Unwelcome Guests

After a morning of sightseeing around Fukuoka, Japan in December 2006, Connie Ang felt so ill that she barely made it back to the tour bus. Once on board, the Filipino medical technologist scrambled to find a plastic bag before vomiting violently. By dinnertime, she had chills, a fever and watery diarrhoea.

Luckily, Ang was travelling with three doctors from the infectious diseases section of the Philippine General Hospital. Suspecting food poisoning, they urged her to drink lots of water and reviewed everything they'd eaten in the past 48 hours. They surmised that the cold dishes – including sushi and snails – served during the welcome dinner were the culprits.

Ang's case is all too common in Asia. Anthony Roy Hazzard, a food safety expert with the World Health Organization in Manila estimates that millions of Asians fall victim to dangerous bugs such as E. coli, Salmonella and Vibrio parahaemolyticus each year. ''It's difficult to determine just how many people in Asia fall victim because the cases aren't always
reported,'' says Hazzard.

To make matters worse, it's often tricky to tell if you have a food-borne illness. Many people think they're suffering from the flu, since symptoms are similar. A small percentage can go on to experience chronic conditions such as arthritis or paralysis, or even death. All this makes it even more crucial to know which microorganisms hide where and how to prevent them from invading your food.

''You don't need to be afraid of food-borne illness, just informed about food safety,'' says Jun Bueno, a senior quality manager at an international airline caterer in the Philippines.

:: Chicken ::
Who doesn't love chicken? The problem is, so do salmonella and campylobacter. Salmonella in chicken infected 236 people in Hong Kong between 1998 and 2002, and A. A. Saleha, a faculty member  of veterinary medicine at the Universiti Putra Malaysia, found campylobacter in 45 per cent of 21-day-old chickens in ten broiler farms in Malaysia in 2002.

Free-range birds aren't necessarily cleaner. ''Free-range chickens don't carry a lower risk of food-borne illness,'' says Georgina Cairns, a nutritional consultant at the Asian Food Information Centre in Bangkok. ''Bacteria can grow on them just as happily.''

What about chicken nuggets and strips? They aren't more contaminated than any other chicken shape. Their preformed white insides are just better at fooling us into believing they've been precooked, when in fact they're often raw or only partially cooked.

Bug Busting
• When buying birds at a wet market, look for the vendor who has the most hygienic slaughtering and hand washing facilities, says Hazzard. Once the bird is slaughtered, store the meat below 5°C as soon as possible and certainly within a few hours.
• At the grocery, choose well-wrapped chicken from the bottom of the case, where the temperature is coolest. Be sure to check the best-before date.
• Protect yourself and other purchases by bagging poultry before putting it in your cart. Also ask that your chicken be placed in a separate bag from your produce in case the poultry juices leak.
• When you arrive home, if the packaging of your poultry has been punctured, transfer the chicken to a resealable bag or container. Keep it up to three days in the refrigerator.
• Don't waste time bathing your bird in the sink. You won't wash off all the bacteria. Instead, pop it directly into the roasting pan. Cook chicken until it reaches an internal temperature of at least 70°C. Don't have a food thermometer? Then cook the chicken until all the meat has changed from pink-tan to white and all juices run clear, says Cairns.
• Always follow the cooking instructions for chicken nuggets. If you throw away the box, keep the directions on your fridge door. Skip microwaving frozen nuggets because it won't kill all the harmful bugs.

:: Cold Cuts ::
Cold meats are eaten, well, cold. And nothing tolerates the cold better than listeria, which can grow in climates such as the one inside your fridge or the grocer's deli case. According to Kalidas Shetty, a professor of food
science at the University of Massachusetts Amherst, listeria may hang out on the knives, slicers and cutting boards of meat processors and delis and potentially contaminate any meat that touches them.

Bug Busting
•Choose delis where business is steady so the meat doesn't stick around long.
•Only buy as much as you can eat within two days.
•Always check the best-before date on pre-packaged cuts.
•Thoroughly wash and dry all surfaces and equipment used for food preparation, recommends Dr Abdul Rahim Mohamad,
director of food safety at the department of public health in Malaysia.
Microorganisms can be found in wiping cloths and utensils, especially cutting boards. Even the slightest contact can transfer these nasties to food and cause food-borne diseases.

:: Cooked Rice ::
A bacterium in soil, known as Bacillus cereus, loves to hitch a ride on this staple grain and pepper it with bacteria-producing spores. The catch is, cooking will not destroy the spores. And if you leave your cooked rice out more than a couple of hours, the bacteria may not only flourish but also pump out various poisons that can cause severe stomach cramps, nausea and diarrhoea.

Bug Busting
• Refrigerate your leftover rice immediately to keep it below 5°C. And store cooked rice in a clean and sealed container to
prevent cross-contamination, says Bueno.

:: Eggs ::
Eggs are certainly nutritious. But, if improperly  handled, they can be a source of food-borne illness such as salmonellosis. We once thought that salmonella could only be found on the shell of the egg; now we know it can also be found inside the egg.

In July 2004, salmonella downed 199 factory workers in Huizhou, China. The bug was borne by raw eggs in a mixture poured over a cake that was served at a factory canteen. Between 1998 and 2002, salmonella in egg and egg products, including desserts such as tiramisu and pudding, sickened 415 people in Hong Kong.

Bug Busting
• Avoid eating raw eggs or uncooked foods made with raw eggs, advises the Food Safety Unit at the WHO. Undercooked eggs and food such as puddings, mayonnaise, ice creams, and mousses can also harbour bugs.
• If you're shopping in a grocery store, look for the term ''grade'' on the carton, which ensures the eggs have passed through a grading station. You'll know the ones that haven't gone through this safeguard by the blood, faeces, feathers and number of cracks sometimes found on ungraded eggs.
• Avoid using eggs whose shells are cracked or soiled with chicken droppings, cautions Dr Rahim. They are more likely to be contaminated and thus present a higher health risk.
• Always eat eggs by their best-before date. Cartons that don't have an expiry date are a tip-off that the eggs haven't been inspected.
• Store eggs in the refrigerator at temperatures below 10°C.

:: Ground Meat ::
It's convenient. It's cheap. And it's as attractive to bugs as a climbing frame is to children. The reason? Ground meat, including everything from turkey to pork, has so much more surface area for bacteria to play on and multiply.

Bug Busting
• Check the best-before date and look for the freshest meat. Freeze raw meat or cook within 24 hours of purchase.
• Check the thermometer in the store's meat case. If stored above 4°C, many of these bugs can multiply, doubling every 20 minutes.
• For the drive home, Dr Rahim suggests stashing a small cooler in your car to store meat.
• If you buy a large chunk of ground meat, divide it into smaller portions and thaw only as much as you need, advises Bueno. This way, you avoid thawing and refreezing meat, a process which increases the odds that it will be contaminated.
• Wash your hands before and after handling any meat, eggs or produce: scrub in warm soapy water for 30 seconds. Then dry with a paper towel.
• Make your patties no more than 1.5 centimetres thick or they'll burn before their internal temperature gets hot enough (71°C for beef; 70°C for poultry) to kill all bugs.
• Use a food thermometer.

:: Raw Fruit and Vegetables ::
A diet rich in fresh fruit and vegetables is the cornerstone of a healthy lifestyle. However, any food eaten raw is a particular concern for food safety. Fresh manure used to fertilise fruits and vegetables is the usual cause of contamination in melons and other hard-skinned fruit. This is why you shouldn't ever cut into melons without washing them with clean water first.
The reason for this? These fruits grow on the ground: the same ground where farmers may spread contaminated irrigation water or uncomposted manure, or where birds poop. Strawberries, which are a low-growing fruit, may also be tainted by fresh manure or unsafe water.

Bug Busting 
• Rinse produce thoroughly with running water that is safe and clean enough to drink, advises Hazzard.
• Scrub fruit and vegetables that have firm surfaces, such as melons, with a clean brush. Rinse all produce even if the skins will not be consumed. Dirt and microorganisms on the surface can be passed to the flesh when the fruit is cut open.
• Wash your hands, cutting board and utensils before and after handling fruits and vegetables. Once it's cut, refrigerate it within two hours.

:: Raw Shellfish and Seafood ::
Imagine you were an oyster, sucking in water all day to filter your favourite food, plankton. Now imagine getting a daily side dish of toxins from algae and bacteria from such things as human sewage – all of which concentrate inside you. Nice, huh?
These shellfish are getting their revenge through norovirus, hepatitis A virus and vibrio bacteria. These bacteria live in tidal rivers and bays and makes its way to us through raw or undercooked shellfish.

Bug Busting
• ''All raw or undercooked shellfish or seafood should be regarded as risky foods,'' cautions Cairns. ''If you must eat them, do so only at restaurants where you have confidence in the sourcing, quality, and preparation of the ingredients,'' she says.
• Look for popular restaurants that have been around for a while – if they were making people sick, they wouldn't be in business. And buy fresh shellfish or seafood only from reputable stores.
• Cook seafood well at a temperature of 72°C and above, advises Bueno.

:: Raw Sprouts ::
In Japan, an outbreak of E. coli infected over 6300 school children in 1996, killing three of them. The WHO considers this the largest outbreak ever recorded for this pathogen. The culprit? White radish sprouts.
Sprouts loom on the food-risk radar for several reasons: first, because we eat them raw; second, because their seed coats have tiny cracks and crevices that can harbour bacteria, making them difficult to wash thoroughly; and third, their warm, wet growing conditions get bugs multiplying like crazy.

Bug Busting 
• The only safe sprout is a fully cooked one, advises Dr Rahim. Otherwise wash sprouts properly in clean water to minimise the risk. Look for fresh crisp sprouts with the bud attached, and avoid those that are dark or musty-smelling.