Cholera

Vibrios (which have a curved rod morphology or comma shape) are very common bacteria in aquatic environments. Pseudomonads favour fresh water and vibrios prefer salt water. The genus Vibrio contains an important human pathogen. Vibrio cholerae, the cause of Asiatic cholera. Cholera is an intestinal disease with a pathology related diarrhoeal diseases caused by the enteric bacteria. The source of the contamination is usually the feces of an infected person. Incubation is one to two days. The cholera bacteria produces a toxin that inhibits the absorption of liquids by the body. It kills because it dehydrates the body. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water, brackish rivers and coastal waters, raw or undercooked shellfish from the Gulf of Mexico. In 1991 Cholera was present in coastal areas of Peru. The disease spread rapidly throughout Peru and into other countries in South, Central and North America. The Minister of Fishery of Peru wanting to restore public confidence on marine food ate in a TVshow an undercooked fish. The day after he was hospitalised with cholera. Cholera is a disease associated with poverty, inadequate sanitation and low medical care. The key to effective control is environmental sanitation. Whenever these conditions are present in a region from where food and raw materials are imported, auditing should keep this in mind.

Contaminated water and food are the main cause of cholera in Zimbabwe
[17] Cholera is a disease associated with poverty, inadequate sanitation and low medical care. The key to effective control is environmental sanitation. The cholera bacteria (Vibrio cholerae) produces a toxin that inhibits the absorption of liquids by the body. It kills because it dehydrates the body. Zimbabwe's cholera outbreak, one of the world's largest ever recorded, is far from being brought under control. An enhanced response is needed to urgently reverse an epidemic that has so far infected more than 60,000 people and killed more than 3,100 since August 2008. Former Cholera outbreaks took place in Gorna in 1994 affecting Rwandan refugees and killed 50,000 people within 3 weeks. The outbreak in 2006 killed 2.700 persons in Angola.

Transmission of Cholera through contaminated food and water

[18] Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. Recent interruptions to the water supplies, together with overcrowding, are aggravating factors in this epidemic. Communities are being encouraged to protect themselves against cholera by adhering to proper food safety practices as well as to good personal hygiene. Early rehydration at home by using oral rehydration salts is paramount to diminishing mortality. Mass chemoprophylaxis with antibiotics is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.

How to reduce cholera risk in epidemic regions

[19] [20] - Drink water that you have boiled for at least one minute or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled or treated water, as well as drinks that have been bottled and sealed (such as bottled water, carbonated drinks, and sports drinks). -Do not put ice in drinks, unless the ice is made from boiled or treated water. - Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself. - Do not eat undercooked or raw fish or shellfish, including ceviche. - Make sure all vegetables are cooked. Do not eat salads or other raw vegetables. - Do not eat foods and drink beverages from street vendors.

Cholera epidemic 2010 in Haiti

[21] Cholera is transmitted through fecal contamination of water or food and causes an acute, severe, watery diarrhoea that can result in hypovolemic shock and death if not treated with fluid replacement promptly. The cholera epidemic in Haiti killed 1400 people. 50000 went sick and are being medicated. According to Dr. Scott Dowell of CDC it is not possible to find out how the cholera came to Haiti. Cholera can be treated with antibiotics but the usual best course is giving intravenous fluids, salts and sugars to restore what is lost through diarrhoea and vomiting. It seems hard to get the bacterium out of Haiti and the country will have to deal with the disease for a long time. Genetic tests show the Vibrio cholerae bacteria isolated in Haiti is almost identical to one another, which supports the theory of a single source. It is the same strain previously found in

countries in South Asia and elsewhere, and can be trace. Back to a pandemic in Indonesia 49 years in Sulawesi, Indonesia. The outbreak of cholera in Haiti was first seen affecting workers in rice paddies in the Artibonite Department. They were drinking untreated water and practiced open defecation. Haiti lacks piped, treated water and adequate sanitation. The Haitian population has no pre-existing immunity to cholera. The toxigenic strain Vibrio cholerae O1, serotype Ogawa, biotype El Tor was identified. The strain is susceptible to tetracycline, ciprofloxacin, and kanamycin; and resistant to trimethoprim-sulfamethoxazole, furazolidone, nalidixic acid, sulfisoxazole, and streptomycin. The CDC stresses the importance of preventing infection by promoting water treatment, adequate sanitation and hygiene, and safe food preparation. [22]

Prevention and control measures

[23] The CDC reports that prevention and control measures are focused on 1) providing better access to treated drinking water; 2) providing education on improvement of sanitation, hygiene, and food preparation practices; 3) advising ill persons to begin using oral rehydration solution immediately and seek health care at the onset of watery diarrhoea; 4) enhancing cholera treatment capacity at existing health-care institutions; and 5) establishing cholera treatment centres.

Individual protection from Cholera

[24] The CDC recommends individual measures to protect from the disease: - Drink and use safe water. Boil it for at least 1 minute, or treat it with chlorine. - Wash your hands often with soap and safe water. - Use latrines or bury your faeces; do not defecate in any body of water. If there are no latrines installed, defecate at least 30 meters away from any body of water and then bury your faeces. - Cook food well, especially seafood, keep it covered, eat it hot, and peel fruits and vegetables. Boil it, Cook it, Peel it, or Leave it. - Clean up safely - in the kitchen and in places where the family bathes and washes clothes. Read more at http://www.cdc.gov/haiticholera/pdf/cholera_preventionmessages.pdf

Ongoing cholera epidemic in Congo and Haiti in 2011

[25] Cholera is an acute intestinal infection transmited by faecal contaminated food or drinking water. The agent of the disease is the Vibrio cholerae bacterium. The disease has an incubation period of 1 to 2 days causing watery diarrhoea, vomiting, severe dehydration and death if treatment is not administered promptly. Vomiting also occurs in most patients. According to WHO cholera no longer poses a threat to countries with high standards of hygiene, however, it remains a challenge in countries with unsafe drinking water and inappropriate

sanitation. Congo: The disease has spread to the provinces of Equateur, Bandundu and the capital, Kinshasa, from where it spreads downstream along the River Congo. At least 3,896 cases, with 265 fatalities have been reported in the Democratic Republic of Congo (DRC) since March. In the Republic of Congo 181 cases are suspected, and six people died, following a report issued by WHO. The WHO and partners, together with the government promote hygiene campaigns, send experts to the affected regions, set up water chlorination points and provide treatment for infected persons.

Cholera cases increasing in Haiti

[26] Cases of cholera are on the rise in Haiti and neighbouring Dominican Republic. Since the beginning of the outbreak last October til 12 June 2011, there had been 344,623 cases of cholera and 5,397 deaths. Access to clean water and proper sanitation in Haiti remains the main challenge in fighting the epidemic, according to WHO. In the Dominican Republic there have been 1,727 confirmed cases, including 46 deaths. The country is improving water quality and sanitation services, and public awareness campaigns on prevention.

Consumers feel no health benefits of bottled water over tap water, says study
[27] Bottled water became an important business. It is a bulky department of food stores. Ward and colleagues 2009 assessed the health beliefs of consumers concerning bottled mineral water. The authors found that drinking bottled water was motivated by the believe it may confer general health benefits linked to the minerals in bottled water. This, however, plays a minor role in the decision to buy bottled water, where convenience, cost and taste are the important criterion. Links between plastic bottle and cancer, also detrimental effect on the environment were of concern. This study supports an earlier study of Napier and Kodner 2008 which say that health benefits of bottled water for routine use is unclear. The authors stress, however the importance of bottled water in handling emergencies or natural disasters, compromising safety of tap water. [28]

US Regulations for bottled water

[29] The Institute of Food Technologists: published in 2008 an overview of drinking water standards and regulations, freshwater resources, water pollution and predominant sources of

contamination, and the effects of agriculture and food processing on water quality and wastewater treatment. The overview also describes bottled water as defined by the U.S. Food and Drug Administration (FDA) as water intended for human consumption that is enclosed in a sanitary container, contains no added ingredients (except or optional antimicrobial agents or FDA-specified amounts of fluoride), and meets all applicable federal and state standards. It must comply with FDA's standards of quality, standards of identity (including labelling requirements), and current good manufacturing practices, and FDA's standards of quality (21 CFR 165.110[b]) [30] establishing maximum allowable levels of contaminants such asd chemical, physical, microbiological, and radiological in bottled water.

Staphylococcus aureus
Staphylococcus aureus causes suppurative infections in animals and man. It can form toxins which cause food poisoning. The contamination of food with Staphylococcus aureus occurs due to contact with infected wounds of animals or hands of food workers. That is why gloves are indispensable. Contaminated fish caused intoxication with staphylotoxin which is resistant to heat. The fish had been left for hours without cooling, the bacteria produced the toxin which can be present in deep frozen fish and its products.

Half of US meat and poultry found contaminated with antibiotic resistant Staphylococcus aureus
[31] Waters et al. 2011 found that 47 % of meat and poultry were contaminated with Staphylococcus . aureus, of which 52 % were resistant to at least three classes of antibiotics. The genotypes and resistant profiles suggest that the source of these bacteria come from food animals. Low doses of antibiotics used as feed supplements industrial farms are ideal places for the development of drug-resistant bacteria.

Staphylococcal enterotoxin is resistant to cooking temperatures

Staphylococcus aureus causes cause a range of illnesses from skin infections to life-threatening diseases, such as pneumonia, endocarditis and sepsis in animals and man. Important for the food industry is the fact that Staphylococcus aureus may form toxins which cause food poisoning. Contamination of meat, poultry or even eggs may be traced back to contact with infected wounds of animals or hands of food workers. Waters and colleagues 2011 stress the need to

wear gloves when handling foodstuffs and refer to proper cooling of meat and poultry to avoid the development of staphylococcal enterotoxin. There are about 14 different staphylococcal enterotoxins which are highly resistant to digestion by proteolytic enzymes such as pepsin and trypsin. Staphylococcus enterotoxins are highly resistant to heat.

Staphylococcal enterotoxin A in pasteurised milk

[32] Staphylococcal enterotoxin A is an exotoxin is resposible for frequent staphylococca food poisoning worldwide. The toxin is heat-resistant, and are not completely inactivated by usual cooking procedures. Sospedra et al. 2011 describe a method to detect Staphylococcal enterotoxin A from pasteurised milk.

Ham staphylococcal food poisoning

[33] Staphylococcal enterotoxin D production in boiled ham, smoked ham and dry-curred Serrano after 7 days at room temperature were analysed by Mrta et al 2011. Smoked ham developed nine times less Staphylococcal enterotoxin D per colony-forming unit of Staphylococcus aureus than in boiled ham. In boiled ham, the SED levels unpredictably decreased after three days of incubation. The authors stress that production levels of SED vary in the different ham products, but after five days all ham products developed staphylococcal enterotoxin D sufficient to cause staphylococcal food poisoning.

Other bacteria producing toxins

Powerful toxins are also known from Bacillus anthracis causing Anthrax, a disease of cattle, sheep and humans. Clostridium botulinum causes food poisoning, mainly in low acidic foods. Clostridium perfringens also produces an enterotoxin and is an important cause of food poisoning and infections such as gas gangrene. (Ernest Hemingway describes a case of gas gangrene in his book " The snows of Kilimanjaro "). Botulism: Many human deaths have also been attributed to the consumption of food or water containing the toxin. Clostridium botulinum is widely dispersed in soils. Ingestion of the organism is not harmful. It becomes dangerous only when conditions are favourable for its growth and subsequent toxin formation. The organism in an environment containing decaying plant or animal organic material. Stagnant pools or damp areas with buried decaying matter are danger areas for toxin development Decaying carcasses are a frequent source of the toxin, as are many insects feeding in the same tissue. The insects may contain enough toxin to cause the disease in any bird and chicken that ingests it. Since the toxin is water soluble, water sources may become contaminated and provide a reservoir for the disease.Keeping the environment clean is important to avoid botulic poisoning

of birds and water contamination. There are different types of the toxin; types A and C cause the disease in birds while type B frequently produces the disease in man.

Moulds
Some strains of moulds produce mycotoxins. Mycotoxins in eggs and meat is mainly influenced by the concentration of mycotoxins in fodder. Auditing should always look after fodder quality of breeding stations. Bad hygienic condition during harvest, drying, transport of figs and weather conditions such as high humidity and high temperatures are the cause of rising mould spoilage. Consumer should look inside the figs and discard those which are dark. Several brands of dried figs with origin from Turkey and Greece have high amount of aflatoxin B1,B2, G1 and G from Aspergillus flavus. The aflatoxins which are found on these samples are located in the interior of the fruits. As spoiled figs are detected under UV light when they are packed, only the fruits with mould contamination from inside are not removed and are often eaten despite a high level up to 900 microgram/kg of aflatoxin B1. (Only 2 micrograms are allowed). It is estimated that 25 per cent of all agricultural crops worldwide are contaminated by molds that produce mycotoxins. The toxins are mostly found in cereals, nuts, cocoa and coffee beans and other foods like dried fruits and meat, particularly when the water content/activity and the temperature are poorly controlled. The EC Scientific Committee for Food endorsed in 2004 a provisional maximum TDI (Tolerable Daily Intake) for: Patulin 0.4 g/kg bw/day Ochratoxin A 5 ng/kg bw/day

Prevention and reduction of mycotoxin contamination in cereals

The complete elimination of mycotoxin such as Ochratoxin, Zearalenone, Fumonisis and tricothecenes is not achievable at this time, according to Codex CAC/RCP- 2003.

Good agricultural practices (GAP) represent the measures against contamination of cereals with mycotoxins during handling, storage, processing, and distribution of cereals for human food and animal feed. Wheat and maize are hosts to Fusarium. A crop rotation using potato, other vegetables, clover and alfalfa can reduce the spores of the mold in the field. Old seed heads should be removed, destroyed or plowing under. Make soil tests to ensure adequate soil pH and optimal fertilisation. Seed varieties particularly resistant to molds and pests should be used. Moisture boosts mould infections. Irrigation during flowering and during the ripening of the normal crops, specifically wheat, barley, and rye, should, therefore, be avoided. If the crop is harvested with a water activity higher than 0.70, the grain must be dried immediately to less than 14% moisture content in small grain. Moisture levels of the crop during storage should be less than 15%. Kernels containing symptomless infections cannot be removed by standard cleaning methods. Seed cleaning procedures, such as gravity tables, may remove some infected kernels. A temperature rise of 2-3C may indicate microbial growth and/or insect infestation in stored grains.

Intermediate storage
Buffer storage resulting from low drying capacity should only be made when the moisture is less than 16%, the storage time is less than 10 days, and the temperature is less than 20 C. Organic acids, like propionic acid may be used as preservatives. These acids are effective in killing various fungi and thus prevent the production of mycotoxins in grains intended only for animal feed. The salts of the acids are usually more effective for long-term storage. Care must be taken because these compounds can negatively affect the taste and odour of the grain. Small, shriveled grain may contain more zearalenone than healthy normal grain. Winnowing grains at harvest or later will remove shriveled grain. Mature grains should not remain in the field for extended periods of time, particularly in cold, wet weather. T-2 and HT-2 toxins are not usually found in grains at harvest, but can result from grains that are water-damaged in the field or grains that become wet at harvest or during storage.

Candida albicans as example of microorganism which can act as opportunists

Candida albicans can cause infections of mouth and digestive tract by persons with weak immunological system. Yeasts being found in food should be controlled on regard of the presence of Candida albicans.

Infectious coryza
Infectious coryza is a specific respiratory disease in chickens The disease is caused by a bacterium known as Hemophilus gallinarum.

Pullorum Disease
It is caused by Salmonella pullorum and is primarily egg transmitted. It is also known as "bacillary white diarrhoea" Fowl typhoid It is caused by Salmonella gallinarum. The transmission includes eggs. The poultry infections with Salmonella gallinarum and Salmonella pullorum killed large numbers of birds and were therefore eradicated in the 1970s. They had not cause harm in humans and were acting as a natural vaccine against Salmonella enteritidis. The chickens' immunity was lost and this opened the door for Salmonella enteritidis.

Fowl Cholera
It is an infectious disease of turkeys caused by Pasteurella multocida with watery yellowish orgreen diarrhoea.The current bird flu scenario should not cause panic and fear; instead it calls for rational and immediate action to fight the disease at its origin - that means in animals. Avian influenza is first of all an animal disease that requires a veterinarian response. The virus can be defeated and contained if countries and the international community work closely together and set up efficient surveillance and disease control programs. Virus outbreaks in animals need to be detected at a very early stage, infected poultry must be slaughtered and animals at risk have to be vaccinated. Reducing avian influenza in animals contributes directly to protecting people's health. Affected countries in Southeast Asia are proving that the virus can be successfully contained. Thailand has obtained an impressive reduction of outbreaks through massive investment in controlling the disease in poultry, using slaughtering and improved surveillance and active disease search. In Viet Nam, improved on-farm hygiene, farming practices, poultry movement controls and

vaccination campaigns will reduce the frequency of bird flu outbreaks. Several countries such as Malaysia, South Korea and Japan have eliminated the disease rapidly after the occurrence of new outbreaks. Regrettably, most of the public discussion focuses on the human-health aspects of bird flu, while the weak state of veterinary services in many poor countries is being ignored. Affected countries and the international community urgently need to invest more in support of veterinarians and animal health workers, because they represent the first line of defence against the virus. [34] A Swedish study leaded by Anna Thorson says that epidemiological data from a rural Area in Vietnam suggest that transmission of highly pathogenic avian influenza to humans could be more common than anticipated, though close contact seems required. Thorson's group found that simply having sick or dead poultry in the house did not significantly increase the risk of flu-like illness