Dr. Rasha Salama
M.Sc., PhD Public Health
Suez Canal University
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Dr. Rasha is a physician (MB BCH in Medicine and Surgery- 1995) with a
PhD in Public health since 2003, a master degree in Public health in 2000
from Suez Canal University, a diploma in endocrinology & diabetes from
Cardiff University – UK, and Nutrition Diploma from Oxford University.
She is currently working in Dubai Health Authority - joined 2011 at the Health Policy and
Strategy Department, Public Health and Safety Department/ Preventive Medicine Section-as a
senior specialist and worked actively to achieve the strategic goals of Dubai health sector
strategy through reducing the burden of non-communicable diseases, communicable diseases
and injuries in the Emirate of Dubai. She is a member of the national Public Health Law and
Communicable disease Law committees in collaboration with ministry of health and a member
in the Occupational Medicine Committee working on the initiative of promotion of occupational
health and Safety in the Emirate of Dubai.
Prior to joining DHA, She spent five years in Community Medicine Department – Hamad Medical
Corporation – Qatar, as a consultant training candidates for the Community medicine Arab
Board and supervising public health thesis dissertations for postgraduates, as well as
publishing many papers in reputed public health journals. She was awarded Best Public Health
Trainer Award for four consecutive years for Community medicine Department in HMC-Qatar
(years 2006 throughout 2010)
Dr. Rasha is also currently designated as a lecturer in Faculty of Medicine –Suez Canal
University- Community Medicine Department, since 1995.
Contact Details:
Rashasalama2004@yahoo.com
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Foodborne illnesses are prevalent in all parts
of the world, and the toll in terms of human
life and suffering is enormous.
Contaminated food contributes to 1.5 billion
cases of diarrhea in children each year,
resulting in more than three million premature
deaths, (according to WHO).
Those deaths and illnesses are shared by both
developed and developing nations.
In the United States, the CDC estimates that foodborne diseases cause
approximately 76 million illnesses annually among the country’s 290 million
residents, as well as 325,000 hospitalizations, and 5,000 deaths. In South East
Asia, approximately one million children under five years of age die each year
from diarrheal diseases after consuming contaminated food and water.
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Foodborne diseases create an enormous burden on the
economy.
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Consumer costs include medical, legal, and other
expenses, as well as absenteeism at work and school.
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Costs to national governments stem from increased
medical expenses, outbreak investigations, food recalls,
and loss of consumer confidence in the products.
Foodborne diseases lead to increased demands on
already overburdened healthcare systems in developing
countries.
In the US, a government estimate of seven foodborne pathogens reported
a cost of between U.S. $5.6 billion to $9.4 billion in lost work and medical
expenses. · In the European Union, the annual costs incurred by the
health care system as a consequence of Salmonella infections alone are
estimated to be around EUR €3 billion.
In Australia, the cost of an estimated 11,500 daily cases of food poisoning
was calculated at AU $2.6 billion annually.
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The symptoms of foodborne illnesses range
from mild to life-threatening. While nausea
and diarrhea are the most common, kidney
and liver failure, brain and neural disorders,
and even death can also result.
For example, Listeria monocytogenes
infection, which mainly affects the elderly and
pregnant women, has a mortality rate of 2030 percent.
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Food safety challenges differ by region, due to
differences in income level, diets, local
conditions, and government infrastructures.
Changes in animal husbandry: Modern intensive
animal husbandry practices used to maximize
production resulted in increased prevalence of
several human pathogens, like Salmonella and
Campylobacter, in flocks. Crowding of animals has
been linked to the emergence of new strains of
antibiotic-resistant bacteria. Feeding practices also
have come under increased scrutiny as a result of
BSE.
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Agricultural practices have contributed to the
increased risks associated with fresh fruit and
vegetables, such as the use of manure,
chemical fertilizers, untreated sewage, or
irrigation water containing pathogens.
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International trade allows for the rapid transfer of
microorganisms from one country to another.
The increased time between processing and
consumption of food leads to additional opportunities
for contamination and time/temperature abuse,
increasing the risk of foodborne illness.
New and unfamiliar foodborne hazards can more easily
reach consumers who have not developed immunities to
those pathogens.
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Advances in processing, preservation,
packaging, shipping, and storage
technologies bring new forms of foods to the
market, and sometimes new hazards.
For example, the increased use of
refrigeration to prolong shelf-life of readyto-eat foods has contributed to the
emergence of Listeria
monocytogenes.
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Persons exposed to a foodborne illness in
one country can expose others to the
infection in a location thousands of miles
from the original source.
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Many trends impact the frequency and nature of
foodborne illnesses.
In many developed countries, a larger share of
the food budget is spent on food prepared
outside the home. In developing countries, there
is a general rise in urban living and street food is
an important component of the daily diet.
As a result, outbreaks associated with food
prepared outside the home are increasing in
many regions.
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Preventing foodborne disease relies on our
ability to translate knowledge of the
principles of “ food safety ”to the practices
of food production at each level of the food
system. Foodborne disease outbreaks
represent important sentinel events that
signal a failure of this process.
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Safety of food and water is a requirement of
public health. Safety refers to all those
hazards which make food injurious to health.
These hazards may arise at all stages of the
food chain, and lack of preventive control.
Specific concerns about food hazards are
chemical and microbiological contaminants,
biological toxins, pesticide residues,
veterinary drug residues, and allergens.
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Public health surveillance is the foundation of
communicable disease epidemiology and an
essential component of a food-safety
program.
Effective surveillance requires the continuous
collection of relevant epidemiological data, its
timely analysis and interpretation of these
data and the rapid dissemination of the
results to all who need to know.
The objectives of foodborne illness surveillance are to:
◦ determine the magnitude of the public health problem
posed by foodborne diseases and monitor trends
◦ identify outbreaks of foodborne disease at an early stage in
order to take timely remedial action
◦ determine to what extent food acts as a route of
transmission for specific pathogens and identify high-risk
foods, improper food production and handling practices
◦ determine the risk factors and behaviors for illness in
vulnerable populations
◦ assess the effectiveness of programs to improve food
safety
◦ provide information to enable the formulation of health
policies regarding foodborne diseases (preventive
strategies).
In order to achieve the above objectives,
various surveillance methods may be
employed:
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Notification of human foodborne disease
Laboratory surveillance of human foodborne
disease
Outbreak investigation of human foodborne
disease
Microbiological food surveillance
Microbiological surveillance of food animals.
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Statutory notifications
from medical
practitioners
Voluntary reporting by
laboratories
Informal reports from
members of the public.
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Multiple types of surveillance systems are used related to
foodborne disease.
Some of them, including notifiable condition surveillance,
complaints from consumers about potential illness, and
reports of outbreaks, focus on the detection of specific
enteric diseases likely to be transmitted by food and have
been used extensively by health-related agencies for
decades.
More recently, new surveillance methods have emerged
including:
◦ hazard surveillance,
◦ sentinel surveillance systems, and
◦ national laboratory networks for comparing pathogen subtypes
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Begins with an ill person who seeks medical
attention.
The health-care provider sends a specimen to the
laboratory for the appropriate tests, and the
laboratory identifies the agent responsible for the
patient’s illness so the patient can be treated.
Next, the laboratory or health-care provider notifies
local public health officials of the illness.
Once the patient’s information goes to a public
health agency, the illness is no longer considered as
an isolated incident but is compared with other
similar reports.
Combining the information in these separate reports
allows investigators to identify trends and detect
outbreaks.
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Notifiable disease
surveillance is
“passive”—i.e., the
investigator waits
for a disease report
from health-care
providers,
laboratories, and
others who are
requested or
required to report
these diseases to
the public health
agency
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The Behavioral Risk Factor Surveillance System
(BRFSS) is a system of health surveys that collects
information about health risk behaviors,
preventive health practices, and health-care
access primarily related to chronic disease and
injury.
BRFSS can be used to identify behaviors, such as
food handling methods, or trends, such as
changes in the number of meals eaten outside
the home, that can provide information about
efforts to prevent foodborne illness
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Factors that contribute to foodborne outbreaks
(e.g., factors that lead to contamination of food
with microorganisms or toxins or allow survival
and growth of microorganisms in food) are used
to develop control and intervention measures at
food-service establishments.
Routine inspections then focus on
implementation of these measures. Often
referred to as Hazard Analysis Critical Control
Point (HACCP) inspections, this is the basis for
hazard surveillance.
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Foodborne outbreak surveillance officials
from health departments gather information
about contributing factors in outbreaks from
environmental assessments
Sophisticated listing of factors based on
known microbiologic characteristics of and
symptoms produced by specific pathogens,
toxins, or chemicals and historical
associations between known causative agents
and specific food vehicles.
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A sentinel surveillance system, is an enhanced
foodborne disease surveillance system
Objectives:
1. Determine the burden of foodborne illness
2. Monitor trends in the burden of specific foodborne illness
over time
3. Attribute the burden of foodborne illness to specific foods
and settings
4. Develop and assess interventions to reduce the burden of
foodborne illness
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Example: FoodNet led by CDC
National Molecular Subtyping Network for Foodborne Disease
Surveillance (PulseNet):
 is a network of laboratories coordinated by CDC that allows
comparison of subtypes of pathogens isolated from humans,
animals, and foods.
 The name derives from pulsed-field gel electrophoresis (PFGE), a
laboratory method used to determine the molecular fingerprints
of bacteria.
 Because foodborne outbreaks usually are caused by a single
bacterial strain, investigators can identify illnesses in the
subgroup of persons infected with the same strain of as a cluster
of possibly related cases, to be considered separately from
persons infected with other strains, thus enabling investigators
to focus on the correct group of individuals and more quickly
identify the source of an outbreak.
 PFGE also can be used to characterize bacterial strains in food or
the environment to determine whether those strains match the
pattern responsible for an outbreak
Cluster of undistinguishable pattern
Objectives:
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To detect and investigate outbreaks of
foodborne, waterborne, and other enteric
illnesses
To establish both short-term interventions
and long-term control measures to prevent
similar outbreaks in the future
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Dubai Municipality and Dubai Health Authority jointly launched
first Foodborne Disease Investigation and Surveillance Program
With the disease surveillance system in place, hospitals are able
to provide real time reports on suspected foodborne illnesses to
the Food Control Department. Investigations are conducted by
the department based on these reports.
Dubai Municipality and Dubai Health Authority have jointly
launched the first project at the national level to investigate
cases of transmitted food poisoning and diseases at the start of
2010.
Through DHA, the Food Control Department is now linked to all
hospitals in Dubai. The hospitals are required to report all
suspected foodborne diseases (food poisoning cases) to DHA
and the Food Control Department,"
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Surveillance also provides the Food Control
Department with the basis for developing,
implementing, and evaluating control policies
that will lead to reduced rate of illnesses,
An active surveillance system will help to identify
foodborne diseases that are predominant in
Dubai and help focus on the efforts to protect
people from those illnesses. Food safety
programs for the food industry such as GAPs,
GMPs, and HACCP can be further developed
based on the surveillance data to prevent
contamination of food during its journey from
the farm to the table.
Surveillance statistics reflect a
fraction of cases that occur in
the community. Underdiagnosis and underreporting
of foodborne illnesses present
challenges for surveillance and
the detection of outbreaks.
“Good surveillance
does not necessarily
ensure the making of
the right decisions,
but it reduces the
chances of wrong ones.”
Dr. Alexander D. Langmuir, 1963
Founder of the Epidemic Intelligence
Service
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One of the aims of improving surveillance is that it should allow a more
proactive response to controlling food poisoning. At present much of
the response is reactive, i.e. the first indication we have of a new
pathogen often comes when people fall ill and it is this that triggers
surveys of foods and farm animals.
A co-ordinated system would be able to predict with a reasonable
degree of confidence the next threat and would thus act as an early
warning system.
Furthermore, with the identification of foodborne zoonoses in food
animals or food products preventative measures could be instituted so
that humans do not become ill.
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Links between foodborne human disease and possible food sources are
also required for the early detection of foodborne disease outbreaks.
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The successful containment of an outbreak also involves links between
the surveillance system and the agencies that carry them out.
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A common definition of food poisoning for the whole
country should be worked towards and this should be
compatible with that used within other countries.
The development of joint standard protocols and
guidelines, including a standard notification form for the
reporting of notifiable diseases.
Continuing education is required for clinicians to
encourage more complete and timely
Integrated Surveillance- Intersectoral collaborationpromote harmonization of notifiable foodborne diseases
within concerned stakeholders.
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Electronic reporting
Regular laboratory sampling, testing protocols and
reporting guidelines for foodborne organisms is
necessary.
The laboratory reporting of foodborne pathogens,
currently voluntary, should be made legally notifiable to
ensure completeness in reporting of information.
In order to improve timeliness of reports and adequate
communications, there is an urgent need for an integrated
computerized information system and information
exchange.