05/11/2014. Food Safety in PAHO. Enrique Perez Gutierrez, Department of Communicable Diseases and Health Analysis, PAHO/WHO

Transcription

1 Food Safety in PAHO Enrique Perez Gutierrez, Department of Communicable Diseases and Health Analysis, PAHO/WHO 1 INFOSAN REGIONAL MEETING,

2 Outline Conceptual Framework: WHO, PAHO Veterinary Public Health PAHO Regional Strategy for Food Safety and Prevention of Foodborne Diseases for the Americas ( ) PAHO BWP AMRO, INFOSAN REGIONAL MEETING, 2014 Monitoring and assessing health trends WHO is the directing and coordinating authority for health within the UN Leadership on global health matters Providing technical support to countries Shaping the health research agenda Articulating evidence-based policy options Setting norms and standards 2

3 PAHO/WHO role in food safety To support countries develop and strengthen risk based national food safety systems CONCEPTUAL FRAMEWORK OF THE LINKAGES BETWEEN HEALTH AND AGRICULTURE POLICY AND PROCESS GOVERNANCE AGRICULTURAL SUPPLY CHAIN Agricultural producers (farmers and workers) INTERMEDIARY PROCESSES/DETERMINANTS Labor process HEALTH OUTCOMES a Occupational health risks Water associated vector-borne diseases Agricultural systems (types, practices, technologies, location, ownership) Environmental change (water, air, soil) Under nutrition Chronic diseases Income generation Foodborned iseases Agricultural outputs (distribution, quantity, quality, diversity, price) Access to food, water, land, and health-related services Zoonotic diseases Livestock related illnesses a These health conditions are not mutually exclusive livestock-related illnesses, for example, are also occupation health risks. The list of health oucomes is not necessarily inclusive. Other health conditions are also likely to interact with agriculture, but these have not yet been identified as such in the published scientific literature. 3

4 All Hazards Food Safety Approach: Chemicals, Viruses, Bacteria, Fungi, Parasites, Radiation COMPONENTS IN THE REGIONAL FOOD SAFETY STRATEGY ( ) Advocate and support the development of sustainable, integrated, risk-based food safety systems Provide evidence-based scientific options for risk analysis, policy development and decision-making to protect health and manage food safety risks Risk communication and management, in cooperation with other sectors and partners 7 4

5 What type of support does PAHO/WHO provide to countries? Supporting public health authorities to actively engage in intersectoral collaboration, coordination and information exchange 5

6 ADVOCATE AND SUPPORT THE DEVELOPMENT OF SUSTAINABLE, INTEGRATED, RISK-BASED FOOD SAFETY SYSTEMS Development of policies, strategies and intersectoral action for the prevention and control food hazards at regional and national level. o COPAIA 10 Developing national risk analysis capacities to enable countries to prioritize food safety activities 6

7 Modernization of legislation and institutional frameworks based on risk. o PVS Support capacity for prevention, detection, evaluation and management of emergency incidents and food safety. o INFOSAN/RSI 12 Developing standardized systems to monitor detect and assess foodborne risks including; foodborne disease surveillance, antimicrobial resistance monitoring and, integrated surveillance 7

8 FBD Surveillance and Response: Our vision Carry out needs assessments and develop work plans Develop and Strengthen: o o o Standardized systems to monitor, detect and assess priority foodborne risks: Microbial (including AMR monitoring) Parasites Chemicals ( acute events) FBD outbreak response capacity Intersectoral collaboration along the food chain aimed at facilitating: Integrated surveillance The use of information from surveillance and outbreak response to inform prevention and control measures Multidisciplinary outbreak investigations Stepwise approach towards a functional and sustainable system for the surveillance and response to foodborne diseases Components Processes Stage one IBS EBS Notifiable disease surveillance Rapid Risk Assessment of acute public health events Response Strengthening indicator based surveillance Stage two Stage 1 Risk Profile Multisectoral collaboration Sharing data to better understand risks in the food chain IBS Laboratory surveillance Ad hoc studie s Ad hoc public health interventions along the food chain (reactive) Stage three Stage 2 Risk Analysis across the food chain by all stakeholders Integrated surveillanc e Sharing Data from other competent authorities with a stake in food safety (food safety and monitoring, agriculture, inspection services etc) Regular public health interventions along the food chain (proactive) Public health intervention specific to events 8

9 Laboratory as part of Integrated Surveillance Alerts to the Health System Specificity In diagnosis: etiological agent transmission routes reservoir source In outbreaks detection and investigation Control and prevention Laboratory Networks for control and prevention OBJECTIVES Standarize and improve diagnostic methods (pheno and genotype) Facilitate the generation of databases and their analysis Contribute to the epidemiological surveillance of diseases 9

10 International Networks WHO Global Foodborne Infections Network (WHO GFN) formerly WHO Global Salmonella Surveillance (WHO GSS) PulseNet International Molecular Subtyping Network for Foodborne Disease Surveillance What is WHO GFN? Initiated January 2000 A network of institutions and individuals working in veterinary, food and public health to enhance capacity of countries to detect, respond and prevent foodborne and other enteric infections 10

11 Elements of the network Electronic discussion group Salmonella International Database Regional Reference Center International Courses (Epi-Micro) Quality Assurance System (EQAS) Referential Diagnosis Pathogens covered: according to regional needs. In South America Salmonella, Shigella, Campylobacter, Vibrio, enterohemorragic E.coli Web Page Agregar nueva gfn 21 Title of the Presentation 11

12 WHO GFN Regional Reference Centers and Training Sites Costa Rica Trinidad Russia, St. Petersburg Russia, Moscow Kazakhstan Poland China Egypt Thailand Brazil Cameroon Madagascar Fiji Argentina Training Centers Regional Reference Centers May 2012, 1062 Members 184 Countries Salmonella spp. in Latin America 12

13 # AMRO INFOSAN REGIONAL MEETING, 2014 # AMRO INFOSAN REGIONAL MEETING,

14 # AMRO INFOSAN REGIONAL MEETING, 2014 # AMRO INFOSAN REGIONAL MEETING,

15 # AMRO INFOSAN REGIONAL MEETING, 2014 # AMRO INFOSAN REGIONAL MEETING,

16 PATOGENOS REPORTADOS A CARPHA, ETA: AUMENTO DEL 32% Salmonella: Mas Comun: 22% incremento Del 43% al 65% de ETA 31 16

17 Network of National and Regional Laboratories dedicated to foodborne diseases surveillance through molecular subtyping methods PulseNet - Objectives To strengthen national and regional laboratory based surveillance of FBD To promote the use of standardized molecular techniques for the diagnosis and subtyping of foodborne pathogens To have QA/QC programs for reproducibility and comparable databases results. To establish national and regional databases 17

18 PulseNet: International Molecular Subtyping Network for Foodborne Disease Surveillance Pulse Field Gel Electrophoresis International Standard Strain S. Braenderup H9812 Profile of a large section of genome Different profiles can be obtained by using different restriction enzymes and/or electrophoresis conditions Epidemiologically relevant Versatile: applicable to a large number of bacterial enteropathogens (Salmonella, Shigella, E. coli, Vibrio cholerae, Vibrio parahaemolyticus, Listeria, Campylobacter, Cronobacter formerly Enterobacter sakazakii-) International Standardized Protocols How does subtyping help in epidemiological investigations? Understanding clonality, spread and relationship of pathogens. Identification and monitoring of prevalent clones updated vaccines Detecting outbreaks through surveillance - Linking apparently sporadic cases: clusters - Epidemiological investigation Detecting the source and demonstrating that the pathogen came from that source (timely recall of contaminated food) Describing the transmission 18

19 Hacia donde vamos INTERPRETANDO EL ADN 36 Title of the Presentation PulseNet International A Family of Networks 19

20 México Cuba Caribbean Public Health Agency (CARPHA) Guatemala Nicaragua Costa Rica Venezuela Panama Colombia Ecuador Perú Bolivia Brazil (2) 16 countries of LA & 21 Caribbean countries 18 Reference Labs Chile Argentina Paraguay Uruguay Coordination - PAHO / WHO - INEI-ANLIS Dr. Carlos G. Malbrán Pathogen # isolates submitted # PFGE patterns (first enzyme) # submitting laboratories Salmonella (Bolivia, Brasil-2 labs-, Chile, Colombia, Costa Rica, Guatemala, Paraguay, Perú, Uruguay, Argentina) STEC O157 Listeria monocytogenes Shigella sonnei (Argentina, Chile, Cuba, Paraguay) (Chile, Costa Rica, Argentina) 5 (Brasil, Costa Rica, Perú, Chile, Argentina) Vibrio cholerae (Perú, Argentina, Paraguay) Campylobacter C.jejuni: 210 C.jejuni: (Paraguay, Argentina) C.coli: 41 C.coli: 25 20

21 # outbreaks investigated by PFGE (# labs) countries comments Salmonella 498 (9) Brazil, Chile, Colombia, Costa Rica, Guatemala, Nicaragua, Paraguay, Peru, Argentina S. Enteritidis, S. Typhimurium, S. Typhi, and other serovars like S. Weltevreden, S. Newport, S. Muenchen, S. Blegdam Shigella 57 (2) Brazil, Argentina S. sonnei (23), S. flexneri (34) STEC 43 (2) Brazil, Argentina Vibrio parahaemolyticus 12 (1) Brazil Vibrio cholerae 1 (1) Venezuela O1 Ogawa Haiti strain imported in Venezuela. PFGE S. Kentucky. Comparación del aislamiento de Costa Rica con los patrones más cercanos de PulseNet USA PFGE S. Kentucky. Comparación del aislamiento de Costa Rica con los patrones más cercanos de PulseNet USA El aislamiento con mayor similitud no posee un perfil de resistencia similar. El segundo aislamiento posee un perfil de resistenca simila al de CR. Resistencia a amoxicilina, cefoxitin, estreptomicina y ceftiofur. Sin embargo, el pulsotipo es diferente al detectado. 21

22 PulseNet: esquema actual 2008 Database (SQL SERVER) BNAdmin OPS-FOS SERVER Rio de Janeiro - Brasil I. Malbrán Buenos Aires -Argentina BNServer BNClient Organización Panamericana De la Salud How PAHO/WHO works Country Cooperation Strategy or request for cooperation. Needs Assessment Work plans Country level activities 22

23 PAHO/WHO cant do all this work alone PAHO/WHO needs partners to help 23