Chairman Professor D L Georgala
Members Mr D Clarke
Dr T Clayton
Mrs P Jefford
Professor A M Johnston
Ms E Lewis
Dr M J Painter
Professor S R Palmer
Dr T A Roberts
Dr N A Simmons
Professor W C S Smith
Dr J V Stevens
Mrs B W Thomas
Dr T D Wyatt
Assessors Mr P J R Gayford (MAFF)
Professor C H McMurray (NIDARD)
Dr R Skinner (FSA)
Secretariat Dr J Hilton (Medical Secretary)
Mr C R Mylchreest (Administrative Secretary)
Mrs E A Stretton
Ms J Kerr
Others Dr J P Back/Ms G Hoad (FSA) - for item 7
Dr P E Cook (FSA) - for item 8
Dr D Paton (CVL) -
1. Chairman's introduction
1.1 The Chairman welcomed Members to the Committee's thirty-ninth meeting, its first to be held in public. He also extended a warm welcome to those members of the public present.
1.2 He explained that time had been allocated at the end of business for public statements and questions. To assist the production of minutes, including questions from members of the public, the proceedings were being recorded, but it was not proposed to produce a verbatim record.
1.3 The Chairman reminded Members of the need to declare any particular interests arising from any of the items for discussion. He reminded Members, in connection with agenda item 7, of the declaration he had made when the Mycobacterium avium subsp. paratuberculosis (MAP) results from the FSA milk study had been discussed at the Committee's thirty-eighth meeting. On that occasion, he had also stepped down from the Chair (and Professor Johnston had taken over) while the item was discussed. On this occasion, when the Committee would be looking at the non-MAP results, having taken the advice of the Secretariat, he had decided that it was not necessary for him to vacate the Chair.
1.4 Dr Stevens also declared an interest in connection with agenda item 7, as he had when the MAP results had been discussed at the previous meeting. The company for which he worked had now divested itself of its liquid milk business but was still engaged in the manufacture of dairy products.
2. Apologies for absence
2.1 Apologies were received from one Member, Mr Kilsby, and three Assessors, Dr Donaghy (SEHD), Dr Mitchell (NIDHSSPS) and Mrs Whinney (FSA/W).
3. Minutes of the thirty-eighth meeting
3.1 Draft minutes of the thirty-eighth meeting (ACM/MIN/38) had been posted on the Committee's website and had been circulated for Members' comments. A further draft(a) had been prepared which showed Members' suggested amendments.
3.2 The amended minutes were approved as a correct record of the thirty-eighth meeting and would be posted on the Committee's website.
4. Matters arising
4.1 The Chairman dealt with those matters arising not covered specifically by other agenda items.
4.2 He reported that, following the thirty-eighth meeting, the Secretariat had alerted the Secretariat of the Advisory Committee on Dangerous Pathogens to the ACMSF¿s discussions on MAP and the Committee's recommendations for action by the Food Standards Agency (FSA). The ACDP Secretariat had subsequently prepared an information note for the ACDP based on the ACMSF's 29 September press release.
4.3 The Chairman reported that he had written to the FSA's Deputy Chief Executive and Director of Food Safety Policy (Dr Jon Bell) about handling of any future requests for advice on specific products produced by individual companies (see ACM/MIN/38 para. 7.5). He had arranged to meet Dr Bell to discuss the matter and would report back to Members in due course.
4.4 Professor Georgala said that the Salmonella in Eggs Working Group had held a final meeting on 16 November to amend its draft report to reflect comments made by the full Committee at its thirty-eighth meeting. The Secretariat was now finalising a draft for him to submit to the FSA.
4.5 Finally, Professor Georgala reported that the Secretariat was close to finalising the terms of reference and membership of the new Working Group on Mycobacterium bovis (see ACM/MIN/38 para. 8.2).
5. ACMSF reporting lines and terms of reference
5.1 The Chairman drew attention to paper ACM/497 which explained that, with the setting up of the FSA, food safety and other interests of consumers in relation to food became the responsibility the Agency. Thus, where previously the Committee had reported to UK Health and Agriculture Ministers, it would in future report to the FSA. The opportunity was being taken to update the Committee's terms of reference and Members' comments were invited.
5.2 In response to a Member's question it was explained that the Committee would continue to operate on a UK-wide basis. Advice would normally go from the Committee to the Agency in London. However, that did not preclude the FSA in Northern Ireland, Scotland and Wales referring matters direct to the ACMSF for advice.
5.3 Members indicated that they were content with the proposed new terms of reference.
6. Annual Report 2000
6.1 The Chairman introduced ACM/498, the Committee's draft Annual Report for the calendar year 2000. This was along traditional lines and constituted a factual record of the Committee's work in 2000. The intention was to produce a second draft which would reflect the outcome of the thirty-ninth meeting plus Members' comments. This would be cleared with Members in correspondence before being submitted to the FSA. It was thus hoped to secure much earlier publication than would be possible if the second draft had to await Members' consideration at the ACMSF's next meeting (scheduled for 21 March 2001).
6.2 A small number of detailed drafting suggestions was made. Members were asked to send any further comments as soon as possible to the Secretariat. In addition, they were particularly asked to verify their personal details as recorded in Annexes I and II.
7. FSA national study on the microbiological quality and heat processing of cows¿ milk
7.1 Ms Geraldine Hoad and Dr Jonathan Back, both of the FSA, attended for this item. Ms Hoad presented paper ACM/499. This contained the results of the non-MAP microbiological determinations carried out under the survey. The MAP results had been considered at the Committee's thirty-eighth meeting.
7.2 As regards future intentions, Dr Back explained that a considerable amount of additional information about the participant dairies had been collected as part of the survey which had been carried out in cooperation with the dairy industry. This included information about the size of the operation, training, quality systems in place, management, process controls and testing undertaken by the dairies. This information had yet to be analysed but it was hoped to assess it alongside the microbiological results to see whether there were any lessons which could usefully be learned. The results of this exercise would be presented to the Committee at a future meeting.
7.3 Members made a number of points in detailed discussion of the paper. The question was posed whether the survey could be held to be representative of the UK dairy industry, given its reliance on the cooperation of dairies and the fact that only 258 out of 755 approved dairy establishments in the UK who heat treat milk had agreed to participate. It was also noted that, as sampling had taken place at dairies, and given the possibility of post-pasteurisation contamination, the results did not necessarily reflect the quality of milk reaching the consumer. The FSA said in response that the sample obtained had been checked against the range of size and geographical spread of dairies in the UK and had been found to be representative of the industry as a whole. The participant dairies accounted for more than 258/755ths of UK output. Samples for pasteurised milk intended for direct consumption were taken from retail packs. Samples of manufacturing milk had been taken from holding vessels directly after the pasteuriser.
7.4 Some concern was expressed about the Mycobacterium bovis results and whether the explanation that the presence of the organism in the samples arose from laboratory cross-contamination called into doubt the reliability of the results for other organisms. The FSA pointed out that the work on MAP and M. bovis had been carried out at a specialist laboratory (because of the difficulties associated with testing for these organisms) whereas the other microbiological determinations had been carried out at laboratories which undertake this kind of work on a routine basis. The FSA felt that, for the reasons given in the Annex to ACM/499, there were grounds for confidence that the presence of M. bovis in the sample was a result of laboratory contamination.
7.5 Other points to emerge from discussion were that:
- all Campylobacter species isolated from the samples were thermophilic;
- the results from the survey served to underline both the importance of the Committee's advice on the dangers inherent in the consumption of raw milk and the contribution made by pasteurisation to the prevention of milk-borne disease;
- the time delay between sampling and testing was not greater than 24 hours and samples were held in the intervening period under refrigeration;
- survey results needed to be published as quickly as possible, bearing in mind competing priorities;
- the Committee had set up a standing Surveillance Working Group to help the Agency plan future surveillance projects and Members hoped that this would be fully utilised.
7.6 In conclusion, the Committee expressed concern that a number of pasteurised milk samples had been found to contain coliforms, E. coli, and, in some cases, potential pathogens. These clearly showed that a small number of dairies in what was a very large industry needed reminding of the steps required to ensure that pasteurisation, a highly effective process, was properly executed on every occasion. Members felt that the FSA should discuss with industry the unsatisfactory nature of some of the results, with a view to achieving the required improvement. Any discussion should also incorporate the question of on-farm pasteurisation about which the Committee had expressed concerns in the past.
8. Clostridium botulinum
8.1 The Chairman recalled that, at its June meeting, the Committee's views were sought on a Department of Health-commissioned report evaluating the risk of growth and toxin production by C. botulinum in selected food products. The Committee had, at that time, recommended that the FSA, in consultation with other interested bodies, should jointly consider whether the report justified the ACMSF reviewing the advice given in its Report on Vacuum Packaging and Associated Processes, and whether there was any need to amend the industry code of practice. The FSA had also been asked to identify any areas of difficulty for enforcement staff, and to consider the case for challenge testing. Professor Georgala reminded Members that cases of botulism were extremely rare in the UK as a cause of illness. When it did occur, however, it was extremely serious and was associated with a significant fatality rate. It was thus something which the whole food industry for over a 100 years had been geared up to prevent.
8.2 Dr Paul Cook (FSA) introduced paper ACM/500. He pointed out that, while the earlier paper considered by the Committee (ACM/479) had covered ambient stable, as well as chilled products, ACM/500 primarily focused on vacuum and modified atmosphere packaged (VP/MAP) chilled (rather than ambient) products. In preparing the paper, the Institute of Food Research (IFR), Campden and Chorleywood Food Research Association (CCFRA) and the Local Authority Co-ordinating Body on Food and Trading Standards (LACOTS) had all been consulted. The general view had been that the advice contained in the ACMSF¿s Vacuum Packaging Report and the industry Code of Practice, remained valid and did not require amendment. However, there was a need to consider ways of making the advice more accessible by, for example, simplifying it and placing it on appropriate websites. Any simplified advice should also take account of the further advice issued by the Committee which appeared as Annex III of its 1995 Annual Report. It had become clear during discussions that local authorities and businesses (particularly small and medium sized enterprises) often found it difficult to identify sources of expert advice on food safety in relation to C. botulinum and VP/MAP products. In addition to the need for simplified guidance, it was therefore felt that access to a list of experts and expert organisations would also be very helpful. The review had also concluded that, notwithstanding the difficulties of challenge testing, this should be the standard requirement in cases where producers of VP/MAP products could not demonstrate that their products met the criteria identified in the ACMSF¿s advice and the industry Code of Practice. Predictive modelling, whilst helpful in identifying the likelihood of growth of C. botulinum in a product, was not regarded as an alternative to challenge testing. Finally, the review had led to the conclusion that, whereas ACM/500 focused primarily on VP and MAP products, consideration should also be given to the need for simple food safety guidance for businesses and consumers in relation to vegetable in oil products.
8.3 The Committee was invited to consider (through its Secretariat or a small working group) summarising its 1992 and 1995 advice and improving access to it. It was also proposed that the industry code of practice should be simplified and made more accessible and relevant to target audiences. Members were also invited to consider whether the Committee¿s published advice, that heat treatment of 90°C for 10 minutes, or equivalent was needed in order to deliver a protection factor of 6 with regard to spores of non-proteolytic C. botulinum, was still appropriate. The other recommendations emerging from the review were that a list of organisations and experts should be identified from whom small businesses, trade associations and local authorities could obtain expert advice across the range of products considered in ACM/500; and that guidance should be developed on the appropriate use of challenge testing, and on products in oil, both for businesses and home bottlers of these products.
8.4 Following detailed discussion, Members were broadly supportive of the measures recommended in the paper. The Committee's published advice remained valid, but it now seemed timely for the FSA to take forward with the other parties concerned a review of the industry code of practice. The Committee noted, in relation to the question that had been raised about its advice on the efficacy of heat treatment at 90¿C for 10 minutes, that if recovery media contained lysozyme, or enzymes which acted like lysozyme, spores which would normally be expected to be killed could survive the heat process. Such products should be addressed as part of the review process. The advice to local authorities must be that challenge testing should be a standard requirement where producers of VP/MAP products could not satisfactorily demonstrate the application of appropriate heat and preservative factors in the manufacturing process. New ways needed to be found of bringing to the public's attention the potential dangers of home bottling/preservation of fruit and vegetables.
9. Verocytotoxin-producing E. coli (VTEC)
9.1 Reflecting the Committee's on-going interest in this topic, Mr Gayford and Dr Hilton provided oral reports on recent conferences in Edinburgh and Kyoto and Dr Simmons reported on the work of the Joint FSA/Scottish Executive Task Force on E. coli O157.
9.2 Mr Gayford reported on the conference on zoonotic infections in livestock and the risk to public health, held in Edinburgh on 28 June. The background was that a large volume of research and survey data had become available. The Government had taken the opportunity of releasing all of these data simultaneously and of putting the results into context in relation to the risks to human health. Preliminary results were reported from a number of livestock studies mainly carried out by the Scottish Agriculture College (SAC) and the Veterinary Laboratories Agencies (VLA).
9.3 The main SAC study had been to determine the prevalence of O157 in Scottish beef cattle. The study had found a prevalence of 8.6% in individual animals and a herd prevalence of 23.7%. The study had also identified risk factors associated with the shedding of VTEC O157 by cattle. Results were given from two VLA studies. One, an abattoir survey, found faecal carriage rates of 4.7% in slaughter cattle, 1.8% in sheep and 0.16% in pigs. The other, a farm study, isolated VTEC O157 from 44% of randomly-selected herds, a similar rate to that found in studies carried out elsewhere in the world.
9.4 Results were also reported from two human case control studies, one by the Scottish Centre for Infection and Environmental Health (SCIEH) and the other by the Public Health Laboratory Service (PHLS). Both studies reinforced previous work showing that transmission of VTEC O157 occurred by a number of routes, not only through exposure to contaminated food. Both studies showed significant associations between illness and environmental factors.
9.5 An overview was also presented of current research and recommendations to protect public health. The conclusions drawn from the animal data were that, at any one time, VTEC was carried by a relatively small proportion of animals, but that it was present on a fairly large proportion of farms, particularly in cattle. Current measures did not adequately control the organism on-farm, reflecting the fact that the risk factors for animal colonisation and shedding were not sufficiently understood. However, research to identify these risk factors was on-going.
9.6 In conclusion, Mr Gayford reported that a second conference, to report Salmonella, Campylobacter and Yersinia results in cattle, sheep and pigs, was scheduled to take place in London at the Glaziers Hall on 7 December. The final O157 VTEC results would also be available in poster format.
9.7 Dr Hilton reported on VTEC 2000 which had been held at the end of October/beginning of November in Kyoto. This had been the fourth in a series of international seminars held every 3-4 years, bringing together researchers in the field. The main presentations were by invitation and were principally in the nature of overviews. With regard to epidemiology, evidence seemed to point to a geographical gradient, with the disease becoming more common the greater the distance from the Equator. For example, in the cone of South America (Argentina, Chile), there was a high prevalence of E. coli (mostly non-O157 VTECs, but O157s too), whereas VTECs were seldom seen in Central America (eg Mexico). US data continued to identify food sources as a problem, unlike a lot of UK data and some data from Europe which showed that direct exposure to contaminated environments was becoming increasingly recognised as an important factor. However, the US data were now beginning to show a problem with direct contact and the drinking water exposure pathway had been identified as important in Canada. About one-third of foodborne cases in the US were associated with the consumption of ground beef and about one-third with fruit and vegetables. This contrasted with the position in England where a lot of foodborne outbreaks were associated with the consumption of dairy products, and meat products were not featuring very prominently. Delegates had also received a presentation on a US Food Safety Inspection Service (FSIS) E. coli O157 in ground beef risk assessment. A preliminary discussion paper was being published on the FSIS website.
9.8 As regards animal reservoirs, pigs had been reported as a significant reservoir for the organism in Chile. There was some discussion of control strategies but these were regarded as a distant prospect in relation to ruminants.
9.9 The importance of polymorphonuclear leucocytes to the pathogenesis of disease was highlighted, together with reports of the detection of toxin in circulation bound to polymorphs. It was felt that, if confirmed, this observation might result in progress with regard to early detection and management. There was also discussion of the use in Japan of antibiotic therapy (with fosfomycin), which ran contrary to the general view in other countries that antimicrobials should not be prescribed because they may promote the release of toxins. It had been agreed that a working group should be convened to look at issues about patient management.
Scottish Joint E. coli O157 Task Force
9.10 Dr Simmons reported on the work of this Task Force which was charged with producing an action plan to reduce the risk to public health from the organism. Dr Simmons had represented the ACMSF at the second meeting of the Task Force which had addressed the subject of human health. There had been presentations on diagnosis, surveillance, treatment and care, outbreak management, and person-to-person spread. He had been asked to give a presentation updating the situation since publication of the ACMSF VTEC Report in 1995. Dr Simmons had said that, although the ACMSF was aware that the disease might be contracted other than by food, the Committee was essentially concerned with foodborne transmission because outbreaks could be big and serious. There was interest in the modes of transmission, particularly the importance of milk and milk products. There had been a number of outbreaks associated with the consumption of raw and inadequately pasteurised milk. Fortunately these had so far tended to be rather small, reflecting the pattern of sale of raw milk, but reliance should not be placed on this trend continuing.
9.11 The Task Force meeting reached a number of conclusions. In relation to diagnosis, laboratories should continue to examine all diarrhoeal stools for this pathogen, even though there was some resistance because the yield was low and the cost high. Children with diarrhoea for more than 24 hours should be taken to see their general practitioner. Antibiotics and antimotility agents should not be prescribed for children with unexplained diarrhoeal illness. Information had been provided on surveillance, treatment and care, and outbreak management. It was recommended that advice on avoiding person-to-person spread should be incorporated in the Task Force's report. All siblings under 7 years old, and siblings of patients associated with any outbreak, should be routinely tested. The importance of risk assessment, risk communication and risk management was stressed.
9.12 Dr Simmons reported that, since the meeting he had attended, there had been further meetings of the Task Force on animal and farming issues (on 14 November), and on access and other uses of farming land (on 20 November). A further meeting was scheduled for 12 December, on foodborne transmission, which he planned to attend. He undertook to report back to the Committee.
9.13 In general discussion following the three presentations, ACMSF Members made a number of points. It seemed clear that VTEC was present in a small number of animals on a large number of farms, and that control at the farm level was difficult. It was noted, however, that there was a whole array of food hygiene measures that could be applied throughout the food chain to protect against infection from this organism, including HACCP, pasteurisation and proper cooking. In relation to stool testing, the PHLS had been involved in a study comparing cases of haemolytic uraemic syndrome (HUS) and the pick up of O157 by laboratories. It was hoped that the results of that study would help identify laboratories which were not picking up as many O157s as one would expect, based on the number of cases of HUS in their area. The Committee felt that the time was now ripe for the Department of Health and professional bodies to reinforce the guidance on stool testing issued to laboratories in the aftermath of the ACMSF's VTEC Report. It was noted that the Scottish Task Force was proposing to produce guidelines for general practitioners on when they should take stool samples. The argument often advanced against stool sampling was that, with little therapy available, a microbiological diagnosis was of no benefit to the individual patient. Rather the benefit was an epidemiological one, which made it difficult to justify the cost involved.
10. Listeria monocytogenes
10.1 Dr Hilton introduced paper ACM/501. This item had been carried over from the June 2000 meeting. ACM/501 comprised a briefing paper requested by Members on Listeria outbreaks in the USA (in 1998) and in France (in November 1999-March 2000), to enable them to judge whether these outbreaks highlighted new features requiring further work or advice from the Committee.
10.2 Dr Hilton said that the French outbreak had involved a total of 32 cases and 10 deaths. Meat products (notably pork tongue in jelly, and pate) had been implicated but investigation by the French authorities had failed to identify a single source of contaminated product. In the US outbreak, more than a 100 people had become ill, and 21 had died, after eating contaminated hot dogs and, possibly, delicatessen meats from a single production plant. The definite source of contamination had not been identified but the Centers for Disease Control and Prevention (CDC) had tentatively concluded that the bacteria had been spread by contaminated dust particles disturbed during replacement of a refrigeration unit in the Sara Lee Corporation's Bil Mar plant in Michigan. Assuming CDC's conclusion to be correct, the US outbreak served to underline the importance of the factory environment as a source of L. monocytogenes.
10.3 Members' views were sought on whether they regarded environmental monitoring for Listeria spp. as important. If so, and in the light of a recent European Union proposal for the control of L. monocytogenes in ready-to-eat foods, which included proposed guidance on environmental sampling, they were also asked whether they were content for the matter to be pursued in on-going discussion of the EU proposal.
10.4 Members felt that, as far as could be ascertained on the basis of the investigations carried out, the US outbreak did not highlight any new factors requiring further ACMSF advice. Events served as a useful reminder of the way in which the complex interaction of events could easily give rise to problems. It was clear that sound hygiene principles had not been applied. In the absence of scientific evidence to the contrary, all strains of L. monocytogenes should be regarded as potentially pathogenic. The US outbreak particularly served to underline the importance of HACCP and the need for changes in factory operation to be covered in the HACCP arrangements. Members were divided on the importance of environmental sampling. Such sampling, particularly of surfaces coming into direct contact with food, could expose lapses of good hygiene practice. On the other hand, environmental sampling could lead to complacency and neglect of good hygiene practice.
11. Zoonotic potential of Norwalk-like calicivirus (NLV) and rotavirus
11.1 The Chairman recalled that the ACMSF had had a long-standing interest in foodborne viruses. The Committee had held an international workshop in 1994 on foodborne viral infections and had subsequently published a comprehensive report to Government on the subject. The recently completed study of infectious intestinal disease (IID) in England had identified viruses as a major component of IID. Members had received an abstract in March 2000 (ACM/466) reporting that viruses closely related to NLV had been found in animal stools, sparking discussion about the potential for zoonotic transmission. MAFF had subsequently commissioned an assessment by the Veterinary Laboratories Agencies (VLA). VLA were also asked to make an assessment of the zoonotic implications of a molecular typing study of human rotaviruses.
11.2 Dr David Paton, Head of the VLA's Virology Department, presented these assessments (ACM/502). He had reviewed two papers. The first was from Wim van der Poel et al. characterising Norwalk-like caliciviruses from calves and pigs. The second, from the PHLS at Addenbrooke's Hospital, Cambridge, gave a detailed account of their molecular and epidemiological studies of rotaviruses in the UK between 1995 and 1998.
11.3 Dr Paton said that caliciviruses and rotaviruses were both capable of causing similar gastroenteric diseases in humans and animals. Much less was known about the disease potential for caliciviruses in animals than was the case for rotaviruses. It was now possible to carry out very precise genetic comparisons between the viruses which were being isolated and, using this approach, it had recently been discovered that some of the caliciviruses, particularly from calves and pigs, were very similar to human caliciviruses. It had also been shown that a very small minority of rotaviruses obtained from humans had a genetic type more normally found in domestic animals. The problem in drawing any conclusions regarding similarities was that, to date, only a very small number of these viruses had been studied. There was a tendency for humans and animals to have similar viruses. Until the exact relationship between these similar viruses could be established, it was impossible to say whether there was regular transmission between the two species. Direct evidence of inter-species transmission of enteric caliciviruses was lacking, but it was known that rotaviruses were fairly promiscuous and could cross-infect from one species to another. Conventional epidemiological investigations of these conditions generally showed that the diseases came from other people, and, if they were being introduced from animals, they were being introduced only very occasionally. The concern was whether they had the potential to cause new epidemics with new variants in the human population. Critical factors would be the frequency with which the virus passed from animals to humans, and how effectively it was able to replicate in humans. This would influence the type of disease and the ability of the virus to spread to other people. Also important would be whether the virus was able to benefit from the potential advantage of being immunologically distinct. Dr Paton thought that many of these questions could not yet be answered. However, the fact that viruses were highly adapted to enteric replication in animals and humans suggested that an enteric tropism was most likely if host-switching was to occur. There was little evidence of super-virulent forms of these viruses with altered pathogenicity, and certainly little evidence that more virulent types per se came from animals. It was known that most viruses replicated and were transmitted less effectively when first introduced into a new host, but there was a concern, particularly with rotaviruses, over possible reassortment. Dr Paton said that were very few baseline data on these viruses in animals. It was not even known whether caliciviruses were important causes of gastroenteritis in animals.
11.4 In discussion, Members made the point that it was unknown whether these viruses were the cause of zoonoses resulting in foodborne disease in humans. The conventional assumption was that viruses did not replicate in foods. There was no new evidence of zoonotic illness associated with these viruses. Molecular epidemiology appeared to offer the best way of increasing the knowledge base. ACMSF's concern with regard to viruses had been with NLVs in bivalve molluscan shellfish and person-to-person spread. The Committee had issued hygiene advice to address these aspects. If it transpired that viruses were zoonotic, that would raise a new area of concern that the Committee had not previously focused on. The Committee would clearly be interested in any evidence which showed an animal reservoir of potential pathogens for humans. Care was needed to ensure that zoonoses did not fall down a gap between the medical and veterinary professions. Information was required on what was being done to monitor the potential emergence of new types of viral gastroenteritis, whether a strategy was being developed and, if so, what it was. A possible way forward would be to monitor re