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Reducing the Burden of Foodborne Diseases Department of Food Safety and Zoonoses
Source: EIO (Engaging Intergovernmental Organizations) 2013
Why food safety matters more than we may think
The Good, the Bad and
the Underreported
How big is the burden of foodborne diseases?
Reported human cases
What we know from surveillance data
What we need to know
Actual human disease burden
Reported human cases
42% 51%
6%
1%
Food vehicle for the >9 million annual illnesses
Plant commodities Land animal commodities Aquatic animal commodities Undetermined
25%
43%
6%
25%
Food vehicle for 1,451 deaths annually
Plant commodities Land animal commodities Aquatic animal commodities Undetermined
CDC report on foodborne illnesses 1998-2008
Attribution of Foodborne Illnesses, Hospitalizations, and Deaths to Food Commodities by using Outbreak Data, United States, 1998–2008 (Emerging Infectious Diseases, Mar 2013)
Key messages:
• > 9 million people annually affected by foodborne illness, leading to 57,462 hospitalizations, 1,451 deaths
• > 13 000 foodborne disease outbreaks each year (bacterial, chemical, parasitic and viral causes)
• Produce and poultry a key impact:
- 46% of illnesses was due to produce (mainly leafy vegetables)
- Illnesses associated with leafy vegetables were the second most frequent
cause of hospitalizations (14%) and the fifth most frequent cause of death (6%) - More deaths were attributed to poultry (19 %) than to any other
commodity
WHO Initiative to Estimate the Global Burden of Foodborne Diseases
• Foodborne Disease Burden Epidemiology Reference Group (FERG)
• Thematic task forces
http://www.who.int/foodborne_disease/burden/en/index.html
COMPUTATIONAL TASK FORCE
What are foodborne diseases ?
• Diseases transmitted through the ingestion of contaminated food
• Caused by bacteria, viruses, parasites, prions and
chemicals/toxins (incl. allergens)
They are everywhere
Food Safety in a Global Marketplace
Rapidly changing world:
• Global demographics
• Globalization and interconnectivity
• Communication (24/7; social media)
• Climate change
• Challenges go beyond diseases
– Economic loss
– Food security and healthy nutrition – Antimicrobial resistance
– Threat for national and global health security
Need for better collaboration:
across sector, across nations, across jurisdictions
Food trade: a global interdependance
1356 billion dollars of exports of food in 2011 [WTO]
•All types of food are involved in complex and global flows
•Hazards also travel easily and quickly from one source to global
dissemination
•Amplified economic consequences
•International networks – surveillance, rapid
response, surge capacity, technical cooperation
World beef trade flows, 2007
Key improvements needed to strengthen food safety globally
• National systems covering farm-to-table seamlessly
– Based on the principle of reducing risk
• International commitment to strengthen capacities in developing countries
– Prevention at the source is the most efficient food safety measure
• Harmonized, coordinated international approach/systems to detect, address & respond to contamination / outbreaks
– Rapid communication, capacity to verify and make decisions
– Ability to share information quickly during rapidly evolving food safety events
– Procedures to respond and capacity to assist
– One inter-linked system (covering both intentional and accidental contamination)
Department of Food Safety and Zoonoses (FOS)
Our Mission:
To lower the burden of foodborne disease, thereby strengthening the health security and sustainable development of countries
By focusing on industrialized and traditional production
systems, and integrating prevention from farm to table
WHO Strategic Action Plan
to strengthen global food safety
Based on three strategic directions:
1. Infrastructure
strengthen national, risk-based, integrated food safety systems
2. Normative work
Provide the science base for measures along the food- chain
3. Cross-sectoral collaboration and communication
Improve national and international collaboration
between sectors (agriculture, veterinary and human
health)
• Capacity Building
• GFN / AMR
• Total diet study workshop
• Communication/Health Promotion
• 5-keys for safer food
• Safe preparation of
powdered infant formula
• Human-Animal Interface
– Tripartite activities (FAO, OIE, WHO)
– Zoonoses coordination
Overview of FOS activities
• Early Warning, Communication and Prevention
– INFOSAN – GLEWS
• Food Contamination Monitoring
– GEMS/Food Databases – GFN
• Scientific evidence
– Risk Assessment (JECFA, JMPR,
JEMRA, ad hoc consultations); AMR – Burden of Foodborne Disease (FERG) – FOSCOLLAB
• International food safety standards
– Codex Alimentarius Commission – Codex Trust Fund
1. Strengthening national food safety systems
• Capacity building programs on monitoring and surveillance
– Chemical hazards – Microbial hazards – Foodborne diseases
– Antimicrobial use and resistance development
• Capacity building for effective participation in Codex
– Codex Trust Fund:
• To help developing countries and those with economies in
transition to enhance their level of effective participation in the development of global food safety and quality standards by the Codex Alimentarius Commission (CAC)
Global Foodborne Infections Network (GFN)
Goal:
• Strengthen national and regional capacities for
integrated surveillance of foodborne & other enteric infections, including
antimicrobial resistance
Activities:
• (Inter)national Training
• Post training implementation – External Quality Assurance
System (EQAS)
– Country Data Bank (CDB) – Onsite Problem Solving
– Focused Regional and National Projects
– Reference Services
• Communication
GFN training activities
St. Petersburg, Russian Federation
Papua New Guinea Moscow, Russian Federation
Guam
Fiji Argentina
Poland
Thailand Cameroon
Egypt
China
Kenya
Brazil Guatemala
Madagascar Costa Rica Trinidad
& Tobago
South Africa Tunisia
India
St. Petersburg, Russian Federation
Papua New Guinea Moscow, Russian Federation
Guam
Fiji Argentina
Poland
Thailand Cameroon
Egypt
China
Kenya
Brazil Guatemala
Madagascar Costa Rica Trinidad
& Tobago
South Africa Tunisia
India
20 Training Sites
> 1 300 Trained
> 130 MS
Training in microbiology, epidemiology and joint training
2. Evidence-base and normative work
• Scientific advice as basis for standard setting: (JECFA, JMPR, JEMRA, ad hoc)
• Standard setting: Codex Alimentarius Commission
• Estimating the burden of foodborne disease
• IT tools for improved knowledge
management
Scientific Advice
• Joint FAO/WHO Expert Consultations on Microbiological Risk Assessment (JEMRA)
• Joint FAO/WHO Expert Committee on Food Additives (JECFA)
• Joint FAO/WHO Meetings on Pesticide Residues (JMPR)
• Ad hoc expert meetings
• Methods development and harmonization
Codex Alimentarius Commission
• Intergovernmental body implementing the Joint FAO/WHO Food Standards Programme
• Created in 1963 to develop standards,
guidelines and other documents for foods
(e.g. ‘Code of Practice’)
• Main Objectives
Health protection of consumers
Fair practices in food trade
• Based on science
FOSCOLLAB:
improved data access and sharing
• Global platform to better guide risk analysis and decision-making
• Integrates existing sources of data and information
• Next Steps:
– Feedback solicitation – Data Quality Working
Group to ensure reliability – Integrate new sources,
particularly microbiological hazards
http://www.who.int/foodsafety/foscollab
3. Cross-sectoral Collaboration and Communication
• Linking agriculture, animal and human health sectors (Tripartite – GLEWS)
• Improving communication and coordination in food safety and zoonotic emergencies
(INFOSAN)
• Communication and Health promotion (5 keys)
Environment Ecosystem
Wildlife
Communication between sectors is key in fast and targeted reaction to problems
• Zoonotic diseases increasing concern
–
Animals essential in maintaining zoonotic infections in nature
–
Emerging and endemic
– Collaborative work FAO, OIE, WHO
• GLEWS: global early warning
system for major animal diseases
• INFOSAN: international food
safety authorities network
Global Early Warning System (GLEWS)
• Early warning system based on FAO, OIE, WHO systems
providing joint risk /
epidemiological assessment
• Links to other networks e.g.
OFFLU (OIE-FAO flu network), INFOSAN (International Food Safety Authorities Network)
• Provides guidance & other
assistance
International Food Safety Authorities Network
(INFOSAN)
Joint FAO/WHO network: 178 countries
Web-based platform to exchange information & strengthen community practice
Verifies information on food safety emergencies and alerts members accordingly
Assists countries in responding to food safety emergencies
Multisectoral participation
(human and animal health, agriculture,
food safety, trade, standards, etc.)
Farm to Table Information Sharing
Farm Table
Animal Slaughter Processing Food product Handling
Markets
Markets
Markets
Global Early Warning System for Major Animal Diseases, including Zoonoses
(GLEWS)
International Food Safety Authorities Network (INFOSAN)
Food safety strategic approach:
Act global to protect local
• Hazards do not respect borders or boundaries
• Isolated national systems insufficient to manage foodborne diseases and zoonoses
• Increased complexity of products, manufacturing methods and supply chain
• Need for a global monitoring and preparedness – move from reactive to proactive systems
• Individual bi- or multilateral agreements are
time-consuming and often cannot cover all
aspects
Food Safety: shared responsibility
Industry Governments Consumers
Producers
Three examples:
INFOSAN in action
Melamine (2008)
- Adulteration of milk and other products with melamine, leading to illness and death in Chinese infants
- INFOSAN provided information on identified products and distribution chains, analytical methods, interpretation of findings of low levels, health consequences (risk assessment) - At least 47 countries world-wide affected
Outbreak of Botulism in Finland linked to Olives stuffed with almonds from Italy (2011)
- 2 cases of Botulism were identified in Finland linked to olives stuffed with almonds from Italy - implicated product was also distributed to other countries including the USA
International Distribution of gluco-oligosachcaride (GOS, ingredient in infant formula) from South Korea (2012)
- Salmonella outbreak in Russia due to infant formula in early 2012, traced back to Belgian manufacturer, later traced to GOS ingredient from South Korea.
- Later in 2012 same Salmonella strain (S. Oranienburg, same PFGE) detected in USA and Netherlands, reported to INFOSAN
- INFOSAN could link these incidents and inform USA of the origin of the contamination - INFOSAN issued an alert to all members
Linking global information
to prevent further distribution and illness
Russia
Haiti
Congo
Mozambique Burundi
USA
Peru
Norway
South Korea
New Zealand China
Taiwan UK Belgium
Netherlands France
Hong Kong
International Distribution of GOS and Products Containing GOS from South
Korea ( + S. Oranienburg in USA and Netherlands with same PFGE)
Contamination chain of events
Example Melamine (2008):
47 countries with contaminated products
Analysis reported Import of contaminated products reported
In China: over 22 mill patients screened, 300'000 children ill, 6 confirmed deaths