Foodborne diseases can be classified into two main types: food infection and food poisoning.

Food infections are classified as

bacterial, viral, parasitic or fungal. Food poisoning is classified according to the type of toxin that causes it which may be natural,
bacterial, fungal or chemical.

Introduction

Foodborne diseases are a major public health problem. They result from eating foods that contain substances which are either
infectious or toxic in nature.

Overview of foodborne diseases

Since as far back as the time when the documentation of human history began, consumption of contaminated food and foodborne
diseases have been a major global health problem.

Contamination can be with microorganisms, chemicals and physical objects in food, which can lead to a variety of foodborne diseases
or ill effects such as poisoning.

Foodborne diseases are still a major public health concern all over the world today. They are responsible for many cases of adult
illnesses and some deaths, but more importantly, contaminated food is a source of the acute diarrhoeal diseases that claim the lives
of enormous numbers of children every day. Worldwide, about 2 million children under the age of five years die from diarrhoeal
diseases every year.

In developing countries like Ethiopia, the problem reaches great proportions for many reasons. Most basic among these are poverty
and a lack of public health awareness. The problem of foodborne disease is more serious among rural communities where there tends
to be a lower level of awareness about the causes and prevention of foodborne infection.

Well-documented information is lacking regarding the extent of foodborne diseases in Ethiopia because many cases are not properly
diagnosed or not reported, and many people who are sick with foodborne diseases do not visit health facilities. This makes it difficult
to collect statistical data or even make an estimation of the level of the problem except that it is certainly huge.

Transmission of foodborne diseases

The single method of transmission of foodborne diseases to human beings is through ingestion (eating) of food in the following
categories:

● Raw or undercooked meat and meat products

● raw milk (that is, milk that has not been pasteurised or sterilised)

● food items contaminated with human faeces (directly or indirectly)

● raw vegetables contaminated with soil

● food contaminated by chemicals, e.g. pesticides such as malathion

● food prepared using contaminated water, e.g. for washing vegetables

● food kept in an unsuitable condition for a long time after preparation.

● poisonous plants.

Why is it unwise to eat food that has been kept for a long time after it was prepared?

● It may have been kept in conditions that created a favourable environment for the growth and multiplication of
microorganisms in the food, especially if it was exposed to flies, cockroaches, etc., or kept at a warm temperature.

Classification of foodborne diseases

Foodborne diseases are usually classified on the basis of whatever causes them. Accordingly they are divided into two broad
categories: food poisoning and food infections.
Food poisoning (Intoxication)

Food poisoning can be from chemical or biological sources. If we eat food that contains harmful chemicals, or biological toxins
(poisons) from plants, animals or microorganisms, that food can make us sick. Some common sources of food poisoning are caused
by contaminants already in the food when the raw materials are harvested, for example:

● Bacterial toxins produced by bacteria such as Clostridium botulinum and Clostridium perfringens, which are
commonly found in the natural environment, e.g. in soil.

● Chemical toxins, e.g. insecticides sprayed onto growing crops.

● Heavy metals, e.g. lead and mercury, particularly in fish caught near chemical processing facilities.

● Certain toxic plant tissues, e.g. poisonous mushrooms.

● Toxic animal tissues, e.g. the poison glands of certain fish, crabs, etc.

Chemical food poisoning can also occur if foodstuffs have been in contact with toxic chemicals during food production, processing,
storage and handling.

The symptoms of food poisoning can range from mild headache to severe flu-like symptoms. The most common signs and symptoms
are nausea, stomach cramps, diarrhoea, fever, chills and vomiting. A person with food poisoning may have any combination of these
symptoms depending on the cause or the agent involved. The illness may begin from 1 to 72 hours after eating the food.

Food infection

Occurs as a result of ingestion of pathogenic microorganisms with food. The ingested microorganisms multiply in the gut and can
cause diseases like diarrhoea, typhoid fever and cholera; intestinal parasites can cause diseases such as amoebiasis and taeniasis
(tapeworm disease); and zoonotic foodborne diseases (i.e. those that are transmitted to humans from other animals), e.g. anthrax
and bovine tuberculosis.

There are many different kinds of foodborne diseases and they may require different treatments, depending on the symptoms they
cause. Illnesses that cause acute watery diarrhoea or persistent vomiting lead to dehydration if the person loses more body fluids and
salts (electrolytes) than they are able to replace. It is therefore important to rehydrate the person, ideally with oral rehydration salts
(ORS), or if this is not available, a simple mixture of clean water with some sugar and salt is advised.

Steps in investigating a foodborne disease outbreak:

1. Collect initial information about the number of cases and report this to the appropriate person at the nearest Health
Centre or District Health Office.
 2. Develop an initial case definition (who is ill, where are they, what are their symptoms, when did they become ill). You
should also record the age and gender of all people affected.

3. Develop an initial questionnaire to determine if there is a common source of contamination (e.g. if everyone affected
ate the same food, or food from the same place).

4. Collect specimens of faeces, vomit, etc. according to the procedures laid down by the Federal Ministry of Health
(FMOH) and send them to the Health Centre for transport to the nearest Laboratory of Public Health. You will need to
use a sterile container for the samples and store them in an icebox. Wear gloves and wash your hands thoroughly
before and after taking samples. Send the samples to the laboratory immediately.

5. If you identify a particular location or event as the origin of the outbreak you should visit the exposure site for a field
inspection and environmental sampling.

6. Take samples of the foods under investigation according to the procedures laid down by the FMOH. You will need to
use sterile bags or containers and ensure that your sample is representative of the food consumed. You may need to
act quickly to obtain food samples in case any remainder has been used up or disposed of.

7. If the source of the outbreak is a workplace, you will need to interview the employers and employees. You should try
to find out how many of them ate the same food, when they ate it, how much they ate, and where the food came from.

8. Data analysis and interpretation. For example, does the data you have recorded indicate that any particular age group
or gender is affected more than others?

9. Report. Summarise the findings from your investigation and compile into a brief report that should be submitted to the
Health Centre or public health emergency management Centre.

Hazard Analysis Critical Control Points (HACCP) is a system which provides the framework for monitoring the total food system, from
harvesting to consumption, to reduce the risk of foodborne illness. The system is designed to identify and control potential problems
before they occur.

Vaccinations are commonly used to protect pets from highly contagious and deadly diseases like rabies, parvovirus, distemper and
kennel cough. Livestock and poultry such as chickens, turkeys, pigs and cattle are vaccinated to protect against diseases like rotavirus,
E. coli, pinkeye and infectious bronchitis.

Rodents and birds pose a significant contamination risk to produce after it is picked. Feces from rats and birds can spread E. coli and
Salmonella on produce and packaging. Minimizing and controlling rodents should be a part of farms where produce is packed or
stored in close proximity to the production area.

DIARRHEAGENIC ESCHERICHIA COLI.

The gastrointestinal epithelium is an important defense barrier against infections. Enteric pathogens have acquired virulence traits
that enable them to colonize and break this barrier, by adhering to the epithelium, delivering toxins and invading intestinal epithelial
cells. To this end, several important human and animal pathogens employ type III secretion systems (T3SS) to inject virulence factors
into infected eukaryotic cells, where they take control of cell signaling.
Characteristics of the ETEC infection. ETEC is the major enteric pathogen that account for the diarrhea that occurs in travelers and
children in developing countries. ETEC infection is caused by ingestion of contaminated food and water, ETEC through the
gastrointestinal tract, and eventually colonization in the small intestine. When ETEC is exposed in the small intestine, it colonizes
intestinal epithelial cells via CFs, and ETEC proliferates on the intestinal epithelial after colonization. ETEC produces and delivers
heat-labile (LT) and/or heat-stable (ST) enterotoxins to exert toxic effect.

ETEC infection is followed by a variety of symptoms, including vomiting, stomach cramps, headache, and, in rare cases, a slight fever.

Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate
psychosocial stimulation. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO
Child Growth Standards median.

Treatment.

Antibiotics and oral rehydration are the most popular treatments.

Enteroinvasive Escherichia coli (EIEC)

Is a type of pathogenic bacteria whose infection causes a syndrome that is identical to shigellosis, with profuse diarrhea and high
fever. EIEC are highly invasive, and they use adhesin proteins to bind to and enter intestinal cells. They produce no toxins, but severely
damage the intestinal wall through mechanical cell destruction.
After the E. coli strain penetrates through the epithelial wall, the endocytosis vacuole gets lysed, the strain multiplies using the host
cell machinery, and extends to the adjacent epithelial cell. In addition, the plasmid of the strain carries genes for a type III secretion
system that is used as the virulent factor. Although it is an invasive disease, the invasion usually does not pass the submucosal layer.
The invasion of the cells can trigger a mild form of diarrhea or dysentery, often mistaken for dysentery caused by Shigella species.
The illness is characterized by the appearance of blood and mucus in the stools of infected individuals, or a condition called colitis.
Dysentery caused by EIEC usually occurs within 12 to 72 hours following the ingestion of contaminated food. The illness is
characterized by abdominal cramps, diarrhea, vomiting, fever, chills, and a generalized malaise. Dysentery caused by this organism
is generally self-limiting with no known complications.
It is currently unknown what foods may harbor EIEC, but any food contaminated with human feces from an ill individual, either directly
or via contaminated water, could cause disease in others. Outbreaks have been associated with hamburger meat and unpasteurized
milk.

Enteropathogenic Escherichia coli (EPEC).

Enteropathogenic Escherichia coli (EPEC) remain an important cause of infant diarrhoea in many parts of the developing world.
Essential for virulence is their ability to adhere to the small intestinal mucosa and produce a striking 'attaching and effacing' (AE) lesion
characterised by localised destruction of brush border microvilli, intimate attachment of bacteria to the residual apical enterocyte
membrane, often in a cuplike pedestal structure, and formation of a dense plaque of actin (and other) cytoskeletal filaments beneath
adherent bacteria.
Manifestations
Although not all EAEC infections result in symptomatic illness, the most commonly reported symptoms are watery diarrhea with or
without blood and mucus, abdominal pain, nausea, vomiting, and low-grade fever.
Pathogenesis
The pathogenesis of EAEC is really complex as strains are relatively heterogeneous. The best-studied virulence factor is AggR, the
master regulator of EAEC virulence, which controls expression of adherence factors, a dispersin protein, and a large cluster of genes
encoded on the EAEC chromosome. EAEC pathogenesis involves three stages: (1) adherence to the intestinal mucosa by aggregative
adherence fimbriae (AAF) and adherence factors, (2) increased production of mucus that encrusts EAEC on the surface of
enterocytes; and (3) release of toxins and elicitation of an inflammatory response, mucosal toxicity, and intestinal secretion.

Enteroaggregative Escherichia coli (EAEC or EAggEC) are a pathotype of Escherichia coli which cause acute and chronic
diarrhea in both the developed and developing world. They may also cause urinary tract infections. EAEC are defined by their
"stacked-brick" pattern of adhesion to the human laryngeal epithelial cell line HEp-2. The pathogenesis of EAEC involves the
aggregation of and adherence of the bacteria to the intestinal mucosa, where they elaborate enterotoxins and cytotoxins that damage
host cells and induce inflammation that results in diarrhea.

Treatment

As with other self-limiting infections, the decision to use antibiotic therapy should be done on an individual basis and the antibiotic
selection depends on the local antimicrobial susceptibility patterns. In most regions of the world, EAEC strains are susceptible to
fluoroquinolones, azithromycin, rifaximin, amoxycillin/clavulanic acid, and nalidixic acid.

How Airborne Transmission Works

Airborne diseases are bacteria or viruses that are most commonly transmitted through small respiratory droplets. These droplets are
expelled when someone with the airborne disease sneezes, coughs, laughs, or otherwise exhales in some way. These infectious
vehicles can travel along air currents, linger in the air, or cling to surfaces, where they are eventually inhaled by someone else.

Airborne transmission can occur over relatively long distances and spans of time. If you go into the bathroom that someone coughed
in minutes before, it could be a danger. This makes it possible for airborne diseases to infect larger numbers of people and more
difficult to determine the causes due to a lack of person-to-person contact.

Airborne transmission has varying capabilities. Airborne diseases can travel distances greater than 6 feet and remain infectious in the
air from minutes to hours. This largely depends on the type of ventilation and preventative measures inside the building.

Diphtheria

Diphtheria is a serious infection caused by strains of bacteria called Corynebacterium diphtheriae that make toxin in your nose or
throat. It can lead to difficulty breathing, heart rhythm problems, and even death. Symptoms include sore throat, fever, swollen lymph
nodes and weakness.

A sheet of thick, grey matter covers the back of the throat, making breathing hard.

Treatments include antibiotics and an antitoxin that neutralizes the diphtheria toxin. A vaccine is available.

Chlamydial pneumonia

Chlamydia pneumoniae is a type of bacteria that causes respiratory tract infections, such as pneumonia (lung infection). The bacteria
cause illness by damaging the lining of the respiratory tract including the throat, windpipe, and lungs. Some people may become
infected and have mild or no symptoms.

How is it spread?

People spread C. pneumoniae by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.