Foodborne Disease

MADYA ARDI WICAKSONO

AT EITHER END OF ANY FOOD CHAIN YOU
FIND A BIOLOGICAL SYSTEMA PATCH OF
SOIL, A HUMAN BODYAND THE HEALTH
OF ONE IS CONNECTEDLITERALLYTO
THE HEALTH OF THE OTHER.
Michael Pollan
The Omnivores Dilemma,
2006
2
Background
The diet transformed significantly in
What food we eat
How we grow or raise that food
How that food arrives in our tables
Industry consolidation and globalization
Health concerns and dietary
recommendations
Culinary trends and dining habits
3
Dietary changes
Instant foods
Lifestyle
Culture
Dining habits
4
Food products
Industrialization of food production processing &
packaging methods
Animal feeding & breeding
Agricultural practices pesticides & insecticides
Broadening distributions of food products
5
Food product recalls
Distributors or manufacturers voluntarily recall their
food products for either of two reasons:
a problem discovered in the course of routine
inspection of the food or its processing or
distribution
suspicion or identification of the product as the
cause of human or animal disease
6
Definition
considered to be any illness that is related to
food ingestion
gastrointestinal tract symptoms are the most
common clinical manifestations of foodborne
illnesses
numerous and varied, involving biological and
nonbiological agents
7
Causes
Biological agents
Bacteria
Virus
Fungus
Parasite
Biological toxins
Chemical agents
8
Type of agent: Bacterias
General mechanism
of actions
Example
Preformed toxin Bacillus cereus
Clostridium botulinum
Staphylococcus aureus
Infection and
production of
enterotoxins
Bacillus cereus
Clostridium botulinum
Clostridium perfringens
Enterohemorrhagic
Escherichia coli
Enterotoxigenic E. coli
(ETEC)
Vibrio cholerae
9
Type of agent: Bacterias
General mechanism of
actions
Example
Infection Bacillus anthracis
Brucella spp. (B. melitensis, B.
abortus, B. suis) Campylobacter
jejuni
Enteroinvasive E. coli
Listeria monocytogenes
Plesiomonas shigelloides
Salmonella spp.
Shigella spp.
Streptococcus pyogenes
Vibrio parahaemolyticus
Vibrio vulnificus
Yersinia enterocolytica and Y.
pseudotuberculosis
10
Type of agent: Viruses
General mechanism
of actions
Example
Infection Hepatitis A
Norovirus (and other
caliciviruses)
Rotavirus
Astroviruses,
adenoviruses,
parvoviruses
11
Type of agent: Parasites
General mechanism
of actions
Example
Infection Cryptosporidium
Cyclospora cayetanensis
Diphyllobothriumlatum
Entamoeba histolytica
Giardia lamblia
Taenia saginata
Taenia solium
Toxoplasma gondii
Trichinella spiralis
12
Type of agent: Marine algae toxins
General mechanism
of actions
Example
Preformed toxin Brevetoxin (neurotoxic
shellfish poisoning)
Ciguatoxin (ciguatera)
Domoic acid (amnestic
shellfish poisoning)
Saxitoxin (paralytic
shellfish poisoning)
13
Type of agent: Fungal toxins
General mechanism
of actions
Example
Preformed toxin Aflatoxin
Mushroom toxins
(amanitin, ibotenic acid,
museinol, muscarine,
and psilocybin)
14
Type of agent: Fish toxins
General mechanism
of actions
Example
Preformed toxin Gempylotoxin (escolar)
Scombrotoxin
(histamine fish
poisoning)
Tetrodotoxin (puffer
fish)
15
Type of agent: Chemicals
Antimony
Arsenic
Cadmium
Copper
Fluoride
Lead
Mercury
Nitrites
Pesticides (e.g.,
organophosphates, carbamate)
Thallium
Tin
Zinc
16
Determining the etiologic agent
Clues
Predominant signs and symptoms among ill
individuals
Incubation period, if known
Duration of illness, and
Suspected food, if known
Laboratory confirmation
17
Signs, symptoms, incubation period, and
duration of illness: toxins
Preformed toxins bacteria-releasing toxins into food during
growth in the food (Staphylococcus aureus, Bacillus cereus,
and Clostridium botulinum) ingested live bacteria do not
need to be consumed to cause illness
Illness from a preformed toxin manifests more rapidly time
for growth and invasion of the intestinal lining is not required
the incubation period: minutes or hours
18
Signs, symptoms, incubation period, and
duration of illness: toxins
Signs and symptoms depend on the toxin ingested but
commonly include:
Vomiting
Nausea
Diarrhea
Interference with sensory and motor functions, such as
double vision, weakness, respiratory failure, numbness,
tingling of the face, and disorientation
Fever is rarely present.
19
Signs, symptoms, incubation period, and
duration of illness: infections
Viruses, bacteria, or parasites invade the intestinal
mucosa and/or other tissues, multiply, and directly
damage surrounding tissues
Bacteria and certain viruses invade and multiply in
the intestinal tract and then release toxins that
damage surrounding tissues or interfere with normal
organ or tissue function (enterotoxins)
20
Signs, symptoms, incubation period, and
duration of illness: infections
The necessary growth of the microorganism, damage
of tissues, and production and release of toxins takes
time the incubation periods for infections are
relatively long, often days
The incubation periods for viruses (excluding
hepatitis A) tend to be shorter than for bacteria
which tend to be shorter than the incubation periods
for most parasites.
21
Signs, symptoms, incubation period, and
duration of illness: infections
Sign and symptoms of infection usually include:
Diarrhea
Nausea
Vomiting
Abdominal cramps
Fever
Elevated white blood cell count
Spread to other organs longer duration,
increased severity, and signs and symptoms
associated with the particular organ affected
22
Examples of food items and commonly
associated microorganisms
Item Commonly associated
microorganism
Raw seafood Vibrio spp., Hepatitis A,
Noroviruses
Raw eggs Salmonella (particurlarly serotype
Enteritidis)
Undercooked meat or
poultry
Salmonella and Campylobacter
spp., Shiga toxin-producing
Escherichia coli (STEC),
Clostridium perfringens
Unpasteurized milk or
juice
Salmonella, Campylobacter, and
Yersinia spp., ETEC
Unpasteurized soft
cheeses
Salmonella, Campylobacter,
Yersinia, and Listeria spp., ETEC
Home-made canned Clostridium botulinum
23
Prevention: control of source
Foods associated with food-service
establishments or home processing
Removing food from consumption
Cleaning and sanitizing
Training
Modifying a food-production or food-
preparation process
Modifying the menu
Removing infected food workers
Closing food premises
Communication with the public
24
Prevention: control of source
Foods associated with a processor/producer
Procedures for removing food from the market
Communication with the public
Postrecall reporting by the business
25
Prevention: control of secondary
transmission
Information for Health-Care Providers
Information for the Public
Personal protection from disease outbreak
Proper food preparation
Exclusion of Infected Persons from Settings Where
Transmission Can Occur
Infection Control Precautions
Prophylaxis
26
Prevention: simple recommendations
Cook meat, poultry and eggs and other raw foods
thoroughly
Separate cooked and uncooked food. Avoid cross-
contamination by not using platters or utensils
contaminated by raw foods for cooked foods. Put cooked
foods on clean platters, not the ones that held the raw
meat.
Chill leftovers promptly. Don't leave food out for more
than 4 hours
Clean produce. Wash hands before preparing food and
immediately after handling raw foods.
Report suspected food borne illness to the local health
department.
27
Prevention: in an epidemiological
setting
Surveillance system
Hazard Analysis Critical Control Point (HACCP)
Quarantine system
28
Tujuan dari surveilans penyakit
bawaan makanan
Menentukan besaran masalah kesehatan masyarakat
yang diakibatkan oleh penyakit bawaan makanan,
dan memonitor trennya
Mengindentifikasi wabah penyakit bawaan makanan
pada tahap awal sehingga tindakan pengobatan
dapat diberikan tepat pada waktunya
29
Tujuan dari surveilans penyakit
bawaan makanan
Menentukan besarnya peranan makanan
yang bertindak sebagai jalur transmisi
mikroba patogen yang spesifik, dan
mengidentifikasi makanan beresiko tinggi,
pengolahan makanan yang beresiko tinggi
dan populasi rawan resiko
Mengukur efektifitas program untuk
meningkatkan keamanan pangan
Menyediakan informasi untuk perancangan
kebijakan kesehatan tentang penyakit
bawaan makanan (termasuk di dalamnya
adalah perancangan dan penentuan
prioritas strategi pencegahan)
30
Sources of information for public
health surveillance
Public
health
surveillance
Human
disease
Environmental
data
Animal data
Healthcare
services data
Population
characters
31
Burden of illness pyramid reflecting the proportion of
foodborne illnesses that make it through each step of the
diagnosis and reporting process
32
HACCP
HACCP adalah suatu sistemjaminan mutu yang berdasarkan
kepada kesadaran bahwa hazard (bahaya) dapat timbul pada
berbagai titik atau tahap produksi tertentu, tetapi dapat
dilakukan pengendaliannya untuk mengontrol bahaya bahaya
tersebut. Kunci utama HACCP adalah antisipasi dan
identifikasi titik pengawasan yang mengutamakan
kepada tindakan pencegahan, daripada mengandalkan
kepada pengujian produk akhir.
33
HACCP
Food safety / keamanan pangan
Wholesomeness / kebersihan
Economic fraud / pemalsuan
34
Manfaat HACCP
Menjamin keamanan pangan
Mencegah kasus keracunan pangan
Mencegah/mengurangi terjadinya
kerusakkan produksi atau ketidakamanan
pangan
Menjadi standar internasional dan
persyaratan wajib pemerintah,
Memberikan efisiensi manajemen
keamanan pangan
35
Prinsip HACCP
1. Mengidentifikasi potensi bahaya yang berhubungan dengan
produksi pangan pada semua tahapan, mulai dari usaha tani,
penanganan, pengolahan di pabrik dan distribusi, sampai
kepada titik produk pangan dikonsumsi.
2. Menentukan titik atau tahap prosedur operasional yang
dapat dikendalikan untuk menghilangkan bahaya atau
mengurangi kemungkinan terjadi bahaya tersebut.
36
Prinsip HACCP
3. Menetapkan batas kritis yang harus dicapai untuk menjamin
bahwa CCP berada dalamkendali
4. Menetapkan sistempemantauan pengendalian (monitoring)
dari CCP dengan cara pengujian atau pengamatan
5. Menetapkan tindakan perbaikan yang dilaksanakan jika hasil
pemantauan menunjukkan bahwa CCP tertentu tidak
terkendali
37
Prinsip HACCP
6. Menetapkan prosedur verifikasi yang mencakup dari
pengujian tambahan dan prosedur penyesuaian yang
menyatakan bahwa sistemHACCP berjalan efektif
7. Mengembangkan dokumentasi mengenai senua prosedur
dan pencatatan yang tepat untuk prinsip-prinsip ini dan
penerapannya.
38
39
Quarantine / Karantina
Dasar peraturan
UU no 18/2009 tentang peternakan dan kesehatan hewan
UU no 16/1992 tentang karantina hewan, ikan, dan
tumbuhan
40
Quarantine / Karantina
Karantina adalah tempat pengasingan dan atau tindakan
sebagai upaya pencegahan masuk dan tersebarnya hama dan
penyakit (termasuk foodborne disease) dari luar negeri, dan
dari suatu area ke area lain di Indonesia, maupun keluarnya
hama dan penyakit dari dalamwilayah negara Republik
Indonesia
Setiap lalu lintas media pembawa hama penyakit harus
memenuhi persyaratan karantina
41
Persyaratan karantina
Dilengkapi dengan sertifikat kesehatan atau s
anitasi
Melalui tempat yang telah ditetapkan
Dilaporkan dan diserahkan kepada petugas karanti
na untuk dilakukan tindakan karantina
Dapat dikenakan kewajiban tambahan yang
berhubungan dengan sifat penyakit, sesuai kaidah
ilmu kedokteran hewan
42
Pelaksanaan tindakan karantina
Dilakukan kepada media pembawa hama
penyakit hewan karantina (HPHK)
HPHK adalah penyakit yang ditetapkan oleh
menteri untuk dicegah masuk, keluar dan
tersebarnya
Media pembawa HPHK adalah
hewan (misalnya sapi)
bahan asal hewan (misalnya daging, susu, telur)
hasil bahan asal hewan (misalnya bakso, sosis,
keju)

43
Tindakan karantina
Pemeriksaan
Pengasingan
Pengamatan
Perlakuan
Penahanan
Penolakan
Pemusnahan
Pembebasan
44
Tempat pelaksanaan
Negara asal
Tempat pemasukan (pelabuhan, bandara)
Tempat transit
Tempat pengeluaran (pelabuhan, bandara)
45
Waktu pelaksanaan
Saat akan dimasukkan ke dalamwilayah RI (impor)
Saat akan dilalu-lintaskan antar area dalamwilayah RI
Saat akan dikeluarkan ke dalamwilayah RI (ekspor)
46