Work of WHO in food safety

Soren Bo Madsen Technical Officer, Food Safety WHO/EMRO

Food safety

• Food safety is a public health issue • Affects 1/3 of population every year – Diarrhea most common health issue – But also: • Organ failure • Neurological disorders • Cancer • Death

Food safety is complex

• Environmental management • Agricultural practices • Animal husbandry skills • Veterinary services • Industrial processing • Trade – Transport – Wholesale – Retail • Food service practices • Food handlers education • Consumers knowledge

Nature of food safety challenges

• Microbiological hazards – bacteria – vira – parasites • Chemical hazards – Contaminants – Residues (e.g. pesticides, veterinary drugs) – food additives – natural toxins

Factors influencing food safety

• Changing lifestyle • Changes in food trade and production patterns

Regional challenges

• Food safety systems are often rigid and spread over several ministerial domains • Weak role of health sector in food safety policy development • Public perception in the region of FBD: – Episodes of diarrhea and fever are ‘facts of life’ – Self medication is common and drugs easily available – Medical attention sought late

What is WHO doing to help countries improve food safety? (1) • Developing and disseminating guidance for risk assessment of foods • Supporting surveillance of foodborne diseases and monitoring of chemicals in food • Facilitating exchange of information through INFOSAN and IHR between national authorities on foodborne disease outbreaks and food contamination events • Providing guidance on containment of antimicrobial resistance

What is WHO doing to help countries improve food safety? (2) • Coordinating Global Food-borne infections Network courses for laboratory and epidemiology staff (GFN) • Providing an external quality assurance programme to laboratories (through GFN) • Developing training and communication tools in support of safe food

Public health threats originating from farm animals

• Zoonotic diseases • Veterinary drugs residues • Anti-microbial resistance

Antimicrobial resistance (AMR)

• Current antimicrobial usage patterns in industrial food animal production lead to development of AMR • AMR is a problem in human infections and is a major emerging threat to public health • Antibiotics are used in farm animals for: – Treatment of infections – Disease prevention – Growth promotion

More than half of anti-microbial drugs are used non-therapeutically in animal husbandry  In industrial production, antibiotics may be added to drinking water to decrease diseases of crowding and as growth promoters  Bacteria persistently exposed to low levels of antibiotics will develop resistance to these drugs  AMR may spread through food or other transmission routes

Resistance to critically important antibiotics for human medicine • Use of fluoro-quinolones in food animals has led to corresponding AMR in e.g. Salmonella and Campylobacter isolates • AMR in Salmonella in human infections is associated with: – more frequent and longer hospitalization – Longer periods of illness – a twofold increase in the risk of death within two years after infection – Treatment failure (rare for the time being…)

Policy response options (1)

• Ban or restrict use of antibiotics for growth promotion in farm animals • Increase use of biosecurity measures incl. animal vaccines to reduce need for antibiotics for disease prevention and treatment • Develop an integrated AMR approach among veterinary, food and health sectors

Policy response options (2)

• Require antibiotics to be administered to animals only when prescribed by a veterinarian • Reserve antibiotics identified as critically important in human medicine for use in humans • Eliminate economic incentives that leads to inappropriate prescription of antibiotics – both in animals and humans

Surveillance

• The systematic, ongoing, collection, analysis, interpretation, and dissemination of data for public health action

Public health action Dissemination Collection Analysis Interpretation

Surveillance pyramid

Case reported Lab identifies pathogen Sample submitted to lab Doctor requests sample Person goes to doctor Person has symptoms

Surveillance in support of food safety

• Health systems may react on basis of FBD surveillance data • Surveillance data needs to be transferred to food control and food production sectors for preventive action • Data to be integrated with data from food monitoring and veterinary surveillance for best outcome

Complexity Levels

Person has symptoms Person goes to doctor Doctor reports case Doctor requests sample Sample submitted to lab Lab identifies pathogen Case reported Human cases compared to animal and food data No formal surveillance Syndromic surveillance Lab-based surveillance Integrated surveillance

Integrated surveillance

• Outbreak detection and identification of source • Estimate burden of foodborne disease specifically by food/animal category in support of policy decisions • Tool for assessment of effectiveness of food safety policies

Full value of surveillance data is only achieved through sharing and using all available data for

PUBLIC HEALTH ACTION ------------------------------------------------------ Public health action Dissemination Collection Analysis Interpretation

Thank You

Further information available at: http://www.who.int/foodsafety/en/