• Introduction• Pathogensis and transmission• Epidemiology• Important pathogens and toxins• Prevention and control• References

• Food poisoning is an acute gastroenteritis caused by ingestion of food or drink contaminated with either living bacteria or their toxins or inorganic chemical substance and poison derived from plants and animals .

• Pain in abdomen,vomitting diarrhoea with or without fever of short duration.

May be of 2 types-• Bacterial-Caused by ingestion of foods contaminated with living

bacteria or their toxins.• Non bacterial-Caused by chemicals such as arsenic,certain plant and

sea food in recent years,there has been a growing concern about contamination of food by chemicals eg. fertilizers,pesticides cadmium Mercury etc.

• Bacterial/viral/parasite.• Invasive and or multiply in lining of intestine.• Incubation period-hours to days.• S/s-• Diarrhoea,nausea,vomitting,abdominal

cramps, fever.• Communicable-spread from person to

person.• Factor-inadequate cooking poor personal

hygiene, bare hand contact, cross contamination.

• Natural/preformed/bacterial/chemical.

• No invasion or multiplication.

• Incubation period-minutes to hours.

• S/s-vomiting, Nausea,Diplopia,weakness,diarrhoea,respiratory failure,sensory/motor dysfunction.

• Not communicable.

• Factor-inadequate cooking, improper handling temperature.

Epidemiology in India

Initial assessment of cases – Detailed clinical history including time of onset , duration of illness , symptoms , h /o travel , recent meals , cooking and refrigeration , details of others with similar complaints

Detailed clinical examination – Vitals and degree of dehydration , systemic signs

Main Objectives-a) To confirm clinical diagnosis by isolation of causative agent from proper samples , eg . stool , vomitus / gastric aspirate , food specimens

b) Ensure proper identification of disease

c) Determine causative agent if present in food sources with relevant epidemiological markers- eg. Bio typing , serotyping , PCR , Phage typing etc

• Using aseptic technique n appropriate containers samples be refrigerated during storage and transport must arrive lab within 3 days of Collection of food samples.• Adequate sample - minimum 100 grams.• Containers - not to be filled >75% of capacity.• Proper labeling is utmost important labeled specimen be placed in zip lock bag and sealed.• Vaccine carrier with ice packs for transport and cold chain maintenance ( avoid freezing ).

1. Initial T/t - Assessment and reversal of dehydration ( ORT / IV Fluids ).

2. Cause specific treatment if any- eg. chelating agents in case of pesticide poisoning.

3. Use of antibiotics can be considered if bacterial cause is identified.

• Proper hand washing and personal hygiene

• Proper storage (refrigeration)

• Food safety education – community and food handlers

• Environmental measures - Discourage sewage farming for growing fruits and vegetables

• Prevention of Food Adulteration Act , 1954• To Ensure pure and wholesome food and to protect from fraudulent practices• Amendments - 1964, 1976, 1986• Case of proven adulteration –Minimum imprisonment of 6 months and minimum fine of Rs 1000 envisaged• Grievous Hurt-(320 IPC)- Death or such harm can be punished up to Life imprisonment and fine not <Rs 5000• Food Standards- Codex Alimentarius , Agmark standards,• Bureau of Indian Standards• National Nutrition Policy - 1993 - Food Security

1. Keep Clean – • Wash hands before handling food and often during• preparation• Wash hands after going to toilet• Wash n sanitize all surfaces n equipment for food preparation-protect kitchen from insects , pets

2. Separate raw and cooked food-• Separate raw meat , poultry n seafood from other foods• Use separate utensils for handling raw foods• Store food in containers to avoid contact between raw and cooked foods

3. Cook Thoroughly –• esp. Meat , poultry , eggs and Seafood• Bring soups n stews to boiling (ensure>70degree temp)• Reheat cooked food thoroughly

4. Keep food at safe temperature -• Don't leave cooked food at room temp.>2 hours• Prompt refrigeration of cooked n perishable food• Keep cooked food piping hot(>60 de.) prior to serving• Don’t store food too long even in refrigerator• Don’t thaw frozen food at room temperature

5. Use safe water and raw materials-• Use safe water or treat to make it safe• Select fresh and wholesome fruits• Choose foods processed for safety - pasteurized milk• Wash fruits n vegetables if eaten raw• Don’t use food beyond expiry date

• 1-Park’s textbook of preventive and social medicine- K.Park[23rd edition ]• nicd.nic.in