Towards the enhancement of foodborne disease surveillance: A consultation paper

Foodborne disease is a source of increasing morbidity and fatality in the island of Ireland. It also has an economic impact. As a result of the continuing concern about food safety and its implications on an all-island basis, the North/South Ministerial Council established the Food Safety Promotion Board (FSPB) on December 2nd 1999. At its Board meeting in February 2000, the FSPB considered the issue of microbiological surveillance and, in noting the complexity of the issues, recommended that the key players in foodborne disease surveillance in Northern Ireland and the Republic of Ireland consider ways for the improvement of microbiological surveillance on an all-island basis. To assist in the development of a surveillance strategy for the FSPB, a Functional Meeting Group on Disease Surveillance was convened. The group compiled this consultation paper. A series of recommendations are made in the consultation paper and the key recommendations are summarised below.

Foodborne infections & gastrointestinal disease on the island Of Ireland in 2002

A safefood consultation paper, ‘Towards the Enhancement of Foodborne Disease Surveillance’ indicated that the guiding principles for the development of surveillance in Northern Ireland and the Republic of Ireland should be the integration of data collection systems and analysis of combined data. The current surveillance systems have developed independently from each other and clinical, food and animal surveillance systems remain un-integrated in both jurisdictions. A more complete and efficient food safety system could be achieved through co-ordination and linkages across the disease surveillance systems and jurisdictions. For that reason, stronger links are being developed between safefood, surveillance agencies, government departments and public health professionals. This report is an examination and review of the clinical surveillance data collected in both jurisdictions. The work was undertaken as part of safefood’s support for the European Programme for Intervention Epidemiology Training (EPIET), which trains EU medical practitioners, public health nurses, microbiologists or veterinarians in all aspects of foodborne disease surveillance.

Foodborne norovirus outbreak: the role of an asymptomatic food handler

Background: In July 2005 an outbreak of acute gastroenteritis occurred on a residential summer camp in the province of Barcelona (northeast of Spain). Forty-four people were affected among residents and employees. All of them had in common a meal at lunch time on 13 July (paella, round of beef and fruit). The aim of this study was to investigate a foodborne norovirus outbreak that occurred in the residential summer camp and in which the implication of a food handler was demonstrated by laboratory tests. Methods: A retrospective cohort study was designed. Personal or telephone interview was carried out to collect demographic, clinical and microbiological data of the exposed people, as well as food consumption in the suspected lunch. Food handlers of the mentioned summer camp were interviewed. Ten stool samples were requested from symptomatic exposed residents and the three food handlers that prepared the suspected food. Stools were tested for bacteries and noroviruses. Norovirus was detected using RT-PCR and sequence analysis. Attack rate, relative risks (RR) and its 95% confidence intervals (CI) were calculated to assess the association between food consumption and disease. Results: The global attack rate of the outbreak was 55%. The main symptoms were abdominal pain (90%), nausea (85%), vomiting (70%) and diarrhoea (42.5%). The disease remitted in 24-48 hours. Norovirus was detected in seven faecal samples, one of them was from an asymptomatic food handler who had not eaten the suspected food (round of beef), but cooked and served the lunch. Analysis of the two suspected foods isolated no pathogenic bacteria and detected no viruses. Molecular analysis showed that the viral strain was the same in ill patients and in the asymptomatic food handler (genotype GII.2 Melksham-like). Conclusions: In outbreaks of foodborne disease, the search for viruses in affected patients and all food handlers, even in those that are asymptomatic, is essential. Health education of food handlers with respect to hand washing should be promoted.

Foodborne illness, food inspection policy and restaurants in the U.S.

Objectives. The purpose of this paper is to conduct a literature review of research relating to foodborne illness, food inspection policy, and restaurants in the United States. Aim 1: To convey the public health importance of studying restaurant food inspection policies and suggest that more research is needed in this field, Aim 2: To conduct a systematic literature review of recent literature pertaining to this subject such that future researchers can understand the: (1) Public perception and expectations of restaurant food inspection policies; (2) Arguments in favor of a grade card policy; and, conversely; (3) Reasons why inspection policies may not work. ^ Data/methods. This paper utilizes a systematic review format to review articles relating to food inspections and restaurants in the U.S. Eight articles were reviewed. ^ Results. The resulting data from the literature provides no conclusive answer as to how, when, and in what method inspection policies should be carried out. The authors do, however, put forward varying solutions as to how to fix the problem of foodborne illness outbreaks in restaurants. These solutions include the implementation of grade cards in restaurants and, conversely, a complete overhaul of the inspection policy system.^ Discussion. The literature on foodborne disease, food inspection policy, and restaurants in the U.S. is limited and varied. But, from the research that is available, we can see that two schools of thought exist. The first of these calls for the implementation of a grade card system, while the second proposes a reassessment and possible overhaul of the food inspection policy system. It is still unclear which of these methods would best slow the increase in foodborne disease transmission in the U.S.^ Conclusion. In order to arrive at solutions to the problem of foodborne disease transmission as it relates to restaurants in this country, we may need to look at literature from other countries and, subsequently, begin incremental changes in the way inspection policies are developed and enforced.^

Disparities in foodborne illness in Harris County, Texas, 2005--2010

Using a retrospective cross-sectional approach, this study quantitatively analyzed foodborne illness data, restaurant inspection data, and census-derived socioeconomic and demographic data within Harris County, Texas between 2005 and 2010. The main research question investigated involved determining the extent to which contextual and regulatory conditions distinguish outbreak and non-outbreak establishments within Harris County. Two groups of Harris County establishments were analyzed: outbreak and non-outbreak restaurants. STATA 11 was employed to determine the average profiles of each category across both the regulatory and socioeconomic (contextual) variables. Cross tabulations of all of the non-quantitative variables were also performed, and finally, a discriminant analysis was conducted to assess how well the variables were able to allocate the restaurants into their respective categories. Contextual and regulatory conditions were found to be minimally associated with the occurrence of foodborne outbreaks within Harris County. Across both the categories (outbreak and non-outbreak establishments), variables included were extremely similar in means, and when possible to observe, distributions. The variables analyzed in this study, both regulatory and contextual, were not found to significantly allocate the establishments into their correct outbreak or non-outbreak categories. The implications of these findings are that regulatory processes and guidelines in place in Harris County do not effectively to distinguish outbreak from non-outbreak restaurants. Additionally, no socioeconomic or racial/ethnic patterns are apparent in the incidence of foodborne disease in the county. ^

Listeria monocytogenes in two different poultry facilities: Manual and automatic evisceration

Listeriosis is a serious foodborne disease caused by Listeria monocytogenes, a pathogen often found in food processing plants. Poultry meat and its derivatives may harbor L. monocytogenes even if good manufacturing practices are implanted in abattoirs. Little information exists in Brazil on the frequency of L. monocytogenes contamination, even though the country is considered the top poultry meat exporter in the world. This study attempted to compare 2 exporters poultry facilities following same the standards but differing only in manual (plant M) or automatic (plant A) evisceration. Eight hundred fifty-one samples from food, food contact and non-food contact surfaces, water, and workers` hands were collected from cage to finished products over a 1-yr period. In plant A, 20.1% of the samples were positive for L. monocytogenes, whereas in plant M, 16.4% was found. The greatest incidence of contamination with the pathogen in plant A was found in non- food contact surfaces (27.3%), while in plant M, it was found in products (19.4%). The most prevalent serovars were 1/2a or 3a (plant M) and 4b, 4d, or 4e (plant A). Despite having proper hygiene and good manufacturing practices, controlling the entry and persistence of L. monocytogenes in processing facilities remains a formidable task.

Segurança alimentar nos refeitórios de uma universidade portuguesa : aplicação da teoria do comportamento planeado

A Organização Mundial de Saúde estima que nos países mais industrializados uma em cada três pessoas sofra, por ano, de uma doença de origem alimentar. De acordo com os dados da Agência Europeia para a Segurança Alimentar foram relatados pelos 27 Estados Membros da União Europeia, no ano 2012, um total de 5.363 surtos de origem alimentar, assistindo-se a uma prevalência do setor da restauração, como o local de maior ocorrência dos surtos de doenças de origem alimentar. Para o mesmo ano, Portugal reportou 7 surtos de origem alimentar, envolvendo 135 pessoas com 42 hospitalizações. Neste contexto, a aplicação de boas práticas de higiene, nomeadamente no setor da restauração, é essencial para proteger o consumidor das doenças de origem alimentar. Neste estudo, pretendeu-se identificar os constructos do modelo da Teoria do Comportamento Planeado (Theory of Planned Behaviour – TPB, segundo a terminologia anglo-saxónica), de Icek Ajzen, que melhor explicam a intenção dos operadores de alimentos em adotarem os comportamentos de higiene, a saber: i) utilização de luvas e touca de proteção de cabelos, e ii) remoção de adornos pessoais, durante a manipulação de alimentos. Para o efeito, foi aplicado um questionário tendo por base a Teoria do Comportamento Planeado, a uma amostra de cento e vinte e três operadores dos vários refeitórios de uma universidade portuguesa, na sua grande maioria do sexo feminino (91,1%) e que manipulam alimentos numa base diária, recorrendo-se primeiramente a uma fase preliminar de estudo qualitativo, ou pré-inquérito, para melhor selecionar os temas essenciais e as principais categorias a considerar na construção deste inquérito. Os inquéritos foram tratados estatisticamente recorrendo-se à estatística descritiva, à análise fatorial e avaliação da consistência interna dos fatores resultantes, seguido da aplicação de regressão linear e metodologia de análise de trajetórias (path modeling) com vista à validação do TPB. Os resultados obtidos apontam para o fato de a Atitude ser o melhor preditor da Intenção em adotar os comportamentos em estudo. Verificou-se também que a motivação de cumprir resulta da pressão exercida pelos superiores hierárquicos ou colegas, influenciando positivamente a intenção, na medida em que as crenças normativas assumiram-se como sendo o segundo preditor que melhor previu a intenção.

Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.

Surto de listeria monocytogenes na Região de Lisboa e Vale do Tejo : 2009-2011

RESUMO - O género Listeria contém oito espécies (L. monocytogenes, L. ivanovii, L. innocua, L. seeligeri, L. welshimeri, L. grayi, L. marthii, e a L. rocoutiae), das quais duas são patogénicas. L. monocytogenes é patogénica para humanos e animais; L. ivanovii primeiramente infecta animais e raramente causa doenças em humanos. A Listeria monocytogenes é uma bactéria patogénica Gram-positiva facultativa intracelular, ubíqua na natureza. Nos últimos anos o número de casos de listeriose tem vindo a aumentar. Pode causar uma doença rara e grave chamada listeriose, especialmente nas mulheres grávidas, nos idosos ou em indivíduos com o sistema imunitário debilitado, de maneira esporádica ou em forma surtos. Realizou-se um estudo observacional, descritivo com o objectivo de se fazer a descrição e a caracterização do surto de listeriose ocorrido na região de Lisboa e Vale do Tejo entre 2009-2011. O período de maior número de casos diagnosticados de listeriose ocorreu entre o mês de Abril e Agosto de 2010. Mas a janela temporal em que ocorreu o surto estendeu-se de Março de 2009 a Janeiro de 2012. Ocorreram 51 casos de internamento com diagnóstico de listeriose, dos quais 25 casos foram confirmados, pela técnica de PFGE, pertencer à mesma estirpe I, sorotipo 4b e pulsotipo 070 e 0101. Na maioria dos casos eram do sexo feminino, com uma média de 57,14 anos de idade e com residência na região de Lisboa e Vale do Tejo. Em 96,08% dos doentes internados com listeriose apresentavam factores de predisposição, comorbilidade e /ou imunossupressão. A bacteriemia foi a manifestação clínica mais frequente, seguida da meningite. A letalidade da listeriose foi de 15,69%.

Species and Strain-specific Typing of Cryptosporidium Parasites in Clinical and Environmental Samples

Cryptosporidiosis has recently attracted attention as an emerging waterborne and foodborne disease as well as an opportunistic infection in HIV infected individuals. The lack of genetic information, however, has resulted in confusion in the taxonomy of Cryptosporidium parasites and in the development of molecular tools for the identification and typing of oocysts in environmental samples. Phylogenetic analysis of the small subunit ribosomal RNA (SSU rRNA) gene has shown that the genus Cryptosporidium is comprised of several distinct species. Our data show the presence of at least four species: C. parvum, C. muris, C. baileyi and C. serpentis (C. meleagridis, C. nasorum and C. felis were not studied). Within each species, there is some sequence variation. Thus, various genotypes (genotype 1, genotype 2, guinea pig genotype, monkey genotype and koala genotype, etc.) of C. parvum differ from each other in six regions of the SSU rRNA gene. Information on polymorphism in Cryptosporidium parasites has been used in the development of species and strain-specific diagnostic tools. Use of these tools in the characterization of oocysts various samples indicates that C. parvum genotype 1 is the strain responsible for most human Cryptosporidium infections. In contrast, genotype 2 is probably the major source for environmental contamination of environment, and has been found in most oysters examined from Chesapeake Bay that serve as biologic monitors of surface water. Parasites of Cryptosporidium species other than C. parvum have not been detected in HIV+ individuals, indicating that the disease in humans is caused only by C. parvum.

Detection of virulence-associated genes in Salmonella Enteritidis isolates from chicken in South of Brazil

Salmonella spp. are considered the main agents of foodborne disease and Salmonella Enteritidis is one of the most frequently isolated serovars worldwide. The virulence of Salmonella spp. and their interaction with the host are complex processes involving virulence factors to overcome host defenses. The purpose of this study was to detect virulence genes in S. Enteritidis isolates from poultry in the South of Brazil. PCR-based assays were developed in order to detect nine genes (lpfA, agfA, sefA, invA, hilA, avrA, sopE, sivH and spvC) associated with the virulence in eighty-four isolates of S. Enteritidis isolated from poultry. The invA, hilA, sivH, sefA and avrA genes were present in 100% of the isolates; lpfA and sopE were present in 99%; agfA was present in 96%; and the spvC gene was present in 92%. It was possible to characterize the isolates with four different genetic profiles (P1, P2, P3 and P4), as it follows: P1, positive for all genes; P2, negative only for spvC; P3, negative for agfA; and P4, negative for lpfA, spvC and sopE. The most prevalent profile was P1, which was present in 88% of the isolates. Although all isolates belong to the same serovar, it was possible to observe variations in the presence of these virulence-associated genes between different isolates. The characterization of the mechanisms of virulence circulating in the population of Salmonella Enteritidis is important for a better understanding of its biology and pathogenicity. The frequency of these genes and the establishment of genetic profiles can be used to determine patterns of virulence. These patterns, associated with in vivo studies, may help develop tools to predict the ability of virulence of different strains.

Elimination of Salmonella enterica serovar Typhimurium in artificially contaminated eggs through correct cooking and frying procedures

Salmonellosis is a serious foodborne disease associated with the presence of bacteria in eggs or foods containing raw eggs. However, the use of appropriate procedures of cooking and frying can eliminate this contamination. There are few studies on the elimination of contamination of Salmonella in hens' eggs through typical frying procedures, especially for Salmonella enterica serovar Typhimurium (or S. typhimurium). The aim of this study was to determine the appropriate conditions for cooking and frying hens' eggs artificially contaminated with S. typhimurium, making them free of bacterial contamination. Hens' eggs were artificially contaminated with S. typhimurium and subjected to various processes of cooking, frying and food preparation. It was observed that the minimum time necessary to eliminate contamination through cooking procedures is 5 minutes after the water starts boiling, and also that, cooking in the microwave oven complete eliminates the bacterial contamination. When the eggs were fried on both sides, keeping the yolk hard, a complete bacterial elimination was observed. Mayonnaise prepared with vinegar presented a decrease in bacterial colonies when compared mayonese prepared with lemon.

Molecular characterization and evaluation of antimicrobial susceptibility of enteropathogenic E. coli (EPEC) isolated from minas soft cheese

Foodborne disease caused by microorganisms is a problem of public health. Minas soft cheese is a national product manufactured using simple technology; it has high level of acceptance in the country making its production an important economic activity. Many microorganisms may be present in foods including the bacterium Escherichia coli (E. coli). Overall, E. coli is a harmless commensal bacterium; however, some strains may have a pathogenic potential. Several outbreaks of foodborne diseases associated with consumption of contaminated cheese have been reported, and the presence of pathogenic strains of E. coli has increased. The objective of this study was to isolate, evaluate the antimicrobial susceptibility, and characterize, by Multiplex PCR, the pathogenic E. coli strains isolated from Minas cheese commercialized in Rio de Janeiro. Thirty samples were analyzed and five strains of E. coli (EPEC) were identified. The assessment of antimicrobial susceptibility revealed 40% of the isolates resistant to ampicillin and 40% with intermediate resistance to ampicillin-sulbactam combination. These findings are a warning signal to health authorities since Minas cheese is a ready to eat food product, and therefore should not pose health risks to the population.

Survival of Shiga toxin-producing Escherichia coli O157:H7 in Minas frescal cheese

Shiga toxin-producing Escherichia coli (STEC) O157:H7 strains (isolated by cattle’s faeces and a reference strain, EDL933), were inoculated into pasteurized milk (102 and 103 cells.mL–1) to prepare the Minas frescal cheese. As control was used uninfected milk. Physicochemical and microbiological analyses were performed to milk and elaborated cheese. The O157:H7 strains were quantified in the stages of cheese processing and during 0, 2, 4, 5, 7, 10 and 15 storage days at 8 °C onto Sorbitol MacConkey Agar supplemented with potassium tellurite and cefixime (CT-SMAC). O157:H7 was not present in the pasteurised milk prior to the artificial inoculation. At the end of the processing the cheese had 10 to 100 times more STEC O157:H7 than the initial inoculum. During the storage, the Minas frescal cheese exhibited the largest population increase on the 4th and 5th day when inoculated with 102 and 103 cells.mL–1, respectively. Additionally, viable cells were found up to the 10th and 15th day, according to the amount of initial inoculum. This number of cells is able to cause infection in humans, and therefore, Minas frescal cheese, even when stored under refrigeration, is a potential vehicle of disease caused by STEC O157:H7.

Ocorrência de Staphylococcus aureus em queijo tipo frescal

OBJETIVO: Verificar a ocorrência de Staphylococcus aureus em uma amostra de queijo tipo Minas frescal comercializado na cidade de Poços de Caldas, MG, de modo a obter subsídios que permitam avaliar o risco potencial que este produto pode representar para a saúde da população consumidora. MÉTODOS: Foi investigada a presença e o número de cepas de Staphylococcus aureus em 80 amostras de queijo tipo Minas frescal produzido artesanalmente e comercializado na cidade de Poços de Caldas, MG, Brasil. RESULTADOS: Os resultados obtidos evidenciaram a presença de S. aureus em 40 (50,0%) amostras, cujas contagens revelaram valores médios em torno de 10(5)/g. CONCLUSÕES: Tais achados parecem ser extremamente preocupantes, pois além de se situarem acima do limite máximo de 10³/g estabelecido pelo Ministério da Saúde, estes valores mostraram-se muito próximos dos requeridos para a produção de enterotoxinas em quantidades suficientes para a ocorrência de surtos de intoxicação alimentar estafilocócica.