Elaheh Sayyad PhD student of Pubic Health Walden University

1. ElahehSayyadPhD student of Pubic HealthWalden University Foodborne illness- Salmonella April 21, 2013

2. Salmonellosis • Salmonellosis is an infection with bacteria called Salmonella. Salmonella serotype typhimurium and Salmonella serotype enteritidis are the most common in USA. The infected persons developed: • Diarrhea • Fever and abdominal cramps 12 -72 hours after infection.

3. Infected by Salmonella • Salmonella live in the intestinal tracts of humans and animals (such as birds). • Human by eating foods contaminated with animal feces • Contaminated foods are beef, milk, eggs, and poultry, also vegetables can be contaminated. • Foods can be contaminated by the hands of an infected food handler • Salmonella may also found in the faces of some pets, especially those with diarrhea, and people can become infected after contact with pets or pet feces.

4. Our Ecosystem

5. Diagnostic Test The diagnostic laboratory tests that identify salmonella in the stool of an infected person.

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

7. Explanation of Fig.2 • Fig.1. The Laboratory confirmed Salmonella incidence rate per 100,000 population , by age group, as compared to the overall incidence rate and the national health objectives for 2010 and 2020, United States (CDC, 2011). • The incidence of laboratory confirmed salmonella infection was 17.6 cases per 100,000 persons in 2010 (Red Line).This was more than twice the US Healthy People 2010 objective of 6.8 cases per 100,000 persons (Blue line).

8. Healthy People 2020 • Per CDC the incidence of salmonella infections in 2010 was significantly higher than during 2006-2008 representing an increase of about 10% with the confidence interval of 95%.

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

10. Cont. A Case of Salmonella • Among 94 persons were hospitalized. Three deaths were reported in Kentucky. • 55% of the patients were female • Per FDA and Indiana State Department of Health regulatory inspection, the outbreak of the salmonella of the Chamberlain farms may due to one of the following conditions: Equipment Design & Packing and Holding

11. Packinghouse Area • Packinghouse and equipment sanitary design • Pest control/intrusion • Cleaning and sanitizing practices • Washing and drying the fresh and raw product • Cooling, Packing , and transportation

12. Cont. A Case of Salmonella • Equipment Design: • Food contact and non- food contact surfaces at the farms packinghouse were constructed of materials that could not be effectively cleaned or sanitized. Specially, carpeting was used as cushioning and wood was used as directional mechanism for conveyances. • Multiple locations of the conveyer food contact surfaces used to transport cantaloupe such as rollers and belts were noted to have an accumulation of organic materials and biofilms.

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

14. Cont. A Case of Salmonella 2. An accumulation of debris including trash, wood, and dirt was observed the conveyer belt in the cantaloupe packinghouse (FDA, 2013). 3. Cantaloupes were not pre-cooled after packing before shipment to retail stores (FDA, 2013)

15. Good Agriculture Practice (GAP) • Areas of focus for the agricultural production operations included: • Agricultural water • Soil amendments • Harvesting and transporting to the packinghouse • Animal intrusion • Adjacent land use • Employee health and hygiene practice

16. The Food Production Chain

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

18. Cont. The Food Production Chain • Processing means changing plants or animals into buying as food. Processing involves different steps for different kinds of foods (CDC, 2009). Processing can be : • Cleaning and sorting • Rimming , slicing or shredding and bagging. • Example of contamination in processing; peanut butter can become contaminated if roasted peanuts are stored in unclean conditions or come into contact with contaminated raw peanuts (CDC, 2009).

19. Incidence of Salmonella Link to Live Poultry

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

21. Government Responsibilities • The CDC monitors the frequency of Salmonella infections in the country and assists the local and State health departments in investigating outbreaks and devising control measures (CDC, 2010). • CDC monitors the types of Salmonella that are reported • The Food and Drug Administration (FDA) inspects imported foods, oversees inspection of milk pasteurization plants, and promotes better food preparation techniques in restaurants and food processing plants (CDC, 2010).

22. Hand Washing

23. Prevention of Salmonella • Wash hands before starting preparing food • Cook poultry until it reaches an internal temperature of 165 F • Cook beef and pork until they reach 160 F • Cook egg until they reach 160 F or until the yoke is solid • Do not eat or drink foods containing raw eggs • Do not drink raw or unpasteurized milk • Avoid using the microwave for cooking the foods of animal origin

24. Cont. Prevention of Salmonella • Avoid cross contamination. Should not allow foods that not cooked to come into contact with raw foods of animal origin • Wash hands after handling reptiles, amphibians or birds • Do not use an alcohol based (waterless) sanitizer instead of washing the hands when cooking or when hands are visibly soiled. • Hands should be washed with soap and clean warm running water for 20 second.

25. References • Centers for Disease Control and Prevention ( May, 2008). National Center for Emerging and Zoonotic infectious Diseases: Salmonellosis. Retrieved April 10, 2013 from: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/salmonellosis/#what • Centers for Disease Control and Prevention (Jan, 2010). Foodborne Outbreak Investigations. Retrieved April 13, 2013 from: http://www.cdc.gov/outbreaknet/investigations/figure_food_production.html

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

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

28. References • Choctaw Nation Health Services (2013). Hand Washing. Retrieved May 11, 2013 from: http://www.cnhsa.com/hand-washing.aspx • KnowSalmonella (2008). Public Health. Retrieved May 12, 2013 from: http://www.knowsalmonella.com/en/foodsafety.html • Mayo Clinic (April, 2011). Salmonella Infection : Prevention. Retrieved April 17, 2013 from: http://www.mayoclinic.com/health/salmonella/DS00926/DSECTION=prevention

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

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