1. PH 6165-5 (Environmental Health) Instructor: Dr. Rebecca Heick
Salmonella: What You Need to Know
Kenneth Onyewurunwa, (MPH Student)
Walden University
PH (Environmental Health)
Instructor: Dr. Rebecca Heick
June, 2009

2. Local government staff
Welcome!!
Food handlers
Local government staff
Health care providers
General public
My name is Kenneth Onyewurunwa, on behalf of Walden University I would like to welcome you to this occasion.
Before we go into our presentation this morning, by show of hands how many of you are Food handlers, health care providers (doctors, nurses, physician assistants, medical assistants, etc), from Local health departments/governments and members of the general public whom are seeking health-related knowledge.

3. Objectives Increase knowledge Burden of disease Public health Impact
Cost of disease
The objectives of this presentation are to increase knowledge about the prevalence and burden of Salmonella foodborne illness in the United States and, as well as understanding of the public health impact and cost of complications associated with Salmonella.

4. Expected Learning Outcomes for participants
Public health issue/concern
Health complications
Prevalence
Intervention
At the end of this presentation, participants will:
Recognize Salmonella as an important public health issue for the United States
Understand how Salmonella causes illness and health complications
Be aware of the prevalence of Salmonella in the United States
Name the major ways Salmonella can be prevented or controlled

5. What is Salmonella? Source Symptoms Nature of disease
Food & Drug Administration (2009) Retrieved on June 15, 2009 from:
Salmonella is a Foodborne pathogenic microorganism that widely occurs in poultry and swine. According to the Food & Drug Administration (FDA, 2009) “the environmental source of this pathogen is mainly from water, soil, insects, factory surfaces, kitchen surfaces, animal feces, raw meats, raw poultry, and raw seafood”. In recent times in the United States, outbreak of Salmonella has become a frequent occurrence in humans.
What are the symptoms of Salmonella?
Acute symptoms which may last 1 to 2 days or may be prolonged depending on host factors, ingested dose, and strain characteristics.
Symptoms include Nausea, vomiting, abdominal cramps, minimal diarrhea, fever, and headache.
Chronic consequences include arthritic which may follow 3 to 4 weeks after onset of acute symptoms. Onset time is 6-48 hours.
Cause of disease – Penetration and passage of Salmonella organisms from gut lumen into epithelium of small intestine where inflammation occurs; there is evidence that an enterotoxin may be produced, perhaps within the enterocyte (FDA, 2009).

6. What foods are associated with Salmonella
Raw meat
Poultry
Eggs
Milk & dairy products
Fish & shrimp
Sauces & salad dressing
Examples of foods involved in outbreaks of salmonellosis are raw meats, poultry, eggs, milk and dairy products, fish, shrimp, frog legs, yeast, coconut, sauces and salad dressing, cake mixes, cream-filled desserts and toppings, dried gelatin, peanut butter, cocoa, and chocolate.

7. Prevalence/Incidence Reported cases of Salmonellosis in the U. S
Prevalence/Incidence Reported cases of Salmonellosis in the U.S. excluding typhoid fever for the years 1988 to The number of cases for each year varies between 40,000 and 50,000. From Summary of Notifiable Diseases, United States MMWR 44(53): 1996 (October 25).
It is estimated that from 2 to 4 million cases of salmonellosis occur in the U.S. annually.
The incidence of salmonellosis appears to be rising both in the U.S. and in other industrialized nations. S. enteritidis isolations from humans
have shown a dramatic rise in the past decade, particularly in the northeast United States (6 times or more), and the increase in human
infections is spreading south and west, with sporadic outbreaks in other regions (CDC MMWR, 1996).

8. Public Health Impact Multi- state outbreaks Hospitalization
Over burdened health system
Death
Centers for Disease Control & Prevention (2009) Retrieved on June 15, 2009 from:
The most recent outbreak of Salmonella was in 2008 to 2009; there was a multi-state outbreak of Salmonella Infections associated with peanut butter (CDC, 2009). Each year, approximately 40,000 laboratories- confirmed cases of Salmonella infections are reported to the National Salmonella Surveillance System (CDC, 2009). The Centers for Disease Control & Prevention (CDC) PulseNet as of January 28, 2009, indicated 529 persons from 43 states and one person from Canada were reportedly infected with the outbreak strain. A total of 116 patients were reportedly hospitalized, and the infection might have contributed to eight deaths
CDC collects data on foodborne disease outbreaks (FBDOs) from all states and territories through the Foodborne Disease Outbreak Surveillance System (FBDSS). This report summarizes epidemiologic data on foodborne disease outbreak. In the most recent report – 2006, a total of 1,270 FBDOs were reported, resulting in 27,634 cases and 11 deaths. Among the 624 FBDOs with a confirmed etiology, 18% of outbreaks and 3,252 cases were Salmonella. Among the 11 reported deaths, one was Salmonella serotype Enteritidis (CDC, 2009). When this number is applied to a larger population, the rate becomes staggering.

9. Burden of Disease
Medical care cost Lost productivity Frenzen PD, Riggs LT, Buzby JC, Breuer T, Roberts T, Voetsch D, Reddy S and the FoodNet Working Group (1999) Salmonella Cost Estimate Updated Using FoodNet Data Retrieved June 15, 2009 from: Todd Neale (2009) Staff Writer, MedPage Today. Retrieved on June 15, 2009 from:
The estimated annual costs (in 1998 dollars) of medical care and lost productivity due to foodborne Salmonella infections were $0.5 billion, based on the human capital approach for calculating forgone earnings (Frenzen et al., 1999). In news article by Todd Neale (2009), estimated that “the cost of the recent salmonella out break will likely top $1 Billion”.

10. Environmental stewardship
Intervention
Clinical
Public health
Environmental stewardship
Moeller, D. W. (2005). Environmental health (3rd Ed.). Boston: Harvard University Press
Clinical Intervention Model: Prevention of a specific disease from leading to death of an individual;
Public health environmental model: This calls for preventing the development of disease;
Environmental stewardship model: This has its goal to protect humans by preventing environmental degradation and its impacts on health (Moeller, 2005).

11. Clinical Intervention
What can a person do to prevent this disease?
Avoid raw or undercooked eggs, poultry, or meat
Cross-contamination of foods should be avoided
Test Restaurant Workers with previous cases
Use of intravenous fluids and antibiotics
Wash your hands
Report all cases
Better Education
Centers for Disease Control & Prevention (2009) Retrieved on June 15,
Because foods of animal origin may be contaminated with Salmonella, people should not eat raw or undercooked eggs, poultry, or meat. Poultry and meat, including hamburgers, should be well-cooked. Cross-contamination of foods should be avoided. Uncooked meats should be kept separate. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after touching uncooked foods. Hand should be washed before handling food, and between handling different food items.
The CDC (2009) recommends that restaurant workers with previous Salmonella infection should have a stool test showing that they are no longer carrying the Salmonella bacterium before they return to work. People should wash their hands after contact with animal feces. Children can be exposed to the bacteria by simply holding, cuddling, or kissing the birds. Children should not handle baby chicks or other young birds.  Everyone should immediately wash their hands after touching birds, including baby chicks and ducklings, or their environment. Persons with severe diarrhea may require re-hydration with intravenous fluids. Antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin, are not usually necessary unless the infection spreads from the intestines. Report all cases of salmonellosis to the local health department. Better education such as the one we are having today, for food industry workers in Salmonella disease.

12. Public Health & Environmental Stewardship Intervention
From Farm to Table
Eliminating middle men
Eliminating the use of antimicrobials & hormone
Food co-ops or similar Local system
A combination of public health and environmental stewardship measures would be most effective intervention for Salmonella foodborne pathogens; Community health professionals should target control strategies for specific pathogens in particular foods along the farm/fork -to-table continuum, this process will eliminate the middle men involved in pre-packing and preservation process of food that comes to our table. The case of peanut butter Salmonella outbreak cited above started at one food processing plant and spread to 43 states in the US. One will argue that the advent of packing and repacking food while has some limited benefits has also lead to many foodborne outbreaks.
Perhaps reverting to simple food production system will minimize such outbreaks; the growing complexity of our food production systems should be challenged, we live in an era of mega farms and food monopolies, use of antimicrobials and hormone treatments in food process should be discourages, like many other use of antibiotics, the Salmonella bacteria has continually developed resistance to many of the agents used in food production.
Another example of simpler food production system is using food co-ops or similar local systems that will significantly decrease the problem of Salmonella. If each state, each community, individual household would use a small piece of land in their backyard to plant a crop/ vegetable, grow a chicken in their backyard.
Source: 2007 Eastern Marker Corporation.

13. Barriers to Intervention
Effects of globalization
Antibiotic resistance
The globalization of food trade has also contributed to this problem. The food production chain has become more complex, providing greater opportunities for contamination and growth of pathogens. Many outbreaks of foodborne diseases that were once contained within a small community may now take on global dimensions. A simple contamination of green pepper or tomatoes in Mexico could have a tremendous effect in the US and around the globe. As mentioned in the previous slide the Salmonella bacteria has continually developed resistance to many of the agents used in food production.

14. Some key learning points Public health issue/concern
Summary/Conclusion
Some key learning points
Public health issue/concern
Health complications
Prevalence
Intervention
As we have seen in this presentation Salmonella is a major public health issue that could infect anyone that comes into contact with this organism.
It may result to enormous health complication and possible death. The public health impact may also range from lost hours of work, cost associated with productivity, and treatment.
Therefore as public health workers, local government officials, food handlers and citizens in general, we need to prevent Salmonella from affecting our food chain and help in making all Americans healthy.

15. Further Reading Materials:
The CDC provides an informational brochure on preventing Salmonella enteritidis infection. Food Safety Facts for Consumers
A Loci index for genome Salmonella enteritidis is available from GenBank.
Morbidity and Mortality Weekly Reports from CDC
Bad Bug Book - Salmonella spp. Foodborne Pathogenic Microorganisms and Natural Toxins Handbook
    

16. References
Food & Drug Administration (2009) Retrieved on June 15, 2009 from:
Centers for Disease Control & Prevention (2009) Retrieved on June 15, 2009 from:
Frenzen PD, Riggs LT, Buzby JC, Breuer T, Roberts T, Voetsch D, Reddy S and the FoodNet Working Group (1999) Salmonella Cost Estimate Updated Using FoodNet Data Retrieved June 15, 2009 from:
Todd Neale (2009) Staff Writer, Med Page Today. Retrieved on June 15, 2009 from:
World Health Organization (2009) Retrieved on June 15, 2009 from:
Centers for Disease Control & Prevention (2009) Retrieved on June 15,

17. Thank you.
Questions?
Thank you!! At this time I would like to take any Questions.