2024/25 Hygiene and Food Safety Past Paper PDF

For teaching purposes only! Food Hazards: Ricardo Assunção, DVM, PhD Biological Hygiene & Food Safety Integrated M...

For teaching purposes only! Food Hazards: Ricardo Assunção, DVM, PhD Biological Hygiene & Food Safety Integrated Master in Veterinary Medicine 2024/25 www.egasmoniz.com/pt For teaching purposes only! Objectives to be attained during this lecture: To know the main biological hazards, how they could occur in foods, and health consequences - Master’s Degree in Veterinary Medicine WHY ARE THESE TOPICS IMPORTANT? 2  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt 3 Biological hazards For teaching purposes only! www.egasmoniz.com/pt For teaching purposes only! Biological hazards It is estimated that around 90% of food-borne illnesses are caused by microorganisms - Microorganisms can be found in almost all foods, but in most cases their Master’s Degree in Veterinary Medicine transmission results from the use of incorrect methodologies in the final stages of their preparation or distribution Why? 4 www.egasmoniz.com/pt For teaching purposes only! Foodborne outbreaks in the EU (2021) - Master’s Degree in Veterinary Medicine https://www.efsa.europa.eu/en/topics/topic/foodborne-zoonotic-diseases 5 www.egasmoniz.com/pt For teaching purposes only! Foodborne outbreaks in the EU (2021) - Master’s Degree in Veterinary Medicine https://www.efsa.europa.eu/en/topics/topic/foodborne-zoonotic-diseases 6 www.egasmoniz.com/pt For teaching purposes only! Foodborne biological hazards Pathogenic or potentially pathogenic bacteria: Salmonella spp., Campylobacter spp., Listeria monocytogenes, Clostridium botulinum, Cl. perfringens, Staphylococcus aureus, E. coli EPEC and VTEC, Bacillus cereus, Shigella spp., Brucella spp., Vibrio cholerae, V. parahaemolyticus, Mycobacterium sp., Yersinia enterocolitica,... Virus and Prions: - Hepatitis A, Norovirus, Rotavirus, Astrovirus, PRP’ nVCJD Master’s Degree in Veterinary Medicine Protozoa: Toxoplasma gondii, Cryptosporidium parvum, Giardia spp., Neospora spp., Sarcocystis hominis, Entamoeba spp. Nematode: Trichinella spiraliis, Anizakis spp., Ascaris spp., Oxiuros spp., … Cestode: Taenia solium (Cysticercus cellulosae), C. bovis, Diphylobothrium spp. Trematode: Fasciola hepatica, Opistorquis spp. 7 www.egasmoniz.com/pt For teaching purposes only! Transmission of biological hazards Contact Humans Humans with Foods - Master’s Degree in Veterinary Medicine Animal- Animals origin food Humans products Contamination Environment Humans of food chain 8 www.egasmoniz.com/pt - Master’s Degree in Veterinary Medicine For teaching purposes only! Direct cycle (Fecal-Oral Route) Contact Humans Humans with Foods 9  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt Unsplash Animals Animal- products Zoonotic cycle origin food https://www.inrae.fr/en/ne ws/quality-foods-animal- Humans origin-based-production- and-processing-conditions 10 https://www.fooddocs.com/post/h ow-to-prevent-foodborne-illness For teaching purposes only!  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt Environment of food chain Contamination Telluric/Environmental cycle Humans 11 https://www.fooddocs.com/post/h ow-to-prevent-foodborne-illness For teaching purposes only! www.egasmoniz.com/pt - Master’s Degree in Veterinary Medicine For teaching purposes only! Direct cycle (Fecal-Oral Route) 12 www.egasmoniz.com/pt - Master’s Degree in Veterinary Medicine For teaching purposes only! Direct cycle (Fecal-Oral Route) Contact Humans Humans with Foods 13  For teaching purposes only! Salmonella enterica www.egasmoniz.com/pt Serovar Typhi Cause systemic infections and typhoid fever in humans Gastroenteritis severe - Severe diarrhea Master’s Degree in Veterinary Medicine Dehydration nigerian-government-action-plan-on-water-and-sanitation-crisis https://www.wateraid.org/au/articles/wateraid-welcomes- Death Asymptomatic carriers 14 www.egasmoniz.com/pt For teaching purposes only! Vibrio cholerae DOI: 10.1007/s11908-011-0221-9 Gram -, comma-shaped, very mobile, does not form spores People can get sick when they swallow fresh food or water contaminated with cholera bacteria - Acute diarrheal illness (secretory diarrhea → secretion >> absorption) Rice water stool produced by a cholera patient Master’s Degree in Veterinary Medicine About 1 in 10 people with cholera will experience severe symptoms, which, in the early stages, include: DOI: 10.1007/s11908-011-0221-9 Profuse watery diarrhea, sometimes described as “rice-water stools” Vomiting Thirst Leg cramps Restlessness or irritability Dehydration The cholera cot Death 15 www.egasmoniz.com/pt For teaching purposes only! Foodborne viruses Human enteric viruses are the major cause of nonbacterial gastroenteritis also known as stomach flu and are transmitted via food and waterborne route Foodborne viruses include the human noroviruses (HNoV), hepatitis A virus (HAV), hepatitis E virus (HEV), rotavirus (RV), - Aichi virus (AiV), astroviruses, sapoviruses, adenoviruses, coxsackievirus, parvovirus, and picornavirus. Master’s Degree in Veterinary Medicine https://www.cdc.gov/foodborneburden/pdfs/scallan -estimated-illnesses-foodborne-pathogens.pdf Estimated annual number of episodes of illnesses caused by 31 pathogens transmitted commonly by food, United States* 16 www.egasmoniz.com/pt For teaching purposes only! Norovirus Norovirus infection Infectious dose: 10-100 viral particles - 24-48 hour incubation period 12-60 hours duration of illness Master’s Degree in Veterinary Medicine Transmission Faecal-oral route Food (39%) Hands, person to person (12%) Water (3%) Environmental surfaces Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003. 17 www.egasmoniz.com/pt For teaching purposes only! Norovirus Forms of Foodborne Transmission Food (i.e. food that arrives contaminated) - Food preparation Master’s Degree in Veterinary Medicine Food handlers Sellers Mainly: ready-to-eat (RTE) products that require handling but no subsequent cooking (e.g. salads) Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003. 18 www.egasmoniz.com/pt For teaching purposes only! Norovirus Mild gastrointestinal problems such as nausea, headache, abdominal pain and vomiting Very contagious - Multiple forms of transmission Master’s Degree in Veterinary Medicine Stable in the environment These viruses can survive at low pH (2 – 4) and can remain in the environment and food for a long time. Resistant to routine disinfection methods Carriers may be asymptomatic Maintaining good hygienic practices by food handlers can prevent the transmission rate as there is no vaccine and antiviral treatment available against this infection Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003. 19  For teaching purposes only! https://www.netmeds.com/health-library/post/hepatitis-a-causes-symptoms-and-treatment www.egasmoniz.com/pt Hepatitis A The incubation period of HAV is approximately 28 days long Symptoms: Fever - Liver pain Steatorrhea Master’s Degree in Veterinary Medicine Acolic feces Very dark urine Jaundice Undigested fats HAV can resist very low pH up to 1.0 therefore it has high infectivity in the environment and can survive in harsh conditions as well The pathogenic mechanism is similar to all the viruses occurring in the upper gastrointestinal tract of the human intestine Vaccination is available which provides lifetime immunity but a majority of HAV infection resolves on their own 20 www.egasmoniz.com/pt For teaching purposes only! Cryptosporidium parvum Protozoan - Coccidia Pathogenic form: oocyst 3 μm in diameter - (1/2 the size of an erythrocyte) Master’s Degree in Veterinary Medicine Consequences of infection: Enteritis Intermittent diarrhoea Emaciation Dehydration 21  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt Cryptosporidium parvum 22 For teaching purposes only! https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6825a3-H.pdf  https://www.uol.com.br/vivabem/faq/giar transmissao-e-prevencao-da-doenca.htm For teaching purposes only! diase-causa-diarreia-veja-sintomas- www.egasmoniz.com/pt Giardia spp. Enterocolitis Chronic diarrhoea - Abdominal pain Malnutrition Master’s Degree in Veterinary Medicine Dehydration Estimated prevalence 1 to 20 % of the population (depending on age) Vulnerable groups: Children up to 5 and immunocompromised 23  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt Giardia spp. https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7009a2-H.pdf 24 For teaching purposes only! www.egasmoniz.com/pt For teaching purposes only! Entamoeba histolytica Enterocolitis Watery diarrhoea - Abdominal pain Master’s Degree in Veterinary Medicine Dehydration 25 www.egasmoniz.com/pt For teaching purposes only! Ascaris spp. Oxiuros spp. Strongyloides spp. Enterocolitis Diarrhoea - Emaciation Master’s Degree in Veterinary Medicine Malnutrition Growth retardation 26  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt 27 Zoonotic cycle For teaching purposes only!  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt Unsplash Animals Animal- products Zoonotic cycle origin food https://www.inrae.fr/en/ne ws/quality-foods-animal- Humans origin-based-production- and-processing-conditions 28 https://www.fooddocs.com/post/h ow-to-prevent-foodborne-illness For teaching purposes only! www.egasmoniz.com/pt For teaching purposes only! Salmonella spp. Taxonomy https://freitag.com.br/blog/salmonella-e-perigosa/ Family: Enterobacteriaceae - Genus: Salmonella Master’s Degree in Veterinary Medicine Species: Salmonella enterica Salmonella bongori 29  For teaching purposes only! Salmonella spp. www.egasmoniz.com/pt Taxonomia Serotypes S. enterica subspecies enterica (1478) “ subspecies salamae (498) - “ subspecies arizonae (94) Master’s Degree in Veterinary Medicine “ subspecies diarizonae (327) “ subspecies houtenae (71) “ subspecies indica (12) S. bongori (21) TOTAL (2501) Kauffmann-White, 8a ed. 2001 (M.Y. Popoff) 30 www.egasmoniz.com/pt For teaching purposes only! Salmonellosis Symptoms: Incubation period: 12 to 36 hours - Abdominal pain, nausea, rare vomiting, chills, fever (39 ºC) Mucous, bloody diarrhoea (green > red) Master’s Degree in Veterinary Medicine Cures in 2 to 7 days Usually associated foods: Eggs, Raw meat, Raw milk, Raw or insufficiently heat-processed shellfish Sources: Intestine and faeces of warm-blooded animals; Animals with Salmonellosis; Humans 31  For teaching purposes only! In 2021, the number of confirmed cases of human www.egasmoniz.com/pt Salmonella spp. salmonellosis was 60,050, corresponding to an EU notification rate of 15.7 per 100,000 population. This was an increase of 14.3% compared with the rate in 2020. - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 32  For teaching purposes only! In 2020, ECDC recorded the lowest number of human Salmonella cases since 2007, when salmonellosis surveillance www.egasmoniz.com/pt Salmonella spp. started. The number of cases was impacted by the COVID-19 pandemic and the United Kingdom’s withdrawal from the EU. - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 33 www.egasmoniz.com/pt For teaching purposes only! Salmonella spp. Seasonal trend was observed for - confirmed salmonellosis cases in Master’s Degree in Veterinary Medicine the EU in 2012–2021, with more cases reported during the summer months 34 www.egasmoniz.com/pt For teaching purposes only! Campylobacteriosis https://www.cdc.gov/campylobacter/index.html Worldwide distribution Campylobacter jejuni and Campylobacter coli are the most common species - Widespread in nature and in the gastrointestinal tract of domestic and wild animals Master’s Degree in Veterinary Medicine Infection with this bacterium causes gastroenteritis in humans and animals Microaerophilic require a reduced oxygen concentration for growth 35 www.egasmoniz.com/pt For teaching purposes only! Campylobacteriosis https://www.cdc.gov/campylobacter/index.html Symptoms: Incubation period: 2 to 5 days Intestinal infection - Abdominal pain Master’s Degree in Veterinary Medicine Diarrhoea (sometimes bloody), fever, headache, myalgias Usually self-limiting within a few days Usually associated foods: Meat and poultry, raw milk and water (contaminated with faeces from farm animals, healthy carriers) Sources: Inadequate heat treatment of food; cross-contamination 36  For teaching purposes only! Campylobacteriosis is the most commonly reported foodborne www.egasmoniz.com/pt Campylobacter gastrointestinal infection in humans in the EU and has been so since 2007. - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 37  For teaching purposes In 2021, the number of confirmed cases of human campylobacteriosis was only! 127,840, corresponding to an EU notification rate of 41.1 per 100,000 population. This was an increase of 2.1% compared with 2020 (40.2 per www.egasmoniz.com/pt Campylobacter 100,000 population). In 2020, ECDC recorded the lowest number of human cases of campylobacteriosis in any year since surveillance began in 2007, owing to the impact of the COVID-19 pandemic and the withdrawal of the United Kingdom from the EU. - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 38 www.egasmoniz.com/pt For teaching purposes only! Campylobacter Between 2012 and 2021, the number of - confirmed campylobacteriosis cases reported in the EU showed a clear Master’s Degree in Veterinary Medicine seasonal trend, peaking in the summer months. Annual winter peaks were also observed in January from 2012 to 2021, although peak numbers were lower than those observed during the summer. EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 39  For teaching purposes only! Escherichia coli (E. coli) is a bacterium that is commonly found www.egasmoniz.com/pt Colibacillosis in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless. Gastroenteritis caused by enteropathogenic Escherichia coli: - Enteropathogenic E. coli (EPEC) Master’s Degree in Veterinary Medicine Enterotoxigenic E. coli (ETEC) Enteroinvasive E. coli (EIEC) Enterohaemorrhagic E. coli (EHEC) or Shiga toxin-producing E. coli (STEC)—STEC or Verocytotoxin-producing E. coli (VTEC) or enterohemorrhagic E. coli (EHEC) 40 www.egasmoniz.com/pt For teaching purposes only! Colibacillosis - Master’s Degree in Veterinary Medicine https://doi.org/10.3390/gastroent12010004 41 www.egasmoniz.com/pt For teaching purposes only! Colibacillosis Enteropathogenic E. coli (EPEC) Important agent of gastroenteritis in children, especially in developing countries - Symptoms: Master’s Degree in Veterinary Medicine Photo of Larm Rmah, Unsplash Diarrhoea, usually accompanied by abdominal pain, vomiting and fever Duration of illness: 6 hours - 3 days Incubation period 17 - 72 hours 42 www.egasmoniz.com/pt For teaching purposes only! Colibacillosis Enterotoxigenic E. coli (ETEC) Symptoms: - Watery diarrhoea, usually accompanied by low-grade fever, abdominal pain and nausea Master’s Degree in Veterinary Medicine Incubation period: 8 - 44 hours In malnourished individuals, gastroenteritis can last for weeks, leading to severe dehydration In mild cases, it is self-limiting, without medical treatment 43 www.egasmoniz.com/pt For teaching purposes only! Colibacillosis Enteroinvasive E. coli (EIEC) Symptoms: - Abdominal pain, fever Master’s Degree in Veterinary Medicine Faeces with elimination of blood, mucus Incubation period: 8 - 24 hours Children and adults Transmitted through contaminated water and/or food or personal contact 44 www.egasmoniz.com/pt For teaching purposes only! Colibacillosis Enterohaemorrhagic E. coli (EHEC) Symptoms: - Haemorrhagic colitis Master’s Degree in Veterinary Medicine Intense abdominal pain and acute diarrhoea with blood and no fever Incubation period: 3 - 9 days Duration of illness varies from 2 - 9 days 45 www.egasmoniz.com/pt For teaching purposes only! E. coli O157:H7 | an example E. coli O157 Ingested 3-4 days - Master’s Degree in Veterinary Medicine Diarrhea without blood, Abdominal pain 1-2 days Diarrhea with blood 94% 5 days 6% https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645889/ Recovery HUS Hemolytic uremic syndrome 46  For teaching purposes only! Shiga toxin-producing www.egasmoniz.com/pt Escherichia coli (STEC) - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 47 www.egasmoniz.com/pt For teaching purposes only! Yersiniosis Yersinia enterocolitica Enterobacteriaceae: Psychrotrophic - Intestinal infection can grow at temperatures equal to or lower than 7°C Master’s Degree in Veterinary Medicine 48 www.egasmoniz.com/pt For teaching purposes only! Yersiniosis Symptoms: Usually associated foods: Incubation period: 3 to 7 days Meat (especially pork), but also beef, sheep, oysters, - Acute gastroenteritis fish; Watery diarrhoea with or without vomiting Raw milk, ice cream and water Master’s Degree in Veterinary Medicine Fever, abdominal cramps Meat eaten undercooked, without adequate heat treatment Mimics appendicitis Post-pasteurisation contamination 49 www.egasmoniz.com/pt For teaching purposes only! Clostridium perfringens inactive forms of the bacterium that help it survive heat, dryness, and Clostridium perfringens, type A, B, C other environmental conditions The toxin is produced when the spores germinate - (thermosensitive) Master’s Degree in Veterinary Medicine Under certain conditions, such as when food is kept at an unsafe temperature, C. perfringens spores can transform into active bacteria, which multiply in the food “Cafeteria bacteria” many outbreaks result from food left for long periods in steam tables or at room temperature 50 www.egasmoniz.com/pt For teaching purposes only! Clostridium perfringens Symptoms: Incubation period: 8 to 24 hours - Abdominal pain, watery diarrhoea, vomiting Master’s Degree in Veterinary Medicine Usually associated foods: Highly manipulated meals prepared more than 12 hours in advance; reheating at T < 70ºC Environmental contamination: Soil, fresh vegetables, meat (faeces) 51 www.egasmoniz.com/pt For teaching purposes only! Staphylococcus aureus Thermoduric enterotoxins preformed in food Symptoms: - Incubation period: 1 to 8 hours Nausea, vomiting, watery diarrhoea Master’s Degree in Veterinary Medicine Dehydration Usually associated foods: Heavily handled dishes Leftover food, cold desserts, salads Cheese and pâté Humans and animals (skin, mucous discharges, infected wounds, abscesses) 52  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt 53 Telluric/Environmental cycle For teaching purposes only!  Master’s Degree in Veterinary Medicine - www.egasmoniz.com/pt Environment of food chain Contamination Telluric/Environmental cycle Humans 54 https://www.fooddocs.com/post/h ow-to-prevent-foodborne-illness For teaching purposes only!  For teaching purposes only! Two types of gastrointestinal illness: www.egasmoniz.com/pt Bacillus cereus Emetic (vomiting) syndrome Diarrhoeal syndrome Haemetic and diarrhoeal enterotoxins preformed in the food Symptoms: - Incubation period: 1 to 8 hours Nausea, vomiting, watery diarrhoea Master’s Degree in Veterinary Medicine Dehydration Usually associated foods: Environment (soils), spices Cereal dishes Leftover food Dried fruit 55 www.egasmoniz.com/pt For teaching purposes only! Listeria monocytogenes Symptoms: Usually associated foods: 24 hours to 5 days Cured cheeses - Fever (flu-like syndrome, headache) Meat Master’s Degree in Veterinary Medicine Meningitis, encephalitis Vegetables Abortion and prenatal death Sources: environment Death (40%) 56 www.egasmoniz.com/pt For teaching purposes only! Listeria monocytogenes - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 57  For teaching purposes only! The EU notification rate was 0.49 per www.egasmoniz.com/pt Listeria monocytogenes 100,000 population, 14.0% higher compared with the rate in 2020 (0.43 per 100,000 population). - Master’s Degree in Veterinary Medicine EFSA and ECDC (European Food Safety Authority and European Centre forDisease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report. EFSAJournal 2022;20(12):7666, 273 pp. https://doi.org/10.2903/j.efsa.2022.7666 58 www.egasmoniz.com/pt For teaching purposes only! Listeria monocytogenes - Master’s Degree in Veterinary Medicine https://www.cdc.gov/listeria/outbreaks/ice-cream-08-23/index.html 59 www.egasmoniz.com/pt For teaching purposes only! Clostridium botulinum Gram-positive, spore-producing bacilli Source: Found in soil; multiplies in the absence of oxygen - Botulism: Master’s Degree in Veterinary Medicine Food Wounds (lesions) Infant 60 www.egasmoniz.com/pt For teaching purposes only! Clostridium botulinum - Toxin binds to pre-synaptic Master’s Degree in Veterinary Medicine membranes in motor neurons at the neuro-muscular junction Blocks release of acetylcholine, preventing muscle contraction https://biologydictionary.net/botulinum-toxin/ 61 www.egasmoniz.com/pt For teaching purposes only! Clostridium botulinum Anaerobic spore-forming resistant to high temperatures Spores germinate at 10°C, with toxin production (Type E germinates at 3.3°C) - Thermosensitive toxins Master’s Degree in Veterinary Medicine Incubation period: 4 to 36 hours Symptoms: Headaches, prostration, vertigo Asphyxiation, muscle paralysis, respiratory and heart failure Death (% mortality can reach 60%) 62 www.egasmoniz.com/pt For teaching purposes only! Clostridium botulinum Usually associated foods: Packaged mature cheeses - Canned meat, fish and vegetables without adequate sterilization Master’s Degree in Veterinary Medicine Honey; soups; vacuum-packed foods with low acidity and semi-preserves (pickles) Sources: Bovine faeces, Soil, water, vegetables from soils with a lot of humus (carrots, mushrooms) 63 www.egasmoniz.com/pt For teaching purposes only! Infant botulism Disease that affects infants primarily under 1 year of age Ingested spores of the bacterium Clostridium botulinum colonize and grow in the infant's large intestine and produce botulinum neurotoxin in it - Patients with infant botulism may present with some or all the following signs and symptoms: Master’s Degree in Veterinary Medicine Constipation Poor feeding Ptosis Honey can contain the Sluggish pupils bacteria that causes doi: 10.5152/eajm.2010.25 infant botulism → do not Flattened facial expression feed honey to children Diminished suck and gag reflexes younger than 12 months Weak and altered cry Respiratory difficulty and possibly respiratory arrest 64 www.egasmoniz.com/pt For teaching purposes only! Objectives to be attained during this lecture: To know the main biological hazards, how they could occur in foods, and health consequences - Master’s Degree in Veterinary Medicine WHY ARE THESE TOPICS IMPORTANT? 65  For teaching purposes only! Food Hazards: Ricardo Assunção, DVM, PhD Biological Hygiene & Food Safety Integrated Master in Veterinary Medicine 2024/25