International Food Safety International Food Safety Authorities Network Authorities Network

(INFOSAN) (INFOSAN)

Dr Richard BrownDr Richard BrownWHO ThailandWHO Thailand

Priorities and Context for Health Security in the Priorities and Context for Health Security in the South-East Asia Region?South-East Asia Region?

Priority Hazards to Public Health in the SEA Priority Hazards to Public Health in the SEA Region..?Region..?

• Emerging and re-emerging communicable diseasesEmerging and re-emerging communicable diseases• Anti-microbial resistanceAnti-microbial resistance• Food safetyFood safety• Increasing incidence / recognition of chemical eventsIncreasing incidence / recognition of chemical events• Natural disastersNatural disasters

A changing context…A changing context…

• Rapid developmentRapid development• Increasing travel and industrialization Increasing travel and industrialization • Climate changeClimate change

Food safety issuesFood safety issues

International foodborne disease outbreaks:International foodborne disease outbreaks: Rapid spread worldwide by movement of foodRapid spread worldwide by movement of food

Globalisation of Trade :Globalisation of Trade :““The World on your PlateThe World on your Plate””

Herb Butter Herb Butter ::

Salted butterSalted butterGarlic pureeGarlic pureeGarlic saltGarlic saltLemonLemonParsleyParsleyPepperPepperWaterWater

Chicken BreastChicken Breast: Chicken

Batter:Batter: FlourWater

Bread CrumbBread Crumb:: Bread crumbRape-seed oil

- Ireland- Ireland- China, USA, Spain- China, USA, Spain- - China, USA, SpainChina, USA, Spain- USA- USA- France, UK- France, UK- Indonesia- Indonesia- Ireland- Ireland

- - Ireland, BelgiumIreland, Belgium UK, France etc.UK, France etc.- - BelgiumBelgium, , FranceFrance- Ireland- Ireland

- - Ireland, UKIreland, UK- EU, Australia - EU, Australia Eastern EuropeEastern Europe

Chicken KievCourtesy A. Reilly, FSAI, Ireland

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Some food safety challenges?Some food safety challenges? Contaminated food usually looks, smells Contaminated food usually looks, smells

and tastes normaland tastes normal• Traditional (visual) food inspection is not Traditional (visual) food inspection is not

sufficientsufficient

Pathogens may survive traditional food Pathogens may survive traditional food preparation techniquespreparation techniques• New control techniques are requiredNew control techniques are required

Infected animals often show no illnessInfected animals often show no illness• Public health initiatives must address apparently Public health initiatives must address apparently

healthy animals healthy animals • Public health initiatives must include the safety Public health initiatives must include the safety

of the food animals consumeof the food animals consume

What are the International Health What are the International Health Regulations (2005)?Regulations (2005)?

An internationally agreed An internationally agreed instrument instrument for global public for global public health securityhealth security

Represents the Represents the joint joint commitment commitment by all countries for by all countries for shared shared responsibilitiesresponsibilities and and collective collective defence defence against disease spreadagainst disease spread

Legally bindingLegally binding for WHO Member for WHO Member States since June 2007States since June 2007

Approach of the New IHRApproach of the New IHR

FFrom controlling at borders, to containment ‘at source’rom controlling at borders, to containment ‘at source’

From a list of From a list of diseases, to a very broad range of threatsdiseases, to a very broad range of threats

Focus on ‘risk-based’ assessment & responseFocus on ‘risk-based’ assessment & response

New ‘infrastructure’New ‘infrastructure’• National IHR Focal pointsNational IHR Focal points• WHO IHR Contact Points in Regional OfficesWHO IHR Contact Points in Regional Offices• IHR Department in WHO Headquarters in Geneva, SwitzerlandIHR Department in WHO Headquarters in Geneva, Switzerland• Annual reporting to the World Health AssemblyAnnual reporting to the World Health Assembly• Secure Event Information Site (EIS)Secure Event Information Site (EIS)• Emergency Committee and a ‘review process’Emergency Committee and a ‘review process’

What does IHR implementation mean…?What does IHR implementation mean…?

Two very important aspects…Two very important aspects…

1.1. An An immediate and ongoing immediate and ongoing requirement requirement for countries to report some types of event for countries to report some types of event

when they occur, when they occur, and and for WHO to provide assistancefor WHO to provide assistance

2.2. A requirement, A requirement, linked to a timeframe linked to a timeframe for for countries to establish capacities to detect countries to establish capacities to detect and respond to public health events and respond to public health events (initially, by June 2012) (initially, by June 2012)

What should be reported to WHO?What should be reported to WHO?

Any potential ‘Public Heath Event of International Concern’ (PHEIC)Any potential ‘Public Heath Event of International Concern’ (PHEIC)

To help any decision, some criteria have been establishedTo help any decision, some criteria have been established

1.1. Is the public health impact of the event serious?Is the public health impact of the event serious?

2.2. Is the event unusual or unexpected?Is the event unusual or unexpected?

3.3. Is there a significant risk of international spread?Is there a significant risk of international spread?

4.4. Is there a significant risk of international travel or trade restrictions?Is there a significant risk of international travel or trade restrictions?

A decision on whether to report an event will normally be made at A decision on whether to report an event will normally be made at national level (by the national IHR focal point)national level (by the national IHR focal point)

Only the DG of WHO (advised by experts) can declare a PHEICOnly the DG of WHO (advised by experts) can declare a PHEIC

National IHR Core Capacities National IHR Core Capacities RequirementsRequirements

8 Core capacities8 Core capacities– – Legislation and PolicyLegislation and Policy

– – CoordinationCoordination

– – SurveillanceSurveillance

– – ResponseResponse

– – PreparednessPreparedness

– – Risk CommunicationsRisk Communications

– – Human ResourcesHuman Resources

– – LaboratoryLaboratory

3 levels3 levels– – NationalNational

– – IntermediateIntermediate

– – Peripheral/CommunityPeripheral/Community

Potential HazardsPotential Hazards InfectiousInfectious ZoonosisZoonosis Food safetyFood safety ChemicalChemical Radio nuclearRadio nuclear

Events at Points of Events at Points of EntryEntry

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Hazard types of acute public health Hazard types of acute public health events reported to WHO, 2001-2012events reported to WHO, 2001-2012

Source: Event Management System WHO

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What is INFOSAN?What is INFOSAN?A global network of national food safety A global network of national food safety authorities that… authorities that…

Promotes the exchange ofPromotes the exchange of important food safety important food safety information globallyinformation globally

Responds to international food safety eventsResponds to international food safety events Helps countries strengthen their capacity to manage Helps countries strengthen their capacity to manage

food safety risks with a goal of preventing foodborne food safety risks with a goal of preventing foodborne diseasedisease

Support capacity building on the reporting of international food safety events to the global community in collaboration with the WHO Global Foodborne Infections Network (GFN)

As of today, there are 177 country members of INFOSANAs of today, there are 177 country members of INFOSAN

INFOSAN MembershipINFOSAN Membership

• Emergency Contact Points From the national authority responsible for coordination of national food safety emergency response

• Focal Points Other national authorities with a stake in food safety (i.e. human health, animal health, agriculture, trade, fisheries, etc.)

• Other members Advisory Group Members, WHO Regional Food Safety Advisors; FAO Regional Food Safety Officers; Regional Food Safety Authorities (i.e. ECDC, OIRSA, etc.)

Emergency Contact Point Roles and Responsibilities

• Reports urgent food safety events of potential international significance to the INFOSAN Secretariat

• Collaborates with their IHR National Focal Point on food safety events that fall under the IHR

• Assists the INFOSAN Secretariat in the verification and assessment of events by providing all necessary information, and reviews INFOSAN Alert messages pertaining to an event in their country

• Requests international assistance through the INFOSAN Secretariat to respond to a food safety incident or emergency, as necessary

• Takes action on INFOSAN Alerts and disseminates information accordingly

• Disseminates INFOSAN notes, FAO/WHO guidelines, and other important food safety information from INFOSAN within their agency, as appropriate

• Provides comments to INFOSAN on information products disseminated to the Network

• Engages in sharing information with the INFOSAN Secretariat and other members on food safety issues that may be relevant at the international level and beneficial to all members, including risk assessments on emerging hazards, lessons learnt, identified good practices, etc.

• Collaborates with INFOSAN Emergency Contact point on emergency events involving their respective agency

Focal Point Roles and Responsibilities

Global Early Warning System for Major Global Early Warning System for Major Animal Diseases, including Zoonoses Animal Diseases, including Zoonoses (GLEWS)(GLEWS)

World Organisation for Animal Health (OIE)World Organisation for Animal Health (OIE) Global Foodborne Infections Network (GFN) Global Foodborne Infections Network (GFN) European Union - Rapid Alert System for European Union - Rapid Alert System for

Food and Feed (RASFF)Food and Feed (RASFF) EMPRES Food SafetyEMPRES Food Safety WHO's Global Outbreak Alert and Response WHO's Global Outbreak Alert and Response

NetworkNetwork PulseNet InternationalPulseNet International

INFOSAN Collaborative Partnerships

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The International Health Regulations The International Health Regulations and INFOSANand INFOSAN

National IHR Focal Point and

INFOSAN Emergency

Contact Point

IHR Reports Disseminate Public Health Information

Assistance / Response

WHOWHO

Event Risk Assessment

Initial screen

Public Health Emergency of International

Concern (PHEIC) Assessment

Verification

Others sources Informal/Unofficial Information

2020

Examples of INFOSAN Emergency ALERTSExamples of INFOSAN Emergency ALERTS20052005 SalmonellaSalmonella in powdered infant formula from France to 13 countries in powdered infant formula from France to 13 countries

20062006 E. coliE. coli 0157 in spinach from USA to all 150 member countries 0157 in spinach from USA to all 150 member countries

20072007 Shigella sonneiShigella sonnei in baby corn – export from Thailand in baby corn – export from Thailand

20082008 Melamine-contaminated powdered infant formula, China

20092009 Outbreak of Salmonella Typhimurium in the USA linked to domestically Outbreak of Salmonella Typhimurium in the USA linked to domestically produced peanut butterproduced peanut butter

20102010 Outbreak of Thyrotoxicosis in Australia linked to internationally distributed soy milk from Japan

20112011 Outbreak of haemolytic uraemic syndrome caused by enterohaemorrhagic Escherichia coli in Germany

20122012 S. Bareilly and S. Nchanga Infections in the USA

20132013 Outbreak of Hepatitis A infections in Denmark linked to frozen berries

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Melamine-tainted milk – Concern for ALL!Melamine-tainted milk – Concern for ALL!

Melamine has a protein that includes "NITROGEN" (NPN)                              

2007 –pet food and death

2008 – Kidney stone, deaths among infants in China

Panic over food safety once link Panic over food safety once link between melamine tainted milk and between melamine tainted milk and infant sickness was established infant sickness was established 4 died and 50,000 left sick4 died and 50,000 left sick

On 23 December 2009, information received On 23 December 2009, information received advising of 10 cases of thyrotoxicosis in one advising of 10 cases of thyrotoxicosis in one state of country ‘A’.state of country ‘A’.

Cases are linked to an imported soy milk Cases are linked to an imported soy milk product, brand X soy milk.product, brand X soy milk.

INFOSAN Alert: Thyrotoxicosis from INFOSAN Alert: Thyrotoxicosis from excess iodine in soy milk productexcess iodine in soy milk product

International Distribution of Soy milkInternational Distribution of Soy milk

Japan

Hong Kong

Singapore

Australia

New Zealand

Cyprus

Germany

Spain

United Kingdom

Ireland

Hazard CharacterisationHazard Characterisation Iodine content of the soy milk was 31 000 µg/L. Iodine content of the soy milk was 31 000 µg/L.

= .031mg/ml= .031mg/ml TDI (Tolerable Daily Intake) - .017mg/kg body weightTDI (Tolerable Daily Intake) - .017mg/kg body weight ~Adult body weight = 60 kg~Adult body weight = 60 kg 0.017mg x 60 = 1.02mg TDI (Adult)0.017mg x 60 = 1.02mg TDI (Adult) 1.02/.031= 32.9ml1.02/.031= 32.9ml

Exposure over 32.9ml per day will exceed TDI (1 Exposure over 32.9ml per day will exceed TDI (1 cup is 250ml) (adult)cup is 250ml) (adult)

Risk AssessmentRisk Assessment

Hazardidentification

Exposure assessment

Hazard characterisation

Risk characterization

Excessive iodine consumption has been linked to clinical thyrotoxicosis and, less commonly, hypothyroidism.

Imported food product (Brand)

9 adult, 1 infant affected

Epidemiological information and analysis

31 000 µg/L iodine in milk

Tolerable daily intake is likely to be exceeded if 33ml is consumed per day by an adult.

The commonest symptoms are

- Low muscle tone - Jaundice- Poor feeding - Constipation - Sleepiness/sluggishness- Hypothermia (reversible)Iodine can cross the placenta and may cause foetal and neonatal hypothyroidism which can cause loss of cognitive functions (irreversible)

National and international distribution

Tetra Pack (Shelf Stable)

Intake can vary from use in tea/coffee or as a milk drink

Average quality of intake not clear

Take home messages!Take home messages!

• Build national INFOSAN networks (ensuring Build national INFOSAN networks (ensuring farm-to-table representation) and increase farm-to-table representation) and increase their operational capacitytheir operational capacity

• Enhance communication between INFOSAN Enhance communication between INFOSAN Emergency Contact Points and National Emergency Contact Points and National IHR focal pointIHR focal point

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