A surveillance of food borne disease outbreaks in India: 2009–2018

Understanding the dynamics of malnutrition dichotomy in India: Trends and insights from the National Family Health Surveys

Purpose

India is confronted with a multifaceted malnutrition landscape, characterized by the coexistence of stunting, underweight, and escalating overweight and obesity rates. Current programs predominantly target undernutrition, overlooking the surging prevalence of overweight and obesity. These trends carry substantial economic ramifications, with obesity-related costs expected to rise significantly. Addressing these challenges requires enhanced policy execution and strategic collaboration. This article seeks to help overcome policy inertia in addressing the other end of the malnutrition spectrum-overnutrition.

Methods

The National Family Health Survey (NFHS), a large-scale survey conducted by the Ministry of Health and Family Welfare, Government of India, provides high-quality data on population dynamics and health indicators. Data for relevant health indicators were extracted from NFHS-3 to NFHS-5 to identify trends and shifting paradigms in malnutrition profiles. Data from the latest NFHS (NFHS-5) were briefly analyzed to highlight the malnutrition dichotomy and perform linear regression analysis.

Results

The data revealed a declining trend in stunting and underweight prevalence alongside a rise in overweight prevalence. Linear regression analyses on NFHS-5 data showed a positive association between literacy and obesity in both men and women. The findings also indicated that children fed with minimum dietary diversity were more likely to be overweight, and revealed a significant association between elevated random blood glucose levels and obesity in women.

Conclusions

By implementing the necessary interventions and strategies, India can establish a holistic approach to addressing both undernutrition and overnutrition effectively, thus contributing to Sustainable Development Goal-2 and paving the way for a healthier and more productive future for India's population.

Fostering Food Safety Culture in Restaurants in the United Arab Emirates (UAE): Leadership Impact on Food Handlers' Commitment and Compliance

The frequency of foodborne illnesses remains high in most countries and is influenced, among other factors, by the hygienic practices of food handlers. It is now widely recognized that food handlers' behaviours are often determined by the food safety culture of the businesses in which they work. Proposed models of food safety culture consistently identify food safety leadership as a factor integral to success. Leadership styles vary and can influence the level of commitment to food safety shown by both the business and its employees and particularly by food handlers. To improve food safety performance, this study was designed to: i) evaluate the level of commitment among food handlers within restaurant environments in Dubai / United Arab Emirates (UAE) and ii) to investigate the impact of two leadership styles on the food handlers' commitment to food hygiene behaviour using structural equation modelling (SEM). A cross-sectional study was undertaken using a validated questionnaire to collect data from 712 food handlers in 70 restaurants, which was analysed. Food handlers expressed a high commitment to food safety (75.3%), and a desire to implement good hygiene behaviors (80.8%). After applying SEM and factor analyses, food handlers' responses showed that they had a very positive perception of transformational leadership styles (80.3%) and to a slightly lesser extent transactional style (70%). These perceptions of leadership behaviors positively influenced their commitment to food safety and acceptable hygiene practices (p < 0.05). These findings will assist food services management in developing a leadership style capable of generating a positive food safety culture firmly based on employee commitment to continuously improve food hygiene behaviors and compliance.

Surveillance of Food and Waterborne Pathogens in North-East India: Protocol for a Laboratory-Based Sentinel Surveillance Study

BACKGROUND

Food safety is a global concern, which is often underestimated owing to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, and shifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented foods pose significant health risks. Despite these challenges, systematic data on foodborne pathogens is lacking in India, highlighting a crucial gap in understanding food safety issues.

OBJECTIVE

The aim of this research protocol is to establish an integrated surveillance system to identify enteric pathogens circulating within humans, food animals, and the environment through a health approach in North-East India, and to conduct outbreak investigations.

METHODS

The Indian Council of Medical Research (ICMR) initiated a surveillance study across all 8 North-East states in India, employing a centralized digital database for data collation. The project aims to enhance the infrastructure for microbial culture, antibiotic sensitivity testing, and molecular epidemiological studies. The study involves laboratory-based surveillance of foodborne pathogens in market foods, hospitalized diarrheal patients, poultry and animal farms, slaughterhouses, butcher shops, and diarrheal outbreaks. A standardized case report form ensures consistent data collection of age, sex, signs, symptoms, and admission dates for diarrheal cases. Stool and rectal swabs will undergo testing for pathogen identification and antimicrobial resistance. Similarly, samples of market foods, food animals, and the environment will be collected. Outbreaks confirmed by the Integrated Disease Surveillance Project (IDSP) will be thoroughly investigated following standardized guidelines.

RESULTS

In phase I, 5 surveillance centers were established across 4 states (ie, Assam [Dibrugarh and Guwahati], Tripura, Sikkim, and Arunachal Pradesh) in 2020. Following an interim phase I data assessment and the successful establishment of a streamlined system for data procurement, investigation, recording, and analysis, along with the implementation of regular training and monitoring programs, phase II expansion was initiated in 2023-24. This includes the addition of 7 more centers (including 3 veterinary centers) in the remaining 4 states (ie, Manipur, Meghalaya, Mizoram, and Nagaland), eventually covering the entire North-Eastern Region of India.

CONCLUSIONS

Food and waterborne diseases are a constant public health problem in many countries. Key challenges to the enhancement of food safety policy include the paucity of systematic data and awareness. With this background, ICMR's initiative is the first systematic surveillance study in the country to adopt a single health approach. Data obtained from this project will help to understand the risk of acquiring food and waterborne pathogens, their transmission pathways, and antimicrobial resistance patterns. The scientific evidence generated through this project will be helpful in formulating and strengthening food safety policy and in initiating government programs to protect the health of the nation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56469.

Combating foodborne disease through household food handling behavior improvement: A comparison between education and price interventions

Foodborne disease cases are increasingly occurring in home kitchens because of improper food handling behavior. Human factors are considered major determinants of such behavior, although economic factors, which have attracted little attention, may also be important influencers. Taking the service time of kitchen towels as an example, we construct a theoretical model to analyze food handling behavior under an economic framework and empirically explore its economic determinants. Empirically, we use a randomized controlled trial (RCT) coupled with pre- and postsurveys in rural China. The RCT intervention includes information with tips for proper kitchen towel use and in-kind subsidies of one, two, or three packs of kitchen towels, which is regarded as a price intervention. We find that information alone and information plus one pack of towels are not enough to stimulate behavior improvement, whereas information plus two or three packs is sufficient. This implies that the quantity of kitchen towels used increases only as the towel price drops below a certain threshold. As an early attempt, we indicate that food handling behavior is economically driven, suggesting that a well-designed policy should combine educational campaigns and appropriate economic incentives to improve such behavior to reduce the risk of foodborne disease.

Comprehending the risk of foodborne and waterborne disease outbreaks: Current situation and control measures with Special reference to the Indian Scenario

Background

Foodborne and waterborne diseases and outbreaks are a neglected public health issue worldwide. In developing countries, diarrheal disease caused by foodborne and waterborne infections is a major cause of ill health. There is a lack of information on foodborne pathogens, their transmission routes, outbreaks, and related mortalities, due to the absence of a robust disease surveillance system and adequately equipped laboratories. Although hygiene practices are much better in Western countries, the widespread use of preserved and raw food items is a cause of concern. Consequently, the occurrence of foodborne diseases is not rare in these countries either. WHO has recently released the 'Global Strategy for Food Safety 2022-2030', addressing the emerging challenges, new technologies, and innovative approaches to strengthen food safety systems and enhance laboratory capacity for foodborne disease surveillance. Foodborne outbreaks are a huge challenge in India. Malnutrition, anemia, hookworm and enteric infections, are the predominant cryptic health conditions among children in rural and tribal areas, leading to severe consequences, including death, and posing a substantial threat to public health. Combating such events with adequate food safety and hygiene practices is achievable. Systematic collection of data can help to develop food safety policies that could reduce the burden of foodborne diseases.

Objective

This review aims to examine the current situation of foodborne and waterborne diseases, identification of the factors contributing to their occurrence and outbreaks, and defining the gaps in control measures, challenges, and potential solutions in improving the public health system.

Methods

Strengths, weaknesses, opportunities, and threats (SWOT) analysis was made based on the literature review of foodborne and waterborne infections to assess the current situation and to identify knowledge gaps.

Finding

SWOT analysis showed the strength and gaps in the different national initiatives analogous to the global programs. Though, Integrated Disease Surveillance Programme (IDSP), Food Safety and Standards Authority of India (FSSAI), the core Government missions, independently generate substantial information, sporadic and outbreak cases of diarrhea still prevail in the country due to the absence of a systematic national surveillance system. Recently, many government initiatives have been made through Sustainable Development Goals (SDGs), G20 goals, etc. However, potential threats such as risk of zoonotic disease transmission to humans, emerging infections and antimicrobial resistance (AMR), and unauthorized activities in the food sector pose a big challenge in safeguarding the public health.

Conclusion

Maintenance of global food safety requires a systematic analysis of present situations, identification of existing shortcomings, and targeted efforts toward prevention of infections. The ongoing G20 mission and the SDGs for 2030 represent significant strides in this direction. To have pathogen-free animals and supply of contamination-free raw foods is impractical, but, mitigating the prevalence of zoonotic diseases can be accomplished by rigorously enforcing hygiene standards throughout the food production chain. A crucial requirement at present is the implementation of integrated laboratory surveillance for foodborne and waterborne infections, as this will provide policymakers and stakeholders all the evidence based scientific information. This system will facilitate efforts in minimizing the risks associated with foodborne and waterborne infections.

Enterocin LD3 from Enterococcus hirae LD3 Inhibits the Growth of Salmonella enterica subsp. enterica serovar Typhimurium ATCC 13311 in Fruit Juice

In order to prevent the growth of pathogens in food, bacteriocins produced by various probiotic lactic acid bacteria have been recognized as potential substitutes of chemical preservatives. In this study, enterocin LD3 was purified from the cell-free supernatant of a food isolate, Enterococcus hirae LD3 using multistep chromatography. In the fruit juice, lethal concentration (LC50) of enterocin LD3 was found to be 260 µg/mL against Salmonella enterica subsp. enterica serovar Typhimurium ATCC 13311. The cells treated with enterocin LD3 were red colour indicating dead cells after propidium iodide staining, while untreated cells were found blue after staining with 4', 6-diamidino-2-phenylindole. The mechanism of cell killing was analyzed using infrared spectrum of cells treated with enterocin LD3 which was found altered in the range of 1,094.30 and 1,451.82 cm-1 corresponding to nucleic acids and phospholipids, respectively. The morphology of target cells were severely ruptured and lysed as observed under electron microscopy. Thus, the present study suggested that enterocin LD3 showed bactericidal activity against Salm. enterica subsp. enterica serovar Typhimurium ATCC 13311 and may be applied as a bio-preservative for the safety of fruit juices.

Microbiological assessment of ready-to-eat foods and drinking water sources as a potential vehicle of bacterial pathogens in northern India

Foodborne illnesses caused by the consumption of contaminated foods have frequent occurrences in developing countries. The incorporation of contaminated water in food processes, preparation, and serving is directly linked to several gastrointestinal infections. Keeping in view, this study was conducted to assess the microbial quality of both drinking water sources and commonly consumed fresh ready-to-eat (RTE) foods in the region. The drinking water samples from water sources and consumer points, as well as food samples from canteens, cafes, hotels, and restaurants, were collected for the microbiological analysis. Fifty-five percent (n = 286) of water samples were found to be positive for total coliforms with MPN counts ranging from 3 to 2600 (100 ml) -1. E. coli was detected in nearly 30% of the total water samples. Overall, 65% tap water samples were found unsatisfactory, followed by submersible (53%), filter (40%), and WTP (30%) sources. Furthermore, the examination of RTE foods (n = 80) found that 60% were of unsatisfactory microbial quality with high aerobic plate counts. The salads were the most contaminated category with highest mean APC 8.3 log CFU/g followed by pani puri, chats, and chutneys. Presence of coliforms and common enteropathogens was observed in both water and food samples. The detected isolates from the samples were identified as Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Salmonella spp., Shigella spp., and Staphylococcus spp. Based on these findings, microbiological quality was found compromised and this may pose hazard to public health. This exploratory study in the Punjab region also suggests that poor microbiological quality of water sources can be an important source of contamination for fresh uncooked RTE foods, thus transferring pathogens to the food chain. Therefore, only safe potable drinking water post-treatment should be used at all stages.

Foodborne Outbreak by Salmonella enterica Serovar Weltevreden in West Bengal, India

Foodborne gastroenteritis outbreaks owing to Salmonella enterica serovar Weltevreden (Salmonella Weltevreden) represent a significant global public health problem. In the past two decades, Salmonella Weltevreden has emerged as a dominant foodborne pathogen, especially in South-East Asian countries. This report describes a community foodborne outbreak of gastroenteritis caused by Salmonella Weltevreden in August 2022 following consumption of panipuri from a street vendor in the Polba block in Hooghly district, West Bengal, India. This food item was consumed by 185 people, of whom 129 had acute watery diarrhea with other clinical symptoms and 65 of them were admitted to different District hospitals for treatment. Stool specimens collected from hospitalized cases were positive for S. enterica, and further serotyped as Salmonella Weltevreden. All the Salmonella Weltevreden strains possessed the Salmonella pathogenicity islands associated genes (invA/E, orgA, ttrc, ssaQ, mgtC, misL, spi4D), the enterotoxin (stn), and hyperinvasive locus gene (hilA). Except erythromycin, all the strains were susceptible for commonly used antimicrobials in the treatment of diarrhea. The XbaI-based pulsed-field gel electrophoresis analysis indicated that all the isolates responsible for the recent outbreak were similar, but diverged from other Salmonella Weltevreden that were previously reported in West Bengal. This report indicates that foodborne infection is a major public health concern in India and demands to strengthen capacity-building measures at the local health care levels for linking causative agents of outbreaks.

Advanced diagnostic methods for identification of bacterial foodborne pathogens: contemporary and upcoming challenges

It is a public health imperative to have safe food and water across the population. Foodborne infections are one of the primary causes of sickness and mortality in both developed and developing countries. An estimated 100 million foodborne diseases and 120 000 foodborne illness-related fatalities occur each year in India. Several factors affect foodborne illness, such as improper farming methods, poor sanitary and hygienic conditions at all levels of the food supply chain, the lack of preventative measures in the food processing industry, the misuse of food additives, as well as improper storage and handling. In addition, chemical and microbiological combinations also play a key role in disease development. But recent disease outbreaks indicated that microbial pathogens played a major role in the development of foodborne diseases. Therefore, prompt, rapid, and accurate detection of high-risk food pathogens is extremely vital to warrant the safety of the food items. Conventional approaches for identifying foodborne pathogens are labor-intensive and cumbersome. As a result, a range of technologies for the rapid detection of foodborne bacterial pathogens have been developed. Presently, many methods are available for the instantaneous detection, identification, and monitoring of foodborne pathogens, such as nucleic acid-based methods, biosensor-based methods, and immunological-based methods. The goal of this review is to provide a complete evaluation of several existing and emerging strategies for detecting food-borne pathogens. Furthermore, this review outlines innovative methodologies and their uses in food testing, along with their existing limits and future possibilities in the detection of live pathogens in food.

Climate Change and Aging Health in Developing Countries

The climate of the Earth has changed throughout history. Climate change negatively impacts human rights in a wide range of ways. The study aims to find out the impact of climate change on aging health in developing countries. The study found that public health will be devastated if climate change continues unabated. Countries that are least responsible for global warming are most susceptible to the effects of higher temperatures, such as death and disease. In low- and middle-income countries, disasters are more likely to happen to people aged 60 and over. Although climate change affects all of us, older people are especially at risk from it, as evidenced by a growing body of research. The study also offers countermeasures and suggestions to develop aging health in developing countries affected by climate change.

A Novel Foodborne Illness Detection and Web Application Tool Based on Social Media

Foodborne diseases and outbreaks are significant threats to public health, resulting in millions of illnesses and deaths worldwide each year. Traditional foodborne disease surveillance systems rely on data from healthcare facilities, laboratories, and government agencies to monitor and control outbreaks. Recently, there is a growing recognition of the potential value of incorporating social media data into surveillance systems. This paper explores the use of social media data as an alternative surveillance tool for foodborne diseases by collecting large-scale Twitter data, building food safety data storage models, and developing a novel frontend foodborne illness surveillance system. Descriptive and predictive analyses of the collected data were conducted in comparison with ground truth data reported by the U.S. Centers for Disease Control and Prevention (CDC). The results indicate that the most implicated food categories and the distributions from both Twitter and the CDC were similar. The system developed with Twitter data could complement traditional foodborne disease surveillance systems by providing near-real-time information on foodborne illnesses, implicated foods, symptoms, locations, and other information critical for detecting a potential foodborne outbreak.

Food Safety Issues Related to Eating In and Eating Out

Because of growing urbanization and lack of time to prepare meals at home, eating out or getting food delivered have become common trends for many people. The consumption of food from unknown sources may impose an increased chance of contamination with microbiological hazards, especially if sanitary conditions are not met. We evaluated data from health surveillance agencies and scientific articles on foodborne diseases (FBD) reported internationally according to the exposure sites. We observed that the data are influenced by cultural, political, and socioeconomic differences. For instance, in New Zealand, Australia, United States, Denmark and India, the occurrence of FBD outbreaks was greater from foods prepared in commercial establishments and street vendors than from households. Conversely, in China, countries of the European Union and Brazil, the results are the opposite. Additionally, the pandemic imposed new eating behavior patterns, increasing delivery services and foods prepared in so-called "Dark Kitchens". The underreporting and heterogeneity of data among countries prevented a precise conclusion to the question of whether homemade foods are inherently safer than foods prepared out. Nevertheless, a lower level of development in a country influences its sanitation conditions, as well as the number of street food vendors, the search for cheaper foods, and insufficient knowledge of the population on good hygiene practices, which can all increase the chances of FBD cases.

Application of Electrolyzed Water in the Food Industry: A Review

Electrolyzed water is a novel disinfectant and cleaner that has been widely utilized in the food sector for several years to ensure that surfaces are sterilized, and that food is safe. It is produced by the electrolysis of a dilute salt solution, and the reaction products include sodium hydroxide (NaOH) and hypochlorous acid. In comparison to conventional cleaning agents, electrolyzed water is economical and eco-friendly, easy to use, and strongly effective. Electrolyzed water is also used in its acidic form, but it is non-corrosive to the human epithelium and other organic matter. The electrolyzed water can be utilized in a diverse range of foods; thus, it is an appropriate choice for synergistic microbial control in the food industry to ensure food safety and quality without damaging the organoleptic parameters of the food. The present review article highlights the latest information on the factors responsible for food spoilage and the antimicrobial potential of electrolyzed water in fresh or processed plant and animal products.