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Surveillance of FBD in the Caribbean and Pulse Net

Surveillance of FBD in the Caribbean and Pulse Net. Pulse Net Latin America Meeting Argentina, Oct 22-2, 2007. Lisa Indar Caribbean Epidemiology Centre (CAREC/PAHO/WHO ). Outline. CAREC and its member countries (CMCs) Surveillance and outbreak investigations (FBD)

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Surveillance of FBD in the Caribbean and Pulse Net

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  1. Surveillance of FBD in the Caribbean and Pulse Net Pulse Net Latin America Meeting Argentina, Oct 22-2, 2007 Lisa Indar Caribbean Epidemiology Centre (CAREC/PAHO/WHO)

  2. Outline • CAREC and its member countries (CMCs) • Surveillance and outbreak investigations (FBD) • Laboratory surveillance of FBD in CMCs- particularly related to Salmonella, E coli 0157, Shigella and Campylobacter • Proposal of CAREC being part of Pulse Net

  3. CAREC and its member countries

  4. GUADELOUPE FR. GUIANA Caribbean and CAREC Member Countries (CMCs)-25 Countries linking North and South America

  5. What is CAREC? • A public health information, service and consulting organization • The Caribbean’s health monitoring and disease prevention agency – serving and acting on behalf of 21 member countries (CMCs) • A PAHO/WHO Centre in the Americas, also governed by CARICOM • Regional Epidemiological center- collation and analysis of data • Regional reference and diagnostic Laboratory • Regional training center • An instrument of Caribbean Cooperation in Health (CCH) • Directing Council and Scientific Advisory Committee • Founded 1975 after outbreaks of polio, typhoid • Multi Lateral & Bilateral Agreements;US$8M budget, 130 staff • >35 regional and international partners

  6. VISION and MISSION Vision: CAREC, a public health information, service and consulting organisation, dedicated to being the best at providing the information and specialised support services people need to promote health and prevent disease in the Caribbean Mission : To improve the health status of Caribbean people by improving country capacity in epidemiology, laboratory and related public health disciplines, through programs of service, training and technical cooperation and through a well trained, motivated staff

  7. CAREC Member Countries by Size • Pop. >250,000 • Bahamas, Barbados, Guyana, Jamaica, Suriname, Trinidad & Tobago • Pop. 50,000-250,000 • Antigua & Barbuda, Aruba, Belize, Bermuda, Dominica, Grenada, Netherlands Antilles, St. Lucia, St. Vincent & the Grenadines • Pop. <50,000 • Anguilla, Br. Virgin Is., Cayman Is., Montserrat, St. Kitts & Nevis, Turks & Caicos Is. Total Pop: approx 7 million Note: Haiti and Dom Rep are beneficiaries of several major projects, although not CMCs

  8. Contextual issues: Challenges • Small populations ; Diverse economies, cultures, varying development • Most tourism dependent region in the world • Intense movement via Trade, Labor and Tourism • Complex health situations: • Health transition to NCDs, low mortality & fertility • Various health conditions – CDs, NCDs, social pathologies • Susceptible to natural disasters • Each CMC: own political governance; varying capacity, & priorities Budgetary limitations; Bureaucracy, politics • Lack of communication, collaboration, information dissemination • Deficiency in regional and national information systems on surveillance, and harmonization of food safety and quality standards

  9. Caribbean Travel & Tourism, 2002-most tourism dependant region in the world • 20 million stay-over arrivals • 14 million cruise ship arrivals CAREC/PAHO/WHO

  10. CAREC’s Programs • Surveillance and Response (Epidemiology Division) • Laboratory diagnostic and reference service (Lab Division) • Foodborne Disease prevention (FBD program) • Vector borne diseases (VBD program) • Immunization program coordination (EPI program) • Special Program on Sexually Transmitted Infections (SPSTI) • Travel & Health (Quality Tourism for Caribbean (QTC) • NCD, Injury & Substance Abuse Prevention • Information, Training, Research (IT Division)

  11. Surveillance and outbreak investigations

  12. Health Situation Complex Communicable diseases • Elimination of polio, measles, rubella • AIDS continue increase-leading cause of death in 25-44 yrs • EIDS: TB, Dengue & DHF, Malaria • Tuberculosis (estimated 4,600 excess cases in last 12 years) • Food borne disease increasing, outbreaks in tourism industry • Potential EIDS: Chikungunya, pandemic flu • Chronic Non-communicable diseases • Leading causes of death • Heart disease, cancers, cerebrovascular diseases, diabetes, hypertension • Huge cost: Morbidity, Treatment, Disability, Premature death • Injuries, violence & substance abuse: 4 CMCs 2nd yr of record homicides • Behavioral risks underpin most preventable ill health & avoidable health costs

  13. Surveillance of diseases in the Caribbean • Syndromic surveillance – reported weekly • Acute flaccid paralysis - Fever & haemorrhagic symptoms • Fever and jaundice - Fever and neurological symptoms • Fever and rash - Undifferentiated fever <5 & ≥ 5 yrs • Fever and respiratory symptoms (ARI) < 5 yrs & ≥ 5 yrs • Gastroenteritis < 5 year olds and ≥ 5 yrs • Laboratory Based /disease specific surveillance – Monthly • Salmonella, Shigella, Campylobacter, E coli, S aureus • Outbreak surveillance- immediate reporting • Integrated FBD surveillance : Salmonella • clinical, food and animal data for 6 CMCs

  14. FBD in the Caribbean • Major cause of economic burden, illness & death • 1989-2005: FBD increased >500% • GE in < 5 years: 1981-’06: 24,000 to 52,385 cases • GE in > 5 years:’94-06: 7000 to 53,303 cases • 1990-2006: >140 outbreaks: (40% viral, >50% bacteria) • 48% were FBD due to Salmonella (mainly SE) • Multiple hotel based FBD outbreaks • 2002: 4 hotels, 10 cruise ships FBD outbreaks • 2006: 21 reported FBD outbreaks source: surveillance data at CAREC

  15. Foodborne Diseases Surveillance Program • Established in February 2003 (CCH & WHO/PAHO priority) • Initiated by PAHO/FOS: Strategic Plan: by PAHO, CPC, CAREC Goal:To decrease the incidence and impact of FBD among Caribbean people and visitors thereby enhancing food safety in Caribbean. Purpose: To strengthen national and regional capacity to develop and sustain effective integrated FBD surveillance systems Strategy: • Multidisciplinary, integrated farm to table approach to FBD surveill. • Integrating epidemiological, laboratory and environmental aspects of FBD surveillance and response: coordinated approach • Inter-country, interagency, intersectoral, interdepartmental linkages

  16. Integrated FBD surveillance • Epidemiological • epidemiologists • surv. officers • Laboratory • clinical • food • veterinary • analytical • Environmental • EHOs • Vets Environment Food Clinical (human) Veterinary (animal) Linking pathogens to the source: Farm to Table

  17. Integrated FBD Activities • Develop/enhance integrated national & regional FBD surveillance systems • Strengthen laboratory infrastructure and technical capacity for FBD • Training to enhance food safety and intersectoral, multidisciplinary FBD surveillance • Conduct applied research in collaboration with tertiary institutions to provide information on FBD impact and prevention • Provide science-based information to facilitate farm to table prevention and control interventions • Provide standards and training to upgrade food safety at public health and industry (tourism) level •  Coordination , Communication and Networking

  18. Laboratory surveillance of FBD in CMCsparticularly related to Salmonella, E coli 0157, Shigella and Campylobacter

  19. LABORATORY SURVEILLANCE OF FBD Regional (CAREC) • Reference lab (21 CMCs) , diagnostic (some CMCs) • AMR and Serotyping of Salmonella and Shigella • Phage typing Typing of SE • Facilitate Outbreak investigations and further referral to other labs • Central depository of data and FBD isolates (mainly Salmonella, Shigella and Campylobacter) from countries • Databases (Salmonella, LABIS), analysis and reporting of data In country • Diagnostic capacity varies widely between countries • No lab diagnosis, only Salmonella, 1-3, >3 organisms • Only 6 CMCs has PH labs, most cases the hospital lab is PH lab • Through GSS and FBD: 6-8 countries now trained in isolation of • Salmonella, Shigella, Campylobacter, Norovirus. • Sept 2007: E coli 0157:H7, Vibrio, pathogenic S aureus

  20. Regional WHO-GSS Laboratory and Integrated FBD Training

  21. Country Number and T ype of laboratories trained Total Clinical Clinical Vet erina r y Food Universi (public) (private) /water ty Barbados 6 1 2 1 2 Belize 6 3 1 1 1 St Lucia 9 3 2 1 3 Jamaica 9 2 4 1 1 1 Suriname 3 2 1 Trinidad 17 6 4 3 4 1 Bahamas 10 3 3 4 SVG 4 1 2 1 SKN 1 1 Total 2 1(32%) 16 (25 %) 10 (1 5 %) 1 6 (2 5 %) 2 (3 % ) 65 Countries and Labs with Enhanced Laboratory Capacity 9 Countries > 60 LABS >150 persons

  22. Reported cases of GE & specific FBD pathogens Source: Surveys: Lab. confirmed cases CMC; outbreaks, specific pathogens, FBD–related data from CAREC’s Epidemiology and Laboratory division (2007)

  23. Food & water borne illnesses in the Caribbean • FBD continued to be a major cause of human illnesses, economic burden and public health concern • High & increased reported cases of GE (doubling in < 5 years and 1.5 times in >5 years) – high burden & marked increase in FBD • Salmonella and Shigella :most common, Ciguatera fish poisoning: 6 CMCs • Etiologic determination: reflection of laboratory capacity- • Continued occurrence of FBD: only some reported Hence: Urgent need: -determine the proportion of GE that is FBD; -enhanced laboratory testing for wider range of key pathogens commonly transmitted by food of pathogens • Implement PFGE for further discrimination, esp for Salmonella

  24. Current Laboratory capacity for FBD • Improved capacity: • isolation of Salmonella, Shigella, Campylobacter (9-15 CMCs) • Serotyping of Salmonella and AMR (8 CMCs) • Isolation of E coli0157;H7, path S. Aureus, vibrio, Norovirus (6 CMCs) • Standard methods for FBD isolation being used by clinical, food, veterinary, public health labs: in country, between countries • Improved linkages bet. clinical, food & vet labs: enhanced integrated laboratory surveillance (human, animal food data): 80% reported improved communication • Phage typing of Salmonella Enteritidis • Early detection of outbreaks • Improved and timely outbreak investigation • Laboratories part of WHO GSS network

  25. Proposal of how CAREC could being part of Pulse Net

  26. How can CAREC be part of PN • Because of costs and skills needed, CAREC proposes to join PN as a one regional lab- representing 21 English countries • PFGE at CAREC will be a regional reference service • What CAREC currently has to facilitate PFGE: • Laboratory space- new molecular lab • One person qualified in PFGE • Regional database and depository of isolates • What CAREC Needs • PFGE equipment - determines when we can start ??? • 1 new staff and Training of staff • Mechanism for data sharing to be worked out

  27. Discussion-Obtaining donation/funds for PFGE equipment and personnel- Data sharing issues

  28. Thank You

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