SIRVETA and National FBD Surveillance in Peru
Marisa L. Caipo, Ph.D.Asociacion Peruana de Consumidores y Usuarios
(ASPEC)University of Maryland, USA
Universidad San Ignacio de Loyola, Lima, Peru
Major developments that have a significant effect on food safety
• Changes in the nature and concentration of hazards in food
• Changes in the controls used to ensure that food is safe to eat
• A shift of the primary responsibility for food safety to industry
• Changes in consumer habits.
Mackenzie et al, 2004
Epidemiologic surveillance of Fooodborne illness
Needs:– Modes of transmission and risk of foodborne
disease– Focus on policies and strategies for prevention
and control– Identify priorities for interventions, particularly
at the local level– Evaluate the impact of food safety intervention
programs
Types of SurveillanceTypes of SurveillanceType Expected Results Relationship Food-
FBD agent
Passive Unspecified indicators for illness
None
Syndromic Unspecified indicators for illness
None
Laboratory based Specific pathogens (subtypes)
Moderate
Active Specific pathogens (subtypes), population
Moderate
Integrated Specific pathogens (subtypes), population, reservoirs
High
Lopez, 2005
Integrated surveillance approach to the Food Chain
Mangos for export from Brazil
Contaminated hot water is used as treatment against Mediterranean fruit fly
Mangos contaminated with Salmonella Newport exported to USA
Consequences: 78 human cases 14 hospitalized 2 deaths
PAHO, Lopez, 2005
FBD Outbreaks / DetectionFBD Outbreaks / Detection
Traditional Scenario
• Locally detected – MD– Community– Epidemiologist
• Based on syndromic surveillance and good relationships
New Scenario
• Detected by the lab– Rare Serotypes– Subtypes
(phagetyping PFGE)– AMR
• Based on lab surveillance and communication between lab and epidemiology
PAHO, Lopez, 2005
Integrated surveillanceIntegrated surveillance
Animal and Plant Health
Animal and Plant Health
Human HealthHuman Health
LaboratoriesLaboratories
Food ChainFood Chain
Environmental HealthEnvironmental Health
National PoliciesNational Policies
LaboratoriesLaboratories
FBI Surveillance in Latin America
FBI Surveillance in Latin America
• Low coverage in general and in particular for FBI
• Low sensibility in detection and investigation of outbreaks
• Problems with data analysis and information management
• Low coverage in general and in particular for FBI
• Low sensibility in detection and investigation of outbreaks
• Problems with data analysis and information management
INFORMATION SYSTEM FOR EPIDEMIOLOGICAL SURVEILLANCE OF FOODBORNE DISEASES –
SIRVETA
1995 – 2002
6930 reports of FBI outbreaks from 22 countries in the region.
Food items most commonly associated with the reported outbreaks were fish (22%), water (20%) and red meats (14%).
COUNTRY OUTBREAKS SICK DECEASED
Argentina 155 3520 5
Bahamas 89 10688 0
Barbados 2 7 0
Bolivia 5 1244 2
Brasil 645 18945 5
Chile 342 4101 2
Colombia 9 383 0
Costa rica 54 146 0
Cuba 3996 159272 59
Ecuador 54 2670 23
El Salvador 26 7984 4
Guatemala 21 291 7
Jamaica 3 99 0
México 633 19493 107
Nicaragua 129 1152 0
Panama 73 1131 2
Paraguay 89 1277 0
Perú 112 5285 89
Rep. Dominicana 85 1833 0
Trinidad y Tobago 54 567 1
Uruguay 120 3322 1
Venezuela 234 5787 11
TOTALS6930 249197 318
Bacteria59%
Viruses12%
Marine Toxins21%
Parasites8%
Chemical Contaminants,Plant toxins
New and improved SirvetaNew and improved Sirveta
Lopez, 2005
PERU
• Population 26.7 M• Surface Area 1.3 M sq km• Population per sq km
20.5• Life expectancy 69.8
years• GNI per capita $2020
USD• GDP 56.5 billion USDSource: World Development Indicators, 2004
Most common causes of FBD
• Salmonella spp• Staphylococcus aureus• Enteric viruses
Source: Ministerio de Salud, 2004
PERUIllnesses subject to Epidemiological Surveillance
Immunopreventable (Hep B, MMR, Yellow fever, etc)Zoonoses
Human rabies, anthrax, plagueVector-transmitted (dengue, malaria)Other transmissible (cholera)
Mandatory weekly notificationAcute Diarrheal diseases (EDAs)Other illnesses (Chagas, bartonellosis, etc.)
Occurences of importance for public healthOutbreaksEpizootiesNatural disasters
PERU
Adequate surveillance requiresAdequate surveillance requires
• Political decision and implementation techniques
• Integrate FBD within the National Surveillance Programs
• Coordinated participation with the lab
• Continuous training• Appropriate Resources
• Political decision and implementation techniques
• Integrate FBD within the National Surveillance Programs
• Coordinated participation with the lab
• Continuous training• Appropriate Resources
Adequate SurveillanceAdequate Surveillance
• Capability for detection of outbreaks and cases
• Capability to identify agent
• Identify place in the food chain where contamination occured
• Identify associated risk factors
• Define risk scenarios
• Capability for detection of outbreaks and cases
• Capability to identify agent
• Identify place in the food chain where contamination occured
• Identify associated risk factors
• Define risk scenarios
Local LevelLocal Level• Interinstitutional coordination
• Integrated surveillance
• Outbreak analysis
• Preventive approach
• Interinstitutional coordination
• Integrated surveillance
• Outbreak analysis
• Preventive approach
Success stories
• Municipality of Maldonado, Uruguay.
Population 127,257Tourists +600,000
• Municipality of Galvez, Argentina
GIS
Success stories
• Municipality of Maldonado, Uruguay.
Population 127,257Tourists +600,000
• Municipality of Galvez, Argentina
GIS
Food Analysis LabTraining for
Food HandlersTechniciansHygiene Inspectors
Primary School Ed
Food Analysis LabTraining for
Food HandlersTechniciansHygiene Inspectors
Primary School Ed
General levelGeneral level• Networking to improve
national capacities in surveillance and laboratory confirmation
– Training– Standardization– Quality assurance– Scientific support
The Inter-American Network of Food Analysis Laboratories - INFAL
54 laboratories from 28 countriesAchieve equivalence in methods and quality management systems for food analysis laboratoriesRegarding FBD surveillance, INFAL is promotes the integration of the official laboratories dealing with analysis of foodstuffs into programs of food safety and epidemiological surveillance.
Inter-American Network of Food Analysis Laboratories (INFAL) http://www.panalimentos.org/rilaa/ingles/index.aspInter-American Network of Food Analysis Laboratories (INFAL) http://www.panalimentos.org/rilaa/ingles/index.asp
WHO-GLOBAL SALM SURV
All countries of the Region General objective Strengthen the capability of the
participating countries in the surveillance and response systems and to contribute to the global effort of containment of antimicrobial resistance of foodborne pathogens.
WHO - Global Salm-Surv WHO - Global Salm-Surv www.panalimentos.org.salmsurvwww.panalimentos.org.salmsurv
Bolivia•Instituto Nacional de Lab. de Salud (INLASA)•Lab. de Investigación y Diagnóstico Veterinario (LIDIVET)
Colombia •Instituto Nacional de Salud•Inst. de Vig. de Medicamentos y Alimentos (INVIMA) •Instituto Colombiano Agropecuario (ICA)
Chile •Instituto de Salud Pública de Chile •Servicio Agrícola Ganadero
Perú•Inst. Nac. de Salud – Centro Nac. Lab. Salud Publica.- Div de Bacteriología – Lab Entero patógenos •Inst. Nac. de Salud -Centro Nac. de Alimentación y Nutrición
Ecuador•Instituto Nacional de Higiene
Argentina•Inst. Nac. de Enfermedades Infecciosas (INEI) - ANLIS “Dr. Carlos G. Malbran”•Inst. Nac. de Producción de Biológicos (INPB)- ANLIS “Dr. C G. Malbran”• Instituto Nacional de Alimentos (INAL) •Servicio Nac. de Sanidad Animal (SENASA)
Brasil •Inst.Oswaldo Cruz - Centro de Referencia Nac. de Cólera y Entero infecciones Bacterianas (FIOCRUZ – RJ)•Ministerio da Agricultura e do AbastecimientoSecretaria de Defensa AnimalDepartamento de Defensa animal
Paraguay•Laboratorio Central de Salud Pública•Ministerio de Agricultura y Ganadería
Uruguay•Centro Nacional de Salmonella, Inst. de Higiene •Min. de Ganadería, Agricultura y Pesca (DILAVE)
Venezuela •Instituto Nacional de Higiene “Rafael Rangel”
CENTRO REGIONAL: Instituto Nacional de Enfermedades Infecciosas (INEI) - ANLIS “Dr.Carlos G. Malbran”
- 7 countries - Strengthen the surveillance of
FBD in Latin America, by the use of biological molecular techniques.
- Database for regional isolates– Quality Assurance Program
- 7 countries - Strengthen the surveillance of
FBD in Latin America, by the use of biological molecular techniques.
- Database for regional isolates– Quality Assurance Program
http://www.panalimentos.org/pulsenet