FOOD BORNE DISEASES

Moderator Dr B S Garg
Presenter - Dr Gaurij Hood

Food borne Diseases

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

1.Introduction

Food borne diseases-(intoxications and

infections) Covers illnesses acquired through
consumption of contaminated food-food poisoning

Food borne disease outbreaksOccurrence of 2 or more cases of similar illness

resulting from ingestion of common food
OR
When observed number of paticular disease
exceeds expected number

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)

Food borne infections vs intoxication

Infections

Bacterial / Viral / parasite

Invade and or multiply in

lining of intestine
Incubation periodhours
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 periodminutes to hours

S/s Vomitting , nausea,

diarrhea , diplopia, weakness,
resp. failure , numbness,
sensory/motor dysfunction
Not communicable
Factors-inadequate cooking ,
improper handling
temperatures

Epidemiology in India
Agent

People
affected
1995 Yavatmal
33

Implicated
Food

Clostridiu
m
butyricum

1996 Gujarat-

Sevu
(Gram flour
crisp)

Salmonell
a

1998 Armed
Forces

Salmonell
a
paratyphi
A

Year

Region

residenti
al school

34
students

Vegetarian
food

78
Frozen fowl
personnel

Epidemiology in India
Agent

Year

Region

People

Implicated
Food

affecte
d
Norwalk
like Virus
Staph.
Aureus

Salmonell
a
welteverd

2002
2007

Delhi
Hospital
MP

2008- Mangalor
09
e

130
nurses
>100
childre
nn
adults

Salad
Sandwiches
Bhalla ( fried
potato balls)

34
and
10

Chicken
and
Fish

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

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

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

Some common bacterial food poisons

Incubation
period
1-6 hours

Cause
Staph aureus
(enterotoxin)

Symptoms
Nausea,
vomitting,
diarrhea

Bacillus
Nausea,
cereus
vomitting,
(enterotoxin) (emetic
form)

Common
foods
Milk n milk
products,
ham, poultry,
salads,
custards
Fried rice

Some common bacterial food poisons

Incubation
period

Cause

8-16 hours Clostridium

perfringes
(spores)

Bacillus cereus
( diarrheal
formpreformed n
stable toxins)

Symptoms

Common
foods

Abd.cramps,
diarrhea
Nausea and
Vomitting -rare

Meat,
poultry,
legumes.
gravies

Diarrhea,
abd.pain,
nausea,
vomitting/fever
-No

Some common bacterial food poisons

Incubation
Cause
Symptoms
period
>16 hours Vibrio cholera Rice watery
stools

Common
foods
Water and
ice creams,
sea food

Salmonella
spp

Inflammator Meat , milk

y diarrhea
n milk
products,
poultry

Shigella sp

dysentry

Potato/raw
eggs-salad

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

Lab diagnosis

Main objectives-

a) To confirm
causative

clinical diagnosis by isolation of

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

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 >75% 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 )

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

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

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

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)

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

Safety Regulations

Prevention of Food Adulteration Act , 1954To 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 <Rs 5000
Food Standards- Codex Alimentarius , Agmark
standards,
Bureau of Indian Standards
National Nutrition Policy -1993- Food Security

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 foodSeparate 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

Five Keys to Safer Food

3. Cook Thoroughly
esp. Meat , poultry , eggs and Seafood
Bring soups n stews to boiling (ensure>70degree
temp)
Reheat cooked food thoroughly
4. Keep food at safe temperature Dont leave cooked food at room temp.>2 hours
Prompt refrigeration of cooked n perishable food
Keep cooked food piping hot(>60 de.) prior to
serving
Dont store food too long even in refrigerator
Dont thaw frozen food at room temperature

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

References
1. CD Alert December 2009, vol.13:No.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

THANK

YOU