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Foodborne Illness: The Guest Nobody Invited

Medically reviewed on Nov 9, 2017 by L. Anderson, PharmD.

No Thanks! Foodborne Illness is Lurking

You probably don't think about food safety and food-borne illness -- or food poisoning -- very much, but you should; especially as the get-togethers roll around this holiday season. Turkeys on the table, eggnog in your belly, and lack of adequate refrigeration can spell food safety disaster.

Food safety boils down to not eating food that is contaminated with disease-causing organisms -- potentially harmful bacteria, parasites, viruses, toxins and chemicals. In fact, each year, roughly 48 million people get sick by consuming contaminated foods or beverages. More than 250 different infectious food-borne diseases are known, caused by a variety of these bad organisms.

Norovirus: A Cruise Ship's Nightmare

Maybe you'll be hitting the high seas over the holidays. You’ve probably heard of salmonella, or E. coli more frequently, but the Centers for Disease Control and Prevention (CDC) rates norovirus as one of the top culprits in food poisoning acquired through contaminated food in the U.S.

You do not have to consume the contaminated food or drink to get norovirus. In facts, it's a contagious virus that you can get from others or by touching contaminated surfaces. Norovirus spreads quickly in crowded, contained areas like daycare centers, nursing homes, schools, and cruise ships, and is most common from November to April, but may occur year-round.

Prevention is Key, So Do This

While most people recover fully from norovirus, it can be an unpleasant illness that may interfere with your family holiday. Since there is no vaccine, to help prevent infections, follow these guidelines:

  • Wash your hands with soap and water before eating, after the restroom, and before preparing food.
  • Alcohol-based hand-sanitizers can be used in addition, but not as a substitute for soap and water.
  • Don’t prepare food for others until three days after you are well.
  • Thoroughly wash fruits and vegetables and cook seafood fully; quick steaming (for example, with oysters) may not be adequate.
  • Clean vomit or diarrhea areas with bleach, and wash clothes and bedsheets.

Salmonella: Cook Your Eggs

Eggnog is a crowd favorite. But Salmonella can be seen around the holidays because it can be transmitted by undercooked poultry and other meats, eggs, raw eggs, and even raw cookie dough.

Every year one million U.S. cases of salmonellosis occur. Salmonella can also be transmitted by tainted food, water, or contact with infected animals, like chickens or pet lizards.

Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness clears up in a week, and most everyone recovers without issues, although some may need antibiotic treatment, fluid replacements, and possibly hospitalization.

Reptiles, Turtles, and Lizards, Oh My....

Since salmonella can be transmitted in undercooked poultry like chicken or turkey, undercooked or raw eggs, and other meats, be sure to thoroughly cook these foods. Avoid pink hamburger meat, and unpasteurized dairy products like cheese or milk. Plus, be sure to wash your hands, utensils and cutting surfaces as you cook to avoid cross-contamination in the kitchen. A simple task that can be a life-saver. Watch for symptoms of Salmonella infection, such as diarrhea, stomach pain, nausea, vomiting, fever, and headache. Call your doctor immediately if you have any of those symptoms.

Reptiles like turtles and lizards, baby chicks, and any other animal in contact with feces can be a source of contamination. Pet turtles are no longer sold legally in the U.S. due to salmonella risk. There has been trouble with geckos, too. Follow this FDA advice:

  • Don’t buy small turtles or other reptiles or amphibians for pets or as gifts.
  • Remove any reptile or amphibian from homes with infants; keep them away from children under 5, the elderly, people with weak immune systems.
  • Don't allow reptiles or amphibians to roam freely in the house.
  • Do not clean aquariums or supplies in the kitchen sink. Use bleach to disinfect areas/tools where aquariums are cleaned.
  • Always wash your hands thoroughly with soap and water after touching any reptile or amphibian, it's home, or food.
  • Salmonella infection can be caused by contact with reptiles or amphibians in petting zoos, parks, child-care facilities, or other locations, too. Wash your hands afterwards.

Clostridium: It Hates a Fridge

Be sure your packed fridge stays at the right temperature over the holidays, especially with raw meat inside.

Like Salmonella, about one million cases of clostridium food poisoning occur every year. But there’s no vomiting or fever with clostridium, just diarrhea and cramps that typically last 8 to 12 hours. Clostridium may multiply on meat that is not properly refrigerated, and if the meat is eaten when undercooked, illness will occur.

Outbreaks can occur at hospitals, schools, prisons, and nursing homes. Clostridium is not contagious like norovirus, but the young and elderly are at most risk. Treatments involves replenishing fluids and electrolytes; antibiotics are not used often.

Clostridium: It Loves a Picnic

Celebrating the holidays in warm weather? Lucky you! But picnics can be a party, too, for Mr. Clostridium, and you definitely do not want to invite this dude to your cookout. Food poisoning can definitely put a damper on the festivities.

Foods that are cooked, but not kept at proper temperatures, can grow Clostridium perfringens. Beef, poultry, gravies and other foods prone to clostridium should be cooked to proper temperatures, then kept either warmer than 140°F (60°C) or cooler than 41°F (5°C) to prevent further growth of clostridium.

Refrigerate leftover foods within 2 hours of preparation. Split up large leftovers, like whole roasts or large pots of stew, for quicker cooling in the fridge. Reheat to at least 165°F (74°C) before serving. Foods with dangerous bacteria like clostridium may not look, smell or even taste different.

Campylobacter Can Set You Back

This foodborne illness is easy to get right from your own kitchen. The campylobacter jejuni organism leads to campylobacteriosis, an illness defined by unpleasant cramping, abdominal pain, diarrhea and fever within two to five days after exposure to the organism. Nausea and vomiting and even blood in the stool may occur, and symptoms usually last one week.

Campylobacter is estimated to affect 1.3 million people per year, and is usually contracted by eating raw or undercooked poultry or from cross-contamination in the kitchen. Campylobacter can be especially dangerous in people with a weak immune system if it spreads to the bloodstream.

Preventing Campylobacter: No Pink Poultry

Are you in charge of the turkey this year? When grilling or oven roasting, all poultry should be cooked to reach a minimum internal temperature of 165°F and there should be only clear juices when the meat is pierced. Never use leftover marinade on cooked foods, and don't use utensils that have touched uncooked food to serve prepared items.

Plus, it’s equally important to use good hygiene in the kitchen or campsite. Don’t cut up raw chicken, turkey or any other meats and then use that cutting board to prepare other non-meat foods; use separate cutting boards. Be sure to wash all utensils and cutting boards thoroughly with soap and hot water. Keep your hands clean and wash your hands after handling raw meat. If you’re in a restaurant, and your poultry comes out pink and not fully cooked, send it back.

Escherica Coli: Usually a Normal Flora

Like clostridium, E. coli are normal flora found in your gut and are usually harmless. However, certain E. coli can cause disease, coming from contaminated water or food, or through contact with animals or persons.

You have probably heard of outbreaks in the U.S. due to ground beef. The most common E. Coli in North America involved in outbreaks is the Shiga-toxin producing E. coli O157. It takes about 3 to 4 days to get sick after ingestion.

Symptoms include severe stomach cramps, diarrhea (may be bloody), gas, vomiting, loss of appetite and low fever. Most people recover in 5 to 7 days, but E. coli can also be severe.

Escherica Coli: It’s Not Just Ground Beef Anymore

E. coli can be contracted from many other food, animal and human sources besides beef. Unpasteurized milk or apple cider, contaminated lettuce, lake water, petting zoos, and eating food prepared by people who have not properly washed their hands are just a few of the ways E. coli can be transmitted.

To help prevent E. coli infection, be sure to wash your hands after using the bathroom, going to a petting zoo, changing diapers, and before preparing food. Cook meats thoroughly to a temperature of at least 160°F (70˚C), avoid unpasteurized dairy and juices, avoid swallowing pool or lake water, and keep hands and kitchen utensils clean throughout the cooking process.

Here are more experts tips on preventing food poisoning.

Traveler’s Diarrhea: Play it Safe

Holiday travel to developing foreign countries in Africa, Asia, Latin America, the Middle East and the Caribbean may up your risk for foodborne illness.

Food or water contaminated with bacteria, viruses or parasites can lead to traveler’s diarrhea; E. Coli is the most common culprit. To avoid traveler’s diarrhea, follow these tips:

  • Use bottled water for drinking, for ice for drinks, and for brushing teeth
  • Only drink pasteurized milk or juice products
  • Avoid raw fruits and vegetables, unless you peel them yourself
  • Skip raw or undercooked fish or meat
  • Steer clear of food from street vendors.

Usually traveler's diarrhea clears up on it's own, but a doctor may prescribe antibiotics in rare cases, for treatment. Azithromycin (Zithromax), fluoroquinolones like ciprofloxacin (Cipro), and rifaximin are recommended antibiotic options, depending upon region.

To help prevent traveler's diarrhea, some doctors suggest taking bismuth subsalicylate (Pepto-Bismol), which has been shown to decrease the likelihood of diarrhea. However, don't take this medication for over 3 weeks, if you're pregnant, allergic to aspirin, or taking certain medications, such as anticoagulants (blood thinners). Common but harmless side effects of bismuth subsalicylate may include a black-colored tongue and dark stools. In some cases it can cause constipation, nausea or ringing in your ears (tinnitus).

Learn More: 2017 guidelines "Guidelines for the Prevention and Treatment of Travelers’ Diarrhea: a Graded Expert Panel Report"

Food Poisoning: Is it Treatable?

Foodborne illness is nothing to celebrate.

Luckily, time and fluid and electrolyte replacement are usually the only treatments needed for most foodborne illnesses.

Some over-the-counter (OTC) medications, such as loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol) may be appropriate to slow diarrhea; however, retaining toxins in the gut can be dangerous, too, so always check with your doctor before you use these products.

If you have bloody diarrhea, which may be a sign of infection, do NOT use these medications. In children, always get the doctor’s okay. At the doctor's discretion, antibiotics may be used in some, but not all, cases.

Foodborne Illnesses: When to See Your Doc

While it is true that most food poisoning episodes will clear up on their own, some symptoms may suggest you need to see a doctor right away:

  • Dehydration
  • Prolonged vomiting and inability to keep liquids down
  • Diarrhea for over 2 days in adults and 24 hours in kids
  • Severe pain in the stomach or intestine
  • Fever over 101 degrees F (38 degrees C)
  • Stools that are black, tarry with blood or pus
  • Check with your doctor at any time for foodborne illness in children

Keep Your Independence From Foodborne Illness

Here's a general overview of tips that's good advice to apply to all food situations:

  • Cook meats, poultry, and eggs thoroughly.
  • Don't cross-contaminate one food with another; the same goes with utensils.
  • Refrigerate leftovers immediately; When in doubt, throw it out!
  • Clean fresh fruits and vegetables with running water.
  • Don't be a source of foodborne illness yourself - wash your hands with soap and hot water.
  • Avoid water, fruits, raw fish or meat when traveling abroad to developing countries.

Finished: Foodborne Illness: The Guest Nobody Invited

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Sources

  • Riddle M, Connor B, Beeching N, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. Journal of Travel Medicine, Volume 24, Issue suppl_1, 1 April 2017, Pages S63–S80. Accessed Nov. 9, 2017 at https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/tax026
  • Pet Turtles: Cute But Commonly Contaminated with Salmonella. US Food and Drug Administration (FDA). Accessed November 9, 2017 at https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048151.htm
  • Centers for Disease Control and Prevention (CDC). Foodborne Germs and Illnesses. Last updated: 12/21/2015. Accessed 11/9/2017 at http://www.cdc.gov/foodsafety/foodborne-germs.html
  • U.S. Department of Health & Human Services (HHS). Keep Food Safe. Accessed 11/9/2017 at https://www.foodsafety.gov/keep/index.html
  • National Digestive Diseases Information Clearinghouse (NDDIC). Foodborne Illnesses. Accessed 11/9/2017 at http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/#1
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