Salmonella

1. Salmonella • This presentation focus on efforts to make the population at that are risk the awareness of Salmonella. It offers suggestions of ways of effective plans for prevention.

2. SalmonellaKelly Staten Ph.D. Public HealthWalden UniversityPUBH 8165Dr. Howard RubinSecond Term, 2010 Salmonella Infections

3. Audience • This Project includes fact sheets written with at-risk citizens in mind. Infants and young children, pregnant women, older adults, and people with weakened immune systems caused by cancer treatment, diabetes, AIDS, and bone marrow and organ transplants are at greatest risk for food borne illness. U.S. Department of Agriculture, (2010) Food Safety and Inspection Service

4. What is Salmonellosis? • Salmonellosis is an infection with a bacteria called Salmonella. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons the diarrhea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the • blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. • Centers for Disease Control and Prevention, (2010)

5. Causes • Salmonella bacteria live in the intestines of people, animals and birds. Most people are infected with salmonella by eating foods that have been contaminated by feces. U.S. Department of Health & Human Services, (2006) http://www.FoodSafety.gov

6. Symptoms • People who get infected with Salmonella develop diarrhea, • Fever • Vomiting • Abdominal cramps www.fda.gov

7. How To Prevent • By not eating raw eggs. • By avoiding food, that contains raw eggs (such as cookie dough, Caesar salad dressing) • By making sure your chicken is cooked thoroughly. • By making sure you prevent cross contamination. • Poultry and meat, including hamburgers, should be well-cooked, not pink in the middle. Department of Health and Human Services, (2010) Centers for Disease and Prevention

8. How To Prevent (cont’d) • Use separate cookware when preparing raw chicken and cooked products. • Wash your hands before dealing with cooked food. • Produce should be thoroughly washed before consuming. • People should wash their hands after contact with animal feces. U.S. Food and Drug Administration, (2010) Protecting and Promoting your Health

9. Wash your hands • Washing your hands thoroughly can help prevent the transfer of salmonella bacteria to your mouth or to any food you're preparing. Wash your hands after you: • Use the toilet • Change a diaper • Handle raw meat or poultry • Clean up pet feces • Touch reptiles or birds Centers for Disease Control and Prevention, (2010) Managing acute gastroenteritis among children: Oral rehydration, maintenance and nutritional therapy Atlanta, Ga.

10. Keep Things Separate • Store raw meat, poultry and seafood away from other foods in your refrigerator • If possible, have two cutting boards in your kitchen - one for raw meat and the other for fruits and vegetables US Department of Health and Human Services, (2010) http://www.niaid.nih.gov

11. Facts • It’s a illness that can be spread by roaches or rodents. • The illness is commonly called "food poisoning“ because people get sick from eating. • It is also a widespread in the intestines of birds, reptiles and mammals. • Its a bacteria found naturally in the feces of many animals, including turtles, that can cause food poisoning in humans when ingested. Fact sheet: Salmonella questions and answers. Food Safety and Inspection Service, United States Department of Agriculture. http://www.fsis.usda.gov/factsheets/salmonella_questions_&_answers/index.asp. Accessed Jan. 28, 2009.

12. Top Causes of Poisoning

13. 2010 Outbreak • This year there was a very big recall on eggs that were infected with salmonella. • About 1,500 people got sick which led to the recall of 550 million eggs. • www.fda.gov

14. Raw Meat, Poultry and Seafood. • Feces may get on to raw meat and poultry during the butchering process. Seafood may be contaminated if it is harvested from contaminated water. United States Department of Agriculture (USADA), 2010

15. Raw Eggs • While an egg's shell may seem to be a perfect barrier to contamination, some infected chickens produce eggs that contain salmonella before the shell is even formed. Raw eggs are used in homemade versions of mayonnaise and hollandaise sauce. Mayo Foundation for Medical Education and Research, 1998-2010 (MFMER).

16. Fruits and Vegetables. • Some fresh produce, particularly imported varieties, may be watered in the field or washed during processing with water contaminated with salmonella. Contamination can also occur in the kitchen, when juices from raw meat and poultry come into contact with uncooked foods, such as salads. Mayo Foundation for Medical Education and Research, 1998-2010 (MFMER).

17. Risk Factors • International travel. Salmonella infection, including the varieties that cause typhoid fever, is more common in developing countries with poor sanitation. • Owning a pet bird or reptile. Some pets, particularly birds and reptiles, can be infected with salmonella bacteria. • Living in groups. People who live in college dorms or nursing homes might be at higher risk of infection simply because they are exposed to more people. In addition, food prepared at institutions often uses large amounts of ground meat or unshelled eggs that have been pooled from many different sources. This allows one infected egg or one pound of infected hamburger to contaminate the entire batch Mayo Foundation for Medical Education and Research, 1998-2010 (MFMER).

18. Who is most at risk for getting Salmonella Enteritidis? The elderly, infants, and those with impaired immune systems may have a more severe illness. In these patients, the infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. Centers for Disease Control and Prevention Page last updated: September 7, 2010 Content source: National Center for Emergency and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases.

19. Treatments and DrugsMedications • Antidiarrheals. Medications like loperamide (Imodium) can help relieve cramping, but they may also prolong the diarrhea associated with salmonella infection. • Antibiotics. If your doctor suspects that salmonella bacteria have entered your bloodstream, he or she may prescribe antibiotics to kill the bacteria. Mayo Foundation for Medical Education and Research, 1998-2010 (MFMER).

20. CDC's Role in Food Safety • As an agency within the U.S. Department of Health and Human Services (HHS), CDC leads federal efforts to gather data on foodborne illnesses, investigate foodborne illnesses and outbreaks, and monitor the effectiveness of prevention and control efforts. CDC is not a food safety regulatory agency but works closely with the food safety regulatory agencies, in particular with HHS's U.S. Food and Drug Administration (FDA) and the Food Safety and Inspection Service within the United States Department of Agriculture (USDA). CDC also plays a key role in building state and local health department epidemiology, laboratory, and environmental health capacity to support foodborne disease surveillance and outbreak response. Centers for Disease Control and Prevention, (2010)

21. Did You Know? • NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov US Department of Health and Human Services, (2010)

22. Public Health Focus The ongoing investigation into the salmonella outbreak source is being carried out by the FDA, the Centers for Disease Control and Prevention, and various state health agencies, as well as Daniele International Inc based out of Rhode Island.The FDA says the meat processor has already stopped using the black pepper in stock.  A voluntary recall has been issued earlier for the possible tainted salami/salame sausage products.However, the FDA warns that because the shelf-life for the sausage products is one year and chances are good that the recalled Italian style salami/salame products may still be kept in grocery stores and in food consumers' home refrigerators or freezers. The health agency advised that food consumers should learn to ascertain whether or not the sausages they keep or use are being recalled. If they are, they should be wrapped and disposed of carefully. Food consumer, (2010)

23. Conclusion • Despite prevention and control efforts, Salmonella remains the leading cause of foodborne gastroenteritis outbreaks in developed countries. Changes in dietary habits, changes in modes of food production and distribution, and increases in the size of more vulnerable populations have been implicated as contributing factors. In humans, Salmonella may cause sporadic disease, family outbreaks, and community outbreaks either limited to a defined population or spread community-wide. In France, Salmonella is involved in 75.6 percent of reported foodborne outbreaks with an identified causative organism, 70 percent of which occur in a family household. Johns Hopkins Bloomberg School of Public Health, (2010) American Journal of Epidemiology

24. References • L Knodler et al. Dissemination of invasive salmonella via bacterial-induced extrusion of mucosal epithelia Proceedings of the National Academy of Sciences DOI: 10.1073/pnas.1006098107 (2010). Mayo Foundation for Medical Education and Research, 1998-2010 (MFMER) • US Department of Health and Human Services, (2010) • www.niaid.nih.gov • www.fda.gov • Food consumer, (2010) • Centers for Disease Control and Prevention, Page last updated: September 7, 2010 • National Center for Emergency and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases. • U.S. Department of Health & Human Services, www.FoodSafety.gov

25. References (cont’d) • Salmonellosis. Centers for Disease Control and Prevention www.cdc.gov/nczved/dfbmd/disease_listing/salmonellosis_gi.html. Accessed Jan. 28, 2009 • Salmonella enteritis. Centers for Disease Control and Prevention www.cdc.gov/ncidod/dbmd/diseaseinfo/salment_g.htm. Accessed Jan. 28, 2009 • Fact sheet: Salmonella questions and answers. Food Safety and Inspection Service, United States Department of Agriculture. www.fsis.usda.gov/factsheets/salmonella_questions_&_answers/index.asp. Accessed Jan. 28, 2009 • U.S. Food and Drug Administration, (2010) Protecting and Promoting your Health • U.S. Department of Agriculture, (2010) Food Safety and Inspection Service

26. References (cont’d) • Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day –cdcinfo@cdc.gov (TTY) Page last modified: August 20, 2010 • United States Department of Agriculture. (USADA), 2010 info@eggsafety.org • Johns Hopkins Bloomberg School of Public Health, (2010) American Journal of Epidemiolgy

27. Additional Resources Public Health Laboratory Information System (PHLIS) National Electronic Telecommunications System for Surveillance (NETSS) FoodNet National Molecular Subtyping Network for Foodborne Diseases Surveillance (PulseNet) Electronic Foodborne Outbreak Reporting System National Antimicrobial Resistance Monitoring System (NARMS) Annual summaries of the PHLIS Salmonella surveillance data can be found at www.cdc.gov/ncidad/dbmd/phlisdata/salmonella.htm Additional information and related links are available at www.cdc.gov/nationalsurveillance.index.html