ACMSF Minutes: 31 January 2013

Meeting held at 1pm in Aviation House, Kingsway, London WC2B 6NH.

Present

Chair:
Professor Sarah O’Brien

Members:
Mr John Bassett
Dr Roy Betts
Mrs Vivianne Buller
Professor John Coia
Mrs Rosie Glazebrook
Professor Rick Holliman
Ms Jenny Hopwood
Professor David McDowell
Mr Paul McMullin

Departmental representatives:
Mr Stephen Wyllie (Defra)
Ms Liz Redmond (FSA)
Ms Ruth Parry (DH)

Officials in attendance:
Dr Patrick Miller

Secretariat:
Dr Paul Cook (Scientific Secretary)
Dr Sophie Rollinson
Mr Adekunle Adeoye
Ms Sarah Butler

Invited experts:
Miss Lesley Johnson (VMD)
Mr Chris Teale (AHVLA)
Miss Lesley Larkin (AHVLA)

Others:
Members of the public

Catherine Cockcroft Exova
Karen Dalgarno Morrisons
Kaarin Goodburn Chilled Food Association
Intisar Khan Dairy Crest
Ed Komorowski Dairy UK
Tom Miller
Barry Mirhabib Brakes
Eric Samuels Pall Life Sciences
Karen Sims Waitrose
John Threlfall
Elizabeth Williamson Sainsburys
Andy Walker Premier Foods
Keith Watkin Eurofins Food Testing UK
Nicola Wilson Westward Labs
Michael Wood Norpath Scientific Services
Stephen Forsythe ACAF

1. Chair’s introduction

1.1 The Chair welcomed ACMSF Members, members of the public, Miss Lesley Johnson, Mr Chris Teale and Miss Lesley Larkin to the Committee’s 79th meeting.

2. Apologies for absence

2.1 Apologies for absence were received from Dr Bob Adak, Mrs Jenny Morris, Prof Jim Gray, Prof Peter Williams, Dr Sally Millership and Mr David Nuttall.

2.2 The Chair noted that Prof Williams was due to retire from the Committee on 31 March 2013 after 9 years of service and thanked Peter (in his absence) on behalf of the Committee for all his hard work. The Chair noted that recruitment for a new member of the Committee was underway and that Prof David McDowell had been selected to act as the new Deputy Chair of ACMSF, which was a role previously filled by Prof Williams. Volunteers were requested to replace Prof Williams’ involvement as Chair of the Emerging Pathogens Working Group and Prof Holliman was selected as the new Chair of the group.

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. Prof Coia declared he provided consultancy advice to Tesco. Mr McMullin declared an interest in relation to item 6 (antimicrobial resistance) as he was a prescribing vet and had written reports on antimicrobials. Prof McDowell declared an interest in relation to item 6 as he carried out funded research in the area of antibiotic resistance. Prof O’Brien declared an interest in relation to item 7 as she carried out funded research in this area. Members were reminded to raise any other declarations of interest if the need arose during discussions.

4. Minutes of the 78th meeting (ACM/MIN/78)

4.1 The secretariat was asked to replace the word ‘proscribed’ with ‘defined’ in the final paragraph on page 4 of the minutes. Subject to this amendment the minutes were accepted as an accurate record of the last meeting and the Secretariat was asked to publish them on the ACMSF website.

Action: Secretariat

5. Matters arising (ACM/1090)

5.1 Dr Rollinson drew Members’ attention to the summary of actions taken on matters arising from previous meetings. All matters had been actioned and Members’ comments on the EHEC workshop and Food Safety Week evaluation had been fed back to relevant FSA officials.

6. Antimicrobial resistance (ACM/1091)

6.1 Dr Cook introduced the paper providing background to the Committee’s previous discussions on antimicrobial resistance (AMR) and recent developments. Dr Cook reminded members that ACMSF published a report on antimicrobial resistance in the food chain in 1999 and that the majority of the report recommendations had now been taken forward, either by FSA or other government departments. The need for a co-ordinated government approach to antimicrobial resistance was highlighted, as a range of departments, groups and organisations are responsible for different linked areas. Department of Health (DH) lead on human medicine and Defra and Veterinary Medicines Directorate (VMD) lead on control and use of drugs in animal medicine. The FSA’s role is complementary to Defra’s and FSA has responsibility for assessing whether current agricultural practices may lead to a deleterious effect on public health via the foodchain. It was noted that DH will be publishing a new UK five year Antimicrobial Resistance Strategy and action plan.

6.2 Dr Cook noted there has been recent wider interest and action in relation to antimicrobial resistance at the EU and international levels. A number of emerging issues were also highlighted with updates on Meticillin Resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-lactamases (ESBLs), Carbapenems and Fluoroquinolones. A brief outline of current food surveillance for antimicrobial resistance was given.

6.3 The Chair invited Miss Johnson to give a presentation on VMD’s activities in relation to antimicrobial resistance. Miss Johnson outlined the legislation relating to prescription and advertising of veterinary medicines and guidelines relating to the responsible use of medicines on farm. It was noted that there was a lot of current activity at UK, EU and international level on antimicrobial resistance and VMD’s involvement and activities in these areas was highlighted. VMD’s policy is the promotion of the responsible use of veterinary antimicrobials to protect public health, animal health and welfare and to ensure continuing availability of veterinary medicines. Brief summaries of five current issues in relation to antimicrobials were given, which included MRSA, ESBLs and Campylobacter. Miss Johnson outlined some potential restrictions on the use of antimicrobials that may be imposed by EU legislation in the future.

6.4 The Chair noted that the Committee was asked to; comment on progress in understanding the issue in relation to the food chain since the ACMSF’s 1999 report and subsequent reviews (in 2005 and 2007); identify the key risks to the food chain which may have consequences for human health and highlight key research or surveillance gaps in relation to the food chain. The Chair invited Prof Stephen Forsythe (ACAF member) and Dr John Threlfall (microbiology expert) to the table to join discussions.

6.5 The following comments were made in discussions:

  • The issue of AMR has become more severe over time and patients who cannot be treated with available antibiotics are now seen more frequently.
  • The importance of a “one health” approach was highlighted with the need to look at how the environment, animals and humans interact. The scope of the issue should not ignore infection control and preventing the dissemination of resistant organisms, the role of infected food handlers in spreading resistant organisms and the role of the environment.
  • It was queried whether resistant organisms behave in the same way as non-resistant types and whether existing food hygiene controls also work with respect to resistant organisms. It was noted that there is some evidence that resistant organisms tend to grow more slowly and therefore may be more resistant to environmental stresses and also more likely to accumulate multiple drug resistances.
  • Safefood are planning to look at the prevalence of ESBL organisms in the foodchain in beef, pork and chicken.
  • Microbiolgical surveillance may need to take account of developments in molecular methods for tracking transfer of resistant elements, both within and between species. Currently used phenotypic methods are not good at detecting resistance or its underlying mechanisms.
  • It was highlighted that a recent EFSA report called for rewriting of veterinary Cephalosporin-based medicine labels across the EU. This has been implemented in the UK and labels now state that use of the medicine should not be population based.
  • It was clarified that the British Poultry Council (BPC) voluntary ban on the use of certain antibiotics relates to use in day old chicks only.
  • Paper ACM/1091 identified some gaps in the knowledge base and identified which of ACMSF’s recommendations made in 1999 are still outstanding. There may be merit in revisiting these to check their current relevance.
  • The ACAF member noted that he was here to ensure a chain of communication between the two Committees on the issue of AMR as this was currently under discussion by both Committees. It was suggested that there is often confusion amongst the public on the differing regulations in different countries relating to use of antimicrobials in animals.
  • The importance of environmental seeding with AMR organisms via human sewage was highlighted. Animals may then be exposed to these resistant organisms in the environment and can pass infection back to humans.
  • A new EFSA mandate to look at Carbapenem resistance in food animal ecosystems has been issued. Carbapenems are not known to be used in food animals but cases of resistant organisms in animals have been identified.

6.6 The Chair noted that many groups were already doing a lot of work on AMR and therefore duplication should be avoided. However, as foodchain aspects were not being discussed in detail in other UK fora a small group should be established to consider AMR and foodchain issues with relevant external expertise, to ensure appropriate weight is being given to food safety. Prof Coia, Prof Holliman, Prof Forsythe and Mr McMullin were asked to be on the group and Prof McDowell was asked to Chair it.

6.7 The Defra representative offered to check any terms of reference for the group with the Defra Antimicrobial Resistance Co-ordination Group (DARC) terms to ensure there was not a significant overlap and suggested the groups could feed back to each other. It was also noted there was a list of research on AMR which could be made available.

Action: Secretariat

7. Application of molecular epidemiology to investigation of foodborne disease outbreaks (ACM/1092)

7.1 Prof McDowell was asked to chair agenda item 7 as Prof O’Brien was due to give a presentation under this item. Prof McDowell informed members that in January 2012 the FSA held a workshop on the Application of Molecular Epidemiology to Investigation of foodborne disease outbreaks. A report of the workshop was provided as paper ACM/1092. Dr Cook presented the paper noting that this was a rapidly developing area with falling sequencing costs. Some of the key issues raised by the workshop in relation to standardisation, data sharing and bioinformatics were highlighted. Members were asked to comment on the report and the relative importance of the different issues raised and also to identify any gaps not highlighted which were relevant to the application of this technology to microbiological food safety.

7.2 Members made the following comments in discussions:

  • The archiving, storage and ability to analyse the sequencing data produced are very important considerations due to the large volume of data being generated. The difficultly in finding bioinfomaticians to analyse sequence data was also raised.
  • When designing sequence databases thought should be given to the additional information fields required for each entry as this increases the value of the sequence information.
  • It was noted that other polyomic approaches analysing, for example how genes are expressed, will give useful additional information in the future.
  • A forthcoming meeting in Copenhagen, addressing both the EU and US approaches to molecular epidemiology, aimed to develop a more global strategy on this issue, looking at issues such as standardisation of databases. An EFSA Biohaz panel working group on the subject has also been established.
  • The report focused on outbreaks, which are the hazard identification part of a risk assessment i.e. identifying the organism of concern. There needs to be some consideration of how ‘omics’ technologies could help improve the whole risk assessment process, particularly the dose-response element as this can be a more complex part of the process. There has been a recent International Life Sciences Institute initiative looking at use of these technologies to understand how organisms behave in the environment and interact with humans to help in getting a better handle on the level of risk.
  • There are a number of operational issues that need to be overcome in implementation such as use of different sequencing systems by different groups, whether data should be held centrally or by individual labs, the role of National Reference Laboratories and data ownership issues.

7.3 As time was short Prof O’Brien was not able to give her presentation on a project applying a molecular epidemiological surveillance approach in investigation of gastrointestinal disease outbreaks but it was noted that the presentation slides were available as handouts.

7.4 Prof McDowell summarised the Committees’ discussions noting the importance of sequence data in risk assessment as well as outbreak investigation and the need to consider fitting the systems and the results generated into the current legislative structure. The importance of focussing on the overall usefulness and application of the data and concerns in relation to availability of bioinformatics expertise were also noted.

8. EFIG (ACM/1093 and ACM/1094)

8.1 Dr Paul Cook updated Members on the outcome of the Epidemiology of Foodborne Infections Group (EFIG) meetings on 20 June and 6 December 2012. Dr Cook reported on trends in Salmonella in animals from data collected in 2011 and 2012. Trends in laboratory reports for Salmonella, Campylobacter, Listeria monocytogenes and E.coli O157 in humans were also reported. Other items of interest discussed at EFIG were highlighted, these included a paper on the estimated cost of Campylobacter infection to the Scottish health service, a descriptive study by HPA reviewing Campylobacter cases and an update from HPA on UK co-ordinated food surveillance studies.

8.2 The Chair noted that it was helpful to see the graphs in paper ACM/1093 showing the trends in laboratory reports of human illness. The Chair invited Miss Lesley Larkin to give a presentation on Salmonella Surveillance in Great Britain.

8.3 Miss Larkin outlined the legislative background to Salmonella surveillance in GB and the main data sources that contribute to the Surveillance. Data comes from both statutory Salmonella National Control Plans (NCP) for chickens and turkey and from non-statutory passive surveillance, mainly in cattle, sheep and pigs. NCP data provides a relatively reliable prevalence estimate that is flock based, non-statutory surveillance data is reported as incidents and this data lacks reliable denominators. Other monitoring includes voluntary industry monitoring and surveys. The options for defining a suitable denominator for Salmonella surveillance data were outlined. These included using the total number of samples submitted, total number submitted for a specific disease, total number of animals/farms or number of submitting farms. The limitations for each option were highlighted. It was noted that the non-NCP data does allow for looking at trends over time and monitoring changes and an early detection system is used to flag for new and emerging strains. It was suggested that, where practical, the best approach in the future may be the use of test-based denominators or the number of farms submitting samples, with suitable quality statements.

8.4 The Chair noted that HPA and AHVLA data are fundamental to the risk assessments that ACMSF carry out and if numerator data cannot be interpreted it makes risk assessment difficult. The Chair reminded members that the lack of good denominator data was an issue that had been raised at ACMSF and EFIG several times and asked Members to comment on what the Committee could do to move this forward.

8.5 The following points were covered in the discussion:

  • In response to a query on the use of sentinel surveillance Miss Larkin responded that a project looking at this option had been undertaken but there were difficulties for Salmonella as the symptoms were non-specific.
  • It was noted that accredited laboratories can provide denominator data if given appropriate notice. Reporting of the number of samples tested and number of positives would be a start but there would be a need to consider the burden on labs for multiple reporting.
  • It was noted that there are many similarities with human denominator data issues and the pyramid of ascertainment is analogous to the human situation in that samples tested are not gathered in any systematic way and the figures presented almost certainly underestimate the true prevalence.
  • Miss Larkin suggested that because of the inherent biases attempting to use any of the currently available denominator data approaches may be flawed. A survey-based approach may be the most robust way forward with the use of passive surveillance to pick up emerging issues.
  • It was suggested that the Committee should always consider the limitations in any assessment it carries out including how the available data affects the validity and certainty of any opinions it gives. Margins for error should be captured in any conclusions when the denominator data is not given and the variation in data is unknown and in some extremes the Committee may be unable to give an opinion if the data is not sufficient. It was also suggested that in some cases the Committee may need to accept that denominator data is not available and this should be noted as a limitation on the assessment and a data gap.
  • It was noted that AHVLA are consulting on their surveillance 2014 proposal at present and ACMSF may wish to comment on the issue of denominator data in a consultation response.

8.6 The Chair summarised discussions noting the important points made about uncertainty around risk assessment and suggested the Committee should keep pressing for denominator data which would allow them to distinguish real trends in disease from surveillance artefacts.

9. Science Governance in the FSA (ACM/1095)

9.1 The Chair invited Dr Patrick Miller to provide an update on the review of science governance in the FSA and the implications for Scientific Advisory Committees (SACs). Dr Miller outlined the reasons for the review and what it aimed to achieve, noting that the outcome of the review had been presented to the FSA Board in July and agreed. As a result of the review minor changes had been made to the Science Checklist and Good Practice Guidelines (the tool for use by Scientific Advisory Committees). A new framework for iteration and dialogue between SACs and the Agency has been produced to ensure that dialogue is transparent and respects the different roles and responsibilities.

9.2 Members were invited to make any comments on the paper. The Committee agreed it was useful to be reminded of the guidelines and checklist and appreciated that the process was not overly burdensome. It was noted that the key documents are available on the FSA website. It was suggested that there may be value in having a document listing some of the common errors made by Committees and a facility for capturing feedback on issues that had not gone well or where the Committees advice had been misunderstood or misinterpreted. Dr Miller noted that the aim was to pick these issues up through dialogue with the Committees and after the processes had been in place for a few years it might be appropriate to review the learning, both good and bad.

10. Committee sub-groups

10.1 Dr Roy Betts provided a report on the first, second and third meetings of the Ad Hoc Group on Raw, Rare and Low Temperature Cooked Foods. The group has agreed their terms of reference and the scope of discussions and outlined a workplan detailing the evidence they intend to consider. The group has also considered definitions and standardisation of relevant terms. Evidence on low temperature and slow cooking had been considered first, before moving on to consideration of raw and rare foods.

10.2 A member noted that Unilever have carried out some research on sous-vide cooking in relation to B. cereus and the role that injury plays in the shelf-life of products and offered to provide the data.

10.3 Professor O’Brien provided a report on the last four meetings of the Ad Hoc Group on Foodborne Viral Infections. The group has considered the EFSA opinion on foodborne viruses, norovirus in oysters, viruses in the context of consumer awareness and minimum requirements for norovirus surveillance. They have also looked at thermal inactivation data for Hepatitis E and a case control study identifying Hepatitis E risk factors in older people. The group aim to have a draft final report for the June 2013 ACMSF meeting.

11. Dates of future meetings (ACM/1096)

11.1 Members were asked to note the dates of the 2013 ACMSF meetings on 27 June and 3 October and the 2014 meetings on 30 January, 26 June and 2 October.

13. AOB

13.1 Dr Cook provided an update on the FSA’s foodborne viral infections workshop held on 15 and 16 January. The workshop focussed on norovirus but Hepatitis A and E were also considered. As a result of the workshop the Agency is looking at the future research needs identified and will do this in discussion with other public funders. The proceedings of the conference will be produced and drawn to the attention of the Committee in due course.

13.2 Dr Rollinson provided details of the forthcoming Campylobacter workshop organised by FSA, BBSRC and Defra. The workshop will take place on 12-14 March and aims to review and evaluate whether the UK Campylobacter research and innovation strategy is on-track.

13.3 Prof O’Brien provided an update on the October General Advisory Committee on Science (GACS) meeting. GACS received a presentation on horizon scanning which included feedback from a pilot horizon scanning exercise undertaken by the Social Science Research Committee facilitated by the Centre for Environmental Risks and Futures (CERF). The pilot was intended to target horizon scanning in a constructive and focussed way.

Public Questions and Answers

14.1 The Chair drew formal proceedings to a close and invited questions and comments from the public in relation to ACMSF and risk assessment.

14.2 Tom Miller (retired catering technologist) made a comment in relation to the Ad Hoc Group on Raw, Rare and Low Temperature Cooked Foods. The website summaries of meetings refer to cooking at 70°C for 2 minutes. However, the group that produced the official Guide to Good Hygiene Practice, under the then hygiene regulations decided to remove the necessity to measure time as well as temperature as this was considered impractical in a busy kitchen. The group agreed that the requirement should be to achieve 75°C on cooking but did appreciate there would be a finite time related to 75°C. It was suggest the Ad Hoc group should be aware of this in their deliberations.

14.3 Dr Betts (Chair of the Group) agreed it would be useful to debate this issue at the Group’s next meeting.

14.4 Catherine Cockroft (Exova) asked a question in relation to application of molecular epidemiology to outbreak investigation and whether non-reference labs would be expected to submit results to sequence databases as some clients may have reservations about this. A Member noted that the existence of sequence databases would not change the current situation where private labs do not have to submit routine surveillance data. This had been raised as an issue before and there had been instances where, if data had been made available, would have prevented or curtailed an outbreak. It was noted that Public Health England and others bodies will have to consider this issue in terms of how these technologies are implemented. In principle any isolate of public health significance should be made available. It was also noted that there are other clinical areas where such data are shared anonymously.

14.5 Ed Komorowski (Dairy UK) asked whether ACMSF had carried out a risk assessment in relation to Schmallenberg virus. The Chair noted that there was a formal mechanism through the Human and Animal Infections and Risk Surveillance (HAIRS) Group to assess the risks from new and emerging infections including consideration of zoonotic spread.

14.6 Kaarin Goodburn (Chilled Food Association) asked when the outbreak epidemiology investigation protocols were last reviewed as there was a need to ensure that they were fit for purpose and reflect 21st century food distribution systems (including web sales) and changes in demographics. Ms Goodburn also asked about the mechanism for validating and agreeing protocols for the epidemiological investigation of outbreaks. The Chair noted that there were no standard protocols across the NHS for microbiological examination (different laboratories look for different combinations of organisms) and results were reported in different ways. The emergence of new and rapid technologies will, however, change surveillance and detection of outbreaks, shortening the time to detection of clusters. It was also noted that an initiative being undertaken in the North West using molecular methods hoped to reduce time to detection of outbreaks by at least two thirds.