The workshop "Bon Appétit One Health - Food-borne Diseases caused by Zoonoses" was hosted by the Academy of Public Health Düsseldorf and the National Research Platform for Zoonoses on 31 May 2016 in Berlin. The event was initiated in order to enter into a dialogue between the Public Health Service (ÖGD) and research on a specific topic.
Camyplobacter, E. coli and Listeria - each pathogen makes its own demands on science and healthcare
The programme covered selected zoonotic pathogens such as Campylobacter, Escherichia coli and Listeria and highlighted current challenges in science and health care. Prof. Dr. Thomas Alter (Department of Veterinary Medicine of the Free University of Berlin) introduced the topic of Campylobacter. He explained the microbiological peculiarities of this pathogen - including stress response and strain diversity - and went into detail on the different transmission pathways between animals and humans. He highlighted the particularities of poultry slaughter and the relevance of flies as vectors in all areas of food production and processing. The question was discussed as to why Campylobacter case numbers cannot simply be reduced by appropriate measures in a similar way as the number of salmonella infections. One current answer to this question is that there is currently no suitable vaccination option, mainly due to the special pathogen properties.
Participants from ÖGD and science met for the workshop on 31.5.2016 in Berlin.
Dr. Elisabeth Hauser (Federal Institute for Risk Assessment (BfR), Berlin) summarised the current state of knowledge on Escherichia coli bacteria as food-borne zoonotic agents. She addressed the different toxins of E. coli bacteria that influence the pathogenesis in humans and animals. She also explained the complex transmission pathways between animals, humans and the environment (water, wastewater, agriculture, plants). She explained the current possibilities of diagnosing E. coli and described epidemiological relationships on the basis of concrete outbreaks.
Following this presentation, Dr. Sven Halbedel from the Robert Koch Institute described the bacterium Listeria and its versatility. It should be emphasized that Listeria have a very high tenacity and can multiply even at temperatures around 4 degrees and in (medium) acidic environments. In the host, due to their preference for a specific receptor combination, they possess tropism for the liver, placenta and brain, which is responsible for the severity of the diseases. Since the treatment of listeriosis is complex, Dr. Halbedel also discussed the therapeutic options. As a solution, he presented an approach for improved listeriosis management, which consists of two building blocks: 1. molecular surveillance for outbreak detection and 2. investigation of genetic factors of listeria for b-lactam tolerance in order to find new starting points for more effective antibiotics. For both approaches, he presented current research results from projects that have been developed in cooperation with the BfR in Berlin and the AGES in Vienna.
Public health challenges are many and varied
After the lunch break, Dr. Bornhofen from the Offenbach Health Office presented the current challenges in the everyday life of a health authority. He explained the complexity of the reporting procedures and the outbreak management that health authorities have to carry out every day with fewer and fewer staff, among many other tasks. A particular challenge here is to clearly identify rare events and to circumvent all possible problems quickly and reliably. Numerous factors play a role here, such as the time delay until patients go to the doctor, the duration of laboratory examinations, reporting processes, missing retained samples, etc., until an outbreak can be recognised as such and then successfully combated. In conclusion, he says that public health authorities could play an indirect role in combating food-borne diseases.
Dr. Bornhofen describes the challenges for the ÖGD
Dr. Friebertshäuser from the Health Services Hochtaunuskreis represented both aspects of the health service as head of an office that combines the veterinary and health authorities in one house. Using illustrative examples from the veterinary and food sectors, she emphasized the importance of cooperation between all three areas - veterinary, health and food - and the advantages of sharing information between them and of knowing the work procedures of the other areas of authority. At the same time, she stressed the importance of knowledge of legal issues and the importance of formalities in the food sector. Using the example of the amended restaurant ordinance in Hesse, she explained what effects official regulations or changes to them can have on everyday life and the probability of infection for the population. For important and simple measures, such as washing hands, favourable or unfavourable conditions can be created so that these obvious personal hygiene measures are possible - or not
One Health means cooperation
The lectures were concluded with the "Bridge One Health" by Prof. Dr. Wieler, President of the Robert Koch Institute (RKI). He emphasized the great added value of the cooperation of several federal ministries under the keyword zoonoses since 2006 - with the visible success story of the zoonoses platform as one result of this cooperation. The RKI supported the demand for more staff for the numerous and important tasks of the ÖGD, he explained. He explained that "One Health" - with zoonoses in particular - is an interdisciplinary task that has to be solved in cooperation, using the vivid example of the successful control of salmonella in recent years. Here, the cooperation of human and veterinary medicine would have produced excellent, visible results. In addition, he sees modern techniques such as NGS and MLST combined with open databases and corresponding infrastructures as important tools for the rapid detection and effective control of food-borne zoonoses.
Between the individual presentations and in the final discussion there was a heated debate. How important is the early and complete reporting of infections by doctors and authorities? Is the much-cited "food chain" from the food-supplying animal to the consumer, including trade and processing channels, and not actually more of a "food network"? How can diagnostics be accelerated in such a way that dangerous foods can actually disappear from the shelves in time? What can be done to ensure that consumers learn to protect themselves better by adapting their behaviour?
Numerous aspects were mentioned and knowledge was exchanged during the discussion:
Knowledge about the occurrence of regionally occurring infections can actually create a more concrete picture on a supra-regional level and often make it possible to take appropriate measures. In the food sector, trade is often conducted supra-regionally or internationally, which can mean a very large spread of infections based on the same cause.
Especially important in the case of food-borne zoonoses is the close cooperation between the public health department, the veterinary office and the food control authorities. Very rarely are these offices united under one roof, so that close exchange cannot be taken for granted. Depending on the food involved in the transmission of an infectious disease, an outbreak can be detected and contained more quickly or more slowly. If frozen foods are involved, an outbreak can last for months as long as it is not detected. If fresh goods with a very short sell-by date, such as fish, are involved, it is even extremely difficult to withdraw individual batches from circulation in time, as detailed diagnostics are sometimes more time-consuming than the food is in the shops or in the refrigerators of consumers. This shows how important knowledge and interdisciplinary cooperation are in this type of zoonosis.
In order to enable consumers to protect themselves better, more basic knowledge of kitchen hygiene should be taught. An appealing example of how to raise awareness of pathogens in food is the WHO's "5 Keys" video on kitchen hygiene.
The speakers and organisers of the workshop (from left to right): Britt Friebertshäuser, Lothar H. Wieler, Bernhard Bornhofen, Stephan Ludwig, Elisabeth Hauser, Thomas Alter, Ilia Semmler, Sven Halbedel, Peter Tinnemann
Proposals for cooperation
In principle, both representatives of the scientific community and the health care system are very interested in cooperation. Models for effective cooperation were discussed. For example, diagnostic kits or examination materials from scientific laboratories could be made available to the authorities if certain questions are to be dealt with in a scientific cooperation project. The results of such projects should then in turn be published - not only accessible to scientists but also easily accessible and comprehensible, so that it is also easier for politicians to recognise how important it is for the ÖGD to participate in research and what concrete relevance the jointly developed results have for the population. The importance of the data from the offices for research was emphasized - whereby it was pointed out that the offices should by no means be understood as mere data providers, but rather as an important interface between the population and science. The ÖGD can provide local and regional appropriate impulses and actively contribute to health protection, while science can provide analyses and current research results.
With 64 participants from science, public veterinary and health services and interested parties from state ministries and associations, the event room was filled to capacity. Unfortunately, many people on the waiting list could not attend. Due to the great popularity of the event, it is currently being examined to what extent it can be offered again in this or a similar form next year.
Program of the event
The slides of the presentations were kindly provided by the speakers for reference. Further use is not permitted. If you have any questions regarding the slides, please contact the respective speaker.
Prof. Dr. Thomas Alter, Institute for Food Hygiene, FB Veterinary Medicine, Freie Universität Berlin
Focus Escherichia coli
Dr. Elisabeth Hauser, Division of Food Technology Processes, Product Chains and Product Protection, Bundesinstitut für Risikobewertung, Berlin
Dr. Sven Halbedel, National reference centre for salmonella and other enteric pathogens, Robert Koch-Institut, Wernigerode
What are the most relevant challenges in the daily practice of the health authority?
Dr. Bernhard Bornhofen, City Health Department Offenbach
What are the most relevant challenges in the daily practice of the veterinary office?
Dr. Britt Friebertshäuser, Health services Hochtaunuskreis
Perspectives for bridging the gap with the One Health Concept - what do we need to work on together to reduce the risks of food-borne transmission?
Prof Dr. Lothar Wieler, Robert Koch-Institut, Berlin