Foodborne and Waterborne Diseases

Foodborne and Waterborne Diseases

The foodborne disease epidemiology team in the Acute Disease Epidemiology Section has primary responsibility for conducting food and waterborne disease surveillance and supporting Public Health Districts with outbreak response in Georgia. Foodborne diseases are infections that are commonly transmitted through consuming contaminated food, but can also be spread through contact with water, animals, ill persons, and other environmental sources. The foodborne disease team conducts surveillance for the following pathogens, all of which are notifiable conditions in Georgia:

Cyclospora

Cyclosporiasis is a diarrheal disease caused by the parasite, Cyclospora cayetanensis.  People can become infected with it by consuming contaminated food or water.  People who travel to tropical and subtropical countries where Cyclospora is endemic may be at higher risk for illness.

Cryptosporidium

Cryptosporidiosis is the diarrheal disease caused by the parasite, Cryptosporidium.  The parasite and the disease are commonly known as “Crytpo.”  Crypto lives in the gut of infected humans and animals.  Cryptosporidium has an outer shell that helps it survive in the environment for long periods of time and also makes it tolerant to chlorine disinfection.  People can get Crypto through swimming in contaminated water (i.e. pools, waterparks, lakes), drinking contaminated water, coming in contact with infected animals or people, or eating contaminated food.

Giardia

Giardiasis is the diarrheal disease caused by the parasite, Giardia.  It is the most commonly reported intestinal parasitic disease in the United States.  Giardia can be found on surfaces or in water, soil, or food that has been contaminated with human or animal feces.  Giardia has an outer shell that helps it survive in the environment for long periods of time and also makes it tolerant to chlorine disinfection.  People can get giardiasis through swimming in contaminated water (i.e. pools, waterparks, lakes), drinking contaminated water, coming in contact with infected animals or people, or eating contaminated food.

Salmonella (including Typhoid fever)

Salmonellosis is caused by the bacterium Salmonella. It is spread by ingesting food or water contaminated by feces or through contact with infected persons. Diarrhea is a common symptom, in addition to abdominal cramping and fever. Salmonellosis can be prevented by thoroughly cooking foods, avoiding unpasteurized dairy and practicing proper hand hygiene, especially after contact with raw meat, uncooked eggs or live animals.

Typhoid fever is caused by the bacterium Salmonella Typhi. Symptoms range from fever with mild illness to severe disease. Transmission occurs through consuming contaminated food or water and can be spread from person to person. Typhoid fever is not typically acquired in Georgia; it is associated with international travel. Proper hand hygiene and food preparation can help to prevent illness, as can immunization prior to travel to endemic areas. 

Shigella

Shigellosis is illness caused by the bacterium Shigella. Shigellosis symptoms typically include diarrhea (sometimes with bloody stool), fever, nausea, abdominal pain, or vomiting. Most persons with Shigella infection do not require medical treatment, and symptoms often resolve without medication. It is important to know that people infected with Shigella may continue to shed the bacteria in their stool and be infectious to others even after their symptoms resolve.

Campylobacter

Campylobacteriosis is an enteric illness caused by the bacterium Campylobacter. CDC estimates that infections with Campylobacter cause almost 1.5 million illnesses in the United States every year. 

Shiga toxin-producing E. coli (including E. coli O157)

Escherichia coli (E. coli) bacteria normally live in the intestines of people and animals. Most E. coli are harmless and actually are an important part of a healthy human intestinal tract. However, some E. coli are pathogenic, meaning they can cause illness, either diarrhea or illness outside of the intestinal tract. The types of E. coli that can cause diarrhea can be transmitted through contaminated water or food, or through contact with animals or persons. Shiga toxin-producing E. coli (STEC) is the one most commonly heard about in the news in association with foodborne outbreaks.

Vibrio (including cholera)

CDC estimates that Vibrio causes 80,000 illnesses each year in the United States, and about 52,000 of these illnesses are estimated to be the result of eating contaminated food.  About a dozen Vibrio species can cause human illness.  The most common species in United States and in Georgia are Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio alginolyticus

Yersinia

Yersinosis is an enteric illness most commonly caused by the bacteria Yersinia enterocolitica. CDC estimates that infections with Yersinia enterocolitica cause almost 117,000 illnesses, 640 hospitalizations, and 35 deaths in the United States every year. 

Listeria

Listeriosis is a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes. Most people do not get listeriosis, even when exposed to the bacteria, but persons with certain health conditions can become ill. According to the Centers for Disease Control and Prevention, an estimated 2500 persons become seriously ill with listeriosis in the United States each year. Of these, approximately 500 die. Listeriosis is the third leading cause of death from foodborne illness.

Outbreaks

An outbreak is defined as more cases of disease in time or place than expected. If the condition is rare (i.e. foodborne botulism) or has serious public health implications (i.e. bioterrorism agent), an outbreak may involve only one case. When two or more cases have the same laboratory diagnosis of the etiologic agent, the outbreak is considered laboratory confirmed. A cluster is a group of cases linked together in place and time (and may represent an outbreak). Not all clusters are outbreaks but all clusters are investigated thoroughly and rapidly to rule out an outbreak or to implement control measures. All physicians, laboratorians, and other healthcare providers are required by law to immediately report any cluster of illnesses to the Georgia Department of Public Health.

Collaborations and Resources:

In addition to the Georgia notifiable diseases surveillance system, all of the listed pathogens except Giardia are included in the CDC Emerging Infections Program's Foodborne Diseases Active Surveillance Network (FoodNet). FoodNet Fast is a new interactive program developed by CDC so that users can obtain information on illness cases reported to FoodNet.  For additional information about FoodNet and the Emerging Infections Program, please see the following links:

http://www.cdc.gov/foodnet/

https://www.cdc.gov/foodnet/foodnet-fast.html

https://dph.georgia.gov/EIP

The foodborne disease team also collaborates closely with the DPH Environmental Health Section to facilitate outbreak prevention, detection and response.  The Environmental Health Section has regulatory authority to exclude food-handlers ill with certain foodborne conditions.  More information can be found under the specific pathogens and a link to the Food Service Rules and supporting documents is found here:

https://dph.georgia.gov/food-service-rules-and-documents

Finally, the foodborne disease team works closely with agencies such as the Georgia Department of Agriculture, the Food and Drug Administration, and the United States Department of Agriculture and other partners through the Georgia Food Safety and Defense Task Force to promote food safety in Georgia.

https://ga.foodprotectiontaskforce.com/