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 Surveillance Type Expected Results Relationship Food-FBD agent Passive Unspecified indicators for illness None Syndromic Laboratory based Specific pathogens (subtypes) Moderate Active Specific pathogens (subtypes), population 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 Consequences: 78 human cases 14 hospitalized 2 deaths Mangos contaminated with Salmonella Newport exported to USA PAHO, Lopez, 2005

FBD 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 surveillance Animal and Plant Health Human Health Laboratories Food Chain Environmental Health National Policies

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

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%).

Chemical Contaminants, Plant toxins COUNTRY OUTBREAKS SICK DECEASED Argentina  155  3520 5 Bahamas  89  10688 Barbados  2  7 Bolivia  5  1244 2 Brasil  645  18945 Chile  342  4101 Colombia  9  383 Costa rica  54  146 Cuba  3996  159272 59 Ecuador  2670 23 El Salvador  26  7984 4 Guatemala  21  291 Jamaica  3  99 México  633  19493 107 Nicaragua  129  1152 Panama  73  1131 Paraguay  1277 Perú  112  5285 89 Rep. Dominicana  85  1833 Trinidad y Tobago  567 1 Uruguay  120  3322 Venezuela  234  5787 11 TOTALS 6930  249197 318 Chemical Contaminants, Plant toxins

New 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 USD Source: World Development Indicators, 2004 Most common causes of FBD Salmonella spp Staphylococcus aureus Enteric viruses Source: Ministerio de Salud, 2004

PERU Illnesses subject to Epidemiological Surveillance Immunopreventable (Hep B, MMR, Yellow fever, etc) Zoonoses Human rabies, anthrax, plague Vector-transmitted (dengue, malaria) Other transmissible (cholera) Mandatory weekly notification Acute Diarrheal diseases (EDAs) Other illnesses (Chagas, bartonellosis, etc.) Occurences of importance for public health Outbreaks Epizooties Natural disasters

PERU

Adequate surveillance requires Political decision and implementation techniques Integrate FBD within the National Surveillance Programs Coordinated participation with the lab Continuous training Appropriate Resources

Adequate 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

Local Level Interinstitutional coordination Integrated surveillance Outbreak analysis Preventive approach Local Level Success stories Municipality of Maldonado, Uruguay. Population 127,257 Tourists +600,000 Municipality of Galvez, Argentina GIS Food Analysis Lab Training for Food Handlers Technicians Hygiene Inspectors Primary School Ed

General 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 countries Achieve equivalence in methods and quality management systems for food analysis laboratories Regarding 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.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.

www.panalimentos.org.salmsurv WHO - Global Salm-Surv CENTRO REGIONAL: Colombia Instituto Nacional de Salud Inst. de Vig. de Medicamentos y Alimentos (INVIMA) Instituto Colombiano Agropecuario (ICA) Venezuela Instituto Nacional de Higiene “Rafael Rangel” Brasil Inst.Oswaldo Cruz - Centro de Referencia Nac. de Cólera y Entero infecciones Bacterianas (FIOCRUZ – RJ) Ministerio da Agricultura e do Abastecimiento Secretaria de Defensa Animal Departamento de Defensa animal Ecuador Instituto Nacional de Higiene 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 Paraguay Laboratorio Central de Salud Pública Ministerio de Agricultura y Ganadería Bolivia Instituto Nacional de Lab. de Salud (INLASA) Lab. de Investigación y Diagnóstico Veterinario (LIDIVET) Uruguay Centro Nacional de Salmonella, Inst. de Higiene Min. de Ganadería, Agricultura y Pesca (DILAVE) Chile Instituto de Salud Pública de Chile Servicio Agrícola Ganadero CENTRO REGIONAL: Instituto Nacional de Enfermedades Infecciosas (INEI) - ANLIS “Dr.Carlos G. Malbran” 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)

- 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