Transcript Key Issues related to Environmental Health Activities

Chemical and Allergy Food Safety
CDC Perspective
Thomas Sinks, PhD
Deputy Director NCEH/ATSDR
Centers for Disease Control and Prevention
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and
Prevention and do not represent any agency determination or policy.
Different strategies are
necessary to prevent disease
from infectious agents, toxins,
chemicals, and allergens in
our food.
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
Different prevention strategies are needed to prevent disease from
infectious, chemical, and allergic agents in food
Food
A few dozen
organism or toxins
100’s of chemicals
A handful of allergens
Latency
hours
days, weeks, years
minutes
Effect
Severity variable
Diagnosis is agent specific
Reportable condition
Risk = infectious
dose
Acute poisoning, neuro-,
or chronic disease.
Not reportable
Chronic outcomes are
not exposure specific
Risk =
cumulative dose
Non-specific reaction
Defined constellation of
responses
Not reportable
Risk = susceptibility
Food Safety – Risks from Chemicals and Allergens
• NCEH/ATSDR Data and Resources
– National Report on Human Exposure to
Environmental Chemicals
– National Poison Control Center Data Base
– ATSDR Minimal Risk Levels
• Community Site Assessments
• Food Allergies
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
National Report on Human Exposure to
Environmental Chemicals
• NCEH lab measurement of chemicals
in human blood and urine
• NHANES samples linkable to health
effect and dietary data
• 4th National Report
– 228 chemicals in blood and urine
– Approximately 25,000 people
– Nationally representative sample
– Years: 1999 – 2008
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
Distribution of urinary arsenic (µg/L)
U.S. population 2007-2008*
percentile Arsenic As from seafood DMA
MMA
50th
7.5
nc
3.7
<LOD
75th
14.9
4.3
6.0
1.1
95th
50.8
29.5
13.3
2.1
•
•
Relative distribution of
inorganic and organic arsenic
at the 95th percentile
•
•
•
known
seafood
known
inorganic
other
Difference in toxicity
between inorganic and
organic As.
Inorganic As occurs in water
and food.
66% of inorganic arsenic is
from foods (vegetables, fruit
juices, rice, ET0H, grain** )
10% of total As in food is
inorganic.**
Need inorganic HBGVs for
foods.
*Fourth National Report on Human Exposure to
Environmental Chemicals, Updated tables, February 2012;
** Xue et al., EHP March 2010
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
National Report on Human Exposure to Environmental Chemicals
Strengths and Limitations re Food Safety
• Represent population-based urine and blood
concentrations to hundreds of chemicals by
gender, race, age, and calendar time.
• Limited relative source contribution
calculations are possible.
• Few measured chemicals are exclusively food
contaminants.
• Food is one of several exposure pathways for
many, perhaps most, of the chemicals.
• Few measurements can be directly linked to
health outcomes.
• Most HBGV do not use [blood or urine].
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
The largest contributor to Cd
body burdens is smoking.
National Chemical Event Surveillance Using
the AAPCC National Poison Center Data System
•
•
CDC uses the NPDS to conduct 24/7 public health surveillance
for early detection and situational awareness of a chemical,
radiological and biologic (e.g.; plague, anthrax) exposures &
illness
– NPCD covers calls and reports to poison control centers
across the US
– Real-time data collected every 15 minutes
A mathematical algorithm monitors the database to identify
excursions from baseline using defined syndromes.
– 11,061 excursions were reviewed or investigated in 2011 The largest number of calls
to poison control centers
– 194 notifications were made to state /federal agencies.
• Situational awareness
– Japan tsunami and Fukushima nuclear event
– Deepwater Horizon Oil spill
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
was due to KI.
Foodborne Illness Identified through the
National Poison Control Center Data Base
• 2008 through 2011: 112 automatic alerts
related to puffer fish associated illness were
evaluated.
– 48 suspect cases of puffer fish associated
illness were identified.
– 3 significant public health events occurred
involving 13 of these cases.
•
October 2011: FDA and CDC collaborated in an
investigation of scombrotoxin poisoning involving
2 people consuming Tuna from a fast food
restaurant in Ohio.
– 20 additional reported exposures in 7 other
states were identified using this database.
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
National Poison Control Center Database
Strengths and Limitations re Food Safety
Strengths
–
–
–
–
–
24/7 coverage of acute poisonings and exposures
Entire United States
Immediate data access
Established syndromic algorithms and baselines
Flexibility to examine emerging issues
• Limitations
– Reports do not equal patients - a mixture of calls from the
public and calls from clinicians attending to patients.
– Passive surveillance -dependent upon contacts with
poison control centers.
– Chronic illnesses not included
ATSDR Resources Relevant to Chemical Food Safety
Non-cancer Health Based Guidance Values
Minimal Risk Levels (MRLs) - an estimate of daily human
exposure to a substance [mg/kg/day] that is likely to be
without non-carcinogenic health effects during a specified
duration of exposure based on ATSDR evaluations.
ATSDR uses the no observed adverse effect level/uncertainty
factor (NOAEL/UF) approach.
MRLs are set below levels that, based on current
information, might cause adverse health effects in the people
most sensitive to such substance-induced effects.
Environmental Media Evaluation Guides (EMEGs)
EMEGs are estimated contaminant concentrations that are
not expected to result in adverse non-carcinogenic health
effects based on ATSDR evaluation. EMEGs are based on
HBGVs and conservative assumptions about intake rate,
exposure frequency, duration, and body weight. We do not
have default values for intakes of specific foods so food
EMEGs would be developed on a case by case basis.
172 Tox Profiles
MRLs
122 Acute: 1 to 14 days
164 Intermediate: 15 to 364 days
111 Chronic: 1 year +
Community-based health
assessments and consultations
• Local issues with local stakeholders
• 90% are not listed on the NPL – many are
petition requests
• In 2011; ATSDR produced:
382 technical assists
124 health consultations
41 health assessments
health guidance value
[hazardous substance] exposure pathway
The Food Pathway in ATSDR Final Public Health Assessments
with a Public Health Hazard Finding (2008-2010)
• 18 sites
• Foods: fish (18), shellfish (1),
waterfowl (1), frogs & turtles (1)
• States: AK, CA, CT, GA, ID, MA,
MI, NC, NH, TN, TX, & WA
• Chemicals: Hg (7), dioxins (3),
PCBs (4), lead (3), cadmium (2),
arsenic (2), heptachlor, dieldrin,
DDT, aldrin , toxaphene, zinc,
uranium, strontium, nickel,
manganese, & aluminum
Food Allergies
• Trend: Food allergy (FA) appears to be increasing over time. (Boyce, et al., 2010)
• Comorbidity: Children with FA are 2-4x more likely to have other
allergic conditions and asthma than children without FA. Children with
coexisting FA and asthma may be more likely to experience anaphylactic
reactions to foods and be at a higher risk of death.
(Bock, et al., 2007 & Colver, et al.,
2005)
• Mortality: An estimated 150-200 people die of food-induced
anaphylaxis per year. (Sampson, 2003)
Diagnostic Criteria
Overall Prevalence
Self-reported symptoms: Children
12%
Self-reported symptoms: Adults
13%
Symptoms plus SPT or serum IgE: All ages
3%
Food Challenge: All ages
3%
Source: Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored
Expert Panel (2010)
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
Is there a need for a public health
approach to food allergies?
“Despite the risk of severe allergic reactions and even
death, there is no current treatment for FA: the disease
can only be managed by allergen avoidance or
treatment of symptoms.”
-Guidelines for the Diagnosis and Management of Food Allergy in the
United States: Report of the NIAID-Sponsored Expert Panel (2010)
GAPS
• Leading expert guidance does not sufficiently
address the management of persons with FA outside
of clinical care settings or related public health policy
issues.
• Significant gaps exist in practice (e.g., addressing FA
in the restaurant, home, and retail environments),
policy (e.g., local, state, and federal FA policy),
surveillance, and economic analysis.
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
Food Allergens: CDC Activities
CDC School Health Guidelines requirements under Food
Safety Modernization Act:
• (i) develop [voluntary] guidelines … to develop plans for
individuals to manage the risk of food allergy and
anaphylaxis in schools and early childhood education
programs; and
• (ii) make such guidelines available to local educational
agencies, schools, early childhood education programs …
to be implemented on a voluntary basis only.
Other proposals (not–funded):
• Surveillance and Burden
– Add anaphylaxis to Poison Control Center
reporting
– NCHS healthcare utilization data analysis
• Practice:
– Environmental Health Specialists Network (EHSNet) Restaurant Allergen Study to collect
descriptive data on restaurant knowledge,
attitudes, policies, and practices concerning food
allergens.
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
Different strategies are
necessary to prevent disease
from infectious agents, toxins,
chemicals, and allergens in
our food.
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry