PBL 15
SUPERVISED BY DR. EMAN
KHASHABA
PAY
ATTENTION
PLEASE !!!!
Objectives
Epidemic
0 Sudden appearance of disease in a certain
area & in specific time.
0 Or the occurrence of an illness in excess of
normal expectation based on past experience
in a community or specific area.
0 Mainly caused by consumption of
contaminated food or water
Characteristics of Epidemic
0 Explosive in character affecting a large number of people in
0
0
0
0
0
a short period of time (1ry wave).
All ages , both sexes and all socioeconomic status are
affected.
Distribution of cases follow distribution of water supply
thus it could be traced to source of infection.
1ry wave is preceded by a smaller wave of diarrhea (due to
simultaneous pollution with organisms which cause
diarrhea with shorter incubation period).
1ry wave is followed by a smaller and less abrupt 2ry wave
of enteric infection.
Once source is discovered & controlled [ new cases of
infection decrease rapidly.
Causative agents of Epidemic
Bacteria
Salmonella spp ,Campylobacter jejuni ,Shigella spp,
Enterotoxigenic E. coli (ETEC)
Virus
Hepatitis A&E .Norovirus -Rotavirus -Rubivirus
Parasites
Entamoeba histolytica -Giardia lamblia Cryptosporidium spp.
Toxin
Corynebacterium Diphtherriae -Bacillus cereus
Clostridium botulinum
Risk Factors of Water & Food
Borne
0 Age: Young children &Elderly persons.
0 Food traditions: Intentionally undercooked or raw
meats and fish (e.g., steak tartare, sushi, and oysters).
0 Hygiene: lack of clean water, infected food handlers,
or hand washing is not possible.
0 Disasters: earthquakes, volcanic eruptions,
landslides, tsunamis, floods, and drought due to
damage in infrastructure including public water
supply and sewage drainage system.
Clinical Manifestation of Water & Food
Borne Diseases
FEVER,
RASHES
DYSENTRY
IRRITATED
EYES
VOMITTING
ABD.
CRAMPS
SORE
THROAT
DIARRHEA
SYSTEMIC
ILLNESS
PNEUMONIA
Epidemic Water Borne in Malaysia &
Egypt
Year
Place
Cause
No Of Cases
Typhoid Mary
1907
USA
Contaminated
Food prepared
by Typhoid
Mary
3500
Epidemic In
Malaysia
(Typhoid)
1997
-Kelantan
-Sabah
-Terengganu
Contamination
of river water &
drinking water
180
Epidemic In
August 2009
Egypt (Typhoid)
-Qolioubiya
-Abu Qurqas
-Fayoum
Breakdown
342
sewage
drainage system
Tajikistan
(Typhoid)
Dushanbe
Contimination
Death : 95
of the municipal 8901 cases
water system
Feb 1997
Incidence Rate of Typhoid in Malaysia
2000-2011 (per 100,000 population)
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Steps of outbreak investigation
1. Verification of diagnosis.
2. Confirmation of the existence of an epidemic.
3. Cases finding and their characteristics.
4. Study of environmental factors
5. Investigations of population at risk.
6. Data analysis.
7. Formulation of hypothesis.
8. Recommendation for prevention & control
Prevention of Water & Food- borne
Epidemic
1- General Prevention:
2. Specific prevention
A .Environmental sanitation:
1. Adequate supply of safe drinking water.
2. Sanitary disposal of wastes (refuse &
sewage).
3. Insect eradication that can cause
epidemic (flies & cockroaches).
4. Food sanitation: - Strict measures for
food preparation, processing or
handling.+- Control of food handlers .
A. Immunization
• Vaccines.:Typhoid -Hepatitis A - Polio
vaccine- Cholera
B. Health Education:
• Of the public about the natural of water
& foodborne diseases and mode of
transmission.
B. Chemoprophylaxis
• Tetracyclin for Cholera.
• Deoxycycline prophylaxis for Shigella.
• Ciprofloxacin for Salmonella.
Control Measures
Ecological Measures
Food-borne
Take food samples for examination.
Water-borne
Water examination and sampling from suspected
source around distribution of cases
Superchlorination
Environmental measures
1.
2.
3.
4.
5.
Avoid use of untreated sewage water for
irrigation of crops unless proved safe.
Boil preserve food just before eating
Get rid of spoiled canned food of odors or
changed taste
Avoid eating / catching fishes in contaminated
water.
Report any confirmed cases of food-borne
illnesses to province/territory.
1. Repairing the water treatment and distribution
systems.
2. Evaluated municipal drinking water quality and
water wastage.
3. Municipal water supplies should routinely
monitored by frequent bacteriological and
chemical testing.
Public health measures



Meat sanitation and proper cooking
Pasteurization or boiling of milk
Good personal hygiene of food handler



Boiling all drinking water.
Conserving municipal water
Promoting basic hygiene measures to prevent the
TYPHOID MARY
0 The most notorious carrier of typhoid fever—but by no
means the most destructive—was Mary Mallon, also
known as Typhoid Mary.
0 In 1907, she became the first American carrier to be
identified and traced. She was a cook in New York.
0 She is closely associated with fifty-three cases and three
deaths. Public health authorities told Mary to give up
working as a cook or have her gall bladder removed.
0 Mary quit her job but returned later under a false name.
She was detained and quarantined after another typhoid
outbreak. She died of pneumonia after 26 years in
quarantine.
SUMMARY
0 Determining the sources of foodborne illness is the
important part of identifying opportunities to
improve food safety.
0 Having a better sense of the relationship between
contaminated food and illness supports food safety
along the entire food production change
0 One way with approach attribution, estimation is to
use the data collected during foodborne outbreaks
investigation.
ARE YOU
READY FOR
THE QUIZ?
0 1. What is the first step for outbreak
investigation ?
0 2. One of the following is wrong regarding
water borne disease control measures :
A. Boiling all drinking water
B. Avoid catching fish in contaminated water
C. Superchlorination
D. Evaluated municipal drinking water quality
& water wastage
THANK YOU
0 Hidayah
0 Syamimi
0 Adriana
0 Batrisha
0 Ainur Nelissa
0 Haziqah
0 Heba
0 Adham
0 Arif Rozain
0 Afiq
0 Abbas