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PubMed2004

The effect of temperature on food poisoning: a time-series analysis of salmonellosis in ten European countries.

We investigated the relationship between environmental temperature and reported Salmonella infections in 10 European populations. Poisson regression adapted for time-series data was used to estimate the percentage change in the number of cases associated with a 1 degree C increase in average temperature above an identified threshold value. We found, on average, a linear association between temperature and the number of reported cases of salmonellosis above a threshold of 6 degrees C. The relationships were very similar in The Netherlands, England and Wales, Switzerland, Spain and the Czech Republic. The greatest effect was apparent for temperature 1 week before the onset of illness. The strongest associations were observed in adults in the 15-64 years age group and infection with Salmonella Enteritidis (a serotype of Salmonella). Our findings indicate that higher temperatures around the time of consumption are important and reinforce the need for further education on food-handling behaviour.

Adolescent↗
PubMed2000

Food labeling, safe handling statements, labeling of shell eggs; refrigeration of shell eggs held for retail distribution. Food and Drug Administration, HHS. Final rule.

The Food and Drug Administration (FDA) is revising its food labeling regulations to require a safe handling statement on cartons of shell eggs that have not been treated to destroy Salmonella microorganisms. The agency also is requiring that, when held at retail establishments, shell eggs be stored and displayed under refrigeration at a temperature of 7.2 degrees C (45 degrees F) or less. FDA is taking these actions because of the number of outbreaks of foodborne illnesses and deaths caused by Salmonella Enteritidis (SE) that are associated with the consumption of shell eggs. These actions also respond, in part, to petitions from Rose Acres Farm, Inc., and the Center for Science in the Public Interest (CSPI). Safe handling statements will help consumers take measures to protect themselves from illness or deaths associated with consumption of shell eggs that have not been treated to destroy Salmonella (all serotypes). Refrigeration of shell eggs that have not been treated to destroy Salmonella will help prevent the growth of SE in shell eggs.

Consumer Product Safety↗
PubMed2004

Cholera epidemic associated with raw vegetables--Lusaka, Zambia, 2003-2004.

Zambia experienced widespread cholera epidemics in 1991 (13,154 cases), 1992 (11,659), and 1999 (11,327). In response to the large outbreak in 1999, the Zambian Ministry of Health (ZMOH) urged use of in-home chlorination with the locally produced solution, Clorin, and the practice increased substantially Clorin had been introduced in Zambia in 1998 as part of the Safe Water System (SWS), a point-of-use water disinfection and safe-water storage strategy launched by the Society for Family Health, in partnership with ZMOH, the U.S. Agency for International Development, and CDC. Although no outbreaks were reported during 2000-2002, cholera remained endemic. Epidemic cholera returned to Zambia in November 2003, when cases of toxigenic Vibrio cholerae O1, serotype Ogawa, biotype El Tor were confirmed in the capital city, Lusaka. During November 28, 2003-January 4, 2004, an estimated 2,529 cholera cases and 128 cholera deaths (case-fatality rate [CFR] = 5.1%) occurred in Lusaka. In February 2004, the Lusaka District Health Management Team (LDHMT) invited CDC to assist in an investigation of the epidemic. This report summarizes the results of that investigation, which implicated foodborne transmission via raw vegetables and demonstrated a protective role for hand washing with soap. The results underscore the importance of hygiene, clean water, and sanitary food handling for cholera prevention.

Adolescent↗
PubMed2001

Evaluation of food safety education for consumers.

Traditionally, nutrition educators have used a fairly global approach to teach food safety by teaching a broad range of safe food handling behaviors in the expectation that this will lead to the avoidance of foodborne illness. This approach can be confusing and lead to evaluation data that are difficult to interpret. This article suggests that food safety education and evaluation in the future be organized around five behavioral constructs: practice personal hygiene, cook foods adequately, avoid cross-contamination, keep foods at safe temperatures, and avoid food from unsafe sources. These five constructs are derived from data on actual outbreaks and estimated incidences of foodborne illness. Research is needed to establish reliable and valid evaluation measures for these five behavioral constructs. Evaluation instruments can be tailored to fit specific education programs. If evaluation instruments focus on these five behavior areas, the result will be meaningful evaluation data that can be more easily summarized across food safety education programs for consumers.

Adolescent↗
PubMedDate not supplied

Evaluation of a HACCP pilot program for the food service industry.

OBJECTIVE: To evaluate the efficacy and applicability of a HACCP-based program for use in restaurants. PARTICIPANTS: A randomly selected sample of 16 intervention and 42 control full service, "stand-alone" restaurants with a minimum of 3 full-time food handling staff on duty per shift. SETTING: Six communities in Central West Ontario. INTERVENTION: The Critical Approach, a HACCP-based program for use in restaurants, was designed in consultation with health inspectors and restaurant operators. It focusses on generic risk factors (Critical Control Points, CCPs) for food handlers rather than assessing specific menu items or foods; offers appropriate training of both management and staff; and encourages self-monitoring of CCPs by operators without extensive record keeping or retention. OUTCOMES: Outcome indicators measured changes in three areas: the environment, knowledge, and behaviour. CONCLUSION: Results suggest that among a subpopulation of restaurants, the program is acceptable to operators and capable of producing tangible results. Principles and methods of the program (i.e., an initial assessment of the site, working with the operator to identify and suggest improvements, and return visits to monitor compliance) may be transferable to other types of food service operations.

Food Contamination↗
PubMed2005

Attitudes, practices, and beliefs of individuals consuming a raw foods diet.

OBJECTIVE: Describe dietary practices of U.S. raw foods leaders, examine diet rationale, attitudes and health practices of raw foodists. DESIGN: Nonexperimental, descriptive, using semistructured qualitative interview data. PARTICIPANTS: Purposeful (nonrandom) sample of 17 U.S. raw foods leaders, including 11 males and 6 females. Leaders were targeted to provide insights into practices modeled for larger community. PHENOMENA OF INTEREST: Attitudes, practices, and beliefs of individuals consuming a raw foods diet. ANALYSIS: Text analysis and simple descriptive statistics. RESULTS: Subjects averaged 13 years on the diet (range: 3-32 years). Twelve subjects reported a diet at least 85% raw. All diets were primarily vegan. Primary constituents included fruits and juices, vegetables, nuts and seeds, and vegetable fats. Subjects consumed no dairy, eggs, meat, fish, poultry, commercial sweets or alcohol in a typical week. Only one subject used a commercial, nonfood-based supplement weekly (vitamin B12). Six subjects consumed food-based supplements, and remainder used no supplements at all. On average, subjects met or exceeded recommended intakes of vegetables, fruits, and fats and did not meet recommendations for calcium-rich foods, protein-rich foods, and grains. CONCLUSIONS AND IMPLICATIONS: Those counseling raw foodists must understand the rationale and practices that characterize this eating style. Further research is needed on larger populations to validate findings and determine the extent to which reported health benefits may compare to those from other vegetarian diets. Further studies should examine food-handling and preparation practices in relation to food safety and raw produce.

Adult↗
PubMed1991

Hepatitis A outbreak involving bread.

An outbreak of hepatitis A involved more than 50 residents of a group of villages in the late spring and summer of 1989. The only food that was common to all the laboratory-confirmed cases was bread, purchased either unwrapped or as rolls, sandwiches or filled rolls, and supplied either directly from one shop or indirectly through its subsidiary outlets. It was concluded that this bread was the most likely vehicle of transmission of the hepatitis A virus and that the bread was contaminated by soiled hands which were inadequately washed because of painful skin lesions. Comprehensive control measures were successful in limiting further spread of the infection. This outbreak highlights the transmissibility of hepatitis A virus on food. The use of disposable gloves when handling food which is to be consumed without further cooking would prevent transmission of this or other infectious agents by this route.

Bread↗
PubMed2005

An outbreak of norovirus gastroenteritis associated with wedding cakes.

We sought to determine the source of a norovirus outbreak among attendees of 46 weddings taking place during a single weekend. Norovirus-compatible illness was experienced by 332 (39%) of wedding guests surveyed; the outbreak affected up to 2700 persons. Illness was associated with eating wedding cake provided by a bakery common to the weddings (adjusted RR 4.5, P<0.001). A cake requiring direct hand contact during its preparation accounted for the majority of illness. At least two bakery employees experienced norovirus-compatible illness during the week preceding the weddings. Identical sequence types of norovirus were detected in stool specimens submitted by two wedding guests, a wedding hall employee, and one of the ill bakery employees. It is likely that one or more food workers at the bakery contaminated the wedding cakes through direct and indirect contact. These findings reinforce the necessity of proper food-handling practices and of policies that discourage food handlers from working while ill.

Disease Outbreaks↗
PubMed2001

Enteric virus contamination of foods through industrial practices: a primer on intervention strategies.

Hepatitis A and E viruses, rotaviruses, Norwalk-like caliciviruses, and astroviruses are among the enteric viruses known to cause food- and waterborne illness. These viruses are spread by the fecal-oral route and are a major cause of morbidity and mortality worldwide. Foods may be contaminated at any time pre- or post-harvest; however, many outbreaks are associated with foods handled by infected restaurant workers. Produce may be contaminated by improper irrigation or fertilization practices, by the hands of infected pickers or processors, or as the result of adulteration during any stage of handling. Outbreaks have been commonly associated with foods which are served raw or only lightly cooked, such as molluscan shellfish, fruits and vegetables, and salads or products contaminated after cooking like frosted bakery products. The farming, shellfish, processing, transportation, and restaurant industries must maintain vigilance to reduce outbreaks of enteric virus illness. Intervention strategies to enhance product safety include increased industry and consumer education; changes in industrial practices, product management, and processing technologies; worker immunizations; and the development of improved monitoring tools for the detection of enteric viruses in foods.

Caliciviridae Infections↗
PubMed2004

A quantitative analysis of cross-contamination of Salmonella and Campylobacter spp. via domestic kitchen surfaces.

Epidemiological data indicate that cross-contamination during food preparation in the home contributes noticeably to the occurrence of foodborne diseases. To help prevent such occurrences, the inclusion of a cross-contamination model in exposure assessments would aid in the development and evaluation of interventions used to control the spread of pathogenic bacteria. A quantitative analysis was carried out to estimate the probability of contamination and the levels of Salmonella and Campylobacter spp. on salads as a result of cross-contamination from contaminated chicken carcasses via kitchen surfaces. Data on the prevalence and numbers of these bacteria on retail chicken carcasses and the use of unwashed surfaces to prepare foods were collected from scientific literature. The rates of bacterial transfer were collected from laboratory experiments and literature. A deterministic approach and Monte Carlo simulations that incorporated input parameter distributions were used to estimate the contamination of the product. The results have shown that the probability of Campylobacter spp. contamination on salads is higher than that of Salmonella spp., since both the prevalence and levels of Campylobacter spp. on chicken carcasses are higher than those of Salmonella spp. It is realistic to expect that a fraction of the human exposure to Campylobacter spp., in particular, originates from cross-contamination in private kitchens during food handling. The number of human campylobacteriosis cases could be reduced either by reducing the degree of Campylobacter spp. contamination on chicken carcasses or by improving the hygiene in private kitchens. To eliminate the cross-contamination route, it is important to use separate surfaces or to properly wash the surfaces during the preparation of raw and cooked foods or ready-to-eat foods.

Animals↗
PubMed1975

Gastrointestinal illness on passenger cruise ships.

Medical logs of 2,445 cruises taken by 38 vessels over a 20-month period beginning Jan 1, 1972, were reviewed. On 92% of the cruises, the recorded incidence of gastrointestinal illness was 1% or less; on 2% of cruises, it was 5% or greater. The actual incidence of gastrointestinal illness determined by a questionnaire survey of passengers sailing on nine cruises was found to be at least four times as high as that recorded in the medical logs. Although the cause of the illnesses was not known, there was evidence that transmission took place aboard ship. A survey of food-handling practices and water systems aboard selected ships demonstrated a significant potential for transmission of foodborne and waterborne disease.

Delivery of Health Care↗
PubMedDate not supplied

[Contact urticaria with transition to protein contact dermatitis in a cook with atopic diathesis].

Protein contact dermatitis is a rare disease within the group of occupational dermatoses. However, it is of some importance to people in food handling occupations. Skin symptoms usually manifest as immediate-type reactions (type-I-reaction according to Coombs and Gell), but changes to type IV-reactions are known. This applies especially to people with atopic eczema who have contact to fish proteins. This can be derived from a case presented here and a few similar observations described in the literature.

Animals↗
PubMed2004

Risk factors for sporadic Campylobacter infection in the United States: A case-control study in FoodNet sites.

Campylobacter is a common cause of gastroenteritis in the United States. We conducted a population-based case-control study to determine risk factors for sporadic Campylobacter infection. During a 12-month study, we enrolled 1316 patients with culture-confirmed Campylobacter infections from 7 states, collecting demographic, clinical, and exposure data using a standardized questionnaire. We interviewed 1 matched control subject for each case patient. Thirteen percent of patients had traveled abroad. In multivariate analysis of persons who had not traveled, the largest population attributable fraction (PAF) of 24% was related to consumption of chicken prepared at a restaurant. The PAF for consumption of nonpoultry meat that was prepared at a restaurant was also large (21%); smaller proportions of illness were associated with other food and nonfood exposures. Efforts to reduce contamination of poultry with Campylobacter should benefit public health. Restaurants should improve food-handling practices, ensure adequate cooking of meat and poultry, and consider purchasing poultry that has been treated to reduce Campylobacter contamination.

Adolescent↗
PubMed2001

Consumer acceptance of irradiated meat and poultry in the United States.

Food manufacturers in the United States are currently allowed to irradiate raw meat and poultry to control microbial pathogens and began marketing irradiated beef products in mid-2000. Consumers can reduce their risk of foodborne illness by substituting irradiated meat and poultry for nonirradiated products, particularly if they are more susceptible to foodborne illness. The objective of this study was to identify the individual characteristics associated with willingness to buy irradiated meat and poultry, with a focus on five risk factors for foodborne illness: unsafe food handling and consumption behavior, young and old age, and compromised immune status. A logistic regression model of willingness to buy irradiated meat or poultry was estimated using data from the 1998-1999 FoodNet Population Survey, a single-stage random-digit dialing telephone survey conducted in seven sites covering 11% of the U.S. population. Nearly one-half (49.8%) of the 10,780 adult respondents were willing to buy irradiated meat or poultry. After adjusting for other factors, consumer acceptance of these products was associated with male gender, greater education, higher household income, food irradiation knowledge, household exposure to raw meat and poultry, consumption of animal flesh, and geographic location. However, there was no difference in consumer acceptance by any of the foodborne illness risk factors. It is unclear why persons at increased risk of foodborne illness were not more willing to buy irradiated products, which could reduce the hazards they faced from handling or undercooking raw meat or poultry contaminated by microbial pathogens.

Age Factors↗
PubMed1991

Escherichia coli O157:H7 and its significance in foods.

Escherichia coli O157:H7 was conclusively identified as a pathogen in 1982 following its association with two food-related outbreaks of an unusual gastrointestinal illness. The organism is now recognized as an important cause of foodborne disease, with outbreaks reported in the U.S.A., Canada, and the United Kingdom. Illness is generally quite severe, and can include three different syndromes, i.e., hemorrhagic colitis, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Most outbreaks have been associated with eating undercooked ground beef or, less frequently, drinking raw milk. Surveys of retail raw meats and poultry revealed E. coli O157:H7 in 1.5 to 3.5% of ground beef, pork, poultry, and lamb. Dairy cattle, especially young animals, have been identified as a reservoir. The organism is typical of most E. coli, but does possess distinguishing characteristics. For example, E. coli O157:H7 does not ferment sorbitol within 24 h, does not possess beta-glucuronidase activity, and does not grow well or at all at 44-45.5 degrees C. The organism has no unusual heat resistance; heating ground beef sufficiently to kill typical strains of salmonellae will also kill E. coli O157:H7. The mechanism of pathogenicity has not been fully elucidated, but clinical isolates produce one or more verotoxins which are believed to be important virulence factors. Little is known about the significance of pre-formed verotoxins in foods. The use of proper hygienic practices in handling foods of animal origin and proper heating of such foods before consumption are important control measures for the prevention of E. coli O157:H7 infections.

Animals↗
PubMed2003

Calicivirus infections in children.

PURPOSE OF REVIEW: Caliciviruses are a major cause of human illness, and are listed as category B pathogens according to the National Institute of Allergy and Infectious Diseases classification of pathogens important for biodefense. Caliciviruses are commonly encountered in contaminated food and water, and a large variety has been implicated as sources of infection during outbreak investigations. RECENT FINDINGS: New names for two of the four genera of the Caliciviridae were approved in 2002. They are Norovirus, for what were previously called Norwalk-like viruses or small, round-structured viruses, and Sapovirus, for what were previously called Sapporo-like viruses. Caliciviruses are highly diverse genetically and antigenically. This diversity complicates the design of diagnostic assays, yet can be used to discriminate contaminating and infecting strains during outbreak investigations. Of particular interest is the recent finding of naturally occurring recombinant Norovirus strains, all of which have been virulent and are widely dispersed and apparently ecologically indistinguishable from other calicivirus strains. This finding is considered in light of the evidence for recombination between caliciviruses and picornaviruses, and recombination as a more general phenomenon for virus evolution. SUMMARY: Continued investigations of calicivirus outbreaks are now focusing on the implicated sources of infection. While many foods and environmental waters have long been implicated as outbreak sources, the methods for detecting caliciviruses are being developed and refined. Recognition is now turning to unexpected sources of contamination, such as presumably clean foods and waters, including bottled water and minimally handled foods. Parallels between Norovirus and Salmonella ecology and epidemiology are noted, as a guide to understanding evolving new information about caliciviruses.

Caliciviridae↗
PubMed1997

Emerging issues in microbiological food safety.

Many microorganisms previously unrecognized as food-borne or harmful are emerging as human pathogens transmitted by food. This is a result of recent acquisition of key virulence factors, detection by newly developed isolation procedures, or astute detective-like laboratory skills of microbiologists. Six microbial pathogens, including Shiga toxin-producing Escherichia coli, Listeria monocytogenes, Arcobacter butzleri, Helicobacter pylori, Cryptosporidium parvum, and Cyclospora, have become recognized as significant causes of human illness. Although the ecology and epidemiology of illness caused by some of these pathogens have not been fully elucidated, food has the potential of being an important vehicle in their dissemination. Existing technologies and new approaches such as irradiation and hazard analysis critical control point (HACCP) programs are useful tools in the control of food-borne hazards. However, because of ever-changing products, processes, food-handling practices, societal habits, and pathogens, emerging food-borne diseases will continue to be an important public health concern.

Campylobacter Infections↗