EMERGING FOODBORNE PATHOGENS

Prof. Dr. İrfan EROL, DVM, Ph.D. Turkish Representative of World Vet. Assoc.Department of Food Hygiene and TechnologySchool of Veterinary MedicineAnkara University

Despite advances in hygiene, consumer knowledge, food treatment and processing, foodborne diseases mediated by pathogenic microorganisms or microbial toxins still represent a significant treat to public health worldwide.

Globally, the WHO has estimated that approximately 1.5 billion episodes of diarrhea and more than 3 million deaths occurred in children under 5 years of age, and a significant proportion of these results from consumption of food mainly food of animal origin with microbial pathogens and toxins

Emerging & Reemerging Zoonotic Diseases

60 % of the human pathogens are zoonotic

75 % of emerging zoonotic

Emerging Foodborne Pathogens Definition:

those causing illnesses that have only recently appeared or been recognised in a population or that are well recognised but are rapidly increasing in incidence or geographic range

Appeared recently Extended to new vehicles of transmission Started to increase rapidly in incidence or

geographic range Been widespread for many years but only

recently identified through new or increased knowledge or methods of identification and analysis of the disease agent

Emerging Foodborne Diseases

Pose a threat to all persons; no matter on age, sex, lifestyle or socio-economic status etc.

Feel pain and death

Economic impact

Emerging Foodborne Diseases

Changes in environment (technology, climate, etc) Mass production and globalisation of food supply Economic development International travel and trade Changing character of the population Breakdown in public health Lifestyle changes Microbial adaptation

Emerging Foodborne DiseasesMajor trends

Emerging Foodborne Pathogens Bacteria

Viruses Parasites Prion

Emerging foodborne bacteria

Salmonella (multidrug resistant strain)

Campylobacter jejuni

E. coli O157:H7

Listeria monocytogenes

S. aureus MRSA

Vibrio vulnificus

Yersinia enterocolitica

Arcobacter spp.

Mycobacterium paratuberculosis

Emerging foodborne viruses

Hepatit A and E

Norovirus

(Avian influenza, AI)

Emerging foodborne parasites

Cryptosporidium parvum

Cyclospora cayetanensis

Anisakis spp.

Foodborne outbreaks 1996 - 2006

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▼ Cryptosporidiosis, Leptospirosis, Lyme borreliosis

● Brucellosis, E. coli 0157, Salmonellosis

BSE

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Reference: WHO

Reference: CDC

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 8th Report 1999-2000 Country Reports: Turkey

Pathogen Emerging foodborne diseaeses estimated annually

Cases No. of No. of

Ilnesses Deaths

Economic losses from foodborne diseases estimated annualy

$ billion

Campylobacter spp.

1,963,141 10,539 99 1.2

Salmonella non-typhoidal

1,341,873 15,608 553 2.4

E. coli O157:H7 62,458 1,843 52 .7

E. coli non-O157-STEC

31,229 921 26 .3

L. monocytogenes 2,493 2,298 499 2.3

Total 3,401,194 31,209 1,229 6.9

Reference: USDA’s Economic Research Service & CDC

Year Country Food Serotype/Phage type

No. of cases

No. of deaths

1991 Germany Orange cream S.Enteritidis PT4 109 4

1991 Germany Puding (egg) S.Enteritidis 87 10

1994 U.S.A Ice cream S.Enteritidis 224000 -

2003 U.S.A Chicken S. Typhimurium 38 -

2005 Spain Processed

chicken

S. Hadar 2138 1

2006 Norway Salami S. Kedougou 54 1

2008 Ireland&U.K Beef, chicken S. Agona 119 -

Some Important Salmonella Outbreaks in the World

Salmonella serotype distribution in Turkey(Erol et al., 2009)

S. Agona S. Kentucky Spices S. Bredeney

Some Important Campylobacter Outbreaks in the World

Year Country Food No. of cases

2000 U.K & Wales Raw milk 333

2001-2002

Australia Chicken 601

2005 Denmark Chicken salad 4

2005 Scotland Chicken pate 82

2005-2006

U.S.A Water 32

2007 U.S.A Cheese (from unpasteurized milk)

67

2007 Denmark Water 16

Campylobacter jejuni

Quinolone- and fluoroquinolone-resistant Campylobacter jejuni in the United States, 1982–2001

Campylobacter jejuni

Thermophilic Campylobacter spp. in turkey meat (n=270)(Cakmak and Erol, 2009)

Thermophilic Camylobacter spp. 123 (45.5%)

C. jejuni 109 (40.3 %) C. coli 11 ( 4.0 %) Not typed 3

100 bp

500 bp

735 bp

Antibiotic resistance profile of C. jejuni isolates in turkey meat (Cakmak and Erol, 2009)

Antibiotics Resistant % Intermediate % Sensitive %

Azithromycin 104 (95.4) 2 (1.8) 3 (2.7)

Erythromycin 103 (94.4) 0 6 (5.5)

Gentamicin 0 0 109 (100.0)

Chloramphenicol 0 3 (2.7) 106 (97.2)

Nalidixic acid 10 (9.1) 0 99 (90.8)

Ciprofloxacin 19 (17.4) 0 90 (82.5)

Tetracycline 40 (36.6) 2 (1.8) 67 (61.4)

Country Year No of cases(age)

Complications Infection source

Japan 1996 >5499 (students)

12 deaths Alfalfa

U.S.A 1999 321 - Beef

Canada 2000 27 5 deaths Water

Sweden 2002 39 - Fermented sausage

U.S.A 2002 34 5 HUS Ground beef

Netherlands 2005 32 - Steak tartare

U.S.A 2006 376 3 deaths Fresh spinach

Some important E. coli O157:H7 Outbreaks in the World

E. coli O157:H7 isolates found in fecal samples of cattle and sheep at slaughter in Turkey (Erol et al., 2008)

Sheep Cattle

Cattle(male)

Cattle(female) Total

Number of

samples

218 282 207 75 500

Number of

positive samples

14 11 7 4 25

Percent(%)

6.42 3.90 3.38 5.33 5.00

Positive Negative Total

stx1 7 4 11

stx2 9 2 11

eaeA 11 - 11

hly 11 - 11

H7 11 - 11

Toxin profiles of E. coli O157:H7 isolated in Turkey (Erol et al., 2008)

Toxin profiles of 11 E. coli O157:H7 isolates within the PFGE groups in cattle in Turkey (Erol et al., 2008)

PFGE groups N Toxin profiles

A 1 stx2

B 2 stx2

C 1 stx1 and stx2

D

4 stx1 and stx2

2 stx1

1 stx2

Some Important Listeria outbreaks in the WorldCountry Year Food Serotype No. of

casesNo. of deaths

U.S.A. 1998 Turkey products

4b 108 18

Finland 1998 Butter 3a 25 24

France 2000 Pork meat 4b 32 31

U.S.A. 2000 Turkey products

1/2a 30 7

U.S.A. 2002 Turkey products

- 54 11

U.S.A. 2003 Mexican cheese

4b 12 2

Switzerland 2005 Soft cheese

- 11 2

Norway 2007 Cheese - 12 2

Canada 2008 Red meat - 53 20

Contamination level of turkey meat withL. monocytogenes is 17.8 % (32/180) (Ayaz and Erol 2008)

L. monocytogenes serotype distribution

44.9 % 1/2a 37.2 % 4b 9.0 % 1/2b 9.0 % 1/2c

Antibiotic resistance profiles of L. monocytogenes in turkey meat (n:24) (Ayaz and Erol, 2008)

Antibiotics Resistant (%) Intermediate (%)

Sensitive (%)

Ampicillin 18 (75.0) - 6 (25.0)

Chloramphenicol - - 24 (100)

Erythromycin - 9 (37.5) 15 (62.5)

Gentamicin - - 24 (100)

Penicillin 20 (83.3) - 4 (16.7)

Streptomycin - 8 (33.3) 16 (66.7)

Tetracycline - - 24 (100)

Vancomycin - - 24 (100)

0

4.000

8.000

12.000

16.000

20.000

1999 2000 2001 2002 2003

Number of Brucella cases in Turkey, 1999-2003 (Ministry of Health)

Occurrence of Cryptosporidium spp. oocysts in Turkey(Kursun and Erol, 2003)

Surface waterSewage water treatment at

slaughterhouse

Ent. Exist.

Slaughtered

Cattle Sheep

Number of samples 24 13 13 60 60

Number of positive samples

24 13 13 23 4

Percent(%) 100 100 100 38.3 6.6

Antibiotic resistance It’s a global concern of the antibiotic

resistance of major foodborne pathogens such as;

Salmonella Typhimurium DT 104Campylobacter spp.Listeria monocytogenesE. coli O157:H7Staphylococcus aureus (MRSA)Enterococcus (VRE)

Lab. Confirmed

Cases

ReportedPositive Isolates

Suspectible Cases

Unnotified Cases

HospitalisedNo sample taken

No medical intervention

Foodborne Infections&IntoxicationsKnown/ Unknown

Farm to table; main contamination points

Surveillance

Risk managementEpidemiological

evaluation /

Risk assessment

Research

Control of Foodborne Disease From farm to table approach Implementation of GMP and HACCP

Public Health Approach Public health system Surveillance Epidemiology for earlier diagnosis Early response to outbreaks Provide to disease patterns changing Public health lab. support for rapid and accurate

diagnosis Rapid communication links Communication to public Education on prevention and/or detection

E-mail:erol@veterinary.ankara.edu.tr

Factors contributing to the global incidence of foodborne disease

Poor sanitary conditions Malnutrition Changing demographics (increasing population of infants, elderly) Inadequate public health infrastructure Inadequate hygienic and technological conditions of food production Inadequate cooking, reheating and storage conditions Increasing tourism and international trade Increasing animal movement and insufficient control of borders Increasing international trade of animal and food Inadequate legislation and official control system Emerging/reemerging foodborne pathogens Acquisition of virulence and antibiotic genes by nonpathogenic bacteria Adaptation and enhanced survival of pathogens in food Inadequate consumer education

Trichinellosisoutbreak in Turkey

Although there is a religious restriction on pork meat consumption, in January 2004 there was a big trichinellosis outbreak occurred by consuming çiğ köfte (raw ground meat ball-traditional food) in Izmir

542 people were affected and samples were found to be contaminated with T. britovi

One World One Health (OWOH) The medical and veterinary professions have a common interest in many diseases, primarily zoonotic diseases such as BSE, SARS and, most recently, Avian Influenza (H5N1), have highlighted the need for interprofessional collaboration not just locally and nationally, but on a global scale.

One World One Health (OWOH)

Improving animal and human health globally through collaboration among all the health sciences, especially between the veterinary and human medical professions to address critical needs.