FOODBORNE DISEASES

What Is Foodborne Disease?

Foodborne disease, commonly called food poisoning, is any disease that is transmitted via food.
Picnic foods create a heightened risk of foodborne disease mainly because of problems with
temperature control. If hot foods are not kept hot enough or cold foods are not kept cold enough,
foods may enter a temperature range in which microorganisms such as bacteria can thrive.
Many people do not think about food safety until a foodborne disease affects them or a family
member. While the food supply in the United States is one of the safest in the world, the CDC
estimates that 76 million Americans a year get a foodborne disease, of whom more than 300,000
are hospitalized and 5,000 die. Preventing foodborne disease remains a major public health
challenge.
Causes of Foodborne Disease
Most foodborne diseases are caused by microorganisms in food. Some are caused by toxins in
food or adulteration of food by foreign bodies.
Microorganisms
Microorganisms that cause foodborne diseases include bacteria, viruses, parasites, and prions.
The four most common foodborne pathogens in the United States are a virus called norovirus
and three genera of bacteria: Salmonella species (such as Salmonella typhimurium, pictured
below), Clostridium perfringens, and Campylobacter jejune. Although norovirus causes many
more cases of foodborne disease, Salmonella species are the pathogens in food that are most
likely to be deadly. Parasites that cause human foodborne diseases are
mostly zoonoses — animal infections that can be transmitted to humans. Parasites such as pork
tapeworm (Taenia solium) are ingested when people eat inadequately cooked
infected animal tissue. The prions that cause mad-cow disease have been transmitted to people
through the ingestion of contaminated beef.

Figure : Salmonella bacteria, shown here in red, cause potentially deadly foodborne disease.
Toxins
Toxins are another common cause of foodborne disease. Toxins may come from a variety of
sources. Foods may be contaminated with toxins in the environment. Pesticides applied to farm
fields are common examples of environmental food toxins. Toxins may be produced by
microorganisms in food. An example is botulism toxin that is produced by the
bacterium Clostridium botulinum. Some toxins occur naturally in certain plants and fungi. A
common example is mushrooms. Dozens of species are poisonous and some are deadly, like the
aptly named death-cap mushroom pictured below. Many deadly mushrooms look similar to
edible species, making them even more dangerous. Food plants can also be infected with fungi
that make people sick when they eat the plants. Fungi in the genus Aspergillus are frequently
found in nuts, maize, and corn. They produce a toxin called aflatoxin, which targets the liver,
potentially causing cirrhosis of the liver and liver cancer.

Figure : The death-cap mushroom (Amanita phalloides) contains toxins that are not affected by
cooking. More than half of the people who accidentally eat these mushrooms die from the
poison.
Adulteration by Foreign Bodies
Another potential cause of the foodborne disease is the adulteration of foods by foreign bodies.
Foreign bodies refer to any substances or particles that are not meant to be foods. They can
include pests such as insects, animal feces such as mouse droppings, hairs (human or
nonhuman), cigarette butts, and wood chips, to name just a few. Some foods are at risk of
contamination with lead or other toxic chemicals because they are stored or cooked in unsafe
containers, such as ceramic pots with lead-based glaze.
Characteristics of Foodborne Diseases
Foodborne diseases differ in specific characteristics but they share some commonalities, often
including similar symptoms.
Symptoms and Incubation Period
Foodborne diseases commonly cause gastrointestinal symptoms such as vomiting and diarrhea.
They also frequently cause fevers, aches, and pains. The length of time between the consumption
of contaminated food and the first appearance of symptoms is called the incubation period. This
concept is illustrated in the figure below. The incubation period for a foodborne disease can
range from a few hours to several days or even longer, depending on the cause of the disease.
Toxins generally cause symptoms sooner than microorganisms. When symptoms do not appear
for days, it is difficult to connect them with the agent that caused them.

Figure : This graph shows the incubation period of a disease, which is the time
between infection and the first appearance of symptoms. It also shows the period of
communicability, which is the time during which infected individuals can spread the
disease. This period may begin before symptoms appear and infected individuals know they are
sick. During the incubation period, microbes generally pass through the stomach and into the
small intestine. Once in the small intestine, they attach to cells lining the intestinal walls and
begin to multiply. Some types of microbes stay in place in the intestine, although they may
produce toxins that are absorbed into the bloodstream and carried to cells throughout the body.
Other types of microbes directly invade deeper body tissues.
Infectious Dose
Whether a person becomes ill from a microbe or a toxin depends on how much of the agent was
consumed. The amount that must be consumed to cause disease is called the infectious dose. It
varies by disease agent and also by host factors, such as age and overall health.
Sporadic Cases vs. Outbreaks
The vast majority of reported cases of foodborne disease occur as sporadic cases in individuals.
The origin of most sporadic cases is never determined. Only a small number of foodborne
disease cases happen as part of disease outbreaks. An outbreak of a foodborne disease occurs
when two or more people experience the same disease after consuming food from a common
source. The majority of foodborne disease outbreaks originate in restaurants, but they also
originate in nursing homes, hospitals, schools, and summer camps.
An example of a foodborne disease outbreak in the United States is the Salmonella outbreak
shown in Figure . The CDC map below shows where most of the cases occurred. The reported
cases began in July and were traced back to onions produced in California. Within 2 weeks the
onions were recalled. The outbreak was over by October. Overall, a total of 1,127 people across
48 states, were infected with the outbreak strain of Salmonella Newport. There were 167
hospitalizations and no deaths reported.
Figure 4.7.54.7.5: This map shows the distribution of cases in a 2020 Salmonella outbreak in the
United States.

Factors that Increase the Risk of Food Contamination

The foodborne disease usually arises from food contamination through improper handling,
preparation, or storage of food. Food can become contaminated at any stage from the farmer’s
field to the consumer’s plate.
Poor Hygiene
Many foods become contaminated by microorganisms because of poor hygienic practices, such
as handling or preparing foods with unwashed hands. Consider norovirus, the leading cause of
foodborne disease in the United States. The virus can easily contaminate food because it is very
tiny and highly infective. People sick with the virus shed billions of virus particles.
Unfortunately, It takes fewer than 20 virus particles to make someone else sick.
Food can become contaminated with virus particles when infected people get stool or vomit on
their hands and then fail to wash their hands before handling food. People who consume food
can ingest the virus particles and get sick.
Cross-Contamination
Another major way that foods become contaminated is through cross-contamination. This
occurs when microbes are transferred from one food to another. Some raw foods commonly
contain bacteria such as Salmonella, including eggs, poultry, and meat. These foods should never
come into contact with ready-to-eat foods, such as raw fruits and vegetables or bread. If a cutting
board, knife, or counter-top is used to prepare contaminated foods, it should not be used to
prepare other foods without proper cleaning in between.
Failure of Temperature Control
Foods contaminated with bacteria or other microorganisms may become even more dangerous if
failure of temperature control allows the rapid multiplication of microorganisms.
Bacteria generally multiply most rapidly at temperatures between about 4 and 60 degrees C (40
and 140 degrees F). Perishable foods that remain within that temperature range for more than
two hours may become dangerous to eat because of rapid bacterial growth.
Prevention of Foodborne Disease
Preventing foodborne disease is both a personal and a society-wide problem. Both governments
and individuals must work to solve it.
The Government’s Role
In the United States, the prevention of foodborne disease is mainly the role of government
agencies such as the Food and Drug Administration and local departments of health. Such
government agencies are responsible for setting and enforcing strict rules of hygiene in food
handling in stores and restaurants (see the sign below). Government agencies are also
responsible for enforcing safety regulations in food production, from the way foods are grown
and processed to the way they are shipped and stored. Government regulations require that
food to be traceable to their point of origin and date of processing. This helps epidemiologists
identify the source of foodborne disease outbreaks.

Figure : This historic sign was created by the Minnesota Department of Health in the 1930s. It
instructs food service workers to wash their hands frequently. It was part of a campaign to reduce
foodborne diseases.
Food Safety at Home
At home, the prevention of foodborne disease depends mainly on good food safety practices.
  Regular handwashing is one of the most effective defenses against the spread of
foodborne diseases. Always wash hands before and after handling or preparing
food and before eating.
 Rotate food in your pantry so older items are used first. Make sure foods have not expired
before you consume them. Be aware that perishable foods such as unpreserved meats and
dairy products have a relatively short storage life, usually just a few days in the
refrigerator.
 Rinse fresh produce before eating. This is especially important if the produce is to be
eaten raw. Even if you do not plan to eat the outer skin or rind, wash it because microbes
or toxins on the surface can contaminate the inside when the food is cut open or peeled.
 Many bacteria in food can be killed by thorough cooking, but food must reach an internal
temperature of at least 74 degrees C (165 degrees F) to kill
any bacteria the food contains. Use a cooking thermometer like the one pictured below to
ensure food gets hot enough to make it safe to eat.
 Foods meant to be eaten hot should be kept hot until served, and foods meant to be eaten
cold should be kept refrigerated until served. Perishable leftovers should be refrigerated
as soon as possible. Any perishable foods left at a temperature between 4 and 60 degrees
C (40 and 140 degrees F) for more than two hours should be thrown out.

Figure : To be on the safe side, use a thermometer to make sure food reaches a high enough
temperature to kill any bacteria it contains.
 Make sure the temperature in the refrigerator is kept at or below 4 degrees C (40 degrees
F) to inhibit bacterial growth in refrigerated foods. If your refrigerator does not have a
built-in thermometer, you can buy one to monitor the temperature. This is especially
important in a power outage. If the temperature stays below 40 degrees F until the power
comes back on, the food is safe to eat. If the temperature goes above 40 degrees F for two
hours or more, the food may no longer be safe and should not be consumed.
 Keep the temperature of the freezer below 18 degrees C (0 degrees F). Foods frozen at
this temperature will keep indefinitely, although they may gradually deteriorate in
quality.
 Do not thaw foods at room temperature. Freezing foods does not kill microbes; it
preserves them. They will become active again as soon as they thaw. Either thaw frozen
 foods slowly in the refrigerator or thaw them quickly in the microwave, cool water, or
while cooking. Never refreeze food once it has thawed.

QUESTIONS
1. What is a foodborne disease?
2. How common are foodborne diseases in the United States?
3. What are the main causes of foodborne disease? Give examples of each cause.
4. Define the incubation period and infectious dose.
5. Discuss similarities and differences among foodborne diseases.
6. Compare and contrast sporadic cases and disease outbreaks of foodborne disease.
7. What are the three main ways that food becomes contaminated?
8. List three food safety practices that can help prevent transmission of
foodborne disease in the home.
9. If you store cooked leftovers at room temperature (about 68 degrees F) for more than two
hours, are they safe to eat if you heat them up well first? Explain your answer.
10. True or False. There is no need to wash a melon before cutting it because you will not be
eating the rind.
11. True or False. Foodborne diseases can sometimes cause a form of cancer.
12. Explain why it can be hard to trace the source of a foodborne disease if it has a long
incubation period.
13. Which are a bacterial species that can cause foodborne disease?
A. Clostridium perfringens
B. Norovirus
C. Taenia solium
D. All of the above
14. Why do you think the incubation period for a foodborne disease is generally shorter when
the agent is a toxin compared to a microorganism?
15. Why do you think it is often recommended to rapidly cool a large quantity of homemade
soup by putting the pot in an ice water bath before storing it in the refrigerator?