1.1 The Chair welcomed ACMSF Members and members of the public to the 73rd meeting of the Committee. The Chair welcomed Professor David McDowell and Mr David Nuttall as new Committee Members and invited them to introduce themselves. The Chair also welcomed Ms Gael O’Neill (FSA) who would be presenting agenda item 6, Ms Catherine Bowles (FSA) who would be presenting agenda item 7, Mr Nick Laverty (FSA) who would be presenting agenda item 10, Mr Adam Hardgrave (FSA) who would be presenting agenda item 11 and Dr Sophie Rollinson who had joined the Secretariat.
2. Apologies for absence
2.1 Apologies for absence had been received from Dr David Brown, Professor John Coia and Professor Tom Humphrey.
3. Declarations of interest
3.1 The Chair reminded Members of the need to declare any conflicts of interest relating to items on the agenda. Mr John Bassett declared a conflict of interest in the discussions on item 9 as his employer, makes ice-cream from milk. Mr Alec Kyriakides declared a conflict of interest on items 9, 10 & 11 as his employer sells the products under discussion. Professor David McDowell raised a conflict of interest in the discussions on item 13 as he carried out research on some of the areas discussed.
4. Minutes of the 72nd meeting
4.1 Members approved ACM/MIN/72 as a correct record of the previous meeting subject to an amendment to paragraph 2.1 to record Prof Peter Williams’ apology for absence and an amendment to paragraph 6.6 to reflect that Mr Stephen Wyllie’s comment on the remit of the VLA risk assessment model was made in the context of the discussions on animal diseases. The Secretariat was asked to arrange for the final minutes to be posted on the Committee’s website.
5. Matters arising
5.1 Ms Geraldine Hoad summarised the actions taken on matters arising from previous meetings (ACM/991). There were no comments on the paper.
6. Foodborne Disease Strategy
6.1 Ms Gael O’Neill presented an overview of the FSA’s Foodborne Disease Strategy (FDS) 2010-2015. Ms O’Neill noted that most Members had seen and commented on the strategy during the recent consultation period and the presentation would therefore focus on the background to development of the programme, its context in relation to other Agency work and identification of FDS priorities.
6.2 The FDS is one of a suite of complementary Agency work programmes including the Safer Food Better Business (SFBB) and Food Hygiene Delivery Programmes delivering FSA strategic objectives on food safety. These programmes have grown and changed over time and the opportunity was therefore taken to re-focus the FDS to tackle specific issues around reducing foodborne disease. The FDS 2010-2015 priorities were shaped through a Food Chain Analysis project which looked at the major microbiological causes of foodborne disease and analysis of high risk-food chains.
6.3 The new strategy comprises three main work strands, two risk management programmes on Campylobacter and Listeria and a refreshed Food Hygiene Campaign to deliver consumer awareness aspects. Work on other pathogens such as Salmonella, Norovirus and E. coli O157 is ongoing but some of this is being taken forward under other research programmes and through work with external partners.
6.4 The Committee raised a number of issues in the ensuing discussion.
- There were concerns that reorganisation of the health service could affect accessibility to data for monitoring human foodborne disease. Ms O’Neill noted that this had already been identified as a key risk in delivery of the programme and Ms Redmond added that the FSA were making links with DH and HPA to ensure the FSA has a voice in this process. The Chair commented that until the White Paper was published it was difficult to comment on the effect of proposed reorganisation but the Committee may need to consider this issue at a future meeting or teleconference depending on the consultation timings. It was also noted that following the Comprehensive Spending Review Local Authorities, who had assisted in delivering some aspects of the FDS, were likely to experience reduced resources and there would potentially be restrictions on communication campaigns.
- The high public health burden due to Norovirus infection was discussed and whether or not this was reflected effectively by the FDS pathogen ranking. Ms O’Neill responded that a specific model was used to calculate the foodborne component of disease using best available data to produce the rankings but it was recognised that Norovirus attribution data were poor. A cross-government approach would possibly be the best means of addressing the Norovirus burden as it is wider than simply a foodborne viral infection issue.
- Several Committee Members were complimentary about the strategy in terms of its clear focus and pathogen- specific, risk-based approach. The low priority for C. perfringens was questioned but it was noted that the results of the Second Infectious Intestinal Disease (IID2) study would shed some light on the health burden due to this pathogen. It was also agreed that lessons could be learnt from the US experiences about their Listeria zero-tolerance strategy and from New Zealand and Canada about their experiences of Listeria risk management.
6.5 In summary, the Chair noted that there was general support for the strategy and its development and it was pleasing to see that work to understand the foodborne component of Norovirus infection was included. However there was a need to improve hospitalisation data for Norovirus. The Committee might need to revisit the effects of organisation change and spending cuts next year.
7. Food Hygiene Delivery Programme
7.1 Ms Catherine Bowles presented paper ACM/993 on the Agency’s Food Hygiene Delivery Programme (FHDP). The programme was created to drive forward the FSA’s response to the Public Inquiry into the 2005 Wales E. coli O157 outbreak and address specific recommendations for the FSA. As part of the programme a review of regulation cultures and behaviours was commissioned to investigate how a culture of sustained compliance could be supported by the regulator and by Food Business Operators (FBOs). In the review a range of activities were found to contribute towards business compliance including manager commitment, high quality training, peer group support and in-house expertise and it was recognised these activities are, in some cases, a particular challenge for small businesses. In terms of regulator culture, clear communication, incentivisation and use of a range of methods were considered important. The Agency will reflect on the review findings and ask some difficult questions about where to allocate its resources in order to drive up standards across the piece and deliver food hygiene.
7.2 In the ensuing discussion the Committee noted that:
- The impact of conflicting priorities, such as waste reduction, on FBO food safety behaviours should be considered. Ms Bowles responded that the Agency would need to reflect on how to address issues of segmentation. For example some recommendations under SFBB assisted FBOs in improving in areas such as stock management and waste reduction. In response to a query about how culture change would be tackled Ms Bowles highlighted that it was important to deal stringently with non-compliant businesses and developing a compliance and enforcement strategy would allow better targeting of resources relative to the risk.
- The benefits and risks of a joined up approach with the education system to deliver increased awareness and food hygiene skills were discussed briefly. In response to the Chair’s query on links between the FDS and the FHDP Ms Bowles commented that links between operations and policy need to be clear and explicit within the FSA and the FDS would be informed by the FHDP.
7.3 In summarising the Chair noted that conflicting priorities for food businesses were an important consideration for delivery of food hygiene as were links with education and influencing behaviours.
8. The isolation of Campylobacter spp. from food and environmental samples
8.1 Mr Alec Kyriakides was invited to present paper ACM/994. Mr Kyriakides explained that the paper pulled together some of the concerns around isolation of Campylobacter from previous surveys. The paper was not intended to be an extensive review of methods but highlighted elements that need to be considered for reliable isolation of Campylobacter. Members were asked to approve the paper for forwarding to the FSA.
8.2 It was noted that although the paper suggests further research is needed a number of recommendations can be made now and routine protocols for food and water practitioners could be drawn up. The Chair clarified that one of the aims of the paper was to draw attention to considerations such as the sensitivity and specificity of methods when considering research and survey specifications. Mr Kyriakides suggested that a more comprehensive review of methods might be required which could be supported by further research particularly on the isolation of Campylobacter from poultry.
8.3 There was some discussion on molecular detection methods. It was suggested that where Campylobacter detection is the aim molecular methods may be more reliable than culture-based methods but they would not be appropriate where it is important to establish whether organism levels are of clinical significance. It was also suggested that if further work is undertaken, methods which do not require eight hour incubation should be considered as this is not very practical for commercial laboratories. Mr Wyllie (Defra) stated that it would be desirable to agree on a single Campylobacter isolation method to allow trend analysis and if the EC do introduce harmonised monitoring for Campylobacter the UK may wish to be in a position to influence discussions on appropriate methods.
8.4 The Committee agreed to submit the paper to the FSA noting that it was not a systematic review and that a systematic review of methods might be required.
9. Mycobacterium bovis: possible health risks from pasteurised milk and milk products
9.1 The Chair reminded Members they had been asked to consider the health risks to consumers associated with meat and milk from animals with evidence of M. bovis infection at their March 2010 meeting. The Committee had agreed that, on the basis of current evidence, no change was needed to the existing risk assessment on meat. The Committee had agreed to reconsider the risk from raw milk at a later meeting when the results of a study on survival of M. bovis in unpasteurised milk cheeses were available. The Chair invited Ms Geraldine Hoad to present paper ACM/995 seeking the views of Members on the potential for pasteurised milk and milk products contaminated with M. bovis to enter the food chain and whether the risk has changed in light of the increase in M. bovis infection in cattle in the UK.
9.2 The paper addressed the potential for the presence of M. bovis in cow’s milk through the occurrence of tuberculous mastitis which was highlighted as rare in the UK. The potential for undiagnosed but infected cows to remain in a herd was also outlined. This can arise from a failure of the tuberculin skin test, which is recognised to be 80% sensitive, and the presence of anergic cows in a herd. The potential for the presence of M. bovis in milk is minimised through frequent TB testing and removal of infected cattle, and exclusion of milk from reactors from the food chain. The risk cannot be eliminated as the screening methods are not 100% sensitive and specific, and milk from anergic cattle may enter the food chain. However, tuberculous mastitis resulting in shedding into milk is considered rare and, where it does occur and M. bovis infection is unrecognised, the cow is likely to be culled due to chronic mastitis.
9.3 Details of pasteurisation standards and evidence for the efficacy of pasteurisation on M. bovis contaminated milk were presented. It was highlighted that the standards in place provide an adequate safety margin and, in practice, industry often apply higher time temperature combinations for pasteurisation than those laid down in legislation. Some information on microfiltration was given and it was noted that microfiltered milk is always pasteurised as well. A brief update on the status of human cases of M. bovis was given noting that less than 1% of human TB cases were due to M. bovis and there was no evidence linking these cases with consumption of M. bovis contaminated meat or dairy products.
9.4 In the ensuing discussion the Committee considered that:
- The risk has changed because there is more M. bovis present due to the increased incidence in cattle. However, the risk is still acceptably low due to the on-farm controls in place and the efficacy of pasteurisation, validated by the lack of human cases.
- Some concerns were raised over the potential for failures of on-farm pasteurisation and it was suggested there may be around 100 farms in England and Wales that carry out on-farm pasteurisation.
- Recent evidence of “D” and “Z” values for High Temperature Short Time (HTST) treatment of milk, as opposed to batch pasteurisation, would be desirable to ensure there was no data gap. Ms Hoad agreed to look into this.
9.5 The Chair summarised that, in response to the questions posed, the risk from pasteurised milk and milk products contaminated with M. bovis has changed but in milk that is properly pasteurised the risk remains acceptably low. The Chair noted there were two potential caveats; break-downs of on-farm pasteurisation and further clarification of “D” and ”Z” values for HTST milk.
10. Possible health risks from consuming chicken liver pâtés
10.1 Mr Nick Laverty presented paper ACM/996 noting that in 2009 and 2010 there had been an apparent increase in Campylobacter outbreaks in England, Wales and Scotland associated with consumption of chicken liver pâté/parfait, with nine of the 15 outbreaks in the period 2005-2009 occurring in 2009. Undercooking of the pâté or parfait was identified as a key factor in causing a number of the outbreaks. Five outbreaks have been reported in 2010 to date. The FSA issued advice to caterers on the safe handling and cooking of livers in July 2010.
10.2 In light of this information the FSA asked the ACMSF to consider whether the outbreaks were linked to the overall reported increase in Campylobacter cases, were there changes in the sourcing, preparation or consumption of these types of pâté products and was there any evidence of changes in poultry production practices which may influence the type, level or frequency of Campylobacter contamination?
10.3 Further information was requested on the outbreak associated with pâté that had been cooked to 100°C. Mr Laverty noted this situation, involving a product prepared by a catering company outside the UK, was in contrast to the other outbreaks where there was some suggestion the livers had not been properly cooked. This suggested illness could have been caused by post-processing product contamination. Another Member asked whether proactive targeting of the relevant food hygiene messages had been carried out and whether the FSA had issued advice for enforcement officers. Mr Laverty responded that advice for enforcement officers was judged on a case by case basis and he was not aware that any more specific targeting of the hygiene messages had been issued but he would check this.
10.4 In discussing the paper the Committee noted that:
- The practice of injecting blood into pâté to make it pink had been raised in previous Committee discussions on pâtés and might need to be reconsidered.
- Informal feedback from environmental health officers suggested a greater use of experimental food processing using high-risk techniques, which might need consideration under ACMSF horizon scanning discussions. Furthermore it was considered difficult to get heat to flow through a pâté on cooking. The Committee noted that there appeared to be a change to traditional pâté preparation practices, moving away from cooking livers in a pan and then in a bain-marie to cooking them on a stove followed by blending and chilling. It was also suggested that in some cases food safety messages might not be reaching the intended target with some caterers unaware of recent FSA advice on chicken liver pâté and some chefs recommended leaving cooked livers pink in the middle. This indicated consumers and caterers might not appreciate that Campylobacter can be present in the centre of a solid organ. It was suggested that reducing consumer acceptance of undercooked livers might be effective as evidenced by work in the US on VTEC contamination, encouraging consumers to reject pink burgers.
- In some circumstances Campylobacter in poultry tissues might be more significant than surface contamination and since the liver acts as a filter for everything from the gut the liver might, in certain cases, be an appropriate place to monitor Campylobacter in chicken. There was some uncertainty about the source of chicken livers used in UK catering as contacts had suggested that the major UK poultry producers do not supply livers to the catering sector.
- Sufficient data may be available to enable completion of a risk assessment on the issue. This could be used to provide information on a thermal processing method that would render the products acceptably safe.
- The available descriptive, microbiological and analytical evidence linking pâté to the outbreaks would have been useful in the paper presented. It was also noted that it was not known if the outbreak strains were similar to circulating Campylobacter strains or whether outbreaks could be linked to the appearance of new strain.
10.5 The Chair summarised the Committee’s wide-ranging discussion that had raised several hypotheses for the increase in outbreaks including changes in culinary fashions, customer demands and advice not reaching the intended target. The topic could be amenable to a formal risk assessment.
11. Red meat survey
11.1 Mr Adam Hardgrave presented paper ACM/997, advising Members that the FSA published the findings of a survey of microbiological contamination of raw red meat on 03 September 2010. The aim of the survey was to establish the prevalence of a range of foodborne pathogens and indicator organisms in red raw meat at retail. Key findings were that Campylobacter and Salmonella contamination levels were low, and only one sample contained E.coli O157. As the raw meat would undergo cooking prior to consumption the low levels detected were not considered to be of major concern.
11.2 In response to a question about survey sampling structure and confidence intervals Joshua Atkinson (FSA Statistics Advisor) responded that sampling was based on market share data and confidence intervals for the prevalence figures given were approximately +/- 2% for each meat type. It was also noted that S. aureus was referred to as pathogenic in one part of the summary but subsequently included in the prevalence range for non-pathogenic microorganisms. The validity of quoting a prevalence range for different microorganisms was also questioned.
11.3 Some Members considered that the risk in raw products should not be dismissed as pathogen multiplication and cross-contamination could occur during handling and storage of the food and even though pathogen levels detected were low they would still be a risk for some consumers. However it was also suggested that industry should be commended for maintaining the low pathogen levels found and whilst we should strive to reduce these further the findings were reassuring given the practicalities of processing a live animal into a piece of meat.
11.4 The Chair summarised that the survey had already been published but the sampling plan would have been a useful addition to the paper presented. It would also have been interesting to consider the data alongside the poultry survey findings.
12. Epidemiology of Foodborne Infections Group (EFIG)
12.1 Dr Paul Cook introduced paper ACM/998 and provided an overview of the May 2010 EFIG meeting. Key items highlighted were the January 2009 to December 2009 figures for Salmonella in livestock. A fall in Salmonella in chickens, pigs and sheep was reported with a rise in Salmonella reports in cattle. There were only 19 reports of S. Enteritidis in 2009 contrasting with 250 reports of S. Typhimurium. There were eleven reports of the monophasic Salmonella 4,5,12:i:- in pigs in 2009 compared with eight reports in 2008. This is an emerging strain across Europe which has characteristics in common with S. Typhimurium. EFSA have set up a working group to look at the emergence of S. Typhimurium–like strains. It terms of human data it was highlighted that laboratory reports continue to decline for Salmonella but a significant rise in Campylobacters was reported in 2009. The number of foodborne outbreaks of all agents appeared to have increased dramatically in 2009 but this should be considered in the context of the more vigorous outbreak ascertainment follow-up system implemented by the HPA and enhanced surveillance for VTEC.
12.2 Dr Cook provided some background to the establishment of EFIG, its membership, remit and frequency of meetings and explained that following discussions at the May meeting on the role and future of EFIG the Group wished to ask ACMSF to comment on the input it received from EFIG. The Committee considered that the information provided by EFIG was useful to inform them about trends and suggested that future update papers include a short bullet point summary of important trends and some graphs and figures. It was noted that the Human Animal Infections Risk Surveillance Group (HAIRS) has some similarities with EFIG but their remits do not overlap as HAIRS focuses more on emerging organisms.
12.3 In summary the Chair noted that the updates from EFIG are valued and the group would like some summary data as graphs or tables to judge trends and, where possible, inclusion of denominator data in terms of sampling and populations.
13. Horizon Scanning
13.1 Ms Geraldine Hoad introduced ACM/999 and reminded Members that they had recently been consulted on potential topics for horizon scanning. Members were invited to comment on the summary of these topics in ACM/999, considering mechanisms by which to address them. The Chair initiated discussions, asking Members whether the topics were still right, how they should be prioritised and what specific aspects should be included.
13.2 The Committee considered some of the proposed areas very broad and suggested a need to prioritise and be more specific about which aspects should be looked at. Some Members wanted to focus on specific organisms, for example, Hepatitis E, Clostridium difficile and Norovirus, to investigate to what extent these are foodborne diseases. Other suggestions were for a non-pathogen specific approach, for example work on antimicrobial resistance and changes in persistence and dissemination of organisms. Other horizon scanning topics raised included investigating changes in: the processing of foods, food procurement in the catering sector and increased on-site food production for school catering.
13.3 The Chair requested that a brainstorming session be arranged to discuss the topics in more detail and report back to the main Committee in January with some concrete proposals and prioritisation. Mr Alex Kyriakides, Prof David McDowell, Mr John Bassett and Mrs Vivienne Buller were invited to take this forward.
Action: Members named above/Secretariat
14. ACMSF response to the Waste and Resources Action Programme (WRAP) risk assessment on the use of source segregated composts in agriculture
14.1 The Chair reminded Members that the WRAP risk assessment on the use of source segregated composts in agriculture was presented at the March 2010 ACMSF meeting. A small group was established following this meeting to consider the Committees response to the WRAP risk assessments since a large number of questions and issues had been raised. Mr John Bassett was invited to introduce paper ACM/1000 summarising the group’s conclusions for ACMSF consideration.
14.2 Mr Bassett summarised the group’s broad conclusions, gaps identified and key points. Generally the methodology was found to be robust. The process was however, considered over complex and it was noted this can reduce transparency. Some issues were identified around uncertainty and the risk ratios approach used which was not considered entirely appropriate when approaching the threshold of what is accepted as a ‘safe dose’. It was suggested, a more thorough assessment was needed as you approach these threshold levels and E.coli O157 and C. botulinum were highlighted as organisms where this was perhaps required. For other organisms the level of safety demonstrated indicated the risk was very low. Some gaps in the hazard identification process were noted, specifically the lack of consideration of spore forming organisms, fungi and encysted parasites. The other major omission was the lack of assessment of by-pass or system failure in the risk assessment which assumed 100% compliance.
14.3 A Member referred to section 6.2 of the March 2010 minutes and requested that an update on the industry numbers compliant with BSI PAS100 specification, including the number working towards compliance, be given in the revised WRAP document. Mr Wyllie (Defra) noted that the BSI standard was probably applied by the Environment Agency under environmental rules and where food waste or animal by-products were involved in the processing. Authorisation would be required by Defra under the animal by-products legislation.
14.4 The Chair summarised that the Committee were content their concerns were reflected in the paper. The Chair requested that the broad conclusions presented by Mr Bassett should be summarised and added to the paper which could then be forwarded to WRAP.
15. Committee sub-groups
15.1 Mr Kyriakides provided an update on the Ad Hoc Group on Vulnerable Group’s toxoplasmosis risk assessment. A draft report has been compiled and the group has identified gaps in the data, particularly in relation to prevalence and survival of toxoplasmosis, which will be used to compile a list of questions for Professor Dubey, a US expert on toxoplasmosis, to respond to. The group plan to meet in early December to reach some conclusions on the risk to human health of toxoplasmosis in the food chain. The final report might not be completed by January but the group will be in a position to provide a report to the January ACMSF meeting.
16. Dates of Future Meetings
16.1 Members were reminded of the proposal to move to three meetings a year starting at lunchtime. The 2011 ACMSF meetings would be held on the 20 January, 18 May and 22 September. This proposal will be reviewed and if required the Committee could revert to four meetings a year.
17. Any Other Business
17.1 There were no items of Any Other Business.