Surveillance and Response to Foodborne Disease Association of Local Public Health Associations

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Surveillance and Response to Foodborne
DiseaseAssociation of Local Public Health
Associations

• Dr. Paul Sockett
• November 2004

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Sources of Infectious Disease Information?
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Surveillance Aims.

• Determine magnitude and monitor trends
• Identify outbreaks and take action
• Identify high risk
• populations, foods, behaviours
• Evaluate health impact of food safety programs
• Information for policy and other prevention
  strategies, risk assessment and priority setting
  (public private sectors)

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The Activity level of the surveillance program
is influenced by perceived need on the one hand
and on the type, availability and
sensitivity/specificity of data on the other
Anticipatory?
Surveillance for disease in non-human species
Near Real-time
ID Surveillance Approaches
Syndromic reporting (ASAP)
Detection of Environmental/agricultural change
which could impact/indicate future human health
threats
Enhanced Active
Alert Reporting (CEOSC/PulseNet)
Detection of current events leading to immediate
intervention
Active
NESP Enteric Surveillance
Population-based Sentinel studies (NSAGI)
Detection of recent events leading to planned
control and Prevention programs
Passive
NDSS
Observation of Long-term and Short-term trends
Passive
Active/Reactive
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Nationally Notifiable Diseases
Nationally Notifiable Diseases in Canada

• Botulism
• Salmonella (also Typhoid)
• Campylobacter
• Shigella
• Verotoxigenic Escherichia coli
• Vibrio (Cholera)

• Cryptosporidium
• Cyclospora
• Giardia
• Hepatitis A

Not reported through NESP
Others Reported through NESP Yersinia Rotavirus N
orovirus Entamoeba
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National Enteric Surveillance Program (NESP)
A surveillance program which integrates national
data on enteric pathogens for outbreak detection
and response
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NESP - Major Disease Groups
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NATIONAL ENTERIC SURVEILLANCE PROGRAMANNUAL
SUMMARY REPORT - 2003Isolates Reported by
Major Disease Group
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Outbreaks Reported to the NESP in 2003
Numbers based mostly on partial information
received via the NESP reports
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Canadian Enteric Outbreak Surveillance
CentreCEOSC Alerts Sources of Alerts
Provincial/territorial Public Health
Federal Public Health
CEOSC Alerts
Local/ Regional Public Health
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Enteric Alerts (regional Health Authority
coverage) as of Sept 2003
CNPHI - ALERTS
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How its working..

• Alert posted
• S.Enteritidis PT5b Cuba
• 5 provinces identify cases
• Cases travelled to same region in Cuba
• Cuban government informed
• Local investigators identify source institute
  control measures

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PulseNet Canada?

• A co-ordinated network of laboratories for rapid
  exchange of molecular typing information.
• 2000 Consultation meeting with partners
• 2000-1 Sharing and standardized methods
• 2001 established listserv for exchanging
  information
• Allow future real time surveillance
• Employs single IT platform Bionumerics

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Pulse NetNational and International Harmonization

• Standardized database allow interchange with
• PulseNet US established in 1995 for E. coli
• PulseNet Europe 2003
• PulseNet Central Asia 2003
• PulseNet South America 2004

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• Community surveillance of gastroenteritis based
  on over-the-counter sales of anti-diarrheal and
  anti-nausea medications

• To reduce impact of a severe and sudden
  introduction of an infectious agent in the
  community by facilitating rapid outbreak
  detection
• Applications to other disease syndromes,
  including respiratory, dermatological, etc

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Key Components

• Automated data download/exchange system
• Establish a relevant baseline of unit sales for
  each pharmacy
• Create an automatic analytic system to detect
  trends that deviate from this baseline

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Information Sources(Foodborne Diseases)

• International
• Global Public Health Intelligence Network
• (GPHIN)
• PROMED
• EnterNet (Europe plus)
• WHO Outbreak Verification List
• PulseNet

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European Enteric Disease Network (Enter Net)

• Established international network
• EU and non EU European countries linked to
• Canada and USA
• Australia and New Zealand
• Japan
• Focused on Surveillance and Epidemiological
  research (Salmonella and VTEC)
• Regular sharing of standardised data and alert
  mechanism

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Available electronically at
lthttp//www.hc-sc.gc.ca/pphb-dgspspgt
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Health Canada Food Safety ProgramIntegrated
Surveillance Report

• Salmonella, Campylobacter, pathogenic E.
  coli,Shigella 1996-1999
• Multiple data sources relating to human and
  animal disease
• Focus disease trends over time
• comparison of geographic distributions
• comparison of data from different sources
• comparison of disease trends in humans and
  animal species

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VTEC - Cases and Incidence Rates Reported to the
NDRS, PPHB, Health Canada
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VTEC Cases by Month, 1997 to 2001, NNDS
1997
1998
1999
2000
2001
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VTEC Outbreaks by Month 1996 - 2002
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VTEC Outbreaks by Type1996 - 2002
e.g. church supper, BBQ, etc.
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VTEC Outbreaks by Source1996 - 2002
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Health Canada Food Safety ProgramsSurveillance
Future Focus

• Further development of electronic networks for
  sharing data
• Rapid detection of issues, and response
• Analysis of data from multiple risk sources
• Integration of risk assessment and policy needs
  with surveillance objectives
• Enhancing skills in outbreak response
• Development of decisions tools (guidelines, data,
  analysis)