The Role of an Food Examiner in the Control and Investigation of Food Poisoning Outbreaks John Waddell Glasgow Scientific Services.
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The Role of an Food Examiner in the The Role of an Food Examiner in the Control and Investigation of Food Control and Investigation of Food
Poisoning Outbreaks Poisoning Outbreaks
John WaddellJohn Waddell
Glasgow Scientific ServicesGlasgow Scientific Services
Three main rolesThree main roles
SurveillanceSurveillance
Enforcement Enforcement
Outbreak investigationOutbreak investigation
The Queen meeting local dignitaries, June 28 1964. (Aberdeen Journal)
L
“ Aberdeen in early summer 1964, was in the grip of a typhoid epidemic that was eventually to hospitalise over five hundred people. The Aberdeen outbreak highlighted the continuing potential for serious food poisoning episodes within modern food systems. It was the first such outbreak to attract intense media interest”.The Aberdeen Typhoid Outbreak, 1964
Lesley Diack and David Smith
Aberdeen 1964 – Typhoid OutbreakAberdeen 1964 – Typhoid OutbreakTraced to single 6lb Can of Traced to single 6lb Can of Argentinean Corned BeefArgentinean Corned BeefCooled in untreated river Cooled in untreated river waterwaterS.typhi thought to have S.typhi thought to have entered can through fault in entered can through fault in seamseamCross contamination from Cross contamination from meat slicer to other meat slicer to other productsproducts50 victims a day at height 50 victims a day at height of epidemic which lasted 3 of epidemic which lasted 3 monthsmonths500 hospitalised500 hospitalised
Wishaw 1996 - E.Coli 0157 Wishaw 1996 - E.Coli 0157 OutbreakOutbreak
Worst recorded case of E.coli 0157 food Worst recorded case of E.coli 0157 food poisoningpoisoning21 fatalities21 fatalitiesSource traced to apparently clean Source traced to apparently clean butcher’s shop butcher’s shop Cross contamination between raw and Cross contamination between raw and cooked meatcooked meatButchers licensing introduced as a Butchers licensing introduced as a consequenceconsequence
What did these outbreaks have in What did these outbreaks have in common?common?
Large outbreaksLarge outbreaks
Meat productsMeat products
Pathogenic organisms of faecal originPathogenic organisms of faecal origin
Causes of outbreaks hypothesised by Causes of outbreaks hypothesised by epidemiologistsepidemiologists
Inadequate HACCPInadequate HACCP
The Role of an Food Examiner in The Role of an Food Examiner in the Control and Investigation of the Control and Investigation of
Food Poisoning OutbreaksFood Poisoning Outbreaks
SurveillanceSurveillance
Enforcement Enforcement
Outbreak investigationOutbreak investigation
Food ExaminerFood Examiner
Food Safety Act 1990 places importance on role Food Safety Act 1990 places importance on role of microbiological monitoring processof microbiological monitoring process
The Food Examiner performs the statutory The Food Examiner performs the statutory function of Microbiological Examination of Foodfunction of Microbiological Examination of Food
This mirrors the Public Analysts responsibility for This mirrors the Public Analysts responsibility for Chemical Analysis of foodChemical Analysis of food
Food Safety (Sampling and Qualification) Food Safety (Sampling and Qualification) Regulations 1990 sets requirements for Regulations 1990 sets requirements for qualifications for Food Examinersqualifications for Food Examiners
Food Examiner’s ResponsibilitiesFood Examiner’s Responsibilities
Awareness of current legislation Awareness of current legislation Awareness of current methods and Awareness of current methods and standardsstandardsMethod selection and developmentMethod selection and developmentStaff trainingStaff trainingAchieve & maintain UKAS accreditationAchieve & maintain UKAS accreditation Awareness of emerging techniquesAwareness of emerging techniquesAwareness of emerging pathogensAwareness of emerging pathogens
SurveillanceSurveillance
Small local surveys ~ 20 samplesSmall local surveys ~ 20 samples
Medium sized surveys ~100 samplesMedium sized surveys ~100 samples
National surveys 1000sNational surveys 1000s
SurveillanceSurveillance
1990-Richmond Committee 1990-Richmond Committee RecommendationsRecommendations
Coordinated food surveillanceCoordinated food surveillance
Targeted food surveillanceTargeted food surveillance
More emphasis on HACCPMore emphasis on HACCP
National database to be establishedNational database to be established
Surveillance Surveillance
FSA commissioned HPS (April 2000) to FSA commissioned HPS (April 2000) to deliver UK Food surveillance systemdeliver UK Food surveillance system
Coordination of approach to surveillanceCoordination of approach to surveillance
FSS system established in 2002 by 4 FSS system established in 2002 by 4 APA Scottish labs + 4 Scottish NHSAPA Scottish labs + 4 Scottish NHS
IT and laboratory partnershipIT and laboratory partnership
FSS being rolled out across UKFSS being rolled out across UK
EnforcementEnforcement
Statutory Standards specified in Regulations Statutory Standards specified in Regulations
EC RegulationsEC Regulations
UK Regulations based on EC DirectivesUK Regulations based on EC Directives
UK RegulationsUK Regulations
Non-Statutory StandardsNon-Statutory Standards
Guidelines (e.g. HPA Guidelines for Food Guidelines (e.g. HPA Guidelines for Food Examiners)Examiners)
Industry Codes of PracticeIndustry Codes of Practice
Enforcement Enforcement
Range of Food Categories covered by EC Range of Food Categories covered by EC Microbiological Criteria RegulationsMicrobiological Criteria Regulations
Meat- carcasses, meat preparations, meat Meat- carcasses, meat preparations, meat products, MRM, minced meatproducts, MRM, minced meat
Dairy- milk, cheese, butter, cream, ice creamDairy- milk, cheese, butter, cream, ice cream
Shellfish - live and cookedShellfish - live and cooked
Fresh produce – fresh cut fruit and vegetables, Fresh produce – fresh cut fruit and vegetables, unpasteurised juice and sprouted seedsunpasteurised juice and sprouted seeds
Miscellaneous - e.g. Infant Foods, RTE foods, Miscellaneous - e.g. Infant Foods, RTE foods, Egg ProductsEgg Products
Surveillance + Enforcement = Surveillance + Enforcement = Prevention?Prevention?
SMA infant formula contaminated with SMA infant formula contaminated with Botulism sporesBotulism spores
Cadbury’s Chocolate contaminated with Cadbury’s Chocolate contaminated with Salmonella – Withdrawal of 1 Million barsSalmonella – Withdrawal of 1 Million bars
Cadbury’s lab found to have been using Cadbury’s lab found to have been using methods which underestimated the risk of methods which underestimated the risk of Salmonella contaminationSalmonella contamination
Current Rates for Food Current Rates for Food Poisoning Cases in ScotlandPoisoning Cases in Scotland
E.coli 0157 (~200 cases per annum)E.coli 0157 (~200 cases per annum)
Salmonella (~800 cases per annumSalmonella (~800 cases per annum
Campylobacter (~5000 cases per Campylobacter (~5000 cases per annum)annum)
What is an Outbreak?What is an Outbreak?
Two or more linked casesTwo or more linked cases
A greater than expected rate of illness or A greater than expected rate of illness or infection in the communityinfection in the community
A single case of certain serious, possibly A single case of certain serious, possibly contagious infections suggesting that there contagious infections suggesting that there will be many more in the community will be many more in the community
Outbreak Control TeamOutbreak Control Team
OCT are chaired by a CPHMOCT are chaired by a CPHM
Format and agenda in accordance with Format and agenda in accordance with Outbreak Control PlanOutbreak Control Plan
Purpose is to identify whether there is an Purpose is to identify whether there is an outbreakoutbreak
Identify the sourceIdentify the source
Identify the casesIdentify the cases
Stop the outbreakStop the outbreak
Learn from the outbreakLearn from the outbreak
Outbreak Control Team MembersOutbreak Control Team Members
CPHM(s)CPHM(s)Infection Control Specialist(s)Infection Control Specialist(s)EHO(s)EHO(s)Clinician(s)Clinician(s)Medical Microbiologist(s)Medical Microbiologist(s)
++Food Examiner(s)Food Examiner(s)
+ + Water AuthoritiesWater AuthoritiesOther agencies – Police, Public Relations etcOther agencies – Police, Public Relations etc
Targeted examinationTargeted examination
Based on clinical symptomsBased on clinical symptoms
Based on epidemiologyBased on epidemiology
Based on availability of sampleBased on availability of sample
Standard Microbiological Technique for Standard Microbiological Technique for Detection of PathogensDetection of Pathogens
1.1. Pre-enrichment – To boost the numbers Pre-enrichment – To boost the numbers of organisms to detectable levelsof organisms to detectable levels
2.2. Selective enrichment – To further boost Selective enrichment – To further boost the numbers of the target organism the numbers of the target organism whilst reducing levels of otherswhilst reducing levels of others
3.3. Selective isolationSelective isolation
4.4. PurificationPurification
5.5. ConfirmationConfirmation
Some pathogens can present new Some pathogens can present new challengeschallenges
E.coli 0157 – very low E.coli 0157 – very low infectious doseinfectious dose
Technique developed Technique developed using using Immunomagnetic Immunomagnetic Beads as an aid to Beads as an aid to isolationisolation
Principle of IMSPrinciple of IMS
-IMS + low volumes of sample low sensitivity of detection(e.g. 20 cfu/ml in PBS)
Campylobacter Campylobacter
Campylobacter – Campylobacter – Growth is Growth is microaerophilicmicroaerophilic
Requires incubation Requires incubation in modified in modified atmosphereatmosphere
+ complex nutritional + complex nutritional requirementsrequirements
The Role of an APA Food Examiner in the The Role of an APA Food Examiner in the Control and Investigation of Food Poisoning Control and Investigation of Food Poisoning
OutbreaksOutbreaks
SUMMARYSUMMARY
SurveillanceSurveillance
EnforcmentEnforcment
Outbreak InvestigationOutbreak Investigation
Pathogens that emerged in late 20Pathogens that emerged in late 20thth Century Century
Listeria monocytogenesListeria monocytogenesYersinia enterolyticaYersinia enterolyticaE.coli 0157E.coli 0157Campylobacter jejuniCampylobacter jejuniBSEBSECryptosporidiumCryptosporidiumHelicobacter pylori Helicobacter pylori HIVHIVSARSSARSAvian FluAvian FluClostridium difficileClostridium difficileLegionella pneumophilaLegionella pneumophilaEnterobacter sakazakkiEnterobacter sakazakkiMRSAMRSA
Thank you for listeningThank you for listening
Any Questions?Any Questions?
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