MECIDS

Projects

::Enhanced Surveillance for Detection of Foodborne Epidemics

Technician working in the Palestinian Central Laboratory
In the framework of MECIDS, we wish to establish national laboratory-based surveillance networks for foodborne diseases in Jordan, Israel, Palestine and Egypt that will be conduct surveillance according to harmonized methodology, will have a common platform of communication, data sharing and analysis, and will discuss intervention steps when needed. Against the background of the close proximity among Jordan, Israel, Palestine and Egypt, and a level of food exchange that hopefully will increase in the near future, we anticipate that the significant upgrade in the methods of surveillance will play an important role in the prevention and control of occurrence and transmission of foodborne diseases in the whole region. It will also create and strengthen mechanisms for cooperative detection and management of an outbreak due to a biological terrorist attack.

The MECIDS foodborne disease surveillance project will be a three-year project and will include five different components. It will strengthen the ability to detect, characterize, and analyze foodborne diseases at every level in the participating nations, and it will create a new mechanism for sharing information across borders. The project will work within the existing health infrastructure. The participants will be the Israeli Ministry of Health in partnership with Tel Aviv University; the Palestinian Ministry of Health in partnership with Al Quds University; the Jordanian Ministry of Health in partnership with the Royal Scientific Society; and potentially, the Egyptian Ministry of Health and Population. Click here to see System Diagram (WORD document)

1. Sentinel Laboratories: Because most foodborne infections cause diarrheal illness, the MECIDS foodborne disease surveillance will focus on cases of diarrheal illness. Each of the four MECIDS participants will select three or four microbiological labs that will form the network of sentinel labs and will cover the different regions of each country. In most cases, these will be public laboratories that report to the Ministry of Health. These labs will receive stool specimens from cases of diarrhea occurring in the community or cases admitted to emergency departments. The stool specimens will be tested for presence of a defined range of foodborne enteropathogens. When significant clusters of diarrheal diseases are identified, case-control studies will be carried out as an attempt to trace food items possibly associated with the epidemic spread of the pathogen.

2. Central Reference Laboratory: Each MECIDS member will develop or enhance activities carried out at one or more central reference labs, housed either within the Ministry of Health or university system, that will serve for characterization of strains (phenotypic and genotypic) isolated by the sentinel labs. The central labs will also carry out more advanced diagnostic tests which than can be performed at the level of the sentinel lab. (See Annex B for a detailed description of laboratory activities.)

3. Food Microbiology Laboratory: The MECIDS members will establish or enhance capabilities at a Ministry of Health or university laboratory for rapid detection of enteropathogens in samples from food items suspected to be involved in the epidemic transmission of the pathogens according to the results of the case-control studies conducted.

4. Data Analysis Unit: To manage the data developed by the project and to serve as a central point of contact in each country, a Data Analysis Unit will be established. Data on submission of stool specimens and isolation of the enteropathogens at the sentinel lab, information related to the patients (gender, age, address, etc.), results of microbiological examination of food items, and characterization of isolates at the central reference laboratories and food laboratories will all be gathered and analyzed at the unit. This unit will provide a central storage system for national foodborne disease data to include extensive details that would be invaluable to the nation but would be of too sensitive a nature for sharing beyond national borders. It will provide for quality control of data, collection of data, storage of data, standardization of data, elaboration of data, analysis of data, and presentation of data to review users. It will also aid in making data interoperable across national lines.

Finally, the National Data Analysis Unit will conduct real-time data analysis, identification of clusters of disease and initiation of case-control studies to attempt to identify food items associated with disease. It will alert the public health authorities when necessary.

5. Regional Data Analysis Unit: The MECIDS network will create a mechanism for sharing data from the national systems. This Regional Data Analysis Unit will begin as a web site, on which participants can store national food borne disease data to include all pathogen-specific information, after it has been vetted by the National Data Analysis Units to ensure that it complies with national patient privacy laws and is not of too sensitive a nature for sharing across borders. Access to data will be provided to users according to the levels of permissions for data access based on who the user is, where they are from and what they have a need to know.

Participants will cooperate on analyzing data collected through the new system, with the objective of improving disease surveillance in the region. The web site may be equipped with tools to facilitate data analysis.

Project participants will develop procedures for routine sharing of data, such as data on the incidence and prevalence of specific foodborne diseases. This may be accomplished by posting it on the web site or using other means. Participants will also develop procedures for rapid sharing of data following a suspected outbreak.