Philippine Journal of Science 148 (2): 317-336, June 2019 ISSN 0031 - 7683 Date Received: 16 Nov 2018 Foodborne Disease Outbreaks in the Philippines (2005–2018) Maria Patricia V. Azanza*, Bernard Niño Q. Membrebe, Rowena Grace R. Sanchez, Emil Emmanuel C. Estilo, Una Grace M. Dollete, Rodney J. Feliciano, and Nadine Kristel A. Garcia Department of Food Science and Nutrition, College of Home Economics University of the Philippines, Diliman 1101 Quezon City, Philippines The study detailed 209 reported Philippine foodborne disease outbreaks (FBDOs) for the period 2005 – Jun 2018. Multiple implicated foods were associated in majority of the studied outbreaks. Meat-containing dishes were the most common causative foods in the evaluated outbreaks with defined food vehicles. Food service eating facilities and households were found more prone to outbreak occurrences. Although there were reported outbreaks with unidentified causative agents, Salmonella spp., Henipavirus, Entamoeba histolytica, and Vibrio parahaemolyticus were cited as primary causes of infections. Human intoxications involved staphylococcal enterotoxins, carbamate toxin, and paralytic shellfish poisoning (PSP) toxin. Impact of the study on the implementation of national food safety controls of the Philippines was also cited. Keywords: foodborne diseases, foodborne outbreaks, food safety, Philippines INTRODUCTION of 140–360 disability-adjusted life years per 100,000 population (WHO 2015). Although unhygienic food An FBDO is defined by the US Center for Disease Control preparation occurs both in developing and industrialized and Prevention (CDC) as an occurrence in which at least countries, it was reported that a safe food supply chain two persons experience a similar illness resulting from becomes more difficult to obtain in developing countries the ingestion of a common food (CDC 2012). Foodborne because of poverty (Kaferstein 2003). Several unhygienic illness is a global issue with the continuous increase in food preparation conditions that were cited in developing food safety risks brought about by internationalization countries included poor personal hygiene of food handlers, of food trade (Choi 2008). These include outbreaks that restricted access to clean facilities, and lack of food storage are due to microbial pathogens, residue contaminations, facilities at the appropriate temperatures (Kaferstein biological toxins from fishery products, and other 2003). The main reason for FBDOs in Malaysia was also chemical and physical contaminants (Spiric et al. 2015). attributed to unsanitary food handling procedures, which There is usually a high prevalence of FBDOs in contributed to 50% of the cases (MOH 2007). Analysis developing countries due to poor sanitation (O’Ryan et al. of surveillance data in South Vietnam (2009–2013) also 2005). The World Health Organization (WHO), through showed that most outbreaks were associated with canteens the Foodborne Disease Burden Epidemiology Reference and the cases were linked to poor personal hygiene and Group, identified the West Pacific Region – including the time-temperature abuse (Vo et al. 2014). Philippines – to have intermediate burdens in the range In the Philippines, a national food safety program was *Corresponding author: [email protected] initiated in 2013. Collective efforts of food regulatory 317 Philippine Journal of Science Azanza et al.: FBDO in the Philippines Vol. 148 No. 2, June 2019 agencies have increased awareness and significance of rice-based products, and root crops); and vegetables. If food safety in the country with the signing of the Philippine mixed foods or meals were associated with FBDOs and Food Safety Act (2013) into law. This law aims to promote no specific food vehicle was identified as the main cause, the right to health of the people and strengthen the food the cases were classified under “Multiple implicated food regulatory system in the country (Republic Act 10611). dishes.” Lastly, foods that do not fall under the enumerated However, the Implementing Rules and Regulations (IRR) major food categories and the multiple implicated foods of this law have only been finalized in Feb 2015 (DA and were classified as “Others” and this group includes egg, DOH 2015). The positive impact of the food safety act of desserts, and beverages. Further, the distribution of the country cannot still be fully appreciated in this study recorded FBDOs was also mapped out by regions. Relative since the law enactment is only in its infancy. percentages were calculated for the compiled data. Systematic monitoring of foodborne disease outbreaks Outbreaks with multiple implicated food vehicles were by country is required to allow evaluation of outbreak those involving cases that implicated the consumption trends. Normally, food regulatory agencies involved in the of several types of foods and no exact food vector was implementation of food safety systems must rely heavily definitively identified as the cause of the outbreak. on surveillance data for the appropriate formulation of Institutionally prepared implicated foods were classified prevention and control measures to ensure national food as those prepared and consumed on site or delivered safety control. The data collection rests on the competence outside of the food service area preparation. Home- of health officers up to the municipality level, the prepared foods reported in this study were classified either professionals involved in the food supply chain, and the as those prepared or consumed by a single household or facilities and laboratories for testing and analyses (Collado prepared and consumed by multiple households. et al. 2015). A previous study already presented trends of FBDOs in the Philippines for the preceding period of 1995–2004 (Azanza 2006). Continuous monitoring and analyses of information from outbreaks occurring in RESULTS AND DISCUSSION the country could help contribute to the development of national food safety systems. The objective of this article Food Vehicles of Outbreaks was to present trends in the foodborne disease outbreaks Multiple implicated foods. Different food types that in the Philippines for the period of 2005 – Jun 2018. served as vehicles for Philippine FBDOs from 2005 to Jun 2018 were classified (Table 1). Most of the FBDOs involved were categorized as multiple incriminated foods (27.27%). The highest incidences involving multiple MATERIALS AND METHODS food vehicles were institutionally prepared, followed Data from 209 Philippine FBDOs for the period of Jan by home prepared foods. Ninety five percent (95%) of 2005 – Jun 2018 was covered in this study. Secondary the disease manifestations that were described for the archival data analyses were conducted on information FBDOs associated with multiple food vehicles in this accessed from five web portals, five electronic archives report with unknown etiological agents of illnesses were of local news agencies, five electronic archives of local gastrointestinal symptoms including vomiting, diarrhea, newspapers, two government websites, and printed and stomach ache. Amoebiasis, fever, and cholera were reports from the Epidemiology Bureau of the Philippine associated to a lesser percentage to these food vehicle Department of Health (DOH). group causing FBDOs. The data gathered were categorized and evaluated in terms The DOH undertaking epidemiological studies should of associated food vehicles, etiological agents, venues be more focused in identifying the food vehicles of of outbreaks, and morbidity and mortality cases. The these outbreaks to strategically control future related associated food vehicles were grouped into seven major FBDOs. Food service institutions were restaurants (GMA groups – namely meat-based dishes (includes all types of News 2006, Uy 2006); hotels (Carcamo 2009, Cinco pork, chicken, beef and other meats fresh or processed); 2014); and canteens or cafeterias. Outbreaks involving fish and other seafood dishes (includes fish and fish canteen-prepared take-out foods (Uy 2006; GMA News products plus other seafoods); inedible materials (plant or 2008, 2013) or served on-site were reported (Araneta animal-based materials that have toxins and considered 2011, Manlupig 2012, SunStar 2013). The reported inedible); noodles and pasta dishes (all types of noodles high occurrence of FBDO under the institutionally and pasta); bakery and confectionery products (include all prepared category may be linked to the fact that these types of baked foods and confectionery products such as establishments cater to large number of consumers, which cocoa, chocolates, and candies); rice and root crops (rice, in turn increases the probability of FBDO occurrences and 318 Philippine Journal of Science Azanza et al.: FBDO in the Philippines Vol. 148 No. 2, June 2019 Table 1. Foodborne disease outbreaks in the Philippines classified by incriminated food vehicles from 2005 to Jun 2018 (N = 209). Food Vehicles Occurrence Relative Percentage (%) Multiple implicated food dishes Food service (catering, school and work place canteens, hotel, restaurant) 41 27.27 Home-prepared food (birthday, outing, funeral) 13 Unknown 3 Subtotal 57 Meat based dishes Pork dishes (adobo, fried, roasted, stew) 15 14.35 Fried processed meat (beef loaf, hotdog, sausage, hamburger) 6 Chicken dishes (adobo, roasted) 3 Beef dishes (stew, braised) 2 Other meats (water buffalo, horse, dog) 4 Subtotal 30 Fish and other seafood dishes and manufactured products Fish dishes (mackerel, roundscad, snapper, tuna, silver