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I Page 2 Foodborne diseases, 1411-1413H The expression "food poisoning" is generally applied to any disease caused by food. A more appropriate ru- bric is "foodborne disease" or "water- borne disease," which refers to illnesses acquired through consump- tion of food or water. This designation includes not only true poisoning, such as from the metabolic products (tox- ins) produced by certain organisms, but also foodborne contamination such as bacteria. We reviewed all computerized data for foodborne diseases sent to the Min- istry of Health from all the regions in Saudi Arabia for the years 1411- 1413H and analyzed the data by com- puter. We found 781 events of foodborne diseases reported from 18 regions. There were 6,052 cases, of which 3,515 required hospitalization. No deaths due to foodborne disease I I were reported. The highest rate of events was re- ported from Riyadh region, followed by Taif (Table 1) . In this three-year pe- riod, more than 70% of the cases oc- curred in adult males, and 30% in children. More than 40% of the cases were non-Saudi. Food prepared in restaurants ac- counted for 32% of the events, while 64% of events were associated with food prepared at home. Staphylococcus aureus was the most common organism associated with events (319 events, 41 %), fol- lowed by Salmonella (Figure I). Chicken, meat and rice were the food items most commonly associated with events. All the events were associated with abdominal colic, vomiting and di- arrhea. For all events the most com- mon contributing factors were poor storage, unsafe food sources and inade- quate refrigeration. The data which were presented were not enough to give a good picture about these events. Data should be en- tered into the computer by case, not by event. This is important in determining the incubation period and any associa- tion between cases. The high rate of reporting from Ri- yadh and Taif regions may be due to good reporting from regional authori- ties or to underreporting from other re- gions. There is a steady increase in num- ber of cases in children. We do not know if the children were of school age or preschool age, or the sex of the children. This information is impor- tant, especially in girls' schools be- cause they have lessons about food preparation and cooking. More than 40% of events occurred among non-Saudis. According to the last census, non-Saudis account for 30% of the popUlation, so that means that they have a high percentage of events. Occupations were not listed, so we were unable to determine from the data whether they were laborers. A high percentage of events oc- curred in the home, but this does not mean that houses have greater prob- lems than restaurants. Because most people eat at home, a higher percent- age there would be expected. The difference in the relation be- tween organisms isolated and associ- ates symptoms may be caused by improper epidemiological investiga- tion of the cases, including the ques- tionnaire or a laboratory error. Because data were not available, we were unable to determine the relation- ship between events and food handlers or to determine the incubation period or attack rate. -- Reported by Dr. Tomader S. Kurdy (Field Epidemiology Training Program) Editorial note: Food poisoning out- breaks are usually recognized by the occurrence of illness within a Sh0l1 pe- riod of time after consumption. Single cases of food poisoning are difficult to identify, with the exception of botu- lism. Usually there is no microorgan- Figure 1: Causative agents of food poisoning, 1411-1413H No. of events 140 - .1411 [J1412 01413 o S. au reus Shigell a Salmonella E.coli Coliform Mixed org Unknown C. perfringens Chemical

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Page 1: I Page 2 Foodborne diseases, 1411-1413Hfetp.edu.sa/downloads/articles/y1994/A1994-V01-4-00023.pdf · I Page 2 Foodborne diseases, 1411-1413H The expression "food poisoning" is generally

I Page 2

Foodborne diseases, 1411-1413H The expression "food poisoning" is

generally applied to any disease caused by food. A more appropriate ru­bric is "foodborne disease" or "water­borne disease," which refers to illnesses acquired through consump­tion of food or water. This designation includes not only true poisoning, such as from the metabolic products (tox­ins) produced by certain organisms, but also foodborne contamination such as bacteria.

We reviewed all computerized data for foodborne diseases sent to the Min­istry of Health from all the regions in Saudi Arabia for the years 1411-1413H and analyzed the data by com­puter. We found 781 events of foodborne diseases reported from 18 regions. There were 6,052 cases, of which 3,515 required hospitalization. No deaths due to foodborne disease I I

were reported. The highest rate of events was re­

ported from Riyadh region, followed by Taif (Table 1). In this three-year pe­riod, more than 70% of the cases oc­curred in adult males, and 30% in children. More than 40% of the cases were non-Saudi .

Food prepared in restaurants ac­counted for 32% of the events, while 64% of events were associated with food prepared at home.

Staphylococcus aureus was the most common organism associated with events (319 events, 41 %), fol­lowed by Salmonella (Figure I). Chicken, meat and rice were the food items most commonly associated with events. All the events were associated with abdominal colic, vomiting and di­arrhea. For all events the most com­mon contributing factors were poor storage, unsafe food sources and inade­quate refrigeration.

The data which were presented were not enough to give a good picture about these events. Data should be en­tered into the computer by case, not by event. This is important in determining the incubation period and any associa­tion between cases.

The high rate of reporting from Ri­yadh and Taif regions may be due to good reporting from regional authori­ties or to underreporting from other re­gions.

There is a steady increase in num­ber of cases in children. We do not know if the children were of school age or preschool age, or the sex of the children. This information is impor­tant, especially in girls' schools be­cause they have lessons about food preparation and cooking.

More than 40% of events occurred among non-Saudis. According to the

last census, non-Saudis account for 30% of the popUlation, so that means that they have a high percentage of events. Occupations were not listed, so we were unable to determine from the data whether they were laborers.

A high percentage of events oc­curred in the home, but this does not mean that houses have greater prob­lems than restaurants. Because most people eat at home, a higher percent­age there would be expected.

The difference in the relation be­tween organisms isolated and associ­ates symptoms may be caused by improper epidemiological investiga­tion of the cases, including the ques­tionnaire or a laboratory error. Because data were not available, we were unable to determine the relation­ship between events and food handlers or to determine the incubation period or attack rate.

-- Reported by Dr. Tomader S. Kurdy (Field Epidemiology Training Program)

Editorial note: Food poisoning out­breaks are usually recognized by the occurrence of illness within a Sh0l1 pe­riod of time after consumption. Single cases of food poisoning are difficult to identify, with the exception of botu­lism. Usually there is no microorgan-

Figure 1: Causative agents of food poisoning, 1411-1413H

No. of events 140 -

.1411 [J1412 01413

o S. au reus Shigella

Salmonella E.coli

Coliform Mixed org Unknown

C. perfringens Chemical

Page 2: I Page 2 Foodborne diseases, 1411-1413Hfetp.edu.sa/downloads/articles/y1994/A1994-V01-4-00023.pdf · I Page 2 Foodborne diseases, 1411-1413H The expression "food poisoning" is generally

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ism isolated. Many cases and out- Regions 1411H 141 2H 1413H breaks are underrecognized and under- (N=217) (N=270) (N=294) reported. Riyadh 35.5 40.4 30.3

Food contamination occurs in the presence of living pathogenic agents

Taif 25.8 17 19.4 on food. The illness is caused by the entrance of these agents or their toxins

Makkah 8.3 3.3 6.8 into the body and the reaction of body tissues to their presence. 1

Eastern 6.5 7.8 10.9 Foodborne disease surveillance has traditionally served three objectives:

Tabuk 5.5 0.7 1 disease prevention and control, knowl-edge of disease causation and adminis-

Jeddah 3.7 2.6 1 trative guidance.2 Ten" Sflden rules" . for safe food preparation are:

Asir 3.7 4.4 3.4 (1) Choose food processed for safety.

AI Ahsa 3.7 3.7 1.7 (2) Cook food thoroughly. (3) Eat cooked food immediately.

Hail 2.8 3 3.4 (4) Store cooked foods carefully . (5) Reheat cooked foods thor-

Arar 1.7 0.7 0 oughly. (6) Avoid contact between raw

foods and cooked foods. Gizan 0.9 0 1 (7) Wash hands repeatedly. (8) Keep kitchen surfaces clean. Qassim 0.9 3.3 0.7 (9) Protect foods from insects, ro-

dents, and other animals. 'lajran 0.5 2.6 2 (10) Use pure water.

Madinah 0.5 2 3.4 References 1. Center for Disease Control. Dis-

Bisha 0 5.2 10.2 eases transmitted by foods. Atlanta, Center for Disease Control: 1976.

2. Last JM , Wallace RR, editors. Hafr al-Batin 0 2.2 3.1 Maxcy-Rosenau-Last public health & preventive medicine. Norwalk: Apple- AI Baha 0 0.7 1.7 ton & Lange, 1992.

3. Benenson AS, editor. Control of Goriat 0 0.4 0 communicable diseases in man. Wash-ington: American Public Health Asso-ciation, 1990. Table 1: Percentage of events by region, 1411-1413"

Brucellosis in an urban setting Prince Salman Hospital, which

serves southwest Riyadh city, noted in­creasing numbers of brucellosis cases during 1993 and requested a study to determine the risk factors for brucello­sis in this urban setting.

We identified all positive (>= 1: 160) Brucella agglutination tests from the hospital laboratory logbook for 1993 and from those chose 52 patients (case­persons) with a clinical history ofbru­cellosis.

We interviewed all case-persons about their exposure to dairy products, meat and livestock during the,60 days before the first symptom. We also asked about their habitual exposure to these same things.

We selected as household control-

persons two persons of the same sex and approximate age from the same household as each case. We also se­lected 52 community control-persons from among visitors to two primary health clinics in the same districts from which most of the cases came. We interviewed all control persons us­ing the same questions covering the same possible exposure period for the corresponding case.

The incidence rate of laboratory-di­agnosed brucellosis from the Prince Salman Hospital catchment area was 78.5/ 100,000 popUlation in 1993. Males accounted for 65% of brucello­sis cases.

Sixty-nine percent of case-house­holds kept livestock, compared with

19% of community control households (odds ratio [OR] = 9.5, 95% confi­dence interval [CI] 3.2-24). Sick live­stock were reported by 32 of 36 case households, compared with none of the 10 community control households that reported raising livestock (p<O.OOJ).

We next looked at 36 households that raise livestock for risk factors spe­cific to contact with livestock. In these households 83% of case-persons per­formed general livestock care, com­pared with 9% of household control,­persons (OR = 51, 95% CI 13-217).

Because the livestock were kept out­side the city, usually only one family member was responsible for animal

Contlnued.pn Page 4