ORAL FECAL
TRANSMITTED DISEASES
Omar Hamud
Content of the presentation
Basic concepts and definitions
Overview of the disease
Epidemiology
Risk factors
Prevention
Control
Introduction
Definition
Fecal oral diseases are those caused by fecal oral contamination whose causative organisms
are excreted in the stool of an infected person and then by various ways enter the mouth of a
susceptible person
The portal of entry for these diseases is the mouth. Therefore, the causative organisms have
to pass through the environment from the feces of an infected person to the gastro intestinal
tract of a susceptible person
This is known as the fecal oral transmission route
Feco-oral Disease
The fecal–oral route (also called the oral–fecal route or orofecal route)
describes a particular route of transmission of a disease where pathogens in fecal
particles pass from one person to the mouth of another person.
Feco-oral disease are an important cause of
morbidity worldwide
and represent the second largest cause of death globally among children aged under 5
years.
The World Health Organization (WHO) estimates that 1.5 million children in this age
group die from diarrheal diseases every year, almost half of them in Africa.
The most vulnerable children are the youngest ones, particularly before their second
birthday
The elderly remain especially susceptible to the complications of diarrhea and account for
85% of related deaths
Diarrhea : Is derived from Greek word ,meaning (flowing through)
defined by WHO:
Three or more watery stool in 24hrs or passing more stool than normal for age .
Diarrhea defined as
acute if present for less than 2 weeks
persistent if present for2-4 weeks
chronic if greater than 4weeks in duration.
Infectious agents account for 90% of cases of acute diarrhea, and bloody diarrhea.
The majority of patient with acute diarrhea not seek medical attention and investigation are
frequently omitted in those who do,
therefore the prevalence of infectious diarrhea is grossly under estimated.
Most are viral,
with bacterial stool culture positive less than 5% of presentation
Causes of diarrhea
Bacterial causes
1-Vibrio cholera
2-Salmonella
3-E coli
4-Shigella
5-Campylobacter species
Viral causes of diarrhea
1-Rota virus
2-Entero virus
3-Adeno virus
Viral gasteroenterpathy is most common etiological agent of the nonbacterial
gastroenteritis outbreak worldwide and all age groups are affected.
Parasitic causes of diarrhea
1-Entameba histolytica
2-Giardia lamblia
3-Cryptosporidosis
Other causes of diarrhea
1-Inflammatry bowel disease
2-Ischemic colitis
3-Acut diverticulitis
4-Toxin
5-Hyperthyrodism
6-Diabetus mellitus
7-Antibiotic and medication
Mode of Transmission
-Most diarrheal Causative agents are transmitted by the fecal-oral route .
-Some viruses ( such as Rotavirus ) can be transmitted through air .
-Nosocommial transmission is possible .
faeco-oral transmission means ‘from feces to mouth’. But
the route can either be
direct transmission from contaminated hands touching the
mouth and transferring the infectious agents directly;
or indirect transmission through consumption of food or
water, or using utensils
contaminated with the infectious agents
Cont..
Fecal oral transmission occurs mostly through unapparent fecal contamination of food,
water and hands
Food takes a central position: it can be directly or indirectly contaminated via polluted
water, dirty hands, contaminated soil or flies
The five Fs which play an important role in fecal oral disease transmission (finger,
flies, food, fomites and fluid)
Direct pathway; feces-fingers-food
Indirect pathway; passes through fluids and fomites
Fecal oral transmission route
Person at risk:
Cholera : 2 years and above
Shigellosis : Children below 5 years .
Rotavirus : infants and children aged 1-2 years .
E.coli : all age groups .
Amoebiasis : adults
Diarrhea results in dehydration –
The rapid loss of body fluids and important salts required for proper control of body functions,
particularly in the brain, nerves and muscles.
Children are highly susceptible to dehydration if they have diarrhoea, even after only one day;
they can quickly die if the fluid loss is continuous .
Medication
Antimicrobial according to the type of pathogens, most
cases of diarrhea are self limiting and cure with
supportive therapy.
Anti motility and anti-diarrhoeal may be toxic and should
be avoided.
Medical staff and parents have to concentrate on essential
treatment which is rehydration
Preventive measures for diarrhea.
1-health education.
2-provision of adequate water supply.
3-effective sewage system and proper sanitation.
4-good personal hygiene and hands washing.
5-control of insects.
6-breast feeding.
7-immunization.
Cholera
Cholera is an acute diarrheal illness caused by infection of
the intestine with the bacteria Vibrio cholerae
Cholera is an intestinal disease which is characterised by
sudden onset of profuse watery stools and vomiting
leading to severe dehydration, acidosis and circulatory
collapse
Epidemiology
Cholera was prevalent in the 1800s but due to proper treatment of sewage and drinking
water has become rare in developed countries
Cholera is a fecal disease meaning that it is spread when feces of an infected person
come into contact with food or water
It is caused by a small comma shaped motile organism called vibrio cholerae
There are about four sub strains of the cholera vibrio namely El Tor, Ogawa, Luaba and
Hikojima. The El Tor sub strain causes cholera epidemics in East Africa
Incidence; 1 in 100,000 world wide
Over 1 million cases and nearly 10,000 fatalities
Cont.
The vibrios are very sensitive to the hydrochloric acid found in the human stomach and so
a large number of organisms must be ingested for infection to occur
Cholera occurs in all parts of the world where the living conditions are unsanitary
In sea water, the organisms can live even longer multiplying in crabs and shrimps
Vibrios also multiply in certain foods such as milk and boiled rice
What is the role and importance of
carriers
The reservoir of infection in cholera is formed mainly by the carriers
For every clinical case of cholera there may be 50-100 asymptomatic carriers
Although the carriers excrete a smaller number of vibrios than the patients, they form
the greatest danger to the community because of their sheer number and freedom of
movement
Pathophysiology of cholera
Signs and symptoms
Most people remain asymptomatic. The symptoms of cholera include;
Cholera beds
Risk factors
Poor sanitary conditions
Raw or uncooked food
Hypochlorhydria
Causes (transmission mode)
Diagnosis
Prognosis
The prognosis of cholera can range depending on the severity of dehydration and how
quickly the patient is given and responds to treatments
Death (mortality) rates in untreated cholera can be as high as 50%-60% during large
outbreaks but can be reduced to about 1% if treatment protocols are rapidly put into
action
Prevention
Basic health education and hygiene
Mass chemoprophylaxis
Provision of safe water and sanitation
Comprehensive multidisciplinary approach; water, sanitation
Controlling cholera
Bacillary dysentery (shigellosis)
Bacillary dysentery also known as shigellosis is an acute bacterial disease of the
intestines
It is common especially in areas where the standards of hygiene are low, particularly
where there is scarcity of safe water, improper human excreta disposal, large population
of flies and child malnutrition
Once again humans are the only known reservoir
Cont.
It is caused by a non motile gram-negative bacilli of the genus shigella spp. The
organisms responsible for outbreaks are:
Shigella sonnei
Shigella dysentriae
Shigella flexneri
Shigella boydii
However, the first three organisms are the most common causes of outbreaks
Mode of transmission
The mode of transmission of the disease is the fecal oral route
The organisms are transmitted directly through flies or contaminated hands.
Indirect transmission may also occur through dishes which are poorly washed
The shigella multiply in food which when ingested causes dysentery
Prevention and control
The prevention and control of bacillary dysentery depends on stopping the fecal oral
transmission through the following ways:
Safe water supply
Improvement in personal hygiene
Digging and use of pit latrines
Practicing food hygiene
Giving health education that emphasizes environmental hygiene and breast feeding
Inspection of public eating places, markets, boarding schools and camps
Enteric fevers
Enteric fevers include typhoid fever and paratyphoid A and B fevers.
Typhoid fever is an infectious disease characterised by high continuous fever, malaise and involvement of
lymphoid tissue and spleen
Diarrhea is not a common symptom in typhoid fever
Paratyphoid fever may present like typhoid fever but in most cases, it presents as gastroenteritis or transient
diarrhea
Both are mainly spread by the fecal oral route through contaminated food, water and milk. Flies are also
important in the transmission of enteric fevers
Typhoid fever
A systemic infectious disease characterised by high continuous fever, malaise and
involvement of lymphoid tissues
Infectious agent
- Salmonella typhi
Salmonella enteritidis (rare cause)
The disease has a case fatality rate of 3% with treatment and 10% without adequate
antibiotics treatment.
Human beings are the only known reservoirs and host
Epidemiology
It occurs worldwide particularly in poor socioeconomic areas
Annual incidence is estimated at about 17 million cases with appropriately 600,000
deaths worldwide
In endemic areas the disease is most common in pre school and school aged children
(5-19) years of age
Reservoir – Humans
Mod of transmission – by water and food contaminated by feces and urine of patients
and carriers
Flies may infect foods in which the organisms then multiply to achieve an infective
dose
Incubation period – 1 to 3 weeks
Period of communicability
As long as the bacilli appear in excreta usually from the first week throughout
convalescence
About 10% of untreated patients will discharge bacilli for 3 months after on set of
symptoms and 2%- 5% become chronic carriers
Susceptibility and resistance
Susceptibility is general and increased in individual with gastric achlorhydria or those
are HIV positive
Relative specific immunity follows recovery from clinical disease, unapparent infection
and active immunisation but inadequate to protect against subsequent ingestion of large
numbers of organisms
Prevention and control
The prevention and control of typhoid fever is similar to that of many diarrhea diseases
Treatment of patients and carriers
Education on handwashing particularly food handlers, patients and child care givers
Sanitary disposal of feces and control of flies
Prevention and control
Provision of safe and adequate water
Safe handling
Exclusion of typhoid carriers and patients from handling of food and patients
Immunisation for people at special risk (e.g. Travelers to endemic areas)
Regular checkups of food handlers in food and drinking establishments
Paratyphoid fever
This is the second type of enteric fever which was mentioned earlier.
It is caused by bacteria known as salmonella Para typhi types A,B and C
The disease runs a milder cause than typhoid fever and also has enlargement of the
spleen, bloodstained diarrhea and swelling of the peyer's patches
Prevention and control
The prevention and control measures are similar to those that were covered under
typhoid fever
Giardiasis
This is an infection of the small intestines by protozoa called giardia lamblia
The disease may be mild (asymptomatic) in some individuals while in others it may
cause diarrhea, malabsorption of digested nutrients and weight loss
Giardiasis if found in all the countries of the world but it is more common in
developing countries where the water supply may be contaminated by human faces or
sewage
Mode of transmission
Often the disease is spread from person to person within families by asymptomatic
carriers
Cysts which are excreted in the stool of an infected person remain infectious for up to
three months in cold water or four days if the temperature is 37oC
As soon as the cysts are ingested by a human being, they are activated by the
hydrochloric acid in the stomach
Trophozoites emerge and adhere to the wall of the upper portion of the small intestine.
Here they begin to multiply and in about 10-14 days, the symptoms manifest
Prevention and control
The cysts of giardia lamblia are not affected by chlorine treatment of water or by iodine
However, they are highly susceptible to heat, therefore the following preventive
measures are important
Cooking food and boiling drinking eater to kill the cysts
Advise people to avoid eating raw salads, ice cream, unpeeled fruit and ice cubes in
endemic areas
Use of sand filters is also effective in protecting water from giardia cysts
Tracing and treatment of unhealthy human carriers
Amoebiasis
This is a protozoal infection mainly of intestinal mucous membrane in humans caused
by entamoeba histolytica
The disease is found in all parts of the world but more common where sanitary
conditions are poor
Amoebiasis can occur in families or spread through institutions but usually does not
occur in epidemics
It can be endemic in a population in which many individuals are asymptomatic cyst
passers with only a few getting the disease
Mode of transmission
Cysts are passed from person to person by fecal oral route by fingers soiled with feces
either directly into the mouth or via food
Infections may also occur from drinking contaminated water
Amoebiasis can occasionally spread from the bowels to other organs of the body,
especially to the liver leading to amoebic liver disease
Prevention and control
Who is responsible for the spread of amoebic dysentery
It is the cysts-passers who are usually asymptomatic
Therefore, in order to prevent and control this disease you need to do the following:
Advise people to boil drinking water (chlorination does not kill the cysts)
Commence a campaign for more latrines in an area with endemic amoebiasis
Conduct community campaigns about good personal hygiene practices such as regular
hand washing
Viral hepatitis
This is an acute viral disease which mainly affects the liver causing inflammation of liver cells
(hepatocellular inflammation) followed by jaundice
1. The disease is found in all the countries in the world
2. There are five types of viruses which cause hepatitis. These are
Hepatitis A Virus
Hepatitis B Virus
Hepatitis C Virus
Hepatitis D Virus
Hepatitis E Virus
Cont.
Hepatitis A virus causes infections hepatitis and is the most infectious of these viruses
while Hep B virus causes serum hepatitis (also called epidemic hepatitis)
The Hep B virus causes chronic active infection of the liver (hepatitis) which may be
followed some ten years later by liver cirrhosis (in 10-20% of patients)
In some of the patients who develop cirrhosis the disease progresses to liver cancer
(hepatocellular carcinoma)
Cont.
Hep B infection occurs in about 1-3% of the human beings but the incidence may be
higher in patients undergoing kidney dialysis and in cancer wards (due to repeated
blood transfusions) and among children because of close personal contact
It is difficult to tell the difference between infectious hepatitis and serum hepatitis on
clinical observation alone
Mode of transmission
Those at risk of hepatitis
Reservoirs of Hep B virus include sexually promiscuous individuals
Spouse of acutely infected person
Health workers exposed to blood
Family members of chronically infected persons
Anyone who requires repeated blood transfusion
Prevention and control
Bacterial food poisoning
Clostridium Botulinum food poisoning
Prevention and control
Health education to encourage people to serve meals immediately they are prepared in
order to prevent growth of organisms such as staphylococci
Keeping food covered to keep off dust and rodents
Thorough reheating of left over foods
Refrigerating cooked food
Keeping the kitchen and cooling areas clean
Foodborne illness
Foodborne illness
Food borne disease” is defined as a disease caused by agents
that enter the body through the ingestion of contaminated food
and water.
These agents may be infectious agents or toxic substances.
Food borne illnesses have significant impact worldwide
including developed nations.
causes of foodborne illness
The causes of foodborne illness fall into the following 3
categories:
1. Biological hazards include bacteria, viruses, and parasites.
Bacteria and viruses are responsible for most foodborne illnesses.
Biological hazards are the biggest threat to food safety. They can
be inherent in the product .
2.Chemical hazards due to consumption of food contaminated
by chemical poisons.
include natural toxins and chemical contaminants
Some natural toxins are associated with the food itself (i.e.,
certain mushrooms)
some are made by pathogens in the food when it is
time/temperature abused .
Some additives, such as sulfites, can be a hazard to some
people.
Chemical contamination can occur when products (i.e.,
cleaners) are not used correctly.
Contamination of food can happen at any point during
production, growing, harvesting, processing,
storing, shipping, or preparing.
3. Physical hazards can include metal shavings
from cans and plastic pieces
types of foodborne illness
Pathogens can cause different types of foodborne illness:-
Illness can be caused by the pathogens themselves
(foodborne infection);
caused by toxins produced in the food by pathogens
(foodborne intoxication)
and caused by toxins produced in the body by pathogens
(foodborne toxin-mediated infection).
Bacterial pathogens
Clostridium botulinum
Escherichia coli
Listeria
Salmonella
Vibrio cholerae
Others
Viral pathogens
Enterovirus
Hepatitis A
Hepatitis E
Rotavirus
Risk group
Foodborne illness can affect anyone who eats contaminated
food;
however, certain populations are more susceptible to
becoming ill with a greater severity of illness.
These populations include infants and children, the elderly,
pregnant women,
people taking certain kinds of medications or immune
suppressed (e.g., cancer patients, diabetics).
complications of foodborne illnesses
Dehydration.
HUS.(E.COLI)
Others:
Abortion, still birth (c.botulism)
Research suggests that acute foodborne illnesses may
lead to chronic disorders, including
Reactive arthritis
Irritable bowel syndrome.
Guillain Barre syndrome.
Prevention and Control of Food-borne Diseases
Prevention and control of food–borne diseases, regardless of the
specific cause, are based on the same principles:
1. Avoidance of food contamination
2. Destruction or prevention of contaminants
3. Prevention of further spread or multiplication of
contaminants.
Specific modes of intervention vary from area to area
depending on environmental, economic, political,
technology and socio-cultural factors.
The preventive and control strategies may be approached
based on the major site in the cycle of transmission or
acquisition where they are implemented.
These involve the activities performed at:
-Source of infection,
-Environment
- Host
Source of infection
Thorough cooking of raw food.
Thorough washing of raw vegetables with clean water
Keeping uncooked animal products far separate
from cooked and ready-to-eat foods.
Avoiding raw milk or foods made from raw milk.
Appropriate heat treatment of food items before
consumption
Barriers for prevention of fecal oral
disease
Barrierscan stop the transmission of disease; these can be
primary (preventing the initial contact with the feces) or
secondary (preventing it being ingested by a new person)
They can be controlled by interventions towards
- water
- sanitation
- hygiene
How do we prevent epidemics?
Epidemics of fecal-oral infections can be prevented by some simple actions:
• Hygiene. Wash hands with soap at critical times, especially after going to the toilet, after
cleaning children’s bottoms, and before preparing food and eating.
• Drink only clean and safe water. Where safe drinking water (including bottled water) is
unavailable, boil or filter water or treat it with chlorine, and store it in clean containers.
• Eat safe food. Wash vegetables and fruits with safe water, thoroughly cook meat and other
animal products, store food in clean conditions and reheat food before eating it.
• Build appropriate sanitation facilities (latrines) in the community. This will help reduce the
likelihood that stools will contaminate water or food. Special care should be taken with
children’s stools, which should be properly disposed of in the latrine or buried.
• Breastfeed babies during the first six months of life. Exclusive breastfeeding will protect
infants and prevent severe forms of diarrhea. Breastfeeding should not be interrupted when a
child is sick because it is not the cause of the diarrhea and has a continuous beneficial effect on
survival.
THANK YOU
