foodborne outbreak investigation, hanoi, vietnam 01 – 05 june 2009 foodborne diseases integrating...
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Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Foodborne DiseasesIntegrating efforts from feed to food
Dr Danilo Lo Fo Wong
Foodborne DiseasesIntegrating efforts from feed to food
Dr Danilo Lo Fo Wong
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Food safety throughout the production chain
Food safety throughout the production chain
Contaminants
Chemicals
Toxins
Residues
Micro-organisms
Pre-harvest
Transport
Harvest
Processing
Retail
Consumers
Feed
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
FPD Surveillance from feed-to-foodFPD Surveillance from feed-to-food
Numerous possible routes for introduction and transmission of foodborne pathogens
Each link in the chain is responsible for the quality and safety of its products
Coordination of control activities
Communication between many stakeholders– Producers– Consumers– Policy makers
To form the basis for qualified feedback to stakeholders
Pre-harvest
Transport
Harvest
Processing
Retail
Consumers
Feed
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Cycle of animal and public health protection
Cycle of animal and public health protection
Surveillance
Epidemiologicalevaluation/Risk assessment
Research
Risk management
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Control of foodborne diseasesControl of foodborne diseases
Information needed
The source(s)
The route(s) of transmission
Efficient control strategies
Public health burden
Tools needed
Diagnostic tools
Epidemiological tools
Mathematical modelling tools
Decision support tools
Pre-harvest Harvest Processing Retail ConsumersFeed
Trace-backPredict forward
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Main pieces of the food safety puzzleMain pieces of the food safety puzzle
1. Ministry of Agriculture
2 .Ministry of Public Health
3 .Food industry
4 .Consumers
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Ministry of AgricultureMinistry of Agriculture
Take care of the interests of the food producing industry
Initiate, implement and maintain animal health and food safety programs
– Legislative– Technical– Practical
Information– Producers– Veterinarians – Food safety professionals
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Ministry of Public HealthMinistry of Public Health
Take care of the interests of the general public
Initiate, implement and maintain public health programs– Legislative– Technical– Practical
Information– Public– Medical doctors – Health care workers
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Food industryFood industry
Responsible for quality and safety of their products
Monitoring programs at various levels of production– Certification programs– Process control, Good Manufacturing/Hygiene Procedures– Final product control– HACCP-based control programs
Contribution to national surveillance programs
Collaboration with (local) government in case of outbreak investigation and trace-back
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
ConsumersConsumers
Influence through demand, willingness-to-pay and outrage
Consumer organisations– Consumer interests– Seldom involved in data generation– Driving force behind food safety initiatives
Media plays an important role
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Public Health Authorities
Veterinary Authorities
Food Authorities
Nat. Human Reference Lab
Nat. Veterinary Reference Lab
Nat. FoodReference Lab
Non-governmental Organisations
Industry
Ministry of Agriculture Ministry of Health
Major stakeholders in food safety
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Veterinary Authorities
Nat. FoodReference Lab
Non-governmental Organisations
Industry
Ministry of Agriculture Ministry of Health
Integration = communication
Public Health Authorities
Food Authorities
Nat. Human Reference Lab
Nat. Veterinary Reference Lab
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Public Health Authorities
Veterinary Authorities
Food Authorities
Nat. Human Reference Lab
Nat. Veterinary Reference Lab
Nat. FoodReference Lab
Co-ordinating bodycollection, collation, analysis,
interpretation of datadissemination of
information
Industry
Ministry of Agriculture Ministry of Health
Collaboration & coordination
Non-governmental Organisations
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Co-ordinating bodyCo-ordinating body
Coordinate multi-disciplinary and multi-sectoral control and response
Levels of collaboration/coordination:– microbiology - epidemiology - risk assessor– feed - veterinary - food - medical – government - industry - consumers
Comparative analysis of data from different sources
– animal - food - human
Pre-harvest
Transport
Harvest
Processing
Retail
Consumers
Feed
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Tasks for a co-ordinating bodyTasks for a co-ordinating body
Coordinate activities / information flow between major stakeholders
Outbreak detection and coordinate response
Perform timely & comprehensive analysis of surveillance data
Conduct epidemiological research and risk assessment
Evaluate effectiveness of intervention and control programmes
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Main pieces of the food safety puzzleMain pieces of the food safety puzzle
1. Ministry of Agriculture
2. Ministry of Public Health
3. Food industry
4. Consumers
5. Co-ordinating body
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
MoA MoH
Co-ordinatingbody
Industry Consumers
National Integrated food safety
program
Fitting the pieces of the food safety puzzleFitting the pieces of the food safety puzzle
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
EXAMPLES OF INFORMATION OBTAINED THROUGH NATIONAL
INTEGRATED FOOD SAFETY PROGRAMS
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
AB resistance in Campylobacter jejuni from farm-to-consumption
AB resistance in Campylobacter jejuni from farm-to-consumption
0
5
10
15
20
25
Tetracycline Erythromycin Streptomycin Ciprofloxacin Nalidixic acid
Broilers Broiler meat Humans
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Automatic outbreak alert systemAutomatic outbreak alert system
S. Infantis
S. Java
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Tracing sources of infectionTracing sources of infection
Integrated outbreak investigation and response
• Multi-disciplinary microbiology – epidemiology veterinary – human
• Multi-sector government - industry
• Strain bank routine surveillance previous outbreaks epidemiological data
Egg
s
Bee
f
Egg
s
Out
brea
k
Impo
rted
egg
s
Por
k
Egg
s
Pou
ltry
Por
k
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Attributing human cases to food animal reservoirs
Attributing human cases to food animal reservoirs
Comparison of the number of reported human cases caused by different Salmonella subtypes with the distribution of Salmonella subtypes isolated from the various animal food sources
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Estimated major sources of human salmonellosis in Denmark
Estimated major sources of human salmonellosis in Denmark
Travels (mean: 27.5%)
Imported turkey (1.4-3.5%)
Imported chicken (6.9-12%)
Imported beef (0.5-1.3%)
Broilers (1.7-4.6%)
Ducks (0.2-1.5%)
Imported pork (3-5.5%)
Table eggs (5-8.2%)
Beef (1.4-2.7%)
Pork (5-8.2%)
Unknown (26.4-33.6%)
Outbreaks unknown source (3.3%)
Imported duck (3-5.2%)
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
Trends in sources for human salmonellosis
Trends in sources for human salmonellosis
Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009
4 C’s of Integrated Food Safety Programs4 C’s of Integrated Food Safety Programs
Communication– regular meetings– direct and informal
contact
Collaboration– data exchange– during outbreaks
Coordination– control activities
Central database– monitoring trends– outbreak detection– comprehensive analysis– program evaluation
Optimal use of data that already is being generated