Epidemiology of Common

Food Born Diseases

Dr. Moutafa ElHousinie
 Enterica
Typhoid fever
Diarrhea
Gastroenteritis
 Enterica, typhoid and paratyphoid
fever
 A world-wide disease
 17 million cases per year, 600000 deaths
 Endemic in less developed countries
 Epidemics and outbreaks may occur on
top of endemic status
 S. Para occurs sporadically or outbreaks
 Clinical Picture
 IP 1-3 weeks
 Fever, headache, abdominal discomfort,
relative bradycardia, cough and
abdominal rosy spots on 7th day of fever
 May pass un-noticed as mild or sub-clinical
case with the development of chronic
carrier status
 S. paratyphi – less severe and less
frequently diagnosed
 Organism and source
 Salmonella typhi, S. paratyphi A, B and C
 Intestines of humans (rarely in S paratyphi
in domestic animals)
 Excreted in stools and urine of humans
 Humans as cases or carriers – more
urinary carriers with Schistosomiasis
 Carriers may be temporary or chronic
 Transmission
 Human to food or drinks including milk -----
carriers among food handlers ---
inadequate toilet hygiene
 Sewage to drinking water ---- piping
system through shellfish raw vegetables or
fruits
 The organism is resistant to dryness and
cold temperature (contaminated water
used to make ice)
 Flies especially in summer
 Epidemiology
 In endemic areas more common in
preschool and school children (5-19)
 More in summer.
 Young males.
 Common foods as camps, prisons, hotels
and restaurants.
 Urban slums
 Low socio-economic status
 Diagnosis
 Blood culture
 Widal test: a rising titre
 Stool and urine culture
 Therapeutic test
 Prevention
 General:
 Environmental sanitation
 Food and water sanitation
 Health education for toilet hygiene
 Specific
 Vaccination TAB heat killed phenol-preserved
 0.5 ml – 4weeks – 1ml SC
 To specific groups
 Oral live avirulant vaccine
 Control
 Case
 Notification
 Isolation
 Disinfection: concurrent and terminal
 Treatment
 Release: 3 negative successive 24 hours
apart stools. 1st after four weeks from onset
 Control
 Contacts
 Under surveillance for 3 weeks
 TAB vaccine
 Search for carrier
 Control
 Environment: (also applied to epidemic
measures)
 Search for source: carriers among food
handlers, sewage leakage ..etc
 Super-chlorination of water
 Supervision for restaurants, hotels, camps
..etc
 Health education programs for food and water
sanitation
 Diarrhea and Dysentries
Share the epidemiology of Enterica

 Diarrhea > 3 passes of loose stools/day

 Dysentery tenesmus stools mucus and blood
 Gastroenteritis vomiting and diarrhea
 Travellers’ diarrhea self-limited condition
 Diarrhea and Dysentries
 E. coli most frequent
 Rota virus, Shigella, Salmonella
------------------------ sometimes
 Staph. Aureus, Giardia, chlosteridia
------------------- less common
 Vibrios and E. histolytica
---------------------------------- rare
 Gastro-enteritis
 Vomiting + Diarrhea ± fever
 Dehydration ----- the main complication
 Viral, Bacterial or Parasitic
 IP hours, days, weeks according to agent
 The main cause of deaths in infants and
preschool children in less developed
countries with bad environmental
sanitation.
 Gastro-enteritis
Epidemiology
 Both sexes
 Two months – Five years
 Summer
 Weaning
 Malnutrition
 Low socio-economic standards
 Lack of environmental hygiene: food,
water and flies
 Gastro-enteritis
Control
 Early case finding (health education to
mothers)
 Rehydration therapy:
 ORS for mild – moderate cases
 or IV fluids for severe cases
 Chemotherapy
 Diet therapy
 Treatment of specific causes
 ORS
 Saline = water + NaCl + KCl + NaHCO3
 Glucose < 20% added to facilitate
absorption of water and electrolytes
 Packets…add to each 100 ml of safe
water and give by spoon
 The main cause of the drop of IMR during
the last 20 years.
 Gastro-enteritis
Prevention
 Health education
 Health promotion
 Environmental sanitation
 Specifics for specific infections