Foodborne Illnesses at Subway

The Du Page County Illinois Health Department has reported 12 confirmed cases of shigellosis 7 of this cases have required hospitalization In November 1999 there were 18 confirmed cases of hepatitis A in Northeast Seattle and Snohomish County, Washington Surveys conducted by Public Health officials linked the cases with two Subway Sandwich outlets. An investigation later showed that neither of the two Subway outlets had written hand washing policies and employees were not required to document proper hand washing techniques. It has been shown that over 40 persons became ill as a result of eating contaminated food sold at the two Subway outlets. One child developed acute liver failure and required a transplant; many others were hospitalized with severe symptoms.

Shigellosis
Shigellosis, also known as bacillary dysentery or Marlow Syndrome, in its most severe manifestation, is a food borne illness caused by infection by bacteria of the genus Shigella. The causative organism is frequently found in water polluted with human feces, and is transmitted via the fecal-oral route. The usual mode of transmission is directly person-to-person hand-to-mouth, in the setting of poor hygiene among children

Symptoms may range from mild abdominal discomfort to fullblown dysentery characterized by cramps, diarrhea, fever, vomiting, blood, pus, or mucus in stools or tenesmus. Onset time is 12 to 50 hours. Infections are associated mucosal ulceration, rectal bleeding, drastic dehydration; fatality may be as high as 10-15% with some strains. Reiter's disease and hemolytic uremic syndrome are possible sequelae that have been reported in the aftermath of shigellosis.

Prevention

Simple precautions can be taken to prevent getting shigellosis: wash hands before handling food and thoroughly cook all food before eating. In addition to improved sanitation and hygiene, several vaccine candidates for Shigella are in various stages of development. According to the World Health Organization, candidates in development include live attenuated, conjugate, ribosomal, and proteosome vaccines. There are promising results for a vaccine against serotype 1, which otherwise show large resistance to antibiotics.

Hepatitis A
Hepatitis A (formerly known as infectious hepatitis) is an acute infectious disease of the liver caused by the hepatitis A virus, an RNA virus, usually spread the fecal-oral route; transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person. Tens of millions of individuals worldwide are estimated to become infected with Hep A each year. The time between infection and the appearance of the symptoms (the incubation period) is between two and six weeks and the average incubation period is 28 days. Early symptoms of hepatitis A infection can be mistaken for influenza, but some sufferers, especially children, exhibit no symptoms at all. Symptoms typically appear 2 to 6 weeks, (the incubation period), after the initial infection. Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months. Symptoms include fatigue, fever, abdominal pain, nausea and appetite loss.

Prevention
Hepatitis A can be prevented by vaccination, good hygiene and sanitation. The vaccine protects against HAV in more than 95% of cases for longer than 20 years. It contains inactivated hepatitis A virus providing active immunity against a future infection The vaccine was first phased in 1996 for children in high-risk areas, and in 1999 it was spread to areas with elevating levels of infection. The vaccine is given by injection. An initial dose provides protection starting two to four weeks after vaccination; the second booster dose, given six to twelve months later, provides protection for over twenty years.