1. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 International Foodborne Disease Outbreaks and Global Early Warning Systems Dr Danilo Lo Fo Wong

2. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009

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

4. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 SARS OUTBREAK, 2003: Rapid spread worldwide by movement of people

5. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 New Influenza A (H1N1), 2009: Rapid spread worldwide by movement of people

6. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Globalisation of Trade : “The World on your Plate” Herb Butter: Salted butter Garlic puree Garlic salt Lemon Parsley Pepper Water Chicken Breast Chicken Breast: Chicken Batter: Flour Water Bread Crumb: Bread crumb Rape-seed oil - Ireland - 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

7. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Food safety Public health priorities Polio Malaria Tuberculosis Food security Environment Climate change HIV/AIDS Cancer Tobacco Nutrition Influenza Diabetes Substance abuse

8. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Surveillance of Foodborne Diseases Reported human cases What we know What we need to know Actual human disease burden Reported human cases

9. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Comparative Risk Assessment Foodbor ne disease?

10. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 WHO Initiative to Estimate the Global Burden of Foodborne Diseases (FBD) Why? –Because information on burden of FBD from all causes is poor –To assist policy makers to assess effectiveness of prevention and interventions What? –Estimation of current morbidity, disability and mortality of FBD –Development of tools for countries to conduct BoD studies How? –Foodborne Disease Burden Epidemiology Reference Group (FERG) –Time frame of ~ 5 years Outcome? –Global report and global atlas –Country Burden of Disease studies

11. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 International Health Regulations (2005)

12. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 The International Health Regulations (2005) ●Old IHR (1969) only covered Yellow Fever, Cholera and Plague ●New IHR (2005) include all public health emergencies of international concern - including those caused by food ●IHR (2005) entered into force on 15 June 2007 ●All WHO Member States are obliged to declare all public health emergencies of international concern to WHO ●Each country has a national IHR focal point

13. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 What do the IHR call for? Strengthened national capacity for surveillance and control, including in travel and transport Prevention, alert and response to international public health emergencies Global partnership and international collaboration Rights, obligations and procedures, and progress monitoring

14. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 IHR (2005) Key Surveillance Obligations and Functions of Countries Notification of all events in State which may constitute a public health emergency of international concern Reporting of public health risks in other States: imported/exported human cases, contaminated/infected vectors, and contaminated goods Verification on request to WHO on status of alleged public health events reported from sources other than notifications/consultations

15. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Optional Consultations with WHO on non-notifiable events Information sharing to WHO of all relevant public health information on unexpected/unusual events within territory, which may constitute a PHEIC Development/maintenance of core surveillance/response capacities: Domestic detection/assessment/reporting and international reporting IHR (2005) Key Surveillance Obligations and Functions of Countries

16. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009

17. International Food Safety Authorities Network INFOSAN

18. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 INFOSAN A global network of national food safety authorities that… Promotes the exchange of important food safety information globally Responds to international food safety events and requests for assistance Helps countries strengthen their capacity to manage food safety risks

19. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 WHO surveillance and response systems Structure of the INFOSAN Network INFOSAN Secretariat Advisory Board National INFOSAN Focal Points Information Dissemination National INFOSAN Emergency Contact Point Emergency response

20. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 INFOSAN International Food Safety Authorities Network INFOSAN International Food Safety Authorities Network INFOSAN Focal point in Food Safety Authority Counterparts across the farm to table continuum INFOSAN Focal point in Agriculture Sector INFOSAN Focal point in Health Sector INFOSAN Focal point in Trade Sector INFOSAN Focal point in other Sectors

21. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 INFOSAN Information Notes Practical and Accurate Information on Current and Emerging Food Safety Issues Designed for Capacity Building and Action by INFOSAN Members Examples –Avian Influenza –Food Allergies –Contamination of Fresh Spinach –Nanotechnology

22. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009

23. WHO surveillance and response systems Structure of the INFOSAN Network INFOSAN Secretariat Advisory Board National INFOSAN Focal Points Information Dissemination National INFOSAN Emergency Contact Point Emergency response

24. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 The International Health Regulations and INFOSAN Formal / Informal information IHR Reports Initial screen Verification Event risk assessment Disseminate public health information Close event Assistance / Response Public Health Emergency of International Concern (PHEIC) assessment Average 200 per month 10-20 per month 1-2 per month 1 so far

25. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Examples of INFOSAN Emergency Actions 2007/2008 Dec 2007 - Angola – in-country assistance Feb 2007 - Salmonella in Peanut Butter – alert to 70 countries May 2007 - Melamine in pet food – alert sent to all countries Sep 2007 - Shigella in baby corn – alert sent to 3 countries Oct 2007 - Metal pieces in yoghurt – alert sent to 8 countries Nov 2007 - Rift Valley Fever and risk of importing live animals – alert sent to 5 countries Sep 2008 - Listeria in soft-cheese – alert sent to 2 countries March 2008 - Excessive levels of copper, iron and zinc in infant formula– alert sent to 2 countries Sep 2008 – Melamine in milk and milk products – alerts sent to all countries

26. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Contaminated Infant Formula Melamine added in the primary production sector (milk collection centres) to disguise diluting milk with water 22 of 79 Chinese powdered infant formula producers affected Products from affected producers exported to 5 countries Levels detected range from <0.1 – 2600 mg/kg

27. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Other products contaminated Other products affected: Milk (powder), yoghurt, biscuits, instant & liquid coffee preparations Egg powder, fresh eggs, animal feed Sodium bicarbonate (raising agent) Exports reported all over the world

28. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009

29. INFOSAN Actions Disseminate information to food safety authorities of Member States Collaborate with Chinese authorities to provide technical support and expertise Set up dedicated websites - continuously updated 4 alerts to targeted countries and 11 INFOSAN alert updates issued to INFOSAN network –Regular updates on: lists of contaminated products, analytical methods, laboratories, limits set by authorities Coordinate international alert and response Expert consultation

30. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Farm to Table Information Sharing Farm Table Animal Slaughter Processing Food product Handling Markets Global Early Warning System for Major Animal Diseases, including Zoonoses (GLEWS) International Food Safety Authorities Network (INFOSAN)

31. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 GLEWS system GLEWS: formalized FAO/ OIE/ WHO initiative Early Warning Systems linking existing human - veterinary health systems through a common platform. –Zoonotic disease outbreak information –Epidemiological analysis –Triggers appropriate action Desired outcome: –Timely, information driven decision making –Avoided/ decreased zoonotic disease burden –Coherent messages from participating organizations

32. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 What feeds GLEWS? Types of alert data Rumour Suspected Confirmed GLEWS Outbreak alert Outbreak verification Outbreak assessment Animal health surveillance systems Media Laboratory networks Human health surveillance systems Other networks e.g. trade, economics Individual contacts, including NGOs *diagram not all inclusive

33. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 GLEWS in WHO Lead focal point in Food Safety, Zoonosis and Foodborne Disease (FOS) Interaction with other programmes e.g. Global Influenza Programme (GIP), Epidemic and Pandemic Alert and Response (EPR) –Alert and Response (ARO) –Biorisk Reduction for Dangerous Pathogens (BDP) Control of Neglected Tropical Diseases (NTD),

34. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Conclusion Member States need to have the capacity to detect and respond to national food safety issues Member States need to be aware of their responsibilities towards prevention and control of international food safety events as well '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

35. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Thank you for your attention