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Microbiology Research Paper

Food borne Incident Relating to Escherichia coli
Efficient and effective supervision of contamination of food and inspection of food borne diseases in UK needs a harmonized multidisciplinary method with fervent contribution of stakeholders from every aspect of the society together with the public health quarter. To make easy communication and organization of this process, a coordinating body is required to be instituted with strong contribution of applicable stakeholders. However, appropriate observation data from every stage in the food manufacture chain including the supervision of human disease must be constantly collected and examined to assess trends and causal source of food borne disease (FBD). The incidence of the food borne disease in UK requires health organizations and Health departments in UK of a dedicated multidisciplinary inspection unit that involves the microbiological and epidemiological proficiency from every sector will assist and enhance the success of consistent data analysis and criticism.

The main purpose of this supervision is to enhance the management and control of food borne disease outbreak and provide a management framework for professionals that will help them control further spread of the disease. Ingestion of microbial contaminated foods is very harmful; outbreak management team should be vigilant in dealing with an outbreak especially the type that concern food borne. Rees G and Pond (1995) explained that medical and nursing staffs are required to use the aide-memoir made available for checking health implications and functions. In addition, the essence of this paper is reflected in the roles and responsibilities of public bodies involved in maintaining health care services and public health.

Controlling and managing FBD outbreak is critical to ensure that:

  • the minimum number of primary cases of infected people is reduced. This can be achieved through prompt reporting and response to infected foods;
  • the number of secondary cases of infected individual is reduced through proper identification of FBD infected persons and taking appropriate measures to prevent further spread of the disease;
  • causal organisms and continuous hazards are eliminated or minimize the risk of infection;

Food Borne Disease (FBD) Outbreak Definition
Pathogenic microbes normally penetrate food chain at any position from livestock through on-site production, feed, parking plant, or at slaughterhouses in the UK (Hald et al, 2004). In addition, this bacteria enter food chain during food retailing, processing, manufacturing, as well as via food preparation and catering. However, since several potential routes for spreading pathogens during production, remote actions such as sanitization of animal feed is normally performed to guarantee consumer protection. To effectively control and manage the crisis of food-borne disease, certain procedures should be well thought-out at the various levels of production. This requires a harmonized inspection and response attempt from every key stakeholder responsible for food safety. Food industries are accountable for the quality and the security measures of the food they produce for consumers, together with relevant stakeholder in food safety. Production may be supervised through process control programs, certification programs, or HACCP (Hazard Analysis Critical Control Points) based control programs (Noordhuizen and Dufour 2007). These control functions create data that comprises of significant input to national supervision programs. In addition, in an epidemic analysis, extra sampling is normally required to investigate human infection rate to the extent of infectivity in the food manufacture chain. Close teamwork between the public and private sector is very critical in this aspect.

Disease Reporting as a Good Management and Control Practice
To effectively manage and control food safety, it is very important for health departments in the UK to have adequate information on the existing situation and development as it concerns the infection and spread of FBD outbreak in the food manufacture chain. This information requires frequent update so that proper responses can be organized. Activities involved in such a system are gathered under the inspection and supervisory terms (Ressom et al, 2004). Inspection involves the presentation and investigation of regular practices aimed at identifying changes in the surroundings or health position of populations. While supervision involves the continuing methodical collection, analysis, collation, and interpretation of data with the distribution of information to every department involved to enable the implementation of directed actions (Schwimmer and Schwimmer 2009). Supervision refers to a particular addition of monitoring where collected information is developed and decisions are taken concerning standards and values associated to disease condition.

The major aims of supervision include examining trends in prevalent disease, outbreak discovery, analyzing program performance, assessing interventions, and evaluating progress towards a programmed control purpose (Wegener et al, 2003). However, supervision is not just a practical evaluation of the present situation, but a foundation for providing qualified reaction to producers, indicating effective control factors during production, tracing back contaminated food to its source, and initiating planned action. In addition, different levels of concentration and management in supervision systems. Supervision can be disjointed or incorporated, universal or sentinel, dynamic or reactive permanent or irregular, in most cases, the strength of supervision is an invention of social impact, convenient access to epidemiological information, as well as financial parameters.

Identification of Causative Organism of Foodborne Disease (FBD)
From laboratory tests, various microorganisms cause food borne disease (FBD). The bacteria called S. Enteritidis cause the salmonenela infections, and it is considered the major cause of the food borne disease (FBD). The S. Typhimurium is considered to be the most dreaded bacteria that infect people with food borne disease (FBD). According to Rees G and Pond (1995) reported that, S. Typhimurium and other salmonella species are major causes of food borne disease. The Campylobacter group in recent times has become the most frequently identified cause of the gastroenteritis. The ability to identify the source and cause of the outbreak depends on the causal organism. The Enterohaemorrhagic Escherichia coli, which is a major public health significance, is the focus of this research paper. This can be contacted from contaminated drinking water, and contaminated swimming pools.

Outbreak Identification of Food Borne Disease (FBD)
Waterborne disease (FBD) outbreak could be identified or diagnosed through laboratory service, testing, collection of manufactured food:

  1. Laboratory diagnosis; FBD outbreaks can be confirmed through laboratory testing and confirming the particular causal organism responsible for the outbreak by health laboratories in the UK. Detecting the causal organism clinically from manufactured food or infected persons with similar symptoms.
  2. Performing tests, tests are performed through public health laboratories (PHL), industrial manufactured food including infected patients with food borne disease outbreak symptoms. These tests are performed to test for food borne bacteria such as S. Typhimurium, Escherichia coli, and other parasitic agents that causes food borne infection. Most commercial laboratories test for bacteria that produce toxins such as E.coli. There is always a repeated testing performed in cases of serious food borne disease outbreaks.
  3. Specimen collection; in cases of food borne disease outbreaks, samples of manufactured food are normally collected and delivered to public health laboratories for testing. Protocols regarding the proper collection of these samples must be strictly observed. In most cases, consultation with the necessary Ecology Department in the UK is an essential step for proper rules on sample collections. Information based on sample labeling food samples, kits for sample collection, and proper handling of samples are available with this department.
  4. The Zoonosis centre; where periodic meetings are organized to check the prevalence of the organism in humans and management programs on food-borne disease outbreak and corresponded to appropriate stakeholders.

FBD Outbreak Management Team
Food borne disease outbreak is the responsibility of doctors, public health authorities, as well as recreational facilities heads and swimming pools that involve in the management and control of this outbreak.

Local health authorities; public health authorities in the UK play critical role in managing food borne disease (FBD). They are normally responsible for treating infected people as well as giving infected and non-infected people good health tips that will manage and control the FBD outbreak.

Managers of recreational and public facilities; they are charged with the responsibility of reporting infected and contaminated food and the number of people infected through their facilities to appropriate heads in the UK.

Authorities of public recreational areas; responsible for reporting infected outbreaks of FBD and suspected infected persons.

Doctors and laboratory personnel; these set of people help perform test, treatment and provide measures that will prevent further spread of the FBD outbreak.

Government officials and legislative heads; the UK government will help make laws that restrain infected public places and sharing ingested food materials.

Food Borne Disease (FBD) Management Functions/Responsibilities
The integration of supervision activities is aimed at promoting optimization and cost effectively managing, utilizing, and inspection of data. The major roles and responsibilities is to optimize the understanding of the supervision system that prevent further spread of the FBD outbreak. Some of these roles and responsibilities include:

well-outlined activities and information of infected individuals; food borne disease outbreak management and control worksheet can help in collecting necessary information required for effective control management.

They include;

  1. Demographics, including address, name, age, telephone number, sex, and other relevant factors such as residence, occupation, ward, classroom, cell block and so forth;symptoms such as diarrhea, nausea, abdominal cramps, fever, jaundice, respiratory irritation, hospitalization status and medical care received, and systemic illness (Ruoff, 1990);time and date of symptom occurrence and for how long symptom lasted;food consumption history for a period of at least 72 hours before illness occurred. Food consumption history, shared meals for a period of at least 72 hours before illness began is also necessary information. This is necessary because some causal agents have longer incubation periods, necessitating the information regarding longer period of food history;travel including food consumption, locations, and recreational exposures;addresses, names, phone numbers, and other information that will assist in locating anybody who might be involved in the outbreak including sick people, healthy people, and organizers of group activities;
  2. Identifying additional cases, if indicated, such methods like calling other potentially exposed individuals, sending provider alerts, releasing a media alert, and requesting specimens from laboratories.
  3. Confirming the existence of an outbreak, local health jurisdictions must ensure that several relevant questions concerning management and control measures.
  4. Develop an environmental field management and control based on the epidemiologic case data: here the objective of the combined environmental and epidemiologic outbreak management and control measures is to identify the causal organism, the food source, mode of transmission, and the source of contamination. This will also consider the possible infectious agent based on symptoms and incubation period. Possible modes of transmission for that particular agent to focus on the exact environmental management and control procedure or method.
  5. Implementing immediate, appropriate mismanagement and control measures based on the possible FBD causal organism.
  6. Consider testing for the presence of the disease with an epidemiologic study (cohort or case control).
  7. Managing and controlling further spread: patients with abdominal cramps should be restricted from sharing and eating contaminated foods. Infected persons should be well instructed and advice on effective and proper hand washing and proper food handling practices and preservation methods (Lewis, 2002). More particularly, follow-up of issues and causes of these infections.

Remarks and Recommendations
The identification of transformation of food borne diseases (FBD) prototypes and differences in the infection of food production chain are an unconditional requirement for the effective management and control, together with constant improvement in the safety and quality of food. These processes helps in preventing further spread of the disease and it is cost proficient. Managing and controlling food borne disease (FBD) supervision at various public level provides a comprehensive and appropriate synopsis of the public and veterinary health position of the society. The incorporation of food borne disease (FBD) outbreaks investigation is aimed at colleting all activities responsible to perform many functions via related process, structures, and personnel. The framework of a conventional supervision program in a particular aspect may serve the same structural purpose for intensifying other inspection activities. It is however recommended that, both infected and non-infected persons should follow certain practices to prevent further spread of the disease.

These processes include:

  • Avoid eating contaminated food.
  • Only food tested and recommended by appropriate food control agencies and veterinary authorities should be consumes.
  • People should observe appropriate food handling practices to avoid outbreak re-occurrence.

Waterborne Disease (WBD) Outbreak Relating to Cyanobacteria Toxins
Waterborne Outbreak Definition
A waterborne disease (WBD) outbreak is an occurrence whereby several epidemiologically connected persons experience the same illness after exposure to the same source of water and the epidemiological evidence identifies the water as the possible cause of the illness. This occurrence happened in Washington, United States were most population was affected. However, the implicated water in a waterborne disease (WBD) outbreak could possibly be recreational water, drinking water, water meant for agricultural purposes, as well as unknown water. The path of this water can be through ingestion, intranasal, inhalation, or contact. Chemicals, microbes, or toxins could be the agent connected to the water borne disease (WBD) outbreak. Normally, water is tested to determine the contamination level and identify the etiologic agent.

Disease Reporting as a Good Management and Control Practice
A. Purpose of reporting and surveillance: reporting suspicious or symptoms of disease is one good way of managing and controlling the WBD, these purposes include:
to prevent transmission from one infected person to the other;
to identify and correct sources of exposure for waterborne disease (WBD) outbreaks;
to prevent further exposures to infected water and avoid spreading infections;
to expand existing comprehension of the mode of transmission of these disease, causal agent, and the effect on the community of the infections by the identified WBD causal agent (Herceg et al, 2006);
to identify new WBD causal hazards, agents, and issues in the water safety system;

B. Legal reporting requirements for effective outbreak management and control.
Legal jurisdictions will assist and help control WBD outbreak especially when it involves the public. Infections should be reported to Washington State Department of Health (DOH) Office of the Communicable Disease Epidemiology (CDE). These rules require that certain heads of health care, public recreational parks, and pools warn immediately and appropriately the public to prevent further spread of the infection.

These include:
health care providers; WBD outbreak should be appropriately reported to local health care authorities, this will help manage and control further infection;
hospitals; outbreaks should be immediately and promptly reported to local head authorities for effective management and control (Keene et al, 2006);
laboratories; tests indicating suspicious causal agent should be reported to CDE and health centers for effective management and control;
local health authorities; outbreaks should be promptly reported to (DOH) for public media notification of the public. This will help manage and control infection to a great extent;

Identification of Causative Organism of WBD Outbreak
The causal organism of waterborne disease (WBD) outbreaks ranges from bacterial such as Shigella, also known as shiga toxin-producing E. coli, Campylobacter, Salmonella, cholera, typhoid, and other Vibro species that causes gastrointestinal symptoms. The Virus group includes hepatitis A virus and norovirus (Lane and Baker, 2003). The poliovirus causes gastrointestinal symptoms. The parasites group includes Cryptosporidium and Giardia causing gastrointestinal symptoms, invasive amoeba such as Naeglaria that causes meningitis, Schistosoma that causes schistosomiasis. The noninfectious agents, which is the major point of study includes cynobacteria (blue green algae) toxins, nitrates, copper, and other different chemicals that contaminates water. In most cases, the symptoms depend on the causal agent. Waterborne disease (WBD) causal organism may also cause gastrointestinal, less commonly respiratory, or systemic or skin infection. Symptoms of this illness or infection may include vomiting, abdominal cramps, diarrhea, bloody diarrhea, irritated eyes, hives, sore throat, rashes, systemic illness, pneumonia (Lewis et al, 2002). However, the causal organism of waterborne disease discussed in this research is the Cyanobacterial toxins.

WBD Outbreak Identification
Waterborne disease (WBD) outbreak could be identified or diagnosed through laboratory service, testing, collection of specimen.

  1. Laboratory diagnosis; WBD outbreaks can be confirmed through laboratory diagnosis and confirming the particular etiologic agent in an outbreak. This should be reported to the Washington State Department of Health (DOH) Office of the Communicable Disease Epidemiology (CDE).
  2. Performing tests, tests are performed through public health laboratories (PHL), clinical specimens from patients with waterborne disease outbreak symptoms. These tests are performed to test for waterborne bacteria, norovirus, and parasitic agents to confirm any of these causal agents. Most commercial laboratories test for bacterias that produce toxins such as E.coli and hepatitis A (Ruoff, 1990). There is always a repeated testing performed in cases of serious waterborne disease outbreaks.
  3. Specimen collection; in cases of waterborne disease outbreaks, sample specimens are normally collected and delivered to public health laboratories for testing. Protocols regarding the proper collection of these samples must be strictly observed (van den Hoek et al, 1995). In most cases, consultation with the necessary Ecology Department is a necessary for proper rules on sample collections. Information based on sample labeling, kits for sample collection, and proper handling of samples are available with this department.

In recent years, the United States health Department on Communicable Diseases received reports of WBD outbreaks that involved hundreds of infected people. According to Hathaway (2005), the department took the case up, performed several surveillance, and discovered that it was the cyanobacteria toxin, which was the major cause of this WBD outbreak. Sources of this infection were drinking water, recreational and public lakes, swimming pools and other public recreational areas. This organism was transferred from one person to another through ingestion of this water, eating infected animals, and unauthorized access to restricted areas.

WBD Outbreak Management Team
Management team responsible for the effective control and prevention of further spread of the WBD outbreak included;
Local health authorities: Washington State Department of Health (DOH) Office of the Communicable Disease Epidemiology (CDE) constitute the management and control team.
Public health workers; responsible for treating infected people as well as giving infected and non-infected people good health tips that will manage and control the outbreak.
Managers of recreational and public facilities; these people are responsible for reporting infected water and the number of people infected through their facilities to appropriate heads (Kvenberg et al, 1995).

Authorities of public lakes and swimming pools; responsible for reporting infected outbreaks and suspected infected persons.
Doctors and laboratory personnel; these set f people help perform test, treatment and provide measures that will prevent further spread of the outbreak.
Government officials and legislative heads; these people help make laws that restrain infected public places.

Outbreak Management Functions
Waterborne disease (WBD) outbreaks can be identified through notifying conditions reporting, isolation of bacterial sub-typing as well as molecular analysis in the laboratory. The Washington State Department of Health (DOH) Office of the Communicable Disease Epidemiology (CDE) and other management team ensure that this WBD outbreak is managed effectively to avoid further spread of the outbreak. Other methods of detecting the WBD outbreaks include syndrome surveillance systems, and consumer complaints. In most cases, investigation depends on the causal sources: building water system, drinking water, natural water, treated recreational water, and so forth.

Outbreak management normally involves the following steps:
1. Detail activities and information of affected individuals; waterborne disease management and control worksheet can help in collecting necessary information required for effective control management. They include;
Demographics, including address, name, age, telephone number, sex, and other relevant factors such as residence, occupation, ward, classroom, cell block and so forth (Henessey et al, 1996);
symptoms such as diarrhea, nausea, bloody diarrhea, abdominal cramps, fever, muscle ache, jaundice, rashes, respiratory irritation, hospitalization status and medical care received, and systemic illness;
time and date of symptom occurrence and for how long symptom lasted;
water consumption history and common activities for a period of at least 72 hours before illness occurred. Food and drink consumption history, shared meals for a period of at least 72 hours before illness began is also necessary information. This is necessary because some causal agents have longer incubation periods, necessitating the information regarding longer period of food history (Herceg et al, 2006);
travel including water consumption, locations, and recreational water exposures. Pertinent details for travel including cruise ships or motels name, dates, and room. Information on the use of pools, hot tubs, spas, as well as other water recreational sites;
addresses, names, phone numbers, and other information that will assist in locating anybody who might be involved in the outbreak including sick people, healthy people, and organizers of group activities;

2. Identifying additional cases, if indicated, such methods like calling other potentially exposed individuals, sending provider alerts, releasing a media alert, and requesting specimens from laboratories.

3. Confirming the existence of an outbreak, local health jurisdictions must ensure that several relevant questions concerning management and control measures are asked. Questions such as:
Are there people from various households with similar illness due to exposure to the same water or recreational facilities?
Are illness symptoms and signs together with the incubation period and duration of symptom consistent with an illness because of reported exposure?
Is every illness consistent and similar to a WBD causal agent?
Is the number of illnesses more than what is expected in this group of people and in the entire population?
Are there reports of possibly related problems from similar sources?
Are there common exposures such as personal or occupational contact or food, apart from water that could explain transmission?
Does certain demographic information such as ethnicity, age and so forth, indicate a common source?

4. Develop a hypothesis about the Causal Agent of the disease and suggest appropriate clinical laboratory testing if indicated. This will include:
referring affected individuals for appropriate medical testing and evaluation if symptoms are severe, and if bloody diarrhea is reported, or if the person is vulnerable to complications due to age or disability;
collect fresh specimens for laboratory testing as soon as possible after the diseases is noticed;
collect samples from many people as possible. The criteria for confirming an outbreak is caused by a particular organism, and suggest whether infected persons should be isolated from the unaffected population;

5. Develop an environmental field management and control based on the epidemiologic case data: Here the objective of the combined environmental and epidemiologic outbreak management and control measures is to identify the causal and infecting agents, the water source, mode of transmission, and the source of contamination. This will also consider the possible infectious agent based on symptoms and incubation period. Possible modes of transmission for that particular agent to focus on the exact environmental management and control procedure or method (Guzewich and Morse, 2008). Apart from identifying the infectious causes of this particular disease, certain information are also important such as:
Possible normal situations or practices just before the outbreak started that could possibly contaminate the water, possible power outages, other equipment failure, as well as water back-ups.
if there is any unusual weather issues just before the outbreak due to heavy rains, and floods.
Were there any water reaction staff ill during the incubation period of the suspect WBD agent, when did they get ill, which water sources they worked with?
Do all the staff involved with water source have body contact with the water or ingest the water they worked with?

6. Implementing immediate, appropriate mismanagement and control measures based on the possible WBD source. Kvenberg et al (1995) said that, this usually depends on the circumstances to initiate immediate management and control measures such as posting warnings at lakes, boiling of water order, recalling a commercial product like bottled water, closing a facility, or issuing a press release to warn and restrain citizens who may from contacting the disease.

7. Consider testing for the presence of the disease with an epidemiologic study (cohort or case control). This control and management approach is critical as it does the following:
Determine the initial interviews and the amount of infected persons will support the idea of epidemiologic study that compares various groups made up of infected people and non-infected individuals.
Get a complete list of possible people that may likely share exposure. This list can be gotten from an event organizer or a reserved list meant for that purpose.
Obtain necessary information about particular water source.
Develop questionnaire to many people include infected persons, and non-infected persons as soon as possible after the case report (McCall et al, 1996). One very important thing to remember here is that, people’s memories become less reliable after some time.
after finalizing a case definition, the data should be analyzed to obtain certain information that include:
(a) demographic profile; the amount of cases by age group and sex;
(b) symptom profile; the percentage of cases that have vomiting, bloody diarrhea, diarrhea, abdominal cramps, fever, respiratory symptoms, jaundice, other symptoms, and rashes;
(c) epidemic curve; determines the number of cases by time of the begging of the infection or symptoms;
(d) event attack rate; the number of cases divided by the total people exposed. Event attack rate can only be calculated if the total number of attendants is known;
(e) median incubation period; the total time taken for 50% of the infected people to the WBD causal agent. The men incubation period can only be calculated if the time of exposure is known;
(f) water specific attack rate; the percentage of people infected with specific exposure;
(g) relative risk; the percentage of people infected with the source after a particular exposure;

8. Managing and controlling further spread: patients with diarrhea should be restricted from swimming in public areas. Infected persons should be well instructed and advice on effective and proper hand washing and proper food handling practices. More particularly, follow-up of issues and causes of these infections.

Recommendations and Practices
Certain preventive guidelines for infected and non-infected persons for preventing and managing further infections of the disease. These guidelines should include:
Appropriate use of safe drinking water sources as well as water for recreation purposes. If the source of any water cannot be ascertained, boil the water should before use. The water should be chemically treated before used for drinking, rinsing uncooked foods, or brushing of teeth.
Wash hands after and before eating, using the toilet, or changing a child’s diapers. During an outbreak, some jurisdictions restrict children with diapers from recreation facilities. In most cases, a more restrained and aggressive media is used to achieve this purpose through campaigns by pool and local park managers, day care institutions, as well as other normal areas of public work. This will help reduce and effectively manage and control the infection (Lippy and Erb, 2006).
Children vomiting and infected with diarrhea should avoid public places and recreational areas to as a way of controlling this infection.

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