Please know that any use or reproduction of content must systematically and clearly state the following copyright: World Organisation for Animal Health (OIE).

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

51% 42%

6%

1%

Food vehicle for the >9 million annual illnesses

Plantcommodities

Land animalcommodities

Aquatic animalcommodities

Undetermined

25%

43%

6%

25%

Food vehicle for 1,451 deaths annually

PlantcommoditiesLand animalcommoditiesAquatic animalcommoditiesUndetermined

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

TunisiaIndia

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

TunisiaIndia 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

An

imal

Sla

ug

hte

r

Pro

cessin

g

Fo

od

pro

du

ct

Han

dlin

g

Mark

ets

Mark

ets

Mark

ets

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