 h
ou
r
Ba
cte
ria
l [a
nd
A
nim
al] A
ge
nts
Histam
ine
poisoning
[S
com
broid
po
iso
nin
g]
40
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
ou
tb
re
ak
s
Usin
g e
xce
ssive
am
ou
nts o
f M
SG
a
s
flavour intensifier
Using
sod
iu
m
nicotinate as colour
preservative,
im
proper m
ixing
Sp
ecim
en
s to
Co
llect
Fo
od
u
su
ally
In
vo
lv
ed
3
Foods seasoned
with
M
SG
Meat or other food
in w
hich sodium
nicotinate has
been add
ed,
including baby
fo
od
Sy
mp
to
ms
a
nd
Sig
ns
Burning sensation
in
b
ack o
f n
eck,
fo
re
arm
s, ch
est,
feeling of tightness,
headache, nausea
Flushing,
se
nsa
tio
n o
f
wa
rm
th
, itch
in
g,
ab
do
min
al p
ain
,
puffing of face and
knees
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
Few
m
in to 1 hour
Few
m
in to 1 hour
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Mo
no
so
diu
m
glutam
ate [M
SG
]
Vitam
in, sod
iu
m
nicotinate used
as
colour
preservative
Dis
ea
se
Ch
em
ic
al A
ge
nts
Mo
no
so
diu
m
glutam
ate
poisonin
g
[C
hin
ese
resta
urant
syndrom
e]
Nico
tin
ic a
cid
[n
ia
cin
]
poisonin
g
41
Fa
cto
rs
th
at
Co
ntrib
ute
d to
Fo
od
bo
rn
e
Ou
tb
re
ak
s
Eating liver and
kid
ne
y o
f a
nim
als
fro
m co
ld
re
gio
n
Sp
ecim
en
s to
Co
llect
Blo
od
Fo
od
u
su
ally
In
vo
lv
ed
3
Live
r a
nd
kid
ne
y
of artic m
am
mals
Sy
mp
to
ms
a
nd
Sig
ns
He
adache,
gastrointestinal
sym
ptom
s,
dizzin
ess, co
lla
pse
,
insom
nia,
desq
uam
ation of
skin
In
cu
ba
tio
n o
r
Laten
cy p
erio
d
1 to 6 hours
Ae
tio
lo
gic
a
ge
nt
An
d s
ou
rc
e
Vitam
in A
Dis
ea
se
Incu
bat
ion
[L
aten
cy]
Per
iod
in t
he
Ran
ge
of
1 to
6 h
ou
rs
To
xic
A
nim
als
Hyp
er
vita
min
osis A
1.
Sym
ptom
s and incubation periods w
ill vary w
ith the individua
l and group exposed because of resistence, age, and nutritional statu
s o
f in
divid
ua
ls,
num
ber of organism
s or concentration of poison in ingested foods, am
ount of food ingested, and pa
thogenicity and virulence of strain of
microorganism
s or toxicity of chem
ical involved. S
everal of the illnesses are m
anifested by additional sym
ptom
s and have incubation periods that are
shorter or longer than stated.
2.
A m
or d
etailed review
ca
n be found in : B
ryan, F
.L. 198
2 D
iseases T
ra
nsm
itted by F
ood [A
classifications and sum
mary], 2
nd
ed., C
enters for D
isease
Control, A
tlanta.
3.
Sam
ples of any of the listed foods that have
b
ee
n in
ge
ste
d d
urin
g the incubation period of the disease should be collected.
4.
Carbon m
onoxide poisoning m
ay sim
ulate so
me of the diseases listed in this cate
gory. P
atients w
ho have been in closed cars w
ith m
otors ru
nning or
have been in room
s w
ith im
properly ve
nted heaters are subject to exposure to carbon m
onoxide.
42
43
44
45
46
47
1
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
- - - No.
Daftar
Episod
BAHAGIAN KAWALAN PENYAKIT
KEMENTERIAN KESIHATAN MALAYSIA
BORANG SIASATAN/LAPORAN WABAK KERACUNAN MAKANAN
(FWBD/KRM/BG/001 (Pindaan 2006))
A: NOTIFIKASI
Institusi
Institusi
Tarikh
Tarikh
Masa
Masa
Nama
Nama
Pe
la
por
Jawatan
Pe
ne
rim
a
Jawatan
Cara
Notifikasi
Telefon Faks E-mail Borang Lain-lain
B1: ANALISA DESKRIPTIF – TEMPAT (PLACE)
1. Alamat tempat/
premis kejadian
Mukim Daerah
Negeri
Koodinat:- Longitud Latitud
Sekolah/asrama sekolah Kolej/universiti
Hospital/klinik kesihatan
Pejabat kerajaan/swasta
Penjara/pusat jagaan khusus
Perkhemahan/kenduri/keramaian
2. Jenis
tempat/premis
kejadian
Rumah persendirian
B2: ANALISA DESKRIPTIF – ORANG (PERSON)
Kes dinotifikasi
Bilangan orang terdedah
Kes baru dikesan
Kadar Serangan
%
1. Bilangan
Kes
Jumlah Kes
Pesakit luar
Bilangan kes mati
Dimasukkan ke wad
Kadar Kematian Kes
%
2. Bilangan
kes
menerima
rawatan
Jumlah dirawat
Kes
Kontrol
3. Bilangan subjek
dimasukkan dalam
penyiasatan
epidemiologi
Jumlah
Lampiran 5
2
B2: ANALISA DESKRIPTIF – ORANG (PERSON) – Sambungan.
4
Kes mengikut kumpulan umur
5 Bilangan kes mengikut
gejala
Bilangan
Kumpulan
umur
Lelaki Perempuan Jumlah
Kadar
serangan
mengikut
kumpulan
umur
Gejala Bil. %
Bawah 1 th.
1 - < 5 th.
5 - < 13 th.
13 - < 19 th.
19 - < 25 th.
25 - < 55 th.
55 - < 65 th.
65 th, ke atas
Jumlah
B3: ANALISA DESKRIPTIF - MASA
Onset terawal
Onset terakhir
Onset
Median
Tarikh
Tarikh
Tarikh
Masa
Masa
Masa
Tarikh
Jam
Jangkaan masa pendedahan kepada
agen:
Masa
Jangkaan
tempoh
inkubasi:
minit
B4: KELUK EPIDEMIK
Bilan
gan
K
es
Onset
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
3
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
C: KAJIAN ANALITIK
Dibuat
Tidak dibuat (Nyatakan sebab)
Tarikh mula:
/ /
Bilangan kes/kontrol terlalu sedikit
Tarikh tamat:
/ /
Kejadian adalah terpencil (isolated)
Jenis Kajian: Case-Control
Analisa/kajian deskriptif kes sudah memadai
Kohort
Agen atau cara penularan telah diketahui
Definisi Kes:
Jadual Analisis Makanan/Hidangan
Makan Tidak Makan
Beza
Kadar
Serangan
(D-H)
RR
atau
OR
2
Nilai
p
Confid.
Interval
(CI)
A B C D E F G H
Bil.
Jenis Makanan/
Jenis Hidangan
1
Sakit
Tidak S
akit
Jum
lah A
+B
Ka
da
r: A
/C
x 1
00
Sakit
Tidak S
akit
Jum
lah E
+F
Ka
da
r: E
/G
x 1
00
Nota:
1
Pengiraan makanan berisiko (food attack rate) atau hidangan berisiko (meal attack rate) boleh dikira bergantung
kepada keadaan.
2
OR (Odd Ratio) digunakan untuk kajian kes control manakala RR (Relative Risk) digunakan untuk kajian kohort.
Jika kajian kes kontrol dibuat, kolum D, H dan perbezaan kadar serangan (D-H) tidak perlu diisi.
OR dan RR boleh dikira dengan menggunakan perisian seperti Epi Info dan SPSS.
4
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
D: SIASATAN DI PREMIS MAKANAN YANG TERLIBAT
Perkara Tempat Makanan Disediakan Tempat Makanan Dijual/Hidang
1. Nama premis:
Alamat:
Gred kebersihan (jika
ada):
Berlesen Berlesen
Tidak berlesen Tidak berlesen
2. Status pelesenan
Restoran/kedai makan Restoran/kedai makan
Gerai/warong Gerai/warong
Kafeteria/kantin Kafeteria/kantin
Dapur/Dewan asrama Dapur/Dewan asrama
Dapur persendirian Dapur persendirian
Kenduri/perhimpunan Kenduri/perhimpunan
Penjaja bergerak Penjaja bergerak
Lain-lain
Lain-lain
3. Jenis premis
Terawat sepenuhnya Terawat sepenuhnya
Air bekalan JBA Air bekalan JBA
Air mineral/proses/tapis Air mineral/proses/tapis
Terkawal, tidak terawat Terkawal, tidak terawat
Telaga terbuka Telaga terbuka
Telaga tiub Telaga tiub
Gravity Feed System (GFS) Gravity Feed System (GFS)
Tadahan air hujan
Tadahan air hujan
Tidak terkawal Tidak terkawal
Sungai/parit/terusan Sungai/parit/terusan
Lain-lain Lain-lain
4. Sumber bekalan air
(boleh lebih daripada
satu pilihan)
Tandas pam Tandas pam
Tandas curah Tandas curah
Tandas lubang/timbus Tandas lubang/timbus
Tandas awam/berkongsi Tandas awam/berkongsi
Dalam sungai/semak Dalam sungai/semak
Lain-lain Lain-lain
5. Jenis tandas yang kerap
digunakan
Memuaskan Memuaskan
Kotor Kotor
6. Keadaan kebersihan
tandas
5
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
D: SIASATAN DI PREMIS MAKANAN YANG TERLIBAT (Sambungan)
Perkara Tempat Makanan Disediakan Tempat Makanan Dijual/Hidang
Terkawal Terkawal
Tidak terkawal Tidak terkawal
7. Pelupusan air limbah
Terkawal Terkawal
Tidak terkawal Tidak terkawal
8. Pelupusan sampah/
sisa pepejal
Ada Ada
Tiada Tiada
9. Pembiakan LILATI
Tetap Orang Tetap Orang
Sementara Orang Sementara Orang
Tempatan Orang Tempatan Orang
Wargasing Orang Wargasing Orang
10. Bilangan pengendali
makanan mengikut
status dan
kewarganegaraan
Ada sijil kursus Orang Ada sijil kursus Orang
Ada kad kesihatan Orang Ada kad kesihatan Orang
Ada pelalian anti-Tifoid Orang Ada pelalian anti-Tifoid Orang
Kesihatan memuaskan Orang Kesihatan memuaskan Orang
11. Bilangan pengendali
makanan mengikut
tahap kesihatan dan
kebersihan
Penilaian terakhir (sebelum
kejadian)
Penilaian terakhir (sebelum
kejadian)
Tarikh: / / Tarikh: / /
Rating: % Rating: %
Penilaian semasa Penilaian semasa
Tarikh: / / Tarikh: / /
Rating: % Rating: %
12. Tahap kebersihan
keseluruhan premis
(Mengikut gred/rating
menggunakan format
KMM):
∀ KMM 3P1
∀ KMM 3P2
∀ KMM 3P3
Kontaminasi agen/penyebab Kontaminasi agen/penyebab
Ada Ada
Tiada Tiada
Pembiakan mikroorganisma Pembiakan mikroorganisma
Ada Ada
Tiada Tiada
Ketahanan survival mikrooganisma Ketahanan survival mikrooganisma
Ada Ada
Tiada Tiada
13. Hasil analisa HACCP
(spt. cara
penyimpanan bahan
mentah, semasa
penyediaan makanan,
proses memasak,
proses menghidang
dsbnya) bagi
memastikan
kewujudan faktor-faktor
berkaitan yang
mendorong kejadian
yang dilaporkan (Jika
ada, nyatakan)
6
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
E: PENYIASATAN MAKMAL
Spesimen Klinikal Pesakit
Keputusan
Nama pesakit
Jenis
spesimen
Tarikh
ambil
Tarikh
hantar
Jenis
analisis
Pos. Neg
No. Rujukan/
Catatan
Spesimen Dari Pengendali Makanan
Keputusan
Nama pengendali
makanan
Jenis
spesimen
Tarikh
ambil
Tarikh
hantar
Jenis
analisis
Pos. Neg
No. Rujukan/
Catatan
Spesimen Makanan
Keputusan
Jenis
makanan
Tempat/premis
persampelan
Tarikh
ambil
Tarikh
hantar
Jenis
analisis
Pos. Neg
No. Rujukan/
Catatan
Spesimen Persekitaran
Keputusan
Jenis
sampel
Tempat/premis
persampelan
Tarikh
ambil
Tarikh
hantar
Jenis
analisis
Pos. Neg
No. Rujukan/
Catatan
7
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
F: RUMUSAN AKHIR/ULASAN PEGAWAI PENYIASAT
1. Makanan/minuman disyakki/disahkan tercemar 2. Jenis agen pencemaran (jelaskan)
a. Jenis
Bakteria
b. Cara ditentukan
Virus
Analisa epidemiologi (Deskriptif, OR, RR)
Parasit
Ujian makmal
Kulat
Berdasarkan maklumat saintifik lain
Kimia/Logam berat
Berdasarkan gejala dan tempoh inkubasi
Lain-lain
Berdasarkan pengalaman lalu
Tiada bukti/sokongan khusus
3. Sumber makanan tersebut diperolehi
4. Jenis epidemik/wabak
Dapur perseorangan
Common source
Dapur institusi/asrama
Single exposure
Premis makanan tetap
Multiple/intermittent exposure
Pasar/supermarket/kedai runcit
Propagated
Penjaja bergerak
Bercampur (mixed)
Kenduri/perkhemahan/keramaian
Vending machine/kiosk
Lain-lain
5. Episod lain/terdahulu yang berkaitan (jika ada) 6. Tindakan kawalan khas dilaksanakan
Tempat Tarikh
Penutupan premis makanan
Akta CDC: Bilangan
buah
Akta Makanan: Bilangan
buah
Rampasan makanan
Ceramah/pamiran kesihatan berkumpulan
Kawalan pencemaran setempat
Lain-lain
7. Ulasan umum
Tandatangan & cop
Tarikh
8
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
G: ULASAN PEGAWAI PENYELIA
i. Ulasan PPKP U32/36 Daerah
Tandatangan & cop
Tarikh
ii. Ulasan Pegawai Kesihatan/Pengerusi JW Teknikal Penyakit Berjangkit
Tandatangan & cop
Tarikh kes dibincangkan
di dalam Mesy JW
Teknikal
iii. Ulasan Pegawai Epidemiologi (CDC) Negeri
Tandatangan & cop
Tarikh
Nota Akhir
1. Borang Siasatan yang lengkap mesti disimpan di dalam Fail Siasatan Keracunan Makanan di Pejabat
Kesihatan Daerah/ Bahagian/ Kawasan yang terlibat.
2. Satu salinan perlu dihantar ke Unit Epidemiologi, Jabatan Kesihatan Negeri . JKN akan menghantar laporan
yang lengkap ke Unit Kawalan Penyakit Bawaan Makanan dan Air, Bahagian Kawalan Penyakit, KKM dan satu
salinan untuk makluman ke PKD /Bahagian/ Kawasan dalam masa sebulan dari tarikh selesai siasatan dan
kawalan
3. Dalam keadaan tertentu, laporan bertulis yang lebih lengkap perlu disediakan dan dihantar ke JKN dan
Kementerian juga dalam masa sebulan dari tarikh selesai siasatan dan kawalan
4. Kemaskini data dalam Modul Siasatan CDCIS perlu dilengkapkan sebaik sahaja selesai siasatan dan kawalan
(Tamat Kejadian)
9
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
H: LAMPIRAN 1 - LINE LISTING KES DAN KONTROL
Nota:
1. Jadual ini hanya sebagai panduan. Pegawai penyiasat boleh menambah variabel yang ingin dikaji mengikut definisi kes
yang digunakan
2. Senaraikan jenis makanan yang diambil sekurang-kurangnya 72 jam sebelum onset.
3. Asingkan kolum bagi makanan yang sama tetapi diambil pada waktu yang berbeza. Umpamanya mengikut sarapan
pagi, makan tengahari, minum petang atau makan malam,
4. Gunakan helaian tambahan jika perlu
SAKIT
(Nyatakan
Onset)
Gejala
Jenis
makanan/minuman
(Tanda ∀ jika makan, X
jika tidak makan,
tinggalkan kosong jika
tidak pasti)
Bil.
Nama
Jantina
Um
ur
Ba
ng
sa
Ma
sa
Ta
rik
h
TID
AK
S
AK
IT
57
58