Foodborne illness

Food safety
Food Safety 1.svg
Terms
Foodborne illness
HACCP
Critical control point
Critical factors
FAT TOM
pH
Water activity (Wa)
Pathogens
Clostridium botulinum
E. coli
Hepatitis A

Foodborne illness (also foodborne disease and colloquially referred to as food poisoning) is any illness resulting from the consumption of food.

There are two types of food poisoning: food infection and food intoxication. Food infection refers to the presence of bacteria or other microbes which infect the body after consumption. Food intoxication refers to the ingestion of toxins contained within the food, including bacterially produced exotoxins, which can happen even when the microbe that produced the toxin is no longer present or able to cause infection. In spite of the common term food poisoning, most cases are caused by a variety of pathogenic bacteria, viruses, prions or parasites that contaminate food,[1] rather than chemical or natural toxins.

Contents

Causes

Foodborne illness usually arises from improper handling, preparation, or food storage. Good hygiene practices before, during, and after food preparation can reduce the chances of contracting an illness. The action of monitoring food to ensure that it will not cause foodborne illness is known as food safety. Foodborne disease can also be caused by a large variety of toxins that affect the environment. For foodborne illness caused by chemicals, see Food contaminants.

Foodborne illness can also be caused by pesticides or medicines in food and naturally toxic substances like poisonous mushrooms or reef fish.

Symptoms and mortality

Symptoms typically begin several hours to several days after consumption and depending on the agent involved, can include one or more of the following: nausea, abdominal pain, vomiting, diarrhea, gastroenteritis, fever, headache or fatigue.

In most cases the body is able to permanently recover after a short period of acute discomfort and illness. However, foodborne illness can result in permanent health problems or even death, especially for people at high risk, including babies, young children, pregnant women (and their fetuses), elderly people, sick people and others with weak immune systems.

Foodborne illness is a major cause of reactive arthritis, which typically occurs 1–3 weeks afterward. Similarly, people with liver disease are especially susceptible to infections from Vibrio vulnificus, which can be found in oysters or crabs.

Tetrodotoxin poisoning from reef fish and other animals manifests rapidly as numbness and shortness of breath, and is often fatal.

Incubation period

The delay between consumption of a contaminated food and appearance of the first symptoms of illness is called the incubation period. This ranges from hours to days (and rarely months or even years, such as in the case of Listeriosis or Creutzfeldt-Jacob disease), depending on the agent, and on how much was consumed. If symptoms occur within 1–6 hours after eating the food, it suggests that it is caused by a bacterial toxin or a chemical rather than live bacteria.

The long incubation period of many foodborne illnesses tends to cause sufferers to attribute their symptoms to "stomach flu."

During the incubation period, microbes pass through the stomach into the intestine, attach to the cells lining the intestinal walls, and begin to multiply there. Some types of microbes stay in the intestine, some produce a toxin that is absorbed into the bloodstream, and some can directly invade the deeper body tissues. The symptoms produced depend on the type of microbe.[2]

Infectious dose

The infectious dose is the amount of agent that must be consumed to give rise to symptoms of foodborne illness, and varies according to the agent and the consumer's age and overall health. In the case of Salmonella a relatively large inoculum of 1 million to 1 billion organisms is necessary to produce symptoms in healthy human volunteers[1], as Salmonella are very sensitive to acid. An unusually high stomach pH level (low acidity) greatly reduces the number of bacteria required to cause symptoms by a factor of between 10 and 100.

Pathogenic agents

See also: Pathogen

Bacteria

Bacteria are a common cause of foodborne illness. In the United Kingdom during 2000 the individual bacteria involved were as follows: Campylobacter jejuni 77.3%, Salmonella 20.9%, Escherichia coli O157:H7 1.4%, and all others less than 0.1%.[3] In the past, bacterial infections were thought to be more prevalent because few places had the capability to test for norovirus and no active surveillance was being done for this particular organism. Symptoms for bacterial infections are delayed because the bacteria need time to multiply. They are usually not seen until 12–72 hours or more after eating contaminated food.

Most common bacterial foodborne pathogens are:

Other common bacterial foodborne pathogens are:

Salmonella

Less common bacterial agents:

Exotoxins

In addition to disease caused by direct bacterial infection, some foodborne illnesses are caused by exotoxins which are excreted by the cell as the bacterium grows. Exotoxins can produce illness even when the microbes that produced them have been killed. Symptoms typically appear after 1–6 hours depending on the amount of toxin ingested.

For example Staphylococcus aureus produces a toxin that causes intense vomiting. The rare but potentially deadly disease botulism occurs when the anaerobic bacterium Clostridium botulinum grows in improperly canned low-acid foods and produces botulin, a powerful paralytic toxin. The disease of MMS was recently diagnosed for the first time in the United States in Tucson, Arizona. Symptoms include nausea, fatigue and excessive vomiting. This disease is caused from eating meat sticks that are past an acceptable shelf life.

Pseudoalteromonas tetraodonis, certain species of Pseudomonas and Vibrio, and some other bacteria, produce the lethal tetrodotoxin, which is present in the tissues of some living animal species rather than being a product of decomposition.

Mycotoxins and alimentary mycotoxicoses

The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins through food consumption. Mycotoxins have prominently affected on human and animal health such as an outbreak which occurred in the UK in 1960 that caused the death of 100,000 turkeys which had consumed aflatoxin-contaminated peanut meal and the death of 5000 human lives by Alimentary toxic aleukia (ALA) in the USSR in World War II[9]. The common foodborne Mycotoxins include

Emerging foodborne pathogens

Much is still not known about foodborne illness. Approximately sixty percent of outbreaks are still caused by unknown sources.

Preventing bacterial food poisoning

Prevention is mainly the role of the state, through the definition of strict rules of hygiene and a public services of veterinary surveying of animal products in the food chain, from farming to the transformation industry and delivery (shops and restaurants). This regulation includes:

In August 2006, the United States Food and Drug Administration approved Phage therapy which involves spraying meat with viruses that infect bacteria, and thus preventing infection. This has raised concerns, because without mandatory labelling consumers wouldn't be aware that meat and poultry products have been treated with the spray. [2]

At home, prevention mainly consists of good food safety practices. Many forms of bacterial poisoning can be prevented even if food is contaminated by cooking it sufficiently, and either eating it quickly or refrigerating it effectively. Many toxins, however, are not destroyed by heat treatment.

Viruses

Viral infections make up perhaps one third of cases of food poisoning in developed countries. In the US, more than 50% of cases are viral and noroviruses are the most common foodborne illness, causing 57% of outbreaks in 2004. Foodborne viral infection are usually of intermediate (1–3 days) incubation period, causing illnesses which are self-limited in otherwise healthy individuals, and are similar to the bacterial forms described above.

Rotavirus

Parasites

Most foodborne parasites are zoonoses.

Platyhelminthes:

The scolex of Tenia solium

See also: Tapeworm and Flatworm

Nematode:

Protozoa:

Giardia lamblia

Natural toxins

Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants in particular may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal, but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

Some plants contain substances which are toxic in large doses, but have therapeutic properties in appropriate dosages.

Other pathogenic agents

"Ptomaine poisoning"

An early theory on the causes of food poisoning involved ptomaines (from Greek ptōma, "fall, fallen body, corpse"), alkaloids found in decaying animal and vegetable matter. While some alkaloids do cause poisoning, the discovery of bacteria left the ptomaine theory obsolete and the word ptomaine is no longer used scientifically.

Global Impact

In modern times, rapid globalization of food production and trade has increased the potential likelihood of food contamination. Many outbreaks of foodborne diseases that were once contained within a small community may now take place on global dimensions. Food safety authorities all over the world have acknowledged that ensuring food safety must not only be tackled at the national level but also through closer linkages among food safety authorities at the international level. This is important for exchanging routine information on food safety issues and to have rapid access to information in case of food safety emergencies."

It is difficult to estimate the global incidence of foodborne disease, but it has been reported that in the year 2000 about 2.1 million people died from diarrhoeal diseases. Many of these cases have been attributed to contamination of food and drinking water. Additionally, diarrhoea is a major cause of malnutrition in infants and young children.

Even in industrialized countries, up to 30% of the population of people have been reported to suffer from foodborne diseases every year. In the U.S, around 76 million cases of foodborne diseases, which resulted in 325,000 hospitalizations and 5,000 deaths, are estimated to occur each year. Developing countries in particular, are worst affected by foodborne illnesses due to the presence of a wide range of diseases, including those caused by parasites. Foodborne illnesses can and did inflict serious and extensive harm on society. In 1994, an outbreak of salmonellosis due to contaminated ice cream occurred in the USA, affecting an estimated 224,000 persons. In 1988, an outbreak of hepatitis A, resulting from the consumption of contaminated clams, affected some 300,000 individuals in China.

Food contamination creates an enormous social and economic strain on societies. In the U.S., diseases caused by the major pathogens alone are estimated to cost up to US $35 billion annually (1997) in medical costs and lost productivity. The re-emergence of cholera in Peru in 1991 resulted in the loss of US $500 million in fish and fishery product exports that year.

Statistics

Every year there are about 76 million foodborne illnesses in the United States (26,000 cases for 100,000 inhabitants), 2 million in the United Kingdom (3,400 cases for 100,000 inhabitants) and 750,000 in France (1,210 cases for 100,000 inhabitants).

United States

In the United States, there are approximately 76 million foodborne illnesses (26,000 cases for 100,000 inhabitants):[36]

France

In France, for 750,000 cases(1,210 per 100,000 inhabitants):

Causes of foodborne illness in France[37][38]
Cause Annual cases Rate
(per 100,000 inhabitants)
1 Salmonella ~8,000 cases 13
2 Campylobacter ~3,000 cases 4.8
3 Parasites
incl. Toxoplasma		 ~500 cases
~400 cases		 0.8
0.65
4 Listeria ~300 cases 0.5
5 Hepatitis A ~60 cases 0.1
Causes of death by foodborne illness in France
Cause Annual Rate
(per 100,000 inhabitants)
1 Salmonella ~300 cases 0.5
2 Listeria ~80 cases 0.13
3 Parasites ~37 cases 0.06
(95% due to toxoplasma)
4 Campylobacter ~15 cases 0.02
5 Hepatitis A ~2 cases 0.003

Australia

In Australia, there are an estimated 5.4 million cases of food-borne illness every year, causing:[39]

Outbreaks

The vast majority of reported cases of foodborne illness occur as individual or sporadic cases. The origin of most sporadic cases is undetermined. In the United States, where people eat outside the home frequently, most outbreaks (58%) originate from commercial food facilities (2004 FoodNet data). An outbreak is defined as occurring when two or more people experience similar illness after consuming food from a common source.

Often, a combination of events contributes to an outbreak, for example, food might be left at room temperature for many hours, allowing bacteria to multiply which is compounded by inadequate cooking which results in a failure to kill the dangerously elevated bacterial levels.

Outbreaks are usually identified when those affected know each other. However, more and more, outbreaks are identified by public health staff from unexpected increases in laboratory results for certain strains of bacteria. Outbreak detection and investigation in the United States is primarily handled by local health jurisdictions and is inconsistent from district to district. It is estimated that 1–2% of outbreaks are detected.

Political issues

United Kingdom

In postwar Aberdeen (1964) a large scale (>400 cases) outbreak of Typhoid occurred, this was caused by contaminated corned beef which had been imported from Argentina[3] The corned beef was placed in cans, because the cooling plant had failed cold water from the river plate was used to cool the cans, because one of the cans had a defect the meat inside was contaminated. This meat was then sliced using a meat slicer in a shop in aberdeen, thus the contamination was spread to other meats. The meat was then eaten by the people of aberdeen who then became ill.

In the UK serious outbreaks of foodborne illness since the 1970s prompted key changes in UK food safety law. These included the death of 19 patients in the Stanley Royd Hospital outbreak [4] and the bovine spongiform encephalopathy (BSE, mad cow disease) outbreak identified in the 1980s. The death of 17 people in the 1996 Wishaw outbreak of E. coli O157 [5] was a precursor to the establishment of the Food Standards Agency which, according to Tony Blair in the 1998 white paper A Force for Change Cm 3830 "would be powerful, open and dedicated to the interests of consumers".

United States

In 2001, the Center for Science in the Public Interest (CSPI) petitioned the United States Department of Agriculture to require meat packers to remove spinal cords before processing cattle carcasses for human consumption, a measure designed to lessen the risk of infection by variant Creutzfeldt-Jakob disease. The petition was supported by the American Public Health Association, the Consumer Federation of America, the Government Accountability Project, the National Consumers League, and Safe Tables Our Priority. This was opposed by the National Cattlemen's Beef Association, the National Renderers Association, the National Meat Association, the Pork Producers Council, sheep raisers, milk producers, the Turkey Federation, and eight other organizations from the animal-derived food industry. This was part of a larger controversy regarding the United States' violation of World Health Organization proscriptions to lessen the risk of infection by variant Creutzfeldt-Jakob disease.

None of the US Department of Health and Human Services targets [40] regarding incidence of foodborne infections were reached in 2007 [41]

Organizations

World Health Organization Food Safety Department

The WHO provides scientific advice for organizations and the public on issues concerning the safety of food. It serves as a medium linking the food safety systems in countries around the world. Food safety is currently one of WHO's top ten priorities. Food Safety is one of the major issues in our world today, and the Organization calls for more systematic and aggressive steps to be taken to significantly reduce the risk of foodborne diseases.

The Department of Food Safety, Zoonoses and Foodborne Diseases

The Department of Food Safety, Zoonoses and Foodborne Diseases is a department under the WHO. Its mission is to: to reduce the serious negative impact of foodborne diseases worldwide. According to the WHO website, food and waterborne diarrhoeal diseases are leading causes of illness and death in less developed countries, killing approximately 3.8 million people annually, most of whom are children.

WHO works closely with the Food and Agriculture Organization of the United Nations (FAO) to address food safety issues along the entire food production chain--from production to consumption--using new methods of risk analysis. These methods provide efficient, science-based tools to improve food safety, thereby benefiting both public health and economic development.

The International Food Safety Authorities Network (INFOSAN)

This network is intended to complement and support the existing WHO Global Outbreak Alert and Response Network (GOARN) which includes a Chemical Alert and Response component.

Academic resources

Periodicals

Books

See also

  • List of foodborne illness outbreaks by country
  • 1984 Rajneeshee bioterror attack
  • 2006 North American E. coli outbreak
  • Alexander Litvinenko poisoning
  • Attack rate
  • United States Disease Control and Prevention
  • Food allergy
  • Food hygiene
  • Food quality
  • Food Microbiology
  • Food safety
  • Food Testing Strips
  • Gastroenteritis
  • Juice
  • List of infectious diseases

References

  1. ↑ US CDC food poisoning guide
  2. ↑ "Food-Related Diseases".
  3. ↑ Food Standards Agency
  4. ↑ Humphrey, Tom et al. (2007). "Campylobacters as zoonotic pathogens: A food production perspective <internet>". International Journal of Food Microbiology 117 (3). doi:10.1016 (inactive 2008-06-21). http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7K-4N0PPRG-1&_user=10&_coverDate=07%2F15%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=74b7c07635a1873ca815b3139b56d2e0. 
  5. ↑ USDA. "[http://www.fsis.usda.gov/Fact_Sheets/Foodborne_Illness_What_Consumers_Need_to_Know/index.asp Foodborne Illness: What Consumers Need to Know]".
  6. ↑ Tribe, Ingrid G. et al.. "An outbreak of Salmonella Typhimurium phage type 135 infection linked to the consumption of raw shell eggs in an aged care facility <internet>". Retrieved on 29 August 2008.
  7. ↑ Centers for Disease Control and Prevention. "Salmonella Infection (salmonellosis) and Animals <internet>". Retrieved on 12 August 2007.
  8. ↑ Doyle, M. P.; M. C. Erickson. "Reducing the carriage of foodborne pathogens in livestock and poultry <internet>". Retrieved on 12 August 2007.
  9. ↑ E. Mount, Michael. "Fungi and Mycotoxins <internet>". Retrieved on 11 August 2007.
  10. ↑ Center for Food Safety & Applied Nutrition. "Aflatoxins <internet>". Retrieved on 12 August 2007.
  11. ↑ Food and Agriculture Organization of the United Nations. "GASGA Technical Leaflet - 3 Mycotoxins in Grain <internet>". Retrieved on 12 August 2007.
  12. ↑ World Health Organization. "Chapter 2 Foodborne Hazards in Basic Food Safety for Health Workers <internet>". Retrieved on 12 August 2007.
  13. ↑ Food and Drug Administration. "Sec. 683.100 Action Levels for Aflatoxins in Animal Feeds (CPG 7126.33) <internet>". Retrieved on 13 August 2007.
  14. ↑ Henry, Michael H.. "Mycotoxins in Feeds: CVM’s Perspective <internet>". Retrieved on 13 August 2007.
  15. ↑ Webley, D. J. et al.. "Alternaria toxins in weather-damaged wheat and sorghum in the 1995-1996 Australian harvest <internet>". Retrieved on 13 August 2007.
  16. ↑ Li, Feng-qin; Takumi Yoshizawa. "Alternaria Mycotoxins in Weathered Wheat from China <internet>". Retrieved on 13 August 2007.
  17. ↑ da Motta, Silvana; Lucia M. Valente Soares. "Survey of Brazilian tomato products for alternariol, alternariol monomethyl ether, tenuazonic acid and cyclopiazonic acid <internet>". Retrieved on 13 August 2007.
  18. ↑ Li, F. Q. et al.. "Production of Alternaria Mycotoxins by Alternaria alternata Isolated from Weather-Damaged Wheat <internet>". Retrieved on 13 August 2007.
  19. ↑ Marasas, Walter F. O.. "Fumonisins: Their implications for human and animal health <internet>". Retrieved on 12 August 2007.
  20. ↑ Soriano, J.M.; S. Dragacci. "Occurrence of fumonisins in foods <internet>". Retrieved on 12 August 2007.
  21. ↑ Food and Drug Administration. "CVM and Fumonisins <internet>". Retrieved on 13 August 2007.
  22. ↑ Food Standards Agency. "More contaminated maize meal products withdrawn from sale <internet>". Retrieved on 12 August 2007.
  23. ↑ Food Standards Australia New Zealand. "20th Australian Total Diet Survey - Part B <internet>". Retrieved on 13 August 2007.
  24. ↑ 24.0 24.1 FAO FOOD AND NUTRITION PAPER 81. "Worldwide regulations for mycotoxins in food and feed in 2003 <internet>". Retrieved on 13 August 2007.
  25. ↑ Food and Drug Administration. "Patulin in Apple Juice, Apple Juice Concentrates and Apple Juice Products <internet>". Retrieved on 16 August 2007.
  26. ↑ Sabater-Vilar, M.. "Genotoxicity Assessment of Five Tremorgenic Mycotoxins (Fumitremorgen B, Paxilline, Penitrem A, Verruculogen, and Verrucosidin) Produced by Molds Isolated from Fermented Meats <internet>". Retrieved on 16 August 2007.
  27. ↑ Adejumo, Timothy O.. "Occurrence of Fusarium species and trichothecenes in Nigerian maize <internet>". Elsevier. Retrieved on 12 August 2007.
  28. ↑ Mazur, Lynnette J.; Janice Kim. "Spectrum of Noninfectious Health Effects From Molds <internet>". American Academy of Pediatrics. Retrieved on 12 August 2007.
  29. ↑ Froquet, R. et al.. "Trichothecene toxicity on human megakaryocyte progenitors (CFU-MK) <internet>". SAGE Publications. Retrieved on 12 August 2007.
  30. ↑ Joffe, A. Z.; B. Yagen. "Comparative study of the yield of T-2 toxic produced by Fusarium poae, F. sporotrichioides and F. sporotrichioides var. tricinctum strains from different sources <internet>". SAGE Publications. Retrieved on 12 August 2007.
  31. ↑ Hay, Rod J.; B. Yagen. "Fusarium infections of the skin <internet>". Retrieved on 12 August 2007.
  32. ↑ Food and Drug Administration. "Guidance for Industry and FDA - Letter to State Agricultural Directors, State Feed Control Officials, and Food, Feed, and Grain Trade Organizations <internet>". Retrieved on 13 August 2007.
  33. ↑ Hohn, Thomas M.. "Trichothecene-resistant transgenic plants <internet>". Retrieved on 13 August 2007.
  34. ↑ Dubois, Eric et al.. "Intra-laboratory validation of a concentration method adapted for the enumeration of infectious F-specific RNA coliphage, enterovirus, and hepatitis A virus from inoculated leaves of salad vegetables spt on from mexican migrant workers. <internet>". Retrieved on 11 August 2007.
  35. ↑ Schmidt, Heather Martin. "Improving the microbilological quality and safety of fresh-cut tomatoes by low dose dlectron beam irradiation - Master thesis <internet>". Retrieved on 11 August 2007.
  36. ↑ "Food safety and foodborne illness".
  37. ↑ "Report of the French sanitary agencies" (in French). INVS/Afssa.
  38. ↑ "Summary of Report of the French sanitary agencies" (in French). INVS/Afssa.
  39. ↑ "Food borne illness in Australia".
  40. ↑ Healthy People 2010 Home Page
  41. ↑ "Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food". CDC Morbidity and Mortality Weekly Report. Retrieved on 2008-04-15.

External links

This article contains material from the CDC (Center for Disease Control) website which, as a U.S. government publication, is in the public domain.