GuiaVETA - Chapter IV - Intervention measures

CHAPTER IV.

INTERVENTION MEASURES

Faced with solid evidence of an outbreak of FBD, measures must be taken to stop the outbreak and prevent its repetition.

History is full of control measures that have created problems among the population and in food production, but the most frequent has been the lack of appropriate control measures with outbreaks persisting or occurring repeatedly because the conditions that created them were not eliminated.

Taking the legal implications into account, the head of the research team should maintain frequent communication with his superiors on control measures to be taken, given the importance of these activities to public health.

Step 8

Develop control measures

The actions taken should be preceded by knowledge of:
The causative agent and the extent of the damage done.
The source of the contaminant.
The food or ingredient that carried the polluting agent.
The methods of processing, packing and preparation which the food underwent.
The methods and places in which the implicated food was distributed
Alternative places and sources of food for the population.
Possible treatments of the implicated food to remove the danger.
Population groups at risk.
The cost of possible actions with regard to the risk of undesirable consequences.
Communication of risk to the population.
Administrative or legal measures that should be taken.

In general, the emergence of outbreaks creates panic when deaths occur, when people must be hospitalized, when children are affected, or when large numbers of people are affected.

The affected population will often identify a particular food, leading to an immediate rejection of that food, even before the survey begins or before it has come to any conclusion. The practical thing to do in the presence of major outbreaks is to set about taking effective control measures, because the consequences could often be significant and the health authorities could be held morally and legally responsible for a lack of action. A ban on consumption of the suspected food or foods is recommended, as well as the suspension of further production, until the survey has been completed and measures taken that can guarantee the safety of renewed output.

Apart from informing the population of the risks involved, it is necessary to continue monitoring the incidence of the disease in order to determine when the outbreak has really ended and, of course, to evaluate the actions taken.

If, during the survey, the food involved is once again rendered safe then the required corrective actions might be modified.

Actions should be taken according to the countryes legally established rules.

Communication of risks to the population should always be the responsibility of an authorized person who is technically trained, and the rest of the team should abstain from making conjectures, assumptions or any other kind of announcement.

a. - With foods:

Prohibit distribution of the food and store it in appropriate places under a restriction order until more information is obtained. Suspend production, processing and preparation of the implicated food.

Ensure that all batches of the implicated food are collected.

Hold, seize or destroy the food depending on the results of the epidemiological study, even when laboratory results have not demonstrated contamination.

All confiscated food should be denatured in order to avoid it falling into the hands of unscrupulous people who would market it clandestinely.

When the food has been identified, processing or preparation must be suspended until the corrective measures have been carried out and it is certain that treatment guarantees elimination of the agents, that the toxins are deactivated or the risk of bacterial multiplication reduced.

All establishments, depending on their size and functions, should set up a HACCP System, or at least proceed on the basis of its seven principles, guaranteeing the existence of appropriate records that allow the authorities to verify the results.

Control criteria should be established or checked frequently enough to ensure prevention of the factors that led to the outbreak.

Even when many producers and processors voluntarily suspend production and distribution, the actions of the health team should have firm backing in order to prevent transgressions, without losing sight of their moral and legal responsibility.

b. - With establishments

When the establishment remains in operation, it is necessary to proceed with the closure of the establishment, until the contributing factors have been corrected. Consideration for its reopening should only be given when all risk factors have been removed and a control system that guarantees `food safety` is in place.

Occasionally, especially in preparation and serving operations, if the means of contamination or the factors that lead to rapid multiplication are quickly identified, then it might be possible to ban the specific food and to authorize use of others. This would follow resolution of the existing risk factors, among them medical evaluation and re-qualification of handlers.

c. - With handlers

Handlers, who have diseases, skin lesions, or sores, or who report an infectious disease in the family, should be removed from direct contact with food. If during an outbreak, the handler should become ill and the agent can be eliminated in the feces over some period of time, then periodic controls should be carried out so elimination can be verified.

In any case, the fact that an agent is not isolated in a person does not mean that that person is not carrying the agent. As a result sanitary control measures should be enforced, particularly the washing of hands and the use of gloves for operations where it is not possible to hold the food with utensils.

It should be remembered that some workers who do not become ill could be carrying the agent and may therefore be as dangerous or even more dangerous than those who fell ill.

d. - Communication of risks and informing the public

When imminent risk threatens the public, this should be announced in the mass media so that people do not consume the food and, if they do, that they return it the center where it was bought, and they should go to the doctor, etc.

The need to reach the entire at risk population should be taken into account and, to this end, the message should be sent out by all possible means in order to achieve the greatest impact in the shortest possible time.

Information on the outbreak should be objective and be based solely on concern for the health of the population. Information should always be confirmed before dissemination; never publish preliminary information. The etiologic agent, its source and means of transmission, as well as the measures to eliminate the risk should all be well documented.

If the health risk were imminent, then the population should be warned that this is a preliminary bulletin and when the etiologic agent is confirmed and the contributing factors identified, then the definitive measures will be issued.

In important outbreaks the appropriate health center will name a person to liaise with the press and others. A telephone contact, manned by a qualified person, should also be established where the population can make necessary queries and be given appropriate instructions, since wrong information could lead to legal, economic and political problems.