Foodborne IllnessFocusing on

Salmonellosis

ALFREDO CARDOSO, MPH STUDENTWALDEN UNIVERSITY

PUBH 6165-3INSTRUCTOR: DR. RAYMOND THRON

SPRING QUARTER, 2014

Local Restaurant Owners & Food Handlers

We Will Answer…• What is a foodborne illness?• What is salmonellosis?• How do we get it?• How do we prevent it?• How do we prepare food safely?• How do we report an outbreak?• What has been done about salmonellosis?

Foodborne illnesses are diseases that are transferred to humans by ingesting or using contaminated water or food. Many different germs and chemicals are able to contaminate food and water. We will focus on salmonellosis for this presentation.

WHO (2014). Foodborne diseases. Retrieved from http://www.who.int/topics/foodborne_diseases/en/

• Salmonellosis is the disease caused by non-typhoidal Salmonella enterica subspecies.• Is a common bacterial infection which can be completely asymptomatic in some people while in others can become life threatening.

Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Salmonellosis in Numbers• During the year 2013, CDC

identified 19,000 food-related infections, 4200 hospitalizations, and 80 deaths in the United States.

• Salmonellosis accounted for 35% of all the foodborne disease cases, around 6650 infections.

CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Recent Outbreaks in the United States

• January, 2014: An outbreak of Salmonellosis involving several states was caused by raw cashew cheese. The outbreak affected people living in California, Nevada, and Wyoming. There were 17 reported cases, 3 hospitalizations and no deaths. The cheese was effectively recalled and taken from shelves.

• February, 2014: An outbreak of Salmonellosis was attributed to Tyson brand chicken. The cases were reported by a correctional institution in Tennessee. The total of cases was 9, and 2 of them needed hospitalization, no deaths were reported. The chicken was recalled.

CDC (2014). Recent salmonella outbreaks. Retrieved from http://www.salmonella/Heidelberg-01-14/index.html

Symptoms of Salmonellosis• Nausea• Vomiting• Abdominal cramps• Fever• Chills• Headache• Blood in stool

Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Disease Progression• Generally people develop symptoms within 8 to 72 hours

after infection.• Most healthy people recover within a week without

specific treatment.• The diarrhea and vomiting can cause dehydration that

requires medical attention.• The worst case scenario is when the bacteria spreads

beyond the GI tract and reaches blood stream, bacteremia is life threatening and requires fast and aggressive treatment.

Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Salmonellosis Usual Targets• Infants and young children• Elderly persons• Immune-compromised persons such as HIV/AIDS

patients, organ transplant recipients, those with sickle cell disease, and malaria patients.• All of the above mentioned tend to show worst

symptoms and complications from salmonellosis

CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Salmonella HostsPeople can be at risk for Salmonellosis when handling animals including:• Dogs• Pet chickens and ducks• Reptiles• Cats

Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

How does Salmonella contaminates food?• The bacteria lives in the intestines of humans, animals, and birds.• The most common way to contaminate food is with poor hygiene, the food gets in contact with feces when food handlers do not wash their hands

Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Commonly Infected Foods:• Raw poultry, meat, and

seafood.• Raw eggs.• Fruits and vegetables.• Cross-contamination occurs

in the kitchen when contaminated raw food (meat, poultry, etc.) gets in contact with uncooked foods, such as salads.CDC (2010). Salmonella. Retrieved from

http://www.salmonella/general/index.html

Making Food SafeRecommendations for Food Handlers

• Both professional and domestic food handlers must observe hygienic rules of food preparation.

• Professional food handlers must inform their supervisor right away if they are suffering from fever, diarrhea, vomiting and/or skin lesions that are visible and exposed.

• The five keys to safer food defined by the World Health Organization (WHO) are extremely important to prevent foodborne illnesses, and they are:

1. Keep clean (surfaces and kitchen in general).2. Separate raw and cooked foods (avoids cross-contamination).3. Cook thoroughly (kills bacteria responsible for diseases).4. Keep food at safe temperatures (prevent food from spoiling).5. Use safe water and raw materials (we can only hope).

CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Prevention • Wash hands thoroughly before and after food

consumption and preparation.• Do the same with children, make sure they wash their

hands after playing with pets.• Raw eggs, meat, and poultry must be treated as if they

were contaminated and handled with care.• When refrigerating food avoid dripping from one food to

another. Use proper containers or place them on the bottom shelf of the refrigerator.

• Avoid eating raw or undercooked eggs.• Avoid drinking and using unpasteurized milk or milk

products.• Always wash hands thoroughly with soap after visiting

the restroom.CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

More About Prevention

• Extra attention must be taken when preparing nourishments for babies, seniors and immune-depressed persons.

• Keep everything clean. Take extra caution when handling raw meat or poultry.

• Wash hands after changing diapers.• Avoid direct or indirect contact between reptiles and

people at risk.• Children should avoid handling or playing with baby

ducks, baby chicks, and their surroundings.CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Getting Food Handlers CertifiedMany leading restaurant companies (McDonald’s, P.F. Chang, Denny’s, among others) are taking advantage of online certification classes for managers and food handlers.The classes cover safe practices when preparing and storing food, and they focus on foodborne disease prevention.The courses include tips on personal hygiene, avoiding cross-contamination, food allergy, cooking time and temperature, storing food safely, cleaning and sanitation of cooking utensils and the kitchen.Getting food handlers and managers certified is a big deal in preventing foodborne disease and keeping a restaurant open and safe to all.

Serv Safe (2014). About our program. Retrieved from https://www.servsafe.com/ss/FoodHandler/index.aspx

Local Statistics on Salmonellosis

• The data shows the numbers for 2012.• The incidence rate is

per 100,000.

4990Total Cases

Incidence Rate of 18.9

Texas545 Total Cases

Incidence Rate of 12.8

HarrisCount

y

DSHSTX (2013). Salmonellosis data for Texas. Retrieved from http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=29853&id=8589960296&terms=salmonellosis

Government involvement in Salmonellosis?• The CDC monitors the frequency and severity of

Salmonella outbreaks and helps local health department in investigating, responding, and solving outbreaks.

• The Food and Drug Administration (FDA) inspects processing plants, checks milk pasteurization processes, inspects imported foods, and regulates the sales of turtles one of the carriers of Salmonella.

• The US Department of Agriculture (USDA) keeps track of the animals’ health and their handling, inspecting slaughtering facilities, oversees the quality of meat and poultry, and inspects egg pasteurization plants.

• A program known as the National Antimicrobial Resistance Monitoring System (NARMS) is in charge of tracking antimicrobial resistance of Salmonella bacteria in humans and animals.

CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

Take Home Message

Hand washing and proper food handling is the most powerful weapon to fight salmonellosis.

How to Report a Foodborne Illness Outbreak

• First contact your local health department at www.houstontx.gov/health/Epidemiology/foodborneform.html

• Contact CDC about a foodborne illness, dial

1-800-CDC-INFO 

More Information About Salmonellosis Available At

www.cdc.gov/nczved/divisions/dfbmd/diseases/salmonellosis/www.fda.gov/Food/default.htmwww.fsis.usda.gov/wps/portal/fsis/homewww.foodsafety.gov/poisoning/causes/bacteriaviruses/salmonella/index.htmlwww.cdc.gov/salmonella/outbreaks-2014.html

Just Click on the Link to Open the Web Page

References:CDC (2010). Salmonella. Retrieved from http://www.salmonella/general/index.html

CDC (2014). Recent salmonella outbreaks. Retrieved from http://www.salmonella/Heidelberg-01-14/index.html

DSHSTX (2013). Salmonellosis data for Texas. Retrieved from http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?PageID=29853&id=8589960296&terms=salmonellosis

Mayo Clinic (2014). Salmonella infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/salmonella/basics/definition

Serv Safe (2014). About our program. Retrieved from https://www.servsafe.com/ss/FoodHandler/index.aspx

WHO (2014). Foodborne diseases. Retrieved from http://www.who.int/topics/foodborne_diseases/en

Any Questions???