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FOOD BORNE DISEASES

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FOOD BORNE DISEASES Moderator Dr B S Garg Presenter - Dr Gaurij Hood Epidemiology in India Epidemiology in India Safety Regulations Prevention of Food Adulteration ... – PowerPoint PPT presentation

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Title: FOOD BORNE DISEASES


1
FOOD BORNE DISEASES
  • Moderator Dr B S Garg
  • Presenter - Dr Gaurij Hood

2
Food borne Diseases
  • 1.Introduction
  • 2.Pathogenesis and Transmission
  • 3.Important foodborne pathogens/toxins/chemicals
  • 4.Investigations and Lab diagnosis
  • 5.Treatment and Prevention

3
1.Introduction
  • Food borne diseases-(intoxications and
    infections) Covers illnesses acquired through
    consumption of contaminated food-food poisoning
  • Food borne disease outbreaks-
  • Occurrence of 2 or more cases of similar
    illness resulting from ingestion of common food
  • OR
  • When observed number of paticular disease
    exceeds expected number

4
1.Introduction
  • Global burden- high morbidity and mortality
  • Infectious diarrhoea- 3 to 5 billion cases and
    1.8 million deaths annually
  • CDC- 76 million cases of food borne diseases in
    US annually with appx.5000 deaths
  • In India- Integrated disease surveillance
    Project (IDSP) - Food poisoning outbreak
    reporting increased to more than double in 2009
    from 2008 (120 in 2009 and 50 in 2008)

5
Food borne infections vs intoxication
  • Infections
  • Bacterial / Viral / parasite
  • Invade and or multiply in lining of
    intestine
  • Incubation period- hours to days
  • S/s Diarrhoea , nausea, vomitting , abdominal
    cramps, fever
  • Communicable-spreads from person to person
  • Factors-inadequate cooking, cross contamination ,
    poor personal hygiene , bare hand contact
  • Intoxications
  • toxins ( natural / preformed bacterial /
    chemical)
  • No invasion or multiplication
  • Incubation period-
  • minutes to hours
  • S/s Vomitting , nausea, diarrhea , diplopia,
    weakness, resp. failure , numbness, sensory/motor
    dysfunction
  • Not communicable
  • Factors-inadequate cooking , improper handling
    temperatures

6
Epidemiology in India
Agent Year Region People affected Implicated Food
Salmonella paratyphi A 1995 Yavatmal 33 Vegetarian food
Clostridium butyricum 1996 Gujarat- residential school 34 students Sevu (Gram flour crisp)
Salmonella Enteritidis 1998 Armed Forces 78 personnel Frozen fowl
7
Epidemiology in India
Agent Year Region People affected Implicated Food
Norwalk like Virus 2002 Delhi Hospital 130 nurses Salad Sandwiches
Staph. Aureus 2007 MP gt100 children n adults Bhalla ( fried potato balls)
Salmonella welteverden and Wein 2008-09 Mangalore 34 and 10 Chicken and Fish
8
Some important food-borne pathogens, toxins and
chemicals
  • 1. Bacteria - Bacillus cereus , Brucella ,
    Campylobacter, Clostridium sp , E.coli,
    Salmonella sp , Listeria , Staph aureus , Vibrio
    cholera and V.parahemolyticus
  • 2. Viruses - Hepatitis A and E , Rotavirus ,
    Norvovirus
  • 3. Protozoa Cryptosporidium , Cyclospora ,
    Entamoeba , Giardia , T. gondii
  • 4. Trematodes , Cestodes and Nematodes

9
Food borne pathogens-toxins and chemicals
  • Toxins - marine biotoxins , tetrodotoxin (puffer
    fish), pyrrolizidine alka (Endemic ascites) ,
    mushroom toxins , shellfish toxins ,
    mycotoxins-(Aflatoxins ,Ergot and Fusarium),
    plant intoxicants , BOAA (Lathyrism)
  • Chemicals - pesticides (OPP,sb) , radionuclides ,
    nitrites (food preservatives) toxic metals - cd,
    cu, hg, pb, sn, fluoride , MSG

10
Pathogenesis and Transmission
  • Inoculum / size of infective dose -Can be as
    small as 10-100 bacterial cysts for Shigella ,
    EHEC , Giardia, E. histolytica
  • or 10 5-10 8 for Vibrio cholera, variable
    for salmonella
  • Animals / humans harbouring infection ? shed in
    feces ? contaminate water , fruits , vegetables
    ?inadequate cooking / improper storage ?
    infection
  • Warm temperature(10-50 degree cent.)-
  • multiplication of pathogens

11
Some common bacterial food poisons
Incubation period Cause Symptoms Common foods
1-6 hours Staph aureus (enterotoxin) Nausea, vomitting, diarrhea Milk n milk products, ham, poultry, salads, custards
Bacillus cereus (enterotoxin) Nausea, vomitting, (emetic form) Fried rice
12
Some common bacterial food poisons
Incubation period Cause Symptoms Common foods
8-16 hours Clostridium perfringes (spores) Abd.cramps, diarrhea Nausea and Vomitting -rare Meat, poultry, legumes. gravies
Bacillus cereus ( diarrheal form- preformed n stable toxins) Diarrhea, abd.pain, nausea, vomitting/fever-No

13
Some common bacterial food poisons
Incubation period Cause Symptoms Common foods
gt16 hours Vibrio cholera Rice watery stools Water and ice creams, sea food
Salmonella spp Inflammatory diarrhea Meat , milk n milk products, poultry
Shigella sp dysentry Potato/raw eggs-salad
14
Early diagnosis and investigations
  • 1.Initial assessment of cases
  • Detailed clinical history including time
    of onset , duration of illness , symptoms , h /o
    travel , recent meals , cooking and refrigeration
    , details of others with similar complaints
  • 2.Detailed clinical examination
  • Vitals and degree of dehydration ,
    systemic signs

15
Lab diagnosis
  • Main objectives-
  • a) To confirm clinical diagnosis by isolation
    of causative agent from proper samples ,
  • eg . stool , vomitus / gastric aspirate ,
    food specimens
  • b) Ensure proper identification of disease
  • c) Determine causative agent if present in food
    sources with relevant epidemiological markers-
    eg. Biotyping , serotyping , PCR , Phage typing
    etc

16
Collection of food samples
  • Using aseptic technique n appropriate containers
    ? samples be refrigerated during storage and
    transport ? must arrive lab within 3 days of
    collection
  • Adequate sample - minimum 100 grams
  • Containers - not to be filled gt75 of capacity
  • Proper labelling is utmost important ? labelled
    specimen be placed in zip lock bag and sealed
  • Vaccine carrier with ice packs for transport and
    cold chain maintenance ( avoid freezing )

17
Steps of outbreak investigation
Establishing existence
Co-ordination
Collection and transport
Lab testing
Control and preventive measures
Definition of cases, population
Description of epidemiology
Possible hypotheses
Epidemiological study
Analysis of data and interpretation
Reporting
18
Treatment
  • 1. Initial T/t - Assessment and reversal of
    dehydration ( ORT / IV Fluids )
  • 2. Cause specific treatment if any- eg.
    chelating agents in case of pesticide poisoning
  • 3. Use of antibiotics can be considered if
    bacterial cause is identified

19
Steps of outbreak investigation
  • Establishing existence of outbreak(detailed
    baseline epidemiological information)?Co-ordinatio
    n with key personnel?Collection and transport of
    clinical specimens and food samples for lab
    testing?Implementation of control and preventive
    measures?definition of cases,population at risk
    and finding cases?Description of
    epidemiology?Development of possible
    hypotheses?Epidemiological study to evaluate
    hypotheses?Analysis of data and
    interpretation?Reporting findings of outbreak
    investigation

20
Prevention in community
  • Proper handwashing and personal hygiene
  • Proper storage (refrigeration)
  • Food saftey education community and food
    handlers
  • Environmental measures - Discourage sewage
    farming for growing fruits and vegetables

21
Prevention
  • Hazard Analysis and Critical Control Point
    (HACCP) -
  • Systematic preventive approach to food safety
  • Addresses physical , chemical and biological
    hazards as means of prevention rather than
    finished product inspection
  • Food industry - Food safety hazards identified at
    all stages of food production and preparation
    processes ? key action taken at Critical Control
    Points (CCP s)

22
Principles of Hazard Analysis and Critical
Control Point ( HACCP )
  • Analyse hazards ? Identify critical control
    points ? Establish preventive measures with
    critical limits for each CCP ? Establish
    procedures to monitor CCPS ? Establish corrective
    actions when monitoring shows that critical limit
    has not met ? Establish procedures to verify that
    system is working properly ? Establish effective
    record keeping for documentation

23
Safety Regulations
  • Prevention of Food Adulteration Act , 1954-
  • To Ensure pure and wholesome food and to
    protect from fradulent practices
  • Amendments -1964,1976,1986
  • Case of proven adulteration Minimum imprisonment
    of 6 months and minimum fine of Rs 1000 envisaged
  • Grievous Hurt-(320 IPC)- Death or such harm can
    be punished upto Life imprisonment and fine not
    ltRs 5000
  • Food Standards- Codex Alimentarius , Agmark
    standards,
  • Bureau of Indian Standards
  • National Nutrition Policy -1993- Food Security

24
Five keys to Safer food
  • 1. Keep Clean
  • Wash hands before handling food and often
    during
  • preparation
  • Wash hands after going to toilet
  • Wash n sanitise all surfaces n equipment for
    food preparation-protect kitchen from insects ,
    pets
  • 2. Separate raw and cooked food-
  • Separate raw meat , poultry n seafood from
    other foods
  • Use separate utensils for handling raw foods
  • Store food in containers to avoid contact
    between raw and cooked foods

25
Five Keys to Safer Food
  • 3. Cook Thoroughly
  • esp. Meat , poultry , eggs and Seafood
  • Bring soups n stews to boiling
    (ensuregt70degree temp)
  • Reheat cooked food thoroughly
  • 4. Keep food at safe temperature -
  • Dont leave cooked food at room temp.gt2 hours
  • Prompt refrigeration of cooked n perishable
    food
  • Keep cooked food piping hot(gt60 de.) prior
    to serving
  • Dont store food too long even in
    refrigerator
  • Dont thaw frozen food at room temperature

26
Five keys to safer food
  • 5. Use safe water and raw materials-
  • Use safe water or treat to make it safe
  • Select fresh and wholesome fruits
  • Choose foods processed for safety - pasteurised
    milk
  • Wash fruits n vegetables if eaten raw
  • Dont use food beyond expiry date

27
References
  • 1. CD Alert December 2009, vol.13No.4
    Food Borne
  • Diseases, page no. 1-12
  • 2.Parks Textbook of PSM , Twentieth Edition,
    Intestinal
  • infections Food Poisoning , page no.
    210-212
  • 3.Internet- www.nicd.nic.in

28
  • THANK YOU
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