Prevalence of Intestinal Parasites in Food Handlers of Bandar Abbas, Southern Iran

BACKGROUND

Food handlers play a significant role in the dissemination and transmission of enteropathogenic microorganisms, including intestinal parasites. The aim of this study was to determine the prevalence of intestinal parasites in food handlers of Bandar Abbas, southern Iran.

METHODS

In this cross-sectional study, 800 stool samples were randomly collected in a period of 6 months from Jun to Nov 2015. The diagnosis was made on direct wet mount, formalin-ether concentration, Ziehl-Neelsen, and Trichrome stained slides.

RESULTS

34.9% of participants were positive for stool parasites. The most infected individuals were seen in the workers of bakeries 54.3%, factories 41.1% fast foods 35.7%, supermarkets 34.7%, restaurants 33.9%, offices 29.8%, butchers 27.3% and coffee shops 26.7% respectively (P<0.05). The intestinal parasites were Blastocystis hominis 24.3%, Entamoeba coli 8%, Giardia lamblia 6.8% and Dientamoeba fragilis 4.3% respectively. Only two infections by Hymenolepis nana (0.3%) and one by Enterobius vermicularis (0.1%) were detected in this study. Living in the workplace and direct contact with the raw foodstuff affected the prevalence of intestinal parasites (P<0.05).

CONCLUSION

The use of concentration methods for the detection of intestinal parasites as well as continuous and effective education in short-term courses to promote hygienic behavior is suggested.

An Investigation of Factors that Influence Hygiene Practices at a Small Day Care Center

The aim of this study was to explore factors that influence hygiene practices at small day care centers. It examines the effect of food hygiene training on hygiene practices and investigates the correlations between the hygienic status of food handlers' hands and that of kitchen utensils. Furthermore, it determines the influences of demographic and facility-related factors on hygiene practices in small day care centers. A total of 56 food handlers at 49 day care centers in the Gyeongnam area of South Korea participated in hygiene training. The results of the study showed that after two training sessions, the ATP bioluminescence levels of knives ( P < 0.01), cutting boards ( P < 0.01), food handlers' hands ( P < 0.001), and UV disinfection cabinets ( P < 0.01) decreased. After training, the total scores on the inspection checklist were significantly improved ( P < 0.05). Strong associations between the microbial quality of hands and kitchen utensils were seen. Classification and regression tree analysis identified important factors that influence hygiene practices at small food service kitchens, such as status of registration with the government certification authority, length of food handlers' working experience and their age, and maximum number of people served. This study helps to broaden our knowledge of food hygiene issues in small day care centers.

Socio-demographic factors and availability of piped fountains affect food hygiene practice of food handlers in Bahir Dar Town, northwest Ethiopia: a cross-sectional study

Background

Morbidity and mortality rates of food borne diseases are consistently highest in African due to poor food handling and sanitation practices. Thus, the study aimed to assess food handling practice and associated factors among food handlers of Restaurants in Bahir Dar Town, northwest, Ethiopia. A cross-sectional study was conducted from December, 7/2012 to January, 2/2013 among food handlers working in 106 restaurants in Bahir Dar Town. A structured questionnaire composed of socio-demographic factors, food safety knowledge, working environmental characteristics and food hygiene practice of food handlers was employed to collect the data via interviewing and observations. Binary logistic regression model was fitted to assess factors associated with food hygiene practice after multi-collinearity and outlier were checked and data was clean. Both crude odds ratio (COR) and adjusted odds ratio (AOR) were estimated to show the strength of association. In multivariate analysis, variables with a P value of ≤ 0.05 were considered as statistical significant.

Results

About 67.6% [95% confidence interval (CI) 58.8, 76.4] of food handlers had good food hygiene practice, whereas 32.4% of food handlers had poor food hygiene practice. The odds of having good food hygiene practice was higher among food handlers who had received food safety training [AOR: 4.7, 95% CI 1.7, 12.8], had formal education [AOR: 6.4, 95% CI 3.5, 11.5] and work experiences greater than 2 years [AOR: 3.4, 95% CI 1.8, 6.4]. At last, food handlers working in restaurants which had piped fountains for hand wash were 2.1 times more likely to have good food hygiene practice[AOR: 2.1, 95% CI 1.1, 3.8].

Conclusion

In this study, the overall food hygiene practice of food handlers is not to the acceptable level. Therefore, endeavors ought to be reinforced to improve food hygiene practices of food handlers through intervention programs such as training and education. Also emphasis should be given on the accessibility of piped fountains for the better food handling practice of food handlers.

Prevalence and factors associated with intestinal parasites among food handlers of food and drinking establishments in Aksum Town, Northern Ethiopia

BACKGROUND

Various epidemiological studies indicate that the prevalence of intestinal parasites is high in developing countries and those parasites are major public health importance in Sub-Saharan Africa. Their distribution is mainly associated with poor personal hygiene, environmental sanitation and lack of access to clean water. This study was conducted to estimate the prevalence of intestinal parasitic infection and identify factors associated with intestinal parasitic infection among food handlers in the Aksum Town of Tigray Regional State, North Ethiopia.

METHODS

A cross-sectional study design was used among 400 randomly selected food handlers who were selected as respondents. Data were collected by face to face interviewer administered questionnaire supplemented with observational checklist. Fresh stool samples were collected from respondents and were examined microscopically for the presence of any of intestinal parasites using standard laboratory methods. Multivariable logistic regression model using Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) was fitted to analyze the independent predictors of intestinal parasitic infections.

RESULT

The mean age of the food handlers included in this study was 26.0 years. Of the total respondents, 72.5% were females, 63% have completed at least secondary school educational level. Five species of Intestinal Parasites (IPs) were identified. The overall prevalence of being infected with at least one intestinal parasite was 14.5%, 95% CI (11.3, 18.0). The odds of being positive for at least one intestinal parasitic infection was 12.3 times higher among food handlers who practice medical checkup every 9 months compared to those who have a medical checkup every 3 months. The odds of being positive for intestinal parasitic infection was 3 times higher among food handlers with no formal education compared to those who have a level of education secondary school and above. Food handlers who received food hygiene and safety training were 66% less likely to be positive for at least one intestinal parasitic infection as compared to those who did not receive training.

CONCLUSION

Prevalence of parasitic infection among food handlers observed in the current study is relatively low but is still a public health importance. Number of medical checkup, training in food hygiene and safety, feedback from customers and level of education were significantly associated with reduced odds of being infected with parasitic infection. Hence, these factors should be focused by policy makers and implementers to further bring the prevalence below the level of public health importance.

Giardiasis Outbreak Associated with Asymptomatic Food Handlers in New York State, 2015

Giardia duodenalis is a protozoan that causes a gastrointestinal illness called giardiasis. Giardiasis outbreaks in the United States are most commonly associated with waterborne transmission and are less commonly associated with food, person-to-person, and zoonotic transmission. During June to September 2015, an outbreak of 20 giardiasis cases occurred and were epidemiologically linked to a local grocery store chain on Long Island, New York. Further investigation revealed three asymptomatic food handlers were infected with G. duodenalis, and one food handler and one case were coinfected with Cryptosporidium spp. Although G. duodenalis was not detected in food samples, Cryptosporidium was identified in samples of spinach dip and potato salad. The G. duodenalis assemblage and subtype from one of the food handlers matched two outbreak cases for which genotyping could be performed. This outbreak highlights the potential role of asymptomatically infected food handlers in giardiasis outbreaks.

Role of Food Handlers in Norovirus Outbreaks in London and South East England, 2013 to 2015

Outbreaks caused by norovirus infection are common and occur throughout the year. Outbreaks can be related to food outlets either through a contaminated food source or an infected food handler. Both asymptomatic and symptomatic food handlers are potentially implicated in outbreaks, but evidence of transmission is limited. To understand potential food handler transmission in outbreak scenarios, epidemiological and microbiological data on possible and confirmed norovirus outbreaks reported in London and South East England in a 2-year period were reviewed. One hundred eighty-six outbreaks were associated with a food outlet or registered caterer in this period. These occurred throughout the year with peaks in quarter 1 of study years. A case series of 17 outbreaks investigated by the local field epidemiological service were evaluated further, representing more than 606 cases. In five outbreaks, symptomatic food handlers were tested and found positive for norovirus. In four outbreaks, symptomatic food handlers were not tested. Asymptomatic food handlers were tested in three outbreaks but positive for norovirus in one only. Environmental sampling did not identify the causative agent conclusively in any of the outbreaks included in this analysis. Food sampling identified norovirus in one outbreak. Recommendations from this study include for outbreak investigations to encourage testing of symptomatic food handlers and for food and environmental samples to be taken as soon as possible. In addition, sampling of asymptomatic food handlers should be considered when possible. However, in light of the complexity in conclusively identifying a source of infection, general measures to improve hand hygiene are recommended, with specific education among food handlers about the potential for foodborne pathogen transmission during asymptomatic infection, as well as reinforcing the importance of self-exclusion from food handling activities when symptomatic.

Effectiveness of an intervention package on knowledge, attitude, and practices of food handlers in a tertiary care hospital of north India: A before and after comparison study

BACKGROUND

Food-borne illnesses have been a recognized hazard for decades. Recent promulgation of Food Safety and Standards Act (FSSA), 2006, indicates the concern of our Govt. for food safety. Research on effectiveness of food safety interventions in our country is remarkably scarce. Hence, the present study was conducted in a tertiary care hospital of north India to create evidence-based results for food safety interventions.

METHODS

The study was before and after intervention trial which was registered with CTRI. Data collection was paperless using a software. All food handlers (n = 280) working inside the hospital were recruited. Intervention package comprised Self-Instructional Manual in Hindi for food handlers, short film for sensitization of food handlers on food safety titled 'Gravy Extra', and a documentary titled 'Food Safety from farm to Fork'. Chi square test, paired t test, and Wilcoxon sign rank test were used.

RESULTS

The mean age of food handlers was 35 ± 2 years. Majority (61.7%) of food handlers were educated less than 10th standard. Nearly 60% of them had up to five years of experience. At base line majority (68.9%) had a fair knowledge about food safety issues. There was a significant improvement in food safety knowledge and practice score of food handlers after the intervention (p < 0.05). Their attitude toward food safety changed in a positive direction (p < 0.05).

CONCLUSION

The intervention package was useful in improving the knowledge, creating a positive attitude and enhancing the food safety practices of food handlers working inside a tertiary care hospital.

Prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella and Salmonella among food handlers in Arba Minch University, South Ethiopia

BACKGROUND

The availability of safe food improves health of the people that contributes to productivity and provides an effective platform for development and poverty alleviation. On the other hand, unsafe food handling and processing can serve as a vehicle for the transmission of a variety of disease causing agents. The risk of food getting contaminated depends largely on the health status of the food handlers, their personal hygiene, knowledge and practice of food hygiene. Food borne diseases are therefore a public health problem in developed and developing countries which is also true for Ethiopia. Hence, the aim of this study was to determine prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella and Salmonella among food handlers in Arba Minch University, South Ethiopia.

METHODS

A cross sectional study was conducted among food handlers in Arba Minch University students' cafeteria from April- June, 2015. Structured questionnaire was used to collect socio demographic data and associated risk factors. Stool sample was collected and examined for pathogens following standard procedures. Biochemical tests were done to identify the species of pathogens and sensitivity test was done using Kirby- Baur disk diffusion technique.

RESULTS

A total of 376 food handlers were enrolled in the study with the response rate of 100% for data collected by questionnaire. About 7.4% were aged less than 20 years with majority (63.3%) lay in the working age group of 21-35 years. However, a total of 345 food handlers participated for stool examination of whom, stool cultures revealed 6.9% of Salmonella and 3% Shigella isolates. Finger nail status (AOR=0.033), hand washing practice after toilet (AOR= 0.006) and touching food with bare hands (AOR= p < 0.001) were independent predictors of infectious enteric diseases among the food handlers. All isolated pathogens were resistant to amoxicillin (100%), followed by clarithromycin (41%) and amoxicillin-clavulanic acid (35%).

CONCLUSION

The present study showed high prevalence of enteropathogens among the study participants. The study also revealed poor personal hygiene like poor practice of hand washing. Therefore, pre placement, in service training on personal and food hygiene should be provided to all food handlers with regular sanitary inspection to improve adherence of food handlers to personal hygiene and food safety practices.

coli

Contamination rate of Ethiopian paper currency notes handled by various food handlers with Escherichia coli and antimicrobial susceptibility of the isolates was assessed. A total of 384 Ethiopian Birr (ETB) notes were randomly sampled from meat handlers at butchers, bread and the related food handlers at cafeteria, fruit and vegetables handlers at supermarket, and milk sellers both at open market and dairy station. Fifty control new currencies were also sampled from Commercial Bank of Ethiopia. Both surfaces of the currency were swabbed using wet sterile cotton. The swab was overnight incubated in buffered peptone water. A loop full was streaked on eosin methylene blue agar and followed by biochemical test on presumptive E. coli colonies. Randomly selected isolates were exposed to chloramphenicol (C-30 µg), neomycin (N-30 µg), oxytetracycline (OT-30 µg), polymyxin-B (PB-300 IU) and trimethoprim-sulfamethoxazole (SXT-1.25/23.75/µg) susceptibility using disc diffusion techniques. E. coli was not isolated from currency used as control. A total of 288 (75 %) currency notes were found carrying E. coli. E. coli prevalence was ranges from 67.2 % at open market milk sellers to 87.2 % at dairy station milk sellers; from 64.8 % on ETB 100 to 82.9 % on ETB 1. Differences were not observed in E. coli prevalence on currency notes from among almost all food handlers (P > 0.05). Susceptibility of tested isolates to each chloramphenicol, oxytetracycline and trimethoprim-sulfamethoxazole was 100 %, and to polymyxin-B was 97.3 %. High resistance (83.7 %) was observed to neomycin. The finding indicates, contaminated food can be a source of E. coli for further contamination of currency which again transfer through various foods ready for consumption.

Bacterial assessment of food handlers in Sari City, Mazandaran Province, north of Iran

Food handlers with poor personal hygiene could be potential sources of infection due to pathogenic bacteria. This study was designed to determine the prevalence of bacterial infestation among the food handlers attending the public health center laboratory in Sari, northern Iran for annual check-up. This study was performed from September 2013 to August 2014. Stool samples, fingernail specimens of both hands and nasal swabs were collected from 220 male and female food handlers of different jobs, aged between 17-65 years. The samples were cultured on bacteriological culture media and bacterial species were identified following standard procedures. A structured questionnaire was used to record sociodemographic and behavioral data analysis of the food handlers. Of the total 220 subjects examined, 62.2% showed positive culture for different bacterial species from their fingernail contents, 65.4% were found to be harboring Staphylococcus aureus in their nostrils and 0.9% tested positive for Shigella boydii from stool samples. Staphylococcus aureus was the predominant bacteria isolated from fingernail specimens (46%), followed by Escherichia coli (29.2%), Coliforms (18.2%) and Pseudomonas aeruginosa (6.6%). This study showed a statistically significant difference in the rate of bacterial infestation between different occupational categories (p=0.04). Butchers showed the highest prevalence of bacteria (86.6%) in their fingernail contents, followed by fast food workers (76.5%), bakers (73.5%), chicken store workers (73%), school cafeterias staff (53.3%), restaurant workers (46.9%) and fruit/vegetables sellers (42.5%). The highest rate of nasal carrier for Staphylococcus aureus was observed among chicken store workers 14/17(20.8%). These findings indicate the need for intensive training/retraining and health education of all food service employees and strengthening the existing screening methods to control the problem of bacterial infestation in food handlers.

Carriage rate and methicillin resistance of Staphylococcus aureus in food handlers in Kars City, Turkey

The aim of this study was determine carriage rate and methicillin resistance of Staphylococcus aureus among food handlers. Samples were collected by swabbing the mouth, nasal cavity and hands of food workers. The isolation of S. aureus was performed using a culture method and verified by using a genetic method (PCR). The presence of mecA gene was analysed by PCR. The fourteen antimicrobial disks were also used to determine antimicrobial susceptibility of S. aureus. The 56 out of 282 isolates were identified as S. aureus. It is found that 10 workers out of 28 carried S. aureus in their nasal cavity while 4 and 3 workers out of 21 carriered S. aureus in mouth and hands respectively. None of the isolates carried mecA genes and also their antibacterial susceptibility test for methicillin resistance, using cefoxitin (30 µg), shown that all the isolates was susceptible to methicillin. In conclusion, the results of the present study indicated that the prevalence of antibiotic resistance of S. aureus strains isolated from food handlers was low. However carriage rate of S. aureus among food handlers was quite high.

Food handlers as potential sources of dissemination of virulent strains of Staphylococcus aureus in the community

Food handlers may constitute a reservoir of virulent strains of Staphylococcus aureus and may be vehicles of their transmission to food. One hundred and sixty-two volunteers were assessed for the presence of S. aureus on the hands and in the nose. S. aureus was isolated by routine procedures, and the isolates were tested for susceptibility against a panel of nine antimicrobial agents. The isolates were further characterized by SmaI-PFGE profiling and the presence of virulence factors.

RESULTS

The prevalence of S. aureus was 19.8% in the nose and 11.1% on the hands; 6.2% of the individuals carried S. aureus both in their noses and hands, and three individuals had the same strain (PFGE type) in the nose and on the hands. Although 82% of the isolates were resistant to at least one antibiotic, none demonstrated the presence of either mecA gene or resistance to oxacillin (none identified as MRSA). Sixty-eight percent of the isolates from the nose and hands possessed enterotoxin genes. This study revealed a high prevalence of antibiotic resistance and virulence determinants among the isolates, including not only classical and novel enterotoxin genes but also major virulence factors such as tst. Potential dissemination of these strains in the community is a matter of concern.

Hygiene Practices among Workers in Local Eateries of Orolu Community in South Western Nigeria

Background:

Activities of local food premises and monitoring of food handlers are usually not regulated.

Aim:

The objective of this study was to determine food hygiene (FH) practices among food handlers in rural communities in South Western Nigeria.

Subjects and Methods:

Descriptive cross-sectional study was carried out among 235 food handlers; data collection was by interviewer administered questionnaires. Using the SPSS software, multivariate analysis in two separate models was done to explore the predictors of correct knowledge and good hygiene practices. The model fit was assessed as good using the Hosmer and Lemeshow test.

Results:

Mean age of respondents was 31.8 (10.8) years. Of the respondents (134) that had training, 17.2% (23/134) had formal training, and 82.8% (111/134) had apprenticeship; about 31.5% (74/235) of respondents maintained a good level of hygiene in their practices. Significant predictors of correct knowledge were found to be being trained (significant 0.01, odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2–4.8) and receiving the training as an apprentice (significant 0.01, OR – referent group); or in a formal setting (significant 0.01, OR 3.3, 95% CI 1.6–7.0) and having no formal education (significant 0.04, OR – reference group).

Conclusion:

Good knowledge and attitude but low level of good practices toward FH characterized food handlers under study.

Bacterial contamination of the hands of food handlers as indicator of hand washing efficacy in some convenient food industries in South Africa

BACKGROUND AND OBJECTIVES

Hands of ready-to-eat food service employees have been shown to be vectors in the spread of foodborne disease, mainly because of poor personal hygiene and accounting for approximately 97% of food borne illnesses in food service establishments and homes. Our objective was to evaluate the efficacy of hand washing practices and sanitation before commencing work among food handlers in the convenient food industry in Gauteng, South Africa.

METHODS

A total of 230 samples were collected, involving 100% of the food handlers, in 8 selected convenient food outlets with their main focus on preparing ready-to-eat foods. The workers' cleaned and disinfected dominant hands were sampled for Total Plate Count (TPC), Staphylococcus aureus and Escherichia coli. Bacteria were isolated and counted using standard methods.

RESULTS

The highest bacterial count from the hand samples was 7.4 x 10(3) cfu.cm(-2) and the lowest showed no detectable growth. Although hands with a count of 0 cfu.cm(-2) were found in all of the plants, the results indicated that all the plants exceeded the legal limit for food surfaces or hands of < 100 cfu.cm(-2) when the average bacterial counts on hands were compared. Sixty percent of the TPC analysed exceeded the legal limit and only 18% of the food handlers had no bacteria detectable on their hands. One sample tested positive for E. coli and S. aureus could not be detected on the hands of any of the food handlers.

CONCLUSION

The study revealed that hand hygiene is unsatisfactory and may have serious implications for public health due to contamination of food from food handlers' hands. This therefore underlined the importance of further training to improve food handlers' knowledge of good hand washing practices.

Virus transfer proportions between gloved fingertips, soft berries, and lettuce, and associated health risks

Multiple outbreaks of human norovirus (hNoV) have been associated with fresh produce, such as soft berries and lettuce. Even though food handlers are considered an important source for the introduction of hNoV into food chains, their contribution to public health risks associated with hNoV remains unknown. To assess to which extent food handlers contribute to the introduction and spread of hNoV in fresh produce chains quantitative virus transfer data are needed. We estimated transfer proportions of hNoV GI.4, GII.4, murine norovirus (MNV-1), a culturable surrogate of hNoV, and human adenovirus (hAdV-2), a human pathogen proposed as an indicator for human faecal pollution, between gloved fingertips and raspberries, strawberries, and lettuce, by quantitative RT-PCR and cell culture if applicable. Virus transfer proportions were corrected for virus-matrix specific recoveries, and variability and uncertainty of the parameters were estimated. Virus transfer from gloves to soft berries was generally lower as compared to lettuce, with mean transfer proportions ranging between 0.1 to 2.3% and 9 to 10% for infectious MNV-1 and hAdV-2, respectively. Transfer from produce to glove was mostly greater than transfer from glove to produce, adding to the likelihood of virus transfer due to cross contamination from contaminated produce via food handlers. HNoV GI.4 and hNoV GII.4 showed no significant difference between their mean transfer proportions. Using the estimated transfer proportions, we studied the impact of low and high transfer proportions on the public health risk, based on a scenario in which a food handler picked raspberries with contaminated fingertips. Given the made assumptions, we could show that for a pathogen as infectious as hNoV, low transfer proportions may pose a greater public health risk than high transfer proportions, due to a greater viral spread. We demonstrated the potential of food handlers in spreading hNoV in food chains, showing that prevention of virus contamination on food handlers' hands is crucial for food safety. Nevertheless, complete prevention of virus contamination on fresh produce cannot be achieved in reality, and reliable and effective intervention measures are consequently required. We estimated that, especially for low transfer proportions, a robust one log10-unit reduction of infectious hNoV on contaminated produce, and on food handlers' hands, could lower the public health risk substantially. Using the obtained data in quantitative risk assessment will aid in elucidating the contribution of food handlers in hNoV transmission.

Microbiological and parasitological investigation among food handlers in hotels in the Dead Sea area, Jordan

BACKGROUND/PURPOSE

Intestinal parasitic and bacterial infections constitute a major health issue in developing countries. The present study investigates and assesses infection rates among food handlers with intestinal parasites and microbial agents in luxurious hotels in the Dead Sea area of Jordan.

METHODS

A total of 901 stool samples were collected from food handlers (35 females and 866 males) employed in four main hotels in the Dead Sea area. Fecal samples were examined microscopically for intestinal parasites. Standard culture and biochemical techniques were used for the isolation and identification of Salmonella and Shigella spp. in stool samples.

RESULTS

Five species of protozoan (Blastocystis hominis, Giardia intestinalis, Entamoeba coli, Entamoeba histolytica, and Endolimax nana), one helminth (Hymenolepis nana), and one cylindrical worm (Enterobius vermicularis) were recovered with an overall infection rate of 3.7%. G. intestinalis was the most prevalent parasitic infection with infection rate of 2.44%. All samples were negative for both Salmonella and Shigella.

CONCLUSION

Findings highlight the important role of food handlers in the transmission of intestinal parasites to high-class clients accommodated in luxury hotels, and stress the urgent need for regular health and parasitologic examination of food handlers.

The sanitary conditions of food service establishments and food safety knowledge and practices of food handlers in bahir dar town

BACKGROUND

Lack of basic infrastructure, poor knowledge of hygiene and practices in food service establishments can contribute to outbreaks of foodborne illnesses. The aims of this study were to investigate the food safety knowledge and practices of food handlers and to assess the sanitary conditions of food service establishments in Bahir Dar town.

METHODS

A cross-sectional study was conducted in Bahir Dar in May 2011 and data were collected using questionnaire and observation checklist on employees' knowledge of food hygiene and their practices as well on sanitary conditions of the food service establishments

RESULTS

The median age of the food handlers was 22 years and among the 455 subjects 99 (21.8%) have had food hygiene training. Sixty six percent of the establishments had flush toilets whereas 5.9% of the establishment had no toilet. Only 149 (33.6%) of the establishments had a proper solid waste collection receptacle and there was statistically significant association between the sanitary conditions and license status of the establishments (p=0.01). Most of all, knowledge gap in food hygiene and handling practice was observed. In addition, there was statistically significant difference between trained (professional) handlers and non-trained handlers with regard to food hygiene practices (p<0.05). While more than 50% of the handlers prepare meals ahead of the peak selling time, more than 50% of the left over was poorly managed.

CONCLUSION

This study revealed poor sanitary conditions and poor food hygiene practices of handlers. Educational programs targeted at improving the attitude of food handlers and licensing and regular inspections have been recommended.

Foodborne spread of hepatitis A: Recent studies on virus survival, transfer and inactivation

Hepatitis A virus (HAV) is responsible for considerable morbidity and economic losses worldwide, and is the only reportable, foodborne viral pathogen in Canada. Outbreaks caused by it occur more frequently in settings such as hospitals, daycare centres, schools, and in association with foods and food service establishments. In recent years, the incidence of hepatitis A has increased in Canada. Many factors, including changing lifestyles and demographics, faster and more frequent travel, and enhanced importation of foods from hepatitis A-endemic regions, may be behind this increase. Despite its increasing significance as a human pathogen, not much was known until recently about the survival and inactivation of HAV, and even less was understood about the effectiveness of measures to prevent and control its foodborne spread. Studies conducted in the past decade have shown that HAV can survive for several hours on human hands and for several days on environmental surfaces indoors. The virus can also retain its infectivity for several days on fruits and vegetables which are often consumed raw, and such imported items have already been incriminated in disease outbreaks. Casual contact between contaminated hands and clean food items can readily lead to a transfer of as much as 10% of the infectious virus. HAV is also relatively resistant to inactivation by heat, gamma irradiation and chemical germicides. In view of these findings, better approaches to prevent the contamination of foods with HAV and more effective methods for its inactivation in foods, on environmental surfaces and on the hands of food handlers are needed.

Food Poisoning Outbreak in a Military Establishment

BACKGROUND

An outbreak of food poisoning involving 121 persons of a military establishment was investigated.

METHODS

On investigation, a total of 94 persons became ill, with an attack rate of 77.7%. The symptoms included nausea, vomiting, abdominal pain, diarrhoea, weakness and fever. The mean incubation period was 2.3 hours while the median was 1.7 hours. Retrospective cohort study incriminated raita as the food item responsible for the outbreak, with a risk ratio of 21.35. Left over food was not available for laboratory analysis. There were no deaths and all affected persons recovered within 24 hours.

RESULT

Coagulase positive staphylococci were cultured from the vomitus and stool samples of cases. Nasal and fingernail swabs collected from food handlers also showed staphylococcal growth. The most likely cause of contamination of raita with the enterotoxin could be the staphylococci which had colonised the bodies of food handlers.

CONCLUSION

The aggravating factor was the storage of raita at room temperature before its consumption, which provided ideal conditions for enterotoxin formation.