ACMSF Minutes: 27 June 2011

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

Present:

Chair: Prof S O’Brien

Members:
Dr B Adak
Mr J Bassett
Dr R Betts
Mrs V Buller
Mrs R Glazebrook
Prof J Gray
Ms J Hopwood
Prof D McDowell
Mr P McMullin
Dr S Millership
Mrs J Morris
Mr D Nuttall
Prof P Williams

Assessors:
Ms L Redmond (FSA)
Mr S Wyllie (Defra)

Officials in Attendance:
Miss R Ackerman (FSA)

Secretariat:
Ms G Hoad (Administrative Secretary)
Dr P Cook (Scientific Secretary)
Mr A Adeoye
Dr S Rollinson

Invited experts:
Dr M Rowe (Queen’s University Belfast)
Dr R Forgrave (Queen’s University Belfast)

Others:
Fiona Brookes, Northern Foods
Clare Cheney, Specialist Cheesemakers’ Association
Catherine Cockcroft, Exova
Jane Duddle, Waitrose
Kaarin Goodburn, Chilled Food Association
Waheed Hassan, Booths
Ed Komorowski, Dairy UK
Alan Long, VEGA
Alan Lyne, ADAS
Tom Miller, National Consumer Federation
Barry Mirhabib, Brakes
Jamie Montgomery, Specialist Cheesemakers’ Association
Rick Pendrous, Food Manufacture Magazine
Sian Thomas, Fresh Produce Consortium
Phil Voysey, Campden BRI
Nicola Wilson, Westward Labs

1 Chair’s Introduction

1.1 The Chair welcomed ACMSF Members and members of the public to the 75th meeting of the Committee. The Chair welcomed four new Members to the Committee; Dr Roy Betts who had joined to provide expertise in food microbiology, Dr Bob Adak who had joined to provide expertise in epidemiology and public health, Ms Jenny Hopwood who had joined to provide expertise in food retailing and Prof Jim Gray who had joined to provide expertise in virology. Committee Members, new Members, the Secretariat and Assessors, were invited to introduce themselves. The Chair also welcomed Dr Michael Rowe and Dr Richard Forgrave (Queen’s University Belfast) who would be presenting agenda item 6 and Miss Robyn Ackerman (FSA) who would be presenting agenda item 8.

2 Apologies for absence

2.1 Apologies for absence had been received from Prof J Coia and Dr R Holliman.

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, both at the beginning of the meeting and subsequently if the need arose during discussions. Dr Roy Betts declared that his employers, Camden BRI, played a role in management of the Mycobacterium bovis project to be discussed under item 6.

4 Minutes of the 74th meeting

4.1 Members approved ACM/MIN/74 as a correct record of the previous meeting subject to a minor amendment to paragraph 6.5 to remove ‘in’ from the fourth sentence. The Secretariat was asked to arrange for the final minutes to be posted on the Committee’s website.
Action: Secretariat

5 Matters arising

5.1 Ms Geraldine Hoad summarised the actions taken on matters arising from previous meetings (ACM/1020). All actions had been completed except for actions in relation to horizon scanning, raw milk, the Listeria in smoked fish survey and the second Infectious Intestinal Disease (IID2) study where work was in progress. There were no comments on paper ACM/1020.

6 Mycobacterium bovis and the possible health risks associated with unpasteurised milk and milk products part II

6.1 The Chair invited Ms Geraldine Hoad to introduce paper ACM/1021 on risks to consumers associated with M. bovis and unpasteurised milk and milk products. The Committee were reminded that the possible health risks associated with M. bovis infection in cattle had been discussed twice recently by the Committee, once in relation to meat and once in relation to pasteurised milk and milk products. The FSA intends to report the outcome of the discussions on M. bovis and milk and milk products to the Board in November.

6.2 Ms Hoad outlined the information presented in paper ACM/1021 including the exposure assessment, the TB controls on cattle (cows and buffaloes) and on non-bovines (sheep and goats), the controls on sales of unpasteurised milk and milk products to the consumer and the potential for M. bovis to be present in unpasteurised milk and milk products for human consumption. The Committee was asked to give a view on the potential for unpasteurised milk and milk products contaminated with M. bovis to enter the food chain and the risk to human health associated with these products, also whether this risk has changed in light of the increase in M. bovis in cattle in the UK.

6.3 The Chair invited Dr Michael Rowe and Dr Richard Forgrave to present their research on the survival of M. bovis in unpasteurised milk cheeses. The research was commissioned to assist in assessing the risk from raw milk cheeses made prior to identification of a TB reactor in a herd i.e. cheeses maturing but not yet on the market. The presentation outlined the research objective (to assess the survival kinetics of M. bovis in raw milk Cheddar and Caerphilly), the steps taken in designing a protocol for production of experimentally contaminated cheese in a Category 3 facility, selection of media suitable for enumeration of M. bovis and the results of challenge test experiments performed using the optimised protocol. Overall average D10 values were calculated for M. bovis in Cheddar (48 days) and in Caerphilly (58 days).

6.4 In relation to the research presented the Committee had a number of questions and comments:

  • Members queried the mechanism for the observed reduction of M. bovis in cheese and whether it was due to pH, salt, moisture, competition with other organisms, etc. The possibility of eventually developing predictive models for cheese products using the methods developed in this study was raised. Dr Rowe commented that reduction in bacterial numbers was probably due to a combination of all the suggested factors and also highlighted that the calculated D10 values for M. bovis were approximately half of the D10 value for M. avium subspecies paratuberculosis (MAP).
  • Dr Forgrave confirmed that the pre-warmed milk sample was not used in the production of the cheeses and Dr Rowe confirmed that the volumes of milk used in experimental production were restricted due to the need to use Category 3 facilities and therefore were not representative of typical volumes used in cheese production.
  • Members noted that the minimum maturation period was the key consideration in assessing the risk from a product and it was confirmed that Caerphilly may have a minimum maturation of 2 weeks.
  • Members suggested that it would be interesting to look at M. bovis survival in Cheddar for longer maturation periods to see whether there was any tailing-off effect.
  • Dr Forgrave confirmed that the D10 values were calculated from the straight portion of the challenge test graph but that Cheddar samples were still available for further experimentation if desired.

6.5 The Chair asked the Committee to consider the risk assessment on M. bovis and the questions posed in paper ACM/1021. In the ensuing discussion the following points were made:

  • Members felt it was difficult to come to a robust conclusion based on the data presented in the risk assessment. The increased incidence of M. bovis in cattle meant there was potentially an increased risk to consumers but it was not easy to quantify this increased risk as there was insufficient information available.
  • Members suggested that a more detailed paper with further more precise data and references would assist the Committee in assessing the risk. In particular the paper could include more complete references to the data presented (in para’s 21,22, 24 and 41), give an indication of the prevalence of M. bovis and TB mastitis in cattle (Defra noted there was a wealth of data on the prevalence of bovine TB) and clarification of terms like small, high, low should be given. There were also concerns that some of the conclusions were validated with inadequate surveillance data, for example for non-bovine species.
  • It was suggested that the data available should be mapped out at each step of the risk assessment, i.e. under the sections on exposure, prevalence, shedding etc., rather than starting with outlining risk management activities. This would allow a conclusion to be drawn on probability rather than possibility. In cases where no published data were available expert opinion could be sought.
  • Questions were raised around the quoted efficacy of the BCG vaccine in humans and on what data this was based. A member confirmed there had been a significant amount of research on efficacy of the BCG vaccine which showed it varied from 0-80%, but suggested this information was not relevant to the risk assessment. It was also suggested that the risk assessment should make reference to the gap in the population that will be unvaccinated due to the recent change in vaccination strategy. It was also suggested that if health warnings were in place that vaccination was of variable efficacy and there were potential long term health effects related to M. bovis is raw milk there may be less of a market for unpasteurised milk/milk products.
  • A Member queried the information presented on the infectious dose of M. bovis and suggested that if, in some cases, a low dose could cause infection in some individuals this would affect the assessment of risk. It was confirmed that information on the infectious dose for M. bovis was sourced from the HPA TB Reference Unit and references could be provided if required.
  • In relation to the published evidence on survival of M. bovis in cheeses it was confirmed that there is little available evidence on this but what is available suggests survival is possible in short shelf-life products.

6.6 The Chair summarised that it was difficult to draw a robust conclusion on the risks to consumers associated with M. bovis and unpasteurised milk and milk products, recognising the difficulties in finding robust data to support a risk assessment. The risk of human TB infection being acquired from unpasteurised milk and milk products had probably changed with the increase in M. bovis in cattle but uncertainties around the change in the level of risk were large and difficult to define. There were no data presented in the paper that warranted a change to the previous view of the Committee on unpasteurised milk which was that all milk should be pastuerised. The Secretariat asked if the Committee would like to revisit the risk assessment if further detail was added to the paper. The Chair suggested a small group could be set up to look at the data in more depth and suggested Mr Bassett and Prof McDowell may wish to be involved.
Action: Secretariat

7 A report of the quinquennial review of the ACMSF (ACM/1022)

7.1 The Chair reminded members that an independent quinquennial review of the ACMSF had taken place between January and March 2011 and a number of Members and stakeholders had been interviewed. Dr Sophie Rollinson presented paper ACM/1022 updating Members on the outcome of the review. The review had concluded there was still a need for the ACMSF with value to the FSA, other departments and stakeholders and the report had highlighted 6 examples of good practice by the Committee and made 12 recommendations. Members were invited to note the review and recommendations and to consider the Secretariat’s comments and specific questions posed in paper ACM/1022 to assist the Secretariat in preparing a response to the recommendations.

7.2 The Committee made the following comments in discussing the recommendations:

Recommendation 1: The Chair and the Secretariat should ensure that the work of the Committee continues to be focused on where it can have most impact, value and relevance.
Recommendation 2: Horizon scanning should be undertaken on an annual basis. Recommendation 3: The process for determining the work programme should be improved and a forward work plan published with proposed timescales for the work.

  • Members were content with the Secretariat’s proposal to develop a more formal work planning process to be reviewed by the Chair, Committee and Secretariat. It was suggested the work plan should be viewed as a living document and the importance of maintaining flexibility to defer discussions, if necessary, was highlighted. Members felt it was appropriate to undertake horizon scanning more frequently than at present and every 12-18 months was suggested. The possibility of using horizon scanning matrices was also raised. Members felt the work of existing sub-groups should be borne in mind when planning how to take forward issues identified through horizon scanning to ensure the burden of any additional work on the Secretariat and Members was not unmanageable. It was suggested that the frequency of ACMSF meetings and the potential for scheduling of subgroups with main meetings should be reviewed.

Recommendation 4: Completed work should be summarised in terms of outcomes and impact achieved. This should be updated to track known outcomes and impacts over time.

  • Members were unclear how recommendation 4 should apply to a risk assessment committee. As the outcome of ACMSF risk assessments depended on how a risk was managed the Committee felt this recommendation was straying into risk management territory. They also highlighted that it was challenging to measure the outcomes and impact of advice and identify incidents that might have been prevented by specific advice. It was suggested that if ACMSF recommendations resulted in a change to FSA risk management advice, the outcome could be summarised for the Committee and the ACMSF annual report was suggested as the appropriate mechanism through which to provide this information.

Recommendation 5: It is recommended that the Committee takes greater steps to show evidence of scientific rigour by using the FSA’s Good Practice Guidelines and Science Checklist more explicitly and also routinely considering whether peer reviews are appropriate for work on which the Committee’s decisions are based.

  • Members suggested that the way the Committee works, and in particular production of sub group reports, might have an impact on scientific rigour as reports were not always thought to be written by the people most qualified in the specific area under assessment. It was suggested that the Committee could operate more effectively by peer-reviewing and giving an oversight to risk assessments whose production was out-sourced. Sub-groups could maintain an involvement in scoping of out-sourced risk assessments. The Chair summarised that there was a need for careful thought on how ad-hoc groups were used and the proposal to consider peer-review on a case by case basis was welcomed.

Recommendation 6: There is currently no ACMSF assessor appointed for Northern Ireland and it is recommended that FSA addresses that in the near future.
Recommendation 7: The Chair and Secretariat should consider Secretariat resources in terms of scientific expertise and amount of resource available when planning ACMSF’s work programme and identify and address any gaps as appropriate.
Recommendation 11: There is a need to clarify the role and responsibilities of the assessors on the Committee.

  • No specific comments were made on the proposed responses to recommendations 6, 7 and 11. The Chair noted that previous discussions in relation to horizon scanning and sub groups were relevant to recommendation 7.

Recommendation 8: The Committee should review the balance of expertise on the Committee at regular intervals in the context of the future work programme for the Committee.
Recommendation 9: It is recommended that in future the recruitment process for new members starts earlier, so that the new members are in place either before or by the end of the terms of the retiring members to provide continuity of membership for the Committee and the sub group work.

  • Members supported the proposal for the Chair and Secretariat to review the balance of expertise on the Committee ahead of new appointments and to have new Members in place by the end of the terms of retiring members.

Recommendation 10: It is recommended that new members have an induction meeting with the Secretariat.

  • Members felt that short induction meetings for new members would be useful and suggested issues such as the role of members and background on recent Committee discussions could be covered.

Recommendation 12: The work of the ad hoc groups should in general be run to a tighter timescale with the timescale being agreed at the start of the group’s work.

  • Members noted the Ad Hoc Group on Foodborne Viral Infections had a clear timeline for their work but it was agreed that a balance needs to be struck between progressing work rapidly and the availability and resources of Members and the Secretariat.

7.3 The Chair thanked members for their comments and noted she would be providing the Committee’s response to the quinquennial review report at the autumn GACS meeting.
Action: Secretariat

8 Food and You Survey (ACM/1023)

8.1 Miss Robyn Ackerman was invited to present the findings of the Agency’s Food and You survey. The survey was commissioned to address a need to collect more robust data on consumer attitudes, behaviours and knowledge. The food safety aspects of the survey were highlighted including top-line findings on questions around chilling, cross-contamination, cleaning and cooking of food. Segmentation analysis to group survey respondents based on their attitudes and habits rather than socio-demographics had started to identify some discreet groups. Analysis to segment the responses from the over 60’s was also ongoing. Further work is planned to attempt to measure actual, rather than reported, behaviours in the home and a second wave of the survey is planned for 2012 to track how practices change and attitudes develop over time.

8.2 Miss Ackerman noted that the survey report is available on foodbase and there was some publicity around the survey when it was published in March. The FSA is also trying to encourage other researchers who may want to analyse the data which is deposited in the Essex data archives.

8.3 Members had a number of questions about the survey including whether it covered how people chose where to eat out, how non-response bias was controlled for, whether children were included in the survey and whether the results were relevant for investigating the increase in listeriosis in the over 60s. Miss Ackerman clarified that one of the survey questions covered the factors that people take into consideration when deciding where to eat out. Respondents who said food hygiene was a consideration were followed up to ask how they assessed the hygiene standards at premises. In relation to non-response the survey response rate, which was 52%, was considered relatively good for surveys of this type. The sampling strategy allowed weighting to correct for non-response. Children were not included in the survey, which included over 16’s only. In relation to listeriosis it was noted that the segmentation of data from the over-60’s should help explore attitudes/behaviours that may increase the risk from listeriosis in this age-group. However, there were no baseline data on attitudes prior to the increase in listeriosis for comparison.

9 Epidemiology of Foodborne Infections Group (EFIG)

9.1 Dr Paul Cook introduced paper ACM/1024 providing an overview of the May 2011 EFIG meeting. EFIG had discussed practicalities and difficulties in providing denominators for animal data which will be explored further by Animal Health and Veterinary Laboratories Agency (AHVLA). The provisional 2010 animal data for Salmonella (excluding data collected under the National Control Plans) were reported as well as an update on human foodborne pathogen incidence data for 2010. Other items discussed by EFIG included the Local Government Regulation and the HPA programme of national microbiological surveys, results from various surveys and analyses of Campylobacter in humans and animals and the European Food Safety Authority (EFSA) mandate regarding modernisation of meat inspection in the EU.

9.2 The Committee raised several questions in relation to the paper. Clarification of the use of the term “levels” in paragraphs 8 and 10 was requested. In relation to paragraph 8 it was confirmed that Campylobacter cases have continued to increase in 2010 but at lower rates than in 2009. In relation to paragraph 10 Ms Liz Redmond confirmed that the FSA’s aim is to reduce the proportion of birds in the highest contaminated category. It was also clarified that data on the number of people tested for Campylobacter were not collated. Mr Stephen Wyllie reminded members that the 2010 UK Zoonoses Report, which provides more detailed zoonoses data, was currently in preparation.

10 German E. coli outbreak

10.1 Dr Paul Cook provided an oral update on the E.coli outbreaks currently identified in both Germany and France noting that these were on-going outbreaks and therefore figures presented could change. The German outbreak is the most serious foodborne disease outbreak identified to date in the EU. Many agencies and organisations have been involved in the investigations both in Germany and across the EU, including EFSA, the European Centre for Disease Prevention and Control (ECDC) and the Commission and several documents have been published describing preliminary outbreak findings, including sequencing information on the outbreak strain. The Commission have indicated the Shiga-toxin producing E.coli O104 outbreak strain should be referred to as STEC (the nomenclature used in US and Germany) rather than VTEC in relation to the German outbreak. An update on the number of cases of E. coli infection and Haemolytic Uremic Syndrome (HUS) cases was given and the onset dates of the outbreak, geographical location and typing data results were briefly described. Dr Cook outlined the epidemiological and microbiological investigations to date and the implication of sprouted seeds as a possible source from the most recent trace-back and trace-forward investigations.

10.2 Dr Cook gave a brief update on the E. coli outbreak in France, linked to sprouted seeds produced for a school community event. Initial typing information from some of the cases indicated the same O104 strain may be involved. Samples of the implicated seeds had been submitted for testing and the FSA had issued a webstory with advice for consumers to thoroughly cook sprouted seeds. An EFSA task-force had been set up to co-ordinate investigations and try and identify any common links between the two outbreaks.

10.3 Dr Bob Adak provided some additional information on the outbreaks. The outbreak strain is genetically different to previous VTEC strains, possessing a unique combination of virulence factors that has not been seen in an EU foodborne outbreak before. It also has a different disease profile from classic VTEC infections with a higher number of associated HUS cases and a longer incubation period. All E. coli O104 cases outside Germany could be linked back to travel to Germany or consumption of German sprouted seeds. Dr Adak noted that Germany had done a lot of in-depth investigation to try and identify the source of infection and provided some further detail on the investigations into both the German and French outbreaks. It was noted that sprouted seeds had caused large outbreaks of foodborne illness in the past.

11 Committee sub-groups

11.1 Prof O’Brien provided an update on the second and third meeting of the Ad Hoc Group on Foodborne Viral Infections. The Group had reviewed the ACMSF previous report on foodborne viruses including the government response to the report. The WHO foodborne viruses report and Codex report on controlling viruses in foods had been reviewed as had preliminary data from the IID2 study, in relation to viruses. In discussing the scope of their report the Group had agreed to focus on norovirus and Hepatitis E as priorities. The third meeting had looked at risks from shellfish and fresh produce. The next few meetings would focus on environmental health officer investigations of norovirus outbreaks and Cefas work on sewage discharges and the work of the Cleaner Seas Forum. The Group plan to produce a draft report by early 2012.

11.2 Mrs Jenny Morris provided an update on the work on the Vulnerable Groups Ad Hoc Group explaining that their full report on toxoplasmosis would be presented to the Committee at its September meeting. In drawing up a risk profile for toxoplasmosis in food the group had reviewed evidence on the prevalence of toxoplasmosis in humans, the estimated burden of disease, seroprevalence data in farmed and non-farmed animals, presence and survival in food, outbreaks and case-control studies and consumer advice given by other countries in relation to toxoplasmosis. As the report was nearing completion the last two meetings of the group had focussed on reviewing and finalising the report.

12 Dates of Future Meetings

12.1 Members were asked to note the dates of the 2011 and 2012 ACMSF meetings.

13 AOB

13.1 The Chair provided Members with an update on the latest meeting of the General Advisory Committee on Science (GACS). Items discussed at GACS included a report from the Agency’s Chief Scientist on strategic evidence needs, revisions to the FSA’s Science and Evidence Strategy, the BBSRC’s research strategy for a global food security initiative and the FSA’s Food and You survey. The Chair of the Advisory Committee on Novel Foods and Processes (ACNFP) gave a presentation on the work of his Committee. The Chair will provide GACS with an overview of the work of the ACMSF at their next meeting.

14 Public Questions and Answers

14.1 The Chair drew formal proceedings to a close and invited questions and comments from the public.

14.2 Ms Sian Thomas (Fresh Produce Consortium) asked for the Committee’s support to ensure any advice provided by the FSA in response to the E. coli O104 outbreaks was rigorously looked at and suggested that the advice is currently confusing. The Chair responded that it was not possible for the Committee to comment at present on what was an on-going investigation.

14.3 Mr Alan Long (VEGA) asked whether the issue of bioterrorism had been considered in relation to the recent E. coli outbreaks. The Chair replied that terrorist acts were probably considered alongside other issues in such incidents, if only to dismiss them.

14.4 Ms Catherine Cockroft (Exova) asked if there would be a co-ordinated approach in response to management of E.coli outbreaks in the future. The Chair considered there would be lots of lessons learnt across the EU in co-ordinating action in response to the ongoing outbreaks but noted the question related to risk management so was outside the remit of the ACMSF.