SIRVETA and National FBD Surveillance in Peru

Marisa L. Caipo, Ph.D.Asociacion Peruana de Consumidores y Usuarios

(ASPEC)University of Maryland, USA

Universidad San Ignacio de Loyola, Lima, Peru

Major developments that have a significant effect on food safety

• Changes in the nature and concentration of hazards in food

• Changes in the controls used to ensure that food is safe to eat

• A shift of the primary responsibility for food safety to industry

• Changes in consumer habits.

Mackenzie et al, 2004

Epidemiologic surveillance of Fooodborne illness

Needs:– Modes of transmission and risk of foodborne

disease– Focus on policies and strategies for prevention

and control– Identify priorities for interventions, particularly

at the local level– Evaluate the impact of food safety intervention

programs

Types of SurveillanceTypes of SurveillanceType Expected Results Relationship Food-

FBD agent

Passive Unspecified indicators for illness

None

Syndromic Unspecified indicators for illness

None

Laboratory based Specific pathogens (subtypes)

Moderate

Active Specific pathogens (subtypes), population

Moderate

Integrated Specific pathogens (subtypes), population, reservoirs

High

Lopez, 2005

Integrated surveillance approach to the Food Chain

Mangos for export from Brazil

Contaminated hot water is used as treatment against Mediterranean fruit fly

Mangos contaminated with Salmonella Newport exported to USA

Consequences: 78 human cases 14 hospitalized 2 deaths

PAHO, Lopez, 2005

FBD Outbreaks / DetectionFBD Outbreaks / Detection

Traditional Scenario

• Locally detected – MD– Community– Epidemiologist

• Based on syndromic surveillance and good relationships

New Scenario

• Detected by the lab– Rare Serotypes– Subtypes

(phagetyping PFGE)– AMR

• Based on lab surveillance and communication between lab and epidemiology

PAHO, Lopez, 2005

Integrated surveillanceIntegrated surveillance

Animal and Plant Health

Animal and Plant Health

Human HealthHuman Health

LaboratoriesLaboratories

Food ChainFood Chain

Environmental HealthEnvironmental Health

National PoliciesNational Policies

LaboratoriesLaboratories

FBI Surveillance in Latin America

FBI Surveillance in Latin America

• Low coverage in general and in particular for FBI

• Low sensibility in detection and investigation of outbreaks

• Problems with data analysis and information management

• Low coverage in general and in particular for FBI

• Low sensibility in detection and investigation of outbreaks

• Problems with data analysis and information management

INFORMATION SYSTEM FOR EPIDEMIOLOGICAL SURVEILLANCE OF FOODBORNE DISEASES –

SIRVETA

1995 – 2002

6930 reports of FBI outbreaks from 22 countries in the region.

Food items most commonly associated with the reported outbreaks were fish (22%), water (20%) and red meats (14%).

COUNTRY OUTBREAKS SICK DECEASED

Argentina  155  3520 5

Bahamas  89  10688 0

Barbados  2  7 0

Bolivia  5  1244 2

Brasil  645  18945 5

Chile  342  4101 2

Colombia  9  383 0

Costa rica  54  146 0

Cuba  3996  159272 59

Ecuador  54  2670 23

El Salvador  26  7984 4

Guatemala  21  291 7

Jamaica  3  99 0

México  633  19493 107

Nicaragua  129  1152 0

Panama  73  1131 2

Paraguay  89  1277 0

Perú  112  5285 89

Rep. Dominicana  85  1833 0

Trinidad y Tobago  54  567 1

Uruguay  120  3322 1

Venezuela  234  5787 11

TOTALS6930  249197 318

Bacteria59%

Viruses12%

Marine Toxins21%

Parasites8%

Chemical Contaminants,Plant toxins

New and improved SirvetaNew and improved Sirveta

Lopez, 2005

PERU

• Population 26.7 M• Surface Area 1.3 M sq km• Population per sq km

20.5• Life expectancy 69.8

years• GNI per capita $2020

USD• GDP 56.5 billion USDSource: World Development Indicators, 2004

Most common causes of FBD

• Salmonella spp• Staphylococcus aureus• Enteric viruses

Source: Ministerio de Salud, 2004

PERUIllnesses subject to Epidemiological Surveillance

Immunopreventable (Hep B, MMR, Yellow fever, etc)Zoonoses

Human rabies, anthrax, plagueVector-transmitted (dengue, malaria)Other transmissible (cholera)

Mandatory weekly notificationAcute Diarrheal diseases (EDAs)Other illnesses (Chagas, bartonellosis, etc.)

Occurences of importance for public healthOutbreaksEpizootiesNatural disasters

PERU

Adequate surveillance requiresAdequate surveillance requires

• Political decision and implementation techniques

• Integrate FBD within the National Surveillance Programs

• Coordinated participation with the lab

• Continuous training• Appropriate Resources

• Political decision and implementation techniques

• Integrate FBD within the National Surveillance Programs

• Coordinated participation with the lab

• Continuous training• Appropriate Resources

Adequate SurveillanceAdequate Surveillance

• Capability for detection of outbreaks and cases

• Capability to identify agent

• Identify place in the food chain where contamination occured

• Identify associated risk factors

• Define risk scenarios

• Capability for detection of outbreaks and cases

• Capability to identify agent

• Identify place in the food chain where contamination occured

• Identify associated risk factors

• Define risk scenarios

Local LevelLocal Level• Interinstitutional coordination

• Integrated surveillance

• Outbreak analysis

• Preventive approach

• Interinstitutional coordination

• Integrated surveillance

• Outbreak analysis

• Preventive approach

Success stories

• Municipality of Maldonado, Uruguay.

Population 127,257Tourists +600,000

• Municipality of Galvez, Argentina

GIS

Success stories

• Municipality of Maldonado, Uruguay.

Population 127,257Tourists +600,000

• Municipality of Galvez, Argentina

GIS

Food Analysis LabTraining for

Food HandlersTechniciansHygiene Inspectors

Primary School Ed

Food Analysis LabTraining for

Food HandlersTechniciansHygiene Inspectors

Primary School Ed

General levelGeneral level• Networking to improve

national capacities in surveillance and laboratory confirmation

– Training– Standardization– Quality assurance– Scientific support

The Inter-American Network of Food Analysis Laboratories - INFAL

54 laboratories from 28 countriesAchieve equivalence in methods and quality management systems for food analysis laboratoriesRegarding FBD surveillance, INFAL is promotes the integration of the official laboratories dealing with analysis of foodstuffs into programs of food safety and epidemiological surveillance.

Inter-American Network of Food Analysis Laboratories (INFAL) http://www.panalimentos.org/rilaa/ingles/index.aspInter-American Network of Food Analysis Laboratories (INFAL) http://www.panalimentos.org/rilaa/ingles/index.asp

WHO-GLOBAL SALM SURV

All countries of the Region General objective Strengthen the capability of the

participating countries in the surveillance and response systems and to contribute to the global effort of containment of antimicrobial resistance of foodborne pathogens.

WHO - Global Salm-Surv WHO - Global Salm-Surv www.panalimentos.org.salmsurvwww.panalimentos.org.salmsurv

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

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

Perú•Inst. Nac. de Salud – Centro Nac. Lab. Salud Publica.- Div de Bacteriología – Lab Entero patógenos •Inst. Nac. de Salud -Centro Nac. de Alimentación y Nutrición

Ecuador•Instituto Nacional de Higiene

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)

Brasil •Inst.Oswaldo Cruz - Centro de Referencia Nac. de Cólera y Entero infecciones Bacterianas (FIOCRUZ – RJ)•Ministerio da Agricultura e do AbastecimientoSecretaria de Defensa AnimalDepartamento de Defensa animal

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

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

Venezuela •Instituto Nacional de Higiene “Rafael Rangel”

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

- 7 countries - Strengthen the surveillance of

FBD in Latin America, by the use of biological molecular techniques.

- Database for regional isolates– Quality Assurance Program

- 7 countries - Strengthen the surveillance of

FBD in Latin America, by the use of biological molecular techniques.

- Database for regional isolates– Quality Assurance Program

http://www.panalimentos.org/pulsenet