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EPIDEMIOLOGICAL SURVEILLANCE OF FOOD-BORNE DISEASES (fbd) AND FOOD SAFETY RAPID ALERT SYSTEMS (Agenda Item 5)


53. The theme paper, presented by Dr Peter Karim Ben Embarek on behalf of the Secretariat, argued that due to the globalization of the food supply and the fbd, there is a need for global fbd surveillance. Such global surveillance networks must be based on data generated and shared from national surveillance systems. He highlighted that the objectives of surveillance are to inform response systems, allow informed interventions, and provide a basis for efficient risk based strategies to lower the burden of disease.

54. It was emphasized that the vast challenges in implementing global food-borne disease surveillance and food safety rapid alert systems, including the large variety in countries' capacity to detect, investigate and mitigate food-borne diseases, necessitate international cooperation and assistance. The speaker then described the role of international organizations such as FAO and WHO in developing such networks.

55. The speaker outlined the International Health Regulations (IHR), which now cover only three diseases (cholera, plague and yellow fewer) and are undergoing revision to include all events of international public health importance. These events include infectious and non- infectious diseases and unacceptable level of micro organisms, toxins and chemicals in foods. The revised IHR will also provide guidelines for implementing surveillance systems. In addition to these and other international requirements, such as the WTO SPS Agreement, the speaker then briefly noted the ongoing integration of existing and new surveillance, alert and response systems in FAO and WHO. For example:

- Global Alert and Response System
- Global Outbreak Alert and Response Network
- Global Public Health Information Network
- Global Chemical Incident Alert and Response System
- Global Salmonella Surveillance system
- INFOSAN

56. The presentation was followed by a live video conference on INFOSAN moderated by Dr Kerstin Leitner, WHO, with food safety authorities from Australia, Canada, Jordan, Spain, Uganda and the USA and Mr Mike Ryan, Director of Alert and Response Operations, WHO, Geneva.

57. INFOSAN (the International Food Safety Authorities Network) will serve as a vehicle for food safety authorities and other agencies involved in food safety to share information and experiences. INFOSAN Emergency, embedded in this network, will link official national contact points to address outbreaks and emergencies of international importance.

58. The video conference served to 1) highlight the important aspects of INFOSAN related to food-borne disease surveillance; 2) demonstrate the potential for real-time discussion between food safety regulators; and 3) show the importance of interaction between surveillance personnel and food safety regulators.

Follow-up Discussion:

59. The participants congratulated WHO and FAO on this initiative and requested more information on becoming a member of INFOSAN. The Secretariat noted that countries may have numerous focal points based on the number of relevant agencies in those countries. However, for sake of efficiency, there will only be one officially designated INFOSAN emergency contact in each country.

60. Information on registration with INFOSAN is available from the following internet site: http://www.who.int/foodsafety, or E-mail address: foodsafety@who.int.

61. Some delegates noted several areas where FAO/WHO could take the lead role in guiding member countries at the regional level including: 1) strengthening capacity for surveillance and response of food-borne diseases through networking; 2) harmonizing the various systems of food-borne diseases surveillance; 3) enhancing surveillance along the entire feed food chain including risk analysis and 4) providing assistance in training and capacity building programmes for development of technical expertise.

Food Contamination Monitoring and Food-borne Disease Surveillance at National Level (Agenda Item 5.1)

62. The topic paper was presented by Dr Danilo Lo Fo Wong, Danish Zoonosis Centre. He outlined the general purpose of food-borne diseases surveillance: to establish a baseline, to measure the burden of food-borne diseases, to monitor trends and patterns in endemic diseases, to detect and investigate outbreaks, to initialize targeted action, to evaluate interventions and help prioritize efforts and resources. Surveillance is a prerequisite for qualified feedback to stakeholders. He further described the different types of surveillance systems. These can be passive or active, syndromic or laboratory- based, general or sentinel, continuous or intermittent, disjointed or integrated. In general, the intensity of surveillance is dependent on social, practical and financial parameters. He illustrated these principles by describing the Danish national integrated salmonella surveillance model. The successful implementation of this system can be accredited to the close cooperation between the public and private sector and between medical and veterinary epidemiologists and microbiologists. The system is based on integration of data from animals, food and humans, enabling the attribution of human cases of salmonellosis to specific foods through genetic finger-printing of relevant strains from all three sectors. Similar typing systems are being developed for other important food-borne pathogens.

Follow up Discussion

63. Delegates commended Denmark for its achievements in developing such an efficient system. However, several delegates noted the high cost of such a surveillance system and expressed the need for support to developing countries to establish food-borne disease surveillance systems. Other delegates referred to similar systems to the one presented by the speaker. In some instances, it was noted that having access to industry data was a major difficulty. It was stated that the system could not be used to evaluate transmission of pathogens from humans to animals.

64. To those who were concerned about the cost of the Danish system, the speaker, while acknowledging the high cost of the system, argued that other less costly surveillance systems, based on the same principles could be - and were being - established also in developing countries. Their level of sophistication would then match available resources. More than necessarily looking for new resources, the real issue was to use existing resources to focus testing strategically in relevant sectors and then ensure central compilation of data. Some of the developing countries participating in the Global WHO Salm-Surv Network were starting to move in this direction.

International Cooperation on Food Contamination Monitoring and Food-borne Disease Surveillance (Agenda Item 5.2)

65. The topic paper on international cooperation on food contamination monitoring and food-borne disease surveillance was presented by Mr Robert Brackett, Director of the Center of Food Safety and Applied Nutrition at the US Food and Drug Administration. The speaker pointed out that over the past two decades, the food supply has become truly global. With the globalization of the food supply, food-borne illness has become a global issue that demands international cooperation to address food contamination.

66. The speaker stated that surveillance data, integrated with and compared to epidemiological data, allows for more rapid detection of food-borne illness and trace back to identify implicated lots of food.

67. The speaker described the robust monitoring and alert system that exists in the United States of America for protecting consumers and suggested that the elements of a successful national monitoring system could be applied internationally. The speaker acknowledged that several regional and international surveillance and alert programmes have been developed to accomplish this goal. He recommended that WHO, together with FAO, serve as the focal point of a global food safety surveillance system.

Follow-up Discussion

68. Several delegates asked questions regarding the need for active surveillance and establishing priorities on what should be monitored. The speaker explained that passive surveillance systems do not give an accurate measure of the true burden of food-borne disease and that food-borne disease surveillance systems should target the largest public health problems.

69. The speaker encouraged all countries to initiate food-borne surveillance programmes. He cautioned that once surveillance begins, countries may experience the paradox of success, i.e., a successful surveillance programme will find more cases of food-borne disease so it may appear that the problem of food-borne disease is increasing. Finally, the speaker encouraged countries to tailor their risk communication messages to fit the needs of their country.

Dealing with emerging risks related to the environment and new technologies (Agenda Item 5.3)

70. Mr Alexander Haslberger, Professor at the University of Vienna, presented a paper prepared on behalf of the FAO/WHO Secretariat which focused on the possible consequences of emerging technologies used in food production. The speaker noted that evidence has shown that new technologies used in food production often improve food security, but may also result in adverse environmental effects and raise ethical and food safety concerns. In addition to genetic modification (GM), the modern methods cited also include the induction of unspecific mutagenesis and marker directed breeding.

71. The speaker emphasized that the relevant Codex texts, as well as the Cartagena Protocol on Biosafety provide international guidance and regulation for the safety of GM foods and for related environmental safety. He underlined the importance of a thorough molecular characterization of GM organisms, improved models for the assessment of gene flow and further research into subsequent risk management options. The speaker asserted that special attention is needed in the assessment of local agro-ecological conditions influencing the environmental safety of living modified organisms. He also drew attention to the consequences of environmental responses to agricultural practices which may have consequences for human health and development, such as within the food chain. It was emphasized that ethical considerations should also be included when evaluating all the aspects associated with the safety of modern food production technologies, including agro-ecological and socio-economic factors.

Follow-up Discussion:

72. Delegations expressed their views on this topic, with some noting the current initiatives in their country relating to environmental issues and concerns with the safety of food produced by modern technologies. The Chairman of the Codex Alimentarius Commission announced the re-establishment of the Codex Intergovernmental Task Force on Foods Derived from Modern Biotechnology and that the Government of Japan would send out a circular letter to Codex Member countries to solicit priorities for new work for the Task Force. Delegations were encouraged to submit their proposals at that time.

73. The following points emerged from the discussion:

- Genetic modification of organisms can be compared in some ways to the natural evolutionary changes of genes in nature;

- The issue of intellectual property rights related to GM foods must be considered;

- The safety of GM products should be assessed on a case-by-case basis;

- The co-existence of GM and non-GM crops should be minimized;

- Traceability/product tracing, labelling and post-market monitoring of GM foods are important;

- Governments must consider the ethics of testing the safety of GM foods.

74. An observer emphasized the necessary elements of national capacity needed to regulate GM foods, including mandatory environmental assessment, mandatory human safety evaluation, science-based food safety standards, post-market monitoring, mandatory labelling, traceability requirements, stakeholder input from the initial phases and strict liability provisions. The observer noted that many countries lacked some or all of these elements, and as they also have other priorities competing for limited resources for food safety, they must be allowed to prioritize these resources nationally and not be pressured regarding their position on GM foods.

Prevention and response to intentional contamination (Agenda Item 5.4)

75. A paper on intentional contamination of food was presented by Dr Jorgen Schlundt, Director, Food Safety Department, WHO. The speaker noted that while WHO work related to intentional contamination has been ongoing for some time, the importance of these issues has increased since the terrorist attacks on the United States of America in 2001. The malicious contamination of food for terrorist purposes was cited as a real and current threat, and it was noted that deliberate contamination of food at one location could have global public health implications.

76. The Fifty-fifth World Health Assembly in May 2002 requested WHO to provide tools and support to Member States to increase the capacity of national health systems to respond to such events. It was underlined that outbreaks of both unintentional and deliberate food-borne diseases should be managed by the same mechanisms.

77. The speaker asserted that sensible precautions, coupled with strong surveillance and response capacity, constitute the most effective way of countering emergencies, including food terrorism. It was emphasized that consideration of deliberate acts of food sabotage should be incorporated into existing programmes for controlling the production of safe food as the strengthening of such programmes will both increase Member States' capacity to reduce the increasing burden of food-borne illness and help them to address the threat of food terrorism. The speaker highlighted that prevention, although never completely effective, is the first line of defence and that the key to preventing food terrorism is establishment and enhancement of existing food safety management programmes and implementation of reasonable security measures. It was noted that WHO has developed a guidance document on the subject for governments as well as for industry and provides advice on strengthening national systems to respond more efficiently to potential food terrorism. The speaker stated that WHO can also coordinate existing international systems for public health disease surveillance and emergency response, including food terrorism. Finally, the representative from WHO underlined the importance of the new international network, INFOSAN Emergency, aimed at informing Member States and supporting international response in the event of an outbreak.

78. Mr Leslye Fraser, Director, Office of Regulation and Policy at the US FDA Center of Food Safety and Applied Nutrition provided the Forum with an update on the implementation of the registration and prior notice interim final rule under the US Bioterrorism Act. The speaker explained that following the events of 11 September 2001, the United States Congress had passed a new law that provides the US Food and Drug Administration with more authority to prevent, prepare for and respond to acts of bioterrorism and other public health emergencies.

79. The speaker explained that because of the new requirements, FDA will now have an inventory of all domestic and foreign facilities that manufacture, process, pack or hold food for human or animal consumption in the United States. This information will help the FDA determine the location and source of food-borne illness, either intentional or accidental; and quickly notify facilities that may be affected. In addition, the speaker noted that FDA must be notified in advance of any shipments of food for humans and animals that are imported into the United States, which will allow FDA to better target food inspections and help intercept contaminated products.

Follow up Discussion

80. During the discussion, it was emphasized that communicating efficiently to Member States while ensuring that information does not lead to dual use (by terrorists) is crucial. Issues related to the use of pesticides in agriculture and their potentially negative effects were also raised, focusing on the way to lower such use in the future, e.g. through integrated pest management schemes and possibly new technologies. The representative of the IAEA also noted the efforts of international organizations in addressing preparedness for and response to nuclear emergencies affecting agriculture. It was generally agreed that international systems such as INFOSAN Emergency could be instrumental in improving global preparedness and thereby a deterrent to terrorists, but that exercises are needed to evaluate the readiness of the system.

81. In response to a question on the cost effectiveness of the Bioterrorism Act even though there have been no acts of food terrorism, Mr Fraser indicated that the additional authorities granted to the US FDA under the law will improve food safety, as this allows the US FDA to address both intentional and unintentional incidents of contamination.


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