Review of Related Literature

The worldwide problem of food-borne disease is currently unknown but the World Health

Organization (WHO) has answered to this data gap by letting a new initiative launch to give

better estimates(Newell, Koopmans, Verhoef, Duizer, Aidara-Kane, Sprong et al., 2010). A major

public health issue related to the food safety management in a country is the food-borne disease

outbreak (FBDO). Unsafe or contaminated food makes at least two billion people ill globally

each year, or about one-third of the global population (WHO, 2004 as cited in Cheng, Kuo, Chi,

Lin, Lee, Feng et al., 2010). About 1 in 6 Americans (or 48 million people) falls ill, 128,000 are

hospitalized, and 3000 die of food-borne illnesses each year as estimated by the United States

(US) Centers for Disease Control and Prevention(CDC) (Cheng, et al., 2010).

It was reported in 2005 that 1.8 million people died from diarrhoeal diseases, largely due to

the exposure to contaminated drinking water and food. This is not just an underdeveloped world

problem. 325,000 hospitalizations and 5000 deaths are due to the 76 million cases of food borne

illnesses, It is estimated to happen yearly in the United States of America (USA) alone (Mead et

al., 1999). There are roughly 200 known microbial, chemical or physical agents that can cause

illness when ingested (Acheson, 1999). At least in the industrialised world, over the last 20 years

or so, food-borne diseases caused by bacteria, parasites, viruses and prions have significantly

generated and moved up the political agenda, on occasionally, media attention. Public health

efforts have been directed mainly towards the well-recognised food-borne diseases and

pathogens in the food chain, in the face of such public concern, In an attempt to lower the disease

problem, the monitoring of food-borne diseases and pathogens in the food chain has been

implemented and a farm-to-fork approach has been adopted encouraging all sectors of the food
production chain to improve hygiene and actively incorporate structured approaches to food

safety, such as HACCP principles (Newell, et al., 2010).

Overall, public food-safety education must be strongly followed and implemented to help

prevent the variety of causes of food borne-illnesses outbreak in the country. Well-educated food-

regulatory personnel are expected to be in a better position to give effective services, while the

recipients of these services who are also well informed are likely to follow appropriately the

guidelines provided to them (Azanza, 2004).

Typhoid fever

There are many people believes that typhoid fever is something that only occurred in the

past, but the truth is that typhoid fever is a popular reason of death in the developing world . In

areas where poverty and under development are high, typhoid fever is a dangerous killer . In

some developing and undeveloped countries, where sanitation is wanting, and extreme poverty

persists, typhoid fever remains a major health risk and killer.

Typhoid fever or enteric fever is a systemic infection caused by Salmonella enterica

subsp. Enteric serovar Typhi and sometimes Salmonella Paratyphi characterized by severe

systemic illness, often presenting with features of fever, constipation, and abdominal pain (Al
Reesi, Stephens & McMullan, 2016). Factors such as hygiene, water quality and food handling

are often involved in the transmission of S. Typhi (Naheed, Ram, Brooks, Hossain, Parsons,

Talukder et al., 2010).

In typhoid fever, thrombocytopenia its course, answer to treatment and need for therapies

like platelet transfusion are not well characterized (Al Reesi, Stephens & McMullan, 2016) .

There are no studies or directions referring to the management of thrombocytopenia in typhoid

fever. It poses a challenge for clinicians, specifically when faced with severe thrombocytopenia,

as in this case (Serefhanoglu, Kaya, Sevinc, Aydogdu, Kuku & Ersoy, 2003; Gehlawat, Rizwan

& Silan, 2013 as cited in Al Reesi, Stephens & McMullan, 2016) . Enteric fever is significant

cause of human morbidity and mortality in developing nations like India (Singla, Bansal, Gupta

& Chander, 2013). Though sporadic cases occur throughout the year, small outbreaks are

common whenever there is lapse in sanitary practices. These outbreaks are seen more often in

suburban and slum areas where low socioeconomic conditions, overcrowding and poor sanitary

practices best conspire to foster the emergence and transmission of the bacterium . Humans are

the only natural reservoir and the main source of infection is water and food contaminated with

feces or urine of cases and carriers (Misra, Bawa, Magu, Bhandari, Nagendra & Menon, 2005 as

cited in Singla, Bansal, Gupta & Chander, 2013).

World Health Organization (WHO) identifies typhoid as a serious public health problem .

Its incidence is highest in children and young adults between 5 and 19 years old . Both female

and male have equal chances of acquiring the disease. The greatest risk of having this disease are
the Asians, African and American since geographic location plays a major role .

Thrombocytopenia is relatively common in typhoid fever, with a reported incidence up to 26% in

children. It has been classified as a marker of severity in typhoid fever and indicates a high risk

for development of complications. Its incidence in endemic countries can be as high as 540 cases

per 100,000 populations, making it a public health challenge . Typhoid/paratyphoid fever was

responsible for 14% of the cases, ranking fifth after malaria, acute human immunodeficiency

virus (HIV) infection, dengue fever, and Epstein-Barr virus (EBV) infectious mononucleosis .

The most frequent travel destination in the study was Asia (42%) . Thrombocytopenia is well

reported in patients with typhoid fever (Al Reesi, Stephens & McMullan ., 2016). The World

Health Organization (WHO) in 2006 reported an incidence of up to 33 million cases of enteric

fever occurring globally per year, with 500 000 to 600 000 deaths and 1.5%-3.8% case fatality

rate (Farooqui, Khan, Kazmi, 2009 as cited in Singla, Bansal, Gupta & Chander, 2013). Typhoid

fever occurred in more than 20 million people in the year 2000 and causes approximately 200

000 deaths annually (Crump, Luby, Mintz, 2004 as cited Naheed, Ram, Brooks, Hossain,

Parsons, Talukder, et al., 2010). More than 90% of typhoid fever cases are estimated to occur in

Asia. The challenges of reliably diagnosing typhoid fever have led to varying estimates of the

disease burden and epidemiology in Asia . In India and Bangladesh, the highest incidence has

been observed among children aged <5 years, while in Vietnam, the peak incidence has been

found to occur in children aged 5-9 years (Sinha, Sazawal, Kumar, Sood, Reddaish, Singh, et al.,

1999; Brooks, Hossain, Goswami, Nahar, Ahmed, et al., 2005; Lin, Vo, Phan, Nguyen, Bryla,

Tran, et al., 2000 as cited in Naheed, Ram, Brooks, Hossain, Parsons, Talukder, et al., 2010 ). To

prevent and control typhoid fever one must drink safe water, improved sanitation and adequate
medical care. Typhoid fever can be controlled by vaccinating and this vaccination is important

especially if youre travelling in areas where the risk of typhoid fever is high.

Listeriosis

Listeria monocytogenes is the causative agent of human listeriosis, a food borne

infection. Clinical manifestations range from febrile gastroenteritis to more severe invasive

forms including sepsis, meningitis, rhomb encephalitis, perinatal infections, and abortions

(Allerberger & Wagner, 2010). These increases primarily reect a higher rate of bacteraemic

listeriosis in those over 65 years of age, and are not otherwise correlated with geography, gender,

ethnicity, socioeconomic factors or infectious serotypes. In the late 1980s, an upsurge in

listeriosis rates was due to the contamination of a small number of food products . However, a

restricted range of strains was responsible for most of the additional cases at that time, and no

evidence exists for such a pattern since 2001 . From a clinical perspective, the importance of
isolating the pathogen as a prerequisite for an accurate epidemiological investigation and

ultimately stopping transmission cannot be overemphasized (Allerberger & Wagner, 2009) .

Listeriosis is one important bacterial infections worldwide that arises from the consumption of

contaminated food (Acha & Szyfres, 2001; Malik, Barbuddhe & Chaudhari, 2002 as cited in

Reda, Abdel-Moein, Hegazi, Mohamed & Abdel-Razik, 2015). Contaminated food with L.

monocytogenes represents is the main source of listeriosis transmission to people . In the

gastrointestinal tract the pathogen might cause a non-invasively localized infection in the

intestine or an invasive infection, which may be systemic or localized (Cruz et al., 2008; Martins

et al., 2010; Reis et al., 2011 as cited in Rodrigues, Cordeiro de S & Barros de Melo, 2017) .

The likelihood of invasion from the gastrointestinal tract depends on these factors including the

number of ingested bacteria cells, the susceptibility of the host and the virulence of the strain

(HOF & ROCOURT, 1992; WHO/FAO, 2004 as cited in Rodrigues, Cordeiro de S & Barros

de Melo, 2017).

According to the study of Reda, Abdel-Moein, Hegazi, Mohamed & Abdel-Razik, 2015 .

Food borne listeriosis is rare but is a serious disease with high death rates (20%30%) compared

with other food-borne microbial pathogens. Ready-to-eat meat products presents a high risk to

the consumers because they are usually cooked during manufacturing and are consumed without

heating, so cross-contamination with food-borne pathogens during the processing cannot be

overcome (Reda, Abdel-Moein, Hegazi, Mohamed & Abdel-Razik, 2015). In a meta-analysis

studied conducted by Noordhout,2014 as cited in Rodrigues, Cordeiro de S & Barros de

Melo, 2017, predominantly related to the consumption of ready to eat food , it was estimated that

only in 2010, about 23,150 people were stricken by listeriosis in the world, resulting in 5,463
deaths (Okutani, 2004; WHO/FAO, 2004; Todd & Notermans, 2011; Lambertz, 2012 as cited in

Rodrigues, Cordeiro de S & Barros de Melo, 2017 ). Most reported listeriosis outbreaks

occurred in Europe, Canada, United States and, in lesser extent, in Australia and New Zealand

(Todd & Notermans, 2011 as cited in Rodrigues, Cordeiro de S & Barros de Melo, 2017 ) .

Although L. monocytogenes can be reported in a wide variety of food, outbreaks and sporadic

cases in humans are predominantly related to the consumption of ready to eat food (Okutani,

2004; WHO/FAO, 2004; Todd & Notermans, 2011; Lambertz, 2012 as cited in Rodrigues,

Cordeiro de S & Barros de Melo, 2017 ) . In the United States, in 2008, 959 samples of ready

to eat meat products were examined, and in 5 (0 .52%) were reported L. monocytogenes, of

these, 2 were from frankfurters (Mamber, 2010 as cited in Rodrigues, Cordeiro de S & Barros

de Melo., 2017). In Australia, data from 1997 to 2003 appointed L . monocytogenes

contamination rate in 4.7% of sliced RTE meat products, 1.2% in pates and 2.7% in cooked

sausages and frankfurters (Ross, 2009 as cited in Rodrigues, Cordeiro de S & Barros de

Melo., 2017). In Chile, samples examined between 2008 and 2012 detected L. monocytogenes in

5% of sausage and cured meat, 3% in cheese and 3% in seafoods (Saludes, 2015 as cited in

Rodrigues, Cordeiro de S & Barros de Melo, 2017).

Hepatitis A
 The study conducted by Halicioglu, Akman, Tatar, Atesli & Kose in Izmir, Turkey year

2011 stated that Hepatitis A virus (HAV) is spread by contaminated food or water or fecal-oral

contact. Seroprevalence rates are highly connected with people with low socioeconomic

conditions and have no proper sanitation and no access to a clean water source . The risk of HAV

infection increases in developing regions with low-income families that has limited access to a

clean water source. An examination of the relationship of water, sanitation coverage, and age

adjusted seroprevalence rate discovered that seroprevalence rates decreases as access to

improved clean water sources increased. The age distribution of HAV seroprevalence also differs

according to geographical, environmental and socioeconomic conditions. As a conclusion, in

many developed countries with low prevalence of HAV infection, the infection is more likely to

occur during adulthood rather than childhood, though the maximum rates of infection usually

occurs during late childhood to adolescence. HAV seropositivity is much higher in preschool

children in hyperendemic regions than those living in intermediate endemicity areas and

although the infection only leads to mild symptoms in general, adults however develop a much

complicated illness with fatigue, malaise, fever and jaundice . The severity of illness increases

with age, educational level, and socioeconomic status since the results of the study that was

conducted showed that the majority of families that participated in the study were within low

socioeconomic group.

Roughly about 30% of the families had crowded family conditions with small living

areas. Parental education level below 5 years was 74.1% for mothers and 65.6% for fathers. As

the parents educational level increased the risk for HAV infection decreased significantly (p <
0.05). Another study conducted in Israel-which is also an endemic country- with those working

in the sewages also showed results that age and years of education are also a major risk factors in

the prevalence of seropositivity. Though the seropositivity for hepatitis A (IgG) was 82% in

sewage workers, compared to the control group with a 91% (not significantly different) . The

results of the study conducted in Israel between of comparing those who are exposed to sewages

and those who are not the individuals with hepatitis A seropositivity were not significantly

different from those without such seropositivity with respect to frequency of daily exposure,

wounds, use of protective equipment. The years of education reflects the socioeconomic status .

Workers with higher level of education, like individual with a high school degree only had an

increasing prevalence of seropositivity over time as they age 30 years old and above while those

with less than a high school degree has a 100% prevalence of seroposivitivity even at ages

between 20 and 30 years old. As a result the individuals who were seropositive were

significantly older, shorter, and less educated than nonseropositive workers . Higher education

and increased seniority lessens the risk of seropositivity . There was a significant connection

between education and for all 200 workers. Individuals with no high-school degree as stated

above has 100% seropositivity, no matter the age . Workers under the age of 40 years old and had

at least 12 years of proper education had a 65% prevalence of seropositivity, which drastically

increased to 100% in individuals aged 60 or older (Levin, Froom, Askenazi & Lerman, 2000).

Exposure
 Modernization and a countrys progress has had its disadvantages and one of the

major aspects of concern is the pollution it causes to earth in land, air and water. In the increase

of global population and the rise of demand for food, there has been a rise in the amount of solid

waste generated by each household. This waster is thrown into the municipal waste centres from

where it is collected by the area municipalities to be thrown into landfills and dumpsites. Human

feces and urine can contain enormous amounts of enteric viruses excreted from infected

individuals (Osuolale & Okoh, 2015). If disposal is improperly done, it can cause serious

impacts on health and problems to the surrounding environment. The group at risk from

improperly disposed solid waste include the population where there is no proper waste disposal

method, especially the pre-school children; waste workers. Other high-risk group includes

population living close to a dump site (Halicioglu, Akman, Tatar, Atesli & Kose, 2011). Poor

food sanitation remains a major threat to human health and food borne disease outbreaks have

occurred worldwide in recent years (Faustini, Rossi & Perucci, 2003; Kuo, Kasper, Jelovcan,

Hoger, Lederer, Konig et al., 2009; Pichler, Much, Kasper, Fretz, Auer, Kathan et al., 2009;

Wadl, Scherer, Nielsen, Diedrich, Ellerbroek, Frank et al., 2010 as cited in Yu, Zhai, Bie, Lu,

Zhang, Tao, et al., 2016). Proper waste disposal have to be undertaken to secure that it does not

affect the environment around the area or cause health hazards to the people living there. At the

household-level proper segregation of waste has to be done and it should be ensured that all

organic matter is kept aside for composting, which is undoubtedly the best method for the correct

disposal of this segment of the waste. In fact, the organic part of the waste that is generated

decomposes more easily, attracts insects and causes disease.