Food Additives & Contaminants
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Epidemiological aspects in food safety Dinko Kello To cite this article: Dinko Kello (1990) Epidemiological aspects in food safety, Food Additives & Contaminants, 7:S1, S5-S11, DOI: 10.1080/02652039009373835 To link to this article: http://dx.doi.org/10.1080/02652039009373835
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FOOD ADDITIVES AND CONTAMINANTS, 1990, VOL. 7, SUPPLEMENT NO. 1, S 5 - S 1 1
Epidemiological aspects in food safety DINKO KELLO
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Toxicology and Food Safety, Environment and Health Service, World Health Organization, Regional Office for Europe, 8 Scherfigsvej, 2100 Copenhagen, Denmark The rapid growth of international trade in food products has resulted in increased hazards from transboundary foodborne infections and intoxication. Therefore, the development of multinational surveillance and registration of foodborne diseases or food contamination, of both biological and chemical origin, is of utmost importance for their prevention and control. Recognizing the importance of accurate and adequate epidemiological data for decision making with respect to priorities, resources and management, the World Health Organization (WHO) launched in 1976 the Joint UNEP/FAO/WHO Food Contamination Monitoring Programme (GEMS/Food) and in 1980 the surveillance programme for control of foodborne infections and intoxications in Europe. Although the response of participating countries in both programmes was very positive, many questions have arisen during this period which require further improvements through national and international action. Monitoring and surveillance of food contamination and foodborne infections and intoxications is a multidisciplinary process and requires the active involvement of experts in medical and veterinary food hygiene, food chemistry and epidemiology. Since health risk management with respect to food safety is frequently delegated to different authorities, much better coordination between the sectors is needed in order to improve epidemiological analysis at national and international level. The purpose of this paper is to review the WHO regional programme for prevention and control of foodborne infections and intoxications in the light of accumulated experience and to discuss plans and possibilities for further improvements through national and international action in the 1990s.
Introduction
Changing social habits, tourism and the entry of a large proportion of the female population into the paid workforce in many countries of the European Region have led to dramatic changes in the pattern of food consumption. In some countries, most meals are now produced outside the home; mass catering, therefore, is increasingly replacing home cooking, leading to new problems of food hygiene relating to changing methods of food production, storage and preparation. Furthermore, the rapidly growing international trade in food products has resulted in increased hazard from transboundary foodborne infections and intoxication (WHO 1983, 1987, 1988a). National food safety legislation and services in Europe have developed over the years under different circumstances. Given these different patterns of development, recent surveys performed by WHO/EURO indicate that food safety services differ widely in their scope, organization and staffing, leaving ill defined areas where coordination and work are inadequate (WHO 1987). Since food is, besides water and air, the major vehicle for the entry of environmental pollutants into the human body, the chemical safety of food is of special importance for an industrial region such as Europe. Chemicals from either 0265-203X/90 $3.00 © 1990 Taylor & Francis Ltd.
D. Kello
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Table 1. Summary of icases of foodborne diseases by causative agents. Salmonella FIN
Staphylococcus
Clostridium perfringens
Bacillus cereus Others
82 310
451 210
217 59
413 421
133 1361
81
1981 1985
166 191
1982 1987
520 1925
1981
42236
1987
39243
GDR
1981 1987
8397 13985
HUN
1981 1987
8379 9192
ITA
1982 1984
12535 9474
NET
1981 1984
7496 5593
POL
1982 1987
6503 19019
SWE
1981 1987
3205 3904
SWI
1981 1984
2812 2067
322
1981 1987 1981 1987
8021 18000 2487 942
14
50
9
27196 64 97
8 5
364 149
6 12
1981
1142
28
500
225
28
1987
2670
427
220
FRA
FRG
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Campylobacter
UNK a UNK b
YUG
a b
103
354
933
46 Clostridium botulinum 137 Scombrotoxin 800 Yersinia 60 Clostridium 18 Clostridium
botulinum botulinum
43 Clostridium 21 Clostridium
botulinum botulinum
173 275
1496 114
28 52
13 51
27 12
626 731
262 Yersinia
742 Yersinia 19 Yersinia 190 Trichinella
2974
638 Yersinia
UNK = England, Wales, Northern Ireland UNK = Scotland
633 185 32 174
Scombrotoxin Trichinella Scombrotoxin Trichinella
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Epidemiological aspects in food safety
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natural, industrial or agricultural sources can be detrimental to food safety, with potential health effects ranging from acute poisoning to long-term effects revealed as cancer or reproductive damage (UNEP/FAO/WHO 1988). A number of dramatic incidents have occurred involving the chemical contamination of foods creating considerable concern in European countries. A well known example of such incidents is the toxic oil syndrome which killed some people and seriously impaired the health of many others (WHO 1984a). In this and other cases of such unsafe food and beverages, communication with the general public and the trade must be effective, both within the country of origin as well as internationally. The importance of clear and informative communication was clearly demonstrated by the Chernobyl nuclear accident. Partly owing to early uncertainties about the nature and extent of the accident and partly because intersectoral contingency planning had been inadequate, the information reaching the population was confused and the measures imposed in Europe to safeguard foodstuffs were often contradictory (WHO 1988b). The continuous movement of millions of people through Europe—migrants, Table 2. Salmonellosis and other foodborne gastroenteritis in Europe. Country
Salmonella
Gastroenteritis
Total
FIN
1981 1985
166 1911
3708 1052
3874 1243
FRA
1982 1987
520 1925
592 2000
1112 3925
FRG
1981 1987
42236 39243
3309 22932
45545 62175
GDR
1981 1987
8397 13985
HUN
1981 1985
8379 9192
ITA
1982 1984
12535 9474
1946
11420
NET
1981 1984
7496 5593
1826 376
9322 5969
POL
1982 1987
6503 19019
1368 1224
7871 20243
SPA
1981 1986
1862 9363
915 697
2777 10060
SWE
1981 1987
3205 3904
3612
6817
SWI
1981 1984
2812 2067
1433
3500
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D. Kello
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refugees and tourists—greatly facilitates the spread and transmission of enteric pathogens (Pasini 1988). It was estimated that morbidity due to food contamination, particularly of microbiological origin, is in fact the second largest cause of morbidity in Europe, exceeded only by respiratory tract infections. The Second World Congress on Foodborne Infections and Intoxication recently held in West Berlin indicated that foodborne illness, particularly of bacterial origin continues to increase especially in industrialized countries (tables 1 and 2) (Asvall 1986).
Suggested solutions To break the vicious circle of food contamination leading to foodborne illness a new approach to food safety has to be found. More legislation, more standards and more inspection and food control alone will not be the answer to the problem in European countries. Certainly, the main prerequisite for making any decision is the availability of accurate and adequate data concerning food contamination and its risk to human health.
Current programmes Across Europe there is a plethora of national and international programmes or networks for generation or collection of data on food contamination or foodborne diseases. Recognizing the importance of accurate, adequate and comparable data for decision making with respect to priorities, resources and management actions, the World Health Organization launched the following two international programmes directly relevant to monitoring and surveillance of food contamination and foodborne diseases of chemical and microbiological origin. (a) Joint UNEPjFAOj WHO Food Contamination Monitoring Programme. This programme (UNEP/FAO/WHO 1988) was established in 1976 as a global programme with the initial participation of 13 countries. It is not a compulsory system, with the major objective being to compile food contamination monitoring data concerning chemicals from the different countries which would enable one to: establish a baseline and indicate trends in the levels of a contaminant in food with time; give an indication of the effectiveness of measures introduced to reduce food contamination; and compare the levels of contaminants in food with established standards or guidelines. By 1988 the number of countries involved had increased to 35. Nineteen contaminants are covered by the GEMS/Food project including selected pesticides, industrial chemicals and naturally occurring toxins. The available data on pesticide residues in food cover eight of the organochlorine pesticides most prevalent in the environment, e.g., DDT, aldrin, dieldrin and five organophosphorus pesticides, including malathion and parathion. The industrial chemicals included in the GEMS/Food data base are PCBs, lead, cadmium, mercury and tin. At present, aflatoxins are the only naturally occurring toxins covered by the project. All monitoring data collected so far were compiled and analysed recently, and for each topic an assessment was made on the global and regional levels and trends (UNEP/FAO/WHO 1988). The main results of this most recent assessment of chemical contamination of food in most of the countries of the European region could be summarized in the following:
Epidemiological aspects in food safety
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—the current median/mean levels of contaminants in individual foods and in total diet are generally well within established health criteria, guidelines or standards; —the trend in contaminant levels in food is generally downward, as the use of the persistent pesticides and other toxic chemicals is curtailed or banned altogether; —there are situations where the general population may not be at risk but specific population groups may be unduly exposed; considerable contamination of food is noted, such as organochlorine pesticides and PCBs in human milk, mercury and PCBs in fish, lead in canned foods and aflatoxins in nuts and cereals. (b) The WHO Surveillance Programme for the Control of Foodborne Infections and Intoxications in Europe. (WHO 1984 b) includes a nucleus of an Early Warning (Alert) System which is based at the FAO/WHO Collaborating Centre for Research and Training in Food Hygiene and Zoonoses, West Berlin. It is not a compulsory system and has been specially designed for better information on foodborne diseases in the region. It was launched in 1980 and at present 23 European countries are participating in the programme. The main objectives of the programme are: to identify the causes of foodborne diseases and to delineate factors contributing to the spread of these diseases; to make available and distribute relevant surveillance information; to cooperate with national authorities in identification of priorities and use of resources to meet both emergency and other needs in the prevention and control of foodborne diseases. Another part of the programme is the Early Warning (Alert) System by which important information should be quickly transmitted to official national agencies responsible for food control or diseases control. They should than decide on appropriate measures to be taken in their country in order to protect the consumer from possible foodborne diseases. The 1984 report summarizes the situation in Europe as follows: 163000 cases of foodborne diseases caused by microbiological contamination have been recorded in 21 countries inhabited by 417 million people. This means a calculated incidence rate of more than 400 cases per one million inhabitants. Taking into account the rate of under-reporting, this figure should be multiplied by a factor of 10 to 100 in order to attain a realistic incidence rate (WHO 1984 b). The most recent evaluation by the Programme indicates that there is an overall trend in the European region in increase of foodborne diseases, primarily caused by microbiological contamination (table 1) (WHO 1989). Also, there are several other international networks in Europe that are dealing to some extent with reporting and surveillance systems of foodborne infections and intoxication. (a) The WHO communication system for the prevention of infettious diseases (communicable diseases) and for epidemiological surveillance (WHO 1984c) is a compulsory WHO system which takes care of immediate information to the health authorities on outbreaks and cases of infectious diseases in the various countries. Foodborne diseases are only a small fraction of this information. Usually no epidemiological background information on foodborne diseases is given through this system.
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D. Kello
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(b) The EEC system for the rapid exchange of information on dangers arising from the use of consumer products (EEC 1984) deals with products which may have entered or are on the market in the EEC and which may endanger the health of the consumers. Rapid information on those products to all EEC countries can help the responsible authorities to initiate appropriate measures of control. Although each of the above-mentioned systems has its own merits and serves different purposes there is a certain overlapping and the assumption of combining the systems or at least a close coordination should be used as the basis for future developments in introducing a standardized approach in final achievements of a European Food Safety Early Warning System. There are many criticisms about the adequacy and utility of current strategies in control, monitoring, reporting and surveillance systems related to food safety at local, national and international levels. It is clear that not everything that can be monitored should be monitored, while that what must be monitored, should be monitored properly. Many priorities nowadays are governed purely by public perception and various political pressures rather than by the justifiable risk assessments. Underreporting of outbreaks of foodborne diseases either because of inadequate primary health care systems or political and economical reasons is still reality in Europe and probably not more than 5% of acute incidents are notified in most European countries. There is a strong tendency to undermine many successful international programmes, such as FAO/WHO Codex Alimentarius Programme (FAO/WHO 1981), and to develop new national and subregional independent systems. Lack of intersectoral cooperation at the local, national and international levels complicates the situation still further. Programme for the 1990s Reflecting this view and specific needs of the European Member States in the light of the Single European Market in 1992 with removal of trade barriers, the WHO Regional office for Europe is starting to prepare a comprehensive regional food safety programme for the 1990s. The overall objective is to minimize the hazards to human health from biological and chemical contamination of food that can be associated with food production, processing, and distribution systems, with emphasis on the enhancement of international cooperation among all European countries in improvement and development of mechanisms for monitoring, surveillance and control of foodborne diseases or food contamination. Accurate, adequate and accessible data are prerequisite for the most appropriate cost/benefit decisions for the public health protection. Epidemiological studies using geographically linked exposure and health data are the tools of choice for health risk management decisions in development of prevention strategies and regional priority settings. It will indicate where major research efforts should be allocated. While it will be necessary to introduce new ways and ideas to develop and implement this programme, great reliance will need to be placed upon the existing systems and mechanisms. Europe, as one of the most developed regions of the world, has many institutions, programmes, professionals and organizations that are dealing with all aspects of control and prevention of foodborne infections and intoxications and therefore it would be inappropriate not to rely on the existing capacities in the implementation of the programme. It will be particularly
Epidemiological aspects in food safety
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inappropriate not to rely on the WHO/FAO Codex Alimentarius Programme in an overall coordination of all those international activities.
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References ASVALL, J. E., 1986, Inaugural address—Final Congress Document. Proceedings of the 2nd World Congress on Foodborne Infections and Intoxications held in West Berlin, FR Germany on 26-30 May 1986 (Institute of Veterinary Medicine—Robert von Ostertag Institute), (Oraniendvück GmbH, Berlin) pp. 28-31. EEC, 1984, Council Decision of 2 March 1984 introducing a Community system for the rapid exchange of information on dangers arising from the use of consumer products. Official Journal of the European Communities, No. L 70/16, 18 (84/133/EEC). FAO/WHO, 1981, Codex Alimentarius Commission, Procedural Manual, Fifth Edition, Joint FAO/WHO Food Standards Programme, FAO, Rome. PASINI, W, (Ed.), 1988, Tourist Health: A New Branch of Public Health, Vol. II. Proceedings of the International Meeting on Prevention and Control of Infections in Tourists in the Mediterranean Area, held in Rimini, Italy, on 8-11 February 1988 (Societa Italiana di Medicina del Turismo). UNEP/FAO/WHO, 1988, Assessment of Chemical Contaminants in Food. Report on the results of the UNEP/FAO/WHO programme on health-related environmental monitoring. WHO, 1983, Mass catering, edited by Dr R. H. G. Charles, WHO Regional Publications, European Series No. 15. WHO, 1984a, Toxic oil syndrome. Mass food poisoning in Spain, edited by P. Grandjean and S. Tarkowski (Copenhagen: World Health Organization). WHO, 1984b, WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe, Third report (West Berlin: Institute of Veterinary Medicine—Robert von Ostertag Institute). WHO, 1984 c, WHO Communicable disease Surveillance Programme in the European Region, First report (Rome: Laboratorio do Epidemilogia a Biostatistica, Istituto Superiore di Sanità. WHO, 1987, Food Safety Services, Second edition, Public Health in Europe 28 (Copenhagen: World Health Organization). WHO, 1988 a, Healthy Nutrition. Preventing nutrition-related diseases in Europe. WHO Regional Publications, European Series, No. 24 (Copenhagen: World Health Organization). WHO, 1988 b, Derived intervention levels for radionuclides in food. Guidlines for application after widespread readioactive contamination resulting from a major radiation accident (Geneva: World Health Organization). WHO. 1989, WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe, Fourth report (West Berlin: Institute of Veterinary Medcine—Robert von Ostertag Institute), in press.