WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe.

FAO/WHO Collaborating Center for Research and Training
In Food Hygiene and Zoonoses

Federal Institute for Health Protection of
Consumers and Veterinary Medicine

1. Introduction
2. FAO/WHO Collaborating centres
3. Centre accomplishments
4. Future considerations for the programme

I. Introduction

Right to Safe and High Quality Food

Access to a safe, high quality and nutritious food supply is a basic right of all the people of the world. Producing good quality and safe food is a prerequisite to food security, to successful and sustainable development of national agricultural resources and the facilitation of domestic and international food trade. Establishing food safety standards within the acceptable levels of risk to hazards in or on food provide the best mechanism to assure the protection of consumer health, establish scientifically supportable food control measures, and they serve as a basis for surveillance and prevention of foodborne diseases.

Consumer Concerns for food safety

Consumers are concerned over the number and severity of food safety risks, the increased level of foodborne disease outbreaks and numbers of cases involved, and the nearly continuous emergence of new food safety issues. In recent times, the growth in and the globalization of the food trade has been beneficial to the economies of many countries, including developing and transitional countries. However, potentially negative effects are also a consequence, as hazards in or on food from one country may now be spread rapidly from country to country and simultaneously to many countries, once it enters the global distribution chain. The potential exposure of mass populations in enormous geographical areas seriously threatens the public health of the global population. A properly managed surveillance, monitoring and early alert system for the purpose of prevention, protection and control of foodborne diseases and intoxications is essential to protect the public health.

FAO/WHO Collaborating Centre

The work of the FAO/WHO Collaborating Center for Research and Training in Food Hygiene and Zoonoses, in the 20 plus years of management of the WHO Surveillance Programme for the Control of Foodborne Infections and Intoxications in Europe, becomes more relevant with each passing day. Since early 1980 with eight (8) participating countries to the present day with 49 participating countries out of 51 WHO European Region countries, valuable data on foodborne disease is compiled and disseminated to all member countries within the European Region as well as those outside the region. The important work of participating countries at the national level, serves to inform and educate all member countries of potentially hazardous food products, (including primary, fresh and processed foods), handling practices, technical failures and emerging food safety problems. Through the years, with the cooperation of the sponsoring organizations of WHO and FAO, and the participating countries, many improvements and advancements have been accomplished at the national level conducting surveillance and at the Centre in the administration of the programme. Continued success of the programme in light of the importance of this work requires continued programme review and updating to match the needs of the participating countries and to utilize modern methods and approaches to surveillance and monitoring.

About this Document

This document is intended to provide a brief background and description of the programme, emphasize the importance of this work in today’s context, point to its successes as the leading surveillance and monitoring programme in the region (and perhaps the world), and to begin a forward planning programme for updating and modernizing the surveillance programme to accommodate anticipated future needs.

II. FAO/WHO Collaborating centres

World Health Organization

The World Health Organization (WHO) is a specialized international organization of the United Nations International System, and has the primarily international responsibility for overall food safety worldwide. With headquarters in Geneva, Switzerland and regional office throughout the world, programmes for improving food safety for domestic consumption and trade at all levels are conducted to protect the health and safety of consumers throughout the world. These programmes often involve the cooperation and coordination with sister UN organizations, such as the Food and Agriculture Organization (FAO).

Collaborating Centres

WHO has utilized an international collaborating network of institutions to support their activities in disease prevention and health protection for many years. Selected institutions are approved to serve in specific health activities and disciplines. Selection is based on the institution’s reputation being well recognized by their peers, for their scientific and administrative abilities, their technical expertise and their contribution in furthering the development and advancement of science and training in activities supporting the goals and mandate of WHO. Some institutions serve in a joint capacity for both WHO and FAO, when institutions meet similar criteria for both organizations.

Joint FAO/WHO Collaborating Centre

The FAO/WHO Collaborating Centre for Research and Training in Food Hygiene and Zoonoses was first designated in 1975. It was selected by both FAO and WHO on the basis that their institutional objectives were relevant to FAO and WHO mandated activities, they could fulfill the functions to support the international organization’s priority programmes, had the scientific and technical standing and demonstrated a high level of commitment at the national, regional and international level. The Centre played an important role in assisting the international organizations by strengthening institutional capacity in countries in the region and contributed in implementing programmes in close coordination with the regional offices and other national governments.

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe

In 1980, as recommended by the WHO representatives of the European Region during their meeting in April 1979, a Surveillance Programme for the Control of Foodborne Infections and Intoxications in Europe was established. The Collaborating Centre was designated to "function on behalf of FAO and WHO as an international focal point for the collection and dissemination of data and related information for all concerned".

Programme Intent

The intent of the WHO Surveillance Programme is to strengthen the national food control and surveillance programmes through activities which:

• Identify the causes of foodborne diseases and delineates factors contributing to the spread of these diseases
• Makes available and distributes relevant surveillance information
• Facilitates cooperate with national authorities in identifying programme priorities and the use of resources to meet both emergency and other needs in the prevention and control of foodborne diseases.

Early Warning System

The WHO Surveillance Programme has the mandate to serve as an early warning system by establishing control measures and an emergency reporting system. The system is to be invoked when:

• Internationally distributed foods or feeds resulted in incidents or are contaminated
• Incidents associated with international caterer and carriers (air, train or ship)
• Illness occurs among members of a tourist group or is introduced by tourists or immigrants
• Incidence of unusual foodborne diseases are recorded in a country
• Incidents concern a disease of a severe nature
• Other matters considered being an emergency by the country making the observations.

Participating Country Responsibilities

The responsibilities of the participating member countries, within the scope of their technical capabilities and available resources, are to designate one or more contact points to provide official data and other related information to the Collaborating Center. It is desirable that a contact point represents the national authority responsible for the surveillance and control of communicable diseases. In addition, if veterinary data is to be included, the veterinary authorities should participate equally in the programme.

The national authorities are to investigate foodborne disease and report data related to the findings including the causal agents (a list of agents is provided), epidemiological and clinical investigation data, vector or vehicle of transmission, cost benefit analysis (if done) to estimate and quantify the value of the programme, and prevention and control measures. A specific reporting system utilizes a standardized report format (Report of Incident), and attachments to this report with additional details are encouraged. Frequency of reporting is suggested to be at the completion of the investigation.

Responsibilities of the Collaborating Centre

The Collaborating Centre is responsible for reviewing the data received from the participating countries for completeness. If the submitted information is sufficient, a comprehensive assessment of the situation is made by the Centre. The data is collated, evaluated and analyzed for regional and international trends by the Centre. Annual summaries are made and published by the Centre and distributed to all regional participating countries, other member countries and other interested parties. The published report provides the data on foodborne incidents based on the data submitted by the participating countries. The report particularly identifies causes of foodborne diseases occurring in Europe, delineates the factors contributing to the illness and outlines preventive actions. The report also contains narrative reports of foodborne incidents of epidemiological significance, results of special surveys carried out for specific reasons, and references to scientific literature.

III. Centre accomplishments

Surveillance Reports

Remarkable accomplishments have been achieved in the limited time of the existence of the Collaborating Centre and particularly in the administration of the WHO Surveillance Programme. In cooperation and with the able assistance of the national representatives of the participating countries, a major achievements since 1980 is the publication of the Surveillance Programme Reports beginning with the first report in 1981 to the latest report, the 7^th Report, issued in 2001. The reports provide analysis of the causes and preventive measures for control of foodborne diseases. They provide a country report from each participating country, which includes a description of the surveillance system used and provides the results of their investigations of incidents within their borders. The reports provide comprehensive reviews of major foodborne outbreaks of significant impact in Europe, when they occurred. The most recent report contains surveillance data from 51 countries and is likely to be the most comprehensive compilation of foodborne disease data published for this time span (6 years) of the report.

Definitions of Terms and Codes Developed

Another achievement, in cooperation with national representatives of the participant countries, includes the establishment of a set of harmonized definitions for terms used in the surveillance and monitoring field. In addition, elements of the programme were codified to provide consistant meaning when used in reporting such as the codes used to identify the causative agents, involved food products or type, types of marketing involved, contributing factors such as handling practices, and places where food may have been contaminated.

Conferences, Meetings, Consultations

The Centre has hosted a number of significant meetings related to food safety, foodborne diseases and surveillance and monitoring programmes. In November of 1990 in cooperation with the WHO Regional Office for Europe, Copenhagen, the Centre planned and hosted an Expert Consultation on the Situation of Foodborne Disease in Europe. Expert panel, after reviewing the existing situation in Europe made recommendations to improve routine surveillance systems, epidemiological investigations, data management, laboratory procedures, and early warning systems. They also recommended specific activities for future surveillance programmes.

The Centre played a major role and hosted four World Congresses on Foodborne Infections and Intoxications, held in Berlin in 1980, 1986, 1992, 1998. The Fifth World Congress is presently in the planning stages to be held in 2003. These meetings have provided a forum for scientist, risk assessors and managers, food control officials and food industry experts to consider the food safety issues of the times. They also promoted cooperation between scientists engaged in this field around the world, bringing the combined expertise to bear on these problems and to recommend possible solutions in the interest of consumer protection.

In 1994 and again in 1999, the Centre called upon the experts within the member countries to provide the needed advice and consultation for continued programme development and improvement. A Steering Committee was formed for each meeting, resulting in programme review and recommendations for future improvements.

Over the years, the Centre has published for the members and all other interested parties a WHO Surveillances Programme Newsletter. Newsletter No. 70 was recently issued and copies are being made available with this document. The Newsletter provides summaries and abbreviated reports of foodborne outbreaks and investigations world wide, results of surveys and studies in food safety related fields, and research results in laboratory methods, technology development, and food control. Newsletters are issued 3 to 4 times per year and can be obtained by requesting the Centre to place your name or institution on the current mailing list.

IV. FUTURE CONSIDERATIONS FOR THE PROGRAMME

Participating Country National Contact Point Meeting

The Centre will be hosting a meeting of the national contact point representatives, which is tentatively scheduled for April 23-25 2002, in Berlin. The meeting agenda is currently being planned and the invitation letters will be sent soon. The meeting will focus on an assessment of the value of the programme’s usefulness and outputs to the participating countries and the means by which the programme can be strengthened for that purpose. A Questionnaire may be used to assemble information related to the administration and operational procedures of the programme from the view of the national participants in advance of the meeting. An additional Survey is anticipated to obtain current information related to IT capabilities at the national level, in anticipation of establishing an electronic reporting system and an interactive database in the near future. A data system is currently in the design stages and the input of the national contact points is essential to the proper development of the system. The Centre encourages contact point personnel to be prepared for and to actively participate in this very important meeting.

Reporting and Data Handling

Depending on the present IT capability of most of the participating countries, the Center is anticipating the use of electronic entry technology and the development of a data base system to streamlined the country reporting process. Such a system can improve the system by allowing for up-to-date and nearly real time data availability. It is anticipated that these changes may reduce the national workload and reporting time, make information more readily available in a timely fashion, and allow for the more efficient handling of the early warning aspects of the programme. At the present time, a prototype system is in the design stages. Discussions during the national contact point meeting in April will provide opportunity for national input at this early but critical phase in the system development.

Programme Review

The basic objectives and the procedures were established in 1980 with the establishment of the WHO Surveillance Programme. Although improvements have been made from time to time since then, it is important to make a formal comprehensive review of any programme at periodic intervals to assure the goals and objectives are being met and that the effort in time and resource expenditures is worthy for the benefits received. At present, the Centre believes such a review is needed and for this purpose, a Steering Committee Meeting is currently under consideration, pending the results of an informal programme review currently nearing completion. The results of the informal review should be available for discussion during the April Contact Point Representatives meeting.

Steering Committee Meeting

The Center will hold a Steering Committee Meeting in late 2002, made up of representatives of selected countries to review, assess the future strategy, and make recommendations on programme initiatives for the future. The meeting is now in the very early stages of planning.