Document 7170178
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Transcript Document 7170178
ENVR 430:
Foodborne
Microbial
Disease
And Food
Safety
Suggested Reading:
Brock
Chapter 29 – Food Preservation
and Foodborne Microbial Diseases
pp. 950
Simmons 1
E. coli 0157:H7 Spinach
Date: Tue 19 Sep 2006
Source: FDA.gov
Case Reports:To date, 131 cases of illness due to _E. coli_ infection have
been reported to the Centers for Disease Control and Prevention (CDC),
including 20 cases of Hemolytic Uremic Syndrome (HUS), 66
hospitalizations, and one death.
Illnesses:Illnesses continue to be reported to CDC. This is considered to
be an ongoing investigation.
States Affected:There are 21 confirmed states: California, Connecticut,
Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Minnesota, Nebraska,
Nevada, New Mexico, New York, Ohio, Oregon, Pennsylvania, Utah,
Virginia, Washington, Wisconsin, and Wyoming.
Simmons 2
E. coli 0157:H7 Spinach
Date: Thu, 21 Sep 2006
Source: CNN.com
Health authorities hunting the source of a nationwide _E. coli_ [O157:H7] outbreak
are focusing on 9 California farms after discovering what could be a crucial clue:
an opened bag of spinach left in the refrigerator of someone sickened by the
bacteria. The bag of tainted Dole baby spinach is the "smoking gun" that has
allowed investigators to zero in on 3 counties in California's greater Salinas Valley,
said Dr. Mark Horton, the state public health officer. Authorities also were checking
processing plants, Horton said. Officials said consumers still shouldn't eat bagged
spinach, even as they closed in on the source of the bacteria as likely somewhere
in Monterey, San Benito or Santa Clara counties. The bag of fresh spinach that
tested positive for _E. coli_ was found in New Mexico, and other bags recovered
elsewhere in the country also were being tested. "It's certainly premature to say
only this bag is going to test positive," said Dr. David Acheson of the FDA's Center
for Food Safety and Applied Nutrition. "There are others in the works." New Mexico
Department of Health officials confirmed the tainted bag of spinach was found
after a person who ate some of the leafy greens became 1 of 146 people in 23
states sickened by the outbreak, and 1 person has died. The spinach tested
positive for the same strain of _E. coli_ linked to the outbreak, Acheson said. Dole
is one of the brands of spinach recalled Friday by Natural Selection Foods LLC of
San Juan Bautista, California.
Simmons 3
Spinach E.Coli Source: Wild Pigs On Monterey Ranch
(CBS 5 / AP / BCN) MONTEREY 10/26/2006
Wild pigs at a single ranch in the Monterey-San Benito county area may have spread deadly bacteria onto a
California spinach field, sparking an outbreak that killed three people and sickened more than 200 others
nationwide in recent months, investigators said Thursday. They also said the outbreak appears to be over.
No one has become ill from eating contaminated spinach since Sept. 25. "All evidence points to this outbreak
having concluded," said Dr. Kevin Reilly of the California Department of Health Services. "The outbreak
appears to be over at this point." State and federal investigators have narrowed their focus to the ranch,
where boars trampled fences that had hemmed in a spinach field. Samples taken from a wild pig, as well as
from stream water and cattle on the ranch, have tested positive for the same strain of E. coli implicated in the
outbreak, Reilly said. He cautioned, though, that the investigation into the E. coli outbreak remains ongoing
and investigators have not completely ruled out the possibility that the bacteria contaminated the spinach
somewhere else. "We are not saying this is the source at this point," Reilly said of the ranch. However, he
said nine samples of the same E. coli strain as in the outbreak were found in various places on or near the
one ranch. "All these findings ... have been found on the same ranch," Reilly said. "All of the specimens were
between one-half mile and one mile from the spinach field.“ The outbreak sickened 204 people in 26 states
and one Canadian province, he said. Wild pigs are one "real clear vehicle" that could explain how E. coli
spread from cattle on the ranch to the spinach field less than a mile away, Reilly said. The pigs could have
tracked the bacteria into the field or spread it through their droppings. "I think we have good evidence"
pointing to feral pigs as the vehicle that transported the bacteria to the spinach fields, Reilly said.
Investigators also are looking at runoff, flooding, irrigation water, fertilizer and other wildlife, including deer,
as possible sources. Reilly refused to give a specific location for the ranch, other than to say it's in a valley
in the area of San Benito and Monterey counties. Investigators first recovered the same strain of bacteria
earlier this month from three cattle manure specimens collected on the ranch. On Thursday, Reilly said the
strain had been isolated from six other samples collected on the ranch, including from cattle. The finds mark
the first time that investigators have identified a possible source for any of the multiple E. coli outbreaks
linked to the heavily agricultural area. Still, investigators continue to look at three other ranches in the area
in seeking the source of the contaminated fresh spinach. Investigators have taken roughly 750 samples from
the four ranches. They've found generic E. coli on all four ranches the bug is commonly found in cattle but
turned up the particular strain involved in the outbreak on only one. "We have no evidence to suggest people
should not be eating spinach from other places except from these four ranches," said Jack Guzewich, of the
Food and Drug Administration's Center for Food Safety and Applied Nutrition.
Simmons 4
E. COLI VTEC NON-O157, LETTUCE - USA (UTAH
Date: Thu 30 Aug 2006
Source: Monterey Herald
Utah health officials say Salinas Valley lettuce may be responsible for an _E. coli_ outbreak in their
state in June 2006 that sickened 73 people, including 3 who developed kidney failure. The
announcement comes just 2 days after federal and state regulators began inspecting local lettuce
fields, plants and coolers in response to an increase in lettuce-related _E. coli_ outbreaks over the
past decade. The iceberg lettuce was served in salads from a Wendy's restaurant in North Ogden,
Utah, which catered a teachers' conference at a junior high school. Just where between field and fork
the lettuce was contaminated is unknown, Utah health officials said. In the past decade, said the FDA,
more than 400 people nationwide have been sickened in leafy-produce-related _E. coli_ outbreaks,
including 2 people who died. Investigations into these outbreaks, often done weeks and months after
they occur, rarely reveal how or when the lettuce is tainted. In response, federal and state regulators
this week began the unprecedented monitoring of the local industry, which produces at least 75
percent of the nation's lettuce. At least 2 women, one who ate salad at the conference and one who
didn't attend the conference but ate a hamburger with lettuce from the same restaurant, experienced
serious complications. One of the women is now on a kidney transplant list. The other was on dialysis
for several weeks and nearly had to have her large intestine removed. The outbreak involved _E. coli_
O121:H19, a rare form of the bacteria that normally live in the intestines of humans and animals. Most
_E. coli_ outbreaks connected to leafy greens in the past decade have involved the 0157:H7
strain. Officials from the Weber-Morgan Health Department in Utah said they narrowed their focus on
the lettuce because it was the only food that all of the sickened people ate. Wendy's International
spokesman Denny Lynch stressed on Tue, 29 Aug 2006, that the lettuce in question wasn't tested
following the outbreak. Instead, health officials are using patients' eating histories to deduce what
carried the bacteria, he said. "There is no confirmation there was lettuce because there was nothing to
test," Lynch said. Two days before the outbreak, Lynch said, the Wendy's in North Ogden passed a
routine health inspection "with flying colors." Once the company learned about the outbreak, it asked
the health department to come back to the restaurant for an inspection, and nothing inappropriate was
found, he said.
Simmons 5
California –
another outbreak!!
E. COLI O157, UNPASTEURIZED
MILK - USA (CALIFORNIA)
Date: Fri, 22 Sep 2006
Source: CBS2.com
Tainted milk has infected people with _E. coli_ [O157:H7] bacteria, prompting a recall of
some milk products, health officials said Fri, 22 Sep 2006. Those infected got sick after
drinking unpasteurized milk produced by Organic Pastures, a Fresno County, California
dairy, according to the San Diego County Health and Human Services Agency. An 8-yearold San Diego County girl, a Riverside County boy, 7, and a 10-year-old girl in San
Bernardino County got sick after drinking the contaminated milk. The state has ordered
all Organic Pastures whole and skim raw milk to be pulled immediately from stores and
consumers were encouraged to throw away any of the milk in their refrigerators. The
recall order also affects raw cream and raw colostrum made by the dairy. Organic
Pastures has been prohibited from producing raw milk for the retail market until further
notice, officials said. The _E. coli_ outbreak was limited to raw, or unpasteurized milk,
county health officials said. Most milk consumed in California is pasteurized, which
reduces the risk of getting a bacterial illness.
Simmons 6
SALMONELLOSIS, SEROTYPE TYPHIMURIUM - USA (MULTISTATE)
Date: Tue 31 Oct 2006
Source: CDC
The CDC, in collaboration with state departments of health and the FDA, is investigating an outbreak
of infections caused by a type of salmonella called _Salmonella_ [enterica_ serotype] Typhimurium.
This infection has no relationship to typhoid fever, which is caused by another organism. Serotype
Typhimurium typically causes an illness with fever and non-bloody diarrhea, which commonly
resolves after about one week. This illness is different from that caused by _E. coli_ O157:H7, which
produces bloody diarrhea, severe cramps, and in some persons, severe kidney disease. PulseNet, the
network of public health laboratories that performs molecular subtyping [DNA fingerprinting?] on
bacteria that cause foodborne illnesses, has identified a specific strain of _S._ Typhimurium that has
caused this outbreak. Cases caused by the specific strain have been detected regularly at low
frequency (average, 86 cases per year) for the past 5 years, indicating the presence of this strain at
low levels in the environment and the food chain. The outbreak has involved 171 cases of infection by
this strain in 19 states reported since 1 Sep 2006. The median age of patients is 36 years, and 59
percent are female. As with most infections by salmonella, most patients had a febrile diarrheal
illness. Of 73 patients for whom clinical data has been reported, 14 (19 percent) were hospitalized;
there have been no deaths reported. At this time, few new cases are being detected, and there is little
evidence of continuing risk to the public. CDC and its public health partners are vigorously working to
identify the specific contaminated food or foods that caused this outbreak. Outbreaks from a widely
distributed contaminated food cause cases to be scattered across the country, and the identity of the
contaminated food is often not readily apparent. In outbreaks like this one, identification of the
contaminated food requires conducting detailed standardized interviews with recovering case-patients
and with non-ill members of the public to compare the foods they had eaten. Using statistical
methods, the contaminated food is identified as one eaten more commonly by case-patients than the
controls. This statistically-based method of identifying contaminated foods is routinely supplemented
and confirmed by laboratory testing of foods. The process is labor intensive and may require days to
weeks. As soon as the contaminated food is identified, if there is evidence of ongoing risk, public
health officials can advise the public to avoid it and remove the food from the marketplace. Precise
information on avoiding infection with the outbreak strain of salmonella will be provided by CDC as
Simmons 7
soon as the contaminated food(s) is identified.
Date: 2 Nov 2006
Source: CIDRAP (Center for Infectious Disease Research And Policy) News
Tomatoes suspected in Salmonella outbreak
Federal investigators have turned up few solid leads in a Salmonella outbreak that has sickened 171 people in 19
states, but some food safety experts are suggesting that contaminated tomatoes and infected food service workers
might have played a role. The Centers for Disease Control and Prevention (CDC), in a press release yesterday, said
DNA fingerprinting revealed that _Salmonella enterica serotype Typhimurium_ caused the outbreak. The organism
typically causes fever and nonbloody diarrhea that resolves in a week. Of 73 patients for whom the CDC has clinical
data, 14 (19 percent) were hospitalized; no deaths have been reported. The CDC said the outbreak appears to be over:
"At this time, few new cases are being detected, and there is little evidence of continuing risk to the public." The
agency said the hunt for the source of the outbreak may take days to weeks. The New York Times reported yesterday
that the CDC detected the outbreak 2 weeks ago through a national database that identifies patterns in foodborne
illness reports. The CDC said cases in the outbreak have been reported since 1 Sep [2006]. Most of the states affected
are in the eastern half of the nation. Carlota Medus, PhD, an epidemiologist with the Minnesota Department of Health in
St. Paul, said samples from 14 patients in Minnesota matched the outbreak strain on pulsed-field gel electrophoresis
(PFGE). She said most of the Minnesota cases occurred between 12 Sep and 13 Oct [2006]. Minnesota, like some of the
other states involved in the outbreak, noticed the pattern and contacted the CDC. Medus said a case-control study in
Minnesota suggests the contamination source may be tomatoes, adding that 5 cases appear to be linked to the same
fast-food restaurant. "Our study is pretty small, though. It would be nice to have more supporting information, so it's a
little too soon to say," she said. Jack Guzewich, RS, MPH, director of emergency coordination and response in the
Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition (CFSAN), said _S. Typhimurium_ is
the most common strain found in humans and that the CDC usually sees about 5 to 10 cases each month; the numbers
usually peak in September and October. "It is found in many places in the food supply, but most often in poultry," he
said. Foodborne disease expert Craig W. Hedberg, PhD, an associate professor of environmental health sciences at the
University of Minnesota School of Public Health in Minneapolis, called the outbreak fairly significant in its size and
scope. "This outbreak is most likely due to tomatoes, and many cases were probably exposed through restaurants," he
said, though health officials have not linked the outbreak to a specific product, restaurant, or store. David Acheson,
MD, chief medical officer for the FDA's CFSAN, told the Associated Press yesterday that if fresh tomatoes are to blame
in the outbreak, it will be more difficult to trace the original source of the contamination than it was in the recent
Escherichia coli O157:H7 outbreak linked to fresh spinach. "You can get a lot of information from looking at a bag. You
don't get that information from looking at a tomato," he told the AP. During the summer of 2004, three Salmonella
outbreaks were traced to contaminated Roma tomatoes. The outbreak sickened 561 people in 18 states and one
Canadian province, the CDC said in an April 2005 article in Morbidity and Mortality Weekly Report. Hedberg said a
major concern in restaurant-related outbreaks of salmonellosis is the role of infected food handlers in spreading the
disease. He said food service workers can become ill from eating the contaminated product and then expose
customers to the disease when they are still shedding the organism and don't use proper hygiene practices.
Simmons 8
Campus Health Alert - Confirmed E. Coli Cases Among UNC Students (11-6-2006)
In recent days, three University students have developed confirmed cases of gastroenteritis caused by E. coli
O157:H7 bacteria. This illness causes severe diarrhea (often bloody), abdominal cramps and is occasionally
associated with severe complications, especially in young children and the elderly. The affected students
developed symptoms between October 26th and 29th. Health authorities are investigating a small number of
additional possible cases among University students. To date, the investigation by public health authorities
has not identified any common source of exposure. Currently, there is no indication that other students are at
risk. These bacteria usually make people sick within 10 days of exposure. The Orange County Health
Department, working in consultation with the North Carolina Communicable Disease Branch, is investigating
all of the cases involving the small number of UNC students. Officials from the University's Campus Health
Services, Department of Environment, Health and Safety and other offices are monitoring the situation
closely and collaborating in the investigation. If you experience severe diarrhea and abdominal cramps, you
are encouraged to seek medical attention immediately.
Following is a sampling of general tips from the Centers for Disease Control and Prevention on how you can
prevent E. coli infection:
1.Washing hands frequently and well is the most important thing you can do to avoid bacterial illness.
2.People with diarrhea should wash their hands carefully with soap after bowel movements to reduce the risk
of spreading infection. Anyone with a diarrheal illness should avoid swimming in public pools, sharing baths
with others, preparing food for others, providing day care or direct health-care services.
3.Cook all meat and eggs thoroughly. You can decrease the risk of illness by not eating raw or undercooked
meat or eggs. Use a digital instant-read meat thermometer to ensure thorough cooking.
4.If you are served an undercooked meat or eggs in a restaurant, send it back for more cooking and ask for a
clean plate.
5.Avoid spreading harmful bacteria in the kitchen. Keep raw meat separate from ready-to-eat foods. Wash
hands, counters and utensils with hot soapy water after they touch raw meat or eggs. Never place cooked
food on the unwashed plate that held raw meat or eggs. Wash meat thermometers in between tests.
6.Wash fruits and vegetables under running water, especially those that will not be cooked. Bacteria are
sticky, so even thorough washing may not remove all contamination. Remove the outer leaves of leafy
vegetables. People at high risk of complications from food-borne illness may wish to eat cooked vegetables
and peeled fruits.
Simmons 9
Foodborne Disease Burden in The
United States
• Estimated morbidity and mortality:
– 76 million illnesses / yr
– 325,000 hospitalizations / yr
– 5,000 deaths / yr
• Estimated costs:
– billions $
– loss of consumer confidence
– loss of profits
Mead et al. (1999) Food-Related Illness and Death in the United States.
Emerging Infectious Diseases 5(5):607-625.
www.cdc.gov/ncidod/EID/index.htm
Simmons 10
Number Of Reported Foodborne Disease Outbreaks,
Cases, And Deaths, By Etiology, United States (Incl.
Guam, Puerto Rico, U.S. Virgin Islands) 1993-1997
Confirmed
etiology
32%
n = 878
Unknown
etiology
68%
n = 1873
OUTBREAKS
n = 2,751
Confirmed
etiology
59%
n = 50, 788
Unknown
etiology
41%
n = 35,270
CASES
n = 86,058
=> 29 deaths: 28 confirmed, 1 unknown etiology
Source: Surveillance for Foodborne Disease Outbreaks - United States, 1993-1997
MMWR (2000) 49(SS01):1-51
www.cdc.gov/mmwr
Simmons 11
Only a Fraction of Foodborne Illnesses Are
Routinely Reported to the CDC
1. Passive surveillance system
2. Many diseases not reportable
3. A complex chain of events must occur to report
a foodborne infection to the CDC
4. Most household foodborne infections are not
recognized or reported
Simmons 12
Foodborne Disease: Vehicles
•Fruits and
vegetables
and Other
salad
accounted for
highest
number of
outbreaks
•Beef, chicken,
and fish also
important
Most
Foodborne
Disease of
Unknown
Etiology
Simmons 13
Foods Implicated in Foodborne Illness: Meats
Red Meats
– High contamination in comminuted and
processed meats (e.g. ground beef, sausage)
• High surface area, increased contact with processing
equipment; increased handling; variety of sources from
the animal (organs, trimmings, etc.).
• E. coli O157:H7 common etiologic agent in outbreaks
assoc. with improperly cooked hamburger and other
foods
Simmons 14
Foods Implicated in Foodborne Illness: Meats
Poultry
– High contamination levels in cut-up poultry
• Increased handling, processing and contact with common equipment
• Salmonella and Campylobacter are prevalent in poultry flocks
– can contaminate an entire processing plant via equipment and process
baths (e.g., chiller tank)
– Eggs
• Endogenous contamination by Salmonella enteritidis in some flocks
– Time and temperature abuse leads to proliferation in the egg
– Raw / undercooked eggs a source of exposure and infection
Simmons 15
Foods Implicated in Foodborne Illness: Fish
Contamination depends on type of seafood, quality of harvest
water, and amount of processing, handling and storage
Bivalve mollusks (oysters, clams, mussels, etc.); filter feeders
–
Accumulate enteric pathogens from fecally contaminated waters
Crustaceans (e.g. crabs, shrimp)
–
–
Acquire some pathogens by feeding on mollusks
Acquire high levels of vibrios from their water environment
Fin fish
–
–
Outer surface and epithelial lining (e.g. gut) contamination by
enteric microbes in fecally contaminated waters;
Contamination during processing (e.g., filleting).
Simmons 16
Other Foods Implicated in Foodborne Illness
Produce (fruits and vegetables)
– fecal contamination in irrigation water and other fecal sources
(animal droppings, birds, etc.)
– inadequate or unsanitary harvesting, washing or processing.
Dairy Products
– In developed countries milk and related dairy products are usually
made from pasteurized milk.
• Raw milk and products (e.g., cheeses) made from unpasteurized
milk are high risk of bacteria contamination
– Salmonella, Campylobacter, Brucella, Yersinia, Listeria
Simmons 17
Other Foods Implicated in Foodborne Illness
• Unpasteurized fruit juices and other beverages
– fecal contamination from animal and human sources
• Deli, "Fast" and Restaurant Foods
– salads, sandwiches, other fast, deli or restaurant foods
– become fecally contaminated during preparation and handling
• Cereal and Grain: inadequate storage of cooked rice/grain
Simmons 18
Comparison Of # Outbreaks, # Cases, and
# Deaths by Food Vehicle (All Etiologic Agents):
Shellfish, Poultry, And Produce
1988-1997
Shellfish
OUTBREAKS
81
CASES
2,547
DEATHS
3
Poultry
70
2,707
0
Produce
130
14,805
11
MMWR (1996) 45(SS-5):1-66;
MMWR (2000) 49(SS-01):1-51
Simmons 19
Foodborne
Disease:
Etiologic Agents
Most reported
outbreaks and
cases are caused
by bacteria:
•Salmonella
•Campylobacter
•E. coli
•Cl. perfringens
•Shigella
•Staph. aureus
These pathogens were
responsible for 22% reported
outbreaks; 49% cases; 79%
deaths from 1993-1997
Simmons 20
Food Poisoning vs. Food Infection
Food poisoning or food intoxication: disease that
results from the ingestion of food containing
microbial toxins
– Microbes that produced the toxins do not have to grow
and are often not viable at the time the food is
consumed
Food infection: active infections resulting from
ingestion of pathogen-contaminated foods
– Microbes are actively growing in the host
– Clinical illness associated with microbial infection, but
may also be attributed to toxins produced by the
actively growing microbes
Simmons 21
Salmonella
• Causes an estimated 1.4 million
foodborne illnesses / year
• Est. 500 deaths / year
• Decrease risks for egg-associated infections of S. enteritidis
by not eating raw or undercooked eggs
• ~40% of persons who died from S. enteritidis were residents of
nursing homes; serious disease in others with weakened
immune systems
– Nursing homes, hospitals, and commercial kitchens should use
pasteurized egg products for all recipes requiring pooled or lightly
cooked eggs.
• Proper egg storage in homes.
Simmons 22
Campylobacter jejuni
• Causes an estimated 2.5 million
foodborne illnesses / year
• Among the most common causes of
enteric infection in humans overall
• Usually mild disease in immunocompetent hosts
• for immunocompromised hosts, antimicrobial therapy needed
• ~2 in 100,000 diagnosed infections lead to Guillan-Barre
syndrome, a paralysis that lasts several weeks
• Primary vehicles: milk, poultry, pork
• colonization of poultry flocks almost universal; 106-107 cells /
processed bird
• inadequate cooking, cross-contamination primary causes of infection
Simmons 23
Escherichia coli
E. coli 0157:H7 (EHEC)
• Causes at least 60,000 infections
and 50 deaths per year
• Leading cause of kidney failure in children
• Produces a verotoxin (enterotoxin) similar to Shiga toxin
• Associated with undercooked meat, particularly ground meat
E. coli (ETEC)
• “travelers diarrhea”
• Produces two heat-liable
enterotoxins
• Associated with fresh vegetables
Also, enteropathogenic (EPEC) and
enterinvasive (EIEC) E. coli
Simmons 24
Clostridium
Anaerobic spore-forming, gram-positive rod;
ubiquitous in the environment
Clostridium perfringens
• Most prevalent cause of food poisoning in
the US (248,000 cases per year)
• Perfringens enterotoxin
• Generally self-limiting
Clostridium botulinum
• Botulism – severe food poisoning
• Neurotoxin – seven distinct types of botulinum toxin
• Destroyed by high heat (80oC, 10 m)
• Associated with foods not cooked after processing; homecanned vegetables, smoked fish vacuum-packed
Simmons 25
FOODNET:
1. Active lab-based surveillance
2. Survey of clinical labs
3. Survey of physicians
4. Survey of the population
5. Epidemiologic studies
FoodNet also looks for:
Listeria monocytogenes
Vibrio spp.
Yersinia enterocolitica
Cyclospora
Cryptosporidium
www.cdc.gov/foodnet
Simmons 26
HOWEVER, Recall that 68% of Reported
FBDOs were of Unknown Etiology
•Retrospective analysis of clinical data shows that about
50% had incubations period of >15 hours, suggesting viral
etiology. Viruses (e.g., Noroviruses; human caliciviruses)
are likely a much more important cause of foodborne
disease outbreaks than is currently recognized.
•Local and state public health programs lack resources and
expertise to diagnose viral pathogens, but methods are
becoming increasingly available.
Viral outbreaks are more likely to be
detected in the future.
Simmons 27
Human Caliciviruses
•
ex. Norwalk-like virus(es)
•
Major agents of foodborne disease.
•
Outbreaks due to fecally contaminated bivalve
mollusks, deli meats, produce, and many other foods.
•
Relatively persistent in the environment.
•
Fecal-oral transmission in all age groups; worldwide; direct / indirect
contact; secondary spread: common, 25-50%.
•
Causes acute gastroenteritis: humans are only host;
~1-2 day incubation period and ~1-4 day duration;
(diarrhea, vomiting, nausea, abdominal pain, anorexia, etc.)
•
Multiplies in upper small intestine epithelium; blunts microvilli
Simmons 28
Hepatitis A Virus (HAV)
•
•
•
•
•
•
•
•
Fecal-oral route of exposure
Incubation period: 2-6 weeks
Serious debilitating disease (general infection): fever, abdominal pain,
headache, jaundice, nausea, diarrhea
Fecally excreted at concentrations up to 106 infectious units per gram (>109
virions per gram)
Infectious at relatively low doses
Persistent in feces and on foods and environmental surfaces for weeks to
months, depending on temperature and other environmental factors.
Heat resistant: requires >60oC for rapid inactivation.
HAV associated with largest documented outbreak of shellfish illness ever
recorded:
– ~300,000 cases in Shanghai, China 1988
– Traced to consumption of clams harvested from a sewage-polluted area.
Simmons 29
Natural Toxins
Toxin: A poison, usually a protein, formed by microorganisms.
• Exotoxins are given off as waste products of a microorganism.
• Endotoxins are contained within the cells, and are liberated only
when the cell dies and disintegrates.
Marine Biotoxins
•
Ciguatera poisoning (fish)
•
Shellfish toxins (PSP, DSP, NSP, ASP)
PSP=paralytic; DSP=diarrheal; NSP=neurotoxic,
ASP=amnesic shellfish poisoning
•
•
Scombroid poisoning (fish)
Tetrodotoxin (Pufferfish)
Fungal And Plant Toxins
•
Mushroom toxins
•
Aflatoxins
•
Pyrrolizidine alkaloids
•
Phytohaemagglutinin (Red kidney bean poisoning)
•
Grayanotoxin (Honey intoxication)
Simmons 30
Sources of Foodborne Enteric Microbial Contamination
Food handler-associated contamination: inadequate personal hygiene
fecal contamination of foods (e.g., hands)
Food processing: equipment, packaging, and personnel may contaminate
foods during processing
Simmons 31
Sources of Foodborne Enteric Microbial Contamination
Food storage: time and temperature abuse bacterial growth
Fecal contamination prior to harvest or collection:
– Animal foods contaminated naturally (e.g., salmonella)
– Surface contamination (e.g., feces on fur, feathers,
hooves, etc.)
– Shellfish and finfish contaminated in their environment
• Fecal (sewage) contamination of water pathogen uptake
by filter-feeding on waterborne particles
– Fish and shellfish naturally colonized by aquatic
pathogens (e.g. Vibrios)
– Produce contaminated by irrigation with sewage or
contaminated water or fertilization with nightsoil (feces)
or animal feces.
Simmons 32
Factors Contributing to the Emergence
of Foodborne Diseases
•Human demographics
-growing segments of the population at
increased susceptibility to infections; ex. elderly
•Human behavior
-changes in dietary patterns; ex. increasing consumption
of produce, shellfish
•Changes in agricultural industry and technology
-greater geographic distribution of certain types of foods
-mass production, rapid dissemination
•Microbial adaptation / evolution
-environmental conditions; antimicrobial resistance
-newly emerging human pathogens
•Public health infrastructure
-limited or passive surveillance; monitoring; lack of $$
Simmons 33
Microbial Contamination of Foods
Food spoilage: any change in the appearance, smell,
or taste of a food product that makes it
unacceptable to the consumer
–
May or may not make the food unsafe to eat
Foods can be classified into categories with respect to
spoilage:
1)
2)
3)
Perishable foods
Semiperishable foods
Stable or nonperishable foods
related to their moisture content or water activity
Simmons 34
Methods to Control Microbial
Contamination of Foods
1.
2.
Prevention: keep enteric microbes out
Remove enteric microbes
–
–
–
3.
Identify and remove contaminated food items and ingredients
Wash to remove contaminants filtration or
other physical separation methods
Depurate or relay live shellfish.
Inactivate: kill / destroy microbes
–
–
–
–
4.
Use of heat
•
sterilize
•
disinfect (e.g., pasteurize and cook to destroy pathogens)
Drying, dehydration and intermediate-moisture processing
Chemical treatments: disinfect and sanitize
Irradiation: UV and gamma (ionizing) radiation
Prevent growth of microbes
–
Use cold and freezing to prevent proliferation
Simmons 35
Methods to Control Microbial
Contamination of Foods
Prevent exposure to fecal contamination in the environment,
after harvest or during processing, preparation and handling:
Maintain uninfected herds and flocks of animals
1. Immunize animals against infectious diseases:
•
Brucella abortus: brucellosis from cattle;
raw milk/dairy products
2. Colonize animals with harmless microflora:
•
colonize baby chicks with harmless
bacteria competitive to Salmonella
3. Destroy animals harboring pathogens:
•
Bovine Spongiform Encephalopathy (BSE; “mad cow” disease)
– caused by a prion able to infect humans (neural tissue in meat)
Maintain sanitation in the environment
1. harvest shellfish only from waters that are not fecally contaminated
2. irrigate fruits and vegetables with non-fecally contaminated water
3. use uncontaminated fertilizer for fruits and vegetables
Simmons 36
Methods to Control Microbial
Contamination of Foods
Maintain adequate hygiene and sanitation during harvest,
processing, storage and distribution
1. Use clean water for washing, processing,
cleaning and worker hygiene
2. Adequate human and food waste treatment and disposal facilities
3. Plant and equipment sanitation: clean, sanitize, etc.
4. Personal hygiene, food handling practices and
employee health (education, training and policies)
Source control: use of non-fecally contaminated foods and ingredients
1.
2.
Establish criteria, standards, and guidelines for measuring fecal
contamination of foods (pathogens and microbial indicators)
Inspection, monitoring and surveillance (product testing)
Simmons 37
Heat and Thermal Treatment
Effects of heat vary with food composition and microbe
• food composition: water, fat, proteins, carbohydrates, salts and pH
• organism factors: form, composition, growth stage, age, etc.
Sterilize (or nearly sterilize) foods (destroys all viable microbes)
– heat >100oC; usually uses high pressure and steam
– typical target temperature is 115-116oC for about 60 minutes
• ex. retorting of canned foods
Pasteurization
– intended to kill pathogens but does not sterilize the food
– often used prior to subsequent cold storage so pathogens
or spoilage organisms do not proliferate
• High Temperature-Short Time Method: 72oC; 15 sec. (milk)
• Low Temperature-Long Time Method: 62.8oC for 30 min. (milk)
– pasteurization times and temperatures for other foods depend on the
effects of heat on the food, food composition and the target organisms of
interest
Simmons 38
Drying, Dehydration, and Desiccation
Low moisture foods: usually <15% moisture
Intermediate moisture foods (IMF): 15-50% moisture
– fruits, cakes, syrups, candies, jams, milks,
some meats and cheeses
•
•
•
•
Sun (natural) drying: often used for fruits
Heat drying (dehydration; desiccation)
Freeze drying (lyophilization; cryophilization)
Condensing or evaporating: reducing moisture in
a liquid food; e.g., evaporated or sweetened condensed milk.
Drying destroys some enteric microbes but
is not very effective for others
Simmons 39
Chemical Treatments
Preservatives:
– Most are designed to control certain bacteria and molds
• Generally, ineffective against viruses and protozoan cysts
– Propionates, sorbates, benzoates and p-hydroxybenzoates: molds
– Nitrates and nitrites (ex. for Clostridium botulinum; Cl. perfringens)
– Sulfur dioxide and sulfites
– Acetic, lactic and other organic acids
– NaCl and sugars
– Ethylene and propylene oxides
Disinfectants and sanitizers:
– Used to treat (by washing or dipping) certain meats and produce
– Chlorine, peroxyacetic acid, ozone, hydrogen peroxide
– Concentrations: 10s to 100s of mg/L; contact times: seconds to minutes
– Organic acids (acetic, lactic and citric) at 2-7%; less effective
Simmons 40
Food Irradiation
Ionizing radiation (X-rays and gamma rays)
– Becoming more widely used
• gamma radiation from Co-60 and Cs-137 sources
– Effectiveness depends on: organism, composition of the food,
temperature, and presence of oxygen
• undesirable changes in foods from excessive radiation
UV radiation
– low (monochromatic 254 nm) and medium (polychromatic)
– used primarily for beverages: water, juices, ciders, etc.
Simmons 41
Shellfish Depuration and Relaying
Place live bivalve mollusks shellfish in clean flowing seawater
– normal pumping, feeding and related activity rids accumulated microbes
Relaying:
– transfer shellfish from contaminated (restricted) waters to uncontaminated
natural estuarine waters
– typical holding times in the clean water are two weeks or longer
Depuration:
– Place restricted shellfish in shore-based tanks of clean, flowing seawater
under controlled conditions for periods of several days
– Factors influencing deputation efficiency:
• tank geometry and loading
• water quality
• temperature
Simmons 42
Hazard Analysis / Critical Control Points
(HACCP)
A program of process control to (1) identify microbial hazards,
(2) identify the most vulnerable (critical) sites or steps in the
process and (3) implement an in-house monitoring system for
quality assurance and hygiene.
Incorporates elements of:
(i) education and training
(iv) inspection
(ii) ingredient or commodity control
(iii) process control
(iv) microbiological and
related surveys
HACCP is designed and implemented on a commodity-specific
and production facility-specific basis
Simmons 43
Foodborne Safety in the Home
• Investigations from outbreaks indicate that consumers do not
always take precautions to reduce the risks of foodborne
infections
• About half of all Salmonella cases result from unsafe handling of
food in the home
• Many experts believe the kitchen harbors more potentially
dangerous bacteria than even the bathroom
• Individuals at increased risk and others in the population may be
unaware of the risks involved, or of risk-reducing practice(s)
Simmons 44
Steps to Prevent Foodborne Illness
1.
Clean: wash hands
and surfaces often
2.
Separate: don't
cross-contaminate
3.
Cook: cook to
proper temperatures
(minimum 160oF)
4.
Cool / chill:
refrigerate promptly
(refrigerator= 41oF)
Simmons 45
Study Points:
• What are the three leading foods associated with illness?
• Food poisoning vs. food infection
• Agents of disease:
– Bacteria
•
•
•
•
Campylobacter
Salmonella
E. coli
Clostridium
– Viruses
• Noroviruses
• Hepatitis A virus
• Sources of food contamination
• Methods to control contamination
– Thermal, chemical, desiccation, irradiation, etc.
• HACCP
• Steps to prevent foodborne illness in the home
Simmons 46