Food and Water borne Enteric Protozoa: Current considerations for Environmental Health

Enteric protozoa continue to contribute to the burden from preventable infectious diseases affecting humans and animal health in industrialized settings. Giardia, Cryptosporidium and Entamoeba sp., are the most commonly reported protozoa associated with enteric infections, and are mainly associated with food and waterborne outbreaks. Others such as Cyclospora, Dientamoeba fragilis, Balantidium coli, Cystoisospora belli, and Blastocystis hominis are emerging as important causes of illness, with serious implications for travellers to developing regions, immuno-compromised populations and young children. Although public health measures in most developed countries are more stringent than in developing settings, minority groups, institutionalized persons and the immuno-compromised remain at extremely high risk. In an era where environmental health interventions has reversed the burden from communicable diseases, globalization, explosion of urban populations and the
emerging effects of climate change, are predicted to have unprecedented effects on the risk and transmission of infectious intestinal illnesses, threatening previous gains. Furthermore, the challenges of protozoan diseases transmitted by food, water and animals are expected to increase as a result of complex interactions between the human and animal hosts, and the need to increase food production, international food trade and the demand for alternate water sources.

Enteric protozoa have been implicated in several large water-bone outbreaks in
the USA, Norway, and Australia. Giardia intestinalis was the most common cause of parasitic drinking water outbreaks and Cryptosporidium was responsible for the majority of individual cases, while Entamoeba histolytica and Cyclospora have caused fewer cases in the USA. Cryptosporidium, C. cayetanensis, Giardia and Toxoplasma gondii are the main protozoa associated with food-borne infections in developed countries. While the majority of laboratory confirmed cases of foodborne parasitic diseases are due to G. intestinalis, Toxoplasma is the major cause of reported illness, the fourth highest cause of hospitalization and the second leading cause of deaths from overall foodborne illnesses in the USA.  This paper discusses food and waterborne transmission of enteric protozoa, highlights emerging technologies for their diagnosis and molecular epidemiology, and emerging water and waste water quality issues and technologies, to aid in their surveillance, prevention and control.

High levels of arsenic contamination around CCA-treated staircases in high-density apartment complexes: strategies for mitigating health risks

Chromated copper arsenate (CCA) is a commonly used wood preservative that was phased out of residential use after arsenic contamination resulted from rainwater leaching. Because CCA-lumber has a useful lifetime of 20-40 years, it is still prevalent in residential neighborhoods, where it is found in fencing, childrens’ playhouses, surrounding raised beds, in decking, picnic tables and exterior stairs. This study evaluated soil contamination outside multi-storied, high-density apartment complexes that have exterior staircases constructed of CCA lumber. High levels of arsenic, averaging 50 ppm, were found surrounding the stairs and had migrated into areas where people and pets have frequent contact with the soil, dust and run-off. Several mitigation strategies are under evaluation, including phytoremediation and other direct barriers to contact.

What Goes Up Must Come Down: Lessons Learned from Emergency Air Monitoring during the Escondido Bomb House Burn

On December 9, 2011, San Diego County authorities intentionally burned a house with the largest stash of homemade explosives and bomb-making material ever discovered in the United States. The cache was discovered when a gardener stepped on an unknown substance in the backyard, touching off an explosion that sent him to the hospital. When county, state, and federal hazardous materials experts surveyed the property they found highly toxic and explosive chemicals along with blasting caps, homemade hand grenades, and improvised explosive devices. Hazmat crews and bomb squads tried repeatedly to enter the home to remove chemicals and explosives. When the situation became too dangerous, the San Diego County Sheriff and Environmental Health Department officials decided the best alternative was to burn the house down.

State-of-the-science plume models were employed to predict the worst-case chemical release. Based on those models, neighbors living close to the home were evacuated and residents, businesses, and schools farther away were provided instructions to "shelter in place" before and during the burn. A multi-agency air monitoring task force consisting of the California Air Resources Board, the San Diego County Air Pollution Control District, and the San Diego County Hazardous Materials Incident Response Team was deployed to monitor and analyze toxics and smoke from community locations immediately adjacent to the “bomb house” and throughout the projected plume path. Some hazardous chemicals, including hydrochloric acid and hydrogen cyanide, were detected in the evacuation zone during the burn but at levels below emergency health action limits. Downwind concentrations of smoke and toxics were not significantly elevated during the height of the burn. However, homes close to the incident did experience smoky conditions overnight as the home was allowed to slowly smolder out. The time and day of the burn were selected to maximize favorable meteorological conditions. This was the key in preventing any reported public exposures. This presentation will detail the interagency monitoring and sampling efforts, a summary of the results of airborne sampling and analysis, and lessons learned from successful efforts to protect public health during such an unprecedented event.                 

Exploring the Nature of Acute Petroleum Releases Using Data from the National Toxic Substance Incidents Program, 2010 [POSTER]

Introduction

In January 2010, the Agency for Toxic Substances and Disease Registry established the National Toxic Substance Incidents Program (NTSIP) to reduce injuries and deaths associated with acute hazardous substance incidents. Unlike its predecessor, the Hazardous Substances Emergency Events Surveillance system, NTSIP captures petroleum only releases that result in a public health action (e.g. evacuations or injuries). Petroleum can cause serious morbidity, mortality, and property loss due to its explosive properties. Additionally, it can have a negative impact on the environment (e.g., Deep Water Horizon oil spill). In this analysis we characterize the nature of petroleum incidents to guide future prevention efforts.

Methods

We analyzed single substance incidents involving petroleum that occurred in 2010 from the seven state NTSIP dataset.  To identify petroleum incidents, we queried the field “chemical name” for petroleum fuels; including but not limited to:  gasoline, diesel, kerosene, propane, and natural gas.

Results

Of the 2,806 single chemical releases that occurred in 2010, 345 (12.3%) were petroleum.  A majority of the petroleum events occurred at fixed facilities (79.4%).  Equipment failure and human error were the most frequently reported contributing factors (46.8% of events each). Fires and/or explosions were involved in 13.0% of the events. Of the 278 events that included an industry type, utilities were the most commonly reported (33.1%).  A total of 9,395 persons evacuated in 63.5% of the events. Sixty-two events (18.0%) resulted in 116 injured persons and five fatalities. The public (65.5%) and employees

(31.9%) were the most frequently injured population groups.  Dizziness and headaches were the most frequently reported injuries.

Discussion

Utilities constituted about a third of all petroleum incidents and should be the main focus of prevention outreach.  Recent high profile incidents have increased the awareness of the dangers associated with petroleum releases. Data gained from this analysis, and other more in-depth reports, can be used to guide prevention efforts.

Conclusion

Because of the potential dangers caused by petroleum incidents, efforts should continue to find alternatives.  Additionally, strong efforts to improve safety, including the safety culture, training, and equipment design and maintenance are crucial for preventing loss of life and property.

Empowering a Superfund-impacted community by increasing environmental health literacy

The Koppers  Superfund site is a former wood treatment facility located in a residential neighborhood in Gainesville, Florida.  Improper waste disposal methods led to widespread soil and water contamination from numerous toxic chemicals, including dioxin.  Soil sampling in the neighborhood adjacent to Koppers found dioxin concentrations above the Florida SCTL and residential yards are slated for remediation.  Many residents in this low-income neighborhood have experienced high levels of anxiety and fear because of the soil contamination and disclosure that indoor dust samples also indicate high levels of dioxin and dioxin-like chemicals in their homes.  The Gainesville Environmental Health Education Project was developed with the goal of reducing residents’ exposure to hazardous chemicals in their home environment by addressing gaps in knowledge and understanding about routes of exposure, risk behaviors and the attention needed to keep infants, children and pets safe from contact with harmful chemicals – communicated in easy-to-comprehend language and hands-on activities. The culminating event will be the Eco-Health Festival, a family-friendly event to be held for 500 families next May at the neighborhood elementary school.  This project is supported by a $25,000 EPA Environmental Justice grant administered by Suwannee River Area Health Education Center, in Alachua, Florida.

Birth Anomalies Caused by Environmental Factors

Many environmental factors are linked with birth defects. These range from chemical teratogens and hormones to maternal infections, and nutritional factors. Environmental agents may affect the developmental process of the embryo and the fetus causing birth defects following maternal exposure to them. Many environmental agents may act as a teratogen.  A teratogen is any agent that causes congenital birth defects. Environmental factors like infection, drugs, sunbath, extremes of temperature, ionizing radiation may cause birth anomalies.

The embryo is most sensitive to teratogenic agents during this period of rapid differentiation and cell multiplication. Environmental factor causes 7 to 10% of congenital birth defects.  Early actions of environmental teratogen during first two week of development may cause death of the embryo. The exact mechanism by which drugs, chemicals, and other environmental factors disrupt embryonic development and induce birth defects is unknown. Many studies has shown that certain hereditary and environmental influences may adversely affect embryonic development by altering  such fundamental processes as the intracellular component, surface of the cell, extracellular matrix, and fetal environment.

Rapid progress in molecular biology is providing more information on the genetic control of differentiation of the embryo and the vulnerability of environmental teratogenic insults.  Teratogen acting during the first 2 weeks either kills all the embryo or their disruptive effects are compensated for powerful regulatory properties of the early embryo. Development of the embryo is most easily disrupted when the tissue or organs are forming. There are genetic differences in response to a teratogen.Animal research has shown that there is a dose response relationship for teratogens.

The purpose of this study is to Enumerate the environmental teratogenic agents, their possible mechanism of action.

Recommendations for possible ways to prevent the environmental teratogenic insults Method—Going through multiple text books and searching the literature.

Conclusion. There are many environmental teratogens.Although the list of suspected teratogenic factors is long, relatively few are unquestionably teratogenic in humans.  It is possible to prevent the congenital birth defects by avoiding the teratogens.

Woodstock to WWF: How to Benefit from Gererational Differences in the Workplace [LEARNING LAB]

Multiple generations are in the workforce, now more than ever.  We will discuss each generation in your organization, events that define generations and potential barriers.  Learn how to break down barriers and benefit from each others' strengths, overcome challenges and how to successfully co-exist.

FSMA and the Food Safety Professional: What Industry NEEDS from an Inspection.

Food safety inspectors play a vital role in helping ensure a safe food supply. But how effective are your inspections? Are you writing violations but not having a long-term impact? 

This presentation explores methods to enable your inspection to truly have a long-term impact on the firms you regulate by adopting the emphasis on prevention found in the Food Safety Modernization Act. Learn to focus your efforts on changing behavior, not merely correcting violations.

A Day of Disaster: The Environmental Health Impact of the April 2011 Tornadoes in Alabama

The severe weather outbreak that occurred on Wednesday, April 27, 2011 moved across the state of Alabama in two devastating waves and tested the environmental health response capabilities of the Alabama Department of Public Health.  The first wave made its way across the northern portions of central Alabama in the early morning hours and produced widespread damage from straight line winds and a few isolated tornadoes.  The second wave involved numerous super-cell thunderstorms that spawned long lived, strong to violent tornadoes across the northern two-thirds of the state.  The damage brought about by this weather system and its estimated 62 tornadoes was widespread and catastrophic in a large portion of the state and caused the death of 247 Alabamians.

From the earliest power outages through the weeks of debris clean-up, environmental health specialists were on the front lines of response, mitigation, and recovery.  This monumental event had far reaching impact on environmental health from the issuing of boil water notices; devising alternative means of sewage disposal; water filtration for community use; rapid assessments of food establishments; and the removal and proper disposal of solid waste.

Environmental health staff from across the state responded to the affected areas and were put in situations very different from what they had experienced before.  Those who were members of strike teams” and completed the CDC’s Environmental Health Training for Emergency Response course were better equipped to react to the unusual environmental health circumstances caused by the devastating storms.  Preparedness training in environmental health is essential for local staff so that citizens can be protected from potential environmental health hazards and inspections can be made to prevent further disease outbreak by successful interventions from environmental health staff. 

Improving the Effectiveness of Training in Occupational Health Through the use of Personal Reflection

The value of personal reflection as an aid to deep and transformative learning is well documented. The work of Kolb, Lewin, Schon and Moon etc is accepted and valued worldwide. This paper will explore personal reflection; it will review the evidence associated with the enhancement of the learning experience through reflection and will go on to consider whether the principals of personal reflection can and should be applied to training for improved occupational health and safety performance. The paper will suggest that reflection become a standard part of all training but it also recognizes that there a series of risks associated with businesses adopting this approach.

Using dashboards to make more sense of your data

Our inspectors had used a software program to collect inspection results since 2002, but the reports were a dead end and did not lead to data manipulation or to a corrective action system to drive improvement. In 2009, Sodexo decided to invest on closing the loop with their USMC client serving the troops at Garrison mess halls in the continental United States. Released in phases during 2011, the program is now live and provides our customers with the ability to track their progress and opportunities for improvement. Each level of the management hierarchy was consulted for their needs and desires when developing this custom web site that captures information. This should help us move towards a goal of being transparent and help the environment since in the future all concerned parties can log in and view results in 'real' time vs. having to rely on printed copies of reports and inspections.

Food Service for the US Marine Corps in the 21st Century

San Diego is home to thousands of US Marines and as their provider of food services to the Garrison mess halls in the Western Region, Sodexo has worked with the quality and safety of their food service program for the past 9 years.

The Quality Control department is a customized functionality that works with the food service managers on a variety of topics including: food safety, OSHA standards, contractual compliance and improving guest safety and satisfaction.

To accomplish this goal we work on both consulting and educating the work force as well as inspecting their programs. In our locations that still serve as a training environment for Marine cooks, this role is doubly important in maintaining a continuous program of food safety since the turnover of personnel is quiet frequent. Learn how our armed forces are changing and driving change within the military food service arena and be exposed to a little of the challenges faced by the Sodexo operations teams.

The presentation will also cover some of the complicated boundaries between US government regulations, local regulations, and state regulations and how our team acts as intermediaries for the operations team.

EXAMINATION OF THE ASSOCIATION BETWEEN ANNOUNCED RESTAURANT INSPECTIONS AND INSPECTION SCORES

In 2010 The Salt Lake Valley Health Department (SLVHD) conducted a pilot of an announced inspection program utilizing a randomized assignment of restaurants to an intervention group with announced inspections and a control group which remained on the usual schedule of unannounced inspections. A total of 122 restaurants were included in the study; the intervention group consisted of 63 restaurants and the control group included 59 establishments. Each restaurant was inspected four times during the study period.

Outcome variables in this study included the five most frequently cited critical violations in Salt Lake County – poor hygiene practices, improper holding temperatures, unclean food equipment, failure to protect from cross-contamination, and improper sanitizer concentration levels.

After adjusting for food type, visible kitchen, outside quality assurance, season and standardized inspector, significant reductions were found in the odds of personal hygiene and equipment cleanliness violations.

Oriental food restaurants had significantly increased odds of being cited for a targeted violation compared to American restaurants, but this was only for cross-contamination violations and sanitizer concentration violations.

Restaurants with a visible kitchen were at a significantly lower risk of cross-contamination violations compared to restaurants without a visible kitchen. Utilizing outside quality assurance reduced the odds of a cross-contamination violation, but had no significant effect with any of the other targeted violations.

The season in which the inspection was conducted had no significant association with any of the outcome measures with the exception of equipment cleanliness violations.

FDA standardized inspectors were twice as likely to cite holding temperature violations compared to non-standardized inspectors, however the odds of a standardized inspector citing equipment cleanliness violations was about half of a non-standardized inspector.