International Food Safety Authorities Network (INFOSAN)

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TECHNICAL TRAINING ON RISK ANALYSIS FOR SAARC COUNTRIES

FAO RAP, Bangkok, Thailand Quality Council of India

Delhi, India, June 17-21, 2013

Gyanendra Gongal Scientist (VPH)

Disease Surveillance and Epidemiology WHO Regional Office for South East Asia

New Delhi

Food safety issues

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

Globalisation of Trade : “The World on your Plate”

Herb Butter :

Salted butter Garlic puree Garlic salt Lemon Parsley Pepper Water

Chicken Breast: Chicken

Batter: Flour Water

Bread Crumb: Bread crumb Rape-seed oil

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

- Indonesia - Ireland

- Ireland, Belgium UK, France etc.

- Belgium, France - Ireland

- Ireland, UK - EU, Australia Eastern Europe

Chicken Kiev Courtesy A. Reilly, FSAI, Ireland

Food safety challenges

• Infected animals often show no illness – Public health initiatives must include apparently

healthy animals – Public health initiatives must include the safety of

what food animals consume

• Contaminated food usually looks, smells and tastes normal – Traditional (visual) food inspection is not sufficient

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

International health at the point of entry!

The International Sanitary Regulations (ISR), providing a framework on quarantine measures were adopted in 1951

These were revised and became the International Health Regulations (IHR) in 1969

IHR 1969 only applied to the traditionally “quarantinable” diseases of small pox, cholera, plague, and yellow fever

The resurgence of infectious diseases noted in the first half of the 1990s showed IHR 1969’s limitations

Travel by sea route- 1st Millennium

-

Travel by air route - 21st century

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International Health Regulations 2005

From a disease list to broad range of serious public health Risks

From passive to pro-active using real time surveillance/evidence

From control at borders to detection and containment at source

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Key Features of IHR 2005

The IHR (2005) is a fairly unique international agreement, legally binding on all Member States (194)

Expands the scope of the regulation’s application

Represents a historic development in international law on public health

Permits WHO to collect and use information from multiple sources

Strengthens WHO’s authority in surveillance and response

Contains more demanding surveillance and response obligations

National IHR Core Capacities Requirements

8 Core capacities – Legislation and Policy

– Coordination

– Surveillance

– Response

– Preparedness

– Risk Communications

– Human Resources

– Laboratory

3 levels – National

– Intermediate

– Peripheral/Community

Potential Hazards • Biological

• Infectious

• Zoonosis

• Food safety

• Chemical

• Radio nuclear

• Events at Points of Entry

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Decision making and response: International Health Regulations (2005)

National

containment

of public

health risk

Public health risk

reporting by countries

National

containment

of public

health risk

NO YES

Public health risk reporting from WHO

Alert & Response Network

Collaborative risk-based

public health measures

identified and managed

pro-actively by WHO

Decision-tree analysis to determine if of urgent

international public health importance

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Case study – E.coli 0157:H7

• Few days ago, the country XYZ experienced an E. coli O157:H7 outbreak involving fresh, bagged spinach with reported 205 cases of illness including 104 hospitalizations, 31 cases of kidney failure and 3 deaths.

• Primary distribution of the product to three countries was confirmed and another country received the product through secondary distribution.

• INFOSAN EMERGENCY: – You represent the national food safety authority responsible for risk

assessment of all food safety related public health events. As your country is one of the States Parties who is under the International Health Regulations, you now need to assess 4 criterion:

1 – Seriousness of the public health impact 2 - Unusual or unexpected nature of the event 3 - Significant risk of international spread of disease 4 - Significant risk of international trade or travel restrictions

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

Source: Event Management System WHO

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

13 Source: Event Management System WHO

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INFOSAN – Proactive? A global network of national food safety authorities that… Promotes the exchange of important food safety information

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

risks with a goal of preventing foodborne disease Support capacity building on the reporting of international food

safety events to the global community The International Food Safety Authorities Network (INFOSAN) is a

joint initiative between WHO and the Food and Agriculture Organization of the United Nations (FAO).

As of today, there are 177 country members of INFOSAN

INFOSAN 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

• Carries out functions outlined for Focal Points within their Agency

• 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, such as but not limited to: 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 Animal Diseases, including Zoonoses (GLEWS)

• World Organisation for Animal Health (OIE)

• Global Foodborne Infections Network (GFN)

• European Union - Rapid Alert System for Food and Feed (RASFF)

• EMPRES Food Safety

• WHO's Global Outbreak Alert and Response Network

• PulseNet International

INFOSAN Collaborative Partnerships

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The International Health Regulations and INFOSAN

National IHR

Focal Point and

INFOSAN

Emergency

Contact Point

IHR Reports Disseminate Public

Health Information

Assistance /

Response

WHO

Event Risk

Assessment

Initial

screen

Public Health

Emergency of

International

Concern (PHEIC)

Assessment

Verification

Others sources Informal/Unofficial Information

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Melamine-tainted milk – Concern for ALL!

Melamine has the same protein that contains "NITROGEN" (NPN)

2007 –pet food and death

2008 – Kidney stone, deaths among infants in China

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

Examples of INFOSAN Emergency ALERTS

Year Food safety event

2005 Salmonella in powdered infant formula from France to 13 countries

2006 E. coli 0157 in spinach from USA to all 150 member countries

2007 Shigella sonnei in baby corn – export from Thailand

2008 Melamine-contaminated powdered infant formula, China

2009 Outbreak of Salmonella typhimurium in the USA linked to domestically produced peanut butter

2010 Outbreak of Thyrotoxicosis in Australia linked to internationally distributed soy milk from Japan

2011 Outbreak of haemolytic uraemic syndrome caused by enterohaemorrhagic Escherichia coli in Germany

2012 S. Bareilly and S. Nchanga Infections in the USA

2013 Outbreak of Hepatitis A infections in Denmark linked to frozen berries

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

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

INFOSAN Alert: Thyrotoxicosis from excess iodine in soy milk product

Hazard Characterization

• Iodine content of the soy milk was 31 000 µg/L.

= .031mg/ml

• Tolerable Daily Intake - .017mg/kg body weight

• ~Adult body weight = 60 kg

.017mg x 60 = 1.02mg TDI (Adult)

1.02/.031= 32.9ml

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

Risk Assessment

Hazard

identification

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 quantity of intake not clear

International Distribution of X brand Soy milk

Japan

Hong Kong

Singapore

Australia

New Zealand

Cyprus

Germany

Spain

United Kingdom

Ireland

Take home message!

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

– Enhance communication between INFOSAN Emergency Contact Points and National IHR Focal Point

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Thank You

''Only if we act together,

can we respond effectively to

international food safety problems and ensure

safer food for everyone''

Dr Margaret Chan – Director General, WHO