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Jackie Dawson, PhD Public Health Epidemiologist Chelan, Douglas, Grant, Kittitas and Okanogan Counties 886-6428 jacqueline.dawson@cdhd.wa.gov. FOOD: What is making us sick?. Outbreak of Shiga toxin-producing  Escherichia coli O121 Infections Linked to Raw Clover Sprouts.

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food what is making us sick

Jackie Dawson, PhDPublic Health EpidemiologistChelan, Douglas, Grant, Kittitas and Okanogan Counties886-6428jacqueline.dawson@cdhd.wa.gov

FOOD: What is making us sick?

outbreak of shiga toxin producing escherichia coli o121 infections linked to raw clover sprouts
Outbreak of Shiga toxin-producing Escherichia coliO121 Infections Linked to Raw Clover Sprouts
  • Last update: June 10, 2014
  • Case Count: 17
  • Age range 11 to 45 years (median=27 yrs)
  • States: 5
  • Deaths: 0
  • Hospitalizations: 47%
  • Recall: No
what are shiga toxin producing e coli
What are Shiga toxin-producing E. coli?
  • Some kinds of E. coli cause disease by making a toxin called Shiga toxin.
  • “Shiga toxin-producing” E. coli, or STEC for short
  • STEC live in the guts of ruminant animals:
    • Cattle (major source for human illnesses)
    • Goats
    • Sheep
    • Deer
    • Elk
  • STEC generally do not make animals sick.
  • Pigs and birds sometimes pick up STEC from the environment and spread it.
e coli clinical features
E.coli Clinical Features
  • People usually get sick 2-8 days (average of 3-4 days) after swallowing the bacteria
  • Severe stomach cramps, diarrhea (often bloody) & vomiting
  • If there is fever, it usually is not very high (less than 101˚F)
  • Most people get better within 5–7 days.
  • 5–10% develop kidney failure called hemolytic uremic syndrome (HUS)
    • HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
    • Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination.
    • Most recover within a few weeks, but some suffer permanent damage or die.
what is the best treatment for stec infection
What is the best treatment for STEC infection?
  • Non-specific supportive therapy (including hydration)
  • Antibiotics should not be used to treat this infection.
  • Taking antibiotics may increase the risk of HUS.
  • Anti-diarrheal agents like Imodium® may also increase that risk.
  • Work and Child Care Restrictions:
    • Food handlers, child care attendants, child care attendees and healthcare workers require 2 negative stool specimens before returning to work or child care.
    • Stool specimens should be collected 24 hours apart and not sooner than 48 hours after the last dose of antibiotics
how long can an infected person carry stec
How long can an infected person carry STEC?
  • Typically disappear from the feces by the time the illness is resolved
  • May shed for several weeks-months, even after symptoms go away.
  • Young children tend to carry STEC longer than adults.
  • Good hand-washing!
slide9

~265,000 STEC infections occur each year

  • O157 =36% (95,400 cases)
  • non-O157 =64%(169,600 cases)
source of e coli o121 infection
Source of E. coli O121 Infection?

Advice to Consumers:

  • Raw clover sprouts have not been recalled from Evergreen Fresh Sprouts (Moyie Springs, Idaho)
  • Evergreen Sprouts supplied sprouts to 7 restaurants
  • CDC recommends that consumers do not eat any raw clover sprouts produced by Evergreen Fresh Sprouts.
  • Contact your health care provider if you think you may have become ill from eating raw clover sprouts.
  • Sprouts are a known source of foodborne illness.
    • 1996, ~10 000 cases of E. coli O157:H7 occurred primarily in schoolchildren in Osaka, Japan
    • 2011, ~4,000 cases (>50 deaths) of E. coli O104:H4 occurred in northern Germany
    • Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (alfalfa, clover, radish, and mung bean sprouts).
    • Cook sprouts thoroughly to reduce the risk of illness.
  • When in doubt, throw it out!
fda inspection
FDA Inspection
  • FDA also conducted an inspection of Evergreen Fresh Sprouts' facility on 22-23 May 2014; 27-30 May 2014; and 6 Jun 2014.
  • Investigators observed a number of unsanitary conditions,
    • condensate and irrigation water dripping from rusty valves
    • rusty and corroded mung bean room watering system
    • tennis rackets that had scratches, chips, and frayed plastic used to scoop mung bean sprouts
    • pitchfork with corroded metal being used to transfer sprouts
    • squeegee with visible corroded metal and non-treated wood being used to agitate mung bean sprouts inside a soak vat
    • Recall: No
past problems at evergreen sprouts
Past Problems at Evergreen Sprouts
  • April- July, 2011, a total of 25 persons infected with the outbreak strain of Salmonella Enteritidis have been reported from 5 states.
  • On July 1, 2011, Evergreen Fresh Sprouts LLC of Moyie Springs, Idaho, announced a recall of specific lots of alfalfa sprouts and spicy sprouts.
how can stec infections be prevented
How can STEC infections be prevented?
  • WASH YOUR HANDS thoroughly after:
    • using the bathroom
    • changing diapers
    • before preparing or eating food
    • contact with animals or their environments (farms, petting zoos, fairs, home)
  • COOK meats thoroughly
    • Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160°F/70˚C
    • It’s best to use a thermometer
  • AVOID raw milk,unpasteurized dairy products,unpasteurized juices
  • AVOID swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard “kiddie” pools.
  • PREVENT cross contamination in food preparation areas by:
    • washing hands, counters, cutting boards, & utensils after they touch raw meat
slide14

http://www.cdc.gov/foodnet/PDFs/incidence-bacterial-infections-2013-508c.pdfhttp://www.cdc.gov/foodnet/PDFs/incidence-bacterial-infections-2013-508c.pdf

slide15

Bacteria (Vibriovulnificus)

    • Isolated from oysters and other shellfish in warm coastal waters during the summer
    • 85% cases occur between May and October
  • Transmission: Eating raw or undercooked shellfish, particularly oysters harvested from warmer waters.
    • Bacteria does not alter the appearance, taste, or odor of oysters
  • Signs/symptoms:
    • Wound or soft tissue infections (direct contact with seawater)
    • Healthy people: causes watery diarrhea, vomiting & abdominal pain
    • Underlying medical conditions: especially liver disease, can cause bloodstream infections characterized by fever, chills, decreased blood pressure, blistering skin lesions, and often, death.