ACMSF minutes: 26 March 2009

Meeting held in Aviation House 125 Kingsway, London WC2B 6NH

Present

Chair: Professor S O’Brien

Members:
Mr J Bassett
Mrs V Buller
Prof J Coia
Mrs R Glazebrook
Dr R Holliman
Prof T Humphrey
Prof P Hunter
Mr A Kyriakides
Mr P McMullin
Dr S Millership
Mrs J Morris
Prof P Williams (chaired item 6)

Assessors:
Mr S Wyllie (Defra)
Dr J Hilton (FSA)

Secretariat:
Dr L Foster (Administrative Secretary)
Dr P Cook (Scientific Secretary)
Mr A Adeoye
Miss S Butler

Others:
Bob Adak, HPA Centre for Infections
Sally Barber, British Retail Consortium
Steve Batchford, Brakes
Mary Brennan, FSA Social Science Research Committee
Jane Buckles, Brakes
Bridgette Clarke, Bakkavor Ltd
Iain Gillespie, HPA Centre for Infections
Kaarin Goodburn, Chilled Food Association
Dr Fraser Gormley, HPA Centre for Infections
Kathie Grant, HPA Centre for Infections
Jenny Hopwood, Marks & Spencer
Karen Job, Marks & Spencer
David Kennedy, Uniq Prepared Foods
Samantha Kirk, Tesco
John Lepley, Food and Drink Federation
Alan Lyne, ADAS
David McCleery, Food Safety Promotion Board, Ireland
Tom Miller, Retired consultant
Rick Pendrous, Food Manufacture magazine
Bernard Rowe, Consultant, Tesco
Karen Sims, Waitrose

1. Chair’s Introduction

1.1. The Chair welcomed ACMSF Members and members of the public to the 69th meeting of the Committee. She also welcomed Dr Iain Gillespie and Dr Bob Adak (HPA) who would be presenting agenda item 6, Ceri Cooper and John Ferrier (FSA) who would be presenting agenda item 8, and Nicola Walker (FSA) who would be presenting agenda item 9.

1.2. She informed the Members of 2 items to be taken under “Any Other Business:” an update from Mr Wyllie on the Defra prevalence study and an item on reappointments to the Committee.

2. Apologies for absence

2.1. Apologies for absence had been received from Dr David Brown, Prof Mike Gasson, Dr Sydney Neill and Mr Robert Rees.

3. Declarations of interests

3.1. The Chair reminded the Committee of the need to declare any conflicts of interests relating to items on the agenda. She declared an interest under agenda item 6 as she was one of the authors of the paper on campylobacteriosis which was to be discussed. Because of this she had asked Prof Peter Williams to take the chair for item 6. Prof John Coia declared that he undertook consultancy work for Tesco. Mr Kyriakides declared an interest in agenda item 8 as his employer sold eggs. Mr McMullin declared an interest with regard to items 8 and 10 as he is a consultant to BEIC.

4. Minutes of the 68th meeting

4.1. Members approved ACM/MIN/68 as a correct record of the previous meeting. The Secretariat was asked to arrange for the minutes to be posted on the Committee’s website.

5. Matters arising

5.1. The Chair drew attention to a summary of action taken on matters arising from previous meetings produced by the Secretariat. Most of the points raised had either been actioned or related to work in progress.

6. Campylobacter in the elderly

6.1. Prof Williams (Chair for this item) reminded members that in March 2008 the cross-government Epidemiology of Foodborne Infection Group (EFIG) was briefed on a change in age-specific incidence of Campylobacter infection in the over 60s age group. He invited Dr Iain Gillespie and Dr Bob Adak (HPA) to present paper ACM/935 which updated the Committee on changes in human Campylobacter infection in England.

6.2. Dr Gillespie explained that there were 12 species of Campylobacter, which were Gram negative bacteria. Infection resulted from either direct or indirect contact with animals and there was a low infective dose for illness. The organism caused acute enteritis, with approximately 10% of cases requiring hospital admission. There were various sequelae reported including up to a quarter of patients developing irritable bowel syndrome. In the period 1993 to 2006 there were 45 deaths from Campylobacter infection.

6.3. Dr Gillespie presented graphs showing the incidence of campylobacteriosis in England and Wales since the late 1970s when the role of Campylobacter in gastrointestinal disease had been discovered. He explained that reasons for a decline in incidence between 2000 and 2004 and a subsequent increase from 2005 to 2007 were unknown. Therefore a study had been set up to investigate this further.

6.4. Dr Gillespie reported the conclusions of this study. These were that there had been a dramatic change in the age structure of human campylobacteriosis in England and Wales with older people being the most at risk of infection.

6.5. Prof Williams invited comments from Members on the issues raised in the paper and presentation.

6.6. Dr Millership asked whether the study had shown any differences in cases in rural and urban areas. Dr Gillespie said that the catchment areas for the laboratories involved in the study were not coterminous with Local Authority areas and post code data was not available.

6.7. In answer to a question from Professor Hunter, Dr Gillespie said that it was too early to say whether the increase in cases had continued in 2008 as not all the data were yet available. Prof Hunter also asked whether it would be possible to do any subgroup analyses from the case control study. Prof O’Brien replied that a case control study on Campylobacter during the period of the increase had recently been completed. Recruitment amongst elderly people had been better than those in other age groups and she suggested that it might be possible to re-analyse the data, accepting that study power would be low, to generate further hypotheses to test. This could be presented at the ACMSF meeting in June.

6.8. Dr Holliman asked whether a similar increase in campylobacteriosis had been reported in other European countries. Dr Adak replied that he was not aware of a similar increase from contacts in Europe but this was something they would want to investigate before doing a further phase of enhanced surveillance.

6.9. Mr McMullin asked whether there was a known pathogenic dose of the bacteria. Dr Gillespie mentioned that some work had been done in Holland by Black in the 1980’s which showed that dose response appeared to be exponential rather than linear. Prof Hunter said that the model of infective dose was based on probability distribution function and it appeared that some people could be infected by exposure to one single cell.

6.10. Mr Kyriakides asked whether, as Food Safety Week was focussing on the over 60s, there was a need to include anything general on Campylobacter. Dr Cook replied that messages such as the 4 C’s were targeted at reducing foodborne disease in general. The FSA would reflect on the findings that had been presented as part of the work to develop Food Safety Week and consider including Campylobacter as well as Listeria.

6.11. Prof Williams concluded the discussion by concurring with Prof O’Brien’s suggestion that a further analysis of data sets from the study should be presented to the ACMSF’s next meeting.
Action: HPA/Secretariat

7. Report on Listeria in the elderly

7.1. The Chair reminded Members that at the last meeting the Committee had agreed that the Ad Hoc Group’s report on the increased incidence of listeriosis in England and Wales should be subjected to a period of public consultation. The consultation period had ended in February and the Ad Hoc Group had met to consider the responses received. She invited Prof Humphrey (Chair, Ad Hoc Group) to present the outcome of the consultation.

7.2. Prof Humphrey drew Members’ attention to the summary report ACM/936a which listed the key proposals on which the consultation had been based and attached a table showing the comments received and the Ad Hoc Group’s response to these comments. A large number of the responses to the consultation had been positive about the report.

7.3. The Chair invited comments from Members on the proposal to publish the summary report on the FSA website and to publish the Group’s report following some minor editing.

7.4. Mrs Glazebrook commented that there appeared to be a lack of consistency in the Report regarding definition of the group that was at risk. She thought that people would be unclear whether it was the over 60s or over 65s and whether it was healthy people or those who were immuno-compromised who were considered vulnerable.

7.5. Prof Humphrey explained that there were no standard definitions of “the elderly” or “vulnerable” but that the report had been concerned with vulnerable people over the age of 60. However, he agreed that the report should be amended to make these definitions clearer.
Action: Secretariat/Ad Hoc Group

7.6. Dr Holliman said that as the Group was aware of the increase in campylobacteriosis in the elderly, this similarity should be referenced in the Listeria report. Members of the Committee agreed.
Action: Secretariat/Ad Hoc Group

7.7. Prof Williams asked for some clarification of the Group’s response to a comment made by the Chilled Food Association on page 29 of the table of responses. Prof Hunter said that it was difficult to include information on ethnicity in surveillance as this created ethical dilemmas which made it impractical.

7.8. In summing up the discussion the Chair asked the Ad Hoc Group to expand on some of the responses in the table to provide greater clarification. Members agreed that following these amendments and some final edits to the Report that both should be published.
Action: Secretariat/Ad Hoc Group

8. Salmonella in eggs risk assessment model

8.1. The Chair informed Members that one of the recommendations from the ACMSF’s second Salmonella in eggs report was to further develop and enhance a Department of Health Salmonella in eggs risk assessment model. She invited Ceri Cooper and John Ferrier from the FSA’s Analysis and Research Division to introduce paper ACM/937 which outlined the features of the model.

8.2. Miss Cooper explained that using information from several FSA egg surveys a quantitative risk assessment model had been produced which could be used to inform risk management decision making. She explained that the model used Monte Carlo simulation to model uncertainty. Mr Ferrier outlined the stages of the model which estimates the prevalence of Salmonella contamination at the production, retail, preparation and cooking stages by compounding probabilities of cross contamination at each stage. The outputs were the probability of contamination of eggs at point of sale and at point of consumption in an egg based meal.

8.3. The Chair invited comments from Members following the presentation.

8.4. Members discussed whether the model reflected current practice in catering establishments regarding use of eggs (e.g. pooling) and kinds of dishes prepared. Miss Cooper agreed to produce an annexe to the paper containing further detail for ACMSF Members to comment on. Mr Bassett commented that the model asked the right questions and he encouraged the FSA to share further details of the model with the ACMSF.
Action: FSA

8.5. In answer to a question about enumeration Dr Cook explained that when the Committee had considered the model previously, the decision had been made not to look at dose/response because sufficient data were not available.

8.6. The Chair thanked Miss Cooper and Mr Ferrier for their presentation. The ACMSF endorsed the work the FSA had done and suggested that it should be shared widely including peer review and amongst industry stakeholders.

9. Codex Food Hygiene meeting

9.1. Dr Paul Cook (FSA) had attended the 40th session of the Codex Committee on Food Hygiene held in December in Guatemala. He updated the Committee on discussions at this meeting, which included completing work on two texts (microbiological criteria for powdered follow-up formula and formulae for special medical purposes for young children, and microbiological criteria for Listeria monocytogenes in ready-to-eat foods). Two new pieces of work had been agreed (elaboration of a Code of Hygienic Practice for the Control of Viruses in Food, and Annexes to the Draft code of Hygienic Practice for Pathogenic Vibrio species in Seafood). These were outlined in paper ACM/938. He informed Members that the full report of the meeting could be found on the Codex website.

10. EFIG

10.1. The Chair invited Dr Judith Hilton (Chair, EFIG) to update Members on the work of the Epidemiology of Foodborne Infections Group.

10.2. Dr Hilton informed Members that there had been 2 meetings of EFIG since the ACMSF had last met but she would report on the meeting held on 5 March. She outlined trends in human data which showed that Salmonella had declined in the UK, and in particular in England, in 2008. The decrease was mostly in Salmonella Enteritidis PT4. Listeria monocytogenes had increased in the early 2000s but had been levelling off in the last 4-5 years but was still approximately double that seen in the late 1990s. VTEC O157 levels were comparable to the 1990s. Campylobacter had showed a downward trend between 2000 and 2004 but recently had shown a rise. She outlined the trends in animal data, where Salmonella had also decreased in most species. There had been an increase in chickens and pigs but this was linked to increased testing under National Control Plans.

10.3. She summarised the findings from the CLASSP poultry survey and compared these with the results of the 2001 FSA survey and HPA/NPHSW surveys of Campylobacter in chicken. She explained that Salmonella had been detected at a low level in these surveys and that results were comparable with each other and with the recently completed FSA survey of Campylobacter and Salmonella in chicken on retail sale in the UK. However, there were differences in the Campylobacter results between HPA/NPHSW surveys and the recent FSA poultry meat survey.

10.4. Dr Hilton informed Members that the group had received a presentation on the UK Food Surveillance database, a national database for food sampling data from LAs, PHAs and public laboratories. Members expressed an interest in this database and it was agreed that the Secretariat would arrange for a similar presentation be given to a future ACMSF meeting.
Action: Secretariat

10.5. Mr Kyriakides sought a view from FSA on the proposed Zoonoses Regulation that required an absence of Salmonella in 25g in raw poultry as there was a discrepancy with the requirements of National Control Plans. He highlighted concerns that although the industry had made great strides in reducing levels of contamination, the regulation could lead to many recalls. Dr Hilton replied that this had been pointed out when the criterion had been set and it was being reviewed by the Commission Working Group.

11. Botulism in sheep and goats

11.1. The Chair informed members that following the publication of the ACMSF’s report on botulism in sheep and goats in January, the FSA was taking forward work to implement the recommendations highlighted in this report. She invited Nicola Walker (FSA) to update the Committee on this work.

11.2. Miss Walker explained that following a change in advice on management of suspected botulism in cattle in 2006, an Ad Hoc group of the ACMSF was convened in 2007 to consider the potential risk to human health from food chain issues linked to botulism in sheep and goats. The Group was particularly asked to consider the risk in relation to the spreading of poultry litter on agricultural land.

11.3. Based on a thorough review of the scientific literature the group’s report concluded that the current voluntary restrictions on meat and milk from clinically affected animals appear to be appropriate, and such foods should continue to be withheld from the food chain.

11.4. The Group also concluded that voluntary restrictions applied to unaffected animals could be considered to be over-precautionary based on current scientific evidence. One of the reasons for this was because the botulinum toxin types identified in animals have rarely been associated with disease in humans. The Group’s draft Report was the subject of a public consultation and no objections were raised to their recommendations.

11.5. The FSA would be implementing the change to its advice, and would no longer request voluntary restrictions for healthy sheep and goats from farms where cases of botulism are suspected. However, this would need to be reviewed if evidence emerged that the botulinum toxin types that affect humans were causing outbreaks in sheep or goats. Miss Walker explained that a communications strategy was being developed to disseminate the change in advice in early April. Articles would be published in the Veterinary Record, the VLA newsletter, and the FSA’s website. The change in advice would also be brought to the attention of the farming press and would include links to guidelines provided by Defra regarding the use of poultry litter.

11.6. The Chair asked Members to comment on the FSA’s work. Mr Kyriakides asked whether it would be possible to have an annual update on outbreaks of botulism in cattle, sheep and goats and the toxin types involved. It was agreed that the Secretariat would provide this in the form of an annual information paper.
Action: Secretariat

12. Committee sub-groups

Ad Hoc Group on vulnerable groups

12.1. Prof Humphrey (Chair of the Ad Hoc Group) informed Members of work being done in association with the FSA’s Social Science Research Committee (SSRC). He had given the SSRC a presentation about the work on Listeria in the elderly in November. A sub-group of SSRC had subsequently been set up to investigate some of the issues highlighted by the Ad Hoc Group, in particular hygiene in the home. This work was continuing and the SSRC Subgroup would be asked to report on their findings at the next ACMSF meeting.

12.2. Prof Humphrey also reported that the Ad Hoc Group had had a meeting in December 2008 to discuss Toxoplasma and had included a presentation by Dr Ed Guy, Head of the Toxoplasma Reference Unit. The Group had concluded that they needed more information before proceeding and the FSA had been asked to provide a position paper for them to consider later in the year.

13. Working Group on Surveillance

13.1. Prof Humphrey (Chair of the Surveillance Working Group) reported that the Group had met to discuss the Campylobacter in retail chicken survey. This had revealed an apparent discrepancy in the Campylobacter results which had shown a prevalence of 40% compared to 70% prevalence published in other surveys. Prof Humphrey said that discussions were taking place with the contractors to investigate the results.

14. Update on GACS

14.1. The Chair reported that the General Advisory Committee on Science (GACS) had met twice since the last ACMSF meeting in October and February. The Committee was involved in various activities including developing a co-ordinated approach by the scientific advisory committees to horizon scanning. She reported that a workshop on this subject was being planned for June 2009.

14.2. At the February meeting GACS considered the FSA’s next Science and Evidence Strategy which is being developed in parallel with the FSA’s new Strategic plan for 2010-15.

14.3. GACS had also agreed a revised set of performance indicators for the Agency’s science focussing on the quality of questions posed, research carried out and how outputs of research have been used.

14.4. At the GACS meeting in September the Committee would focus on ways to establish a community of experts and progress on developing the Agency’s Science and Evidence Strategy.

15. Dates of future meetings

15.1. The Chair drew Members’ attention to Paper ACM/941 which gave the dates for meetings of the full ACMSF for 2009 and 2010. All these meetings would be open to Members of the public.

16. Any other business

16.1. At the Chair’s invitation Mr Wyllie updated Members on the Defra Mycobacterium avium subsp. paratuberculosis (MAP) Prevalence Survey. The draft report was with the Veterinary Laboratories Agency which was carrying out a review of the comments of the independent peer review and would be liaising with Defra and industry colleagues. He said the aim was to publish the final report on the Defra website during the second quarter of the year. This would be accompanied by a joint briefing between Defra, FSA and DH and information for farmers would be drafted to give them feedback from the report.

16.2. The Chair informed Members that the following ACMSF Members had been re-appointed to the Committee: Tom Humphrey, Alec Kyriakides, Rick Holliman, Jenny Morris and Sally Millership. She congratulated them and thanked them for their continuing commitment to ACMSF. She also announced that Dr Lucy Foster would be leaving the FSA to take up a post in Defra. She thanked Lucy for all her hard work as Secretary to the Committee and wished her well in her new post.

Public questions and answers

17.1. Mr Tom Miller (member of the Food Policy Group of the National Consumer Federation) drew attention to the issue of clarity of definitions in the Ad Hoc Group on Vulnerable Groups’ draft Report. He said this needed to be addressed otherwise there was a danger that some vulnerable people would not think that they are at risk. Secondly he referred to the need for clearer labelling for those with poor eyesight especially when colours were used against certain backgrounds. The Chair said these points were noted and would be addressed in the final report.

17.2. Dr Bernard Rowe (independent consultant), referring to the presentation on Campylobacter, asked if there had been a change in types of the organism over the years coinciding with the changes in epidemiology. He also asked about the methods currently being used for typing. The Chair said that phenotypic methods were not now routinely used for Campylobacter. HPA had also taken a decision not to use these methods. Molecular methods were being targeted at specific research questions rather than comprehensive typing but it had been carried out in specific circumstances including in the national case control study.

17.3. Mr Rick Pendrous (Editor of Food Manufacture magazine) asked if the ACMSF would be taking any action following publication of Prof Hugh Pennington’s report on the E. coli outbreak in Wales. Although most of the recommendations from the Report were concerned with risk management issues, it was agreed that it would be appropriate for the Committee to consider the report at a future meeting.
Action: Secretariat

17.4. Dr Mary Brennan (member of the FSA Social Science Committee) commented on the cross-over between social science and work being carried out by the ACMSF. She hoped that work the SSRC sub-group were doing, on the way people handled food at home, would feed into the ACMSF’s work on both Listeria and Campylobacter. She explained that her group had found a lack of published research on the over-60s.

17.5. Kaarin Goodburn (Chilled Food Association) asked if the question of ethnicity would be covered as part of the SSRC work on Listeria. She also pointed out there were different definitions of “high risk” foods in the UK and Europe. On the question of ethnicity Prof Humphrey said there were certain data protection restrictions which made information on this difficult to obtain. Prof Hunter added that most surveillance data did not have very good person identifiable data that were useable.

17.6. Dr Rowe commented on the withholding of information by food manufacturers. He referred to a large US outbreak related to peanut butter as a result of which the FDA were considering making changes to the law which would require food manufacturers to disclose information. He asked for reassurance that ACMSF would keep this in mind. Dr Hilton confirmed that this issue was under consideration by the FSA and that it was concentrating on its incident prevention work as a way of improving the flow of information from industry. Mr Kyriakides commented that the vast majority of the industry did disclose information relating to possible public health risks.

17.7. There being no further business, the Chair thanked Members and members of the public for attending and closed the meeting.