1. The Anatomy of Food-borne Disease Outbreaks In New York : A Study of the Food Service Establishment Ifeanyi Malu, Ph.D. Student Walden University PHBH 8165-1 Instructor: Dr. Robert Marino Fall, 2011.

2. Learning Objectives By the end of this presentation, stakeholders will be able to : Describe the environmental causes of disease outbreaks. Define the environmental causes of disease outbreaks. Recognize the challenges posed by food-borne disease outbreaks in the state. Develop strategies for the preservation and handling of food, understand the importance of sanitation and personal hygiene, and distinguish between the types of state laws, local ordinances and federal Act. Design a training program for its workers in order to maintain competitive advantage, increase customer satisfaction and adopt the inclusion of calorie information on food menus. Implement motivational action within and across food services centers in order to affect changes in the industry

3. National Food-borne Disease Outbreak in the U.S.-1993-1997 550 food borne illness outbreak from 1993 to 1997 40 percent of these outbreak were attributed to food service outlets Selman, C. A., & Green, L. R. (2008). Environmental health specialists' self-reported food borne illness outbreak investigation practices. Journal of Environmental Health, 70(6), 16–21.

4. Overview of Outbreaks in the U.S. 2007 497 outbreaks resulting in 12,767 illnesses Bacteria caused 259 outbreaks and 6441 illnesses Virus caused 199 outbreaks with 6120 illness Chemical agents caused 34 outbreak and 141 illnesses Parasites caused five outbreak with 65 illness Center for Disease Control and Prevention (August,2010).Surveillance of Foodborne Disease Outbreak –United States. Retrieved October 9, 2011 from http://www.cdc.gov/mmwr/pdf/wk/mm5931.pdf

5. Overview of 2006 Foodborne Disease Outbreaks In New York 84 foodborne disease outbreak reported 1,834 cases of foodborne illness 124 people hospitalization 42.3 % foodborne illness associated with calicivirus outbreak 33 foodborne disease outbreak attributed to bacterial illness New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

6. Overview of 2006 Foodborne Disease Outbreaks In New York Salmonella species accounts for 15 of the 33 bacterial outbreak 11 calicivirus outbreak recorded 3 cases of V. parahaemolyticus confirmed 2 cases of V. parahaemolyticus suspected New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

7. Analysis of Etiology Etiology was confirmed in 53.6% of the 84 outbreaks in 2006 Suspected etiology was documented for 9.5% Unknown etiology was identified for 36.9% From 2001-2005, 274 outbreak reported 28 Confirmed etiology were bacterial (62.2%) 8 confirmed etiology were viral(17.8%) 6 confirmed etiology were chemical(13.3%) New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

8. Mortality and Morbidity Rate in 2006 In 2006, no food-borne related death were reported in the state In 2005, one death was reported in the state 124 food-borne disease hospitalization in 2006 In 2005, 38 hospitalization was reported 65.6% of morbidity were calicivirus 16.5% of morbidity caused by salmonella 8.0% of morbidity caused by perfringens New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

9. In-Year Temporal Trend in NYS Disease outbreak peaked in June,July and August of 2006 13.1% in June, 15.5 % in July and 11.9% in August November witnessed about 10.7% in foodborne disease outbreak in 2006 In 2006, salmonella caused 32.5% of the 40 foodborne disease between May and August From 2001 through 2005, salmonella species were associated with 24.1% of the 108 outbreak in the summer months New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

10. Method of Food Preparation in NY Cook/serve food caused 22.6 of disease outbreaks of the 84 outbreaks in the state, Solid masses with potentially hazardous foods account for 14.3% of the 84 outbreaks Seafood caused 9.5% of the outbreaks Starchy food caused 8.3% New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

11. New York State Laws Article 17-B Licensing of Food Salvagers Article 17 Food and Food Products Article 5B Sale of Meat and Article 5D Sale of Poultry and Poultry Products Article 5A Licensing of Slaughterhouses Article 20-C Licensing of Food Processing Establishments New York State Department of Agriculture(n.d.). NYS Food Safety Rule and Regulations. Retrieved October 1,2011 from http://www.agriculture.ny.gov/FS/industry/circs.html

12. New York City Ordinances Health Code regulations and Chapter 23, Title 24 Rules of the City of New York. The New York City Smoke-Free Air Act 2002 New York City Department of Health. (n.d.). Food safety and community sanitation. Retrieved September, 29,2011 from http://www.nyc.gov/html/doh/html/inspect/insp-scoring.shtml

13. Food Protection Course in NYC Satisfies the provision of the state law Requires that food service mangers be certified in food protection Managers are issued a certificate Online classes conducted in English, Spanish and Chinese New York City Department of Health(n.d.). Food protection courses. Retrieved October 2,2011 from http://www.nyc.gov/html/doh/html/hany/hanyfood.shtml

14. Food borne reporting system in the U.S. Electronic Food borne Outbreak Reporting System (EFORS) National Antimicorobial Resistance Monitoring System National Electronic Norovirus Outbreak Network National Notifiable Disease Surveillance System Foodborne Outbreak Surveillance Contributing Factors Surveillance Center for Disease Control and Prevention. (2011). Foodborne illness Surveillance Response and Data System. Retrieved September 1, 2011 from http://www.cdc.gov/foodborneburden/surveillance-systems.html Selman, C. A., & Green, L. R. (2008). Environmental health specialists' self-reported food borne illness outbreak investigation practices. Journal of Environmental Health, 70(6), 16–21.

15. Food borne Surveillance system in the NYS New York State Department of Health Foodborne Disease Surveillance System New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf

16. Foodborne illness and their causes Bacterial infections Campylobacter Dysentery Salmonellosis Gastroenteritis Moeller, D. (2011). Environmental Health. 4 th ed. Cambridge: MA. Harvard University Press FDA (N.D.). Bad bug book: Introduction foodborne pathogenic. Retrieved September 1,2011 from http://www.fda.gov/Food/Food Safety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/Bad BugBook/default.htm

17. Foodborne illness and their causes Viral Infections Norwalk-like viruses Infectious hepatitis Bovine spongiform encephalopathy (BSE) Moeller, D. (2011). Environmental Health. 4 th ed. Cambridge: MA. Harvard University Press FDA (N.D.). Bad bug book: Introduction foodborne pathogenic. Retrieved September 1,2011 from http://www.fda.gov/Food/Food Safety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/Bad BugBook/default.htm

18. Foodborne Illness and their Causes Toxins Staphylococcus aureus Clostridium botulinum Escherichia coli. E. coli Brevtoxins Moeller, D. (2011). Environmental Health. 4 th ed. Cambridge: MA. Harvard University Press FDA (N.D.). Bad bug book: Introduction foodborne pathogenic. Retrieved September 1,2011 from http://www.fda.gov/Food/Food Safety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/Bad BugBook/default.htm

19. Food Poisoning in the U.S. 48 million reported being sick( 1 in 6 Americans) 3000 die each year 76 million suffer food-borne disease each year 31 pathogen caused 9.4 million illness Unspecified agents caused 38.4 million illness New York Times (2010). Food safety. Retrieved October 10, 2011 from http://topics.nytimes.com/top/reference/timestopics/subjects/f/food_safety/index.ht ml http://topics.nytimes.com/top/reference/timestopics/subjects/f/food_safety/index.ht ml Center for Disease Control and Prevention. (2011). Estimates of foodborne illness in the United States. Retrieved October 1,2011 from http://www.cdc.gov/foodborneburden/index.html

20. Preservation and Handling Cooking Canning Drying and dehydration Preservatives Refrigeration Freezing Pasteurization Moeller, D. (2011). Environmental Health. 4 th ed. Cambridge: MA. Harvard University Press Images courtesy of the health department of the city of New York. Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/inspect/food_safety_fact.pdf

21. Sanitation, Hygiene and Inspection Equipment and facilities Personnel training Hand washing Standards and regulation Enforcement and monitoring Moeller, D. (2011). Environmental Health. 4 th ed. Cambridge: MA. Harvard University Press

22. Keep Your Food Safe from Bacteria When in Doubt, Throw it Out!

23. Stakeholders New York State Department of Health New York City Department of Health Food and Drug Administration Center for Disease Control and Prevention NYS Department of Agriculture U.S. Department of Agriculture National Institute of Health National Restaurant Association NYS Association for Food Protection The Public

24. Recommendations – Improved technology and new CDC reporting guidelines – Increase databases to identify place of contamination – Improve and extend the current grading system in NYC to all counties in the state – Hire more food inspectors

25. Thank you

26. References Center for Disease Control and Prevention (August,2010).Surveillance of Foodborne Disease Outbreak –United States. Retrieved October 9, 2011 from http://www.cdc.gov/mmwr/pdf/wk/mm5931.pdf New York State Department of Health( April 2006). Foodborne Disease Outbreak in New York State,2006. Retrieved October 1,2011 from http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf http://www.health.state.ny.us/statistics/diseases/foodborne/outbreaks/2006/2006_o utbreak_report_bw.pdf New York City Department of Health. (n.d.). Food safety and community sanitation. Retrieved September, 29,2011 from http://www.nyc.gov/html/doh/html/inspect/insp- scoring.shtml New York Time. (2010). Food Safety. Retrieved October 10, 2011 from http://topics.nytimes.com/top/reference/timestopics/subjects/f/food_safety/index.ht ml Moeller, D. (2011). Environmental Health. 4 th ed. Cambridge: MA. Harvard University Press Selman, C. A., & Green, L. R. (2008). Environmental health specialists' self-reported food borne illness outbreak investigation practices. Journal of Environmental Health, 70(6), 16–21.

27. References Center for Disease Control and Prevention. (2011). Foodborne illness Surveillance Response and Data System. Retrieved September 1, 2011 from http://www.cdc.gov/foodborneburden/surveillance-systems.html http://www.cdc.gov/foodborneburden/surveillance-systems.html FDA (N.D.). Bad bug book: Introduction foodborne pathogenic. Retrieved September 1,2011 from http://www.fda.gov/Food/Food Safety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/Bad BugBook/default.htm

28. Further Readings Centers for Disease Control and Prevention (CDC): Environmental Health: Data and Statistics. http://www.cdc.gov/environmental/ MacKenzie, W., Hoxie, N., Proctor, M., Gradus, M., Blair, K., Peterson, D., et al. (1994). A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. New England Journal of Medicine, 331(3), 161–16 Selman, C. A., & Green, L. R. (2008). Environmental health specialists' self-reported food borne illness outbreak investigation practices. Journal of Environmental Health, 70(6), 16–21.