EMERGING FOODBORNE PATHOGENS

Prof. Dr. rfan EROL, DVM, Ph.D.

Turkish Representative of World Vet. Assoc. Department of Food Hygiene and Technology School of Veterinary Medicine Ankara University

Despite advances in hygiene, consumer knowledge, food treatment and processing, foodborne diseases mediated by pathogenic microorganisms or microbial toxins still represent a significant treat to public health worldwide.

Globally, the WHO has estimated that approximately 1.5 billion episodes of diarrhea and more than 3 million deaths occurred in children under 5 years of age, and a significant proportion of these results from consumption of food mainly food of animal origin with microbial pathogens and toxins

Emerging & Reemerging Zoonotic Diseases

60 % of the human pathogens are zoonotic

75 % of emerging zoonotic

Emerging Foodborne Pathogens

Definition: those causing illnesses that have only recently appeared or been recognised in a population or that are well recognised but are rapidly increasing in incidence or geographic range

Emerging Foodborne Diseases

Appeared recently Extended to new vehicles of transmission Started to increase rapidly in incidence or geographic range Been widespread for many years but only recently identified through new or increased knowledge or methods of identification and analysis of the disease agent

Emerging Foodborne Diseases

Pose a threat to all persons; no matter on age, sex, lifestyle or socio-economic status etc.

Feel pain and death

Economic impact

Emerging Foodborne Diseases Major trends

Changes in environment (technology, climate, etc) Mass production and globalisation of food supply Economic development International travel and trade Changing character of the population Breakdown in public health Lifestyle changes Microbial adaptation

Emerging Foodborne Pathogens

Bacteria Viruses Parasites Prion

Emerging foodborne bacteria

Salmonella (multidrug resistant strain) Campylobacter jejuni E. coli O157:H7 Listeria monocytogenes S. aureus MRSA Vibrio vulnificus Yersinia enterocolitica

Arcobacter spp.
Mycobacterium paratuberculosis

Emerging foodborne viruses

Hepatit A and E Norovirus (Avian influenza, AI)

Emerging foodborne parasites

Cryptosporidium parvum Cyclospora cayetanensis Anisakis spp.

Foodborne outbreaks 1996 - 2006

Cryptosporidiosis, Leptospirosis, Lyme borreliosis

Reference: WHO

Brucellosis, E. coli 0157, Salmonellosis BSE

Reference: CDC

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 8th Report 1999-2000 Country Reports: Turkey

Pathogen

Emerging foodborne diseaeses estimated annually

Cases

No. of Ilnesses

No. of Deaths

Economic losses from foodborne diseases estimated annualy $ billion

Campylobacter spp.
Salmonella nontyphoidal E. coli O157:H7 E. coli non-O157STEC L. monocytogenes

1,963,141
1,341,873 62,458 31,229 2,493

10,539
15,608 1,843 921 2,298

99
553 52 26 499

1.2
2.4 .7 .3 2.3

Total

3,401,194

31,209

1,229

6.9

Reference: USDAs Economic Research Service & CDC

Some Important Salmonella Outbreaks in the World

Year Country
1991 Germany 1991 Germany 1994 U.S.A 2003 U.S.A 2005 Spain 2006 Norway 2008 Ireland&U.K

Food
Orange cream Puding (egg) Ice cream Chicken Processed chicken Salami Beef, chicken

Serotype/Phage type
S.Enteritidis PT4 S.Enteritidis S.Enteritidis S. Typhimurium S. Hadar S. Kedougou S. Agona

No. of cases
109 87

No. of deaths
4 10

224000 38 2138 54 119 1 1 -

Salmonella serotype distribution in Turkey

(Erol et al., 2009)

S. Agona S. Kentucky S. Bredeney

Spices

Some Important Campylobacter Outbreaks in the World

Year 2000 Country U.K & Wales Food Raw milk Chicken Chicken salad Chicken pate Water Cheese (from unpasteurized milk) Water No. of cases 333 601 4 82 32 67 16

2001-2002 Australia 2005 2005 Denmark Scotland

2005-2006 U.S.A 2007 2007 U.S.A Denmark

Campylobacter jejuni

Quinolone- and fluoroquinolone-resistant Campylobacter jejuni in the United States, 19822001

Campylobacter jejuni

Thermophilic Campylobacter spp. in turkey meat (n=270) (Cakmak and Erol, 2009)

Thermophilic Camylobacter spp. 123 (45.5%)

C. jejuni 109 (40.3 %) C. coli 11 ( 4.0 %) Not typed 3

100 bp

500 bp 735 bp

Antibiotic resistance profile of C. jejuni isolates in turkey meat (Cakmak and Erol, 2009)
Antibiotics
Azithromycin Resistant % 104 (95.4) Intermediate % 2 (1.8) Sensitive % 3 (2.7)

Erythromycin
Gentamicin

103 (94.4)
0

0
0 3 (2.7) 0 0 2 (1.8)

6 (5.5)
109 (100.0) 106 (97.2) 99 (90.8) 90 (82.5) 67 (61.4)

Chloramphenicol 0 Nalidixic acid Ciprofloxacin Tetracycline 10 (9.1) 19 (17.4) 40 (36.6)

Some important E. coli O157:H7 Outbreaks in the World

Country Japan Year 1996 No of cases(age) >5499 (students) Complications 12 deaths Infection source Alfalfa

U.S.A
Canada Sweden U.S.A

1999
2000 2002 2002

321
27 39 34

5 deaths 5 HUS

Beef
Water Fermented sausage Ground beef

Netherlands 2005 U.S.A 2006

32 376

3 deaths

Steak tartare Fresh spinach

E. coli O157:H7 isolates found in fecal samples of cattle and

sheep at slaughter in Turkey (Erol et al., 2008)

Sheep
Number of samples
Number of positive samples Percent (%)

Cattle
282

Cattle (male)
207

Cattle (female)
75

Total
500

218

14

11

25

6.42

3.90

3.38

5.33

5.00

Positive stx1 7

Negative 4

Total 11

stx2
eaeA hly

9
11 11

2
-

11
11 11

H7

11

11

Toxin profiles of E. coli O157:H7 isolated in Turkey (Erol et al., 2008)

Toxin profiles of 11 E. coli O157:H7 isolates within the PFGE groups in cattle in Turkey (Erol et al., 2008)

PFGE groups

N
1

Toxin profiles
stx2

B
C

2
1

stx2
stx1 and stx2

stx1 and stx2

stx1 stx2

2 1

Some Important Listeria outbreaks in the World

Country U.S.A. Finland France U.S.A. U.S.A. U.S.A. Switzerland Norway Canada Year 1998 1998 2000 2000 2002 2003 2005 2007 2008 Food Turkey products Butter Turkey products Turkey products Mexican cheese Soft cheese Cheese Serotype 4b 3a 1/2a 4b No. of cases 108 25 32 30 54 12 11 12 53 No. of deaths 18 24 31 7 11 2 2 2 20

Pork meat 4b

Red meat -

Contamination level of turkey meat with L. monocytogenes is 17.8 % (32/180) (Ayaz and Erol 2008)

L. monocytogenes serotype distribution

44.9 % 37.2 % 9.0 % 9.0 % 1/2a 4b 1/2b 1/2c

Antibiotic resistance profiles of L. monocytogenes in turkey meat (n:24) (Ayaz and Erol, 2008)
Antibiotics
Ampicillin Chloramphenicol Erythromycin Gentamicin Penicillin Streptomycin Tetracycline Vancomycin

Resistant (%)

Intermediate (%)

Sensitive (%)

18 (75.0) 20 (83.3) -

9 (37.5) 8 (33.3) -

6 (25.0) 24 (100) 15 (62.5) 24 (100) 4 (16.7) 16 (66.7) 24 (100) 24 (100)

Number of Brucella cases in Turkey, 1999-2003 (Ministry of Health) 20.000 16.000

12.000

8.000 4.000

0 1999 2000 2001 2002 2003

Occurrence of Cryptosporidium spp. oocysts in Turkey (Kursun and Erol, 2003)

Surface water
Sewage water treatment at slaughterhouse Ent. Exist. Slaughtered

Cattle

Sheep

Number of samples Number of positive samples Percent (%)

24 24

13 13

13 13

60 23

60 4

100

100

100

38.3

6.6

Antibiotic resistance

Its a global concern of the antibiotic resistance of major foodborne pathogens such as;

Salmonella Typhimurium DT 104 Campylobacter spp. Listeria monocytogenes E. coli O157:H7 Staphylococcus aureus (MRSA) Enterococcus (VRE)

Lab. Confirmed Cases

Foodborne Infections&Intoxications Known/ Unknown

Reported Positive Isolates

Suspectible Cases

Hospitalised No sample taken

Unnotified Cases No medical intervention

Farm to table; main contamination points

Surveillance

Risk management

Epidemiological evaluation / Risk assessment

Research

Control of Foodborne Disease

From farm to table approach Implementation of GMP and HACCP

Public Health Approach

Public health system Surveillance Epidemiology for earlier diagnosis Early response to outbreaks Provide to disease patterns changing Public health lab. support for rapid and accurate diagnosis Rapid communication links Communication to public Education on prevention and/or detection

E-mail: erol@veterinary.ankara.edu.tr

Factors contributing to the global incidence of foodborne disease

Poor sanitary conditions Malnutrition Changing demographics (increasing population of infants, elderly) Inadequate public health infrastructure Inadequate hygienic and technological conditions of food production Inadequate cooking, reheating and storage conditions Increasing tourism and international trade Increasing animal movement and insufficient control of borders Increasing international trade of animal and food Inadequate legislation and official control system Emerging/reemerging foodborne pathogens Acquisition of virulence and antibiotic genes by nonpathogenic bacteria Adaptation and enhanced survival of pathogens in food Inadequate consumer education

Trichinellosis outbreak in Turkey

Although there is a religious restriction on pork meat consumption, in January 2004 there was a big trichinellosis outbreak occurred by consuming i kfte (raw ground meat ball-traditional food) in Izmir 542 people were affected and samples were found to be contaminated with T. britovi

One World One Health (OWOH)

The medical and veterinary professions have a common interest in many diseases, primarily zoonotic diseases such as BSE, SARS and, most recently, Avian Influenza (H5N1), have highlighted the need for interprofessional collaboration not just locally and nationally, but on a global scale.

One World One Health (OWOH)

Improving animal and human health globally through collaboration among all the health sciences, especially between the veterinary and human medical professions to address critical needs.