PU340 Public Health LawQuiana BradshawJune 30, 2011

Chapter 15 Control of Foodborne Diseases

Foodborne Disease• Too often, outbreaks of foodborne disease go unrecognized or

unreported or are not• investigated. Many resources are available for the investigation of

foodborne disease• outbreaks, but few are directed at developing countries. These

guidelines are intended to• serve as a general introduction to the identification and investigation of

foodborne disease• outbreaks in a variety of settings. Numerous other resources are

available for additional, more• detailed, information on surveillance, epidemiology, statistical analyses

and the medical• aspects of foodborne diseases. It is important to remember that no

general guidelines will fit a specific situation perfectly, and the local environment will always make it necessary to

• modify investigation techniques to account for the unique characteristics of every outbreak.

Foodborne Disease• It is also important to note that addressing the risk of

foodborne disease goes beyond the public• health worker. Ultimately it requires the implementation of a

well functioning and integrated• food control system. This necessitates collaboration among all

the components of a food• control system, including food law and regulations, food

control management, inspection• services, epidemiological and food monitoring (laboratory

services) and education of and communication with the consumer Foodborne Disease.

Foodborne Disease• The investigation and control of foodborne disease outbreaks

are multi-disciplinary tasks• requiring skills in the areas of clinical medicine, epidemiology,

laboratory medicine, food• microbiology and chemistry, food safety and food control, and

risk communication and• management. Many outbreaks of foodborne disease are

poorly investigated, if at all, because• these skills are unavailable or because a field investigator is

expected to master them all• single-handedly without having been trained.

Foodborne Disease• Consider whether or not the cases have the same illness (or

different manifestations of• the same disease).• Determine whether there is a real outbreak by assessing the normal

background activity of disease.• Conduct in-depth interviews with initial cases.• Collect clinical specimens from cases.• Identify factors common to all or most cases.• Conduct site investigation at implicated premises.• Collect food specimens when appropriate.• Formulate preliminary hypotheses.• Initiate control measures as appropriate.• Decide whether to convene a formal outbreak control team.• Make a decision about the need for further investigation.

Descriptive Epidemiology

• Descriptive epidemiology• Establish case definitions for confirmed and probable cases.• Identify as many cases as possible.• Collect data from affected persons on a standardized

questionnaire.• Categorize cases by time, place and person.• Determine who is at risk of becoming ill.• Calculate attack rates.

Typical steps in the investigation of a foodborne disease outbreak• Typical steps in the investigation of a foodborne disease

outbreak include:• - establishing the existence of an outbreak;• - verifying the diagnosis;• - defining and counting cases;• - determining the population at risk;• - describing the epidemiology;

Typical steps in the investigation of a foodborne disease outbreak• developing hypotheses;• - evaluating the hypotheses;• - undertaking additional epidemiological, environmental and

laboratory studies, as• necessary;• - implementing control and prevention measures;• - communicating findings.

Outbreak control team• The criteria for convening a multidisciplinary outbreak control

team (OCT) will vary• according to the seriousness of the illness, its geographical

spread, local circumstances and• the available resources.

Outbreak control team• An OCT may be considered when:• - the outbreak poses an immediate health hazard to the local

population;• - there are many cases;• - the disease is important in terms of its severity or its

propensity to spread;• - cases have occurred over a widespread area without obvious

point source;• - cases have occurred in high-risk establishments (schools,

day-care centers, hospitals, food and premises, etc.).

Outbreak control team• deciding whether there is really an outbreak;• - deciding on the type of investigations to be conducted;• - case-finding and interviews;• - planning the appropriate clinical and environmental

sampling;• - ensuring that all collaborators use a complementary

methodology;• - conducting an environmental investigation of suspected food

premises;• - agreeing and implementing control measures to prevent the

further spread by means of• exclusions, withdrawal of foods, closure of premises, etc.;

Outbreak control team• working in concert with local medical providers to make

recommendations on treatment• and/or prophylaxis;• - organizing ongoing communications among OCT members

about the outbreak;• - making arrangements for liaison with the media;• - producing reports, including lessons learned, for health

authorities and other interested• parties;• - requesting external assistance, e.g. secondment of a national

investigation team.

Foodborne Disease Outbreak• The purpose of public information in the event of an outbreak

of foodborne disease is to• provide:• - accurate information about the outbreak;• - information on implicated food products and how they

should be handled;• - advice on personal hygiene measures to reduce the risk of

person-to-person spread.

Foodborne Disease Outbreak• In some outbreaks, communication with the public will also

help in identifying additional• cases. Methods of communication will depend on local

circumstances but may include• regular press releases via newspapers, radio or television,

public meetings, leaflets delivered• to households and public gathering places, face-to-face advice

in clinics, and messages• displayed on notice boards and disseminated to consumer

groups.

Chapter 16 • Chapter 16, “Blood borne and Sexually Transmitted

Infections’

Blood borne and Sexually Transmitted Infections

• In view of the current epidemic of HIV, STDs, and blood borne infections sweeping the world, the AAFP (American Academy of Family Physicians) recognizes the need for intensified public and professional education which will result in increased awareness, proper diagnosis, effective prevention, treatment and prompt reporting with appropriate confidentiality to achieve the proper epidemiological investigation and treatment to stem the tide of these infections.

American Academy of Family Physicians

• The AAFP endorses and encourages the following HIV, STDs and blood borne infections prevention strategies:

1. The most effective strategies to prevent sexual transmission are abstinence and the maintenance of life-long mutually monogamous relationship with one uninfected partner. For individuals choosing to be sexually active in other situations, the following are generally effective for infections transmitted through bodily fluids:

• Engaging in sexual activities that do not involve or lead to vaginal, anal, or oral intercourse;

• Having intercourse with one uninfected partner;• Using latex and other effective condoms in a correct manner from

the start to finish of every episode of intercourse or other sexual contact;

American Academy of Family Physicians

Prevention of blood-borne infection by: •Appropriate immunization;•Safe blood banking, transfusion services and organ donor services. Deferral of donation by persons at risk for or with blood borne infections;•Avoidance of accidental inoculation and exposures by the use of universal precautions•Avoiding use of contaminated needles;•Reduction of contaminated needles in circulation by the development of regulated needle exchange programs;•Treatment and treatment programs when considered curative or effective in reducing transmission.

American Academy of Family Physicians

• The reduction of congenital and perinatal infection with appropriate detection and treatment of infected individuals and their partners and the proscription of breastfeeding when appropriate and safe for the infant.

The AAFP believes that in any program for detection and treatment of HIV, STDs and blood borne infections, the emphasis should be directed towards the family physician and other primary care physicians for initial diagnosis and treatment.

STI’s & BBV’s• Sexually transmitted infections (STIs) are infections usually passed on during

unprotected sex with an infected partner. This can be vaginal, oral or anal sex, and sometimes skin-to-skin contact.

A blood-borne virus (BBV) is a virus that is transmitted by blood or body fluids that contain blood. Blood-borne viruses may be transmitted if blood, semen or vaginal fluids pass from a person who is infected with the virus into the bloodstream of another person via a break in the skin or mucous membrane.

Click on an STI or BBV link below to read some useful information on your chosen topic.

• Common STIs and BBVs• Chlamydia Hepatitis B

Genital herpes Hepatitis C

Genital warts HIV/AIDS

Gonorrhoea Syphilis

STI’s & BBV’s• Less common STIs• Donovanosis Lymphogranuloma venereum (LGV)

Trichomoniasis• Other STIs and BBVs

(these are not always classified as STIs but can be transmitted through sexual contact)

• Bacterial vaginosis Non-specific Urethritis (NSU) and Cervicitis

Cystitis Pelvic Inflammatory Disease (PID)

Hepatitis A Pubic lice and Scabies

Thrush Molluscum contagiosum

Common STI’s• trichomoniasis • gonorrhea • chlamydia • syphilis• chancroid • pubic lice• scabies • hepatitis B virus (HBV)• cytomegalovirus (CMV)• human papilloma viruses (HPVs)

• some HPVs can cause genital warts• some can cause cancer

• herpes simplex virus (HSV) • can cause oral and genital herpes

• human immunodeficiency virus (HIV) • can cause AIDS

UNPROTECTED ORAL SEX• UNPROTECTED ORAL SEX - HIGH RISK FOR

gonorrhea• syphilis• hepatitis B virus (HBV) • herpes simplex virus (HSV) • cytomegalovirus (CMV)

Protection of STI Information• Both State & federal courts have ruled that using the police

power to circumvent the constitutional protections against unreasonable search and seizure is unconstitutional.

• For instance, public health inspectors can enter private property to look for rats without procuring a criminal search warrant.

• Much of the information that public health professionals collect about STI’s is not constitutionally protected.

The Police Power• Control of STI’s tests the limit of public health authority under

the police power more than most areas of public health practice.

• Understanding the breadth of the police power is critical because STI control requires the state to intrude on the most intimate relationships and to collect the most private information.

• Each state has STI-control laws.

Legal Issues & Controversies• Core STI public health control function, which include primary

reporting and partner notification, pose four types of legal issues:

• 1) Invasion of privacy• 2) Invasion of the person• 3) Nuisance abatement (closures)• 4) Regulation of interstate commerce(blood).

Conclusion• Thanks for attending, do you have any questions?

ReferencesAmerican Academy of Family Physicians (2011). Sexually Transmitted Diseases and Blood Borne Infections, Prevention and Control. Retrieved June 30, 2011 from http://www.aafp.org/online/en/home/policy/policies/s/std.html

Government of Western Australia (2011). Sexually transmitted infections and blood-borne viruses. Retrieved June 30, 2011 from http://www.public.health.wa.gov.au/2/106/2/sexually_transmitted_infections_and_bloodborne_vir.pm

The Source for Women (2011). STI / STD Information. Retrieved June 30, 2011 from http://www.thesourceforwomen.org/services_std.html World Health Organization (2008). Foodborne disease outbreaks : guidelines for investigation and control. Retrieved June 30, 2011 from http://www.who.int/foodsafety/publications/foodborne_disease/outbreak_guidelines.pdf