Professional Documents
Culture Documents
cb1910en
cb1910en
in food
An invisible threat
7
FOOD SAFETY
TECHNICAL TOOLKIT FOR ASIA AND THE PACIFIC
Parasites in food – An invisible threat
Parasites
in food
An invisible threat
7
FOOD SAFETY
TECHNICAL TOOLKIT FOR ASIA AND THE PACIFIC
The designations employed and the presentation of material in this information product do
not imply the expression of any opinion whatsoever on the part of the Food and Agriculture
Organization of the United Nations (FAO) concerning the legal or development status of any
country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or
boundaries. The mention of specific companies or products of manufacturers, whether or not these
have been patented, does not imply that these have been endorsed or recommended by FAO in
preference to others of a similar nature that are not mentioned.
© FAO, 2021
Some rights reserved. This work is made available under the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO;
https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this license, this work may be copied, redistributed and adapted for non-
commercial purposes, provided that the work is appropriately cited. In any use of this work, there
should be no suggestion that FAO endorses any specific organization, products or services.
The use of the FAO logo is not permitted. If the work is adapted, then it must be licensed under the
same or equivalent Creative Commons license. If a translation of this work is created, it must include
the following disclaimer along with the required citation: “This translation was not created by the
Food and Agriculture Organization of the United Nations (FAO). FAO is not responsible for the
content or accuracy of this translation. The original English edition shall be the authoritative edition.
Any mediation relating to disputes arising under the license shall be conducted in accordance with
the Arbitration Rules of the United Nations Commission on International Trade Law (UNCITRAL)
as at present in force.
Third-party materials. Users wishing to reuse material from this work that is attributed to a third party,
such as tables, figures or images, are responsible for determining whether permission is needed for
that reuse and for obtaining permission from the copyright holder. The risk of claims resulting from
infringement of any third-party-owned component in the work rests solely with the user.
Sales, rights and licensing. FAO information products are available on the FAO website
(www.fao.org/publications) and can be purchased through publications-sales@fao.org.
Requests for commercial use should be submitted via: www.fao.org/contact-us/licence-request.
Queries regarding rights and licensing should be submitted to: copyright@fao.org.
Abstract
Foodborne parasitic diseases are often neglected in various food safety
control systems, even though they can create severe human health
problems. Because the production and monetary losses associated with
them are often not visible, and the infected animals often show no signs,
they are very difficult to detect. Different types of parasitic diseases
can be transmitted to humans from pork, fish, freshwater crustaceans,
vegetables, water and the environment. The risks associated with all of
them can, however, be avoided through the application of good hygiene,
farming and fishing practices, and with the promotion of the community
awareness. For example, the promotion of a participatory approach and
the development of training packages for food businesses operators
would be beneficial in raising awareness within the community. Basic
information regarding the how the parasites are transmitted and their
effects, and any and all preventive measure that each person can take
should be included in communication topics. Food safety authorities
can play an important part by using the guidance provided by Codex
Alimentarius regarding animal production, food processing, and meat
inspection. Furthermore, the development of networks of authorities
committed to addressing the problem, would help prevent and control
the spread of parasitic diseases.
Keywords
Parasites, parasitic diseases, raw fish, freshwater fish, pork,
undercooking, food safety, food consumption pattern, food hygiene,
community education, awareness raising, animal production, food
processing, aquaculture, meat inspection, food legislations, food
standards, Codex Alimentarius, Food and Agriculture Organization
of the United Nations (FAO), Asia and the Pacific
iii
iv
Contents
Abstract iii
Keywords iii
Acknowledgements vi
1. Introduction 1
2. Foodborne parasitic diseases 3
2.1. Parasites transmitted by pork 3
2.1.1. Taenia solium 2
2.1.2. Trichinella spp. 6
2.1.3. Toxoplasma gondii 9
2.2. Parasites transmitted by freshwater 10
fish and crustaceans
2.2.1. Clonorchis sinensis and Opisthorchis viverrini 10
2.2.2. Paragonimus spp. 14
2.3. Parasites transmitted by vegetables, 17
water and the environment
2.3.1. Fascioliasis 17
2.3.2. Cestodes 20
2.3.3. Protozoa 22
3. Conclusion 23
4. Practical generic recommendations 25
for food safety authorities
4.1. Practical recommendations 25
4.2. Specific training and awareness creation activities 27
5. Resources 33
5.1. FAO bibliography 33
5.2. Other readings 34
v
Acknowledgements
The Food and Agriculture Organization of the United Nations (FAO)
would like to express its appreciation to the many people who
contributed to this document, which is authored by Meritxell Donadeu
and Aya Yajima (World Health Organization) and prepared and
developed for FAO under the coordination of Masami Takeuchi (FAO).
Technical and editorial inputs provided by various FAO colleagues,
including Markus Lipp, Isabella Apruzzese and Sridhar Dharmapuri
are gratefully acknowledged. Technical editing was done by
Kim Des Rochers.
vi
1 Introduction
©FAO/Meritxell Donadeu
1
In this report, we focus on the major foodborne parasites transmitted by
pork, freshwater fish, and freshwater crustaceans, for which food safety
measures play an important role in their prevention and control (Table 1).
Taeniasis
Tapeworm Cysts
(immature parasite)
Taenia solium
Cysts (Neuro)
cysticercosis
Porcine
cysticercosis
3
Humans can also become infected by ingesting the eggs via the faecal-
oral route, or by eating vegetables and drinking water contaminated
with the eggs. In this case, they develop cysts in different parts of the
body, including the brain (Figure 4).
©FAO/Marshall Lightowlers
Health impacts
In humans, Taenia solium causes two diseases: 1) taeniasis, which is
usually asymptomatic and occurs when humans have the adult tapeworm
in their intestines; and 2) neurocysticercosis, which is more serious, and
occurs when immature parasites form cysts, mainly in the brain, causing
seizures and other neurological disorders. Neurocysticercosis is the main
cause of acquired epilepsy in poor communities where Taenia solium is
endemic, and in which epilepsy is very difficult to treat. Less frequently,
cysts can also develop in muscles, eyes and other organs.
Health impacts
About 15 percent of people who eat infected meat develop the intestinal
phase, which usually includes non-specific signs such as gastroenteritis
and diarrhoea. When larvae migrate from the intestine to other parts of
the body, people may present fever, muscle pain, inflammation of the
upper eyelids (a common sign), headaches and other signs. The signs
depend on the number of parasites. A small number of severely affected
patients may experience skin rashes and respiratory and neurologic
symptoms. Occasionally, there are life-threatening manifestations such
as heart failure.
Larval stages
Adult parasite
Larval stages
©FAO/CDC PHIL
Specific food safety interventions at authorities’ level
• Food safety authorities can promote the implementation of good
farming practices as explained above by, for example, facilitating
the training of farmers by agricultural extension officers.
• Food safety authorities can also promote awareness in the
community about the risk factors mentioned above, and to
thoroughly cook pork. This parasite can be killed by reaching
71 °C for at least one minute (the meat should change colour
from pink to grey throughout, and the muscle fibres can be
easily separated from each other). Curing, drying or smoking the
meat are inadequate methods to kill the parasite. Some species
of Trichinella can be killed by freezing (time and temperatures
depends on the thickness of the meat cuts) but not all species of
Trichinella. Some suggested activities for food safety authorities
are listed in Chapter 4.
oocysts
Toxoplasma gondii
Tissue cysts
Tissue cysts
Adult fluke
Second Clonorchis
intermediate sinensis
host Opisthorchis
viverrini
Transmission cycle
Adult flukes live in the liver of humans, cats, dogs, pigs and other fish-
eating mammals (Figure 8). The adult flukes produce eggs that are
released in the faeces of humans and other animals. The eggs need
to reach freshwater and be found by specific types of snail. When the
snails eat the eggs, the eggs hatch in the snail, and immature parasites
called miracidia are released into the snail. These immature parasites
continue to develop until they reach a juvenile stage (called cercariae)
that eventually leave the snail and enter into freshwater. When these
juvenile parasites find a fish, they penetrate the skin of the fish and
form a cyst (called metacercariae). Humans and many other animals
can become infected by eating raw or undercooked freshwater fish
that contain the parasitic cysts (Figure 9). Once the cysts are eaten, the
young flukes are released in the small intestine and, through the bile
duct, they reach the liver where they become adult flukes.
©FAO/Banchob Sripa
Health impacts
Most infected persons do not show any signs or symptoms, and the
signs depend on the number of parasites. In heavily infected people,
there is a loss of appetite, indigestion and diarrhoea, and the parasites
can block the liver ducts. There can also be fever and pain in the
abdomen. Untreated infections may last 25 years or more, and can
lead to liver enlargement and liver damage, including a severe and
fatal type of cancer called cholangiocarcinoma.
The eggs must reach freshwater to hatch, and the miracidiae (the
immature parasite) must enter specific types of snails in which they
continue to develop. After several stages of development in the snail,
the juvenile parasites (called cercariae) leave the snail and, on contact
with freshwater crabs or crayfish, penetrate them and form a cyst.
Crabs and crayfish can also become infected by eating infected snails.
When humans, dogs, cats and other mammals eat raw, undercooked or
pickled crustaceans with parasitic cysts, the young flukes are released
from the cysts in the small intestine and migrate until reaching the lungs
and other organs. In the lungs, the young flukes mature and start laying
eggs. In some places, such as Japan, it has been observed that wild
boars and deer might become infected, but the young fluke does not
mature until a human, for example, eats the meat of those animals.
Adult fluke
Free
living
Health impacts
Health impacts vary, depending on the species of Paragonimus and
the number of parasites; but in general, when the young parasites
migrate from the intestine to the lungs, they can cause abdominal pain,
fever and diarrhoea. Once they reach the lungs, symptoms can include
a chronic productive cough, chest pain, blood-stained sputum, and
sometimes fever. Signs can be similar to those of tuberculosis or lung
cancer. Sometimes the parasites become “lost” on their way to the
lungs, and end up in the brain, chest muscles, under the skin and other
places, producing a variety of signs and symptoms.
Transmission cycle
With Fasciola hepatica, the adult parasites are relatively large flukes,
with Fasciola hepatica measuring 20-40 mm x 10-15 mm, and Fasciola
gigantica 25-75 mm x 12 mm. Both species live in the large bile ducts
of the liver and gallbladder of ruminants, especially sheep, goats and
cattle. Other animals such as buffalo, deer and pigs can also become
infected. While this is mainly a non-human animal disease, it does
occasionally affect people. However, the epidemiology is complex, and
the frequency of the parasite in animals does not appear to be closely
correlated to the occurrence in people.
Adult fluke
Free
living
©FAO/Marshall Lightowlers
23
Parasitic diseases transmitted by vegetables can be caused by two
species of leaf-shaped flatworms – Fasciola hepatica and Fasciola
gigantica – that particularly affect the liver. Diseases caused by these
are acquired mainly by eating raw plants such as watercress and other
freshwater cultivated or wild plants, but can also be transmitted by
drinking contaminated water. Signs of infection depend on the number
of parasites and the duration of the infection. Awareness raising within
the community is, as always, required to prevent and control the
parasite’s transmission to humans and animals.
25
5. Develop a network with relevant partner agencies, such as the
Ministry of Public Health, the Ministry of Education, to create
awareness in schools, with the Ministry of infrastructure, Ministry
of Environment, local government agencies and others to improve
access to safe water and basic sanitation; and with the Ministry of
Agriculture (livestock, fisheries or similar) to create awareness and
train farmers on good farming practices. Food safety authorities can
work in synergy with other authorities responsible for improving
access to safe water and basic sanitation to decrease diseases
caused by foodborne pathogens.
©WHO
33
FAO. 2020. Be safe from pork tapeworms. In: FAO [online]. [Cited 15
October 2020]. http://www.fao.org/3/ca9095en/CA9095EN.pdf
FAO, OIE & WHO. 2020. Foodborne parasitic infections: Trichinellosis.
In: FAO [online]. [Cited 15 October 2020].
http://www.fao.org/3/cb1206en/cb1206en.pdf
FAO, OIE & WHO. 2020. Foodborne parasitic infections: Taeniasis and
cysticercosis. In: FAO [online]. [Cited 15 October 2020].
http://www.fao.org/3/cb1129en/cb1129en.pdf
FAO, OIE & WHO. 2020. Foodborne parasitic infections: Fascioliasis
(liver fluke). In: FAO [online]. [Cited 15 October 2020].
http://www.fao.org/3/cb1127en/cb1127en.pdf
FAO, OIE & WHO. 2020. Foodborne parasitic infections: Cystic and
alveolar echinococcosis. In: FAO [online]. [Cited 15 October 2020].
http://www.fao.org/3/cb1128en/cb1128en.pdf
FAO, OIE & WHO. 2020. Foodborne parasitic infections: Clorochiasis
and opisthorchiasis. In: FAO [online]. [Cited 15 October 2020].
http://www.fao.org/3/cb1208en/cb1208en.pdf
FAO & WHO. 2020. Codex Alimentarius – In: FAO [online]. [Cited 23
October 2020]. http://www.fao.org/fao-who-codexalimentarius/en/
FAO & WHO. 2020. Codex Alimentarius: Code of Practice – In: FAO
[online]. [Cited 23 October 2020]. http://www.fao.org/fao-who-
codexalimentarius/codex-texts/codes-of-practice/en/
OIE resources:
Coordinating surveillance policies in animal health and food safety
“from farm to fork”. Scientifical and Technical Review 32 (2)
OIE. 2020. Terrestrial Animal Health Code – In: OIE [online]. [Cited 23
October 2020]. https://www.oie.int/standard-setting/terrestrial-code/
access-online/
Resources 35
OIE. 2020. Terrestrial Animal Health Code: Chapter 15.4 – Infection
with Taenia solium (porcine cysticercosis) – In: OIE [online]. [Cited
23 October 2020]. https://www.oie.int/fileadmin/Home/eng/Health_
standards/tahc/2018/en_chapitre_taenia_solium.htm
WHO. 2020. Food safety: The five keys to safer food programme –
In: WHO [online]. [Cited 23 October 2020].
https://www.who.int/foodsafety/consumer/5keys/en/
WHO. 2020. Food safety: The five keys to safer food programme
(poster) – In: WHO [online]. [Cited 23 October 2020].
https://www.who.int/foodsafety/areas_work/food-hygiene/5keys-
poster/en/
WHO. 2020. Food safety: The five keys to safer food programme
(brochure) – In: WHO [online]. [Cited 23 October 2020].
https://www.who.int/foodsafety/areas_work/food-hygiene/5keys-
brochure.pdf?ua=1
WHO. 2020. Food safety: The five keys to safer food programme
(manual) – In: WHO [online]. [Cited 23 October 2020].
https://www.who.int/foodsafety/publications/5keysmanual/en/
Resources 37
International Commission on Trichinellosis:
Resources from the International Commission on Trichinellosis
International Commission on Trichinellosis. 2020. Recommendations –
In: International Commission on Trichinellosis [online]. [Cited 23 October
2020]. http://www.trichinellosis.org/Guidelines.html
FAO-RAP@fao.org
fao.org/asiapacific