Decline in food poisoning cases

Cases of food poisoning in Malta have declined over the years but have now stabilised, according to records of notification at the Disease Surveillance Unit within the Department of Public Health.

The unit investigates single and outbreak cases of suspected food-borne illnesses and tries to identify the source of the rogue food items.

A zero rate of incidence of food poisoning and a zero risk factor were impossible to achieve, according to manager health inspector of the Health Inspectorate Services, John Attard Kingswell.

Statistics list 70 individual cases of salmonella and 49 cases involved in eight outbreaks in 2002. In the case of campylobacter, there were 31 cases and five outbreaks involving 10 people.

Scombrotoxic, E. Coli and shigella were uncommon, while certain measures have led to a decline in cases of brucellosis from four in 1998 to one last year, which was imported.

Other unspecified cases of food poisoning amounted to 64 individual cases and 322 cases in 35 outbreaks.

Mr Attard Kingswell said the new Food Safety Act, which came into force in September, "differs from the previous legislation primarily in that the onus has shifted from the Health Authority onto the food operators".

Prior to the introduction of the new act, any action was carried out through normal court procedures. The Health Authority is now allowed to close down premises, or part of an operation, although there have been no such situations since the act came into force.

Last year, there were 965 food-related contraventions, although not necessarily associated with cases of food poisoning. Since October, 20 undertakings were agreed to between the operator and the Health Authority, 13 of which were concluded by the end of December.

A total of 6,607 inspections were carried out at retail outlets, food manufacturers, catering establishments and hotels in 2002. These did not include the 92 follow-up inspections that were carried out after the Disease Surveillance Unit pointed out cases of food poisoning. Not all the 92 operators were sources of food poisoning, however.

"For some unknown reason, the Maltese tend to complain very little about food and anything related to food," said Mr Attard Kingswell.

"We had 6,125 complaints last year, but only 11 per cent - the lowest percentage - were related to food."

On the other hand, most contraventions were food-related, he said.

Mr Attard Kingswell pointed out a discrepancy between the number of complaints made over the media, for example, and those that were actually lodged to the complaints section.

The low percentage was probably due to social factors and the fear that their complaints would be heard by the operators they were lodged against.

Principal medical officer in the Department of Public Health, Charmaine Gauci, said that in Malta, as in most other European countries, under-notification of food-borne illnesses was high. Many victims of food poisoning do not call a doctor and, therefore, many cases do not come to the attention of the authorities.

Malta being small, patients often did not want to get an operator into trouble and may even ask their doctor not to notify the authorities.

Malta compared well with other European countries as regards hygiene and enforcement, as well as the incidence of food poisoning. Food safety legislation was in compliance with the relevant EU directives, Dr Gauci said.

The main difficulty the Health Inspectorate faced was those operators "who do not know much about food hygiene".

Both premises and operators were in the process of being registered and the Health Inspectorate has started to take legal action against those who have not done so yet, mostly out of negligence.

Although the focus was on restaurants (32 per cent), households (24 per cent) were the second largest implicated source of food-borne disease outbreaks last year, Dr Gauci pointed out.

"A even higher number of individual cases originate from the household and should not be ignored," she said.

Households were followed by hotels (22 per cent), takeaways (12 per cent) and hospitals (10 per cent).

The incidences of food poisoning are controlled by education to understand how serious it can be, Dr Gauci said. Food poisoning is mainly due to cross-contamination, such as using the same unwashed cutting board for handling raw meat and cooked food.

Lack of education among food handlers was one of the major problems, hence the courses in hygiene, which they now have to follow.