Food and Water-Borne

Diseases
 Overview of the PIDSR Food and Water- Borne
Diseases

By the end of this session the participants will be able to:

• Enumerate notifiable diseases under the FWBD cluster

• Identify cases using case definitions
• Detect, register and report FWBD cases using the PIDSR core
processes
What is Food and Water Borne Disease (FWB)?

a category of illnesses caused by the

consumption of contaminated food or water.
These diseases are typically caused by
microorganisms such as bacteria, viruses,
parasites, and sometimes chemical
contaminants or toxins present in food and
water.

Food and waterborne diseases can have serious health consequences, and surveillance
is vital for early detection, prevention, and control. Timely identification of outbreaks and
their sources helps protect public health and ensures the safety of the food and water
supply.
Why is FWB Diseases Surveillance is important?

Signs & Symptoms

 Category II

Acute bloody diarrhea (ABD) is also called dysentery.

Bloody diarrhea is usually a sign of invasive enteric infection that

carries a substantial risk of serious morbidity and death, especially
in children in developing countries.

The disease is characterized by acute fever and bloody diarrhea,

and can also present with systemic symptoms
and signs as well as dehydration especially in young children.

ABD is spread among humans through contaminated food and water. Once a person is infected, the infectious organism
lives in the intestines and is passed in the stool of the infected person. With some infections, animals can also be infected
and spread the disease to humans.

Shigella (Bacillary dysentery) and Entamoeba histolytica (Amoebic dysentery) are most frequently isolated from the stools of
affected children and is transmitted from person-to-person through the fecal-oral route.

Source: Center for Disease Prevention - US

CASE DEFINITION
Suspected Case
A person with acute (< 14 days) diarrhea with visible blood in the stool.

Confirmed Case
A suspect case with stool positive for bacterial and parasitic pathogens (i.e Shigella
dysenteriae type 1, Entamoeba histolytica or Escherichia coli) thru bacterial culture or any
molecular diagnostic test

Laboratory testing:
Stool/rectal swab: for Bacteriology culture;
Clinical microscopy(Salmonella ssp., Shigella dysenteriae , Campylobacter jejuni.
Aeromonas, Entamoeba histolytica, E. coli)
Source: IRR RA11332
 Category II
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged,
its function can be affected. Heavy alcohol use, toxins, some medications, and
certain medical conditions can cause hepatitis, but it is often caused by a virus.
Currently there are 5 unique hepatitis viruses, identified by the letters A, B, C, D,
and E. While all cause liver disease, they vary in important ways.

When they occur, the signs and symptoms of acute viral hepatitis and liver injury
include: Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain,
Jaundice, Dark urine, Clay-colored stool, Joint pain

Hepatitis A and E is a highly contagious, short-term liver infection caused by the

hepatitis A and E virus. Present in the feces of infected persons and is most
often transmitted through consumption of contaminated water or food. Hepatitis
A and E Infections are in many cases mild, with most people making a full
recovery and remaining immune from further infections. However, HAV and HEV
infections can also be severe and life threatening. Most people in areas of the
world with poor sanitation have been infected with this virus.

Source: Center for Disease Prevention - US

CASE DEFINITION
Suspected Case
a person with acute illness characterized by acute jaundice, dark urine, loss of appetite, body
weakness, extreme fatigue and right upper quadrant tenderness.

Confirmed Case
A suspect case that is laboratory confirmed

Laboratory Confirmation
• Hepatitis A: Positive for IgM anti-HAV
• Hepatitis B: Positive for Hepatitis B surface antigen (HBsAg) or Positive for IgM anti-HBc and antiHBe
• Non-A, Non-B: Negative for IgM anti-HAV and IgM anti-HBs (or HBsAg)
• Hepatitis C: Positive for anti-HCV
• Hepatitis D: HBsAg positive or IgM anti-HBc positive PLUS anti-HDV positive (only as co-infection or super-infection of hepatitis B)
• Hepatitis E: IgM anti-HEV positive

Source: IRR RA11332

 Category II

Cholera is an acute, diarrheal illness caused by infection of the intestine with

the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. People can
get sick when they swallow food or water contaminated with cholera bacteria.
The infection is often mild or without symptoms, but can sometimes be
severe and life-threatening. People with severe cholera can develop severe
dehydration, which can lead to kidney failure. If left untreated, severe
dehydration can lead to shock, coma, and death within hours.

Image Source: NY Times

Signs and symptoms includes profuse watery diarrhea, sometimes described as “rice-water stools”, vomiting, thirst, leg
cramps, restlessness or irritability.

The profuse diarrhea produced by cholera patients contains large amounts of the infectious Vibrio cholerae germ that can
infect others if swallowed. This can happen when the bacteria get on food or into water.

An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from it.
(According to updated Global Burden of Cholera in Endemic Countries 2015)

Source: Center for Disease Prevention - US

CASE DEFINITION
Suspected Case
A suspected case is any patient aged ≥ 2 years who has acute watery diarrhoea and severe
dehydration or died from acute watery diarrhoea.(Acute watery diarrhoea is characterized by three or more
loose or watery, non-bloody stools within a 24-hour period.)

Probable Case
A suspected case that is cholera RDT positive.

Confirmed Case:
A suspected case that is laboratory-confirmed.
(Isolation of Vibrio cholerae 01 or 0139 from stools in any patient with diarrhea by culture or any molecular
diagnostic test)

Source: IRR RA11332

 Category II
Rotavirus is a very contagious virus that causes diarrhea. Before the development of a
vaccine, most children had been infected with the virus. Rotavirus is common,
accounting for 35–60% of acute severe diarrhoea in children < 5 years of age in
countries without rotavirus vaccine, with the highest attributable percentage in infants.

Symptoms usually start about two days after a person is exposed to rotavirus.
Vomiting and watery diarrhea can last three to eight days. Additional symptoms may
include loss of appetite and dehydration (loss of body fluids), which can be especially
dangerous for infants and young children.

Rotavirus is highly communicable; it is shed in the stool at high concentration, and transmission is through faecal-oral route,
either person-to-person or through fomites in the environment.

According to WHO Rotavirus is the leading cause of severe diarrheal disease and dehydration in infants and young children
throughout the world.

Source: Center for Disease Prevention - US, Mayo Clinic

CASE DEFINITION
Suspected Case
Acute watery diarrhoea (defined as 3 more loose or watery stools in a 24 hour period in a child who is <5
years of age who is admitted for treatment of diarrhea to a hospital ward or emergency room.

Note: Undergoes treatment’ means that the child has received intravenous (IV) rehydration therapy while
undergoing observation in the Emergency Room (ER) or was admitted in the hospital ward for acute
diarrhea;

Confirmed Case:
A suspected case that has been laboratory-confirmed as Rotavirus.

Source: IRR RA11332

 Category II

Typhoid fever and paratyphoid fever are life-threatening illnesses caused by Salmonella serotype Typhi and Salmonella
serotype Paratyphi, respectively.

Typhoid fever and paratyphoid fever have similar symptoms. People usually have a sustained fever that can be as high as
103–104°F (39–40°C). A sustained fever is a fever that does not come and go. Other symptoms of typhoid fever include
weakness, stomach pain, headache, diarrhea or constipation, cough, loss of appetite.

Typhoid fever and paratyphoid fever are most common in parts of the world
where water and food may be unsafe and sanitation is poor.

Typhoid fever and paratyphoid fever are transmitted commonly through the
consumption of drinking water or food contaminated with the feces of
people who have typhoid fever or paratyphoid fever or of people who are
chronic carriers of the responsible bacteria.

Source: Center for Disease Prevention - US, Mayo Clinic

CASE DEFINITION
Suspected Case
A person with an illness characterized by insidious onset of sustained fever, headache, malaise, anorexia,
relative bradycardia, constipation or diarrhea, and non-productive cough.

Probable Case
A suspected case that is positive in Typhoid Rapid Diagnostic Test, or a suspected case that is
epidemiologically linked to a confirmed case in an outbreak.

Confirmed Case:
A suspected case that has been laboratory-confirmed (Salmonella typhi, Salmonella Paratyphi)

Laboratory Test:
Bacteriology culture: Blood – 1st week ,Urine / stool – 2nd - 3rd week

Source: IRR RA11332