Wong f Food Overview

7/28/2019 Wong f Food Overview

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The Food and Drug Administration (FDA)Ranking of Food Hazards

ranking*

1. microbial contamination

2. naturally occurring toxicants

3. environmental contaminants (e.g., metals4. nutritional problems (i.e., malnutrition,

undernutrition)

5. pesticide residues

6. food additives

*1 being most dangerous, 6 least dangerous


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Definitions

Infection

Intoxication

Metabolic food

disorder Allergy

Idiopathic illness

Foodborne disease is any

illness resulting from the

consumption of food

contaminated with one or

more disease-producingagents. These include

bacteria, parasites, viruses,

fungi and their products as

well as toxic substances notof microbial origin.


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Risks perception vs. realityWhat is the likelihood that you will die of foodborne illness?

Deaths per year from selected causes in the United States (NCHS, 1986)All causes 2,105,361Ischemic heart disease 520,729All cancers 476,106Heart attack (acute myocardial infarction 261,002Motor vehicle accidents 47,885Diabetes mellitus 37,184Chronic liver disease and cirrhosis (alcohol not mentioned) 13,867Firearm assaults, including handguns 13,029Falling (accidental) 11,444Chronic liver disease and cirrhosis (alcoholic) 11,060Choking on a piece of food 3,692Firearm accidents, including handguns 1,452Intestinal infectious diseases 466

A one-in-a-million risk of death in the U.S. in 1986 242Salmonella infections 102Lightning 78Botulism 3


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Outbreaks vs. Cases

Foodborne disease outbreak: an incident inwhich two or more persons experienced a similarillness after ingestion of a common food, andepidemiologic analysis implicated a food as thesource of illness.

Foodborne disease case: one individualexperiences illness after ingestion of an

epidemiologically incriminated food.


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Estimates of the yearly incidence offoodborne illness

The estimates vary greatly but thought to bearound 76 million cases per year

Cost estimates range from $523 billion per year

High cost due to many factors: medical care, investigation of illness, loss of

productivity, loss of business, legal activities


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Infection

Definition:a disease state caused by the presence of viable,usually multiplying organisms at the site ofinflammation

Bacteria - Salmonella, Campylobacter

Virus - hepatitis A, Norwalk virus

Protozoa - Cryptosporidium, Cyclospora

other parasites - Trichinella spiralis


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Intoxication

Definition:a disease state, caused by exposure to a toxicchemical, that is not mediated immunologicallyand is not primarily the result of a geneticdeficiency.

Staphylococcal food poisoning, botulism

Saxitoxin, ciguatera


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Foodborne Diseases

Infections

Poisonous

Animal

Tissues

Poisonous

Plant

Tissues

Chemical

Poisoning

Intoxications

Microbial

Intoxications

Other Neurotoxins Enterotoxins

Toxicoinfection Invasive Infection

Intestinal

Mucosa

Systemic Other

Tissues or

Organs

(Muscle,

Liver, Joints,

Fetus, Other)

Mycotoxins

(Fungal

Toxins)

Algal Toxins Bacterial

Toxins

Diarrhogenic Emetic Enterotoxins Neurotoxins Other


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Foodborne Diseases

InfectionsIntoxications

Invasive

Infection

Intestinal

Mucosa

Systemic Other

Tissues or

Organs(Muscle,

Liver,

Joints,

Fetus,

Other)

Other Neurotoxins Enterotoxins

Toxicoinfection


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Foodborne Diseases

Diarrhogenic Emetic Enterotoxins Neurotoxins Other

Infections

Poisonous

Animal

Tissues

Poisonous

Plant

Tissues

Chemical

Poisoning

Intoxications

Microbial

Intoxications

Mycotoxins

(Fungal

Toxins)

Algal

Toxins

Bacterial

Toxins


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Examples of foodborne infections/intoxications

Disease Reservoir

Botulism food intoxication Soil contaminated foods

Campylobacteriosis Cattle, poultry, shellfish

Clostridium perfringens Soil contaminated foodsfood poisoning

Salmonellosis Animals and birds

Staphylococcal food poisoning Human carriers

Vibrio parahaemolyticus Seafoodsinfection

Yersinia enterocolitica Animal intestinesinfection


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Metabolic food disorder

Definition:a disease state caused by exposure to a chemicalthat is toxic to certain individuals only becausethey exhibit some genetic deficiency

lactose intolerance

favism


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Allergy

Definition:a disease state caused by exposure to a particularchemical that (often proteinaceous) to which certainindividuals have a heightened sensitivity

(hypersensitivity) that has an immunological basis proteins (heat resistant and resistant to digestion)

cows milk: b-lactoglobulin, casein, etc.

egg-ovalbumin

small molecules

penicillin


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Idiopathic illness

Definition:any illness of uncertain pathogenesis that may

possibly but not certainly be due to foods; also, anyfood-caused illness that does not fit into one of theother categories

Chinese restaurant syndrome

celiac disease

hyperkinesis


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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


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Information reported to and compiled by theCenters for Disease Control (CDC)

Outbreaks of known etiology = where laboratory evidence indicated aspecific agent

Outbreaks of unknown etiology = where epidemiological evidenceimplicated foodborne transmission, butthe etiological agent was notidentified.

4 subgroups based on incubation period:

< 1 hr = probable chemical poisoning

17 hr = probable Staphylococcus aureus poisoning

814 hr = probable Clostridium perfringens food poisoning

> 14 hr = probably other infectious/toxic agents

Outbreaks of known vehicle = a particular food item was associatedwith the illness


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Number of reported foodborne-disease outbreaks, cases,and deaths, by etiology United States, 19931997

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 etiology 878 (31.9) 50,788 (59.0) 28 (96.6)

Unknown etiology 1,873 (68.1) 35,270 (41.0) 1 (3.4)

Total 19931997 2,751 (100.0) 86,058 (100.0) 29 (100.0)

No. (%) No. (%) No. (%)

Outbreaks Cases Deaths

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


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Estimated illnesses for knownfoodborne pathogens, United States

Disease or agent Estimated total cases

Bacteria 5,204,934

Parasites 2,541,316

Viruses 30,883,391

Grand Total 38,629,641

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):607625

(1999). http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm


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Top Twelve Factors Contributing to 345 Outbreaks ofFoodborne Disease Caused by Mishandling and/orMistreatment of Foods in Homes in the U.S., 19731982

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 preparingand eating 12.8

6. Colonized person handling implicated food 9.9

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


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The World Health Organizations Golden Rulesfor 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 otheranimals.

10. Use pure water.


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The future and foodborne illness

Demographics

Human behavior changing

Technology changing

Global market


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Populationssensitive to foodborne disease

Pregnant women

Neonates

Elderly (over 65)

Residents in nursing home or related carefacilities

Cancer patients (nonhospitalized)

Organ transplant patients AIDS patients


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The aging population

0

50

100

150

200

250

300

350

400

450

Numbersofp

eople

(inmillion

s)

263 276

3

65 years of age


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Population

Earths increasing population 1900 1.7 billion people

1998 6.0 billion people

2050 8.2 billion people (medium population projection)


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Future water usage

Competition betweenagriculture, industry,and personalhouseholds.

Modern agricultureaccounts for 7080%of water usage.

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