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The rise of Foodborne illnesses

Aling Carina was experiencing bouts of diarrhea and muscle cramps.  She’d rushed to the toilet a fourth time.  Her head was throbbing with pain.  She has fever and was vomiting.  What might have caused her suffering?  Suddenly, woozy thoughts of the foods she wolfed raced through her mind.

Global rise
Foodborne illnesses are on the rise globally.  These diseases are either infectious or toxic in nature caused by ingesting “pathogens” (e.g. bacteria, fungi, parasites, viruses) through contaminated food or water.  The condition is also known as “food poisoning”.

Foodborne illnesses are a growing health problem in both developed and developing countries.  It was reported that in 2000 alone, 2.1 million people died of diarrheal disease worldwide.

Some well known foodborne illness are considered as emerging because recently, these foodborne illnesses are getting more common like salmonellosisSalmonellosis has been reported decades ago but is now blamed for growing incidence in many countries.

Every year, there are, there are 76 million cases of foodborne illnesses in United States, two million cases in the United Kingdom, one million cases in Canada, and 750,000 cases in France.

The Food and Agriculture Organization statistics show that every year 700,000 people die from food and water borne disease in the Asia-Pacific region including the Philippines .

Most foodborne illnesses are sporadic and often unreported, thus less documented. There are no available statistics for foodborne illnesses in developing countries.

The World Health Organization said that in the Asia-Pacific region, the danger of food related outbreaks is acute due to the proximity of animal and people to food production and food distribution centers that are unsafe.

Foodborne illnesses are costly.  In the US for example, health experts estimated the annual costs of foodborne illnesses at $6 billion in medical costs and productivity loss. For salmonellosis alone, the cost is a stiff $1 billion per year.

Occurrence
The most common causes of foodborne illness are unsafe food handling and preparation at home, in restaurants, and other dining places.  Busy persons turn to convenience foods for lack of time.  They resort to prepared or cooked foods instead of preparing foods themselves resulting to higher health hazards.

Risk factors
Children, pregnant mothers, the elderly, and the immuno-compromised are at greater risks from foodborne illnessses due to age and immune condition.

Symptoms
Individuals infected with foodborne organisms may have no symptoms or may develop any of the symptoms such as headache, dizziness, fever, vomiting, diarrhea, stomach upset, muscle pain, severe cramps, and dehydration.  The onset of the symptoms may not occur immediately.  It may take two days or more after ingesting contaminated food.

Causes
The common causes of foodborne illness are harmful bacteria, moulds, parasites, and viruses.  Some of the common food pathogens responsible for majority of reported cases of foodborne illnesses are Escherichia coli, Campylobacter jejuni, Listeria, Salmonella, Shigella, Vibrio cholerae, Hepatitis A, Entamoeba histolytica and norwalk viruses.

Escherichea Coli 0157:H7 became known to the public because of an outbreak caused by contaminated hamburgers. E. coli 0157:H7 infection causes severe bloody diarrhea and abdominal cramps, with little or no fever. It can lead to hemorrhagic colitis and causes hemolytic uremic syndrome in children. Incubation period is from 3 to 5 days. Outbreaks have been associated to foods like hamburger, unpasteurized milk, juice, lettuce, salami, sprouts, and cantaloupe.

  • S. typhimurium and S. enteriditis are the two leading causes of salmonellosis. Salmonella bacteria live in the intestinal tracts of domestic and wild animals and may contaminate raw meat, poultry, eggs, dairy products, and other foods.  S. typhimurium is only carried by humans that causes typhoid fever and is characterized by fever, diarrhea, and inflammation of the infected organs.  S. enteriditis is egg-associated salmonellosis.  It is characterized by fever, nausea, abdominal cramps, and diarrhea beginning 12 to 72 hours after consuming contaminated food or beverage.  The illness can last four to seven days.

  • Listeria monocytogenes is a gram-positive bacterium and it is hardy, resists freezing, drying, and heat.  Listeria is associated with foods like raw milk, soft or semi-soft cheeses, ice cream, raw vegetables, meat, poultry, raw, and smoked fish. Listeria can grow at refrigerated temperature.  Incubation period for Listeriosis is four days to several weeks and can cause meningitis and spontaneous abortion. Listeria monocytogenes has a fatality rate of 30%.

  • Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter.  Symptoms of diarrhea, cramping, abdominal pain, fever, and vomiting usually occur two to five days after ingestion of contaminated food or water.  The diarrhea may be bloody and the illness typically lasts one week.  In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.  Incubation period is from two to five days.

    Consumption of undercooked poultry and cross-contamination of other foods with drippings from raw poultry are the leading risk factors for human campylobacteriosis. Larger outbreaks due to Campylobacter are not usually associated with raw poultry but are usually related to drinking unpasteurized milk or contaminated water.

  • Shigellosis or bacillary dysentery is an infectious disease caused by the bacteria shigella.  The most common symptoms are bloody diarrhea, fever, nausea, vomiting, and cramps.  Shigellosis usually resolves in five to seven days.

  • Outbreaks of shigellosis occur frequently in overcrowded places and poor sanitation and where personal hygiene is poor.  Shigella organisms are transmitted via the fecal-oral route.  The most common cause of contamination is unsanitary handling of food and water contaminated with human waste.  Vegetables are sources of contamination if they are harvested from a field with sewage in it.  Foods associated with shigella are salads (potato, tuna, shrimp, macaroni, and chicken), raw vegetables, milk and dairy products, and poultry.

  • Cholera is an acute diarrheal disease caused by the bacterium Vibrio cholerae.  The disease is characterized by profuse watery stools, vomiting, and leg cramps.  The incubation period for vibrio cholerae is 24 to 48 hours. The rapid loss of body fluids leads to dehydration and shock and if left untreated may cause death.  The cause of contamination is water, fish, shellfish, and street foods that are unhygienically prepared.

  • Entamoeba histolytica is the parasite causing inflammation of the intestine called amoebiasis or amoebic dysentery.  The symptoms include bloody diarrhea, nausea, stomach cramps, vomiting, loss of appetite, and fatigue.  Symptoms appear from 2-3 days to 1-4 weeks.  Foods associated with the disease are water, any uncooked foods or foods contaminated by an ill food handler.

  • Hepatitis A, the most common of hepatitis is transmitted through person-to-person contact when a person does not wash his hands properly after toilet use.  Common sources of outbreaks have been related to water contamination, food contamination by infected food handlers, and raw or undercooked shellfish from contaminated waters.  The symptoms are fever, fatigue, loss of appetite, nausea, abdominal discomfort, jaundice, dark urine, and joint aches.  The symptoms occur within 15 – 50 days from exposure.

  • Norwalk and Norwalk-like viruses are transmitted through the fecal-oral route via contaminated water and foods.  Water is the most common source of the outbreaks while shellfish and salad ingredients are the common implicated foods, although any food can be contaminated with the virus by an infected person.  The symptoms of the illness occur within 24-48 hours after contaminated water or food has been ingested.  Symptoms are nausea, vomiting, diarrhea, abdominal cramps, fever, headache, and muscle pains.

Emergence
New foodborne illnesses occur due to globalization of the food supply; increase in international travel and trade; changes in micro-organisms, i.e. evolution of new pathogens, changes in the ability to survive in various environmental conditions, development of new virulent strains from old pathogens, development of resistance to drugs making the treatment of the disease difficult; changes in the food production system, and; changes in lifestyles of the population.

Treatment
Mild cases of foodborne illness can be treated by increased fluid intake to replace fluid and electrolyte losses, while severe cases need hospitalization for medical and nutritional therapy.

Prevention
To avoid foodborne diseases, the basic rules to follow are careful washing of hands before preparing food; thorough cooking of foods particularly beef, poultry and eggs; thorough washing of fruits and vegetables especially those that will be taken raw; avoid drinking unpasteurized milk, fruit juices, and untreated surface water, and; protecting foods from insects, animals, and rodents.

To prevent harmful bacteria from growing in foods, these should be refrigerated immediately.  Cook foods to proper temperature.  Properly cooked foods are heated long and at high temperature to kill the harmful bacteria.  Prevent cross contamination (e.g. separate raw foods from cooked foods).  Handle foods properly.

Conclusion
Food safety is an increasingly important public health issue.  Foodborne illnesses continue to have major impact on the health of individuals.  Microorganisms continue to adapt and evolve, increasing their virulence.  The foodborne illness, E. coli 0157:H7 was unrecognized as a foodborne disease two decades ago.

Bacteria that are recognized as sources of foodborne illnesses have found new modes of transmission.  For example, Salmonella enteritidis, which only contaminated the outside shell of eggs, is now also found inside many eggs, making uncooked eggs unsafe to eat.

Foodborne illness is costly in terms of direct medical expenses and loss in productivity.

Aggressive research efforts must be done to identify, assess, and control microbiological hazards associated with food production from the farm to the dining table.  Intensified focus on education to all food handlers and consumers about safe food handling must be a priority.  Reinforcing hygienic practices at each link in the food chain, from producer to consumer, is critical in preventing foodborne diseases.•


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