CIPHI BOC Study Questions (Answered) Exam board exam Predictions.

foodborne illnesses, waterborne illnesses, vector borne diseases, zoonotic diseases, other related questions Hepatitis A - Incubation period - 15-50 days Usually 28-30 days Hepatitis A - Symptoms - loss of appetite, fatigue, nausea, vomiting, abdominal pain, fever, malaise and yellow skin (jaundice) Hepatitis A - transmission - fecal-oral route Infective: up to 2 weeks before onset to 1 week post-jaundice. Humans are reservoir. Hepatitis A - suspect foods - Ice, shellfish contaminated with sewage. Hepatitis A - exclusion criteria - 14 days if no jaundice. 7 days after jaundice onset. Life-long immunity following recovery. Last 2 - 6 months. Norovirus - incubation period - 24-48 hours Norovirus - symptoms - Sudden onset, watery diarrhea, vomiting, cramp, nausea, low fever. Norovirus - transmission - Very contagious. Low infective dose. Fecal-oral. Person-Person. Humans only reservoir. Norovirus - most at risk - o Children o Older Adults o Those with weakened immune systems. o These higher risk groups are more likely to experience dehydration as a result of severe vomiting and diarrhea Salmonellosis types - S. enteritis S. typhimurium Salmonellosis incubation - 6-72 hours Usually 12-36 hours Salmonellosis symptoms - Sudden onset, cramp, diarrhea, nausea, headache, possible vomit. Salmonellosis transmission - Bacterial. Usually contaminated food, raw bean sprouts. Human and animal reservoir. Pet contact. Salmonellosis suspect foods - Raw egg, unpasteurized milk, unwashed fruit/veg. Raw meat. Shigellosis IP - 12-96 hours (usually 1-3 days) Shigellosis symptoms - Diarrhea, fever, cramp. Nausea. Possible bloody diarrhea. May cause HUS in kids. Shigellosis transmission - Bacterial. Fecal-oral. Sexual contact Humans only reservoir. Possibly via mechanical vectors (flies, cockroaches) Low infectious dose. Shigellosis suspect foods - Shigella is not naturally present on foods, but can contaminate food through cross contamination during handling, or from exposure to polluted water Food is most often contaminated with Shigella from water polluted by human sewage. IP - 1-90 days (usually 3-70 days) Symptoms - Most cases asymptomatic. Fever, headache. 5% vomit & diarrhea. Transmission: Environmental bacteria. Gets in raw product (between cooking & packaging) & spreads via cross-contamination. ** Psychrotroph. Hardy. Suspect Foods: Soft cheeses, deli meats, hot dogs, ready to eat meats, unpasteurized milk. Concern for pregnant women - Listeriosis L. monocytogenes IP - 0.5-6 hours Symptoms - Nausea, vomiting, rarely fever and diarrhea Transmission - Bacterial. Grows and produces heat stable enterotoxin in food. Suspect foods - Cooked rice left at room temperature - Bacillus Cereus (emetic) IP - 4-96 hours (usually 12-24) Symptoms - Severe cramp, watery diarrhea, nausea, vomiting, headache, fever. Transmission - Bacterial. Marine organism. More wound infections than FBI. Suspect foods - raw shellfish - Vibrio parahemolyticus IP - 6-24 hours Symptoms - Cramp, diarrhea, nausea, rarely vomit and fever. Transmission - Bacterial. Grows and produces heat labile enterotoxin in food. Suspect foods - Meat and vegetable soups, cooked meat, desserts, starches. - Bacillus Cereus (diarrheal) IP - 0.5 - 8 hours (usually 2-4 hours) Symptoms - Vomiting, cramp, diarrhea, nausea. Transmission - Bacterial. Humans main reservoir. Carried in nares. Produces heat stable enterotoxin as grows in food. Suspect foods - Pork, ham, custard, cream desserts. Raw meat rarely associated with OB b/c poor competitor. - Staphylococcus S. aureus IP - 1-10 days (usually 2-5 days) Symptoms - Sudden onset cramp, fever, nausea and/or vomit, possible bloody diarrhea, greenish stool. (Appendicitis like) Transmission - Bacterial. Microaerophilic - grows in gut, not at room temperature. Fecal-oral. Water/food. Most raw poultry contamination. Suspect foods - Contaminated food, water, raw poultry, contact with infected animals. Non-chlorinated water. - Campylobacter enteritis C. jejuni C. coli IP - 3-7 days Symptoms - Cramp, fever, headache, diarrhea, vomiting, nausea, lower right quadrant pain Transmission - Bacterial. Psychrotroph. High infectious dose. Animals (pigs) are the main reservoir. Fecal-oral. Suspect foods - Pork and milk products. Chocolate milk. - Yersiniosis Y. Enterocolitica IP - 2-10 days (usually 3-4 days) Symptoms - Diarrhea, fever, possible headache, cramp, possible bloody diarrhea. HUS possible in kids 5yrs. Transmission - Bacterial. Fecal-oral. Some strains produce enterotoxin. Usually harmless gut flora. 0157:H7 linked to beef Suspect foods - Contaminated food, unpasteurized product. Raw beef, raw milk and apple cider, sprouts. - E-coli (STEC, EHEC, VTEC) (STEC: 0157:H7) IP - 6-36 hours (earlier symptoms = increased severity) Symptoms - Fatigue, weakness, vertigo. Nausea, vomiting, diarrhea. Neurological symptoms (flaccid paralysis). Transmission - Bacterial. 4 clinical forms. Produces a heat labile neurotoxin in food. Anaerobic. Suspect foods - Carrot juice, baked potatoes, improper canning, fermented meat (Muktuk), honey, corn syrup. Meat, bacon. - Botulism Clostridium botulinum IP - 6-24 hours (usually 10-12) Symptoms - Sudden onset nausea, bloating, severe cramp, profuse diarrhea. Usually no fever, vomit, headache. Transmission - Bacterial. Spores common in GIT of animals and people, dust soil - may survive cooking and sporulate in gut. Suspect foods - Large chunks of meat - difficult to cool so interior anaerobic. - Clostridium perfringens IP - 1-14 days (usually 7 days) Symptoms - Profuse watery diarrhea, nausea, vomiting, anorexia, weight loss, bloating, cramping. 50% get low-grade fever. Transmission - Protozoan. Oocysts passed in stool. Fecal-oral via contaminated food or water. Humans only known reservoir. Suspect foods - Fresh produce and fruit. OB associated with Guatemalan raspberries. - Cyclosporiasis C. cayetanensis IP - 5-60 days (usually 1-2 months) Symptoms - Fever, headache, weakness, profuse sweating, chills, aching, weight loss. Transmission - Bacterial. Reservoir cattle, swine, ovine. Transmitted via ingestion of raw milk/dairy. (also breaks in skin with infected fluids) Suspect foods - Raw milk and other dairy products, unpasteurized cheese. - Brucellosis B. abortus B. melitensis B. suis IP - 3-25 days (usually 7-10 days) Symptoms - Often asymptomatic. Diarrhea, cramp, bloating, pale & greasy stool, fatigue, weight loss. Transmission - Protozoan. Fecal-oral. Drinking unfiltered or contaminated water. Contaminated food, recreational water. Reservoir is human/beaver. Suspect foods - Drinking unfiltered water or from shallow wells. Contaminated food, recreational water. - Giardiasis Giardia lamblia "Beaver Fever" IP - 1-12 days (usually 7 days) Symptoms - Often asymptomatic. Diarrhea (possibly watery), preceded by anorexia and vomiting in children, cramp. Rarely fever, nausea and vomiting. Transmission - Parasitic. Reservoir humans, cattle. Fecal-oral. Waterborne, food borne. Chlorination not effective against oocysts. Suspect foods - Contaminated drinking water, recreational water (pools, slides), lakes, food, beverages. - Cryptosporidiosis C. parvum C. hominis IP - Symptoms - Transmission - Suspect foods - - E. coli exclusion criteria - - food handlers, daycare, or health care workers - they should not return to work until 2 negative stool samples taken 24 hours apart and 48 hours after completing antibiotics have been completed E.coli prevention measures - - Hand hygiene (when food handling, or around pets/livestock) - Cook food to a safe internal temperature - Wash raw fruits and vegetables thoroughly before eating - Avoid cross-contamination - Drink treated water - Drink only pasteurized milk, apple cider and orange juice - Keep pets away from food storage and preparation areas - Test private small drinking water systems (wells) for bacteria Clostridium perfringens transmission - - not spread from person to person. - found naturally in environments, such as: - soil - dust - sewage - can be found in contaminated food that has been: - cooked slowly - cooled too slowly - kept too warm in storage - reheated to a temperature that is too low Clostridium perfringens suspect foods - o stews o gravies o meat pies o thick soups o cooked beans o dried or precooked foods o raw meat, especially poultry and beef When do Clostridium perfringens outbreaks occur? - - Outbreaks happen more often in institutions where food is: o produced in large quantities o kept warm for a long time before serving - Such places include: - prisons - schools - hospitals - cafeterias - long-term care facilities - events with catered food Types of clostridium botulinum - o Foodborne - rare, potentially life-threatening, caused by eating food contaminated with botulinum toxin. o Wound - unusual, rare. Occurs when an open wound becomes contaminated with the bacteria which produce the toxin which is then released into the bloodstream. o Infant botulism - typically in children less than a year old, as a result of eating bacterial spores and results in toxin in the intestines. o Inhalational botulism is the only known human-made form. It has been known to be transmitted from monkeys to veterinarians and lab workers. Botulism suspect foods - o improperly prepared home-canned, low-acid foods (for example, corn, green beans, peas, asparagus, beets, mushrooms, spaghetti sauce, salmon); o improperly stored low acid fruit juices (for example, carrot juice); o leftover baked potatoes stored in aluminium foil; o honey, which has been linked to cases of infantile botulism and should not be fed to infants under one year of age. What is infant botulism? - - Infant botulism is a rare but serious form of food poisoning caused by Clostridium botulinum spores, which are sometimes found in both pasteurized and unpasteurized honey. o When an infant ingests honey, bacteria from these spores can grow and produce toxins that could lead to paralysis. o In Canada, honey is the only food that has been linked to infant botulism. - Bees may pick up the botulism spores from flowers or soil and the spores are not destroyed in the processing of honey Symptoms of infant botulism - § is constipated § has weak muscles § is too weak to cry or suck as usual § has a wobbly head because the neck is weak § lacks facial expression § has weak arms and legs § has trouble breathing § is not able to swallow IP - 5-45 days - intestinal roundworm that migrates into muscle tissues · Pigs, feral hogs, cougars and black bears can all harbor · The severity of illness in humans depends on that number of parasites ingested · During the first week after ingesting infected meat, the person may be asymptomatic, or they may experience the following symptoms: o abdominal discomfort, o nausea, o vomiting o diarrhea. · One to several weeks later, as larvae migrate into tissues, the following symptoms may develop: o fever, o myalgia, o swelling of the eyes, o skin rash o abnormal fear of light; o Conjunctival and subungual hemorrhages; pockets of blood in the eye or skin from broken blood vessels · Cardiac and neurological complications may appear in the third to sixth week. o Inflammation of the heart muscle and the brain, if they occur, are serious and may be life-threatening. - Trichinellosis Public pool safety equipment - (a) an electrically insulated or non-conducting reaching pole at least 3.65 m long; (b) in the case of a public pool, two buoyant throwing aids, each of which has securely attached to it a six mm diameter rope of a length not less than one-half the width of the pool plus 3 m; (c) in the case of a Class B pool that is in operation and has a slope of more than 8 %, a buoy line; (d) in the case of a public spa, a buoyant throwing aid to which is securely attached a six mm diameter rope of a length not less than one-half the width of the pool area plus 3 m; and (e) a spine board or device designed for lifting from the pool or spa a person who may have incurred a spinal injury (f) emergency phone (g) first aid kit What is required in a first aid kit? - (a) a current copy of a standard first aid manual; (b) safety pins; (c) adhesive dressings individually wrapped; (d) sterile gauze pads, each 75 mm square; (e) 50 mm gauze bandages; (f) 100 mm gauze bandages; (g) sterile surgical pads suitable for pressure dressings individually wrapped; (h) triangular bandages; (i) rolls of splint padding; (j) at least one roll-up splint; (k) at least one pair of scissors; (l) non-permeable gloves, and (m) resuscitation pocket masks What are the effects of having pool water with a high pH? What chemicals can be added to the water to lower the pH - o Causes scaling o Decreases effectiveness of chlorine o Fosters growth of algae o Add muriatic acid or sodium bisulphate What are the effects of having pool water with a low pH? What chemicals can be added to the water to increase the pH - o Causes corrosion o Causes bather discomfort o Add soda ash or sodium hydroxide What types of pathogens are commonly associated with pools and spas? - o Pseudomonas Aeruginosa; can cause folliculitis from dermal contact with water o Staphylococcus aureus; can cause follicultis from dermal contact with water o Legionella pneumophila; can cause Legionnaire's disease when inhaled o Giardia lamblia; can cause giardiasis if parasite is ingested o Cryptosporidium; can cause cryptosporidiosis if cysts are ingested o Shigella; can cause shigellosis if toxin is ingested o E. coli; can cause enteric illness if bacteria is ingested Why are vacuum release mechanisms so important for spas? - o A Safety Vacuum Release System (SVRS) helps prevent suction entrapment by monitoring pump pressure. o When a drain is blocked by an object, SVRS detects the change in pressure § In a stand-alone system, SVRS releases a vent, allowing the object to be released. § In a pump equipped with the system, SVRS shuts the motor down, allowing the object to be released. o If the trapped object is a person, SVRS may prevent injury and may even save a life. Why is it important to regulate the temperature of spas? - o When the core body temperature is over 40°C, the body gains heat faster than it can cool itself. o Heat-Related Illness Bathing in hot water for an extended period of time can lead to illness and even death. o Symptoms that can result include nausea, pale cool skin, fatigue, muscle cramps, unconsciousness and even death. o The upper limit cut-off switch is a device that limits the maximum temperature of the spa - This switch, along with the timing device and clock are required by regulation to help prevent heat-related illness and drowning What does the Oxidation-Reduction Potential (ORP) tell us? - o ORP is a measurement of chlorine's ability to oxidize contaminants in the pool water o It is the potential of a disinfectant to inactivate contaminants o Should be between 600 to 900 mV for maximum disinfectant effectiveness Why is cyanuric acid used in outdoor pools/spas? - o Cyanuric acid is a white granular or solid chemical that helps to reduce the loss of chlorine due to the ultraviolet rays from direct sunlight. o It is a form of a stabilizer and conditioner. o It locks in chlorine and protects against the loss of chlorine when exposed to the sun. Why is filtration of water important? - o The use of filters such as sand filters or cartridge filters is important for removal of contaminants o Chemical disinfectant is ineffective against parasites such as Giardia and Cryptosporidium, so we must rely on filters to capture the cysts/oocysts and on UV treatment to inactivate cysts/oocysts List of environmental factors monitored at beaches - o Environmental factors to be observed include: § a) Water and ambient air temperature; § b) Rainfall within 24 and 48 hours; § c) Rain intensity; § d) Weather conditions (e.g. cloudy, sunny); § e) Wind speed and direction; § f) Water clarity/turbidity; § g) Wave height; § h) Pollution sources, such as waterfowl, industrial waste discharges, storm water outflows, septic system discharges, algal blooms and agricultural run-off; and § i) Other environmental factors that may be locally significant. Giardiasis prevention - o Thorough hand washing is the best prevention. § Since the parasite is passed in stool, the single most important prevention activity is careful hand washing after using the washroom, handling diapers, before and after preparing food and before eating. o Do not prepare food for others if you have diarrhea. o Peel fruits and vegetables, or wash with uncontaminated or bottled water before eating. o Drink water that you are certain has been properly treated and not directly from rivers, creeks and lakes. Do not swallow recreational water. o If treated or bottled water isn't available, boil water for at least one minute. The boiled water should be used for drinking, brushing teeth, making ice cubes, washing uncooked fruits and vegetables, cooking and washing dishes. o Avoid contact with stool during sex. o Do not swim in recreational water (e.g., swimming pool, hot tub) until at least 24 hours after symptoms have gone away. Occurrence: Chemical compound formed as a by-product when chlorine and interacts with organic matter during disinfection process. More common in surface water Health effects: Possibly carcinogenic. Adverse birth outcomes Threshold: 0.1 mg/L (100 ug/L) Remedy: Use a carbon filter; Use alternate water source; Limit time spent in showers and baths when in high concentrated areas - Trihalomethanes (THMs) Occurrence: Rock (limestone, bedrock, shale, clay); Industrial processes (aluminum production); Black teas, raisins, dental products Signs: Tasteless, odourless Health effects: Dental fluorosis in children (white flecks on teeth); not harmful; Skeletal fluorosis causing difficulty moving, joint pain similar to arthritis Threshold: 1.5 mg/L Remedy: Chemical testing; Filter or treatment system for levels 2.4 mg/L; Alternate source for drinking and food prep - Fluoride Trihalomethanes threshold - 0.1 mg/L Fluoride threshold - 1.5 mg/L Occurrence: Soil, rock; Agriculture, mining activities Signs: tasteless, odourless Health effects: Cancers; Poisoning (rare) causing pins and needles feeling and changes in thickness/colour of skin on hands/feet Threshold: 0.01 mg/L (or 10 ug/L) ALARA Remedy: Chemical testing; Treatment device at Point of Entry; Contact well contractor/ professional - Arsenic Occurrence: Soil, dusts and air; Pipes, fixtures, soldered connections, paints, industrial emissions, refineries Signs: tasteless, odourless Health effects: Brain and CNS impairment to exposed fetuses, infants and children during development Threshold: 0.005 mg/L ALARA (as low as reasonably achievable) Remedy: Contact plumber to check piping; Use cold water & flush taps (5 mins/day); Use NSF filter *Boiling will not reduce it Use alternate source for drinking and cooking - Lead Occurrence: Bioconcentration in fish, Earth's crust, Soil (especially near cinnabar ore deposits); Fungicides, pulp and paper industry, dental preparations, thermometers, fluorescent and UV lamps, chlor-alkali industry (produces chlorine and caustic soda); Environmental spills/accidents Health effects: Minimata disease -- numbness in the hands and feet, muscle weakness, loss of peripheral vision, and damage to hearing and speech, insanity, paralysis, coma, and death. Renal disturbances, abdominal pain, nausea, vomiting, loosening of teeth, nephritis, hepatitis, renal failure, death Acute lethal toxic doses will result in the same terminal symptoms; shock, cardiovascular collapse, acute renal failure, and severe gastrointestinal damage Infants born to exposed mothers may suffer from mental retardation, cerebral palsy, and convulsions Developing fetuses and children under 10 are far more sensitive Threshold: 0.001 mg - Mercury Occurrence: Groundwater, plants; Fertilizers, industrial wastes, mining explosives, septic system leaks Signs: tasteless, odourless Health effects: "Probably carcinogenic" classification Methemoglobinemia or "Blue Baby Syndrome"; infants 0-6 months unable to receive oxygen and become blue around eyes/mouth Adverse pregnancy outcomes Threshold: 10 mg/L Remedy: Chemical testing ;Treatment system; Contact well contractor - inspector for damages; Reduce sources near the well *Boiling will not reduce Use alternate source of water - Nitrates Occurrence: Road salt, water treatment, water softeners Signs: altered taste Health effects: For people with pre-existing hypertension, congestive heart failure, or on restricted diets there may be concerns; seek medical advice from family doctor Threshold: 200 mg/L Remedy: Use a reverse osmosis filter; Remove water softener or use a separate line; Contact water professional *Boiling and charcoal filters will not reduce Use alternate source - Sodium Nitrate threshold - 10 mg/L What does E. coli mean in well water results? What is the maximum allowed in lab results? - Fecal contamination from animals or humans, usually entering the well from nearby source - 0 CFU/100 ml What does total coliforms mean in well water results? What is the maximum allowed in lab results? - Environmental contamination by organic matter from sewage, vegetation, soils and waste, usually entering the well from surface water Ideally 0 CFU/100 ml, but 5 CFU/100 ml maximum Remedies for adverse well water results - Do not drink, cook, wash food, brush teeth, or bathe using water Boil for at least one minute, cool Refrigerate boiled water for later use Use alternate source Disconnect filters Disinfect the well by adding bleach to 200 ppm chlorine concentration (using calculation), running all taps until odour of bleach, closing taps for 24 hours, then flushing taps until odour of bleach is gone Resample in 48 hours. Three satisfactory samples collected one to three weeks apart indicate a bacteriologically safe supply. Contact well contractor Main pollutants in wood smoke - - particulate matter (small liquid or solid particles in the air and contribute to smog) - Carbon monoxide (CO) - Volatile organic compounds (VOCs) - Polycyclic aromatic hydrocarbons (PAHs) - other chemical compounds (nitrogen oxides) Who is most at risk of health effects from wood smoke? - - people with heart and/or lung problems - children, as they are still developing and tend to inhale more air What types of wood should never be burned? - - wood that has been painted or chemically treated - ocean driftwood, plywood, particle board, or any wood with glue on it (they all release chemicals when burned) - wet, rotted, diseased or mouldy wood (may expose to mould or spores) Safety tips for wood smoke - - Switch heating source (natural gas or oil) - Choose a low emissions stove (environmentally approved) - Maintain stove (have it professionally inspected yearly) - Allow air ventilation (use dampers) - Burn wisely (don't burn on high air pollution days) - Use dry, seasoned wood in small pieces What is smog? - - is a noxious mixture of gases and particles that appear as a haze in the air. Two primary smog pollutants - - Ground level ozone (O3) and particulate matter (PM) When does smog usually occur? - - high levels associated with summer weather due to presence of sunlight and warm temperatures. - high levels associated with winter months due to particulate matter from increased wood heating and vehicle usage. Areas of concerns for smog in Canada - Ontario, Quebec, BC and southern Atlantic region Types and sources of air pollution contributing to smog - - Particulate matter (PM) sources -- industrial/vehicle emissions, road dust, agriculture, construction & wood burning