Practical 1
DISEASE REPORTING SYSTEM IN NEPAL
Objectives:
·
To know the flow of health related information in Nepal
·
To know about different authorities responsible for disease reporting
·
To understand Nepal;s Health Management Information System (HMIS)
Comments:
Sentinel
Reporting:
Sentinel reporting uses data from
a few selected sites rather than the data from all sites. It is particularly
useful as a compliment to the routine system when routine reports are late,
incomplete or inaccurate. Sentinel surveillance is the collection and analysis
of data by designated institutions selected for their geographic location,
medical specialty, and ability to accurately diagnose and report high quality
data. For example, district hospitals may be required to report specific
conditions such as AGE in order to quantify the burden of disease. Generally,
sentinel surveillance is useful for answering specific epidemiologic questions,
but, because sentinel sites may not represent the general population or the
general incidence of disease, they may have limited usefulness in analyzing
national disease patterns and trends.
Sentinel reports can serve as a
useful early warning system. Data from a sentinel hospital are available more
quickly than the data from the districts as a whole and can provide an early
warning of outbreaks. These health facilities report the number of cases of
disease that occur for a specific time period. They will also be asked to
report additional information, such as age, location, immunization status,
etc., as well as weekly “ZERO” reports (no occurrence of cases). Sentinel sites
are chosen because they are likely to see cases of a certain disease in a
certain age group, and their staff have been trained and motivated, and are
willing to report timely, regularly and accurately.
Early
Warning Reporting System (EWARS):
Early Warning Reporting System
(EWARS) is a hospital-based sentinel surveillance system currently operational
in 40 hospitals throughout Nepal. EWARS is designed to complement the country’s
Health Management Information System (HMIS) by providing timely reporting for
the early detection of selected vector-borne, water and food borne diseases
with outbreak potential.
The hospital based reporting
provides timely signal or alert and early detection of possible outbreak due to
increased number of cases in the community leading to continuous transmission
of the disease for timely response. This dynamics is lacking with HMIS being a
monthly reporting system. The main objective of EWARS is to strengthen the flow
of information on vector borne and other outbreak prone infectious diseases
from the districts; and to facilitate prompt outbreak response to be carried
out by Rapid Response Teams (RRTs) at Central, Regional and District level,
which can be mobilized at short notice to support the local levels (DHO/HP/SHP)
in case investigation and outbreak control activities.
In the broader perspective, it
also aids on program planning, evaluation, and the formulation of research
hypotheses and to disseminate data/information on infectious diseases through
appropriate feedback system. It was established in 1997 first in 8 sentinel
sites and expanded to 24 sites in 1998, 26 sites in 2002, 28 sites in 2003 and
40 sites in 2008. The EWARS mainly focuses on the weekly reporting of number of
cases and deaths (including "zero" reports) of six priority diseases:
three vector-borne diseases Malaria, Kala-azar and Dengue and three outbreak
potential diseases Acute Gastroenteritis (AGE), Cholera and Severe Acute
Respiratory Infection (SARI). It equally focuses on immediate reporting (to be
reported within 24 hours of diagnosis) of one confirmed case of Cholera, and
severe and complicated Malaria and one suspect/clinical case of Dengue as well
as 5 or more than 5 cases of AGE and SARI from the same geographical locality
in a one week period. Based on the experiences of reported outbreaks of acute
diarrhoeal diseases and influenza by several districts, these two diseases are
included for reporting in EWARS from the year 2005. Likewise, Dengue and DHF
case reporting will be required to be reported in EWARS due to its high
potential of impending epidemics. Other communicable diseases besides these six
prioritized diseases also need to be reported in EWARS, whenever the numbers of
cases exceed the expected level.
Information
Flow Mechanism in EWARS:
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It is very important to
understand this flow diagram describing the flow of information at different
levels. Since, the response/actions are expected at each level. And it is
equally important that the flow of information should be timely and regular, thus
unduly delays are avoided for appropriate functioning of EWARS. The suspected
cases of EWARS reportable diseases originate in the availability of the
services referred to district level hospitals. With respect to EWARS, the
report (both immediate and weekly) is generated at the hospitals (district,
zonal, regional and sub-regional, central and others) called the sentinel site.
Each sentinel site sends those reports to VBDRTC, Hetauda and this institution
consolidates the reports of all reporting sites and sends both immediate and
weekly summaries to EDCD as well as to the respective public health offices-
only the immediate reports requiring rapid actions. EDCD on receipt of the
summaries prepares a weekly bulletin and disseminates to all sites and relevant
stakeholders as a feedback for timely and appropriate actions.
Reporting
system: SENTINEL SITE LEVEL
Type and
frequency:
a. Type One- Immediate report
(EWARS-2): The sentinel hospitals prepare IMMEDIATE REPORT within
24 hours of confirmation of diagnosis (clinical and/or laboratory) of all EWARS
reportable diseases except Kalaazar. The importance of reporting of those
diseases are determined due to their high potentials to outbreaks, and targeted
for disease control. In order to confirm to report immediately is guided by
their threshold to report, likewise vector borne diseases (VBDs) one case of
severe and complicated malaria, suspected Dengue/DHF; Airborne disease 5 cases
of Severe Acute Respiratory Infection (SARI) in one week period from one
locality and water/food borne diseases one case of confirm Cholera and 5 cases
of Acute Gastroenteritis from one locality in one week period. The frequency
will be every 24 hours.
b. Type Two-
WEEKLY Report (EWARS-3): The sentinel hospitals prepare
WEEKLY REPORT on the basis of epidemiological week calendar (starts on Sunday
and ends on Saturday). Epidemiological week calendar for each calendar year
starts on the first week of January, which will be Epidemiological Week 1 and
ends on lasts week of December i.e. Epidemiological Week 52. For example for
the year 2022 starts from December 26 (Epidemiological Week 1) and ends on
December 25 (Epidemiological Week 52). The report of the week consists of the
cases of this particular week including those reported in immediate reports.
Thus, the frequency will be every week of the corresponding Epidemiological
Week.
Linkage with
DPHO or Public Health Section in DHO
Transmission
of reports
A. Immediate
reports: Consolidated immediate reports should be verified and signed by Medical
Recorder and Medical Superintendent of the hospital and faxed to both EDCD (Fax
number 01-4262268) and VBDRTC (Fax number 057-521826). The fax transmission
result should be attached with the original report and filed for record (this
helps in determining the timeliness and regularity)
B. Weekly
reports: Consolidated weekly reports should be prepared for the epidemiological
week and sent by fax to VBDRTC by Tuesday noon of the following week.
Timeliness: The
timeliness and regularity of the report for that reporting week is categorized
as follows:
a. On time
Report: Report of following epidemiological week received at VBDRTC before
Tuesday noon.
b. Late
Report: Report of following epidemiological week received at VBDRTC before Friday
noon.
c. No Report: Not
receiving of Report till Friday noon at VBDRTC.
Note:
·
If the reports cannot be sent through fax due to various reasons; it can be
sent through courier and the duplicate of receipt should be kept for file
record.
·
If either of the mechanism doesn't work, it is advisable and wise to
inform/report VBDRTC and/or EDCD by telephone for timely action. If you have
access of internet send the report by e-mail for timely response, later send
report by post.
Reporting
system: VBDRTC, Hetauda
Vector-borne Disease Research and
Training Center (VBDRTC) serves as a focal point for EWARS by receiving and
consolidate all immediate and weekly reports sent from the sentinel hospitals.
VBDRTC has two functions:
a. Every immediate reports
received from the sites are consolidated within the day the reports are
received and sends to respective DHOs/DPHOs for action and also to EDCD
b. Weekly reports received from
all sites within the reporting week are consolidated in 8 different tables as
follows and sent to EDCD by e-mail and fax by Friday evening of the following
week.
Function of
EDCD in EWARS
EDCD compiles, analyzes and
disseminated the weekly report as a feedback to the all sites by preparing a
EWARS Bulletin.
The product of the week on
National epidemiological information with importance of outbreaks for the week
are disseminated to all sentinel sites including all major health institutions
of 75 districts in Nepal. Along with the epidemiological report, recent
developments in epidemiology in other countries, WHO fact sheets, WHO Press
releases, CDC Atlanta fact sheets, epidemiological analysis of the outbreaks,
public health related articles, reports and information on zoonotic diseases
and Food safety and food borne illnesses are included on the back page of EWARS
bulletin.
In addition to the above, EDCD
facilitates in resource mobilization for EWARS related activities like printing
of EWARS guidelines and forms, laboratory supplies, outbreak investigation with
logistics and supplies, training and coordination with related organizations.
CONCLSION……..
Practical 2
ONE HEALTH IN
PRACTICE: UNDER-NUTRITION IN CHILDREN LESS THAN FIVE YEARS OLD AND GASTRO-INTESTINAL
PARASITE BURDEN IN CHILDREN AND DOGS IN A COMMUNITY
Comments
Malnutrition is a state in which an imbalance
in nutrient intake results in one of two main outcomes- undernutrition or
obesity. Malnutrition is attributed to various factors such as age, chronic
illness, and medication intake. Another important factor is gastrointestinal
parasite burden in children. A questionnaire survey was developed to assess the
nutritional status of children and gastro-intestinal parasite burden in them.
Questionnaire
Name / Identification code of parents:…………………………….Address……………..
Name / Identification code of child:
Age:…………………Weight:……..Height:…………BMI:………………….
1.
Is there any weight loss of your child greater than 6 kg in last six
months? YES/NO
2.
Does your child finishes all food on the plate or left some
parts?..........................................
3.
Does your child feel hungry and ask for food frequently (2-3 hrs
interval)?????? YES/NO
4.
Do you visit pediatrics when your child have loss of appetite? YES/NO
5.
If Yes, how frequently?..........................
6.
Does your child consume enough protein like meat, fish eggs or legumes?
YES/NO
7.
Do you provide any supplemental drinks to your child? YES/NO
8.
Has your child experience diarrhea for the last 6 months? YES/NO
9.
Do you give your child deworming tablets regularly in a programmed way?
YES/NO
10. How frequently do your family members have
problem of diarrhea or abdominal pain?........
11. Do you own pet animals like cat or dogs?
YES/NO
12. DO your pet animals roam outside your house
in the community? YES/NO
13. Have you ever seen diarrhea in your pets?
YES/NO
14. If yes, how frequently?...........
15. Did you treat diarrhea for your pets? YES/NO
16. Do you have any idea about regular deworming
of your pets? YES/NO
17. If yes, do you practice regular deworming for
your pets?
18. Do you and your community members know about
parasitic zoonosis caused by pets? YES/NO
Practical
3
TITLE: GUIDELINES OF FAO-WOAH-WHO-UNEP ON ONE HEALTH
Comments:
One Health has recently been defined by the
One Health High-Level Expert Panel (OHHLEP) as “an integrated, unifying
approach that aims to sustainably balance and optimize the health of people,
animals and ecosystems. It recognizes the health of humans, domestic and wild
animals, plants, and the wider environment (including ecosystems) are closely
linked and inter-dependent. The approach mobilizes multiple sectors,
disciplines and communities at varying levels of society to work together to
foster well-being and tackle threats to health and ecosystems, while addressing
the collective need for clean water, energy and air, safe and nutritious food,
taking action on climate change, and contributing to sustainable
development”.
Update on FAO’s work on the One Health
approach including the One Health Joint Plan of Action
(16-20 May 2022)
EXECUTIVE SUMMARY
·
The
Programme Committee, at its 130th Session, welcomed the integration of
recommendations from FAO Technical Committees for the mainstreaming of One
Health in the work of the Organization.
·
The
Council, at its 166th Session, welcomed FAO’s One Health work, including the
positive collaboration within the Tripartite and UNEP and their work to develop
reporting mechanisms and a joint strategy and joint work plan on One Health.
·
Recognizing
the fundamental importance of One Health in the agriculture and food sectors,
FAO has identified One Health as a cross-cutting and important concept that
needs to be considered across the Programme Priority Areas of its Strategic
Framework 2022-31, and specifically in the One Health Programme Priority Area
(PPA-BP3).
·
This
document provides an overview and an update on FAO’s One Health activities
across the Organization, in particular through the collaboration between FAO,
the World Health Organization (WHO), the United Nations Environment Programme
(UNEP) and the World Organisation for Animal Health (OIE) (Quadripartite)
partners to support global governance of One Health and foster comprehensive
One Health at country level.
·
This
document provides also an update on the development of the One Health Joint
Plan of Action (previously called the Global Plan of Action on One Health).
·
Substantial
progress has been made over the past year to mainstream One Health globally,
regionally and nationally through multiple initiatives that help with
collaboration, networking, knowledge sharing, communication and awareness
raising.
·
FAO
is now scaling up its efforts, in collaboration with partners, towards the
application of One Health along the entire agrifood systems domain to build
sustainable agrifood systems and reduce global health risks.
GUIDANCE SOUGHT FROM THE PROGRAMME COMMITTEE
The Programme Committee is invited to review the content
of the document and provide guidance as deemed appropriate.
Draft Advice
The Committee:
·
noted
with appreciation the progress on the mainstreaming of the One Health approach
in FAO’s work and on the coordination of One Health activities under the
Quadripartite partnership; and
·
noted
the initiative of developing a One Health Joint Plan of Action (OH JPA) by the
Quadripartite (FAO/WHO/UNEP/OIE).
I. Background
1. FAO promotes One Health in its work
related to animal and plant health, food safety, nutrition, antimicrobial
resistance (AMR), fisheries and the health of the environment. Recognizing the
fundamental importance of One Health in these activities, FAO is now scaling up
its efforts, in collaboration with partners, towards the application of One
Health along the entire agrifood systems domain to improve food security and
livelihoods. This is critical for achieving the 2030 Agenda for Sustainable
Development and the related Sustainable Development Goals (SDGs). More
information on One Health collaborative and integrative activities can be found
in the document “Strengthening national coordinated capacities to manage the
risks of animal diseases and emerging zoonoses through the One Health approach”
presented in the Committee on Agriculture (COAG) Sub-Committee on Livestock
(March 2022).
2. In its Strategic Framework 2022-31,
FAO has identified One Health as a cross-cutting and important concept that
needs to be considered across the four betters and specifically in its
One Health Programme Priority Area (PPA-BP3). In doing so, the intent is to
promote a more systematic mainstreaming and operationalization of One Health
across all of FAO’s work.
3. The One Health PPA-BP3 promotes an
integrated and coordinated One Health approach to reduce losses to agrifood
systems and adverse ecosystems impacts, caused by the spread of animal, plant
and aquatic pests and diseases, including zoonotic infections of pandemic
potential and antimicrobial resistance (AMR). The main goals of the PPA are to
enhance productivity, and reduce risks from biological threats, applying
integrated pest and biosecurity management approaches at national level for
more sustainable, resilient, and inclusive agrifood systems, in a changing
climate and environment.
4. FAO supports the mainstreaming of
One Health globally, regionally, and nationally through multiple initiatives
that help with collaboration, networking, communication, and awareness-raising.
Internal efforts promote intra-organization exchange, learning and the
consolidation of One Health activities.
5. External efforts on One Health
build on and benefit from collaborations with the World Health Organization
(WHO), the United Nations Environment Programme (UNEP) and the World
Organisation for Animal Health (OIE). At its annual executive meeting in March
2022, the FAO/WHO/OIE Tripartite signed a Memorandum of Understanding with UNEP
to formally establish the Quadripartite.
6. Under this quadripartite partnership, substantial
progress has been made over the past year particularly to collectively develop
the One Health Joint Plan of Action (OH JPA).
II. Mainstreaming One Health in FAO programmes and
country support
7. FAO has longstanding experience in
One Health with its work on zoonotic diseases, food safety and antimicrobial
resistance. Important efforts are ongoing to broaden this scope and mainstream
One Health across agrifood systems, spanning multiple sectors and disciplines
including biodiversity, biosecurity, soil and microbiome health as well as
water quality and safety. The broadening and mainstreaming of One Health across
the agrifood system domain helps build sustainable food systems to improve food
security and reduce global health security risks.
8. To support this dynamic and
synergize FAO's One Health work across the Organization, FAO launched a
cross-cutting interdisciplinary One Health Technical Working Group (OH-TWG) in
July 2021. It helps to mainstream One Health across the agriculture and food
sectors and to understand and address connections between biodiversity, food
production and the health of people, animals, plants, and the environment.
9. At the programme level, FAO has successfully worked
with Members and international partners, through the Emergency Prevention
System for Animal Health (EMPRES-AH) programme, to develop and implement
strategies and policies for improved early warning, prevention, timely
response, and long-term management of high-impact transboundary and emerging
diseases, including zoonoses, under the One Health approach. EMPRES-AH will now
focus on enhancing biosecurity along the livestock value chains by establishing
a Progressive Management Pathway for Biosecurity (PMP-B) and associated
national capacities for risk assessments, science and evidence-based and
progressive risk mitigation to manage the risks of animal diseases and emerging
zoonoses. The pathway for biosecurity will be an essential component of the OH
PPA, and the OH JPA, and will be a stakeholder-led, collaborative, stepwise
approach to mainstream One Health and biosecurity for producer resilience and
One Health outcomes at country level.
10. FAO’s Action Plan on Antimicrobial
Resistance is one of the Organization’s One Health flagship programmes. With
FAO assistance, 47 countries have accelerated the implementation of national
action plans on AMR through applying the FAO Progressive Management Pathway for
AMR (FAO-PMP-AMR) and legal methodology, etc. The International FAO
Antimicrobial Resistance Monitoring (InFARM) is being developed to strengthen
national AMR surveillance systems. Some of the progress is documented in the
report on the implementation of the FAO Action Plan on Antimicrobial Resistance
2021-2025 presented at the First Session of the Sub-Committee on Livestock,
which will be further discussed at the 28th Session of COAG.
11. For most of the AMR work, FAO
works actively with its Quadripartite partners to develop the global and local
tools required to decrease the threat of AMR, and advance assistance to Members
to develop their national action plans.
12. The AMR work is supported by a
number of coordination initiatives such as the Quadripartite Strategic
Framework on AMR, the One Health Global Leaders Group (GLG) on AMR and the soon
to be established AMR Multi-Stakeholder Partnership.
13. In line with SDG 6 - Ensure
availability and sustainable management of water and sanitation for all, FAO
promotes an integrated water resources management approach that embraces the
value of water in all its forms and recognizes the intrinsic role of water in
protecting human, animal, and ecosystem health. FAO addresses agricultural
pollution prevention and control to improve food production, food safety,
tackle AMR in the environment, and ecosystems conservation using
agri-water-environmental controls to prevent the spread of water-associated,
vector-borne diseases and apply innovative techniques such as genomic tracking
from source water to food for ensuring health and safety.
14. Recognizing that the One Health
approach is essential to food safety, the FAO Strategic Framework 2022-31
includes a PPA on food safety (BN3: Safe food for everyone) to promote agrifood
systems policies and programmes. These priorities reflect the inter-sectoral
nature of food safety and mark an effort both to capture and to integrate it
across all sectors of the agrifood systems.
15. With more than 35 countries
currently working on their United Nations Sustainable Development Cooperation
Frameworks (UNSDCF), and following the publication on “Antimicrobial Resistance
and United Nations Sustainable Development Cooperation Framework”, FAO is
leading the development of guidance notes on how to embed One Health in the
UNSDCF and monitor progress using smart indicators for UNSDCFs.
16. FAO advocates One Health on a new level by engaging
with university students across the globe. FAO organized a Youth dialogue in
October 2021 with discussions to better apprehend the various components of One
Health across agrifood systems, an art contest and curated One Health content
(videos, song). With 200 participants, this first edition gave FAO a first
group of One Health young ambassadors who shape the approach with their vision
and take into account regional priorities.
III. Advancing One Health through strategic partnerships
and coordination
17. Work to tackle the challenges of human, animal, plant
and environmental health using a more integrated approach has seen significant
progress in the past year with the expansion of the Tripartite collaboration to
include UNEP. Under this Quadripartite collaboration, great strides have been
made over the past year particularly to support global governance of One Health
and engage in several joint One Health initiatives. At the executive meeting in
March 2022, a revised Memorandum of Understanding was signed by the heads of
the four organizations to establish the Quadripartite.
18. As Chair of the Tripartite plus
UNEP for the period from February 2021 to March 2022, FAO developed, in
consultation with its partners, a vision paper to pursue certain goals for
2022, which was unanimously agreed by the heads of the four organizations. One
of these goals was to collectively develop the One Health Joint Plan of Action
(see Section IV).
19. The Tripartite plus UNEP has been
active in promoting One Health in global events such as the G7 and G20
meetings, the Global Health Summit and the UN Food Systems Summit.
20. Following the G7 event, FAO, along
with its Tripartite plus UNEP partners, has been undertaking a One Health
scoping study to strengthen One Health intelligence through identifying good
practices, and proposing a One Health early warning framework for effective
sharing of One Health information at national level, and mapping strengths and
weaknesses of existing information systems within the Tripartite plus UNEP and
other international organizations.
21. In response to a request by the
G20 Italian Presidency, theTripartite plus UNEP together with the World Bank
developed the One Health advocacy document on “Investing in One Health” for the
G20, to provide a cost-benefit analysis of One Health financing.
22. The then Tripartite plus UNEP
registered a One Health Commitment at the UN Food Systems Summit to establish a
One Health Coalition and build commitment across sectors, disciplines, and all
levels of society. This commitment will bear influence on national agrifood
systems transformation pathways that are being followed up after the summit.
23. Funding and financing mechanisms
were explored to further mobilize resources and coordinate efforts in support
of One Health and the establishment of coalitions with other relevant technical
and resource partners.
24. To support the One Health
collaboration and partnership, in May 2021, 26 experts were invited to form the
One Health High-Level Expert Panel (OHHLEP), which has an advisory role to the
four organizations on One Health matters in relation to evidence-based
scientific and policy advice. One of the prominent outputs of OHHLEP work over
the past six months is the recent One Health definition1.
25. At the regional level, One Health
coordination has been consolidated through the establishment of coordination
mechanisms. A regional One Health Secretariat has been established in Africa to
reinforce One Health collaboration with stakeholders and support regional and
country One Health frameworks across the continent. In Asia and the Pacific, a
number of joint One Health products have been developed to share information
and best practices on zoonotic diseases, AMR, and food safety.
26. The One Health Coordination Mechanism for the Region
of Europe and Central Asia (OHCM) was established in April 2021. In addition,
the establishment of a well-defined institutionalized regional One Health
Platform in coordination with other stakeholders is foreseen in the Near East
and North Africa region. Similar arrangements are under discussion with
relevant partners in Latin America and the Caribbean. These regional One Health
coordination mechanisms allow a formalized Quadripartite cooperation regionally,
both on a political and technical level.
FAO is leading the establishment of the Quadripartite AMR
Multi-Stakeholders Partnership Platform, which aims to be inclusive by bringing
together relevant stakeholders across the human, animal, plant, and environment
sectors, to address AMR risks through the One Health approach. An inception
public discussion with a wide range of stakeholders across the globe was
organized in summer-autumn 2021.
IV. The One Health Joint Plan of Action
28. The 166th Session of the Council
“welcomed FAO’s One Health work, including the positive collaboration within
the Tripartite and UNEP and their work to develop reporting mechanisms and a
joint strategy and joint work plan on One Health”. The call for developing a
joint vision for One Health including a joint work plan was reinforced by the
World Health Assembly resolution (WHA74.7) to build on and strengthen the
existing cooperation among FAO, WHO, UNEP and OIE.
29. In response, FAO, as Chair of the
then Tripartite plus UNEP in 2021, has led the co-development of the OH JPA
(2022-2026) with advice from the One Health High-Level Expert Panel.
30. The OH JPA is intended to guide
the four organizations to work together on One Health with the aim of
supporting their Members, based on their mandates, comparative advantages and
programming and strategic documents of each organization.
31. The OH JPA aims to further
strengthen a comprehensive One Health and to foster the change pathways
required for successful mainstreaming of One Health at all levels thereby
promoting the health of people, animals, plants, and the environment. It builds
on six action tracks, namely:
i. Enhancing One Health capacities to strengthen health systems;
ii. Reducing risks from emerging and re-emerging zoonotic epidemics and
pandemics;
iii. Controlling and eliminating endemic and neglected zoonotic and
vector-borne diseases;
iv. Strengthening the assessment, management, and communication of food
safety risks
v. Curbing the silent pandemic of antimicrobial resistance; and
vi. Integrating the environment into One Health.
32. Each of the four organizations will organize a
consultation with their respective membership to collect feedback on the scope,
operability and feasibility of the activities.
Practical 4
RISK ASSESSMENT AND RISK MANAGEMENT OF POULTRY SLAUGHTER
HOUSE
Comments:
Food safety can become a real fact only if it constitutes a responsibility
of all the actors involved in the food domain, from the professionals to the
consumers. Along the food chain, there are various procedures and control
mechanisms involved, which assure that the food products reaching the
consumers’ table are safe and the risk of contamination is reduced at minimum,
so that the population is healthier after the benefits implied by the safe and
healthy diet.
Objectives:
·
to evaluate the
potential hazards along the birds’ slaughtering technological course and
identify critical control points
·
to analyse the
hazards and identify control measures for hazard management
Table. 1: Hazards
categorization on the birds’ slaughtering technological flow
|
s. no |
Technological flux step |
Potential physical hazards |
Potential chemical hazards |
Potential biological hazards |
Which are the most probable for occurring? |
|
1 |
Transport |
Impurities , dust |
Cages disinfectants |
Air microbial agents |
Physical, chemical and biological
hazards |
|
2 |
Reception |
Accidental occurrence of foreign
particles during debarkation, accidental injuries |
Possibility of antibiotic residues,
hormones, pesticides following medical treatments |
Possibility of non-identifying the germ carrying
and contaminating birds, without clinical signs, dead birds |
Physical, chemical and biological
hazards |
|
3 |
Hanging on conveyer I |
- |
Oil, vaseline |
Contamination through operators
manipulation |
chemical and biological hazards |
|
4 |
Stunning |
Voltage and amperage adjustment |
- |
- |
Physical hazard |
|
5 |
Bleeding |
- |
- |
Not cleaning and disinfecting properly
the knife as well as its use from one bird to other. Incomplete bleeding |
Biological hazard |
|
6 |
Scalding |
- |
Residual disinfectant substances |
The developing of thermophillic
bacteria, difficult plucking |
Chemical and biological hazards. |
|
7 |
Plucking |
The traumatic action of the active parts from the plucker |
- |
On the skin level
it might appear frequently, discontinuities
through which, under the pressure on the carcasses,
the surface microflora
can appear in the
subcutaneous tissue and even
muscle. |
Physical and biological hazards. |
|
8 |
Head removal |
- |
Residual disinfectant substances |
Contamination
through the head removal
machinery |
Chemical and biological hazards. |
|
9 |
Leg sectioning from hook |
- |
Residual disinfectant substances |
Contamination
through the disk knife |
Chemical and biological hazards. |
|
10 |
Hanging on conveyor II |
- |
- |
Contamination
through operators
manipulation |
Biological hazards. |
|
11 |
Evisceration |
- |
- |
Organ and tissue
lesions, intestine ruptures
with food content contamination |
Biological hazards. |
|
12 |
Organs processing |
- |
- |
Contamination
through operators |
Biological hazards. |
|
13 |
Cooling in tanks |
- |
Residual substances |
The ice flakes cooling system can lead to
cross contamination of
the carcasses, raising
the germ number. |
Chemical and Biological hazards. |
|
14 |
Hanging on conveyer III |
- |
- |
Contamination
through operators |
Biological hazards. |
|
15 |
Drying |
- |
- |
Carcass contamination with drying air |
Biological hazards. |
Table2: Hazard analysis and control
measures for their management
|
s. no |
Technological flux step |
Potential hazard categories identified |
Is the potential Hazard significant? |
Control
measures imposed for hazard handling |
|
1 |
Transport |
Physical, chemical biological |
Significant Significant Less significant |
The detailed exam
of the transport way, the hygiene check after each transport and the
conditions according to the
common law |
|
2 |
Reception |
Physical Chemical biological |
Less significant Significant Significant |
Checking the documents; sanitary veterinary exam prior
to slaughtering is considered as a medical action to insure the food safety
and it is made by the official veterinary. |
|
3 |
Hanging on conveyer I |
Chemical biological |
Less significant Less significant |
The control of
proper hygiene |
|
4 |
Stunning |
Physical |
significant |
The voltage and
amperage adjustment |
|
5 |
Bleeding |
Biological |
Very significnt |
Supervising the
bleeding and adjusting the bleeding time |
|
6 |
Scalding |
Chemical Biological |
Less significant Very significant |
Permanent adjustment of temperature and time according
to the wanted product; The control of proper hygiene |
|
7 |
Plucking |
Physical biological. |
Significant Very significant |
Adjusting the distance between the reels; rigorous
disinfection of the plucking machine |
|
8 |
Head removal |
Chemical biological |
Less significant Less significant |
Rigorous
disinfection of the machinery |
|
9 |
Leg sectioning from hook |
Physical biological |
Less significant Less significant |
Adjustment of the
disk knife; Rigorous disinfection |
|
10 |
Hanging on conveyor II |
Biological |
Very significant |
The corresponding
hygiene of the operators |
|
11 |
Evisceration |
Biological |
Very significant |
Proper opening of digestive tract and of
organs |
|
12 |
Organs processing |
Biological |
Very significant |
Very correct processing |
|
13 |
Cooling in tanks |
Chemical Biological |
Less significant Very significant |
Cold water assuring at a right temperature; corresponding
hygiene of the tanks; |
|
14 |
Hanging on conveyer III |
Biological |
Less significant |
The corresponding
hygiene of the operators |
|
15 |
Drying |
Biological |
Very significant |
The using of a
fresh cooled air, sanitation tests. |
|
16 |
Packing |
Biological |
Significant |
The hygiene of the
places and personnel, sanitation tests from the environment, periodical
medical analysis for the
operators. |
|
17 |
Depositing |
Biological |
Significant |
Maintaining a constant temperature in the technological
limits according to the products (frozen or refrigerated) |
|
18 |
Delivery |
Physical Biological |
Less significant Significant |
The hygiene control of the transport ways; the control
of the temperature maintenance; Sanitation tests; |
Conclusion……………………
Practical 5
DETERMINATION OF
ANTIBIOTIC RESIDUES IN MILK
Introduction
Antibiotics are substances of natural, semi-synthetic, or
synthetic origin that exhibit antibacterial activity. Their presence in foods
is essentially due either to therapeutic treatments or to the
antibiotic-supplemented food given to certain animals. The consequences of the
presence of antibiotic residues are as numerous to human health as they are to
certain processing operations. Where human health is concerned, a number of
dangers must be avoided, such as allergic effects and possibilities of microbial
selections and of mutations that essentially have two consequences:
1. Selection of resistant strains.
2. Disequilibrium of the normal flora of the digestive
tract.
Methods of determination:
In processing operations, the presence of residues with
antibiotic activity in milk or meat makes them unsuitable for some uses. For
all these reasons, the problems related to the presence of the antibiotic
residues in foods have been extensively studied. The detection and the
determination of these residues are therefore essential elements in the study
of antibiotic evolution and the protection of the consumer. The methods of
determination used at present can be classified into three groups:
•microbiological methods;
•eletrophoretic methods;
•physicochemical methods.
Microbiological Methods
The most frequently used detection methods are those that
exploit the sensitivity of certain bacterial strains vis-à-vis one or several
antibiotics. The manifestation of this inhibition is affected either in liquid
(e.g., acidification method) or solid media (e.g., agar diffusion method).
A. Liquid medium method:
Principle
This technique is widely used for the detection of
antibiotics in milk. After pasteurization, the sample is cultured with a strain
sensitive to antibiotics (e.g., Bacillus, Strentococcus, etc.). After
incubation, the production of latic acid, which results from the growth of test
bacteria in the absence of antibiotic residues, is detected either by a pH
indicator or by the coagulation of the milk. The bacterial growth can also be
measured by nephtelometry.
Several methods based on this principle are currently
being used.
1.Reduction of Colored Indicators
•Methylene Blue test
2. Measurement of the Coagulation Time
The test germ is yogurt fermenting agent (e.g.,
Streptococcus thermophilus and Lactobacillus bulgaricus). The presence of
inhibiting substances is detected through the absence of milk coagulation after
a fixed culture period
3. Measurement of Acidity
A technique that consists of adding a strain of
Streptococcus thermophilus to milk and titrating the lactic acid produced after
incubation.
4. Measurement of Medium Turbidity
Measure the growth of the test germ by recording the
variations in medium turbidity over time.
By using method studying antibiotics in liquid media,
results can be obtained rapidly. They allow the analysis of large series of
milk samples and can act as a primary selection method. All positive of
questions samples must be subjected to a confirmation test by the agar
diffusion method.
B.
Agar Diffusion Methods
These techniques have been employed in antibiotic
analyses in all food products.
Principle
When one or more antibiotics in a solution are brought
into contact with an agar medium, they diffuse into it. The diffusion is
proportional to the logarithm of their concentrations. The growth of a test
germ cultured in agar after incubation shows the presence of an inhibiting
substance through the appearance of a clear zone in the antibiotic diffusion
zone, while everywhere else the growth of the microorganism is visible.
Methods:
1.
Agar Culture Media
The composition of the agar medium depends on the strain
used and the antibiotic studied. For example, one may use: Healtey’s agar;
Chabbert medium; Bacto Whey Agar medium. The pH must be adjusted to 6.6 or 7.8,
depending on the antibiotic studied.
Sample Preparation
1. In its original state (milk);
2. After mixing it aseptically in a small quantity of
sterile physiological serum (e.g., curdled milk, cheese, or antibiotic
supplemented food);
3. After solvent extraction (e.g., muscular tissues). For
extraction, three solvents: pure methanol, methanol + pH 8 bicarbonate 1/1
buffer (V/V); or distilled water + pH 8 bicarbonate 3/7 buffer (V/V) are
recommended.
TEST MICROORGANISMS:
The following strains are used most often:
•Bacillus stearothermophilus var calidolactis strain
•Bacillus subtilis ATCC 6633,
•Sarcina lutea ATCC 9341:
•Staphylococcus aureus,
•Bacillus megaterium ATCC 9855:
•Micrococcus luteus and Bacillus cereus.
* Other sensitive bacteria can also be used; including
Micro flavus, Bacillus cereus, Sarcina lutea, and Escherichia coli.
PROCEDURE:
1. The agar medium, which is melted and then cooled to
45℃, is cultured with a diluted suspension of the test germ. It is homogenized
and the mixture is poured into Petri dishes left to cool horizontally. After
pasteurization, the sample is aseptically placed in contact with the agar
according to two techniques:
2. A filter paper disk is saturated with a fraction of
the sample product or the extraction solution (in this case, drying is very
important), and then deposited on the surface of the cultured agar;
3. The sample is placed into hollow cavities in the agar
or small stainless steel cylinders applied to the agar surface.
INTERPRETATION OF RESULTS:
Petri dishes prepared as discussed are incubated. A clear
zone around the filter paper disk or the cavity indicates the presence of a
substance in the sample with antibiotic activity. Otherwise, colonies propagate
through the entire agar surface. A control must always be performed with a
preparation that does not contain antibiotics. It is important that this test
be conducted under conditions that are rigorously identical to the sample
biological liquid. Most biological products (e.g., serum, liver, milk, muscle,
urine, etc.) have enzyme binding or destructive properties that are likely to
distort the results. It is possible to detect penicillin by performing an assay
with a disk saturated with penicillinase. If the sample contains penicillin at
the start, then no inhibition zone appears around the disk saturated with
penicillinase. If it contains an antibiotic other than penicillin, then an
inhibition zone appears around the disk saturated with penicillinase.
The agar diffusion method is relatively rapid and does
not require much laboratory equipment. However, just like the liquid medium
methods, it is only an “all or none” technique that permits neither the
determination nor the identification of the antibiotic (except for penicillin).
It is especially well adapted when the sample antibiotic is known, as is the
case with pharmacodynamic studies of a product in a particular animal. For a
“regulatory type” control test, however, there are other problems. One may work
either with a whole “bank” of bacterial strains of varying sensitivity in such
a way as to cover the largest range of antibiotics used, making it a cumbersome
detection system, or else neglect the antibiotic and make do with a few
sensitive bacteria that will not produce inhibition rings with the sample
examined.
Finally, it should always be kept in mind that there are
natural antibiotics in the plant kingdom, and that in the animal world,
substances like lactic acid, the lactoperoxidoses, the aglutinins, and the
lactoransferinses can produce inhibition rings. That is why it is so important
to interpret the results carefully. In order to partially remedy these
drawbacks, a modification was made in the agar diffusion method. It consists of
performing a preliminary electrophoretic separation of the sample or extract to
be analyzed.