FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

ciguatoxinas@msssi.es

“RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN

EUROPE”

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

ciguatoxinas@msssi.es

EuroCigua Project focuses on the risk characterization of ciguatera food poisoning in Europe with the following main objectives:

o To determine the incidence of ciguatera in Europe and the epidemiological characteristics of cases. (SG2)

o To assess the presence of ciguatoxin in food and the environment in Europe.(SG3)

o To develop and validate methods for the detection, quantification and confirmation of the presence of ciguatoxin contaminated specimens.(SG4)

MAIN GOALS

HEALTH AUTHORITIES

FOOD SAFEETY AUTHORITIES

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UNDERREPORTING

MOST COMMON REPORTED NATURAL MARINE TOXIN: 10.000-50.000 (2-10% REPORTED)

UNDERREPORTING: NOT WEL KNOWN IN NON-ENDEMIC AREAS: CONSUMERS

AND HEALTH PROFESIONALS NOT MANDATORY NOTIFICATION OF INTOXICATIONS,

EXCEPT OUTBREAKS NO TREATMENT

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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• SG2: To determine the incidence and epidemiological characteristics of ciguatera cases in Europe

Deliverables

Case definition http://www.aecosan.msssi.gob.es/AECOSAN/docs/documentos/ciguatera/Ciguatera_Case_definition_EN.pdf

List of possible data sources for ciguatera cases and outbreaks

Surveillance protocol for ciguatera cases and outbreaks

Database for collecting cases and outbreaks

Report on the epidemiology of ciguatera in Europe

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Surveillance protocol Deliverable 3

Table of contents

Foreword ........................................................................................................................................................ 2 Scope .............................................................................................................................................................. 2 Disease Description ....................................................................................................................................... 2

Introduction ................................................................................................................................................ 2

Symptoms .................................................................................................................................................. 2

Agent .......................................................................................................................................................... 3

Reservoirs .................................................................................................................................................. 3

Modes of transmission ............................................................................................................................... 3

Incubation period ....................................................................................................................................... 3

Period of communicability ......................................................................................................................... 3

Laboratory testing ...................................................................................................................................... 3

Disease Reporting .......................................................................................................................................... 4 Objective .................................................................................................................................................... 4

Case definition ........................................................................................................................................... 4

Other definitions ........................................................................................................................................ 5

Reporting flow ........................................................................................................................................... 5

Legal reporting requirements ..................................................................................................................... 5

Public Health Measures ................................................................................................................................. 6 Preventive measures................................................................................................................................... 6

Measures for single cases........................................................................................................................... 6

Measures for outbreaks .............................................................................................................................. 6

Annex. Case report form ................................................................................................................................ 7

Annex Outbreak report form .......................................................................................................................... 8 References ...................................................................................................................................................... 9

INFORMATION

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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Case report form Surveillance protocol Deliverable 3

CASE INFORMATION

DISEASE DATA

FOOD RISK DATA ( FISH)

LABORATORY DATA

MEASURES

IMPLEMENTED

CLASIFICATION

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Outbreak report form Surveillance protocol Deliverable 3

CASE INFORMATION

DISEASE DATA

FOOD RISK DATA ( FISH)

LABORATORY DATA

MEASURES IMPLEMENTED

CLASIFICATION

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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Possible data sources

At country level

• Public health surveillance system (ECDC)

• General Practitioners records (outpatients)

• Hospital Emergency Records

• Hospital Discharge Records (inpatients)

• Poison Centres records

• Travel or Tropical Medicine Units/Facilities records

• Food Safety Authorities

• Vital statistics

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Which food-borne outbreaks caused by which marine biotoxins are investigated in your country?

In case of such food-borne outbreaks, are both general

outbreaks as well as household outbreaks investigated? Or only one of the two?

Are there factors hampering a smooth reporting to EFSA and the

EU of eventual outbreaks due to ciguatoxin in your country? Does your country test fish for detection of ciguatoxin? Information on annual statistics: Number of fish tested per

year/Number of positive fish per year/Species or type of fish found positive

Poland

Estonia

Slovenia

Switzerland

Czech Republic

Belgium

Sweden

Germany

Croatia

the Netherlands

Norway

Luxembourg

France

Austria

Slovak Republic

Portugal

QUESTIONAIRE: November 2016 Zoonoses Monitoring Data Network

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Contact points for food-borne outbreaks reporting ADVISORY FORUM MEMBERS, june 2016

Austria Austrian Agency for Health and Food Safety (AGES)

Belgium Scientific Institute of Public Health

Technical University of Denmark

Danish Veterinary and Food Administration

Estonia Food Department Veterinary and Food Board

Finland Finnish Food Safety Authority Evira

France Ministry of agriculture

Greece Ministry of Rural Development and Food, Animal Health Directorate

Ministry of health

Fondazione Centro Ricerche Marine

Lithuania Center for Communicable Diseases and AIDS

National Health Laboratory, Epidemiological surveillance of transmissible diseases

Directorate for public Health, health inspection services

Netherlands National Institute for Public Health and the Environment (RIVM)

Portugal National Authority for Animal Health (DGAV)

Romania*

Slovakia Regional Public Health Authority in Banská Bystrica

Sweden Swedish National Food Agency

Luxembourg

Italy

Denmark

* Gambierdiscus is not found in the black sea

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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Possible data sources

At European Union level

• EU Food-borne reporting System (EU-FORS). EFSA

• Epidemic Intelligence Information System, EPICS. ECDC

• Alert systems from the European Commission

EWRS

RASFF

RAS-CHEM

• World Health Organization

EFSA: European Food Safety Authority ECDC: European Centre for Disease Prevention and Control EWRS: Early Warning and Response System RASFF: Rapid Alert System for Food and Feed RAS-CHEM: Rapid Alert System for Chemicals

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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GENERAL NOTIFICATION DATA; DATE, NOTIFICATION COUNTRY,

COUNTRY OF ORIGEN

PRODUCT INFORMATION: SPECIE, BACTH

SAMPLE INFORMATION; PLACE, LABORATORY, ANALYTICAL

METHOD, RESULTS

EPIDEMIOLOGICAL DATA: NUMBER AFECTED, SYMPTOMATOLOGY

RASFF NOTIFICATION INFORMATION TEMPLATE

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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Possible data sources

At European Union level

• EU Food-borne reporting System (EU-FORS). EFSA

• Epidemic Intelligence Information System. ECDC

• Alert systems from the European Commission

EWRS

RASFF

RAS-CHEM

• World Health Organization

EFSA: European Food Safety Authority ECDC: European Centre for Disease Prevention and Control EWRS: Early Warning and Response System RASFF: Rapid Alert System for Food and Feed RAS-CHEM: Rapid Alert System for Chemicals

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EU food-borne reporting system

Causative agent Country Number of

s-e outbreaks

Cases

(s-e outbreaks)

Hospitalized

(s-e outbreaks)

Deaths

(s-e outbreaks)

Total outbreaks

Histamine Belgium 1 2 2 0 1

Croatia 4 61 1 0 4

France 11 87 7 0 11

Germany 5 21 0 0 5

Sweden 2 22 1 0 2

Switzerland 2 24 0 0 2

Marine biotoxins - ciguatoxin Germany 1 6 0 0 1

Mushroom toxins Hungary 1 8 0 0 1

Total (MSs) 25 207 11 0 25

Note: ‘s-e’= strong-evidence;

Strong evidence food-borne outbreaks caused by other causative agents

(excluding waterborne outbreaks), 2015

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CIGUATERA FOOD POISONING

ZOONOSIS SSD2 CATALOG CIGUATOXINS

T61.0Ciguatera fish poisoning

RF-00000009-TOXI Marine biotoxines RF-00000450-TOXI Ciguatoxins

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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English Portuguese Spanish German

BUILD UP AWARENESS

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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Date Place No. of Cases Type of fish Size (kg) Fish origen Ctx detection

Nov 2008 Tenerife 25 Seriola fasciata 37 Local market Yes

Jan 2009 Tenerife 4 Seriola dumerilis 67 Sport fishing Yes

Sep 2009 Gran Canaria 3 Seriola spp. UNK UNK

Nov 2009 Tenerife 2 Seriola spp. UNK Sport fishing

Apr 2010 Tenerife 6 Seriola spp. 80 UNK

Jun 2011 Gran Canaria 5 Seriola spp. 24 Sport fishing Yes

Jan 2012 Lanzarote 10 Seriola spp. 15 Sport fishing

Apr 2012 Lanzarote 9 Seriola spp. 26 Sport fishing

May 2012 Tenerife 4 Seriola spp. UNK Local market

Dec 2012 Tenerife 12 Epinephelus spp. 18 Sport fishing Yes

Dec 2013 Lanzarote 16 Epinephelus spp. UNK Local market Yes

Feb 2015 Tenerife 3 Mycteroperca fusca 3-4 Local market

Apr 2015 Tenerife 3 UNK UNK UNK

May 2015 Tenerife 2 Pamatomus saltatriz <10 Sport fishing Yes

Nov 2016 Tenerife 2 Epinephelus spp. 7 Local market Yes

Dec 2016 Tenerife 3 Seriola spp. 12 Street vendor Yes

Dec 2016 La Palma 2 Pagrus pagrus 5 Sport fishing Yes

Epinephelus spp. 29 Sport fishing Yes

Mycteroperca fusca 8 Sport fishing YesApr 2017 El Hierro 2

TWO FISHERMEN NOT RECOGNIZED CFP BY PHISCICIAN CONSUMPTION CONTINOUSLY FROM 13-22 APRIL FISH SPECIES UNDER RISK CONTACTED UNIVERSISTY FOR FISH ANALYSIS

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FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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Río de Janeiro, Brazil – 3-7 April 2017

CCCF :Ciguatera is a natural occurring toxin in fish and CCCF will be the relevant subsidiary body of CAC to recommend measures to reduce contamination to safe levels to ensure public health and facilitate trade.

Ciguatoxins and CODEX

FRAMEWORK PARTNERSHIP AGREEMENT GP/EFSA/AFSCO/2015/03 RISK CHARACTERIZATION OF CIGUATERA FOOD POISONING IN EUROPE s

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How can you help us?

MEMBER STATES CONTACT POINTS FOR SENDING THE SURVEILLANCE

QUESTIONAIRE ANY INFORMATION ON POSSIBLE DATA SOURCES FOR

CONTACT UPDATE AND PROVIDE MORE INFORMATION OF CIGUATERA

OUTBREAKS TO EFSA USE EUROCIGUA MATERIALS (WEB) TO CREATE AWARENESS

EU-FOOD REPORTING SYSTEM MORE INFORMATION OF CIGUATERA OUTBREAKS MORE FLEXIBILITY IN REPORTING WINDOWS

http://www.aecosan.msssi.gob.es/AECOSAN/web/ciguatera/home/aecosan_home_ciguatera.htm Contact: ciguatoxinas@msssi.es

CONTACT: eurocigua@msssi.es