Symptoms
Symptoms usually start within 12 to 36 hours of eating food contaminated with Clostridium botulinum.

• blurred vision
• dry mouth
• paralysis of the muscles, particularly muscles that control the face, swallowing and breathing
• constipation

How It Is Spread

• Clostridium botulinum spores are common in the soil and can often be found on agricultural products.
• Poorly prepared, home canned vegetables and fruits are the most common source. Toxins are formed when foods are inadequately heated during canning.
• Illnesses have also occurred with commercial products such as potpies, baked potatoes, garlic in oil, and sauteed onions and cured foods in airtight packaging.
• Honey can be a source of botulism for infants because honey often contains Clostridium botulinum spores.

Diagnosis & Treatment

• The bacteria can be cultured from the stool (feces), but diagnosis is usually made by identifying the toxin in blood, stool or suspected food.
• Requires immediate medical attention.

Prevention

• Follow proper home canning techniques (the time, pressure, and temperature required to destroy spores).
• Never eat food from damaged cans (food cans with slits, holes, dents or bulges).
• Do not feed honey or honey-water to infants under 12 months of age.

CAMPYLOBACTERIOSIS
Campylobacteriosis is an infection of the intestines caused by bacteria called Campylobacter jejuni. The bacteria is commonly found in the feces of infected people and animals.

Symptoms
Infected persons may have mild symptoms or no symptoms at all.  Symptoms start 1 to 10 days after exposure, but usually within 3 to 5 days.

• Mild to severe diarrhea (may be bloody)
• Stomach cramps
• Fever (can be high)
• Vomiting
• Convulsions (in severe cases)

How It Is Spread

• People can get the infection by eating contaminated food, or by drinking contaminated water or unpasteurized milk. The bacteria are often found in poorly cooked meat or poultry.
• People can also get the illness from infected pets (especially puppies and kittens with diarrhea), or from handling wild animals.
• The bacteria can also be spread from an infected person to others.  Bacteria leave the body in the stool and enter another person when hands, food, or objects, contaminated with stool, are put in the mouth.
• Infected persons or animals are contagious as long as the bacteria are in the stool – this may be several days or weeks.

Diagnosis & Treatment

• The disease can be diagnosed from a stool sample.
• Most people recover without treatment. If the infection is severe or prolonged, an antibiotic may be prescribed.

Prevention

• Wash hands well with soap and warm water after using the bathroom or changing diapers. Make sure children also wash their hands well after going to the bathroom.
• Wash hands well before and after preparing food, especially after handling raw meat or poultry.
• Do not drink unpasteurized milk or eat cheese made from unpasteurized milk.
• Thoroughly cook all meats, especially poultry.
• Make sure that other foods, such as fruits or vegetables, do not come into contact with cutting boards or knives that have been used with raw meat or poultry. Wash, rinse, and sanitize contaminated surfaces carefully to avoid cross-contamination.
• Wash hands after handling animals, including pets, and their waste.

CLOSTRIDIUM PERFRINGENS POISONING
Clostridium perfringens is an anaerobic, spore former (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution.

Symptoms
Many times, people confuse this foodborne illness with the "24-Hour Flu."  The illness is usually over within 24 hours.  Less severe symptoms may last longer for some people, especially very young or elderly people

• Intense abdominal pain
• Diarrhea begins 8 to 22 hours after eating foods that contain these bacteria
• Dehydration can occur with this type of foodborne illness

How It Is Spread

• Poor temperature control
• Between the temperatures of 70ºF and 140ºF, when air and moisture levels are right, these organisms will produce the toxin that makes people sick.
• Meats, meat products, and gravy are the foods most frequently containing the spores.

Diagnosis & Treatment

• Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. The bacteria can be identified from a stool sample.
• Diagnosis is confirmed by detecting the toxin in the feces of patients.
• Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients.

Prevention

• Thoroughly cook foods with meat – such as stews, soups and casseroles.
• Keep hot foods hot (above 140ºF) and cold foods cold (below 45ºF).
• If you have a large portion of food leftover, divide it into smaller portions less than two inches deep to refrigerate so it cools quickly.  Leave the food uncovered until it reaches 45ºF.
• Reheat foods to at least 165ºF.

ESCHERICHIA COLI INFECTION
Escherichia coli (E. coli) are bacteria that normally live in the intestines of humans and animals. There are many strains of E. coli bacteria. Most of them are harmless. However, one particular strain, E. coli O157:H7, may cause serious illness in people. Cattle may be a prime source of infection for people.

Symptoms
Symptoms appear from 1 to 10 days after exposure, usually within 2 four 4 days.

• Diarrhea (which often becomes bloody)
• Stomach cramps
• Slight fever (often no fever)

How It Is Spread

• It can spread from cattle to people through raw or undercooked meat, unpasteurized milk or contaminated water, or by foods which were contaminated by raw beef products.
• An infected person may spread the illness to others by failure to wash hands well after a bowel movement.

Diagnosis & Treatment

• E. coli O157:H7 is diagnosed by examining a stool sample. This requires a special test that is not available in all laboratories. If an E. coli O157:H7 infection is suspected, a health care provider must request a culture for this bacteria so that the stool sample will be sent to a laboratory that can perform the test.
• The diarrhea usually goes away in a few days without treatment. As with any diarrhea, it is important to drink plenty of fluids to prevent dehydration (fluid loss). Do not use anti-diarrhea medicines.

Prevention

• Cook all meat, especially ground beef, thoroughly. Contaminated meat looks and smells normal. There is no risk from E. coli O157:H7 if the meat is thoroughly cooked.
• Wash hands thoroughly after handling raw hamburger.
• Clean all utensils and surfaces after contact with raw meat.
• Make certain that cooked meat is gray or brown (not pink) throughout.  Cook ground beef to 155ºF.  There should be no bloody juices.
• If you are served pink meat, especially hamburger, in a restaurant, send it back for further cooking.
• Drink only pasteurized milk. Eat only milk products (for example cheese) made with pasteurized milk.
• Wash hands frequently and thoroughly, using soap and warm water. Wash after going to the bathroom or changing a diaper and before preparing or eating food.
• Teach children good hygiene habits.
• Keep infected children away from other children and the elderly and follow your health care provider's advice about returning to school or day care.

Hemolytic Uremic Syndrome
Hemolytic Uremic Syndrome (HUS) is a serious complication of E. coli O157:H7 infection.  The bacteria produce a toxin that causes anemia and damage to kidneys and blood vessels.  Although most people recover, this damage can be permanent.  It is more common in children than in adults. It is not known why some people develop HUS, while others do not.

HEPATITIS A
Hepatitis A is a viral infection that causes damage to the liver.

Symptoms
Symptoms usually begin 2 to 6 weeks after exposure to the virus. The duration of illness varies; most people recover within 3 weeks. Hepatitis A infection is more severe with age, and in rare circumstances, can cause severe complications and liver failure.  People can have all or only a few of the following symptoms.

• In adults, early symptoms include nausea (upset stomach), loss of appetite, vomiting, fatigue, fever, and abdominal cramps (stomach or side pain).
• Young children who are infected with hepatitis A may have only a mild flu-like illness without jaundice, or may have no symptoms.
• Dark yellow or brown urine, pale or white-colored stool (bowel movements), and jaundice (yellow eyes or skin) may also be present but do not occur in all cases.

How It Is Spread

• The virus lives in the liver and is passed in the stool.
• A person can be infected when hands, food, or objects contaminated with stool are put in the mouth. The amount of contamination needed to spread the infection is very small and is not visible to the eye.
• Hepatitis A can be spread when an infected person does not thoroughly wash his/her hands after going to the bathroom.
• Hepatitis A can be spread through drinking water or eating shellfish contaminated with the virus.
• Hepatitis A can also be spread through sexual activity if hands or mouth come in contact with stool or parts of the body contaminated with stool.
• Hepatitis A is not spread by kissing, sneezing, or by saliva.
• A person is most contagious during the 2 weeks before the illness symptoms begin.

Diagnosis & Treatment

• Hepatitis A is diagnosed by a blood test called the hepatitis A IgM test.
• The recommended treatment of hepatitis A includes rest, a low fat diet, and plenty of fluids. 
• Avoid drugs and alcohol.

Prevention

• Wash hands thoroughly with soap and warm, running water after using the toilet, changing diapers, and before preparing or eating food.
• Keep bathrooms clean and supplied with soap and clean towels.
• Change diapers on surfaces that can be cleaned and sanitized after every use.
• Never change diapers on eating or food preparation surfaces.
• Cook shellfish thoroughly before eating.
• Drink water from approved sources only.
• Hepatitis A vaccine provides protection against hepatitis A for many years. The vaccination series consists of 2 doses that are given at least 6 months apart.

Symptoms

• Fever, muscle aches, and sometimes gastrointestinal symptoms such as nausea or diarrhea.
• If infection spreads to the nervous system, symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can occur.
• Infected pregnant women may experience only a mild, flu-like illness; however, infections during pregnancy can lead to premature delivery, infection of the newborn, or even stillbirth.

How It Is Spread

• Listeria monocytogenes is commonly found in soil and water.
• The bacterium has been found in a variety of raw foods, such as uncooked meats and vegetables, as well as in processed foods that become contaminated after processing, such as soft cheeses and cold cuts at the deli counter.
• Unpasteurized (raw) milk or foods made from unpasteurized milk may contain the bacterium.
  Eating food contaminated with Listeria.
• Babies can be born with listeriosis if their mothers have eaten contaminated food during pregnancy.

Diagnosis & Treatment

• If you have symptoms such as fever or stiff neck, consult your doctor. A blood or spinal fluid test (to cultivate the bacteria) will show if you have listeriosis.
• During pregnancy, a blood test is the most reliable way to find out if your symptoms are due to listeriosis.
• When infection occurs during pregnancy, antibiotics given promptly can often prevent infection of the fetus or newborn.
  Babies with listeriosis receive the same antibiotics as adults,
• Even with prompt treatment, some infections result in death. Serious infections are more likely in the elderly and in persons with other serious medical problems.

Prevention

• Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.
• Wash raw vegetables thoroughly before eating.
• Keep uncooked meats separate from vegetables, cooked foods, and ready-to-eat foods.
• Avoid raw (unpasteurized) milk or foods made from raw milk.
• Wash hands after handling uncooked foods.
• Wash, rinse, and sanitize knives and cutting boards that contact uncooked foods.

Additional recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems:

• Avoid soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. Hard cheeses, processed cheeses, cream cheese, cottage cheese, or yogurt need not be avoided.
• Left-over foods or ready-to-eat foods, such as hot dogs, should be cooked until at least 165°F before eating.
• Although the risk of listeriosis associated with cold cuts is relatively low, pregnant women and immunosupressed persons may choose to avoid these foods or thoroughly reheat before eating.

NORWALK-LIKE VIRUS

Common names for illnesses from Norwalk and Norwalk-like viruses are viral gastroenteritis, acute nonbacterial gastroenteritis, food poisoning, and food infection.

Symptoms
The disease is usually mild and brief. It will develop 24 to 48 hours after consumption of contaminated food or water and lasts for 24 to 60 hours.  Symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Headache and low-grade fever may occur

How It Is Spread

• Norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods.  The infectious dose is unknown but presumed to be low.
• An infected person may spread the illness to others by failing to wash hands thoroughly after a bowel movement.
• Secondary person-to-person transmission has been documented.
• Water is the most common source of outbreaks and may include water from municipal supplies, wells, recreational lakes, swimming pools, and water stored aboard cruise ships.
• Shellfish and salad ingredients are the foods most often implicated in Norwalk outbreaks. Ingestion of raw or insufficiently steamed clams and oysters poses a high risk for infection with Norwalk virus.
• Foods other than shellfish are contaminated by ill food handlers.

 Diagnosis & Treatment

• Identification of the virus can be made from stool samples collected early in the course of the illness.

Prevention

• Wash hands well after going to the bathroom, after changing diapers, after animal contact, and before and after preparing food.
• Protect water supplies from human and animal waste.
• Drink and use only pasteurized milk.
• Cook food thoroughly.

SALMONELLA POISONING
Salmonellosis is an infection of the intestines caused by bacteria called Salmonella.

Symptoms
Symptoms usually develop 6 to 72 hours after bacteria are swallowed.  Symptoms may disappear untreated within 2 to 5 days.

• Diarrhea
• Stomach cramps
• Headache
• Fever
• Vomiting (sometimes)
• Dehydration, especially among infants and the elderly.

How It Is Spread

• Salmonella bacteria leaves the body in the stool. If infected people fail to wash their hands well after going to the bathroom, they can pass the bacteria to others from their hands.
• Salmonella can be spread by contaminated food, water, or milk.
• Salmonella spreads through contact with infected animals, especially poultry, pigs, cattle, rodents, and pets such as reptiles, chicks, ducklings, turtles, dogs, and cats.
• Outbreaks of salmonella are usually traced to foods such as:
• commercially processed meat products
• inadequately cooked poultry and poultry products
• uncooked or lightly cooked foods containing eggs and egg products
• unpasteurized milk and dairy products
• foods contaminated with feces of an infected food handler
• Salmonella contamination has been identified in food that was processed or prepared with contaminated cooking utensils or on contaminated cutting boards or counter tops.

Diagnosis & Treatment

• Salmonella infection can be diagnosed from a stool sample.
• Most people recover on their own without any treatment.
• Drink plenty of liquids (clean water, clear juices, and soup) to prevent dehydration (fluid loss).

Prevention

• Wash hands thoroughly after going to the bathroom and before eating or preparing food.
• Cook all meats, particularly poultry, pork, egg products and meat dishes thoroughly.
• Wash, rinse, and sanitize food preparation surfaces and utensils after each use (1 teaspoon liquid household bleach per gallon of water can be used for sanitizing).  Do not rinse.  Let air dry.  Prepare fresh bleach solution frequently throughout the day.
• Do not eat raw or undercooked eggs.
• Drink only pasteurized milk.
• Dispose of diapers properly and wash your hands after changing diapers.
• Refrigerate food promptly.

NOTE: People who have diarrhea should avoid handling food or caring for children or patients. Children who have diarrhea should not go to child care.

SHIGELLOSIS
Shigellosis is an infection of the intestines caused by bacteria called Shigella.

Symptoms
Illness usually begins 1 to 4 days after swallowing the bacteria and may last 4 to 7 days. Sometimes people have no or few symptoms. Symptoms include:

• Diarrhea (may be watery or bloody)
• Fever
• Stomach cramps
• Nausea or vomiting
• Severe cases may cause dehydration (loss of fluids) or convulsions (in young children).

How It Is Spread

• Shigella bacteria leave the body in the stool. If infected people fail to wash their hands well after going to the bathroom, they can pass the bacteria to others from their hands.
• Spread can occur whether or not the infected person has symptoms.
• Flies can spread Shigella when they have contact with infected stool and then contaminate drinking water or food.

Diagnosis & Treatment

• Shigella can be identified from a stool sample.
• Antibiotics can be prescribed to shorten both the duration of illness and the length of time bacteria are passed in the stool.
• Sometimes the infection clears without treatment.

Prevention

• Shigellosis can be prevented by practicing good hygiene and sanitation. Wash hands well with soap and water each time you use the bathroom.
• Keep your home and surroundings clean to prevent contamination of food and water supply. Pay special attention to the proper disposal of soiled diapers and other human waste.
• Keep kitchen work surfaces clean.

NOTE: It is important that infected food handlers, child care workers, children attending child care, and patient care providers stay away from their regular activities until they have completed at least 5 days of a proper antibiotic treatment or have had two consecutive shigella negative stool samples.

STAPHYLOCOCCUS AUREUS INFECTION
Staphylococcus aureus (often referred to as "Staph") is a common cause of foodborne illness.  It is a bacterium that produces a poison/toxin which causes the illness.

Symptoms
Symptoms are usually rapid and in many cases serious, depending on individual response to the toxin, the amount of contaminated food eaten, the amount of toxin in the food ingested, and the general health of the victim.  Some individuals may not always demonstrate all the symptoms associated with the illness.  Recovery generally takes two days.  However, it is not unusual for complete recovery to take three days or longer.  Symptoms include:

• Nausea
• Vomiting
• Abdominal cramping
• Prostration
• In more severe cases, headache, muscle cramping, and changes in blood pressure and pulse rate may occur.

How It Is Spread

• People can contract the illness by eating food that is contaminated with any one of many strains of staph, usually because the food has not been kept hot enough or cold enough. Staph bacteria grow and reproduce at temperatures from 50ºF to 120ºF, with the most rapid growth occurring near body temperature (about 98ºF).
• Foods that are frequently implicated in staphylococcal food poisoning include:
• Meat and meat products;
• Poultry and egg products;
• Salads such as egg, tuna, chicken, potato, and macaroni;
• Bakery products such as cream-filled pastries, cream pies, and chocolate eclairs;
• Sandwich fillings;
• Milk and dairy products;
• Foods that require considerable handling during preparation and kept at improper temperatures after preparation;
• Raw milk and raw milk products.

Diagnosis & Treatment

• The bacteria can be identified from a food sample.
• Most people recover without treatment.

 Prevention

• Wash hands thoroughly before and after all food preparation.
• Any food service worker who has skin infections should not be handling food.
• Food preparation equipment must be thoroughly washed before it is used.
• Refrigerate meats and leftovers promptly.
• Keep hot foods hot (over 140ºF) and cold foods cold (below 45ºF).
• Employees must bandage burns, cuts or sores on their hands and cover the area with disposable food service gloves.
• The toxin produced by staph bacteria is very heat-stable – so it is not easily destroyed by heat at normal cooking temperatures. The bacteria may be killed, but the toxin remains. Careful handling of food that is prepared ahead of serving is important. This is especially important with foods left over after one meal and planned to be used again at a later meal. Quick cooling and refrigeration, or holding at or above 140ºF, can help ensure that toxin has no chance to be formed.

VIBRIOSIS
Vibriosis is caused by a contagious bacteria (germ) named Vibrio parahaemolyticus. The germ may be in coastal waters, or uncooked shellfish or finfish harvested from coastal waters.

Symptoms
Usually start 12 to 24 hours after exposure and include:

• Moderate to severe watery diarrhea
• Abdominal cramps
• Sometimes nausea and vomiting, fever, chills and headache

How It Is Spread

• Raw, infected shellfish
• Other foods can be "cross-contaminated."  For example, a food washed in contaminated sea water and not cooked before eating could be a source of vibriosis.

Diagnosis & Treatment

• The bacteria can be cultured from a stool sample.
• Treatment is not usually needed.
• Fluid replacement therapy may be needed.
• Antibiotics are usually not necessary, but may be prescribed in severe cases.

Prevention

• Thoroughly cook shellfish and finfish to at least 140ºF before eating.
• Do not rinse cooked shellfish or finfish with seawater which may be contaminated.
• Keep raw or cooked shellfish or finfish well refrigerated below 45ºF before serving.

YERSINIOSIS
Yersiniosis is an infection caused by a bacteria (germ) called Yersinia that is found in the stool (bowel movements) of infected people and animals and in some types of food. It does not come from the mouth of an infected person.

Symptoms
Sometimes people have no symptoms, yet carry the bacteria in their stool. People who have not taken an antibiotic treatment may have the bacteria in their stool for 2 to 3 months, even if they have no symptoms.  Symptoms start 3 to 7 days after exposure and include:

• Watery diarrhea
• Abdominal pain (sometimes like appendicitis)
• Fever
• A variety of other symptoms such as nausea or vomiting.

How It Is Spread

• Infected people who do not wash their hands thoroughly after using the bathroom can spread the infection to other people
• Food or water contaminated by feces or urine from infected animals or pets (they may have no symptoms)
• Raw pork or pork products
• Blood transfusion

Diagnosis & Treatment

• The bacteria can be identified from a stool sample.
• Antibiotics may be prescribed as a treatment.

Prevention

• Wash hands thoroughly after going to the bathroom, changing diapers, or animal contact, and before and after preparing food.
• Dispose of human, dog, and cat feces properly. 
• Discard soiled diapers properly.
• Protect water supplies from human and animal waste.
• Drink and use only pasteurized milk.
• Cook food thoroughly.

NOTE:  Persons with food handling, child care or patient care responsibilities should not handle food until all symptoms are gone.