Foodborne Illness Focusing on Salmonellosis

1. Foodborne IllnessFocusing on Salmonellosis Alfredo Cardoso, MPH Student Walden University PUBH 6165-3 Instructor: Dr. Raymond Thron Spring Quarter, 2014

2. Local Restaurant Owners & Food Handlers

3. We Will Answer… • What is a foodborne illness? • What is salmonellosis? • How do we get it? • How do we prevent it? • How do we prepare food safely? • How do we report an outbreak? • What has been done about salmonellosis?

4. Foodborne illnesses are diseases that are transferred to humans by ingesting or using contaminated water or food. Many different germs and chemicals are able to contaminate food and water. We will focus on salmonellosis for this presentation. WHO (2014). Foodborne diseases. Retrieved from http://www.who.int/topics/foodborne_diseases/en/

5. Salmonellosis is the disease caused by non-typhoidal Salmonella enterica subspecies. • Is a common bacterial infection which can be completely asymptomatic in some people while in others can become life threatening. Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

6. Salmonellosis in Numbers • During the year 2013, CDC identified 19,000 food-related infections, 4200 hospitalizations, and 80 deaths in the United States. • Salmonellosis accounted for 35% of all the foodborne disease cases, around 6650 infections. CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

7. Recent Outbreaks in the United States • January, 2014: An outbreak of Salmonellosis involving several states was caused by raw cashew cheese. The outbreak affected people living in California, Nevada, and Wyoming. There were 17 reported cases, 3 hospitalizations and no deaths. The cheese was effectively recalled and taken from shelves. • February, 2014: An outbreak of Salmonellosis was attributed to Tyson brand chicken. The cases were reported by a correctional institution in Tennessee. The total of cases was 9, and 2 of them needed hospitalization, no deaths were reported. The chicken was recalled. CDC (2014). Recent salmonella outbreaks. Retrieved from http://www.salmonella/Heidelberg-01-14/index.html

8. Symptoms of Salmonellosis • Nausea • Vomiting • Abdominal cramps • Fever • Chills • Headache • Blood in stool • Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

9. Disease Progression • Generally people develop symptoms within 8 to 72 hours after infection. • Most healthy people recover within a week without specific treatment. • The diarrhea and vomiting can cause dehydration that requires medical attention. • The worst case scenario is when the bacteria spreads beyond the GI tract and reaches blood stream, bacteremia is life threatening and requires fast and aggressive treatment. Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

10. Salmonellosis Usual Targets • Infants and young children • Elderly persons • Immune-compromised persons such as HIV/AIDS patients, organ transplant recipients, those with sickle cell disease, and malaria patients. • All of the above mentioned tend to show worst symptoms and complications from salmonellosis CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

11. Salmonella Hosts • People can be at risk for Salmonellosis when handling animals including: • Dogs • Pet chickens and ducks • Reptiles • Cats Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

12. How does Salmonella contaminates food? • The bacteria lives in the intestines of humans, animals, and birds. • The most common way to contaminate food is with poor hygiene, the food gets in contact with feces when food handlers do not wash their hands Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

13. Commonly Infected Foods: • Raw poultry, meat, and seafood. • Raw eggs. • Fruits and vegetables. • Cross-contamination occurs in the kitchen when contaminated raw food (meat, poultry, etc.) gets in contact with uncooked foods, such as salads. CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

14. Making Food SafeRecommendations for Food Handlers • Both professional and domestic food handlers must observe hygienic rules of food preparation. • Professional food handlers must inform their supervisor right away if they are suffering from fever, diarrhea, vomiting and/or skin lesions that are visible and exposed. • The five keys to safer food defined by the World Health Organization (WHO) are extremely important to prevent foodborne illnesses, and they are: • Keep clean (surfaces and kitchen in general). • Separate raw and cooked foods (avoids cross-contamination). • Cook thoroughly (kills bacteria responsible for diseases). • Keep food at safe temperatures (prevent food from spoiling). • Use safe water and raw materials (we can only hope). CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

15. Prevention • Wash hands thoroughly before and after food consumption and preparation. • Do the same with children, make sure they wash their hands after playing with pets. • Raw eggs, meat, and poultry must be treated as if they were contaminated and handled with care. • When refrigerating food avoid dripping from one food to another. Use proper containers or place them on the bottom shelf of the refrigerator. • Avoid eating raw or undercooked eggs. • Avoid drinking and using unpasteurized milk or milk products. • Always wash hands thoroughly with soap after visiting the restroom. CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

16. More About Prevention • Extra attention must be taken when preparing nourishments for babies, seniors and immune-depressed persons. • Keep everything clean. Take extra caution when handling raw meat or poultry. • Wash hands after changing diapers. • Avoid direct or indirect contact between reptiles and people at risk. • Children should avoid handling or playing with baby ducks, baby chicks, and their surroundings. CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

17. Getting Food Handlers Certified Many leading restaurant companies (McDonald’s, P.F. Chang, Denny’s, among others) are taking advantage of online certification classes for managers and food handlers. The classes cover safe practices when preparing and storing food, and they focus on foodborne disease prevention. The courses include tips on personal hygiene, avoiding cross-contamination, food allergy, cooking time and temperature, storing food safely, cleaning and sanitation of cooking utensils and the kitchen. Getting food handlers and managers certified is a big deal in preventing foodborne disease and keeping a restaurant open and safe to all. Serv Safe (2014). About our program. Retrieved from https://www.servsafe.com/ss/FoodHandler/index.aspx

18. Local Statistics on Salmonellosis • The data shows the numbers for 2012. • The incidence rate is per 100,000. DSHSTX (2013). Salmonellosis data for Texas. Retrieved from http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=29853&id=8589960296&terms=salmonellosis

19. Government involvement in Salmonellosis? • The CDC monitors the frequency and severity of Salmonella outbreaks and helps local health department in investigating, responding, and solving outbreaks. • The Food and Drug Administration (FDA) inspects processing plants, checks milk pasteurization processes, inspects imported foods, and regulates the sales of turtles one of the carriers of Salmonella. • The US Department of Agriculture (USDA) keeps track of the animals’ health and their handling, inspecting slaughtering facilities, oversees the quality of meat and poultry, and inspects egg pasteurization plants. • A program known as the National Antimicrobial Resistance Monitoring System (NARMS) is in charge of tracking antimicrobial resistance of Salmonella bacteria in humans and animals. CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

20. Take Home Message Hand washing and proper food handling is the most powerful weapon to fight salmonellosis.

21. How to Report a Foodborne Illness Outbreak • First contact your local health department at www.houstontx.gov/health/Epidemiology/foodborneform.html • Contact CDC about a foodborne illness, dial • 1-800-CDC-INFO

22. More Information About Salmonellosis Available At www.cdc.gov/nczved/divisions/dfbmd/diseases/salmonellosis/ www.fda.gov/Food/default.htm www.fsis.usda.gov/wps/portal/fsis/home www.foodsafety.gov/poisoning/causes/bacteriaviruses/salmonella/index.html www.cdc.gov/salmonella/outbreaks-2014.html Just Click on the Link to Open the Web Page

23. References: CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html CDC (2014). Recent salmonella outbreaks. Retrieved from http://www.salmonella/Heidelberg-01-14/index.html DSHSTX (2013). Salmonellosis data for Texas. Retrieved from http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=29853&id=8589960296&terms=salmonellosis Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition Serv Safe (2014). About our program. Retrieved from https://www.servsafe.com/ss/FoodHandler/index.aspx WHO (2014). Foodborne diseases. Retrieved from http://www.who.int/topics/foodborne_diseases/en

24. Any Questions???