Food Borne Diseases and Food Safety

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