FBDs Outbreak

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EXPLORE AND DISCUSS THE PUBLIC

HEALTH CHALLENGES OF THREE MOST


RECENT FOODBORNE DISEASES
OUTBREAKS OCCURRED IN THE WORLD

HAMDI MICHAEL

DR GETACHEW KABEW

12/2/24
OUTLINE
Salmonella
Enteritidis

Outbreak E. Coli O157:H7


Public Health challenge

Listeria
monocytogenes
Introduction

Foodborne diseases, caused by consuming


contaminated food or water, pose a
significant global health challenge
impacting individuals of all ages and
socioeconomic backgrounds
Burden

Each year, an estimated 600 million people fall ill and


420,000 die from unsafe food, resulting in the loss of 33
million healthy life years (DALYs)

Children under 5 years of age are particularly at risk, with


125,000 children dying from foodborne diseases annually.
Salmonella outbreak linked to Milo’s Poultry
Farms in the United States

 This outbreak affected at least 65 people across nine states,


with illnesses reported between May and August(CDC ,2024)

 The infections were linked to eggs consumed at various


restaurants supplied by Milo’s Poultry Farms
 The Salmonella outbreak linked to Milo’s Poultry Farms in 2024
significantly impacted public health in the United States, highlighting
key vulnerabilities in food production and safety

 Investigations by the CDC and FDA revealed that Salmonella was


present in the egg packing facility and hen housing environments at
Milo’s Poultry Farms
The infections were caused by Salmonella Enteritidis, a common
pathogen transmitted through contaminated eggs and poultry

Symptoms included diarrhea, fever, and abdominal cramps, typically


occurring 6 to 72 hours after ingestion. The most severe cases led to
hospitalization, with 24 individuals requiring medical care

Genetic testing indicated that the outbreak strain showed resistance to


ciprofloxacin, complicating treatment for those requiring antibiotics.
Public Health Challenges
Contamination at Source:

The discovery of Salmonella in the production


environment indicates systemic failures in hygiene
and biosecurity measures. Ensuring clean housing
for hens and sterilized packing processes are critical
to preventing such contamination.
Public Health Challenges
Antimicrobial Resistance (AMR):

The outbreak strain demonstrated resistance to ciprofloxacin, a


commonly used antibiotic. This resistance poses treatment
challenges, particularly for severe cases. Antimicrobial
resistance in foodborne pathogens complicates disease
management and highlights the need for judicious antibiotic
use in agriculture
Public Health Challenges
Delayed Reporting:

The time between exposure and confirmation of the outbreak


strain in patients underscores the need for faster diagnostic
tools. Many cases may go unreported, as individuals often
recover without seeking medical care, masking the
outbreak’s true scope.
Public Health Challenges
Supply Chain Complexity:

Eggs from Milo’s Poultry Farms were distributed to multiple


states, reaching consumers through restaurants and grocery
stores. The widespread distribution increases the potential
impact of contamination and complicates traceback efforts.
Response and Control Measures
Milo’s Poultry Farms initiated a recall of all eggs linked to the
outbreak in September 2024, effectively removing contaminated
products from circulation.

Public health agencies, including the CDC and FDA, advised


consumers and businesses to discard affected eggs and reinforced
guidelines for proper cooking of eggs to kill bacteria.
Investigations utilized advanced genomic tools, such as whole
genome sequencing (WGS), to link the outbreak strain to its source.
These tools are essential for modern epidemiology, allowing precise
traceback and containment.
Prevention Strategies

 Enhanced Biosecurity: Farms must implement stricter sanitation


protocols, including regular disinfection of equipment and facilities
and monitoring for potential contamination sources.
 Antimicrobial Stewardship: Limiting antibiotic use in poultry farming
is critical to reducing AMR risks. Investment in vaccines and
alternative preventive measures for poultry health can also help
 Consumer Education: Public awareness campaigns on safe egg
handling, such as refrigeration and thorough cooking, can
significantly reduce risks.
E. coli O157:H7 outbreak at McDonald’s

Outbreak began with illnesses reported in late September, peaking


by mid-October 2024,

The outbreak spread across 13 states

Multiple individuals across various states reported symptoms


consistent with an E. coli infection after eating at McDonald’s
The patients, whose ages ranged from 13 to 88, exhibited classic
symptoms of E. coli infection, including severe stomach cramps,
diarrhea (often bloody), and vomiting.

As of late October, 90 cases were reported across 13 states, with 27


hospitalizations, two cases of hemolytic uremic syndrome (HUS),
and one death
As part of the investigation, public health authorities conducted
interviews with affected individuals, all of whom had consumed
McDonald’s Quarter Pounder hamburgers before becoming ill.

This pattern raised suspicion that a common ingredient in the meal might
be responsible for the outbreak
They conducted testing on beef patties used in the affected sandwiches.
The results of these tests were negative for E. coli, further confirming that
the source was not the beef but rather the onions.

Investigations shifted focus to the Taylor Farms onions, leading to a recall of


slivered, whole, and diced onions distributed to food service businesses.
The investigation by the CDC and FDA focused on identifying the specific
batches of onions linked to the outbreak

The FDA and CDC coordinated closely with state agencies to trace the onions'
supply chain, ultimately linking contamination to a Taylor Farms processing
facility and an onion grower in Washington State.
Public Health Challenge

 Spread of Illness and Public Health Impact

 The E. coli O157:H7 strain responsible for the outbreak is known to produces
Shiga toxin, causing symptoms such as severe abdominal pain, bloody diarrhea,
and, cause severe gastrointestinal illness

 While many infected individuals recover within a week, a subset of patients can
develop more severe complications, such as hemolytic uremic syndrome
(HUS), a life-threatening condition that can lead to kidney failure
 Many of the patients experienced symptoms between September 27 and October 16,
2024, but it is likely that additional cases were still in the process of being diagnosed
at the time of the report.

 It was noted that the true number of cases was likely higher than reported, as many
individuals with mild symptoms may not have sought medical care or were not
tested for E. coli.

 Public health officials estimated that for every diagnosed case, approximately 26
others might go undiagnosed.
 Risk Factors and Vulnerable Populations

 E. coli O157:H7 poses a particularly high risk to certain populations, including young chil
the elderly, and immunocompromised individuals. These groups are more susceptible to
developing severe complications, including HUS. As a result, public health communication
surrounding the outbreak emphasized the importance of seeking medical attention if sympt
E. coli infection were observed, particularly for vulnerable individuals

Low Infectious Dose:


The infectious dose of E. coli O157:H7 is as low as 10-100 organisms, making it highly conta
This characteristic complicates containment efforts and underscores the need for rigorous hyg
practices throughout the food chain.
 Complexity of Tracebacks:
Fresh produce is often sourced from multiple farms and facilities, making it
difficult to pinpoint the exact source of contamination. Advances in traceability
technologies, such as blockchain and electronic record-keeping, can improve
response times.
 Public Awareness and Behavior:
Many consumers are unaware of the risks associated with raw produce.
Educational campaigns on proper handling, washing, and cooking of fresh
produce can reduce exposure risks.
Public Health Response

 Immediate Actions:
Upon identifying the outbreak, McDonald’s and Taylor Farms voluntarily recalled all
slivered onions from affected batches. Restaurants stopped serving onions in menu items
nationwide as a precautionary measure. Public advisories were issued, warning consumers
about potential exposure.
 Traceback Investigations:
Federal and state health agencies collaborated to trace the onions through the supply
chain. Advanced techniques like whole-genome sequencing (WGS) confirmed the
genetic match between the outbreak strain found in patients and the contaminated
onions.
 Medical Treatment and Monitoring:
Hospitals reported increased admissions for suspected E. coli infections during the
outbreak period. Patients with severe symptoms were treated with supportive care,
including hydration and monitoring for complications like HUS.
Listeria Monocytogenes Outbreak Linked To Deli Meats In The USA

Presents an alarming example of how foodborne pathogens


continue to pose significant risks to public health, particularly
among vulnerable populations.

The outbreak spanned 13 states and The onset of illnesses


ranged from late May to mid-July 2024 resulted in 43
confirmed cases

Notably, all affected individuals were hospitalized, with


three fatalities reported
Public Health Response

The CDC and local health departments carried out


extensive surveillance and interviews with affected
individuals

This epidemiological approach allowed officials to


identify common factors, such as the consumption of
deli meats from specific stores and brands, that
ultimately linked the outbreak to the contaminated
Boar’s Head products
The contamination was
identified and traced

The affected deli meats,


including liverwurst, were
recalled by Boar’s Head and
other distributors.
Listeria and Public Health Challenges
 Food Safety Challenges in the Supply Chain
 Listeria monocytogenes is a particularly
dangerous pathogen because it can survive in
environments where most bacteria would
not, including on cold food surfaces, and in
refrigerated temperatures

 Listeria can grow at temperatures as low as 32°F


(0°C). This characteristic makes ready-to-eat foods,
such as deli meats, unpasteurized cheeses, and
 Vulnerable Populations and Invasive
Listeriosis

 The most significant public health challenge posed by the


outbreak was the heightened risk to vulnerable
populations.

 Listeria monocytogenes infection, known as listeriosis,


can cause severe illness, particularly in pregnant
women, the elderly, and individuals with weakened
immune systems
 Listeria is unique in its ability to cause severe
infections, such as meningitis, septicemia, and
encephalitis, in addition to foodborne
gastrointestinal illness

 For pregnant women, Listeria poses a unique risk.


The infection can lead to miscarriage, stillbirth, or
severe health complications in the newborn
 Ineffective Traceback and Detection of Contamination

 Tracing the source of Listeria contamination in food products


can be difficult, particularly when the pathogen spreads across
multiple retail locations and production facilities

 the traceback process involved identifying the specific batches of


Boar’s Head liverwurst linked to the outbreak by utilizing
advanced tools such as whole genome sequencing (WGS).
 Delay in detection and response posed a public health risk,
as individuals continued to consume

 The outbreak also underscored the challenges in ensuring timely


detection of contamination, as many people may recover from
Listeria infection without seeking medical attention or being
tested..

 This means that many cases may go unreported, further


complicating the ability to identify and contain the outbreak
 Challenges in Consumer Education and Awareness

 Despite public health campaigns and advice, many consumers continue to


consume deli meats without heating them, not realizing that this puts them
at risk for Listeria infection

 Public health agencies have made efforts to educate consumers about the need to cook
deli meats to an internal temperature of 165°F (74°C), but this advice is not always
followed, particularly if individuals are unfamiliar with the severity of Listeria infection
or if heating deli meats is not considered convenient.

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