1. ANNETTE SILVIA PhD PUBLIC HEALTH, EPIDEMIOLOGY WALDEN UNIVERSITY PUBH 8165–2 DR. FREDERICK GRANT SUMMER QUARTER, 2013 Introduction to Foodborne Illness and Food Safety Food for Thought for Those in Culinary Arts

2. Learning Objectives for Students in Culinary Arts and/or Science Expected learning outcomes What you should know Why you should care

3. AGENDA Culinary Arts and Science Foodborne illness by the numbers Evidence that may something may bug you when you eat What doesn’t kill you may not make you stronger Symptoms of foodborne illness Sources to consider in an outbreak New food sources in the mix Farm to table food supply chain Break the cycle with safe food handling Public Health Challenges Q & A

4. Food has a way of “bugging” you According to the Centers for Disease Control and Prevention (CDC) 2011 estimates: 1 in 6 Americans get sick each year from contaminated food (approximately 48 million people) 128,000 people are hospitalized 3,000 die from foodborne illness 31 known pathogens Source: Centers for Disease Control and Prevention (CDC). (2011). CDC Estimates of Foodborne Illness in the United States.

5. United States 2011 Estimates for Foodborne Illness Foodborne Agents Estimated annual number of illnesses (90% credible interval) % Estimated annual number of hospitalizations (90% credible interval) % Estimated annual number of deaths (90% credible interval) % 31 known pathogens 9.4 million (6.6–12.7 million) 20 55,961 (39,534–75,741) 44 1,351 (712–2,268) 44 Unspecified agents 38.4 million (19.8–61.2 million) 80 71,878 (9,924–157,340) 56 1,686 (369–3,338) 56 Total 47.8 million (28.7–71.1 million) 100 127,839 (62,529–215,562) 100 3,037 (1,492–4,983) 100 Source: Centers for Disease Control and Prevention (CDC). (2011). CDC Estimates of Foodborne Illness in the United States.

6. Estimated Number of Illnesses by Pathogen Estimated Hospitalizations and Deaths by Pathogen PathogenEstimated illnesses Norovirus5,461,731 (58%) Salmonella, nontyphoidal1,027,561 (11%) Clostridium perfringens965,958 (10%) Campylobacter spp..845,024 (9%) Staphylococcus aureus241,148 (3%) Pathogen Estimated hospitalizations Estimated deaths Salmonella, nontyphoidal 19,336 (35%)378 (28%) Norovirus14,663 (26%)149 (11%) Campylobacter spp..8,463 (15%)76 (6%) Toxoplasma gondii4,428 (8%)327 (24%) E.coli (STEC) O1572,138 (4%) Listeria monocytogenes 255 (19%) Top Five Foodborne Pathogens Source: Centers for Disease Control and Prevention (CDC). (2011). CDC Estimates of Foodborne Illness in the United States

7. Worth a Thousand Words Source: www.nature.com Campylobacter species

8. Worth a Thousand Words Source: www.smartkitchen.com Clostridium perfringens Thoroughly cook foods to a safe internal temperature (especially meat, poultry, sauces) Use a food thermometer Keep food hot after cooking (≥140˚) Microwave reheated food thoroughly (to ≥165˚) Refrigerate foods within two hours (≤40˚) Divide leftovers into shallow containers and refrigerate immediately. Do not let them cool on the counter.

9. Worth a Thousand Words Source: www.healthhype.com Escherichia coli (E. coli)

10. Worth a Thousand Words Source: healthwise-everythinghealth.blogspot.com Listeria monocytogenes

11. Worth a Thousand Words Source: www.fehd.gov.hk Campylobacter

12. Worth a Thousand Words Source: www.foodpoisonjournal.com

13. Worth a Thousand Words Source: http://www.webmd.com/food-recipes/food-poisoning/tc/staph-food-poisoning-topic-overview Meats Poultry and egg products Salads such as egg, tuna, chicken, potato, and macaroni Bakery products such as cream-filled pastries, cream pies, and chocolate eclairs Sandwich fillings Milk and dairy products Staphylococcus aureus

14. Worth a Thousand Words Source: http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm Toxoplasma gondii

15. Symptoms of Foodborne Illness Diarrhea Abdominal cramps Vomiting Fever When severe, these can lead to Dehydration Lightheadedness/fainting Organ failure Death

16. Foods Evaluated in an Outbreak

17. New Sources of Illness (2006-2011) Source: PulseNet, OutbreakNet, Foodborne Disease Outbreak Surveillance System

18. Food Supply Chain – Farm to Table Point of origin (farm, sea, land) Manufacture Distribution Packing/Processing Market (point of sale) Kitchen preparation Where do you think contamination comes from?

19. Breaking the Cycle with Safe Food Handling Food Supply ChainPrevention Point of origin (farm, sea, land)Preventative controls, clean handling, clean housing, use of reputable sources, temperature controls, routine testing, inspections ManufactureClean facilities, avoid cross contamination (raw/contaminated food), proper handling, inspections Distribution/TransportClean facilities and transport trucks, monitor for proper storage temperatures, track transports and storage conditions Packing/ProcessingReduce entry of contamination from source as well as process, clean facilities, proper handling, quality checks, inspections Market (point of sale)Clean market space and display cases, proper handling and storage on shelf, prevent cross contamination Kitchen preparationCook food properly, disinfect surfaces, clean raw foods prior to eating, know your source

20. Public Health Challenges Ensuring food safety from farm to table Educating the public about safe food handling practices Educating food handlers about proper handling and storage Assure health and safety of public by ensuring regulations are followed, recalls as needed Track outbreaks to identify source as quickly as possible to limit spread Other thoughts…?

21. Q & A Don’t let what you eat end up bugging you Think about what you should and shouldn’t do Make sure that you choose your food with care Know how to handle it and safely prepare Eat a variety of fresh foods each day Less worry now that you’ve learned the safe way! Thank you for allowing me the time To share with you (and attempt to rhyme).

22. References Centers for Disease Control and Prevention (CDC). (2011). CDC Estimates of Foodborne Illness in the United States. Retrieved from http://www.cdc.gov/foodborneburden/2011-foodborne-estimates.html Painter, J. A., Ayers, T., Woodruff, R., Blanton, E.,, Perez, N., Hoeksstra, R., Griffin, P. M., & Braden, C. (2009). Recipes for foodborne outbreaks: a scheme for categorizing and grouping implicated foods. Foodborne Pathogens and Disease, 6, 259-264. Young, K. T., Davis, L. M., & DiRita, V. J. (2007) Campylobacter jejuni: molecular biology and pathogenesis. Nature Reviews Microbiology 5, 665-679 doi:10.1038/nrmicro1718 http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm www.foodpoisonjournal.com http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/cperfringens/ www.healthhype.com healthwise-everythinghealth.blogspot.com www.fehd.gov.hk www.nature.com PulseNet, OutbreakNet, Foodborne Disease Outbreak Surveillance System Retrieved from http://www.cdc.gov/outbreaknet/ www.smartkitchen.com http://www.webmd.com/food-recipes/food-poisoning/tc/staph-food-poisoning-topic-overview

23. Additional Resources Centers for Disease Control and Prevention (CDC) Food Safety  http://www.cdc.gov/foodsafety/ Keep Food Safe  http://www.foodsafety.gov/keep/index.html U. S. Food and Drug Administration (FDA)  http://www.fda.gov/Food/FoodborneIllnessContaminants/de fault.htm WebMD Food Poisoning Health Center  http://www.webmd.com/food-recipes/food- poisoning/default.htm