2004

Pan AmericanHealthOrganization

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5th World Congress on Foodborne Infections and Intoxications

Berlin, 7 - 11 June 2004

5th World Congress on Foodborne Infections and Intoxications

Berlin, 7 - 11 June 2004

2004

Pan AmericanHealthOrganization

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Network and Epidemiological Surveillance of Foodborne Diseases

Claudio AlmeidaDirector INPPAZ

Network and Epidemiological Surveillance of Foodborne Diseases

Claudio AlmeidaDirector INPPAZ

2004

Pan AmericanHealthOrganization

OutlineOutline

• Data of foodborne diseases in WHO/AMRO Region• PAHO/WHO strategy to improve FBD surveillance• Networks

– INFAL– WHO-Global Salm Surv (LAC)– EpiEta– PulseNet LA– SIRVETA

• Data of foodborne diseases in WHO/AMRO Region• PAHO/WHO strategy to improve FBD surveillance• Networks

– INFAL– WHO-Global Salm Surv (LAC)– EpiEta– PulseNet LA– SIRVETA

2004

Pan AmericanHealthOrganization

SIRVETA WHO/AMRO Region (1993-2003)

SIRVETA WHO/AMRO Region (1993-2003)

• Outbreaks 6511

• Cases 232,576

• Deaths 317

• Outbreaks 6511

• Cases 232,576

• Deaths 317

Fuente: SIRVETA Fuente: SIRVETA

2004

Pan AmericanHealthOrganization

SIRVETA WHO/AMRO Region (1993-2003)

SIRVETA WHO/AMRO Region (1993-2003)

Known70.63%

Unknown29.37%

Bacteria57.08%

Vegetal Toxins0.93%

Parasites3.59%

Chemicals4.76%

Marine Toxins21.37%

Virus12.27%

2004

Pan AmericanHealthOrganization

SIRVETA WHO/AMRO Region (1993-2003)

SIRVETA WHO/AMRO Region (1993-2003)

Known90.94%

Unknown9.06%

Other20.52%

Schools19.49%

Social-Restaurant

13.47% Restaurant6.94%

Health Units2.24%

Household36.09%

Street Vendors

1.25%

2004

Pan AmericanHealthOrganization

PAHO strategy for strengthening foodborne disease surveillance PAHO strategy for strengthening foodborne disease surveillance

• Technical aspects:– Improve outbreak detection and notification– Improve outbreak investigation– Promote quality assurance in diagnosis– Promote active surveillance of selected

pathogens (Salmonella, E..coli 0157 :H7, Listeria , Campylobacter.)

– Promote studies on social and economic impact of foodborne diseases

• Managerial aspects– Improve intra-sectoral coordination to address

efficiently the food chain – Promote local surveillance systems

• Technical aspects:– Improve outbreak detection and notification– Improve outbreak investigation– Promote quality assurance in diagnosis– Promote active surveillance of selected

pathogens (Salmonella, E..coli 0157 :H7, Listeria , Campylobacter.)

– Promote studies on social and economic impact of foodborne diseases

• Managerial aspects– Improve intra-sectoral coordination to address

efficiently the food chain – Promote local surveillance systems

2004

Pan AmericanHealthOrganization

How networking supports this strategy?How networking supports this strategy?

• INFAL and diagnosis quality assurance:– Developed an information system among member

laboratories– Facilitates availability of reference materials and

participation in inter-laboratory testing– Organizes and promotes programs for training and

education promoting the sharing of experiences and resources available

– Promotes and strengthens the intersectoral participation in building and operating national networks

– Promotes and strengthens integration of member laboratories food safety programs and epidemiological surveillance

• INFAL and diagnosis quality assurance:– Developed an information system among member

laboratories– Facilitates availability of reference materials and

participation in inter-laboratory testing– Organizes and promotes programs for training and

education promoting the sharing of experiences and resources available

– Promotes and strengthens the intersectoral participation in building and operating national networks

– Promotes and strengthens integration of member laboratories food safety programs and epidemiological surveillance

2004

Pan AmericanHealthOrganization

Sub-networksLabs

Labs

Labs

National Networks Labs

LabsLabs

Labs

INFAL

Country - Labs

Country - Labs

Country - Labs

Country - Labs

Country - Labs

Structure of INFAL

•Assembly

•Excecutive Committee

•Technical Working Groups

•Ex-officio Joint Secretariat (FAO/PAHO)

•Advisory Board

2004

Pan AmericanHealthOrganization

How networking supports this strategy?How networking supports this strategy?

• WHO-GLOBAL SALM SURV (Central America, South America and Caribbean (CAREC):– Training in standardized protocols in

Salmonella sp and Campylobacter sp.– Training in epidemiology of FBD and

outbreak investigation– Inclusion of managers component (Directors

of Labs and Epi)– Regional database – Quality assurance program– Improve communication between labs

(http://www.panalimentos.org/salmsurv/)

• WHO-GLOBAL SALM SURV (Central America, South America and Caribbean (CAREC):– Training in standardized protocols in

Salmonella sp and Campylobacter sp.– Training in epidemiology of FBD and

outbreak investigation– Inclusion of managers component (Directors

of Labs and Epi)– Regional database – Quality assurance program– Improve communication between labs

(http://www.panalimentos.org/salmsurv/)

2004

Pan AmericanHealthOrganization

WHO Global Salm-SurvSout America

Argentina•Inst. Nac. de Enfermedades Infecciosas (INEI) - ANLIS “Dr.Carlos G. Malbran”•Inst. Nac. de Producción de Biológicos (INPB)- ANLIS “Dr. C G. Malbran”• Instituto Nacional de Alimentos (INAL) •Servicio Nac. de Sanidad Animal (SENASA)

Bolivia•Instituto Nacional de Lab. de Salud (INLASA)•Lab. de Investigación y Diagnóstico Veterinario (LIDIVET)

Brasil •Inst.Oswaldo Cruz - Centro de Referencia Nac. de Colera y Enteroinfeccoes Bacterianas (FIOCRUZ – RJ)•Ministério da Agricultura e do AbastecimentoSecretaria de Defesa AnimalDepartamento de Defesa animal

Colombia •Instituto Nacional de Salud•Inst. de Vig. de Medicamentos y Alimentos (INVIMA) •Instituto Colombiano Agropecuario (ICA)

Chile •Instituto de Salud Pública de Chile •Servicio Agrícola Ganadero

Paraguay•Laboratorio Central de Salud Pública•Ministerio de Agricultura y Ganadería

Peru•Inst. Nac. de Salud – Centro Nac. Lab. Salud Publica.- Div de Bacteriologia – Lab Enteropatogenos •Inst. Nac. de Salud -Centro Nac. de Alimentación y Nutrición

Uruguay•Centro Nacional de Salmonella, Inst. de Higiene •Min.de Ganaderia, Agricultura y Pesca (DILAVE)

Venezuela •Instituto Nacional de Higiene “Rafael Rangel”

REGIONAL CENTER: Instituto Nacional de Enfermedades Infecciosas (INEI) - ANLIS “Dr.Carlos G. Malbran”

Ecuador•Instituto Nacional de Higiene

2004

Pan AmericanHealthOrganization

How networking supports this strategy?How networking supports this strategy?

• Epi-Eta– Defines an international community of foodborne

disease epidemiologists– Provides communication and discussion of topics of

international interest among foodborne disease epidemiologists by means of moderated electronic discussion site

– Provides a platform for exchange of scientific information among epidemiologists

– Provides a model of regional epidemiologic networks for other Regions

• Epi-Eta– Defines an international community of foodborne

disease epidemiologists– Provides communication and discussion of topics of

international interest among foodborne disease epidemiologists by means of moderated electronic discussion site

– Provides a platform for exchange of scientific information among epidemiologists

– Provides a model of regional epidemiologic networks for other Regions

2004

Pan AmericanHealthOrganization

www.epi-eta.orgwww.epi-eta.org

2004

Pan AmericanHealthOrganization

How networking supports this strategy?How networking supports this strategy?

• PulseNet Latin America (PAHO/CDC)– Training in pulse field gel

electrophoresis– Training in the use of biological

molecular techniques applied to FBD surveillance

– Regional database PFGE isolates– Quality assurance program

• PulseNet Latin America (PAHO/CDC)– Training in pulse field gel

electrophoresis– Training in the use of biological

molecular techniques applied to FBD surveillance

– Regional database PFGE isolates– Quality assurance program

2004

Pan AmericanHealthOrganization

Conclusions of the first meetingDecember 2003

Conclusions of the first meetingDecember 2003

All countries agreed on building up PulseNet in LA

The benefits pointed out were:• Strengthen the laboratory capabilities and the

interaction epidemiology-laboratory in the Region

• Improve FBD surveillance by incorporating PulseNet data into country surveillance systems

• Regional Steering Committee: Uruguay, Chile and Brazil

All countries agreed on building up PulseNet in LA

The benefits pointed out were:• Strengthen the laboratory capabilities and the

interaction epidemiology-laboratory in the Region

• Improve FBD surveillance by incorporating PulseNet data into country surveillance systems

• Regional Steering Committee: Uruguay, Chile and Brazil

2004

Pan AmericanHealthOrganization

Action Plan 2004-2005Action Plan 2004-2005

• 1st Training Course (7 countries, July 2004)• 2nd PulseNet LA meeting (approval of bylaws, July

2004)• Certification of the Malbran Institute (2004)• Send images from the 7 NRLs (2004)• Laboratory Certification of the 7 LA-NRLs (2005)• Emailing tiff files and text data / Establish the LA-

Data Bank (2005)• Consolidate the network (Follow-up missions, 2005)• Incorporate the Bio-Numerics (2005)• 2nd training course (incorporate new members,

2005)

• 1st Training Course (7 countries, July 2004)• 2nd PulseNet LA meeting (approval of bylaws, July

2004)• Certification of the Malbran Institute (2004)• Send images from the 7 NRLs (2004)• Laboratory Certification of the 7 LA-NRLs (2005)• Emailing tiff files and text data / Establish the LA-

Data Bank (2005)• Consolidate the network (Follow-up missions, 2005)• Incorporate the Bio-Numerics (2005)• 2nd training course (incorporate new members,

2005)

2004

Pan AmericanHealthOrganization

SIRVETASIRVETA

• About improvements– Data collection

• New online interfaces

– Data analysis• New queries capability designed by the

user• New export capabilities

– ASCII format, Spreadsheet format

• About improvements– Data collection

• New online interfaces

– Data analysis• New queries capability designed by the

user• New export capabilities

– ASCII format, Spreadsheet format

2004

Pan AmericanHealthOrganization

Hierarchical Screens with drop-down lists to assure input consistency

Hierarchical Screens with drop-down lists to assure input consistency

2004

Pan AmericanHealthOrganization

Hierarchical ScreensHierarchical ScreensPlace of Consumption

Place of contamination

Contaminant

Risk factor,proliferation

Risk factor, survival

2004

Pan AmericanHealthOrganization

ConclusionsConclusions

• It is clear that networking improves national capability for surveillance and laboratory confirmation of FBD

– Training– Standardization– Quality assurance– Scientific advice

• It is clear that networking improves national capability for surveillance and laboratory confirmation of FBD

– Training– Standardization– Quality assurance– Scientific advice

2004

Pan AmericanHealthOrganization

Thank you very much!Thank you very much!