U.S final - Food and Drugs as Public Health Issues

Question 1

Foodborne illness

what is the definition?

what organisms can it be caused by

Answer 1

Definition of foodborne illness:
Foodborne illnesses are defined as diseases, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food. Every person is at risk of foodborne illness.

Caused by bacteria, viruses, parasites, toxins, pollutants, metals

Question 2

Foodborne Illness

what can it be caused by

Answer 2

Caused by
* Breakdowns in sanitation
* Poor food handling practices

Question 3

Foodborne Illness

what is a foodborne outbreak

Answer 3

When two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne outbreak.

Public health officials investigate outbreaks to control them, so more people do not get sick in the outbreak, and to learn how to prevent similar outbreaks from happening in the future. http://www.cdc.gov/outbreaknet/outbreaks.html

Question 4

Sporadic Foodborne Illness

what is not a part of outbreaks

what is more common than Foodborne outbreaks

Answer 4

Sporadic illnesses are not part of outbreaks

Sporadic illnesses are far more common than foodborne outbreaks

The origin of sporadic illnesses is often not known

Question 5

Some Stats

Answer 5

CDC estimates that each year
76 million people contract foodborne diseases

5000 people die from foodborne illness
Deaths occur most frequently in the elderly, young, immune-compromised and those exposed to high doses of the causative agent

The FDA estimates that 2 to 3% of foodborne illnesses lead to long-term illness

Question 6

Foodborne Disease

what organisms most often causes foodborne outbreaks

how do some bacteria produce illness

Answer 6

Foodborne disease and illness caused by contaminated foods most often with:
Bacteria
Viruses
Parasites

Some bacteria cause illness by way of toxins they produce

Question 7

Outbreaks

what is it linked to

what are the most common sources?

Answer 7

CDC research shows outbreaks linked to imported foods increasing

Fish and spices the most common sources

CDC experts reviewed outbreaks reported to CDC’s Foodborne Disease Outbreak Surveillance System from 2005 to present for implicated foods that were imported into the United States

Question 8

Foodborne Diseases are also Caused by

Answer 8

Chemicals (antimony, arsenic, cadmium, copper, mercury, nitrates, sodium fluoride, thallium, tin, zinc, lead)

Pesticides

Hormones
Antibiotics
Mushrooms
Shellfish toxin
Physical contaminants (feces, hair, insects)

Question 9

Foods Most Often Associated with Foodborne Illness

what raw foods are from animal origin

Answer 9

Raw foods of animal origin
Meat and poultry
Produce
Eggs
Milk
Raw fish From contaminated water
Nuts
Raw product
- Cleaned with contaminated water
- Not cleaned at all
- Unpasteurized fruit and Vegetable juices

Question 10

Common Pathogens

Answer 10

Salmonella
E coli
Hepatitis A
Cholera
Norovirus/Calicivirus

Question 11

charts

Question 12

Salmonella
Sources of Salmonella Outbreak Investigations

Answer 12

Peanut Butter
Hedgehogs
Mangoes
Cantaloupe
Ground Beef
Live Poultry
Salmonella Montevideo
Small Turtles
Dry Dog Food
Raw Ground Tuna

Question 13

Salmonella

what are the symptoms

what is the treatment

Answer 13

Symptoms
Diarrhea (sometimes bloody), fever, and abdominal cramps. Occasionally can establish localized infection (e.g., in a joint) or enter the blood

Treatment
Usually resolves in 5 to 7 days with oral fluids
May require IV fluid replacement
May require antibiotics in severe cases

Question 14

E Coli

how do infections start

what are the common vehicles

Answer 14

Infections start when you get tiny (usually invisible) amounts of human or animal feces in your mouth

Common vehicles
Unpasteurized milk or cider
Raw vegetables
Hamburg
Soft cheeses from raw milk
Contaminated water

Question 15

E Coli

what are the symptoms

what is the treatment

Answer 15

Symptoms
Severe stomach cramps, diarrhea (often bloody), and vomiting. If there is fever, it usually is not very high

Treatment
Most people get better within 5–7 days. Some infections are very mild, but others are severe or even life-threatening
Antibiotics are not indicated

Question 16

Hepatitis A

what is it transmitted by

what are the symptoms

Answer 16

Infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food or water

Symptoms
Appear several weeks after exposure
Fatigue
Nausea and vomiting
Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
Loss of appetite
Low-grade fever
Dark urine
Muscle pain
Yellowing of the skin and eyes (jaundice)

Question 17

Hepatitis A

what is the treatment?

Answer 17

Treatment
No specific treatment exists for hepatitis A. The body will clear the hepatitis A virus on its own. In most cases of hepatitis A, the liver heals completely in a month or two with no lasting damage
Complications
Acute liver failure
Death

hepatitis: hepatic (liver) inflammation

Question 18

Cholera

Answer 18

Rare in industrialized countries in the past 100 years
A bacterial intestinal infection
Caused by ingestion of food or water containing the bacteria
Usually self limiting, may require fluid replacement
Symptoms include watery diarrhea, vomiting and leg cramps

Question 19

Norovirus

Answer 19

A very contagious virus
You can get norovirus from an infected person, contaminated food or water, or by touching contaminated surface
The virus causes your stomach or intestines or both to get inflamed (acute gastroenteritis)
Prevention – hand washing, avoid contact with infected people

Question 20

Norovirus

Answer 20

Symptoms
Stomach pain
Nausea
Diarrhea
Vomiting

Treatment
Non-specific
Fluid replacement
Self limiting

Question 21

Calicivirus

Answer 21

Similar to norovirus in symptoms and treatment
Caused by a different virus

Question 22

Government Action to Prevent Foodborne Disease

Answer 22

Federal, state and local agencies are responsible for protection of the public from foodborne illness

Question 23

FDA and Department of Agriculture (USDA)

Answer 23

Responsible for ensuring foods are safe, wholesome and properly labeled
Regulate the safety of the food supply
Inspect products, promulgate and enforce regulations, work with the industry to improve safety

Question 24

USDA

Answer 24

Responsible for safety of meat and poultry, including products containing more than 2% of cooked meat or poultry, and eggs
Requires inspection of processing plants daily
Requires presence of inspector on site whenever a slaughtering plant is in operation

Question 25

USDA

Answer 25

Account for about 20% of federally regulated foods
Account for about 27% of foodborne illness outbreaks
Has the power to ban importing of meat and poultry from countries with inferior food safety systems

Question 26

FDA

Answer 26

Responsible for all other foods, including seafood, produce, grains
Responsible for about 80% of federally regulated foods
Account for about 67% of reported foodborne illness outbreaks

Question 27

FDA

Answer 27

Inspections may occur once every 10 years
Don’t inspect farms unless there is an outbreak
Does not have the power to ban importing of fruits, vegetables, grains or fish from countries with inferior food safety systems (but the USDA does!)

Question 28

USDA/FDA

Answer 28

Many inconsistencies between the 2 agencies, what are they?

Issues with the system
Patchwork legislation
Division of responsibility
Lack of coordination

Question 29

USDA/FDA

Answer 29

Inconsistencies among different types of food in the way food safety is regulated
System depends too heavily on detecting and correcting problems after they occur rather than focusing on prevention

Question 30

HACCP

Answer 30

HACCP: Hazard Analysis Critical Control Point
Originally invented by NASA to ensure food safety in outer space
A proactive approach to food safety
Focuses on procedures
Implemented by the Clinton administration as a preventive approach to meat and seafood safety

Question 31

HACCP

Answer 31

Puts the responsibility on food businesses to analyze their procedures
Requires government inspectors to verify compliance
Identifies potential sources of contamination and devises ways to avoid them
Should reduce the need for inspections
The USDA reports nearly 96% compliance

Question 32

HACCP Procedures

Answer 32

Conduct a hazard analysis
Determine the critical control points
Establish critical limits
Establish monitoring procedures
Establish corrective actions
Establish verification procedures
Establish record-keeping and documentation procedures

Question 33

HACCP Procedures

Answer 33

Very similar to other cause and effect/failure mode and effects analysis models

Question 34

Irradiation of Food

Answer 34

The use of radiation to kill microbial contaminants of food
Opposition among consumer groups
FDA has approved irradiation of red meat, poultry, pork, fruits and vegetables, seeds, herbs and spices, eggs and wheat
Foods that have been irradiated must be labeled as such
Controversial?

Question 35

CDC Program PulseNet

Answer 35

Consists of public health laboratories in all 50 states and Canada
Network permits timely comparisons of pathogens that may cause outbreaks in various parts of the country
Identifies common sources of contamination
Enables public health officials to take action to halt distribution of contaminated foods
Passive surveillance (waits for information to be reported by doctors, hospitals, labs)

Question 36

CDC Program FoodNet

Answer 36

An active surveillance network
Designed to help public health officials better understand the epidemiology of foodborne diseases
Contact labs, survey physicians, contact members of the general public

Question 37

CDC Program FoodNet

Answer 37

Data collected provides information on less severe foodborne illnesses that are often not reported to public health authorities
Data helps officials at the USDA and FDA identify where their regulatory systems should be improved
Includes investigators at the USDA and FDA and ten state health departments

Question 38

Additives and Contaminants

Answer 38

Food safety standards include limits on additives and contaminants in food
Additives are intentional, purposely incorporated into food to improve taste, color, nutritional value and resistance to deterioration

Question 39

Contaminants Detected by Inspection Include

Answer 39

Dirt
Hair
Rodent feces
Insect parts
Pesticide residues
Hormones
Antibiotics

Question 40

Drugs and Cosmetics

Answer 40

Prescription and OTC drugs regulated by FDA though different levels of regulation exist between the two
Complex system for new drug approval
Cosmetics more loosely regulated
No requirement for safety testing
Warning label must be on products not tested

Question 41

Food and Drug Labeling and Advertising

Answer 41

Regulations established in 1994 require labels on prepared foods to contain information on
Fats including saturated and trans-fats
Fiber
Vitamins
Other nutrients and recommended daily intakes for these nutrients

Question 42

Politics of the FDA

Answer 42

FDA regulates products accounting for approximately 25% of consumer dollars spent
FDA criticized for
Being too slow in approval of new drugs (criticism from the drug companies)
Being too ready to approve new drugs (criticism from consumer advocates)

Question 43

Politics of the FDA

Answer 43

FDA’s issues led to a review by the IOM which recommended
Increased funding for improved monitoring of the safety of drugs post marketing
Greater authority for the FDA to require companies to conduct follow-up clinical studies on newly detected adverse effects

Question 44

Politics of the FDA

Answer 44

Congress passed legislation in 2007 that addressed some of these recommendations
Reauthorized the use of user fees for the drug approval process
Increased funding for post-marketing studies and surveillance
Granted the FDA authority to require companies to conduct follow-up clinical studies on newly detected adverse effects

Question 45

Safe Food and Drugs

Answer 45

What is the role of the pharmacist?:
Education
Regulation compliance
OTC medication recommendation
Referral to primary care providers
Others?