FEDERAL INSTITUTE FOR RISK ASSESSMENT From Farm to Fork - How to Improve Surveillance of the Food Supply Chain Prof. Dr. Dr. Andreas Hensel
What can we do in the face of terrorist threats to food? 1. Improve the surveillance of the food supply chain Including: agricultural production and harvesting processing and manufacture storage and transport sale and trade (import) food service 2. Be well prepared for the case of a terrorist attack Including: recognition a terrorist attack identify involved food public health capacities tracing systems and food recalls communication Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 2
Food - a target for terrorist attacks? The malicious contamination of food for terrorist purposes is a real und current threat, and deliberate contamination of food at one location could have global public health implications (WHO, 2002) Proactive risk analysis can reduce vulnerability in the same way as analysis of the risks of inadvertent contamination (WHO, 2002) Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 3
Food - a target for terrorist attacks? Special food characteristics associated with terrorist attacks The Food Supply Chain is relative easy accessible at many points. There is a wide spread of products as a result of the globalization of the food-markets. Therefore it is not enough to conduct national monitoring systems, it is necessary to find global solutions. Additional the risk from imported products is to note like risks coming from Farm-To-Fork -Chain. A special aspect is the possibility of growth and inactivation of agents in the Farm-To- Fork -Chain. Possible health effects of a terrorist attack varies much. You have long-term-effects and acute effects. In the case of long-term-effects you have to expect an enormity of number of infected people, because the determination of a terrorist attack is possible at a later point. You have not only to calculate for health effects, but also for long-term economic damages. Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 4
Food - a target for terrorist attacks? Learning from outbreaks Type of outbreak deliberate unintentional unintentional unintentional unintentional Agent and food Salmonella typhimurium in salad bars Salmonella typhimurium in pasteurized milk Salmonella enteritides in pasteurized ice cream Escherichia coli O157:H7 in radish sprouts watermelon contaminated with Aldicarb Region and year USA, 1984 USA, 1985 USA, 1994 Japan, 1996 USA, 1985 Infected people Point of contamination Time for identification causing food 751 service about 1 week 170.000 plant (after pasteurization) < 1 month 224.000 transport about 2 month 7.000 (including some deaths) 1.373 service (at school) agricultural production Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 5 about 1 month < 1 week
Food - a target for terrorist attacks? Yes, it is! How can we counteract this threat? We can rely on many existing and good running control systems, like: Monitoring programs Surveillance systems Traceable products Food import inspections National outbreak alert system Poison control centres HACCP Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 6
What kind of food and biological or chemical weapons are especially capable? raw foods or foods without production processes with an impact to pathogen agents stable agents (eg. to heat, to ph-value) genetic modified, antimicrobial resistant food, which is stored or transported in bulk not visible and not to smell complicate tracebility Foods Agents unexpected agents in unexpected foods, which fail the existing control systems high percentage of consumers and a wide distribution high economic losses long incubation period CDC-Criteria for building hazard categories: possibility of production possibilities to bring them out possibilities of human-human transmission morbidity and mortality Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 7
An Example - pasteurized milk contaminated with botulinum toxin stored in relative easily accessible bulk tanks durability up to 7 days agents relevant production stages pasteurization (75 for 30s or 85 for 10s), could be passed by the toxin relatively easy to produce inactivation at temperatures of 85 for at 1 minute (80 for 6min/ 65 for 1,5h) high percentage of consumers many involved people difficult identification as causing product and therefore time lag could be consumed without preparation is not expected in milk failed the surveillance systems high toxicity (LD50: 0,001 µg/kg) incubation period of 12-36h, up to few days difficult to diagnose, because short on experience of the physicians with botulism antitoxin is available, but in sufficient quantity? Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 8
Farm-to-Fork for pasteurized milk contaminated with botulinum-toxin or Salmonella typhi dairy bulk tank transport by milk car stable toxin and bacteria agent characteristics tank accessible tank accessible only with help of driver milk production tank of about 200.000 L milk production pasteurization of milk stable toxin, instable bacteria stable toxin, new contamination with bacteria (stable) tank limited accessible entry of agent Impossible to contaminate high amounts, accessible only with help of workers milk production packaging in carton transport trading Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 9
Botulinum in milk - Modelling the case of a terrorist attack Simulation for scenario: botulinum toxin in milk 200.000l tank were contaminated with 0,14 g of botulinum-toxin all of raw milk were pasteurized at one day and used for fresh-milkproduction about 73% percent of German people drink milk at least one time a week 75% percent of this people drinks more than 100 ml in one portion With data based at German household statistics, we can assume in the average about 1,5 persons drinking from the same bottle or carton of milk We assume: nothing of this milk will be used for cooking or baking in the household. Further on we assume, all milk will be consumed within the durability of 7 days. About 213.000 people infected under this assumptions Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 10
Other scenarios other agents, more instability in the case of heating other agents with long-term effects of intoxications other foods, with more or less processes effecting the stability of the agents (including scenarios with growth of bacteria during storage or other processes of the Farm-To- Fork -Chain) contamination of fields in the agricultural phase (pesticides or other) contamination the feeding storage of products in great amounts after production scenarios for bring out the agents in preprocessed food of communal feeding (plants, schools, etc.) Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 11
Detection of a terrorist attack Warnings by the terrorists How exact would be the information? Unable to model and be prepared for it Monitoring Systems the detection of contamination with terroristic background is difficult monitoring systems regarding pesticides,... implace (no systematic check on terroristic activities) monitoring for imported products Surveillance-Systems obligation to register infections and intoxications epidemiological methods to identify the causing products criteria for getting hints to an intentional attack traceability of products for possible recall actions Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 12
Surveillance Systems in Germany Detection of Infections or Intoxications consumer consumption of contaminated food t 1 incubation time disease symptoms t 2 medical institution consultation t 3 suspicion transmission laboratory diagnostic institution confirmation of pathogen pathogen suspicion t 4 < 24h IfSG concerned local health authority editing of message after case-definition transmission t 5 < 10 Tage IfSG concerned public health department access of message transmission t 6 < 7 Tage IfSG Robert Koch- Institut access of message Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 13
Botulinum-toxin in milk - Modelling the case of a terrorist attack 0. Consumption of the contaminated product Best Case: 0 days Worst-Case: 7 days 1. Incubation time Best Case: 12h Average Case: 24h Worst-Case: 10 days 6. Receipt of the case in the national surveillance center for infectious diseases (RKI) Best Case: 1 day Average Case: 2 days Worst-Case: 6 days (maximum time regulated by law) 5. Draw up a case definition and inform the public health department of the federal state Best Case: 1 days Average Case: 5 days Worst-Case: 10 days (maximum time regulated by law) 2. Time until visiting a doctor Best Case: 0 days Average Case: 2 days Worst-Case: 2 days 3. Time for right diagnosis Best Case: 0 days Average Case: 4 days Worst-Case: 14 days 4. Inform local health authority 1 day (maximum time regulated by law) Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 14
Botulinum-toxin in milk - results of the simulation (1) Steps with most influence to total time of the registration procedure diagnosis of the practitioner incubation time consumption of food local health authority health authority of federal state consultation of practitioner report by practitioner 0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 training the practitioners focus on agents with a longer incubation-time accelerate the completion of case definitions at the local health authority Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 15
Botulinum in milk - results of the simulation (2) Numbers of cases at various steps of reporting procedure 6.000 250.000 5.000 200.000 4.000 150.000 3.000 100.000 2.000 50.000 1.000 0 0 7. Tag 14.Tag 21. Tag 28. Tag 2. Tag 3. Tag 4. Tag general practitioner 5. Tag 6. Tag 7. Tag local health autorithy general practitioner local health autorithy public health authority of federal state national surveillance center It needs probably 5 to 6 days to recognize an terrorist attack assuming a wide geographical spread. More days were needed to identify the product. Expiration date of milk will be passed and we had to assume, all milk were consumed before it is possible to start recall actions or warnings. Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 16
Requirements to surveillance systems check laboratory capacities in consideration of the numbers of potentially infected people microbiological laboratories capacities to analyze food specificity, sensitivity and celerity of chemical and microbial tests to confirm a presumed medical diagnose to identify contaminated products practicable tests for imported products epidemiological methods had to be able to discover all infected persons and to prevent contagion had to be able to identify the source of infections (e.g. food) had to be able to distinct between intentional and unintentional outbreaks Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 17
Possibilities to distinct between unintentional and deliberate outbreaks atypical and unspecific symptoms of the disease epidemiological-based advises accumulation of rare diseases atypical regions atypical season non native source of infection infected persons who are resistant to occurring disease in normal cases atypical combination of food and agents affected groups with a political or other uncommon background Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 18
Conclusions - What should we do to be prepared better? 1. test and training existing systems use HACCP, import surveillance, agricultural surveillance and monitoring programs interlaboratory tests for agents in human material and food (developing new tests) tracebility systems Diagnosis, case definitions (training software developed by Hutchinson et.al., Kizakevich et.al.) epidemiological instruments taken terrorist aspects into account in risk assessments and authorization of agents 2. compile emergency plans containing create a schedule of responsibilities possibilities of decontamination risk communication (preparing flyers with right behavior for safe food-handling, recognition of symptoms) charge serum for vaccinations and giving antitoxins and develop a stepwise plan to dispense it to the population check and charge capacities in public health sector 3. create scenarios for reactions in population and prepare for it buying (hoarding, drugs, black-markets) self-cooking panic (migration) Prof. Dr. Dr. Andreas Hensel, 2004-07-19 Page 19
FEDERAL INSTITUTE FOR RISK ASSESSMENT Thank you for your attention Prof. Dr. Dr. Andreas Hensel Federal Institute for Risk Assessment Thielallee 88-92 D-14195 Berlin Tel. +49 30-8412-0 Fax +49 30-8412-4741 bfr@bfr.bund.de www.bfr.bund.de