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| Agenda Item 5.2 | Conference Room Document 56 English only |
second fao/who global forum of food safety regulators
Bangkok, Thailand, 12-14 October 2004
(Prepared by WHO)
World Health Organization Global Salm-Surv is a collaborative effort between WHO, the Danish Institute for Food and Veterinary Research, the United States Centers for Disease Control and Prevention, Reseau International Des Instituts Pasteur, Health Canada, the Animal Sciences Group, The Netherlands, the United States Food and Drug Administration, Enter-net - human enteric pathogen surveillance network, Europe, and OzFoodNet - Enhanced Food borne Disease Surveillance Network, Australia. The program is aimed at reducing food borne diseases worldwide through enhancement of laboratory-based surveillance and outbreak detection and response. WHO Global Salm-Surv is an international resource for training and expertise in food borne disease. Through this program, collaboration and communication between epidemiologists and microbiologists nationally and internationally, involved in human disease, animal disease, and food safety, is fostered.
WHO Global Salm-Surv has 840 general members from 471 institutions in 138 countries. WHO Global Salm-Surv general members represent member institutions, national reference laboratories which isolate and serotype Salmonella data, other laboratories which perform isolation and serotyping of Salmonella, and individuals involved in food borne disease surveillance and response issues. General members are encouraged to participate in various WHO Global Salm-Surv Program Activities.
WHO Global Salm-Surv Partners and members work towards achieving the mission of enhancing laboratory-based surveillance and outbreak detection and response through five project components that promote capacity building, collaboration, and communication. These components include International Training Courses, an External Quality Assurance System (EQAS), Focused Regional and National Projects, an Electronic Discussion Group (EDG), and a Country Databank.
The primary means by which WHO Global Salm-Surv strives to enhance laboratory-based surveillance and outbreak detection and response for food borne disease is by building capacity in the regions. WHO Global Salm-Surv offers international training courses at nine sites in the six WHO regions to achieve its goal. WHO Global Salm-Surv Training Sites include Bangkok, Thailand (for Southeast Asia), Buenos Aires, Argentina (for South America), Cairo, Egypt (for the Mid-East), Merida, Mexico (for Central America), Port-of-Spain, Trinidad (for the Caribbean), Warsaw, Poland (for Eastern Europe) and Yaoundé, Cameroon (for West Africa). Country-specific courses are offered in Beijing, China and St. Petersburg, Russia. Four of the nine sites also take on additional responsibilities to help the region develop food borne disease capabilities by acting as WHO Global Salm-Surv Regional Centers. WHO Global Salm-Surv Regional Centers include the Argentina, Mexico, Poland, and Thailand Training Sites.
WHO Global Salm-Surv Training Sites and Regional Centers work in conjunction with WHO Global Salm-Surv Steering Committee Partners and Applied Epidemiology Training Programs (AETPs) to help build infrastructure in a region and affect change. International training courses for microbiologists and epidemiologists are offered in four level cycles, each level course being offered every one to one and a half years. Level 1 focuses on microbiological training for Salmonella isolation, identification, serotyping and antimicrobial resistance. Laboratory-based surveillance is discussed. Interaction between the human, animal and food microbiologists is encouraged. The Level II Course reviews Level I theory and techniques, with additional course work focusing on Campylobacter isolation and resistance testing. Level III Courses bring together epidemiologists and microbiologists who attended the Level I and II Courses. Epidemiologists focus on laboratory-based surveillance and outbreak detection and response issues, while microbiologists review Level I and II Techniques. Practical case study exercises are carried out by epidemiologists and microbiologists from each country, working together as a team. Country Plans of Action are created to implement skills after the course and to build on intra-country relationships developed while there. Level IV Courses focus on molecular subtyping methods, and bring together epidemiologists, microbiologists and managers, allowing for a more sophisticated food borne disease country plan of action to be developed.
Since WHO Global Salm-Surv began in 2000, over 300 microbiologists and epidemiologists from >90 countries internationally have been trained at the 23 WHO Global Salm-Surv Training Courses. Courses have been offered in English, Spanish, French, Chinese, Russian, and Arabic. Needs assessments have been performed at many of these courses, and needs have been met, when possible.
Another way that WHO Global Salm-Surv promotes capacity building is through its annual External Quality Assurance System (EQAS), which encourages laboratories to achieve the highest quality isolations, identifications, serotyping and antimicrobial susceptibility test results. Through the Danish Institute for Food and Veterinary Research (DFVF), WHO Global Salm-Surv distributes blinded Salmonella strains to participants for serotyping and susceptibility testing. Additional testing on Campylobacter is also performed. Results are entered into a web-based system, with DFVF determining percent correct results. Laboratories with less than desired results are encouraged to seek assistance to better their skills.
Three EQAS cycles have been conducted, with an increasing number of laboratories participating in each cycle. In 2003, 152 laboratories participated in WHO Global Salm-Surv EQAS. Recent available data from 2002 indicates that about 91% of antimicrobial susceptibility results were correct, while 90% of serotyping was deemed correct (Petersen, et al, 2003). WHO Global Salm-Surv General Members who have attended WHO Global Salm-Surv Training Courses, as well as National Reference Laboratories, are encouraged to participate.
In addition to the International Training Courses, one mechanism for encouraging collaboration between the countries and different scientists is through Focused Regional and National Projects, which are created to promote the continued development and application of skills or concepts introduced or learned at the WHO Global Salm-Surv Training Courses. Focused Regional Projects are developed between training course participants and WHO Global Salm-Surv Steering Committee Partners focusing on regional food borne pathogens, serotypes, or public health practices of interest. The Salmonella Weltevreden Project, focusing on predominantly Southeast Asian and Western Pacific isolates of S.Weltevreden, is a successful example of a focused regional project. This study promoted collaboration between two regions and one of the Steering Committee Partners, DFVF, and generated interesting scientific results demonstrating that Weltevreden is associated with chicken, water and seafood, and has low levels of antibiotic resistance in the study regions. Importantly, this study showed that regions can successfully work together to learn more about food borne diseases (Patrick, et al, 2004).
Focused National Projects also promote application of science taught at the training courses and focus on encouraging interaction between microbiologists and epidemiologists within a country. Burden of Illness studies, surveillance enhancement, and investigation of predominant Salmonella serotypes are examples of types of Focused National Projects that can be performed. The Slovenia Burden of Illness Project is a direct example of a Focused National Project that developed as a result of interactions between Slovenian participants at the Poland Level III Course (April 2004) and WHO Global Salm-Surv Trainers. This study will encourage epidemiologists and microbiologists within Slovenia to use data for action and to build stronger relationships.
The goal of fostering communication among an international network of individuals working in food borne diseases is achieved through the WHO Global Salm-Surv Electronic Discussion Group (EDG), linking WHO Global Salm-Surv members through a listserv. Messages on the EDG range from programmatic issues, to solicitations for information on outbreaks or rare serotypes, to training materials and recent publications on food borne disease. Messages are provided in English, Spanish, and French, with an Arabic translation posted to the web.
A second method for information sharing in WHO Global Salm-Surv occurs through the WHO Global Salm-Surv Country Databank. This web-based databank contains the top fifteen Salmonella Serotypes submitted by WHO Global Salm-Surv General and Member Institutions in different nations. Data may be from human, animal, food, feed, or environmental sources.
The Country Databank can be accessed on the web and used by individuals or countries as a resource. For example, individuals can research rare serotypes or can explore the databank to learn more about prevalent serotypes in specific regions. WHO Global Salm-Surv Member Contact Information is also accessible from this database and members can contact each other regarding projects or outbreak investigations.
As WHO Global Salm-Surv concludes its fifth year as a program, it continues to mature and grow, continuing to build capacity and promote collaboration and communication among those working in food borne disease surveillance and outbreak detection and response. Current Training Regions will benefit as training course cycles continue and interactions between country and regional microbiologists (human, animal and food) and epidemiologists grow stronger. New regions for training courses will be launched in Central Asia, Eastern and Southern Africa, Brazil, and Europe to build regional capacity more globally. Additional participants will be encouraged to participate in EQAS and in Focused Regional or National Projects and more individuals and countries will be urged to take part in the Electronic Discussion Group and to contribute to and use the Country Databank. All of these strides will continue to make progress towards enhanced surveillance and response systems in an effort to reduce food borne disease worldwide.
1. Petersen A., Aarestrup F. M., Jensen A. B., Lo Fo Wong D., Evans M. C., Angulo F., et al. Results External Quality Assurance System (EQAS) of the WHO Global Salmonella Surveillance and Laboratory Support Project (Global Salm-Surv) Results from 2002.Available at : http://www.who.int/salmsurv/activities/GSS_EQAS/GSSequas2002page/en/. Accessed: 8 September 2004.
2. Patrick ME, Hendriksen RS, Lertworapreecha M, Aarestrup FM, Chalermchaikit T, Wegener HC, et al. Epidemiology of Salmonella Weltevreden in Southeast Asia and the Western Pacific – A WHO Global Salm-Surv Regional Research Project. In:Program and Abstracts of the 3rd International Conference on Emerging Infectious Diseases (Atlanta, Georgia). Atlanta: Centers for Disease Control and Prevention, 2004:62.