|Bureau of Epidemiology|
|Bureau of Epidemiology||August 2001||Utah Department of Health|
Food Safety September is National Food Safety Education Month (NFSEM), an annual observance to focus attention on the importance of safe food handling in both home and commercial kitchens. In addition to drawing attention to safe food handling practices, we feel it important to focus on early identification of outbreaks and diagnosis of food borne illness in order to protect household contacts as well as members of the public as a whole. Primary care and emergency room physicians are often the first professionals to be notified of a possible food borne outbreak or disease. Cooperation between physicians, local health departments and state health departments is needed to protect individual and public health.
Clinical presentation is similar in many cases regardless of the etiologic agent. Differentiating food borne disease from other GI illness is difficult when patients have chronic diarrhea, severe abdominal pain or underlying chronic conditions. Food borne disease should be considered and laboratory testing done if any of the following signs and symptoms are present:
Table 1 provides a list of food borne illnesses that are notifiable in the United States. However, if an outbreak is suspected, it is not necessary to wait for laboratory confirmation before reporting to the local or state health department. Situations where two or more patients present with a similar illness that may have resulted from the ingestion of a common food, consumption of a classic outbreak-associated food within approximately 72 hours of symptom onset combined with symptoms typically seen in food borne illness should also be reported promptly to public health officials. In addition, clinical specimens should be collected for laboratory analysis.
Selection of appropriate treatment depends on identification of the responsible pathogen if possible. Most episodes of acute gastroenteritis are self limiting and require only fluid replacement and supportive care. Many antidiarrheal agents have potentially serious adverse effect in infants and young children; their routine use is not recommended in this age group. In addition, antimicrobial therapy for acute gastrointestinal illness is seldom necessary and may even have adverse effects. Treating E. coli O157:H7 with antibiotics can increase the risk of hemolytic uremic syndrome and treating salmonellosis can actually prolong carriage of the microbe.
Patients, especially children should be educated on proper hand washing procedures. In addition, consumers should be advised to prepare and store food properly. Growth of bacterial pathogens can be prevented if cold foods are properly refrigerated and hot foods are held at temperatures above 140 degrees. Avoid cross contamination by keeping raw meat, poultry and seafood away from ready to eat foods. Patients should also avoid drinking unpasteurized milk and juice. Raw fruits and vegetable should be washed thoroughly before eating.
Now its time to find out how well you know your diarrheal illnesses. Match the disease with the correct scenario.
1. A business traveler who returned one month ago from Mexico is ill with fatigue, jaundice, abdominal pain and diarrhea.______
2. A patient has had chronic intermittent diarrhea for about 3 weeks. There is no vomiting and no blood in the stool. The patient camps often and may have consumed untreated water._______
3. A child is brought to your office with fever, bloody diarrhea and vomiting and has a history of drinking unpasteurized milk within the last 48 hours._______
4. A child who presents with severe bloody diarrhea, abdominal cramps which have been present for two days. No fever. The family visited a petting zoo five days before onset of symptoms._______
5. Several family members are ill with diarrhea, fever and vomiting. The common food reported was Grandpas home-made ice cream, prepared using raw shelled eggs._______
6. A 23 year old female reports nausea, diarrhea, fever and muscle aches. Her food history includes homemade fresh soft cheese given to her by her neighbor about 36 hours before onset of illness._______
7. A day care provider reports an outbreak of diarrhea among her class and staff. Symptoms are abdominal cramps, fever, and diarrhea containing blood and mucus._______
8. Forty-eight hours after eating home-canned green beans, patient presents with vomiting, diarrhea, blurred vision and descending muscle weakness._______
9. A family of 4 is reports symptoms including nausea, vomiting and watery diarrhea. They returned yesterday from a trip to the East Coast. They reported eating raw oysters on the last night of the trip. ________
10. A cluster of illness characterized by cramping, abdominal pain, watery diarrhea, fever and vomiting appears among neighbors soon after their public water supply is changed. ________
KEY: 1-C, 2-E, 3-B, 4-F, 5-D, 6-H, 7-G, 8-A, 9-I, 10-J
Maryam will be assisting with epidemiologic investigations and analyses and preparation for the 2002 Winter Olympics. We are fortunate to have an EIS Officer and would like to welcome Maryam to Utah.Return
How Can You Prepare Now for the Flu Season? Get a Pneumococcal Vaccination! Pneumococcal disease is the leading cause of serious illness in children and adults throughout the world, and typically results in more deaths in the United States each year than all other vaccine-preventable diseases combined. The disease is caused by a common bacterium, Streptococcus pneumoniae and can affect anyone, primarily children under two years of age and adults over 65. Each year in the United States, pneumococcal diseases account for approximately 50,000 cases of bloodstream infection (bacteremia), 3,000 cases of meningitis (infection of the tissues and fluids surrounding the brain and spinal cord), and 100,000 to 175,000 hospitalizations from pneumonia.
Pneumococcal pneumonia is the most common clinical illness among adults. It is also a common bacterial complication of influenza and measles. Between 20,000 and 40,000 deaths are attributed to flu and pneumonia in the United States each year, with more than 90 percent of these deaths occurring in people age 65 and older. Symptoms of pneumococcal pneumonia may include an abrupt onset of fever, shaking chills, a productive cough, and stabbing chest pains that increase with breathing and coughing. The symptoms of meningitis include stiff neck, fever, mental confusion and photophobia. Bacteremia may include a combination of the symptoms of pneumonia and meningitis along with arthritis.Who should receive pneumococcal vaccine and when?
Because of the complications associated with pneumococcal disease, the polysaccharide pneumococcal vaccine is recommended for high-risk children >2 years of age and for adults, specifically those over 65 and with chronic medical conditions. A single dose of the pneumococcal polysaccharide vaccine protects against 23 types of pneumonia bacteria. Unlike the annual flu vaccine, pneumococcal vaccine can be given at any time during the year and is generally a lifetime vaccination. Revaccination is only recommended under certain conditions, depending upon the persons age and other high-risk factors. A recently licensed pneumococcal conjugate vaccine is now available for children under 2 years of age.
General Pneumococcal Polysaccharide Vaccine Recommendations:
Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary
August 2001 - Provisional Data
The Epidemiology Newsletter is published monthly by
the Utah Department of Health, Division of Epidemiology and Laboratory
Services, Office of Epidemiology, to disseminate epidemiologic information
to the health care professional
Send comments to: The Office of Epidemiology, Box 142104,Salt Lake City, UT 84114-2104, or call (801) 538-6191
Approval 8000008: Appropriation 3705
Rod Betit, Executive Director, Utah Department of