Foodborne Illness: Oubreadks of Salmonella in America - Report Example

Analysis of outbreak Name Institution Table of Contents Table of Contents 2 Introduction 3 Pathophysiology 4 Risk factors 5 Epidemiology 5 Mortality and morbidity 6 Origin of the outbreak in comparison with previous outbreaks of the associated with the agent 6 Observations and Lessons Learned 9 Conclusion 10 References 12 Introduction Salmonella outbreaks stand out as one of the severe and common disease outbreaks in the US and many other places the world. Annually, 1.4 million American suffer from this disease1. America reprots about 15, 000 hospitalization incidents and about 400 salmonella linked deaths yearly. Symptoms manifest within 12 to 72 hours of infection and they include a fever, abdominal cramps, and diarrhea. It takes about 4 to 7 days to heal. Also, a number of people have been reported to heal without taking mediccation. The disease demographics are an indication of how frequently people suffer for salmonella in America, despite numerous hygiene programs designed to ensure sanitation and disease prevention. Salmonella bacterium is mainly transmitted through contaminated food. Ingestion of contaminated food easily gives the bacterium access to intestinal wall which it affects leading to the above symptoms1. The ability of various animals to act as carriers for the bacteria lead incread probability of cross-contamination creates challenges in the control of the disease. With cross contamination transmission is not limited to food alone. The 2009 multistate outbreak of the disease for instance, exhibited the ability of the disease to spread through a simple act of hygiene neglect such as washing contaminated aquarium in kitchen sinks. This case study will review the report on the 2009 multistate salmonella outbreak in the US which was associated amphibians1. Ther report will all compare the 2009 outbreak with earlier multinstae oubreadks of salmonella in America. Pathophysiology Salmonella typhimurium is a kind of bacteria that inhabits the intestinal lumen. It infects people through contact with non-phytocytic cells. These bacteria cause the host’s cytoskeleton to allow it to enter the cells. The effects of salmonella typhimurium can range from fever, focal infections and a range of gastroenteris diseases2. It has a wide range of distribution in the environment which makes humans the most susceptible to its infections. However, its increasing adaptability, resistance, prevalence and virulence remain a major challenge worldwide. Salmonella infections are brought about by the ingestion of food which is bacteria contaminated. Direct contact with the carriers such as reptile animals, amphibians and other humans is also a cause of the diseases. It is confirmed that once the bacteria have survived the acidity in the stomach, they go ahead to terrorize the intestines by thoroughly invading the epithelial cells. The interaction with the epithelial cells causes eruption and the inflammation of the intestinal cells, which includes the cytokinins, dendric cells and macrophages. Once the bacteria pass the epithelial layer of the intestine, they replicate and increase in number in the lymph nodes, peyer’s patches and the spleen. From those areas they shift to such organs as the lungs, kidneys and the gall bladder. The severity of the diseases is dependent upon the number of the organisms and the host factors. The most common sources of the salmonella typhimurium infections are the contamination of the water, milk, eggs and poultry as well as other dairy products. In recent times, the most reported human outbreaks are the contaminated dog foods, puffed vegetables, and the peanut butter products. The reservoir of the bacteria includes the human, poultry, swine, cattle as well as rodents. The oral transmission of the typhimurium from one person to another, especially in areas with very poor sanitation, contaminated and non-chlorinated water is the route for the entery of salmonella. Humans are, however, mostly the carriers of the bacteria. Individual susceptibility is however determined by the age, recent bowel surgery as well as the malnutrition3. Risk factors Salmonella gets transmitted in three different ways. First is oral transmission through cold beverages or food that has been in contact with an asymptomatic carrier that frequently sheds the bacteria through urine or feces. Second, it may also be transmitted from hand to mouth after one has used a contaminated toiled and failed to observe hand hygiene3. Third, it may also be transmitted through drinking of contaminated water that has been in contact with human feces The bacteria are common in foods that are sold by food vendors in microbial friendly environments. The bacteria can survive low pH at 1.53. Agents the reduce stomach acidity such as antacids and proton pump inhibitor facilitate the infection process. Genetic polymorphisms are also critical risk factors since they predispose people to intracellular pathogens. Epidemiology Sanitation improvement and effective use of antibiotics for treatment of salmonella successfully and gradually reduced the rate of infection in the US since 1900. For instance, in 1920s salmonella accounted for about 35,994 cases, while in 2006, annually salmonella related deaths were about 3143. Also, most of the cases (79%) reported between 1999 and 2006 occurred in the victims that had been outside the county in about thirty days prior to the infection. About three cases were traced to imported food. Only 17% percent of the cases were traced to domestic carriers. Other parts of the world experience higher cases of salmonella infection. India leads while the rest of Asia is in the second place3. Mortality and morbidity Prompt and suitable antibiotic therapy heals salmonella in a few days. Patients normally require as little as 6 days of hospitalization. Treatments normally reduce the patients’ risk of mortality to 0.2%. However, when it is untreated, it becomes life threatening and may take several weeks to heal. It may result in long-term morbidity through damage to the central nervous system. In the prenatibiotic era, America recoded 9% to 13% mortality rate associated with salmonella. Also, children and young adults account for the largest number of infections. Most of these are school-going kids and youths. It is not easy to point to the actual figure of young children or infants that are infected by the disease since not all cases are reported. The manifestation in these children includes mild illness to extreme convulsion which may go unrecognized. As a result, the reports on the infection are likely to give higher or lower figures on mortality and morbidity. Origin of the outbreak in comparison with previous outbreaks of the associated with the agent The 2009 multistate Salmonella Typhimurium outbreak, which affected people in 31 states was spread by frogs. Reports of the infection were first published in April and by July health authorities in Utah isolated five cases1. CDC organized a multistate case-control study in august to establish the infection sources. In total 85 infections had been reported by the winter in a total of 31 states. The multistate control case study revealed a strong association between infections and frogs. About 63% of the victims had had contact with frogs. 14 patients pointed out that they had been in contact with the African dwarf frog. CDC tested samples from the frogs’ aquariums during the investigations and found S.Typhimurium strains similar to the outbreak strains. Alongside case-control studies, environmental testing and traceback lead through the channels of the turtles’ distribution to the original source1. The turtles were traced to supplier in California who breaded reptiles and amphibians. For instance, he had turtles, which are also known to spread salmonella. Turtles have been for a long time been found to spread salmonella and even the government had banned the trade of turtles in 1975. However, this was the first time a frog had been responsible for the bacteria outbreak. The outbreak strain was XbaI of the pattern JPXX01.0177. Symptoms appeared a week after exposures. Demographic of the infected was as follows; women accounted for 52%, median age was of the affects was 5 years and the range was three weeks to 54 years. A majority, 76% of the infections were children below ten years. 16 patients were hospitalized, but there were no casualties1. 19 patients from the case-control study new that salmonella can spread through turtles while 11 knew of the link between salmonella and amphibians. 20 patients reported having washed the aquarium in the kitchen sink and in their bathrooms. Cleaning the aquarium in the kitchen sink must have increased chances of cross-infection from the sink to the to the food prepared in the contaminated kitchen In 2006, there was a tomato linked multistate Salmonella Typhimurium outbreak. Infected persons experience diarrhea and fever that went away within a week4. It affected 21 states and two cases were reported in Canada. One of the Canadians had recently been to US. The vitamins median ageof victims was 34 years while 57% of the victims were women. 22 (about 12% of the victims) got hospitalized. There were no casualties. Reports indicated that the infection occurred between the last two weeks of September and October with 93% of manifestations being reported within this window4. The investigations and the data collected on the disease indicate that the bacteria mainly spread through tomatoes that were served in restaurants. Like the Aquatic Frogs associated outbreak of 2009, this outbreak was investigated by CDC in conjunction with the affected states’ public health officials. The instigations also use a case-control epidemiological study. Infected perasons and health persons were interviewed on what they had eaten day before the outbreak and it emerged that tomatoes served at restaurants were the main source of the spread. However, the investigation did not trace the tomatoes since infections ceased. There was also no need to tell the public to stop consuming tomatoes in restaurants4. Another outbreak is the 2008 multistate outbreak of Salmonella Typhimurium. It was linked to pet turtle exposures5. First detected in Pennsylvania, the Pennsylvania Department of Health (PADOH) found the strain and alerted others, including CDC. A multistate investigation lead by CDC lasted between September and November 2008. In total 135 people had been in affected in a total of 25 states. 45% of those infected were children below the age of five years. 70 patients were considered to have primary infection and 37% of them had had a direct contact with turtles, mostly small turtles sold frequently in streets by vendors. The case-control study used to investigate the cases showed a strong association between the turtles and the infection. The first case was of a two year old girl whose stool was found to contain S. Typhimurium on July 9, 2008. The tests were done after a three day of fever and diarrhea. The girls contact with the turtles had been three weeks prior to the infections. Her family had purchased pet turtles. Although she never handled the turtles, she had been in contact with the aquarium. By 28 July, five other patients’ stools tested positive for S. Typhimurium in Pennsylvania5. PulsNet already had other reports from other states and in total it now had over ten cases. Multistate investigation found the outbreak strain in samples collected from the aquarium the girl’s parent had bought with the turtles. Investigation indicated that the first infection had been recorded in March 13 and person-to-person transmission also played a role in the transmission. The outbreak variety was PFGE XBaI with the patterns JPXX01.0006 or JPXX01.04165. The final reports show the median age of the victims was 7 years and they ranged from less than one year to 94 years. A large number, 45% (54 victims) were children below five years of age, and females accounted for a large majority 51% (which is 63 victims). The most common symptom of this outbreak was diarrhea full of blood. Hospitalized cases were 29 and most them were severe. They had had direct contact with turtles. A number of patients had been in contact other reptiles, mostly iguanas and snakes. Between 2008 and 2009, another Salmonella Typhimurium multistate outbreak occurred6. This one was linked to Peanut Butter and the infection statistics were as follows; 714 people in 43 states got infected. The infections age range < 1 to 98 years (Median age 16 years). 48% of the infected were women and 24% of the infected got hospitalized. 9 deaths were recorded. Investigations were also conducted through a CDC led the investigation by finding out what healthy people had eaten and what the infected had eaten. The results indicated that the peanut butter was the source of the bacterial6. Observations and Lessons Learned The multistate outbreaks of Salmonella Typhimurium have been dynamic mostly coming the pets and food. Two cases have been through reptiles. There are reptiles such as turtles and amphibians mainly African dwarf frog. The two other cases have been through food, once through tomatoes served at restaurants and the other through processed food, peanuts. The investigations of the infection used case control studies which involved interviewing patients on what they had eaten in the days leading to infections. Investigation used the non infected persons and the control for the studies. Common food consumed by the infected persons was the pursued and tested through laboratory test for salmonella. Most of the food products which had been collected from the infected persons were found to have salmonella bacteria. The investigator then went ahead to teas the products at manufacturer of the products and most of them were found to be contaminated by salmonella. Case controlled studies were also used to investigate infections by pets. There are several lesson learn from this case study and from the investigations. First, the past salmonella infections reveal the ability of the bacteria to bacteria to be carried to distant place and cause multiple infections in different areas. Second, hygiene and cleanliness are the best way to avoid the spread of salmonella. For instance, one should always wash hands thoroughly after being in contact with pests. The people who keep amphibian or reptile in aquarium at home should be carefully when handling the aquarium and should clan the aquarium far away from where far away from food preparation areas. Also manufactured food is not always as clean as it is expected to be. The food may be contaminated during packaging or processing and thus spread the infection once it is packed and distributed. Conclusion Salmonella outbreaks occur frequently. When outbreaks occur, quick response through prompt antibiotics treatment is necessary to in improve recovery chances of the patients. Salmonella can lead to death if not promptly attended. Second, once an outbreak is reported, investigation must take place in order to indentify sources of the infection to prevent further infections. It is necessary to improve hygiene in factories to ensure packaged food is clean. People handling food in restaurants and factories should be tested and vaccinated to ensure they do not spread salmonella infections. References 1. Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Aquatic Frogs --- United States, 2009. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5851a1.htm. Published January 8, 2010. Updated January 8, 2010. Accessed May 30, 2015. 2. Ohl ME & Miller SI,Salmonella: a model for bacterial pathogenesis. Annual review of medicine, (2001).52(1), 259-274. 3. Domschke W. Intestinal mucosa and its diseases: Pathophysiology and clinics : proceedings of the Falk Symposium 110 held in Titisee, Germany, October 16-17, 1998. Dordrecht [u.a.: Kluwer. 1999 4. Multistate Outbreak of Salmonella Typhimurium Infections Linked to Tomatoes. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/salmonella/typh2006/index.html. Published November 3, 2006. Updated May 13, 2008. Accessed May 30, 2015. 5. Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Pet Turtle Exposure --- United States, 2008. Centers for Disease Control and Prevention Web site http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5907a2.htm Web site. Published February 26, 2010. Updated February 26, 2010. Accessed May 30, 2015. 6. Multistate Outbreak of Salmonella Typhimurium Infections Linked to Peanut Butter, 2008–2009  http://www.cdc.gov/salmonella/typhimurium/update.html Published March 17, 2009. Last edited December 2, 2012. Accessed May 30, 2015. 7. Read More