Rwanda Food Borne Disease Guidelines 2019 PDF

REPUBLIC OF RWANDA RWANDAFDA Rwanda Food and Drugs Authority GUIDELINES FOR INVESTIGATION AND CONTROL OF FOOD BORNE DISEASES MAY, 2019  Guidelines for investigation and control ojfood borne diseases TABLE OF CONTENTS...

REPUBLIC OF RWANDA RWANDAFDA Rwanda Food and Drugs Authority GUIDELINES FOR INVESTIGATION AND CONTROL OF FOOD BORNE DISEASES MAY, 2019  Guidelines for investigation and control ojfood borne diseases TABLE OF CONTENTS Abbreviations................................................................................................................ v Foreword.................................................................................................................... vi Definition of Terms........................................................................................................ 7 1.0 Introduction......................................................................................................... 8 Background of Food Borne Diseases................................................................................. 9 1.1 Causes of Food-borne Diseases....................................................................................................... 10 1.2 Reservoirs and Sources....................................................................................................................... 10 1.3 Transmission of FBDs........................................................................................................................ 10 1.4 Epide mio logy.................................................................................................................................... 10 2.0 Surveillance of Food Borne Diseases......................................................................... 11 2. 1 Routine Surveillance........................................................................................................................... 11 2.2 Detection of FBD outbreaks............................................................................................................. 12 3.0 Investigation of Food-Borne Diseases Outbreak........................................................... 12 3.1 Outbreak Contrai Team................................................................................................................... 12 3.2 Epidemiological Investigations..................................................................................................... 13 3.2. 1 Notification............................................................................................................................... 13 3.2.2 Preliminary Assessment of the Situation............................................................................. 13 3.2.3 Descriptive Epidemiological Investigations............................................................................ 14 3.2.4 Establishing a Case Definition.............................................................................................. 14 3.2.5 ldentifying Cases.................................................................................................................... 15 3.2.6 Interviewing Cases, Medical and Health Personnel.................................................................... 16 3.2. 7 Collating Data.......................................................................................................................... 17 3.3 Environmental and Food Investigations......................................................................................... 17 3.3.1 Inspection of Suspected Premises............................................................................................ 17 3.3.2 Inspection of Suspect Food...................................................................................................... 18 3.3.2.1 Product Description................................................................................................................. 18 3.3.2.2 Observation of Procedures from Receipt to Finish................................................................ 18 3.3.3 Interviewing Food-handlers.................................................................................................... 19 3.3.4 Taking Appropriate Measurements........................................................................................ 19 3.3.5 Drawing a Flowchart of the Operations................................................................................. 19 3.3.6 Conducting an Outbreak Hazard Analysis............................................................................ 19 3.4 Laboratory Investigation..................................................................................................................... 20 3.4.1 Food and Environmental Sampling............................................................................................ 20 3.4.1.1 Food Samples............................................................................................................................ 20 3.4.1.2 Environ mental Sam pies........................................................................................................... 21 3.4.1.3 Clinicat Specimen................................................................................................................... 21 3.4.1.4 Chemical Investigation............................................................................................................ 22 4.0 Data Analysis and Interpretation............................................................................ 23 4. 1 Symptoms Profile (Frequency of Signs and Symptoms among Cases)......................................... 23 Tablel: Example of Symptoms profile (sample size =30)........................................................ 23 Doc. No.:DIS/GDL/004 Revision Date: 06/05/2019 Review Due Date: 13/05/2022 Revision No.:0 Effective Date: 13/05/2019 ii  10 (in decreasing order) years (children < JO vears) Organic Serum Two(one) 10-ml s ilicon-free vacutainers; freeze Urine 50-100ml(25-50ml) prescreened collection cup;store in wheaton glass bottle, freeze Wholeblood(usuallyheparinised) One- two(one) 10mltubes;Refrigerate fnorganic Urine 50- 100ml (25-50ml) in prescreened collection cup;(no preservative if frozen promptly Whole b lood (usually with One2-3-ml pre-screened container; EDTA) Serum refrigerate.One 7ml trace e lements vacutainer; freeze Unknown Serum Three (one 0 10-ml s ilicon free vacutainers; Urine 50- l 00ml Prescreened collection cup; store m wheaton glass bottle, freeze. Whole blood (usually One 3-ml rescreened EDTA) container; refrigerate Whole b lood(heparin) One 7-10-ml (5-ml) heparin vacutainer; Tissues, stomach content 10-50g, no preservatives; seal in smal l zip-lock bag, freeze Food As much as possible, place in large ziplock bag, freeze 63 Doc. No.: DIS/GDU004 Revision Date:06/05/2019 Review Due Date:1 3/05/2022 Revision No. :0 Effective Date:13/05/2019  Guidelines for investigation and control offood borne diseases DIS/FOM/027 ANNEX X: OUTBREAK SUMMARY SHEET ,k ~. ~ ,-. ,, ~j f ' , ~ 1 - 1 1 - ,1 '~ RWANDAFDA Rwanda Food and Drugs Authon!} (This form is to be fi lled by the investigation team at the conclusion of the control operations). Facility: ---------------------------- District: --------------------------- Province: --------- Date: ------------------------------------ 1. Outbreak Code N um ber---------------------------------------------------------------------------- 2. Local ity/ Area where it Occurred ------------------------------------------------------------------- 3. Dates of commencement and End of the outbreak---------------------------------------------- 4. Confirmed aetio logical agent(s) involved ---------------------------------------------------------- 5. Confirmed veh icle of transmission----------------------------------------------------------------- 6. Source of infection/conta mi nation--- -------------------------------------------------------------- 7. Method of confirmation used = Laboratory/ epidemiological or both (Delete appropriately) ------ 8. Cases and deaths recorded by age and sex Cases Deaths Age Males Females Males Females 0 -1 yrs 1-5 yrs 5- 10 yrs 10-25 yrs 25-45 yrs 45 yrs TOTAL 64 Doc. No.: DIS/GDU004 Revision Date:06/05/201 9 Review Due Date:13/05/2022 Revis ion No.:0 Effective Date: 13/05/2019  Guidelinesfor investigation and control o.ffood borne tliseases 9. APPL!ED CONTROL MEASURE(S) THOUGHT TO BE MOST EFFECTIVE IN ARRESTING THE OUTBREAK. ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- 10. Any other remarks from the investigation team. (Use extra sheet ifspace provid!;!d is inadequate). -------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- Names and Signatures of the Investigator (s) Name Signature Date Address 65 Doc. No.: DIS/GDL/004 Revision Date:06/05/2019 Review Due Date: 13/05/2022 Revision No.:O Effective Date: 13/05/2019  Guidelines for investigation and control offo od borne diseases DIS/FMT/026 ANNEX XI :INVESTIGATION REPORT FORMAT Outline of an outbreak investigation report Cover page Title of report lndicate whether this is a pre liminary or a final report. Keep the title short and memorable, but include information on the type of problem under investigation, the location and date. Date of report Names and affiliations of the main authors and investigators Abstract The abstract should be written after the report has been completed. lt shou ld stand alone and contain the most relevant data and conclusions. Ali data mentioned in the abstract must also appear in the main section of the report. Sentences from the Discussion section can be used verbatim in the abstract. Report Introduction Statement of the problem and its public health importance. Details and time frame regarding initial source of information. Reasons for investigating event. Type of investigations conducted and agencies involved. Background Generally available information to help the reader interpret epidemiology and data presented in the report (e.g. population size, socioeconomic status of community, ethn icity, etc.) If outbreak occurred in a food premises, description ofpremises (e.g. s ize of restaurant, usual practices and operations, etc.). 66 Doc. No.: DIS/GDU004 Revision Date:06/05/2019 Review Due Date: 13/05/2022 Revision No. :0 Effective Date:13/05/2019 11  Guidelinesfor investigation and comrol offood borne diseases Description 6fthe problern. Sequence of events leading to the study or invest-igation.Brief statement of the working hypothesis. Objectives Specify targets to be achieved by the investigations. Keep objectives concise and follow a logical, sequentialpattern. The objectives rnay includehypotheses, if any, to be tested.Methods Epidemiology: - description ofstudy population - type of study conducted - case definition - procedutes for case-ascertainrnent and select ion of contro!s (if any) - methods of data collection, including questionnaire design, administration and contents - rnethods of data analysis. Medical laboratory testing: - methods of specirnen collection and processing - name of laboratory carrying out tests - laboratory techniques ernployed and methods of data analysis. Food and food testing: - description of inspection process - methods of food and environmental sampling - narne of laboratory carrying out tests - laboratory techniques ernployed and methods of data analysis. Results Present ail pertinent results from clinical, laboratory, epidemiological and environmental findings. Present results in same order as described in the methods section. Do not interpret or discuss the data in this section. Epidemiology: - number of cases, overall attack rate - clinical details ofi\lness (symptoms, duration, hospitalization, outcome, etc.) - descriptive epidemiology by time (epidemic curve), place, and person (age, sex, race, specific characteristics) expressed as rates - risk factor exposures - further data analysis and data presentation depending on specific studies undertaken (e.g. cohort or case-contrai study). Laboratory (microbiology, chemical, toxicologica!): -nurnber ofspecirnens collected - findings by type of laboratory analysis. Food investigation and food testing: - findings of food inspections 67 Doc. No.: DIS/GDU004 Revision Date:06/05/2019 Review Due Date:13/05/2022 Revision No.:0 Effective Date: 13/05/2019  Guhlelines for investigation and coll/roi of.food borne diseases - results of laboratory tests performed on food and environmental samples. Discussion The discussion is the most important part of the report and should caver: - summary of the major findings - likely accuracy of the results - conclusions withjustificatîon for those conclusion and rejection of alternative explanations - relationship ofthese results to other studies and the literature - implications of the findings - an assessment of contrai measures - needs for future research. Recommendations Initial recommendations and those for future prevention and contrai should be listed numerically. Appendices Questionnaires and/or other survey forms Appropriate field reports Any other relevant documents, including press releases. References Select appropriate references, including reviews in major -scientific journals. Fôllow a standard style of referencing (e.g. Vancouve_r style), numbering the references in the order in which they appear in the text. 68 Doc. No.: DIS/GDL/004 Revision Date:06/05/2019 Review Due Date: 13/05/2022 Revision No. :0 Effective Date: 13/05/2019  Guidelines for investigation and control offood borne diseases --- _.,,____ ,,.., ___ -- --- E ·- ·--- -XII ANNEX Attack ----- f -------- Rate Tabl, - ---- Type of Group A Group B Relative Food Persons who ate specified Persons who did not eat Risk Food specified food Ill Not Total Attack rate % ill Not Total Attack rate % ill ill ~ Baked beans Spinach 32 24 20 15 52 39 62 62 19 18 14 10 33 28 58 64 1.07 0.97 Cooked 20 11 31 65 20 11 31 65 1.00 potato Cabbage 15 11 26 58 25 16 41 61 0.95 Bread 20 12 32 63 30 22 52 58 1.09 Milk 4 4 8 50 46 29 75 61 0.82 Coffee 20 13 33 61 28 18 46 61 1.00 55 32 17 49 65 0.85 ffe Water Cakes (ce cream 12 30 45 10 16 13 22 46 58 65 78 21 5 18 20 39 25 54 20 1.20 3.90 Juice 5 2 7 71 38 9 61 62 1.15 To compute the attack rate in percentage divide the number who became ill by the number who ate the food item and multiply by 100. ( ln the above example the attack rate for milk was (4/8) x 100 = 50%). The suspect food will show the greatest difference between the two attack rate percentages. The suspect food shou ld have a highest attack rate in group A and the lowest attack rate in group B. For example, in the table above, the attack rate for persons who ate ice cream (suspect food) was 78% white the attack rate for persons who did not eat ice cream was 20%. The disparity between the persons in the group A and group B is the important point for consideration. To compute the relative risk divide the attack rate of people who ate specified food and fell sick by the attack rate of people who did not eat the specified food and fell sick. For example for ice cream 78%/20% = 3.9 - 69 , Doc. No.: DIS/GDU004 Revision Date:06/05/2019 Review Due Date: 13/05/2022 Revision No.:0 Effective Date: 13/05/2019  Gui ~ c:.i.:!;.... "t.... - C1,j.:= · - V, 0 V, V, l. >, V, l. >, V, V, l. V, l...... l. V,..... V, V, l. V, l. >, V, l...... V, V, l. V, l. >, "'..... l. ·-.. ' ~ ~ 01).... "O V, l...... 0..... el) 0 -~ ~ V, ' ~ (J : ~ l..Q ~ = ~ -= Q., 1,,..... >, If)..,. If) V, 1,, 1,, If) If) -o:r1 "' 1,,..... 1,,..... >, If) If) ~ 1,,..... >, If) If) -o:r1 V, 1,. Cl> Q., ë. = (J ~ - ( Q.,... c:.i l.........._ e>, 0 M >. If) M 1 If) 0 ~ M 1 ~ 1 If) 0 ~ M 1 >, - =-' If) If) ~ 1 1 If) ~ If) If) >, ~ = ~ u ~ 0.. ·- f.... -,(.5 (J -,( 0 00., ,..!_ ~ 1 If) 1 0 ~ ~ ~ ,..!_ ~ 1 1 tri 0 ~ ~ ~ ,..!_ 1 ,-;.:.. 0 ~ If) M ~ ,..!_ 1 ,-;.:.. 0 ,-; If) N tri ~ 2 3 4 5 TOTAL *Control measures taken Preferred age groups: 0-5, 1-5 yrs, 5-10 yrs, 10-25 yrs, 25-45 yrs, 45 yrs ~ 71 Doc. No.: DIS/GDU004 Revision Date:06/05/2019 Review Due Date:13/05/2022 Revision No. :0 Effective Date: 13/05/2019  Guidelines for investigation mut control of f ood borne diseases Author Authorised by Approved by Title Division Manager of Head of Food and Drugs Director General Pharmacovigi lance & Food Inspection & Safety Safety Monitoring Monitoring Department Name JJ1!l