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C-EnterNet (FoodNet Canada):

Andrea Nesbitt, MSc., Public Health Agency of Canada Canadian Public Health Association, Toronto, O ntario May 28, 2014. C-EnterNet (FoodNet Canada): Integrating Enteric Disease and Source Surveillance Data for Decision-Making. FoodNet Canada (formerly known as C- EnterNet ).

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C-EnterNet (FoodNet Canada):

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  1. Andrea Nesbitt, MSc., Public Health Agency of Canada Canadian Public Health Association, Toronto, Ontario May 28, 2014 C-EnterNet (FoodNet Canada): Integrating Enteric Disease and Source Surveillance Data for Decision-Making

  2. FoodNet Canada FoodNet Canada (formerly known as C-EnterNet) What is a sentinel site? • What is it? • A national integrated food safety surveillance system that uses sentinel sites to gather information. • 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) • Whywe do it? • Inform food and water safety policy in Canada

  3. FoodNet Canada FoodNet Canada Structure Data integration and analysis FoodNet Canada Central Data collection BC AB ON

  4. FoodNet Canada Surveillance: 4 Components Meat: chicken, beef, pork Produce: soft berries, fresh cut fruits, leafy greens (episodic) Raw surface water Stool samples Enhanced standardized questionnaires Dairy, beef, swine, broiler (manure samples) Farm management questionnaire

  5. FoodNet Canada Surveillance: Target Pathogens • Bacteria • Salmonella spp. • Campylobacter spp. • VerotoxigenicE. coli • Shigellaspp. • Yersinia enterocolitica • Listeria monocytogenes • Parasites • Giardia • Cryptosporidium • Cyclospora • Viruses • Norovirus • Rotavirus Systematic typing of isolates • Harmonisedmethodologyacross components • Enhanced subtyping • Speciation • Serotyping • Phagetyping • AMR • PFGE • Genotyping • Ribotyping

  6. Slaughter / transformation Retail Farm Consumption Infection FoodNet Canada Data Integration: Source Attribution • 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

  7. Built on Public Health Collaboration Enhanced passive surveillance Links rich risk factor data & lab data Standardized Questionnaire Enhancing Capacity - training Collaborative projects/research FoodNet Canada

  8. FoodNet Canada Understanding Travel Related Illness • Travel-related cases (TRC) have been poorly estimated and described in Canada • FoodNet data (June 2005 to May 2009) used to describe TRC • TRC caused by enteropathogens in Canada = a significant proportion of the burden of the total diseases • More than one in four reported cases of enteric infection were related to travel. • Informed assessment of the actual risk related to travel for subgroups of travelers and quantified the attribution of traveling abroad to the overall burden of these gastrointestinal diseases Ravel, A et. al. “Description and burden of travel-related cases caused by enteropathogens reported in a Canadian community.”Journal of Travel Medicine, 2011

  9. Public Health Action FoodNet identified consumption of raw milk as a risk factor for Campylobacter (over 2X risk) PHAC, U of G & Region of Waterloo collaboration Consultation with the community; and ON Ministry of Health re: messaging Fact sheets developed: educational tool for general public and raw milk distributors FoodNet Canada

  10. MLSI • Specific open text field in standardized questionnaires • Opinion of public health inspectors • Analysis • Classification in 9 potential routes of infection • All endemic cases • Results • Inform source attribution hypotheses • Assist in the direction and development of public health programs for prevention and control of enteric illness • High-risk sources identified and addressed FoodNet Canada Most likely source of infection (MLSI) Dumoulin et. al. (2012). “Informing source attribution of enteric disease: An analysis of public health inspectors’ opinions on the ‘‘most likely source of infection”. Environ Health Review, 55(1):27-36.

  11. FoodNet Canada Cryptosporidium and recreational water risks • Recreational water QMRA publication* for ON Sentinel Site helped inform the development of an OPHA Resolution regarding the regulation and inspection of splash pads and other similar forms of wet recreation. • Ontario updated the guideline for enhanced treatment of recreational water parks/splash pads in 2010. *Pintar, K.D.M. et. al. (2010). “A Risk Assessment Model to Evaluate the Role of Fecal Contamination in Recreational Water on the Incidence of Cryptosporidiosis at the Community Level in Ontario”. Risk Analysis, 30(1):49-64

  12. FoodNet Canada Collaborative research studies based on FNC data • Canada’s revised foodborne illness estimates • 1.6 million illnesses from 30 known pathogens and 2.4 million illnesses from unspecified agents annually • About 1 in 8 Canadians (4 million people) experience an episode of domestically acquired, food-borne illness each year. Thomas et. al. (2013). “Estimates of the Burden of Foodborne Illness in Canada for 30 Specified Pathogens and Unspecified Agents, Circa 2006”.Foodborne Pathogens and Disease, 10(7):639-48.

  13. FoodNet Canada Other ways FNC data is helping • Information provided to the Canadian F/P/T Government/Industry Salmonella Enteritidis Working Group, • providing evidence that poultry was contributing to the observed increase in endemic SEillness nationally • Information used in provincial/territorial and national outbreak investigations and response (retail component data and food consumption data) • Support of a wide range of studies on foodborneillness • Manycollaboratorsfromwithin PHAC to industry • High value database as a result of an integrated, standardized, and harmonized data collection process

  14. FoodNet Canada Moving Forward in 2014 • Enhanced and integrated surveillance: a priority for Health and Agriculture • Eye to the future: expansion to full 5 sites • Include AMR work • Continue to inform food and water policy and decision making in Canada

  15. FoodNet Canada FNC relies on collaboration with public health at all levels of government, provincial agriculture and environment, industry and other stakeholders Thank you Questions? Contact: phac-FoodNet.Canada-aspc@phac-aspc.gc.ca

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