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Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
12 November 2015
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Terms of Reference
MANDATE M-2013-0315
Therefore, in line with the general request for scientific and technical assistance as mentioned above, and I particular as indicated in ToR 3, I would like to ask EFSA for assistance in the ongoing investigations.Under the coordination of Unit G4: Food, Alert System and Training, the tracing back & forward exercises of the affected Member States should be merged and analysed to identify the potential links and also data gaps. Moreover, advice on the common source of the outbreak should be given and guidance on the robustness of evidence pointing towards suspected sources based on epidemiological links and laboratory analysis (including molecular testing) should be given Ares (2013)3322396 of 23rd October 2013
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
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WORKFLOW IN OUTBREAK INVESTIGATIONS
Status
• Collection of existing evidence• Starting point for tracing (food & time)
Tracing
• Mapping of food pathways through EU• Identification of Hot Spots
Analysis
• Collection of additional evidence• Interpretation and conclusions
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
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DATA ANALYSIS: BUILDING THE FOOD SUPPLY CHAIN
SupplierEstablishmentCustomerProduct Ingredient
SupplierEstablishmentCustomerProduct Ingredient
Identification of common links by Costumer=EstablishmentA / EstablishmentB=Supplier / Product=IngredientVerification (proof of consistency) by correct date of delivery / correct amount of the product
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
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STARTING POINTS FOR TRACINGLevel of evidence
Lot Consumption Case
No starting points
11.13 04.14Very high
(1)Confirmed lot (HAV 1A, OS detected)
IT: 1 lot
NO: 1 lot
Very high (2A)
Confirmed lot (HAV detected)
Consumed by at least one confirmed case
Confirmed case (HAV 1A, OS detected)
IT: 5 lots
FR: 1(+1) lot
High (2B) Suspected lot Consumed by at least one confirmed case
Confirmed case (HAV 1A, OS detected)
IT: 5 lots
NO: 1 lot
High (2C) Confirmed lot (HAV detected)
IT: 8 lots
Medium (3A) Possible lot
Produced in reasonable time before infection of at least one confirmed case
Confirmed case (HAV 1A, OS detected)
IE: 11 cases
SE: 2 cases
NL: 8 cases
Low (3B) Suspected lot Consumed by at least one non-genotyped case Probable case Not
tracedNot traced
Low (4) Possible lotProduced in reasonable time before infection of a tested case
Probable case Not traced
Not traced
Total 43 lots or cases
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
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IRASFFRecurring hepatitis A outbreaks in the EU/EEA: food tracing activities
The final dataset comprised 6227 transactions among 1974 food operators
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NETWORK ANALYSISRecurring hepatitis A outbreaks in the EU/EEA: food tracing activities
Principle of network graphs: the circles are the nodes (e.g. companies trading a product), the lines are the edges (e.g. representing the movement from one company to another)
Primary production
Processing
Distribution
Final preparation
Contamination
BfR Food chain lab• collects data in the right structure / performs data
validation• filters and visualizes food supply networks• performs data analysis: Scoring, cross-contamination,
regional analysis
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BULGARIAN BLACKBERRIESRecurring hepatitis A outbreaks in the EU/EEA: food tracing activities
Network visualisation of connections between all blackberry suppliers in Bulgaria (blue node) and starting points (lots, cases) in the complete dataset (excluding the Netherlands)
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DETAILED ANALYSIS – FREEZING PROCESSOR
A detailed analysis reconstructs the flow of material, incl. processing and possible cross-contamination
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
6/11/2012 Frozen mixed berries (4800kg)
Berry Yoghurt
Jan-Mar 2011
Apr-Jun 2011
Jul-Sep 2011
Oct-Dec 2011
Jan-Mar 2012
Apr-Jun 2012
Jul-Sep 2012
Oct-Dec 2012
Jan-Mar 2013
Apr-Jun 2013
Jul-Sep 2013
Oct-Dec 2013
Jan-Mar 2014
Apr-Jun 2014
Onset dates
26/6/2012 Fresh redcurrants PL Trader (PL#404) & Producer (PL#825)
27/6/2012 Fresh redcurrants PL Trader (PL#435)
30/6/2012 Fresh redcurrants PL Trader (PL#826) & Producer (PL#1173)
1/7/2012 Fresh redcurrants PL Trader (435)
2/7/2012 Fresh redcurrants PL Trader (PL#1075) & Producers (PL#875,PL#403,PL#1185)
4/7/2012 Fresh redcurrants PL Trader (PL#1075)
10/7/2012 Fresh redcurrants PL Trader (PL#833)
15/10/2012 Frozen blackberry BG Supplier (BG#1807, BG#1884)
3/7/2012 Fresh redcurrants PL Traders (826,1038, 435,850,427) & Producers (875,403,1082,844)
18/12/2012 Frozen blackberry BG Supplier (BG#1807, BG#1884)
7/1/2013 Red berry mix (1040kg)
Smoothie of Red Berry Mix
30/1/2013 Mixed berries IQF (3150kg)
9/7/2013 Pastry
7/3/2013 Frozen mixed berries (7200kg)
Cake (Lot FR#1)
Case IE#431742
Case IE#434360
Case IE#439499
Case IE#439125
Case IE#440889
Case FR#1
Case FR#2
Case FR#3
Jan-Mar 2011
Apr-Jun 2011
Jul-Sep 2011
Oct-Dec 2011
Jan-Mar 2012
Apr-Jun 2012
Jul-Sep 2012
Oct-Dec 2012
Jan-Mar 2013
Apr-Jun 2013
Jul-Sep 2013
Oct-Dec 2013
Jan-Mar 2014
Apr-Jun 2014
FREEZING PROCESSOR
PL#273
Case IE#438998
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TWO HYPOTHESIS FOR THE OUTBREAKRedcurrants produced in Poland Blackberries from Bulgaria
31 of 35 lots/cases could be connected,additional links via cross-contamination
25 of 35 lots/cases could be connected
Connects: IT, IE, FR / NO / SE Connects: IT, IE, FR / NO / SE Nearly complete back tracing In most cases is tracing incompleteSingle point source (e.g. common primary producer) is unlikely
No common source in the chain before Bulgaria identified
Three consecutive harvest years:2011-2013
Local picking in public forest area
Main producer of redcurrants in EU Highest reported incidence of HAV in 2011 and 2012 (decrease in 2013)
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
HAV contamination could have occurred at the freezing processor or in primary production of berries
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“Identify and assess the relevant default tracing parameters needed for tracing back & forward foodstuffs from farm to fork.
Evaluate the applicability of such datasets for the most relevant foodborne pathogens for the purpose of outbreak investigations and extend where necessary to parameters on primary production level, transport or processing steps.
Identify and recommend available IT-tools to analyse and visualize such datasets in view of determining the most probable source of contamination and data gaps.”
(Ares(2014)4315795 of 22nd December 2014, EFSA M-2015-0001)
Terms of ReferenceEC mandate on revision of the data structuresNEXT STEPS: DEMOS
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
12... and all co-workers in EFSA and the member states.
PROJECT GROUPExpertise Epidemiologists Exposure AnalystsInvestigationsin Italy Caterina RIZZO (ISS) Gaia SCAVIA, Martina ESCHER (ISS)
in Ireland Lelia THORNTON (HSE) Lisa O'CONNOR (FSAI)in the Netherlands Barbara SCHIMMER (RIVM) Judith LEBLANC , Ingeborg BOXMAN
(NVWA)in France Elisabeth COUTURIER (INVS) Aurelié KUAKAVI (DGCCRF)in Norway Line VOLD, B Guzman (FHI) Laila JENSVOLL (NO FSA)in Sweden Lena SUNDQVIST Mats LINDBLAD (SLV)in Poland Anna BAUMANN-POPCZYK (PZH) Maciej KAŁUŻA (GIS)
European background information / MethodologyExternal Ettore SEVERI ,
Johanna TAKKINEN (ECDC)Annemarie KAESBOHRER , Christian THÖNS, Matthias FILTER (BfR), Armin WEISER
Internal (EFSA) Jane RICHARDSON (AMU) Olaf MOSBACH-SCHULZ (AMU)DG Sanco Klaus KOSTENZER (G4), Jan BAELE
(RASFF)
Recurring hepatitis A outbreaks in the EU/EEA: food tracing activities
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Q&A: WHAT NEEDS TO CHANGERecurring hepatitis A outbreaks in the EU/EEA: food tracing activities
Good Agricultural Practice (GAP). It is recommended to focus on preventive measures to avoid viral contamination rather than trying to remove/inactivate these viruses from food.
Good Hygiene Practice (GHP). Workers (including migrant pickers) in the frozen berry production chain should receive hygiene training with a focus on hand hygiene and personal cleanliness.
HAV vaccination is recommended for all non-immune berry pickers and handlers
Actors: Freezing processors, local inspectors, auditors (local and FVO), occupational safety and health, GlobalG.A.P
Training: Environmental and Occupational Health