In addition to serving quality foods, learning how to prevent foodborne illnesses from occurring is part of the responsibility of food handlers to...
What is a foodborne illness? A foodborne illness outbreak occurs when...?
Foodborne illnesses are caused by pathogenic agents and are contracted through the consumption of contaminated food or ...
- Foodborne illnesses are caused by pathogenic agents and are contracted through the consumption of contaminated food or water.
- A foodborne illness outbreak occurs when two or more consumers become afflicted with a foodborne disease that has originated from a single food source.
- Proper food safety and hygiene practices, in addition to basic knowledge about the causative agents of foodborne diseases, are key steps in avoiding the spread of foodborne illnesses.
- What is a foodborne illness?
- What are the most common symptoms of a foodborne illness?
- What is a foodborne illness outbreak?
- What happens after a foodborne illness outbreak?
- Where do most of the foodborne illnesses occur?
- What to do during a foodborne illness outbreak?
- What to eat and not eat when you have a food poisoning?
- What are the 5 major foodborne illnesses?
- Which groups are least susceptible to foodborne illnesses?
- What are the most common causes of foodborne illnesses?
- What foods are most associated with foodborne illnesses?
- Prevalence of foodborne diseases around the world
- Best practices to avoid foodborne illness
- Digital solution to avoid foodborne illnesses
Food hygiene and restaurant cleanliness are vital to keeping yourself, your family, or your customers healthy. The lack of good hygiene and improper food handling practices have led to several outbreaks in the past. A foodborne illness outbreak occurs when contamination of food inflicts food poisoning on two or more customers at a given duration.
As a food handler, you are responsible for ensuring public safety from every restaurant meal you provide them with. In addition to foodborne illnesses and injuries, the lack of proper hygiene can also lead to serious economic loss due to reduced productivity.
What is a foodborne illness?
A foodborne illness is any condition resulting from the consumption of food contaminated with microbial pathogens such as bacteria, fungi, viruses, parasites, or chemical substances. Any causative agent can also include toxins derived from these foodborne pathogens which are harder to remove. These pathogens can naturally occur on food or contaminate food through cross-contamination from equipment, sick employee, or food as well. Shortly, a foodborne illness is a disease that is transmitted to people from the food, and causing it can be considered one of the food safety violations in restaurants.
Foodborne illnesses can be categorized as either food intoxication or food infection. Food infection refers to the disease caused by the microorganisms themselves, whereas intoxication is caused by the bacterial toxin these pathogens produce. The food itself can be contaminated at any stage, from the production, transportation, and storage, right through to cooking in your own home or food establishment.
Contamination can be a result of poor food handling practices. With a broad range of symptoms, it can be easy to confuse a foodborne illness with other illnesses. Still, with serious side effects and potential hospitalization or even death, you must pay attention to any symptoms you feel to dispose of the contaminated food.
Anyone can be a victim of any food-related illness while some are more susceptible than others.
Individuals considered to be more susceptible to foodborne illnesses include:
- Elderly people (65 and older)
- Children (younger than 5 years old)
- Immunocompromised people (people with chronic disease)
- Pregnant women (including the unborn baby)
What are the most common symptoms of a foodborne illness?
Foodborne infections take time to manifest their symptoms in an infected person. This factor depends on the incubation period of the causative pathogen on the unsafe food. The incubation period is the length of time it takes before the onset of symptoms becomes evident from the point of consuming a contaminated product. This period can range from hours to days on average depending on many factors such as the food you ate, the potential causative pathogen, and others.
Although highly variable, foodborne diseases usually have overlapping and common symptoms and medical conditions.
Some of the most common symptoms of foodborne illness include:
- Fever or mild illness
- Abdominal pain or Stomach cramps
- Watery Diarrhea or loose stools
- Dehydration (causes dry mouth)
In extreme cases, symptoms may persist for several hours and can worsen. Some severe foodborne illnesses can even manifest through symptoms such as bloody diarrhea, vomit, and even liver disease or respiratory failure. Once symptoms persist for several hours or if blood is detected in stool or vomit, you should seek immediate medical care. Similarly, in cases with severe diarrhea that lasts longer than three days, if your fever is above 101.5°F (38.6°C), blurred vision, severe stomach pain, or if your vomiting is stopping you from holding down liquids, it would be best to seek professional medical attention.
What is a foodborne illness outbreak?
A foodborne illness outbreak occurs when two or more persons become inflicted with the same foodborne disease that has been traced down to come from a common food source. To further confirm if the series of foodborne illnesses can be considered an outbreak, an authorized food agency will declare whether the implicated contaminated food is indeed the source of illnesses.
The effects of such an event can be devastating for food establishments. Outbreak costs can significantly drain a restaurant of its annual revenue. The typical cost of lawsuits, sanitation costs after, and the damages to the brand image can be very serious.
According to the Foodborne Disease Outbreak Surveillance System (FDOSS), a program with a dedicated response team structure of the Centers for Disease Control and Prevention (CDC), there are at least 250 agents that can cause a foodborne outbreak. Other agency programs function as a foodborne illness surveillance and response team for different outbreaks such as the FDA's Coordinated Outbreak Response and Evaluation (CORE). Any investigative team from these agencies helps address outbreaks once one is announced to control its effects and protect other consumers who may be in danger. They are also responsible for post-response activities to facilitate orderliness.
Based on an official survey on the occurrences of outbreaks, CDC alone conducts foodborne illness outbreak investigations to at least 17 to 36 cases of potential multistate outbreaks in the United States. These cases are mostly dominated by foodborne illnesses caused by bacterial pathogen types of Salmonella, Listeria, and E. coli.
Depending on the source of the foodborne illness, the ratio for outbreak level can be narrow or wide. Contaminated foods from a variety of settings including a small gathering, catering service, or restaurant service can cause a more narrow outbreak size than an outbreak caused by a contaminated batch of processed food that has been distributed nationwide. Once the local health department detects and establishes that an outbreak has occurred, public health officials are mandated to investigate the case. Regardless of the scale of the outbreak, swift action is one of the keys to minimizing its effects.
What was the most recent foodborne illness outbreak?
As we come near to the first quarter of 2022, at least 8 foodborne illness outbreaks have already occurred in the United States as reported by the FDA. These outbreaks may either be closed or active as of writing. One of the farthest-reaching outbreaks of early 2022, is the Salmonella outbreak whose source is yet to be released by the food agency. The foodborne illness outbreak has already infected at least 59 customers.
What was the worst Salmonella outbreak?
Salmonella is a bacteria that is considered one of the top 5 foodborne illness-causing microorganisms. In the past, this pathogen has caused some of the most notable outbreaks. Every year and in the United States alone, Salmonella is estimated to cause approximately 1.35 million infections. This pathogen is most commonly associated with poultry but is capable of contaminating other food items such as vegetables and fruits, especially with improper food handling.
There have been several cases of foodborne illnesses caused by this pathogen. Among the biggest and most far-reaching cases involve an outbreak traced back to the consumption of peanut butter and paste in 2008-2009. This foodborne illness outbreak infected at least 714 consumers across 46 states of the United States and Canada with a total of 9 deaths.
In 2015, another notable Salmonella outbreak caused 907 counts of foodborne illnesses across 40 states of the United States. Among these afflicted consumers, a death toll of 6 consumers was announced. This outbreak was traced to have been caused by contaminated cucumbers grown in Mexico.
What happens after a foodborne illness outbreak?
A foodborne illness outbreak is assessed and resolved by concerned food safety agencies through a systematic approach. Different agencies may have varying sequences of these approaches, but their principles are the same. These steps include:
- Detection of a potential outbreak
- Defining outbreak characteristics and collecting cases
- Generate hypotheses for the scenario
- Hypothesis testing
- Detection and solution to the point of pathogen contamination
- Outbreak control
These steps are based on the directives of the CDC. After an outbreak, food safety agencies and public health departments are tasked to provide sanctions to the implicated food manufacturers and issue health directives to the victims. During a foodborne disease outbreak investigation and once the outbreak has been properly controlled, measures such as inspecting the involved food company takes place. During this investigation, inspectors are tasked to find out what went wrong.
Once the foodborne illness investigations prove to be significant, food agencies can request a recall of potentially contaminated batches of the food in concern. This step is on to avoid any further foodborne diseases from happening due to the contaminated product. The authority of an agency to issue or request for recall varies. The FDA for example is authorized through the provisions of the Food Safety Modernization Act of 2011 to issue mandatory recalls, whereas other agencies can only request it.
During a recall, a public health alert may be released by food safety agencies to control any potential illness from recurring. In case of insubordination or if proven that the offense was deliberate or grave, food safety agencies have the discretion to temporarily or permanently shut down a food business. In cases where the company is proven to have deliberately committed food safety violations, they can face foodborne illness lawsuits which can cause a significant loss in revenue.
Where do most foodborne illness cases reported each year occur?
Foodborne illnesses can occur as a result of the lack of appropriate food safety practices and prevention activities at any point in the food supply chain. In a report released by the CDC, restaurants were most implicated in causing foodborne illness outbreaks more than any other sources. Restaurant-associated foodborne disease outbreaks are attributed to the 64% of outbreaks that occurred in 2017 alone.
The World Health Organization (WHO), together with over 100 food safety experts, estimated that most foodborne illnesses occur in the African and South-East Asian Regions. This estimate was based on the highest rates of occurrence and death tolls including children under 5 years.
What do you do during a foodborne illness outbreak?
In the unfortunate event that your food business has become implicated in a foodborne illness outbreak, your utmost cooperation with the authorities is needed. Immediate contact tracing and identification of the potentially contaminated food are very important. In such cases, restaurant employees must also be oriented with the proper operations on how to handle a foodborne illness outbreak.
What are the four steps you should take if there is a foodborne illness outbreak?
As part of your participation in the investigation and control of the outbreak, here are four things that you should do in case of a suspected foodborne illness outbreak:
- Immediately alert your local food safety authority and health department
- Limit operations
- Keep all potentially contaminated foods isolated without disposing of them
- Provide all necessary information to your local health officer
With these four steps, time is always of the essence. Your team must quickly alert officials to help you control the situation. This alert may also include contacting a health care provider to serve as an aid to the affected customers. While waiting, a team effort must be exerted to do everything to minimize the spread of an outbreak by limiting your operations. A very helpful tool in identifying the culprit in such situations is having a comprehensive food safety management system (FSMS) in your food business.
Under a comprehensive FSMS, you can trace the origin of the contaminant that caused the outbreak. Monitoring forms can show you if there was any problem with the preparation of the food such as in cooking. They can be an effective food safety surveillance tool. It would be problematic if the monitoring forms are not properly filled up nor are they correct at all.
A solution to this is to use a digital Food Safety Management System. At FoodDocs, our digital FSMS ensures that all monitoring forms are ensured to be accurate and timely filled. Our digital monitoring forms can be set to be automatically filled by our system based on your previous data entries. Additionally, we also feature a smart notification system that will alert food handlers of any task to be done.
What to eat when you have food poisoning?
With nausea after eating and other severe symptoms of food poisoning, eating is usually the last thing on your mind due to a potentially persistent upset stomach. However, once you feel you can eat, you should try any common food such as light, bland meals such as toast, bananas, cereals, or rice until you begin to feel better. Extra precaution must be practiced to avoid further upsetting the stomach.
As bloody diarrhea and vomiting are two symptoms of a foodborne illness that make people sick and dehydrated, you must drink plenty of clear liquids to rehydrate yourself. The concern for dehydration in patients suffering from acute diarrhea is high. If you feel you need it, you can also visit your local drug store or health unit to get an oral rehydration drink.
What not to eat when you have food poisoning?
After having bacterial food poisoning, it is best to avoid foods that may continue to cause nausea and bloating. In general, it is advised that you do not eat dairy foods, fatty foods, or spicy foods. Some specific foods that cause bloating after food poisoning to avoid are apples, beans, cabbage, onions, and garlic. In addition to these foods, you should try to avoid drinking coffee, dark sodas, milk, and caffeinated tea as these can easily cause abdominal cramps.
If you have any of the symptoms mentioned above, you should then contact your doctor or health care providers. Different countries have different agencies that conduct individual outbreak investigations and monitor any foodborne illness outbreaks in their country.
What are the 5 major foodborne illnesses?
According to the Center for Disease Control and Prevention, researchers have identified at least 250 foodborne disease outcomes. Among these agents, five (5) major pathogens have been identified to be the major foodborne illnesses that make people sick:
- Norovirus infection - may be acquired through the person-to-person spread, contaminated water and food, cross-contamination, and causes viral gastroenteritis.
- Salmonellosis - spread through foodborne transmission from contaminated and improperly handled food sources such as poultry, beef, eggs, fruits, and vegetables.
- Food poisoning and intoxication from Clostridium perfringens - can come from meat, poultry, gravies, and other foods that have been inadequately processed.
- Foodborne gastroenteritis from Campylobacter - can be contracted from undercooked poultry or cross-contaminating foods.
- Staphylococcal food poisoning - is caused by Staphylococcus aureus which is a commensal pathogen and can be transmitted from the skin to the food item with very inadequate food hygiene practices.
As mentioned, the causative agent for these illnesses includes pathogenic microorganisms and toxins produced by some of them. Foodborne illness-causing pathogens greatly vary in many ways and can be present singularly or in groups.
The diseases-causing pathogens greatly depend on factors such as:
- The type of food
- Presence of oxygen
- Amount of moisture in the food
Some disease-causing microorganisms are specific to certain conditions. Perhaps the best example of this is one of the most notorious pathogens, the Clostridium botulinum. This pathogen is responsible for the dreaded disease, botulism, which is caused by the toxin that the pathogen releases in certain conditions. Clostridium botulinum is a microorganism that is specifically found in conditions without oxygen such as in canned foods. Botulism is such a potent foodborne illness that it only takes 2 patients to be inflicted with it to declare an outbreak.
Some of the other common and dangerous types of pathogenic bacteria include E. coli, Listeria, Campylobacter, and Salmonella. As mentioned, an outbreak of Salmonella serotype is one of the major causes of foodborne illness and is extremely infamous for its effects in the infected person such as severe stomach pain and loose stools. Approximately 268,300 deaths have been recorded worldwide in previous estimates in 2015 alone because of adverse health consequences caused by this pathogen.
A foodborne illness outbreak occurs when two or more people become ill from consuming the same contaminated food product or drink. Some outbreaks are small-scale, so they can be easily monitored and eradicated. However, large outbreaks can easily spiral out of control when contaminated products are on the market and sold to thousands of consumers across the world. Over the past decade, serious foodborne illness outbreaks have occurred on every continent.
Which groups are least susceptible to foodborne illnesses?
Groups who are least likely to become affected by foodborne illnesses include healthy young and adult individuals. Healthy consumers include those who are not immunocompromised by any sicknesses and are not undergoing any medical treatment.
In healthy individuals, their immune systems are capable of fighting off particular amounts of foodborne pathogens. The human gut microflora contributes to this effect. It contains thousands of beneficial microorganisms that can act as antagonists against pathogens.
Despite this circumstance, it does not mean that healthy individuals cannot get sick from any foodborne illness. Depending on the microbial load of the contaminated products, healthy individuals can still get sick. A very high microbial load or toxin can dose can overthrow the body's immune responses. Additionally, some toxins such as the botulin from Clostridium botulinum are capable of killing individuals, healthy or not.
What are the most common causes of foodborne illnesses?
- Unhygienic or unsafe source of raw materials
Most pathogenic microorganisms abundantly thrive in soil. This means that they get almost inevitably transferred to food materials during harvest, storage, and delivery. This is most especially true for root crops. Without the proper food handling practices such as cleaning and sanitary storage areas, the risk of foodborne illnesses becomes higher.
- Inadequate cooking
One of the best ways to eliminate the threat of food safety hazards is to cook them to the correct internal temperature. Heat deactivates most of the known pathogenic microorganisms and can render the food safe. Cooking to the correct internal temperature ensures that foods such as raw meat are thoroughly free of pathogens.
- Improper storage or holding temperatures
As mentioned, food can become contaminated at any point in the whole food supply chain. Holding cooked food products at the wrong temperature increases the chances of surviving pathogens to more dangerous levels. This is even more concerning with high-risk foods. The safe temperature for storage can extend the shelflife of foods significantly.
One of the most common causes of foodborne illnesses, cross-contamination occurs when food preparation is done carelessly. It stems from inadequate segregation of equipment and foods; as well as uncooked foods from cooked food materials. Cross-contamination can easily spread pathogenic microorganisms.
- Poor personal hygiene
Perhaps the biggest cause of foodborne illness in dining restaurants is poor personal hygiene. As a food handler, whether you are at home or at a food establishment, you are expected to know and promote good food hygiene practices such as washing your hands.
What foods are most associated with foodborne illness?
Pathogenic microorganisms and other food safety hazards that can cause foodborne illnesses and related injuries are inherently present in food materials. Food processing and other food safety practices only aim to minimize or eliminate these hazards. As such, a variety of foods have been linked with certain foodborne illness-causing pathogens. This specificity may be due to the nature of the food material and the growing requirements of the pathogen.
Below are some of the common food sources that are most associated with some of the common foodborne illnesses:
- Raw meat, poultry, fish, and their derived products. Different types of uncooked foods may harbor various pathogens, with some being more prevalent than others. A good example of this is poultry. Chicken, duck, or turkey, when not cooked properly, can cause foodborne illnesses related to Salmonella, Campylobacter, and Listeria which are found in the feathers and guts of birds.
- Vegetables and fruits. These food products are rich in vitamins and nutrients and therefore are great growing media for pathogens. Both vegetables and fruits may house bacteria such as E.coli and Salmonella as well as yeasts and molds that can have negative effects.
- Unpasteurized milk. Before determining the key foodborne disease-causing pathogen, consumption of raw milk has caused several outbreaks. Pasteurization was designed to kill pathogenic bacteria that can cause severe illness and are specifically known to be found in raw milk (e.g. Coxiella burnetti and Mycobacterium tuberculosis)
- Untreated water. Although it may seem unlikely, unclean and untreated water houses many known pathogens and has been linked as a source of outbreaks including vibriosis and diarrheal illness or traveler's diarrhea caused by E.coli. This is why having clean drinking water is an essential part of a comprehensive food safety management system.
- Rice and root crops. Like vegetables, these agricultural products are grown very close to the soil and therefore can harbor several pathogenic microorganisms. Rice, specifically, is known to be a good medium for food intoxication-causing bacteria Bacillus cereus.
Despite being good reservoirs for pathogenic microorganisms, any food source can become free from these hazards and mitigate the risks of foodborne illnesses. With adequate processing, adequate knowledge of food hygiene practices, and good management, such risks are significantly decreased.
Prevalence of foodborne diseases around the world
Many people do not realize the wide reach of foodborne illnesses, but with thousands of deaths every year, it is something important to pay attention to. According to the World Health Organization (WHO), unsafe food causes 600 million cases of foodborne diseases and 420 000 deaths every year. These cases are distributed all over the world.
Below we will go through some foodborne illness statistics from Australia, Canada, the European Union, the United Kingdom, and the United States.
Despite being known as a country with high standards when it comes to food safety, the USA is not exempted from the risks of foodborne illnesses. Food poisoning remains one of the most significant public health threats. According to the USDA Food Safety and Inspection Service, foodborne illness estimates for at least $15.6 billion every year to the American economy. This economic impact is due to the loss of productivity and mortality rates once afflicted with the condition. The longer the duration of illness, the greater the economic impact.
The Australian government predicts that approximately 4.1 million Australians are affected by foodborne illnesses every year, with 31,920 hospitalizations, and 86 deaths. That breaks down to 11,233 new cases every day on average.
In a report released by the country's foodborne diseases active surveillance network, OzFoodNet, approximately 450 foodborne illness outbreaks occurred in Australia from 2013 to 2015. This accounts for 7,361 people affected by these gastrointestinal illness outbreaks and at least 705 hospitalizations with 18 deaths. In Australia, the biggest cause of foodborne illness is attributed to the pathogen, Salmonella.
In Canada, at least 1.6 million cases of foodborne illnesses occur every year, with 4000 hospitalizations and 105 deaths. However, this is only taking into account cases of known foodborne illnesses, and they report a further 2.4 million cases, 7,600 hospitalizations, and 133 deaths each year listed as caused by unspecified agents. To date, the Government of Canada has estimated at least 4 million cases of foodborne illnesses in the country every year. This estimate includes 11,600 hospitalizations and 238 deaths per year.
In the UK, The Food Standards Agency (FSA) estimates a total of 2.4 million cases of foodborne illnesses annually, with 16,400 hospitalizations and 180 deaths. These cases happen despite the very stringent and comprehensive protocols of the FSA to mitigate food safety hazards.
The biggest cause of foodborne illness is attributed to two causative agents, the Norovirus and Campylobacter spp in the UK. In 2017, at least 56, 729 cases were caused by Campylobacter sp. Outbreaks concerning the two previously mentioned pathogens as well as Salmonella have been reported in the UK over the last few years as well.
Best practices to avoid foodborne illness
Despite being prevalent all over the world, foodborne illnesses are very much preventable and can be controlled. The efforts of food safety agencies and like-minded organizations all over the world have led to standard food safety management systems that aim to avoid food hazards from occurring and protect public health.
Within these food safety management systems are basic food safety principles and practices that everyone can do to mitigate the spread of foodborne illness agents and control food safety issues.
If you are unsure, send it back
Particularly if you have ordered meat, fish, or poultry that you believe has not been cooked fully, do not hesitate to send it back to the kitchen. The workers should always have your safety in mind and make sure the food has been cooked thoroughly.
The four C's is a term coined by countries worldwide, as it is the best way to avoid foodborne illnesses simply and effectively to lessen the possibility of contaminating food and passing on a foodborne illness.
- Cleaning: You can avoid the spread of harmful bacteria and viruses by maintaining good personal hygiene standards and keeping work surfaces and utensils clean. Always make sure to wash your hands, especially after handling raw foods, garbage, or going to the toilet.
- Cooking: It is vital when preparing food, particularly raw shellfish, meat, fish, and poultry, that you make sure the food is cooked thoroughly. To make sure, you can always use a food thermometer to ensure the food you have cooked is at least 167°F (75°C) or hotter. When reheating food, always ensure it is completely heated by using a meat thermometer, and never reheat food more than once. Always check that the reheated food is heated evenly throughout. Additionally, if you intend to store foods longer than two hours, hot foods and cold foods must be kept from the temperature danger zone.
- Chilling: Unrefrigerated leftover food is an extremely common cause of food poisoning. It is vital that leftovers are refrigerated within two hours of eating, or one hour if it is particularly hot outside (90°F or 32°C). Always eat leftover food within three to four days, or less if you think it seems necessary. That is the best way to limit bacterial growth in food. If you need to refrigerate food, make sure your refrigerator is set between 32°F and 41°F (0-5°C). That said, dangerous pathogens grow well between 41°F -135°F (5°C-57°C)
- Cross-contamination: Cross-contamination is when bacteria are transferred from one food to another. This usually occurs with raw foods. This usually happens when foods touch each other or when bacteria on your hands, equipment, work surfaces, or utensils are transferred to other food. Following food health and safety guidelines and making sure your kitchen and equipment are always clean is the best way to avoid cross-contamination.