Foodborne Illness Overview with a Focus on E. Coli O157:H7 Dawn M. Ford, Walden University Environmental Health: Dr. Thron Welcome to this presentation. This presentation is designed for restaurant management staff and health department staff. The presentation will give them an overview of foodborne illnesses and specific information about E. coli O157:H7 and prevention measures.

Learning Objectives Increase knowledge of: Foodborne illnesses E. coli O157:H7 Prevention methods The learning objectives of this presentation are to: 1) learn more about foodborne illnesses, including the causes, symptoms, and common infections in the United States and 2) learn more about E. coli O157:H7 including the history, symptoms, sources, and the impact on the public, and 3) prevention methods to reduce the prevalence of foodborne illness.

Foodborne Illness Overview Foodborne illness is an important public health problem in the United States. It is caused by consuming contaminated food or drink. Foodborne illness is an important public health problem in the United States and is caused by consuming contaminated food or drink. For example, eating raw cookie dough can make you sick because raw eggs can carry salmonella. Credit: http://kidshealth.org Source: Centers for Disease Control and Prevention, [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm#mostcommon.

Foodborne Illness Overview Common symptoms are nausea, vomiting, abdominal cramps, and diarrhea. Most foodborne illnesses are preventable. The common symptoms of foodborne illness are nausea, vomiting, abdominal cramps, and diarrhea. Most cases of foodborne illness are preventable, and we will talk about prevention methods at the end of the presentation. Credit: http://kidshealth.org Source: Centers for Disease Control and Prevention, [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm#mostcommon.

Foodborne Illness Overview How does food get contaminated? During slaughter of animals Crops irrigated with contaminated water Unwashed hands Cross-contamination of foods Insufficiently cooked food Food stored at the incorrect temperature Food gets contaminated in a number of ways. The food may get contaminated during slaughter, when irrigated with contaminated water, when food handlers do not wash their hands properly, through cross-contamination, when insufficiently cooked, or when stored at the incorrect temperature. These are all opportunities for interventions to reduce the burden of foodborne illness. Credit: http://www.fda.gov Source: Centers for Disease Control and Prevention, [CDC]. (n.d.). Guidelines for preventing foodborne illness in schools. Retrieved January 27, 2010 from www.cdc.gov/healthyYouth/.../preventing_foodborne_illness.ppt .

Foodborne Illness Overview More than 250 foodborne diseases have been described. Most are infections (bacteria, parasites, and viruses) Some are poisonings (toxins and chemicals) Most common infections: Campylobacter Salmonella E. coli Norwalk and Norwalk-like viruses Source: Centers for Disease Control and Prevention, [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm#mostcommon. More than 250 foodborne diseases have been identified. Most of these diseases are infections, caused by bacteria, parasites, and viruses. However, some are poisonings which are caused by toxins and chemicals. The most common infections identified are Campylobacter, Salmonella, E. coli, and Norwalk/Norwalk-like viruses.

Foodborne Illness Overview For more information about bacteria and foodborne illnesses, visit the National Digestive Diseases Information Clearinghouse. For more information about bacteria and foodborne illnesses, visit the National Digestive Diseases Information Clearinghouse. Source: National Digestive Diseases Information Clearinghouse. (2007). Bacteria and foodborne illness. Retrieved February 5, 2010, from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/.

Rate of reported foodborne disease outbreaks caused by bacteria and viruses per 100,000 and number of outbreaks by state --- United States, 2006 Bacteria cause the most foodborne disease outbreaks in 2006, followed by viruses, chemicals, and parasites. An outbreak is described as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Source: Centers for Disease Control and Prevention [CDC]. (2009). Surveillance for foodborne disease outbreaks – United States, 2006. Morbidity and Mortality Weekly Report, 58(22), 609-615.

Foodborne Illness Overview Every year, foodborne disease causes: 76 million illnesses 325,000 hospitalizations 5,000 deaths Each year, foodborne disease causes 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths. This is a serious public health issue. Source: Centers for Disease Control and Prevention, [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm#mostcommon.

Foodborne Illness Overview Foodborne Disease Outbreaks (FBDO) An outbreak is when two or more people in a group get sick after consuming the same food item. 1,270 FBDO in 48 states in 2006 Of those caused by bacteria, Salmonella caused 52% and E. coli caused 13%. Most deaths were attributed to E.coli O157:H7 (6 of 11 FBDO deaths in 2006). The latest data for Foodborne Disease Outbreaks, abbreviated FBDO is for 2006. In that year, there were 1,270 foodborne disease outbreaks across 48 states. Of the outbreaks caused by bactgeria, Salmonella caused 52% and E. coli caused 13%. Most deaths, however, were attributed to E. coli O157:H7 (6 deaths). Source: Centers for Disease Control and Prevention [CDC], 2009, Surveillance for foodborne disease outbreaks – United States, 2006. Morbidity and Mortality Weekly Report, 58(22), 609-615.

Foodborne Illness Overview How do outbreaks of foodborne illness get detected? Health Departments analyze patient data from sources such as physician offices and emergency rooms to detect outbreaks. Foodborne illnesses that are reported to the health department are investigated. Foodborne illnesses are usually diagnosed by culturing stool specimens. How do outbreaks of foodborne illness get detected? Health Departments analyze patient data from sources such as physician offices and emergency rooms to detect outbreaks of disease. Health Departments also investigate foodborne illnesses that are reported and try to identify the source of the outbreak. Foodborne illnesses are usually diagnosed by culturing stool specimens. So, health department staff often send stool specimens to a laboratory for analysis.

Focus on: Escherichia coli O157:H7 Escherichia coli (E. coli) are a large group of bacteria. Normally present in healthy human and animal digestive tracts. Most are harmless, but some strains can cause disease. Escherichia coli are a large group of bacteria. E. coli are normally present in the human digestive tract. Most are harmless, but some can cause disease. Credit: Rocky Mountain Laboratories, NIAID, NIH Source: Centers for Disease Control and Prevention [CDC]. (2008). Escherichia coli. Retrieved January 28, 2010 from http://www.cdc.gov/nczved/dfbmd/disease_listing/stec_gi.html#1.

Focus on: Escherichia coli O157:H7 E. coli O157:H7 was first identified as a human pathogen in 1982. Gained attention in 1993 when several people got sick and four children died after eating hamburgers at Jack in the Box. Strain had acquired the ability to produce shiga toxins. E. coli O157:H7 was first identified as a human pathogen in 1982. The bacterium gained attention in 1993 when several people got sick and four children died after eating hamburgers at the Jack in the Box restaurant. This strain had acquired the ability to produce shiga toxins. Credit: Rocky Mountain Laboratories, NIAID, NIH Source: Schneider, M.J. (2006). Introduction to public health (2nd ed.), Sudbury, MA: Jones and Bartlett Publishers.

Focus on: Escherichia coli O157:H7 This bacterium is found in the gut of ruminants animals. Cattle are the major reservoir, and the bacteria are transmitted through manure. E. Coli O157:H7 is found in the gut of ruminants animals. Although its found in sheep, goats and other ruminants, cattle are the major reservoir of this bacterium. Credit: USDA Agricultural Research Service Source: Centers for Disease Control and Prevention [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm

Focus on: Escherichia coli O157:H7 People can get infected when they: Eat contaminated beef Eat other foods that are contaminated Consume contaminated drinking water or recreational water Have direct contact with infected animals Most people get infected when they eat or come into contact with things contaminated with manure, such as contaminated beef or other foods, contaminated drinking or recreational water, or the animals themselves. Credit: USDA Agricultural Research Service Source: Centers for Disease Control and Prevention [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm

Focus on: Escherichia coli O157:H7 In 2006, Four foodborne outbreaks were caused by E. coli O157:H7 One was caused by contaminated beef and three were caused by contaminated leafy vegetables One was traced back to a single spinach farm. In 2006, there were four foodborne outbreaks caused by E. coli O157:H7. One of them was caused by contaminated beef and the other three were caused by contaminated leafy vegetables. One of those three was traced back to a single spinach farm. Credit: www.usda.gov Source: Centers for Disease Control and Prevention [CDC], 2009, Surveillance for foodborne disease outbreaks – United States, 2006. Morbidity and Mortality Weekly Report, 58(22), 609-615.

Focus on: Escherichia coli O157:H7 Disease ranges from mild intestinal disease to severe kidney complications. Each year, there are an estimated: 73,000 people who become ill 2,000 people who become hospitalized 60 deaths Disease ranges from mild intestinal disease to severe kidney complications. Each year, 73,000 people become ill from an E Coli O157:H7 infection. Some people become seriously ill, with 2,000 hospitalizations and 60 deaths. Credit: www.womenshealth.gov Source: Frenzen, P.D., Drake, A., Angulo, F.J., & the Emerging Infections Program Foodnet Working Group. (2005). Economic cost of illness due to Escherichia coli O157 infections in the United States. Journal of Food Protection, 68 (12), 2623-2630.

Focus on: Escherichia coli O157:H7 Symptoms of infection are stomach cramps, and diarrhea, which can be bloody. Symptoms develop 5-10 days after exposure. Infection is usually diagnosed by culture of a stool sample. Disease ranges from mild intestinal disease to severe kidney complications. Each year, 73,000 people become ill from an E Coli O157:H7 infection. Some people become seriously ill, with 2,000 hospitalizations and 60 deaths. Credit: www.womenshealth.gov Source: Centers for Disease Control and Prevention [CDC]. (2009). Multistate outbreak of E. coli O157:H7 Infections linked to eating raw refrigerated, prepackaged cookie dough. Retrieved January 28, 2010 from http://www.cdc.gov/ecoli/2009/0630.html.

Focus on: Escherichia coli O157:H7 In 5-10% of the cases, patients develop hemolytic uremic syndrome (HUS). HUS is a type of kidney failure. Children under 5 and the elderly are most at risk. In 5-10% of the cases, patients developed hemolytic uremic syndrome. HUS is a type of kidney failure. Children under five and the elderly are most at risk. Source: Frenzen, P.D., Drake, A., Angulo, F.J., & the Emerging Infections Program Foodnet Working Group. (2005). Economic cost of illness due to Escherichia coli O157 infections in the United States. Journal of Food Protection, 68 (12), 2623-2630.

Focus on: Escherichia coli O157:H7 For more information about E. coli O157:H7, visit the CDC’s Division of Foodborne, Bacterial, and Mycotic Diseases website. For more information about E. coli O157:H7 visit the CDC’s Division of Foodborne, Bacterials, and Mycotic Diseases website. Credit: www.cdc.gov Source: Centers for Disease Control and Prevention Division of Foodborne, Bacterial, and Mycotic Diseases. (2008). Escherichia coli. Retrieved February 5, 2010, from http://www.cdc.gov/nczved/dfbmd/disease_listing/stec_gi.html.

Prevention There are a number of steps to take to ensure safe food reaches the public. Starting with production, processing, and the pathogen-kill-step. We will focus on the last step which is final preparation and cooking. This involves consumer education, foodhandler certification, and restaurant inspections in addition to the basic food safety measures that we will now discuss. Source: Tauxe, R.V. (2001). Food safety and irradiation: Protecting the public from foodborne infections. Emerging Infectious Diseases, 7(3). Retrieved January 29, 2010, from http://www.cdc.gov/ncidod/eid/vol7no3_supp/tauxe.htm#Figure .

Prevention – Final Preparation and Cooking Handwashing Pathogens can be introduced into food from infected people who do not properly wash their hands. Wash hands before preparing food and after handling uncooked meat and poultry. Wash with soap and water for at least 30 seconds. As the CDC signs reads, hand hygiene saves lives. Pathogens can be introduced into food from infected people who do not properly wash their hands. You should wash hands before preparing food and after handling uncooked meat and poultry. Wash with soap and water for at least 30 seconds. Credit: www.cdc.gov Source: Centers for Disease Control and Prevention [CDC]. 2009. Handwashing. Retrieved January 30, 2010 from http://www.cdc.gov/Features/HandWashing/.

Prevention – Final Preparation and Cooking Prevent Cross-Contamination The transfer of harmful bacteria from food, cutting boards, utensils, etc, to other foods when not handled properly. “Be smart, keep foods apart” It is important to prevent the transfer of harmful bacteria from food to other foods and surfaces. Always use a clean cutting board. Separate raw meat, poultry, and seafood from other foods. When serving food, always use a clean plate. Never put cooked foods back on a plate that had raw food on it. Credit: http://www.fda.gov Source: United States Department of Agriculture, Food Safety and Inspection Service. (2006). Safe food handling. Retrieved January 31, 2010, from http://www.fsis.usda.gov/Factsheets/Be_Smart_Keep_Foods_Apart/index.asp.

Prevention – Final Preparation and Cooking Cook to Proper Internal Temperature Beef, veal, and lamb steaks to 145 °F Pork and ground beef, veal, & lamb to 160 °F Poultry to165 °F. Use a food thermometer to assure that meat and poultry have reached a safe minimum internal temperature. It is also important to cook to the proper internal temperature for meat and poultry. For beef, veal, and lamb steaks, cook to 145 degrees F. For pork and ground beef, veal, and lamb, cook to 160 degrees F, and for poultry cook to 165 degrees F. Always use a food thermometer to assure that meat and poultry have reached a safe minimum internal temperature. Credit: www.nps.gov Source: United States Department of Agriculture, Food Safety and Inspection Service. (2006). Safe food handling. Retrieved January 31, 2010, from http://www.fsis.usda.gov/Factsheets/How_Temperatures_Affect_Food/index.asp

Prevention – Final Preparation and Cooking Store at proper temperature Food that is properly handled and stored in a freezer at 0 °F will always be safe. A temperature of 40 °F should be maintained in the refrigerator. For more information about food safety, visit www.foodsafety.gov Foods should always be stored at the proper temperature. Food that is handled properly and stored in a freezer at 0 degrees F will always be safe. For the refrigerator, keep the temperature at 40 degrees F. Credit: USDA FSIS Source: United States Department of Agriculture, Food Safety and Inspection Service. (2006). Safe food handling. Retrieved January 31, 2010, from http://www.fsis.usda.gov/Factsheets/How_Temperatures_Affect_Food/index.asp

Overview of Objectives In this presentation, we reviewed: Foodborne illnesses E. coli O157:H7 Prevention measures In this presentation, we reviewed foodborne illnesses, E. coli O157:H7, and prevention measures. I hope you have an increased knowledge in each of these areas.

References Centers for Disease Control and Prevention, [CDC]. (n.d.). Guidelines for preventing foodborne illness in schools. Retrieved January 27, 2010 from www.cdc.gov/healthyYouth/.../preventing_foodborne_illness.ppt . Centers for Disease Control and Prevention, [CDC]. (2005). Foodborne illness. Retrieved January 28, 2010 from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm#mostcommon. Centers for Disease Control and Prevention Division of Foodborne, Bacterial, and Mycotic Diseases. (2008). Escherichia coli. Retrieved February 5, 2010, from http://www.cdc.gov/nczved/dfbmd/disease_listing/stec_gi.html. Centers for Disease Control and Prevention, [CDC]. (2008). Escherichia coli. Retrieved January 28, 2010 from http://www.cdc.gov/nczved/dfbmd/disease_listing/stec_gi.html#1. Centers for Disease Control and Prevention [CDC]. (2009). Handwashing. Retrieved January 30, 2010 from http://www.cdc.gov/Features/HandWashing/. Centers for Disease Control and Prevention [CDC]. (2009). Multistate outbreak of E. coli O157:H7 Infections linked to eating raw refrigerated, prepackaged cookie dough. Retrieved January 28, 2010 from http://www.cdc.gov/ecoli/2009/0630.html. Centers for Disease Control and Prevention [CDC]. (2009). Surveillance for foodborne disease outbreaks – United States, 2006. Morbidity and Mortality Weekly Report, 58(22), 609-615. Frenzen, P.D., Drake, A., Angulo, F.J., & the Emerging Infections Program Foodnet Working Group. (2005). Economic cost of illness due to Escherichia coli O157 infections in the United States. Journal of Food Protection, 68 (12), 2623-2630. References

References National Digestive Diseases Information Clearinghouse. (2007). Bacteria and foodborne illness. Retrieved February 5, 2010, from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/. U.S. Department of Health and Human Services. (n.d.). Food safety. Retrieved February 5, 2010, www.foodsafety.gov. Schneider, M.J. (2006). Introduction to public health (2nd ed.), Sudbury, MA: Jones and Bartlett Publishers. Tauxe, R.V. (2001). Food safety and irradiation: Protecting the public from foodborne infections. Emerging Infectious Diseases, 7(3). Retrieved January 29, 2010, from http://www.cdc.gov/ncidod/eid/vol7no3_supp/tauxe.htm#Figure . United States Department of Agriculture, Food Safety and Inspection Service. (2006). Safe food handling. Retrieved January 31, 2010, from http://www.fsis.usda.gov/Factsheets/Be_Smart_Keep_Foods_Apart/index.asp. References

Further Reading Centers for Disease Control and Prevention, OutbreakNet, http://www.cdc.gov/outbreaknet/ Federal Drug Administration, Bad Bug Book, http://www.fda.gov/food/foodsafety/foodborneillness/foodborneillnessfoodbornepathogensnaturaltoxins/badbugbook/ucm071284.htm Partnership for Food Safety Education, “Fight bac” http://www.fightbac.org/ Here are some resources for further reading, if you are interested in learning more.