Food gtk207

• Major Foodborne Diseases in Malaysia:

  • Acute Gastro Enteritis (AGE)
  • Cholera
  • Dysentery
  • Food Poisoning
  • Hepatitis A
  • Typhoid
• Incidence of foodborne disease:

  • Foodborne disease has emerged as an important and growing public health and economic problem in many countries in the last two decades
  • Estimated cases annually: 130 million Europeans, 2.4 million Great Britons, 76 million Americans, and 5.4 million Australians
  • Diarrhoeal disease accounts for 1.5 million childhood deaths annually, mostly in developing countries
• Definition of Foodborne disease:

  • Any illness resulting from the consumption of food or drink contaminated with pathogenic bacteria/their toxins, viruses, parasites or chemicals/poisons derived from plants and animals
• Classification of Food-borne illness Causative Agents:

  • Bacterial:
  • Salmonella typhi, typhimurium, enteritidis, choleraesuis
  • Staphylococcus aureus
  • Clostridium botulinum, perfringens
  • Bacillus cereus
  • Escherichia coli
  • Viral:
  • Norovirus, Rotavirus
  • Inherently poisonous foods:
  • Mushrooms, Shellfish, Dhatura
  • Allergic foods:
  • Prawns
  • Chemicals:
  • Zinc, Copper, Mercury, Lead, Arsenic
  • Pesticides, insecticides like DDT, BHC, Malathion
  • Parasites:
  • Trichinella, Taenia
• Common Causative Agents:

  • Bacteria:
  • Bacillus cereus, Campylobacter, Clostridium botulinum, Clostridium perfringens, Escherichia coli, Listeria monocytogenes, Salmonella (non-typhoid, Typhi), Shigella, Staphylococcus aureus, Vibrio, Yersinia enterocolitica
  • Viruses:
  • Norovirus, Astrovirus, Hepatitis A virus
  • Parasites:
  • Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia intestinalis, Trichinella
  • Chemicals/other:
  • Heavy metals, Pesticides, Fungal toxins, Fish toxins
• Definition of Outbreak:

  • Unusual occurrence of disease or health related events clearly in excess of the usual occurrence in a defined community, region, or season
  • Trigger events for a Foodborne/Waterborne Disease Outbreak:
  • Time clustering of cases of diarrhea with or without fever
  • Unusual increase in cases or deaths of foodborne diseases
  • Occurrence of two or more epidemiologically linked cases of viral hepatitis
  • Natural disasters
  • A single case of cholera
• Foodborne Outbreak Investigation:

  • Requires an Outbreak Control Team (OCT) with a multidisciplinary task
  • Multidisciplinary task includes skills in clinical medicine, epidemiology, laboratory medicine, food microbiology and chemistry, food safety and food control, and risk communication and management
  • Role of OCT:
  • Coordinate all activities to investigate and control an outbreak
  • Case finding, interviews, clinical and environmental sampling, control measures, environmental investigation, communication, media liaison, reports, external assistance
• Steps in the investigation of a foodborne disease outbreak:
• Verify and confirm the existence of the outbreak and prepare for field work
• Case-finding through active surveillance and community surveys
• Line listing of cases
• Descriptive epidemiology
• Determining who is at risk of disease
• Formulation of hypothesis
• Testing of hypothesis
• Refining the hypothesis and conducting additional studies
• Deciding when the outbreak is over and documentation
• Prevention and control
• Verify and confirm the existence of the outbreak and prepare for field work:
• Initial reports of an outbreak are generally reported by laypersons, media, or primary health care workers
• The first step is to verify the number of cases and confirm the diagnosis of reported cases
• Reported cases should be investigated by a medical officer to confirm the diagnosis
• Laboratory confirmation of clinically diagnosed cases may be necessary
• A case definition is a set of criteria for determining whether a person should be classified as affected by the disease
• Case-finding through active surveillance and community surveys:
• Accurately define and count the cases of the foodborne disease
• Active surveillance includes visits to the susceptible population or telephone calls to hospitals
• Initial case definitions may be based on "suspect cases" and later made more specific as "probable" or "confirmed" cases
• Line listing of cases:
• Record clinical and epidemiological information in a standardized manner in an epidemiological case sheet
• Include details of intake of food items likely to cause the outbreak, outcome, and date of admission/discharge/death
• A line list can be created directly from a computerized database
• Descriptive epidemiology:
• Provides a detailed description of outbreaks in terms of time, place, and person
• Distribution by time includes creating an epidemic curve to show the onset of illness
• Cases should be described in terms of age, sex, occupation, and other relevant characteristics
• A map can be drawn to show the geographical distribution of cases (spot map)
• Laboratory investigation:
• Include results of laboratory investigations on the identification of suspected agents from food items, cooks, vomitus, etc.
• Action should be initiated based on clinical, epidemiological, and environmental findings