Food and Waterborne Diseases Prevention and Control Program Food and Waterborne Diseases (FWBDs) Are among

the most common causes of diarrhea. In the Philippines, diarrheal diseases for the past 20 years is the number one cause of morbidity and mortality incidence rate is as high as 1,997 per 100,000 population while mortality rate is 6.7 per 100,000 population. From 1993 to 2002, FWBDs such as cholera, typhoid fever, hepatitis A and other food poisoning/food borne diseases were the most common outbreaks investigated by the Department of Health. Also, outbreaks from FWBDs can be very passive and catastrophic. Since most of these diseases have no specific treatment modalities, the best approach to limit economic losses due to FWBDs is prevention through health education and strict food and water sanitation. Are among the most common causes of diarrhea. In the Philippines, diarrheal diseases for the past 20 years is the number one cause of morbidity and mortality incidence rate is as high as 1,997 per 100,000 population while mortality rate is 6.7 per 100,000 population. From 1993 to 2002, FWBDs such as cholera, typhoid fever, hepatitis A and other food poisoning/food borne diseases were the most common outbreaks investigated by the Department of Health. Also, outbreaks from FWBDs can be very passive and catastrophic. Since most of these diseases have no specific treatment modalities, the best approach to limit economic losses due to FWBDs is prevention through health education and strict food and water sanitation. Mode of Transmission: is acquired through ingestion of fecally contaminated food or water. It is often the result of an infection with one of a Varity of organisms (bacterial, viral or parasitic). All travelers are exposed but persons at particular high risk include young adults, immuno -suppressed persons, persons with inflammatory bowel disease or diabetes, and persons taking H2 blockers or antacids. Travelers should understand the following: 1. Consider that all untreated water and food that they do not know to be properly prepared is probably contaminated and could be dangerous to their health. 2. Be aware of diseases transmitted through contaminated food and water and how contamination occurs. 3. Know the proper methods of food and water preparations. In order to reduce the risk of infection, travelers must: Ensure the quality of their food and drinking water. Be knowledgeable about potential diseases in the region to be visited. Manifestations: Diarrhea and vomiting are the most common symptoms. The disease usually results in an increased frequency, weight and volume of stools with altered consistency. Typically, a traveler experiences four to five loose of watery bowel movement each day. Other non specific symptoms that commonly associated are: Fever, headache, anorexia, Malaise and abdominal cramping pain. Course of illness: Most cases are benign, 90 % of cases resolve within one week, and 98 % resolve within 1 month.

Prevention of Food and Water Borne Diseases: The primary strategy in preventing diarrhea is the avoidance of food and water contaminated with fecal pathogens.

Food Preparation: 1. All vegetables or fruits that can be peeled are safe once peeled. 2. Fruits and vegetables that are not or cannot be peeled should be thoroughly washed under a cleanrunning tape water as in step number 3, as they maybe fertilized with human waste or handled by several people. 3. Soak items in a solution of one table spoon household bleach per gallon for 15 minutes and then rinse in treated water. 4. Thoroughly cooking of vegetables inactivates pathogens even if destroys some important nutrients. 5. Adequate thoroughly cooking of meat should be done to prevent bacterial and parasitic infections. 6. Food should be eaten immediately after cooking as any delay can allow bacteria to multiply again. 7. Cooked food that has been allowed to stand for several hours at ambient temperature provide a fertile medium for bacterial growth and should be reheated thoroughly. 8. Cooked food should be covered to be protected from flies and recontamination. 9. Freezing doesn't disinfect food. 10. Canned foods are generally safe. 11. Fresh un-pasteurized milk should be boiled for at least three minutes before consuming. 12. Avoid eating fresh cultured direct products (as yogurt and white cheese) since there is no way of pasteurization for it. 13. Generally, travelers should be advised to select food with care and avoid all the following foods as much as possible: - Avoid all raw foods especially in areas where hygiene and sanitation are inadequate. - Avoid salads, uncooked vegetables. - Avoid consumption of food and beverages obtained from street food vendors. - Avoid un-pasteurized milk and milk products. - Uncooked and row meat, fish and shellfish. 14. The easiest way to guarantee a safe food source for an infant 6 months of age is to have the infant breast-feed. If the infant already was weaned from the breast, formula prepared from commercial powder boiled water is the safest and most practical food. 15. Some antibiotics administered in a once a day dose are 90 % effective at preventing traveler's diarrhea, however, antibiotics are not recommended as prophylaxis as routine use may increase risk of adverse reaction and infection with resistant organism. 16. TD usually self limited but in severe cases oral rehydration is markedly important and consultation of a doctor.

Water Preparation: 1. Travelers should consider tap water and ice may be contaminated unless it is known to be safe. 2. Drinking bottled water may be the best advice during traveling anywhere. 3. Ice should be considered as if it is contaminated, as if it has been in contact with containers used for drinking, cleaning of containers with soap and hot water after discarding ice should be done. 4. It is usually safe to drink: o Beverages, such as tea and coffee, made with boiled water. o Canned or bottled carbonated beverages, including carbonated bottled soft drinks. 5. It is safer to drink a beverage directly from the can or bottle. 6. Travelers should be advised to dry wet cans or bottles before opening. 7. Travelers should be advised to wipe clean surfaces with which the mouth will have direct contact. 8. Travelers should be advised to avoid brushing their teeth with tap water. Treatment of water: 1. There are two preferred methods of water disinfection that are effective against all pathogens. o Boiling of water for three minutes is adequate even if heavily contaminated water. o Filter using a 1-2micron pore-size filter followed by treatment with iodine or chlorine. o Chlorine bleaches 2 drops / liter, let stand for 15 minutes. o Iodine 2% 5 drops / liters, let stand for 15 minutes. o Iodine tablets 1/2 tablet / liter, let stand for 15 minutes. 2. The following methods are less effective as they don't kill cryptosporidium and cyclospora, use if unable to use the previous methods: A. Iodine tablets: 1 tablet / liter, let stand for 6 minutes. B. Iodine 2 % liquid: 10 drops / liter, let stand for 60 minutes. C. Iodine resin filters: Allow water to stand 30 minutes after filtering it cold. (Follow manufacturer directions). For best results, cloudy water should be filtered before adding iodine or chlorine. The contact times listed are minimum times to cloudy or cold water. The use of chlorine bleach alone (4 drops / liter, let stand for 60 minutes) is less effective than the methods described above and should be avoided unless unable to use the other methods. Iodine tablets must be kept in a tightly closed bottle and should be grayish blue, not yellow, in color. Chlorine bleach must be kept in a tightly closed bottle. Alcohol does not disinfect water or other fluids.