Learning Objectives

 At the end of the chapter you will be able to:

 Define food borne disease/illness
 Differentiate food borne infections and food borne
poisoning/intoxication
 Identify the causes, transmission method and
control measures of food borne illnesses
 Know what food borne outbreak is
 Know the measures taken to manage food borne
outbreaks
 Understand what HACCP is & its elements

2
 What is Food Borne Illness?

 Is a disease which is caused by ingesting of food

which is contaminated by:
 Microbial cells
 Biological toxins
• Microbial toxins
• Poisonous plants
• Poisonous animals
 Harmful chemicals
• Intentional
• Accidental
3
Causes of Food Contamination

4
Common symptoms

Stomach Pain
Diarrhea
Vomiting
Nausea
Headache

These are symptoms of a

FOODBORNE ILLNESS
5
 Microbial food contamination
 The common microbes causing food borne illness
are:
 Bacteria  Viruses
Salmonella Hepatitis A
Campylobacter Norovirus
Bacillus
Staphylococcus
Clostridium
E-coli 0157:H7

6
 Epidemiology
 2 million deaths/year due to contaminated food
worldwide (WHO, 2014)
 They have significant impact worldwide including
developed nation like the US.
 The Center for Disease Control and Prevention (CDC)
estimates for the US:
 76 million cases/year
 >300,000 hospitalization/year
 5000 deaths/year
 400-500 out breaks are reported each year

7
 Epidemiology

 In developing countries like Ethiopia, the problem

attains great proportions due to many reasons:
Poverty
Lack of public health awareness
Poor water supply
Poor personal hygiene and
Environmental sanitation

8
 According to the 2002-2003 Health and Health-related
Indicators MoH of Ethiopia:
 Dysentery and different parasitic infections were
among the ten top causes of illness
 Dysentery was among the leading causes of
hospital admissions and deaths
 The national average access to safe water was
28.4%
o 75.7% for urban &
o 19.9% for rural

9
 Epidemiology

 National figure for safe excreta disposal was 11.5%

 49.7% for urban &
 3.9% for rural
 reported causes of outbreaks
 Typhoid fever
 acute diarrheal diseases
 bloody diarrhoea
 anthrax

10
Classification of Food Borne Diseases

 Depending on the causative agent they are grouped

into two:
1. Food-borne poisonings/intoxications &
2. Food-borne infections

11
 Food borne
diseases

Food borne poisoning/ Food borne

intoxications infections

Chemical
poisoning
Intoxications Bacteria

Poisonous Poisonous Microbial

plants animals toxins Viral

Bacterial
Fungal toxins Algal toxins toxins Parasites

Aflatoxin Enterotoxins

Ergot 12
Neurotoxins
 1. Food Poisoning/Intoxication
 Caused by ingestion of microbial toxins, swallowing
of poisonous plants and animal tissues or due to the
consumption of food contaminated by chemical
poisonous.
 The main causes of food poisoning are:
 Staphylococcal food poisoning
 E. Coli food poisoning
 Gram positive spore forming bacteria
 Poisonous plants
 Poisonous animals
 Harmful Chemicals

13
 I. Staphylococcal Food Poisoning

 Disease which occurs after eating food which has

been contaminated with staphylococcal organisms
like:
 S. aureus
 S. epidermides
 S. sapropyticus

14
 Staphylococcus aureus
Toxin Enterotoxin (heat stable)
IP 1-7 hrs (usually 2-4hrs)
Foods involved Potato salad, Poultry, Sliced meat, Milk & Milk
products
Source Human & animal origin (human nose &
skin/wound)
Contributing Inadequate refrigeration & cooking or heat
factors processing of foods, practicing poor personal
hygiene, Keeping food at danger zone
Control Practicing good PH, Exclusion of infected
measures people from food handling, Proper handling of
high risk foods, Refrigeration of foods

15
 Haemorrhagic Colitis
Causative Escherichia coli O157:H7 (Shiga toxin)
agent
IP 2- 4 days
Symptoms Severe abdominal cramps, Bloody diarrhoea,
Nausea, Vomiting, Low-grade fever
Foods involved Ground beef, Unpasteurized apple cider,
Unpasteurized milk, Lettuce
Source Intestinal tracts of infected animals, Fecally
contaminated water
Control Thoroughly cook ground beef products,
measures Practicing good personal hygiene, Reheat
foods to 165°F for 15 seconds, Refrigerate
foods at 41°F or below.

16
 II. Poisoning by Gram positive, Anaerobic
Spore forming bacteria

 Common food borne poisonings caused by gram

positive spore forming bacteria:
1. Botulism – caused by Clostridium botulinum, rod
shaped bacteria
2. Perfringens – Clostridium perfringens rod
shaped
3. Cereus – Bacillus cereus rod shaped bacteria

17
 Botulism
Toxin Neurotoxin (heat liable)
IP 12- 72 hours (average 1-2 days)
Symptoms Double vision, Difficulty speaking and
swallowing, Difficulty with breathing, Paralysis
Foods involved Home canned foods, Low acid (alkaline)
vegetables, Corn, Peas & other cereals
Source Soil, Plant crops, Intestine of animals
Control Heating suspected food to boiling temperature
measures for some time, Ensuring lower pH(<4.5),
Destruction of spores or inhibiting of their
growth, Creating aerobic conditions,
Refrigeration of foods to below 5°C,
Avoidance of home canned foods

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 Perfringens Food Poisoning

Toxin Enterotoxin
IP 8-24 hrs (8-12 hrs)
Symptoms Abdominal cramps, Watery diarrhoea, Nausea
Foods involved Meat dishes prepared one day and eaten the
next
Source Soil, Spices, Human & animal intestinal tract,
Sewage, Poultry, raw Meats
Control • Proper waste management
measures • Cold storage of foods
• Adequate cooking of foods
• Good personal hygiene of food handlers

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 Bacillus Cereus Food Poisoning

Toxin Enterotoxin
IP 10-16 hours
Symptoms • Abdominal cramps
• Watery diarrhoea
• Nausea
• Vomiting
Foods involved Meat pies, Rice, Starchy foods (potato, pasta)
Food mixtures (soups, sauces)
Source Soil, Dust and Water
Control • Thoroughly cook ground meat products.
measures • Cool cooked products to 41°F within 4hrs.
• Hold hot foods at or above 140°F.

20
 III. Chemical Food Poisoning
 Caused by ingesting different chemicals with food
 It may occur in either of the following ways:
I. Accidental Poisoning
 Carelessly stored chemicals in food premises might
be mistaken for food ingredients and could be added
to food during preparation
II. Unauthorized additives
 Additives should be added with the right dose with
right person

21
 Chemical Food Poisoning…

III. Residues of chemicals on raw food staffs

 This refers to chemicals which have been applied to
control crops, vegetables and fruits during growing,
storage or processing and remaining as residues which
finally may reach mouth of consumers
 Chemicals applied in food service establishments to
control rats, flies, cockroaches and other vermin may
contaminate carelessly exposed foods which finally may
be ingested with the food

22
Chemical Food Poisoning…

IV. Poisons resulting from containers

 From food utensils & equipment
 Toxic heavy metals (lead, cadmium, zinc, copper)
 Contamination from containers that are used to
store / hold chemicals
V. Radiation accident food contamination
 Radionuclide (Radium 226, Iodine 131, Strontium
90, Cesium 137) in the fallout from a nuclear test
explosion or a reactor accident can contaminate
foods

23
 Chemical Food Poisoning…

VI. Food sources polluted by toxic/hazardous

chemicals such as pollution from industrial
effluents
 In areas where there is extensive industry and
mining, fish, vegetables and grains accumulate
concentrations of toxic substances such as lead
and mercury from industrial wastes/ discharges

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 IV. Poisonous Animals
1. Paralytic shellfish poisoning
 By consumption of shellfish (mussels and clams)
 Ganyaulax Cantanella (poisonous sea weed)
2. Fish poisoning
 By eating of tetradon type of fishes

25
 Poisonous Animals…
IP 5-30 minutes
Symptoms Trembling lips, Complete loss of power in
muscles of extremities and neck, Respiratory
paralysis
Control  Avoiding eating of shellfish when in doubt
measures and give enough caution for such foods as
to where they are harvested and whether
the poisonous weed grows in the area.
 Cooking has no effect on poison

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 V. Poisonous Plants & Fungus

 Food poisoning due to the consumption of plants

are commonly related to the ingestion of certain
toxic fungi.
 The most common are:
 Mushroom
 Water hemlock
 Grass pea

27
 Mushroom Poisoning
 Certain species of mushroom, such as:
 Amanita phalloides &
 Amanita muscaria
 These fungi contain certain:
 Phalloidine & other alkaloids which are poisonous
in nature

28
Amanita phalloides Amanita muscaria
 Mushroom Poisoning…

 IP
 15 minutes to 15 hours
 Symptoms-
 Salivation  Watery stools
 abdominal pain  Excessive perspiration
 intense thirst  Flow of tears &
 nausea  Death in many instances
 Vomiting

 Cooking has no effect on the poison

29
 Fungal poisoning

 Ergot

 Ergot is produced by a group of parasitic fungus called

Claviseps purpurea
 These fungi produce the ergot poison in certain cereal
crops such as wheat, barely
 Ergotism is a crippling disease which affects different
areas of the body such as the extremities, legs, arms,
breasts

30
 Ergotism…

 IP
 Is very long as it is dependent on the consumption of
several meals containing the toxin
 Symptoms
 Gangrenous involvement of the limbs specially the
fingers, toes, occasionally ears and nose
 Weakness
 Headaches
 Painful cramps in limbs
 Itching of the skin

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 Ergotism…

 Control measures
 Protecting the cereal grains from contamination
by ergot producing fungus during growing,
storage and processing of the cereals by
application of fungicides
 If possible, avoiding consumption of single cereal
grains such as barley & wheat for long period of
time
 Cooking or baking has no effect on the poison

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 Other fungal toxins
 Aflatoxins
 Carcinogens produced in fungus-infected
grains and nut products
 Fumonisins
 Carcinogens produced in fungus-infected
corn
 Food borne Infections

 Caused by consuming foods or liquids contaminated

with:
 Bacteria
 Viruses
 Parasites
 These pathogens cause infection by:
 Invading and multiplying in the lining of the
intestines and/or other tissues.
 Mode of transmission – indirect

34
 Bacterial food borne infections
 The main causative agents of bacterial food borne
infections are:
 Salmonella
 Vibrio
 Shigella
 Camphylocter
 Listeria

35
 Salmonellosis
Causative Salmonella sps.
agent
IP 6-72 hrs (12- 36 hrs)
Symptoms Diarrhea, stomach cramps, fever, loss of
appetite, headache, nausea & vomiting
Foods involved Milk, Egg, Poultry
Source Infected human & animal intestine
Control Hand washing, Thoroughly cooking of all
measures foods, Avoiding recontamination of cooked
foods, Do not use raw/cracked eggs
Use only pasteurized milk and milk products
Keep cold food below 5°C and hot food above
60°C, Educating FH on how to keep food safe

36
 Typhoid Fever
Causative Salmonella typhi
agent
IP 1-3 weeks
Symptoms Fever, headache, weakness, loss of appetite,
cough & rash, constipation (in adults)
Foods involved
Source Intestine of infected human, Water, Soil
Control • Practice good personal hygiene, Practice
measures basic food safety precautions, Avoid water
that might be contaminated, Do not drink
untreated surface water
• A vaccine for typhoid fever is available.

37
 Shigellosis (Bacillary dysentery)
Causative Shigella spp.
agent
IP 1-7 days (1-3 days)
Symptoms mild to severe diarrhea, fever, nausea,
vomiting & cramps, Stools may contain blood,
mucus and pus
Foods involved
Source Intestines of infected persons, soil, food,
water
Control Practice good personal hygiene, Practice
measures basic food safety precautions, Avoid water
that might be contaminated

38
 Cholera
Causative Vibrio cholerae
agent
IP Few hrs to 5 days (2- 3 days)
Symptoms severe diarrhoea, vomiting, dehydration &
shock, death (if untreated)
Foods involved Seafood (fish, crab, shrimp, oysters), raw or
undercooked
Source Water, intestine of infected humans
Control • Thoroughly cook seafood
measures • Practice good personal hygiene
• Proper sanitation of food contact surfaces
and utensils
• Use a safe water supply

39
 Listeriosis
Cause Listeria sps. (Listeria monocytogenes)
IP 2-21 days
Symptoms Meningitis, Spontaneous abortions, Stillbirths,
Nausea, Fever, Diarrhoea, Encephalitis,
Vomiting
Foods involved Unpasteurized milk, Soft cheeses made from
unpasteurized milk, Raw fruits and vegetables
Ready to eat deli meats & salads, Hot dogs
Source Intestinal tracts of animals & humans, Soil,
Contaminated water, Manure
Control Thoroughly cook foods, Use pasteurized milk,
measures Proper sanitation of food contact surfaces and
utensils, Thoroughly wash fresh fruits and
vegetables, Prevent cross contamination.

40
 Campylobacterosis
Causative Campylobacter jejuni
agent
IP 2-3 days
Symptoms Abdominal cramps, Headache, Diarrhoea,
Fever, Watery and occasionally bloody stools
Foods involved Poultry, Unpasteurized milk, Raw meat (beef,
pork, mutton), Shellfish
Habitat Normal microflora of most animals & poultry,
Contaminated water, Infected pets
Control Thoroughly cook meat, poultry and fish,
measures Proper hand washing after handling raw meat,
poultry and seafood, Use pasteurized milk,
Use a safe water supply.

41
 Viral Food borne infections

 The main are:

 Norovirus
 Hepatitis A
 Rota virus

42
 Rotavirus gastroenteritis
Cause Rotavirus
IP 1–3 days
Symptoms Vomiting, watery diarrhoea, abdominal pains
and mild fever
Foods involved Ready-to-eat foods such as salads,
sandwiches, baked products, contaminated
water
Habitat Human faeces, faecal contaminated waters,
faecal contaminated food
Control Prevent ill food workers from working until
measures fully
Recovered, Ensure that food workers practice
good personal hygiene, Avoid cross
contamination, Clean and sanitize food
contact surfaces, Use potable water 43
 Hepatitis A

Causative Hepatitis A virus

agent
IP 10-50 days
Symptoms Loss of appetite, Nausea, Vomiting, Fever,
Jaundice
Foods involved Seafood, Any food handled by an infected
food handler
Habitat Intestinal tracts of infected humans,
Contaminated water
Control Thoroughly cook seafood including oysters,
measures Practice good personal hygiene

44
 Parasitic food borne infections

 The main causative agents which lead to

parasitic food borne infections include:
 Giardia
 Amoeba
 Tania
 Trichinella

45
 Giardiasis
Causative Giardia lamblia
agent
IP 1-4 weeks
Symptoms Diarrhoea, Bloating
Foods involved Water, Any food handled by an infected food
handler
Habitat Intestinal tracts of infected animals & humans,
Water
Control Proper disposal waste, drinking of chlorinated
measures water, Cooking contaminated foods, Boiling
suspect water, practice good personal
hygiene

46
 Trichinosis
Causative Trichinella spiralis
agent
IP 1 day – 8 weeks
Symptoms Diarrhoea, Fever, Profuse sweating,
Weakness, Muscular pain, Swelling around
eyes
Foods involved Pork, Wild game (bear)
Habitat Muscle tissue of infected animals
Control • Thoroughly cook pork and wild game
measures • Storing infected meat in a freezer with a
temperature no higher than -13⁰F for 10
days will also destroy the parasite

47
 What is food borne disease outbreak?

 Food borne disease outbreak:

 The occurrence of two or more cases of a similar
illness resulting from the ingestion of a common
food.
 An unexpected increase of a similar illness and
food is a likely source.

49
 Factors for foodborne disease out breaks

 These factors can be categorized into 3 groups:

1. Microbiological contamination of food
2. Improper time / temperature control
3. Other sources of contamination

50
 1. Microbiological contamination of food

 Use of risky foods (raw, undercooked, unpasteurized)

 Cross-contamination(The process by which bacteria
are transferred from one area to another)
 Infected food handlers
 Poor personal hygiene
 Unsanitary dish ware & utensils
 Improper food handling procedures
 Unhygienic food preparation area
 Improper handling of leftovers

51
 2. Improper time / temperature control

 Inadequate cooking
 Unsafe food holding
(danger zone) - 4°C
and 60°C
 Improper cooling
 Inadequate reheating

52
3. Other sources of contamination

 Insects and rodents

 Chemicals

53
How can we identify foodborne disease
outbreaks?

 Food borne illness complaints from private

citizens
 Medical evaluations of ill individuals from
healthcare professionals at hospitals, clinics, or
physician offices
 Routine surveillance and case investigation
of reportable diarrheal illnesses by
epidemiologists and public health nurses at state
and local health departments

54
How can we identify foodborne disease
outbreaks?
 Routine laboratory testing and techniques
conducted by microbiologists
 Information received through the media and
public information officers
 Reports from state and federal food safety
regulators and environmental health
specialists

55
 Investigation of foodborne disease outbreaks

 Food borne disease out breaks are among the

common occurrences everywhere.

 Why we do an investigation?

 To prevent reoccurrence of food borne disease

out breaks systematic investigations have to be
made.

56
 Objectives
 To identify the cause, the risk factor(s), or source of
infection
 To determine how the food staff became contaminated
 To implement interventions or corrective actions to
prevent others from becoming ill
 To fulfill statutory obligations and respond to public and
political concern
 To evaluate existing recommendations or strategies for
preventing similar outbreaks
 To educate responsible people in the prevention of
similar occurrences

57
 Investigation procedures
1. Take prompt action whenever outbreaks occurred or
reported
2. Immediately visit and make a complete inspection of
the places where the suspected foods were consumed
and make a complete inspection
3. Interview as many persons as possible that partook of
the suspected food
4. Prepare a questionnaire suitable for the outbreak to be
completed for each person. It should contain pertinent
questions
5. If patients to be visited are hospitalized or being treated,
obtain information from the responsible physician
58
 Investigation procedures

6. Obtain specimens of stool/vomits from ill

persons
7. Collect and obtain for laboratory examinations
from the suspected food or beverage that was
served and appropriate specimen from the
victims or the food handlers
8. Arrange for the immediate laboratory
examination of the food samples and specimen
collected for conformed diagnosis

59
 Personnel involved in investigation

 Epidemiologist (public health practitioner)

 Environmental health officer (food safety controller)
 Laboratory professional (microbiologist, toxicologist)
 Physician (clinician)
 Others (community leaders, press officer, Hospital
director, Secretarial and logistic support)

60
Env’t Health Investigator

The Env’tal Health Investigator focuses on

Contaminated food:
 Receives foodborne illness complaints
 Investigates suspected food and/or food establishment
• Interviews food workers and managers
• Examines food storage, handling, preparation
• Identifies factors that resulted in food contamination
• Collects environmental and food samples
• Collects paperwork
 Implements control measures
 Epidemiologic Investigator

The epidemiologist investigator focuses

on cases:
 Analyzes data from pathogen- specific surveillance &
identifies clusters
 Characterizes cases by time & place
 Plans epidemiologic studies
 Interviews cases and healthy controls
 Analyzes and interprets results of epidemiologic studies
 Public Health Nurse

The public health nurse focuses on

patients:
 Interviews patients
 Collects clinical specimens from
patients
 Administers questionnaires for
epidemiologic studies
 Advises patients on how to prevent spread of
illness
 Provides public health education
 Laboratory Investigator

The laboratory investigator focuses on

specimens:
 Analyzes clinical, food, and
environmental specimens
 Interprets test results
 Advises team about tests and collection, handling,
storage, and transport of specimens
 Coordinates additional testing by partner laboratories
 Prevention Measures

Trace back Investigations

Epidemiologic Environmental
Investigations
Assessments

Laboratory
Investigations
 FOOD BORNE OUTBREAK INVESTIGATION FLOW CHART

Outbreak investigation
Conduct environmental Conduct epidemiologic
assessment investigation
Contact & coordinate with key
Contact supervisor
personnel
Inspect food establishment and enforce Obtain clinical specimens & food
safe handling practices samples
Interview manager & distribute food Implement control & preventive
employ surveys measures
Obtain menu & collect food samples Define cases & conduct case finding
for testing
Develop possible hypothesis
Conduct HACCP inspection
Plan & conduct epidemiological study
Report findings to test hypothesis
Analyze data & interpret results
Report finding 66
 How we can prevent food borne disease?

THE BEST APPROACH IS APPLYING OF HACCP

Hazard Analysis and Critical Control Points
(HACCP)

 What is HACCP?
 Systematic preventive approach that identifies
specific hazards and measures for their control to
ensure the safety of food.
 A tool to assess hazards and establish control
systems from farm to table that focus on prevention
rather than relying mainly on end-product testing.
 Before doing HACCP Flow diagram should be
developed

68
 HACCP Principles

1. Assess the hazards and risks

2. Determine the CCP(s) required to control the identified
hazards
3. Establish the critical limits that must be met at each identified
CCP
4. Establish procedures to monitor the CCP(s)
5. Establish corrective actions
6. Establish procedures for verification that the HACCP system
is working correctly
7. Establish effective record-keeping systems that document
the HACCP plan

69
 1. Conduct a Hazard Analysis

 Assess the hazards and risks associated with the

growing, harvesting, raw materials, ingredients,
processing, manufacturing, distribution, marketing,
preparation, and consumption of the food in question.
 Hazard
 Biological
 Chemical
 Physical

70
 2. Determine Critical Control Points

 A CCP is an operation or step by which preventive or

control measures can be exercised that will eliminate,
prevent or minimize a hazard that has occurred prior to
this point.
 All hazards identified in step #1 (Hazard Analysis) must
be controlled at some point in the process
 2 types of CCPs:
 CCP1 – to control hazards
 CCP2 – to minimize hazards

71
 3. Establish Critical Limits

 Critical limits
 One or more prescribed tolerances that must be met
to ensure that a CCP effectively controls a hazard.
 To prevent, reduce or eliminate hazards
 These limits can be obtained experimentally, from
regulatory sources, expert opinions and surveys
of the literature pertaining to a particular product.

72
 4. Establish Monitoring Procedures
 Monitoring is a scheduled observation of a CCP and its
limits
 Monitoring is essential because it:
 Tracks the operation of a process and predicts trends
that might eventually result in exceeding limits
previously set
 Determines if a critical limits being exceeded
 Provides confirmation or documentation of the
HACCP plan

73
 5. Establish Corrective Actions

 When there is deviation from an established CCP,

corrective actions must be taken to prevent a product
that may be unsafe from reaching consumers
 Corrective action must include:
 Correcting the problem and putting the process back in
control
 Placing the product on hold pending evaluation of safety

74
 6. Establish Verification Procedures

 Every HACCP plan should be examined to validate its

ability to control food safety hazards that are reasonably
likely to occur, and that the plan is being effectively
implemented
 Verification should include:
 Reassessment of the HACCP plan
 Review of CCP records
 Review of deviations
 Random sample collection and analysis
 Records review

75
7. Establish Record Keeping & Documentation
Procedures

 The HACCP plan must be on file at the facility

 It must include documentation relating to CCP’s and
any action on deviations and/or disposition of product
 Types of records could include:
 Processing
 Deviation
 Ingredients
 Product safety
 Storage and distribution
 Validation studies

76
Example of a flow diagram for the production
of frozen, cooked beef patties
RECEIVING (BEEF)

GRINDING

MIXING

FORMING

COOKING

FREEZING

BOXING

DISTRIBUTING

REHEAT

SERVE

77
 Limitations of HACCP
1. HACCP requires the education of non-professional food
handlers
2. To be effective, this concept must be accepted not only
by food processors but also by food inspectors and the
public.
3. Expert variability - experts will differ as to whether a
given step is a CCP and how best to monitor such
steps
4. The adoption of HACCP by industry has the potential of
giving false assurance to consumers that a product is
safe, and, therefore, there is no need to exercise the
usual precautions between the purchase and
consumption of a product.
78
Merci!

79