1. FOODBORNE ILLNESS

2. OVERVIEW Presenter Target audience Presentation Time allocated
Post test
My name is Karen D. I am doctoral student of Public Health at Walden University. The topic of my presentation is food borne illness. (will not state during presentation: The audience is composed of the Fairfax County Health Department Food and Nutrition Services Division. This Division supports, provides and promote education for healthy foods, proper food handling and prevention of food borne illness to the Fairfax County general public and school system. The group is comprised of community partners, healthcare workers, educators, and the general public) This presentation should take approximately 1 hour with a post test and question and answer period afterwards. (will not state this to the audience, but the stakeholders are: Fairfax County Health Department personnel, community partners, i.e. food industry businesses, physicians, nurses; Fairfax County School Board; Fairfax County Government officials, and community lay members).
Across this nation and worldwide, food borne illness is widespread and a growing significant problem to public health and the economy. The CDC estimates there are approximately 76 million cases of food borne illnesses in the U.S. per year and over 5000 related deaths (FTSI, 2011). The United Nations Food and Agricultural Organization/World Health Organization (FAO/WHO) has reported that illness due to contaminated food is “perhaps the most widespread health problem in the contemporary world and an important cause of reduced economic activity.” (FTSI, 2011). During this presentation, it is my goal to increase your awareness of food borne illnesses, common sources, causative agents, public health challenges and preventive measures in which you can develop and implement.

3. PURPOSE
To increase the knowledge of foodborne illnesses and pathogens/organisms
To increase awareness of preventive measures to reduce the incidence of foodborne illnesses
The purpose of this presentation today is to increase your knowledge of foodborne illness, the organisms that causes these illnesses, and to increase your awareness of actual and proposed interventions implemented by food inspection agencies, such as the USDA and FDA. In addition, I will cover a few simple and memorable preventive measures for protecting yourselves, your family and the public

4. OBJECTIVES
At the end of this presentation, participants will be able to:
Define foodborne illness and identify common risk groups
Identify the most common culprits (pathogens) causing foodborne illness
Discuss the impact of foodborne illnesses on the economy and public health
Identify trends in foodborne illness
Identify interventions and preventive measures to lower incidence of foodborne illness

5. Foodborne Illness
The World Health Organization (2011) defines foodborne illness as a preventable public health problem by agents that enter the body through eating contaminated food and water. These diseases can either be infectious or toxic in nature.
*Every year in the U.S., foodborne pathogens causes millions of illnesses and thousands of deaths. There are 31 known foodborne pathogens that are composed of viruses, bacteria, toxins, and parasites. Some recent challenges facing public health officials is the epidemiology of foodborne illness. New pathogens are emerging and affecting populations on a global level (Tauxe, 1997). Approximately 81% of unknown agents (organisms yet to be identified or not detected) account for foodborne illness/hospitalization and 64% are related to death (Wotecki and Kineman, 2003).
*(Question to the audience) What are some of the most common pathogens or organisms that cause foodborne illness? (wait for responses)
*First of all, there are a total of 31 important known organisma that causes foodborne illness. Of the known pathogens, the most common pathogens are: salmonella, norovirus, campylobacter, toxoplasma, clostridium botulinum, shigella, E coli, and Hepatitis A
It is an illness that comes from eating contaminated food.

6. Categoriesof Foodborne Pathogens
Viruses
Bacteria
Parasites
Toxins
Pathogens that cause foodborne illness is classified into 4 different categories:
Examples of foodborne Viruses – hepatitis, norovirus
Examples of Bacteria – campyolobacteria, salmonella
Examples of parasites – giardia, toxoplasma gondii
Examples of toxins – clostridrium perfringens, clostridium botulism, E. Coli 0157H7

7. The most common culprits of food borne illnesses
Campylobacter – second most common bacterial cause of diarrhea
Norovirus – leading viral cause of diarrhea
Salmonella – most common bacterial cause of diarrhea and most common cause of foodborne deaths
These pathogens are the most common culprits of foodborne illness, either because of the severity of the sickness or the number of cases of illness they cause. Campylobacter, Norovirus – poor hygiene causes easy transmission from person-to-person and Salmonella causes 1.4 million cases of foodborne illness/yr

8. The most common culprits of food borne illnesses
E coli/STEC – produces a deadly toxin and causes foodborne illness.
Clostridium botulinum – produces a toxin that causes life threatening illness that can compromise breathing
Shigella – causes diarrhea illness, Transmission caused by poor hygiene, person-person and infected person to food item
E coli/STEC (Shiga Toxin Producing E coli) is one of the most severe forms of foodborne illness
Clostridium botulinum
Shigella – stringent hygienic practices are important for preventing the transmission of shigella

9. At risk populations Elderly Persons with chronic diseases
Young Children
Infants
Unborn babies
Pregnant women
Everyone is at risk for getting a foodborne illness; however, the elderly are at a greater risk because as people age their stomach and intestinal tract may hold on to foods longer, their liver and kidneys may not rid itself of toxins (poisons) as quickly, and their sense of taste and smell is sometimes altered, thereby making them unable to smell spoilage of foods
Chronic disease patients are at risk because the disease may weaken their immune system and their bodies are unable to fight off the illness
Young children – are at risk because their immune system, stomach, intestines, and digestive organs are not yet fully developed. Food does not digest as quickly and children lack the adequate amount of enzymes, stomach acid, beneficial bacteria, and muscular development in comparison to adults
Pregnant women are at high risk due to the alteration in cell-mediated immunity that alters the immune response. Listeria is the most common foodborne illness affecting pregnant women

10. Leading causes of foodborne related illnesses
Norovirus
Salmonella
Clostridium perfringens
Campylobacter
Staphylococcus aureus
Norovirus caused 5, 461, 731 illnesses, Salmonella caused 1,027,561 illnesses, clost. Perf. caused 965, 958 illnesses, and staph aureus caused 241, 148 illnesses

11. Leading causes of foodborne related hospitalizations
Salmonella
Norovirus
Campylobacter
Toxoplasma gondii
Escherichia (E coli)
Salmonella – 19, 336; norovirus – 14, 663; campylobacter- 8463; toxoplasma g. – 4428; E coli- 2138

12. Leading causes of foodborne related deaths
Salmonella
Toxoplasma gondii
Listeria monocytogenes
Norovirus
Camplylobacter
Salmonella – 378 death/year; toxoplasmosis – 327/year; listeria monocytogenes – 255/year; norovirus – 149/year; campylobacter – 76/year

13. Public Health Challenges
Emergence of new foodborne pathogens and the re- emergence of past problematic organisms
Emergence of multi-drug resistant (MDR) organisms
Current scientific knowledge, laws, regulations, and organizations affiliated with the food safety system are inconsistent
Increase in international trade
* While Americans can boast about the benefits of access to the one of the world’s safest supply, foodborne illness continues to be an important issue for public health as well as presents with its own challenges. Some of the challenges are:
*Microorganisms have adapted to changes in food production, processing, and preservation techniques, resulting in a number of new and emerging foodborne pathogens and the re-emergence of organisms that have been a problem in the past. Many foodborne pathogens are posing a risk for resistance to antibiotics that were commonly used to treat illnesses, such as the flouroquinolones and cephalosporin. It is also important to identify new foodborne pathogens that are infiltrating into the American food supply.
*The existing regulatory framework is a patchwork of laws and regulations that are frequently inconsistent and lag behind current scientific knowledge regarding the risks posed by foodborne pathogens and toxic chemicals. Future systemic changes to enhance food safety will require better understanding of risks associated with specific pathogens occurring in the food supply and the costs and benefits of implementing new strategies.
(Wotecki, and Kineman, 2003)
*Increase in international trade has increased the risk for cross border transmission of infectious diseases. Infectious organisms can be disseminated from the original point of processing and packaging to a multitude of locations thousands of miles away (Kaferstein, et al, 1997).

14. Public Health Challenges
Shared responsibilities of agencies
Chronic lack of resources provided to regulatory agencies pose yet another set of challenges to improving the safety of the food supply
Food industry workforce
Globalization of the food supply
*12 different federal and international agencies share responsibilities and overlapping authority for carrying out the authorities of 35 food safety laws, and at times, these responsibilities and policies are in conflict with one another and have led to a disjointed strategy for protecting human health from foodborne disease. The FDA, USDA and EPA all share in the responsibility of protecting the American food supply.
* The chronic lack of resources is a continuing challenge to the federal regulatory agencies
The FDA, with jurisdiction over most of the food supply, has approximately 250
inspectors who annually are expected to visit 5000 of the 53,000 food producing
establishments. Many times there is not enough inspectors to complete the inspections, thereby increasing the risk for a breach in the food safety system
*The food industry workforce represents an entirely different problem for the assurance
of food safety. The problems that exists are: the typical food-handling job requires a minimal education (HS level at best), low salary with little to no benefits; requires long work hours which involve performing tedious, repetitive tasks; and, can be physically demanding. Injury rates in the food processing industry are among
the highest in any job category—in 1999, there were 2.7 cases of work-related
injury or illness per 100 full-time food-processing workers. There is a need for an increased competent, well trained workforce in order to protect America’s food safety but until these issues are addressed, this will continue to be a public health issue for the American people.
* Globalization of the food supply has presented new challenges for food safety and has contributed to the international public health problem of foodborne disease
(Wotecki, and Kineman, 2003)
Flint, J.A., et al, 2005

15. Globally: Foodborne Illnesses
Significant increases in foodborne illness incidence
Increase in the number of foodborne diseases reported in industrialized countries
*Most countries with systems for reporting cases of foodborne illness have documented significant increases over the past few decades in the incidence of diseases caused by microorganisms in food, including pathogens such as Salmonella, Campylobacter jejuni and enterohaemorrhagic Escherichia coli, and parasites such as cryptosporidium. Foodborne diseases are a widespread and growing public health problem, both in developed and developing countries
*It is difficult to estimate, but it has been reported that in 2005 alone 1.8 million people died from diarrhoeal diseases. The majority of these cases were attributed to contamination of food and drinking water
* In industrialized countries, the percentage of the population suffering from foodborne diseases each year has been reported to be up by 30% (WHO, 2011)

16. Strategic Interventions
Conducting routine sampling of bench trim for E coli
Initiating controls that minimize or eliminate contamination of leafy greens, melons and tomatoes
Streamline guidelines and instructions to inspectors
Consumer Education
USDA, 2011
*President Obama’s Food Safety Working Group has made prevention a priority in reducing foodborne illness with the goal of taking actions today that will result in safer food thorughout Ameerica, which means healthier children, longer lives and less costly healthcare (Vilsack, 2010). Some strategic interventions drafted by FDA and USDA are:
*Issuing guidance for inspectors to begin conducting routine sampling of bench trim for E. coli. Bench trim are the pieces left over from steaks and other cuts that are then used to make ground beef
*These proposed controls provide a guide for growers and processors to follow so they may better protect their produce from becoming contaminated
*Issuance of streamlined, consolidated instructions to its personnel for inspection, sampling and other actions to reduce E. coli O157:H7 in beef. Also the issuance of streamlined instructions to its inspectors to provide a simplified procedure to find and eliminate E. coli before it reaches consumers
*Consumer play a vital role in ensuring the safety of the food they eat. It is imperative that consumers are provided with education to facilitate decreasing or eliminating foodborne illness (Vilsack and Sebelius, 2009)
Due some of the interventions implemented by the Food Safety Workgroup, this led to President Obama signing into law, January 2011, the Food Safety Modernization Act. This law aims to ensure the U.S. food supply is safe by shifting the focus of federal regulators from responding to contamination and preventing it (FDA, 2011). “It moves us towards a risk based food supply system that focuses on prevention and improving public health” (Kowalcyk, B., 2011)

17. Consumer Preventive Measures
Remain out of the “Danger Zone”
Four easy basic steps: Clean
Separate
Cook
Chill
Don’t buy damaged foods, i.e. can goods, fresh produce/vegetables, etc
Wash fresh produce and vegetables thoroughly under running water
Some tips from the CDC are:
*Remember the Danger Zone: Bacteria multiply rapidly between 40 °F and 140 °F. To keep food out of this "Danger Zone," keep cold food cold and hot food hot. Store food in the refrigerator (40 °F or below) or freezer (0 °F or below). Cook food to a safe minimum internal temperature. Maintain hot cooked food at 140 °F or above. When reheating cooked food, reheat to 165 °F .
*Follow 4 easy basic steps to avoid foodborne illness. Clean – wash hands, utensils, and cutting boards, before/after contact with raw meat, poultry, seafood and eggs Separate – keep raw meat, poultry and seafood apart from foods that wont be cooked Cook – use a food thermometer because you can not tell food is cooked just by the appearance Chill – leftovers and takeover foods within 2 hours and keep at 40 degrees or below (USDA, 2008)