Review Article

Parasitic Contamination in Commonly Consumed Raw

Vegetables: A Review Study
Arun Padmanandan *, Saudan Singh**, Rajni Gaind***
Abstract
Raw vegetables are a great source of vitamins, dietary fibers, minerals and their regular
consumption is associated with a reduced risk of cardiovascular diseases, stroke and certain
cancers. The consumption of raw vegetables without proper washing is an important route in
the transmission of parasitic diseases. There has been an increase in the number of reported
cases of food-borne illness linked to fresh vegetables. Soil-transmitted helminth infection is
endemic in many parts of the world, principally in developing countries, where there is poor
environmental sanitation and hygiene. The rate of parasitic contamination in vegetables is
more during warm season than cold season. Food shops and food stalls need continuous
monitoring and food handlers should receive suitable training in the basic principles of food
safety as well as rules of personal hygiene and approved practices in food handling. Similarly,
there is lack of food safety knowledge and practices among home food preparers. Though
there is much evidence stating that parasites are transmitted through raw vegetables, more
research is needed to be done in different geographic regions, especially in developing
countries like India.

Keywords: Helminth infection, Raw vegetables, Food safety, Personal hygiene.

Introduction

Vegetables are essential part of a healthy human diet vegetables without proper washing is an important
owing to their nutritional value. Raw vegetables are a route in the transmission of parasitic diseases.3
great source of vitamins, dietary fibers, minerals and
their regular consumption is associated with a reduced It is estimated that as much as 60% of the world’s
risk of cardiovascular diseases, stroke and certain population is infected with gut parasites which may be
cancers.1 transmitted through direct and indirect contact, food,
water, soil, vertebrate, arthropod vectors and rarely
Vegetables contain valuable nutritional factors which from mother to offspring. There has been an increase in
can be successfully utilized to build up and repair the the number of reported cases of food-borne illnesses
body. The Joint FAO/ WHO expert consultation on diet, linked to fresh vegetables.
nutrition and prevention of chronic diseases has Several factors may contribute to contamination of
recommended the intake of a minimum of 400 g of crops. They become contaminated while still on the
vegetables and fruits per day for prevention of chronic plant in fields, orchards, during harvesting, transport,
diseases such as heart disease, cancer, diabetes, obesity processing, distribution and marketing or even at home.
as well as for the prevention and alleviation of several Other factors are waste water used for irrigating
micronutrient deficiencies.2 vegetables4 and contamination of soil with animal and
human wastes and increased application of improperly
Consumption of raw vegetables and salads is a common composted manures to soil in which vegetables are
practice as they retain their natural flavor and preserve grown play a role in parasitic contamination of green
the heat labile nutrients. The consumption of raw vegetables.5
*
PG Resident, Community Medicine, VMMC & Safdarjung Hospital, New Delhi.
**
Director Professor, Community Medicine, VMMC & Safdarjung Hospital, New Delhi.
***
Professor and Head of Department, Microbiology, VMMC & Safdarjung Hospital, New Delhi.
Correspondence to: Dr Arun Padmanandan, Community Medicine, VMMC & Safdarjung Hospital, New Delhi.
E-mail Id: arun.padmanandan@gmail.com

© ADR Journals 2016. All Rights Reserved.

Padmanandan A et al.
Bad hygienic practices during production, transport,
processing and preparation by handlers including
consumers also contribute to vegetable contamination.6
By international trade developing into a major industry
and by rapid refrigerated food transport which became
available at the end of 20th century, taking into account
that a proportion of vegetables cultivated in developing
countries is exported to developed ones, the risk of
spreading these contamination to other countries
cannot be over looked.7 In developing countries,
because of inadequate or even non-existing systems for
routine diagnosis and monitoring or reporting for many
food-borne pathogens, most outbreaks caused by
contaminated vegetables go undetected and the
incidence of their occurrence in food is under-
estimated.8
The review aims at exploring the research done in this
field with regard to parasitic contamination in raw
vegetables, common parasites found in raw vegetables,
climatic influences on contamination and knowledge,
and attitude and practices of street vendors regarding
parasitic contamination in raw vegetables.
Methodology
The review was undertaken in multiple ways. Majority
of the research in this regard was done using internet.
The major sites accessed for relevant literature were
Google Scholar and Pub Med. The keywords used were:
raw vegetables, parasites, seasonal variation, helminthic
eggs, parasitic contamination, and public health.
Seventeen published articles were screened and
reviewed for recent information and cross referencing
was done to find out the previous trends as well. Among
the articles screened, fifteen were retained and two
rejected.
Parasitic Contamination in Raw Vegetables
The consumption of fruits and vegetables contaminated
with the eggs of parasites may be the cause of
parasitoses in humans. A study was conducted during
the year 2009 by Klapec and Borecka to evaluate the
contamination of vegetables, fruits and soil with
zoonotic parasitic eggs on organic and conventional
farms in south eastern Poland.9 Selected fruits and
vegetables were included in the study and the study
finally revealed that highest number of contamination
was found in samples from conventional farms in
comparison to the organic farms. The eggs were of
toxocara, ascaris and trichuris. The study also concluded
ISSN: 2455-7048
Epidem. Int. 2016; 1(1)
that stricter sanitary standards on farms of all types may
limit the incidence of parasitic zoonoses.9
Soil-transmitted helminth infection is endemic in many
parts of the world principally in developing countries
where there is poor environmental sanitation and
hygiene. A study was conducted by Uga et al. to find out
the parasitic egg contamination of vegetables from a
suburban market in Vietnam.10
Out of 317 vegetables, 82 samples were found to be
contaminated and contamination was highest in leafy
vegetables followed by root vegetables and fruit
vegetables. Throughout the survey, eggs of ascaris,
trichuris, toxocara, taenia, ascaridia galli were found.
The study also interviewed 149 villagers out of which
121 stated that they not only use animal feces as
fertilizer but also human feces as well. Contamination
was highest during the dry season than rainy season.
The study concluded that considering the eating habits
of Vietnamese and 17% embryonation rate of the
parasites, vegetables play an important role in
transmitting soil-related helminthic infection. The
results suggested the necessity for nation-wide control
measures against parasitic infection.10
Raw vegetable consumption is a threat to public health
by transmission of intestinal parasites to humans. A
study was conducted by Said et al. during the year 2010-
11 in Egypt to find out parasitic contamination in
commonly consumed raw vegetables and it was found
that intestinal parasites were detected in 31.7% of the
examined samples and cryptosporidium was found to be
present in most of the samples. The findings of this
study may have important implications for global food
safety and emphasize the importance of raw vegetables
in threatening public health by transmission of intestinal
parasites to humans.11
In order to find out the prevalence of parasitic
contamination of raw vegetables, Ezatpour et al.
conducted a study in Iran to find out the prevalence of
parasitic contamination in raw vegetables. This study
showed a considerably high level of contamination in
green vegetables (56.2% in spring and 26%in winter).12
The finding is consistent with previous studies that
reported higher rate of parasitic contamination in
vegetables during warm season than those during cold
season. It has been determined that the excretion of
parasite eggs to environment by humans or animals is
higher in warm season when compared to cold
season.12
28
Epidem. Int. 2016; 1(1)
Vegetables are an important cause in transmission of
parasites. A study was conducted by Olyaeyi et al. in the
year 2011-12 to detect the parasitological
contamination of markets and farms in vegetables
consumed in southern Iran. It was found that 38.5% of
market vegetables and 48.9% of farm vegetables were
contaminated. This study also showed that prevalence
of parasitic infection was higher in spring as compared
to winter. This study also concluded that the importance
of vegetables in the transmission of parasites is stressed
and it is necessary to improve sanitary conditions. The
inhabitants must be informed and educated with
regards to food safety, good distribution practices and
improving the safety concerns in farms and markets.
People should also avoid using untreated water for
irrigation of vegetables as this constitutes an important
route of intestinal parasites transmission.13
From the above studies, it is seen that consumption of
vegetables and fruits contaminated with the eggs of
parasites are important cause of parasitoses in humans.
The rate of parasitic contamination in vegetables is
more during warm seasons than cold seasons. Soil
transmitted helminth infection is endemic in many parts
of the world principally in developing countries where
there is poor environmental sanitation and hygiene.
Knowledge, Attitude and Practices of Food
Safety among Food Handlers
Food shops and food stalls need continuous monitoring
and food handlers should receive suitable training in the
basic principles of food safety as well as rules of
personal hygiene and approved practices in food
handling. A survey was carried out by Cuprasitrut et al.
during the year 2010 to determine the food safety
situation among food shops and food stalls which sell
foods to be given to monks for the purpose of making
merit and to assess the relationship between
knowledge, attitude and practice of food safety in
Bangkok. It was found that both microbiological and
chemical contamination was present in 13 food shops
and 55 food stalls examined. It also showed that only
13% of food handlers had good knowledge, 18.5% had
good attitude and 15.2% had good practices.14
There is a lack of food safety knowledge and practices
among home food preparers. A cross-sectional study
was carried out by Farahat et al. to find out the food
safety knowledge and practices among 811 Saudi
women. It was found that the women reported better
food safety practices than food safety knowledge in all
parameters except cooking where they recorded lowest
mean practice score. Working women showed higher
29
Padmanandan A et al.
mean knowledge and practice scores when compared to
non-working women. The study was done on the
following parameters:
1. Food safety knowledge and practices concerning
purchasing and storage
2. Food safety knowledge and practices concerning
preparation
3. Food safety knowledge and practices concerning
cooking
4. Food safety knowledge and practices concerning
utensils and equipment
5. Food safety knowledge and practices concerning
cooking
The present study revealed gaps between food safety
knowledge and practices that were significant in most
parameters among Saudi women with secondary and
bachelor education, from East and Middle provinces, in
the age groups 20-, 30- and 40-years as well as among
both working and non-working women.
Better food safety practices indicated that some women
used to do the right practices although their knowledge
was deficient. Even the personal hygiene where the
interviewed women reported better knowledge and
practice, its score needs further improvements. This
necessitates launching a food safety training program
from the responsible authorities emphasizing all studied
food safety parameters. Motivation for proper food
handling practices requires that the consumer view the
mishandling of food as a direct threat to their health.
The limitations of the study were that Saudi women
were easily accessible by students and hence results
cannot be generalized to all women and also that food
safety practices were assessed through self-reporting
that may over-estimate the actual practices.15
Discussion
Different parasitic stages can contaminate several food
stuffs. If the food-borne route is suspected in an
outbreak, it is easy to identify how the food implicated
became contaminated. However, it is often difficult to
associate an outbreak with a particular food item.
Vegetables, especially salads, are an important route of
transmission of intestinal parasites and they have been
shown to be an important source of food borne
outbreaks in developing countries.
The most likely hypothesis is that contamination
occurred before harvest, either by contaminated
manure, manure compost, sewage sludge, irrigation
water, runoff water from livestock operations or directly
from wild and domestic animals. These potential
ISSN: 2455-7048
Padmanandan A et al.
contamination events are all plausible and consistent
with the assumption that the level of contamination
must have been high.
Though there is much evidence stating that parasites
are transmitted through raw vegetables, more
researches are needed to be done in different
geographic regions especially in developing countries
like India. In these researches, viability of the
contaminating parasites, larvation and sporulation of
the detected parasites can be done. Also, other
researches must be done to evaluate the contamination
of irrigating water and soil in which green vegetables
are cultivated.
The local health and environmental authorities should
improve the sanitary conditions in those areas where
vegetables are cultivated and consumed. Proper
treatment of waste water used for irrigation of
vegetables should be implemented. Media programs
should inform the consumers the potential health
consequences of parasitic contamination in vegetables
and the importance of proper washing and disinfection
of vegetables before consumption. The use of night soil
as fertilizer in farms may be solved by storage or by
chemical disinfection of feces. Food handlers should
attend proper training in the basic principles of food
safety and rules of personal hygiene in order to improve
their practices in food handling.
Conclusion
These findings may have important implications for
global food safety and emphasize the importance of raw
vegetables in threatening the public health by
transmission of intestinal parasites to humans.
Conflict of Interest: None
References
1. Van Duyn MA, Pivonka E. Overview of the health
benefits of fruit and vegetable consumption for the
dietetics professional. J Am Diet Assoc 2000; 100:
1511–21.
2. WHO. Diet, nutrition and prevention of chronic
diseases. Report of a joint FAO/WHO expert
consultation, Geneva, World Health Organization.
WHO Technical Report 2003: 916.
3. Slifko TR, Smith HV, Rose JB. Emerging parasite
ISSN: 2455-7048
Epidem. Int. 2016; 1(1)
zoonoses associated with water and food. Int J
Parasitol 2000; 30: 1379-93.
4. Mahvi AH, Kia EB. Helminth eggs in raw and treated
wastewater in the Islamic republic of Iran. East
Mediterr Health J 2006; 12: 137-43.
5. Beuchat LR. Ecological factors influencing survival
and growth of human pathogens on raw fruits and
vegetables. Microbes Infect J 2002; 4: 413-23.
6. Gupta S, Satpati S, Nayek S et al. Effect of waste
water irrigation on vegetables in relation to
bioaccumulation of heavy metals and biochemical
changes. Environ Monit Assess 2010; 165: 169-77.
7. Orlandi PA, Chu DMT, Bier JW et al. Parasites and
the food supply. Food Technol 2002; 56: 72-81.
8. Dorny P, Praet N, Deckers N et al. Emerging food
borne parasites. Vet Parasitol J 2009; 163: 196-206.
9. Klapec T, Borecka A. Contamination of vegetables,
fruits and soil with geohelminths eggs on organic
farms in Poland. Annals of Agricultural and
Environmental Medicine 2012; 19(3): 421-25.
10. Uga S, Hoa NTV, Noda S et al. Parasite egg
contamination of vegetables from a suburban
market in Hanoi, Vietnam. Nepal Med Coll J 2009;
11(2): 7578.
11. Said DES. Detection of parasites in commonly
consumed raw vegetables. Alexandria Journal of
Medicine 2012; 48: 345-52.
12. Ezatpour B, Chegeni AS, Abdollahpour F et al.
Prevalence of parasitic contamination of raw
vegetables in Khorramabad, Iran. Food Control
2013; 34: 92-95.
13. Olyaei A, Hajivandi. Parasitological contamination of
markets and farms in vegetables consumed in
southern Iran. Global Veterinaria 2013; 10(3): 327-
31.
14. Cuprasitrut T, Srisorrachatr S, Malai D. Food safety
knowledge, attitude and practice of food handlers
and microbiological and chemical food quality
assessment of food for making merit for monks in
Ratchathewi, Bangkok. Asia Journal of Public Health
2011; 2: 27-34.
15. Farahat MF, El-shafie MM, Waly MI. Food safety
knowledge and practices among Saudi women.
Food Control 2015; 47: 427-35.
Date of Submission: 11th Feb. 2016
Date of Acceptance: 12th Feb. 2016
30