1. 23 to 25 de october, 2007 PulseNet Latin America: Updating Enrique Perez Norma Binsztein

2. PulseNet Latin America (LA) To reduce the Diseases of Food Transmission Promoting the utilization of Molecular Techniques for the diagnosis and typing of pathogens in order to strengthen surveillance and the system of response in the countries of Latin America, being part of the PulseNet International Network

3. Molecular Epidemiology Powerful tool for Laboratory Based Surveillance FBD = Integrated Surveillance

4. PulseNet LA Consolidate the collaboration between Laboratory, Epidemiology and Clinical Benefits for establishing the PulseNet Network in LA Specific objectives Strengthen National and Regional Surveillance of FBDs Improve the recognition, diagnosis, and investigation of outbreaks Detect early emerging and re-emerging pathogens Establish National and Regional Databases Strengthen communication between countries Use carefully the National and Regional Information in actions and health coordinated interventions

5. PulseNet LA History of the Network (I) - Agreement to develop PN in Latin America -1st training Course and 2nd Meeting. Seven countries: Brazil, Chile, Colombia, Mexico, Argentina, Uruguay and Venezuela. - Operation regulation Terms of Reference for the Network - Process of certification: `Salmonella` and E. coli O157. Beginning - 2nd Course training and 3rd Meeting. Six countries are incorporated: Bolivia, Cuba, Costa Rica, Nicaragua, Paraguay and Peru

6. PulseNet LA History of the Network (II) - 3rd Training Course and 4th Annual Meeting Process of certification and proficiency Continues Salmonella and E. coli O157 Other (Campylobacter, Shigella sonnei, Lysteria monocytogenes, Vibrio cholerae)

7. Who participate in the PulseNet LA  Interest of the country and of the National Reference Laboratory Incorporation for Surveillance, Control and FBD Prevention  Active involvement in the Pathogen Monitoring of Foodborne transmission  Participation in the EQAS program (Quality Control) of the WHO Global Salmonella Surveillance  Submission of application to the Steering Committee of PulseNet LA

8. Data from surveillance, outbreaks, projects National database Surveillance, outbreaks, projects Regional Center -PFGE -Analysis National Database (Regional Center) PFGE Equipment and Software Available in countries Not-available in countries Regional Center Databases Management Client Admin Results

9. Mexico Nicaragua Costa Rica Cuba Argentina Chile Uruguay Brazil (2) Colombia Perú Paraguay Bolivia Venezuela PulseNet Latin America Participants

10. PulseNet LA Situation up to October 2007 14 National Reference Laboratories of 13 countries 11/14 Cheff (10) Another (1) Guefast 06 6/14 BioNumerics (4) GelCompar (2)

11. PulseNet LA Certification 1. Salmonella and E. coli O157 2. Other microorganisms–Regional Center Gels and Analysis - Campylobacter - Listeria monocytogenes - Shigella sonnei - Vibrio cholerae SalmonellaE. coli O157 Gels (7/11)XbaI – BlnI = 5 XbaI = 3 XbaI – BlnI = 2 Analysis (2/6)21

12. PulseNet LA Activities 2006 - 2007 a)Studies conducted by the participants of the Network b)Response to international requests of information c)Regional Database d)Collaborations among the participants (intra Network) e)Participation in the meeting of the PulseNet International Steering Committee. Providence, USA, 16 April 2007 f)Participation in the Shigella flexneri working group for the PFGE protocol g)Development of a new protocol for Enterobacter sakazakii PFGE a)

13. PulseNet LA Surveillance and outbreaks of FBD. Studies conducted by 12/14 participants of the Network Network of Laboratories = 11/12 Sentinel Units = 5/12 Mandatory notification = 7/12 E. coli and/or Salmonella and/or Shigella # outbreaks # outbreaks-PFGE observations (participants) (participants) Salmonella 134 (8/12) 64 (6/12) * S Typhi, Typhimurium, Enteritidis, other Shigella 39 (3/12) 11 (1/12) Sh flexneri, Sh sonnei, Sh boydii E. coli O157 5 (1/12) 5 (1/12) participants # isolations observations Salmonella 8/12 ** 745 S Typhi, Typhimurium, Enteritidis, other E. coli 3/12 619 O157(332) and no-O157 (287) Others PTA 2/12 213 Sh sonnei, Campylobacter and other *, **: PFGE of 1 and 2 participants, respectively, carried out in the INEI

14. PulseNet LA Activities 2006-2007 International requests of information and responses of PN-LA 1. PulseNet International 1.a. S Muenchen and S Wandsworth - isolates in WGSS South and Central America response of 17 countries 1.b. outbreak of S Enteritidis in Qatar response of 3 participants PN-LA 1.c. S Typhymurium in Pennsylvania, USA response of 2 participants PN-LA 1.d. Salmonella I4,[5].12:i:-, outbreak in USA, October 2007 2. INFOSAN Shigella sonnei outbreak in Denmark. Answer of the Regional Center Results of the experience: How to continue

15. PulseNet LA Activities 2006-2007 Regional DataBases (RDB) a)Training at CDC, December 2006 (Mariana Picheland Isabel Chinen) Objectives: operation, interrelationship between National Databases and Regional Database. Organization and transmission of the information b) Interconnection with the RDB: data entry, information comparison and acquisition. Technical difficulties in the connection and configuration with the Server Central PAHO/WHO to strengthen 2007-2008 c)Income of 110 patterns of S. Enteritidis

16. PulseNet LA Activities 2006-2007 Collaboration intra Net 1. Visits of technical cooperation Regional Center 2. Creation of National Data Bases of participants Labs Two in the Regional Center (Salmonella) 3.Continuous technical assistance 2005: Uruguay and Venezuela 2006: Mexico and Perú

17. PulseNet LA T echnical group of the Regional Center–Octubre2007 - Supervision Salmonella, Shigella, Campylobacter, Vibrio cholerae: Mariana Pichel Escherichia coli: Isabel Chinen - Database Administration Escherichia coli: Isabel Chinen; Carolina Carbonari Salmonella: Angela Salve; Mariana Pichel Shigella sonnei, Campylobacter: María Rosa Viñas; Mariana Pichel Vibrio cholerae: María Rosa Viñas Lysteria monocytogenes: Claudia Martinez - Administrative collaboration Lorena Chaparro

18. PulseNet LA Where are we and how to follow Proposals for the 5th discussion Meeting 1.Intensify Surveillance of PTA and study of outbreaks of FBD by PFGE “per se” or in collaboration 2. Creation and consolidation of National Databases “per se” or in collaboration 3. Operation of Regional Database 4. Communication among the members of the Network. Information. Definition of tools and timetable of “encounters” 5. Pending certifications: when and who (in accordance with the operating capacities) 3 participants = gels Salmonella and/or E coli 3 participants = gels partial Salmonella 1 participant = gels and analysis Salmonella 3 participants = analysis Salmonella and/or E.coli O157

19. PulseNet LA Where are we and how to follow Proposals for the 5th discussion Meeting (cont) 6. Beginning process of Periodic Proficiency test Who/ When/ Microorganism 7. Incorporation of new pathogens Campylobacter/ Vibrio cholerae/ Vibrio parahaemolyticus/ Lysteria monocytogenes/ Shigella sonnei Which? Who? Timetable of certifications 8. Incorporation of new participants 9. Commitments

20. PulseNet LA Acknowledgements Participants of the 14 National Reference Laboratories Technical Group of the Regional Center Members of PN-International and its coordinator (Ahmed Elsedawy) Coordinators of PN-USA, CDC (Peter Gerner Smidt), laboratory (Efrain Ribot, Kara Cooper and Mary Ann Fair) and of administration of databases (Kelley Hise) Technical group of Informatics in Regional Bases (Alberto Mendia) in the CDC (Brenda Brown) and in the INEI (Ciro Rasmussen) PAHO/WHO in Argentina Dr. Antonio Pagés and Dr. Celso Rodriguez FOS-OPS/OMS