Food Borne Diseases New 1

7/25/2019 Food Borne Diseases New 1

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FOOD BORNE DISEASESFOOD BORNE DISEASES

Moderator –Dr B S GargModerator –Dr B S Garg

Presenter - Dr Gaurij HoodPresenter - Dr Gaurij Hood



Food borne DiseasesFood borne Diseases

11..IntroductionIntroduction

2.Pathogenesis and Transmission2.Pathogenesis and Transmission

3.Important foodborne3.Important foodborne

pathogens/toxins/chemicalspathogens/toxins/chemicals

4.Investigations and Lab diagnosis4.Investigations and Lab diagnosis

.Treatment and Prevention.Treatment and Prevention



.Introdu!tion.Introdu!tion

!ood borne diseases"!ood borne diseases"""intoxicationsintoxications andand

infectionsinfections# $o%ers i&&nesses a!'uired t(roug(# $o%ers i&&nesses a!'uired t(roug(

!onsu)*tion o+ !onta)inated +ood-+ood *oisoning!onsu)*tion o+ !onta)inated +ood-+ood *oisoning

!ood borne!ood borne disease outbrea#s"disease outbrea#s"

O!!urren!e o+ , or )ore !ases o+ si)i&ar i&&nessO!!urren!e o+ , or )ore !ases o+ si)i&ar i&&nessresu&ting +ro) ingestion o+ !o))on +oodresu&ting +ro) ingestion o+ !o))on +ood

$%$% (en obser%ed nu)ber o+ *ati!u&ar disease(en obser%ed nu)ber o+ *ati!u&ar diseasee!eeds e*e!ted nu)bere!eeds e*e!ted nu)ber



.Introdu!tion.Introdu!tion

G&oba& burden-G&oba& burden- highhigh morbidit&morbidit& andand mortalit&mortalit&

Infectious diarrhoea" 3 to billion casesInfectious diarrhoea" 3 to billion cases

andand 1.' million deaths1.' million deaths annua&&/annua&&/

()(" *+ million cases()(" *+ million cases o+ +ood borne diseases ino+ +ood borne diseases in

0S annua&&/ 1it(0S annua&&/ 1it( appx.,,, deathsappx.,,, deaths

InIn India" Integrated disease surveillanceIndia" Integrated disease surveillance

Pro-ect I)P0 "Pro-ect I)P0 " Food *oisoning outbrea2Food *oisoning outbrea2re*orting in!reased tore*orting in!reased to more than double inmore than double in

2,,2,, +ro) ,334 ",3 in ,335 and 63 in ,334#+ro) ,334 ",3 in ,335 and 63 in ,334#



Food borne in+e!tions %s intoi!ationFood borne in+e!tions %s intoi!ation

InfectionsInfections acterial / iral / parasiteacterial / iral / parasite

InvadeInvade and orand or multipl&multipl& inin

lining of intestinelining of intestine

Incubation periodIncubation period" hours" hours

to da&sto da&s

/s /s )iarrhoea 5 nausea5)iarrhoea 5 nausea5

vomitting 5 abdominal cramps5vomitting 5 abdominal cramps5

feverfever

(ommunicable(ommunicable"spreads from"spreads from

person to personperson to person !actors!actors"inade6uate coo#ing5"inade6uate coo#ing5

cross contamination 5 poorcross contamination 5 poor

personal h&giene 5 bare handpersonal h&giene 5 bare hand

contactcontact

IntoxicationsIntoxications toxins natural / preformedtoxins natural / preformed

bacterial / chemical0bacterial / chemical0 7o invasion7o invasion or multiplicationor multiplication

Incubation periodIncubation period""

minutes to hoursminutes to hours

/s /s omitting 5 nausea5omitting 5 nausea5

diarrhea 5 diplopia5 8ea#ness5diarrhea 5 diplopia5 8ea#ness5

resp. failure 5 numbness5resp. failure 5 numbness5

sensor&/motor d&sfunctionsensor&/motor d&sfunction

7ot communicable7ot communicable !actors!actors"inade6uate coo#ing 5"inade6uate coo#ing 5

improper handlingimproper handling

temperaturestemperatures



E*ide)io&og/ in IndiaE*ide)io&og/ in India

AgentAgent 7ear 7ear RegionRegion Peo*&ePeo*&e

a8e!teda8e!ted

I)*&i!atedI)*&i!ated

FoodFood

Sa&)one&&Sa&)one&&aa*arat/*(i*arat/*(i

AA

556556 7a%at)a& 7a%at)a& 9999 :egetarian:egetarian+ood+ood

$&ostridiu$&ostridiu))but/ri!u)but/ri!u)

55;55; Gujarat-Gujarat-

residentiresidenti

a& s!(oo&a& s!(oo&

9<9<studentsstudents Se%uSe%u

"Gra) =our"Gra) =our

!ris*#!ris*#

Sa&)one&&Sa&)one&&

aa 554554 Ar)edAr)ed

For!esFor!es

>4>4

*ersonne&*ersonne&

Fro?en +o1&Fro?en +o1&



E*ide)io&og/ in IndiaE*ide)io&og/ in India

AgentAgent 7ear 7ear RegionRegion

Peo*&ePeo*&e

a8e!tea8e!te

dd

I)*&i!atedI)*&i!ated

FoodFood

Nor1a&2Nor1a&2&i2e :irus&i2e :irus

,33,,33,

De&(iDe&(iHos*ita&Hos*ita&

9393

nursesnurses

Sa&adSa&ad

Sand1i!(esSand1i!(es

Sta*(.Sta*(.

AureusAureus ,33>,33>

MPMP @33@33

!(i&dre!(i&dre

n nn n

adu&tsadu&ts

B(a&&a " +riedB(a&&a " +ried

*otato ba&&s#*otato ba&&s#

Sa&)one&&Sa&)one&&

aa

1e&te%erd1e&te%erd

,334-,334-

3535 Manga&orManga&or

ee

9<9<

andand

33

$(i!2en$(i!2en

andand

Fis(Fis(



So)e i)*ortant +ood-borneSo)e i)*ortant +ood-borne

*at(ogens toins and !(e)i!a&s*at(ogens toins and !(e)i!a&s

1. acteria1. acteria - Ba!i&&us !ereus Bru!e&&a - Ba!i&&us !ereus Bru!e&&a

$a)*/&oba!ter $&ostridiu) s* E.!o&i Sa&)one&&a$a)*/&oba!ter $&ostridiu) s* E.!o&i Sa&)one&&a

s* isteria Sta*( aureus :ibrio !(o&era ands* isteria Sta*( aureus :ibrio !(o&era and

:.*ara(e)o&/ti!us:.*ara(e)o&/ti!us

2. iruses2. iruses - He*atitis A and E Rota%irus - He*atitis A and E Rota%irus

Nor%o%irusNor%o%irus

3. Proto9oa3. Proto9oa – $r/*tos*oridiu) $/!&os*ora – $r/*tos*oridiu) $/!&os*ora

Enta)oeba Giardia C. gondiiEnta)oeba Giardia C. gondii

4. Trematodes 5 (estodes and 7ematodes4. Trematodes 5 (estodes and 7ematodes



Food borne *at(ogens-toins andFood borne *at(ogens-toins and

!(e)i!a&s!(e)i!a&s

ToxinsToxins - )arine biotoins tetrodotoin "*u8er s(#- )arine biotoins tetrodotoin "*u8er s(#

*/rro&i?idine a&2a "Ende)i! as!ites# )us(roo)*/rro&i?idine a&2a "Ende)i! as!ites# )us(roo)

toins s(e&&s( toins )/!otoins-"A=atoinstoins s(e&&s( toins )/!otoins-"A=atoins

Ergot and Fusariu)# *&ant intoi!ants BOAAErgot and Fusariu)# *&ant intoi!ants BOAA

"at(/ris)#"at(/ris)#

(hemicals(hemicals - *esti!ides "OPPsb# radionu!&ides - *esti!ides "OPPsb# radionu!&ides nitrites "+ood *reser%ati%es# toi! )eta&s - !d !u (gnitrites "+ood *reser%ati%es# toi! )eta&s - !d !u (g

*b sn =uoride MSG*b sn =uoride MSG



Pat(ogenesis and Crans)issionPat(ogenesis and Crans)ission

Inoculum / si9eInoculum / si9e o+ in+e!ti%e dose -$an be aso+ in+e!ti%e dose -$an be ass)a&& as 3-33 ba!teria& !/sts +or S(ige&&a EHE$s)a&& as 3-33 ba!teria& !/sts +or S(ige&&a EHE$ Giardia E. (isto&/ti!a Giardia E. (isto&/ti!a

or 3 6-3 4 +or :ibrio !(o&era %ariab&e +oror 3 6-3 4 +or :ibrio !(o&era %ariab&e +orsa&)one&&asa&)one&&a

Ani)a&s (u)ans (arbouring in+e!tionAni)a&s (u)ans (arbouring in+e!tion s(ed ins(ed in+e!es+e!es contaminate 8ater 5 fruits 5contaminate 8ater 5 fruits 5vegetablesvegetables inade6uate coo#ing / improperinade6uate coo#ing / improper

storagestorage infectioninfection

ar) te)*erature"ar) te)*erature"1,",1,", degree !ent.#-degree !ent.#-

)u&ti*&i!ation o+ *at(ogens)u&ti*&i!ation o+ *at(ogens



So)e !o))on ba!teria& +ood *oisonsSo)e !o))on ba!teria& +ood *oisons

In!ubationIn!ubation

*eriod *eriod

$ause$ause S/)*to)sS/)*to)s $o))on$o))on

+oods+oods

-; (ours-; (ours Sta*( aureusSta*( aureus

"enterotoin#"enterotoin#NauseaNausea

%o)itting%o)itting

diarr(eadiarr(ea

Mi&2 n )i&2Mi&2 n )i&2

*rodu!ts*rodu!ts

(a) *ou&tr/(a) *ou&tr/

sa&adssa&ads!ustards!ustards

Ba!i&&usBa!i&&us

!ereus!ereus

"enterotoin#"enterotoin#

NauseaNausea

%o)itting%o)itting

"e)eti!"e)eti!+or)#+or)#

Fried ri!eFried ri!e




In!ubationIn!ubation*eriod*eriod $ause$ause S/)*to)sS/)*to)s $o))on$o))on+oods+oods

4-; (ours4-; (ours $&ostridiu)$&ostridiu)

*er+ringes*er+ringes

"s*ores#"s*ores#

Abd.!ra)*sAbd.!ra)*s

diarr(eadiarr(ea

Nausea andNausea and

:o)itting -rare:o)itting -rare

MeatMeat

*ou&tr/*ou&tr/

&egu)es.&egu)es.

gra%iesgra%ies

Ba!i&&us !ereusBa!i&&us !ereus

" diarr(ea&" diarr(ea&+or)-+or)-

*re+or)ed n*re+or)ed n

stab&e toins#stab&e toins#

Diarr(eaDiarr(ea

abd.*ainabd.*ainnauseanausea

%o)itting+e%er%o)itting+e%er

-No-No




In!ubationIn!ubation

*eriod*eriod

$ause$ause S/)*to)sS/)*to)s $o))on$o))on

+oods+oods

@; (ours@; (ours :ibrio !(o&era:ibrio !(o&era Ri!e 1ater/Ri!e 1ater/

stoo&sstoo&sater andater and

i!e !rea)si!e !rea)s

sea +oodsea +ood

Sa&)one&&aSa&)one&&a

s**s**In=a))atorIn=a))ator

/ diarr(ea/ diarr(eaMeat )i&2Meat )i&2

n )i&2n )i&2

*rodu!ts*rodu!ts*ou&tr/*ou&tr/

S(ige&&a s*S(ige&&a s* d/sentr/d/sentr/ Potatora1Potatora1

eggs-sa&adeggs-sa&ad



Ear&/ diagnosis and in%estigationsEar&/ diagnosis and in%estigations

1.Initial assessment1.Initial assessment o+ !ases –o+ !ases –

)etailed)etailed clinical histor&clinical histor& in!&uding ti)e o+in!&uding ti)e o+

onset duration o+ i&&ness s/)*to)s ( o tra%e&onset duration o+ i&&ness s/)*to)s ( o tra%e&

re!ent )ea&s !oo2ing and re+rigeration detai&s re!ent )ea&s !oo2ing and re+rigeration detai&so+ ot(ers 1it( si)i&ar !o)*&aintso+ ot(ers 1it( si)i&ar !o)*&aints

,.,.)etailed clinical)etailed clinical examinationexamination ––

:ita&s and degree o+ de(/dration s/ste)i! signs:ita&s and degree o+ de(/dration s/ste)i! signs



ab diagnosisab diagnosis

Main obje!ti%es-Main obje!ti%es-

a# Coa# Co con:rm clinical diagnosiscon:rm clinical diagnosis b/b/ isolation ofisolation of

causative agentcausative agent +ro) *ro*er sa)*&es +ro) *ro*er sa)*&es

eg . stoo& %o)itus gastri! as*irate +oodeg . stoo& %o)itus gastri! as*irate +ood

s*e!i)enss*e!i)ens

b# Ensureb# Ensure proper identi:cationproper identi:cation o+ diseaseo+ disease

c)c) Deter)ineDeter)ine causative agentcausative agent i+ *resent in +oodi+ *resent in +ood

sour!es 1it( re&e%ant e*ide)io&ogi!a& )ar2ers- eg.sour!es 1it( re&e%ant e*ide)io&ogi!a& )ar2ers- eg.

iot&ping 5 serot&ping 5 P(% 5 Phage t&ping etciot&ping 5 serot&ping 5 P(% 5 Phage t&ping etc



$o&&e!tion o+ +ood sa)*&es$o&&e!tion o+ +ood sa)*&es

0sing0sing aseptic techni6ueaseptic techni6ue nn appropriateappropriatecontainerscontainers sa)*&es besa)*&es be refrigeratedrefrigerated duringduring

storage and trans*ortstorage and trans*ort )ust)ust arrive lab 8ithinarrive lab 8ithin

3 da&s of collection3 da&s of collection

;de6uate;de6uate sa)*&e - )ini)u)sa)*&e - )ini)u) 1,, grams1,, grams (ontainers(ontainers - not to be &&ed- not to be &&ed <*=<*= o+ !a*a!it/o+ !a*a!it/

Proper labellingProper labelling is ut)ost i)*ortantis ut)ost i)*ortant &abe&&ed&abe&&ed

s*e!i)en be *&a!ed ins*e!i)en be *&a!ed in 9ip loc# bag9ip loc# bag andand sealedsealed accine carrieraccine carrier 1it( i!e *a!2s +or trans*ort and1it( i!e *a!2s +or trans*ort and

cold chaincold chain )aintenan!e " a%oid +ree?ing #)aintenan!e " a%oid +ree?ing #

St f tb k i ti ti



Steps of outbreak investigation

Establishing existence

Co-ordination

Collection and transport

Lab testing

Control and preventive measures

Definition of cases, population

Description of epidemiology

Possible hypotheses

Epidemiological study

nalysis of data and interpretation

!eporting



Creat)ent Creat)ent

.. Initial Initial T T t -t - ;ssessment;ssessment andand reversalreversal o+o+deh&drationdeh&dration "" $%T$%T I: F&uids # I: F&uids #

,. $ause,. $ause speci:cspeci:c treat)ent i+ an/- eg.treat)ent i+ an/- eg. chelatingchelating

agents in !ase o+agents in !ase o+ pesticidepesticide *oisoning*oisoning

9.9. >se>se o+o+ antibioticsantibiotics !an be !onsidered i+ ba!teria&!an be !onsidered i+ ba!teria&!ause is identied!ause is identied



Pre%ention in !o))unit/Pre%ention in !o))unit/

Pro*er (and1as(ing and *ersona& (/gienePro*er (and1as(ing and *ersona& (/giene

Pro*er storage "re+rigeration#Pro*er storage "re+rigeration#

Food sa+te/ edu!ation – !o))unit/ and +oodFood sa+te/ edu!ation – !o))unit/ and +ood

(and&ers(and&ers

En%iron)enta& )easures - Dis!ourage se1ageEn%iron)enta& )easures - Dis!ourage se1age+ar)ing +or gro1ing +ruits and %egetab&es+ar)ing +or gro1ing +ruits and %egetab&es



Pre%entionPre%ention

?a9ard ;nal&sis and (ritical (ontrol Point?a9ard ;nal&sis and (ritical (ontrol Point

?;((P0 "?;((P0 " S/ste)ati! *re%enti%e a**roa!( to +ood sa+et/S/ste)ati! *re%enti%e a**roa!( to +ood sa+et/

Addresses *(/si!a& !(e)i!a& and bio&ogi!a&Addresses *(/si!a& !(e)i!a& and bio&ogi!a&(a?ards as )eans o+ *re%ention rat(er t(an(a?ards as )eans o+ *re%ention rat(er t(annis(ed *rodu!t ins*e!tionnis(ed *rodu!t ins*e!tion

Food industr/ - Food sa+et/ (a?ards identied atFood industr/ - Food sa+et/ (a?ards identied ata&& stages o+ +ood *rodu!tion and *re*arationa&& stages o+ +ood *rodu!tion and *re*aration*ro!esses*ro!esses 2e/ a!tion ta2en at2e/ a!tion ta2en at (ritical (ontrol(ritical (ontrolPoints ((P sPoints ((P s##



Prin!i*&es o+ Ha?ard Ana&/sis andPrin!i*&es o+ Ha?ard Ana&/sis and

$riti!a& $ontro& Point " HA$$P$riti!a& $ontro& Point " HA$$P ##

Ana&/se (a?ardsAna&/se (a?ards Identi+/ !riti!a& !ontro&Identi+/ !riti!a& !ontro&

*oints*oints Estab&is( *re%enti%e )easures 1it(Estab&is( *re%enti%e )easures 1it(

!riti!a& &i)its +or ea!( $$P!riti!a& &i)its +or ea!( $$P Estab&is(Estab&is(*ro!edures to )onitor $$PS*ro!edures to )onitor $$PS Estab&is(Estab&is(

!orre!ti%e a!tions 1(en )onitoring s(o1s!orre!ti%e a!tions 1(en )onitoring s(o1s

t(at !riti!a& &i)it (as not )ett(at !riti!a& &i)it (as not )et Estab&is(Estab&is(

*ro!edures to %eri+/ t(at s/ste) is 1or2ing*ro!edures to %eri+/ t(at s/ste) is 1or2ing*ro*er&/*ro*er&/ Estab&is( e8e!ti%e re!ord 2ee*ingEstab&is( e8e!ti%e re!ord 2ee*ing

+or do!u)entation+or do!u)entation



Sa+et/ Regu&ationsSa+et/ Regu&ations

Pre%ention o+ Food Adu&teration A!t 56<-Pre%ention o+ Food Adu&teration A!t 56<- Co Ensure *ure and 1(o&eso)e +ood and to *rote!t Co Ensure *ure and 1(o&eso)e +ood and to *rote!t

+ro) +radu&ent *ra!ti!es+ro) +radu&ent *ra!ti!es

A)end)ents -5;<5>;54;A)end)ents -5;<5>;54;

$ase o+ *ro%en adu&teration –Mini)u) i)*rison)ent o+$ase o+ *ro%en adu&teration –Mini)u) i)*rison)ent o+; )ont(s and )ini)u) ne o+ Rs 333 en%isaged; )ont(s and )ini)u) ne o+ Rs 333 en%isaged

Grie%ous Hurt-"9,3 IP$#- Deat( or su!( (ar) !an beGrie%ous Hurt-"9,3 IP$#- Deat( or su!( (ar) !an be

*unis(ed u*to i+e i)*rison)ent and ne not Rs 6333*unis(ed u*to i+e i)*rison)ent and ne not Rs 6333

Food Standards- $ode A&i)entarius Ag)ar2Food Standards- $ode A&i)entarius Ag)ar2

standardsstandards Bureau o+ Indian StandardsBureau o+ Indian Standards

Nationa& Nutrition Po&i!/ -559- Food Se!urit/Nationa& Nutrition Po&i!/ -559- Food Se!urit/



Fi%e 2e/s to Sa+er +oodFi%e 2e/s to Sa+er +ood

1. @eep (lean1. @eep (lean ––

as( (ands be+ore (and&ing +ood and o+ten duringas( (ands be+ore (and&ing +ood and o+ten during *re*aration*re*aration

as( (ands a+ter going to toi&etas( (ands a+ter going to toi&et

as( n sanitise a&& sur+a!es n e'ui*)ent +or +oodas( n sanitise a&& sur+a!es n e'ui*)ent +or +ood

*re*aration-*rote!t 2it!(en +ro) inse!ts *ets*re*aration-*rote!t 2it!(en +ro) inse!ts *ets

2. eparate ra8 and coo#ed2. eparate ra8 and coo#ed foodfood--

Se*arate ra1 )eat *ou&tr/ n sea+ood +ro) ot(erSe*arate ra1 )eat *ou&tr/ n sea+ood +ro) ot(er

+oods+oods 0se se*arate utensi&s +or (and&ing ra1 +oods0se se*arate utensi&s +or (and&ing ra1 +oods

Store +ood in !ontainers to a%oid !onta!t bet1een ra1Store +ood in !ontainers to a%oid !onta!t bet1een ra1

and !oo2ed +oodsand !oo2ed +oods



Fi%e e/s to Sa+er FoodFi%e e/s to Sa+er Food

3. (oo# Thoroughl&3. (oo# Thoroughl& –– es*. Meat *ou&tr/ eggs and Sea+oodes*. Meat *ou&tr/ eggs and Sea+ood

Bring sou*s n ste1s to boi&ing "ensure@>3degreeBring sou*s n ste1s to boi&ing "ensure@>3degree

te)*#te)*#

Re(eat !oo2ed +ood t(oroug(&/Re(eat !oo2ed +ood t(oroug(&/

4. @eep food at safe temperature "4. @eep food at safe temperature "

Dont &ea%e !oo2ed +ood at roo) te)*.@, (oursDont &ea%e !oo2ed +ood at roo) te)*.@, (ours

Pro)*t re+rigeration o+ !oo2ed n *eris(ab&e +oodPro)*t re+rigeration o+ !oo2ed n *eris(ab&e +ood

ee* !oo2ed +ood *i*ing (ot"@;3 de.# *rior toee* !oo2ed +ood *i*ing (ot"@;3 de.# *rior to

ser%ingser%ing

Dont store +ood too &ong e%en in re+rigeratorDont store +ood too &ong e%en in re+rigerator

Dont t(a1 +ro?en +ood at roo) te) eratureDont t(a1 +ro?en +ood at roo) te) erature



Fi%e 2e/s to sa+er +oodFi%e 2e/s to sa+er +ood

. >se safe 8ater and ra8 materials". >se safe 8ater and ra8 materials"

0se sa+e 1ater or treat to )a2e it sa+e0se sa+e 1ater or treat to )a2e it sa+e

Se&e!t +res( and 1(o&eso)e +ruitsSe&e!t +res( and 1(o&eso)e +ruits

$(oose +oods *ro!essed +or sa+et/ - *asteurised$(oose +oods *ro!essed +or sa+et/ - *asteurised

)i&2)i&2

as( +ruits n %egetab&es i+ eaten ra1as( +ruits n %egetab&es i+ eaten ra1 Dont use +ood be/ond e*ir/ dateDont use +ood be/ond e*ir/ date



Re+eren!esRe+eren!es

. $D A&ert – De!e)ber ,335 %o&.9JNo.< – Food. $D A&ert – De!e)ber ,335 %o&.9JNo.< – Food

BorneBorne

Diseases *age no. -,Diseases *age no. -,

,.Par2s Cetboo2 o+ PSM C1entiet( Edition,.Par2s Cetboo2 o+ PSM C1entiet( Edition

Intestina&Intestina&

in+e!tions –Food Poisoning *age no. ,3-,,in+e!tions –Food Poisoning *age no. ,3-,,

9.Internet- 111.ni!d.ni!.in9.Internet- 111.ni!d.ni!.in



CHAN 7O0 CHAN 7O0

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Food Borne Diseases New 1