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Archiving of food samples from restaurants and caterers

Archiving of food samples from restaurants and caterers. Fumiko Kasuga National Institute of Health Sciences, Japan (National Institute of Infectious Diseases). An example of data collection for Hazard Characterization. Analysis of outbreak data in Japan. Hazard Characterization describes,.

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Archiving of food samples from restaurants and caterers

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  1. Archiving of food samples from restaurants and caterers Fumiko Kasuga National Institute of Health Sciences, Japan (National Institute of Infectious Diseases)

  2. An example of data collection for Hazard Characterization • Analysis of outbreak data in Japan

  3. Hazard Characterization describes, • Pathogen concerned • serotypes, virulence, toxins, etc • Population involved, susceptible, at risk • Vehicle foods • contaminated, protect pathogens against stomach acid, inactivate pathogens or inhibit proliferation • Dose response: how likely to get ill?

  4. Data for dose-response • Pathogen dose ingested • concentration in food • food amount taken • Attack rate (or P(infection), P(death), etc.) • population exposed • infected, ill, dead, etc.

  5. Data source for dose-response * Outbreak data has limitations, needs assumptions when used, but reflects real-world events.

  6. What we have experienced…

  7. Food and Agriculture Organizationof the United Nations World Health Organization Joint FAO/WHO Expert Consultation on Risk Assessment of Microbiological Hazards in Foods FAO Headquarters, Rome, Italy  17 - 21 July 2000 - Preliminary Report - Hazard Identification and Hazard Characterization of Salmonella in broilers and eggs MRA 00/03

  8. 1.0 1 2 0.9 3 4 0.8 5 7 0.7 11 12 0.6 13 18 Attack Rate 19 20 0.5 22 23 0.4 24 25 0.3 30 31 0.2 32 34 0.1 Otbrk-BP 0.0 0 1 2 3 4 5 6 7 8 9 10 Log Dose Beta-Poisson model for Salmonella spp. derived using outbreak data

  9. Why was it possible?

  10. Japanese Directive "Controlmeasures against foodborne outbreaks" • issued • in march 1997 • by Director General of Environmental Sanitation Bureau of the Japanese Ministry of Health and Welfare • large scale cooking facilities • more than 750 meals per day • more than 300 dishes of a single menu at a time • food saving • 50 gram aliquots of each raw food material and cooked dish • more than 2 weeks, lower than -20 C

  11. Original purpose of food-storing system was to improve identification of vehicle food by microbiological examination.

  12. Kitchen owners Food-storing system improvement of causative food identification • cost supply • Exposed • Ill • Food amount taken Health centers • epidemiological • investigation Complete data set for Hazard Characterization Coordination Quantitative data (concentration in food) co-operation with laboratories Prefectural laboratories • facility and technique • capacity • cost supply

  13. How do we combine those data?

  14. Outbreak reports • Format, elements vary • Essential elements are required to be included. • Rapid reports by FAX or e-mails • Changeable, not confirmed • Detail reports • Several months later • Administrative reports • in Japanese

  15. Outbreaks for which detail reports to MHLW are required (1) • With more than 50 patients • With less than 50 patients and with following characteristics • Death involved • Caused by imported food • Occurred in more than two prefectures by single source

  16. Outbreaks for which detail reports to MHLW are required (2) • With less than 50 patients and with following characteristics (continued) • Unique epidemiology, or complicated investigation and actions needed • Caused by the following pathogens • Yersinia enterocolitica O8 • Campylobacter jejuni / coli • Salmonella Enteritidis • Enterohemorrhagic E. coli • Clostridium botulinum

  17. Analysis of outbreak data (1989 – 1998) with Salmonella concentrations in implicated foods:In total 39 outbreak reports were collected, and they were divided into 5 categories upon settings.

  18. Outbreaks occurred at schools • Ages of pupils in an elementary school are 6 to 12. • Most schools serve the same lunch menu to all of their pupils on a single day. • All the pupils in the school are reasonably considered to be the exposed population in those outbreaks. • The exposed population to the contaminated food is usually very large

  19. Outbreaks occurred at schools

  20. Outbreaks occurred at schools

  21. Outbreaks occurred at daycare centers • The age of children is less than 1 up to 6 years old. • In general, the size of daycare population is smaller than that of schools and each daycare has its own kitchen in most places. • Therefore the exposed populations were smaller than those of school cases. • Attack rates were higher than those in school outbreaks, which might reflect the susceptibility of the population.

  22. Outbreaks occurred at daycare centers

  23. Outbreaks occurred at hospitals • Hospital inpatients are generally considered to be more susceptible to pathogens than the healthy, normal population. • The attack rates in collected outbreaks, however, were not very high. • the influence of concurrent medications including antibiotics??

  24. Outbreaks occurred at hospitals

  25. Outbreaks occurred at restaurants, hotels, caterers, and other business kitchens(20 outbreaks) • Kitchens vary in size, the scale of outbreaks also differs. • Amounts of ingested food were not always specified in the original reports, and assumptions were often made to estimate ingested dose of pathogens. • The food storage conditions were also different among the outbreaks.

  26. Outbreaks caused by confectionaries(6 outbreaks) • Number of exposed people varies much in this group, from small outbreak with 5 cases to very large outbreak with more than one thousand.

  27. Comparison of dose-response from outbreaks where food samples were kept frozen or not- effect of freezing food system

  28. Outbreaks where food portions were stored frozen

  29. Outbreaks where food portions were not frozen

  30. Summary of my talk (1) Food-storing system • Might be a good example of co-operation of management and assessment. • Existing measures helped data collection for risk assessment. • Very useful for developing dose-response models. • Need to encourage local authorities to continue enumeration of causative microbes. • May need additional mechanism, cost supply.

  31. Summary of my talk (2) Outbreak reports • Not always comprehensive, improvement of epidemiological investigation and report formatting needed. • Case definition, recognition of foodborne outbreak is not systematically defined. • Underestimation of reported cases. • Many outbreak reports are useful. • Translating to English under discussion. • Current summary to be available.

  32. Thank you! Co-workers: Masamitsu Hirota1), Masamichi Wada2), Toshihiko Yunokawa3), Hajime Toyofuku4), Masaki Shibatsuji5), Hideshi Michino5), Toshiaki Kuwasaki5), Susumu Kumagai6), Shigeki Yamamoto1) 1)National Institute of Health Sciences 2)Nagano Research Institute for Health and Pollution 3)National Institute of Public Health 4)Food Safety Programme, World Health Organization 5)Ministry of Health, Labour and Welfare 6) The University of Tokyo Special advisors: Anna Lammerding, Aamir Fazil, Eric Ebel

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