In 2010, another food borne outbreak was reported during wedding ceremony in small town near Riyadh called Sulyyel. People who attended the wedding ceremony suffered from gastroenteritis 21 hours after the meal. Investigation done in Sulyyel hospital showed that Salmonella spp was the causative agent of this outbreak as mentioned in table one (23)
While numerous potential vehicles of transmission exist, commercial chicken meat has been identified as one of the most important food vehicles for Salmonella (24). Meat could be contaminated from cutting boards (25); other ingredients could be contaminated from the hands of food handlers (26). Furthermore, seasoning sauces and mayonnaise used in sandwich dressing could also be contaminated. This may explain the relatively higher prevalence of Salmonella spp. in chicken shawarma (30/37, 81%) than beef shawarma (7/37, 19%), and may explain the Salmonella outbreak in Jordan in 2005 that was attributed to contaminated mayonnaise (27).
Although death from Staphylococci food poisoning is rare (28) it can cause death in small children and the immunocompromised. The presence of Staphylococcus auerus, a pathogenic organism of public health concern and significance in these vegetables might have contaminated the stored vegetables from source as a result of handling by farmers or retailers. Improper handling and improper hygiene might lead to the contamination of food and this might eventually affects the health of the consumers (29).
Staphylococcus aureus was isolated from 12 (8.3%) of the sandwiches, mainly from the chicken sandwiches (10 out of 12). Similar shawarma contamination rates with S. aureus were reported in Sudan (30), and in the US in chicken (41%) and beef (37%) samples (31). It is well known that S. aureus is a major food borne pathogen in many countries and is probably responsible for even more individual and family cases than documented. Its presence in sandwiches is of primary concern because some strains are capable of producing a highly heat-stable enterotoxin that causes food poisoning in humans and should be taken into account in risk assessment. Possible sources of contamination of the sandwiches with this pathogen include the hands of food handlers, who handle the food items bare-handed, which indicate poor handling or sanitation.
Intestinal Bacteria in Saudi Arabia during the Past 10 Years: The Ministry of Health (MOH) as well as the local food industry is cognizant of the threats posed by the food borne diseases and infections to the citizens and residents in the Kingdom. They strive to identify the bacteria that cause food borne diseases. This study attempts to look into the incidence of food borne diseases on different occasions and in different cities in the Kingdom in the light of studies already conducted at national and international level. In this study, we have tried to focus on the causative agents of bacteria that cause responsible for food borne diseases like Salmonellatyphimurium, Salmonella enteritidisu, Clostridium botulinum, Clostridium botulinum, Clostridium botulinum, ETEC, EPEC, Shigella, Vibrio cholera, S. aureus, C. perfringens(32). In the case control study conducted, Salmonella enteritis’s group D was isolated from 80% of the patients who consented to give their stool or rectal swab specimens (33). Salmonella was responsible for a mass gastroenteritis as reported by Sulyyel hospital authorities following an indigestion caused by contaminated food in a wedding party (34).
From October 2011 to June 2012, samples of 811 Saudi women, 80% of whom were educated, were examined for food KP (food safety knowledge and practices). Results suggested a big difference between the level of knowledge and their practices reporting higher mean knowledge and practice (63.4% and 73.8%; respectively) (35). In 2013, 2732 stool samples were examined for intestinal parasites of which 407 stool samples (14.9%) were found positive. Infection was higher in young people 20 – 29 (18.5%) age groups and tended to be less in older people > 50 years (11.8%). Pakistanis were found to be highly infected (23.2%), and Sudanese were the lowest (18.7%) (36).
A favorite type of fast food for the Lebanese is shawarma sandwiches. Shawarma can be originally traced back to Turkey, where it was called “çevirme”, which means “turning”, but the dish itself is usually called döner kebab, meaning “turning kebab”. It has become more popular among consumers of fast foods in the Middle East, Europe, Canada, and other countries (37). Chicken shawarma is basically a wrap of shredded marinated chicken, prepared by alternately stacking strips of pieces chicken on a rotating vertical skewer rod. The strips are roasted from the outside, while most of the inside remains rare. Shavings are cut off the block for serving, and the remaining block of chicken is kept heated on the rotating skewer rod. Chicken shawarma sandwiches contain sliced chicken seasoned with peppers and with a special garlic spread (prepared with local mayonnaise and other ingredients that may differ from one restaurant to another) and served in a pita bread wrap. Shawarma sandwiches are similar to donairs, and such types of foods are subjected to contamination with pathogens during preparation, processing, and serving (38). These foods are manipulated extensively during processing and therefore have a potential for high bacterial contamination levels on the surface of the meat, as well as the inside. As a result, there is an increased risk of pathogens surviving and transferring not only by cross-contamination, but also by undercooking as observed in this kind of fast-food industry (39) The results of this study indicated that 3 sandwiches obtained from 3 different restaurants (30%) in the area tested were contaminated with Salmonellaspp.. Two positive samples were from the part of the sandwich that did not contain the garlic spread while one positive sample was obtained from the part that contained the garlic spread. Garlic is widely known for its antibacterial properties with a notable effect on Salmonella spp.(40). Accordingly, it is presumed that an ordinary shawarma chicken sandwich, even if slightly contaminated, should be safe to consume as the garlic will reduce any bacterial count to a dose that is harmless. The garlic spread, however, is not prepared in the same way in all restaurants and the amount of garlic included may differ in different preparations. The presence of mayonnaise as a major component of the spread may affect the outcome. If mayonnaise composed the bigger part of the spread then it might have served as a rich culture medium that allow the growth of food borne pathogens such as Escherichia coli, Staphylococcus aureus, Salmonella. The overall prevalence of food borne pathogen in this study was 16.6% which is comparatively lesser than finding reported from Lebanon (41)