A Systems Approach for Responding to Foodborne Hazards and Illness Outbreaks in Ontario

Transcription

1 A Systems Approach for Responding to Foodborne Hazards and Illness Outbreaks in Ontario Amrita Maharaj Public Health Ontario May 29, 2014 Prepared for: Public Health 2014, Annual Conference of the Canadian Public Health Association

2 Objectives To present a systems approach for increasing coordination and communication among local, provincial and federal departments with food safety and communicable disease responsibilities To illustrate mechanisms for integrating science and policy to effectively investigate and manage foodborne hazards and illness To demonstrate the application of a systems approach to responding to an Escherichia coli outbreak in Ontario 2

3 Why the need for a systems approach? Globalization Impacts Increased morbidity and mortality Increased health care costs 6 4 Economic Performance Products moving across jurisdictional boundaries Shared roles and responsibilities Economic losses Loss of consumer confidence 3

4 Ontario Foodborne Illness Outbreak Response Protocol (ON-FIORP) Scope Potential foodborne hazards and illness outbreaks resulting from natural, accidental, or intentional contamination of foods by microbiological, chemical, physical, or other hazardous substances (e.g. radiological hazards) 4

5 Responding to foodborne hazards and illness outbreaks involves many partners Public Health Units Ministry of Health and Long-Term Care Public Health Ontario Ontario Ministry of Agriculture and Food Ministry of Environment Ministry of Natural Resources Provincial Canadian Food Inspection Agency Public Health Agency of Canada Health Canada Local Federal 5

6 How do partners work together? Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief 6

7 E. coli Outbreak Ontario Fall 2013 Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief Cluster of E. coli O157:H7 cases in multiple health units Two cases reported consuming the same brand of frozen hamburger Immediate notification of partners Control sample for the brand of frozen hamburger submitted for testing PHO requests health units re-interview other cases about exposure to frozen hamburger Day 1 Timeline of Events 7

8 E. coli Outbreak Ontario Fall 2013 Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief Assessment call initiated Outbreak declared Ontario Outbreak Investigation Coordinating Committee established to coordinate the investigation Public Health Alert and Enhanced Surveillance Directive issued to all Ontario jurisdictions Day 1 Day 4 Timeline of Events 8

9 E. coli Outbreak Ontario Fall 2013 Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief Review weight of evidence Confirmation that all cases reported eating frozen hamburgers, with almost all cases identifying the same brand of product CFIA begins sampling lots of product from retail stores for testing Request to Health Canada for a health risk Day 1 Day 4 Day 5 Timeline of Events 9

10 E. coli Outbreak Ontario Fall 2013 Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief Health Risk Assessment concludes that brand of frozen hamburgers may pose a risk to consumers Manufacturer issues voluntary recall of product CFIA issues consumer Health Hazard Alert Day 1 Day 4 Day 5 Day 6 Timeline of Events 10

11 E. coli Outbreak Ontario Fall 2013 Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief Regular information sharing among partners Retail samples confirmed positive for E. coli O157:H7 Recall expanded to include additional products Communications to the public by multiple jurisdictions Additional cases reported in Ontario Day 1 Day 4 Day 5 Day 6 Day 7-24 Timeline of Events 11

12 E. coli Outbreak Ontario Fall 2013 Identification of foodborne hazard or human illness potentially linked to food Notification of partners Initial Notify ON- FIORP representatives Activation of ON-OICC Epidemiological, food safety and laboratory investigation Central integrated analysis Health risk Public health and food safety actions Food recalls Public communication Response conclusion Postoutbreak debrief Continued surveillance for cases, but no new cases identified Monitoring of effectiveness of recall Outbreak declared over and ON-OICC dismantled November 19, 2013 Day 1 Day 4 Day 5 Day 6 Day 7-24 Day Timeline of Events 12

13 What have we learned? ON-FIORP allows partners to identify potential outbreaks and linkages to food sources at an early stage Enhances routine information sharing about ongoing foodborne surveillance findings of potential concern Protocol provides an effective and streamlined process to respond to foodborne illness outbreaks and hazards Helps ensure the right partners are at the table at the right time Effective process for integrating science into policy decisions The ON-FIORP is adaptable Operating procedures have provided a mechanism to assist with the coordination of responses to outbreaks and hazards that are not covered under the protocol 13

14 Acknowledgements Tony Amalfa, Ontario Ministry of Health and Long-Term Care Nina Arron, Ontario Ministry of Health and Long-Term Care Nomi Caplan, Ontario Ministry of Health and Long-Term Care Lisa Fortuna, Public Health Ontario Moira Grant, Public Health Ontario Mark Nelder, Public Health Ontario Brian Schwartz, Public Health Ontario Hilary Stone, Ontario Ministry of Health and Long-Term Care Dawn Williams 14

15 Questions? 15