Transcript Dioxins in animal feed Current issue in Germany
The EHEC Outbreak in Germany 2012
Andreas Hensel Bernd Appel, Lueppo Ellerbroek, Matthias Greiner
EHEC-Outbreak in Germany, Mai/Juni/Juli 2011
Data forwarded to the RKI 16.08.2011
EHEC or HUS-
cases of illness
, EHEC or HUS-
cases of death
2.987 EHEC 855 HUS 18 EHEC 35 HUS Quelle: RKI, „Abschließende Darstellung und Bewertung der epidemiologischen Erkenntnisse im EHEC O104:H4 Ausbruch Deutschland 2011“
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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EHEC O104:H4 characteristics
Major characteristics of the aggregative EHEC O104:H4 outbreak strain Hybrid pathogenicity characteristics EHEC/EAEC ► „EAHEC“
stx
2a (Shigatoxin 2)-positive enteroaggregative (AAF/I fimbrial cluster)
eae
(Intimin)
-
negative and e
hly
(Enterohemolysin)-negative ► Aggregative adherence (AA) means effective and long colonization of humans ► Production of Stx2a associated with an effective and long intestinal colonization could explain the high virulence of this organism!
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Outbreaks resulting from contaminations along the food chain Local foodborne outbreak vs.
Diffuse foodborne outbreak Primary production Processing Primary production Processing Contamination Distribution Distribution Final preparation Final preparation Contamination Source of contamination Contamination dose Detection Investigation Focal local food handling high self-reporting, lab follow-up local, tracing back Multifocal or diffuse at production or processing low lab-based subtype surveillance Complex multistate investigation
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Local foodborne outbreak vs. diffuse foodborne outbreak
Local Diffuse
• Acute large • Local • High food handling error dose outbreak • High attack rate • Detected by group themselves • Local investigation • Diffuse widespread outbreak • Contamination at production processing level or • Low dose • Low attack rate • Number of cases higher than expected • Detection by lab-based surveillance subtype • Complex multistate investigation
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Investigation of foodborne outbreaks along the food chain:
What tasks to do?
Exchange of information between authorities Assembling an outbreak investigation team Interviews with cases (and healthy controls) Interviews with food chain industry Inspection of food establishments Tracing foodstuffs Collection and analysis of samples Documentation, assessment and publication of results
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
- tomato - cucumber - salad …..?
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Foodborne outbreaks: Tasks on the food safety side – a shared responsibility
Länder (Federal States) Level Federal Level European level
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Foodborne outbreaks: Tasks on the food safety side
Investigations • Assembling an outbreak investigation team • Inspection of food establishments, interviews with food handlers • Tracing foodstuffs • Collection and analysis of samples • Epidemiological analysis of the food chain system* • Identifying the source
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
*Responsibility of BfR
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Foodborne outbreaks: Tasks on the food safety side
Scientific assessment* • Assessing dietary exposure and consumer’s risks • Coordination and exchange with all involved institutions • Elaborating recommendations to authorities, industries and consumers Communication* • With stakeholder and media • Timely, transparent, understandable
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
*Responsibility of BfR
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Outbreak investigation… Gambling?
…now live from the Robert-Koch-Institute:
… we pick now the EHEC vector of the day …
Offers on the wheel of fortune: Sprouts, beer, salat, football, cucumber, sex, tomatoes, German Liberal Party, chips, TV, fish, internet
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Time scale at a glance (1)
1 st information of RKI Joint opinion BfR/RKI: Preliminary results of the EHEC/HUS study
May 2011 20 21 22 23 24 25 26 27 28 29 30 31
German EHEC task force BfR, BVL, RKI consumption recommendation clusters traced back to one sprout producer
June 2011 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15
EFSA: Task Force France
June 2011 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 consumption recommendations: raw tomatoes, cucumbers and green salads raw sprouts Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Time scale at a glance (2)
BfR opinion No. 23/2011 1 press conference: outbreak clarified
July 2011 0 1 0 2 0 3 04 0 5 06 0 7 0 8 0 9 10 1 1 12 1 3 1 4 1 5
Commission implementing decision 3
July 2011 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 consumption recommendations:
BfR opinion No. 31/2011 2 RKI: end of outbreak
raw sprouts raw sprouts including home-grown raw sprouts and germ buds raw fenugreek seeds imported from Egypt as well as sprouts and germ buds grown from these 1 Relevance of sprouts and germ buds as well as seeds for sprout production in the current EHEC O104:H4 outbreak event in May and June 2011 2 Relevance of EHEC O104:H4 in fenugreek seeds which are processed into other foods than sprouts and germ buds 3 Commission implementing decision of 6 July 2011 on emergency measures applicable to fenugreek seeds and certain seeds and beans imported from Egypt Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey - Outbreak investigation - methodology • Identification of „Outbreak-Clusters“ • Supply chain analysis: - Tracing backward : Clusters common Producer / Source - Tracing forward: Producer / Source further Clusters - Network analysis • Risk oriented sampling in factories, further tracing backward/forward
Tracing backward
Source / Producer Distributor
Tracing forward Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
Cluster
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Epidemiological investigations
Methodological issues in tracing • Defining candidate list of food and food components • Understanding industry structure and processing flows • Retrieving data from regional authorities • Dealing with repackaging and changing lot numbers • Data management and quality assurance • Constructing the supply network based on one-step-up one-step-down data
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey Delivery channels of fenugreek seeds explain german and french EHEC outbreak
Date: 12 th July 2011 horticultural farm in Lower Saxony retail in France seed producer intermediaries (colours: european states) outbreak clusters sprout delivery seed delivery Task Force EHEC; 2011, BfR, 2011; EFSA, 2011
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Outbreak investigation
Targeted sampling (food and environmental samples) • Outbreak sites, distributors along the supply chain, production sites • Selection of sampling points: • Hypotheses of the investigation team • Epidemiological evidence and strategic importance • Micro-environmental conditions • Analytical and diagnostic sensitivity • Coordinated with epidemiological investigations (health and food)
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey
Support of regional authorities: BfR outbreak teams investigating in • a horticultural farm producing sprouts • Hamburg Wholesale Market for Fruit, Vegetables and Flowers • several Federal States • … BfR outbreak teams
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Laboratory investigations (food & environment)
Food samples
844 Cucumber 805 Tomatoes 947 Salad 170 Strawberries 165 Bell peppers 64 Asparagus 154 Seeds 1043 Sprouts 75 Milk 3433 Other food
Other samples
174 swab samples 172 water (irrigation and processing) 16 environmental samples
Stage of sampling at the food chain
Food retail Whole sale Outbreak locations, e.g. restaurants, canteens
Laboratory analyses at BfR
SampleType Sample Number DNA Isolates Vegetables* Seeds Sprouts Swaps/environment Water Other 14 27 73 58 329 77 41 33
*Vegetables including cucumbers, tomatoes and lettuce Total EU 10392 samples taken 41 samples stx positive 8 samples positive for O104:H4 Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey Sprouts as origin of infection?
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey
9,3% 5,6% 0,6% 3,0% 7,2%
Usage of fenugreek seeds (lot 48088) in Germany
74,2% Small packagings for end users (74,2%) Sprout production (3,0%) Other (spice, tea, baking ingredient, pharmacy, clinical supply) (0,6%) Feed supplements for different animals (7,2%) Storage and production losses (5,6%) unknown (9,3%) Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey Distribution of sprouts from the horticultural farm in lower saxony
HUS incidences by residence (per 100.000 inhabitants) Robert Koch-Institute (
data 13 July 11)
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey Distribution of fenugreek seeds (lot 48088) in Germany
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Epidemiological survey Example: network graph for all collected data on seed supply chains
German Foreign > 1000 kg > 100 kg > 10 kg > 1 kg <= 1 kg Another style of visualization: • the boxes include anonymized names of the companies and represent a distributor/producer/consumer (colored: foreign) • the delivery quantity varies between 50g packets und 15 tons
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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BfR risk communication – a few numbers
> 300 media requests > 50 TV-interviews 17 messages to EFSA and other european states EFSA Focal Point) 10 statements (2 of these detailed risk assesments) 9 press releases 5 press conferences (2 of these held at BfR)
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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BfR risk communication – reaching the consumer?
Fear: How concerned are you personally that you could infect yourself with the EHEC pathogen?
60 % 40 % 40 % 40 % 40 % 34 % 43 % 26 % 20 % 0 % 6 % 3 % 9 % Extremely concerned 19 % 14 % 24 % Very concerned Less concerned Total Men Women Hardly concerned Information:
Germany; from 18 years; 982 interviewees who had already heard or read about the EHEC pathogen; 30.05.2011 to 31.05.2011
By courtesy of GF Böl and S Fiack, BfR Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
Source: Forsa © Statista 2011
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BfR risk communication – reaching the consumer?
Nutritional behaviour: Did you change your nutritional behaviour since the publication of the first reports on the EHEC pathogen?
80 % 59 % 59 % 60 % 50 % 50 % 41 % 41 % 40 % 20 % 0 % Yes No Information: Total Men Women
Germany; from 18 years; 982 interviewees who had already heard or read about the EHEC pathogen; 30.05.2011 to 31.05.2011
Source: Forsa © Statista 2011
By courtesy of GF Böl and S Fiack, BfR Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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BfR risk communication – reaching the consumer?
Hand washing: Have you washed your hands more often since the publication of the reports about the EHEC pathogen?
100 % 78 % 73 % 75 % 67 % 50 % 27 % 22 % 33 % 25 % 0 % Yes No Information: Total Men Women
Germany; from 18 years; 982 interviewees who had already heard or read about the EHEC pathogen; 30.05.2011 to 31.05.2011
Source: Forsa © Statista 2011
By courtesy of GF Böl and S Fiack, BfR Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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What could this outbreak teach us for prevention and combating intentional contaminations of feed and food?
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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25 kg bags of fenugreek seeds - target quantity
Seed distributors (mostly 1:3 mixes) 25 kg 25 kg Sprout producers (mostly 1:4 mixes) Packaging units: 25 g 3.000 bags Self sprouting 9.000 bags End consumer Packaging units: 50 g 9.000 people 27.000 people 3 person household
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Conclusions
• EHEC O104:H4 outbreak has been successfully clarified due to constructive team work on all levels • Fenugreek seeds were determined as food source through epidemiological investigation of delivery channels of suspect lots • Requirements for investigation of large outbreaks http://amrutamlifecare.com/Diexi productname-26.html
• clear competences and communication pathways • multidisciplinary outbreak investigation team • do joint analysis of investigation results • adequately qualified and trained staff • adequate laboratory capacities and analysis methods http://pilladvised.com/herb-guide/fenugreek know-what-herbs-do-what/ • appropriate information management systems • close cooperation between press office and scientific department for successful risk communication
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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… be prepared
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Acknowledgement
The Task Force EHEC
Julian Adolphs, Bernd Appel, Helen Bernard, Martin Bisping, Juliane Bräunig, Bernd Broschewitz, Michael Bucher, Andrea Ernert, Alexandra Fetsch, Doris Förster, Oliver Frandrup-Kuhr, Gerd Fricke, Matthias Greiner, Stefan Gross, Christoph Michael Hänel, Katrin Heusler, Petra Hiller, Jan Hoffbauer, Julia Jähne, Marcel Kalytta, Annemarie Käsbohrer, Norbert Kenntner, Andreas Kliemant, Désirée Krügerke, Simone Kuhlmey, Kristian Kühn, Manfred Kutzke, Wulf Ladehoff, Oliver Lehmensiek, Petra Luber, Olaf Mosbach Schulz, Britta Müller, Christine Müller-Graf, Irina Otto, Albert Rampp, Annette Reinecke, Karen Remm, Bettina Rosner, Anika Schielke, David Trigo, Helmut Tschiersky Schöneburg, Jürgen Wallmann, Armin Weiser, Heidi Wichmann Schauer, Jan-Frederik Wigger
Involved Institutions
BfR, RKI, EFSA, BVL and the Federal Länder Authorities
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Thank you for your attention
Andreas Hensel
Role of the BfR
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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Some general sound views….
The opposit of risk is not safety: it is another kind of hazard Whatever I do, I take a hazard, always possible to fail, unexpected events are always feasibel.
Message: Niklas Luhmann:
Die Moral des Risikos und das Risiko der Moral
, 1993 Take the risk and try to manage an outbreak crisis successful
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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….and some specific conclusions ...
to successfully manage an outbreak crisis it is neccessary to: • have clear competences and communication pathways • quickly assemble a multidisciplinary outbreak investigation team • do joint analysis of investigation results • have adequately qualified and trained staff (media training) • have adequate laboratory capacities and analysis methods • have appropriate information management systems • have a close cooperation between press office and scientific department to facilitate successful risk communication
Professor Dr. Dr. Andreas Hensel, Maastricht ECVPH Annual Scientific Conference, 23.08.2012
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