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Animal diseases of public health importance.

The Food and Agriculture Organization's (FAO) interest in emerging diseases caused by foodborne pathogens derives from its role as the leading United Nations agency with a mandate for food quality and safety matters. The Food Quality and Standards Service of FAO's Food and Nutrition Division is active in all areas related to food safety and implements the FAO/World Health Organization Food Standards Program. Its activities include providing assistance to FAO's member nations in addressing problems, strengthening infrastructure, promoting standardization as a means of facilitating trade, and safeguarding the interests of consumers. This paper considers the importance of emerging foodborne diseases from the perspectives of the consumer, international trade in food, producers and processors, and developing countries and addresses prevention and control measures.

Animal Feed↗

The need for continuous training in food factories.

The dissemination in food factories of the organisms I have referred to earlier, represent significant and interesting issues of public health concern. Yet there seem to be difficulties in incorporating material in education-training-information programmes explaining merely the most simple and basic facts about the risk involved in food being contaminated in food factories. Such educational programmes are essential components in the overall scheme of foodborne disease control, yet they often represent the weakest links in the control chain. There has been a decline in the emphasis on food hygiene in some programmes at the level of institutions of higher education, and a de-emphasis on food hygiene has occurred over the past few decades in schools of veterinary medicine in some parts of the world. This committee has taken active steps to improve this situation by convening a professorial consultation on post-graduate teaching in advanced food microbiology, Copenhagen 1989 (Park, 1990). The public, as well as politicians, focus for the time being on chemical contamination of foods, possible presence of residues, thereby ignoring the fact that statistically it is not the residues that cause deaths which count, but, without a shadow of doubt, the foodborne pathogens. This fact emphasizes the need for intensive training in preventive hygienic measures. Since representatives of the food industry are participating in the Symposium, I would like to balance the problems by saying: we all share a responsibility in securing education in food hygiene in food factories.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Continuing↗

Surface architecture of the bacterial envelope determines phage adsorption route in pathogenic Escherichia coli O157:H7.

UNLABELLED: The outermost surface layers of Gram-negative bacteria determine phage access to terminal receptors, yet their genetic basis has been mapped almost exclusively in laboratory strains that lack them. Here we apply genome-wide RB-TnSeq fitness profiling to four Escherichia coli O157:H7 strains from distinct phylogenetic clades sharing the O157 O-antigen, using 38 phages with terminal receptors previously mapped in E. coli K-12 strain. RB-TnSeq fitness landscapes across all four pathogenic backgrounds were mostly similar, and dominated by surface-associated loci, including the gfc-etk group 4 capsule operon, O-antigen biosynthesis genes, LPS core assembly genes and outer membrane proteins. Disruption of gfc-etk abolished infection in 11 genetically diverse myoviruses, establishing the O-antigen capsule as a widespread required primary recognition substrate. O-antigen loci generated two classes of fitness score patterns. For 10 phages, disruption increased infectivity, indicating it is a barrier to receptor access; for 3 others, disruption abolished infectivity, demonstrating it can also be a primary recognition substrate. Outer membrane protein receptor identity was conserved across laboratory and pathogenic backgrounds, with the same proteins recognized in both K-12 and O157:H7, while glycan layer state determines whether these receptors are reached. These results demonstrate that outer surface glycan layers can act as primary and optional recognition substrates for phage infection, or as physical barriers preventing terminal receptor access. Extending the ability to probe phage-targeted receptors beyond outer membrane proteins provides a framework for incorporating glycan layer state into predictive models of phage-host interactions. IMPORTANCE: Bacteriophage-based interventions for controlling Escherichia coli O157:H7, a major foodborne pathogen responsible for tens of thousands of illnesses annually in the United States, require a mechanistic understanding of the factors governing strain-level susceptibility. Predictive frameworks developed in laboratory model strains lacking O-antigen and capsular polysaccharides can map the terminal protein receptors that phages bind, but are currently limited in their ability to determine whether those receptors are accessible in pathogenic isolates carrying full outer surface complexity. This study provides the first genome-scale, functional genetic map of phage susceptibility determinants in O157:H7 and demonstrates that the state of the outer surface layers, specifically the O-antigen and the gfc-etk capsule, determines whether phages can reach conserved terminal receptors. This finding explains differences in phage susceptibility between strains sharing nearly identical gene content, and identifies the molecular layers that must be characterized to predict phage host interaction in pathogenic E. coli backgrounds.

Journal Article↗

Antimicrobial-resistant and extraintestinal pathogenic Escherichia coli in retail foods.

BACKGROUND: Extraintestinal Escherichia coli infections are associated with specialized extraintestinal pathogenic E. coli (ExPEC) strains and, increasingly, with antimicrobial resistance. The food supply may disseminate ExPEC and antimicrobial-resistant E. coli. METHODS: In a prospective survey of 1648 diverse food items from 10 retail markets in the Minneapolis-St. Paul area during 2001-2003, selective cultures and disk-diffusion assays for the isolation and characterization of antimicrobial-resistant E. coli and polymerase chain reaction-based assays and O serotyping to define ExPEC-associated traits were performed. RESULTS: E. coli contamination exhibited a prevalence gradient from miscellaneous foods (9%), through beef or pork (69%), to poultry (92%; P<.001). Among E. coli-positive samples, similar prevalence gradients were detected for antimicrobial resistance (27%, 85%, and 94% of samples, respectively; P<.001) and ExPEC contamination (4%, 19%, and 46%, respectively; P<.001). By multivariate analysis, beef or pork and poultry from natural-food stores exhibited reduced risks of E. coli contamination and antimicrobial resistance. Indirect evidence suggested on-farm selection of resistance. Four food-source ExPEC isolates (from pea pods, turkey parts, ground pork, and vegetable dip) closely resembled selected human clinical isolates by O antigen and genomic profile. CONCLUSIONS: Retail foods may be an important vehicle for community-wide dissemination of antimicrobial-resistant E. coli and ExPEC, which may represent a newly recognized group of medically significant foodborne pathogens.

Animals↗

Molecular detection of Clostridium botulinum type E neurotoxin gene in smoked fish by polymerase chain reaction and capillary electrophoresis.

The polymerase chain reaction (PCR), a rapid, sensitive technique for amplifying target DNA sequences of pathogenic microorganisms, was used to amplify Clostridium botulinum type E neurotoxin gene fragments in smoked fish. Other botulinal neurotoxin-producing strains, nontoxigenic strains, and food-related microorganisms did not yield nonspecific amplification products with this PCR assay. PCR products were analyzed by capillary electrophoresis (CE) using a low-viscosity entangled polymer system. Resolution, sensitivity, and DNA sizing accuracy were improved, and analytical times were markedly shortened. The PCR/CE assay detected the C. botulinum type E neurotoxin gene in as few as 10 cells. The technique to other foods may also be a valuable tool for detecting foodborne pathogens.

Animals↗

Prevention and control of enterohaemorrhagic Escherichia coli (EHEC) infections: memorandum from a WHO meeting. WHO Consultation on Prevention and Control of Enterohaemorrhagic Escherichia coli (EHEC) Infections.

Escherichia coli is a commonly occurring inhabitant of the intestine of humans and other animals, but there are several pathogenic types of E. coli which cause a variety of human diseases. One of these pathogenic types, E. coli O157:H7, belongs to the group of enterohaemorrhagic E. coli (EHEC) which produce potent toxins and cause a particularly severe form of disease, haemorrhagic colitis (HC). About 10% of patients with HC can go on to develop haemolytic uraemic syndrome (HUS), a life-threatening complication of E. coli O157:H7 infection that is characterized by acute renal failure, haemolytic anaemia, and thrombocytopenia. These sequelae are particularly serious in young children and older people. On average, 2-7% of patients with HUS die, but in some outbreaks among the elderly the mortality rate has been as high as 50%. This Memorandum reviews the growing importance of E. coli O157:H7 as a foodborne pathogen and reports on the issues of surveillance, outbreak investigation, and control strategies with respect to EHEC infections that were discussed at the WHO Consultation on Prevention and Control of EHEC Infections, held in Geneva on 28 April to 1 May 1997. Recommended measures for prevention and control include the following: use of potable water in food production; presentation of clean animals at slaughter; improved hygiene throughout the slaughter process; appropriate use of food processing measures; thorough cooking of foods; and the education of food handlers, abattoir workers, and farm workers on the principles and application of food hygiene.

Child↗

Foodborne listeriosis.

Various epidemiological investigations of outbreaks and sporadic cases have clearly demonstrated that the consumption of contaminated food is responsible for a high proportion of listeriosis cases and Listeria monocytogenes has been increasingly recognized as an important foodborne pathogen over the last 15 years. The emergence of listeriosis is the result of complex interactions of different factors: medical progress which increases the lifespan and allows immunodeficient people to survive, expansion of the food industry and cold storage systems as well as changes in food habits. None of these factors on its own is entirely responsible. Considerable research has attempted to characterize the organism, define the magnitude of the public health problem and its impact on the food industry, identify the risk factors associated with the disease, and devise appropriate control strategies. Nevertheless, a number of crucial questions remains incompletely elucidated (extent of the foodborne transmission of listeriosis, health status of apparently "healthy patients" with the possible role of an intercurrent infection or genetic susceptibility, how to distinguish highly virulent from less virulent strains of L. monocytogenes, factors contributing to the emergence of outbreaks, the possible role of healthy carriers in the epidemiology of listeriosis, etc.). To investigate the complexity of listeriosis requires the close collaboration of clinicians, epidemiologists, clinical and food microbiologists, food scientists and the food industry. A large amount of data has been accumulated during the past 10 years but more research is required to elucidate the epidemiology of the disease and the virulence of the causative agent.

Disease Outbreaks↗

Foodborne listeriosis.

Listeria monocytogenes emerged as an important foodborne pathogen in the latter part of the 20th century. Clinical syndromes caused by this microorganism include sepsis in the immunocompromised patient, meningoencephalitis in infants and adults, and febrile gastroenteritis. Focal infections at other sites are less frequent. Listeria species are commonly found in raw and unprocessed food products. Major outbreaks of listeriosis, with high morbidity and mortality, have been caused by a variety of foods, including soft cheeses, delicatessen meats, and vegetable products. Improved detection methods, dietary recommendations, and, in some cases, preemptive antibiotic treatment or prophylaxis have reduced the incidence of sporadic listeriosis infections in the United States. Microbial virulence factors distinguishing environmental strains of L. monocytogenes from invasive strains causing foodborne illness and host factors promoting human infection remain incompletely understood.

Adult↗

Assessment of control measures to achieve a food safety objective of less than 100 CFU of Listeria monocytogenes per gram at the point of consumption for fresh precut iceberg lettuce.

The important new concept of the food safety objective (FSO) offers a strategy to translate public health risk into a definable goal such as a specified maximum frequency or concentration of a hazardous agent in a food at the time of consumption that is deemed to provide an appropriate level of health protection. For the foodborne pathogen Listeria monocytogenes, there is a proposed FSO of < 100 CFU/g in ready-to-eat (RTE) products at the time of consumption. Fresh precut iceberg lettuce is one of these RTE products. In this study, we worked with a commercial manufacturer to evaluate the effectiveness of two antimicrobial washing agents (sodium hypochlorite and a mixture of hydrogen peroxide and peroxyacetic acid) against L. monocytogenes under simulated fresh precut washing conditions and evaluated the growth potential of this pathogen on lettuce packaged in a gas-permeable film and stored at 4 or 8 degrees C for 14 days. We used the results of this experiment to demonstrate how the commercial manufacturer could meet the FSO for L. monocytogenes in fresh precut lettuce through the application of performance, process, and microbiological criteria.

Colony Count, Microbial↗

Nonimmunized egg yolk powder can suppress the colonization of Salmonella typhimurium, Escherichia coli O157:H7, and Campylobacter jejuni in laying hens.

If colonized, poultry shed enteric pathogens in the feces. Of those that colonize poultry Salmonella spp., Campylobacter jejuni (C. jejuni), and Escherichia coli (E. coli) O157:H7 are the most concern to the industry. The authors previously discovered that the introduction of 5% dried nonimmunized egg yolk powder in the regular feed could eliminate and prevent Salmonella enteritidis intestinal colonization of laying hens. Hence, the efficacy of nonimmunized dried egg yolk powder supplement in controlling the colonization of laying hens with Salmonella typhimurium (S. typhimurium), C. jejuni, and E. coli O157:H7 was investigated in this study. The 10% (wt/ wt) egg yolk powder eliminated S. typhimurium after 2 wk of feeding and the 5 and 7.5% (wt/wt) supplements significantly (P < 0.05) reduced the frequency of colonization. Similarly, 7.5 and 10% egg yolk powder reduced the colonization of C. jejuni and E. coli O157:H7 significantly (P < 0.05) after 1 wk of feeding. In the prevention trial, pathogen-free chickens were fed supplemented feed (10% egg yolk powder) for 4 wk and were then infected. S. typhimurium was prevented from colonizing the intestine throughout the 4-wk test, and E. coli O157:H7 colonization was delayed for 2 wk. C. jejuni and E. coli O157:H7 populations in the intestine were significantly (P < 0.05) suppressed by egg yolk powder supplementation throughout the test. None of the supplement concentrations affected BW or the mean weight and number of the eggs laid per hen. At the end of the study, the organisms were absent or significantly (P < 0.05) reduced in the intestine, ovary, oviduct, and spleen of hens fed the egg yolk powder treatment. This study indicates that nonimmunized egg yolk powder is able to reduce the frequency of colonization of foodborne pathogens and prevent these organisms from colonizing the intestinal tract. Addition of egg yolk powder to the regular feed at a concentration of 7.5 to 10% (wt/wt) may be a simple means of reducing or inhibiting S. typhimurium, C. jejuni, and E. coli O157:H7 colonization in laying hens.

Animal Feed↗

Molecular applications for identifying microbial pathogens in the post-9/11 era.

Rapid advances in molecular and optical technologies over the past 10 years have dramatically impacted the way biologic research is conducted today. Examples include microarrays, capillary sequencing, optical mapping and real-time sequencing (Pyrosequencing). These technologies are capable of rapidly delivering massive amounts of genetic information and are becoming routine mainstays of many laboratories. Fortunately, advances in scientific computing have provided the enormous computing power necessary to analyze these enormous data sets. The application of molecular technologies should prove useful to the burgeoning field of microbial forensics. In the post-9/11 era, when securing America's food supply is a major endeavor, the need for rapid identification of microbes that accidentally or intentionally find their way into foods is apparent. The principle that distinguishes a microbial forensic investigation from a molecular epidemiology study is that a biocrime has been committed. If proper attribution is to be attained, a link must be made between a particular microbe in the food and the perpetrator who placed it there. Therefore, the techniques used must be able to discriminate individual isolates of a particular microbe. A battery of techniques in development for distinguishing individual isolates of particular foodborne pathogens is discussed.

Bioterrorism↗

[Maximum likelihood estimation of date of infection in an outbreak of diarrhea due to contaminated foods assuming lognormal distribution for the incubation period].

This paper proposes a new method for estimating the date of infection in an outbreak of diarrhea caused by eating foods contaminated by some sort of foodborne pathogens such as Escherichia coli O-157:H7. Simple methods for calculating maximum likelihood estimator and confidence interval are proposed assuming (1) a common date of infection and (2) the incubation period has a log-normal distribution. Further, this paper shows that all three methods proposed so far for estimating the date of infection under the same assumptions are theoretically inappropriate or computationally imprecise. The proposed methods are illustrated with data from three outbreaks of Escherichia coli O-157:H7 and outbreak due to Escherichia coli O-118:H2 in Japan.

Disease Outbreaks↗

Consumer knowledge of foodborne microbial hazards and food-handling practices.

A national telephone survey was conducted of 1,620 randomly selected U.S. residents who spoke English, were at least 18 years old, and resided in households with kitchen facilities. Respondents were interviewed about their recognition of foodborne pathogens, foods at risk for transmitting infection, knowledge of safe food handling, and food-handling practices. One-third of the respondents who prepared meals reported unsafe food hygiene practices: e.g., they did not wash hands or take precautions to prevent cross-contamination from raw meat. Unsafe practices were reported more often by men, adults 18 to 29 years of age, and occasional food preparers than by women, persons 30 years old or older, and frequent food preparers. Respondents who identified a food vehicle for Salmonella spp. were more likely to report washing their hands and cleaning cutting boards after preparing raw meat and poultry. The results raise concerns about consumer food-handling practices. The influence of food safety training, food-handling experience, and age on food-handling practices should be studied further. Awareness of a food vehicle for Salmonella spp., for example, may indicate knowledge of the etiology of foodborne disease that promotes safe food handling. Understanding the factors associated with safe food handling will assist in development of effective safe-food instruction programs.

Adolescent↗

Bacterial microflora of normal and telangiectatic livers in cattle.

OBJECTIVE: To identify potential bacterial pathogens in normal and telangiectatic livers of mature cattle at slaughter and to identify consumer risk associated with hepatic telangiectasia. SAMPLE POPULATION: 50 normal livers and 50 severely telangiectatic livers. PROCEDURE: Normal and telangiectatic livers were collected at slaughter for aerobic and anaerobic bacterial culture. Isolates were identified, and patterns of isolation were analyzed. Histologic examination of all livers was performed. RESULTS: Human pathogens isolated from normal and telangiectatic livers included Escherichia coli O157:H7 and group-D streptococci. Most livers in both groups contained bacteria in low numbers; however, more normal livers yielded negative culture results. More group-D streptococci were isolated from the right lobes of telangiectatic livers than from the left lobes, and more gram-negative anaerobic bacteria were isolated from left lobes of telangiectatic livers than from right lobes. All telangiectatic lesions were free of fibrosis, active necrotizing processes, and inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: The USDA regulation condemning telangiectatic livers is justified insofar as these livers contain more bacteria than normal livers do; however, normal livers contain similar species of microflora. Development of telangiectasia could not be linked to an infectious process. The finding of E coli O157:H7 in bovine livers suggests that information regarding bacterial content of other offal and muscle may identify sources of this and other potential foodborne pathogens and assist in establishing critical control points for the meat industry.

Animals↗

[The infectious disease epidemiology research network--a bridge between science and public health service. The example of the network for foodborne infections].

In order to respond to emerging food borne diseases, a new data-driven approach guided by epidemiologic and microbiologic data has been developed in Germany. An interdisciplinary network of scientists at the national, regional and local levels conducted surveillance and epidemiologic research of foodborne pathogens (Shiga toxin-producing Escherichia coli (STEC), Salmonella and Campylobacter). The objectives of the network include (1) determining incidence and distribution of STEC and Salmonella, (2) assessing the importance of typing systems for Campylobacter, (3) determining risk factors for sporadic STEC infections, (4) developing a system for detection of disperse outbreaks, including a national reference library of pulsed-field gel electrophoresis (PFGE) patterns, (5) examining risk factors for outbreaks, (6) carrying out a quantitative microbiological risk assessment for consumption of fresh chicken and (7) determining long-term sequelae of HUS patients.

Bacterial Infections↗

Thermal tolerance of acid-adapted and non-adapted Escherichia coli O157:H7 and Salmonella in ground beef during storage.

Thermal tolerance of acid-adapted Escherichia coli O157:H7 or Salmonella in ground beef was evaluated during storage at 4 degrees C or -20 degrees C. Both pathogens were adapted to acidic conditions (pH approximately 4.6) by growing in tryptic soy broth supplemented with 1% glucose. A five-strain cocktail of E. coli O157:H7 or Salmonella was grown separately in TSB (pH approximately 6.6) and TSB + 1% glucose for 24 h at 37 degrees C to provide cells with or without acid adaptation. Irradiated ground beef was inoculated with either acid-adapted or non-adapted E. coli O157:H7 or Salmonella; the samples stored at 4 degrees C were subjected to heat treatment at 62 degrees C or 65 degrees C on days 1, 7, 14, 21, and 28, and the samples stored at -20 degrees C were subjected to heat treatment at 62 degrees C or 65 degrees C on days 1, 30, 60, 90, and 120. Decimal reduction time (D values) of the pathogens was determined as an indicator of thermal tolerance. Significantly higher D(62) values were observed on days 21 and 28 for non-adapted E. coli O157:H7 stored at 4 degrees C and on days 90 and 120 for non-adapted E. coli O157:H7 stored at -20 degrees C (P < 0.05). Higher D(62) values were observed on days 21 and 28 among non-adapted Salmonella strains stored at 4 degrees C and on day 28 for acid-adapted strains of Salmonella stored at 4 degrees C (P < 0.05). Higher D(62) values for acid-adapted strains of Salmonella stored at -20 degrees C were observed on days 30, 60, and 90 (P < 0.05), when while no differences were observed in the D(65) values of acid-adapted and non-adapted strains of E. coli O157:H7 and Salmonella throughout storage at both temperatures (P > 0.05). This suggests that acid adaptation of foodborne pathogens provides a certain level of protection against heat treatment at lower cooking temperatures, while at higher temperatures there were no observed differences between the sensitivity of acid-adapted and non-adapted strains in an actual food system over an extended period of refrigerated and frozen storage.

Adaptation, Physiological↗

[Excess mortality associated with antibiotic resistant Salmonella typhimurium].

INTRODUCTION: The use of antimicrobials in food production has been associated with drug-resistance in foodborne pathogens such as Salmonella and Campylobacter. However, little is known about the health impact of antimicrobial drug-resistance in these pathogens. In a matched cohort study, we determined the mortality associated with drug-resistance in Salmonella Typhimurium. MATERIAL AND METHODS: Data from the Danish Surveillance Registry for Enteric Pathogens were linked with the Civil Registration System and the Danish National Patient Registry. By survival analysis, the two-year mortality among patients was compared with a matched sample of the general Danish population adjusted for differences in comorbidity. RESULTS: Among 2047 cases of S. Typhimurium, 59 deaths were identified. Patients with pan-susceptible strains of S. Typhimurium were 2.3 times (95 per cent confidence interval [CI] 1.5-3.5) more likely to die in the two-year follow-up period after infection than persons in the general Danish population. Patients infected with strains resistant to ampicillin, chloramphenicol, streptomycin, sulfonamide, and tetracycline were 4.8 times (95 per cent CI 2.2-10.5) more likely to die, whereas quinolone-resistance was associated with a 10.3 times (95 percent CI 2.8-37.8) higher mortality than the general population. DISCUSSION: Overall, infections with S. Typhimurium were associated with excess mortality. Patients infected with multi-drug resistant strains had a tendency towards higher mortality than patients infected with non-multiresistant strains. Particular risk was associated with quinolone-resistance in foodborne S. Typhimurium, and the excess mortality among patients infected with multi-drug resistant S. Typhimurium could be attributed to additional quinolone resistance in many of the multi-drug resistant isolates.

4-Quinolones↗

Public health aspects of food irradiation.

In view of the enormous health and economic consequences of foodborne diseases, the World Health Organization (WHO) encourages its Member States to consider all measures to eliminate or reduce foodborne pathogens in food and improve their supplies of safe and nutritious food. With the wholesomeness of irradiated food clearly established by extensive scientific studies, food irradiation has important roles to play in both ensuring food safety and reducing food losses. Food irradiation may be one of the most significant contributions to public health to be made by food science and technology since the introduction of pasteurization. Because the promotion of a safe, nutritious and adequate food supply is an essential component of its primary health care strategy, WHO is concerned that the unwarranted rejection of this process may endanger public health and deprive consumers of the choice of food processed for safety.

Animals↗