ENPH 110 Introduction to Environmental Health Session 14: Food Quality By the end of class you should be able to: Describe foodborne illness trends in the U.S. Explain how outbreaks are investigated and reported Name agents and causes of foodborne illness Explain the steps in foodborne illness outbreak investigations Describe how multi-state foodborne illness outbreaks are identified Explain how outbreaks are controlled Objectives Foodborne Illness (FBI) Outbreaks in the US, 2013 CDC, 2015 Rates of Foodborne Infection by Year, CDC, 2011 Changes in Bacterial Infection Incidence, to 2012 CDC, 2011 Top 5 pathogens causing foodborne illnesses in 2011 CDC, 2011 Top 5 pathogens causing foodborne- related deaths in 2011 CDC, 2011 Norovirus CDC, 2011 aka Stomach Flu or 24 hour flu Symptoms: vomiting, diarrhea, stomach cramping lasting for 24 hours Onset: symptoms within hours after ingesting virus Very contagious: found in stool and vomit of infected people Spread by not washing hands after using toilet or via aerosolized vomit Very difficult to detect in the lab Hand sanitizer does not inactivate! *Known cause of FBI 20%; unknown 80% = Norovirus Process for local health departments Ill persons report to state Occurrence of two or more similar illnesses resulting from ingestion of a common food If two or more separate parties report illness from same establishment, outbreak investigation occurs State acquires: history of persons who have eaten at establishment Employee information Employee illness logs Local health department performs interviews of ill persons/all employees Collection of stool samples Epidemiologic analysis/report by state Case-control Foodborne Illness Outbreak Investigations CDC, 2011 Process for CDC Active surveillance system: Foodborne Illness Surveillance, Response, and Data Systems (FoodNet) Information collected weekly from clinics in surveillance areas (10 states) Confirmed cases: 10 different foodborne pathogens Use samples from confirmed cases to fingerprint DNA and link cases across the country through PulseNet (Pulsed-field Gel Electrophoresis) National molecular subtyping network for foodborne bacterial pathogens Foodborne Illness Outbreak Investigations CDC, 2011 Sliced Tomatoes: Salmonella CDC, 2011 Sliced Tomatoes: Salmonella CDC, cases (18 confirmed) No foodworkers ill prior to cases Tomatoes highly significant in ingredient-specific analysis Grown in California CDC, 2011 CDC, 2011 1.Purchasing food from unsafe source 2.Failing to cook food adequately 3.Holding food at incorrect temperature 4.Using contaminated equipment 5.Poor personal hygiene Top 5 CDC Risk Factors for FBI Food safety: health inspection Restaurant inspections (high, med, low) Temporary events School kitchens Plan reviews for new construction HACCP audits Foodborne illness outbreak investigations Food Code Critical and non- critical violations Pathogen tracker:In groups, record and upload into D2L: Throughout the investigation, define these terms: Riboprint Incidence Matched pairs analysis (aka case - control) Food recall What pathogen caused the outbreak? What food was contaminated and how? How do outbreak investigators determine the mode of food contamination? What is the best response to stop transmission and the outbreak? Group activity