Limitations to successful investigation and reporting of foodborne outbreaks: an analysis of foodborne disease outbreaks in FoodNet catchment areas, 1998-1999.
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To better understand factors associated with confirming the etiologic organism and identifying the food vehicle responsible for foodborne-disease outbreaks, we examined data from outbreaks reported in 1998 and 1999 through active surveillance by Foodborne Disease Active Surveillance Network (FoodNet) surveillance areas in 7 states. In 71% of these outbreaks, no confirmed etiology was identified, and in 46%, no suspected food vehicle was identified. Outbreaks involving > or =10 cases were significantly more likely to have their etiology identified than were smaller outbreaks. In two-thirds of outbreaks in which an etiology was not confirmed, no stool specimens were collected for laboratory testing; in 55% of these outbreaks, neither clinical specimens nor food samples were tested. If the etiology of and factors contributing to foodborne-disease outbreaks are to be understood, adequate resources must be available to allow specimens to be collected and tested and epidemiologic investigations to be conducted appropriately. (+info)
Airway disease risk from environmental tobacco smoke among coffeehouse workers in Turkey.
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OBJECTIVES: To examine the effect of ETS exposure on respiratory symptoms and pulmonary function and to compare workers in coffeehouses to those in other occupations in order to assess the risk of respiratory illness in this occupation. DESIGN: Cross sectional study. SETTING: The study area consisted of the three metropolitan districts of the city of Izmir, Turkey. 86 coffeehouses and 80 other small scale shops which had no known respiratory risk factor, located in the same area, were taken as the study group. SUBJECTS: 207 workers were assessed. MAIN OUTCOME MEASUREMENTS: Subjects answered a questionnaire about demographic and working characteristics, respiratory symptoms, and smoking behaviour. Physical examinations and spirometric measurements were carried out at the workplaces. RESULTS: There was a significant increase in respiratory symptoms in coffeehouse workers. Working in a coffeehouse showed a significant risk for chronic bronchitis (odds ratio (OR) 4.3). In coffeehouse workers, forced expiratory volume in one second (FEV(1)) decreased 5.1%, forced vital capacity (FVC) 3.4%, FEV(1)/FVC 1.6%, peak expiratory flow (PEF) 6.45%, and forced expiratory flow (FEF(25)) 7.2%, FEF(50) 10%, and FEF(25-75) 9.8%. Among workers who were described as having an "airway disease", coffeehouse workers were significantly greater in number. When age, body mass index, and smoking behaviour were controlled, working in a coffeehouse was strongly associated with "airway disease" compared to other workers (OR 5.35, 95% confidence interval 2.41 to 11.87). CONCLUSIONS: Workers in coffeehouses showed significant increases in respiratory symptoms and decreased pulmonary function. All workers need to gain an awareness of these occupational risks and working conditions should be improved immediately. (+info)
Restaurant inspection scores and foodborne disease.
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Restaurants in the United States are regularly inspected by health departments, but few data exist regarding the effect of restaurant inspections on food safety. We examined statewide inspection records from January 1993 through April 2000. Data were available from 167,574 restaurant inspections. From 1993 to 2000, mean scores rose steadily from 80.2 to 83.8. Mean inspection scores of individual inspectors were 69-92. None of the 12 most commonly cited violations were critical food safety hazards. Establishments scoring <60 had a mean improvement of 16 points on subsequent inspections. Mean scores of restaurants experiencing foodborne disease outbreaks did not differ from restaurants with no reported outbreaks. A variety of factors influence the uniformity of restaurant inspections. The restaurant inspection system should be examined to identify ways to ensure food safety. (+info)
A multistate outbreak of Escherichia coli O157:H7 infection linked to consumption of beef tacos at a fast-food restaurant chain.
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We investigated a multistate outbreak of Escherichia coli O157:H7 infections. Isolates from 13 case patients from California, Nevada, and Arizona were matched by pulsed-field gel electrophoresis subtyping. Five case patients (38%) were hospitalized, and 3 (23%) developed hemolytic uremic syndrome; none died. The median age was 12 years (range, 2-75 years), and 10 (77%) were female. Case-control studies found an association between illness and eating beef tacos at a national Mexican-style fast-food restaurant chain (88% of cases versus 38% of controls; matched OR, undefined; 95% confidence interval, 1.49 to infinity; P=.009). A trace-back investigation implicated an upstream supplier of beef, but a farm investigation was not possible. This outbreak illustrates the value of employing hospital laboratory-based surveillance to detect local clusters of infections and the effectiveness of using molecular subtyping to identify geographically dispersed outbreaks. The outbreak investigation also highlights the need for a more efficient tracking system for food products. (+info)
Cultural and historical trends and influences of food, nutrition and cuisine on health and development.
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The distinctive qualities of the cuisine of Hangzhou are the result of its geographical situation, which provided good soils, reliable rainfall, a lake that has been a water source and renowned beauty spot for centuries. The rich water-sources facilitated the development of gastronomy, agriculture, trade and administration, especially after it became the capital of the Southern Sung Dynasty. Hangzhou's food sources are especially diverse, notably for fish, green vegetables, fungi, and tofu, and have been since early records. As capital, it became a leader in cuisine, and in the development of the restaurant industry. The strength of food traditions has been reinforced constantly by the cultural, medicinal, nutritional, and social values of food and cooking, by the interest of Chinese scholars in food and wine, and by the narrative that accompanies specific dishes. (+info)
Estimating the beginning of the waterpipe epidemic in Syria.
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BACKGROUND: Waterpipe smoking is becoming a global public health problem, especially in the Eastern Mediterranean region (EMR). METHODS: We try in this study, which is a cross sectional survey among a representative sample of waterpipe smokers in cafes/restaurants in Aleppo-Syria, to assess the time period for the beginning of this new smoking hype. We recruited 268 waterpipe smokers (161 men, 107 women; mean age +/- standard deviation (SD) 30.1 +/- 10.2, response rate 95.3%). Participants were divided into 4 birth cohorts (1980) and year of initiation of waterpipe smoking and daily cigarette smoking were plotted according to these birth cohorts. RESULTS: Data indicate that unlike initiation of cigarette smoking, which shows a clear age-related pattern, the nineties was the starting point for most of waterpipe smoking implicating this time period for the beginning of the waterpipe epidemic in Syria. CONCLUSION: The introduction of new flavored and aromatic waterpipe tobacco (Maassel), and the proliferation of satellite and electronic media during the nineties may have helped spread the new hype all over the Arab World. (+info)
An outbreak of Salmonella enteritidis phage type 34a infection associated with a Chinese restaurant in Suffolk, United Kingdom.
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BACKGROUND: On 30th July 2002, the Suffolk Communicable Disease Control Team received notifications of gastrointestinal illness due to Salmonella Enteritidis in subjects who had eaten food from a Chinese restaurant on 27th July. An Outbreak Control Team was formed resulting in extensive epidemiological, microbiological and environmental investigations. METHODS: Attempts were made to contact everybody who ate food from the restaurant on 27th July and a standard case definition was adopted. Using a pre-designed proforma information was gathered from both sick and well subjects. Food specific attack rates were calculated and two-tailed Fisher's exact test was used to test the difference between type of food consumed and the health status. Using a retrospective cohort design univariate Relative Risks and 95% Confidence Intervals were calculated for specific food items. RESULTS: Data was gathered on 52 people of whom 38 developed gastrointestinal symptoms; 16 male and 22 female. The mean age was 27 years. The mean incubation period was 30 hours with a range of 6 to 90 hours. Food attack rates were significantly higher for egg, special and chicken fried rice. Relative risk and the Confidence interval for these food items were 1.97 (1.11-3.48), 1.56 (1.23-1.97) and 1.48 (1.20-1.83) respectively. Interviews with the chef revealed that many eggs were used in the preparation of egg-fried rice, which was left at room temperature for seven hours and was used in the preparation of the other two rice dishes. Of the 31 submitted stool specimens 28 tested positive for S Enteritidis phage type 34a and one for S Enteritidis phage type 4. CONCLUSION: In the absence of left over food available for microbiological examination, epidemiological investigation strongly suggested the eggs used in the preparation of the egg-fried rice as the vehicle for this outbreak. This investigation highlights the importance of safe practices in cooking and handling of eggs in restaurants. (+info)
Risk factors for transmission of foodborne illness in restaurants and street vendors in Jakarta, Indonesia.
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In a previous risk factor study in Jakarta we identified purchasing street food as an independent risk factor for paratyphoid. Eating from restaurants, however, was not associated with disease. To explain these findings we compared 128 street food-vendors with 74 food handlers from restaurants in a cross-sectional study in the same study area. Poor hand-washing hygiene and direct hand contact with foods, male sex and low educational level were independent characteristics of street vendors in a logistic regression analysis. Faecal contamination of drinking water (in 65 % of samples), dishwater (in 91 %) and ice cubes (in 100 %) was frequent. Directly transmittable pathogens including S. typhi (n = 1) and non-typhoidal Salmonella spp. (n = 6) were isolated in faecal samples in 13 (7 %) vendors; the groups did not differ, however, in contamination rates of drinking water and Salmonella isolation rates in stools. Poor hygiene of street vendors compared to restaurant vendors, in combination with faecal carriage of enteric pathogens including S. typhi, may help explain the association found between purchasing street food and foodborne illness, in particular Salmonella infections. Public health interventions to reduce transmission of foodborne illness should focus on general hygienic measures in street food trade, i.e. hand washing with soap, adequate food-handling hygiene, and frequent renewal of dishwater. (+info)