A survey of important emerging and reemerging foodborne diseases including their biological, chemical and physical etiological spectrum. Role of epidemiology in the study of foodborne diseases; measurement of commonality of foodborne diseases using rates, proportions and prevalence. Principles of outbreak investigation with training exercises on classical foodborne diseases. Identification, characterization, and modeling of the consumer’s risk for foodborne diseases. Introduction to HACCP approach in the prevention of foodborne diseases and tracking of foodborne pathogens from farm to table. Identification, assessment, management, and communication of the public health risks associated with foodborne microbial and chemical hazards.

 

Foodborne diseases, emerging and reemerging: Introduction

a.     Ecological Changes and Agricultural Development

b.     Changes in Human Demographics and Behavior

c.      International Travel and Commerce

d.     Technology and Industry

e.     Microbial Adaptation and Change

f.        Breakdown of Public Health Measures and Deficiencies in Public Health Infrastructure

A.     Introduction to food safety epidemiology (rates and proportions. Incidence and prevalence     of foodborne diseases).

B.     How much disease? Estimated frequency of foodborne disease in the US.

a.     Morbidity and mortality rates:

                                                              i.      Attack rate

                                                            ii.      Prevalence

                                                          iii.      Time

                                                           iv.      Temporal relation between exposure and occurrence

                                                             v.      How to graph time data

                                                           vi.      Number of cases over time

                                                         vii.      Rates over time

                                                       viii.      Special features

                                                           ix.      Examining your graph

                                                             x.      Epidemic curves

                                                           xi.      Point sources epidemics

                                                         xii.      Person to person

                                                       xiii.      Intermittent or continuing common source

                                                       xiv.      Information on place

                                                         xv.      How to examine place

                                                       xvi.      Person

b. Attribute categories

c. Examination of person data

d. Interpretation of person data

C. Epidemiologic investigation. Reasons and standards for epidemiologic investigations.

                                                              i.      Operational aspects of epidemiologic investigations

                                                            ii.      Legal considerations in a Field investigation

                                                          iii.      Investigation in food catering facilities

                                                           iv.      Investigation in child care facilities

                                                             v.      Epidemiologic investigation in international settings

                                                           vi.      Laboratory support for the epidemiologic investigation in the field

                                                         vii.      Dealing with the public and the media

                                                       viii.      The response and responsibilities:

a.      To control and prevent further disease

b.      b. To provide agreed upon or statutorily mandate services

c.      To derive more information about interaction between the human host, the foodborne agent, and the environment

d.      To strengthen surveillance at eh local level through assessment of its quality and by direct and personal contact or to determine the need to establish a new surveillance system

e.      To provide training opportunities in epidemiology

f.        What resources, including personnel, will be available locally?

g.      What resources the visiting team will provide?

h.      Who will direct the day-to-day investigation?

i.        Who will provide the overall supervision and ultimately be responsible for the investigation?

j.         How will the data be shared and who will be responsible for their analysis?

k.      Will a report of the findings be written?

D. Ten steps of field investigation:

1.      Determine the existence of the epidemic

2.      Confirm the diagnosis

3.      Define a case and count cases

4.      Orient the data in term of time, place, and person

5.      Determine who is at risk of becoming ill

6.      Develop a hypothesis explaining the specific exposure that caused disease and test this hypothesis by appropriate statistical methods

7.      Compare the hypothesis with the established facts

8.      Plan a more systemic study

9.      Prepare a written report

10.Execute control and preventive measures of foodborne pathogens

A.                 Consumption frequency as a risk factor for foodborne diseases

B.                 Consumption frequency estimates for different subpopulations

C.                Data needed for the estimation of consumption frequency of food by different populations.

D.                Surveys with individual food data. Sources:

1.     The National Health and Nutrition Examination Survey III (NHANES III)

2.     The continuing Survey of Food Intake by Individuals II conducted by the USDA. (CSFII II)

3.     The Market Research Corporation of America Panel Diary Survey

4.     The National Purchase Dairy Group, Inc, National Eating Trends Survey

E.                 Consumption probability illustrations

1.     Probabilistic Scenario Analysis

2.     Event tree

3.     Fault tree

4.     Raw foods

                                                              i.      Raw beef (raw ground beef, steak tartare, raw liver)

                                                            ii.      Raw fish (Unspecified, flounder, herring, mackerel, mullet, ocean perch, pompano, salmon, trout, tuna, squid)

                                                          iii.      Raw shellfish (Clams, mussels,, and oysters)

                                                           iv.      Raw eggs (Raw whole egg, raw egg yolk, and raw egg white)

                                                             v.      Calculation of expected number of foodborne illness cases

A.                 Seven Principles of HACCP:

1.     Hazard analysis

2.     Determine critical control points

3.     Establish critical limits for critical control points

4.     Monitoring critical control points

5.     Corrective action

6.     Record keeping

7.     Verification

B.                 Definitions Used in HACCP

C.                Steps in Designing a HACCP Plan

D.                Good Manufacturing Practices

E.                 Regulatory Requirements for HACCP Implementation (and understanding the pathogen reduction act) requirements, development, and implementation of HACCP in

1.     Laying poultry farms,

2.     Duck production farms,

3.     Meat packing plants, and

4.     Food retail outlets

A.                 Current microbial food safety system

B.                 Factors increasing the risk of foodborne infection or the severity of illness:

1.     Microbial factors

                                                              i.      Campylobacter in broilers

                                                            ii.      Salmonella Enteritidis in eggs

                                                          iii.      E. coli O157:H7 in beef

2. Host-related factors

C.       Uses of risk:

1.      Prediction

2.      Cause

3.      Diagnosis)

4.      Prevention

5.      Comparing risks

6.      Attributable risk

7.      Relative risk

8.      Population attributable risk

9.      Population attributable fraction

1.      Determining acceptable risk

2.      Setting safety standards

3.      Benefit-Cost Analysis in safety standards

4.      Selecting cost-Effective methods for reducing Foodborne illness

5.      Risk mediation techniques