foodborne illness

foodborne illness, any sickness that is caused by the consumption of foods or beverages that are contaminated with certain infectious or noninfectious agents. Most cases of foodborne illness are caused by agents such as bacteria, viruses, or parasites. Other agents include mycotoxins (fungal toxins), marine biotoxins, and the toxins occurring in poisonous mushrooms; metals such as lead, mercury, and cadmium, which may contaminate food through air, water, or soil pollution; organic pollutants, such as dioxin and polychlorinated biphenyls (PCBs), which are by-products of some industrial processes; and prions (abnormal forms of normally harmless proteins). The agents of foodborne illnesses cause a variety of conditions, ranging from gastroenteritis to reproductive or developmental disorders and neurodegenerative diseases, such as bovine spongiform encephalopathy (mad cow disease). People sometimes refer to foodborne illnesses, particularly those involving gastroenteritis, as food poisoning. Food poisoning, however, is a type of foodborne illness and specifically is caused by toxins present in foods; typically, those toxins are produced by bacteria and cause symptoms soon after the contaminated food is consumed. By contrast, certain other types of foodborne illnesses arise from ingestion of the infectious organisms or chemicals themselves and may take days to develop.

Although the incidence of foodborne illness is difficult to estimate, since many cases go unreported, the burden of illness is thought to be high. For example, tens of millions of people worldwide are affected annually by diarrheal diseases, a common proxy measure for foodborne illness. Foodborne illnesses often occur as outbreaks that have the potential to affect large numbers of people. For instance, in 1988 in China an outbreak of hepatitis A, caused by the consumption of contaminated clams, affected more than 300,000 people, and an outbreak of salmonellosis in the United States in 1994, caused by the consumption of contaminated ice cream, affected 224,000 people. Foodborne illnesses can be deadly. In 1985, for example, a listeriosis outbreak in California, involving a contaminated cheese product, caused 48 deaths out of 142 cases.

Common foodborne illnesses

There are a number of different types of foodborne illnesses. Several commonly occurring illnesses and their causes are discussed here.

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Escherichia coli is a type of bacteria that lives in the intestines of many animals, including humans and cattle. Most strains of E. coli are not harmful to humans. However, several strains can have serious health effects when ingested by humans. For example, E. coli 0157:H7, which lives in the intestines of cattle, is usually ingested in undercooked ground beef, although it may also be transmitted through unpasteurized milk and fruit juice, contaminated water, uncooked produce, and person-to-person contact. Symptoms of E. coli 0157:H7 infection often include severe abdominal cramps and bloody diarrhea. In a small percentage of cases, hemolytic uremic syndrome may develop, which can result in kidney failure and death. Examples of other strains that cause illness in humans include E. coli O104:H4, O26:H11, and O111:H8.

Salmonellosis is caused by Salmonella bacteria, which commonly are found in the intestines of mammals, reptiles, and birds and usually are spread to humans through the consumption of foods of animal origin, including eggs, meat, and milk. Symptoms of salmonellosis include fever, headache, abdominal pain, nausea, vomiting, and diarrhea; in persons with weakened immune systems or poor health, it can be life-threatening.

Listeriosis, caused by the bacterium Listeria monocytogenes, is most often transmitted through milk, soft cheeses and ice cream, raw vegetables, and raw meat and poultry. Because L. monocytogenes can grow at low temperatures, certain foods that are refrigerated for long periods of time are particularly likely routes of transmission. Symptoms of listeriosis include flulike illness, with fever, fatigue, and muscle aches. Some people experience a loss of balance, confusion, or even convulsions. Listeriosis is dangerous particularly for pregnant women, because it can cause miscarriage and stillbirth, and for infants and persons with weakened immune systems, in whom it can cause meningitis (inflammation of the membranes that cover the brain and spinal cord) or septicemia (blood poisoning).

Campylobacteriosis is caused by Campylobacter bacteria. In some countries it is more common than salmonellosis, and worldwide it is the most commonly identified bacterial cause of diarrheal illness. Campylobacteriosis is transmitted mainly through drinking water, undercooked poultry, and raw milk. Because Campylobacter bacteria live in the intestines of healthy birds, most raw poultry can be assumed to be contaminated with it. The symptoms of campylobacteriosis include fever, nausea, severe abdominal pain, and diarrhea. Major health consequences, such as neurological conditions and reactive arthritis, may develop in a small number of cases.

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Prevention and control

Major foodborne illnesses, including salmonellosis and E. coli infections, are reportable diseases in many places, meaning that infections caused by those agents must be reported by physicians and medical laboratories to local, state, or national health departments. However, because most cases of foodborne illness are mild and are not diagnosed, the reported number of cases is assumed to be an undercount of the true number of cases.

Many laws regulating the production, transport, and preparation of food are intended to prevent foodborne illness and limit its consequences. For example, laws have been implemented to help prevent the contamination of raw food, to mandate its safe preparation and storage, and, if necessary, to close restaurants or food suppliers responsible for disease outbreaks or who fail to follow safe food-hygiene practices. There are many means by which raw food may be contaminated, including irrigating or washing with unclean water, contamination of meat and poultry with fecal matter during the slaughtering and packaging processes, preparation by food handlers who carry bacteria or viruses on their hands, or using utensils and preparation surfaces that are not clean.

Cooking at a sufficient temperature kills many microbes and parasites. However, some microbes may also be present in cooked food, such as when contamination occurs during handling after cooking or pasteurization. In some instances, contamination post-cooking or post-pasteurization may not pose a health risk, if only a small number of microbes are present. Most bacteria grow rapidly at room temperature, whereas refrigeration or freezing keeps them from multiplying (L. monocytogenes is a notable exception). Hence, even cooked foods must be promptly refrigerated in order to prevent the multiplication of disease-causing organisms.