Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Foodborne Diseases Integrating efforts from feed to food Dr Danilo Lo Fo Wong

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


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


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


Cycle of animal and public health protection

Cycle of animal and public health protection

Surveillance

Epidemiologicalevaluation/Risk assessment

Research

Risk management


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


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


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


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


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


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


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





Industry


Integration = communication


Food Authorities






Food Authorities




Co-ordinating bodycollection, collation, analysis,

interpretation of datadissemination of

information

Industry


Collaboration & coordination



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


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


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


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


EXAMPLES OF INFORMATION OBTAINED THROUGH NATIONAL

INTEGRATED FOOD SAFETY PROGRAMS


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


Automatic outbreak alert systemAutomatic outbreak alert system

S. Infantis

S. Java


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


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


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%)


Trends in sources for human salmonellosis

Trends in sources for human salmonellosis


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


Thank you for your attention

Documents

Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Foodborne Diseases Integrating efforts from feed to food Dr Danilo Lo Fo Wong