MANUAL OF PROCEDURES FOR THE SURVEILLANCE, OUTBREAK INVESTIGATION AND RESPONSE TO MICROBIAL AGENTS OF FOOD AND WATERBORNE DISEASES EDITOR AND PROJECT PROPONENT Celia C. Carlos, M.D. Research Institute for Tropical Medicine, Department of Health With contributions from the Departments of Health, Agriculture, the Interior and Local Government Philippines Supported by a grant from the World Health Organization Manila, Philippines 2007 CONTRIBUTORS Department of Health MA. SONABEL ANARNA, MSc. DONATO ESPARAR, RMT Supervising Health Program Officer Science Research Specialist I Food and Waterborne Disease Control Research Institute for Tropical Medicine Program Department of Health National Center for Disease Prevention and Control HAZEL GALANG, RMT Department of Health Senior Science Research Specialist Research Institute for Tropical Medicine GERALDINE M. BICOL, MD Department of Health Contributor Alabang, Muntinlupa, Metro Manila Research Institute for Tropical Medicin e Department of Health JOSEFINA GERONIMO, RMT, MPH CELIA C. CARLOS, MD Science Research Specialist II Medical Specialist IV Research Institute for Tropical Medicine Consultant in Pediatrics and Infectious Department of Health Diseases Alabang, Muntinlupa, Metro Manila Antimicrobial Resistance Surveillance Reference Laboratory MARITESS GO, RMT Research Institute for Tropical Medicine Medical Technologist II Department of Health National Reference Laboratory for Water Alabang, Muntinlupa, Metro Manila East Avenue Medical Center ALMUEDA C. DAVID, RMT MANUEL JAMORALIN, RMT Food-Drug Regulation Officer Bacteriologist II Laboratory Services Division Antimicrobial Resistance Surveillance Bureau of Food and Drugs Reference Laboratory Alabang, Muntinlupa, Metro Manila Research Institute for Tropical Medicine Alabang, Muntinlupa, Metro Manila MA. CECILIA DE LA CRUZ, RMT, MSc. MARIETTA LAGRADA, RMT Bacteriologist II Medical Technologist IV Research Institute for Tropical Medicine Antimicrobial Resistance Surveillance Department of Health Reference Laboratory Alabang, Muntinlupa, Metro Manila Research Institute for Tropical Medicine Alabang, Muntinlupa, Metro Manila VIKKI CARR DE LOS REYES, MD Medical Officer III NENITA MARAYAG National Epidemiology Center Chemist IV Department of Health National Reference Laboratory for Water East Avenue Medical Center VITO ROQUE, MD SONIA B. SIA, M.D. Medical Specialist IV Medical Specialist II National Epidemiology Center Research Institute for Tropical Medicine Department of Health Department of Health Department of Agriculture RAYNE BIGAY, RMT JUDITH PLATERO Microbiologist Development Management Officer V Laboratory Services Division Laboratory Department National Meat Inspection Service National Dairy Authority LAARNI CABANTAC DVM BELINDA RAYMUNDO OIC, Epidemiology and Intelligence Chief, Product Testing Laboratory Section Fish Product Testing Laboratory Animal Health Division Bureau of Fisheries and Aquatic Bureau of Animal Industry Resources JULIA GARCIA, DVM LILIA RETES, DVM Supervising Agriculturist Agriculturist II Bacteriology Laboratory Bacteriology Laboratory Bureau of Animal Industry Bureau of Animal Industry SUSANA GONZALO MARVIN B. VICENTE, DVM, OIC, Laboratory Services Division MSAH, MPM Laboratory Services Division Supervising Meat Control Officer Bureau of Plant Industry Laboratory Services Division National Meat Inspection Service Department of the Interior and Local Government MANUEL Q. GOTIS EDWARD T. TEMPLONUEVO Director IV Asst. Chief, LFRDD Bureau of Local Government Development Bureau of Local Government Department of the Interior and Development Local Government Department of the Interior and Local Government FOREWORD Food and waterborne diseases caused by microorganisms is a large and growing global public health problem. Three major reasons are the globalization of food supply, travel and migration. In the Philippines, diarrheal diseases has been the numbe r one cause of morbidity for many years to the present time with a morbidity rate of 913.6/100,000 . While not all gastroenteritis is foodborne, and not all foodborne diseases cause gastroenteritis, food does represent an important vehicle for pathogens of substantial public health significance. In the limited reviews conducted on foodborne diseases in the Philippines from 1988-96 and 1999-2004, the authors admitted that their reviews may underestimate the true situation since it is likely that numerous food-related outbreaks are unreported or uninvestigated. Both papers recommended the need to establish a foodborne disease surveillance in the Philippines. Realizing the importance of foodborne diseases, t he Fifty-third World Health Assembly, in resolution WHA 53.15 requested the World Health Organization (WHO) Director-General to put in place a global strategy for surveillance of foodborne diseases and to initiate a range of other activities on food safety and health. The WHO recommends the establishment of integrated foodchain surveillance systems. An integrated foodchain surveillance system monitors the nature and level of foodborne disease integrated with food monitoring data along the entire foodchain (from the farm to the plate) utilizing sentinel sites linked with local, national and international laboratory networks. An integrated foodchain surveillance system entails collection, analysis, interpretation of laboratory-confirmed data from animals, food and humans in order to provide etiology-specific outputs including subtypes of microorganisms. In addition, internationally agreed methods in epidemiology and microbiology are needed for surveying foodborne diseases and linking them to food contamination on the basis of risk. This manual is the initial effort by representatives of government agencies under the Departments of Health, Agriculture and Interior and Local Government to establish standard procedures in the epidemiologic and laboratory investigation of food as well as waterborne diseases. It details the surveillance and outbreak investigation and respons e methods that will be utilized including procedures for reporting and investigating food and waterborne diseases and appropriate collection, transport and preservation of specimens from th e field to the different agencies which have jurisdiction for testing the various food types as detailed in Annex 4.4.8E. In the preparation of standard procedures to undertake in surveillance and outbreak investigation, consideration has also been given to the International Health Regulations of 2005 recently approved by the World Health Assembly in June 2007, most especially on the aspects of reporting foodborne diseases to the WHO. The manual had been reviewed by various stakeholders in volved in food and water safety, nevertheless, the contributors heartily welcome suggestions for its improvement. There are likewise plans to field test the document in selected sites to be able to assess where improvements in its content may still be applied. The contributors look forward to the manual being utilized at all levels of the political structure nationwide as well as the general public with the goal being, the Philippines having valid data on food and waterborne diseases which will direct interventions towards their control. In the course of preparing this manual, the contributors identified certain weaknesses in the existing system and have therefore laid down some recommendations to address these weaknesses which are detailed in Annex 6.5. The undersigned wishes to thank the WHO for providing support to undertake this activity, the contributors from the various agencies of government for sharing their precious time i and effort towards drafting this manual, and the secretariat of the antimicrobial resistance surveillance reference laboratory, namely M s. Ma. Theresa Sepulveda, Ms. Lea Platon, Mr. June Gayeta, Ms. Eleanor Azores, Mr. Danilo Patulot and Mr. Alex Petersen for technical assistance. Acknowledgement is also given to Dr. Enrique Tayag, director, Natio nal Epidemiology Center; Dr. Marlow Niñal, medical officer VII, Mr. Petronilo Buendia, general manager, Philippine Fisheries Development Authority and his chief of staff, Engineer Virgilio Suarez for their valuable comments. Celia C. Carlos, M.D. Project Proponent September 21, 2007 ii Republic of the Philippines Department of Health OFFICE OF THE SECRETARY Building 1, San Lazaro Compound, Rizal Avenue Sta. Cruz, Manila, Philippines Tel Nos. (632) 711-9502 MESSAGE Realizing the importance of foodborne diseases, the Department of Health (DOH) has initiated a range of activities to promote food safety and health. The DOH has therefore taken a lead in bringing together technical staff of the Departments of Agriculture (DA) and the Interior and Local Government (DILG) together with its own staff to collectively craft A Manual of Procedures for the Surveillance, Outbreak Investigation and Response to Microbial Agents of Food and Waterborne Diseases. The objective of the manual is to outline the epidemiologic and microbiologic methods that will be employed in the surveillance, outbreak investigation and response to food and waterborne diseases and to identify personnel and logistic requirements including techniques for effective communication and coordination. This manual is intended to be use to all stakeholders in food safety from both the government and non-government sectors and will certainly be useful to all levels of healthcare infrastructure in the investigation and control of foodborne diseases. We hope that through it, the prevalence of food