WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 7th Report FRANCE (FRA)

Transcription

1 WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe FRANCE (FRA) Population: 60.2 million Area: km 2 The designations and the presentation of material on this map of the Member States of the WHO European Region (as at 31 July 1997) do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines represent approximate border lines for which there may not yet be full agreement. 1. General information In France, foodborne diseases surveillance relies on 3 surveillance systems (figure 1): 1. Mandatory notification of foodborne outbreaks, botulism, brucellosis and listeriosis 2. Surveillance data from National Reference laboratories (CNR): salmonellosis, listeriosis 3. National hospital network: Haemolytic Uraemic Syndrome (HUS). 1.1 Mandatory notification of foodborne outbreaks An outbreak is defined as the occurrence of at least two cases of a similar illness, usually gastro-intestinal, due to the consumption of a common food product. Botulism and listeriosis are notifiable even for a single case. Notifications are done by general practitioners, hospital physicians, medical laboratories. Foodborne outbreaks can also be notified by the head of the establishment (schools, restaurants, etc.) or the head of the family where the cases occur. Outbreaks are investigated by the local public health authorities (DDASS = Direction Départementale des Affaires Sanitaires et Sociales) and Veterinary officers (DSV = Services Vétérinaires Départementaux). Standardized reports are sent to the French Public Health Institute (Institut de Veille Sanitaire) and Department of Agriculture. Theses reports are pooled and analyzed on an annual basis after checking for double notifications. The results are annually published in the Bulletin Epidémiologique Hebdomadaire.

2 Notifications, investigations of outbreaks and collaboration between local Public Heath Authorities and Veterinarian Services have been strengthened in 1987 by the implementation of the following measures: - An information was sent to physicians to improve the notification, - Guidelines dealing with methodology of investigations and control measures were provided to local Health and Veterinarian Services, - An epidemiological software TIAC was developed to encourage case control studies and facilitate data analysis in foodborne outbreak management. 1.2 Contribution of National Reference Centres Contribution of National Reference Centres in foodborne diseases surveillance consists in: - microbiological expertise (typing) of strains sent by medical laboratories - epidemiological surveillance - early warning - technical advisory function For example, the National Reference Centre for Salmonella and Shigella receives: Strains of Salmonella from medical laboratories Epidemiological informations about Salmonella strains isolated in laboratories performing serotyping. Data analysis according to serotype and place (department) and date of isolation allows to detect an unusual increase of a serotype which may be due to the consumption of a commercialized contaminated product. For foodborne infections, bacteria under surveillance by National Reference Centres are: Salmonella, Shigella, Yersinia, Campylobacter, Vibrio, anaerobic bacteria (Clostridium perfringens and Clostridium botulinum), Listeria

3 Figure FR 1 Surveillance of foodborne diseases Laboratories Physicians Head of establishments Cases Mandatory Notification Isolates DDASS DSV Epidemiological studies Microbiological analyses (cases, food) Study of food chain Identification : -microorganism - Food - contributing factors - lots - supply Control measures CNR InVS Ministry of Agriculture Trend analysis Establishing of alert thresholds Data Analysis 1.3 National hospital network Since 1996, a surveillance system based on a national network of pediatric nephrology departments has been established for the monitoring of HUS in children under 15 years and is ruled by the InVS

4 2. Notified cases of foodborne diseases (mandatory notification + laboratories and hospital networks) Table FR 1 Notified cases of foodborne diseases FRANCE Disease Salmonellosis* Incidence rate** Listeriosis Incidence rate SHU E.coli O157+other serogroups/not O / / / /2 Trichinellosis Brucellosis* * Source of data: EU Zoonoses Reports ** per Mandatory notification Botulism Botulism is notifiable whether it occurs as single case or if more than one person is involved. The incidents are reported by the DDASS and the National Reference Centre for anaerobic microorganisms at the Institut Pasteur. The number of episodes of botulism is given in Table FR 2. Table FR 2 Botulism incidents reported in mandatory notification framework. FRANCE Total No. of episodes N of cases Foodborne outbreaks The following results include foodborne outbreaks notified in the framework of mandatory notification on one hand and the outbreaks of salmonellosis and shigellosis, reported by the National Reference Centre (CNR) on the other hand. Data collected from mandatory notification and data collected from the CNR can't be pooled for two main reasons: - there is actually no way to identify common notifications between the two systems; - the CNR provides data only for salmonellosis and shigellosis outbreaks. The foodborne origin of these outbreaks is not confirmed

5 Salmonellosis outbreaks notified by the CNR are used to assess the exhaustivity of the mandatory notification framework for salmonellosis outbreaks. In 1995, the exhaustivity of the mandatory notification system for salmonellosis outbreaks has been estimated to 20%. Because of previously discussed reasons, epidemiological characteristics of outbreaks are presented only for foodborne outbreaks reported in the mandatory notification framework. 3. Epidemiological characteristics of outbreaks The total number of reported outbreaks from 1988 to 1997, including mandatory notifications on one hand and CNR notifications on the other hand is shown in figure FR 2 and table FR 3. Figure FR 2 Foodborne Diseases Outbreaks Reported in Mandatory Notification Framework and by CNR France Mandatory notifications of foodborne outbreaks Outbreaks of salmonellosis or shigellosis reported by the CNR BgVV; FAO/WHO Centre, Berlin Table FR 3 Foodborne outbreaks reported in the mandatory notification system and number of cases involved FRANCE Outbreaks Cases

6 3.1 Causative agents Table FR 4 Confirmed causative agents in foodborne outbreaks reported in the mandatory notification system FRANCE Total No. % Salmonella Clostridium perfringens Staphylococcus aureus Histamine Bacillus cereus Shigella Others DSP Trichinella Hepatitis A Clembuterol Total agent identified Agent not identified Total Figure FR 3 Foodborne Disease Outbreaks Confirmed Causative Agents France Salmonella spp. 88,7% Cl.perfring.1,9% Agent not identified 34,8% Agent identified 65,2% Staph.aureus 3,7% Others 5,7% Total outbreaks agent identified: 1428 Total outbreaks agent not identified: 761 BgVV; FAO / WHO Centre, Berlin - 6 -

7 Table FR 5 Salmonella serotypes in foodborne outbreaks reported in the mandatory notification system. FRANCE Total No. % Enteritidis Typhimurium Heidelberg Virchow Hadar Others serotypes Total serotypes identified Non identified serotypes Total Salmonella Figure FR 4 Foodborne Disease Outbreaks Salmonella Serotypes France 1993 and S.Enteritidis 62,5% S.Enteritidis 58,7% Unknown 18,0% Unknown 12,9% S.Typhimurium 13,5% Other 6,0% S.Typhimurium 20,4% Other 8,0% BgVV; FAO / WHO Centre, Berlin - 7 -

8 3.2 Incriminated food Table FR 6 Food S. Enteritidis Foodborne outbreaks by incriminated foods and confirmed or suspected causative agents (Outbreaks reported to D.D.A.S.S. or D.S.V.) FRANCE Salmonella S. Typhimuriu m Other Serotypes Not serotyped Causative agent Cl. Staph. perfr. aureus Other agents Unknown Total No. % Milk/milk products Eggs/egg products Meat Poultry Fish/shellfish Other foods Unknown Total Figure FR 5 Foodborne Disease Outbreaks Incriminated Foods France Poultry 4,4% Fish and fish prod. 9,4% Milk and milk prod. 5,3% Eggs/-prod. 32,8% Meat and meat prod. 11,0% Other 13,1% Total outbreaks: 2189 Unknown 24,0% BgVV; FAO/WHO Centre, Berlin - 8 -

9 3.3 Place where food was acquired or eaten Table FR 7 a Foodborne outbreaks by place where food was acquired or eaten FRANCE Place Year Total No. No. % Private Home Total collectives School Social/Medical Institutions * Canteen (restaurant in a work establishment) Restaurant Other communities ** Community wide *** Unknown TOTAL * hospitals, homes for elderly people, kindergarten etc. ** holiday resorts, prisons, gatherings *** Several establishments or families with the same source of contamination - 9 -

10 Table FR 7b Total foodborne outbreaks by confirmed or suspected causative agents and place where food was eaten FRANCE Place Causative agent Salmonella Cl. Perfr. B. cereus Staph. aureus other agents Histamine Unknown Total S. Enteritidis S. Typhimurium Other Serotypes Not serotyped Schools Canteen Social/Medical Institutions * Restaurants Other Communities* * Private home Community wide *** Unknown TOTAL * hospitals, homes for elderly people, kindergarten etc. ** holiday resorts, prisons, gatherings *** Several establishments or families with the same source of contamination Figure FR 6 Foodborne Disease Outbreaks Place where Food was Eaten France School/kindergarten 16,7% Canteen 5,3% Other community 13,2% Restaurant,hotel 14,8% Medical care fac. 7,4% Unknown 1,0% Community wide 2,1% Private home 39,6% BgVV; FAO/WHO Centre, Berlin Total outbreaks:

11 While most of the total number of outbreaks from were reported to occur in various places outside from home, the majority of the salmonellosis outbreaks were reported to occur in private homes (see Figure FR7). This different frequency distribution reflects the efficacy of the control measures that have been implemented to reduce salmonellosis hazards in the restauration/public sector. In private homes, education programmes (e.g. storage and cooking) may, therefore, be needed as complementary measures to limit the transmission of salmonellosis. Figure FR 7 Salmonella Outbreaks by Place where Food was Eaten France Other community 9,5% Medical care fac. 6,0% School/kindergarten 7,1% Canteen 1,5% Restaurant,hotel 13,5% Unknown 0,8% Community wide 2,7% Private home 58,8% BgVV; FAO/WHO Centre, Berlin Total Salmonella outbreaks:

12 3.4 Contributing factors Table FR 8 Foodborne disease outbreaks by contributing factors FRANCE Figure FR 9 Contributing Factor Total Outbreaks No. No. * % Contaminated raw material Environmental contamination - personnel equipment Faults in processing Temperature misuse - preparation too far in advance inadequate heating inadequate cooling Total * More than one factor is mentioned in some outbreaks Foodborne Disease Outbreaks Contributing Factors France BgVV; FAO/WHO Centre, Berlin 4. Additional Information The French National Institute for Public Health Surveillance (Institut de Veille Sanitaire) publishes a weekly electronic epidemiological bulletin (B.E.H) that can be found at: For further reference on national and international data on foodborne diseases please visit the web page