May 6, 2015 Food Forum for Industry and Government in Southwestern Ontario Ingersoll, Ontario FoodNet Canada – Integrated Surveillance for Food Safety from Farm to Fork

What is it? »Canada’s National Integrated Enteric Pathogen Surveillance Program »Coordinated by Public Health Agency of Canada (PHAC) »Collaboration with federal, provincial & regional partners What we do? »Collect data from sentinel sites to detect trends in human enteric illness and exposures from food, animal, and water sources »Determine significant risk factors for enteric illness »Determine the relative contribution of foods & other sources to illness in Canada (Source attribution) Why we do it? »Inform food and water safety policy in Canada FoodNet Canada 2 What is a sentinel site? Sentinel site Community from which in-depth data are collected Generates results that are extrapolated to the broader population

British Columbia Sentinel Site - April Alberta Sentinel Site - August 2014 Ontario Sentinel Site - August 2014 FoodNet Canada – Three Sentinel Sites

FoodNet Canada Structure 4 BCABON FoodNet Canada Central Data integration and analysis Data collection

5 HumanRetailWaterFarms Dairy, beef, swine, broiler, layer (manure samples) Farm management questionnaire Raw surface water Meat: chicken, beef, pork Produce: soft berries, fresh cut fruits, leafy greens and herbs (episodic) Stool samples Enhanced standardized questionnaires FoodNet Canada - Design FoodNet Canada Surveillance: 4 components

Bacteria Salmonella spp. Campylobacter spp. Verotoxigenic E. coli Shigella spp. Yersinia enterocolitica Listeria monocytogenes Parasites Giardia Cryptosporidium Cyclospora Viruses Norovirus Rotavirus Speciation Serotyping Phagetyping AMR PFGE Genotyping Ribotyping Systematic typing of isolates »Harmonised methodology across components »Enhanced subtyping 6 Surveillance : target pathogens FoodNet Canada

7 Built on Public Health Collaboration »Enhanced passive surveillance »Links rich risk factor data & lab data »Standardized Questionnaire »Enhancing Capacity - training »Collaborative projects/research »Inform food and water policy and decision making in Canada FoodNet Canada

8 FNC Retail Surveillance Sampling at the grocery store level helps to characterize the risk of exposure at the food handling & consumption levels - can also be used to identify trends at processing (for federally inspected products) 3 or 4 randomly selected stores are visited each week Samplers are public health inspectors

FNC Agriculture Surveillance Collaboration with CIPARS Commodity inclusion in the farm component is based on the agricultural profile of the sentinel site region. Third party sampling to maintain confidentiality Manure sampling Sampling in commodities may include the following commodities: swine dairy beef broiler chicken egg layer turkey 9

Agriculture Surveillance in Middlesex- London Sampling is being conducted in the following commodities: Swine Broiler chicken Egg layer Sampling is planned for the following commodities: Dairy 10

FNC Water Surveillance 11 Ontario Sentinel Site » : sampling on Grand River »Partnership with OMOE »3 years of beach sampling »2015 – planned sampling on Thames River & well water testing

Attribution is the partitioning of the human disease burden of one (or more) foodborne infections to specific sources (Pires, 2009) Burden : sporadic and/or outbreak cases Sources : reservoirs and/ or vehicles Partitioning : ranking of sources or number of cases per source Modes of transmission: partition cases to transmission routes to understand impact of interventions 12 Slaughter / transformation Retail ConsumptionInfectionFarm FoodNet Canada Data integration : source attribution

Practical Benefits Science to Inform Prevention »Identifies what foods and other sources cause illness in Canada, and regional differences in risk »Positive results from food sampling are shared with food safety partners and support risk assessments and follow-up »Supports efforts to direct actions based on the greatest risks to public health System Performance »Evaluates the effectiveness of food safety programs »Provides the performance evidence demanded by our trade partners. Example: FNC detected reduced levels of E. coli O157 in ground beef correlated with a decrease in human cases of E. coli O157 Stakeholder Engagement »Provides practical information to federal, provincial and territorial food and water safety partners »Provides industry with information that can support better industry-led approaches to improve upstream prevention efforts FoodNet Canada - Roles 13

14 CIPARS: Active and Passive Surveillance Components

Farm Surveillance - Methods Sentinel farm based system Field work: Flock/herd veterinarians »Confidentiality and biosecurity »Compensation for producers and vets Flock/herd selection and recruitment »Inclusion and exclusion criteria Composite fecal samples »E. coli, Salmonella (Campylobacter) »AMR testing: Sensititre ® System –NARMS panel of antimicrobials Questionnaires »Antimicrobial use data »Flock/herd demographics, animal inventory and health data 15

(12)* Nationally: 129 flocks 15 Vets Implementation flocks allocation per province (Target of 30 flocks in each FoodNet Canada sentinel site) AB Ag Lab, Edmonton AB PHAC-LFZ Lab, Guelph ON PHAC-LFZ Lab, St. Hyacinth QC 9191 *Additional flocks sampled within London-Middlesex FoodNet Canada Sentinel Site * Broiler Poultry: Distribution of sentinel flocks & vets

21>301 Hatchery Stage Broiler Barn AT PLACEMENT Characterization of : 1)Vertically-transmitted E. coli and Salmonella spp 2)Carry-over 3) AMR emergence associated with subcutaneous & in-ovo drug uses - Reflects barn-level AMR associated with total antimicrobial exposure and barn characteristics; - Proximal to consumer Subcutin-ovo Broiler Barn PRE-HARVEST 1 AGE TO MARKET Feed & Water AMU 18 Placement Pre-harvest Sampling points Stage (Days) Antimicrobial Use Significance Broiler Poultry: Surveillance Methods

Nationally: 108 Herds 29 Vets At implementation, herds were allocated per province proportional to the number of Grower/Finisher Units in each province AF Lab PDS Lab PHAC-LFZ Lab 18 G-F Swine: Distribution of sentinel herds & vets

WINTERSUMMERFALL Herd data Pig #s AM use Health Composite fecal samples from CTM* pens collected & submitted by the herd veterinarian CTM* Questionnaire: Herd/site demographic data Number of pigs, mortalities, marketed Antimicrobial use data Animal Health data * CTM = Close-To-Market, pigs > 80 Kgs (175 Lbs) Sampling Seasons Herd data Pig #s AM use Pig Health One sampling/data collection visit per herd per year Veterinarians distribute sampling of herds over the calendar year G-F Swine: Sample & Data Collection - Refined 19

Human Component ON Site 2013 o 438 Cases Reported o 57% endemic o 25% travel-related o 15% LTF o 2% outbreak-related o Top 3 endemic diseases reported: o Campylobacteriosis o Salmonellosis o Giardiasis FNC Data Highlights 20 Endemic Cases

Yearly distribution of pathogen contamination on retail meat in the ON site, 2006 to Note: Dashed lines indicate a laboratory or sampling method change. Chicken breast samples with skin were tested in 2006 and Starting in 2008, skinless chicken breast samples were tested. Testing for Campylobacter and Salmonella on ground beef samples was discontinued in Testing for VTEC on chicken breast samples was discontinued in FNC Data Highlights

22 FNC Data Highlights Retail Component - Targeted Surveillance, Ontario, 2013 Pathogen Detection on Retail Meat Ground ChickenFrozen Chicken Nuggets 2012 † † 2013 percent positive (number positive/number tested) Campylobacter20% (29/142)17% (17/102)0% (0/29) a. Salmonella66% (95/144)54% (55/102)*41% (59/144)39% (40/102) Listeria monocytogenes35% (51/144)31% (32/102)20% (29/144)17% (17/102)

Retail Component - Targeted Surveillance, Ontario, 2013 Bagged Leafy Greens 23 FNC Data Highlights Pathogen Detection on Leafy Greens a ON SiteBC Site 2010 † † 2013 percent positive (number positive/number tested) Cryptosporidium0% (0/372)3.8% (11/293)***0% (0/202)2.4% (7/294) c ** Giardia3.0% (11/372)8.5% (25/296)***2.0% (4/202)5.4% (16/295)* Cyclospora0% (0/372)0.34% (1/296)0% (0/202)0.34% (1/295) Norovirus0.54% (2/372)0.68% (2/296)0.50% (1/202)0.68% (2/294) Rotavirus0% (0/372)0% (0/296)0% (0/202)0.34% (1/294) Listeria monocytogenes 2.4% (9/372)1.0% (3/296)0% (0/202)0.34% (1/294)

24 Agriculture Component - Individual Manure Samples FNC Data Highlights

Broiler chicken: Placement and pre-harvest recovery rates, 2013 Broiler Poultry: CIPARS results, RECOVERY RESULTS Higher percentages of recovery at preharvest

26 Surveillance initiative supported by: »PHAC Food Safety Action Plan »Ontario Ministry of Agriculture and Food (OMAF) Ranking exposures and identifying knowledge gaps (Evers et al. 2008) »QMRA based »Ontario »19 exposure routes: foodborne (beef, pork, chicken, seafood/fish, vegetables, firm and soft fruits, raw milk), waterborne (drinking water, recreational water), and contact with animals (dog/cat, petting zoos, & living on or visiting chicken, pig, beef, or dairy farms). Campylobacter Comparative Exposure Assessment FoodNet Canada: Successes

Possible routes of exposure considered in FoodNet study Raw chicken, beef, pork, fish, shellfish Prepared chicken, beef, pork Produce (fruit and vegetables) Raw milk (scoping review and meta-analysis) Water Treated drinking water »Untreated well water (scoping review) Recreational water (accidental ingestion during swim) Animal contact »Pets (scoping review and meta-analysis) »Petting zoos (scoping review and meta-analysis) Farms 27 Campylobacter Comparative Exposure Assessment

28 Campylobacter Comparative Exposure Assessment

Identifying Issues: Retail Frozen Chicken Nuggets/Strips and Salmonella Enteritidis Establishment Proportion positive Salmonella Proportion positive S. Enteritidis Identified establishment 41.7%25.0% All other establishments 19.2%3.4% Total 28.3% FoodNet Canada: Successes

30 Percent of Ground Beef positive for VTEC Decline in Human illness and VTEC in Ground Beef with Increased Interventions by Industry Preliminary results FoodNet Canada: Successes

FoodNet Canada Data and Research:  Enables the PHAC to determine the proportion of human illness stemming from various sources  Informs data and knowledge gaps in Canada  Informs the Canadian F/P/T Government/Industry  Informs Provincial, Territorial and National outbreak investigations and response 31

Informing national/provincial/territorial outbreak investigations and response  Salmonella Enteritidis subtypes in exposures  Salmonella Thompson WGS  Evaluating VTEC in swine manure and ground pork  Identifying parasites on produce as an emerging issue for risk profile/policy development 32 FoodNet Canada: Successes

33 Enhanced and integrated surveillance: a priority for Health and Agriculture »Exploring expansion to full FNC design: 5 sites AMR also a priority »Continued collaboration with CIPARS Full operation in BC, AB & ON sites Bolster KT & Science to Policy Focus on utilizing source attribution methodologies that are based on molecular typing Inform food and water policy and decision making in Canada Moving into 2015 FoodNet Canada

34 FNC & CIPARS rely on collaboration with public health at all levels of government, provincial agriculture and environment, industry and other stakeholders Thank you! Q&A and Discussion FoodNet Canada