EMERGING FOODBORNE PATHOGENS

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EMERGING FOODBORNE PATHOGENS

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

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• 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.

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• 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

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Emerging Reemerging Zoonotic Diseases

• 60 of the human pathogens are zoonotic
• 75 of emerging zoonotic

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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

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Emerging Foodborne Diseases

• 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

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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

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Emerging Foodborne DiseasesMajor trends

• 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

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Emerging Foodborne Pathogens

• Bacteria
• Viruses
• Parasites
• Prion

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Emerging foodborne bacteria

• Salmonella (multidrug resistant strain)
• Campylobacter jejuni
• E. coli O157H7
• Listeria monocytogenes
• S. aureus MRSA
• Vibrio vulnificus
• Yersinia enterocolitica
• Arcobacter spp.
• Mycobacterium paratuberculosis

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Emerging foodborne viruses

• Hepatit A and E
• Norovirus
• (Avian influenza, AI)

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Emerging foodborne parasites

• Cryptosporidium parvum
• Cyclospora cayetanensis
• Anisakis spp.

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Foodborne outbreaks 1996 - 2006
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? Cryptosporidiosis, Leptospirosis, Lyme
borreliosis ? Brucellosis, E. coli 0157,
Salmonellosis ? BSE
Reference WHO
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Reference CDC
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• WHO Surveillance Programme for Control of
  Foodborne Infections and Intoxications in Europe
  8th Report 1999-2000 Country Reports Turkey

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Pathogen Emerging foodborne diseaeses estimated annually Cases No. of No. of Ilnesses Deaths Emerging foodborne diseaeses estimated annually Cases No. of No. of Ilnesses Deaths 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 O157H7 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 USDAs Economic Research Service
CDC
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Some Important Salmonella Outbreaks in the World
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 IrelandU.K Beef, chicken S. Agona 119 -
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Salmonella serotype distribution in Turkey(Erol
et al., 2009)

• S. Agona
• S. Kentucky Spices
• S. Bredeney

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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
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Campylobacter jejuni

• Quinolone- and fluoroquinolone-resistant
  Campylobacter jejuni in the United States,
  19822001

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Campylobacter jejuni
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Thermophilic Campylobacter spp. in turkey meat
(n270)(Cakmak and Erol, 2009)

• Thermophilic Camylobacter spp. 123 (45.5)
• C. jejuni 109 (40.3 )
• C. coli 11 ( 4.0 )
• Not typed 3

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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)
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Some important E. coli O157H7 Outbreaks in the
World
Country Year No of cases(age) Complications Infection source
Japan 1996 gt5499 (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
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E. coli O157H7 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
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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 O157H7 isolated in
Turkey (Erol et al., 2008)
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Toxin profiles of 11 E. coli O157H7 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
D 2 stx1
D 1 stx2
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Some Important Listeria outbreaks in the World
Country Year Food Serotype No. of cases No. 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
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• Contamination level of turkey meat with
• L. monocytogenes is 17.8 (32/180)
• (Ayaz and Erol 2008)

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L. monocytogenes serotype distribution

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

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Antibiotic resistance profiles of L.
monocytogenes in turkey meat (n24) (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)
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Occurrence of Cryptosporidium spp. oocysts in
Turkey(Kursun and Erol, 2003)
Surface water Sewage 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
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Antibiotic resistance

• Its a global concern of the antibiotic
  resistance of major foodborne pathogens such as
• Salmonella Typhimurium DT 104
• Campylobacter spp.
• Listeria monocytogenes
• E. coli O157H7
• Staphylococcus aureus (MRSA)
• Enterococcus (VRE)

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Foodborne InfectionsIntoxications Known/ Unknown
Reported Positive Isolates
Lab. Confirmed Cases
Suspectible Cases
Hospitalised No sample taken
Unnotified Cases
No medical intervention
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Farm to table main contamination points
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• Surveillance
• Risk management Epidemiologi
  cal evaluation /
• Risk assessment
• Research

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Control of Foodborne Disease

• From farm to table approach
• Implementation of GMP and HACCP

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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

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THANK YOU
E-mail erol_at_veterinary.ankara.edu.tr
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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

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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 çig
  köfte (raw ground meat ball-traditional food) in
  Izmir
• 542 people were affected and samples were found
  to be contaminated with T. britovi

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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.

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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.