Food-borne viruses : progress and challenges
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The mushrooms could also have been contaminated by contact with flatware or dishes, previously contaminated by the symptomatic kitchen worker during cleaning. Globally, there are an estimated 1. In non-endemic countries with a low incidence of disease and low vaccine coverage there is a large susceptible population, which regularly receives imported products from HAV-endemic regions. Since some of these products have a long shelf-life, especially if frozen or preserved, the potential is created for extended HAV outbreaks.
Frequently when HAV infection has been identified in a food handler, the exposed public is notified and offered immunoglobulin. These bivalve molluscs complied with European Union standards, based on the numbers of Escherichia coli in shellfish meat, but E. Very similar HAV sequences were detected in clinical and bivalve samples from both outbreaks.
The authors estimated that from the outbreak, there were 1—10 infectious units per gram after light cooking of clams with attack rates of 0. A risk assessment showed that, as to be expected, the attack rates decreased the more the clams were cooked, eg, for the 1. Based on national epidemic data, HAV cases were also likely associated with these clams in Peru.
The most widespread HAV outbreak in the USA affected at least people with four deaths in north-eastern Ohio and south-western Pennsylvania in late arising from green onions served in salsa at a restaurant in Monaca, Pennsylvania; the onions were likely contaminated at source in Mexico. In , 59 cases of non-travel-associated illness with genotype I, subtype B IB strains of HAV in France were linked with most cases consuming semidried tomatoes from one of three different sandwich shop chains, traced back to a supplier in France that imported frozen semidried tomatoes from Turkey.
The investigation showed that a foreign supplier was likely, and that the diffuse pattern of distribution of cases pointed to a contamination source further back in the food production chain; contaminated water could have been used during cultivation of the tomatoes, as described for a green onion outbreak.
An outbreak of HAV genotype I subtype B infection in individuals occurred in ten US states in associated with pomegranate arils imported from Turkey where this genotype is common.
The World Health Organization reports over 20 million HEV infections annually with 56, related deaths, mainly associated with contaminated water, with the highest prevalence in East and South Asia. In , in Corsica, France, seven of 13 individuals who ate raw figatellu, a traditional sausage made with pig liver and commonly eaten raw, were identified with acute or recent HEV infection. Genotype 3 HEV sequences were recovered from seven sausages purchased from supermarkets in southeastern France and were genetically linked with patients who ate raw figatellu.
An HEV outbreak was reported from Japan in associated with consumption of undercooked deer meat 6—7 weeks before symptom onset. The HEV nucleotide sequences in the remaining meat matched those from patients and also wild boar meat in a separate study. Family members who did not eat the meat, or ate very little, did not become infected. Investigation revealed of persons were seropositive for HEV and 33 had immunoglobulin M levels, indicating recent acute infection eleven were symptomatic. Analysis showed significant association between acute HEV infection and being male, drinking alcohol, and consuming shellfish while on board, demonstrating this was likely a common source foodborne outbreak.
HRV is among the leading causes of diarrhea and dehydration in children worldwide, particularly group A. Group C rotavirus has been associated with rare and sporadic cases of diarrhea in children in many countries; however, the first outbreaks were reported in Japan and England. In the USA, the occurrence of rotavirus disease has dropped considerably since introduction of a vaccine in HRV can spread rapidly in child care centers, where children may be asymptomatic.
These acidic conditions represent the environment encountered in the stomach; this could account for the fact that HRV disease occurs in children younger than 3 years as the stomach in this age group is characterized by a higher pH. A HRV outbreak occurred on a Washington DC university campus in , with cases associated with eating tuna or chicken salad sandwiches from a campus dining hall.
It was also noted that six employees reported illness. The outbreak began as foodborne, but spread by person-to-person contact during the second week. HAstVs are widespread globally. These products usually undergo little if any processing before consumption and act as vehicles for human enteric virus transmission.
Viruses of foodborne origin: a review
Serving and chopping utensils or other food contact surfaces play an important role in the institutional spread of HAstV infections, as these viruses can persist on surfaces in high numbers. HAstV is stable in drinking water, fresh surface water, and seawater, indicating another means of transmission.
This is demonstrated by an outbreak of gastroenteritis among children and adults who bathed in a Helsinki outdoor wading pool contaminated with NoV and HAstV. For all these outbreaks, the authors hypothesized that the enteric viruses could have been circulating within a given population and been transmitted through the oysters. The following outbreak gives details of one of the earlier HAstV outbreaks. HAstV can be an important agent of epidemic acute nonbacterial gastroenteritis in school-aged children and adults in Japan.
HAstV was first detected in among children and staff during an outbreak of gastroenteritis at a Sendai kindergarten. In June , a large outbreak of acute nonbacterial gastroenteritis occurred among students and teachers at ten primary and four junior high schools in Katano City, Osaka, Japan. The 14 school cafeterias had separate water supplies, but received lunches from a common supplier delivering the food prepared in three central kitchens.
SaV is an important pathogen causing acute gastroenteritis in humans globally, especially in infants and young children; SaV outbreaks have become more frequent recently, especially in Japan. Illness was strongly associated with eating a delivered box lunch prepared by one catering company in Aichi Prefecture. Of the cases, SaV genotype I. These SaV outbreak strains showed SaV GI. This suggests worldwide circulation of SaV GI. Aichi viruses AiV have been proposed as causative agents of human gastroenteritis potentially transmitted by fecal—oral routes through contaminated food or water.
However, AiV was subsequently detected in feces of patients with gastroenteritis worldwide.
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For instance, AiV was isolated in Vero cells from six AiV is frequently found in wastewater and river water. Following a flooding event close to a shellfish production lagoon, cases of gastroenteritis were linked to oyster consumption. Analysis of shellfish implicated in the outbreak demonstrated the same diversity of enteric viruses, with some viral genomic sequences identical to case samples. Shellfish were contaminated by as many as five different enteric viruses; this was the first time AiV was identified in European oysters.
Over 3 weeks following the outbreak, there was a progressive reduction in virus contamination in shellfish samples; although the actual etiology of the outbreak was inconclusive, it likely included AiV. Although the authors concluded this was the first documentation of AiV transmission by food in Europe, it is uncertain what role AiV played in these infections. The role of AiV as a human pathogen has been strengthened since then; stool specimens from children hospitalized with acute diarrhea and stool specimens from adults and children involved in gastroenteritis outbreaks were screened for AiV by RT-PCR amplification of the genomic region of the 3C and 3D nonstructural proteins.
From the outbreak survey, it appears that the presence of AiV is an indicator of mixed infections causing gastroenteritis outbreaks and AiV could be involved in half of the oyster-associated outbreaks; however, in two fecal samples from hospitalized children, AiV was the only microbiological agent detected among all of the known agents, such as HRV, AstV, adenovirus, SaV, NoV, and bacteria. Since children typically do not consume oysters, there may be other vehicles for AiV transmission.
This was confirmed in an outbreak of gastroenteritis in Germany where AiV was the only pathogen found excreted at concentrations as high as 10 12 RNA copies per gram stool; no obvious food source was identified. Human-to-human transmission seems limited to family and health care settings, but a recent study raises concerns that MERS-CoV could be transmitted by camel milk and its products. From studies in Kenya and Saudi Arabia, MERS-CoV has been circulating in dromedary camels for at least 20 years, and young dromedary camels have lower seroprevalences and are more likely to carry infectious virus.
The nucleotide sequence of an ORF1a fragment nucleotides and a 4. Eight additional camel nose swabs were positive on one or more RT-PCRs, but could not be confirmed by sequencing.
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Milk could be contaminated by nasal secretions or feces from the camel, saliva of the calves allowed to suckle prior to milking to initiate the milk flow, or dirt from the bowl or hands of the milker. A powdered camel milk product from the United Arab Emirates is now sold in Europe; such processing is likely to destroy any virus present. Severe acute respiratory syndrome SARS is an enteric as well as a respiratory disease. Enteroviruses polioviruses, Coxsackievirus, and echoviruses as a group have not been associated with foodborne illness, 68 but polio virus has historically been linked to waterborne illness, and probably still is in endemic Pakistan.
Adenoviruses are commonly associated with severe gastroenteritis in closed communities, but links to a foodborne source are infrequent. In Kansas in , 64 cases reported eating sausages at a restaurant; 69 although HAdV and NoV were isolated, no food vehicle was confirmed. Infectious H5N1 avian influenza virus has been cultured from duck meat, and the consumption of duck blood and direct contact with poultry has resulted in human infection.
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Those who had intestinal infection with H5N1 reported diarrhea as the sole first symptom of illness and other patients reported consumption of raw duck blood as their only possible exposure to poultry. NiV may be transmitted through consumption of fruits contaminated with the saliva of fruit bats.
Food-Borne Viruses: Progress and Challenges / Edition 1
The growth of large intensively managed commercial pig farms in Malaysia with fruit trees on the farm created an environment where bats could drop partially eaten fruit contaminated with NiV-laden bat saliva into pig stalls. The pigs could eat the fruit, become infected with NiV, and efficiently transmit virus to other pigs because of the dense pig population on the farms and frequent respiratory shedding of the virus among infected pigs.
Farmers were infected directly from the sick pigs. In Bangladesh, NiV is transmitted from bats to people by ingestion of fresh date palm sap. Pteropus giganteus bats frequently visit date palm sap trees and lick the sap during collection; NiV can survive for days on sugar-rich solutions such as fruit pulp. In the Nipah outbreak in Bangladesh, the only exposure significantly associated with illness was drinking raw date palm sap. In outbreak investigations, villagers, especially children, commonly report consuming fruit that has been partially eaten by bats.