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Food Safety and S.C. Public Health

Foodborne Diseases/Outbreaks

This photo shows a sick woman lying in hospitalMore than 200 known diseases are transmitted by bacteria, viruses and parasites through food and water. Symptoms of foodborne illness can range from mild stomach upset to life-threatening brain, nerve, blood and kidney conditions.

Outbreaks of Food Poisoning

When two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne illness outbreak. DHEC investigates reported outbreaks to try to pinpoint the source. Thousands of foodborne outbreaks have occurred in the U.S., including the:The photo shows people in a buffet line

  • 2009 Salmonella outbreak involving peanut butter from Peanut Corporation of America in which nine people died and an estimated 22,500 were sickened. Recalls cost the peanut industry an estimated $1 billion.
  • 2002 Listeria outbreak traced back to processed chicken from Pilgrim's Pride. Seven people died, 46 people were sickened. Over 27 million pounds of poultry product were recalled.
  • 1994 Salmonella outbreak involving Schwan's Ice Cream, which sickened 224,000 people in 48 states.
  • 1993 E. coli 0157:H7 outbreak involving Jack-in-the-Box fast food restaurants in which four children died and 700 people were sickened after eating undercooked hamburger patties contaminated with fecal matter. Lawsuit settlements totaled more than $50 million.

Types of Foodborne Diseases

Here are some of the foodborne illnesses seen each year in the United States:

Botulism (Clostridium botulinum)

The photo shows clostridium botulinum Type E coloniesA rare, serious muscle-paralyzing disease caused by a poisonous substance (toxin) made by a germ called Clostridium botulinum. The germ can live as a spore for years in soil, dust and sediment. It’s not harmful to humans or animals until it encounters a warm (40°F to 120°F), moist, low-acid, oxygen-free environment. These conditions cause the spores to multiply and produce the botulism toxin.

  • Foodborne botulism occurs when a person eats or drinks something containing the pre-formed toxin, leading to illness within 6 hours to 2 weeks.
  • Infant botulism occurs in a small number of susceptible infants each year who harbor Clostridium botulinum in their intestinal tract.
  • Wound botulism occurs when wounds are infected with Clostridium botulinum that secretes the toxin.
  • Manmade botulism is deliberately produced for use as a terrorist or criminal weapon. One manmade form harms people who breathe it in; a second type is made to be sprayed onto food.

Common or Likely Sources

  • Home canned or home bottled low acid foods (like vegetables) (foodborne botulism)
  • Fermented, salted or smoked fish and meat (foodborne botulism)
  • Commercially canned meats and vegetables (foodborne botulism)
  • Restaurants (foodborne botulism)
  • Honey (infant botulism)
  • Soil or dust containing Clostridium botulinum spores (infant botulism)
  • Injection of illegal drugs, especially black tar heroin (wound botulism)
  • Crush injuries to the extremities (wound botulism)

Symptoms

Symptoms appear 6 hours to 2 weeks (most commonly between 12 and 36 hours) after eating or drinking contaminated food or drink, require immediate medical attention, and may include:

  • Double vision, blurred vision and/or drooping eyelids
  • Slurred speech
  • Difficulty swallowing
  • Dry mouth
  • Muscle weakness that always descends through the body: first shoulders are affected, then upper arms, lower arms, thighs, calves, etc.
  • Constipation, nausea or vomiting (some people do not experience stomach symptoms)
  • Possible paralysis of breathing muscles that can cause a person to stop breathing and die, unless assistance with breathing (mechanical ventilation) is provided.

How to Lower the Risk

Campylobacter (Campylobacter jejuni)

The photo shows Campylobacter  jejuni bacteriaThe most commonly identified bacterial cause of diarrheal illness in the world. Over 60 percent of broiler chickens processed for food in the U.S. have campylobacter.

Common or Likely Sources

  • Raw or undercooked chicken or turkey
  • Raw milk
  • Raw or undercooked meat or shellfish
  • Contaminated water

Symptoms

  • Fever, headache, and muscle pain followed by diarrhea (sometimes bloody), abdominal pain, and nausea that appear two to five days after eating
  • Illness may last seven to 10 days.
  • Bacteria may spread to bloodstream and cause a serious life-threatening infection.
  • Up to 40 percent of cases of Guillain-Barré Syndrome, a rare but serious paralytic disease, have been linked to Campylobacter.

How to Lower the Risk

Clostridium (Clostridium perfringens)

The photo shows Clostridium perfringensCalled the “cafeteria germ” because many outbreaks result from food left for long periods on steam tables or at room temperature.

Common or Likely Sources

  • Meats
  • Meat products
  • Gravy made from meat.

Symptoms

  • Intense abdominal cramps and diarrhea begin 8 to 22 hours after eating and usually lasts 24 hours.
  • In the elderly, symptoms may last one to two weeks.
  • Complications and/or death occur only very rarely.

How to Lower the Risk

E Coli (Escherichia coli O157:H7)

The photo shows Escherichia coli bacteriaOne of several strains of E. coli that can cause human illness

Common or Likely Sources

  • Undercooked beef, especially ground beef (hamburger)
  • Unpasteurized milk and juice
  • Contaminated raw fruits, vegetables and water
  • Other people who have the illness

Symptoms

  • Severe diarrhea that is often bloody, abdominal cramps, and vomiting. Usually little or no fever.
  • Symptoms can begin one to eight days after food is eaten; they last from five to 10 days.
  • Some victims, especially the very young, have developed hemolytic-uremic syndrome (HUS), several weeks after the initial symptoms. HUS causes temporary anemia, profuse bleeding, kidney failure and sometimes, death.

How to Lower the Risk

  • Cook meat to the right temperature. Freezing meat will not kill the E.coli bacteria, so you must cook the meat throughout.
  • Cook all ground beef or hamburger well done to 155 degrees Fahrenheit or higher (internal).Use a meat thermometer. Meat should be brown throughout, not pink. Juices should be clear, not bloody.
  • Don't let blood from raw meat drip onto other foods, which is cross contamination. Always place meat in a container on the bottom shelf of the refrigerator.
  • Wash your hands often with hot soapy water before preparing food or eating, before and after diapering a child, after using the bathroom.
  • When eating out or grilling, check hamburgers for doneness. No pink should be in the center of the meat. Return any under cooked food for further coking.
  • Carefully wash all fruits and vegetables before eating.

Hepatitis A

Thephoto shows a Hepatitis A virus cellA serious liver disease caused by a virus passed through sexual contact or contaminated food and water.

Common or Likely Sources

  • Raw or undercooked shellfish harvested from contaminated water
  • Eating or drinking food handled by an infected person.
  • Sexual activity

Symptoms

  • Tiredness, poor appetite, fever, nausea, vomiting, abdominal pain, jaundice (yellowing of the skin and the whites of the eye); may have dark-colored urine.
  • Symptoms can appear two to six weeks after the person came into contact with the virus.
  • Adults may feel ill for several weeks.
  • Infected people, including children, may not have symptoms but can still spread the virus.

How to Lower the Risk

  • Wash hands frequently and carefully with soap and warm water.
  • Never allow ill workers to prepare or handle food.
  • Cooking food to a temperature of 185°F or higher will inactivate hepatitis A.
  • A vaccine for high risk groups is available (for travelers to developing countries; families with young children in communities where there are high rates of Hepatitis A or frequent outbreaks; those with chronic liver disease; people infected with Hepatitis C; people who have a chronic clotting factor disease; illegal drug users; men who have sexual contact with men.)

Listeriosis (Listeria monocytogenes)

The photo shows Listeria bacterium in tissueA disease-causing bacterium that can grow slowly at refrigerator temperatures. Pregnant women are at much higher risk than other groups and the disease can harm them and result in fetal infection, spontaneous abortion and stillbirth.

Common or Likely Sources

  • Contaminated hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry
  • Soft cheeses
  • Pates
  • Raw, unpasteurized milk.

Symptoms

  • Fever, chills, headache, stiff neck, backache, sometimes upset stomach, abdominal pain, and diarrhea.
  • May take up to three weeks to become ill.
  • At-risk patients (including pregnant women) may later develop more serious illness from bacteria that could result in meningitis, encephalitis, even death. Pregnant women, the elderly and those with weak immune systems who think they have eaten contaminated food should seek medical advice immediately.
  • Spontaneous abortion, miscarriage, stillbirth or infection of fetus.

How to Lower the Risk

  • Do not consume undercooked animal products. Cook meats to proper temperatures.
  • If pregnant, elderly, or otherwise at higher risk, avoid soft French style cheeses, pates, uncooked hot dogs, sliced deli meats, alfalfa sprouts and unpasteurized juices.

Norovirus

The photo shows Norovirus virionsA highly contagious illness that remains active in the stool of infected people up to two weeks after they feel better.

Common or Likely Sources

  • Shellfish and contaminated foods or water
  • Ready-to-eat food touched by infected food workers, e.g., salads, sandwiches, ice, cookies, fruit.

Symptoms

  • Nausea, vomiting, stomach pain, fever, muscle aches, and some headache usually appear within one to two days and may last one to two days.
  • Diarrhea is more prevalent in adults, and vomiting is more prevalent in children.

How to Lower the Risk

  • Wash hands frequently, especially after using the bathroom and before handling food.
  • Wipe doorknobs, faucets, light switches, keyboards, remote controls and commodes daily with a mild bleach solution made of 1 cup of bleach in 9 cups of water.
  • Do not share hand towels.
  • Do not chew fingernails, or put pencils, pens or other items in your mouth.
  • Steam clean carpets or upholstery that has been contaminated by feces or vomit from an ill person.
  • Put soiled towels, sheets and clothing that have been soiled with contaminated feces or vomit in a bag before carrying through any area where food is prepared or handled.

Salmonella

The photo shows a large grouping of Gram-negative Salmonella typhimurium bacteriaOne of the most common intestinal (gut) infections in the U.S., believed to be responsible for one-third of all deaths from foodborne illness. Fetuses infected in the first trimester of pregnancy usually die. In the second and third trimester of pregnancy, salmonella can cause severe health problems in a fetus. There are more than 2,300 types of salmonella.

Common or Likely Sources

  • Raw or undercooked eggs, poultry, and meat
  • Raw milk and juice (non-pasteurized)
  • Foods containing raw eggs such as Caesar salad dressing, some other types of salad dressing, homemade hollandaise sauce, homemade ice cream, homemade mayonnaise
  • Cake batter
  • Cookie dough
  • Cheese and seafood
  • Contaminated fresh fruits and vegetables.

Symptoms

  • Stomach pain, diarrhea, nausea, chills, fever, and headache usually appear eight to 72 hours after eating.
  • Symptoms may last one to seven days.
  • A more severe illness may result if the infection spreads from the intestines to the bloodstream. Without treatment, a victim could die from it.

How to Lower the Risk

  • Cook poultry, ground beef and eggs to correct internal temperature to kill the salmonella bacteria. Use a food thermometer to measure the inside (internal) temperature.
  • Always make sure eggs are well cooked.
  • Do not eat or drink foods containing raw eggs or unpasteurized milk. Raw eggs may be in Caesar and other salad dressings, homemade hollandaise sauce, homemade ice cream, homemade mayonnaise, cookie dough, cake batter, and other foods.
  • Wash hands frequently with soap and warm water before and during food preparation, after using the bathroom, after touching reptiles and birds.
  • Wash surfaces before use and after contact with raw foods. Always wash and sanitize cutting boards, knives and utensils, food preparation surfaces, and dishcloths.
  • Keep raw foods separated from cooked, ready-to-eat foods. Place different type meats and poultry in separate containers and place them on the bottom shelf of the refrigerator.
  • Don’t let the juices of raw foods leak onto other foods. By preventing “cross contamination” you will not transfer or pass harmful bacteria in the blood and juices to other foods.
  • Use proper utensils to handle foods.
  • Minimize hand contact with food.
  • Refrigerate food promptly.

Shigellosis (Shigella)

The photo shows Shigella boydii bacteriaOne of the most contagious types of diarrhea caused by bacteria, shigellosis can be passed from person to person and through contaminated drinking water, recreational water and food. The Shigella germ is present in the diarrheal stools of an infected person while they are sick and for up to two weeks after all their symptoms go away.

Common or Likely Sources

  • Food, drinks, objects and surfaces handled or touched by the inadequately-washed hands and fingers of an infected person
  • Drinking water or recreational water contaminated by:
    • Sewage system overflows and malfunctions
    • Stormwater runoff that contains bacteria-laden feces from high volume animal farms, household pets or wild animals.
    • Flooding, which can submerge private wells in polluted water
    • Human feces in recreational waters.
  • Contaminated irrigational waters can contaminate fields of vegetables
  • Flies that breed in infected feces and then contaminate food
  • Sexual contact with an infected person.

Symptoms

  • Symptoms begin from 12 hours to four days after exposure.
  • Diarrhea is often bloody.
  • Patients have abdominal pain and cramps.
  • Some patients also have fever.

How to Lower the Risk

  • Wash hands with soap carefully and frequently, especially after going to the bathroom, after changing diapers, and before preparing foods or beverages.
  • If you manage a restaurant or food service, do not allow sick employees to handle or be around food.
  • Dispose of soiled diapers properly.
  • Disinfect diaper changing areas after using them.
  • Keep children with diarrhea out of child care settings.
  • Supervise hand washing of toddlers and small children after they use the toilet.
  • Do not prepare food for others while ill with diarrhea.
  • Avoid swallowing water from ponds, lakes, or untreated pools. Don't swim when you have diarrhea. You can spread germs in the water and make other people sick.
  • Don't swallow pool water. Avoid getting water in your mouth.
  • To kill or inactivate Shigella, bring your water to a rolling boil for one minute (at elevations above 6,500 feet, boil for three minutes). Allowed water to cool and store it in a clean sanitized container with a tight cover in the fridge.

Staphylococcus aureus

The photo shows a strain of Staphylococcus aureus bacteriaCommon or Likely Sources

  • Contaminated milk and cheeses
  • Salty foods; e.g., ham
  • Sliced meat
  • Food made by hand that require no cooking; e.g., puddings, sandwiches
  • Food workers who carry the bacteria and contaminate food.

Symptoms

  • Nausea, vomiting, stomach cramps, and diarrhea usually occur within 30 minutes to 6 hours after eating contaminated food.
  • Symptoms typically last 1 to 3 days.
  • The young and the elderly may have a more severe illness.

How to Lower the Risk

  • Wash hands frequently, especially after using the bathroom and before handling food.

Toxoplasma gondii

The photo shows Toxoplasma gondiiCommon or Likely Sources

  • Raw or undercooked meat
  • Accidental ingestion of soil on fruits or vegetables contaminated with cat feces.

Symptoms

  • Flu-like illness usually appear five to 23 days after eating
  • Symptoms may last months.
  • Those with a weakened immune system may develop more serious illness.
  • Can cause problems with pregnancy, including miscarriage, stillbirth, mental retardation, premature delivery.

Ways to Lower the Risk

  • If you are pregnant and have cats in your home, wear gloves when changing the litterbox or better yet, have another person handle that job.
  • Cook meats thoroughly.

Vibrio vulnificus

The photo shows a grouping of Vibrio yulnificus bacteriaCommon or Likely Sources

  • Undercooked or raw seafood, such as fish and shellfish

Symptoms

  • Diarrhea, stomach pain, and vomiting may appear within one to seven days and last two to eight days.
  • May result in a blood infection
  • Can result in death for those with a weakened immune system (from health problems such as bowel disorders, cancer, diabetes, hemochromatosis, HIV/AIDS, liver disease, stomach disorders or if you use alcohol or steroids heavily or long-term).

Ways to Lower the Risk

  • If you are at high risk, do not eat raw shellfish (oysters, clams, mussels). Choose cooked shellfish when eating out and always cook oysters, clams and mussels thoroughly.
  • Do not swim or wade in saltwater with open wounds or sores.


Food Safety Fact Sheets

Raw Milk (English, Spanish)

Listeria and Pregnancy (English, Spanish)

Handwashing