i

ii
iii
iv
1
bakteria,

2
3
4
5
6
7
8
 Jika populasi terlalu ramai dan penyiasat tidak
mempunyai cukup anggota untuk melakukan temubual,
pilih sebahagian dari mereka yang ada gejala dan
sebahagian dari yang tidak mengalami sebarang gejala
secara rawak. Langkah ini membolehkan analisa statistik
dibuat mengikut kaedah case control.
Gabungkan hasil analisa dari kajian epidemiologi di atas
dengan penemuan dari ujian makmal dan siasatan
persekitaran untuk merumuskan punca berlakunya
keracunan.

b. Mengambil sampel-sampel klinikal, makanan yang

disyaki, bahan mentah dan sampel lain jika berkaitan
seperti:
spesimen najis
sample muntah
swab rektal
swab peralatan memasak
swab (hidung, tekak, anggota) pengendali makanan
Swab persekitaran (meja, peti ais, kepala paip, effluen
tangki septic dan lain-lain)

PENGAMBILAN SAMPEL KLINIKAL AMAT PENTING kerana

ia boleh memberi petunjuk mengenai jenis patogen penyebab.
Ini kerana, sampel makanan biasanya tidak dapat diperolehi
semasa penyiasatan.

c. Menjalankan pemeriksaan ke atas premis makanan di

mana berlaku kejadian keracunan makanan.
Menganalisa keselamatan makanan menggunakan kaedah
HACCP. Pegawai Teknologi Makanan boleh dipanggil
dalam membantu siasatan.
Menutup premis di bawah Sek 18(1)(d) Akta 342
[Pengawalan dan Pencegahan Penyakit Berjangkit 1988]
atau (seksyen 10 atau 11 Akta Makanan 1983)
Menyita makanan.

Kawalan vektor (LILATI)

d. Pendidikan Kesihatan

Prosedur penyiasatan dan kawalan adalah seperti mana yang

dijelaskan di dalam Garispanduan Umum FWBD/UMU/GP/001
(pindaan2006).

9
10
11
12
 TABLE B – ILLNESSES ATTRIBUTED TO FOODS
A CONDENSED CLASSIFICATION BY SYMPTOMS, INCUBATION PERIOD, AND TYPES OF AGENTS 1,2

Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
and source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

UPPER GASTROINTESTINAL, TRACT SYMPTOMS AND SIGNS [NAUSEA, VOMITING] OCCUR FIRST OR PREDOMINATE

Incubation [Latency] Period Usually Less than 1 hour

Fungal Agents

14
Gastroin- Possibly resin-like 3 min to 2 hours Nausea, vomiting Many varieties Vomitus Eating unknown
testinal substances in retching, diarrhea, of vild varieties of
irritating group some mushrooms abdominal cramps mushrooms mushrooms,
mushroom mistaking toxic
poisoining mushrooms for
edible varieties

Chemical Agent4
Antimony Antimony in gray Few min to Vomiting, abdominal High-acid food Vomitus, stools, Purchasing
enamelware 1 hours pain, diarrhoea and beverages urine antimony containing
utensils, storing high
acid foods in gray
enamelware
Lampiran 2
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Fluoride Sodium fluoride in Few min to Salty or soapy taste, Any accidentally Vomitus, gastric Storing
poisoning insecticides and 2 hours numbness of mouth, contaminated washing insecticides in
rodenticides vomiting, diarrhea, foods, same areas as
abdominal pain, particularly dry foods, mistaking
pallor, cyanosis, foods [such as pesticides for
dilated pupils, dry milk, flour, baking powdered foods
spasms, collapse, powder,
shock cake mixes]

15
Lead Lead in 30 min or longer Metalic taste, High acid foods Vomitus, gastric Purchasing lead
poisoning earthenware burning of mouth, and beverages washings, stools, containing
vessels, abdominal pain, stored in lead blood, urine vessels, storing
pesticides, paint, milky vomitus, containing high acid foods in
plaster, putty, bloody or black vessels, any lead containing
soldered joints stools, foul breath, accidentally vessels, storing
shock, blue gum contaminated pesticides in same
line food area as food.

Tin Tin in tinned cans 30 min to 2 hours Bloating, nausea, High-acid foods Vomitus, stools Using uncoated tin
poisoning vomiting, and beverages urine, blood containers for
abdominal, cramps, storing high-acid
diarrhoea, foods
headache
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Cadmium Cadmium in 15 to 30 min Nause, vomiting High-acid foods Vomitus, stools, Purchasing
poisoning plated utensils abdominal cramps, and beverages urine, blood Cadmium
diarrhea, shock [metal colored containing
cake decorations] utensils, storing
high acid foods in
cadmium
containing
containers,
ingesting

16
cadmium
containing foods

Cooper poisoning Copper in pipes Few min to Metalic taste, High-acid foods Vomitus, gastric Storing high-acid
and utensils few hours nausea, vomiting and beverages washings, urine, foods in copper
[green vomitus], blood utensils or using
abdominal pain copper pipes for
diarrhoea dispensing high-
acid beverages,
faulty backflow
prevented valves
in vending
machines
 Disease Aetiologic agent Incubation or Symptoms and Signs Food usually Specimens to Factors that
And source Latency period Involved3 Collect Contributed to
Foodborne
outbreaks
Zinc poisoning Zinc in galvanized Few min to Pain in mouth and High-acid foods Vomitus, gastric Storing high-acid
containers few hours abdomen, nausea, and beverages washings, urine, foods in
vomiting, dizzines blood, stools galvanized cans

Incubation [Latency] Period Usually in the Range of 1 to 6 hours

Bacterial Agents

Bacillus Exo-enterotoxin of ½ to 5 hours Nausea, vomiting, Boiled or fried Vomitus, stool Storing cooked foods at room
cereus B. cereus. occasionally Rice temperature, storing cooked

17
gastroenteritis Organism in soil Diarrhoea foods in large containers in
refrigerators, preparing foods
several hours before serving

Staphylococcal Exo-enterotoxins A, 1 to 8 hours. Mean Nausea, vomiting, Ham, meat and Vomitus, stools, Stored cooked food at room
intoxication B, C, D, E or F of 2 to 4 hours. retching, abdominal poultry products, rectal swab. temperature, storing cooked
Staphylococci pain, diarrhoeal, cream-filled Carriers: nasal food in large containers in
aureus. Organism prostrations pastries, whipped swab, swab of refrigarators, touching cooked
from naoses, skin butter, cheese, dry lesions, anal swab foods, preparing foods several
and lesions of milk, food mixture, hours before serving, person
infected humans with infections containing pus,
high protein leftover
holiding foods at warm
and animals and foods. temperatures, fermentation of
from udders of cows abnormally low-acids foods
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Chemical Agents

Nitrite Nitrites or nitrates 1 to 2 hours Nause, vomiting Cured meats, any Blood Using excessive
poisoning used as meat cyanosis, headache, accidentally amounts of nitrites
curing compounds dizziness, contaminated or nitrates in foods
or ground water weakness, loss of food, spinach for curing or for
from shallow consciousness, exposed to covering up
wells, fertilizer chocolate brown excessive spoilage,
coloured blood nitrification mistaking nitrites
for common salt
and other
condiments,

18
improper
refrigeration of
fresh produce.
Excessive
nitrification of
fertilized fields

Diarrhetic Okadaic acid and ½ to 12 hours Nausea, vomiting Mussels, clams, Gastric washings Harvesting
shellfish other toxins usually 4 hours abdominal cramps, scallops shellfish from
poisoning produced by chills waters with high
dinoflagellates concentration of
Dinophyses Dinophyses
acuminate and D.
forti
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Incubation [Latency] Period Usually in the Range of 7 to 12 hours

Fungal Agent

Cyclopeptide Cyclopeptides and 6 to 24 hours Abdominal pain, Amanita Urine, blood, Eating certain
and gyromitrin gyromitrin in some feeling of fullness, phalloides, A, vomitus species of
groups of mushrooms vomiting, protracted verna, Galerina Amanita,
mushroom diarrhoea, loss of autumnalis, Galerine, and
poisoning strength, thirst, Gyromitra Tyromitra
muscle cramps, esculenta [false mushrooms,
collapse, jaundice, morels] and eating unknown

19
drowsiness, dilated similar species of varieties of
pupils, coma death mushrooms mushrooms,
mistaking toxic
mushrooms for
edible varieties
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

SORE THROAT AND RESPIRATORY SYMPTOMS AND SIGNS OCCUR

Incubation [Latency] Period Usually Less than 1 hours

Chemical Agents
Sodium hydroxide Sodium hydroxide Few min Burning of lips, Bottled Vomitus Inadequate
poisoning in bottle washing mouth and throat, beverages, rinsing of bottles
compounds, vomiting, pretzels cleaned with
detergents, drain abdominal pain, caustic soda,
cleaners, or hair diarrhoea inadequate baking
straighteners of pretzels

20
Incubation [Latency] Period Usually in the Range of 13 to 72 hours
Bacterial Agents
Beta hemolytic Streptococcus 1 to 3 days Sore throat, fever, Raw milk, foods Throat swabs, Persons touching cooked
streptococcal pyogenes from nausea, vomiting, containing eggs vomitus foods, persons with
infections throat and lesions rhinorrhoea, infections containing
of infected sometimes a rash pus, room temperature
humans storage, storing cooked
food in large containers
in refrigerators,
inadequate cooking or
reheating preparing
foods several hours
before serving.
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

LOWER GASTROINTESTINAL TRACT SYMPTOMS AND SIGNS [ABDOMINAL CRAMPS, DIARRHEA] OCCUR FIRST OR PREDOMINATE
Incubation [Latency] Period Usually in the “Range of 7 to 12 hours”

Bacterial Agents

Bacillus cereus Enterotoxin of B. 8 to 16 hours Nausea, abdominal Cereal products Stools Storing cooked foods
enteritis cereus. Organism [mean 12 hours] pain, watery soups, custards at room temperature,
in soil diarrhoea and sauces, storing cooked foods
meatloaf, in large containers in
sausage, cooked refrigerators, holding
vegetables, foods at warm

21
reconstituted [bacterial incubating]
dried potatoes, temperatures,
refried beans preparing foods
several hours before
serving, inadequate
reheating of leftovers
Clostridium Endo-enterotoxin 8 to 22 hours Abdominal pain, Cooked meat, Stools Storing cooked foods
perfringens formed during [mean 10 hours] diarrhoea poultry, gravy, at room temperature,
enteritis sporulation of C. sauces, soups, storing cooked foods
perfringens in refried beans in large containers in
intestines. holding foods at
Organism warm [bacterial
in faeces of incubating] temperature,
humans, other preparing foods
animals, and in serving, inadequate
soil reheating of leftovers.
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Incubation [Latency] Period Usually in the “Range of 13 to 72 hours”

Bacterial Agents

Campylobacter C. jejuni 2 to 7 days, Diarrhoea, [often Raw milk, poultry, Stools, rectal Drinking raw milk,
enterocolitis [mean 3 to bloody] beef liver, raw swab, blood eating raw meat,
5 days] severe abdominal clams, water inadequate
pain, fever, cooking or
anorexia, malaise, pasteurization
headache,

22
vomiting

Cholera Enterotoxin of 1 to 3 days Profuse watery Raw fish, raw Stools Obtaining fish and shell
Vibrio cholerae 01 diarrhoea [rice shellfish, fish from sewage
classical and El water stools], crustacea, foods contaminated waters in
Tor biotypes, from vomiting, washed or endemic areas, poor
faeces of infected abdominal pain, prepared with personal hygiene,
humans dehydration, contaminated infected persons
thirst, collapse, water, water touching foods,
reduced skin inadequate cooking
turgor, wrinkled using contaminated
fingers, sunken water to wash or freshen
eyes foods, improper sewage
disposal, using night soil
as fertilizer
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Salmonellosis Various serotypes 6 to 72 hours Abdominal pain, Poultry and meat Stools, rectal Storing cooked foods
of Salmonella from mean 18 to 36 diarrhoea, chills, and their products. swabs at room temperature,
faeces of animals hours fever, nausea, Egg products raw storing cooked foods
vomiting, malaise milk and dairy in large containers in
products, other refrigerators, holding
foods contaminated foods at warm
by salmonella [bacterial incubating]
temperatures, inadequate
cooking and reheating
preparing foods several

23
hours before serving,
cross contamination,
improper cleaning of
equipment, obtaining
foods from contaminated
sources

Shigellosis Shigella flexneri, S. 24 to 72 hours Abdominal pain, Any contaminated Stools, rectal Infected persons
dysenteriae, S. diarrhoea, bloody food, frequently swabs touching foods,
sonnel and S. and mucoid salads, water Improper
boydii from faeces stools, fever refrigeration,
of infected inadequate cooking
humans and reheating
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Vibrio Non 01 vibrios: 2 to 3 days Watery diarrhoea Shellfish, Fish Stools Obtaining fish and
cholera-like Vibrio cholerae, [varies from loose shellfish from sewage
gastroenteritis Vibrio mimicus, stools to cholera- contaminated waters,
Vibrio fluvialis, lime disease] inadequate cooking, cross
Vibrio hollisae contamination

24
Pathogenic Entero- 5 to 48 hours Severe abdominal Soft cheese, rare Stools, rectal Infected persons
Escherichia pathogenic, mean 10 to 24 pain, diarrhoea hamburger, water swabs touching foods,
coli diarrhea enterotoxigenic, hours [sometimes Improper
enteroinvasive bloody] nausea, refrigeration,
hemorrhagic vomiting fever, inadequate
strains [e.g. 0157] chills, headache, cooking, improper
of E. coli from muscular pain. cleaning and
faeces of infected [bloody urine- disinfecting of
humans and other hemorrhagic equipment, eating
animal strains] raw or rare meats
[hemorrhagic
syndrome]
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Vibro para Vibro 2 to 48 hours Abdominal pain, Marine fish, Stools, rectal Inadequate
haemolyticus parahaemolyticus mean 12 hours diarrhoea, shellfish, swabs cooking, improper
gastroenteritis from seafood and nausea, vomiting, crustacea [raw or refrigeration,
seawater fever, chills, contaminated] cross contami-
headache nation, improper
cleaning of

25
equipment, using
sea water in food
preparation or to
cool cooked foods

Yersiniosis Yersinia 24 to 36 hours Severe abdominal Milk, tofu, water Stools, blood Inadequate cooking
enterocolitica. Y. pain, fever contamination after
pseudotuber- headache, pasteurization, contamination
culosis malaise, sore of foods by water, rodents,
throat. May other animals
stimulate
appendicitis
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
Outbreaks

Incubation [Latency] Period Usually Greater than 72 hours

Viral Agents

Norwalk agent Norwalk agent 16 - 48 hours Nausea, vomiting, Clams, oysters, Stools Sewage pollution
gastroenteritis virus Abdominal pain, cockles, green of shellfish
diarrhoea, low salads, pastry, growing waters,
grade fever, chills, fostings poor personal

26
malaise, anorexia hygiene, infected
headache; persons touching
Duration approxi- foods
mately 36 h

Non specific Enteric viruses 3 to 5 days Diarrhoea, fever, Unknown Stools Poor personal
viral [EHCO viruses, vomiting, hygiene, infected
gastroenteritis Coxsackie abdominal pain, persons touching
viruses, sometimes foods, inadequate
reoviruses, respiratory cooking and
adenoviruses symptoms reheating
rotaviruses,
polioviruses]
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Parasitic Agents

Amoebic Entamoeba 5 days to several Abdominal pain, Raw vegetables Stools Poor personal
dysentery histolytica from mon, mean 3 to 4 constipation or and fruits [ hygiene, infected
[Amoebiasis] feces of infected weeks diarrhoea [faeces persons touching

27
humans containing blood foods, inadequate
and mucous] cooking

Giardiasis Giardia lamblia 1 to 4 weeks Abdominal pain, Salmon, water Stools Poor personal hygiene,
from faeces of mucoid diarrhoea raw vegetables infected person touching
infected humans fatty stools and fruits [ foods, inadequate
or animals cooking, improper
sewage disposal, water
contaminated by
animals.
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Anisakiasis Anisakis 4 to 6 hours Stomach pain, Rock fish, herring, Stools Ingestion of raw
Phocanema nausea, vomiting cod, squid fish, inadequate
Porrocaecum abdominal pain, cooking
diarrhoea, fever

Beef tapeworm Taenia saginata 8 to 14 weeks Vague discomfort, Raw or insufficiently Stools Lack of meat
infection form flesh of hunger pain, loss cooked beef inspection,
[Taeniasis] infested cattle of weight, inadequate
abdominal pain cooking
inadequate
sewage disposal,
sewage

28
contaminated
pastures

Fish tapewarm Diphyllobothrium 5 to 6 weeks Vague gastro Raw or Stools Inadequate

infection latum from flesh of intestinal Insufficiently cooking, improper
[Diphyllo- infested fish discomfort, cooked freshwater sewage disposal,
bothriasis] anaemia may fish [perch, pike, sewage
occur turbot, salmon] contaminated
lakes

Pork tapeworm Taenia solium 8 to 14 weeks Vague discomfort, Raw or Stools Lack of meat
infection from flesh of hunger pains, loss insufficiently inspection,
[Taeniasis] infected swine of weight cooked pork inadequate
convulsions cooking improper
sewage disposal,
contaminated
pastures
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
NEUROLOGICAL SYMTOMS AND SIGN [VISUAL DISTURBANCES, TINGLING, AND/OR PARALYSIS] OCCUR4
Incubation [Latency] Period Usually Less Than 1 hours
Chemical Agents

Carbamate Carbarly [sevin] ½ hours Epigastric pain, Watermelons, any Blood, urine Inappropriate
poisoning Temik [aldicarb] vomiting, accidentally application for
abnormal contaminated food melons, storing
salivation, nsecticides in
sweating, same area as
contraction of foods, mistaking
pupils, muscular pesticides for
incoordination powdered foods

29
Organophos Organo Few min to few Nausea, vomiting Any accidentally Blood, urine, fat Spraying foods
phorous phosphorous hours abdominal contaminated food biopsy just before
poisoning insecticides [such cramps, harvesting,
as parathion, diarrhoea, storing
TEPP, diazinon headache insecticides in
malathion] nervousness, same area as
blurred vision, foods, mistaking
chest pain, pesticides for
cyanosis, dried foods.
confusion
twitching,
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Toxic Animals

Paralytic Saxitoxin and Few min to 30 min Tingling, burning, Mussels and Gastric Harvesting
neurologic similar toxins from numbness around calms washings shellfish from
shellfish dinoflagellates lips, and finger waters with high
poisoning Protogonaulax tips, giddiness, concentration of
and Gymnodinium incoherent Protogonalulax or
species, which are speech, difficulty Gymnodinium
consumed to stand species [Red
respiratory tides]
paralysis

30
Tetraodon Tetrodotoxin from 10 min to 3 hours Tingling sensation Puffer-type fish Eating puffer-type
[Fugu/Puffer] intestines and of fingers and fish, failure to
poisoning gonads of toes, dizziness, effectively remove
puffertype fish pallor, numbness intestines and
of mouth and gonads from
extremities, puffer-type fish if
gastrointestinal they are to be
symptoms, eaten
haemorrhage,
desquamation of
skin, eyes, fixed,
twitching,
paralysis,
cyanosis, fatalities
occur
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Plant Toxicants

Ibotenic acid Ibotenic acid and 30 to 60 min Drowsiness and Amanita Eating A.
group of muscinol in some state of muscaria, A. muscaria and
mushroom mushrooms intoxication, pantherina and related species of
poisoning confusion related species of mushrooms,
muscular spasms, mushrooms eating unknown
delirium, visual varieties of
disturbances mushrooms,

31
mistaking toxic
mushrooms for
edible varieties,
Muscarine Muscarine in 15 min to 2 hours Excessive Clitocybe Vomitus Eating muscarine
group of some mushrooms salivation, dealbata, C. group of
mushroom perspiration, rivulosa and many mushrooms,
poisoning tearing, reduced species of Inocybe eating unknown
blood pressure, and Boletus varieties of
irregular pulse, mushrooms mushrooms,
pupils constricted, mistaking toxic
blurred vision, mushroom for
asthmatic edible mushrooms
breathing
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Jimson weed Tropane alkaloids Less than 1 hours Abnormal thirst, Any part of plant, Urine Eating any part of
photophobia, tomatoes grafted Jimson weed or
distorted sight, to jimson weed eating tomatoes
difficulty in stock from tomato plant
speaking, grafted to jimson
flushing, delirium, weed stock

32
coma, rapid heart
beat

Water hemlock Resin and 15 to 60 minutes Excessive Root of water Urine Eating water
poisoning cicutoxin in salivation, hemlock Cicuta hemlock;
hemlock root nausea, vomiting, virosa. C. mestaking water
stomach pain, masculate, and C. hemlock root for
frothing at mouth, douglaril wild parsnip,
irregular breating, sweet potato, or
convulsions, carrot
respiratory
paralysis
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Incubation [Latency] Period Usually in the Range of 1 to 6 hours

Chemical Agents

Chlorinated Chlorinated 30 min to 6 hours Nausea, vomiting Any accidentally Blood, urine, Storing
hydrocarbon hydrocarbon paraesthesia, contaminated food stools, gastric insecticides in
poisoning insecticides dizziness, washings same area as
muscular food, mistaking
weakness, pesticides for
anorexia, weight dried foods

33
loss, confusion

Toxic Animals

Ciguatera Ciguatoxin in 3 to 5 hours Gastroinestinal Numerous Eating liver,

poisoning intestines, raw sometimes symptoms, varieties of intestines, roe,
gonads, and flesh longer tingling and tropical fish, e.g. gonads, or flesh of
of tropical marine numbness around barracuda, tropicfal reef
fish mouth and grouper, red fishes; usually
limbs, muscular snapper, amber large reef fish are
and joint pain, jack, goat fish, more commonly
dizziness, cold- skip jack, parrot toxic
hot sensations, fish
rash, weakness,
slowness of heart
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
beat, prostration,
paralysis.
gastroenteritis
disappears in a
few days
neurological
problems may last
several days.
deaths occur

34
Incubation [Latency] Period Usually in the Range of 12 to 72 hours

Bacterial Agents

Botulism Neurotoxins 2 hours to 8 days Gastroinestinal Canned low-acid Blood, stool, Inadequate heat
A,B,E, and F of [mean symptoms may foods [usually gastric washings processing of
Clostridium 18 to 36 hours] precede home canned]; canned foods and
botulinum. Spores neurological smoked fish; smoked fish, post-
found in soil, fresh symptoms. cooked potatoes; processing
water mud and vertigo, double or frozen pot pies, contamination,
animal blurred vision, meat loaf, stew uncontrolled
dryness of mouth, left in ovens fermentations,
difficulty in without heat improper curing of
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
swallowing, overnight; hams and fish,
speaking and fermented fish time temperature
breathing egg, fish, marine abuse of potatoes,
descending mammals, pot pies, stews,
muscular muskrat tails holding foods at
weakness, room and warm
constipation, temperatures
pupils dilated or
fixed, respiratory
paralysis.

35
Fatalities occur

Incubation [Latency] Period Usually Greater Than 72 hours

Chemical Agents

Mercury Methyl and ethyl 1 week or longer Numbness, Grains treated Urine, blood, hair Streams polluted with
poisoning mercury weakness of legs, with mercury mercury compounds,
compounds from spastic paralysis, containing feeding animals
industrial waste impairment of fungicide; pork, grains treated with
and organic vision, blindness, fish and shellfish mercury fungicides,
mercury in coma exposed to eating mercury
fungicides mercury treated grains or
compounds meats from animals
feed such grains.
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Triortho- Triorthocresyl 5 to 21 days Gastrointestinal Cooking oils, Biopsy of Using compound
cresyl phosphate used [mean 10 days] symptoms, [eg. extracts and other gastrocnemius as food extract or
phosphate as extracts or as pain, ungainly foods conta- muscle as cooking or
poisoning oil substitute high steeping gait, minated with salad oil.
food and wrist drop triorthocresy
phosphate

36
GENERALIZED INFECTION SYMPTOMS AND SIGN [FEVER, CHILLS, MALAISE, AND/OR ACHES] OCCUR

Incubation [Latency] Period Usually Greater Than 72 hours

Bacterial Agents

Brucellosis Brucella abortus, 7 to 21 days Fever, chills, Raw milk, goat Blood Failure to
B. melitenisis and sweating, cheese pasteurize milk,
B. suis from weakness, livestock infected
tissues and milk of malaise, with brucellac
infected animals headache, muscle
and joint pain,
loss of weight
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Listeriosis Listeria 4 – 21 days Fever, headache, Coleslaw, milk, Blood, Inadequate
monocytogenes nausea, vomiting, cheese, animal urine cooking, failure to
stillbirths, products properly
meningitis, pasteurize milk,
encephalitis, prolonged
sepsis refrigeration

Q fever Coxiella burnetii 14 to 26 days, Chills, headache, Raw milk [rare] Blood Ingestion of
from tissue and mean 20 days weakness, contaminated raw
milk of infected Malaise milk, failure to

37
animals perspiration, fever pasteurize milk
cough, chest pain [145 F/63 C, 30
minutes, 161 F/
72 C 15 seconds]

Typhoid or Salmonella typhi 7 to 28 days, Malaise, Shellfish, any food Stools, rectal Infected persons
Paratyphoid [typhoid] from mean 14 days headache, fever, contaminated by swabs, blood touching foods, poor
fevers faeces of infected cough, nausea, persons who personal hygiene,
humans. Other vomiting, touch foods, raw inadequate cooking,
serotypes of constipation, milk, post process improper refrigeration,
Salmonella from abdominal pain, contaminated improper sewage
faeces of infected chills, rose spots, meat, cheese, disposal, obtaining
humans or other bloody stools watercress water foods from unsafe
animals sources, harvesting
shellfish from sewage
contaminated waters
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Viral Agents

Hepatitis A Hepatitis A virus 10 to to days Fever, malaise, Raw shellfish Urine blood Infected persons
[Infectious from faeces, mean 25 days lassitude, salads, cold cuts, touching foods, poor
hepatitis] urine, blood of anorexia, nausea, any food personal hygiene,
infected humans abdominal pain, contaminated by inadequate cooking,
and other jaundice hepatitis viruses, harvesting shellfish

38
primates water from sewage
contaminated
waters, improper
sewage disposal

Parasitic Agents

Angio Angiostrongylus 14 to 16 days Gastroenteritis, Raw crabs, slugs, Blood Ingesting raw
strongyliasis cantonensis [rat headache, stiff prawns, shrimp, foods, inadequate
[Eosinophilic lung worm] from neck and back, snails cooking
meningo rodent faeces and low grade fever
encephalitis] soil
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks
Trichinosis Trichinella 4 to 28 days Gastroenteritis, Pork, bear meat, Blood, muscle Eating raw or
spiralis [mean 9 days] fever, oedema walrus flesh, biopsy skin test inadequately cooked
[roundworm] from around eyes, cross pork or bear meat
flesh or infested muscular pain, contaminated inadequate cooking
swine, bear, chills, prostration, ground beef and or heat processing,
walrus laboured lamb feeding uncooked ro
breathing inadequately
heatprocessed
garbage to swine

39
ALLERGIC TYPE SYMPTOMS AND SIGNS [FACIAL FLUSHING AND/OR ITCHING] OCCUR

Incubation [Latency] Period Usually Less Than 1 hour

Bacterial [and Animal] Agents

Histamine Histamine-like Few min to Headache, Tuna mackerel, Vomitus Inadequate

poisoning substance 1 hours dizziness, nausea, Pacific dolphin cooling, improper
[Scombroid produced by vomiting, peppery [mahi mahi], refrigeration of
poisoning] Proteus spp. or taste, burning bluefish, cheese fish, improper
other bacteria throat, facial curing of cheese
swelling and
flushing, stomach
pain, diarrhoea,
itching of skin
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
outbreaks

Chemical Agents

Monosodium Monosodium Few min to 1 hour Burning sensation Foods seasoned Using excessive
glutamate glutamate [MSG] in back of neck, with MSG amounts of MSG as
poisoning forearms, chest, flavour intensifier
[Chinese feeling of tightness,

40
restaurant headache, nausea
syndrome]

Nicotinic acid Vitamin, sodium Few min to 1 hour Flushing, Meat or other food Using sodium
[niacin] nicotinate used as sensation of in which sodium nicotinate as colour
poisoning colour warmth, itching, nicotinate has preservative,
preservative abdominal pain, been added, improper mixing
puffing of face and including baby
knees food
 Disease Aetiologic agent Incubation or Symptoms and Food usually Specimens to Factors that
And source Latency period Signs Involved3 Collect Contributed to
Foodborne
Outbreaks

Incubation [Latency] Period in the Range of 1 to 6 hours

Toxic Animals

Hyper Vitamin A 1 to 6 hours Headache, Liver and kidney Blood Eating liver and
vitaminosis A gastrointestinal of artic mammals kidney of animals
symptoms, from cold region
dizziness, collapse,
insomnia,

41
desquamation of
skin

1. Symptoms and incubation periods will vary with the individual and group exposed because of resistence, age, and nutritional status of individuals,
number of organisms or concentration of poison in ingested foods, amount of food ingested, and pathogenicity and virulence of strain of
microorganisms or toxicity of chemical involved. Several of the illnesses are manifested by additional symptoms and have incubation periods that are
shorter or longer than stated.
2. A mor detailed review can be found in : Bryan, F.L. 1982 Diseases Transmitted by Food [A classifications and summary], 2nd ed., Centers for Disease
Control, Atlanta.
3. Samples of any of the listed foods that have been ingested during the incubation period of the disease should be collected.
4. Carbon monoxide poisoning may simulate some of the diseases listed in this category. Patients who have been in closed cars with motors running or
have been in rooms with improperly vented heaters are subject to exposure to carbon monoxide.
42
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 Lampiran 5

No. - - -
Daftar
Episod

BAHAGIAN KAWALAN PENYAKIT

KEMENTERIAN KESIHATAN MALAYSIA
BORANG SIASATAN/LAPORAN WABAK KERACUNAN MAKANAN
(FWBD/KRM/BG/001 (Pindaan 2006))

A: NOTIFIKASI
Institusi Institusi

Penerima
Tarikh Tarikh
Pelapor

Masa Masa
Nama Nama
Jawatan Jawatan
Cara Telefon Faks E-mail Borang Lain-lain
Notifikasi

B1: ANALISA DESKRIPTIF – TEMPAT (PLACE)

1. Alamat tempat/ Mukim Daerah
premis kejadian
Negeri
Koodinat:- Longitud Latitud
2. Jenis Sekolah/asrama sekolah Kolej/universiti
tempat/premis
kejadian Hospital/klinik kesihatan Pejabat kerajaan/swasta
Penjara/pusat jagaan khusus Perkhemahan/kenduri/keramaian
Rumah persendirian

B2: ANALISA DESKRIPTIF – ORANG (PERSON)

1. Bilangan Kes dinotifikasi Bilangan orang terdedah
Kes
Kes baru dikesan Kadar Serangan %
Jumlah Kes

2. Bilangan Pesakit luar Bilangan kes mati

kes
menerima Dimasukkan ke wad Kadar Kematian Kes %
rawatan
Jumlah dirawat

3. Bilangan subjek Kes

dimasukkan dalam
penyiasatan Kontrol
epidemiologi Jumlah

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
1
 B2: ANALISA DESKRIPTIF – ORANG (PERSON) – Sambungan.
4 Kadar 5 Bilangan kes mengikut
Kes mengikut kumpulan umur
serangan gejala
Bilangan mengikut
Kumpulan
kumpulan Gejala Bil. %
umur Lelaki Perempuan Jumlah umur
Bawah 1 th.
1 - < 5 th.
5 - < 13 th.
13 - < 19 th.
19 - < 25 th.
25 - < 55 th.
55 - < 65 th.
65 th, ke atas
Jumlah

B3: ANALISA DESKRIPTIF - MASA

Onset
Onset terawal Onset terakhir
Median
Tarikh Tarikh Tarikh
Masa Masa Masa
Tarikh Jangkaan Jam
Jangkaan masa pendedahan kepada
tempoh
agen: Masa minit
inkubasi:
B4: KELUK EPIDEMIK
Bilangan Kes

Onset

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Kementerian Kesihatan Malaysia, 2006.
2
 C: KAJIAN ANALITIK

Dibuat Tidak dibuat (Nyatakan sebab)

Tarikh mula: / / Bilangan kes/kontrol terlalu sedikit
Tarikh tamat: / / Kejadian adalah terpencil (isolated)

Jenis Kajian: Case-Control Analisa/kajian deskriptif kes sudah memadai

Kohort Agen atau cara penularan telah diketahui

Definisi Kes:

Jadual Analisis Makanan/Hidangan

Beza
RR Confid.
Kadar Nilai
Makan Tidak Makan atau Interval
Serangan p
OR2 (CI)
(D-H)
A B C D E F G H
Jenis Makanan/
Kadar: E/G x 100
Kadar: A/C x 100
Bil.

Jenis Hidangan1
Jumlah A+B

Jumlah E+F
Tidak Sakit

Tidak Sakit
Sakit

Sakit

Nota:
1
Pengiraan makanan berisiko (food attack rate) atau hidangan berisiko (meal attack rate) boleh dikira bergantung
kepada keadaan.
2
OR (Odd Ratio) digunakan untuk kajian kes control manakala RR (Relative Risk) digunakan untuk kajian kohort.
Jika kajian kes kontrol dibuat, kolum D, H dan perbezaan kadar serangan (D-H) tidak perlu diisi.
OR dan RR boleh dikira dengan menggunakan perisian seperti Epi Info dan SPSS.

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
3
 D: SIASATAN DI PREMIS MAKANAN YANG TERLIBAT
Perkara Tempat Makanan Disediakan
1. Nama premis:
Alamat:
Gred kebersihan (jika
ada):
2. Status pelesenan
Berlesen
Tidak berlesen
3. Jenis premis
Restoran/kedai makan
Gerai/warong
Kafeteria/kantin
Dapur/Dewan asrama
Dapur persendirian
Kenduri/perhimpunan
Penjaja bergerak
Lain-lain
4. Sumber bekalan air
Terawat sepenuhnya
(boleh lebih daripada
satu pilihan) Air bekalan JBA
Air mineral/proses/tapis
Terkawal, tidak terawat
Telaga terbuka
Telaga tiub
Gravity Feed System (GFS)
Tadahan air hujan
Tidak terkawal
Sungai/parit/terusan
Lain-lain
5. Jenis tandas yang kerap
Tandas pam
digunakan
Tandas curah
Tandas lubang/timbus
Tandas awam/berkongsi
Dalam sungai/semak
Lain-lain
6. Keadaan kebersihan
Memuaskan
tandas
Kotor
Cawangan Penyakit Bawaan Makanan dan Air
Kementerian Kesihatan Malaysia, 2006.
4
Tempat Makanan Dijual/Hidang
Berlesen
Tidak berlesen
Restoran/kedai makan
Gerai/warong
Kafeteria/kantin
Dapur/Dewan asrama
Dapur persendirian
Kenduri/perhimpunan
Penjaja bergerak
Lain-lain
Terawat sepenuhnya
Air bekalan JBA
Air mineral/proses/tapis
Terkawal, tidak terawat
Telaga terbuka
Telaga tiub
Gravity Feed System (GFS)
Tadahan air hujan
Tidak terkawal
Sungai/parit/terusan
Lain-lain
Tandas pam
Tandas curah
Tandas lubang/timbus
Tandas awam/berkongsi
Dalam sungai/semak
Lain-lain
Memuaskan
Kotor
 D: SIASATAN DI PREMIS MAKANAN YANG TERLIBAT (Sambungan)
Perkara Tempat Makanan Disediakan Tempat Makanan Dijual/Hidang
7. Pelupusan air limbah
Terkawal Terkawal
Tidak terkawal Tidak terkawal
8. Pelupusan sampah/
Terkawal Terkawal
sisa pepejal
Tidak terkawal Tidak terkawal
9. Pembiakan LILATI
Ada Ada
Tiada Tiada
10. Bilangan pengendali
Tetap Orang Tetap Orang
makanan mengikut
status dan Sementara Orang Sementara Orang
kewarganegaraan
Tempatan Orang Tempatan Orang
Wargasing Orang Wargasing Orang
11. Bilangan pengendali
Ada sijil kursus Orang Ada sijil kursus Orang
makanan mengikut
tahap kesihatan dan Ada kad kesihatan Orang Ada kad kesihatan Orang
kebersihan
Ada pelalian anti-Tifoid Orang Ada pelalian anti-Tifoid Orang
Kesihatan memuaskan Orang Kesihatan memuaskan Orang
12. Tahap kebersihan
Penilaian terakhir (sebelum Penilaian terakhir (sebelum
keseluruhan premis
kejadian) kejadian)
(Mengikut gred/rating
menggunakan format Tarikh: / / Tarikh: / /
KMM):
∀ KMM 3P1 Rating: % Rating: %
∀ KMM 3P2
∀ KMM 3P3 Penilaian semasa Penilaian semasa
Tarikh: / / Tarikh: / /
Rating: % Rating: %
13. Hasil analisa HACCP
Kontaminasi agen/penyebab Kontaminasi agen/penyebab
(spt. cara
penyimpanan bahan Ada Ada
mentah, semasa
penyediaan makanan, Tiada Tiada
proses memasak,
proses menghidang Pembiakan mikroorganisma Pembiakan mikroorganisma
dsbnya) bagi
memastikan Ada Ada
kewujudan faktor-faktor Tiada Tiada
berkaitan yang
mendorong kejadian
Ketahanan survival mikrooganisma Ketahanan survival mikrooganisma
yang dilaporkan (Jika
ada, nyatakan) Ada Ada
Tiada Tiada

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
5
 E: PENYIASATAN MAKMAL
Spesimen Klinikal Pesakit
Jenis Tarikh Tarikh Jenis Keputusan No. Rujukan/
Nama pesakit
spesimen ambil hantar analisis Pos. Neg Catatan

Spesimen Dari Pengendali Makanan

Nama pengendali Jenis Tarikh Tarikh Jenis Keputusan No. Rujukan/
makanan spesimen ambil hantar analisis Pos. Neg Catatan

Spesimen Makanan
Jenis Tempat/premis Tarikh Tarikh Jenis Keputusan No. Rujukan/
makanan persampelan ambil hantar analisis Pos. Neg Catatan

Spesimen Persekitaran
Jenis Tempat/premis Tarikh Tarikh Jenis Keputusan No. Rujukan/
sampel persampelan ambil hantar analisis Pos. Neg Catatan

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
6
 F: RUMUSAN AKHIR/ULASAN PEGAWAI PENYIASAT
1. Makanan/minuman disyakki/disahkan tercemar 2. Jenis agen pencemaran (jelaskan)
a. Jenis Bakteria
b. Cara ditentukan Virus
Analisa epidemiologi (Deskriptif, OR, RR) Parasit
Ujian makmal Kulat
Berdasarkan maklumat saintifik lain Kimia/Logam berat
Berdasarkan gejala dan tempoh inkubasi Lain-lain
Berdasarkan pengalaman lalu
Tiada bukti/sokongan khusus

3. Sumber makanan tersebut diperolehi 4. Jenis epidemik/wabak

Dapur perseorangan Common source

Dapur institusi/asrama Single exposure
Premis makanan tetap Multiple/intermittent exposure

Pasar/supermarket/kedai runcit Propagated

Penjaja bergerak Bercampur (mixed)

Kenduri/perkhemahan/keramaian
Vending machine/kiosk
Lain-lain

5. Episod lain/terdahulu yang berkaitan (jika ada) 6. Tindakan kawalan khas dilaksanakan
Tempat Tarikh Penutupan premis makanan
Akta CDC: Bilangan buah
Akta Makanan: Bilangan buah
Rampasan makanan
Ceramah/pamiran kesihatan berkumpulan
Kawalan pencemaran setempat
Lain-lain

7. Ulasan umum

Tandatangan & cop

Tarikh

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
7
 G: ULASAN PEGAWAI PENYELIA
i. Ulasan PPKP U32/36 Daerah

Tandatangan & cop

Tarikh

ii. Ulasan Pegawai Kesihatan/Pengerusi JW Teknikal Penyakit Berjangkit

Tandatangan & cop

Tarikh kes dibincangkan

di dalam Mesy JW
Teknikal

iii. Ulasan Pegawai Epidemiologi (CDC) Negeri

Tandatangan & cop

Tarikh

Nota Akhir

1. Borang Siasatan yang lengkap mesti disimpan di dalam Fail Siasatan Keracunan Makanan di Pejabat
Kesihatan Daerah/ Bahagian/ Kawasan yang terlibat.

2. Satu salinan perlu dihantar ke Unit Epidemiologi, Jabatan Kesihatan Negeri . JKN akan menghantar laporan
yang lengkap ke Unit Kawalan Penyakit Bawaan Makanan dan Air, Bahagian Kawalan Penyakit, KKM dan satu
salinan untuk makluman ke PKD /Bahagian/ Kawasan dalam masa sebulan dari tarikh selesai siasatan dan
kawalan

3. Dalam keadaan tertentu, laporan bertulis yang lebih lengkap perlu disediakan dan dihantar ke JKN dan
Kementerian juga dalam masa sebulan dari tarikh selesai siasatan dan kawalan

4. Kemaskini data dalam Modul Siasatan CDCIS perlu dilengkapkan sebaik sahaja selesai siasatan dan kawalan
(Tamat Kejadian)

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
8
 H: LAMPIRAN 1 - LINE LISTING KES DAN KONTROL
Nota:
1. Jadual ini hanya sebagai panduan. Pegawai penyiasat boleh menambah variabel yang ingin dikaji mengikut definisi kes
yang digunakan
2. Senaraikan jenis makanan yang diambil sekurang-kurangnya 72 jam sebelum onset.
3. Asingkan kolum bagi makanan yang sama tetapi diambil pada waktu yang berbeza. Umpamanya mengikut sarapan
pagi, makan tengahari, minum petang atau makan malam,
4. Gunakan helaian tambahan jika perlu
Jenis
SAKIT makanan/minuman
(Nyatakan Gejala (Tanda ∀jika makan, X
Onset) jika tidak makan,
tinggalkan kosong jika
Bil.

Nama

TIDAK SAKIT
Bangsa tidak pasti)
Jantina

Tarikh
Masa
Umur

Cawangan Penyakit Bawaan Makanan dan Air

Kementerian Kesihatan Malaysia, 2006.
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