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Food and Agriculture Organization of the United Nations

INFOSAN

International Food Safety Authorities Network

Jenny Bishop and Carmen Savelli

World Health Organization

Introduction

• Daily reports of foodborne outbreaks around the globe; various populations; numerous different foods

• Foodborne diseases are not just diarrhoeal diseases; many different hazards and hundreds of individual contaminants and causes

• Contamination can occur at many different points in the food chain – this makes the assessment of the actual burden of disease very complex and challenging to address


Origin of INFOSAN

• Resolutions of the World Health Assembly in 2000 and 2002 (improved communication re: food safety; WHO to coordinate identification/response to food safety emergencies)

• Specific request from FAO/WHO Codex Alimentarius Commission in 2004 for WHO to develop a network for the exchange of information during food safety emergencies

• INFOSAN launched by WHO in 2004 in collaboration with FAO


What is INFOSAN and its Purpose?

• A voluntary network of national food safety authorities (178

countries) jointly managed by FAO/WHO

• Aims to prevent international spread of contaminated food and foodborne disease and strengthen food safety systems globally, by:

• promoting the rapid exchange of information during food safety events

• sharing information on important food safety issues of global interest

• promoting partnership and collaboration between countries

• helping countries strengthen their capacity to manage food safety risks


INFOSAN Membership

• Emergency Contact Points From the national authority responsible for coordination of national food safety emergency response

• Focal Points Other national authorities with a stake in food safety (i.e. human health, veterinary health, agriculture, trade, fisheries, etc.)

• Other members Advisory Group Members, WHO Regional Food Safety Advisors; FAO Regional Food Safety Officers; Regional Food Safety Authorities (i.e. ECDC, OIRSA, etc.)


B C

D

E

F Xn

INFOSAN Secretariat (FAO/WHO)

Emergency

Contact

Point (Food Safety

Authority) Focal Point

(e.g.

Agriculture)

Focal Point

(e.g. Trade)

Focal Point

(e.g.

Fisheries)

Focal Point (e.g.

Veterinary

Services)

Focal Point (e.g. Industry

and

Standards)

Focal Point (e.g. Health

Department)

Country A

INFOSAN Structure


• Advise the Secretariat on effective ways to interact with Member States

• Review current operations and recommend ways to improve the functions

of the Network

• Provide input on the INFOSAN strategic plan and work plan

• Engage in strengthening the Network through advocacy and fund raising

INFOSAN Advisory Group


• INFOSAN Information Notes are developed by the INFOSAN

Secretariat to provide key information about emergent or topical food safety issues

• Food safety guidelines, questionnaires, surveys, newsletters and factsheets are shared with INFOSAN members for further dissemination within their organizations

• INFOSAN members aid routine in-country sharing of information to strengthen the national food control system

• INFOSAN Members are engaged by the Secretariat for gathering information on emerging issues

Routine Activities


• INFOSAN identifies, verifies and shares information on food

safety-related events which involve contaminated foods in international commerce, and foodborne illness outbreaks, not limited to one country

• INFOSAN Secretariat provides technical assistance to national governments in managing food safety and food production-related events or emergencies

• INFOSAN Secretariat coordinates information exchange between countries and will facilitate technical assistance in the field, if requested

Emergency Activities

Yes Assessment

No

Internal Assessment and Verification

INFOSAN Secretariat Event Detection and Action

Information Sources

Media/Internet Searches

WHO Alert and Response

Operations (ARO)

WHO Regional Food Safety/IHR

Contacts

INFOSAN Contact and/or Focal

Points

Other Partners i.e. RASFF,

GLEWS, etc.

WHO Programs WHO Regional

Food Safety/IHR Contacts

FAO Programs

Is follow up needed?

Close File

Monitor if needed

Send information request to INFOSAN

Emergency Contact Point

Post Alert to Network

Consider lessons learned to be

shared

Close File

No further action

Further info

needed

Alert to network (consult

with country) Close File


Emergency Activities

• Global Early Warning System for Major Animal Diseases, including Zoonoses (GLEWS)

• World Organisation for Animal Health (OIE) • Global Foodborne Infections Network (GFN) • European Union - Rapid Alert System for Food and Feed (RASFF) • EMPRES Food Safety • WHO's Global Outbreak Alert and Response Network • PulseNet International

• APEC Food Safety Cooperation Forum


International Health Regulations (IHR)

• 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

• Member States are obliged to declare all public health emergencies of international concern to WHO

• Reports from sources other than Member States (media, private sector, NGOs, social networks, etc.)

• WHO 24-hour monitoring, operations and response


Reporting under the IHR (2005)

Under the IHR (2005) States Parties are required to assess public health events utilizing this decision instrument and notify WHO of all qualifying events within 24 hours of such an assessment.

WHO IHR RO

WHO HQ

National IHR Focal

Point


• Requires collaboration of different partners in-country

• Requires different expertise than most infectious disease events

• Requires different types of questions to be asked

• Often multi-regional due to international distribution

• Sometimes treated with lower priority in the face of other infectious disease events

• Can have major economic and trade implications

Multi-disciplinary, Multi-sectoral, Integrated, Collaborative

What is unique about Food Safety Events?


Key aspects of IHR for Food Safety

• Food safety events which could have international implications should be reported to WHO in accordance with the IHR

• Includes events due to imported foods or events that are linked to domestic product known to have been exported abroad

– Can help to confirm food vehicle if other countries observing same problem

– Can help to avoid illnesses in other countries

• Links need to be established between INFOSAN Emergency Contact Points and IHR NFP


Sample Protocol for Communication between INFOSAN Emergency Contact Point and National IHR Focal Point

• Some countries have established agreed upon administrative procedures for notification of, and communication with the INFOSAN Emergency Contact Point regarding identification, assessment and management of food safety related public health events that may have international implications

• Sample protocol template is in the new INFOSAN Members' Guide

Aims and objectives of INFOSAN

Aims and objectives of INFOSAN

Food and Agriculture

Organization of

the United Nations

Example of INFOSAN in Action

S. Oranienburg in

Galactooligosaccharide (GOS)


INFOSAN Alert

Outbreak of S. Oranienburg in Russia linked to internationally distributed powdered infant formula from Belgium – January 2012

• Russian media report picked up by WHO-EURO and relayed to INFOSAN Secretariat

• INFOSAN Secretariat contacted RASFF Secretariat and colleagues in Belgium

• Belgian Authorities subsequently launched an investigation into the Belgian producer

• Communicated to INFOSAN Secretariat that product was sent to additional countries

• INFOSAN notified national authorities in these countries

Russia

Haiti

Congo

Mozambique

Burundi

Belgium


Russia

Belgium

Haiti

Congo

Mozambique

Burundi

Outbreak of S. Oranienburg in Russia linked to internationally distributed powdered infant formula from Belgium – January 2012


Russia

Haiti

Congo

Mozambique

Burundi

USA

Peru

Norway

South Korea

New Zealand

China

Taiwan

UK Belgium

Netherlands France

Hong Kong

International Distribution of GOS and Products Containing GOS from South Korea ( + S. Oranienburg in USA and Netherlands with same PFGE)

International Distribution of GOS and Products Containing GOS from South Korea ( + S. Oranienburg in USA and Netherlands with same PFGE)

INFOSAN Alert


Strengthening the Food Safety Community


2011 Outbreak of E. coli O104:H4 infections in Germany and France

• Unusually large foodborne disease outbreak caused by a pathogen with novel characteristics resulting in more virulent behaviour than is normally observed

• Outbreak demonstrated high attack rate in female adults and a high rate of hemolytic uremic

syndrome (HUS) as a severe complication (~1 HUS case for 3-4 EHEC cases; typically only seen in 10% of cases of EHEC).

• 16 countries in Europe and North America reported ~4000 cases and 55 deaths; onset dates range from 1 May to 4 July 2011

• ~3000 EHEC infections resulting in 18 deaths, and ~850 HUS cases resulting in 35 deaths were reported in Germany alone

• Thirteen other European countries reported the following number of cases: Austria (1 HUS, 4 EHEC); Czech Republic (0, 1); Denmark (10, 16); France (9, 8); Greece (0, 1); Luxembourg (1, 1); Netherlands (4, 7); Norway (0, 1); Poland (2, 1); Spain (1, 1); Sweden (18, 35); Switzerland (0, 5); and United Kingdom (3, 4).

• Canada reported 1 EHEC case; the USA reported 2 EHEC cases and 4 HUS.



• The two fatal cases outside Germany were reported from Sweden and the

USA, both HUS-attributed deaths. • All but 21 of the above HUS and EHEC cases occurred among persons who

had travelled to, or lived in Germany during the incubation period; 5 cases had not travelled or lived in Germany but could still be linked to the outbreak in Germany; Fifteen cases are part of the cluster that occurred in France; one case in Sweden could not be linked to the outbreak either in Germany or France.

• During this outbreak, 6 INFOSAN messages were sent to the Network between 27 May and 5 July (including 4 Emergency Alerts, and 2 Updates)



• This report is one of many elements contributing to the investigation of the

cause of this outbreak, and should not be considered in isolation.

• The findings of this study are consistent with other investigations conducted

thus far. Specifically, it supports the hypothesis that the outbreaks in Germany and

France are linked, and are due to the import of fenugreek seeds, which became

contaminated with STEC O104:H4 at some point prior to leaving the Importer.

• The contamination of seeds with the STEC O104:H4 strain reflects a production

or distribution process which allowed contamination with faecal material of human

and/or animal origin.

• Where exactly this took place is still an open question.

• Typically such contamination could occur during production at the farm level.

While contamination at subsequent steps in, up to, and including at the Importer

can not be excluded, it is highly unlikely that contamination could have taken

place during transport of the sealed container.

Sprouts continue to be a high risk food item

• Worldwide, at least 40 outbreaks of foodborne illnesses have been linked to sprouts

since 1973

• Scientists believe that the most likely source of contamination is the seeds that are used

to grow the sprouts; seeds may become contaminated by animal manure in the field or

during storage, and the conditions required to grow sprouts (like warmth and humidity) are

ideal for the rapid growth of bacteria

• Poor hygienic practices during production of sprouts have also caused some sprout-

related outbreaks of foodborne illness in the past

Sprouts continue to be a high risk food item

• Most sprouts can only be eaten raw; i.e. not exposed to temperatures high enough to kill

bacteria that may be present

• Anyone who eats raw sprouts or lightly cooked sprouts is at risk for exposure to harmful

bacteria

• Although the risk of serious health effects is usually greatest for young children, seniors

and people with weak immune systems, this outbreak has demonstrated that healthy

adults can also be affected (~86% of cases aged 18 years or older)

• High risk groups (young children, seniors and people with weak immune systems) should

avoid eating raw sprouts

•Import vs process control


Draft Strategy: Enhancing INFOSAN in Asia

2010

Global INFOSAN meeting agreed to the development of regionally-based strategies for enhancing participation in INFOSAN

2011

Further discussion during ‘Information Exchange and Emergency Response Capacity to Support Participation in INFOSAN’

2012 - July

Questionnaire development, application and summary

2012 – July – November

Strategy drafted

2012 – November

Strategy reviewed and agreed

2013 – Asking for other countries interest


Aim of Strategy

Enhancing INFOSAN in Asia will:

i) Strengthen the global INFOSAN network through unprompted and timely

reporting of food safety events of international concern in Asia and

increased sharing of information relating to managing such events.

ii) Facilitate the identification of food safety events of international

concern, through food safety information exchange in Asia.

iii) Facilitate national food control system development in Asia through the

sharing of information, experiences and best practices between

countries

iv) To improve the capacity of members to better fulfill their roles and

responsibilities in the network.


• 1) INFOSAN Community

Development

• 2) Capacity Building and

Education

• 3) Responding Effectively to

Food Safety Emergencies

• 4) Global issues to be

supported by countries of

Asia

Four themes of the Strategy


Thank You

''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, WHO

[email protected]

mailto:[email protected]

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