1. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Foodborne Diseases Integrating efforts from feed to food Dr Danilo Lo Fo Wong

2. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Food safety throughout the production chain Contaminants Chemicals Toxins Residues Micro-organisms Pre-harvest Transport Harvest Processing Retail Consumers Feed

3. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 FPD Surveillance from feed-to-food Numerous possible routes for introduction and transmission of foodborne pathogens Each link in the chain is responsible for the quality and safety of its products Coordination of control activities Communication between many stakeholders –Producers –Consumers –Policy makers To form the basis for qualified feedback to stakeholders Pre-harvest Transport Harvest Processing Retail Consumers Feed

4. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Cycle of animal and public health protection Surveillance Epidemiological evaluation/ Risk assessment Research Risk management

5. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Control of foodborne diseases Information needed The source(s) The route(s) of transmission Efficient control strategies Public health burden Tools needed Diagnostic tools Epidemiological tools Mathematical modelling tools Decision support tools Pre-harvestHarvestProcessing Retail Consumers Feed Trace-back Predict forward

6. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Main pieces of the food safety puzzle 1.Ministry of Agriculture 2. Ministry of Public Health 3. Food industry 4. Consumers

7. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Ministry of Agriculture Take care of the interests of the food producing industry Initiate, implement and maintain animal health and food safety programs –Legislative –Technical –Practical Information –Producers –Veterinarians –Food safety professionals

8. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Ministry of Public Health Take care of the interests of the general public Initiate, implement and maintain public health programs –Legislative –Technical –Practical Information –Public –Medical doctors –Health care workers

9. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Food industry Responsible for quality and safety of their products Monitoring programs at various levels of production –Certification programs –Process control, Good Manufacturing/Hygiene Procedures –Final product control –HACCP-based control programs Contribution to national surveillance programs Collaboration with (local) government in case of outbreak investigation and trace-back

10. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Consumers Influence through demand, willingness-to-pay and outrage Consumer organisations –Consumer interests –Seldom involved in data generation –Driving force behind food safety initiatives Media plays an important role

11. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Public Health Authorities Veterinary Authorities Food Authorities Nat. Human Reference Lab Nat. Veterinary Reference Lab Nat. Food Reference Lab Non-governmental Organisations Industry Ministry of AgricultureMinistry of Health Major stakeholders in food safety

12. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Veterinary Authorities Nat. Food Reference Lab Non-governmental Organisations Industry Ministry of AgricultureMinistry of Health Integration = communication Public Health Authorities Food Authorities Nat. Human Reference Lab Nat. Veterinary Reference Lab

13. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Public Health Authorities Veterinary Authorities Food Authorities Nat. Human Reference Lab Nat. Veterinary Reference Lab Nat. Food Reference Lab Co-ordinating body collection, collation, analysis, interpretation of data dissemination of information Industry Ministry of AgricultureMinistry of Health Collaboration & coordination Non-governmental Organisations

14. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Co-ordinating body Coordinate multi-disciplinary and multi- sectoral control and response Levels of collaboration/coordination: –microbiology - epidemiology - risk assessor –feed - veterinary - food - medical –government - industry - consumers Comparative analysis of data from different sources –animal - food - human Pre-harvest Transport Harvest Processing Retail Consumers Feed

15. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Tasks for a co-ordinating body Coordinate activities / information flow between major stakeholders Outbreak detection and coordinate response Perform timely & comprehensive analysis of surveillance data Conduct epidemiological research and risk assessment Evaluate effectiveness of intervention and control programmes

16. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Main pieces of the food safety puzzle 1.Ministry of Agriculture 2. Ministry of Public Health 3. Food industry 4. Consumers 5. Co-ordinating body

17. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 MoA MoH Co-ordinating body Industry Consumers National Integrated food safety program Fitting the pieces of the food safety puzzle

18. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 EXAMPLES OF INFORMATION OBTAINED THROUGH NATIONAL INTEGRATED FOOD SAFETY PROGRAMS

19. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 AB resistance in Campylobacter jejuni from farm-to-consumption

20. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Automatic outbreak alert system S. Infantis S. Java

21. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Tracing sources of infection Integrated outbreak investigation and response Multi-disciplinary  microbiology – epidemiology  veterinary – human Multi-sector  government - industry Strain bank  routine surveillance  previous outbreaks  epidemiological data Eggs Beef Eggs Outbreak Imported eggs Pork Eggs Poultry Pork

22. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Attributing human cases to food animal reservoirs Comparison of the number of reported human cases caused by different Salmonella subtypes with the distribution of Salmonella subtypes isolated from the various animal food sources

23. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Estimated major sources of human salmonellosis in Denmark

24. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Trends in sources for human salmonellosis

25. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 4 C’s of Integrated Food Safety Programs Communication –regular meetings –direct and informal contact Collaboration –data exchange –during outbreaks Coordination –control activities Central database –monitoring trends –outbreak detection –comprehensive analysis –program evaluation Optimal use of data that already is being generated

26. Foodborne Outbreak Investigation, Hanoi, Vietnam 01 – 05 June 2009 Thank you for your attention