Transcript Source

Surveillance and Response to
Foodborne Disease
Association of Local Public Health
Associations
Dr. Paul Sockett
November 2004
1
Sources of Infectious Disease Information?
Public Health
Laboratories
Hospitals
Public Health
Community
Infectious
Disease
Networks
Media
National
Surveillance
Networks
Public Health
agencies
International
Surveillance
Networks
2
Surveillance Aims…….
•Determine magnitude and monitor trends
•Identify outbreaks and take action
•Identify high risk
populations, foods, behaviours…
•Evaluate health impact of food safety programs
•Information for policy and- other prevention
strategies, risk assessment and priority setting
(public & private sectors)
-
3
Anticipatory?
ID Surveillance – Approaches
The “Activity” level of the surveillance
program is influenced by perceived need
on the one hand and on the type,
availability and sensitivity/specificity of
data on the other
Enhanced Active
Alert Reporting
(CEOSC/PulseNet)
Active
Passive
NDSS
Passive
NESP
Enteric Surveillance
Detection of
recent events leading
to planned control and
Prevention programs
Surveillance for
disease in
non-human species
Near
Real-time
Syndromic
reporting
(ASAP)
Detection of
Environmental/agricultural
change which
could impact/indicate
future human health threats
Detection of current
events leading to
immediate intervention
Population-based
Sentinel studies
(NSAGI)
Observation of
Long-term and
Short-term trends
Active/Reactive
4
Nationally
Notifiable
Diseases
Nationally
Notifiable
Diseases
in Canada
•
•
•
•
•
•
Botulism*
Salmonella (also Typhoid)
Campylobacter
Shigella
Verotoxigenic Escherichia coli
Vibrio (Cholera)
•
•
•
•
Cryptosporidium
Cyclospora
Giardia
Hepatitis A*
* Not reported through NESP
Others Reported through NESP
Yersinia
Norovirus
Rotavirus
Entamoeba
5
National Enteric Surveillance Program (NESP)
A surveillance program which integrates national data on enteric
pathogens for outbreak detection and response
Pulsenet
Canada
Provincial-Territorial
Laboratories
Outbreak
Investigations
FWZID + NLEP
Facilitates analysis
for outbreak
detection
Annual descriptive
report
Weekly NESP
Reports
6
NESP - Major Disease Groups
Organism
2001
2002
2003
Salmonella
6383
6256
5411
Campylobacter
1732
1818
1530
Shigella
692
1159
819
E. coli
1333
1284
1063
Vibrio
23
42
45
Yersinia
767
609
546
Parasites
2355
2098
1926
Viruses
1437
1767
2493
Total
14722
15033
13833
7
NATIONAL ENTERIC SURVEILLANCE PROGRAM
ANNUAL SUMMARY REPORT - 2003
Isolates Reported by Major Disease Group
Salmonella 39.1%
Viruses 18.0%
Vibrio 0.3%
Yersinia 3.9%
Shigella 5.9%
Parasites 13.9%
E. coli 7.7%
Campylobacter 11.1%
8
Outbreaks Reported to the NESP in 2003
*Numbers based mostly on partial information received via the NESP reports
Organism
No. of Outbreaks *
No. of Cases *
33 (10.6%)
10
4
2
2
2
2
1
1
1
10
254 (23.6%)
Campylobacter jejuni
2 (0.6%)
5 (0.5%)
E. coli 0157
13 (4.2%)
95 (8.8%)
Shigella
S. sonnei
S. dysenteriae
10 (3.2%)
9
1
52 (4.8%)
49
3
Yersinia enterocolitica
1 (0.3%)
2 (0.2%)
Cryptosporidium
1 (0.3%)
4 (0.4%)
250 (80.6%)
241*
9
663 (61.7%)
643*
20*
310*
1075*
Salmonella
S. Typhimurium
S. Enteritidis
S. Heidelberg
S. Newport
S. Thompson
S. Oranienburg
S. Hartford
S. ssp. 1 4,5,12:b:Others (10 serotypes)
Viruses
Norovirus
Rotavirus
Totals
73
20
12
7
19
35
16
27
45
9
Canadian Enteric Outbreak Surveillance Centre
CEOSC Alerts
Sources of Alerts
Provincial/territorial
Public Health
Federal
Public Health
CEOSC
Alerts
Local/ Regional
Public Health
10
Enteric Alerts
CNPHI - ALERTS
(regional Health Authority coverage) – as of Sept 2003
Cnphi
nphi
C
11
How its working…..
• Alert posted…
S.Enteritidis PT5b & Cuba
•
•
•
•
5 provinces identify cases
Cases travelled to same region in Cuba
Cuban government informed
Local investigators identify source;
institute control measures
12
PulseNet Canada?
• A co-ordinated network of laboratories for
rapid exchange of molecular typing
information.
– 2000: Consultation meeting with partners
– 2000-1: Sharing and standardized methods
– 2001: established listserv for exchanging
information
• Allow future real time surveillance
• Employs single IT platform: Bionumerics
13
Pulse Net
National and International
Harmonization
• Standardized database allow
interchange with
– PulseNet US : established in 1995 for E.
coli
– PulseNet Europe: 2003
– PulseNet Central Asia: 2003
– PulseNet South America: 2004
14
A. S. A .P.
Alternative Surveillance Alert Project
Community surveillance of gastroenteritis based
on over-the-counter sales of anti-diarrheal and
anti-nausea medications
• To reduce impact of a severe and sudden introduction of an
infectious agent in the community by facilitating rapid outbreak
detection
• Applications to other disease syndromes, including respiratory,
dermatological, etc…
15
Key Components
• Automated data download/exchange system
• Establish a relevant baseline of unit sales for
each pharmacy
• Create an automatic analytic system to detect
trends that deviate from this baseline
60
ALERT!
40
20
0
week1
week2
week3
week4
week5
week6
16
Information Sources
(Foodborne Diseases)
International
• Global Public Health Intelligence Network
(GPHIN)
• PROMED
• EnterNet (Europe plus)
• WHO Outbreak Verification List
• PulseNet
17
European Enteric Disease Network
(Enter Net)
• Established international network
• EU and non EU European countries & linked to:
– Canada and USA
– Australia and New Zealand
– Japan
• Focused on Surveillance and Epidemiological
research (Salmonella and VTEC)
• Regular sharing of standardised data and alert
mechanism
18
CanadianIntegrated
Surveillance report
Salmonella,
Campylobacter,
pathogenic E. coli and
Shigella from 1996 to 1999
19
Available electronically at:
<http://www.hc-sc.gc.ca/pphb-dgspsp>
Health Canada Food Safety Program
Integrated Surveillance Report
• Salmonella, Campylobacter, pathogenic E. coli,Shigella:
1996-1999
• Multiple data sources relating to human and animal
disease
• Focus: disease trends over time
comparison of geographic distributions
comparison of data from different sources
comparison of disease trends in humans and
animal species
20
Number of Human Cases
Salmonella cases from 1990 to 1999
10,000
9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
1990
1991
1992 1993
1994 1995
Year
Salmonella - NLEP/NESP
1996
1997
1998
1999
Salmonella - NND
21
Salmonella Reports by Month, 1996-1999
Frequency of Reported Cases
1996
1997
1998
1999
1000
900
800
700
600
500
400
300
200
100
0
J M M J S N J M M J S N J M M J S N J M M J S N
All Salmonella - NNDS
All Salmonella - NLEP/NESP
Typhimurium
Enteritidis
Heidelberg
Hadar
Data from NNDS, NLEP and NESP
22
8
7
6
5
4
3
2
1
0
1500
1000
500
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
0
19
91
No. of Reported Cases
2000
Incidence rate per 100,000
VTEC - Cases and Incidence Rates Reported to the
NDRS, PPHB, Health Canada
Year
Cases
Incidence rate
23
VTEC Cases by Month,
1997 to 2001, NNDS
1200
800
600
400
200
1997
1998
1999
2000
O
J
A
J
O
J
A
J
O
J
A
J
O
J
A
J
O
J
A
0
J
Frequency of Reported Cases
1000
2001
24
ct
D
ec
N
ov
O
Ju
l
A
ug
Se
p
Fe
b
M
ar
A
pr
M
ay
Ju
n
Ja
n
Number of Outbreaks
VTEC Outbreaks by Month 1996 - 2002
20
18
16
14
12
10
8
6
4
2
0
25
VTEC Outbreaks by Type
1996 - 2002
Type
Total (n=114)
Household
51
Community
27
Daycare / School / Camp
18
Event*
6
Institution (Hospital)
5 (2)
Restaurant
5
Unknown
2
* e.g. church supper, BBQ, etc.
26
VTEC Outbreaks by Source
1996 - 2002
Source
Food
Total (n=114)
Beef
Deli Meats
Turkey
Not specified
20
14
3
1
2
Municipal
Surface
3
1
2
Salads (+ sandwiches)
3 (1)
Water
Person to Person
3
Apple Cider/Juice
2
Bean Sprouts
1
Petting Zoo
1
Goat’s Milk
1
Cheese
1
Unknown
79
27
Health Canada Food Safety Programs
Surveillance – Future Focus
• Further development of electronic networks for
sharing data
• Rapid detection of issues, and response
• Analysis of data from multiple “risk” sources
• Integration of risk assessment and policy needs
with surveillance objectives
• Enhancing skills in outbreak response
• Development of decisions tools (guidelines,
data, analysis)
28