waralukhealth'moph'go'th

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• waraluk_at_health.moph.go.th

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Main contents

• Impact of diarrhea diseases
• Diarrhea as a part of Food and water borne
  diseases (FWD)
• Strategy for prevention and control of diarrhea
• Food safety as a key component on decreasing
  burden of diarrhea

Dr.Waraluk, 12 Feb. 2008
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Diarrhea definition
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Dr.Waraluk, 12 Feb. 2008
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Impact of diarrhea (1)

• More than 1.5 billion episodes of diarrhea have
  been reported in the children less than 5 years.
• Diarrhea continues to plaque the developing
  world, resulting in 3 million deaths.
• Children especially who are malnourished remain
  at a greater risk as elderly and immunocompromised

Source Malik K.R. et al, 1996, 1998
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IMPACT (2)
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Impact of diarrhea (3)

• 90 of diarrhea cases cause by infectious agents.
• Estimated 250 foodborne pathogens
• Foodborne illness
• 2 or more cases of a similar illness resulting
  from ingestion of a common food
• Bacteria most common cause
• Also viruses, parasites, natural and manufactured
  chemicals, and toxins from organisms
• 10 cause by medication, toxic ingestion,
  ischemia, other

Dr.Waraluk, 12 Feb. 2008
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Impact of diarrhea (4)

• Foodborne diseases each year in US
• Affects 1 in 4 Americans
• 76 million illnesses
• 325,000 hospitalizations
• 5,000 deaths
• 1,500 of those deaths caused by Salmonella,
  Listeria, and Toxoplasma
• Many unrecognized or unreported
• Mild disease undetected
• Same pathogens in water and person to person
• Emerging pathogens unidentifiable

Dr.Waraluk, 12 Feb. 2008
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Impact 5
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Estimated global distribution of the 600,000
annual deaths caused by rotavirus diarrhea
(impact 6)
1 dot 1000 deaths
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Morbidity of Diarrheal Disease , 1990-2007
Rate per 100,000 pop.
Year
Impact 7
Source 506 report, Bureau of Epidemiology,
Department of Disease Control
Dr.Waraluk, 12 Feb. 2008
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?? 2548 OPD IPD 1,008,389 133,311cost OPD
IPD 143 2,288 x 3Total cost
629,101,477underreport 36,000 ???????
Extensive social and economic impacts
Dr.Waraluk, 12 Feb. 2008
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Diarrhea as a FWD (1)

• The WHO estimated that 1500 million of children
  under five years of age annually suffer from
  diarrhea and over three million die as a result.
  A great proportion of these cases can be
  attributed to contamination of food and drinking
  water.
• The global incidence of food and water borne
  disease is difficult to estimate because of poor
  documentation or reporting.

Dr.Waraluk, 12 Feb. 2008
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Diarrhea as a FWD (2)

• The WHO (2002) estimates that there are 2.1
  million deaths from every year in the world, most
  of them among children, and that 65 of these
  deaths could be prevented by water hygiene and
  sanitation interventions.
• Approximately 4,000,000,000 cases per year
  globally
• Approximately 1, 800,000 deaths per year globally

WHO, 2005
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Diarrhea as a FWD (3)

• Contaminated water and food play an important
  role in the etiology of diarrhea. (Sheth M. et
  al, 1983, 2000)
• The chances of food contamination and cross
  contamination, become higher especially in the
  lower socio-economic due to unsatisfactory
  environment conditions, poor personal hygiene,
  poor quality and insufficient water supplies,
  unhygienic preparation storage and feeding of
  foods (Raymond Isley B. et al, 1985, 1996, 1997,
  2000)

Dr.Waraluk, 12 Feb. 2008
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Strategy for prevention and control of diarrhea

• 1. ??????????????????????????????????
• 2. ????????????????????????????????????????
• 3.???????????????????????????????????????????????
• 4.????????????? ??????????????????

Dr.Waraluk, 12 Feb. 2008
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1. ??????????????????????????????????

• 1.1 ????????????????????????????????????????
  ????? ??????????????????? ??????????????????????
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• 1.2 ????????????????????????????????????
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  ????????????????
• 1.3 ???????????????????????????????????????????
  ??????????????????????

Dr.Waraluk, 12 Feb. 2008
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Oral rehydration as first line treatment of
diarrhea
Dr.Waraluk, 12 Feb. 2008
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Dr.Waraluk, 12 Feb. 2008
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(No Transcript)
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???????????????????????????????????

• Randomized control trial ?????????? 2 59
  ????????????????????????????????? OPD ????????
  Fortaleza (Brazil), Addis Ababa (Ethiopia), Cairo
  (Egypt), Lucknow , Nagpur (India) Manila
  (Philippines).
• ?????????? Zinc tablet 20 mg ???????????????/?? 5
  ???? ?????????? 14 ??? ??????? ORS ????????????
  (1010 cases) ?????? ORS ???????????????????????
  (992 cases)
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  ??????????????????????? ?????? 3 5
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• Source Effectiveness and acceptability of zinc
  supplementation for children with acute diarrhea
  a randomized five-country trial Presented by
  Shally Awasthi, Professor, Paediatrics, King
  George Medical College, India
• Presentation made at Forum 9, Mumbai, India,
  12-16 September 2005

Dr.Waraluk, 12 Feb. 2008
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2. ???????????????????????????????????????? (1)

• 2.1 ??????????????????????????????????????????????
  ? ?????????????????????????????????????? (low
  birth weight) ???????????????????????????????????
  ???????????????????
• 2.2 ????????????????????????????????? ??????
  ?????????????????????????????????? ????????? 4
  ??? 6 ????? ????????????????????????????????????
  6 ????????????????????????????????????????????
  ????????????????????????????????????????? 6 ?????
  ????? 59 ????? ???????????????????????????????????
  ??????????????????????????????? ???????????
  (growth charts)

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Breast feeding
Dr.Waraluk, 12 Feb. 2008
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Under 5 yrs that could be prevented in the 42
countries with 90 of worldwide child deaths in
2000 through achievement of universal coverage
with individual interventions

• Preventive interventions
• Breast feeding 13 (1,301,000 deaths)
• Zinc supplement 5 (459,000 deaths)
• Water sanitation hygiene 3 (326,000 deaths)

Dr.Waraluk, 12 Feb. 2008
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2. ???????????????????????????????????????? (2)

• 2.3 ???????????? ?????????????????????????????????
  ????????
• 2.4 ?????????????????????? ???????????????????????
  ???????? ??????????????????? ?????????????????????
  ????????? ???? ?????? Prebiotics

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Intestinal Flora

• 1012 viable bacteria/gram of large bowel content
• More than total cells in the human body
• More than total humans who have ever lived
• At least 17 families
• At least 50 genera
• 400-500 species in any single person
• 80-90 unculturable

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Probiotics Definition

• Nutritional supplement
• Contains 1 or more cultures of living organisms
• Typically bacteria or yeast
• Modify the endogenous microflora
• Have a positive effect on the host

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Synbiotics Definition

• A probiotic organism in combination with its
  prebiotic food
• Providing both the organism and substrate at the
  time of ingestion may offer improved chance of
  survival in GI tract

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Probiotics Candidates

• Lactobacillus
• acidophilus, reuteri, casei, planatarum,
  rhamnosus GG
• Bifidobacteria
• bifidum, breve, infantis, longum
• Streptococcus
• thermophilus
• Saccharomyces
• Several combinations on the market

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Probiotics Potential Mechanisms of Action

• Inhibition of adhesion
• Immunomodulation
• Production of antimicrobial substances
• Modification of toxins or toxin receptors
• Competition for nutrients
• Reduction in bacterial translocation
• Anti-inflammatory signaling within the epithelium

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3.???????????????????????????????????????????????

• 3.1 ????????????? ????????????????????????????????
  ? ???????? ???????????????????? ????????????????
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• 3.2 ??????????????????????????????????????????????
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• 3.3 ?????????? ??????????????????????????????????
  ????????????????????????? ????????????????????????
  ????????????? ??????????? ???????????????
• 3.4 ??????????????????????????????????????????????
  ?????? ????????????????? ????????????????

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Decrease transmission Wash Your Hands!

• Best defense against foodborne illness!
• Wash after handling raw meat
• Use soap and safe drinking water
• Best for removing visible dirt and debris
• Other options
• Disposable wipes
• Instant hand sanitizer
• Waterless soap

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Drinking Water Safety

• Boil water 3-5 minutes before drinking, cooking
  or washing dishes
• Water filters
• Filter pore size of 1 micron or less
• Chlorinate with household bleach
• 1 drop per quart, ½ tsp. Per 5 gallons
• Halozone tablets
• Wait at least 30 minutes before using
• Tincture of iodine or iodine tablets
• 12 drops per quart
• Wait at least 30 minutes before using

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Drinking Water Safety

• Take bottled water if possible
• Drink municipally treated water
• Use cleanest source possible
• Keep lids on containers
• Have reserve supply

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4.????????????? ??????????????????

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  ?????? ??????????????????????????????????????????
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  ?????????????????????? ???????????????????????????
  ?

Dr.Waraluk, 12 Feb. 2008
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• ????????? Ogawa ????????
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Ogawa 703 ??? Inaba 263 ??? O139 5
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01 ??? ????????? 5 ??? ???????? 42 ???????
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Cholera in the environment
Cholera biofilm
Cholera single org.
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Out break investigation and control
Dr.Waraluk, 12 Feb. 2008
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Food safety and diarrhea (1)

• Personal hygiene and environment sanitation are
  of ulmost importance in the prevention of
  diarrhea, health education in food safety must
  receive high priority.
• Education of care takers particularly mothers in
  the principle of food safety should be considered
  as an important intervention in prevention of
  diarrhoel diseases in young children.
• Education by the health workers, from the
  community can play a vital role in this
  preventive aspects, as they make regular and
  frequent home visits that help them to establish
  close links with mothers, thus enhancing
  prospects for maternal and child health.

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Four Steps to Food Safety

• CLEAN
• Wash hands and surfaces often
• SEPARATE
• Avoid cross-contamination
• COOK
• Cook to proper temperatures
• CHILL
• Refrigerate foods promptly

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Decrease transmission Avoid Cross-contamination

• Keep raw meats separate from cooked or
  ready-to-eat foods
• Dont put cooked food on plates that had raw meat
  on them
• Dont use same knife to cut raw meat and
  ready-to-eat food
• Use disposable utensils if possible

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Decrease transmission Keep Hot Foods Hot and
Cold Foods Cold!

• Many bacteria grow between 40F (4.4C) and 140F
  (65C)
• The Temperature Danger Zone
• Bacteria counts may double every 20 minutes
• 1, 2, 4, 8, 16, 32, etc.

C/5 F-32/9
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Food safety In the Home (1)

• Drink pasteurized milk and juices
• Wash hands carefully and frequently
• After using the bathroom
• Changing infants diapers
• Cleaning up animal feces
• Wash hands before preparing food

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Food safety In the Home (2)

• Wash raw fruits and vegetables before eating
• After contact with raw meat or poultry
• Wash hands, utensils and kitchen surfaces
• Hot soapy water
• Defrost meats in the refrigerator

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Food safety In the Home (3)

• Cook beef/beef products thoroughly
• Internal temp. of 160oF (71.1C)
• Cook poultry and eggs thoroughly
• Internal temp.of 170-180oF(76.682.2C)
• Eat cooked food promptly
• Refrigerate leftovers within 2 hours after
  cooking
• Store in shallow containers

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Thank You