1. Bacillus cereus and How It Impacts You Presented by Shermin Murji to Alberta Post-secondary educational cafeteria food handlers and processors

2. Learning Objectives What is Baccillus cereus? –What is it? –What are the dangers? How does this bacteria affect you? –How can I prevent an outbreak? –What should I do if I think there may be a case of Baccillus cereus ?

3. What Is Bacillus cereus? Gram positive bacteria that has large rods Causes food poisoning when ingested Targets people regardless of race, age, or gender Is not communicable person to person (PHAC, 2001) Food and Drug Administration. (2009). Bad Bug Book – Bacillus cereus. Retrieved June 11, 2009 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNat uralToxins/BadBugBook/ucm070492.htm Miliotis, M.D., & Bier, J.W. (Eds.) (2003). International Handbook of Foodborne Pathogens. New York, NY: Marcel Dekker Inc. Public Health Agency of Canada. (2001). Bacillus cereus – Material Safety Data Sheets. Retrieved June 11, 2009 from http://www.phac-aspc.gc.ca/msds-ftss/msds13e-eng.php.

4. What Are The Dangers? Been recognized as a food poisoning organism since the 1950s Ingestion can cause two types of illness 1.Diarrhea illness 2.Vomiting illness (FDA, 2009) Not commonly reported, but true numbers unknown Rarely causes death References: Food and Drug Administration. (2009). Bad Bug Book – Bacillus cereus. Retrieved June 11, 2009 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathoge nsNaturalToxins/BadBugBook/ucm070492.htm Gaulin, C., Viger, Y.B, & Fillion, L. (2002). At outbreak of Bacillus cereus implicating a part- time banquet caterer. Canadian Journal of Public Health, 93 (5), 353-355.

5. Diarrhea Illness Caused by a large molecular weight protein Typically lasts 24 hours Onset is 6 to 15 hours Experience abdominal cramps and pain Some common foods include milk, meats, vegetables, and fish References: Food and Drug Administration. (2009). Bad Bug Book – Bacillus cereus. Retrieved June 11, 2009 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathoge nsNaturalToxins/BadBugBook/ucm070492.htm

6. Emetic (Vomiting) Illness Caused by a low molecular weight, heat stable peptide Typically lasts less than 24 hours Onset is almost immediate at 30 minutes to 6 hours Experience nausea and vomiting Some associated foods include rice products, potato, pasta, cheese, and mixes (e.g. soup, sauces, pudding) References: Food and Drug Administration. (2009). Bad Bug Book – Bacillus cereus. Retrieved June 11, 2009 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathoge nsNaturalToxins/BadBugBook/ucm070492.htm

7. 2 Historical Cases 2 food poisoning cases as examples 1)1993: A day care ordered food from a local Chinese restaurant and did not reheat the rice when it was served at lunch (hours after the arrival of the food). 14 people became ill: 12 children and two staff members. 2)1997: A father and son became ill after making a pesto sauce at home. It was not cooked adequately and not refrigerated quickly enough. The son eventually died from food poisoning caused by Bacillus cereus. References: Centers for Disease Control and Prevention. Epidemiologic Notes and Reports Bacillus cereus Food poisoning associated with fried rice at two child day care centers – Virginia, 1993. MMWR, 43 (10), 177-8. Mahler, H., Pasi, A., Kramer, J.M., Schulte, P., et al. (1997). Fulminant liver failure in association with the emetic toxin of Bacillus cereus. The New England Journal of Medicine, 336 (16), 1142- 1148.

8. How Does This Impact Me? If an outbreak occurs, your site can be closed down temporarily which impacts your  Reputation  Output  Ultimately: revenue If you are shut down, there may be additional food inspection procedures that will be implemented (translates into added cost and time) Best way to avoid this: PREVENTION References: Alberta Regulation. (2003). Public Health Act: Food and Food establishments regulation. Retrieved July 7, 2009 from http://www.dthr.ab.ca/resources/documents/foodestablishment/Food%20and%20Food%20 Establishments%20Regulation.pdf

9. How Can I Prevent An Outbreak? Optimal growing conditions: 40° to 140° F (5° to 60°C) Adequate cooking and refrigeration may be sufficient to reduce likelihood of bacteria growth Ensure proper food handling and storage techniques High standard of cleaning practices Follow these practices at home and reinforce them with employees to take home as well Wash your hands frequently Todar, K. (2008). Bacillus cereus Food Poisoning. Retrieved June 11, 2009 from http://www.textbookofbacteriology.net/B.cereus.html.

10. What Should I Do If There Is An Outbreak? In Alberta, call Health Link (1-866-408-LINK) To determine if Bacillus cereus is present on site:  Diarrhea type: can be detected using a serological method  Vomiting type: can be detected by animal models or cell cultures References: Food and Drug Administration. (2009). Bad Bug Book – Bacillus cereus. Retrieved June 11, 2009 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathoge nsNaturalToxins/BadBugBook/ucm070492.htm

11. Last Thoughts Growth and outbreaks of Bacillus cereus is preventable:  Follow proper food handling techniques  Allow for sufficient cooking times  Refrigerate immediately  Reheat leftovers to over 140°F/60°C  Wash hands frequently Call Health Link in Alberta if you have any concerns

12. References Centers for Disease Control and Prevention. Epidemiologic Notes and Reports Bacillus cereus Food poisoning associated with fried rice at two child day care centers – Virginia, 1993. MMWR, 43 (10), 177-8. Food and Drug Administration. (2009). Bad Bug Book – Bacillus cereus. Retrieved June 11, 2009 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalTo xins/BadBugBook/ucm070492.htm Gaulin, C., Viger, Y.B, & Fillion, L. (2002). At outbreak of Bacillus cereus implicating a part-time banquet caterer. Canadian Journal of Public Health, 93 (5), 353-355. Mahler, H., Pasi, A., Kramer, J.M., Schulte, P., et al. (1997). Fulminant liver failure in association with the emetic toxin of Bacillus cereus. The New England Journal of Medicine, 336 (16), 1142-1148. Miliotis, M.D., & Bier, J.W. (Eds.) (2003). International Handbook of Foodborne Pathogens. New York, NY: Marcel Dekker Inc. Public Health Agency of Canada. (2001). Bacillus cereus – Material Safety Data Sheets. Retrieved June 11, 2009 from http://www.phac-aspc.gc.ca/msds-ftss/msds13e-eng.php. Rajkovic, A., Uyttendaele, M., Vermeulen, A., Andjelkovoc, M., Fitz-James, I., Veld, P., et al. (2008). Heat resistance of Bacillus cereus emetic toxin, cereulide. The Society for Applied Microbiology, Letters in Applied Microbiology, 46 (5), 536-541.. Todar, K. (2008). Bacillus cereus Food Poisoning. Retrieved June 11, 2009 from http://www.textbookofbacteriology.net/B.cereus.html.

13. For More Info Visit: Public Health Agency of Canada http://www.phac-aspc.gc.ca/fs-sa/index-eng.php Health Canada http://www.hc-sc.gc.ca/fn-an/securit/index-eng.php Canadian Food Inspection Agency http://www.inspection.gc.ca/english/toce.shtml

14. For More Info Visit: MicrobiologyBytes http://www.microbiologybytes.com/video/Bcereus.html Food-info http://www.food-info.net/uk/bact/bacer.htm Bacteriology at University of Wisconsin-Madison http://bioinfo.bact.wisc.edu/themicrobialworld/B.cereus.html

15. For More Info Books: Fratamic, P.M., Bhunia, A.K., & Smith, J.L. (Eds.) (2005). Foodborne Pathogens: Micorbiology and Molecular Biology. United Kingdom: Caister Academic Press. Graumann, P. (Ed.) (2007). Bacillus: Cellular and Molecular Biology. United Kingdom: Caister Academic Press. Miliotis, M.D., & Bier, J.W. (Eds.) (2003). International Handbook of Foodborne Pathogens. New York, NY: Marcel Dekker Inc.

16. For More Info Studies: Amodio-Cocchieri, R., Cirillo, T., Villani, F., & Moschetti, G. (1998). The occurrence of Bacillus cereus in fast foods. International Journal of Food Sciences and Nutrition, 49 (4), 303-308. Arnold, K., Drenzek, C., Salter, M., & Arduino, M.J. (2005). Outbreak of cutaneous Bacillus cereus infections among cadets in a university military program – Georgia, August 2004. MMWR, 54 (48), 1233-1235. Barrie, D., Hoffman, P.N., Wilson, J.A., & Kramer, J.M. (1994). Contamination of hospital linen by Bacillus cereus. Epidemiology and Infection, 113 (2), 297-306.

17. For More Info Guven, K. & Mutlu, B. (2009). Properties of Bacillus cereus collected from different food sources. Turkish Journal of Biology, 33 (2), 101-108. Hedberg, C.W. Palazzi-Chursa, K.L., Radke, V.J., Selman, C.A., & Tauxe R.V. (2008). The use of clinical profiles in the investigation of foodborne outbreaks in restaurants: United States, 1982-1997. Epidemiology and Infection, 136 (1), 65- 72. Magnusson, M., Christiansson, A., & Svensson, B. (2007). Bacillus cereus spores during housing of dairy cows: factors affecting contamination of raw milk. Journal of Dairy Science, 90 (6), 2745-2754.

18. For More Info Sliman, R., Rehm, S., & Shlaes, D.M. (1987). Serious infections caused by Bacillus species. Medicine, 66 (3), 218-223. Stenfors Arnesen, L.P., Fagerlung, A., & Granum P.E. (2008). From soil to gut: Bacillus cereus and its food poisoning toxins. FEMS Microbiology Reviews, 32 (4), 579-606. Vissers, M.M., Te Giffel, M.C, Criehuls, F., De Jong, R., & Lankveld, J.M. (2007). Minimizing the level of Bacillus cereus spores in farm tank milk. Journal of Dairy Science, 90 (7), 3286-3293.

19. Questions?