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FOOD BORNE DISEASES. Moderator –Dr B S Garg Presenter - Dr Gaurij Hood. Food borne Diseases. 1 . Introduction 2.Pathogenesis and Transmission 3.Important foodborne pathogens/toxins/chemicals 4.Investigations and Lab diagnosis 5.Treatment and Prevention. 1.Introduction.

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food borne diseases


Moderator –Dr B S Garg

Presenter - Dr Gaurij Hood

food borne diseases2

Food borne Diseases


2.Pathogenesis and Transmission

3.Important foodborne pathogens/toxins/chemicals

4.Investigations and Lab diagnosis

5.Treatment and Prevention

1 introduction

Food borne diseases-(intoxications and infections) Covers illnesses acquired through consumption of contaminated food-food poisoning

Food bornedisease outbreaks-

Occurrence of 2 or more cases of similar illness resulting from ingestion of common food


When observed number of paticular disease exceeds expected number

1 introduction4

Global burden- highmorbidity and mortality

Infectious diarrhoea- 3 to 5 billion cases and 1.8 million deaths annually

CDC- 76 million cases of food borne diseases in US annually with appx.5000 deaths

In India- Integrated disease surveillance Project (IDSP) - Food poisoning outbreak reporting increased to more than double in 2009 from 2008 (120 in 2009 and 50 in 2008)

food borne infections vs intoxication
Food borne infections vs intoxication


Bacterial / Viral / parasite

Invade and or multiply in lining of intestine

Incubation period- hours to days

S/s – Diarrhoea , nausea, vomitting , abdominal cramps, fever

Communicable-spreads from person to person

Factors-inadequate cooking, cross contamination , poor personal hygiene , bare hand contact


toxins ( natural / preformed bacterial / chemical)

No invasion or multiplication

Incubation period-

minutes to hours

S/s – Vomitting , nausea, diarrhea , diplopia, weakness, resp. failure , numbness, sensory/motor dysfunction

Not communicable

Factors-inadequate cooking , improper handling temperatures

some important food borne pathogens toxins and chemicals
Some important food-borne pathogens, toxins and chemicals

1. Bacteria - Bacillus cereus , Brucella , Campylobacter, Clostridium sp , E.coli, Salmonella sp , Listeria , Staph aureus , Vibrio cholera and V.parahemolyticus

2. Viruses - Hepatitis A and E , Rotavirus , Norvovirus

3. Protozoa – Cryptosporidium , Cyclospora , Entamoeba , Giardia , T. gondii

4. Trematodes , Cestodes and Nematodes

food borne pathogens toxins and chemicals
Food borne pathogens-toxins and chemicals

Toxins - marine biotoxins , tetrodotoxin (puffer fish), pyrrolizidine alka (Endemic ascites) , mushroom toxins , shellfish toxins , mycotoxins-(Aflatoxins ,Ergot and Fusarium), plant intoxicants , BOAA (Lathyrism)

Chemicals - pesticides (OPP,sb) , radionuclides , nitrites (food preservatives) toxic metals - cd, cu, hg, pb, sn, fluoride , MSG

pathogenesis and transmission
Pathogenesis and Transmission

Inoculum / size of infective dose -Can be as small as 10-100 bacterial cysts for Shigella , EHEC , Giardia, E. histolytica

or 10^ 5-10^ 8 for Vibrio cholera, variable for salmonella

Animals / humans harbouring infection  shed in feces  contaminate water , fruits , vegetables inadequate cooking / improper storage  infection

Warm temperature(10-50 degree cent.)-

multiplication of pathogens

early diagnosis and investigations
Early diagnosis and investigations

1.Initial assessment of cases –

Detailedclinical history including time of onset , duration of illness , symptoms , h /o travel , recent meals , cooking and refrigeration , details of others with similar complaints

2.Detailed clinicalexamination –

Vitals and degree of dehydration , systemic signs

lab diagnosis
Lab diagnosis

Main objectives-

a) To confirm clinical diagnosis by isolation of causative agent from proper samples ,

eg . stool , vomitus / gastric aspirate , food specimens

b) Ensure proper identification of disease

c) Determine causative agent if present in food sources with relevant epidemiological markers- eg. Biotyping , serotyping , PCR , Phage typing etc

collection of food samples
Collection of food samples

Using aseptic technique n appropriate containers  samples be refrigerated during storage and transport  must arrive lab within 3 days of collection

Adequate sample - minimum 100 grams

Containers - not to be filled >75% of capacity

Proper labelling is utmost important  labelled specimen be placed in zip lock bag and sealed

Vaccine carrier with ice packs for transport and cold chain maintenance ( avoid freezing )


Steps of outbreak investigation

Establishing existence


Collection and transport

Lab testing

Control and preventive measures

Definition of cases, population

Description of epidemiology


Epidemiological study

Analysis of data and interpretation



1. Initial T/t - Assessment and reversal of dehydration ( ORT / IV Fluids )

2. Cause specific treatment if any- eg. chelating agents in case of pesticide poisoning

3. Use of antibiotics can be considered if bacterial cause is identified

prevention in community
Prevention in community

Proper handwashing and personal hygiene

Proper storage (refrigeration)

Food saftey education – community and food handlers

Environmental measures - Discourage sewage farming for growing fruits and vegetables


Hazard Analysis and Critical Control Point (HACCP) -

Systematic preventive approach to food safety

Addresses physical , chemical and biological hazards as means of prevention rather than finished product inspection

Food industry - Food safety hazards identified at all stages of food production and preparation processes  key action taken at Critical Control Points (CCP s)

principles of hazard analysis and critical control point haccp
Principles of Hazard Analysis and Critical Control Point ( HACCP )

Analyse hazards  Identify critical control points  Establish preventive measures with critical limits for each CCP  Establish procedures to monitor CCPS  Establish corrective actions when monitoring shows that critical limit has not met  Establish procedures to verify that system is working properly  Establish effective record keeping for documentation

safety regulations
Safety Regulations
  • Prevention of Food Adulteration Act , 1954-
  • To Ensure pure and wholesome food and to protect from fradulent practices
  • Amendments -1964,1976,1986
  • Case of proven adulteration –Minimum imprisonment of 6 months and minimum fine of Rs 1000 envisaged
  • Grievous Hurt-(320 IPC)- Death or such harm can be punished upto Life imprisonment and fine not <Rs 5000
  • Food Standards- Codex Alimentarius , Agmark standards,
  • Bureau of Indian Standards
  • National Nutrition Policy -1993- Food Security
five keys to safer food
Five keys to Safer food

1. Keep Clean –

Wash hands before handling food and often during


Wash hands after going to toilet

Wash n sanitise all surfaces n equipment for food preparation-protect kitchen from insects , pets

2. Separate raw and cookedfood-

Separate raw meat , poultry n seafood from other foods

Use separate utensils for handling raw foods

Store food in containers to avoid contact between raw and cooked foods

five keys to safer food24
Five Keys to Safer Food

3. Cook Thoroughly –

esp. Meat , poultry , eggs and Seafood

Bring soups n stews to boiling (ensure>70degree temp)

Reheat cooked food thoroughly

4. Keep food at safe temperature -

Dont leave cooked food at room temp.>2 hours

Prompt refrigeration of cooked n perishable food

Keep cooked food piping hot(>60 de.) prior to serving

Don’t store food too long even in refrigerator

Don’t thaw frozen food at room temperature

five keys to safer food25
Five keys to safer food

5. Use safe water and raw materials-

Use safe water or treat to make it safe

Select fresh and wholesome fruits

Choose foods processed for safety - pasteurised milk

Wash fruits n vegetables if eaten raw

Don’t use food beyond expiry date


1. CD Alert – December 2009, vol.13:No.4 – Food Borne

Diseases, page no. 1-12

2.Parks Textbook of PSM , Twentieth Edition, Intestinal

infections –Food Poisoning , page no. 210-212