C-EnterNet News

Volume 4, Summer/Fall 2007
PDF Version - 4 pages, 559 KB

• Editor's Note
• Notes from C-EnterNet Central
• Sentinel Site 1: The Region of Waterloo
• Retail Food and Agriculture Component
• Water Component
• Source Attribution Component
• Knowledge Exchange and Dissemination

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Editor's Note

As we transition from summer to autumn season and schedules, C-EnterNet pauses to reflect on how far we have travelled and where we are headed. Throughout the summer, the team moved forward on the integrated analysis of C-EnterNet data, along with the preparation of the first full year Annual Report 2006, planned for release in Fall 2007. With the recent addition of poultry and beef, to the C-EnterNet sampling framework, the agrifood component now has all the main commodities represented.

Currently the team is preparing for the annual C-EnterNet advisory committee meeting, to be held in Ottawa in November. The focus of the meeting will be source attribution (human illness attribution). Read more on human illness attribution in the newsletter.

- Dr. Frank Pollari, C-EnterNet Program Lead

Back Row: Susan Read, (Scientific Advisor at LFZ) Frank Pollari, and Barb Marshall.
Front: Andre Ravel, Andrea Nesbitt, and Angela Cook, at LFZ Surveillance Retreat,
Guelph, Ont., June 2007

Notes from C-EnterNet Central

In addition to analysis and scientific writing, team members shared C-EnterNet results and information at various venues. In May, Barb Marshall moderated a lively debate on syndromic surveillance between Medical Officers of Health, Doug Sider and Hazel Lynn at the CIPHI Ontario Branch Communicable Disease conference in Toronto. Eleni Galanis invited André Ravel and Barb Marshall to participate in the BC CDC Integrated Surveillance of Foodborne Pathogens meeting in Vancouver, B.C. in June.

While in B.C, Barb presented at the National Canadian Institute of Public Health Inspectors annual conference in Kelowna. In May, Andrea Nesbitt and Barb Marshall were invited to speak at the Canadian Partnership for Consumer Food Safety Education annual meeting in Ottawa. Exciting for C-EnterNet, Frank Pollari delivered a talk at the 94th annual meeting of the International Association of Food Protection in Florida in July, while Angela Cook shared results at the Guelph Food Safety Symposium.

Suzanne Dietrich (Ryerson University), is working with Sandy Isaacs (PHAC) on an investigation of traditional foods, values and food safety practices of new immigrants and refugees and the potential infectious disease and food safety issues related to these foods and practices. C-EnterNet teamed up with Sandy, with the first task to provide a list of food safety related questions for focus groups conducted by Health Canada to inform Canada's Food Guide on what additional information would assist members of ethnocultural communities in making healthy food choices. Information from this research initiative will assist C-EnterNet and PHAC in understanding food safety knowledge and practices among new ethnocultural communities in order to inform policy supporting the reduction of foodborne disease in a changing Canadian culture.

C-EnterNet has begun designing a control survey in order to strengthen source attribution. Epidemiological case-control studies are one of five general scientific approaches considered worthwhile for quantifying human illness attribution, as this approach allows quantitative comparisons of exposures of sick and healthy individuals in order to determine which exposures are statistically significant. Through its collaborative partnership with Waterloo public health, C-EnterNet continuously receives de-personalized data for all reportable enteric disease cases in this community. The collection of similar data from healthy individuals living in the community through the control surveys for case-control analyses will strengthen source attribution in order to inform policy and decision making to reduce the occurrence of enteric disease. Implementation of the survey is anticipated for Spring 2008.

Dr. Cliff Clark, National Microbiology Laboratory, Winnipeg visited C-EnterNet in July to discuss the analysis of Campylobacter molecular subtyping results. Also in July, team members met Dr. Anna Lammerding, Aamir Fazil and Ainsley Otten of PHAC's Microbial Food Safety Risk Assessment Unit to incorporate C-EnterNet data into modeling analyses that will help lead to a better understanding of the critical areas that should be considered by the Public Health Agency of Canada and others to help Canadian regulators, food-producing industries and consumers.

Sentinel Site 1: The Region of Waterloo

Region of Waterloo Public Health staff have been preparing the much anticipated, Region of Waterloo Communicable Disease Report, 1995-2004. The enteric disease section was enhanced by the work of C-EnterNet, with input from the team and references to the C-EnterNet 2005-2006 Annual Report. Of interest, Campylobacter rates have increased within the sentinel site in January-May 2007 compared to the same time period in the previous year (2006). In order to help with the investigation into possible reasons for the increase, Waterloo epidemiologists assessed C-EnterNet Campylobacter data, which is entered into their EpiData system, to establish there was no common link. Along with site coordinator, Nancy Sittler, C-EnterNet is planning the 5th public health training workshop to be held in October, with a focus on the standardized endemic case questionnaire. Dr. Carlota Medus, from CDC FoodNet, Minnesota will be keynote speaker at the workshop. Waterloo epidemiologist, Rachel McCormick has been accepted into the Canadian Field Epi Program (CFEP) with a placement in PHAC's Guelph office. Dr. Hsiu-Li Wang, Waterloo's Associate Medical Officer of Health will be participating in the CFEP short course in September.

Reviewing the first C-EnterNet Annual Report at Region of Waterloo.
From left: Barb Marshall, Chris Komorowski, Peter Heywood, Dr. Hsiu-Li Wang, and Nancy Sittler.

Retail Food and Agriculture components

In collaboration with the Ontario Cattle Association and Chicken Farmers of Ontario, the on-farm component of C-EnterNet has expanded to include sampling of beef and poultry operations in the sentinel site. As with the swine and dairy sampling, this will be done in partnership with the Ontario Veterinary College, University of Guelph.

Water Component

Upon invitation, Dr. Frank Pollari spoke at the Canadian Water Network's Pathogens-In-Groundwater Research Consortium on June 12 at the Renaissance Hotel, Toronto. The goal of the workshop was to launch the consortium research projects, and to create an active and participatory community of practice. “Protecting Groundwater Supplies from Pathogens Health Risks” was the theme. Frank's talk highlighted molecular subtyping results from Cryptosporidium and Giardia identified in surface water in the sentinel site.

Source Attribution Component

In early April 2007, André Ravel attended two workshops organized by the Med-Vet-Net, a European network of excellence working for the prevention and control of zoonosis and food borne diseases. The source attribution workshop, organized by the Danish National Food Institute and US CDC, reviewed the concepts and approaches for attribution and detailed three main approaches to enhance understanding and practice: 1) exposure assessment; 2) outbreak data analysis; and 3) the application of deterministic and Bayesian analysis of microbial subtyping, mainly for human salmonellosis. The workshops also provided a great opportunity to talk with other European colleagues, and showed that C-EnterNet's efforts on human illness attribution are in line with those from other countries. Since these workshops, C-EnterNet has gathered Canada representative Salmonella serotype and phagetype data from human patients and exposure reservoirs (farm animals, food, imported food) in an attempt to apply and adapt the Bayesian analysis of subtyping data for human salmonellosis attribution developed in Denmark. Running this model with the Canadian data, as well as the subtyping data from human and non-human isolates from the first two years of operation in Sentinel Site 1 is planned for Fall 2007. C-EnterNet and its collaborators completed data analysis of the past 30 years of domestic food borne outbreaks in Canada for the purpose of human illness attribution. A paper has been prepared for publication in a peer-reviewed journal. In parallel, André co-authored a paper with Judy Greig (Laboratory for Foodborne Zoonoses, PHAC) on the analysis of food borne outbreak data extracted through a systematic scanning of publicly available outbreak reports from around the world.

Knowledge Exchange and Dissemination

Recent C-EnterNet publications and reports:

• Government of Canada.
  Canadian National Enteric Pathogen Surveillance System (C-EnterNet) 2006. Guelph, ON: Public Health Agency of Canada, 2007. In press.

• Mattison, K., Shukla, A., Cook, A., Pollari, F., Friend- ship, R., Kelton, D., Bidawid, S. & Farber, J. M. Human noroviruses in swine and cattle. Emerging Infectious Diseases, 200713(8): 1184-1188. http://www.cdc.gov/eid/content/13/8/1184.htm

• P. Heywood, K. Burrows, J. Cutler, C. Komorowski, B. Marshall and H.L.Wang, Hepatitis A, Foodhandlers, International Travel and Community Risk: Public Health Outbreak Intervention Strategies. Prepared for submission.

Conferences and meetings attended:

• OMAFRA Food Safety/Innovation meeting

• EPI Emergency Response Training. Ottawa, Ontario.

Presentations:

• CIPHI Ontario Branch C.D. conference, Toronto, Ontario. May 4, 2007.

• CFIA Update, Guelph, Ontario. May 4 and May 17, 2007

• Canadian Partnership for Consumer Food Safety Education Annual Meeting, Ottawa, Ontario. May 29, 2007

• Source Attribution Working Group, Guelph, Ontario. May 29 & June 20, 2007

• Guelph Food Safety Symposium, Guelph, Ontario. June 13, 2007

• BC CDC Integrated Surveillance of Foodborne Pathogens meeting, Vancouver, B.C. June 13, 2007

• Canadian Water Network, Toronto, Ontario, June 14, 2007.

• Canadian Institute of Public Health Inspectors Annual Conference, Kelowna B.C. June 19, 2007

• International Association of Food Protection 94th Annual Meeting, Lake Buena Vista, Florida. July 8, 2007

• Ministry officials from, Malaysia organized by CFIA Guelph, Ontario. July 27, 2007

Looking ahead

• Advisory Committee Meeting

• 2006 Annual Report

• Human Illness Attribution work

• Expansion to Next Sentinel Sites