International Food Safety Authorities Network (INFOSAN)

1. International Food Safety Authorities Network (INFOSAN) Dr Richard Brown WHO Thailand

2. Priorities and Context for Health Security in the South-East Asia Region? • Priority Hazards to Public Health in the SEA Region..? • Emerging and re-emerging communicable diseases • Anti-microbial resistance • Food safety • Increasing incidence / recognition of chemical events • Natural disasters • A changing context… • Rapid development • Increasing travel and industrialization • Climate change

3. Food safety issues

4. International foodborne disease outbreaks:Rapid spread worldwide by movement of food

5. Globalisation of Trade :“The World on your Plate” Salted butter Garlic puree Garlic salt Lemon Parsley Pepper Water - Ireland - China, USA, Spain Herb Butter : - China, USA, Spain - USA - France, UK - Indonesia - Ireland Chicken Breast: Chicken Batter: - Belgium, France Flour Water - Ireland - Ireland, UK Bread Crumb: Bread crumb Rape-seed oil - EU, Australia Eastern Europe - Ireland, Belgium UK, France etc. Chicken Kiev Courtesy A. Reilly, FSAI, Ireland

7. Some food safety challenges? • Contaminated food usually looks, smells and tastes normal • Traditional (visual) food inspection is not sufficient • Pathogens may survive traditional food preparation techniques • New control techniques are required • Infected animals often show no illness • Public health initiatives must address apparently healthy animals • Public health initiatives must include the safety of the food animals consume

8. What are the International Health Regulations (2005)? • An internationally agreed instrument for global public health security • Represents the joint commitment by all countries for shared responsibilities and collective defence against disease spread • Legally binding for WHO Member States since June 2007

9. Approach of the New IHR • From controlling at borders, to containment ‘at source’ • From a list of diseases, to a very broad range of threats • Focus on ‘risk-based’ assessment & response • New ‘infrastructure’ • National IHR Focal points • WHO IHR Contact Points in Regional Offices • IHR Department in WHO Headquarters in Geneva, Switzerland • Annual reporting to the World Health Assembly • Secure Event Information Site (EIS) • Emergency Committee and a ‘review process’

10. What does IHR implementation mean…? • Two very important aspects… • An immediate and ongoing requirement • for countries to report some types of event when they occur, and • for WHO to provide assistance • A requirement, linked to a timeframe for countries to establish capacities to detect and respond to public health events (initially, by June 2012)

11. What should be reported to WHO? • Any potential ‘Public Heath Event of International Concern’ (PHEIC) • To help any decision, some criteria have been established • Is the public health impact of the event serious? • Is the event unusual or unexpected? • Is there a significant risk of international spread? • Is there a significant risk of international travel or trade restrictions? • A decision on whether to report an event will normally be made at national level (by the national IHR focal point) • Only the DG of WHO (advised by experts) can declare a PHEIC

12. National IHR Core Capacities Requirements 8 Core capacities – Legislation and Policy – Coordination – Surveillance – Response – Preparedness – Risk Communications – Human Resources – Laboratory 3 levels – National – Intermediate – Peripheral/Community Potential Hazards • Infectious • Zoonosis • Food safety • Chemical • Radio nuclear • Events at Points of Entry

13. Hazard types of acute public health events reported to WHO, 2001-2012 Source: Event Management System WHO

14. What is INFOSAN? A global network of national food safety authorities that… • Promotes the exchange ofimportant food safety information globally • Responds to international food safety events • Helps countries strengthen their capacity to manage food safety risks with a goal of preventing foodborne disease • Support capacity building on the reporting of international food safety events to the global community in collaboration with the WHO Global Foodborne Infections Network (GFN) • As of today, there are 177 country members of INFOSAN

15. INFOSAN Membership • Emergency Contact Points  From the national authority responsible for coordination of national food safety emergency response • Focal Points  Other national authorities with a stake in food safety (i.e. human health, animal health, agriculture, trade, fisheries, etc.) • Other members  Advisory Group Members, WHO Regional Food Safety Advisors; FAO Regional Food Safety Officers; Regional Food Safety Authorities (i.e. ECDC, OIRSA, etc.)

16. Emergency Contact Point Roles and Responsibilities • Reports urgent food safety events of potential international significance to the INFOSAN Secretariat • Collaborates with their IHR National Focal Point on food safety events that fall under the IHR • Assists the INFOSAN Secretariat in the verification and assessment of events by providing all necessary information, and reviews INFOSAN Alert messages pertaining to an event in their country • Requests international assistance through the INFOSAN Secretariat to respond to a food safety incident or emergency, as necessary • Takes action on INFOSAN Alerts and disseminates information accordingly

17. Focal Point Roles and Responsibilities • Disseminates INFOSAN notes, FAO/WHO guidelines, and other important food safety information from INFOSAN within their agency, as appropriate • Provides comments to INFOSAN on information products disseminated to the Network • Engages in sharing information with the INFOSAN Secretariat and other members on food safety issues that may be relevant at the international level and beneficial to all members, including risk assessments on emerging hazards, lessons learnt, identified good practices, etc. • Collaborates with INFOSAN Emergency Contact point on emergency events involving their respective agency

18. INFOSAN Collaborative Partnerships • Global Early Warning System for Major Animal Diseases, including Zoonoses (GLEWS) • World Organisation for Animal Health (OIE) • Global Foodborne Infections Network (GFN) • European Union - Rapid Alert System for Food and Feed (RASFF) • EMPRES Food Safety • WHO's Global Outbreak Alert and Response Network • PulseNet International

19. The International Health Regulations and INFOSAN Disseminate Public Health Information Others sources Informal/UnofficialInformation National IHR Focal Point and INFOSAN Emergency Contact Point IHR Reports Verification WHO Initial screen Public Health Emergency of International Concern (PHEIC) Assessment Event Risk Assessment Assistance / Response

20. Examples of INFOSAN Emergency ALERTS 2005Salmonella in powdered infant formula from France to 13 countries 2006E. coli 0157 in spinach from USA to all 150 member countries 2007Shigella sonnei in baby corn – export from Thailand 2008Melamine-contaminated powdered infant formula, China 2009 Outbreak of Salmonella Typhimurium in the USA linked to domestically produced peanut butter 2010Outbreak of Thyrotoxicosis in Australia linked to internationally distributed soy milk from Japan 2011Outbreak of haemolytic uraemic syndrome caused by enterohaemorrhagic Escherichia coli in Germany 2012S. Bareilly and S. Nchanga Infections in the USA 2013Outbreak of Hepatitis A infections in Denmark linked to frozen berries

21. Melamine-tainted milk – Concern for ALL! Melamine has a protein that includes "NITROGEN" (NPN)                               2007 –pet food and death 2008 – Kidney stone, deaths among infants in China Panic over food safety once link between melamine tainted milk and infant sickness was established 4 died and 50,000 left sick

22. On 23 December 2009, information received advising of 10 cases of thyrotoxicosis in one state of country ‘A’. Cases are linked to an imported soy milk product, brand X soy milk. INFOSAN Alert: Thyrotoxicosis from excess iodine in soy milk product

23. International Distribution of Soy milk United Kingdom Ireland Germany Japan Spain Cyprus Hong Kong Singapore Australia New Zealand

24. Hazard Characterisation Iodine content of the soy milk was 31 000 µg/L. = .031mg/ml TDI (Tolerable Daily Intake) - .017mg/kg body weight ~Adult body weight = 60 kg 0.017mg x 60 = 1.02mg TDI (Adult) 1.02/.031= 32.9ml Exposure over 32.9ml per day will exceed TDI (1 cup is 250ml) (adult)

25. Risk Assessment Hazardidentification Hazard characterisation Exposure assessment Risk characterization Excessive iodine consumption has been linked to clinical thyrotoxicosis and, less commonly, hypothyroidism. Epidemiological information and analysis 31 000 µg/L iodine in milk Imported food product (Brand) 9 adult, 1 infant affected Tolerable daily intake is likely to be exceeded if 33ml is consumed per day by an adult. National and international distribution Tetra Pack (Shelf Stable) Intake can vary from use in tea/coffee or as a milk drink Average quality of intake not clear The commonest symptoms are - Low muscle tone - Jaundice - Poor feeding - Constipation - Sleepiness/sluggishness - Hypothermia (reversible) Iodine can cross the placenta and may cause foetal and neonatal hypothyroidism which can cause loss of cognitive functions (irreversible)

26. Take home messages! • Build national INFOSAN networks (ensuring farm-to-table representation) and increase their operational capacity • Enhance communication between INFOSAN Emergency Contact Points and National IHR focal point