Foodborne disease outbreaks in flour and flour-based food products from microbial pathogens in the United States, and their health economic burden.

The most comprehensive and inclusive estimates for the economic burden of foodborne illness yield values as high as $97.4 billion USD annually. However, broad incidence and cost estimates have limited use if they cannot be attributed to specific foods, for the purposes of food safety control. In this study, we estimated the economic burden of foodborne illnesses resulting from flour and flour-based food products in the United States from the years 2001 to 2021. The outbreak, illness burden, and health economic data are combined to generate these estimates. Our model combined outbreak data with published Centers for Disease Control and Prevention multipliers to estimate the annual number of illnesses associated with flour-borne pathogens. We then integrated illness severity data with an updated economic model that accounts for costs related to medical care, productivity loss, loss of life, along with the quality of life loss that entails pain and suffering. In total, 752 cases and 223 hospitalizations from flour-related illnesses were reported from 2001 to 2021, with an average of 37.6 cases of reported cases annually. However, the actual number of cases, accounting for underreporting and underdiagnosis, can be as high as 19,440 annually. Pathogens involved in these outbreaks are Salmonella, E. coli O157:H7, and E. coli O121. Our estimates suggest average annual economic losses, including healthy years of life lost, of $108 and $258 million using two alternative models.

Assessment of Food Safety Knowledge, Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study.

Food safety knowledge, attitudes and practices among hospital food service staff are crucial in the prevention of foodborne disease outbreaks, as hospitalized patients are more vulnerable to potential hazards. This study, therefore, sought to assess the food safety knowledge, attitudes and practices of food service staff in Bangladeshi hospitals. A cross-sectional study was conducted among 191 food service staff from seven different hospitals in Dhaka and Chattogram from October 2021 to March 2022 using pretested questionnaires. Multiple linear regression was used to identify the factors associated with the food safety knowledge, attitudes and practices. The findings showed moderate knowledge but high levels of attitudes and practices of food safety among hospital food handlers. Food safety knowledge was significantly higher among males, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations. Moreover, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations had more positive attitudes and better practices regarding food safety. Hospital management should consider these factors for enhancing food handlers' knowledge and increase training and supervision on food safety practices to reduce foodborne diseases and outbreaks.

Recent Advances and Applications of Rapid Microbial Assessment from a Food Safety Perspective.

Unsafe food is estimated to cause 600 million cases of foodborne disease, annually. Thus, the development of methods that could assist in the prevention of foodborne diseases is of high interest. This review summarizes the recent progress toward rapid microbial assessment through (i) spectroscopic techniques, (ii) spectral imaging techniques, (iii) biosensors and (iv) sensors designed to mimic human senses. These methods often produce complex and high-dimensional data that cannot be analyzed with conventional statistical methods. Multivariate statistics and machine learning approaches seemed to be valuable for these methods so as to "translate" measurements to microbial estimations. However, a great proportion of the models reported in the literature misuse these approaches, which may lead to models with low predictive power under generic conditions. Overall, all the methods showed great potential for rapid microbial assessment. Biosensors are closer to wide-scale implementation followed by spectroscopic techniques and then by spectral imaging techniques and sensors designed to mimic human senses.

Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model.

ABSTRACT: Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness.

Health and economic burden of foodborne zoonotic diseases in Amhara region, Ethiopia.

Diseases from food of animal origin are common health problems in Ethiopia. A cross-sectional study was carried out to estimate health and economic burden, and to identify demographic factors associated with community awareness of foodborne zoonotic diseases in Amhara region, Ethiopia. Data was collected from 435 households in three towns: Gondar, Lalibela and Debark. A retrospective data was also collected from health records in each town. The health burden due to zoonotic diseases was estimated at 0.2, 0.1 and 1.3 DALYs per household per year and at 73.2, 146.6 and 1,689.5 DALYs out of 100,000 populations per year in Gondar, Lalibela and Debark, respectively. The overall health burden due to foodborne zoonotic diseases (aggregated over the 435 households in the three towns) was estimated to be 89.9 DALYs per 100,000 populations per year. The economic impact of foodborne zoonotic diseases in the three towns of Amhara regional state was 278.98 Ethiopian Birr (ETB) (1ETB = 0.025 US Dollar) per household per year and 121,355.68 ETB per year. Costs of preventive measures followed by costs of patients' time made the highest contribution while costs of diagnosis made the lowest contribution to the total economic burden of foodborne zoonotic diseases. From a total of 435 respondents, 305 (70.1%) had known the presence of zoonotic diseases. Level of education, number of families in the house and income were highly associated with awareness of zoonosis. Although majority of respondents had known zoonotic diseases exists (70.1%) and disease can be acquired from animal source food (63.2%), the health and economic burden associated to foodborne zoonotic diseases are still high. Therefore, changing mindset and practical training aiming in controlling foodborne zoonotic diseases may be suggested to the community in the health improvement extension service.

Food Safety Implications of Transitions Toward Sustainable Healthy Diets.

Despite increased political attention, foodborne diseases still cause a substantial public health, economic, and social burden worldwide. Children younger than 5 years, people living in developing regions, and in the poorest areas of the world are disproportionally affected, bearing a large proportion of the global burden of foodborne disease. Yet, food safety is a prerequisite to ensuring food security globally: Foods that are responsible for important food safety problems are also crucial to ensure food security in some regions and are essential sources of nutrition. Moreover, together with calls for action to meeting international sustainable development goals, global efforts to promote food security and healthy diets have now highlighted the need to modify food systems globally. This article therefore explores the food safety dimensions of transitions toward food systems that promote sustainable healthy diets. The current body of evidence points to the combined health and environmental benefits of shifting toward a more plant-based diet, including vegetables and fruits, nuts, pulses, and whole grains. As a shift toward more plant-based diets may also lead to higher exposures to chemicals or pathogens present in these foods, an evaluation of food safety implications of such transitions is now imperative. We conclude that several synergies between public health, environmental, and food safety strategies can be identified to support dietary transitions.

Assessment of knowledge, practice, and status of food handlers toward Salmonella, Shigella, and intestinal parasites: A cross-sectional study in Tigrai prison centers, Ethiopia.

BACKGROUND: Unsafe food becomes a global public health and economic threat to humans. The health status, personal hygiene, knowledge, and practice of food handlers have crucial impact on food contamination. Hence, this study is aimed at assessing the knowledge, practice, and prevalence of Salmonella, Shigella, and intestinal parasites among food handlers in Eastern Tigrai prison centers, Northern Ethiopia. METHODS: An institutional-based cross-sectional study was carried out from April to September 2019 among food handlers in Eastern Tigrai prison centers, Northern Ethiopia. A structured questionnaire was used to collect the demographic characteristics, the knowledge, and the practice of the study participants. Direct wet mount and formol-ether concentration techniques were applied to identify intestinal parasites. Culture and biochemical tests were used to isolate the Salmonella and the Shigella species. Additionally, antimicrobial susceptibility tests to selected antibiotics were performed using Kirby-Baur disk diffusion method. We used SPSS version 23 software for statistical analysis. RESULTS: Thirty-seven (62.7%, 37/59) of the participants had harbored one or more intestinal parasites. The protozoan Entamoeba histolytica/dispar was detected among 23.7% (14/59) of the study participants who provided stool specimen. Besides, 6.8% (4/59) of the samples were positive for either Salmonella or Shigella species. The Salmonella isolates (n = 2) were sensitive to Gentamicin, Ciprofloxacin, Ceftriaxone, and Clarithromycin but resistant to Amoxicillin, Ampicillin, and Amoxicillin/clavulanic acid. Similarly, the two Shigella isolates were susceptible to Gentamicin, Ciprofloxacin, and Ceftriaxone but showed resistance to Amoxicillin, Tetracycline, and Chloramphenicol. Further, 60.6% (40/66) of the participants had good level of knowledge, and 51.5% (34/66) had good level of practice on foodborne diseases and on food safety. CONCLUSIONS: We conclude that foodborne pathogens are significant health problems in the study areas. Regular health education and training programs among the food handlers are demanded to tackle foodborne diseases at the prison centers.

Mycotoxins in Ethiopia: A Review on Prevalence, Economic and Health Impacts.

Mycotoxigenic fungi and their toxins are a global concern, causing huge economic and health impacts in developing countries such as Ethiopia, where the mycotoxin control system is inadequate. This work aimed to review the occurrences of agriculturally essential fungi such as Aspergillus, Fusarium, and Penicillium and their major mycotoxins in Ethiopian food/feedstuffs. The incidents of crucial toxins, including aflatoxins (B1, B2, G1, G2, M1), fumonisins (B1, B2), zearalenone, deoxynivalenol, and ochratoxin A, were studied. The impacts of chronic aflatoxin exposure on liver cancer risks, synergy with chronic hepatitis B infection, and possible links with Ethiopian childhood malnutrition were thoroughly examined. In addition, health risks of other potential mycotoxin exposure are also discussed, and the impacts of unsafe level of mycotoxin contaminations on economically essential export products and livestock productions were assessed. Feasible mycotoxin mitigation strategies such as biocontrol methods and binding agents (bentonite) were recommended because they are relatively cheap for low-income farmers and widely available in Ethiopia, respectively. Moreover, Ethiopian mycotoxin regulations, storage practice, adulteration practice, mycotoxin tests, and knowledge gaps among value chain actors were highlighted. Finally, sustained public awareness was suggested, along with technical and human capacity developments in the food control sector.

Assessment of control strategies against Clonorchis sinensis infection based on a multi-group dynamic transmission model.

Clonorchiasis is one of the most important food-borne trematodiases affecting millions of people. Strategies were recommended by different organizations and control programmes were implemented but mostly in short-time periods. It's important to assess the long-term benefits and sustainability of possible control strategies on morbidity control of the disease. We developed a multi-group transmission model to describe the dynamics of C. sinensis transmission among different groups of people with different raw-fish-consumption behaviors, based on which, a full model with interventions was proposed and three common control measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental modification) and their possible combinations were considered. Under a typical setting of C. sinensis transmission, we simulated interventions according to different strategies and with a series of values of intervention parameters. We found that combinations of measures were much beneficial than those singly applied; higher coverages of measures had better effects; and strategies targeted on whole population performed better than that on at-risk population with raw-fish-consumption behaviors. The strategy recommended by the government of Guangdong Province, China shows good and sustainable effects, under which, the infection control (with human prevalence <5%) could be achieved within 7.84 years (95% CI: 5.78-12.16 years) in our study setting (with original observed prevalence 33.67%). Several sustainable strategies were provided, which could lead to infection control within 10 years. This study makes the effort to quantitatively assess the long-term effects of possible control strategies against C. sinensis infection under a typical transmission setting, with application of a multi-group dynamic transmission model. The proposed model is easily facilitated with other transmission settings and the simulation outputs provide useful information to support the decision-making of control strategies on clonorchiasis.

Assessment of transmission risk in WSSV-infected shrimp Litopenaeus vannamei upon cooking.

White spot syndrome virus has been a threat to the global shrimp industry since it was discovered in Taiwan in 1992. Thus, shrimp-producing countries have launched regulations to prevent import of WSSV-infected commodity shrimp from endemic areas. Recently, cooked shrimp that is infected with WSSV tested positive by PCR. However, there is no study to determine the infectivity of WSSV in cooked shrimp that tested positive by PCR. In the present study, WSSV-infected shrimp were cooked at boiling temperature for different times including 0, 1, 3, 5, 10 and 30 min. Upon exposure to boiling temperature, WSSV-infected shrimp were fed to SPF shrimp (Litopenaeus vannamei). The result showed experimentally challenged shrimp from 0-min treatment (positive control) indeed got infected with WSSV. However, experimentally challenged shrimp that were fed tissues boiled at 1, 3, 5, 10 and 30 min were not infected with WSSV. Mortality data showed that only the positive control (0-min) treatment displayed high mortality, whereas no mortality was observed in any other treatment category. These findings suggest that cooking shrimp at boiling temperature for at least 1 min might prevent any potential spread of WSSV from endemic countries to other geographical areas where WSSV has not yet been reported.

Assessment of Food Safety Knowledge and Behaviors of Cancer Patients Receiving Treatment.

Cancer patients receiving treatment are at a higher risk for the acquisition of foodborne illness than the general population. Despite this, few studies have assessed the food safety behaviors, attitudes, risk perceptions, and food acquisition behaviors of this population. Further, no studies have, yet, quantified the food safety knowledge of these patients. This study aims to fill these gaps in the literature by administering a thorough questionnaire to cancer patients seeking treatment in three hospitals in a Midwest, metropolitan area. Demographic, treatment, food security, and food safety knowledge, behaviors, attitudes, risk perceptions, and acquisition information was assessed for 288 patients. Specific unsafe attitudes, behaviors, and acquisition practices were identified. Most notable is that 49.4% (n = 139) of participants were not aware that they were at increased risk of foodborne infection, due to their disease and treatment. Additionally, though patients exhibited a general understanding of food safety, the participant average for correctly answering the food safety questions was 74.77% ± 12.24%. The section concerning food storage showed lowest participant knowledge, with an average score of 69.53% ± 17.47%. Finally, patients reporting low food security also reported a higher incidence of unsafe food acquisition practices (P < 0.05). These findings will help healthcare providers to better educate patients in the food safety practices necessary to decrease risk of foodborne infection, and to provide targeted food safety education to low-food-security patients.

Using disease-burden method to evaluate the strategies for reduction of aflatoxin exposure in peanuts.

Aflatoxin is a fungal secondary metabolite with high toxicity that is capable of contaminating various types of food crops. It has been identified as a Group 1 human carcinogen by the International Agency for Research on Cancer. Chronic aflatoxin exposure has caused worldwide concern as a matter of public food safety. Peanuts and peanut products are the major sources of aflatoxin exposure. Therefore, some reduction interventions have been developed to minimize contamination throughout the peanut production chain. The purpose of this study is to estimate the efficacy of interventions in reducing the health impact of hepatocellular carcinoma caused by aflatoxin contamination in peanuts. The estimated total Disability-Adjusted Life Years (DALYs) were calculated using FDA-iRISK software. Six aflatoxin reduction strategies were evaluated, including good agricultural practice (GAP), biocontrol, Purdue Improved Crop Storage packaging, basic processing, ozonolysis, and ultraviolet irradiation. The results indicated that basic processing could prevent huge public health loss of 4,079.7-21,833 total DALYs per year. In addition, GAP and biocontrol were both found to be effective strategies in the farm field. Meanwhile, the other three interventions had limited effectiveness in reducing total DALYs. In conclusion, this study could help farmers, processing plants, and government policy makers to alleviate aflatoxin contamination issues in the peanut production chain.

Foodborne Parasites in Europe: Present Status and Future Trends.

Although foodborne parasites (FBPs) are becoming recognized as important foodborne pathogens, they remain neglected compared with bacterial and viral foodborne pathogens. As drivers for infection with FBPs are variable, it is often unclear for funding bodies where research should be prioritized. Through a COST Action (Euro-FBP; FA1408), we harnessed Europe-wide expertise to address these questions, using an Expert Knowledge Elicitation approach. Eating habits, lack of food-chain control, lack of awareness from relevant agencies, globalization, and water quality were identified as major drivers for FBP infection. Prioritized research needs to be largely focused on methodological gaps, but also on surveillance concerns, impact-assessment issues, and the role of microbiota. Despite the European focus, these responses should be relevant to those concerned with FBPs globally.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi.

Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of contextual and psychosocial factors for behavior change was conducted using Risk, Attitude, Norms, Ability, and Self-regulation model. We conducted 323 household surveys with caregivers of children aged 6 to 24 months. Analysis of variance was used to estimate difference between doers and non-doers of three targeted behaviors: washing utensils with soap, keeping utensils on a raised place, and handwashing with soap. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Perceived vulnerability determined effective handwashing and storage of utensils. Perceived social norms and ability estimates were favorable for the three targeted behaviors. Promotion of already existing targeted beneficial behaviors should be encouraged among caregivers. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers' technical know-how of local dish rack and tippy tap construction is essential.

Good Practices in Home Kitchens: Construction and Validation of an Instrument for Household Food-Borne Disease Assessment and Prevention.

This study aimed to develop and validate an instrument to evaluate Brazilian home kitchens' good practices. We elaborated on the preliminary version of the check-list based on the Brazilian resolution for food safety Collegiate Board Resolution 216 (RDC 216), Collegiate Board Resolution 275 (RDC 275), the standard 22000 from the International Organization for Standardization (ISO 22000) and Codex Alimentarius. Seven experts with experience in the area participated in the check-list validation and semantic evaluation. The criteria used for the approval of the items, as to their importance for the prevention of food contamination and clarity of the wording, was the achievement of a minimum of five out of seven of agreement among the experts (W-values ≥ 0.7). Moreover, items should have a mean ≥3 for the evaluation of importance (content validation) and clarity (semantic evaluation) to be maintained in the instrument. After the expert phase, we conducted another semantic evaluation of the check-list with a focus group composed of 13 undergraduate students, one moderator, and one observer of the process, to evaluate each item regarding its clarity, considering their level of understanding of the item. The final version of the check-list was composed of 77 items, divided into four blocks. The check-list developed was validated with respect to content with a W-value of 0.86 and approved in the semantic evaluation.

Food Trucks: Assessment of an Evaluation Instrument Designed for the Prevention of Foodborne Diseases.

This study aimed to validate an evaluation instrument for food trucks (FTs) regarding its internal consistency and to establish a score classification according to the food contamination probability assessment. The instrument was applied in 44 food trucks (convenience sample), along with microbial analysis, in the Federal District, Brazil. After its application, sample collection and statistical analysis, the evaluation instrument was reduced to a 22-item final version. FTs were divided into three groups according to their ready-to-eat foods. Food trucks from Group A (hot and cold sandwiches) presented the highest percentage of contamination. The lowest percentage of contamination was observed in food trucks from Group C (regional and international cuisine). The application of the validated evaluation instrument to the 44 food trucks revealed that none achieved 100% adequacy. The reproducibility analysis exhibited an Intraclass Correlation Coefficient (ICC) value of 0.780 (CI 95%: 0.597; 0.880), indicating good reproducibility of the instrument. The reliability assessment presented a Kuder⁻Richardson Formula 20 (KR-20) value of 0.627 and a Cronbach's alpha coefficient of 0.634, indicating good internal consistency. The proposed classification score was obtained by assigning 1 point for each item with an inadequate response, and the final score may vary between 0 and 20 points. Food trucks with up to 11 points exhibit low probability of contamination and low risk of foodborne diseases, while food trucks scoring 12 or more points exhibit a high probability of contamination and high risk of foodborne diseases. The evaluation instrument will allow effective assessment of the hygienic⁻sanitary practices and conditions of food trucks and potentially ensure consumers' access to safe food.

Mapping evidence on charitable food assistance system's compliance with safety and general hygiene requirements in Africa and the rest of the world: a systematic scoping review protocol.

BACKGROUND: The charitable food assistance system has an influential role in the larger effort to curtail the problem of food insecurity globally. They often play a crucial role in meeting the food security needs of the poor, particularly resource-limited settings where food security is a challenge. The aim of our study is to compare evidence on the safety and general hygiene of charitable food assistance system in Africa and the rest of the world. METHODS: This study will be conducted through a systematic scoping review. We will search for literature from the following electronic databases: African Index Medicus, PubMed, Google Scholar, EBSCOhost (MEDLINE with full text, Academic Search Complete, MEDLINE) and open access for unpublished theses and dissertations. Articles will also be searched through the 'Cited by' search as well as citations included in the reference lists of included articles. Websites, such as the World Health Organization (WHO) and the Departments of Health websites, will be searched for policies and guidelines for food charity practice. Studies will be identified by searching literature published in any language between 1967 and 2018. Then, following title screening, eligible studies will be exported to EndNote library where duplicates will be removed before the parallel screening of abstracts and full articles by two independent reviewers. Screening will be guided by the study eligibility criteria. Data from the included studies will be extracted, and the emerging themes will be analysed. The relationship of the emerging themes to the research question will be critically examined. The quality of the included studies will be determined by the use of Mixed Method Appraisal Tool (MMAT)-version 2011. The search results will be presented through the use of the adapted PRISMA-P chart. DISCUSSION: We hope to find relevant studies that highlight evidence of charitable organisations' food safety and general hygiene practices, in order to effectively compare their performance to those of formal and informal food establishments. Findings of this study will be disseminated electronically, in print and through peer presentation, conferences and congresses on synergies between efforts to reduce food loss and waste and those practices of public health concern.

[Delphi methodology in food safety management and foodborne disease prevention]. / Metodología Delphi en la gestión de la inocuidad alimentaria y prevención de enfermedades transmitidas por alimentos.

This review assesses the Delphi methodology as an expert consulting technique in the area of Public Health, particularly with a focus on food safety management and prevention of foodborne diseases, providing researchers with methodological information for its use. The data was compiled during January-August 2017 in the databases of Scopus, Medline, and Scielo. It was evidenced that, with the technological advances, the method shows an upturn, obtaining results in less time and cost of process, and a greater reach to distant experts, diversifying its applicability in Food Safety and ATS prevention. Among the main applications are: design of Hazard Analysis and Critical Control Points (HACCP) systems, a tool widely used to ensure that the food consumed does not cause any harm to the consumer, description of variables, processes, and situations related to good manufacturing practices and sanitary conditions in the food production and retail industry, useful for decision making.

La presente revisión valora la metodología Delphi como técnica de consulta a expertos en el área Salud Pública, particularmente con un enfoque en la gestión de la inocuidad alimentaria y prevención de enfermedades transmitidas por los alimentos (ETA), brindándole a los investigadores, información metodológica para su uso. La compilación de la data se efectuó durante enero-agosto de 2017 en las bases de datos de Scopus, Medline y Scielo. Se evidenció que con los avances tecnológicos el método muestra un repunte, logrando obtener resultados en menor tiempo y costo de proceso, y un mayor alcance a expertos distantes, diversificándose su aplicabilidad en Inocuidad Alimentaria y prevención de ETA. Entre las principales aplicaciones destacan: diseño de sistemas de Análisis de Peligros y Puntos Críticos de Control (HACCP), herramienta ampliamente utilizada para lograr que los alimentos consumidos no ocasionen ningún daño al consumidor, descripción de variables, procesos y situaciones relacionados con las buenas prácticas de manufactura y condiciones sanitarias en la industria de producción y expendio de alimentos, útiles para la toma de decisiones.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades transmitidas por agua y alimentos. No. 03 / Protocol of the National Epidemiological Surveillance System: water and foodborne diseases. No. 03

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. Las enfermedades transmitidas por alimentos y agua (ETA´s), constituyen un importante problema de Salud Pública, debido a su magnitud, trascendencia, tendencia fluctuante y aumentos en su comportamiento durante el año, lo que ha significado etapas de emergencia, re emergencia, aparición de agentes nuevos con potencial epidémico y el incremento a la resistencia a los antimicrobianos con impacto negativo económico, en grupos de población. Las enfermedades transmitidas por alimentos y agua, se registran entre las primeras diez causas de morbilidad y mortalidad en el país; evento notificado como enfermedad diarreica, con frecuencia los servicios de salud tienen poca capacidad de respuesta para identificación del agente etiológico, limitándose a implementar medidas de control eficientes de las fuentes de infección o contaminación y divulgación de acciones dirigidas a minimizan los factores de riesgo identificados.