Epidemiology of foodborne disease outbreaks from 2011 to 2016 in Shandong Province, China

Screening and early detection of communicable diseases on board cruise ships: An assessment of passengers' preferences on technical solutions

BACKGROUND

Implementing technological solutions to screen for and detect early the most prevalent communicable diseases on cruise ships is contingent on, among others, willingness of passengers to accept use of such solutions.

METHOD

We surveyed passenger preferences to record their willingness to accept technological solutions for screening and early detection of communicable diseases on cruise ships. Self-reported sociodemographic characteristics, use of technology and acceptance of solutions were recorded anonymously in paper format. Multiple logistic regression analyses investigated the association of demographic and other characteristics with willingness and barriers/concerns of passengers to endorse proposed solutions.

RESULTS

Of a total of 1344 passengers on two successive cruises on board CELESTYAL OLYMPIA, 336 (1 every 4) participated in the survey. The vast majority of passengers (92.3 %, n = 310) agreed with at least one solution. Passengers showed lower levels of acceptance for more personalized solutions, such as use of wearable devices (45.5 %) and monitoring with cameras (64.0 %), whereas they were more receptive to less personally invasive solutions, such as integration of cabins with air purifiers (89.6 %) and air quality sensors (80.4 %). Age, self-employment status, educational level, and fear of contacting a communicable disease were significantly correlated with passengers' willingness to adopt proposed solutions.

CONCLUSIONS

To successfully integrate screening and early detection technological solutions in cruise ships, it is imperative that targeted awareness and education interventions are implemented on passengers to strengthen understanding and acceptance of such solutions and assuage concerns around monitoring and handling of personal health data.

Attribution Analysis of Household Foodborne Disease Outbreaks in China, 2010-2020

Foodborne diseases have become a serious public health problem worldwide, and foodborne disease outbreaks have placed a heavy disease burden on China. Foodborne disease outbreaks occur most frequently among families in China. The objectives of this study were to analyze the cause of household foodborne disease outbreaks in China from 2010 to 2020 and to identify where preventive measures could be targeted. All data were obtained from the China Foodborne Disease Surveillance System Report. A total of 17,985 outbreaks, which resulted in 73,252 illnesses, 38,829 hospitalizations, and 1269 deaths, were reported in this period. Most household outbreaks of foodborne diseases occurred in May-October, and the highest number occurred in July (3620 outbreaks, 20%). The province with the highest number of outbreaks was Yunnan Province (4829 outbreaks), followed by Hunan Province (2264 outbreaks). The attribution analysis revealed that fungi (mainly poisonous mushrooms) were the most implicated food category, with 8873 (49.3%) cases. The second was poisonous plants and their products, with 1552 (8.6%) cases. Fungi were the primary etiologic agent, with 31,125 illnesses, accounting for 42.5% of the incidents. Inedibility and misuse (9423 outbreaks), unknown origin (2505 outbreaks), and improper processing (2365 outbreaks) were the main contributing factors causing outbreaks of foodborne diseases. The results show that southwest China was a high-risk area for household foodborne diseases. Therefore, public health institutions should strengthen supervision and food safety education of residents to reduce the outbreaks of household foodborne diseases.

Bacteria and poisonous plants/fungi were the primary causative hazards of foodborne disease outbreaks: A five-year survey from Guangzhou, Guangdong

The burden of foodborne diseases is of serious concern. More effective and localized intervention policies for outbreak prevention and management are required; however, policy modification is hampered due to a lack of information on the epidemiological characteristics of outbreaks in Guangzhou. We collected data from 182 foodborne disease outbreaks reported in Guangzhou, China from 2017 to 2021 to investigate the epidemiological characteristics and associated factors. Nine outbreaks were serious enough to be labelled as level IV public health emergencies, all of which were associated with canteens. In terms of the number of outbreaks, morbidity and clinical medical needs, bacteria and poisonous plants/fungi were the primary causative hazards of outbreaks, and were found mostly in foodservice establishments (96 %, 95/99) and private homes (86 %, 37/43) respectively. Surprisingly, Vibrio parahaemolyticus was primarily identified in meat and poultry products rather than in aquatic products in these outbreaks. Patient specimens and food samples were among the most common sources of detected pathogens in foodservice establishments and private homes. Cross-contamination (35 %), improper processing (32 %) and equipment/utensil contamination (30 %) were the top three risk factors for outbreaks related to foodservice establishments, while accidental ingestion of poisonous food (78 %) was the most common risk factor in private homes. Based on the above epidemiological characteristics of the outbreaks, key foodborne disease intervention policy points should be to raise public awareness of harmful food and avoid risk behaviour, improve handler hygiene training, and strengthen the hygiene management and supervision of kitchens, especially canteens in collective units.

Epidemiology and Economic Burden of an Outbreak of Cyclopeptide-Containing Mushroom Poisoning in the West of Iran

Little evidence is available on the epidemiological and economical dimensions of certain foodborne diseases such as wild mushroom poisoning. This study aimed to investigate the epidemiology and estimate the costs of poisoning with cyclopeptide-containing mushrooms in Kermanshah province in 2018. In this study, poisoning was investigated in different subgroups. The cost of illness method with a bottom-up approach was used to estimate the poisoning costs. Both direct and indirect costs of the poisoning were included in the analysis. The perspective of the study was society. Required data were obtained from the medical records of Imam Khomeini hospital and completed through a line survey with the patients. Two hundred eighty-three patients were poisoned in Kermanshah due to poisoning with cyclopeptide-containing mushrooms. Of 283 patients, 143 (50.53%) were men and 59.01% of patients were rural residents. About 43% of admissions were out-patient cases and ~40% of patients were hospitalized within 1-3 days. Also, eight patients were pronounced dead in the area. The total cost of poisoning with cyclopeptide-containing mushrooms in Kermanshah province was $ 1,259,349.26. Of that, $ 69,281.65 was related to direct medical costs and $ 10,727.23 was direct non-medical costs. The indirect costs of death were estimated to be $ 1,125,829.7. The current study revealed that there is a significant financial burden due to cyclopeptide-containing mushrooms on patients, the health system, and society as a whole. Further studies are recommended to clarify the epidemiological and economic burden of foodborne illnesses related to wild mushroom poisonings. Sharing the outputs with health authorities, and informing the general public are warranted to reduce the burden of such diseases.

Saudi Arabia Household Awareness and Knowledge of Food Safety

Food safety is a critical problem that impacts everyone worldwide. Many countries around the world are becoming increasingly reliant on the availability and safety of their food supply. Despite growing public consciousness about food-related dangers, the growth in food poisoning cases implies that individuals continue to make food consumption, food storage, and food preparation decisions that are less than optimal from a health and safety standpoint. The aim of this study was to assess Saudi Arabia's households' knowledge and practices of food safety. A cross-sectional study was conducted to assess knowledge of food safety and practices among a group of households in Saudi Arabia. An online questionnaire using social media (Facebook, Twitter, Instagram, and WhatsApp), and emails communications were distributed. A total of 309 adults (age range 18-59 years) participated in the study. In general, there were no differences between regions regarding the knowledge of food safety. Additionally, most of the participants had good practices of food safety. The findings of our study show that the gender, age, and educational level are factors that have an impact on the knowledge of food safety among respondents. Regarding food safety practices, in general, the results show that the participants had good practices. Therefore, organizations should focus on educational programs, training, holding workshops and activities in public places such as malls, schools, and home visit to improve and increases food safety knowledge and practices.

Lactate and blood ammonia on admission as biomarkers to predict the prognosis of patients with acute mushroom poisoning and liver failure: a retrospective study

The diagnosis of liver damage induced by mushroom poisoning is still challenging. This study aims to screen the early biological indexes that could predict acute mushroom poisoning with liver damage. The patients with acute mushroom poisoning and liver damage admitted to The First Affiliated Hospital of Dalian Medical University，China from July 2007 to August 2017 were analyzed retrospectively. A total of 66 patients were enrolled in this study, with 44 and 22 patients in the liver injury group and liver failure group, respectively. Ten patients in the liver failure group died, with a mortality of 45.5% in this group. Multivariable Cox regression showed that the blood ammonia (NH3) and lactic acid (Lac) at the time of admission were independently associated with the in-hospital time to death for patients with liver failure induced by mushroom poisoning. Lactate and blood ammonia at the time of admission could be used to predict the prognosis of patients with acute mushroom poisoning and liver failure.

High-Efficiency Machine Learning Method for Identifying Foodborne Disease Outbreaks and Confounding Factors

The China National Center for Food Safety Risk Assessment (CFSA) uses the Foodborne Disease Monitoring and Reporting System (FDMRS) to monitor outbreaks of foodborne diseases across the country. However, there are problems of underreporting or erroneous reporting in FDMRS, which significantly increase the cost of related epidemic investigations. To solve this problem, we designed a model to identify suspected outbreaks from the data generated by the FDMRS of CFSA. In this study, machine learning models were used to fit the data. The recall rate and F1-score were used as evaluation metrics to compare the classification performance of each model. Feature importance and pathogenic factors were identified and analyzed using tree-based and gradient boosting models. Three real foodborne disease outbreaks were then used to evaluate the best performing model. Furthermore, the SHapley Additive exPlanation value was used to identify the effect of features. Among all machine learning classification models, the eXtreme Gradient Boosting (XGBoost) model achieved the best performance, with the highest recall rate and F1-score of 0.9699 and 0.9582, respectively. In terms of model validation, the model provides a correct judgment of real outbreaks. In the feature importance analysis with the XGBoost model, the health status of the other people with the same exposure has the highest weight, reaching 0.65. The machine learning model built in this study exhibits high accuracy in recognizing foodborne disease outbreaks, thus reducing the manual burden for medical staff. The model helped us identify the confounding factors of foodborne disease outbreaks. Attention should be paid not only to the health status of those with the same exposure but also to the similarity of the cases in time and space.

Incidence of Multidrug-Resistant Escherichia coli Harbouring blaTEM and tetA Genes Isolated from Seafoods in Lagos Nigeria

The presence of multidrug-resistant Escherichia coli of fecal origin in seafood is a serious concern. Seafood containing MDR E. coli can serve as a medium for the transfer of resistant bacteria to consumers. The aim of the present study is to isolate and identify multidrug-resistant E. coli and associated resistant genes from selected seafood (catfish, crabs and tilapia fish) purchased from wholesalers and retailers at sea landing areas in Lagos state, Nigeria. A total of two hundred and thirty-eight (238) samples consisting of catfish (52), tilapia fish (78) and crab (108) were collected and investigated for the presence of E. coli from the period of June 2018-April 2019. Colonies that showed metallic sheen were considered presumptive E. coli isolates, and positive isolates were chosen for further confirmed by biochemical methods using IMViC tests, Oxidase test, triple sugar iron agar test and sugar fermentation test. Antimicrobial susceptibility of the isolates to eight classes of antibiotics was determined by disc diffusion methods while amplification of suspected antibiotic resistance genes were done by the polymerase chain reaction (PCR) using specific primers. A total of 105 (44.1%) E. coli were isolated from selected samples by standard microbiological procedures. The grand total of 59 (56.2%) isolates showed multiple antibiotic-resistant patterns. The overall result showed high-level resistance to tetracycline 101/105 (96.1%) and trimethoprim 90/105 (85.7%), cefotaxime 67/105 (42.9%) while the highest susceptibility of 101/105 (96.2%) was recorded for amikacin followed by gentamicin 84/105 (80%), meropenem 75/105 (71.4%), ceftazidime (69.5). The presence of tetA and blaTEM was prevalent among the isolates. Our results indicate that seafood may be a reservoir of β-lactam and tetracycline-resistance determinants.

Food Safety Knowledge and Hygienic Practices among Different Groups of Restaurants in Muscat, Oman

Food safety is vital to human beings as well as to the food industry. Therefore, knowledge and hygiene practice of food safety among food handlers are particularly important. Evaluation of food safety knowledge and hygienic practices among 18 restaurants in three different regions (i.e., districts) in the Governorate of Muscat was performed. In order to determine the quality level of restaurants, grouping (i.e., Region 1, Region 2, and Region 3; e.g., Group I, Group II, and Group III) was adopted from the regulations and assigned by the municipality based on the number of complaints against the restaurants. A questionnaire was designed to assess the knowledge of hygiene, food poisoning, food handling, cooking, and local regulations/rules of the food handlers in selected restaurants. The food handlers in the Region 1 restaurants showed significantly higher (p < 0.05) overall knowledge (58.6%) in food safety as compared to Region 2 (52.1%) and Region 3 (53.2%). Overall knowledge of food handlers in Group I restaurants was significantly higher (p < 0.05) (64.4%) as compared to Group II (53.1%) and Group III (48.1%). The hygiene practices in Group I restaurants were significantly higher (p < 0.05) than those in Groups II and III. A small but significant inverse association (r ² = -0.38) between total knowledge scores and hygiene practices was found. In conclusion, higher knowledge in the field is associated with better hygiene practices, and these are more likely to prevent food poisoning originating from restaurants. We recommend implementing specialized education courses and workshops for the food handlers as a requirement before embarking on service to decrease the risks of foodborne diseases.

Assessment and molecular characterization of Bacillus cereus isolated from edible fungi in China

Background

Bacillus cereus is a foodborne pathogen commonly found in nature and food and can cause food spoilage and health issues. Although the prevalence of B. cereus in foods has been reported worldwide, the extent of contamination in edible fungi, which has become increasingly popular as traditional or functional food, is largely unknown. Here we investigated the prevalence, toxin genes’ distribution, antibiotic resistance, and genetic diversity of B. cereus isolated from edible fungi in China.

Results

Six hundred and ninety-nine edible fungi samples were collected across China, with 198 (28.3%) samples found to be contaminated by B. cereus, with an average contamination level of 55.4 most probable number (MPN)/g. Two hundred and forty-seven B. cereus strains were isolated from the contaminated samples. Seven enterotoxin genes and one cereulide synthetase gene were detected. The detection frequencies of all enterotoxin genes were ≥ 80%, whereas the positive rate of the cesB gene in B. cereus was 3%. Most isolates were resistant to penicillins, β-lactam/β-lactamase inhibitor combinations, cephems, and ansamycins, but were susceptible to penems, aminoglycosides, macrolides, ketolide, glycopeptides, quinolones, phenylpropanol, tetracyclines, lincosamides, streptogramins, and nitrofurans. Meanwhile, 99.6% of all isolates displayed multiple antimicrobial resistance to three or more classes of antimicrobials. Using genetic diversity analysis, all isolates were defined in 171 sequence types (STs), of which 83 isolates were assigned to 78 new STs.

Conclusions

This study provides large-scale insight into the prevalence and potential risk of B. cereus in edible fungi in China. Approximately one-third of the samples were contaminated with B. cereus, and almost all isolates showed multiple antimicrobial resistance. Detection frequencies of all seven enterotoxin genes were equal to or more than 80%. These new findings may indicate a need for proper pre-/post-processing of edible fungi to eliminate B. cereus, thereby preventing the potential risk to public health.

Epidemiological study of sausage in Algeria: Prevalence, quality assessment, and antibiotic resistance of Staphylococcus aureus isolates and the risk factors associated with consumer habits affecting foodborne poisoning

Aim:

The first aim was to assess the quality and determine the prevalence and antibiotic susceptibility of Staphylococcus aureus contamination of raw sausage sold in ten municipalities in the Northeast of Algeria. Second, a consumer sausage purchasing survey was designed to investigate potential risk factors that have a significant association with the occurrence of foodborne poisoning among sausage consumers’ behavior and its relationship with independent variables.

Materials and Methods:

A total of 230 butcheries from ten departments (Daira) of Algiers with more than 40 municipalities were included randomly in these studies to collect raw sausage samples and to distribute 700 structured questionnaires to meat consumers. Our two studies were conducted at the same time, between June 2016 and April 2018. Sausage samples were taken once per butchery to estimate the prevalence of S. aureus contamination and therefore deduct the quality assessment of raw sausage (Merguez) sold in Algiers, Algeria. All isolated strains were tested for their antimicrobial resistance. Furthermore, questionnaires were distributed and used to collect information on various aspects of sausage consumption and foodborne disease. The data collected were analyzed with different statistical approaches, such as the Chi-square test and the odds ratio (OR) univariable logistic model. All the risk factors were analyzed by studying their association with the occurrence of consumers who claimed to have food poisoning after consuming sausage.

Results:

The overall prevalence of S. aureus contamination from sausages was 25.22% (n=58/230). Over 83.33% of strains showed resistance to at least one of the antibiotics tested. The most important was for tetracycline (58%) followed by fosfomycin (33%), penicillin G (25%), and oxacillin (36%). Moreover, the multiple antibiotic resistance (MAR) index include 20 profiles with MAR >0.2. Out of the 440 meat consumers, 22.16% revealed having food poisoning after sausage consumption. The risk factors recorded were: Consumption outside of home (24.30%, OR=1.769, p=0.040), during the summer season (24.30%, OR=1.159) and during lunch (26.50%, OR=1.421).

Conclusion:

Our study highlights a high prevalence of S. aureus contamination in Merguez, especially in some departments of Algiers, and the high multidrug resistance of S. aureus isolates against tetracycline and oxacillin; thus, S. aureus contamination in sausage is considered a potential risk to public health. Therefore, to reduce and prevent the spread of resistant strains, robust management and monitoring of antibiotic use should be established. Therefore, it is necessary to improve the sanitation conditions and education regarding personal hygiene and change certain consumption habits of Algerian consumers to ensure food safety. Finally, it can be concluded that the application of the HACCP system is essential either in butcheries producing sausage and/or slaughterhouses. From this perspective, studies might be performed to characterize Staphylococcus spp and S. aureus to investigate their virulence factors.