vector borne diseases

What is malaria?

Malaria is a protozoal disease caused by Plasmodium and transmitted by the female anopheles mosquito. Malaria is a common public health problem in India. Among the many species of Plasmodium, Plasmodium vivax and Falciparum, and others are common main causes of Malaria in India. According to the National Vector Borne Diseases Control Programme (NVBDCP), in 2015, 11.2 lakh cases of Malaria were reported with 7.6 lakh Falciparum cases and 287 deaths

what is filaria disease?

Lymphatic Filariasis, commonly known as Filaria is caused by 3 nematode parasites– Wucheria bancrofti, Brugia malayi, and Brugia Timor. Only Wucheria bancrofti and Brugia malayi are found in India. Predominantly, Wucheria bancrofti spread by Culex mosquito causes– 99.4 % of the Filariasis in India. Brugia malayi infection has been reported earlier from some rural areas in seven States viz., Kerala, Odisha, Tamil Nadu, Andhra Pradesh, Madhya Pradesh, Assam, and West Bengal, but now it is restricted to rural areas of Kerala. Brugia Malayi is spread through the Mansonia mosquito. Filariasis affects 120 million people worldwide, with India, Indonesia, Nigeria, and Bangladesh alone contributing to about 70% of the infection worldwide. Indigenous lymphatic filariasis cases are reported from 20 States/UTs namely Andhra Pradesh, Assam, Bihar, Chhattisgarh, Goa, Gujarat, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha, Tamil Nadu, Uttar Pradesh, West Bengal, Puducherry, Andaman & Nicobar Islands, Daman & Diu, Lakshadweep and Dadra & Nagar Haveli. From these States/UTs, a total of 250 districts have been identified to be endemic to filariasis with a population of about 600 million at risk.

what is Kala-Azar?

Kala-azar or Indian Leishmaniasis is caused by the parasite – Leishmania donovani and transmitted by Sandfly (Phlebotomus argentipes). In 2015, 8500 cases were reported with 5 deaths in India.

what is Japanese Encephalitis?

Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia, with up to 70,000 cases reported annually, caused by the Japanese Encephalitis virus. The disease is transmitted by the culex mosquito. Japanese Encephalitis is widespread in India, its annual incidence ranges between 1714–6594, with 367– 1665 deaths.

what is dengue?

Dengue is a mosquito-borne viral infection transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus. This is the same mosquito that transmits chikungunya, yellow fever, and Zika infection.There are 4 distinct, but closely related, serotypes of the virus that cause

what is chikungunya?

Chikungunya disease is a viral disease transmitted in humans by the bite of infected mosquitoes. Two types of Aedes species are implicated in causing this disease, Ae. aegypti and Ae. albopictus. Ae. aegypti mosquito (which you must be familiar with from the yellow fever section) is the primary transmission agent of the Chikungunya Virus in the Indian subcontinent. In 2015, a total of 27,553 cases of Chikungunya were reported in our country.

Vitamins

What is a vitamin?

• these are required by the body in much smaller amounts. They do not yield energy like fats But they are vital for the survival of man as catalysts in various body processes.

Classification of Vitamins:-

Fat soluble vitamins : Vitamins A, D, E, and K are fat saluble vitamins.

1. Vitamin A or retinol
2. Vitamin D (Caliciferol-D2, cholecalciferol D3)
3. Vitamin E (Tocopherol)
4. Vitamin K

Water-soluble vitamins :

1. Thiamine ( vitamin B1)
2. Riboflavin (vitamin B2)
3. Nicotinic acid
4. Pyridoxine ( vitamin B6)
5. Pantothenic acid
6. Folic acid
7. Vitamin B12
8. Ascorbic acid (vitamin C)

<<<Important Question>>>

Nutrition Quiz Questions and Answers 

What is Vitamin A (Retinol)

• Vitamin A is a fat-soluble vitamin. Its chemical name is “retinol”. In India 8% of children aged 6 months–6 years have vitamin A deficiency. It is a major cause of preventable

The function of Vitamin A:

• Normal vision and health of the
• The health of the skin and mucous

Sources of Vitamin A: Animal Sources: Butter, ghee, egg, milk, liver, and fish are good sources.

The daily requirement of Vitamin A: (1 I.U. of vitamin A =0.3 u g retinol)

Effects of deficiency: Night blindness, Bitot’s spots, Xerophthalmia, Keratomalacia.

What is Vitamin D

• It occurs in mainly 2
• Vitamin D2 or ergocalciferol (does not occur in nature)
• Vitamin D3 or cholecalciferol (occurs widely in animal fats and fish oils)

Functions of Vitamin D:-

1. formation of the healthy bones and It has a direct action on the mineralization of the bones.
2. It promotes the intestinal absorption and utilization of calcium and

Sources: Sunlight, Food, Daily requirement

2. Adults: They need 5 micrograms (100 i.u.) per day.
3. Pregnancy, lactation, and growing children: This may be up to 10 micrograms (400 u.) per day.

What is Vitamin E?

• It is available in small quantities in meats, fruits, and vegetables.
• The richest sources are vegetable oils (e.g., oils of sunflower seeds). Humans on a balanced diet do not easily suffer from its

The function of Vitamin K( Thiamine)

• It is also synthesized to some extent by intestinal
• It is necessary for proper clotting It is used, therefore, for the prevention and treatment of bleeding.
• . Its daily requirement is about 03 mg/kg for the adult.

Function of Thiamine

• It is a water-soluble
• It plays an important part in carbohydrate metabolism. In thiamine deficiency, there is an accumulation of pyruvic and lactic acids in the tissues and body fluids. It is also essential for the proper functioning of the nervous

Sources of Thiamine: in small amounts in all-natural foods, cereals, pulses, and nuts groundnut.

Daily requirements of Thiamine: It is 0.5 mg per 100 kcals of energy intake.

Function of Riboflavin

The function of Riboflavin: It is involved in protein, fat, and carbohydrate metabolism.

Sources of Riboflavin: Good sources are milk and milk products, eggs, liver, and green leafy vegetables. Wheat, millets, and pulses are fair sources, but rice is a poor source.

The daily requirement of Riboflavin is- 0.6 mg per 1,000 calories.

Deficiency: cheilosis (red lips, with the fissured angle of the mouth), soreness of the tongue, redness and burning sensation in the eyes, dermatitis.

What is Niacin?

Function: It is required by the body for the utilization of carbohydrate and tissue respiration.

Sources: grain cereals, pulses, nuts, meat, liver, and chicken. Requirement: The daily requirement is 6.6 mg. per 1,000 calories. Deficiency: It may lead to pellagra, characterized by soreness of the tongue, pigmented scaly skin, dementia, and diarrhea.

Pyridoxine (Vitamin B6)

It plays an important role in the metabolism of amino acids, fats, and carbohydrates.

Source- Food rich in pyridoxine are liver, meat, fish, whole cereals, and legumes.

Deficiency – skin lesions, cheilosis, glossitis, and convulsions in children.

Requirement – require 2.0 mg per day

Pantothenic acid

• It is widely distributed in animal and vegetable
• No deficiency symptoms have been reported in
• The human requirement for this vitamin has not been clearly

What is Folic acid?

It is essential for the synthesis of DNA (deoxyribonucleic acid).

Sources: The liver is one of the richest sources. It is also found in pulses, nuts, and whole grains.

Deficiency results in anemia which is common among poor people and also among pregnant women.

Requirement: For healthy adults, it is 100 micrograms and during pregnancy 400 micrograms; children need 100 micrograms.

What is Vitamin B12?

It is also necessary for the synthesis of DNA and also in carbohydrate, fat, and protein metabolism.

Source: Liver, eggs, fish, and milk contain vitamin B12.

Deficiency: It leads to pernicious anemia. It can also affect the nervous system, including the spinal cord.

Requirement: About 1 microgram for adults. For proper utilization of vitamin B12 intestinal secretion should be normal.

What is Vitamin C?

It is a water-soluble vitamin. It is the most unstable of all the vitamins. It gets rapidly destroyed by high temperature, oxidation, drying, or storage.

Functions: It is required to form collagen, the protein substance that binds the cells together, if this substance is not formed, healing of the wounds will be delayed. Bleeding phenomena appear on vitamin C deficiency. It helps in the absorption of iron. It helps in increasing the general resistance of the body to fight infection.

Sources: All fresh fruits contain vitamin C. Amla is one of the richest sources, Guavas are cheap but rich sources. Green leafy vegetables are rich in vitamin C. Roots and tubers (potatoes) contain very small amounts.

Deficiency: It results in a bleeding disease called scurvy seen in infants on artificial feeds.

What is Minerals –

These are divided into two major groups: •

Major minerals: Calcium, phosphorus, sodium, potassium, and magnesium.

Trace elements: These are required by the body in less than a few milligrams per day e.g. iron, iodine, fluorine, zinc, copper, and cobalt.

<<<Important Question>>>

Nutrition Quiz Questions and Answers 

Nutrition is required During Pregnancy and Lactation Mother: Vitamins, Proteins, Minerals, Calcium, Zink Requirement.

A pregnant woman’s body undergoes several Physical and Mental changes to prepare her for upcoming motherhood. Her requirements for all the nutrients increase. Malnutrition in mothers has been found to be associated with adverse pregnancy outcomes, e.g. anaemia in pregnant women may compromise maternal and foetal health. During lactation nutrition of the baby is solely dependent on the mother. So, diet during lactation helps the mother to maintain sound health and also ensures a good milk supply for the baby.

PHYSIOLOGICAL CHANGES IN THE BODY DURING PREGNANCY-

• Changes in Uterus and Breasts
• Weight Gain
• Changes in Body Fluids

INCREASED NUTRITIONAL REQUIREMENTS DURING PREGNANCY

1. Calories – Additional energy is required during pregnancy to support the metabolic demands of pregnancy and foetal The average pregnant woman needs only an additional 150 kcal/day during the first trimester of pregnancy and 350 kcal/day during the second and third trimesters of pregnancy.
2. Proteins- To support the synthesis of maternal and foetal tissues, additional protein is required (up to 20 gm per day). This demand increases throughout gestation. It is maximised during the third Protein deficiency during pregnancy has adverse consequences, including poor foetal growth.
3. Micronutrients – All vitamins and minerals are needed for optimal pregnancy outcomes. In some instances requirements may be met through diet; for others, a supplement is often The requirement for most of the vitamins and minerals increases with pregnancy.

The following micronutrients such as minerals and vitamins are given in detail below:

Minerals Required During Pregnancy

1. Iron: Its requirement increases from 21 mg/day to 35 mg/day during This is due to –
   • expansion of maternal tissues including red cell mass,
   • the iron content of the placenta,
   • blood loss during
   • Total iron requirement during pregnancy is estimated to be approximately 1,000 This is distributed in the foetus and placenta (300 mg) and expanded red cell mass (400 mg).
2. Calcium: Its requirement for an adult woman is 600 mg/day/woman for good Growth of the baby. During pregnancy, there is an increase in the demand for calcium by the growing So the requirement increases up to 1200 mg/day.
3. Zinc: Deficiency of zinc adversely affects the outcome of Severe deficiency in the mother can lead to spontaneous abortions and congenital malformations. The requirement increases from 10 mg/ day (pre-pregnant) to 12 mg/day during pregnancy. Dietary sources of zinc are meat and fish. Wheat, pulses and nuts also provide zinc.

Vitamins Required During Pregnancy

Vitamin A: High levels of some forms of vitamin A can harm the foetus’s development if taken in too high amounts during pregnancy. Mothers should avoid vitamin A supplements and animal sources of vitamin A (e.g. Liver) throughout pregnancy.

Vitamin D: Its active forms (calcidiol and calcitriol) can pass through the placenta with ease and help in the calcium metabolism of the foetus.

Vitamin B complex: Requirement for Thiamine, Riboflavin and Niacin increase during pregnancy i.e. +0.2 mg, +0.3 mg and +2.0 mg respectively. Pyridoxine (vitamin B6) needs are increased during pregnancy. (2.5mg of vitamin B6 during pregnancy; vitamin B12 = 1.2 mg / day). Dietary sources of vitamin B are milk and orange juice are good sources.

Folic acid: Adult women require 200 µg of folic acid per day necessary. In pregnancy, it is 500 µg/day. It is an essential element for blood formation and synthesis of essential components of DNA/RNA which increase rapidly during the growth of a baby. It may also lead to congenital

malformations (spina bifida and anencephaly), cleft lip and congenital heart defects. Supplementation of folic acid before conception and during the first twelve weeks of pregnancy is therefore recommended. Dietary sources of folic acid are Liver, soybean and dark green leafy vegetables.

Vitamin C: Its daily requirement for an adult woman is 40 mg/day. Additional 20 mg are needed during pregnancy. Dietary sources are Fresh fruits, lemon, amla, tomato, orange, and fresh green leafy vegetables.

DIET DURING PREGNANCY –

Additional* Allowances during Pregnancy and Lactation

Meal Planning for a Pregnant Woman-

the pregnant woman should eat a variety of foods. There is no need to modify the usual diet if the quantity and frequency of usage of the different foods should be increased to and maximum.

• She can derive maximum energy (about 60%) from cereals like rice, wheat and (9 portions-30 g each)
• Cooking oil is a concentrated source of both energy and polyunsaturated fatty (Fats/Oils-6 portions-5 gm each)
• Good quality protein is derived from milk, fish, meat, poultry and eggs. However, a proper combination of cereals, pulses and nuts also provides adequate (2 portions of pulses and 1 portion of non-veg-30 gm each)
• (vegetables- 5 portions and fruits- 2 portions- 100 gm each)
• Bioavailability of iron in pulses can be improved by fermentation and sprouting and eating foods rich in vitamin C such as citrus •
• Milk and milk products are the best sources of biologically available (5 portions-100 gm each)

Model Menu during Pregnancy-

1. Before getting off the bed: Tea 1 cup with 1–2 teaspoons of sugar + milk rusk/biscuit
2. Breakfast: Milk 200 ml (1 glass) Porridge (1 bowl)/ Idli (2 medium)/ Chapati Parantha (2 medium) Cheese 30 gm (1 cube)/ egg-1/ sprouts 25 gm (1 bowl)
3. Mid Morning: Buttermilk 1 glass or fruit – 1 medium
4. Lunch: Fresh salad, Chapati – 4 medium sizes (100 gm), preferably made with a mix of wheat with Bengal gram/soya Or Rice (100 gm)- 4 servings Pulses (25 gm)- 1 Katori or meat or fish or chicken (90 gm), Curd 125 gm (1 bowl), Green vegetables 250 gm (2 bowls), Cooking oil 10 gm (2 teaspoons) Fruit: 1–2 servings any time during the day
5. Evening Snacks: Freshly prepared snacks, such as sandwiches, pav bhaji, noodles, dhokla, khandvi, dal Wada, medu Wada, Dahi Wada, and appams. Milk 200 ml (1 glass) Cheese sandwich (1 small) or Poha (1 bowl) or Upma (1 bowl) or Vada (1 large)
6. Dinner: Same as Lunch, Bed Time: Milk 200 ml (1 glass)

Iron Folic Acid Supplementation-

• Prophylactic dose: All pregnant women need to be given one tablet of IFA (100 mg elemental iron and 5 mg folic acid) every day for at least 100 days, starting after the first trimester, at 14–16 weeks of gestation to prevent the occurrence of anaemia (prophylactic dose).
• Therapeutic dose: If a woman is anaemic (haemoglobin less than 11 g/dl) or has pallor, give her two IFA tablets per day (one morning and one evening) for three months. This means that a pregnant woman with anaemia needs to take at least 200 tablets of IFA for correction of anaemia (therapeutic dose).

CONCEPT OF NUTRITION-

Nutrition is the science of food and its relationship to health. The following three processes are involved in the utilization of food in our bodies.

Ingestion: It implies intake of food (by mouth)
Digestion: After ingestion food is digested to make it absorbable. It is achieved by enzymes present in our mouth (saliva), stomach, and intestines.
Absorption: Digested food gets absorbed and passes from our intestines into the blood circulation and lymphatic system for distribution all over the body.

Food has major physiological functions as follows:

• Provides energy for body functions. •
• Nutrients build and maintain body tissues. •
• Safeguarding body against diseases. •
• Regulating body functions.

The psychological function of food includes the following:

• Satisfying hunger and taste buds. •
• Provides comfort in a depressive mood. •
• Used as a reward or punishment e.g. good or bad food.

TYPES OF NUTRIENTS-

There are a variety of nutrients that are supplied through the foods. Nutrients play a critical role in health and disease. Each nutrient performs a specific function in the body. The absence of a particular nutrient can cause a specific deficiency disorder.

Functions of nutrients:

• Energy production for physical
• Growth, development and •
• Resistance to infection and protection from •
• Control of temperature, blood pressure, metabolism, and waste

Macronutrients –

These are organic nutrients required in large quantities. These are proteins, fats, and carbohydrates.

1. Proteins- These are of the greatest importance in humans Proteins are composed of carbon, hydrogen, oxygen, nitrogen and sulfur, phosphorus, iron, and other elements in varying amounts. These are built of amino acids. The human body requires 22 amino acids. Of

these 8 are called “essential” because the body cannot synthesize them in sufficient quantity. The essential amino acids are as follows: 1) Isoleucine 2) Leucine 3) Lysine 4) Sulphur-containing amino acids (methionine + cysteine) 5) Phenylalanine Tyrosine 6) Threonine 7) Tryptophan, and 8) Valine.

Functions of Proteins:

• For growth and development: since they provide the building material e. the amino acids
• For repair of body tissues and their maintenance
• For the synthesis of antibodies, enzymes and The body requires protein to produce anti-bodies.

Sources of proteins:

• Animal Source: found in milk, meat, eggs, cheese, and fish.
• Plant Source: found in pulses (legumes) cereals, beans, nuts, oil-seed cakes, etc
• Protein Requirements: Usually 1.0 gm protein/ kg body weight is needed for an Indian adult.

Fats

Fats are composed of carbon, hydrogen, and oxygen. They are composed of fatty acids. Fats are again classified into saturated and unsaturated fats. In general, animal fats are “saturated” fats; vegetable oils and fats are “unsaturated” fats.

Functions of Fats:

• It is the source of One gram of fat and supplies 9 calories of energy.
• Fats are carriers of fat-soluble vitamins, g. vitamins A, D, E, and K.
• Fats provide cushioning for many organs in the body (heart, kidney, intestine )

Sources of Fats:

• Animal sources: These are ghee, butter, fat from meat, fish oil, etc.
• Vegetable sources: these are various vegetable oils such as groundnut, ginger, mustard, cottonseed, safflower (kardi), and coconut

Fat requirements:

• In developed countries, dietary fats provide 30–40 % of total energy Ideally only 20–30 % of total dietary energy should be provided by fats.

Carbohydrates:

These are the main source of energy, providing 4 kcals per gram. Carbohydrate is also essential for the oxidation of fats and for the synthesis of certain non-essential amino acids. There are 3 main sources of carbohydrates, viz., starches, sugar, and cellulose.

Micronutrients –

• Micronutrients are needed only in minuscule amounts, these substances enable the body to produce enzymes, hormones, and other substances essential for proper growth and
• There are two types of Micronutrients, these are Vitamins and

MEAL PLANNING –

• A suitable diet for the individuals and families shall be as per the local food items available, individual dietary habits, and as per the economic status of families. The diet should also satisfy hunger and
• It provides 50–60% energy from carbohydrates (preferably complex carbohydrates), 10– 15% from protein, and 20–30% from oils and

Aims of Meal Planning

• Fulfill the nutrition needs of an individual or members of a
• Invest in nutrient-dense food items rather than energy-dense
• Help in the purchase, preparation, and service of appropriate food
• Provide variety in the diet through proper selection of

Diet Plan for Different Age Groups

Diet Plan for a Toddler: Children aged 1–4 years can eat the same foods as an adult, about half the amount. Healthy foods are good to include. But do not forget to remind the

parents to ensure that their children drink plenty of fluids throughout the day. Try also to make foods fun and easy to eat.

Diet Plan for Children aged 5–12 yrs: They are still developing both physically and mentally. They also need good nutrition. Calcium-rich foods, sources of essential fats; high protein foods, and slow-released carbohydrate sources need particular attention. They should be encouraged to eat the same meal as the whole family. Sitting down together is also important to help behavioral development and for the re-enforcement of family values.

Diet Plan for Adolescents: Adolescence ranges from 10–19 years of age. If they are into sports or heavy physical activities, they need to eat more. Good calcium and iron intake are important in girls. They should avoid junk foods.

Diet Plan for an Elderly Person: One particular concern in the elderly is obtaining sufficient fluid intake. Some old people also have difficulty in passing stools; therefore a good fiber intake is encouraged.

NUTRITIONAL ASSESSMENT –

The nutritional status of an individual is the result of many interrelated factors. It is influenced by the adequacy of food intake both in terms of quality and quantity and also by the physical health of the individual.

Objectives of Nutritional Assessment –

• To obtain information on the extent of nutritional problems of a
• To identify the population group ‘at risk’ or in greatest need of
• To develop a nutrition program that meets the needs defined by the
• To evaluate the failure or success of nutrition
• To assess the degree of malnutrition in preschool and school going

Methods of Assessment – This involves various techniques and methods.

1. Clinical Examination: It is also the most practical method of ascertaining the nutritional status of a group of individuals. There are a number of physical signs, some specific and many When two or more clinical signs/characteristics of a deficiency disease are present simultaneously, their diagnostic significance is greatly enhanced.

Signs used in the nutritional survey:

• Not related to nutrition, g. alopecia, pyorrhoea, pterygium.
• That needs further investigation (molar pigmentation, coined vascularisation, geographic tongue)
• Known to be of value, g. angular stomatitis, Bitot’s spot, calf tenderness, absence of knee or ankle jerks (beriberi), enlargement of the thyroid gland (endemic goiter), etc.

2. Laboratory and Biochemical Assessment:

Hemoglobin estimations: It is the most important laboratory test that is carried out in nutritional surveys. It is a useful index of the overall state of nutrition. Stools and urine be examined for intestinal parasites. History of parasitic infestation, chronic dysentery, and diarrhea provide useful information about the nutritional status. Urine should also be examined for albumin and sugar.

Biochemical test: These may be applied to measure individual nutrient concentration in body fluids (e.g. serum retinol, serum iron) or to detect abnormal amounts of metabolites in urine (iodine). Biochemical tests are time-consuming and expensive. They cannot be applied on a large scale, e.g. in the nutritional assessment for the whole community.

3. Assessment of Dietary Intake: Direct assessment of food consumption involves dietary surveys which may be household inquiries on individual food consumption surveys. A diet survey may be carried out by one of the following methods:
   • Weight of raw foods
   • Weighing of cooked foods

Nutrition Quiz Questions and Answers

Food Borne Diseases and Food Safety Introduction

• Food safety can be compromised at any stage from the farm (where food is grown) to the fork (when it is consumed)
• Food can easily become unsafe when we do not follow hygienic Cleaning principles during its transport, storage, cooking, and serving of food and food items

Objectives of Food Safety:-

• Recognize, assess and classify different food-borne diseases
• Investigate food poisoning cases/outbreaks
• Describe preventive and control measures for food-borne diseases
• Identify the signs and symptoms of food poisoning and refer for management
• Identify the measures to be taken at various levels to ensure food safety
• Make people aware of practicing the five keys to safer food
• Describe the food storage, food handling, and cooking

What is Food borne diseases

• The illnesses resulting from the ingestion of food contaminated with microorganisms (bacteria, viruses, parasites, etc) or harmful chemicals (toxins)
• The contamination may occur at any stage in the process from food production to consumption
• An estimated 600 million – almost 1 in 10 people in the world – fall ill after eating contaminated food and 420 000 die every year
• Children under 5 yrs age carry 40% of the FBD burden

Causes of Food Borne Diseases

• Bacteria – Salmonella, Campylobacter, Escherichia coli, Vibrio cholera, Listeria, Staphylococcus
• Virus – Norovirus, Rotavirus, Hepatitis A and E virus, and other viruses.
• Parasites – Entamoeba histolytica, Giardia lamblia, Cryptosporidium, Fish- borne
• Toxins – Mycotoxins (e.g. aflatoxins), Marine biotoxins, Mushroom toxins,
• Chemicals – Pesticides, Polychlorinated biphenyls (PCBs) Heavy metals (lead, cadmium, mercury, copper) Nitrites

Classification of Food Borne Diseases

• Food-borne infections – Caused by microorganisms
• Food-borne intoxications – Caused by toxins and chemicals

Differences between Food-borne Infections and Intoxication

Signs and Symptoms of Foodborne Disease:-

• Abdominal cramps
• Diarrhea (bloody)
• Nausea
• Vomiting, Fever, Headache, Fatigue, Body aches

Transmission of Food-Borne Pathogens and Toxins

1. Food production and processing –
   • Foods get contaminated if washed or irrigated with water that is contaminated with pathogens from animal or human feces
   • Animals naturally harbor many food-borne bacteria in their intestines that can cause illness in humans
   • During slaughter, meat and poultry carcasses can become contaminated if they are exposed to small amounts of intestinal contents

2. Food preparation and handling

• Infected individuals
  • Food-borne pathogens are shed in the feces of infected persons
  • These are transferred to others through food via the fecal-oral route
  • Bacteria present in infected lesions and our nose may also be transmitted from an infected food handler to ready-to-eat foods
• Cross-contamination-
  • Pathogens present in one food may be transferred to other foods during cooking if utensils are used without washing and disinfecting
• Inadequate cooking temperature

3. Food storage
   • Food held or stored at more than 250C to 600C) temperature allows multiplication of

Food poisoning and food intoxications –

Epidemiological Features / Clinical Characteristics –

• Food poisoning is an acute inflammatory disease of the gastrointestinal tract
• It is caused by the ingestion of food contaminated with toxin-producing bacteria, their pre-formed toxins, chemical substances, or other poisonous substances
• Food poisoning is very More than 10 million cases occur in India per year

Characteristics of Food Poisoning

• History of ingestion of common food (as in family functions, hostels/hotels)
• A group of persons being affected simultaneously
• The similarity of signs and symptoms in the majority of cases
• Common symptoms are vomiting, diarrhea, pain in the abdomen, fever, etc
• Short incubation period
• Absence of secondary cases
• Laboratory tests are rarely required Types of Food Poisoning

Bacterial food poisoning

• • Caused by taking contaminated food
  • It may be:
    • Infective: Organism enters the body through the food, produce toxin, cause pathology and result in clinical manifestations (Salmonella, Clostridium perfringes, Vibrio parahaemolyticus) ‒
    • Toxic: Due to already formed toxins in the food (Staphylococcus aureus, Clostridium botulinum, Bacillus cereus

Nonbacterial food poisoning

• Chemical poisoning: Due to pesticides, arsenic, mercury

Food Intoxications

• Intoxications are of two categories:
  • Due to naturally occurring toxins in the food grains:
  • Lathyrism, Epidemic dropsy, Endemic ascites, Toxic polyphenol
  • Due to toxins produced by the fungi in the food grains: ‒Aflatoxicosis, Ergotism

Public health response to food-borne diseases

1. Early detection, management, and referral
   • Identify the cases and assess for severity
   • Refer the severe cases urgently to the health center for proper management
   • Assure and help patients accordingly
   • Ensuring hydration is the mainstay of
   • Focus on assessment and reversal of dehydration, through ORS or IV fluids in serious cases

2. Reporting of any case /outbreak and investigation
   • Inform any case/ outbreak immediately to a higher level as per the existing program /project (e.g. IDSP) guidelines
   • Outbreaks of food poisoning need to be investigated by a team and take part in such investigations (as has been discussed elsewhere in other units)
   • Investigations will help to identify appropriate control and preventive measures

3. Health Education
   • Educating people about reservoir/source of contamination and transmission, common foods involved, signs/symptoms and danger signs, personal hygiene, and food hygiene
   • Most FBD are preventable by simple behavioral changes

Food Safety

• Food safety describes the handling, preparation, and storage of food in ways that prevent food-borne diseases
• The main idea is a concept of defense to prevent harm to the
• Unsafe food poses health threats; endangering
• It creates a vicious cycle of illness and

Food Safety Considerations and Measures

• Policy making/administrative level – Role is of government:
  • Developing policies and regulatory frameworks (Laws, Acts, etc)
  • Establishing and implementing effective food safety systems to respond to and manage food safety risks along the entire food chain
  • Fostering collaboration among health and other sectors
• Food handlers and consumers level:
  • Be aware of the common hazards linked with the food they use
  • Handle and prepare food safely
  • Practicing the WHO Five Keys to Safer Food at home, or when selling at restaurants or at local markets
  • Grow fruits and vegetables to decrease microbial contamination

Food Safety Regulatory Measures in India

• FSSAI (Food Safety and Standards Authority of India)is responsible for setting standards for food by:
• Framing of Regulations to lay down food safety standards
• Laying down guidelines for accreditation of laboratories for food testing
• Providing scientific advice and technical support
• Disseminating information and promoting awareness
• Food Safety Voice’ has been launched which helps consumers to register their complaints and feedback about food safety issues

Keep Clean

• Wash your hands before handling food and often during food preparation
• Wash your hands after going to the toilet
• Wash and sanitize all surfaces and equipment used for food preparation
• Protect kitchen areas and food from insects, pests, and other animals

Separate raw and cooked food

• Separate raw meat, poultry, and seafood from other foods
• Use separate utensils, knives, and cutting boards for handling raw foods
• Store food in containers to avoid contact between raw and prepared foods

Keep food at safe temperatures

• Do not leave cooked food at room temperature for more than 2 hours
• Refrigerate promptly all cooked and perishable food (preferably below 5°C)
• Keep cooked food piping hot (more than 60°C) prior to serving
• Do not store food too long even in the refrigerator
• Do not thaw frozen food at room temperature

Food storage, food handling, and cooking

• General Principles of Safe Storage of Food Items
  • Chemicals and cleaning supplies are stored away from food
  • Non-vegetarian and vegetarian products are kept physically separated
  • Raw materials are kept separately with proper labeling from semi-processed and processed (cooked) foods
  • All foods are stored off the floor and away from the walls (at least 6 inches)
  • The principles of FIFO (first in first out) and FEFO (first expiry first out) should be applied

Role of Food Handlers in Food Borne Diseases

• The term food handler includes all those involved in various stages/activities related to preparation, processing, cleaning, and chopping, making, boiling/ frying/sauté, washing of utensils, cooking and serving of food
• Similarly, if food handlers have eye /ear/skin infection, cough, or running nose the related germs will infect the consumers
• This spreads through their hands through eye/ ear/ skin discharges, urine, sputum
• A cook with diseases like jaundice or typhoid may continue to spread these for a long time