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FNH 413 > Quiz 1 Content > Flashcards

Quiz 1 Content Flashcards

1
Q

How many Canadians get sick due to domestically acquired foodborne diseases each year?

A

The Public Health Agency of Canada (PHAC) estimates that each year roughly one in eight Canadians (or four million people) get sick due to domestically acquired foodborne diseases.
– 30 known pathogens
– Unspecified agents

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2
Q

Known pathogens are responsible for 40% of all domestically acquired foodborne disease each year in Canada.

True or False?

A

True.

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3
Q

Known pathogens are responsible for 60% of all domestically acquired foodborne disease each year in Canada.

True or False?

A

False.

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4
Q

What are the top four pathogens responsible for domestically acquired foodborne illnesses in Canada?

A
  1. Norovirus
  2. Clostridium perfringens
  3. Campylobacter spp.
  4. Salmonella, nontyphoidal
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5
Q

How many Americans get sick from domestically acquired foodborne diseases each year?

A

The Centers for Disease Control and Prevention (CDC) estimates that each year roughly 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.
– 31 known pathogens (Mycobacterium bovis)
– Unspecified agents

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6
Q

What are the top five pathogens responsible for domestically acquired foodborne illnesses in the U.S.?

A
  1. Norovirus
  2. Salmonella, nontyphoidal
  3. Clostridium perfringens
  4. Campylobacter spp.
  5. Staphylococcus aureus
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7
Q

What are the top five pathogens contributing to domestically acquired foodborne illnesses resulting in hospitalization in the U.S.?

A
  1. Salmonella, nontyphoidal
  2. Norovirus
  3. Campylobacter spp.
  4. Toxoplasma gondii
  5. E. coli (STEC) O157

Notice that there is no S. aureus or C. perfringens here.

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8
Q

What are the top five pathogens contributing to domestically acquired foodborne illnesses resulting in death in the U.S.?

A
  1. Salmonella, nontyphoidal
  2. Toxoplasma gondii
  3. Listeria monocytogenes
  4. Norovirus
  5. Camplyobacter spp.

Notice that L. monocytogenes only appears on this list and not the previous ones. Fewer people are falling ill with listeriosis, but those that do face a high chance of death.

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9
Q

Compare the top 5 pathogens contributing to domestically acquired foodborne illnesses, domestically acquired foodborne illnesses resulting in hospitalization, and domestically acquired foodborne illnesses resulting in death in the U.S.

A
  • Observe the incidence and severity of Salmonella, nontyphoidal.
  • Norovirus, Toxoplasma gondii, and Campylobacter spp. may result in death
  • C. perfringens and S. aureus get many people sick, but not very sick
  • Listeria monocytogenes kills
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10
Q

In the WHO Report, how was the disease burden estimated?

A

Disability Adjusted Life Years (DALYs) was used as a parameter

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11
Q

How many foodborne hazards and diseases were included in the WHO global estimates?

A

Thirty-one foodborne hazards causing 32 diseases were included:

  • 11 diarrhoeal disease agents (1 virus, 7 bacteria, 3 protozoa)
  • 7 invasive infectious disease agents (1 virus, 5 bacteria, 1 protozoon)
  • 10 helminths
  • 3 chemicals
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12
Q

According to the WHO Report, what were the most frequent causes of foodborne illness?

A

Diarrhoeal disease agents
(particularly norovirus and Campylobacter spp.

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13
Q

According to the WHO report, what was the leading foodborne diarrhoeal disease agent in causing death?

A

non-typhoidal Salmonella

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14
Q

According to the WHO report, what was the global burden of foodborne disease in 2010?

A

33 million DALYs; 40% among children under 5

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15
Q

How many DALYs were attributed to diarrhoeal disease agents in 2010 according to the WHO report?

A

18 million DALYs, particularly due to enteropathogenic Escherichia coli (EPEC) and nontyphoidal Salmonella

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16
Q

Where was the highest burden (of foodborne disease) per population observed? [3]

A

(1) Africa, followed by (2) South-East Asia, and the (3) Eastern Mediterranean

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17
Q

Who bears the burden of foodborne diseases?

A

Individuals of all ages, but particularly children under 5 years of age, and by persons living in low-income subregions of the world.

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18
Q

What was the major hurdle in estimating the foodborne disease burden?

A

Data gaps

The global and regional estimates provided by FERG offer an interim solution, until improved surveillance and laboratory capacity is developed.

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19
Q

Which disease agents were the leading cause of foodborne disease in most subregions?

A

Diarrhoeal disease agents

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20
Q

Which was an important diarrhoeal foodborne disease agent in all subregions, particularly Africa?

A

nontyphoidal Salmonella

Other main diarrhoeal agents include EPEC and ETEC.

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21
Q

What is a main dairrhoeal cause of foodborne disease in low-income subregions?

A

Vibrio cholerae

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22
Q

What is a main diarrhoeal cause of foodborne disease in high-income subregions?

A

Campylobacter spp.

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23
Q

Where is the burden of aflatoxin high? [3]

A

(1) Africa, (2) South East Asia, (3) Western Pacific

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24
Q

Where is there a considerable burden of Salmonella Typhi?

A

South East Asia

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25
Q

Where are seafood-borne trematodes important in foodborne disease burden?

A

South East Asia

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26
Q

Where is the burden of Opisthorchis spp. concentrated?

A

South East Asia

These are ‘liver fluke parasites’ associated with eating raw or undercooked fish.

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27
Q

Which disease agents contributed significantly to the food borne disease burden in the Americas? [2]

A

Taenia solium and Toxoplasma gondii

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28
Q

Which countries were the pilot studies conducted in?

A

Albania
Japan
Thailand
Uganda

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29
Q

Compare the yearly Canadian estimates for number of illnesses, hospitalizations, and deaths caused by the top four disease agents.

A

Notice how dangerous L. monocytogenes can be and how comparatively harmless Campylobacter spp. can be.

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30
Q

What is the leading cause of foodborne illnesses and hospitalizations in Canada?

A

Norovirus

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31
Q

What is the leading cause of deaths related to foodborne illness each year in Canada?

A

Listeria monocytogenes

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32
Q

What contributes to 1 in 4 hospitalizations of all food-borne illnesses in Canada?

A

Salmonella

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33
Q

What is one of the top food-borne bacteria causing severe illness in Canada?

A

E. coli O157

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34
Q

What is the third leading cause of food-borne illnesses and hospitalizations in Canada?

A

Campylobacter

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35
Q

Give 4 food safety tips.

A
  • Clean your hands, kitchen surfaces and utensils with warm, soapy water.
  • Separate raw foods, like meat and eggs, from cooked foods, fruit and veggies to avoid cross-contamination.
  • Cook food to safe internal temperatures – use a digital food thermometer.
  • Chill food and leftovers within 2 hours.
36
Q

How many hazards cause half of the global burden of disease?

A

31 hazards

37
Q

What are the key global causes of diarrhoeal disease? [4]

A
  • Norovirus
  • Campylobacter spp.
  • E. coli
  • Non-typhoidal Salmonella
38
Q

What does surveillance in foodborne illness entail?

A

Collection, analysis, interpretation and dissemination of data that leads to action to prevent and control disease

39
Q

What is a hospital visit like for foodborne illness?

A
  • Patient will be questioned regarding what they have eaten
  • Samples will be taken for lab analysis (e.g., stool; blood) to determine whether a bacterial infection is present
40
Q

How are foodborne illness cases reported?

A
  • Person falls ill
  • Person seeks medical care
  • Specimen submitted for testing
  • Laboratory tests for pathogen
  • Laboratory identifies pathogen
  • Notifiable disease/ condition report form
  • Illness reported to surveillance (e.g., BC Centre for Disease Control)
What is finally reported in the database does not include all cases (e.g., some patients don't seek medical attention, some pathogens cannot be detected by routine lab tests, etc.)
41
Q

Compare the surveillance of known pathogens and unspecified agents.

A
  • Known pathogens: lab-based data available; estimated using ‘burden-of-illness pyramid’; under-reporting
  • Unspecified: less well-understood; may not be routinely recognized as having a transmission route through food; microbes, chemicals, and other substances known to be in food that could at some time be shown to cause acute illness
42
Q

Which pathogen is most commonly associated with poultry?

A

Campylobacter

43
Q

Which pathogen is most commonly associated with pork?

A

Toxoplasma

44
Q

Which pathogen is most commonly associated with deli meats?

A

Listeria monocytogenes

45
Q

Which pathogen is most commonly associated with dairy?

A

Listeria monocytogenes

46
Q

Which pathogen is most commonly associated with complex foods?

A

Norovirus

47
Q

Which pathogen is most commonly associated with produce?

A

Salmonella

48
Q

Which pathogen is most commonly associated with beef?

A

Toxoplasma

49
Q

Which pathogen is most commonly associated with eggs?

A

Salmonella

50
Q

Which foods are most commonly associated with Campylobacter?

A

Poultry

51
Q

Which foods are commonly associated with Toxoplasma? [2]

A
  • Pork
  • Beef
52
Q

Which foods are most commonly associated with Listeria? [3]

A
  • Deli meats
  • Dairy

Also recall that the CDC report mentions fruit as a common association with Listeria

Also recall that RTE foods can be a concern for Listeria monocytogenes

53
Q

Which foods are most commonly associated with Salmonella? [4]

A
  • Poultry
  • Complex foods
  • Produce
  • Eggs
54
Q

Which foods are most commonly associated with Norovirus?

A

Complex foods

55
Q

Based on this graph, it can be concluded that the number of foodborne disease outbreaks is increasing.
True or False?

A

False - this may also suggest that surveillance is improving.

In 2009, the use of whole genome sequencing was introduced into outbreak surveillance. Because of this advancing technology, more outbreaks were detected, but this doesn’t necessarily mean that there were more outbreaks.

56
Q

Why do we need to know the most common pathogen/food combinations? [8]

A
  1. Food safety
  2. Disease prevention
  3. Outbreak investigation
  4. Risk assessment
  5. Food regulations
  6. Consumer education
  7. Industry guidance
  8. Research and development
57
Q

What is foodborne illness source attribution?

A
  • The process of estimating the most common food sources responsible for specific foodborne illnesses.
  • Multiple sources of data are needed to do this
58
Q

Why conduct foodborne illness source attribution? [2]

A
  • To prevent foodborne illness, food safety regulators, industry, and consumers need to know the major food sources.
  • By attributing the estimated number of foodborne illnesses to particular categories of foods, we can target measures to prevent food contamination and set goals for improvement.
59
Q

How are food sources categorized in attribution?

A
  • There is no consensus; depends on attribution approach
60
Q

What are complex and simple foods?

A
  • Complex = food vehicle that contains ingredients from >1 commodity
E.g., romaine lettuce = simple food; salad containing romaine lettuce as one of its ingredients = complex food
61
Q

According to the CDC IFSAC report, most Campylobacter illnesses were attributed to [2]:

A

Dairy and chicken

62
Q

According to the CDC IFSAC report, most E. coli O157 illnesses were attributed to [2]:

A

Beef and vegetable row crops

63
Q

According to the CDC IFSAC report, most Listeria monocytogenes illnesses were attributed to:

A

Fruits and dairy

While not mentioned in this report, recall that L. monocytogenes is associated with deli meats as well.

64
Q

According to the CDC IFSAC report, which pathogen is the hardest to control in food systems?

A

Salmonella - more broadly attributed than the other pathogens

65
Q

What are integrated measures of disease burden? [2]

A
  • Cost of illness (COI) - health care costs; loss of productivity (e.g., sick days)
  • Health-adjusted life year (HALY); includes quality-adjusted and disability-adjusted life years (QALYs and DALYs)
66
Q

What is COI?

A
  • Cost of illness - one technique used to estimate the economic burden of disease
  • Direct costs - healthcare costs (inpatient care; physician services); non-healthcare costs (social services; legal costs)
  • Indirect costs - productivity losses; time spent by family & visitors; forgone leisure time
67
Q

What does one DALY represent?

A

The loss of the equivalent of one year of full health.

68
Q

How do QALYs relate to DALYs?

A
  • QALYs illustrate health benefits
  • States of health are assigned
  • Amount of time spent in a given health state is multiplied by the health state preference value to calculate QALYs gained.
69
Q

1) A person lives for 10 years in full health, and another 10 years in a health state with a quality weight of 0.7, then followed by death. How many QALYs has this individual achieved?

2) Suppose a foodborne illness occurred, the same person live for 10 years in in a health state with a quality weight of 0.8, 6 years in a health state valued at 0.7, 3 years in a health state valued at 0.6, followed by death. How many QALYs has this individual achieved?

3) What is the QALYs loss because of the illness?

A

1) (10 x 1) + (10 x 0.7) = 17
2) (10 x 0.8) + (6 x 0.7) + (3 x 0.6) = 14
3) 17 - 14 = 3

70
Q

What are limitations of DALYs and QALYs?

A

Neither measure fully captures the wider effects that stem from interventions: emotional and mental health, impact on carers and family, or non-health effects such as economic and social consequences (e.g. loss of work)

Are young adults and non-disabled more productive and valuable to society? Does the value of health decrease over time?

71
Q

What methods are used for foodborne illness attribution? [5]

A
  • Analysis of outbreak data
  • Studies of sporadic cases
  • Comparative exposure assessment
  • Microbial subtyping
  • Expert elicitation
72
Q

Describe: analysis of outbreak data.

A
  • For each pathogen, the number of outbreaks or outbreak cases due to a food category is divided by the total across all foods to obtain an attribution percentage.
  • “Work backwards” from data on human illness to estimate the role of foods
  • Used in many countries and regions
73
Q

What is one major advantage of analysis of outbreak data?

A
  • Data are available for many pathogens at the national level across time, allowing for comparison of a wide range of pathogens
74
Q

What is one major disadvantage of analysis of outbreak data?

A
  • Misclassification bias
    • Outbreaks are uncharacteristic of sporadic cases
    • Investigation bias (differences in investigation)
      • Due to outbreak size, duration, setting, or organism, detection bias (certain vehicles are more likely to be identified), and temporal or geographic inconsistency
75
Q

Describe studies of sporadic cases.

A
  • A case-control study is designed to help determine if an exposure is associated with an outcome (identify cases & controls; look back in time to learn which subject in each group had the exposure(s), comparing the frequency of exposure in the case group to the control group)
  • Retrospective
76
Q

What are the major advantages of studies of sporadic cases?

A
  • Population based - better reflects risks in the general population
  • Reflective of sporadic infections
77
Q

What are the major disadvantages of studies of sporadic cases? [4]

A
  • Food vehicles are rarely lab-confirmed
  • Have issues due to selection bias in questionnaires, recall bias of respondents, long exposure windows
  • Case patients generally reflect more serious cases that have sought health care
  • Often leave a significant portion of illnesses unattributed
78
Q

Describe comparative exposure assessment.

A
  • “Work forward” from data on the prevalence and/or level of microbial contamination in food sources to estimate human illnesses due to these routes
  • Attributable fractions are estimated by comparing the results of separate risk assessments for all relevant food and non-food transmission routes
    • pathogen growth, persistence, and inactivation along the transmission route, relies on food consumption data to estimate exposure
79
Q

What are the limitations of comparative exposure assessment? [3]

A
  • Do not predict illnesses, but instead rely on comparing estimates of exposures
  • Have significant data requirements and modelling uncertainties
  • Are likely to perform best when there are limited and well-understood routes of exposure

A good pathogen for comparative exposure would be Camplyobacter, because this pathogen has limited and well-understood routes of exposure.

80
Q

Describe microbial subtyping in illness attribution.

A
  • Work both forwards and backwards, using microbial data from both human illness and contaminated foods and animals
  • Microorganisms have unique “signatures”
Think 'forensics'
81
Q

What is the major advantage of microbial subtyping?

A
  • Involves directly linking human and animal data, and is therefore very powerful for certain zoonotic diseases
82
Q

What are the major disadvantages of microbial subtyping? [2]

A
  • Data and resource intensive
  • Cannot easily distinguish between routes of transmission, but instead point upstream to reservoirs
83
Q

What is expert elicitation?

A
  • Provide alternative parameter estimates where there are gaps or disagreement in available data or to characterize uncertainty about existing scientific knowledge
  • Provide a unique average estimate or a range of estimates on most likely sources and routes
84
Q

What are the major disadvantages of expert elicitation? [3]

A
  • Selection of experts
  • Wording choice
  • Systematic biases in existing data
85
Q

The major advantage of […] is that data are available for many pathogens at the national level across time, allowing for comparison of a wide range of pathogens.

A

The major advantage of analysis of outbreak data is that data are available for many pathogens at the national level across time, allowing for comparison of a wide range of pathogens.

86
Q

The major advantage of […] is that it’s a population based method and the results better reflect risks in the general population.

A

The major advantage of studies of sporadic cases is that it’s a population based method and the results better reflect risks in the general population.

FNH 413 (7 decks)

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