| am) DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control Diseases Transmitted Through The Food Supply Agency: Centers for Disease Control, Public Health service, HHS Action: Notice of final list of infections and communicable diseases that are transmitted through handling the food supply and the methods by which such diseases are transmitted. Summary: Section 103 (d) of the Americans with Disabilities Act of 1990 requires the Secretary to publish a list of infectious and communicable diseases that are transmitted through handling the food supply. The Centers for Disease Control (CDC) published an interim list and request for comments on May 16, 1991 (56FR22726) Six comments were received. The interim list was reviewed in light of the comments and the final list is set forth below. Press 'S' to stop or any other key to continue... Effective Date: August 16, 1991. For Further Information Contact: Dr. Morris E. Potter, National center for Infectious Diseases, Centers for Disease Control, 1600 Clifton Road, N.E. Mailstop COG, Atlanta, Georgia 30333; telephone (404) 839-2287. Supplementary Information: Section 103(d) of the Americans with Disabilities Act of 1990, 42 U.S.C. 12113(d), requires the Secretary of Health and Human Services to: 1. Review all infectious and communicable diseases which may be transmitted through handling the food supply; 2. Publish a list of infectious and communicable diseases which are transmitted through handling the food supply; 3. Publish the methods by which such diseases are transmitted; and 4. Widely disseminate such information regarding the list od diseases and their modes of transmissibility to the general public. Press 'S' to stop or any other key to continue... Additionally the list is to be updated annually. After consultation with the Food and Drug Administration, the National Institutes of Health, State and local health officers, and national public health organizations, CDC published an interim list and request for documents in the Federal Register on May 15, 1991 (56 FR22726). Six written comments were received; four before publication of the interim list and two during the comment period. Organizations representing the food processing/food service industries provided four of the comments; a professional medical association and an association representing State, local, and federal public health regulatory officials also submitted comments. In general, the commenters approved of the approach taken in response to the Act's requirements, especially the listing of relevant signs and symptoms that indicate the possibility of elevated risk of transmission of infectious and communicable disease through the handling of the food supply. Comment: Food industry associations and the medical association Press 'S' to stop or any other key to continue... expressed the view that persons who are sick should not handle food and therefore advocated expanding the list to include upper and lower respiratory tract infections. Response: Section 103(d) of the Act specifies that the infectious and communicable diseases to be listed are those that are transmitted from infected food workers through the handling of the food supply. Therefore, while infectious and communicable diseases exist that can be transmitted to the public and coworkers by routes other than through food, diseases spread through the air are inappropriate on this list. However, appropriate measures undertaken to protect the public;s health from non-foodborne diseases should not be constrained by this list. Comment: Commenters suggested that a wider range of skin lesions should be included (e.g., rashes, boils, acne, and burns). Response: Open skin lesions are included on the list to protect consumers from foodborne exposure to Staphylococcus aureus and Streptococcus pyogenes. While intact skin provides a measure of Press 'S' to stop or any other key to continue... protection, the presence of unruptured boils could indicate elevated risk to the public, and therefore boils are included in the final list. Comment: One respondent from the food service industry advocated adding to the list headache, unusual fatigue, unexplained chills, and conditions which would be likely to increase manual or airborne exposure to secretions and excretions, such as colostomy/ileostomy pouches, urinary catheters/pouches, incontinence, nasal catheters, blood clotting disorders, or other invasive or indwelling devices. Response: Headache, unusual fatigue and unexplained chill are not specific to or indicative of foodborne diseases that are likely to be transmitted from infected food workers through contamination of the food supply and are, therefore, inappropriate on this list. Persons with medical conditions that increase their contact with their secretions and excretions certainly require additional education about prevention of fecaloral transmission of disease-producing microorganisms and training regarding hand washing. However, in the absence of Press 'S' to stop or any other key to continue... evidence of infection by one of the listed pathogenic microorganisms, persons with such medical conditions do not require special consideration under section 103(d) of the Act. Comment: Comment was made that identifying pathogenic microorganisms by name and providing separate lists of pathogens that are often transmitted by contamination of the food supply and occasionally transmitted by such contamination is not helpful to managers in the food processing/food service industries. Response: The signs and symptoms in the list can inform the public and alert food workers and their employers of the possibility of increase risk of transmission of infectious diseases. Identifying specific pathogens and separating them according to whether infected food workers play a major or minor role may be helpful in guiding medical care providers and public health officials who may examine the food workers and determine the appropriate public health response. Separating disease according to whether infected food workers play a major or minor role also emphasized the importance of primary contamination of Press 'S' to stop or any other key to continue... raw food ingredients in the epidemiology of foodborne disease. Comment: Two respondents encouraged adding to the list food workers living with a person infected by the hepatitis. A virus and having travelled to countries with high rates of enteric diseases, including hepatitis a. Response: Persons infected with hepatitis A can transmit their infection for a few days before they become clinically ill. However, everyone exposed does not become infected and it seems unreasonable to exclude from food service all workers who have been potentially exposed to hepatitis A virus until they have passed the 15-50 day incubation period for the disease. Comment: the association representing regulatory officials representing regulatory officials advocated limiting the list to those diseases for which risk of transmission from infected food workers through contamination of the food supply has been established. Response: In fact, the list only contains such diseases. As Press 'S' to stop or any other key to continue... provided in the Act, we will consider new information as it becomes available and will update the list with additional pathogenic microorganisms when scientific evidence indicates that it is appropriate. Therefore, the final list of infectious and communicable diseases that are transmitted through handling the food supply and the methods by which such diseases are transmitted are set forth below: 1. Pathogens often Transmitted by Food Contaminated by Infected Persons Who Handle Food and the Modes of Transmission of Such Pathogens The contamination of raw ingredients from infected food-producing animals and contamination during processing are more important causes of foodborne disease than is contamination of foods by persons with infectious or contagious diseases. However, some pathogens are frequently transmitted by food contaminated by infected persons The presence of anyone of the following signs or symptoms in persons who handle food may indicate infection by Press 'S' to stop or any other key to continue... one of these pathogens; diarrhea, vomiting, open skin sores, boils, fe er, dark urine, or jaundice. The failure of food employees to wash hands (in situations such as after using the toilet, handling raw chicken, cleaning spills, or carrying garbage, for example), wear clean gloves, or use clean utensils is responsible for thee foodborne transmission of these pathogens. Non-foodborne routes of transmission such as from one person to another, are also important in the spread of these pathogens. Pathogens that can cause diseases after an infected persons handles food are the following: Hepatitis A virus Norwalk and Norwalk-like viruses Salmonella typhi Shigella species Staphylococcus aureus Streptococcus pyogenes II. Pathogens Occasionally transmitted by Food Contaminated by infected Persons who Handle Food, but Usually Transmitted by Contamination at the Source or in Food Processing or by Press 'S' to stop or any other key to continue... Nonfoodborne Routes Other pathogens are occasionally transmitted by infected persons who handle food, but usually cause disease when food is intrinsically contaminated or cross-contaminated during processing or preparation. Bacterial pathogens in this category often require a period of temperature abuse to permit their multiplication to an infectious dose before they will cause disease in consumers. Preventing food contact by persons who have an acute diarrhea illness will decrease the risk of transmitting the following pathogens: Compylobacter jejuni Entamoeba histolytica Enterohemorrhagic Escherichia coli Enterotoxigenic Escherichia coli Giardia lamblia Nontyphoidal Salmonella Rotavirus Vibrio cholerae 01 Yersinia entercolitica Press 'S' to stop or any other key to continue... References: 1. World Health Organization. Health surveillance and management procedures for food=handling personnel; report of WHO consultation. World Health Organization technical report series;785, Genova;World Health Organization, 191989. 2. Frank F. Barnhart HM Food and dairy sanitation. In: Last Med Maxcy-Rosenau public health and preventive medicine 112th edition, new York; Appleton-Century-Crofts, 1988;765-806. 3. Bennett V Holmberg SD Rogers MF Solomon SL Infectious and parasitic diseases In: Amler RW, Dull HB, eds. Closing the gap; the burden of unnecessary illness. New York: Oxford University Press, 1987;102-114. Dated: August 9, 1991 Walter R. Dowdle, Acting Director, Centers for disease Control Press 'S' to stop or any other key to continue... FR Doc 81-19587 Filed 8-15-91; 8:45 | |
|
