Food borne Food borne Diseases:Diseases:

By: By: Dr. Amr El-Dakroury Dr. Amr El-Dakroury Dept. of Medical Dept. of Medical commissioncommissionSupreme Council of HealthSupreme Council of Health

The etiology of Food-borne diseasesThe etiology of Food-borne diseases::

Food-borne diseasesFood-borne diseases are those diseases that are are those diseases that are the result of exposure to pathogenic the result of exposure to pathogenic microorganisms, such as bacteria, viruses and microorganisms, such as bacteria, viruses and parasites, which tend to have acute effects on parasites, which tend to have acute effects on human health. human health.

HoweverHowever, chronic, and in some cases acute, , chronic, and in some cases acute, food-borne illness may also be caused by the food-borne illness may also be caused by the presence of various chemical substances presence of various chemical substances including residues of pesticides and veterinary including residues of pesticides and veterinary drugs, unlawful food additives, mycotoxins, drugs, unlawful food additives, mycotoxins, biotoxins and radionuclides that enter the food biotoxins and radionuclides that enter the food intentionally or unintentionally. intentionally or unintentionally.

The problemsThe problems :due to consumption of :due to consumption of contaminatedcontaminated food and its detrimental effect on food and its detrimental effect on human health .human health .

Epidemiology of FBDEpidemiology of FBD: : WHO WHO estimates that one in three people worldwide estimates that one in three people worldwide

suffer from a food-borne disease every year, suffer from a food-borne disease every year, 1.8 million1.8 million die from severe food and waterborne die from severe food and waterborne

diarrhea ,related illness diarrhea ,related illness Most of these illnesses are due to microorganisms Most of these illnesses are due to microorganisms

and chemical contaminants, which may occur and chemical contaminants, which may occur naturally or be introduced at some point along the naturally or be introduced at some point along the food chain. food chain.

CampylobacterCampylobacter and and Salmonella Salmonella species account for species account for over over 90%90% of all reported cases of bacteria related of all reported cases of bacteria related to to food poisoning worldwide.food poisoning worldwide.

As most cases of food borne disease are not As most cases of food borne disease are not reported, the true dimension of the problem is reported, the true dimension of the problem is unknown. unknown.

Today food safety is one of WHO’s top eleven Today food safety is one of WHO’s top eleven prioritiespriorities

Food safety and securityFood safety and security: : The World Food SummitThe World Food Summit, organized by , organized by FAOFAO in in

1996, recognized that access to safe food is in 1996, recognized that access to safe food is in itself an element of food security, itself an element of food security,

The World Health Assembly Resolution on The World Health Assembly Resolution on Food safety from May 2000 stated that :Food safety from May 2000 stated that :

1. Everyone should have the right to an 1. Everyone should have the right to an adequate supply of safe, nutritious food ,adequate supply of safe, nutritious food ,

2. Encourages WHO member states ‘‘to 2. Encourages WHO member states ‘‘to implement and keep national and, when implement and keep national and, when appropriate, regional mechanisms for food appropriate, regional mechanisms for food borne disease surveillance’’borne disease surveillance’’

3. Governments should take the necessary 3. Governments should take the necessary measures to ensure the availability of safe measures to ensure the availability of safe food for all in order to sustain the health and food for all in order to sustain the health and economic development of their people.economic development of their people.

The Response in QatarThe Response in Qatar The Programme on Food- and Waterborne The Programme on Food- and Waterborne

Diseases and Zoonoses (FWD) in Qatar was set Diseases and Zoonoses (FWD) in Qatar was set up with the establishment of SCH , up with the establishment of SCH ,

One of the key objectives for the programme is One of the key objectives for the programme is improving and harmonizing the surveillance improving and harmonizing the surveillance system in Qatar in order to increase the scientific system in Qatar in order to increase the scientific knowledge regarding etiology, risk factors and knowledge regarding etiology, risk factors and burden of food- and waterborne diseases and burden of food- and waterborne diseases and zoonoses. zoonoses.

at present covers the following diseases: at present covers the following diseases: brucellosis, campylobacteriosis, cholera, brucellosis, campylobacteriosis, cholera, giardiasis, hepatitis A, salmonellosis, shigellosis, giardiasis, hepatitis A, salmonellosis, shigellosis, toxoplasmosis, typhoid and paratyphoid fever, toxoplasmosis, typhoid and paratyphoid fever, Escherichia coli infection,Escherichia coli infection,

Reported food Borne Cases During 2006 -2010 in Qatar

156

1889

3511

1398

312 404

0

500

1000

1500

2000

2500

3000

3500

4000

Brucellosis Food poisoning OtherInfc.Diarrhea(N.Diarreh)

Salmonella Shegellosis Typhoid

Objectives of the FWD programmeObjectives of the FWD programme: : Improving and harmonizing surveillance Improving and harmonizing surveillance

and control interventions of FWDand control interventions of FWD Improving knowledge of prevention and Improving knowledge of prevention and

control of FWDcontrol of FWD Strengthening SCH and Stakeholders Strengthening SCH and Stakeholders

capacities in the area of FBD .capacities in the area of FBD . Improving early detection and Improving early detection and

coordinated response to Qatar-wide FWD coordinated response to Qatar-wide FWD outbreaks ,as well as control outbreaks ,as well as control interventions .interventions .

Facilitating collaboration between public Facilitating collaboration between public health, municipality veterinary and food health, municipality veterinary and food sectors sectors

surveillance activities in Qatar surveillance activities in Qatar

Food borne disease data collected Food borne disease data collected through :through :

1. Routine surveillance activities1. Routine surveillance activities

2. Outbreaks investigations and2. Outbreaks investigations and

3. Conducting special studies.3. Conducting special studies.

Aims of FBD surveillance systemAims of FBD surveillance system: :

Food borne disease surveillance is essential Food borne disease surveillance is essential for:for:

1. Estimating the burden of food borne 1. Estimating the burden of food borne diseases, and monitor trends;diseases, and monitor trends;

2. Identifying priorities and setting policy in 2. Identifying priorities and setting policy in the control and prevention of food borne the control and prevention of food borne diseases;diseases;

3. Detecting, controlling and preventing food 3. Detecting, controlling and preventing food borne disease outbreaks;borne disease outbreaks;

4. Identifying emerging food safety issues; 4. Identifying emerging food safety issues; and evaluating food borne disease and evaluating food borne disease prevention and control strategies.prevention and control strategies.

OverviewOverview

OrganismsOrganisms EpidemiologyEpidemiology TransmissionTransmission Foodborne illnessFoodborne illness Prevention and ControlPrevention and Control

OrganismsOrganisms

There are an There are an estimated 250 pathogensestimated 250 pathogens that can that can cause foodborne related illnesses. cause foodborne related illnesses.

Foodborne illness is defined asFoodborne illness is defined as two or more cases two or more cases of a similar illness resulting from ingestion of a common of a similar illness resulting from ingestion of a common food. It can result from consuming foods contaminated with food. It can result from consuming foods contaminated with various pathogens.various pathogens. In most cases bacteria are the In most cases bacteria are the major pathogen followed by viruses, then major pathogen followed by viruses, then parasites. However, natural or manufactured parasites. However, natural or manufactured chemicals and toxins from organisms can also chemicals and toxins from organisms can also cause foodborne illnesses. cause foodborne illnesses.

The most commonly recognized foodborne The most commonly recognized foodborne infections are caused byinfections are caused by Campylobacter, Campylobacter, Salmonella, E. coli Salmonella, E. coli O157:H7 and by caliciviruses O157:H7 and by caliciviruses (better know as Norwalk viruses.)(better know as Norwalk viruses.)

EpidemiologyEpidemiology

EpidemiologyEpidemiologyMany foodborne illnesses are not recognized or Many foodborne illnesses are not recognized or

go unreported for a variety of reasons:go unreported for a variety of reasons: First,First, routine surveillance may not detect a routine surveillance may not detect a

mild foodborne illness.mild foodborne illness. second,second, some of the same pathogens that some of the same pathogens that

cause foodborne illness can also be cause foodborne illness can also be transmitted in water or from person to transmitted in water or from person to person.person.

Lastly,Lastly, some pathogens are emerging and are some pathogens are emerging and are not yet identifiable or able to be diagnosed.not yet identifiable or able to be diagnosed.

Considering these factors, the above listed Considering these factors, the above listed number of illnesses, hospitalizations and number of illnesses, hospitalizations and death may be obsolete.death may be obsolete.

High Risk GroupsHigh Risk Groups

The elderlyThe elderly

ChildrenChildren

Immunocompromised individuals are Immunocompromised individuals are usually at the greatest risk for these usually at the greatest risk for these illnesses.illnesses.

TransmissionTransmission

TransmissionTransmission Transmission of foodborne pathogens occurs via the oral Transmission of foodborne pathogens occurs via the oral

route. route.

How those pathogens contaminate food can vary based How those pathogens contaminate food can vary based on the organism, its reservoir, food handling/processing, on the organism, its reservoir, food handling/processing, and cross-contamination prior to serving.and cross-contamination prior to serving.

Some organisms rely on a human reservoir, such as Some organisms rely on a human reservoir, such as Norwalk-like virus, Norwalk-like virus, ShigellaShigella, , CampylobacterCampylobacter. .

Others have an animal reservoir such as Others have an animal reservoir such as CampylobacterCampylobacter, ,

SalmonellaSalmonella, , E. coliE. coli 0157:H7, 0157:H7, ListeriaListeria, and , and ToxoplasmaToxoplasma..

TransmissionTransmission

Contamination can occur at several Contamination can occur at several points along the food chainpoints along the food chain On the farm or in the fieldOn the farm or in the field At the slaughter plantAt the slaughter plant During processingDuring processing At the point of saleAt the point of sale At homeAt home

Produce ProcessingProduce Processing Animal products are not Animal products are not

the only food that can the only food that can be contaminated. be contaminated. Various foodborne Various foodborne disease outbreaks have disease outbreaks have occurred due to fruits occurred due to fruits and vegetables.and vegetables.

This table indicates the This table indicates the

many possible sources many possible sources for contamination for contamination during the processing of during the processing of produce.produce.

Important OrganismsImportant Organisms

Although many pathogens can cause Although many pathogens can cause foodborne illnesses, we will briefly foodborne illnesses, we will briefly cover those of greatest impact. cover those of greatest impact. These may also be potential These may also be potential bioterrorism agents for food sources. bioterrorism agents for food sources.

Important OrganismsImportant Organisms Norwalk-like virusesNorwalk-like viruses CampylobacterCampylobacter SalmonellaSalmonella E. coliE. coli O157:H7 O157:H7 Clostridium botulinumClostridium botulinum ShigellaShigella ToxoplasmaToxoplasma Emerging organismsEmerging organisms

Norwalk-like VirusesNorwalk-like Viruses Norovirus; Caliciviridae familyNorovirus; Caliciviridae family They are an important cause of sporadic They are an important cause of sporadic

gastrointestinal disease outbreaks gastrointestinal disease outbreaks throughout the world. It is considered the throughout the world. It is considered the most common foodborne infectious agent most common foodborne infectious agent and an estimated 23 million cases occur and an estimated 23 million cases occur each year. each year.

SourcesSources Person-to-person :Person-to-person :

Shed in human feces (up to 2weeks), vomitus.Shed in human feces (up to 2weeks), vomitus. Outbreaks in daycares, nursing homes, cruise shipsOutbreaks in daycares, nursing homes, cruise ships

Contaminated raw shellfish.Contaminated raw shellfish.

Campylobacter jejuniCampylobacter jejuni Leading cause of bacterial diarrhea.Leading cause of bacterial diarrhea. It is considered the leading bacterial cause of It is considered the leading bacterial cause of

foodborne related diarrheafoodborne related diarrhea affecting 2.4 million affecting 2.4 million people each year (5-14% of all diarrheal illnesses people each year (5-14% of all diarrheal illnesses worldwide). Usually these are children under the worldwide). Usually these are children under the age of 5 and young adults (15-29 years of age).age of 5 and young adults (15-29 years of age).

Very few deaths are caused by this organismVery few deaths are caused by this organism. . Recently Guillain-Barré Syndrome has been Recently Guillain-Barré Syndrome has been associated with a small number of associated with a small number of CampylobacterCampylobacter cases. This syndrome is the leading cause of acute cases. This syndrome is the leading cause of acute paralysis and develops 2-4 weeks after a paralysis and develops 2-4 weeks after a CampylobacterCampylobacter infection (after diarrheal signs infection (after diarrheal signs disappear).disappear).

CampylobacteriosisCampylobacteriosis It is caused primarily by It is caused primarily by Campylobacter jejuni, Campylobacter jejuni,

but also but also C. C. fetus fetus and C. coli. and C. coli. Sources Sources

Raw or undercooked poultryRaw or undercooked poultry Non-chlorinated waterNon-chlorinated water Raw milkRaw milk Infected animal or human fecesInfected animal or human feces

Poultry, cattle, puppies, kittens, pet birdsPoultry, cattle, puppies, kittens, pet birds

Clinical signsClinical signs Diarrhea, abdominal cramps, Diarrhea, abdominal cramps,

fever, nauseafever, nausea Duration: 2-5 daysDuration: 2-5 days

SalmonellosisSalmonellosis SalmonellaSalmonella is a gram negative bacteria with is a gram negative bacteria with

many serotypes that cause foodborne related many serotypes that cause foodborne related illnesses. The ones we most commonly associated illnesses. The ones we most commonly associated with human foodborne illness are S. typhimurium with human foodborne illness are S. typhimurium and and SS. enteritidis. enteritidis

They account for about 41% of all human cases They account for about 41% of all human cases reportedreported

causes an estimated 1.4 million reported cases causes an estimated 1.4 million reported cases annually with 580 deathsannually with 580 deaths

SalmonellosisSalmonellosis SourcesSources

Raw poultry and eggsRaw poultry and eggs Raw milkRaw milk Raw beefRaw beef Unwashed fruitUnwashed fruit Reptile pets: Snakes, turtles, lizardsReptile pets: Snakes, turtles, lizards

SignsSigns Onset: 12-72 hours Onset: 12-72 hours Diarrhea, fever, crampsDiarrhea, fever, cramps Duration: 4-7 daysDuration: 4-7 days

E. coliE. coli O157:H7 O157:H7 Escherichia coliEscherichia coli is another major pathogen of is another major pathogen of

foodborne related illnesses. foodborne related illnesses. Harmless strains of Harmless strains of E. coliE. coli are found in nature, are found in nature,

including the intestinal tracts of humans and including the intestinal tracts of humans and animals. animals.

Diarrheal disease is caused by several different Diarrheal disease is caused by several different strains of harmful strains of harmful E. coliE. coli. The most dangerous . The most dangerous type is enterohemorrhagic type is enterohemorrhagic E. coliE. coli (EHEC). (EHEC).

It gets its name because it can cause bloody It gets its name because it can cause bloody diarrhea and can lead to kidney failure in diarrhea and can lead to kidney failure in children or immunocompromised persons. children or immunocompromised persons. E. coliE. coli O157:H7 is the most common EHEC and its O157:H7 is the most common EHEC and its enterohemorrhagic toxin is what actually causes enterohemorrhagic toxin is what actually causes the diseasethe disease

E. coliE. coli O157:H7 O157:H7 SignsSigns

Watery or bloody diarrhea, nausea, Watery or bloody diarrhea, nausea, crampscramps

Onset: 2-5 daysOnset: 2-5 days Duration: 5-10 daysDuration: 5-10 days

SequelaSequela Hemolytic Uremic Syndrome (HUS)Hemolytic Uremic Syndrome (HUS)

Most commonly affecting children. HUS is Most commonly affecting children. HUS is the most common cause of acute kidney the most common cause of acute kidney failure in children.failure in children.

BotulismBotulism Botulism is caused by a neurotoxin from Botulism is caused by a neurotoxin from

Clostridium botulinumClostridium botulinum This toxin causes flaccid paralysis and This toxin causes flaccid paralysis and

cranial nerve deficits, and can lead to cranial nerve deficits, and can lead to death.death.

The most common sources are home-The most common sources are home-canned foods, fermented meats and honeycanned foods, fermented meats and honey

SignsSigns Double vision, drooping eyelids, difficulty Double vision, drooping eyelids, difficulty

speaking and swallowingspeaking and swallowing Onset: 18-36 hoursOnset: 18-36 hours

ShigellosisShigellosis Shigellosis is also known as bacillary dysenteryShigellosis is also known as bacillary dysentery Most cases are caused by Most cases are caused by Shigella sonneiShigella sonnei. .

However, However, S. dysenteriae, S. flexneri and S. boydiiS. dysenteriae, S. flexneri and S. boydii can also cause foodborne related illnesses.can also cause foodborne related illnesses.

Sources:Sources: Human fecal contamination of food, beverages, Human fecal contamination of food, beverages,

vegetables, watervegetables, water Signs:Signs:

Watery or bloody diarrhea, nausea, vomiting, cramps, Watery or bloody diarrhea, nausea, vomiting, cramps, feverfever

Onset: 2 daysOnset: 2 days Duration: 5-7 daysDuration: 5-7 days

ToxoplasmosisToxoplasmosis ToxoplasmosisToxoplasmosis is caused by an intracellular protozoan, is caused by an intracellular protozoan, Toxoplasma Toxoplasma

gondiigondii

It is one of the three leading causes of death from a foodborne It is one of the three leading causes of death from a foodborne disease the others were disease the others were SalmonellaSalmonella and and ListeriaListeria

Pregnant women and immunocompromised individuals, especially Pregnant women and immunocompromised individuals, especially HIV positive patients, are at the greatest risk of toxoplasmosisHIV positive patients, are at the greatest risk of toxoplasmosis

The source of this protozoan includeThe source of this protozoan include infected cats shedding in their infected cats shedding in their feces, soil, undercooked meat, and mechanical vectors such as feces, soil, undercooked meat, and mechanical vectors such as cockroaches and fliescockroaches and flies

Clinical signs in humansClinical signs in humans can by asymptomatic to fever, headache, can by asymptomatic to fever, headache, and swollen lymph nodes. If the protozoan cysts develop in tissue, and swollen lymph nodes. If the protozoan cysts develop in tissue, other more severe clinical signs can be observed. other more severe clinical signs can be observed.

To prevent infectionTo prevent infection, gloves should be worn while gardening, , gloves should be worn while gardening, changing cat litter boxes and thoroughly washing raw fruits and changing cat litter boxes and thoroughly washing raw fruits and vegetables before eating. Irradiation and thoroughly cooking meat vegetables before eating. Irradiation and thoroughly cooking meat to 160to 160ooF internal temperature to destroy the F internal temperature to destroy the ToxoplasmaToxoplasma cysts. cysts.

Emerging PathogensEmerging Pathogens

Cyclospora (Protozoan)Cyclospora (Protozoan) Sources >>>> Imported raspberriesSources >>>> Imported raspberries

Listeria monocytogenesListeria monocytogenes SourcesSources

Ready-to-eat meats, soft cheesesReady-to-eat meats, soft cheeses SignsSigns

Human abortions and stillbirthsHuman abortions and stillbirths Septicemia in young or low-immune Septicemia in young or low-immune

As stated earlier listeriosis is one of the 3 most As stated earlier listeriosis is one of the 3 most common causes of food borne related death.common causes of food borne related death.

Prevention and ControlPrevention and Control

HACCPHACCP Food producers and processors have implemented Food producers and processors have implemented

the the HACCPHACCP program in their operation to reduce program in their operation to reduce the possibility of food-borne pathogens.the possibility of food-borne pathogens.

The Hazard Analysis Critical Control Point The Hazard Analysis Critical Control Point (HACCP) program(HACCP) program is used to monitor and control is used to monitor and control the production process by identifying food safety the production process by identifying food safety hazards. Additionally, critical control points in hazards. Additionally, critical control points in production, processing and marketing are production, processing and marketing are identified. Critical limits for each of these points is identified. Critical limits for each of these points is established and monitored for food quality and established and monitored for food quality and safety. It is applied to the meat, poultry and egg safety. It is applied to the meat, poultry and egg industries.industries.

On Farm StrategiesOn Farm Strategies To help control To help control SalmonellaSalmonella Testing and removal Testing and removal

this is done through:this is done through: Serologic testing, fecal or hide culturing of animals to Serologic testing, fecal or hide culturing of animals to

identify carriers of the bacteriaidentify carriers of the bacteria VaccinationVaccinationIt is important to remember that vaccines are not 100% It is important to remember that vaccines are not 100%

effective, and with the various serotypes of bacteria and effective, and with the various serotypes of bacteria and immune status of animals, they should be used in immune status of animals, they should be used in accordance with other prevention methods.accordance with other prevention methods.

Minimize rodents, wild birdsMinimize rodents, wild birds as they are often carriers of bacteria,as they are often carriers of bacteria, will also help reduce the will also help reduce the

transmission.transmission. Isolation of new animalsIsolation of new animals will also help decrease the chance of spread.will also help decrease the chance of spread.

At the Slaughter PlantAt the Slaughter Plant FSIS (Food Safety Inspection Service)FSIS (Food Safety Inspection Service) has Identified target organisms :has Identified target organisms :

SalmonellaSalmonella and and E. coliE. coli Control pointsControl points

Removal of internal organs.Removal of internal organs. Minimize contact between carcasses.Minimize contact between carcasses. Proper movement through facilities .Proper movement through facilities . Chilling .Chilling . Cooking processes (proper time, Cooking processes (proper time,

temperature).temperature).

At HomeAt Home

Drink pasteurized milk and juices.Drink pasteurized milk and juices. Wash hands carefully and frequentlyWash hands carefully and frequently

After using the bathroom.After using the bathroom. Changing infant’s diapers.Changing infant’s diapers. Cleaning up animal feces.Cleaning up animal feces.

Wash hands before preparing food.Wash hands before preparing food.

At HomeAt Home

Wash raw fruits and vegetables Wash raw fruits and vegetables before eatingbefore eating

After contact with raw meat or After contact with raw meat or poultrypoultry Wash hands, utensils and kitchen Wash hands, utensils and kitchen

surfaces.surfaces. Hot soapy water.Hot soapy water.

Defrost meats in the refrigeratorDefrost meats in the refrigerator

At HomeAt Home

Cook beef/beef products thoroughlyCook beef/beef products thoroughly Internal temperature of 160Internal temperature of 160ooFF

Cook poultry and eggs thoroughlyCook poultry and eggs thoroughly Internal temperature of 170-180Internal temperature of 170-180ooFF

Eat cooked food promptlyEat cooked food promptly Refrigerate leftovers within 2 hours Refrigerate leftovers within 2 hours

after cookingafter cooking Store in shallow containersStore in shallow containers

Special AttributesSpecial Attributesto Dr. Farahto Dr. Farah