Serving You a Bacteria Treat

Every day, it seems there are headlines telling people of a new outbreak of food poisoning in the world. In October 2007 alone, prominent cases included incidents in Russia, the United States, and the Philippines that left thousands (many of them children) sick with salmonellosis and other food-borne illnesses.

Another case in Egypt sent about 215 men observing i`tikaf (seclusion in the mosque for prayers during the last third of Ramadan) to the hospital. They suffered diarrhea and vomiting after eating a meal that may have been contaminated with sewage water from a broken pipe (Ammar; Cooper; Funk; Napallacan; South Russia Food Poisoning Affects Over 650 Children).

To date, no deaths have been reported in any of the above cases. But contaminated food and drinking water are responsible for many deaths each year - as many as 1.8 million, according to the World Health Organization (WHO).

Shocking

In the United States, where the standards for food safety are considered among the best in the world, the results are shocking. The Centers for Disease Control and Prevention (CDC) estimates that 76 million people in the country get sick every year because of food-borne illnesses. More than 300,000 of these are hospitalized and around 5,000 die. This makes the prevention of food-borne illnesses in America "a major public health challenge" (WHO, CDC).

Nicole Bovey said she became infected with Salmonella twice after eating out while living and studying in Egypt. She lost several pounds each time because of severe dehydration. "I am manic about cooking chicken correctly since these incidences," she said. "I own meat thermometers, and I am very wary about eating barbequed chicken. The most difficult result of this illness is the dehydration. God willing, my family and I will be spared from Salmonella in the future."

If untreated, Salmonella infections can have dire consequences. It may lead to a type of arthritis called reactive arthritis and may even cause death.

Sumayah Fannoun, too, contracted salmonellosis, experiencing a low-grade fever, vomiting, diarrhea, and severe stomach cramps for three days. This was the price she paid for eating roasted meat, hummus, and a good portion of tabbouleh (a salad dish based on cracked wheat) out in a restaurant.

"It's not a pleasant experience," she told IslamOnline.net. "I suspect it was from mishandled meat. Perhaps they didn't keep uncooked meat away from the cooked meat or did not wash their hands or utensils after handling raw meat. Allahu a`lam (Allah knows best)."

According to the CDC, commercially prepared food is responsible for about 79 percent of food-poisoning cases. In general, this is because the consumer has no control over the personal hygiene habits of food servers and preparers. The growth and preparation conditions of the ingredients used are also unknown.

In one recent case, for example, investigators in Madinah, Saudi Arabia, traced the origin of Salmonella poisoning that left 23 restaurant diners ill to bacteria under a worker's fingernails (Abdullah).

shawarma

In Jordan, where Fannoun and Bovey both live, the sale of the popular shawarma (barbequed chicken) sandwiches was actually banned this summer. This came after more than 200 people in Al-Baq`ah refugee camp, Amman, Jordan fell ill after consuming sandwiches tainted with Salmonella. One person actually died due to the infection.

This followed another shawarma incident in 2006 that infected nearly 800 people in Jordan.

Shawarmasandwiches are notoriously dangerous for consumers. In Jordan and the Arab world, the culprit is most often spoiled mayonnaise or undercooked meat.

Shawarma meat is cooked on huge skewers and sliced off as the sandwiches are prepared. On busy days, when vendors work faster than usual to serve their customers, the meat often does not get thoroughly cooked at the center. This provides a prime breeding ground for the dangerous Salmonella bacteria to multiply.

"By the time they whittle away to the very last bit of the meat, the bacterial population could be much higher than it was on the outer portion of the meat as it had a much longer time to incubate," explained Fannoun, who has a bachelor of science degree in microbiology. "I'm surprised [infections] don't happen more often. But, then again, just look at how much people blame 'cold' for stomach illnesses," she said, "I tell them, 'I am from Minnesota, it is colder than you can even imagine, and we never vomit or get diarrhea from cold.'"

Another danger to food is rodents and other pests. In Russia, rats in the kiosks where shawarma is sold regularly contaminate the salad used in the sandwiches with urine and feces. This puts people at risk from Escherichia coli bacteria, which causes severe cramps and diarrhea.

Nikolay Filatov, Moscow's chief state health inspector, cautioned reporters that the cabbage used in shawarma sandwiches has tested positive for Escherichia coli in 70 percent of laboratory tests. The first week of October 2007 alone has recorded more than 900 cases of acute intestinal infections resulting from outdoor fast food kiosks in Moscow (Cooper).

Keep Clean

Fannoun said the restaurant she became ill in was a high-scale eatery and that nothing was overtly amiss. "But, really, nothing of the food preparation was in sight," she recalled. "We were out in a large dining room, and the waiters brought everything out."

These days, Fannoun looks for "general cleanliness" as well as refrigeration of salads, hummus, and mayonnaise. She observes whether employees are wearing hats or gloves and if food is covered to prevent insects landing on it.

"I've told the [local] bakery here to cover the cheese and za`tar [thyme] pies to keep the flies off them," she said. "They look so good and fresh, but I won't buy them since they're out in the open."

A joint report prepared by the Food and Agriculture Organization of the United Nations (FAO) and WHO states that food-borne diseases with symptoms such as diarrhea and fever are "a fact of daily life" in countries of the Near and Middle East.

The report explains that "certain regional or local habits, such as the consumption of raw and uncooked salads, and certain specific food preparation techniques, such as the preparation of cheeses from raw milk, enhance the opportunity for microbiological contamination and thus the spread of food-borne diseases." It also mentions the role of street vending in the region, calling it an "important food source for a large part of the population," despite the fact that vendors often have "little or no formal education in food handling practices."

Demonstrating how serious this is, the CDC estimates that 97 percent of food poisoning cases result from improper food handling.

Dr. Saleem Musa, a pediatrician of more than 30 years of experience who practices medicine in Jordan, said that simple preventive measures are absolutely vital. Careful attention to basic health rules, such as washing hands before eating food, can certainly do much to stave off food-borne illness.

A WHO report also confirms that proper food preparation techniques and attention to basic hygiene can prevent most food-borne diseases.

This is as important inside the home (where approximately 21 percent of food poisoning cases occur) as it is elsewhere. Although the problem of food poisoning is most acute in the developing world, the FAO states that one in three persons living in industrialized countries may also be affected by food-borne illnesses each year.

More than 250 food-borne diseases have been identified. These disease are typically caused by pathogens that may be bacteria, viruses, or parasites. Other types of food poisoning may be environmental, such as chemical waste that finds its way into the food supply. Some foods are naturally toxic, such as some types of mushrooms or fish.

Depending on the severity and type of food poisoning, antibiotics or other medications may be required. But treating the dehydration that accompanies a case of food poisoning is always a priority.

A new study conducted by the University of Missouri-Columbia also suggests that drinking grape juice may protect humans from common food-borne illnesses by inhibiting the pathogens that cause disease.

Prevention?

The CDC's Division of Bacterial and Mycotic Diseasesoffers the following tips for preventing the spread of food-borne illness:

1. Cookmeat, poultry, and eggs thoroughly, and use a thermometer to make sure the internal temperature of meat has reached 70^{o Celsius (160o Fahrenheit). Eggs should be cooked until the yolk is firm.}

2. Separate raw and prepared foods to avoid cross-contamination. You can do this by washing hands, utensils, and cutting boards after they have been in contact with raw meat or poultry and before they touch another food.

3. Chill foods by refrigerating leftovers promptly (within four hours of consumption).

4. Cleanthe foods you consume. Rinse fresh fruits and vegetables in running tap water to remove visible dirt and grime. Discard the outermost leaves of a head of lettuce or cabbage. Wash your hands with soap and water before preparing food and after using the bathroom. Persons with diarrheal illness should not prepare food for others.

5. Reportsuspected food-borne illnesses to your local health department. Your cooperation may be needed even if you are not ill.

The CDC also advises that if you have small children or work with them:

When traveling:"Boil it, cook it, peel it, or forget it."

(CDC)

Finally,consult your doctor if a diarrheal illness that lasts for more than three days or is accompanied by:

(Division of Bacterial and Mycotic Diseases, CDC)

Sources

Abdullah, Sarah. "Doctors Blame Street Food for Surge in Ramadan Illnesses ." Muslim News. 27 Sep. 2007. Accessed 4 Nov. 2007.

Ammar, Manar. "Food at Cairo Mosque Sends 215 to Hospital ." All Headline News. 9 Oct. 2007. Accessed 4 Nov. 2007.

Cooper, Nathalie. "Illnesses Blamed on Shawarma." Moscow News Weekly. Accessed 15 Oct. 2007.

"Foodborne Illness ." Centers for Disease Control and Prevention. Accessed 4 Nov. 2007.

"First Pan-European Conference on Food Quality and Safety: Foodborne Diseases are on the Rise in Europe - FAO/WHO Call for Better Consumer Protection ." Food and Agriculture Organization of the United Nations. 25 Feb. 2002. Accessed 4 Nov. 2007.

"Food Safety and Foodborne Illness ." World Health Organization. March 2007. Accessed 4 Nov. 2007.

"Food Safety Office ." Centers for Disease Control and Prevention. Accessed 4 Nov. 2007.

Funk, Josh. "Critics: ConAgra Mishandled Recall ." Associated Press. 15 Oct. 2007. Accessed 4 Nov. 2007.

Gamarra, Roberto M. "Food Poisoning ." eMedicine. 2 Jan. 2007. Accessed 4 Nov. 2007.

"Jordan Bans Sandwiches Over Salmonella Outbreak ." Middle East Online. 13 Aug. 2007. Accessed 4 Nov. 2007.

Malkawi, Feisal and Al Khudari, Majed. "762 Food Poisoning Cases Test Positive for Salmonella ." Salmonella Blog. 11 Sep. 2006. Accessed 4 Nov. 2007.

Napallacan, Jhunnex. "Chinese Food Safety Team Probes Cebu Food Poisoning ." Inquirer. 10 Oct. 2007. Accessed 4 Nov. 2007.

"Practical Actions to Promote Food Safety ." FAO/WHO Regional Meeting on Food Safety for the Near East (Final Report).

"Prevention of Foodborne Disease: Five Keys to Safer Food ." World Health Organization. 24 July 2007. Accessed 4 Nov. 2007.

"Red Wine and Grape Juice Help Defend Against Food-Borne Diseases, Study Suggests ." ScienceDaily. 13 Oct. 2007. Accessed 4 Nov. 2007.

"Shigellosis ." Centers for Disease Control and Prevention. Accessed 4 Nov. 2007.

"South Russia Food Poisoning Affects Over 650 Children ." RIA Novosti. 10 Oct. 2007. Accessed 4 Nov. 2007.

Amel Abdullah is a freelance writer and the managing editor of Our Rising Star, a bimonthly magazine packed with Islamic knowledge, community news, and informative articles for today's Muslim family.