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Most people when told they have a food-borne illness blame the last thing that they ate. After experiencing a night of vomiting as a 9-year old, I was sure it was the cream-filled cupcakes I had devoured before bed. In retrospect it may have been something I ate the week prior. It also could have been from playing in the "creek" (AKA drainage ditch) in our backyard. Most illnesses caused by germs that infect our food or water take more than a few hours to develop (incubate). Some can take days; some, weeks.

By law, labs and doctors must report food and water-borne illnesses to the local health department. Each case is investigated in an attempt to prevent additional cases. If you are diagnosed with this sort of illness, a public health professional will contact you within a few days. Some questions he/she might ask you are:

• What sorts of foods did you eat in the days prior to your illness?
• Do you know other people with similar symptoms?
• Did you eat at any restaurants or group events?
• Where does your drinking water come from?
• Have you been hiking, camping, fishing, or swimming?
• Do you have any pets?
• Have you recently traveled out of the country?

Most cases are isolated; just one person is sick. This makes it difficult to tell where the infection came from. It is thought that many people are exposed in their own kitchens or back yards. Occasionally infections are traced to a common source; restaurant, water-park, pet supply company, etc.

Sometimes a community member calls the health department complaining of "food poisoning". When this occurs individuals are asked about foods they have eaten and places they have visited. A stool sample might be recommended. Nausea, vomiting and diarrhea have many causes, most of which are not related to food preparation. For this reason restaurant inspections are not routinely ordered when one person complains of illness. An inspection might be indicated if the health department receives numerous calls.

If you think you have a food or water related illness:

• Call your physician and ask for advice. Many healthcare providers do not order stool tests because symptoms usually go away on their own. Those who are very young, elderly, or with immune system problems may be sicker than others. Some might need an antibiotic or fluids through an IV in the hospital.

• Wash your hands frequently: after using the bathroom and changing diapers; prior to preparing or eating food. Disinfect toilet flushers and faucet handles often.

• If you become ill after eating out, notify the restaurant of your concerns. In NY State, managers must contact the health department when someone complains of illness after eating at their restaurant.

• Keep in mind that most food-borne illnesses take longer than just a few hours to develop. Start to think back a week or two. Write down what you remember about foods you have eaten and places you have visited. Gather restaurant and grocery store receipts. These will come in handy later if the health department needs to interview you.

• Call the health department in the county in which you live. Health departments in NY have a mechanism to handle after hour calls. For Ontario County, calls after 5:00 pm and on weekends/holidays are taken by the Ontario County Dispatcher at 394-4560.

It is impossible to prevent all food and water related illness, but having some knowledge about the most common types is helpful. In Ontario County campylobacteriosis, salmonellosis, and giardiasis are the most frequently reported illnesses of this type (see chart below).

Campylobacteriosis is caused by bacteria often found in poultry. Cross contamination during food preparation, eating undercooked chicken, drinking unpasteurized (raw) milk and having animal contact are risk factors for this infection. Incubation takes one to ten days; most commonly two to five. Symptoms include diarrhea (sometimes bloody), cramps and fever. Some people have nausea and vomiting. Outbreaks are uncommon. Person-to-person spread is rare. For more information on the prevention of campylobacteriosis see: http://www.health.state.ny.us/diseases/communicable/campylobacteriosis/fact_sheet.htm

Salmonellosis is also caused by bacteria. Symptoms include diarrhea, cramps, vomiting, fever, and chills. It has a fairly short incubation period; one to three days. Salmonella has been linked to many food items: eggs, poultry, raw milk, meats, and fruits/vegetables contaminated by animal manure. Ducks, cows, turtles, iguanas, and most recently aquatic frogs have been implicated in salmonella infections. Person-to-person spread can occur and outbreaks are not uncommon in the US. For more information on the prevention of salmonellosis see: http://www.health.state.ny.us/diseases/communicable/salmonellosis/fact_sheet.htm

Giardiasis is caused by a parasite. Incubation takes three to twenty-five days; most commonly seven to ten. Symptoms include diarrhea, cramps, bloating, and fatigue. Fever is rare. Some individuals experience symptoms over the course of a few weeks and have significant weight loss. The parasite can be found in surface water and contaminated swimming areas. Beavers have often been blamed for the contamination of streams and lakes but human waste is probably just as significant. For more information on the prevention of giardiasis see: http://www.health.state.ny.us/diseases/communicable/giardiasis/fact_sheet.html

June, 2011