The expression "food poisoning" is generally applied to any disease caused by food. A more appropriate rubric is "foodborne disease" or "waterborne disease," which refers to illnesses acquired through consumption of food or water. This designation includes not only true poisoning, such as from the metabolic products (toxins) produced by certain organisms, but also foodborne contamination such as bacteria.
We reviewed all computerized data for foodborne diseases sent to the Ministry of Health from all the regions in Saudi Arabia for the years 14111413H and analyzed the data by computer. We found 781 events of foodborne diseases reported from 18 regions. There were 6,052 cases, of which 3,515 required hospitalization. No deaths due to foodborne disease were reported.
The highest rate of events was reported from Riyadh region, followed by Taif (Table 1). In this three-year period, more than 70% of the cases occurred in adult males, and 30% in children. More than 40% of the cases were non-Saudi.
Food prepared in restaurants accounted for 32% of the events, while 64% of events were associated with food prepared at home.
Staphylococcus aureus was the most common organism associated with events (319 events, 41%), followed by Salmonella (Figure 1).
Chicken, meat and rice were the food items most commonly associated with events. All the events were associated with abdominal colic, vomiting and diarrhea. For all events the most common contributing factors were poor storage, unsafe food sources and inadequate refrigeration.
The data which were presented were not enough to give a good picture about these events. Data should be entered into the computer by case, not by event. This is important in determining the incubation period and any association between cases.
The high rate of reporting from Riyadh and Taif regions may be due to good reporting from regional authorities or to underreporting from other regions.
There is a steady increase in number of cases in children. We do not know if the children were of school age or preschool age, or the sex of the children. This information is important, especially in girls' schools because they have lessons about food preparation and cooking.
More than 40% of events occurred among non-Saudis. According to the last census, non-Saudis account for 30% of the population, so that means that they have a high percentage of events. Occupations were not listed, so we were unable to determine from the data whether they were laborers.
A high percentage of events occurred in the home, but this does not mean that houses have greater problems than restaurants. Because most people eat at home, a higher percentage there would be expected.
The difference in the relation between organisms isolated and associates symptoms may be caused by improper epidemiological investigation of the cases, including the questionnaire or a laboratory error.
Because data were not available, we were unable to determine the relationship between events and food handlers or to determine the incubation period or attack rate.
Editorial note:
Food poisoning outbreaks are usually recognized by the occurrence of illness within a short period of time after consumption. Single cases of food poisoning are difficult to identify, with the exception of botulism. Usually there is no microorganism isolated. Many cases and outbreaks are underrecognized and underreported.
Food contamination occurs in the presence of living pathogenic agents on food. The illness is caused by the entrance of these agents or their toxins into the body and the reaction of body tissues to their presence.[1]
Foodborne disease surveillance has traditionally served three objectives: disease prevention and control, knowledge of disease causation and administrative guidance.[2] Ten "golden rules" for safe food preparation are[3]
- Choose food processed for safety.
- Cook food thoroughly.
- Eat cooked food immediately.
- Store cooked foods carefully.
- Reheat cooked foods thoroughly.
- Avoid contact between raw foods and cooked foods.
- Wash hands repeatedly.
- Keep kitchen surfaces clean.
- Protect foods from insects, rodents, and other animals.
- Use pure water.
References
- Center for Disease Control. Diseases transmitted by foods. Atlanta, Center for Disease Control: 1976.
- Last JM, Wallace RR, editors. Maxcy-Rosenau-Last public health & preventive medicine. Norwalk: Appleton & Lange, 1992.
- Benenson AS, editor. Control of communicable diseases in man. Washington: American Public Health Association, 1990.
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Table 1: Percentage of events by region, 1411-1413H
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Regions
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1411H
(N=217)
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1412H
(N=270)
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1413H
(N=294)
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Riyadh
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35.5
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40.4
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30.3
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Taif
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25.8
|
17
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19.4
|
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Makkah
|
8.3
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3.3
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6.8
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Eastern
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6.5
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7.8
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10.9
|
|
Tabuk
|
5.5
|
0.7
|
1
|
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Jeddah
|
3.7
|
2.6
|
1
|
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Asir
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3.7
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4.4
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3.4
|
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AI Ahsa
|
3.7
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3.7
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1.7
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Hail
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2.8
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3
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3.4
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Arar
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1.7
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0.7
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0
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Gizan
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0.9
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0
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1
|
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Qassim
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0.9
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3.3
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0.7
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Najran
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0.5
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2.6
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2
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Madinah
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0.5
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2
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3.4
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Bisha
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0
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5.2
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10.2
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Hafr al-Batin
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0
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2.2
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3.1
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AI Baha
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0
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0.7
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1.7
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Goriat
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0
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0.4
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0
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