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Epidemiology of Foodborne Diseases

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Epidemiology of Foodborne Diseases Epidemiology of Foodborne Diseases Center for Acute Disease Epidemiology Lucas State Office Building, 321 E. 12th Street Des Moines, Iowa 50319-0075 Visit our web site at www.idph.state.ia.us/Cade/Foodborne.aspx PATHOGEN INCUBATION PERIOD / ASSOCIATED FOODS/ SIGNS AND SYMPTOMS TREATMENT PUBLIC HEALTH (PH) COMMUNICABILITY TRANSMISSION RESPONSE Bacillus anthracis * 3-7 days, although up to 60 Ingestion of contaminated Nause a, vomiting, malaise, bloody Ciprofloxacin is 1st line treatment. Anthrax is a potential (anthrax - days possible. Not undercooked food. diarrhea, acute abdominal pain followed Alternatives are doxycycline and bioterrorism agent. communicable person-to- by fever, septicemia. amoxicillin if susceptible. Begin gastrointestinal) person. therapy with two intravenous antimicrobials. Cephalosporins and trimethoprim-sulfamethoxazole should not be used. Bacillus cereus 6 - 24 hours. Not Food kept at room Abdominal cramps, watery diarrhea, Rehydration. Illness is self-limiting. Foods should not remain at (diarrheal toxin) communicable person-to- temperature after cooking, nausea. Fever is rare. Antibiotics are of no use. room temperature after person. commonly meats, stews and cooking. Refrigerate leftover gravies. food promptly and reheat thoroughly. Bacillus cereus 0.5 -6 hours. Not Food kept at room Sudden onset of severe nausea and Rehydration. Illness is self-limiting. Proper cooking and storage of (preformed enterotoxin) communicable person-to- temperature after cooking, vomiting, abdominal cramps. Fever is Antibiotics are of no use. foods, particularly rice cooked person. commonly fried rice. rare. Usually last < 24 hours. for later use. Brucella abortus, Highly variable; usually 1-2 Ingestion of raw milk and Acute or insidious onset. Fever, chills, Rifampicin or streptomycin AND Brucella is a potential Brucella melitensis, months with a range of 5-60 dairy products sweating, weakness, headache, muscle doxycycline for at least 6 weeks. bioterrorism agent. PH follow- and Brucella suis * days. Rare person-to- (unpasteurized cheese) from and joint pain, weight loss, diarrhea (may Corticosteroids may be helpful in up to determine source of person transmission. infected animals. Contact of be bloody), sacroiliitis, epididymitis, severely ill patients. infection. Pasteurization of non-intact skin with body orchitis. milk and milk products. fluids of infected animals. Campylobacter * Usually 2-5 days, with a Ingestion of undercooked Diarrhea, abdominal pain, fever, malaise Rehydration and electrolyte Thorough cooking of pork and range of 1-10 days. chicken and pork, and vomiting; diarrhea may be bloody. replacement. Antibiotics are not poultry. Pasteurization of milk Communicable through the contaminated food and Less commonly: typhoid-like syndrome, generally indicated. For severe cases, and milk products. course of infection (usually water, or unpasteurized milk. febrile convulsions, meningeal antibiotics may be indicated early in Chlorination of water. Exclude several days to several syndrome. May mimic acute appendicitis the course of illness. symptomatic people from food weeks), though person-to- or irritable bowel syndrome. handling, childcare, and direct person transmission appears patient care. to be uncommon. Clostridium botulinum Neurological symptoms Ingestion of food in which Early signs are marked fatigue, Intravenous administration as soon as Notify the Center for Acute children and adults ** usually appear within 12-36 toxin has formed, and not weakness, vertigo, constipation, possible of polyvalent botulism Disease Epidemiology (CADE) hours. Not communicable destroyed due to inadequate vomiting, and diarrhea, followed by antitoxin. Supportive care, especially immediately at 1-800-362- (preformed toxin) person-to-person. heating during preservation blurred vision, diplopia, dysphagia, dry for respiratory failure, which is the 2736 to obtain the botulism and without subsequent mouth and symmetrical descending usual cause of death. antitoxin. Botulism is a adequate cooking, (e.g. muscle weakness with respiratory potential bioterrorism agent. home canned vegetables muscle paralysis. Do not use food containers and fruits, garlic in oil). that bulge. Clostridium botulinum Incubation is unknown. Not Ingestion of botulinum Lethargy, weakness, poor feeding, Supportive care; assisted respiration Contact CADE immediately at intestinal (formerly communicable person-to- spores. Possible sources of constipation, hypotonia, poor head may be required. Botulism IG has 1-800-362-2736. Do not give infant) ** person. spores are multiple, and control, poor gag and suck mechanism, been shown to improve the course of infants honey. include the following foods: “failure to thrive.” Disease can range illness. Botulism antitoxin is generally honey, home-canned from mild, with a gradual onset, to not recommended for infants. vegetables and fruits, light sudden infant death. Some studies Antibiotics do not improve the course and dark corn syrup. suggest the cause of an estimated five of disease, and aminoglycosides can percent of sudden infant death. worsen the disease. Rehydration. Clostridium perfringens 6 - 24 hours, usually 10-12 Ingestion of food that has Sudden onset of abdominal cramps Rehydration. Antibiotics are of no use. Do not leave food at room (toxin) hours. Not communicable been contaminated by soil or followed by diarrhea and usually nausea; temperature to cool. Roast, person-to-person. feces and then held under fever and vomiting are usually absent. stews, and gravies should be conditions that permits Mild disease of short duration (1 day or thoroughly cooked and divided multiplication of organism. less). into smaller quantities for Specific foods may include cooling and reheating. meat, poultry, gravy, and dried or precooked foods. Cryptosporidium* Incubation not precisely Person to person and fecal- Diarrhea, which may be profuse and Rehydration. Nitazoxanide for Specific O&P testing must be known; 1-12 days is the oral transmission. watery, cramping abdominal pain. immunocompetent. In requested. Persons with likely range, with an average Contaminated food or water. General malaise, fever, anorexia, immunocompromised persons, diarrhea should not use public of about 7 days. Outbreaks have been nausea, and vomiting occur less often. experimental treatments include recreational water. Hand Communicable from onset of associated with child care Symptoms often wax and wane. paromomycin and orally administered hygiene after handling illness to several weeks after centers, swimming pools and Asymptomatic infections are common. human serum immunoglobulin or animals. symptoms resolve. lakes, and unpasteurized bovine colostrum. Stop or reduce beverages (apple cider) immunosuppressive drugs if possible. contaminated with animal manure. Cyclospora Median incubation 1 week Ingestion of contaminated Profuse watery diarrhea, nausea, Trimethoprim-sulfamethoxazole for 7- Consider this diagnosis in cayetanensis * with a 1-2 week range. No water and foods such as anorexia, abdominal cramping, fatigue, 10 days may shorten the course of persons with prolonged evidence of communicability imported berries, lettuce, and and weight loss; fever is rare. Symptoms illness. Ciprofloxacin if sulfa allergy. diarrheal illness. Specific O&P person-to-person. basil fruits and vegetables. lasts 10-24 days testing must be requested. Hand hygiene after handling animals Entamoeba Variable, from a few days to Ingestion of fecally Varies from acute fulminating dysentery Antiparasitic drugs such as Handwashing, sanitary histolytica several months or years; contaminated foods or water with fever, chills, and bloody or mucoid metronidazole. Asymptomatic carriers disposal of feces, and commonly 2-4 weeks. containing cysts. diarrhea to mild abdominal discomfort may be treated. Corticosteroids and treatment of drinking water. Communicable during the with diarrhea alternating with periods of antimotility drugs can worsen Contact public health if an period the cysts are passed, constipation or remission. Dissemination symptoms. Additional antiparasitic outbreak is suspected. which may continue for via the bloodstream may occur and drugs can be added for refractory or years. produce abscesses of the liver or, less extra-intestinal disease. commonly, the lung or brain. Enterohemorrhagic 2-10 days with a median of Person to person and fecal- Diarrhea that may range from mild and Rehydration. Antimotility drugs may Exclude patients and Escherichia coli (EHEC) 3-4 days. Communicable oral. Ingestion of non-bloody to stools that are virtually all worsen illness. Most experts would symptomatic contacts from * # Includes E. coli from onset of illness to a contaminated foods such as blood, abdominal pain, and vomiting. not treat because no benefit has been high-risk settings (food O157:H7 week later in adults; can be undercooked ground meats, Usually little or no fever present. More proven and harm is possible. handling, direct patient care, up to 3 weeks in one third of unpasteurized milk, fruits or common in children <5 years of age. child care) until 2 negative and other Shiga toxin children. vegetables contaminated Severe clinical manifestations include stools are collected at least 24 producing E. coli (STEC) with feces and contaminated hemolytic uremic syndrome (HUS) and hours apart and at least 48 water. thrombotic thrombocytopenic purpura hours after antibiotics are (TTP). discontinued. If high-risk setting is involved, immediately contact CADE at 1-800-362-
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