FOOD BORNE DISEASES

1. FOOD BORNE DISEASES Moderator –Dr B S Garg Presenter - Dr Gaurij Hood

2. Food borne Diseases 1.Introduction 2.Pathogenesis and Transmission 3.Important foodborne pathogens/toxins/chemicals 4.Investigations and Lab diagnosis 5.Treatment and Prevention

3. 1.Introduction Food borne diseases-(intoxications and infections) Covers illnesses acquired through consumption of contaminated food-food poisoning Food bornedisease outbreaks- Occurrence of 2 or more cases of similar illness resulting from ingestion of common food OR When observed number of paticular disease exceeds expected number

4. 1.Introduction Global burden- highmorbidity and mortality Infectious diarrhoea- 3 to 5 billion cases and 1.8 million deaths annually CDC- 76 million cases of food borne diseases in US annually with appx.5000 deaths In India- Integrated disease surveillance Project (IDSP) - Food poisoning outbreak reporting increased to more than double in 2009 from 2008 (120 in 2009 and 50 in 2008)

5. Food borne infections vs intoxication Infections Bacterial / Viral / parasite Invade and or multiply in lining of intestine Incubation period- hours to days S/s – Diarrhoea , nausea, vomitting , abdominal cramps, fever Communicable-spreads from person to person Factors-inadequate cooking, cross contamination , poor personal hygiene , bare hand contact Intoxications toxins ( natural / preformed bacterial / chemical) No invasion or multiplication Incubation period- minutes to hours S/s – Vomitting , nausea, diarrhea , diplopia, weakness, resp. failure , numbness, sensory/motor dysfunction Not communicable Factors-inadequate cooking , improper handling temperatures

6. Epidemiology in India

7. Epidemiology in India

8. Some important food-borne pathogens, toxins and chemicals 1. Bacteria - Bacillus cereus , Brucella , Campylobacter, Clostridium sp , E.coli, Salmonella sp , Listeria , Staph aureus , Vibrio cholera and V.parahemolyticus 2. Viruses - Hepatitis A and E , Rotavirus , Norvovirus 3. Protozoa – Cryptosporidium , Cyclospora , Entamoeba , Giardia , T. gondii 4. Trematodes , Cestodes and Nematodes

9. Food borne pathogens-toxins and chemicals Toxins - marine biotoxins , tetrodotoxin (puffer fish), pyrrolizidine alka (Endemic ascites) , mushroom toxins , shellfish toxins , mycotoxins-(Aflatoxins ,Ergot and Fusarium), plant intoxicants , BOAA (Lathyrism) Chemicals - pesticides (OPP,sb) , radionuclides , nitrites (food preservatives) toxic metals - cd, cu, hg, pb, sn, fluoride , MSG

10. Pathogenesis and Transmission Inoculum / size of infective dose -Can be as small as 10-100 bacterial cysts for Shigella , EHEC , Giardia, E. histolytica or 10^ 5-10^ 8 for Vibrio cholera, variable for salmonella Animals / humans harbouring infection  shed in feces  contaminate water , fruits , vegetables inadequate cooking / improper storage  infection Warm temperature(10-50 degree cent.)- multiplication of pathogens

11. Some common bacterial food poisons

12. Some common bacterial food poisons

13. Some common bacterial food poisons

14. Early diagnosis and investigations 1.Initial assessment of cases – Detailedclinical history including time of onset , duration of illness , symptoms , h /o travel , recent meals , cooking and refrigeration , details of others with similar complaints 2.Detailed clinicalexamination – Vitals and degree of dehydration , systemic signs

15. Lab diagnosis Main objectives- a) To confirm clinical diagnosis by isolation of causative agent from proper samples , eg . stool , vomitus / gastric aspirate , food specimens b) Ensure proper identification of disease c) Determine causative agent if present in food sources with relevant epidemiological markers- eg. Biotyping , serotyping , PCR , Phage typing etc

16. Collection of food samples Using aseptic technique n appropriate containers  samples be refrigerated during storage and transport  must arrive lab within 3 days of collection Adequate sample - minimum 100 grams Containers - not to be filled >75% of capacity Proper labelling is utmost important  labelled specimen be placed in zip lock bag and sealed Vaccine carrier with ice packs for transport and cold chain maintenance ( avoid freezing )

17. Steps of outbreak investigation Establishing existence Co-ordination Collection and transport Lab testing Control and preventive measures Definition of cases, population Description of epidemiology Possiblehypotheses Epidemiological study Analysis of data and interpretation Reporting

18. Treatment 1. Initial T/t - Assessment and reversal of dehydration ( ORT / IV Fluids ) 2. Cause specific treatment if any- eg. chelating agents in case of pesticide poisoning 3. Use of antibiotics can be considered if bacterial cause is identified

19. Prevention in community Proper handwashing and personal hygiene Proper storage (refrigeration) Food saftey education – community and food handlers Environmental measures - Discourage sewage farming for growing fruits and vegetables

20. Prevention Hazard Analysis and Critical Control Point (HACCP) - Systematic preventive approach to food safety Addresses physical , chemical and biological hazards as means of prevention rather than finished product inspection Food industry - Food safety hazards identified at all stages of food production and preparation processes  key action taken at Critical Control Points (CCP s)

21. Principles of Hazard Analysis and Critical Control Point ( HACCP ) Analyse hazards  Identify critical control points  Establish preventive measures with critical limits for each CCP  Establish procedures to monitor CCPS  Establish corrective actions when monitoring shows that critical limit has not met  Establish procedures to verify that system is working properly  Establish effective record keeping for documentation

22. Safety Regulations • Prevention of Food Adulteration Act , 1954- • To Ensure pure and wholesome food and to protect from fradulent practices • Amendments -1964,1976,1986 • Case of proven adulteration –Minimum imprisonment of 6 months and minimum fine of Rs 1000 envisaged • Grievous Hurt-(320 IPC)- Death or such harm can be punished upto Life imprisonment and fine not <Rs 5000 • Food Standards- Codex Alimentarius , Agmark standards, • Bureau of Indian Standards • National Nutrition Policy -1993- Food Security

23. Five keys to Safer food 1. Keep Clean – Wash hands before handling food and often during preparation Wash hands after going to toilet Wash n sanitise all surfaces n equipment for food preparation-protect kitchen from insects , pets 2. Separate raw and cookedfood- Separate raw meat , poultry n seafood from other foods Use separate utensils for handling raw foods Store food in containers to avoid contact between raw and cooked foods

24. Five Keys to Safer Food 3. Cook Thoroughly – esp. Meat , poultry , eggs and Seafood Bring soups n stews to boiling (ensure>70degree temp) Reheat cooked food thoroughly 4. Keep food at safe temperature - Dont leave cooked food at room temp.>2 hours Prompt refrigeration of cooked n perishable food Keep cooked food piping hot(>60 de.) prior to serving Don’t store food too long even in refrigerator Don’t thaw frozen food at room temperature

25. Five keys to safer food 5. Use safe water and raw materials- Use safe water or treat to make it safe Select fresh and wholesome fruits Choose foods processed for safety - pasteurised milk Wash fruits n vegetables if eaten raw Don’t use food beyond expiry date

26. References 1. CD Alert – December 2009, vol.13:No.4 – Food Borne Diseases, page no. 1-12 2.Parks Textbook of PSM , Twentieth Edition, Intestinal infections –Food Poisoning , page no. 210-212 3.Internet- www.nicd.nic.in

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