Foodborne diseases- a public health concern

Foodborne diseases are caused by consuming foods contaminated with toxic chemicals or biotoxins or foods containing bacteria, viruses, fungi, parasites, or foods containing bacteria, viruses, fungi, or parasites. Foodborne infections are a major global health problem that causes substantial morbidity and mortality around the world. Each year, over 600 million people are affected by foodborne diseases. Children under five years are particularly at a high risk comprising 30% of the total foodborne deaths annually. Foodborne diseases are classified as foodborne infection, foodborne intoxication and foodborne toxic infection. Ingestion of viable pathogens like bacteria, viruses, parasites and protozoa along with the food leads to food infection. Ingestion of preformed toxins, previously generated by bacteria in food, are causes foodborne intoxication. Staphylococcal intoxication and botulism are some examples of food intoxication. Foodborne toxic infection is caused by microorganisms that create toxins in situ after being eaten with food, infecting the intestine. Cholera, listeriosis and Clostridium perfringens gastroenteritis are some examples of toxic infections. Foodborne diseases can be prevented by proper sanitation and hygiene, using safe raw materials and using the right temperature to prepare and store food. Safe food handling practices can be ensured by following HACCP (Hazard Analysis and Critical Control Point) and FSSAI (Food Safety and Standards Authority of India) guidelines. Foodborne disease will continue to be a major hazard around the world, but with effective sanitation and hygiene, prevention is not difficult.

1. 1 (WHO, 2021) (WHO, 2017) 12000 deaths each year Impose a burden over 8 million disability adjusted lives Children under 5 are at higher risk with 80,000 deaths per year Children account for more than 1/3 of deaths due to food borne disease deaths

2. FOODBORNE DISEASES – A PUBLIC HEALTH CHALLENGE Name : Gayathri M. Admission no. : 2020-16-002 Department : Community Science 2

3. CONTENTS 3

4. DEFINITION Foodborne diseases are conditions that result from the consumption of food containing microbial agents such as bacteria, viruses, parasites or food contaminated with poisonous chemicals or biotoxins. (WHO, 2011) Foodborne diseases are pathological conditions that result mostly from ingestion of raw or improperly prepared or stored foods contaminated by microbial pathogens, toxins or other toxic agents. (Liu, 2018) 4

5. Classification 5 Foodborne infection Ingestion of food containing live microbes Foodborne intoxication Ingestion of food containing preformed toxins Foodborne toxic infections Organisms produce toxins in situ ( Unuvar, 2018)

6. 1. FOODBORNE INFECTION 6 Bacteria Virus Parasite Protozoa Bacterial infections Salmonellosis, Shigellosis and EPEC diarrhoea Viral infections Hepatitis A and E, Norovirus and Rotavirus Parasitic infections Hydatidosis, Taeniasis and Anisakiasis Protozoan infections Cryptosporidiosis, Toxoplasmosis and Sarcocytosis

7. 1a. Bacterial infections Salmonellosis Causative organism - Salmonella typhimurium, Salmonella enteriditis Risk group - Children < 5, elderly, people with weakened immune systems Mode of transmission - Fecal - oral route Symptoms - Watery diarrhoea, abdominal cramps, nausea and vomiting 7 Raw beef Unpasteurised milk Poultry Eggs

8. 8 ( Kaavya et al., 2021)

9. Shigellosis Causative organism - Shigella dysenteriae, Shigella flexneri Risk group - Children (< 5years), older adults Mode of transmission - Human to human, fecal - oral route Symptoms - Acute onset of fever, diarrhoea with abdominal cramps or with blood and mucus, nausea and vomiting 9

10. Enteropathogenic E. coli diarrhoea Causative organism - Enteropathogenic E. coli Risk group - Infants Mode of transmission - Fecal - oral route Symptoms - Acute gastroenteritis in children under 5 years; infantile diarrhoea Sources - Contaminated water and food 10

11. E. coli count of water samples collected from street vending sites 11 ( Bindhya , 2010)

12. 1b. Viral infections Viral foodborne pathogens - Hepatitis A and E, Rotavirus and Norovirus Mode of transmission - Fecal - oral route Symptoms - Diarrhoea, vomiting and abdominal cramps Sources - Shellfish, undercooked meats and fruit and vegetables 12 Hepatitis virus Norovirus Rotavirus

13. 1c. Parasitic infections Hydatidosis Taeniasis Anisakiasis Causative organism Echinococcus granulosus Taenia saginata (tapeworm) Anisakid nematodes Sources Vegetables grown in contaminated garden Beef, Pork R aw seafood dishes Symptoms Stomach upset, diarrhoea, unexplained weight loss, swollen abdomen, anaemia and jaundice Unexplained weight loss, abdominal pain, digestive problems Abdominal pain, nausea, vomiting, abdominal distention, diarrhoea and mild fever 13

14. 1d. Protozoan infections 14 Toxoplasmosis Cryptosporidiosis Sarcocystosis Causative organism Toxoplasma gondii Cryptosporidia Sarcocystis hominis Symptoms Swollen lymph nodes in neck and muscle pain Watery diarrhoea , weight loss and abdominal cramps Myalgia, muscle weakness and transitory edema

15. 2. FOODBORNE INTOXICATION 15 Exotoxin - Toxin produced in cell and expelled out Eg. Enterotoxin, Neurotoxin, Cytotoxin Endotoxin - Toxin produced in cell and remains within the cell untill the cell rupture Eg. Hepatotoxin, Nephrotoxin Cell wall Exotoxin Endotoxin

16. Staphylococcal Food Intoxication 16 Causative organism - Staphylococcus aureus Symptoms - Nausea, abdominal cramping, with or without diarrhoea Sources - Meat and its products, poultry and egg products, dairy products, salads, khoa Staphylococcus aureus

17. Bacillus cereus poisoning 17 Bacillus cereus Causative organism - Bacillus cereus Types - Emetic and diarrhoeal Toxin - Cereulide (heat sensitive) Symptom - Nausea, vomiting, abdominal pain and diarrhoea Sources - Meat, eggs and dairy products

18. Botulism Causative organism - Clostridium botulinum Types - Infant, wound, food borne, adult intestinal toxemia Symptoms - Muscle weakness, drooping eyelids, difficulty in swallowing, blurry vision, slurred speech, difficulty in breathing, vomiting and diarrhoea 18 Clostridium botulinum

19. Frequency of signs and symptoms at admission among patients hospitalized with botulism 19 (Varma et al., 2004)

20. Aflatoxicosis 20 Causative organism - Aspergillus flavus  Symptoms - Hemorrhagic necrosis of the liver, bile duct proliferation, oedema, and lethargy Risk group - Adults - high tolerance, fatal for children

21. Aflatoxin  contamination of parboiled rice samples collected from different states of India 21 ( Toteja et al., 2007)

22. 3. FOODBORNE TOXIC INFECTIONS Cholera 22 Causative organism - Vibrio cholerae Symptoms - Characteristic rice water stool, dehydration, persistent vomiting Risk group - Poverty, children <5, immune compromised and malnourished Source - Inadequate treatment of sewage and drinking water  Still exists in - Africa, Southeast Asia and Haiti

23. Prevalence of Cholera 23 (John, 2021)

24. Listeriosis 24 Causative organism - Listeria monocytogenes Risk group - Foetus , new born, pregnant women and elderly Symptoms - Mild : M uscle aches, nausea, and diarrhoea Severe : H eadache, stiff neck, loss of balance, and convulsions Sources - Milk, mea t, fruits and vegetables

25. 25 ( Kalorey et al., 2008) Total samples - 2060 Samples with Listeria spp. - 139

26. Clostridium perfringens gastroenteritis 26 Causative organism - Clostridium perfringens Risk group - Very young and elderly Symptoms - Intense abdominal cramps and watery diarrhoea Sources - Uncooked poultry, packed gravies and other foods cooked in batches

27. Prevention 27 Keep clean Do not cross contaminate Cook food thoroughly Keep food at safe temperature Use potable water and safe raw materials (WHO, 2019)

28. Contd.. Conduct a hazard analysis Determine critical c ontrol p oints Establish critical l imits Establish monitoring p rocedures Establish corrective a ctions Establish verification procedures Establish record keeping and document keeping procedure 28 Principles of HACCP

29. SUMMARY Definition Infection Intoxication Toxic infection Prevention 29

30. CONCLUSION 30 “ The Food You Eat Can Be Either The Safest & Most Powerful Form Of Medicine Or The Slowest Form Of Poison .” - Ann Wigmore