EMERGING FOODBORNE PATHOGENS

Prof.

Dr. İrfan EROL , DVM, Ph.D. Turkish Representative of World Vet. Assoc.

Department of Food Hygiene and Technology School of Veterinary Medicine Ankara University

 Despite advances in hygiene, consumer knowledge, food treatment and processing, foodborne diseases mediated by pathogenic microorganisms or microbial toxins still represent a significant treat to public health worldwide.

 Globally, the WHO has estimated that approximately 1.5 billion episodes of diarrhea and more than 3 million deaths occurred in children under 5 years of age, and a significant proportion of these results from consumption of food mainly food of animal origin with microbial pathogens and toxins

Emerging & Reemerging Zoonotic Diseases

 60 % of the human pathogens are zoonotic  75 % of emerging zoonotic

Emerging Foodborne Pathogens

 Definition: those causing illnesses that have only

recently appeared

or been recognised in a population or that are well recognised but are

rapidly increasing

in incidence or geographic range

Emerging Foodborne Diseases

 Appeared recently  Extended to new vehicles of transmission  Started to increase rapidly in incidence or geographic range  Been widespread for many years but only recently identified through new or increased knowledge or methods of identification and analysis of the disease agent

Emerging Foodborne Diseases

 Pose a threat to all persons; no matter on age, sex, lifestyle or socio-economic status etc.

 Feel pain and death  Economic impact

Emerging Foodborne Diseases Major trends

        Changes in environment (technology, climate, etc) Mass production and globalisation of food supply Economic development International travel and trade Changing character of the population Breakdown in public health Lifestyle changes Microbial adaptation

Emerging Foodborne Pathogens



Bacteria



Viruses



Parasites



Prion

Emerging foodborne bacteria



Salmonella

(multidrug resistant strain) 

Campylobacter jejuni



E. coli

O157:H7 

Listeria monocytogenes



S. aureus

MRSA 

Vibrio vulnificus



Yersinia enterocolitica



Arcobacter

spp. 

Mycobacterium paratuberculosis

Emerging foodborne viruses

 Hepatit A and E  Norovirus  (Avian influenza, AI)

Emerging foodborne parasites



Cryptosporidium parvum



Cyclospora cayetanensis



Anisakis

spp.

Foodborne outbreaks 1996 - 2006

 ▼ ● ▼  ● ● ▼ ▼ ▼ ● ● ●  ● ●  ● ● ● ●  ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ●  ▼

●

 ●

Cryptosporidiosis, Leptospirosis, Lyme borreliosis Brucellosis, E. coli 0157, Salmonellosis BSE Reference: WHO

Reference: CDC



WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 8th Report 1999-2000 Country Reports: Turkey

Pathogen Emerging foodborne diseaeses estimated annually Cases No. of No. of Ilnesses Deaths

1,963,141 10,539 99

Economic losses from foodborne diseases estimated annualy $ billion

1.2

Campylobacter

spp.

Salmonella non typhoidal E. coli O157:H7 Total

1,341,873 62,458

E. coli non-O157 STEC

L. monocytogenes

31,229 2,493 3,401,194 15,608 1,843 921 2,298 31,209 553 52 26 499 1,229 2.4

.7

.3

2.3

6.9

Reference: USDA’s Economic Research Service & CDC

Some Important

Salmonella

Outbreaks in the World

Year Country 1991

Germany

Food

Orange cream

Serotype/Phage type No. of cases No. of deaths

S

.Enteritidis PT4 109 4

1991

Germany

1994

U.S.A

Puding (egg) Ice cream

S

.Enteritidis

S

.Enteritidis

87 224000 10

2003

U.S.A

Chicken

2005

Spain

2006 2008

Norway Ireland&U.K

Processed chicken Salami Beef, chicken

S.

Typhimurium 38

S

. Hadar

S

. Kedougou

S

. Agona 2138 1 54 119 1

Salmonella

serotype distribution in Turkey

(Erol et al., 2009) 

S

. Agona 

S

. Kentucky 

S

. Bredeney Spices

Some Important

Campylobacter

Outbreaks in the World

Year 2007 Country 2000

U.K & Wales

2001-2002

Australia

2005 2005

Denmark Scotland

2005-2006

U.S.A

2007

U.S.A

Denmark

Food

Raw milk Chicken Chicken salad Chicken pate Water Cheese (from unpasteurized milk) Water

No. of cases

333 601 4 82 32 67 16

Campylobacter jejuni

Quinolone- and fluoroquinolone-resistant

Campylobacter jejuni

States, 1982 –2001 in the United

Campylobacter jejuni

Thermophilic Campylobacter spp. in turkey meat (n=270) (Cakmak and Erol, 2009)

 Thermophilic

Camylobacter

spp. 123 (45.5%)   

C. jejuni

109 (40.3 %)

C. coli

11 ( 4.0 %) Not typed 3

100 bp 500 bp 735 bp

Antibiotic resistance profile of

C. jejuni

isolates in turkey meat (Cakmak and Erol, 2009)

Antibiotics Azithromycin Resistant %

104 (95.4)

Erythromycin Gentamicin Chloramphenicol

0 103 (94.4) 0

Nalidixic acid Ciprofloxacin Tetracycline

10 (9.1) 19 (17.4) 40 (36.6) 0 0

Intermediate %

2 (1.8) 3 (2.7) 0 0 2 (1.8)

Sensitive %

3 (2.7) 6 (5.5) 109 (100.0) 106 (97.2) 99 (90.8) 90 (82.5) 67 (61.4)

Some important E. coli O157:H7 Outbreaks in the World Country Japan U.S.A

Canada Sweden Year

1996 1999 2000 2002

No of cases(age)

>5499 (students) 321 27 39

U.S.A

U.S.A

2002

Netherlands

2005 2006 34 32 376 -

Complications

12 deaths

Infection source

Alfalfa 5 deaths 5 HUS 3 deaths Beef Water Fermented sausage Ground beef Steak tartare Fresh spinach

E. coli O157:H7 isolates found in fecal samples of cattle and sheep at slaughter in Turkey (Erol et al., 2008) Sheep Cattle Cattle (male) Cattle (female) Total 282 207 75 500 Number of samples Number of positive samples Percent (%) 218 14 6.42

11 3.90

7 3.38

4 5.33

25 5.00

stx 1 stx 2 eaeA hly H7 Positive 7 9 11 11 11 Negative 4 2 Total 11 11 11 11 11 Toxin profiles of E. coli O157:H7 isolated in Turkey (Erol et al., 2008)

Toxin profiles of 11 E. coli O157:H7 isolates within the PFGE groups in cattle in Turkey (Erol et al., 2008) PFGE groups A B C D 1 4 2 1 N 1 2 Toxin profiles

stx 2 stx 2 stx 1

and stx

2 stx 1

and stx

2 stx 1 stx 2

Some Important

Listeria

outbreaks in the World

Country Year Food Serotype No. of cases No. of deaths

U.S.A.

1998 Turkey products 4b 108 18 Finland France 1998 2000 Butter 3a Pork meat 4b 25 32 24 31 U.S.A.

U.S.A.

U.S.A.

Switzerland Norway 2000 2002 2003 2005 2007 Turkey products Turkey products Mexican cheese Soft cheese Cheese 1/2a 4b 30 54 12 11 12 7 11 2 2 2 Canada 2008 Red meat 53 20

Contamination level of turkey meat with

L. monocytogenes

is 17.8 % (32/180) (Ayaz and Erol 2008)

L. monocytogenes serotype distribution

   

44.9 % 37.2 % 9.0 % 9.0 % 1/2a 4b 1/2b 1/2c

Antibiotic resistance profiles of L. monocytogenes in turkey meat (n:24) (Ayaz and Erol, 2008) Antibiotics Resistant (%) Sensitive (%) Ampicillin Chloramphenicol Erythromycin Gentamicin Penicillin Streptomycin Tetracycline Vancomycin 18 (75.0) 20 (83.3) Intermediate (%) 9 (37.5) 8 (33.3) 6 (25.0) 24 (100) 15 (62.5) 24 (100) 4 (16.7) 16 (66.7) 24 (100) 24 (100)

Number of Brucella cases in Turkey, 1999-2003 (Ministry of Health) 20.000

16.000

12.000

8.000

4.000

0 1999 2000 2001 2002 2003

Occurrence of Cryptosporidium (Kursun and Erol, 2003) spp. oocysts in Turkey Slaughtered Surface water Ent.

Sewage water treatment at slaughterhouse Exist.

Cattle Sheep Number of samples Number of positive samples Percent (%) 24 24 100 13 13 60 13 100 13 23 60 4 100 38.3 6.6



Antibiotic resistance

It’s a global concern of the antibiotic resistance of major foodborne pathogens such as;

Salmonella

Typhimurium DT 104

Campylobacter

spp.

Listeria monocytogenes E. coli

O157:H7

Staphylococcus aureus

(MRSA)

Enterococcus

(VRE)

Lab. Confirmed Cases Foodborne Infections&Intoxications Known/ Unknown Reported Positive Isolates Suspectible Cases Unnotified Cases Hospitalised No sample taken No medical intervention

Farm to table; main contamination points

Risk management Surveillance Epidemiological evaluation / Risk assessment Research

Control of Foodborne Disease

 From farm to table approach  Implementation of GMP and HACCP

Public Health Approach

         Public health system Surveillance Epidemiology for earlier diagnosis Early response to outbreaks Provide to disease patterns changing Public health lab. support for rapid and accurate diagnosis Rapid communication links Communication to public Education on prevention and/or detection

E-mail: [email protected]

             

Factors contributing to the global incidence of foodborne disease

Poor sanitary conditions Malnutrition Changing demographics (increasing population of infants, elderly) Inadequate public health infrastructure Inadequate hygienic and technological conditions of food production Inadequate cooking, reheating and storage conditions Increasing tourism and international trade Increasing animal movement and insufficient control of borders Increasing international trade of animal and food Inadequate legislation and official control system Emerging/reemerging foodborne pathogens Acquisition of virulence and antibiotic genes by nonpathogenic bacteria Adaptation and enhanced survival of pathogens in food Inadequate consumer education

Trichinellosis outbreak in Turkey

 Although there is a religious restriction on pork meat consumption, in January 2004 there was a big trichinellosis outbreak occurred by consuming çiğ köfte (raw ground meat ball-traditional food) in Izmir  542 people were affected and samples were found to be contaminated with

T. britovi

One World One Health (OWOH)

 The medical and veterinary professions have a common interest in many diseases, primarily zoonotic diseases such as BSE, SARS and, most recently, Avian Influenza (H5N1), have highlighted the need for interprofessional collaboration not just locally and nationally, but on a global scale.

One World One Health (OWOH)

 Improving animal and human health globally through collaboration among all the health sciences, especially between the veterinary and human medical professions to address critical needs.