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| Agenda Item 6.2 | Conference Room Document 66 |
FAO/WHO SECOND GLOBAL FORUM OF FOOD SAFETY REGULATORS
Bangkok, Thailand, 12-14 October 2004
(Prepared by Instituto Panamericano de Protección de Alimentos y Zoonosis [INPPAZ])
Foodborne disease (FBD) surveillance and food monitoring are essential to characterize the epidemiological dynamics and directing the planning of control and prevention strategies and policies. They are also important tools for assessing the impact of the food safety programs and identifying areas requiring urgent attention, particularly at the local level. Furthermore, to have scientific evidence of the mode of transmission and the burden of a FBD outbreak, it is necessary to have local, national and international food monitoring and surveillance systems in place.
On the other hand, the international food safety regulatory community needs more knowledge based on scientific information, to couple with adequate regulatory response that could deal with the increasingly complex situation related to food safety. Food safety is influenced by the nature and concentration of hazards in food, the changes in the controls used to ensure that the food is safe, and the incredibly development recently achieved by the food industry and the changes in consumer habits. All these trends lead to the need of a global response. However, much more work remains to be done if there is to be an integrated national and international response to that challenge.
One of the current biggest concerns is the scarcity of reliable data about FBD outbreaks and contaminants in food. As an example, it is a fact that the countries of Americas reported only, in the last 10 years, less then 7,000 outbreaks to the WHO/PAHO Regional Information System on foodborne diseases surveillance - SIRVETA. Probably, tone of the major causes for of that insufficient data is that the majority of the counties are collecting syndromic data (e.g., diarrhea or food poisoning), and in almost all outbreaks investigated there was no formal laboratory-based surveillance. Furthermore, when SIRVETA was established, at the beginning of nineties, the strategy was to work with Member States to build national capacity for FBD surveillance. Nevertheless, weaknesses still persist in many countries in epidemiological surveillance, illness reporting, detection and investigation of outbreaks, and data analysis for decision-making on policies and programs. It is therefore urgent to a re-evaluate that strategy.
To cope with this weakness PAHO/WHO developed a new approach based on the promotion of networking to improve and/or strengthen the countries' capabilities of monitoring and surveillance of FBD. Networking promotes knowledge interchange of knowledge in systematic collection, collation, analysis and interpretation of accurate data about food contaminants and FBD. Networking facilitates training, the development of guidelines and standards based on successful experiences, the production and distribution of reagents at regional level, and promotes the use of external quality assurance programs for laboratories.
PAHO/WHO is promoting through its technical cooperation program the use of integrated food-chain food monitoring and FBD surveillance. The initiative is based in the collection, collation, analysis, and interpretation of data from animals, food, and humans. In countries where the system is being implemented, it is possible to attribute the burden of illness to specific food categories through the use of detailed information obtained from monitoring food and animals.
As mentioned elsewhere, one of the strategic action lines used is to promote this integrated approach is by networking. At the present time, PAHO/WHO uses three major networks for that purpose:
INFAL was established in December 1997, as a result of a consultation meeting promoted by PAHO and attended by representatives of 24 countries of the Region and 6 international organisms.
INFAL has the mission of promoting food safety and food quality in the Region of the Americas to avoid foodborne diseases, protect consumers' health and facilitate trade, fostering and strengthening analytical laboratories development and interaction within the framework of integrated national programs for food safety. To achieve that goal, INFAL has developed an information system for the member laboratories, distributes reference manuals, promotes their participation on proficiency tests, organizes training programs and fosters interchange of experiences between laboratories.
For the period 2003-2005 INFAL Executive Committee has defined the following strategic lines of action:
INFAL conducts periodical surveys to assess the technical necessities of its members, and based on that information develops activities to support members. Currently, those activities are focused on inter-laboratory programs, training, reference materials and quality management. The specific tasks of the three technical groups are available in the report of the last INFAL meeting at INFAL website.
The aim of PulseNet Latin America is to strengthen the surveillance of Foodborne Diseases in Latin America based on Pulse Field Gel Electrophoresis methodology on the prevailing foodborne pathogens in the Region, by the organization of a regional-international network integrating the areas of public health, animal health and food safety. This initiative is conducted under the strategic alliance of Pulse Net-CDC/WHO-PAHO/INPPAZ and the National Institute for Infectious Diseases in Argentina (INEI/ANLIS) “Dr. Carlos G. Malbran”.
The network was established in a consultation meeting with the participation of microbiologists and epidemiologists from 14 Latin American countries. As a result of this meeting, the participants agreed on building up the PulseNet Latin America network and a plan of action was developed for the incorporation of PulseNet into the countries surveillance systems. A Regional Steering Committee was designated the bylaws were approved. A training course for microbiologists focused on laboratory and software aspects is scheduled, including the use of the PulseNet data for the surveillance and outbreak detection and investigation. The benefits of establishing the network in Latin America are:
It is expected that, in the long term, all these achievements will result in the reduction of diarrhea cases in the Region, with benefits in all implicated areas by both improving the quality of life and preventing economical losses in the whole Region.
WHO-Global Salm-Surv is a global network of laboratories and individuals involved in surveillance, isolation, identification and antimicrobial resistance testing of Salmonella. It is part of WHO endeavors to strengthen the capabilities of its Member States on the surveillance and control of major foodborne diseases and to contribute to the global effort of containment of antimicrobial resistance in foodborne pathogens.
GSS, in its version for the AMRO Region, has included other major foodborne pathogens such as Campylobacter and in the next training courses of level IV, E. coli O157:H7 will be added. PAHO/WHO supports the regional reference centers located in Argentina and Mexico in developing a regional strategy to provide high quality antiserum for National Reference Laboratories for Salmonella and other foodborne pathogens; in facilitating communications related to foodborne diseases and surveillance, in promoting relevant research projects and in training. This includes fostering communications between microbiologists and epidemiologists working in multiple areas such as public health, animal health and food related disciplines. This is the purpose of the new the level III courses, the “Managers” curriculum aiming the strengthening of the interaction between microbiological laboratory and epidemiology.
SIRVETA was established at the beginning of the last decade, as a system with the objective of assuring permanent flow of information of the epidemiological situation of FBD in the AMRO Region. Until today, it has a web based database where users enter queries about FBD. PAHO Member Countries have agreed to report, at least once a month, the information related to cases/outbreaks, with information of patients in terms of place, time and person, the implicated food and the etiological agent. It was expected that countries would organize their own national systems in the same structure and the regional database would begin to collect, analyze and use data.
The results achieved until now show a partial coverage and a partial picture of the epidemiological situation of FBD in the AMRO Region. The following is a summary of the information reported to SIRVETA over the past years, giving an idea of foodborne morbidity. Since its inception in 1994, SIRVETA has received 6511 outbreak reports from 22 countries. Only one country contributed with more than 54% of them. Close to 250,000 people fell ill in those outbreaks, and 317 died. Thirty seven percent of all outbreaks occurred at home. In 29% of the outbreaks, no laboratory analysis was performed to identify the etiologic agents. Among those with confirmed etiology, 57% were attributed to bacteria, 12% to viruses, and 21% to marine toxins. The remaining 10% were caused by parasites, chemical contaminants, or plant toxins. Food items most commonly associated with the reported outbreaks were: fish/seafood (22%), water (20%) and red meats (14%). Based on the available data where the laboratory was used to confirm the etiological agent of the outbreak, Salmonella was undoubtedly the most frequent bacteria reported, corresponding to 20%. Another pathogen increasing dangerously in the Americas is the Shiga-toxin producing E. coli (STEC). Argentina has one of the highest incidences of HUS, a known complication of STEC infection, especially in the pediatric age group.
INPPAZ is working to improve SIRVETA by establishing a web-based data collection form with new online interfaces, with hierarchical screens with drop-down lists to assure input consistency.
International cooperation on FBD surveillance and food monitoring is not just a matter of bringing the right professionals together. There are other issues that have to be addressed.
First, food safety systems are complex in nature. They have a large amount of inter-connections along the food chain. The actors act according their own knowledge of that specific step of the food chain, with a high level of uncertainty of the actions of the other stakeholders. Networking is though an invaluable tool, as it helps the definition of roles and responsibilities of all the participants. It can be achieved by stating simple objectives for the network, reducing the grade of uncertainty of the stakeholders and increasing the agreement and collaboration among them.
Secondly, ownership of data (in terms of what can be released to the public, scientific publications), access to databases, and security requirements, in terms of confidentiality, should be clearly stated in the bylaws of networks. Having an international organization coordinating or acting as secretariat of a network has been very useful for the AMRO Region.
Finally, the keyword for success is flexibility, networking should not be considered unchallengeable. Unforeseen situations affecting public health, market access, animal and plant health and the environment, can always arise, leading to the need for updating principles and objectives of the network.