How toxic is Salmonella in the food you prepare?

1. How toxic is Salmonella in the food you prepare? Adrienne N. Jones – MPH student/researcher

2. What is Salmonella? • “Salmonella is a motile, non-sporeforming, Gram- negative, rod-shaped bacterium in the family” (Lampel, Al-Khaldi, & Cahill, 2012, p. 12) • Salmonella is a foodborne disease • The bacteria Salmonella can be found in eggs, raw fruits and vegetables, poultry, and unpasteurized milk and juice Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm

3. The affects of Salmonella • The bacteria salmonella causes Salmonellosis (non-typhoid) and typhoid fever, or Salmonella typhi (Typhimurium) • “There are many different kinds of these bacteria. Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common types in the United States” (Food Poisoning Health Center, 2012). • Salmonellosis (non-typhoid) can be less threatening than typhoid fever; however, reports show that salmonellosis can cause death as well (Lampel, Al-Khaldi, & Cahill, 2012, p. 12-13). • “Every year, approximately 42,000 cases of salmonellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be twenty-nine or more times greater” (Centers of Disease Control and Prevention, 2012). Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html Food Poisoning Health Center. (2012). Retrieved from the internet athttp://www.webmd.com/food-recipes/food-poisoning/tc/ salmonellosis-topic-overview Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm

4. Salmonella in the food we eat?

5. More affects of Salmonella • Persons “infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection…the illness usually lasts 4 to 7 days, and most persons recover without treatment” (Centers of Disease Control, 2012). • Salmonella enters the body through the oral route and once infected the bacteria “may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics”; the most susceptible victims to severe salmonellosis are the elderly, infants, and individuals in which are immunocompromised (Centers of Disease Control, 2012). • Research also shows that about 400 people expire every year as a result of acute salmonellosis, and the morbidity continues to increase (Centers of Disease Control, 2012). Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html

6. Salmonellosis vs. food • “Many kinds of food can become contaminated with the first type, from meats and eggs to fruits and vegetables, and even dry foods, like spices and raw tree nuts” (Lampel, Al-Khaldi, & Cahill, 2012, p. 12). • There are many types of foods that may be contaminated with salmonella, these foods include: meats, eggs (especially unpasteurized eggs), fruits, vegetables, as well as spices and raw tree nuts (Lampel, Al-Khaldi, & Cahill, 2012, p. 12). • Most important fact: The typhoidal (salmonella) illness is typically associated with sewage-contaminated drinking water, or crops irrigated with sewage-contaminated water • So as you can see salmonella is also waterborne Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet athttp://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm

7. How Salmonella is diagnosed • “Determining that Salmonella is the cause of the illness depends on laboratory tests that identify Salmonella in the stool of an infected person..OnceSalmonella has been identified, further testing can determine its specific type” (Centers of Disease Control and Prevention). • According to the Centers of Disease Control and Prevention (2012), “Antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin, are not usually necessary unless the infection spreads from the intestines…Some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of food animals” (http://www.cdc.gov/salmonella/general/diagnosis.html) • Infected individuals that do not seek medical help and/or are unable to may die. The stakes are much higher when typhoid fever is the cause. Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html

8. Statistics • In the U.S.: In reference to non-typhoidalsalmonellosis , “A recent report from the Centers for Disease Control and Prevention (CDC) estimates that 1,027,561 cases of domestically acquired nontyphoidal salmonellosis occur annually in the U.S., when under-reporting and under-diagnosis are taken into account” (Lampel, Al-Khaldi, & Cahill, 2012, p. 14). • “In terms of domestically acquired S. enterica serotype Typhi, the CDC recently estimated that a mean of 1,821 cases occur annually in the U.S. Additional cases in the U.S. are associated with foreign travel…The report estimates that 433 cases of typhoid fever in the U.S., overall (i.e., whether or not they are domestically acquired), are culture-confirmed” (Centers of Disease Control and Prevention, 2012). Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm

9. Thinking yet…?

10. Salmonella outbreaks Outbreaks that occurred in the U.S. in 2012 • Peanut Butter– SalmonellaBredeney • Hedgehogs – SalmonellaTyphimurium • Mangoes – SalmonellaBraenderup • Cantaloupe – SalmonellaTyphimurium and Salmonella Newport • Ground Beef-SalmonellaEnteritidis • Live Poultry– SalmonellaHadar Centers of Disease Control and Prevention. (2012). Salmonella: Reports of the Selected Salmonella Outbreak Investigation. Retrieved from the internet at http://www.cdc.gov/salmonella/outbreaks.html

11. Facts about Salmonella • “In Brazil, from 1999 to 2008, there were 6,602 outbreaks of foodborne diseases, and Salmonella spp. was present in 43% of the outbreaks in which the etiologic agent was identified” (Medeiros, Oliveira, Rodrigues, & Freitas, 2011, p. 555). • Research shows that “Extensive antibiotic use and subtherapeutic doses in the diet can contribute to increased prevalence of multidrug­resistant bacteria in human and veterinary medicine” (Medeiros, Oliveira, Rodrigues, & Freitas, 2011, p. 557). • In many countries, “prevalence rates can vary—for example, from 13.0% to 88.2%” (Medeiros, Oliveira, Rodrigues, & Freitas, 2011, p. 557). • The widespread use of antibiotics bacteria in animals “can spread through the food chain and a pool of resistance genes can be transferred to human pathogens, reducing the availability of effective molecules to treat infectious diseases caused by these agents” (Medeiros, Oliveira, Rodrigues, & Freitas, 2011, p. 557). • So, the “increasing isolation of Salmonella spp. with antimicrobial resistance in humans and other animals is a public health problem” (Medeiros, Oliveira, Rodrigues, & Freitas, 2011, p. 557). Medeiros, M., Oliveira, D., Rodrigues, D., & Freitas, D. (2011). Prevalence and antimicrobial resistance of Salmonella in chicken carcasses at retail in 15 Brazilian cities. RevistaPanamericana De SaludPública, 30(6), 555-560.

12. Morbidity and Mortality • NontyphoidalSalmonellosis: Caused by serotypes other than S. Typhi and S. Paratyphi A. In reference to mortality, “Generally less than 1%; however, S. Enteritidis has a 3.6% mortality rate in outbreaks in nursing homes and hospitals, with the elderly being particularly affected” (Lampel, Al-Khaldi, & Cahill, 2012, p. 13). • This infection can lead to death, especially considering Salmonella can “sometimes escape from the gastrointestinal tract into the body and cause blood poisoning (septicemia)or infect the blood, internal organs, and/or joints (bacteremia)” (Lampel, Al-Khaldi, & Cahill, 2012, p. 13). Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm

13. Morbidity and Mortality • Typhoid Fever • Caused by serotypes S. Typhi and S. Paratyphi A, both of which are found only in humans. • In reference to mortality, if it is left untreated rates are as high as 10%(Lampel, Al-Khaldi, & Cahill, 2012, p. 13). • This infection leads to “septicemia, with colonization of other tissues and organs; e.g., may lead to endocarditis”, and “Septic arthritis may occur, in which the infection directly affects the joints and may be difficult to treat…Chronic infection of the gallbladder may occur, which may cause the infected person to become a carrier” (Lampel, Al-Khaldi, & Cahill, 2012, p. 14). Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm

14. Government interventions • The CDC and U.S. Food and Drug Administration (FDA) reports to the public that it is imperative to thoroughly cook poultry, ground beef, and eggs and encourages the public not drink/eat foods with raw eggs and/or unpasteurized milk, carefully clean foods before preparing for children especially (Centers of Disease Control and Prevention, 2012). • The FDA also also encourages hand washing after direct contact with live chickens, birds, and feces because you can also spread the bacteria. Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html

15. Preventative measures • Pasteurization of milk, treatment of municipal water supplies, vast improvements in farming and animal hygiene and slaughter plant practices, in fruit and vegetable gathering operations, and have been helpful in the prevention salmonellosis transmitted through contaminated foods assist in the prevention of Salmonella (Centers of Disease Control and Prevention, 2012). • The FDA is responsible for inspecting “imported foods, oversees inspection of milk pasteurization plants, promotes better food preparation techniques in restaurants and food processing plants, and regulates the sale of turtles”, and also regulates the proper use of antibiotics growth promotions in food (animals) (Centers of Disease Control and Prevention, 2012). • But you have to do your part as well. Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html

16. Decrease Salmonella…

17. What you can do • Make sure you are properly washing your hands with handling food products • Separate animals and meat carcasses from feces • Decrease amount of antibiotics given to animals being raised for feeding to reduce multi-drug resistance in both animals as well as humans. • Also, its important to follow government regulations.

18. Questions? • Any questions?

19. Thank you!

20. References Centers for Disease Control and Prevention (CDC). (2012). Salmonella: What is Salmonellosis. Retrieved from the internet http://www.cdc.gov/salmonella/general/index.html Centers of Disease Control and Prevention. (2012). Salmonella: Reports of the Selected Salmonella Outbreak Investigation. Retrieved from the internet at http://www.cdc.gov/salmonella/outbreaks.html Food Poisoning Health Center. (2012). Retrieved from the internet athttp://www.webmd.com/food-recipes/food-poisoning/tc/salmonellosis-topic-overview Lampel, K. A., Al-Khaldi, S., & Cahill, S. M. (2012). Bad Bug Book – Foodborne Pathogenic Microorganisms and Natural Toxins (2nd ed.). Retrieved from the internet at http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm Medeiros, M., Oliveira, D., Rodrigues, D., & Freitas, D. (2011). Prevalence and antimicrobial resistance of Salmonella in chicken carcasses at retail in 15 Brazilian cities. RevistaPanamericana De SaludPública, 30(6), 555-560.