Food Borne Diseases and Its Prevention

Foodborne disease and
its prevention
Definitions
Foodborne disease is any
illness resulting from the • Infection
consumption of food
contaminated with one or
• Intoxication
more disease-producing • Metabolic food
agents. These include disorder
bacteria, parasites, viruses,
• Allergy
fungi and their products as
well as toxic substances not • Idiopathic illness
of microbial origin.
The Food and Drug
Administration (FDA) Ranking of
Food Hazards
ranking*
1. microbial contamination
2. naturally occurring toxicants
3. environmental contaminants (e.g., metals
4. nutritional problems (i.e., malnutrition,
undernutrition)
5. pesticide residues
6. food additives
*1 being most dangerous, 6 least dangerous
Major identified foodborne pathogens,
United States – circa 2002
• Bacterial: • Bacterial, continued:
 Vibrio vulnificus*
 Bacillus cereus  Vibrio, other*
 Brucella  Yersinia enterocolitica*
 Campylobacter*
• Parasitic:
 Clostridium botulinum  Cryptosporidium*
 Clostridium perfringens  Cyclospora*
 Giardia*
 E. coli O157:H7*  Toxoplasma*
 E. coli, non-O157 STEC*  Trichinella
 E. coli, other diarrheagenic*
• Viral:
 Listeria monocytogenes*  Norwalk-like viruses*
 Salmonella Typhi  Rotavirus*
 Salmonella non-typhoidal  Astrovirus*
 Hepatitis A
 Shigella Prions*
 Staphylococcus
 Streptococcus
 Vibrio cholerae, toxigenic*
* Recognized as foodborne in last 30 years (Zoonotic reservoir)

Classification of Foodborne
Illness
1. Bacterial foodborne infection
• Disease-causing organism is carried by food or water
into the host
• While infection occurs inside the body, there is lag-time:
 onset time = time from infection to appearance of
symptoms
• Fever usually appears
• Possibly nausea, headaches, vomiting and chills
2. Bacterial foodborne intoxication (poisoning)

 Organisms multiply to great numbers within the food
product and then produce toxin in the process.
 If enough quantities of the toxin are ingested, it’ll
override the body’s immune system and cause illness.
 Faster acting than food infections
 NO fever usually (toxin acts immediately on the body)
 Vomiting may result
Classification of Food Poisoning
Toxins
1. Exotoxins
• Released by the bacteria when they are alive and
growing
 Endotoxins
 Released by the bacteria after they die
1. Enterotoxins
 Toxins that develop in the gastro-intestinal tract
Toxins may be:

1. Heat stable – hot temp. does not alter the toxin chemical
e.g. Staphylococcus aureus toxin
1. Heat labile – hot temp. alters the toxin protein which get
deactivated
e.g. Clostridium botulinum toxin
Food poisoning: Notifications and
laboratory reports, 1995-2005, Northern
Ireland
Campylobacter sp Cryptosporidium sp Salmonella sp Food Poisoning Notifications
2500
2000
Number of notifications/lab reports
1500
1000
500
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Clostridium
difficile toxin (all specimen types),
1995 – 2005,
Northern Ireland
1600
Number of Lab Reports
1400
1200
1000
800
600
400
200
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Clostridium
perfringens (all specimen types),
1995 – 2005,
Northern Ireland
25
20
15
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Campylobacter
sp
(all specimen types),
1995 – 2005, Northern Ireland
1200
1000
800
600
400
200
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of
Cryptosporidium sp
450
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Escherichia coli
O157
60
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Giardia lamblia

60
50
40
30
20
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Listeria sp
7
6
5
4
3
2
1
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Rotavirus
700
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella sp,
1995-2005, Northern Ireland
800
Salmonella (total)
700 S. enteritidis
S. typhimurium
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella sp
800
700
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Laboratory reports of Salmonella
enteritidis
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
enteritidis PT4 (all specimen types),
450
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
typhimurium (all specimen types),
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
typhimurium DT 104 (all specimen
types),
160
140
120
100
80
60
40
20
0
95
96
97
98
99
00
01
02
03
04
05
19
19
20
20
20
19
19
19
20
20
20
Year
Laboratory reports of Shigella sp
300
250
200
150
100
50
0
92
93
94
95
96
97
98
99
00
01
02
03
04
05
19
19
19
19
19
19
20
20
20
19
19
20
20
20
Year
Laboratory reports of Norovirus
450
400
350
300
250
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Outbreaks vs. Cases
• Foodborne disease outbreak: an incident in
which two or more persons experienced a similar
illness after ingestion of a common food, and
epidemiologic analysis implicated a food as the
source of illness.
• Foodborne disease case: one individual
experiences illness after ingestion of an
epidemiologically incriminated food.
Estimates of the yearly incidence of
foodborne illness
• The estimates vary greatly but thought to be
around 76 million cases per year
• Cost estimates range from $5–23 billion per
year
• High cost due to many factors:
– medical care, investigation of illness, loss of
productivity, loss of business, legal activities
Information reported to and compiled by
the Centers for Disease Control (CDC)
Outbreaks of known etiology = where laboratory evidence indicated a specific
agent
Outbreaks of unknown etiology = where epidemiological evidence implicated
foodborne transmission, but the etiological agent
was not identified.
4 subgroups based on incubation period:
< 1 hr = probable chemical poisoning
1 – 7 hr = probable Staphylococcus aureus
poisoning
8 – 14 hr = probable Clostridium perfringens
food poisoning
> 14 hr = probably other infectious/toxic agents
Outbreaks of known vehicle =a particular food item was associated with the
illness
Number of reported foodborne-disease outbreaks, cases, and
deaths, by etiology — United States, 1993–1997
Outbreaks Cases Deaths

No. (%) No. (%) No. (%)
Bacterial 655(23.8) 43,821(50.9) 28(96.6)

Chemical 148(5.4) 576(0.7) 0(0)
Parasitic 19(0.7) 2,325(2.7) 0(0)
Viral 56(2.0) 4,066(4.7) 0(0)
Confirmed etiology878 (31.9) 50,788(59.0) 28(96.6)
Unknown etiology1,873(68.1) 35,270(41.0) 1(3.4)
Total 1993–19972,751(100.0) 86,058(100.0) 29(100.0)
ex MMWR Table 1, Vol. 49/No. SS-1, p. 11 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4901a1.htm

Foodborne diseases
Infection with a variety of different pathogens
Illness may occur in large focal outbreaks

Most illness is “sporadic”: either individual cases or
part of unrecognized dispersed outbreaks
Reservoir: locus of sustained transmission and

persistence
• Some have a human reservoir: Shigella, hepatitis A, Norwalk
virus
• Some have an animal reservoir: Salmonella, Campylobacter,

E. coli O157:H7, Listeria, Vibrio, Yersinia, Toxoplasma
Often transmitted by several different pathways

• Specific foods, water, direct contact with animals, direct
contact with humans
The new foodborne zoonoses
The infected food animal looks healthy

Sustained or repeated infections in animals
Contaminated food looks normal
Pathogen survives standard processing
and preparation
Missed by current inspection strategies
Spreads silently around the globe
Requires new control strategies
More to be discovered
Estimated illnesses for known
foodborne pathogens, United States
Disease or agent Estimated total cases
Bacteria5,204,934
Parasites2,541,316
Viruses30,883,391
Grand Total38,629,641
ex Mead, P. S., L. Slutskaer, V. Dietz, L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V.
Tauxe. Food-related illness and death in the United States. Emerging Infectious Diseases 5(5):607–625
(1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm
Public health burden of foodborne
disease
Each year an estimated 76 million cases
• 1 in four Americans gets a foodborne illness each
year
• 1 in 1000 Americans is hospitalized each year
• $6.5 billion in medical and other costs
• Prevention depends on efforts from farm to

table to reduce contamination of food
Public health burden of foodborne disease
1997 Estimate: each year an estimated 76 million
cases*
• 1 in four Americans gets a foodborne illness each
year
• 1 in 1000 Americans is hospitalized each year
Prevention depends on efforts from farm to table to

reduce contamination of food
Healthy People Goals for 2010: 50% reduction from
1997 baseline in incidence of infections with:
• Salmonella
• Campylobacter
• E. coli O157
• Listeria monocytogenes
• Outbreaks caused by Salmonella Enteritidis
* Mead, EID 5:607, 1999

Top Twelve Factors Contributing to 345 Outbreaks of
Foodborne Disease Caused by Mishandling and/or
Mistreatment of Foods in Homes in the U.S., 1973–1982
Ranking Contributing Factor
Percent*
1. Contaminated raw food/ingredient 42.0
2. Inadequate cooking/canning/heat processing 31.3
3. Obtained food from unsafe source 28.7
4. Improper cooling 22.3
5. Lapse of 12 or more hours between preparing
and eating 12.8
6. Colonized person handling implicated food9.9
7. Mistaken for food 7.0
8. Improper fermentations 4.6
9. Inadequate reheating 3.5
10. Toxic containers 3.5
11. Improper hot holding 3.2
12. Cross-contamination 3.2
*Percentage exceeds 100 because multiple factors contribute to single outbreak
Organisms that Cause Bacterial
Foodborne Infections
Infection
• Definition:
a disease state caused by the presence of
viable, usually multiplying organisms at the
site of inflammation
– Bacteria - Salmonella, Campylobacter
– Virus - hepatitis A, Norwalk virus
– Protozoa - Cryptosporidium, Cyclospora
– other parasites - Trichinella spiralis
Sources of Foodborne
Pathogens
“You mean there are things on my hands that can

make people sick?”
Overview
• Microorganisms
• Susceptible Populations
• Infectious Doses
• Intoxication vs. Infection
• Fungal Pathogens
• Parasitic Pathogens
• Bacterial Pathogens
• Viral Pathogens
Pathogenic Microorganisms
• Fungi
• Parasites
• Bacteria
• Viruses
Salmonella - salmonellosis
• Symptoms - 7-72 hrs • Over 2000 Salmonella
• Livestock, poultry, • Grow well at 95 oF
eggs, pets, wild • Healthy adults – ingest
animals, people thousands to get ill;
young children, elderly
• Meat, poultry, - few cells
eggs/products, • Killed by heat if hot
unpasteurized dairy enough – 150o F
Eggs - Salmonella Enteritidis
• Uncracked shell eggs --- 3-7%
• Transmission from hen to egg before egg is
laid
• Processed foods pasteurized eggs required –
examples:
Campylobacter jejuni -
campylobacteriosis
• Sym – headache, fever, abdominal pain, recurring over several
weeks
• Anaerobic bacteria, no spores
• Source: livestock of various species
• Foods: meat, poultry, unpasteurized dairy, cross-contaminated
foods
• Very frequent cause of illness

Escherichia coli O157:H7
• First recognized in 1982
• Infection and/or intoxication
• Causes severe illness/kidney failure/death
• Sym - ab pain, fever, cramps, nausea,
bloody diarrhea - particularly harmful to
children, elders
• Secondary infections caused by
• poor hand washing
• Source - intestinal tract of livestock, wild
game,
• Food: ground beef, other undercooked
meats, apple cider, water
Listeria monocytogenes -
Listeriosis
• Meningitis
• Nausea, vomiting, headache in healthy
adults.
• Miscarriage, stillbirth in pregnant women.
• Retardation, meningitis, deaths in newborns
• 1 day to 3 weeks
• Source
• Unpasteurized dairy; raw, soil-grown
vegetables may be contaminated; raw
meats and poultry, processed meats
Viral Causes of FBI
Hepatitis A virus
• Sym - Fever, nausea, ab pain, fatigue, jaundice, may be liver
involvement
• 15-50 days onset
• Source: human
• Foods - Prepared salads, oysters/clams - raw or slightly cooked
• Does not reproduce in food
Norwalk virus
• Sym - ab pain, vomiting, diarrhea, headache, low
grade fever
• 1-2 days for onset
• Source - human
• Does NOT reproduce in food
• Virus particles stay viable a long time
Intoxication
• Definition:
a disease state, caused by exposure to a
toxic chemical, that is not mediated
immunologically and is not primarily the
result of a genetic deficiency.
– Staphylococcal food poisoning, botulism
– Saxitoxin, ciguatera
Foodborne Intoxications
Staphphyloccus aureus - food
intoxication
• Bacteria secrete toxins into surrounding
food as they grow.
• Bacteria killed by heat; but toxin is very
heat stabile
• Sym.- nausea, vomiting, diarrhea, cramps,

dehydration, prostration.
• 1-7 hours after eating toxin in food - FAST
• Source - people !
• 40 - 50 % of all healthy adults are carriers.
• Found in nasal passage, cuts, wounds, boils,
acne,skin.
• Foods: ham, chicken and potato
salads, cream fillings good places for bacteria to
grow and produce toxin
• Under what conditions?
Clostridium botulinum - botulism
• Rare but very serious, often fatal or long-term recovery.
• Symptoms: double vision, constipation; difficult eye movement,
swallowing, speech, loss of autonomic nervous system function
• Spore forming, anaerobic - organism becomes vegetative and

produces toxin
• Vegetative and spore forms found in soil, water, intestinal tracts
of animals, fish
Processed Foods
• Improperly canned low acid meats,
vegetables
• Smoked, vacuum-packed fish
• Other improperly prepared and held,
modified - atmosphere packaged
Clostridium perfringens
• Toxin-mediated infection - organisms eaten in
food, stay in intestine and produce toxin
• Mild illness
• Sym 8-22 hours
• Source- soil, dust, human and animal feces
• Foods - cooked meats, chili, stews, poultry,
gravies, baked beans, other thick dishes
Foodborne Diseases
Infections
Intoxications Toxicoinfection Invasive

Infection
Chemical Poisonous Poisonous Microbial Other Neurotoxins Enterotoxins

Poisoning Plant Animal Intoxications
Tissues Tissues
Intestinal Systemic Other

Mucosa Tissues or
Organs
Mycotoxins Algal Toxins Bacterial (Muscle,
(Fungal Toxins Liver, Joints,
Toxins) Fetus, Other)
Diarrhogenic Emetic Enterotoxins Neurotoxins Other

Foodborne Diseases
Intoxications Infections
Toxicoinfection Invasive
Infection
Other Neurotoxins Enterotoxins
Intestinal Systemic Other

Mucosa Tissues or
Organs
(Muscle,
Liver,
Joints,
Fetus,
Other)
Foodborne Diseases
Intoxications Infections
Chemical Microbial
Poisoning Poisonous Poisonous Intoxications
Plant Animal
Tissues Tissues
Mycotoxins Algal Bacterial

(Fungal Toxins Toxins
Toxins)
Diarrhogenic Emetic Enterotoxins Neurotoxins Other

Examples of foodborne
infections/intoxications
Disease Reservoir
Botulism food intoxication Soil contaminated foods
Campylobacteriosis Cattle, poultry, shellfish
Clostridium perfringens Soil contaminated foods
food poisoning
Salmonellosis Animals and birds
Staphylococcal food poisoningHuman carriers
Vibrio parahaemolyticus Seafoods
infection
Yersinia enterocolitica Animal intestines
infection
Objectives of foodborne disease
surveillance
prevention and control:
identification of contaminated products
knowledge of disease causation:
observe the track record of various illness-
causing agents
administrative guidance:
assessment of trends to justify regulatory
decisions/actions
Susceptible Populations
 Elderlyand infants
 Pregnant women
 Impaired immune system (AIDS)
 Cancer patients
 Organ transplant recipients
 Predisposing illness (ex. alcoholism,
diabetes, cirrhosis of the liver)
Infectious Doses
 Minimum infectious dose (MID) not
determined for most pathogens
 Consumption of just a few (10-100)
organisms in some individuals may
cause disease (depends upon immune
status)
 High numbers (>106) of organisms may
be required to cause disease in
healthy adults
Infection vs. Intoxication
Foodborne Infection
• occurs when pathogens (bacteria, viruses, or parasites) are ingested
with food and multiply in the human body
• symptoms can occur 1 to 50 days after ingestion
• symptoms may include fever, chills, malaise, headache, vomiting,
diarrhea, dehydration, intestinal cramping, arthritis (3-4 weeks
later), septicemia, miscarriages, stillbirths, death
Examples of Foodborne Infection
• Virus: Hepatitis A, Norwalk, Rotavirus

• Bacteria: Salmonella spp., Vibrio spp.
Campylobacter spp., Yersinia spp., Shigella spp.,
Listeria monocytogenes
• Parasite: Trichinella spiralis, Anisakis simplex,
Giardia duodenalis (protozoan)
Foodborne Intoxication
• occurs when food are ingested that contain toxins produced by
bacteria or molds
• toxins may be heat stable
• symptoms can occur within minutes to 15 hours after
ingestion
• symptoms may include headache, vomiting, diarrhea,
dehydration, intestinal cramping, weakness, blurred vision -->
paralysis/death (ex. C. botulinum); no fever
Examples of Foodborne
Intoxication
• Staphylococcus aureus
• Bacillus cereus
• Clostridium botulinum
• Aspergillus flavus/parasiticus
Foodborne Parasites
• Trichinella spiralis
• Giardia lamblia
• Cryptosporidium parvum
• Cyclospora
Trichinella spiralis
Trichinella spiralis
Nematode/roundworm
AKA=Trichinosis
Foodborne infection; 2-28 days
Symptom: abdominal pain, fever, thirst, bleeding
Found in pigs, wild game
Associated foods: undercooked pork or wild game
Controlled by freezing, cooking, salting, irradiation
Giardia lamblia
Giardia lamblia
• Flagellated protozoan
• Found in domesticated and wild animals,
humans, rodents, contaminated water supplies
• Foodborne infection-1 week
• May require only 1 cyst to cause infection
• Diarrhea
Giardia lamblia
• Associated foods: salads, water
 Poor personal hygiene is responsible for
contamination of foods handled by infected
employees
Cryptosporidium parvum
• Protozoa, obligate intracellular parasite
• Found in domesticated and wild animals,
humans, rodents, contaminated water supplies
• Foodborne infection
• May require only 10 organisms to cause
infection
• Symptoms: Severe watery diarrhea
• Associated foods: water, vegetables treated with
animal manure
• Poor personal hygiene is responsible for
employees
Cyclospora
Cyclospora
• Unicellular parasite
• Associated with contaminated water supplies, human waste
• Foodborne infection-1 week
• Symptoms: Watery diarrhea, explosive bowel movements,
stomach cramping, low grade fever
Cyclospora
• Associated foods: water, fruits and vegetables
treated with animal manure
• Poor personal hygiene is responsible for
employees
Bacterial Pathogens
• Salmonella spp. Clostridium spp.

• Listeria Aeromonas spp.
monocytogenes Vibrio spp.
• Campylobacter jejuni Yersinia spp.
• E. coli O157:H7 Shigella spp.
• Staphylococcus aureus
Bacteria
Differentiated according
to ability to retain
specific stains
Gram Stain:
Gram
Positive
Gram
Negative
Salmonella spp.
Salmonella spp.
Gram negative, non-spore forming,
aerobic, motile rod
Found in animals, man, soil, water, insects,
raw meat, poultry, seafood, kitchens
As few as 20 cells-10,000 cells may cause
disease (depends upon host, age, etc).
Symptoms: Diarrhea, fever, vomiting,
severe dehydration
Salmonella spp.
May cause arthritis (3-4 weeks after

infection)
Associated foods: undercooked poultry
and meat, beef jerky, unpasteurized or
contaminated milk, salad dressings, cream
filled desserts, eggs, orange juice
Gram positive, non-spore forming,
facultative anaerobe, motile rod
Found in intestinal tracts of man, birds,
soil, silage, water, livestock, cold & damp
areas
Survives drying, refrigeration, freezing,
and heat treatments
Symptoms: Diarrhea, meningitis,
encephalitis, septicemia, miscarriages,
stillbirths
Infective dose may be <1000 cells
Associated foods: RTE meats, hot dogs,
deli meats, unpasteurized dairy products,
ice cream, raw vegetables, fermented
sausages, raw meat, poultry
Campylobacter jejuni
motile rod
Microaerophilic-low oxygen
Found in man, animals (domestic and
wild), birds, flies, water
As few as 400-500 cells cause
infection
Symptoms: Watery-bloody diarrhea,

Guillain Barre syndrome
May be most common cause of
gastroenteritis in US
Associated foods: undercooked poultry
and meat, unpasteurized milk,
contaminated water
Escherichia coli O157:H7
E. coli O157:H7
aerobic, rod
Found in intestinal tracts of cattle,
deer, birds, man
Acid tolerant, heat tolerant
Symptoms: bloody diarrhea, fever,
severe cramping, Hemolytic Uremic
Syndrome (HUS)
E. coli O157:H7
As few as 10 cells may cause disease
Associated foods: undercooked
hamburgers, venison jerky, water,
unpasteurized milk, fermented
sausages, sprouts, water, roast beef,
apple cider, salami, lettuce, yogurt,
cantaloupe
Staphylococcus aureus
Gram positive, aerobic cocci
Staph are found in air, dust, sewage,
water milk, food, equipment, animals and
humans: skin, hair, nose, throat, open
sores, boils, saliva
Transmitted to foods via handling,
coughing, sneezing, wiping
Foodborne intoxication; hours

Symptoms: Vomiting, abdominal cramping
Organism produces toxin in food
Toxin is heat stable
Associated foods: cured meat products,
improperly cooled food products, salads
(ex. egg, tuna, chicken, potato, macaroni),
crème filled pastries, canned mushrooms
Gram positive, spore forming, anaerobic rod

Found in soil, intestinal tracts of man and
animals
Foodborne infection;8-22 hours; toxin is
formed in the gut
Symptoms: Diarrhea, severe dehydration,
cramps
Large number of cells (108) needed to cause

disease
Associated foods: temperature abused
foods, roast beef, stews, meat gravy, poultry
Clostridium botulinum
Gram positive, spore forming,
anaerobic rod
Found in soil, water, animal, poultry,
vegetables, shellfish, horses, fish
Foodborne intoxication; hours
Symptoms: Paralysis, blurred vision,
death
Toxin is susceptible to heat
(175F, 10 min)
Associated foods: honey, improperly

canned foods, underprocessed or
temperature abused foods, stews,
meat/poultry loaves; sausages, seafood
products, garlic-in-oil, liver pate,
smoked and salted fish, baked potatoes,
pickled eggs
Aeromonas hydrophila
Aeromonas hydrophila
Gram negative, non-spore forming, aerobic
rod
Found in brackish freshwater, seafood,
fish, salt water
Foodborne infection
Symptoms: Watery diarrhea, dehydration,
septicemia
Associated foods: fish, shellfish, beef,
pork, lamb, poultry
Vibrio spp.
Vibrio vulnificus

aerobic rod
Found in fresh and salt water,
plankton, shellfish, brackish lakes
Foodborne infection or enters via
wound (shucking oysters, stepping on
shell, etc).
Vibrio vulnificus
Symptoms: Diarrhea, septicemia,

septic shock, death
Associated foods: raw, undercooked,
or contaminated oysters, clams, crabs
Yersinia enterocolitica
 Gram negative, non-spore forming, aerobic
rod
 Found in domestic and wild animals, pigs,
ponds, lakes, birds, beavers
 Foodborne infection
 Symptoms:Diarrhea, cramps, nausea,
vomiting, fever, severe abdominal pain
(mimic appendicitis), septicemia
 Associated foods: pork, beef, lamb, oysters,
fish, raw milk, chocolate milk, tofu,
chitterlings
Shigella spp.
Shigella spp.
 Gram negative, non-spore forming, non-

motile, aerobic rod
 Found in feces of humans and primates,
water contaminated with human feces
 Foodborne infection (12-50 hours)
 Need as few as 10 cells to cause disease
 Symptoms: Diarrhea, cramps, nausea,
vomiting, fever, mucus in stools
Shigella spp.
 Associated foods: potato, tuna, shrimp,

macaroni, chicken salads, raw vegetables,
milk and other dairy products
 Fecally contaminated water and poor
personal hygiene are the most common
causes of contamination
Viruses
Hepatitis A
Rotavirus
Norwalk
Hepatitis A
Hepatitis A
AKA: type A viral hepatitis
Excreted in feces of infected employees
Foodborne infection (10 to 50 days)
Infection may occur with approximately 10-
100 virus particles
Symptoms: Fever, malaise, nausea,
abdominal discomfort, jaundice
Associated foods: deli meats, salads,
beverages, sandwiches, fruits, dairy
products
Hepatitis A
Poor personal hygiene is responsible for
employees
Rotavirus
Rotavirus
AKA: Viral gastroenteritis
Excreted in feces (108-10 ) of infected
employees; found in fecally contaminated
water supplies
Foodborne infection (1-3 days)
Symptoms: Vomiting, diarrhea, dehydration
employees
Norwalk Virus
Norwalk Virus
AKA= Norwalk-like virus, viral
gastroenteritis
Found in contaminated water supplies;
contaminated shellfish beds, cruise ships
Foodborne infection: 1-2 days
Symptoms: Nausea, vomiting diarrhea,
abdominal pain, low grade fever
employees
Norwalk Virus
Associated foods: fruits, eggs, clams,

oysters, bakery items, salads, ice, shrimp
Botulism
Botulinim toxin
History
• Neurologic disease from botulinum toxin
– Most lethal substance known
History
• History as bioweapon
History
– Japanese in WWII (Unit 731)
History
– Former US and USSR programs
History
– Iraqi deployed weapons
History
– Iraqi deployed weapons
– Japanese cult in early 1990’s
Epidemiology
• Found worldwide
• U.S. incidence
– ~100 cases annually (1/4 foodborne)
Epidemiology
• Mechanisms of intoxication
– No person-to-person transmission
Epidemiology
– Toxin ingestion (foodborne)
Epidemiology
– Toxin generated from wound infection (wound)
Epidemiology
– Toxin from intestinal colonization (infant, intestinal)
Epidemiology
– Toxin inhalation (aerosol release)
Epidemiology
– Toxin inhalation (aerosol release)
• Mortality <10%
Microbiology
Microbiology
– Large, anaerobic Gram positive bacillus
– Spore-forming
Microbiology
– Spore-forming
– Rarely infects humans
Microbiology
– Spore-forming
– Produces potent neurotoxin
• 7 types (A-G)
Microbiology
– Spore-forming
• 7 types (A-G)
• Types A, E, B most common in U.S.
Microbiology
– Spore-forming
• 7 types (A-G)
• Types A, E, B most common in U.S.
• Same general mechanism
Arnon S, et al. JAMA. 2001;285:1059-70.
Clinical Features
• Incubation 12-72 hours
– Probably faster if inhalational exposure
Clinical Features
• Classic syndrome
Clinical Features
– Acute symmetric cranial nerve palsies
Clinical Features
• Blurry vision, ptosis, dysphasia
Clinical Features
– Descending flaccid paralysis
Clinical Features
• Complete skeletal muscle paralysis
Clinical Features
• Respiratory (ventilatory) failure
Clinical Features
– Autonomic – urinary retention, orthostasis
Clinical Features
– Autonomic – urinary retention, orthostasis
– Afebrile, normal mentation
Clinical Features
• Differential Diagnosis
Clinical Features
– Myasthenia Gravis – anticholinesterase response
Clinical Features
– Guillaine-Barre Syndrome - ascending
Clinical Features
– Stroke – asymmetric, abnormal brain imaging
Clinical Features
– Tick paralysis – ascending, presence of tick
Clinical Features
– Tick paralysis – ascending, presence of tick
– Poliomyelitis – asymmetric, preceding viral illness
Clinical Features
• Other features
– Foodborne – nausea, diarrhea, dry mouth
Clinical Features
• Other features
– Foodborne – nausea, diarrhea, dry mouth
– Infant - constipation
Diagnosis
• High index of suspicion necessary
– No readily available rapid confirmatory tests
Diagnosis
• High index of suspicion necessary
– No readily available rapid confirmatory tests
• Clinical diagnosis
Diagnosis
• Laboratory confirmation
– Specimens – blood, stool
– At reference labs
– Mouse bioassay
– ELISA
Treatment
• Supportive care
Treatment
• Supportive care
– Mechanical ventilation, nutritional support
– Prevention of secondary infections
Treatment
• Supportive care
– Mechanical ventilation, nutritional support
– Prevention of secondary infections
– Avoid aminoglycosides, clindamycin
Treatment
• Passive immunization (antitoxin)
Treatment
– Halts paralysis, doesn’t reverse
Treatment
– Must be given ASAP
Treatment
– Equine antitoxin (Types A, B and E toxins)
• Serum sickness (9%), anaphylaxis (2%)
Treatment
– Equine antitoxin (Types A, B and E toxins)
• Serum sickness (9%), anaphylaxis (2%)
– Heptavalent antitoxin (Types A-G)
• Investigational, less hypersensitivity
Post-Exposure Prophylaxis
• Antitoxin not recommended
– High incidence hypersensitivity
– Limited supplies
Post-Exposure Prophylaxis
• Antitoxin not recommended
– High incidence hypersensitivity
– Limited supplies
• Clinical monitoring
– Extreme vigilance for symptoms
– At least 72 hours
– Antitoxin immediately for any symptoms
Vaccination
• Botulinum toxoid
– No role for post-exposure prophylaxis
• Immunity develops over months
Vaccination
• Botulinum toxoid
– No role for post-exposure prophylaxis
• Immunity develops over months
– Excellent efficacy
• Not tested versus aerosol exposure
– Few adverse effects
Infection Control
• No person-to-person transmission
• Patient handling
– Standard precautions
• Clinical specimens
– Standard precautions
Metabolic food disorder
• Definition:
a disease state caused by exposure to a
chemical that is toxic to certain individuals
only because they exhibit some genetic
deficiency
– lactose intolerance
– favism
Allergy
• Definition:
a disease state caused by exposure to a particular
chemical that (often proteinaceous) to which certain
individuals have a heightened sensitivity
(hypersensitivity) that has an immunological basis
– proteins (heat resistant and resistant to digestion)
• cow’s milk: β -lactoglobulin, casein, etc.
• egg-ovalbumin
– small molecules
• penicillin
Idiopathic illness
• Definition:
any illness of uncertain pathogenesis that may
possibly but not certainly be due to foods;
also, any food-caused illness that does not fit
into one of the other categories
– Chinese restaurant syndrome
– celiac disease
– hyperkinesis
Foodborne diseases:
Philosophy of prevention
No vaccines for most of these pathogens
Educating consumers, foodhandlers and producers is important, but

not sufficient
Groups at highest risk: Young children, elderly, immunocompromised
Contamination can occur from farm to table
Understand mechanisms of contamination well enough to prevent it

upstream from the consumer
Targets: Specific pathogen – food combinations

“The World Health Organization’s
Golden Rules for Safe Food Preparation”
1. Choose foods processed for safety
2. Cook food thoroughly
3. Eat cooked foods immediately.
4. Store cooked foods carefully.
5. Reheat cooked foods thoroughly.
6. Avoid contact between raw and cooked foods.
7. Wash hands repeatedly.
8. Keep all kitchen surfaces meticulously clean.
9. Protect foods from insects, rodents, and other
animals.
10. Use pure water.

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Food Borne Diseases and Its Prevention

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Foodborne disease and

* Recognized as foodborne in last 30 years (Zoonotic reservoir)

2. Bacterial foodborne intoxication (poisoning)

Toxins may be:

(all specimen types),

Outbreaks Cases Deaths

Bacterial 655(23.8) 43,821(50.9) 28(96.6)

ex MMWR Table 1, Vol. 49/No. SS-1, p. 11 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4901a1.htm

Illness may occur in large focal outbreaks

Reservoir: locus of sustained transmission and

• Some have an animal reservoir: Salmonella, Campylobacter,

Often transmitted by several different pathways

The infected food animal looks healthy

• Prevention depends on efforts from farm to

Prevention depends on efforts from farm to table to

* Mead, EID 5:607, 1999

“You mean there are things on my hands that can

• Very frequent cause of illness

• Sym.- nausea, vomiting, diarrhea, cramps,

• Spore forming, anaerobic - organism becomes vegetative and

Intoxications Toxicoinfection Invasive

Chemical Poisonous Poisonous Microbial Other Neurotoxins Enterotoxins

Intestinal Systemic Other

Diarrhogenic Emetic Enterotoxins Neurotoxins Other

Other Neurotoxins Enterotoxins

Intestinal Systemic Other

Mycotoxins Algal Bacterial

Diarrhogenic Emetic Enterotoxins Neurotoxins Other

• Virus: Hepatitis A, Norwalk, Rotavirus

• Salmonella spp. Clostridium spp.

monocytogenes Vibrio spp.

• Campylobacter jejuni Yersinia spp.

• E. coli O157:H7 Shigella spp.

May cause arthritis (3-4 weeks after

Symptoms: Watery-bloody diarrhea,

Foodborne intoxication; hours

Gram positive, spore forming, anaerobic rod

Large number of cells (108) needed to cause

Associated foods: honey, improperly

Gram negative, non-spore forming,

Symptoms: Diarrhea, septicemia,

 Gram negative, non-spore forming, non-

 Associated foods: potato, tuna, shrimp,

Associated foods: fruits, eggs, clams,

Educating consumers, foodhandlers and producers is important, but

Groups at highest risk: Young children, elderly, immunocompromised

Contamination can occur from farm to table

Understand mechanisms of contamination well enough to prevent it

Targets: Specific pathogen – food combinations

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