Rapid Sharing and Analysis of Information Is Crucial for Food Borne Disease Surveillance


Methods and tools for early detection of food-borne diseases is one of the subjects that will be discussed at Uppsala Health Summit this year, both in plenum and in a separate workshop. New technologies, such as sequencing techniques, have opened up great possibilities to improve detection. But to have an impact, we need an efficient system for response that works across national borders and contains solutions to ethical and economic barriers.

Dr. Johanna Takkinen, Head of the Food- and waterborne diseases and zoonoses programme at the European Centre for Disease Prevention and Control, ECDC, is one of Uppsala Health Summit’s keynote speakers. In this interview, Johanna Takkinen discusses some experiences from working with food borne disease surveillance.

Dr. Johanna Takkinen, would you say that people in general today are aware of the danger with food borne diseases?

- I would say yes. There are multiple channels and sources of information for the public in social media, in addition to the traditional information sharing via newspapers, scientific journals, and web sites of national and international public health authorities.

A few years ago, in 2011, European consumers suddenly became highly aware of the risks with EHEC-bacteria (a form of bacterium Escherichia coli). Initially the bacteria were “traced” to Spanish cucumbers, but the origin was finally located to seeds from fenugreek (Trigonella foenum-graecum).
What can we learn from this tragic event?

- This was a very severe outbreak and ECDC was intensively involved in the investigation, in close collaboration with our sister agency EFSA. ECDC issued several risk assessments as well as daily updates of the epidemiological situation that proved to be a useful way of informing all stakeholders.

There were several lessons to be learned.

  • From a public health perspective, it underlined the need for rapid centralised sharing and analysis of systematically collected information, both at the national and EU level. While local investigations are crucial to identify the cause of the local outbreak, also sharing the data at the national, as well as at the EU level, is essential to assess the population at risk and the risk of spread across countries.
  • The importance of checking the validity of the information before communicating it to media was clearly demonstrated when health authorities in Hamburg were convinced they had detected the causative agent in cucumbers. This resulted in a large-scale political crisis, with heavy economic impact on European producers of fresh vegetables.
  • The outbreak highlighted the importance of sharing subtyping data of isolates from patients and from foods, which provided further strength of evidence to the link between human infections and sprouts.
  • The outbreak illustrated well the added value of cross-country collaboration, and the good national preparedness for rapid investigation of local foodborne outbreaks, including well performed trace-back investigations. The investigations in France and their comparison with German studies enabled investigators to narrow down the suspected vehicle to fenugreek seeds.
  • The exceptional pathotype of this EHEC strain highlighted the great value of whole genome sequencing, which revealed the unusual genetic combination of enteroaggregative E. coli with Shiga toxin-producing E. coli, and the emergence of a highly virulent strain.

In what ways do you think an implemented One Health perspective could improve food safety in Europe? In other less well-off regions in the world?

- A One Health perspective is a crucial underlying concept of any effort to improve food safety and thereby reduce the public health risk for foodborne diseases. There are several pillars that are important in this aspect:

  • Good and smooth collaboration between food safety and the public health sector at the national level, including trust between the actors and sharing of data and information between each other;
  • Sufficient laboratory capacity to further characterize the causative agents isolated from humans and food using molecular subtyping techniques that produce comparable results;
  • Ensure linkage of historical (molecular) typing data with that of next generation sequencing techniques so that comprehensive description of molecular epidemiology is possible, thus enhancing our understanding of epidemiology of infections in humans and circulation of pathogens in the food chain;
  • Offering training opportunities that allow countries to develop their capacity at the pace that is suitable and feasible for them so that learning occurs at the right time;
  • Since Europe is tightly linked to the global world through travel and trade, link to global, comparable surveillance of foodborne diseases through international partners is of crucial importance;
  • Bringing networks of experts together , so that they have a chance to exchange experiences and ideas, develop new ones, and establish collaborative projects.

Late June, the European Commission released its new plan on Antimicrobial Resistance, titled: “A European One Health Action Plan against Antimicrobial Resistance”. What impact do you think this plan can have for surveillance and detection of food borne diseases?

- I believe that the new advanced sequencing techniques will help us to refine the links and transmission chains between humans and primary food production. The same general principle applies here as for the investigation of a multi-country foodborne outbreak: sequencing data with relevant attached epidemiological data, from humans, primary production, and along the food chain, will increase understanding of the occurrence and spread of AMR via foodborne diseases.

Thank you Dr. Takkinen, and welcome to Uppsala Health Summit in October!

During the EHEC outbreak in 2011, the European Commission coordinated the cross-country response at the EU level. A more detailed collection of lessons learned are available on the Commission’s web site: https://ec.europa.eu/food/sites/food/files/safety/docs/biosafety-crisis-cswd_lessons_learned_en.pdf