The Chief Public Health Officer's Report on the State of Public Health in Canada 2013 – Food-borne and water-borne infections
Food-borne and Water-borne Infections–Invisible Threats
- Food- and water-borne illnesses are common and preventable public health issues.
- Serious outbreaks of food- and water-borne diseases in Canada are rare.
- Food and water safety are a responsibility shared among governments, industry and consumers.
- Large-scale farming and food processing combined with a global food supply makes it more challenging to keep food safe.
- Water-borne pathogens contaminating drinking water supplies, recreational water and water used in food production can pose significant threats to human health.
- Small and private water systems are more vulnerable to water-borne disease outbreaks.
Safe food and water are critical for good health and are a core public health issue.Footnote 1, Footnote 2 However, supplies of safe food and water cannot be taken for granted.Footnote 3, Footnote 4 Many sectors work together in Canada–through innovation, technology and policy–to keep food and water safe.Footnote 2, Footnote 5-Footnote 11
Cause and effect
A food-borne illness, often called "food poisoning," occurs when a person consumes contaminated food, while a water-borne illness is caused by contaminated water.Footnote 7, Footnote 12-Footnote 15 In both cases, contaminants are usually micro-organisms–bacteria (e.g. Salmonella or Campylobacter), parasites (e.g. Cryptosporidium) or viruses (e.g. noroviruses)–but may also be chemical or physical.Footnote 7, Footnote 12-Footnote 14, Footnote 16-Footnote 18 Chemical contamination of food occurs when a foreign substance, such as bleach, comes into contact with food.Footnote 12, Footnote 19 Examples of physical contamination include shards of glass or metal.Footnote 12 Surface and ground water generally becomes contaminated by pets, livestock or wild animals defecating in or near a water source.Footnote 16, Footnote 18, Footnote 20, Footnote 21 Run-off from landfills, septic fields, sewers and agricultural lands can also contaminate water.Footnote 16, Footnote 18, Footnote 20, Footnote 21
Regardless of the type of contamination, it can be very difficult for individuals to determine if food or water is contaminated, as it may appear and taste fine but still make people sick.Footnote 4
Food- and water-borne events in Canada
Between 1995 and 2011, about 1,000 reported cases of food-borne illnesses involved sprouts–no fewer than eight outbreaks in five different provinces.Footnote 22, Footnote 23 During the largest of these outbreaks, in 2005, there were more than 648 reported cases of salmonellosis in Ontario.Footnote 22, Footnote 23
The presence of pathogenic Escherichia coli and Campylobacter in the community water supply of Walkerton (Ontario) in 2000 claimed seven lives and left almost one-half the town's population ill.Footnote 24
In 2001, the community water supply in North Battleford (Saskatchewan) was contaminated with Cryptosporidium, causing between 5,800 and 7,100 people to become ill.Footnote 25
While there were no reported illnesses, residents of the Kashechewan reserve in Northern Ontario were evacuated when Escherichia coli contaminated all of the water supply in 2005.Footnote 26, Footnote 27
In the summer of 2008, a listeriosis outbreak linked to deli meat caused the death of 23 Canadians.Footnote 5
Food-borne illnesses are estimated to affect 4 million Canadians each year.Footnote 28 While a number of cases of food- and water-borne illnesses are reported each year (see Table 1), many more go unreported.Footnote 29, Footnote 30 In fact, not everyone exposed to a food- or water-borne pathogen will become sick. Many will have no symptoms and no consequences to their overall health.Footnote 4, Footnote 16, Footnote 29, Footnote 31-Footnote 35 Of those who do become sick, symptoms are often mild and can include stomach cramps, nausea, vomiting, diarrhea and low-grade fever.Footnote 15, Footnote 16, Footnote 29-Footnote 34, Footnote 36 As a result, most people do not seek medical treatment and the number of reported cases are under-represented.Footnote 4, Footnote 16, Footnote 29, Footnote 31-Footnote 33, Footnote 37 However, the most vulnerable–the very young, the elderly, pregnant women and those with chronic diseases or weakened immune systems–may have more severe symptoms and even die.Footnote 4, Footnote 16, Footnote 29, Footnote 31, Footnote 32, Footnote 34, Footnote 38, Footnote 39 For example, about 2% to 3% of people who become sick with a food-borne illness may develop chronic health problems such as chronic arthritis or kidney failure.Footnote 32, Footnote 34, Footnote 35, Footnote 40, Footnote 41
Water-borne pathogens pose a threat to human health and are also a threat to animal health, as well as to the health and biodiversity of aquatic ecosystems.Footnote 18 Disease outbreaks related to inadequate drinking water and sewage treatment practices were commonplace among early settlers.Footnote 42, Footnote 43 Only in the beginning of the last century did public officials embrace the water-waste-health connection and begin to actively pursue adequate sanitation and clean water systems with an eye to improving and maintaining public health.Footnote 42-Footnote 44 Advances in sanitation, water treatment and distribution have directly contributed to reduced mortality rates in Canada and the elimination of water-borne diseases such as cholera and typhoid.Footnote 3, Footnote 44, Footnote 45
|Pathogen||Description||Sources||Reported cases in CanadaFootnote 60|
|Campylobacter||A bacterium that attacks the digestive system. Symptoms usually occur 2 to 5 days after initial exposure, but can occur up to a month later. Symptoms are characterized by diarrhea, abdominal pain, malaise, fever, nausea and vomiting.Footnote 61||
|Cryptosporidium||A very contagious parasite that causes stomach pain, nausea, diarrhea and vomiting. Most people will recover but some infections, especially in those who have weakened immune systems, can cause death.Footnote 62||
|Giardia||A microscopic parasite that causes diarrhea. Complications such as arthritis can arise from prolonged infection.Footnote 64||
|Salmonella||A bacterium that attacks the digestive system. Symptoms generally occur 6 to 72 hours after ingesting contaminated food or water. Symptoms can include sudden onset of diarrhea, fever, abdominal cramps, nausea and vomiting lasting 4 to 7 days.Footnote 66||
|Shigella||A group of bacteria that typically causes diarrhea, fever and stomach cramps. Severe cases can cause death.Footnote 50, Footnote 67||
|Verotoxigenic Escherichia coli
|A bacterium that affects the digestive system. Symptoms often include severe stomach cramps, diarrhea, vomiting and fever.Footnote 48||
From farm to fork
The route from food production to consumption is very complex, with many points where it can be contaminated (see Figure 1).Footnote 4 For example, meat can become contaminated during slaughter if it comes into contact with intestinal contents; raw fruits and vegetables can be contaminated if washed or irrigated with contaminated water; food handlers may neglect to wash their hands and introduce micro-organisms into food; and micro-organisms can be transferred through shared contaminated surfaces.Footnote 41, Footnote 46-Footnote 53 Large-scale farming and the global nature of the food supply further complicate food safety.Footnote 5, Footnote 54 Longer shelf lives, wider and more rapid distribution of foods, and increased trade and travel all make tracing the source of food-borne contamination more difficult.Footnote 54
Figure 1 Potential routes of gastrointestinal illnessFootnote 17
Text Equivalent - Figure 1
The figure illustrates the flow of pathogens responsible for acute gastrointestinal illness. The pathogens are generated by a variety of reservoirs, including animal groups on the left and infected humans on the right. Pathogens may be transmitted from food animal reservoirs to the food actually ingested along the food chain (grey arrow – Food-borne route). They may also spread from the animal reservoirs to raw waters. These contaminated waters may infect human beings through drinking water, in the case of insufficient treatment, or directly when there is contact and accidental ingestion of the raw water (grey arrow – Water-borne route). In addition, raw water that is contaminated may spread the pathogens to animal and vegetable production. People may get infected when they are in contact with animals or their environment. Finally, infected people may transmit the pathogens to other humans, to food or to raw water.
Despite the many opportunities for contamination in the food supply chain, most food-borne illnesses can be prevented during the final preparation and handling of food.Footnote 4, Footnote 55-Footnote 57 Making sure that food is properly prepared, cooked and stored can reduce or eliminate the risk of illness (see the textbox "Food handling tips").Footnote 31, Footnote 56-Footnote 59 For example, even if a batch of meat was contaminated with E. coli during slaughter, the risk of illness can be significantly reduced if the meat is handled and cooked properly.Footnote 46, Footnote 48
- Cook food thoroughly and use a food thermometer to verify that the recommended internal temperature has been reached.
- Avoid cross-contamination by separating raw and cooked foods.
- Wash hands, utensils and cutting boards before touching other foods.
- Wash raw fruits and vegetables well.
- Refrigerate leftovers promptly.
- Follow safe home canning practices.
From source to tap
Drinking water systems in Canada vary greatly.Footnote 9 Water can come from surface water or ground water, as well as cisterns and water trucks in remote communities.Footnote 9, Footnote 68-Footnote 70 Surface water refers to water collected in lakes, streams and rivers.Footnote 9, Footnote 68, Footnote 69 Ground water is commonly found in underground aquifers (geological formations of sand, gravel or permeable rock that can store and transmit water).Footnote 71 Accessing ground water requires drilling a well and using pumps to bring the water to the surface.Footnote 9, Footnote 68, Footnote 69 When not properly constructed or protected, wells may be contaminated by surface water or other contaminants.Footnote 72
It is estimated that there are more than 45,000 drinking water systems in Canada, the majority being small systems serving populations of 5,000 people or less.Footnote 73 Providing safe drinking water requires an understanding of the drinking water supply and associated infrastructure, including identifying potential threats to water quality.Footnote 74-Footnote 76 These threats can occur naturally (e.g. seasonal droughts or flooding), be created by human activity (e.g. agriculture, industrial practices or recreational activities) or as a result of operational breakdown or aging infrastructure of treatment plants or distribution systems.Footnote 75, Footnote 76
Drinking water, recreational water (e.g. pools and lakes) and water used for food production can all become contaminated from multiple sources (see Figure 1).Footnote 17, Footnote 20, Footnote 77, Footnote 78 Factors that contribute to water-borne illness outbreaks include a lack of source water protection; contamination from weather events such as heavy precipitation and spring thaw; inadequacy or failure of water treatment; failure of water distribution systems; and other factors such as ongoing maintenance work (including repairs and replacements) and human error.Footnote 20 One of the difficulties of identifying the source of sporadic or outbreak related water-borne illnesses is that many of the pathogens spread by water are also spread by food, animals and person-to-person.Footnote 20
Surveillance, detection and response
Despite the mild symptoms that most people experience, food-borne illnesses cost the healthcare system and the food industry billions of dollars every year.Footnote 7, Footnote 35, Footnote 79 While Canada's food safety system is robust and generally protects the health of Canadians, more can be done.Footnote 4
While most cases of food-borne illnesses are sporadic and isolated, some will be part of an outbreak.Footnote 29 An outbreak of food-borne illness outbreak occurs when a group of people eat the same contaminated food and two or more of them become ill.Footnote 7, Footnote 29 Notification of a potential outbreak of food-borne illness can be triggered in many different ways: consumer complaints concerning a food; deviations in the way food is processed identified during inspection; laboratory reports showing the presence of a hazardous contaminant (biological or chemical) in food; notification from industry (e.g. manufacturer, processor, distributor, importer, common carrier) of a potential food safety problem; national surveillance of human illness; or information about a food safety problem from foreign health officials, industry or public health associations or academia.Footnote 7, Footnote 80 In some cases, these food safety investigations may lead to a food recall.Footnote 80
Figure 2 Overview of notification pathways (communication between partners to identify issues of concern)Footnote 7
Text Equivalent - Figure 2
Figure describes the way partners communicate and share information when an issue is identified with the potential to become a multi-jurisdictional food-borne illness outbreak. Local, provincial/territorial and/or federal officials should notify their appropriate partners when there is a potential multi-jurisdictional food-borne illness outbreak and exchange relevant information. Public Health Alerts can be used by stakeholders to share information. They are an effective communication tool used for early notification of possible or confirmed outbreaks with the potential to be multi-jurisdictional among local/regional and F/P/T health officials (some F/P/T agricultural authorities also have access).
While the source of most outbreaks of food-borne illness can be traced to food service establishments, risks to food safety can happen at any stage from "farm to fork" (see Figure 1).Footnote 4, Footnote 17 Identified food-borne pathogens should be reported to provincial and territorial health officials, who in turn, report these to federal health officials (see Figure 2).Footnote 7 Public health officials will then begin an investigation to determine the source of the outbreak through interviews and laboratory testing of suspected sources.Footnote 80 If a food source is identified, the Canadian Food Inspection Agency conducts an investigation and steps are taken to ensure that unsafe food products are recalled.Footnote 80
When a multijurisdictional food-borne illness outbreak occurs, the various levels of government use the Food-borne Illness Outbreak Response Protocol (FIORP) to guide how they will manage the outbreak.Footnote 7, Footnote 81 FIORP is a technical and operational guide that sets out the key guiding principles and operating procedures for identifying and responding to multijurisdictional food-borne illness outbreaks.Footnote 7, Footnote 81 Using FIORP helps partners to work together and allows for a faster, more efficient and effective response to outbreaks.Footnote 5, Footnote 7, Footnote 81 Following the 2008 national listeriosis outbreak, FIORP was updated to further improve the response and management of outbreaks.Footnote 5, Footnote 7, Footnote 81 As a result, roles and responsibilities are clearer, additional information sharing and communication guidelines are now in place and additional public health personnel have been identified to help during outbreaks as needed.Footnote 5
PulseNet Canada is a critical national surveillance system that helps identify and respond to potential illness outbreaks as early as possible.Footnote 82 It is an electronic network that links all provincial public health laboratories and Canadian Food Inspection Agency laboratories with the Public Health Agency of Canada.Footnote 83 Cases of food-borne illness across the country are tested using genetic fingerprinting; these "fingerprints" are constantly monitored to look out for potential outbreaks.Footnote 83 Contaminated foods are also tested with the same genetic fingerprinting, which allows the source of an outbreak to be confirmed.Footnote 83
Increased surveillance is helping to improve detection of food-borne illnesses and the risks that cause them. A major factor in the increased surveillance is the improved ability to detect food-borne illness because of the greater capacity of the PulseNet Canada network across its laboratories.Footnote 5 The PulseNet Canada network of laboratories uses DNA fingerprinting technology to test for food-borne illnesses and detect outbreaks at the earliest possible stage.Footnote 5, Footnote 83, Footnote 84 Advances in science and technology, such as the Genomics Research and Development Initiative, have allowed officials to more easily investigate possible links between cases of food-borne illness that may not have previously been linked.Footnote 85, Footnote 86
The National Enteric Surveillance Program (NESP) is a laboratory-based surveillance system capturing weekly data on laboratory-confirmed enteric diseases to monitor trends and detect outbreaks that also includes an enhanced case-based surveillance program for invasive listeriosis cases.Footnote 87 C-EnterNet is a national integrated food safety surveillance system that tracks food- and water-borne gastrointestinal illnesses and their likely sources (e.g. food, water and livestock) to identify risks, to prevent diseases from occurring and to lessen the impact of illness on Canadians.Footnote 88
Addressing food safety is a balancing act between many players and between real and perceived risk. Some technologies can improve food safety and reduce food-borne illnesses by reducing the levels of harmful bacteria in food, but implementing such technologies is not always straightforward or easy.Footnote 4 For example, food irradiation can greatly reduce or eliminate micro-organisms and bacteria from foods, while the food itself remains unchanged, becoming neither radioactive nor contaminated with dangerous substances.Footnote 89, Footnote 90 Currently, potatoes, onions, wheat, flour, whole wheat flour, whole and ground spices and dehydrated seasonings have been approved for irradiation in Canada, and all irradiated food must be labelled.Footnote 90 Also, the Guelph Food Research Centre, part of Agriculture and Agri-Food Canada's research network, focuses on mitigation of food safety risks in food production systems; development of food with enhanced health benefits; and structure and functional characteristics of food and food ingredients.Footnote 91
As with food, ensuring the safety of water in Canada involves many partners.Footnote 92, Footnote 93 Monitoring of drinking water quality, while typically done at the municipal level, may also be conducted at the provincial/territorial level.Footnote 92-Footnote 94 However, water-borne disease surveillance is currently not standardized or consistently linked, making it difficult to understand the scope of water-borne illnesses.Footnote 95 Detecting water-borne illnesses includes patients identifying their illness and phone inquiries as well as reports by local public health authorities, physicians and laboratories.Footnote 20, Footnote 95 Outbreaks associated with small drinking water systems are also identified through monitoring of water quality, epidemiological investigations, laboratory confirmation or a combination of these methods.Footnote 20, Footnote 95 Outbreaks are not always reported beyond the local authorities.Footnote 95
There are more than 1,000 active boil water advisories in Canada at any given time, most of which occur in small systems.Footnote 73, Footnote 96, Footnote 97 Advisories are primarily issued as a precaution when authorities are concerned that contamination may occur.Footnote 98 These notifications may also be issued when unacceptable levels of indicator bacteria, disease-causing bacteria, viruses or parasites are discovered in the water system anywhere from the source to the tap; unacceptable levels of cloudiness (turbidity) are measured; filtration or disinfection during treatment is inadequate; or water is re-contaminated during distribution.Footnote 98 Fecal contamination of water used for drinking, recreation and food production can have significant impacts on human health and local economies through disease outbreaks, beach and shellfish closures, and boil water advisories.Footnote 99
Both surface water and ground water can be contaminated with chemicals and pathogens. Almost all water will require some type of treatment before it is safe to drink.Footnote 9, Footnote 100 Public drinking water systems use a variety of treatment processes to remove or inactivate contaminants and provide safe drinking water to communities.Footnote 101, Footnote 102 Since the quality of the source water and types of contaminant can vary, the types of treatment must also vary.Footnote 101, Footnote 102 Generally, the types of treatment used by a water system are based on the contaminants found in the source water.Footnote 101 The most common processes include coagulation/flocculation/sedimentation, filtration, and disinfection, often applied in sequence.Footnote 101 Occasionally the disinfectants used to treat the water can react with naturally occurring materials in the water to form unintended by-products that may pose health risks.Footnote 93
Figure 3 The multi-barrier approachFootnote 76
Text Equivalent - Figure 3
The figure depicts a multi-barrier approach to safe drinking water that contains three major elements. These elements are source water protection, drinking water treatment, and the drinking water distribution system. These elements are addressed in an integrated manner by using a system of procedures and tools, such as: Water quality monitoring and management of water supplies from source to tap; Legislative and policy frameworks; Public involvement and awareness; Guidelines, standards and objectives; Research; and the development of science and technology solutions.
The water system has three main parts: the source, the treatment system and the distribution system.Footnote 93, Footnote 103, Footnote 104 Contamination needs to be prevented in each of these areas.Footnote 104 The multi-barrier approach reflects this concept by considering the whole drinking water system (see Figure 3).Footnote 75, Footnote 76>, Footnote 93, Footnote 103, Footnote 104 The best available water source (e.g. lake, river, aquifer) is selected and protected from contamination, the water is effectively treated, and finally, the water is kept clean and safe during distribution.Footnote 75, Footnote 76 This is done by ensuring that appropriate legislation, environmental policies and guidelines are in place, that staff are appropriately trained and supervised, and that proper monitoring is set up.Footnote 93, Footnote 103, Footnote 104 Investment in research to develop alternative solutions and approaches, such as microbial source tracking to prevent fecal contamination of source water, is also necessary.Footnote 99 The multi-barrier approach recognizes that, while each individual barrier may not be able to completely remove or prevent contamination, the barriers work together to make the water safe to drink over the long term.Footnote 75, Footnote 76
Roles and responsibilities
Food safety depends on the concerted actions of all levels of government, food industries and consumers (see the textbox "Food safety responsibilities in Canada").Footnote 4, Footnote 5 In 2012, the federal government passed the Safe Food for Canadians Act, which targets unsafe food practices and implements penalties for activities that put health and safety at risk.Footnote 105 The Act provides better control over imports, institutes more consistent inspections across all food commodities and strengthens food traceability.Footnote 105 In 2012, the government also amended the Food and Drugs Act (FDA) which will allow the government to make the food regulatory system more efficient and flexible.Footnote 106
- Canadian Food Inspection Agency:
- Inspects and enforces federal regulations about food.
- Investigates food safety (e.g. traceback).
- Tests food and recalls unsafe food.
- Informs Canadians of potential food hazards.
- Health Canada:
- Sets food standards and policies governing safety and nutritional quality.
- Engages in research and health-risk-and-benefits assessments.
- Evaluates the safety of veterinary drugs in food-producing animals.
- Informs Canadians of potential health risks.
- Public Health Agency of Canada:
- Conducts surveillance and identifies public health risk factors.
- Detects and responds to multijurisdictional food-borne illness outbreaks (e.g. epidemiological and laboratory).
- Informs Canadians on how to prevent illness.
- Store, handle and prepare food safely.
Provincial/territorial governments :
- Enact and enforce food safety laws within their jurisdiction.
- Regulate food processing within their jurisdictions.
- Implement food safety programs.
- Lead illness outbreak investigations within their jurisdictions.
- Communicate food safety messages to food handlers.
Local/regional public health authorities:
- Inspect food establishments.
- Educate about food safety practices.
- Report confirmed cases of food-borne illnesses to province/territory.
- Investigate food-borne illness outbreaks, collect food samples and send samples to laboratories.
- Analyze findings.
- Complies with government standards in food production.
- Monitors and verifies the effectiveness of food safety systems to ensure that food is safely produced and distributed.
- Establishes and conducts food safety programs in keeping with regulatory requirements and industry practice.
In Canada, the federal, provincial/territorial, local and municipal governments, as well as First Nations band councils, industry, non-governmental organizations and individual Canadians have a role to play in protecting the quality of drinking water.Footnote 1, Footnote 9, Footnote 74, Footnote 104 Because of the number of steps involved in ensuring access to safe drinking water, effective collaboration is essential.Footnote 9
The federal government's role in drinking water quality focuses on regulation, science, including risk assessment, and the provision of technical expertise.Footnote 9, Footnote 107 Most recently, the Government of Canada passed the Act Respecting the Safety of Drinking Water on First Nation Lands, which demonstrates a commitment to improving the health and safety of residents of First Nation lands.Footnote 108 Together with the provinces and territories, Health Canada continues to develop and update the Guidelines for Canadian Drinking Water Quality, which form the basis for drinking water quality requirements across the country.Footnote 9, Footnote 21 Today, the majority of Canadians get their drinking water supply from treated municipal water works.Footnote 68, Footnote 109 However, some people get their drinking water from wells and/or from surface water on their own property.Footnote 9, Footnote 109 In those situations, individuals are responsible for the safety of their drinking water and should have it tested regularly, which can be particularly difficult for those living in small and remote communities and on some First Nations reserves.Footnote 9, Footnote 110
Responsibilities for drinking water are shared among First Nations band councils, Health Canada and Aboriginal Affairs and Northern Development Canada (AANDC) in First Nations communities south of 60° north latitude (see the textbox "Water quality roles and responsibilities in First Nations communities").Footnote 9-Footnote 11, Footnote 110 Ensuring that water facilities are designed, built, maintained and operated in accordance with established federal or provincial standards are the responsibility of band councils.Footnote 11 Federally, AANDC funds construction or upgrading of water and wastewater facilities, and Health Canada helps ensure drinking water quality monitoring programs are in place in First Nations communities.Footnote 9-Footnote 11, Footnote 111 While AANDC helps to protect water quality and water resources north of 60° north latitude, responsibilities for drinking water rest with territorial governments.Footnote 9, Footnote 10, Footnote 112, Footnote 113
- Own, manage, monitor and operate water and wastewater services.
- Design and construct water and wastewater facilities.
- Issue Drinking Water Advisories.
Aboriginal Affairs and Northern Development Canada:
- Provides funding for training, construction, operation and maintenance of water and wastewater facilities.
- Collaborates with Health Canada and Environment Canada to review designs.
- Regulates water treatment discharged into receiving waters.
- Provides advice and guidance on sustainable water use and protection.
- Ensures that monitoring programs for water quality are in place on-reserves south of 60° north latitude.
- Assists in identifying possible drinking water quality problems.
- Advises and provides recommendations on drinking water safety and safe disposal of on-site domestic sewage.
- Reviews, interprets and disseminates results of the overall quality of drinking water.
- Reviews water and wastewater infrastructure project proposals from a public health perspective.
Actions for success
Safe food and water involves considering human, animal and environmental health; the complexity of food-borne and water-borne infections requires a comprehensive approach, relying on the integrated effort of multiple disciplines working locally, nationally and globally.Footnote 9, Footnote 68 A comprehensive approach includes an interdisciplinary, cross-sectoral approach to surveillance, monitoring, prevention, control and mitigation of public health risks associated with food and water.Footnote 7, Footnote 76
- Robust cooperation among regulators, public health officials, municipalities, industry and researchers reduces the incidence of food- and water-borne illnesses.
- Effective surveillance of food- and water-borne illnesses and their sources is necessary to detect and control outbreaks.
- Greater public awareness and improved education for food consumers, producers and handlers prevents food-borne illnesses.
- Targeted efforts in science and technology can improve food and water safety.
- Better food handling and preparation prevents many cases of food-borne illnesses.
- Water safety measures including regular checks, appropriate treatment and adherence to boil water advisories (if necessary) are important to prevent water-borne illnesses.
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