Foodborne diseases in developing countries: aetiology, epidemiology and strategies for prevention.

Our knowledge of diseases caused by biologically and chemically contaminated food varies considerably between developing countries. While in Latin America and the Caribbean some information regarding foodborne hazards, high-risk foods and the extent of any resulting disease is available, in many other developing countries little is known about the nature and extent of such diseases. Systematic foodborne surveillance activities, including epidemiological studies, are rarely undertaken. Public health authorities and the public frequently learn about the more dramatic disease outbreaks from news media. A good indication of the importance of food contamination for health and well-being is the information available about infant diarrhoea, infant/child and adult malnutrition. Both conditions are closely related to contaminated food and drinking water, and are particularly important public health problems in most developing countries, as is cholera. With regard to chemicals, little information is available in developing countries on the occurrence of food contamination. Without such information, the health of hundreds of millions of people may be threatened. Improving the safety of the food supply and reducing foodborne diseases requires the concept of shared responsibility to be adopted. All of society needs to accept that food is not only an agricultural and trade commodity but a public health issue. Consequently, Ministries of Health in all countries must integrate food safety as an essential public health function into their work.

Food safety in the 21st century.

The global importance of food safety is not fully appreciated by many public health authorities despite a constant increase in the prevalence of foodborne illness. Numerous devastating outbreaks of salmonellosis, cholera, enterohaemorrhagic Escherichia coli infections, hepatitis A and other diseases have occurred in both industrialized and developing countries. In addition, many of the re-emerging or newly recognized pathogens are foodborne or have the potential of being transmitted by food and/or drinking water. More foodborne pathogens can be expected because of changing production methods, processes, practices and habits. During the early 21st century, foodborne diseases can be expected to increase, especially in developing countries, in part because of environmental and demographic changes. These vary from climatic changes, changes in microbial and other ecological systems, to decreasing freshwater supplies. However, an even greater challenge to food safety will come from changes resulting directly in degradation of sanitation and the immediate human environment. These include the increased age of human populations, unplanned urbanization and migration and mass production of food due to population growth and changed food habits. Mass tourism and the huge international trade in food and feed is causing food and feedborne pathogens to spread transnationally. As new toxic agents are identified and new toxic effects recognized, the health and trade consequences of toxic chemicals in food will also have global implications. Meeting the huge challenge of food safety in the 21st century will require the application of new methods to identify, monitor and assess foodborne hazards. Both traditional and new technologies for assuring food safety should be improved and fully exploited. This needs to be done through legislative measures where suitable, but with much greater reliance on voluntary compliance and education of consumers and professional food handlers. This will be an important task for the primary health care system aiming at "health for all".

Food safety training for nutritionists.

A course on food safety for nutritionists has been developed in Indonesia through collaboration between government, industry, academia and international agencies. By teaching the basic principles of the subject it equips the participants to recommend foods that are safe as well as nutritious.

Food safety in international trade.

International approaches are indispensable in the management of foodborne risks to health. The contributions made by WHO and the World Trade Organization to achieving food safety are discussed below, and particular reference is made to the Agreement on the Application of Sanitary and Phytosanitary Measures and to the work of the Codex Alimentarius Commission.

Food safety and products from aquaculture.

Aquaculture is currently one of the fastest growing food production systems in the world with production increasing at an average rate of 9.6% per year over the past decade. As world fish stocks are reaching the limits of exploitation, we shall rely to a far greater extent on products from aquaculture as food sources of high nutritional value. Approximately 90% of global aquaculture production is based in Asia, where it provides an important source of dietary animal protein of the region and income for millions of small-scale farmers. Commercial aquaculture contributes significantly to the economies of many producing countries, where highly valued species are a major source of foreign. Many different aquaculture systems exist world wide, ranging from small family-sized fish ponds to intensive cage culture industries as used in salmon fishing. There has been an expansion in the use of integrated farming systems, especially in Asia, where animal and human faeces are used to fertilise ponds. This paper will review global aquaculture systems used in the production of finfish and crustaceans and will focus on potential hazards arising from biological contamination of products that pose risks to public health.

Foodborne disease control: a transnational challenge.

In the globalized political economy of the late 20th century, increasing social, political, and economic interdependence is occurring as a result of the rapid movement of people, images, values, and financial transactions across national borders. Another consequence of the increase in transnational trade, travel, and migration is the greater risk of cross-border transmission of infectious diseases. As the world becomes more interconnected, diseases spread more rapidly and effectively. With more than one million people crossing international borders every day, and with the globalization of food production, manufacturing, and marketing, the risk of infectious disease transmission is greater. Economic globalization has also increased the need for governmental budget austerity, and consequent national preparedness has been eroded. The emergence of new infectious diseases, as well as the reemergence of old ones, thus represents a crucial transnational policy issue. These problems cannot be resolved by national governments alone; they require international cooperation. This article analyzes the role of foodborne disease surveillance programs, nationally and internationally, in the control of foodborne diseases.

Global estimation of foodborne diseases.

Foodborne diseases are one of the most widespread health problems, but because of weaknesses in foodborne disease surveillance and variation in reporting systems between countries, it is difficult to make an estimation of their true incidence. This paper describes the constraints in the collection of information on the incidence and/or prevalence of foodborne diseases, including investigation and reporting at national and international levels. It also makes an attempt to semiquantify the occurrence of foodborne diseases of microbial and parasitical origin in different regions of the world.

Foodborne salmonellosis.

Foodborne diseases caused by non-typhoid Salmonella are a very important public health problem and an economic burden in many parts of the world. Salmonellosis data from the WHO Global Databank on Foodborne Disease, from the literature and from the WHO Surveillance Programme in Europe were reviewed for the years 1985-1995, showing an apparent increase in the incidence of salmonellosis in many parts of the world. In industrialized countries, this increase may be due to the emergence and increase of S. enteritidis and S. typhimurium DT104. In order to reduce the incidence of human foodborne salmonellosis, measures should be taken simultaneously during the production, processing, distribution, retail marketing and handling/preparation of food to prevent the introduction of Salmonella and its multiplication. These control measures need to be supported by effective foodborne disease surveillance programmes which make it possible to recognize and investigate outbreaks and emerging pathogens, and to assess the need for and evaluate interventions by monitoring longer term trends.

Improving the safety of street-vended food.

An integrated plan of action for improving street food involving health and other regulatory authorities, vendors and consumers should address not only food safety, but also environmental health management, including consideration of inadequate sanitation and waste management, possible environmental pollution, congestion and disturbances to traffic. However, WHO cautions that, in view of their importance in the diets of urban populations, particularly the socially disadvantaged, every effort should be made to preserve the benefits provided by varied, inexpensive and often nutritious street food. Therefore, authorities concerned with street food management must balance efforts aimed at reducing the negative aspects on the environment with the benefits of street food and its important role in the community. Health authorities charged with responsibility for food safety control should match risk management action to the level of assessed risk. The rigorous application of codes and enforcement of regulations more suited to larger and permanent food service establishments is unlikely to be justifiable. Such rigorous application of codes and regulations may result in disappearance of the trade with consequent aggravation of hunger and malnutrition. Moreover, most codes and regulations have not been based on any systematic identification and assessment of health hazards associated with different types of foods and operations as embodied in the HACCP approach which has been recognized by Codex as the most cost-effective means for promoting food safety. WHO encourages the development of regulations that empower vendors to take greater responsibility for the preparation of safe food, and of codes of practice based on the HACCP system.

Panel: el Codex Alimentarius e inocuidad de alimentos; el Codex Alimentarius y su importancia para la salud publica

Reunion Interamericana de Salud Animal a Nivel Ministerial, 10. Organizacion Panamericana de la Salud; 23-25 abr. 1997

Panel: el Codex Alimentarius e inocuidad de alimentos; el Codex Alimentarius y su importancia para la salud publica

Reunion Interamericana de Salud Animal a Nivel Ministerial, 10. Organizacion Panamericana de la Salud; 23-25 abr. 1997