Foodborne Illness Focusing on Salmonellosis Alfredo Cardoso, MPH Student Walden University PUBH 6165-3 Instructor: Dr. Raymond Thron Spring Quarter, 2014 The information page with all the requirements from the template. The presentation should take 30-40 minutes.

Local Restaurant Owners & Food Handlers Warm welcome to my audience

We Will Answer… What is a foodborne illness? What is salmonellosis? How do we get it? How do we prevent it? How do we prepare food safely? How do we report an outbreak? What has been done about salmonellosis? Definition of the objectives of this presentation

Foodborne illnesses are diseases that are transferred to humans by ingesting or using contaminated water or food. Many different germs and chemicals are able to contaminate food and water. We will focus on salmonellosis for this presentation. Defining foodborne illness WHO (2014). Foodborne diseases. Retrieved from http://www.who.int/topics/foodborne_diseases/en/

Salmonellosis is the disease caused by non- typhoidal Salmonella enterica subspecies. Is a common bacterial infection which can be completely asymptomatic in some people while in others can become life threatening. Salmonellosis as the focus of this presentation Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Salmonellosis in Numbers During the year 2013, CDC identified 19,000 food-related infections, 4200 hospitalizations, and 80 deaths in the United States. Salmonellosis accounted for 35% of all the foodborne disease cases, around 6650 infections. National stats on salmonellosis CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Recent Outbreaks in the United States January, 2014: An outbreak of Salmonellosis involving several states was caused by raw cashew cheese. The outbreak affected people living in California, Nevada, and Wyoming. There were 17 reported cases, 3 hospitalizations and no deaths. The cheese was effectively recalled and taken from shelves. February, 2014: An outbreak of Salmonellosis was attributed to Tyson brand chicken. The cases were reported by a correctional institution in Tennessee. The total of cases was 9, and 2 of them needed hospitalization, no deaths were reported. The chicken was recalled. My objective in this slide is to demonstrate that salmonellosis is a threat today, every single day. Shortcuts must be avoided when handling food. Hygiene and proper handling are necessary to prepare safe meals. CDC (2014). Recent salmonella outbreaks. Retrieved from http://www.salmonella/Heidelberg-01-14/index.html

Symptoms of Salmonellosis Nausea Vomiting Abdominal cramps Fever Chills Headache Blood in stool Self explanatory list of the most common symptoms of salmonellosis. Click on the doctor to learn more about salmonellosis. Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Disease Progression Generally people develop symptoms within 8 to 72 hours after infection. Most healthy people recover within a week without specific treatment. The diarrhea and vomiting can cause dehydration that requires medical attention. The worst case scenario is when the bacteria spreads beyond the GI tract and reaches blood stream, bacteremia is life threatening and requires fast and aggressive treatment. Complications caused by the bacteria can become life threatening Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Salmonellosis Usual Targets Infants and young children Elderly persons Immune-compromised persons such as HIV/AIDS patients, organ transplant recipients, those with sickle cell disease, and malaria patients. All of the above mentioned tend to show worst symptoms and complications from salmonellosis Know who are the most susceptible people in the community to salmonellosis CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Salmonella Hosts People can be at risk for Salmonellosis when handling animals including: Dogs Pet chickens and ducks Reptiles Cats The Salmonella carriers are listed Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

How does Salmonella contaminates food? The bacteria lives in the intestines of humans, animals, and birds. The most common way to contaminate food is with poor hygiene, the food gets in contact with feces when food handlers do not wash their hands The number one reason of food contamination with Salmonella bacteria: poor hand washing Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Commonly Infected Foods: Raw poultry, meat, and seafood. Raw eggs. Fruits and vegetables. Cross-contamination occurs in the kitchen when contaminated raw food (meat, poultry, etc.) gets in contact with uncooked foods, such as salads. Avoid raw eggs, poultry and meat. Cook food thoroughly and avoid cross-contamination CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Making Food Safe Recommendations for Food Handlers Both professional and domestic food handlers must observe hygienic rules of food preparation. Professional food handlers must inform their supervisor right away if they are suffering from fever, diarrhea, vomiting and/or skin lesions that are visible and exposed. The five keys to safer food defined by the World Health Organization (WHO) are extremely important to prevent foodborne illnesses, and they are: Keep clean (surfaces and kitchen in general). Separate raw and cooked foods (avoids cross-contamination). Cook thoroughly (kills bacteria responsible for diseases). Keep food at safe temperatures (prevent food from spoiling). Use safe water and raw materials (we can only hope). Important tips for food handlers and the five keys to safer food. CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Prevention Wash hands thoroughly before and after food consumption and preparation. Do the same with children, make sure they wash their hands after playing with pets. Raw eggs, meat, and poultry must be treated as if they were contaminated and handled with care. When refrigerating food avoid dripping from one food to another. Use proper containers or place them on the bottom shelf of the refrigerator. Avoid eating raw or undercooked eggs. Avoid drinking and using unpasteurized milk or milk products. Always wash hands thoroughly with soap after visiting the restroom. Useful tips that work wonders preventing salmonellosis CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

More About Prevention Extra attention must be taken when preparing nourishments for babies, seniors and immune-depressed persons. Keep everything clean. Take extra caution when handling raw meat or poultry. Wash hands after changing diapers. Avoid direct or indirect contact between reptiles and people at risk. Children should avoid handling or playing with baby ducks, baby chicks, and their surroundings. Application of what we know about susceptible hosts, carriers, and salmonellosis prevention CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Getting Food Handlers Certified Many leading restaurant companies (McDonald’s, P.F. Chang, Denny’s, among others) are taking advantage of online certification classes for managers and food handlers. The classes cover safe practices when preparing and storing food, and they focus on foodborne disease prevention. The courses include tips on personal hygiene, avoiding cross-contamination, food allergy, cooking time and temperature, storing food safely, cleaning and sanitation of cooking utensils and the kitchen. Getting food handlers and managers certified is a big deal in preventing foodborne disease and keeping a restaurant open and safe to all. A great incentive for restaurant owners and operators, getting the staff educated on preparing food safely. Click on the graduate to open the certification web page. Serv Safe (2014). About our program. Retrieved from https://www.servsafe.com/ss/FoodHandler/index.aspx

Local Statistics on Salmonellosis 4990 Total Cases Incidence Rate of 18.9 Texas 545 12.8 Harris County The data shows the numbers for 2012. The incidence rate is per 100,000. Salmonellosis statistics in the state of Texas and Harris county. DSHSTX (2013). Salmonellosis data for Texas. Retrieved from http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=29853&id=8589960296&terms=salmonellosis

Government involvement in Salmonellosis? The CDC monitors the frequency and severity of Salmonella outbreaks and helps local health department in investigating, responding, and solving outbreaks. The Food and Drug Administration (FDA) inspects processing plants, checks milk pasteurization processes, inspects imported foods, and regulates the sales of turtles one of the carriers of Salmonella. The US Department of Agriculture (USDA) keeps track of the animals’ health and their handling, inspecting slaughtering facilities, oversees the quality of meat and poultry, and inspects egg pasteurization plants. A program known as the National Antimicrobial Resistance Monitoring System (NARMS) is in charge of tracking antimicrobial resistance of Salmonella bacteria in humans and animals. Recent measures taken by several federal organizations to reduce the burden caused by salmonellosis CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Take Home Message Hand washing and proper food handling is the most powerful weapon to fight salmonellosis. Remember…

How to Report a Foodborne Illness Outbreak First contact your local health department at www.houstontx.gov/health/Epidemiology/foodborneform.html Contact CDC about a foodborne illness, dial 1-800-CDC-INFO  Click on the link to open web page

More Information About Salmonellosis Available At www.cdc.gov/nczved/divisions/dfbmd/diseases/salmonellosis/ www.fda.gov/Food/default.htm www.fsis.usda.gov/wps/portal/fsis/home www.foodsafety.gov/poisoning/causes/bacteriaviruses/salmonella/index.html www.cdc.gov/salmonella/outbreaks-2014.html Just Click on the Link to Open the Web Page All the links are live. Just click on them to open the corresponding web site.

References: CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html CDC (2014). Recent salmonella outbreaks. Retrieved from http://www.salmonella/Heidelberg-01-14/index.html DSHSTX (2013). Salmonellosis data for Texas. Retrieved from http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=29853&id=8589960296&terms=salmonellosis Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition Serv Safe (2014). About our program. Retrieved from https://www.servsafe.com/ss/FoodHandler/index.aspx WHO (2014). Foodborne diseases. Retrieved from http://www.who.int/topics/foodborne_diseases/en

Any Questions??? Any questions or comments???

Thank you for your attention and interest today!!!