Infectious Diseases

Environmental Health's Food Safety Team are responsible for investigating causes of Infectious Diseases including Food Poisoning within the Arun District and work very closely with the Consultant in Communicable Disease Control to protect the public .

Arun's Environmental Health Service has been at the forefront of a campaign to raise awareness of Lyme Disease, an infection that is carried by ticks. In 2005 we set up a separate web page for Lyme. This and the Frequently Asked Questions (FAQs) can be found by visiting the Lyme Disease Home Page.

Information on Food Poisoning and some food and water borne infections is set out below. Food poisoning unfortunately affects hundreds of thousands of people in the United Kingdom each year. We believe that many more cases go unreported as people do not visit their doctors for formal diagnosis. If you are an Arun resident and you believe that you or a member of your family have symptoms of food poisoning please let us know so that we can try to trace the source and prevent further cases. Telephone 01903 737755 or e-mail food.safety@arun.gov.uk.

Click on any of the following headings to go straight to the relevant section:

What is food poisoning?

Food poisoning occurs from eating food contaminated with sufficiently high numbers of bacteria, viruses other organisms or chemicals. It is likely to occur at any time of the year, although Spring, Summer and Autumn tend to be more likely times because of warm temperatures.

Who is more likely to get food poisoning?

Generally the very young and the elderly are more likely to suffer, however, anyone who is ill or weak could also be vulnerable to food poisoning.

What symptoms are experienced?

The symptoms of food poisoning vary but generally include some or all of the following:-

Headache
Fever
Stomach pains
Diarrhoea
Vomiting (Sickness)

Common sources of food poisoning

There are four main types of food poisoning and these are:-

Bacteria - By far the most common source.
Viruses - These do not actually grow on food but may be carried in food. Viral outbreaks often originate from water, which produces typical food poisoning symptoms.
Chemicals and Metals - Food poisoning caused by chemicals is rare and is often caused through carelessness, e.g. allowing cleaning materials to contaminate food.
Poisonous Plants - Food poisoning caused by eating or handling poisonous plants, e.g. deadly nightshade or some fungi. This cause of illness is rare.

What are bacteria?

Bacteria are very small - they cannot be detected by the naked eye - up to 3 million can fit on the end of a pin. Some bacteria are essential to life and are naturally present in the human gut and help in the digestion of food. Bacteria which are harmful to man are called Pathogens and it is these that cause food poisoning and other illnesses. Many of these bacteria are destroyed during cooking, however some of them may produce spores and toxins which can survive very high temperatures, and are therefore able to re-contaminate food as it cools.

Where do bacteria come from?

People - People commonly carry food poisoning bacteria on their skin and also within the nose, mouth, ears and intestines. These bacteria may contaminate food directly by touch or by food handlers sneezing and coughing.
Raw Food - A variety of raw food, particularly poultry, red meat and uncooked shellfish may carry food poisoning bacteria. Unwashed salad products may also carry bacteria.
Pests - Many insect pests, notably flies, wasps and cockroaches, carry food poisoning on their legs and bodies. They contaminate food and work surfaces when they walk on them. Many rodents commonly excrete bacteria and may contaminate worktops and food.
Dirt/Dust - Food poisoning bacteria may be present in dirt and dust. It is for this reason that thorough cleaning is vital.

What are the main causes of food poisoning?

Food prepared too far in advance and then kept at room temperature

Food poisoning bacteria grow rapidly at room temperature. Any food which has been prepared in advance must, therefore, be refrigerated in order to slow bacterial growth.

Undercooking

This may be dangerous as any harmful bacteria in the food will not be destroyed.

Not reheating food to high enough temperatures

Reheated products are those which have been previously cooked. If the subsequent cooling has not been rapid enough, any spores in the food will have had time to germinate. It is vital that these products are thoroughly recooked in order to destroy any bacteria which may have been produced by the spores.

Cross contamination from raw food to cooked food

Food poisoning bacteria may be naturally present in raw food, especially raw meat and poultry. If these bacteria are allowed to contaminate food which is not going to receive further heat treatment, food poisoning can result. Cross contamination may be direct, i.e. poor storage when the juices from raw meat are allowed to drip on to cooked food, or indirect, i.e. via a chopping board, work surface or food handlers' hands.

Failure to keep hot food above 63oC. As even thorough cooking does not destroy spores, if hot foods are held below 63oC, the spores may germinate and produce food poisoning bacteria. Alternatively, if food is re-contaminated whilst being held below 63oC, food poisoning bacteria may be able to multiply to sufficient numbers to cause illness.

Poor personal hygiene and infected food handlers

Poor personal hygiene can result in food becoming contaminated with bacteria. Additionally, persons suffering from infections, e.g. vomiting, diarrhoea and food borne illness can contaminate the food. It is important to remember that anyone who has been in contact with someone suffering from food poisoning can pass on bacteria, even though they show no symptoms themselves.

What should I do if I have symptoms?

Food poisoning can make us feel ill within an hour or as much as several days after eating affected food. The most common symptoms are stomach ache, vomiting and diarrhoea. If painful or persistent, consult your doctor especially if you are elderly, pregnant or the sufferer is a child. If you are only mildly ill, take plenty of fluids and rest until you feel ready to eat solid food again. Don't prepare food for other people while you are suffering from vomiting or diarrhoea, however if it is unavoidable, take extra care with hand washing.

Reporting suspected food poisoning to the Environmental Health Officer

If you or your Doctor thinks the infection was linked to a particular food, shop or eating place within the Arun District, you should contact us. e-mail: food.safety@arun.gov.uk. It may be necessary to ask for a faecal specimen so that the exact type of bacteria can be identified. We may need to investigate the source, in order to identify others who may be suffering to prevent others becoming infected. We will also be able to offer advice on the specific type of food poisoning you have and how to manage it until you are well.

It is important to inform your Doctor and Environmental Health e-mail: food.safety@arun.gov.uk or Telephone 01903 737755 if you:-

Are a food handler whose work is connected with the preparation or handling of food or drink.
Are a health care, nursery or other staff who have direct contact or contact through serving food, with highly susceptible patients or persons in whom an intestinal infection would have particularly serious consequences.

Please Note: If you or your Doctor thinks the infection was linked to a particular food, shop or eating place outside of the Arun District then you should contact the Food Safety Team of the local authority where the premises is located.

What can I do to prevent food poisoning?

Wash hands regularly when preparing food but especially:

After going to the toilet.
Before starting to handle food.
In between handling raw and cooked food.
Before eating.
After blowing your nose.
After handling refuse.

Also

Cover cuts and boils using a waterproof plaster.
Avoid habits such as touching your nose, mouth, and hair, when handling food.
No smoking during food preparation.
Work in a tidy manner.
Clean all utensils and other food contact surfaces thoroughly before use with different foods.
Avoid leaving food at room temperature.
Thaw frozen food completely before cooking.
Cook food thoroughly.
Reheat food correctly.
Refrigerate food as soon as possible.
Store raw and cooked foods separately - cooked food above raw food.
Closely wrap all food before putting into fridge or freezer.

Specific infections:

CAMPYLOBACTER

What is Campylobacter?

Campylobacter jejuni is the most frequent cause of diarrhoea in the UK. It is generally considered to be a food borne or water borne infection rather than food poisoning. If the bacteria are present in food they do not tend to multiply in it, however once swallowed the bacteria can multiply in the gut causing infection. Only a small number of bacteria need to be ingested to produce the symptoms. Illness lasts for about 1 week, but even after recovering, the patient can continue to pass the bacteria in their stools for a number of weeks - as a "healthy carrier". Infections are usually highest in the late spring and early summer and then in the autumn. The reason for this are not altogether understood at present.

What food is affected?

This type of food poisoning is not only associated with raw meat and poultry but also with untreated milk and infected pets. Around 50% of dogs and cats excrete the bacteria in their faeces and as a result, the animal's coat becomes contaminated. In this way it is passed on to humans, especially children who stroke their pets.

Campylobacter bacterium can also be found on many farm animals, such as cows, sheep and chickens.

What are the symptoms?

Flu-like symptoms for the first 24 hours, consisting of fever, headaches and aching muscles, then followed by stomach cramps and severe diarrhoea which usually last from 1-10 days. The symptoms start between 2 and 10 days after eating the contaminated food.

Action to be taken!

During the diarrhoea phase personal hygiene should be scrupulous and food handling avoided. It is during this time that it is possible to pass the infection on to other people.

NOTE: Campylobacter bacteria are easily killed by thorough cooking, therefore the risk lies in the consumption of raw foods or cooked foods which have been contaminated either as a result of poor handling or the use of dirty utensils.

CLOSTRIDIUM PERFRINGENS

What is Clostridium perfringens?

Clostridium perfringens is a type of food poisoning organism often associated with large scale catering, such as canteens, schools and hospitals. It may be found in the bowels of animals, birds and man, and in such a habitat it spores readily. Spores will survive in soil or dust for a very long time and if the vegetation or water sources are contaminated, infection of food animals is likely. Contaminated products may result in human infection. Soil adhering to vegetables is another potential source in food preparation areas. Very large numbers of this organism are required to cause human illness.

What food is affected?

This type of food poisoning is often associated with reheated meat and meat products. Since the organism is only able to multiply in the absence of air, it thrives at the bottom of a stock pot or in the centre of a meat pie or rolled joint. Most outbreaks normally involve a large number of people because Clostridium perfringens is more commonly found in foods that have been prepared in bulk.

What are the symptoms?

The symptoms include stomach pains and diarrhoea and usually last for 12-24 hours. The patient rarely vomits. The symptoms start between 8-14 hours after eating contaminated food.

Action to be taken!

During the diarrhoea phase hygiene should be scrupulous and food handling avoided. It is during this time that it is possible to pass the infection on to another person.

DYSENTERY - AMOEBIC AND BACILLARY

What is Dysentery?

There are many types of Dysentery in the UK although most fall into the categories of Amoebic (Entamoeba Histolytica) and Bacillary (Shigellosis). Basically Dysentery is by far the most common form experienced and is an infection in the gut caused by bacteria. The bacteria can live outside the body on surfaces and in the soil for some weeks.

Bacillary (Shigellosis) the most common form is caused by the bacteria Shigella Sonnei although there are other kinds. It is milder in its effects than other strains which are present in hot countries. There has been an increase in this type of dysentery over recent years.

The bacteria is in your faeces when you are ill and may be present for up to 4 weeks later. Even after the symptoms have stopped, you may still be able to infect other people, so personal hygiene is most important.

What are the symptoms?

The symptoms include fever and raised temperature, loss of appetite, nausea and vomiting, stomach pains or cramps and diarrhoea, sometimes with blood or mucus.

What food is affected?

As the main cause of spread is by the faecal-oral route, contamination of food by the food handler is the most common cause. It may also be spread directly by handling soiled clothes, bedding or nappies etc., and indirectly by hand to mouth contact with infected objects such as door and toilet handles, etc. Flies may also carry the cysts on to food from faecal material.

Action to be taken!

During the diarrhoea phase hygiene must be scrupulous and food handling avoided if possible. In particular, attention should be given to:

Wash hands with soap and warm water after using the toilet or handling soiled clothing, and scrub your finger nails every time.
Clean and disinfect the toilet seat and bowl each day.
Clean and disinfect the toilet chain or handle, the door handle and taps every day.
Always keep kitchen worktops and equipment very clean and wash down with a disinfectant afterwards.

GIARDIASIS

What is Giardiasis?

Giardiasis is the most common gastro-enteritis parasite of man in the west. Although many infections may have been acquired through travel abroad, there is a substantial number of people who have acquired the infection without travel. Giardiasis is caused by the protozoan Giardia lamblia which infects the small intestine. The parasite is found in contaminated water.

What food is affected?

Giardiasis is spread by drinking untreated water or eating food that has been contaminated by sewage, or by person to person contact.

What are the symptoms?

About two thirds of those infected have no symptoms, however, when symptoms do occur, they begin 1-3 days after the parasite has entered the body. Violent attacks of diarrhoea accompanied by severe wind is common. Stomach ache with some swelling, loss of appetite and nausea can also occur. The symptoms can last for several weeks.

Action to be taken!

During the diarrhoea phase of the infection, personal hygiene should be scrupulous and food handling should be avoided. It is during this phase that it is possible to pass on infection to another person by hand to hand contact or the faecal-oral route. If food handling is unavoidable , hands should be thoroughly scrubbed before handling the food.

SALMONELLA

What is Salmonella?

Salmonella is one of the most common type of food poisoning in the UK. There are many types, however, Salmonella enteritis (phase type IV) is the most common of all.

What food is affected?

Almost all food can be affected by Salmonella but in particular poultry, raw meat, untreated milk, duck and hens eggs. Insects, birds, vermin and domestic pets can spread the bacteria on to food if they are allowed into the kitchen. Raw meat can spread the bacteria on to work surfaces which, unless cleaned thoroughly, will infect other foods prepared on the same surfaces.

What are the symptoms?

Symptoms usually develop about 12 to 36 hours after infection, and can cause fever, headaches, stomach pains and diarrhoea. These last for about a week but even after recovering, the patient can continue to pass the bacteria in their faeces for a number of weeks - as a "healthy carrier".

Action to be taken!

During the diarrhoea phase of the infection, personal hygiene should be scrupulous and food handling should be avoided. It is during this time that it is possible to pass on infection to another person via the faecal-oral route.

NOTE: Salmonella is easily killed by heat therefore the risk lies in the consumption of raw foods, inadequately cooked foods or cooked foods which have been contaminated either as a result of poor handling or the use of dirty utensils.

STAPHYLOCOCCUS AUREUS

What is Staphylococcus aureas?

This bacteria occurs on the human body, e.g. skin, nasal passages, throat and in particular, skin lesions such as boils. It is not the ingestion of this organism that causes food poisoning but the toxin which the bacteria produces. Whilst growing and multiplying in food stored at warm temperature (optimum 20-36oC) it produces a toxin (a poisonous substance) and when swallowed with the food the toxin irritates the stomach lining causing vomiting. At least a million organisms per gram of foodstuff are required to produce sufficient toxin for illness. The bacteria is introduced by people sneezing or coughing over food or by people who do not cover septic cuts, boils or styes, when handling foodstuffs.

What food is affected?

Many kinds of food have been involved with staphylococcal food poisoning, including poultry, fish, meat, milk and related products. Special care should be taken with creams, custards and sauces, and any baked food containing creams, that are likely to be contaminated by the food handler after they have been cooked.

What are the symptoms?

The toxin produced normally takes effect within 1-4 hours of eating, but can take as long as 7 hours. The symptoms are salivation, nausea, vomiting, abdominal cramps and diarrhoea, and usually last between 6-24 hours.

Action to be taken!

During the symptoms of staphylococcus food poisoning, personal hygiene should be scrupulous and food handling should be avoided. It is during this time that it is possible to pass the infection on to another person.

NOTE: Good food handling practices should be observed. Hygienic preparation and thorough cooking of food will prevent it from becoming contaminated with the bacterium. However, if contamination has taken place and the bacteria have produced toxins, these toxins will not be destroyed by reheating. For this reason prevention is all important.